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040-1267-50-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 569565 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. Permit Holder's Name: Village X Township Parcel Tax No: City Luedtke, Kristo her&Jennifer Troy, Town of 040-1267-50-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: 16.28.19.1457 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION , S bHl FS ELEV. e Septic ?i� Benchmark U?,a�i� ! Dosing Cf Y4 J-10 D Alt. BM Aeration r 525- BI g.Sewer ^• O l Holding W Inlet (D ` St/Ht D ; o p•3 9�• 5� TANK SETBACK INFORMATION SVHt Outlet TANK TO n P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic F / > r I DtDt B�r/Man. 3 2 1 Dosing f I He 3.38 Di• Aeration I?ist. Pike i.2s 3.�o �o/• � Holding Bot.System, O e ./ /oa . / ' PUMPiSIPHON INFORMATION Final Grade d2 �3 Manufacturer Demand St Cover GPM 3'�,, f d S-�YS .O 1,90 iO Model Number pe S IV •6, TDH Li Friction L ss System Head TDLjFt 1 � ; S �' Forcemain Lent IDia.Z fl D SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No.Of Trenches PIT DIME Of Pits Inside Dia. Liquid Depth DIMENSIONS �� /h 1 �� SETBACK SYSTEM TO ({/(/ P/L e JBLDG JW5. LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Sys�;e'm�� 7/ �� / UNIT Model Number: > DISTRIBU N SYSTEM ,(l��f dAtj" 4&22 Header anifold j Distribution x Hole Size x Hole Spacing Vent Ip Air Intake 2" Pipe(s)S� �6 a ( (� d Length�17 Dia/ Length Dia �' Z Spacing 3 J �> d 3-496 SOIL COVER x Pressure Systems Only x Mound r At-Grade Systems Only Depth Over Depth Over kj2g,De xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Q00P/« Yes No p;- Yes ❑ No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1:—L/ /3 /—Y Inspection#2:_/-13/Z 5( pQ Location: 317 Empire B�uil er Drive Hudson,WI 54016(/SW 1/4 SE 1/4 16 T28N R19W) Glover Station 5th d Lot 96 Parcel No: 16.28.19.1457 -. �-- 1. Alt BM Descri tion- �341,� L j"1 T G tAtr 4:i l ✓L` i �f�d,( �; 2.)Bldg sewer length=61-7 r7'YO YCX� 1 ^C.7 uho_ a4 4znk ko.,L-- bPelhd -amount of cover= h.0 V&Z S � io - Plan revision Required? Fe-1 Yes AL.No Use other side for additional information. 1_ tr? SBD-6710(R.3/97) Date Insepctor's re Cert.No. Plot Plan Page 8 of S Property Owner �cs�r-� �Sif,4 1� LueD� I---1 p 40 ft. Legal Description LT g(,, arovee --x-�►ow ` 1 (except where noted) Backhoe pit North t�irat? PIL y 21jV49 P� o gq.70 eu t�'C��vE �20etNJ s who � Site Location: w -TO,� Kle- �I � 1A� sou-*rw'I Wt. DR 0� 1 �' Ob County �- C 9 © _ Safety and Buildings Division _(—��(-�--- 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit 1 umber(to be filled in by Co.) 'y ITV 7"2 56D l �(O Se4 1 )ONN State Transaction Number wit Application -L ..3 $ In accordance with SI5�3 is.Adm.Code,submission of this form to the appropriate governmental unit is required prior to a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address) the Department ety and Professional Servies. Personal information you provide may be used for secondary oses in accordance with the Privacy Law,s.15.04 1 m,Stets. �� �pl��. L�L PA L Application Information-Please Print.All Information r I� Y Property Owner's Name Parcel#AJJ >c c� o U ty o ti k P9�- �- 0 v a a Property Owner's Mailing Address Property Location / i b s p r! 0,4 D Govt.Lot ---> (/ • L / City,State Zi ode Phone Number- y,, 