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HomeMy WebLinkAbout022-1087-20-000 0 l O n N O 3 m c d �• A 3 3 A� w z z m z o w cn A x u, z o cn z+ o N) , C ? oa O O C1 c � a. N N C A 0' j N N ►�! CD Z a °. <, J Q rt 7 N i O�Z, n .7 O N N CD 7 j CS - G N O -' m s a u m m m' _ d m r ''' ° °' O ° N �' 9' p, rn N °o ro > > 6 ° co cc ° d W o °' 3 `° a a o ;L > > ° ° D ° T 7 N go 7 N O O f/1 M C/) . C .y. '� G z D o V D a 0 ° I m D �� In ,� I m aR ? w o. s ro W ro W m C 5 a (� w� N V CD 2 cD z - � 74 L .. \ E L ° N N n O C W CD OD co I c CD O O O O O O I �c N N to ° ° 3 ° CD Lrl ° m � w N N O D1 N N C — T N I � I ID � N D D o D D o O ° t N • N A N nl�,_ill (D CD O tm N d N p 3 7 m �p 7 c A Z A in c n n CL N A 0 ca m N o a ` o m z ° ° z ao N z H CD CD a O A p� m o I a m wvm o T N x� v w C CD D CL N o a o a m a c° y wom a ° 3 0 a CD ° clo) U1 n '* Z CD CI O 3 y (Q 7 N 0 O N v O O C ( p w 0 69 0 4fl.. o : E ° o y ° o C ° o CL i onsi,q Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Sat-ty r and Building Division INSPECTION REPORT Sanitary Permit No: 514902 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)]. Permit Holder's Name: City Village X Township Parcel Tax No: Hebert, Linda Trust & Charles Luick Trust Kinnickinnic, Town of 022 - 1087 -20 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 30.28.18.469A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS Wi I FS ELEV. 2 4.43 Septic Benchmark Dosing OV�O b g� A� B ' 77 ' Po I Bldg. Sewer /6 J . r Holding St/Ht Inlet L U 1,x O2, f3 l� / TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom lv�v /13 /`/ /4 / �' Z•b`� q'6 .7 Dosing T / Header /Man. � �.5 Aeration Dist. Pipe � fiff 95 Holding Bot. System � 7. k. 93.7 PUMP /SIPHON INFORMATION Final Grade A- 5.g°i 9s•s � � Manufacturer 5 Dem and / St Co GPM Model Number 3 ✓ • d� �r y� S 93 TDH LijJ, I Friction L, ss System Head TDH Q �• cJ , �Z' U Forcemain Length / Dia. Z ►/ Dist. to Well 3 t SOIL ABSORPTION SYSTEM BED /TRENCH Width Length / No. Of Trenchips PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS �Q 6 ____ SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type g� f ystem: / UNIT Model Number: ill cam (,I" mA- DISTRIBUTION SYSTEM A ` Header /Manifold , 911 Distribution 1 A x Hole Size c / x Hole Spacing q Ve o Air Intake Length ( 6 4 0 Dia / S Length :+ �'� Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only G Depth Over Depth Over xx Depth of xx Seeded /Sodded pub xx ulch d Bed /Trench Center ` Bed/Trench Edges Topsoil ' (��__ +r'r s,� s No es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / 6 �tCJ Inspection #2: Location: 194 Hwy 65 River Falls Is, Wl 540 2 (NE 114 NW 114 30 T28N R18W) metes & bounds Lot dlka3Q Parcel No: 30.28.18.469A 1.) Alt BM Description = cZ A 2.) Bldg sewer length = `tb'1 - amount of cover = '`vJ // AJZ Plan revision Required? Yes � q � ❑ No Jse other side for additional information. Date Insep is Sign re Cert. No. 3D -6710 (R.3/97) � y 9 commarceml.gov Safety and Buildings Division County n « 201 W. Washington Ave., P.O. Box 7162 C 2 ©� Gt3 [ Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) Department of Comm tie 51 1 4 90 Z, Sanitary Permit Application ` cacti ° Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate overnmental 2 6 S unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned are rglect Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary p urposes in accordance with the Privacy Law, s. 15.04 I m , Slats. L Application Information - Please Print All Information Property Owner's Name Parc I # I AJ Q A B�� 4 `Z Z— 0 9'7 —_Z0 — 00 6 Property Owner's Mailing Address lu LUUU Prop y Location w .S C Govt. of Ci Xkv tate Zip Code Phon NumbfrT. y , /t `�C Z Z ZONING OFFIC circle O Il. Type of Building (check call that \ Lot# T� N; R Eo� X -t-or 2 Family Dwelling- Number of Bedrooms _.__ 4.a ... _._.. __ .._ ... Subd_iY�siQnNatne._______.. Block # ❑ Public/Commercial - Describe Use ❑ City of ❑State Owned - Describe Use CSM Number ❑ Village of Town of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. 4em �. Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS S stem /Com onent/Device: Check all that appl ❑ Non - Pressurized In -Ground ❑ Pressurized In- Ground ❑ At -Grade JIvlound > 24 in. ofsuitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) Pretreatment Device (explain) A t V. Dis ersa[/I'reatment Area Information: ti Design Flow Design Soil Application Rate so Dispersa)Area Required (sf) Dispe% Area Proposed (st) System Elevation V ( 0 J� VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units F o New Tanks Existing Tanks Septic or Holding Tank �w s C�! , 1<1 Dosing Chamber _i � t T VII. Responsibility Statement- I, the undersigned, assume responsibility for installation ofthe POWTS shown on the attached plans. Plumber' Name (Print) Plumber' Signature MP /A401lSNumber Business Phone Number Z24 r ��S- 27? e s Plum dress (Street, City, State, Zip