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002-1032-70-200
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County Croix Safety and Building Division .St. INSPECTION REPORT Sanitary Permit No GENERAL INFORMATION (ATTACH TO PERMIT) 633333 State Plan ID No Personal Information you provide may be used for secondary purposes [Privacy Law, s 15 04 (1)(m)] Permit Holder's Name Robin (Caroline) Stoner City Village Township 1 Parcel Tax No TOWN OF BALDWIN 002-1032-70-200 TANK INFORMATION TYPE MANUFACTURER „N CAPACITY Septic C aLi =y �O Dosing III rtfAeratturt Sit l o0 f; r /11 N ( id Holding TANK SETBACK INFORMATION LpL)--- t- (l cz Yr<I TANK TO P L WELL BLDG Vent to Air Intake ROAD~ Septic . 301 Dosing �zs , t t�] 3& r yQ Aeration Holding PUMPISIPHON INFORMATION Al./d ✓lil. i. e 3 Z- 'I/ 1 Loss Forcemai❑ ILe/`OJ , JOB •• IDist to Well SOIL ABSORPTION SYSTEM ELEVATION DATA STATION `B 7 yI lo5•`i FS ELEV. �x, Benchmark Alt BIA"lif (Ovc,- Bldg Sewer 95 St1Ht Inlet 1'i.8 9D. G SUHt Outlet Dt Inlet Dt Bottom l� Header/Man Dist Pipe -7 /5 loz• /6 Bot System 3, /oz . (I Final Grade St Crr.lhr O ovr ) , Z / /• BEDrTRENCH DIMENSIONS Width r 3,75 Le gth Z D` N0R �r� �� PIT DIMENSIONS No Of Plts a Dla Iquid Depth SETBACK INFORMATION SYSTEM TO P BLDG JVVELL LAKES RE L ACHIN CH MBE R O factu Ty p Of SystemJ{ DU� , 3 >100 ` �%f, [Man Mod umber UTA I KItlU I IUN JTJ I tM Header/Manifold jDambution I I, Pipes) Arnnnr ✓ x Hole Size s r x Hole Spacing , Veggqt to Air Intake /\ `- -k� Ii Lengtn Die Lengthy Dia� Spacng 3Z fJDic. oUIL it uvCK x Prwes.urn 4vdnme nniv — I111nund n. A._nl-.. ei'n-1 L* , f /U u . Lr. e, Over aptgr) _ r v , 4h Depth Over Bed/Trench EdgEs--� xx Depth of Topsoil 7/ Z rt . Seeded/Sodded Yes No n xx Mulched Ayes No rT O COMMENTS: (Include code discrepencies, persons present. etc) Inspection #1. 0/,#0 7,Z. 4 -41 Inspection #2 Location: No Address Available C kKe � I ` 0`jp 1.) Alt BM Description = r +'T" �6v'�-r No v'�'I` © I x5p RI h 2) Bldg sewer length = 31 ,. r - amount of cover = > l 1 1 revision Required? Yes No -7 Use y 2� I Use other side for additional Informati� / / ' SBD-6710 (R 3197) Date Insepctors Signature Cart No - na v�ti Met. I$,. Pj spn, � 3 (0) VJ.` County -r---nr+, , 0 / Safety and Buildings Division 4501.0 0Y tb e 8 3 p 2021 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) P $ MpR Madison, WI 53,707-7162 33333 Coro �' mtaryPermitApplicatio StateT action Number o Fu,M-03zleo3oS-C- In accordance with SPS 383 21(2), Wis Admit Code, submission of this form m th ovemmental unit x D : t : if 9 W3i+ Project is required prior to obtaining a sanitary permit. Note, Application forms for state-owned POWTS-a-rF7lMfflVW to the Department of Safety and Professional Services Personal information you provide may be used for seoondary Address (if different than mailing address) purposes in accordance with the Privacy Law, s. 15.04 I m Slats. oS L Application Information- Please Print All Information A Property Owner's Name IVQ Parcel # 60 a- i o;a-7o--,10L) Property Owner's Mailing Address , Property Location I i rl, jb. daE )3 G o". Lot 1/4 61/4 Section I S City, State Zip Code Phone Number LW WT: (circled T ZQ N; R (s (Wes!) II. Type of Building (check all that apply) I Family Dwelling 3 Lot # or -Number of edrooms 2—Subdivision �0.S i1 Dtock # Public /commercial -Describe use State owned - Described use No ❑ City of �tAita� CSM Number V,Zo 10.,D33 Vdlageof �4 Town of I11. Type of Permit: (Check only one box online A. Complete line B if applicable) A. New System Replacement System Treatment(Holditlg Tank Replacement Only Other Modification to Existing System (explain) B. ❑Permit Renewal ❑Permit Revision ❑ Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owrier IV. Type of POWTS System/Componeot/Device: (Check all that apply) rr Non-Pressurizedlit-Ground ❑ Pressuei�Rd In -Ground At -Grade Mound > 24 in. of suitable x ound < 24 in, of suitable sail Holding Tank ❑ Other Dispersal Component (exp m) _ ❑ Pretreatment Device (explain) V. DispersaVlYeatmentArea Information: 3,'Kj X 20 eA __ Design Flow (gpd) Design Soil Application Rate dst) Dispersal Area Re u' d (sf) Dispersal Area Pr 9posed (sf) System Elevation 9.,r o,z ysa 2250 t ti5o 22so� loz VI. Tank Info Capacity i6 Total # of Mainifiactur6r L Gallons Gallons Units J �" New Tanks Existing Tanks J u v y Septic Tank —km Lift Tank I• •� JC VIL Responsibility Statement- I, the undersigned, time poWAMAIX for installation of the POWTS shown on the attached plans. Plumber's Name (Print) MP/MPRS Number Business Phone Number Lewis Bork 7�� 253976 715-231-7375 Plumber's Address (Street City, State, Zip Code) E7818 County Road E Menomonie, WI 54751 VHI. County/Department Use Only Approved ❑ Disapproved fermi/t Fee /D�a/ts Issued sir g AgeT Signature `� � 7/a(zvZ� en on for Denial O�tJ i 2U+Q� � ozr IX. Cont�itut' prov ews fer-BlsePpreval 3)� C"�5 PS .S SYSTEM t - 1. Septic tank. effluent filter and —/ � / t �ttixl I maintained TtaL 1 a ,,. �� � dispersal cell must t a provided as per management plan provided by plumbef. 1 .1A 1 A _ I� ryv, Dom"`"` / �fL w� rtl L 2. All setback requirements must be maintained S wry. `S TS-O321oo os-L) ces. t�bt.i r CSc�e oxf eA,�ev1GQ•t``�IiL1 S t t� c t -hr- s. n1_ IL. �_W `i �u`C /)Liwt .I Vl-rY Yll.4 nr�,7f1S•A O-tt[- 1 i� .ri{kCCit' w t -1 •y r -+ I F�((�TaA*JS lb! 1113`{36 YV CHECK 8OX AS APPLICAMLE. CHECK BOX AS APFUCABI-E. SOIL EVALUATION scale: ao 30' YSTEM WAGE 2 OF a SITE MAP PLOT PLAN PROJECT NAME: 75' DESIGN FLOW: 450 coo Caroline Stoner Attach design flow calculations for commercial plans. PROJECT ADDRESS 90th ave / 240th street / InDe Material / ASTM Standard (Tables 384.30-3 & 384.30-5) BM Sy;nbd: BM Elevation: 00 FT NSanitary Sewer: 4 PVC 2 PVC BM Descrlptbn base of wood corner post Fwce Main: f slo eGradk t % P ( I 3 wen Symdcl (UappllcaMe): p of Tesled Area'. Inalaaie north by Crawlq an. IMPORTANT: Show ground elevation contours at suitable intervals. on the ngvoprlie Me. 05 0 Lic IZ-0 S ? � 6 c(! w 1 114G .H Bs ?E.ps yr� o�AAall (✓I'itf Y'� `G�7cr� � . T b/'(2. IN�+r ar. 7yjxv.CjS vv%jvr �J 4c, e-e,4e, 0 O�CI�I Sri J J� 3'/e f X � f�1COPY I I March 10, 2021 CONDITIONAL. APPROVAL PLAN APPROVAL EXPIRES: 2023-03-09 Plan Review: PWTS-032100305-C LEWIS C WORK E7818 County Rd E Menomonie WI 54751 SITE: Caroline Stoner Lot'_ 90th avc Town of BALDWIN St. Croix County Total Amount: $250.00 Descrinlion: 450 GPD (3 Bedrooms — New Construction) Maintenance Required DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 54304-5211 Contact Through Relay httpl/dspami gov/programs/industry-services w .wisconsin.gov Tony Evers • Governor Dawn Crlm • Secretary Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE CORRESPONDENCE Pressure Distribution Component Manual— Ver. 2.0, SBD-10706-p (N.01 /01, R 10/ 12) Mound Component Manual— Ver. 2.0, SBD-10691-P (N.01/01, R 10/12) 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 to or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stall The following conditions shall be met during construction or installation and prior to occupancy or use: • Page 3 — "I" = 15.0 Feet • Page 3 — "W" = 29.15 Feet • Page 5 — Head Calculations Changed Slightly • Preserve dispersal area prior and during construction to avoid disturbance, compaction and use of the site. • With new construction; it is recommended not to activate the pump in the dose tank until the tanks are pumped prior to homeowner occupancy. • Wastewater generated from contractors cleaning of equipment and tools and/or left over construction products shall not be discharged into the drains discharging to the private onsite wastewater treatment system (POWTS). Waste generated shall be properly disposed of on -site or off site. • Any tall grasses, leaves and shrubs shall be cut short and removed prior to tilling the surface for installation to prevent matting under the dispersal area. All loose organic material to be removed from POWTS Dispersal Area. • Divert surface water from all POWTS Areas. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1 /4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacture's recommendations. • Verify property line(s) prior to installation. • Pump Floats to be set and verified per approved plan. Any changes may result in pump resizing to meet TDH and GPM Specifications. • .Areas that are occupied with rock fragnxnts, tree root,, stumps anc boulders reduce rne amount of soil a� mlable for proper it I f no other site is available, trees in the basal area of the mound must be cut off at ground level A larger till area is necessary when anc of the above conditions are encountered, to provide sufficient inf Ittative area. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Thanks, r�,e'nr �n.r�ir �eem1 POWTS Plan Reviewer — Wastewater Specialist Department of Safety & Professional Services I Division of Industry Services email: tun . Cell: 608-516-6134 PAGE 1 OF 6 Mound Plan Index & Cover Sheet Component Manual Design References: Version 2.0, SBD-10691-P (N.01/01, R. 10/12) & Version 2.0, SBD-10706-P (N.01/01, R. 10/12) Pg 1 of 6 Index & Cover Page Pg 2 of 6 Plot Plan Pg 3 of 6 Mound Cross -Section & Plan View Pg 4 of 6 Distribution Network Specifications Pg 5 of 6 Pump Tank Specifications Pg 6 of 6 Management Plan Attachments: Enclosures: Pump Curve POWTS Application for Review Effluent filter Soil Evaluation Report & Site Map tanks Project Name / Description Caroline Stoner - Mound system Owner Name(s): Caroline Stoner Owner Address: 1793 Hillcrest Drive New Richmond WI Phone:715 _247 _3262 Zip: Project Address: 90th ave / 240th street , Town of Baldwin Govt. Lot: SW 1/4 of SW 1/4, Section 15 , T 29 N-R 16 E❑or W ✓] Township: Baldwin Project Parcel ID #: 002-1032-70-200 County: St.Croix Designer Information Designer Name: Lewis Bjork Phone: 715 -231 _7375 Designer Address: E7818 County E Menomonie WI Zip: 54751 E-mail: lewisbjork@yahoo.com License Number: 253976 APPROVED -- 01 �T.O�',AI h ', AtIO PFOFF£ iIONA_ NICE', Remarks: scN ouSFFV r_Hva-s Signature: Date: 2-10-2021 Onglnal signature required on each submitted copy. CHECK BOX AS APPLICn E, CHECK BOX AS APPLICABLE. PAGE 2 OF ❑ SOIL EVALUATION Scale: f 30' YSTEM D SITE MAP 45 60 PLOT PLAN PROJECT NAME: ' DESIGN FLOW 450 GPD Caroline StonerAttach 7.5 design flow calculations for commercial plans. PROJECT ADDRESS, 90th ave / 240th street Pipe Material / ASTM Standard (Tables 384,30.3 & 384.30.5) BM Symbol: BM Elevation 100 FT N 8an4ary Sewer 4 / PVC Fame Mein 2 j PVC BM Description base Of WOOd corner post Slope Gradient I%1 well mbd (k applbada' of Tested Area 3 ) O imkate north M drawing an arrow IMPORTANT: Show ground elevation Contours at suitable intervals. onto eparopow H. IZo �a z•S A�fiE� 253� T loaf E: Z., z.G .91 L. ( K. 13,L Z.Ir 101 I le I ,�,g OPCN Mgt P�DS(�5 �-q0•r All 9K 0 Low X MZ (4 k6 PsP5 6i5r,g C",' T5s>tc5Y w= 0.5' TO 2.5' WASHED AGGREGATE (min. 6.0' beneath distribution pipe - (nin.2.0' over distnbuaDn pipe and covered with approved synthetic fabric) El ASTM C-33 SAND FILL Plowed Surface SINGLE -CELL MOUND DISPERSAL AREA ���II' r • •' •COVER iill�lll� min- 1.0 It min. 0.5 It — I FA= 3.71 ft I (tyPical) I surface Contour Elevation = 99 •g ft (Show force main, manifold, and flush valve locations on plan view.) `{ ��i % slope D= Z-S it E = Z', It System Elevation = 10 Z ft Lateral Invert Elevation = ft PLAN VIEW (No Scale) 2 ' 13 SChdl40 t _ IDt1 ft L ft PVC Lateral i�Z (typal) (typical) -------------------------- -•--..—..—•---•------ observamn O I P pre INI L------ --------------------------------------------- j B=Im-tt 1 I 29.15 ft I 15.0 ft KI 1= I.LZ It = .1� Z It (typical) D Bend as necessary to follow contour 'n DOWNSLOPE TOE M W I 0 L = f T1 Prohibit disturbance and vehicufar traffic within 15 feet of downs" toe. Reset Page DISTRIBUTION NETWORK SPECIFICATIONS (No Scale) Laterals to be level Fist Orifice 1 Z. 'D Schdl 40 Schdl40 PVC Lateral 0 =1 3 in (typical) : PVC Force Main (typical) (dser pipe (slope to pump tank FLUSH VALVE TAIL \ �v�� optional for (No Scale) Orifice in — Valve Box Center of Threaded Cap (insulation optional) for Head Testing (optional) \ \ r ) \ Ball Valve I \ (optional) if / \ Orifices equally spaced. 4fcheyka) OR b) below] i \ a) almp bogom of lateral " b) yL along top of lateral Flush Valve J with every _ th tole Assen,"y faang dawn (typical - see detal) Shield orifices for gmvelless applications Last Orifice (typical) LATERAL INVERT ELEVATION = ft (typical) OBSERVATION PIPE DETAIL (No Scale) Screw -Type or '� '. • • Finished Grade SIB Cap (loose) v (mulched 8 seeded) 4'0 PVC Pipe ,',.� Topsoil Cover Top of pipe to terminate (min. 1 foot) at or above finished grade (4) t/4'-1 X 6' Slots (a1 apart Anchoring Device infiltration Surface Orifice Diameter = (typical) Orifice Spacing (X) = 7-114 in (�i) in Lateral Length (P)= 59 ft Number of Orifices per Lateral = w rai Orifice Discharge Rate = r i.1 gpm Number of Laterals = _c Lateral Discharge Rate = Ya. Z gpm TOTAL DISCHARGE RATE = 32. L _GPM First Orifice (typal) END MANIFOLD (typ l) ❑ CONNECTION Check applicable box. Manifold Fist Orifice (riser pipe optional D (typal) 0 - DTI I 4--- X --�— X/2 X/2 - )^ X �� � (type-l) (typical) Q CENTER MANIFOLD -n Manifold CONNECTION 0) (riser pipe optional) SEPTIC / PUMP TANK SPEC 4"0 Vent Pipe (No Scale) >10 fl from Bulldog Electrical must comply with 12" Min. or 2.0 ft above BPS 316 and NEC 300 Established Flood Elevation Weatherproof (typical) Junction Box Approved IMPORTANT: vent cap Anchor tank(s) as necessary Canduil pursuant to SPS 383.43(8)(g) T Flnlshed Grade CAPACITIES @ I&Lf7 gal/in Depth (in) Volume (gal) A 1i 31Z.43 B 2.1 Z. [C] S•� D I Ll 230.5B W= *T A T BT_I__ *Pump Tank Liquid Level Ac� in D Force Main Diameter = in Force Main Length = I ftq 3"Approved Force Main Void Volume =�y • I I gal [C] Total Dose Volume (TDV) = 6 S. 86 gal/dose (5X total lateral void vol < TDV S 00.2X design flow) + (force main dralnback volume) MIN. PUMP DISCHARGE RATE = 32• gpm TPAGE 5 OF 6 IFICATIONS Wy. t , 39'l '� /I'—Aidrghl Seal Weep Hole Extend manhole riser as necessary. Approved Locking Manhole with Warning Label Attached (typical) 4' Mln. or 2.0 It above Established Flood Elevall (typical) Quick Disconnect 16' Min. (typical) 1 Approved Joints with Approved Pipe 3 it onto Solid Ground (typical) PUMP -OFF C� ELEVATION = ; I ft Concrete • INSIDE BOTTOM QQ Block ELEVATION = ICJ ft ing McWhat Beneath Tank 1� Vertical Head = S ft + Min. Supply Head =�Z• S ft + FM Friction Loss = I o f ft + Fitting Loss" _ [0(3- ft '(min. supply head x 0.3) = = TOTAL DYNAMIC HEAD = 19. 1• e3 ft PUMP TANK: SEPTIC TANK(S): Volume = i I gal (ROC Total Volume = [ OUO gal Manufacturer: V A LLk SL4.AVJ l Manufacturer(s): I-GLIL iW Pump Manufacturer: AMO Pump Model: CIF`E SS� sceattachadpp pWrve) Controls/Alarm Manufacturer: t S Install approved effluent filter at the septic tank outlet immediately upstream of the pump tank inlet. Filter Manufacturer: W&$ Q Controls/Alarm Model: !) iD t Filter Model: lh]ia Float switches containing mercury are prohibited. " PAGE 5 OF 6 SEPTIC / PUMP TANK SPECIFICATIONS (No Scale) 4'0 Vent Pipe >10 ft from Building Electrical must comply vAh 12" Min. or 2 0 ft above SPS 316 and NEC 300 Established Flood Elevation �'jj 1,y�IryeRycof ((typical)+, I I Junc leis aox IMPORTANT: Anchor tank(s) as necessary pursuant to SPS 383.43(8)(g) Finished Grade CAPACITIES gaUn y �4 't\ WAw *Pump Tank Liquid Level=�Force Main Diameter = z in Force Main Length =ft Force Main Void Volume = 1 3 gal [C] Total Dose Volume (TDV) = rj gal1dose t (5t— X total lateral vdd vo <_ TOV < 0.2X design flow) \ + (force m (iralnback volume) seal ' Extend manhole near as necessary. 