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034-1053-60-001
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 487934 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m) Permit Holder's Name: City Village X Township Parcel Tax No: Evans Robert & Laura I Springfield, Town of 034 - 1053 -60 -000 CST BM Elev: Insp. BM Elev: BM T on: Section/Town /Range /Map No: OD b t� • O 24.29.15.373 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark .25 6 Dosing Alt. BM BI Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. jVent r Intake RO AD Dt Inlet Septic Dt Bottom -2'-1 O • 0, Dosing Header /Man �• Z , Dist. Pipe Iding WK K- V V 1 / t S� Bot. System S y Final Grade j PUMP /SIPHON INFORMATION 2 Manufacturer Demand St Cover W/ GPM Model Number TDH Li Fric n ss System ead TD Ft , t , Forcemain Len(t ,) Dia .,f Dist. to Well SOIL ABSORPTION SYSTEM 1't f — t441 G � BED/TRENCH Width Length No. Of Trenc as PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over =Bed/Trench pth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Edges Topsoil 0 Yes D No E Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:_�Q 1_LZ-119 �' Inspection #2: / / Location: 3241 90th Avenue Glenwood Cy, WI 54013 (NE 1/4 NW 1/4 24 T29N R15W) 40 acres Lot I, Parcel No: 24.29.15.373 1.) Alt BM Description =qp d'� � �y l u , � � 2.) Bldg sewer length= QAAS e' h 2 - amount of cover = 1 'l/ ��� Plan revision Required? Yes D0 // ' Use other side for additional information. I b ' D Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) ` Safety and Buildings Division County 20 1 & Washington Ave., P.O. Box 7162 5' T C QO I X Aseons 6. adison, WI n6-3 G2 Sanilaty Permit Number (to be filled in by Co.) Dep artment of Commerce ! /S ''�! (608) A, Sanitary Permit Applieati n State Ian 1. D. Number f� In accord with Comm 83.21, Wis. Adm. Code,'personal informal' i n you provide /N / 1 maybe used for secondary purposes Privacy Law, s15.0 1)(m) f N Prgi t Address (if dill'crenl than mailing address) 1. Application information - Please Print All Information Property Owner's Na " Pos I.,ot fl Mock N L \) P S o y- 10 too 000 Property Owner's Mailing Address Property Location 32 L41 goTh ALJ NE .2-14 rCitfy,rStatel ' . 1 Zip Code Phone Number V LC N 0- 1T W y 1 5 4 0 / 3 1 -1 iS `7 7z - '33 z 2- T 2-7 N; R �� (cirCle oaC) 11. Type of Building (check all that apply) ___ ■ 1 or 2 Family Dwelling - Number of Bedrooms E LA 1 l Subdivision Name CSM� Public/Commerci it - Describe Use v ❑ Stale Owned - Describe Use QCity []village E1'ownship of PR -- ill. Type of Permit: (Check only one box on line A. Complete line B if applicable) yL A ' 0 News stem s st y ❑ Replacement System ❑ Treatment/l�olding Tank Replacement Only Other Modification to l xislillg S stern - fR lss Fe - rA P B• i] Permit Renewal ❑ Permit Revision ❑ Change of a Permit Transfer to New List Previous Permit Number and Dalle Issued Before Expiration Plumber Owner 31 H Q O 8 = 8 - /j,- 2.0 D O IV. Type of POWTS System: Check all that a l t ❑ Non - Pressurized In -Ground ❑ Mound > 24 in. of suitable soil ound A24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand fitter ❑ Constructed Wetland 0 Pressurized In -Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber 13 Drip Line 0 Gravel -less Pipe ❑ Other (explain) V. Dis ersaVTreatment Area Information: Design flow (gpd) Design Soil Application Rele(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sl) Sysicm Elevation VI. Tank Info Capacity In Total Number Manufacturer Prefab Site Steel fiber I'laslic Gallons Gallons or Units Concrete Constructed Glass New Existing Tanks Tanks Holding Tank 600 i (D oD Z weoes C. P c# Dosing Chs I C -, S Vllf. Responsiblilly Statement- 1, the undersigned, assume responsibility for In tallatlon of (he PONNITS shown on floe nllnched plans. umber's Nam u ber's Signatu /MPRS Number Business Phone Number � 1�1� TR�Ca (T�cl �� Iy5g,h 7 /5�,3,S Coco0 Plumber's Address (Street, City, State, Zip C e) 3� ID(o LO EST PkDSOECT AJE ALME lJ A w ( S44 Vl1 onn /De ertment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater I Date 'sued uing A nt Si let a (N 1ps) Surcharge Fee) . 0 10 0/! a ❑ Owner Given Reason for D enial iFj+ IX. Conditions of Approval/Reasons or Dis proval �. dell 7 Attach to eta plans (to the County only) for the system an paper not less than a 1!2 x 1 I inches in size SDD -6398 (R. 01/03) qo 400- ik ; r 3q O PT V4 / %4ELL �XlSrin�C i U•N� NomE 70 OF W ELL � �- - - - - - - -- User4 KO Pt) I / PRESS LIK3C ' PROPOSE � I ' P,-) r: BaRtJ c.o l / W'303LA Pic P►PE (300F'-) Al)OEb (6DO GAL Puw,PTAN1� E"�c►ST NCB i Q3 qS ion ' qcl gD7h 4JE ORt E 3qo� 0 RT V4 VWLL / pp 4 gEQRoOM CJ• (� HO E 70 OF G) ELL ,- - - - -- — - --� L sc,4 to Po ' Pt�oPoSE'� t G.O / W aq PuG PIPE (300 F7-) ADDED boo GA Puv,,pTAni� � �BAR►J � / � � 93 qS toy Qa . SECTION: 2.30.020 /7 �? O FM0390 QZ,4ZIrI / �F1WI ����/ 1097 Product information ` � a oM Supersedes presented here reflects N ` y / ,/ 7ZI Ap Z- 0297 conditions at time of " publication. Consult factory regarding discrepancies or MAIL TO: P.O. BOX 16347 • Louisville, KY 40256 -0347 inconsistencies. �+ %'�` SHIP T0: 3649 Cane Run Road •Louisville, KY 40211 -1961 http : //www.zoeller.com (502) 778 -2731. 1 (800) 928 -PUMP • FAX (502) 774 -3624 ` COMPARE THESE FEATURES 266 _ Z67 _ 268 - 270 _ 4270 SeTI @S • Float operated, submersible (NEMA 6) 2 pole mechanical switch. • Durable cast construction. ASTM Class 25 Cast iron, switch case (For Pump Prefix Identification see News & Views 0052) and pump housing • Cast iron base on 267, 268, & 4270. "WAST • Engineered Plastic base on 266 & 270. • Non - Clogging Vortex Impeller Design. Engineered plastic impeller with metal inserts on models 266, 267 & 268 (1 Ph). Model 267 SUBMERSIBLE available with cast iron impeller option. (Cast iron impeller standard S E WAG E/ *EFFLUENT PUMP on 3 Ph models.) (Model 27014270, Non - Clogging Bronze Vortex Impeller.) OR DEWATERING PUMP • Not effected by materials normally found in drainage and sewage SSPMA sumps. a 2" NPT DISCHARGE MEMBER Stainless steel screws, bolts, handle, guard, and arm and seal assembly. S ,, P DS UL Listed 3 -wire neoprene cord and plug. ` ' PUM MFR A ASSN. 10 ft. cord standard for automatic. 15 ft. cord standard for Nonautomatic. • Thermal overload protected on single phase pumps. • Oil filled motor - hermetically sealed. • Square Ring & Gasket - Neoprene. • 266/267/268 Series -' /2 HP 60 cycle, 1725 RPM. a1, 270 Series -1 HP 60 cycle, 3450 RPM.'" • Carbon and ceramic shaft seal. • Double seal pump available - 4270 Series. • Oil lubricated bearings. • Passes 2 -inch solids. • 2" NPT Discharge. Automatic • On point -12 ". Off point - 4" (Automatic units). "267" • Engineered plastic base on all 266 and 270 models. • Model 268 (shown below). Combination 2" and 3" discharge. 2" N.P.T. Female discharge / 3" N.P.T. Male discharge. 