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HomeMy WebLinkAbout018-1036-40-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 579033 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: Lewis, Sean Hammond, Town of 018-1036-40-000 CST BM Elev: Insp. BM Elev: BM Description: nn Section/Town/Range/Map No: OC) l~ G5 16.29.17.254 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 9 /02.9 Septic =.n a Benchmark 60o L IOU: 100 0 Dosing ~ Alt. BM C vw 11-f 3 4i " ~a Z •-q4 /ao. /Z AeratioiL Bldg. Sewer d S 3 •r5 q9.9 ~ Holding St/Ht Inlet lo•g5 96.61 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent Air Intake ROAD Dt Inlet Septic i 7 i60 AA+ 5 1 7t Bottom Ia • 9L • q (p Dosing I ~6b `v'4- 5 i ! (P6 , Header/Man. qg Aeration Dist. Pipe Holding Bot. System -5.6 9 -7• c/ PUMP/SIPHON INFORMATION Final Grade 134 147-fez Manufacturer ` If/ I De and St Cover ~l l~ GPM /aa 1 Model Number p 04 •q, ( I • o TDH Lift 1 ' Frictio~ Loosss System Hea.L TDH ' ~t 6 J Forcemain Lengths Dia.Z~ c Dist. to Well A SOIL ABSORPTION SYSTEM BED/TRENCH Width j ength / No. Of Tren es PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ` 75 3 SETBACK SYSTEM TO J P/L tBLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type ystem: CHAMBER OR 37 / x A)+ AlI.1.~ UNIT Model Number: DISTRIBUTION SYSTEM (/V rT ~V~ 1 Header/Manifo~l of Distribution x Hole Size x Hole Spacing / IVe;P, Air Intake / S 513 Z, z8'. s V Length Dia Length 7 Dia 1 • 3 Spacing -;L 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 Bed/Trench Edges Topsoil- es No es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1 10 Vj5 \Inspection #2: / / Location: 928 Cty Rd T Ham nd, WI 54015 (NE 1/4 SE 1/4 16 T29N R17W) NA Lot 1tAj" ~ S~`\~~ ~Pa?ftl No: 16.29.17.254 F.• Goy cam. Sr,~nc~ oU~-ec;hi` 1.) Alt Description = C ; ,~s 1F"~ oea k' 2.) Bldg g sewer length = t? 1/1%- - amount of cover = 7 417- Plan revision Required? 0 Yes '/No 5 5 ~:3q Use other side for additional information. _ SBD-6710 (R.3/97) Date Insepctor's Signa re Cert. No. County St. Croix t• Safety and Buildi s Division r1 u 1 1 201 W. Washington AV .O. ox 7 Sanitary Permit Number (to be filled in by Co.) Madison, WI 5 c~OV COUNTY 6 0 677 C33 114, IN[W ME oplimm Sanitary ermit Application State Transaction Number 2563680 In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mail' address) the Department of Safety and Professional 1s. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, , s s. . 15.04 1 m , Slats. I. Application Infor - Please Print All Information Property Owner's Name Parcel # Sean Lewis ( a~ y• /e :W, to - d -T~db Property Owner's Mailing Address Property Location- 1774 Hwy 12 Govt. Lot City, State Zip Code Phone Number NE -/,,SE v, section 16 Hammond Wi. 54015 715-220-1471 (circle one II. Type of Building (check all that apply) Lot # T _9 N, R 17 E or ~ZSy ( I or 2 Family Dwelling - Number of Bedrooms 3 Subdivision Name Block # ❑ Public/Commercial - Describe Use r S' 41 ❑ City of ❑ State Owned - Describe Use 1 CSM Number 347(47 ❑ Village of )4-/5 ER Townof Hammond bU t.~t Ida III. Type of Permit: (Check only one box on line A. Complete line B if applicab A. New S stem y ❑ Replacement System ❑ Treatment(Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. T e of POWTS S •stem/Com onent/Device: Check all that apply) p t^ t7v ❑ 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 rsal/Treat ent Area Informal' Design Flow (gpd) Design Soil Appl' tonXte(gpdsf) Dispersal Area R red (s Dispersal Area S stem levation 450 1 450 450 VI. T ank Info Capacity in Total of Manuf cturer Gallons Gallons Units / o v ° Polylok _ New Tanks Existing Tanks w° G h 525 a U iz n M w C7 a. Septic or Holding Tank 1000 1000 Wieser x Dosing Chamber X CC)rnho VII. Responsibility Statement- I, the undersigned, assum respo o nstallatio f the POWTS shown on the attached plans. Plumber's Name (Print) P MP/MPRS