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HomeMy WebLinkAbout016-1050-30-050 Wisconsin Departmer�of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 574364 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: Hughes, Mark D. I Glenwood, Town of 016-1050-30-050 CST BM Elev: Insp.BM Elev: IBM Description: ,,/� Section/Town/Range/Map No: #3�1 � GS I 22.30.15.360A20 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER r� 5 CAPACITY STATION BS HI FS ELEV. I Septic o,ti Benchmark S. Dosing �a ( ` Alt. BM ttj l0 °n 0� AeraM �� Bldg.Sewer L 93 , z Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLD vent t Air Intake ROAD Dt Inlet ` Septic 7 _ Dt Bottom 25-� -773 Dosing �G c, Header/Man. T Aeration Dist. Pipe �• DT 7 Holding Bot.System PUMP/SIPHON INFORMATION Final Grade 7 Manufacturer l 5 Demand St Coverer p q GPM f 1 �JS � N, Model Number L ^ a 4n TDH Lip Friction Los System Head � TDH (J V, f Forcemain Len th I Dia.Z I Dist.to Well �z SOIL ABSORPTION §YS TEM BEDITRENCH Width Length No.Of Trenche PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 75 6 --- -,--I ---- SETBACK SYSTEM TO P/L JBLDG I IWELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type O ystem: UNIT Model Number: 76 DISTRIBUTION SYSTEM Header/ anifold Distribution x Hole Siz� /I Ix Hole Spacing Ven o it Inta Length Dia Pipe(s) ength 73 Dia / + 5 Spacing l 6 v SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only a•^^ Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mul ed Bed/Trench Center / Bed/Trench Edges Topsoil ` I Yes l No es No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / Inspection#2: Location: 1425 300th Street GI nwood Ci y,WI 54013(SW 1/4 SW 1/4 22 T30N R15W) NA Lot 1t ► Parcel No: 22.30.15.360A20 1.)Alt BM Description= J�. / 00 2.)Bldg sewer length -amount of cover= Plan revision Required? 7k Yes No p 7i 11— �- G t Use other side for additional information. ] Date Insepctor's Si ature Cart.No. SBD-6710(R.3/97) 14a A va s 1 , -7,:l P-9 r L two, 14 i c►1 r-Out rN l z rr PAID County ,y Safety and � Buildings Division � C...o?a i 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.) Madison,WI 53707-7162 �. [�0 r. `rrmit Application State Transaction Number In accordance with SPSc�3�3. Q,l�is.Adm.Code,submission of this form to the appropriate governmental unit 2�� �� ��1• is required prior to,Q� 'd$'a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than m iling address) the Department of�'dfety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law,s.15.04(1)(m),Slats. _ �G 1. Application Information—Please Print All Information Property Owner's Name Parcel 1�1�-e 1 u s v? Property Owner's Mailing Address Property Location /3 W A2 O zt C h e Govt.Lot (/ City,State / Mn Code Phone Number L,� y. S(,d y,, Section �Z G d /'r 1 1 5/ ^ �3G^GA 3� �cvcle one) Cf�f ex 4 �/7 + T N; R E or W II.Type of Building(check all that apply) Lot# 1 or 2 F it Dwelliinngg—Number of Subdivision Name / ,' r � /"t ," �[aZ V (( t✓/ Block# .