1 o SIMPLEX AND DUPLEX SYSTEMS AVAILABLE PACKAGED SYSTEMS AVAILABLE Nonautomatic "4270" double seal pump FEATURES AVAILABLE • Automatic (Not available in 270/4270) • Nonautomatic (for variable level systems) • Double Seal Pump in 4270, 115 or 230V, 1 Ph, 1 HP • 2" NPT Discharge (2" & 3" Model 268) ' /2 H.P., 1 Ph, 115V, 200 -208V, or 230V • Passes 2" Solids Automatic Nonautomatic "267" BN and BE267 pumps available packaged with a "268" for variable Piggyback Variable Level Float Switch level systems '/2 H.P., 3 Ph, 200 -208V, 230V, or 460V 1 HP, 1 Ph, 115V & 230V 270/4270 models ' May be used in those states where codes do not restrict solids size in effluent systems. "' See back page for UL & CSA listings. m TOTAL DYNAMIC HEAD /CAPACITY o: D HEAD CAPACITY CURVE PER MINUTE I� C 4 "266/267/268/270 /4270" MODELS SEWAGE AND DEWATERING y l 10 3 MODELS MODELS I 266/267/268 270/4270 D 3 - 270 FL Meters I Gal. Ltrs. Got. Ltrs. � 4270 3 1.5 129 4e1 132 500 8 2 1*1 10 3.1 89 337 101 382 E I 15 4.6 50 leg 77 291 266 I 1 267 1 268 6- 20 i0 6.1 10 38 56 11i F 2 25 7.8 - - 29 110 I U 15 L «k Vol.: 21.5' 29' ro 4 I � G I ° 10 i 2 H 5 - SK375 0 GALLONS 2 43 60 80 100 120 140 LITERS MODEL A B C D E F G H 0 so 160 240 320 400 480 266 4 -314 8- 5116 6 -13132 4 -3/4 6 -15132 ZIPS 14 -7/32 6 -11132 FLOW PER MINUTE 009892 267 4 -3/4 8-5116 6 -13132 4 -3/4 6 -15/32 29PS 14.114 6.3/6 268 4.3/4 8 -13132 6.13/32 4 -3/4 6.15132 2739PS 14 -1/4 8 -11/16 270 43/4 85/16 613132 43/4 WA 2' IPS 15 6114 4270 4314 85/16 1 613132 1 4 314 1 NIA 2' IPS 1 18 202 1 61/4 CONSULT FACTORY FOR SPECIAL APPLICATIONS 266 MODELS Control Selection Lis tin s " Electrical alternators for duplex systems available with variable level Model VoHs - Ph Mode Amps Simplex Duplex CSA UL control switches. M266 115 1 Auto 10.4 1 or 1 & 8 - Y Y • Minimum recommended basin size (Small load applications) N266 115 1 Non 10.4 2 or 2& 7 3 or 5& 6 Y Y Simplex -18" x 30 ". D266 230 1 Auto 5.5 1 or 1 & 8 -- Y Y Duplex - 30" x 30 ". E266 230 t Non 5.5 2 or 2 & 7 3 or 5 & 6 Y Y • For Over 130° F. (54° C.) special quotation required. H266 200 -209 1 Auto 6.2 1&8 - N N Standard All Models - 1266 200.208 1 Non 1 6.2 1 2&7 3 or 5 & 6 N N 266 - ' Weight 41 lbs. '/ 2 H. P. J266 200 -208 3 Non 2.6 4&6 3 & 4 or 5 & 6 N Y 267- Weight 50 Ibs. '/2 H.P. F266 230 3 Non 2.6 4&6 3 & 4 or 5 & 6 N Y 268- Weight 51 lbs. '/2 H.P. G266 460 3 Non 1 1.3 4&6 3 &4 or 5 & 8 N N 270- Weight 49 lbs. 1 H.P. 267 MODELS Control Selection List in gs 4270- Weight 73 lbs. 1 H.P. High water alarms available. Model Volts -Ph Mode Am Sim Iex Duplex CSA UL Mechanical alternators available for duplex systems. M267 115 1 Auto 10.4 1 or i& 8 -- Y Y p y • BN267 1 15 1 Auto 10.4 2 Y Y Caution: Maximum temperature of sewage or dewatering must be limited N267 115 1 Non 10.4 2 or 2 & 7 3 or 5 & 6 Y Y to 130° F. (54° C.) D267 230 1 Auto 5.5 1 or 1& 8 Y Y E267 230 1 Non 5.5 2or2 &7 3or5 &6 Y Y SELECTION GUIDE SE267 230 1 Auto 5.5 2 Y Y 1. Integral float operated 2 pole mechanical switch, no external control H267 20D -208 1 Auto 6.2 1&8 N N required. 1267 200.208 1 Non 6.2 2&7 3 or 5 & 6 N N 2, Single p i g gyback variable level float switch or double I 9 P 99Y pi variable 267 200-208 3 Non 2.6 4&6 3 & 4 or 5 & 6 N Y F267 230 3 Non 2.6 4& 6 3& 4 or 5& 6 N Y level float switch. Refer to FM0477. • F G267 460 3 Non 1.3 4&6 3 & 4 or 5 116 N N 3. Mechanical alternator M -Pak 10 -0072 or 10 -0075. 4. Simplex Control Panel. Refer to FM 1596. 268 MODELS Control Selection Listings 5. See FM0712, for correct model of Electrical Alternator, E -Pak. Model Vohs -Ph Mode Amp Simplex Duplex CSA UL 6. Variable level control switch 10 -0225 used as a control activator, specify M268 115 1 Auto 10.4 1 or 1 & 8 •- Y Y simplex or duplex (3) or (4) float system. N268 115 1 Non 10.4 2 or 2 & 7 3 or 5 & 6 Y Y 7. Four (4) hole J -Pak, junction box, for watertight connection or wired -in D268 230 1 Auto 5.5 1 or 1 & 8 Y Y simplex or duplex operation, 10 -0002. E268 230 1 Non 5.5 2 or 2 & 7 3 or 5 & 6 Y Y 8, Two (2) hole J -Pak, junction box, for watertight connection or splice, H268 200 208 1 Auto 6.2 1&8 Y N 10 -0003. 1268 2110.208 1 Non 6.2 2 &7 3or5 &6 Y. N J268 200.208 3 Non 2.6 4& 6 3& 4 or 5& 6 Y Y F268 230 3 Non 2.6 4&6 3 & 4 or 5 & 6 Y Y For infotmation on additional Zoeller products referto catalog on Simplex Panels, FM1596; Pggyback G268 460 3 Non 1 1.3 4&6 3 & 4 or 5 & 6 N N Variable Level Switches, FMO477; Electrical Alternator, FM0486; Mechanical Alternator, FM0495; 'No molded plug "'Single piggyback switch Included SumplSewege Basins, FM0487; Single Phase Alarm Systems, FM0732; Watertight Junctions Boxes, FM1597; and Disconnect & Rail Systems, FM0787. 27014270• MODELS Control Selection Listin s A CAUTION Model Model Volts -Ph Mode Amp Simp lex Duplex CSA UL Allinstallatio of controls, protection devices and wiring should be done by a qualified licensed N270 N4270 115 1 Non 15.0 2or2 &7 3or5 &6 N N electrician. All electrical and safety codes should be followed including the most recent National E270 E4270 230 1 Non 7.5 2 or 2 & 7 1 3 or 5 & 6 N N Electric Code (NEC) and the Occypatjonal Safety and Health Act (OSHA). k,,g ,P RESERVE POWERED DESIGN ' "gy p ' uSB6 For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. TANK /PUMP CHAMBER 4" Vent Pipe with (No scale) Approved CAP +10 ,Approved Locking Manl't�ie Cover From Bui ldings With Warning Label Attached fy r Weatherproof Approved Z I Junction Box Junction' Cap 12" Minima condutt 4" Minimum — Disconnect . 1 /4" We Hole Airtight Seal � 1 A Al atin 6 B A On 6 t C Off T • D Conc. B1ocK 3" of Bedding Under Tank Note: Pump and Alarm Are On Separate CIrtuIts: Number of Doses: Per Daly , Gallons Per Day / o oSes: 2i0 .Gal'lon Volume of Backflow: ....... + 9 6,- Gallon Tank Manufacturer: lt T l rl Total Oose Yol ume :......... ■ s8 Gal on Tank Size—Septic/Pumps, loop G allons ` ,'Alarm Manufacturer: Sx Ct T tC Model Number: -- ►vl Capacities: A 1q inches or Zoo G allon! .Switch Type: S NCI. E + B . Z inches or l onr + C , inches or G llon ?amp panufacturer: - - • Model Number: Leo + D or ►�30_ uallon G al1on! .Minimum Discharge ate: 3t� Total • • • • • ° w inches 'or c _ Vertical Difference B etween Pump.Off and Distribution Pipe: Feet Minimum Required Supply Pressure: ....... ....... + ---- F2�5 eet SOD Feet of Force Main x 1- Friction-Factue/100 -Febt: + d 2, eet Z Inch Diameter Force Main ; - - Total Dynamic Head:.. ■ 17 Feet Internal Tank Dimensions: Lsingth y q ; Width liquid Depth 1 42, Gallons /Ii Signature O n_� License Number n1P cq 5f[,_Uate 10 r r Wisconsin Department of Commerce EVALUATION REPORT Page _ ,� of Division of Safety and Buildings 4 In accordance with Wis. Adm. Code County l G 0 / Attach complete site plan on paper not less tha 114 1 an mu t include, but not limited to: vertical and horizonta fare n an Parcel I.D. percent slope, scale or dimensions, north arrow nd location and dl t an t road. - Q Q Please print all i orrn �ppp. Rev iewe by Date Personal information you provide may be used for sec ndary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner ST. ., IXGUui Ropert(Location 0 Q >5V NS I ZONING OFFIC Ot �- 1/4 �1/4 Sit T Z9 N R Property Owner's Mailing Address Lot # Bloc Subd- Name or CSM# J2 q1 10 1 ? 1 Avg City State zip Code Phone Number ❑ City ❑ Village XTown Nearest Road 4� 4MWoob off (rill olZ (7/ >') 7�Z — Z� / N �J - f-b New Construction User Residential / Number of bedrooms O Code derived design flow rate 75 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material 1*C,+ey -[- bk FT i Lo ES 5 Flood Plain elevation if applicable � � � ft. General comments 1jEj /lN F�olnl �/h'� 'G� L�ec (. T/ oN S /Nly �v/�E F�L ,a P1 V 40 C' 140"45' and recommend 8�, Fo2 PE2S�N FP 1 1. y , �/�'! Wlf-L NAVE A SINK, T f Ll= 'r- , �r�� s u �/ �vE E v� Z NoRSES wkSNEI� PEi r�r:EK . E ` H 9 A q04 b 1; L 171 Boring # Boring Xy pit Ground surface elev. O ft. Depth to limiting factor d in. - joil — Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. '01#1 'Efl##2 / a- s /1 = S r' Z•K •� r s Z•K . G Z 7 /o ie A 5 - s stir, ' M4' e - s e i s Boring # ❑ Boring ® pit Ground surface elev. 8 ft. Depth to limiting factor �Z' in. Soil Application 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 Q - ?sa s z - eti, ic s A4 I G ' 8 /0 .3 " Effluent #1 = BOD > 30 1220 mg/L and TSS >30 5 150 mg/L ` Effluent #2 = BOD 5 30 mg/L and TSS <- 30 mg/L CST Nam �� (P l ease. Print ignature CST Number E/2I�5 r 7�� /g Address FREDERICKS PERC TESTING Date Evaluation Conducted Telephone Number 2017 6' /Z Street Cumberland WI 54829 (715)822 -2996 I y S Property Owner E V'�i� 5 __ Marcel ID # �_ Page — of F-51 Boring # ❑ Boring ® Pit Ground surface elev. 93.3 ft. Depth to limiting factor in. S,,il Application Rata 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 0 0 G •�- c! oaND � SEA E 7 �i Boring # ❑ Boring O ® pit Ground surface elev. /�• L ft. Depth to limiting factor d In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDI" In. Munsell Qu. Sz. Cont Color Gr. Sz. Sli. `Eff#1 'Eff#2 F-1 Boring # [] Boring Ground surface elev. _— ft Depth to limiting factor in. C1 pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. "Eff#1 "Eff#2 i Effluent #1 = BOO > 30 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOO 130 mg/L 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. SBD -8330 (RA7=) 9 rN A V9 ►or t fv ®/�T� �xcEP� wA� SMov�N w6LL PQ�MkRI' � = ►pp, a' �-- - — - — — — — — Top 4' we -1 i ea l; �-� ►N1,LUbe5.' TOILET, SirIK, L Pe � wnsH srRU.. � n/E 1 � W n l 5 PQ -►r4G G, D Tw�Sff r� 5 T, cR o, x GnuN ty CX►5T/n1(,� nortl,e.