1/4, Section q(crcle one ZZ T N; R —Bo II.Type of Building(check all that apply) Lot# A Y y/ 6 Subdivision Name 1 or 2 Family Dwelling-Number of Bedrooms Block# fr�lOhJ 6 k- 0 Public/Commercial i-Des�c ,U ❑ City of CSM Number ❑Village of C1 State Owned se � 71 ®-Town of l /D e') III.Type of Permit: (Check only one box on line A. Complete line B if applicable) Ze A. XNew System ❑Replacement System ❑Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain) B• ❑Permit Renewal Q Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV.T e of POWTS S stem/Com onent/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.Dis ersaareatm nt Area Information: a't' Design Flow(gpd) Design Soil Application gpdsf) Dispersal Area quire f) Dispersal Area Proposed System Elevation VI.Tank Info Capacity in To #of Manufacturer d Gallons Gallons Units n :? d v New Tanks Existing Tanks / d c :' 2 72 (.✓ v l O I�.,�z a U v� y A Septic or Holding Tank Dosing Chamber 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/h5W Number Business Phone Number A/ T Plumbe s Address(Street,City,State,Zip Code) V M.__SC o u n /De artment Use Only proved Disapp�oved Permit Fee Date sued suing nt Signature enial DL Cond easons for Disapproval r t rj�- IT 3, Ga ors t A 1,. Se ic'tank,effluent filter Find •�--•/ dispersal cell must all be ser0ces/maintained as per management plan provided by plurrtber. 2 All setck � nts must betnanaicl as per irAble erode/ordkwirAi: B Attach to complete plans for the system and submit to the County only on paper not less than 8 in x 11 inches in size SBD-6398(R. 11/11) MARY JO HUPPERT Page 2 5/6/2014 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. Oard 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 WiSMART 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. �otiraxTUE�� DIVISION OF INDUSTRY SERVICES 3824 N CREEKSIDE LA HOLMEN WI 54636 Contact Through Relay www.dsps.wi.gov/sb/ 'y w www.wisconsin.gov ADO sSION+� Scott Walker,Governor Dave Ross,Secretary May 06,2014 CUST ID No. 224832 ATTN.•POWTS Inspector MARY JO RUPPERT ZONING OFFICE HOLLISTERS SOIL TESTING&DESIGN ST CROIX COUNTY SPIA W9875 690TH AVE 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/06/2016 SITE: Kristopher&Jennifer Luedtke Identification Numbers 317 Empire Builder Dr Transaction ID No.2398980 Town of Troy, 54022 Site ID No. 801832 St Croix County Please refer to both identification numbers, SWIA, SE1/4,S16,T28N,R19W above,in all correspondence with the agency. Subdivision: Glover Station 5th Addition;lot 96 FOR: Description:Four Bedroom Mound System/—1%slope Object Type:POWTS Component Manual Regulated Object ID No.: 1483220 Maintenance required; 600 GPD Flow rate; 27 in Soil minimum depth to limiting factor from original grade System(s):Mound Component Manual-Ver.2.0, SBD-10691-P(N.01/01,R. 10/12),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. The owner,as defined in chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, co""' stats. DEp APP The following conditions shall be met during construction or installation and prior to occupancy or use: T OF$ DIVISR N�SSt0N Reminders: O F IND • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19,Wis.Stats. • Inspection of the private sewage system installation is required.Arrangements for inspection shall be ma the designated county official in