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HomeMy WebLinkAbout022-1014-90-500 a f y ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner s /gLlliv 5 E - 1 , 1// 6-- S Address $ r -�� City /State 11PfaAj to/s S /D /C�► Legal Description: Lot M # &f ? y6v yal ./5 Pe ' � a R _ Block CS '/4#ia /a ,Vi �, Sec. , T N- R!W, Town of Z /NNi PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: A A" Tank manufacturer Size ST/PC / Setback from: House Well PAL Pump manufacturer Oo EMEh Model _ 13 ? Ys. f f P Alarm location [LV S49 e WAj , (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM atl 2 , i Type of system: M ' Width & f Length Number of Trenches Setback from: House >loo Well NA • P/L ZS ` Vent to fresh air intake > .SO .v o !v E!/ AP ►! /E!-) 7� �.r� . ELEVATIONS CST's flAf *1 --7 70 o/ % '' S� Description of benchmark Elevation • Description of alternate benchmark 8o &m S' /Dim S *T SAP j;"� Elevation /0 -C, 5' Building Sewer /0/. ST/JAT Inlet X00 ST Outlet /00' SL PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines( R�I E Bottom of System (-f� 5 ZOO �! o Final Grade �z3S � Date of installation / / Permit nu ber 3 9 . State plan number 60 2X43 0 9 2e ©1 Plumber's signature License number V Date Inspector VtU t tj &RA tt Complete plot plan - ORIGINAL i r EFFLUENT & DEWATERING 140 42 135 40 130 191 '` AGRICULTURE PUMPS 38 125 120 --- 38 186 - IIS 4186 34 — - - -- - 110 I - 32 105 — 100 y 4291 95 �; 28 90 26 42gr1 24 6U 165 N US. GAILONG 10 20 30 40 W 60 70 60 90 100 110 120 1$1 1 'a. 'f� IT 180 t90 2(X1 -- - --- -_.... 4165 !'1ER; 0 80 160 240 320 400 480 y 75 \ n i w ri r, MiN11 22 010652 70 183 1 4163 ° 20- 65 1- �, 18 60 161 189 4161 4189 55 16 50 ise 14 4188 140 12 4140 t0 30 13 165 8 4185 9° 25 GRINDER PUMPS eM - - - -- • ,. �., '• "' � e Z,e► ;0 4(+D ( I I "137" (;ash` Iran Series "139 Bronze Series HEAD CAPACITY UNITS /MIN Feet Meters Gal. Ltrs. • Automatic or Non - Automatic. 5 1 52 104 394 0 '/2 H.P., 1 Ph., 115V, 200 -208V or 230V. 10 304 79 3 00 15 4 57 64 242 • 1 12 H.P., 3 Ph., 200 -208 or 230V. 20 6.10 36 136 • Non - clogging vortex impeller design. 25 7.62 a 30 • Passes spa inch solids (sphere). Lock Valve: 26' • 1 NPT discharge. Cana • Float operated, submersible (NEMA 6) 2 pole �� listed C Assoc Approval Standards mechanical switch. available e Automatic reset thermal overload protection. - 137 Series SC-2225 • Stainless steel screws, bolts. guard,, handle and Lr 139 Series SO arm and seal assembly. - Bronze motor and pump hous -c sw case. base and impeller. NOTE: No UL listing for 200- 208V/1 Ph. pumps. - Mercury float switches are evadable for non automatic models. t .. d i . � �. u• „ 1 X11: r iitr inr] • ��� 1 _ - - - - II sc�f be GviEst A6, COA 4JI 2 I y�� ye �.� 80 Yom C1- F ,,pi.v M � \ I v � I \ I I o y � 15 I I Be 710M i ti 1 ; o Pomp OFF r70 i \ 4 ,� foo o V0 716o Gtr/ _ -- I q Il k ho 3 #14 I�,yS co l/ �/ /3 Y�- �� ,yo, ioT ��,�� Wi �ccsnsin Depa(tment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 395235 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 3 Permit Holder's Name: City Village x Township Parcel Tax No: Selvi , Shawn I Kinnickinnic Townshi CST BM Elev: Insp. BM Elev: BM Description f n TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM - 1- 3 0 1 ' ab Aeration Bldg. Sewer /w S QL to`IDS Holding St/Ht Inlet SUHt Outlet `C TANK SETBACK INFORMATION / '� TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet t� gG gs . * 6 I Septic to .7 Dt Bottom 1z•1G 9S. 44. Dosing Header /Man. Aeration