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018-2011-82-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division I _ INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 569579 0 GENERAL INFORMATION 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: Koe ke, James& Pamela Hammond, Town of 018-2011-82-000 CST BM Elev: Insp.BM Elev: BM Des ption: Section/Town/Range/Map No: � a(,L — SE 14,70a 30.29.17.1097 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ,n ^'e ` �Z.o Benchr»ark /O� 2 i Ds"S Dosing Alt.BM 1,0 in --- �� �� s%nt � . JL Aeration q. Bldg.Sewer _ Holding St/Ht Inlet j SVHt Outlet TANK SETBACK INFORMATION TANK TO P/L WEL BLDG. Vent Air Intake ROAD Dt Inlet Septic ,S i 7 / 1 1, Dt Bottom , l /0V `PL) k1k Q 7 d Dosing Heade n.' !i F 10 U a `/. / /V7. �7 Aeration 9`l i Dist.Pipe 1l � , j`y - `f Holding Bot.Syste, Final Grade y PUMP/SIPHON INFORMATION /- Manufacturer r G GPm�tand St Cover 2- ci lD lo Model Number �, ( Z• 7 165-.5- L"-'. TDH L' r Friction L ss Syste Head Tp Ft Z i -r un Forcemam Len Dia.2 Dist.to Well /> (�brll 1;R d SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No.Of Trenches PIT DIMENSIONS Po.Of Pits Inside Dia. Liquid Depth ` DIMENSIONS SETBACK SYSTEM TO P/L C— BLDG WELL' • LAKE/STREAM' LEACHI G Manufacturer: INFORMATION C OR Type Of System: � IT n� ���)D ) j�j " Model Number: DISTRI PQN SYSTEM (v Header anifold /, DistributiCo�1�,�[/ / x Hole Size x Hole Spacing ! Ve t it Intake "- , [ Pipe(s) /J,�� / rt'/ /Z �rdY A– . Length Dia( '� Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound At-Grade Systems Only Depth Over Depth Over �Depth xx Seed /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges , /gggddd i G 116-11 'Yes No 0 Yes ❑ No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / Inspection#2: Location: 1517 78th Ave Roberts,WI 54023(NW 1/4 NW 1/4 30 T29N R17W) Emerald Acres 1 st Add of 8 Parcel No: 30.29.17.1097 1.)Alt BM Description= 'G ,r V ��'I �V �I- ( 7v G- �6wr � S6 � n�d 3•► 45-- 2.)Bldg sewer length- (/, ' -amount of cover = �j vl i J Plan revision Required? ❑ Yes �Nl o Use other side for additional information. y L`"�--J �'h�_- ( C fry bs SBD-6710(R.3/97) Date Insepctor's Signature Cert.No. I 6 looflt Sat I N { All-s' yO ) I 1 vv�hr7ti;v`� i , �t 6 , � i i i S c onto v d ' C[ ihlt t Ln I � PO� �(!�• �Otj'S rte" - I r, � I� �VU 7 7 k L. OVr -_� 2c�uiaaooaor.l� �anlL 1 F:IttT l.oa4e j•rnZ, ..�. { Dh mah�.v( . \ ejjSeal/q�tOt� Plot' M146�s�c.+ I I Q� Ab�tr , ra/n a + e" afr- rM77 1i l LD _ __ PAGE 7 OF 18 County f 4 Safety and Buildings Division ST. CROIX �? 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.) Madison,WI 53707-7162 p� / PAID 56 '7-5 / Permit Ap is n t'^" State Transaction Number In accordance with SPS 84, )� is. Adm. Code, submission of this form to the appropriate governmental Z 0 �Z unit is required prior Co ng a sanitary permit. Note: Application forms for state-owned POWTS are Project Address(if different than mailing r�s-s submitted to the Depa of Safety and Professional Servies. Personal information you provide may be used for secondary u ® accordance with the Privacy Law,s. 15.04(1)(m),Stats. 1517 78TH AVE I. Application In riUyiftftQn-Please Print All Information HAMMOND WI 54015 Property Owner's Na Parcel# JAMES KOEPKE Lam, 018-2011-82-000 Property Owner's Mailing Address Property Location 199 CANYON PASS, HUDSON, WI 54016 Govt. Lot �• /097 97 City,State Zip Code Phone Number NW y,—NW r/,, Section 30 HUDSON, WI 54016 N/A T 29 N; R 17 (circle E or NO e) II. Type of Building(check all that apply) Lot# 1 or 2 Family Dwelling-Number of Bedrooms 4 Subdivision Name 10K 4b,P4,16— lock# EMERALD ACRES ❑ Public/Commercial-Describe Use HAMMOND N/A [N City of ❑State Owned- escribe Use / CSM Number ❑ Village of If (/ )r N/A ❑ Town of III.Type of Permit: (Check only one box on line A. Complete line B if applicable) Z& A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain) B List Previous Permit Number and Date Issued ❑ Permit Renewal ❑ Permit Revision El Change of El Permit Transfer to New � Before Expiration Plumber Owner . IV.type of POWTS S stem/Com nent/Device: (Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade T] Mound > 24 in.of suitable soil ❑ Mound < 24 in.of suitable soil ❑ Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) 5 V. Dispersal/Tr ment Area Information: Design Flow(gpd) Design Soil Application Rate(gp t) Dispersal Area Requir (sf) Dispersal Area Pro se f) System Elevation 600 .4 600 601> 600 y 1 16 VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units c o New Tanks Existing Tanks ` c y t,/1/1 a 1. `U vi cn ii C7 P, Septic or Holding Tank 1200 0 1200 1 EISER Dosing Chamber 800 0 800 1 WEISER X VII. Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber's Sign at MP/MPRS Number Business Phone Number PAUL KOEHLER � �=�— 225410 1715-246-2660 Plumber's Address(Street,City,State,Zip Code) 321 WISCONSIN DRIVE, NEW RICHMOND, WI 54017 VIII. County Department Use Only Approved proi l Permit1Fee Date ssu Issuing nt Signatur ❑ en Reason for Denial $ �•�� / / IX. CondW /Reasons for Disapproval 1: 3eptid"tank,eiNtittit filter ihd 3 Got �,�•�v45 /ti ,dispersal cell must all be servk:as I maintained 7(A 104 J .'4^. "per rnanagement plan provided by plumber. ` $ ! attaKE t m�iMairied Attach to complete plans for the system and siflunit to the County only on paper not less th n S 1/2 11 inches in sine �r�t � � SBD-6398(R. 11/11) PAUL R KOEHLER Page 2 5/19/2014 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. 