HomeMy WebLinkAbout018-1031-40-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No: 572813 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:
Wikkerink, Bernard A. Hammond, Town of 018-1031-40-000
CST BM Elev: Insp.BM EI BM Description: Section/Town/Range/Map No:
/ /� GSr 14.29.17.224B
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic r•. / Benchmark
/Z60
Dosing GD bO P Z.s Alt. BN►7 6 .5 1D/' 4%W ry
n Bldg.Sewer
� ;-I 5.a 9'4 •ss
Holding
St/Ht Inlet
5.Z5 q6 -3
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent it Intake ROAD Dt Inlet
4.1(
Septic 7 / IT Bottom
Dosing /00, Z) Header/Man. /�33 /a , Z
Aeration Dist. Pipe
Holding Bot. System
qs. s Z. �''' sg
L
PUMP/SIPHON INFORMATION Final Grade 0•3 /-61- Z 7
Manufacturer z� Demand St Cover 8 /,S o/.
Model Number / ' a u 3v 75 q3
TDH Lift Friction Lo ,/ System HeadC/q.
Forcemain Length/ Dial/t Dist.to Well S�f
SOIL ABSORPTION SY TEM 7
BED/TRENCH Width Length No.O ench PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth
DIMENSIONS $ 7 �r
SETBACK SYSTEM TO U P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type ,stem: 7/66 Sy 75 UNIT Model Number:
du
DISTRIBUTION SYSTEM
Header/Manifold Distribution f Ix Hole Size it x Hole Spacing e Ve Air I
/ Pipe(s) / Q /1 'j s 3L 3
Length '•Z5 Dia ,' Length 6 V r� Dia `� Spacing z' T(O
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only I V A
Depth Over Depth Over xx Depth of xx Seeded/So ded xx Mul VYe.Bed/Trench Center "7 Bed/Trench Edges Topsoil Yes «F No 0 ]No
COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1:/0 /�/ � Inspection#2:
Location: 916 200TH S aldwin,WI 54002(SE 1/4 SE 1/4 14 T29N R17W) metes&bounds Lota,14tv' Pa el No: 14.29.17.224B
1. Alt BM Description= / ' NO Lj
2.)Bldg sewer length= Q 6�_ p/pl,�J 01C
-amount of cover I
Z o✓�- a�-�C--
Plan revision Required? El Yes No /6 36
Use other side for additional information. i l(i ✓
SBD-6710(R.3197) Date Insepctor's ignature Cart.No.
HANNA SEPTIC SYSTEMS
N PRS/CST 824825
Tn.Q cS o?c- N Li Coa-tic-2 p� �oufE S-rep-
w
=
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CA
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7 3� ce
- 334
County
A ��` :- Safety and Buildings Division
201 W.Washington Ave.,P.O.Box 7162 Sanitary Permit Number(to be filled in by Co.)
e;1
1(� Madison,WI 53707-7162
M.
171
-r State Transaction Number
s� 2214(2111is Zit Apph&6 i�eff----- //In accordance 0 '38 .Adm.Code,submission of this form to the appropriate governmental unit lD J
is required prier 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 Servies. Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law,s.15. 1 m,Stats.