Number Business Phone Number Keith Knudtson 648443 651-470-1737 Plumber's Address (Street, City, State, Zip Code 927 150th St. Roberts Wi. 54023 VIII oun /De artment Use On pproved Per/m-it F- Date Issued Issuing A6fnt Signatur erG" n $ ( PZJ 66 l IX. Conditlteasons for DI proval p 3) /a i ~~5 I~/~ WI. lank; enttleilt lifter and . dispersal cetl.must all l maims r~taired as per imnagement plan provided by plutnkv. I •AM,sellwk~egi~reriial,t~smuat~*MWAtairfed. s perappNcabla t / ordil>anoslr. Attach to complete plans for the system and submit to the County only on paper not less than 812 a I I inches in size SBD-6398 (R. 11/11) a x ~ U d d d ~ •ti R h n 1 Ol X ~ C a 0 cn X O U 00 cn o O S W [y t.. v rr~~ n'1 ti. cn ° Q •i~., O. X G M h d O Q ti~~' b Co N tz' U w ~ 0.. rr o .r LLJ U x II u A c z CC a N ~ ~ v1 x ~ W II > o> C a~ W o Jodi ~ ~ a c d `n o d ~ c a EI U by o ° o y O o0 d w ~ q Ua u ',Z3 v d a. ~ d o o W C7 Q O ~ ~ K ~ H y U ° o /a~S bA //O11 n 7~ ~L N / L. U d h A H-I _o p p O ~1CC3~.1T a ~ 1 ~ WQV r otirt+xT~rF~f DIVISION OF INDUSTRY SERVICES 10541 N RANCH ROAD HAYWARD WI 54843 Contact Through Relay y~ P N http://dsps.wi.gov/programs/industry-services www.wisconsin.gov ~0 8[01'4 Scott Walker, Governor Dave Ross, Secretary June 30, 2015 CUST ID No. 224059 ATTN.• POWTS Inspector KEITH E STONER ZONING OFFICE KEITH STONER SOIL TESTING SANITARY DESIGN ST CROIX COUNTY SPIA 23220 WOOD CREEK RD 1101 CARMICHAEL RD SIREN WI 54872 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/30/2017 Identification Numbers Transaction ID No. 2563680 SITE: Site ID No. 814153 Duane Lewis Please refer to both identification numbers, Co Rd T above, in all correspondence with the agency. Town of Hammond St Croix County NE1/4, SE1/4, S16, T29N, R17W FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1542442 Maintenance required; 450 GPD Flow rate; 25 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01101, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01101, R. 10/12), SSWMP Pub. 9.6; Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: All lot lines must meet minimum setbacks. 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. KEITH E STONER Page 2 6/30/2015 Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Carl J ip rt Please Include a Copy With Your Wastewater Specialist, Division of Industry Services Payment Submittal. (715)634-5035, M-f 7AM - 12PM WiSMART code: 7633 carl.lippert@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484 , Monday - Friday 8:00 am To 4:30 pm Keith E Knudtson, Knudtson Plumbing (Plans Mailed To) I I I i' MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Duane Lewis Mound System Owner's Name: Duane Lewis Owner's Address: 1667 Hwy 12 Hammond WI 54015 Na Legal Description: NE1/4-NE1/4 + NW1/4-SE1/4 Sec. 16 T29N-R1 7W Township: Hammond County: St. Croix Subdivision Name: Csm Vol. 5 Pg. 1486 Lot Number: 1 Block Number: Na Parcel I.D. Number: 018-1035-70-000 + 018-1036-40-000 Plan Transaction No.: CONDITIONALLY Page 1 Index and title APPROVED Page 2 Data entry DEPT OF SAFETY AND Page 3 Mound drawings PROFESSIONAL SERVICES Page 4 Lateral and dose tank DIVISION OF INDUSTRY SERVICES Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan SEE CO : SPONDENCE Desi9ner. Keith E. Stoner Ci01Vq nse Number: Designer 1575-007 Date: 06/12/15 ~ph~fpe Number: 715-653-2324 : KEITH E. * s Signature: k1ld STONER c Z, \J c - 1 ,ren - I~sig dF uanIAbthq$ K-!b/fa Mound Component Manual for •V'eFS+arf~0 ~C~"'-10691-P (N. 01/01), and both SSWMP Publication 9.6 Design of Pr>'i*i~~Networks for ST-SAS (01/81) and Pressure Distribution Component Wffi er, 2.0 SBD-10706-P (N. 01/01) 2 - 1 Version 7.0 (R. 03/2012) Page 1 of 8 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 38344-3 in-situ soil treatment for 1.50 Peaking Factor (e.g. 1.5 = 150%) fecal coliform of 36 inches. 