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002-1063-70-100
Wisconsin Department of Corhm6rce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 574342 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Hopp, Jason &Tristy I Baldwin, Town of 002-1063-70-100 CST BM Elev: Insp.BM Elev: BM Description: /n Section/Town/Range/Map No: 16 9, Z- �C 9-C' oc ;X• 26.29.16.388 B1 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic J / O Benck 21-7 /// Dosing l:0 l'A l0 D l—� ALJum 7-01P o ' �y '` /0 3. 9 Aeration �/ L; � Bldg.Sewer /00. 3 Holding ttfflt�Inlet (p /{�S s�p{� /3.2 `I�'•7 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L W� BLDG. Vent Air Intake ROAD Dt Inlet _ Olt .� Septic , ' /��/ n/� L� / ( Dt B tom Qf ,v Dosing �� v / d�•� Heade an �70 2•S� r a Aeration ��� Dist. Pip d /D Z.5- Holding Bot. System /Ol. 6 OK Final6rade i PUMP/SIPHON INFORMATION Ile >10 3•S— Manufacturer 2 Demand S over / GPM 110$ v Model Number TDH L'i�f, / Frican L System Head TDH(/ ` Ft �. �j Gt (J Forcemain Len th O f Dia. ti Dist.to Well SOIL ABSORPTION SYSTEM �qf of BEDITRENCH Width / Leng / No.Of Trenches IT DIMENSIONS o.Of Pits Inside Dia. Liquid Depth DIMENSIONS 70 / SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM L ING Manufacturer: INFORMATION CH OR TypOf System / !�/0� > l b b UNIT Model Number: >Lo DISTRI N SYSTEM Z 4 h HeaderNani45K r•w I Distribution p r/ n _ x Hole Size x Hole Spacing Vent to Air Int e Length •S Dia 'S Length �0 r�/ Dia Spacing G T• 6 b I— SOIL COVER x Pressure Systems Only xx Mound r At-Grade Systems Only Depth Over Depth Over xx C f / � xx Seeded/ od ed d Bed/Trench Center Bed/Trench Edges opsoil T !� A��` , Yes ,' No Yes No COMMENTS: (Include code discrepencies, persons present,etc.) Inspection#1: /� / L� Inspection#2: X / 20/ l Location: 2543 80th Ave. Baldwin,.WI 54002(NE 1/4 NVyJy ?6 T29N R1 6W) N Lot 3 Parcel No: 29.16.388 B1 1.)AItBM Description �� �'� � �h��� 0110 4-a .. 01663 G(,t �'�� �� (��P /- �<< G,� 2.)Bldg sewer length= �/f /s°�j 74 / �N t.J�J[x- -amount of cover Plan revision Required? r=J YesQ' �3 q 7"S Use other side for additional information. L___ 11-- Date Insepctor Signature / Ce No. SBD-6710(R.3/97) CL JIN r v a r Q� —D Ld m v ri � � v © 00 C 0 County Industry Services Division (� ! r 1400 E Washington Ave Sanitary Permit Number(to be filled in by Co.) P.Q�Bo ,71 Mab6ison,WI 5370 16 Z �` a 026,Mrmit Application State Transaction Number In accordance with Slh 3fthe ) .Code,submission of this form to the appropriate governmental unit is re uired rior to ob i Try permit, Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address)Ave q P the Department of S fessional Servies. Personal information you provide may be used for secondary ur ses in accorda rivac L aw,s. 15.04(1)(m),Stats. 1. Applicati orr ormation—Please Print All Information Property Owner's Name._ Parcel# nom; CO2 -10G3 -70 --100 Property Owner's /Mailing Address /� p Property Location / 3 v p f as /3 8� �� V 1tJ i� Govt.Lot City,State Zip Code Phone Number C 1/,, Section o�b iJL CJV arcle onu L o O� T�N; R �� EorW 11 Type of Building(check all that apply) Lot# V 1 or 2 Family Dwelling—Number of Bedrooms Subdivision Name ✓✓✓ ❑Public/Commercial—Describe Use ❑City of CSM Number Z6 ❑ Village of ❑State Owned—Describe Use � � � ,�/ I 5 8J ✓ll1.a' l ,�'J Town of 2,4 tjw,`J 111.Type of Permit: (Check only one box on line A. Complete line B if appy le) A. ❑ New System Replacement System ❑Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain) B. ❑ Permit Renewal El Permit Revision List Previous Permit Number and Date Issued ❑ Change of Plumber ❑Permit Transfer to New l/1V Before Expiration IV.Type of POWTS S stem/Corn onent/Device: Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade XMound>24 in.of suitable soil ❑ Mound 124 in of suitable soil ❑ Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dispersal/Treat t Area Information: i Design Flow(gpd) Design Soil Application Rate(gpd Dispersal Area Required(sf) Dispersal Area Proposed(s System Elevation ys� Y � �lso Is21, 1 © I , B3 Vl.