I. Application Information-Please Print All Information G1/r
Property Owner's Name Parcel#
�-Z aA9� �1 �4r:7 AJ k vl�- I� 1 -�Id -oo
Property Owner's Mailing Address Property Location Z �
91� -ao a-rµ T, Govt.Lot l/
City,State Zip Code Phone Number
/ Jr /,, Section
L ` AJ ltq l �� (circle one)
II.Type of Building(check tallth� J
at apply) ' ' ' Lot# T�_N; R :7 _E or ID
1 or 2 Family Dwelling-Number of Bedrooms I f 1, Subdivision Nfine
ri
,,'(�C�G�'r.�'� Cr'I�' r',t-G_t�✓3,c- " �.�c��t,cJ Block#
❑Public/Commercial-Describe Use ;'"J J ❑City of
❑State Owned-Describe Use CSM Number ❑Village of
-Townof� JR,0 L
III.Type of Permit: (Check on line A. Complete line B if applicable)
A' ❑New System Replacement System ❑Treatment/Holdin g Replacement Only Other Modification to Existing,System(explain)
B. El Permit Renewal ❑Permit Revision ❑Change of Plumber List vious Permit Number an Date Issued
❑Permit Transfer to New r / ' e
Before Expiration Owner / "` j( 1/�
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 soil Mound<24 in.of suitable soil
❑Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(exp iq)
1
V.Dis ersallTreatment Area Information: ' A Al �11/Vy?E'
Design Flow(gpd) I Design oil Applica on Rate(gpdsf) Dispersal Area Re uired(sf) Dispersal Ar Pro sed(sf) System Elevation 6 zv
VI.Tank Info Capacity in Total #of Manufacturer
Gallons Gallons Units a o $
New Tanks Existing Tanks c
U 0 ti ) W
Septic or Holding Tank
Dosing Chamber 79-0 T-5)
VII.Responsibility Statement-I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name(Pri"nt�) Plumber's Signs MP/MPRS Number Business Phone Number
Plumber's Address(Street,City,State,Zip Code)
LAa-
County/De artment Use Only
Permit Fee Date Issued Issuing Agent Si afore
Approved 0 Disapproved L�J
/„ 1
❑Owner Given Reason for Denial S l '� GLv
c
DL Conditions of Approval/Reasons for Disapproval
SYSTEM OWNER:
1.Septic tank,effluent filter and
dispersal cell must be d/maintained
�J
as per management plan provided by plumber.
13
o lens for the system and submit to the County only on paper not less than 81n x 11 inches in size
per licable co efor`�ift'�94i
asp pp
SBD-6398(R.11/11)
BOB J HARDINA I + Page 2 10/3/2014
• 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.
1 3.A monthly average o f 5 0 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.
Sincerely, Fee Required$ 250.00
Fee Received$ 250.00
Balance Due $ 0.00
dwin A Taylor
Wastewater Specialist,Integrated Services WSMART code:7633'
(715)634-3484,Monday-Friday 8:00 am To 4:30 pm
edwin.taylor @wisconsin.gov
I
.VAR � DIVISION OF INDUSTRY SERVICES
ion ,
10541N RANCH ROAD
HAYWARD WI 54843
3 r r,; � Contact Through Relay
9 P F http://dsps.wi.gov/programs/industry-services
www.wisconsin.gov
�OF�SS(OIvAl S�
Scott Walker,Governor
Dave Ross,Secretary
October 03,2014
CUST ID No. 824825 ATTN:POWTS Inspector
BOB J HARDINA ZONING OFFICE
14ARDINA SEPTIC SYSTEMS ST CROIX COUNTY SPIA
477 170TH AVE 1101 CARMICHAEL RD
TURTLE LAKE WI 54889-9187 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 10/03/2016 Identification Numbers
Transaction ID No.2463056
SITE: Site ID No. 806655
Bernard Wikkerink Please refer to both identification numbers,
916 200TH St above,in all correspondence with the agency.
Town of Hammond
St Croix County
SE 1/4, SE 1/4, S14,T29N,RI 7W
FOR:
Object Type:POWTS Component Manual Regulated Object ID No.: 1505790
Maintenance required; Replacement system; 600 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. •t
The owner,as defined in chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all code
p.®•�
requirements. CQnd>!tio
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06,
stats.
xpp
EpT Of
The following conditions shall be met during construction or installation and prior to occupancy or use: DEVARl M SAF*V
DNts� '
• A copy of this approval letter and index sheet shall be attached to plans that correspond with the copy on file
with the Department. Changes to the approved plan must be submitted for review and approval. Failure to GORRES
properly attach the approval and index page to plans that match the copy on file with the Department may'result S
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.
• Abandon the existing system components per SPS 383.33
MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: WIKKERINK
Owner's Name: BERNARD WIKKERINK
Owner's Address: 972 200TH ST.
BALDWIN WI 54002
22 ACRES
Legal Description: SE,SE,S.14,T.29 N-R17W
Township: HAMMOND
County: ST. CROIX
i
Subdivision Name: NA
Lot Number: NA Block Number: NA
Parcel I.D. Number: 018-1031-40-000
Plan Transaction No.:
Page 1 Index and title ^
Page 2 Data entry OY
Page 3 Mound drawings
Page 4 Lateral and dose tank
Page 5 System maintenance specifications A-D
Page 6 Management and contingency plan oM��� c
Page 7 Pump curve and specifications
Page 8 Tank specifications
Page 9 Site plan 1"=40' , N
Page 10 Filter specs.
