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030-2080-50-000 (2)
Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM County: St. Croix INSPECTION REPORT Sanitary Permit No GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for seconds 597382 Permit Holder's Name: secondary Purposes Privacy Law, s.15.04 (1)(m)] State Plan ID No: RONNIE & DEBORAH DECKARD city Village Township Parcel Tax No 2952296 CST BM Elev: Insp. BM Elev: 2080-50-Q~Q } BM Description: TOWN OF SAINT JOSEPH 030_ "I CN ` P Section/Town/Range/Map No: TANK INFORMATION 40' 25.30.20.682 TYPE MANUFACTURER ELEVATION D TA CAPACITY STATION Septic I I B HI FS ELEV. W {DE. Dosing Sf ( Benchmark 9 (41 16o,6o 1 110 Alt.,kM Aeration q ~1~•[~[ , / 4 { / tf i~G 5 i p l i F' I Bldg. Sewer Holding ~ !V•O ~ U r St/Ht Inle j ~ TANK SETBACK INFORMATION St/Ht Outlet IP• t LI I O•a( TANK TO P/L WELL BLDG. en '-f ~.fj, en o Air Intake ROAD Dt Inlet Septic ")A' Dt Bottom Dosing t t f Header/Man. / Aeration CS. ~ f } • Dist. Pipe ~ G~ Holding • Bot. System y l PUMP/SIPHON INFORMATION Final Grade 731/ 1 Manufacturer /i' 0 Demand ill Ate', ,,St Cover r , Model Number GPM , .r 7q ( 3,7 Igo.1~ TDH Lift Friction Loss System H q a C T ~h~o r g' 6 I l~ • Ft RY Forcemain Ler~qth~ Dia.., / Dist. to I SOIL ABSORPTION SYSTEM BED/TRENCH Widtft DIMENSIONS AR Length No. Of Trenches PIT DIMENSIONS No. Of Rkts Inside Dia. Liquid Depth SETBACK SYSTEM TO INFORMATION P/L.; - BLDG WELL LAKE/STREAM LEACHING Manufiacturer: auvn A t q CHAMBER OR i E UNIT DISTRIBUTION SYSTEM Model Number: Header/Manifold Distribution Length Dia Pipe(s) f w x Hole Size r Length ( g d'~ , x Hole S acing Ant to Air Intake SOIL COVER Depth Over Spacing. ('5' z . X Pressure Systems Only zx Mound 4 Depth Over Or At-Grade Systems Only 7 Bed/Trench Edges yl G xx Depth of _ xx Seeded/Sodded Topsoil xx Mulched COMMENTS 11 ~'fes No (Include code discrepencies, persons present, etc. ns ✓ Yes LJJi No Inspection #1:- I r ~7 Inspection #2: Location: 1382 PINE VIEW TRL r P1 1.) Alt BM Description 2.) Bldg sewer length = >f. . > ft 0 { o - amount of cover = T*rt Plan revision Required? Yes I r Use other side for additional information. I = SBD-6710 (R.3/97) Date Insepctor's Sign ture " • ~I Cert. No. fr:VNR7.4 County _ W® Industry Services Division St. Croix 1400 E Washington Ave JUN 1N Z~ P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) ~nh AiN Madi W 37 71 ~ d ! 7'3 163 _Z ^pMMUN ~ rCriit App1i State Transaction Number In accordance with SPS 383 1(2), Wis. Adm. Code, submission of this form to the appropri e Al to unit prior to obtaining a sanitary 2952296 forms te- the Purposes Department of Safety a d Profes onal Servi Note Pe P opal information oyouaprovowned are submitted to ide mayPOWTS is required be used for secondary Address (if different than mailing address) in accordance with the Privacy Law, s. 15.04(l)(m), Stats. Project I. Application Informati 1382 Pine View Trail - lease Print All Information Property Owner's Name Ronnie & Deborah Deckard Parcel /t ? ~I~Q~► y M4'1969 891990 Property Owner's Mailing Address 1382 Pine View Trail Property Location • City, State Govt. Lot 76, ~ . City, t1, Zip Code Phone Number NW '/a, NE Section 25 HoultoI 54082 It. Type of Building (check all that apply) R 20 E or ® I or 2 Family Dwelling - Number of Bedrooms t # 5 Subdivision Name ❑ Public/Commercial - Describe Use ~Q Block # Woodland Hills ❑ State Owned - Describe Use ❑ City of 76A- n CSM Number ❑ Village of 0 All ® Town of St. Joseph III. T e of Permit: (Check our one box on line A. Complete line B if a licable A' ❑ New System t>1~ ® Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Before Expiration Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Owner / IV. T e of POWTS System/Com onent/Device: (Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade [E Mound? 24 in. of suitable soil ❑ Holding Tank El Other Dispersal Component (explain) El Mound < 24 in. of citable soil ❑ Pretreatment Device (explain) V. Dis ersal/Treat ent Area Information: ~ Z Design Flow (gp Design Soil Application De Design Soil Dispersal Area Require (sf) Dispersal Area Propos (st 750 Rate(gpdsO 0.4 i 875 1875 ) System Elevatio 93.85 VI. Tank Info Capacity in Gallons Total # of Gallons Unitsanufactuter .0 2 v New Tanks Existing Tanks //JJ~~ r Septic or [folding Tank ° U v iz U 1645 1000 2645 2 ^ Dosing Chamber Un - own/ teser Concrete 0 ❑ ❑ ❑ ❑ 1000 1000 1 VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. ❑ ❑ ❑ Plumber's Name (Print) Plu ! S. ature John Schmitt MP/MPRS Number Business Phone Number ~ Plumber's Address (Street, City, State, Zip Code) 223760 715-760 0486 616 150` Ave. Somerset, WI 54025 1 VIII oun /Department Use Only Approved d Pert Fq~ , Date sued Issuing ent Signature weer n Reason for al $ Z ' IX. Condi easons for Disapproval MW C 3 61 oi+4t wrdi cell.-ust all be sehif l mE int-'r eAA6 per tllqca&emen! ptzn p o ride i by piumbe.,. L . 2. ' `regUM-tems miss r e r• M AW 1VPkmW4i crxl / :rdinanci:?. ( ~.-an Q( ~G Attach to complete plans for the system and sub it to the County only on paper n I than i/Z x 11 inch IZ SBD-6398 (R03/14)~ I E=~ C ~wn-✓~"'~ lz / P PLOT PLAN N Project Name: Deckard 5 Bedroom Replacement Mound /4, S25, T30N, R20W Legal DescriptionIm Subdivision Nameills Lot of 030-2080-50-000 Townshipg ° CountyParcel Size: 2.290 Acres SCALE: 1 40' Contour Line Elevation: System Elevation Cell Dimensions: 7.5' X 100.00' Slope Mound Dimensions: 113.58' x 33.56' Einch h 40 -AST M D2685 BM1 Elevation: ottom of Sidin 40 -ASTM BM2 Elevation xisfin se tic tank outlet ■ Backhoe Pits: Existing septic tank 1000 gallon septic tank New Septic Tank Wieser Concrete WLP1645-MR w/ Pol lok 525 Dose tank Wieser Concrete WLP1000-MR o Pcp2COrti~ I.,I p,,I S 1' 5i1EN i _ ~o Q~i~o ~1'~ ~'1 1 ~ i h xr5~ iN je~C~ac jai Sc p is bus'tCf~ I a~ A Ga~uc~e ~ s~Pr'r~.