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HomeMy WebLinkAbout014-1057-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 574400 0 GENERAL INFORMATION State Plan ID No,,7 ? Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)). 4 u 7 3 0 Permit Holder's Name: City Village X Township Parcel Tax No: Miller, Robert J. &Annette I Forest, Town of 014-1057-20-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: OIL, 'c 17 111 / 27.31.15.427B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic t.t( Benchmark f , Dosing IL's? G �> Alt.BM S,_ ` 3.po gb- 1-7 Aerati ., Bldg.Sewer Holding ' SUHtInlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Iynt�ke ROAD Dt Inlet Septic > 5b1 ft, / _ /� Dt Bottom f �� Dosing E T Header! an. (ITTV-L Aeration 7/ D e 2.g3 96 /s, Holding gRLS stem �- 7 c, �' 3 .S- Final 9s.7 Gra e PUMP/SIPHON INFORMATION Manufacturer Demand St Cover -7 r GPM ()y ( / Model Number F� yZ 7-7 l <l'��I TDH Lift Friction Loss System Hea TDH Ft 742-1 0 ,11 . L-5 Forcemain Len th IDia. ,7 �, Dist.to Well SOIL ABSORPTION SYSTEM B DIMENSIONS Width ^/ Length / No.Of Trenches PIT IMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS (•Yf J bL SETBACK SYSTEM TO P/L BLDG WELL LAKE L G Manufacturer: L INFORMATION CHA OR Type f System: / 0/ • �C / UNIT Model Number: !J J DISTRIBUT ON SYSTEM fAiga Header anifold Distributio C/ J Hole Size x Hole Spacing Vent to 'i Intake Pipe(s) 0• T •� G ry Length Dia length Dia S Spacing J a a 3 O SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of Seeded/So d �,�/ M IGi ❑ Bed/Trench Center Bed/Trench Edges Topsoil Q es "� No Yes No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: Inspection#2:/0 14 Location: 2920 Hwy 64 Glenwood City,WI 54013(SW 1/4 SW 1/4 27 T31 N R1 5W) >35 acres Lot � Parcel Noi W15171 .1 �� � 1.)Alt BM Description �`� U Sam �'►ti.�.e� 2.)Bldg sewer length= O -amount of cover s1iGL3 / f ' , Plan revision Required? [1 YesNo 6— Use other side for additional information. D 1 4 ate Insepctor's Signal a Cert.No ` SBD-6710(R.3/97) ■ .R. HARDINA SEPTIC SYSTEMS MPICST 82825 3 sA�e� PXti:�C. A1d L,>61-L -Tb`��. iAv5-rA1(,6--J wt7 . ��o��� 5—'F3A fe = Iao�Jloc CAL. tbM9e TK,J)I- '67 � a g /J L r h - r 4 f i � 1'S t—� - f--t- rl [�(,J q z,,6' W, County /! ":�� O� Industry Services Division 1 • G�` 1400 E Washington Ave Sanitary Permit Number(to be filled in by Co.) P.O.Box 7162 Madiso 37� 2 -7 L 1/t`'V`j 7 Cs ermit Appl at�ra=� State Transaction Number In accordance with Q is.Adm.Code,submission of this form to the appropriate governmental unit ! / is required prior to o a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address) the Department and Professional Servies. Personal information you provide may be used for secondary purposes in acc ounce with the Privacy Law,s.15.04 1 m,Stats. I. Application Information-Please Print All Information �e12c Property Owner's Name Parcel# M L C -2 D /1/— 10,5 26—Ucr> Property Owner's Mailing Address Property Location 1-7 8 ` 0 / Govt.Lot cf J City,State y Zip Code Phone Number Section one) IL Type of Building(check all t at apply) Lot# T _N; REor6 -or 2 Family Dwelling-/Number of Bedrooms Subdivision Name 3 )3/a s 0l4 G"37 Block# 3� ❑Public/Commercial-Describe Use ❑ City of ❑State Owned-Describe Use CSM Number ❑Village of AT-wn of �d � III.Type it. Check only one box on line A. Complete line B if applicable) A. New System y El Replacement System ❑Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) B. ❑Permit Renewal ❑Permit Revision El Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV.Type of POWTS System/Component/Device: Check all that apply) ❑Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable sl Mound<24 in.of suitable soil j ❑Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Dev'iee{explaia} V.Dispersal/Treatment Area Information: C- -6 l"f Design Flow(gpd) Design Soil App'cation Ra gpdsf) Dispersal Required(sf) Dispersal Ar Proposed(sf) System Elevation 1 �� /10 i �5��1/Z� ray 9G 75 VI.Tank Info f Capacity in Total #of Manufacturer Gallons Gallons Units New Tanks Existing Tanks .S f` �� �� '�� /yy(IIlii d c V y N W V V V F 2 p .a^3 � 6 N .D_� N A4 U rA v, y W C7 Pr Septic or Holding Tank Dosing Chamber , C� t Owt 22o VII.Responsibility Statement-I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print') f Plum s S�'' MP/MPRS Number Business Phone u/mber Plumber's Address(Street,City,State,Zip Code) 7,9-r a- tie Ui6c- L,.9 VIII. oun /De artment Use Only Approved ❑ Disapproved Permit Fee Date Is ed Issuing Ag Signa�� ❑Owner Given Reason for Denial IX.Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: % 1.Septic tank,effluent filter and c# - �14�° �� lz'4 ✓ ' ' i � dispersal cell must be serviced/maintained f Pt - as per management plan provided by plumber. _ 1. 2.All sethseli Fe9"ireMeQtq must he maintained �L as per applicable c�ffftM?R ►ans for the systAmsdd su to a onnty on p t less t an,a`/2 z 11 inches in size SBD-6398(R0313) �GLYI LIB Gt.{Z..t �� �I�.��2��� -��'►^(�A � A ��-�`Lfl c�CL rills✓L���' 9� c / BOB J HARDINA + Page 2 9/23/2014 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). 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. Sincerel Fee Required$ 250.00 Fee Received$ 250.00 Balance Due $ 0.00 Edwin A Taylor Wastewater Specialist,Integrated Services WiSMART code:7633 (715)634-3484,Monday-Friday 8:00 am To 4:30 pm edwin.taylor @wisconsin.gov I p�3ART1{Eq� DIVISION OF INDUSTRY SERVICES 10541 N RANCH ROAD HAYWARD WI 54843 3 I Contact Through Relay p http://dsps.wi.gov/programs/industry-services www.wisconsin.gov �A Jti �O ssION��S� Scott Walker,Governor Dave Ross,Secretary September 23,2014 CUST ID No. 824825 ATTN.•POWTS Inspector BOB J HARDINA ZONING OFFICE 14ARDINA SEPTIC SYSTEMS ST CROIX COUNTY SPIA 477 170TH AVE 1 101 CARMICHAEL RD TURTLE LAKE WI 54889-9187 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/23/2016 Identification Numbers Transaction ID No.2454381 SITE: Site ID No. 805750 Bob&Annette Miller Please refer to both identification numbers, St Hwy 64 1 above,in all correspondence with the agency. Town of Cylon St Croix County SW1/4, SW1/4, S27,T3 IN,RI 5W FOR: Object Type:POWTS Component Manual Regulated Object ID No.: 1501493 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. The owner,as defined in chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, P•0• T stats. C'onditi The following conditions shall be met during construction or installation and prior to occupancy or use: 0 • A co of this approval letter and index sheet shall be attached to plans that correspond with the co on fil F PY PP P P PY � ME with the Department. Changes to the approved plan must be submitted for review and approval. Failure to VISION SAl:E7Y A properly attach the approval and index page to plans that match the copy on file with the Department may res 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 S GORRESP 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. • 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: MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: MILLER i Owner's Name: BOB&ANNETTE MILLER Owner's Address: 2948 HWY 64 GLENWOOD CITY, WI 54013 20 ACRES Legal Description: -570 $t,�, �, o2�7,T. 31, d 1:5c.3 Township: County: ST.CROIX Subdivision Name: NA Lot Number: NA Block Number: NA Parcel I.D. Number: 1 4 L DS`j — A0 UC) Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank ally Page 5 System maintenance specifications Page 6 Management and contingency plan �� Page 7 Pump curve and specifications Page 8 Site plan 1"=40' )MMERCE Page 9 Filter maint. t LI)mG Page 10 Att. Soil test - ENC Designer: Robert Harding License Number: MPRS 824825 Date: 08/18/14 Phone Number: 715-986-2508 Signature: ����= . Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SBD-10691-P(N.01/01, R. 10/12),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, R. 10/12) Version 7.0(R. 11/12) Pagel of 10 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%) fecal coliform of<-36 inches. 450.00 Design Flow(gpd) 3.50 Site Slope(%) 93.75 Contour Line Elevation (ft) 12.00 Depth to Limiting Factor(in) 0.40 In-situ Soil Application Rate(gpd/ft2) Distribution Cell Information 50.001 Dispersal Cell Length Along Contour(ft) = 9.00 CeII Width (ft) 1.00 Dispersal Cell Design Loading Rate(gpd/ft2) 1 I 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) a Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation ft 3 Number of Laterals of the highest point. 0.188 Orifice Diameter(in) 3.00 Estimated Orifice Spacing (ft)= 8.82 ft2/orifice 2.00 Forcemain Diameter(in) 50.00 Forcemain Length (ft) Does the forcemain drain back? Y 87.00 Pump Tank Elevation (ft) Enter Y or N 3.25 System Head (ft)x 1.3 8.16 Forcemain Drainback(gal) 8.38 Vertical Lift(ft) 66.72 5x Void Volume(gal) 1.18 Friction Loss(ft) 74.88 Minimum Dose Volume(gal) 0.00 In-line Filter Loss(ft) 33.42 System Demand (gpm) 12.81 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 1.00 1.50 x 1.25 x 2.00 x x 1.50 x x 3.00 2.00 x 3.00 x Gallons/Inch Calculator(optional) Treatment Tank Information Total Tank Capacity(gal) 1000.001 Septic Tank Capacity(gal) Total Working Liquid Depth (in) huffcutt Manufacturer gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 627.001 Dose Tank Capacity(gal) bear _ Filter Manufacturer 14.931 Dose Tank Volume(gal/in) Imi 1 Filter Model Number huffcutt Manufacturer Project: MILLER Page 2 of 10 Mound Plan and Cross Section Views T •.•.... ....... ( . . J Observation Pipe ' :.TrT K A B . ::::.:::::::.:::::.:.:::.:.:.:.:,:,:::,:: L Mound Component Dimensions Down slope toe extension made. A 9.00 ft E Aft in H 1.00 ft K 11.85 ft B 50 O ft F in z 13.50 ft L 73.70 ft D 424-00 G J 8.94 ft W 31.44 ft 450.00 (ft) Dispersal Cell Area 1125.00 (ftz) Basal Area Available 9.00 (gpd/ft) Linear Loading Rate 5.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 97.54 (ft) ///r,/„, G ♦ H / 96.25 ( F Lateral ispersa......... Invert p I Cell ft) 95.75 ft)--+► _' ell t Di p Q, Elevation ' 4 on 93J �( 5ft)Contour Elevation t 3.5 % Site Slope Geotextile Fabric Cover Shading Key �- Dispersal Cell See lateral details on a 1 5 ft Page 4 for number,size, 11 Topsoil Cap o t and spacing of laterals. Subsoil Cap `� ° rO /-� Laterals are equally ASTM C33 Sand t9 1° F spaced from the m Tilled Layer 0.5 ft Tyaicai Lateral distribution cell's c �, © ] Aggregate o centerline l the distribution cell(AxB)_ Project: MILLER Page 3 of 10 End Connection Lateral Layout Diagram Center the laterals over the A&B dimension