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units u H ,, New Tanks Existing Tanks ��• t7i 2 v) • N Septic or Holding Tank Dosing Chamber X x VII.Responsibility Statement- 1,the undersigne ,assu sponsibili for install tion of the POWTS shown on the attached plans. Plum s Si nat MP/MPRS Number Business Phone Number Plumber's Name(Print) g 1Lt v, , �o�L 9S397, Plumber's Address(Street,City,State,Zip Code) Ev��� C� )& 8 ��iLt7vttiur vl/� �S/ VIII-Count /De artment Use Only Approved is tpprere Permit�Flee Date 1 ued Issuing A Signature ven Reason for nial $ ZS• / IX.Cond easons for Disapproval Tie Ri 4 Y� t. Septic tank,effluient tai t�tiix� . dispersal cell must all be services/rriatihtalnld _ A �� as per management plan provided by plunrd r. A+c� 2 AN setback requOmettta nne�;t�tC eruritttaiitt d Attach to complete plans for the system and submit to the County only on paper not less than 8 ux x t t inches in size SBD-6398(R0313) LEWIS C BJORK Page 2 7/25/2014 is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • The existing POWTS must be properly abandoned per s. SPS 3 83.3 3 Wis.Adm.Code. 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 re or the installation,operation or maintenance of the POWTS. Since Fee Required$ 250.00 Fee Received$ 250.00 Balance Due $ 0.00 atrici orf POWTS Plan Reviewe VInteated Services WiSM ART code:7633 (715)634-7810, Fax: 0,M-F 8:00 a.m.-4:45 p.m. pat.shandorf@wisconsin.gov 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. l 9 ART.itg� DIVISION OF INDUSTRY SERVICES r yS' lO 10541 N RANCH ROAD 1P� HAYWARD WI 54843 Contact Through Relay www.dsps.wi.govlsb/ www.wisconsin.gov A�O2SSIONI�S� Scott Walker,Governor Dave Ross,Secretary July 25,2014 CUST ID No. 253976 ATTN:POWTS Inspector LEWIS C BJORK ZONING OFFICE LEWIS BJORK LLC ST CROIX COUNTY SPIA E7818 CTY RD E 1101 CARMIICHAEL RD MENOMONIE WI 54751 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/25/2016 Identification Numbers Transaction ID No.2425389 SITE: Site ID No. 804003 Jason&Tristy Hopp Please refer to both identification numbers, 2543 80TH Ave above,in all correspondence with the agency. Town of Baldwin St Croix County NE1/4,NW1/4, S26,T29N,R16W FOR: Description:Mound,3 bedroom residence Object Type: POWTS Component Manual Regulated Object. 1)No.: 1493424 Maintenance required; Replacement system; 450 GPD Flow rate; 14 in Soil minimum depth to limiting factor fro 1i1,pITIOR�� original grade; System(s):Mound Component Manual-Ver.2.0, SBD-10691-P(N.01 101,R. 10/12),Pressure Ufa Distribution Component Manual-Ver.2.0, SBD-10706-P(N.01/01,R. 10/12),SSWMP Pub.9.6; Effluent Filter APPROVE[ DEFT FET The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative SFi N S and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be con ® OF IN S and located in accordance with the enclosed approved plans and with any component manual(s)reference 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 stats. SEE CORRESPOP The following conditions shall be met during construction or installation and prior to occupancy or use: Key Item(s) • 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.In addition,the owner must insure that the operation,maintenance and monitoring duties as described in section VIII of the mound component manual are complied with.A copy of this information must be given to the owner upon completion of the project. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per SPS 383.44(6)(a)2. • Limit activities in the area 15'beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of SPS 384.10.No fixture,appliance,appurtenance,material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system,unless it a. C MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Jason &Tristy Hopp- Replacment Mound Owner's Name: Jason &Tristy Hopp Owner's Address: 2543 80th Ave Woodville WI 54028 651-271-3509 Legal Description: NE NW 26 29 16 Township: Baldwin County: St. Croix Subdivision Name: 5 acre parcel/ Lot Number: NA Block Number: NA Parcel I.D. Number: LY Plan Transaction No.: ( AND Page 1 Index and title :RVICES Page 2 Data entry J�E ICES 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 Septic and Dose Tanks Page 9 Plot Plan Page 10 Plot plan Legend Page 11 Attchments , Tanks , Effluent filter, soil report Designer: Lewis Bork License Number: 253976 Date: Phone Number: 715-231-7375 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(01/81)and Pressure Distribution Component Manual Ver.2.0 SBD-10706-P(N.01/01) Version 7.0(R. 0312012) Page 1 of 11 Mound and Pressure Distribution Component Deign Design Worksheet Site Information (R or C) r Residential or Commercial Design Note: Sand fill(D)calculations assume a 300.00 Estimated Wastewater Flow(gpd) Table 38344-3 in-situ soil treatment for of-36 inches. 1.50 Peaking Factor(e.g. 1.5= 150%) fecal coliforrn 450.00 Design Flow(gpd) 5.00 Site Slope (%) 100.00 Contour Line Elevation (ft) 14.00 Depth to Limiting Factor(in) 0.60 In-situ Soil Application Rate(gpd/ft) Distribution Cell Information 90.001 Dispersal Cell Length Along Contour(ft) F____50_0_1 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate(gpd/ft2) 1 1 Influent Wastewater Quality(1 or 2) Are the laterals the highest point in the distribution F Y Pressure Disribution Information network? Enter Y or N (C or E) c Center or End Manifold 2.50 Lateral Spacing(ft) If N above, enter the elevation ft 4 Number of Laterals of the highest point. 0.188 Orifice Diameter(in) 4.25 Estimated Orifice Spacing(ft)= 11.25 ft2/orifice 2.00 Forcemain Diameter(in) 30.00 Forcemain Length (ft) Does the forcemain drain back? Y 95.00 Pump Tank Elevation (ft) Enter Y or N A',-- 3.25 System Head (ft)x 1.3 4.89 Forcemain Drainback(gal) .71 3Si 6.50 Vertical Lift(ft) 81.24 5x Void Volume(gal) 0.45 Friction Loss(ft) 86.13 Minimum Dose Volume(gal) 0.00 In-line Filter Loss (ft) 26.21 System Demand(gpm) /J 10.20 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 x 1.50 x x 1.25 x 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons/Inch Calculator(optional) Treatment Tank Information Total Tank Capacity(gal) 1000.00 Septic Tank Capacity(gal) Total Working Liquid Depth (in) Wieser I Manufacturer gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 600.001 Dose Tank Capacity(gal) Life time Filter Manufacturer 16.761 Dose Tank Volume(gal/in) LT-1/8 Filter Model Number Weser IManufacturer Project: Jason&Tristy Hopp- Replacment Mound Page 2 of 11 i Mound Plan and Cross Section Views . . T -: /10 J 1 B j. • . •_ . . Observation Pipe Tom . . . . . . : : : :•. . . . . . . . . . . . . . . . . . . . . . . . . . K y;y�.;••; y..,..,.y.y.............•....;•.;•...y.y.............y.y.y....y.y.......y.y.• :•r•:•:•:•:•r•r_r•r•r:::r' ':::•r•r•r•::::::r•:•r•:•r•r•r•r•:•r• ::'r:::' •'y::,:. yy.y.•,.•,.• y.•,.