450.00 Design Flow (gpd) 8.00 Site Slope 97.00 Contour Line Elevation (ft) 25.00 Depth to Limiting Factor (in) 0.40 In-situ Soil Application Rate (gpd/ftz) Distribution Cell Information 75.00 Dispersal Cell Length Along Contour (ft) = 6A0 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft ) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point _ in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) E Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation ft 2 Number of Laterals of the highest point. 0.156 Orifice Diameter (in) 2.33 Estimated Orifice Spacing (ft) = 7.03 ft%rifrce 2.00 Forcemain Diameter (in) 30.00 Forcemain Length (ft) Does the forcemain drain back? Y 99.40 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 4.89 Forcemain Drainback (gal) 6.27 Vertical Lift (ft) 67.41 5x Void Volume (gal) 0.75 Friction Loss (ft) 72.30 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 34.46 System Demand (gpm) 11.57 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x x 1.25 2.00 1.50 x x 3.00 2.00 x - 3.00 x Gallons/Inch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1000.00 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Wieser Concrete Manufacturer gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 603.36 Dose Tank Capacity (gal) Pol Lok Filter Manufacturer 16.76 Dose Tank Volume (gal/in) PL-525 Filter Model Number Weiser Concrete Manufacturer Project: Duane Lewis Mound System Page 2 of 8 Mound Plan and Cross Section Views . . . . . . . ' 1 /10 B : - Observation Pipe J K:° db*e:" b~o•M1ebpq" b~.b:b.....b;ti;b,e.,b.bw b.°". M1, b,ti.^.:,~• A h°b fib. .p9,"` mb b tigti ":°;°w""°o.'^•"°"°;"'^°^"•°,J"„"'°°"^r`.°. q'"° W +8 :^n.°."..i<.. ."..°.,T...d'..':e°.e.P.{..°~.^°b{e°"T:•.eM1.." y..Y.." .,y.•° 4:5r°^5~...••.:.u^4: :°b pq: 'F,:.° L Mound Component Dimensions ft A 6.00 ft E 16.76 in H [Aft ft K [Aft B 75.00 ft F 9.50 in z ft L ft D 11.00 in G 0.50 ft J W 450.00 (ftz) Dispersal Cell Area 1245.89 (ft2) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 7.50 (ft)1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 99.71 (ft) --e H rrrrrrrrrrrrhlS+Yrrrrrrrrrr,... G rr~iiruirorndrr r~iiririiinini . I F Dispersal Cell 98.42 (ft) Lateral 97.92 (ft) - Invert Dispersal Cell Elevation •4 •A 4 8.0 % Site Slope 97.00 (ft) Contour Elevation Geotextile Fabric Cover Shading Key HL Dispersal Cell See lateral details on F Topsoil Cap =o 1.5 ft Page 4 for number, size, rriiuir p M ~=P"•°°e; refti~g.° e'~", and spacing of laterals. Subsoil Ca ASTM C33 Sand Laterals are equally .,f.., Tilled Layer c a 0.5 ft p a ?Typical Lateral spaced from the n Aggregate b=1`+1~ e'•1,<.u°°°_y:q::a;,y 1 distribution cell's o :ti.° A;bti. bf. centerline in the A distribution cell (AxB). Project: Duane Lewis Mound System Page 3 of 8 End Connection Lateral Layout Diagram Lateraft oenttred over the A& 8 dimension ♦ n Turn-upvWbsllvalv®or cl®anoutplup € P All laterals are Identical IF- X I Holes drilled on the bottom or tho lateral equalil} spaced S Foree main connection via tap or cross to manifold at vw point Laterals Worcemain Sch 40 PVC per SPS Table 384.30-6 Number of Laterals 2 Orifice Diameter 0.156 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.37 ft Lateral Length (P) 73.47 ft Orifices per Lateral 32 Lateral Spacing (S) 3.00 ft Orifice Density 7.03 ftz/orifice Lateral Flow Rate 17.23 gpm Manifold Length 3.00 ft System Flow Rate 34.46 gpm Manifold Diameter 1.50 in Total Dynamic Head 11.57 ft Forcemain Velocity 3.52 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and SPS 316.300 WAC 4 in. min. Disconnect Tank component is properly vented F--- Alternate outlet location Forcemain diameter Weiser Concrete Manufacturer 2 in. Capacityl 603.36 Gallons Volume 16.76 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 20.69 346.70 B 2.00 33.52 C Plum off elevation (ft) C 4.31 72.30 92.15 D 9.00 150.84 D Total 36.00 603.36 11 Dose tank elevation (ft) 3" Bedding un er tank. F 91 40 Alarm Manuafacturer SJE. Rhombus Note: Switches Alarm Model Number Tank Alert 1~ containing mercury may not be used in Pump Manufacturer Goulds this system. Pump Model Number 3871 EP04 Pump Must Deliver 34.46 gpm at 11.57 ft TDH Project: Duane Lewis Mound System Page 4 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name Powers Sanitation - Phone 715-246-5738 POWTS Regulator's Name St. Croix County Landuse Dept. 