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034-1074-70-000
,in Department of Commerce PRIVATE SEWAGE SYSTEM County. St. C roix and Building Division INSPECTION REPORT Sanitary Permit No: 430612 0 3ENERAL 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)]. 9 y31 t = TK,Rwi /p Permit Holder's Name: City Village X Township Parcel Tax No: Mousel, Larry Springfield 034 - 1074 -70 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: O - VA 33.29.15.502 TANK INFORMATION EL VATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic r Benchmark 2-5 U �5 `�V V Dosing Alt. BM A } . m 2 f h S�� (o 11 6Yg- a. (a < ��s• Aeration \ Bld . Sewer U r o nu (� h ow Holding St/Ht Inlet TANK SETBACK INFORMATION �� �1� Loo St/Ht outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic G >SQ D �� (K V � Dt Bottom J �. Z7 Dosing tvc�l = / _ Header an. ,� 94,E L 30 i Z Aeration Dist. Pipe Holding v Bot. System Z p 1� G(� z •, Z ,� s 9 / PUMP /SIPHON INFORMATION O ina Ea - o J�1 tea I? f 5 - e« _ y°"P�\ Manufacturer Demand St Cover PM Model Number y t DH Lift Friction Loss System Head TDH �g t 1-7 DqZ 2 -sue' 13 % °/Y.? �c- Forcemain Lengt I Dia. tt I Dist. to Well �t ' lD D IV z Tsa e SOIL ABSORPTION SYSTEM S - 4�, BEDITRENCH Width Length / No. Of Twgepes. PIT DIMEN o. Of Pits Inside Dia. Liquidpt DIMENSIONS ` Ids � �' SETBACK SYSTEM TO ! P/L J BLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of str ' CHAMBER OR UNIT Model Number: DISTRIBUTION SYSTEM {° e •° . "' 4 U,-z Header /Manifold Distribution i to x Hole Size x Hole Spacing Vent to Air Intake 2 Pipe(s) t r 3 Length Dia Length � Dia /Z Spacin 3 � /fib s SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Overj xx Depth of xx Seeded /Sodded T Mulched Bed/Trench Center Bed/Trench Edges Topsoil - Yes La No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /� /Q Inspection #2: / ZCXI Location: 2945 US Hwy 12 Wilson, WI 54027 (NE 1/4 NW 1/4 33 T29N R15W) NA Lot Parcel No: 33.29.15. 0 O r = s -4- 1. It BM Descrip !` �D A p / — T — � (M,�t7ti✓�. � t7 2.) Bldg sewer length = N5 - amount of cover = 3 , S 1 (nvwr e + S l b fires - 0 -Crtll lob/ \j�� � pe corl>l 2 tz Au re � u �. Plan revision Required? Yes No -- y Use other side for additional information. SBD -8710 (R.3/97) Date Insepctor's Signature Cart. No. � I EC Sanitary Permit Application Safety & Buildings Division l Visconsin In accord with Comm 83.21, Wis. Adm. Code [ion D 2 W Washington Ave. See reverse side for instructions for completing this applic C 2 3 200 3 PO Box 7302 Personal information you provide may be used for secondary Mdison, WI 53707 -7302 Department of Commerce [Privacy Law, s. 15.04(l)(m)] '� r� ROI comple d form to county if not ZONING O.FF)(,,F i state owned.) Attach complete plans (to the county copy only) for th e system, on paper not less than 8 -1/2 x I ImM - 6 1 9'ttr'siie. County , AA State Sanitary Permit Number ❑ Check if revision to previous application State Plan I. D. Number Ci ®� I. Application Information - Please Print all Information Locati n: Property Owner Name Property Location SO Z e R 3 3 I/4N/0/4, Tat ,N, ) w Property Owner's Mailing Address Lot Number Block Number 0 2 // /T ` z° /), City, State Ziptode Phone Number Subdivision Name or CSM Number II. Type of Building: (check one) ❑ city /O hu d 1 or 2 Family Dwelling - No. of Bedrooms: r1 ❑ Village T ❑Public /Commercial (describe use):_ gTown of ❑ State -Owned " L /el a/ fi 0 t J S T . C &Z 6 — r X 7 �Y� Nearest Road �d (/Yt 9 - 9 Qf h.9'T;..t7i ._S ,d i �� std - � °�( Parcel T � ber(Lt/ / III. Type of Permit: ( hec