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032-2031-30-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 578963 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: e Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)j. Permit Holder's Name: City Village X Township Parcel Tax No: Rad'enovich, Joel & P gy I Somerset, Town of 032-2031-30-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: I D O. o �O O.D LS t GM' I 08.30.19.587G TANK INFORMATION ELEVATION DATA b A_1 013/ D,v TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic C X ST I1 v C�� Benchmark �Y D2 1b5.6 I c)L) O 7 t Dosing ' Iti1�� DD,\ Or, Alt. BM 0$ �� r Aefa ierr V V Bldg.Sewer �O V I mi. Holding I St44Hnlet x 15 n N Cs TANK SETBACK INFORMATION Stff tt Outlet p,�-� y�/ TANK TO P/L WELL BLDG. en Air Intake ROAD Dt Inlet 3 ',/ 2 67� Septic 1 lob, f I 1 )j t Dt Bottom Dosing �Iub 1 �� b I 1u 1 010l I \t b I Header/Man. / ,.,C 6v l Aeration 11lJ / V —` /` Dist.Pipe (D ,(��C a D. Holding Bot.System q9. 85 PUMP/SIPHON INFORMATION Final Grade jb x•52 Manufacturer Demand St Cover ` p O p 'q -7 6 L`LL GPM x 1 I D l , Model Number ,� �< 15� /IOn,}, L) f /_,QI_ G�'Q�1-7 TDH Lift Friction oss System e d TDH (Q tlli� l> n.ql .�S �. Forcemain Length Dia. /t Dist.to Well D 5 >��Ut SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG IWELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of Sys m: 1 L�tJt \)2 UNIT CHAMBER UN T OR Model Number: vtnv\ !l DISTRIBUTION SYSTEM Header/Manifold Distribution �� Ix Hole Size x Hole Spacing � Venyte,A�ntak� 1 r1 Pi s �z� r, r//,,��// Length Dia J Le gth��� Dia ' 4 5 Spacing—Z-.—•J�J 2-.,S U 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 Bedrrrench Edges Topsoil 1I yes N No Yes No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / / *5 Inspection#2: Location: 415 169th Ave.SOMERSET,WI 54025(NW 1/4 NW 1/4 8 T30N R1 9W) NA Lot 4 4?ere 760 f4",—Parcel No: 08.30.19.587G 1.)Alt BM Description= F I c-I a— C""_ �j� (,I\ I 2.)Bldg sewer length= ('J ism&- �J C /` Y `� Q� -amount of cover V Plan revision Required? ❑ Yes r' o Use other side for additional information C(/ ' bfi4,� Dat6 Insepctor's Signature Cert.No. SBD-6710(R.3/97) County 1 Industry Services Division St.Croix $ 1400 E Washington Ave Sanitary Permit Number(to be filled in by Co.) P P.O. Box 7162 Madi �-7162 C �� Sanitary Permit Applicat�'J State Transaction Number d€di�a �o4. l. i. 2539723 In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form t pp utt_,' ernmental unit is required prior to obtaining a sanitary permit. Note:Application forms f sta ed POWTS are submitted to the Department of Safety and Professional Services. Personal infortt�gq 7 ��1tfor secondary Project Address(if different than mailing address) purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. uMwa �j`��":' same L /_ L Application Information—Please Print All Information �t- Property Owner's Name ja Parcel# i G` e`� ,/ �� 032-2031-30-000 Property Owner's Mailing Address V Property Location 5 g7 415 169h Avenue Govt.Lot City,State Zip Code Phone Number NE'/a,NW'/4, Section 8 Somerset, WI 54025 (circle one) T30N ; R19EorW II.Type of Building(check all that apply) � o # ® 1 or 2 Family Dwelling—Number of Bedrooms 4 Subdivision Name 1 NA ❑Public/Commercial—Describe Use l Block# ❑ City of ❑State Owned—Describe Use / Fs M Number Village of 75 0✓� (�( 7,,26 ® Town of Somerset I P, III.Type of Permit: (Check a A. Complete line B if al licable) A• ❑ New System ® Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain) B. ❑ Permit Renewal ❑ Permit Revision ❑Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued / Before Expiration Plumber Owner IV.Type of POWTS System/Component/Device: (Check all that apply) ❑Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound?24 in.of suitable soil ® Mound<24 in.of suitable soil El Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dispersal/Treatu Dispersal/Treat at Area Information: t Design Flow(gpd) Design Soil Application Dispersal Area Required(sf) Dispersal Area Pr osed(sf) System Elevation i 450 Rate(gpdsf) 1125 2648 99.82 1// .4 VI.Tank Info Capacity in a � Gallons Total #of Manufacturer w o U Gallons Units ^ New Tanks Existing Tanks f r JI\ 16/( �iJ p" U Ln v vn w C7 ti Septic or Holding Tank 1000 1000 2000 2 Wieser Co rete/Unknown ® ❑ ❑ ❑ ❑ Dosing Chamber 650 650 1 1 Wieser Concrete C 4 c> ® ❑ ❑ ❑ ❑ VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumb ' i ture MP/MPRS Number Business Phone Number John Schmitt 223760 715-760-0486 Plumber's Address(Street,City,State,Zip Code) 616 1501h Avenue,Somerset,WI 54025 VIII.Count /De artment Use Only Approved K2f2Zaso. Permit Fee Dat' sssuued Issuing�ent i gnatur for Denial $ Z5 '06 15 z/ IX.Condt �!t� 1 1► IV .Reasons for Disapproval 3, 6n��. 