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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County:
Safety and Buildings bivWon
INSPECTION REPORT 1 �4. G/ !20!
,GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary PermitNo.:
Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)). q o�V Z - 1 8
Permit Holder's Name: ❑ City ❑ Village ❑ Town of: State Plan ID No.:
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.:
a .30 -z! - o -06
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic (Ben m r t
Dosing
Aeration Bldg. Sewer �o • /3
Holding St / Ht Inlet .0
TANK SETBACK INFORMATION St/ Ht Outlet .30
TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet 2„(pp
Air Intake
Septic ( it NA Dt Bottom q
Dosing 3b NA Header /Man.
Aeration NA Dist. Pipe
Holding Bot. System
PUMP / IPHON INFORMATION Final Grade
Manufacturer Demand rd,t , f'�0
Model Number GPM f Z
TDH Lift Friction System TDH Ft jAA.o„� `(o.9D
oss ti �
rForcemain Length Dia. Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width
I Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS DIMENSION
SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
SETBACK CHAMBER
INFORMATION Type O Model Number:
System:
OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length Dia. Length Dia. Spacing I i
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑Yes [] No ❑Yes E] No
COMMENTS: (Include code discrepancies, p rsonss present, et .)
c
-, ft 04^4a e. 4 +cs - 5T rca et
Plan revision required? ❑ Yes ❑ No TTJ I
Use other side for additional information.
SBD -6710 (R.3/97) Date Inspector's Signature Cert No
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77
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® Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7082
iseonsin Madison, Wl 53707 - 7082 Sanitary ermit Number (to be filled in by Co.)
Department of Commerce ( 261.6546 4 -M
Sanitary Permit App State Plan LD. Number
In accord with Comm 83.21, Wis. Adm. Code, personal form FwW.E D
may be used for secondary purposes Privacy it , sl5.04(1 xm) Project Address (if-different than mailing address)
I. Application Information - Please Print All Information APR 0 r! ZUO3
'a Name ST. CROIX COUNTY Parcel # Lot # / Block#
P / 7/7.
_ - FFICE C (
Prooerty Owner's Mailing Address Property Location
City. S Zip Code Phone Number ti Section
T � N; R)_tE
II. Type of Building (check all that apply)
Subdivision Name
❑ 1 or 2 Family Dwelling - Number of Bodrooms )
O PubliclCommercial - Describe Use
❑ State Owned - Describe Use ❑City ❑Vi ge ownship of
IIL Type of Permit: (Check only one box on line A. Complete Hue B If applicable) D3D of - . 006
A ' ❑ New Sy yet ❑Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System
B - Permit Renewal ❑ Permit Revision ❑ Change of ❑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 V Mound 2:24 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 ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip lane ❑ Gravel -less Pipe ❑ Other (explain)
V. Dispersalfrreatment Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
6
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New I Existing
Tanks Tanks
Septic or Holding Tads
Aerobic Treatment Unit
Dosing Clamber
VII.
Responsibility Statement- I, the undersigned, ume respon for Installation of the POWT shown on t he attached pleas.
7 P ber' (Pri ) Plum 's MP/MPRS Number Business Phone Number
-I�
i ber's Address ( treet, Ci State, Zip
VIII. Cou'lity iD ggartment Use onl
Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date issued s ' g Agent Signs (No Stamps)
Surcharge Fee) 5O
❑Owner Given Reason for Denial
IX. Conditions of Approval/Reasons for Disapproval
Attach complete plans (to the County only) for the system an paper sot less than gin z I I Inches is also
SBD -6398 (R. 08/02)
7-8`
Sanitary Permit Application Safefy & Buildings Division
In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave.
See reverse side for instructions for completing this application PO Box 7302
`� seonsin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302
Department of Commerce (Submit completed o
[Privacy Law, s. 15.04(lxm)] td f t county if not state owned.)
Attach complete plans (to the county-copy only) for the system, on paper not less than 8 -1/2 x 1 I inches in size.
