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030-2137-07-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM county: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 569512 (ATTACH TO PERMIT) State Plan ID No GENERAL INFORMATION : S/ 9 Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. Parcel Tax No: Permit Holder's Name: City Village X Township 030-2137-07-000 Brush Mound PaEhi jEKI St. Jose h Town of /Range/Map No CST BM Elev: Insp. : ^ �t��13 'p 61. 05.29.19.2033 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY P1nletffl4j47 FS ELEV. Septic ) •3�-�-.t 1 SCE C Qlosiag �i 3.7 e9�4 1 b Aeration /� �, -7 Holding 5. g S- Z St/Ht Outlet J .Z C75-07 TANK SETBACK INFORMATION TANK TO c P/L' WELL BLDG. Vent t Air In ROAD Dt Inlet \ Septic G / .Z.7 �_ Dt Bottom �.._ Dosing Header/Man. Aeration Dist. Pipe 7. '*Z- .c-r!; Holding Holding Bot.System 7.9 97 Z - PUMP/SIPHON INFORMATION Final Grade ?. 3 � '7-� , Manufacturer Demand St Cover. F el er LI Friction Loss System Head DH Ft emain Length Dia. Dist.to Well SOIL ABSORPTIOtj SYSTEM PIT DIMENSIONS No.Of Pits Inside Dia. Liquid De tp h BED/TRENCH Width Length No.Of Trenr ches �1.. DIMENSIONS '? 4 f t SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHAMBEIR OR Manufacture SETBACK C`/�� INFORMATION Type Of System: Z UNIT Model Number: �r J&f `I6 G a Gc o")e u,411 DISTRIBUTION SYSTEM �— Vent to�ir ly�ke x Hole Size x Hole Spacing F-__ HeaderlManifolyl �! Distribution � /gyp� Pipes) �_ Length J Dia � Length Dia pacing n>f-s SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only t d✓� B•ti � Depth Over xx D th of �se d/ odded xx Mulched Depth Over i(� Bed/Trench Ede Top Yes No Yes 0 No Bed/Trench Center �� g � COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 451 Bluebird Drive Hudson,WI 54016(NE 1/4 NW 1/4 5 T29N R19W) Bluebird Bluffs Lot 7 Parcel No: 05.29.19.2033 � t. U 1.)Alt BM Description= i,n l s.�- Gov 6 v-'_u 2.)Bldg sewer length= 33 -amount of cover= �Z'11 D✓`.. wwwccc...nnn..�++ Plan revision Required? Yes No J- TTT"' , '� ---. _ _ —- -- - � ' - Use other side for additional information. L __ —1--- --- — Cert No. Date Insepctors Sig lure SBD-6710(R.3/97) SLt�lGr� C�egl�tDh �Z� ! / /Jcc111�GL mat rG'— �0�'� i� I ,t i � vc' i 1 1 i w I •� �aY,A I I t 0. a (Jooc o fac 1 i 1,d J�^f F:It�r 1 Zoe ' C ram s!'llk� °` a�l,y r� [` I� � �SZ •9L s - ca County F Safety and Buildings Division ST. CROIX Q� 201 W.Washington Ave., P.O. BOX 7162 Sanitary Permit Number(to be filled in by Co.) °N Madison,WI 53707-7162 I /) TApphcat1 ' �' - State Transaction Number In accordance with SPS 383 trs e, submission of this form to the ppte governmental unit is required prior 00 a sanitary permit. Note: Application forms for state-owned POWTS are Project Addr ss(if different than mailing address) submitted to the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law,s. 15.04(1)(m),Slats. 51 113/,)L dI. Ap lication Information-Please nt AlKnformation Property Owner's Name Parcel# I J BRUSHY MOUND PARTNERS 030-2137-07-000 1 Property Owner's Mailing-Address Property Location Z033 P.O. BOX 445 Govt. Lot_ 7 Gam/ City,State Zip Code Phone Number -NE F/4,_X_ �/4, Section 5 NEW RICHMOND, WI 54017 715-246-2320 T 29 N; R 19 (ci cl�rre) II. Type of Building(check all that apply) Lot# OC1 or 2 Family Dwelling-Number of Bedroo 7 Subdivision Name Z_07NA_ x L Btock# BLUEBIRD BLUFFS ` ❑ Public/Commercial-Describe Use OR. N/A 11 City of P14 CSM Number [I Villa e of ❑ State Owned-Describe Use g Town of ST To -F.PH N/ T a A III.Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System(explain) B List Previous Permit Number and Date Issued ❑ Permit Renewal Permit Revision ❑ Change of ❑Permit Transfer to New Before Expiration Plumber Owner cz IV. Type of POWTS System/Component/Device: (Check all that apply) Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in.of suitable soil ❑ Mound < 24 in.of suitable soil ❑ Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) V. Dispersal/Treatment Area Information: Design Flo (gpd) I Design Soil Application Rate(g f) Dispersal Ar✓e�Required(sf) Dispersal Area Pronosed(sf) System Elevation 4A •7 $ .` 1 000 92.4 VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units ^ o New Tanks Existing Tanks °o v y ^a C / -O �4/a k U on h G4 c7 P. Septic or Holding Tank 1250 0 1_25_0 ; 1 WIESER X Dosing Chamber N/A N/A N/A VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) >��nature MP/MPRS Number Business Phone Number PAUL KOEHLER 225410 715-246-2660 Plumber's Address(Street,City,State,Zip Code) 321 WISCONSIN DRIVE. NE RICHMOND, WI 54017 VIII. County/Department Use Only Permit Fee Date Issue Issuing Ag ignature El Dis pro $ !!� El Ow en Reason for Dental r 7 7 IX. Con Reasons for Disapproval jou.'_ ro✓,peHtcitant titter ati` �" ' Ilisp"trsal ceN',must A be servtc"I Maintained k6 W-4 0L V J.C.. o 111 tner"ement plan provided by plumber. tpmenta mtotl�."llik"Nted fz...,, �1 �• #a RK Attach to complete plans for the system and sul7mit to the unlyf my on paper not less thaan*S 1/ x 11 inches in ize SBD-6398(R. 11/11) �� •� ��� i CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: DERRICK LOT 7 BLUE BIRD BLUFFS Owner's Name: BRUSHY MOUND PARTNERS Owner's Address: PO BOX 445 NEW RICHMOND, WI 54017 J Legal Description: NE 1/4 NW 1/4 S 5 T 29 R 19 T Township: ST JOSEPH County: ST. CROIX Subdivision Name: BLUEBIRD BLUFFS Lot Number: 7 Parcel ID Number: 030-2137-07-000 Pagel Index and title Page 2 Plot Plan Page 3 System Sizing &Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form ti Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test.&House Plans Designer/Plumber: PAUL KOEHLER License Number: 225410 Date: 07/02/14 Phone Number 715-246-9660 Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P(N.01101). Page 1 11 i i I 1 GarNb(, I I T�iTrK ���Fo �O ScC.YcJ Z r �J— p o% l•r�"�at I � � 2S _ I ! i i f � I a l o o I ip C3 HoVSf- ON .Z O I 13Q267� �Ct'f _ _ f I � 195• °I`�-` 172.3G� PI->LV Ga.( rZL Sa5r-s S'1"G1?,n>(KCo u�,q-f W�S�ontsr►� SOIL ABSORPTION SYSTEM DETAIL/GRAVELLESS LEACHING UNIT Page—of Project Name: q No. of Cells _Per Cell 3 ft Cell Width _Total No of_l a ft Cell Length _�D sq ft EISA Per Cell _ ft Cell Spacing r��19� sq ft Total EISA Manufacturer Model Laying Length EISA Rating Infiltrator hEZ1203H-5ft 5.0' 25.0 1203H-10ft 10.0' 50.0 Gravelless Leaching Unit Manufacturer: "A, Gravelless Leaching Unit Model: Typical Cross Section Finished Grade ft Observation Pipe with approved cap or vent as e vY- • Soil Backfill kin Fabric r <r ft Infiltrative Surface 12 in 0 it ft Limiting Factor 3(o✓'f in Slotted and Anchored Vent/ Observation Pipe with Cap ..r..e.■..aa.aa..a..er����■■.a...r ...................... Plumber/Designer Signature: License#: /IV 2 Z x Date: �� ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM a OwneuBuyer f "t` `Y = t r -`> l.-.L. Mailing Address ec, Pra .Address � t � i�1 i�-fi�_ ilt:u (Verification required from Planning!se-Zoning Dcpartmenr or net onctruction_) City/State - ltk D.t.c;.,A. t Parcel Identification Number LEGAL DESCRIPTION .Property Location`-Aw r/a, 'fa, Sec. '5� T 71 N R I'( 'W,Town of Subdivision— # � �� .�t�i�-� � 1,. �a ..,_cam ,Lai# � Certified Survey Map # -� , Volume Page# Warranty ed > - �' �. .�r`� , 'Volttme � , Page# Spec house` yes' 1410 Lot lines identiftabfe yesy 1310 SYSTEM MAINTENANCE AND OWNER CERTIFICATION lu►proper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists ofpuniping out the septic tank every three years or sooner,ifneeded,by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in§Comm.