~wi~~ ~ r C ~.C( Z'' S'cra ZIG l c>r?Ce ~l)llriU. i -c ~i2 Nc iati d uJ/ \ 12" ~~cr.ti .2 Uiv Oman 1 ~/~FYAR7:ifE: . DIVISION OF INDUSTRY SERVICES 0 1 \f 3824 CREEKSIDE LN m HOLMEN WI 54636-9466 Contact Through Relay r ~http://dsps.wi.gov/programs/indust services ~~~~s'srohTLS~e wwv.wisconsin.gov Scott Walker, Governor Laura Gutierrez, Secretary June 15, 2017 CUST ID No. 223760 A7-TN: POWTS Inspector, JOHN F SCHMITT SCHMITT & SONS EXCAVATING ZONING OFFICE 616 150TH AVE ST CROIX COUNTY SPIA SOMERSET WI 54025-6920 110 1 CARMICHAEL RD HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/15/2019 SITE: Ronnie & Deborah Deckard Identification Numbers 1382 Pine View Trail Transaction ID No. 2952296 Town of Saint Joseph Site ID No. 838639 St Croix County Please refer to both identification numbers, NWI/4, NEI/4, S25, T30N, R20W above, in all corres ondence with the a enc . FOR: Description: Five Bedroom Mound System \ Sloping site Object Type: POWTS Component Manual Regulated Object ID No.: 1709162 Maintenance required; Replacement system; 750 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. ~ DII The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code APPI requirements. j`,2 PT No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06 td OF E stars. $ p :~f ! The following conditions shall be met during construction or installation and prior to occupancy or use:~~~ Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of See. 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. • The existing POWTS dispersal cell shall be abandoned per SPS 383.33, Wis. Adm. Code. • All POWTS component piping material shall be SPS 384, Wis. Adm. Code compliant. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • A co of the approved plans, specifications and this letter shall be on-site during construction and open to inspection b authorized -e resentatives of the Department, which may include local inspectors. JOHN F SCHMITT Page 2 6/15/2017 Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. erard M Swim When You Receive That Invoice, POWTS Plan Reviewer, Division of Industry Services Please Include a Copy With Your (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm Payment Submittal. jerry.swim@wisconsin.gov WiSMART code: 7633 cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Deckard 5 Bedroom Replacement Mound Owners Name: Ronnie & Deborah Deckard Owner's Address 1382 Pine View Trail Houlton, WI 54082 Legal Description: NW1/4, NE1/4, S25, T30N, R20W Township St Joseph County: St. Croix Subdivision Name: Woodland Hills Lot Number: 5 Block Number Parcel I.D, Number 030-2080-50-000 Plan Transaction No. OV D Page 1 Index and title t E # ADD Page 2 Data entry ~~E~°ICES Page 3 Mound drawings °°1 Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Septic tank specifications- - Page 8 Effluent filter information Page 9 Dose tank specifications Page 10 & 11 Pump specifications and curve Page 12 Plot plan Page 13 Septic tank maintenance agreement Page 14 Existing tank certification Page 15-17 Existing septic tank setback variance Page 18 Warranty deed Page 19 CSM Attachment Soil evaluation report Designer: John Schmitt License Number; 223760 Date: 5/24/2017 Phone Number: 715-760-0486 Signature: 1/1 Designed Pursuant to the Mound Component Manual for POwTS Version 2.0 SBD-10691-P (N. 01/01) and both SSWMP Publication 9.6 Design of pressure Distribution Networks for ST-SAS (10/81) and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706-P (N. 01/01) Version 7.0 (R. 03/2012) Page 1 Mound and Pressure Distribution Component Design Design Worksheet site information (R or C) R Residential or commercial Design 500.00 Estimated Wastewater Flow Note: Sand fill (D) calculations assume a 1.50 Peaking Factor (e.g, 1.5 = 150%)) Table 383 44-3 in-situ soil treatment for fecal coliform of 36 inches. 750.00 Design Flow (gpd) 7.00+ Site Slope 92.85! Contour Line Elevation (ft) 24.00' Depth to Limiting Factor (in) 0.40 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 100.00; Dispersal Cell Length Along Contour (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ftz 7.50 Cell Width (ft) 1; Influent Wastewater Quality or 2 ) ( ) Are the laterals the highest point Pressure Disribution Information in the distribution y (C or E) c Center or End Manifold network? Enter Y or N 2.50 Lateral Spacing (ft) 6 Number of Laterals If N above, enter the elevation (ft) 0.156 Orifice Diameter (in) of the highest point. 2.67' Estld Orifice Spacing (ft) = 6.94 ft2/orifice 2.00 Forcemain Diameter (in) 60.00 Forcemain Length (ft) Does the forcemain drain back? 85.50 Pump Tank Elevation (ft) Y Enter Y or itl 4.55 ,gystem Head (ft) x 1.3 9.79 Forcemain Drainback (gal '-'8.02 Vertical Lift (ft) 135.36 5x Void Volume (gal) } 3.96 Friction Loss (ft) 145.15 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 58.16 System Demand 16.52 Total Dynamic Head (ft) (gpm) Lateral iameter Selectio ;n; o teter Manifold Diameter Se tion choice in. dia. 0.75 options choice ~t 1.00 1.25 1.25 1.50 x 2.00 1.50 x x 3.00 x x 2.00 x 3.00 x Treatment Tank Information Gallons/Inch Calculator (optional) 1645.00 Septic Tank Capacity Total Tank Capacity (gal) Wieser Concrete (gal) Total Working Liquid Depth (in) Manufacturer gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 1000.00 Dose Tank Capacity (gal) POLYLOK Filter Manufacturer 27.83 Dose Tank Volume (gal/in) 525 Wieser Concrete , Manufacturer Filter Model Number Project: Deckard 5 Bedroom Replacement Mound Page 2 Mound Plan and Cross Section Views 11./10B_ fK :.Observation Pipe J jj 5 - T W I.: A L Mound Component Dimensions Down slope toe extension made. A 7,50 ft E 18.30 in H B 1 QO.OO ft F 1.00 ft K 9.16 ft D 9.50 in I 11.25 ft L 118.33 ft 12.00 in G 0.50 ft J 5.68 ft W 24.43 ft 750.00 (ft2) Dispersal Cell Area z )Basal Area Available 7.50 1875.00 (ft (gpd/ft} Linear Loading Rate 10.