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026-1292-31-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 479262 e 0 i 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: Hanson, Ja ne I Richmond, Town of CST BM Elev: Insp. BM Elev: BM Descr' tion ::/ Section/Town /Range /Map No: /0 7. - 7 1 /0 7. 7 / (d. oT /- 15.30.18. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 3.0 ID 1 7f Benchmark 2 •� � b� O ,� ., Dosing oa Aeration ` Bldg. Sewer u ( . ? q /O 2, 9 Holding St/Ht Inlet o io l• s" St/Ht Outlet TANK SETBACK INFORMATION C (• 7 /N. / TANK TO P/L WE BLDG. Vent to Air Intake ROAD DtJDlet 0 Septic Dt Botto SU' M —�' 3• `1 Dosing i 5 Header an. /O V- 0 2 6r V �' L `7 ( 7 Aeration Dist. Pipe Holding Bo t. System 7 • -3 O 3. F inal Gr ade PUMP /SIPHON INFORMATION - ` S `OS. Manufacturer Demand t Cover A l J /o b. Z GPM 7 • Model Number 7°� � �o 2• ��s L3 1 6)2_ 3 TDH Lift Friction Loss System ead TD Ft Forcemain Lent , Dia. Dist. to W ell Z 5 i. SOIL ABSORPTION SYSTEM BEDfrRENCH Width / / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S �j SETBACK SYSTEM TO ` P/L BLDG IWELL LAKE /STREAM ACHIN Manufacturer: INFORMATION CHA E OR Type f System: > � �/ �� ' ' I � , U Model Number. DISTRJBUTION SYSTEM r� Heade Manifol Distribution / x Size x Hole Spacing Vent to Air Intake 9 � S H Pipe(s) � / � g 2 �> Len th Dia Length Dia 1 o Sp acin SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only •- k444l- Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulch 4d Bed/Trench Center I Bed/Trench Edges Topsoil Yes No [] Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 0� y� Inspection #2: 10 ! 3 Location: 1567 127th Street New Richmond, WI 54017 (NE 1/4 SE 1/4 15 T30N R18W) Cherry Knolls 2nd Add Lot 31 Parcel No: 15.30.18. / y� 1.) Alt BM Description = 6_ 11 (�j�UGI 3 2.) Bldg sewer length = (S - amount of cover = y f l I�LQ�)"YT►� Plan revision Required? �,j' Yes ( No Use other side for additional information. , — Date Insepctor's ignature Cert. No. SBD -6710 (R.3/97) MA, S and Buildings Division Court r ` W. !shit Ave., P.O. Box 7162 p is (60 266 - rry P erm �(to�fil / led in consin Co.) D e a rtment of Commerce f ` Sanitary Permit Applica On i Sca Plan I.D. " umber In accord with Comm 83.21, Wis. Adm. Code, personal inform, on you ptbvide may be used for secondary purposes Privacy Law, A S. 1)(m) Pro Address (if different than mailing address) 1. Application Information - PleasePrintAllInformation ZpNC OFF Cr / 1p 147 NI Property Owner's Name Lot # Block # 0 1 % 3� Pro Owner's Mailing Address ropem' L ocat 0 00-J- � Section City, St to Zip Code Phone Number P a d 5 0 lN� /W T N; R /B( cEcle 9yg) II. Type of Building (check all that apply) Or a.,S ` 6(" t•'� CSM Number 'g 1 or 2 Family Dwelling - Number of Bedrooms 'Sub,µ: 1� t dt rte ,r51_ Llk1- u Subdivision Name / J ❑ Public/Commercial - Describe Use ❑ State Owned - Describe Use CeA 0 (�er.1�o�7 (- 1 ❑City_❑Vil ge 5LTownship of Nje III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. A N Sys tem ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal Permit Revision List Previous Permit Number and Date Issued ❑ Change of ❑Permit Transfer to New Before Expiratfon Plumber Owner Ejry a6 It T/ IV. Type of POWTS System- Check all that appl ❑ Non - Pressurized In -Ground )k Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In -Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculati g Sand F ❑ Recirculating Synthetic Media Filter (I Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe 11 Other (explain) qr.7 m V. DispersalfIrrmeat meat Area Information: Design Flow(gpd) Design Soil lication Ra gpdst) Dispersal Area Requi Dispersal Area Pro t) System Elevation / VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank t7 Aerobic Treatment Unit Dosing Chamber dQ Wee ks VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Si to MP/MPRS Number Business Phones Number q �� Plumber's Address (Street, City, State, Zip C ) 1 U O 5 v O VIII County/ e art ent Use Onl Approved ❑ D' pprove Sanitary Permit Fee (includes Groundwater D Issued Issuin ent Signa ure o Surcharge Fee) 4 /�C t6 ❑ O r G' Reason o 14 ( J I IX. Conditions of Approval /Reasons for Disapproval SYSTEM OWNER: 3) Cc t- J Q 11. `Septic tllstk, affluent fNter and ! le-4" o , - " i ✓�. �� c...l! ' S dispersal cell must all be services / mtdtnlhted t as per management plan provided by plumber. er,n�l t• lir-, 2. An setback requirements must be maintained as per applicable trade / wdinainces. Attach complete plans (to the County only) for the system on paper not less t 81/2 x 11 Inches In size SBD -6398 (R. 01/03) pro % war? ii!fK �t� !nhv��49 aR1i::111t�]rZ 1 A E /edao•� • /o caec! P�oP. s624i� 3G 7 39 46.CIeViX tJ /. �'opost.d An w /o x 1 0 0 0r j pro poscd � ,ee f,cl t nGe graa/< elegy! = Jo7 7 ` \\ r A•»pos�ol u�ccfsCa„u -vfc Ko -: O•�rl 8� ncl, Baer desf.