accordance with the provisions of Sec. 145.20(2)(d),Wis.Stats. E CQRRES • 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. • The area within 15' downslope of the dispersal component shall remain undisturbed.Vehicular traffic, excavation or soil compaction is prohibited in this area. • 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. Note:Per CST's recommendations,the dispersal cell area shall be deep chisel plowed to a min.of 10"to help break,up platy soil structure found in the area. MARY JO HUPPERT Page 2 5/6/2014 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 ' 0 erardThis Amount Will Be Invoiced. M Swan When You Receive That Invoice, Please Include a Co With Your POWTS Plan Reviewer,Integrated Services Copy (608)789-7892,Mon-Fri, 7:15 am-4:00 pm Payment Submittal. jerry.swim @wisconsin.gov WiSMART code:7633 cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm Note: Effective January 2012 all codes under the jurisdiction of the Division of Indus Services(formerly rY � J �' ( Y 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. FE. MQLJND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Ov' Project Name: KRISTOPHER AND JENNIFER LUEDTKE Owner's Name: (same) Owner's Address: 1629 South Ridge Road River Falls, WI 54022 Legal Description: SW1/4 of the SE1/4, S 16,T28N, R19W Township: Troy County: St. Croix Subdivision Name: Glover Station 5th Addition Lot Number. 96 Block Number: NA Parcel I.D. Number: 040-1267-50-000 Plan Transaction No.: ?()eD D Page 1 Index and title 4 PETYAND Page 2 Data entry L SF �CE$ Page 3 Mound drawings STRYS •_*• •�. Page 4 Lateral and dose tank •' ,��.. Page 5 System maintenance specifications a Page 6 Management and contingency plan • Page 7 Pump curve and specifications • D V,3S E Page 8 Plot Ian N 9 p A /11 CE G �s3 Designer: Mary Jo Huppert License Number. 1859-007 Date: 04/29/14 Phone Number. 715-426-1775 Signature: Z!vg� z Aod-y-- 1-J fV Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P(N.01/01),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(R. 03/2012) Page 1 of 8 f Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) 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 1.50 Peaking Factor(e.g. 1.5= 150%) fecal coliform of-36 inches. 600.00 Design Flow(gpd) 1.00 Site Slope(%) 99.50 Contour Line Elevation (ft) 27.00 Depth to Limiting Factor(in) 0.40 In-situ Soil Application Rate(gpd/ft2) Distribution Cell Information I� 60.00 Dispersal Cell Length Along Contour(ft) = 10.00 1 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? Enter Y or N (C or E) a Center or End Manifold 3.33 Lateral Spacing (ft) If N above, enter the elevation (ft) 3 Number of Laterals of the highest point. _0.156 Orifice Diameter(in) 3.50 Estimated Orifice Spacing (ft)= 11.76 ft2/orifice _ 2.00 Forcemain Diameter(in) F 40.00 Forcemain Length (ft) Does the forcemain drain back? Y 90.00 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft)x 1.3 6.52 Forcemain Drainback(gal) 9.84 Vertical Lift(ft) 55.97 5x Void Volume(gal) 0.66 Friction Loss (ft) 62.49 Minimum Dose Volume(gal) 0.00 In-line Filter Loss (ft) 27.46 System Demand (gpm) 15.05 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. o tions choice in. dia. options choice 0.75 1.25 x x 1.00 _� 1.50 x 1.25 x ? x 1 2.00 1.50 x 3.00 2.00 x 3.00 x Gallons/Inch Calculator(optional) Capacity