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HomeMy WebLinkAbout020-1260-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 80 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: City Village X Township Parcel Tax No: Hermes Land Company LLC Hudson, Town of 020-1260-50-000 CST BM Elev: Insp.BM E/llev: BM Description: /� 2 .� Section/Town/Range/Map No: cr(` /J'' J �5 21.29.19.1258 TANK INFORMATION A ELEVATION DATA TYPE MANUFACTURER CAPACITY STATI BS HI FS ELEV. #Z 10 Septic '4 J� O^ I� Benchmark ' /�• 910.3 Dosing t�✓w`�O �� Alt.a4 OJ*_ Bldg.Sewer 7. 3 Holding St/Ht Inlet $,r I LP 9Z \ TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic > 01 35' t �I G / Dt BS �( �Z • �7.g Dosing �-+1 Header/Man. o -01 =T f (a AC 13 .c,S Aeration Dist. Pipe Holding. Bot.System/['6ovF°I C� �+ 3 Sc"3 Q f PUMP/SIPHON INFORMATION Fina de Manufacturer / Demand St Cover Z-6 eJ LA— GPM Model Number AJ > 20 TDH Lift Friction Loss System Head TDH Ft G9•-, 3 ti N , yt1aM Forcemain Length / Dia. .l Dist.to Well D > 35 SOIL ARSOR15TION SYSTEM BED/TRENCH Width Length / No.Of Trenches. PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 1 --d SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufact CHAMBER OR ur: INFORMATION w Type f System: Md f A '�(,J4,.. UNIT Mo Number � 5� v ' DISTRIBUTION SYSTEM a5 C r I nifolti Distribution x Hole Size x Hole Spacing Vent t it Intake —L�// Pipe(s) �/ Q \Dia Length_ Dia Spacing r / �-V SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over / Depth Over xx Depth of xx SeededlSodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil F-� n/ + Yes No Yes i_ No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#oia/ ( Inspection#2: Location: 568 Stagecoach Tr it Hudson,WI 54016(NW 1/4 SE 1/4 21 T29N R19W) Prairi 2nd A d Lot 19 Parcel No: 21.29.19.1258 1.)Alt BM Description= "" `G� 6 J�`" /6 a'7 2.)Bldg sewer length= -amount of cover= �� � � l� � /��/�� -Tt' a.� _ �� k Plan revision Required? ❑ Yes X No Use other side for additional information. L - SBD-6710(R.3/97) Date Insepctors Signature Cert.No. N� %sue `/y� sz/ T^� ,�✓ 'o'4'e,4j �- �► c 604 46lk''� r® f;KA 1 6 5 rJ 3— ;l, 77— 6 cc t ,� �-t►�t T w�F F�l�r,� l pl� RECEIVED Safety and Buildings Division Coun ty 201 W.Washi n1 v.�e BOX 7162 Sanitary Permit Number(to be filled in by Co.) �! JUN 17 2Q14 M o1 7� 2 ST.CROIX COUNTY vv� t vv G anhK IRTMit Application State Transaction Number In accordance with SPS 383.21(2),Wis,Adm.Code,submission of this form to the appropriate governmental unit 1,,J A 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 L^ _q/ purposes in accordance with the Privacy e Law,s.15.04 1)(m),Stats. �jg C (' I. Application Information—Please Print All Information Property Owner's Name N Parcel# V T P d�-� ��`I Oro-1 2100- 5c) -600 Property Owner's Mailing Address Property Location i v Govt.Lot City, Zip Code Phone Number w e1,l ;4i�WAI' P k'r►''°'L/ Stv /a, Section O/ �_ � 0557 circle one(f v T �� N; R�E or V� II.Type of Building(check all that apply) Lot# or 2 Family Dwelling—Number of Bedrooms l Subd(iwis�ion Name t I Block# �1�—f'r�1�.6� V`���� At ❑Public/Commercial—Describe Use ❑ lla ity of e of ❑State Owned—Describe Use CSM Number g Town of �.