HomeMy WebLinkAbout032-2181-15-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County:
Safety and Building Division St. Croix
INSPECTION REPORT Sanitary Permit No:
GENERAL INFORMATION (ATTACH TO PERMIT) No: 574392
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. State Plan ID ~q5
Permit Holder's Name: City Village Township Parcel Tax No:
Timothy & Jennifer Musta TOWN OF SOMERSET 032-2181-15-000
CST BM Elev: Insp. BM lev: BM DA iption: ^ , / ~J J ction/Town/Range/Map No:
11 It rJ 6 01.31.19.1539
TANK INFORMATION ELEVATION DATA
TYPE MANUF TU +I CAPACITY STATION BS HI FS ELEV.
Septic a Ol Benchmark
3@ r 5. 1 by 3 qg,7
Dosing L O Alt. M /01 y0 lDb-z
Ion Bldg. wer
Holding r .
Ht Inlet A C'
J~~ J
TANKS ACK INFORMATION St/Ht Outlet
TAN O P/ WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic / , L ~3 / Dt Bottom G~
~ • 1 qZ•
D Header/M . /
Aeration ' b ~ b ~ ~
Dist. Pipe
Holding 3.09 I~ l,
Bot. System
PUMP/SIPHON INFORMATION Final Grade Z• Z f b z b~
Manufacturer GDe~~~ f
mtland Cover 11-e4 to'
Model Number l^b ~ ,r~ f Lj ~ q~•
P
TDH Lift8 Friction Los/ • 3 System Head / 55 TDH •~F1
Forcemain Length 52!1 Dia. V1 Dist. to wel_I ] (0q 1
SOIL ABSORPTION SYSTEM
BED/TRENCH Width + Length / No. es ~ o ~j i PIT DIMENSI NS No. Of Pits Inside Dia. Li uid De th
DIMENSIONS 7 ` ) 9 P
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION
Type Of System: I CHAMBER OR
u T UNIT Model Number:
I I M fi)\) I 4 I 45q LA
DISTRIBUTION SYSTEM V
Hea an'rfold fl piserisution Z Hole Size 3114 x Hole S acin'7j I I Vent to Air Intake
Pipe(s) ^7I ix 5~P
Length Dia Length 73 • I Dia Spacing. SOIL COVER ressure systems Only xx Mound Or At-Grade Systems Only VA.' 11 10A,1
Depth Over
Bed/Trench Center i 'Ql~ Depth Over xx Depth of to xx Seeded/Sod;;/Yes Mulched
Bed/Trench Edges Topsoil _717- 1 j [E No Yes 0 No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 2336 76TH ST v I/
1.) Alt BM Description JOT ~ INtI I CfiSI n~ ~l0✓ 'i l~ ldN pIPr/ ~d./.~, ►'I VS{~
-Several stv~Ps I~ Ce(I arra, C~-09VA
- rI 2.) Bldg sewer length = ZJI yl $
-amount of cover =
e4 CGVtr + 1q, w~ /n aM
Plan revision Required? 0 Yes Use other side for additional informa` f
SBD-6710 (R.3/97) Date Is ors Signa ure Cert. No.
1
I'~t'2`i ) 19 'I 64 100ev an -Ire~ncun 65
CA ~ vt
Z ~
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d
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-ate
ell
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a
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` a~ AA ounty
~£4r nnreyr 1~ C~ O % X
h~T o~ r- r Industry Services Divi on
r C- co 1400 E Washington Ave Sanitary Permit Number (to be filled in by Co.)
~4N P.O. Box 7162
S rI` Madison, WI 53707-7162 I-) J
~OSSIOf1PV GOVN
State Transaction Number
ppWA~ fl ary Permit Application -7
In accordance witfi SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit ~v
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to project Address (if different than mailing address)
the Department of Safety and Professional Services. Personal information you provide may be used for secondary u oses in accordance with the Privacy Law, s. 15.04(1)(m), Slats.