9A t4m 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. o NR TyfFN DIVISION OF INDUSTRY SERVICES 3824 N CREEKSIDE LA u0 f 1P HOLMEN W1,54636 Contact Through Relay , P www.dsps.wi.gov/sb/ www.wisconsin.gov �OssloNPtis� Scott Walker,Governor Dave Ross,Secretary May 19,2014 CUST ID No. 225410 ATTN:POWTS Inspector PAUL R KOEHLER ZONING OFFICE COUNTRYSIDE PLUMBING&HEATING INC ST CROIX COUNTY SPIA 321 WISCONSIN DR 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/19/2016 SITE: Identification Numbers James Koepke Transaction ID No.2401239 County Road TT Site ID No. 802068 Town of Hammond Please refer to both identification numbers, St Croix County above,in all correspondence with the agency. NW1/4,NW1/4,S30,T29N,R17W Subdivision:Emerald Acres;lot 82 FOR: Description:Four Bedroom Mound System/8%slope Object Type:POWTS Component Manual Regulated Object ID No.: 1484418 Maintenance required; Replacement system; 600 GPD Flow rate; 36 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); 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 CON requirements. AP No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, DEPT OF stats. PROFESSI The following conditions shall be met during construction or installation and prior to occupancy or use: DIVISION OF III Reminders: • 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. # SEE CORK • Inspection of the private sewage system installation is required.Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d),Wis. Stats. • A state approved effluent filter is required.Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required.Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • All POWTS component piping material shall be SPS 384,Wis.Adm.Code compliant. • The area within 15' downslope of the dispersal component shall remain undisturbed.Vehicular traffic, excavation or soil compaction is prohibited in this area. • A copy of the approve Mans 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. PAUL R KOE=R Page 2 5/19/2014 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. rard M wim 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 n and addressed in a"300" series. For future reference,the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. MOUND AND PRESSURE DISTRIBUTION COMPONtEN33)ESIGN Residential Application INDEX AND TITLE PAGE Project Name: JAMES KOEPKE Owner's Name: JAMES KOEPKE Owner's Address: 199 CANYON PASS HUDSON WI Legal Description: NW 1/4 NW 1/4 SEC 30 T 29 N R 17 W Township: HAMMOND County: ST CROIX Subdivision Name: EMERALD ACRES IriONALLY VED Lot Number: 82 Block Number: SAFETYAND Parcel I.D. Number: 018-2011-82-000 NAL SERVICES Plan Transaction No.: $ERV�CE. ��O P age 1 Index and title Page 2 Data entry N Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 PLOT PLAN Page 9 SEPTIC FILTER Page 10 CROSS SECTION OF SPTIC TANK Page 11 PUMP SPECS Page 12 ALARM SPECS Designer: PAUL KOEHLER License Number: MP 225410 Date: 05/07/14 Phone Number: 7152462660 Signature: 0,00 .00, 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 5.1 (R. 06/06) Pagel of 18 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 63-44-3 in-situ soil treatment for 1.50 Peaking Factor(e.g. 1.5=150%) fecal coliform of-36 inches. 600.00 Design Flow(gpd) 8.00 Site Slope(%) 105.50 Contour Line Elevation(ft) 36.00 Depth to Limiting Factor(in) 0.40 In-situ Soil Application Rate(gpd/ft2) Distribution Cell Information 100.00 Dispersal Cell Length Along Contour(ft) = 6.001 Cell Width(ft) 1.00 Dispersal Cell Design Loading Rate(gpd/ft) 1 Influent Wastewater Quality(1 or 2) Are the laterals the highest point in the distribution F Pressure Disribution Information network? Enter Y or N (C or E) E Center or End Manifold 3.00 Lateral Spacing(ft) If N above, enter the elevation ft 2 Number of Laterals of the highest point. 0.125 Orifice Diameter(in) 3.00 Estimated Orifice Spacing(ft)= 9.09 ft2/orifice 2.00 Forcemain Diameter(in) 35.00 Forcemain Length (ft) Does the forcemain drain back? �� 92.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head(ft)x 1.3 5.71 Forcemain Drainback(gal) 13.67 Vertical Lift(ft) 90.43 5x Void Volume(gal) 0.57 Friction Loss(ft) 96.14 Minimum Dose Volume(gal) 0.00 In-line Filter Loss (ft) 27.19 System Demand (gpm) 20.73 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in.dia. options choice in. dia. options 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(optional) Treatment Tank Information 0.00 Total Tank Capacity(gal) 1200.00 Septic Tank Capacity(gal) 0.00 Total Working Liquid Depth (in) WIESER Manufacturer #DIV/0! gal/in(enter result in cell B49) Dose Tank Information Effluent Filter Information 800.641 Dose Tank Capacity(gal) 1POLYLOCK Filter Manufacturer 22.401 Dose Tank Volume(gal/in) 525 Filter Model Number W EISER Manufacturer Project: JAMES KOEPKE Page 2 of 12 Mound Plan and Cross Section Views 1 1/10 B ..:.....:.....:.............'