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 95.64 (ft) G 1 93.85 (ft) ► i Dispersal Cell 94.35 (ft) Lateral Dispersal Cell Invert Elevation :•Q:::::::; ; E ® o g 92.85 (ft) Contour Elevation 7.0 % Site Slope Shading Key a a Geotextile Fabric Cover R 1 Dispersal Ceti ❑ ~ Topsoil Cap Z. 1.5 ft See lateral details on ---7777777777- Subsoil Cap 'v, a Page 4 for number, size, © ASTM C33 Sand 1° I and spacing of laterals. Tilted Layer F Laterals are equally 0.5 ft Typical Lateral spaced from the © Aggregate o distribution cell's centerline in the A distribution cell (AxB). Project: Deckard 5 Bedroom Replacement Mound Page 3 Center Connection Lateral Layout Diagram Force main connection via tee or cross to manifold at ang point Laterals are identical TT s i IE P T s y 0= Turn-up -Mballvalve or (FX-~'Fx12 .x12->J Laterals &forcemain $ch 40 PVC cleanoutplug f)er SPS Table 384.30-6 Holes drilled on the bottom of the lateral. Number of Laterals 6 Orifice Diameter 0.156 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.81 ft Lateral Length (P) 49.18 ft Orifices per Lateral 18 Lateral Spacing (S) 2.50 ft Orifice Density 6.94 ft2/orifce Lateral Flow Rate 9.69 gpm Manifold Length 5.00 ft System Flow Rate 58.16 g p m Manifold Diameter 2.00 in Total Dynamic Head 16.52 ft Forcemain Velocity 5.94 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 Disconnect 4 in. min. Dis Tank component is properly vented E Alternate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in Capacit 1000.00 Gallons Volume 27.83 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A _ 18.72 _ 520.89 B 2.00 55.66 C Pump off elevation (ft) C 5.22 145.15 86.33 D 10.00 278.30 Total 35.93 1000.00 D Dose tank elevation (ft) 3" Bedding un er tank. 85.50 Alarm Manuafacturer SJE Rhombus Note: Switches Alarm Model Number 1036378 _ containing mercury may not be used in Pump Manufacturer Zoeller this system. Pump Model Number 140 Pump Must Deliver 58.16 gpm at 16.52 ft T D H Project: Deckard 5 Bedroom Replacement Mound Page 4 Mound S stem Maintenance and 4 eration S ecifications Service Provider's Name POWTS Regulator's Name John Schmitt Phone 715-760-0486 St. Croix County Zoning Phone; 715-760_-0.486 System Flow and Load Parameters Design Flow - Peak 750 gpd Maximum Influent Particle Size Estimated Flow -Average 500 1/8 in Septic Tank Capacity 1645 gpd Maximum BODS 220 mg/L Soil Absorption Component Size 750 gal Maximum TSS 150 mg/L Type of Wastewater Domestic Maximum FOG 30 mg/L Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspectce once eve 3 ears Effluent Filter Should ins ect 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 ressure tested eve 3 ears Mound Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished Grade 6-8" Diameter Lawn Sprinkler Valve Box Threaded Cleanout Plug or Ball Valve Distribution Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Deckard 5 Bedroom Replacement Mound Page 5 Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01, R. 10/12), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706-P (N. 01/01, R. 10/12)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L 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. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 UM-i"km :3111 98tb8-8Z~-008 0 \ OSLbS m 'NOON N301VW OL AMH Sn 9LL£M Z :anod-tsod :3n3NQ oo /000 :3iVO 313000UU l`dfiNt/W ~Ild3S w 0 :8nOd-38d „0-,L=J, l :31VOS dOM 'A R NMVNO 13531M _ \ dW-5•b9ldlM V 0 J w w U) x J H d Q o co O w z 0 LLJ V) Q. z Z) z o a= m uwi a m O~u 0 C J Ld V1 d Z 1- X 00 LL. 0 < O x~ Z tY m¢ w N Om 0 ~ Z wp U in o z f- ~ 0 0w QQU < uj o a o M (n w1-w z p oF-' C; z (n o i w } M cie t)00~ QQ ¢w ~ M J1- p fn z 000 X l ¢ a U7 LL U _ N O o "t n O w t~ M W 'i d U Q Z U a N ¢\tDUF-.I0 W 1< WV'¢ Jd co 0 p oZ UjH W -I CCU n z ,end v `J` ~2 q: ?c1-n ~ °c4~ z = = W~ zo LLJ Q vi ..0~0~~ ~p~ OQY Oow Q QWd w w 0 _~0 aW J OQwp O ~ z Q z~0 U U~U Q N CL w OO Q W i1 Qad U' < 0 c9 Z Z3mCJ22J`s'QIJ 0 ZOQ Z 0 OO Q J w 0 ° Q Y >Z ~ p Z Z CY O 0 z 0FQ- V H n_ O tl ~ H ~ Z 0_ W (if W it w I~ I I JI Q 0~ IC• N i o'¢ I ~ N it I l I ~ ~ m I I I I II II w W W ll J II I o II ~ I! ~ I9~ w 11 i II 119 .2 o II N II. i i w °I I a I I w II Y 1 II I I I o ~ W U ~ M < W Z_ Q Clb3N ~ "te SV Q «~5 N Y Z Q F- Page 7 ' 7'11 IQ A Division of Polflaa Inc. t~ The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has 525 linear feet of 1/1.6" filtration slots. Like the Polylok PL-122, the PolyIok PL-525 has an automatic shut-off bal l installed with every filter. WI-ten the filter is removed for cleaning, the ball will float up and temporarily shut off the system so the effluent won't leave the tank. s: / f $ Rated for 70,000 GI'D (gallons per day). Alarm Switch (Optional) 10 000 GP]D 525 linear feet of 1/16" filtration. " Accepts 4" and 6" SCHD 40 pipe. Accepts 1" PVC Extension Handle Built in gas deflector. Automatic shut-off ball when filter is removed. Y Alarm accessibility. Rated for x f 10,000 GPD Accepts PVC extension handle. i s Ideal for residential and commercial waste flows up to~ , 525 Linear Ft. 10,000 gallons per day (GPD). of 1/16' Filtration Slots 1. Locate the outlet of the septic tank. 2. Remove the tank cover and pump tank if necessary. Accepts 4" & 6" ~3. Glue the filter housing to the 4" or 6" outlet pipe. If SCHD 40 pipe the filter is not centered under the access opening use a Polylok Extend & Lok or piece of pipe to center filter. 