) 3 / -76 4' -T+. 1. Application Information - Please Print All Information Parcel #
Property Owner's Name O 3 Z- - Z l 6 1 1000
f t~N
Property Location
Property Owner's Mailing Address ( J
4t~(- ES4 )OA- . Govt. Lot
` Zip Code Phone Number W 14, S Section
City, State circle one)
T31 N40; R Eq6)
II. Type of Building (check all that apply) 3 # ` s Subdivision Name
051 or 2 Family Dwelling - Number of Bedrooms
L a.5 Block # W Od ~ a N~ ~vc~0~1 s
❑ Public/Commercial -Describe Use 6k ❑ City of
Q w-
❑ State Owned - Describe Use CSM Number ❑ Village of
Town of Vd/»'► ~~r .5 C7
III. T mi • (Check onl one box on line A. Com lete line B if applicable)
Other Modification to Existing System (explain)
A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑
❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
B ❑ Permit Renewal ❑ Permit Revision Plumber Owner
Before Expiration
IV. T e of POWTS S stem/Com onent/Device: (Check all that apply)
❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound ? 24 in. of suitable soil U Mound < 24 in. of suitable soil
❑ Pretreatment Device (explain)
❑ Holding Tank ❑ Other Dispersal Component (explain)
V. Dis ersal/Treatment Area Information: Dispersal rea Proposed (so System Elevation ct `J~
Design Flow (gpd) Design Soil Application Dispersal ea Required ((s 1
. 8 yr
Rate(gPdsf) "f y,)-z> 0/
° ° b U
VI. Tank Info Capa ty in
Gallons Total # of R V v y N
Manufacturer
Gallons Units a U N is c7 a
New Tanks Existing Tanks
eptic Holding Tank 0 a ~
sing Ch ber
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Signature MP Number Business Phone N ber
P tier's Name (Pri ) c. L L Z,971-- 7 /,3r `Y9 J -
as ate. k; S
Plumber's Address (Street, City, State, Zip Code)
VII Count [De artment Use Only
Permit Fees- 4+,;• Date sued Issuin n atu
Approved ❑ Disapproved 6v- 2~. 1, l `f ~1~.
❑ Owner Given Reason for Deni $
al r L'~
IX. Conditions of Approval/Reasons for Disapproval yl -L~• f Z n
S STEM OWNER: ( J2. 1ti' A„
-
1. eptic tank, effluent filter and lr ~,{,r~ In (-(pct
ispersal II must be serviced / main i ed 0 I Z I
ma iI t Panl~rovidec y 6~.0 b
s per
2 s must be maintained
as per applicable code/ordiP1ff1"9 complete plans for the system and submit to the County only on paper not less than 8 1/2 x 1 inches in size
SBD-6398 (R03/14)
JACQUE M HAWKINS Page 2 9/19/2014
f ~
• The system was designed to meet the influent quality defined in SPS 383.44(2)(a) The quality of influent
discharged into a POWTS treatment or dispersal component consisting in part of in situ soil shall be equal to or
less than all of the following:
1. A monthly average of 30 mg/L fats, oil and grease.
2. A monthly average of 220 mg/L BOD5.
3. A monthly average of 150 mg/L TSS.
• SPS 383.54(3)(b) (b) The servicing frequency of an anaerobic treatment tank for a POWTS shall occur at least
when the combined sludge and scum volume equals 1/3 of the tank volume.
• The inspection, maintenance and servicing reports shall be submitted to the governmental unit within 30
calendar days from the date of inspection, maintenance and servicing.
• The owner is responsible for the operation and maintenance of the private onsite wastewater treatment system
(POWTS) in accordance with SPS 383 and the approved management plan
• The owner of a POWTS shall be responsible for ensuring that access opening covers remain locked or
secured except for inspection, evaluation, maintenance or servicing purposes.
• Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for
the POWTS described in this approval.
• Provide a copy of the approved POWTS plans and this letter to the owner.
• Prohibit vehicle traffic and soil disturbance within 15 feet of the downslope edge of the mound pursuant to
"Mound Component Manual Version 2.0" SBD-10691-P (N.01/01; R. 10/12).
• Insulate 4" 0 conveyance pipe as necessary pursuant to SPS 382.30 (11)(c), W.A.C.
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.
' Sincerely, Fee Required S 250.00
This Amount Will Be Invoiced.
When You Receive That Invoice,
Edwin A Taylor Please Include a Copy With Your
Wastewater Specialist, Integrated Services Payment Submittal.
