HomeMy WebLinkAbout022-1014-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
572815 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:
Hunter, a I Kinnickinnic, Town of 022-1014-20-000
CST BM Elev: Insp.BM Elev: BM Description: ^ � � � C� Section/Town/Range/Map No:
NC
I ) (3 J 06.28.18.82
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER !J. CAPACITY STATION B HI FS ELEV.
Al Z. �j o Z-'1 ao
Septic /
p - Benchmark
/,,&s4 7.OS /6Z• /db
Dosin g , Alt. f, 31
6"Z) ✓ b •
won Bldg.Sewe //` Io 176 • 7�
Holding f St/Ht Inlet ) O
d Iz. 90 . 5
TANK SETBACK I ORMATION St/Ht Outlet
TANK TO „P/� WELL BLDG. Vent it Intake ROAD Dt Inlet
Septic -2 /66 3� f 3 Dt Bottom �S. $1.9g
Dosing /OU Header/Man.
3a /3 Z� 3. �$ 'N . 72-
Aeration Dist. Pipe I g
yy.5Z
Holding Bot. Syste4-7 5 -1,7. 9
PUMP/SIPHON INFORMATION Final Grade Z .01%, ( c` . 7
Manufacturer Demand St C er
Model Number O GPM '14
GO C 'y3 -7s•
9 7
• Z 4!5'jn O 1
TDH Lift Friction Los System Head TDH Ft
dlt7
Z. 9? 3•Z� .5
Forcemain Leng6 ' Dia. /I Dist.to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No.Of TIrench PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth
DIMENSIONS S 1 /ad J/5
SETBACK SYSTEM TO P/L JBLDG WELL LAKE/STREAM LEACHING Manufacturer: \
INFORMATION CHAMBER OR
Type(�,Mystem: ! 6 UNIT
l,'/r I �/� Model Number: �
p J v,.
DISTRIBUTION SYSTEM [
Header/Manifold ( Distribution x Hole Size x Hole Spacing i Ve t o Air In e
5 Pipe(s)Len /111 p�
Length •� Dia 2 gth 'T Dia � ZS Spacing 7•Z
3• f' O `�
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only a
Depth Over Depth Over xx Depth of xx Seeded/ dded xx Mulched
Bed/Trench Center / a•Z Bed/Trench Edges Topsoil ' Yes No es 7[,1N
D �
COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: a / 30/ Inspection#2:
Location: 963 CTY RD N,soberts,WI 54023(NW 1/4 NE 1/4 6 T28N R1 8W) 40 acres Lot ' .t.. - Parcel No: 06.28.18.82
. . f'v
1.)Alt BM Description
2.)Bldg sewer length
-amount of cover
Plan revision Required? Yes (No
Use other side for additional informati n.
SBD-6710(R.3/97) Date InsepctXSiure Cert.No.
C
p — 701-lE
1 �
��3ti3
o(UP' , S�
14\�Cj
a
1
County
,- �T Safety and Buildings Division ,
p 201 W.Washington P x 7162 Sanitary Permit Number(to be filled in by Co.)