Code) VIII. County /De artment Use Onl pproved Disappro Permit Fee Date Is rued Issuing nt Signatur iven Re ason rBenial $ } , O° t��t 9 fa8 IX. Conditi"314"MO.easons for Disapproval 3) t�o > � o rte} r n• �e1r�t, c. - r2_,, t. Septic tank, call mush all b and t � dispersal cell must all be services'/ maintained as per management plan provided by plum ber. 2. All setback requirements must be maintained 111111 PK Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD -6398 (R. 01/07) Valid thru 01/09 l 09f` 4. ^ib -,n ✓:i f I t ` Plot Plaft -page 6 Of 8 Property Owner Lwam Z • h E m`fI 1 " =4Dft Legal Description miE`14 oy- - Tye N W& --ss, - sn , . (except where note t =Backhoepit 19. Lz Ac RM- NoH* �RDpaS _ OLD GL S[E,R 1 J' ro t�ocr T o wl f+SJwDONED FE N O CST�KEb� �apa�4 La Ido ^io °✓ Q �3 Ur a A " 3 - 2 " gc. 43.3 Z 9 � Site Locatio : 0W�> ECOPY Plot Plan Page 6 of 8 Property Owner bmtm Z- 'hss' 1 » = 40, ft Leg Description _ Nti`ty o� -�y� N W`�. (exc where noted) ��83J l W e ova �1 t> t »J 1 C-K 114 M t C- ST c R�tyC 'n = Backhoe pit {q. Zz -AcRv-� North a A V EWAAV zZ Cs�s�K.e�� a •a to ��• r �Oti���ti� t}� j°4o°Q�e� Q 2 t oo C � �af"thallC 6 Z I, FORC LC,k � �L R3.3Z � P / Site Locado : \ ELq x a� �3 �' Safety and Buildings 4 N CREEKSIDE LA 382 commerce.wi.gov HOLMEN WI 54636 ■ TDD #: (608) 264 -8777 i s c o n s n www.commerce.wi.gov /sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Jack L. Fischer, A.I.A., Secretary June 10, 2008 CUST ID No. 224832 ATTN.• POWTS Inspector MARY JO HOLLISTER ZONING OFFICE HOLLISTERS SOIL TESTING ST CROIX COUNTY SPIA W9875 690TH AVE 1101 CARMICHAEL RD RIVER FALLS WI 54022 -4011 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/10/2010 Identification Numbers Transaction ID No. 1542568 SITE: Site ID No. 738207 Linda J Heybert Please refer to both identification numbers, 194 Hwy 65 above, in all correspondence with the a enc . Town of Kinnickinnic St Croix County NEIA, NW1 /4, S30, T28N, RI 8W FOR: Description: Four Bedroom Mound System / Replacement construction / 6% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1184944 Maintenance required; 600 GPD Flow rate; 39 in Soil minimum depth to limiting factor from original Bade; System(s): Mound Component Manual- Version 2.0, SBD- 10691 -P (N.01 101), Pressure Distribution Component Manual- Version 2.0, SBD - 10706 -P (N.01 101) The submittal described above has been reviewed for conformance with applicable Wisconsin Administative 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. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of See. 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 ofSec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally down slope of the dispersal cell shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • The existing POWTS shall be properly abandoned per Comm 83.33, Wis. Adm. Code. • Maintenance information must be given to the owner of the tank explaining that periodic cleating of the effluent filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • A cony 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 t? OAV.T.S Conditionwh:, PPDn11Crk t MARY JO HOLLISTER Page 2 6/10/2008 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.Comm 83.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptabb to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changesor 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 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART;code,: 7633 jeny.swim@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. RECE MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TRLE PAGE Project Name: LINDA J. HEBERT Owner's Name: same Owner's Address: 194 Hv�v r. 65 River Falls, WI 54022 Legal Description: NE 1/4 of the NW 114, S 30, T28N, R18W Township: Kinnic klonic County St Croix Subdivision Name: NA Lot Number. NA Block Number. NA Parcel I.D. Number. 022- 1087 -20-000 Plan Transaction No.: r 4rrr1a "refere Page 1 Index and title G Q ... .. . .. .. . N S tr%.... Page 2 Data entry ��• �� : •••. •� Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specwmations y NO0 1.� -5' Page 6 Management and contingency plan V � R FP Page 7 Pump curve and specifications '•, R� Page 8 Plot Plan ►.® #40 DEP � �y MMERCE DEg�Gc ARTMENT OF �������r� ►r�� DtV15►oN of AfETY AND BUILDiN�S EE GGRR PONDENGE Designer. Mary Jo Hollister License Number. 1859 Date: . 06/22/08 L Phone Number (715) 426-1775 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SM10691 -P (N. 01/01), and both SSWMP Publication 9.6 Design of Pressure Distribution Nets vft for ST -SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706 -P (N. 01101) Version 5.1 (R. 06/06) 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 - 36 inches. 