(715)634-3484, Monday - Friday 8:00 am To 4:30 pm WiSMART code: 7633,
edwin.taylor@wisconsin.gov
o-,MR ~r DIVISION OF INDUSTRY SERVICES
10541 N RANCH ROAD
HAYWARD WI 54843
3 S Contact Through Relay
P S http://dsps.wi.gov/programs/industry-services
92
www.wisconsin.gov
° ssr°r+Scott Walker, Governor
Dave Ross, Secretary
September 19, 2014
CUST ID No. 222872 ATTIC- POWTS Inspector
ZONING OFFICE
JACQUE M HAWKINS ST CROIX COUNTY SPIA
PO BOX 2 1101 CARMICHAEL RD
LUCK WI 54853 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 09/19/2016 Identification Numbers
Transaction ID No. 2454678
SITE: Site ID No. 805784
Tim & Jenny MustaI4 Please refer to both identification numbers,
76TH St above, in all correspondence with the agency.
Town of Somerset
St Croix County
, S1, T3 IN, R19W
Lot: 15, Subdivision: Woodland Meadows Sub
FOR:
Object Type: POWTS Component Manual Regulated Object ID No.: 1501634
Maintenance required; 450 GPD Flow rate; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-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. P OM
The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code Cn72d1t10
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, A P P
stats. DEPARTMENT OF C
DIV F SAFETY A
The following conditions shall be met during construction or installation and prior to occupancy or use:
• A copy of this approval letter and index sheet shall be attached to plans that correspond with the copy on eSEE CORRESP 14 with the Department. Changes to the approved
plan must be submitted for review and approval. Failure to
properly attach the approval and index page to plans that match the copy on file with the Department may result
in enforcement action under s. 145. 10, Stats.
• This system is to be constructed and located in accordance with the approved plans, and the "Mound
Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD-10691-P (N.01/01).
• This system is to be constructed and located in accordance with the approved plans and with the "Pressure
Distribution Component Manual for Private Onsite Wastewater Treatment Systems Version 2.0" SBD-10706-P
(N.01/01).
• Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches.
Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil
moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire,
the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not
proceed until it dries.
MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: Tim and Jenny Mustah Mound System
Owner's Name: Tim and Jenny Mustah
Owner's Address:
Somerset Wl 54025
Legal Description: NW1/4- SE1/4 Sec. 1 T31N-R19W
Township: Somerset
County: St. Croix
Subdivision Name: Woodland Meadows
Lot Number: 15 Block Number: Na
Parcel I.D. Number: 032-2181-15-000
Plan Transaction No.:
Page 1 Index and title
Page 2 Data entry
Page 3 Mound drawings tially
Page 4 Lateral and dose tank
Page 5 System maintenance specifications VED
Page 6 Management and contingency plan OMMERCE
Page 7 Pump curve and specifications 40 su NGS
Page 8 Site Plan
Designer: Jacque Hawkins License Number: MPRS#222872
Date: 08/24/14 Phone Number:
Signature: EZ-~~
0 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 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
1.50 Peaking Factor (e.g. 1.5 = 150°/x) fecal collform of 36 inches.
450.00 Design Flow (gpd)
2.00 Site Slope
99.60 Contour Line Elevation (ft)
17.00 Depth to Limiting Factor (in)
0.40 In-situ Soil Application Rate (gpde)
Distribution Cell Information
75.00 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft)