�I.JV III.Type of Permit: (Check only one box on line A. Complete line B if applicable) A. .New System El Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System(explain) List Previous Permit Number and Date Issu d B. ❑Permit Renewal Permit Revision `Change of Plumber Permit Transfer to New ���� l4 Before Expiration Owner IV. a of POWTS S stem/Com onent/Device: Check all that apply) Non-Pressurized In-Ground ❑pressurized In-Ground ❑ At-Grade Q Mound?124 ig,.of suitable.soiL Mound 24 in.of suitable oil ❑Holding Tank ❑Other Dispersal Component(explain) ce(explai ) V.Dis ersaUTreatment Area Information: "<� Design Flow(gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required(sf) Dispersal Area Proposed(sf) System Elevation A� 1 SU . 7 l 0�7� ✓ ® !4 t VI.Tank Info Capacity in Total #of ufac er L.i .�►, Gallons Gallons Units a c New Tanks Existing Tanks a a U r%, Septic or Holding Tank Q i 1 ' l "K Dosing Chamber U �"L VII.Responsibility Statement-I,the undersigned,assum sponsibi'y f nstallation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber's i atur MP/MPRS Number Business Phone Number �Oo S1i r-YZ- 3a �� ��-013 Flo Plumber's Address(Street,City,State,Zip Code) p VIII. ount /De artment Use Only' Permit Fee , Date ssued suing Agent Si natur Approved ❑Disapproved $ Ce) G� ❑Owner Given Reason for Denial �' f / J IXS�I Y ra# roval/Reasons for Disapproval 1.Septic tank,effluent filter and dispersal cell must be serv_i__ d/M_00ritated as per management plan provided by plumber. 0 2.All setback requirements must be maintained as per applieable ✓ M S.plans for the system and submit to the County only on paper not less than 8 1/2x 11 inches in size SBD-6398(R. 11/11) s Private Onsite wastewater Treatment System Index and Title Page Project Name: Owner's Name: Pit Owner's Address: ' " F AIX) Legal Description: ,asp/ N Municipality; Village, City of County: ---7 Subdivision Name: Lot Number: Block Number: Parcel I,D, Number: Q /��©— U Page 1 � Page 2c�— Page 3 — ` red°' # Page 4 Page-5 Page 6 Page 7 Page Page 9 License Number: Name of Designer: f�/.3S'��Z. Signature: Date: l3 Designed Pursuant to the Followi Ow Component Manual Pw2pr-S � 6 h i E I I t i AKA I OD i' L mot' �';?r�iJ a�J � � - �i/� ,5,;`7 ','�✓y'N,1�., • -ZUtuLL��,� �vwt�Q Leaching Chamber Dispersal Cell Cross-Section ft Vent Cap at Distal Ends 4" Schedule 40 Final I Grade Elevation Water Tight Cap at Manifold End Pipe With Vent 3 3 Cap (typical) ft �---- Top Elevation Leaching 10 Cell 1 Cell Cella ft Chamber ` �— 4-- System Elevation 2.84 ft S ft S ft Dispersal Cell Plan View ASTM o 3� -71--ft 4" PVC Pipe 2.84 ft ---�,--� Leaching Cell 1 S ft / ft(typical) Chambers M1 111111111111111111 111111111)�M__ Cell 2 Vent Pipe (typical) Observation Pipe (typical) Cell 3 I Leaching_Chamber Specifications Infiltrator QUIck4W0 Chambers 3 rows of /S chambers each plus 2 end caps on each row (3 cells )( 5q )(20 sq. ft. EISA) + (6) (2.9 sq. ft. EISA/endcap) _ 1497 sq. ft. total This dispersal system is designed at 150% of design flow and only 2/3 of the system needs to be in use at any one time. Therefore, one cell in rotation may be turned off to rest each year. Project Name: 9d T `3 N, R E o Town of l50� Signature: �(' License Number: A'p agdI`O 7— Date: Page of • !`.♦ J.r r. •• .. r •.tir I ...J................. . •. •\'• •.... . . .. .•,....�,....�r..+r\.+ww..a..�� •r• •,r.1��.•..., � ... .. �...w.l.n..+.ww�wA.r�www�./.e�•ry�....... • •� WN't�i�tXltISIJ1� . ld�r'h►S�*GC-�A t9Vi4K W�►LCi�at **�. 4!+ PYC �.4r� J7t. n1 ip ubibTURUD - d�` 40 S41 ZQ u .%.'0. �} Yf�titT Ma-4a1uQL� i'. A / spy 0Nw!vi� 4 0 �S ^o �L. `L. . 3'owro P iwEvrio" "" 6tou�co b In D b$L ,� 1- -..w`� TA �AUUFACTQILCR: 00, DCsb"Lf: �..,r,,..,ILk .C•�•i1 TAWK S[Zt , Ilp09 1400 -6 AL,401Ji OC1SE VCtUM�. AL.AILA AA6WP'^CTUX tQ: S �1 t' v IUCI UDIIJG i�G1G/44W: I(ov G�LLO�►S' hoot� d a w OPACITIES: As,3�IUCACS 0A 8 w;.Lous swircw rCg,4,J 1Gv+�L.._ g s,,,l;,_lucuts 04 5 '6 �" ....