Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
002-1074-70-000
r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix 4 Saf+ty and Building Division INSPECTION REPORT Sanitary Permit No: 483962 0 (ATTACH TO PERMIT) GENERAL INFORMATION 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: Jacobson, Lyle & Delores Baldwin, Town of 002 - 1074 -70 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: /e06 I ms's 1 r 29.29.16.443B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER k CAPACITY STATION H BSS / HI / FS Septic . S 6 , Benchmark tV' i / �"� S.6 I2,01 Z . /OZ -6 /06 Dosing S S / Alt BM 5 91 , 5 F f gb � � : /6 Bldg. Sew r of 16 iii ' Holding -S~ St/Ht Inlet Q St/Ht Outlet TANK SETBACK INFORMATION TANK TO � P /l, WELL BLDG. Vent to Air Intake ROAD Dt Inlet j Septic /t / 9b 1 7� lU D 40 4,. 9 � �� 1 $, 4.7 Dosing 1 /en r6 / 4/6/ 116 / Header /Man. 4 57 W i'.3 T V Aeration Dist. Pipe 1. 4 9'V Holding ��-"*"---- Bot. System za o 74 Final Grade PUMP /SIPHON INFORMATION �� .3. 5 7 pa .4_3 Manufacturer ("cu.) `�& GPM Demand St tyver 6a J ~� , / L , Model Number c-P x C 2.1 / 4 41 g7. I TDH Lift Friction st _I System Head TD � z Fl Forcemain r ngttl , ' Dia. 1 / Dist. to Well 7X 1 SOIL ABSORPTION SYSTEM C, DIMENSIONS BED/TRENCH Width , �� / Length / No. Qf Tre es PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMEN ( / p , _-� _ SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of tem: / i / ♦ CHAMBER OR ...........s O c.) 756 56 fli i 3Z, . /► / UNIT Model Number: `r DISTRIBUTION SYSTEM��'s"`-����CCC / ��/ c Header /Manifold 1 ( Distribution // ') /I 1 / x Hole Sri I r x Hole Spacing if Very Air take Length 3. ✓ b5 Length s) $ u f" L " Dia / 5 Spacing 3' O `7 p hi'Z J/ ✓ SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only a Depth Over / Depth Over xx Depth of xx Seeded/ dded 1#0,�,�� c Mulched Bed/Trench Center I . 71 Bed/Trench Edges \ Topsoil 1 Yes in No ,; ` Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 10 / / /d Inspection #2: / / Location: 2270 Hwy 12 Ba win, WI 54002 (SW 1/4 SE 1/4 29 T29N R16W) m tes & bounds Lot / —`� Parcel No: 29.29.16.443B 1.) Alt BM Description = n' , 2.) Bldg sewer length = /'CJ / �` P'o OJr - amount of cover = / 4 M C_.00 l / d lcAk . r...s Plan revision Required? Yes No / gt I Use other side for additional information. �D 1 1 �� • � � Date ' Insepctor' Cert. No. SBD -6710 (R.3/97) S ant By: SAWYER COUNTY Zoning; 715638 3277; Jul -21 -100 Page �8 " :36AM; corCO I'CO.WI.90V Safety and Bui /� t y 201 W. Waahinstan Av- 71e� 62 62 Nladisao, WI n ary FetmitN (#o bo titled w by Co.) . e Sanitary Permit Application stat MC T UA A Trtu►sactiat N txr '� in w otdsmcc with s. Comm. 83 21M Wis. Adm. Code. subrrri -dM Of this IbrM to dm Riprop We gpverasttxtttrl writ is required prior to obtaining IL wormy permit. Note: Appliootioa forms ft+ dA owmed POVPI'S ere plaim Ai r (if d fferent than mailirq ) !� mbmiltpd to die Deg of Commaee. Personal infwnMtibe YOU Saga. � Z 7D �e • In eooardanoe with the Law a M t L A ika tioa Iafot matitsn - Pkase Print All lnformatioa Property Ovaer's Name A" �- la2 d P Owner's Maitireg Addreis 1J�J'f� 7 ✓ 2 a ?© u SI j.� f i - ST. CROIX COUNTY Lot • ( `l,, Section -At City, state Zip Code /,, �� pp 13 a G Zc IZ (� 1 00 2 - _ 5 - T K R aitcle Doe) 1L or W IL Type of 1laitding (check all tha #apply) L • — $uAA ivitioa Name 511 or2 Family Dwclling- Numb- ofIiedraoms _ -- Block # ❑ City of NblidCommeroial - Describe Use ❑ State awned- Dascri Use _ In ❑ vatagc of Town of CSM Nambt7 V" ' 111. Typo of Perm (Cheek only ase boa on line A. Complete line H if apptieable) Rep Sy*= © Tnannan[l OMINS TO* Replaeemem Only Other to Existing System (Mq"n) L © Permit Itenewst © Permit Revision ❑ ChmP OfPlutnbcr b Prsmit Trnns6er to Ntrw Ust Previous Permit end Do& Issued Befte 11111 ati m 10WM IV. Type of POWiS aarJCoae orewtlAevie e: Check all Oat r► ❑ Noe- Presas l hpavemd 0 PF=urisod ht nxmd CI At-iiraft I] Mamd ? 