Dist. Pipe +Sa ' (oZ.48 Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer ^ ^ Demand St Cover GPM • Model Number 13 � 60 fN` ( A. S M -5 2.10 ) o TDH Lift Friction Lose System Hea o TDH ij Ft IL Z 0 DO 0 Forcemain Length s I 2 Dia. Dist. to well e SOIL ABSORPTION SYSTEM `• $�° S 0 L _ b E idth Length / Nq. Qf PI IMENSIONS No. Of is Inside �epth ENSIGNS /_ , , \! SETBACK SYSTEM TO P/L BLDG I WELL LAKE /STREAM LEACHIN anufacturer: INFORMATION C " A OR Type Of Syst �) �. UNIT Model Nu 1 ) % I Aj 80 DISTRIBUTION SYSTEM At4 r14-) 4 Header /Manifold t l Distribution I if / x Hole Size I x Hole Spacing rt to Air Intake Pipe(s) U Length Dia Length TT Dia ' Z Spacing 4 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil � Yes ❑ No Fal Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #�:� -/ 6 /_�- _ Inspection #2: (1 Location: 597 90th Street Hudson, n WI 54016 (NW 1/4 NW 1/ T28N R1 8W) NA Lot )11 Marcel No: I 1.) Alt BM Description = �,1c / 7 2.) Bldg sewer length - ` ( 7 I (�> - amount o& cover = , ` � Lt 3.1 Contour • -"1 M1-4 L a+— Cr Pfan revision Required? No r#� C.rt � for additional informat O� e' � *3 Date Insepctor's Signature . . Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 5T G�PD�' N viscons i n Madison, WI '53707 - 7162 Site Address De artment ofi Commerce K 54'7 9 5r. Sanitary Permit Application Sanitary Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide 3 ? !5 ­ Z 3 5 — may be used for seco Purposes Privacv Law, s15. 1 m ❑ Check if Revision I. Application Information - Please Print All Information State Plan I.D. Number �+ Co'ZI 7� 3 j Property Owner's Name r Parcel Number Property Owner's Mailing Address Property Location 73.5 ? :27PEA) f al( So . r -_,. _ T 111w> Nw 4 2. S T N, R 1• City {�Std (J� jeme ` ate�j Zip Code , hone Number' .' ; \ Lot Number Block Number �!/� / //� S.sD/ T•� Ssbd>risivira CSM Number GSM W7S00 Uo/ !S P4 . R. Type of Building (check all that apply) 1 "` ❑City ' XI or 2 Family Dwelling - Number of Bedrooms ❑village ❑ Public /Commercial - Describe Use i + XTownship itwl lc4f El State Owned I� / Nearest Road III. Type of Permit: (Check only one box on line A (numbering schetrri , irt ernal use). Complete tine B if applicable) A. New 2 El Replacement System 3 ❑ Replacement of 6 ❑ Addition to For County use S stem Tank Oni Existim System B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that appiy)(numbering scheme is for internal use) 44 ❑ Non - Pressurized In- Ground 21W-Mound C 6 k /0V1 47 11 Sand Filter 50 11 Constructed Wetland 22 11 Pressurized In- Ground 41 ❑ Holding Tank ) 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Dis ersal/Treatment Area Information: fir nElevaZon Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate Sysinal Grade Requir ed Proposed Rate(Gals. /Days /Sq.Ft.) (Min./Inch) levation s (G 0) � /D � D VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks % Sep tic or Holding Tank 1 cja Dosing Chamber O 144' VII. Responsibility Statement- I, We undersigned, assume responsibility for installation of the POWTS shown on the attached plans. ' Plumber's Name (Print) Plumber's Signature I 11QP/MPRS Number Business Phone Number R' - 24 L9rn - T — 1 2 S. 7 AV/ 95 Plumber's Address (Street, City, State, Zip Code) VIII. Count /De artment Use Onl ,Q Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) l Surcharge Fee) ❑ Owner Given Initial Adverse . ,J Determination IX. of A / oval/R . / easons for Disapproval J / /� ir. t� �JeY AV-,_ V, 4AC �Ct fer'b ✓e GO[vt�e1". -�Q,�i � �rDS;oy�. csv�7"rd� h.CR,Sk/'cs `tom fle r �` (�a,,. s ��a, �( 6 S a,lw..