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008-1058-30-000
Wisconsin Department of Commerce Safety and Building Division GENERAL INFORMATION Personal Information you provide may be used for Permit Holder's Name Bruce & Jane Erickson CST BM Elev Inso BM Elev TANK INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) purposes [Privacy Law, s 15 04 (1)(m)] Description TYPE MANUFACTU ER F_i BS CAPACITY Septic � r ;Ike 5 �i' a Dosing v bo &00 to k 5Z Holding OF EAU GALLE UL ELEVATION DATA TANK SETBACK INFORMATION L -. r L—< , _ l TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 7p Dosing 7 ' S $ ' -�. �5 • — Aeration Holding PUMPISIPHON INFORMATION 33 µ Manufacturer Z Derr oc �� •' GPM Model Number "f 45 TDH L2t�� Fri Iinoosss System Uyd T H 7 Ft 1• 3 s�z.IZ Forcemain I LengtF.d5 Dia 7 „ Dist to well '� , SOIL ABSORPTION SYSTEM STATION BS HI FS ELEV Benchmark S z3 JDS. /dd Alt M T vV •- r• t 3. C) 8 s4 ,33 Bldg Sewer 7 35 6310 St/Ht Inlet la. 81. oa SVHt Outlet Of Inlet Dt Bottom 1 77. (03 Header/Man Z.9 Ioz.33 Dist. Pipe Z.9 !oz-33 Bot. System 3. )ol. l03 Final Grade StCle`� �•� �G•�g r4tt$�tfA(r I� 9 51.33�.� 88. 33 DIMENSIONSNCH DIMENSIONS Width y I Length 5 ,, �/7 No Of Trenches )A Arno PIT DIMENSIONS No Of Pits h SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR UNIT ONI7 Manufacturer Ty e Of System m6iimd2� \ CO /J Model Numbe�� 10101 RIOV IIVIV 0 T 0 1 1 Header7Mamfold 1 ,. LJ ` Distribution s „ I Pipes) 7 Z I `T x Hole Size I 3 x Hole Spading , Vent to Air Intake Length Dia Length Dia Z Spacing ✓ O VIL l V V CR x Pressure Svstoms Only .. Mn.m.i n, el-n:.adn c n..i„ V s D I- .. _ 1. - Dept! evel Be L er �.• ® IDepth Over Bed/Trench Edges xx Depth of 1 Topsoil % I '• xx Seeded/Sod d yes No xx Mulc ed� Yes No I CI _ 7 COMMENTS: (Include code discrepancies, persons present, etc) Inspection #1 t Ll N— Inspection #2 iC" t^� r19 Location: No Address Available 1) Alt BM Description = %&�R 4y-4 As 4 477-ur &/4 F - l^ 5 /OL•o +.•. 2) Bldg sewer length =51, _�1�VIM,�� hqd 1, Y-+ih37z1� �4{}Gf �VN-a/, Qj`6,p amount of cover = >HZ G;ffl� 'All b!///f N a. Je tvtmvJL�. Plan revision Required? J Yes x No Use other side for additional information ✓ I �+�", (�' SBD-6710 (R 3/97) Date Insepetor's Signature Cert No 'N7 -��ad -a�5 ..\ Industry Services Division - 6 _ \\11ff p 4 2�2o N00 E Washtn^ton Ave County Sr. �ito/JeSanitary $ P - PvU y P.O. 7162 S 4 - Madison- 5 7 716 Penma Number (to be filled in by Co.)� _ t L.�q �' 0 Sanitary Permit Applicatio state Transaction Number In accordance troth SPS 333 21I2), Nis Adm. Code, submissmn of Ibis form to the appropriate gmemmem,l unit IA%� Q Z� I T 3 —G ! is regmred prior m obtaining a sanitary permit Nate: Application forms for state -mooed POR?S are submitted to Project Address (i fdifferent than mailing address) the Dep:utmem of Safety and Professional Services Pcnonal information you provide may he used for secondary Lpurposes m accordanca tvah the Pnvacv law, n 15 ()lm), Stars. 4 "�� _?O I. Application Information- Please Print All Information Property Owner's Name f 1_ � is i CCr't E J (� Parcel . O a,1 do8- /a38-do- aao Property Owner's Mailing 9ddress Property Location l ��89 36 rf �✓E Guvc Let City, State Zip Code Phone Number _ Z,4(d4J/-d. 4)L SYoad 7/5- 7,'o-0739 T �B V. R i/ (circle one) � _ It. Type of Building (check all that apply) �— Lm � �f / r .—;&q,/D Subdivision Name i R _ �lor2 Family Dwelling -Number ofB rooms _[.y������tJ I fX ack r• h S I p^'^`� 7 1 ❑ mere PUbIIC/Cumial -Descnbe Use n ., b-t4v of H _ CSM Number : (t0 ( 4. U State Owned - Descnbe Use — A -,village of ®Tmmaf E --i lr.3o/P �y� _ o4 sT - Ill. Type of Permit: (Check only one box on line A. Complete line b B if appli-cable) A i ixNrtsSslem j ❑Replacement System ❑ freaunenUFloidmg Tank Replacement OnlyOther Modihcahon to Existing System tcxpiain) ❑ Pcmtit Renewal l ❑ Pc.11 Rcvumn ❑ Chdoc,c of plumber ❑ Permit Transfer to New List Previous Permit Numbering] Dale Issued Before Expiration Owner I IV. Type of POWTS SvsteMComponenlDevice: t(Chuck all that apply) ��� — r ❑ Nnn-Premtuizcd In -Ground ❑ Prusunred in Ground ElAt-Gmde ElMound > 24 in Mound <24 ba of suitable said m-f osuitable soil ❑ Holding Tank ❑Other Dispersal Companem plat ) Prcncatmrnt Devine (explain) V. Dis ersal/Treatmettf Area Information: O I Design Flow (gpd) Design Sod Appllcauon Rate(spdsQ Dispersal Are, Regm (Sf) Dispersal Area Propo d (sQ System Elevation Ce,✓rtw.t Goo � o r0. VI. Tank Info Capac tv m iota) Aor Manufachurcr it Gallons Gallons 1-hias 'rank< Nca Excatiny Tan-' S U _ J =_ c v n F O i Dosi , Cluin4ur 'J VII. Responsibility Statement- I, the undersigned, assume respansibifil}' for ins[a1luUoo of the POINTS shmvn an the al[ncbed plays. Pcr's Name (PrtnO Plu 's Si MRRS Number Business Phone Number 6 �I"A/S A4u6/L e7.7-8]]Y j i I'Iumbci s Adds¢ (Street, Coy, Slate, Zip Code) 1 N GY93 /J' ems /'`i/4c xo. Uu(eai/4)I SY73G ].� V _ y�Coun /De artmeot Use Only ' �Apprm cJ ❑ Ui Is t FFFee/e//s D/at-e}Issued',s uvi Agent�4itmatu ❑ O i Reason far Denial S1tSTEM IX. Conditions o p rova OWNER: 3)�% r� 1. t Septic tank, effluent filter and 54 to L t spersal cell must be vd maintaine_d I 0 /1 s per management plan provided by plumber.MxAAJr_n_ Cs,�dC- C40- 2. I setbark requirements m Ist nP na nla nP pa IVs�taM0�C1 lQ(� t rapist, plans for 1Ln zt mum and submit m the Count a h on paper not I� tha a i 11 as per applicable codelordlli'�11��°. �d s D 102o eon MSPQC-�h`iilt } l c- �rfQ� .p//ol 70/ a h�E f y' JY, rAvl pv7 h°°/ (•D as Yo/ yyr S�S s.t r'� o✓ P,"Q ✓ 8'84, n 779" 7/>oy, S•G FHB O 0 4- a qsy> pY °' 0-1i7W5l air/ 7^d Yo y°d p'pp� f t 'I4 7 ��r ,rr5 1 a7,9la ip Ma-s o n 7 °p/ f Xsny po9 —oo Q i 7�7srs 91'7� op Jrri;f , 'off NJoq� 15- J377yC� nt>� ./o —1 YY )4�\ ?V(x Sir. 'FIX o) \nor, Iti�� t / a7j VOW S'Cv/ - '°a7,� •nnl l v 7 I1K711 ur7od prn°W g'86 n,bd p 3"bW- Q£ and Ind do d°A QVv/ i L9S) p79A, p�3 to istav7 y I f aMV ,SL ?