Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
030-2143-22-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 572873 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: Bruvold Roger& Elizabeth I St. Joseph, Town of 030-2143-22-000 CST BM Elev: Insp.BM Elev: BM Description: Sectionrrown/Range/Map No: l&yv G5( 05.29.19.2091 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ;A924 CAPACITY STATION BS HI I FS ELEV. Septic �„^ Benchmark c• 01— �a,5•� /� Dosing Alt. BM„»r, GO ^ 2461 7:5.7 Bldg.Sewer ' -7• '3 u . ,$,Z 741ding P.6 l a r. S ZS 7r v St/Ht Inlet - '•7 f Qa •Lit It TANK SETBACK INFORMATION St/Ht Outlet !� a TANK TO 4 P/L WELL BLDG. ent o Air Intake ROAD Dt Inlet ` \ Septic 1 /JA- lb ,,,� Dt Bottom 21L 11.57 76- 38 Dosing v s to! Header/Man. S a$ 99. 9 Aeration Dist.Pipe 5.68 !• �� Holding Bot.System ✓•l 197. I Z Final Grade q�/b% /66 •t ,1 7 PUMP/SIPHON INFORMATION -i. -7 Manufacturer e// Demand St Cover / l(.•G.`_ GPM Model Number / 37, ' / a..kb a 5•Q q79- TDH 11-ift. • Friction Lossf System H ad TDH Ft -r.0 / A ,� Z b / 2. 'Pl 4 o {- 0�n�oJti �J Forcemain Length Dia. Dist.to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width 1 Length No.Of riches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS f� 2�/ 1�1r _ _� — __1 SETBACK SYSTEM TO ✓T P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Ty O Syste CHA UNIT OR Model Number: Q A rA A)A DISTRIBUTION SYSTEM Header/Manifold ID istribution �/ {( x Hole Si e x Hole Spacings Ve to Air Intake Pipes) /34Z- zvD' Spacing. ~ ' J P✓ Length Dia Length is SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/So ded xx Mulched Bed/Trench Center Bedrrrench Edges Topsoil 1 P4, Yes [jE � No s No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: /Z-1/ Ins ection#2: Location: 1187 42nd Street Hudson,WI 54016(NE 1/4 NW 1/4 5 T29N R19W) Bluebird Bluffs LTtIZ/ Parcel N 05 29 19 2091 / �►o c.J O 4Z_ 1.)Alt BM Description= ri t 44— GO GL1,40 „` �"" �d�� O ✓� 2.)Bldg sewer length= 713 1 -amount of cover= aQ Plan revision Required? Yes )No Use other side for additional information. ✓ V Date Insepctor's nature Cert.No. SBD-6710(R.3/97) PUMP PERFORMANCE CURVE PUMP PERFORMANCE CURVE FFLUENT MODELS 3/8-,1/2'&314'SOLID PASSING CAPACITY WHEN �- ■■■■■■■I°®©oommma�®m®m°°m°mom■®mm ONE INEVE Milk ■■\■\■■' �, masse°e°eeeeeis°eases° hl 0m0®m®aaommm0m0m \19\11,111\■■■■■■■■ mm®m®eeom0o0mo■m 0®0mm®°emm0m®®om amm' 011■1■\\ ■■■■■ 0m0®°m°°m°°o®0°° 0m©mmmaaom®m®mom 'iI■■1l'■1■■D■■■■■■ m®©mom0®0mm�amo0m \\►\11►\`i■■ \■■■■■ 0m®®0 ®�omom0m0 ;m\\\` 1111\■■\\\■■■■ .� °aa°aa°e00ea0oo® ' ®\\11111\!■■■■■\■■■ °aa°eeeeo®aaeeom \\■111101►■u■■■■■■ vee°°°aae°°°a°°ae°°s0m ■\0441 1111E!01\\■■■\■ ■■\\Hal 21■1►a\►�■■■■■■ ■■■11�■■■■■■■■■■ SEWAGEAND Nunn lomo mm ®©®o©®©a®a mum®®� DEWATERING ©mo©o®o®o ®o®oes 0�o®©vv0o0aomv�®v�o®m0v®now .� ■�®■o�sass0a0v0va®©��m0©moo®v®v omssssssssaso�vo©0®voo®®®° SEEN �v�sssssssassssss00v®ommww m A�ssasasassassssss®�v00v�© o®ssasassssssassss0om�oo®© ■■ v®ssossossassosassasasoovm v�sasosssasssassssssos®oov o®asassosssssassssssasss©v ■■�■�■ W 31 ■■����\nom\��'��.�■■ subjected to less than 15 feet TDH. ,,evxR 7l( F,,. County o���j Safety and Buildings Division ST. CROIX � "° 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.) a� ,' 'r N,C3 Madison,WI 53707-7162 7 p 7 Z , ®Y ` '' 1 State Transaction Number ,,� Permit Application _,. In accordance with SPS .. ( is. Adm. Code, submission of this form to the apptaptiam g men-tkI 25(� $� �S unit is required prior to 'jigs a sanitary permit. Note: Application forms for state-owned POWTS are Project Address(if different than mailing address) submitted to the Depa of Safety and Professional Servies. Personal information you provide may be used 1187 42ND STREET for secondary purpose n accordance with the Privacy Law,s. 15.04(1)(m),Stats. I. Application Information-Please Print All Information HUDSON, WI 54016 Property Owner's Name Parcel# ROGER & ELIZABETH BRUVOLD 030-2143-22-000 Property Owner's Mailing Address Property Location / itl 1 2585 RALPH STREET, WHITE BEAR LAKE, MN 55110 Govt. Lot 22 L • City,State Zip Code Phone Number NE I/., NW /<, Section 5 WHITE BEAR LAKE, MN 55110 N/A (circle ne) T 29 N; R 19 Eor II. Type of Building(check all that apply) Lot# 51 1 or 2 Family Dwelling-Number of Bedrooms N/A �f 2_ Subdivision Name Oki - # v- BLUEBIRD BLUFFS ii Public/Commercial-Describe Use Q/ i - N/A ❑ City of tAoJ5t� ❑State Owned-Describe Use CSM Number ❑ Village of /J '. /3� ' ��r /� N/A ® Town of ST. JOSEPH III.Type of Permit: (Check only one box odline A. Complete line B if applicable) A. 4 New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain) B. List Previous Permit Number and Date Issued ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑Permit Transfer to New / Before Expiration Plumber Owner IV.Type of POWTS System/Component/Device: (Check all that apply) 6-6":1--ovr ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground XII At-Grade ❑ Mound > 24 in.of suitable soil ❑ Mound < 24 in.of suitable soil • ❑ Holding Tank ❑0 er Dispersal Component(explain) ❑Pretreatment