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HomeMy WebLinkAbout040-1295-80-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 579054 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: Grundhauser, David & Rosanne Troy, Town of 040-1295-80-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: /ob yVl 651 19.28.19.1700 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER/,e----0 CAPACITY STATION BS HI FS ELEV. Sz I a s ion Septic :Y3 Benchmark bg 1D a..' zi 1 S ' Dosing ~ ' Alt. BM 3,s Gev K'I1-~ ),44 14J. yy, /oi~.. Bldg. Sewer r { J S. 75 k-62 .1 Holding St/Ht Inlet G•Y3 98:a7 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. ent to it Intake ROAD Dt Inlet \ Goad' Septic -341 Dt Bottom 9~1- 57 Dosing 31) Header/Man. Ili ~b $4 3•6 iii. $ Aeration Dist. Pipe Holding - Bot. System PUMP/SIPHON INFORMATION Final Grade Z • / 2 • S Manufacturer 6 ov S f~ GPM Demand St Cover Go X 1 Q$ J43 • if Model Number 510615 Z7 V ,J13 Cd ~..d~, ~ .r g. e !ate TDH Li Friction Loss System Head TDH Ft 95 Forcemain Length / Dia. 1 I Dist. to Well / SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No. Trenc s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS le 45 e SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type System: CHAMBER OR o /I- JZo UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold / of Distribution /6' / x Hole Size x Hole Spacing T lVeno A21nt e Pipe(s) Dia / ZS Spacing 7. 3 3 3 3, 35 u Length ' 67 Dia Length Z -746 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only 4 Depth Over Depth Over xx Depth of xx Seeded/Sodded- xx Mulched Bed/Trench Center J ~S Bed/Trench Edges` Topsoil l ~-Z No es 0 No -I I COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 16127115 Inspection #2: Location: 386 Mitchell Rd Hudson, WI /54016 (NE 1/4 SE 1/4 19 T28N RI 9W) Trebus Valley) Estates Lo 8 f r Xarcel No: 19.28.19.1700 1.) Alt BM Description = r' t t_° S 2.) Bldg sewer length = $ / C - amount of cover = ~ a+ S ~ ~e c..~c a o v` 1o t,,! d k Plan revision Required? ❑ Yes )C'No L lb Z7 Use other side for additional information. _ lD SBD-6710 (R.3197) Date Insepc s Signa a Cert. No. "aTU~rr County Safety and Buildings Division 5 EP V i 1tl 201 W. Washington A P. Bo 162 Sanitary Permit Number (to be filled in by Co.) Sp S Madison, WI 2 ~ 1i0~ AUG 1 2015 Us-79 5 ~7~bs .~~~ST.0 WA Application StateTrra annsactionNumber In accordance;11` " 21( de, submission of this form to the appropriate governmental unit Gr 5-6 :5 C)3 is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary, u purposes in accordance with the Privacy Law, s. 15.04(1 (m , Stats. 1. Application Information -"ease Print All Information Prope Owner's N e j~s N Parcel # U ~1 d S~- o Properly Owner's Mailing Address Property Location / 366 Govt. Lot City, State Zip Code 7Phone Number Qy, y, Section 7 x(00 _'ol T v N; R 1 circlE or~ H. Type of Building (check all that apply) Lot # XL or 2 Family Dwelling - Number of Bedrooms Subdivision Name / k ~ ~ Block -3 1 -A ❑ Public/Commercial - Describe Use (1~- CLV..