600.00 Design Flow (gpd) 6.00 Site Slope ( %) 93.00 Contour Line Elevation (ft) 39.00 Depth to Limiting Factor (in) 0.60 In -situ Soil Application Rate (gpd/fl?) Distribution Cell Information 1 60.00 Dispersal Cell Length Along Contour (ft) = 10.00 Cell Width (ft) 1.00 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 3.33 Lateral Spacing (ft) If N above, enter the elevation ft 3 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) 2.08 Estimated Orifice Spacing (ft) = 6.90 fe /orifice t� 2 Forcemain Diameter (in) _J 6. orcemain Length (ft) Does the forcemain drain back? Y 7.00 Pump Tank Elevation (ft) Enter Y or N b� � 6.50 System Head (ft) x 1.3 12.40 Forcemain Drainback (gal) ,� 6.33 Vertical Lift (ft) 80.54 5x Void Volume (gal) �^ 2.05 Friction Loss (ft) 92.94 Minimum Dose Volume (gal) - (ft) ^'� 35.84 System Demand (gpm) 15.38 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 1.00 1.50 x x 1.25 x 2.00 x 1.50 x x 3.00 2.00 x 3.00 x Gallonslinch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1200.001 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Wieser Manufacturer gal /in (enter result in cell B49) Dose Tank Information Effluent Filter Information 800.00 Dose Tank Capacity (gal) I Pol lok Filter Manufacturer 22.24 Dose Tank Volume (gal/in) 525 Filter Model Number Wieser I Manufacturer Project: LINDA J. HEBERT Page 2 of 8 x .. Mound Plan and Cross Section Views T 1/10 B � J ... ... Observation L Pipe :: : — l T W — l: .:::::...... .: :::::::::::::::::::::::::::: :::::: :::::: :: :: :::�::::::::::: ::...' ......................... ............................... z :.� ... . - -' -' 4— L Mound Component Dimensions A 10.00 ft E 13.20 in H 1.00 ft K Qlft ft B 60.00 ft F 9.50 in z 8.75 ft L ft D 6.00 in G 0.50 ft J 4.56 ft W 600.00( ) Dispersal Cell Area 1125.00 (fe) Basal Area Available 10.00 (gpd/ft) Linear Loading Rate 1 6.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 95.29 (ft) --► ,,,, H 2 ,,,,,,,,,, .. G F Dispersal Cell 94.00 (ft) Lateral 93.50 (ft) —► -- Invert Dispersal rsal Cell •�a•`��'�� �'�`�`�`:���:::•. Elevation ::: E I 4 .:. { nn i ;l i ' 4 1111, 93.00 (ft) Contour Elevation 6.0 %Site Slope Geotextile Fabric Cover Shading Key $.— Dispersal Cell See lateral details on 1[, _ Topsoil Cap c 1.5 ft Page :.:..:..:..:::. ::::.;•.:;::::..:;.:.::: Page 4 for number, size, Subsoil Cap c 5 and spacing of laterals. ASTM C33 Sand .— F Laterals are equally Tilled Layer 0.5 ft Typical Lateral spaced from the [0 EM Aggregate distribution cell's : }: :; } : ce nterline in the distribution cell (AxB). Project: LINDA J. HEBERT Page 3 of 8 End Connection Lateral Layout Diagram Center the laterals over the A & 8 dimension •- Turn -uP w /boll vehro or oloonout plug FForate. m larals are hdentfoal I*. �( — >I Holes drilled on the bottom of the lateral equally spaced Laterals & force main of PVC Sch 40 (per COMM Table 84.30 -5) ain connection via tee or cross to manifold at any point. Number of Laterals 3 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.09 ft Lateral Length (P) 58.52 ft Orifices per Lateral 29 Lateral Spacing (S) 3.33 ft Orifice Density 6.90 ft /orifice Lateral Flow Rate 11.95 gpm Manifold Length 6.67 ft System Flow Rate 35.84 gpm Manifold Diameter 1.50 in Total Dynamic Head 15.38 ft Forcemain Velocity 3.66 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and --10 Comm 16.28 WAC Disconnect 4 in. min. r Tank component is property vented F---- Alternate outlet location _ Forcemain diameter Wieser Manufacturer 2 in. Capacityl 80030 Gallons T Volume 22.24 gal/inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 21.79 484.66 B 2.00 44.48 C Pump off elevation (ft) C 4.18 92.94 87.67 D 8.00 177.92 D Total 1 35.971 800.00 Dose tank elevation (ft) 3" Bedding under tank. 87.00 Alarm Manuafacturer I Tank Alert Alarm Model Number I HW101 Pump Manufacturer JGould Pump Model Number I PE41 Pump Must Deliver 1 35.84 gpm at 15.38 ft TDH Project: LINDA J. HEBERT Page 4 of 8 Mound Svstem Maintenance and Operation Specifications Service Provider's Name Darrell's Septic Service Phone 1 (715 ) 425 -1025 POWTS Regulator's Name St. Croix County Zonin Phone (715 386 -4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1200 gal Maximum TSS 150 mg /L Soil Absorption Component Size 600 ft' Maximum FOG 30 mg /L Type of Wastewater 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 Laterals should be flushed and pressure tested every 1.5 years Mound 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 .. . . • • ..• ..... • . 