Device(explain) V. Dispersal/Treat ent Area Information: Design Flow(gpd) Design Soil Application Rate(gpd Dispersal Area Required(sf) Dispersal Area Pro (sf) System Elevation / 600 .5 1,200 1,200 1ZOCO 99.0 ✓/ VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units a o a New Tanks Existing Tanks ' //13L41 / k5z5 a v 'v'1 v� i�.c7 a Septic or Holding Tank 1200 0 1200 1 WTESRR X Dosing Chamber 800 0 800 1 WIESER X VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber' gnatu MP/MPRS Number Business Phone Number PAUL KOEHLER ��--/ ------- 225410 715-246-2660 Plumber's Address(Street,City,State,Zip Code) 321 WISCONSIN DRIVE, NEW RICHMOND, WI 54017 / / VIII ounty/Department Use Only Approved ❑ ! .pprove• Pert Fee Date Issued Issuing A t Signature Ill . - ..'en Reason for Denial $ co l i5.ati 2'/2.C1/5. IX. CondlEMBE'614141(Wi&1t/Reasons for Disapproval 1. Septic tank,effluent filter and ,3) CQ ;d-ttv-� iti.. ,(e / ' 1 G Illik dispersal cell must all be services/rpjtaine4 / , 1 as per management plan provided by plumber, G,.f e_- i I` t v4 ' i � Jr^^'`'c 2. Alt-setback requirements must ben intalr»d as per appticablseode/orclnunas. Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398(R. 11/11) Jr. . G al a .e/.01\' ‘t ozot a" i. 1 t ;A, ® —s r rs A , P.3(i 4)0 \ IA) ■ r '� - _ o ,a c -t P t _ e I c 1 �J 1 .Qa 4z ,` n n e \` N ti •ym.. P! fi rv- or ,I It. y"' !, '" ` ` w I / 1 ;r -q 9 A o ' C�Si t�rJ cn m H z ab n n a y �� 0 xx a H n H O o O & ,-d1-4 3 i-4 rxi t=i t7^1 o n its n R` 't = b l o z C H cn H to %or< le .. H Z z 'CrICO P ' N ed °o r n n 0 -P- t./1 PAUL R KOEHLER Page 2 2/11/2015 Owner Responsibilities • The current owner,and each subsequent owner,shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard,the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s)utilized in the POWTS. 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 This Amount Will Be Invoiced. Gerard M Swim When You Receive That Invoice, POWTS Plan Reviewer,Integrated Services Please Include a Copy With Your (608)789-7892,Mon-Fri, 7:15 am-4:00 pm Payment Submittal. jerry.swim @wisconsin.gov WiSMART code:7633 cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm 9ti4�T�F� DIVISION OF INDUSTRY SERVICES 3824 N CREEKSIDE LA �ok d,� HOLMEN WI 54636 3 t. Q Contact Through Relay P www.dsps.wi.gov/sb/ S www.wisconsin.gov �OssroN�LS� Scott Walker,Governor Dave Ross,Secretary February 11,2015 CUST ID No. 225410 ATTN:POWTS Inspector PAUL R KOEHLER ZONING OFFICE COUNTRYSIDE PLUMBING&HEATING INC ST CROIX COUNTY SPIA 321 WISCONSIN DR 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 02/11/2017 SITE Identification Numbers Brushy Mound Partners LLC Transaction ID No.2508455 42 Street Nearest Rd Site ID No. 810104 Town of Saint Joseph Please refer to both identification numbers, St Croix County above,in all correspondence with the agency. NE1/4,NW1/4, S5,T29N,R19W Subdivision:Bluebird Bluffs; 1st Addition—lot 22 FOR: Description:Four Bedroom At-grade System/6%slope Object Type:POWTS Component Manual Regulated Object ID No.: 1523202 Maintenance required;600 GPD Flow rate; 36 in Soil minimum depth to limiting factor from original grade System(s):At-grade Component Manual,Version 2.0, SBD-10854-P(N.03/07,R. 1/12),Pressure Distribution Component Manual-Ver.2.0, SBD-10706-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 CONDITI) requirements. APPR( No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, DEPT OF SA stars. PROFESSIONA The following conditions shall be met during construction or installation and prior to occupancy or use: DIVISION OF INDUS Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with -7! �'P tY P J �/ requirements of Sec. 145.135 and 145.19,Wis.Stats. f SEE R• SP • Inspection of the private sewage system installation is required.Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d),Wis.Stats. • A state approved effluent filter is required.Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required.Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • All POWTS component piping material shall be SPS 384,Wis.Adm.Code compliant. • The area within 15' downslope of the dispersal cell shall remain undisturbed.Vehicular traffic,excavation or soil compaction is prohibited in this area. • A copy of the approved plans,specifications and this letter shall be en-site during construction and open to inspection by authorized representatives of the Depai tnient,which may include local inspectors. PAUL R KOEHLER Page 2 2/11/2015 Owner Responsibilities • The current owner, toe proper use and ,maintenance s subsequent enttow owner, receive a copy py of this letter including maintenance manual and/or owners manual for the POWTS described in g instructions relating ' copy of the appropriate operation and • The owner of a POWTS this approval. WTS shall be responsible for ensuring that the operation and maintenance of the in accordance with this chapter and the approved management plan e POWTS S • In the event this soil abso system g P under s. SPS 383.54(1). hazard,the property owner follow the ancontin component parts malfunctions