2A ire of suit*k soil MouM � 7'd in suitabk eg Q Mdit Taok d Other Dlaperwl C..V sieat (explain) CI R>wtreamient Davies (s lain) V. D Ilmeatment Area 10wo retioa. Design FWw ( Design Sod Appiindon f) DigasO Area Rai Disp"M An* (So S e Elevation qp �3 Lao 1 r o. �6� l�vv 3 5r� VI. Task In o cv adfy in Tow tof Mwuf mtuw Mons Galtuns Units U Hew Teaks Bxiet" " i •/ d; � _ 9 . • I •f/ :xptic a tloillillg Twk k t1 U l " e 5 e? tb3ingC6alnber VIL Responsibility Statement- 1, the uyderslgned, M res p an xibift for twollat[an of the POWTS shown on tba attached Plumber's Name (Print) Flom s Signahue RS TNum P1165. ushiCSS Phone N ba 3 '_ `)�5 Plumber's Address (5htet, City, &W Zip Code) P U l30 6 ' ? v i He- Ll�)t' S ^ '10 e' VIII eu 1Tfe Artment Use Qn - Per Fee D issuing %phtue Appr ovcd / mit h G utd © Veal for Denial DL Conditi ofp roval/ asons for Disapproval c3, /) A �1STEIVO J s�dlr ce17+++ If A• 1. Septic tank, effluent fiNer and dispersal cell must all be services / maintained as per management plan provided by p wAw. 2 AN aelbadrtequkert* is mist,! "gWrg *d d� ty'�'�+�`• 'r 1^'• `97 Il��le �a.cw. �.... —o .e ...o ..�� -^i -•• r ^. -- -- SBD•6398 (1L 02109) Valid thru 02/11 07 -21 -10 10 :05 TO: FROM :715638 3277 P01 c, a So y A. card ,, 40Ai - ion �5 X90 U.S itW Y 12- t lC� win LLIi 4 2 '�'1` Tu DIV_ Tod =11 ZZ:69 0T -0E commercem.gov isconsin Department of Commerce Safety and Buildings 10541N RANCH ROAD HAYWARD WI 54843 Contact Through Relay www.commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Aaron Olver, Secretary July 30, 2010 CUST ID No. 223475 JOE STANG STANG PLUMBING & ELECTRIC PO BOX 263 WOODVILLE WI 54028 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/30/2012 SITE: Lyle & Delores Jacobson 2270 USH 12 Town of Baldwin St Croix County W1/2, SETA, S29, T29N, R16W Identification Numbers Transaction ID No. 1836371 Site ED No. 758653 Please refer to both identification numbers, above, in all correspondence with the agency. FOR: P.0 Description: Mound, 4 bedroom residence Object Type: POWTS Component Manual Regulated Object ID No.: 1274645 (;ond i Maintenance required; Replacement system; 600 GPD Flow rate; 20 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution AP I Component Manual - Version 2.0, SBD - 10706 -P (N.01 /01); Effluent Filter pEPARTMI wilso OF 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 constructe SEE COF 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: Key Item(s) • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product. approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. JOE STANG Page 2 7/30/2010 • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • The existing POWTS must be properly abandoned per s. Comm 83.33 Wis. Adm. Code. 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 Safety & Buildings 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, Patricia L Shandorf. POWTS Plan Reviewer, Integrated Services (715) 634 -7810, Fax: (715) 634-5150, M -fr 8:00 - 4:45 pat.shandorf @wisconsin.gov Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 828-5902, Monday, 7:00 A.M. To 3:30 P.M. Notice: Starting July 1, 2009, no person or entity may engage or offer to engage in construction business in Wisconsin unless they hold a Building Contractor Registration, or equivalent, issued by the Safety and Buildings Division of the Wisconsin Department of Commerce. "Construction business" means a trade that installs, alters or repairs any building element, component, material or device that is regulated under the commercial building code, chs. Comm 60 to 66, the uniform dwelling code, chs. Comm 20 to 25, the electrical code, ch. Comm 16, the plumbing code, chs. Comm 81 to 87, or the public swimming pools and water attractions code, ch. Comm 90. The term does not include the delivery of building supplies or materials, or the manufacture of a building product not on the building site. For further information, go to our website: www. commerce. wi. aov/ SB/ SB- BuildingContractorProgram.html JOE STANG Page 2 7/30/2010 • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • The existing POWTS must be properly abandoned per s. Comm 83.33 Wis. Adm. Code. 