HomeMy WebLinkAbout014-1018-90-000 Wisconsin Department of Commerce County:
PRIVATE SEWAGE SYSTEM St. Croix
Safety and Building Division
Sanitary Permit No:
INSPECTION REPORT 578945 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:
Bergmann, Richard & Eileen I Forest, Town of 014-1018-90-000
CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No:
08.31.15.127A
TANK INFORMATION A ELEVATION DATA Z.-25 /dZ•7j ZC:!S
TYPE MANUFACTURER `t CAPACITY STATION B HI FS ELEV.
1 IDl 16
Septic �•,�, S , / Benchmark
i O
Dosing `• I Alt. BMr[,.o
Bldg.Sewer
Holding St/Ht Inlet
5
SVHt Outlet
TANK SETBACK INFORMATION
TANK TO toP&, WELL BLDG. ent t Air Intake ROAD Dt Inlet
Septic �3 /ZO/ � Dt Bottom �•�
Dosing / J Header/Man. 13- 74 9
Aeration Dist.Pipe 3.7q I -6 t
Holding Bot.System y� •3 ��
I - 4.q
PUMP/SIPHON INFORMATION Final Grade z.-74 led - b I
Manufacturer a J� 5 Demand St Cover 1 -7-4 y`'
GPM
Model Number 314� u
e�—P 0!5 1�.✓L�V� !•�0 (q
6.7
TDH Lift Friction Loss System Head TDH Ft
13. -A Z'-A .zs
Forcemain Length / DiaZ Dist.to well Z O /
13d
SOIL ABSORPTION SYSTEM A !Z.
BEDITRENCH Width Length No. rench s �
PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth
DIMENSIONS 1 vv Ip 1 •�S e *-
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION t CHAMBER OR Aj+Type 2910,tem: �' UNIT Model Number:k I a&Jtti
DISTRIBUTION SYSTEM Srne
Header/Manifold /! Distributiolnl� �l 3 7 Ix Hole Size /-�! x Hole Spacing V�to Air Intake
Length :31 Dia�L Length �7 /"✓ DO
/ 5 Spacing Z `� /�(J J
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 C;H Bedlrrench Center ) / Bed/Trench Edges Topsoil
I Yes Q No Yes ra-] No
COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: /-ZJ/—a Inspection#2: / /
Location: 2750 220th Ave Clear Lake,WI 54005(SW 1/4 SE 1/4 8 T31 N R1 5W) 40 acres Lot �f Parcel No, 08A31 127A 1.)Alt BM Description= r �- _ ` � a ��
2.)Bldg sewer length= �,S � e K-" 6�-" C p t
-amount of cover= J
Plan revision Required? ❑ Yes No
Use other side for additional information.
Date Insepctor's nature Cert.No.
SBD-6710(R.3/97)
r County
" Safety and Buildings Division
'•' ® 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.)
Ty Madison,WI 53707-7162
MAY 0 8201b!
�1(n`tiAt '
I t3oww Application State Transaction Number //��
accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit 56 "7V
s required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address)
e Department of Safety and Professional Servies. Personal information you provide may be used for secondary
oses in accordance with the Privacy Law,s. 15.04(1)(m),Stars. ��Q
I. Application Information-Please Print All Information
Prope Owner's Name Parcel#
®/4/ -/o/S -- 70 - e000
Property Owner's Mailing Address /�, Property Location / —7
S F-00 AA AE ! 0 4UE, Govt.Lot (/° /
City,State / �,t Zip Code Phone Number s lyl ' �'/<, Section
A C S �h/" ® ON S S�y� 15 6 Q " 02y crrcle one
H.Type of Building(check all that apply) Lot# T �N; R E or
/Ll or 2 Family Dwelling-Number of Bedrooms Subdivision Name
Block#
11 Public/Commercial-Describe Use t
❑ City of
❑State Owned-Describe Use CSM Number ❑ Village of y
d *Town ofy l �G�
III.Type of Permit: (Check only one box on line A. Complete line B if applicable) ZU �a-
` . ❑New System )(Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain)
B. ❑Permit Renewal El Permit Revision El Change of Plumber ❑ List Previous Permit Number and Date Issued Permit Transfer to New /
Before Expiration Owner
IV.Type of POWTS System/Component/Device: Check all that apply) 6/'\N du /
❑Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ,Mound<24 in.of suitable soil
❑Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain)
V.Dis ersal/Treatm t Area Information:
Design Flow(gpd) Design Soil Application Rate(gpds Dispersal Area Require (sf) Dispersal Area Propose (sf) SystemCElevation
/-7 d cif S l %SD V� �/Jr� O Jam/
VI.Tank Info Capacity in Total #of Manufacturer
Gallons Gallons Units n l o o
New Tanks Existing Tanks [J C, a� 0 .0 Z I k %2 a U cis 67 ii. 5 0.