Page 11 aft. Soil test
Designer: Robert Hardina License Number: 824825
Date: 09/15/14 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 11
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
400.00 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.
600.00 Design Flow(gpd)
4.50 Site Slope(%)
97.67 Contour Line Elevation (ft)
16.00 Depth to Limiting Factor(in)
0.40 In-situ Soil Application Rate(gpd/ft2)
Distribution Cell Information
70.001 Dispersal Cell Length Along Contour(ft) = 8.58 Cell Width (ft)
1.00 Dispersal Cell Design Loading Rate(gpd/ft2)
1 I Influent Wastewater Quality(1 or 2) Are the laterals the highest point
in the distribution Y
Pressure Disribution Information network? Enter Y or N
(C or E) a Center or End Manifold
2.86 Lateral Spacing (ft) If N above, enter the elevation (ft)
3 Number of Laterals of the highest point.
0.156 Orifice Diameter(in)
3.00 Estimated Orifice Spacing (ft)= 8.70 ft2/orifice
2.00 Forcemain Diameter(in)
50.00 Forcemain Length (ft) Does the forcemain drain back? - Y
92.00 Pump Tank Elevation (ft) Enter Y or N
4.55 System Head (ft)x 1.3 8.16 Forcemain Drainback(gal)
6.96 Vertical Lift(ft) 94.17 5x Void Volume(gal)
1.44 Friction Loss(ft) 102.32 Minimum Dose Volume(gal)
0.00 In-line Filter Loss(ft) 37.16 System Demand (gpm)
12.95 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 x
1.25 2.00 x
1.50 x x 3.00
2.00 x
3.00 x
Gallons/Inch Calculator(optional)
Treatment Tank Information 758.00 Total Tank Capacity(gal)
1250.001 Septic Tank Capacity(gal) 45.00 Total Working Liquid Depth (in)
huffcutt I Manufacturer 16.84 gal/in (enter result in cell B49)
Dose Tank Information Effluent Filter Information
750.001 Dose Tank Capacity(gal) Best _ Filter Manufacturer
16.851 Dose Tank Volume(gal/in) f10-8 -Filter Model Number
huffcutt Manufacturer
Project: WIKKERINK Page 2 of 11
Mound Plan and Cross Section Views
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . .
t
1/10 B : : : : : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... . J
observation Pipe
K
A
W : : :I: . . . . : . . . . . . . . . . : . . . ' t . ..:.:.
. . . . . . . . . . . . ....
L
Mound Component Dimensions
Down slop toe extension made.
A 8.58 ft E 24.63 in H A7.82 ft K 10.95 ft
B 70.00 ft F 9.50 in z ft L 91.91 ft
D 20.00 in G 0.50 ft J ft W 29.25 ft
600.60 (ft2) Dispersal Cell Area 1 1500.00 (ft2) Basal Area Available
8.57 (gpd/ft) Linear Loading Rate 1 7.00 (ft) 1/10 B Obs. Pipe Placement
Mound Cross Section View
Aggregate Dispersal Area
Finished Grade 101.13 (ft) --~►
.rrfrrrr r,... H
rrriirrirr friirriir+.- v"
I F Dispersal Cell
99.84 (ft) Latera l
99.34 (ft)---11- Invert
Dispersal Cell [ ;
Elevation Q ' ' ':: :
:.:•:.
4 '
_tea ] 1 4 ] „ { A A" „ ]
]
97.67 (ft)Contour Elevation
4.5 % Site Slope
Geotextile Fabric Cover
Shading Key $, � Dispensal Cell See lateral details on
10 Topsoil Cap 1.5 ft Page 4 for number,size,
2 ”""" Subsoil Cap and spacing of laterals.
ASTM C33 Sand R t6 Laterals are equally
'o F spaced from the
Tilled Layer d 0 ft Tvaical Lateral distribution cell's
Aggregate d o _ centerline in the
A distribution cell(Ax6).
Project: WIKKERINK Page 3 of 11
End Connection Lateral Layout Diagram
Center the laterals over the A&B dimension •-Turn-up wlball valve or clean out plug
P _l
All laterals are Wentical IE X-->I Holes drilled on the bottom of the lateral S
equally spaced
Laterals&forcemain Sch 40 PVC per SPS Table 384.30-6 S
Force main connection via tee or cross to manifold at any point.