County State Sanitary Permit Number ❑ Check if revision to previous application tate P an I. D. Number S w
3�3 3
I. Application Information - Please Print all Information ocation:
Pmpe er Name Property Location
Z�'
1/4 1/4, S T ,N, R (or
Property Ownees MaflffiTAddress Ut Number Block Number
o+�
Gty, S Zip Code Phone Number Subdi 'sion Name or CSM Number
II. Type of Building: (check one) ❑ city
❑ 1 or 2 Family Dwelling -No. of Bedrooms: ❑ Village U 15 �y 0
99 Public /Commercial (describe use):_ �6-� uk �J/q _a Town of ( l
❑ State-Owned
12 S nn nn pp_� " 100 v Nearest Road
6 O X �o s� , C�> ?� �ox0.�}a ¢�,� Parcel T Nuni er s
III. Type of Permit: (Check only one box orf line A. Check box on line B if applicable) ? 1 . 3 0 . 9 1
A) 1. 0 New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to
System System Tank Only Existing System
B) Permit Number Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply)
❑ Non - pressurized In- ground JO Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In-
ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade I ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
C
V Disp ersa l/T reatment Area Information:
I 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation
_ / r
VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks
/Oa d A ❑ ❑ ❑ ❑
Iso Gv _
P 0 J 0 E3 L
VIII. Responsibility Statement
I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Yarne rint) Plumbe 's Signa (no slam MP/MPRS No. Business Phone Number
/> --/67 s = -
Pl m er's Address (Street, City, State, Zip ode)
IX. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued s ing (No s)
(Approved ❑ Owner Given Initial Adverse Su!rharge Fee) ao
Determination n '
X. Conditions of Appr val /Reasons f Disapproval.- - -
}.
1411 s _ m'' P Q- �°°4� • ' +
SBD -6398 (R. 07/00)
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. Safety and Buildings
10541 N RANCH ROAD
HAYWARD WI 54843
TDD #: (608) 264 -8777
lf
vsconsin www.commercestate.wi.us
Department of Commerce Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
October 07, 2000
CUST ID No.224263 A77N.• POWTS INSPECTOR
ZONING OFFICE
KIM A O'CONNELL ST CROIX COUNTY SPIA
504 3RD AVE 1101 CARMICHAEL RD
OSCEOLA WI 54020 HUDSON WI 54016
RE: CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 10/07/2002 Identification Numbers
Transaction ID No. 436408
Site ID No. 164746
SITE: Please refer to both identification numbers,
Site ID: 164746, WHITE EAGLE GOLF COURSE above, in all correspondence with the agency.
ST CROIX County, Town of SAINT JOSEPH; NWl /4, NW1 /4, S31, T30N, R19W
Facility: WHITE EAGLE GOLF COURSE - RAINSHACK/BTHRM FACILITY 1297 COUNTY HIGHWAY V,
HUDSON 54016
FOR: NEW MOUND, 615 GPD
Object Type: POWT System Regulated Object ID No.: 762560
(�) This approval is for a new mound system to serve a maintenance building with 10 employees, one shower taken per
day in the public shower and 1 floor drain.
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. Pp
C
The following conditions shall be met during construction or installation and prior to occupancy or use:
1. This plan action is subject to designer comments on the plan.
2. The maintenance plan for this system must be given to the owner of the POWTS.
3. The orientation of the mound system must be such that the longest dimension is oriented along the
surface contour per COMM 83.44(6)(a)2.
4. Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. G�i(
5. Holes must be drilled with sharp bit and all burrs and foreign matter removed before installation.
1 contain the telephone numbers of persons to contact. Be sure
6. The management plan /users manual must c p p
g P
to amend your plan and provide this information to the owner.
➢ NOTE: A soil absorption system should be designed as long and narrow as possible. This system has a high
linear loading rate of 10.0 gallons per foot.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction /installation/operation.