� VLG --7
z P Madison,V1/I ! CK/
GGT 14 2014 4
Sanitary Permit Application State Transactio-n7NumberC
In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form tQ t�a m�l mt z 5 ( �3J
is required prior to obtaining a sanitary permit. Note:Application forms fors roject Address(if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary /y`�3 „ n
purposes in accordance with the Privacy Law,s.15.04(1)(m),Stats. f{J�_Gy1/
L Application Information-Please Print All Information
Property Owner's Name Parcel#
/� //
Property Owner's Mailing Address Property Location /
Govt.Lot
City State Zip Code Phone Number �1/, /., Section
jrt �v� 7/5 -7G b CJ
( circle one
IL Type of Building(check all that apply) Lot#
)<1 or 2 Family Dwelling-Number of Bedrooms Subdivision Name
<)k - — L�l� .. Block#
El Public/Commercial-D-
escribe Use
❑ City of
CSM Number ❑ Village of
❑State Owned-Describe se
✓ A Town of�l
of of
lII.Type of Permit: (Check only one box on line A. Complete line B if applicable) G
A, ❑New System Replacement System ❑Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain)
B. El Permit Renewal 11 Permit Revision El change of Plumber ❑Permit Transfer to New List Previous Permit Number d Date Issued
Before Expiration Owner V K�O� /
IV.Type of POWTS Sy onent/Device: Check all that apply) n G v
❑Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade V Mound>24 in.of suitable soil Mound<24 in.of suitable soil
❑Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain)
V.Dispersal/Treatment Area Information: Z 4w
Design Flow(gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required f) Dispersal Area Propos (s System Elevation /
41.5-0 �'Sd 6D SSG n� 1� 7,7
VL Tank Info Capacity in Total #of Manufacturer
Gallons Gallons UnitsD � c
n U y
New Tanks Existing Tanks /I/✓OJ I C c� o ., " s
U 'M h v)
Septic or Holding Tank vDG
Dosing Chamber /
VII.Responsibility Statement-I,the undersigned,as me responsibility for installation of the PORTS shown on the attached plans.
Plumber's Name(Print) Plum s Sign 1MPRS Number Business Phone Number
u A �s o .vq
Plumb 's Address(SqFt,City,State,Zip Code)
dX 11-3
VIII.County/Department Use Only
Approved Disaptv.Rva,so.for Permit Fee ate Issued Issuing t Signature
Denial $ `Z d ��j/,
DL Condijj%ji6h499fR0kReasons for Disapproval 3 6t�
Y." Septic'tank,effluent fitter and f
dispersal cell must all be services/maintained (gyp
as per management plan provided by plumber.
2: At selllack requirements:must be maintained
sa Or awkwe c6d /ordinarx t.
Attach to complete plans for the system and submit to the County only on paper ass 1181/2X:11, Ch
in siu
Atc. ,'A
SBD-6398(R. 11/11) 5 6L4 foot e_ be— 1 +
t.V oYA G ��• a
r- e -.) vL
BRADY J UTGARD ` , Page 2 9/18/2014
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 downslo a 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
Edwin A Taylor
Wastewater Specialist,Integrated Se - es WiSMART code:7633
(715)634-3484,Monday-Friday 8:00 am To 4:30 pm
edwin.taylor @wisconsin.gov
cc: Utgard Plumbing
�4ARTNp DIVISION OF INDUSTRY SERVICES
10541 N RANCH ROAD
HAYWARD WI 54843
3 = Contact Through Relay
hftp://dsps.wi.gov/programs/industry-services
www.wisconsin.gov
�OFZSSION AtiS�
Scott Walker,Governor
Dave Ross,Secretary
September 18,2014
CUST ID No. 220357 ATTN:POWTS Inspector
BRADY J UTGARD ZONING OFFICE
UTGARD PLUMBING&HEATING ST CROIX COUNTY SPIA
PO BOX 413 1101 CARMICHAEL RD
AMERY WI 54001 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 09/18/2016 Identification Numbers
Transaction ID No.2457435
SITE: Site ID No. 806135
Kathleen Hunter
Please refer to both identification numbers,
Town of Kinnickinnic above,in all correspondence with the agency.
St Croix County
NW1/4,NEIA, S6,T28N,R18W
FOR:
Object Type:POWTS Component Manual Regulated Object ID No.: 1503190
Maintenance required; Replacement system; 450 GPD Flow rate; System(s):Mound Component Manual-Ver.2.0,
SBD-10691-P(N.01/0I,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 n1anual(s)referenced above.
The owner,as defined in chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all code P.O.
requirements. Condl�l
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. A R
DEPARTMENT 0
The following conditions shall be met during construction or installation and prior to occupancy or use: OF SAFET
• 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 SEE GORRE
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.
• 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.
BRADY J UTGARD Page 2 9/18/2014
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.
