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HomeMy WebLinkAbout032-2029-10-200 Wisconsin Department of Commerce R ` ED PRIVATE SEWAGE SOT county St. Croix Safety and Building Division q INSPECTION REP Sanitary Permit No: JUL 1 .l 20`4 (ATTACH TO PERMIT) _ 569542 0 GENERAL INFORMATION 4411e State Plan ID No: Personal information you provide ma � ary Law,s.15.04(1)(m)]. Permit Holder's Name: ' City Village X Township Parcel Tax No: Hartman, Zacka & Ka la Somerset, Town of 032-2029-10-200 CST BM Elev: Ins �A ' o,;( •`✓` Section/Town/Range/Map No: I Y, e-i 07.30.19.578B TA NK INFORMATION ELEVATION DATA TYPE MANUFACTURER f-. 15 !� CAPACITY STATION BS HI FS ELEV. Septic .e r j,, Z f IZO6 Benchmark Z_ /02 A06 Dosing ,,p Alt. B►y J 7 Bldg.Sewer 1 , -7 /o/.15 Holding - SUHt Inlet 5 5 9 7 St/Ht Outlet \ TANK SETBACK INFORMATION TANK TO P/J � WELL BLDG. vent Air Intake ROAD Dt Inlet a Septic 96 Dt Bottom AA 5,q .�•--._ �. 9 Dosing / w I� `� /q / Header/Man. rQ� • Z Aeration ✓ (/ / Dist. Pipe I Z Z.95 Sao. Holding Bot. System Q Final Grade , �L 101, PUMP/SIPHON INFORMATION J ate Manufacturer Demand St Cover o P e� Model Number \ �� 1 ' Z'3 1 1AJ J o J r- TDH Lift Friction Loss System Head TDH Ft tp, i5 /./ S Forcemain Length Dia. /I Dist.to Well Aj 4--SOIL ABSORPTION SYSTEM 9• /� BED/TRENCH Width Length No.OJ�rench PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 4/J(e �- SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer �\ INFORMATION CHAMBER OR Tyne Of ystem: Ga VI , 1/) UNIT Model Number: DISTRIBUTION SYSTEM a Header/Manifold Distribution x Hole Size I x Hole Spacing Ven Air Intake // rpe(S) 1 2_63 u Length L4 Dia 0 L` Length :3• Dia I 1 Spacing Z SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx M Iched Bed/Trench Center Bed/Trench Edges Topsoil f O � Yes D No Yes a No COMMENTS: (Include code discrepencies, persons present,etc.) Inspection#1:7/ / / Inspection#2: Location: 385 165th Avenu.2 S merset,WI 54025(NE 1/4 SE 1/4 7 T30N R1 9W) NA Lot 1 0� 6(Z_ Parcel No: 07.3 .19 578B 1.)Alt BM Description= f l 2.)Bldg sewer length -amount of cover= y 0� s _-- - y7s Plan revision Required? ❑ Yes No Use other side for additional information. Date Insepctor's Sign ure Cert.No. SBD-6710(R.3/97) ,��prnmar�o county Safety and Building i 2a (� 201 W.Washington Ave.,����--�$ anitary Permit Number(to be filled in by Co.) isf l,n 53707-7162 JUL 152011, o�ugx�ti / tate Transaction Number Sanit�Y Permit Application �OMMINTY DEVELOPMENT Z,41367-7 In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address) 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,Stats. I. Application Information—Please Print All InformaPon Property Owner's Name 1 Parcel# ►'-1CZ N1 632- 202-3 - l0 - Zo Property Owner's Mailing Address 1 p Property Location l -PQ o l�v l/!� Govt.Lot �� City,State �� p� �/�n 1 Zip Code S Phone Number �E �/, S� /<, Section V V OOI) I t l" SS 17-5 T r N; R C.(4circle one) E o6 IL Type of Building(check all that apply) Lot# )94 or 2 Family Dwelling—Number of Bedroom ' Subdivision Name El Public/Commercial—Describe Use Block ❑ City of ❑State Ow7d—Describe Use CSM Number El Village of k �� IwTown of �a�F�S!✓T III.Type of Permit: (Check only one boa on line A. Complete line B if applicable) A. M New System ❑ Replacement System ❑Treatment/Holding Tank Replacement Only Other Modification to Existing System(explain) B. ❑ Permit Renewal Permit Revision El change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner W.Type of POWTS System/Component/Device: Check all that a,�pc1 D O El Non-Pressurized In-Ground El Pressurized In-Ground El At-Grade "vlound>24 in.of suitable soil ❑Mound<24 in.of suitable soil ❑Holding Tank ❑ r Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dispersal/Treat nt Area Information: Design Flow(gpd) Design Soil Application e( Dispersal Area Re ed(sf) Dispersal Area Prop 98Q s System Elevation w D. b� bU 99�S� VL Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units c O New Tanks Existing Tanks � / ,r1 � to o 2 Septic or Holding Tank 'Z 06 Asle I Zoz c^Cr g Dosing Chamber O6 (9 a� J VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber's Signature MP umber Business Phone Number 0E— 1/, ZZ3z q z -7 1 S- Ss- 2`1W I Plumber's Address(Street,City,State,Zip Code) (). &)(- S'(v S N RCS SC- t< VI/`l t106 VIII. oun /De artment Use Only Approved pp a Permit Fee Date ued Issuing A t Signature er Given Reason or Denial IX.Condi t0M"*Reasons for Disapproval r4 "9eptic"tank,effluent filter and 3) , dispersal cell must all be services I maintalrtQd r ^ w� , 5 �e!'M r�. as per management plan provided by plumber. are K requirements must be maintained as Per applic"code/ordinances. Attach to complete plans for the system and submit to the County only on paper not less than 8 1n z 11 inches in size SBD-6398(R. 11/11) I JEFFERY V FOX Page 2 6/26/2014 is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • Maintain well and waterline set backs per SPS 383.43(8)(i).Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. 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. 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$ 85.00 �, This Amount Will Be Invoiced. When You Receive That Invoice, Patrici ando Please Include a Copy With Your POWTS Plan R view ,Integrated Services Payment Submittal. (715)634-7810, F :(7 15)634-5150,M-F 8:00 a.m.-4:45 p.m. WiSMART code:7633' pat.shandorf@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. 