. KIM A O'CONNELL Page 2 10/7/00
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
Sincerely, DATE RECEIVED 09/08/2000
FEE REQUIRED $ 175.00
FEE RECEIVED $ 175.00
PATRICIA L SHANDORF , PO TS PLAN REVIEWER BALANCE DUE $ 0.00
Integrated Services
(715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM
PSHANDORF @COMMERCE.STATE.WI.US WiSMART' code: 7633
cc: WILLIAM R BLOCK WHITE EAGLE LLC
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MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN
Commercial Application
INDEX AND TITLE PAGE
Project Name: WHITE EAGLE G.C. LLC
Owner's Name: WILLIAM BLOCK
Owner's Address: 1297 CTY RD V
HUDSON WI 54016
Legal Description: NW- NW- SEC31- T30N -R19W
Township: ST. JOSEPH
County: ST. CROIX
Subdivision Name WHITE EAGLE GOLF COURSE
Lot Number: Dock Number:
Parcel I.D. Number. '
Plan Transaction No.: «`
Page 1 Index and title
Page 2 Data entry
Page 3 Mound drawings
Page 4 Lateral and dose tank
Page 5 Pump specifications / y
Page 6 Management plan «<
Page 7 System and maintenance specifications
Designer: KIM A. OCONNELL License Number: 224263
Date: one Number: 1- 715 - 755 -3145
Signature:
Version 2.2 (814100) Page 1 of
i
10/06/2000 09:19 7152473038 BELISLE EXCAVATING I PAGE 01
Mound and Pressure OWbutlon Component Design
Maxi mum Design Flow 900 gad
t� InPorntailon
C Residential or Commercial Design (R or C) OrNwe
416. EsdmOed 1 HAVA W Flow(gWd) OWMAn
1:54 Pealvrtg Factor (e,g. 1.5 =15O%) 1b =0025
&S m a1SS
615.00 Design Flow (90) we- 0.180
8.00 Sit M 7182 - 0.219
GO-50 CO VW I** Elevation 0 114 = 02M
24.00 Depth to Limiting Factor (in) am - 0 MI
0.50 irt4tu Soil Application Rate (gpcW) srle Q313
ota rmfilon Cell kowma*m
1.00 Di9pe -ar Call DWgn Loa*ng Raft (gpd/ft
8,.50 Dispersal Con Length along Contour (ft)
1 Influent Wastewater Quality (1 or 2) Are the laterals the high Point
In the disbib bon Y
Presswe OlarnxWon Inforrrtallon networkT Enter Y or N
Center or End Manifold (C or E)
3.50 Uftn l Sparing (ft) If N above, enter the ekavOdw R
Number of laterals of the highest pant.
0.125 OWIce Diameter (in) (e.g. 025)
1.70 gNm#W Orifice Spacing (ft) 5.69 ft Orifice Density
2.00 Faumtjoin Diameter (in)
✓ 30.00 Fa vervain Length (ft) Does the fomomain drain bach'r
90.00 Pump Tank Edwation (ft) Eater Y or N
6.50 Operational Head (ft) 4.89 For+cemain Orainback (gal)
ago vertical uft (ft 81.37 3x Void volume (gall)
1.21 Friction I Loss (ft) 87.28 Minimurn Dose Volume (gel)
17.21 TcW Dynamic Head (ft) 44.49 System Demand (gpm)
L+oWmi D h mall r Selection MarWWd 014= 11W 864dion
in- oils o ions
c h o i ce in. dia o ions ctK*ce
1.00 1.00
1.25 x 1.25
I.-SO x X 1.50
2.00 x 2.00 x X
3.p0 x 77 1 3.00 x
Treatment tank Informallion Gallone/lnch Cokidatur (optional)
1000.00 ST /ATU Capacity (gat) 1000.00 Totes Tank Capacity (gal)
WL=EK5 Martuf
ac haw 53.00 Total OjoNng Uquid Depth (in)
18.888 gWAn (enter result in cell 848)
Dose Tank lnk m wm I
800.00 Dose Tank QwOO (gal) ,l llue Filter Mfv rmatton
19.34 Dose Twik Volume (gellin) ✓ ZABEL Fi ter Merxrtacdxer
WF_EKS ManufWurer A100 Filter Model Number
Projecti: WHITE EAGLE G.C. LLC Pigs 2 of
1
10/06/,2000 '09:19 7152473038 BELISLE EXCAVATING I PAGE 02
i
Mound Plan View
:....... ..... ). ;: J
t�e�srv�a+ Peas —
:...,.:. .......