Sincerely, Fee Required$ 250.00
�—' Fee Received$ 250.00
Balance Due $ 0.00
Edwin A Taylor
Wastewater Specialist,Integrated Se es WiSMART code:7633
(715)634-3484,Monday-Friday 8:00 am To 4:30 pm
edwin.taylor @wisconsin.gov
cc: Utgard Plumbing
e
t
MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN
INDEX AND TITLE PAGE
Project Name: KATHLEEN HUNTER
Owner's Name: KATHLEEN HUNTER
Owner's Address: 963 CO. RD. N
963 CO. RD. N
ROBERTS W1. 54023
Legal Description: NW/NE/S6/T28f R19W
Township: KINNICKINNIC
County: ST. CROIX
Subdivision Name:
Lot Number: Block Number.
Parcel I.D. Number: 022-1014-20-0000
Plan Transaction No.:
Page 1 Index and title .T.$.
Page 2 Data entry 9naIIV
Page 3 Mound drawings
Page 4 Lateral and dose tank IV
Page 5 System maintenance specifications CO Mr = E
Page 6 Management and contingency plan D taut IN
Page 7 Pump curve and specifications
Page 8 PLOT PLAN O
Page 9 SOIL EVALUATION
Designer: BRADY UTGARD License Number: 220357
Date: 09/08114 Phone Number: 715-268-6995
Signature:
Designed Pursuant to the
Mound Component Manual for POWTS Version 2.0 SDB-10691-P(N.01/01),and
SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS(01/81)
Version 3.11 (R. 06/01) Page 1 of 9
Mound and Pressure Distribution Component Design
Site information
R Residential or Commercial Design Note: sand fill(D)caWshons assume a
300.00 Estimated Wastewater Flow(gpd) Tabie 83-44.3 in-situ sod treatment for fecal
1.50 Peaking Factor(e.g. 1.5= 150%) co6forrn of-36 inches.
450.00 Design Flow(gpd)
2.60 Site Slope(%)
97.27 Contour Line Elevation(ft)
36.00 Depth to Limiting Factor(in)
0.50 In-situ Soil Application Rabe(gpdtfe)
Distribution Cell Information
100.00 Dispersal Cell Length Akxtg Contour(ft) = 4.50 Cell Width(ft)
1.00 Dispersal Cell Design Loading Rabe(gpd4f)
1 Influent Wastewater Quality(1 or 2) Are the laterals the highest point
in the distribution Y
Pressure Danbution hrformabon network?
c Center or End Manifold
2.25 Lateral Spacing(ft) If N above,enter the elevation(ft)
4 Number of Laterals of the highest pant.
0.188 Orifice Diameter(in)(e.g.025)
3.00 Orifice Spacing(ft)= 7,03 felorifxe
2.00 Forcemain Diameter(in)
140.00 Forcemain Length(ft) Does the forcemain drain back? Y
88.00 Pump Tank Elevation(ft)
3.25 System Head(ft)x 1.3 22.84 Forcemain Drainback(gal)
9.77 Vertical Lift(ft) 62.81 5x Void Volume(gal)
5.04 Friction Loss(ft) 85.65 Minimum Dose Volume(gal)
18.06 Total Dynamic Head(ft) 41.94 System Demand(gpm)
Lateral Diameter Selection Manifold Diameter Sete tction
in. dia. options choice in. dia. optione choice
0.75 1.25 x
1.00 1.50 x
1.25 x x 2.00 x x
1.50 x 3.00
2.00 x
3.00 x
Gallons/Inch Calculator
Treatment Tank Information 600.00 Total Tank Capacity(gal)
1000.00 Septic Tank Capacity(gal) 36.00 Total Working Liquid Depth(in)
weiser Manufacturer 1 16.67 gal/in (enter result in cell B49)
Dose Tank Information Effluent Filter Information
600.00 Dose Tank Capacity(gal) POLYLOK Fitter Manufacturer
16.67 Dose Tank Volume(galtin) PL-525 Fitter Model Number
Weiser Manufacturer
Project: KATHLEEN HUNTER Page 2 of 9
Mound Plan View
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..... . . . . . . . . . . . . . . . . . J
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1/10 B . . . . . . . . . . . .
Observation Pipe . . . . 3
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
A
C�
F. . . . . . . . . . . . . . . .
B .
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. ............... . . . . . . . . . . . . . . . . . . . . . . . . . .