•,.y. ti:ti:ti.y.y.�„y.y.•,.y.y.y.y.y.y.•,.•,.•,.y.•,. y"ti.y.y, - 5 A A 'y"•'y"•"•'y"•"•'y'y' y"•'y"•"•'' y'y''•'y"•''"' 1'y'y' •' ':'1;r::•r• ::f•r•:•:.:•:•r•r•r•:• :'r:r'f:r•r•r•r•r•r:f•r•r•r•r•:•r:r::::. r•:.:.r•;• y.y.y.y.y....y....y....•..•..y..,,.,... .y.{.y..,.y..,..,..,.y.y.y..,.y..,.y.y.y................y..,.y. •}r:r••,:•• •••;•r•••r.;• ,:•,•:•,•r•::r•r•r• ,:•;•:•r•••r•r•,•r• •r•r•r•r•••:•,•r- W a : i : ; :.� B . .:.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :-:- _ L Mound Component Dimensions A 5.00 ft E 25.00 in H 1.00 ft K Aft ft B 90.00 ft F 9.50 in 1 11.91 ft L ft D 22.00 in G 0.50 ft J 8.15 ft W 450.00 (ft2)Dispersal Cell Area 1 1522.06 (ft) Basal Area Available 5.00 (gpd/ft)Linear Loading Rate 9.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 103.63 (ft) H G I F Dispersal cell 102.33 (ft)Lateral 101.83 (ft) Invert Dispersal Cell Elevation E D :;:: .4. .•. .••. 4 .x x� ,� ti_ti�.4�j��,�}�{x� � ,�?.•'J.?,�.�.'4 100.00 (ft)Contour Elevation 5.0 % Site Slope Geotextile Fabric Cover Shading Key m fl. T Dispersal Cell See lateral details on Topsoil Cap V a 1.5 ft y y y y •y y •y:•:•' Page 4 for number,size, r/,rrrrr Subsoil Cap a 0 5 5 r. y:r r and spacing of laterals. 0 ASTM C33 Sand t° `° f _ - .y�? Laterals are equally 'a ; ;.; F spaced from the Tilled Layer � m 0.5 ft �; Typical Lateral ;,;r;: w :�r� • • • distribution cell's O© Aggregate y.•r..• yry. . . .•: - -1.r Centerline In the * A distribution cell(AxB). Project: Jason&Tristy Hopp-Replacment Mound Page 3 of 11 Center Connection Lateral Layout Diagram Face*main cormection Y4 tee at ocoss to rnaraoW at aryl point Later4is are idlentic al P S Turn-up%ftsll volvo or X--+1+T-dZ Lateraft Morcanain SCh 40 PVC Table ciesnoutpluo per SPS To 384,30-6 Holes drilled on the boom of the lateral., I Number of Laterals 4 Orifice Diameter 0.188 in Lateral Diameter 1.50 in Orifice Spacing (X) 4.66,ft Lateral Length(P) 44.27 ft Orifices per Lateral 10 Lateral Spacing(S) 2.50 ft Orifice Density 11.25 ft/orifice Lateral Flow Rate 6.55 gpm Manifold Length 2.50 ft System Flow Rate 26.21 gpm Manifold Diameter 1.50 in ft Total Dynamic Head 10.20 Forcemain Velocity 2.6 ft/sec Dose Tank Information Locking cover with warning label and locking device and 0/"-- sealed watertight Electrical as per NEC 300 and SPS 316.300 WAC Disconnect 4 in.-min. per NEC 300 and 3 �16_300 WAC Tank component is properly vented Alternate outlet location Forcemain diameter wieser Manufacturer 2 in. Capacityl 600.00 Gallons T Volume 16.76 gal/inch A Weep We or anti- Dimension Inches Gallons B siphon device A 18.66 312.75 C B 2.00 33.52 -d Pump off elevation(ft) C 5.14 86.13 95.83 D 10.00 167.60 D r—Total 35.80 600.00 IF- Dose tank elevation(ft) 3"Bedding under tank. F-95.001 Alarm Manuafacturer ISJE-RomBus Note: Switches Alarm Model Number 1520-002A containing mercury may not be used in Pump Manufacturer JZohler I this system. Pump Model Number 1152 Pump Must Deliver 1 26.21 Igpm at F1_0_2_0_1ft TDH Project: Jason &Tristy Hopp-Replacment Mound Page 4 of 11 r Mound System Maintenance and Operation Specifications Service Provider's Name I Lewis Bork LLC Phone 715-231-7375 POWTS Regulator's Name St. Croix Count Phone 715-386-4680 System Flow and Load Parameters Design Flow-Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow-Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ft' Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 m 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 eve 1.5 ears Mound Inspect for pondin and seepage once every 3 ears Other Lewis Bork for Pumping 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 v1 � 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: Jason &Tristy Hopp- Replacment Mound Page 5 of 11 r 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 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 Commence. 