4- ,'A /� � �J �'�ptid'tank,effluent filter and J 1`11A r I .;dispersal cell must all be ser*gs I mpintained j A e_ L.J t ✓`^ W . a$per management plan provided by plumber. 2. *,s lut Utrements must be maintained as t> code/ordinances', Attach to complete plans for the system and su mit to the County o t y on paper not less than 8 1n x 11 inches in size /I SBD-6398(R03/14) C.(1 PLOT PLAN N Project Name: Jondal 3 Bedroom Mound Legal Description: NW1/4,NW1 14,S8,T30N, R18W P.1.D: 032-2031-30-000 Subdivision Name: na Lot#,, 4 SCALE: 1^=-40' Township: Somerset Parcel Size: 5.000 Acres County: St.Croix Contour Line Elevation: 98.40 Cell Dimensions: 6'X 75' 4 inch Sch 40-ASTM D2665 System Elevationj 99.82 Mound Dimensions: 97.85'x 40.39' 2 inch Sch 40-ASTM D1785 Slope_ 20% 1112 Sch 40-ASTM D1785 A BM1 Elevation: 1DD.00' Top of 2"PVC pipe BM2 Elevation: 99.94' Top of 2"PVC pipe ■ 'Backhoe Pits: Existing Tank:11000 gallon Septic Tank New Tank: 1000 allon Septic Tank with Pol lok 525,650 gallon Pump Chamber it \ � y � �L�i'r \ Z C. / 1 L \ L 7 C' H NG�L 14,u> = ,� / V ! � 4- Page 11 L JOHN F SCHMITT Page 2 5/14/2015 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 Swan When You Receive That Invoice, POWTS Plan Reviewer,Division of Industry 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 DIVISION OF INDUSTRY SERVICES 3824 N CREEKSIDE LA 9 HOLMEN WI 54636 Contact Through Relay 3 e http://dsps.wi.gov/programs/industry-services www.wisconsin.gov A�OssioN Sw� Scott Walker,Governor Dave Ross,Secretary May 14,2015 CUST ID No. 223760 ATTN.POWTS Inspector JOHN F SCHMITT ZONING OFFICE SCHMITT&SONS EXCAVATING ST CROIX COUNTY SPIA 616 150TH AVE 1101 CARMIC14AEL RD SOMERSET WI 54025 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/14/2017 SITE: Identification Numbers Steven&Mary Jondal Transaction ID No.2539723 415 169TH Avenue Site ID No. 812157 Town of Somerset Please refer to both identification numbers, St Croix County above,in all correspondence with the aenc NW1/4,NWl/4, S8,T30N,R19W FOR: Description: Three Bedroom Mound System/ 10%slope Object Type:POWTS Component Manual Regulated Object ID No.: 1533906 Maintenance required; Replacement system; 450 GPD Flow rate; 19 in Soil minimum depth to limiting factor from original grade; System(s):Mound Component Manual-Ver.2.0, SBD-10691-P(N.01/01,R. 10/12),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 CONDITIO requirements. APPRO 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 stats. PROFESSION The following conditions shall be met during construction or installation and prior to occupancy or use: DIVISION OF INDU Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19,Wis. Stats. • Inspection of the private sewage system installation is required.Arrangements for inspection shall be mad lth SEE CORRES 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 approvedplans 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. i JOHN F SCHMrrT Page 2 5/14/2015 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,Division of Industry 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 I MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN APR 2015 Residential Application INDUSTRY SERVICES INDEX AND TITLE PAGE Project Name: Jondal 3 Bedroom Mound Owners Name: Steven & Mary Ann Jondal Owner's Address 415 169th Avenue Somerset, WI 54025 Legal Description: NW1/4, NW1/4, S8, T30N, R19W Township Somerset County: St. Croix 4ALLY JED Subdivision Name: NA 'ETY AND _ SERVICES Lot Number: 4 Block Number ;TRY SERVICES Parcel I.D. Number 032-2031-30-000 t Plan Transaction No. ? DENCE Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Septic and Dose tank specifications Page 8 Effluent filter information Page 9 & 10 Pump specifications and curve Page 11 Plot plan Page 12 Septic tank maintenance agreement Page 13 Existing Septic Tank Certification Page 14 Warranty deed Page 15 CSM Attachment Soil evaluation report Designer: John Schmitt License Number: 223760 Date: 4/20/2015 Phone Number: 715-760-0486 Signature: ( - ;__ , Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SBD-10691-P(N.01/01)and both SSWMP Publication 9.6 Design of pressure Distribution Networks for ST-SAS(10/81)and Pressure Distribution Component Manual Ver.2.0 SBD-10706-P(N.01/01) Version 7.0 (R. 03/2012) Page 1 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill(D)calculations assume a 300.00 Estimated Wastewater Flow(gpd) Table 383-44-3 in-situ soil treatment for 1..50 Peaking Factor(e.g. 1.5= 150%) fecal coliform of<=36 inches. 