-Mt-y a5v ay1 hgCj F ,.k-1 7o-fY �Si'%ri° rod � t oh'n3 Ind � I u 7'00l ,�o.L •�0-0��� �a7vrd 3Y7{ op /sl/d = ry °ti cp O o 41 aZN� 'off xloY� :15' 377YC� M'� ,�o S P'V/ `Nsr '0P- 91V 10A /r0��a-�}}►►��j�� CS :.may y, OE'-rvvSr7/v� �7nY1 <! I Y WrIf aala 1)4} -)cA ?5"Q VA ECO SEP 11 2020 St. Croix County CERTIFIED SURVEY MAP LOCATED IN THE NWY OF THE NEYi AND THE HEY OF THE NEYa OF SECTION 20. T21 N, R16W, SOWN OF EAU GALLE, ST. CROIX COUNTY, WISCONSIN; INCLUDING LOT 2 OF THAT CERTIFIED SURVEY MAP FILED IN VOLUME 19. PAGE 4930 AS DOCUAffNiTNUNEBER 788066IN THE ST. CROIX COUNTY REGISTER OF DEEDS. SECEON CORNERS SHOWN HEREON HAVE BEEN FOUND AND WR$RM W11H TIES OF RECORD AND PUBUSXm ST. ZOX COUHW C DWAIES nEW WORK WAS CONPI.ETEO nn ..nn BEARINGS REFERENCED TO THE NORTH UNE A IHE NY4 CORNER SEC. 20 Q:NPLA�Ij(E®LAIN®� CNEX OF ROIX SEC71 COO UNE SEARS SE7'31'1YE. S7. (1' STEEL SURVEY ..... _ _ MARK NAIL FOUND) DRIVEWAY YAY (� 30TH AM�� NE CORNER, SEC. 20 -F (F SB9T 01 "E) NORTH LINE OF THE NEy (1- STEEL SURVEY w S87'31'13'E 84916' MARK NAIL FOUND) —� —— �1— �__ e__ aeae., —T 5T1.07 ec-S8T31'133_E 7776.16ti � o S87-40'43-E� I l 8.13 84— T6fi.B3 �S02'29'40"W �. ry 1i 1 ' DRIVEWAY t8'I1 p$92' 26.68' (R NCO -£) It LOT 4 ) !i = SHARED sEMENT. 87'40'43'VJ S32'12'37E / DRIVEWAk'_ I 789.08' 80.12' �I 481,484 SQ. FT. (1059 fl I (R N33'52'25"W) z EASEMENT. z SB92O'JO"E ACRES) INCLUDING (;; _ 1 )I RIGHT-0E-WAY i SEE DETAIL � 451,838 SQ FT. (10.37 n ACRES) EXCLUDING /]"' O 1 0 3 OLL RIGHT-OF-WAYi'� ry ` {{{tt1 jQQQ'' Inc a L07 1 OF N 0 t/`m PAM.4930 1 pN 2 wol ® ia 'o r �ga i� � 89'38'49-E (R S891 1'57"E) S87'3709'E 610.59 °z` 1 N ; it g G PCRIN S f L0T OF ! Z. z o y o �.$.Dl. @ . 9�7 P(nE.4930 ° 1----"---"" - - - 9'4T ? 153.56' I LOT 3 _ 1 914,485 SQ. FT. (20.99 O LL Z ! Z@ O Z I ACRES)INCLUDING 13 u3 e 0 �' 180 1 RIGHTOF-WAY Om ?� F m IJi 1 900,509 SO. FT. (20.87 / m 52 P E I ACRES) EXCLUDING N i-i a m z u w a`Ri RIGHT-OF-WAY 0 w vOR ¢ u < (D 2N o ylm-'0 WJ 1 w w n 0 a I SOUTH LINE OF THE Bra o0ya: 1 NW✓a OF THE NV, 1 (R N89T2'55-W 318,85, 337.84' i 1014.51' / 676.87' I N87°353�'s7�7"pW4, 1333.35! LEGEND 11-u�E'I dANDs CTON C Q5 SEORNER MONUMENT (AZ M NOTED). IOU • PI E FOUND- S I.3' OUTSIDE DIAMETER IRON PIPE FOUND. ® INDICATES 1..18' IRON REBAR 502 L g cR WEIGHING Bs./LINEAR FOOT SET. FEN >" INDICATES FENCE z (R) INDICATES PREVIOUSLY RECORDED INFORMATION. SYa CORNER SEC. 20 (0 75' IRON REBAR FOUND �± J LAND SURVEYOR: PREPARED FOR: S soilm0813 & JOSEPH GRANBERG BRUCE ERICKSON DRA D 1428 134TH AVENUE 2259 30TH AVENUE JO N0. 100-67 SHEET NEW RICHMOND. Wi 54017 BALDWIN. WI 54002 1A Ofi/09/20 1 OF 2 0EQMTM�,V,T o� I no CIA D S AUG August 11, 2020 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2022-08-11 Plan Review: PWTS-082001730-C CHRIS M BAUER N6483 Dorwins Mill Rd Durand WI 54736 SITE: Bruce Erickson 30th Avenue Town of Eau Galle St. Croix County NW, NE, S20, T28N, R16W Total Amount: $250.00 W` DIVISION OF INDUSTRY SERVICES 2850 MIDWEST DR STE 104 ONALASKA WI 54650 Contact Through Relay http://dsps.wi.gov/programs/Default.aspx www.wisconsin.gov Conditionally APPROVED Tony Evers - Governor Dawn Crim - Secretary c �h DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE CORRESPONDENCE FOR: Description: Four Bedroom Mound System \ Sloping site Mound Component Manaul — Ver. 2.0, SBD-10601-P(N. 01/01, R. 10/12), Pressure Distribution Component Manual — Vet. 2.0, SBD-10706-P(N.0I/01, R. 10/12), 600 GPD, 16" depth to limiting factor from original grade, Maintenance required, Effluent filter, New construction 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: Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. 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. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter. Owners shall also receive a copy of the appropriate operation and maintenance manual(s) and be responsible for ensuring that POWTS is operated and maintained in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health haaatd, ine property owner must follow the contingency pian 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 component(s) utilized in the POWTS. 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 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. Sincerely, !r i Gerard M Swim POWTS Plan Reviewer, Division of Industry Services (608)789-7892 — voice \ (608)785-9330 — fax terry.swim Cawi.cov Page I of 9 Private Onsite Wastewater Treatment System Index and Title Page Project Name: /J4ucE ERICKSo i- 7'/J,t, ��op 10,rr5 CUFJ� Owner's Name: n „ Owner's Address: o7a?8 9 30 �uE l.�AtDaiv� c.JI .SYda,� ii5 7.10- 6737 Legal Description: _ &� IV&i d0� ,74 ^f4 /C [j Municipality: Town, V+R-age, City of Etu /� tuF County: $T, 4',Lo,X Conditionally Lot Number. 5/ Block Number:— APPROVED Subdivision Name: DEPT. OF SAFETY AND PROFESSIONAL 36 r� i1uE. SERVICES DIVISION OF INDUSTRY SERVICES Parcel l_D.Number: Od8-/oS8- 30-00o Page 1 Index and Title Page i9/%/� Page 2 Plot Plan Page 3 Cross -Section & Plan View of Mound SEE CORRESPONDENCE Page 4 Pipe Lateral Layout Page 5 Septic Tank / Pump Chamber Crass -Section & Specifications Page 6 Pump Performance Information Page 7 POWTS Owners Manual & Management Plan Page 8 POWTS Owner's Manual & Management Plan Page 9 Filter Information Name of Designer. Zit iu5 xsif,&a License #: /yip- .72668 y Signature: Date: 7-d8-.7e.2o SBD-10691-P (N.01/01) "Mound Component Manual" Version 2.0 SBD-10706-P (N.01101) "Pressure Distribution Component Manual" Version 2.0 Attachment: Soil Evaluation Report PY,C7P PLAN f 7/% ,Baud �/cicxse r- 3a=�,puE IVW, NE ?o, 29N, /6 W %, of EAN GActF .51- �/fOIX LC, fi N ad AC&F IAGCFL I -----Q3 6or / If /dc scfr. y6 / 3�y a puc 0""r ?uc J3o�v LA /ti/ES£.l CEO ` 66Mde r4.lK 36 Rf ACE. 4"6. aZ aF Q Y.vIL a , e a, 4 s A.aFeSfA jk\ AAIofUAYamp A a6scs si - /S4. i1AePaseA % 8 Y )S /Lnc fG c6GL d 9.Yf # �}8.8f Mould /4o,Jr1 /66.6 Fa/l of y7.4f �� (f 0 D = /, 7 -Ct ft = 9 ft G = S ft El = /. / ft A = S f-t $ = 75 ft s = /3.2 ft j = 8.a ft K = _(/. 9 ft L = 9a.8 ft W = W? I/ ft 4" sch. 40 PVC observation pipe `m w � v �1.5 ft 0 0 a TO ft m� N °• o'j TOE Page 3 of 9 CROSS-SECTION OF MOUND UPTURNED LATERAL & ACCESS BOX Sr TOPSOIL OBSERVATION PIPE & WATERTIGHT CAP GEOTEXTILE FABRIC COVERING ..