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HomeMy WebLinkAbout012-1029-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 572830 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: Village X Township Parcel Tax No: City Patterson, John F. Erin Prairie, Town of 012-1029-50-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: �pNf'1 Gs 11.30.17.1678 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER Al CAPACITY STATION BS HI FS ELEV. Septic q —j:Z $ J Benchmark Alt. BM Dosing L.) i GSt , ✓ 750 Pal ' IC+ �� Bldg.Sewer � Holding SVHt Inlet 1 ,77 95•�/ �, a! y5• TANK SETBACK INFORMATION SUHtOutlet q TANK TO E P/4 WELL BLDG kVeOto Air Intake ROAD Dt Inlet Septic 76 Dt Bottom Dosing / Header/Man. g5 7a 7� 3. ag q7. I`7 Aeration Dist. Pipe 3. zg a7 4 •cf 7 Holding Bot. S tem .94 74- -35 3, 3 i PUMP/SIPHON INFORMATION Final Grade n Z .Z�9 5-g-' 17 Manufacturer a GPM nd St Cover �� Model Number Es�a /�I� 94 to b.ZS yF' lI a r�, o v �' C1.0 9 TDH Li Friction Loss System Head TDHft,a / / t • Z Forcemain Length` Dia., 11 1 Dist.to Well / 52) SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No.Of ench PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS Y SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Ty---- yp_,,, Y t m: S7 I(� / 1 �� CHAMBER OR Model Number: DISTRIBUTION SYSTEM gG.5 / / Header/Manifold /I IDistribution 4 x Hole Size 3 !/ x Hole Spacing Ve o it Inta L Pipe(s) 4�j 7•/� Length Z'Z�5 Dia Z Length � ? Dia A Z" Spacing �'�� � �' or SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center I �Z Bed/Trench Edges Topsoil 1 ,; Yes [E NoGe,� No COMMENTS: (Include code discrepencies,persons present,etc.) spection#1 / 4 /, /,1 Q Inspection#2:A 6614, � Location: 1920 160th Avenu�aN�ew Richmond,WI 54017(SW1/4 SW 1/4 11 T30MR17W). metes&bounds�ot e Pjceo: 11.30.17.167B 1.)Alt BM Description= F/ / GCJlti 60 � g4e4v � •Gµ/K_�S Gv a 2.)Bldg sewer length= /$ 4b C4.L� 0�ALA., SI -amount of cover= � I Plan revision Required? [] Yes No Fy O 7 Use other side for additional information. 1 Date nsepctor's SioM lure Cert.No. SBD-6710(R.3/97) /314 /�-/= -A L qt � 1 1 dr✓ o a _--�f q<<303 7—ef- eyf -3 a NJ PO-�), �O - 3�� r countyS Safety and Buildings Division � 4 r 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.) TO Madison,WI 53707-7162 � QM�N'C 77 1-'-� }"f V{ G N State Transaction Number Sc. � 'Y Permit A PP h a •� 2 S In accordance,%i $ 321(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit '7 3,9 is required prior Wtatning a sanitary permit Note:Application forts 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.15.04(1)(m,Stats. Q 7� //D '•� /Q i 11�C� L Application Information-Please Print All Information Property Owner's Name Parcel# D/o?- d 2 C? Property Location Owner's Mailing Address /' p /17070 (OC�/ ' /'/ L" • Govt Lot City,State Zip Code Phone Number c, / J U,( 1�4 �(�1/4, Section�— �.0 O e715° 7 row'-C_ © le one T 3a N; R Eo� EL Type of Building(check all that apply) Lot# Subdivision Name or 2 Family Dwelling Number of Bedrooms L` r Block# ❑Public/Commercial-Describe Use —h e El city of CSM Number 11 Village of ❑State Owned-Describe Use A' Town of—LK M A.A1AlQ III.Type of Permit. (Check only one bog on line A. Complete line B if applicable) A- ❑New System kReplacement System ❑Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain) B. ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit N ber and Date Issued Before Expiration Owner 111AIZ f 7 IV.Type of POWTS S stem/Com onent/Device: Check all that apply) ❑Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil k Mound<24 in.of suitable sn+ ❑Holding Tank ❑Other Dispersal Component(explain) J.A ❑Pretreatment Device(explain) / V.Dispersal/Treatment Area Information: Design Flow(gpd) Design Soil A plication Rate(gpdsf) Dispersal Area Requu d(s Dispersal Area Proposed(sf) System Elevation VL Tank Info Capacity in Total #of Manufacturey Gallons Gallons Units { % J / New Tanks Existing Tanks I o 2 a U Septic or Holding Tank zoo d �� Dosing Chamber amcp VII.Responsibility StateMiF I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumb_.er's Sig7d= MP/NIPRS Number Business Phone Number L�4 0-35-7 7/37 Plum 's Address(Syct,City,State,Zip Code) IVA ,r V Oak 1-11-3 A L& 0 'Coun /De artment Use Only Permit Fee Date Issued Issuing ent gn .