. . . . . . . . . . . . r-i' ' J Observation Pipe . .�?? : : : : : : : : : : : : : : : : . . . . —1 K . r 7"'"Y°r"r.Y.Y" *'.r"r °" '`" r"r : •.±'"Y"r•r•r" r•r"r•Y•:-Y".=.;•r.r+.=" r.r"r.r-rw•Y•r•r•r"r°r"r•r"r•r"r r;�•.=_•._• .�e'.Lr•3•;x 4".r•'>. rb.r•'.k r"S.;•t,r"".0 r"S,,r"1.r"-b"r•4.r.1"r" 5 _ A r•r•r•rxr-rx.°.r.r.r.t.dxF..'..'.a°. r fxr ° .'.C.r.a":d°-.f.r"r.d..ax...r„P,J.s.a. �i.r",•.,a.,t. :t:d•""":+.`a?.`.':.":u':Y:a"4";.°";t:°d°e°:tSt.x'';ll;,"�,Y";r�,Y�,Y J°:•d°xY�,:ie'SrSB.°d`Sn°4;°R rbr:;4r°xrtr4x,3r4f4r4 W . - B ' :':':': :': : : : : : : : : : :': : :': : . . . . z : © L Mound Component Dimensions Down slop toe extension made. A 6.00 ft E 11.76 in H 1.00 ft K 7.60 ft B 100.00 ft F 9.50 in 1 9.00 ft L 115.19 ft D 6.00 in G 0.50 ft J 4.33 ft W 19.33 ft 600.00 (ft2) Dispersal Cell Area 1500.00 (ft2) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 10.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 107.79 (ft) --► G t H ............... j F Dispersal Cell 106.50 (ft) Lateral 106.00 (ft)—� — E . . Invert Dispersal Cell Elevation D • .... �i�.ca't,<,. �`�..Ct`y 1... .'� � .. :2,,t'?,a„ [.t.t..t a 4 a .t AA L:' ? z. 4 ,{.�.A. �.: �,� "t� �"a' ,. s a�.t. "i...a .t �S..A_.:�..z...A�,..a. 1.��'rl,a^�'w '�.,y � d� `4 �•..�•',`� "-..' A,_A�l A.i<. �L.`-.�. "4. 105.50 (ft) Contour Elevation 8.0 % Site Slope Geotextile Fabric Cover Shading Key fl. �— Dispersal Cell See lateral details on ,❑ Topsoil Cap c a 1.5 ft ,p...;;,.ti"ti. : . . ;ti.ti Page 4 for number,size, 4e ".'..S.S. 4.4.5.1.1 ❑2 ,.,..,,, Subsoil Cap H e 1 =s: . . . . and spacing of laterals. © " T `�xtRtiR �'' "4x� =srti 4x� Laterals are equally ASTM C33 Sand R r-r-r+:->_.”.• i�.r,:. .r,r,r.:.t. F spaced from the Tilled Layer d 0 5 ft r:�x=?YPical lateral ti;::�ti © � e distribution cell's r�'r1r1r Aggregate 4rti;'ie«.:.'tie*,..>we�..�..;^���., .b o ";"_ "t, . .P. '" centerline in the q ♦ distribution cell(AxB). Project: JAMES KOEPKE Page 3 of 18 End Connection Lateral Layout Diagram Gate ralsdeoWedomtheA&BdMnsion #=tT urjn-upVd:b9lFVAW, 1 orofeoti,Utplu9 I All.lateralsa€#WOW �:�° --�� 6+�Etabc#ktt�tltoEth�laitatai � (per COMM tai :* i Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing(X) 3.08 ft Lateral Length(P) 98.56 ft Orifices per Lateral 33 Lateral Spacing(S) 3.00 ft Orifice Density 9.09 ft2/orifice Lateral Flow Rate 13.59 gpm Manifold Length 3.00 ft System Flow Rate 27.19 gpm Manifold Diameter I 1.50 in Total Dynamic Head 20.73 ft Forcemain Velocity 2.78 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and % Comm 16.28 WAC _T 4 in.min. Disconnect Tank component is properly vented Altemate outlet location Forcemain diameter WEISER Manufacturer 2 in. Capacityl 800.64 Gallons Volume 1 22.40 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 19.45 435.70 B 2.00 44.80 C P� ump off elevation(ft) C 4.29 96.14 _t 92.83 D 10.00 224.00 D Total 1 35.741 800.64 ir Dose tank elevation(ft) 3"Bedding under tank. 1 92.00 Alarm Manuafacturer JSRJ RHOMBUS Alarm Model Number IPS PATROL Pump Manufacturer 1GOULDS Pump Model Number IEP05 Pump Must Deliver 27.19 gpm at 20.73 ft TDH Project: JAMES KOEPKE Page 4 of 12 Mound System Maintenance and Operation Specifications Service Provider's Name COUNTRYSIDE PLG Phone 715246-2660 POWTS Regulator's Name COUNTRYSIDE PLG Phone 715-246-2660 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 ftz 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 yea rs Moundl Inspect for ponding and seepage once every 3 years Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis.Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, 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 •.........•... �� 00000000000000, . . . . . . . . . . . . . . Grade \_/0 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: JAMES KOEPKE Page 5 of 18 Mound System Management Plan Pursuant to Comm 83.54,Wis.Adm. Code General This system shall be operated in accordance with Comm 82-84 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 Comm 83.33,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 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 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. 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. I I Project: Page 6 of 18 oyi-�� liz V a = j scull ly— Llo looflt Sr�t { �Gdl60}V �l67t L { ' H 40 So, ;svG. 4 l � � Pol1� l off• •. F V� K f Z43,4F �oaaot.lo �eenOL 1.o�kAp r� h�aavl•t.,t. ..V' f Dh INa'4°( , '. As h f+ll0+. Ma � u 1 C.Gnfovp r'/' Dra n al men f PAGE 7 OF 18 INSTALLATION INSTRUCTIONS pol I CTIONS TMtnc &WI rim 4 1 ' AMft PL-525/PL-625 FILTER 3r Wislewa!e'FroGi: -A OiviNcn°f,el9;ak inc. PL-525/PL-625 FEATURES & BENEFITS Features & Benefits: •Rated for 10,000 GPD .PL-525 = 525 Linear Feet of 1/18" Filtration PL-625 = 625 Linear Feet of 1/32" Filtration PL-525- PL-625 •Accepts 4" and 6" SCHD. 40 pipe The PL-525/625 Effluent Filter should operate efficiently s Built in Gas Deflector for several years under normal conditions before ,Automatic Shut-Off Ball when Filter is Removed requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped or at least every *Alarm Accessibility three years. If the installed filter contains an optional alarm,.the owner will be notified by an alarm when the *Accepts PVC Extension Handle filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. RECOMMENDED PRODUCTS Polylok PVC Fitter Extension Handle s.... '* M Risers&Riser Covers Extend& Lok- Riser Safety Screens Filter Alarm Panel and Polytok risers bring your Polylok Extend&Lo0l Polylok safety screens SmartFiltetT""Control Switc septic tank cover to grade. is a simple, easy to use prevent tragic accidents h This allows locating and solution that can extend from happening by children Polylok filter alarm panels servicing your filter easier the inlet or outlet pipe and and pets falling into open and switchs provid a visual and time saving by elimi- make filter and/or baffle septic tank entrances. and audible notification of nating digging to find tank installation a snap. impending filter and tank entrance. Fits 3"and 4"pipe. servicing. For a full list of Polylok products please visit our web site at: www.polylok.com PAGE 8 OF 18 w Y W U o 000- LY o wp cn � v av = N w U m z C07 M � e O 0 i Ej Z ! Z O � Z o € d' s 0 0- � 0 Q 0 Q f�- U O �a �� O Q M U O U O O _ j M OMO M LLJ O U J M U 0 Ch U — O N M tt) O C DO N 11') � M � u J � N E O ti r CO N u O U O N co CD z a- 4 0 w m N U 2 Z C-) U � X Z to � w 2 06 f f- J =3 Y w Z f- _ 2 U 0 J c) U Q LL - 0v W m Z W U U) C.9 � � W N O ® Vi i ¢ I— d- >1 Lu Z 0 J o O = D z w LA- r� v- Q > LC) J , W CL LL L f Z — Q cV L[) 1— H � QQO � Ln aa � = Ocd PAGE 9 OF 18 D Z N 53" AS 96" REQD rn 41" z Z- m c -i q w_ 0 v o U 40" uoz'10 m 4 " CAS n 0 3" 44" 6" M D m Dm m x -,x m 36" r-o m rm v 0 s N N v m UP 38" m L4" CAS , c m Z O n 39° c+ D ° m in � I D I N A i0 D r C �Z- Z m g -� N �� D 2 -4 � r Z z OK D z n ONN�ZD-Z �m020>0OD�O �m x- z-0 Z v FN v - 5 (80 NA° C)0� a25 �FZ c° a0 mnm -* _ (A D Moor*1D0 -1 �.. �-10•• ;w, � fV n N 0> 0y �yc F z W- I r-30 0 rn�cn..vsCA m O nmvl �z�,� r�, w ;N ZZ �� D O OD Nw DNS ND� ��*o •? s z _v° =A y IS* <m o nNi�"' �rm*t-> I D ao CA 0 � O p o m u n U NZ zm m ' �� mm� Dr JN ' z •°• n m m °� W 0 >0 � y DD mD� mp opo v ° ° o n 3 z F=� \n O D �r =�z �O mo 0 m < o m m H y m� C Z 21 ZZ z�° WO tn� uDi O .. .. .. Z 0 m.. � � y .... �o� 0� <n � Z TI 0 z c c m r -a m O U) 0°c Z m 09 � m� D 0 H z O r O m ;u m Z E Fn \ cn WLP1200/800—MR rri m DRAWN BY. SME SCALE: 1 4"=1'-0" RE-POUR: SEPTIC MANUAL COOCOETE DATE: JANUARY 2010 1 DATE:. 6T-POUR: \ Z W3716 US HWY 10 MAIDEN ROCK, WI 54750 ° REVISED JAN. 2010 800-325-8456 RLE rlsoo/eao PAGE 10 OF 18 GOULDS PUMPS Submersible Effluent Pump MODEL 3871 EP04 & EP05 Series APPLICATIONS •Fully submerged in high ■EP05 Impeller:Thermoplas- ■Bearings:Upper and lower grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically designed for the lubrication and efficient improved performance. construction. following uses: heat transfer. • Effluent systems ■Casing and Base:Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms manual operation.Auto- superior strength and corrosion AS"*Canadian standards Association • Heavy duty sump matic models include resistance. File#LR38549 • Water transfer Mechanical Float Switch ■Motor Housing:Cast iron Goulds Pumps is I50 9001 Registered. • Dewatering assembled and preset at the for efficient heat transfer, factory. strength,and durability. SPECIFICATIONS ■Motor Cover:Thermoplastic FEATURES cover with integral handle and •Solids handling capability: float switch attachment points. 3/4"maximum. ■EP04 Impeller:Thermoplas- 0 Power Cable:Severe duty •Capacities:up to 60 GPM. tic semi-open design with rated oil and water resistant. •Total heads:up to 31 feet. pump out vanes for mechanical •Discharge size: 11/2"NPT. seal protection. •Mechanical seal:carbon- rotary/ceramic-stationary, BUNA-N elastomers. •Temperature: 104T(40°C)continuous 140OF(60°C)intermittent. METERS FEET r--*Fasteners:300 series --------------------------------- ------------ I-------------- ....... + - ----------- stainless steel. 9 30 �- —SGPM •Capable of running dry without damage to 8 - - -- ----- - __ _ _____ ____ —2.s --------,__________ components. 25 a° 7 I -- -- -—- --- ---------- --- - -- - -- -- ------ Motor: "' x •EP04 Single phase:0.4 HP, `—' 6 z° 115 or 230 V,60 Hz, 1550 z s -- -- --- ---- ----- ------- - --- -------- -- — — - t -------- RPM,built in overload with > • 4- 15 f — - ---------------------- .l.- - ------------+--------- ---� - —- - automatic reset. EP05 Single phase:0.5 HP, o EPOS - 115 V or 230V,60 Hz, 1550 3 10 RPM, built in overload with i --------,----------- - -- }- —-=- -- ------ +--------- --EP04-— -+---- automatic reset. 2 I j •Power cord: 10 foot 5 j standard length, 16/3 1 --------------------------- ----- -----— - --------------------t--------- --- -- - - S1TW with three prong grounding plug.Optional 20 ° °0 10 zo 1 30 40 50 GPM _ foot length, 16/3 S1TW with three prong grounding plug o z a s 8 10 1�z m3/h (standard on EP05). CAPACITY Goulds Pumps ©2003 Goulds Pumps PAGE 11 OF 18 Effective July,2003 ITT Industries 83871 <& - SES Controls Page 1 of 2 Home Careers Contact • 1 ��, IINI�II�I rp I SJE-Rhombus SES Controls Build-A-Panels 4 Go Back to All BAP -Product Info Features • Mode III ,.,�... • Model 115 speca d • Model 712 Downloads; .