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018-1038-40-050
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: $t. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 574352 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)J. Parcel Tax No: Permit Holder's Name: City Village X Township 018-1038-40-050 Evenson, William&Colleen Hammond, Town of Section/Town/Range/Map No: CST BM Elev: Insp.BM.Elev: BM Description: G5� 17.29.17.268D-10 � � o �j06 a� TANK INFORMATION ELEVATION DATA T MANUFACTURER CAPACITY STATION BS HI FS ELEV. I /v 3�L Benchmark Z /aZ �/ Septic � �� �y� Dosing Alt.BM p7,. Aeration r3 cJ olding St/Ht Inlet ��• / r H Z 1 WL St/Ht Outlet TANK SETBACK INFORMATION , TANK TO P/L WE BLDG, Vent t Air Intake ROAD Dt Inlet • / �' Dt Bottom � 3-(o Septic \ I C I f C" / 3 -01 J to Dosing � 2 DJ -Pipe rt Z 166- �v Aeration BoLSIstem -3-.Z� c�l� Gj r/ Holding Final Grade 6-Tt-L _ Q� PUMPISIPHON INFORMATION r Demand St ver Manufacturer "' GPM � Model Number rte" 3'1(o H Friction SysteH ad� T D F t tbf Dia. i/ Dist.to Well ` (Jl ,R SOIL ABSORPTION SYSTEM l Length No.Of Trenches PIT DIMENSIONS, Of Pits inside Dia. Liquid Dep BEDITRENCH Width th DIMENSIONS P/L BLDG WELL LAK EAM LEA G Manufacturer: SETBACK SYSTEM TO CHA OR INFORMATION TypXQ system: r UNIT Model Number: flat 4AP, DIST5151MON SYSTEM x Hole Spacing ent to Air intake ti Distribution x Hole Size mi _ f r (l�fiyi Gt a ` II Leng h r Di ' o- 1 `S SOIL COVER x Pressure Systems Only xx Mound Or At-Grade SSeeded/S odd y xx Mulch Depth Over Depth of f� r Depth Over p Topsoil i �.f��' y �'] Yes _ No 11 Yes No BedlTrench Center BedlTrench Edges p `f`, , p Z7 � Inspection#2: COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: ! / G/ r� Parce o: 17.29.17.268D-10 Location: 1644 HWY 12 Hammond,WI 54015(SE 1/4 SW 1/4 17 T29N R17W) metes&bounds Lot !^ VS 1.)Alt BM Description= �(Y` 2.)Bldg sewer length -amount of cover= r _ _ ) -- Plan revision Required �� ��.� ? Yes No L' --- Use other side for additional information. Date Insepctors Sign.tu Cert.No. SBD-6710(R.3/97) Page 8 of 8 100.20' Sanitary Site Plan For:Bill Evenson Parcel in the SE1/4-SW1/4 Sec. 17 T29N-R17W 0 za 40 Shed 99.20' Town of Hammond-St.Croix County BM azarhto S-18(F-0 1 twh - 40 FL 460 ft. 98.20' 2% elm 5% f B #s d � 2.11 Acre Parcel Proposed 2" Sch. 40 Force Main I fix, #2 A BM• WELL PIL BM#2=Top of Well Head Elev. =97.01' , PIL Proposed 4"Sch. ,Proposed Wieser Concrete WLP1200 1800 Four Bedroo 0`41 40 Bldg.Sewer Combination Tank w/a Poly-Lok PL-525 Filter Home Walk-Out Existing 4"Bldg.Sewer Existing Septic Tank and Dry Well Insulate Bldg. Sewer per SPS 382.30(11)(c)and provide frost protection per SPS 383.43(8)(4)c Abandon failed system per SPS 383.33 Elevation Data B#1 =99.20' Found Iron B#2 =99.56' B#3 =98.76' A BM=Tbp of Siding in W,side of sbed door frame 200 ft.Lot Width * EMP=Same FN#1644 State Hwy. 12 ASSUMED ELEV.= 100.00' ' =Backhoe Pit Safety and Buildings Division County 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be ffiled in by Co.) a` l 7162 � 5 '7� 35Z "OW` `Sanitary Permit Application State Transaction Numbber, In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit A � 7 is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWYS 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 j purp ores in accordance with the Privacy Law,s.15.04 1 m,Slats. � /� 4 I• Application Information-Please Print All Information / / Property Owner's Name Parcel# Property Owner's Mailing Address Property lion Govt.Lot ` Z�g�~�O City,State Zip Code Phone Number ,/4 , tC.1 /<, Section c . -2/t1.