� i� ����✓ i �' s, �� for- �r'r�s�. s a� � � :v� n e eess� �Y Q,v�o( Gw�,SiS �e•.t..fi y�csi� (�'tih itfr�iNes� Gt/re�GrSneC► �aa� atv.oQ o�OJ�rU�S Attach complete plant (to the County only) for the system on paper not less than 81/2 =11 Inches in size SM-6398 (R. 05101) Safety and Buildings ' PO BOX 7162 MADISON WI 53707 -7162 TDD #: (608) 264 -8777 isconsin www.commerce.statemi.us /SB Department of Commerce Scott McCallum, Governor Brenda J. Blanchard, Secretary March 09, 2001 CUST ID No.226375 ATTN.• POWTS Inspector ZONING OFFICE ROBERT W ULBRICHT ST CROIX COUNTY SPIA 655 O'NEIL RD 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/09/2003 Identifi on Transaction ID o. 621713 SITE: Site ID No. 62701 STEVE GERMAIN - RESIDENCE Please refer to both ification numbers, ST CROIX COUNTY, TOWN OF KINNICKINNIC; 90 TH ST above, in all correspondence with the agency. NWI /4, NWl /4, S6, T28N, RI 8W, LOT: 11 FOR: DESCRIPTION: NEW MOUND SYSTEM / 600 GPD OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 783204 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: 1. This approval assumes that the following component manuals were used in this design. The manuals were not indicated on the plans as required: a. "Mound Component Manual For Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD- 10691 -P (N.01 /01). b. "Pressure Distribution Component Manual For Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD- 10706 -P (N 01/01). 2. On the cover page, the soils on this site are seasonally saturated at 20 inches and the mound system will incorporate a minimum of 16 inches of sand fill. 3. On page 2, there shall be six inches of aggregate under the distribution pipes and two inches of aggregate over the distribution pipes.the aggregate shall be covered with approved geotextile fabric that conforms to s. Comm 84.30(6)(g)., Wis. Adm. Code. 4. On page 3, X = 34 inches and Y = 27 inches. 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. 0 ROBERT W ULBRICHT Page 2 3/9/01 Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. jSm'cere DATE RECEIVED 03/02/2001 FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 E PAGEL BALANCE DUE $ 0.00 S PLAN IEWER II , INTEGRATED SERVICES (608)266-2889, M - F, 0700 - 1530 HRS PEPAGEL @COMMERCE.STATE. WI.US WiMART', eod':. 76 cc: STEVE GERMAIN ULBRICHT & ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 ' :7w V Z Reg. Designers of Engineering Systems 715- 386 -8185 Private Sewage Consultants MAR 0 2 _ -., SAFETY & BLDGS. PROJECT INDEX Plan I.D. # Date 2 '7• 2 00 Owner 54,eUE 6f q-j' Phone - 745 • . 3 2_ Address 906 S T 110PY -O 4v /. Sy /6, Legal Description / of pE,v01'W6 CSiy ?, 2- GLes. ticv /vw . Go , - r.2 SX) R l8 Lo Town of Count S T• GI' C I C.S.T. �• �� ZZ43ZS Installer Local Authority/ Supervision •� C PROJECT DESCRIPTION /flew• co,) S 7'�el) 13o f C o � 2 s•v /' 1f4 U-- C +� P ' 0 :W a mwnn►nnrn r ,�� atl onally .,� c oN DE p 0 ? ;` ROBERT W. DIVI ENT C D == ULBRICHT S.4F y p 4 ILOI S ��,," -. HUDSON. WI R SEE Cp ESPO �b .,��d�;•••...w...