89 Approved Looking Manhola th bliLabel Altned o a above ,aood Elevation l aloal) 1113.5' VFlWood Min.mal) - Approved Joints with Approved Pipe 3 it onto solid Ground (typical) PUMP -OFF ELEVATION =__ 89 ft INSIDE BOTTOM Z5B ELEVATION = It Tank 13.5 Vertical Head = + Min. Supply Head = a ft 1.78 + FM Friction Loss = ft + Fitting Loss" = ft `(min. supply head x 0.3) 19.K ft TOT DYNAMIC HEAD = `b ft PUMP TANK: SE TIC TANK(S): Volume = gal Total Volume = 11 of gal Man cturer:. WL� Manufacturer(s): Wl *(,t\ b Pump Manufacturer: L Install approved effluent filter at the septic tank outlet Pump Model: immediately upstream of the pump tank inlet wom (Seeatlad pumpourve.) Controls/Alarm Manufacturer: SA Filter Manufacturer.Oytr Iyco Controls/Alarm Model: 6A Filter Model: T l -- O gZ2 `)< Float switches�ntaining mercury are Prohibited mercury are prohibited. ramWINES PAGE 6OF6 Mound Management Plan IMPORTANT: The owner of this mound system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintalner in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = Lfep gpd; BODs S 220 mgL"; TSS S 150 mgL''; FOG S 30 mgL-' Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e„ pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities (i.e., pump re -cycling, float switch settings, etc.) o electrical components (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tankfsl shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids in the tank(s) exceeds one-third (1f3) the liquid volume of the tank(*) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent filters) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. c Qj§LrL4Ujj2a1Ajffji shall be flushed once every 3 years or when necessary. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383,55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Lewis Bjork Family Septic Service Phone: 715-231-7375 Local government unit: JT'tlL� Phone: is 30b-'%8 CIO Local government unit address: Ito (iFiflryifG� I ajf� (D ZIP: Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed mound dispersal component may be re -constructed within the originally approved area after removal of all failed components. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. L CIS Maintenance Instructions ,aeasea.eew Biotube® Effluent Fitter How to Clean Your Effluent Filter To ensure your effluent filter is functioning properly, it should be inspected every year. Under normal conditions, your effluent filter will function for several years before cleaning is necessary. The filter should be cleaned when it becomes clogged enough to restrict normal flows out of the septic tank At a minimum, the fitter should be cleaned whenever the tank is pumped. Most people prefer to have a septic tank service provider take care of fitter maintenance and cleaning. You can find a septic tank service provider in the Yellow Pages, under *Septic Tanks & Systems' Or you can contact your county health department for a list If you wish to inspect and/or clean your effluent fitter yourself, be sure to dress properly. Wear full-length pants and shirt, shoes, gloves, and goggles or glasses. Then follow these instructions: 1. Remove the access lid to your septic tank by unscrew- ing the stainless steel lid bogs with hex head wrench provided. If your lid is above ground, it will be easy to find. If it is buried below ground, find the marker that indicates its location. 2 Remove the fitter cartridge by grasping the tee handle and lifting it out of its housing (see photo 1). 3. Spray the cartridge tubes with a hose to remove any material sticking to them (see photo 2), Ensure the three orifices in the optional flow modulation plate inside the filter are clear of any debris. Make sure the rinse water runs back into the tank, but do not allow solids material to fall into the open fitter housing. 4. Firmly place the cartridge back into the housing. 5. Some effluent fitters come with an alarm that activates when the filter needs cleaning. If you have an alarm, check to make sure it is working by lifting the float with a stick An audible hom should sound. The alarm panel is normally mounted on the side of the house or in the garage. Note: If your effluent fitter doesn't have an alarm system and you would like one, call your local septic system installer. 6. Record the date that you inspected and/or cleaned your filter on the form that follows. If you checked the alarm or made any other observations about the tank or system, include that information under"Notes" Attach access lid by placing it on the riser, matching the openings in the lid with the bolt catches. Insert lid bolts into catches and tighten with hex head wrench provided. Photo 1. Remove the filter cartridge by IifNng it out of its housing. Photo Z. Spray the carridge tubes wipe a hose. NIN-rF(r•1 A".. aZ rM Pop 3 aft 71 (t;-)16 I )c s6 �- 11568�) 5L 30 ,ru air •J 1AL •�1�� w41r i �S _ 1 dle filar zz LjE "iil� y(tif6t ✓Ef t N R�„ �tl: )N «�� ✓ i�/{i CtQ, Uou ",I-+ i.at}r w'AJGDI a' iJ< f �r Q WAHMUD DEATHW Y CCaU T. ZEHr wi n+o u r m a+ER to H r+kx r 0 worE- sff a'HFR wAu veoTo off niE rxclu✓c�a.vFT;xcws rAcF. am rTm ti{—e.�c I u4 f� i ' zm < NXN FlPEST SSA! Q1y'!ET L__-qyml yTER OUTLET END VIEW OF TAW amJ SECTYON VIEWOF TAWAND COVEN -i f lm NtcT-`...sr IOW / 600 SKAW PRE —CAST Phone: a15) W,-2277 App mod for sEr'rasErn SO-" fAtnle SEPM'sm" OR HU Dw z5255 tam Ssea. New #an ToN Free: i-80M4.8625 wegdt an uv_Depth cd./In. Nary. Cep. yin6a757 Fax: (715)967-2707 Y3.05031s. ,4. `z. 39' 1647 642.33 ga.. 146' i�4" Nil C -A-SEAL I 1i11 II P24' I I CI V FILTER OR , I� BAFFLE IN ll 0 a N INLET -- — — — II l 3' I I I L_T_ �__�-� n WLP1000/650-MR TANK SPECIFICATIONS DIMENSIONS: WALL: 3' BOTTOM: 3' COVER: 5' MAN : 24" LD. OPRECAST CONCRETE RISER HEI : 54 1/2' .D. 146' O.D. 84' O.D. LOW INLET: 43' 0.0. r 4" CAST -A -SEAL QUID LEVEL 36' ( WEIGHT: 14,940 LBS. <VENT T AND OUTLET: 4' CAST -A -SEAL BOOT OR EQUAL GASKET, CAST -A -SEAL BOOT OR EQUAL T AND OUTLET BAFFLE AND FILTER: NISCONSIN. SEE DETAIL F10 (OTHER STATES SEE CHART) Q CAPACITY: 26.32 GAL/IN (SEPTIC) 17.DO GAL/IN (PUMP) DING DESIGN: 8' 0" UNSATURATED SOIL (��/�j� BE USED AS y1*TIC/SEPTIC, SEPTIC/ PUMP OR SEPTIC/SIPHON R: MIXDESIGN [8 (NO FIBER) : MIX DESIGN 110 (STRUCTURAL FIBER) M PUMP PAD TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS CD TANKS: CUSTOM TANKS CONTACT WIESER CONCRETE FOR APPROVAL WED BY: PRODUCTS NEEDED BY: W x W m an g W W O 0 1 O co J J Q z U F 9 mpion! CPESS EFFLUENT/SUMP impEvery pump tested in water to ensure pump meets plormonce curve. OWERCORD 7 50.Scries litlluenl Pumps Zoeller pump Company 4upsa7www.zoellerpumps.cunren-na product~'sump-effluent-pumps'cf... tr Uj W W PUMP PERFORMANCE CURVE MODEL 151/152/153 50 14 45 153 40 12 35 152 ull 10 t, 30 ki a 8 151 0 25 J R 20 g 15 4 10 2 5 0 10 20 30 40 50 60 70 80 90 100 G LONS �_ LITERS �r T-T 0 40 80 120 160 200 240 280 320 360 FLOW PER MINUTE 2 of 5 2/21!2018, 10:05 AM commercemi.gov isconsin Department of Commerce September 29, 2005 CUST ID No. 222774 HENRY F GROTE CERTIFIED SOIL TESTING E4366 353RD AVE MENOMONIE WI 54751 RECEIVED Nov 2 3 2005 ST. CROIX COUNTY 70NING OFFICE A7TN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TOO #(608) 264-8777 www. commerce wi gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: NA Transaction ID No. 1193436 SITE: Cindy Lamprecht Site ID No. 704408 Town of Baldwin. St Croix County Please refer to both identification numbers, SW 1/4, SW 1A4 S15, T29N, R16W above, in all correspondence with the agency. FOR: Object Type: Soil Saturation Determination Regulated Object ID No.: 1039229 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 I01.