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 Safety & Buildings 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, Patricia L Shandorf._ POWTS Plan Reviewer, Integrated Services (715) 634 -7810, Fax: (715) 634 -5150 , M -fr 8:00 - 4:45 pat.shandorf@wisconsin.gov Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 828-5902, Monday, 7:00 A.M. To 3:30 P.M. Notice: Starting July 1, 2009, no person or entity may engage or offer to engage in construction business in Wisconsin unless they hold a Building Contractor Registration, or equivalent, issued by the Safety and Buildings Division of the Wisconsin Department of Commerce. "Construction business" means a trade that installs, alters or repairs any building element, component, material or device that is regulated under the commercial building code, chs. Comm 60 to 66, the uniform dwelling code, chs. Comm 20 to 25, the electrical code, ch. Comm 16, the plumbing code, chs. Comm 81 to 87, or the public swimming pools and water attractions code, ch. Comm 90. The term does not include the delivery of building supplies or materials, or the manufacture of a buildingproduct not on the building site. For further information, go to our website: www. commerce. wi. gov/ SB/ SB- BuildingContractorProaTam.html MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Jacobson Replacement Mound Owner's Name: Lyle & Delores Jacobson Owner's Address: 2270 U.S. Hwy 12 Baldwin, Wisc. Legal Description: SW1 /4, SE1 /4, S29, T29N, R16W Township: Baldwin County: St. Croix Subdivision Name: W.T.S. Lot Number: Block Number. ' E� Parcel I.D. Number: 002 - 1074 -70 -000 11 ®!I Nj OF CO RC Plan Transaction No.: AFETY UILDI Page 1 Index and title RFS PO NCE Page 2 Data entry Page 3 Mound drawings Page 4 Page 5 Lateral and dose tank System maintenance specifications 5� 3 (0 , -' Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan Page 9 Soil Evaluation Report Designer: Joe Stang License Number: 223475 Date: 07/1 /10 Phone Number: 1- 715 -684 -5166 Signature: — . . .... ... . ... Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Version 4.01 (R. 09/04) Page 1 of 9 Mound and Pressure Distribution Component Design Design Worksheet (r or c) Site information Residential or Commercial Design Estimated Wastewater Flow (gpd) Peaking Factor (e.g. 1.5 = 150 %) Design Flow (gpd) Site Slope ( %) Contour Line Elevation (ft) Depth to Limiting Factor (in) In -situ Soil Application Rate (gpd /ft R 400.00 1.50 600.00 3.20 97.40 20.00 0.40 Note: Sand fill (D) calculations assume a Table 83 -44 -3 in -situ soil treatment for fecal coliform of - 36 inches. Distribution Cell Information 90.001 Dispersal Cell Length Along Contour (ft) = F 6.67 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /ft 1 I Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (c or e) a Center or End Manifold 3.34 Lateral Spacing (ft) If N above, enter the elevation (ft) 2 Number of Laterals of the highest point. 