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 eve 3 ears Effluent Filter Should inspect and dean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Ins ect for ondin and seepage once eve 3 years 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 . • • • • • .r..v~~„~, ..............16. . Grade \'Jo 6-8" Diameter Lawn Threaded Cieanout Sprinkler Valve Box Plug or Ball Valve Distribution / U Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Duane Lewis Mound System Page 5 of 8 Mound System Management Plan Pursuant to SPS 363.54, 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), SSWMP Publication 9.6 (01181), and pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01101)) 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, Slats. 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 fitter when removed from its enclosure. If the fitter is equipped with an alarm, the filter shall be serviced N 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 113 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shalt advise the owner of when the next service needs to be performed to maintain less than maximum scum and st The addition of biological or chemical additives to enhance septic tank performance is age ao generally ku not mulatlo in the owe are used they shall be approved for required. However, if such produce septic tank use by the Department of Commerce. PWnp Ta The pump (dosing) shah be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filler is installed within the tank it shalt be inspected and serviced as necessary. Mound and Pressure ib4 + c+ 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 mulcted 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 mgA. TSS, 10 mg/L FOG, and 10' cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Cordinuyentir Man If the septic tank or any of its components become defective the tank or c~riponent shall be repaired or replaced to k the s proper operating condition. eep yslem in 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 dogged 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. Er_eUV@bpM Units The information and schedule of mananagement and maint enance 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. Project: Page 6 of 8 Page 7 of 8 21GOULDS PUMPS Submersible Effluent Pump EP04 } 3871 EP05 APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing lubrication and efficient improved performance. construction. following uses: heat transfer, • Effluent systems ■ Casing and Base: Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • farms manual operation. Auto- superior strength and corrosion • Heavy duty sump matic models include Canadian Standards As00ali0" • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in "C" or 7".) factory. strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic Goulds ftsw is So MM RK- ft red. • Solids handling capability; FEATURES cover with integral handle and float switch attachment points. 3h" maximum. ■ EP04 Impeller: Thermoplas- III Power Cable: Severe duty • Capacities: up to 60 GPM. tic Semi-open design with rated ail and water resistant. • Total heads: up to 31 feet, pump out vanes for mechanical • Discharge size: 11/2" NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40cC) continuous 140OF (60°C) Intermittent. METERS FEET • Fasteners: 300 series 1 ° stainless steel. 9 301, • Capable of running S GPM dry without damage to 2.5 rr j components. 