9 AxruE�T DIVISION OF INDUSTRY SERVICES 10541 N RANCH ROAD o� ( HAYWARD WI 54843 Contact Through Relay 3 P www.dsps.wi.gov/sb/ r o" www.wisconsin.gov SIONAt Scott Walker,Governor Dave Ross,Secretary June 26,2014 CUST ID No. 223242 ATTIC•POWTS Inspector JEFFERY V FOX ZONING OFFICE JEFF FOX CONTRACTING&SEPTIC INC ST CROIX COUNTY SPIA PO BOX 565 1101 CARMICHAEL RD DRESSER WI 54009 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/26/2016 Identification Numbers Transaction ID No.2413077 SITE• Site ID No. 800778 Zack Hartman Please refer to both identification numbers, 165TH Ave above,in all correspondence with the agency. Town of Somerset St Croix County NE1/4, SE1/4, S7,T30N,R19W FOR: Description:Mound,4 bedroom residence Object Type:POWTS Component Manual Regulated Object ID No.: 1477197 Revision;Maintenance required; 600 GPD Flow rate; 41 in Soil minimum depth to limiting factor from original grade; System(s):Mound Component Manual-Ver.2.0, SBD-10691-P(N.01 101,R. 10/12),Pressure Distribution Component Manual-Ver.2.0, SBD-10706-P(N.01 101,R. 10/12), SSWMP Pub.9.6; Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes CON and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed A and located in accordance with the enclosed approved plans and with any component manual(s)referenced above. DEFT The owner,as defined in chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all code PROFESS requirements. DIVISI O 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: Key Item(s) SEE C • 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.In addition,the owner must insure that the operation,maintenance and monitoring duties as described in section VIII of the mound component manual are complied with.A copy of this information must be given to the owner upon completion of the project. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per SPS 383.44(6)(a)2. • Limit activities in the area 15'beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of SPS 384.10.No fixture,appliance,appurtenance,material, . device or product may be sold for use in a plumbing system or may be installed in a plumbing system,unless it J JEFFERY V FOX Page 2 6/26/2014 is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • Maintain well and waterline set backs per SPS 383.43(8)(i).Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. 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. 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$ 85.00 This Amount Will Be Invoiced. When You Receive That Invoice, Patncl ando Please Include a Copy With Your POWTS Plan Review?/,Integrated Services Payment Submittal. (715)634-7810, F : (715)634-5150,M-F 8:00 a.m.-4:45 p.m. WiSMART code' pat.shandorf@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. A MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Zack Hartman Owner's Name: Owner's Address: 10644 Pond Curve Woodbury MN 55125 Legal Description: NE1/4 SE1/4 S7 T30N/R19W Township: Somerset County: ST. Croix Subdivision Name: CSM VOL 14 Pg 4023 Lot Number: 1 Block Number: Parcel I.D. Number: 032-2029-10-200 ;;`ITIONALLY Plan Transaction No.: PROVED SAFETY AND Page 1 Index and title ONAL SERVICES Page 2 Data entry NDUSTRY SERVICE$ Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan ZRE$ ND Page 7 Pump curve and specifications Page 8 plot plan Page 9 soil test Designer: Jeff Fox License Number: MPRS 223242 Date: 06/05/14 Phone Number: 715 755 2461 Signature. Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SBD-10691-P(N. 01/01, R. 11/12), 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, R. 10/12) Version 7.0 (R. 11/12) Page 1 of 9 Mound and Pressure Distribution Component Design Site Information R Residential or Commercial Design Note: Sand fill(D)calculations assume a 400.00 Estimated Wastewater Flow(gpd) Table 383.44-3 in-situ soil treatment for fecal coliform of-36 inches. 1.50 Peaking Factor(e.g. 1.5= 150%) 600.00 Design Flow(gpd) 14.00 Site Slope(%) 99.00 Contour Line Elevation (ft) ---- 41.00 Depth to Limiting Factor(in) 0.40 In-situ Soil Application Rate(gpd/ft2) Distribution Cell Information 75.00 Dispersal Cell Length Along Contour(ft) = 8.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate(gpd/ft2) 1 Influent Wastewater Quality(1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? e Center or End Manifold 700 Lateral Spacing (ft) If N above, enter the elevation (ft) 2 Number of Laterals of the highest point. 0.156 Orifice Diameter(in) 1 / 2.50 Orifice Spacing (ft)= 10.00 ft2/orifice llll� / 2.00 Forcemain Diameter(In) y 40.00 Forcemain Length (ft) Does the forcemain drain back? Y x 95.00 Pump Tank Elevation (ft) (� 4.55 System Head (ft)x 1.3 6.52 Forcemain Drainback(gal) 4.09 Vertical Lift(ft) 67.32 5x Void Volume(gal) 0.89 Friction Loss(ft) 73.84 Minimum Dose Volume(gal) 0.00 In-line Filter Loss(ft) 32.31 System Demand (gpm) 9.53 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options I choice 0.75 1.25 x 1.00 1.50 x x 1.25 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons/Inch Calculator Treatment Tank Information Total Tank Capacity(gal) 1250.00 Septic Tank Capacity(gal) Total Working Liquid Depth (in) Wieser Manufacturer gal/in (enter result in cell B49) Dose Tank Information Efflu nt Filter Information 800.00 Dose Tank Capacity(gal) Be On site Filter Manufacturer 22.24 Dose Tank Volume(gal/in) Be r nsite Filter Model Number Wieser Manufacturer ' Project: Zack Hartman �� Page 2 of 9 Mound Plan and Cross Section Views J . . . . /iI B Observation Pipe 7-7--) K 0 Q A W l . . . . B 4 L Mound Component Dimensions A 8.00 ft E 19.44 in H 1.00 ft K 8.56 ft B 75.00 ft F 9.50 in ft L 92.11 ft D 6.00 in G 0.50 ft J ft W ff26.5865 ft 600.00(W) Dispersal Cell Area 1729.53 (W) Basal Area Available 0 8.00](gpd/ft) Linear Loading Rate 7!50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 101.29(ft) H 2 G r ..................... r ila� 100.00( ) Lateral F Dispersal Cell : . .. 1. . : ft. 99.50(ft) Invert Dispersal Cell r Elevation E D 41 F 99.00(ft)Contour Elevation 14.0% Site Slope Geotextile Fabric Cover Shading Key 4 in. + Dispersal Cell See lateral details on 0 Topsoil Cap dia. 1.5 ft — Page 4 for number,size, Subsoil Cap slotte 0 and spacing of laterals. d Laterals are equally ASTIVI C33 Sand obse F spaced from the [A—] Tilled Layer rvati 0.5 ft Typical Lateral distribution cell's Aggregate on I N I I centerline in the pipe distribution cell(AxB).Imo—A Project: Zack Hartman Page 3 of 9 End Connection Lateral Layout Diagram A'.E. •=Turn-up P All I X-1 rl.e t-111M.'l,11,e lateral a.