�oyed, �Sfi'�cG QanG�y9aI�ES'�G+� /if�lte�a.s �rj0 of �'i s E, � ,hoc.,„ c�«.•Er'c�. E /e ✓a,�?,r� s �'tc.rCa�c4( 5o. %evb. /��'�/�• �, � 32. U.� Or'i %la.��•/Yl, /ocn- �b�- ,SG..+o� � Soi /�Oi'� /o crud. Safety and Buildings 4003 N KINNEY COULEE RD commercemi.gov LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 ,tic sco n s' n www.w www.coe.wi.gov/s ! e of Commerce isconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary August 05, 2005 CUST ID No.222904 ATTN. POWTS Inspector JAMES W BOUMEESTER ZONING OFFICE BOUMEESTER & SONS EXCAVATING INC ST CROIX COUNTY SPIA 1070 HWY 35 N 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/05/2007 Identification Numbers Transaction ID No. 1162302 SITE: Site ID No. 702567 Jayne Hanson &Jason Bahneman Please refer to both identification numbers, 1567 127th Street above, in all correspondence with the Agenc Town of Richmond St Croix County NE 1/4, SE 1/4, S15, T3 ON, Rw Lot: 31, Subdivision: Cherry Hills FOR: Description: Proposed Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1032261 Maintenance required; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.0 1 /0 1), Pressure Distribution Component Manual - Version 2.0, SBD - 10706 -P (N.01 101); Biofilter 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. 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 approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD - 10691- P(N.01 /01). • The pressure network is to be constructed in accordance with publications SBD- 10706- P(NO1 /O1) 'Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems - Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) ". • 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 POWTS 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 area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter ispe cf to the filter for cleaning must be provided per Comm 84 product approval conditigm 0" V E UEPARTMENI OF COMWIERCE ' JAMES W BOUMEESTER Page 2 8/5/2005 • Comm 83.22(7) - 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. 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. • Comm 83.52(1)(a) - 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). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. 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 acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the components) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 &4G-� Balance Due $ 0.00 Gerard M. Swim POWTS Plan Reviewer - Integrated Services W code: 7633 (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm jswim @commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Applicatim INDEX AND TITLE PAGE Project Name: Hanson/Bahneman 3 bedroom residential mound Owner's Name: Jayne Hanson & Jason Bahneman Owner's Address: 830 Harbor View Road RE CEIVED Hudson, WI. 54016 JUL 2 9 2005 Parcel Address: 1567 127th Street SAF Leg es ripttio�n: NE1 /4SE1/4, Sec. 15, T.30N., R.18W. Township: Richmond County: St.Croix Subdivision Name: Cherry Hills Lot Number. 31 1 Block Number. Parcel I.D. Number. 026 - 1040 -60 -000 Plan Transaction No.: Page 1 Index and title Page 2 Data entry 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 Jim Boumeester License Number. 222904 Date: 07/21/05 Phone Number (115) 386 -9020 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) Version 4.01 (R. 09/04) 0ti,,, Page 1 Of 9 ;:EE CORRESP ENCE f Mound and Pressure Distribution Component Design Design Worksheet Site Infor mation (r or c) R Residential or Commercial Design Note: sand fill (D) calmilaions assume a 300.00 Estimated Wastewater Flow (gpd) Table 83-44-3 in -situ soil tr�trnent for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) colifonn of <= 36 inches. 