The URL can be used to link to this page

Home My WebLink About018-1099-49-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM uu„ty St. Crop( Safety and Building Division INSPECTION REPORT Sanitary Permit No 617847 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)] PWTS-032000275-C Permit Holder's Name City Village Township Parcel Tax No: Bruce and Stacy Noll I TOWN OF HAMMOND 1 018-1099-49-000 CST BM Elev Insp BM Eley, BM Description Or+ Pled- �� Sectionrlown/RangelMap No SV,E Aki k a e v} 13 09.29.17.859 TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing C 1. law Ai n $2 S TANK SETBACK INFORMATION 1(.2c -S tq; i I TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic > 1 5 I / Dosing , n r `Z �� to I r Aeration Holding PUMP/SIPHON INFORMATION /Yl vf% 0&//'LCLr ZR 66 Manufacturer _ I L. E Demand GPM al4 Model Number 1 S1 - 55 TDH LiJ1, �' Fncti9n o � System ad� TD # Forcemain Len $y Dia z Dst to Well SOIL ABSORPTION SYSTEM ELEVATION DATA STATION ES HI FS ELEV Benchngmark 7 lZ8! AIF/ rLov21 /Sewer jO6.7"1 Bldg S • / 97 S Z SVHt Inlet St/Ht Outlet b�Z T7 3.l Dt Inlet Dt Bottom Header/Man. •a /O�, p/ Dist Pipe Bot. System / 3. 0 �1 Final Grade ' St Cover 1D4,77 2-1 1 /=% %% p i v11� `f -/-'I t Z F/wJ$ / /9 All I BEDiTRENCH DIMENSIONS Width r Length / o • nc es Z Q -Il-C ^yI s PIT DIMENSIONS No Of Pits Inside Dia Liquid De SETBACK INFORMATION SYSTEM TO EZ Of.% P!L BLDG/ WELL LAKE/STREAM LEACHING CHAMBER OR UNIT Manufacturer �•' (r� 1' 11 Type Oy{tgpyTO MID V>,.�I 25 . LI/ • / • / (� Model Number�� _ 0 Depth ryAM, DISTRIBUTION SYSTEM xx Ivi •e� ♦iA { Header/Manifold Length 1 9 Dia J 1 , Z Distribution{' q Pipets) V/. ZCJ ` Len th Dia / Z r, pacing S acin 31 z Hole Size /� I 6 x Hole Spacing , Vent toAirInttaytke, L/��C. 1�l SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only vCy DeiF •� Bedlrr8gq0rC2--M / 0� Depth Over BedlTrench Edges xx Depth of r Topsoil zx SeededlSodded xx Mulched StiNa / z I Yes Na I;EI Yes No COMMENTS: (Include code discrepencies, persons present, etc) Inspection #1 /�/z /�=O Inspection #2: P10t„J Location: 1015 174TH SST �,,/ �1 ua' 'e1•+ J'�•?�J 1.) All BM Description= 1'9 B��-"`- ' ^]t�p,tyL� bJ�S•vL Cj D!T 21 Bldg sewamount length = ✓ -amount of cover= 3) 2,r71.�� SU-sa�d12 ��j,-4tl W.�L 0Z Eld(/r Plan revision Required? ] Yee No 4�I�s@r-oth r sid for dional informati nI. r�U�J��t"1�l � a�� I Ilrl iD `9BD�7`1�`(R 3 /r� l'tefX-"_'t- .."`�"'^' _< o atur Carl No "� 9"il t � oaeaa �^ 0 if J'/C2/(J M Safety and Buildings Division - G J County St. Croix W. Washington Ave., RO Box 7162 Sanitary Permit Number (to be filled in by Co ) MAR 05 2020 Madis9�t, WI 53707-7162 e*)7 (0 I —1 <2,� pe rmi Appljeatj� State Transaction Number In accordance with SPS 383.21(2), Wis. in sion of this form to the strip vemment unit PWTS-032000275-C is required poor to obtaining a sanitary permit. Note' cation to for state-owned POWT fed to the Department of Safety and Professional Services. Personal information you provide may be used for se dary Project Address (if different than mailing address) . 2urposes in accordance with the PrivacX Law, s 15.04 I m Stats. .+ 1015 17411 St. 1. Application Information -Please Print All Information Property Owner's Name 'iRl_N E Parcel # Bruce & Stacy Noll 018-1099-49-000 Property Owner's Mailing Address Property Location Gc7 9,9 - 1 P.O. Box 301 Govt Lot S6 '/., SW '/., Section 09. City, State Zip Code Phone Number New Richmond, W1 54017 715 491-4061 (circle one) T 29 N, R 17 W ❑. Type of Building (check all that apply) Lot q ® l or 2 Family Dwelling- Number of Bedrooms 3 �� 49 Subdivision Name ❑ Public/Commercial - Describe Use s Pheasant Ride Is' Addition Block # Na ❑ City of ❑ State Owned - Describe Use ❑ Village of CSM Number 3 2 ® Town of Hammond III. Type of Permit: (Check only one box on line A. Complete line B if applicable) '4 ® ew System Y El Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification [o 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 W. Type of POWTS System/Component/Device: (Check all that apply) � r ❑ Non -Pressurized In -Ground ❑ Pressurized In -Ground ❑ At -Grade ound> 24 m of suitable sod ❑ Mound <24 m. of suitable sod ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretrc en Device (ex lmt5-� V. Dis ersaVTreatment Area Information. Pot Lok PL-525 et3lnew filter at ST outlet Design Flow (gpd) Design Soil Application Ra (gpdsf) Dispersal Area Required (at) Dispersal Area Proposed 450.0 Gpd 0.4 Gpd/sq. ft. native soil 1,125.00 sq. ft. 1,148.94 sq. ft..25' 1.0 G s . ft. ASTM C-33 VI. Tank Info Capacity m Total # of Manufacturer Gallons Gallons Units New Tanks Existing Tanks �U in H ti iLO c. Septic or Holding Tank 1,000 I,000 I Wieser Concrete X Dosing Chambm 0 600 1 W 1000/600-MR X VIL Responsibility Statement- 1, the and signed, ass me responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' Signature MP/MPRS Number Business Phone Number James K. Thom son MPRS 30021 715 248-7767 Plumber's Address (Street, City, State, ZipCode) 340 Paulson Lake Lane Osceola,' 54020 Vill. Count /De artment Use Out Approved ❑Disapproved Permit FFeeee� Date Issued I ui Agent Signature ❑ Owner Given Reason for Denial [X. Conditions of ApprovaUReasons for Disapproval 3\ S S SYSTEM OWNER: JJ t ` 1. Septic tank, effluent filter and dispersal cell must be serviced 1 maintained t� t as per management plan provided by plumber. 