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HomeMy WebLinkAbout022-1011-40-150 � r Wisconsin Department of Commerce Count PRIVATE SEWAGE SYSTEM St. Croix Safety and Buildiro Division • 1 4 INSPECTION REPORT Sanitary Permit No: 430531 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 1 I 44 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: _ Nelson, Gar Kinnickinnic Township CST BM Elev: Insp. BM Elev: BM Description: Section/Town /R ge/Map No: 7 � 1 19- 4 7 1 A 6mS - tlrE 05.28.18. TANK INFORMATION' EL VATION D A TYPE MANUFACTURER CAPACITY STATION BS HI 3 FS ELEV. c Septic / Ben mark jDq•j 8� 9�- �! / Z t!o o 2 , `f' Dosing Alt. BM Aeration Bldg. Sewer � 23 Holding SVHt Inlet - 7 Z. cl7 -`�2 TANK SETBACK INFORMATION St/Ht outlet 3 TANK TO /L WELL BLDG. Vent to Air Intake ROAD Dt Inlet qZ Septic / I 77 _ Ft Botto tn'►� Dosing r � Head � •' / on. Aeration Dist. Pipe Holding Bot. System .gyp qq . PUMP /SIPHON INFORMATION Final Gr ade ` f cI �� & 6 Manufacturer Demand St Cover 11 0 GPM . 7 r a ( . Model Number f O �� 21 , t 'k � aq. ry TDH Lift Friction Loss System Head TD Ft b F u'l a in Length rl Dia. Z . Dist. to Nell I DD V SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS — rjj 1 SETBACK SYSTEM TO BLDG WELL LAKE /STREAM LEACHING Manufacturer. INFORMATION AMBE Type Of System: ` �b� 1 ,5 / Z Mo N her: _ DISTRIBUTION SQ— YSSTEEM > COY Header /Manifold Distribution , I x Hole Size / x Hole Spacing Vent to it take Pipe(s) �, 1 Length _Z LLDia Length Dia t� Spacing y+r 3 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only cezv Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center ,� Bed/Trench Edges Topsoil -I 7 — Yes �i No � J Yes COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1:/ � Inspection #2: /A d Location: 1096 Co Road N Hudson, WI 54016 (SE 1/4 NE 1/4 5 T28N R1 8W) NA Lot 4 Parcel No: 05.28.18. 1.) Alt BM Description = 2.) Bldg sewer length = 531juvac., G� , - amount of cover = Plan revision Required? (] Yes /No Use other side for additional information. 4aturee -6710 (R.3/97) Date Insepctor's Cert. No. r Sa anal n f CV 1 l 201 W. W hin 82 N visconsin Ma ison, WI 53707 — 7082 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608 261 -6546 / Sanitary Permit Appl cation S Plannl.D.. Number ,gyp h In accord with Comm 83.21, Wis. Adm. Code, personal forma�libn�kXvWUNTY may be used for secondary purposes Privacy s15.09()Qt ING OFFICE Project Address (if different than I. Application Information — Please Print All Information lo` c Co �• N Property Owner's Name Parcel # Lot # Block # rl i J Property Owner Mailing Address Property Location city S '�a ALL V4, Section tY, Zip Code Phone Number �P .c o ircle one) II . Type of Building (check all that apply) 1 or 2 Family Dwelling — Number of Bedrooms T. N; R Sub&,i�e CSM N�n±ber ❑ Public/Commercial — Describe cUse n W ,ot� ❑ State Owned — Describe Use 1�/S I , C: �(,[� �p X�r� / t t/ / S SiP/jY ❑City illage g ownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ' J. New System ❑ Replacement System ❑ Trealment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl ❑ Non — Pressurized In -Ground ❑ Mound > 24 in. of suitable soil 0 Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Application te(gpdsf) Dispersal Area Requ' (sf) Dispersal Area Proposed (0) S ystem Elevation 0 �l I U D /S 5/y. s' VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units i,�/ tJ Concrete Constructed Glass New I Existing Tanks Tanks Septic or Holding Tank r Aerobic Treatment Unit Dosing Chamber r VII. Responsibility Statement- I , the undersigned, ass me responsibility for installation of the POWTS shown on the attached plans. Plumber's ame Print) Plumber' igna r , MP/MPRS Number Business Phone Number - 'Z- P u 's A dress (Street, City, State, Zip Code VII Coun /De artment Use Onl Approved ❑ Disapproved Sanitary Permit F includes Groundwater Dat Issu ssuing Age Sign Lure o mps) Surcharge Fee) ❑Owner Given Reason for Denial 3 ✓ / j ���--- fff"'lll / I Conditipns of 4pproval/Reasons for Di approval (I 2 kt . r� SYSTEM OWNER: 1 Septic tank, effluent filter and c yk w. d p 3 .