so as to create a health • The owner is responsible for submitting oency plan as described in the approved plans. maintenance tracking a maintenance verification report acceptable to the county for in the POWTS. g purposes. Reports shall be submitted at intervals appropriate PP priate for the component(s)utilized granting this approval the,Division of Indus () tilrzed conditions arise approval them Division Services reserves the right to require chance conditions relieve the making them the necessary for code compliance.As per state stats 101.12 2 changes or in this re should responsibility for designing a safe building, ( c' mpo e in this review Inquiries concerning this correspondence may be made to me at the telephone number or component. on this letterhead. P umber listed below, or at the address The above left addressee shall provide a copy who are responsible for the installation, operation or maintenance of the PO py of this letter and the POWTS management plan to the owner and any Sincerely, POWTS. Fee Required$ 250.00 Gerard M Swim POWTS Plan Reviewer,Integrated T is`mount Will Be Invoiced. (608)789-7892 , Services a Copy With Your Please Include When You Receive That Invoice, Mon-Fri, 7:15 am-4:00 pm Jerry.swim @wisconsin.gov Payment Submittal. WrSMART code: 7633 cc: Edwin A Taylor, Wastewater Specialist, (715)634-3484 Monday Friday 8:00 am To 4:30 pm RECEIVED FEB 9 2015 INDUSTRY SERVICES RESIDENTIAL AT-GRADE DESIGN Pressurized-Sloping Site INDEX AND TITLE SHEET Project DERRICK/BRUVOLD Owner BRUSHY MOUND PARTNERS Address PO BOX 445 NEW RICHMOND WI 54017 Legal Description NE 1/4 NW 1/4 SEC 5 T 29 N R 19 Township ST JOSEPH County ST CROIX Subdivision Name BLUEBIRD BLUFFS Lot No. 22 V£o cY Parcel ID Number 030-2143-22-000 YANG ERV/CE Plan Transaction Number 3TRY SERV CES Index sheet Page 1 Calculations Page 2 At-grade drawings Page 3 Laterals and dose tank Page 4 E/VCE Specifications Page 5 Management&contingency plan Page 6 PLOT PLAN Page 7 PUMP CURVE Page 8 FILTER SPEC Page 9 SEPTIC TANK Page 10 Designer PAUL R KOEHLER License Number MP224510 Signature G�� � Phone Number 715-246-2660 Date 02/06/15 Designed pursuant to: At-grade Component Manual Ver.2.0 for POWTS SBD-10854-P(N.03/07),and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS(01/81)and Pressure Distribution Component Manual Ver.2.0 SBD-10706-P(N.01/01) Version 7.0(03/12) Page 1 of 10 PRESSURIZED AT-GRADE DESIGN At-grade Design Worksheet-Sloping Site Flows and Site Data Entry. (r or c) r Residential or commercial? 400.0 Estimated wastewater flow(gpd) 600.0 Design wastewater flow(gpd) 6.00 % Site slope 99.00 Contour elev. below lateral (ft) 36.00 Depth to limiting factor(in) 0.50 In-situ soil application rate (gpd/ft^2) Distribution Cell Information (1 or 2) 1 Influent wastewater quality 4.50 Linear loading rate gpd/ft 9.00 Effective absorption width (ft) 9.00 Max. effective width permitted (ft) 134.00 Aggregate length (ft) Pressure Distribution Data Entry (c or e) Information Center or end lateral connection 1 Number of laterals 0.125 Orifice diameter(in)e.g. 0.25 Not a .50 stimated orifice spacing calculation Estimated ft( ) 2.00 Forcemain diameter(in) 3.79 Forcemain flow velocity(ft/sec) 90.00 Forcemain length (ft) y or n y Does forcemain drain back? 86.30 Pump tank elevation (ft) y or n y Are laterals at highest point? 6.5 System head (ft)x 1.3 NA 12.37 Vertical lift(ft) 14.7 Forcemain drainback(gal) 2.58 Friction loss (ft) 108.0 5x Lateral void volume (gal) 0.00 In-line Filter Loss (ft) / 122.7 Minimum dose volume(gal) / 21.45 Total dynamic head (ft) 1 37.1 System demand(gpm) Lateral Diameter Selection Gallons/Inch Calculator(optional) Pipe diameter Design options Design choice 1200 Total Tank Capacity(gal) Designer 1 in 33.46 Total Working Liquid Depth(in) must select 1.25 in 35.9 Gal/in(enter result in cell G46) one lateral 1.5 in diameter 2 in x X Treatment Tank Information 3 in x 1200JSeptic tank capacity(gal) WIESER 'Manufacturer Effluent Filter Information Dose Tank Information POLYLOCK Filter manufacturer 800.0 Dose tank capacity(gal) 525 Filter model number 22.2 Dose tank volume(gal/in) WIESER I Manufacturer Project: DERRICK/BRUVOLD Transaction Number: Page 2 of 6 AT-GRADE PLAN VIEW }-D -t iff- T 1/6 B Observation pipes(2 typical) A 9.00 ft D B 134.00 ft 1 +—Li \ 1/6 B 22.33 ft W ` C 11.00 ft i , , 3j. :: C D 2.00 ft E 2.00 ft ID D I L 144.00 ft B W 21.00 ft 1 _, A x B 1200.00 ft^2 4 L 4 1 I I < ..__ Cap =Total aggregate ce x Typical obs.pipe. Ea =`A° Ttl cell A B Slotted in the lower 6",and 1 ) =Plowed area L x W anchored securely. 7 AT-GRADE CROSS SECTION Synthetic fabric cover ,,f ", 100.83 ft Finished grade r 0;"; .: ` elevation Lateral , �, invert elev. 99.50 ft ,,� . �` .— Observation pipe r'+" i '�`��� � ,. at aggregate toe E ,. ''" Surface contour _ ______.6.___._.