Number of Laterals 3 Orifice Diameter 0.156 in
Lateral Diameter 1.50 in Orifice Spacing (X) 3.11 ft
Lateral Length (P) 68.42 ft Orifices per Lateral 23
Lateral Spacing (S) 2.86 ft Orifice Density 8.70 ft/orifice
Lateral Flow Rate 12.39 gpm Manifold Length 5.72 ft
System Flow Rate 37.16 gpm Manifold Diameter 1.50 in
Total Dynamic Head 12.95 ft Forcemain Velocity 3.79 ft/sec
Dose Tank Information Locking cover with warning
label and locking device and
sealed watertight
Electrical as per NEC 300 and —— ► �.rr�-
SPS 316.300 WAC 4 in.min.
Disconnect
Tank component is properly vented E— Alternate outlet
location
Forcemain diameter
huffcutt Manufacturer 2 in.
Ca aci 750.00 Gallons
Volume 16.85 gal/inch A
if Weep hole or anti-
Dimension Inches Gallons B siphon device
A 25.94 437.05
B 2.00 33.70 C P4 ump off elevation(ft)
C 6.07 102.32 92.88 1 Ir
D 10.50 176.93 D
Total 1 44.511 750.00
iF Dom se tank elevation(ft)
3" Bedding under tank. 1 92.00
Alarm Manuafacturer s e rhombus —� Note: Switches
Alarm Model Number Tank Alert AB Duo J containing mercury
_____ may not be used in
Pump Manufacturer zoeller this system.
Pump Model Number I bn 152
Pump Must Deliver 1 37.16 gpm at 12.95 ft TDH
Project: WIKKERINK Page 4 of 11
Mound System Maintenance and Operation Specifications
Service Provider's Name I Robert Hardina -I Phone 715-986-2508
POWTS Regulator's Name St Croix co zoning Phone
System Flow and Load Parameters
Design Flow- Peak 600 gpd Maximum Influent Particle Size 1/8 in
Estimated Flow-Average 400 gpd Maximum BOD5 220 mg/L
Septic Tank Capacity 1250 gal Maximum TSS 150 mg/L
Soil Absorption Component Size 600.6 ftz 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
Mound 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 Sweep 90 or Two
45 Degree Bends Same
Diameter as Lateral
Project: WIKKERINK Page 5 of 11
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,Stats. The contents of the septic
tank shall be disposed of in accordance with NR 113,Wis.Adm.Code. The operating condition of the septic tank and outlet filter shall be
assessed at least once every 3 years by inspection.
The outlet filter shall be cleaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions
are made to retain solids in the tank that may slough off the fitter 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 Distribultion 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.
&ontinaency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in
proper operating condition.
If the dosing tank,pump,pump controls,alarm or related wiring becomes defective the defective component(s)shall be immediately
repaired or replaced with a component of the same or equal performance.
If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface,it will be repaired or
replaced in its'present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal
media,and related piping,and replacing said components as deemed necessary to bring the system into proper operating condition.
See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider.
Pretreatment Units
The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection
units are attached as separate documents and are considered part of the overall management plan for this system.
Project: Page 6 of 11
� I
u W PUMP PERFORMANCE CURVE
MODEL 15111521153
50
14 45 153
12 40
a 35 152
10
30
8 25 151
6. 20
15
4
10
2
5
0
10 20 301' 0 50 60 70 80 90 100
GALLONS
LITERS 0 40 80 120 160 200 240 280 320 360
FLOW PER MINUTE 014508
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Wisconsin De rr®Rt� �e SOIL EVALUATION REPORT Page of
Division of Saf ,�pdA6�lil rags
in accordance with Comm 85,Wis. Adm. Code
County ST.CROIX
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must
include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. 018-1031-40-0000
percent slope,scale or dimensions,north arrow,and location and distance to nearest road. -..-..
Please print all information. Reviewed / Datett
Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)).
Property Owner Property Location
BERNARD WIKKERINK
SE El El
Govt.Lot 1/4SE 1/4 S14 T29 17
N R E(or)W
Property Owner's Mailing Address Lot# Block# Subd.Name or CSM#^
972 200TH ST. 1't Z, =.LG✓L f7 e�y
City State Zip Code Phone Number ity Village ■ Town Nearest Road'
BALDWIN WI 54002 ( ) MON 200th ST.
