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HomeMy WebLinkAbout034-1031-96-000 .n Department df Commerce PRIVATE SEWAGE SYSTEM County: St. Croix and Building Division INSPECTION REPORT Sanitary Permit No: 514894 0 I1ERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: arsonal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. ?ermit Holder's Name: City Village X Township Parcel Tax No: Pax, Eric I Springfield, Town of 034 - 1031 -96 -000 CST BM Elev: Insp. BM Elew BM Description: Section/Town /Range /Map No: P 6 ?kv ,� S� 14.29.15.2248 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic /001 2 Benchmark S . O 3. /. Dosing (t /^ Alt. BM Aeration Bldg. S er /I► i( '7 1 p Holding SUHt Inlet �CN L/0 /'i St/Ht Outlet TANK SETBACK INFORMATION c iao' TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet fZocEd ar 5 Septic 7 i S r Dt Bottom Q ff /4 /� 5 d osing Header an. Aeration mike Holding Bot. Syste /0 wa Final Grade � n PUMP /SIPHON NFORMATI l (� / D Manufacturer n Demand St Cover S 5 ? - A 12t GPM g 7 ' Model Number /� n 0 5 - p 3Q ?i / .2f /0 57. /7 7� / 6 u - f'�yt/z� i o TDH Lift � � Frict� Loss Systgt» Fjead TDIJ ' + ( Ft 3 / r � r S � 5 A- I + G r (�. So Forcemain L< tg h Dia. '2# Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PI DIM SIONS No. Of Pits Inside Dia Liquid Depth DIMENSIONS A Al SETBACK SYSTEM TO /L BLDG WEL LAKE /STREAM EAC ING L facturer: INFORMATION CH ER OR Type Cat System: , I � 0 - IT Number. DISTRIB41 ION / SYSTEM '2 •S' t`K" IGI -G�- eel Header/ anifold �� Distribution �(_ / �� Spacing x Hole pie x Hole p �� Ve t Air Inta Length Di l- ll- ength 4 V Dia /" � I ,, 31:� SOIL COVER x Pressure Systems Only x Mound Or A - Grade Systems Only Ila — Depth Over Depth over xx Depth of xx Seeded /Sodded Mulched Bed/Trench Center Bed/Trench Edges Topsoil I Yes No Yes No [�J ❑ _� COMMENTS: (Include code discrepencies, persons present, etc.) ection # Z Inspection #2:�/ / Parcel No. • Y Road W Glenwo 14.29.15.2248 13 E Location: 922 Count d Cit , W 15 40 S ) NA Lot 1 1 " 1.) Alt BM Description S L "`kV ( 1/4 SE 1/4 14 T29N R15W /��' If,GK� a'fh- -i- / fi 2.) Bldg sewer length = - ►10b11 VA - amount of cover =� Plan revision Required? Ijo Yes /No n v �' Use other side for additional information. ' Date Insepctor's Si ature /} G^ _C�er� N6. SBD -6710 (R.3197) °_ r � •�OW� commerce Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 ST. CROIX ' i sc o n s i n Madison, WI 53707 -7 162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce 5i,q ac} ZI Sanitary Permit Application ` S 53868isaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the to governmental unit is required prior to obtaining a sanitary permit. Note: Application or state -own oject Address (if different than mailing address) POWTS are submitted to the Department of Commerce. Personal information you provide may for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. / 2z- / I. Application Informat' - Plea se Print All Infor v Property Owner's Name Parcel # 034 - 1031 -96 —and ERIC PAX Property Owner's Mailing Address JUN 0 5 2008 Property Location 922 COUNTY ROAD W ' Govt. Lot City, State Zip Cod r SE � /o,SE -/a, Stion 14 GLENWOOD CITY, WI 54013 ZO I (circle one) II. Type of Building (check all that apply) Lot # T 29 N; R 15 W ®1 or 2 Family Dwelling - Number of Bedroom 3 �q�y,�. Subdivision Name 1 N/A ock # El Public /Commercial - Describe Use ❑ city of N/A ❑ ❑State Owned - Describe Use � ♦ � CSM Number Village of /' 5 X /t � 37090 ® Town of SPRINGFIELD III. Type of Permit: (Che o nly one bo x o n line A. Co mpl e t e line B if applicable) A. ❑ New System ® Replacement ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) System B. ❑ Permit ❑ Permit Revision ❑ Change of ❑ Permit Transfer to List Previous Permit Number and Date Issued Renewal Before Plumber New Owner Ex iration 1 144 IV. Type of P OWTS S stem /Com onent /Device: Check all that appl ✓ ( ) rt. D ❑ Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ® Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) I A L V. Dispersal/Treatment Area Information: S Design Flow (gpd) Design Soil Ap 'cation Rate dsf) Dispersal Are equired (sf) Dispersal Ar roposed System Elevation 450 �/ 1.00 �. 450 9� 450 Z�j ado 102 S VI. Tank Info Capacity in Total # of Manufacturer w a Gallons Gallons Units o' New Tanks Existing Tanks �� l SZ w Z H ] w' W ¢ a ¢ Septic or Holding Tank 1000 1000 1 WIESER CONCRETE ® ❑ ❑ ❑ ❑ Dosing Chamber 1 600 600 WIESER CONCRETE ® ❑ ❑ ❑ ❑ VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plu s Signature MP /MPRS Number Business Phone Number BENNIE HELGESON 220292 715- 772 -3278 Plumber's Address (Street, City, State, Zip Code) W1229 770TH AVENUE, SPRING VALLEY, WI 54767 VIII Count /De artment Use Onl pproved _ isa ved Permit F e ate Issued Issuing nt Signature caner son for Denial $ IX. Conditions of App roval /Reasons for Disapproval SYSTEM OWNER: � PI C., C-N-1 i ♦` 3�Co,.J1 � �"iww�3 ��� ..JSr� 4 1. Septic tank, effluent finer and f dispersal cell must all be services'/ maintained 1,.4 1 as per management plan provided by plumber. 2. All sack requiremen must be rfMintaihed as Pw app!L" code I ordinances. J 7u lar a c Q (.� �! ► Je lit an r `! yrn dC,�: Attach to complete plans for the system and submit ot the qounty only on paper not less than �9 x niche 'n siz 1 I SBD -6398 (R. 01/07) Valid thru 01/09 0. J 'ro a C► v T OF _ Oro a A �v o� C� 1 . r -T-� a LS o i 1 ni Op o a� 7r. a� s ru 1 S� ap F- i r . n `1 o �( v 0. L <-� 3 3 6"' = to y V C, c, W J' it �J � ..J !/ L 0 .. c� o-�A \ C 4 \ ci a W O F Safety and Buildings 10541N RANCH ROAD commerce HAYWARD WI 54843 TDD #: (608) 264 -8777 Y It isconsin www.w w ww.coe.wi.gov/s sin.go / iscosin.gov Department of Commerce Jim Doyle, Governor Jack L. Fischer, A.I.A., Secretary June 02, 2008 CUST ID No. 220292 AMT POIFTS Inspector BENNIE W HELGESON ZONING OFFICE HELGESON EXCAVATING ST CROIX COUNTY SPIA W1229 770TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/02/2010 Identifeattpnluberi Transaction ID No. 1538681 SITE: Eric Pax Site ID No. 737725 922 Co Rd W Please refer tv bgth eletttrcatton numbers,;: Town of Springfield, St Croix County L ebOe�'m, i cp2•• and09 oe "nth the a en, SE 1/4, SE 1/4, S14, T29N, R15W FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1183510 Maintenance required; Replacement system; 450 GPD Flow rate System(s): Mound Component Manual, SBD- 10572 -P (R.6/99) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED Tlu ssterxt;to;be ponsttczttd xlataethpene saPdahepxllpo�et.ma zciu. 