--7 $,-Ta (circle one TA 5? N; R Ed H.Type of Building(check all that apply) Lot# for 2 Family Dwelling—Number of Bedrooms Subdivision Name Block# ❑Public/Commercial—Describe Use 4�v C ❑City of ❑State Owned—Describe,5 )(- 75,Use / / CSM Number ❑Village of d✓ / , ❑Town of _�l © III.Type of Permit: (Check only one box on line A. Complete line B if applicable) A' ❑New System 94eplacement System Treatment/Holding Tank Replacement Only El Other Modification to Existing System(explain) B. El Permit Renewal El Permit Revision ❑Change of Plumber FIDIPermit Transfer to New List Previous Permit Number and Date Issued Before Expiration IV.Type of POWTS S stem/Com nent/Device: Check all that a ,�-1 11 Non-Pressurized In-Ground 11 Pressurized In-Ground El At-Grade 9L„6.und>24 in.of suitable soil ❑Mound<24 in.of suitable soil ❑Holding ank ❑Other Dispersal Component ng pe ponent(explain) ❑Pretreatment Device(explain) V.Dispersalffrmeat ent Area Information: Design Flow(Rd) Design Soil Application Rat /sf) Dispersal Area Required Dispersal Area,Pro po System Elevation _ VI.Tank Info Capacity in Total #of Magufacturer Gallons Gallons Units J�c�G f� / o o New Tanks Existing Tanks V'd .32 U M y w C7 Ci Septic or Holding Tank Dosing Chamber ! O� �j D VII.Responsibility Statement-I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print)`� J Plumber's ignature 9 MP/MPRS Number Business Phone Number /SIP J !, /'f>i �1�-s�•� -- Plumber's Address(Street,City,State,Zip C ) VIII.Coun /De artment Use Only pproved ❑ sapproved Permit�Fee j Date Issuued Issuing t Signature ❑ ason for Denial $ G” IX.Condi [ Leasons fpr Disapproval 1 `�8ieptk'tank,eft9t�rtf'fifter`an$' . 3) 64 5 yb'}�e.n�,. a c�.w ct+0 dis 4ml.cell lnusf all be serVk:es'f hialrhkW U 1 t>tsp8t.taanagetnent plan provided by plu r. Ga - 2 regtplementstuust, -v�il?>3utrta i 66 W 60ph=We CO&I Oder Attach to complete plans for the system and submit to the County only on pa epaper of less than 8 1/2,1 11 inchel#i size SBD-6398(R. 11/11) KEITH E KNUDTSON Page 2 7/24/2014 Owner Responsibilities: • The current owner,and each subsequent owner,shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard,the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance.As per state stats 101.12(2),nothing in this review shall relieve the designer of the responsibility for designing a safe building,structure,or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, Fee Required$ 250.00 This Amount Will Be Invoiced. and M Swan 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. jeny.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 byAPS Chapters 360-366. �e�TtirF DIVISION OF INDUSTRY SERVICES 3824 N CREEKSIDE LA o�y 9 HOLMEN WI 54636 s Contact Through Relay 3 www.dsps.wi.gov/sb/ www.wisconsin.gov ��OssroN�+y Scott Walker,Governor Dave Ross,Secretary July 24,2014 CUST ID No. 648443 ATTN:POWTS Inspector KEITH E KNUDTSON ZONING OFFICE KNUDTSON PLUMBING ST CROIX COUNTY SPIA 927 150TH ST 1101 CARMICHAEL RD ROBERTS WI 54023 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/24/2016 SITE: Identification Numbers Bill Evenson Transaction ID No.2434994 1644 Hwy 12 Site ID No. 804194 Town of Hammond Please refer to both identification numbers, St Croix County above,in all correspondence with the