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HomeMy WebLinkAbout022-1021-60-000 1 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 574369 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: Jackman, James&Joyce I Kinnickinnic, Town of 022-1021-60-000 CST BM Elev: Insp.BM I IBM Description:, Section/Town/Range/Map No: � �t� 'D I / �U U 11( 08.28.18.124C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. on, 6 Septic ! j Benchmark Dosing 1..,G•��2-r h .. ��� Alt. BM ,T„� � �C t•i � L�� / / ' l Aeration a Bldg.Sewer c� fig .Sc Holding I �„ St/Ht Inlet 4 r'vl 2 g2fi St/Ht Outlet TANK SETBACK INFORMATION i TANK TO P/L WELL BLDG. Vent t Air Intake ROAD Dt Inlet / Septic . / / Dt Bottom ` Dosing Header an. ' `2 J_ Aeration Dist. Pipe 11 / '7 Holding Bot.System t'/ PUMP/SIPHON INFORMATION Final Grade Manufacturer ^ Demand St Cover ! //SiJL GPM . /OCIc Model Number q r, l� 2 -;76 TDH Lift Friction Loss Systeyn}iead TDH Ft �L Forcemain Leng� Dia. Z Dist.to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length _ No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. t Liquid Depth DIMENSIONS � , )-S �..�- SETBACK SYSTEM TO P/L BL WEL LAKE/S AM LEA G Manufacturer: INFORMATION Type Of System, / CHA OR CZL j(Cy I�t;/ NI Model Number: DIST ION SYSTEM Heade Manifol rI Distribution _ r r x Hole Size x Hole Spacing Vent to�Intak. Len th Dia 1.25 S acin .Pipe(s) Dia _ g P 9 SOIL COVER x Pressure Systems Only xx Mound.1>4t-Grade Systems Only Depth Over Depth Over _jxx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil , / r: - J.r,�f: 4-rres � �' No Yes + No p, COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / -I / / 19 Inspection#2: T/ / Location: 1028 TOWN HALL DR River Falls,WI 54022(SE 1/4 SW 1/4 8 T28N R18W) mete r&bo s Lot Parcel No: 08.28.18.1240 1 ) Alt BM Description= �� �(�°�`�''� ✓kG'�n�u CCZ x1'v 2.)Bldg sewer length= S l] -amount of cover= -- Plan revision Required? L_1 Yes ': No -� ���L�L� Use other side for additional Information. � _�-.-�`— !.� —- — -- - Date Insepctor's Signat a Cert.No. SBD-6710(R.3/97) Pktphw - _ Page 8 of 8 Pmpffty Owaff 1 =46 ft & + s � f sgc. # 0 Ae5 Vol 1 o tk Sea, YL ,fl � -� 1Ta' V i i Site Locaion: $ _ -rokw rbtu- + w 5/ cow-fe a- N R� 'fOW e% County �- �' Safety and Buildings Division Cold ' "� r ? ' 201 W.Washington Ave., P.O. Box 7162 4, 0 Sanitary Permit Number(to be filled in by Co.) g P f Madison,WI 70 -7 (` s State Transaction Number ermit Application o2 yy37d 3 In accordance with SPS 3$.. governmental 1Z 1' P)Qrn.Code,submission of this form to the appropriate gove unit is required prior to obtaini ugh `tary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address) the Department of SafeOj"?Ia Professional Servies. Personal information you provide may be used for secondary ur oses in accordance'with the Privacy Law,s. I5.04(I)(m),Slats. c � -- I. Application Information-Please Print All Information Property Owner's Name Parcel# eS Q e e J";fC,/C-..W JvtJ Z^16V -e d --60 Property Owner's Mailing Address Property Location �6k"XJ hit (/I- Govt.Lot City,State Zi C d�,� Phone Number A '/ Section TN; R�Eor G H.Type of Building(check all that apply) Lot# � �w�t��.L/ � Subdivision Name Block#or 2 Family Dwelling-Number of Bedrooms — ���1�7 r ❑Public/Commercial-Describe Use _ ❑ City of ❑State Owned-Describe Use CSM Number El Village of ----------- Town Of_ ixl�/G� Ill.Type of Permit: (Check only of line A. Complete line B if