___4s%Slope and system 99.00 ft C A 4 elevation D = 12 in. topsoil and subsoil IN, over aggregate and tapered to toes. Plowed layer below L x W eggig = 6 in. aggregate below pipe(s),and 2 in. above pipe. Project: DERRICK/BRUVOLD Transaction Number: Page 3 of 6 PRESSURE DISTRIBUTION AND DOSE TANK Lateral Diagram -Center Connection t P Last hots dr&ed nett W x-4 of PVC Se&4 Ho4es dated CM di.bottom of the Wesel per T *gimes spaced 0, et Tr p millball weIe+ or ateenoutpliug Lateral Specifications 0.125 Orifice diameter(in) Center Lateral connection point X 1.48 Orifice spacing(ft) 1 Number laterals 90 Orifices/lateral P 132.46 Lateral length (ft) 37.1 Lat. discharge rate(gpm) 2.00 Lateral diameter(in) 2.00 Forcemain diameter(in) 37.1 Sys. discharge rate(gpm) 90.00 Forcemain Length (ft) 21.45 TDH (ft) Typical Pump Chamber Layout Approved manhole cover with Weather-proof ' warning label and locking device junction box Final grade II disconnect 11-1 4 Tank component is Alternate �' properly vented " • I U 0�\ outlet location 18" min. Electrical as per NEC 300 and f Approved 4, SPS 316.300 WAC ■■ outlet Tank full joint c Inches Gallons A Provide 1/4" .n A 18.5 410.9 Alarm on weep hole or c B 2.0 44.4 B devisciehon E C 5.5 122.7 Pump on -�— G D 10.0 222.0 87.13f + ft C Totals 36.0 800.0 Pump off ill D 71 3"Bedding under tank • t---- 86.30 ft GOULDS Pump manufacturer SJE RHOMBUS Alarm manufacturer EPO5 Pump model number SJE RHOMBUS Alarm model number Project: DERRICK/BRUVOLD Transaction Number: Page 4 of 6 At-qrade System Maintenance and Operation Specifications Service Provider's Name POWERS SEPTIC SERVICE Phone 7152465738 POWTS Regulator's Name PAUL KOEHLER Phone 7152462660 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 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 1200.0 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Inspect and clean 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 Mound Inspect for ponding and seepage once every 3 years Other Clean effluent filter once a year 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 at-grade 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 at-grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. 6. Areas within 15 feet of the downslope toe will be protected from compaction. 7. All other construction details are as per the at-grade component manual SBD-10854-P (N. 03/07). Lateral Turn-up Detail Finished • Grade v1 � . . . . . . . . . . .• 6-8"Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Long Sweep 90 or Two 99.50 ft 45 Degree Bends Same Diameter as Lateral Project: DERRICK/BRUVOLD Transaction Number: Page 5 of 6 At-grade System Management Plan Pursuant to SPS 383.54,Wis.Adm. Code General This system shall be operated in accordance with SPS 382-384 Wis.Adm.Code,and shall maintained in accordance with its'component manuals[SBD-10854-P(N.03/07),SSWMP Pub.9.6(01/81),and Pressure Distribution Component Manual Ver.2.0 SBD-10706(N.01/01)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33,Wis.Adm.Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers,access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound,defective,or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter 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 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. At-grade and Pressure Distribution System No trees or shrubs should be planted on the at-grade. Plantings may be made around the at-grade's perimeter,and the at-grade 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 at-grade 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 at- grade be heavily mulched as protection from freezing. Influent quality into the at-grade 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 4 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 at-grade 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 renovating the biologically clogged absorption and dispersal media,installing new piping,and replacing other 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: DERRICK/BRUVOLD Transaction Number: Page 6 of 6 . ' • : . ,.. ., il\r, 4 1[¢ �,�� G :JJ I V\ 9 i '. ''' -4116, ' .44 \ '3° x r, { :yam.. � eC ; G ca f� l�, „jam -. 4 c$ Q G ri' 1'1 T ,"a'E ' T' . v1 I ) 4 ) yj...... ; ....."-•-...6„. .t.,4,4 ....:(.:*,..:ai7.,,,, ,.........7,7_430, T. , '•'' t... F to -4 N . j._ N .", i •4 4, � . ' ' 144,W � Ai rF !-�. If" ''''-- -..41: "'4 '1 -c' �� • C h HOtii 00 �` O x tr=i C) - i ∎, L.,J .jd O P Lai x'00 hl N -•C I O '=J °' ' y 3 H ,- N iOd I o c-, Z c. N O- 1 � I zi � J O C) i"d n% C7 � Oo x �- ro a zO H H C H tj XI H td En VI �, GOULDS PUMPS Submersible Effluent Pump all 10 6 MODEL 3871 8 6 EPO4 & EPO5 9 5 • 2 Series 1 2 COMPONENTS DIMENSIONS (All dimensions are in inches.Do not use for construction purposes.) Item No. Description imirmig 1 Impeller 2 Base 3 Pump Casing A W. ii 4 Mechanical Seal /00: 5 Ball Bearings 9 6 0-Rings `. 7 Power Cord T/: ' 11 MAX.10% 1'/:NPT 8 Oil Filled Motor 9 Motor Housing/ e 9,741A En o.