450.00 Design.Flow(gpd) 20.00 Site Slope(%) 98.40 Contour Line Elevation(ft) 19.00 Depth to Limiting Factor(in) 0.40 In-situ.Soil Application Rate(gpole) Distribution Cell Information 75.001 Dispersal Cell Length Along Contour(ft) = 6.00 Cell Width(ft) 1.00 1 Dispersal Cell.Design Loading Rate(gpd/fl?) 1 Influent'Wastewater Quality(1 or 2) Are the laterals the highest{point in the distribution L____ Pressure Disribution Information network? Enter Y or N (C or E) C Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation ft 4 Number of Laterals of the highest point. 0.188 Orifice Diameter(in) 2.50 Estimated Orifice Spacing (ft)= 7.50 ftz/orifice 2.00 Forcemain Diameter(in) 75.00 Forcemain Length (ft) Does the forcemain drain back? 89.00 Pump Tank Elevation(ft) Enter Y or N 3.25 System Head (ft)x 13 12.23 Forcemain Drainback(gal) 10.40 Vertical Lift(ft) 67.32 5x Void Volume(gal) 2.40 Friction Loss(ft) 79.55 Minimum Dose Volume(gal) !v\ 0.00 In-line Filter Loss(ft) 39.32 System Demand (gpm) 16.05 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice M� 0.75 1.25 1.00 1.50 x x 1.25 x 2.00 x 1.50 x x 3.00 2.00 x 3.00 x Gallons/Inch Calculator(optional) Treatment Tank Information Total Tank Capacity(gal) 1000.001 Septic Tank Capacity(gal) Total Working Liquid Depth (in) Wieser Concrete I Manufacturer gal/in(enter result in cell B49) Dose Tank Information Effluent Filter Information 650.00 Dose Tank Capacity(gal) Pal lok I Filter Manufacturer 17.00 Dose Tank Volume(gal/in) 1525 Filter Model Number Wieser Concrete IManufacturer Project: Jondal 3 Bedroom Mound Page 2 Mound Plan and Cross Section Views 4 1110 B ; :' Observation Pipe lr t A W I :l B I _a L Mound Component Dimensions A A17.00 ft E 31.40in H 1.00ft K 191ft ft B ft F 9.50 in z 29.31 ft L ft D in G 0.50 ft J 5.08 ft W . 450.00 (ft2}Di spersal Cell Area 1 2648.44 (ft) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 1 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 101.6.1 (ft) G I F dispersal 100.32 (ft)Lateral 99.82 (ft) Invert Dispersal Cell Elevation E D Y.. � �i ice.?'.i e�.1�..,.. � J J,,J,t y�{ •y ni:.�..�n i.J�: :r. rnry:.n�� � �r+.Lf •r-��f � P�} �vy.+Z.,r ��h,Ct.%a�N '..�,rJ U ' l,.�. .: �?.,�.t Z 4:t ,,ya� � ---> �- 98.40 (ft) Contour Elevation 20.0 % Site Slope —#-- Geotextile Fabric.Cover Shading Key o I Dispersal Cell See lateral details on . 10 Topsoil Cap c 1.5 ft „ Page 4 for number,size, and spacing of laterals. Subsoil Cap N 0 ASTM C33 Sand � t° f F Laterals are equally =a Z spaced from the FA� TvQtica{Lateral �2• �` Tilled Layer d � 0.5 ft distribution cell's Q Aggregate �*o _ centerline in the A distribution cell(AxB). Project: Jondal 3 Bedroom Mound Page 3 Center Connection Lateral Layout Diagram Force main connection via tee or cross to manifold at any point, Laterals are identical IE IP •=Turn-upv.i bsllvalveor jEX-��EAr2 , xr241 Laterals&forcemain Sch 40 PVC oleanoutplug per SPS Table 384.30 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.188 in Lateral Diameter 1.50 in Orifice Spacing (X), 2.53 ft Lateral Length (P) 36.69 ft Orifices per Lateral 15 Lateral Spacing(S) 3.00 ft Orifice Density 7.50 ft2lorifict Lateral Flow Rate 9.83 gpm Manifold Length 3.00 ft System Flow Rate 39.32 gpm Manifold Diameter 1.50 in Total Dynamic Head 16.05 ft Forcemain Velocity 4,02 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight I Electrical as per NEC 300 and —► SPS 316.300 WAG D 4 in.min. Disconnect Tank component is properly vented Alternate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. Capacityl 650.00 Gallons T Volume 17.00 gal/inch A _ Weep hole or anti Dimension Inches Gallons B siphon device A 20.56 349.45 B 2.00 34.00 C Pump off elevation(ft) C 4.68 79.55 89.92 D 11.00 187.00 D Total 38.241 650.00 iF Do, se tank elevation(ft) 3" Bedding un er tank. 89.00 Alarm Manuafacturer ISJE Rhombus Note: Switches Alarm Model Number I Tank Alert AB �— containing mercury may not be used in Pump Manufacturer Zoeller this system, Pump Model Number 1152 Pump Must Deliver 39.32 gpm at F---1-6-0-51 ft T D H Project: Jondal 3 Bedroom Mound Page 4 Mound System Maintenance and Operation Specifications Service Provider's Name �— John Schmitt Phone 715-760-0486 POWTS Regulator's Name St. Criox County Zoning Phone 715-386-4680 System Flow and Load Parameters Design Flow- Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow-Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 3 years Moundl Ins ect for ponding and seepage once every 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis.Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis.Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished ............... Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Jondal 3 Bedroom Mound Page 5 Mound System Management Plan Pursuant to SPS 383.54,Wis.Adm.Code General This system shall be operated in accordance with SPS 382-84 Wis.Adm.Code,and shall maintained in accordance with its'component manuals(SBD-10691-P(N.01/01,R. 10/12),SSWMP Publication 9.6(01/81),and Pressure Distribution Component Manual Ver.2.0 SBD- 10706-P(N.01/01,R. 10/12)]and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33,Wis.Adm.Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers,access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound,defective,or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s.281.48,Stats. The contents of the septic tank shall be disposed of in accordance with NR 113,Wis.Adm.Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm,the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment,maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump(dosing)tank shall be inspected at least once every 3 years. All switches,alarms,and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter,and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic(other than for vegetative maintenance)on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations(October-February)dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS,and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS,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. Continuency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank,pump,pump controls,alarm or related wiring becomes defective the defective component(s)shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface,it will be repaired or replaced in its'present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media,and related piping,and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. 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PL-525 Filter The PL-525 Filter is rated for 10,000 GPD(gallons per day)making it one of the largest filters in its class.It has 525 linear feet of 1/16"filtration slots.Like the Polylok PL-122,the Polylok PL-525 has an automatic shut-off ball installed with every filter.When the filter is removed for cleaning,the ball will float up and temporarily shut off the system so the effluent wont leave the tank. Features: 1/16" Filtration Slots Alarm Switch • Rated for 10,000 GPD(gallons per day). (optional) • 525 linear feet of 1/16"filtration. 10, GPD • Accepts 4"and 6"SCHD 40 pipe. G� Extension on Hand e • Built in gas deflector. • Automatic shut-off ball when filter is removed. for • Alarm accessibility. 110,000 GPD • Accepts PVC extension handle. PL-525 Installation: Ideal for residential and commercial waste flows up to 525 Linear Ft. of 10,000 gallons per day(GPD). Filtration Slots 1.Locate the outlet of the septic tank. 2.Remove the tank cover and pump tank if necessary. Accepts 4"&6" 3.Glue the filter housing to the 4"or 6 outlet pipe.If SCHD 40 pipe the filter is not centered under the access opening use a Polylok Extend &Lok or piece of pipe to center filter. 4.Insert the PL-525 filter into its housing. to 5.Replace and secure the septic tank cover. certified d p p NSF/ANSI Standard 46 PL-525 Maintenance: The PL-525 Effluent Filters will operate efficiently for several years under normal conditions before requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped,or at least every three years.If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter J::== needs servicing.Servicing should be done by a certified Gas Deflector septic tank pumper or installer. Automatic Shut Off Ball 1.Locate the outlet of the septic tank. 2.Remove tank cover and pump tank if necessary. 3.Do not use plumbing when filter is removed. , 4.Pull PL-525 cartridge out of the housing. �^ 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank. K : 6.Insert the filter cartridge back into the housing making Sure the filter is properly aligned and Completely nSerbE'd. Outdoor Sinmhilter,-"�Alarm extend&1,ok111 Polylok,Zabel&Best filters accept Easily installs 7.Replace and secure septic tank cover. the SmartFilter®switch and alarm. into existing tanks. Polylok,Inc. 3 Fairfield Blvd. Wallingford,CT 06492 Toll Free:877.765.9565 Fax:203.284.8514 www.polylok.com Page 8 SECTION: 2.20.047 `Q21&/TY/C!/MP6�AOT /9,79„ FM1919 0110 ® l0 Supersedes Product information presented here reflects .Consult a time 2*211"P l0. 