1.00 Dispersal Cell Design Loading Rate (gpd/ft)
1 Influent Wastewater Quality (1 or 2) Are the laterals the highest oint
in the distribution Y
Pressure Disribution Information network? Enter Y or N
(C or E) E Center or End Manifold
3.00 Lateral Spacing (ft) If N above, enter the elevation ft
2 Number of Laterals of the highest point.
0.156 Orifice Diameter (in)
2.33 Estimated Orifice Spacing (ft) = 7.03 ft2/orifice
2.00 Forcemain Diameter (in)
90.00 Forcemain Length (ft) Does the forcemain drain back? Y
9100 Pump Tank Elevation (ft) Enter Y or N
4.55 System Head (ft) x 1.3 14.68 Forcemain Drainback (gal)
9.68 Vertical Lift (ft) 67.41 5x Void Volume (gal)
2.25 Friction Loss (ft) 82.09 Minimum Dose Volume (gal)
0.00 In-line Filter Loss (ft) 34.46 System Demand (gpm)
16.49 Total Dynamic Head (ft)
Lateral Diameter Selection Manifold Diameter Selection
in. dia. options choice in. dia. options choice
0.75 1.25 x
1.00 1.50 x x
1.25 2.00
1.50 x x 3.00
2.00 x
3.00 x
Gallonslinch Calculator (optional)
Treatment Tank Information Total Tank Capacity (gal)
1000.00 Septic Tank Capacity (gal) Total Working Liquid Depth (in)
Skaw Precast Manufacturer gaVin (enter result in cell B49)
Dose Tank Information Effluent Filter Information
642.33 Dose Tank Capacity (gal) Best, Filter Manufacturer
16.47 Dose Tank Volume (gal/in) GF-10 Filter Model Number
Skaw Precast Manufacturer
Project: Tim and Jenny Mustah Mound System Page 2 of 8
Mound Plan and Cross Section Views
1110 B J
Observation Pipe
W B
L
Mound Component Dimensions
A 6.00 ft E 20.44 in H 1.00 ft K 10.31 ft
B 75.00 ft F 9.50 in I 9.56 ft L 95.61 ft
D 19.00 in G 0.50 ft J 8.14 ft W 23.70 ft
450.00 (ft2) Dispersal Cell Area 1166.89 (ftz) Basal Area Available
6.00 (gpd/ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement
Mound Cross Section View
Aggregate Dispersal Area
Finished Grade 102.98 (ft)
I F Dispersal Cell 101.68 (ft) Lateral
10ft) Invert
.18 Dispersal Cell
Di
Elevation
11 55 •i.~i
t
- .;i•. `cl a s 1~ 1 X". a 1.{s ) ? ..4>~4''. ~%'•-%4 1. A.; :1,^~
A. j, 4
'4
9 .60 (ft) Contour Elevation
2.0 % Site Slope
Geotextile Fabric Cover
Shading Key m Dispersal Cell See lateral details on
10 _ Topsoil Cap c a 1.5 ft 4: ;•a•• ; Page 4 for number, size,
Subsoil Cap 0 and spacing of laterals.
ASTM C33 Sand F Laterals are equally
Tilled Layer Typical Lateral spaced from the
G °1 0. ft distribution cell's
Q M Aggregate o centerline in the
0""---- A distribution cell (AxB).
Project: Tim and Jenny Mustah Mound System Page 3 of 8
End Connection Lateral Layout Diagram
Lawn s CoNtred over tf# A & 41mens on 1 maul l u
• Turn•u +ntrkrshrusNwora wa
Ib P p
P
AN la+le►a4x are t ►eiraal 1+1 art ~ Hot+rf d644 on 01w bottom of dw lateral
equally spaced
Fond mats QCrnn ion vla too or cross to ma *old at m q poinc
Laterals Wcrrcemain Sch 40 PVC per SPS Table 38430-6
Number of Laterals 2 Orifice Diameter 0.156 in
Lateral Diameter 1.50 in Orifice Spacing (X) 2.37 ft
Lateral Length (P) 73.47 ft Orifices per Lateral 32
Lateral Spacing (S) 3.00 ft Orifice Density 7.03 IY/orifice
Lateral Flow Rate 17.23 gpm Manifold Length 3.00 ft
System Flow Rate 34.46 gpm Manifold Diameter 1.50 in
Total Dynamic Head 16.49 ft Forcemain Velocity 3.52 ft/sec
Dose Tank Information Locking cover with warning
label and locking device and
seated watertight
Electrical as per NEC 300 and
SPS 316.300 WAC 4 In. min.
Disconnect
Tank component is properly vented E - Alternate outlet
location
_ Forcemain diameter
Skaw Precast Manufacturer 2 in.
Capacityl 642.33 Gallons
16.47 gaIlinch A
Volume
Weep hole or anti-
Dimension Inches_ Gallons B siphon device
A 20.02 329.66
B 2.00 32.94 C Pump off elevation ft
C 4.98 82.09 92.00
D 12.00 197.64 D
Total 39.00 642.33
Doi se tank elevation ft
3" Bedding un er tank. 91.00
Alarm Manuafacturer SJE. Rhombus Note: Switches
Number Tank Alert 1 containing mercury
Alarm Model 9 ry
may not be used in
Pump Manufacturer Goulds this system.