Septic or Holding Tank
Dosing Chamber 600 CC
VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name(Print) P17 Sign _.._.. RS Number Business Phone Number
Plumber's Address(Street,City,State,Zip Code)
1�6" OX 7/ l s 6
VIII Coun /De artment Use Only
Approved El Permit Fee Date Issue Issuing ent Signature
iven Reason for Denial
�z5 do 5 Iz 15
IX•Condit— for Disapproval n ,A
tank,if livent filter and 3) Ce n� +,o
distaerMal cell must all be services/maintained
as per management plan provided by plumber. J
2. All setback must be maintained (� 9 �� ��
as per al code%ordinances. l Q a
Attach to complete plans for the system and subilait to the County onif on paper not less than 8 121 11 inches in size
SBD-6398(R. 11/11)
1
&K
f !
f3a " 45 I
V �
MOO j
;;acopy
ol 4-
BRADY J UTGARD Page 2 11/5/2014
is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145,
Stats.
• The existing POWTS must be properly abandoned per s. SPS 383.33 Wis.Adm.Code.
• Maintain well and waterline set backs per SPS 383.43(8)(i).Consult the Department of Natural Resources for
well setbacks and other regulations and exceptions.
A copy of the approved plans,specifications and this letter shall be on-site during construction and open to
inspection by authorized representatives of the Department,which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction/installation/operation.
In granting this approval the Division of Industry Services reserves the right to require changes or additions should
conditions arise making them necessary for code compliance.As per state stats 101.12(2),nothing in this review
shall relieve the designer of the responsibility for designing a safe building,structure,or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any
others who are responsible for the installation,operation or maintenance of the POWTS.
Sincerely, Fee Required$ 250.00
Fee Received$ 250.00
Balance Due $ 0.00
Patricia L Shandorf
POWTS Plan Reviewer,Integrated Services WiSMART code:7633
(715)634-7810, Fax: (715)634-5150,M-F 8:00 a.m.-4:45 p.m.
pat.shandorf@wisconsin.gov
cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm
Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services(formerly
Safety&Buildings)will be modified. Code references with prefixes starting with"Comm"have been replaced with
"SPS"to recognize the relocation of the Division of Industry Services from the former Department of Commerce to
the Department of Safety&Professional Services.Additionally, all IS(formerly S&B)codes have been renumbered
and addressed in a"300"series. For future reference,the Wisconsin Commercial Building Code will be addressed
by SPS Chapters 360-366.
or�T+rF� DIVISION OF INDUSTRY SERVICES
n 10541 N RANCH ROAD
HAYWARD WI 54843
Contact Through Relay
9 p y www.dsps.wi.gov/sb/
°w www.wisconsin.gov
SIONP+�'� �
Scott Walker,Governor
Dave Ross,Secretary
November 05,2014
CUST ID No. 220357 ATTN.-POWTS Inspector
BRADY J UTGARD ZONING OFFICE
UTGARD PLUMBING&HEATING ST CROIX COUNTY SPIA
PO BOX 413 1101 CARMICHAEL RD
AMERY WI 54001 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 11/05/2016 Identification Numbers
Transaction ID No.2475040
SITE• Site ID No. 807673
Richard Bergman Please refer to both identification numbers,
2750 220TH Ave above,in all correspondence with the agency.
Town of Forest
St Croix County
SW1/4, SE1/4, S8,T3 IN,R15W
FOR:
Description:Mound,3 bedroom residence
Object Type:POWTS Component Manual Regulated Object ID No.: 1511107
Maintenance required; Replacement system; 450 GPD Flow rate; 20 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 CONDI
Distribution Component Manual-Ver.2.0, SBD-10706-P(N.01/01,R. 10/12), SSWMP Pub.9.6; Effluent Filter AP
DEPT OF
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes ' PROFESSI
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed OF IN
and located in accordance with the enclosed approved plans and with any component manual(s)referenced above.