.. . .. .. ..... .. ... ........... .. ..
......... .
W a
B
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r:...... -.. :: .....::: :. -. :...
Mound Component Dimensions
A 10.00 E 19.20 In H 1.00 ft K 9.28 ft
B 81.50 ft F 9. in z ft L 80.05 ft
12.00 in G 0.50 ft J 5.83 ft W ft
515.00 (fe) Dlsperdeil Cell Ame 1285.83 (fe) Basal Area
10.00 (jpolft) Linear Loading s 10.25 (ft) 1'6B Obss. Pipe Pfaeenw t
Mound Cross $eCtion View
A wrepsrte Dispwaal Area
FrAaW Grede F tO T Etc} y H
C T�
F CINPIN al CO 1Q0.00 (ft) lateral
9o.sa (ft )�I► . l
Dispervel Ceti EL ;::
D _ _
_ ....
.50 (ft) Contour Elevation
t0 Site Scope
Shadings Key Olsperam Cell
TopWd Cap See t wAv RNs
subsoll. Cap :..�, ... ► pop 4 for number of
ASTM C33 Sand► w F Iatersis; site, and
-billed Lacer Q.. L- Tygpkd Ult8fel wades- Laterals are
�e , ..:..... Centered In the AX3
A Dstribution cell.
Pr� VWrM EAGLE G.C. LLC Page 3 of
10/9612000 09:14 7152473038 BELISLE EXCAVATING I PAGE 01
Latorid :Layout Cilawam
C4614w 010 14 4& OVW ".A el 0 .Finn -JA 7i/l.Il v�I�. or dYInPY� p1Y�
t P
AM iAwals
we* "s 004d (E, x — Hd•s drl Pw ah• B ottom d w• u twar
� sp+osd
L~44s a Fargo ruin of PVC **h W S
tn« C� T4** "..WSJ
�o<w main oonr O"" % fds tw OF arose to Fro OOK at wm point.
Number of La*Ws 3 Orifice owneter 0.123 in
Lateral Diameter 1.50 in Orifice Spacing (X) i - ft
Lateral Length (P) 50,55. ft Ofifkoes per Lateral 3!l
Lanai Spw®inp (5) 3.60 ft Orifice Dwisity 5.86 ft
Lateral !Clow Rat 14.83 gpm Manifold Lengm 7.00 ft
System Flow Rate 44.49 9pm Mairgold Diameter 2.00 in
Total Oftisimic Head 1 T.27 ft
Dose Tank Mformeftn LudwV amw „ WnN
WW end WW's at" a rw
. t�Srir,�Ed eeF pw t�ec 9w.F>d —�
CO M 1Q211 WAC Dlaconrt6Ci 4 in. ROM
Tar* oornpam is prWj w1y venisti E-- Aitometa oWat
Wdiort
WEEKS. MarwfeCturer 2 in.
SM-00 Gallons — x -
Volume 19.340 9WAnch A
VVWP We gr W6.