� // / DISTRIBUTION LATERAL ( /SR in. sch. 40 PVC 132665) ASTM C-33 SAND FILL ", V! _ Lateral Invert El.= 164 3 ft sr/ TOPSOIL,., SYstem El.= /618 ft NI Contour El.= /06. / ft �Culr',1.,icew'su;.i+;u"rE?±'••`....y,-_�••--••—> : .,-F. „ Ua;,� '. ,"'; ._'`:. C. PLOWED SURFACE 5=G %SLOPE FORCE MAIN (2" sch. 40 PVC D2665) DISTRIBUTION CELL = _$ It x XS R = 466 fIF (YV-2Y" aggregate) Min. Required = 6e4 + G o &166 ft2 2" Force PLAN VIEW OF MOUND Main observation pipe r b7.7 U 7S SrA Manifold rl .. (/Yz in. 'a,YW sch, 4a PVC T 02.. 1/6B = I Distribution Cell a„ 5' ft (Yd'-2Ys" aggregate) I 8V76r Observation pipe .. Iox K — Distribution pipes Iles/.? S R ( !_S in. sch.40) OX= Upturned Lateral with Access Box Prohibit disturbance and vehicle traffic within 15 ft of downslope toe. L 98&` Basal Area = ci/; it x iS It = 1594 ft2 Min. Required = 606 , L = /460 ft? PIPE LATERAL LAYOUT OF MOUND (End Manifold with Aggregate) HOLE DIAMETER = �114 in. LATERAL DIA, _ ,1_ in. (sch. q0 PVC ed MANIFOLD DIA. _ /�a in, ad pipe D2G66) �OCe��G$�eeve FORCE MAIN DIA,= a in. P - 72 Et. x = 3 ft, )C y/ Y = 3 ft, \may . i� 3 3 R 404v a0 Otst�O%e XA' V AJ �26yr,1 1 �\� X 1 1 rP i rY33 r` ANIFOLD 3 r �\ (/1 in. sch. 40.�� x PVC D2665) aY e FORCE MAIN (2' sch. 40 PVC D2665) Page y of 9 Access DoX Y� s�3 Q 3 i 3 v t YA ,- Nc�e Lass r 72 HOLES LOCATED EVENLY ON BOTTOM OF PIPE. Minimum Number of Holes = G 60 ft' - 12 = S4 Holes —A SHoles/Lateral x 2 Laterals = ,SD (3/16") Holes x 0.66 gpm / (3/16") Hole = 33 GPM = SYSTEM FLOW RATE PIPE VOLUME_ /yy ft, Laterals (total) x 0,092 gal/ft. = /3.a5 X 6 = 4L.-7S GAL = MINIMUM DOSE VOLUME PIPE INVERT ELEVATION = 142.3 ft, E Page S of 9 COMBINATION SEPTIC/DOSE TANK. CROSS-SECTION (DRAWING NOT TO SCALE] MANHOLE RISER 0 COVER FINAL GRADE {perSPS 384.25n & is). approved {slapegtoond sud2f°avmyftom tacking dei4ce.& warning label; Extend manbole(s)for pmperdrairrage) manhole riseres necessary.) 4' Mm- Srh. 40 PVC Tank Vent ELECTRICAL locatedl2'abovegradsor24- BUILDING SEWER 4• Mted 12' a 0 Pe grade Vent JUNCTION BOX mraveRegi abovegraae or 24' above Regional Flood Elevation {per SPS 38Z30(tt)} abova Regional Road Elevation {comply Wilk SPS 316 vatic and NEC Sob} FORCE - ",.' i MAIN I z• OPTIONS ` "I : ��. I56"cover l 1 ............ �>t8' �1e• MMIHOLE r. i) : cro_ .- 1 twain aOTTOA10PtwLEr Gn'Rrt�a:aL•on) Flu+lrrve— W'n t I iNUFr— 6ras7errdglewJ)-- --- aa aaa3� Gtep:ty retltl y/ 01 . J A6- C Ararm Final on'r1m ' a'aC�rPic AP�ad EVEN Finer/ r I _ I .• NequirdOnOune: - A. 9Float DQ' ' ........... ................. . . ........ _ ..... ...... MINIMUM OF 3" OF SUITABLE BEDDING BENEATH TANK € MAXIMUM BURY DEPTH OF 98" Anchoring or tank may be required per SPS 383.43(8)(q) Tank Manufacturer. 4J/ESEA LajeArT6 SeptidPump Size: AZ60180o gallons Alarm Maanufacturer. S7. E. dlyo^dus Model Number: %N.JK ALEQ r / Switch Type: yJeaNn,rr/�ar. Zm�lta Effluent Pump Manufacturer: Model Number. %aw `{ D Minimum Discharge Rate: 33 GPM Vertical lift (pump off to lateral invert) ------- .---- 47.3 ft System head (distal pressure 2 S x 1.3 fr)_ 3.3 ft as it Force main x a-y /100 friction factor . G ft Filter fliction loss ------- ..:. ...................... ft Total Dynamic Head (rDH): /G . d ft Daily Wastewater Flow (DWF): GPD Number of daily doses: S o? i /9. 3 Force main volume:�75' fi x . /6 3 gaVft= '/ I gal Actual dose volume: /,26.1 gal - '/. / gal = /A gal (total dose volume -volume of force main) DOSE TANK CAPACITIES: Reserve above alarm 10. G in = Y". 1 gal (D) Alarm float above on float_ in = -131. S gal (C) On/Off float measurement 51 in= /?D,l gal(B) Off above tank bottom _ ' in = /77 1 gal (A) DOSE TANK DIMENSIONS: Length /G 4/ in Width -- in Outlet height .34- in Gallonsnn=n ��-may 5/4/2021 150090_CuNe_1403enes.tpg(939xl630) 2: 2( tf 1( 14 n Y L L Lu LL 75 70 PUMP PERFORMANCE CURVE MODEL 140/4140/145/4145 65 60 55 50 45 40 35 30 25 20 15 10 5 1451 4145 1401 4140 3ALLONS 10 20 30 40 50 60 70 60 9C LITERS 0 80 160 240 320 FLOW PER MINUTE 150090 https:fl e zoellerpumps.com/content/literaturelCuNes/150090_CuNe_14OSeries jpg 111 9EN-OA-SFS 9EWOA-SF5 9ENCA-RF LM a w laa no t ao iaa is li is a 0 �s �o 9 7 6 5 d 3 t �' - 9 = G m m � da sa a m w [warm -raft Franklin Electric Ma inc MUDUt94 I *wmink almm 6r 9EN-OA-RF cover Epoxy -coated cast i on' Thermo lastk Motor Housing Epoxy -coated cut iron impeller Material Themwplasticelastomer I eller a Non -do Votute -coated cast iron MotorShaft Steel Medupfcal SbaftSeal Nitrite with carbon and ceramic faces Fasteners Stainless steel Bearings Uppersinteredslee eandk ball 6eari r Cord SJTW "SJiow •aasn "ew' ad 7 Page % of Q POWTS OWNEWS IViANUAL AND MANAGEMENT PLAN FILE INFORMATION Owner Permit..' .U" E,elGK $owl j DESIGNP.ARANIETERS Number of Bedrooms 000 gpd/bedroom) y I Number or Commercial Units Estimated flow (average) z1do gal/day Design flow (DWF) = estimated x 15 L 00 gaUday Soil Application Rate /,0 gal/day/ft' Influent/Effluent Quality (O NA) lonthiy Average Fals.01I & Grease(FOG) �3D mVL Biochemical Oxygen Demand (BODs) <20 mg/L Total Suspended Solids JSS) < 15 0 mJL Pretreated Effluent Quality (9 NA) Monthly Average Biochemical Oxygen Demand(BODs) <_30 mJL' Total Suspended Solids (TSS) 530 mJL Fecal Colifotm(geometric mean) 510 cfu/1 oomL Nlaximum Effluent Particle Size 1 1/3 inch diameter Dispersal Unit 3if-,JNJodel Number: Calculations: Soil Dispersal End Cap 0"rr - Application Rate = Area Required - EISA - 00 r /.O 1,00 - SYSTEM SPECIFICATIONS Septic Tank C welt- a0 p gal O NA Septic Tanlr. Manufacturer Gl/E En. ed„ r c.t. O N EfrtuentFilter Manufacturer ozyIec/e CNA Effluent Filter Model 027S O N Pump Tank Capacity , 800 gal [IN Pump Tank Manufacturer GJ/ESE �ea�ca, 0 N PumpManufacturer Z• ONA Pump Model ON Pretreatment Unit (0 NA) O Sand/Gravel Filter O PeatFilter O Mechanical Aeration O \Vetland O Disinfection ❑ Other. Manufacturer tiviodel: Soil Absorption Component (C3 NA) ❑ In-ground(gravity) O In -ground (pressurized) • At -grade 9 Mound O Drip -line 6 Other. Vertical Distance Tank Bottom to Service Pad- it Horizontal Distance Tanks)to Service Pad: !M fr (Dispersal Unit EISA) or (Trench Width) _ 4 Units or Total Length of Trench(s) Qr — TSr C7 "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems' Publication 9-6 O "ICC Flowrech Mound Componenr Manual• Version 12 O "EZ Flow Mound Component Manual" Version 8/20PJ)07 O SBD- 10854-P (R-1/12) "Ar-Grade Component -Manual Using PtessumDistribution" Version 2-0 O SBD- 10705-P (N_01101)"In Ground Soil Absorption Component Manual' Version 2.0 10 SBD - 10691-P (N-01/01) "Mound Component Manual" Version 2.0 rJ SBD-106i7-P (R.6/99) 'Drip -line Effluent Disposal Component Manual" 0 SBD - 10706-P (N.01/01) "Pressurt Distribution Component Manual" Version 20 MAINTENANCE MONITORING S('HRniri.F-NieiNrrWA1J(F ANrl MANA(_t:MFAT Service Eveo[ Service Frequency Pump/ins ect dispersal cents). clean filter 1 At least once every li months 03 ears O Other. [n r pump & pumpcontrols, alarm pretreatment unit At ]east once every: ❑ months 0 3 years O NA Flush and pressure test laterals At least once even•: O months 9 3 years O NA START UP AND OPERATION: for aew construction. prior to using the PO\lr'IS check treatment Lank(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 prior to use. STstemstartupshall notoccur when soft conditions are frozen at the h�ffltndive surface. the property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water -saving appliances and fixtures along with prompt repair of leaks reduces the Wastewater volume. Also the brine or haste from Nvater softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundiy waste, showers, dishwmtec etc - This system is designed to handle domestic strength wastcwatc , however, the disposal of food based greases, oils, vegetable fruit peels. seeds, bones, and food solids, such as those produced by a garbage disposal should he minimized Toilet tissue is the only paper that should be discharged into the system- Other non -biodegradable items, such as baby wipes tampons, sanitary napkins buns, dental doss, and cotton swabs, should not enter the system_ Chemicals, such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc_ should not be 11ushed into the system because they con seriously damage your POWTS and contaminate your Page 8 of 9 drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction ofsnow overthe dispersal unitmay cause it Lofreeze up. INSPECTIONS & -MAINTENANCE: Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer, or Septage Servicing Operator (per the attached Maintenance Schedule). Tank inspections must include a visual inspection of the tank to identify any missing or broken hardws rP, identify any cracks or leaks. rapers- the .•c'.cc;c of care i.Lmu Mudge and scum and check for any backup or ponding of effluent to the ground surface and test all electrical equipment such as Pumps and alarms_ Any defuts shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with effective locking devices to prevent accidental or unauthorized entry the tanks. When the combination of sludge and sctmt in any tank exceeds one-third (1/3) ormore of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Opemior and disposed of in aeeordanee with Ch_ NR 113, Wisconsin Admin. Code. Specific servicing mechanics must be provided i vertical is>15 feet or if horizontal is> 150 feet and instructions to be provided below. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Solids washed from the filter shall be retained in the tank_ Filter cleaning may be necessary at more frequent intervals than stated in the maintenancescheduletokeepthesystem operating. Alarms should be tested on a regular basis by the home owner. If an alert sounds, contact an individual licensed to service P OWTS, Thefe is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surfacing. ABANDONMENT- When the POWTS fails and/or is permanently taken out of service the following steps shal l be taken to ensure that the system is properly and safely abandoned in compliance with Ch. SPS 30.33, Wisconsin Admin. 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 other 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: O 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 renders itunusable. Replacement systems must comply with the rules in effect at the time of replacement O 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 has not 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. 1< Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions ofsuch systems must comply with the rules in effectat thattime. 'Y.ARN1NGMT, SEPTIC, PUMP, AND OTHER TREATMENT TANKS MAY CONTLAN LETHAL GASSES ANDIOR LNSUITICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP, OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES_ DEATH MAY RESULT. RESCUEOFA PERSON FROM THE INTERIOR OFA TANK MAYBE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS: POWTS INSTALLER POYVTS MAINTAINER Name: e/VA,15 4ar4 /lid— id6$ Name_ Ad4fJkA. 241y61-$4 Phone: /S C7.7-8I Phone: 3 d 3-S22'1 SEPTACE SERVICING OPERATOR (Pumper) 7 LOCAL REGULATORY AUTHORITY Name:.10 Name: Y• Choeg o v >•'/ EU [. honey Phone: /6 38G- `iG8 Step 1: (A) Locate the outlet of the septic tank. (B) Remove tank cover and pump tank if necessary. Step 1: Locate the outlet of the septic tank ii sE RUBBER GLOVES WHEAL CLEANING FILTER INSTALLATION INSTRUCTIONS PL-525/PL-625 FILTER gof9 Centerfilter with opening i w WN J7 al0 x Atlditional pipe or PoWok Extend & Lok" forcentering. Step 2: (A) Before installation, place the filter housing on to the outlet pipe. (B) Make sure that the housing is positioned so the filter can be removed from the tank for maintenance and service. Step 2: (A) Remove tank cover and pump if necessary. (B) Pull the fitter out of the housing. (C) Hose off the fiber over the septic tank Make: aura all suilds ralf tiaCK Info the septic tank Step 3: (A) Glue the filter housing on the outlet pipe. (B) Insert the filter cartridge in the housing, making sure the filter cartridge is properly aligned and completely inserted in the housing. Step 3: (A) Insert the fitter cartridge back into the the housing,making sure the filter is properly.alighed and completely inserted. (B) nupldue septic tanK cover rs kEi£Rr -- dFBaf 'and k :i e $ aa9e Oro, ip ndIMY„5985,-`•' ,Lbde co St Croa �>a 'hBe"�_""' Ire-r opmplate site Plan op pepeYehQF d : pucaltD. Set not lIMIL-d[o. Y4rtlC,glmdna "', r7 at road ar c`�3ape nraedrdhrgaeiarlh s- �- ' r. - -ywwft �^„ ax'mtormauo�`=r--.. -oars +§"`T-fik,;.tm&��{p,ISagmr�a�W,(s)Imn tr—f�� 114 N�'l/4 3 20T 2�N R E toy yq ..