000000000000000 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: LINDA J. HEBERT Page 5 of 8 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code 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), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD 10706 -P (N. 01/01)] 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 84nches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats, The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the fitter shall be serviced if the alarm is activated continuously. Intermittent fitter 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 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 flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Pond'+ng levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically dogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: LAW0A �5. NE6�RT Page 6 of 8 r - L(qj GdULDS PUMPS Submersible Effluent Pump PE _ l Cw0sion r io� WO -6o iii . Cad kon body. ma ftm, ualehtinu w when • 115 and 230 volts ■ Thernoplask impeler and 6* wWmjetL • Burn dtehow wMi ad pro- aver. • so6s : 'A' faction rich M40ok n'sa ■tipper deeye and lower maximum, sphere. ' Class B hadi Lion. heavy duly bA bea" • Adwatic moM u+dttde a amaudkm APPMTKOS float 9A& ' X sfto carbon steel ■ Moto' is pernwier ly Sped* designed for due Manua) models avaBable. It --- for +Ended Wwwim uses. g see PE31 Motet: seMce kle• perknwnce chart or Cm. • .33 14P, 3000 RPM is Pbwned forantirvota • • Low he�Pipe Systems ' Miad t i an capadty: 53 GPM • Shaded Pole design • AN radrigs are vrlthin the • Basement Draining • Max n m head; 25' Tai PE41 Motor: worW lid of the won • "m D+eY Sump/ FE41 Pump: • .40 HP, 3400 RPM N Qukkdhwrwwpmw Dowat � p• d length, ering • maharm Cap* GPM ' 115 and 230 irons �Y duly 16 3 d f W t h, Mahcimtxrh heed: 29' 1'DH • � 115 or 230 vole graundehq PE51 Pwrhpr PEST Moffat: ' Wdo m capacity: 70 GPM • 50 HP, 3400 RPM M unk is hsq dft • Maronaun heat 37' TDH • 115 and 230 voles port and ownpaa METERS FEET • P5C deign ■ Mcdww sw iS 40 , , t'Jo ur. BUNA and AwAess — :L_ -- r • • :.` •'t'.T. _ . ' 'h" AACO[it PE3t. vts41. PESt� �. a 5 !' W. J. ao: so � r 5t ss steel faaleners 10 2 1 - L7rNt AGBIICT LISTOM 1 tT lot C 4 20 14 ` t t!'�tid tdD U< Tit ilMi ° _ GA 22.2108 9iatrdw& a -tt >q . y. �►u; llssortatieo T. ~ '�'- -1 -:�_- �;- - �-� -� -- •- -r-r.. � 1 : 1 ���l50909l111�Rgird, fl 1A 7A , ]A AA CA ��. •Aw • '"'SE�'� a• L�N'vl �. • '�'✓�" Wisconsin Department of Commerce � �L EVALUATION REPORT page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Count ST. CROIX Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal pa reet4e Parcel I.D. 0 2 - 1087 - 20 - 000 percent slope, scale or dimensions, north arrow, a loca"R V6[�arest ad. Please print all info anon. Re ' b Date Personal information you provide may be used for secon ry pu &).04 (1) )). Property Owner Pr L on LINDA J. HEBERT TRUST ST, CROIX CO 4Y&Y Lot NE 1/4 NW 1/4 S 30 T 28 N R 18 E( W Property Owner's Mailing Address t 6H # Subd. N1 or fSW 194 Hwy. 65 — — • &��0 l ,�- c f"'y► y /179 City State Zip Code Phone Number [3vllage ElTown Nearest Road River Falls, WI 1 54022 1 ( ) NK Hwy. 65 New Construction UseEj Residential / Number of bedrooms 4 Code derived design flow rate 6 00 GPD E] Replacement Public or commensal - Describe: Parent material sandstone Flood Plain elevation if applicable General comments Mound System -- 0.50 ft. sand fill — 0.6 loading rate and recommendations: Boring # 0 Boring Q Pit Ground surface elev. 91.82 ft. Depth to limiting factor 59 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-5 10YR2 /2 - sl 2fgr ds cb 3vf-m 0.6 1.0 2 5 -14 10YR2/2 — sl 2f-msbk ds cb 2vf-m 0.6 1.0 3 14 -36 10YR2 /2 -- 1 2f-msbk mfr cs 2vf-f 0.6 0.8 4 36 -48 10YR3 /6 — sil If- -msbk mfr cs 2vf-f 0.4c 0.6 5 48 -59 10YR4/4 — sicl lmsbk mfi as lvf-f 0.2 0.3 6 59 -63 10YR4/4 eld 1o /6& IOYR6/2 cl Om mfi __ __ 0,0 0.0 ❑ 2 Boring # Borin 93.32 39 El Pit Ground surface elev. ft. Depth to limiting factor in. Soil Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 '002 1 0-4 10YR2/2 — sl 3fgr ds cs 3vf-m 0.6 1.0 2 4 -12 10YR2 /2 -- sl 2f -msbk ds cs 2vf-m 0.6 1.0 3 12 -31 10yR3/2 — I& If- -msbk mvfr cs 2vf-f 0.5 1.0 4 31 -39 10yR4/3 — Ifs lfsbk mvfr ab lvf-f 0.5 1.0 5 39-44 10YR8 /1 cId IOYR4 /4 vfs Om mvfr — _ 0.5 1.0 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 150 mgA. ' Effluent 02 = BOD < 30 mg/- and TSS < 30 mg/L CST Name (Please Print) � �L CST Number M Jo Hollister ollister's Soil Testing & Desi Cl 224832 Address Date Evaluation Conducted Telephone Number 530 C.T.H. M, #17, River Falls, WI 54022 05-21-08 (715) 426 - 1775 Pro perty Owner HEBERT, Linda J. Parcel ID # 022 -1087- 20-000 Page 2 of 3 - Li F 3 Boring # Boring 97.12 39 Pit Ground surface elev. ft. Depth to limiting factor in. Soft Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 1 '01102 1 0 -5 10YR2 /2 -- sl 3fabk ds cb 3vf-m 0.6 1.0 2 5 -14 10YR2/2 — sl 2f -msbk ds cs 2vf-m 0.6 1.0 3 14 -32 10YR2/2 — I lm -csbk mfr cs lvf-m 0.4 0.6 4 32 -39 10yR3 /2 sil Ifabk mfr cs lvf-f 0.4c 0.6 5 39-44 10YR4 /4 c l d l 0YR4 /6 sicl 1 fsbk mfi — -- 0.2 0.3 4� F Boring # Boring 97.87 Pit Ground surface elev. ft. Depth to limiting factor 49 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Shicture Consistence Boundary Roots GPDW in. Murrell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'E11111 1 0_5 10YR2/2 -- sl 3f -mgr ds cb 3vf-m 0.6 1.0 2 1 5 -13 sl 2f -msbk I ds cs 2vf-f 0.6 1.0 