-ed ---ch 411 P,-- 4, U-16 Fier Force m,air,c,Dn.r--tj,--r, .-•r r r anih--ld at ar,,J pt•mt. Number of Laterals 2 Orifice Diameter 0.16 in Lateral Diameter 1.5 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 73.37 ft Orifices per Lateral '30 Lateral Spacing (S) 4.00 ft Orifice Density 10.00ft2/odfice Lateral Flow Rate 16.161gpm Manifold Length 4.00 System Flow Rate 32.311gpm Manifold Diameter 1.50 in Total Dynamic Head 9.53 Forcemain Velocity 3.30 sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and SPS 316.300 WAC An teminlate outlet Tank component is properly-VeRnTe-d--- location B Forcemain diameter Wieser Manufacturer 2 in. CapaciA 800.00 Gallons Volume 22.24 gal/inch Weep hole or anti- Dimension Inches Gallons siphon device A 19.75 439.26 B 2.00 44.48 Pump off elevation(ft) C 3.32 73.84 f 95.5-11 D 10.90 242.421 Total 35.971 800.00 Dose tank elevation(ft) 3" Bedding under tank. F95.00 1 Alarm Manuafacturer Septronics, Alarm Model Number MJJ1 Pump Manufacturer Zoeller Pump Model Number BN151 Pump Must Deliver F---3-2-3-1 lgpm at 9.53 ft TDH Project: Zack Hartman Page 4 of 9 Septic-Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer VVW17SFT?1 Pump Manufacturer Tank Model Number j-Z-5 GC' L#' Pump Model Number Total Tank Capacity i L5)v Alarm Manufacturer Marc.Bury Depth P Alarm Model Number J Switch Type Filter Manufacturer Total Dynamic H H)-Feet Filter Model Number S I!C— Elevation Head Distal Pressure Network Loss Minimum Pump Performance Required Force Main Loss M c Ft TDH Total Outlet Manhole Min.4"Above Grade With Manhole Min.4"Above Grade Locking Device. Inlet Manhole With Locldng Device <6"Below Grade Sealed Watertight Securely Mounted Weather-proof _P Junction Box —' Finished Grade % ® Depth of Cover Vent Min. 12" Disconnect Ft Above Grade Means With Vent Cap >S> [ < Outlet s< Outlet Filter --_ ------ Inlet >�> � Inlet Baffle �i ----- - - ---- T.0 C < ><Y 1 ['< '< T )< ><> < A , Switch Settings and Reserve Capacity <;4 34 '/a" .Tank Volume= GPI '` ,< Weep <, ! < ><) ,< '< Hole >�) Dimension Inches Volume Gal. B (reserve)A 19 6 `133%- < < ' [;< Off Elevation . C >; ><> (alarm) B 2 `/ 34 a< (dose) C 3.32 7��81 }� Bottom 3.3�3 (dead) D ZilZ - t D ;. Elevation ' Ft Total 43<!['< GENERAL INSTALLATION: The septictdose tank is bedded and back filled m accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manutwunw may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device(padlock) installed Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4"Sch.40 PVC to bridge the tank excavation and the sleeve is sealed watertight Electrical service complies with NEC 300 and Comm 1628 WAC. 02/05 LJ Page of Mound System Maintenance and Operation Specifications Service Provider's Name Jeff Fox Phone 715 755 2461 POWTS Regulator's Name St. Croix Cty Phone 715 86 4680 System Flow and Load Parameters Design Flow-Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow-Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1250 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 ft2 Maximum FOG 30 mg/L Type of Wastewateq Domestic Maximum Fecal Coliform >10E4 fu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once every 3 years 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 mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Ws.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 mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished ............ .■. ............... Grade \ ,� 6-8" Diameter Lawn _ Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Zack Hartman Page 5 of 9 Mound System Management Plan Pursuant to SPS 383.54,Wis.Adm.Code General This system shall be operated in accordance with SPS 382-84 Wis.Adm.Code,and shall maintained in accordance with its' component manuals[SBD-10691-P(N.01/01,R. 11/12),SSWMP Publication 9.6(01/81),and Pressure Distribution Component Manual Ver.2.0 SBD-10706-P(N.01/01,R. 10/12)]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. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter,and the mound 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 mound 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 mound be heavily mulched as protection from freezing. Influent quality into the mound 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 BOD5,30 mg/L TSS,10 mg/L FOG,and 10"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 6 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 mound 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 removing biologically clogged absorption and dispersal media,and related piping,and replacing said 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. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. ? � Mum- ,.t r ,s J" J izz tA 7A jr � � � mw � ti r Gam. rj �s f � � P6 ro , 9 A 00 p -- OIL EVALUATI k #1208 { 1 �a p 3 Department of Safety and Professional Services JUN N 1 3 2014 Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85,Wis. Keith E.Stoner Attach complete site plan on paper not less than 8%x 11 inches in size. fj3%Wtv11°`(D St.Croix include,but not limited to:vertical and horizontal reference point(BM),direction and parcel I percent slope,scale or dimensions,north arrow,and location and distance to nearest road. 032 02 0-200 Please print all information. R:fW By Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(l)(m)). 7 Property Owner Properly Location Zackary Hartman Govt.Lot NE1/ ,SE 4,S7,T301N, R19W Property Owner's Mailing Address Lot# Block# I Subd.Na or CSM# 10644 Pond Curve 1 CSM- 1. 