applicable) A. ❑ New System eplacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain) B. ❑ Permit Renewal ❑ Permit Revision List Previous Permit Number and Date Issued ❑ Change of Plumber ❑Permit Transfer to New A Before Expiration Owner / ,,o- IV.Type of POWTS System/Component/Device: (Check all that apply) — i_-I Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound?24 in.of suitable soil Mound<24 in.of suitable s l ❑ Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) T� V.Dispersal/Treatment Area Information: - ��,� Design Flow(gpd) Design Soil plication Rate(gpdsY) Dispersal Area egmred(std Dispersal Area Pro sed(sfl system evati ri " - / IfU 1" 12 4i -- - ---- Vl.Tank Info Capacity in To.I #of M ufacture Gallons Gallons Units ° o New Tanks Existing Tanks " �t✓ w Y X O ; b0 -fj /�w av n y c7 a Septic or Ho dmg Tank /dd� V al CCF_ � �QSCooL Dosing Chamber O 'O VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Pl mber's Na ume(Print) Plumber's ure MP/MPRS Number Business Phone Number Plumber s Address(Street,C ty,State,Zrp Code) esc G,#,/As e-✓r S yGa z VIII. oun /De artment Use Onl Approved ❑ Disapproved Permit Fee Date Issued Issuing Age Signature ❑ Owner Given Reason for Denial Z �.✓ /7 / ( L�< " u��� IX.Conditions of Approval/Reasons for Disapproval i✓t������������, 1_�� SYSTEM OWNER; 1 TL 1.Septic tank,effluent filter and S('.S 3 13, 3 3 dispersal sell must t2e�efiped/mainta n, -- ___ __as per management plan provided by plumber. r� , C'C�t(,G;t �,y,' S y u� r2 z,' It 2.All setback regtrl[e-It+em e n and submit to the ounty only on paper not less than 8 1/2 x ' ches in size as per applicable code/ordinances. 1N iait/IG�� , SBD-6398(R. 1 1/11) < � e MARY JO HUPPERT Page 2 8/26/2014 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). n of its component arts malfunctions so as to create a health In the event this soil absorption system or any p p 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. erard M 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 i and addressed in a"300" series. For future reference,the Wisconsin Commercial Building Code will be addressed byJPS Chapters 360-366. M 9EYARTU DIVISION OF INDUSTRY SERVICES 5�S' ron 3824 N CREEKSIDE LA dot'+l Y P it HOLMEN WI 54636 14(Al C Contact Through Relay www.dsps.wi.gov/sb/ www.wisconsin.gov �poss ���sw� Scott Walker,Governor Dave Ross,Secretary August 26,2014 CUST ID No. 224832 ATTN:POWTS Inspector MARY JO RUPPERT ZONING OFFICE HOLLISTERS SOIL TESTING&DESIGN ST CROIX COUNTY SPIA W9875 690TH AVE 1101 CARMICHAEL RD RIVER FALLS WI .54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/26/2016 SITE: Identification Numbers James&Joyce Jackman Transaction ID No.2443703 1028 Town Hall Dr Site ID No. 804855 Town of Kinnickinnic Please refer to both identification numbers, St Croix County above,in all correspondence with the agency. SETA, SW1/4, S8,T28N,R18W FOR: Description: Three Bedroom Mound System/6%slope Object Type:POWTS Component Manual Regulated Object ID No.: 1497266 Maintenance required; Replacement system; 450 GPD Flow rate; 16 in Soil minimum depth to limiting factor from original grade; System(s):Mound Component Manual-Ver.2.0, SBD-10691-P(N.01 101,R. 10/12),Pressure Distribution Component Manual-Ver.2.0, SBD-10706-P(N.01/01,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 CONO requirements. A 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. pROFESS1O �,v' The following conditions shall be met during construction or installation and prior to occupancy or use: S'ON OF tN 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. e C0041ES • Inspection of the private sewage system installation is required.Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d),Wis.Stats. • A state approved effluent filter is required.Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required.Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • All POWTS component piping material shall be SPS 384,Wis.Adm.Code compliant. • The area within 15' downslope of the dispersal component shall remain undisturbed.Vehicular traffic, excavation or soil compaction is prohibited in this area. • A copy of the 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. MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN JUL 3 ( 2014 Residential Application ff4M AND TITLE PAGE r_ Project Name: JAMES&JOYCE JACKMAN Owner's Name: (same) Owner's Address: 1028 Town Hall Road River Falls,WI 54022 Legal Description: SE 114 of the SW 114, Sec. 8,T28N, R18W Township: Kinnickinnic County: St Croix Subdivision Name: NA Lot Number NA Block Number NA Parcel I.D. Number. 022-1021 -60-000 Plan Transaction No.: 'ROB AQCY Page 1 Index and tale S FD �2 Data� �A�Fry AND /1!�o'Dft"*/ZN Page 3 Mound drawings SFR Page 5 System main maintenance specifications U$rRY`SZRV S NIPPY - Y CAS Page 6 Management and contingency plan 3 ri 1859 " Page 7 Pump curve and specifications =.RIVER w A LLS, Page 8 Plot plan W1 FNCE f/rtlJ,slf!tF4ta11ttltt� Designer_ Mary Jo Huppert License Number_ 1859-007 Date: 07128114 Phone Number. 715-426-1775 Signature: Acoop�- Designed Pursuant to the Mmad CoaWnett Marwal for PO TS Version 2.0 SDB-10691-P(N.01101),and both SSwmp Pub cMon 9.S Design of Pressure Distibution Netwoft for ST-SAS(01/81)and pressure DWbufion CmWnertt Manuat Ver.2.0 SBD-10706-P(N.01101) Version 7.0(R.03(2012) Pagel of 8 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 300.00 Estimated Wastewater Flow(gpd) Table 383-44-3 in-situ soil treatment for fecal coliform of<=36 inches. 1.50 Peaking Factor(e.g. 1.5= 150%) 450.00 Design Flow(gpd) 6.00 Site Slope(%) 91.70 Contour Line Elevation (ft) 16.00 Depth to Limiting Factor(in) 0.40 In-situ Soil Application Rate(gpd/ft2) Distribution Cell Information 66.261 Dispersal Cell Length Along Contour(ft) = 8.00 Cell Width (ft) 1.001 Dispersal Cell Design Loading Rate(gpd/ft2) � _ Influent Wastewater Quality(1 or 2) Are the laterals the hlghest�olnt 1 in the distribution [_�_.__Y Pressure Disribution Information network? Enter Y or N (C or E) c Center or End Manifold 2.67 Lateral Spacing (ft) If N above, enter the elevation (ft) _ 6 Number of Laterals of the highest point. Orifice Diameter(in) 3.50 Estimated Orifice Spacing (ft)= 9.38 ft2/orifice -2.00 Forcemain Diameter(in) 116.00 Forcemain Length (ft) Does the forcemain drain back? _ Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft)x 1.3 18.92 Forcemain Drainback(gal) 4.96 Vertical Lift(ft) 52.33 5x Void Volume(gal) 1.71 Friction Loss(ft) 71.25 Minimum Dose Volume(gal) 0.00 In-line Filter Loss(ft) 25.85 System Demand (gpm) 11.22 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. option choice 0.75 x 1.25 x x 1.00 x _ 1.50 x 1.25 x x 2.00 1.50 x t 3.00 2.00 x a. 3.00 x j Gallons/Inch Calculator(optional) Treatment Tank Information Total Tank Capacity(gal) S�tic Tank Capacity(gal) _ Total Working Liquid Depth (in) F:j000.00 i