4. Insert the PL-525 filter into its housing. _t a 2E 5. Replace and secure the septic tank cover. ; ~x f The PL 525 Effluent Filters will operate efficiently for several years under normal conditions before requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped, or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter Gas Deflector needs servicing. Servicing should be done by a certified septic tank pumper or installer. Automatic Shut-Off Ball 1. Locate the outlet of the septic tank. 2. Remove tank cover and pump tank if necessary. 3. Do not use plumbing when filter is removed. 4. Pull PL-525 cartridge out of the housing. _ 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank. 6. Insert the filter cartridge back into the housing making sure the filter is properly aligned and completely inserted. Pol yIok', Zabel & Best Bestfilters accept Easily I . installs lls 7. Replace and secure septic tank cover. the SinartFilterOO switch and alarm. into existing tanks. Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll Free: 877.765.9565 Fax: 203.284.8514 www.polylok.com Page 8 an-OOOIdW :31U 99-b9-9Z2-009 Z \ :?JnOd-1SOd -31VO 00 00 00 ]31V0 05Lt~5 IM 'N008 N301VYV OL AMH Sn 9LL£M ivnNVIN 3lid3S w O :850d-32ld 0-,L=„4 L :31VOS dOM :,kG NMV210 313031 log 13531M w \ ~W-000WIM r-- (awn uj LLJ U H z _ ° m0 w~ o O a D (n v) x W w V1 t1. V~ 0 0 O W O CWT 0- lz w CL V, W F-- J J F- J (A Q w O 0000 0 d' 0 a^t1 V Z w m a- m pia z r CL w~ H 0 0 o z 1- w,p oQ a-Q oa Q m~ z 3 u- o a G U aa.a p 0NV wWW 0 0 ~ CL o~ O Q CL 0 o V) ry, I ` N J I Gj- p r7 U? W a n° ° t, 00 C J C7 O V- q 0 0 N '(0 23 Q Q u' Y z U -UO p,tn w I awvWi a- o Q- 000 z a s O U_ F = O ~U mW!- N wQ o) p~ f4- O W N n- `i FQ- d O t= (:.~ji (T, F- I Q F- C _i p. W O Z U1 LAJ NJOa -J QV (yZ~ Oa Z (nx 0Z z~ n a' ~Lj ~COZwco D~~ YxV O 5~ w0 Zo V) w .J fn N O a0}-~ ..3 p z O V Y OOW Q Q~ Q W m pp on 0 Q0 OQwwpOwcy QLd< z 00 U V -'U c~ QW ~g Na z Z3m U~xJsmZoa Z U ~O p Ow J -j CY p 0 Z > Z p Z J x J o~ U U J Q W in I 4 ~ W < ~ d „62 p w U p Q ~ F O a Li ~ O D a - a N i o ` al w m II W W Q ii 1 5 a_ 5 I .92 Q w a ~I. o - x 1 C) l t ~ \ I ~ o \`N/ ii/ I I 1 ~ W 0 L Q ~ N Li W J z Q „99 < 03JM03H SV „ £5 w w Q Y z Q Page 9 - - - - SECTION: 2.20.045 Qr~a~/rv Pins SyCF . = FM1502 1211 Supersedes A © Product information presented - here reflects conditions at time 0710 of publication. Consult factory regarding discrepancies or inconsistencies. MAIL TO: P.O. BOX 16347 • Louisville, KY 40256-0347 VIS%t our web site: SHIP TO: 3649 Cane Run Road • Louisville, KY 40211-1961 www.zoeller com (502) 778-2731. 1(800) 928-PUMP • FAX (502) 774-3624 t 14014140 & 14514145 Cast Iron Series Durable Cast Iron construction Model 140 features a Non-Clogging engineered (For Pump Prefix Identification see News & Views 0052) thermoplastic vortex impeller design and passes Y2" spherical solids Model 145 features an engineered thermoplastic single vane impeller design and passes 1/4" spherical solids FOR SEPTIC TANK - LOW PRESSURE PIPE (LPP) Motor-60 Hz, 3450 RPM, oil-filled, hermetically AND ENHANCED FLOW STEP SYSTEMS sealed, automatic reset, thermal overload protected r A Available in both single or double shaft seal designs EFFLUENT Carbon/Ceramic mechanical shaft seals OR DEWATERING PUMPS Assembled with Stainless Steel bolts SUBMERSIBLE m`s~AA Stainless Steel lifting handle 11/2" NPT DISCHARGE Upper sleeve and lower ball beating running in bath of oil 20 ft. UL Listed Neoprene cord with molded plug cap and ground wire k 'z~.lt #a i lod 1 1W NPT vertical discharge l` BN and BE models include a variable level float switch and 11/2" X 2 PVC adapter fitting Operates at temperatures to 130°F (54°C) in effluent or dewatering applications t Yn I 1 . Corrosion resistant powder coated epoxy finish Note: The sizing of effluent systems normally requires variable level float(s) controls and properly sized basins to achieve required pumping cycles or dosing timers with t..., nonautomatic pumps. C US t; - . Tested to UL Standard ULT78 d and CerBeed to CSA rJ r1L3t it - ` • Standad 0222 No. 108 6 v. POWDER i COATED ' MAIL TO: P.O. BOX 16347 T'OUGH" WVA Louisville, KY 40256-0347 SHIP TO: 3649 Cane Run Road ' Louisville, KY 40211-1961 (502) 778-2731. 1(800) 928-PUMP "it FAX (502) 774-3624 Automatic (Models BN & BE) Nonautomatic Manufacturers of 1 HP, 1Ph 115V or 230V (14014140) Z ~ HP, 1Ph 115V (14514145) O QvQZIr{' lglW.1s 51VCE /~93~9 © Copyright 2011 Zoeller Co. All rights reserved. D- 1n PUMP PERFORMANCE CURVE TOTAL DYNAMIC HEAD/FLOW 1 1 qL~ ,I r MODEL 140141401145/4145 PER MINUTE fit a s 72 EFFLUENT AND DEWATERING - - - I 37/6 `I--- 6517G MODEL 140/4140 145/4145 14 Feet Meters Gal. Liters Gal. Liters w ° 5 1.5 86 326 61 232 ° 329732 ss 10 10 80 303 60 228 ° Is 15 416 73 276 56 213 4- 20 6.1 ° 66 250 53 201 14 25 Z6 59 223 49 186 2 ar 11 2, 9.1 49 185 45 171 12 10 40 12.2 28 106 35 133 3s 50 151 - - 26 99 m 60 18.3 - - 16 61 ° ,s Shut-off Head: 50 8.(15.2m) 74 ft .(22.6m) 1 e zs a 12 1313 S - 750090 l0 45132 5 ( i'W 1W I 1 SK 1524A 0 115 ItW f0 70 10 40 50 fA 70 BO GNL"f15 "FRS 0 80 I00 2b ~ FLOWPER MINUTE ' I ! 1.- I 1. 1.' • Electrical alternators, for duplex systems are available and supplied with an alarm. 378 65,10 • Mechanical alternators, for duplex systems, are available with or without alarms. «a • Control alarm systems are available for 1 phase pumps used in simplex system. See FM0732. 