1108 of publication.Consult factory regarding discrepancies or visit our web site: inconsistencies. MAIL TO. P.O.BOX 16347•Louisville,KY 40256-0347 SHIP TO: 3649 Cane Run Road •Louisville,KY 40211-1961 www.zoeller.com (502)778-2731.1(800)928-PUMP•FAX(502)774-3624 COMPARE THESE FEATURES • Durable cast iron construction 151/1521153 EFFLUENT SERIES • Model 151 comes standard with a glass-filled polypropylene base (For Pump Prefix Identification see News& Views 0052) • Corrosion resistant powder coated epoxy finish • Stainless steel lifting handle " D O S E _MATE " • Assembled with stainless steel bolts • Non-clogging engineered thermoplastic vortex FOR SEPTIC TANK-LOW PRESSURE PIPE(LPP) impeller design AND ENHANCED FLOW STEP SYSTEMS • Model 151 -1/3 HP passes Y2'spherical solids crpstt EFFLUENT • Model 152-.4 HP passes%"spherical solids ;°! SUBMERSIBLE • Model 153-1/2 HP passes%"spherical solids 1'/2" NPT DISCHARGE • Motor-60 Hz,3450 RPM,oil-filled,hermetically sealed, automatic reset thermal overload protected Model N152/N153 • Carbon/Ceramic seals ® High Head C u Effluent • Upper sleeve bearing and lower ball bearing running Tested to UL StandardUU78 and in bath of oil StandCW2.2NNo.108 • 20 ft. UL Listed power cord with molded 3-wire plug • 1 Y2" NPT vertical discharge MODELS AVAILABLE • BN and BE standard models include a 20 ft.variable N151/N152/N153&E151/E152/E153 nonautomatic level float switch •BN151/BN152/BN153&BE151/BE152/BE153 • Operates at temperatures to 130°F 54°C in effluent packaged 2 H Piggyback Variable Level Float Switch p l� ( ) •113,.4&1l2 HP,1 Ph 115V or 230V applications • All models include a 1Y2"x 2" PVC adapter fitting Note:The sizing of effluent systems normally requires variable level float(s)controls and properly sized W basins to achieve required pumping cycles or dosing timers with nonautomatic pumps. POWDER COATED TOUGH" PUMP l0_ Model BN152/BN153 MAIL T0: P.O. BOX 16347 High Head Louisville,KY 40256-0347 Effluent SHIP TO: 3649 Cane Run Road Louisville,KY 40211-1961 (502)778-2731.1(800)928-PUMP FAX(502)774.3624 Manufacturers of.. .�! p Z® Q&&1TV PUMPS sNCF 19,Jq " ©Copyright 2010 Zoeller Co.All rights reserved. Page 9 TOTAL DYNAMIC HEAD/FLOW w w PUMP PERFORMANCE CURVE PER MINUTE MODEL 151/1521153 EFFLUENT AND DEWATERING so 14 45 153 MODEL 151 152 153 12 40 Feet Meters Gal. Liters Gal. Lders Gal. Liters 9 3 5 1.5 50 189 69 261 77 291 = 10 15 10 3.0 45 170 61 231 70 265 30 15 4.6 38 144 53 209 61 231 0 8 25 151 20 6.1 29 110 44 167 52 197 25 7.6 16 61 34 129 42 159 ° 5 20 30 9.1 — — 23 87 33 125 35 t0.7 — — — — 22 85 40 12.2 4 Shut-off Head: 30 ft.(9.1m) 381E(11.6m) 44 R(13.4m) 10 014508B 2 5 Model 151 Models 152/ 153 to A 30 0 50 60 70 80 90 100 GALLONS 67!32 67132 LITERS 0 40 80 120 180 200 240 280 320 360 3718 4518 3716 4518 FLOW PER MINUTE 014508A CONSULT FACTORY FOR tt e SPECIAL APPLICATIONS o e 3716 ° I 3718 e •Timed dosing panels available •Electrical alternators,for duplex systems,are available and I 117 NPT supplied with an alarm •Variable level control switches are available for controlling single phase systems •Double piggyback variable level float switches are available for variable level long and short cycle controls •Sealed Qwik-Box available for outdoor installations-See 1111116 z,re FM1420 •Over 130°F(54°C)special quotation required 415/6 u6 15111521153 Series I SK2444 SK2064 15111521153 MODELS Control Selection Model Volts-Ph Mode Amps Simplex Duplex N151 115 1 Non 6.0 1 2or3 BN 551 115 1 Auto 6,0 Included 2or3 E151 230 1 Non 3.2 1 2 or 3 BE151 g2301 Auto 32 Included 2or3 °Easy assembly° N152 Non 8.5 1 2 or 3 (pump&discharge pipe BN152 Auto 8.5 Included 2 or 3 not included.) E152 Non .3 1 2 or BE15 Auto 4.3 Included 2 or 3 N153 Non 10.5 or 3 BN153 Auto 105 Included 2or3 E153 Non 5.3 1 2or3 BE153 230 1 Auto 5.3 1 Included 2 or 3 SELECTION GUIDE OPTIONAL PUMP STAND PIN 10-2421 1. Single piggyback variable level float switch or double piggyback variable level Reduces potential clogging by debris float switch. Refer to FM0477. • Replaces rocks or bricks under the pump 2. See FMO712 for correct model of Electrical Alternator E-Pak. Made of durable,noncorrosive ABS 3. Variable level control switch 10-0743 used as a control activator,specify duplex Raises pump 2"off bottom of basin (3)or(4)float system. Provides the ability to raise intake by adding sections of 1 W or 2•PVC piping A CAUTION • Attaches securely to pump All installation of controls,protection devices and wiring should be done by a qualified • Accommodates sump,dewatering and effluent applications licensed electrician. All