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: 1. Approval is hereby granted pursuant to s. Comm 85.60(2), Wis. Adm. Code, to estimate the depth to seasonal soil saturation based on an interpretive determination process. Approval of the interpretive determination negates the requirement in s. Comm 85.30(2)(b), Wis. Adm. Code to designate the ground surface as the highest level of soil saturation when redoximorphic features are less than 4 inches below the bottom of the A horizon. 2. The estimated highest level of prolonged soil saturation approved under this determination is XXX inches below grade. At least 30 inches of sand lift on top of six inches of unsaturated, in -situ soil is required for adequate treatment and dispersal. 3. The basal soil application rate for the mound shall be 0.20 gpd/sf, and the linear loading rate 3.75 gpd/ft. 4. Chisel plowing to a depth of 16 inches immediately prior to sand placement is required to improve vertical water movement into the soil solum. 5. Landscaping up slope of the mound shall be incorporated into the POWTS design to prevent surface water from concentrating along the up slope edge of the mound and to divert surface water drainage away from the system. The drainage gradient of the adjacent road ditch along 90th Ave must be checked to ensure that it drains to minimize infiltration immediately up slope of the mound. 6. This approval shall remain valid unless the site is altered in such a way that the depth to soil saturation would change or if saturated conditions are observed for seven consecutive days at depths less than 3 feet below the infiltrative surface of the POWTS distribution component 7. This approval in no way relinquishes the use of color patterns to estimate the depth to high groundwater on any other parcels or portions of parcels. 8. A copy of this approval letter and attachments must accompany the mound system design for this site for purposes of plan approval and sanitary permit issuance. If the Interpretive Determination Report was accompanied with a plan and an expiration date is shown on this letter, the expiration date only applies to the plans for the design, not to the decision on the Interpretive Determination Report. HENRY F GROTE Page 2 9/29/2005 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. If plan index sheets were submitted in lieu of additional full plansets, a copy of this approval letter and index sheet shall be attached to plans that correspond with the copy on file with the Department. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installatiam/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, O,wy�ban'sky, S, Was ater Specialist Integrated Services Bureau (715)726-2544 Voice (715)726-2549 Fax Ij ansky@.commerce. state.wi.us Fee Required S 100.00 Fee Received $ 100.00 Balance Due $ 0.00 WiSMART code: 7633 1193436 commerce.wi.gov isconsin Department of Commerce INSPECTION REPORT Date of Inspection: September 26, 2005 Project Name: Lamprecht Use: Residential Legal Description: SW, SW, 15, 29, 16W Site Number: Subdivision: Municipality: Town of Baldwin County: St. Croix Plan Transaction Number: 1193436 Sanitary Permit Number: NA Wastewater Flow: 450 gpd Persons Present: H. Grote, K. Grabau SAFETY AND BUILDINGS DIVISION Integrated Services Bureau 13 East Spruce Street Chippewa Falls, WI 54729 www.commermwi.gov/sb (715) 726-2544 Plumber Name and Address: Certified Soil Tester Name and Address: Henry F. Grote, CST'222774 E 4366 353rd Ave. Menomonie, WI 54751 Owner Name and Address: Cindy Lamprecht An onsite soils verification was conducted at the above referenced site as per district policy for all sites with less than four inches of unsaturated soil below the bottom of the A horizon The intent of this investigation is to confine initial observations by the certified soil tester (CST) relating to the presence or absence of redoximorphic features in the A horizon and/or subsoil In -situ soil texture, structure, and consistence factors were also reviewed as they relate to wastewater application rates. Other site conditions such as percent and direction of slope, landscape position, land surface contour length, and surface water hydrology may also be noted and their effects are factors considered in the recommendations and conclusions portion of this report. A typical soil profile at T-1 could be described as follows: 00-04" 10YR 3/3 sil, 2m-cgr, mfr, aw. 04-10" 10YR 3/3 sil, 2msbk parting to pl, mfr, as. 10-16" 10YR 4/4 sil, 2fpl, mfr, w/ c3d 10YR 5/6 and 5/3 rmfs. If a mound system is designed to overcome limitations of a high level of seasonal soil saturation and slow permeability, the linear loading rate should not exceed 4.5 gpd/ft and the basal wastewater application rated should not exceed 0.2 gpd/ft2. The additional basal area will partially compensate for the gentle to moderate land slope and platy subsoil structure to prevent wastewater leakage at the mound toe. At least 30 inches of sand lift is recommended when applying septic tank effluent to the distribution cell of the mound to ensure proper treatment. The longest portion of the mound must be orientated along the contour. The mound shall be constructed to divert surface water around the mound structure as much as possible. In addition, an up slope drainage ditch should be considered if it is determined that surface or subsurface hydrology is improved by intercepting water and diverting it away from the mound site. If there are any questions regarding this report, please contact me eroy G.ArInsky, stewat "pecialist cc ® County ❑ Plumber Ljansky commerce.state.w s E-mail © CST ❑ Owner 715/726-2544 Voice 715/726-2549 Fax ❑ Other Interpretive Determination Report For an A+0" Mound Septic System 1193436 1 On the Cindy Lamprecht Property SW 1/4, SW '/4 Section 15, T 29 N, R 16 W P.O.W.T.S. Conditionally APPROVED DEPARTMENT OF COMMERCE DIVIS1N Of OF SAFETY AND BUILDINGS PEC ESP ENCE RECEIVED SEP 0 7 2005 SAFETY & BUILDINGS Town of Baldwin St. Croix County, Wisconsin Submitted by 4��s Henry F. Grote, CSTM 222774 Certified Soil Testing, LLC E. 4366 353rd Ave. Menomonie, WI 54751 715-233-0398 September 6, 2005 Contents Introduction Page Methods 1 Local Hydrology 2 Geomorphology 3 Soil Disturbance and Hydraulic Modification 3 Landscape Position 3 Soil Series 4 Data 5 Conclusions/Recommendations 5 Attachments Soil Evaluation Report, Henry F. Grote Topographic Detail, Section 9, T 29 N, R 16 W Soil Series Map, Soil Survey of St. Croix County i Interpretive Determination Report for an A+0" Mound Septic System on Cindy Lamprecht Property Introduction On May 13, 2005 Henry F. Grote, CSTM 222774, Certified Soil Testing, conducted a Soil and Site Evaluation on the Cindy Lamprecht property for the purpose of establishing the potential for an onsite wastewater dispersal system. This evaluation was conducted on the five acres located at the northeast corner of 240u' St. and 90u' Ave. in the SW %4 of the SW 1/4 of Section 15, T 29 N, R 16 W, Town of Baldwin, St. Croix County, Wisconsin. Initial work was conducted for a potential buyer, Diane Hughes. Methods Soil color, texture, structure, consistence and redoximorphic features have been evaluated and reported on the accompanying Soil