�� F"od Pi 4 - Public/Commercial—Describe Use Ai�Q {S LL ❑City of /i17 > 5,/ El State Owned—Describe Use CSM Number ❑ Village of V,,7o P +5-JO Town of G 1 h t:✓t•a III.Ty 1 Check only one box on line A. Complete line B if appy bie 4' �ytem ❑Replacement System ❑Treatment/Holding Tank Replacement Only El Other Modification to Existing System(explain) B. El Permit Renewal El Permit Revision ❑Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV.Type of POWTS System/Component/Device: Check all that a ❑Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade (Mound>24 in.of suitable soil Mound<24 in.of suitable soil ❑ Holding Tank ❑Other Dispersal Component(explain) Pre �atment Dev fe(e)p!ain) V.Dis ersal/Treatment Area Information: _ Design Flow(gpd) Design Soil Applicatio Rate(gpdsf) Dispersal Area quire d(sf) Dispersal Area Pro osed(s System Elevation Sd0 ✓ Q+ 0 u `3 d U /S( , IL VI.Tank Info ' C pacity in Total #of Manufacturer �" / Gallons Gallons Units7` V " i _ New Tanks Existing Tanks y 48 v o a A 'I, U (n V Zn w 0 CL Septic or Holding Tank c.%.S e- Dosing Chamber 'C VII.Responsibility Statement-1,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plum 's Signatur RS Number Business Phone Number �G Plumber's Address(Street,City,SlAe,Zip Code) p t-t1osA I I/X-e VIII. ountv/De artment Use Only s , T2 ateAsu Issuing Age t Sig re PProved ❑ Permit Fee Disapproved $ 13 Ll ' + ❑Owner Given Reason for Denial _ IX.Conditions of ApprovaVReasons for Disapproval /y 2S- SYSTEM OWNER; S'� ' 7� 6vu%lvn Yil- � a - 1.Septic tank,effluent filter and dispersal cell must tZe eryv pedl maintained as per management plan provided by plumber. L Hulf ld& 1 Ifflibilhdamine6t and submit to a Cou ty only on paper not less th'aa 8 1l2 11 inches in si as per applicable code/ordinances. �f//�U--. 6 �" SBD-6398( 11) pd AR 5�ci� Tp DIVISION OF INDUSTRY SERVICES 141 NW BARSTOW ST FL 4TH M WAUKESHA WI 53188-3789 K Contact Through Relay 9 www.dsps.wi.gov/sb/ aka` www.wisconsin.gov p�ssic�x��g� Scott Walker,Governor Dave Ross,Secretary August 29,2014 CUST ID No. 223475 ATTN.,POW7SInspector JOE STANG ZONING OFFICE STANG PLUMBING&ELECTRIC ST CROIX COUNTY SPIA PO BOX 263 1101 CARMICHAEL RD ` OODVILLE W1 54028 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES.0812912016 Identification hers ion ID No.2445304 SITE: Site ID No. 885451 Mark Hughes Please refer to both idennftica;Um,nu00rs, 300TH St above,in all correspondence Town of Glenwood agcncyw St Croix County SWl/4, SWI/4, S22, T30N,R15W Lot: 1, FOR: Description:Refound Object Type:POWTS Component Manual Regulated Object ID No.: 1498090 Maintenance required; 300 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s):MAuud,Component Manual-Ver. 2.0, SBD-10691-P(N.01/01,R. 10/12),Pressure Distribution Component Manual-Ver. 2.0, SBD-10706-P(N.01/01,R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above.The owner,as defined in chapter 101.01(10), Wisconsin Statutes,is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the enclosed approved play � a d with the"Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P 10/12)and the"Pressure Distribution Component Manual for Private Onsite Wastewater Trgat> Syys , 2.0"SBD 10706-P(N.01/01,R 10/12). � 1p IQ�� C, The `, The building sewer and distribution network piping shall be of material listed i y3 4.30�`3vb►d 384.30-5, Wis. Adm. Code. In the event this soil absorption system or any of its component parts malfun ;oLts to create a health hazard, the property owner must follow the contingency plan as described in the appii ik In addition,the owner must comply with the operation,maintenance and monitoring duties as described in 'ction VIII of the mound component manual.A copy of this information must be given to the owner upon completion of the project. All holding/treatment tanks are to comply with SPS 384.25(7)(a). JOE STANG Page 2 8/29/2014 I 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. A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19,Wis. Stats. Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d),Wis. Stats. Owner Responsibilities: • SPS 383,52 Responsibilities. 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). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4)shall be considered a human health hazard. • SPS 383.55 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. A copy of the approved plans,specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department,which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2),nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure,or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sin ely Fee Required$ 250.00 Fee Received$ 250.00 Balance Due $ 0.00 Julia Lewis-Osborne POWTS Reviewer 2,Integrated Services *OtW) " (262)397-6005, Fax: (608)283-7481 julia.lewis@wisconsin.gov Nate: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety&Buildings)will be modified. Code references with prefixes starting with"Comm"have been replaced with"SPS"to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety&Professional Services, Additionally,all IS(formerly S&B)codes have been renumbered and addressed in a"300" series. For future reference,the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. Mound System Maintenance and Operation Specifications Service Provider's Name Joe Stang Phone 715-684-5166 POWTS Regulator's Name St. Croix County Zonimg Phone 715-386-4680 System Flow and Load Parameters Design Flow-Peak 300 gpd Maximum Influent Particle Size 1/8 in Estimated Flow-Average 200 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 300 ft2 Maximum FOG 30 mg/L Type of Wastewateq Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound 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 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 Finishe Detail d Grade\,Jt 6-8 Diameter Threaded Lawn Sprinkler Cleanout Plug Valve Box or Ball Valve Distributiox iDegreeil n Lateral'��, ' Long STwo 4Bends Diame Project: Hughes Mound Page 5 of 9 Mound System Management Plan Pursuant to SPS 383.54,Wis.Adm.Code General This system shall be operated in accordance with SPS 382-84 Wis.Adm.Code,and shall maintained in accordance with its'component manuals[SBD-10691-P(N.01/01),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 P revent 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 o ensure proper operation. The filter cartridge should not be removed unless provisions ry P P P 9 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 ctu/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. t ;W 1, 1 di r Loy CIO. U � a t� De cr � r 1 r y f , MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN RECEIVED Residential Application AUG INDEX AND TITLE PAGE I —42014 Np�STRY SERVICES Project Name: Hughes Mound ES Owner's Name: Mark Hughes Owner's Address: 2405 Larpenteur Lauderdale, Minn. 55113 Legal Description: SW1/4 SW1/4 S22 T30N R15W Township: Glenwood County: St. Croix Subdivision Name: Lot Number: 1 Block Number: N/A Parcel I.D. Number: 16P05030050 Plan Transaction No.: Page 1 Index and title Page 2 Data entry 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 Site Plan Page 9 Soil Evaluation Report I Designer: Joe Stang License Number: 223475 , Date: 07/314#4 Phone Number: 1-715-684-5166 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P(N.01/01), d both C�s+ SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS- and Pressure Distribution Component Manual Ver.2.0 SBD-10706-P(N.01/01 ��F Version 7.0(R. 03/2012) Page 1 of 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 200.00 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. 