�yf' Corner o� S1,eQ. �(�► «7/6/$ �'B'O SNED X0 �0 1 keg" 9 X 3 5 7, 311 i. (�� Q0. 6 \ § k ƒR o � � � �k / 2rq 2 . k\ 2 e xg g u G � ) « 0° S d ° j ° 7 , / — C, to C9 \ 2 k i/7 2 m ® ®§ % 2 / o \ # { 2— 2 f K k mƒ g) $ 2\ ca / f (� / -Z; 2 ° t 2dd2 / /� /�2d Cl Cl § / 7 \ � °\ o \•- ( t o \•� o$ kƒ rn ��— /�� ƒ /�� $§ //� ƒ?�2 7� /\ b 3 8. »d d E\ 4 S ® $ / /ON�U 0C'nZ0 /U ®OC4 /�/ Parcel #: 034 09/20/2005 09:21 AM 1053 60 000 PAGE 1 of 2 Alt. Parcel M 24.29.15.373 034 - TOWN OF SPRINGFIELD Current X i ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner ROBERT J & LAURA E EVANS O - EVANS, ROBERT J & LAURA E 3241 90TH AVE GLENWOOD CITY WI 54013 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A -NOT AVAILABLE SEC 24 T29N RI 5W 40A NE NW EZ- UT- 1557/45 Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 24- 29N -15W Notes: Parcel History: Date Doc # Vol /Page Type 08/23/2004 772274 2641/525 WD 10/01/2001 657830 1728/397 EZ 04/12/2000 621045 1501/591 TD 01/29/1999 596722 1399/178 .29 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/26/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 12,950 276,350 289,300 NO UNDEVELOPED G5 8.000 6,600 0 6,600 NO PRODUCTIVE FORST LANC G6 30.000 54,000 0 54,000 NO Totals for 2005: General Property 40.000 73,550 276,350 349,900 Woodland 0.000 0 0 Totals for 2004: General Property 40.000 73,550 276,350 349,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 'Parcel #: 034 - 1053 -60 -000 09/20/2005 09:21 AM PAGE 2OF2 Parcel History: cont. 02/03/1998 572248 1292/544 WD 07/23/1997 1213/568 QC 07/23/1997 1175/99 SD n cn t 3 d 0 d r� 7 a a `+1 �V`-D: a ' � O W Z N N Q e 3 y N < ti O .p `1, *0 0. c O oo° > > Q a - \ O 1 c w <"' c A7 O � N U, 1 p 0 - !r v cn z cn z D o CD D c5 D d D m CD c m N 3 O V C o O CD .,' ,'�,• N �1 A G z FD O O O O O 3 O C a � O O O� 0 V ? N N N cr C 0 . S OA `^ �^ O C' w y "1 3 y �o �� S ` �N,�m�O DDo O �ev�` �� T o t�l cl D CD � Q So . 0 4 0 u CD O N C O CO O a W V O CD G CD O d N Z �! w- CD 'O ( M D (D o �o m 3 y 0 (D v m a G) 3 S O n Cn > 7 9 W 0. < �• CC Z N v (D oo V m � m CD CD z m ° 3 a z CD CD S y m .P f � 0 ?D<i N x o�.m m tO o� n D < o 'er D a m a O o oo -o m m = n rn 3 m CL V w c C O 7= 2 O D 7_ CD a CD j C1 U) O 1 C CD N CS CD x 0 7 C x =r CD V O O N N O _3 3 �Cn„ * O D fi 7 7 N N �__ 7 -p CO y OMEL m w . �'O SCE 0 CD R Or .< CO cn 3 m? p N CD :E O (, .�0. �_ CT T' N n O CD O O O O Q D O O M C� CD CD a y - w O VO r _ w CD ti (Dmda�a3 —_' a cs a o ° O O a c Cp LA O O A O < dQ W fD O O O 0 ~ N O 8 CL ~ 'Pam Quinn From: Robert Bezek Sent: Tuesday, September 20, 200510:15 AM To: Pam Quinn Cc: Kevin Grabau; Ryan Yarrington; Jennifer Emmerich; Jennifer Shillcox Subject: RE: Question on Holding Tank prohibition -Code 15:04(3)3 Pam, The new code has this prohibition in 12.1 IV. 5. 1). We need to hold the line on no holding tanks. In this case I would make the argument that the construction to build the restroom is new residential construction and subject to the prohibition. While the construction isn't for the principal al structure (the residence) the overall use of the property is residential. We would not require a land use permit but the addition of a restroom would most likely require a Town building permit through their implementation of the UDC. I copied some others on this response because this is somewhat of a liberal interpretation and we all need to be on the same page. Also, if anyone has anything that might add to the debate on this lease forward our thoughts. P Y 9 bob - - - -- Original Message - - - -- From: Pam Quinn Sent: Tuesday, September 20, 2005 9:27 AM To: Robert Bezek Subject: Question on Holding Tank prohibition -Code 15:04(3)3 1 received a phone call from both a property owner and his plumber about adding a convenience toilet in an accessory pole building used for their personal horses not a commercial stable). However, they have done a rY P 9 P ( ) new soil evaluation and cannot find soils to allow a POWTS and were planning on a holding tank to service that bathroom. The house itself has a mound, but is over 350 feet away and according to them not feasible to pump wastewater over to be treated in the POWTS. Do they need to obtain a special exception permit or variance to D Ilow installation of a holding tank? Since it is not a dwelling and not really new construction (the barn was constructed 2 -3 years ago), can we issue a permit without a land use permit? I haven't encountered this type of V �V situation before!! 1* p C PAMELA QUINN, ZONING SPECIALIST ST. CROIX CO. ZONING DEPT. PAMQG&CO. SAINT- CROIX. WI. US 1 nch o ■ -0 o @ $ § ; ■ ° (D ��/ / / 7 z \ w z = w � c > E / \ � ( \ i § \ , j %w @ ��— UE -W N) / / \ --1 - e ^ E E \ ! \ - ' � cft ■ _ # § � CD / §£ ¢ �i yl § \ a 8E§ 0. z \ § % j z §§ g n r CA ° e E £ 9 Z C L a� , z 0 3 0 / . ƒ \3 222\ § _ 'a o R i� n N) £ % . E § z _ _ § § ƒ Q » ® / [f m k E ° =anEi£ :E , ƒ§RE0= \ 0J� =,� cn R � � w CD =r I 2 . jR $�\2 -4 CA { /\ @%$in \ ��$\ CD 7 R . E 7 $ m ® § & CD f\ co V 7) k CD m E , z \ \ CL t \ 7 \ CD , £ , $ , � # ■ ® E)0> 3o iz f \ \k 2 n . E�2) % 2 ±Ei CD C 0 . ¥) f � 20 o � {\ � CL 2 C CD \ � 0 } � � < \ ' � 8 E � ISS � l onshi Department of Commerce p PRIVATE SEWAGE SYSTEM Count 3afeiy and Buildings Division y St. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitarlp40 No.: Personal inf m , awn you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: []City ❑ Village wn of: State Plan ID No.: Nelson, Jeff Sprmgie�d Township _10 11 CST BM Elev.: Insp. BM Elev.: BM Description: Parcel 6 4141- 34 1 053 -60 -000 ao O tso -� CST 8,w * I TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION 3 �B HI FS ELEV. Septic 9:it!V0 Benchmark �03`�� 60„L Dosing W - (3'0 Alt. BM 'q'�Z 2 - 7 !an ,gg' Ff__-�D Bldg. Sewer St /Ht Inlet 12- TANK SETBACK INFORMATION St /Ht Outlet IZ'g��F IZ.?3 9o.q Vent to TANKTO P/L WELL BLDG. Airintake ROAD Dt Inlet 13•ae Septic > l/ > loo I am NA Dt Bottom 1 � ,��z 15'.38 Dosing ? 09 / } 1v 0 I NA Header / Man. Aefa ZZ ?tc9U� > (00' p ` NA Dist. Pipe 3 3 L 3.2 H Bot. System PUMP / SIPHON INFORMATION Final Grade `+ _ Manufacturer Lint Demand St cover Model Number b 05 GPM 2 IZ TDH Lift Friction S stem TDH Ft ' ` L H (2 II ] �f ]z- 9'f to • T3 Forcemain Length Dia. 2 U Dist. To Well SOIL ABSORPTION SYSTEM \ I BED/TRENCH Width t Length f . f PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS O DIMEN I N SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Marie acturer: SETBACK CHAMBER INFORMATION Type Of M Number: System: 1 rj O QR UNIT DISTRIBUTION SYSTEM S °I0" 2.o,t.>) DT (� z" +(401 " Header ani old q Distribution Pipe(s) I V x Hole Size x Hole Spacin Vent To z Air Intake Length 1e-e- Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed/ Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1 •Ui"/2 Inspection #2• ER12 Location: 3241 90th Avenue, GlenW9od City, WI 54013 (NE 1/4 NW 1/4 24 T29N R15W) - 2429 1.) Alt BM Description= 64L n �Cee,r, ,}, 2.) Bldg sewer length= Lfo I , - "� - amount of cover = 6 o " .I. J j 3.) contour= qe �Y' 5 w-, -'E. 93 , to 3,c ° Plan revision required? Y ❑ No Use other side for additio Information. SBD -6710 (R.3197) Z a Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: 44 9 € 3 S [ b t 5p I � 3 � ®p d i a � i Y m 4 � k - E m € g € ' _ ' E P I Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21. Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 ® iscvnsin Personal information you provide may be used for secondan purposes Madison. WI 53707 -730" Department of Commerce (Submit completed form to cou:tty if r [Privacy Lay,, s. 15.04(1) m state owner Attach complete plans (to the county cop) only) for than 8 - 1/2 x I I inches in size. County State Sanitary Permit Number V6ision to prey s,i[i cation State Ian 1. D. Number 9e4.At&" 5T• 20( r, 1. Application Information - Please Print all Information ECEIVEH Location: Property Owner Namen' o C"7 j Property Location 9)44. J I /4 S T 7i9,N. or M Pro rty Owner's Mailing Address T C#ox Lot Number Block Number ,- Z h. City, State Zip Code te Number �' '� Subdivision Name or CSM Number Q ! 11 t5c& r n II Type of Building: (check one) ❑ City )2�, I or 2 Family Dwelling — No. of Bedrooms: ❑ Village n • Public /Commercial (describe use): ,Town of • State -owned III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Neaf Road7_ A) 1. &New System 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s) System Tank Only Existing System D,3 — 16 S j — d(? a B) Permit Number Dat Issued A Sanitary Permit was previously issued "IqO da IV. Type of POWT System: (Check all that apply) ❑ Non - pressurized In ground Mound O Sand Filter O Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At- grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V Dis ersaUTreatment Area Information: 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation 4 1;�o ;;?_ -3-!5 ! 2 '17, 75 AV, 7-5 VI Tank Capacity in Total 4 of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks /bay do Z &Iaaf C, 0o vv / 5b ❑ ❑ ❑ ❑ VII Responsibility Statement I, the undersigned, assume responsibility f_r installation of the POWTS shown on the attached plans. Plumbes Name (print) Plumber's Signature (no stamps): MP /MPRS No . Business Phone Number L a a 2( - 7'7 L - 3 z /y� Plum bets Address (Street, City, State, Zip Code) jiag VIII County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) J,Approved ❑ Owner Given Initial Adverse Surcharge Fee) Determination IX. Conditions of Approval /Reasons fo Disapproval: A 0 U t) C? ::�� 0�lAlti nx1w, SBD -6398 (R. 07/00) Safety and Buildings •• 10541N RANCH ROAD ' HAYWARD WI 54843 TDD #: (608) 264 -8777 isconsin www.commercestate.wi.us /SB Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary November 21, 2000 CUST ID No.226524 ATTN: POWTS INSPECTOR ZONING OFFICE ROGER L TIMM ST CROIX COUNTY SPIA 3128 20TH AVE 1101 CARMICHAEL RD WILSON WI 54027 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/21/2002 Identification Numbers Transaction ID No. 446296 Site ID No. 196171 SITE: Please refer to both identification numbers, Site ID: 196171, JEFF & SUSAN NELSON L above, in all correspondence with the agency. ST CROIX County, Town of SPRINGFIELD; 90TH AVE NEIA, NW1 /4, S24, T29N, R15W FOR: NEW MOUND, 600 GPD Object Type: POWT System Regulated Object ID No.: 752967 1 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. U 11 The following conditions shall be met during construction or installation and prior to occupancy or use: 1. This plan action is subject to designer comments on the plan. 2. The maintenance plan for this system must be given to the owner of the POWTS. 3. The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. 4. Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual 5. The management plan / users manual must contain the telephone numbers of persons to contact in case c any component failure. GC 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. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address LIntegrated DATE RECEIVED 10/20/2000 FEE REQUIRED $ 60.00 FEE RECEIVED $ 60.00 ORF , POWT N REVIEWER BALANCE DUE $ 0.00 (715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM PSHANDORF @COMMERCE.STATE.WI.US WiSMART code: 7633 cc: JEFF & SUSAN NELSON Jeff & Susan Nelson - Mound Revision to Transaction # 409911 Location: NE 1/4, NW 1/4, Sec. 24, T 29 N, R 15 W Town: Springfield County: St. Croix Date: October 20, 2000 Owner: Jeff & Susan Nelson Address: 504 Main St. ' Knapp, Wl 54749 far Plumber: Roger Timm Signature: EDG License # MP 4226524 226524 Attachments: 6748 -Plan Review Application see previous application page 1: cover 2: design criteria & calculations 3: plot plan 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail 7: pump curve 8: system management page 1 of 8 Design Criteria Residential Wastewater Contaminant Load: 30 mg /L < BOD < 220 mg/L Anticipated septic tank effluent 30 mg /L < TSS < 150mg /L Fecal Coliform > 10,000 cfu/100 mL Treated Residential Wastewater Contaminant Load: 30 mg/L < BOD Septic tank + "highly treated" effluent 30 mg /L < TSS Fecal Coliform < 10,000 cfu/100 mL Bedrooms x 100 gal/bedroom/day x 1.5 to u,:� gallons /day hydraulic load Construction Materials and Techniques All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. Construction methods must comply with the most current, pertinent Component Manual(s). t` O%A au SBD- t D % - 4 s. k' SBD \ �s - +S — t° Design Calculations In situ designed loading rate 3 4� gallons /sq. ft. per day Depth to estimated high ground water in. Depth to bedrock 4 in. Cross slope at system z �� 0 Force main length ft. of 3 in. Lo Manifold/header length of 3 in. Drain -back ' gallons Lateral length 4' @ 5 8 Ile ft. of 12 in. Lateral elevation t ` ' L 5 ft. @ bottom of lateral Lateral hole size / in. @ 2 is • g in. 2 4 ft.) Spacing 2 � holes /lateral t holes total Lateral volume Z , b 4- gallons Total lateral discharge rate �_ gallons /minute @ IS ft. head Elevation difference k ft. Friction loss 3 • s Z ft. @ ° gallons /minute Total dynamic head t-T ft. Pump /si*n gpm @ 2 Z ft. of head Manufacturer C'' "''�� 3 Model # V 3 Dose volume g gallons Lift/sifton tank `^' ���`s "-' gallons Septic tank kr� gallons Effluent filter c-o Measurement pump on and off in. Height alarm from tank bottom 1 o'b in. Reserve capacity 4 ' 4 �� 5 � ` gallons �y specs.calcs Page Z Of o i PL P LAN Page 3 of =3 3 S TTt ST. \O S' C 8 � 1 Q. 0 • W . L t1u E i I 1 I 1 - Es-. 100. Q ' ON SP11z -E Z � ROUE ClUuK p Ins PP � i I i 1 %I �I %I 1' ,3L 3 8•Z 6"l Sw( LC; .1 I 4L (L ' 1 . L L4 c t u � 1 �•o � 1.6t,b � x-_71 1 1 � e.v _[ a U V Z r' 2 4 _4 12,p.O` 46A O� '.` 4 l� \ u C. ` � . O 1 R.r v . o ... �.... t o `.. }a 1 t • �. ( l�.i 11 3 N QV C Se� }•�a<w '`�L" �UC Sch 4� ET I 2. I I z 4 ` 1 1,2 ` z.4' f • 3 11 b \ csi ,.'t °%. o o ; .. a S Z • $ Q � y _ U ) r VCUT CAP PIPE WEATHER PROOF APPROVED LOCK k;(, � z RO B DOOR, JUIJCTIOAJ BOX MAIJHOCE COVEF. ;')'CC'w 0R F RESH AIR IIJ' GRADE COQC)UiT 7�1 -- I PROVIDE AIRTIGHT SEAL APPROVED TS W /C.I. PIPE V I II ALARM EXrE1JDIUG 3' (f L!"o � � � ��� I � I oNro soup sol>_ I I o ►J PUM OFF N BLOCK c 6 Loy [QGOULDS PUMPS Submersible Sewage Pump "1 I I 3336 NEWLY IMPROVEb PERFORMANCE Af10 7' SOLIDS HANDLING See order number chart for new order number. Prosurance available for residerftiat appikdona. APPLICATIONS against component damage starting torque. ■ Power Cable: Severe duty Specifically designed for the on accidental reverse rotation. • Built-in overload with rated, oil and ureter resistant. following uses: ■ Fasteners: 300 series automatic reset. Epoxy seal on motor end • Homes stainless steel. • `!7 and 'h HP —16/3 SJTOW provides secondary+ nloiMre • Sewage systems ■ Capable of running dry with 115V or 230V three barrier In case of outer jacket • Oewaterina/Efflueni without damage to prong plug. damage and to prevent oil • Water transfer Components, • % and 1 HP —1413 STOW wicking. 20 foot standard ■ Designed for continuous with bare leads. with optional lenths g SPECiFICAT_IONS operation, when fully Three phase (60 Hz): ��e• submerged. • Overload protection must be ■ Motor Cover 0-rn� Pump: provided in starter unit. Assures positive seeing • Solids handling capabilities: •'r4••1 HP -14/4 STOW with against contaminants 2' maximum. MOTORS bare leads. and oil leakage. • Discharge sizA: 2' NPT. rr Fully submerged in high m Bearings: Upper and lower ■ Consult factory for informa- • Capacities: up to 185 GPM. grade turbine all for lubrica- heavy duty ball bearing tion on CSA listed models. • Total heads: up to 36 feet tion and efficient heat construction. TRH, transfer. All ratings are within w Designed for Continuous AMICY LfSitilBS • Temperature: the working limits of tie Operation: Pump ratings are 104 (40•C) continpous motor, within the motor ( q 0 " 1 40 °F (60 °C) intermittent. ■ Class B insulation. manufacturers recommended • See order numbers on Singte phase (6D Hz): working limits, can be Q Ri dgwftm reverse side for specific HP, . All single phase models operated continuously voltage, phase and RPM'S feature capacitor start without damage. + available. motors for maximum FEATURES ""`T` R °" MODEL 3886 l ■ impeller. Cast iron, same. open, dynamically balanced, 2' SOURS non -clog with pump out 20 —�, - RPM 1725 eo vanes for mechanical seal protection, Optional S111con i•wQ *a .. ; ,., L, ............... .. -- bronze impeller available. 