Turn-up wt bell vslve or olesnout plug e P ' All laterals are Wentical l4-X—a I Holes drilled on the bottom of the lateral eguially spaced S Laterals&forcemain Sch 40 PVC per SPS Table 384.30-6 S Force main connection via toe or cross to manifold at any point. Number of Laterals 3 Orifice Diameter 0.188 in Lateral Diameter 1.50 in Orifice Spacing (X) 3.03 ft Lateral Length (P) 48.48 ft Orifices per Lateral 17 Lateral Spacing (S) 3.00 ft Orifice Density 8.82 ft2/orifice Lateral Flow Rate 11.14 gpm Manifold Length 6.00 ft System Flow Rate 33.42 gpm Manifold Diameter 2.00 in Total Dynamic Head 12.81 ft Forcemain Velocity 3.41 1 ft/sec Dose Tank Information Locking over withwarnin 9 9 label and locking device and sealed watertight Electrical as L6.3WA 300 and -► SPS 31C 4 in.min. Disconnect Tank component is properly vented Alternate outlet location Forcemain diameter huffcutt Manufacturer 2 in. Capacityl 627.00 Gallons �- Volume 14.93 gal/inch A _ Weep hole or anti- Dimension Inches Gallons B siphon device A 24.48 365.50 B 2.00 29.86 C Pump off elevation(ft) C 5.02 74.88 87.88 D 10.50 156.77 D Total 1 42.001 627.00 D4 ose tank elevation(ft) 3"Bedding under tank. 87.00 Alarm Manuafacturer JSJE RHOMBUS Note: Switches Alarm Model Number Itank alert I containing mercury may not be used in Pump Manufacturer Izoeller this system. Pump Model Number I bn 152 Pump Must Deliver 1 33.42 gpm at 12.81 ft TDH Project: MILLER Page 4 of 10 Mound System Maintenance and Operation Specifications Service Provider's Name Robert Hardina —� Phone 715-986-2508 POWTS Regulator's Name St. Croix Co. I Phone 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 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 3 years Moundl Ins ect for ponding and seepage once every 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 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 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Long Swee p 90 or Two 45 Degree Bends Same Diameter as Lateral Project: MILLER Page 5 of 10 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,R. 10/12),SSWMP Publication 9.6(01/81),and Pressure Distribution Component Manual Ver.2.0 SBD- 10706-P(N.01/01,R. 10/12)]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,Slats. 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 Commerce. Pump Tank The pump(dosing)tank shall be inspected at least once every 3 years. All switches,alarms,and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter,and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic(other than for vegetative maintenance)on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations(October-February)dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS,and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5,30 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. Continency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank,pump,pump controls,alarm or related wiring becomes defective the defective component(s)shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface,it will be repaired or replaced in its'present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media,and related piping,and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 10 co cc uJ W W PUMP PERFORMANCE CURVE E MODEL 15111521153 50 14 . 