Dina ' Inches C3ellCns B sow dev;06
A 29.85 666.02
B 2.00 38. C �purnp Orr 41e4rtion
C 4.51 47.25 �—
D 6.00 116-04 p
Total 4t.37 800.00
Alarm M=Waftm S.J. EtECTRO S YSTEMS
Alarm Model Number H - 101
Pwv Manufacturer Qq Ads
Pump Model Number 34155 - 0311 L
Pump Must Deii+rer F777744 9ptrt at 77.21 ft TDH
Project: VVHTE EAGLE O.C. LLC Pape 4 of
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' f�!,r•..;�� �. 7•1 1 dN; r r `�,G. , >. , / ' ` l.�U�V,� PUMPS. ��1L
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Mound System Management Plan
Pursuant to Comm 83.54, We. Adm. Code
Septic Tank
The septic tank shall be maintained by an Individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic
be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be asses
least once every 3 years by Inspection. The outlet filter shall be cleaned as necessary to ensure proper operation, The filter cartridge i
be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If thi
equipped with an alarm, the filter shall be serviced If the alarm is activated continuously. Intermittent filter alarms may Indicate surge fit
impending continuous alarm. The septic tank shall have is contents removed when the volume of sludge and scum in the tank exceed
liquid volume of the tank If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shal
the owner of when the next service needs to be performed to maintain less then maxdmum scum and sludge accumulation in the tank
addition of biological or chemical additives to enhance septic tank performance is generally not required. However, If such products on
shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division.
Paano Tank
The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verity props
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 ar
mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maim
on the mound Is not recommended since soil conpadion may hinder aeration of the infiltrative surface within the mound and snow corn
the winter will promote frost penetration. Cold weather installations (October - February) dictate that the mound be heavily mulched for h
protection.
Influent quality into the mound system may not exceed 220 mg& BOD5, 150 mg&TSS, and 30 mglL FOG. Influent flow may not exC&
maximum design flow specified in the permit for this Installation.
The pressure distribution system is provided with a hushing point at the end of each lateral, and t is recommended that each lateral be
accumulated solids at least once every 18 months. When a pressure test Is peformed it should be compared to the Initial test when tht
was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the d*
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and an
above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring.
Gems
This system shall be operated In accordance with Comm 82-84 Wis. Adm. Code, and shall maintained In accordance with Its' componn
(SBD- 10572 -P (R. OM)l and local or state rules pertaining to system mafntence and maintenance reporting.
No one should ever enter a septic or pump tank since dangerous gases may be present that could cause deeth. Septic and pump tanb
abandonment shall be in accordance with Conan 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components.
Septic or pump tank manhole risers, sccess risers and covers should be inspected for water tightness and soundness. Access openir
for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or sul
failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device t
accidental or unauthorized entry into a tank or component.
ContiW20" 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
operating condition.
If the dosing tank pump, pump controls, alarm or rebated wiring becomes defective the detective component shall be immediately repsi
replaced with a component of the some 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 replai
present location by increasing basal area If toe leakage occurs or by removing biologically clogged absorption and dispersal media, and
piping, and replacing said components as deemed necessary to bring the system into proper operating condition.
Questions on the operation or mointence of this system should be directed to your designer, county zoning or health inspector.
Page a of
r '
Mound System Specifications
Owner's Name I WILLIAM BLOCK
Designer's Name I KIM A. OCONNELL
Sanitary Permit Number
Design Flow - Peak (gpd) 615
Estimated Flow - Average (gpd) 410
Septic Tank Capacity (gal) 1000
Soil Absorption Component Size (ft) 615
Type of Wastewater Domestic
Inffluent Limits
Septic Tank Pump Tank Dispersal
Design Flow - Peak (gpd) 1000 615 615
Maximum Influent Particle Size (in) NA NA 1/8
Maximum BOD5 (mg/L) NA NA 220
Maximum TSS (mg/L) NA NA 150
Maximum FOG (mg/L)i NA NA 30
Service Frequency
Septic Tank Inspect and /or service once every 3 years
Outlet Filter Should inspect once a year and clean once every 3 years
Pump and Controls Test once every 3 years
Alarm Should test month)
Pressure System Laterals flushed and pressure tested once every 1.5 years
Mioundi Ins t once every 3 years
Other
Lateral Turn -up Detail
■ ou■ 6" Diameter Lawn
Finished Grade ':' `' " :'` ::':': ... ` Sprinkler Valve Box
Threaded
Cleanout Plug
or Ball Valve
Distribution
Lateral
--
-; = - - Long Sweep 90 or Two 45 Bends
Same Diameter as Lateral
Project. WHITE EAGLE G.C. LLC Page 7 of
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Wilco Department of Industry, SOIL AND SITE EVALUATION REPORT Page \ of
Lab� Human Relations
.V Safety & Buildngs in accord with ILHR 83.05, Wi Adm. Code
COUNTY
Attach complete site plan on paper not less t h a n, iq , . Plan must include, but
not limited to vertical and horizontal reference t irectiort sand ° /a. slope, scale or PARCEL I.D. # pe,fijN�j G
dimensioned, north arrow, and location and t e to near* road.