- V& ❑ City of ❑ State Owned - Describe Use ~jl.1e2. M Number 11 Village of / IwTown of 6 >r ZJ C: ✓ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) :Z6 A. $&w System ❑ 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 W. Type of POWTS S stem/Corn onent/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 s it ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treat nt Area Information: Design Flow (gpd) Design Soil Application R gpdsf) Dispersal Area Required Dispersal Area Pmposeqsf~ System Elevation "Ail /Do ? VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o o m cc New Tanks Existing Tanks & ra / " o L;~ L Cc z, Sz a w 0 Septic or Holding Tank JD ~Q~ J u~~ Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume r sponsibility for installation of the POWTS shown on the attached plans. Plumb 's Name t) Plumber's S afore RS Number Business Phone Number &L)_~ s 7 o9y Plumb 's Address tr City, S , Zip Code) J~ 6 0 VIII. oun e Use Only pproved Permit ee Date Issued Issuing nt Signature $/_'Z5 c o ❑ w rven Reason o nial 6O p //Ir IX. Condit S P141fifte:asons for Disapproval 1 / •~+0~5 l^ V ~,C ' 1. Septit> tank, effluent filter and 3 0 ~ t .Oispersal cell must all be services I maintained it per management plan provided by plumber., 1 kregUlremefltgrntrstbw►t * 'akAW Z as per ap hmble code / ordkiii e. Attach to complete plans for the system and submit to the County only on paper not less than 8 in a 11 inches in size SBD-6398 (R 11/11) c~ 13, AC- ,54 \ y w' Y C~ { DIVISION OF INDUSTRY SERVICES c~~tis' ' ro 9 10541 N RANCH ROAD HAYWARD WI 54843 3 $ I Contact Through Relay P i http://dsps.wi.gov/programs/industry-services S G www.wisconsin.gov sSScott Walker, Governor Dave Ross, Secretary August 14, 2015 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: 08/14/2017 Identification Numbers Transaction ID No. 2585037 SITE: Site ID No. 815960 David Grundhauser Please refer to both identification numbers, 386 Mitchel Rd above, in all correspondence with the agency. Town of Troy St Croix County NE1/4, SE1/4, S19, T28N, R19W FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1550679 Maintenance required; 450 GPD Flow rate; 38 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), 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: Please see additions made to the plan in red. 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. } BRADY J UTGARD Page 2 8/14/2015 Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Carl J Lippert Wastewater Specialist, Division of Industry Services WISNIART code: 7633 (715)634-5035, M-f 7AM - 12PM carl.lippert@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Utgard Plumbing BRADY J UTGARD Paee 2 8/14/2015 Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Carl J Lippert Wastewater Specialist, Division of Industry Services WiSMART code: 7633 (715)634-5035, M-f 7AM - 12PM carl.lippert@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Utgard Plumbing I MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: GRUNDHAUSER Owner's Name: DAVID GRUNDHAUSER Owner's Address: 386 MITCHEL RD. HUDSON WI. 54016 Legal Description: NE/SE/S191T28/R19W Township: TROY County: ST.CROIX Subdivision Name: TREBUS VALLEY ESTATES Lot Number: 8 Block Number: Parcel L.D. Number 040-1295-80-0000 C NLJtT'ION ALLY Plan Transaction No.: APPROVED DEPT OF SAFETY AND Pagel Index and title Page 2 Data entry PROFESSION STRSERVIt-OES Y SERV CES Page 3 Mound drawings DIVISION OF INDU Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency pla Page 7 Pump curve and specificati SPONDENCE Page 8 PLOT PLAN SEE COR Page 9 SOIL EVALUATION Designer: BRADY UTGARD License Number: 220357 Date: 08/05/15 Phone Number: 715-268-6995 Signature: Desig 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) 3.10 Site Slope 100.07 Contour Line Elevation (ft) 38.00 Depth to Limiting Factor (in) 0.50 In-situ Soil Application Rate (gpd/fe) Distribution Cell Information 45.00 Dispersal Cell Length Along Contour (ft) = 10.00 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? c Center or End Manifold 3.33 Lateral Spacing (ft) If N above, enter the elevation (ft) 6 Number of Laterals of the highest point. 0.188 Orifice Diameter (in) (e.g. 0.25) 3.00 Orifice Spacing (ft) = 10.71 ftz/orifice 2.00 Forcemain Diameter (in) 70.00 Forcemain Length (ft) Does the forcemain drain back? Y 90.00 Pump Tank Elevation (ft) 3.25 System Head (ft) x 1.3 11.42 Forcemain Drainback (gal) 10.57 Vertical Lift (ft) 41.62 5x Void Volume (gal) 1.16 Friction Loss (ft) 53.04 Minimum Dose Volume (gal) 14.98 Total Dynamic Head (ft) 27.53 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 x 1.25 1.00 x 1.50 x x 1.25 x x 2.00 1.50 x 3.00 2.00 x 3.00 x Gallonslinch 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 B49) Dose Tank Information Effluent Filter Information 600.00 Dose Tank Capacity (gal) POLYLOK Filter Manufacturer 16.67 Dose Tank Volume (gal/in) PL-525 Filter Model Number weiser Manufacturer Project: GRUNDHAUSER Page 2 of 9 . Mound Plan View _ 1110 B Observation Pipe •Q' J O Q A ~B - i L Mound Component Dimensions A 10.00 ft E aft in H 1.00 ft K 7.28 ft B 45.00 ft F in I 10.00 ft L 59.56 ft D 6.00 in G J 4.86 ft W 24.86 ft 450.00 (ft2) Dispersal Cell Area 900.00 (ft) Basal Area Available 10.00 (gpd/ft) Linear Loading Rate 4.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 102.34 (ft) H Dispersal cell 101.07 (ft) Lateral 100.57 (ft)-Ill - : : Invert Dispersal Cell Elevation E 100.07 (ft) Contour Elevation 3.1 % Site Slope Geotextile Fabric Cover Shading Key m c. T Dispersal Cell See lateral details on Q = Topsoil Cap c E 1.5 ft Page 4 for number, size, © l'{" Subsoil Ca o p ~ and spacing of laterals. = ASTM C33 Sand F Laterals are equally Tilled Layer ® 0.5 ft Typical Lateral spaced from the 5 .8 Q5 I distribution cell's [5] Aggregate .t 0 H + centerline in the A distribution cell (AxB). Project: GRUNDHAUSER Page 3 of 9 Center Connection Lateral Layout Daigram Force main connection via tee or cross to manifold at any point. Laterals are identical s ~f P s y i = Turn-up idball valve or X--+.d x12+1 Laterals & force main of PVC Sch 40 ' ¢leanourtplug per COMM Table 84.30-5 Holes drilled km the bottom of the lateral. Number of Laterals 6 Orifice Diameter 0.188 in Lateral Diameter 1.25 in Orifice Spacing (X) 3.35 ft Lateral Length (P) 21.78 ft Orifices per Lateral 7 Lateral Spacing (S) 3.33 ft Orifice Density 10.71 ftzlorifice Lateral Flow Rate 4.59 gpm Manifold Length 6.67 ft System Flow Rate 27.53 gpm Manifold Diameter 1.50 in Total Dynamic Head 14.98 ]ft Forcemain Velocity 2.81 ft/sec Dose Tank Information Locking cover with warning label and locking device and watertight Electrical as per NEC 300 and sealed 16.28 WAC 4 in. min. Disconnect Tank component is properly vented E--- Altemate outlet