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 BODr, 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. Project: Page 6 of 11 Page t or t C� w PUMP PERFORMANCE CURVE MODEL 1511152/153 50 14 45 153 12- 40 35 L5 152 L5 10 30 o $ 25 151 0 6 20 15 10 2 5 0 10 20 30 40 50 60 70 80 90 100 GALLONS LITERS 0 40 80 120 160 200 240 280 320 360 FLOW PER MINUTE 014508 https://app.gleapahead.com/rtp/tools/93928-63.gif 8/26/2013 t Plot Plan Legend 1 4" PVC ASTM D 3034. 42"Min. Cover where snow is not removed. 2 24" inside diameter plastic manhole brought min.4" above surrounding grade. Concrete/plastic covers screwed down. i 3 Precast concrete septic tank. I 4 Effluent filter location. 5 4" PVC ASTM D3034. 18" Min . cover . Effluent piping or building sewer where tank is within 30'. 6 Precast concrete dose/pump/filter tank. 7 12-2 OF-B Power conductor . 14-2 OF-B alarm circuit conductor. Both wires are UL listed A-2057 8 2" PVC ASTM D-2665 -09 Schedule 40 Pipe Force main. 9 4" PVC ASTM D-2665 -09 Schedule 40 Pipe . Entering and exiting concrete tanks min 10' in length. 10 Carlon All weather pvc junction box. UL listed # A-241 11 treatment/dispersal cell 12 Inspection wells Projdct: Hopp Page t T (A 56" AS 84" REOD 42" z 2 m G � D � A m 0 a UP 41" m 4" CAS I rn 3. � 5» I r > I aD m D;u > — 36" I m rn r o� r D N n 1 N �4 UP 38" L4" CAS g � m m m z c � 0 39" r� D m cn 1 � I D I rn m D r C DO D x O r Z Z o to Z Z D m m rn rn � � z p c7 Z D G)�y fn mm 00> �N Zit °1N*i 2 2 O A O�Z D m x— o D No to o = �s=� uGi� mo T n m a X LA n lq°zg iuDig i2601021* ;wN O �D �N G F D z �N m�ii��cno; O Z A O DC O� Amm LglIn O� p o a 1 V O'S _- N f+1m O vm NfnD I D � N• Op- Q o m o O N v'i'z m . (Dm mm� DF : a o' o Q r o m z W n �° Z Z DO mDm mpW tO o °D m 1W AA' 2 A m A �O D 1* =r 2 r o F. A m < v m a A � ; tZ9 m m NA VOA $� N yj 0 N � � Zg � M �j � 3 m O �� m D A Q rn rn —I o g �+ Z o z rn m m z Fn \ (A WLP1000/600—MR m DRAWN BY. SME SCALE: 1 4"=1'-W -POUR: n -1 SEPTIC MANUAL 6AwCRETE DATE JANUARY 2010 DATE. T-POUR: \Z W3716 US HWY 10 MAIDEN ROCK, WI 54750 ° REVISED JAN. 2010 800-325-8456 RLEWPW 20140048A 1" A 0 Oil 11,11"I" 1�11'115 6 'A hi 11 1�1111 s! Installation and Maintenance Instructions Installation Step Dry fit the filter case onto the outlet pipe going to the drain field.Ensure it is centered directly under the access opening.(if outlet pipe is already in a fixed position,additional pipe may need to be added) Step 2 If utilizing the additional single side support and the two bottom supports: While the case is still dry fit to the outlet pipe, measure and cut 1"sched.ule 40 pvc pipe to the length needed to extend from the hubs that are pre-molded Into the case to the side wall and the inside floor of tank. solvent weld pipe into the hubs that are pre-molded onto the case. Step 3 Solvent weld the case to the outlet pipe.Insert the filter cartridge into the case pressing down on the cartridge until It locks into place at the bottom of case. Step 4 if utilizing a vertical read switch:Insert switch into the hole pre-molded into the top of the filter.Press straignt down until it locks into place Maintenance 1) Remove the access lid of the tank, Note:To ensure undesirable solids do not exit the tank and into the drain field,the tank should be pumped out until the level of effluent is below the outlet level of the tank. 2) To remove the filter cartridge from the filter case,pull up firmly on the handle of the cartridge dislodging It from the case.