��4 CORREC�tiON NEEDED ONCE r G SEE W PLAN VIEWS SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS 9. r g, PIPE LATERAL LAYOUT Pg. 4 DOSING CHAMBER CROSS SECTION & SPECS. P 5 PUMP PERFORMANCE SPECS OPERATION, MAINTENANCE, AND PERFORMANCE REQUIREMENTS This design for installation is based entirely on measurements, elevations, landscape conditions (slopes etc.) and soil suitability provided by CSTM z 2 & 3 S The accuracy of his specs, as reported, shall remain the sole responsibility .j of the CSTM. Any use of this POWTS design ty any licensed plumber, or any related unlicensed parties or persons (excavaters, laborers) shall not be construed as an assumption of responsibility by the designer for the workmanship, construction, placement, substitution or selection of any components not specified, or �. any assumptions by the plumber that any unspecified components are state approved or proper, or the effects of poor judgement r if working under adverse damaging weather conditions soils) by any such parties or persons. (wet /frozen i Y ND o r t- Z yLO j T -Pr i l i PC , yc o �� cs C S 7 � y � , 7 0 � p' E y �A ) �o . � �� �.Vslo�lCo �owns ��. cv r �.s ��1 � s1u� It, n�i � e a gnu �h sleet must terra / .I go �' o�labso�Q�ionSy s , T , S 9 /e / 30 ash j 4dlfe;elt&�e Al - 75 a I I 1 Ce CR S ECT 1 dN OF Nt o U A-) D -~ to r to %WORRECTION NEEDED SEE CORRESPONDENCE e o F I a Ay9�pcSAT Vi StR430T� rNickpjes3 P P t oG- or T�p soiC. V/ - r4ehl,wz- sysrEM UO i FORM T-o a 14 / D", - O RATIO Mao. � B � • , - - �9 plowEO T Sol u u i fro pm R SIopE MAW EIE VATDoa 70 �• , ? j _ Fr. — ELEV S F 101) Fr. lmvE�Rr of y IATGRA 5 102. • s'a FT' To /t�Z• Z . o p of Ro g G F N D ' Tdp FT. °F Z IATERAIS �. PLA VIEW OF MOU -0D -- wi r 13E D FoRm MAiO A ( e F r• - -- -- K /2- F r �._. - - -- a FT K -TI a F r �W Y M w F T l am of To I y" Pvc cAppa A 91pFIA dC3SERVhTic7� P i p E s /oCA r :ays : /� �T• ,-w.H 5cti 4 0 ) PF-QMA,JtoT MARKERS RECgViRED BA SAL. /ARE 'D �, - 50i t- 101 ITKMnTiuE • s cA 5 ciT y 4. F PA r. PRoposed BAsAl MeN = B (A t z FT, L AY OUT OT CEOTRAL, P P 5 ` � Z F� � x/ Z F R 3.5 F r CEORAL_ r o Rc E M Ai'k3 CSION NE DEOX 3� INcNE< Fr ,, CORRE 7 5 E CORRESpONpENCE o P v c SE y / �- luc N �5 V RRi • R(3LE TOTAL V(9tp l)b(U)je `Z- � GA15 • 'Pi N o i ci b A M E -M 3 To T�4L R 1- hT t� QA t1 2 itil HAS r (� 0 CEuTRAL, MA*%FoLr> ` S �' -- I�cN�s or HOIE5/Pi PE' I.uvERr E LEVi171ok1 or- LAT S SEE QEU�PSE SIDE .Fp� /� SD Tl OM i "A (._ c/o btT>4 PER FOR hTE d R�tito�E All 3)R (3uRR5 Floe loc ^TEb o ,� t�orroM UgUAlly SpAcE v . r: �15T au r lo" y�S� hAR C>E PAR R ATE PO I;Ac LA 1. g� o S �I A L / M i Al . TOTAL 17i STR1QUTiorJ �ISct1�l RATE r—O R GAL��'11 a• MI•NI•MOAA r 'bET o ` t- L ATL7R A I C D P 4!5 o vE A T �,vz-,D o f , E - 4 6 161, At Rok a ��� yy ^ 13411 4 ME- PUMP CHAMBER CROSS SECTION AMID SPECIFICATIONS P,4 ,E y " Sal 46 -S > /D' fo evi. _DCOR 41;e %v le4 F— pvG _ -VEMT CAP I PI 1* VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MAIJHOLE COVER t�2 . ' 12 "MIU. I w/ [vlf,0 IA13EI 1 1/ D . -. r- N� r- r1E; ("17/0 Af GRADE I I 'i " MIN. —T -I IB "MIU. 1 COUDUIT W LE T PROVIDE AIRTIGHT SEAL t1 I II APPROVED JOIN A SI I III APPROVED JOIN w/ PIPE (V� I I III W/ PIPE EXTEMDIIJG 3' 0 I (I ALARM EXTENDIMC, 3' JUTO SOLID SOIL B �^ � 1 O .� 1 I i i I oNS� L� USO�Uc 4 Pac 7 � o 3 J I I OBI a s'20 C y ' ELEV. 1 FT. __J 1 1 PUMP �, OFF 2/SE 3 j die 1, 5 l axis- eF �(AN �EnOI� I BLOCK 511AIP it VA f io,J KIStR EXIT PERMITTED GUI-9 IF TAIJK MAIJUFACTURER HAS SUCH APPROVAL -�( SEPTIC E SPECIFI'CATIOUS DOSE ' TA NKS MAMUFACTURER: G►iAES 4 AO 14 1 > e � WMBER OF DOSES: PER DA.4 '( 00 1 TANK SIZE: �Ol�'f> GALLONS DOSE VOLUME 1 L' 1 G�IU.r,L �� INCLUDING BACKFLOW: /d GALLONS ALARM MAMUFACTURER. ��rriy MODEL NUMBER: �• y' L CAPACITIES: A= INCHES OR �yv GALLONS SWITCH TYPE: / IP B= 2 - INCHES OR GALLOMSS PUMP MANUFACTURER: / 4S ; V � S C = IUCHES OR GALLOIJS MODEL NUMBER: 6- / /o D = INCHES OR GALLOUS SWITCH TYPE: / / 4r -,( c : 5 � MOTE: PUMP AMD ALARM ARE TO BE MINIMUM DISCHARGE RATE _s O ! GPM INSTALLED ON SEPARATE 7 C�IRCUITS VERTICAL DIFFERENCE BETWEEAI PUMP OFF AND DISTRIBUTION PIPE. FEET fiAA)k SrfCs MINIMUM NETWORK SUPPLY PRESSURE / , ,'. . , . , * . 