•� �]Approved 11 Disapproved $ � _ Lr-� - - El Owner Given Reason for Denial f�Z�. _ � v 5I iY DL Conditions of Approval/Reasons for Disapproval f U3 I& C: SYSTEM OWNER: „ , � -- 1.Septic tank,effluent filter and � y L dispersal cell must be serviced/maintained ? ( � S t �. `33. , tz�� - .� � as per management plan provided by plumber. 2.All as per applicable` "f8MWBAC °S or a em and submit to the County only on paper not less than 8 12 z 11 inches in size SBD-6398(R. 11/11) BRADY J UTGARD , Page 2 9/18/2014 • 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. 3.A monthly average of 150 mg/L TSS. • SPS 383.54(3)(b)(b)The servicing frequency of an anaerobic treatment tank for a POWTS shall occur at least when the combined sludge and scum volume equals 1/3 of the tank volume. • 'The inspection,maintenance and servicing reports shall be submitted to the governmental unit within 30 calendar days from the date of inspection,maintenance and servicing. • The owner is responsible for the operation and maintenance of the private onsite wastewater treatment system (POWTS)in accordance with SPS 383 and the approved management plan • The owner of a POWTS shall be responsible for ensuring that access opening covers remain locked or secured except for inspection,evaluation,maintenance or servicing purposes. • Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Provide a copy of the approved POWTS plans and this letter to the owner. • Prohibit vehicle traffic and soil disturbance within 15 feet of the downslope edge of the mound pursuant to "Mound Component Manual Version 2.0" SBD-10691-P(N.01/01;R. 10/12). • Insulate 4"0 conveyance pipe pursuant to SPS 382.30(11)(c),W.A.C. A copy of the approved plans,specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department,which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance.As per state stats 101.12(2),nothing in this review shall relieve the designer of the responsibility for designing a safe building,structure,or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, Fee Required$ 250.00 Fee Received$ 250.00 Balance Due $ 0.00 Edwin A Taylor Wastewater Specialist,Integrated ervices WiSMART code:7633 (715)634-3484,Monday-Friday 8:00 am To 4:30 pm edwin.taylor@wisconsin.gov cc: Utgard Plumbing y��pgPARTLt� DIVISION OF INDUSTRY SERVICES L 10541 N RANCH ROAD HAYWARD WI 54843 3 Contact Through Relay hftp://dsps.wi.gov/programs/industry-services www.wisconsin.gov �OssroN�+ti 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.2457438 SITE: Site ID No. 806138 Avis Baker Please refer to both identification numbers, 1920 160TH Ave I above,in all correspondence with the agency. Town of Erin Prairie St Croix County SW1/4, SWl/4, SIt,T30N,R17W FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1503191 Maintenance required; Replacement system; 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.p•W.T•S stats. cond ltion The following conditions shall be met during construction or installation and prior to occupancy or use: 3 • A copy of this approval letter and index sheet shall be attached to plans that correspond with the copy on A101FARETETF COM with the Department. Changes to the approved plan must be submitted for review and approval. Failure toDIvIS10N TY AND 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. RESPO , • This system is to be constructed and located in accordance with the approved plans,and the"Mound SEE 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 r MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN INDEX AND TITLE PAGE I Project Name: AVIS BAKER Owner's Name: AVIS BAKER Owner's Address: 1920 160 TH.AVE. 1920 160 TH.AVE. NEW RICHMOND WI. 54017 Legal Description: SW/SW/S11/T30/R17W Township: ERIN PRAIRIE County: ST. CROIX Subdivision Name: Lot Number: Block Number: Parcel I.D. Number. 