�. "U.:0, S �UMC /1A6JUrAcTUKCR: � �-L ✓Z . IUGKCi 09 ALLOWS MpOCL 1.1U1�ADLR: 0�..-�d tuUwES cc 2:03 (JAL L.014 �wITCI{ Tbi.a[; {1q' °. n',ji� "L- _ _ .....,,.... WCTCi PUAP AWO M o.KA ARC or* 6L f"tIUIMUM CJSGK/l1l(r[ SAT'=--,.,�.�.«,�,..,,,.,;, 'y►M� �NSTAtI.EO Ou SLIA�ATC C1KCU�Ta /CRTi6AL OrritRCUCJ 6cTwcrki PU1'v Orl AQ0 513TtiWTIOU PtOC.. MY t M�ulKUn '�CTWCKK SUPPL tRttSURt . . . . , , — l=ECT p . + & FEET ET OF FOkCC t-%AIW X 1,.3 ! F iK�t lou VACTdx..� ' J7rCsIJ*" dIMCU6t044t or TAUK: LEU47.11 �.��,,,lW 0fiN � _�...,. i �.IoU10 otp rw 67' 57' 10' 3' 54' N CA J D Cn • N N Z m w w m 20' 2' r9 r r D z r m Ll c n D f1 O `13 C3 u u Z go m Ln C3 D t,,,'I, �• r �7I�IXI—� m v .r. 4' 1 63' N N A m ru e < d d ey � D V D O v m 53' A x o A N 3'L N i i N p�=D r y I A o D m e g m d 6.5' gi ri gS Mr DfZ'7 m M C6 Om --i <fm" u u >m m m N O, • m C C w (n D C r f7 yH g Z -4 po A A A O D O y 55' 12' m W m 52' A g a<rn mA �p S4 w � r Z D F d Cn D PROJECT HUFFCUTT 4154 123rd STREET �1 I�.P.C.A. CERTIFIED PLAN CNO'PEWA FALLS, WI 54729 a 1 & 1,600/1,400 GALLON 'a A (715) 723-7446 [ (900) 924-1516 MEMBER OF: PUMP OR SEPTIC TANK C Q A C R C T[. (A C FAX (715) 723-7111 ■ www.huPFcutt.com NATIONAL 3 wsCONSq�PRE ASSOCIATIONS of TOTAL DYNAMIC HEAD/FLOW 1,— UJ PUMP PERFORMANCE CURVE PER MINUTE MODELS 53/55/57/59 EFFLUENTAND DEWATERING 6 20 MODEL 53/55/57/59 ir Feet Meters Gal. Liters 15 5 1.5 43 163 } 4 10 3.0 34 129 a 10 15 4,6 19 72 -7, 00e8e7 Shut-off Head; 19,25 ft,(5.9m) 2 5 37/8 63/16 4 518 1 112.11 112 NPT 0 10 20 30 40 50 37/8 GALLONS LITERS 0 80 160 FLOW PER MINUTE a I I CONSULT FACTORY i FOR SPECIAL APPLICATIONS i I • Variable level float switches available. I • Variable level long cycle systems available. • Available with special cord lengths of 15', 25', 35' and 50'. i • Alarm systems available. 101f16 • Duplex systems available. 33/32 I SKa58 Sin le Seal Control Selection Listings SELECTION GUIDE; Model Volts Phase Mode Amps Simplex Duplex CSA UL 1, Integral float operated mechanical switch,no external control required. M53155&M57159 115 1 Auto 9.7 1 Y Y 2.Single piggyback variable level float switch or double piggyback variable level N53155&N57159 115 1 Non 9.7 2 3 or 4&5 y y float switch.Refer to FMO477. BN53 115 1 Auto 9.7 y y 3.Mechanical alternator"M-Pak"10.0072 or 10-0075. 'BN57 115 1 Auto 9.7 N y 4.See FM0712 for correct m del of Electrical Alternator. 'BE53157 230 1 Auto 4.8 Y Y D53155&D57159 230 1 Auto 4.8 1 --- Y Y 5 Variable level control switch 10-0225 used as a control activator,with Electrical E53155&E57159 230 1 Non 4.8 2 3 or 4&5 Y y Alternator(3)or(4)float system. Single piggyback switch included. CAUTION For information on additional Zoeller products refer to catalog on Piggyback Variable Level FloatSwilches,FM0477; All installation of controls,protection devices and wiring should be done by a qualified Electrical Alternator,FM0486;Mechanical Xternator,FM0495;Sump/Sewage Basins,FM0487;and Single Phase licensed electrician. All electrical and safety codes should be followed including the Simplex Pump Control/Alarm Systems,FM0732. most recent National Electric Code(NEC)and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGNS For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O.BOX 16347 Louisville,KY 40256-0347 Manufacturers of.. SHIP 70: 3649 Cane Run Road p Louisville,KY 40211.1961 �(lrY/'•'*w lww 4,7.