3 13-42 10YR2/2 -- I If- -msbk mfr cs lvf-f 0.4 0.6 4 42-49 7.5YR3/3 -- sil lfsbk mfr cs lvf-f 0.4 0.6 5 49 -54 10YR4 /4 c 1 d 10YR4/6 cl 0m mfi -- — 0.0 0.0 F-1 Boring # ra 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 GPDff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. " Eff#1 *Eff#2 ' Effluent #1 = BOD > 30 220 mg1L and TSS >30 < 150 mgA. * Effluent #2 = BOD < 30 mg/- and TSS < 30 mg1L 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. sB13-833ffea (x 07100) Plot Plan .f or Site and Soil Evaluation 1' � 3 of 3 Property Owner LiNrm Z, 1 " =4D Legal Description mii* of - TAT-- N (wept where noted) in = Bacoe p it it 1 4. Lz ,Aces o �rt o►�s�►J • North Loco. aRtyEv T tptJ A L3MtQON� VEt6. �n1E uum Co b Cs-r�KEn� ' Q� o 2 a$ 87 ,y EL gl.gZ Site Locado, : \ ca"� Parcel #: 022 - 1087 -20 -000 06/12/2008 03:06 PM PAGE 1 OF 1 Alt. Parcel #: 30.28.18.469A 022 - TOWN OF KINNICKINNIC Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - HEBERT, LINDA J TR LINDA J TR HEBERT C - LUICK, CHARLES G & JUDITH A TR CHARLES G & JUDITH A TR LUICK 194 HWY 65 RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 194 HWY 65 SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 19.220 Plat: N/A -NOT AVAILABLE SEC 30 T28N R18W NE1 /4 OF NW 1/4 EXC Block/Condo Bldg: P469B,C,D,E,F, & PT SELY OF HWY 65 EXC CSM VOL 4 PAGE 1173 (.78A) ASSM - T INC Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 022 - 1086 -20 30- 28N -18W Notes: Parcel History: Date Doc # Vol /Page Type 11/21/2007 864522 QC 07/23/1997 1115/139 TD 07/23/1997 790/510 07/23/1997 701/376 more... 2008 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 08/08/2007 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 9.500 1,200 0 1,200 NO AGRICULTURAL FOREST G5M 8.750 26,000 0 26,000 NO OTHER G7 2.000 20,000 121,600 141,600 NO Totals for 2008: General Property 20.250 47,200 121,600 168,800 Woodland 0.000 0 0 Totals for 2007: General Property 20.250 47,200 121,600 168,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 550 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 06/16/2006 14:26 FAX 715 273 0444 NELSON- PLUMBING 002/003 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGUEMENT AND J OWNERSHIP CERTIFICATION FORM OwnerfBuyer ',! ( h d0. 1, Utthtrl 1 Pa t - Mailing Address l q7 U q 6 S 6C' I tx- F I/S W/s C 5yaa). Property Address _ f qT H,4 t� J� R "S &JISC (Verification required from Planning Department for new construction) City /Stage Riucr & U s Parcel Identification Number IOU U 0 00 LEGAL DESCRI Property Locaticrr N '/a, ' /., Sec. , T p N - R W, Town of I )f)JI/C �C'�� Subdivision , Lot # Certified Survey Map # , 'Volume , Page # Warranty Deed # -_- Volu= _ - Page # Spec house O yes X no Lot lines identifiable A yes O no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result is its prcmature failure io handle wastes. Proper inaintenanc consists of pimping out the septic tame every three years or sooner, if needed by a licensed pumper, What you put into the systen can affect the fit_zction of the septiz tack as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a cerlificatiozl form, signed by tht; owner and by : mast crpli - nber, journeyman pltunbcr, restnctedpluzrber or a licensed pumpervorifying that (I) the on -site wastewater disposal systen is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tarhk is loss 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 standard set forth, herein, as set by the Department of Comraeree and the Department of Natural Resources, State of Wisconsin. Certificatim stating that your septic system has been maintained must be completed and returned to the St. Croix County zonssig Office within X days of the three year expiration date. IJA,.� 16NAIUlu bf APPLICANT DATE OWNER CERTIFICATION I (we) certify that all slaterrents on this form are true to die best of my (our) knowledge, I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. /7/ U s - S ONAT n APPLICANT DATE Any informatior. that is mis- represantedmay result in the sanitary permit being revoked by the zoning Department_ " Include with this applioatlon; a stamped warranty deed from [lac Resistor of Deeds office a copy of the grnlrled survey map if reference is made in the watTanry deed Document Number QUIT CLAIM DEED 864522 KATHLEEN H. WALSH REGISTER OF DEEDS Linda J. Hebert, a single person, quit - claims to the Hebert/Luick ST. CROIX CO., WI Irrevocable Residential Trust, dated October 17, 2007, Linda J. Hebert, RECEIVED FOR RECORD Charles G. Luick, and Judith A. Luick, Trustees, all with full power of sale 11/21/2007 11 :05AM or encumbrancing, the following described real estate in St. Croix County, QUIT CLAIM DEED State of Wisconsin: EXEMPT 1 16 REC FEE: 13.00 See attached description. PAGES: 2 Recording Area /3 Name and Return Address C. L. Gaylord Attorney at Law P. O. Box 46 River Falls, WI 54022 022 - 1086 -80 -000, 022 - 1086-90-000, 022- 