�� R
APPLICANT INFORMATION -PLEAS NT AUQtI���6ATION IEWED BY DATE
Taw1.
PROPERTY OWNER:P7UC °M\) Wn =LOCATION
c/o ICN J - t`1W 1/4 Nw 1 /4,S3\ T 30 ,N,R 19. E (or V�ll
PROPERTY OWNER':S MAILING ADDRESS COUt4ty , .L # BLOCK # SUBD. NAME OR CSM #
3 f o ° ( �. �.�LLAGG C3t.� � 'S Z'tAfNGOFFtGr ,! _ — wA'S'E eh6Lt3 60L1= CwS
CITY, STATE ZIP CODE P . UMBER ❑CITY []VILLAGE RITOWN NEAREST ROAD aT v' q
ST< V P-� ►v Ss to► IC_ sue. S �4 t'rest `t
[�] New Construction Use [ ] Residential / Number of bedrooms [ ] AdditiQn to existing building
] Replacement [j Public or commercial descxibe V_. G 1f'ttPQ Wrkib".►"CQ� $L-DG.
Code derived daily flow Z6S gpd Recommended design loading rate o - 3 bed, gpd$ - trench, gpolft
Absorption area required ZZ 1 bed, ft zz-I trench, ft Maximum design loading rate - S bed, gpd /ft - b trench, gpd/ft
Recommended infiltration surface elevation(s) aa. S It (as referred to site plan benchmark)
Additional design / site considerations "Qu" - W/ Z')', Z$ r Mb , M wt M uh Y or- S " R L.L,
Parent material Lo `S 3 o v �_-7Tt GLn� [� t O its 1.i Rood plain elevation, if applicable l'l A It
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem ❑ S RU NS ❑ U ❑ S EP U ❑ S OU I ❑ S &U [is R U
IN �► ' � SOIL DESCRIPTION REPORT me t'�S�e \.3"SUzrfa� -
�,oT
E�k LEI Wvt'h`#'sSVG
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bmidary Roots GPD /ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ITrench
xw•, x
1 0 -tn iotitz Z! z s " zms wt`Qr- CS - •s -�
Z to zv I zm v_ 31 � s I I Z S�k vn C_ S • S - �
Ground 3 Z,% -3 ` Z -SY R 31 — 6r sal VA Ab Z y,•
elev.
LlA n b -uy ?.S LtIz L//` w)�t
Depth to S 4 4,. s3 -) .s ti m q/ y S l 1 t, I Sbk hti-1- a s -
limi ting
factor L 5 o •SY Q y /l, - S 61- O S 9 >�
> '► O'�
Remarks:
Boring #
E l to - l1t _3 sbk mf>-- �S •S
3 11 -q Z - 1 -5 4 V 1 L `�s 1 z_. -O ; 'W% A- C ►ti
Ground
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Depth to
limiting
factor
Remarks:
TName:— Please Print Arthur L. We e r e r Phone. 715-425-0165
e Soil Test & Design Service - P.O. Box 74 River Fa11s,WI 54022 '
Signature Date: 98-3 l 3 Date: 11 Z S -9 S CST Number 2 0 2 5 4
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PR�-*3�.R.v1�'Tl0►J �
PROPERTYOWNER Z)QN)Q,, i?MZwT 0 -Mt-P SOIL DESCRIPTION REPORT
Page f 3
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PARCEL I.D. # Pt3vb1►y G
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourd3y Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed tench
ail Zwtsbk mi► -
Ground ZZ -39 lu`1t X yvl`�f,. &LJ -Z, •3
elev.