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 Dept. per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • Proper landscaping of the mound and land surface up slope of the mound is critical to proper operation. See the approved plans for details. • Four inches of sand is placed over the basal area prior to chisel plowing to a depth of 12 inches. • This approval is based in part on an interpretive determination approved pursuant to s. Comm 85.60(2), Wis. Adm. Code and recorded under transaction number 1537401. It is subject to the conditions set forth in that approval. • This system is to be constructed and located in accordance with the enclosed approved plans and with publication SBD - 10572- P(R.6/99) "Mound Component Manual for Private Onsite Wastewater Systems ". • The pressure network is to be constructed in accordance with publications SBD - 10573- P(R.6/99) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) ". • Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the septic tank outlet filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover and ' effective locking device. • This approval is conditional on the private water well meeting the requirements specified in NR �J" ' 812.08(1)(b), Wis. Adm. Code for wells down gradient of a possible contamination source. r w ` BENNIE W HELGESON Page 2 6!212008 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, or 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. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 gyky, 4 Pi Soil POWTS Wastewater Specialist' Integrated Services Bureau (715)726-2544, Friday, 7:00 a.m. To 3:30 p.m. leroy.j ansky @wisconsin.gov NR 812.08 Well, reservoir and spring location. (1) GENERAL. Any potable or nonpotable well or reservoir shall be located: (a) So the well and its surroundings can be kept in a sanitary condition. (b) At the highest point on the property consistent with the general layout and surroundings if reasonably possible, but in any case protected against surface water flow and flooding and not downslope from a contamination source on the property or on an adjacent property regardless of what was installed first, the well or the contamination source. When a contamination source is installed upslope from a well in violation of this section after the well construction has been completed, the violation is not the responsibility of the well driller, except if the well driller knew or should have known of the proposed upslope installation of the contamination source. When there is no location on the property where this requirement can be met, a well may be constructed without a variance if it is constructed with a minimum of 20 or more feet of well casing pipe than is required by ss. NR 812.12 and 812.13 and Tables I and Il or with a minimum of 60 feet of well casing pipe provided that the minimum well casing pipe depth requirements of s. NR 812.12 or 812.13 and Tab le I or II are met. This exception does not apply to high capacity, school or wastewater treatment plant wells. A well or reservoir is located downslope from a contamination source, regardless of the presence or absence of a structure between the well and the contamination source, if 1. The ground surface elevation at the well or reservoir is lower than the elevation at the contamination source, and 2. Surface water that washes over the contamination source would travel within eight feet of the well or reservoir, or over the well or reservoir. INDEX SHEET Y PROPERTY OWNER: ERIC PAX 922 CORD W GLENWOOD CITY, WI 54013 PROJECT NAME: ERIC PAX SEE CORRESPONDENCE PROJECT LOCATION: SE 1/4 SE 1/4, S 14 T 29 N, R 16 W MUNICIPALITY: TOWNSHIP OF SPRINGFIELD p.0. % -S COUNTY: ST. CROIX Conditionally , R OVED DESIGN: PRESSURE DISTRIBUTION MANUAL SBD -1057 I MOUND COMPONENT MANUAL SBD- 10572 -P �I MENT Of COMMERCE OF SAFETY AND BUILDINGS CONTENTS: 1 53 8 68 1 E CO ESPOND CE Page 1: Plot Plan Page 2: Cross Section and Plan View of Mound Page 3: Distribution Pipe Layout Page 4: Septic Tank & Pump Chamber Cross Section and Specifications Page 5: WLP 1000/600 -MR ZABLE Tank Specifications Page 6: Pump Specifications Page 7: POWTS Owner's Manual & Management Plan - Pg. 1 Page 8: POWTS Owner's Manual & Management Plan - Pg. 2 Name: Bennie Helgeson Signed Address: W1229 770th Avenue Spring Valley, WI 54767 Credential Number: 220292 Date: May 13, 2008 I RECEIVED MAY 2 0 2008 SAFETY & BUILDINGS d R- C PAX Page Of Y 1 Synthetic Covering C Distribution Pipe AS7�M 3 � bQjjW Sand — �`' `� H G Topsoil � = = == F _J I D 3 h on r /00, ov % Slope C :3 Plae 3" Fb `1 " d! ova C F_ LILOf 2�— 2 Force Main Plowed fo r Aggregate From Pump Layer - p Ll�,s� To a�� f o �' S f� �� �(� 5 tj D6- Ft. CL E �•c`6 Cross Section Of A Mound �, ��' F Ft. G Ft. A y.r Ft. H �_ Ft. Signed: g app Ft. License Number: ' L / Ft. Date: _ d � Ft. T /g— Ft. W L Observation Pipe B p - K a vL - - -- ----------------- - - - - -- - - -�►� - - - - - — \� % CDistribution �t L O f Z 2 2 Pipe Aggregate 14 I � l3��G r X5 Observation Pipe Plan View Of Mound ��rr11 - -� r AJ IE ; �l2 i G — f 4 X p L S ` o. . , Perforolen Plpe Oeloll End Vltw ' Pat lot oICd 1 PVC Pip, Y( r�lf 4u�fJ I I \Ob • fi e Holes Located on Bottom are Equally Spaced e f�•c.4,c «�5 --a oi�f,lb�flo�.. Plp. Distribution Pi he Layo P , /0 ii R S ag" X f y , w y 21 y Hole Diameter Inch Signed: 11 J License Number: Lateral .. a _- Inch Cesl • ,1 Date: Manifold " Force Mai TIO LIE R O IPS �et- �- .. ro,�a / ti rz i C, PA.X Page 1 Of SEPTIC TANK E PUMP CHAMBER CROSS SECTION AND SPECIFICATION$ 4" PLAC VENT PIPE 12" MIN. ABOVE GRADE E WEATHERPROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE f9 T WITH CONDUIT MANHOLE COVER W/ PADLOCK E WARNING LABEL MIN . INLET WATER TIGHT SEALS GAS. -�- TIGHT �, VAPPROVEO FILTER ---•+� A SEAL JOINTS WITH APPROVED° - I - ALM APPROVED PIPS PIPE 3' :_ B ON 3' ONTO ONTO. SOLID ' SOLID SOIL SOIL PUMP OFF ELEV . Z�.&T. - - ) OFF D 3" APPROVED BEDDING UNDER TANK. CONCRETE PAD SPECIFICATIONS L 1 nto cd.� S _ =h I � L, a ra- C SEPTIC / DOSE � TANK MANUFACTURER: � �SeF- /g x 57 70 (5ct TANK SIZES SEPTIC 1000 GAL. DOSE VOLUME INCLUDING DOSE (c�p� GAL. S/g,9' /, FLOWBACK: GAL. ALARM MANUFACTURER. � eG r� CAPACITIES: A = / INGHES 32tt P_ L - . �.'` - MODEL NUMBER: l b / N SWITCH TYPE: ,,t4 ppc B = 2 INCHES GAL. PUMP MANUFACTURER: S A )� C = _. INCHES ''� _:fAL. MODEL. NUMBER : SWITCH TYPE: _tea ( 0 D = . !_.�_ INCHES = /as, - GAL. REQUIRED DISCHARGE RATE 3 /. /(o GPM PUMP E ALARM WIRING AS PER IL R 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE aS FEET 23 "� + MINIMUM NETWORK SUPPLY PRESSURE FEET + FEET FORCEMAIN X. d FT /100 FT. FRICTION FACTOR .& FEET TOTAL DYNAMIC HEAD = Q,�� FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH DIAMETER LIQUID DEPTH i�.761 6c.1,11v ease ,Se-le- ;�,k sh_ {1 SIGNED: LICENSE NUMBER: DATE: 1/88 r a r rLn-9 a a� LL,� a C3 v} w w ��d �� C _J V �w Fa �' C I 1 cia (� (L M o r2-9 W � 0 (L Q �y" CY m O � V) CL n 6u ) Lfr UQ zZ nnn o I OUO uj 0 -1 Q oL)(n o 'mow c!i¢ v aQ O t V 0 0 1 �ww 00 D �V NO � w oto ww , [� J op6�r to -)') V) Qw ° ln ^ R� � W 0 1— m w w d s C e 1- J 03 f- a I— N Q N r E Mfl - W �+1 W W —J �x D U t, ' 0 3: 0 Soy 00Y 0 0� Q w Z = m a z c9 O — � 0 cn OO o z o _ r wgo0 <i'� *m2w a�< Z ° d cD o z J J Q Q — O Z Z J O Z c — N) I 1 I� e C CL ii w .... I ' . 1 1 , I I in W D p62 W ., 95 I COMPOSITE CURVES 5�slc. EFFLUENT/SPEQ,1ALTy PUMPS PE RFORMANCE CURVE S CAPACITY LITRES PER MINUTE 0 50 100 150 200 250 300 350 400 450 500 550 90 IO 4� 1 hb .Gf 5 �i nyi 26 A g4 a S j 7w, XK w 80 2 4 22 70 C >> ti . gyp 60 7 f 18 tz 50 Rp s 14 z 0 40 12 o 30 20 . y C3' 4 10 � ;ems; 2 0 0 25 �1,'� 50 75 100 125 150 CAPACITY GALLONS PER MINUTE NOTE Please see page 11 for ST.E.P. Plus' Series performance curves. 