�Z Gt � � r XV_ dispersal cell must all serviced / maim :! as per management p rev' IG 01 2. 11 se ac requirements must be MW ta" rn rn.. e Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 Inches in sine SBD -6398 (R. 08/02) ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 r Fax (715) 386 -4686 EROSION & SEDIMENT CONTROL PLAN Parcel #05.28.18. ep ndine For Lot 4, 1096 C.T.H. "N" (Kinnickinnic ) – owner (s) Gary Nelson Under St. Croix County Zoning Code 17.70(3)(b)5: "The (Zoning) Administrator may attach reasonable erosion prevention conditions to a permit approved for issuance." Comm. 21.125 also requires the building permit applicant and/or landowner to follow erosion control procedures and maintain them until the site has been stabilized. The owner is responsible for notifying all contractors performing construction on this site that an Erosion Control Plan is in effect and the following activities will be required in order to maintain compliance with the plan: 1. The primary source for construction site runoff will be the house foundation excavation, driveway, and any soil stockpiled until final grading and stabilization is complete. Septic system excavation/installation adds to temporary disturbance, but establishing cover on exposed soils will prevent erosion. Plan to apply seed and mulch as recommended in #5. Maintain existing vegetation wherever possible to minimize sediment movement. Surface drainage is to the northeast, with >250 ft. to a drainage easement between Lots 2 & 3. 2. Route contaminated runoff into vegetated buffer areas by creating temporary diversions graded ALONG CONTOUR between excavation areas and any drainage ditches or waterways. A diversion may be used to contain runoff on owner's property. Zoning Dept provides specifications for temporary diversions. 3. If builder /excavator grades the site to create temporary diversions (see #2) to contain sediment and leaves adequate vegetative cover to protect areas of concern, installation of silt fence MAY not be necessary. Silt fence or other approved sediment control products will be required if sediment cannot be contained on owner's property with diversions and vegetative buffers. The POWTS inspector and/or building inspector will evaluate ESC plan effectiveness and make recommendations to owner for any action required to comply with applicable regulations. 4. Construction equipment and vehicles must utilize a stabilized driveway access off public road for heavy equipment; this includes cement trucks, well drillers, and other contractor's vehicles that access the property during construction. This helps avoid muddy, rutted conditions that may allow contaminated runoff to reach waterways and/or drainage ditches. Property owner must repair damage to ditches resulting from multiple access points and sediment tracked on public roadways must be removed at the end of each workday. 5. Stabilize new topsoil cover over septic system with seed and mulch immediately after installation – do not wait for final stabilization and/or landscaping of entire site to cover exposed soils on the system. If weather will not permit seed germination, a heavy straw mulch cover will prevent erosion until grass /vegetation can get established. Erosion control matting can be applied any time of year and if installed properly, will provide protection even if seed germination is delayed. The owner of record during site construction will be responsible for com liance with the ESC Plan. Please feel free to contact me with questions regarding erosion edimen c installation. Prepared by: Pamela Quinn, Soil Erosion Inspector #66505 Owner acknowledgement of ESC Plan requirements: '—/—/2003 _ 3 G / ff / •r I L _ i if{J�t•; y %� I ` I QC , / ji b/ / a T,/ C(D _ ,. Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264 -8777 ,\ Visconsin www•commerc .vWs ons Department of Commerce www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary October 28, 2003 CUST ID No.224263 ATTIC- POWTS Inspector KIM A O CONNELL ZONING OFFICE K.O. CONSTRUCTION ST CROIX COUNTY SPIA 504 3RD AVE 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers ,:_ PLAN APPROVAL EXPIRES: 10/28/2005 Transaction ID No. 931249 SITE• Site ID No. 667002 Gary Nelson Please refer to both identification numbers,'� CTH N above, in all correspondence with the agency: own of Kinnickinnic St Croix County SE1/4, NE1/4, S5, T28N, R18W FOR: New mound, 600 GPD Object Type: POWT System Regulated Object ID No.: 926650 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes �,' and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: tJ' T W General Approval Conditions: 0i • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10(91 -1' ( N.01 /01) and SSWMP Publication 9.6, "Design Of Pressurized Distribution Networks For Septic Tank- Soil Absorption Systems." • 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. Key Item(s) • A copy of this approval letter and index sheet shall be attached to plans that correspond with the copy on file with the Department. Changes to the approved plan must be submitted for review and approval. Failure to properly attach the approval and index page to plans that match the copy on file with the Department may result in enforcement action under s. 145. 10, Stats. • 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. KIM A 0 CONNELL Page 2 10/28/03 y _ 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. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(i). Consult the Department of Natural Resources for well setbacks and exceptions to the setbacks. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of 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 to the owner and any others who are responsible for the installation, operation - or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Patricia L Shandorf� POWTS Plan Reviewed - -hf egrated Services W SMART -code X 63 (715) 634 -7810, Fax: (715) 634-5150, M -f 7:45 am - 4:30 pm pshandorf@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: GARY NELSON Owner's Name: GARY NELSON Owner's Address: P.O. BOX 24 ROBERTS WI 54023 Legal Description: SE- NE- SEC5- T28N -R18W Township: KINNICKINNIC County: GSW Subdivision Name: S Lot Number: 4 Block Number: *NU Parcel I.D. Number: 022 - 1011 -40 -000 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings _ Page 4 Lateral and dose tank ESPOND CE Page 5 System maintenance specifications Page 6 Management and contingency plan y< J Page 7 Pump curve and specifications / I Page 8 PLOT PLAN Designer: KIM A OCONNELL License Number: 224263 Date: 10/0 1 /0!3 Phone Number: 715 - 755 -3145 f Signature: YJJ 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 (01181) Version 3.0 (03/01/01) Page 1 of 8 Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 83 -44 -3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of e- 36 inches. 