0.156 Orifice Diameter (in) (e.g. 0.25) 3.50 Estimated Orifice Spacing (ft) = 11.54 ft /orifice 2.00 Forcemain Diameter (in) 40.00 Forcemain Length (ft) Does the forcemain drain back? Y 87.00 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 11.40 Vertical Lift (ft) 0.68 Friction Loss (ft) 16.63 Total Dynamic Head (ft) 6.52 Forcemain Drainback (gal) 81.20 5x Void Volume (gal) 87.73 Minimum Dose Volume (gal) 28.00 System Demand (gpm) Lateral Diameter Selection in. dia. options choice 0.75 x 1.00 x x 1.25 1.50 x x 2.00 x 3.00 x Treatment Tank Information 1200.001 Septic Tank Capacity (gal) Wieser Manufacturer Dose Tank Information 800.001 Dose Tank Capacity (gal) 22.241 Dose Tank Volume (gal /in) Wieser I Manufacturer Manifold Diameter Selection in. dia. options choice 1.25 x 1.50 x x 2.00 3.00 Gallons /Inch Calculator (optional) 800.00 Total Tank Capacity (gal) 36.00 Total Working Liquid Depth (in) 22.22 gal /in (enter result in cell B49) Effluent Filter Information Best Filter Manufacturer GF10 -8 10x18 Filter Model Number Project: Jacobson Replacement Mound Page 2 of 9 Mound Plan View 1_ ------------------------------------ .1, 1 / 10 . B • . 'Observation Pipe 1. B. .. t .... LF . JJ — T A _l I L Mound Component Dimensions Down slop toe extension made. A 6.67 ft E 18.561 in H 1.00 ft K [ Aft ft B 90.00 ft F 9.50 in z 10.00 ft L ft D 16.00 in G 0.50 ft J 7.19 ft W 600.30 (ft Dispersal Cell Area 1500.00 (ft) Basal Area Available 6.67 (gpd /ft) Linear Loading Rate 9.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 100.53 (ft) F 98.73 (ft) —► Dispersal Cell Elevation ..... :.. - -.'a GI H Dispersal Cell 99.23 (ft) Lateral Invert 3.2 % Site Slope Shading Key 11 Topsoil Cap © {� Subsoil Cap ASTM C33 Sand Tilled Layer 05 ��: ~:: Aggregate a Dispersal Cell 0 w o 1.5 ft 5° Page 4 for number, size, and spacing of m 0.5 ft Typical Lateral 0 distribution cell's centerline in the *— A 97.40 (ft) Contour Elevation Geotextile Fabric Cover See lateral details on Page 4 for number, size, and spacing of F laterals. Laterals are equally spaced from the distribution cell's centerline in the distribution cell (AxB). Project: Jacobson Replacement Mound Page 3 of 9 End Connection Lateral Layout Diagram Laterals centered over the A & B dimension += Turn -up w1ball valve or oleanoutpluq P .I All laterals are identical IE X--+I Hales drilled on the bottom of the lateral I equally spaced S I Force main connection via tee or cross to maniFold at any point. Laterals & force main of PVC Sch 40 (per COMM Table 84.30 -5) Number of Laterals Lateral Diameter Lateral Length (P) Lateral Spacing (S) Lateral Flow Rate System Flow Rate Total Dynamic Head 2 Orifice Diameter in Orifice Spacing (X) ft Orifices per Lateral ft Orifice Density gpm Manifold Length gpm Manifold Diameter ft Forcemain Velocity 1.50 88.50 3.34 14.00 28.00 16.63 Dose Tank Information Electrical as per NEC 300 and -► Comm 16.28 WAC Disconnect Tank component is properly vented Wieser Capacityl 800.00 Volume 1 22.24 Manufacturer Gallons gal /inch A B C — t D Dimension Inches Gallons A 20.03 445.39 B 2.00 44.48 C 3.94 87.73 D 10.00 222.40 Total 1 35.971 800.00 Locking cover with warning label and locking device and sealed watertight 4 in. min. Alternate outlet location Forcemain diameter --- 2 in. Weep hole or anti - siphon device P� ump off elevation (ft) 87.83 Dose se tank elevation (ft) 87.00 Alarm Manuafacturer I SJE- Rhombus Controls Alarm Model Number Tank Alert! Pump Manufacturer Goulds Pump Model Number 3887 EP05 Pump Must Deliver 1 28.00 gpm at 16.63 ft TDH Project: Jacobson Replacement Mound Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name Joe Stang Phone 715 -684 -5166 POWTS Regulator's Name St. Croix County Zoning Phone 715- 386 -4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1200 gal Maximum TSS 150 mg /L Soil Absorption Component Size 600.3 ft Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Frequency Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other Inspect and /or service once every 3 years Should inspect and clean at least once every 3 years Test once every 3 years Should test month) Laterals should be flushed and pressure tested every 1.5 years Inspect for ponding and seepage once every 3 nn Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished , .,.