450.00 Design Flow (gpd) 3.0 Site Slope ( %) 102.15 Contour Line Elevation (ft) _ 24.0 Depth to Limiting Factor (in) 0.40 In -situ Soil Application Rate (gpde) Dist T_1 l n Cell Information 90.OV Dispersal Cell Length Along Contour (ft) _ .00 ell Width (ft) .0 0' Dispersal Cell Design Loading Rate (gpd/ft 1� Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y - P res sure Information network? Enter Y or N (c or e) a Center or End Manifold 2.50 Lateral Spacing (ft) If N above, enter the elevation (ft) 21 Number of Laterals of the highest point. 0.12 Orifice Diameter (in) (e.g. 0.25) r Estimated Orifice Spacing (ft) = 6.25 ft /orifice 2.00 Diameter (in) 30. 00! Forcemain Length (ft) Does the forcemain drain back? �� C 93.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 4.89 Forcemain Drainback (gaq 9.65 Vertical Lift (ft) 81.25 5x Void Volume (gaD 0.57 Friction Loss (ft) 86.14 Minimum Dose Volume (gao 16.72 Total Dynamic Head (ft) 29.66 System Demand (gpm) Lateral Diameter selection Manifold Diameter Selection in. dia. options choice dia. options choice 0.75 _ 1.25 x 1.00 1.50 x 1.25 2.00 1.50 x 1 3.00 2.00 x I 3.00 x _ Gallons /Inch Calculator (optional) T reatme nt Tank Information 805.12 Total Tank Capacity (gal) 1000.00 Sept Tank Capacity (gal) 37.00 Total Working Liquid Depth (in) W eeks Co ncrete Manufacturer 21.76 gal/in (enter result in cell B49) _D Tan Information Effluent Filter Info 805 Dose Tank Capacity (gal) JZabel _'_ Filter Manufacturer 21.76 Do se T ank Volume (galfin) A100 ______ _, Fifter Model Number Weeks Concrete Manufacturer Project: Hanson/Bahneman 3 bedroom residential mound Page 2 of 9 Mound Plan View 1/10 B •. ... ... .. ... 3 J • , , : i _• : .Observation Pipe . Q K T" � W :.�. .. . .:F. . . ... . .. B . . . . . :. .:.:.... ..:.:............ • ..•.• •...• z L - - Mound Component Dimensions A 5.00 ft E 14.40 in H 1.00 ft K [ Aft ft B 90.00 ft F 9.50 in 1 8.49 ft L ft D 12.00 in G 0.50 ft J 6.14 ft W 450.00 (ft Dispersal Cell Area 1214.49 (ft Basal Area Available 5.00 (gpd/ft) Linear Loading Rate 9.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 104.94 (ft) —� H I F :: / 103.65 (ft) Lateral ./ Dispersal Cell 103.15 (ft)- Invert Dispersal Cell Elevation E D 102.15 (ft) Contour Elevation 4.0 %Site Slope Geotextile Fabric Cover Shading Key Dispersal Cell See lateral details on a 1 Topsoil Ca 1.5 ft Pag 4 for number, size Q g Subsoil Cap MR and spacing of laterals. ASTM C33 Sand F Laterals are equally ® Tilled Layer 6 m 0.5 ft `. Lateral spaced from the ❑5 Aggregate o distribution cell's `''' A'' ' "� centerline in the distribution cell (AxB). Project: Hanson/Bahneman 3 bedroom residential mound Page 3 of 9 End Connection Lateral Layout Diagram Laterals centered over the A& dimension 0= Turn- upadballvalveorclesnoutplug P J AN laterals are identical IF X —� I Holes drilled on the bottom of the lateral S equallq spaced Force main connection vW tee or cross to manifold at any poke. Laterals & force main of PVC Sch 40 (per COMM Table 8430-5) Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 88.55 ft Orifices per Lateral 36 Lateral Spacing (S) 2.50 ft Orifice Density 6.25 ft /orifice Lateral Flow Rate 14.83 gpm Manifold Length 2.50 ft System Flow Rate 29.66 gpm Manifold Diameter 1.50 in Total Dynamic Head 16.72 ft Forcemain Velocity 3.03 ft/sec Dose Tank Information Locking cover wit „warning label and locking device and sealed watertight Electrical as per NEC 300 and —0 "'— Comm 16.28 WAC 4 in. min. Disconnect Tank component is property vented Akernate outlet location Forcemain diameter Weeks Concrete Manufacturer 2 in. Capacityl 805.12 Gallons Volume 21.76 galrnch A _ Weep hole or anti - Dimension Inches Gallons B siphon device A 19.04 414.34 B 2.00 43.52 C PPUMI off e levation (ft) C 3.96 86.14 94.00 D 12.00; 261.12 D Total 37.001 805.12 tank elevation (ft) 3" Bedding un er tank. 93.00 Alarm Manuafacturer i LevelArTn Alarm Model Number'i DLV Pump Manufacturer !2 oel r Pump Model Number 'i BN 98 Pump Must Deliver 29.66 gpm at F 16.72 ft TDH Project: Hanson/Bahneman 3 bedroom residential mound Page 4 of 9 ,J Mound System Maintenance and Operation Specifications Service Provider's Name Jim Boumeester Phone (715) 386 -90201) POWTS Regulator's Name St. Croix County Zoning Phone 715-3 66 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 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 ears 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 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: Hanson /Bahneman 3 bedroom residential mound Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, 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 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 113 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. 