Evaluation Report in accordance with guidelines under Comm 85 of the Wisconsin Administrative Code. Pertinent information has been abstracted from the Soil Survey of St. Croix County, Wisconsin. Topographic detail has been obtained from the DeLorme 3-D TopoQuads CD mapping release. Additional reference sources include Redoximorphic Features for Identifying Aquic Conditions,' Field Indicators of Hydric Soils in the United States2, and notes from a continuing education program for shallow soil saturation.3 Field investigation included four backhoe pits, two were located on the optimal landscape position, higher ground north of the 90'h Ave. right-of-way and two were located northwest of this area. Subsequently, three, additional, hand -dug pits were constructed in the optimal landscape area. Rod and transit elevations were obtained at pit locations and twenty foot intervals to allow the insertion of contour lines on the detailed plot plan. ' Redoximorphic Features for Identifying Aquic Conditions, North Carolina Agricultural Research Service, Technical Bulletin 301, December 1999. '- Field Indicators of Hydric Soils in the United States, A Guide for Identifying and Delineating Hydric Soils, Version 4.0, March 1998. ' Reading Shallow Soil Saturation, Ashland UW Ag Research Station, Jerry Tyler, October 15, 2004. Local Hydrology The major local hydrology input is from annual precipitation. This is estimated at from 29.57 inches' to 30 inches.` Surface runoff is an additional input most significantly during heavy precipitation events. The proposed mound site land use is weedy sod with corn ground down - slope to the north. A small upslope area land use is also weedy sod to the fence line which is nominally the right-of-way. South of the fence line is a moderately deep road ditch which serves to minimize surface and subsurface drainage to the north. Dense glacial till beneath a shallow loess cap provides significant groundwater protection from possible surface contamination. Water outputs consist of surface runoff, soil infiltration, and evapotranspiration. Surface runoff will generally be minimal unless frozen soil conditions or excessively heavy and prolonged precipitation occurs; the road ditch to the south minimizes upslope runoff in the proposed system area. Soil infiltration is described as "moderate" in the subsoil to "moderately slow" in the substratum for the Freeon silt loam, heavy substratum Series soils6 which are mapped in the proposed site area. The lower portion of the subsoil and the substratum are described as remaining saturated with water for longer times. Moderate infiltration is reasonable for the well structured silt loam A horizon; infiltration will slow through the B horizon because the subsoil at increasing depth exhibits weaker structure with increasing clay content occasionally texturing as silty clay loam with sandy clay loam noted at depth in good agreement with soils mapping. The proposed mound site has a surface drainage feature down -slope to the north. Slower infiltration is anticipated during wet spring periods when the soils are closer to field capacity and slow to dry. The underlying massive till unit will be significantly restrictive to vertical infiltration. Lateral movement of water through more permeable upper horizons will be facilitated by the 3.0 to 4.0 percent cross slopes below the proposed system design line. Heavy 4 Soil Survey of St. Croix County, United States Department of Agriculture, Soil Conservation Service, July 1987, p 139. (River Falls, WI data) Wisconsin Average Annual Precipitation (1961-1990), www.crh noaa.gov/mkx/data/wipcpn.gif Soil Survey of St Croix County, United States Department of Agriculture, Soil Conservation Service, Jul} 1987, p 31, and prolonged precipitation - 2.5 inches in 24 hours; described as once in two years? - will also slow infiltration as the more permeable A horizon nears field capacity. Evapotranspiration will be a significant factor during the growing season but of no value during the winter season Geomorphology Limestone bedrock underlies most of St. Croix County. Typically the limestone is sandwiched between layers of sandstone which is then overlaid with glacial till forming the principal soil parent material. Cary sandy loam till, correlated with the third sub -stage of Wisconsin glaciation, is the parent till for Freeon Series soils. The Cary till is overlain by a thin concurrent and/or post -glaciation loess cap. Soil Disturbance and Hydraulic Modification The proposed mound location is uniform topography. The A horizon has generally moderate, medium granular and moderate fine sub -angular blocky structure; the B horizon generally has weak medium to coarse subangular blocky structure but frequently exhibits weak to moderate fine platy structure. While platy structure is often developed by the natural deposition of loess silt loam soils, some of the observed platy structure is likely induced by farm field operations as this site is immediately west of farm buildings and would have been a logical entrance to farm fields to the north. Hydraulic conductivity of the solum can — and should be — improved by deep chisel plowing to a depth of at least sixteen inches. This will reorient any platy structure at depth. Landscape Position The landscape position of the proposed mound site is on the east slope of a glacial ground moraine about one half mile south of the north terminus of the moraine. The proposed location, along the 100.0 contour, is located on Freeon silt loam soils, heavy substratum, up -slope from somewhat poorly drained Magnor Series soils to the north. A proposed design line of nominal ' Soil Survey of St. Croix County, United States Department of Agriculture, Soil Conservation Service, July 1987, p 140. 100.0 contour has a classic "nose" landscape, convex orientation. The moraine rises to the west to a nominal elevation of 1250 MSL about 1/8 mile northwest of the 100.0 contour which is at a nominal elevation of 1240 MSL. Small scale cross slopes at the proposed mound site are 3.0 to 4.0 to the north below the 100.0 contour. The moraine slopes from the 100.0 contour to the north and east about'/4 mile to 1220 MSL at a surface drainage feature heading south to Carr Creek and continues to the south of Woodville joining the Eau Galle River at a nominal 1120 MSL. Surrounding land use is row crop farm fields the north both south of and north of the east -west drainage feature. A small area of dense brush and woods are located immediately northeast of the intersection of 240a' Street and 901h Ave. No structures are down -slope to interfere with lateral movement of effluent. The 3.0 to 4.0% slopes at the mound site will somewhat increase the hydraulic gradient and encourage lateral movement of treated effluent. The existing road ditch serves to divert surface drainage away from and around the system. Road ditch effectiveness should be verified with elevation shots to ensure adequate slopes to avoid ponded water. Near - system upslope surface runoff can — and should — be minimized by the addition of extra fill soils from the center of the upslope mound structure. The extra fill materials will divert surface runoff towards the road ditch and to the west around the proposed mound system. Soil Series The Soil Survey of St. Croix County maps the site soils as Freeon silt loam, heavy substratum Series south of and up -slope from Magnor Series soils mapped to the north. The Magnor Series is on both sides of the east -west drainage feature generally trends to the east before entering the north -south drainage which becomes a part of Carr Creek. These soils are