600.00 Design Flow (gpd) 4.00 Site Sloe p (%) 98.50 Contour Line Elevation (ft) 21.00 Depth to Limiting Factor (in) 0.40 In -situ Soil Application Rate (gpd/ft Distribution Cell Information 100.001 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) 1.001 Dispersal Cell Design Loading Rate (gpd/ft 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (c or e) E Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation ft 2 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 3.00 Estimated Orifice Spacing (ft) = 9.09 ft /orifice 2.00 Forcemain Diameter (in) 40.00 Forcemain Length (ft) Does the forcemain drain back? Y 90.50 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 6.52 Forcemain Drainback (gal) 9.08 Vertical Lift (ft) 90.43 5x Void Volume (gal) 0.65 Friction Loss (ft) 96.96 Minimum Dose Volume (gal) 16.23 Total Dynamic Head (ft) 27.19 System Demand (gpm) Lat Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x X 1.25 2.00 1.50 x x 3.00 2.00 x 3.00 x +_ Gallons /Inch Calculator (optional) Treatment Tank Information 800.001 Total Tank Capacity (gal) 1260.001 Septic Tank Capacity (gal) 36.00 Total Working Liquid Depth (in) WEEKS I Manufacturer 22.22 gal /in (enter result in cell B49) Dose Tank Information Efflu Filter Information 800.00 Dose Tank Capacity (gal) lZabel I Filter Manufacturer 21.76 Dose Tank Volume (gal /in) JAII 00 Filter Model Number WEEKS IManufacturer Project: GARY NELSON Page 2 of 8 Mound Plan View t .... ..... . ....... . .. . . . . . . . . ............. . .. J 1/108 3 Observation Pipe .. K . (� A W I I........... _ B ...... ... ....:� :.. L Mound Component Dimensions A 6.00 ft E 17.88 in H Eaft ft K A22.29 ft B 100.00 ft F 9.50 in z ft L ft 15.00 in G 0.50 ft J W ft 600.00 (ft Dispersal Cell Area 1 1548.30 (ft) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 1 10.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 101.54 (ft) ► F ;: Dispersal Cell " 100.25 (ft) L ateral 99.75 ( ft) —►� — Invert i i 3 .iii : '; ` ii 'i'' i' i ?: i'i ii i i i i'' i'ii i•. 1 Dispersal Cell ..:.�.....•.:........ . E D 3 Elevation :.:.:.:.:.:.:.:::::::.. 98.50 (ft) Contour Elevation 4.0 % Site Slope Geotextile Fabric Cover Shading Key m — T Dispersal Cell See lateral details on Topsoil Cap c r 1.5 ft r�r Page 4 for number, © "" " "' Subsoil Cap ► '0 � size, and spacing of ASTM C33 Sand F laterals. Laterals are 0,5 ft Typical Lath erai 0 Tilled Layer c equally spaced from 05 Aggregate o the distribution cell's �— A centerline in the distribution cell (AxB). Project: GARY NELSON Page 3 of 8 End Connection Lateral Layout Diagram Laterals centered over the A & B dimension 9 = Turn -up W ball valve or oleanoutplug P .I AN laterals are identioal IF X-+I Holes,drilled on the bottom of the lateral s equaUyspaced Force main connection via tee or cross to manifold at any point. Laterals & force main of PVC son 40 (per COMM Table 84.30 -5) Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 3.08 ft Lateral Length (P) 98.56 ft Orifices per Lateral 33 Lateral Spacing (S) 3.00 ft Orifice Density 9.09 ft /orifice Lateral Flow Rate 13.59 gpm Manifold Length 3.00 ft System Flow Rate 27.19 gpm Manifold Diameter 1.50 in Total Dynamic Head 16.23 ft Forcemain Velocity 2.78 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and - 0 Disconnect Comm 16.28 WAC 4 in. min. Tank component is properly vented E Alternate outlet location w _ Forcemain diameter WEEKS Manufacturer —r 2 in. Ca aci 800.00 Gallons Volume 21.76 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 21.19 461.10 G B 2.00 43.52 Pump off e levation (ft) C 5.57 121.30 91.17 D __ 1 8.00. 174.081 D Total; 36.761 O.00 ? Do� elevation (ft) 3" Bedding un er tank. 90.50 Alarm Manuafacturer ! SJ ELECTRO Alarm Model" Number HW 100 Pump Manufacturer GOULDS „ Pump Model Number WE 0311 L ____ Pump Musf Deliver I 27.19 gpm at 16.23 ft TDH Project: GARY NELSON Page 4 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name KIM A OCONNELL Phone r715-386-4680 5 - 755 -3145 POWTS Regulator's Name ST. CROIX COUNTY ZONING Phone 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 1260 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 ft Maximum FOG 30 mg /L Type of Wastewaterl Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System I Laterals should be flushed and pressure tested every 1.5 years Moundl inspect for ponding and seepage once every 3 years Other 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 .........