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HomeMy WebLinkAbout018-1087-63-000o ~ o _ m m n ~ • ~7 G ~ Z N c8 D ~ a O Z 0 _~ o~ ~~ ~~ ti O m ;CI C (D (D N m ~ D ~ < n N_ j. O a? m ~' o' z ~~ o O ~'~ N O O A Q N a g y (D n N fD ~. Ut W O G1 O 7 N O ~ O L c ~ ~ ,.-' o ~ _ w ~ cwi, ? L d N ~- C ~ O a o ~ w ~D. 0 01 ~ o a O O O ~ ~~~~ v ~ q ~, 1 ~ ~ d ~~ 7 D D o c a N A O O fD M C 01 Q m o, ~ ~ a g 3 .~. Z A C e 0 a 3 obi o c ~'~v ~ ~ = N o m O 3 ~ ~° o a°, ~ v V d al ~ O W W ~ O 7 O y R c 3 •• m ;.. w~ 0 Q 0 y a a A Z ~ J ~ M A ~ 3 mN~~ J ~. _~ VS J A d A~ 0 ~"! O rte. Q ~• O ~~yyl~. v~ O lr. lei A A fi ~C~ ti ti N O b 40 b ~ N ~ N a ti MAR-21-2Q05 15:39 FROM: 70:17153864656 P.2 YJ Jf tl! Lt7C1:J 1`t. It ll:JJOlJrtU 1\L+'+rM+ •~TM` ~ "~^" ""'~- ~~ ~ ~999'rs!!~1 Xi p~gy~-L'Md taPoW 4°~''J „9. ~ v Y~ s+oor9 W- 'w~te6 -~ pins ag v~y ooc It~9ros•+ . ~ t ~ ~ ~ ~ ~ ~ H i IF ~/I~~~t ~ 1~71MM!'LL7A~ ~'NLL1Bi4~B~^i .}'N/FO' ~'~/F~3 ~~~~ + 1 ~ a ~ ~.. ~j 9 ~~ '/J~'~\\ ~./ ~~. '/~1 1^~ I ^vA1 ^~ i ` r -~a li li 1 1 I 1 1 1 1 . . 1 ; i1 I ' 1 I 11 11 11 11 11 11 1/ 11 •1 11 1 1 1 1 1 ~ i 1 1 1 1 ' / 1 1 1 11 1 I 11 1 1 1 1 1 I 1 • 1 I 1. ,. ;: z 1 ,; 1 1 .1 . 1 :~ d . I ;' 1 ~ ~ 1 . 1 .__r I . -- 1 . 1/ F -- I{ ~ 1 / 1 ~; : 1 ' ~` ~. : 1 ,/ 1 ~ 1 ~, I . ; ~. .. 1 1 .+ .1 . 1 11 1 1 / , ; 1 ,; 1 1 I ~ ~ 1~ 11 1 1 1 I • 1 1 : I ; I I ; I + 1 i 1 ; ~ I 1 1 11 1. 1 1 IL~_.~`. / 1 1 1 1 1 1 1 1 11 1• 1 1 .~ __ I 1 1 1 i 1 1 i R *~ ~... . MAR-21-2005 15:39 FROM: T0: 17153864686 P.3 63/ Z1 / ZbF75 14: 1Y /15~tl15 ~'Lb ~mHn i ~t~+i 1 r~G~-u 1 T rr,a~ uc ~~ ti86~t~Yit'!~t 7c~ O~BS•i00+!'rtt'Nd I~P~W 4~~ ~~1u ..- ¢OOrS IM'YNMD7i~ • 7.t ~8 ~S ~+leP146t :~a~ruua ~ ~ "' ~s~ a~i-Fx+,x~rrhLL'~.~tlID~1 •~'D1~07 si7~~3 ~ll9~n ~ ~ ~ ~` ~~~ :moo $ ~ ~~ ~~ ~~ ~~ [n S.~aJ Safety and Buildings Division 201 W W hi A County ~ ,., ~ , as ngton ve., P.O. Box 70$2 C ir~cons~n De artment of Commerce Madison, WI (~ d 08 I-65f~E``~~~ED nitary Permit Number (to be filled in by Co.) ~~ Sanitary Permi 'A stet Plan LD. Number In accord with Comm 83.21, Wis. Adm. Code, personal informati you p~ ~ ~ 2~~5 ~ may be used for secondary purposes Privacy Law, s15.04 )(m) Pro ct Address (if different than mailing address) ST. CROIX COUNT I. Application Information -Please Print All Information ING OFFICE SS`s M b e" ~ y S T-, Property Owner's Name Parcel # t # ~w-IM S n! ~. Q/~- ~~O 7~" ~ I Property Owner's Mailing Address Z2 Prop canon , ~ 0 3 d -1 ~ I+~ Sufi 2,v0 ~ City, State Zip Code Phone Number -~-'~`~ Mw ~~~. Sec on ZO Sort ~.1~ Spy©~ ~t;s __ (circle ne) . I ~ T ~ II Type of Building (che k ll th t l N; R ZE or . c a a app y) rn~~~t ~'1 or 2 Family Dwelling -Number of Bedrooms ~ ~' Subdivision Name CSM Number ^ Public/Commercial -Describe Use n / ~ f>~kg T /t-Y~~ . ^ State Owned -Describe Use ^City ^Village ~1'ownship of /j~ ,x III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ,0 New System ^ Replacement System ^ Treatment/I-lolding Tank Replacement Only ^ Other Modification to Existing System B• ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New last Previous Permit Number and Date Issued Before Expiration Plumber Chvner IV. T e of POWTS S stem: Check all that a 1 J$'j; pyt Zr• ^ Non -Pressurized In-Ground ~MOUnd > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ ",D ~' Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe Other (explain) V. Dis ersal/Treatment Area Information: Design Flow (gpd) Desi~ Soration Rate / sf) Dispersa~ ea Re fired (sf) DispSr a Area roposed (sf) System ElevaHOon / VI. Tank Info Capacity in Gallons To Gallons Number of Units Manufacturer Prefab Concrete Site Constructed Steel Fiber Glass Plastic New Exishng Tanks Tanks Septic or Holding Tank ~ ~~~ 1 ~ ~FS~ Aerobic Treatment Unit ~, , Dosing Chamber 1 /` VII. Responsibility Statement- I, the undersigned, assume respons bility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumbe ' Si ature MPIMPRS Number Business Phone Number ~~ ~ ~ ° ' N ~ ~~ ~~y l~ -~b2 ~~ 1 Plumber's Address (Street, City, State, Zip Co d / ~ /~ VII oun IDe artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued suing Ag t Sign ure tamps) Surcharge Fee) C- dp ^ Owner Given Reason for Denial ~ y~J `'~ ~ 02/ Q IX. Conditions of Approval/Reasons for Disapproval G~~ /~ ~ SYSTEM OWNER: ~ G~~ . 1 Sep I Cuelit filter and ~3., f"Z ~ ~,~. l~yt,, dis ers l ll t ll b ~ p a ce mus a e serviced ! maintaine~ _ as per management plan provided by plumber. ~~~~ 2. ~ ' 2. All setback requirements must be maintained / ~ ~ ~ as per applicable codelordinances. ~ V~ 4 ~ (~(~l~l~Yi rZ ~G~/t. ~~~"r~-// /.(ik,l/ ,/1/5.nu ~/~ G /'/S ,rv,.~ ...SD~r~fi,~n: ~i/r..~lr/ ~ ~ Attach complete plans (to the Couaty`~ t e system on paper not less than 81/2 x Il inche~~ _ / ~K `fQf'i~K.-X.L'GtLtt l~Vf~ ' SBD-6398 1R. 08/02) z ~ ~ ~ ~ . $ ------------------------------------ ------------------------------------------ ~ ~ ~ ~ a oo ~ co :a ! ~ Proposed Road $ ~ E ~ _ € ~ ~m~ = z m~s-0~3 . 2 ~n tq Z E~~j~W a ~ ~^Nzl-m gQ i ~ N )I z 0 ~- r o 0 Qa ~ ~ £3 ~~ _ o J 0 Z W LL ~ ~ ~ ~ 2 d )I a -- 11 n IM Iv ~' a c+~ Z 7 ~ 3 U ~ U ~ ~ i~ 00 ~ t~ ~ N v~ ~ ' ~~ o QU ~ m o ~ pp t ~ ~ o ~ ~ m ~ ~ X ~_ ~ i ~ ~ ~ i I~ 0 ~ / ~/ i / C Q fQ i ~ i F i i C ~ l6 ~ ~ ~ ~/ ~ ~ m ~ i` U ~ ~ O p i i V' O i ~~ i %8~ (V (O i i ~ i i i ~ r i ~ i i 1 m *mrn ~ ~ ~ r ~ ~ ~ i ~ i r i i r i i i i i ~ r i i i lld U m a I~ 2 _ ~j ~ ~ N Y N Y (O C T § ,s -g ti 3 N ~ r m f" ~ I~ L i~ Q 0 1 , ' ~~gQ c '^ m W W v / II ~-- ~ ~ II m m ~~ ~ artment of Commerce PRIVATE SEWAGE SYSTEM ' g Division ' ,~, INSPECTIQN REPORT ATION (ATTACH TO PERMIT) ovide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. City Village X Township s Hammond, Town of ~, ~ In v; BM Description; ~~ I•PJ1/lf~c../ ^ -' tKJ'r_Y1" ~ INFORMATION ELEVATION DATA HYPE MANUFACTURER CAPACITY Septic Dosing Aeration v Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLS Vent to Air Intake ~' ROAD Septic ~ !_\ " ~~ r ~ Dosing ~ Aeration Holding j PUMP/SIPHON INFORMATION Manufacturer f ~ ,Q Demand GPM Model Number ~~ TDH Li i ~,~~ Fric~io ~Lo~ (~S Syste HeS TDD~i ZFt gyn. Forcemain L gth ~ Dia. ~, D st. to Well ~ „~ ~ T SOIL ABSORPTION SYSTEM BED/TRENCH Width j Len h DIMENSIONS ~ ~ ~ ~~ SETBACK SYSTEM TO INFORMATION Typ~( System: / - SYSTEM Of Trenches .