153 45 12 40 0 35 L5 10 152 30 o $ 25 151 N4N 6 20 15 4 12 yj 10 2 5 0 10 20 30 1'li 40 50 60 70 80 90 100 GALLONS LITERS 0 40 80 120 160 200 240 280 320 360 FLOW PER MINUTE 014508 HARDINA SEPTIC SYSTEMS MFRS/CST 824825 A + - _ _ SAIAGL o�k z`e.EC, w f��►C-t`��a�� 3-S ,A c e�...F*���(. Na j..)CLL i Av 5-rAl-C6J L-3174 f po(ttp 5cT r3;�c fcs 8= lcoa�ioc+c CAL. tbM'90 -r,4,J)Z Mvkso� Atc-A �k chYio Z r rQ - r A FeAlc s MR) . �� q N � W � o+a+ p1 LL. Cm > 'a; d O E w v m O � Q avaa 4 m o E a 4-0 ® 'QL.+c Q d R H A C 1••I T (� � �f ��• N w O V, W O o ° c a > 3 0 � v O Y _ G m w, W N o N C W c+�. ° �' °c x v v L N L. o m E «a VW m m V ! N v O O c o�-a J o . �F co A1 _ �nn v o .` > v C ( i YJ 3 o y Y d N m p 3 Cl. ca M V O •L 3 vO M n 0 Z u O c , N c m '- E w N 4• a• V A c 4) t v W ° o N v of EVE 4� C V W N a+ i••i v m (' O a c E v /�♦ O Q ` _ 0 .� V T N N L r Y a; cL „y 5 , ofl OG V oMN�o. a ° j 3 C w c y o o a v 0 W a N L O 4 Q T V N R CX �1 H m r a a o 0 r m w m ° ° C N v w O c o o a Y = O y C �� 6�nmc . 3QO . - - - 7 m V O � 1 ■ bi of w v a �.. 3 m a', $ C Y L L �, V o u O c v 3 8 v I « V/ G A °c N 3 0 0 3 5 > a s �LVc0 m o. 1 A C y V O C N L N Y OY y m a,0 V�Y M p• g c �.°b' r E 1 ;n a I 2 v E q"a" 1 V °' a, •v vc « ° C 4-6 N i � E __ C Y N OC vY R 4"A 1 v � �� a0. O v 1 ELY 'CL �-+ 1 C) E V W= 1 .� 1 +•� > r Y Y C N m Y� 3 0. 0 C 1 •� 1 aY a vcv I � •� O ago da° : av 4-5-5 N u vOi C 0 0 — — — isconsi pt�men SOIL EVALUATION REPORT Page / of Division fety a s �6� in accordance wit 5, m. Code County ST.CROIX Attact�ont t2 site plan on paper not less than 8 1/ 1 ' must inolud limited to:vertical and horizontal refe point(BM).direction and Parcel I.D. 014-1057-20-000 per4 slope,scale or dimensions,north arrow,and location and distance to nearest road. Please print all information. Re y Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). Property Owner Property Location ROBERT&ANNETTE MILLER 31 Govt.Lot P 1/4�/ 1/4 S 27 T N R 15 E(or)W Property Owner's Mailing Address Lot# Block# Subd.Name or giijim#let. 2948 HWY 64 /vL/ l t. Ci State Zip Code Phone Number ity Village ■ Town Nearest Road GL CITY WI 54013 715-265-4731 EST ST RD 64 Z 0 New Construction Use Residential/Number of bedrooms Code derived design flow rate GPD Replacement n Public or commercial-Describe: Parent material Flood Plain elevation if applicable ft. General comments SYSTEM RECOMMENDATION ; MOUND AT 93.75 CONTOUR and recommendations: G'c F7] Dorng Boring# Bi 93.75 M Pit Ground surface elev. ft. Depth to limiting fac(131 _in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 'Eff#2 1 0-6 10YR3/3 -0- SIL 1MSBK MFR CW 2M .4 .6 6-13 2 IOYR4/4 tt SIL 2MSBK MFR GW IF .6 .8 3 13-25 10YR4/4 =5YR4!4SCL SIll 2MSBK MFR GW N/A N/A N/A 4 25-40 10YR4/6 C2D5YR4/4SC1, SL 3MSBK MFR N/A N/A N/A N/A Boring# n Boring 93.75 13 Pit Ground surface elev. ft. Depth to limiting facto in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 'Eff#2 1 0-6 10YR3/3 -0- SIL 1MSBK MFR CW 2M .4 .6 2 - 10YR4/4 -0- SIL 2MSBK AFR GW 1F .6 .8 3 - I OYR4/4 C2D5YR4/4SL SIL 2MSBK MFR GW N/A N/A N/A 4 1 OYR4/6 C2D5YR4/4SL SL 2MSBK MFR N/A N/A N/A N/A *Effluent#1 =BOD >30<220 mg/L and TSS>30<150 mg/L *Effluent# =BO 5 30 mg/L and TSS<30 mg/L CST Name (Please Print) Signa CST Number ROBERT IIARDINA 824825 Address ate valuation Conducted Telephone Number 477 170th AVE TURTLE LAKE WI 54889 8-8-14 715-986-2508 r MILLER 014-1057-20-000 Property Owner Parcel ID# Page of Br-1 oring# Boring 93.5 13 n 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/fF in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 I *Eff#2 1 -5 10YR3/3 0- SIL 1 MSBK MFR CW 1 M .4 .6 2 - I OYR4/4 0- SIL 2MSBK MFR CW 1 F .6 .8 3 13-26 OYR4/4 C2D5YR4/4SL SIL 2MSBK MFR GW N/A 6 .8 4 26-40 OYR4/6 C2D5YR4/4SL SL 2MSBK MFR N/A N/A N/A N/A 4❑ Boring# Boring 92.67 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/fF in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 -5 1OYR3/3 -0- SIL 1MSBK MFR CW 1M .4 .6 2 5-12 1OYR4/4 -0- SIL 2MSBK MFR CW 1F .6 .8 3 12-25 OYR4/4 C2D5YR4/4SL SIL 2MSBK MIFIR GW N/A .6 .8 4 25-38 1 OYR4/6 C2D5YR4/4SL SL 2MSBK FR N/A N/A N/A N/A Boring ❑ Boring# Ground surface elev. ft. Depth to limiting factor in. Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 *Effluent#1 =BODS>30:a 220 mg/L and TSS>30<150 mg/L *Effluent#2=BODS<30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330T.t(R.07/00) i V f HARDINA SEPTIC SYSTEMS 1VI RS/CST 824825 _.._.. AA 11 0-4 k Sall- ` NR o y r £ q� 93,'7S ............ .. e , j`l �> q -- r c Y II IIII ff IIIII IIIII III I IIIII (( II c,z4 ( S�+ 'e,S 8247440 �Q^d C�� ��. Tx:4202347 State Bar of Wisconsin Form 1-2003 C; `7a O WARRANTY DEED 999445 vy1 BETH PABST V0� D tyJ cumentNluhber Document Name REGISTER OF DEEDS ( w ST. CROIX CO., WI THIS DEED,made between c t,> (e r;C'P_ a �Q fhU�� 07/31/2014 12:35 PM EXEMPT#: 17 ("Grantor,"whether one or more), REC FEE: 30.00 and PAGES: 1 ("Grantee,"whether one or more). Grantor,for a valuable consideration,conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in County,State of Wisconsin("Property")(if more space is Recording Area needed,please attach addendum): N;X= Address ►_Or,�ais ON - t051 -at)—00 Parcel Identification Number(PIN) ASe � � � This VS 00t homestead property. It LA) i (is)(is not) Grantor warrants that the title to the Property is good,indefeasible in fee simple and free and clear of encumbrances except: Dated (SEAL) (SEAL) s /. . It e-r- 1;7 j (SEAL) (SEAL) AUTHENTICATION , ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) Q ss. authenticated on l'.rO j X COUNTY ) Personally came before me on Lx Lt_ l * the above-named'R TITLE:MEMBER STATE BAR OF WISCONSIN Asilltr V, rij a. (If not, to me known to be the ersdii(s) who executed the foregoing authorized by Wis.Stat.§706.06) instrument and acknowledged&'§htne T�;y - o � T S INSTRUMENT DRAFTED BY: leeter; ( Notary Public,State e ; Vi 2toYI siti Y My Commission(isp6tmayyn'e'ri explrj. ' 15, dD 15) (Signatures may be authenticated or acknowledged. Both are tibt gecel�at ).u a� NOTE:THIS IS A_STANDARD FORM. ANY MODIFICATIONS TO THIS FORA%I:�nnUEA BE CLE Y;IDENTIFIED. " N ' . • .F RM NO.1-2003 WARRA NTY DEED ®2003 STATE B AR OF WISCONSI O Fi r Type name below signatures. , Y° i St. Croix County 9 999445 Page 1 of 1 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer - A1L---t-6 MJ61CC Mailing Address a'96 � c Property Address 'z 9 G1 b A/6,U/ &� 8 K (Verification required from Planning& oning Department for new construction.) City/State e` Parcel Identification Number a� C LEh7c '( LEGAL DESCRIPTION Property Location Sli '/4 , Sec. L-x77,r T L3/ N R 1,'*- W, Town of CO9-g-ST Subdivision Plat: A" V&2'1 rt , Lot# Certified Survey Map # / /C�S , Volume , Page# D� 7 Warranty Deed # (79 / 7 (before 2007)Volume , Page# Spec house❑yes L no Lot lines identifiable es❑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. 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 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 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. N ber of bedro s _ //JY SI ATU 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.09/07) 00 ug T C�. C) j col �� C( �. cl$ (�ar-L y C a be, J J $ Q dp Obi Onw bj2,J