eser _Manufacturer gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 650.00 Dose Tank Capacity(gal) �PolyLok _ _ _____]Filter Manufacturer ---f7-,001 Dose Tank Volume(gal/in) _ 525__ _-V Filter Model Number Weiser �� Manufacturer i Project: JAMES &JOYCE JACKMAN Page 2 of 8 Mound Plan and Cross Section Views T : : : : : : : : : : : : : : : : : :::::.. . .... J 1/10 B Observation Pipe . . . �. . . . . . . . . . . . . . . . . . . •: : : : - K, r•r•r•r•r•r•r:r•r.r.r.r.r•r.f.r.r.r.r;r.r.r•r.r.r.r.f.r.f•r.r.r.r.r.r.r.r.r.r.r• r.r.r.r ''.�4.4.4.4.1.1.4.4.4.4.4.1.1.4.4.4• L`1 4.4.1.4•L•1•L•4.4.4•L`4.1••.•1.4.4.4• i•1.1`L• r•r•r• r•f.t•r•r•r•r•r•r•r.f•111'•••_���.p r•d•r•r•r•l`r•f•f•r•f•r•r•r•r•d•r•r•d• f•r•r•d A ''.�ti.4.4.�1.•..L.L•L°4.4.4.4.4.•..'�`'S.•4•L 4.1.1.1.4.4.••.1°L.4••••4.4.4.L•L• •1.4.4.4. r•r•r• r•hr•f•r•r•r•r•rY•r r•r•r•r•r•r•r•r•r•f°r`f•r•r°f•r•r•r•r• •r'r'••'1' y:1.1.4.•,. ti•4.4•`•`4.1.1.1.4.4.4• L••••4 4.1.1.•••1.4.••.1.1.1.4.1.4.4.1.1.1. 1:.•4.4.4. 1:1:5:.r.r•r•r.r1ltid.r4rtirtirtiP•,r4r1t1a•r.r.f.r.r1r•r°r.r.r1:.'r1•,`LrL:•'r•r11'.:°••'.:L:•r.r.r.r 4.1.1.1.1• 1.1.4 1.4• 4.4••.•1• 4• 4.1• L• 4.4.•..1. _ B . .i. .m. .a. i,;r•. . . . : I L Mound Component Dimensions A 8.00 ft E 25.76 in H 1.00 ft K [Aft ft B 56.25 ft F 9.25 in z 12.50 ft L ft D 20.00 in G 0.50 ft J 7.47 ft W 450.00 (ft) Dispersal Cell Area P1.63.30 (ft) Basal Area Available 8.00 (gpd/ft) Linear Loading Rate (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 95.14 (ft) -♦ G j,...,.,,.,,.,....2,..,.,.....,,,,,. I 93.87 (F Dispersal Cell - I (ft) Lateral 93.37 (ft)--► -~ Invert Dispersal Cell ] Elevation D Q 4 4 3 91.70 (ft) Contour Elevation 6.0 %Site Slope "1� Geotextile Fabric Cover Shading Key $' - Dispersal Cell See lateral details on ❑ 1 soil Cap p To °' 1.5 ft r r r•r•r•r•r•r•r•r•r•r•r•r•r Page 4 for number,size, 0 ti 4.1.1°1.•..1.1.1'.4.e,.1.4.4• Subsoil Cap JlKgj[.:°r°r°r•1;:'r°r•P•r•r•r•r•r•r and spacing of laterals. Q f•r r f•.•. °r4 f^r1 f° rti r•�fLr° f';f}�•"f Laterals are equally © ASTM C33 Sand 4.1.4.4+1•L�ti: .ti•L•4•°.•1.5�4.4.1r. • r•r•r;r;r;r;r r;r;r;r;r;r;r•r•r•r 4 ;1: spaced from the Tilled Layer f.r.7pical Lateral }.r•r.r ® Y C y 0.5 ft distribution cell's r•rYY© 4.4.4.1• Aggregate 4.1.4.E 1.1.4.1.1 f 4.4.1.1.4.4 centerline in the Q _ A - distribution cell(AxB). Project: JAMES&JOYCE JACKMAN Page 3 of 8 Center Connection Lateral Layout Diagram Foice.main eoarvooWn via tee or<ross to marigold at ang point. Latecals arc identic al 71c— .. S T l IP s WP •=Yurn-uptafb&IlvaIveor I6-X-- �Exr2 W3I Laterals8�forceetawlSch�40PVC c164noutplug per SPSTable 384305 Flutes drilled on�e bcttorn of ehe lateral_ Number of Laterals 6 Orifice Diameter 0.156 in Lateral Diameter 1.25 in Orifice Spacing (X) 3.65 ft Lateral Length (P) 27.38 ft Orifices per Lateral 8 Lateral Spacing (S) 2.67 ft Orifice Density 9.38 fe/orifice Lateral Flow Rate 4.311 gpm Manifold Length 5.33 ft System Flow Rate 25.85 gpm Manifold Diameter 1.25 in Total Dynamic Head 11.22 ft Forcemain Velocity 2.64 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and —10 SPS 316.300 WAC 4 in.min. Disconnect Tank component is properly vented �- Alternate outlet location Forcemain diameter Weiser Manufacturer 2 in. Capacityl 650.00 Gallons T Volume 17.00 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 21.14 359.45 C B — 2.00 34.00 P� ump off elevation(ft) C _4.19 71.25 88.91 D 10.90 185.30 D Total 38.24 650.00 D♦ ose tank elevation(ft) 