(if utilizing a vertical read switch,removal of switch Is optional) 3) Using an ordinary garden hose,rinse the filter cartridge ensuring all visible septage material Is removed. 4) Place the filter cartridge back Into the filter case pressing down on the cartridge until It locks Into place. 5) Place the access lid back onto the tank ensuring it is secure. RLEZCER/ED FEB .6 �'_`014 GAFEIN & F3 U1 Li Lifetime filter has a lifetime limited warranty: Lifetime filter LILC warrants the filter will he free of manufacturing and workmanship defects during normal use for the period of time the original purchaser owns the product.Lifetime filter will provide a replacement filter in the event that the original filter was not damaged during the installation or maintenance process.Damage to this product caused by accident,misuse or abuse will not be covered under this warranty.Improper care or malfunctions resulting from product not being installed,operated or maintained property will void this warranty.Lifetime filter assumes no responsibility for labor charges,removal charges,Installation or other Incidental or consequential costs. Contact:mike(Mlifetimefilterlic.corn Phone;502-724-2231 I , Y - DIVISION OF INDUSTRY SERVICES ofi Plumbing Product Review I y P.O.Box 2658 j 1 Madison,Wisconsin 53701-2658 1 � TTY:Contact Through Relay yL\ A.'s �y Scott Walker,Governor Dave Ross,Secretary March 12, 2014 LIFETIME FILTER LLC MIKE HORNBACK 146 CLIFTON HALL COURT SHEPHERDSVILLE KY 40165 Re: Description: SEWAGE TREATMENT APPARATUS, EFFLUENT FILTER Manufacturer: LIFETIME FILTER LLC Product Name: LIFETIME EFFLUENT FILTERS Model Number(s): LT 1/8, LT 1116, LT 1/32 AND LT 1164 [SEE ATTACHED TABLE OUTLINING: FILTRATION SIZE AND RATINGS IN GPD] Product File No: 20140048 The specifications and/or plans for this plumbing product have been reviewed and determined to be in compliance with chapters SPS 382 through 384,Wisconsin Administrative Code, and Chapters 145 and 160,Wisconsin Statutes. The Department hereby issues an approval based on the Wisconsin Statutes and the Wisconsin Administrative Code. This approval is valid until the end of March 2019. This approval is contingent upon compliance with the following stipulation(s): • Installation and servicing of this product must be in accordance with the manufacturer's instructions. A copy of the manufacturer's installation and servicing instructions must be given to the owner of the system. • Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter will be necessary. • A manhole extending to grade must be provided over the filter. • MAINTENANCE: Clean filter at inspection/pumping interval. • Additional information is included as attachment(s)to this letter; see attachment A. The department is in no way endorsing this product or any advertising, and is not responsible for any situation which may result from its use. Sincerely, <1 Glen Jo s, S. POWTS roduct Reviewer phone: (608)267-5265 fax: (608)267-9723 email: glen.jones @wi.gov I SBD-10564-E(N.10/97) File Ref:14004801.DOC I rtment of commerce IL EVALUATION REPORT �� I of 3 Wisconsin Depa SO Page Division of Safety and Buildings in accordance with Comm 85,Wis. Adm. Code County St.Croix Attach complete site plan on paper not less than 81/2 x 11 inches in size.Plan must include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. percent slope,scale or dimensions,north arrow,and location and distance rtnst road. 2—- / r�U• / Please print all information. ,:: �` Re d by Date Personal information you provide