2. All setback requirements must be maintained ae mr non ,moo -yr-•-gyp,-1r1),^��^ �^^�^� Ww4nruae mr me eprem /ova uomi ro me l,ouary Doty rt Doit ev di h t/1 i 11 ivch ve _ • -� _ sBD-§3Q81R�`^'�i'euG a4ya��a 1'�- � �L IrJt--'�--i-MI'aa•Itio�.Q n t{ {M6.(,�i�'e'GNYf /i, ,T of /M. Ekr S.:/e✓a�ie4Vl7,4E • fY/n' !� rrpt.Aj.rurode%K��as.•o �ucet,5�oe .r(r,// /aS/7U�3� lot leg A/W .0 4eQj" yec a1 r2lr(y�/7rJ, T. o! QNi.nnr.naf SE.GnrxG, c.x peJ � o/B- /off- $i9- me 6e, n, /, Si -acres. ef"Jt 'j uirew Cl..trat ra:✓ato - Are am "41*, oatrt E, y ;(� rM- Or7Jts St/•YO in fe•Q'af LRw.r. 9°"� "Oe u / d'o 3 kter�" Qe s:ak�K 00 ✓io f mwh bor,'// e%vH. s d co„�„� .�D; J ,IcskY yY� dC {f/br uJ r�� 0% l S or yC / r P�PIEt ft,-Jir; 611/'l'S leom)r`r� . 1f 40? A At /I' Sor 43 to/n v-d a / o✓ �' e%l /tea /+ors ha Cof/G/1g14 W �. So. l to I / rr'eppsta� A(twti 4E /6.K3'XroS, 3C' w/ Lxto'drsrr�sa/fer/ >o+n(tj /n.Etir.(.t aE �yi'.r dp.,td'.wYi •a�-r,�icu Sras esd o.E ,Z.Sd; �id`/e-a6�.r s�iGtt e1w,'em 6e i0/75a t G� CAMV 144AS'C+ty r VV�c PI try. Residential Mound POWTS Index & Title Sheet Project Name: Noll 3 Bedroom Residential Mound Owners Name: Bruce & Stacy Noll Owner's address: P.O. Box 301, New Richmond, WI 54017 Site address: 1015 174th St., Hammond, WI 54015 Project Location: Subdivision: Lot 49, Plat of Pheasant Ridge 1 st Addition Legal Description: SE1'4 SW ]i4, Sec. 09, T.29N., R.17W , Town of Hammond St Croix Co.,WI. Parcel ID #: 018-1099-49-000 Mater Signature: Page 1 Index and Title Sheet Page 2 State Approved Mound Design Plans Page 3 Treatment Tank Cros Section Page 4 Filter Specifications Page 5 Septic Tank Maintenance Agreement Page 6 Parcel Plat Map Page 7 Warranty Deed Attachments: House Plans Service: James K. Thompson, DSPS Credential #30021 5_ Date: Page 1 of 7 Design pursuant to In -Ground Sod Absorption Component Manual for POWTS, version 2 0 SBD-10705-P (N 01/01) DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 54304-5211 Contact Through Relay http //dsps.wi.gov/programs(industry-services w .wsconsin gov Tony Evers - Governor Dawn Crim - Secretary March 4,2020 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2022-03-04 Plan Review: PWTS-032000275-C JAMES K THOMPSON 340 Paulsen Lake Ln Osceola WI54020 SITE: Noll 1015 174th St.. Hammond. Wl 547015 Town of Hammond Saint Croix County Total Amount: $250.00 Pressure Distribution Component Manual — Ver. 2.0, SBD-10706-p (N,01/01, R 10/12) EZFlow Mound Component Manual — December 2017 Version Description: 450 GPD /.3 Bedrooms — New Construction Maintenance Required The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. 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: • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • With new construction; it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (POWTS). Waste generated shall be properly disposed of on -site or off site • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area All loose organic material to be removed from POWTS Dispersal Area. • Divert surface water from all POWTS Areas. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire, the site is too wet to prepare If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. • Pump Floats to be set and verified per approved plan. Any changes may result in pump resizing to meet TDH and GPM Specifications. • Areas that are occupied with rock fragments, tree roots. stumps and boulders reduce the amount of soil available for proper treatment, If no other site is available, trees in the basal area of the mound must be cut off at ground level A larger fill area is necessary when an)of the above conditions are encountered. to provide sufficient infiltrative area. 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 SPS 383.54(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. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/instal lation/operation. In granting this approval the Division of Industry Services 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 and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Thanks, POWTS Plan Reviewer — Wastewater Specialist Department of Safety & Professional Services I Division of Industry Services email: tint.vanderleest%wisconsin eov Cell: 608-516-6134 EZflow® MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Noll 3 bedroom replacement mound o ; s MUY Owners Name: P Bruce & Stacey Noll Owners Address: 1362 Creekwood Dr. # New Richmond, WI 54017 Property Address: 1015 174th St Hammond WI 54015 Legal Description: SE1/4 SW1/4, Sec. 09, T.29N., R.17W. Township: Hammond County: St. Croix Subdivision Name: Pheasant Ridge 1st Addition Lot Number. .49 Block Number: Na Parcel I.D. Number: 018-1099-49-000 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 EZflow mound drawings Page 4 Lateral and dose tank Page 5 Distribution media Page 6 System maintenance specifications Page 7 Management and contingency plan Page 8 Pump curve and specifications Page 9 Site Plan Page 10 Attached Soil Evaluation Report Designer: Thompson License Number. 