-axe sass - Lof# Brc,.ii:# Subd NameaCSMµ ) k 2289�08Mttei 4r CSM -'-,fl[m�er - ItY QVlllags own Nearest Read 7,55-7W-0739 -:tau Galle 30th Ave - t - Uae�de/•jJlimbar of bedrooms 4 Co de denved design floir rate - 'I Cpamw � na 1 -i1aE 4 e$Cnbo' Flood Plain elevation tfiWrdble na lo tOft onM- can" , � ouRd Grade tl .s: e-s ..r r*,-,` nt eltorr,1417aftba5ed on ctoLrlln9 efeVafion'100 mimumm 2l7 chs ,ra ads „�..�A 3e„-.- �AS�Ti13$iBwSa[td.o�tetba detemaned b)!1lie desigrer. - i J Y w�.z-si-+��eL�arD1-.i�.,`OS.4ti t_.- ,n Safi.n fitiX�� e of .a:a(i'krW'zflil ?' = sir 3�.§:v- �j-�... iY - CS s: 1Yf-: �r3�`.y-�': V: # �r-_"3.•. Y' .Nreh�a•F.: ,]'i_ i.•il .-i $z�'Fa - i 'R. C• :_a]I`ie -Y.a6.eJ.._._. 1 .:.'d'i 1 T _ ✓,: 2. _ EfiimRt#1 BGD 530:e2201rrg7L"_ 3e>30"`Stj�t�rg�-s�!k±s`i - GSTName{PIknfi - ar� T r hB ism David J. Steelf - und; W1 54017 - II_ T taluation Cr J-2- n �.RY 5¢y'5�i ���`° a 1 fib' �'2 �,sa �i�Y5g1jt c �2 �- 6rueroEncksariY��+`,Ri�Parsibl1D#-•e,. n8 2 3 -tom• 4)% prn:"'Y Omer: a a i'rf� Page ai _ -44 I �' 19a�r Bof!n9 ---c'r�'L*n.`'�.60 y :'• ,� _--sa L• '18� y•` a!r Cround su7e9q. ^ < '"1t OepNbQmlHne>•adnr- in �5- ?. 1Ho,^zc� I Oeplh 'Cmrnan±Ca!or Necox ueampuan - r6zrGra Svuaure, nislance _ ndary I in. - hiunse.l 4u..Sz Corn C,`olor Mp4 fix2 :� 70yr312 .]: none .74yr414 none 1 Sid 2mSbk' rpir none mfr na a na Y+ -7777 1�1 ,Gmundsurfaceelev d Crep[hlo lim.6n3"rador in. - ncrsi r'eplli Carn.rian; Color Reds: O?s�npvon Tez'.ure ShUdure sislenc2 Ie o.mdary Rdols 'GPDrx?- n '. un-'e1 Qc. Cc �! Cn'o Gr Sx. Sn, _i - oxn - ound sndaee,elev.. Gear t, limror.., w r n —r-- <-' I ra o, _ }iedva Desa Otion I_ r_ ., c Sz G_n NO ! Cm C Tr. SO <220 end IS&>3tl C - � + 4 n18n J50 g7glL i� .! aTrs�c6�ah ra �9x"1 �, - The; e. kz r� r'z �S3 kF 4` r � Yo �'ap ���`��Y�rGqudl .PP° .. ,'Ft�QOF'etiA,em�11'ayer. c., •3 I !arneaS•SefC1C.e5'orneed xjrayepy.�ari;sltein3te foi3nar, eoatsct iLe dep�hnenf at 60H-?6531.i�-, ------------- V Bruce �-iclson 289 30th Ave SWU43W1/4,518 T29N RS8W Baldwin W'l 54002 { > Tov of StiCmimCo 715 760-0739 Ski I,ot'a o at cfy s y �rveell A �vIWII Vpt be suitbble for your use. I,t 1 p7 yao.6e�s;116 ,aSIV tol ines were not established -at the _ t el uu ov rli CU N --;legend N I00 00 ft 6Q1Qfc {t Aft _- � �y� ti� sa �. �+gimt,Z � - � �ti�-..,✓J'.x{+� -1 � Y �.�tMx: . -Y4. � M �� ,y'��'IS� ai�¢I �4,gY°ox 'CKaS.w-ra! -rirx �g''�'�'r �•-k4-�za��;�?� . .iRI rs. 1 x <�. "�:. -..wt+'ix.1�k`..��s'.'4..x''x'`"s�.`��-'il,�-+,�7r'r F.. �--+s v.--::.its; "i...'+i:.., i�,-'wlrw 2;�•.y+"�,S.v`ruE.y��,"�::_ '_ APPLICATION FOR REVIEW -Complete all pages- :r �! P S NOTE Personal information you provide maybe used for secondary purposes —' [Privacy Laws. 15.04(1)(m), Slats.) ❑ Plans to be E-filed. Provide SharePoint User name below: Private Onsite Wastewater Treatment Systems Division of Industry Services For plan status, check our website at htto:/ldsos.lvi.aev Finail tA�h cal ccwde n.�....n-__._ - .. yew...., m w ., L'ru.uJYOJCi'UY/i51 echoril po9 Several counties have been delegated certain authority to review plans in lieu or Division of Industry services. For a current list of those 1. Project Information -Fill in all known Information. Projecl/Sile Name: lJRutE CiUCKSoJ Location, Number & Street of project (d unknown, indicated nearest mad) 30 TJ lfaE Legal Description: N Jy NC. A-01 .ZBNr /6 Cd County Sr. t!Roix 2-61ry.Qlage I�Townof EAu L7A[tE 2. After plans are reviewed, please: (check all that apply) ❑ Cali customer 1, 2 (circle number)` C3 Requesting party will pick up }Mail plans to customed 2 (circle number)` *Refers to customer number from below - Confirmation of assignment to a reviewer - Transaction to: Previous Related Trans. ID_ Estimated Completion Date: Assigned Reviewer. Assigned Office: Mai: to your office of choice below: La Crosse, Green Bay NOTE: We reserve the right to re -distribute plans to another office if needed to reasonably balance turnaround times. Check at:olidsosrA.cv for next available review date 3. Complete the following designerlownerfrequesiing information. Utilize the check boxes when designe , owner or requesting party is the same to avoid repeating information - Designer Information (Customer l) DSPS First Name Last Name Customer Number CN,t,s llRu62 r/N-11oC8Y Company Name %rJ AU Ex, i"Lu,•yd i✓L '1 SEpr/G Address N GY83 %a.cwws //iu QiI. City n cJS S973L Stale Zip+4 (9 digits) ll4R .f.va, Phone Number E-mail address Cell phone (area code) 7/5- 47.7-87.7f, 46c6 Rt2e/Sen-7te/fief Check if applicable ❑ Owner along with your registered SharePoint usemame to D will be assigned to a reviewer after receipt at a DSPS Other Please Specify Below (Customer 2) DSPS First Name Last Name Customer Number IdAUZE E!!/[KSeJ Company Name Address City State Zip+4 (9 digits) 13A14&MIJ WS St/de] Phone Number i E-mail address Cell phone (area code) 7/1- 7Go- 0739 Check if applicable or specify relationship an review complete the 'appropriate application form and e-mail it, )UIE0.1,Visconsln.coy. If plans are being submitted via paper, they checklists can be found in each applicable component manual Holman/Onalaska Area DSPS Green Bay DSPS 2850 Midwest Or Ste 104 2331 San Luis Place Onalaska, WI 54650 Green Bay, WI 54304 608-785-9334 920-492-5601 Far- 608-785-9330 Fax 920-492-%04 Email: 3sos5bPlanScte:dulefld vi.00v Email: IxsnsSbrfarSc;a:avleut•.i.cov Make Checks Payable to: Division of Industry Services OR ❑ Check box to inv d 'gner and sign below TOTAL AMOUNT DUE s a75o,a° Review Code 7633 Designer Signature 1 SBD-10577 (R 3/19) 5. POWTS SUBMITTAL (check all that apply —Incomplete forms may result In processing delays) ® NEW ❑ Aerobic Treatment Unit(s) ❑ Chlorinator ❑ Tani( Replacement Only El REPLACEMENT ❑ Commercial System El