New Construction Use Residential/Number of bedrooms 4 Code derived design flow rate 600 GPD
aReplacement Public or commercial-Describe:
Parent material Flood Plain elevation if applicable ft•
General comments RECOMMEND MOUND COTOUR 97.67'
and recommendations:
SITE ADRESS IS 916 200TH ST. Y11 �� �✓ v
1❑ Boring# 11 Boring 97.67 18
■ 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. I *Eff#1 *Eff#2
1 0-10 10YR3/3 -0- SIL 2MSBK MFR CW 2M .6 8
2 10-18 -0_ CL 2MSBK MFR N/A IF 6
10YR5/3
3 18-33 10YR4/6 C2D5YR5/6SCL SCL 2MSBK MFR N/A N/A 4 6
F-1 Boring# Q
Boring 97.58 17
'' 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/fg
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2
1 0-9 10YR3/3 -0- SIL 2MSBK MFR CW 2M .6 .8
2 10YR4/6 -0- SCL 2MSBK MFR N/A 1 F .4 6
3 11-36 10YR4/6 C2D5YR5/6SCL SCL 2MSBK MFR N/A N/A .4 .6
*Effluent#1 =BOD >30:5 220 mg/L and TSS>30 5 150 mg/L *Effluent#2=BOD <30 mg/L and TSS<30 mg/L
CST Name (Please Print) ' nature CST Number
ROBERT HARDINA 824825
Address Date Evaluation Conducted Telephone Number
477 170TIl AVE.TURTLE LAKE WI 54889 9-12-14 715-986-2509
f .
HA.RDINA SEPTIC SYSTEMS
• WRSICST 824825
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address -r — LJ 00
Property Address 2—lee a 066 O75 t'?,60 LOr+3 (-J( 5g40J- (E i"2
(Verification required from Planning&Zoning Department for new construction.)
��I
City/State Parcel Identification Number loig- 1,0-5140-6
r�L ,J t..J(
LEGAL DESCRIPTION q
Property Location S E '/4, $C '/4 , Sec. ,T o11 N RL7—W, Town of 4
Subdivision Plat: / UL ! `�� L_�G' J ��� 2Z , Lot#
Certified Survey Map # c �J , Volume , Page#
Warranty Deed # q -3 (} / (before 2007)Volume , Page#
Spec house❑yes 14401 Lot lines identifiable❑yes❑no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in§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.
Number of bedrooms J�'J 7
moo/ �Md/li �C COMA �0/1 l
SIGNATURE 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)
Parcel #: 018-1031-40-000 10/14/2014 09:30 AM
PAGE 1 OF 1
Alt. Parcel M 14.29.17.224B 018-TOWN OF HAMMOND
Current ❑ ST. CROIX COUNTY,WISCONSIN
Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units
00 0
Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner
0-WIKKERINK, BERNARD A
BERNARD A WIKKERINK
972 200TH ST
BALDWIN WI 54002
Pro erty Address(es): *=Primary
19
2 200TH ST
Districts: SC=School SP=Special
Type Dist# Description 1 1 0 0
SC 0231 SCH D BALDWIN-WDVILLE
SP 1700 WITC Notes:
Legal Description: Acres: 22.000
SEC 14 T29N R17W SE1/4-SE1/4 THE E1/2 OF
SE-SE SEC 14 ALSO A PARCEL 4RDS DEEP ALG Parcel History:
W SIDE OF E1/2 SE1/4-SE1/4 P224B V631 Date Doc# Vol/Page Type
P365 22AC 04/13/2011 934898 WD
12/23/2008 885727 TI
10/06/2003 742497 2428/88 ALC
1185/179 LC
more
Plat: *=Primary Tract: (S-T-R 40%160'%GL) Block/Condo Bldg:
*N/A-NOT AVAILABLE 14-29N-17W
2014 SUMMARY Bill M Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 06/07/2012
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 34,700 121,400 156,100 NO
AGRICULTURAL G4 15.500 3,800 0 3,800 NO
UNDEVELOPED G5 2.500 1,600 0 1,600 NO
AGRICULTURAL FOREST G5M 2.000 4,000 0 4,000 NO
Totals for 2014:
General Property 22.000 44,100 121,400 165,500
Woodland 0.000 0 0
Totals for 2013:
General Property 22.000 44,100 121,400 165,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch M
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
Parcel #: 018-1029-80-000 10/14/2014 E 1 AM
PAGE 1 OF 1
Alt. Parcel M 14.29.17.212 018-TOWN OF HAMMOND
Current ❑
ST. CROIX COUNTY,WISCONSIN
Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units
00 0
Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner
0-WIKKERINK, BERNARD A
BERNARD A WIKKERINK
972 200TH ST
BALDWIN WI 54002
fy�operty A dress es): *=Primary
i*
Districts: SC=School SP=Special 972 200TH ST
—
Type Dist# Description Gv/ to
SC 0231 SCH D BALDWIN-WDVILLE
SP 1700 WITC Notes:
IV J—
Legal Description: Acres: 40.000
SEC 14 T29N R1 7W 40AC SE NE
Parcel History:
Date Doc# Vol/Page Type
04/13/2011 934898 WD
12/23/2008 885727 TI
10/06/2003 742497 2428/88 ALC
1185/179 LC
more...