20 I - - POWTS OWNER'S MANUAL & MANAGEMENT A GEMENT PLAN Page 7 of FI INFORMA SYSTEM SPECIFICATIONS Owner ERIC PAX Septic Tank Capacity a l ❑ NA Permit /1 Septic Tank Manufacturer WIESER CONCRETE p NA DESIGN PARAMETERS Effluent Filter Manufacturer POLYLOK ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model PL -525 ❑ NA Number of Public Facility Units 12 NA Pump Tank Capacity 600 g ❑ NA Estimated flow (average) 300 gal/day Pump Tank Manufacturer STA RITE ❑ NA Design flow (peak), (Estimated x 1.5) 450 al /day Pump ManufactureSTA RITE .0 NA Soil Application Rate 0.5 1 al /day /ft2 Pump ModeliT 7 ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit (RNA Fats, Oil & Grease (FOG) 530 mg /L O Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L �7IFb ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) 0 NA Biochemical Oxygen Demand (BOD 530 mg /L ❑ In- Ground (gravity) ❑ (n-Ground (pressurized!` Total Suspended Solids (TSS) 530 mg /L IN NA O At -Grade IN Mound Fecal Coliform (geometric mean) 510" cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. DNA Other: ❑ NA Other: ❑ NA Other: ❑ NA 'Values typical for domestic wastewater and septic tank effluent. Other: O NA YP P MAINTENANCE SCHEDULE Service Event Service Frequency [� month(s) Inspect condition of tankis) At least once every: 2 [� (Maximum 3 years) O NA y ear(s) Pump out contents of tanks) When combined sludge and scum equals one -third (Y) of tank volume ❑ NA ❑ month(s) Inspect dispersal cell(s) At least once every: 2 CKyear(s) (Maximum 3 years) ❑' NA month(s) Clean effluent filter At least once every: 13 year(s► ❑ NA ❑ Inspect pump, pump controls & alarm At least once every: 3 ❑ jP month(s) ❑ NA year(s) Flush laterals and pressure test At least once every: 3 ❑ month(s) ❑ NA LX year(s) Other: At least once every: ❑ month(s) p NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third IY or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. OWNER: ERIC PAX Page 8 of 8 STAPT UP AND OPERATION .For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cells) in one large dose, overloading the cells) and may result in the backup or surface disch:arge,of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. • A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. • The site 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. Mound. and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name HELGESON EXCAVATION Name JOHNSO Phone 715- 772-3278 Phone 715- 273 -5811 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name JOHNSON SANITATION Name ST CROIX COUNT Phone 715- 273 -5811 Phone 715 -386 -4680 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. III i r , Safety and Buildings 10541N RANCH ROAD commerce.wi.gov HAYWARD WI 54843 TDD #: (608) 264 -8777 t isconsin www.commerce.wi.gov /sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Jack L. Fischer, A.I.A., Secretary June 02, 2008 RECEIVED CUST ID No. 46672 JUN 0 5 2008 ATTN.• POWTS Inspector MARK W IVERSON S7 CROIXCOUNTY ZONING OFFICE EVERGREEN IRRIGATION IN ZONING OFFICE ST CROIX COUNTY SPIA PO BOX 155 1101 CARMICHAEL RD HAMMOND WI 54015 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 06/02/2010 Transaction ID No. 1537401 SITE: Eric Pax Site ID No. 737725 922 Co Rd W Please refer to both identification numbers., Town of Springfield, St Croix County above, in all correspondence with the agenc SE 1/4, SE 1/4, S14, T29N, R15W FOR: Object Type: Soil Saturation Determination Regulated Object ID No.: 1183497 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. Only those object types listed above have been approved; other submittals such as plumbing and those listed below under Also Submit, may be required. 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 13 inches below grade. At least 23 inches of sand lift on top of 13 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 <4.50 gpd/ft. 4. Chisel plowing to a depth of ?12 inches after placement of 4 inches of sand is required to improve vertical water movement into the soil solum. The remaining sand fill is placed after the initial fill is plowed in. 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. 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 Pp lan approval and sanitary permit issuance. P 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. i MARK W IVERSON Paget 6/2/2008 A copy of the approved plans, speci fications and this. lett�-rshall be on -site during construction and open to inspection by authorized representatives of the Deeartmennt, which may include local inspectors. If plan index sheets were submitted in lieu of additional full pransets, 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 /installation /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. The Division does not take responsibility for the design or construction of the reviewed items. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, Fee Required $ 100.00, Fee Received $ 100.00 /� Balance Due $ 0.00 Leroy G. J sky, Professional Soil ientist POWTS Wastewater Specialist WiSMART code: 7633 Integrated Services Bureau (715)726-2544, Friday, 7:00 a.m. To 3:30 p.m. leroyjansky@wisconsin.gov i INTERPRETIVE DETERNIINATION REPORT Property Owner: Eric Pax P.O. W T. S. 922 Co. Rd. W Conditionally Glenwood City, WI 54013 APPROVED DEPARTMENT OF COMMERCE D( (SJON OF SAFETY AND BUILDINGS 4' F-:E RRES NDENC Site Location: SE '/4 of the SE '/4, Sec. 14, Town 29N, Range 15W Town of Springfield' 1 5 St. Croix County * MARK W. IVERSON Prepared by: 197 WISCONSIM Mark Iverson, PSS #197, CST #46� May 7, 2008 Date Evergreen Irrigation Inc. Mark Iverson, Professional Soil Scientist P.O. Box 155 Hammond, WI 54015 Phone: 715- 796 -5664 Fax: 715- 796 -5246 e -mail: evergreenetc @baldwin- telecom.net RECEIVED MAY 2 0 2008 SAFETY & BUILDINGS ' TABLE OF CONTENTS I . Introduction ............................................................................... ..............................1 II. Project Information .................................................................... ..............................1 III. Method ....................................................................................... ..............................1 IV. Discussion of Results ................................................................. ..............................2 A. Local Hydrology ............................................................ ..............................2 B . Geomorphology ............................................................. ..............................2 C. Soil Disturbance and Hydraulic Modifications .............. ..............................2 D. Landscape Position and Local Topography ................... ..............................3 E. Soil Series and Mapping Units ...................................... ..............................3 F. Additional Data .............................................................. ..............................4 G. Comparative Analysis .................................................... ..............................5 H. Government Reports and Comments ............................ ............................... 5 V. Conclusions and Recommendations .......................................... ..............................5 VI. References .................................................................................. ..............................6 TABLES Table 1 - Soil Series Characteristics Table 2 - Hydric Soil Classification FIGURES Figure 1 - USGS Topographic Map Figure 2 - Soil Map APPENDICES Appendix A - Soil Evaluation Report Appendix B - Boundary Survey Map I. INTRODUCTION On April 30, 2008 Mark Iverson, Professional Soil Scientist #197 and Certified Soil Tester 946672, completed an interpretive onsite soils evaluation. An interpretive evaluation is required because the site does not meet the requirements to install a new private on -site waste treatment system (POWTS) through completion of a conventional onsite soils evaluation ( <A +4 inches of acceptable soil must be present). The onsite evaluation was completed through the observation of the soil profiles at six test pit locations. This report has been prepared to present the results of an interpretive onsite soils evaluation. The evaluation was completed at the request of the client, Eric Pax. The property is located on Co. Rd. W '/< mile north of Co. Hwy E in the Township of Springfield, St. Croix Count Wisconsin. II. PROJECT INFORMATION The following is site - specific background information: Property Owner: Eric Pax 922 Co. Rd. W Glenwood City, WI 54013 Site Location: SE' /< of the Se 1 /4, Sec. 14, Town 29N, Range 15W Parcel ID # 034 - 1031 -96 -000 Town of Springfield St. Croix County Historic Land Use: Lawn Current Land Use: Lawn Vegetation: The vegetation within the tested area consists of miscellaneous grasses. There are no signs of stress within the tested area due to excess or insufficient moisture. Hydric vegetation was not observed within the project area. III. METHOD This interpretive evaluation and report was completed following the guidelines set forth in Comm 85.60(2) of the Wisconsin Administrative Code and in the summary provided by Leroy Jansky titled, "Preparing the Interpretive Determination Report" (March 13, 2002). 1 IV. DISCUSSION OF RESULTS A. Local Hydrology 1. Surface Water Drainage Patterns — Surface water drainage is uniform over the proposed system area (borings 1, 2, 3, & 4). The proposed system location is on the back slope. The slope within the proposed system area is approximately 6 to 7 %. Evidence of concentrated surface water flow was not observed within the proposed system area. 2. Subsurface Water Drainage - The silt loam texture and lack of compaction within the rooting zone of the lawn offers good infiltration and lateral movement of precipitation received on site. Moderate compaction due to occasional vehicle and ATV traffic was observed in borings B -4 and B -6. This was observed through the platy structure that was present within the soil profiles. Similar compaction is likely to be present where the vehicle traffic occurred, on the north side of the system between B -1 and B -2. The platy structure limits the infiltration of surface water within the profile. During and immediately following frozen conditions and following heavy precipitation events, runoff will be much greater. 3. Artificial Drainage Devices — No artificial drainage devices were observed during the completion of the evaluation. 4. Contributing Drainage Area — The proposed system area is located on the backslope of the hill slope profile. The summit of the profile is located approximately 100 feet west of the proposed installation contour, just to the west of the white pines shown on the map. There is contributing drainage area up slope of the tested area. A surface water diversion ditch will need to be constructed to limit the effects of potential surface water received from upslope. 5. Soil Saturation — Saturated soil was observed in B -2 at 28 to 40+ inches below surface. 6. Surface Water Elevations - Surface water within the immediate vicinity of the site, if present, has been identified on Figure 1. B. Geomorphology 1. Parent Material — The parent material is loess over glacial outwash/till. 2. Landform Type — Ground moraines. C. Soil Disturbance and Hydraulic Modifications The proposed system location is in an existing lawn. No hydraulic modifications, such as drain tile or ditches, were observed at the time of the assessment. No additional surface water is received from impervious surfaces. 2 D. Landscape Position and Local Topography The regional topography is shown on figure 1. The ground surface elevation is approximately 1240 feet mean sea level (msl). The topography within the proposed system area is shown on the site map included in Appendix A. The proposed system elevation is 100.00 feet (site specific elevation). The shape of the slope within the proposed system area is generally linear (perpendicular to the contour) and slightly convex (parallel to the contour). FIGURE 1— USGS TOPOGRAPHIC MAP 7 - 1 j87 r Site Location 4 i I r ■ T �-8 , ` l E. Soil Series and Mapping Units The Natural Resources Conservation Service Web Soil Survey maps the soils on the property as Magnor silt loam (MaB) and Santiago silt loam (SaB & SaC2). The location of each soil type is identified on Figure 2. The primary soil characteristics as described in the series descriptions are identified on the Table 1. TABLE 1— SOIL SERIES CHARACTERISTICS Texture Parent Material Permeabilit Soil A E or B Surface Subsurf. Surface Subsurf. Drainage Series Horizon Horizon Class Ma SIL SIL Loess Till* M MS to S SP Sa SIL SIL /SL Loess Till* M S to MS W 3 Abbreviations Permeability IM = Impermeable MS = Moderately Slow RA = Rapid VS = Very Slow M = Moderate VR = Very Rapid S = Slow MR = Moderately Rapid Drainage Class VP = Very Poorly W = Well P = Poorly SE = Somewhat Excessively SP = Somewhat Poorly E = Excessively MW = Moderately Well TABLE 2 — HYDRIC SOIL CLASSIFICATION NRCS - USDA Soil Series Component Inclusions USACOE Ma No Adolph No Sa I No None No USACOE = US Army Corps of Engineers FIGURE 2 — SOIL MAP Site Location INVT F. Field Observations The soil present within the proposed system area has slight similarities to the description of the mapped soil unit Santiago, identified on the Natural Resources Conservation Service Web Soil Survey. The A horizon extends 8 to 11 inches below surface within the proposed system area (Borings 1, 2, 3 and 4). Moderate granular structure is dominant in the surface horizon (A). Moderate blocky structure extends from directly below the surface horizon to 25+ inches below surface in B -1, B -2, and B -3. The presence of the granular and blocky structure in the upper 25 inches of B -1, B -2, & B -3 offers excellent opportunity for infiltration and lateral movement of effluent during dry conditions. Moderate compaction was observed in B -4 at 6 to 13 inches below