14 Pg.4023 City State Zip Code Phone Number ❑ City ❑Village ® Town Nearest Road Woodbury MN 1 55125 1 Somerset 1 385 165Th Ave ®New Construction Use: ® Residential/Number of bedrooms 4 Code derived design flow rate 600 GPD [_1 Replacement ❑ Public or commercial-Describe: Parent material Glacial Till Flood plain elevation,if applicable NA ft. General comments Propose a 8 x 76 mound cell located along the 99.00'contour with a system elevation=99.59. Upslope cell contour staked onsite. and recommendations: Fi Boring# E]Boring ®Pit Ground surface elev. 97.35 ft. Depth to limiting factor 43 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. -Efrai -EfW2 1 0-7 10YR3/3 - sil 2msbk mvfr Cs 3f-m 0.6 0.8 2 7-25 10YR4/3 - I imsbk mvfr gs 2f-m 0.4 0.6 3 25-43 10YR4/4 - sil 2msbk mvfr gs 2f-m 0.6 0.8 4 43-50 5YR4/4 f2d5YR5/8 sil imsbk mvfr gs 21' 0.4 0.6 5 50-70 5YR4/4 f2d5YR5/8 sl m mvfr - if 0.4 0.7 2]Boring# ❑Boring ®Pit Ground surface elev. 97.00 ft. Depth to limiting factor 41 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. -Efflkl -Efll2 1 0-4 10YR3/3 - sil 2msbk mvfr Cs 3f-m 0.6 0.8 2 4-13 10YR4/3 - sil 2msbk mvfr gs 2f-m 0.6 0.8 3 13-21 10YR4/4 - sil 2msbk mvfr gs 2f-m 0.6 0.8 4 21-30 5YR4/4 - sl 2msbk mvfr gs 2f 0.6 1.0 5 30-41 5YR4/4 - sl m mvfr gs if 0.4 0.7 6 41-54 5YR4/4 f2d5YR5/8 sil m mvfr - - 0.4 0.6 #6-with bards of sand 'Effluent#1 =BOD 5>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 Keith E.Stoner 224059 Address Keith E.Stoner Date Evaluation Conducted Telephone Number 23220 Wood Creek rd.Siren,WI 54872 5/28/2014 715-653-2324 SBD4330 pt 11111) Property Owner Zackary Hartman Parcel ID# 032-2029-10-200 Page 2 of 3 ❑ Boring# ❑Boring Pit Ground surface elev. 101.35 ft. Depth to limiting factor >56 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. 'EfM 'Eff#2 1 0-5 10YR3/3 - sii 2msbk mvfr rs 3f-m 0.6 0.8 2 5-15 10YR4/3 - sil 2msbk mvfr gs 31F-M 0.6 0.8 3 15-25 10YR4/4 - sil 2msbk mvfr gs 3f-W 0.6 0.8 4 25-42 10YR4/4 - sicl 2msbk mvfr gs 2f-oo 0.4 0.6 5 42-56 5YR4/4 - sl m mvfr - 2f-w 0.4 0.7 #5-water seeping out of is inclusion F E]Boring 4 Boring# ®Pit Ground surface elev. 115.80 ft. Depth to limiting factor 40 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. 'Eft#1 'Eff#2 1 0-4 10YR3/3 - sil 2msbk mvfr a 3f-m 0.6 0.8 2 4-22 5YR4/4 - sil 2msbk mvfr gs 2f-m 0.6 0.8 3 22-29 7.5YR5/4 - s Osg ml gs 2f-m 0.7 1.6 4 29-40 5YR4/4 - s/Is imsbk ml gs 2f 0.7 1.6 5 40-80 5YR4/4 f2d5YR5/8 sl imsbk/m mvfr - if 0.4 0.7 #5-2-6"bands of sand F-1 E]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/ft' in. Munsell Qu_Sz.Cont.Color Gr.Sz.Sh. 'Eff#t 'Eff#2 *Effluent#1=BODS>30<220 mg/L and TSS>30<150 mg/L 'Effluent#2=BODS<30 mg/1-and TSS<_30 mgA- The Department of Safety and Professional Servicese is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,contact the department at 608-266-3151 or TIY through Relay. ► 0 A 0 ? m O ti U A C i x x 0 b A ti Con C4 C� b O ti O Ln w o II II II II � Lnon A Q h o 0 oowC) UnC� `� w � O to Pill hi C� (Zb N J ' � N a wl 0 1 ti G. f 1 F--- �1„ I c O b Qi c gyp, p _ I O�b�d1 111 V N tp O O y IA y w � w � � w �D � (p N O y� I �� I µ t 0 ' �rTi � � � � gg n ut Q � 1 10 0! �� z - � ; � o r ! 4�Cr' R( I o j � DO � {,iN UI 0 Ln P W W (J, CNJ� ;�' bD I Ito < Plan 4 ZoroROa d rocs(nmm�N1° O Ca CJi D 0�_ N Z sf I�} wQpO' °- ° p ° °-°- v m 1°' ro� ( I "JAN 242001 W T p � L',, It tot n rse S(]Nd1 a31Ld1dNn w j� - ap`0 d �-- --- L12 I-- v 3 ail; }o �/} 3N 84; }o aull }saM ` y�h x ti� i \�a2a�s u� _ Q r O G 7 ",l`l �.1., 4h I r. 9 � j . 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Macfisw,WI 53707-7162 She Transaction Number ermit Application 2�8�� In accordance with SPS 3 ), Adm.Code,submission of this farm to the ap�opriate g nmentel unit obi pent Note:Application�for staff-owned POWTS are submitted to Project Address(� / tbrm a>a+�°8 ) the Department of Safety and profdwiaoal Servies. Personal m&rew iou You povide may be used for secondary 7rij' ��� puqxxm Ilk ;n acoordence with the Law,s.15,04(lXml Stars. L Application Information-Please Print All Information Parcel ff Property -ZAE&I ITIRR-MAd property Uicafiria I Owner's Name Qy C4- ® 63 Z-Zv LR- io -Zc() ' �ROi 014 . 5 7g(��� R)N(J co,rt. At zip Code �J'r=: � s v,, sdx '7 city,St\at�e��c7� _ SsI ZS DPMFNr T 20 N; R (q(�E or(D EL Type of Building(check all that apply) Lf Subdivision Name 04 dx 2 Famfly Dwelling-Number of Bedrooms 6k ah ❑pu kX*mm rcW-Describe Use_ ❑city of CSM ❑wage of ❑State Owned-Describe Use— p )KTown of �. 2-4 65 HL Type o ' (Check only one boa on fine plete li% Z o A- 111*,Y Sys ❑Reglatxncut Systicmm T T Replaxmcm 0n1Y ❑Otter Modificam to ExiamS (-PI—) B. ❑Permit Renewal ❑Permit Revision ❑ ba ❑Permit Transfer to New List Previous ma Number and Date lgted Before Expiration owner IV.Type of POWTS S m/Com nent/Deviee: (Check a 6 "�T ❑Prtsstaized rt-Ground ❑Ai-Grade ormd>24 is of suit"..A Mound<24 in.of sakable soil t ❑Non-Presnrized to-Grtumd S ❑Holding?ank ❑Other Dispersal Component(ctpbm) V.Du VTrea ent Area Information: Area acted D�9 Arm S70�-� Design Flow(gp� Design Soil fl D VL Tank Info Capacity in Total #of M�Gwiow Gallons Unrts a fleet Turks T� o g septic WH- g T-k I 0 Dosing Chamber M r VII.Responsibility Statement-1,the and—k-ed,assume responsibility for i tion of the POWTS shown on the attached pleas. /MP bar 3s�phone Number Plumber's Name(Print) Plumers Snahxe LrL 7)S" 755 1 lG"l Plumber's Address(Street City Staff Zip Code) 03ax 515 2 w� 540 bq VIII. oan coartment Use Only Lssuing Signature Permit Fee Date Approved S (�Z 5 CO / �� f iven Reason UL Condi6altfisT "o for Disapproval 3 Con ;d o"s i Jl S 1: Septic tank,effluent filter and �'� ,Qef dispersal cell must all be servl ae t main4ata* t� -44 / as per management plan provided by plumber, 2. Alt f end*requlr®ment i must be maintaiesetl as per applicable coda I or WWWAs. Attacb m cenphxe Plans for the system ant submit to the CsestY nary a Paper cot lea thus a trz:mt sscha is sure SBD-6398(R 11/11) �oerAR T.usy DIVISION OF INDUSTRY SERVICES f °1P 10541 N RANCH