012-1029-50-0000 Plan Transaction No.: Page 1 Index and this Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Idy Page 6 Management and contingency plan Page 7 Pump curve and specifications ED Page 8 PLOT PLAN 1AERCE Page 9 SOIL EVALUATION ire s ONCE Designer: BRADY UTGARD License Number: 220357 Date: 09/08/1 hone Number: 715-268-6995 Signature: it V Design uant to the Mound Componelt 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 611(D) ,calculations assume a 300.00 Estimated Wastewater Flow(gpd) Table 8344-3 in,-situ sal treatment for fecal 1.50 Peaking Factor(e.g. 1.5= 150%) colform of-36 inches. 450.00 Design Flow(gpd) 4.30 Site Slope(%) 94.83 Contour Line Elevation(ft) 16.00 Depth to Limiting Factor(in) O.SO In-situ Soil Application Rate(gpde) Distribution Cell Information 100.00 Dispersal Cell Length Along Contour(ft) = 4.50 Cell Width(ft) 1.00 Dispersal Cell Design Loading Rate(gpdffe) 1 Influent Wastewater Quality(1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information 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 point. 0.188 Orifice Diameter(in)(e.g.0.25) 3.00 Orifice Spacing(ft)= 7.03 felorfice 2.00 Forcemain Diameter(in) 100.00 Forcemain Length(ft) Does the forcemain drain back? Y 88.00 Pump Tank Elevation(ft) 3.25 System Head(ft)x 1.3 16.31 Forcemain Drainback(gal) 8.50 Vertical Lift(ft) 52.81 5x Void Volume(gal) 3.60 Friction Loss(ft) 79.12 Minimum Dose Volume(gal) 15.35 Total Dynamic Head(ft) 41.94 System Demand(gpm) Lateral Diameter Selection Manifold Diameter Selection in.dia. options choice in. dia. options_ 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 Gallonslinch Calculator Treatment Tank Information 750.00 Total Tank Capacity(gal) 1000.00 Septic Tank Capacity(gal) 37.00 Total Working Liquid Depth(in) w1eiser Manufacturer 20.27 gaUn(enter result in cell B49) Dose Tank Information Effluent Fifter Information 750.00 Dose Tank Capacity(gal) POLYLOK Filter Manufacturer 20.27 Dose Tank Volume(galrn) PL-525 Filter Model Number weiser Manufacturer Project: AVIS BAKER Page 2 of 9 Mound Plan View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1/10 B . . . . . . . . . . . . . . .6. . . . . . . . . . . . . . . . . J . . Observation Pipe K . . . . A W . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . — . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . —T- L Mound Component Dimensions A 4.50 ft E .32 in H 1.00 ft K 10.60 ft B 100.00 ft F .25 in 1 10.78 ft L 121.21 ft DAin G 0.50 ft J A7.81 ft W A23.09 ft r 450.00 (if)Dispersal Cell Area 1 1528.421 (fe)Basal Area Available 4.50 (gpd/ft)Linear Loading Rate 1 10.00 (ft) 1/10 B Obs-Pipe PkKanent Mound Cross Section View Aggregate Dispersal Area Finished Grade 98.27 (ft) H 2 G F Dispersal Cell 97.00 (ft)Lateral . . . . . . . . . . . 96.50 (ft)--* Invert . . . . . . . . . . .. . . . . . . . . . Dispersal Cell . . . . ... . . . . D Elevation E . . . . . . . . . . . . . . . . . . . . . . . . . .: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .................................... ... ........................ . . . . . . . . . . . . . . . F H 1 94.83 (ft)Contour Elevation 4.3 %Site Slope Geotextile Fabric Cover Shading Key Dispersal Cell See lateral details on Fil= Topsoii cap 0 1.5 ft Page 4 for number,size, [2–] Subsoil Cap -a 0 J'*O and spacing of laterals. 