300.00 Design Flow(gpd) 16.00 Site Slope(%) 92.40 Contour Line Elevation (ft) 24.00 Depth to Limiting Factor(in) 0.40 In-situ Soil Application Rate (gpd/ft ) Distribution Cell Information 75.001 Dispersal Cell Length Along Contour(ft) = 4.00 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) a Center or End Manifold 0.00 Lateral Spacing (ft) If N above, enter the elevation ft 1 Number of Laterals of the highest point. 0.125 Orifice Diameter(in) 1.50 Estimated Orifice Spacing (ft) = 6.00 ft2/orifice 2.00 Forcemain Diameter(in) _ 90.00 Forcemain Length (ft) Does the forcemain drain back? Y 77.70 Pump Tank Elevation(ft) Enter Y or N 6.50 System Head (ft)x 1.3 14.68 Forcemain Drainback(gal) 15.29 Vertical Lift(ft) 33.72 5x Void Volume(gal) 0,87 Friction Loss(ft) 48.40 Minimum Dose Volume(gal) 0.00 In-line Filter Loss(ft) 20.60 System Demand (gpm) 22.66 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 1.00 1.50 1.25 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons/Inch Calculator(optional) Treatment Tank Information 650.00 Total Tank Capacity(gal) 1000.001 Septic Tank Capacity(gal) 38.00 Total Working Liquid Depth (in) Wieser IManufacturer 17.11 gaUin (enter result in cell B49) Dose Tank Information Effluent Filter Information 650.00 Dose Tank Capacity(gal) Best Filter Manufacturer 17.00 Dose Tank Volume(gal/in) GF10-8 10x18 Filter Model Number Weiser Manufactur r e Project: Hughes Mound Page 2 of 9 I Mound Plan and Cross Section Views 1 I 1/10 B Observation Pipe K s A W B '3 L Mound Component Dimensions 4.00 ft E 19.68 in H 1.00 ft K 9.34 ft B 75.00 ft F 9.50 in z 16.91 ft L 93.67 ft D 12.00 in G 0.50 ft J 4.65 W 25.56 ft 300.00(ft2) Dispersal Cell Area 1568.51 (ft2) Basal Area Available 4.00(gpd/ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 95.19(ft) ► 2 GI H F dispersal cell 93.90(ft) Lateral 93.40(ft)—► Invert Dispersal Cell Elevation E D, 4 9 .40(ft)Contour Elevation 16.0%Site Slope Geotextile Fabric Cover Shading Key au rod T Disersal Cell See lateral details on 10_ Topsoil Cap ROM 1.5 ft Page 4 for number,size, 0 Subsoil Cap esqo 5 and spacing of laterals. ASTM C33 Sand P Laterals are equally Tilled Layer -P 0.5 ft F spaced from the distribution cell's © Aggregate ul q centerline in the distribution cell(AxB). Project: Hughes Mound Page 3 of 9 End Connection Lateral Layout Diagram Laterals centered over the A&B dimension •=Turn-up vidball valve or cleanoutplug P .I Last hole drilled next to end cap 1<-}CSI Laterals Morcemain Sch 40 PVC Holes drilled on the bottom of the lateral per S P S Table 384.30-5 equally spaced Number of Laterals 1 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 1.50 ft Lateral Length (P) 73.50 ft Orifices per Lateral 50 Lateral Spacing (S) 0.00 ft Orifice Density 6.00 ft2/orifice Lateral Flow Rate 20.60 gpm Manifold Length 0.00 ft System Flow Rate 20.60 gpm Manifold Diameter 0.00 in Total Dynamic Head 22.66 ft Forcemain Velocity 2.10 ft1sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and --► SPS 316.300 WAC 4 