agency. SETA, SWI/4, S17,T29N,R17W FOR: Description:Four Bedroom Mound System/4%slope Object Type:POWTS Component Manual Regulated Object ID No.: 1494245 Maintenance required; Replacement system; 600 GPD Flow rate; 37 in Soil minimum depth to limiting factor from original grade; System(s):Mound Component Manual-Ver.2.0,SBD-10691-P(N.01/01,R. 10/12),Pressure Distribution Component Manual-Ver.2.0, SBD-10706-P(N.01/01,R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s)referenced above. The owner,as defined in chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all code CONE) 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. PROFESSIO The following conditions shall be met during construction or installation and prior to occupancy or use: DIVISION OF IN 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 • Inspection of the private sewage system installation is required.Arrangements for inspection shall be made with co E 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 approved plans specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. KEITH E KNUDTSON Page 2 7/24/2014 Owner Responsibilities: • The current owner,and each subsequent owner,shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard,the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance.As per state stats 101.12(2),nothing in this review shall relieve the designer of the responsibility for designing a safe building,structure,or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, Fee Required$ 250.00 This Amount Will Be Invoiced. and M Swan 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 byPS Chapters 360-366. MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE 'UL -1 2014 Project Name: Bill Evenson Mound System Owner's Name: Bill Evanson Owner's Address: 1644 Hwy 12 Hammond WI 54015 715-796-5534 Legal Description. SE1 14 of the SW1/4 Sec. 17 T29N-R1 7W Township: Hammond County: St. Croix Subdivision Name: Na 'TIONALLY Lot Number N-a.�.. Block Number. Na )ROVED AND Parcel I.D. Number: 018-1038.40-050 'IAL SERVICES Plan Transaction No.: USTRY SERVICES Page 1 Index and title Page 2 Data entry Page 3 Mound drawings P ENCE 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 Designer. Keith Knudtson L' nse Number; MPRS#648443 Date: 06126114 one Number; 651-470-1737 Signature: 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(01181)and Pressure Distribution Component Manual Ver.2.0 SBD-10706-P(N.01/01) Version 7.0(R.0312012) Page 1 of 8 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand till(D)calculations assume a 400.00 Estimated Wastewater Flow(gpd) Table 383-44-3 in-situ soil treatment for 1.50 Peaking Factor(e.g. 1.5= 150%) fecal coliform of<°36 inches. 600.00 Design Flow(gpd) 4.00 Site Slope(%) 99.30 Contour Line Elevation(ft) 37.00 Depth to Limiting Factor(in) 0.60 In-situ Soil Application Rate(gpd/ft2) Distribution Cell Information 75.00 Dispersal Cell Length Along Contour(ft) = 8.00 Cell Width(ft) 1.00 Dispersal Cell Design Loading Rate(gpd/ft2) 1 Influent Wastewater Quality(1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) E Center or End Manifold 4.00 Lateral Spacing(ft) If N above, enter the elevation ft 2 Number of Laterals of the highest point. 