5 ■ Casing: Cast iron volute wso�e l type for maximum ettidency. I ... i _ .. .. , wsese Designed for easy installation 5 !_ zo on A10 -20 slide call. 1° a Meohanioal Seal. SIUCON .. i .. .............._......... ; ... ....... ,... _...;._. :......_ ....... _..... wawa f } CARBIDE Vii. SILICON ' CARBIDE searing faces for or resistance, � � 1 superior abrasive reslsia � �... ........L ............. , . i ;, .l ...... ....,. _.. .. .... stainless steel metal parts, c ' ° _ o..... »,,,..a,..,... ID BUNA -N elastomer5. p .0 50 5o too +zo ,.n ,tl ■ Shalt: Corrosion- resistant L ' ' 0 5 10 15 70 U 30 3d 40 " M" stainless steel. ThrWed CAMM design. Locknut on three S Goulds Pumps phase models to guard you PUM a S ITT Industries W lNetttve January, +99e 93eae System Management Management of this system is critical. As a condition of approval of these plans this system management must be reviewed with the homeowner, and the homeowner must be provided with a complete set of plans including this management section. General Proper functioning of an on -site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. l.. If the septic tank is installed prior to sheet -rock and /or painting, pump the septic tank before normal residential use begins to ensure adherence to contaminant load design criteria. 2 Install water- saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. _ 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly. 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. .Avoid surge flows of water; try to spread laundry throughout the week. Maintenance 1. The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the Filter must be back - washed into the septic tank to remove accumulated material. 4. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in- situ soil adsorption cell. Quarterly inspections are recommended, and a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. 5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Wastewater monitoring of volume and quality is not a normal requirement for residential systems such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and /or installation of additional treatment components or conversion to a holding tank may be necessary. Page of � Safety and Buildings 10541N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264 -8777 isconsr►n www.commerce.state.wi.us /SB Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary November 21, 2000 CUST ID No.226524 AM. POWTS INSPECTOR ... OFFICE ROGER L TIMM A 9 �ROIX COUNTY SPIA 3128 20TH AVE I iO1 - §:ARMICHAEL RD WILSON WI 54027 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/21/2002;, Identification Numbers T` x nsaction ID No. 446296 Si ID No. 196171 SITE: V , lease refer to both identification numbers, Site ID: 196171, JEFF & SUSAN NELSON ti bove, in all correspondence with the agency, ST CROIX County, Town of SPRINGFIELD; 90TH AVE NE1 /4, NW1 /4, S24, T29N, R15W FOR: NEW MOUND, 600 GPD Object Type: POWT System Regulated Object ID No.: 752967 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. The following conditions shall be met during construction or installation and prior to occupancy or use: 1. This plan action is subject to designer comments on the plan. 2. The maintenance plan for this system must be given to the owner of the POWTS. 3. The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. 4. Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. 5. The management plan / users manual must contain the telephone numbers of persons to contact in case of any component failure. 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. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 10/20/2000 FEE REQUIRED $ 60.00 FEE RECEIVED $ 60.00 { "PATRICIAHANDO R ~ OWTS PLAN REVIEWER BALANCE DUE $ 0.00 Integrated Services (715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM PSHANDORF @COMMERCE.STATE.WI.US WiSMART code: 76333 cc: JEFF & SUSAN NELSON I Safety and Buildings 10541N RANCH ROAD HAYWARD WI 54843 - TDD #: (608) 2648777 I sconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary August 01, 2000 CUST ID No.226524.; � ATTIC• POWTS INSPECTOR ~ `� • r ZONING OFFICE ROGER L TIMM ~— Ci A ��Gw _ �� ST CROIX COUNTY SPIA 3128 20TH AVE � r -� n o 1101 CARMICHAEL RD WILSON WI 54027 D ��`'� HUDSON WI 54016 RE: CONDITIONAL AP �1�� PLAN APPROVAL EXPIRES: �w Identification Numbers Transaction ID No. 409911 Site ID No. 196171 SITE: Please refer to both identification numbers, Site ID: 196171, JEFF & SUSAN NELSON above, in all correspondence with the agen ST CROIX County, Town of SPRINGFIELD; 90TH AVE NEIA, NW1 /4, S24, T29N, R15W FOR: MOUND, 450 GPD Object Type: POWT System Regulated Object ID No.: 752967 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. The following conditions shall be met during construction or installation and prior to occupancy or use: 1. This plan action is subject to designer comments on the plan. 2. The maintenance plan for this system must be given to the owner of the POWTS. 3. The maintenance plan for this system must be amended to include the names and phone number of the local health authority, component manufacturer and emergency contact in the event of failure. 4. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the septic tank outlet filter will be required. 5. The orientation of the mound system must be such that the mound's longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. 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. Inquiries concerning this n:esponden a may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 07/12/2000 FEE REQUIRED $ 175.00 FEE RECEIVED $ 180.00 P CIA L S RF , POW T LAN REVIEWER REFUND AMT $ 5.00 Integrated Services (715) 634 -7810, FAX: (715) 634-5150, M -F 7 :45 AM - 4:30 PM Refunds of $25 or less will be PSHANDORF @COMMERCE.STATE.WI.US made only on written request. WiSMART code: 7633 cc: JEFF & SUSAN NELSON i 90 L Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21. Wis. Adm. Code 201 W. Washington Ave. PO Box 7302 iseonsin See reverse side for instructions for completing this application Personal information you provide may be used fo r secondan• purposes Madison. WI 53707- 730.^ Department of Commerce ` (Privacy Law, (Submit completed form to county if r s. :f14(l)(m)� �, state ownee Attach complete plans (to the county copy only r the system. on "a ' n ess than 8 -1/2 x 1 I inches in size. County Sta t i umber Q �Ireck if rev' to revi'4 application Stale P I er I. Application Information - Please Print all Informatio Location: Property Owner Name c� ' t s , t r P 11 i .; Property Location / J& (.� fir`- —�� T CKO tV�; Il4 NjJ /4. S.Z ,N. T Z Rj]R or Property Owner's Mailing Address Lot Number Block Number z4 �� �ti (� � Z �1�tsG , ��F�c� � 1 �X 4 City, State Zip Code �(\'ittbar ;, <� Subdivision Name or CSM Number II Type of Building: (ofieck one) ❑ City *, 1 or 2 Family Dwelling — No. of Bedrooms: .3 Ci ❑ Village ❑ Public /Commercial (describe use): KTown of r ❑ State -owned i III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest R d 91.0 ><I A) I. 0 New System 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s) System Tank Only Existing System 403 U 3 — 60 B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) ❑ Non - pressurized In- ground AMound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V Dis ersaVTreatment Area Information: 7 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation 5' �3 /�3 ZQ g9�75 I'd /,7$ VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks ❑ ❑ ❑ ❑ VII Responsibility Statement I, the undersigned, assume responsibility fer installation of the POWTS shown on the attached plans. Plumber's Name (print) Plumber's Signature (no tamps): MP /MPRS No . Business Phone Number �� „ �►, -a. Z Y 77 2 - 3 t I Plunfbees Address (Street, City, State, Zip Code) 1 c) , / VIII County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuin Agent Signature (No stamps) >pproved ❑ Owner Given Initial Adverse Surcharge Fee) oc ,� �� Determination ) U IX. Conditions of Approval /Reasons for Disapproval: �1 ���"`r Ge �� /ten, MAA+ilto y / �Jly ©_K — A6tie— .