4i I T Laterals are equally ASTM C33 Sand :5 F [A–] Tilled Layer 0.5 ft Typicid LatefW spaced from the dislI�n cep's Aggregate 0 centedine in the —A disl!riMjtion cell(AxB). Project: AVIS BAKER Page 3 of 9 r Center Connection Lateral Layout Daigram Force main camectivn via we or sass to marooid at any point. Laterals are identical rJ P S •=Turn-up wlbell sabre or X-3 sr2 eY23� Lateral&force main of PVC Sch 40 olesnoutplug per CQrv91A Tam 84.30-5 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 It Lateral Length(P) 49.29 It Orifices per Lateral 16 Lateral Spacing(S) 2.25 ft Orfice Density 7.03 fe/orifice Lateral Flow Rate 10.49 gpm Manifold Length 2.25 ft System Flow Rate 41.94 gpm Manifold Diameter 2.00 in Total Dynamic Head 15.35 ft Forcemain Velocity 4.28 ft/sec Dose Tank Information Locking cover with warning label and locking device and Electrical as per NEC 300 and —� sealed watertight Comm 16.28 WAC Disconnect in.min. Tank component is properly vented F— Alternate outlet location Forcemain diameter weiser Manufacturer 2 in. Capacityl 750.00 Gallus Volume 20.27 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 25.10 508.72 C B 2.00 40.54 Pump off elevation(tt) C 3.90 79.12 1 88.50 D 6.00 121.62 D Total 37.00 750.00 Dose 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 1 41.94 gpm at 15.35 ft TDH Project: AVIS BAKER Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name UTGARD Phone 715-268-6995 POWTS Regulator's Name ST.CROIX Phone 715-386-4680 System Flow and toad Parameters Design Flow-Peak 450 gpd Maadm um Influent Particle Side 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 fe Maximum FOG 30 mg/L Type of Waskwater Domestic Maximum Feral Cofiform I >10E4 cfu/100 mL Service Finauency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should'ffispect and dean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test monthly Pressure System 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 tc)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 Tum-up Detail Finished •.. ......... Grade �.....�_...... 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: AVIS BAKER Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54,Wis.Adm.Code General This system shall be operated in accordance with Comm 82-84 Wis.Adm.Code,and shall maintained in accordance with its' component manuals[SBD-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 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 ears. All switches alarms and Y 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 SKI 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 So me 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 u Y 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 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. 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: AVIS BAKER Page 6 of 9 GOULDS PUMPS Submersible Effluent Pump :t EP04 & EP05 Series APPLICATIONS •Fu Qy submerged in high ■EPOS Impeller Thermoplas- ■Bearings: Upper and tower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing following uses: lubrication and efficient improved performance. construction. • Effluent systems heat transfer. ■Casing and Base:Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms manual superior strength and corrosion • operation.Auto- resistance. sP•Canadian standards Association Heavy duty sump matic models include i File#UU8549 • Water transfer Mechanical Float Switch ■Motor Housing:Cast iron • Dewatering assembled and preset at the for efficient heat transfer, Goulds Pumps is lso 9001 Registered factory. strength,and durability. SPECIFICATIONS ■Motor Cover:Thermoplastic •Solids handling capability: FEATURES cover with integral handle and '/s"maximum. ■EP04 Impeller:Thermoplas- float switch attachment points. •Capacities.up to 60 GPM. tic semi-open design with 0 Power Cable:Severe duty •Total heads:up to 31 feet, pump out vanes for mechanical rated oil and water resistant. •Discharge size: 17z"NPT. seal protection. •Mechanical seal:carbon- rotary/ceramic-stationary, BONA-N elastomers. •Temperature: 104'-'F(40"C)continuous • 1401(60"C)intermittent. METERS 10 FEET Fasteners:300 series stainless steel. - �t ►—_J •Capable of running 9 30 s _. El— dry without damage to I } components. z s FT -_ X5 __ 7 - T .. }. —} -- Motor: W _. 7 ) I •EP04 Single phase:0.4 HP, y 6 zo 115 or 230 V,60 Hz, 1550 t� RPM,built in overload with o 5 15�__ — — �._ i_..__ ._.