electrical and safety codes should be followed including the NOTE:Make sure float is free from obstruction. most recent National Electrical Code(NEC)and the Occupational Safety and Health Act(OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. ©Copyright 2010 Zoeller Co.All rights reserved. Page 10 PLOT PLAN N7 Project Name: Jondal 3 Bedroom Mound Legal Description: NW1 14,NW1J4,S8,T30N,R18W P.I.D: 032-2031-30-000 Subdivision Name: na Lot#: 4 SCALE:1"=40' Township: Somerset Parcel Size: 5.000 Acres . Courity: St.Croix Contour Line Elevation: 98.40 Cell Dimensions: 6'X 75' 4 inch Sch 40-ASTM D2665 System Elevationj 99.82 Mound Dimensions:197.85'x 40.39` 1 2 inch Sch 40-ASTM 01785 Slope` 20o/u 11/2 Sch 40-ASTM D1785 AL BM1 Elevation: 100.00' To of 2"PVC i e BM2 Elevation: 99.94' Top of 2 PVC pipe ■ Backhoe Pits: Existing Tank:'1000 gallon Septic Tank New Tank: 10DD allon Se tic Tank with Poi lok 525,650 gallon Pump Chamber I f j V f ' i`C:�" i� 1" ` i `\C Z / Co i5!r AiZcA X 4- ,7(0,0 Page 11 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Steven & Mary Ann Jondai Mailing Address 415 169th Avenue Property Address 415 169th Avenue (Verification required from Planning&Zoning Department for new construction.) City/State Somerset, WI Parcel Identification Number 632-2031-30-000 LEGAL DESCRIPTION Property Location NW 1/4, NW `/4, Sec. $ , T 30 N R 19 W, Town of Somerset Subdivision Plat: , Lot# 4 Certified Survey Map# ,Volume ,Page# Warranty Deed# (before 2007)Volume ,Page# Spec house 13yesOno Lot lines identifiable Byes[]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 wi in 30 days of the three year expiration date. I/we certify that all statements 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 arranty deed recorded in Register of Deeds Office. Number of bedrooms 3 SIGN,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. (REV.04/12) ST. CROIX COUNTY ZONING OFFICE I CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) i This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) 415169th Avenue located at: NW 1/4, NE 1/4, Section 8 , Town 30 N. Range 19 W, Town of Somerset , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service 4/17/2015 Did flow back occur from absorption system? Yes X No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: 1000 Construction: Prefab Concrete X Steel Other Manufacturer (if known): unknown Age of Tank (if known): Permit number (if known) a4 �'�C'_4� John Schmitt (L censed Plumber Signature) (Print Name) MPRS 223760 (Title) (License Number) MP/MPRS 5/18/2015 (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 II I�I�III�IIIIIII��IIIIIII�)�II 8302453 State Bar of Wisconsin Form 2-2003 Tx:4249081 WARRANTY DEED 1012050 BETH PABST Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI 05/14/2015 11:49 AM THIS DEED, made between Steven A. Jondal and Ma[y Ann E.Jondal, EXEMPT#: NA husband and wife,as survivorship marital property REC FEE: 30.00 ("Grantor,"whether one or more), TRANS FEE: 1047.00 and Joel Radjenovich and Peggy Radjenovich, husband and wife PAGES• 2 ("Grantee,"whether one or more). Grantor, for a valuable consideration,conveys and warrants to Grantee the following Recording Area described real estate, together with the rents, profits, fixtures and other appurtenant interests, in ST CROIX County, State of Wisconsin ("Property")(if more Name and Return Address space is needed, please attach addendum): Partners Ti 1330 Ho rd St. fffy'P�rt('A dson�fit• Huds WI 54016 G�ix—GOU�Rty,4visconsin. � �/��� , 25 22 "— C'�`•-'o, 6'J 1�►`! 032-2031-30-000 SParcel Identification Number(PIN) This IS homestead property. (is)(is not) Exceptions to warranties: Dated May 1,2015 G. (SEAL)' * Steven A. fondal r* Mary nn E.Jon441 . (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) da STATE OF MINNESOTA ) authenticated on r• LORRIE L.DEMARS )ss. WASHINGTON COUNTY ) Minnesota * Personally came before me on May 1,2015 TITLE: MEMBER STATE BAR OF WISCONSIN the above-named Steven A.Jondal and Mary Ann E. (If not, to me known to e the pers who a ec the foregoing authorized by Wis. Stat. § 706.06) / instrument and'acknow ge he THIS INSTRUMENT DRAFTED BY: f' * Lorr' L. Della Bruce Clark Nota Public, State. innesota M omt tissio s permanent)(expires: 1131/2020 ) (Signatures may be authc(tics or acknowledged. Both are not necessary.��nn l° NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BIT` krRkt%IDENTIFIED. WARRANTY DEED O 2003 STATE BAR OF WISCONSIN FSA Title Services,Ili ZI NO,2-2003 *Type name below signatures. 