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L
Mound Component Dimensions
D[AinA 4.50 ft E .40 in H .00 ft K 6.99 ft
B 100.00 ft F .25 in 1 .14 ft L 113.98 ft
6.00 0.50
G [Aft J A4.93 ft W A15.57 it
I
450.00 (if)Dispersal Cell Area 1064.26 (W) Basal Area Available
I 4-501(gpdfft)Linear Loading Rate 10,001 (ft) 1/10 B Obs. Pipe Placement
Mound Cross Section View
Aggregate Dispersal Area
Finished Grade 99.54 (ft)
I -
. . . . . . . . . .
F Dispersal Cell 98.27 (11)Lateral
. . . . . . . . . .
. . . . . . . . . . . . .
97.77 (ft)--*I . . . . . . . . . . . . ... Invert
. . . . . . . . . . . . . . . . . . .
.
Dispersal Cell . . . . . . . . . * * " ' ' * * . . . . . . . . . . .
. . . . . . . . . . . . . . . . .
. . . . . . . . . . . . .
Elevation E D
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4— 97.27 (ft)Contour Elevation
2.6 %Site Slope Geotexfile Fabric Cover
Shading Key -0 On.
0 — T Dispersal Cell See lateral details on
Topsoil Cap *: CL 1.5 ft Page 4 for number,size,
.2 r-
Subsoil Cap 0 0 0 le_t�o and spacing of laterals.
ASTM C33 Sand a' ' Laterals are equally
:5 9 0.5 It Typical Lateral F spaced from the
Tilled Layer CE :
M distribution cell's
Aggregate It 0 Ell centerline in the
A distribution cell(AxB).
Project: KATHLEEN HUNTER Page 3 of 9
Center Connection Lateral Layout Daigram
Force main con nectim via tee a cross to nW&oW at anspoiu. Laterals are klentic al
ri —IF
IE P S
•=T lesno tplu{valve or }E X—i�rs12 st2i Laterals&face main of PVC Sch 40
desnoutpiug
per COMM Table&4.30-5
Holes drilled on the bottom of the lateral
Number of Laterals 4 Orifice Diameter 0.188 in
Lateral Diameter 1.25 in Orifice Spacing(X) 3.18 ft
Lateral Length(P) 49.29 ft Orifices per Lateral 16
Lateral Spacing(S) 2.25 ft Orifice Density 7.03 fi/orifice
Lateral Flow Rate 10.49 gpm Manifold Length 2.25 ft
System Flow Rate 41.94 gpm Manifokt Diameter 2.00 in
Total Dynamic Head 18.06 ft Foreemain Velocity 4.28 ft/sec
Dose Tank Information Locking cover with waming
label and bcking device and
sealed watertight
Electrical as per NEC M and -►
Comm 16.28 WAC Disconnect 4 in.min.
Tank canpwient is property vented MFor"cemain Altemate outlet
location
diameter
Weiser Manufacturer 2 in.
Capacit 600100 Gallons
Volume 16.67 galtinch A
Weep tole or anti-
Dimension Incites Gallons B siphon device
A 22.85 380.99 C
B 2.00 33.34 p ��n(ft)
C 5.14 85.65 f--�— 88.50
D 6.00 100.02 D
Total 35.99 600.00
IFDow tank elevation(ft)
3"Bedding uncTer tank. 88.00
Alarm Manuafacturer LEVEL
Alarm Model Number DLV
Pump Manufacturer GOULDS
Pump Model Number EP05
Pump Must Deliver 41.94 gpm at 18.06 ft TDH
Project: KATHLEEN HUNTER Page 4 of 9
Mound System Maintenance and Operation Specifications
Service Providers Name UTGARD Phone 715-268-6995
POWTS Regulators Name ST.CROIX Phone 715-386-4680
Syste n 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 Cofifform >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 feast once every 3 years
Pump and Controls Test once every 3 years
Alarm Should test monthly
Pressure System I Laterals should be flushed and pressure tested every 1.5 years
Moundl inspect for ponding and seepage once every 3 years
INSPECT FILTER ONCE A YEAR
Miscellaneous Construction and Materials Standards
1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap,
and are secured in as shown in the mound component manual.