- _�__------ — • PAodel 122 r y • Model 312 *� P' • Model 32S PS Patrol® • Model SGS r • taodel113 • Model 123 Post Alarm With Receptacle for Plug-In Pump • Mode! 14 • Mode;124 ..Control • Mode 3 314 • Model 323 • Intrinsically Safe Post Alarm Provides Convenient Wiring Connection and System Retro Monitoring for Pump Station Applications • Model TD • Model DTD The PS Patrol®post alarm system features a built-in high • Model PS water alarm and provides a convenient location to connect all • IFS Drip wiring required fora pumping station application. • Model DIP • Model RP • JB Plugger The PS Patrol®system employs a receptacle to accept either" • Ultra Nator" a 120V or 230V pump and/or piggy-back pump switch. Vent • P5 Patraik holes on each side of the post help prevent moisture • Model 126 .condensation inside the post. Available in 120V,230V and 9' • Starter Boxes VDC models. • C-t-evell Starter Boxes • SJE Oil Spotter" • SJE Oil Spotter- Auto PS Patrol® Features: • Pedestal rated for outdoor use • Receptacle for 120V or 230V pump and/or piggy-back pump switch • Pull out assembly for easy wiring • Control switch provides alarm activation • Test/normal/silence switch mounted externally for easy operation • Separate 120V alarm and pump circuits • Red alarm beacon • No external cords • U.S.Patent No.7,218,511 Options: • 120V,230V and 9 VDC models • Factory-installed circuit breaker/terminal block • Factory-installed elapsed time meter(ETM)to log pump PAGE 12 OF 18 http://www.sjerhombus.com/ses-controls-build-a-panels-details.php?ID=33 5/7/2014 - SES Controls Page 2 of 2 information(patent pending on ETM with plug assembly) • Factory-installed duo alarms to monitor two level conditions(high water alarm and alarm 2 filter) • For a complete listing of available options,please view the backside of the catalog page. CSA Certified Five-Year Limited Warranty PS Patrol® Specifications: 12l)V or_232 Model ENCLOSURE: 5x5x48 inches(12.7x12.7x121.9cm) ALARM VOLTAGE: 120 VAC,50760 Hz PUMP VOLTAGE: 120 VAC or 230 VAC,50160 Hz RECEPTACLE: 120 VAC NEMA type 5-15 or 230 VAC NEMA type 6-15 ALARM FLOAT: SJE SignalMaster®control switch with mounting clamp .ALARM HORN: 83-85 decibels Available Downloads • Catalog Page with Pricing • Specifications without Pricing • Installation€nstructfons-9V Model • Installation instructions-120V Model • Installation instructions-120V Model with Breaker • Installation Instructions-120V Model with ETM • Installation Instructions-230V Model • Features 8 Benefits • Expedite this Panel with Panel Express Program • Select Models Available for Quick Ship • We're Proud to Offer a Give-Year Limited Warranty Adobe Acrobat is a free download to view.pdfs Visit our downloads section of this website for additional literature. i SJE-Rhornbus 2014 All Rights Reserved. Privacy Policy Slteniap i-fx 8-342-575; 0 PAGE 13 OF 18 http://www.sjerhombus.com/ses-controls-build-a-panels-details.php?ID=33 5/7/2014 )0 - POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page � of -2. FILE INFORMATION SYSTEM SPECIFICATIONS Owner JAMES KOEPKE Septic Tank Capacity 1200 qa( ❑ Ni Permit # 5 Septic Tank Manufacturer WEjSER OW DESIGN PARAMETERS Effluent kilter Manufacturer d Nt Number of Bedrooms 4 q NA Effluent Filter Model ❑ Na Number of Public Facility Units 0 Q NA Pump Tank Capacity 800 gal ❑NO Estimated flow(average) 400 gal/day Pump lank Manufacturer WEISER ❑ NA Design flow (peak), (Estimated x 1.,51 - 600 qal/da Pump Manufacturer GOULDS ❑ NA Soil Application Rate •4 al/day/ft2 Pump Model EP05 ❑NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit Qg NA Fats, Oil & Grease (FOG) 530 mg/L El Sand/Gravel Filter ❑ Peat f=ilter Biochemical Oxygen Demand (BOD,) 5220 mg/L 13 NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 51 SO mg/L ❑ Disinfection ❑ Other. Pretreated Effluent Quality Monthly average Dispersal Cells) 0 NA Biochemical Oxygen Demand (GODS) S30 mg/L ❑ In-Ground (gravityl ❑ In- d Ipressurized) Total Suspended Solids (TSS) 530 mg/L )l(NA ❑ At-Grade ;1] Mound Fecal Coliform (geometric mean) S10'ofu/I00m1 Q Drip-Line er: Maximum Effluent Particle Site Y in diia. ❑ NA Other ❑No# Other: . ❑ NA Other: ❑Nei *Values typical for domestic wastewater and septic tank efftuent, Other: 11 Nil MAINTENANCE SCHEDULE Service Event Service Frequency fFlush ct condition of tank(s) At least once every: 3 ®ryrionn�(s) (Maximum 3 years) ❑Nit out contents of tank(s) When combined sludge and scum equals one-third (Y) of tank volume ❑ Nit ct dispersal cell(s) At least once every: ❑month(s) (Maximum 3 years) ❑ W% 3 Q years) effluent filter At least once every: 1 Q month(s) ❑ NIL year(s) t pump, pump controls& alarm At least once every. ❑month(s) ❑W, ] eadsl laterals and pressure test At least once every, �❑months) ❑ NL, . 