may be used for secondary pur ( y Law, Property Owner Property Location EJ Jason And Tris Ho NE 26 29 • t3' PP Govt.Lot 1/4 1!4 S N R 16 E(or)® Property Owner's Mailing Address Lot# Block# Subd.Name CSM# 2543 80th Ave N/A CRE PARCE City State Zip Code Phone Number []City ®Village own Nearest Road Woodville WI 1 547028 1 ( 6)51-271-3509 80th Ave ® New Construction useEj Residential/Number of bedrooms 3 Code derived design flow rate 450 GPD ElReplacement Public or commercial-Describe: Parent material Loess cap over till Flood Plain elevation if applicable General moments Install 22"mound on the 100"contour,.6 basil and recommendations: CRIGINt 1 , 1 Ing# 0 Boring F] Pit Ground surface elev. 100 ft. Depth to limiting factor 14 in. Sal 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 1 0-6 7.5yr3/3 sil 2fsbk mvfr cs 2f .6 .8 2 6-14 7 5 /4 sil 2msbk mvfs as if .6 .8 3 14-18 5yr5/3 cflt0yr6/2 scl lfsbk mfr - 4 18+ - Free Water 2 11 Boring 30 Bonin # 100 9 El Pit Ground surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Rods GPD/ff! in. Murrell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 I 0-6 7.5yr3/3 sil 2fsbk mvfr cs 2f .6 .8 2 6-14 7.5 4/4 sil 2msbk mvfr gs if •6 .8 3 14-30 5yr5/6 sl Ifsbk ml gs _ .6 1.0 4 30-36 5 /3 cf1l0yr6/2 cl - - - - - yr5 s - 'Effluent#1=BOD t#2-BOD 30 and TSS 30 30_220 rrtglL and TSS 30 E 5_ mglL rrxlfL CST Name(Please Print) CST Number Lewis Bork 253976 Address Date Evaluation t;onduded Telephone Number E7818 County Rd E,Menomonie,WI 54751 6-21-14 715-231-7379 Jason&Tristy Hopp Page 2 of 3 Property Owner Parcel ID# Boring 3 Boring# 98.75 15 pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/lf in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-6 10yr3/3 - sil 2fsbk mvfr cs 2f .6 .8 2 6-15 7.5 4/4 - sil 2msbk mvfr as if .6 .8 3 15+ 5yr5/4 c2flOyr6/2 scl lmsbk mvfr - - - - F-1 Boring# Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil App6catlon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu.Sz. Cont Color Gr.Sz-Sh. *Eff#1 I *Eff#2 F-1 Ong Boring# Ground surface elev. ft. Depth to limiting factor in. 11 Pit Soil time Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ft'- in. Munsell Qu.Sz- Cont Color Gr.Sz.Sh. *Eff#1 *Eff#2 *Effluent#1=BOO,>30<220 mg/L and TSS>30<150 mg/L 'Effluent#2=BODS<30 mg1L 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. SBD-8330T.t(8.07/00) J [.� a _en + N m � 0 0 Ld � � . © 00 C9 C2 O r Ntel y r�Gwi" V pips ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �cisn vN Mailing Address cQ 5 q 3 Property Address a 5 y 3 $O �" S (Verification required from Planning&2oning Department for new co truction.) City/State Wo of yv 1(,e , WT Parcel Identification Number 60D 16(e?2�- -76 LEGAL DESCRIPTION Property Location A)r- 1/4 , A)j 1/4 , Sec. , T c?9 N R /(o W, Town of Bm (A w; Subdivision Plat: , Lot# Certified Survey Map # a n - rz r,G 4 112 2Z , Volume 00 , Page# Warranty Deed # 9 -7Y 1 1 f (before 2007)Volume , Page# Spec house❑yes❑no 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. lumber of bedrooms At t l Zl l SI(jT4AfURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV.04/12) �3 3 RECEIVED VOL�� PAGE 5096 _ rr REGISTER OF DEEDS v RECEIVEDxFOR RECORD 11/e4/2005 M ISAK Nr CR rxcouNTY, CERTIFIED SURVEY KAP REC FEE: 13.00 II?RVEYOR'S RECORD COPY FEE: 3.00 N CD Ln n _ns a3i�uzi3a g Sig n' 4o b JLo5 �a g�f3� I ZY n. ( .09'2Td Funs w ) V .