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HomeMy WebLinkAbout022-1036-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM oun St. Croix 'Safety Atrl Building Diviswon s INSPECTION REPORT Sanitary Permit No: 408286 0 GENERAL_ INFCRMAT'ION (ATTACH TO PERMIT) State Plan ID No: Personal information ycu provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)J. 7(,p Z S3 (� Permit Holder's Name: City Village X Township Parcel Tax No: Larson, Dorothy Kinnickinnic Township 022 - 1036- 30-000 CST BM Elev: Insp. BM Elev: IBM D scription: e. ) t0 03 10 .03 . TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS gLF�J� % 011 • 6 0 _! ` UU Septic Benchma ft+.� Dosing ^, � � � � Alt. BM Aeration Bldg. Sewer , ISM ' Holding St/Ht Inlet �F 9. 0 16 St/Ht Outlet —_ TANK SETBACK INFORMATION cP- livg 6c.Q TANK TO L WELL BLDG. Vent to Air I a e AD Dt Inlet Septic f �Dt Bottom d >1ov �3.% Dosing y �� � Header /Man. J I r Aeration Dis�pe of 7 Holding _ Bot. S tem S ? - n PUMP /SIPHON INFORMATION Final Grade 1 flare 1 7 Manufacturer Demand St Cover . Z d GPM �-. /p �J Model Number TDH Lift / Friction Los System Hea TDH Ft ,7 Forcemain Length r Dia. /, Dist. to Well SOIL ABSORPTION SYSTEM i BEDITRENCH Width , Lengtht a No. Of Trenches PIT DIMENS NS No. Of Pits Inside Dia. Liquid Depth � DIMENSIONS 8 1 ..eJ SETBACK SYSTEM TO P/L JBLDG IWELL LAKE/STREAM L C G Manufacturer: INFORMATION CHA R OR Type S tem: l / >/ / N Model Number. DISTRIBUTION SYSTEM 5 ©� C E �}�/� pS (�5�7 �'�3 (p Header /Manifold Distribution �j � t/ s, Hole ize x H le Spacing Ve Air Inta e ? Pipe(s) Length J,� Dia e vs . _ Length Dia ' Spacing 3 . 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 t s a Yes ] No (J Yes [ l No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / q /� /_ Inspection #2:__l Location: 1429 County Road J River Falls, WI 54022 (NE 1/4 SW 11 13 T28N R18W) NA ` Lot K � Parcel No: 13.28.18. 1.) Alt BM Description = 8 ' 2.) Bldg sewer length = !� p a nSU laid �{► SGt�4lS ( /I C b1 Ldyt� ��r -�_ %'W - amount of cover = 4'(,d vvl+v (31" 3.) Contour Plan revision Required? Yes , *iqo J _-- -___ -- _- - _ —J L_ ' - 11 _ -._ - Use other side for additional information. � _i_ 1 �%'� SBD -6710 (R.3/97) Date Insepctor's Si ture Cart . No. 1,e dAqm des Safety and Buildings Division County 301 W. Washington Ave., P.O. Box 7162 � �+A���",n Madison, WI 53707 - 7162 Site Address �7 V Department of Commerce Sanitary Permit Application Sanitary Permi Number Q In accord with Comm 83.21. Wis. Adm. Code, personal information you provide ❑ Check if Revision may be used for secondary purposen Privacy lA 15. 1 m I. Ap Information - Please Print All Information W to Pl �[,p. Numtr„0 7d AS RECEIVED Property Owner's Name Parcel Number oh a tzf-so JJUL 2 9 ZO0? Property Owner's Mailing Address Property Location Z Q _ LC (Y C Or-FICE A& if Sf: S 3 T $ N. R B� City, State Zip Code Phone Number Lot Number Block Number R a�'k Subdivision Name CSM Number % II. Type of Building (check all that apply) ❑City or 2 Family Dwelling - Number of Bedrooms - O villinage ❑ Public/Commercial - Describe Use Plowr ship ❑ State Owned Nearest Road / / � Cb . (7w M. Type of Permit: (Ch only one box on line A (numbering scheme for internal use). Complete line B if applicab e A For County use LEINe-W 2 Replacement System 3 ❑ Replacement of 6 ❑ Addition to Tank Eris ' stem 