3' 5 FEET EAGLI + FEE OF FORCE MA X �` F /o0 FT. FRICTIOAI FACTOR. �'' FEET(�V� TOTAL 09MAMIC. HEAD = • ZS FEET INTERNAL DIMEIJSIOMS OF TAUK: LEMIGTH t o � ;WIDTH 057" ;LIQUID DEPTH i „ SEPTIC TANK, per Comm. 83.44 (2) (c) shall be equipped with an outlet attached approved filter device (Zabel fliter). Tank shall have an approved above ground locking manhole cover for regular (every 12 months or less) inspection & servicing by a licensdd service pumper. ME40 Series M TWW 4/10 HP Effluent and Drain Water Pumps Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 12 35 10 W 30 tL � H 25 8 X Z O ►, 20 6 J Q 15 J E- ~ 4 O 10 5 2 0 0 0 10 20 30 40 50 60 70 80 90 100 CAPACITY GALLONS PER MINUTE F.E. Myers, A Pentair Company • 1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289 -1144 FAX 419/289 -6658 Telex 98 -7443 K3326 7/91 Printed in U.S.A. jp ME40 SERIES 4/10 HP Effluent and Drain Water Pumps POWER & FLOAT CORDS PLUG DM ENSIONS Quick- connect, watertight Replaces switch assembly fittings are interchange- for manual operation. -- able, replaceable from I i NPr 1 ^<� (381mm) pump exterior. Discharge MECHANICAL FLOAT r SWITCH y Mercury -free, 90 angle a r operation. l 5.66 .. (144mm) - 1168 (296.5mm) -.._.. - i "ON" MOTOR HOUSING t Cast iron for efficient heat transfer. OVERLOAD SWITCH Built -in to protect against overload conditions. . 4/10 HP MOTOR } } 1600 rpm, 60 Hz, 115 or � i 230V, single phase. Oil- cooled and lubricated. ROTARY SHAFT SEAL Carbon, ceramic faces. PERFORMANCE CURVE CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 „wM 12 VOLUTE/1M1 SEAL 35 RING $ �' $; r 10 � Maintains high efficiency 30 �' . Y and reduces recirculation e replaceable. zs ti ART, � ENCLOSED TWO VANE 20 r as 6 IMPELLE High efficiency, passes HIGH EFFICIENCY ABS C' 15 , 4 3 /4" spherical solids, with VOLUTE stainless steel wear ring. Corrosion resistant. Passes ° 3 pu /4" spherical solids. I W' z THRUM WASHER SLEEVE NPT discharge. 5 � t , BEARINGS o . o Entraice smooth operation 0 10 20 30 40 50 60 70 BO 90 100 and extend pump life. CAPACITY GALLONS PER MINUTE K3319 5/92 ® F. E. Myers, A Pentair Company Printed in U.S.A. 1101 Myers Parkway Ashland, Ohio 44805 -1923 419/289 -1144 FAX. 419/289 -6658, T LX: 98 -7443 •� y y Pg. 6 of Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code • 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, Safety and Buildings Division. Pum 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 for frost protection. Influent quality into the mound system may not exceed 220 mg /L BOD5 150 mg /L TSS, and 30 mg /L FOG. 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 ( K���ee �qqriding. Ponding levels shall be reported to the owner, ��i�i�rAIf�'F and any levels above 4 inches considered as an re requiring additional, more frequent monitoring. General SEE CORRESPONDENCE This system shall be o erated i e with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manu SBD -1057 -P (R. 6/99)] d 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. 