surface. Moderate platy structure was observed at this interval. The platy structure is most 4 likely due to occasional vehicle and or ATV traffic to access the northwest corner of the property. Moderate granular structure in the A horizon (0 to 6 inches) will provide for infiltration and lateral movement of the effluent. The soil on site does not meet the hydric soil criteria. The lack of hydric soils indicates that the soil is likely not saturated for greater than 5% of the growing season (approximately 7 consecutive days). A dominance of hydrophytic vegetation was not observed within the proposed system area. The lack of these features does not preclude the possibility that the soil is saturated for a prolonged period of time prior to or on occasion during the growing season. G. Comparative Analysis Soil borings (B -1, B -2, B -3 and B -4) were completed within the proposed system area. Two additional borings were completed, one upslope (B -6) and one down slope (B -5) of the proposed system area. The structure and depth to redox features of borings 4 and 5 were similar to that of the tested area. The texture varied from the proposed system area. Boring 5 had sandy loam present much shallower, directly beneath the A horizon and boring 6 had a clay loam layer at 22 to 33 inches below surface. H. Government Reports and Comments An inspection report completed by Leroy Jansky, Wisconsin Department of Commerce, is included in Appendix B. V. Conclusions and Recommendations Seasonal saturation appears to be limited to greater than 13 inches below surface within the proposed system area, the majority of the time. The lack of soil dominated by low chroma colors within the proposed system area indicates that the redoximorphic features observed are not due to a high water table or perching conditions. The cause of the redox features observed in the test pits is most likely attributed to short-term seasonal saturation due to slow permeability of the dense glacial subsoils. Reorientation of the platy structure observed on the north side of the proposed system area by chisel plowing after placing 3 to 4 inches of ASTM -33 sand on the system area will aid the dispersion of effluent through the subsoil. The site is suitable for installation of a POWTS (mound system) for the following reasons: l.) Redoximorphic features were not observed in the upper 13 inches of soil within the proposed system area. 2.) Neither hydric soils nor a dominance of hydrophytic vegetation are present within the proposed system area. 5 3.) There are no features that concentrate surface water flow toward the proposed location of the system. 4.) The slope at the proposed system location is 6 to 7 %. The slope is uniform with no dips or valleys at the proposed system location. 5.) The lack of soil dominated by low chroma colors indicates that the redoximorphic features observed at depth are due to temporary seasonal saturation and not from a permanently high water table or perching condition. The following recommendations should be considered during installation of the proposed system: 1.) The system should be installed on the 100.0' contour to stay within the tested area. 2.) Sand fill shall consist of 2.5' of material meeting ASTM C -33 specifications. 3.) To break up the platy structure tillage must be completed with a chisel plow to a minimum depth of 12 inches below native ground surface during dry conditions after placing 3 to 4 inches ASTM C -33 soil over the infiltration surface. 4.) The basal loading rate shall not exceed 0.2 GPD /ft 5.) The system shall be designed to have a linear loading rate of 4.5 GPD /ft or less. 6.) The system will follow the contour (100.0') and be nearly linear. 7.) The area upslope of the mound near B -5 must be altered to limit the influence of surface water received from upslope. 8.) The property line is not the fence line. The property line is set back approximately 23' feet from the fence and is identified with lath and 64d nails on the north side of the proposed system area. See the boundary survey map included in Attachment B. The final approval of this site must be made by the Wisconsin Department of Commerce and the St. Croix County Zoning Department. This report represents the observations and professional opinion of Mark Iverson, Professional Soil Scientist ( # 197) and Certified Soil Tester (#46672). VI. REFERENCES 1.) Soil Survey Staff, Natural Resources Conservation Service, United States Department of Agriculture. Web Soil Survey. Available online at http : / /websoilsurvey.nres.usda.gov / accessed [12/18/071. 2.) State of Wisconsin. Department of Commerce Code, Chapters 83 and 85. 3.) US Department of Agriculture, Natural Resources Conservation Service. 1996. Field Indicators of Hydric Soils in the United States. G.W Hurt, Whited, P.M., and Pringle, RF. (eds,). USDA, NRCS, Fort Worth, TX. 6 4.) Schoenberger, P.J., Wysocki, D.A., Benham, E.C., and Broderson, W.D. (editors), 2002. Field book for describing and sampling soils, Version 2.0. Natural Resources Conservation Service, National Soil Survey Center, Lincoln, NE. 5.) United States. Us Geological Survey. Topographical downloaded from http: / /terraserver. microsoft. cony/ 6.) St. Croix County. St. Croix County Land Information System. http: / /72.21.230.178 /website /pas stem /gisportal.litm 7.) United States. United States Department of Agriculture - Natural Resources Conservation Service. Hydric Soil List for St. Croix County, Wisconsin. ftp: / /ftp- fc.sc.e�7ov.usda. ov/WI /Soil /had /hyd109.htm 8.) United States. Us Army Corps of Engineers. 1987. Corp of Engineers Wetland Delineation Manual, Technical Report Y -87 -1. USAEWES Environmental Laboratory, Vicksburg, MS. 7 APPENDIX A SOIL EVALUATION REPORT 8 Wisconsin Department of Commerce SOIL EVALUATION REPORT Pa 1 of 5 Division of Safety and Buildings In accordance with Comm 85, Wis. Adm. Code Counts ' Attach complete site plan on paper not less than 8'-- x 11 inches in size. Plan must St. Croix Include but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 034 - 1031 -96 -000 Percent slope. scale or dimensions, north arrow. and BhI referenced to nearest road. Please print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Lay, s. 15.04 (1) (m)) Property Owner Property Location Eric Pax Govt. Lot SE SE s 14 T 29 N R 15 W Property Owner's Mailing Address Lot x Block= ISubd. Name or CSM- 922 Co. Rd. W City State Zip Code Phone ❑ City ❑ Village is Town Nearest Road Glenwood City WI 54013 715 -781 -1850 1 Springfield 60 t1i Ave. ❑ New Construction Use: ® Residential / Number of Bedrooms 3 Code derived design flow rate 450 GPD ® Replacement ❑ Public or Commercial — Describe: Parent Material Loess over Glacial till Flood Plain elevation if applicable NA ft. General comments and recommendations: 1 Boring # ormg ® Pit Ground Surface Elevation 100.00 ft. Depth to Limiting factor 28 in. i Soil Apolication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Pix in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-8 10YR3/2 - SIL 2 -f-gr mfr gs 3f -c 0.6 0.8 2 8 -11 10YR4 /4 - SIL 2 -f -bk mfr gs 2m 0.6 0.8 3 11 -16 10YR4 /4 - SIL 2 -m-bk mfr gs 1 m 0.6 1 0.8 4 16-28 7.5YR4/4 - SL 3-m-bk mvfi gS 1 m 0.6 1.0 56 28 -37+ 7.5YR4/4 7.5YR513 & 5YR4/6 c -2-d SL 0-m mfr - - 0.2 0.6 a Boring # 0 Boring ®Pit Ground Surface Elevation 100,0 ft. Depth to Limiting factor 13 A +3 in. Soil Avolication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -10 10YR3/2 - SIL 2 -f-gr mfr gs 3 f-co 0.6 0.8 2 10-13 10YR4/4 - SIL 2 -m-bk mfr gs 1 m 0.6 0.8 3 13-16 10YR4/4 7.5YR4/6 f -1-d SIL 2 -m-bk mfr CS If 0.6 0.8 4 16-28 7.5YR4/4 10YR2/1 Mn concretion on face of peds SL 2 -m-bk nwfi gs 1 f 0.6 1.0 5 28-40+ 7.5YR4/4 7.5YR5/3 f -3-f SL 0 -m mfr - - 0.2 0.6 *Effluent ??1 = BOD, 30 < 220 mg L and TSS 30 <_ 150 mg L * Effluent *2 = BOD, 5.' 