1 • Variable level control switches are available for controlling single phase systems. ° 32132 • Double piggyback variable level float switches are available for variable level long cycle controls. ° + - f- • Sealed Qwik•Box available for outdoor installations. See FM1420. ° • Refer to FMOB06 for applications above 130°F (54°C). 140/4140 & 145/4145 MODELS - SINGLE PHASE Control Selection Model Model Volts Mode Amps Simplex Duplex N140 N4140 115 Non 12 1or2 3 E140 E4140 230 Non 6 1 or 2 3 BN140 BN4140 115 Auto 12 _ a,7tl BE140 BE4140 230 Auto 6 N145 N4145 i15 Non 13 1 or 2 3 4 &3 E145 E4145 230 Non 6 2 1 or 2 3 sK1524e BN145 BN4145 115 Auto 13 BE145 BE4145 230 Auto 6 'Single piggyback switch included. 1. For automatic use single piggyback variable level float switch or double Reduces potential clogging bydebris. piggyback variable level float switch. Refer Replaces rocks or bricks under the pump. to control FM0477. Made of durable, noncorrosive ABS. 2. See FM 1228 for correct model of simplex p p - "Easy assembly" panel. Raises um 2" off bottom of basin. a",Padise a 3e pipe Provides the ability to raise intake by adding not included.) 3. See FM0712 for correct model of duplex sections of IW or 2" PVC piping. control panel. Attaches securely to pump. Accommodates sump, dewatering and n caunonl effluent applications, ~ IWI'q NOTE: Make sure float is free from obstruction. n! For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. © Copyright 2011 Zoeller Co. All rights reserved. PaQP 11 PLOT PLAN Project Name: Deckard 5 Bedroom Replacement Mound pp`) Legal Description: NW1/4, NE1/4, S25, T30N, R20W P.I.D: 030-2080-50-000 ~tw Subdivision Name: Woodland Hills Lot 5 0 Township: St. Joseph Parcel Size: 2.290 Acres SCALE: V = 40' County: St. Croix Contour Line Elevation: 92.85 Cell Dimensions: 7.5' X 100.00' 4 inch Sch 40 -ASTM D2665 System Elevation 93.85 Mound Dimensions: 113.58'x 33.56' 2 inch Sch 40 -ASTM D1785 Slope 7 - BM1 Elevation: 100.00' Bottom of Sidin 11/2 Sch 40 -ASTM D1785 BM2 Elevation. 90.50' Existing septic tank outlet ■ Backhoe Pits: Existing septic tank 1000 gallon septic tank New Septic Tank Wieser Concrete WLP1645-MR w/ Pol lok 525 Dose tank Wieser Concrete WLP1000-MR 0 'J1/ it L~ _ > PcOrccr~\ 50 r>In i i h xi5~ iN~ I C'CG~4L T Ii kc Oi=Cr~ Lo, gGpric ~ EXIST 1IV 6 r.7l~~1A3 j ll i` 71) i C1L Ij~f~l)C6tiL S t/'F~r~}iUl~~ I 1 I - _ r- ff ~ ~ tJ ~.C, 5.01 ilG f L,c'Cf !1)~rr`~ Cc ~fti 7 / \ \ Pan 1? i I ST. CROIK COUNTY SEPTIC TANK MAINTENANCE AGREEMENT . AND OWNERSHIP CERTIFICATION FORM Owner/Bapx- Pon r1 i Z~ee'r Mailing Address 13 6 z- A'ne "T%'g;/ Property Address ? ' / (Verification required from Planning & Zoning Department for new construction.) City/State _~{,c.a(sor, Parcel Identification Number d 30- ,2D60 5-D LEGAL DESCRIPTION Property Location i w 114.461114 Sec. 2 5~ , T _,30 N R-2-0 W, Town of 5£ • -oW 4_4C Subdivision 44)Zr_41a,,j,-j h'.'/f5 Lot Certified Survey Map # i1a. , Volume , Page # Warranty Deed # (P 7~ 7Co/ , Volume 1662 , Page # 3c// Spec house )ZT no Lot lines identifiable es ,k SYSTEM MAINTENANCE AND OWNER CERTIEICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in $Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition.and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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 Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three y expiration date. Uwe certify that all statements on this f rm are true to the best of my/our knowledge. Uwe amlare the owner(s) of the property described above, by virtue of a w y deed recorded in Register of Deeds Office. Number b ms 1L,1!51 1eZ' 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, 08/05) PaaP 1 ~ , Safety and Buildings ccmmerce.w{.gOY PO BOX 7162 MADISON WI 53707-7162 TDD (608) 264-8777 isconsin www.oommorce.vA.gov/sb/ www.mdsconsin.gov lt!epartmentol!Commerce Jim Doyle, Governor Jack L. Fischer, A.I.A, Secretary December 06, 2007 CUST ID No. 30021 ATTIC- POWTS Inspector JAMES K THOMPSON ZONING OFFICE A.C.E. SOIL AND SITE EVALUATIONS ST CROIX COUNTY SPIA 340 PAULSON LAKE LN 1101 CAPMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 APPROVAL OF PETITION FOR VARIANCE Identification Numbers Transaction ID No. 1489457 SITE: Site ID No. 732675 Ronnie and Deborah Deckard Please refer to both identification numbers, Town of Saint Joseph, above, in all correspondence with the agency, St Croix County NWl/4, NEI/4, S25, T30N, R20W Lot: 5, FOR: Petition for Variance Comm 83.43(8)(i) The submittal described above has been reviewed for equivalency to applicable Wisconsin Administrative Codes and compliance with Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in section 101.01(10), Wisconsin Statutes, is responsible for compliance with all conditions of this petition approval and other applicable code requirements. Plan submittal and approval to the department or its agent may be necessary prior to construction undertaken per this petition. The code section petitioned requires that the exterior subsurface of a treatment tank or holding tank component be at least five (5) feet from a building. The variance requested is to permit an existing 1000 gallon concrete septic tank to be 16 inches (1.3 feet) from a supporting footing post of a 3-season porch. C The intent of the code section petitioned is to protect the waters of the State, structures and the treatment and dispersal components in the event of a component failure. The petitioner submitted the SB-9890 application form including additional page(s) of supporting documents and/or plans. Reviewer's Comments: QP I . The supporting. footing posts appear not to be affecting the integrity of the septic tank. o C 2. The septic tank manhole cover is accessible for service and maintenance. 