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 toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Hanson /Bahneman 3 bedroom residential mound Page 6 of 9 ' TOTAL DYNAMIC HEAD /FLOW LL PUMP PERFORMANCE CURVE PER MINUTE MODEL 98 EFFLUENT AND DEWATERING s7ro6w I 25 MODEL 98 ^� Feet Meters Gal. I Liters u 20 5 1.5 72 273 374 7 ;- ' 10 3.0 61 231 _ x l 15 4.6 45 170 r l } 4 15 20 7.1 25 95 Shut -off Head: 23 fQ7.0m) 10 >•wsin.la lvr L 009971 I I I I 5 I 0 I I 10 20 10 40 50 60 70 80 121116 1 GALLONS �. ,(yG lnim 3 �� c ��ef l —7 TERS 0 80 160 240 j 42v02 LOW PER MINUTE SK1102 CONSULT FACTORY FOR SPECIAL APPLICATIONS ectrical altemators, for duplex systems, are available and Variable level float switches are available for controlling single supplied with an alarm. and three phase systems. Mechanical altemators, for duplex systems, are available Double piggyback variable level float switches are available for ,vth or without alarm switches. variable level long cycle controls. • Refer to FM1922 and FMO806 for temperatures above 130T. SELECTION GUIDE 98 series Control Selection 1. Integral float operated mechanical switch, no external control required. Model Volts -Ph Mode Amps Simplex Duplex 2. For automatic use single piggyback variable level float switch or double M9c 115 1 Auto 9.4 1 4 piggyback variable level float switch. Refer to FM0477. Nx 115 1 Non. 9.4 2 or 3 4 3, See FM1228 for correct model of simplex control panel. Dx c 230 1 Auto 4.7 1 4 4. See FM0712 for correct model of duplex control panel or FM1663 for a E3, 230 1 Non 4.7 2 or 3 4 residential altemator system. CAUTION For inkrmation on adabonal Zoeller products refer to catalog on Piggyback Variable Level Switches, All installation of controls, protection devices and wiring should be done by a qualified FMW77 OeclricalAlternat of, FMO486; Mechanical Nterrlator, FM0495 ;Surnp/Sewage Basins, FM0487, licensed electrician. All electrical and safety codes should be followed including the Single Phase Simplex Pump Control, FM1596;Aarm Systems, FM0732. most recent National Eleclric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. - - - - - --_ --- - - - - -- - - - - -- - - MAIL TO: P0. BOX 16347 -- H IP To l 49 402 H 56 -0347 Alanufacturers o /.. 1PT0: 3649 Cane Ru Road Lo h' Ill" Ky 40211 -1961 � . ) 178 2731.1(80) 0 PUMP IwCm Pu�.Pa S /999 hupJ1www.zoe / /eccom FAX (502) 774 -3624 ® Copyright 2004 Zoeller Go. All rights reserved. p� 7 d�9 ' � So,% Cdaluaz:'on�oi� A Eledaori • lo cated r orBrO S&+L ►+Son /i n eman / oroJp•, 3 6 y. 39 See-, J ' 5 - T• il. ul T . of Q *C,4 ~170 S�• GD +X C1� cJ /. 14'opostd . �we,lllocs�%o^ 0 0 o{ 1 Pro poscd ��. /oxdo°� , \ \ ,"V,0 4 7 �' L � � es • \�\ . l�ropostd Wet.1s Car,ena(c DO to c. 6a., rw/ \� (Poses! u�cefs Coy, u-vEc _ goo # ylo-f:e: Or des& -oyed �'ons�rkc�E.Yin 8a�cl,rnd��•e5fs�.6l.:sli•rdas faep 5o,leva /c����'�, of dJ�'i �oco �i• E /e ✓a rec -eaAd ,Cod 32. b y 44 /d O ser!/o,7m of 4 rtt.de e /eda- 'c ?s a.�0�'�' iia.��•�'1. /oca- ��i , SG..�ol U � Soy %ro;� .� 4��,� 29. 2� 16�'M EDINA REALTY -NR N0. 867 P. 2 ■ ■■ Wsconsin DepartmemofCo merle° `EC SO EVALUATION REPORT PUQe 1 of 3 Division of Safety and Buildin D E n ITfR y+ith c County St, Croix Attach complete site p(ah o paper not less titan 8 12 x 1 es In a ze,. nclude, but not limitedto: v rtipl poi (BM), direction and Parcel I.D. Pending percent slope, scale or dim sloe i1��°`�F'f on ddistancetonearestroad. Pi I pronT all Inrofffia Reviewed by Date �Preonel Information you Dravida may be used rnr eecondery purposes (Privacy LAW, e, 15.04 (1) (m)). Property Owner Property Location Steve Derrick GOB, Lot NE 114 SE 1/4 S 15 T 30 N R 1l3 E (or) Prope Owners Mailing Address Lot # Block # Subd. Name or CSM# 1438 Count Road G 31 Cherry Knolls 2nd Addition City State Zip Code Phone Number ity village E cm Nearest Road New Richmond I Wl 1 54017 1 ( ) CTH G Q Nt--w Construction UseE] Residential / Number of bedrooms 3 to 4 Code derived design flow rite 450 to 600 GPD © Replacement P u O lic or commercial - Describe: Parent material Loess ovcrtill Flood Plain elevation if applicable ATA ft. Gene-al comments This site is suitable for a conventional below grade systom, recommending that a pressurized system with equal and recommendations: distribution be used so as to distribute the effluent over the entire available area due to the massive(Otn) W, This is not a code roquircment; but rather a suggestion. 