in.min. Disconnect Tank component is properly vented < Alternate outlet location Forcemain diameter Weiser Manufacturer 2 in. Capaci 650.00 Gallons T - Volume 17.00 gaUinch A _ Weep hole or anti- Dimension Inches Gallons B siphon device A 22.49 382.30 B 2.00 34.00 C Pump off elevation(ft) C 2.85 48.40 _t 78.61 D 10.90 185.30 D Total 1 38.241 650.00 Dose tank elevation(ft) 3" Bedding under tank. 77.70 Alarm Manuafacturer SJE-Rhombus Controls Note: Switches Alarm Model Number [Tank Alert 1 �— containing mercury may not be used in Pump Manufacturer Goulds this system. Pump Model Number 3887 EP05 Pump Must Deliver 20.60 gpm at 22.66 ft TDH Project: Hughes Mound Page 4 of 9 ITT GOU-LDS PUMPS Wastewater PERFORMANCE RATINGS COMPONENTS Galow Per ' Rem Total Head (T of water? M'mute No. EP04 EP05 1 Impeller 5 53 - 2 Base 6 10 - 10 46 62 3 Pump Casing 8 15 1 36 55 4 Medwkal Seal 7 20 21 46 5 Ball Bearings 6 25 0 33 6 0-Rings g�r 30 - 11 7 Power Cord 5 8 Oil Filled Motor 4 3 g Motor Housing) 1 StatorA% mbly 10 1 Motor Cover Z METERS FEET 10 I ! 9 305 CPM c 25 7 i �Za6� i j v 6 20� z 5 I I O 15 I i 4 ! i- EP05 O i 3 10 t i i - - - - i - PO4 2 5 1 t � f 0- 00 110 2`0 30 40 50 GPM L 'L 0 2 4 6 8 10 12 rn3/h CAPACITY t i 3 Property Owner_ Parcel ID# j Page of Boring# Boring Q it Ground surface elev9 ft. Depth to limiting factor < 3 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 •Eff#2 EF I Boring# Boring ija---oiSoil Pit Ground surface elev. (� ft. Depth to limiting factor Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 •Eff#2 h7 L J 6c l m. ti/3 (� F-1 Boring# E] Boring 0 Pit Ground surface elev. ft. Depth to limiting factor in. Sal ication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 •Eff#2 Effluent#1 =BOD.>30 1220 mg/L and TSS>30<150 mg/L •Effluent#2=BOD,<30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SOD-8330(R.W00) Ink VAsconsin Department of Commerce tC74ION REPORT Page of Division of Safety and Buildings in acco5 V s.� Cod County Attach complete site plan on paper not less than size.Plan must r include,but not limited to:vertical and horizontaI�Pi lAq�Srd Parcel LD. �/�percent slope;scale or dimensions,north arrow, tmrest ro d. ` (J.� �� V�3�-t�� �j11 U✓�Please print all in Revi by Date Personal information you provide may be or for secondary p rpose Privac Law,s.15.04(1)(m)). 7 LZI 7 a n Property Owner 'C' Property Location /U Lot 3 L J14,56,24 S T N R/J_ E(o W Property Owners Mailing Address I:# Block# Subd. NameQr CSM#�O J Sao 2 City/ /St'at'e Zip Code Phone Number City /[]Village To Nearest Road d 16,/C 1V Ito) C�f3l J(. S ter-New Construction Us sidential/Number of bedrooms. Code derived design flow rate GPD ❑Replacement ublic or commercial-Describe: Parent material Flood Plain elevation if applicable �'V-/i'4- ft. General convnents and recommendations: Boring# Boring ✓ Pit Ground surface elev. �� ft. Depth to limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 2_ 2-2-Y 1 Boring# Boring �„ s� Ground surface elev� ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 'Effluent#1 =BOD >30<220 mg/L and TSS>30<150 mg/L 'Effluent#2=BOD <30 mg/L and TSS<30 mg/L CST Name(Please Print) Si CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 `� —°— 715-246-4516 Soil Test Plot Plan Project Name Chad Behrendt Sh ird Address 1443 300th St. Glenwood Wi54013 M #226900 Lot 1 Subdivision Date 9/19/05 S W 1/4 S W 1/4S 22 T 30 N/1415 W Township Glenwood Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1/2" pipe System Elevation TBD *HRPSameasBenchmark 300th St. -4 20' 150' Scale is 1" = 40' unless otherwise oted r 00' B-2 *B.M.90' t.B.M. is grade CC power pole= 16% Slope 9.4' 100 B-3 50 0' 0' 30' B-1 92' 94' 917' Property Line 8 1 2 1 6 9 3k-0p XAT 20 PAGE 5102 R EiGEEI� H. (y� EGI U ST • �:! � ER OF e O �� DE EDS FEB � ST. CROI X CO. MI 1 RECEIVED FOR kEEORD , h 11/16/2805 09:15Ad CERTIFIED SURVEY MAP t .