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 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 adsorption rind dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions on the operation or maintenance of this system should be directed to your county zoning or health inspector. SEE REVERSE SIDE Pg.6 FOR MAINTENANCE REQUIREMENTS SPECIFIC TO THIS SITE, DESIGN, AND COMPONENTS I Pg. 6 Continued. POWTS (landowner) is reponsible for proper operation and maintenance of this system. Regular periodic inspections and servicing is necessary for the safe healthy operation of this system. The owner is required by code to submit all necessary maintenance /inspection reports to the controlling authorities. SPECIFIC CONTACT AGENTS s�.�orX pry, • Governmental authority/ inspectors: 3�L S/� �o • Licensed installer, responsible for providing an operation/ maintenance "Users" manual: • Licensed service / inspection agent other t installer: 7 � - • Electrician, for pump, electric controls, wiring units: 7/ S"- 1 • 7 33 IMPORTANT OWNER"KA- INTENANGIE REQUIREMENTS 1. Winter traffic (sledding, shoveling, etc.) across the mound . area shall not be permitted, or frost can /will penetrate into the cell, freezing up the system. Discontinuos use in the winter (a vacaction trip, resulting in no water use) can also lead to freeze ups. 2. Water conservation needs to be exercised! Or system can be hydrolically overloaded and destroyed. This system was designed for a maximum wastewater flow of� f� gals. daily. 3. POWTS are not designed to accomodate wastes from a garbage disposal unit, or any other unnatural sources of waste. Any introduction of such waste materials will overload and destroy this system. 4. If a power outage occurs, or a pump fails, it may result in a temporary overload of effluent being pumped into the cell, which may adversely impact the cell (leakkge). It is recommended that a licensed pumper empty the dosing tank, allowing the pump to return to dosing the correct amounts. Consult your installer immediately for advice. 5. Neglect of the vegetative cover (the cells insulation & erosion preventive) can lead to failure. Compaction or heavy traffic also can destroy t he system. It IS NECESSARY TO REGULARLY WATER THE VEGETATION OVER A SYSTEM!! Effluent in the system beneath TS NOT sufficient alone tO maintain a grass cover. 6. Periodic inspections by the owner, or his agents, is necessary. Inspection pipes and ports have been incorporated into the system: on the mound basal area (effluent level inspection pipes), cleanout terminals on the pressurized laterals, at each tip - for flushing and cleaning the laterals out. The filter system in the tanks (via a locked above ground cover /manhole). Only a licensed properly qualibied person should be performing this work which involves health & severe safety risks. Evidence of effluent ponding in the system's treatment cell shall also be regularly inspected. Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County 5T e p ivi ). include, but limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 22 ^'�Q f ��• yD • �� percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information Rev' ed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). A Z Property Owner Property Location G S'fevE E f�' /� Govt. Lot /VW 1/4 /V /N1 /4 S � T 2 N R 146 E (or W Propert Owner's ailing Address Lot # Block # Subd. Name or CSM# 6 o yoe�- sT • r� nE,vo;�vt'rr cs�t EA/ State Zip Code Phone Number 1:1 City E] Village CQTown Nearest Road OS�a cvl. 5yd I& ( ?'5' )71&, y 2 3 2- 9Dd"- 57 New Construction Use: Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if a plicable 'C ft. General comments 5l .T� • a �MM and recommendations: � C. R�Qvl�•K�uTS �.r..e . ��t /.e �3� � Movuo 7 -��� -- sysr�rs F/ I ❑ ��ll Boring Boring 2— Pit Ground surface elev. ft. Depth to limiting factor Z• 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 I 'Eff#2 / o iDy v /.3 SiL 2-fShK n1��i�' �w 2-F . S✓ . 