30021 Date: 02/2812 Phone Number: (715) 248-7767 Signature a -- Designed Pursuant to the EZflow Mound Component Manual Ver. August 20, 2007, 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, R. 10/12) EZflow Mound Version 3.0 (R. 3/1/12) Pagel of 10 Mound and Pressure Distribution Component Design Design Workshest (r or c) Site Information Residential or Commercial Design Estimated Wastewater Flow (gpd) Peaking Factor (e.g. 1.5 = 150%) Design Flow (gpd) Site Slope (%) Installation Contour Line Elevation (ft) Depth to Limiting Factor (in) In -situ Soil Application Rate (gpd/ft) R 300.00 1.60 450.00 2.00 101.26 30.00 0.40 Distribution Cell Information 6.00 Cell Width (ft) 3. 4, 5, 6. 7, 8, 9 or 10 Only 0.85 Dispersal Cell Design Loading Rate (gpd/ft) 11 Influent Wastewater Quality (1 or 2) (c or e) Pressure Disribution Information Center or End Manifold Lateral Spacing (ft) Number of Laterals Orifice Diameter (in) (e.g. 0.25) Estimated Orifice Spacing (ft) _ Forcemain Diameter (in) orcemain Length (ft) Inside Pump Tank Elevation (ft) Forcemain Filter Loss (ft) stem Head (ft) x 1.3 Vertical Lift (ft) -Friction Loss (ft) Total Dynamic Head (ft) E 3 2 0.125 2.50 2.00 45.00 9 O..Ok .50 F1860 Lateral Diameter Selection in. dia. options choice 0.75 1.00 1.25 1.50 x x 2.00 x 3.00 x Treatment Tank Information 1000.00 Septic Tank Capacity (gal) Wieser Concrete Manufacturer 120.00 Contour Length Available (ft) 90.00 = Dispersal Cell Length (ft) Are the laterals the highest point in the distribution network? Enter Y or N If N above, enter the elevation ft of the highest point. 7.50 ft'/orifice Does the forcemain drain back? DY Enter Y or N 7.341 Forcemain Drainback (gal) 81.251 5x Void Volume (gal) 88.59 Minimum Dose Volume (gal) 29.66 System Demand (gpm) Manifold Diameter Selection in. dia. options choice 1.25 x 1.50 x x 2.00 3.00 Gallons/Inch Calculator (optional) 602.82 Total Tank Capacity (gal) 51.00 Total Working Liquid Depth (in) 11.82 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 602.82 Dose Tank Capacity (gal) JPolLok I Filter Manufacturer 11.82 Dose Tank Volume (gal/in) JPL525 I Filter Model Number Wieser Concrete IManufacturer Project: Noll 3 bedroom replacement mound Page 2 of 10 � § V 2 kk LU .§ / ! k R N E U-LL - ; e k . g& f � I x E CL to o� 2 `!0 � )| �coo CL \0 !� $k C A E a� 0 #dam _mqo £ ■ PGU_'BIP ., ad#«_m OCCL f )] 2 3# / M f\jƒ% fk 7 mU) �«< 0 k c :511EMM \ U End Connection Lateral Layout Diagram Place Appropriate Lateral Diagram From Right Below s Z 41 st artrio looted at z k-x—>l oHllns Point w &MY ft one paM dawn for drall �. Fco awbed. L*watsetum*mWncFPyCgoh40 N lidell with tYlaras oqm*y - per We Tabb *04.W4 Number of Laterals Lateral Diameter Lateral Length (P) Lateral End (Z) Lateral Spacing (S) Lateral Flow Rate System Flow Rate Orifice Diameter Orifice Spacing (X) Orifices per Lateral Orifice Density Manifold Length Manifold Diameter Forcemain Velocity Dose Tank Information Electrical as per NEC 300 and --► SPS 316.300 WAC Disconnect y Tank component is properly vented Wieser Concrete Ca aci 602.82 Volume i 11.82 Manufacturer Gallons gallinch Dimension Inches Gallons A 29.51 348.75 B 2.00 23.64 C 7.49 88.59 D 12.00 141.84 Total 5100 602.82 And T A B As Per Manufacturer Locking cover with warning labet and locking device and sealed watertight 4 in. min. E— Alternate outlet location Alarm Manufacturer ISJ Rhombus Alarm Model Number JJB Plugger XL Pump Manufacturer JZoeller Pump Model Number IBN151 Pump Must Deliver 29.66 gpm at 1 18.60 ft TDH Note: Switches containing mercury may not be used in this system. Forcemain diameter 2 in. Weep hole or anti - siphon device Pump off elevation (11) 91.00 Dose tank elevation (it) 90.00 Project Noll bedroom replacement mound Page 4 of 10 EZflow® Distribution Cell Media Layout 6.00 Cell width (ft) 1.50 Sldewall to Lateral (ft) Distribution Cell Cross-section Arrangements. MR N »ti. ♦�til��. ��ti> �ttil�titi1. Component Legend ® SR1-7A Bundle - 5 ft or 10 ft lengths SRI-12A or EZ 1201A in 5 ft or 10 ft lengths SR3-12H or EZ 1201 P or SR3-12H in 5 ft or 10 ft lengths O 4" Perforated Distribution Pipe With Pressure Lateral Inside • Tumup Enclosure - - - - - Pressure Lateral Bundles are covered with approved geotextile fabric as per the their product approval. Distribution Cell Plan View Layout - Typical 6.00 Cell Width - A (ft) 1 90.00 lCell Length - B (ft) Xt�W 0 Center Connection Lateral Layout Diagram Force Main •Y.Y,Y Y`t Y:Y,4°�Y,Y,4` r1Y�Y,YhY,Y.4' hY,Y.+r' h 7. Y.T Y. Y. Y.'r' rY Y. Y. Y' t'r. Y .Y' h'T'. Y. Y' h •r. Y.'f' Project: Noll 3 bedroom replacement mound Page 5 of 10 Mound System Maintenance and Operation Specifications Service Provider's Name JJmaes K. Thompson Phone 715 248-7767 POWTS Regulators Name St. Croix -County Zoning De 't Phone 715 386-4680 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 540 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Cohform >10E4 cfu/100 mL Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other Service Frequency Inspect and/or service once every 3 years Inspect and clean as necessary at least once every 3 years Test once every 3 years Should test periodically Laterals should be flushed and pressure tested every 3 years Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap and are secured in as shown in the EZflow Mound Component Manual Ver. August 20, 2007. 