2. Dispersal cell aggregate conforms to Comm 84.30(6)(i), Wis.Adm. Code.
3. All gravity and pressure piping materials conform to the requirements in Comm 84,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 \11�
6-8"Diameter Lawn Threaded Cleanout
Sprinkler Valve Box Plug or Ball Valve
Distribution
Lateral
Long Sweep 90 or Two
45 Degree Bends Same
Diameter as Lateral
Project: KATHLEEN HUNTER Page 5 of 9
Mound System ManAgement Plan
Pursuant to Comm 83.54,Wis.Adm.Code
General
This system shall be rated in accordance with Comm 82-84 Wis.Adm.Code and shall maintained in accordance with its'
Ys �
component manuals ISBD-10691-P(N.01/01)and SSWMP Publication 9.6(01/81)]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 Comm 83.33,Wis.Adm.Code when the tanks are no longer used as
POWTS components.
Septic or pump tank manhole risers,access risers and covers should be inspected for water tightness and soundness. Access
openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound,
defective,or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an
effective locking device to prevent accidental or unauthorized entry into a tank or component.
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s.281.48,Stats. The contents of the septic
tank shall be disposed of in accordance with NR 113,Wis.Adm.Code. The operating condition of the septic tank and outlet filter shall be
assessed at least once every 3 years by inspection.
The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions
are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm,
the fitter shall be serviced if the alarm is activated continuously. Intermittent fitter 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 fitter 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 BOD5, 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 10'`cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design
flow specified in the permit for this installation.
The pressure distribution system is provided with a flushing point at the end of each lateral,and it is recommended that each lateral be
flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test
when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution
within the dispersal cell.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner,and any
levels above 6 inches considered as an impending hydraulic failure requiring additional,more frequent monitoring.
Contingency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in
proper operating condition.
If the dosing tank,pump,pump controls,alarm or related wiring becomes defective the defective component(s)shall be immediately
repaired or replaced with a component of the same or equal performance.
If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface,it will be repaired or
replaced in its'present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal
media,and related piping,and replacing said components as deemed necessary to bring the system into proper operating condition.
See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider.
Project: KATHLEEN HUNTER Page 6 of 9
�I
' . LqPOULDS PUMPS ,
. Submersible
Effluent Pump
EP04 & EP45
Series
APPLICATION' •Fully submerged in high ■EPOS I
Specifically designed for the grade twine oil for mpelter.Thermoplas ■Bearings: Upper ancf lower
Lubrication and efficient improved enclosed design for heavy duty ball bearing
following uses: improved Perfo►mance.
• Effluent systems heat transfer. construction
• Homes
■Casing and Base:Rugged
Avaikbk for automai�C and thermoplastic design provides AGENCY LISTING
• farms superior strength and corrosion
• Heavy duty sump ma� , p Canadian standards A,..t n
• Water transfer udude resistance.Medliairkall�t Swt�ch 8 Motor �Fde#IA38rA9
• Dewatering Noosing:Cast iron
assembled and preset at the for efficient heat transfer, 0oi'kls%nWs K rso 9001"terea
SPECIFICATIONS factory' strength,and durability.
•Solids handling capability; Cover:Thermoplastic
FEATURES oMot tth integral handle and
'4'maximum, float switch attachment points.
• -apacities: up to 60 GPM. W EP04"M er The"�S_design II Power Cable:Severe duty
•
tic serni-open rotal heads: up to 31 feet. gn wRh rated oil and water resistant
•Discharge size: i'!z"NPT. Pump out vanes for mechanical
•Mechanical seal:carbon_ seat Peon,
rotaryJCerar rik-stationary,
Bt_tNA-N elastomers.
•temperature:
104,f(40"C)continuous
140 F(60-0 intermittent. METERS FEET
•t asteners: 300 series 10
stainless steel. ` =
c -
apatite of run 9
ning 30t
--- — _- +
dry without damage to
components $ i
as -w._ ... t t �-z5FT
a 7
Motor:
{
•EP04 Single phase:0.4 HP, v d
1
IS or 230 V,60 Hz, 1550 s
RPM, built in overload with z s
automatic reset.