13. ❑Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that app scheme is for internal use) 44 ❑ Non - Pressurized In - Ground 21L4'Mound 47 ❑ Sand Filter 50 ❑ Constructed Wedand 22 ❑ Pressarized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Dispe 1saIPI4 eatment Area Information: o r v v r Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals./Days /Sq.Ft.) (Min./Inch / Elevation 1 � O 600 4 �00 A 4 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or i ok - iE►z- a Dosing Chamber VII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP Nrunbe Business Phone Number � ^ X78 7 /5 7jfs lumber's A ress (Street, City, State, Zip Code) � p hwle .Count /De ent Use Onl Sanitary Permit Fee (includes Groundwater Date Issued Is em ignature (No Stamps) ❑ r Given Initial Adverse Approved ❑ Disapproved Surcharge Fee) �I Owner Determination 1X. Conditions of Approval/Rea Disapproval N t �� I �� ` �, ) �u N t� DN u i �� i5�xer� � �(Jr~s�� r 1� 5 .{Y v �f16" 15 wlcciYi `�� ST .�.���c�� � � ►� Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches In size t 9r 0 f �1�-Go a � UIT4 r�t Lt N P 1(LS T6Yv1 !MU � l�v ��5 svJ SBD -6398 (R. 05/01) 13 Y CovlJ l Y 5Ti9"r-F r ~ A. Safety and Buildings ,+ 10541N RANCH ROAD HAYWARD WI 54843 f 6consin TDD #: (608) 264 -8777 www.commero .wis ons Department of Commerce www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary July 15, 2002 CUST ID No.222781 ATTN.- POWTS Inspector ZONING OFFICE HENRY J NECHVILLE ST CROIX COUNTY SPIA 967 HIGHWAY 65 1101 CARMICHAEL RD ROBERTS WI 54023 -8510 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07 /15/2004 Identification Numbers Transaction ID No. 762536 SITE• Site ID No. 646604 Dorothy Larson Please refer to both identification numbers, 1429 Cth J I above, in all correspondence with the agenc Town of Kinnickinnic, 54022 St Croix County NE1 /4, SW1 /4, S13, T28N, R18W FOR: Replacement mound, 600 GPD Object Type: POWT System Regulated Object ID No.: 857489 eofzld 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. RTMI The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: lei • This system is to be constructed and located in accordance with the enclosed approved plans and wi the SEE GOf „ "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10691 -P p o p y ( 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. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The maintenance plan for this system must be given to the owner of the POWTS. Note • 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. i -HENRY J NECHVILLE Page 2 7/15/02 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. • Abandon failing system per COMM 83.33. • Insulate building sewer per COMM 82.30(11)(c). • Provide frost protection per COMM 83.43(8)(c). . • Holes must be drilled with a sharp bit and all burrs and foreign matter removed before installation. 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. V The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the it installation, operatio r ma enance of the POWTS. cere y, _Fee Required $ 175.00 Fee Received $ 175.00 NT Balance Due $ 0.00 Patricia L Sh POWTS Plan Reviewer tegr ed Services WSMART code. 7633 RE (715) 634 -7810, Fax: 15) 6 -5150, M -F 7:45 am - 4:30 pm pshandorf @commer ` wi.us cc: Leroy G Jansky , Wastewater Specialist, (715) 726 -2544 i I ' -02 08V53 AM GTI PARTiGULICH TRUCKING 715 749 3878 P.04 ` ....,. ___�._ � ,� r�'• � yr � � eo Alw J' �Sfry a• � y a 71 � �d•s Rti d 1 7 &*rv,4.n y W-5 di<x J f• 'ti a r'c s,dcnc c �` ti Wdl a $ S ASSwn(�1 L/ev, 3, /Gr0•rb, �e S r CD d e . i�jclS t�rrq d - 35, �� 1/ sc(. yo P. ✓. bur Scrw�ci To Ac whiz. inSa �a�td•+s �cr pek SAX x scw'dYJ°''` � peSal ✓U),.. T uCJ Al {. !3. , j T of eJeode,� � 1(; .8.r� oFsiu 1a1e /,j 4 nWf lip' CO rr , tr4,KC, SE• dr,p -ed Eh w bb. Er /�� : 9 n o' be/,of -,W CFF' /usrrE F, lfc.