The owner,as defined in chapter 101.01(10),Wisconsin Statutes, is responsible for compliance with all code
requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06,
stats. SEE COR
The following conditions shall be met during construction or installation and prior to occupancy or use:
Key Item(s)
• 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. In addition,the
owner must insure that the operation,maintenance and monitoring duties as described in section VIII of the
mound component manual are complied with.A copy of this information must be given to the owner upon
completion of the project.
Reminder
• The orientation of the mound system must be such that the longest dimension is oriented along the surface
contour per SPS 383.44(6)(a)2.
• Limit activities in the area 15'beyond the down slope edge of the mound per Mound Component Manual.
• Surface water drainage shall be diverted away from the system area per Mound Component Manual.
• Materials shall conform to the requirements of SPS 384.10.No fixture,appliance,appurtenance,material,
device or product may be sold for use in a plumbing system or may be installed in a plumbing system,unless it
BRADY J UTGARD Page 2 11/5/2014
is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145,
Stats.
• The existing POWTS must be properly abandoned per s. SPS 3 83.3 3 Wis.Adm.Code.
• Maintain well and waterline set backs per SPS 383.43(8)(i). Consult the Department of Natural Resources for
well setbacks and other regulations and exceptions.
A copy of the approved plans,specifications and this letter shall be on-site during construction and open to
inspection by authorized representatives of the Department,which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction/installation/operation.
In granting this approval the Division of Industry Services reserves the right to require changes or additions should
conditions arise making them necessary for code compliance.As per state stats 101.12(2),nothing in this review
shall relieve the designer of the responsibility for designing a safe building,structure,or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any
others who are responsible for the installation,operation or maintenance of the POWTS.
Sincerely, Fee Required$ 250.00
Fee Received$ 250.00
Balance Due $ 0.00
Patricia L Shandorf
POWTS Plan Reviewer,Integrated Services WSMART code;763.
(715)634-7810, Fax: (715)634-5150,M-F 8:00 a.m. -4:45 p.m.
pat.shandorf @wisconsin.gov
cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm
Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services(formerly
Safety&Buildings)will be modified. Code references with prefixes starting with"Comm"have been replaced with
"SPS"to recognize the relocation of the Division of Industry Services from the former Department of Commerce to
the Department of Safety&Professional Services.Additionally,all IS (formerly S&B)codes have been renumbered
and addressed in a"300"series. For future reference,the Wisconsin Commercial Building Code will be addressed
by SPS Chapters 360-366.
MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN
INDEX AND TITLE PAGE
Project Name: RICHARD BERGMAN
Owner's Name: RICHARD BERGMAN
Owner's Address: 5500 LACK ELMO AVE. N LAKE ELMO MN. 55042
2750 220 TH. AVE.
Legal Description: SW/SE/S8/T31 /R15W
Township: FOREST
County: ST. CROIX
Subdivision Name:
Lot Number: Block Number.
Parcel I.D. Number: 014-1018-90-50
Plan Transaction No.: TIONALLY
Page 1 Index and title ROVED
SAFETY AND
Page 2 Data entry NAL SERVI ES
Page 3 Mound drawings
Page 4 Lateral and dose tank -)USTR ER ICE
Page 5 System maintenance specifications
Page 6 Management and contingency plan
Page 7 Pump curve and specifications
Page 8 PLOT PLAN ESPONDEN
Page 9 SOIL EVALUATION
a
Designer: BRADY UTGARD License Number: 220357
Date: 10/29/14 Phone Number: 715-760-0946
Signature:
Designed Pursuant to the
Mound Component Manual for POWTS Version 2.0 SDB-10691-P(N.01/01),and
SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS(01/81)
Version 3.11 (R. 06/01) Page 1 of 9
Mound and Pressure Distribution Component Design
Site Information
R Residential or commercial Design Note: Sand fill(D)calculations assume a
300.00 Estimated Wastewater Flow(gpd) Table 83-44-3 in-situ soil treatment for fecal
1.50 Peaking Factor(e.g. 1.5= 150%) coliform of<=36 inches.
450.00 Design Flow(gpd)
4.80 Site Slope(%)
97.18 Contour Line Elevation(ft)
20.00 Depth to Limiting Factor(in)
0.50 In-situ Soil Application Rate(gpd/ftz)
Distribution Cell Information
56.25 Dispersal Cell Length Along Contour(ft) = 8.00 Cell Width (ft)
1.00 Dispersal Cell Design Loading Rate(gpd/fe)
1 Influent Wastewater Quality(1 or 2) Are the laterals the highest point
in the distribution Y
Pressure Disribution Information network?