3" Bedding un er tank. 88.00 Alarm Manuafacturer SJE Rhombus _ Note: Switches Alarm Model Number Tank Alert AB_ containing mercury -`- — ---- may not be used in Pump Manufacturer Zoeller _ this system. Pump Model Number ------ Pump Must Deliver I 25.85 gpm at 11.22 ft TDH Project: JAMES &JOYCE JACKMAN Page 4 of 8 Z 'd 2!ui4sal jioS s, u9451110H d81 :60 -1,,1 81 2nd Mound System Maintenance and Operation Specifications Service Provider's Name Darrell's Septic Service — Phone 715-425-1025 POWTS Regulator's Name St. Croix County Zoning Office 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 ftz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliforml >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 C)kher 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 vl 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: JAMES&JOYCE JACKMAN Page 5 of 8 Pursuant to SPS 383.54.Wis.Adm.Code General This system shall be operated in accordance with SPS 382-844 Wis.Adm.Code,and shag nrainWinei is accordance with iW c orWonent manuals ISBD-10691-P(N.OIA"),SSVt W Peon 95(OW),and Presstae man Component Manual>lar-2.0 SSD-110706-P(N. 01101)]and local or stale notes pertaiining to sysim maiiiiiiwdmoe and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present Ihi-it cold cause death. Septic and pump Yards abandonment shall i all be in accordance with SPS 383.33, s_Adm.Code when the tares are no burger used as POINTS 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 sued i upon the corers of service. Any opetdng deemed unsour+d,dellacti,or subject to failure must be replaced. Exposed acmes openings greater than 84riches in diameter shall be secured by an effective iodising device to prevent accidental or unaudwrized entry into a tank or component. Septic Tank The septic tank strap be maintained by an kKWk uat certified to service septic tanks under s-281.48,Scats. The contents of the septic tank shag be disposed of in acco i da nce with AIR 1 i3,Wis.Adm.Code. The operating condition of the septictank and outlet INK shag be assessed at lost once every 3 years by inn- The outlet Oter s3>all be cleaned as necessary to ensure proper operation. The frlte cartridge should not be removed unless provisions are made to retain solids in the tank that may slates off the Mar when removed from its enclosure- N the tgler is ewjWW with an alarm,the krtermittent filler alarms indicate flows or air g contasuous filter shag be serviced if the ataarrs�activated c� may surge alarm. The septic tank shag have its contents removed when the volume of sludge and scum in the tank exceeds 113 the squid volume of the tank_ if the comma of the tank are not removed at the time of a hrisrrrtal assessment,maintenance personnel shag advise the owner of when the next service reeds to be performed to maintain less than maximum scum and sludge accumulation u in the tank_ The addition of biobgical or chemical additives to erne septic tank perlbrmance is geidwallY not required- However,if such products are used they shag be approved for septic tarns use by the Department of Commerce. Pump Tank The pump(dosing)tank stag be inspected at least once every 3 years. AN switches,alarms,and pumps shag be tested to verify proper operation. if an etthrent filter is installed within Use tank it shall be inspected and serviced as necessary. Mound and PWss re DisbVx4 n Svstusm No trees or shrubs should be panted on the mound. Plantings