�7 Stator Assembly 10 Motor Cover 4. rim 3%4Y:-0- ��PERFORMANCE RATINGS 9'/° 'I 6"MINIMUM WATER LEVEL WHEN Total Head Gallons Per SUPPLIED WITH FLOAT SWITCH (ft.of water) Minute EPO4 EPO5 5 53 — 10 46 62 15 36 55 20 21 46 25 0 33 30 — 11 MODEL INFORMATION Minimum Minimum Minimum Minimum Maximum Shipping Float Switch Cord Discharge Order No. HP Volts Amps Circuit Phase Style Length Connection On Off Basin Solids Weight Breaker Level Level Diameter Size lbs/kg EP0411 Plug/No Switch 10' 11/2" Manual- Manual 15" 20/9.1 EP0411A Piggyback/Wide-Angle 10' 11/2" 12" 6" 15" 21/9.5 EP0411 F 4 115 12 20 Plug/No Switch 20' 11/2' Manual Manual 15" 20/9.1 EP0411AC Piggyback/Wide-Angle 20' 11/2" 12" 6" 15" 21/9.5 EP0412 1 Plug/No Switch 10' 11/2' Manual Manual 15" 3/4" 20/9.1 EP0412F 230 6 10 Plug/No Switch 20' 11/2" Manual Manual 15" 20/9.1 EP0511 F Plug/No Switch 10' 11/2" Manual Manual 15" 22/10 EP0511AC .5 115 13 20 Piggyback/Wide-Angle 20' 11/2" 12" 6" 15" 23/10.4 EP0512F 230 6.5 10 Plug/No Switch 20' 11/2" Manual Manual 15" 22/10 Goulds P Goulds Pumps and the ITT Engineered Blocks Symbol are registered trademarks and tradenames of ITT Industries. www.goulds.com PRINTED IN U.S.A. ""' SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE. ITT Industries u GOULDS PUMPS Submersible f il Effluent Pump - = _„ . I MODEL 3871 EPO4 & EPO5 = � I S APPLICATIONS •Fully submerged in high •EPO5 Impeller:Thermo- •Bearings:Upper and lower Specifically designed for the grade turbine oil for plastic enclosed design for heavy duty ball bearing con- following uses: lubrication and efficient improved performance. struction. • Effluent systems heat transfer. •Casing and Base:Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms superior strength and corrosion manual operation.Automatic Cli Canadian Standards • Heavy duty sump resistance models include Mechanical . • Association • Water transfer Float Switch assembled and ■Motor Housing:Cast iron for us File#LR38549 • Dewatering preset at the factory. efficient heat transfer,strength, and durability. Goulds Pumps is ISO 9001 Registered. SPECIFICATIONS FEATURES •Motor Cover:Thermoplastic •Solids handling capability: EPO4 Impeller:Thermo- cover with integral handle and 3/d"maximum. plastic semi open design with float switch attachment points. •Capacities:up to 60 GPM. pump out vanes for mechanical •Power Cable:Severe duty •Total heads:up to 31 feet. rated oil and water resistant. •Discharge size:1 Yz°NPT. seal protection. •Mechanical seal:carbon- rotary/ceramic-stationary, BUNA-N elastomers. •Temperature: METERS FEET :--. .. ... ...__ _.__._-.. 104°F(40°C)continuous 10- ' ■ 140°F(60°C)intermittent. + •Fasteners:300 series ::components.• ning °a 7- W Motor: 6 20: •EPO4 Single phase:0.4 HP Z 5- 115 or 230 V,60 Hz,1550 0 15 --------_.__.._ ..------_..__ - -__ __—._- _ RPM,built in overload with a 4- i I -- ' EPOS automatic reset. o • — — — — -- — EPO5 Single phase:0.5 HP 3- 10 115 V or 230V,60 Hz,1550 EPO4 i RPM,built in overload with 2- i automatic reset 5 -- — ,— •Power cord:10 foot 1 standard length,16/3 0 0 — ' — — —1 SJTW with three prong o 10 20 30 40 50 GPM grounding plug.Optional 20 I , foot length,16/3 SJTW with o 2 4 6 8 10 12 m3/h three prong grounding plug (standard on EPOS). CAPACITY Goulds Pumps C 2005 ITT Water Technology,Inc. ITT Industries Effective January,2005 B3871 ' , •W "-- n M INSTALLATION INSTRUCTIONS o st , := Ate'°..� k PL-525/PL-625 FILTER 3 Wastewater Prothes PL-525/PL-625 FEATURES & BENEFITS Features & Benefits: •Rated for 10,000 GPD • PL-525 = 525 Linear Feet of 1118" Filtration PL-625 = 625 Linear Feet of 1/32" Filtration PL-525- PL 625 a Accepts 4" and 6" SCHD. 40 pipe The PL-525/625 Effluent Filter should operate efficiently •Built in Gas Deflector for several years under normal conditions before *Automatic Shut-Off Ball when Filter is Removed requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped or at least every •Alarm Accessibility three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm w he n the *Accepts PVC Extension n Handle filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. RECOMMENDED PRODUCTS Potylok PVC Filter r Extension Handle # re Risers&Riser Covers Extend&Lokn" Riser Safety Screens Filter Alarm Panel and Polylok risers bring your Polylok Extend &'Loki' Potylok safety screens SitiartFilterT'"Control septic tank cover to grade. is a simple, easy to use . prevent tragic accidents Switch This allows locating and solution that can extend from happening by children Polylok fitter alarm panels servicing your filter easier the inlet or outlet pipe and and pets falling into open and switchs provid a visual and time saving by elimi- make filter and/or baffle septic tank entrances. and audible notification of nating digging to find tank installation a snap. impending filter and tank entrance. Fits 3"and 4"pipe. servicing. For a full list of Polylok products please visit our web site at: www.polylok.com a z 54i" AS 84" N _ _ READ m 43" Z z "" w 1Pi C xi 7 0 4 " CAS ■ m 3" 464" 5.. r z I y r� Q 03IA X 38" I — m m W� II l •� a N UP 40" v 4" CPLG xi 1 m UP 40" o 53 4" CAS , �� m 1 I I z "0v t ° I, ) � _ ��\ il■. • augoalommuni II 10 MI c II 41" Im z o 0 D r0 C 2 2 u) zA z av °c R z y T10 z z ° .. a 4,a ca3* mEcao*tn Z 1— o zm- s� °� z ° a °v1° '° McPOEir1>` C 2 N_, 1°,10 yu v D Z o �O Ov zz ∎D < z w 7ZC .�OD p= s (�71 t0 0 p l"' 6 9.w G sv Q•v m z o CO N VZ o .. C 00 co N 0 Z - -, co . . 