�Ji ,� SBD -6398 (R. 07/00) Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264 -8777 Visconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary August 01, 2000 CUST ID No.226524 ATIN.• POWTS INSPECTOR ZONING OFFICE ROGER L TIMM ST CROIX COUNTY SPIA 3128 20TH AVE 1101 CARMICHAEL RD WILSON WI 54027 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/01/2002 Identification Numbers TraAction ID No. 409911 S, ID No. 196171 SITE: lease refer to both identificatio umbers, Site : 196171, JEFF & SUSAN NELSON above, in all correspondence withV agency. ST C County, Town of SPRINGFIELD; 90TH AVE NEIA, 1/4, S24, T29N, R15W FOR: MOU 50 GPD Object Type: WT System Regulated Object ID No 52967 • The submittal describe ove has been reviewed for c ormance i isconsin Adm' a Cod and Wisconsin Statutes. submittal has been CO TIONA Y O D. The ed in • dti� chapter 101.01(10), Wiscons tatutes, is responsi for comp ce wi code requir colt The following conditions shall be t during c traction or install io d rior too u y or use: NY ? 1. This plan action is subject to igner ments on the pla PpP(iMt 2. The maintenance plan for this s e ust be given to the owner o --1 3. The maintenance plan for this sys must be amended to include th me nd phon umber of the local health authority, componen ufacturer and emergency conta a event failure. 4. Maintenance information must giv to the owner of the tank explain that odic cleaning of the $EE CAw septic tank outlet filter will be quired. 5. The orientation of the moun ystem must such that the mound's longest dimension is oriented al g the surface contour per C M 83.44(6)(a) . A copy of the approved plans pecifications and this lett all be on -site during construction and open to inspection by authorized re sentatives of the Department, 'ch may include local inspectors. All permits required by the state or th ocal municipality shall be obtaine 'or to commencement of construction/installation/ ration. Inquiries concerning is correspondence may be made to me at the tele ne number listed below, or at the address on this letterhead. t Sin cerely , D RECEIVED 07/12/2000 FEE REQUIRED $ 175.00 tom ` s i � FEE RECEIVED $ 180.00 A RICIA LS DORF , POV S, LAN REVIEWER REFUND AMT $ 5.00 Integrated Services (715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM Refunds of $25 or less will be PSHANDORF @COMMERCE.STATE.WI.US made only on written request. WiSMART code: 7633' cc: JEFF & SUSAN NELSON a� F tv Jeff & Susan Nelson - Mound Transaction # Location: NE 1/4, NW 1/4, Sec. 24, T 29 N, R 15 W Town: Springfield County: St. Croix Date: July 10, 2000 Owner: Jeff & Susan Nelson Address: 504 Main St. Knapp, WI 54749 Plumber: Roger Timm �n E Signature: �p Of License # MP IS 226524 Attachments: 6748 -Plan Review Application SBD 8330 C/C) 1 4 page 1: cover 2: design criteria & calculations 3: plot plan 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail 7: pump curve 8: system management page 1 of 8 I� Design Criteria �L Residential Wastewater Contaminant Load: 30 mg/L < BOD < 220 mg/L Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L Fecal Coliform > 10,000 cfu/100 mL µ p ' Treated Residential Wastewater Contaminant Load: 30 mg/L < BOD Septic tank + "highly treated" effluent 30 mg /L < TSS Fecal Coliform < 10,000 cfu/100 mL 3 Bedrooms x 100 gal/bedroom/day x 1.5 �_Sb gallons /day hydraulic load Construction Materials and Techniques All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. Construction methods must comply with the most current, pertinent Component Manual(s). H SBD- 1 r 4 - 'R �rt�-Zs�n� 1�•r, SBD Design Calculations In situ designed loading rate gallons /sq. ft. per day Depth to estimated high ground water ' Zg' in. Depth to bedrock > 3 in. Cross slope at system z 1 � % Force main length `, ft. of 3 in. Manifold /header length �A(A ft. of in. Drain -back 1 90,6 gall Lateral length :21 S 6. ZS' . of Z• in. Lateral elevation t t> ft. @ bottom of lateral Lateral hole size 3 �r in. @ in. ( t 'C ft.) Spacing % TZ holes /lateral b holes total Lateral volume gallons Total lateral discharge rate gallons /minute @ ft. head Elevation difference �t•� Friction loss 1 ��} ft. gallons /minute Total dynamic head to• 7 - ft. Pump /sip'j on 6 O gpm q ft, of head Manufacturer "� S 3't $ Model # Dose volume 3 gallons Lift/si�k4on tank gallons Septic tank gallons Effluent filter Measurement pump on and off S� in. Height alarm from tank bottom V• in. Reserve capacity A• gallons specs.calcs Page Z of Pa °f PLOT P LAN 3 3 EL- \00 , o � Or.► SPIyzr z.' (Ssu "b IAJ PP T II ' f � ff� i 1' 2 � ,( , • s'' b N L, v s.. �� 0 •K 4 J! rNi 3 � �Ol 0. ��Mt L t ��� �Ji.\ O.,•�+ � 111 , Ct� �oo / ( \ � , '� r •ice Q./�l V . Z. s� t� �G TOQL1� Z ' t,�•Sl b s �.�t o ;1 1 0 z�,4t I y ll4 l34• -2` O�L Q V cT Ova 'Z ? I , c s 4v Ar I WX • /jb �o1st o.. �.tQ1.aX cc�y bO ►` or. \:»a- � � J T d� a �.pop }o tee VEUT CAP 1 1 "C. I. VENT PIPE WEATHER PROOF APPROVED LOCKIAJG 25' FROM DOOR, JUIJCTIOM BOX MAIJHOLE COVER. N " c- WINDOW OR FRESH `Z AIR INTAKE { GRADE I q q I 4„ COWDUIT -- z t( PROVIDE { AIRTIGHT SEAL �B'Se(Lyy' Zl.& I II /APPROVED JOIAITS �-Y X+ , .y� I I EXTEAIDPIWG 3' ALARM ONTO SOLID SOIL i I ow �I I OFF �~ _e,w BLOCK - 41.1; " ' TES N { - 6 � 8 I 4 [qGOULDS PUMPS Submersible Sewage Pump 3886 NEWLY 11APROYED PEAPOi1MAnCE AND 7' SOM NANDLW See order number chart for new order number. Prosurance available for residertlial applications. APPUCATIONS against component damage starting torque. ■ Power Cable: Severe duty Specifically designed for the on accidental reverse rotation, • Built -in overload with rated, oil and water resistant, following uses: ■ fasteners: 300 series automatic reset. Epoxy seal on motor end • Homes stainless steel, • `h and 1 h HP -16/3 SJTOW provides seow ary moisture • Sewage systems ■ Capable of running dry with 115V or 230V three barrier in case of outer jacket • Dewatering/Effluent without damage to prong plug. damage and to preverrt oil • Watertransfer components, • V4 and 1 HP —1413 STOW widdrig. 20 foot standard ■Designed for continuous with bare leads. with optional lengths SPECIFICATIONS operation, when fully Three phase (60 Hz): available. submerged. • Overload protection must be ■ Motor Cover 0-ring; Pump: provided in starter unit. Assures Posltive seali • Solids handing capabilities: • T/H HP —14/4 STOW with against contaminants 2' maximum. MOTORS bare leads. and oil leakage, • Discharge size: 2' NPT. er Fully submerged in high ■ Bearings: Upper and lower ■ Consult factory for informs- • Capacities: up to 185 GPM. grade turbine all for lubdea- heavy duty ball bearing lion on CSA listed models. • Total heads: up to 38 feet tion and efficient heat construction. TOH, transfer. AiI ratings are within A Designed for Continuous ARM 1.111ST1111110 • Temperature: the working limits of tie Operation: Pump ratings are 104 -F (40°C) continpous motor, within the motor ftO N"'�' 140 °F (60 °C) intermittent. s Class B insulation, manufacturers recommended • See order numbers on Singte phase (60 Hz): working limits, can be ! Rb M=8 reverse side for specific HP, . All single phase models operated continuously voltage, phase and RPM's feature capacitor start without damage. *ftq*is so em R• available. motors for maximum - FEATURES MODEL 380 10M R { ■ Impeller. Cast iron semi- open, dynamicaly balanced, ! ( -1 - � 2' SOLIDS RPM 1725 non -clog with pump out 20 - vanes for mechanical seal .... ioa�r s — + -- protection. Optional Slhcon ; bronze impeller available. i ■ Casing: Cast Iron volute ,a 1 NS 07 p i i type for maximum effldency. I _.. .. .. r . ..... ..Y.. Designed for easy installation 15 1 D 20 on A10 -20 side rail. ! ; ■ Mechanical Seal: SIUCON CARBIDE VS. SIUCON CARBIDE searing faces for stainless steel meta! rte � � �.._ ......... ................... � � .... _.. .. .. .. superior abrasive resistance l . ............................... ` 1 BUNA -N elastomers. o ao .o so so Too Tav ,.o 110 IND MGM ■ Sham Corrosion- resistant o s Ta Ts w I 30 L .0 w wva stainless steel. Threaded CAPACM design. Locknut on three .9 S Goulds Pumps phase modals t0 guard o r M G&j[M Purnp6 u X U ITT Industries IMaarve January, 'M 93e88 System Management Management of this system is critical. As a condition of approval of these plans this system management must be reviewed with the homeowner, and the homeowner must be provided with a complete set of plans including this management section. General Proper functioning of an on -site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Ty pical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. 