1 j Boring # D Boring L a Pit Ground surface elev, 105.40 ft. Depth to limiting factor - "" 90 in, Sell A Icatlon Rate Hcrizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /T in. Muniseli Qu. Sz Cant Color Gr, Sz. Sh, •FtWj •EfN>2 1 0 -10 10yr3/2 Sit 2msbk mfr as 2f 6 8 2 10 -18 1 4 /4 sil 2msbk mfr cw ]f .6 .8 3 18.32 7,Syr4/4 sl Om mfr cw _ , .6 4 32 -90 7,5yr4/4 fsl Ora ME - - .2 .5 � 2 Boring # l Boring 102.20 >90 Pit Ground surface eiev, ft. Depth to rirniting factor In. Soil A Iration Rate Horton Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlfP in. Munsell Qu. Sz. Cont Color Gr. Sz, Sh, 'EfW •Eff#2 1 0 -15 10yr3/2 sil 2msbk mfr as 2f 6 ,8 2 15 -31 10Yr4 /4 sil 2msbk mfr ow 1 f •6 .8 3 31.90 7.5yr4/4 - fs1 Om rnfi _ 2 .5 Eff uent #1 = BOD > 30 < 220 nV& and TSS >30 < 150 rrg /L • Ertluent #2 = J300 30 rrak and TSS � 30 rrtg/L CS'' Name (Please Print) signature CST Number Thomas C Nelson r 227387 Adc ess Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, W1 ID /21/04 715- 246 -2454 nnT n_.n T.,.r Vin. U :A? 29. 2005 1,O ' L "EDINA- REALTY -NR N0, 867 P, 3 Property Owner D errick Parcel ID # Pending Page 2 of 3 3 Baring # 0 Boring El Pit Ground surface elev. 101'80 R. Depth to IimRing factor >90 In, Soil A Icatlon Rate Horizon Depth Dominant Color Redox Descrli:Wn Texture SuWure Consistence Boundary Roots GPD/ftr In, Munsell Qu. Sz. Cont Color or. Sz. Sh. •E?W 1 0-11 10yr3/2 - sil Impl Mfr as 2f ,4 .6 2 11 -15 10 4/4 - sil 2msbk mfr cw 1f 6 .8 3 I5 - 90 7.5yr4/4 fsl Om I tnfi - _ ,2 .5 ❑Boring # � Boring Pit Ground surface elev, ft, Del Ah to limiting factor in, Soli ApPlIcolon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPI)IM in. Munsell Qu. SZ, Cont Color r. Sz. Sh. - Eff#1 'Et14 F-1 Boring # Boring Pit Ground surface etev. ft, De h to limiting factor in. Sol A ;$lion Rate Horizon Depth Dominant Color Redox Description Texture Structure Conslstence Boundary Roots GPD/ n. Munsell Qu. Sx. Cont Color r, Sz. Sh. 'EMM ■Ef(#2 Effluent #1 - BOO, > 30 <220 Mg /L and TSS >305 150 mg/L • Effluent fR = SOD, < 30 mg/L and TSS _ 30 rng/l_ The Department of Commerce is an equal opportunity service provide and employer. If you need assistance to ace;ss services or need material in an alternate format, please contact the d cnt at 608 -266 -3151 or TlY 608. 264.8777. S8D•6J3dreet6t.a7�oC9 PR 29.2006 1:07PM 11a EDINA -REAL TY -NR N0. 867 P. 4 ` ,,,, Knolls 2nd Addition BM z � of �ond�it JO' Lot: 31 B1 105.40' B 21 0 2,20' 13,0,.60' Nort i 1 q� 0 Thomas Alston ,� 2V3a7 I Joe • POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owne r pNSON SON l`IC Septic Tank Capacity 10(w ga l ❑ NA Permit # Septic Tank Manufacturer U RA -s ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer l r' ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model A-)00 ❑ NA Number of Public Facility Units a: NA Pump Tank Capacity b oo gal ❑ NA Estimated flow (average) d 0 gal/day Pump Tank Manufacturer W ?,� s ❑ NA Design flow (peak), (Estimated x 1.5) () gal /day Pump Manufacturer D P , ❑ NA Soil Application Rate .y gal /day /W Pump Model V ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) <30 mg /I- ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (SOD <220 rng7� ❑ NA ❑Mechanical Aeration ❑Wetland Total Suspended Solids (TSS) <150 m� /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) i ❑ NA Biochemical Oxygen Demand (BOD <30 mg /I- ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) <30 mg /I- ❑ NA ❑ At -Grade eMMound Fecal Coliform (geometric mean) <10' cfu,'100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y iin dia ► ❑ NA other: ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once ever ❑ month(s) (Maximum 3 ears) ❑ NA Ins p y a - 3 19 y ear(s) y Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ® year] l (s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: I P ❑ monthis) 10 year(s) ❑ NA Inspect pump, pump controls &alarm At least once every: I ❑ month(s) ❑ NA J$ year(s) Flush laterals and pressure test At least once every: ❑ mo � year (s) l ❑ NA O� ls) Other: ❑ month(s) At least once every: ❑ ❑ NA year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION Page of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator erator P rior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site h not of been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name �' S Name Phone 11 S ' 1 0 alb Phone SEPTAGE SERVICING R ICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name q (Z ® N N Name St. C 12 u o( cow, Z Oki N Phone W S Phone O, - y L 9 U El I This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f► and 83.54(1), (2) & (3), Wisconsin Administrative Code. Safety and Buildings Division County - t 201 W. Washington Ave., P.O. Box 7162 CRv �seonsin kA adison, I 5 nitary Permit Number (to be filled in by Co.) Department of commerce ( 266 VET 2—G Z `` Sanitary Permit A plic on ' ?005 to Plan .D. Number In accord with Comm 83.21, Wis. Adm. Code, personal Lfor on you provide may be used for secondary purposes Privacy Law, sl (1 , .ROIX COUNTY roject Address (if different than mailing address) - . �( I. Ap lication In mation - Please Print All Information 2- l J 2 7 Property O ner's Na me Parce Lot # Block N \W ' 'd ( 3) ) --- Property ner's M ailing Addr roperty Location 83 bwbo � �d City, State Zip Code Phone Number N r5 I b S E Ii.Section 1 � �^ n `UI` � \Atl, t) N V s' J{ V 1( - i (circle one) II. Type of Building (check all that ap p�� T N; R t E or Lr1 or 2 Family Dwelling - Number of Bedroo j r 5 Subdivision Name a t CSM Number (j H ❑ Public /Commercial - Describe Use C r; g /vg S�• ❑ State Owned - Describe Use UCity_ ❑Village ❑Township of �► C MAN III. Type of Permit: (Check only one box on line A. omplete line if applicable) A. WNew System ❑ Replacement System ❑ Tre ent/H ing Tank Replacement Only ❑ Other Modification to Existing System y B. ❑ Permit Renewal ❑ Permit Revision ❑ Change El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that appl ®%Non - Pressurized In- Ground ❑ Mound > 24 in. of sui le soil U Mou < 24 in. of suitable soil U At- Grade U Single Pass Sand Filter El Constructed Wetland ❑ Pressurized In- Ground ❑ olding Tank U Peat r U Aerobic Treatment Unit ❑ Recirculating Sand Filter IN ❑ Recirculating Synthetic Media Filter El Leaching tuber ❑Drip Line ❑ G el -less Pipe ❑ Other (explain) U V. Dis l/T rsareatment Area Information: Design Flow (gpd) Design Soil :A�lication Rate( sf) Dispersal Area Required (sf) rsal Area Proposed (so System Elevation s u a S a U -4 100.90 M roue �. �9 E- VI. Tank Info Capacity in Tojo Number Manufacturer Prefab Site Steel Fiber Plastic Gallons G ns of Units Concrete Constructed Glass Q New Existing N Tanks Tanks Septic or Holding Tank w Vl Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, a undersigned, assume respon§ibUily for installation of the POWTS shown on t attached plans. C Plumber's Na me (Print) PI ber's nature MP /MPRS Number 11 'ness Phone Number Plu her's Addre ss (Street, City, te, Zip C e) Ob Pw S 01APj0iv s 6 . .� 01 (06 VIII. Count /De artme Use Only Approved ❑ Disapproved Sanitary Permit Fee includes Groundwater Date Issued ssuin Agent St re (No Stamps) Surcharge Fee) ❑ w en Reason for F De ial- IX. Conditions o Approv I \ 3 �` 1� cry SYSTEM OWNER: / t�l 1 Septic tank, effluent filter and T dispersal cell must all be serviced / maintained as per management plan provided by plumber. lrrA_ � S c 2. All setback requirements must be maintained r / as per applicable code /ordinances. < Q� (Q ,ro.� f Al(ach Ito ans (to )he County only) for the syste on paper not less than 8112 x 11 II es In size SBD -6398 (R. 01/03) Cyr ( ^^ J 1'iU � Sb Ne "b SON Sp p .� . y N � .� N Dp�n4�mp�I ..��rY. �Uuti^nteS C�c.. V 000 yp) p � ^I c, w bl ob zb lffg. I� 0rnq 3x - �12lNG� 3 k � l p a.'IV I f i I I i i �KRNC S 10 0 . (� (- �9.v0 C le �by�e �1dN S ON � �aS�N Dp�l�ler�n�nJ ��,rti, (3�ur��eS !f'(Z { ►� 1 000 J10 � � w p j job zo�w J � hl orq ° 3x 1- Tv, NcJ\ l og� f I f r O i N ' loc0 b TON< -" 3 � 100, U i L 9q vU To Wisconsin Department of Co mer g ECEI!