E Center or End Manifold
2.67 Lateral Spacing(ft) If N above, enter the elevation(ft)
3 Number of Laterals of the highest point.
0.188 Orifice Diameter(in)(e.g. 0.25)
3.50 Orifice Spacing(ft)= 9.38 fe/orifice
2.00 Forcemain Diameter(in)
100.00 Forcemain Length(ft) Does the forcemain drain back? Y
86.00 Pump Tank Elevation(ft)
3.25 System Head (ft)x 1.3 16.31 Forcemain Drainback(gal)
12.51 Vertical Lift(ft) 75.35 5x Void Volume(gal)
2.12 Friction Loss(ft) 91.66 Minimum Dose Volume(gal)
17.88 Total Dynamic Head(ft) 31.46 System Demand(gpm)
Lateral Diameter Selection Manifold Diameter Selection
in. dia. options I choice in. dia. options I choice
01-0*25 1.25
00 1.50 x
2.00 x X
l� 1.50 x X 3.00
/ 2.00 x
3.00 x
Gallons/Inch Calculator
Treatment Tank Information 600.00 Total Tank Capacity(gal)
1000.00 Septic Tank Capacity(gal) 36.00 Total Working Liquid Depth (in)
weiser Manufacturer 16.67 gal/in (enter result in cell 1349)
Dose Tank Information Effluent Filter Information
600.00 Dose Tank Capacity(gal) POLYLOK Filter Manufacturer
16.67 Dose Tank Volume(gaVin) PL-525 Fitter Model Number
Weiser Manufacturer
Project: RICHARD BERGMAN Page 2 of 9
Mound Plan View
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1/10 B J
-
Observation Pipe 3
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
K
0 A. . .
C�
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...
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. . . . . . . . . . . . . . . . . . . . . . . . . . . * * * . . . . . . . . . . .
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L
Mound Component Dimensions
A 8.00 ft E 20.61 in H 1.00 ft K 9.95 ft
B 56.25 ft F1 9.50 in 1 10.55 ft L 76.15 ft
6.88 25.43
DA16.00 in G [-0.50 ft J Aft W Eaft
I 450.001(fe)Dispersal Cell Area 1 1043.191 (fe) Basal Area Available
I 8.001(gpd/ft) Linear Loading Rate 1 5.63 (ft) 1/10 B Obs. Pipe Placement
Mound Cross Section View
Aggregate Dispersal Area
Finished Grade 100.31 (ft)
H
G
............— . . . . .
Dispersal 6e11 99.01 (ft) Lateral
.. . . . . . . . . . . . . . . . .
98.51 (ft)-11101— .......i.-.-
. . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . Invert
Dispersal Cell
Elevation E D
...... . . . . . . . . . . . . . . .
. . . . . . . ...
. . . . . . . . . . . . . . .
r4l
97.18 (ft)Contour Elevation
4.8 % Site Slope Geotextile Fabric Cover
Shading Key fl T Dispersal Cell See lateral details on
Topsoil Cap CL 1.5 ft (T Page 4 for number,size,
a 0 0
2 C
Subsoil Cap and spacing of laterals.
-*0
ASTM C33 Sand F Laterals are equally
Tilled Layer C! 0.5 ft Typical Lateral spaced from the
distribution cell's
Aggregate 0 centerline in the
A ♦ distribution cell(AxB).