0.125 Orifice Diameter(in) 2.75 Estimated Orifice Spacing(ft) = 11.11 fe/orifice 2.00 Forcemain Diameter(in) ( , r 119.00 Forcemain Length(ft) Does the forcemain drain back? Y 80.50 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head(ft)x 1.3 19.41 Forcemain Drainback(gal) 1'7,0 18.80 Vertical Lift(ft) 67.51 5x Void Volume(gal) C 1.33 Friction Loss(ft) 86.92 Minimum Dose Volume(gal) 0.00 In-line Filter Loss(ft) 22.24 System Demand(gpm) 26.63 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 x 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallonslinch Calculator(optional) Treatment Tank Information Total Tank Capacity(gal) 1200.001 Septic Tank Capacity(gal) Total Working Liquid Depth(in) Wieser Concrete Manufacturer gal/in(enter result in cell 1349) Dose Tank Information Effluent Filter Information 800.641 Dose Tank Capacity(gal) Pol Lok Filter Manufacturer 16.121 Dose Tank Volume(gal/in) PL-525 Filter Model Number Weiser Concrete Manufacturer Project: Bill Evanson Mound System Page 2 of 8 Mound Plan and Cross Section Views 1/10 B ':: - :.'.:.: Observation Pipe J FK ' A ir•Lr,2.rTi"rvd,r.r•r.r.r,Jo{v{.r•F+�.•u"• Y :,rn..r•.f..F.r.:.{:.".:.{.{.. tl r.{nA..{.,". L•L,L•L•L•L+L•L•L•L•°.•L•L•L•L•L•M1•Lat•ti;;LAS••,•^••L•".•L•M1••.•L+L•L•L•L•L•M1•L•L•°.•L•L•L • {.:•r•{,r•r.r•r•{v:•{.{..".{.:•:•r•:•d•{,:•:•. n•r•r.d•n'^:•{,{n{,{.{.{;r•r•{,:•r•r•r•{.{. W f. 1. _ B L Mound Component Dimensions A 8.00 It E 9.84 in H 1.00 ft K 7.36 ft B 75.00 ft F 9.50 in z 7.20 ft L 89.71 ft D 6.00 in G 0.50 ft J 4.80 ft W 20.00 ft 600.00 (fe) Dispersal Cell Area 1139.91 (fe) Basal Area Available 8.00 (gpd/ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 101.59 (ft) ---► riirri' rrrrr... G H F Dispersal Cell 100.30 (ft)Lateral 99.80 (ft)--► Invert Dispersal Cell [ '- ` '` Elevation . . . . . D E. �4' X. h 99.30 (ft)Contour Elevation 4.0 %Site Slope Geotextile Fabric Cover Shading Key �. Dispersal Cell See lateral details on ® Topsoil Cap ° 1.5 ft Page 4 for number,size, rrrrrrr Subsoil Cap a o q.a ti•ti r and spacing of laterals. ASTM C33 Sand Laterals are equally ® Tilled Layer m 0.5 ft spaced from the +Typical Lateral ,;;L^L, w distribution cell's L L L A('�('�rp/�ate .o •{r::;f;r ::ti d":.r°� © " gg eg � o � �L'+4e1:L�q�q�L:4•S.�L�S YL�ti•'.vS.'� centerline in the *--- A ---} distribution cell(AxB). Project: Bill Evenson Mound System Page 3 of 8 End Connection lateral Layout Diagram Lateratsoenteredoverthe A& dimension •-Turn-Up wtbsllvslv#oroleanoutplug E P AN laterals are identical I<-X- )I Holes&filled on the bottom 06 the lateral equa4 spaced S Force main conneotion via tae or cross to manifold at,arw poird. Latera4s&forcemain Sch 40 PVC per SPS Table 384.30-6 Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing(X) 2.83 ft Lateral Length (P) 73.58 ft Orifices per Lateral 27 Lateral Spacing (S) 4.00 ft Orifice Density 11.11 ftz/orifice Lateral Flow Rate 11.12 gpm Manifold Length ft System Flow Rate 22.24 gpm Manifold Diameter tAft1sec in Total Dynamic Head 26.63 ft Forcemain Velocity Dose Tank Information Locking cover with warning label and locking device and �^ Electrical as per NEC 300 and ----► sealed watertight - SPS 316.300 WAC 4 in.min. Disconnect Tank component is properly vented =: E— Alternate outlet location Forcemain diameter Weiser Concrete Manufacturer `r 2 in. Capacityl 800.64 Gallons Volume 16.12 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 30.28 488.04 B 2.00 32.24 C P` ump off elevation(ft) _t C 5.39 86.92 1 81.50 D 12.00 193.44 D Total 49.67 800.64 D♦, ose tank elevation(ft) 3" Bedding uncler tank. 1 80.50 Alarm Manuafacuurer SJE. Rhombus Note: Switches