respectively generally described as "moderately well drained" (Freeon), and "somewhat poorly drained" (Magnor). The Freeon, heavy substratum is qualified by noting that while the A horizon may be described as moderately well drained the soil "permeability ranges from moderate in the subsoil to moderately slow in the substratum."8 Field observations of soil pits are in good agreement with this mapping. Pit profiles representative of the proposed site agree with the typical Freeon Series s Soil Survey of St. Croix County, United States Department of Agriculture, Soil Conservation Service, July 1987, p 31 4 profiles showing silt loams above silty clay loams and sandy clay loams with A horizon color in good agreement at 10YR 3/2 and 7.5YR 3/2. Both series are Alfisols; Magner and Freeon are Fine -loamy, mixed Family. The Magnor Series are subgroup Aquic Glossoboralfs while the Freeon Series are Typic Glossoboralfs. Field observations show redoximorphic features absent to depths of 9 to 10 inches in the proposed area. The redoximorphic features were not observed in backhoe pits until the B horizon was encountered. Under dry conditions low chroma inclusions, 10YR 6/3, were noted in two of the hand dug pits in the lower 1-2 inches of the A horizon. These low chroma features may be accumulated grey silts. The B horizon upper redoximorphic features were common or typically medium, prominent or distinct. Periodic soil saturation is indicated below seven to nine inches by these observations. Under relati%ely Net soil conditions in mid May a side seep was observed at 26 inches below grade in one backhoe pit; this also suggests suitable soil permeability in upper horizons. A pit at lower elevation and closer to the surface drainage feature gave profiles with darker A horizons, 7.5YR 3/1, and the redoximorphic features were many to common in the upper B horizon. Redoximorphic features in the A horizons may have been masked by the higher organic content and darker color. Data The soil and site evaluation report and data are similar to other sites which have received Department of Commerce approvals for A+0" mounds with a minimum of six inches of seasonally unsaturated soils in the upper A horizon. Examples include the Lisa Mosentine site, ID #636612, Anthony Ludwig site, ID 9634143, Jon Mentink site, ID 4787909, Tim Holldorf site, ID # 849265, and Karen & Keith Anderson site, ID 9639788. Conclusions/Recommendations 1. Seasonally saturated soil conditions do not occur in the upper seven to nine inches of the soil profile as indicated by the absence of redoximorphic features. The site is acceptable for a mound septic system with a minimum of seven inches of unsaturated soil for treatment and dispersal of treated wastewater effluent as allowed by Comm 83.44(3)(b) 1. The seven inches of natural soil will allow treated effluent to be assimilated into the subsurface without ponding on the ground surface. 2. Mid spring observations of a side seep at 26 inches of depth is good evidence for a minimum of seven inches of suitable soils. 3. The A horizon is Munsell color l OYR 3/2 to 7.5YR 3/2 which indicates an organic matter content nominally of 25 g/kg in the range of 20-30 g/kg or 2.5 percent.' This level of organic matter is indicative of relatively good drainage and aerobic conditions. 4. The relatively low level of organic matter indicated by the Munsell value of 3 should facilitate observation of high chroma redoximorphic features in the A horizon. The lack of observation of these features in the A horizon is strengthened by the low organic matter content which lends further evidence to a conclusion that at least seven inches of soil is present which is not periodically saturated for more than seven days. 5. No hydric soil indicators to are present in the observed soil pits; this conclusion is based on particularly careful review of the indicators for All Soils and Loamy and Clayey Soils. 6. Site preparation requires mowing and removal of as much vegetation as possible followed by deep chisel plowing to at least a 16 inch depth which will facilitate infiltration into the natural soils. The deep chisel plowing will reorient any platy structure which might be present. 7. The drainage of the existing road ditch should be verified with elevation shots to ensure drainage with a minimum of three percent slopes which must be uniform to minimize the potential to pond water.. 8. The upslope toe of the mound shall be shaped with additional fill dirt from the center such that a nominal, settled 3% surface gradient is established towards the road ditch and to the west to ensure near surface runoff diversion around the west end of the mound structure. 9 Tyler presentation, Reading Shallow Soil Saturation, 10/15/04, Ashland UW Ag Research Station. 10 Field Indicators of Hydric Soils in the United States, A Guide for Identifying and Delineating Hydric Soils, Version 4.0 (March 1998), p5 ff, 13 ff, & 20ff.. 9. The mound must be a minimum length of 120 feet to ensure a linear loading rate no greater than 3.75 gallons per day per foot for a three bedroom residence. 10. For typical septic system effluent the mound must have a minimum of thirty inches of sand fill to ensure at least thirt<-six inches of suitable soil for proper treatment. 11. Since the well structured silt loam topsoil is relatively shallow in places, consideration should be given to the installation of an aerobic treatment unit, or comparable treatment device. This �N ill reduce the quantity of sand fill required, maximize system life, help overcome any platy soils remaining after deep chisel plowing, and protect the environment. 12. The mound basal area loading must be less than or equal to 0.2 gallons per day per square foot to comply with a highly treated effluent application rate for any moderate to strong platy structured silt loam soils which might remain. Deep chisel plowing should reorient any platy structure which would allow a higher soil application rate, but maintaining less than or equal to 0.2 gallons per day per square foot will ensure a conservative design for extended longevity. 13. Mound construction for ordinary septic effluent requires thirty inches of ASTM C-33 sand lift immediately placed on the freshly plowed ground surface. Construction must take place under relatively drti conditions. This depth of sand creates an effective sand filter and can be expected to produce a treated effluent with less than 30 mg/L of both BOD; and TSS and fecal coliform concentrations of <10,000 cfu/100mL. If the highly treated effluent consideration is used, the sand depth may be reduced to eighteen inches and still maintain a conservative design. 14. The rock cell in the mound structure shall be 3.75' x 120.0' for a linear loading rate of 3.75 gallons per day per foot for a three bedroom residence for untreated effluent. 15. The sand basal area loading must be a maximum of 0.2 gallons per day per square foot which can be accomplished by extending the down -slope sand toe to fifteen feet below the down -slope edge of the rock cell if untreated effluent is used. 16. If highly treated effluent is used for the system design, the rock cell may be reduced to 1.75' x 120' which still maintains the 3.75 gallons per day linear loading rate, and the down -slope sand toe must be extended to seventeen feet to maintain the 0.2 gallons per day sand basal loading rate. This design would be optimal for the site and is recommended. 