Project: RICHARD BERGMAN Page 3 of 9
End Connection Lateral Layout Diagram
Force main connection via tee or cross to manifdd at any point. Laterals are identical
P S
•=Turn-up u0ball valve or �X—)1<-s►2 x12 Later 8 nwin of PVC Sch 40
clesnout.plug per CO WTable84.30-5
vs drilledon�re6ettAmofH�elaw r8a --
Number of Laterals 3 Orifice Diameter 0.188 in
Lateral Diameter 1.50 in Orifice Spacing(X) 3.65 ft
Lateral Length(P) 54.75 ft Orifices per Lateral 16
Lateral Spacing(S) 2.67 ft Orifice Density 9.38 fe/orifice
Lateral Flow Rate 10.49 gpm Manifold Length 5.33 ft
System Flow Rate 31.46 gpm Manifold Diameter 2.00 in
Total Dynamic Head 17.88 ft Force-main Velocity 3.211 ft/sec
Dose Tank Information Locking cover with warning
label and locking device and
sealed watertight
Electrical as per NEC 300 and --00
Comm 16.28 WAC
Disconnect
4 in.min.
Tank component is property vented ='= F— Alternate outlet
location
Forcemain diameter
Weiser Manufacturer _r 2 in.
Capacityl 600.00 Gallons
Volume 16.67 gallinch A
Weep hole or anti-
Dimension Inches Gallons B siphon device
A 22.49 374.98
B 2.00 33.34 C Pump off elevation(ft)
C 5.50 91.66 � 86.50
D 6.00 100A2 D
Total 35.99 600.00
♦Dose tank elevation(ft)
3"Bedding uncler tank. 86.00
Alarm Manuafacturer LEVEL
Alarm Model Number DLV
Pump Manufacturer GOULDS
Pump Model Number EP05
Pump Must Deliver 31.46 gpm at 17.88 TDH
Project: RICHARD BERGMAN Page 4 of 9
i
Mound System Maintenance and Operation Specifications
Service Provider's Name UTGARD Phone 715-268-6995
POWTS Regulator's Name ST. CROIX Phone 715-386-4680
System Flow and 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 fe 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 monthly
Pressure System I Laterals should be flushed and pressure tested every 1.5 ears
Mound Inspect for ponding and seepage once every 3 years
INSPECT FILTER ONCE A YEAR
Miscellaneous Construction and Materials Standards
1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap,
and are secured in as shown in the mound component manual.
2. Dispersal cell aggregate conforms to Comm 84.30(6)(i), Wis. Adm. Code.
3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code.
4. Tillage of the basal area is accomplished with a mold board or chisel plow.
5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion
and help reduce frost penetration.
Lateral Turn-up Detail
Finished ••••....
Grade \
6-8"Diameter Lawn Threaded Cleanout
Sprinkler Valve Box . . . . Plug or Ball Valve
Distribution
Lateral
Long Sweep 90 or Two
45 Degree Bends Same
Diameter as Lateral
Project: RICHARD BERGMAN Page 5 of 9
Mound System Management Plan
Pursuant to Comm 83.54,Wis.Adm.Code
General
This system shall be operated in accordance with Comm 82-84 Wis.Adm.Code,and shall maintained in accordance with its'
component manuals[SBD-10691-P(N.01/01)and SSWMP Publication 9.6(01/81)]and local or state rules pertaining to system
maintenance and maintenance reporting.
No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death.
Septic and pump tank abandonment shall be in accordance with Comm 83.33,Wis.Adm.Code when the tanks are no longer used as
POWTS components.
Septic or pump tank manhole risers,access risers and covers should be inspected for water tightness and soundness. Access
openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound,
defective,or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an
effective locking device to prevent accidental or unauthorized entry into a tank or component.
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s.281.48,Stats. The contents of the septic
tank shall be disposed of in accordance with NR 113,Wis.Adm.Code. The operating condition of the septic tank and outlet filter shall be
assessed at least once every 3 years by inspection.
The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions
are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm,
the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending
continuous alarm.
The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the
tank. If the contents of the tank are not removed at the time of a triennial assessment,maintenance personnel shall advise the owner of
when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank.
The addition of biological or chemical additives to enhance septic tank performance is generally not required. However,if such
products are used they shall be approved for septic tank use by the Department of Commerce.
Pump Tank
The pump(dosing)tank shall be inspected at least once every 3 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 BOD5,150 mg/L TSS,and 30 mg/L FOG for septic tank effluent or 30
mg/L BOD5,30 mg/L TSS, 10 mg/L FOG,and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design
flow specified in the permit for this installation.