Alarm Model Number I Tank Alert 1 containing mercury may not be used in Pump Manufacturer JGoulds this system. Pump Model Number I EP05 Pump Must Deliver I 22.24 gpm at 26.63 ft TDH Project: Bill Evenson Mound System Page 4 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name Powers Sanitation T� Phone 715-246-5738 POWTS Regulator's Name I St. Croix Coun Zoning Phone 725-386-4680 System Flow and Load Parameters Design Flow-Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow-Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 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 monthly Pressure System Laterals should be flushed and pressure tested every 1.5 years Moundl Inspect for ponding and seepNe once eve 3 years Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis.Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis.Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished ...........•.. ............... Grade t 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: Bill Evenson Mound System Page 5 of 8 r Mound System Management Plan Pursuant to SPS 383.54,Wis.Aden.Code General This system shall be operated In accordance with SPS 382-84 Wis.Adm.Code,and shall maintained in accordance with its'oamponent 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 The septic tank shall be maintained by an individual certified to service septic tanks under s.281.48,Stats. The contents of the septic tank shall be disposed of in accordance with NR 113,Wis.Adm.Code. The operating condition of the septic tank and outlet fitter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. if the filter Is equipped with an storm,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 Prnsurs DisWbution 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 BOD9, 150 mg/L TSS,and 30 mg/L FOG for septic tank effluent or 30 mg/L BODE,30 mg/l.TSS,10 mg/L FOG,and 10'cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified In the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral,and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner,and any levels above 6 inches considered as an impending hydraulic failure requiring additional,more frequent monitoring. Continency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank,pump,pump controls,alarm or related wiring becomes defective the defective component(s)shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface,it will be repaired or replaced in its'present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media,and related piping,and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 8 Page 7 of 8 GOULDS PUMPS Submersible Effluent Pump f; EP04 3871 EP05 APPLICATIONS •Fully submerged in high ■EP05 Impeller:Thermoplas- ■Bearings:Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing following uses: lubrication and efficient improved performance. construction. • Effluent systems heat transfer. ■Casing and Base:Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms manual operation,Auto- superior strength and corrosion • Heavy duty sump matic models include resistance. canadimStafxlaftAssoaatbin • Water transfer Mechanical Float Switch ■Motor Housing:Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in"C"or••f".) factory. strength,and durability. SPECIFICATIONS ■Motor Cover.Thermoplastic Got"Pumps is ISO soot Beftered. •Solids handling capability: FEATURES cover with integral handle and ' float switch attachment points./4"maximum. ■EP04 Impeller:Thermoplas- N pow Cable:Severe duty •Capacities:up to 60 GPM. tic Semi-open design with rated oil and water resistan •Total heads:up to 31 feet. pump out vanes for mechanical t •Discharge size:11/2"NPT. seal protection, •Mechanical seal:carbon- rotary/ceramic-stationary, BUNA-N elastomers. •Temperature: 104°F(4090)continuous 140°F(6090) intermittent. METERS FEET _ 10 j •Fasteners:300 series stainless steel. *Capable of running 9 30 "� .