Pump Model Number EP05
Pump Must Deliver 34.46 gpm at 16.49 ft TDH
Project: Tim and Jenny Mustah Mound System Page 4 of 8
Mound System Maintenance and Operation Specifications
Service Provider's Name Powers Sanitation Phone 715-246-5738
POWTS Regulator's Name St. Croix County Zoning Phone 715-386-4680
System Flow ar Loaf Parameters
Design Flow - Peak 450 gpd Maximum Influent Particle Size 118 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 fe Maximum FOG 30 mg/L
Type of Wastewater Domestic Maximum Fecal Coliform >10B4 cfu/100 mL
Service Finauencv
Septic and Pump Tank Inspect and/or service once eve 3 ears
Effluent Filter Should inspect and clean at least once eve 3 ears
Pump and Controls Test once eve 3 ears
Alarm Should test month)
Pressure System Laterals should be flushed and pressure tested eve 1.5 ears
Mound Ins ect for ondin and seepage once eve 3 ears
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 SRS 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 ~>1
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: Tim and Jenny Mustah Mound System Page 5 of 8
Mound System Management Plan
Pursuant to SPS 383.54, Wis. Adm. Code
This system shall be operated in accordance with SPS 382-84 Weiss. A m. Code, and shall maintained in accordance with its' component
manuals (SBD-10691-P (N.01/01), SSWMP Publication 8.6 (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 shalt be secured by an effective locking
device to prevent accidental or unauthorized entry into a tank or component.
Seadc Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, State. 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 fitter 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. Intermittentfiner alarms may indicate surge flows or an Impending continuous
alarm.
The septic tank shall have its convents removed when the volume of sludge and scum in the tank exceeds 113 the liquid volume o 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 perforated 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 PrenE nm DI budon Systam
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 BOD& 150 mg/L TSS, and 30 mglL FOG for septic tank effluent or 30
mg/L BODs, 30 mglL TSS, 10 mglL FOG, and 104 dW100 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. Pondhig levels shall be reported to the owner, and any
levees above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring.
CoWnaenev 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 some 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 props operating condition.
See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider.
Pe+etreetrneat Una
The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection
units are attached as separate documents and are considered part of the overall management plan for this system.
Project: Page 6 of 8
Page 7 of 8
HGOULDS PUMPS Submersible
Effluent Pump
EP04
3871 EP05
APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower
grade turbine al for tic enclosed design for heavy duty ball bearing
Specifically designed for the lubrication and efficient improved performance. construction.
following uses: heat transfer. ■ Casing and Base: Rugged
• Effluent systems thermoplastic design provides AGENCY LISTING
• Homes Available for automatic and superior strength and corrosion
• Farms manual operation. Auto- csnKlan Standards Assoda*m
• Heavy duty sump matic models include resistance.
• Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end
• Dewatering assembled and preset at the for efficient heat transfer, in "C" or "F")
factory. strength, and durability.
SPECIFICATIONS ■ Motor Cover. Thermoplastic Gary RaP is 150 som flulswed
FEATURES cover with integral handle and
• Solids handling capability: float switch attachment points.
'/4" maximum. ■ EP04 Impeller: Thermoplas- ■ power Cable: Severe duty
• Capacities: up to 60 GPM. tic Semi-open design with rated oil and water resistant.
• Total heads: up to 31 feet. pump out vanes for mechanical
• Discharge size: 11/2" NPT. seal protection.
• Mechanical seal: carbon-
rotary/ceramic-stationary,
BUNA-N elastomers.
• Temperature:
104V (40`Q continuous MARS FED
140OF (60°C) intermittent. I '
• fasteners: 300 series 10
stainless steel. 9 30s GPM
• Capable of running 2s
dry without damage to Fr
a
components. 25
c 7-
Motor:
U s 20
• EP04 Single phase: 0.4 HP,
115 or 230 V, 60 Hz, 1550 _
1 j
RPM, built in overload with s is:
automatic reset. 4
1 550 EPOS j
P0 V Single phase: ~5 HP,
c
3 to ~
RPM, built in overload with EP04 .
automatic reset. 2-
• Power cord: 10 foot s
standard length, 165 1 V
SAOW with three prong
grounding plug. Optional 20 ° °0 to I 20 ao 40 so GPM
foot length, 165 SJTW with
three prong grounding plug '
(standard on EP05). 0 2 4 6 a 10 12 n,-/h
CAPACITY
Goulds Pumps
® 2001 Goulds Pumps ITT Industries
Effective May, 2001
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Wisconsin Department of Commerce SOIL EV UATION REPORT Page I of 3
Division of Safety and Buildings
in a9Yrlsncw1 q 85, s. Adm. Code
County St.Croix
Atta ite qa paper no less than 81/2 x 11 inch in size Plan must
dI but no#
in d t : I and orizoi tsfeFce #1N di ion and Parcel I.D. p ding
percent slope, scale o 4i "e ons, ncrh arroqQpgfif)br~~n distan to nearest road.