1.. If the septic tank is installed prior to sheet -rock and /or painting, pump the septic tank before normal residential use begins to ensure adherence to contaminant load design criteria. Install water - saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly. 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. Maintenance I . The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back - washed into the septic tank to remove accumulated material. 4. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in- situ soil adsorption cell. Quarterly inspections are recommended, and a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. 5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Wastewater monitoring of volume and quality is not a normal requirement for residential systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and /or installation of additional treatment components or conversion to a holding tank may be necessary. Page 9 of � Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page N of 3 Labpr and Hunan Rotations D Safety & Buildngs in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 es in size. Plan must include, but S�' ��1L>< not limited to vertical and horizontal reference it n % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and e d 0 3y - bZ S '.s - 0 ► 0 APPLICANT INFORMATION -PLEAS , P f1OF0 MA REVrgWED BY D ATE � (� PROPERTY OWNER: OPERTY LOCATION �( i ,.. St t�l��1EIJ F', t? MIEr 1/4 law 1/4,S ZIT ZOL ,N,R 1S E (01' W PROPERTY OWNERS MAILING ADDRESS � ST CROIX % .� T # BLOCK # SUBD. NAME OR CSM # � SS�O �'1tL`Rj1V " - 1 - - �'n.NPos� CS1^'t CITY, STATE ZIP CO Er' `�. PHMIPNt1 ix i'� CITY (]VILLAGE ®TOWN NEAREST ROAD LPN w► 541 "= Y_ � St�ctt►� GFt�L,1� q O RI RV� Q4 New Construction ' Use 4xJ Residential / Nu Addition to existing building j } Replacement [ J Public or commercial describe Code derived daily flow XAM gpd Recommended design loading rate bed, gpd/ft 0-'3 trench, gpd/ft Absorption area required ; '15 bed, ft 3 - 1S trench, ft M"mum design loading rate • 5 bed, gpd/ft - �Q trench, gpd/ft Recommended infiltration surface elevation(s) q.a -lS ft (as referred to site plan benchmark) Additional design / site considerations h') pvrvD w/ S `x 1 S ` 17Z�uC r�� ry l N9U 1t t kZ 0� St - h jz FI L.\. Parent material L ts E3S 0\1N2 Gtrfre"�PR- T7 \-\ Flood plain elevation, if applicable ►y q It S = Suitable for system CONVENTIONAL I MOUND IN4110UND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= unsuitable fors stem ❑ S IBS[ U ®S O U [IS ®U ❑ S o U 0S IOU [IS U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Twich 3 Z $_2S �O"1tz -3Lb - s 1 � Zm Sbk vvl�� C. L" Ground 3 zs -3 u S -tom 3 I � e elev. 9 It mow, Vvl�i - tvp .Z Depth to limiting factor Z J Remarks: Boring # 1 S O - e �l�` -t�z _ 3 Z - S L� ZvnS�1t `fv1`{ CS Z 31 b — s t ( Z �v► b yn � 1$_30 �.S `11Z 91y - S� � O.s� 1'►'1`FI- �w - ,�[ .S Ground elev. 4 30 v) 5 `'iR 3L - S) g s et 0,, wt t' - !`JP ' .Z 9 9. 0 n Depth to limiting facto Remarks: CST Name: Please Print Phone. Arthur L. W e e r e r 715-425-0165 egerer Soil Testing & Design Service -P.O. Box 74 River Falls,WI 54022 Signature: Date: CST Number: 220254 I PROPERTY OWNER k - � — V EN SOIL DESCRIPTION REPORT Page �? � Of PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu, Sz. Cont Color Gr. Sz, Sh. Bed Trench 3 0 =$ vz`-t1Z 3 lZ. — 1 Z S b w> F� C S — •S •� Z g - L�`-tR. �1 - si 1 Z vn 5�1� >n �►- cS Ground 3 Z� 3S S S�c S/$ • 3 , y elev. 99-Z ft. Depth to limiting fact ,� f i Remarks: Boring # i Ground elev. ft. i Depth to limiting € factor _ i Remarks: Boring # 13 _ Ground elev. ft. i _ Depth to 7 limiting factor { Remarks: Boring # 13 i Ground i elev. ft. Depth to limiting factor Remarks: nnr1.nvini 1 ArnnN r w PLOT P LAN Page 3 of 3 ° J vl 1 1v 9 0 �4 RUE �- SOS' $ 1 V- o . W . L i,v E !�" yf - fit .100.0 ` On.► Sp11z -E Z"."OQE- 6v4uvu UV PP / . v wa. vxr ►ce POST, ' I �l ?1 � � r S ON i 1» ►v oT csar -t pfltT i �y , ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �� '4524 Mailing Address 5' /ka-4- , S;- ZrJ� Property Address 3z f,0 / (Verification required from Planning Department for new co truction) y-C City /State Parcel Identification Number 1.0 <C'o LEGAL DESCRIPTION Properly Location _ ' /o, t7/A '/., Sec. T ZLN -R W, Town of Subdivision Lot # . Certified Survey Map # , Volume , Page # Warranty Deed # �o Z 1 y , Volume 1!50/ , Page # Spec house ❑ yes Jai no Lot lines identifiable K yes ❑ no SYSTEM MAINTENANCE 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeyman plumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge. I/we the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. / / 0 SS E OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. f OF APPLICANT DATE Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. l ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed k 1501 591 621045 DOCUMENT NO. STATE BAR OF WISCONSIN FORM 16 - 1982 KATHLEEN H. WALSH REGISTER OF DEEDS TRUSTEE'S DEED ST. CROIX CO ., WI RECEIVED FOR RECORD Jean M. Kleven 04 -12 -2000 9:30 0M as Trustee of TRUSTEES DEED EXEMPT N Jean Kleven Trust, Dated January 24, 1996 COPY FEE TRNWER FEE: 195.00 RECORDING FEE: 10.00 for a valuable consideration conveys without warranty to PAGES: I Jeffrey M. Nelson and Susan D. Nelson, husband and wife as survivorship marital property Grantee, R FUp _ ,�/- w f�� the following described real estate in ST. CROIX �50H � n � / l a ^ r_�. w - f County, Slate of Wisconsin: �t ` � ' ���`( 1 � 1 kT— J� N 11�N Tau Parcel No: 034- 1053 -60 ay•vot The Northeast Quarter of the Northwest Quarter of Section 24, Township 29 North, Range 15 West, Town of Springfield, St. Croix County, Wisconsin. 4 C a&Aa-& - w v\ 0 1 V\A y � o r 7 71 Dated this day of 44areli r 2000. 1 n✓ (SEAL) (SEAL) • can M. Kleven Trustee AUTHENTICATION ACKNOWLEDGMENT Signatures) STATE OF WISCONSIN • ) authenticated this day of Personally came of me this day of _i 200 th ab anamed Jean M. Kle TITLE: MEMBER STATE BAR OF WISCONSIN (II not, executed the �. authorized by Subsea. 