5649 Memorial Avenue North °` Stillwat r $SO$2 St. Croix County 101205fl Page 1 of 2 Flle # U S r' EXHIBIT "A" LEGAL DESCRIPTION File No.: 25942 A parcel of land located in Northwest Quarter of Northwest Quarter of Section 8-30-19, Town of Somerset, more fully described as follows: Lot 4 of a Certified Survey Map filed April 19, 1976, in Volume 1, Certified Surveys, page 225, #332522 in the office of the Register of Deeds, together with the right of ingress and egress over the roadway described in the above Certified Survey, St. Croix County, Wisconsin. File No.: 25942 Exhibit A Legal Description Page 1 of 1 St. Croix County 1012050 Page 2 of 2 1. r� APR 191976 This replaces the Survey &AW5 in Volume 1 Page 191 CERTIFIED SURVEY MAP '' I_)52 42 I, Arthur L. We erer g , registered land surveyor, hereby certify: That in full compliance with the provisions of Chapter 236.34 of the Wisconsin Statutes and under the direction of Ferris S. Mahmood, owner of said land, I have surveyed, divided, and mapped said parcel of land, that such plat correctly represents all exterior boundaries and the subdivision of the land surveyed; and that this land is located in the ,! NW4 of the NW4 of Section 8, T 30 N, R19 W, Town of Somerset, St.Croix County, Wisconsin, to-wit: Commencing at the Northwest corner of Section 8; thence N 87°39*00" E along the Section line 836.301 to the point cf beginning; thence continuing N 87°39*0011 E 526.36* ; thence S 00 033130" E 1325.74* ; thence S 87057.40" W 798.87• ; thence N 06038*55" W 970.13* ; thence N 88015'45" E 386.67+ ; thence N 02-21*00" W 358.00* to the point of beginning. Subject to a 66• wide easement road as shown. Dated this 6th. day of April, 1976. aixLti., -�✓✓ � Arthur L. Wegerdl- APPROVED Wis. R.L.S. No. S-963 ST. CROIX COUNTY G0M"te[•IENSVVE PARK$ PLA"NINCG AND ZOMIAG C o'E9/ 1 7/7 5 N 87059`OQ"E 526. Amended 4119176 CKS 60 5 R NW CORNER M m� SEC. 8-30-19 31: $ APPROVAL OF THtS MINOR SUBDIVISION S M LOT 2 _N DO-ES t•:OT ",!Efisd AP?ROVAL FOR SEP71C ` N 6.766 ACRES SYSTEM. RIFER TO 1162.20 0 LO 880155" 4 E 386.67' Z 200 N aso 386,67' ORTH LOT I 36 418.26' TO (P_N 5.099 ACRES EAST SCALE—I"=200' O ^pa- W o = ["X24' IRON PIPE WEIGHING 0 1.13 LBS./LINEAL FT tom- w � r� • =IRON PIPE FOUND ti Cn a �8✓ LOT g � 60 ��tri M�c`j 6.274 ACRES N m Z ti: le `L .A2ru+J2 L N -3 .S i ELLS`Y•'� � E �, wrs. LOT 4 F ° _0D -r- 5.000 A S tZ., •.0 RV' 0 17- 798.87 Volume 2 Page 225 S -Is 5 on � `' Tank Anchoring: Per SPS 383.43(8)(8), Wis. Adm. Code, all tank(s)must be anchored whenever they are at risk for being installed in an area where they may be located in saturated conditions all/part of the year. Using soil as the anchor has become an acceptable alternative to concrete. • Flotation potential is the displacement of the tank calculated by its volume in cubic feet. Line A: Calculate cubic feet of tank. ,.Y-5 inches high,x u!inches wide,x/'Jb inches long,_(,(Eje1?cubic inches. Divide this number by 1728 to equal386-t3 cubic feet. Line B: Convert the displacement to the weight of water. ,;66,V (from line A)cubic feet x 62.4 (weight of 1 cubic foot of water) x 1.5 (safety factor)_ 36 z Y lbs, of lift potential. Line C: Calculate weight needed to counter buoyancy. 367-04 lbs. (Displacement weight from line B.) - J qyqy lbs. (weight of tank per manufacturer) =lbs. of soil needed to anchor tank: Z/2.6 q lbs. Line D: Weight of the soil media including safety factor needed over the tank to anchor the tank adequately. Tank cover width inches x tank cover length /IV(v inches, divided by 144= S .2- square feet x 0.083 (1 inch in foot decimal)= 7 J cubic feet(volume of 1 inch of space over the tank cover). Line E: Calculated weight of 1 inch of space over entire cover. 'Z/ cubic feet of space (from line D)x 100 lbs./cubic foot of=710 lbs./inch space above cover. Line F Calculate inches of soil needed to counter buoyancy . Z/264 lbs. (from line C)divided by j/O lbs. per inch of soil (from line E)=inches needed' over tank cover. 