~/ ~.~.._ .. .Sew u n ~- 2 ~~TATI ~ D~ BSS G HI FS L V. Benchmark Z ~ I IDZ ~ I /Ob Alt. BM ~ f ~ ~S l 5 ~ 6 03• 9~, is Bldg. Sew r 1 ~@ ^~7 O ~~ 1 1 ~ ~ • SUHt Inlet ~~ SSG ~(J r'K ~• 25 ~~ -~ SUHt Outlet ~ ~~_ Dt Inlet ~- -~ Dt B tto k ~ •~ ~, 19 '~ Header/Man 2 Z~ 9 D Bot_Sy_tem /03..1 Z.,~ Final Grade St Cover ~f' ~,~~ 7j ri I~ s Z. ~ r (dam ~ ~ _ Cts ,, r 5. Z ~~O ,~ or V~ ?r y•~ q b -~ v K~2 r~~ 3~ a .3 PIT DIMENSIONS No s Inside Dia. Liquid Depth REAM LEACHIf~a.- C R OR UNIT Heade anif Length ~/ Dia_ Distribution Pipe(s) Length ~/ ,5 ~ /` ~ r Dia ~ Spacing ~ ~ x Hol ~ Size $ ~y ~.l ~ x Hole Spacing f E !t S~(L OVER v Drmm~rn s..¢fnn,¢ rlnly YY Mn~~nil nr ef_(;ratla Svstams ~nlv `J/_N yD !).b~.v ~-- Depth Over ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ ,',,,, e ' ~~/"' Bed/Trench Edges Topsoil >~ Yes No Ye No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 5 !~/ ~5 Inspection #l2:'r i~? Location: 858 164th St~reetbHammond, WI/~5~401p5~~(SE 1/4 NW 1/4 20 T29N R17W) Hammond Oaks 1stpAdd L1ot 63 Parcel No: 20.29.1~6C8731 1.)Alt BM Description = ~",T ~~~d-R'`~" °"" =~ I ~Qw v' ~ 2.) Bldg sewer length = ' -amount of cover = ~' P'Oa.) ~a~- G~ ~~ / ~ D'( _ C~~ __ ,uired. , Yes ~ No i -~ , - +I - 1 1, ,_ [,~~L~~v,-: G ~ 0 ~r additional rnformatlon. I Datep L __....,_-- - U ----- 7) U.~ „/ ~ ns c rj~ Signature ` , , ,(~ I `A' I~' County: $f. CfOIX Sanitary Permit No: - 463355 e~,~j0 State Plan ID No: Parce! Tax No: 018-1087-63-000 Section/Town/Range/Map No: 20.29.17.683 ~iue.~ ~ k r Int e Safety and Buiitiings Division Washington Ave., P.O. Box 7162 201 W CouatyC~ J/ - Ch81 ~c . ~~r "'~ Madiso 53707 - Samit~ry Permit Number (to be filled is by Co•) ' /~~~5~~ I (6 -3151 R ' `f 10,3 55 . ~ u , ~~ De artment ofi Commerce ' N„n,~ on Sanitary Permuit Appli ® b(~ in accord with Cmrnn 83.21, Wis. Aam. Code, personal CIS o4<i Xm) •d` I n~-I I r ~~ I, may be used for secondary P~~ ~~' ~~' ~~ i4 (if diffeaa-t them mailing address) i / ' L Application Informaflon -Please Print AII Informaiio ZpN~NG 'X~o lti x$58 ~~~ d N r~ OF 1 # Lot # Block # ply ovma's N J ? ~jJ ~Y~ C~~'N~ •~ Property Locaa propafp owner's Mailing Ad ~ 7 d ~ Z ' ~ ~ ,.~ ( ~ . S'v J s~ '~ti .~~ '/., Section JQ_ ~~• Ststc Zjg t:;ode Phonc Number ,...~~ ~' 1 38I ~ //9~/ TAN, R~~`') lI. Type of Building (check all that a I PP y) _ n ~ ~ ICeJ ~ S i a ~ Subd'vision Narne SM N 4 or 2 Family Dwelling -Number of Bedrooms ~ f j~ ^ public/Cammerciat - Desarl~e Use ~ - ~J f X ~0 ~ty ^V71agr~ovmship of ^StarveOwned -1)escrfbe Use 4 of Permit: (Check on13' one box on line A. Complete line B if applicable) pe TII.1~ , / p'' ,1~-Nevi System ^ Replacement System ^ TreatxticntJHolding Tank Replacement Only ^ Other Modification to Existing System (/ List Previous Permit Number and Dare Issuod B. ^ Pernrit Renewal . ~ 't Revision ^ Change of ^ Permit Transfer to New ~ Plumber owner ~ ~p 3 3 5 Before Expiration fit, of POWTS m: Check all that a ^ Non pad in-(bpund ~tmd > 24 in. of suitable soil ^ Motmd < 24 in. of suitable srn'l ^ At-Llrade ^ Single Pass Sand Ft'1ta ^ CanstntcDcd Wetland ^ Pressurized In-Crrouad ^ Holding Tank !, ^ Peat Filter ^ Aerobic Treatment Unit ^ Recinviating Sand Fi7ttr ~r 9to - S w" R~tiating Synfl~etic Media Filter ^ Leaching charrrber ^ Drig Line ^ Gravel-less Pipe ^ Other (explaizt) 6 V. - tment Area)~uformatfon: _ , / Design Flow (gpd) l~igq Soil Application Dispeasal Area Roquired (sf) ~~ °~~ i~ S 9 y~, •Py~ ~p Capacity:in Total Number ufacturcr Prefab Site Steel Fiber Plastic Gallons Crailons of Units Concrete Constructed Glass New Fatistin8 ~J, M~ F~~~ Tanks Tanks Septic of Iiokting Tank ~ ~ ~ ~' /L Aerobic YreatmerR Unit ~''' Dvi~s~~ t.~ e ~ S F ~ V17. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POW"TS shown oa the attached plans. Phrmber's Name (Print) Plum 's ~gnature MP/MI'12S Number Business Pltane Number is`s ~ z ~ - o ~~s - J i-~ K~ , pi s (Street, City, State, Zip C e) i' i~ I ~ ~-~ ~,.~ J-- J LC 7 S a .VIII, un /De ent Use Onl Sanitary Permit Fee (includes Groundwater Dau sued Issuing A Signs tamps APProv~ ~ Surcharge Fee) ~ Q ' ~ ~ / „` U~ ven Reason for Den I,X. Conditions of Approval/Reasons for Disapproval , - L W, ~-{„ ('~~;fe 5 YN4t ~.~ `~ro ~5 •/\ G 5 ~ ~ r ° ~ ~ eL .3~ S Z "-5~ YSTEM OVVNFR~. ~ C..~ GO-ri•'~•. ~ 1. ?oUc tanK affluent fil±er and f oJc~» / ~dispersai cell rrwst alt be services / mdint0ir18d 6J'~-~ ~ (~ ~ t ~ J~ - . 'O~, as per management plan provided by plumber. plans (to the Cooasty oalY) for the system on p per otof Attach OLi .l 11 J~~ cut~~~AR t'R ()1 /~31 commerce:wi.gov ^ ^ ~scons~n Department of Commerce Safety and Buildings 1340 E GREEN BAY ST STE 300 SHAWANO WI 54166 TDD #: (608) 264-8777 www.commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary March 21, 2005 CUST ID No.227618 THOMAS GUSTUM GUSTUM SEPTIC SERVICE N13450 937TH ST NEW AUBURN WI 54757 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/21/2007 SITE: Jim Henry 160TH St Lot 63 Town of Hammond St Croix County SE1/4, NW1/4, S20, T29N, R17W Lot: 63, Subdivision: Hammond Oaks FOR: Identification Numbers Transaction ID No. 1120360 Site ID No. 692797 Please refer to both identification numbers, above, in all corres ondence with the a enc . Description: Revision to Transaction ID No. 1086590 Object Type: POWTS Component Manual, Regulated Object ID No.: 994442 Revision; Maintenance required; 450 GPD Flow rate; System(s): Mound Component Manual -Version 2.0, SBD- 10691-P (N.01/01) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD-10691-P (N.Ol/O1). • The pressure network is to be constructed in accordance with publications SBD-10706- P (NOl/O1) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems -Version 2.0" and/or the sizing methods of publication "aSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81)". A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. THOMAS GUSTUM Page 2 3/21/2005 In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Keith A Wilkinson POWTS Plan Reviewer ,Integrated Services (715) 524-3630, Fax: (715) 524-3633 , M-f 7:45 am - 4:30 pm kwilkinson@commerce. state.wi.us Fee Required $ 75.00 Fee Received $ 75.