•w., COPY FEE: 3 88 CER TIFIED SUR VE Y MA�GES: 2 LOCATED IN THE SW 114 OF THE SW 1/4 OF SECTION 22, T30N, RI5W, ya TOWN OF GLENWOOD, ST.CROIX COUNTY, WISCONSIN, N PREPARED FORT CHAD BEHRENDT W 1/4 CORNER 3 OF SECTION 22. NOTE., BEARINGS ARE REFERENCED o n CFpUND ALUMINUM CAP) TO THE SOUTH LINE OF THE SW 114 ^o OF SECTION 22. (ASSUMED.). o° UNPLATTED LANDS .............................. N 89.53,36,E 1320.28' Io 300: t2'5 950.01' 1 0 370.26' n Ic^L 7 9aAC ES �p S 89.53'28'W 344,004 SO. FT. to: 01)I :100.00' 7.74 AC. EXC. R/W 3 A: 3 %0 66.99' .O 337,073 SO. FT. N 00.12119'£ c%j 2 ►- °'0 170.00' o o Q' IQaA: �U in q 3 J: ~I � S 89.53'36'W 850.01' �s w W Q: oA� I v1 �- ° ��'� LOT 2 a: r ' Z I I m '-HWY. SETBACK w x �—' 14.48 ACRES o j 33�I I 630,562 SO. FT. ti w 2 p : 14.15 AC. EXC. R/W • N 89'47151'W 850.36' 616,474 SO. FT. p 33.00'0 0 0� 609.36' 3 v: S 241.7'SQG- 1—�♦ �,1 q6? ° 3 o b n, CD y ^008 ,........ .............!�� 32399' °o cu 0.0 I^ 0 7L- Z I" LL7T 3 0 3 S 89.4T35'W 464.98 I DO0% 8.52 ACRES o n� 370,936 SO. FT. I o :7.48 AC. EXC. R/W W -'cG UNPLATTED LANDS 326,025 SO. FT � o%0 cti I. .......................... ... o I°o HWY. SETBACK Zz, o S 89'48'03'W y G ,�. �� 2107.82' S 89.48'03'W 531.OQ' _ °• •� • �•• —ti u� S 89'48'03'W U SOUTH LINE OF THE SW I/4 S 1/4 CORNER SOUTHWEST CORNER OF SECTION 22. OF SECTION 22. (FOUND ALUMINUM CAPS CFDUND ALUMINUM CAPS UNPLATTED LANDS .............................. L EGEND ��gC O jv 0= SET 1' C.D. X 18' IRON PIPE WEIGHING JAMES M. N 1.13 LBS PER LINEAR FOOT. WEBER = GOVERNMENT CORNER AS NOTED. s.1w SPItNO VALLEY, `, wl L0� • O SURV�a 0 SO 100 200 • SHEET 1 OF 2 JAMES N WEBER S-1804 LANDMA K SUR IC N INC. 2005052 THIS INSTRUMENT DRAFTED BY JIM WEBER DATED Z�'� Vol 20 Page 5102 ' dow ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer G 5 Mailing Address L -C Q Dd Property Address l G! sr G�' 'S , lj�_ (Verification required from Planning&Zoning Department for new cons uction.) City/State ! �/. a c� � . Parcel Identification Number o) ,� LEGAL DESCRIPTION / Property Location '/4 , " V s '/a , Sec. 2 2; T 7ON R W, Town of )e 17 Subdivision Plat: , Lot#�. Certified Survey Map# (J / Z l , Volume , Page# Warranty Deed # D 6 J� (before 2007)Volume , Page# Spec house❑yes o Lot lines identifiable yes❑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. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s)of the property described above,by virtue of a warranty deed recorded in Register of Deeds Office. Number of drooms ' /3 / SIGN A O APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV.04/12) � 5�� � ��� � ZY ) : ��Y �� ' �l b k3z` ) _ �cZ ��� ~ � �1K.