The pressure distribution system is provided with a flushing point at the end of each lateral,and it is recommended that each lateral be
flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test
when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution
within the dispersal cell.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner,and any
levels above 6 inches considered as an impending hydraulic failure requiring additional,more frequent monitoring.
Contingency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in
proper operating condition.
If the dosing tank,pump,pump controls,alarm or related wiring becomes defective the defective component(s)shall be immediately
repaired or replaced with a component of the same or equal performance.
If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface,it will be repaired or
replaced in its'present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal
media,and related piping,and replacing said components as deemed necessary to bring the system into proper operating condition.
See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider.
Project: RICHARD BERGMAN Page 6 of 9
. � r;aUtas PUM
Submersible
Effluent Pump
EP04
& EP05
Series
APPLICATIONS +Errlly sut �in high ■EP05 Impeller:Thermoptas ■Bearings:Upper and lower
Specifically designed for the g e turbine ail for tic enclosed design for heavy duty ball bearing
following uses: lubrication dent and of improved performance.
heat transfer. construction
• Effluent systems It Casing and Base:Rugged
• Homes Availablie for automatic and thermoplastic design provides AGENCY LISTING
• Farms'. superior strength and corrosion —
• Heavy duty sump 'Auto- resistance. s� sawaards nssmsabw
madc models+ndcnle C ��ue3as�s
•
Water!transfer Medea"Float Svrltch i Motor Housing:Cast iron
• Dewatering assembled and pme at the for efficient heat transfer, W-gmemt
Goedds Puesgrs is t50 90Qi
factory. strength,and durability.
SPECIFICATIONS ■Motor Cover:Thermoplastic
•Solids handling FEATURES cover with integral handle and
!•,"makimum.
float switch attachment points.
■EPt141mpe11er:The
•Capacities. up to 60 GPM, pc PO4 I pen design v�etth w ■Power fabler severe duty
•Total heads;up to 31 feet pump out vanes for mechanical
rated oil and water resistant
•Discharge size; 1'/z"NPT. seal protection.
•Mechahical seal:carbon-
rotary/ceramic-stationary,
BUNA-N elastomers. _ v
•rempetature: l►1/
1044 4'140"0 continuous
140 1(60")intermittent, METERS FEET
Fasteners: 300 series to I
t I
staaiie5s steel.
CapaW of running 9 30 _-- l
dry without damage to 1 _
Eomponents'. s zs' _ .__.. -rsrl
.. t
Motor: w i
•EP04 Single phase:0.4 HP, u 6
115 or M V, 60 Hz, 1550 c
RPM,
built in overload with
auto r s
tic reset.
•EP05 Single phase:0.5 HP, o s
115 V qir 230V, 60 Hz, 1550 EPOS
3 f U -
RPM,bwiit in overload with �=....s._.._.�`
automatic reset. s Er+u4
•Power cord 10 foot
standard fength. 1613 I ;
S1TW with three prong i
grounding plug. Optional 20 0 0
foot length, 16/3 S1TW with t 20 30 1 40 GPM
three prong grounding plug
__
(standard on EPOS). 2 a 6 s 10
m vfi
CAPACITY
Goulds Pumps
ctiis:.ttN�ility ttis,;.
�r +i ITT Inriustrtes
i7)C&MAPJ
o � i`V 1
q6
,
O
;7 75-0
a r
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v
joy j
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address fS6 0 A A/,f,�,��r� ,q��/y. �,fI�'� rd,osto /1+-N
Property Address 1?7S0 17o?6 (Jim
(Verification required from Planning&Zoning Department for new construction.)
City/State Parcel Identification Number d/ -/®� c/® -<�->o o
LEGAL DESCRIPTION
Property Location S W 1/4 , s r 1/4 , Sec. W , T3/ N R/S W, Town of
Subdivision Plat: , Lot#
Certified Survey Map# ,Volume , Page#
Warranty Deed# U 3 (before 2007)Volume , Page#
Spec house❑yes kno Lot lines identifiable yes❑no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed,by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in§SPS.383.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning&Zoning Department a certification form,signed by the
owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site
wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is
less than 1/3 full of sludge.
Uwe,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 ptic 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 orm are true to the best of my/our knowledge. Uwe am/are the owner(s)of the
property described above,by virtue of a warr ty deed recorded in Register of Deeds Office.