may be ss mormd the mound's perimeter,and the mound shall be seeded and mulched as necessary to pry erosion and to provide some protection from frost penetration. Tr-Oc(oSrer than for vegetative mom)an the mound is not recommended shnce sot common may hinder aeration of the irrTftatine surranoe within the mound and snow compaction in the winter will promote best penetration. Cold weather installations(October-February)dim that the mound be heaviy meshed as protection from Wig. Influent cuarity into the mound system may not exceed 220 m-q&BOD5.150 mg&TSS,and 30 mg&FOG for septic tams et8uent or 30 mgn-130As,30 mglL TSS.10 rrrglt-FOG,and 10=cfutidh0 ml-for highly 1 , A JeftmL krAuest fbw rmW not exceed rmaxiinu m design flow specified in the permssT for this isstallatiom. The pressure CWA*Ub=sysierm is trended with a fketsig point at the and of each laierai,and it is recominanded that eater later be flushed of accumulated solids at least orwae every t 8 morel Ytlben a hest is puerftmmed it shmU be compared iu Sue test when Use system was irrstaied to determine it orb dogging has occurred and if or a cleaning is oequimd fig rrraiio1;iis equal distribution within the disposal erg. Observation pies wiff m the disperand cell she#be chocked for effluent ponding- P N&V levels shall be reported to Use owner.and any levels above 8 iimbes cdndemd as an impemding hydraulic%ftne require adcfaiomat,nixie fiegsuernt asauntrrirrg Cc j I : ,cv Plan 9 the septic tank or airy of its components became defective Are tank or component shag be rid or r to keep See systems in pry U the dosibg#orris pxms pump rsors,atexarr an rsfeci wrsi+g becx>mes de�cdve She )shaA pre iRety repawW or replaced wds a coaapoment of the same or equal perbimsasce. If the momd �to aoYeprt or b�to tp Uwe g surre,S sruli be repaced or replaced in W present location by increasing basal aura Sloe leakage occurs or by removing b and dispersal media,and related ltilsi+S,ad replacing said as deemed necessary to bft the system into WWw of 1 11'n9 condition_ See Page 5 of this plum forge name and tdqftm awliber of your local POWM mgulalor and service provider Pr rt Units The information and schedule of mananagemrent and maintenance for P�dues such as aerobic treafrrrent units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project:MMES 0 '�p jYIPUIS Page 6 of 8 HM CAPACIN CURVE s - 0 35/8 W 2 6 8 's T s 4 3/16 e z s o 1 1/2-11 1/2 WT U.& Gono s r0 Zo'' ro sa sa so utrls o ao use 2.0 U - U Tfez umm MODEL in m � Feet Gallons Ydss Mom s a as =3 m a 3.s zg rs a " ne 12 m a 6.7 m J raa vo c a �✓ Gomm 43/16 slam CONSULT FACTORY FOR SPECIAL APPLICATIONS • BecUmd mss,for dupbc Syskmns,we argyle and - V*Jable bevel goat suftim are avrallable for t1 1 g she wd11 an alam and twee,g I ,, � syskom Med licit errs,ftardtaplmc ,isle araffmblo - Dtwbte pkjgyback vadabis level That svadhes are avalow v4m or vw "alarm swactim fcwmutable level T)tg cyde cari- CRELECTEINt Sh dard all this-Wekjht 38 mss.-3z ELP_ i_ieegmdgoataper d2ndemedaicaismilc .rmmieen dowb inega'sad 2_S&mgp--D IeoenHa�sv 7+ada�tePto, - aaablabom. 99 6 GadralStiidwion 9aedswildu.taeferloF ID977_ Rode! 1Faus-ft Mott Amw WmpkK powbot 3_m1achoorbdaMaa=ftr194XMvw104X9& AM 115 1 Auld SA 1ar1&7 — 4-awFA IZfraos duxddofE3 dda dARenoWL N96 115 1 mm 34 2=2&6 3ar4&5 rIL C odod=mtch 1040225 used as a aoeibe[acEaalor.-Vec3y doom(3)or(4) 096 230 1 A,M 47 1 nrl&? 