£9'2td 3Sd.TOo00S W cu �� G7 E9.6LE If .00'EE cn cn c� ns m C3 w QI I v cn °� gi i QI i a'9a�s m z¢ CD LU 00'EEL can= °pw �I Icn ' �$ I .NQ, ¢U- �� Q �¢$ artnni 2s scE >^ +A S S zo =I I .29'2Td aAR.90a00N Uj N } 1 1 .00.EE $3 ER NOW cn [L< OF YCUS W c0 m c-,OJ rnoF I t�. QI cn$�r-egg 00'EE L Zz I I 00 T92 n�� : 0_1 �I =mQ I I .0avea 3.00.00e00N 4 ;�; Z:1 o W U3 UZ �� �u Z3 a-i Mil H= m o� Q WI z° G41 w �+ WICi? Hx CL F!U3-J QIQI 8 LIJ av �Ic�l O JU3 L) %W cn [r\7 cO.;C �I=1 wQww pX-t�n N H�� AS ocu 4 8� mN 29'92T ; f-----------T— M.SO'.TOo00N 1 HJ.UCN U ui �o z icy 5 1-0 ;-= Vol 20 Page 5096 ' f ilfili Iflll iffll If fll IIlII Ififl Ilfl f111li Ilil Iffl * 8 7 8 1 7 1 1 878171 STATE BAR OF WISCONSIN FORM 2-2000 KATHLEEN H. WALSH REGISTER OF DEEDS Document Number WARRANTY DEED ST. CROIX CO., WI RECEIVED FOR RECORD THIS DEED, made between S&J Properties of Menomonie,LLC, a 07/1012008 11:30AM Wisconsin Limited Liability Company, Grantor, and Jason A. Hopp and WARRANTY DEED Tn Me husband and ry -- 1 Pro p EXE4PI t Grnee. REC FEE: 11.00 Grantor, for a valuable consideration,conveys and warrants to Grantee TRANS FEE: 549.60 the following described real estate in St.Croix County,State of Wisconsin: PAGES: 1 Part of the NE t/+ of NW t/s of Section 26, Township 29 North, Range 16 West, in the Town of Baldwin, St. Croix County, Wisconsin described as follows: Lot 3 of Certified Survey Map filed November 4, 2005 in Volume 2,0`age 509 boc'No. 811220.Together with a 66 foot wide shared access easemBifCas-shu�aid Certified Survey Map. Recording Anew d Return Address: Realty Title,Inc. ed VER VALLEY ABSTRACT&TITLE 4AN.2 St-Suite 1 200 HOSFORD STREET, SUITE 20' Exceptions to warranties: H n,WI 54016 Easements,restrictions and rights-of-way of record,if any. 8 1 L1D$ON,Wl 54016 002-1063-70-100 Parcel Identification Number(PIN) This is not homestead property. Dated this 30th day of June, 2008 S&I Properties of Menomonie,LLC,a Wisconsin Limited Liability Co an B *Scott M.Stairs,Member * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ST.CROIX COUNTY. )ss. authenticated this 1st day of July,2 Oerj 13 Town Personally came before me this 6/30/08 the above N of a t yPublic named Scott M. Stairs, Member, S & J Properties of Menomonie LLC a Wisconsin Limited Liability Company to tAte of wisConsin me known''to be the person(s) who executed the foregoing TITLE:MEMBER STATE BAR OF WISCONSIN in t ac owledged the same. (If not, authorized by§ 706.06,Wis.Stats.) THIS INSTRUMENT WAS DRAFTED BY *Cheri r&n Notary Public,State of Wisconsin Peterson,Fram&Bergman—Steven H.Bruns My commission is permanent. (If not,state expiration date: 50 East Fifth Street,St.Paul,MN 55101 2/27/2011 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000 1 of 1 13 3 eiic�� VOL PAGE 5096 KATFILEEK H. AUSK REGISTER OF DEEDS ST. CROIX CO. MI RECEIVED FOR ECORD 11/04/2005 1O:1OAM CERTIFIED SURVEY MAP REC FEE: 13.00 COPY FEE: 3.00 N �' \O /� '09/-Z 3E)Vd "0L 3Wf oA ♦` �,� d`dVN Jl�/�21f1S C73t�11t13a ru � 3 2 3 I g z AO 110-1 Q-ui Q = j ( .05 ZTd FI1f10S tl I- q: ch H E9ZLb 3.Ttr.10000S E9 6LE cn� °�� �Q? � I .oo•EE ���'� m r I I pk- iZi> i n ml Of ^•I� o mm mOw ®I I �� ml Ln 3N OLL"¢�Q c) ppw I I o� I I I fD F---- - y2 � 71 v O EET 25 " Q3Q oo I IF Ig �a cv c��Qy U,Es LL p Q i ~ I u�'.+•' I AvM3AI80 '17IIs X3 .Z9' g S�4i _I 00'EE Q2 o I¢$ I z9'Zty 3..8T.90o00N W " �50Q � I I_ g wsQ3c F�Z� w. I I-" o > ' m m cn m m cn ��� LLJ "mgr I w I F, w¢�¢ : 1. I � �o� �, � Ise_ .< of cn§4' 5= 4 W �.00'TSZ mQ I ,00 V9Z 3.00.00o00N 2I= Q Z I tm ~ m �I cn ~ LUZ •�g :z Lu =3 ®Lu ° oX cn U� < C) - m --j ° dlr cn � - s U I x w wmm ~W50 Qjljl N ow w 'FWwBw Qw • ~ QdUIQQQ OI Nmn C�J r�[U15 15 >1 4 �, . — cr N . z -------- --- - M.Td.Too00N _ ( Hl!O tl ) • Z3 � nT0^� - ��� H t0 iE dVVJ Amns®3111MM30 I ftl 40-C10-i 0 Vol 20 Page 5096 J a CL In .}. N Ld 2 �A � Q J O l