Number of be ms
SIGNATURE OF APPLICANT(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. ***
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 04/12)
DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982
WARRANTY DEED
8 3--=,I
KATHLEEN H. WALSH
REGISTER OF DEEDS
This Deed, made between ST. CROIX Co., NI
Eleen__ --------------Bergmann,__husband__and-_wife____________________ __
RECEIVED FOR RECORD
--------------------
-------------------------------- ------------ --------------------------•, Grantor, 12/04/2006 11-00AN
and__Richard--J.__Bergmann-_and__Eileen__R_,___Bergmann,___
as__Trustees_----of the__Richard_ J. --_____ WARRANTY DEED
Agreement__dated__5eptember___�O,__1 997___ - _ ----- EXE1P7 16
----------------
---------------- -•---------------------------------- ---------------------• Grantee, REC FEE: 13.00
Witnesseth, That the said Grantor, for a valuable consideration.____ TRANS FEE:rnpy
.-_______________________---------------------------------------_-----------------_----------------------
________ RETURN r-6,i a. ewb
cone s to Grantee the following described real estate in St. Croix__- PO Box Z N erg II
County, State of Wisconsin:
Stillwater MN 55082
Legal description attached Tax Parcel No: __attached
I
This __.-_is_ not ----- homestead property.
(is) (is not)
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And------------------------------------------------------------------- ------- --------------•-------------•--------------•-----•--------------•------...
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
and will warrant and defend the same. /
Datedthis - ----------------- 4F . ------------------ day of ------------- -------------------------------.�0_c2.6-.
(SEAL) --------(SEAL)
Richard J. _Bergmann
-------•---•----•---------------------------- ------------------- -
------(SEAL) �---1 -- �"= .......(SEAL)
_ - * -Eileen__R.__•Bergmann-------•-•----
------------------
-------
AUTHENTICATION ACKNOWLEDGMENT
Signatures) STATE OF S6 3f"XXki-X MINN OTA
as.
O °
-----------------------•------------- -----------------------------------------
- ------ ----County. 7
authenticated this ________day of___________________________ ----- Personally came before me this day of
-------- -------------- --2-j745_`the above named
---------------------------------•---------------------------------------------- R �h�,�d-'7-•---���'3m�iii?---�?3.d__�.X�e�I1------°
*-°•------------------------------------------------------------------------- R.__B rgmanns__h ?s_k2@lO n h' €-----------
TITLE: MEMBER STATE BAR OF WISCONSIN _______________•_______•
(If not- ----------------------------------------------------------- ---•------- ----------- ---------------------------------------------------
----------------------
authorized by § 708.06,Wis. Stats.)
to me known to be the person ------------ who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED GY
David M. Newbe.. P-- Box 206
.__..__.---- � J- '---• __------•----••-----._.---
Stillwater, MN 55082 `-•----------------------•-•---- - --- ---- -
----- Notary Public -_.._.___•____________________________•.__County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commissi piration
are not necessary.) DAVID t I V ERG
date: - mr;., Rrtfie--•----� )
Minnesoia
1 f 2 •Manses of persons signing in any capacity should be typed or printed below tb.Ir signatures. C0W1ieswl .fanua 31.20111
WARRANTY DEED STATE BAR OP WISCOVR1N -^• - —• - -
•r
Legal description:
An undivided One-Half of the following described parcels:
E 1/2 of SW 1/4 and the W 1/4 of SE 114 of Sec.
8-31-15.
Together with a right of way Easement across the following described property:
Beginning at the Northwest corner of the W 1/2 SW 1/4; thence Easterly along the
North line of said W 1/2 SW 1/4 1320 feet to the Northeast corner of the W 1/2 SW
1/4• thence South 33 feet
thence West and P arallel to North line of said W 1/2 of
SW 1/4, 1197 feet; thence directly Southwest to a Town Road; thence Northerly
Pi f Beginning, t. Croix Count
along said Town Road to Point o g g, S y, Wisconsin
and
E 1/2 of W 1/2 of SE 1/4 of Section 8-31-15, St. Croix County, Wisconsin
and
The East 660 feet of the E 1/2 of NW 1/4 of Section 8-31-15
Parcel nos. 014-1018-10, 014-1018-50, 014-1018-90, 014-1017-50, 014-1017-95, 014-
1017-70, 014-1018-80
2of2
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RECEIVED
Ws.Dept.of S MELI'of essional Services SO11— 'E- iALUA I ION REPORT Page
OS- i�iFka �I�f
�OMMUNeN D' In acco rdance with SPS 85 �fJts. Adm. Code County
Attach complete site plan on paper not less than 8 112 x 11 inches in size.Plan must '
4M direction and
Parcel I.D.