2. Dispersal cell media conforms to EZflow products approved for use with the EZflow Mound Component Manual Ver. August 20, 2007. Media is covered with an approved geotextile fabric 3. All gravity and pressure piping materials conform to the requirements in SPS 384, 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 Tum-up Detail Finished Grade` ., 6-8" Diameter Lawn // Sprinkler Valve Box Lateral Ends at Last Orifice Where Variable Length Cleanout Begins Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral 1 • = • = ti11vVi�•�11'1.95 Feet e'i i•Lateral Cleanout Project: Noll 3 bedroom replacement mound Page 6 of 10 Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SPS $82-84 Wis. Adm. Code, and shall maintained in accordance with Its' component manuals "ow Mound Component Manual 820/W, Pressure Distribution Component Manual Ver. 2.0 SBD-107W-P (N. 01/01) and SSWMP Publication 9.6 (01/81)) and local or state rules pertaining to system maintenance and maintenance reporting. Septic and pump tank abandonment shall be in accordance with SPS 383.33, Wis, Adm Code when the tanks are no longer used as POWrS 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 shag 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 Tan The septic tank shall be maintained by an individual certified to service septic tanks under a. 281.48, State. 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 filler 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 lank 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 personnei shall advise the owner as to 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 Wisconsin Department of Commerce. Pump Tank The dosing (pump) 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. If the force main has a weep hob, it should be noted If It is functional during pump operation, and if not, it should be cleaned " No one should ever enter a septic or dose tank since dangerous gas" may be present that could cause death." Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, arid 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 BOD6, 150 mg/L TSS, and 30 mgn_ FOG for septic tank effluent or 30 mg/L BODp, 30 mg/L,TSS, 10 mg/L FOG, and 104 ctW100 mL for highly treated effluent. Influent now may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing paint at the end of each lateral, and it Is recommended that each lateral be flushed of accumulated solids at bast once every 3 years When pressure test is performed it should be compared to the Initial test when the system was Installed to determine 0 oriflce dogging 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 4 inch" considered ass an impending hydraulic failure requiring additional, more frequent monitoring. Continency Plan If the septic tank or any of its components become defective the lank 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 fags 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 sad components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Noll 3 bedroom replacement mound Page 7 of 10 PUMI* PERFaiIMNCE CURVE MODEL 151f152M63 11ArIr11M/rE alalra 29. GG g f7M. :r11'r11 Ca m !Si s L%4 ra�c l� or. CONSULT FACTORY FOR SPECIAL APPLICATIONS ]It • Now daft pa3M3 easlehw. • EWd*d 1N imbR for dtptaa ems, rt arsine rA wgpitd 10 rl drm. •VriiM W4=a rasNrt"ties~foroas ng draw 01 ywnm. • De]Aw pima' ' rrA A 1 famm sot ettMee 3n ride for rri I I Isrt"rid 3Aat cy* =**— • 9rawd Ov*4o11 rriiw for olAim bslydaw. 9es FM1420. • Orr 130'F. (34•C.) 3pedel 4rdion ng1Ad 1511152ff53 Series fa mm" NOMA c10YF2 ta►rta do" rlih rasa Amapa NOW I NOW MI54 in i ham t0 1 I 2r3 BIn51 115 1 Ab to rrtra4 2 r 3 051 230 1 Man 12 1 2 a 3 BE151 230 1 Ada 12 f]drba 2a3 Mir 115 1 Mm t5 1 2ar3 smaz 115 1 Ab is rldreae 2a3 032 23D 1 Mw 43 1 2r3 1 775 / Alb 47 Yd]dad a3 Irl ifs 1 Me] --1QT 1 2a3 B1M53 115 1 Ab lob rrLbd 2r3 Elm 210 1 1. M. 5.3 1 2v3 HEMI 30 1 1 A]lb 1 5.3 eadYd 2a3 TOTAL DYNAMIC NEADIFLOW PER MINUTE EFFLUENT AND DEWATER14G MODEL 151 152 153 ar.. ad Lin Owl u.. Oi uan If so it r 261 n 2" it n 231 19 m 43 1 201 a DItt p2D 44 w TA M39VA 3f ra11la r a ma - - rtv t1 a2 Haeat mt 1w aft. 11 M► ].ea Model 151 are Models 1521153 3Z ➢ SELECTION GUIDE Sanom peppadc rrohla WM ioet vAdoh a dxtb pWybod variable WM Bart I_CAVT _I OAt. fW to 1`140/77. AH Inaalaa.. et mntrW.. Vaaaaron aaMoaa and aldn0 haid W done iry a 0ualhd 2. SM FM0712for arrea nlobl of BOctulAftmia EFet aawead awtldan. A3 aaetmr wd away codesanadd W kllde Inaaaao 1W mow 3. V3aie61e ►1e1 awardf]aiti110022b utd we t coital eciiaala,'Pelt dpc 171 namt Nvba E*A%CodattEc7 and the 0ow"Nma 5atat7 wd wealth Aa(OBMAI. a (4) kw fin. RESERVE POWERED DESIGN For 1s mmmi 11m& ms ■ fawn mmy bft Is wwworod ft ft deeipl of w-wy Zoeller puny. AAg MLM P.O. BOXf047 LO xvm 3eu 40r46G11� / M.r.wa ra.. e LMW^ KY 4WII 13e1 rtw .,.�FI..]�.... O CopyrVft 2004 Zoeller Co. Al dents n ed. p� 8aF9 �Ffi. d w I o 0'si S•:/tr/a iiw �w� fL'E 'fPl. +,wMd�/nK�Mr..O �acc j,Sae ey/� iaS�7tr+r3f- A6, wmfm; e•J� 6fkY . 1406{9, /obE•!'.a4ems.�C sec q, T'�►T,.P. »�, T . o! hG.nwrena( SE. Geis Gy a2r Pe% coo/B-/efl-M9-oen 5--140e -YAA •Cloe-sss aq�4�.e/SiE 4jag— eteel. y �(jrwr-Oi71�t / kepe,.d..ku /aCs'tilon r 3 4drary' �es:a&nK N f ropss.d Ksd at /d I3 jr v4f 34' w/ 4'x Io'dr�.er3a/a64 7r.o(tj 1"wak ai ilk i arAf,.w o •oir,*C" yjoCu,-,"'t-SA. TerC•/d a(W s✓Aa erw. �• bt ie%75'a t G' sisr ZOAAS-Cw *Kr �f �!. e_.r , T p • Psioll /�. - Bruce dS��ydc✓/ rrpr: �lss+e,yRAtfr4r/ne�cD /a.S/7r/�Sf, e.a ens.., Apo-,f�Q �/• E { .i l e ilae /Lci/h1 i7 .SE�9r3k% f#Ifi ..a s+/ , -Ale 3.T.' Su(•Yo in � asd'ef EtwR': F2� �'�.0�, tom. P�epoacd w ✓ pop gel a as d wie .. ci a4 iB.14i'xroS. 34' cy _ �w/ G'x4o'dr�v3a/eea >woiz3 @. 