line A. Check box on linf B if applicable) u A) 1. ❑ New 2 J R Replacement ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tan k Only Existing System $) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) 1 • Non - pressurized In- ground )(Mound <f 2 ��Ol ❑ Sand Filter ❑ Constructed Wetland • Pressurized In- ground ❑ o1dIT ing Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Are 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. y to Elevation 7. Final Grade Required I Proposed ' 27 Rate�CJ�ls. /da . ft.) (Min. /inch) 17 d� Elevation VI . Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing w /z-Q �-i� crete structed Tanks Tanks / Ye X ❑ ❑ ❑ ❑ Z IL" le P aw Ao / e atvha VIII. Responsibility Statement I, the undersign assum responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (print) Plumber's Signature (no tamps): MP /N11W No. Business Phone Number Plumbers Address (Street, City, State, Zip ode) 3--4 - IX. Co nty/Departme t Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater 7teIIsued ssuing Age Signature (No ps) Approved ❑ Owner Given Initial Adverse Surcharge Fee) 0?1 Determination X. Conditions of Approval /Reasons for Disapproval: OWNER: O t s Septic tank, effluent - t f4ter and( �'>'"' m• Y 3 . 5 L dispersal cell must ail be serviced /maintained as per management plan prov_ idea by nlumher All setback requirements must be maintained O / rdinances. �3, 3 �/ `� ve SBD -6398 (R. 07/00) Maiden Rock. WI 1- 800 - 325 -8456 Portage, WI 1- 800 -362 -7220 Fond du lac, WI 1- 800-641 -5937 Webs to MIESE 001ORETE i : ww e cree.c ° w.wiesrc m - - - - -- - -- — - - - - - 7`Rn No• 03�/ - /o ��i �- �O o "r x /� r 2 .lo '6 /4 "'4 4 a/ S' /(V ziI`e �o.0 ve e ' 4k �� o�i1y�� Gvo�c/ F� 0.4)el� NG I ^� Past �,� �r /l5 /ems N I � ca a 9/�7/! ode CL e v It 7 ` ,S� y!/r clvvlo t eAL `/,5'"� o '7• 0 .� �1?AdE e 4 h oG c7a4 � 97.. o Pti sl A f e,4 L.e iPo T.mv rlf'e a a I C h" 8\. 1);,I 5areTy ana N visconsin 10541N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264 -8777 www•commerc i www.wis .wisconsonsin.gov n.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary I December 15, 2003 CUST ID No.222234 A7TN: POWTS Inspector ZONING OFFICE GALE W SMITH ST CROIX COUNTY SPIA 3228 HWY 170 1101 CARMICHAEL RD GLENWOOD CITY WI 54013 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 12/15/2005 Identification Numbers Transaction ID No. 949369 SITE• Site ID No. 669173 Larry Mousel U • S Please refer to both identification numbers, " 2945 Ush 12 {- �(,(J�j above, in all correspondence with the agency. Town of Springfield, 54027 St Croix County NEI /4, NW1/4, S33, T29N, R15W FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 934593 Maintenance required; Replacement system; 450 GPD Flow rate; 12 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 101), Pressure Distribution Component Manual - Version 2.0, SBD - 10706 -P (N.01101) C 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. DEP0 F Di W The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: SEE • This system is to be constructed and located in accordance with the enclosed approved plans and with the design elements listed above. • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the proje Key Item(s) The north end of the upper edge of the gravel shall be at 94.4' and the southern end of the upper edge of the gravel shall be at 95.0'. The cross slope along the length of the mound shall not exceed 1.0% per mound manual, ver. 2. • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that period cl eaning of the of uent i ter i-s require a access opening used to service the filter shall terminate at or above finished grade wit a watertight cover. GALE W SMITH Page 2 12/15/03 i Reminder • 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. ` • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. // • Abandon failing system per COMM 83.33. • Maintain well and waterline set backs per COMM 83.43(8)(1). Consult the Department of Natural Resources for well setbacks and exceptions to the setbacks. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 " Patricia L Sh orf POWTS Plar Revie r , Integrated Services WiSMART'code: 7633' (715) 634 -781 ax: (715) 634 -5150 , M -f 7:45 am - 4:30 pm pshandorf @commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 i MOUND SYSTEM DESIGN Residential Application INDEX AND TITLE SHEET (1ie ,J s/o / V .2 o) / eJ/ Project �'� �i G� /\/ C/ 5 Y S r c.: M /Ve- /v �'- Owner 4 /;S Z - Address Z�_ /— GL-'/L 1 7 Legal Description �,/r, &i-o, 7� Township S,Of� /N ` /� /t d_ County S t C/?eIiC T Subdivision Name ' "' Lot No. ` Parcel ID Number — .O.t��.T.S. Plan Transaction Number 4EM E E Index and title sheet Page 1 UILD1 S Mound calculations Page 2 Mound drawings Page 3 Pres. dlst, calcs. and laterals Page 4 RRESPO CE TDH and pump tank drawing Page 5 Pump curve Page 6 Site plan Page 7 1 Soil test (a,b,& c of page 8) Page 8 Designer [" —A/ e Lt/ SMI7'"h License Number Signatur Phone No Date Notice: Tampering with this file by unauthorized persons is prohibited. Deliberate modification will result in disciplinary action under s. 145.10, Wis. Stats. Personal information you provide may be used for secondary purposes (Privacy Law, s 15 .04 (1)(m)] . _ L '� C Page '`,� of MOUND SYSTEM CROSS SECTION Synthetic Covering Distribution Pipe Med. /Coarse Sand H G 6" Topsoil F Plow Layer E D M � Foot $ Slope 2Yt Contour Aggregate A = 6 Ft. Owner's Name: 1,41 f B = _L! Ft. D = , O. Ft. ✓ Plumber, F Signature: t. F = r -Ft. License Number: G = J Ft. Date - H = O. Ft. / �f Ft. � G�mi t( /� 7 �� 1. K Ft. Ft. W = Ft. MOUND SYSTEM PLAN VIEW Distribution Pipe Observation Pipes J Force Main A w B Permanent I Permanent Markers Markers L Page L of T PE PIPE DETAIL and DISTRIBU Perforated Schedule 40 JTION PIPE LAYOUT PVC Pipe End S CaP� �. a f Holes Located On B IZ Bottom Are Equally observation -box Spaced r L� ide of cell / chedule 40 / III PVC Force � Main Last Hole Should Be Next To typical long sweep ell with valve or threaded P1U-. R Inches Owner's Name: �A/ R V 1 p as L�� p I feet Plumber /designer's Signature: x /__ � / j inches s inches Date: License No.: Hole Diameter Y 6 inch Lateral Diameter /,- inch(es) Force Main Diameter v inches SCREW TYPE CAP Holes per Lateral ��- OR SLIP CAP feet. Invert Elevation of Laterals 4 PVC PIPE Observation T11t�es /� (LENGTH VARIES) oil 1# of laterals 4 - 1 /4 x 4 LONG / ` SLOTS -@ 90° APART b• Discharage rate Der lateral �er min. TOILET RING 41 - -*-� F� - '/4 SLOT Page COMBINATION SEPTIC TANK /PUMP CHAMBE 4" CI Vent Pipe with,, (No Scale) Approved Cap, +25' Approved Locking Manhole Cover From buildings With Warning Label Attached Weatherproof Approved _ Junction Box Vent Cap -� 12" Minimum Final Grade -� 6" inimum 4" Minimum i Quick 18'' Minimum ;___ , Disconnect t 1/4" Weep ' Hole Baffle; x '#� e4 ' * A -lod i A fl ,4 feR Alarm B On , i C *APPROVED Off 6' JOINTS WITH APPROVED PIPE D 3' ONTO Conc. Block SOLID SOIL 3" of Beddinq Under Tank —/ Note, Pump and Alarm Are On Separate Circuits Number of Doses: j Per Day Gallons Per Day /Doses: �Y,,E_ Gallons Volume of Backflow: ....... + y, �2 Gallons lank Manufacturer: 6�R �G'6./wh.b" Total Dose Volume: ........ �,: Gallons ank Size - Septic/ Pump: > > n _ Gal ions hl arm Manufacturer: ; lr'2�L 'yodel Number:_ /c /t u / ) Capacities: AZ,S= inches or allons Switch Type: iv(ERz-_/ 4il;' + B inches or e) lump Manufacturer: GC' , >,_ + C1p _inches or Gallons Model Number: n + D inches or Gallons Minimum Discharge ate: �1�,, Total .....= inches or 7 0 i Gallons Vertical Difference Between Pump Off and Distribution Pipe: / / -U Feet Minimum Required Supply Pressure :........... ..............+ .. - FF eet 5 r Feet of Force Main x / - -31 Friction Factor /100 Feet: +d'_Feet Inch Diameter Force Main Total Dynamic Head: ... = ." Feet Internal Tank Dimensions: Length -- Width -- Liquid Depth�L I Signature License Number Date 12 DUSTRIAL FAD. Goulds ON, W{ 54016 Submersible Effluent Pump 16, 3871 EPO4 EP05 APPLICATIONS • Fasteners 300 series • Fully submerged in high ■ Motor Housing: Cast ^�c l ca' y Cesi 'or Inc stainless steel grade turbine oil for for el enl heat transfer gr " V • f bl Capae o running lubrication and efficient strength, and durnih 9 g tY • Elll��er! srsle� s dry without damage to heal transfer. ■ Motor Cover: Therms;;_: components Motor: Available for automatic and and lien manual operation. Automatic ntl • EPO4 Single phase 0 -4 HP models include Mechanical porn's 115 or 230 V, 60 Hi, 1550 Float Switch assembled and s ` RPM, built iii overload with ■ Power Caole automatic reset preset at the factory, raled oil anc w'a1e es,s..; • EP05 Single phase 0.5 HP ■ Bearings: Upper and SPECIFICATIONS 115V. 60 lir 1550 RPM, FEATURES heavy duty ball bearing Psrnp EPO4 built in overload with ■ EPO4 Impeller: Thermo- construction automatic reset piaslic Semi -open design F yT� r • Power cord. 10 loot v. ih pump out vanes for AGENCY LISTING Gn, h,h standard lcngih, 16/3 SJTO nPchaniCal seal protection r Canadian Standards Associ.v n „gyp' . ? l 12e! with three prong grounding s= s c r1P r plug Optional 20 loos ■ EP05 Impeller: Thermo (CSA lisled rnodel numDe 5ec; O W length, 1613 SJTW w th GJast c enclosed design for end :! F AC three prong fyound+ng plug improved performance (standard on 1r05) ■ Casing and Base: Rugged !hermopiastic design provides a0 �Cj ca ^uous s:.perior strength and ! Ci ,nie- m[!!enI corrosion resistance. - 30C _ "S METERS I FIE r I � d r,,�. �e 0 J0 P MP EP05 a i L.25FT �C is handing rdpabiloy — r;,:n'um w . -_;! es 4 to C O. GPM u 6 20 macs up i 31 feel a?ge site 1 ;�i' NP z 5 � ,aillCal Seal caFbon• p c'� ^,ceramicstal�onary 4 _ EP05 cone,;;; 7 sous ^lien! 2 EPO4 s -- — — - J_ —* - -- ' 0 00_ 10 20 30 40 5C i.a 2.q. `{ L " 0 2 4 6 8 10 12 m:T CAPACITY Flt rw t't itrot - 1 Maiden Rock. WI 1- 800 - 325 -8456 Portage, WI 1- 800 -362 -7220 IIIESER Fond du lac, WI 1- 800-641 -5937 00HORETE r ncre Website: w ww .wi ese co e.com t s ir I ry L, o y GN4 d e /eve e 4; 4a a o-c / Fe- NG / , d S f c 1 n Ix I c� h;.t O L- e v ft 7 ` ,S v y & C!vd O t � q c J �Ad e ev O c/ o' e L Ue/v '. N C �. 1 c �o ���� P.La 7- FA ti eA C'hrrkCd ll �- y r RECEIVED Wisconsin Department ofCom rce DEC 0 3 200 101E EVALUATION REPORT Page of Division of Safety and Buildings ST i�r�N& Com 85, Wi Adm. Code �^ Attach complete site plan on p N NG OFFICE in es in size. Plan must County o I include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 7 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Q✓ Please print all information. A eview by Date Personal information you provide maybe used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). O` Property Owner Property Locati 