0 mg L and TSS 5 30 mg L CST Name (Please Print) Si re CST Number Mark Iverson 46672 Address Date Evaluation C onducted Telephone Number P.O. Box 155 Hammond, WI 54015 April 30, 2008 715- 796 -5664 • Property Owner Eric Pax Parcel ID# 034 - 1031 -96 -000 Page 2 of 5 13 Boring 3 Boring # ®pit Ground Surface Elevation 100.0 ft. Depth to Limiting factor 0 in. Soil Agmilcation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 *Eff#2 1 0 -9 1 OYR312 - SIL 2 -m-gr mfr cS 3 f-co 0.6 0.8 2 9 -19 10YR4/4 10YR4/3 & 7.5YR4/6 c -2-d SIL 2 -m-bk mfr gs 1 f -m 0.6 0.8 3 19-25+ 7.5YR4/4 7.5YR5/3 & 5YR4/6 c -2-d SL 1 -co -bk mvfr - if 0.4 0.7 Boring # 0 Boring ®Pit Ground Surface Elevation 98.4 ft. Depth to Limiting factor 13 A +3 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/e in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Efr#2 1 0-6 10YR3/2 - SIL 2 -f-gr mfr cS 2f 0.6 0.8 2 6 -10 10YR3/2 - SIL 2 -f -pl mfr cS If 0.0 0.2 3 10-13 10YR4/4 - SIL 2 -m-pl mfr gs if 0.0 0.2 4 13-19 10YR4 /4 7.5YR4/6 f -1-d SIL 1-co-bk mfr gs - 0.4 0.6 5 19-35+ 7.5YR4/4 7.5YR4/6 & 4/3 f -3 -f SL 0 -m mfr - - 0.2 0.6 5] Boring # 0 Boring ON Ground Surface Elevation 96.0 ft. Depth to Limiting factor 13 A +3 in. Soil ADDlication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Efr#2 1 0 -10 10YR3/2 - SIL 2 -fir mfr cS 2f 0.6 0.8 2 10-13 10YR4 /4 - SL 1 -m-bk mfr cS if 0.4 0.7 3 13-16 10YR4/4 7.5YR4/6 f-1-d SL 1-m-bk mfr gs if 0.4 0.7 4 16-26 10YR4 /4 5YR4/6 c-2-d SL 2 -m-bk mfr gs - 0.6 1.0 5 26-36+ 7.5YR4/4 7.5YR4/3 & 5YR4/6 c -2-d SL 1 -co -bk mfr - - 0.4 0.7 * Effluent tt 1 = BOD, 30!5 220 mg L and TSS ° Ws 150 mg L * Effluent -2 = BOD. <_ 30 mg L and TSS 5 30 mg L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or Need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. Property Owner Eric Pax Parcel ID# 034 - 1031 -96 -000 Page 3 of 5 Boring # ❑ Boring Wit Ground Surface Elevation 102.4 ft. Depth to Limiting factor 17 A+6 in. Soil Applicatio n Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0-8 10YR3/2 - SIL 2 -m-bk mfr cs 2 f -m 0.6 0.8 2 8 -11 10YR3/2 - SIL 2 -f -pi mfr cs 1f -m 0.0 0.2 3 11 -17 10YR4/4 - SIL 1 -f -pl mfr is 1f 0.4 0.6 4 17 -22 10YR4/4 10R4/6 f-1 -f SIL 2 -m-bk mfr 9S - 0.6 0.8 5 22 -33 10YR4/4 5YR4/6 c-2-d CL 2 -m-bk mfr 9S - 0.4 0.6 6 33-38+ 7.5YR4/4 5YR5/3 f -3-d SL 0 -m mfr - - 0.2 0.6 F-1 ❑ Boring Boring # ®pit Ground Surface Elevation ft. Depth to Limiting factor in. Soil ADDlication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 F-1 ❑ Boring Boring # ®pit Ground Surface Elevation ft. Depth to Limiting factor in. Soil ADolication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eft#1 I 'Eff#2 * Effluent #I = BOD, 30!S 220 mg and TSS 305 150 mg L * Effluent -2 = BOD., <_ 30 mgL and TSS < 30 mg L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or Need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. Page 4 of 5 0 ft. 24 ft. 40 ft. 80 ft. ' N I Site Location Property corner identified by JB Surveying Sect o n J �Q cg X Co. Fence Line 0 0 Hwy E Points on property line set by JB B-2 Surveying 00.01 Property Line 6- � S/o c B-6 102.4' o °° B-1 100.8' � B-4 o° 98.4 B-5 Top of well elevation 92.3' ft ° p QO OO ° 96.0' op ° QD 1 Of \CPi l W B-3 Fire pit 100.0' 00 oe O 0 o ' - Garage n. Box Elder Trees (to be removed) BM# & Description = Bench Mark B 1 Boring ocation & Elevation Elevation 100' g Owner: Eric Pax Site Information: Completed By: Mark Iverson, PSS #197 922 Co. Rd. W SE 1/4, SE 1/4, S14, T29N, R15W 680 Larcom Street Glenwood City, WI 54013 Town of Springfield Hammond, WI 54015 St. Croix County 715- 796 -5664 Phone: 715 - 781 -1850 CST# 46672 Page 5 of 5 Site Map ' N 0 ft. 36 ft. 60 ft. 120 ft. Property corner identified by JB Surveying Points on property line set by JB Surveying Fence Line D-2 o . Property <Jne ao ° o0 o0D ,00.8 Ground E evation 897 B-5 Top of well elevation 92.3' c 4 om o W House c 4 m CL O Garage Driveway a Box Elder - to be removed 0 a APPENDIX B BOUNDRY SURVEY MAP 9 MAP OF SURVEY ' PART OF THE NORTH LINE OF CERTIFIED SURVEY MAP NO. 1962 East 114 SECTION 14, TOWNSHIP 29 NORTH, RANGE 15 WEST, Section 14 -29 -15 TOWN OF SPRINGFIELD, ST.CROIX COUNT Y,WISCONSIN Found 1` Iron Pipe UNPLATTED LANDS � , Z O W fence line N I W X x l x x x x x olo x N N89'41'59 "E 507.11' � _J 140.00' 20.00 347 .11' F Z °IN w 00 V 1 0 1 L UNPLATTED R G P LANDS I Q Q �� Southeast Corner Section 14 -29 -15 f Fd Survey Mark Nail I G� DRAFTED BY Joel A. Brandt JB SURVEYING LLC LEGEND .........Government Corner (as noted) o .......... Set 60d Nail on North line 1.502 lbs. /lineal ft. *........Found 1" Iron Pipe North is referenced to the east line of the Southeast SCALE: 1 " - SO' quarter of Section 14- 29 -15, which bears N01 °32'59 "W (St. Croix County Grid System) 0' S0' 100' �t DUC:JMENTNO I STAVE BAR OF WtSC:ONSiN FORM 2 -1962 T^ SS FAQ -E RESeRVEGFvFRc'GAGir.GO%TA WARRANTY DEED r•r Lawr_nce J. Vogt and Joyce M. Vogt, husband and wife, ���� holding as survivorship marital pro perty - _ t JUN 1 5 1994 conveys and warrants to Dric J. Pax and Jayme L. Pax, husband r y 11 .50 A. - marital wif and to the su the reof, as su rvivorship_ �• n`- !� -marital proRerty ii a� sets ! RETURN To the following described real estate In Sr- Cr oix County, — —_ Slate of Wisconsin: Tax rarcei rvo: 03 ° —) n; ;) —gb Part of the SEA of SE]z of Section 14, Township 29 North, Range 15 West, Town of Springfield, more particularly described as Lot 1 of Certified Survey Maps filed May 9, 1988, in Volume 7 of Certified Survey Maps, Page 1962, as Document No. 437090 (No. 51), Office of the Register of Deeds for St. Croix County, 1 1 j l , wisco{tsin. tl �I Z Ij II i This 13 homestead property. ' Exception•toWarranties; Easements and restrictions of record. n* i Dateo.-t_ -- -day of._—.._. �p (SEAL) x — ZZ (SEAL) Lawr J. Vog �N8 11, 0A A1,&iA M - = "—• (SEAL) (SEAL) F yce Vogt _ —= -- -- 11 1 AUTHENTICATION ACKNOWLEDGMENT Signature(s)— STATE OF WISCONSIN DUNK County. authenticated this day of. . 