25 o 7 Motor: x • EP04 Single phase; 0.4 HP, v 6 20 115 or 230 V, 60 Hz, 1550 i RPM, built in overload with 5 automatic reset. J 1 s • EP05 Single phase: 0.5 HP, ~ 4 - - EPOS 115 V or 230V, 60 Hz, 1550 3 10; RPM, built in overload with automatic reset. 2 i . EP04 • Power card: 10 foot s standard length, 16/3 1 S1TOW with three prong grounding plug, Optional 20 0 00 GPM foot length, 1613 SJTW with 10 20 30 40 50 three prong grounding plug (standard on EP05). ° 2 4 6 s 10 12 m31h CAPACITY Goulds Pumps ®z001 Goulds Pumps ITT Industries Effective May. 2001 83871 00 a ~o 0o x ~ a 0 a h ~ x o N Obi ~ U v ~ M x U N 'fir U d o m °o z° cL c°. 14 ° 44 a ~ ,fl o V w a o ` a 8 s~ ~w J N z W W U x II II A - x i I y0.1~~ a o et°. ~ o q' o QO W o 14~1 o ~ a ° / ~ d O o©o O O ~ Ob+ f' q ~ ~ o j sf'y op d ~ k a~ f~ $ ~ ° p o ~C m ~ ,n C -OF o .Gli OtYi O Fz7~V ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 1-; Mailing Address UJ u a' Pam ^ an- ~ r L,3 W -T 61 E Property Address 72 G 1C (Verification required fro Planning & Zoning Department for ne construction.) City/State Parcel Identification Number LEGAL DESCRIPTION Property Location N E 1/4 , SE 1/4 , Sec. 16, T 29 N R 17 W, Town of H a m mo nd Subdivision Plat: , Lot # Certified Survey Map # Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house Oyes IAO Lot lines identifiablegyes[:]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 staring that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this f 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 warn ty deed recorded in Register of Deeds Office. Number of bedrooms G~-1 l 44" Q 715-er0- 1471 ? 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) EXHIBIT A Part of the Northwest Quarter of the Southeast Quarter (NW 1/4 of SE 1/4) and the Northeast Quarter of the Southeast Quarter (NE 1/4 of SE 1/4) of Section 16, Township 29 North, Range 17 West, Town of Hammond, St. Croix County, Wisconsin, more particularly described as follows: Lot 1 of Certified Survey Map filed November 8, 1984 in Vol. 5 of Certified Survey Maps, Page 1486, as Document No. 397657, EXCEPT Lot 1 of Certified Survey Map filed April 16, 1990 in Vol. 8 of Certified Survey Maps, Page 2195, as Document No. 457427, AND EXCEPT any part of the Northeast Quarter of the Southeast Quarter (NE'/4 of SE 114) lying within Lot 1 of Certified Survey Map filed December 5, 1989 in Vol. 8 of Certified Survey Maps, Page 2177, as Document No. 454016, AND EXCEPT any part of said Northeast Quarter of Southeast Quarter (NE'/4 of SE VI) described in that certain Personal Representative's Deed recorded July 27, 1995, in Vol. 1132, Page 347, as Document No. 531766, as follows: That certain parcel of land located in the Northeast Quarter of the Southeast Quarter (NE '/4 of SE and the Southeast Quarter of the Southeast Quarter (SE'/4 of SE '/4) of Section 16, Township 29 North, Range 17 West, Town of Hammond, St. Croix County, Wisconsin, more fully described as follows: Commencing at the Northwest corner of Lot 1 of that Certified Survey Map recorded in Vol. 8, Page 2177, Document No. 454016 of St. Croix County Certified Survey Maps, the POINT OF BEGINNING, of the parcel to be herein described; thence S 00120'22"W 451.75' on the West line of said Lot 1; thence N 89151'57"E 265.27' on the South line of said Lot 1; thence S 00000100"W 352.15' on the West line of said Lot 1; thence N 88138'00"W 532.16' to the West line of the East Half of the Southeast Quarter (E '/2 of SE ''/4) of said Section 16; thence N 00116'02"E 811.57' on the West line of said East Half of the Southeast Quarter (E %i of SE '/4); thence S 87126'41"E on a Westerly extension of the North line of said Lot 1, to the Northwest corner of said Lot 1 and the POINT OF BEGINNING. St. Croix County 1013785 Page 2 of 2 i 0 ~3 5 9 12 15 118 (21 124 ~27 30 `33 136 39 42 45 48~ X51 6 9 _ 2-ad S- -H 12 s 21~. ~t 24 27 30 - 33 V - _ , Ir~ 3 r l-~eGrrzsna ~ _ { 42 M zu~U~ ' i ?