__._-j- automaticreset. � i i � •EP05 Single phase:0.5 HP, 4 115 V or 230V,60 Hz, 1550 ° 1 , EPOS RPM,built in overload with i automatic reset. z ; t EP04 •Power cord: 10 foot _.._.i standard length, 1613 S1TW with three prong grounding plug.Optional 20 OL 00 10 foot length, 16/3 51TW with 2° 30 40 50 GPM three prong grounding plug (standard on EP05). � nD� 2 4 6 a 10 12 marn YCAPACITY Goulds Pumps V 2003 Goulds Put),ps Effective a„ly,2003 B3871 <& ITT Industries 8:387 t ���TTTT � w 13 .q, 1 _3 33 _ _ -_ qo S� �3 y O �3 � rte. Property Owner k1S > . e— Parcel ID# Page --12—of F-31 Boring# El Boring iA Pit Ground surface elev. 3 ft. Depth to limiting factor in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence, Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. ff#1 02 o--7 )rn - t►y ay�5jq L F K )q-q 76YO L dF b 1 . 0 q•�5 -71:5 YRyl If 7 5'f b Mi r %)F 5•L `{ y fl? S faL SL JIFSb W MV -- 7 Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. -ff#1 * ff#2 Boring ❑ Boring# Ground surface elev. ft. Depth to limiting factor in. ❑ Pit [Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. ff#1 ff#2 *Effluent#1=BOD 5>30<220 mg/L and TSS>30 <150 mg/L *Effluent#2=BOD 5<30 mg/-and TSS <30 mg/L The Dept.of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,contact the department at 608-266-3151 or TTY through Relay. SBD-R130(RI I/11) Nj I } ` .7��C� Wis.Dept.of Safety an e� r fesiii5nal Servi s SOIL EVALUATION REPORT Page of-3 Division of Safety and B ridings ��,�"� .�-,t�� C, r✓ot c'�Y�Y.,.y,•—;",WW666rdance with SPS 385,Wis. Adm. Code County Attach complete,�(y1 'oh paper not less than 8 1/2 x 11 inches in size.Plan must ��• include,but nol 1ie111fed to:vertical and horizontal reference point(BM),direction and Parcel 1.D. percent slope,scale or dimensions, north arrow,and location and distance to nearest road. Q/ a,• a — •• d Please print all information. Reviewed Date r /Personal information you provide may be used for secondary purposes(Privacy Law..s.15.04(1)(m)). Property Owner Property Location ptv S w„k�0, Govt.Lot 5W 1/4 5wl/4 S 1 1 T N R I E(or Property Owner's Mailing Addr ss Lot# Block# Subd.Name or C M# City State Zip Code Phone Number hta Y° �`a� •, F1 City [I Village Town Nearest Road �ew R;�1t►�o„ Syol ( I ) 5C'.0 Th � e r❑ New Construction Use:E4 Residential/Number of bedrooms 3 Code derived design flow rate 5(� GPD Replacement ❑ Public or commercial-Describe: r=arem material Q�n.c-I,z L Fluou Plain elevation If appil,able t. General mmentn S V SSr� 4N L 'X �S �� �, M OV r• S 2.�' vim"{" 9 d and recommendations: J 1 bc,s� 00 N `1 $3'G Boring# Boring Pit Ground surface elev. y.g3 ft. Depth to limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. * ff#1 * ff#2 ON L IFS b� hn r i 1114 L, � I a-I L 7.S 12'/ ` ��S�k lip •a3 15 YA f 1 f 7,S-10- L i rl 5):l, O F • 3-L 07.5-f P, L FS k m f; -- . y , nBoring# Boring p L I R.Pit Ground surface elev. Y•03 tt. Depth to limiting tactor ' in. Soil A plication Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft Z in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. ff#1 ff#2 L af5bk. F CtW M Ila . Z cg- 13 -1 R-i/q I *Effluent#1 =BOD _>30<220 mg/L and TSS>30 <150 mg/L n *Effluent#2=BOD <30 mg/L and TSS <30 mg/L CST Name(Please Print Signature , CST Number Aa rgss Db't'�i ,�•1e ( ate Evaluu�ation Conducted Telephone NumberL/ SBD-8330(Rl 1/11) ' I i I � i I I : , 1 I � i Lill' y I p _ { " , y i I t : I t f I I i - `� I- I I I I r ! , I s 1 , i f II I 1 �I I I � i I - i , f , _ I , - 1 I l i acre- -or, t ZA _ - tPat Al _ � r �c ov �1Y1 l -_-��,�c►- _..1, d x.00, tco Aj ^ �p ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer T4�2i — Mailing Address 19 a® 6 ' '4 cJ JE Property Address 19a o 16o (Verification required from Planning&Zoning Department for new construction.) City/State 1 Ck11'(d N D VVF Parcel Identification Number LEGAL DESCRIPTION Property Location -5W 1/4 , $Lt( 1/4 , Sec. / 1 , T 30 N R_/7 W, Town of 1��►ti. /Q,�,� Subdivision Plat: , Lot# Certified Survey Map# ,Volume , Page# Warranty Deed# /6 (before 2007)Volume , Page# Spec house❑yes&no 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§SPS. 383.