3 V year(sl At least once every: 0 month(s) ❑ Nf, Other: ❑year(s) MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector, POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual Inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground' surfaC a. The dispersal cell(s) shall be visually inspected to check the effluent levels In the observation pipes and to check for any pending of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 11:1, Wisconsin Administrative Code. AR other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatmerit units,and any servicing at intervals of S12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. PAGE 14 OF 18 'START UP AND OPERATION Page Z of_2 For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other ohemic that may impede the treatment process and/or damage the dispersal celf(s). If high concentrations are detected have the conter of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the exoess wastewater will discharged to the dispersal cel((s) in one large dose, overloading the cells) and may result in the backup or surface discharge effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restori! Power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manual! operating the restore normal levels within the pump tank. y P g pump controls Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the an within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or.elimination of the following from the wastewater stream may improve the performance and prolong the life of tt POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; d)slnfectanis; fi foundation drain (sump pump) water, fruit.and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; al Painting products; pesticides;sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the s properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: ystem I • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. 0 The contents of all tanks and Pits shall be removed and properly disposed of by a SeMage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the Vold space filled with soil, gravel or another inert solid material CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replacement system: C� A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorptkn system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot limes and wells. Failure to protect the replacement area K III result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. 0 A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. alua 'te e OKt6rTMh, fb i-A/& ik Mound and at-grade son absorption systems may be reconstructed In place following removal of the biomat at ttie infiltrative surface. Reconstructions of such systems must comply with the rules In effect at that time. <<WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NC T 1=1i1Tl i A SEPTIC. PUMP OR OTHER TRF-ATMMT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSiBLE. ADDITIONAL CommENTS f POWTS INSTALLER POWTS MAINTAINER Name COUNTRYISDE PLUMBING & HEATING, INC Name PAUL KOEHLER Phon® 715-246-2660 Phone 715-246-2660 S£PTAGE SERVICING OPERATOR(PUMPER) LOCAL REGULATORY AUTHORITY Name POWERS LIQUID WASTE MANAGEMENT Name � Gip( 2D�J1N Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f1 and 83.54(11, i21 & (3). Wisconsin Administrative Code. PAGE 15 OF 18 May 05 14 08:09a james koepkeA 7153863872 p.2 ST. CROLX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ` yA u--,e e . Mailing Address RC, Property Address S 1 ` IL_ U-e, n (Verification required from Planning&Zoning Dep anent for new construction.) City/State Parcel Identification Number C y � � ow ` � —SS a "Cs 00 LEGAL DESCRIPTION Property Location 1/4 , ' V,, Sec. C , T J'� N R W, Town of e�'-1 _. Subdivision Plat., (�-✓v, e r Lot# Certified Suryey Map # ,Volume ,Page # Warranty Deed# Q a (before 2007)Volume_ >Page# Z Spec house oyes�io Lot lines identifiable l esono 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 ASPS.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 ofslud.-e. 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. Uwe certify that all statements on his form are true to the best of my/our knowledge. I/we am/are the owner(s)ofthe property described above,by virtue of a rranty deed recorded in Register of Deeds Office. Number of bedrooms rf SIB TURRE 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.04112) y$ F { Y ,... w .....wines...• ...en.w .•w...w.ww. .w.................• ^..«we......... .....................•. .i. w.w.....«.....•... � ... «....,....,....... ........wrr.,.•-. ,w .«.........._.... .... TOWN ROAW NW45'02'E 12.38' .. 21 . . . _ �,.. ., _ . 211.j7__.. •.. _ . ..� •.� _ _. .... . r _. .. _ e • a ,� r e n e s r n a w r o v r w .{• • .• v w r o r v • e r r e, w o • r . r . . n . . . . . . . . r: ^ ^ n • . .. w .. e e • a , I LOT 83 LOT 82 LOT 81 2,0 ACRES ry 2.00 ACRES 2,00 ACRE.' 17,125 Stye FT, 87,125 S r FT, 87,125 SQ, .M. __... �._ ...._ «.. J L . . .._ .. • __ w. _.... . _.a _ w._ 211.47` 166.41' w. SOUTH LINE OF THE NORTH 1 OF THE NWl f4 May 05 14 08:10a james koepkeA 7153863872 p.3 812) 1A212? 4- U 2 8 4 8 P 2 7 4 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROI X Co. , WI STATE BAR OF WISCONSIN FORNI 2-2000 RECEIVED FOR RECORD Document Number I WARRANTY DEED 07/2112005 11:50AN THIS DEED, made between Kernon J. Bast, a married person and WARRANTY DEED Richard O. Stout, a married person, Grantor, and James M, Koepke and EXE+ip? # Pamela J. Koepke, husband and wife, as Survivorship anta r rty, REC FEE: 11. 