0 L Govt. Lot 1/4///,01/4 SS2 T N R /-_,r f W Property OwrWes Mailing Address Lot # B v � City Ste zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road o& i Iv i E v 1 71 (9.1 - ) ❑ New Construction Use :M Residential / Number of bedrooms Code derived design flow rate rd GPD 'Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable A1 ft. General comments and recommendations: / N. de I o"' F- / Boring # ❑ Boring ❑ Pit Ground surface elev. Depth to limiting factor �✓ in. Soil Application 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 A .2 A4 — s s G's / r jr Boring # ❑ Borir:g 10 pit Ground surface elev. q3 {t. Depth to limiting factor a Soil Appl ication Rate Hori¢on Depth Dominant Color Redox Description Texture Structure Consists ndary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I 'Eff#1 'Eff#2 -7 /- a M sd s a . e 42 s,L M A,4 .Z' c S 1 r T g — yg lay& B/al S64 3 MA6 Ir /W kll:: . yr Effluent #1 = BOD > 30 1 220 mg/L and TSS >30 150 mgA- ' Effluent #2 = BOD < 30 mg& and TSS 1 30 mglL CST Name (Please Print) / �� Si natu / rQ / '� CST Number Address Date Evaluation Conducted Telephone Number 3 ?�� w �� 9 -� -�3 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page _oz_ of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code o Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. © �7Q Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Govt. Lot 1/4 1/4 S T N R E (or) W Property Owner's Mailing Address Lot # I Block # Subd. Name or CSM# r City State Zip Code Phone Number ❑ City ❑ Village WTown Nearest Road /Y lv 1 01 ❑ New Construction Use;, Residential / Number of bedrooms Code derived design flow rate - �f`-1 -Q GPD (,,Replacement ❑ Public or commercial - Describe: _ Parent material (5; C / �" / L f=lood Plain elevation if applicable Nd fL General corrmuents and recommendations: 5 Boring # ❑ Boring ® Pit Ground surface elev. 9J�° !7 ft. Depth to limiting factor in. Soil Application 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 All S'L' I ) !-Y- k Iv 2. ; -544 ZdA6 M; ✓,C S o t U Boring # ❑ Boring U ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Effluent #1 = BOD > 30 1220 mg/L and TSS >30 150 mg& • Effluent #2 = BOD < 30 mg/L and TSS 1 30 mg1L CST Name (Please fit) A CST Number Address Date Evaluation Conducted Telephone Number ^. 3'yvi3 Maiden Rock. WI 1- 800 - 325 -8456 Portage, WI 1- 800 -362 -7220 Fond du lac, WI 1- 800-641 -5937 NIESEI IIIIIET E We bs to www.wie : wie oncrete.com r c I ly ®l o.�% - /0 /-7 i CPRANle- Guoe.o/ Fe- Svc I l''Is it ., hest. � � I '5e,o Ce y ;;7 A> ia1ales3 /ye ' g A e ,,�� e v 4 �`' MeW - S F N o ee L X Ho C'e ,4 L P �6 'ysf'�,a�� *,f e,4 Project Name: Computations B\: Date: Location: Checked B\: Date: "I'iticllicm: Shcct:: Of: Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code S eptic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil conpaction may hinder aeration of he infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg /L BODS, 150 mg /LTSS, and 30 mg /L FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure testis peformed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manual (SBD- 10572 -P (R. 6/99)] and local or state rules pertaining to system maintence and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be repaired or replaced immediately with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or removing biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions on the operation or maintence of this system should be directed to your county zoning or health inspector. I - � ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Bwper 41 Address � w vZ Mailing Address _ T Property Address S z✓ (Verification required from Planning Department for new construction) City/State �11- SO,Y �, ALfD.,?