$3.52(1)and in Chapter 12-5t,Croix.County Sanitary ordinance. The property owner agrees to submit to St.Croix County Panning&Zoning Department a certification form,signed by the owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site wastewater disposal system is in proper operating coza"on and/or(2)after inspection and pumping(if necessary),the septic tank is less than 113 full of sludge. Uwe,the undersigned have=ad the above requirements and agree to maiutnin the private-sewage disposal system with the standards set forth,herein,as set by the Department of C ntnerce and the Department of Natural Resources.State of Wisconsin. Cordfzcation stating that your septic system has been maintained must be completed and returned to the St.Croix County Planning& Zoning Department within 30 days of the three year expiration elate. Uwe certify that all statements on this form are tine to the best of my/our knowledge. L;,%--e a fare flue owner(s)of the property described above,by virtue of a my deed recorded in Register of Deeds Office. Number edrrao ICC TURF OF AI?PL ANTS) �DATE ***Arty information that is misrepresented may result in the sanitary permit being revoked by the Planniug&Zoning Dcpartrnent **" Include with this application a recorded warranty,deed from the Register of Deeds Office and a copy of the certified survey rnap if reference is made in the warranty deed_ (REV.08105) 1 2 0 6 5 917 -7Q�e)_'--5.e+-7 STATE BAR OF WISCONSIN FORM 2-29,99 RE13ISTER OF DEMIS rd4 cot Number WARRANTY DEEIJ ST. CROIX Co.' W, RECEIVED F08 RECORD eed,made betwftn Donald J.Nes"d and qtr 12/t32�2002 15:2 @A?1 sband and wife Elm� d Brosby M0' REC l:El»j 1I.t3Q 'TEAKS F'EE: 114@.ae-_ __ C£RT' COPY FEE: PAGES: i antor,for a valuable consideration,conveys to Grantee the cribed real estate in St.Croix ae o Wsconsin{if more space is a Comply, ceded,please attach addendtnau): NE 1/4 of Kw 1/4 of Section 5, Township 29 North] RecardlogAma Range 19 West, St. Croix County, Wisconsin EXCEPT Lot I. of Certified .Survey Map filed January 8, 2602 Name andltdurnAddrsss in Vol.. 15, -Page 4233, Doc. No. 667583 and EXCEPT the North 83 feet thereof, HW 114 of NE 1/4 of Section 5, Township 29 North,? i �/ z�ld-e:002>, Range 19 West, St. Croix County, Wisconsin EXCEPT Certified Survey Map in Vol. 9, Page 2676.1 03G-1018.50-000 Parcel Identification Number(FIN) This ,:r fJa homcgc d piopet,_ e Exceptions to warraatdes: Easements,restrictions and ri (i') ('s not) �ts-of way of record,if any. t Dated this day of November . 2002 • D"td J.Nestrod istz-ud AUTHENTICATION ACKNOWLEDGMENT i Signatute(s) STATE OF-WISCONSIN y A. Aa� Counly ) authcnticetttd this day of i Personally eatno before rac this—2A—day of '�to�!tenber 2002 the above named • and J.'Nestrud and Virginia&L NCStrmR ,husbaad xnd wife TITLE:MEMBER STATE BAR OF WISCONSIl (I£not, -, t..,;,r'• mee be person(s)who executed the foregoing authorized by 6 706.06,wis.Stets.) ins t d ttCwiedged the same. THIS£.ITRUMENT WAS DRAFTED BY Attorney Krintima 091srcd at soa, 15401 Notary P State of Wisconsin 2� I 'qrL is p'n ant.(If no4 state fte9Jd . (Sigaasures stay be authenticated or actmowltdgtd.I3otfi are not necessary,) ) Ntuncs oI pCtSOns sigtiazg in any capacity must be typed or printed below their ' 1 k annmion PM%'WN'dq c Wa„v.Fac au Lao,yra WARRANTY DEED STATE MBAR OF FOttM No.2-1999 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of -2, FILE INFORMATION SYSTEM SPECIFICATIONS Owner BRUSHY MOUND PARTNERS LLP Septic Tank Capacity gal ❑ W Permit # - Septic Tank Manufacturer WFISER O Nic DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA POLYLQK Number of Bedrooms 4 0 NA Effluent Filter Model ❑ N A Number of Public Facility Units ❑ NA Pump Tank Capacity gal M N A Estimated flow (average) 450 gal/day Pump Tank Manufacturer ® NA Design flow (peak), (Estimated x 1.5) 600 qal/da Pump Manufacturer ® NA Soil Application Rate .7 al/day/ft2 Pump Model IA N Standard Influent/Effluent Quality Monthly average* Pretreatment Unit 12 N,� Fats, Oil & Grease (FOG) X30 mg/L a Sand/Gravel Filter ❑ Peat f=ilter Biochemical Oxygen Demand (BODs) ,220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other. Pretreated Effluent Quality Monthly average Dispersal Coll(s) ❑ N,>t Biochemical Oxygen Demand (BOOS) �0 mg/l, XI in-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS? <30 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 ofu/100mi Q Drip-Line ❑ Other: Maximum Effluent Particle Size Ye in dia. ❑ NA Other: 0 NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent, Other: ❑ Ni� MAINTENANCE SCHEDULE Service Event Service Frequency inspect condition of tank(s) At least once every: ❑month(,) (Maximum 3 years) ❑ NA 3 nyear(s) Pump out contents of tanks). When combined sludge and soum equals one-third (Yal of tank volume ❑ N/ti Inspect dispersal cell(s) At least once every: ❑month(si (Maximum 3 years) ❑ NA 3 0 years) Clean effluent filter At least once every: 1 ! ❑ month(s) 13 NEB fJ year(s) Inspect pump, pump controls& alarm At least once every. ❑ month(s) N< 0 year(s) Flush laterals and pressure test At least once every: ❑month(s) U Ni, ❑ year(sl Other: At least once every: ❑ month(s) 4NF, Other: ❑year(s) E3 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 tanks)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 surfao8. The dispersal cells) shall 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 (YI 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 11:3, 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 S12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. - -- ----- ---- _� ...,.. -�...... U1 �.An �.V - I'll\V WJ V 2 START UP AND OPERATION Page y of — For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemic that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the conter Of the tank(s) 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 discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restori! Power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls 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 ari - within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or.elimination of the foilowing from the wastewater stream may improve the performance and prolong the life of tt POWTS: antibiotics; baby wipes; cigarette butts; condoms, cotton swabs; degreasers, dental floss; diapers; disinfectants; f.i foundation drain (sump pump) water; fruit.and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; ai 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 1 properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: 0 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 tha void space filled witt 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 oompliard replacement system: I A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorpton system. The replacement area should be protected from disturbance and compaction and should not be infringed upon I)y required setbacks front existing and proposed structure, lot lines and wells. f=ailure to protect the replacement area K III 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 avallable due to setback and/or soil limitations._ Barring advances in POWTS AA// technology a holding tank may be installed as a last resort to replace the failed POWTS. alua ' CoN5TKi1� n]g5; k rQ4 $ e- ❑ Mound and at-grade son absorption systems may be reconstructed in place following removal of the blomat at the infiltrative 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 NC T 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 DIFIRCULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS UYSTALi.ER POWTS MAINTAINER Name COUNTRYSIDE PLUMBING & HEATING, INC Name PAUL KOEHLER Phone 715-246-2660 Phone : 715-246-2660 SEPTAGE SERVICING OPERATOR(PUMPER) LOCAL REGULATORY AUTHORITY Name POWERS LIQUID WASTE MANAGEMENT Name �-i', Gf p( 2bdw Phone 715-246-5738 Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(tl(d)&(f) and 83.54(11. (21 & (3), wisconsin Administrative Code. s j I FV=W 100NIOX INSTALLATION INSTRUCTIONS .�aewa-rZ X111 zap!} PL-525/PL-625 FILTER &Wascewa':r P.=oFf.:ts AOi:+sicn o!IIei�Ack lac. PL-525/PL-625 FEATURES & BENEFITS Features & Benefits: • Rated. for 10,000 GPD .PL-525 = 525 Linear Feet of 1/18" Filtration PL-625 = 625 Linear Feet of 1/32" Filtration PL-525- PL-625 •Accepts 4"and 6" SCHD. 40 pipe The PL-525/625 Effluent Filter should operate efficiently • Built in Gas Deflector for several years under normal conditions before *Automatic Shut-Off Ball when Filter is Removed requiring cleaning. It is recommended that the filter be cleaned every,time the tank is pumped or at least every *Alarm Accessibility three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the *Accepts PVC Extension Handle filter needs servicing. Servicing should. be done by a certified septic tank pumper or installer. RECOMMENDED PRODUCTS Polyl©k PVC Filter Extension Handle ir A J c { e5 Risers,&Riser Covers Extend& Lok- Riser Safety Screens Fitter Alarm Panel and Polylok risers bring your Polylok Extend &LokTrA' Polylok safety screen SrnartFilterT"'Control: septic tank cover to grade. is a simple, easy to use prevent tragic accidents Switch This allows locating and solution that can extend from happening by children: Polylok filter alarm panels servicing your filter easier the inlet or outlet pipe and and pets falling into open and switehs provid a visual and time saving by elimi- make filter and/or baffle septic tank entrances. and audible notification of nating digging to find tank installation a snap. impending filter and tank entrance. Fits X and 4".pipe. servicing. For a full fist of Polylok products please visit our web site at: www.polylok.com CD o 4 O Nd6 C�J m �o'� ,.ODE , • ;° �I�, AO W 5 9A yw/� . I I 3A.A0 6A n � Cl. � 09 9y � � �' � 2 WI I •, a o � �Ep �=I01 wl `� •� ,� �o �—IUI � � � www o w v o j Q ¢� _ QQ-Q < Q ° o ° 0 o o o o • ' ' •S103922 E 105.77' o Ui L W ¢ 1 � _ off, `o C C) LL_ t,_ LL. LL. LL Cq CY North—South 1/4 Line WZ ` N cn cn V) (n i • `* � Z 0) t• 00N � d- rsc v (0 n CO CO CO 4 66' In 14 to W O v • n N 1 o� ^o• f� d. _ D O o O p p C _` l 2 w� z � : loo .7 � a°O� in V_ 1�1 % �+�• LJ ! • 395. �l d I �f4j J o�° A of oI`-1 0 W 0- UJ QAj� � >I � Ui � L4 w I f Qp0 U� (I W Z QWCL' f� O i mW � F= 00 0 t Wisconsin Department of Comme '� �/ SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and �a WE tl In accordance with Comm 85,Wis.Adm.Code �••�.