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&Zoning Department a certification form,signed by the owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is less than 1/3 full of sludge. I/we,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth,herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St.Croix County Planning&Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s)of the property described above,by virtue of a warranty deed recorded in Register of Deeds Office. Nu ber of I oms SIG ATURE 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. v:mi) State Bar of Wisconsin Form 1-2003 8 2 : 0 1 1 4 Tx:4204401 WARRANTY DEED 1000117 Document Number Document Name BETH PABST REGISTER OF DEEDS THIS DEED, made between Avis Ann Wolske Baker,an unmarried woman ST. CROIX CO., WI ("Grantor,"whether one or more), 08/13/2014 2.59 PM and John F. Patterson,an unmarried man ("Grantee,"whether one or more), EXEMPT#: N/A Grantor,for a valuable consideration,conveys to grantee the following described real REC FEE: 30.00 estate,together with the rents,profits,fixtures and other appurtenant interests, in St. TRANS FEE: 481.50 Croix County,State of Wisconsin("Property")(if more space is needed,please attach PAGES: 2 addendum): Recording Area See attached Exhibit"A" for Legal Description Name and Retum Address J John F. Patterson 425 Park Lane Hudson,WI 54016 012-1029-50-000 Parcel Identification Number(PIN) This is homestead property. (is)(is 1100 Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, ncumbrances and restrictions of record. Dated: St _(SEAL) (SEAL) 7Avis Ann Wolske Baker AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) nU► >ss. authenticated on COUNTY OF kil ) Personally came before me on bf I I tl * the above-named Avis Ann Wolske Ba r to me known to TITLE: MEMBER STATE BAR OF WISCONSIN be the per w xecuted the foregoing instrument and (If not, acknowl at authorized by Wis.Stat§706.06) THIS INSTRUMENT DRAFTED BY: Tony R.Schrader-Attorney Notary Publi State r Wisco m t Q (715)523-9409 File No.OR-14-04089 My Commis on(is ermanent)(expires: c U ul',� ,o CJ (Signatures may he authenticated or acknowledged.Both are not necessary.) NOTE:THIS IS A STANDARD FORM.AN17;NIODIFICATIONS TO'rH1S FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ©2003 STATE BAR OF WISCONSIN FORINI NO.1-2003 'Type name below signatures. St. Croix County 1000117 Page 1 of 2 EXHIBIT"A" LEGAL DESCRIPTION Part of the Southwest Quarter(SW '/4)of the Southwest Quarter(SW'/4)of Section Eleven (11),Township Thirty(30)North, Range Seventeen(17)West,Town of Erin Prairie,St.Croix County,Wisconsin described as follows: Commencing at the center of the road at the Southeast corner of said Southwest Quarter(SW'/4)of the Southwest Quarter(SW %); thence North 800 feet; thence West 555 feet; thence South 800 feet to the center of the road; thence East 555 feet to the point of beginning; EXCEPTING the following described parcel of land: A Parcel of land in the Southwest Quarter(SW '/4)of the Southwest Quarter(SW '/4)of Section Eleven(11), Township Thirty(30) North,Range Seventeen(17)West described as follows: Commencing at the center of the road at the Southeast corner of the Southwest Quarter(SW'/4)of the Southwest Quarter(SW'14)of said Section Eleven(11); thence North 800 feet; thence West 297 '/z feet; thence South 800 feet; thence East 297 '/z feet to the point of beginning. File No.0I2-14-04089 St. Croix County 1000117 Page 2 of 2 , - a o \ 7 C) o ® % c / 0 § 2 \ 2 /% E e� £ f \m \ � � \/ 20 \ - ) z -4 ) , \ b / § 2 § $ ==2 < z § e0 � / § E f k k j k £ m B 2 k 2 % § a � 2 7 ?)§ I (D e N 1 . k } c 65 z z z k � d g e g LO ® 0 ■ ' k § o a E ] 7 ■ m m _, 0§ k \ -W t \ 2 2 2 ' z 0) 0 ° § § § \ o ! > o Q . \ k § @ _ ) . < a 2C) § 2 < z Co 16 2 § / ; � ) 2 a, E _� E j / 2 2 ` k - � ) k k 2 k k w ) o z / z z ) � 2 ' ' COL / \ L: ) a 2 d) f e e c r 2 , 2 J a 2 IA 2 v