� .L "-.k4. VsAeC, F•rce,wa ; ". at S. T. uccf/c�. � � proposed nto.�,�da.t /R�/�x 997/ "w / at !1s':r yl..� "� C.s.�Eer'r„o.,,� / ✓aE � ,dar /arc; „� ( sv..ctd� E b� okib i�d O b�.,cc •� w i 4 �Yti � RR MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Gerald E. Larson 4 bedroom residential mound Owner's Name: Greald E. Larson Q 0 1 - S o h Owner's Address: 1429 Co. Hwy. J River Falls, WI 54002 Legal Description: NE1 /4SW1/4, Sec 13, T.28N., R.18W. Township: Kinnickinnic County: St. Croix Subdivision Name: na I.T.S. Lot Number: na Block Number: na T onal y Parcel I.D. Number: 022 - 1036 -30 -000 R Plan Transaction No.: AN[) Bu INGS, Page 1 Index and title Page 2 Data entry SPONDE E Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications / Page 6 Management and contingency plan (� Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Soil Evaluation Report Designer: Henry Nechville License Number: 222781 Date: 05/13/02 Phone Number: 715 -749 -3322 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 3.0 (03/01/01) Page 1 of 9 '11 xUL -12 -02 01 :52 AM GTI PARTiGULICH TRUCKING 715 749 3878 P.02 1 Vilvk� 1VCCAV Mound and Pressure Distribution Component Design Design Worksheet Ct w�0. ,Site It formation ,DO h0 7X/ (r or c) R Residential or Commercial Des No a Sand fill (0) cd trey" d fad a To4u/v�/ 4p Q .00 Estimated Wastewater Flow (gpd) Table t33.44 3 Ir~aa " I u treetrr�ent for ficy ,50 Peaking Factor (e.g. 1.5 = 150 %) c011fam of - 39 lncnes. e00-00 Design Flow (gpd) __'I.00 Site Slope (%) _ 84.30 Contour Line Elevation (ft) __ _AI .00 Depth to Limiting Factor (in) - (,50 In -situ $Oil Application Gate (gpd/ft') N utlon Cell Information 85.76 Dispersal Cell Length Along Contour (it) = 7.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/N _ 1 Influent Wastewater Duality 6 or 2) Are the laterals the hig iin-t ----� in the distribution Pn!sst ro Dieribution Information network? Enter Y or N (c or e) c Center or End Manifold 50 Lateral Spacing (ft) If N above, enter the elevation ft 4 Number of Laterals of the highest point, 0.726 Orifice Diameter (in) (e.g. 0,25) 3.00 gstimate Orifice Spacing (ft) - 10.71 ft /orifice 200 !~orcemain Diameter (in) / 160,00 orcemaln Length (ft) Does the forcemain drain back? 77.00 Pump Tank Elevation (ft) Enter Y or N 6 ,50 System Head (ft) x 1 -3 24.47 Forcemaln Drainback (gal) $, 7 .30 Vertical Lift (ft) 77.29 5x Vold Volume (gal) 159 Friction Loss (tt) 101.76 Minimum Dose Volume (gal) _ 15,59 Total Dynamic Head (ft) 23.07 System Demand (gpm) L at er FI Diameter Selection Manifold Diameter Selection In. die o Ions choice In. dia. options choice 0 .76 1.25 x .00 x 1.50 x x ' .25 x 2.00 1.50 x x 3.00 E i'..00 x 00 x Gallons /inch Calculator (optional) Treatmi nt Tank Information 757.84 Total Tank Capacity (gal) W125017! Se tic Tank Capacity (gal) 47.00 Total Working Liquid Depth (in) Wieser ;oncrete Manufacturer 1&12 gal/in (enter result in cell 849) Do Ti