__... SGPM dry without damage to components, 2s rr 25 a Motor: , x •EP04 Single phase:0.4 HP, u 6 20 115 or 230 V,60 Hz, 1550 RPM,built in overload with o s 1 s automatic reset. a •EP05 Single phase:0.5 HP, a _.. EPOS .. 115 V or 230V,60 Hz, 1550 3 10' .• %� RPM,built in overload with automatic reset __.I 2 EP04 •Power cord:10 foot s standard length, 16/3 1 JTOW with three prong grounding plug.Optional 20 0 ofl foot length,1613 SJMI with 10 20 30 40 so GPM three prong grounding plug (standard on EP05). 0 2 4 6 8 10 12 W/h CAPACITY Goulds Pumps Ef 2001 Goulds Pumps ITT Industries Effective May,2001 83871 r Page 8 of 8 1100.20' ---_._..___._._.�.-_-----_/ Sanitary Site Plan For:Bill Evenson Parcel in the SE1/4-SWl/4 Sec. 17 T29N-R17W o so +o Shed 99.20' Town of Hammond-St.Croix County Cer 8oe4s(lMst) L in0 ooh . AO 460 ft. 98.20' 2% a / 2 S/o 1B #3 4% 2.11 Acre Parcel Proposed 2" Sch. 40 Force Main #2 A BM• WELL PIL BM#2=Top of Well Head Elev. =97.01' PIL Proposed 4"Sch. Proposed Wieser Concrete WZP1200 1800 Four Bedroom 40 Bldg.Sewer Combination Tank w/a Poly-Lok PL-525 Filter Home Walk-Out Existing 4"Bldg.Sewer Existing Septic Tank and Dry Well Insulate Bldg. Sewer per SPS 382.30(11)(c)and provide frost protection per SPS 383.43(8)(4)c Abandon failed system per SPS 383.33 Elevation Data B#1 =99.20' Found Iron B#2 =99.56' B#3 =98.76' A BM-Tip of Siding in W,side of shed door frame 200 f t Lot Width * HRP=Same FN#1644 State Hwy. 12 ASSUMED ELEV.— 100.00' ' =Backhoe Pit .* n y - •.; r , - Metz Ti: r �• T . 17 L UW7, ,; , . i ��PR M, rom MOM mm� mnuffwjm M- Mmm mmm"Im mm�� mm� mm� mm� JF r 1 4W 7:-4 _ r T V? imp, 4 pap t0 3 # � PR i"r-,�-�-$ Dq*lb%d&Qbdul->—�' --i°" Sod i��Aa Q ti9deRtlw��tsen ' Too= Sys tkaida Bosomy- li0ols or w h Maned CkLQL COLC w aLsL L / 0-7 .r c Ar / 6 Q # B m 1t. Db1gt�dor 6i. Hai�os bob Oaad�srt !lwioa 0aea�jtes Teas 81o�atnae Oeamieleaes 8osideiy tiorAslE � # � � tlaSaon Oepyr Dea�faeat iledaKOaeai�Sen. 'iU*M ammom cm Boside�y litnAs •e�ae at#s=B�o�s�9��D,egli.aad'1ls��'I�oaepA. •Beaent#IZ=ao0�_aeagt.sad70s:861adL _ s'wDmp.m.e 4fftmmmwk=mpd all oa■■so=nkips md, 4"m or = d moo is•aileaM*mwt plash=WW dm at M466MI arTT4 SOB0649M.- - �oI 1yk=o' /s • S-C S`I /1S I d = AfA/Y, ;i J�w�tJ I /7` 2 � Z 4fr j4l�,Eunlfn' S'ar `cc4 J .fe sr. • _ u J.f cdrr. y 127 r AoNs f9.x' = Pf. 76 CenTmul� _ ff. TO? r �'t/sTiY leVcl 76' ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Bill Evenson Mailing Address 1644 Hwy 12 Property Address `S' ame (Verification required from Planning&Zoning Department for new construction.) City/State Hammond Wi. Parcel Identification Number 018-1038-40-050 LEGAL DESCRIPTION Property Location SE '/4 , SW '/4 , Sec. 17 , T 29 N R 17 W, Town of Hammond Subdivision Plat: ,Lot# Certified Survey Map# Volume ,Page# Warranty Deed # 3 S N (before 2007)Volume�� Page# 7i . Spec house E3yes[✓ no Lot lines identifiable Oyes[-]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,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 this form are true to the best of my/our knowledge. Uwe am/are the owner(s)of the. property described above,by virtue of a wa;71y deed recorded in Register of Deeds Office. Number of bedrooms 4 8 /16/14 SIGNATURE 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) ' r� 7 Vo;. .