ty(g al Treatment Tank Information � Total Tank ) 1 1200.001 Septic Tank Capacity(gal) Total Working Liquid Depth (in) Wieser -I Manufacturer �� gal/in (enter result in cell 0349) Dose Tank Information Effluent Filter Information 800.00 Dose Tank Capacity(gal) Po�Lok _ ;Filter Manufacturer 22.24 Dose Tank Volume (gal/in) 525 _ Filter Model Number (Weiser _ �Y 1Manufacturer Project: KRISTOPHER AND JENNIFER LUEDTKE Page 2 of 8 Mound Plan and Cross Section Views 1/10 B ::.:::.......... . . . : : : : : : . . . : : : : : : : : : : : : : : : : : : :j`1 J Observation Pipe ..... .— . . . 8f°ra, .a,.ero,.,;°�,e.t,aar.z.r:r.r'a: .•°�..,p�,° ;}a-};,.5 ego,'.p,+ v�S°�2 `�i.>:.:cY'n"' S ` � . t•y ;S=i:'.°u,'41 4:4 a4a.p�v�4¢>,y_ ,°.'>:eO'ee°ca�.'v4�o•e:�a°n:r '..•.=;.v eo4av Sa. Sa'n� W 1. . . . . . . . . . . 'j. . .°. . . . . 1 . . . . B • • .-i• • • • • • ' • I . .�1'. •. •. .•.•.•.'. . . . . . . . . . . •.•. •. L Mound Component Dimensions Down slope toe extension made. A 10.00 ft E 10.20 in H 1.00 ft K i1ft ft B 60.00 ft F 9.25 in I 15.00 ft L ft D 9.00 in G 0.50 ft J 5.89 ft W 600.00 (ft2) Dispersal Cell Area 1 1500.00 (ft) Basal Area Available 10.00 (gpd/ft) Linear Loading Rate 1 6.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 102.02 (ft) --► 1 H .. G j I F Dispersal Cell 100.75 (ft) Lateral 100.25 (ft)--► Invert Dispersal Cell ] t Elevation D .... : : : :::•. 4 4 a 3 99.50 (ft) Contour Elevation 1.0 %Site Slope Geotextile Fabric Cover Shading Key m Q. 1.5 ft , T Dispersal Cell See lateral details on Topsoil Cap >� Page 4 for number,size, o �. �� � br � 9 Subsoil Cap e w and spacing of laterals. a Laterals are equally ASTM C33 Sand F Tilled Layer m 0-5 ft Tvaicai Lateral spaced from the Y c to ° . ",•:,a o' r distribution cell's Aggregate 1* 0 � 4 centerline in the A distribution cell(AxB). Project: KRISTOPHER AND JENNIFER LUEDTKE Page 3 of 8 End Connection Lateral Layout Diagram Center the Ilalerais over the A&13 dimension 4*a Turn-up vat!ball va l a or clew nowt plug P :411 sterile are id.,bk-B 1� ---dr l Flol es milled on the bottom of thr latest 04-aft Spaced I.elteralo 8:forcametin Sch 40 PVC peg SPS Table 384.30.6 g Forae main vannevtion eie tee as orrice to mimciiPOtd at an}point: "Zu aaer of I_atera"S 3 Orifce Diameter (-0.1561 in Lateral Diameter 1.25 in Orifice Spacing (X) 3.66 ft Lateral Length(P) 5�ft Orifices per Lateral 17 Lateral Spacing ;S; 3.33 ft Orl�ce Dens; 11.76 f�!orifice Lateral Flow Rate 9.15 gpm Manifold Length 6.67 ft System Flow Rate 27.46 gpm Manifold Diameter 1.25 in Total Dy-ia;c Dead 1 15.05,f! Forcernain Velocity 2.80 fUsec Dose Tank Information Locking cover with warning iabei and iocking device and sealed watertight Electrical as per NEC 300 and -� SPS 316.300 WAC Disconnect 4 in.min. Tank component is properly vented F— Alternate outlet ilocation I Forcemain diameter Weiser 1 Manw acturer 2 "r Capacityl 800.00 Gallons �- Volume 22.24 gal/inch A Weep hole or ant!