UV Disinfection Unit El AddddEffluent Filter SYSTEM TYPE(S) NOTE: Submit separate sheets for each system If submitting multiple systems on the same site Enter Fee ❑ Revision to previously approved plan $85.00 ❑ Miscellaneous Review (i.e. replacement of a septic tank, addition of an effluent filter or pretreatment device to an existing system, etc.) $80/hr — ($ Component Manual All treatment components are previously approved ® At -Grade Component Manual - Ver. 2.0, $BD-10854 (N.03107, R. 1/12 P ) Design Wastewater Flow in under s. SPS 384.10 (2) or (3): ❑ In -ground Component Manual - Ver. 2.0, SBD-10705-P (N,01101, R 10/12) ❑ Mound Component Manual —Ver. 2,0. SOD-10691-P (N.01/01, R 10112) Gallons Per day Design wastewater flow of the proposed system: © Pressure Distribution Component Manual —Ver, 2.0, SBD-10706-P (N.01/01, R 10/12) Goo 1,000 gpd or less $ 250,00 co �ii SQ ❑ Other -Please specify GPD 1,001 —2,000 gpd $ 325.00 2,001 — 5 000 d $ 400.00 ❑ Soll Based Individual Site Design" One or more treatment components are not ❑ At Grade previously approved under s. SPS 384.10 (2) or (3): (Individual site design/deviation from component ❑ Non -Pressurized In -ground Design manuals and use of components without product ❑ Pressurized In -ground Wastewater Flow in approval): ❑ Mound Gallons Per day ❑ Drip -line Design wastewater flow of the proposed system: ❑ Constructed Wetlands " Documentation must be provided to support treatment and dispersal claims, In a separate GPD 1,000 gpd or less $460,00 1,001 — 2,000 gpd $600,00 ` statement, provide rationale for the project and attach supporting documents (code sections, test 2,001 — 5,000 gpd $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: Design Holding tanks previously approved under s. SPS ❑ Holding Tank Component Manual, Ver, 2.0, SBD-10855-P (N.03/07, R1112)' Wastewater Flow in 384.10 (2)(3). Design wastewater flow of the proposed system: Gallons Per day " Non -state owned Commercial and Residential Holding tanks that completely utilize this manual 6,000 gpd or less $ 90.00 and have an estimated dally 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 Deparlmeni. [see SPS 383.32(3)(a)j greater than 10,000 gpd $225,00 ❑ Holding Tank Individual Site Design", (I.a. site constructed, a5 day holding capacity, Co- DesignHolding tanks including site constructed tanks NOT mingled wastewater, etc.) Wastewater Flow in previously approved under s, BPS 384.10 (2) or (3). Please specify: _ 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 please Include all code sections, test reports, technical papers, research articles, etc.) 5,001—10,000 gpd $300.00 GPD greater than 10,000gpd $460,00 ❑ Soft Saturation Determination Report (using observation pipes) ❑ Inlerprel ve Determination $240.00 ❑ Experimental System (One time additional fee). Submit fee for individual system as per appropriate above system type) Experiment Number _ $400.00 Priority Review (enter same amount as normal review fee listed above) $ Enter Total (rounded to the nearest dollar) $ 0250, °O SBO.10577 (R 3119) SEP 02 2020 Owner/Buyer Mailing Address Property Address 2 2 S ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM from Planning & Zoning Department for new construction City/State ), W) Parcel Identification Number LEGAL DESCRIPTION Property Location Nl li '/e , ( '/e ,Sec. ,TAM R_IV_W, Town of Subdivision Plat: , Lot # L Certified Survey Map # 1 IC9 191 'Volume �% n , Page # Ugh__ Warranty Deed # u j 0 15 Z (before 2007)Volume Page Spec house 11yesao Lot lines identifiablejayes[]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 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 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. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms SIGNATUREPF APPLICANT(S) 1_l3,l3Q3 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. 01/12) Hines Residence New residence- ------ — - AUG 27 2020 Si 1.; 0,4 CO'.illy Ccmrn'.r:ty D— DESIGN CONTACT GENERAL CONTRA ca,r.cr °' `°r T " xouE nurnw, e CCM4.`T�RV1N B.W EP El1ML ryenaµwnrulwrQrynal wn Area Leg, 0 160" ❑ 2,856 w 9-1 LisaF l CwnSfrci G'0� n i02 A-101 PT' swurc[+w[ny� wns 1 P R Z., As intliwle z s� G C7 Q 0 6 j O W Q a MO ve: � Man NM e Pdim�wy nlul Wy ynPoUY d rT FO � Fppn _ IMz1 'Gunn Ilre HNnt 1� u 20P Bx49PoLNET SB 1.JOR' - fi �BPPN O OP am �exi 'soxe szvz sIo� - ITH EErvon -- ciess sm Nu scnaaowox sa e.un oei - mv 6'O DBiB it 6Y a f s�p.w�eo. sew � coup. w�mw HO T��I qp vela ma. iypo munl txNs.+oewnyuon type wp n gpgn nayn aBN.^w awl La ml: l wiTym— POWW rnwl noupll y I.mJy I. kl� neipM F�db LW� M HuCH r�HeNe nB' _ �• �V �";M" we �vwz�w _ w�� Iss r va• = r a. G 5 ql� 1 O I I = o I� o 0 i " I gq Y s I y;g Hines Residence _y- ��,,,,,,,,�� ooN New re,Jenc ■y n PRELIMINARY 05/11/20 rrra + �.r ���"` qy I I I I I I I I I I I I I I I I I I I I I - 4 II I I II C9, ® I rF-a u f 5 c ?4m S L I- mlv r m r� nl I �I I m❑ I I II I I I I I I I I I I I I I ® I I I ®I I q ® I I moo❑ 01 ❑I ❑I I I I II I I -a `8o a ss= r Hines Residence New residence PRELIMINARY 05/11/20 w mvw nom:rw.,ec..am - k� gy b � I I I I.: .4 • l l I I I I z� �I .I S I I - vr 3 Hines Residence Ne«de�nce _ _ ii A i� b Via» PRELIMINARY 05/11/20 DDVaw ap c vw r � SCC ArcGIS Web Map c T3K ram.....-.e- - : L�� 53/E1K 8/27/2020 2:16:45 PM 1:4,514 D 003 0.05 0.1 ml Public ROW Private Right -of -Way Shoreland Zoning © ZONE AE Lot Tax Parcels Flood Hazard Areas ZONE AE - FLOODWAY 0 0.04 0.09 0.17 km O ZONE A WDNR, SCC COD, SCC COD, Eagleview and SCC COD, FEMA, SCC CDD Limited Common Space or Park � Subdivision/CSM Boundaries Web AppBuilder for ArcGIS SCC CDD I WDNR, $CC CDD I SCC CDD and SCC Highway Dept I FEMA, SCC CDD I COD and NPS I National Geospanal-Intell Bence Agency (NGA), Delta State University, Ean I Eagleviaw and SCC CDD I Surface Water Data Viewer Map 0.1 0 0.06 0.1 Miles DISCLAIMER The information shown on these maps has face, obtained from venous sources and are of varying aide, reliability dad resolution These maps are not intended to be used for navigation nor are these maps an authaotaeve source of information about legal land ownership or public access No warranty, expressed or Implied IS made regarding accuracy. NAO_1983_HARN Wsconsln_TM 1; 3960 ripM1wbility for a pammlar use completeness, orlegallryofthelnfrrrmationdepnirrlonmis r map For more information sec. the DNR Leal Novrxswcb page pup odor wi gnv/logal/ Legend ❑ FIRM Panels — Cross -Sections Flood Hazard Boundaries Other Boundaries — Limt Lines SFHA / Flood Zone Boundary Flood Hazard Zones . 