00 Gran " TRANS FEE. 185.7@ COPY FEE: Grantor, for a valuable consideration, conveys and warrants to Grantee CC FEE: the following described real estate in Sc. Croix County,State of Wisconsin: PAGES: 1 Lot 82,Emerald Acres 151 Addition, Saint Croix County, Wisconsin. Recording Area Name and Return ddress: in a Ti e, C. Suit 115 Exceptions to warranties: H s Ol Easements,restrictions and rights-of-way of record,if any. 470192 018-2011-82-000 Parcel Identification Number(PIN) Metro Legal Sen4ces This is not homestead property. E>=IRET 47(7192 A 476017 I Ti 371-u128 Dated th day of June,2005. r ut B y A� �. *Vernon J.Bast *Kern n J.Bast,a marlid person,Attorney in Fact for Richard O. Stout,a married person * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ST. CROIX COUNTY. )ss. authenticated this 30th day of June, 2005 Personally came before me this June 30, 2005 the above named Kernon J.Bast, A Married Person,and Kernon J. Bast, * Attorney in Fact for Richard O. Stout,A Married Person to me known to be the person(s) who executed the foregoing TITLE: MEMBER STATE BAR OF WISCONSIN instrument and acknowledged the same. (If not, authorized by§ 706.06,Wis. Stats.) � Q w THIS INSTRUMENT WAS DRAFTED BY *I t�jy�G�d /Q-, /,O; 1�►-heh Notary Public,State of Wisconsin Peterson,Fram&Bergman–Steven H.Bruns My commission is permanent (If not,state expiration dare: 50 East Fifth Street,St. Paul,MN 55101 .2–01p-* )I ) (Signatures may be authenticated or acknowledged. Both are not necessary.) Pamela A. Willman *Names of persons signing in any capacity must be typed or printed below their signature Notary Public State of Wisconsin WARRANTY DEED STATE BAR OF WISCONSIN FOILNI No.2-2000 C r _ . Property Owner_ 5 f D --___ - Parcel ID It page of�� _ �---------- f Doling# ❑ Boring go L `Pit Ground surface elev. �05 ft. Ueptlr to WniGng lactur —M. Soil A,�licabon Rate Horizon Deptll Dominant Color RedoxDesc.-ription Texture Structure Consistence Boundary Roots GPDffF in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. — 'Ef(ll t 'Effg2 2 t0 Z 5(1 Zlry,sek � (_S 1,-C ,5_ S _ y- _- 4 q&w 10,1C81Z C2 P ❑ Boring lJ Bonny# B pit Ground surface elev. ft. Depth to limiting factor__-------—_ _ _ �J ❑ in. -Soil!1 licatlon Rate Horfzar Depth Dominant Color Redox Description Texture 5lructure Cunsislence Boundary Roots GPD11F in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Elf#1 'EUN2 Bonny U Boring# Ground surface elev.___—___it. Depth to limiting factor F1 pit _ _ Sod n r licatlon Rate Horizon Deptic Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfF in. Munsell Qu.Sz. Cont.Color Gr.Sz Sh. 'Eff#1 'Eff#2 Effluent#1=BODS>30<220 rnglL and TSS>30<150 my/L 'Effluent#2=BOD,<30 nrglL and 1 SS<30 nrgk The Department of Commerce is an equal opportunity service provider and cngrloyer. If you need assistance to access services or need material in an alternate fomiat,please contact the department at 608-266-3151 or'ITY 608-264-8777. sno-uwrrt.oNOrry Wi,consin Department of Commerce SOIL EVALUATION REPORT Page_�-rat_3 Division of Safety and Buildings in acx;orilame with Comm 05,Wis. Achn. Code County Altadr cumplete sii:e plan on paper Trot less tl n Plan rlrunt Include.b,it not ffmfled to,vertical and horizon al refs � fon end Porcel I.D. per cent�Wps,scale or dimensions,norOr all and location and dish no0resl road. _ O��_ abj�' -6�U Please print all nru►► i1 n r vier" y Uate UL P 1 f iS D pmsonel infomrarron you provide may be used fora condary purposes(p�ivncy La ,s.�Q Un PropeityOwnern ST.CROIXCOUNT Prope o S�w ZONING OFFICE �yL"Lot 114a+&1 U4 S 36 -1- 2-°) N li (? E(or) Properly Owner's Mailing Address Lot# 131uc:k# I Sulxf.Name or CSMIf City State Zip Code Plrone Number U City ❑Village W I own Nearest Ruad PL4d o lJ! I 51404PU7t ) -03q mo 0 7 f.New Construction Use: -Residential/Number of bedrooms_3 Code derived design flow rate_ SU _f?0(9 GPD ❑Replacement ❑ Public or commercial-Describe: — ----------?---------------- Parent material-- ------------------- flood Plain elovalion if applic:abfn ----�1/-/�T -- __ .--------R. General comments � le(-CC/. /v 0 0 and ieconnnendaliuns: Co X44 u r C(-e J.. j© S ,S-O U Boring All �❑LB_oring fU Pit Ground swface elev._1QJ, ft. Ueplh to Ilrniliny factor_ 5-5_____in. —il Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary flools GPD/ll' Ill. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 ( 0-27 to r31Z — s;1 2mf)bL rh�r c.�-) - I v 5 8 Z- 2-1-33 10 y Sr �I 21rs�k I�r c5 — � `_( 3 DBoring# Boring 64—pit Ground surface elev. (O It. Depth to limiti ng factor —in. Sort Application Rate Horizon Depth Dorninant Color Redox Description Texture Structure Consistence Boundary Roots GPDfIF in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sir. 