•EP05 Single phase:0.5 HP, o a j
115 V or 230V, 60 Hz, 1550 EPOS
RPM,built in overload with 3 to
,_.._
dUtOmatiC reset.
•Power cord: 10 foot 1 EP04
standard length, 16/3 } _...._..._
SJTW with three prong i
grounding plug. Optional 20 u
foot length, 16/3 S1TW with 10 20 30 t
ao 5n GPM
three prong grounding plug
(standard on EPO`1) f- ? --- �____--_
6 _.__a__ _
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10 11 m Yh
CAPACITY
Goulds Pumps
tfk,�five;,,riy.
+,r ITT Industries
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Property Owner Kip—'r Parcel ID# Page C� of 2>
1-31 Boring# E] Boring
J.Pit Ground surface elev. �1�3 ft. Depth to limiting factors Vin. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundai# Roots GPD/T
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2
1 o L r a\0
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17- 2 7 5 I w i r a WE R
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❑ Boring#
❑ Boring
❑ 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
❑ Boring
❑ Boring# ❑ 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
*Effluent#1 =BOD,>30<220 mg/L and TSS>30<150 mg/L 'Effluent#2=BOD,<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-3330(R.07/00)
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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3
Division of Safety and Buildings i v
in accordance with Comm 85,Wis. Adm. bode
4r1 ounty s-i' �1
Attach complete site plan on paper not less t 1/2 x 11 inches in size.Pj��/jiust
include,but not limited to:vertical and o n erence point(BM),directioYS4�nco y Parcel I.D.
percent slope,scale ordimensi n�a and location and distance�o nearest T1 �a a VOO
I' Revle
P s rnf ormation, r cgo�xC //y Date
Personal information you provay ed for secondary purposes(Privacy Law,s.15.04(��` "�1�
Property Owner Property Location
Govt.Lot fj{j 1/4 ME 1/4 S T off$ N R $ E(o
Property Owner's Mailing Address Lot# Block# Subd. Name or CSM#
City State Zip Code Phone Number ❑City ❑Village RTown Nearest Road
❑ New Consta<ion Use:a Residential!Number of bedrooms�_ Code derived design flow rate ys 0 GPD
Replacement ❑ Public or commercial-Describe:
Parer.:.,.., na 0-t d P'_�', 1 v Flood Plair elevation if applicable --------.--._ff-
General comments '5e4 A �- '97,77'
and recommendations:= S v �C•, S J try 1��
C o -Av v r
Boring
❑ Boring#
1 [� pit Ground surface elev. /`•$O ft. Depth to limiting factor 36 _in.
Soil Applicatio n 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
wt 51 5: 1... FSbK c w M
3 . 7 1101 ...0 bK MFr
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nBoring# Boring
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So_il A Y lication R-ate
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 YR�/ aV* b & Ca
IS 10a5h — Ss\c
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IF
Effluent#1 =BOD5>30:<220 mg/L and TSS>30<150 mg/L "Effluent#2=BODF_<30 mg/L and TSS<30 mg/L
CST Name (Please Pri nt Signature CST Number
k
ddress Date Evaluation Conducted Telephone Number
o�71e 0'10�T��" t �"o� o��l S) -o� g 061
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Property Owner A>�y' Parcel ID# Page of
aBoring# ❑ Boring
�, pit Ground surface elev. �� to 3 ft. Depth to limiting factor `din.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boun_da'i� Roots GPD/fR
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. ,,- *Eff#1 *Eff#2
1 a-t-). 0-1 23� 6; L QMSbe, ~r aw ��rt
of
F] Boring# F1 Boring
❑ 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
Boring#
F] Boring Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil 7GPD/fF
cation Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Ef *Eff#2
*Effluent#1=BOD,>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD,<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-5330(R07/00)
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Document Number QUIT CLAIM DEED 8 O Tx:4011559 2
928332