•• 4�y AA County Attach complete site !�� rYtOt less than 8%2 x 11 inches in size PI�s St. Croix Include but not lito"ver[ical and horizontal reference point(Blire✓itfion;l ]I Parcel I.D. 030213707000 In Percent slope,scale or dine &mubb-Flt4t 1lafrrm and BM referenced to rest roa . SS � IEW# W&'t all information %Review Date Z / Personal informatiorpb�'��i+i�may be used for secondary purposes(Privacy Law,s.15.04(1)(m)) ` y, �u�Yl/1•. Property Owner Property Location Derrick Construction Govt.Lot NW NE �i. s 5 T 29 N R 19 w Property Owner's Mailing Address Lot# B ISubd.NarneorCSM# 1505 Hwy. 65 7 Bluebird Bluffs City State Zip Code Phone ❑City ❑Village 0 Town Nearest Road New Richmond WI 54017 715-246-2320 1 St. Joseph Bluebird Dr.N 0 New Construction Use: 0 Residential/Number of Bedrooms 4 Code derived design flow rate 600 GPD 0 Replacement 0 Public or Commercial—Describe: Parent Material Glacial outwash&till Flood Plain elevation if applicable N/A ft. General comments and recommendations:Recommended infiltration surface at 92.4',just below the massive loamy sand observed in boring#2. 1 Boring Bormg g 0 Pit Ground Surface Elevation 100.8 ft. Depth to Limiting factor >142 in. Soil ADDfication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/8Z in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. "Eff#1 "Eff#2 1 0-5 10YR3/2 - SL 1-m-bk mfr cs if 0.4 0.7 2 5-20 7.5YR4/3 - SL 1-m-bk mvfr gs - 0.4 0.7 3 20-40 7.5YR4/3 - L 0-m mfi cs - 0.2 0.5 4 40-142+ 10YR4/4 - S 0-sg ml - - 0.7 1.6 t 2 Boring# 13 Boring OPit Ground Surface Elevation 97.6 ft. Depth to Limiting factor >100 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. "Eff#1 'Eff#2 1 0-18 10YR3/2 - SIL 0-m mvfi gs 1f 0.0 0.2 2 18-36 7.5YR4/4 - SL 2-m-bk mfr gs 1f 0.6 1.0 3 36-62 7.5YR4/4 - LS 0-m mfi cs - 0.7 1.6 4 62-98+ 10YR4/4 - S 0-sg ml - - 0.7 1 1.6 1 1 F-1 I •Effluent#1=BOD5>30:s 220 mg/L and TSS>30:5 150 mg/L 'Effluent#2=BOD5 S 30 mg/L and TSS<_30 mg/L CST Name(Please Print) Si ature CST Number Mark Iverson 46672 Address Date Evaluation Conducted Telephone Number P.O. Box 155 Hammond, WI 54015 May 25,2014 715-796-5664 Property Owner Derrick Construction Parcel ID# 030213707000 Page_2_of 3 F31 Boring 13 Boring g ®Pit Ground Surface Elevation 97.1 ft. Depth to Limiting factor >105 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QPQ in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-12 10YR4/3 - SL 1-m-bk mfr gs 1f 0.4 0.7 2 12-105 10YR4/4 - S 0-sg ml - - 0.7 1.6 6 t Boring# 13 Boring OPit Ground Surface Elevation ft. Depth to Limiting factor in. Soil ADDlication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDA2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 Boring Boring# f�fPit Ground Surface Elevation ft. Depth to Limiting factor in. Soil ADDlication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu.Sz.Cont.Color r.Sz.Sh. 'Eff#1 *Eff#2 *Effluent#1=BOD5>30:5 220 mg/L and TSS>30:S 150 mg/L *Effluent#2=BOD55 30 mg/L and TSS 5 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or Need material in an alternate format,please contact the department at 608-266-3151 or TTY 608-264-8777. Page 3 of 3 0��._■�ff N House 1 goy of 6001 jam om �. m o' 103.1 • 7 B 1 B-2 0 100.8 97.6 0 N Contours were not placed • because the slope is irregular 98.9• 97.7 • 99.2 96.3 0 0 B-3 97.1 23 • =Ground Surface Elevation BM#&Description = Bench Mark Elevation 4B-1 = Boring Location &Elevation Owner: Derrick Construction Site Information: Completed By: Mark Iverson, PSS#197 1505 Hwy.65 NW1/4, NE1/4, S5, T29N, R19W 680 Larcom Street New Richmond,WI 54017 Town of St. Joseph Hammond, WI 54015 St. Croix County 715-796-5664 Phone: 715-246-2320 CST#46672 commerce.wi.gov Safety and Buildings Division County : 201 W. Washington Ave.,P.O.Box 7162 ST. CROIX t sconsin Madison,WI 53707-7162 Sanitary Permit Number(to be filled in by Co.) Dent of Commerce 5/ cl J C ! Sanitary Permit Application State Transaction L` / nNu�mbCerr In accordance with s.Comm.83.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental Z3 5 / s unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address(if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary ^�JC �, n urposes in accordance with the Privacy Law,s. 15.04 1(m),Stats. _LT/ 1. Application Information-Please Print All Infor n /v�j Gtr') Property Owner's Name Parcel# BRUSHY MOUND PARTNERS LLC �J ��, 030-2137-07-000 Property Owner's Mailing Address perry Location P.O. BOX 445 FF40 7 b / Govt.Lot City,State Zip Code � NE �, NW �/., Section 5 NEW RICHMOND, WI 54017 N/A N/�,01- FO (circleone4 T 29 N; R 19 Eor II.Type of Building(check all that apply) D� Lot# �O I or 2 Family Dwelling-Number ofBedroo N/A Subdivision Name Block# BLUEBIRD BLUFFS ❑Public/Commercial—Describe N/A City of /� A ❑State Owned-Describe _ �� /'A CSM Number Village of I N/A Town of ST. JOSEPH 9 X 1 /`T t'/ f 0 C1dv3 J S III.Type of Permit: (Check only one box on line A. Complete li B if applicable) A, jj New System y ❑ Replacement System ❑Treatmen Idi Tank Replacement Afly El Other Modification to Existing System(explain)IL B. El Permit Renewal El Permit Revision ❑Change of Plu XN Pe �t fer to New List Previous Permit Number and Date Issued Before Expiration wnelp IV.Type of POWTS S stem/Corn onent/Device: Ch a t J r El Non-Pressurized In-Ground El Pressurized In-Group ®At-Grade o >24 in.of suitable soil El Mound<24 in.of suitable soil ❑ Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dispersal/Treat eat Area Information: Design Flow(gpd) Design Soil Application Rate( sf) Dispersal Area Required(sf) Dispersal Area Proposed( System Elevation 450 .4 1,125 1,125 100.65 VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units ° o $ o New Tanks Existing Tanks , �C7 0 /(/ o a. U yr H v7 cL a Septic or Holding Tank 0 1 000 1 WEISEi X Dosing Chamber 500 0 500 1 WEISER X VII.Responsibility Statement-I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber's Si ATure MP/MPRS Numbe7715-246-2660 usiness Phone Number TIM DE YOUNG �i 664713 Plumber's Address(Sheet,City,State,Zip Code) 321 WISCONSIN DRIVE, NEW RICHMOND, WI 54017 VIII. ount /De artment Use Only Approved asap Permit Feee Date issued J lssuin gent Signatur caner rven Reason for 1 $ IX.Condifterf&ftylNEOReasons for Disapproval 3' nit t n /p r Jt• n� oyr.GOc✓ 1 Septic tank,effluent filter and dispersal cell must all be services/ aintained as per management plan provided by plumber. 