v 3~_
Please print all information. Aeview ~ Date
Personal information you provide may be used for secondary purposes (Privacy Law, a. 15.04 (1) (m)). ` r
ice
Property Owner Property Locati 1:1 El
AHRH Properties LLC Govt Lot NW 1/4 SE 1/4 S I T 31 N R 19 EE (or) W
Property Owner's Mailing Address L Block # Subd. Name or CSM#
404 SCrreen Avenue 15 - Woodland Meadows
City State Tip Code Phone Number ity []Village ■ Town Nearest Road
New Richmond WI 54017 ( 7f5-222-0169 CTH S 7~,
E] New Construction UseE] Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
0 Replacement 0 Pubiic or commercial - Describe:
Parent material Loess over glacial till Flood Plain elevation if applicable ft
General comments Site suitable for a moundsystem and recommendations: ❑ Boring # 0 Boring
ED Pit Ground surface elev. 100.20 ft. Depth to limiting factor 18'23 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/1F
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-7 10yr3/1 sit s mfr as 2f .6 .8
2 7-13 10 4/3 sil lm mfr cw If 4 .6
3 13-18 10yr4/4 sicl 2msbk mfr cw if •6
4 18-23 10yr4/4 flf5yr5/8 sicl lmsbk mr cw - .2 .3
5 23-36 7.5yr4/4 fsl Om dvh - - .2 .5
F 2 Boring # Boring 99.24 17 3
0 Pit Ground surface elev. ft. Depth to limiting factor in.
Soil AoNication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-5 10yr3/1 sil 2msbk mfr as 2f .6 .8
2 5-14 1 4/3 sil lmp mfr cw If 4 .6
3 14-17 10yr4/4 s1c1 2msbk mfr cw 1 f .4 .6
4 17-23 10yr4/4 flf5yr5/8 sicl lmsbk mfr cw - .2 .3
5 23-36 7.5yr4/4 fsl Om dvh - - .2 .5
* Effluent #1 = BOD > 30:5 720 mg/L and TSS >30 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg&
CST Name (Please Print) Signature CST Number
Thomas C. Nelson 227387
Address Date Evaluation Conducted Telephone Number
1432 120th Street, New Richmond, WI 11/17/04 715-246-2454
nTT n~~n Tn.1.nn~
Property Owner AHRH Properties LLC Parcel ID # Pending Page 2 of 3
Boring 11 Boring
❑ Bori# El pit Ground surface elev. 98.70 ft. Depth to limiting factor 18-32 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-6 10yr3/1 - sil 2msbk mfr as 2f .6 .8
2 6-15 10 4/3 - A IM PI mfr cw if .4 .6
3 15-18 10yr4/4 - sic] Ms k mfr cam'
If .4 .6
4 18-32 10yr4/4 flf5yr5/8 sicl lmsbk mfr cw - .2 .3
5 32-36 7.5yr4/4 - fsl Om dvh - - .2 .5
❑ Boring # PBoring
pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
❑ Boring # Boring
Pit Ground surface elev. ft. Depth to limiting factor in.
Soil A 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 = BODS > 30 < 220 rng/L and TSS >30 < 150 mall ' Effluent 42 = BODS < 30 mglL and TSS < 30 rapt
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-8330Tea (R.07/00)
I
Woodland Meadows
scale 1" = 30'
BM1 Top of conduit pipe 100.00; Lot 15
BM2 Top of conduit pipe 100.20
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112 98.70'
83 98.70'
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM A~
Owner/Buyer / ry-Y.
Mailing Address -2-1 ~etitS~ ~it_' ~J~yrr,o,-cs~ 1/1-• j`
Property Address 2334 -70" S~
n (Verification required from Planning & Zoning Departen r ne construction.