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist (715) 726-2544 Mound Svstem pg 1 of 6 Cover Page Project Name: Henry 600 GPD Mound Owner's Name Jim Henry Owners Address 2217 Vine Street Suite 200 Hudson, Wl. 54016 715-381-4904 Legal Description ' sE ' • ' ' Nw~ %< Sec 20 T 29 N, R 17 w I, • Township Hammond County Saint Croix Subdivision Hammond Oaks 1st Addition Lot# Parcel ID# ~r ~.. ~~ ~ ~i~ Z = )l+~(1~SflO tda``•. 'd SaINOHJ 63 ~ --- ~v•~ ~~~. Table of Contents ~:' THOMAS D. ':~'?.,,, p9~ ~~ GUSYU~i ' ~ ,, 1 Cover page 12/.~~ 2 Mound Sizing Calculations 3 Pressure Distribution Layout and Dynamics r4~ • , k 4 Dose Tank /Pump Curve ~•~•W.~•S' ~~~' ~ ' 5 Management and Contingency Pla ' f' ~1 n ~iJ' ~ .~ J 6 Plot Ma ~(jft~+t~10 '. y .. k .y ,~d; ~_. rnh1;ME.RCE _~ total # of pages: 6 ~--""""- NCIr RESPOND' -'; S GOR , _~ ~ . Designer Name: Tom Gustum ' License #: D1201 Date: 3/8/2005 Ph. #: 715-658-1344 Signature: Mound System Design Methods Used per "Mound Component Manual For Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD-10691-P (N.01/01) per" Pressure Distribution Component manual for Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD-10706-P (N 01/01) Spreadsheet provided by: 3bAdvisement N12486 220th St, Boyceville, WI 54725 Ph: 715-643-6068 email: 3ba@3badvisement.com I Mound System ~ Page 2 of 6 Mound Sizing Calculations Project Name: Henry 600 GPD Mound Site Conditions _- Project Type: L1_or 2 Family Dwelling I ~ Slope: i 8 # of Bedrooms: 4 Depth to limiting factor: 24 in. Absorbtion rate of fill material: 1 gal/ft2/day Absorbtion rate of in-situ soil: 0.5 gal/ft2/day Effluent quality !, EfF#1 ! • Max BOD effluent value: 220 mg/I Max TSS effluent value: 150 mg/I Design of the Distribution Cell System Design Flow: 60 gal/day Distribution cell width (A): 7.50 ft Distribution cell length (B): 80 Area of Distribution Cell: 600.0 ft2 Contour Elevation of Mound: 96.90 ft/ System Elevation of Mound: 97.90 ft' Final Grade of Mound: 99.69 ft Design of Entire Fill Cell depth at upslope edge (D): Cell depth at downslope edge (E): Distribution cell depth (F): Cover thickness over edge (G): Cover thickness over center (H): End slope width (K): Fill length (L): Upslope width (J): Downslope width (Toe) (I): Fill Width (W): 2.0 in 19.2 in. 9.5 in. 6 in. 12 in. 9.3 ft. 98.6 ft. 5.6 ft. 11.5 ft. 24.6 ft. Basal Area Basal area required: 1200 ft2 Basal area available: 1520 ft2 Observation Pipes Location from end of cell (Z): 13.33 ft Mound Plan View /Observation Pipes Z I -- - _~ --- - - _ -- - -~- _ _ _ W K~ <"" Distribution Cell "b A -- - _ _ _ - - B K- Tilled Area/Fill Material L Mound Cross Section Final Grade C~bservatian Pipe Synthetic Fabric ~ G Distributit~n Gell System Elevation 6n,~ a ~ ~~~~ F '~~-~~ p d' 1 Lateral ~ 3 Clever Material ~ E D Fill Material Invert Tilled Area .,.~`~ Slope ~~Forcemain System Contour Notes: Fill material to consist of ASTM C33 Sand Distribution cell aggregate to comply with Comm 84.30(6)(1) Synthetic Fabric covering on cell per Comm 84.30(6)(g) Distribution Cell to have minimum 6" aggregate below lateral and 2" above. Mound System Page 3 of 6 Pressure Distribution Calculations Project Name: Henry 600 GPD Mound Lateral Layout Lateral elevation: 98.4 ft Rows of Laterals: 2 _ '~ ~ Manifold type: j center j ~ Orifice diameter: 0.125_. '~, ~ In. # of Laterals: 4 Distal Pressure: 5 ft Lateral Length: 39.5 ft Orifice Spacing/Distribution Orifice spacing (X): 24.31 Inches Orifices per latera-: 20 Avg. ft2lOrifice: 7. to ~-'SO'ftZ Lateral/Manifold D ign Lateral diameter. . 1'i~ ~ ~ In. Lateral spacing (S): 4 ft Lateral to cell edge: 1.75 ft Lateral discharge rate: 8.24 gpm System discharge rate: 32. gpm Manifold diameter: 2 ~ ~ I . Manifold length: -- 4 ,. Forcemain Fri ction L s Forcemain length: 55 ft '~ Forcemain diameter: Lz ~ ~ In. Friction loss in forcemain: 1.269; Lateral Side View I~ Lateral Plan View Turn-up w/ball valve or cleanout 1 PVC Manlfoltl ~i'® ~i ~~ by ~P~~d I PVC laterals, forcemain and manifold to comply with specifications per Comm 84.30[2] Forcemain connection via tee or cross to manifold at any point Clean Out Detail dean-out plug nal Grade ,` or ball valve Observation Pipes Lawn Sprinkler Box Lang 'Sweep 90 ar two 45's-,` 6" Minimum Jdater tight cap ar plug Mate: Closet Collar may 6e wsed in place of 3~8" 6ar `~-3l6" Bar ' Mound System Septic,, Pump and Dose Tank Project: Henry 600 GPD Mound (,J;e~~ Page 4 of 6 ~L:..~ ~ Tank Inform Pump tank manufacturer: Pump tank size/model: Pump tank gal/inch: Tank bottom elevation (inside): Septic tank manufacturer: Septic tank size/model: Skaw Pre 750 16.05 92 Skaw Precast 1254 Pump and Filter Pump Manufacturer: Little Giant Pump Model: 9EH Effluent Filter: simte ~ 110 Note: Access opening of sufficient size to be provided to allow removal of filter. Opening to terminate at or above grade. Pump Tank Diagram Watertight Locking Cover flinch ~ Wdh Warrnng Label Finishr Minimu0l~T _ _ _ _ `Grade Alternate Outlet Location Weep F orAnti- Siphon Device Elect. per Comm 16.28 and NEC 300 Dosage Volume Does forcemain drain back to tank? Lateral void volume: 16.7 gal Dosage to absorbtion Cell: 83.5 gal Forcemain volume: 9.6 gal Total dosage: 93.1 gal Total Dynamic Head Are laterals highest point? if not, enter highest elevation: 0 ft System head (distal x 1.3) 6.50 ft Vertical Lift ("D" to lateral) X5.7.3 ft 7•~ Friction loss in forcemain: 1.27 ft Pressure loss from filter: ~ft Total dynamic head (TDH): 13.50 ft Dose Tank Levels In. Gal A Reserve 3 ~• z e39~9- 496'4' B Pump off to Alarm 2.0 32.1 C Total Dosage 5.8 93.1 D Effluent depth for pump 8.0 128.4 A Total Capacity: -X48:7• e `l`7, ~ C _ Pump Curve: 9EH D FLDV- L[TERS/HOUR 750.0 10 Pump must be capable of: and head pressure of: 33.0 GPM 13.6 Feet 7 •S 2 W W W a N 7.S W H W Z s a 2.5 0 0 20 40 60 80 Little Giant FLDw- GALLONS/MINUTE 9EH PUMP PERFORMANCE CURVE IISV 60HZ Mound System Management Plan pursuant to comm 83.54 W. A. C. page 5 of 6 Owner's Responsibility: The component owner is responsible far the operation and maintenance of the component. The county, department or POWTS service contractor may make periodic inspections of the components, checking for surface discharge, treated effluent levels, etc. The owner or owner's agent is required to submit necessary maintenance reports to the appropriate jurisdiction and/or the department. Septic Tank: Septic tank(s) are to be inspected routinely and maintained by department approved individuals when necessary in accordance with their approvals. The use of chemical/biological "treatments" is not required or recommended. If such additives are used, make sure they are approved by Department of Commerce, Safety and Buildings Div.. Effluent filters are to be removed & cleaned as necessary, with provisions to keep solids from passing the septic during removal. No more than 1 /3 of the usable tank volume may be occupied by sludge/scum. 3 year inspection: If tank has greater than 1 /3 volume sludge, tank contents must be emptied and disposed of in accordance with NR 113 Wisconsin Administrative Code by an approved individual. If the inspector does not recommend pumping of the septic tank, then the owner must be notified of when pumping should be done as to not exceed 1/3 sludge volume. Septic tank should be routinely inspected to be watertight and of good repair. Pump/Dose Tank If an effluent filter has been installed in the pump/dose tank, it must be removed & cleaned as necessary, with provisions to keep solids from passing to the mound component during removal. The pump, float switches and alarms must be inspected at least every three years for proper operation. Pump/dose tank should be routinely inspected to be watertight and of good repair. Mound and Lateral System The mound system component must remain free of ponded surface water prior to pump operation. If 4 inches or more water level is detected in the observation pipes, the owner must be notified of possible problems/failure. The designed daily flow capabilities of the component should never be exceeded. Trees and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the component. Activities OTHER than mowing/maintenance (i.e. excessive walking, pets, vehicles, etc...) could compress the component and reduce it's absorption capabilities and/or possibly cause it to freeze in winter conditions. Lateral distribution pipes should be flushed out/tested every 18 months using the cleanout points at each end of the component to remove scum that may clog orifices. Pertormance Monitoring: Performance monitoring must be done at least once every three years following the installation or at the time of a problem, complaint, or failure. Contingency Plan: If the septic tank, pump tank or any of their components therein (including floats, alarms, pumps, etc) become defective, the defective tank or component must be replaced immediately to ensure that the system can operate as designed. If the mound component cannot accept wastewater or ponds wastewater to the surface, the component must be repaired or replaced in it's current location by either: extending basal toe to provide added absorbtion area; or by removing the clogged bacterial mat,aggregate cell, and distribution piping within the mound and replacing said components in order to return system to proper working order as required. r I u v -- ~ °s a i (fl E 3 y- 0 ~ r- 8 ~ N c0 C ~ (A cp C H (Q ~ _____-___--_ ___-_-_~______~______________________________~_--_____-__--__-_--_-______-___.__-_-_____-__ O O o ~ Pro sed Road ~ ~ o .~ m~=~ C z ®~5 ='s3 - x,`,,,~ ~Z : T ~ ~C...N2F-m ~ N ~ ~ : 4 ; ~ 1 N ~ U \ t ~ N G. ~ ~~ ~ e~l s~ ~ r . i z 0 r o ~~ 0 Q. ¢ °, ~ __ ~ ~ ~d 5 P _ ~ O ~' ~W v ~ o€ ~ o_v= ~- ~& ~ ~~o = a ....) .. I~ ~~ ' --~ ~., b, ~ ~ ~- --~ ~ rn ~ ti ~ _ma~ '~ a U ~ o a r ~ a°o'~ '/ ~ ~ ~ m~ ~~ ~v~ x~ ~'~ ~ ~' ~~~ ~ ~ ~v°I i / ~ ~ $~ i ~ ~~ '~ Nv m G7 ~ O ~'~ ~/ ~ -- - ~ ~ ~, /' / °O/p8 ~ (V ~~ /S ~/ ` 1 O { \J' r m ~ i~ m i i l/d n c~ m ~M iv a I~ a 9, m ~ ~ Y t4 Y f6 A ° '~ ~ ~ ~ ~ ~~ 0 ~ ~ ~ ~ r` ao . . Safety and Buildings Division 201 W W ' County ~ ~ ~ . ashington Ave., P.O. Box 7082 ~ +x iseonsvn D Madison, WI O8 1-65~~C~C~~/~ anitary Permit Number (to be filled in by Co.) - e artment of Commerce ~ (~ d ~ ~ Sanitary Permi A Stat Plan LD. Number In accord with Comm 83.21, Wis. Adm. Code, personal informati you pFo~~ GO ~ 2~d~ ~ maybe used for secondary purposes Privacy Law, s15.04 )(m) Pro ct Address (if different than mailing address) Sl. Ci~O~X COUN i ~ I. Application Information-Please Print All Information ING OFFICE l~S~ ~ 6 - ` ~ ST . ~ ~ Property Owner's Name Parcel # t # Property Owner's Mailing Address Prope canon ` ~ p 3 , ) 22.E V 1~4 ~JUi 2oC~ Nw ' Z~ L ~ Cit State ~•• Sec ton - ~'° y, Zip Code Phone Number ~(~$~„~ iN~ S'y0 ~ ~(S _~ , (circle one) . T ~ N ~ II T f B ildi g h k ll ; R E or . ype o u n (c ec a that apply) 3 B l9'l R.v+,, . ~i or 2 Family Dwelling -Number of Bedrooms ~ ~' ~ Subdivision N ame CSM N u mb er ^ Public/Commercial -Describe Use /}~~„~ t ] j / ~~ ^^a-^a 09"kS ~', /`[ OI G ^ State Owned -Describe Use T ^City ^Viliage ~T'ownship of f,{ „t III. Type of Permit: (Check only one box on tine A. Complete line B if applicable) A, ,8 New System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B• ^ Petmit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner i ~ IV. T e of POWTS S stem: Check all that a 1 /$~ p'yz ~, 2.~~ ^ Non -Pressurized In-Ground E1'MOUttd > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Consuvcted Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ " D ~' , Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe Other (explain) V. Dis ersaUTreatment Area Information: tl Design Flow (gpd) y Design Soil Application Rate(gp sf) ~~ ~ ~ Dispersal Area Re fired (sf) r ~ Dis sa Area roposed (sf) P~ System Elevation ,~ ~~ ~,o - s~ sa . 