_ Dimension Inches Gallons B I I siphon device A 20.26 450.61 C B 2.00 44.48 I I I °arn .fit s!svatior�(ft) C 2_.81 62.49 1 90.91 D 1_0.90 242.42 D Total 35.97 800.00 Dom elevation(ft) 3" Bedding un er tank. 90.00 Alarm Manuafacturer SJE Rhombus Note: Switches , Alarm Model Number Tank Alert AB containing mercury may not be used In Pump Manufacturer Gould this system. Pump Model Number PE41 , Pump Must Deliver I 27.46 gpm at 15.05 ft TDH Project: KRISTOPHER AND,JENNIFER LUEDTKE Page 4 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name Tri-County Sanitation Phone 715-386-2130 POWTS Regulator's Name St. Croix County Zoning Office Phone 715-386-4680 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 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/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 Moundl inspect for ponding and seepage once every 3 ears Other 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 Turn-up Detail Finished . . . . . . . . . . . . . . Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution . . . . . . . . . . . . Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: KRISTOPHER AND JENNIFER LUEDTKE Page 5 of 8 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),SSWMP Publication 9.6(01/81),and Pressure Distribution Component Manual Ver.2.0 SBD-10706-P(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 84nches 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 fitter 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 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 6 inches considered as an impending hydraulic failure requiring additional,more frequent monitoring. Continency 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. Project: Kg s7-o,v/me- I � R L��A�k� Page 6 of 8 04D FOULDS PUMPS Submersible c"Nuerrt Pump f PE 044ft PUW mom _Gertz: C 0 Con osion tint • D barge:t i4•NP? l� ConstnxftL . • TOmperatu re:104'P 0000 • 60 It ■cast iron body. rnanomum,motinums when • 115 and 230 waft ■Therrnoplask impeller and f*aged, • &&m the wemad pro- mver. • Solids handling:W tedwn with ahaana0c MSLt ■Upper sleeve and war rnWdm n • class B insulation. heavy duty ball bearing • Ahdonatk models include a •Willed design. auction. APKICA1!ti M (fit switch. • High Amngth carbon steel ro Motor is *ddy dedped for the • Manual models available. shah Urbricath:d for e�de�ed uses:following g fad:see PE31 Motor. serAm fife. Mound perkonanc a chart or curve. • 33 HP 3000 RPM r Powered ior narhthwas • Effluerrddosing Spstemc PE31 Phi • 115 volts • Low Pressure pipe System ' MaAmum capadty:53 GPM • Shaded Pole design ro A�fimm of the the •Baserrot Draining • Modmum head:25''TDH PE41 Motor: ■Quick is of he motor. ' �hN Duty Sump) P1E41 Pump: • AO HP,3400 RPM �length. Dowroatering • Maximum capacity:61 GPM • 115 and 230 vats 16/3 d hen with • Maximum heck 29'11)H ' n 115 or 230 vok grounding PE51 Pomp: PE51 Motor. plug. • Madmim capaW..70 GPM • -50 HP,3400 RPM ■CamOde unit is heavy duty. • Maximum head:37'TOH •.115 aril 230 volts portable and compam PSC desip ■Medunical seal Is Carbon, METERS FEET ceramic,WNA and stainless 40 Steel. W.33.A4.s0 i ■Sta�S 3te81 fasb2t1e6. T , 35 10- 2 GPM 30 f_ I 25. r s L ' C t15 a fill . TlS11Bd10ULiNd Q 20 CSA U2 109 5laedards z , ;-�—•:��,yt •��jl� 1 -J�� Gaddsiu�shR09AD11i�nnd, p 1 10 �( I , l• _t ..__.�;! _�. ry: 5 Lam. .�._. i.a----• �..,�...�. 0 t O . �`."'"y z . , ' , t' T1• L L -�'s 1 i1C35�.C"t cTW 7L -'ice. -"'rl� 0 10 20 30 40 50 60 70 C,PM 8(t IN.? of! 0 5 1 10 Is 110rh Plot Plan Page S of S Property Owner G-1 5m�wrf �SNfJ F;eA Lu6D7X9 1" = 40ft Legal Description Lz7 %, move z �o,� ,� , (except where noted) sw`IL 1-4 tE ---C- � 5 rZ9 r). �r��,. �w� � - -I L7 = Bpa�ckhoe pit �T C��'X ��UPI� UJ�S ��F1�`..'t� • Z•07� � North f,)ryIff PI L y zyq.LI9 00" 9*1 TDP pile, PIPF •so f e,ovr G'equA!! 1 � W 4 * E 0 1 3 Site Location: IS I Stu 40;1 5 2� SCALE W FW P=W { I 60 0 6@ IWIrjim tjsas ___------__-•- I I • e / r , lifill all r r� i ♦ / r � 1 � % t > e o s°°' sop f. al LAJ Sa � y' .......