9 ft. t4 3cl 23 Z -S M VA s � G►- o s9 ti,, I - .-Z t . �
Depth to -p S 10 (S V V ftlu Ln �SZ 0 Z- Z `CO 39 41 ,
limiting
f f tor O i l
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Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
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elk
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i
Depth to
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Remarks:
Boring #
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Remarks:
enmwii VR or,w)N
F PLOT PLAN Pa 3 of 3
SCALE
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CST Signature Date Signed Telephone No. CST #
9 9 P
• State of Wisconsin 1 DEPARTMENT OF NATO
RAtRESRCES
Scott McCallum, Governor Box 7921
Darrel Bazzel, Secretary 101 South Webster Street
Madison, Wisconsin 53707 -7921
WISCONqRESOURCES TELEPHONE 608 - 266 -2621
DEPT. OF N FAX 608- 267 -3579
TDD 608 -267 -6897
March 30, 2001 IN REPLY REFER TO: S- 2001 -0280
William R. Block
White Eagle Golf Course L.L.C.
1297 Cty. Rd. V
Hudson, WI 54018
Dear Mr. Block:
The Division of Water is conditionally approving plans and specifications for
a holding tank to serve White Eagle Golf Course L.L.C. located at 1297 Cty Rd.
V, Hudson, Wisconsin. The plans and specifications were submitted under the
signature of Kim A. O'Connell, License #224263, Osceola, Wisconsin, and
received for approval on March 22, 2001.
Design Information:
Operation The holding tank will collect wastewater through a floor drain
by gravity. Any hazardous waste generated must be withheld
from the holding tank and handled appropriately. If needed,
oil and grease should be pumped off and disposed of by a
commercial waste oil recycler. A holding tank service contract
will be entered into between White Eagle Golf Course L.L.C. and
a licensed pumper. A condition requiring that wastewater from
the holding tank be disposed of at a sanitary treatment plant
capable of accepting the wastewater has been added below.
Pumping, disposal, testing, and repair of the holding tank will
be conducted by a licensed individual.
Wastewater Wastewater will consist of maintenance area floor water
associated with the maintenance of golf course equipment.
Tank Const. Underground prefabricated concrete holding tank. The tank will
have an inspection manhole, vent, high level alarm, and
watertight joints.
Volume 2000 gallon capacity.
Location The holding tank will be greater than 250 feet from the site's
potable well. As recommended, the holding tank is over 250
feet from any other private well, over 500 feet from any
inhabited dwelling, and over 1,000 feet from any public water
supply well. Under no circumstance are these separation
distances to be reduced to less than 25 feet.
Site Info: Reported general soils information suggests that the depth to
groundwater is greater 70 inches. A separation distance of 5
feet from the base of the holding tank to groundwater and
bedrock must be adhered to whenever possible. Should the tank
need to be located in seasonal groundwater, measures need to be
taken to prevent the movement of the tank once it is placed.
Quality Natural Resources Management € x
Through Excellent Customer Service
RuyclW
Nw
White Eagle Golf Course L.L.C. Page 2.
The plans and specifications are hereby approved in accordance with
sec. 281.41, Wis. Stats., as attested by affixing on them the stamp of
approval, Number 5- 2001 -0280, subject to the following conditions:
1. That the wastewater be disposed of at a sanitary treatment plant capable
of accepting the wastewater. If needed, oil and grease will be pumped
off and disposed of by a commercial waste oil recycler. Other methods
of disposal, such as landspreading, are not allowed unless a WPDES
permit is issued by the Department.
2. That hazardous waste be withheld from the holding tank.
3. That a competent resident inspector be provided during the course of
construction.