ROAD �u P HAYWARD WI 54843 Contact Through Relay P www.dsps.wi.gov/sbl www.wisconsin.gov ' A�OssroxAtiS� Scott Walker,Governor Dave Ross,Secretary April 01,2014 CUST ID No. 223242 ATTIC•POWTS Inspector JEFFERY V FOX ZONING OFFICE JEFF FOX CONTRACTING&SEPTIC INC ST CROIX COUNTY SPIA PO BOX 565 1101 CARMICHAEL RD DRESSER WI 54009 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/01/2016 Identification Numbers Transaction ID No.2385001 SITE: Site ID No. 800778 Zack Hartman Please refer to both identification numbers, 165TH Ave above,in all correspondence with the agency, Town of Somerset St Croix County NEIA, SE1/4, S7,T30N,R19W FOR: Description:Mound,4 bedroom residence ;fits Object Type:POWTS Component Manual. Regulated Object ID No.: 1477197 Maintenance required; 600 GPD Flow rate; 33 in Soil minimum depth to limiting factor from original grade; Iv ��� fit Mound Component Manual-Ver.2.0, SBD-10691-P(N.01/O1,R 10/12),Pressure Distribution Component J L Ver.2.0, SBD-10706-P(N.01/O1,R. 10/12),SSWMP Pub. 9.6; Effluent Filter PRO Np S �� IS'O The submittal described above has been reviewed for conformance with applicable Wisconsin Administrati odes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be construct and located in accordance with the enclosed approved plans and with any component manual(s)referenced abov The owner,as defined in chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all code EE Cop eS requirements. 5 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: Key Item(s) • 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.In addition,the owner must insure that the operation,maintenance and monitoring duties as described in section VIII of the mound component manual are complied with.A copy of this information must be given to the owner upon completion of the project. • The force main scales to be almost 80'long and the dose volume may need to be increased to compensate for additional back flow to the pump tank or chamber. • Care must be taken to preserve the bench mark during construction or establish a new bench mark with the elevation set to relate to the original bench mark. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per SPS 383.44(6)(a)2. • Limit activities in the area 15'beyond the down slope edge of the mound per Mound Component Manual. JEFFERY V FOX Page 2 4/1/2014 , • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of SPS 384.10.No fixture,appliance,appurtenance,material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system,unless it is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • Maintain well and waterline set backs per SPS 383.43(8)(i). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. 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 b the state or the local municipality shall be obtained prior to commencement of q Y P tY P construction/installation/operation. 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. Sincerel Fee Required$ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Patricia L Shandorf Please Include a Copy With Your POWTS Plan Reviewer,Integrated Services Payment Submittal. (715)634-7810, Fax:(715)634-5150,M-F 8:00 a.m.-4:45 p.m. WiSMART code:7633. pat.shandorf @wisconsin.gov cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm .Nate_.,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. JEFFERY V FOX Page 2 4/1/2014 • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of SPS 384.10.No fixture,appliance,appurtenance,material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system,unless it is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • Maintain well and waterline set backs per SPS 383.43(8)(i).Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. 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. 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. Sincere!LS Fee Required$ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Patricia handorf Please Include a Copy With Your POWTS Plan Reviewer,Integrated Services Payment Submittal. (715)634-7810, Fax:(715)634-5150,M-F 8:00 a.m.-4:45 p.m. WiSMART code:7633: pat.shandorf @wisconsin.gov cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm ,Note:._F,.ffect1ve 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. v MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Zack Hartman Owner's Name: 10644 Pond Curve Owner's Address: Woodbury MN 55125 Legal Description: NE1/4 SE1/4 S7 T30 N/R19 W Township: Somerset County: ST. Croix Subdivision Name: CSM 14/4023/381 a Lot Number: Block Number: Parcel I.D. Number: 032-2029-10-200 ;o r Plan Transaction No.: t�Y S Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank �OND� Page 5 System maintenance specifications Page 6 Management and contingency plan I Page 7 Pump curve and specifications Page 8 plot plan -� Page 9 soil test Designer: Jeff Fox License Number: MPRS 223242 Date: 03/25/14 Phone Number: 715 755 2461 Signatu . Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SBD-10691-P(N.01/01, R. 11/12),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. 01101, R. 10/12) Version 7.0 (R. 11/12) Page 1 of 9 Mound and Pressure Distribution Component Design Site Information R Residential or Commercial Design Note: Sand fill(D)calculations assume a 400.00 Estimated Wastewater Flow(gpd) Table 38314-3 in-situ soil treatment for 1.50 Peaking Factor(e.g. 1.5= 150%) kcal cal rm of<=36 inches. 600.00 Design Flow(gpd) 7.00 Site Slope(%) 103.00 Contour Line Elevation (ft) 33.00 Depth to Limiting Factor(in) 0.50 In-situ Soil Application Rate(gpd/ft2) Distribution Cell Information 65.00 Dispersal Cell Length Along Contour(ft) = 9.2 Cell Width(ft) 1.00 Dispersal Cell Design Loading Rate(gpd/ft2) 1 Influent Wastewater Quality(1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? e Center or End Manifold 3.0 Lateral Spacing(ft) If N above, enter the elevation(ft) 3 Number of Laterals of the highest point. 