location Forcemain diameter Weiser Manufacturer 2 in Capacityl 600.00 Gallons Volume 16.67 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 24.81 413.60 C B 2.00 33.34 Pump elevation (ft) C 3.18 53.04 90.50 D 6.00 100.02 D Total 35.99F-600.001 . Dose tank elevation (ft) 3" Bedding un er tank. - 0-0-0- 1 Alarm Manuafacturer LEVEL Alarm Model Number DLV Pump Manufacturer GOULDS Pump Model Number EP05 Pump Must Deliver 27.53 gpm at 14.98 ft TDH Project: GRUNDHAUSER Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name UTGA*D Phone 715-268-6995 POWTS Regulators 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 Freauency I Septic and Pump Tank Inspect and/or service once eve 3 ears Effluent Filter Should inspect and clean 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 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 Tum-up Detail Finished Grade ""..."`~...'..r.._ 6-8" Diameter Lawn 0 Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: GRUNDHAUSER Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code r rt This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and snail maintained in accordance with its' component manuals ISBD-10691-P (N.01/01) and SSWMP Publication 9.6 (01181)] and local or state rules pertaining to system maintenance and maintenance reporting. that could cause death. No one should ever enter a septic or pump tank since dangerous gases may present 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. for water tightness and soundness. Access Septic or pump tank manhole risers, access risers and covers should be inspected unso openings used for service and assessment shall be sealed watertight upon the them 8of service. in diameter shall b fed by and defective, or subject to failure must be replaced. Exposed access openings greater effective locking device to prevent accidental or unauthorized entry into a tank or component. aortic 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 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 o t 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. Puma 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 &W Pr ffia 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 BOD5, 30 mg/L TSS, 10 mg& 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 dogging 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. Continuenchr 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 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. Project: GRUNDHAUSER Page 6 of 9 l - ` • f. rpum i f l' P04 PQ 5 Series A►/IKATIONS 'a SPe Wally AFSgn~ far ' IMPOer: Thenrr0Pys• i uses 2MJKed lolbwinq dec* tr 6flprpv~ """"T dUtV rbel a~lg lower Emu" Systems ~ ~ f~dtxmance. ` Homes QSWJ and Lase: tlorr • Fans UWMOPbSk provides AGENCY LISTING • Heavy duty sump svpenor so"" &W CONOSM • Water transfer • Dewate►ing Motor Mousing; ca# Wn Z1r fir t% M hest transfer. ftapa rs 50 W Arva"re. 5oEOFICATIONS fadd". dutabi , • Solids handy FEATV a Mow Cover, T~K nauimu Y % am wig MOW41 boo W d { 9. • CapwR'es: up to 60 % raft *bdwrw GYM. ~ ~ k1v" ~p • Total heads, up to 31 feet. OW of and water resit • Discharge situ I le N". Med*raW staf- carb W ; rotary~tetamic•statianiry, ~ ^BUNAA NastomeR Temperature; 104'F RM fWttirtuous ~t 40OF (M inwrrot"". . . 