�. -100„x'•-•—•---- "� t ..� ! `- d ' F- Z LLJ Fm t fill ice/� � f V 24L4W . t0 CHATtANOOGA DRIVE '� ST.CROIX COUNTY SEPTIC TANK It%fAIl+tTENANCE AIEEMENT ' I . OWNMZS141P CERTIFICATION FORM Ownw/Buvar NWft Adds 2 PropertyAddress 1� API �uta {Verification wised from Plaaaiug do Zoaing Department fo constiue4ion:). City/State Parcel Tdenti&ation,-2Jt bet'.,Q" Z,(� 56 eve) L Eg ALES MON Pmperfy Locatiott /., Y. Sec TN �-- - subdivision Cerdf aii;Snrvey Msp# volume Page# } ( c Deed# Volwne Spec house yes Lot Imes Wmti W:.T no. SY"TEi1�I MAINTENANCE AND OMTZR CERTMCAT7ON I •" 1 i u�and mai oa a ofyonr sep�c:aytsemcootdse ntm b p�ewe fats#rut#o haredte Vigo". jto ::ofpumg mu i]xphc ttatcsvtt�► ec -craooa�r,�f ya What Y put uao � .�s�stem=si�axtheenof�e �t ���t -rr�at tee k A �'`.a�db�►at ' ,�� ,.. _Saar .� �x. �`w°T ': .. R 'aY1� y' ✓ -.� x 'r' '' 'c-r 'F a is MN Ld I i w 9 S r ° o 1 s+ W p Z.- CL o a _� `- } � o8 _■�� ■sue n N LL 0 s Cr i/t 3s 3FU _40 i/t /AS 3W JO 3NR .ls SaNd� CJ311bldNfl ' .LS'8L£t M r8S 09.10 S O rte. ^ i M + � •� ££1. �-�ri •8S'80L I ,4L �< o + .�N� L_ yt�! g Sr109L`81.t0 S °a .0080L N ! Bi't'6f 3 AZ.81.t0 N «iL.Bi.tO N - i a� W t F ,81T—K 9 .00 Os l �y i .£6'S6i 3 «iL.61.10 N L1^ .OS C) , 1.9 W. ,� LW ^M L61 3 .19.61.40 N z<v� ,CL'LLi` .00'09 Y °rg .£6'S61 3 «19.61. _ - , t0 N m � � N O _ 1 Z AN ost • 9 .00'OL dra I . m 17 3nWQ - �- 1.4 N ' --- -a3Olme •0e 118 M r1Z.81�L0 S O �+ 49 AN to c 0O 0O ° 0O AS 1 2 1 no► $ .09 �-- 1 4� o< .sr'6L9 � I � � ° � �r�g Al + rU.61.to N � n ~ , , ,► 0'099 .9969! ._ ..............:� "�!'. Z - o !'891 snro_ _�.. .. ..tl.. .<�...... y.. i�� i SCALE IN FEET 1"=60' i I 60 0 60 6¢, N89'S7'WE 249.49 LLA i 3 sR cc tar LM Z Y 0 i W Ll s PR0fq$fQ DMI SWAY '-�__ _ = Y i 2 2 2 i Q J a 1- z o �w �x W ` 5� W ' m S8rS7'56"W 249.49' �p CHATTANOOGA DRIVE <cm � CENTERLINE -AF _ ____._. ._ _ ---- _. .------..__ .. --- w 0 OUT w I OF 1 II Illllllllllillllllllllll 11 111 8 2 2 9 8 8 3 Document Numbpr WARRANTY DEED Tx:4188044 995953 BETH PABST THIS DEED made between Brushy Mound Partners, LLP, a REGISTER OF DEEDS Wisconsin Limited Liability Partnership ("Grantor") and Kristopher ST. CROIX CO., Wi W. Luedtke and Jennifer L. Luedtke, husband and wife, as 05/14/2014 11:26 AM survivorship marital property, ("Grantee"), EXEMPT#: N/A WITNESSETH, that the said Grantor, for valuable consideration REC FEE: 30.00 conveys to Grantee the following described real estate in St. Croix TRANS FEE: 169.50 County, State of Wisconsin: PAGES: 1 Lot Ninety-six 9{ 6 ,Plat of Glover Station Fifth Addition in the Name in Area y- '�>� Name and Return Address /yy�79 Township of Troy, t. Croix County,Wisconsin l4,39 7Z;dj, _P-,0,Zd I-eiVer F-IJ16, !,U I 040-1267-50-000 (Parcel Identification Number) This is not homestead property. i Dated this 8th day of May,2014. i I " Michael R.Stevens,Partne AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN — ST.CROIX COUNTY Personally came before me this 8th day of May, 2014, the authenticated this day of 20 above