(502)778.2731-1(800)928-PUMP http:/fwww.io#II*r.GOm 414r. FAX(502)774.3624 ©Copyright 2004 Zoeller Co.All rights reserved. t imef' ,l er to Installation and Maintenance Instructions Installation Step 1 Dry fit the filter case onto the outlet pipe going to the drain field. Ensure it is centered directly under the access opening. (if outlet pipe is already in a fixed position,additional pipe may need to be added) Step 2 If utilizing the additional single side support and the two bottom supports: While the case is still dry fit to the outlet pipe, measure and cut 1 schedule 40 pvc pipe to the length needed to extend from the hubs that are pre-molded into the case to the side wall and the inside floor of tank. solvent weld pipe Into the hubs that are pre-molded onto the case. Step 3 Solvent weld the case to the outlet pipe. Insert the filter cartridge into the case pressing down on the cartridge until it locks into place at the bottom of case, Step 4 if utilizing a vertical read switch: Insert switch into the hole pre-molded into the top of the filter. Press straight down until it locks into place Maintenance 1) Remove the access lid of the tank. Note:To ensure undesirable solids do not exit the tank and into the drain field,the tank should be pumped out until the level of effluent is below the outlet level of the tank. 2) To remove the filter cartridge from the filter case, pull up firmly on the handle of the cartridge dislodging it from the case. (if utilizing a vertical read switch, removal of switch is optional) 3) Using an ordinary garden hose, rinse the filter cartridge ensuring all visible septage material is removed, 4) Place the filter cartridge back into the filter case.pressing down on the cartridge until it locks into place. 5) Place the access lid back onto the tank ensuring it is secure. Lifetime filter has a lifetime limited warranty: Lifetime filter LLC warrants the filter will be free of manufacturing and workmanship defects during normal use for the period of time the original purchaser owns the product.Lifetime filter will provide a replacement filter in the event that the original filter was not damaged during the installation or maintenance process.Damage to this product caused by accident,misuse or abuse will not be covered under this warranty.Improper care or malfunctions resulting from product not being installed,operated or maintained properly will void this warranty.Lifetime filter assumes no responsibility for labor charges,removal charges,installation or other Incidental or consequential costs. Contact:mike@lifetimefilterllc.com Phone:502-724-2231 � 9 J y� a ;� o � � �._� rn < <�„ � '" � M � a � � �ca ;. D �.,• �► ,D ':`�`�F e a 8 ���� l� �' �'�D. / I ,, o ,-� � �� � hr � r✓� cy� ! ff I 4 N S �l�) w � �} 1 i i .� I � �r .�►1±,�� E .� � ,, w ,�. `�"' i � 4 i® `�?':• �`�V Safety and Buildings Division Cou�n�t 4, 201 W.Washington Ave., P.O. BOX 7162 Sanitary Permit Number(to be filled in by Co.) I Madison,WI 53707-7162 3° � N� A110 510/ S d 0 Mary Permit Application---_ State Transactipn Number In accordance wi*:§P 1(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit /'C is required prior��** ming a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Add ess(if different than mailing address) the Departmct prior and Professional Servies. Personal information you provide may be used for secondary oses in accordance with the Privacy Law,s.15.04 1 m,Scats. y �•U�/ I. Application Information—Please Print All Information Property Owner's Name Parcel# t/ O C*T-Mes Lcty% J �'t�> L' �n r:5 Cole V rt� 0 2.0 — 12b D "Sp "OO b Property Owner's Owner's("Mailing Address n , e Property Location �j 5 Z 3 R os e Lct w AT�f. w Govt.Lot �d City,State Zip Code Phone Number N W 1A � � /, Section V.