4sten&s: 300 series #o Stainless steel. • Capable of running 9:.:. dry without darn" to , romponents s s c+s. f Motor- ? • EP04 23t7k phase: 0.4 HP, 6 3t7 60 H2, t55Q RPMr buo rn Owdpdd with X, 5 automatic reset a .iP0~o05; o a 6o Hz' 0 "M buiK in uwditd with 3 to - RtuS automatic reset • Power Cord' 10 foot 2 ep~ "anda,d fen4th. 16/~ SJTW wdh titres prong t 910 Plug- 000nai 10 0 oe foot `-.,vth- 1W S1Tw w6 10 thf" p ong grouding plug tt Y8 so Gatti {Standard on (1`05( o 2 e 6 1 1 mlih CAPACfTv t 2003 r--W, PvnOS GOUIdS Pumps a9e7: [Nect,.riuh 100) G I~~~!/l.>S,./~ ITT 1ildustne5 ~r 16 29 fs, ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND r OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address 8 O (Verification required from Planning & Zoning Department for new Ttruction.) City/State Parcel Identification Number 0 yQ -1,R 5.s - c5~?4 . U6c3'0 LEGAL DESCRIPTION Property Location IUC I/4 Sec. 1 q , TN R~W, Town of Subdivision Plat: n~J'A_ , Lot g Certified Survey Map # , Volume , Page # Warranty Deed # 160 ,sy (before 2007)Volume , Page # Spec house ❑ yeskno Lot lines identifiable A'yes 0 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 on this orm 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 warr ty deed recorded in Register of Deeds Office. Numbe of bedrooms 3 7 /_a Z,.-- 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) RECEIVED A -11 \Ahs. Dept. JUbYej LcKli-sional Services 77 REPORT Page of Division of Safety and Buildings ST. CR61X COUNTY in accordance with SPS Wis. Adm. Code -OMMUNlTY D V LOP11►aV county G R1 l Attach complete s,,e p an on r1net less than 8 1 /2 x ? 1 inches iii sizn > Ian muss include, but not limited to: vertical and horizontal reference point (Bh4). direction and Parcel I.D. percent slope, scale or dimensions north arrow. and location and distance to nearest road. oq0 -j _ i?D ,5Op 0. Please pc'int all 6nformatforz. Rev ed by _ Date Personal infcrmatlon you provide may be used .or secondary p~.,rposes rPr~ r , Lava s. 15.04 r 1 j (rn)l. g ~J Property ~Owner i Property Location ! ~Av + C> n-C J , r~ 0,y$,e g, r p 1 GoNA. Lot N C 1/45 1/4 9 T 1? N R g E (o \N Property Owner's Mailing Address e 4 U~~q Lot # Black # Subd. Name r CSM# 3g (o ►'''1 +G~ t 1, 'rRC 4u s Q0 1) e : s+.+,es city -T State 7_ip Code Phone Number ❑ City ❑ Village ®Town Nearest Road 14UdSa 1QS15`D/L i!715)71.0-t)9-q6-- W, TRD 71 rl;4c. e-L Rd. JA New Construction Use: [ji. Residential !Number of bedroo,- 3 Code derived design flow rate GPD ❑ Replacement ❑ P r commercial - Descrih~-.- Parent material~~`_ Flood Plain elevation if applicable ft. Geneal rnmen = 5V ggGS'1" 0. / 7S t jr and reco,7meca tions ag rage Moves Sa* /00.0-7 Boring Boring L__ I Pit Ground surface elev. 0, Depth to limiting factorin. Soil A lication Rate Horizon Depth Dominant Color Redex Description ext;. re Structure onsistence Boundary Roots GPD/ft z in. Munsell (Du. Sz. Cont. Color Gr. Sz. Sh. 0- (1 Lo jt3 -A-1 a Boring # ❑ Boring Pit Ground surface eiev. tip. ~1 `t. Depth to limiting factor .2 in. Soil Application Rate Horizon Depth Dominant Color Pedox Description ~xiure 1 Structure Consistence Boundary Roots GPD/ft in. Munsell O,i. ST. Cont. Color Gr. Sz. Sh. 11 ff#1 'ff#2 101PO -a► iv~rc~3~' u -7,S~f R~1~1 M 5-1 We 'IRS L- i~~k V11^ cw , Effluent = BOD 30 a•rJ TSH 3(` - , h ~ - ffA,ent u., =ROD 30 mg/L and TSS = 30 mg/I_ CST Name (Please Print) l CST Number n ~V S+4 N k. ddress - COD TH Date Evaluation Conducted Telephone Number a' ,p 1~ -S- ao &6) -a S - V f6~aa1~ - - 3 61 sHn-83:30 cal1n1) Dttv;~ f''R``ps~nn~e aC Property Owner e cy h l1QV JG~' ,rc.e1 ID p J gS g(~"Q~DO Page -4:p- of Boring # ❑ Boring Q Pit Ground surface elev. Depth to limiting factor in. 17- Soil Application Rate Horizon Depth Dominant Color Redox Description i exture Structure onsistence oundary Roots GPD/ft in. Munsell nu- SZ. Cont. Color G. Sz. Sh, ff{#1 h ff#2 - o - 8 oY ~I , - ~ a FSy n ►~_F ~ ~ 2 -a`l I o R3 _5 L _~~SSk. n►Fr ,,42 3 -3 , 5- RS/ SG L ? MSS K m fFr F b-6 ,5'~Q L F 7,SYR L~FS p~-5 s o F-I ❑ Baring Boring # u ❑ pit Ground surface elev. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description exture Structure onsistence Boundary Roots GPD/ft in. Munsell Ou. Sz. Cont. Color ` Gr. Sz. Sh. * ff#1 * ff#2 i i E 1 ~ ❑ Boring ❑ Boring # ❑ pit Ground surface elev. Depth to limiting factor in. Horizon Depth Dominant Color Redox Description 1. Soil Application Rate care Structure onsistence oundary Roots GPD/ft in. Munsell Ou. Sz- Cont. Color Gr. Sz. Sh. _ ff#1 ff#2 I y Effluent #'I = BOD 30 < 220 ma/L and TSS >30 _ i;;fl "Effluent #2 = BOD , = 30 mg/L and TSS < 30 mg/L The TJehr ofSa(cty and niaCessinj^. Cc~~ ces is an i due access nho3itu ity service provider and employer. [f you need assistance to scivices or need material in an 1II_c.tml;r_ MI'M t, cOI-li_act the deparimcnt at 605-266-3151 or TTY through Relay. ,C71 TJ-311r? (RI I!l ij V) o c~.0 L T i - - 014 r 00 A.! Cb f I ' f t I R j R 46 bQ - VIP- w , 1 C6 D i i 8 ..n f n } y y go 0 AL co v w r in ` s a v E-1 "n LL? r y ! `Nt i / < IT E-4 O : / f V) r- dl* to so in co LL: 00 00 (71 Ch E-4 'o E-+ o pn / ss i L lug AW L% AL .t0, tL oo S (m .oc.9c.OON) .0CO l 3 W. i L.00 N IP/ l 3S 3H.! 30 *r/ l 3N 3Hl -40 3NII IS3M 5ON ❑311VldNfl CAAk 1501 Wisconsin Department of Commerce SOIL EVALUATION REPORT h c c r~ 0 z a 7r SI page 1 of 4 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Sal & Site Evaluations Attach complete site plan on paper not less than 8'%x 1 in rze. must County St. Croix include, but not limited to: ventral and horaontal re Rd t B d percent slope, scale or dimensions, north arrow, iQc is road. Parcel I. D. 040- - #19.28.300 Please print all i tion. BAa_te _ o Personal information you provide may be used f ary pu~~ Caw, s.15.04 y _/re~✓~"" ~ IV DIQ~..~ Z Z Property Owner ` 1 r L ion J.T.B. Properties, L.L.P. C/O John W. ~4n Govt NE 19 SE 1/4 S 19 T 28 NR 19 W Property Owner's Mailing Address 51 Lot Block # Subd. Name or CSM# 1564 West University Avenue GG 8~4 Trebus Valley Estates City State Zip Cod Llo N ber ity _j Village i Town Nearest Road Saint Paul MN 55104 1 - 9 . Troy County Highway "F" New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacernent Public or commercial - Describe: Parent material Glacial drift Fkood~`,plain _ elevation, if applicable na General comments XI VC ~ A-66 - 1"70611V TL~,~` and recommendations: Recommend installing mound system at elev. = 103.69' t 15" above 102.44' contour. Aq ❑ Boring # J Boring " FL- . ?