�_r) PAGt c�7�t[.r i STATE BAR OF WISCONSIN FORM 2- 1998 t!^j*A:a$St9L WARRANTY DEED KATHLEEN H. WAL.SH Document Number REGISTER OF DEEDS ST. CRDTX CO., WI This Deed,made between Roger Lindquist and June Lindquist, RECEIVED FOR RECORD husband and wife 04-?7-POOI 9:30 AM Grantor,and William L.Evenson and Colleen A.Evenson,husband and WARRANTY DEED F.YcppT N wife,holding as survivorship marital property CERT..COPY FEE: COPY =.F: TSANSFEB FEE: _3.0 n^E('PUNG FEE: 12.00 Grantee. PAGES; 2 Grantor,for a valuable consideration,conveys and warrants to Grantee the following described real estate in St.Croix County,State of Wisconsin: Recordin Area Name and Return Address See Exhibit A attached hereto and made a part hereof. Thomas A.McCormack PO Box 2120 The parcel on this document is being added to the parcel shown on the Baldwin,Wr 54002 document recorded in Volume 443,Page 320,Document No.292733,described as: West 150 feet of the East 473 feet of South 460 feet of Southeast Quarter of Southwest Quarter(SE I/4 of SW 1/4)of Section Seventeen(17),Townshi 01&1038-40;018 1038-10 _ Twenty-nine(29)North,Range Seventeen(17)West. p Palle!Identi£calion Number(PIN) This is not homestead property. to create one parcel,and this transaction is thereby exempt from Chapter 18 of the 0*(is not) St. Croix County Land Use Regulations pursuant to Section 18.05(A)(3). Exceptions to warranties: Easements and restrictions of record. Dated this _113v—A day of '- X 2001 * jRog ind uist Lindquist AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) )ss. St.Croix County.) Personally came before me this, ,e© day of authenticated this day of -}pry/ _'2001 the above named Roger Lindquist and June Lindquist TITLE:M$MB R STATE BAR OF WISQON9II :*r to me known to be the person(s)who executed the foregoing - trument and acknowI d a the same. authorized by g 706.06,Wis.Stagg,) THIS INSTRUMENT WAS DRAFT";.,� - Thomas A.McCormack Baldwin,WI 54002 Notary Public,State of Wisconsin (Signatures may be authenticated or acknowledged.Both are not My Commission is perutanen. no se explra on-ate:' necessary.) *Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-1998 INFORMATION PROFESSIONALS COMPANY FOND DU LAC,WI 800-655-202? VOl_ 1626PAGF 543 EXHIBIT A Part of SE '/. of SW Y.. of Section 17-29-17 described as follows: Commencing at the South •'/4 corner of said Section 17, thence along the South line of said SW '/., N89 057'42"W, 473.00 feet (assumed bearing on the South line of the SW "A of said Section 17, recorded as West) to the Southwest corner of that parcel of land described in Vol. 443, Page 320 of St. Croix County deed records and the Point of Beginning of the parcel to be herein described; thence continuing along said South line N89°57'42"W 50.00 feet; thence N00°40'56"W, 460.00 feet; thence S89 057142"E, 50.00 feet to the Northwest corner of said parcel of land described in Vol. 443, page 320 of St. Croix County deed records; thence along the West line of said parcel, S00 040'56"E, 460.00 feet (recorded as South 460.00 feet) to said South line of the SW '/. and the Point of Beginning.