1087 -80 4000, 022- 1087 -20-000 (Parcel Identification Numbers) This is and is not homestead property. Dated this 19th day of November 2007. (SEAL) *Linda J. Hebert (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature of Linda J. Hebert thenticated this 19th STATE OF WISCONSIN day of 07. PIERCE COUNTY L. GayWrd Personally came before me this day of TITLE: MEMBER STA ! R OF WISCONSIN , 2007, the above named (if not, to me known to be the person who executed the authorized by § 706.06, Wis. Stats.) foregoing instrument and acknowledge the same. , Notary Public, State of WI My oommission expires THIS INSTRUMENT WAS DRAFTED BY C. L. Gaylord Attorney at Law P. O. Box 46 River Falls, WI 54022 *Names of persons signing in any capacity should be typed or printed below their signatures. 1 of 2 INFORMATION PROFESSIONALS COMPANY FOND DU LAC. WI 800.6552021 k Part of the Northeast Quarter of the Northwest Quarter (NE' /4 of NW' /4), the Northwest Quarter of the Northeast Quarter (NW' /4 of NE'/,), and the Southwest Quarter of the Northeast Quarter (SW' /. of NE' /4), Section 30, Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin, more fully described as follows: Commencing at the North %4 corner of said Section 30, the point of beginning of the parcel to be herein described; thence S.88 °26'23 "E. on the North line of the NE'/4 of said Section 30, a distance of 84.18 feet to the Westerly right of way of State Trunk Highway 65; thence S.21 °1 1'00 "W., on said right of way a distance of 519.51 feet; thence S.32 °44'31 "W., 357.68 feet; thence N.56 °40'22 "W., leaving said right of way a distance of 168.96 feet (recorded as N.57 °07'W.); thence S.33 °19'38 "W., 60.01 feet (recorded as 5.32 °53'W.); thence North 62 1 06'30 "W., 114.42 feet; thence S.44 °52'48 "W., 80.38 feet; thence N.50 °25'05 "W., 210.38 feet; thence N.84 °32'55 "W., 316.64 feet; thence S.69 °28'38 "W., 231.92 feet (recorded as 5.69 "14'W.); thence N.00 °16'43 "E., on the West line of the NE' /4 of NW' /. of said Section 30 a distance of 703.68 feet; thence 5.88 1 20'32 "E., on the North line of the NW' /, of said Section 30, a distance of 1320.70 feet to the point of beginning. ALSO, commencing at the N'' /4 corner of said Section 30; thence 5.88 °26'23 "E., on the North line of the NE' /4 of said Section 30, a distance of 243.97 feet; thence S.21 °1 1'00 "W., 70.07 feet to the point of beginning, of the parcel to be herein described; thence S.88 °26'23 "E., 849.06 feet; thence S -01 °46'05 "W., 110.20 feet; thence 5.42 °00'21 "W., 604.54 feet (recorded as S.40° 14' W. 605.30 feet); thence N.87 °52'36 "W., 107.85 feet (recorded as West 107.20 feet); thence S.09 °18'59 "W., 135.81 feet (recorded as S.07 135.07 feet); thence 5.39 1 19'19 "W., 210.00 feet (recorded as 5.37 0 47'00 "W.); thence S.46 °53'34 "E., 279.97 feet (recorded as S.48 °45'00 "E.) to the meander line of the Kinnickinnic River; thence N.52 °37'55 "E., 332.13 feet; thence S.40 °37'27 "E., leaving said meander line 1.00 feet; thence S.49 °22'33 "W., 833.28 feet - (recorded as 5.47 °26'W., 834.30 feet); thence S.89 °53'09 "W., 240.36 feet (recorded as 5.88 0 00'00 "W.) thence N.00 °16'59 "E:, on the North - South '/4 line of said Section 30, a distance of 168.86 feet; thence N.88 °22'07 "W., on the South line of the NE' /4 of NW' /4 of said Section 30, a distance of 727.59 feet; thence N.55 0 10'10 "E., on the Easterly right of way of State Trunk Highway 65 a distance of 51.64 feet; thence N.56 °27'48 "E., 221.44 feet; thence Northerly on a curve concave to the West having a radius of 1702.02 feet (recorded as 1702.28 feet) whose chord bears N.38 °10'35 "E., 994.85 feet; thence N.02 °l 1'00 "E., 305.69 feet to the point of beginning; including all lands between the meander line and the centerline of the Kinnickinnic River; EXCEPT that part described as Lot 1 of the Certified Survey Map recorded in Volume 6 on page .1788 as Document No. 423197; and EXCEPT those parcels conveyed to Keith 0. Hansen and Julie R. Hansen in Volume 938 on page 557 and in Volume 1090 on page 517; and als -, EXCEPT that part conveyed to Robert E. Smith and Dorothy J. Smith in Volume 1090 on page 518. (For purposes of this description all bearings are referenced to the North line of the NW' /4 of Section 30, Township 28 North, Range 18 West, assumed 5.88 °20'32 "E.) ; an also EXCEPT that part conveyed to Dorothy J. Smith Family Trust in Volume 1337 on page 001. 2of2 Safety and Buildings commerce.wi.gov 3824 N CREEKSIDE LA HOLMEN WI 54636 S / .? TDD #: (608) 264 -8777 isconsin _ www.commerce.wi.gov /sb/ I t, of Commerce www.wisconsin.gov Jim Doyle, Governor Jack L. Fischer, A.I.A., Secretary June 10, 2008 CUST ID No. 224832 ATTN.