3 6�dr)a•m ' rsEea�:(3 ad uy, x dR.ad'wY!'vl,Gc.s Fcsalcicc spsc.-o/o�.2.sa,' S.�re-a.6�.+r srryGce erv, yee io% �6'a! G char .a ti'cmt F. may. (,V'), APPLICATION FOR REVIEW -Complete all pages - NOTE: Personal information you provide may be used for secondary purposes (Privacy Lew s. 15.04(1)(m), State] Private Onsite Wastewater Treatment Systems Division of Industry Services ❑ Plans to be E-filed. Provide SharaPoint User name below: For plan status, check our webli@e at htto://dsps.v i.aov Several counties have been delegated certain authority to review plans in lieu of Division of Industry services. For a current list of those counties and their designation check our website at hit ://ds s.wi. ov 1. Project IMomlatlon -Fill In all known Information. Confirmation of assignment to a reviewer. Project/Site Name: Noll 3 bedroom residential mound Transaction ID: Location, Number & Street of project (if unknown, indicated nearest road) Previous Related Trans, to: 1015 174e St. Hammond WI 54015 Estimated Completion Date: Legal Description: Lot 49, Plat of Pheasant Ridoe 10Addition SE1/4 Assigned Reviewer: SWt/4. Sec. 09 T.29N R.17W Assigned price: County Tn. of Hammond, St. Croix Co., WI. Mall to your office of choice below: ❑ C ❑ Village ® Town of Hayward, LaCrosse, Waukesha _ NOTE: We reserve the right to redistribute plans to another office if 2. After plans are reviewed, plane: (check all that apply) ❑ Cell customer 1, 2 (circle number)' needed to reasonably balance turnaround times. Check htto://dsps.wl.dov for office availability and next available review date I-] Requesting party will pick up ® Mail plans to customer 1, 2 (circle number)' 'Refers to customer number from below. 3. Complete the following designer/owner/requesting Information. Utllhe the check boxes when designer, owner or requesting party Is the same to avoid repeating information. Designer Information (Customer 1) DSPS Other Please Specify Below (Customer 2) DSPS First Name Last Name Customer Number First Name Last Name Customer Number Jim Thompson 30021 Company Name Company Name A.C.E. Soil 8 Site Evaluations, LLC Address Address 340 Paulson Lake Ln. . city State 7ip+4 (9 digits) City State 2ip+4 (9 digits) Osceola WI 54020 Phone Number E-mail address Cell phone Phone Number E-mail address Cell phone (area code) (area code) (715) 248-7767 acesoiififrontiemet net Check if applicable Check if applicable or specify relationship ❑ Owner Owmef El Other — specify relationship Information and Plan Submittal Checklists. POWTS pre -scheduling is not available. Plans will be assigned to a reviewer after receipt at a DSPS office. Submittals received may be assigned to offices other than the receiving office depending on reviewer availability. Submittal checklists can be found in each applicable component manual appearing on the POWTS Publications page, htto://dsps.wi.aov/phptsb-opaloop/i)rodcode result.DhD/POW`rSMIPOwTS COMPONENT MANUAL. You may small tachnloal code questions to DISPS38PowbiTechill%viri.gov. Hayward DSPS LaCrosse Area DSPS Waukesha DSPS 10541 N Ranch Rd 3824 N Creekaide 141 NW Barstow St Hayward WI 54843 Holman WI 54636 41' Floor 715-634-4870 (NOTE CHANGE) Waukesha WN 53188-3789 Fax: 715A34-5150 608-785-9334 262548-SW Email: DBDBStlPlanscheduledl1wi.noV Fax: 608-785-9330 Fax: 262-548-8614 Email: DsotiStiPlanScheduleftwi.dov Email: DsosSbPlanSchedukiftwicov Make Checks Payable to: Division of Industry Services OR ❑ Check box to invoice designer and sign below Designer Signature SPS-10577 (R 10115) TOTAL AMOUNT DUE $ 260.00 Review Code 7633 5. POINTS SUBMITTAL (check all that apply — Incomplete forms may result In processing delays) ® NEW ❑ Aerobic Treatment Unit(s) ❑ Chlorinator ❑ Tank Replacement Only ❑ REPLACEMENT ❑ Commercial System ❑ UV Disinfection Unit ❑ Add Effluent Filter SYSTEM TYPEIS) NOTE: Submit separate sheets for each system it submitting multiple systems on the came she Enter Fee ❑ Revision to previously, approved plan -- $$&QD ❑ -Miscellaneous Review (Le. replacement of a septic tank, addition of an effluent fitter or pretreatment device to an existing system, etc.) $Mr ❑ Component Manual DesAll fin treatment components are previously approved ❑ At -Grade Component Manual- Ver, 2.0, SBD-10854 (N.03107, R. 1/12) Wastewater Flow In under a. SPS 384.10 (2) or (3): ❑ In -ground Component Manual - Ver. 2.0, SB0.10705-P (N.01/01, R 10/12) Gallons Per day Design wastewater flow of the proposed system: ❑ Mound Component Manual — Ver. 2.0, SBD-10591-P (N.01/01, R 10/12) _ ❑ Pressure Distribution Component Manual— Ver. 2.0, SBD-10706-P (N.01/01, R 10112) 300 1,000 gpd or less $ 250.00 250.00 ® Other - Please specify EZBow Mound Component Manual Version 3.0 (R. 3/1/12) GPD 1,001 — 2,000 gpd $ 325.00 2,001 — 5 000 gpd $ 400.00 ❑ Soil Based Individual Site Design' One or more treatment components are not previously approved under s. SPS 384.10 (2) or (3): ❑ At Grade (individual site desgrVdeviation from component ❑ Non -Pressurized In -ground Design manuals and use of components without product ❑ Pressurized In -ground Wastewater Flow in approvag: ❑ Mound Gallons Per day Design wastewater flow of the proposed system: ❑ Drip -line ❑ Constructed Wetlands GPD 1,000 gpd or less $450.00 ' Documentation