4. That the improvement be installed in accordance with the plans and
specifications and above conditions, or subsequent essential and
approved modifications.
These plans and specifications have been reviewed in accordance with
sec. 281.41, Wis. Stats. Where necessary, plans and specifications should be
submitted to the Department of Commerce, Division of Buildings and Safety or
other state or local agencies to insure conformance with applicable codes or
regulations of such agencies.
The Division of Water reserves the right to order changes or additions should
conditions arise making this necessary.
This approval is not to be construed as a Department determination on the
issuance of a Wisconsin Pollutant Discharge Elimination System permit or an
opinion as to the ability of the proposed system to comply with effluent
limitations in such permit, an approval of the Environmental Assessment that
may be prepared for this project, or an approval for any activities requiring
a permit under Chapter 30 or 31, Wis. Stats.
Tangible personal property which becomes part of a waste treatment or
pollution abatement plant or equipment, may be exempt from sales tax under
sec. 77.54(26), Wis. Stats. Similarly, property purchased or constructed as a
waste treatment facility and used for the treatment of industrial wastes may
be exempt from general property taxes under sec. 70.11(21)(a), Wis. Stats. A
prerequisite to exemption is the filing of a statement on forms prescribed by
the Department of Revenue. To obtain the necessary forms, and information on
whether or not your property qualifies for these exemptions, please contact
the Department of Revenue, P.O. Box 8933, Madison, Wisconsin, 53708.
In case installation of these improvements has not been commenced within two
years from this date, this approval shall become void. After two years,
therefore, new application must be made for approval of these or other plans
and specifications before any construction is undertaken.
If you believe that you have a right to challenge this decision, you should
know that Wisconsin Statutes and administrative rules establish time periods
within which requests to review Department decisions must be filed.
For judicial review of a decision pursuant to secs. 227.52 and 227.53, Wis.
Stats., you have 30 days after the decision is mailed, or otherwise served by
the Department, to file your petition with the appropriate circuit court and
serve the petition on the Department. Such a petition for judicial review
shall name the Department of Natural Resources as the respondent.
To request a contested case hearing pursuant to sec. 227.42, Wis. Stats., you
is mailed
have 30 days after the decision , or otherwise served by the
n
Department, to serve a petition for hearing on the Secretary of the Department
of Natural Resources. The filing of a request for a contested case hearing is
not a prerequisite for judicial review and does not extend the 30 -day period
for filing a petition for judicial review.
White Eagle Golf Course L.L.C. Page 3.
This notice is provided pursuant to sec. 227.48(2), Wis. Stats.
/ inney
K
ewater Pe /its and Pretreatment Section
ST TE OF WISCONSIN
DE RTMENT OF N RE CES
i
F THE SECR Y
ne S t elz, P.E., Chie
Wastewater Per its and Pretreat nt ction
Bureau of Watershed Management
DHS:JPK
a:whiteeag
CC: Pete Skorseth - WDNRJWest Central Region - Baldwin Area Office
Plan File (2 copies)
Kim O'Connell - K.O. Construction; 504 3rd. Ave.; Osceola, WI 54020
Jim Kinney - WT/2
I
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
'OwnerBuyer -
Mailing Address
Property Address
(Verification required from Planning Department for new construction)
City /State Parcel Identification Number / r /7& - i =
LE GAL DESCRIPTION
Property Location „&/a) ' /,, fYL'V '/,, Sec. _ - y/ , T,:? - R�
,LW, Town of
Subdivision zrr �� L��, , Lot #
I
Certiried Survey Map # C.S !>, `��- ZS' , Volume ,Page #
Warranty Deed # � 6 3 < 6 1 Volume Page #
Spec house D yes X no Lot lines identifiable JZ yes O no
SYSTEM MAINTENANCE
Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the th expiration date.
tO /7 /�t>
SIGNATURE O T DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
4�� \ t 0
SIGNATURE O CANT DATE
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.'•' * *•
** Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
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