706.06, Wis. Slats.) to me known to be the pare foregoing instrument and ackno same. THIS INSTRUMENT WAS DRAFTED BY Michael J Vinopal l Attorney at Law Notary Public County.Wis. (Signatures may be authenticated or acknowledged, Both My Commissio ' armament, not, state expiration date): are not necessary.) Namssl personaagnhtg in any capeoly should be typed or priniod blow Inelr signatures. n m 0 3 - 0 n 9 c . chi m m O ° v m � A `c • S d < 0 A y 7. N ICI rl \ v N 7 f(D N O L O tp r"7 N fD Cp W V CD -� L (D N W O N N a 7 O' g6 PL C4 (� 0 0 C CD G W W Q Ai O A 3 C CO !r Z D so o. S j m D(n a co < N 0 °°�° C CD �� O ((�� A CL rn G) lei O O O N w C lV 8 3 CL OZ 00 o° ° dq A 3 totoN N Q v O n tai O O :: w ° N ! U7 O O N 'C� � (/r (D N .. W CL N 3 !D Z N z c D D o O N p N N 0 7 N N S y. ? �• - N O O1 7 p Cp •O 7 O O In 0— a N a< c W � SfD C Cp O v � O a Q ni Cp CD � �� a CD U) a N 0 A w O f 7 c p Z N cn Q. S M 7 O A O O = N 7 9 p < �p O CD W M N ? N fD 0 ID !C — Z ;a R � C CD y Z <� < A CD {a O 0 6 S Q o 'O N Cp a y N C 7 OZ D. N y. 0 CD CD C N O �• fi FkL,o O A C p 0 C O 0. w C Cn � � A • b !, < �o o O ° c ° o i ti LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF SPRINGFIELD COMPUTER NUMBER 034 - 1053 -60 -000 Parcel Number 24.29.15.373 OWNER NAME: First JEFFREY M & SUSAN D Last NELSON PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment SECTION 24 TOWN 29N RANGE 15W 1 /4160 '/440 Line Description Line Description PARCE L VOLUME & PAGE HISTORY TYPE VOLUME PAGE DOC# NOTES . ►.EZ 1728/ 397 657830 ST CROIX ELECTRIC CO -OP ROW EASEMENT TD 1501/ 591 621045 JEAN KLEVEN TRUST TO NELSON JEFFREY & SUSAN QC 1399/178 596722 WD 1292/544 572248 QC 1213/568 0 SD 1175/ 99 0 Use Arrow Keys to Select, F7 -ROD, F10 -Exit Wisconsin Department of Commerce ND SITE EVALUATION Page 1 of 3 Dip ion of Safety and Buildings Comm 83.05, Wis. Adm. Code Preliminary: Soils Only _. Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal refer point (BM), direction and $t. Croix !9kr— percent slope, scale or dimensions, north arr d,location'and distance to nearest road. �: Parcel I.D.# APPLICANT INFORMATION - �A pri t all information 034 - 10530 Personal information you provide may be for (Privacy , S. 15.04 (1) (m)). Rev Date y. L v ( - Property Owner Property Location 7 - 7 d y S mit h , G erald & Gordon °R r? Govt. Lot NE 14 NW 1/4 S 24 T 29 N, 15 W th G Property Owner's Mailing Address t - - Lot # Block # Subd. N�nej or� N_�`'""" cR' six ,, C,d �a PO Box 78 r ? City State ..- ,Coc*-0NlR1%t k6er,a ❑ City ❑ Village ®Town Nearest Road Downing WI 715 -64 Springfield 90Th Ave. ® New Construction Use: ® otkal IJ of bedrooms 3 ❑Addition to existing building Replacement F� Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate 0 bed, gpd/ft= _ 0 trench, gpdfftt Absorption area required bed, ft° trench, fts Maximum design loading rate 0 bed, gpd/ft' 0 trench, gpd/W Recommended infiltration surface elevation(s) NA an benchmark) Additional design /site considerationsc codes doe not allow any syste A +4" mound possible w/ code char e Parent material glacial till Flood plain elevation, if applicable NA ft S= Suitable for system Conventional Mound In - Ground Pressure AT Grade System in Fill Holding Tank U= Unsuitable for system ❑ S ® u ❑ S ®u ❑ S ®u I ❑ S ® U ❑ S ® U ❑ S [j U ESCRIPTION REPORT Depth Dominant Color Mottles Structure GPVF I Y Z goring# Horizon in Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Boundary Roots Trench 0 -6 10YR 3/2 - sil 2 cr � mvfr cs l f/m - f° .6 2 6 -11 IOYR 4/4 - sil 1 m sbk mvfr Cs 1m 2 3 Grour _ 3 11 - lOYR 4/4 OYR 6/2 sil 1 m sbk mvfr lm .2 .3 elev NA ft Depth to limiting factor 11" Remarks: lacks 24" for new construction; A +4" mound possible here w/ code change 2.__. 1 0 -8 10YR 3/2 - sil 2 r mvfr es If/m .5 .6 f� 2 8 -18 l OYR 4/4 - sil 1 m sbk mvfr cs 1 m .2 .3 3 18 -36 IOYR 4/4 �I 5 5/8 m round sil 1 sbk mvfr - lm .2 .3 G >: elev NA ft Depth to limiting factor 18" . ........... Remarks: lacks 24" for new construction CST Name (Please Print) Signature: Telephone No. Henry F. Grote 715 -665 -2681 Address P.O. Box 57, Knapp, WI 54749 Date CST Number Ref # 1/17/98 222774 226 PROPERTY OWNER: Smith Gerald & Gordon SOIL DESCRIPTION REPORT ne Page 2 ,qf 3 PARCEL I.D.# 034 - 1053 -60 Horizon Depth Dominant Color Mottles nsistence Boundary Roots Structure MIT in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Bed :Trench 3..,.„ 1 0 -8 10 3/ 2 - sil 2 m cr mvfr cs 1f/m .5 .6 2 8 -22 10YR 4/4 - sil 1 m sbk mvfr cs lm .2 .3 Ground m2p 7.5YR 5/8 elev 3 22 -38 10YR 4/4 10YR 6/2 sil 1 m sbk mvfr - lm .2 .3 NAft Depth to limiting factor 22" Remarks: lacks 24" for new construction 4... 1 0 -7 10YR 3/2 - sil 2 m cr mvfr cs lf/m 5 6 2 .7 -T8 10YR 4/4 - sil 1 m sbk mvfr cs IM 2 3 Ground m2p 7.5YR 5/8 elev 3 18 -40 I OYR 4/4 10YR 6/2 sil I m sbk mvfr - I m .2 .3 NA ft Depth to limiting factor 18" Remarks: lacks 24" for new construction <...5... 1 0-6 10YR 3/2 - sil 2 m cr mvfr cs If/m .5 .6 2 6 -18 10YR 4/4 - sil 1 m sbk mvfr cs lm .2 .3 Ground m2p 7.5YR 5/8 elev 3 18 -40 10YR 4/4 10YR 6/2 sil 1 m sbk mvfr - lm .2 .3 NA ft Depth to limiting factor 1a" Remarks: lacks 24" for new construction I ................. Ground elev Depth to limiting factor Remarks: L9 �«�Gr� 4— �- o�b1.o•� �•.,.:�- � �o� �'� w.., Obi- t��� -1.d IV � • rt w 24 �///J��� V S yyy: r��t(� �fT o U �-T 4iw 4 .rt Obi' Q 4 - 1 �.� a,o ' Wisconsin CrBpartment of Commerce I TE EVALUATION Page 1 of 3 Division of Safety and Buildings c m 83.05, Wis. Adm. Code Preliminary: Soils Only Attach complete site plan on paper not less tha 1 size. Ian must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D.# APPLICANT INFORMATION - t all information 034 - 1053 -60 Personal information you provide may be arka Pur (Privacy Law, s. 15.04 (1) (m)). Revle By Date 8 Z9 - Property Owner f ,� Property Location Smith Gerald & Gord r�_s,ff . `� Govt. Lot NE 14 NW 1/4 S 24 T 29 N,R 15 W Property Owner's Mailing AddMq f Lot # Block # Subd. Name or CSM# PO Box 78 ` "! - City .Stpte ip Code: "ohe umber f E] City ❑ Village ®Town Nearest Road Downing WI �' 54� +3r 5-643' -59i I Springfield 90Th Ave. Z New Construction U .' sl ential / Nl m a of bedrooms 3 Addition to existing building Replacement �' a al describe Code Derived daily flow 450 d Recommended design loading rate 0 bed, gpdfif 0 trench, gpd/ft' Absorption area required bed, ft trench, f? Maximum design loading rate 0 bed, gpolftz 0 trench, gpd/ft= Recommended infiltration surface elevation(s) NA ft (as referred to site plan benchmark) Additional design / site considerationsc codes doe not allow any system; A +4" mound possible w/ code change Parent material glacial till Flood plai n elevation, if applicable NA It S= Suitable for system Conventional Mound In -Ground Pressure AT-Grada System in Fill Holding Tank U= Unsuitable for system I EIS 0 U ❑ S® U ❑ S ®U El S ®U El S ®U F S® U SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color Mottles Structure GPDtft? in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 1.._.. 1 0 -6 10YR 3/2 - sit 2 m cr mvfr cs If/m .5 .6 2 6 -11 10YR 4/4 - sit 1 m sbk mvfr cs I m .2 3 Ground 3 11 - lOYR 4/4 rr'2 IOYR 6/2 /8 sit 1 m sbk mvfr - lm .2 .3 elev NA ft Depth to limiting factor 11" Remarks: lacks 24" for new construction; A +4" mound possible here w/ code change '...,.2... ' 1 0 -8 10YR 3/2 - sit 2 m cr mvfr cs If/m 5 6 2 8 - 18 10YR 4/4 - sit 1 m sbk mvfr cs lm .2 .3 Ground 3 18 - 10YR 4/4 �1OYR 6 5/8 sit I m sbk mvfr - 1 m .2 .3 elev NA It Depth to limiting factor 18" Remarks: lacks 24" for new construction CST Name (Please Print) Signature: Telephone No. Henry F. Grote 715 -665 -2681 Address P.O. Box 57, Knapp, WI 54749 Date CST Number Ref# 1/17/98 222774 226 i PROPERTY OWNER: Smith, Gerald & Gadon SOIL DESCRIPTION REPORT 22s Page 2 of 3 PARCEL LD.# 034- 1053 -60 Horizon Depth Dominant Color Mottles Texture Structure GPDM nsistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -8 10YR 3/2 - sil 2 m cr mvfr cs If /m .5 .6 2 8 -22 10YR 4/4 - sil 1 m sbk mvfr cs I 2 3 Ground m2 7.5YR 5/8 elev 3 22 - 38 10YR 4/4 10YR 6/2 sil 1 m sbk mvfr - lm 2 3 NA ft Depth to limiting factor 22" Remarks: lacks 24" for new construction >:s4 " 1 0 -7 10YR 3/2 - sil 2 m cr mvfr cs I f/m .5 .6 2 7 -I'8 10YR 4/4 sil I m sbk mvfr cs IM .2 .3 I Ground m2 elev 3 18 -40 10YR 4/4 1 7.5 YR 5 8 10YR 6/2 sil 1 m sbk mvfr - 1 m .2 .3 NA ft Depth to limiting factor � 18" Remarks: lacks 24" for new construction .................. ... ' 1 0 -6 10YR 3/2 - sil 2 m cr mvfr cs l f/m .5 .6 - 2 6 -18 1 OYR 4/4 - sil I m sbk mvfr cs IM .2 .3 Ground nQp 7.SYR 5/8 elev 3 18 -40 l OYR 4/4 10YR 6/2 sil 1 m sbk mvfr - IM .2 .3 NA ft Depth to limiting factor 18" Remarks lacks 24" for new construction ................. Ground elev Depth to limiting factor Remarks: �+ ` �} G.�•.a�G - . a►- V o��,o., ��:�C/� - � \o� 1 �wM 03�t• -ta�3-I.o 0v 4t �Nw•KW) �rl1E -MW� G 1:w t3- l _%Quo Q -Z I 4