- SS/1 3 t circle on e T Z g N; R E ot0 Z II.Type of Building(check all that apply) Lot# / 61) r 2 Family Dwe 'ng—Nut er of Bedrooms / Subdivision Name ril _� lock# 111 111 �YG (, 't e V151 A ZivD: ❑Public/Commercial—Describe Use ❑City of ❑State Owned—Describe Use CSM Number El VVil age of L�YTown of 0 J S O� low— III.Ty er it: (Check only one box on line A. Complete line B if applicable) A. New Syste El Replacement Syst Treatment/Holding Tank Replacement my 40 Other Mo ti, stem 4(expla* B. ❑ Permit Renewal ❑Permit Revision ge u be ❑ e ransfer us enrtit Number and to I Before Expiration Owner IV.Type of POWTS S stem/Com onent/Devi Check all that a 1 Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in of sui le soil ❑Holding Tank ❑Other Dispersal Component(explain). ❑ retre me t De ice(explain) V.Dispersal/Treatment Area Information: Design Flow(gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required(sf) Dispersal Area Proposed(sf) System Elevation L�Q -7 SO a .� � 107 Z ✓ /o a � q3. Z VI.Tank Info Capacity in Total #of Manufacturer /� Gallons Gallons Units N —ID a U' New Tanks Existing Tanks/ Y a U Septic or Holding Tank Dosing Chamber l Q 0 P t,rJSCSGr. X VII.Responsibility Statement-I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plum er's Signature MP/MPRS Number Business Phone Number p o i_ A. s Ara - 3 V 7 1- -7 IS "S-//'(T Plumber's Address(Street,City,State,Zip Code) 9- 0- Qex " 3 18 w ', w ; .S< . C-Z/ 0 2- 8 VIII.C4unty/De artment Use Only Permit Fee D21su I ing Agent Si atur pproved ❑Disapproved $ �� dlj❑ Owner Given Reason for Denial - IX.Conditions of Approval/Reasons for Disapproval 3 /I L}' SYSTEM OWNER: �� '.� 1.Septic tank,effluent filter and S �L dispersal cell must be servir�d/mpin fined / ' as per management plan provided by plumber. G -® e Y�-�� 2.All setback requirements must be maintained as per app(cable for the system and su{,it to the County only on p ern ess than 8 to x,11 mches innssiize— SBD-6398(R. 11/11) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE : Project Name . C-0/e �'e,P T;L Owner's Name: "n cl Co. (C h x►5 Ca 1 G Q v,1 ec Owner's Address: 5 Z3 Ro s c l q-y\ A��•�► �oscu,l<<, 1'1'1 n Legal Description: y VJ II `/4 E ��4 S C I T2- N R I W Township: d50►+ County: 5 C r o y� Subdivision Name: �vGt(�rr-�'� Vf S N� AD, Lot Number. l Parcel ID Number. O L O - 1260 -S D- ao D Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing &Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St.Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test&House Plans Designer/Plumber. 3-6 c_- A , License Number. 2 Z 3 c/7.� Date: Phone Number 6$G/-- 4'5-/6 T Signature _4 Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P(N.01/01). Page 1 d (�erfv% �co, Z 3 a wv� y�► C. 5 asp L M N{°n r� 5s � N cYy S21 T 2A OV N o ; v I R N is a TuwH 0-0 Rti 'A a �ji 1 J h 'i r�D# b2D- /21.0- 4-0-00% top i 1 I f t t g. s V � 5 yK 3 : gal 4 {� Rog. � s G4: 2 a i W i Soll Absorotlon Systyn Cross Section ♦_96Zft ft 4'SchWUIS 40 Rnal Grade PVC Vent Pipe with Vent Cap 9y,Zft Leaching Chamber �-- ft System Eleivallon ft ft ft I Soil Absorcfion System Plan View ft ft t ft Leaching Trench 1 Chambers IV Dia. Trench 2 Header Vent Or Observation Pipe Trench 3 Leachirm Chamber SoeciBcadons Manufacturer And Model C k 44 w EISA Rating Z 0 sq ft per chamber Soil Application Rate C Y gpd/sq ft -76() gpd Design Flow-: ©'_Soil Application Rate Z O EISA= 5q Chambers 3 rows of—La—chambers each. page -3 of 54"" 2 41" c0 84" r m 461" r Der r r m r D N C-) m 0 I m O m r r �CD r r r r '. i r r r r r r r r r 1 r r r W _ Z .A D3O 43" M 0z:=! Z m=O --I (noz m � C7 C N I O ZEN Z D O r c m m �0 D Z -� rm�rmm0m�tO nD Z �� O C� O�Z D Z o��ZLn>00Dm DZ 0 rtn 0 D -r00 (n O G�Cp�G�OZm-�iFz a�`!' � _ (n > MOO M00 -4 =moo-Kwo M r- < O SDC �mC ,ri2m .. -z m Z InF -+<r��Cn•• :W 75 , _ - TiYw C p rr*7 rm O w WM> 1 °W��0 w D O u� N * G N N 0-rl D 0 co O -0 D o rn0 0 oZ z > mDm m� m 'O 0. < - " - n m0 Z =rZ rp r 0 x f7f=1 O Z < C D p m D I=JCJ Z rT� m :l7 0 N rn O - D (n �l D m o-� pO c 0 O (n 4 o 0 2 p m -0 ri T 0 00 z $ Ln 7� O m Z z z A a o � � M Z o c� m l C, Typical Pump Chamber Layout Approved manhole cover with Weather-proof warning label and locking device junction box Final grade disconnect 4" Tank is Alternate propery vented oudst location 18" min. Electrical as per NEC 300 and Approved SPS 316.300 WAC outlet Tank full joint C Inches Gallons IA Provide 1/4" o A Alarm on weep hole or antisiphon C ° ': /to 5°., PuB device. Total$ � P Choose larger tank or decrease D JL 3"Sedding under n I a f Pump manufacturer -7 ' *%)W Alarm manufacturer Pump model number -rAA ,4 i,cr Alarm model number Project: Transaction Number Page 4 of 7 -Fvt Lfi�n orj 7i4fVP4V �o I' TT GOULDS PUMPS Wastewater � P PERFORMANCE RATINGS COMPONENTS Total Had Comm Per rom OL of water) K%Mft EP04 EPaS 1 In 5 53 — 2 Base6 10 46 6 to 3 Pump Casing e 15 55 4 1 MK4-Mcal Seal 20 21 46 5 1 Bal Bearings 7 25 0 33 6 O- ngs 8 30 — fi 9 7 Power Cord 5 l 8 01 awd Motor 4 Motor Housingl 9 StmrAswmWy 1 10 Motor Cover METERS FEET 10 EE .I 30 5 GPM � a i 8 � �— j � '• 2.5 FT 25 • d� 7 u 6 20' I i a 5 I i 7 3 - EP04 — - 0. 00 10 20 30 40 50 GPM 0 2 4 6 8 10 12 W/h CAPACCCY 3 61" 86" 39' c° rj m a 451" ( ; W3.;00 m 0 m i � r i rn aso � 4 ri p a 3_ I A S i r0z i a s u i u tun)rat AEmri A N G NLS+ Z rl -4 42" 1 P vo Com r Z O \X (6 D. Z r D O O x C) "- r D rrL i rn rno fn N g o = C o O rn 0 0-19 -c aZrny Z n r+ltz Z Dj2 m arF; Nri���N p�N D EE ,. O v z O n� oo NmD I r La p. ��- Z O V� ;tC W N0-7 D1 �o�N O n� D N� �f^-� m z z o n rn1rn M:ie N o O nO� " 2 DO 4b v O Q C a-0 C Z , D C p ir- 0 p- �O r r j p i o z; m y to -i �E9 m m D-n Z Zr z Z 7C � N� A 0 8 0 rrn s rr Mound System Management Plan Pursuant to SPS 383.54,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 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 t/ 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 ommerce. 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 ne ssary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mou '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 104 du/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. Continoency 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. ` � I -a.ry APP 1<<a�.-f-►"o-�-� 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: Lo r ?t61 r rc 2 V S-r,4, 7 ip ,d d Page 6 of 9 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owne Buyer Christopher Cole ` &�,�° d Ca= ��c" Mailing Address 370 Baer Dr., Hudson, WI 54016 Property Address Stagecoach Tr., Hudson, WI 54016 filcati`on, required from Planning&Zoning Department for new construction.) City/State � J DSD t� Vl/ Parcel Identification Number 0 2 '- r 2 &Q-- S4 LEGAL DESCRIPTION ' 1 Property Location N 'A , 5 E ''A , Sec. , T Z� N R W. Town of AS O�^ Subdivision Plat: 1 1r6( tyf c Vi '<'7-"q 2/II). ADD, , Lot# Certified Survey Map # Volume Page # Warranty Deed # 9 J �J�� (before 2007)Volume , Page # Spec house❑yesT�o Lot lines identifiable Zes❑no 