~v 0o w of 45 1 . 48 51 57 r q~~~31 Wisconsin Depart S e and Professional Services 1 Division I of Indus VED SOIL EVALU #3011 Page 1 of 3 JUN 2 5 20 15 in accordance with SPS 385, Wis. Adm. Code Keith Stoner CST Attach c*"R(qi EK 19 er not less than 8%= x 11 inches in size. Plan must County St. Croix P i rth arrow, reference point (BM), direction and er n s o e, a s rth arrow, and location and distance to nearest road. Parcel I.D. 018-1035-70-900 + 018-1036-40-000 Please print all information. Revi d By ;7z- Property Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Owner Property Location Duane Lewis Govt. Lot NE1/ SE1/4, S16, T29N, R17W Property Owner's Mailing Address Lot # Block # Subd. Na a or CSM# 1667 Hwy 12 1 Prt. Lot 1 5/1486 City State Zip Code Phone Number ❑ City ❑ Village ❑ Town Nearest Road Hammond WI 54015 Hammond County Rd T ❑ New Construction Use: ❑ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Loess over loamy drift-sandstone residium Flood plain elevation, if applicable NA ft. General comments Propose a 6 x 75' mound cell located along the 97.00' contour with a system elevation= 97.92'. Upslope contour staked onsite. and recommendations: ❑ Boring ❑ Boring # ® Pit Ground surface elev. 96.00 ft. Depth to limiting factor 45 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 1 0-8 10YR3/2 - sil 2msbk/1mpl mvfr gs 3f-m 0.4 0.6 2 8-21 10YR4/4 - Cl 2msbk mvfr gs 2f-m 0.4 0.6 3 21-36 5YR4/4 - Is Osg ml gs if-m 0.7 1.6 4 36-45 2.5YR4/4 - sl m mfr gs - 0.2 0.6 5 33-52 2.5YR8/4 c2d5YR5/8 Is Osg ml - - 0.7 1.6 ❑ Boring ❑ Boring # ❑ Pit Ground surface elev. 98.65 ft. Depth to limiting factor 25 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 1 0-7 10YR3/2 - A 2msbk mvfr gs 3f-m 0.6 0.8 2 7-20 10YR4/4 - sl 2msbk mvfr gs 2f-m 0.6 1.0 3 20-25 7.5YR4/4 - Is Osg ml gs 2f-m 0.7 1.6 4 25-33 7.5YR4/4 m2d5YR5/8 Is Osg ml gs 1f-m 0.7 1.6 5 33+-52 2.5YR8/4 c2d5YR5/8 Is Osg ml - - 0.7 1.6 ' Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L Efflu t #2:= BOD5 <_30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number Keith Stoner 224059 Address Keith Stoner CST Date Evaluation Conducted Telephone Number 23220 Wood Creek Rd Siren, WI 54872 6/3/2015 715-566-2128 SBD-8330 (8.07/13) Property Owner Duane Lewis Parcel ID # 018-1035-70-000 + 018-1036-40- Page 2 of 3 E] Boring 3 ]Boring # M Pit Ground surface elev. 95.50 ft. Depth to limiting factor 34 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 "Eff#2 1 0-10 10YR3/2 - sil 2msbk mvfr gs 3f-m 0.6 0.8 2 10-30 10YR4/4 - cl 2msbk mvfr gs 2f-m 0.4 0.6 3 30-34 7.5YR4/4 - Is Osg ml gs 1f-m 0.7 1.6 4 34-62 2.5YR4/4 c2d5YR5/8 Is/sl Osg/m mvfr - - 0.2 0.6 I #4 - with bands of 5YR4/4 massive sl and Is ❑ Boring 4 Boring # Pit Ground surface elev. 98.98 ft. Depth to limiting factor 34 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 -Eff#2 1 0-8 10YR3/2 Fill sl 2msbk mvfr gs 3f-m 0.6 1.0 2 8-18 10YR2/2 Buried A horizon sil 2msbk mvfr gs 2f-m 0.6 0.8 3 18-39 10YR4/4 - sicl 2msbk mvfr gs 1f-m 0.4 0.6 4 39-48 5YR4/4 c2d5YR5/8 gr sl 2msbk mvfr - - 0.6 1.0 ❑ Boring F-1 Boring # E] Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMV in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 4Eff#2 l~ 316 "Effluent #1 = BOD5> 30 < 220 mg/L ar1E ,-4' 150 mg/L ` Effluent #2 = BOD5 < 30 mg/L and TSS <30 mg/L m p ~O in M' N O o~ x ~ 4 v ~ N p M ~ p~ S: rA v ~ d x M C a W 4 y ~d r x o r? U ~ ~ 'Z' ti ~ •K o ate, o b y a ti 00 ~ ~ ~ ~ 0 0 0 0 ~ ~ NN ~ ~1 ~ N~N U o ~ 'n N O ~ ry, c o l~1 O b C5 `N o K ti O Li' O t~ x o O CG g U W ~ ~ o ~ fl ~ x o o W ~ p U x ° C a x N O~ a a I 0 vl wt~ (U W II \ M o 00 O m N ti # M ti M / O Oll q-- o II O f ~ ~ O 0 00 a o o °o a / 3 a~ o o/ cd ! OR 00 U N H Iii o as rA a~ ° „ ~ n r Ao11DnoY1ooQ N 1 N O , 5 OQ C~OGh00~ p ON O1 a's Ch k O ao II It II II O.o'' V N M R PSI G WfrY1WP m <u •