0 z z 0 > -_I —1 tn H n p 0 Z � Z 53 M \—A N WLP1280/800—FDL T DRAWN BY: SME SCALE: 1/4"=1'-0" PRE-POUR: q SEPTIC MANUAL W! H!1M COOCWETE REV. _ AL DATE: JANUARY 2010 DATE:. POST POUR: \Z W3716 US HWY 10 MAIDEN ROCK, NA 54750 ° REVISED JAN. 2010 800-325-8456 FILE: .P128O-eooRL i` S r n o °o ' B w 3 O I} 0 4 w T .. N p pmo O p S 7 ^ 6 D O 2. LOT 1 T:1---."---i, C.S.M. IN I LOT 1 LOT 8 a VOL. 7 C.S.M. IN LOT 4 I I C.S.M.,IN VOL. 12 i `O • 4. PAGE 1849; _VOL._3 C.S.M. IN VOL. 5 PAGE 3391 I !w n°- -I PAGE 846 I PAGE 1441 1 I LOT 5 I LOT 6 �- Z. .w q' West Nnaofthe - L 1 I - I NE-1/4 of the NW-1/4 I r+l 4 42ND SfEET N0016'4 5"W ( 245.35' f I- o , • _ _ L 29713- ` 193.82 °^ -501'16'58"W 754.40 721.27' 50196'58'W 217.55' --, ',, n • _ 7 �=}� -234.13' — 487.15'- 0 o 0 ___ ____2_,„,c.2 • , t I I l t1 \ : 7 ••,.,, a Kr I O ' i.....,O T T I : w w y ., • o o m s4 t o 0 0i4.O r to m$ I m m n y ~ we m Oclio .1 y N N El —1 toner- I 4... i IO t.rN u 7 .. OOAC) I� 4.W Q N00'03'43'W e P 3 p '°0 _ s) m m 4 C y x 1� O b y 482.69' I w 1 1r ti� y ' b- N I °-N 0004'013 2 ,6 1 1 ` �� 1 I a�N N �� y r� � / r r �� c WI • IDIF N `•°i !Alf 11 Q Tr �' a N0091'02"E � 4: IF,' 101- °D A a o A/ = 467.55' ■ lasm °?1 Ic (91Z - �tt ' .0 '' / 1D +W r CO 1 D b `° rci 10 10 0 W. 424.90 tit c' / 1-I�•."� 9i2 m-.0 iftg !o ca. • Iwl� a 1 234.00' 1.4 M5, o^ 4 C o r0 —� 800'03'43'W 658.90' / "� �1 _ N m W O g'd'J'�'& tl'HVt;"2•/1P yI4 - "�/fb s 00, ��s:• �Q J b ,`4o I tiW °° 5,•,:.4.43 0 .'kz- /�y' 4Y NI 28'45•E o9e Ofgda,3•,. I 5 $ o z. A b Ct 0 .�') • BAr •gij e V`• .y4, - iprir •.f 351.90' ,': �&• .p 0•.8 /n. N72za•'yn�t°4t_ N,y7eu� :✓ N /0 / 247,09' f r- '711• �; p r H Ts' Ir 71• m 'ti J.� tY '� . I� 48539, f \ / 4,* a ?,,, 2`rf c 14' 0 6 C PIS \ I S•Mg u w ••m �r .�`Em i1 i \ a� \.... J O v h i f // .y O o•O v.�1 1...,m' .*c fy9� i o O w. r o w w C..."..1 o o e y / Non ; N mor i 7:::/ '\ 01‘ ii-P. ` r ♦� m i 7 / �. o o_ • .0., ,....„ -766.51- i 395.21' u!*0 66.00'6' 409.90' 356.67' -"� S00'03'43"E 1227.78' I 2 LOT 8 I LOT 10 I LOT 7 s s' a BLUEBIRD BLUFFS I i N I ! s c 41Nr o Je 02RA r 22 m 2 m "$ $G6B84. o gd i bO°°�8u� SBW 81 m% nmi o 6 z 41, p,111-36 cm > �g�0 n A O �m m z 4,2°y 2m. nm -f- z0 Lv A -i ° > -• t 0 o -- --m Rg _ jUy 1it61'?i`t1414r4 r, A8>> 2n z'1°1. 5Zs =a m».'.•1° ,Jmc�"c� ›mm„ rn' $�A'1 N�?1'�'jJ+`Nt:H vR4'R��O� - D?N 7o '>2 Cn nV1OUOi 0' ;m o0'0' czi�° � 5•y-r[c��iNm °i•lZ ��jwy , F .°.-fYWmie;eetn�mimD y=o 2'.- 2 0Mta-a>5 'mgo �2 C& fs°+1Z0W< m A m IA po �`' j N mo *� c0 4 >x� N�" : ZQ °coN R �n"o 8`to'i22z u I mrriir PEA+m OPN OO ;�a �i om �c o'u�i '' A n oy1 u12mm off-= >zi%i1�'c li y1 POND _ > 1f7i m Dv-1 'lS ��'i4 -ttiutdiKim�� m- =yo �om� DA> 1° N z$ mv gm° F"° m; L... n ._.._ xm mz m , Amm c0 iF� F �m to cna 1 vm�n y1:� m."....n A �Z ,10 y!n;C1 mN°N �iA11--11.. mA 1 .°. m omA...........40�2••.Z.....' OQy _. 551AA.� aa2.7.n.G pNp1�1 52 C Ul0 Z; A Om O• 0. OS Ummui 0 N1Z00-. -OCm>N p„,000, 'Oy 0�-1I . {� i ---t Iy---,tR t,a m 00' - Am-N OZ OAzr0> 'ice y ZC Oo�Z m> 0�zpr an :_ n A> c2 0m5s C .2 y2p~0 .101 mm '0=N> `=E1 0,11 R.rmn 1ANN'NOJ.�NNWUNPdm ZO D (Nl1NrN N �m �Gr-Z'1N0 O'O� m�Pwmp�o>i "'Sz55 --- 11:�UtNIIVVNA.om�trl �m N CD m O a O O1-6 C°<°<A 1.2p. OOm>D. QA `-Y pi.t.p Wai.1:}smtJNN1,1 Cm > >,110y m'1 mmrm= Z AI° op m T"1 m „ 11 A POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of__! FILE INFORMATION SYSTEM SPECIFICATIONS _ Owner BRUSHY MOUND PARTNERS Septic Tank Capacity 1200 q al ❑ NA Permit # — Septic Tank Manufacturer WIESER Q NA DESIGN PARAMETERS Effluent Filter Manufacturer POLYLOK d NA Number of Bedrooms 4 (7 NA Effluent Filter Model 525 ❑ NA Number of Public Facility Units 6 NA Pump Tank Capacity 800 gal ❑ N4 ^ Estimated flow(average) 450 gal/day Pump Tank Manufacturer WIESER ❑ N. Design flow (peak), (Estimated x 1.5) 600 gal/day Pump Manufacturer GOULDS Cl N.4 Soil Application Rate .5 gal/day/ft2 Pump Model • EP05 D N,a Standard Influent/Effluent Quality Monthly average* Pretreatment Unit 7 N.% Fats, Oil & Grease (FOG) 530 mg/L O Sand/Gravel Filter ❑Peat Filter Biochemical Oxygen Demand (BODs) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L 0 Disinfection ❑ Other. Pretreated Effluent Quality Monthly average Dispersal Cells) O NA Biochemical Oxygen Demand (80D5) 530 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L (5 NA E] At-Grade ❑ Mound Fecal Coliform (geometric mean) 510'ofu/100m1 Q Drip-Line O Other: — Maximum Effluent Particle Size Y in dia. c NA Other: 0 NA Other: ❑ NA Other: O NA *values typical for domestic wastewater end septic tank effluent, Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency r_ Inspect condition of tanks) At least once every: CI month(s)3 ®year(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y,) of tank volume 3 yg NA Inspect dispersal cellls) At least once every: 3 ❑month(s)year(5) (Maximum 3 years) ❑ Nit Clean effluent filter At least once every: Q month(s) CI NA 1, I 121 year(s) _ Inspect pump, pump controls & alarm At least once every; 3 H month(s) ❑ N/1 _ _ year(s) _ Flush laterals and pressure test At least once every: ❑month(s)AS NEEDED ❑ NL, ❑ysaris) _ Other: 0 month(s) At least once every: ❑ NA ❑ year(s) Other: — ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber: Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s)to identify any missing or broken hardware, identify any cracks or leaks. measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services,including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION ` to ut. • Page Z of Z' For new construction, prior to use of the POWYS check treatment tank(s) for the presence of painting products or other ohemica that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the conterr of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will b discharged to the dispersal cells) in one large dose, overloading the cells) and may result in the backup or surface discharge c effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoriri power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls t restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the are. within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or.elimination of the following from the wastewater stream may improve the performance and prolong the life of th( POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat foundation drain (sump pump) water; fruit,and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; ail, painting products; pesticides; sanitary napkins;tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: Cl A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area IA ill result in the need for a new soil and site evalilation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Bening advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. • slue y b e ai rkof.403ffl X0,2 A/.- advsna!CTL ❑ Mound and at•grade soil absorption systems may be reconstructed In place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING> > SEPTIC. PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NC T ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSiBLE. ADDITIONAL COMMENTS • POWTS INSTALLER POWTS MAINTAINER Name PAUL KOEHLER Name ,SOUNTRYSIDE PLUMBING & HEATING INC , Ph one 715-246-2660 Phone 715-246-2660 SEPTAGE SERVICING OPERATOR(PUMPER) LOCAL REGULATORY AUTHORITY Name POWERS LIQUID WASTE MANAGEMENT Name sir-, C�l e ',ovary 20Aho /. Phone 715-246-5738 Phone /IS-- 3 A� '(p8) This document was drafted in compliance with chapter Comm 83.22(211b)(1)(d)&(f) and 85.54111. (21 &(3), Wisconsin Administrative Code. Si'. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer l.n ri - ei L 1 ZA (�. Mailing Address l2. 'tj / , • ` Isc l'4� (), :is.i.2G L._-k% 0 £E I 16 Property Address v 1% i 4-'Z-tom Z) Sr. b (Verification required from Planning&Zoning is -nt for new construction.) City/State 14-11) � ''f 1 h' � 'N- Parcel Identification Number 0� o ° 2! 4'.� 7..�-"�--�� r LEGAL DESCRIPTION Property Location t*.t' - 1/4 , NW% , Sec. , T2t N R 19 W,Town of 1 ' = . Subdivision �fOi r1-.4 (b11-'H 1-1--- , Lot# Z1— Certified Survey Map# , Volume ,, Page# . Warranty Deed# $, c3Q 2 ( ' 3 , Volume , Page# . Spec house yes ) Lot lines identifiable po 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. Uwe certify that all statements on this f are true to the best of my/our knowledge. Uwe am/are the owner(s)of the property described above,by virtue of a wa ty deed recorded in Register of Deeds Office. Numb of bedr ms AI , SIGN OF PPL CANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV.08/05) •.. r - Wisconsin Department of commerce SOIL EVALUATION REPORT page 1 of 3 Division of Safety and Buildings 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. percent slope,scale or dimensions,north arrow,and location and distance to nearest road. �� e g � �Uv 0 r Please print all Information. Revie :• b, Date Personal information you provide may be used for _ .i•.. • ••... - - -.15.04(1)(m)). V A- " . I 3/eg v Y Property Owner i N t..1 °�-,R V F -roperty Location Brushy Mound liiartners • .Lot NE 1/4 NW 1/4 S 5 T 29 N R 19 E(or)pW Property Owner's Mailing Address 4 ,lE.btl\-1 1 4 2004 Lot# Block# Subd.Name or CSM# 1505 Hwy 65 22 - Bluebird Bluffs 1st Addition City State Zip Code prle l[?lapru);, [ity 0 Village [Town Nearest Road New Richmond I WI I 54017 I ( ZOhiNG OFFICE I 42nd Street St. Joseph U New Construction Use Residential/Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD ❑Replacement ❑ Public or commercial-Describe: Parent material Loess over outwash and glacial till Flood Plain elevation if applicable NA R General comments �ih t and recommendations: �s*several laigee rocks present This site is suitable for a conventional below grade system,recommending that a pressurized system with equal , distribution be used so as to distribute the effluent over the entire avai a le area due to the massive(0m)sl.This is not a code requirement,but rather a suggestion. 