0.156 Orifice Diameter(in) 2.75 Orifice Spacing(ft) .34_ t2/orfice 2.00 Forcemain Diameter(in) 50.00 Forcemain Length (ft) Does the forcemain drain back? Y 95.00 Pump Tank Elevation (ft) 4.55 System Head(ft)x 1.3 8.16 Forcemain Drainback(gal) 8.09 Vertical Lift(ft) 87.37 5x Void Volume(gal) 1.56 Friction Loss(ft) 95.52 Minimum Dose Volume(gal) 0.00 In-line Filter Loss(ft) 38.7 System Demand(gpm) 14.2 Total Dynamic Head(ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in dia, options choice 0.75 1.25 1.00 1.50 x x 1.25 2.00 x 1.50 x x 3.00 2.00 x 3.00 x Gallons/inch Calculator Treatment Tank Information Total Tank Capacity(gal) 1250.00 Septic Tank Capacity(gal) Total Working Liquid Depth(in) Wieser Manufacturer gal/in(enter result in cell B49) O 1 Dose Tank Information Effluent Fitter Information 800.00 Dose Tank Capacity(gal) Bear On site Filter Manufacturer 22.24 Dose Tank Volume(gaVin) Bear Onsite Filter Model Number Wieser Manufacturer Project: Zack Hartman Page 2 of 9 1 Mound Plan and Cross Section Views . J 1/10 I� Observation Pipe © . — f--K I� O Q A W . . .. . . . . : . . . B L Mound Component Dimensions 9.24 E 13.76 in H 1.00 ft K 7.85 ft B 65.00 ft F 9.50 in 1 9.26 ft L 80.69 ft D 6.00 in G 0.50 J 4.44 ft W 22.9 600.60(ft2)Dispersal Cell Area 1202.5 (ft2) Basal Area Available 9.2 (gpd/ft) Linear Loading Rate 1 6.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 105.29(ft) -► 2 G H 2 Dispersal Cell 104.00(ft) Lateral F 103.50(ft) — invert Dispersal Cell Elevation E D - F 41 1 l 103.00(ft)Contour Elevation 7.0%Site Slope Geotextile Fabric Cover Shading Key 4 in. ? Dispersal Cell See lateral details on 0= Topsoil Cap dia. 1.5 ft Page 4 for number,size, 0 Subsoil Cap d offs + N 0 �Q ? and spacing of laterals. © ASTM C33 Sand obse "— / F Laterals areequuallly ® � Tilled Layer rvati 0.5 ft Typical Lateral distribution eed from cehe ® � Aggregate on ❑5 centerline in the pipe 1.4 —A distribution cell(AxB). Project: Zack Hartman Page 3 of 9 I Septic-Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer 141(kC Pump Manufacturer Z0�a.�' Tank Model Number T I,P 125 Pump Model Number 5 Total Tank Capacity j - b Alarm Manufacturer !SEEV P LN3 1 ,.S Max.Bury Depth Alarm Model Number I Switch Type M,6�fU(Zy Filter Manufacturer F Total Dynamic Head(TDH)-Feet Filter Model Number ITS Elevation Head cc/- Distal Pressure Network Loss Minimum Pump Performance Required Force Main Loss GPM I @ Ft TDH Total Z C Outlet Manhole Min.4"Above Grade With Manhole Min.4"Above Grade Locking Device. Inlet Manhole With Locking Device <G'Below Grade Sealed Watertight Securely Mounted Weather-proof Junction Box .. —� Finished Grade " "° — — 1 _ AL + ' Depth of Vent a t Min.i 1>2i s"t S<t- Disconnect Cover Above Grade Means Ft With Vent Cap Outlet Outlet Filter ----- In 4 Inlet Baffle -"---- ssY A t {; Switch Settings and Reserve Capacity 't Tank Volume= GPI '< �s Weep '` Hole >S> ID S Dimension Inches Volume Gal. t}< >t> {>t >s >t> (reserve)A 1 s', 8 L ( (alarm) B 2 � ' >i Off Elevation >i >;> t i ,Ft >�> (dose) C ,JC) q-,S� <}< ' s; Bottom ?{� (dead) D [�,yC? Zy�, ZIP `' ;{ Elevation Total .S`'S:`i 7f .f Ft >t >{>{ t t><>{>S>t>i>i>t>S>t>t> > t <:< <> GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device(padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4"Sch.40 PVC to bridge the tank excavation and the sleeve is sealed watertight Electrical service complies with NEC 300 and Comm 1628 WAC. 02/05 LJ Page of End Connection Lateral Layout Diagram I Crenr�r tlt�1,st�ra,1-7 ovc-r rh�A-.e.dtrr�r,---ior, a=Turn-up-M-all ,alv�or al�anoutplug P T All IarG.r als ire..Jwic A X—J Hales drilled ot•tf.e t.ortorr,of tf.e lateral eq—llt4--p a� LaA -tal�8.forcert',ain Sch 40 Pllk-per SPA Table 334-30-5. A' Farce mair, via ree or cross to manifold at arqj point. Number of Laterals Office Diameter 0.16 in Lateral Diameter 1.55 in Orifice Spacing(X) 2.76 ft Lateral Length(P) 63.49 It Orifices per Lateral 24 Lateral Spacing(S) 3.05 ft Orifice,Density 8.34 ft2lorifice Lateral Flow Rate pm Manifold Length 6.161ft System Flow Rate 5..- gpm Manifold Diameter 1.50 in 14.2 Forcemain Velocity 3.]96 Wsec Total Dynamic Head ta Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and SPS 316.300 WAC Tank component is t4 properly—WeRIM— 4--ML-4 AerrNte outlet --I��iocation TB f:I Forcernain diameter Wieser Manufacturer 2 in. Capac!!4 800.00 Gallons Volume 22.21 gal/inch Weep hole or anti- Dimension Inches Gallons siphon device A 18-78 417.58 B 2-00 44.49 Pump off elevation(ft) .0 4.30 95.52 r 95-7911 D 10.90 242.42, Total 35.97F-800.001 Dose tank elevation(ft) 3"Bedding under tank. 1 95. Alarm Manuafacturer Septronics Alarm Model Number MJJ1 Pump Manufacturer Zoeller Pump Model Number BN152 Pump Must Deliver 38.77 gpm at F--154-2- TDH Project Zack Hartman Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name Jeff Fox Phone 715 755 2461 POWTS Regulator's Name St. Croix Cty Phone 715 86 4680 System Flow and Load Parameters Design Flow-Peak 600 pd Maximum Influent Particle Size 1/8 in Estimated Flow-Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1250 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600.6 ft2 Maximum FOG 30 mg/L Type of Wastewateq Domestic Maximum Fecal Conform L >10E4 100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test monthly Pressure Systeml Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once every 3 years 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 mound 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 mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Tum-up Detail Finished so..........so, .....,.s.......i Grade 6-8 Diameter town Threaded Cleanout Sprinkler Valve Box . . . . Plug or Ball Valve Distribution Lateral y Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Zack Hartman Page 5 of 9 Mound System Management Plan Pursuant to SPS 383.54,Wis.Adm.Code