2. All sefl Sck req*"nts Must.b& aiintainid 1' Attach to complete plans for the system and submit to the Coung,`�Li only on�paper not less than 8 Vi x 11 i es in size I'A. w. SBD-6398(R.02/09)Valid thru 02/11 J CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: DERRICK LOT 7 BLUE BIRD BLUFFS Owner's Name: BRUSHY MOUND PARTNERS Owner's Address: PO BOX 445 NEW RICHMONN, WI 54017 Legal Description: NE 1/4 NW 1/4 S 5 T 29 R 19 W Township: ST JOSEPH County: ST. CROIX Subdivision Name: BLUEBIRD BLUFFS Lot Number: 7 Parcel ID Number: 030-2137-07-000 Pagel Index and title Page 2 Plot Plan Page 3 _ System Sizing &Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test&House Plans Designer/Plumber: PAUL KOEHLER License Number: 22541 Date: 07102114 Phone Number 71 5-246-8660 Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P(N.01101). Page 1 /JtnG� mcrrlC JO -°' d i i 1 vo' eAYA I I � � I eerc.L rtJec1� C_J1GSIr e lJvo� /I doe PuC I r I � 1 '7L I 1 S -- I 0 O I`i'1VE. M t I � f i to n 19 5. ST����IKcz�u�..cT`�e; Wls�ontsrr�t SOIL ABSORPTION SYSTEM DETAIL/GRAVELLESS LEACHING UNIT Page_ot_ Project Name: i No. of Cells 5 y Per Cell 3 ft Cell Width _Total No of ,5011,1C) ft Cell Length a sq ft EISA Per Cell _7 ft Cell Spacing Qa sq ft Total EISA Manufacturer Model Laying Length EISA Rating Infiltrator EZ1203H-5ft 5.0' 25.0 EZ1203H-10ft 10.0' 50.0 Gravelless Leaching Unit Manufacturer: 1'A Gravelless Leaching Unit Model: , Typical Cross Section Finished Grade ft Observation Pipe with approved cap or vent e■ SA in =: Soil Backfill in . Geotextile Fabric ft Infiltrative Surface 12 in I(XIO it It Limiting Factor .....7 �� 3b�rin Slotted and Anchored Vent/ Observation Pipe with Cap ......................................................................... Plumber/Designer Signature: License#: //V 2 a x//fI Date: POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of d FILE INFORMATION SYSTEM SPECIFICATIONS Owner BRUSHY MOUND PARTNERS LLP Septic Tank Capacity 1 000 qal 1E1 Permit # - Septic Tank Manufacturer JdEISER 0 N4 DESIGN PARAMETERS Effluent Filter Manufacturer POLYLOK 0 Nh [Number of Bedrooms 3 Q NA Effluent Filter Model ❑ N A Number of Public Facility Units ❑ NA Pump Tank Capacity gal S) NA Estimated flow(average) 300 gal/day Pump Tank Manufacturer M N. Design flow (peak),(Estimated x 1,61 450 gal/day Pump Manufacturer ❑ N.4 Soil Application Rate .7 al/day/ftt Pump Model 0 NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit EA N,a Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD,) $220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 6150 mg/L ❑ Disinfection ❑ Other. _ Pretreated Effluent Quality Monthly average Dispersal Cells) d NA Biochemical Oxygen Demand (SODS) 530 mg/L J3 In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 510'ofu/t00ml la Drip-Line ❑ Other: _ Maximum Effluent Particle Size Ye in dia. ❑ NA Other: ❑ NA I Other: ❑ NA Other: ❑ Nei *Values typical for domestic wastewater and septic tank effluent, Other: ❑ NA I MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: Q month(s) (Maximmm 3 yearn) -❑ Nor 3 imyear(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Ya)of tank volume ❑ Nit Inspect dispersal cells) At least once every: 3 ®mo rm(s) (Maximum 3 years) 11 Nit ' Clean effluent fitter At least once every: l ❑ month(s) El NA 90 year(s) Inspect pump, pump controls& alarm At least once every: ❑month(s) )awl ❑ year(s) Flush laterals and pressure test At least once every: ❑month(s) XX NA, ❑ year($) Other: At least once every: ❑ month(s) NFL ❑year(s) Other: ❑ N<, 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, PUWTS 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 surfacs. The dispersal cell(s) shall 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 tf ie immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) 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 11:3, 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 shall be provided to the local regulatory authority within 10 days of completion of any service event. - - -- - - -� . _ ,.. ... .,a a tit► vv �,viviivu Wi u START UP A Page 7i of 2 T AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other ehemic that may impede the treatment process and/or damage the dispersal ceil(s). If high concentrations are detected have the conter of the tank(s) 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 hi ghwater levels. When power is re stored the excess wastewater will discharged to the dispersal cells) in one large dose, overloading the cell(s) and may result in the backup or surface discharge effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restori! Power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not delve or park over, or otherwise disturb or compact, the art - within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or-elimination of the following from the wastewater stream may improve the performance and prolong the life of th POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fa foundation drain (sump pump) water, fruit,and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; ai 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 I 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 Servioing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled wilt 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 compiiaM replacement system: C� A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorptkn 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 Imes and wells. Failure to protect the replacement area %III result in the need for a new soli 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 satback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. Iv in9 ►k -slue ' o ik � ear - �a(-�I13 TTY iFO�!�/ CaNST72(IG�'l ❑ Mound and at-grade soil absorption systems may be reconstructed In place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules In effect at that tine. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NC T 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. ADDIT1oNAL commENTs POWTS INSTALL„ER POWTS MAINTAINER Name COUNTRYSIDE PLUMBING & HEATING, INC Name PAUL KOEHLER Phone 715-246-2660 Phone 715-246-2660 SEPTAGE SERVICING OPERATOR(PUMPERI LOCAL REGULATORY AUTHORITY Name POWERS LIQUID WASTE MANAGEMENT Name s-i-' C1 C b( 20APAJ Phone 715-246-5738 Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(fl and 83.54(11. (21 & (3), Wisconsin Administrative Code. rf .� INSTALLATION INSTRUCTIONS Ina _ }r t e A PL-525/PL-625 FILTER $GY+s>ewa!?r Plod+Jr:`t A bivisiDn of PMylak tnt. PL-525/PL-625 FEATURES 8& BENEFITS Features & Benefits: s Rated for 10,000 GPD. .PL-525 = 525 Linear Feet of 1/18" Filtration PL-625 = 625 Linear Feet of 1/32" Filtration PL-525 PL-625 •Accepts 4"and 6" SCHD. 40 pipe The PL-525/625 Effluent Filter should operate efficiently • Built in Gas Deflector for several years under normal conditions before #Automatic Shut-Off Ball when Fitter is Removed requiring cleaning. It is recommended that the filter be cleaned every,time the tank is pumped or at least every *Alarm Accessibility three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the *Accepts PVC Extension. Handle filter needs servicing. Servicing should. be done by a certified septic tank pumper or installer. RECOMMENDED PRODUCTS Polylok PVC .Filter Extension Handle i� I I IIII s A I i i 1 I 1,, i Risers&Riser Covers Extend & Lok- Riser Safety Screens Fitter Alarm Panel and Polylok risers bring:your Polylok Extend&LokTm Polylok safety screens SmartFilterT*Control septic tank cover to grade. is a simple, easy to use prevent tragic accidents Switch This allows locating and solution that can extend from happening by children Polylok fiEter alarm panels servicing your filter easier the inlet or outlet pipe and and pets failing into open and switch#provid a visual and time saving by elirni- make filter and/or baffle septic tank entrances. and audible notification of nating digging to find tank installation a snap impending filteP and tank entrance. Fits 3"and 4"pipe. servicing. I For a full fist of Polylok products please visit our web site at: www.pofylok-com I D Z A N D m 61" 86" D Z C y 42" O Z r m m N —� rn 0 o UP 41"--rk r7 4" CAS m D x En c) m 3" 36" 4" 1 v < In r UP 38" -n� D �. 0 riO 4" CAS \r`'X / N V I M m 0 � C_ �;u 0 -V ? � O O � D C z7 D z ° 39" 0<0 n Z N -mj r D rD mDr I D O m D < m Imo m M xM x D Z O m 0 �0 --1 r S r v N z r 1* z z D 0 c r*1 m m —1 �1 O 'C M D v_ v_ - --1 -1 z D M �m my or-N 0 nCc) D pNZ 0 Z Cr-OZ MZO Ofd z Om x z v �r- -4 v �n° Nnv =vp5p x2� �Fz v w-.4 my c0im � _ in r-�z � zzp mNO '{ �.. -!Z �Or� KN* r 4Z �N �C � A z p=* NzO ojC -°'��00'-' r]vm:=v► r n zZ O� Dp -um y' ND � �o� >m� p-0: ,,-,OD D N N O a v v a Z oao �D 5* m (?'v v�im°0 I m r(A-IIR00 zp � � °< OA "' u0 c U N ..r. Gz7 N C OD N v'7 D r m�;�; p p O v C) m O M m z O 0 0 \ O z Z Q 6) (m*I-q rrn (n I AA c N 0 ;0;u-0 Vi a n I O '0 -4 �m D D m0 v M y w m 3 m Z C� C N O v r- Of=> D O c n i-. m v m Z D �M Z C O \ D Z r0 WAD 1*1 (l� Z qk v OJ a O n -0( Dv O N D > =tool O7a AO� v O O � r Z O r -4 m :°0 �p m ( O A p O w 1 O ° O 0 = z � n o m m m (n D M M p -( O m r m r --I 0 z c r� H z p > v O Z m M m z r m \ N KP1000—MR m DRAWN BY. SME SCALE: i 4"=1'-0" PRE-POUR: MIEGER conCAETE REV. -4 SEPTIC MANUAL DATE: JANUARY 2010 DATE:. POST-POUR: \ Z W3716 US HWY 10 MAIDEN ROCK' WI 54750 � P REVISED JAN. 2010 800-325-8456 FILE: XMWD-M 1• �(' 'S'L 4c'�°!