8� 2L • l3 16W 3/3 5" z f she S . 3 • /3 •!(o /D rx 3 11( S!L 2f A *-fk S � 6 .21 2 le ye 51L 2- / #m 4e 41-S • Sr �j 2•y /DY� s/ c2.4 MoTS' CL /f S6,� �+► i N 1J le) Yle 2— 7- a Boring # ❑ Boring Pit Ground surface elev. O 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 - Eff#2 l 0 & /k Z/3 — S/G 2f S 'T: lk+-fe 2 f - S ✓ • !3 /o yR 3/3 s -FR 3 3 •/ /D 1,e,3/ Sit 2 ,d � -�'�' es 2 ? . /ERs/ <Z& H CG /f N / YX &12- Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 _< 150 mg /L * #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature C T Number 013 E R r z2(037 s Address �Eyaluafion Telephone Number ,) azo � ? i 7. 71s •3d'G • Jell Ulbricht & A Private sewage Consultants 2, OZTV 655 O'Neil Rd. Hudson, Wis. 54016 r t i 'Property Owner � ! Parcel ID # Page ;-7 of 3 ❑ Jn� Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor ' .2 0 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 "Eff#2 o '// / '-/3 ---- s/c a s hi- R 2— / / /oYR 3/3 iL f s A ll LD /D YX 31 ---- -- S/L 2N►+ ,(),C' 1 k - o . /'o Y9 C259- MOTS S'L 17• iv Y CZk t T- . sye z 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 /ft= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 F] Boring # ❑ Boring El Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Con ce Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz "Eff#1 "Eff#2 " Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608 -264 -8777. SBD -8330 (R.6=) III as �j� ( r . . SKIS •- ,��,�� Pars ��( �D O pp 0', App o f V2 t Q/� No, 40 T 2-.3 n 2s r i 4 I Z { �a� pp,10 a o / �- C� ST CROIX COUNTY SEPTIC 'TANK M AINTENANCE AGREEMENT G �� S� /✓� AND V/,_5� OWNERSHIP CERTIFICATION FORM Owner /Buyer Mailing Address 73 9 Z -087, v Ay-e . s0 e? 6/ G� � �� e O Ss a el Property Address S ` 7 /� l pyo (Verification required from Planning Department for new construction) City /State Parcel Identification Number - LEGAL DESCRIPTION � GtJ � Al N , D Property Location N /,, /�, Sec. � , T N -R d W, Town of Subdivision , Lot # ` Certified Survey Map # W756W _'Volume 5 , Page # Warranty Deed # 65 3 5 Y L/ , Volume � 7 — , Page # Spec house D yes no Lot lines identifiable X yes O no SYS'T'EM MAIN'T'ENANCE 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification staling 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 dpAe. �6Z AGNATURE OF 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 owner(s) of the property described above, by virtue f f a warranty deed recorded in Register of Deeds Office. 1 4SMATURE OF APPL 'ANT DA E * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with tills 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 i STATE BAR OF WISCONSIN FORM 2 - 1998 WARRANTY DEED 65554 KATHLEEN H. WALSH REGISTER OF DEEDS Document Number 't 0L 169 / PA 462 S I .. CROIX CO., WI 1 * � RECEIVED FOR RECORD This Deed made between Steven B. Germain, 08 -14 -2001 1:00 PM WARRANTY DEED Grantor, EXEMPT # and Shawn R. Selvig, a single person, CERT COPY FEE: COPY FEE: TRANSFER FEE: 135.00 RECORDING FEE: 10.00 Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: Recording Area Name and Return Address Eagle Valley Bank Part of 022 - 1014 -90 -100 Parcel Identification Number (PIN) t This is not homestead property. (is) (is not) Part of NW 1/4 of NW 1/4 of Section 6, Township 28 North, Range 18 West, St. Croix County, Wisconsin