�3X1� ) = �z l (L�� 300 �:4 19CC-K 1—cob _I f6F mo ga <jI Lo Uri 1, 4 /,/ /,)( 0, L _I Ciilll lull illil hill illii ll�i�l�li��il bill * 8 6 3 5 3 8 1 883838 State Bar of Wisconsin Form 1-2003 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI Document Number Document Name RECEIVED FOR RECORD 11/05/2007 09:50AM WARRANTY DEED THIS DEED,made between Chad J.Behrendt and Katrina M.Behrendt,husband EXEMPT R 17 and wife REC FEE: 11.00 ("Grantor,"whether one or more), PAGES: 1 and Mark Hughes ("Grantee,"whether one or more). Grantor,for a valuable consideration,conveys to Grantee the following described real Recording Area estate,together with the rents,profits,fixtures and other appurtenant interests,in St.Croix County,State of Wisconsin("Property")(if more space is Name and Address needed,please attach addendum): River valley Abstract do Tide.Inc. 1200 Hosford Street,Suite 201 Part of the SW'/,of SW'/.of Section 22,Township 30 North,Range 15 West,Town Hudson,Wl 54016 of Glenwood,St.Croix County,Wisconsin described as follows: Lots 1 and 2 of File#2691323A Certified Survey Map recorded November 16,2005 in Volume 20,Page 5102 as Document No.812169. 016.1050-30-050 and 016-1050-30-075 This Deed is in satisfaction of land contract dated September 27,2006,recorded Panel Weimificatron Number(p" September 28,2006 as Document No.83 5495. This is not homestead property. (is)(is not) Grantor warrants that the title to the Property is good,indefeasible in fee simple and free and clear of encumbrances except: Easements,restrictions and riglits-of-way of record,if any. Dated September ! '2007 (SEAL) (SEAL) • 'Chad J.Behrendt (SEAL (SEAL) • "KwAa M.Behrendt AUTHENTICATION ACKNOWLEDGMENT ``��t►littur�. Signature(s) STATE F TENNESSEE �•`�bFL�::.1 Y.4�''.,� authenticated on 3� GO = i SSE _ s Personally came before me on S 00 TITLE:MEMBER STATE BAR OF WISCONSIN the above named Chad J.Behrendt a ' (If not, to me known to be the person(s)who exec e&60 j.6 tHtlegoing authorized by Wis.Stat.§706.06} instrument and acknowledged a same. THIS INSTRUMENT DRAFTED BY: Attorney Doug Berg Notary tic,S o Tennessee 1200 Hosford Street,Suite 201 Hudson,WI 54016 My Commission fs permanent)(expires: Q3 a } (Signatures may be authenticated or acknowledged. Both are not at ccsaa NOTE:THIS IS A STANDARD FORM. ANY MODIRCATIONS TO THIS FORM SHOULD BE CLEARLY 1DENTIFMD. WARRANTY DEED 0=3 STATE BAR OF WISCONSIN FORM NO.1-2003 +Type name below signatures. 1 of 1 l Parcel #: 016-1050-30-050 09/03/20P AGE E 1 PM P 1 OF 1 Alt. Parcel#: 22.30.15.360A-20 016-TOWN OF GLENWOOD Current [X] ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units 09/29/2004 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner O-HUGHES, MARK MARK HUGHES 2405 LARPENTEUR AVE LOUDERDALE MN 55113 Property Address(es): '=Primary * 1425 300TH ST Districts: SC = School SP=Special Type Dist# Description SC 2198 SCH DIST GLENWOOD CITY SP 1700 WITC Notes: Legal Description: Acres: 7.900 SEC 22 T30N R1 5W PT SW SW CSM 20-5102 LOT 1 (7.9 AC) Parcel History: Date Doc# Vol/Page Type 11/05/2007 863538 WD 09/28/2006 835495 LC 12/15/2005 814317 2944/154 AFF 11/16/2005 812169 20/5102 CSM more Plat: "=Primary Tract: (s-T-R 40%1601/.GL) Block/Condo Bldg: *5102-CSM 20-5102 016-2005 22-30N-15W LOT 01 2014 SUMMARY Bill#: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 09/17/2013 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 14,000 20,100 34,100 NO AGRICULTURAL G4 5.000 800 0 800 NO AGRICULTURAL FOREST G5M 1.900 2,300 0 2,300 NO Totals for 2014: General Property 7.900 17,100 20,100 37,200 Woodland 0.000 0 0 Totals for 2013: General Property 7.900 17,100 20,100 37,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00