90 VI. Tank Info Capacity in To Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank ~ '~ ~ ~ 1'f srt Aerobic Treatment Unit S~ , ~ ~T' Dosing Chamber 1 /( VII. Responsibility Statement- I, the undersigned, assume respons bility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) k ~ ~ Plumbe ' Si ature MP/MPRS Number ® Business Phone Number ' "' ~~ ~ rvli a7~y -9~2 -- ~ 1tS~ rS Plumber's Address (Street, City, State, Zip Cod ~. r~ Io C~ 1~~ ~, ~' ~" 3c~ VII oun /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (incl~.tdes Groundwater Date Issued suing Ag t Sign re tamps) ^ Owner Given Reason for Denial Surcharge Fea) ^~ pitJ ~ yol S `'~ ~ ~/ Q IX. Conditions of ApprovaUReasons for Disapp"ro"va~l ~. G~c,C/~'J l~ ~- SYSTEM OWNER: Y~iw G~ "~ 1 ep Ic ~ filter and ~3 - j Z ~G ~~ ~~~-U tom`' ~ dispersal cell must all be serviced / mainfaine~ _" as per management plan provided by plumber. ~~~x- ~ ' 2. Ali setback requirements must be maintained / , / ~ as per applicable code/ordinances. ~ VV ~ ~~+ Q ~~~~ ~~~ ~... J gttach complete plans (to the County` tie system on paper not less than 81/2 x 11 inches s//yy~ ~ K ~GI~C.~~ ~~ ~~~~ t~ v,/ SBD-6398 (R. 08/02) r ` t;ommerce.wi.gov ~isconsin Department of Commerce Safety and Buildings 1340 E GREEN BAY ST STE 300 SHAWANO WI 54166 TDD #: (608) 264-8777 www. commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary November 29, 2004 CUST ID No.227618 THOMAS GUSTUM GUSTUM SEPTIC SERVICE N 13450 937TH ST NEW AUBURN WI 54757 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1 101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/29/2006 SITE: Jim Henry 160TH St Lot 63 Town of Hammond St Croix Co~u~ty SEl/4, NW 1/4, S20, T29N, R17W Lot: 63, Subdivision: Hammond Oaks Identification Numbers Transaction ID No. 1086590 Site ID No. 692797 Please refer to both identification numbers, above, in all corres ondence with the a enc . FOR: Description: Mound System for Tim Henry Object Type: POWTS Component Manual, Regulated Object ID No.: 994442 Maintenance required; 450 GPD Flow rate; System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/01), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/01) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter IOl.Oi(]0), Wisconsin Statutes, is responsible for compliance with ali code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy. or use: • This system is to be constructed and located in accordance with the approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD-10691-P (N.O1/Ol). • The pressure network is to be constructed in accordance with publications SBD-10706- P (NO1/O1) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems -Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81)". A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/instal lation/operation. r ~.. . THOMAS GUSTUM ~, Page 2 I V29/2004 In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to ine at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 ~~ ~ Balance Due $ 0.00 Kei A Wilkinson POWTS Plan Reviewer ,Integrated Services WiSMART code: 7633 (7l 5) 524-3630, Fax: (715) 524-3633 , M-f 6:00 am - 2:45 pm kwilkinson@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist (715) 726-2544 s~ Mound System ~, or s Cover Page ~'ECE~p N 0 V 1 7 ?(J04 Project Name: Henry 450 GPD Mound S~~Y ~ B~pGS~ ~1V, Owner's Name Jim Henry Owners Address 2217 Vine Street Suite 200 Hudson, WI. 54016 715-381-4904 Legal Description I'E I ' I %4, Nw ~ ~ '/4 Sec 20 T 29 N, R 17 W ~ Township Hammond County Saint Croix Subdivision Hammond Oaks 1st Addition s~/ a p r ,,f~ f T ! h ~ ~ ~ Lot# 63 ~' .~ Parcel ID# ~i`llS~,i7N OF sr~FriY r~~ ~ult.ulric5 SSE CO~yf~ESC'OfJDENCE ~~' ~ ~!es pg- Table of Contents O ~ ~~ ~. ~ ~.C® ~~ 1 2 Cover page Mound Sizin Calculations ~ Uj THOMAS D. •°: t~1~ ~ ~ 3 g Pressure Distribution Layout and Dynamics GUSTU1v1 ~ ~ • 4 Dose Tank /Pump Curve 12(71 5 Management and Contingency Plan O••.• e 6 Plot Map >~°. total # of pages: 6 Designer Name: License #: Date: Ph. #: Signature: Tom Gustum D1201 11/15/2004 71.~i-~i.~iR-1 add Mound System Design Methods Used per "Mound Component Manual For Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD-10691-P (N.01/01) per "Pressure Distribution Component manual for Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD-10706-P (N 01/01) 3bAdvisement N12486 220th St, Boyceville, WI 54725 Ph: 715-643-6068 email: ' • ~~ Mound System Mound Sizing Calculations Project Name: Henry 450 GPD Mound Site Conditions Project Type: 1 or 2 Family Dwelling Slope: # of Bedrooms: Depth to limiting factor: Absorbtion rate of fill material: Absorbtion rate of in-situ soil: Effluent quality Max BOD effluent value: Max TSS effluent value: L 241in. 1 gal/ftz/day 0.5 gal/ftz/day Eff# 1 ~ 220 mg/I 150 mg/I Design of Entire Fill Cell depth at upslope edge (D): Cell depth at downslope edge (E): Distribution cell depth (F): Cover thickness over edge (G): Cover thickness over center (H): End slope width (K): Fill length (L): Upslope width (J): Downslope width (Toe) (I): Fill Width (W): Page 2 of 6 12.0 in. 19.2 in. 9.5 in. 6 in. 12 in. 9.3 ft. 78.6 ft. 5.6 ft. 11.5 ft. 24.6 ft. Design of the Distribution Cell Basal Area System Design Flow: 450.0 gal/day Basal area required: 900 ftz Distribution cell width (A): 7.50 ft Basal area available: 1140 ftz Distribution cell length (B): 60.0 ft Area of Distribution Cell: 450.0 ftz Observation Pipes Contour Elevation of Mound: + 96.90 ft Location from end of cell (Z): 10 ft System Elevation of Mound: 97.90 ft Final Grade of Mound: 99.69 ft Mound Plan View /Observation Pipes ~Z~ f I ~ _ W K=-~ ;t'" Distribution Cell ~~}; q II - ------ - - - B-_- _-_ __ -___-_-_ _ - n I Tilled Area/Fill Material Final Grade Synthetic Fabric Distrik,utian Cell ~• ~--System Elevatian ~=-~-L-~, Cawer Materi Fill M~terie.l- L Mound Cross Section .~..-~ ~ d ~. Lateral ~ inert ,L servatian Pipe -:r.~G F '~; r_ ~ I-`--y Tilled Area u •~,, Slape ~`•-Farcemain Notes: Fill material to consist of ASTM C33 Sand Distribution cell aggregate to comply with Comm 84.30(6)(1) Synthetic Fabric covering on cell per Comm 84.30(6)(8) Distribution Cell to have minimum 6" aggregate below lateral and 2" above. System ~~ •CI ' C+ontclur- Mound System Page3ot s Pressure Distribution Calculations Project Name: Henry 450 GPD Mound Lateral Layout Lateral/Manifold Design Lateral elevation: 98.4 ft Lateral diameter: 1'i2 ~ In. Rows of Laterals: 3 ~ Lateral spacing (S): ~ft Manifold type: center ~ Lateral to cell edge: 0.75 ft Orifice diameter: o.