nk Information Efflue Filter I nformation 757.641 Dose Tank Capacity (gal) Izabel I Filter Manufacturer 1e. 12 Dose Tank Volume (gal /in) I Filter Model Number Wle.;er t :oncrete Manufacturer Project: Genild E . Larson 4 bedroom residential mound Page 2 of 9 JUL-12-02 El Et :5 2 AM GT I PARTiGUL I CH TRUCKING 715 749 3878 P.03 9A�hl �Wrh vo4, A 01/ -47 1 el I/V f , 3 Mound Plan View . observation PI . o . . . . . . • X1.:1 .' -• - - I L Mound Component Dimensions Down slop a toe extension made. A— 7.00 ft E 8.84 in H 45. .00 ft K 8.98 tt 8 _ (86.75 F 9.60 in 1 .00 ft L 99.71 ft D , 0 in G 0.50 ft J 22 ft W 19.21 ft [ (g 2 ) Dispersal Cell Are 1200.00 (ft) Basal Area Available (pd/ft) Linear Loading Rate 8.58 (ft) 1110 8 Obs_ Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finish ad Gr ide 86.59 (ft) G H F 013pe�eei Cell 85.30 (ft) Lateral 84.80 (ft)- ♦O invert Dispersat Cell [ Elevation E D f: J dO O �l,� �. /�,�• Y. 4 i..l� �. `5A 17 '1�.� �•�17��1 1 � y �]• 1 ..� 1 �.,�..'vti�� ' � .1 � . ' 84.30 (ft) Contour Elevation 1.0 % Site Slope —�— Geotextile Fabric Cover Top Shading p o 1 Dispersal Cell See lateral details on so l :gp a 1.5 ft ..:....:...:..: : Page 4 for number, ` " Subsoil ,a p • •' •; + size, and spacing of Af11 C 33 Sand " { :� :• %` �' •; F laterals. Laterals are Tilled Li er 0.5 ft °r, Typical Lateral Y y . ; • �+�, equally s patted from Agg egg ie : �� �'f'r' �f`: � �';t°�� the distribution tail's ---- -- A --- centerline in the distribution cell (Ax8). Project: Gtwald E . Larson 4 bedroom residential mound Page 3 of 9 Center Connection Lateral Layout Daigram Force mai n connection via tee or cross to manifold at any point. Laterals are identical �E P S AL •= Turn -up wtball valve or 4<-x Laterals & force main of PVC Sch 40 clesnoutplug per COMM Table 84.30 - 5 Holes drilled on the bottom of the lateral Number of Laterals 4 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 3.12 ft Lateral Length (P) 42.12 ft Orifices per Lateral 14 Lateral Spacing (S) 3.50 ft Orifice Density 10.71 fe /orifice Lateral Flow Rate 57 gpm Manifold Length 3.50 ft System Flow Rate gpm Manifold Diameter 1.50 in Total Dynamic Head Forcemain Velocity 2.36 ft/sec Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and ---► — — in. min. Comm 16.28 WAC Disconnect ------- Tank component is properly vented F-- Aftemate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. Capa cityl 757.64 Gallons Volume 1 16.12 gallinch A ' Weep hole or anti - Dimension Inches Gallons B siphon device A 25.25 407.07 B 2.00 32.24 C Pump off elevation (ft) _ C 7.75 124.89 1 78.00 D 12.00 193.44 D Total 1 47.001 757.64 Dose tank elevation (ft) 3" Bedding un er tank. 77.00 Alarm Manuafacturer LevelArm Alarm Model Number Pump Manufacturer Zoeller � ~ Pump Model Number 198 Pump Must Deliver 23.07 gpm at 15.59 ft TDH Project: Gerald E. Larson 4 bedroom residential mound Page 4 of 9 r - Mound System Maintenance and Operation Specifications Service Provider's Name H Nechville,MPRS #222781 �i Phone 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 1250/75 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 monthl Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table 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 Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Gerald E. Larson 4 bedroom residential mound Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.64, 