6.Eoe<(4)#de:.E4aR.3 boo[io avra0aigi�teoeo+®eSoaora�eeFit E96 230 1 NOR 47 2or266 3ar435 Sknptaeardegtfmco% 6 1040002. 7-Two(2)bob.t-Pal.for wa he rkj rt orspoca- CAI MOM aiaioaeeienoaaiiL piadatl SaeferfoaviegasFY�adcYaiahio nadSma* . All insumateon of controls.Protection devices and airing sb=W be dow by a qualified of t_dH electrical and saiefl wdes siwaldbe is it g the most in9iePkneSlo PtoDCaetRiL J�fafo FLW3t rsacert Hadonat Electric Code W:Q and the OccupoliumdSafift wd tkmM Act(OW1. RES.ERVE POWERED DESIGIN For unusual ca dWmfls a ire m sally tacior is engineered irD the design of emy Zoellff pump. mw P.Q_OCt M ` - aa�KY --Iilneladndad.. -- B $w7fk saxwo PhWPIdW. Pis Of Cb Orr �Ss No rA �$ 3� 'N 0-54g LAW$ , \� 4V Al IMP P oQ � r f$ 3 rrs V a piKt1E = t Wisconsin Depadow,� Praessiorral Services Division cf 3 SOIL��TREPORT page 1 of PM"cordance wih SPS 383,Vft Ado cone Attach cornplets less than 81/2 x 11 ktm in sine.Plan must sonde,but Sum and hori awital references point(81),drec6on and Pamd LDL 022-1021-60-000 percentstop� no -wow,Waloea0asanddislanaefe :11t100t. Pismo po*,t of I in Wo fie"1e"sed by Dale Persardink i'lonyO proA oopybou sdfarssoandslpwp=a Nkvlftar.s/5M(1)(A 1 (/v"wi" y/(1// �c Pmpsdyowner PfoposvLocaion ❑ JAMES dt JOYCE JACKMAIV Govt.lot —SE 1M SW U4 S 8 T 28 N R 18 E(or)WW property 0omWs Mo11ng Address Lot# Bkpck# Subd.Now or 1028 Town Hall Road cKy State Zp code Phase Number ovow 19TOM Neel Road River Falls, Wl 1 54022 1( 715) 425-7455 Town Hall Road ® NewCorsbocion Residential/Numberdbedrooms 3 Codedoweddesignilo raft 450 GPD El Replaoemarit 0 Pak of coaraerdal- Parent matertai loess over till Flood Plan elevation 0 appkabte consnerds Momd System-1.67 R sand fill-0-4 loading cafe and nlcarrrmrld Ilbs: -�----- pb c�G n�i� �,c?2� St'S 3J'3. 3 3 Bwing# pa Gouda Is elarr_ 9435 R �to�factor 33 a. Soi Rate Horimn Depth Oo *mt Red=Oeserk& To dwe Sbuchm Consistence Boundary Roots GPOW in. Yu sd Cu.Sr- OWL cdor Gr.sr-Sh. "Et1iR1 •E11112 1 0-9 7.5YR3/2 - sil 3fabk mvfF as 2vf-m 0.6 0.8 2 9-14 I0YR3f3 - srl 2fabk mfr cs lvf-m 0.6 0.8 3 14-28 10YR3/4 - Sid 2fabk mfi cs lvf-f 0.4 0.6 4 28-33 7.5YR3/4 - 51 If-rasblc m'fr' cw Ivl f 0.4 1 0.7 5 33-38 73YR314 12f7-5YR sl Om mfr cW - 0.2 0.6 6 3&44 2.5Y314 o 110YR5* c Qm meft - - 0.0 0.0 2 goring# ❑ Owing 8$85 16 pit Gmund sar11 o dtrmr_ R. Depth b irrRng favor iflL SW AppOppop Rate F rizon Depth DornkantColm Redou Desraption Teatnae Struchae Consistence Bourdoy Roofs GPDW in, ntunseli tau.Sr- Cont.Color Q Sr_Sh. 'E 1 0-10 73YR2M - sil 2fibk mfr ai 2vf-m 0.6 0.8 2 10-16 1 73 YR3/3 - Sid 2fd* mfr cs lvf-m 0.4 0.7 3 16-30 7-5YR4/4 m2f73YR50At0YRb2 d lfrbk mfi - lvf-sn 02 0.3 *E mt#1-80D >30_<220mglLandTSS>30<150mglL 'Enuatll=80D 5 3DrglLandTSS5 30mgL CST NIM(Please Print) CST Number MARY JO HUPPERTi1`Iolfista"s Sail T & 224832 Address Date EvAorch�d� TeleptnaM3 Number W9875 690th Avcnue,River Falls,WI 54022 07-11-14 715-426-1775 SBD4330(R07/13) prop"Owrrer JACKMAN,James&Joyce pad 022-1021-60-000 p"D 2 of 3 Ep, Qouad wAb wduv t Depa to ia— 0 bcw im W pokabn RRale H i mn D"M Dominant COW ibedm D l l Teom SMX*M cusida oe Boum"y mods GPM in. Mum Qn.Sz coa Odw a Sr_Sh -BM 'on 1 0-9 7SYM — s0 3fabk nw& w 2vf-f 0.6 0.8 2 9-13 725YR313 _ s0 if bk mfr I cs lvf-m 0.4c 0.6 3 13-22 73YR3/3 — cl 2fabk mfi cw lvf-f 0.4 0.6 4 -32 7.M414 12f7SYR416 ad lfabk mfi — — 02 0.3 some gr I E] # 9 BFU t�io�aadssriaoeelar_ t Dept b iiariag factor iR yqi Rde Hormorr DOPM Daminaat