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,hercin,as set by the Department of Safety :And Professional Services and the Dcpurtrnent 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 this 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 aQwarranty deed recorded in Register of Deeds Office. Nu r of rooms 5 SIG ATIJRE 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) Wis.Dept. ety and P t l�'nal Services SOIL EVALIJATUC N REPORT Page 1 of 4 Division of afety a Bugs d� N GG� J MTfi accordance with SPS 385 Wis. Adm. Code G 01? County St Croix Attach complete sit� l a l�¢�per not less than 8 1/2 x 11 inches in size.Plan must include,but notd 6te� .vertical and horizontal reference point(BM),direction and Parcel I.D. 020-1260-50-000 percent slope,sp r dimensions,north arrow,and location and distance to nearest road. l �2 —O Please print all information. eview/ed Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). d h",✓{�. I Oaj/y Property Owner Property Location ® El Hermes Land Company LLC Govt.Lot NW 1/4 SE1/4 S 21T 29N R 19E(or)W Property Owner's Mailing Address Lot# Block# SSuub-d..Name or CSM# 523 Roselawn Ave.W l �'Q t rte�' +S 2�D' City State Zip Code Phone Number City Village Ljjrown Nearest Road Roseville Mn 1 55113 1 ( I Stagecoach E] New Construction UseE] Residential/Number of bedrooms 5 Code derived design flow rate 750 GPD Replacement Public or commercial-Describe: Parent material Outwash Flood Plain elevation if applicable N ri n ft. General comments Conventional System and recommendations: System elevation 93.00 Trenches spaced and depth to code FT] Boring# ® Boring El Pit Ground surface elev. 97.2 ft. Depth to limiting factor >128 in. =Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. ff#1 ff#2 1 0-15 1OYR2/2 --- sill 2msbk mvfr as 2m 0.6 0.8 2 15-32 7.5YR3/3 1 2csbk mfr cW if 0.6 1.0 3 32-38 7.5YR4/4 --- sl 2msbk ml cw -- 0.4 0.7 4 38-128 10YR5/3 --- s Osg ml -- -- 0.7a 1.6a 2 Boring# Boring 97.2 >120 El pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. * ff#1 ff#2 1 0-12 10YR2/2 --- sil 2msbk mvfr as 2m 0.6 0.8 2 12-25 7.5YR3/3 --- 1 2csbk mfr car if 1 0.6 1.0 3 25-41 7.5YR4/4 --- A 2msbk ml cw __ 0.4 0.7 4 41-120 10YR5/3 ---- s Osg m1 -- -- 0.7a 1.6a *Effluent#1 =BOD >30:5 220 mg/L and TSS>30 <150 mg/L *Effluent#2=BOD <30 mg/L and TSS <30 mg/L CST Name(Please Print) gnature CST Number Thomas W.Gedatus 962178 Address Date Evaluation Conducted Telephone Number Stang Plumbing&Electric P.O.Box 263 Woodville,Wisc.54028 05/05/2014 715-684-5166 SBD-8330(RI 1/11) Hermes Land Company LLC 020-1260-50-000 2 4 Property Owner p y Parcel ID# Page of [-3 Boring# ® Boring 96.3 >120 Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft Z in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *1=-ff#1 * ff#2 1 1-8 10YR2/2 --- sil 2msbk mvfr as lm 0.6 0.8 2 8-16 7.5YR3/3 --- 1 2csbk mfr cw if 0.6 1.0 3 1--24 7.5YR4/4 --- sl 2msbk ml cw -- 0.4 0.7 4 24-120 10YR5/3 --- s Osg ml -- -- 0.7a I 1.6a 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 onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. * ff#1 I:ff#2 E Boring# �Boring pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 3 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. * ff#1 102 *Effluent#1=BOD 5>30<220 mg/L and TSS>30 <150 mg/L *Effluent#2=BOD 5<30 mg/L and TSS<30 mg/L The Dept.of Safety and Professional Services 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 TTY through Relay. S1311-8330Tesl(RI 1/11) C STS- q(.21 -7f 5 Z 3 'Zose -Ra5,—v A e, M h. S 5 ! t N W '/y 5E yq S 2-1 T29 N J�15W Tow 0% 0 Ak clso•. Noa-r T-Tj� 020 -1 2f.0-"' S0 -cao 96.30 9 8� 97-YO q-7.2,0 A it I t e-3 100-00 B NO -T TV ( yag PIPL C e A I I' f II! 1 Qa' d � � E N OA AL b 3 SGALF a6 F �m T. F �m(y � Cj9 �� ��. °"� rR ' �� Coy W -,.