19 Personally came before me this 6th day of June 1994. the above named — hu sband and _ -bolding as..sui1"vivo its — TITLE: MEMBER STATE BAR OF WISCONSIN (If not _ to me konwn_fo be ttpeRe•soR who executed the authorized by § 706.06, Wis. Stats.) rorego InstrA#, nd cknowiedge the same. THIS INSTRUMENT WAS GRAFTED By .... Mi[7A F MTi7A_ G e6r reta I 541 Broadway, P.O. Box 408-- htanomnt+i e_ WT S47 S' Notary Pvbtic �Li1?hT County. Wis. (Signature-, may be authenticated or acknowledged Both NI), Cornmisolo es peFinanen,. (If not. State expiration ! jl are not necessary,) " - 4 —2 3 : S ( � - - -- -------- -- - - -- _ ,° ) it It ^ SB2 NTF W21 "Ntl.^a9 Ot p¢r90 9p -�. ".9 ^ J ^Y l:d paC iMO�td 06 IY n0�0r f`r ^led baldw In0 !Q d1�r ^ �� WAA RAN T" GEED STATE SAM OF WISCONSIN Nelco Ta< Forms. P.O. Box 1020b, Gre9n Bay. Wt 54 30 7 - 0208 k - — No 2 -1982 T x s n.rY MAY 81988 - 1 JAMES O'CONNELL 43 090 51 fte^ister of Deeds N. St. Croix o., WI ,` CERTIFIED SURVEY MAP FIRST NAT. BANK OF BALDWIN Part of the Southeast 1/4 of the Southeast 1/4 of Section 14 Township 29 North, Range 15 West, Town of Springfield, St. Croix County, Wisconsin. O Indicates 1" x 24" iron pipe weighing 1.13 lbs. /lin. ft. se 14 coR. SEC. /a, r29N, R)sw, r/ "X 24 " IRON PIPE SET) h M 23' UNPLATTED LA NDS N M E LINE SE I/4 AND 2 C.T.H. "W " �--- S 88 • -45 OO "£ 507. Owner's Address: 1 474. /o' K3' 990 Main St. Baldwin, WI 54002 ( $ DWELLING WITH ti , ATT. GARAGE ` ( ^ I y O O b 2 I LOT / _ —0 I NI Q W SHED J b S I 7.000ACRE W O Q 44 304, 919 SO. FT_ p *� :t p � yu " w NET= 6.5/0 ACRES g I w 283, 557 SO. FT, o p o I t ti Dated: 4 -14 -88 Q` O BARN p ek Ji 4J O N 88. 45'00 "W 27.01' " = I ZE l W 2 2f o J R q I WATER COURSE I h h 2 I ( 18 "CULVERT V ~ S 00'00'00 "W 56,26` 4 4 4 w w 447. /O' 60.01 J N BB • 4'5 '00 "W 507. // UNP LAT TE D LA SCALE 1 " = 200' O !Do' 200 300' 400' Soo, m SE COR, SEC. 14, T 29N, R 15 W, /1 "X 24 " IRON PIPE SET) Description: That certain parcel of land located in the Southeast 1/4 of the Southeast 1/4 of Section 14, Township 29 North, Range 15 West, Town of Springfield, St. Croix County, Wisconsin, more fully described as follows; Commencing at the Southeast corner of said Section 14, thence N 00 "E (assumed bearing on the East line of the Southeast 1/4 of said Section 14) a distance of 681.92' to the POINT OF BEGINNING, of the parcel to be herein described; thence N 88 "W 507.11'; thence N 00 00 11 E 601.43'; thence S 88 "E 507.11'; thence S 00 "W 601.43' on the East line of the Southeast 1/4 of said Section 14, to the POINT OF BEGINNING, containing 7.000 acres, being subject to easement over Easterly portions of said parcel as shown on this map for C.T.H. "W" R.O.W. purposes and also being subject to easements of record, i State of Wisconsin) Part of the Southeast 1/4 of the Southe t 1 Of' tA ' 3 � 15 West, Town of Springfield, St. Croix County, Wiseon. 0 Indicates 1 x 2 iron pipe weighing 1.13 lbs. /lin. ft. set. EB04 COUP S£C- 14. r Z9 M. R 15 W, t1 ° X 24" IR0N P. P'Lr SE TI " M 23' UN PL.4 TIED LANDS N M E LINE SE 114 AND Q 'F - ' S 88 ' -45' O "E 507.11' v ti Owner's Address: 1 474./0' 990 Main St. Baldwin, WI 54002 DWELLING WITH I ' g AT7. GARAGE ` ( H I O 00 h! 2 Q M O w a LOT 1 _ Q "J O SHED � '0 7.000ACR£S uj H , CA C 304, 919 SO. FT. O I R " W h NET= 6.510 ACRES $, O 1 Q W 283, 55 7 SO. FT. Dated 4 -14_88 QI BARN _J " t 4 5 ` O N 88. 4'00 "W 27.01' h zt Z� O WATER COURSE I �+ 2 i 1a "cucvERr 2 S 00.00'00 "w 56.26 Q � w 447. /O' 1 50.01 j 0 h N88 "W 507. //' `J' tk Q O UNPLATTED LA SCALE / " = 200' O /DO' 200' 300' 400' 6 w' b SE COR. SEC. 14, T 29N, R 15 w, / / "X 24 " IRON PIPE SET) Description: That certain parcel of land located in the Southeast 1/4 of the Southeast 1/4 of Section 14, Township 29 North, Range 15 West, Town of Springfield, St. Croix County, Wisconsin, more fully described as follows; Commencing at the Southeast corner of said Section 14, thence N 00 "E (assumed bearing on the East line of the Southeast 1/4 of said Section 14) a distance of 681.92' to the POINT OF BEGINNING, of the parcel to be here described; thence N 88 "W 507.11'; thence N 00 "E 601.43'; thence S 88 45'00 "E 507.11'; thence S 00 601.43' on the East line of the Southeast 1/4 of said Section 14, to the POINT OF BEGINNING, containing 7.000 acres, being subject to easement over Easterly portions of said parcel as shown on this map for C.T.H. "W" R.O.W. purposes and also being subject to easements of record. State of Wisconsin) ,�06*,sJu1u11*0 i J. County of Pierce) �0 ������ I, Laurence W. Murphy, Registered Land Surveyor do hereby certify that by direction of the Owner, The . LAURE Cc First Nat. Bank of Baldwin, I have surveyed and S m W M IiY a divided the lands as shown hereon in accordance with = iB 3 ' ki official records Chapter 236.3 z 4 of the Wisconsin "Nom% = RivER FAILS,. Vyisc � Statutes and the Ordinances of St. Croix County; j'� ••. ..... .•� � �• correct representation thereof ttidion are a true and �-� Wo © ; ;AHO �4�► Vol. 7 Page 19 62 Certified Survey Maps �D _ Laurence W. Murphy _ ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address � q-0I 3 Property Address (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number 0 34 Io - 3 LEGAL DESCRIPTION Property Location S E % , 55 % , Sec. 4 T W, Town of sie rp P1Qjd Subdivision NIA Lot # Certified Survey Map # 4- 3 7 (i d , Volume 7 Page # Warranty Deed # `� , Volume �0 0� , Page # Q Spec house ❑ yes fig no Lot lines identifiable Byes ❑ no I 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 §Comm. 83.52(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. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County 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 '�' �) P.� S A URE OF APPLICANT(S) 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. 08/05) r JUN -06 -2008 11:04 From:DCOM SAFETY &BUILDING 715 726 2549 To:Ri9htFAX P.1/3 w „ w State of Wisconsin 1 DEPARTMENT OF NATURAL. RESOURCES Jim Doyle, Governor West Control Region Hoodquanars Scott Hassett, Socrotary 1300 W. Clairemont Avenue WISCONSIN Scott Mlumrlckhpwso, Roglonpl Director PO Box 4001 Eau Clalro, Wisconsin 54702.4001 DEPT. OF NATURAL RESOURCES Telephone 716. 830.3700 FAX 716- 839.6076 TTY Access via relay • 711 January 31, 2006 ��� 01 20 os John C. Wagner 3320 —.Dunn County E 5247 - Tl Oth Avenue �>��( & BUILDIN UWN PN278 Menomonie, WT 547$1 -;1290 Subject; We.0 Tnspection Dear. Mr.. Wagner. Enclosed is a copy of the inspection report for your well, which was conducted on Wednesduy, Junuaay 25, 2006, 1 have assigned your well the unique well number .P.N278, Please of l the enclosed sticker on your main electrical fuse box, as indicated, and include this number on all future water sampling lab slips. You expressed concerns for your well and drinking water quality if a mound soil absorption system was installed on the adjoining upslope .lot, which :is currently vacant and without a building permit. Leroy fansky of the Dept. of Commerce and Mike :Helgeson of Dunn County Zoning were both present to help resolve your concerns and to clarify regulation interaction. Section NA 81108(1) of the Wis. Adm. Well Construction and Pump Installation code addresses the juxtaposition of wells and potential well contamination sources:related to surface elevation. Wisconsin Dept. of Commerce regulations relating to septic system installation reference NR 8.12, significantly simplifying compliance questions. Plow this section iTecifica.11y applies to your property is explained below. L NR 81.2.080)(c) requires it wel I to be "As Far away from any :known or possible source of contamination as the general layout of the premises and the surroundings allow." The slope and s.i.ze of Elie adjoining undeveloped lot precludes the location of a mound in any location outside of the staked Uca that would also allow'for the construction of a house. The staked system location would satisfy the requirements of "(c) 2. NR 812,08(l)(b) prohibits a well from being downs.lope from a contamination source on an adjacent property. This ])road and all encompassing definition is too vague to be applicable under actual conditions. For example, if an adjacent property happens to be a farmstead on top of u hill, a.l.:l wells on the slope of that hill on adjacent properties would be in violation, as neither a nzi.nimu:m nor maximum separation distance is specified. Section NR 812.08(4.)