on Par I
I reference n >,
d hori_onta (
• i d io:vertical an ,.
include,but not I mi,e
distance rest road. +. '"
- c!:nt slope,scale or dimensions, north arrow,and location a.,c to nearest per p
Please print all information.
P,evi, ed by Date
Personal information you provide may Le used for secondary purposes(Privacy Law s. 15.04(1)Q»)). 5 I�
Proper y Owner Property Location ,,��
f' Govt.Lot 5tJ 1/4 1-.a/4 T 31 N R � E(o VV
Property Owner's Mailing dress L_ot# Block# Subd.Name or SM#
v t�T� J.PN I i�, 1,7
City State Zip Code Phone Number Cibr ❑Village Town Nearest Road
GPD
(❑ Nev,Construction Use Residenilai r Number of bedroocs '?_._ Code derived design flow rate
j$Replacement ❑ Pubiic r,r coinrnr ciai- , s B_ — _ _--
Parent material— l - - Flood Plain elevation if applicable
General comments v ° Fe :. w (.�
and recommendations: 4
c W-too r
Boring# Boring --
®
pit Ground surface elev.ue ^� ft. Depth to limiting factor��in.
Soil A lication Rate
Horizon Depth Dominant Color Redox Descriptioi ilire Stn.lcture onsisience Boundary Roots GPD/ft
in. Munsell Ou.S-7. Cont.Color_ Gr.Sz. Sh. ff#1 ff#2
� t
_ ❑ Boring
Boring# "'
Pit Ground surface eiev. �+f'�!,`'i. Depth'to limiting factor in.
Soil Applicatiori Rate
Horizon Depth Dominant Color Redox Description. e! Structure ,onsistence Boundary Foots GPD/ft
in Munsell Ou. Sz. cont.Color Gr, Sz.Sh. ff#1 ff#2
_� � iyt� e' I ,.,,,...,.,.a=-•=•fi.,M,- a,. I / m I�a,:3 V—
3310 IF
— =— -�--
"Effluent#1 = BOD >30<220 mgil-and TSS>30 150 mg/I- "Effluent#2=BOD <30 mg/L and TSS <30 mg/1-
CST Name(Please Print) nati.re CST Number
ddress ° �a Evaluation Conducted Telephone Number
-- S13D-8.330(RII/11)
LG Page of
Property Owner (arce4!C1 m__---._
Boring
Boring# y $ t — in. Soil A tication Rate
Pit
Ground surface elev. /�7��y�` Y, JFptM to limiting factor
GPD/ft
Horizon Depth Dominant Color Redox Description Textnre ' Structure insistence oundary Roots ff#2
�u.Sz. Cont.Color Gr Sz.Sh..
Mansell
aa
nn
� A
Boring# Boring Depth to limiting factor in.
Ground sarfaee etev tt. Sal Application Rate
Horizon Depth dominant color) Redox Description Texture Structure onsistence oundary Roots a ff#1 GPD.�2
in. Mansell CCU.Sz. Cont.Color Gr.Sz.Sh.
ElBoring
Boring Ground surface etev.` Ctepth.to IimitNig factor in. Soil Application Rate
j� Pii
i lonzon Depth 'Dominant Color Redox Description i^-.xture T!� ture onsistence oundary Roots GPDlft
-- n Mansell :�.a.Sz, ('0111 Color r� . Sh. ff#1 ff#2
1.
Effluent#1 =BOD >30_220 mg/L and TSS%30 _150 n ig/i.. Effluent#2=BOD <30 mg/L and TSS <30 mg/L
I hr Dept ofS:Itfct, mid Scv� ices is;m .gli4 i oppoHlill ily service py((vicicr and employer. tf yurr need assistance t«
in oll ontact.ilic at 668-266-3151 or 1 I through Relay.
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