>ss ~ ~ In. Lateral discharge rate: 7.91 gpm # of Laterals: 6 System discharge rate: 47.44 gpm Distal Pressure: 2.5 ft Manifold diameter: 2 . In. Lateral Length: 29.5 ft Manifold length: 6 ft Orifice Spacing/Distribution Forcemain Friction Loss Orifice spacing (X): 30.78 Inches Forcemain length: 55 ft Orifices per lateral: 12 Forcemain diameter: 2 ~ In. Avg. ft2/Orifice: ~ftz Friction loss in forcemain: 2.489 ft Lateral Side View Cpl anifal~ Lateral Lateral x x x x x x x x x x x x 2 ~ La#eral Length Lateral Length Lateral Plan View lateral Length - Tum-up wlball valve a deanait plug 0 a Y C a, o ~ S ° r S 0 0 Onfices ~ ~0m ~ PVC later~s and forcemain to comply with lateral equally spaced spedficetions per Comm 8430(2) Facemain connedion via tee a aoss to manifdd at any point Clean Out Detail Observation Pipes glean-aut plug Final Grade or ball valve Ihrater tight cap or plug Lawn Sprinkler box Slot Mote: Closet Collar f3" l4tlnlmLln"1 may 6e used in Long Sweep 9l] I place of 318" bar ortwo 45's L 3/8" Bar Lateral Mound System Page a of s Septic, Pump and Dose Tank Project: Henry 450 GPD Mound ? Tank Informa tion Dosage Volume Pump tank manufacturer: kaw Precas Does forcemain drain Pump tank size/model: g42 back to tank? L-~ Pump tank gal/inch: b , y 7 Lateral void volume: 18.7 gal Tank bottom elevation (inside): 92 ft Dosage to absorbtion Cell: 90.0 gal Septic tank manufacturer: Skaw Precast Forcemain volume: 9.6 gal Septic tank size/model: 1000 Total dosage: 99.6 gal Pump and Filter Total Dynamic Head Pump Manufacturer: Little Giant Are laterals highest point? Pump Model: 9EH if not, enter highest elevation: 0 ft Effluent Filter: simtec STF 110 System head (distal x 1.3) 3.25 ft Vertical Lift ("D" to lateral) 5.40 ft Note: Access opening of sufficient size to be provided to allow removal of filter Opening to terminate at or above grade. Friction loss In forcemain: 2.49 ft Pressure loss from filter: L-'Jft Total dynamic head (TDH): 11.14 ft Pump Tank Diagram Watertight Locking Cover 4 inch ~ Vllth VWamurg ~~ Fnishr Minimum _ Grade Alternate J Outlet ~ Location Elect per Comm 16.28 and remain NEC 300 ~~ orArrti- B Siphon Device C D Pump must be capable of: and head pressure of: 47.4 GPM 11.2 Feet Dose Tank Levels In. A Reserve I ~ - 0 -~~ B Pump off to Alarm 2.0 C Total Dosage ~ -o ~.1 D Effluent depth for pump 12.0 Total Capacity: -$3G' 39.0 F- w i a Gal 3 32.5 g~ 9 194.8 642.0 10 N 7.s W W E s a z.s ~z.4. 8.8~ 0 20 40 60 80 Little Giant FLOW- GALLONS/MINUTE 9EH PUMP PERFORMANCE CURVE 115V 60HZ Pump Curve: 9EH FLAW- LITERS/HOUR f n • u v - ~ 3 i s (~ ~ r f ~ Q ~ Q' fA (O ~ H ^^(Q e _____________________________________________________________________________________________ O O O oLL Proposed Road ~ ~ ~ ~ ~ 'e. __ z~ ~3=~ _~~ $~z ,~~~ ~ ,°s ESN ~ ui J ~~c~xF-m@a' N )I Z O H r n` 0 Q ~ ~ ~~ t° ~- '~ o ~w v .Q ~ ~ ~ a co z S ~ 7 S~ ~ g ~ ~,~,_ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~~ O~ w U ~ ~_ CO ~~ v c !; co 3 f' ~~i,I '~m~ ~~ ~~ x ~ / O ~ ~ ~~~~ ~ j A ~ ~ o ~~ j~% ~, ~~~ m' ¢ ~ N _ ~ ~i fh ~ i~ m ~,~ ~/~ ~ /~ ~ ~~ ~i~~/ ~~ ~ gi /; " ~ co ~~%f/ „ ig~ i~ ~~~ ~' °~S ~'~ i ,,\ ~ ~ r~ , ~- ti *mrn ;~ m ~` l/d n r~ IM ~t a I~ d ~ f6 co o v~ y N Y Y ~~~ a ,~ o= m~~~ .. r, 0 ~' ° W Z ~ S S J ~ mW w Q of JU J ~ W W ,o u M ~ g 11 m m ~~ ~ m ~ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of 2 FILE INFORMATION Owner• J ~~~~.5 Permit # ~ 3 ~5 DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units --- ^ NA Estimated flow (average) L30 al/da Design flow Ipeakl, (Estimated x 1.5) $~ al/da Soil Application Rate ~ji-a?ti . S al/da /ft~ Standard Influent/Effluent Quality Monthly average` Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODE) 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODE) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ~NA Fecal Coliform (geometric mean) 5 ` OOmI Maximum Effluent Particle Size Y8 in dia. ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS __ c~rnQ~ Septic Tank Capacity ~~ ~ d2. al ^ NA Septic Tank Manufacturer ~~ ^ NA Effluent Filter Manufacturer Sjy~~ ^ NA Effluent Filter Model s•7~ /~Q ^ NA Pump Tank Capacity ~ al ^ NA Pump Tank Manufacturer - ^ NA Pump Manufacturer L/7T(~ /gv/>- ^ NA Pump Model 9 Er/ ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: NA Dispersal Ce(lls) ^ NA ^ In-Ground (gravity) ^ In-Ground (pressurized- ^ At•Grade Mound ~ Z~ v sbd ~ ^ Drip-Line ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA Service Event Service Frequency Inspect condition of tank(s) At least once every: 2 _ ~ month(s) !Maximum 3 years) earls) ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third IYgI of tank volume ^ NA Inspect dispersal cell(s) At least once every: 2' 3 ^ month(s) (Maximum 3 years) year(s) ^ NA Clean effluent filter S N~~ ~ At least once every: '3 month(s) i ^ NA Inspect pump, pump controls & alarm At least once every: ' ~ month(s) ^ year(S) ^ NA Flush laterals and pressure test At least once every: 2 ~3 ~ ^ month(s) ~yearisl ^ NA Other: At least once every: ~ yea~th(s) ^ NA Other ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shalt be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third IY31 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report steal! be provided to the local regulatory authority within 10 days of completion of any service event. Page Z of 2/ START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal ceN{sl. If high concentrations are detected have the contents of the tankls) removed by a Septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal ce111s1 in one large dose, overloading the cellls) and may result in the backup or surface d'~scharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact s Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the foloowing from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit. and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replacement system: ^ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. • T o mg tank ~~ ai a ' ~ X012 N/ CONS7Rd~Tt oN • a~ ~12i?idl'~ i~ Mound at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the relive surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER ~ L/Jm / ~ POWTS MAINTAINER Name ~T' ~~ ~ LZ ~l9 Phone •~ 'L .~ Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name S C ( bV ~~~~ Phone "''(S- 36 (p- (O ('~ This document was drafted in compliance with chapter Comm 83.22(21(b)(1){dl&(f) and 83.54411, (2) & (3), Wisconsin Administrative Code. ST.1i~12r~IR ~~~3N~'~ S~TIC TANK MAIIrTfiENANGI~ AGREE:MIrI~'F AND f.I~VNERSIiIP CER7TFICA TiG~N FORM C?~u~rnerll3uyer _ ~t,,~ ~~xti Mailing Adsiress U`: 5 ~ti~ c'bb Property Address 1~1 {venfcattan required from Planning 17eparianent far new rcrostructian_} `[ ~ o City/State ~-(~j- /~ Parcel Identi~cativn ~Turtntyer D l~' l®~' 7- l'0 3 -~~ L_~~GALUESC~IpN ~~a~ o19p3 Property Lotion Sf ~/4 , !~ "~ ~/~ y Sec. ~a T zy_ N it~~,~, Tc~~ ~f_ f}nM Ma~ Subdivision ~(- q,.lM ~~ ~~~ 1' ~ ~a~~,~,~ j Lnt # ~, Cea-tii3et! Survey a~ #~ volume ..Page # ~arr~nty ~~ ~ _ . _ ~? aSo ~ ~ volume 2 Fa~ge ~ ~/ 6 Spec boos ycs ~ia .Lot :roes Identifiable / ves o SYSTEI4~I NLAIN'TENA1~iCIW `~ Improper ~+se and, snaintezrcitfcc of your septic system ctxslcl result itt its premature failure to Handle wastes. Proper maintenance consists df pumping out the septic teak every t1u'ee years or sooner, if needed by a licensed putx~-ei. What you poi into dte system can ~'ect the functio:t of the septic tank as a treatment stage in tt-e waste disposal system. f?vvner maint8ttauce trsponsibitities are specified irc g Comm $3.52(1} and in Chapter 12 - St. Croix Caunty Sanitary f3rdinaucc. The property owner agrees to subr~i# Eo St. Crouc Couctty Z.aneng Department a c~tifiCation farm, signed by the ow~r and by a master pltunher, jout?teyman pluruber, res#ricted pltunber or a licensed pumper verifj-ing tkat €1 } the oa~ite wastewater disposal system is in proper operating condition aatllor (2} after in~pectiott and pumfligg (ifnecossary}, the septet tatilc is less than I!3 foil of sludge. I1we, the undersigned have read the above rcquitemertts sr~d agrrec tct maintain the private sewage disposal systeam witty the standards sct forth, herein, as set by the Dept of Ccsnce and the i~eartmcnt of Natural Rcsotu~cs, State of Wisconsi>L Certification static that yotar septic system Ytas been maintained must be cczttpleted anti retucacd E4 the St. Crei~c County Zanmg Department within 30 days of the three year expiratic~t~. etate. SIuNA.'1<'UI~..~C~F' APPLICANT .3 ~1~~~ DA'I~E Uwe Certify that alt statements on this form art true to the best t~f mylour knowledge. Uwe amlare the awner(s) of the pzoperty 'bed above, by of a warranty decd t~ecorded itx Register of Deeds Office SIGNATLJR ()F Av.P,~ .. CANT .~.~1 ~l~ HATE ~y ~ presentedi mx result in the sari ***:~« '~~**** anfartt~tion tlsat is nusre y ta:y permit being n~voked by the Zoning Deparhnent. IncluCle with this application $ stamped waxrsnty deed front the Register of I]eads flf~ce and a copy of the certified survey map of reference is oracle in the ~avars`snty deed. nd System Management Plan pursuant to comm 83.54 W. A. C. page 5 of 6 Owner's Responsibility: The component owner is responsible for the operation and maintenance of the component. The county, department or POWTS service contractor may make periodic inspections of the components, checking for surface discharge, treated effluent levels, etc. The owner or owner's agent is required to submit necessary maintenance reports to the appropriate jurisdiction and/or the department. Septic Tank: Septic tank(s) are to be inspected routinely and maintained by department approved individuals when necessary in accordance with their approvals. The use of chemical/biological "treatments" is not required or recommended. If such additives are used, make sure they are approved by Department of Commerce, Safety and Buildings Div.. Effluent filters are to be removed & cleaned as necessary, with provisions to keep solids from passing the septic during removal. No more than 1/3 of the usable tank volume may be occupied by sludge/scum. 3 year inspection: If tank has greater than 1 /3 volume sludge, tank contents must be emptied and disposed of in accordance with NR 113 Wisconsin Administrative Code by an approved individual. If the inspector does not recommend pumping of the septic tank, then the owner must be notified of when pumping should be done as to not exceed 1/3 sludge volume. Septic tank should be routinely inspected to be watertight and of good repair. Pump/Dose Tank If an effluent filter has been installed in the pump/dose tank, it must be removed & cleaned as necessary, with provisions to keep solids from passing to the mound component during removal. The pump, float switches and alarms must be inspected at least every three years for proper operation. Pump/dose tank should be routinely inspected to be watertight and of good repair. Mound and Lateral System The mound system component must remain free of ponded surface water prior to pump operation. If 4 inches or more water level is detected in the observation pipes, the owner must be notified of possible problems/failure. The designed daily flow capabilities of the component should never be exceeded. Trees and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the component. Activities OTHER than mowing/maintenance (i.e. excessive walking, pets, vehicles, etc...) could compress the component and reduce it's absorbtion capabilities and/or possibly cause it to freeze in winter conditions. Lateral distribution pipes should be flushed out/tested every 18 months using the cleanout points at each end of the component to remove scum that may clog orifices. Performance Monitoring: Performance monitoring must be done at least once every three years following the installation or at the time of a problem, complaint, or failure. Contingency Plan: If the septic tank, pump tank or any of their components therein (including floats, alarms, pumps, etc) become defective, the defective tank or component must be replaced immediately to ensure that the system can operate as designed. If the mound component cannot accept wastewater or ponds wastewater to the surface, the component must be repaired or replaced in it's current location by either: extending basal toe to provide added absorbtion area; or by removing the clogged bacterial mat,aggregate cell, and distribution piping within the mound and replacing said components in order to return system to proper working order as required. uPSconsmDepartmentofCommerce SOIL AND SITE EVALUATION Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Page 1 of 3 Gustum Septic Service Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal refe-ence point (BM), direction and St. Croix percent slope, scale or dimemsions, north arrow, and location and stance to nearest road. -~ t ~ Parcel LD.