� •',nom' / i `, µ ti O J •�!. lip 9 N�/L , M > I . • ' 2 y i � � ^ h � F6A! 10 09.9 ' Q114 IC)I LL- ' `'+ WWWWWWW �- � v va°i 0! U � vc or— Jl ¢ ¢ ¢ ¢ ¢ ¢ a 105.77' a a • � � _ q) J g M '., rh• O L� [�. L� to I IN N Or d Or a Or C1 Cl s I North—South 1/4 Line �' ��Z ° �' Ln rn V) N cn cn cn � i • • `` v � Z rn : p N c (0 Pl co � Do 00 c 4z 0 C; 66' 'o �--- , "" .0 W L6 (O !� t i( N ` N O) v. O 0-1 I� 0 2 z y : r Q loo rn V_ %0V I I Qo. 395 >.22'- ' ' �.� - d I I Q 01 r- rQ� � ° � of °j—j Q ¢ w 101 � UJ Of wI Q ao �1 V) � LU 0 o ;° w Wisconsin Department ofComme `r SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and gi� sl p In accordance with Comm 85,Wis.Adm.Code � t �A County Attach complete site la�nr�p*YL less than 8%2 x 11 inches in size PI s St. CiOix Include but not Ii r 2o''vertical and horizontal reference point(B ! Parcel I.D. 030213707000 Percent slope,scale or dOrtter eouWd,it arrg�,and BM referenced t�pedrest roa . g�. of i�QTA9l information Re.i f Da� Z / Personal informationpi�' wg may be used for secondary purposes(Privacy Law,s.15.04(1)(m)) Property Owner Property Location Derrick Construction Govt.Lot NW v. NE % s 5 T 29 N R 19 W Property Owner's Mailing Address Lot# I Block# Subd.Name or CSM# 1505 Hwy. 65 7 Bluebird Bluffs City State Zip Code Phone ❑City ❑Village 0 Town Nearest Road New Richmond WI 54017 715-246-2320 1 St.Jose h Bluebird Dr.N H New Construction Use: 0 Residential/Number of Bedrooms_Code derived design flow rate 600 GPD ❑Replacement ❑Public or Commercial—Describe: Parent Material Glacial outwash&till Flood Plain elevation if applicable N/A ft. General comments and recommendations:Recommended infiltration surface at 92.4',just below the massive loamy sand observed in boring#2. LTIBoring# Bormg 0 Pit Ground Surface Elevation 100.8 ft. Depth to Limiting factor >142 in. Soil ADDlication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. 'Eff#1 *Eff#2 1 0-5 10YR3/2 - SL 1-m-bk mfr Cs If 0.4 0.7 2 5-20 7.5YR4/3 - SL 1-m-bk mvfr gs - 0.4 0.7 3 20-40 7.5YR4/3 - L 0-m mfi Cs - 0.2 0.5 4 40-142+ 10YR4/4 - S 0-sg ml - - 0.7 1.6 i-2 11 Boring a Boring# 13 Boring Ground Surface Elevation 97.6 ft. Depth to Limiting factor >100 in. Soil ADDlication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 1 0-18 10YR312 SIL 0-M mvf gs if 0.0 0.2 2 18-36 7.5YR4/4 - SL 2-m-bk mfr gs if 0.6 1.0 3 36-62 7.5YR4/4 - LS 0-m mfi Cs - 0.7 1.6 4 62-98+ 10YR4/4 - S 0-sg ml - - 0.7 1.6 *Effluent#I=BOD5>30<_220 mg/L and TSS>30:5 150 mg/L *Effluent#2=BOD5 <30 mg/L and TSS S 30 mg/L CST Name(Please Print) Si mature CST Number Mark Iverson 46672 Address Date Evaluation Conducted Telephone Number P.O. Box 155 Hammond, WI 54015 May 25,2014 715-796-5664 Property Owner Derrick Construction Parcel fD# 030213707000 page-of 3 ❑Boring o Boring# ®pit Ground Surface Elevation 97.1 ft. Depth to Limiting factor >105 in. Soil ADDlication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QP D/ft in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-12 10YR4/3 - SL 1-m-bk mfr gs 1f 0.4 0.7 2 12-105 10YR4/4 - S 0-sg ml - - 0.7 1.6 i 13 Boring 4 Boring# OR Ground Surface Elevation ft. Depth to Limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f? in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 I *Eff#2 Boring Boring# ®Pit Ground Surface Elevation ft. Depth to Limiting factor in. Soil AoDlication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu.Sz.Cont.Color r.Sz.Sh. *0#1 *Eff#2 •Effluent#1=BOD5>30:5 220 mg/L and TSS>30:S 150 mg/L 'Effluent#2=BOD5<_30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or Need material in an alternate format,please contact the department at 608-266-3151 or TTY 608-264-8777. Page 3 of 3 0 ft. 24 ft. 40 ft. 80 ft. N House ofdoo�jaR` o nom x. (�D O 103.1 O • O B-2 0 B-1 100.8 97.6 Contours were not placed because the slope is irregular 98.9• 97.7 `D 99.2 96.3 • • B-3 97.1 9?3 I li • =Ground Surface Elevation I BM#&Description g 1 Elevation = Bench Mark B = Boring Location &Elevation Owner: Derrick Construction Site Information: Completed By: Mark Iverson, PSS#197 1505 Hwy.65 NW1/4, NE1/4, S5, T29N, R19W 680 Larcom Street New Richmond, WI 54017 Town of St. Joseph Hammond, WI 54015 St. Croix County 715-796-5664 Phone: 715-246-2320 CST#46672 commerce.wi.gov, Safety and Buildings Division County 201 W . Washington Ave.,P.O.Box 7162 ST. CROIX i sco n s i n Madison,WI 53707-7162 Sanitary Permit Number(to be filled in by Co.) Department of Commerce 56, 5 Sanitary Permit Application State Transaction NLu,[mbeerr In accordance with s.Comm.83.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental Z3 5 / l / s unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address(if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary �' n purposes in accordance with the Privacy Law,s. 15.04 1 C m,Stats. /v,( CJt(J I. Application Information-Please Print All Infor n Property Owner's Name �j Parcel# �`J BRUSHY MOUND PARTNERS LLC `l , 030-2137-07-000 Property Owner's Mailing Address c perty Location P.O. BOX 445 F`B Z d 33 City, Govt.Lot � ty, Zip Code NE NW /., Section 5 NEW RICHMOND, WI 54017 N/A N/�O CO 29 19(circleonez T N; R E or W II.Type of Building(check all that apply) Dk- Lot# z0 1 or Family Dwelling-Number ofBedroo N/A N Subdivision Name stock# BLUEBIRD BLUFFS ❑Public/Commercial-Describe N/A City of A ❑State Owned-Describe � � � . PA CSM Number Village of i N/A Town of ST. JOSEPH D� �tttivt�5 III.Type of Permit: (Check only one box on line A. Complete IiV B if applicable) A' New S stem y ❑ Replacement System ❑Treatmen I di Tank Replacement ly I ❑Other Modification to Existing System(explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of PI er X11 PeGAIsfer to New List Previous Permit Number and Date Issued Before Expiration .wne ig IV.T e of POWTS System/Component/Device: (Ch applM J ❑ Non-Pressurized In-Ground ❑Pressurized In-Group ®At-Grade o U724 in.of suitable soil ❑ Mound<24 in.of suitable soil ❑ Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dis ersal/Treat ent Area Information: Design Flow(gpd) Design Soil Application Rate( sf) Dispersal Area Required(sf) Dispersal Area Proposed( System Elevation 50 4 .4 1,125 1,125 100.65 I VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units R o $ o New Tanks Existing Tanks AD /�� ✓Z5 a V q) h � LT.C7 a Septic or Holding Tank 0 1 000 1 WET SE X Dosing Chamber 500 0 500 1 1 WEISER X VII.Responsibility Statement-I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name Print ( ) Plumber's Si ure MP/MPRS Number Business Phone Number TIM DE YOUNG �� 664713 715-246-2660 Plumber's Address(Street,City,State,Zip Code) 321 WISCONSIN DRIVE, NEW RICHMOND, WI 54017 VIII. ount /De artment Use Only Approved tsap Permit Fee 06 Date Issu f J [ssuin gent Signatur caner rven Reason for I $ �Z Z �� IX.Condiowafty teasons for Disapproval 3' /)J, n 1 Septic tank,effluent filter and dispersal cell must all be services!maintained as per management plan provided by plumber. 2.,,40 seflAck faquirilments trust be maintainred n cone i orsrtialtoss. Attach to complete plans for the system and submit to the County only on paper not less than 8 112 x 11 i es in size SBD-6398(R.02/09)Valid thm 02/11 J gYrNB DIVISION OF INDUSTRY SERVICES 9 3824 N CREEKSIDE LA lip HOLMEN WI 54636 Contact Through Relay 3 www.dsps.wi.gov/sb/ www.wisconsin.gov Scott Walker,Governor A�p�SSIOLv S� Dave Ross,Secretary January 27,2014 CUST ID No. 664713 ATTN:POWTS Inspector TIMOTHY JAMES DEYOUNG ZONING OFFICE COUNTRYSIDE PLUMBING&HEATING ST CROIX COUNTY SPIA 321 WISCONSIN DRIVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 01/27/2016 SITE: Identification Numbers Brushy Mound Partnership,LLC Transaction ID No.2359495 Blue Bird Drive Site ID No. 799111 Town of Saint Joseph Please refer to both identification numbers, St Croix County above,in all correspondence with the a enc NEIA,NW1/4, S5,T29N,R19W Subdivision:Blue Bird Bluffs;lot 7 FOR: Description: Three Bedroom At-grade System/4%slope Object Type:POWTS Component Manual Regulated Object ID No.: 1467193 Maintenance required; 450 GPD Flow rate; 42 in Soil minimum depth to limiting factor from original grade System(s):At-grade Component Manual,Version 2.0, SBD-10854-P(N.03/07,R. 1/12),Pressure Distribution Component Manual-Ver.2.0, SBD-10706-P(N.01/01,R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s)referenced above. CONDI� The owner,as defined in chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all code requirements. APPR No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.00j, DEPT ROF N stats. DIVISION OF INDU The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders: • A sanitary permit must be obtained from the county where this project is located in accordance with th requirements of Sec. 145.135 and 145.19,Wis.Stats. SEE CORRE p • Inspection of the private sewage system installation is required.Arrangements for inspection shall be made with the designated county official in accordance with the provisions of See. 145.20(2)(d),Wis.Stats. • A state approved effluent filter is required.Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required.Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • All POWTS component piping material shall be SPS 384,Wis.Adm. Code compliant. • The area within 15' downslope of the dispersal component shall remain undisturbed.Vehicular traffic, excavation or soil compaction is prohibited in this area. • A cop, off the approved plans specifications and this letter shall be on-site during construction and oven to inspection by authorized representatives of the Department,which may include local inspectors. TIMOTHY JAMES DEYOUNG Page 2 1/27/2014 Owner Responsibilities: • The current owner,and each subsequent owner,shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard,the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services 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 and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, Fee Required$ 250.00 This Amount Will Be Invoiced. and M Swim When You Receive That Invoice, POWTS Plan Reviewer,Integrated Services Please Include a Copy With Your (608)789-7892,Mon-Fri, 7:15 am-4:00 pm Payment Submittal. jerry.swim @wisconsin.gov W SMART code:;7633 cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm Note: Effective January 1,2012,all codes under the jurisdiction of the Division of Industry Services(formerly Safety&Buildings)will be modified. Code references with prefixes starting with"Comm"have been replaced with "SPS"to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety&Professional Services.Additionally,all IS(formerly S&B)codes have been renumbered and addressed in a"300"series. For future reference,the Wisconsin Commercial Building Code will be addressed by,,SPS Chapters 360-366. TIMOTHY JAMES DEYOUNG Pap 2 1/27/2014 Owner Responsibilities: • The current owner,and each subsequent owner,shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard,the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services 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 and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Fee Required$ 250.00 Sincerely, f/ This Amount Will Be Invoiced. When You Receive That Invoice, and M Swim Please Include a Copy With Your POWTS Plan Reviewer,Integrated Services payment Submittal. (608)789-7892,Mon-Fri, 7:15 am-4:00 pm WiSMART code:7633 jerry.swiin@wisconsin.gov cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm Note: Effective January 1,2012,all codes under the jurisdiction of the Division of Industry Services(formerly Safety&Buildings)will be modified. Code references with prefixes starting with"Comm"have been replaced with "SPS"to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety&Professional Services.Additionally,all IS(formerly S&B)codes have been renumbered "and addressed in a"300"series. For future reference,the Wisconsin Commercial Building Code will be addressed by>SPS Chapters 360-366. r r , J',��f t )1?4 RESIDENTIAL AT-GRADE DESIGN �NDUS� Sc +tr�N` a Pressurized-Sloping Site INDEX AND TITLE SHEET Project DERRICK LOT 7 BLUE BIRD BLUFFS Owner BRUSHY MOUND PARTNERS LLC Address PO BOX 445 NEW RICHMOND WI 54017 Legal Description NE1/4,NW1/4,S5T29,R19W Township ST JOESPH County ST CROIX )V A<<Y D Subdivision Name BLUEBIRD BLUFFS Lot No. 7 FET YAND ERV c Parcel ID Number 030-2137-07-000 'TRYSERVS CES Plan Transaction Number Index sheet Page 1 NDENC ' Calculations Page 2 At-grade drawings Page 3 Laterals and dose tank Page 4 Specifications Page 5 Management&contingency plan Page 6 Pump curve&specifications Page 7 PLOT PLAN Page 8 FILTER SPEC Page 9 SEPTIC TANK Page 10 Designer TIM DEYOUjN>G/ License Number 664713 Signature Phone Number 715-246-2660 Date 01/16/14 Designed pursuant to: At-grade Component Manual Ver.2.0 for POWTS SBD-10854-P(N.03/07),and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS(01/81)and Pressure Distribution Component Manual Ver.2.0 SBD-10706-P(N.01/01) Version 7.0(03/12) Page 1 of 10 PRESSURIZED AT-GRADE DESIGN At-grade Design Worksheet-Sloping Site Flows and Site Data Entry. (r or c) r Residential or commercial? 300.0 Estimated wastewater flow(gpd) 450.0 Design wastewater flow(gpd) 4.00 % Site slope 100.65 Contour elev. below lateral (ft) 42.00 Depth to limiting factor(in) 0.40 In-situ soil application rate(gpd/ft^2) Distribution Cell Information (1 or 2) 1 Influent wastewater quality 4.50 Linear loading rate gpd/ft 9.00 Effective absorption width (ft) 10.00 Max. effective width permitted (ft) 125.00 Aggregate length (ft) Pressure Distribution Data Entry (c or e) c Center or end lateral connection 2 Number of laterals 0.125 Orifice diameter(in)e.g. 0.25 Not a final calculation 1.50 Estimated orifice spacing (ft) 2.00 Forcemain diameter(in) 3.53 Forcemain flow velocity(ft/sec) 60.00 Forcemain length(ft) y or n y Does forcemain drain back? 89.85 Pump ank elevation ft or n Are laterals at highest point? P O Y 6.5 System head (ft)x 1.3 NA 10.30 Vertical lift(ft) 9.8 Forcemain drainback(gal) 1.51 Friction loss (ft) 39.5 5x Lateral void volume(gal) 0.00 In-line Filter Loss(ft) 49.3 Minimum dose volume(gal) 18.31 Total dynamic head (ft) 34.6 System demand (gpm) Lateral Diameter Selection Gallons/inch Calculator(optional) Pipe diameter Design options Design choice 1000 Total Tank Capacity(gal) Designer 1 in 19.61 Total Working Liquid Depth (in) must select 1.25 in x X 51.0 Gal/in (enter result in cell G46) one lateral 1.5 in X diameter 2 in x Treatment Tank Information 3 in x 10001 Septic tank capacity(gal) WIESER IManufacturer Effluent Filter Information Dose Tank Information POLYLOCK Filter manufacturer 500.01 Dose tank capacity(gal) 525 Filter model number 9.81 Dose tank volume(gal/in) WIESER IManufacturer Project: DERRICK LOT 7 BLUE BIRD BLUFFS Transaction Number: Page 2 of -2 10 AT-GRADE PLAN VIEW �p 1/6 B Observation pipes(2 typical) A 9.00 ft D B 125.00 ft 1/6 B 20.83 ft C 11.00 ft W C D 5.00 ft E 2.00 ft I L 135.00 ft p I}— B W 21.00 ft A x BF 125.00 ft^2 L Cap Typical obs.pipe. =Total aggregate cell A x B Slotted in the lower 6 and = Plowed area L x W anchored securely. 6" AT-GRADE CROSS SECTION Svnthetic fabric cover 102.42 ft Finished grade elevation Lateral P invert elev. ft 101.15 Observation pipe at aggregate toe E •//, 4 %Slope Surface contour 100.65 ft C A and system elevation D /f = 12 in. topsoil and subsoil Plowed layer over aggregate and tapered to toes. below L x W = 6 in. aggregate below pipe(s), and 2 in. above pipe. Project: DERRICK LOT 7 BLUE BIRD BLUFFS Transaction Number: Page 3 of 10 �����U�� ��|�T�|�UT|��� �0[� F���� T��� . . . . .^-~^~'~^. .^- ^~..~ . . ~^~.~ . ..~. . ^ ~ .^~ ^~.~.~^- . . - - ' Lateral Diagram 'Center Connection Last hole drilled next to end cap W SPS TiWe,384,�0-6 Holes drilled on the bottom of the latoral, equally spaced 0 Turn-up Wball valve or clean outplug Lateral Specifications Orifice diameter(in) Center Lateral connection point X 1048 Orifice spacing(\) 2 Number laterals Orifices/lateral P 61.42 Lateral length (ft) 17.3 LeL discharge rote(gpm) 1.25 Lateral diameter(in) � 2.00 Foroemain diameter(in) Sys. discharge rate /gpm\ 6 ForcemainLenoUh (ft) TnH (t) ---------- Typical Pump Chamber Layout Approved manhole cover with Weather-proof warning label and locking device Final grade junction box --- I disconnect Tank component is Alternate properly vented El ,*-, outlet location 18" min. Electrical as per NEC 300 and Approved SPuv,v.3vuvw~u outlet Tank full joint Inches Gallons JA Provide 1/4" .2 A 32.0 313.5 Alarm on weep hole or U) antisiphon Pumpon device. Totalsi 500.01 Pump off —Bedding under tank I = 4 89.85 ft IGOULDS Pump manufacturer JSJE RHOMBUS Alarm manufacturer I EP05 Pump model number JSJE RHOMBUS Alarm model number Project: DERRICK LOT 7 BLUE BIRD BLUFFS Transaction Number: Page 4ofrO At-grade System Maintenance and Operation Specifications Service Provider's Name IPOWERS SEPTIC SERVICE Phone 17152465738 POWTS Regulator's Name IPAUL KOEHLER I Phone 7152462660 System Flow and Load Parameters Design Flow- Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow-Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 1125.0 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 m Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test monthly Pressure System Laterals should be flushed and pressure tested every 1.5 years Moundl Inspect for ponding and seepage once every 3 years Other Clean effluent filter once a year Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the at-grade component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis.Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis.Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The at-grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. 6. Areas within 15 feet of the downslope toe will be protected from compaction. 7. All other construction details are as per the at-grade component manual SBD-10854-P (N. 03/07). Lateral Turn-up Detail Finished ••............ Grade vl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution` ~ Long Sweep 90 or Two 10 1.15 ft 45 Degree Bends Same Diameter as Lateral Project: DERRICK LOT 7 BLUE BIRD BLUFFS Transaction Number: Page 5 of Tp At-grade System Management Plan Pursuant to SPS 383.54,Wis.Adm. Code General This system shall be operated in accordance with SPS 382-384 Wis.Adm.Code,and shall maintained in accordance with its'component manuals[SBD-10854-P(N.03/07),SSWMP Pub.9.6(01/81),and Pressure Distribution Component Manual Ver.2.0 SBD-10706(N.01/01)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33,Wis.Adm.Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers,access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound,defective,or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s.281.48,Stats. The contents of the septic tank shall be disposed of in accordance with NR 113,Wis.Adm.Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm,the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment,maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However,if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump(dosing)tank shall be inspected at least once every 3 years. All switches,alarms,and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. At-grade and Pressure Distribution System No trees or shrubs should be planted on the at-grade. Plantings may be made around the at-grade's perimeter,and the at-grade shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic(other than for vegetative maintenance)on the at-grade is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations(October-February)dictate that the at- grade be heavily mulched as protection from freezing. Influent quality into the at-grade system may not exceed 220 mg/L BOD5 150 mg/L TSS,and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS 30 mg/L TSS,10 mg/L FOG,and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral,and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner,and any levels above 4 inches considered as an impending hydraulic failure requiring additional,more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank,pump,pump controls,alarm or related wiring becomes defective the defective component(s)shall be immediately repaired or replaced with a component of the same or equal performance. If the at-grade component fails to accept wastewater or begins to discharge wastewater to the ground surface,it will be repaired or replaced in its'present location by increasing basal area if toe leakage occurs or by renovating the biologically clogged absorption and dispersal media,installing new piping,and replacing other components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: DERRICK LOT 7 BLUE BIRD BLITransaction Number: Page 6 of 10 Eq,GOULDS PUMPS Submersible Effluent Pump ti & EP04 EP05 -- Series APPLICATIONS •Fully submerged in high ■EP05 Impeller:Thermoplas- ■Bearings: Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing following uses: lubrication and efficient improved performance. construction. heat transfer. ■Casing and Base: Rugged • Effluent systems • Homes Available for automatic and thermoplastic design provides AGENCY LISTING• Farms manual operation.Auto superior strength g and corrosion Canadian Standards Association • Heavy duty sump matic models include resistance. S��File#LR38549 • Water transfer Mechanical Float Switch ■Motor Housing:Cast iron Goulds Pumps is ISO 9001 Registered. • Dewatering assembled and preset at the for efficient heat transfer, factory. strength,and durability. SPECIFICATIONS ■Motor Cover:Thermoplastic FEATURES cover with integral handle and •Solids handling capability: float switch attachment points. 3/4"maximum. ■EP04 Impeller:Thermoplas- m Power Cable:Severe duty •Capacities:up to 60 GPM. tic semi-open design with rated oil and water resistant. •Total heads:up to 31 feet. pump out vanes for mechanical •Discharge size: 11/2"NPT. seal protection. •Mechanical seal:carbon- rotary/ceramic-stationary, BUNA-N elastomers. •Temperature: 104°1`(40°C)continuous 140°F(60cC)intermittent. METERS FEET I I I •Fasteners:300 series ° - —`------- --- --- - - — -- — ---------1- ------- — + stainless steel 9 30 I .—s GPnn •Capable of running i i —_--! 1-- I — --t--------- d without damage to ' -- ---.- -- — dry 9 8 j I i j i ' i zs rr i I components. 25 o Motor: w I •EP04 Single phase:0.4 HP, U 6 z 115 or 230 V,60 Hz, 1550 a -- -—— --- - --7— �— -- ---- --— . —-- r --- RPM, built in overload with 5 j automatic reset. ° 4 15 •EP05 Single phase:0.5 HP, o ----1---- -— ------� - —---T—- — I —EP05 115 V or 230V,60 Hz, 1550 3 10 I RPM, built in overload with ff automatic reset. 2 I I j •Power cord: 10 foot s 4 standard length, 16/3 ----,--- - —--+------— --— S1TW with three prong grounding plug.Optional 20 ° 00 10 zo 30 40 50 GPM foot length, 16/3 SJTW with three prong grounding plug ' 0 z 4 6 8 10 12 (standard on EP05). m3/h CAPACITY PA(ve, 7 V F 10 Goulds Pumps ©2003 Goulds Pumps Effective July,2003 ITT Industries 83871 Ul/:&J/ZU14 THU 11: ZZ k,AX _ tgjvvci vvc 1" = 50' o IE Ai- A)Ore'D = BENCHMARK EL. 100.00 FT TOP OF 1/2" PVC PIPE = ALT. BENCHMARK EL. 99.95 FT TOP OF 1/2" PVC PIPE = BORINGS BORING ELEVATIONS B1 = 101.85 FT B2 = 101.85 FT B3 = 100.05 FT STATE TRANSACTION NUMBER - 235-94-95 oR AS NvreD 3 • _ a t "2. FhCw� 0 0: ` 1 W•8o stio� ,n.�;.� .. Q��L� �U� gs 1 �d t � 4 ,.�- E L ►av b5 6 b 5 er Note o'1 �--- � �•t'C.�- ! �{ pe- w' a o� ! Q 0.(tl t �� I -•� � � �F�(Qc�6L t Y t 1 FoR (o{Z£�Ct'2IZ7�S 1C.. t©c - - .372 ' '3 44p#1, tat Lim- OF 10 INSTALLATION INSTRUCTIONS sm r, a Z�el'j PL-!525/PL-625 FILTER &Wasrewafe.Pw�::s A aR 'o!o :��x PL-525/PL-625 FEATURES & BENEFITS Features & Benefits: s Rated for 10,000 GPD * PL-525 = 525 Linear Feet of 1/18" Filtration PL-625 = 625 Linear Feet of 1/32" Filtration PL-525 PL-625 *Accepts 4" and 6" SCHD. 40 pipe The PL-525/625 Effluent Filter should operate efficiently * Built in Gas Deflector for several years under normal conditions before *Automatic Shut-Off Ball when Filter is Removed requiring cleaning. It is recommended that the filter be Gleaned every time the tank is pumped or at least every *Alarm Accessibility three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the *Accepts PVC Extension Handle filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. RECOMMENDED PRODUCTS Polylok PVC Filter Extension Handle Risers&Riser Covers Extend & LokTM Riser Safety Screens Filter Alarm Panel and Polylok risers bring your Polylok Extend&LokT" Polylok safety screens SmartFilterT' Control septic tank cover to grade. . is a simple, easy to use prevent tragic accidents Switch This allows locating and solution that can extend: from happening by children. Polylok filter alarm panels servicing your filter easier the inlet or outlet pipe and and pets falling.into open and switchs provid a visual and time saving by el'imi- make filter and/or baffle septic tank entrances. and audible notification of nating digging to find tank installation a snap. impending filter and tank entrance. Fits 3"and 4" pipe_ servicing. For a full list of Polylok products please visit our web site at: www.polylok.com P'A&f 9 of I6 of.Aa Ql a9lbj D z A N D 691" AS 93" m REQD D c 57" m z 0 m N 0 ;u IT! p .i O UP 56" " N 1 0 4" CAS D�m �° 3^ 61", 5^ o x m� 0 51". I `° D N j UP 53" \ / N 4" CAS \ m c v� � O Z z y 54 "- + -1 p m N uci -; -1 0 c � � z D OX 3� O cn D zgz 0 0 ^ODD C-) p. pmommy00DN Z ;a ;a xx "0 rn Z prof 0 �np Nnp 2po ==;oO cn (nD NN -0 c D Z5 o �zc -jinc �Fcw' rnrnL, (n p mz �c� cJ m cn z ?m I ��m ,o� tn� O �w z [\/l p rn DZ OD D�'� NIDS Nr �o�0\ �N �� n v D n o n y m ..o in m m 1 m 0 ca cil.K - 0 a CD X v -Di u x ...