30" tj6ej)j g) Z,R "7",4A/tC OWNERSHIP CERTIFICATION FORM Owner/Buyer Joel & Peggy Radjenovich Mailing Address 415 169th Ave Property Address Same (Verification required from Planning&Zoning Department for new construction.) City/State Somerset, Wl Parcel Identification Number 032-2031-30-000 LEGAL DESCRIPTION Property Location NW 1/4, NW 1/4, Sec. 8 ,T 30 N R 19 W,Town of Somerset Subdivision Plat: Lot# 4 Certified Survey Map# ,Volume ,Page# Warranty Deed# (before 2007)Volume ,Page# Spec house[3yesEho Lot lines identifiable E]yesE]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 o 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 arranty deed recorded in Register of Deeds Office. Num r of bed 3 aj 5/t1l/s� SIGNXtIRE OF APPLICANTS) 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) De artrne44t 7 #1774 Safety and b SOIL EVALUATION REPORT Page 1 of 4 ,,�_�,.p� 1'n accordance w' Co m Nis.Adm.Code 9 �_ Professional [vltR9 Schmitt Soil Testing,Inc. r Attach complete site plan on opel� �ie88 then d if'4AThe�in size. Plan must County St.Croix include,but not limited to:,)wtical_snil:hotizbrit.1 reference point(BM),direction and percent slope,scale or di"i hsions,north arrow,and location and distance to nearest road. Parcel l 032-2 31- 000 Please print all information. Revie By Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). !, 'L15 Property Owner Property Location Jondal,Steve&Mary Ann Govt.Lot W1/4, N 1/4, 8,T30N, R19W Property Owner's Mailing Address Lot# Block# Subd.Name or ISM# 415 169th Ave. 4 1 Csm VOL 1/225 City State Zip Code Phone Number ❑ City ❑Village ❑ Town Nearest Road Somerset WI 1 54025 1 651-485-2085 Somerset I 169Th Ave [�New Construction Use: ❑ Residential/Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement ❑ Public or commercial-Describe: Parent material Glacial Till(Amery Series) Flood plain elevation,if applicable NA ft. General comments Area is suitable for a Mound system. System elevation is 99.56'based off the contour line established at 98.40'. slope of the area and recommendations: is 20%. Depth to limiting factor is 22". F1-1 Boring# Boring Pit Ground surface elev. 99.46 ft. Depth to limiting factor 29 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-9 10yr3/4 none grsl 2fsbk mvfr as 2vf 0.6 1.0 2 9-16 7.5yr4/6 none grscl 2msbk mfr gW 1vf 0.4 0.6 3 16-29 7.5yr4/6 none grsl imsbk mfr gW lvf 0.4 0.7 4 29-38 7.5yr4/4 c2d 7.5yr6/6 grsl Om mfi cs 2m 0.2 1 0.6 7.5yr6/1 5 38-62 10yr5/6 c210;�r2/6 sl Om mfi - 0.2 0.6 a Boring# ❑Boring Pit Ground surface elev. 99.86 ft. Depth to limiting factor 28 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-4 10yr3/2 none sil 2mgr mvfr as 2vf 0.6 0.8 2 4-8 10yr5/3 none sil 1mpl mvfr a 2vf 0.6 0.8 3 8-28 10yr4/6 none sicl 2fsbk mfr gW 2vf 0.4 0.6 4 28-42 10yr5/6 c2d 10yr6/6 fsl Om mfi cs ivf 0.2 0.5 10yr6/1 5 42-54 5yr4/4 c2d 5y5yyJ2/6 sl Om mfi ---- ------ 0.2 0.6 *Effluent#1 =BOO S>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BODS<_30 mg/L and TSS S30 mg/L CST Name(Please Print) Signature: CST Number Thomas J.Schmitt 227429 Address Schmitt Soil Testing,Inc. Date Evaluation Conducted Telephone Number 1595 72nd St.New Richmond,WI 54017 4/13/2015 715-760-1978 SBD-8330(R.07/00) Property Owner Jondal,Steve&Mary Ann Parcel ID# 032-2031-30-000 Page 2 of 4 Boring ` F Boring# ®Pit Ground surface elev. 94.76 ft. Depth to limiting factor 22 in, Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#t I *Eff#2 1 0-3 10yr3/3 none sil 2mgr mvfr as 2vf 0.6 0.8 2 3-17 10yr4/4 none A 2fsbk mvfr gw 1vf 0.6 0.8 3 17-22 7.5yr4/6 none sid 2msbk mfr gw 2vf 0.4 0.6 4 22-29 7.5yr4/4 m2d 7.5yr6/6 sid imsbk mfr gw ------ 0.2 0.3 7.5yr6/1 5 29-52 10yr6/6 m2d 10 i/6 � Om mfi ---- ------ 0.2 0.5 F ❑Boring 4 Boring# n Pit Ground surface elev. 95.96 ft. Depth to limiting factor 19 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Erf#1 *Eff#2 1 0-6 10yr3/2 none A impl mfr cs 1vf 0.6 0.8 2 6-11 10yr4/64 none sid 2mfsbk mfr gw lvf 0.4 0.6 3 11-19 7.5yr4/6 none A imsbk mfr gw 1vf 0.4 0.6 4 19-30 7.5yr4/4 c2d 7.5yr6/6 sl imsbk mfir 7.5yr6/1 gw ------ 0.4 0.7 5 30-54 5yr4/6 c2d 107.5yr6/6 7 5 r6 2 sl Om mf ---- ------ 0.2 0.6 F-1 ❑ 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/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 *Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD5<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-8330(R.07/00) Schmitt Sod Testing,Inc. _Conducted For. Page 3 of 4 Marx-Ann.JondAl _-:--- Thomas J. Schmitt, CST 227429 Address: 415169th Ave. 586valtey View Trait__ __ _ _--.. . - ---city, State,dip. Somerset,WI 54025, - -- ----_._Somerset,W1 x4025.----- Phone:715 7 01978 Subdivision: CSM Vol 11225 Signature L% - lot NO. : 4 —_ ;-Date ® Backhoe Pit _ Township, County: Somerset Township,St.Croix Count k Bench Mark 1 EI. 100.00'Top of 2'PVG pipe. -- L� Bench-Mat k-2--E1-99.94'- -Z"fv/£pipe. -- - -- -- - - - Top of existing Septic Tank Manhole cover El.99.81' Slope= 20% - - - - - On/ 7bu2 1-/n/6 Z&lve,71-1 7S' L'f�S7 y� LINI_' 60 a oe i f _ -- -- �,4- - C�iSTM/4- P�A� �; SC - - - — _ - -- - - - L.o -- -- W N N a # F3 ' �La t W .F N N �Iy tLx N t O tV +:tA u.� Cs M A i J N +yLS yi I U Ay T'fra GR�O T N N�N iJl Cr Cx' NT. CD VI N 03 (S>S !"s W N N C:fl tj Zp 4Y 1 4x N S