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 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 fiker when removed from As 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 pefsonnel 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. A I switches, alarms, and pumps shall be tested to verify proper operation. If an effluent fitter 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 BOD 150 mg/L TSS, and 30 mg/L 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 flaw may not exceed maximum design flow specked in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan if the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if tee 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: Gerald E. Larson 4 bedroom residential mound Page 6 of 9 HEAD CAPACITY CURVE EFFLUENT MODELS NOWN ■■■■■■■ con Eon IBM EN MOM ■ \ \► \1 \ mom ■■ . ■� ► ■ ►IV ►■■ ■■ m UN . ■ ■■ \111 \� ■ \� \ ■ ■ ■ ■■ ■ ■A■ ■III ■ \� ■ ■■ ■ ■ ■ ■■ .. .. - . . Rollo ■ ' 1 1 ■ ■ ■ ■ ■ ■ \� ■ ■■ .. Z� MW No MEN RING moll W * \ 0 ■ ■ \i \■ ■■1l a ■ Odom ■ ■ ■ ■ ■ ■■ Mr. r.70 MOM ■�■ ■ ■ ■■ ■u se ®see lees ■■OMEN \'` man \► NEWEENNEEN 1111111pill 111.11 JUL El Et :5 3 AM GT I PART -GUL I CH TRUCKING 715 749 3878 P.04 or '. c�. Al r , Z y a a o 6 sc rldsbcr� p c+Clvc 9 � WU�t.7 fCc.�CC "'jF' k� i ►'t F'c.n ey 'c d� a residcncc � �X l J �. � r S �': , n A S.Skh'F��/ G��Y a /Q�•lb, co 4e 6 d r WO/ To is �ekSAZ,/ i�Sa /a�cdVS p�rCea(e. / ► T t / 1 / / / A!�• 8•rr, -� ofSi,r last Cornt�r�entc/cbs�• �r,p rdp�. Eh w = �.8.3',� lei`• = 9o.03,' I I �ropesed �,25Z7 /r3a9K/ bcl �f- IN COSH —od F,'ltcr z �r� lip p ✓,C. Frrcc,na:,�. It it 5. T. Gitct lt�. 8 j•s° Ar'cpQStd ntoK,,da.� /y.,y qy. /'wi at /Yz';r yZ.•�'� C.s.�Eer'r►,a.,,'�S. /✓aE � . ,��* /aEc,•.EC 3,v »�cd�E 8�. �"�� d O�� b� 4-c.4 1 .VY rYti � y0'= �. Sails, iy�+, /. �J.� �°" 'r 8( ` . f1Or 1540 Wisconsin Department of Commerce SOIL EVALUATION REPORT RECEIVED Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Sal & Site Evaluations Cou Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must St. Croon include, but not limited to: vertical and horizontal reference point (BM), direction and Parc�TtSROIX COUNTY percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. ZO N I N G 636 - 00 Please print all information. Reviewed Da Personal Wormabon you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). V s2 Property Owner Property Location !� Gerald E. Larson Govt. Lot NE 1/4 SW 1/4 S 13 T 28 N R 18 W Property Owner's Mailing Address Lot # ame or CSM# 1429 Co. Hwy. J na �#Subd. N a City State Zip Code Phone Number City A Village g Town Nearest Road River Falls WI 1 54022 1 715 -425 -5238 Kinnickinnic I Co. Hwy. "J" A New Construction Use: jo Residential / Number of bedrooms 4 Code derived design flaw rate 600 GPD 16 Replacement �j Public or commercial - Describe: Parent material Glacial drift over weathered sandstone bedrock _ _ Flood plain elevation, if applicable na General comments and recommendations: Install mound system at elev. 84.80' at 6" above 84.30' contour. Boring # j Boring !d Pit Ground Surface elev. 8 ft. Depth to limiting factor 31" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft= *Eff#1 *Eff#2 1 0 -5 10yr3/2 n one sl 2fsbk mvfr cs 2f 0.5 0.9 2 5 -17 10yr4/4 none I� 1rrisbk mvfr cw 1f 0.7 1.2 3 1T -31 10yr4/6 none sl 2msbk mvfr cw - 0.5 0.9 4 3140 7.5yr4/6 