3. Examination of the septic tank by the designer and/or his agent found it to be physically sound and no appearance of the threat of collapse. 4. The existing septic tank will be included as part of the replacement onsite wastewater treatment system serving the residence. Departmental Action: CONDITIONAL APPROVAL Reviewer's Conditions of Approval: None All of the petitioner's statements of fact or intent included on the variance application form, any other documents submitted to the Department, as well as any other conditions of approval listed below, shall be carried out. Any reconunended conditions of approval by the fire department and/or municipal building inspection department listed Page 15 JAMES K THOMPSON Page 2 12!6/2007 above shall also be carried out unless otherwise stated below. This variance is specific to the subject petition and cannot be used for any additional modifications. This decision will become final unless the department within 30 days from the date of this letter receives a written request for a hearing. A request for hearing should be sent to the address shown on this letterhead. A copy of this letter must be included with the request for a hearing. The request for hearing should state the reasons for objecting to the de pa ent's decision, because a request for hearing may be denied if it does not present a significant question in ct, 1 or olicy. In uirie nce g this correspondence may be made to me at the telephone number listed below, or at the address r on this l rhea , n~~S cerel Fee Required $ 225.00 Fee Received $ 225.00 I Balance Due $ 0.00 ar S 1 inger PO TS n iew tegrated Services WiSMART code: 7633 (608) 61-7 5, Fax: (608) 267-9566, M-f 7:OOAM - 3:45PM mark.. er@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. Doan 1 r, IL13?4,6 • comrrterce.wl.gov APPLICATION FOR REVIEW PETITIONnCEIVED sco !sin VARIANCE SBD-9890X LIEU - 6 ZQ~7 -Complete allpages- Dspertment of !Commerce Safety & Buildings Division This page ma tments Bureau of Integrated Services Complete and indicate data plans will be in our office 1. Facility Information 0 910 1-6 Complete for confirmed appointments*: Facility (Building) Name: Rannie ctard residential mound Transaction ID: 148676=3 Number and Street 1382 Pine View Trail. Hudson. WI $4016 Previous Related Trans. ID: Commerce Site Number (if known): Na Assigned Reviewer: Legal Description: NW114NE1/4,, ac 25, T.80N.. R.20W Assigned Office: County of St. Croix Review Start Date*• 1 (17 City Village (X) Town of St. Joseph *Submittal must I* received in the office of the appointment no later than 2 wg cfln days before the confirmed appQIft L NOTE: Personal information you provide may be used for seconds purposes Priva Law s. 15.04 1 m Stats. 2. Owner Information Customers 3. Designer information Customer # Name Ronnie Deckard Designer Jim Thompson 30021 Company Name NA Design Firm A.C.E. Soil & Site Evaluations, LLC Number and Street 1382 Pine View Trail Number and Street 340 Paulson Lake Lane ~v 02 City, State, Zip Code Hudson, WI 54016 City, state, zip code Osceola, Wl 54020 Contact Person Ronnie Deckard Contact Person Jim Thompson =O Telephone Number Fax Number Telephone Number Fax Number (715) 549.6921 715 248-7767 715 248-7764 4. Plan Review Status Plan previously review by (ptease enclose a copy of review let Plan submitted with petition State _ Municipality _Approved X Held Denied + Plan will be submitted after petition determination Code Being Petitioned Requesting revision _ Other: _ Building _ HVAC Plumbing X Private Sewage System Commerce Transaction Number Swimming Pool Electrical S. State the code section being petitioned AND the specific condition or issue you are requesting be covered under this petition for variance. a, Comm 683,43(8)(1) - Existing seatic n located elevated at O'from d by 2Qgt footings. nearest flocated at I 6"-ftm edoe of tank Tank Is also located 52' from existino deck 6. Reason why compliance with the code cannot be attained without the variance. Existing POWTS has hydraulically fiai and Mqilt be re wd. gxisfing.septic k re-used onnot be variance oval. 9&avating to v n or attach to i r uostreliM could, result In Damage to the structure or disturbance of structuryl oootings 7. State your proposed means and rationale of providing equivalent degree of health, safety, or welfare as addressed by the code section petitioned. F-xisting been examined and found RhyQicalty sound and glggs not gopgarto preseala threat of Porch collapse, elevalegi 40 bottom or'oi 5" e grade above o tank over, r vt n acces§ for safe I i n i maintenance, and k and tru a allready In place, 0 physical be no dgMane to the gggiponent r 8. List attachments to be considered as part of the petitioners statements (i.e., model code sections, test reports, research articles, expert /iDo opinion, previously approved variances, pictures, plans, sketches, etc.). t ~~i~ Tank / structure detail, Existing fan s(_certffiration statement `4~ 1 VERIFICATION BY OWNER - PETITION IS VALID ONLY IF NOTARIZED WITH AFFIXED SEAL AND ACCOMPANIED BY REVIEW FEE Note: Petitioner must be the owner of the building or system or credential applicant for a Comm 5 petition. Tenants, agents, deslgnars, go /y attorneys, etc., shall not sign petition unless Power of Attorney Is submitted with the Petition for Variance Application, RonngDeckgrd, being duly sworn, 1 state as petitioner that I llawmTad the foregoing petition and I believe s Petitioner's Na r tint it is true and that 1 have si nificarrt ownershi hts the subject builds or rect. S to Subscribed and swam Note Public My commission expires Z!2 - t ie me this date n.: - on alt Corn lets other side for v once re ussts from Comm 20-25 and Comm 6 -6S MAKE CHECKS PAYABLE TO DEPT. OF COMMERCE =TOTAL AMOUNT DUE $ 225.00 Attach check here. SBD-9MX (R. 11/2005) (Check as website at httn~//www commerce glace v4 us/Sl3tSB-DivFolTns_htms for the most current version orthis form) PaFp 17 • •lr N i z 1 f V G' 182°235.5- 889 9 36E 110.1 woe 352.73' ' S 88"59 34"V T02.