17. The system management plan must provide adequate maintenance information to maximize the system longevity. Final authority for this site's approval rests with the appropriate regulatory authorities, the Wisconsin Department of Commerce and the St, Croix County Zoning Office. This report, conclusions and recommendations are the professional opinion of Henry F. Grote, CSTM 222774. N ar NO N z 12.35 i all N 159-75 --- - NH`59 5 r L ^— or i 9-9 l 3-D I opoQuads Cop-vright C 1999 Del urme Yarmouth, ME 04096 Source Data: OSGS SU It Scale: 1 : 7,200 Detail: 14-7 Datum: WGSS4 quj qu { y. y VI V viq Oj 'All j IX JAW � i I l \ El V4 alVisconsin Department of Commerce Division of Safety and Buildings WrdaUATION REPORT n dh Comm 85, Wis. Adm. Code #2243 Page 1 of 4 Certified Soil Testing, LLC Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road Please print all information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15 04 (1) (m)). County St. Croix Parcel I.D. 002-1032-70-J& 260 Reviewed By Date Property Owner Hughes, Diane (buyer) Property Location Govt. Lot SW1/4, SW1/4, 515, T29N, R16W Property Owners Mailing Address 1333 Pearson Drive, N. Lot # BIoGc # Subd. Name or CSM# Cindy Lamprecht 5 Acres City State Zip Code Phone Number Maplewood MN 1 55119 1 651-773-7540 City Village ® Town Nearest Road Baldwin 1 90Th Ave. ?S New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate 450 GPO Replacement C Public or commercial - Describe: Parent material loess over till Flood plain elevation, if applicable NA ft General comments soils lack A+4"; interpretative report required w/ state & county approval for residential development and recommendations f 1 Bo rig # J Boring Pit Ground surface elev 97.3 ft. Depth to limiting factor 0 in Sod Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence GPD/ft' 1001 `EMIT 1 0-11 7.5YR 3/2 sil 2 f sbk mvfrcs.6 7cnsdarytRoots .8 2 11-16 10YR 5/4 m2p 7.5YR 5/8,4/6 10YR 6 2 sit 1 m -c abk mvfr .4 .6 3 16-30 SYR 4/4 f2d 7.5YR 5/3 scl 0 m mfr lm 0 0 i i lacks A+4"; presumptive limit is 0"; 1 m roots to 22"; 5-11" has 2-20 mm inclusions B horizon 27 Borng # — Boring X Pit Ground surface elev 100-9 ft. Depth to limiting factor 0 in Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. ConsistenceBoundary Roots GPD/R' `Eff#1 `Eff#2 1 0-11 7.SYR 3/1 - sit 2 f sbk mvfr cs lm .6 .8 2 11-25 10YR 5/4 c2p 7.5YR 4/6 10YR 612 sit 1 C abk mvfr cs lm 4 6 3 25-36 SYR 4/4 c2p 7.5YR 5/3 scl 0 m mfr im 0 0 i lacks A+4"; presumptive limit is 0"; side seep @ 30"; horizon 2 parts to 2 f pl; 2-4 mm inclusions B horizon @ 7-11" ` Effluent #1 = BODS> 30 _< 220 mg/L and TSS 30 _< 150 !L ffivant #2 = SODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sign to CST Number Henry F. Grote 222774 Address Certified Soil Testing, LLC Date Evaluation Conducted Telephone Number E 4366 353rd Ave. Menomonie, Wl54751 5/13/2005 715-233-0398 SaD4330 (R 077 Property Owner Hughes, Dlane(bu� - _ Parcel ID# 002-1032-70- Page 2 of 4 3 Boring # Depth to limiting factor _ Pit Ground surface elev. °95 __ ft. 0 in Sotl Application Rat Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' •E8#1 •Et#F2 in. Munsell Co. Sz. Cont. Cola Gr. Sz. Sh. 1 0 9 10YR 3/2 sill 2 f sbk mvfr cs If/m .6 .8 -- - 2 9-19 10YR 5/4 - c2p 7.5YR 5/8,5/3 I slcl 1 f-m sbk mvfr gs lm 2 .3 3 19-30 5YR 4/4 c2p 5YR 5, 8,5/3 scl 0 m mfr lm 0 I 0 lacks A- 4'; presumptive limit is 0" 4 Boring Boring # `- 9 3 Depth to limiting factor 0 Pit Ground surface elev ft in Soil Application Rat Horizon Depth Dominant Color Redox Description e<ture Structure Consistence, Boundary Roots GPDW •ER7tt •Efi#2 in Munsell Co. Sz Cent Cola Gr. Sz. Sh. 1 0-10 10YR 3/2 _ - sill 1 f-m sbk mvfr cs 1f/m .4 .6 2 10-15� 10YR 5/3_- c2p 7.5YR 416 sil 1 f pl mvfr cs inn .4 _6 - - 3 15-30 5YR 4/4 c2p 5YR 5/8,5/3 A0 m mfr lm 0 0 —0 — - — r lacks A+4"; presumptive limit is 0"; side seep Cu 2e ; horzon 2 has some weak sbk structure in places but pl is dominant 5 Boring Boring # 1)0.3 Depth to limiting factor 0 Pot Ground surface elev ft in - Soil Application Rat Horizon Depth Dominant Color Redox Description-I"exture Structure Consistence Boundary Roots GPD/ft' •Eff#1 'Eff#2 in j Munsell Qu, Sz. Cord Cola Gr. Sz. Sh. 170 -9.5 7.5YR 3/2 sd 2 f sbk ds cs im 6 8 - -- - 2 9.5-14 10YR 5/4 c2d 7.5YR 4/6 �icl 2 f pl ds - if 0 .2 lacks A+4"; praximpUve limit is 0"; hand dug pit Effluent #1 = BODs > 30 < 220 mg/L and FS5 >30 < 1 [1 mg/L • Effluent #2 = 8O05 < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal oppoiLunn) xi % ice p. ovider and employer. If you need assistance to access services or need material in an alternate forinat, please nnnact dic department at 608-266-3151 or TTY 608-264-8777. SBD-3330IR O7/001 CeMW Sal Testing, LLr Property Owner Hughes, Diane (buyer) Parcel I D # 002-1032-70-100 Page 2 of4J, 3 ] Boring Boring # cl Pit Ground surface elev. 99.5 ft. Depth to limiting factor 0 in. iCJ Soil Application Rat Horizon Depth in. Dominant Color Munsell Redox Description Qu. SZ. Cont. Colo Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft- 'Eff#t •Eff#2 1 0-9 10YR 3/2 sil 2 f sbk mvfr cs 1f/m 6 8 2 9-19 10YR 5/4 1 c2p 7.5YR 5/8,5/3 SO 1 f-m sbk ni gs lm .2 .3 3 19-30 5YR 4/4 c2p 5YR 5/8,5/3 scl 0 m mfr 1M 0 0 lacks A+4"; presumptive limit is 0" 4 Boring Boring # �� Pit Ground surface elev 99.3 ft. Depth to limiting factor 0 _ in. _ Soil Application Rat Horizon 1 2 3 Depth in. 0-10 10-15 15-30 Dominant Color Munsell 10YR 3/2 10YR 5/3 SYR 4/4 Redox Description Qu. Sz. Cant Colo' c2p 7.SYR 4/6 c2p 5YR 5/8,5/3 Texture Structure Gr Sz. Sh. sit 1 f-m sbk sil 1 f pl scl 0 m Consistence mvfr mvfr mfr Boundary a cs Roots if/m Inn lm GPD/ft' 'Eff#1 •Eff#z .4 .6 .4 .6 0i 0 lacks A+4"; presumptive limit is 0"; side seep @ 26"; horizon 2 has some weak sbk structure in places but pl is dominant 5 1D Boring Boring # rj Pit Ground surface elev. 100.3 ft. Depth to limiting factor 0 in. Sod Application Rat Horizon Depth in Dominant Color Munsell Redox Description Qu. Sz. Cont. Colo' Texture Structure Or. Sz. Sh. Consistence Boundary Roots GPD/fP _ `Eff#1 `Eff#2 1 0-9.5 7.5YR 3/2 sil 2 f sbk ds cs 1m i .6 .8 2 9.5-14 10YR 5/4 c2d 7.5YR 4/6 sicl 2 f pl ds if 0 .2 - � y lacks A+4"; presumptive limit is 0"; hand dug pit Effluent #1 = BODS> 30 < 220 ni and TSS >30 < 150 mg/L • Effluent #2 = BODS < 30 mg/L and TSS 9 30 mg/L The Department of Commerce is an equal opportunity sci vice pi ovider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777 SRD-8330 (R 0]100) Certified Sol Te N, LLC Property Owner Hughes, Diane (buyer) Parcel ID # 002-1032-70-100 Page 3 of-4- 6 j Boring Boring # ; Pit Ground surface elev 98.7 ft Depth to limiting factor 0 in. . Solt Apphcahon Rat Horizon Depth in Dominant Color Munsell Redox Description Qu. Sz. Cont Cola Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft' 'Eff#1 •Eff#2 1 0-7 7.5YR 3/2 sil 2 m gr ds gs if/m 6 8 2 7-9 7.5YR 3/2 3 9-18 10YR 5/4 c2d 10YR 6/3 c2d 7.5YR 4/6 sil 2 m gr sil 1 If pl ds Cs ds - lm - 6 .8 .4 .6 lacks A+4'; presumptive limit is 0"; hand dug pit 7 BoBoring ring # Pit Ground surface elev _ 98.5 It Depth to limiting factor 0 in Sod Application Rat Horizon Depth Dominant Color m Munsell Redox Description l Texture Qu. Sz Cont. Cola Structure Gr. Sz Sh. Consistence Boundary Roots GPD/ft' -Eff#1 Em#2 1 0-8 7.5YR 3/2 - sll 2 m gr ds gs if/m .6 .8 2 8-9 7.5YR 3/2 fld 10Yr 6/3 sil 2 m gr ds Cs lm .6 .8 3 9-16 10YR 4/4 c2d 7.5YR 4/6 10YR 6/2 sil 1 f I P ds .4 .6 —� lacks A+4"; presumptive limit is 0"; hand dug pit Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOOS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity sere ice provider and emplover, If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777 SBD-833D (R �,'M Certrfi i Sal Tesorg, LLC 2 M v - ' ----LI--, 042 c2 a 1h —` t v L7 rSb an 1� _ TD Si't b C•-0\-0t- 4 1-ZOO i Wisconsin ORh: ^' #2243 --�' ""SOtL'EVALUATION REPORT Department of Commerce in accordance with Comm 85, Wis. Adm Code Page 1 of 3 Division of Safety and Buildings Certified Soil Testing, LLC ���((+'C������Cry1 County Attach complete site plan on paper not Jess than 8Y2 x 11 ches 1n'SRPP#AttMrbsF+' St. Croix include, but not limited to. vertical an horizontal referent point (BM), direction and d orth arrow„and Iota n anq di�fani t� nearest road. Parcel 1 D. percent slope, scale or dimensions„n2-1 32-70 00e1 © uZ Z MN1 2005 Please print all info Reviewed By Date Personal information you provide may be used for da (�.