�.......... ............... Grade 6 -8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Jacobson Replacement Mound Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code Gene ral This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals ISBD- 10691 -P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, 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 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 Dlstribution 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 mg1L BOD5, 30 mg/L TSS, 10 mg/L FOG, and 10' cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice 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. Continuencv 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 sald 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: Jacobson Replacement Mound Page 6 of 9 n* ITT PERFORMANCE RATINGS Total Head fR of water) Gallons Per Minute EPO4 EP05 5 53 — 10 46 62 15 36 55 20 21 46 25 0 33 30 — 11 GOULDS PUMPS Wastewater COMPONENTS Item No. 1 Impeller 2 Base 3 Pump Casing 4 Medianical Seal 5 1 Ball Bearings 6 1 0 -Rings 7 Power Cord 8 Oil Filled Motor 9 Motor Housing/ Stator Assembly 10 Motor Corer � se, d w w r. y • Qp,aD � ►'t nl or4 h Z pan A O ld _.~!/� Y be, . vs v1 4 -P 160. 1A iii ss. k tx c 2S' R��� Ted =QI ZZ:69 ST-GS-"? 4& VVIsconsin Department of Commas SOIL EVALUATION REPORT Page I of 1 I Division of Safely and Buildings in accordance with Conan 85, Wis, Adm. Code amity St Croix Attach complete site plan on paper not less than 81/2 x 11 inches In size. Plan rust Include, but not Finned to: vertical and horizontal reference point (BR, direction and Parcel I.D. 002- 1074 -70 -000 percent slope, scale or dirnensions. north arrow, and location and distance to nearest road. Pluses pnW aN wllfbnnarron. Reviewed by Date Personal irronrsdion you provide a" be used for secondary pupoe" (F'dVMY Low, a 18.04 (1) (m)). Property Owner Property Location e Lyle & Delores Jacobson Govt. Lot SW 1/4 SE 1/4 S 29 T 29 N R 16 Property Owner's hlaflrig Address W# 18lock# I Srtd. Name or CSW 2270 U.S. Hwy 12 City State Zp Code Phone Number Elcity oVdage QTown Nearest Road Baldwin I Wisc, l 54002 l ( 715- 684 -3159 Ral udn I U.S. Hwy 12 New Construction L%eE] Residential / Number of bedrooms 4 Corse derived design flow rate 650 GPD Q Replooernent 0 Public or conrnerclol - Descrloe: Parent material Flood Plain elevation IF applicable ,.0 1t General convnerktr, El. 97.4 a recorriniendations: 16" Mound, Contour E Boring # � [] Boring [ ` 1 Pit Ground surface elev. 97.7 R Depth to Wribig factor 30 in. rr� Arr,rrr inn RatR Horizon Depth in. Dominant Color Munsel Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/lp Roots 'E4fit1 T:02 1 0-5 10YR2/2 — SIL, lfbk mfr cs 2 0.4c 0.6 2 5-22 10YR4/4 — S1L lmpl mfr cw 1 0.4c 0.6 3 22 -30 10YR5 /4 — SCL 2mbk mfr Corr — 0.4 0.6 4 34.40 10YR4/6 2mV.5Yit5/8 SCL 2mbk mvfr cw — 0.4 0.6 2] F 9 Q P Groundsurfaceelev. 96.0 fL to factor 31 in. Sol Application Rate Horizon Depth in. Dominant Color Munsefl Redox Description Qu. Sz- Cont. color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPOW "Efflf1 -EM 1 0-7 10YR2/2 — SIL lfbk mfr cs 2 0.4c 0.6 2 7 -20 10YR4/4 — SIL lmpl mfr ew 1 0.4c 0.6 3 20-31 IOYR5 /4 — SCL 2mbk mfr cw _ 0.4 0.6 4 31-40 10YR4/6 2md7.5M/8 SCL 2mbk mvfr cw — 0.4 0.6 Effluent #1 = BOD > 30:5 220 mglL and TSS >30 < 150 mgfL CST Name (Please Print) A Signature Stang Plumbing & Electric P.O. Box 263 Woodville, Wisc. 54028 Y -- K 6/09/2010 715- 6845166 Property Owner Lyle & Delores Jacobson Parcel ID # BorkV Bo"# El pit Ground surfooselev. 97.6 it 002-1074-70-000 2 4 POP —Of— Depth to knbV factor 20 In. I Sta AnnW=Hnn Rain I Horizon Depth in. Dominant Color Mussel Redox Description Ou. Sz. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDRF *0101 *EfW2 1 0-5 I0YR2/2 SEL lfbk mfr Cs 2 0.4c: 0.6 2 5-20 10yR4/4 SEL 1 m f r ew I 0.4c 0.6 3 20-32 10yR4/6 2md7.5YR5/8 SCL 2mbk Mvfr Cw 0.4 0.6 UPft %XFUUFIU 3U"aK= eROV. _ IL LjwUI tu MIa Fj lows -as. Sol AWlication Rate [Horizon I Depth I Dominant Color l Redox Description Texture I Roots Mructure I Consistence I Boundary I RRoo GPOW in. Munsell I Ou Sz. Cont Color Gr. Sz. Sh . O's i - EW ] TdW2 F Bo" i L Pit Sol Applicefion Rats- Horizon I Depth I Da wwd Cokxj Redm Description Texture I Structure lConsistencelBoundaryl Roots C~ I in. Munn" I Ou '-w- Coat Color Gr. Sz Sh. I I —CrM I *EW * Efflue #1 - SOD, > 30:S 220 ffg& and TSS >305 150 m9& * Emuent #2 - SOD, _< 30 nv& and TSS:S 30 nv& The Department of Commerce is an equal opportunity service provider and employer. If you need assistance W WOW swvim Or need material in an alternate format, please contact: the department: at 608-266-3151 or TTY 608- 264 -877 SOD433ff- PL07AM N E Q �e- 3 L `. EL 96.6 EL g l. e A Camace +e 6 lob-00 c►'t N o r-t h Wi+�aOW V Y ie . k be Lo -cec -Ti4ca aa,7 Us Hwy /Z- fig !d ,, ••, w 1 5 , 4 1 0 aZ S w'114, SE `fy, sc'A I w n 0 -P 64% 141 j; wt -rb '# O 167+1 -70-406 v d 9 /go 5T Q 6 g3 T _ �. ► 1 V H w y t �. 3 14 ° �. e 3 1/0'4 �- N Lien e St Croix County, WI Geographic Information Web Server rage i oz i - I 1 0 St. Croix CC County, WI Login Sol D= XLS Tapestry Refresh Tent Home Main I DMrkts I Zoning * Layers 12 Legend 174 Search I U Help OV Map Zoom Rill Zoom Last Zoom In Zoom Out Pan Navigation ldentff%3mnge Toolbars all on page' entire result set VA at I IT4011 I Displaying 1- 2 of 2 records. (Madmurn results returned: 5000) �n red hdicate delllnquent taxes. Parcel ID Name Pro Municival Address JACOBSON, 002-1074-40-000 LYLE 0 & NULL TOM OF DELORES BALDWIN G JACOBSON, 2270 E] jV 002-1074-70-000 LYLE 0 & NULL TOWN OF DELORES HWY 12 BALDWIN G Dr L— http://stcroix 6110/2010 AdW* TOW* n Pan 11 Zom W Scale I a 0 feet GO i � r vYiso nwn Dgmbtrollt of Commove SO,L EVALUATION REPORT Page I of y Df�lsion oFSafely and 8u�ings Soi Rats tbdman Depill Dorrairard in e000rdanoe wilh Conan ft VA& Adm code Flood Plain eWWon # a� VftWie tc rrerai co nvuenis and 16" Mound Contour H. 97A st. Croix Qu. Sz. Cart Color Ansch m. j sae plan on paper not less #ran 81/2 x f 1 kwhm in skm Plan 3 GPD/W *E irchrde. W not laded We m§cal and ha¢aMal reference point {BM), Panel "X 002- 1074 - 70-000 lfok per�centalope, scale orb, noM arrow, and IocaGon and ,t. 080 10 kniling factor 30 im 2 0.4c 0.6 PAW99 pdmt ON bfiicrmaa%m ��i T exkwe SlOM ConsbWm Boundary Ores Rsda ltaww I ft l aon yon, poulas ate► be +e os (1) cna>_ _ Gwn,�..` (o Z 3 — Pmpfto*mr Propel Locown mfr m OE 0.4c L ys Bt Deloms Govt SW 1t4 SE 1/4 S T N R 16 SIL 1 Pwp"0wneesMMngAddmw W# 6bck# NameorCSW 0.6 3 22-30 10YR5/4 227 US. IZ 2mbk b at, cw — 0 P NG OFFICE � own N Road SCL 2mbk Baldwin I Wisc. 1 54002 1 t cw U.S. Hwy 12 Construction UaeM l Wumbw of bedrooms 4 Code derived design bow rate GPD F New Reploommd Q Pubic or camreldai - Desatw Soi Rats tbdman Depill Dorrairard remalarial Flood Plain eWWon # a� VftWie tc rrerai co nvuenis and 16" Mound Contour H. 97A F7,20 - munse• Qu. Sz. Cart Color Gr. Sz Sh. 3 GPD/W *E o 1 7 10YR212 — SIL lfok o # Q pk GmwWuetaoeeiev. 97.7 ,t. 080 10 kniling factor 30 im 2 0.4c 0.6 Hamon DWM Dorrdnara RedoxDearaip6on T exkwe SlOM ConsbWm Boundary Soil Roots GPM Rsda In. Munse L Sr:. cart. color Q Gr_ Sy- Sh. 'EW1 '� 1 0-5 10YR22 — SIL lfb mfr m 2 0.4c 0.6 2 5-22 10YR4/4 — SIL 1 mfr cw 1 0.4c 0.6 3 22-30 10YR5/4 — SCL 2mbk mfr cw — 0 0.6 30 40 10YR4/6 2md7SYP - W SCL 2mbk mvfr cw — 0.4 0.6 1Bognrg GrarM s�rfm wiav s _ ' Batr� # 0 96.0 31 ' Elliuent #1= 80D > 30 < �p + and TSS >30 < 150 mgA. CST Name (please A" Z4 Swish" Stang Plumbing & Mecuie P.O. Box 263 Wooch-Me, Wise. 54028 #2 = W 30 mg!!. and TSS < 30 W_ CSTNUM 6/09/2010 715445166 Soi Rats tbdman Depill Dorrairard lu" Ted a ftuckm Consislence Boundary Roots I F7,20 - munse• Qu. Sz. Cart Color Gr. Sz Sh. GPD/W *E *M 1 7 10YR212 — SIL lfok mfr m cs 2 0.4c 0.6 2 10YR4/4 — SIL 1 mfr aw 1 0.4c 0.6 3 20-31 tjOYR. — SCL 2mbk mfr cvnr _ 0.4 0.6 4 3140 2md7 SYRyg SCL 2mbk mvfr cw — 0.4 0 6 ' Elliuent #1= 80D > 30 < �p + and TSS >30 < 150 mgA. CST Name (please A" Z4 Swish" Stang Plumbing & Mecuie P.O. Box 263 Wooch-Me, Wise. 54028 #2 = W 30 mg!!. and TSS < 30 W_ CSTNUM 6/09/2010 715445166 Lyle & Delores Jacobson Parcel a) # 002- 107470-000 pap 2 or 4 m om MrMITTI M- u rK .,.o . .