~0 1 Pit Ground Surface elev. 102.13 ft. Depth to limiting factor 1 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' *Eff#1 *Eff#2 1 0-8 1Oyr3/3 none sl 2fsbk mvfr as 2f,1mc 0.5 0.9 (p 2 8-23 1Oyr4/6 none scl 2msbk mvfr CS 20m 0.4 0.6 3 23-38 7.5yr4/6 none scl 2msbk mvfr ai if 0.4 0.6 ,cl 4 38118 7.5yr4/4 none scl 2msbk mfr aw if 0.4 0.6 5 48-60 7.5yr4/6 none Is/sl 1med.pl mfr aw 1vf,f 0.4 0.6 . ~ 1 11 E f 6 60-84 1 Oyr5/6 none is 1 msbk =dsgw - 0.4 0.6 H#5 contains colluvial 1 msbk is, 1 med.pl sl, with 15% limestone fragernents at 1/2" - 4" . ❑ Boring # Boring Pit Ground Surface elev. 103.27 ft. Depth to limiting factor 21 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' *Eff#1 *Eff#2 1 0-7 1 Oyr3/3 none sl 2fsbk mvfr CS 2f,1 m 0.5 0.9 , 2 7-13 1Oyr4/3 none sl 2msbk mvfr gw 1f 0.5 0.9 3 13-21 1Oyr4/4 none sl 2msbk mfr Cw 1f 0.5 0.9 , 4 21-32 7.5yr4/6 f2f 7.5yr5/8 Is 1 msbk mvfr aw 1 vf,f 0.7 1.2 5 32114 7.5yr4/4 f2f 7.5yr5/8 scl 2msbk mfi gw - 0.4 0.6 6 44-60 7.5yr4/4 m2d 7.5yr 5/8 scl Om ds - - 0.0 0.0 FF/a5 & C6 -contain -1/4"- 2" 7.5yr4/4 Om sl bands at 1" - 3" intervals. Loading rate reflects reduced permiability associated with banding. * Effluent #1 = BOD ? 30 < 220 mg/L and TSS 30 <-I 50 ft1 = BODS <30 mg/L and TSS <30 mg/L CST Name (Please Print) Sig ure: CST Number James K. Thompson J~-- 3602 Address A.C.E. Sal & Site Evaluations Dale Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 12/5/01 715-248-7767 Property owner J.T.B. Properties, L.L.P. C/O John Parcel ID # 040-1078-20-000, ID#19.28.300 Page 2 of 4 3]# 1' Boring - Y! Pit Ground Surface elev. 99.66 ft. Depth to limiting factor - 40 in. Soil Application Rate F Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 *Eff#1 *Eff#2 1 0-8 1Oyr3/2 none sl 2fsbk mvfr as 2f,1mc 0.5 0.9 2 8-19 1Oyr5/4 none sil 2fsbk mvfr cs 2f,1m 0.5 0.8 4 3 19-32 7.5yr4/6 none scl 2msbk mvfr ai 1 f 0.4 0.6 , If 4 32-40 1Oyr4/4 none sl 2msbk mfr aw 1f 0.5 0.9 5 4 -53 7.5yr4/6 f2f7.5yr5/8 Is Osg mfr aw 1vf,f 0.7 1.2 6 53-70 5yr4/4 none gr. sl Om ds - - 0.3 0.5 H#5 & 6 contain 2" 7.5yr4/4 Om sl bands at 1"- 3" intervals - redox concentrations observed in sandy, materials directly above sl bands. Loading rate reflects reduced permiability associated with banding. ❑ 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 P *Eff#1 *Eff#2 ❑ Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P 2 *Eff#1 *Eff#2 * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS <30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SOIL AND SITE EVALUATION 1501 Page 3 of 4 PROPERTY OWNER: J.T.B. Properties, L.L.P. C/O John W. Nielsen PARCEL I.D.# 040-1078-20-000. ID# 19.28.300 A.C.E. Soil & Site Evaluations REPORT MEMO Soil evaluation completed for plat review purposes and prior to clearing or lot monumentation. Results indicate that the soils at this location are suitable for a mound septic system. Additional soil evaluation and clarification of system location/design may be required prior to POWTS design and sanitary permit acquisition. Pit ax ~ S cc./2 ; / Gam, r i sy 99 ~o 10 i.2 A 1 ~ . d. rri.: To a{ S/ode Al- bC- E/cv- X31 Barc- Mg, r~(: To 0 reba.r. >QSScc,.,kd a lei . lcv.40! /LOT 1 0 4 1491 SO S. F\ 3.42 Ac. ~ ia- ~D• RADNJS 1'~~AR DE-SAC ASEMEN (TONK D IPa EASW4k*f O"Mms"N 4 LOT `8 125567 S> ea L4 1 s 109895 S. 10 l /LOT 147698 S.F. I I T r 3.39 Ac, f l 44