���.8v4m)). Property Owner tion Hughes, Diane (buyer) JPi ik; — GOA Lot SWt/4, SW1/ S15, T29N, R16W Property Owner's Mailing Address Lot # Block # Subd Name or CSM# 1333 Pearson Drive, N. Cindy Lamprecht 5 Acres City _ State Zip Code Phone Number L City I Vdlage Z Town Nearest Road / - 3 Maplewood MN 1 55119 1 651-773-7540 Baldwin 90Th Ave. New Construction Use:Z Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe Parent material loess over till _ `,,, Food lain elevation, if applicableNA ft General comments and recommendations, soils lack A+4"; interpretative report required w/ stale & county aplffoval for residential development ❑ Boring #— Boring Z Pit Ground surface elev. 97.3 ft. Depth to limiting factor 0 in ISoil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consisten Boundary Roots GPDttt' �EH#1 •Eff#2 1 0-11 7.5YR 3/2 - sil 2 f sbk mvfr cs lm .6 .8 2 11-16 10YR 5/4 m2p 7.5YR 5/8,4/6 10YR 6 2 sit 1 m -C abk mvfr . lm .4 .6 CS i 3 16-30 5YR 4/4 f2d 7.5YR 5/3 scl 0 m mfr im 0 0 lacks A+4"; presumptive limit is 0"; 1 m roots to 22"; 5-11" has 2-20 mm inclusions B horizon Boring # Boring 2 Pit Ground surface elev. 100..9 ft. Depth to limiting factor 0 in. Isoil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistent Boundary Roots GPD/ft' -Eff#1 •Eff#2 1 0-11 7.5YR 3/1 sit 2 f sbk mvfr cs lm .6 .8 2 11-25 10YR 5/4 c2p 7.5YR 4/6 10YR 6 2 sit 1 c abk mvfr �i, cs Sm .4 .6 3 25-36 5YR 4/4 c2p 7.5YR 5/3 scl 0 m mfr lm 0 0 I I lacks A+4"; presumptive limit is 0", side seep @ 30"; horizon 2 parts to 2 f pl; 2-4 mm inclusions B horizon @ 7-11" - tmuent si = cuu5> su < 22o mg/L and T55 >30 < 150 mg/L 'Effluent #2 = BODs < 30 mg/L and TSS < 30 mgt CST Name (Please Print) Sign to _ CST Number Henry F. Grote < -_!-y, 222774 Address Certified Soil Testing, LLC Date Evaluation Conducted Telephone Number E 4366 353rd Ave Menomonie, WI 54751 5/13/2005 715-233-0398 $aD-3330 (R 07 oW) Property Owner Hughes, Diane (buyer) Parcel ID # 002-1032-70-100 - Page 2 _ of 3 ❑ Boring # - Boring �_ 99.5 Depth to limiting factor _. Pit Ground surface else it 0 in Soil Application Rat Horizon Depth Dominant Color Redox Description Texture structure Consistence! Boundary Roots GPD/ft' 'Eff#1 'Eff#2 in Munsell Qu. Sz. Cont. Cola Gr Sz Sh 1 0-9 10YR 3/2 sil 2 f sbk mvfr cs if/m .6 8 2 9-19 1 10YR 5/4 c2p 7.5YR 5/8,5/3 slcl 1 f-m sbk mvfr gs 1m .2 .3 3 19-30 SYR 4/4 c2p SYR 5/8,5/3 scl 0 m mfr 1m 0 0 , ! I - lacks A+4", presumptive limit is 0" 4 Boring Boring # 99,3 Depth to inciting factor _ Pit Ground surface else - _ ft 0 In Sou Appl,cation Rat Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in Munsell Qu Sz. Cont. Cola Gr. Sz Sh. _ 'Eff#1 •Eff#2 1 0-10 10YR 3/2 sil 1 f-m sbk mvfr cs if/m .4 .6 it — 2 10-15 10YR 5/3 c2p 7.5YR 4/6 sill _ 1 f pl - mvfr cs lm .4 - - .6 - 3 15-30 SYR 4/4 c2p SYR 5/8,5/3 1 scl i 0 m mfr 1m 0 0 I I I lacks A+4'; presumptive limit is 0"; side seep @ 26"; horizon 2 has some weak sbk structure in places but pl is dominant ❑ Bonn # Boring g Depth to limiting factor Pit Ground surface else ft in Sotl Application Ra! Horizon Depth Dommant Color Redox Description Texture Structure Consistence Boundary Roots 1 GPD/ft' m Munsell Qu. Sz. Cont Coly 1 Gr. Sz. on. _ •Eff#1 ! -Eff#z i Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 ni and TSS < 3C mgrL The Department of Commerce is an equal opportumty service provider and employer If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-315 t or TTY 608-264-8777 W I)-5 , i3I R n /po l Pert,fiea W TesOng, LLC Property Owner Hughes, Diane (buyer) Parcel ID# 002-1032-70-100 Page 2 .of 3 P4 I I I— Rnrinn D"""g'" ® Pit Ground surface elev. 99.5 ft. Depth to limiting factor P 9 0 in Soil Application Rat Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Cola Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDIft' 'Eff#1 *Efr#z 1 0-9 10YR 3/2 - sit 2 f sbk mvfr cs I if/m 1 .6 .8 2 9-19 10YR 5/4 c2p 7.5YR 5/8,5/3 slcl 1 f-m sbk , mvfr gs lm .2 .3 3 19-30 5YR 4/4 c2p SYR 5/8,5/3 sct 0 m lacks A+4"; presumptive limit Is 0" mfr lm 0 0 I n« ] Boring na � - Boring Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce ism equal opportunity service provider and employer If you need assistance to access services or need material in an altemate format, please contact the department at 608-266-3151 ui I'IN 608-264-8777 SBD-8330(R 07/00) Certified Soil Testing, LLC suc�� � 2 i 3,ow v 4 2/w Parcel #: 002-1032-70-200 01/31/2008 07 58 AM PAGE 1 OF 1 Alt. Parcel #: 15.29 16 226B-20 002 - TOWN OF BALDWIN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 04/03/2006 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Cc -Owner 0 - HUGHES, DIANE D DIANE D HUGHES 1333 PEARSON DR N MAPLEWOOD MN 55119 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist# Description SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 4A20 Plat: 5133-CSM 20-5133 SEC 15 T29N R16W SW SW CSM 20-5133 LOT 2 Block/Condo Bldg: LOT 02 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 15-29N-16W SW SW Notes: Parcel History: Date Doc # Vol/Page Type 02/01/2006 817701 WD 12/27/2005 814986 20/5133 CSM 11"'120" 745693 2449/258 WD 04/12/2001 642641 1617176 WD more 2008 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.420 34,000 0 34,000 NO Totals for 2008: General Property 4 420 34,000 0 34,000 Woodland 0 000 0 0 Totals for 2007: General Property 4.420 34,000 0 34,000 Woodland 0 000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0,00 SANITARY SYSTEM Rle ST. C U NT Y FOOffice Use Only -�`y� OWNERSHIP/ADDRESS RM creoted212021 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. OWNER/BUYER INFORMATION Owner/Buyer 516/n2f Mailing Addre City/State/Zip Phone Number (required) 16 - �-ci �-.z1�CD Z Email Address (required) F cn Ll'cr , f • Co Parcel Identification Number (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location jS,L I/< , v 1/4 , Sec. 1 5_ T ci N RAW, Town of /w` \ {�, Subdivision Plat: Lot # Certified Survey Map # 3 �Z I Volume 2g . Page # I Warranty Deed # 1 f Z (O SSf (before 2006)Volume . Page # Number of bedrooms 3 Spec house 13 yes 10 no Lot lines identifiable 0 yes 0 no q OFFICE USE ONLY New Property Address (Verification of new address required from Community Development Department for new construction) q- /ZS/Zf (Staff Imnals) (Date) This form must be submitted with ail Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form 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. Community Development Department - Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax 1101 Carmichael Road, Hudson, WI 54016 �1 • NO. 633333 STATE ANITA"#PERMIT qo5 2Yt Immummme �L PREVIONS NO. OWNER PLUMBE TOWN S BLOCK UBDIVISION CHAPTER 145.135 (2)*TSCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and maybe renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought and that changed regulations may impede renewal. (t) The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. SUING OFFICER - DATE _LNLESS RENEWED BEFORE THIATATE IEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499(RI 1/20)