1 o Annual Change Flood Hazard . Regulatory Flootlway ■ Speclal Flootlway Area of Undetermined Flood Hazard . 0 2% Annual Chance Flood Hazard ■ Future CO,dltiene 1so Annual Chance Flood Hazard . Area with Reduced Risk Due to Levee ♦ Wetland Identifications and Confirmations Wetland Class Points Dammed pond Excavated pond Filled excavated pond Filled/drained wetland Wetland too small to delineate Filled Points Wetland Class Areas Welland Upland Filled Areas Wetland Class Points Dammed pond Excavated pond Filled excavatetl pond Filled/drained wetland Wetland too small to delineate Notes CERTIFIED SURVEY MAP ILOCATED IN THE NWY, OF THE NE'V4 AND THE NEY, OF THE NE�4 OF SECTION 20, T28N, R16W, TOWN OF EAU GALLE, ST. CROIX COUNTY, WISCONSIN; INCLUDING LOT 2 OF THAT CERTIFIED SURVEY MAP FH ED IN VOLUME 19, PAGE 4930 AS DOCUMENT NUMBER 788066 IN TILE ST, CROIX COUNTY REGISTER OF DEEDS. SECTION CORNERS SHOWN HEREON HAVE BEEN FOUND AND VERIFIED 109TH TIES OF RECORD AND PUBLISHED ST. CROIx COUNTY COORDINATES. FIELD WORK WAS COMPLETED BEARINGS REFER'. NY, CORNER, SEC. 20 ' -�- (D NEX OF SECTION CCROTIO [ (I- STEEL SURVEY EXISTING 30TH AA yL%flrp- - - AUG 27 Ma SYSTEM. ST. MARK NAIL FOUND) DRIVEWAY - - - - - _ _ _ c NE CORNER, SEC. 20 t'Or `E) NORTH LINE OF THE NEY, (I- STEEL SURVEY S87°31'13'E 849.16' MARK NAIL FOUND) 337.83' T I I 5 F4461,4&4 S87'40'43'E� 848.13' LOT4 SHARED SID. FT. (10.59 DRIVEWAY ES) INCLUDING EASEMENT. SEE DETAIL GHT-0E-WAY 451,838 SQ. FT. (10.37 in ACRES) EXCLUDING H- RIGHT-OF-WAY M 04 zo N 0 /\ 0 O 0 0; IL ¢ Z 3 �; b w a , It w W OLL z rNi w w o �5 89°38'49'E Last; o I z ap w;i A- FFI 143.72' w m it 1 5 zwatt o W N N i 1,-(LULL oa 0BD W p dip .l 2 FQ pp e- g,z0� 3aZc z r co w S89°4T40'W L _w o 0 153.56' a 00 z x N Z J "i P W v u — 3 00 xw in U 0u1 Z o z OmKw1-z pWzW r0OQO mW .-LD KMcEQ Uitir ro co Oa0-FL T CL w � z 0 O W a r9 KW �� O Z(n0�v ow LLJ co b—a ouJ �LU yW mO zdD "> Q F.pOoF-ara z a.0 co ao��m.- 318.85' 337.84' 387.31'13-E 1776 _ T e—`—tS '--1 U26.66 (R N00'48'59-E) N87°40'43-W S32-IZ37-E 1S89.2 80.12' (R 58920'30 E) (R N33'S2"25"W) z. w� x V4 L m U371 OF N r WSA � VOL.--------------- N Z pbWE 4930 ------------ OI o z �I S87°32'090E 610.50' (R S8977'57 E) LOT 2 OF C.S.N. VOL.19j PGE. 4930 1 1014.51' Nzo 87033'17'W 1333.36' co 1 LEGEND M pL�--- LDi kgU�1Ds a SECTION CORNER MONUMENT (AS M NOTED). 1 w • INDICATES IX OUTSIDE DIAMETER IRON o PIPE FOUND. o IB INDICATES 0.75" X 18' IRON REBAR nL WEIGHING 1.502 LBS. / LINEAR FOOT SET. (� x INDICATES FENCE. Z (R) INDICATES PREVIOUSLY RECORDED INFORMATION. LOT 3 914,485 SQ. FT. (20.99 ACRES) INCLUDING RIGHT-OF-WAY 900.509 SQ. FT. (20.67 ACRES) EXCLUDING RIGHT-OF-WAY SOUTH LINE OF THE NWy OF THE NEY4 (R N8912'55-W) Wis. Dept of Safety and Professional SerbiaCS� Division of Safety and Buildings SOIL EvMUMIM csr aoao — r7� 1 3 Page of in auxxaaruz wan ore ooD, vvis. r uni. w u _ --' Attach complete site plan on paper riot Iessthan 8 12 x 11 inches in sae. Plan must include, but rat limited to"ver&xt and honzontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Personal information you provide may 5e used for secondary purposes (Privacy Law, s. 15 04 (1) (m)). County $t Croix Parcel I.D. na Reviewed by _l1_ _ Date �. 7N/202v Property Owner Bruce Erickson Property Location NW NE 20 28 16 ❑ El Govt. Lot 114 1/4 S T N R E (or) W Property Owners Mailing Address 2289 30th Ave Lot # 4 Bkak # na Subd. Name orCSM# CSM City State Zip Code Phone Number Baldwin WI 54002 715-76"739 ityVillage ElTown Nearest Road au Galle 30th Ave. New Construction Use[] Residential / Number of bedrooms Code derived design flow rate GPD Replacement Public or commercial - Describe: na Parent material Clay loam till Flood Plain elevation if applicable na ft, Geneml comments Mound Grade design, system elevation 101.76 ft based on contour line elevation 100.10 ft. Mi umm 20 in s of and recommendations ASTM33 mound sand or to be determined by the designer_ I ❑ 1 Boring # Boring 100 10 18 a Pit Ground surface elev. ft. Depth to limiting factor Soil Application Rate Horizon Depth in Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Donsistence Gr. Sz. Sh Boundary Roots GPD/ft ' ff#1 ff#2 1 0-9 10yr3/2 none sil 2msbk mfr cs 1vf .6 8 - 10yr4/4 none Sid 2msbk mfr cs na .4 3 1 28 10yr4/4 c2d7.5yr5/6 sic om mfr na na .0 0 Bonng # ❑❑ Boring 10010 18 • pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in Dominant Color Munsell Redox Description Qa Sz Cont. Color Texture Structure Gr Sz. Sh sisters Boundary Roots GPDfft ' ff#1 ' ff#2 1 0-9 10yr3/2 none sil 2msbk mfr cs 1vf .6 .8 2 10yr4/4 none sal 2msbk mfr cs na .4 6 3 10yr4/4 cd7.5yr5/6 sits om mfr na na -0 0 nnuern s i = ouu ou L zcu rngL ana i a».w g iou mgfL - r=rnuenc sz = nuu .w log'- ana i as � au rrxyL CST Name (Please Print) Signalyr�-� CST Number David J. Steel ('� _ /'< �Lc � 248956 1699 150th St New Richmond, WI 54017 5-23-2020 715-760-0347 arilfl/l1l Property Owner Bruce Erickson na Parcel ID # 2 3 Page of 3 Boring # U Bonng 9760 16 ❑' pit Ground surface elev. ft. Depth to limiting factor in. Sal -Application Rate Honzon Depth in Dominant Color Munsell Redox Description Qu Sz Cent Color Texture Structure Gr. Sz. Sh onsistence oundary Roots GPDf t l ff#1 ff#2 1 0-8 10yr3J2 none sll 2msbk mfr rs 1c .6 8 2 - 10yr4l4 none Sid 2msbk mfr cs na .4 6 3 - 4 10yr4l4 none Sid om mfr na na 0 .0 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft Depth to limiting factor in Soil Aoo�tion Rate Horizon Depth in. Dominant Color Munsell Redox Desonphon Qu. Sz. Cent Color Texture Structure Gr. Sz. Sh. nsistence Boundary Roots GPD/ft 2 f #1 ff#2 ❑ Boring # EDBonng Pit Ground surface elev. ft. Depth to