f2f 7.5yr5 /8 Is 1 msbk mvfr gw - 0.7 1.2 5 40-46 10yr6/4 f2f 7.5yr5/8 Ifs 1 msbk mvfr - - 0.7 1.2 Boring # Boning Ie Pit Ground Surface elev. 84.28 ft. Depth to limiting factor 42" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW *Eff#1 *Eff#2 1 0 -7- 10yr3/2 n sl 2fsbk mvfr cs 2f 0.5 0.9 2 7 -14� 10yr4/3 none sl 2msbk mvfr gw 1f 0.5 0.9 3 14 -29 10yr4/4 none sl 2msbk mfr cw - 0.5 0.9 4 29-4 7.5yr4/6 none Is 1 msbk mvfr gw - 0.7 1.2 5 42 -50 7.5yr4/6 f2f 7.5yr5/8 Is 1 msbk mvfr - - 0.7 1.2 #2 hasa high sand content. * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS > < 150 mg/L #2 = BOD < 30 mg/L and TSS <_X mg/L CST Name (Please Print) Sign re: CST Number James K. Thompson ti e—/Cr— at:EZ � 3602 Addre ss A.C.E. Sal & Site Evaluations ation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 5/2/02 715- 248 -7767 Property Owner Gerald E. Larson Parcel ID # 022 - - 000 Page 2 of 3 3] Boring # Boring Pit Ground Surface elev. 84.01 ft. Depth to limiting factor 45" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 2 *Eff#1 *Eff#2 1 0 -8 1Oyr3 /2 none sl 2fsbk mvfr cw 2f 0.5 0.9 2 8 -20 1 Oyr4 /4 none Is 1 msbk mvfr cw 1 f 0.7 1.2 3 2045 7.5yr4/6 none sl 2msbk mvfr as - 0.5 0.9 4 45 -50 1 Oyr5 /6 f2f 7.5yr5/8 s 0 sg ml cw - 0.7 1.2 5 50-61 1 Oy r614 f2f 7. 5yr5/8 s 0 sg ml aw - 0.7 1.2 6 61 -70 1Oyr6/4 m2p 7.5yr5/8 fs Om mfi - - 0.4 0.6 Horizon #6 consists of weakly cemented sand stone that is grading to bedrock at bottom of horizon. F4 ] Boring # Boring jo Pit Ground Surface elev. 88.90 ft. Depth to limiting factor 51" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots T *Eff#1 *Eff#2 1 0 -3 1Oyr312 none sl 2 3 -16 1Oyr4 /4 none Is 3 16 -51 7.5yr4/6 none s 4 51 -70 1Oyr5/6 f2f 7.5 yr5/8 s �� S O 5 70 -86 1 Oyr6 /4 f2f 7.5yr5/8 s 2 S Horizon #6 consists of weakly cemented sand stone that is grading to bedrock at bottom of horizon. F—I Boring # Lj Bering Lj 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& *Eff#1 *Eff#2 * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 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 altemate format, please contact the department at 608 - 266 -3151 or TTY 608- 264 -8777. r i r Co. c� •� y b bac.��pt . iy A E /cvtit�,b» z9 - / Fcr,ee — — wtre Ce-n 50, ohow&" - -7 y Q' GP d der, D� r'esidance. 0 Beric.h ►►1a,^1�C: 130 0 . WeA i n.-1 eu 6 1 c, w,•i Llev.- = /co.4v J w j ✓ht� --- la4 u, d- 'dam •�• �°l. 2 �j(is �' (/ d � we!/ �� .ZV 5 /ope Es}'!v►�+&: c ISOOjaIt ho OVMerev. X2.58 �4b��o EYi J 4q Po /csk gZ.W� -� Oi r dam- 1 6. 8. o of S; �/ /off Co/^n er fence / oosf draped .Elea = 8e�.es' �6Wr4kce Flew = y0.et3.' aF e<'Clucn�. 8 4 3 I��S loPt ST CROIX COUNTY r SEPTIC TANK MAINTENANCE AGREEMENT r AND OWNERSHIP CERTIFICATION FORM Own - Mailing Address -� �.L,2 Property Address 2 G " Yuutt W 3 0'-1*11 (Verification required fmm Planning Department for new construction) City/State Rttt e u-L Parcel Identification Number o LEGAL DESCRIPTION Property Location NE Y4, �5--U7 r /4, Sec. f 3 , T ;;? :? N -R ZL_W, Town of /t Lot # e,��y► :vn•� -e, Subdivision d Lot # : Certified Survey Map # , Volume . .Page # Warranty Deed # ✓ C 7 0 ` , Volume / �' s , Page # a Spec house ❑ yes 9n0 Lot lines identifiable Eryes ❑ 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 maste,rplumber, journeyman plumber, restricted plumber or a li cense d 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 of the threc year expirano date. l � ova ATURE APPLI 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 roperty described above, virtue of a warranty deed recorded in Register of Deeds Office. I ATURE OF PLI 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 JAN -06 -2003 11:00 AM A.C.E. Soil & Site Eval. 715 248 7764 P.02 SOIL AND SITE EVALUATION F PW _ Of 3 __ PRQPER'n Qer!