-'3_~ ~ 153°44 32, N, 88°a9 34rsE 744.66 rh 16 4.68 r t _.'c 290.00 •4 Ufa---- 25~. ~4 5Y , s 6 p S 88''59 3C AE 0 s, E s `QED SURVEY 041 AP 1~A8 7 IT 2.2~ riCRES { 3.00; 00 z 4 w w +d Y o 0 / I 4> 40) E TO 250.0d Al 8 106.19, 13 8.67' ~qy, 88°59" 30RYE 4 2 8 .67 4 (J `'J 296017'4Z Page 1 134.51 ~ : N 80°59 3 tr a 2.4 3 ACRES 2100 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 81A x 1 f Inches in size. Plan must t3- t. Croix Include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to n08 -000 Please print all information. Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 2 0 Property Owner it operty Location Ronnie & Deborah Deckard . Lot NW 1/4 NE S 25 T 30 N R 20 W Property Owner's Mailing Address L t # Block # Subd. Name nr CSM# 1382 Pine View Trail 'A7 5 Woodland Hills City State Zip Code_PhoneJNumNTY City Village e Town Nearest Road Hudson WI 54016 Z &11 St.Joseph Pine View Trail J New Construction Use: 16 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement _j Public or commercial - Describe: Parent material Glacial drift Flood plain elevation, if applicable na General comments and recommendations: Site suitable for mound system with 12" of ASTM-C33 sand placed on 92.85' contour. System elevation 93.65'. D Boring # . I Boring ✓ Pit Ground Surface elev. 92.23 ft. Depth to limiting factor _ 48" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD x in. Munsell Qu. Sz, Cont. Color Gr. Sz. Sh. *Eff#1 2 1 0-9 10yr2J2 none sil 2fsbk mvfr cs 2fmc 0.6 0.8 2 9-19 1Oyr3/4 none sil 2fsbk mfr cw 2fm,1c 0.6 0.8 3 19-34 10yr4/6 none _ sict Irnsbk mfr aw 1fm 0.2 0.3 4 34-41 7.5yr4/6 none Is 0 sg ml cw if 0.7 1.6 5 41-48 10yr4/6 none s 0 sg mi cw - 0.7 1.6 6 48-88 1Oyr4/6 f2d 7.5yr5/8 fsi/ls/fs Icsbk/Osg ml - - 0.2 0.6 consists o a stratified mix of 10yr4/4 fst, r4 4 Its, 10yr416 Is 1 r 4J6 fs. 2 ] Boring # --I Boring Pit Ground Surface elev. 91.55 ft. Depth to limiting factor 28" in. Soil Application Rate F Horizon Depth Dominant Cotor Redox Description Texture Structure Consistence Boundary Roots GPD in. Munseii Qu. Sz. Cont. Color Gr. Sz, Sh. *Eff#1 *Eff#2 1 0-12 10yr2/2 none sil 2fsbk mvfr as 21' 0.6 0.8 2 12-17 1Oyr4/3 none sil 2fsbk mvfr cw 2vf,lf 0.4 0.8 3 17-28 1Oyr5/4 none sin 2f&msbk mfr cw 1vf 0.6 0.8 4 28-36 1 Oyr5/4 f2f 7.5yr5/8 Gil 1 csbk mfr - 1 of 0.2 0.3 * Effluent #1 = BOD? 30 < 220 mg/L d TSS >30 e 1 0 mg/L Effluent #2 = BOD < 30 mg/L and TSS S30 mg/L CST Name (Please Print) Signatur : ST Number James K. Thompson ~'ot 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, 0s WI 54020 10/30/2007 715-248-7767 Property Owner Ronnie & Deborah Deckard Parcel ID# 030-2080-50-000 Page 2 of 3 U Boring # --j Boring L/j Pit Ground Surface elev. 93.58 ft. Depth to limiting factor 24" in, SouApplication Rate Horizon Depth Dominant color Redox Description Texture Structure Consistence Boundary Roots In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 `Eff#2 1 0-9 10yr3/3 none sit 2fsbk mvfr Cs 2fm,1c 0.6 0.8 2 9-19 10yr4/3 none sit 2fsbk mfr cw 2f,1 me 0.6 0.8 3 19-24 7.5yr4/6 none sicl 1f&msbk mfr aw 1fm 0.2 0.3 4 24-36 7.5yr4/6 f2d 7.5yr5/8 sl 1csbk mfr cw 1fm 0.4 0.7 5 36-50 10yr4/6 cap yr4/6 fslAs/fs 1 csbk mfr - 1 fm 0.2 0.6 H#6 consists of a stratified mix of 10yr414 fsl, 10yr4/4 its, 10yr416 Is & 10yr 4/6 fs. ❑ Boring # Boring _ J Pit Ground Surface elev. ft. Depth to limiting factor in, Soil Apoication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDXe In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh, 'EfF#1 •Eff#2 F7 Boring At -j Boring I Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots MAP - in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS <30 mg/L and TSS <30 mgfL 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. SSD-8330 (8.07/00) A.C.E. Soil & Site Evaluations Pole G~'e4t~ (fQt! ~Ot~Q!/Q1ClQL~i'pr)~~'t E,ri3L~irk~~GL2de ElEi.,' Q ~ ,Pann,'e ~ C1eGo~~ o. 4)1 ~ 3 ones U V /.~2fi'n¢ U,~w~7~a,~/ ttJmr-11a0 u 1-1,'115 Ac~Jt's~ /~E1'~; Sac. z S J oo.vngo-50-Ct~ t/ee. 6,-4 1/ a, ~a++sfenner~ ts.- ~4Y ~w ~ w1~ r 0 ~ ..fie..', l~rn-cl.;s e.lc✓a#~d, 3 l ~om o f ~'loorJoist,S Shed ► ; /r~Cs:de~xe - /BO.GD; ~,d.~ yS.Q~' V GOO _ ~~qq 4 pQcr El ConcrL~ s i.uz•at: Fo c6 ~c,%rg S,N,Po,rg F?irt,l, /oca(6Ptcr,20" l/ A-- 6-x, ,v c.c.rrocl~ ttl~rouyh Systc.n/I~ eA M SW ` (pA'604f 93.sn' Owner: Deckard, Ronnie & Deborah Computer 030-2080-50-000 Address: Parcel 25.30.20.682 Unknown Municipality: St. Joseph, Town of Address: 1382 Pine View Trail Hudson, WI 54016 0110812007 Deckard, Ronnie & Deborah Kevin Grabau Per memo from Dwight Farnham, many unlicensed vehicles on property, assorted junk piled in pickups and strewn around property. Based on photos taken by Dwight - sending notice of violation. 0210512015 UNKNOWN, UNKNOWN DO NOT CHANGE Sarah Droher Closing due to inactivity. Commerce.wi.gov Safety and~Buildings Division County 201 W. Washington Ave., P.O. Box 7162 St. Croix S~jo m S ~ Department of Commerce Madison, WI 53707-7] 62 Sanitary Permit umber (to be filled in b Co. y ) r 5i z~ 3 Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental Trans. ID# 1486690 unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address (if different thaylmailing address) submitted to the Department of Commerce. Personal information you provide may be used for seconda l!'1 purposes in accordance with the Privacy Law, s. 15.04(1 )(in), Slats. 