/ED SO L EVALUATION REPORT P 1 of 3 Division of Safety and Buikli D E Cn 1 jocpid 6 � �itn C �/i County St. Croix Attach complete site plan o paper not less than 8i x 11 in es in size. include, tart not limited to: v rtical poi (BM), direction and Parcel I.D. percent slope, scale or dim sion , oa d distance to nearest road. P n on. ev' Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Steve Derrick GovL Lot NE 1/4 SE 1/4 S 15 T 30 N R 18 E (or® Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1438 County Road G 31 _ Cherry Knolls 2nd Addition city State Zip Code Phone Number ity []Village ■ own Nearest Road New Richmond I WI 1 54017 1 ( ) CTH G I Richmond E] New Construction Use>] Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD 11 Replacement [] Public or commercial - Describe: Parent material Loess over till Flood Plain elevation if applicable 1•iA ft. General comments This site is suitable for a conventional below grade system, recommending that a pressurized system with equal and recommendations: distribution be used so as to distribute the effluent over the entire available area due to the massive(Om) fsl. This is not a code requirement, but rather a suggestion. FTI Boring # 0 Boring Q Pit Ground surface elev. 105.40 ft. Depth to limiting factor X90 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP /fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 1 0-10 10yr3 /2 sil 2msbk mfr as 2f .6 .8 2 10 -18 10 4/4 sil 2msbk mfr cw if .6 .8 18 -32 7.Syr4/4 sl Om mfi cw - .2 .6 4 32 -90 7.5yr4/4 fsl Om mfi - - .2 .5 2 Boring # E] Boring 102.20 X90 Q 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/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 I `Eff#2 1 0 -15 10yr3 /2 sil 2msbk mfr as 2f .6 .8 2 15 -31 1 4/4 sil 2msbk mfr cw if .6 • 3 31-90 1 7.5yr4/4 fsl Om mfi - _ .2 .5 ` Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = OD _< 30 mg/L and TSS < 30 mg& CST Name (Please Print) Signature T CST Number Thomas C Nelson 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, WI 10/21/04 715- 246 -2454 nTT n n.1M Property Owner Derrick Parcel ID # P ending Page 2 of 3 ❑ 3 Boring # a Boring >90 10180 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/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 -Eff#2 1 0 -11 10yr3/2 - sil lmpl mfr as 2f .4 .6 2 11 -15 10 4/4 - sil 2msbk mfr cw if .6 .8 3 15 7 90 7.5yr4/4 - fsl Om mfi - - .2 .5 ❑ Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 "Eff#2 a Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 `Eff#2 El I • Effluent #1 = BOD, > 30:5 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD < 30 mg/L and TSS < 30 mg& The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608- 264 -8777. SBD- 8330TO9 (R.07 100) " t 't 8caue 1" _ 30' Cherry Knolls 2nd Addition SM2�a 1.50' Lot 31 02 102."t 15� t o i l f � f . N \ 1� Thomas Nelson y "�' 427367 ! �! Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number 9 22( 2 Number of Bedrooms 03 Design Flow - Peak (gpd) 'Y S O Estimated Flow - Average (gpd) 3 vu Septic Tank Capacity (gal) V bb Soil Absorption Component Size (ft a $ ll Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) O a a S tJ Maximum Influent Particle Size (in) $ 1/8 Maximum BOD (mg /L) ;)a U 220 Maximum TSS (mg /L) 150 150 Table 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Outlet Filter Insp once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years 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 (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). 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 Management Plan for a Septic Tank and Soil Absorption Component 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 scum and sludge 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 an 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. 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 unsoun d 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 the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding may contain lethal gases, and rescue of a Y person from the interior of the tank may be difficult or impossible. ' Tank abandonment shall be in accordance with Comm 83.33 , Wi s. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep- rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. When system fails, we will replace with another system at owner's expense. Alternate area must be left undisturbed. St Croix County Zoning office 386 -4680 Boumeester & Sons Excavating 386 -9020 Tri- County Sanitation 386 -2130 3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Iluyer J C -�1 Ne � 4a h �"o �o {� ,cnr� Mailing Address gJy t-44t uE J `ocp • � �� � Property Address ,. (Verification requited from Ptanntng Department for new construction) City /Stage Mj Q s,� m,,A Parcel Identification Number W(, -Id ve - L EG DESCRIPTION Property Location %., _ ' /., Sec. l T_aO _N -R W, Town of k. u1 v►� Subdivision R C ca „� Tlo.