limiting factor in. Soil Aodicanon Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu Sz. Cont. Color Texture Structure Gr. Sz. Bin. nsistence Boundary Roots GPD/ft ' ff#1 ' ff#2 Effluent #1 = BOD , > 30 < 220 mg(L and TSS >30 < 150 mglL ' Effluent #2 = BOD s < 30 mgfL and TSS < 30 mg1L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay SB0.8330Ta.,(R I I li 1) STEEL'S SOIL SERVICE David J. Steel Bruce Erickson 2289 30th Ave CST-POWTSM SW1/4,SW1/4,S18,T29N,R18W Baldwin,W154002 Lic. #248956 Town of Eau Galle, St Croix Co. 715-760-0739 CSM, Lot 4 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of this test may or may not be as shown, as permanent lot lines were not established at the time the soil test was conducted. O 4-4 Legend — > 1"=40' = Benchmark Eli 100.00 Top of 3/4" pvc pipe M o = Alt Benchmakl 100.60 Top of 3/4" pvc pipe IJ = Borings A Boring Elevations B1 = 100.10 ft 4 B2 = 100.10 ft `Qnce �v,re B3 = 97.60 ft 50, S6 N ^ ft ft I e L &T . CERTIFIED SURVEY MAP LOCATED IN THE NW% OF TILE NE%a AND THE NE%4 OF THE NE!/4 OF SECTION 20, T28N, R16W, TOWN OF EAU GALLE, ST. CROIX COUNTY, WISCONSIN; INCLUDING LOT 2 OF THAT CERTIFIED SURVEY MAP FILED IN VOLUME 19, PAGE 4930 AS DOCUMENT NUMBER 788066IN THE ST. CROIX COUNTY REGISTER OF DEEDS. SECTION CORNERS SHOWN HEREON HAVE BEEN FOUND AND VERIFIED WITH TIES OF RECORD AND PUBLISHED ST. CROIX COUNTY COORDINATES. FIELD WORK WAS COMPLETED --------- �—pp nn5� BEARINGS REFERENCED TO THE NORTH LINE OF THE Ny CORNER, SEC. 20 U rl "LS! p p �CD d NE). OF SECTION 20. LINE BEARS S87'31'13"E, ST. (1" STEEL SURVEY - - AUTADS CROIX COUNTY COORDINATE SYSTEM MARK NAIL FOUND) EXISTING RIVEWAY °���N_ G°, ----M[ NE CORNER, SEC. 20 SB97101 £) NORTH LINE OF THE NE)/4 (1" STEEL SURVEY `4 S87°31'13"E 849 16 MARK NAIL FOUND) 1S _ _ 517.07 �——S87°31'13"E 1776.15' 3�' i 51n arr�' —— V LOT * 461,484 ffi 1 .59 ACRES) LUD G RIGHT-O 4.51.s3° SO. FT. ( 0.37 ; ACRES) EXCLU NG 1 - RIGHT-CF-W li � 3 z � = l 7�, o W O - V - w o°X co �g p Z� CR p 0a W3 to . Va O LL O C� LUZC)S"Z �'opv YL 2aWU' OF- zo Z� �l �wzir Oj00 ,• ouzo �Z Clow W) o J iv O� c X N D ui co �w 3N� o i� ozww g zo�Ta v> 318.85' 0 848.13' JOINT N DRIVEWAY SHARED EASEMENT. DRIVEWAY EASEMENT. Z 1 SEE DETAIL n 1 � I � I zI O m I h 1 0 w 1 w 1 a I I y J qv 143.72' �1 1 rn 153.56' x LLz t J O omwz0 �Ugml2.w_J ddi 0 K LL O <nOr- V G am =�zU) f mo r K w;: O I W r OOorxa O C O o O m ai za.o�J1n� 337.84, I I I I I I I I I 1 I I 1 I I I I I 1.16"102.9T 26.6V (R N00'4859"E,' j87"40'43"W S32-12-37-E 169.08' 80.12' (R S89 20 30"E) (R N33 52'25"W) CN CN m L(O-)T 9 JIB N t-- d�-- -- -— - Lo ------------ o� 0 MR (R S8971 LOT 2-OF C.S.N. VOL. IS POE.49300 1 1014.51' N87°33'17"W' 1333.36, LEGEND-f-pLATTEIDI LANDS SECTION CORNER MONUMENT (AS NOTED). Ill • INDICATES 1.3' OUTSIDE DIAMETER IRON c PIPE FOUND. '0 E3 INDICATES 0.75" X 18' IRON REBAR crl WEIGHING 1.502 LBS. / LINEAR FOOT SET. --X- INDICATES FENCE. z (R) INDICATES PREVIOUSLY RECORDED INFORMATION. SY4 CORNER, SEC. 20 LOT 914,485 SO. FT. (20.99 ACRES) INCLUDING RIGHT-OF-WAY 900,509 SO. FT. (20.67 ACRES) EXCLUDING RIGHT-OF-WAY SOUTH LINE OF THE NWY4 OF THE NEY, (R N89-12'55"W) �I z wl wl 0 z wl r LLI O ul zl J r al W CERTIFIED SURVEY MAP LOCATED IN THE NW%4 OF THE NFY44 AND THE NEY4 OF THE NEY4 OF SECTION 20, T28N, R16W, TOWN OF EAU GALLE, ST CROIX COUNTY, WISCONSIN, INCLUDING LOT 2 OF THAT CERTIFIED SURVEY MAP FILED IN VOLUME 19, PAGE 4930 AS DOCUMENT NUMBER 788066 IN THE ST. CROIX COUNTY REGISTER OF DEEDS. SECTON CORNERS SHOWN HEREON HAVE BEEN FOUND AND VERIFIED WITH TIES OF RECORD AND PUB' [SHED ST. CROIX COUNTY COORDINATES. FIELD WORK WAS COMPLETED BEARINGS REFERENCED TO THE NORIP LINE OF THE o NFII OF SECTION 20. LINE BEARS S8731'13'E, ST NY CORNER, SEC. 20 UNKLL °Q fj TE-D� LA MOB CROIX COUNTY COORDINATE SYSTEM (1' STEEL SURVEY EXISTING ���O1QM QVEFqU�1 NE CORNER, SEC. 20 MARK NAIL FOUND) DRIVEWAY - - - - NORTH LINE OF THE NEY (1" STEEL SURVEY (R 589'iT G7 'E) - L TS87°31'13"E 849.16' I — — — — — MARK NAIL FOUND) —� 338.15' _— ---- — ---_57 01---- ----- �=--587°31'13"E 1776.15' 3376-3 —� —__ —T V --�. o S87'40'43'EI 1 _ 6663' S02'29'40'W 84813' JOINT q RIVEWAV 16 t0292' 26.66' (R NGO'48'59"E) Ii 9i LOT 4 L. SHAR_ ED - SEMENT 87°40'43"W S32°12'37"E 461,484 SQ. FT. 10.59 1, - 169 -2 80.3.3 ( EASEMENT Z S892G'3G'$) (R N33'5225"W) Z ACRES) INCLUDING '; SEE DETAIL i RIGHT-OF-WAY � _ 451,838 SQ. FT. (10.37 ' a N O ACRES) EXCLUDING (n�/�" ❑ N 1 0 Jtl. RIGHT-0E-WAY i DOL6 V 3 LOOT-- - OF 3 V O z pG° UE. 49300------------ IF Of LL 0' 0 Pa g 0 4 O 589'11'S7"E) NJ 89°38'49"E U' ` a 0 143 72' S87°32'09"E 610.50' IX� w m 5 ❑-77 IL >? �' Q o g Q BORINGS d,o yr- 3 3w '°,�- — ---L-- m o ( .s,G, VOL. 99 PC[ 49330 al qyr S8953.56- W 13.56' LOT 3 v Z L= 0 1 914,485 SQ FT. (20.99 >" z ACRES) INCLUDING v �? a p m w Z 0 0 RIGHT-OF-WAY :d n 0 z m LL 900,509 SQ. FT. (20.67 m g 0 O w m o F 6= I ACRES) EXCLUDING o? cJ w Q I RIGHT-OF-WAY o c Kw N Z ZwU < N ON o rCw-oy� J m w wm m > a SOUTH LINE OF THE r 00 or pa Z aOoEom r' NWY, OF THE NEV4 I. 318.65' 33784' 1 1014.51' (R N89'12'55"W) 676.6T N87"33'17"W 1333.36' I LEGEND --------- "NOS n Ia SECTION CORNER MONUMENT (AS NOTED). W • INDICATES I.YOUTSIDE DIAMETER IRON = PIPE FOUND. B3 INDICATES 0.75" X 18" IRON REBAR to WEIGHING 1.502 LBS./ LINEAR FOOT SET. Z (RINDICATES FENCE. - INDICATES PREVIOUSLY RECORDED INFORMATION. SY4 CORNER, SEC. 20 IN 75" IRON REBAR FOUND LAND SURVEYOR: PREPARED FOR: 51S SOLUTIONS JOSEPH GRAN3E_RG BRUCE ERICKSON DRA1 ED '.428 1347H AVENUE 2289 30Ti AVECJE Joe/NO 100-67 SHEET N E'N RIC-iVOND, 'h9 54017 BALDWIN, W 54002 DA E'. 06/09/20 1 OF 2 SEPTIC or HOLDING TANK SERVICING ntract Date NG gal nk Owner(s) Name(s) rom �w� [� contract is made between the on MAR 16 2021 I. 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 septictholding 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 septicfholding 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) Owner's Signature(s) t Subscribed and sworn to me on this date: Toj'cl �&D A j Todays Date Pumper's DaY-rz 11't Pumper's Rbgistration Number 8'S C 13 - L il_y Commission Expiration