General This system shall be operated in accordance with SPS 382-84 Wis.Adm.Code,and shall maintained in accordance with its' component manuals[SBD-10691-P(N.01/01,R. 11/12),SSWMP Publication 9.6(01/81),and Pressure Distribution Component Manual Ver.2.0 SBD-10706-P(N.01/01,R.10/12))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 fitter 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 Commercz_ 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 necessari. I Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter,and the mound 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 mound 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 mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODS, 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 10"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 6 inches considered as an impending hydraulic failure requiring additional,more frequent monitoring. Continaencv 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 mound 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 removing biologically dogged absorption and dispersal media,and related piping,and replacing said 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. Pretreatment units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. _PECa. _i FAX 651 731 OUI- t f TQIFL $ `D , PM Lwuw i � sZ•i� '4 W'`� Q� red 77 221 46 � �p 40 �m 15 4A 3C 2M,25 7-6 v ,,8., vv ,L 0 49 OD go r de St �1 Yi4 - {± S -t WARM FOOL as SIC"L .. T j.sf•�.. t_ �I, IMP d®_ KIM Zo am 43 20 ° 3 fts .' IM No a r . w% J r-� I i �Jj l M, VI _ 2 f Lai IC N Property Owner P Go\.F �1Y��yA6E E>�T Parcel ID# 1����1 NG Page Z of Boring# ❑ Boring ® pit Ground surface elev. y LI• S ft. Depth to limiting factor 3 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 o-b 1D`1Q_31Z — s 1 1 -Z-'{'sblz wlf►-- e)-v Z`� , S w 1 , s • 8 3 30-�l3 -STIR �! - s i l sb1Z wt Ll S y S L-)li 31 y �-!� -r sti i2 S�8 L o . v►-t 'F; - • 3 5 ❑ 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 In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 E I 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 1ft2 In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Ef1#1 •Eff#2 •Effluent#1 =BOD6>30<220 mg/L and TSS>30<150 mg/L •Effluent#2=BOD6<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. SBD-8330(86/00) I Ylry -,onsin Department of Commerce S 0 ALUATIO PORT Page of Division of Safety and Buildings ;: g in accordance with qornr�'85,pWCiC �`Q' '- Code Attach complete site plan on paper not less than 8 1/2 x 111nsh sin sik�4Pan must1 unty ��• 1 x `I include,but not limited to:vertical and horizontal reference' o (BM),directiRQn,pndbM cel I.D. l percent slope,scale or dimensions,north arrow,and locati n d dist� ,toie'arb road. o��R= e �(}- �� FL Please print all informatio -, �buNF�C� 1 �� vi Y Date 0 Personal information you provide may be used for secondary,purpos (P"� Law .66 (1)(m)� 013 (},/Property Owner rty d /�J 1/4 SE 1/4 S 7 T 3Q N R E(or W Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# 60L6 �w� Ct1ZCL� D21 <1C RuPosp cs� City State Zip Code Phone Number ❑City ❑Village ((Town Nearest =:1 LZ) g3S-�� �D Sow1�25�- lbS New Construction Use:® Residential/Number of bedrooms 4 Code derived design flow rate L 03 GPD ❑Replacement ❑ Public or commercial-Describe: Parent material Flood Plain elevation if applicable ti ft. General comments and recommendations: ►'1 1-MI la,Q`nc1�J 0-E-LL IAJ . 6" o►=- Sf�D RLL- "nod 4c�e (/J ,4-la ✓(Q(�•iX. �jyLt.�l01'w10-� F Boring# ❑ Boring pit Ground surface elev. q ft. Depth to limiting factor 3 3 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz. Cont.Color Gr.nSz.Sh. 'Eff#1 'Eff#2 �— O 10 L� iIL 312 S11 Z`t 91- y,-, ^ w Z 3 3--60 1 O ti Ii 316 �t�F 7•S`-!R S/8 S� � �� wt's — .O • Z Boring# ❑ Boring I I pit Ground surface elev. X03's ft. Depth to limiting factor L4 I in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 a-g lO`11Z31Z stI Z`F�1- ►�L�- el,c, Z �5 ,`�, Z $-Zc7 lo`i2312 - S1 Zvr1Sbk mil, a-S 1'e • S 3 Zb-ELI L/ L-1 1-6d SK23It/ 1 --7 -SLi►Z 0 3 . S Effluent#1 =BODS>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) Signpture CST Number Arthur L . Wegerer o7 ��! �"3�-) 220254 Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. Iiain St . River Falls , WI 54022 8- L`7-00 715-425-0165 'Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85,Wis. Adm. Code County Attach complete site plan on paper not less than 8 112 x 11 inches in size.Plan must s�r ` x include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. taa 9 )tit G percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Please print all information. Re ewet b Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). Property Owner Property Location S'F' tJt 1/4 SE 1/4 S 7 T 3Q N R E(or ow Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# 60L6 Ct1 tr-LE �21UL )i I - N TWN>Qst�rj c.sm City State Zip Code Phone Number ❑City ❑Village Ef Town Nearest Road t�llvyv p A MYV 5S3q3 ( 6LZ) g3S-FS(S%-0 I SoKkL E12.SL:'1- I )6 S `n* A-UL New Construction Use:® Residential/Number of bedrooms Y Code derived design flow rate 0 GPD ❑Replacement ❑ Public or commercial-Describe: Parent material Flood Plain elevation if applicable !V ft, General comments and recommendations: , , h n0o�'� Rf„L• F Boring# [] Boring ® pit Ground surface elev. 4 ft. Depth to limiting factor 3 3 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/112 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 I •Eff#2 4-- 0-10 TL 312 — S11 -L4 91- m'�!^ w 'L-� -5 - b Z 10-ZI toyti312 — si1 Zmsbk w�'�- Q-S �'� = S . �' 3 -33 Lr)4 33-1Z 11311Z 316 �!`� �•S'�2 S/8 S t vn`� - -0 • Z F] Boring# I❑I Boring L�l pit Ground surface elev. )O3'S ft. Depth to limiting factor y l in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz In. Munsell Qu.Sz. Cont Color Gr.Sz.Sh. 'Eff#1 'Eff#2 a_$ 3tz slI Z��� ►vl'Fti- elv -i.