^ , Lot # - 31 Certif3eil Survey Map # . Volume , Page # , Warranty Deed # I %� ( D . Volume Q S� f Page # Spec horse ❑ yes F no Lot lines identifiable yes ❑ no 5X d NALMNAN bRvoper use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper maintenance consists o;` 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 Rmction of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verit/ing that (1) the on -site wastewaterdiaposal system L in pax operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 bill of sludge. Itwe, the undersigned have read the above, and agree to maintain the private sewage disposal system with the standards set forth ]mein, as tot by the Deparment of Cornneme sad the Department of Natural Resources, State of Wiwonsin. Certification stating that your septic system bar been maintained must be completed and returned to the St. Croix County Zoning Office within 30 %SIGN the ar exp tion date. DATE no O W NS . I ( that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of th scribed a ve, by virtue of a warranty deed recorded in Register of Deeds Office. SIGN PLICANT DATE ••••• tion that is mis- reprruented may result in the sanitary permit being revoked by the Zoning Department. •'• "• •' Include with tlils application: a stamped warranty deed from the Register of Deeds office A copy of fire Certified survey map if reference is made in the warranty deed r • U 2816P 053 XATHLEEN H. WALS1 State Bar of Wisconsin Form 2 -2003 REGISTER OF DEEDS ' WARRANTY DEED ST. C€ OIX CO. , WI Document Number Document Name RECEIVED FOR RE'COR 06/06/2005 03:45PH WARRANTY DEED THIS DEED, made between Steven J. Derrick and Margaret M. Derrick, husband EXERT # and wife TRANS 14970 _ ( "Grantor," whether ore of more), COPY FEE: and Ja son J. Bahneman, a single person and Jayne Hanson, a single p erson CC FEE: _ PAGES: 1 ( "Grantee," whether one or more). Recording Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Name and Return Address interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is rdir-& Pe d l < - 2 nee please attach addendum): 4K h (( of 31 Plat of Cherry Knolls 2n Addition in the Town of Richmond, St. Croix nty, Wisconsin. N(O 7 ?�� Part of: 026- 1040 -60 -000 & 026- 1040 -70 -000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties Easements, restrictions and rights -of -way of record, if any. Dated (SEAL) — ___(SEAL) * *Steven J. er k (SEAL). ;")l- (SEAL) * * Margare 'I. Derrick AUTHI!NTICATION ACKNOWLEDGMENT Signature(s) Steven J. Derrick and Margaret M. Derrick, husband and wife _ STATE OF ) authentica 1" ) ss. COUNTY ) *Kristina O land Personally came before me on , TITLE: MEMBER STATE BAR OF WISCONSIN the above -named (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: * Attorney Kristina Ogland Notary Public, State of Hudson, WI 54016 My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED © 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 * Type name below signatures. !NFO -PROTm Legal Forms 800- 655 -2021 www.infoproforms.com 1 _ CNO 2ND ADDI (A COUNTY PLAT) vest 1/4 of the Southeast 1 }' the SoutheoS i 4 and part of the Northeast 1/4 of ip 30 North, Ronge 18 West, Town of Richmond, St Croix County, Wisconsin. a 0 APLATTED LANDS ° Eoat ----- - - - - -- N, Sectla" o (Foun - S8944'10 "E 5301.80 East 114 Line )'40 "E • 933.39 „� 589 3 66.00' w 367.39' �. ro :on tract / o ° �oa� N \ = 1001898 95 = o�n 4 —o �ry o-' . —� LOT 31 z �° sq. ft. (• • I 2.05 acres °i o 80" Radius Temporary Cu / —de —sac - I � \ �\ Easement (to be extinguished upon CIO I n extension of the rood) N I � 524.68' `� o O O� 261.79' `� Z `L S78.1 w o 01 . C 43 O o � � o,0 F vl ! N \ • 100.3.51 0 o LOT 29 33'\ 33 _ _ N N 92,522 sq. ft. -LOT 32 (R= s89582 0 2.12 acres = 86,820 sq. ft. S89'49'40 "E 1.99 acres 60.00' / S74 S2,S - -- ( 30 .00. - 9 I L I o O1 01 > 1 '— � '� 6 0 12 , `n �`� 01 1 w 3.53 52.43 -r- �?, / j X0 36� N O -1 I I 165.96 / 8. F 6� I �I < I 87 '04'49 "E �' _ �_ d $ 37 '04'49 "W 1 65.96'- ,n _.