described as follows: Lot 11 of Certified Survey Map filed June 6, 2001 in Volume 15, Page 4108, as Document Number 647500. Exceptions to warranties: Subject to easements, reservations and restrictions of record. Dated this day of August 2001 (SEAL) a Z (SEAL) STEVEN B. GERMAIN (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. St. Croix Count . authenticated this day of Personally came before me this day of August 2 0 O 1 , the above named Steven B. Germain TITLE: MEMBER STATE BAR OF WISCONSIN K A 0 Y to (If not, MA� known to be the person who executed the foregoing tary pu �0 n d authorized by §706.06, Wis. Slats.) �It� t cknow g e t s e. State of Wis THIS INSTRUMENT WAS DRAFTED BY STEPHEN J. DUNLAP aiK Ccr Notary Public, State of Wiscon in Hudson, Wisconsin My commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not At G,/ t� o -PS' ) necessary.) ` Names of persons signing in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. WARRANTY DEED FORM No. 2 - 1998 Milwaukee, Wis. f . Y tfI H c • inA3Z N Q 0 arm v� yl ES -" A OO w � WES N11 CK En CERTITIED SURTVEYMAP Located in the NW' /4 of the NW' /4 of Section 6, T28N, RI 8W, Town of Kinnickinnic and the SW 1 /4 of the SW' /4 of Section 31, T29N, R1 8W, Town of Warren, all in St. Croix County, Wisconsin , io NOTE: NO NEW PAROEUS HAVE W1 /4 CORNER, SECTION 31, BEEN CREATED IN TIE ao T29N,R%W, TOWN OF WARREN. THE q ( ALUMINUM CAP FOUND) TWO NEW Pt RGEUS .ARE N ENTIRELY WITIM TIC TOWN OF KINMCKINNIC. v o v, �. N CERTIFIED SURVEY MAP Scale 1 = 200' V.- "p I VOLUME 13, PAGE 3755._ , o 5 A ^ 1.22' - - - NOTE: I' IRON PIPE FOUND f. ; 89° 17' 14" E 708.48' -- N44 "E 0.71' FROM CL o I I 676.69' COMPU ED POSifIO . 31.79 OINT ACCESS EASEMEN ^ + CL °-' °J N ` C 1 o OWNER / SUBDIVIDER D STEVEN GERMAIN DETAIL n °m o 0� ; - g l z 0 601 90TH STREET NOT W HUDSON, WI. TO SCALE -� I _ �IQ 2 i,_ o >- BEARINGS REFERENCED TO THE WEST LINE o 33 0' LOT 10 I= 0 , >- OF THE SWIM OF SECTION 31, T29N,R18W, L27 I 'Q u, wl w, PREVIOUSLY RECORDED AS AND ASSUMED TO BEAR N00W52"W. ` W - ' M : o Q I ° w a' w DWELLING 33.00 z1 QIN a M;w 5 � z o JA4-99'.. p SEGTION 31 S LINE + _ m � o; LOT 12 tju � - � - SHED SECTION 6 z °• o , _ ^ �► �: 6 1-. :51 0 1W BUILDING SETBACK LINE w - z Q I 0 3 z z FROM RIGHT -OF -WAY. cn W 21 00 Z i 0 : 0 W 0 ( LOT I I f J IF- m rn - W n y 31 LOT 10 °W—°IQ r00i I " z 1 33', I Z" � 633,373 SQUARE FEET (14.540 ACRES) 0 Ca g f- �i INC RIGHT -OF- WAY c z I I w w 0: 607,253 SQUARE FEET( 13.941 ACRES) w < SECTION CORNER Q i EXC RIGHT -OF -WAY -1 MONUMENT AS o W I U j CIM NOTED �$ o I o "o I v m C7 • 1" IRON PIPE FOUND. 1" X 24" IRON PIPE ?' a ;��..., I r. NIv WEIGI NG 1.68 LBS. / (- 27.76' N 89° 17'37" E 709.10' '01 jj LINEAR FOOT SET. I - 681.34' 11 FENCE w I LOT 12 m T N 89 X17' 40" E 317.6Z 142,553 SQUARE FEET • c T r 90.00 ( 3.273 ACRES) N T LOT 11 INCLUDING R.-O.-W. • ( 121, EET 140,725 SQUARE FEET I (2.784 ACRES) ( 3.231 ACRES) INCLUDING R.- O.- W.CLUDING R :O.W. k� 252.00' � N I 1 ' ° 3 110,862 SQUARE FEET N U- r' g ( 2.545 ACRES) ° o I I • v! �I UJ 3 EXCLUDING R.-O.-W. C N o �I (= 126.83' '317.87' 431.13' �� ( yap... ... ,S ,y 1.04' 140.09' •' E • W. QI to S 89° 17'40"W 4 7.96' * f AN R W LLJ UNPLATTED LANDS N v R ICHM OND 5 O F SCALE IN FEET I = 200' �,9'; Wi f� (y 100' 200' 400' S U W1/4 CORNER, SECTION 6 PREPARED BY: T28N,R GRANBERG SURVEYING (1" STEEL SURVEY Y N AIL FOUND) 1239 C .T.H. "E" NEW RICHMOND, WI. 54017 THIS INSTRUMENT DR ID BY: JOSEPH W. 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