named Michael R. Stevens, as partner of-Brushy Mound Partners, LLP, a Wisconsin Limited Liability Partnership to me known to be the person who executed the signature foregoing instrument and acknowledge the same. type or print name TITLE:MEMBER STATE BAR OF WISCONSIN signature y (If not, type or print name Bernadette L. L'Allier authorized by'706.06,Wis.Slats.) Notary Public St.Croix County,Wisconsin. My Commission Expires:October 23,2016. THIS INSTRUMENT WAS DRAFTED BY Michael R. Stevens 'Names of persons signing in any capacity should be typed or Printed below their signatures. Brushy Mound Partners PO Box 445 BERNADETTE L.L'ALLIER New Richmond,WI 54017 Notary PpblioState of VViaoonalo St.Croix County 995953 Page 1 of 1 f � PROPERTY OWNER_ �3`-t� /SQ"UO-2 SOIL DESCRIPTION REPORT Page Zof PARCEL I.D.aY PQ)"JD)N C Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounday Roots GPD/ft in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Trench o-I b 1 t�, z Ground 3 2� cll2 7•S yl2 t//6 I.S-M S�� S3 cJ p Y►�`�'i NP .Z elev. Depth to limiting S L U factor ,� tv `(t 1j t 0 1►U 0 Remarks: Boring # Ground elev. It. Depth to — limiting factor Remarks: Boring # ... ., Ground elev. It. Depth to limiting factor Remarks: 3oring# Cti 'round ,lev. It. )epth to imiling actor Remarks: andHu 116partment of lationdustry, SOIL AND SITE EVALUATION REPORT Page I of 3 •and Human Relations g _ on of Safety 8<Buildings in accord with ILHR 83.05,Wis.AdW-, COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size Plan must i cIU jp but- S-7. not limited to vertical and horizontal reference point(B4,direction and'%of slope,s or CEL I.D.# dimensioned,north arrow,and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION D DATE J PROPERTY OWNER: PROPER ATION C f}�D -UEQQ\S S C 1+j L j 4 �� 1/4 S�"-• 4,S NOT �,N,R � E W ., q PROPERTY OWNER':S MAILING ADDRESS. LOT#, BLOC T .SU�D> AME OR CSM# Z SS TzLU ?S 1DE �2r uE °l .� V S1 olu CITY,STATE ZIP CODE PHONE NUMBER ❑ OWN ' NEAREST ROAD 1ZLUE 2- P CL S wl SyoZZhIS) q i.S- jalel _T'�Ml_f &rhP1RIr eu►L�pZ DTt. New Construction Use(,Q Residential/Number of bedrooms ( ] Additign to existing building [ ] Replacement [ j Public or commercial describe / Code derived daily flow b 00 gpd Recommended design loading rate _bed,gpd/ft2 - trench,gpdM' i Absorption area required Spy bed,ft2 St)O trench,ft2 Ma)dmum design loading rate •S bed,gpd/ft2 -�trench,gpd/ft2 Recommended infiltration surface elevation(s)_ \\)n, S ft (as referred to site plan benchmark) Additional design/site considerations 'M Ou>y-�, w l 5'x-61' 3ND . M liy, Ll14OF- S" H(-L Parent material L•c�ez3 av�Zt Flood plain elevation,if applicable M It S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING, TANK U=Unsuitable for stem [Is 9I U EIS ❑U [Is O U ❑S B U ❑S ®U 0S Eau SOIL DESCRIPTION REPORT Borin # Horizon Depth Dominant Color I Mottles I Structure g in. Munsell Ou.Sz.Cont Color Texture Gr.Sz.Sh. Consistence Bar>dary R Bed rend ki 4 R-- 31 Z Ground 3 3u-y Z.S�t R 31 s 1�� l eSb 1Z ltit�l' cS - - Z •3 elev. cJ�?tL ►.ip Depth to limiting factor l`, Remarks: Boring# � 0_$ 1rw1 D_ 31Z 3 -37 loy 2 316 Ground s I 1 elev. 37-L12. 