roust be provided to support treatment and dispersal claims. In a separate 1,001 — 2,000 gpd $500.00 statement, provide rationale for the project and attach supporting documents (code sections, test 2,001 — 5,000 god $750.00 _ reports, technical papers, research articles, etc.)greater than 5.000 gpd $900.00 plus $0.08 for each gallon over 5000 gpd State-owned facilities: Dter Holding tanks previously approved under s. SPS ElHolding Tank Component Manual, Ver. 2.0, SBD-10855-P (N.03107, RI/12)' Wastewater Flow in 384.10 (2)(3). Design wastewater flow of the proposed system: Gallons Per day ' Non -state owned Commercial ant Residential Holding tanks that completely utilize this manual 5,000 gpd or less $ 90.00 and have an estimated daily flow of less than 3000 gallons per day must be submitted to the GPD 5,001 — 10„000 gpd $150.00 — appropriate governmental unit for review Instead of the Department. Isee SPS 383.32(3)(a)] greater than 10,000 gpd $225.00 ❑ Holding Tank Individual Site Design', 0 e. site constructed, <5 day holding capacity, Co- Design Holding tanks including she constructed tanks NOT mingled wastewater, etc.) astewa Wastewater Flow in astewa previously approved under a. SPS 384.10 (2) or (3). Posse specify: _ - Po Gallons Per day Design wastewater flow of the proposed system: ' Documentation must be provided to support the rationale for the project. In a separate statement, 5,000 gpd or less _ $180.00 — gpd $450.00 _ please include all code sections, test reports, technical papers, research articles, etc.) GPD 10 than -greaterthan 10,000 gpd $450.00. great ❑ Soil Saturation Determination Report (using observation pipes) ❑ Interpretive Determination $240.00 — ❑ E perinerdal System (One time additional fee). Submit fee for Individual system as per appropriate ab" system type) - Experiment Number _ $400-00 — Prior approval from a section chief In required for a priority review. O approval Is granted, the priority will be reviewed within 5 daysof receipt. SPS-10577 (R 10115) Priority Review (enter same amount as normal review fee listed above) Enter Total (rounded to Me Interest dollar) $ $ 250.00 1144' � 4' CAST -A -SEAL t4"ST-A-SEAL Ill OR NI FFLE INI aIa �4' VENT lz I 'n m - -- - - J L PUMP PAD TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS W1000/600-MR TANK SPECIFICATIONS DIMENSIONS - WALL' 2 1/2' BOTTOM: 3' COVER: 5' MANHOLE: 24' I.D. PRECAST CONCRETE RISER HQGHT: 69 1/2' O.D. LENGTH: 114 7/8" O.D. a VADTH: 93' O.D. BELOW INLET: 57' O.D. LIQUID LEVEL: 51' WEIGHT: 12,380 LBS. o INLET AND OUTLET: 4' CAST -A -SEAL BOOT OR EQUAL GASKET, CAST -A -SEAL BOOT OR EQUAL INLET AND OUTLET BAFFLE AND FILTER: m g ee WSCONSIN, SEE DETAIL /10 i (OTHER STATES SEE CHART) s 4 LIQUID CAPACITY: 19.61 GAL/IN (SEPTIC) i5 o c 11.82 GAL/IN (PUMP) LOADING DESIGN: 8' 0' UNSATURATED SOIL W � Y LIT a Y Y� TANK CAN BE USED AS I SEPTIC/SEPTIC, SEPTIC/PUMP N r7 OR SPT1C/SIPHON O i COVER: MIX DESIGN 08 NO FIBER) iSTRUCTURAL a TANK: MIX DESIGN /10 FIBER) CUSTOMIZED TANKS E FOR CUSTOM TANKS CONTACT WIESER CONCRETE � 1g3 Q U g F DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: SHEET N0. APPROVAL DATE: / PRODUCTS NEEDED BY: ppp F / ,� !W0:1110.!11ftT.= IncDrainage Zabel` A amson M Polylok Inc. PL-525 Filter PL-525 Effluent Filter The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the Polylok PL-525 has an automatic shut-off ball installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off the system so the effluent won't leave the tank. I Features: • Rated for 10,000 GPD (gallons per day) • 525 linear feet of 1/16" filtration. • Accepts 4" and 6" SCHD 40 pipe. • Built in gas deflector. • Automatic shut-off ball when filter is removed. • Alarm accessibility. • Accepts PVC extension handle. Pl: 525 Installation: Ideal for residential and commercial waste flows up to 10,000 gallons per day (GPD). 1. Locate the outlet of the septic tank. 2. Remove the tank cover and pump tank if necessary. 3. Glue the filter housing to the 4" or 6" outlet pipe. If the filter is not centered under the access opening use a Polylok Extend & Lok or piece of pipe to center filter. 4. Insert the PL-525 filter into its housing. 5. Replace and secure the septic tank cover PL-525 Maintenance: The PL-525 Effluent Filters will operate efficiently for several years under normal conditions before requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped, or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing Servicing should be done by a certified septic tank pumper or installer. 1. Locate the outlet of the septic tank. 2 Remove tank cover and pump tank if necessary 3. Do not use plumbing when filter is removed. 4 Pull PL-525 cartridge out of the housing. 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank. 6. Insert the filter cartridge back into the housing making sure the filter is properly aligned and completely inserted. 7. Replace and secure septic tank cover. 