� _ —�� ,` ...,_� w a wNORw ml_ +v �"g°�d 8• _..._.._......_._�..._,._.:,....._.._.... _.,n.._.. _ 5' - ,.. „yam � .., x c� r �M1 m m. CS 0 omi a;rn �"s k: -• ZZ c- iR31 D PG 150? a .lz CDw - .k" ; .,. �L,AF�SEN a .. 17 J { '^ j m rN .. `�:..�Y.y rn I r i1 5 sa :a Ls � c• { LA1 w+� �.,.�,.;�'�....�..�,�� �i.�a'-� �,�•,:, ,. ,_ '"�'a,ere�`�„`�:"�,.�. ' s�.c� � �.'�s� ,.. .,..� � �� i ���.. •M € h L II IIIIIIIII 111111 11 Illll 1111 8020517 State Bar of Wisconsin Form 3-2003 Tx:4015184 QUIT CLAIM DEED 9321SS Document Number Document Name BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED,made between Hermes Land Company,a Minnesota general 02/14/2011 1.40 PM partnership EXEMPT#: 6M ("Grantor,"whether one or more), REC FEE: 30.00 and Hermes Land Company,LLC,a limited liability company PAGES• 2 ("Grantee,"whether one or more). Grantor quit claims to Grantee the following described real estate,together with the Recording Area rents,profits, fixtures and other appurtenant interests, in St.Croix Cottnty, State of Wisconsin ("Property") (if more space is needed, please attach Name and Return Address addendum): Fred A.Kueppers,Jr. 101 East Fifth Street,Suite 2300 The p, .:sus uescribed on Exhibit A attached hereto St.Paul,Mi.J3101 i Parcel Identification Number(PIN) This is not homestead property. 020('—sY'b!?1-10-000 020-1054-60-000 020-1054-50-000 020-1054-70-050 020-1260-40-000 020-1260-50-000 Dated January 3„2011 He a Lan Company (SEAL) (SEAL) * * by Donald V.Hermes,A General Partner (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLED Signature(s) LISA L.GRELL STATE OF Minnesota ' "rY Pu Elic-Minnesota authenticated on 31,2013 Ramsey COUNT ) * Personally came before me on January t5,2011 TITLE:MEMBER STATE BAR OF WISCONSIN the above-named Donald V.Hermes,General Partner (If not, authorized by Wis. Stat. §706.06) to me known to be the person(s)who executed the foregoing instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: Fred A.Kueppers,Jr. 101 East Fifth Street,Suite 2300,St.Paul,Mn.55101 Notary Public,State of Wisconsin My Commission(is permanent)(expires: (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. QUIT CLAIM DEED C 2003 STATE BAR OF WISCONSIN FORM NO.3-2003 1 T name below signatures. op� EXHIBIT A Parcel A: The South Half of the Northeast Quarter(S 1/2 NE 1/4)and that part of the North Half of the Northeast Quarter South of Railroad(pt. of N1/2 of NE 1/4)all in Section 21,T29N, R19W, EXCEPT those parcels of land deeded to Richard S. Mann by deed recorded in the office of the Register of Deeds for St. Croix County on March 10, :959 in Volume 355,Page 578,Document #257181 and to Consolidated Lumber Company, a Minnesota corporation by deed recorded in the office of said Register of Deeds on January 18, 1968 in Volume 439,Page 526 as Document #291154,all in the town of Hudson. AND excepting also the land described in the deed to Hermes Land Company,recorded in the office of the Register of Deeds in Volume 841,Page 50, Document 447958; and excepting also approximately 1.95 acres taken for highway as shown in recorded document. i I Parcel B: Lot 18, 9, Prairie Vista Second Addition,Town of Hudson, St. Croix County, Wisconsin. 2 of 2 u .tl . '°, �� a ,,., z ", '. � r. - i a➢t e�l� �ra� v.�'6 �,} �I� �"{ .-,: .�.. 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