1.Sv R 31 Depth to limiting factor Remarks: T Name:—Please Print Phone: Arthur L. We erer 715-425-0165 ' egerer Soil T sting & Design Service-P.O. Box 74 River Yalls,WI 54022 Signature: Date: _ CST Number . �, OU•lo3- °1 S -°t 220254 orand,Hu angel tiondustry, SOIL AND SITE EVALUATION REPORT Page I of 3 or and Human Relations ission of Safety a Buildings in accord with ILHR 83.05,Wis.Adm.Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size.Plan must include,but• not limited to vertical and horizontal reference point(SM),direction and fir,of slope,scale or PARCEL I.D. W G dimensioned,north arrow,and location and distance to nearest road. ' APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVI BY ATE PROPERTY OWNER: PROPERTY LOCATION e M`� $ C ftLD �1Jr.1\S SCHUC ZZ GG;9.66T SW 1/4SP 1/4,S 1�6T Z.�,N,R Lq E(or W PROPERTY OWNER':S MAILING ADDRESS. LOT# I BLOCo SUBD.NAME OR CSM# ,-' Sa XZ-' LV ZS1DE _D2bUE 910 — GL \\) S-Molu S`-A P,�D . CITY,STATE ZIP CODE PHONE NUMBER OCrrY OVILLAGE ®TOWN ' NEAREST ROAD 1ZW�^fZ S w1 sgo17L S) qZ-S'- $lbt �Za`( A1RE8u►t_ jZDR- New Construction Use Residential/Number of bedrooms y [ ) AdditiQn to existing building [ J Replacement [ J Public or commercial describe Code derived daily flow b 00 gpd Recommended design loading rate_gibed,gpd1ft2 - trench,gpolft2 Absorption area required SOU bed,ft2 SLIO trench,ft2 Ma)dmum design loading rate S bed,gpd/ft2 -b trench,gpd/ft2 Recommended infiltration surface elevation(s) 1\)C�. 5 ft (as referred to site plan benchmark) Additional design/site considerations 'M OU lUn W l g'k6 3` B,ND - M l/v. Ll"OF-Sfb,,n H LL (sue rvo` Oki "L\� Parent material Ltz e-s3 oL NZt LIwL� -rwrr Flood plain elevation,if applicable NA It rU-= uitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK nsuit able for stem ❑S 91U ®S ❑U ❑S ®U I IDS BU ❑S ®U I [IS la U SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color Mottles (Texture I Structure ICons�stence l Baixi�y GPD/ft in. Munsell Ou.Sz.Cont Color Gr.Sz.Sh. Roots I g� r�dt o-l L l4`i R- 3 1 _ s i I Z BIZ Y4 Z tz 3o t 4`�R 316 _ S i 1 3`PS�I�t YK S •S -6 Ground s t cl 1 eS�12 1n�I' cS — • Z •3 elev. 7 ft lj y J - l b`l 2 613 — 1`SgR ►.ip Depth to limiting factor r i r /-__.11 Remarks: Boring# °'g 1011 R 313 wl"F- cis -S si 1 Z S m S C- .` S Ground elev. 37-Llz. -).Sty 31 Od—.I f �D`r26l3 _ ZS BR _ — - l.^? 7.►p Depth to limiting - factor • h L � Remarks: 27-Name.—Please Print Phone: Arthur L. We erer 715-425-0165 ' egerer Soil T sting & Design Service-P.O. Box 74 River Yalls,WI 54022 Sgnature: Date: CST Number oJ o o3�— q . 220254 PROPERTY OWNER Z-11, /SCOW O-Z SOIL DESCRIPTION REPORT Page Z of PARCEL I.D.# PeN3b N C Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Y Roo Consistence Bed Tiendi y.y.. 2<:r 3 N o lj tz 31-Z .S Ground 3 Z �•Syf2 -�12 yl6 -�.S�iQ S1� S1cJ q 1ti`Fi NI •Z elev. 9 31t. 1 2 1 2_ y u2- U Y � 3 LS 1-3)'Z NN> Depth to 1 dt \'cl�Pt12. P limiting L UC factor 2� f-3 �1 t p )►v Z� tJ►attiG- Remarks: Boring # - Ground elev. 1t. Depth to — limiting factor i I Remarks: Boring # Ground elev. 1t. Depth to limiting factor Remarks: 3oring # around ?lev. It. )epth to imiting actor Remarks:_ J i PLOT P LAN I Page 3 of 3 SO - L'1 . �0o•2�oN to"tn6it, 3/cP D/q, PVC ?LM�� W� 3.6' L�1GN • 3.9' 11t6t+ PVC M�k�'Q i� -Z / oo NOl' eo�rn-e oR E-09 �' o�sYurza s I Q-wr-oQ2 G_ .ctq.S BUY TDk� OF app eL, WU.S ; I I I 1 f C 'S"C A iv Go CA -I: \-?-I V F oo-\o�-qb f S 71 5 ) L4 s- oils ZZOZS(f CST# GST Signature Date Signed Telephone No.