� �s ��, -Z -Ztrj W-m-31Z - g j 1 Zvn sbk wt* - cS 1f • s • a 3 Zb-qI I(YlR 316 - Si L Z'FSb tvt�- e-g - •5 • 6 S Li 17- S/0 L O►,.� w►'�i - -3 . S 'Effluent#1 =BODs>30<220 mg/L and TSS>30_<150 mg/L 'Effluent#2=BOD,<30 mg/L and TSS<30 mg/L CST Name(Please Print) Signature 00—-L-Sq—( CST Number Arthur L. Wegerer al. 220254 Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. Bain St. River Falls , WI 54022 S-L`7-00 715-425-0165 Property Owner S �• GU\-F ><' ))-xjA 6 E),f E!)- Parcel ID# /1J J AJ G Page Z' of Boring# ❑ Boring ® Pit Ground surface elev. S ft. Depth to limiting factor 43 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 � 0-8 10`LIZ 3 1 Z — s 1 1 Z�sb1-c wt'F►-� �LV Z`� . S . � wl`f1- c w 1`� . 5 • 8 3 30-q3 -SL12 L/ 3 S�/ 7sL-1,2S1/E3 L o� . �i — • 3 S -F -F 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 In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 "Eff#2 ❑ 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 G In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 "Eff#2 Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mg/L •Effluent#2=BOD6<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. SBD-8330(R.6100) PLOT PLAIT Page 3 of 3 Scale I ' = y� ' 3g 114 sT, N�vs� LoT LItuL �` �,n.T ``�S' • C�-tgTl1J G moo\ 20 ��3 I goy �.3 w 1�1P.� ►��L . LI �. 8—M-00 715-425-0165 220254 0 0- Z3 4 CST Signature Date Telephone No . CST No. Job NO . Parcel #: 032-2029-10-200 03/26/2008 12:12 PM PAGE 1 OF 1 Alt. Parcel#: 07.30.19.578B 032-TOWN OF SOMERSET Current X ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner %CAROLYN JOHNSON O-J P GOLF, MANAGEMENT INC MANAGEMENT INC J P GOLF 109 BOCA DE LA PLAYA UNIT B SAN CLEMENTE CA 92672 Districts: SC =School SP=Special Property Address(es): *=Primary Type Dist# Description SC 5432 SOMERSET SP 1700 WITC Legal Description: Acr 3.401 Plat: 4023-CSM 14-4023 SEC 7 T30N R19W NE SE B NG LOT 1 CS Block/Condo Bldg: LOT 1 14/4023 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 07-30N-19W NE SE Notes: Parcel History: Date Doc# Vol/Page Type 07/23/1997 1196/252 QC 07/23/1997 1117/415 WD 07/23/1997 830/160 2008 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/09/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.400 108,900 0 108,900 NO Totals for 2008: General Property 3.400 108,900 0 108,900 Woodland 0.000 0 0 Totals for 2007: General Property 3.400 108,900 0 108,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ST.CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND u OWNERSHIP CERTIFICATION FORM Owner/Buyer O&A H,?r4 h A"1`jkn,4,, / Mailing Address {*/7 ?NW Property Address 39s- 1106- ails Sect Iva 5-y025" r (Verification required from Planning&Zoning Department for new constructi n. City/State 7�dj t Wl Parcel Identification Number U 32-W LEGAL DESCRIPTION Property Location *F 1/4 , 5[ 1/4, Sec. 07 ,T_3aN R W,Town of 50ls4e3l� Subdivision Plat: , Lot#�. Certified Survey Map# S ,Volume ,Page# OZ3 Warranty Deed# g �� (before 2007)Volume ,Page# Spec house Oyes OTno Lot lines identifiable Oyesl6no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper 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 affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in§SPS.383.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&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 1/3 full of sludge. I/we,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 Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification 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 date. I/we certify that all statements on tV t ' form are true to the best of my/our knowledge. I/we am/are the owner(s)of the property described above,by virtue of a w anty deed recorded in Register of Deeds Office. Number of bedrooms S GNATURE OF APPLICANT(S) DATE **Any information 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.04/12) 8220837 State Bar of Wisconsin Form 2-2003 Tx:4181117 WARRANTY DEED 994227 BETH PABST Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI 04/01/2014 11:16 AM EXEMPT#: NA THIS DEED,made between Ronald Anton Johnson REC FEE: 30.00 ("Grantor,"whether one or more), ✓ TRANS FEE, 147.00 and Zachary Hartman and Kayla Hartman,husband and wife ("Grantee,"whether one or more). PAGES: 1 Grantor,for a valuable consideration,conveys and wan-ants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Recording Ares interests,in St.Croix County,State of Wisconsin("Property")(if more space is needed, please attach addendum): Name and Return Address That part of the NE1/4 SE1/4 of Sec.7-T30N-R19W described as follows: Lot l of Certified Survey Map recorded in Vol.14 of Certified Survey Maps,Page 4023 as C Doc.No.637335. 1�1 032-2029-10-200 Parcel Identification Number(PIN) This Is not homestead property. Exceptions to warranties:Easements,restrictions and rights-of-way of record,if any. Dated (SEAL) (SEAL) * Ron d Anton oh son (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signadue(s) authenticated on STATE OF_Calk ill/(to ) )ss. A1,14wt�eL COUNTY ) TITLE:MEMBER STATE BAR OF WISCONSIN Personally came before me on 1A A2 241 2.14 , (If not, the above-named Ronald Anton Johnson authorized by Wis.Stat.§706.06) to me known to be the person(s) who executed the foregoing instrument and aclmowledged the same. THIS INSTRUMENT DRAFTED BY: Aj Attorney Kristina Deland Hudson,WI 54016 Public,Stateof CA r,o io Commission(is permanent)(expires: Z,r-t (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED 0 2003 STATE BAR OF WISCONSIN FORM NO.2-2003 •Type name below signatures. INFO-PRO"LLegal Fors W0455.2021 vwwv.intproibmis.com 7f -::.:•'� J JOSE VLADIMIR GALVAN� a r< COMM.#2016668 -, NOTARY PUBLIC-CALIFORNIA 9 ALAMEDA COUNTY MY COMM.EXP.MARCH 30,2017 St.Croix County 994227 Page 1 of 1 £ZOh abed h L'IQA CSM _P 1620 o a n Found East 1/4 Cor. Vol. 6, q W Section 7 �; PK Nag 3 I ~ �I rn � � � SID �mm� . 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