- POWTS Inspector MARY JO HOLLISTER ZONING OFFICE HOLLISTERS SOIL TESTING ST CROIX COUNTY SPIA W9875 690T1-1 AVE 1101 CARMICHAEL RD RIVER FALLS WI 54022 -4011 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/10/2010 Identification Numbers Transaction ID No. 1542568 SITE: Site ID No. 738207 Linda J Herbert Please refer to both identification numbers, 194 Hwy 65 above, in all corres ondence with the agency. Town of Kinnickinnic St Croix County NE1 /4, NW1 /4, S30, T28N, R18W FOR: Description: Four Bedroom Mound System / Replacement construction / 6% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1184944 Maintenance required; 600 GPD Flow rate; 39 in Soil minimum depth to limiting factor from original gade; System(s): Mound Component Manual- Version 2.0, SBD- 10691 -P (N.01 101), Pressure Distribution Component Manual- Version 2.0, SBD- 10706 -P (N.01/01) The submittal described above has been reviewed for conformance with applicable Wisconsin Administative 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. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. • 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 ofSec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally down slope of the dispersal cell shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • The existing POWTS shall be properly abandoned per Comm 83.33, Wis. Adm. Code. • Maintenance information must be given to the owner of the tank explaining that periodic cleating of the effluent filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • A cony of the ap rp oved Mans 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 RO.W.T.S. Conditionally APPROVED MARY JO HOLLISTER Page 2 6/10/2008 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.Comm 83.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptabb to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changesor 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 t I'lt/ Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jer cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. fa MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: LINDA J. HEBERT Owner's Name: same Owner's Address: 194 Hwy. 65 River Falls, WI 54022 Legal Description: NE 1/4 of the NW 1/4, S 30, T28N, R18W Township: Kinnickinnic County: St. Croix Subdivision Name: NA Lot Number: NA Block Number. NA Parcel I.D. Number: 022 -1087 -20-000 Plan Transaction No.: �•'00*%N'S%,,��',, Page 1 Index and title '• Page 2 Data entry •�•• ��: '••, '�� Page 3 Mound drawings 30 Page 4 Lateral and dose tank MPL �S9ER Page 5 System maintenance specifications \ O 1 �S z ; Page 6 7 Pump contingency plan O f CO Pa MMU �p� 9 e p curve and s pecifications � i A .� • Page 8 Plot Plan �aN of ��i� .... ���� p�v►s NGE ������ pFZRE 0NDE �U■nt���� SEE G Designer. Mary Jo Hollister License Number: 1859-007 Date: 05/22/08 Phone Number. (715) 426 -1775 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706 -P (N. 01/01) Version 5.1 (R. 06 /06) 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 - 36 inches. 600.00 Design Flow (gpd) 6.00 Site Slope ( %) 93.00 Contour Line Elevation (ft) 39.00 Depth to Limiting Factor (in) 0.60 In -situ Soil Application Rate (gpd/ft) Distribution Cell Information 60.001 Dispersal Cell Length Along Contour (ft) = 10.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/fl?) 1 I Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) E Center or End Manifold 3.33 Lateral Spacing (ft) If N above, enter the elevation ft 3 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) 2.08 Estimated Orifice Spacing (ft) = 6.90 fe /orifice 2.00 Forcemain Diameter (in) 76.00 Forcemain Length (ft) Does the forcemain drain back? Y 87.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 12.40 Forcemain Drainback (gal) 6.33 Vertical Lift (ft) 80.54 5x Void Volume (gal) 2.05 Friction Loss (ft) 92.94 Minimum Dose Volume (gal) 0.50 In -line Filter Loss (ft) 35.84 System Demand (gpm) 15.38 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 1.00 1.50 x x 1.25 x 2.00 x 1.50 x x 3.00 2.00 x 3.00 x Gallonslinch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1200.001 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Wieser IManufacturer gal /in (enter result in cell B49) Dose Tank Information Effluent Filter Information 800-001 Dose Tank Capacity (gal) Polylok Filter Manufacturer 22-241 Dose Tank Volume (gal/in) 525 Filter Model Number Wieser IManufacturer Project: LINDA J. HEBERT Page 2 of 8 Mound Plan and Cross Section Views T 1/10 B :::= J observation Pi 3 T A W — I: :::::::....::::::: : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : B :: :. .I ...................... ............................... I :. ...... :- • L Mound Component Dimensions A 10.00 ft E 13.20 in H 1.00 ft K Eilft ft B 60.00 ft F 9.50 in z 8.75 ft L ft D 6.00 in G 0.50 ft J 4.56 ft W 600.00 (fe) Dispersal Cell Area 1125.00 (ft Basal Area Available 10.00 (gpd /ft) Linear Loading Rate 6.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 95.29 (ft) —i F Dispersal cen 94.00 (ft) Lateral 93.50 (ft)—♦ Invert Dis rsal ell Elevation E D ......� :.:.:.:.:.:.:.:.:.:.:. 