•.� .019000 0690*.. Grade \ �1 6 -8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral ---- -- Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: GARY NELSON Page 5 of 8 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet fiker shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The fitter 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 fitter is equipped with an alarm, the flRer 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 mg1L FOG for septic tank effluent or 30 mg/L BOD 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 flashed 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. Continraency 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 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: GARY NELSON Page 6 of 8 At - - rl J ll �G f /V !� 7tW ,'MEN ■ ■ ■ ■NNE■■■ ■N■ MEN 'a �■ri r�ii �'i■■■■■■ ■EN ice rr� ■�'i'irrr"'r ®■"'i •�■■ .- ■■■■■■■■■■■r■ r �!�■rerr��■ �. �rr��Or ■r���rr■��M�r maimSUnrr _,� iO�►�riN�.i■�■rri■rrEi ■rrrr �■r�:�rrriO�s ON ME MOMMMUMMENEW MENOMINEE MODEL 3885 SIZE 3 /4" Solids,j MENEM �r�iNrrrr ■� �`i�•►r. z.�rrrr■�►��.�rrrrrr ® ®am®ma "i S� ■■O ■E■■■■ • Erg. ��■�■ ■■�■■■r■■ :. ■r■Eiir�i► ■�ii ■�i■N■o r�rr OEM NONE ■ MEN ■N NONE ■ N■■N■N ■■ ME N� rr�i r�i i■�i�■i ■■ ■�■►■N ■�i�■r ■■NN ■NEON S MEN ■ NONE MEMO MMINUMM . i■■ MNONME i �r�i riiir�i iiiiiiiii■i rn m , �9WL6t 3p89'S tog 1 ,L t' 69E Z _ I A a — - AS01 0 09'48"W t Uj C 396.26' 1 c (n Z w ao 1 368.97' I m N w -2� 1 m 1 Q I , 8D _ p S', i (c ch) 173 m D N O ca I ^?1 � 5 1 A rn� 10 Z rn i y i O D j - N N 1� m ,; N 1 I Nol mrE'1 L2 t - 1 �] N 1 0 368.97 1 I N S011� 9'48•W 395.61' o 0 1 N r �� i Gt>j j� o N� �_ w0 N o 1 I C`1 t ( S01 8 1 394.9 °09'48"VV j � I rm� 1 n 6' I Z �s INQ I rn to I .���0 7 �► G v t� Z 6 6 - O . g2 t 7u 1 368.96' 2249.96 N01 0 09'4$ "E 394.3 �` TME NEN4 OF l.o = C O� it ° . m 8 I _ _ _ _ _ _ _ , N01 09 48 E 2644.27 m I�, Go��C►� 11G� N P `(l o Cl) -n z��` Z U) m e rn - m a' m Voi.17 Page 4481 Wiscar :partment'of Commerce SOIL EVALUATION ' RECE IV ED Page / of Divisi fety and Buildings in accordance with Comm 85, Wis. Adm. Code County ry Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and parcel 1.6. percent slope, scale or dimensions, north arrow, and location and distance to nearest roa Please print all information. FF - ] Date Personal information you provide may be used for secondary purposes (Privacy Law, s_ 15.04 (1) (m)). W-/f/�, //// Property Owner Property Location Er - e a Govt. Lot s_ 1/4 E1/4 S T Z N R E (or) 10 Property Owner's Mailing Address L F Block # Subd. Name or CSM# City State Zip Code Phone Kimber Village ® Town Nearest Road a v 1/Yl 5507.5 - t > n n c 1 C ti [M New Construction Use: Residential / Number of bedrooms 3 _ y Code derived design flow rate d GPD 0 Replacement �❑ Public or commercial - Describe: Parent material O Flood Plain elevation if applicable / ft• General comments SY and recommendations: << /, Cart-jbv e( -e v, 17 Boring # ❑ Boring O limiting factor in li Depth t D f Z I pit Ground surface elev. t epo mng . Soil Application Rate Horizon Depth Dominant Color Redox Description ETexture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 Z Z Z o i" Z m Sb r C 7, ( ,- , 3 7S Boring # Boring CJ pit Ground surface elev. 6J• ft Depth to limiting facto in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 o // Q ,1 -- 51 m->�� 5 6 G , Z • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 _< 150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L CST Name (Please Print) lure CST Number s3 3a Address W/, Date Evaluation Con uc Telephone Number t.