1/16" Filtration Slots Accepts 4" & 6" SCHD 40 pipe Outdoor SmartFilterns! Alarm Polylok, Zabel & Best filters accept the SmartFilter® switch and alarm Alarm Switch (Optional) Accepts t" PVC FAtension Handle Rated for 10,000 GPD 525 Linear Ft of 1/16" Filtration Slots Certified to NSF/ANSI Standard 43 Gas Deflector Automatic Shut -Off Ball Extend & Lok' Easily installs into exastmg tanks Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll Free: 877.765.9565 Fax: 203.284.8514 www.polylok.com pe.Wa,c7 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Bruce & Stacey Noll Mailing Address P.O BOX 301, New Richmond, WI 54017 Properly Address 1015 174th St., Hammond, WI 54015 (Verification required from Planning & Zoning Department for new construction.) City/State LEGAL DESCRIPTION Property Location S E '/4 Parcel Identification Number 018-1099-49-000 SW'/4,Sec. 09 ,T 29 NR17 W,Townof Hammond Subdivision Plat: Pheasant Ridge 1 st Addition Certified Survey Map # Na Warranty Deed # 1089346 Spec house ❑yes[Dio Lot # 49 Volume Na , Page # Na (before 2007)Volume Na , Page # Na Lot lines identifiable ❑+ yes❑no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383 52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. 11we am/we the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. qMiANTS)� O 03/04/20 DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) D.., Room. UC 2019 F �I a a 6RUCL 6,/7ACY BOLL LOT 49 7M W AAT RIDG[ U*T - 1013 174th ft MAMMOAD, W134013 §q \�&�a�L H m. ,_W� .rze _w __ , m, a,\ ROOF PLAN 1/4 - FOR BIDDING ONLY NOT FOR CONSTRUCTION �8 a s` 6 1 #19-m NO r - m g �q1 ' oor � ~ rifts -rifts ri- ., 91• SE 1.4- OW 1MY'— rn rri rrn --! A /, lad o'f r FI" 8O p r GI +1 a ZAi w ' SIRE -+ g aO f, Lo a F Myi Wisconsin Dbpartmer,i of commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Q Attach complete site plan on paper net less than B 1/2 x 11 inches in size. Plan must •S include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. d Please print all . R iewe y Personal inlormahon you provide may be used for ecan7�ror(�yr' 1.vv, s 15 04 (/) (m)),� PropertyOwner Pro arty Location Page _ I _ of _3 X 9-660 Date 18�/o 3 U �tZ 1r'}S R),m;1tATr44 ,LAN � �i(1riy Gov. Lot Se 1/4.5L�(114 S 9 T 29 N R /7 E I Property Owners Mailinq Address I I Lott I Block # I Subd. Name a CSM# A loll 14D I I Pheosxn+ Rlcl e City State Zip Code Phone!Llh2 by U--'�� ity ❑Village ®Town Nearest Road 11,J1 I I ( 1 i-I xv ,y A, rl I iAAIa ['yT New Construction Use: EY Residential 1 Number of bedrooms_i__ Code derived design flow rate _ S� _L� GPD ❑ Replacement -F El Public or commercial - Describe: ____ _______ Parent material ___1 � ( __ Flood Plain elevation if applicable ,�/,ft. General comments S y_q-eYY\, e/C U, l oo • U and recommendations: - - Qar�cG>ma41,� d a�LoTf�� /Jots ssn 16cA.W ems-- �Si�� i��•�� >S' -� �e1�1�C, /6f �.�i� ! eav�6e �� io%o �,aw� s2o�.e a'"`�e ""`✓ 6e Boring # Boring CCrry� — ® Pit Ground surface elev. �_ O"_ ft. Depth to limiting factor 5 in. Sol Application Rate Horizon Depth in Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDBF •Eff#1 'Eff#2 ( O-tU j0 r313 - 5'I 2 rv,_rr cs 1V� 5 2 fU-(S 10 ri� — c( 2 �' '5 - 3 15-� /o r3/te — Sc I ZI sbk ry Fr — — S CY /04 o ec)L CH-//:77 - 20, „ % `— Boring# El�,]I Boring � L; pit Ground surface slay. f_1� ft. Depth to limiting factor _ r�V —in. Sol Applicalion Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDM 'ER#1 'Eff#2 5(`/ 24y-1 k lrlj��r} C5 IV-0 `� 8 2 -2y 10 — 5tc1 L k yYVtr C 3 Z 1U Sc I Zmsb� T - 9 r_ h Z� n �ot! 3& n 14 10- 7: — Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mglL ' Effluent #2 = BOD < 30 mglL and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Adaxrm 25330 Address Date Evaluation Conducted Telephone Number 2at3 U"- S� _ SomerSG� CLJf SYvzS z- 2-V-5rct� 6aa,L ti property Owner _ — — —_—_- 3 ❑ Boring Boring # Fri,zon Parcel ID # Lv cn_ 7 cl t Page of Soil Application Rate Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDH 'Eff#1 'Eff#2 D-9 /3 — 5'� 2 wl- r' V.' S to y??/// s k s - J6 `) Boring oonng # ❑ pit Ground surface elev. ___ _____ ft. Depth to limiting factor- ____ in. Sol Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Co. Sz. Cent Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD#f 'Eff#1 'Eff#2 Ej ❑ Boring # BoringGround surface elev. ❑ Pit ___ - ___ ft. Depth to limiting factor in. Sol Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/IF 'Eff#1 I 'Eff#2 Effluent #1 = BODs> 30 < 220 mglL and TSS >30 < 150 mg/L ' Effluent 92 = BOD, <30 mglL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If yomneed assistance to access services or .need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SRD-8330(R.07100) I u PAGE 3 OF 3 NAME P ( Fz c4 S �O_l'# y9 LEGAL GA DESCRIPTION SE YV w X S `l T 2 i .NA /7=o & SCALE: I°= %O BM i ELEVATION /60. 0 BM I DESCRIPTION {o 62 o % i .S/tee / W.c0 BM 2 ELEVATION `T (- BM 2 DESCRIPTION%rip SYSTEM ELEVATION 166) O SYSTEM TYPE ro A CONTOUR ELEVATION • ' �. 'ate �. � . cy ml •, s \✓ •O ' q \ 2• ry 0 � I ��: S3 III 8.3 ry \ � 1.84 RES \ Q ' \ 28ARES o \ fs B i Nry i �h (b - � z 4 pda 2.0 AC ES W fl a B- ro ' 0 -a c h, w / �0 o x� 1066.E i Q �j� \1 . I � A 1 .1086.8 - • 8 095.8 --- ' --------t----269._ �o---- ---9- 17 108 6 0 7. -- I Wisconsin Departme;:t of Commerce SOIL EVALUATION REPORT Page_ of_3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Coda County C('O' X Attach complete site plan on paper not less Than 8 112 x 11 inches in size. Plan muss `� 1 include, but not limited to vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Q I 11 U V Please print all ' n.._ _.