—.* — .a -- - sw Rale H"� Depth I =C Red Deecr� TIMM I Strum" I Camwenoe ®ourbary Roofs 1 faF6w in. flu. Sz. Cant Color f. SY. Sd I 'EM a 'sw F - I > # R hound MRface elev. i{ Dan& to imirno falAw in *Blmtfl U Bw6 > <1601rgL 02 = am, _<30 nut awTSSc_30nvL The Departma t of Commerce a = equal opportunity service provider and employer. If yon hoed asdstmwe to access swvk= or nct d mlbW ie OR aloe formal,; please wdMl lase depatm W at 60&266-3151 or TTY 60&-2 444. oftp."" u rK .,.o . .—.* — .a -- - sw Rale H"� Depth I =C Red Deecr� TIMM I Strum" I Camwenoe ®ourbary Roofs 1 faF6w in. flu. Sz. Cant Color f. SY. Sd I 'EM a 'sw F - I > # R hound MRface elev. i{ Dan& to imirno falAw in *Blmtfl U Bw6 > <1601rgL 02 = am, _<30 nut awTSSc_30nvL The Departma t of Commerce a = equal opportunity service provider and employer. If yon hoed asdstmwe to access swvk= or nct d mlbW ie OR aloe formal,; please wdMl lase depatm W at 60&266-3151 or TTY 60&-2 444. oftp."" fi 90 �s EL c7.7 E L ql • (v . t� ov►s e t E 1 ab• d1 °�'t K o rt tr► w:..a / % - T !as an a,ZL70 US Hwy tZ a ti tj -lb +n a -P tea 1 d wa I:b -Jk- 002 -1"V - 70 - 010 4 &/ o 9 o / o .'°' aa�e� :.o�w..«...a•:a+,....., .�.,.,._. ... -.. , .- sr:...aT+.�_.,r...s�i... -.a.a 3140 � � e 3 a (:6,c 3crP Al 1.of St Croix County WI Geographic In meson Web Server SL crobl county wl Main I Dbbicts I Z0nkV OV Map Zoom FUN Zoom Lad Zoom In Zmxn Out 110 Page I Of I Lo* ScM DmXLS Tqxm&y Reftesh Tb& Hamm Layers I rF Legend I - " Sewch 102 Help 4p him PNwwT00mw* Seate�I—igalwl Dbpbft 1- 2 of 2 reaxft (NW*RM MUMS WADTle& MW) Parcel TD Na H'. e Pro rty Municipah Address JACOB", LYLE 0 & NULL TOWN OF DELORES BALDWIN G JACOBSON, LYLE 0 & 2270 TOWN OF NULL BALDWIN DELORES G HWY 12 A on page enihe result set IL - V L -P fat 60 0 * 4 " 4 boamw hV.*//stmixwim%Ving-onlim.comWmbLCoWi/dcfWthtm 6/10f2010 AWn To* f) Pan Zoom lb scab I we r ------ I Parcel #: 002 - 1074 -70 -000 06/23/2010 03:18 PM PAGE 1 OF 1 Alt. Parcel #: 29.29.16.443B 002 - TOWN OF BALDWIN Current XX ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner LYLE O & DELORES G JACOBSON O - JACOBSON, LYLE O & DELORES G 2270 HWY 12 Last Changed: 10/27/2006 Description Class BALDWIN WI 54002 Land Improve Total State Reason Districts: SC = School SP = Special 5.000 Property Address(es): * = Primary 206,800 Type Dist # Description Totals for 2010: * 2270 HWY 12 SC 0231 BALDWIN - WOODVILLE AREA General Property 5.000 SP 1700 WITC 206,800 242,600 Woodland Legal Description: Acres: 5.000 Plat: N/A -NOT AVAILABLE 0 SEC 29 T29N R16W W 1/2 OF E1/2 SW SE N Block/Condo Bldg: OF RR General Property Tract(s): (Sec- Twn -Rng 401/4 1601/4) 35,800 206,800 242,600 Woodland 29- 29N -16W 0 Notes: 0 Parcel History: 1 Certification Date: 04/17/2001 Batch #: 510 Date Doc # Vol /Page Type 06/18/1998 581286 1333/069 WD 03/19/1996 540980 1167/308 TD 03/19/1996 540979 1167/307 WD 10/21/1994 522703 1100/081 QC 2010 SUMMARY Bill #: Fair Market Value: Assessed with: Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 0 Valuations: Last Changed: 10/27/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 5.000 35,800 206,800 242,600 NO Totals for 2010: General Property 5.000 35,800 206,800 242,600 Woodland 0.000 0 0 Totals for 2009: General Property 5.000 35,800 206,800 242,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04/17/2001 Batch #: 510 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ST. CROEK COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Z l e j- /&)Cc S 16 e- Id s 01-. Mailing Address Property Address (Verification required from Planning & Zoning Department for new constructiou-) City/Swe .