�. Yoz s �; �� 3 $0 � � s� f, S Property Owner C h t r T Z Parcel ID . V Page a Boring # ( ❑-i Boring �I l �1 Pit Ground surface elev. 9 0 v ft. Depth to limiting factor in. Soil Application Ralu Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ill In. Munsell t]u. Sz- Cont. Color r " Gr. Sz Sh. 'Eft #1 'Eff #2 0 - /0 Id s, • C l .S z - y �7.s, ry F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate, Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /11 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff #2 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Boundary Roots GPD / ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eft #2 ' Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent 92 = BOD 30 m a < _ gft. and TSS < 30 mg /l. The Department of Commerce is an erptal 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. SBIY8370(RO7100) t . PAGE _ 3 NAME L- eYLer4Z TOT# �' LEGAL DESCRIPTION ,� F X &Pyj P S S 1 3 ,N,R,_ E(or SCALE: I"= �O - - - - -- ' BM I ELEVATION 160 • U BM I DESCRIPTION ,6 c4 Ovc. BM 2 ELEVATION j9, Z d BM 2 DESCRIPTION aayp t- - -- — SYSTEM ELEVATION 99 � SYSTEM TYPE r1J D u no( CONTOUR ELEVATION Sa � o f o �3 Ll ,1�b 0 SIGNATURE _ DATE ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer _ z so Mailing Address S Ya Z3 ' 0 1 Property Address CO R n Al K �-- (Verification required from Planning Department for new construction) City/State I'^ k. N W T Parcel Identification Number �4 2 O i 4/ 0 D o o v4 LEGAL DESCRIPTION Property Location C '/4, A C '/4, Sec. S. T kg N -RAW, Town of k j K t c k( w t c Subdivision . Lot # l 3�� Certified Survey Map # Volume Page # ' I a 3 6 1'1 p age a a 1 Warranty Deed # � � � `7 � � . Volume g # Spec house ayes ❑ no Lot lines identifiable 0 yes ❑ no SYSTEM MAINTENANCE 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. The property owner agrees to submit to St. Croix Zoning Department a certification form., signed by the owner and by a masterplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal 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 been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. 2 � H /of o j SIGNATURE F APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. ti,, .ter 6 /Py/ 0 SIGAKTU APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed 738471 V 2 3 9 7 P 2 0 7 KATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM 1 —1998 REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO.. WI RECEIVED FOR RECORD Document Number 09/02/2 03:15PH This Deed, made between Frederick G. Lenertz. aka. Frederick G. Lenertz, Sr. single , Grantor, and Gary D. Nelson and WARRANTY DEED Jillienne J. Nelson, husband and wife , Grantee. EXEMPT # Grantor, for a valuable consideration conveys to Grantee the following REC FEE: 11.00 described real estate in St. Croix County State of TRANS FEE: 137.70 Wisconsin (the "Property "): COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Return Address I Gary D. Nelson Jillienne J. Nelson X County Road N Kinnickinnic Township, WI 54022 022 1011 40 000 38' Parse emfiWfta ' m er (PIN) This I homestead property. (is) (is not) Lot 4, CSM Vol. 17, Page 4481, Document No. 417311, located in part of the SE % of the NE' /. of Section 5, T 28 N, R 18 W, Town of Kinnickinnic, St. Croix County, Wisconsin. Together with all appurtenant rights, title and interests. None Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except Dated this 02 day of Se temb , 2003 (SEAL) (SEAL) 0 ■ o ■ 2 0 o S � § § $ T� E i 2 E- � � ] � � � ■ � 0 0 2 (D ( § - ƒA 2p \� k \0 Q }$ g U) 0 C O & © > % k ; � a « . 