___ R ie`ve y Date Personal information you provide maybe used for econd2 ,der#osas (PrivaeT )_�.v, s 15�OC (11 (m )) - ab O3 Property Owner Progerty Location U 4, f Govi. Lot SE 114 S 9 T 29 N R 17 E (or)CW, Property Owners Mailing Address Lot f Block # Subd. Name a CSM# (OII 170 SI 1ih I�hec Ar f 12r� Z �T f� City Slate Zip Code Phone Number - ity ❑ Village S Town Nearest Road 10 ( ) UU � lornm 100 rl ja - Ek New Construction Use EY Residential / Number of bedrooms 3-_1_ Code derived design flow, rate _ '�Y S C) / z'0 GPD ❑Replacement ❑ Public or commercial - Describe: __ _ --_ —_---_ Parent malarial __ r ( ( Flood Plain elevation If applicable ---------------------- General comments C y-Z ✓h Pic V D(i • U and recommendations: ' ! ' (�OiYLliGV1-n—�9�r+1¢ lvi L-OT f/�� /"Df vn Sr(in..� IOC/�h�+�- Oh S/ie� ��p�•n�^ �S,r�/ —f0 he•t��t /oi.�cJ � �l Gv�%f tie � /o/a Cc,t{?uv S�'D� R'•rG� ""`� 6¢ `0 U Boring Boring # ® pit Ground surface elev.36 _ft ft. Depth to limiting factor 75 _ in. Sni Annl� ira Hnn Rafe Horizon Depth in Dominant Color Munsell Redox Description Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDR4 'Eft#1 'Eff#2 c5 2 f0 IS lc) r !� — 51 �i Zr Cr 5 — 3 20, a Boring# Boring I + lO / ® pit Ground surface elev. _ U ft. Depth to limiting factor _ t�i� _ in. Sol Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh Consistence Boundary Roots GPDfiF 'EH#1 'Eff#2 D $ ID 3 — 51'l 2:r1sk rv) 1 vP 5 IT 2 z y 10 — 5,< I 2 vn' k ✓v�r < 3 Sc 1 Zmsbk Or Effluentfill = BOD > 30 < 220 mgA- and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg1L CST Name (Please Prima Signature CST Number Adam 25.3W Address Date Evaluation Conducted Telephone Number 2113 b'`— _ SomerS�� ((i t fZ/4zS z — S`—a ? i715 L`f7-5/0.� Property Owner U / Te f -f 5 Parcel ID # Boding# ❑ Bonng C pit Ground surface elev. f ��L_J0ft. Depth to limiting factor _1/— _ in. Page __ Z _ of _v Soi ADo� licaaon Rate Horizon Depth in Dominant Color Munsell Redox Description On. Sz. Cont. Color TexturejG%z. Structure Sh Consistence Boundary Roots GPD/ff •Eff#1 'Eff#2 U-9 13 5�Y/ 3 2 l{ i - ,ye, SDI �r - - -5 -nl ❑ Boring # ❑ Boning ❑ pit Ground surface elev. _______ _ R Depth to limiting factor in. SnR Annl�ira Horizon Depth in. Dominant Color Munsell Redox Description Ou. Sz Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDM 'Eff#1 'Eff#2 ElBoring# ❑ Pit Ground. ____ surface elev----- r — R. Depth to limiting facto_—_ in - Sol Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Ou. Sz. Cont Color Texture Structure Gr. Sz Sh Consistence Boundary Roots GPDtfe 'Eff#1 I •Eff#2 I j -- — ' Effluent #1 = BOD,> 30 < 220 mglL and TSS >30 < 150 mg1L ' Effluent #2 = BOD, < 30 mglL and TSS < 30 mglL 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. SR04330(R 071W) PAGE .'- OF 3 NAME i/I Fz 5 LOT# yy LEGAL DESCRIPTION 5r `/a5w i S `7 T 2-9 ,N.R /-7 E(or SCALE:I"= fC' BM I ELEVA rION /O c a FN BM I DESCRIPTION t,O c j l� BM 2 ELEVATION y�• �c BM 2 DESCRIPTION SYSTEM ELEVATION /6C O SYSTEM TYPE ro ny � >-L { � K � Sic . y I hL 6 - L \ 'tl1 0 i 1..0 AC s N $ o I v Sol qq.6 q ,y 2l �/Oo a . m 01 • CO L sL \ h , 1.54 R SRO / \ 25ARES a , A, r 7^7 4i r , o \ Q � r o - 2 � \\ 8 L T 8 i 309 e 2.0 AC ES g �� W (a` i i ry r r i i b p i Q•� M� , • B— 0 —4 'rOs •�/ �A h . oW o 0 i x • o �1 ... ..... ..t........ r 1 .......... ....... •>l x � a - ---fir- 1086.8 i_" Cl 1095.8 Gt3ECMWE-0 MAYL13 2021St. County Communior HOLDING TANK SERVICING CONTRACT Contract Date S(3 _ This contract is made between the Tank Owner(s) Name(s) and Pumper's Name �jirv.eiZ.-tom 1�w1.C�d-SIQc /VUl J `G°71j 541,VY We acknowledge the installation of (a) septic/holding tanks) on the ollowing roperty: Provide legal description). 1015 / 7 nT atv OL 5 °(U / .�_ 4 sFtt sw y ate, k 17 j✓ f --------------------------------------------- 1. The owner agrees to file a copy of this contract with the local governmental unit (St. Croix County Planning & Zoning Department) to document maintenance by a certified septage servicing operator as required in SPS 383.52(1)(c)2. Wis. Adm. Code and the approved Component Manual. 2. The owner agrees to have the septic/holding tank(s) serviced by the undersigned pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the septic/holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the septic/holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the septic/holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local governmental unit (St. Croix County) a report for the servicing of the septic/holding tank(s) on a monthly basis. The pumper further agrees to include the following in the monthly report: a. The name and address of the person responsible for servicing the septic/holding tank; b. The name of the owner of the septic/holding tank; c. The location of the property on which the septic/holding tank is installed; d. The sanitary permit number issued for the septic/holding tank (if known); e. The dates on which the septic/holding tank was serviced; f. The volume in gallons of the contents pumped from the septic/holding tank for each servicing; g. The disposal sites to which the contents from the septic/holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the local governmental unit named above within ten (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) O'"r's Signature(s) f Subscribed and sworn to me on this date: Today'sDate Pumper's Name (Print) Pumper's Signature Notary Public Signature /1 y' Pumper's Number Commission Expiration //Registr gtion 7 /