93.00 (ft) Contour Elevation 6.0 %Site Slope Geotextile Fabric Cover Shading Key $, - T Dispersal Cell See lateral details on 10 _ Topsoil Cap 1.5 ft .:.:... ::; ..;::. Page 4 for number, size, Subsoil Cap w 5 :;:: i:. :;:::: ?::i:•:::•;:•:•:;:::::::: and g .• pacin of laterals. oil ASTM C33 Sand z ': `i ;.::::; Laterals are equally F ' Tilled Layer m 0.5 ft : Typica) l aterai spaced from the a Q ' S .;: distribution cell's Aggregate o I centerline in the A distribution cell (AxB). Project: LINDA J. HEBERT Page 3 of 8 End Connection Lateral Layout Diagram Center the laterals over the A & B dimension •- Turn -up wlball valve or oleanoutplug P All laterals are 1dentioal I�f- 3C Holes drilled on the bottom of the lateral s equallyspaced Laterals & force main of PVC Sch 40 (per COMM Table 64.30 -5) S Force main connection via tee or cross to manifold at any point. Number of Laterals 3 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.09 ft Lateral Length (P) 58.52 ft Orifices per Lateral 29 Lateral Spacing (S) 3.33 ft Orifice Density 6.90 felorifice Lateral Flow Rate 11.95 gpm Manifold Length 6.67 ft System Flow Rate 35.84 gpm Manifold Diameter 1.50 in Total Dynamic Head 15.38 ft Forcemain Velocity 3.66 fUsec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and -► - Comm 16.28 WAC 4 in. min. Disconnect Tank component is properly vented E- Alternate outlet location Forcemain diameter Wieser Manufacturer _� 2 in. Ca aci 800.00 Gallons Volume 22.24 gal /inch A Weep hole or anti - Dimension Inche Gallons B siphon device A 21.79 484.66 B 2.00 44.48 C Pump off elevation (ft) C 4.18 92.94 t 87.67 D 8.00 177.92 D Total 1 35.971 800.00 Dose tank elevation (ft) 3" Bedding uncler tank. r 87.00 Alarm Manuafacturer ITank Alert Alarm Model Number JHW101 Pump Manufacturer JGould Pump Model Number I PE41 Pump Must Deliver 1 35.84 gpm at 15.38 ft TDH Project: LINDA J. HEBERT Page 4 of 8 , Mound System Maintenance and Operation Specifications Service Provider's Name Darrell's Septic Service -� Phone (715) 425 -1025 POWTS Regulator's Name St. Croix County Zonin Phone (715) 386 -4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1200 gal Maximum TSS 150 mg /L Soil Absorption Component Size 600 ft Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Freguencv 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 Laterals should be flushed and pressure tested every 1.5 ears Moundi 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 ..... • • • •.... Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral y Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: LINDA J. HEBERT 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.01101), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD 10706 -P (N. 01/01)] 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 filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shalt 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 flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contirwency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically dogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: L_l MZA J � tkEbE0 Page 6 of 8 f Lffij GOULDS PUMPS Submersible Effluent Pump P Im"M Maw mum p _ Geno* I r Corrosion refaft • D t!�` N • %V* Phase aoroucftL • Teat &*w 104°F • 60 Heft ■ Cast iron body. rmaarMtm, �oordlr�tt0llS when ' 115 and 230 volts ■ Thmwph* itnpda and • 8wlt-in>h oe pro- ` cover. ma&nutn sphere. • Gass B bw*fm. Awtomatic models indnde a ' 0141W desk. construction. AFMJCATKM float switch. ' XWM6 carbon steel M Motor is p Spey designed for dlte • Manual models avawWe. Nda ed for extlSaled see PE31 Motor. service Ile. pcf onnance diart or dove. • 33 HP, 3000 RPM r Poweved for condor w • Effluenwesing Systems Pwnlx • � 115v OPWAM • tnw P� Pipe e Systems ' Y 53 GPM • Shaded Pole des* :Qukkdbmnmdpmw �� s of the manta. • Basement Draining • Maximum head. 25' TDH PE41 Mato: • H" Duty Sump/ FE41 PwW. • .4014P. 3400 IPM � p� lord IEnglh, �"a g • Maximum ca B*. 61 GPM • 115 and 230 vok �y vx d kn k • Mmdrraun beat 29' TaH ' � 115 or 230 v* growtding PE51 haw PE51 Motor. • Aftftw Y 70 GPM 15 and 230 vat M an0 is 1 duty, Maxinwm head. 37' TDH • METERS FEET PSC design ■ medwW wai is arhom 40 . , oera *. BONA and dainless Steei. 35 -- WW 3x t .so f r sW bstlM1e1's. '+ 10 ,'- AGEWLSTOW 30 , 1 FT c us; 20 Test! Ib 1N.178iAd s - tt >14 T 10 j T -T �.S_�J ' �• Vi i MT .4i.~�_,�' -L' � �� O t � - • — _.L- -le.' ...'ter ;.,�.••� j 7 -- j -• i...�_�o' p,,�. �fl In 7A ' ]A j en c3^ ' ,w .... 1 , V'SEL'T i L,ADA S. '{ '�� � !C F �, : -r vF 9 Plot Plan Page of 8 Properly owner I"= 40ft , noted Legal Description (except where not "��.81r1 t w 'ebv3nl fl F A i.�l t C.1C 1N Ut G.. 5T. C12��X I = Backhoe pit 14. 7- Z. ,Acs o �-� Sa►J • North � d�Y N VW WELL - pROaaS _ O COO '� 8 caesE C tlityaz�oA fgAMOOOSO O w \O� \v OF NCW `v 1 O ` Q Lir �0Lp�� vw �Q��ti 4 04 dD EL COSS � 3 c � i Site Locatro • 0-