# " ~`~"~, APPLICANT INFORMATION - Pl ase ~ r)t BN ~~ ~in it b~ D ~~ (0 3-,~ e i . o ~ r :._ -t- Personal information you provide may be used for secondary purposesPrivacy Law, s. 1 ~:pa (t) (m)). I ~ J iew Da3 2~ ~$~" Property Owner Property Location Humbird Land Co oration Govt Cqt n/a SE 1/4 NW 1/4 S 20 T 29 N,R 17 W Property Owner's Mailing Address . s„~ ~ Lot # 1 ,, Block # Subd. Name or CSM# y f- 1 ~~ 332 Minnesota Street, East 1404 1 Irt Hammond Oaks ~ftD Addition n/a ~ i _ * ~ ~ City State Zip Code.. PhoneNut>~,rt,;~r _ _ ~^C~qy ^VillageTown Nearest Road Saint Paul MN 55101 651- ~y~~FtGE '~~ ` Hammond ~ 160Th Street t-gdr 3 ^Addition to existing building ^ New Construction U ^ Residential I;IVurnb~riof ~ se: ^ Replacement ^ Public or conlrrfeitciaL~iesen e Code Derived daily flow 450 gpd Recommended design loading rate .5 mod, gpd/ft~ .6 trench, gpolftx Absorption area required 900 bed, ftz '750 trench, ftz Maximum design loading rate .5 bed, gpdfftz .6 trench, gpolftz Recommended infiltration surface elevation(s) along 96.9' contour ft (as referred to site plan benchmark) Additional design 1 site considerations BM 2 = 97.3' Parent material _gound moraines Flood lain elevation, if a livable n~a ft S=Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U=Unsuitable for system ^ S ®u ®S ^ v ^ S ®u ^ S ®u ^ S ~ u ^ S ® u 501E DESCRIPTION REPORT Boring# 1' Ground elev 97.3' ft Depth to limiting factor 24" 2 Ground elev 95.3' ft Depth to limiting factor ~~• Horizon Depth Dominant Color Mottles T t Structure Consisten Bounda Roots GPD/ft~ in. Munsell ~. Sz. Cont. Color ex ure Gr. Sz. Sh. ry ~ ;Trench 1 0-8 IOyr3/3 none sil 2msbk mvfr as 2f,lm 0.5 0.6 2 8-14 7.Syr4/4 none sil 2msbk mvfr cw if 0.5 0.6 3 14-18 7.Syr4/6 none gr. sil 2msbk mvfr cw - 0.5 0.6 4 18-24 7.Syr4/6 none gr. sl 2msbk mfr cw - 0.5 0.6 5 24-32 7.5 4/6 3'r c2-3p 10yr7/2 7.Syr5/8 sl 2msbk mfi - - 0.5 0.6 Remarks: 1 0-10 10yr3/3 none sil 2msbk mvfr as 2f,lm 0.5 0.6 2 10-14 7.Syr4/4 none sil 2msbk mvfr cw If 0.5 0.6 3 14-25 7.Syr4/6 none gr. sil 2msbk mv$ cw - 0.5 0.6 4 25-32 7.Syr4/6 c2 ~.p510yr7/2 gr. sil 2msbk mfr - - 0.5 0.6 Remarks: CST Name (Please Print) Signature: ~~ ~ ~-. Telephone No. Tom Gustum ~ j~~~ i~~~~'rGvr,~~ 715-658-1344 Address Gustum Septic Service Date CST Number Ref # N13450 937th St., New Auburn, WI 54757 3/1/00 227618 1178 I PROPERTY OWNER: xumbira>.~a Corporation __ SOIL DESCRIPTION REPORT PARCEL LD.# 3 Ground elev 97.3' ft Depth to limiting factor 25' 178 Page 2 ot`_ 3 - Gustum Septic Service Horizon Depth Dominant Color Mottles Texture Struchtre sistence Boundary Roots ~ GPDIft' in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ~ rtrench 1 0-9 10yr3/3 none sit 2msbk mvfr as 2f,im 0.5 0.6 2 9-12 7.Syr4/4 none sit 2msbk mvfr cw if 0.5 0.6 3 12-25 7.Syt4/6 none gr. sl 2msbk mfr cw - 0.5 0.6 4 25-32 7.Syr4/6 c2 ~ Sys/g7~ gr. sl 2msbk mfi - - 0.5 0.6 KemarKs: Ground eiev Deptl~ to limiting factor Ground elev limiting fat~Or Ground elev Depth to limiting farhu Remarks: ~+ ~., . i3~• sl ~ Rl ~~ Q ___. o ~ ~~ 4 ~~ ' w V J t W ( l' ` y .~ F V c 0 w O .~ ~ l~ 3 ~ i •` R ~~ A ~~ 4 Q V 1 0., u J 0 7fl O Cni `f` • U 2731 P ~I61 U STATE BAR OF WISCONSIN FORM 1 - 1998 WARRANTY DEED Document Number This Deed, made between Walter E. Doelz and Diane L. Doelz. husband and. wife ,Grantor, and Jame D.Henrv. Grante Grantor, for a valuable consideration conveys to Grantee the following described real estate in St. Croix County State of Wisconsin (the "Property"): ACKNOWLEDGMENT - CZ~Z~` 018108764000 i~ T lU ~"~ ~~~ [cel Identitic8 umber (PIN) This is not homestead property. (Isj (is not Q ~ ~p 3 ~~ ~ots 63 a 64, Plat of Hammond Oaks 1`t Sulxiiviston in the Town of Hate~m ~d, St. Croix County, Wisconsin. Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except ~ y\ Dated this ~y day of Januarv, 200b. AUTHENTICATION Signature(s) (SEAL) {SEAL) G Diane L. Doel (SEAL) _ (SEAL) authenticated this day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706:06, Wis. Stats) THIS INSTRUMENT WAS DRAFTED BY Coldwell Banker Burnet 1301 Coulee Road Hudson, W 154016 4-55454 {Signatures may be.authenticated or acknowledged. Both are not necessary.) ~n'Co,p. 8t'CTtYrx~County -~8~e.~$ 7tATHLEEH H. MALSH REGISTER OF DEEDS ST. CROIX CO_. 1fI RECEIVED FOR RECORD 81/14/2805 81:88PM MARRAHTY DEED EXEt+PT t Rtx FEE: 11.80 TRANS F'EE: 213.8@ COPY F£E: CC FEE: PAGES: 1 Scats o~~ } ss. Personally came before me this ~ day of Januarv, 20 5 the above named Wal er E. Iz n L hu nd 'f _ to me known to be the perso who executed the foregoing Instrument and acknowledge t same. Notary Pu Stat of Wisconsin My commission is permanent. (If not, state expiration date: their 11 STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc. WARRANTY DEED FORM Mo. 1 - ig98 Milwaukee, Wis. h 4~;: ~` :,, .~-. ~ ~. I r ~ r r r ~ r , O O ~. O I O I ~ I ~ I `- ~ co I 00 .~ I ~ , -.. I I I ..__. I K SUBDIVISION I H~IMMOND OA S______^ I ~ _.. WEST LINE ~ OF THE SE 1/4 OF THE NW 1 /4 ~OF SECS. 20 ` S 00'23' 21 " E 321.13' ,OB'f l£ .9L'0l£ .ZS'ZZ£ -- ,£l'~S6 -- 00 ~. I ~ I v~ O ~ w ~ ~o ~ Np --i ton ~ ~! z ~ D "~ ~ tG ~ ~ ~ fD O ~ ' N n ~ _ y n, ~ I ~ ~ ~ ~~ ~. O ,.. ,~ T ,.. ~, ,SS'ZZ£ 3»SO,Bq.00S ~' ~ ~ r / ~0` ~o O ~ \ D I ~ ~ ~ -~ N N n O i-- ~ ~ 1 SS'ZZ£ 3 0 B9.OOS ~ ' ' .L8 6£Z ,b0'S8l , lS'L£ t ,B6'0£Z 3» l l,S£.IOS~ ~ ! ~ ® ! 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