�d.� 4 n . PARCEL 1.119 0?2.1Q Q:K0 .... ... _ A.C.B Soil s< Sim Evtlwtiwo REPORT MEMO Exisdng drywell constructed and placed In service In 1966 per owner. Drywall appears to be of block construction, estimated capacity of 1,500 gallons. Grade at drywell vent = 89.25 Elevation at Inside bottom of drywall a 82.58'. Grade elevation at surface discharge as shown on site plan = 82.85'. JAN -06 -2003 11:00 AM R.C.E. Soil & SiLe Eual. 715 248 7764 P.01 of. C H. ,boa # 9 95W Est�llica�'o� "oAVWWh«.tr.W.'•. WAX "a" ffI¢)249&0 To- 715- 386 -4686 From: Jim Thompson Date: 1 n.6 20 3 # pages including cover sheet. if fax is incomplete or illegible, plealie contact Jim Thompson at telephone number listed above. Pam: Attached is the promised memo sheet for the Gerald Larson soil evaluation indicating the elevations that are needed for Wisconsin fund purposes. Jf you have any questions give me a call. Sorty for a oversight, i I DOCUMENT NZ). QUIT CLAIM DLBD ' �, V i � Robert L. Phillippa and Dorothy E. Phillipps, quit -o Gerald E. Larson and Dorothy Larson, husband and wife, as survivorship marital property, the following described real estate in St. Croix county, State of Wisconsin: JAN 'J :; i ;+ J8 0:55 A. That certain parcel of land located in the NVA of the SW'/4 of sec•i i 13, Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin, more fully described as follows: Commencing at the :d Weat quarter corner of said Section 13; thence East (:ec�rded beari on the North line of the SWIA of said Section 13), 1328.51' to the Northwest corner of said NEW of the SWIA and the Point of Beginning of the parcel to be herein described; thence, continuing along said corth line, East, 367.59'; thence S 00'36'04' W 458.66'; thence N89'23'56' W 356.87' to a point on the West line of said NEIA of ti-9 SWIA; thence, alorg said West line, N 00 W 454.93' to the Point of Beginning, containing 3.798 acres, being subject to an easemer.' for C.T.H. 'J' over northerly portions of this parcel and any other easements of record. I NAMF. AND RETURN ADDRESS RodlL, Beskar, Boles Krueger, S.C. TRANSFER 219 North Main PO BOX 139 SO River Falls WI 54022 FE This is not homestead proporty. ( I Parcel Identification Number (PIN) Dated this 2-.It (i day of pQG��h Dl✓ 1997. (SEAL) (SEAL) � Robert L. Phillippa SeI�CE'.C�lt /J (SEAL) (SEAL) Dorothy E. lllpps - ADTHIMICATION ACX3$OWLLDO1m1- Signatures) 1 6,*4 `. (11 aggt STATE OF WISCONSIN ) i ) as. fro lti E. Philp Beni COUNTY . ) Jr authenticated this Z+_Aday of , 19 Personally came before me this day of 19 the above named Robert L. Phillipps and Dorothy E. Phillippa to as known to be the person(s) who executed the a foregoing instrument and acknowledge the same. TITLE? YMOLI'R STATE BAR OF WISCONSIN (If not, authorized by §706.06, win. State.) a TMIS INSTRMCM Mks D>UMM By: Notary Public County, Wis. Stuart J. Krueger My ccaaaissinn is permanent. (If not, expiration date: Rodli, Beskar, Bole* i Krueger, S.C. ) P.O. Box 138 - River Falls, WI 54022