Plat: *=Primary Tract: (S-T-R 40'/.160'/.GQ Block/Condo Bldg:
*N/A-NOT AVAILABLE 14-29N-17W
2014 SUMMARY Bill M Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 07/01/2011
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 37.500 7,700 0 7,700 NO
UNDEVELOPED G5 1.000 50 50 NO
OTHER G7 1.500 10,500 54,200 64,700 NO
Totals for 2014:
General Property 40.000 18,250 54,200 72,450
Woodland 0.000 0 0
Totals for 2013:
General Property 40.000 18,250 54,200 72,450
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch#: 143
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
II Illlllllllilllllllllllllllll
802510 1
State Bar of Wisconsin Form 1-2003 Tx:4018168
WARRANTY DEED 934898
BETH PABST
Document Number Document Name REGISTER OF DEEDS
ST. CROIX CO., WI
THIS DEED,made between Bonita N.McCluskev 04/13/201109:43 AM
EXEMPT#: 17
("Grantor,"whether one or more), REC FEE: 30.00
and Bernard Wikkerink PAGES: 6
("Grantee,"whether one or more).
Grantor,for a valuable consideration,conveys to Grantee the following described real Recording Area
estate,together with the rents,profits,fixtures and other appurtenant interests,in
St Croix County,State of Wisconsin("Property")(if more space is Name and Return Address
needed,please attach addendum): &p h Q✓'d
South half of Northwest(S1/2 of NW 1/4)of section thirteen(13);Southeast quarter q j Q
of Northeast Quarter(SE 1/4 of NE 1/4)of section Fourteen(14);Northwest Quarter 1
of Southwest Quarter(NW 1/4 Of SW 1/4)and West half of Northeast Quarter of lYl vj 1 5 W::),
Southwest Quarter(W 1/2 of NE 1/4 of SW 1/4)of section thirteen(13);Southeast
quarter(SE 1/4)of Section fourteen(14),all in Township twenty-nine(29)North, 018-1027-10,-20,-00,-50,ora-1029-80,ors-1031-00,-10,20,-30,-40
Range seventeen(17)West. Parcel Identification Number(PIN)
This is homestead property.
(is)(is not)
Grantor warrants that the title to the Property is good,indefeasible in fee simple and free and clear of encumbrances except:
None
Dated "7 9
(SEAL) (SEAL)
'Bonita N.McCluskey '
(SEAL) (SEAL)
s s
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
)ss.
COUNTY
authenticated on )
. Personally came before me on
TITLE:MEMBER STATE BAR OF WISCONSIN the above-named 8Uh r` /f'1
(If not, to me known to be the Ferson(s)who executed the foregoing
authorized by Wis.Stat. §706.06) instrument and a [ew? a same.
THIS INSTRUMENT DRAFTED BY:
N6tar}jPu8ti6,Stat f Wisconsin
My Coz lion(i ermanent)(expires: 4!
(Signatures may be authenticated or acicaowd. Both are not newsaly)
NOTE:THIS IS A STANDARD FORM. ANY MODIFICATIONS T6�,IS,FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED C 2003 STATE BAR OFiVX!SCONSJN FORM NO.1.2003
*Type name below signatures.
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