4 ~3 S~ r ^ G V. C s~ 1. Application Information Please Pri Same t All Property Owner's Name (f 0.~• 0 ~A I Parcel # Ron Deckard 0 18 Zang bpCo~ Property Owner's mailing Addres 030"2080-50-000 Property Location ~f Z, 1382 Pine View Trail ST. CROIX COUNTY City, State NNING & ZONING OFFICE Govt. Lot one Number NW Y/, NE Section 25 Hudson, WI 54016 (circle one) II. Type of Building (check all that apply) ❑ 1 or 2 Family Dwelling - Number of Bedroom 5 5 Subdivision Name El Public/Commercial -Describe Use Block # Woodland Hills Na ❑ City of ❑ State Owned - Describe Use CSM Nu r ❑ Village of % ❑ Town of St. Joseph 75A- o~ Na III. Type of Permit: (Check only one box on line A. Com ete line B ' a A. pp able) ❑ New System Replacement System ❑ Tre ment/Hold Replacement Only ❑ Other Modification to Existing System (explain) B. El Permit Renewal El Permit Revision El Ch of tuber 11 Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner #514822, issued 12/21/07 IV. T e of POWTS System/Component/Device: Check a hat apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade Km-ound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) El V. Dis ersal/Treatment Area Information: 6' X 100" dis ersal cell Pretreatment Device (explain) PolvLok PL-525 effluent filter Design Flow (gpd) Design Soil Application Rate ds (gP f) Dispersal Area Required (s Dispersal Area Proposed System Elevation 750 gpd 1.0 ASTM C-33 sand 750 s q. 0.4 in-situ soil q• ~ 16 750 sq. ft. ~ 93.85' at 12" above VI. Tank Info Capacity in 92.85' Contour Total # of Manufacturer Gallons Gallons Units New Tanks Existing Tanks /b i ci J v' Y 52S Septic or Holding Tank 750 Lti --tow 1750 1 ieser Concrete/Unknown X Dosing Chamber 1000 , 1000 1 Wieser Concrete X VII. Responsibility Statement- I, the and rsigned, assume responsibility foyi6tallation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Si °r' MP/MPRS Number Business Phone Number James K. Thompson / Plumber's Address (Street, City, State, Zip Code) 30021 (715) 248-7767 340 Paulson Lake Lane, Osceola, WI 54020-5413 V I. Count /Department Use Only Approved ❑ Perrmmiit Fee Date sued a Issuin ent Signatur ❑ roen Reason for Denial $ V5 ' 2 Z 1 1 IX. Cond~ip ~I/Reasons for Disapproval 1. septic tank, effluent fitter and dispersal cell must all be services / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code / ordinances. Attach to complete plans for the system and submit to the County only on paper not less than 8 t/2 x 11 inches in size SBD-6398 (R. 01/07) Valid thru 01/09 tom merce.wi. 9ov Safety, and buildings Division County 201 W. Washington Ave., P.O. Box 7162 St, Croix i sco n s i n Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) Department of commerce i~S z Sanitary Permit Application State Transaction Number-3 P 110 In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental f F unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address (if different than mailing add ss) submitted to the Department of Commerce. Personal information you provide may be used for secondary , u oses in accordance with the Privac Law, s. Stats. / 3 p / t A(r V + ~t,.~J 0 Z. 1. Application Inform 'on - Please Pri All I Property Owner's Name Parcel # Ron Deckard DEC 2 030-2080-50-000 Property Owner's Mailing Address Property Location 1382 Pine View Trail ST. CRGIX COUNTY ZONING Govt. Lot City, State Zip o e ne Number _NW %a, NE %a, Section 25 Hudson, WI 54016 (circle one) (715 549-6921 T 30 N; R 20 w II. Type of Building (check all that a ) ❑ 1 or 2 Family Dwelling - Number of Bedroo 5 , 5 Subdivision Name 11 Public/Commercial -Describe Use Block # Woodland Hills Na ❑ city of ❑ State Owned - scribe Use CSM Num ❑ Village of 7 k' /to ba & Na ❑ Town of St. Joseph III. Type of Permit: (Check only one box on line A. plete line B if licable) A. ❑ New System Replacement System ❑ Treat nt/Holdin ank Replacement Only ❑ Other Modification to Existing System (explain) B• ❑ Permit Renewal ❑ Permit Revision List Previous Permit Number and Date Issued ❑ Change of PI ber ❑ Permit Transfer to New Before Expiration Owner /Z IV. T e of POWTS S stem/Com nent/Device: Check all at a I ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At rade Mou > 24 in. of suitable soil ound < 4 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate ds 750g F (gP ispersal Area Requtr (s ispersal Area Prop ed (sf) S stem Elevation 1.0 ASTM C-33 sand 50 sq. / f -si#1 s9 ft. 9 93.8 at to above . ' VI. Tank Info Capacity in Total # of Contour Gallons Man cturer Gallons Units New Tanks Existing Tanks v 7 ~ O N cC Septic or Holding Tank SZ 0.U v~ j i 750 1,000 1,750 1 Wieser oncrete/Unknown X Dosing chamber 1,000 - 1,000 1 Wieser Concrete a{ VII. Responsibility Statement- I, the un ersigned, assmite responsibility forin-st tion of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Sig James K. Thompson MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) 30021 (715 248-7767 340 Paulson Lake Lane, Qsceol , WI 54020-5413 VIII. Coun /De artment Use Only proved ❑ , v Permit Fee Date I sued Issuing nt Signature ❑ tv iven Reas Denial ' 00 ~Z Z~ 67 IX. Condift&Wgeasons for Disapproval 1 1. Septic tank, effluent filter and 3 I Qt.IAQ,`. Qb ~q (`t~j ( p dispersal cell must all be services / maintained J l as per management plan provided by plumber. ~1 ` dG: 2. All setback requirements must be maintained T~ G ` li ble code /ordinances. I / J Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 z I1 inches in size SBD-6398 (R. 01/07) Valid thru 01/09