James C. Hunter, a single person, owner of an undivided one-half BETH PABST
interest, quit-claims to Kathleen L. Hunter a single person, the REGISTER OF DEEDS
following described real estate in St. Croix County, State of ST. CROXX CO., Wi
Wisconsin: RECEIVED FOR RECORD
12/08/2010 12:36 PM
EXEMPT *: N/A
The West Half of the Northeast Quarter (W-1/2 of NE-1/4) of REC FEE: 30.00
Section Six (6), Township Twenty Eight (28) North, Range TRANS FEE: 957.00
Eighteen (18)West, Town of Kinnickinnic. PAGES: 1
The East Half of the Northwest Quarter (E-1/2 of NW-1/4) of Recording Area
Section Six (3), Tov;nshlp Twenty Eight _rs) Not-th, Flange NaTe 3n=Return Address
Eighteen (18)West, Town of Kinnickinnic. Stephen A. Kosa
Attorney at Law
The Southeast Quarter of the Northeast Quarter (SE-1/4 of NE- 1601 Maxwell Drive-Suite D
1/4) of Section Six (6), Township Twenty Eight (28) North, Range Hudson,WI 54016
Eighteen (18) West, Town of Kinnickinnic EXCEPT the following:
Commencing on the West line of said Southeast Quarter of the
Northeast Quarter at a point 3 rods South from the Northwest
corner of said forty; thence Southeasterly across said forty to a
point on the East line of same, 7 rods South of the Northeast 022-1014-20-000
corner of said tract; thence North 7 rods; thence West 80 rods; 022-1014-30-000
thence South 3 rods to the point of beginning, being a strip of land 022-1014-40-000
along the North side of said Southeast Quarter of the Northeast 022-1015-50-000
Quarter, 80 rods long and 3 rods wide on West end and 7 rods 022-1014-60-000
Wide On East end. (Parcel Identification Numbers)
This is not homestead property.
7.
��'A'.,,t"�.°'_ yam+-.,.s.a►..s.w
n L
Dated this J .t y F
�� day of November, 2010. K •—: - »
(SEAL) %4e--r _(SEAL)
James C. Hunter
'SEAL)
(SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature of authenticated this STATE OF CALIFORNIA
day of 2010. /2 COUNTY
Personally rr2me before me *his /_,:r 0y ot Ncwe.nbsr,
2010, the above named James C. Hunter, to me known to
be the person who executed the foregoing instrument and
TITLE:MEMBER STATE BAR OF WISCONSIN acknowledg a same.
(if not,
authorized by§706.06,Wis. Stats.) Notary Pubiic,State of CA
My commission expires
THIS INSTRUMENT WAS DRAFTED BY
Stephen A. Kosa 'Names of persons signing in any capacity should be typed or
Attorney at Law printed below their signatures.
1501 Maxwell Drive—Suite D
Hudson, WI 54016 (Signatures may be authenticated or acknowledged. Both are not
necessary.)
1 of 1
INFORMATION PROFESSIONALS COMPANY FOND OU LAC,WI 800-655-2021
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer ��Gl �A le e k /7`4 n 1e
Mailing Address g 3 6w,f y V. r �D 6�rf3, �/-�' S-S<U --2 .3
Property Address ?6 3 C__ 7`174
(Verification required from Planning&Zoning Department for new construction.)
City/State &kx.,_ Parcel Identification Number O�O� -J / " R d -0000
LEGAL DESCRIPTION
Property Location IUW114 , AAELI/4 , Sec. , T,07PDN R/P W, Town of
Subdivision Plat: , Lot#
Certified Survey Map# ,Volume , Page#
Warranty Deed# 2 02 93 (before 2007)Volume , Page#
Spec housey no Lot lines identifiabl yes❑no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in§SPS. 383.52(1)and in Chapter 12-St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning&Zoning Department a certification form,signed by the
owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site
wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is
less than 1/3 full of sludge.
I/we,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth,herein,as set by the Department of Safety And Professional Services and the Department of Natural Resources,
State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St.Croix
County Planning&Zoning Department within 30 days of the three year expiration date.
Uwe 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.
umber of bedrooms 3
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. 04/12)