(c)1., however, does specify a mitlimum of 50 feet of separation. if a mound system was installed, I. estimate it would be not closer than 80 above your well, which would satisfy t:he horizontal separation requirement. dnrmi,gov Quality Natural Rosources Management wisconsln.gov Through Excellent Customer Service ro^� 1".Fr JUN -06 -2008 11:04 From:DCOM SAFETY &BUILDING 715 726 2549 To:Ri P.2/3 3- Again, NR 81.2.08(1.)(b) allows a well to be located below a contamination source without variance, when a minimum of 20 or more feet of additional well casing than what the well code requires is installed, Tile characteristics of your well site dictate a mj, ' jIu of 30 feet of cement grouted well casing. Your well contains 40 feet of casing, which is 1.0 feet short of the 50 feet that would be necessary to satisfy th:i.s aspect of Your well has small protection against unanticipated contamination between the bottom edge of the casing and the strdace of the groundwater. at 85 feet. Your well is somewhat better protected where i.t penetra.tes the diluting properties of the groundwater. below 85 feet. A. comparable protecti.on safeguard for well. water is expected whenever u variance is issued. I would be hard pressed to consider a variance for your well as if offers no significant comparable water quality protection as constructed, 4. NR 812,08'(1)(b)2, addresses .surface water traveling within 8 'reet of a well after washing over a contamination source. If a linear mound would be constructed on the roughly 20% slope above your property, your well ccrtain.ly would be .included under this specific wording, and it is doubtful there is any .realistic well location on your property that would escape such surface flow. Until such time as the language in NR 8 ].2.0$(1) may be clarified. I believe there currently exist on,iy three ways in which a mounded soil absorption system, .located on the slope above your lot, would not place your well into noncompliance. • A surface diversion, such as a .lineal earthen berm or sh ni.l.ar means, which would 1? revent all diva,md hypothetical surface water from passing not nearer than 8 feet to your well., or • Installing a liter within your well in conformity to the requirements of NR 812.21(1). However., to do more than satisfy min.irnal well code standards and to increase the probability of actual well water protection, I believe more is necessary at your site. To this end I would .recommend a con lent grouted liner to at least the contact point with the static water level inside your well and preferably deeper., or • Abandon your current well and construct a well with not less than 85 Peet of grouted casing. Even though your well was drilled :in 1986, the installation of an upslope mound would .immediately put your well into noncompliance, .Bit, because Dept. of Commerce septic system regulations reference NR 812, the continuing compliance of your well rests upon the design elements that are, or should be contained in any :mound approval, I hope I have adequately addressed your questions and concerns. If not, please no not hesitate to call me at (715) 839 -3796. As you are u .master plumber and licensed pump instidl.er, I have enclosed a copy of NR. 812 and related brochures you play :find useful. Sincerely, 7 aclt Bates Drinldng Water and Groundwater Specialist JUN -06 -2008 11:04 From:DCOM SAFETY &BUILDING 715 726 2549 To:RiohtFAX P.3/3 l SAFETY AND BUILDINGS DIVISION commerce.wl.gov i ast Spruca Street 0 Chippewa Fella, WI 54728 t ioepartment � � � IN REPORT www.commoraowi g /ab ( 715) 728.2644 of Commoroe Date of Inspection: January 25, 2008 Plumber Namo and Address: Project Name: Wagner Use: Resdiential Legal Description SE- NE- 1.28.13W Slte Number: NA Subdlvlslon: Lot 1 CSM 440 Certified Soil Tester Namo and Address: Municipality; Town of Menomonie County: Dunn Plan Transaction Number: NA Sanitary Permit Number: NA Owner Name and Address: John C Wagner Wastowater Flow: 450 gpd E5347 — 710th Ave Persons Present: J. Wagner, J, Bates, Menomonie, WI 64751 -1280 and M Helgeson We met with property owner John Wagner at his property, as described above, to discuss a possible setback violation concerning his well and a proposed mound system on the vacant lot (Lot 1 CSM 2884) immediately north of his home and private water well. Comm Table 83.43.1 defers to DNR Administrative Code NR 812 for setbacks from septic tanks and soil treatment components such as a mound system. The normal horizontal setback pursuant to NR 812 is 50 feet.. However, the same rule also has language restricting up slope sources of contamination on adjacent properties. DNR Is responsible for interpretation of NR 812 and setbacks /limitations pertaining to private onsite wastewater treatment systems It Is the responsibility of the county and department to withhold issuance of a sanitary permit for the installation of a private onsite wastewater treatment system. The department may not approve a plan and the county may not issue a sanitary permit for a system unless all aspects of the proposed design are in compliance with Comm 83, Wis Adm Code. I will offer however, that the use of a mound system greatly reduces the risk of groundwater contamination by pathogenic organisms Additional protection could be added by pretreatment of the wastewater prior to its discharge to a mound system for final treatment and dispersal. Review of the Soil 5valuation Report completed by Lewis Bjork for Lot 1 CSM 2864 Indicates that the site plan as depicted is very inaccurate with regards to the dimensions and location of property lines Slope conditions should be verified by the county since slopes greater than 25% are not allowed as a standard component manual approval, The county has contacted the certified soil tester regarding these discrepancies. If there are any questions regarding this report, please contact me roy G. ansky, \ffastewatdi Specialist Leroy. Jansky2Wisconsin.Gov E -mail 716/726.2544 Voice 715/728 -2549 Fax cc; I�.Iounty ❑ Plumber Q CST ,,Owner [K Other JACK 61-W _ - 0 Afk