0 \ k ° / / ;z g §_ ' i 0 $ � 000 # � 0 2 % 4 g § CO) co i / ^ § 7 % t � ; { e K � 9 & § 7 3 E K) _ � ■ a § R CD ■ T ] ° E § / 2 k M co U) z � % # � ^ ¥» °� § §E , CD (Do § CD ƒ m § =� c _�,� ■� § 7CD K /g0 CL ! §i)\ ƒRa3 g ƒ { O r- 0 c S4 M § U) U) % ) C (D q 3o■® $ @ - § R k-j BCD qb � p,= ■ o b < % � � * � o� �� �� I �� � ST. CROIX COUNTY Y WISCONSIN ZONING OFFICE 2004 ST. ROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road sr <:uuN - f Hudson, WI 54016 -7710 ZONING OFFICE (715) 386 -4680 • Fax (715) 386 -4686 09 EROSION & SEDIMENT CONTROL PLAN Parcel #05.28.18. ep ndina For Lot 4, 1096 C.T.H. "N" (Kinnickinnic) — owner(s) Gary Nelson Under St. Croix County Zoning Code 17.70(3)(b)5: "The (Zoning) Administrator may attach reasonable erosion prevention conditions to a permit approved for issuance." Comm. 21.125 also requires the building permit applicant and /or landowner to follow erosion control procedures and maintain them until the site has been stabilized. The owner is responsible for notifying all contractors performing construction on this site that an Erosion Control Plan is in effect and the following activities will be required in order to maintain compliance with the plan: 1. The primary source for construction site runoff will be the house foundation excavation, driveway, and any soil stockpiled until final grading and stabilization is complete. Septic system excavation/installation adds to temporary disturbance, but establishing cover on exposed soils will prevent erosion. Plan to apply seed and mulch as recommended in #5. Maintain existing vegetation wherever possible to minimize sediment movement. Surface drainage is to the northeast, with >250 ft. to a drainage easement between Lots 2 & 3. 2. Route contaminated runoff into vegetated buffer areas b creating temporary diversions graded ALONG g Y g p rY �' CONTOUR between excavation areas and any drainage ditches or waterways. A diversion may be used to contain runoff on owner's property. Zoning Dept provides specifications for temporary diversions. 3. If builder /excavator grades the site to create temporary diversions (see #2) to contain sediment and leaves adequate vegetative cover to protect areas of concern, installation of silt fence MAY not be necessary. Silt fence or other approved sediment control products will be required if sediment cannot be contained on owner's property with diversions and vegetative buffers. The POWTS inspector and/or building inspector will evaluate ESC plan effectiveness and make recommendations to owner for any action required to comply with applicable regulations. 4. Construction equipment and vehicles must utilize a stabilized driveway access off public road for heavy equipment; this includes cement trucks, well drillers, and other contractor's vehicles that access the property during construction. This helps avoid muddy, rutted conditions that may allow contaminated runoff to reach waterways and/or drainage ditches. Property owner must repair damage to ditches resulting from multiple access points and sediment tracked on public roadways must be removed at the end of each workday. 5. Stabilize new topsoil cover over septic system with seed and mulch immediately after installation — do not wait for final stabilization and/or landscaping of entire site to cover exposed soils on the system. If weather will not permit seed germination, a heavy straw mulch cover will prevent erosion until grass /vegetation can get established. Erosion control matting can be applied any time of year and if installed properly, will provide protection even if seed germination is delayed. The owner of record during site construction will be responsible for corn Hance with the ESC Plan. Please feel free to contact me with questions regarding erosion edimen c installation. Prepared by: Pamela Quinn, Soil Erosion Inspector #66505 Owner acknowledizement of ESC Plan re uirements- 2-r _ / _ /2003