1 Boring# ❑ Boring 0 pit Ground surface elev. 101.20 ft. Depth to limiting factor >90 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-10 10yr3/3 - sil 2msbk mfr as 2f .6 .8 2 10-22 7.5yr5/6 - is Osg ml cw if .7 1.6 3 22-90 7.5yr5/6 - s* Osg ml - - .7 1.6 2 Boring# El Boring 98.10 >90 Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 •Eff#2 1 _ 0-10 10yr3/3 - sil 2msbk mfr as 2f .6 .8 2 10-34 7.5yr5/6 - is Osg ml cw if .7 1.6 r 3 3448 7.5yr5/6 - c---- fsl Om mfi - - .2 .5 4 48-90 7.5yr5/6 ' - s Osg ml - - .7 1.6 Effluent#1 =BOD6>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD 30 mg/L and TSS<30 mg/L CST Name(Please Print) Signature ��� CST Number Thomas C Nelson --/"".. 227387 - Address Date Evaluation Conducted Telephone Number 1432 120th Street,New Richmond,WI 6/5/04 715-246-2454 r _ _ Property Owner Brushy Mound Partners Parcel ID# Pending Page 2 3 of Boring 3 Boring# GI >90 Pit Ground surface elev. 96.65 ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl? in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-10 10yr3/3 - sil 2msbk mfr as 2f .6 .8 2 10-32 7.5yr5/6 - _ is ■ = ml cw if .7 1.6 3 32-90 7.5yr5/6 - sl Om mfi - - .6 . . 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# E 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 *Effluent#1=BO;>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BODS<30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,please contact the department at 608-266-3151 or TTY 608-264-8777. SB66330Test(5.07/00) • Bluebird Bluffs 1st Addition Lot 22 North B3 132' ■ I -do 24' 6% slope :7' 86' 191' —ice 50' -s B $39,11111134 BM1 121' —i 33' SE lot corner rod' l e0' cite 44 Scale 1"s40' BM1 Top of conduit 100.00' 8M2 Top of conduit 98.45' B1 101.20' 82 98.10' 83 96.65' Thomas Nelson 227387 r J Za�mla. O O-c =WOXW _• vNOw� m NtU I'IOa,YYY Yf•I T.,•,.p tN. O W'F 4.Zp m 0 Q O O Z V O!U W U N(C m j < W m W Y V l IU Y M `m# FtrWWwa a o wwa ut -SNP,` �F,;u4 moo... QQ} F N �'-p20 �ZC�~ W0I N N < CD Inm. �. NV1 Q O O W <O V I V I F1 M.p N N N N N N...22, OK p O 20 ZKI VI JIn_ W p NVf tomes N= m w N_ K d w X m u T 3 w U� <J Q W < OF N J=Z N VI 0 N 2 Z Z 2 Z N N c1.3< woWNQ <cap �Q�o z0wa < o a°Sn.� r, CCM CO u x • 00 0-1 0 azlo w 'on o c4Q am waN° wg ar F ¢00 Oo- tz0 m00z K�p ZKJ?�N 7 I a?w 3a 0p . �1 p IIV U.o ZUr I�ZO,U<K N<a00 NZ?, <aa0•p2 WI- b VI NJ Z W°CYOm N.Y..N VI�o°`N.Y.-_.N I1,1.'2 t- WNO JJ TN' OZ Otl/1�W�W0 O U1..0 W� O <a pN P N 72:44'I11 If10. n uf KWw?ww 00 �ONW OW QF--W w NN < 0- wILL « U•• m.. Gov u=Qao<o o�w wow <���;N °N �wQ �° j zw �N v 1'I' C h M' f N' ,,,, . ZZ �m< J O MD 0_ m 2W 02 o O0 <t wN- or 11^��ZZ, U�m N Y dO Y.°�Y M r N N o =VI N�Z< Z�[OJ W yzj IlI O W F Q W a VI Y o W. O F-0 0'('i Vl o o°N fU T 17.1-'.+In m 4 _Z 24.0 p<Ux 00-0 rZZqOZ,, ZM YYU �O a2 Opr 6...•..,,Nm N.°NY i�°..°f� �N 1-FFKaw 0 jwo0 o J-. 07 o<a1wp ¢V ‹Q< 1-,900 i W� �w F w‹>W-55 wod°w Fzr wmzr,' w;F .w. mZLio ° 179_ 0 F�$ai nlov°�v°I�o°�°i u`�i<° WJ?Wca U ,xys 0,1-�O Kd0 w1 Np ow Ori to Q JorUVl Oiii,WC3v'Y w ,ow< 14..< WWp< KOwatW <Z OzJ wOOz ZO <03w A`GO YMOYYNNYO+oN WK OW°' m Z m WZ UZ ww3 F> MV)M^N M M m N M 6+^'VI Zp Z Z W O0 JKpW K� OzVVII p J-'r rm00 <F >jD .-.__ pF 0 0_F 0 <Uw2 Z3WZ JU<F- NF 7-m <aWU Z O UWIwiQO �� f=/Z11m/I<O Oa7 30ZVlpOW KN O=mZ ��=x Z� OIw/1 =nm°000000000Q .0ow I. I�yIy��jj3(w.1ZQ (a/IKQm 0<c >J W 1� WOK 0OOO <W wow W M<'il'I U cDco IM'I to n4 Nco m JWOZF ZI,QOUm <N Na ZU<m<U m0 KH4 JQKU �� �U� 4 -.MMMNMM MNNM Y o CO P u00,000,0 ' I I 0 0 0 0 U U U U I I W w s I 1 s3jm8 aaia3me I�'I �I • .3 1 F I - -- Ol 10 I 8 101 9 9 L 101 o i 1 ,9CLZ7l 3„£ti,c0.0 0S J ZSf P■ •_ ,L99Sf -CS'99L- ,0604 I-,00"99 o 3 n� cr. o; I •Win , (�\ 01 to N N , Xi' / N • 3 ° 4 Z •O10 1�ryop z m S °tn"+ 000 o m �.� ° •\ 4:16 n c' {� `^ o °v.J 0 o si In U ,N n n ~O II Q .:6,.. 0 9 � • \ it7,tb Zi L%z h� 'L • / x'140: • < 02 � � °/ JAI a� •'.•-;H I 09 N�t o �, '`" •."..' B H1 Fz 99l 3\ �� "�' / -4. c s d \ •F•9 z\ ,� 3 ,tti �'4 4' • �; 0 / 110 gt -�I \ �.; // .ls!etat.4 X41 - _J07 IN 4, / �.o,. y tai h N to) 43._ //' �.��aPctip a6 .06'ISF 3.Sb,g �N��2a �lC^i) y �'h3��\r B O b Co O °D Ih N g o f� , ''=;:•4 t6P. Prs.,,.. n�yq`�'� /.12h�$/ \\ J m Q v 1 �} {(/ 05 cv 13 nl ;11-. '''l o io<< tsv, c` ,/ V / i ,06'BS9 M,f4,f0.00N 3 ��lap O L g O `� it �� h N `',• i / °'I ,06'424 .00'4fZ .� o O10 0 I0 J �I J^"m & �- • �/ �l ZI W V p co ,aosat " ,SS'L94 Y u o �fi i -ICw7 O., I F II :� 3.ZO.l L00N ';I /�' .. F y �n 1.0( h I- If �� �W< I V �ry Q °c° Y \1 x " o oti vi a &� I c. \ J I-....... u m o UI _ QIoo N to • !f. p.` � I n 1 ,69'284 (\ lnl ® o U m M.£b.£O.00N 0 h O N Oi F-I a p*oo `^3 n n w Jcr _I • o J^fro Ly ._ N o ��.-, N h n w l 3 .I— UL '. r • i < • oI rn� hu 3° mm n ~oI •I n z N. a $ � �v o o m 0� 4 L • m m N J O N•I N z l M� I ° ! o O . 0 c y'S�y• .(Y I the in o. 'r k°' `�� .CC Io 2 °� I ds \ O O vI m . JJ ,SS'L lZ M.BS.96lOS .LrtZL 041,SL M_8S,9I-LOS ° I=/^\ —I ,Sc'StiZ l M„Sti,9 LOON 133E1LS away - - - 4�l MN a4)/o*/l-3N - I - - --- - - f- I - - -t I I -1 -. I D47/°sut/1Sit1 1 Lvv1 3svd I 9179 30Vd 1 :N I h a I e ioi I s ioi I i s179� 3�dd a is9c 30Hd g Son N1 w so "ion • yo I z Son NI "wso I I v ioi I NI wSO Son (,,,.„,,i`,L) 8 lol l 101 I NI 'W'S"� 1 101 O 0 ¢ y < v o 0 0 o o a d co_ S o ; S o u o I . r u v c y m x a n - m m ° u m j d 7 er o E "I A $ IL 0 W , u o s d o o W° w o E .' U ., N