'Eff#1 'Eff#2 O 12 1D 3r2 5, 2 V-f 5 -� 2 iZ- 3 z� c 5 — `4 8 Z C3P-7.,5- '{gym X-5 _ncj�; Effluent 01=BOD >30<220 mg(L and TSS>30<150 mg/L 'Effluent#2=BUD <30 ing/L and TSS<30 mg/L CS (Please Print) --Signature CST Number m �chv vv� Y- J,,. �:_r r` - ' --- 2533 Address Uale Evaluation Conducted Telephone Number Mar 05 14 08:46p james koepkeA 7153863872 p.3 � V du� Page —� L 9 T P reel ID>t _ _-_ Prni►e►ly Owl LOT � _._�_�___� a — 11301hig 9 ❑ Boring :`'� \ 1 �T fit.Grout rd surface elev.r°s•� It,. f JeQUrhnJ► lg fadcx Svl n► rayon Rate I forizon DepU► Datrtinant Color Redox Description Texliir� / trur�ute Currsislence Boundary Roots GPDffR In. Murisell Ou.Sz. CwL Color ` v-^; Gr.St.Sh. 'Ellflt '0192 o-f2 Z — z- 12-2q (0 5(J 2rnS _.nnfr- _ C-5 �c7- Fs z C 2 P-1.5 v ct-� V- El Boring tI bo►iny❑ pit Ground surlace elev. ft Uepilr to lirnifiny factor soil k;atlon Rate I iorf m Depth Don►inard Cukx Redox Description Texture structure Consistence Buundary Rools GPi)IIP In. Munset1 Qu.Sz. CotiL Color Gr.Sz.Sh, 'EIWli 'EIfMT. Boring Bonny • ❑ fi! Grourxl sutface elev. _�R_ Depth to 6uliling factor�,�___—in. ❑ Pit Sal Aplilicadon Rate Horizon Deptir DomfnarrtColor RedoxDestriptiort Texture Structure Consistence Boundary Routs GPD" in. Munsetl Qu.Sz Cont.Color Gr.SL Sit. 'Efrlli 'Eff112 t ' Effluent,IC1=1300,>30<220 nKj&and TSS>3B:S 150 mgIL 'Efliuent fm=ODD,<30 mct/L and 1 SS:S 30 rngA- The Vepattment of Commerce is an equal opportunity service ptuvidcr and etnploycr. lryou need assistance to access services or need material in an alternate fommk please contact ttre departmcut at 609-266-3151 yr-1-CY 608-264-6777. sllD uro Is,a/wo► PAGE 17 OF 18 I'A(;E3 U1•3 ( `' Lurr� Q I.Er,�I. I)ES��tzllrl�)Ii�ii.IM,,!i�►,�:,� rzq.N,li,l�_Er,�,�>Lt'w NAME: SCALE: Dhl t DESC►zll'rloH:_�p. l3M 2 ELEVAI ION: --- L E3til 2 DESCRIP I'IUt l: , v c,-P(;P-c------ SYS"t ENE ELEVi\'1'1OtJ SYSTEM"I'1'I'I?: __-�glcar�e-- Or vywor'A _ OF I � 0 1 7 r� C cs� i 1 VAI �u i✓tq ! a e..vw-✓� SIGNATUKG: - NOTE—60 ft.wide area disked and seeded for drainage easement. Does not appear to have damased POWTS sites - COUNTY PLAT OF: LOCATION SKETCH N aNrm.lNax++^ PREPAREOT-0k SURVEYOR EMERALD ACRES 1 ST AD DITION KAKN&A awlicuAM NE114 OF THE NW114,AND IN `' Rmom e.N��-W N°N"'"N°&AMK LOCATED IN THE NW114 OF THE NE114, Wasw A PART OF THE NW114 OF THE NW114,ALL IN SECTION 30,T29N,R1 7W, F, . I NE,- 1 iAMA'InNiinW. NA97XIASNN 40Nsti TOWN OF HAMMOND,ST.CROIX COUNTY,WISCONSIN, 'mwea'`'�I Wx EE CIS ; I I JL__ - --�� I NNLOPmSECA7ND —— �1nmAAEDwArs i I — SEC.30,T4BN,R17W VWIEN80Ee®}e —— 1 srel7rWm N C---O---U--N— TRUNK HGWAY TT ---- N7ANa:6nEANW R ser4112W 1811.83 — — 8 pm7o m W017xms R —A-- — — — — — — — — — _ ——— } �— `. LOT 50 I, 1031.00 I 9.. .. .. „ �y._._._._.___ � ��� 4 81,19 S0.FT. �'I ! 6 5�[dLA14fy G(3 8 [419 9119 B J�5 9 ; e f' h LEGEND LOT 43 }aanluur w� e SENBIEW10rt R'�017�Y OM 200 ALOES c nn,nonm AB 1 1veaoaxNVOErarc 87,3W SO.FT. LOT 44 S8p4p12W BU.Oi 0 11 a AD, 87,305 Sa FT. LOT 48 n r roo.rawa raw �i mm' use 1ma lux 3"8mm �' N aw4sa R 1.86=103300 1.90 ACRES m 1 w'>vaaA=-aw �i --_-: --3/-ra. �3- ptalw,ct 82,5 SO.FT LOT 36 ACRES r rr sriv, LOT 30 Ea Eat -- S$—�:. e� 101 LOT 45 � 76 �a L u 6 �1Nf.'NONRaf.�AF�b 81,125 Sa FT.rrJr4 vyrr 9 �3 LOT 12 �II,;1� \ ' 87,691 Sa FT. . 1------t lma xaR 'i.} ...... ESaaur 7AIA DAe r r v 200 ACRES 1 l } oar r um yry B7,U3 2 FT, ". ---uu utt aen m Tali B f�E4W4�III��J N7L NHItEeL� �`1 ''! I z j ODRA AAKIVREMBAlt al .i r—'v B. . I I I all ' L9.0.=105500�aralcoDONo �iJ1'NDLH (1 HN.L• CYWGEA#J�Na1 1 1 - LOT 46 1 _.an;anMee r 8 '• LOT 47 '1 1.95 ACRES Z zW pLN�ES LOT 18 186 ACRES j e4,752 sa Fr. ; -- - d 'D: 201 ACRES 81,138 SO,FT LOT 37 LOT X41 W,125 sa FT. &_ 200 ACRES " 87,527 S0,FT, 1 1-1r L99 ACRES 87,126 SO.FT. 200 ACRES j d. ' aoaww _ N Lill IM 4 .wma. .. 87J34 Sa Fi de I. 1 8 I . � 1 VIU4FK94V14 N0113: 1 ___ _ b ___ ipINW?[61R9AW4LN7nAAE01 . 13 ----A'n 4 —-- Aba<AEwIN Na AaIAaENswUvnWAsAnaNI tF nLTOurt'as4LtNNrvrEaCwu1A.nsD4LALC a'a,ALo�nn's•.l<ANSuOOElVae5nS4NCwrCrNfRLm a1ix�zi ¢ R '--------'—'--TOWN ROAD—'—'——— --'—'— —`--- _ a4° D T nurcswxLNrAU rovxrnrAxA I W ____ _ _.__.__.__I}/�_ ___ -_____�__ __._ ______7LI17____ ____NA4Q'.IN4.D 11 ___ _II_._-.___ ____�I!L______ .___ Mme•,1'i1rDAMla1�Ii�64J'�IODAh LID V!r6. FSNDRAG'Mr4 @E 1CAAA7['_E48EaPF E q 8 NA10,,u aaA mar cAN c¢sumc7ne Tis �IOUK+OR�EtlOL1�TMh 94N _�Io 14 c ...... ...... .. ....... ^ ` 00 LOT 78 ..8.. LOT 78 9 p n1scr ar nn.rt°c . I 1 LOT 82 LOT B1 LOT n 2A0 ACRES B : ow,Nn v�uhwN,.1.u¢cAEU+�xwnA LOTH LOT 84 LOT 83 a 200 ACRES 9 2A0 ACRES 2,00 ACRES 2A0 ACRES a uurvaa>uaA9ElwFAUNENRnArwauw;h x WJ25 Sa FT. 87,125 Sa FT. 3 01,125 S0.FT. 3 87,125 S0.!7. ; B7J25 S0.FT. ; w ;IIpN4wAhrwvAlSeaheaeMffwonu a 1 # ,g9 ACRES, ; ZOO LOT 05 A ES 8 87,0 AS6EFT� 3 U325 Sa FT, I 0 a AE g �i LA. =1RA40 87429 So.FT. I H ,o>S SpoNONnnsNA'u¢mcws'wNa+aa: I I ,aA uasmavrrmxvx;w:Nrm I I eNCwua4ucn�vusNCaN 11 I 1 w4 d 1 , of L I I .. ------ y-----'--- ___ �- flOTB-____ 1117 1 OAA:NWC_-___ ;A$:;[Ni @AIR R 4)`---- ------B ni®8 1u �in9 D1.0 R 1Lt1Y a� a117 &Q 184 D711 J <-- AAAnrcc [ASts¢Nr n,o D i''ab n4c N�46'04 E 4877.38 D eoo" \ `9LMlN46ArM0AD@6aENMew �I I; ov.•loco i \\ Cw"49D 60798 , SCALEINFEET V=100' s:i @ ,Gib 9498 i 10190 \ X298 t aQ6©ju 21 1; O; h 1 B r1MM a.l \ �e I ns,may>roAUlmeemNA�wr7Aa ae' uhsna owl OF 3 SHEETS