-',q itl , � Parcel Identification Number LEGAL DESCRIPTION 6 / 6 7 el 70 Cr v 5 , 5 dct./ 1' kL P ro p er t y L 4 ' 1 V4. V4. Sec. T NR Town of — Subdivision - tot Certified Survey Map # Volume Page # Warranty Deed # I volume J. Page # Spec house yes no Lot lines identifiable yes no SYSTEM MAI111TENANCE AND OWNER CERTIFICATION linproper use and maintenance of your septic system could result in its preniature future to handle wastes. Proper ance consists of pumping out The septic tank every three yew 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 we specified in §Co=L 83-52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Departmerst a certification farm, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site was tew ater disposal system is in proper operating condition andibir (2) after itIR)OCtiOn and pumping (if necessary) 60 septic tank is Jk= than 15 fill of sludge. Uwe, On undersigned have read tine above requirements and Wee to unintam the private sewage disposal system With the aw dards set forth, herein, as set by the Department of Commerce and the Department of Natural Resounma Stain of Wisconsin. Catification, stating that your septic system has been manitamed must be completed and returned to the St Crow County Planning & Zoning Department within 30 days of the three year expmtdon, date Uwe certify that all statements on this form at true to the beat of my/our knowledge- Ltwa am0we the owner(s) of the property described above, by vntue of a warranty deed recorded in Register of Dads Office I I I I I 1 � 77% U 13110 DATE **•Any informflon that is mi sre1 vented may result in the sanitary permit being revoked by the Planning & Zoning D"WftWMt *** 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 doed. (REV. 118185) c WL 133: "U69 STATE BAR OF .V]SCONSIN :'OR i 2 —1982 WAR AMITY I>EtV DOCUMENT NO- a1' J. Newton and Teresa A. Newfk,rtn,_ __ husband and wife. rev %vys and " wraasas to L le 0. Jacobson and De G. Jacobson husband and wife, ■!� foI " "tnwtng dacnb d �f estatt m S t . Croix Counts St w of %Vtsronsin- of the Southwest Quarter of the of SW1 /4 of SE1 /4) of Section 29, the right -of -way of the Chicago, Railway Company. All situated in TRANSFER 3/b FE E 002 - 1074 -40, 002 - 107E -70 PARCEL WENTIF1CA711M H1JSd8ER This The East Half of the Northwest Quarter of the Coutheast Quarter (E1 /2 of NW1 /4 of SE1 /4) of Seccson 29, Township 29, Stange 16. The West Hall[ of the East Half Southeast Quarter (W1 /2 of E1 /2 Township 29, Range 16, North of St. Paul, Minneapolis and Omaha St. Croix county, Wisconsin. is hom■:,teod property. (ts) MOW Exceptionto%varrutues: Easements, restrictions and rights -of -way of record, if any. Datedth ay of __ - June A�.D.,I�4 98 EAL) girl iJ� —! , �/i (SEAL) y Newton T eresa A. Newton AUTHENTICATION (SEAL) Signature(s) Jay J. Newton, Te A. Newton authenticated day of June . Kristina Oland TITLE: MEMBER STATE- BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Hudson, Wi 54016 (Signatures may be authenticated or acknowledged. Both are not necessary:) 1 6 , M f �' ST, JUN 1 8 1998 9:30 A ki WIS SPACE RESERVED F.?R RECORO G DATA 94; rAE AND RETWIN ACORES� SZ[ »�.iltr 2'Z�s+" J' C ®!t� tt a{3G`iS& 740 URN* Sltast Qadwin WJ 54002 ACKNOWLEDGMENT State of Wisconsin, Personally came before me this Count): (SEAL) day of 19 . the above named to me known to be the person who executed the foregoing instrument and acknowledge the same_ Notary Public, _ My commission is permanent _— County.'Mis. (If not, state expiration date: `ilm^5 s.t per -•_.n� aX,ual; .r. ao upxcu}' should he ;5Txd x p:m;ed Wow their sip..atures. WARRANTi' DEFD STATE BAR Of WISCONSIN Wacomn to',0 SW* Co. I s Form No. 2 - 1982