/ f~~ "I
City/State Parcel Identification Number h 3 Z - L /81 ' /5-00 0
LEGAL DESCRIPTION
Property Location /Vyw '/4 , /4 , Sec. , T 3 ! N R /9 W, Town of Jol-,n rX
Subdivision Plat: (^-'Odd 10(1,-d ht 's , Lot #-1-!5
Certified Survey Map # p p , Volume , Page #
Warranty Deed #0 O (before 2007)Volume , Page #
Spec house 11 yes/ no Lot lines identifiable/yes i=1 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 §Comm. 83.52(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.
1/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 Commerce 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 thi orm 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 war my deed recorded in Register of Deeds Office.
Number of bedrooms 3
,
IGNATURE 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. 08/05)
8193836
Tx: 4161133
STATE BAR OF WISCONSIN FORM 1 - 2000 988835
BETH PABST
Document Number WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., WI
THIS DEED, made between A.P. Kociscak, a single person, Grantor, 11/08/2013 12:39 PM
and Timoth D. Mttsta and Jennifer E. Musta, husband and wife as EXEMPT#: NA
survivorship marital property, rantee. REC FEE: 30.00
Grantor, for a valuable consideration, conveys to Grantee the following TRANS FEE: 87.00
described real estate in St. Croix County, State of Wisconsin (the PAGES: 1
"Property"):
Lot 15, Woodland Meadows, St. Croix County, Wisconsin.
Recording Area
Name and Return Address:
Land Title Inc. #411673
2200 W County Road C. Suite 2205
Roseville. NIN 551 13
Together with all appurtenant rights, title and interests. 032-2181-15-000
Parcel Identification Number (PIN)
This is not homestead property.
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except
Easements, Restrictions, Reservations, Roadways and Rights of way, if any, of record
Dated this 7th day of November, 2013.
c
4AKoZc6,cak,
AUTHENTICATION ACKNOWLEDGMENT
Si"nature(S) STATE OF WISCONSIN )
ST. CROIX COUNTY. ) ss.
authenticated this 7th day ol'November, 2013 Personally came before me this - day of November. 2013
the above named A.P. Kociscak, a single person to me known to
be the pel'SOn(S) \\'110 CxCCUted the t01'l;°Oing Instrument and
"TITLE: MEMI3ER STA'T'E BAR Oar): ' CONS aekno caged the same.
(If not,
S:) ' 9 S* drti, tied t " t
authorized by 5 706.06, Wis. O
• _ s Connie M. Schroeder
C.) : - .
'I HIS INSTRUINIISNT w kS DR.A Tl_D 131` NG ' _z - Notary Public, State 01' Wisconsin
PU~~' My Commission is permanent. (if not; state expiration date:
Larry S. Mountain, Attorney at La4a; S O , 1/1/2017 )
(Sieiatures may be authenticated or acknutelcd_ct.'~filnYyrlvurmlt~ncccssanJ
*Nami•s ul'PaSUns signing in any Caj),161\ must he typed or primal bCION\ thCir si 2n:pure
1 of 1
WARR,kiNTN DrFD r:vre R.-\R 01: vv ISCONSI;N FORM ,No. 1-2000
Parcel 032-2181-15-000 09/25/2014 09:58 AM
PAGE 1 OF 1
Alt. Parcel 01.31.19.1539 032 - TOWN OF SOMERSET
Current OX ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
01/13/2005 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
0 - MUSTA, TIMOTHY D & JENNIFER E
TIMOTHY D & JENNIFER E MUSTA
211 FORREST DR
SOMERSET WI 54025
Property Address(es): * = Primary
*
Districts: SC =School SP =Special 2336 76TH ST
Type Dist # Description
SC 3962 SCH DIST NEW RICHMOND
SP 1700 WITC Notes:
Legal Description: Acres: 3.000
SEC 1 T31 N R1 9W PT NW SE WOODLAND
MEADOWS LOT 15 Parcel History:
Date Doc # Vol/Page Type
11/08/2013 988835 WD
10/29/2007 863223 WD
10/29/2007 863222 WD
10/29/2007 863221 DOM LTTR
more...
Plat: * = Primary Tract: (S-T-R 40% 160'% GL) Block/Condo Bldg:
* 10-046-WOODLAND MEADOWS LOTS 1/24 03 01-31N-19W NW SE LOT 015
2014 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/12/2010
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.000 20,000 0 20,000 NO
Totals for 2014:
General Property 3.000 20,000 0 20,000
Woodland 0.000 0 0
Totals for 2013:
General Property 3.000 20,000 0 20,000
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