-� z m < 6— m m� D N '' OO D °< z w vCi y 560 _0 O z Z m-arn Nm O'vv " cm cn �� m0 v C2 ° v D 3 z CAF \0 r O D \� =rZ r0 p (mj � 0 m ; H D �M a z A z z >4bv cop N Q ojo -n r O D C m `� r �m 0 Z r.fm/f m 0 v �n �D 0 rri m X 0 � O_ `� mr ;a D .. F c H z o z O m m Z � z r m \ .—a S W1000/500—MR DRAWN BY: SME SCALE: 1/4"=l'-O" PRE-POUR: m REV. SEPTIC MANUAL MIERERCOICIETE WI DATE: JANUARY 2010 DATE:. POST-POUR: W3716 US HWY 10 MAIDEN ROCK. 54750 \ ° REVISED JAN. 2010 800-325-8456 FlLE: WIOW/5oo-lrl ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGR.EEIVMNT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer i ,rt Nk. �a Mailing Address " k-. 44, Property Address "` t - f (Verification required from 1'Eatuaing&Zoning Department or ne onstruction.) City/State -<f,i, i �.�,.. ��. Parcel Identification Number 0 LE- kI,DESCRIPTION Property Location 1/4 , — V4 7 Sec, T T ` N R I W,Town of i Subdivision_ t—"-k f i 0-b _ _ >Lot# � Certified Survey Malt# , Volume Page# Warranty Deed# " VOltlttl8 � , Pa,lzB# � . Spec hour crcy— ','rra Lot lines identifiabie� yes yta SYSTEM MAINTENANCE AND OWNER CERIM'ICATION Improperr use and maintenance of your septic system could result in its premature failure to.handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pumper. What you put into the system can af'f'ect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in§Comm.$3.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance. The property owner agrees to submit to St Croix County Plarming&Zoning Department a certification form,signed by the owner and by a master plumber,,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is less than 113 full of sludge. llwe,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth,herein,as set by the Department of Commerce and the Department of Natural Resources.,State of Wisconsin. Certification stating that your septic system bas been maintained must be completed and returned to the St.Croix County Planning& Zaming Department within 30 days of the three year expiration date. Uwe certify that all statements on is form are true to the/rest of my/our knowledge. Itwe arrilare the owner(s)of the property described above,by virtue of a rranty deed recorded in Register of Deeds Office. Number edroo „ 4� IG TUR.E OF APPL ANT(S) DATE 'Arty itlf0rrnatiOu that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV.08/05) 1 1074 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85,Wis.Adm.Code Steel Soil Service County Attach complete site plan on paper not less than 8%:x 11 inches in size. Plan must St.Croix include,but not limited to:vertical and horizontal reference point(8M),direction and Parcel I.D. 2 �t percent slope,scale or dimensions,north arrow,and location and distance to nearest road. D 3 tai /-- Please print all infortmdon. 7et;��By) Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). � 03 Property Owner Property Location Derrick Construction Inc. Govt.Lot NE 1/4 NW 19 S 5 T 29 N R 19 W Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# 1505 Hwy.65 7 na Bluebird Bluffs City State Zip Code Phone Number City A Village t Town Nearest Road New Richmond WI 54017 715-246-2320 St.Joseph Rolling Hills Trail New Construction Use: Residential/Number of bedr sarived esign flow rate 600 GPD fjM Replacement Public or commercial-Descri : Parent material Pitted outwash plains AUG 2 ] 2p�ad plai elevation,if applicable na General comments G�' - and recommendations: Mound design,system elevation 112.6 ba �oi +Sr(!Wr*e ele tion 100.65ft KING OFFICE Boring# Boring Pit Ground Surface elev. 101.85 ft. Depth to limiting factor 96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 *Eff#1 I *Eff#2 1 0-20 10yr3/3 none sil 2msbk mfr cs 1f .5 .8 2 20-36 10yr4/4 none sicl 2msbk mfr gw na .4 .6 3 36-54 7.5yr4/4 none scl 2msbk mfr gw na .4 .6 4 54-96 7.5yr4/6 none Is osg mvfr na na .7 1.2 Boring# LI Boring Pit Ground Surface elev. 101.85 ft. Depth to limiting factor C42 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence oundary Roots GPD/itz *Eff#1 I *Eff#2 1 0-10 1Oyr3/3 none sil 2msbk mfr cs 1f .5 .8 2 10-42 10yr4/4 none scl 2msbk mfr gw na _4 .6 3 42-96 1Oyr4/4 c2d 7.5yr5/6 sicl 2msbk mfr na na .4 .6 *Effluent#1=BOD?30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BODS<30 mg/L and TSS<30 mg/L CST Name(Please Print) Signature: CST Number David J.Steel 248956 Address Steel Soil Service Date Evaluation Conducted Telephone Number 1564 CR GG,New RiPorw d,W1 54 17 8/20/2002 715-246-5085 Property Owner Derrick Construction Inc. Parcel ID# pending Page 2 of 3 F Boring# Bo ring jg Pit Ground Surface elev. 100.05 ft. Depth to limiting factor 58 in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W 'Eff#1 "Eff#2 1 0-30 10yr3/3 none sil 2msbk mfr cs 1f .5 .8 2 30-45 10yr4/4 none sicl 2msbk mfr gw na .4 .6 3 45-58 7.5yr4/4 none scl 2msbk mfr gw na .4 .6 4 58-96 10yr4/4 —c2d7.5yr5/6 sicl o mfr na na .0 .0 F-1 Boring# Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 *Eff#1 "Eff#2 i F-1 Boring# k Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 "Eff#1 ;Eff#2 "Effluent#1=BOD s>30<220 mg/L and TSS>30<150 mg/L "Effluent#2=BOD5<30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or f � Page 3 of 3 STEEL'S SOIL SERVICE David I Steel 1564 Cty Rd GG CST-POWTSM Derrick Construction,Inc New Richmond, Wl 54017 Lic. #248956 NE1/4,NW1/4,S 5,T29,R19W (715) 246-6200 Town of St.Joseph,St Croix Co. (715)246-5085 Bluebird Bluffs lot#7 This soil evaluation was conducted to satisfy a zoning requirement,it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. �j er•c� a 3enG�►l1kr-k f 4. lOO.00ri P2 Mqt- ��. `19. `T 5 f Ta�a� (�i V C(7'!'� 3ar i',n fs 13oriny f'le✓4E;o.+s 132: ioi.X;+ ,o3.Kfi- 33 14 Cfo �2 cen�e�la'rw— Q A (31r 33 77 £&,.I ad,o�Fr Poo"? 1�ZI r I`lZ QZr 13r 53' 53 ' � y i 1L-L/ ib f G p12-Ivy= Crlo tL o6>21 -.13, ERG 80. lo if a 1 o o o N L,I HO Al- t 1 Lp'j `7 t — } L PoKDluc� l � o EAS c��►.�T � n 19 S, �LV�a;.I r-C Irv(-Fy J 2 0 s 5 917 -7 4D 0 XATHLEEN H. WALSH STATE SAP,OF WISCONSIN FORM 2-2999 REGISTER ()F DEEDS Document Number WARRANTY DEED ST. CROIX Co., wT RECEIVED Ft78 RECORD This Deed,made between Donald J Nestrud and Vi Nestrud,btusband and wife ►'>;�tia IyL 12/82/2002 10:20AM Grantor,and Brusby Mound Partners,LLp yr tLeir asst s REC FEE; 11.00 'CRAMS FEE.- 1140.00 COPY T CD 1f FEE: PAGES: 1 Grantee, Grantor,for a valuable consideration,conveys to Grantee the following described real estate.in St.Croix CO State of Wisconsin(it utoro sp$ce is needed,please attach addendum); NE 1/4 of HW 1/4 of Section 5. Township 29 1Northl Rocmf4ingAma Range 19 We8t:, St. Croix County, Wisconsin EXCEPT' Lot i of Certified Survey Map filed 20Q2 ,January 8 Nam and Ret mAddren In Vol. 15, Page 4233, Doc. No. 667583 and E8, 26 the North 83 feet thereof. NW 114 of NE 1/4 of Section 5, Township 29 North,1 A4' �ld 2', Range 19 West, St. Croix County, Wisconsin EXCEPT Certified Survey map in Vol. 9, Page 2676.i 030•I018.50-000 Parcel Identification Number(FIN) This /T.,Vp l � homrstcad property_ Exceptions to warranties: Easements,restrictions and ri t1�) (�net) ghts-of way of'record,If any. Dated this day of November 2002 i ` Dvnt kld S.Natrad Neatrud AUTHENTICATION ACKNOWLEDGMENT i Signatures) STATE OF-WISCONSIN } County authenticated this day of Personally came before me this day of �r �tovetnber 2002 the above named • aid J.'Nestrud and Vir {nia K Natrmd,husband and wife TITLE:MEMBER STATE DAR OF WISCONS� ()f not, to Person(s)who executed the foregoing authorized by§x'06,06,WE Slats.) ins t d aowtedged the same. THIS INSTRUMENT WAS DRAFTED BY Attorn Kr atill>u:Clgtaud u so-9,41% ou, I 5401 Natary*P State of Wisconsin i on is p n acnt.(If not,state� ($igrsatures play be suthenticatCd or acknowledged.801h are not necessary.) ) `Names of poisons s%tsl g is any rapacity ttntst be typed or ptintod below their s i kamallon Prutas•lonals Cemwy.Fa4 CW LVA w1 WARRANTY DEED STATE 8AR OF W N817Y FORM No.2.ISS9 V•: ' . Q �� WZ: 0�0 . •� OBE V �:X`�3y �,�D� X 01'• „�/ 500^ t ' >- o > 0 co 2 09.9 CO N ' t' C�I J LU l wwwwwww coo c�1 o JI a ¢ a ¢ ¢ \ 0 0 0 0 0 0 �• l� (n 0000 ' c ►M Ni.M rri +� Ld \ • 0-39'22"E lo5.77' • o x M M W 1 Q Q 1--: F-: cv \ v North-South 3/4 Line �� {� Q \ ` ~ a ` t� 0) ^ 000oNOOcooe • � ca <OCOCa � .0 o tip of c 00 l Z � � Q loo 1 95.22'. . . •q 3 o '� °- e. L_j � � w �IOI 5.UJ �! wl Q 0 0 Ul D i LU ¢° w a 0 `r cn J 00V � W