Rod=Dasadpfioa Tedim Sbuciaas Coea6denoe Baa�daty F�Ods GPDlIi; in. Mw" Qr.Sz. Coat Color GY_Sr-SIL 'E1M7 'EW Borirg9 F% tl�omdsar4oeeta+r_ i Oepf►binis9� a- ❑ Sai oyff ReAe Morvarr mph Omiaet lisdracDesaipiaa Teatore C.o oe Bosfidi9► Tfools in. Qt Sr. Cast caw Gr Sz OL 'EiM4 'EM •E>flue[k#1 WDs>30<Z O ffq&and TS8>30:S 150 mg& Mw 0 WD,:5 301 V&and TW`—30 ffV& seo4330(RA9/13) Plot Plan for Site and Soil Evaluation Page 3 of 3 Property owner LILs ,ft e4aV A,,� I" = 4oft. Legal Description PIT, 6F 5EXI of nte SW k/4.1 (except where noted). b,\ n; OF K-AAW(r <1 4/41 , =Backhoe pit North S (I-AWO) B1 C:1g3 94� oi09$ Troy OF s> too.flaA Q, it i (M^N V Site Location: -ro w.i nA LL, Cti uc,.� - TAY Too -- i ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM owner/Buyer James & Joyce Jackman Mailing Address 1028 Town Hall Dr Property Address S a m e (Verification required from Planning&Zoning Department for new construction.) City/State River Falls, Wl Parcel Identification Number 022-1 021 "60-000 LEGAL DESCRIPTION p Property Location se '/4 , sW '/a , Sec. 8 , T 28 NR W, Town of Ki n n ieki n n is Subdivision Plat: -, , Lot# Certified Survey Map #_ Volume 578 , Page # 30 Warranty Deed # °3 (before 2007)Volume 694 , Page #��� Spec house DyesEllo Lot lines identifiable ElyesE]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 bedrooms 3 NATURE OF APPLICA ) 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) ■iCMIN wwmr w.x..a s r WA2ifIJAHtrY i)EE6 � � -+� � e rrafs sa_3.ce nE.sernEe J�ol&nECVrsuiirc tlwrw °� air- I'd. s r a i 2 3tirri3e r-)„bi r a i REG ��ar-5 0 1C ? AT- 1 Cg ix,c A,n 8� r sn.+sys i arar nis to_�T2Jsr s �at3 ta_a_nd Joyca Ati .Taclarotl, "'�- �' i � a b f' { � atx�- �r� as�Oin�. �ctro3.nC.s r�g� I#ve ioiirrwing described real estate In_ Sk- ^oi.li _county; Slate,of M sconsin: ° x W 25 rods of S .51,4 .rods of SF36 of SLR - Tax Key,No n I a •' itrtls ''-9 homestead property. _ - ? ((a)(is 1101) Excbptttift 10 warranties: riC"'ke 01164 lilts day of 5 14$ 19 84 a r✓'r: i _ (SEAL) 'ie Scturalt2 (SEAL) (SEAL) . AUTHENT90-ATION� y L ACKNOWLEDGEMENT Signaturnsr auihenticaied this _ day of STATE OF WISCONSIN 7 -C•aunty. G- r Personally came befa:e me, this _ cay of i TITLE: MEMBER STATE BAR OF :^:ISCONS 7 the above named - (if not. — — - - -- authorized by t5 70$.06.Wis. S.aig.) -- -- — _. This instrument was drafted by — ---- — River r Fall°. I")] to me known to bn the person_who executed the foregoing in- - -- -' strument and acknowiedgad the same. ,Signatures may be authenlrcat.3d or ackmjwiudQeCJ. Both are not necessary.( - —------- — -- Notary Public__—___ T_— _ County,Wis. 'r3A r^sJ'i'Gr:'S4'+v 4•;)r.:na::?a r==-"laf.��r-..+ _ pe,r.is�✓!O'v trsu,.gi9n3SntH3. My Commission is Germanenl, (If not, state expiration date: VJVA-p,T r DEED—S7/­E SIP r,=rJlSr":'.SAN.r'ergrn rgq 2._ e177 Stock No. 13002 - .. tlN O E» ,y 0. o � o ~ N_ O N L a" cc h f0 N w it r OyJ � O [r CL O co = i m o Z L C _ LL c ' a Q g ° I E z E v m d co ul a m cli C O z a c m .' 2 a 1 dzv 4, a w m U) O O •� N N N t a - I N c' O uci� N O Q Q O I Z Z Z O � N - w _ U) R £ :3 - O L LL N L C y = > " m o a ID a o o = � V) mU) E al •� a000 �i a _ z o 0 3 O N J V L .�- rn Z a CD N O` O` .-• O O N 0 0 0 = ,D E m = 0 0 o a m Q z us o N C 0 � !9 v O o 3 N c ►`l o o (D 0 o U I- E aai aai v c4 -' y E E a N v W N Y C ..0.. C ° CN Y `m v v rn l cli CS ~ o o Y o Z 21 Z Z 2 (un C% y tv € a 7 •E L: a ?,- `1�j E .0 C .�+ A V ag I,ONV