/P Identification Number 2 04) L•FGAL DESCRIPTION Property Location 1 /4, /�l i/4 Sec. T N -R Z- ;LW, Town of ,S'px/�'� Subdivision . Lot # Certified Survey Map # _ , Volume , "-` . Page # Warranty Deed # .J .-�' . Volume Page # Spec house ❑ yes P. no Lot lines identifiable ❑ yes , no SYSTEM MAIlVTENANCE 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 mastorplumber, joumeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days the three year expiration date. I / /© E r 1'81( 1NA r RB 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 owners) of the p r A. A d 'bed above, by virtue of a warranty deed recorded in Register of Deeds Office. l - / 6 -6 OF APPLICANT DATE * * * * ** that is mis -re resented may result in the sanitary * * * * ** Any information P Y �' � rmit being revoked by the Zoning Department. ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed MIESER 1111RETE RT. 2 (Hwy. 10) MAIDEN ROCK, WI 54750 • 715 - 647 -2311 • FAX 715 - 647 -5181 1Va /V SR 1r) tell 8 1�RNi ITTfl �Wisconsin Department ofCommerce I AND SITE EVALUATION Page I of 3 Division of Safety and Buildings ith Comm 83.05, Wis. Adm. Code Attach complete site plan on paper not lesw n e. Plan must County include, but not limited to: vertical and horizontal �{ c t ( ) tion and St. Croix percent slope, scale or dimensions, north arr a d ion an 1s rice nearest road. parcel I. . APPLICANT INFORMATION - rma o o7a -7o R iewe Date Personal information you provide may be use and ivacy La .1 .04(1)(m)). Property Owner Lra I � I I r jq97 -P {' erty Location Mousel L o Lot NE 1 4 NW 1/4 S 33 T 29 N,R 15 W Property Owner's Mailing Address ! I.� ^! L t# Block # Su;d. a� or CSM# 2945 HW 12 z; ;;_,�; r ;.) Fls, City State Zip e,�`PhoneNumbK_ Ej City E] Village wn Nearest Road Wilson WI 5402 ` Y -,!) S rin field USHW 12 [] New Construction Use: ® Residential / Number of bedrooms 3 ❑Addition to existing building ® Replacement F ] Public or commercial describe Code Derived daily flog 450 gpd Recommended design loading rate .4 bed, gpd/ft .5 trench, gpd/ftz Absorption_ area required 1125 bed, fF 900 trench, T Maximum design loading rate 4 bed, gpd/ffz .5 trench, gpdff Recommended infiltration surface elevation(s) 108.7 ft (as referred to site plan benchmark) Additional design I site consideration s i nstall 5 'x 75' rook bed mound on ' 06 6 = •psIoPe edge of rock w/ 2.1' sand fill Parent material loess over sandstone Flood plain elevation, if a licable K� ft S= Suitable for system Conventional Mound In Ground Pressure AT - Grade System in Fill Holding Tank U= Unsuitable for system ( [I S® U I ® S❑ U [] S ®U ❑ S M U ❑ S® U ❑ S® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure Consistence Boundar Roots GPD/fF B n Horizon Texture fY gy in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench <......•...,• > <_ 1 0 -7 10YR 3/3 - sil 2 f -m sbk mvfr cs If/m .5 .6 2 7 -21 lOYR 4/4 c2p 10 YR 6 /6 sl 2 m sbk mfr - if 5 6 Ground elev 92.5 ft Depth to limiting factor 7 " Remarks: lacks A +4" 1 0 -10 lOYR 3/3 - sl 2 m cr mvfr cs If /m .5 .6 XXX 2 10 -18 10YR 4/4 - sl 1 m sbk mvfr cs if 4 5 Ground 3 18 -28 7.5YR 4/4 o2g j.5YR 5/3 scl 0 m mvfr - - NP .2 elev 105.3 ft Depth to limiting factor 18" Remarks: 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 # 8/2/97 222774 150 4 PROPERTY OWNER: M-sel Larry SOIL DESCRIPTION REPORT 150 Page 2 of ` 3 PARCEL I.D.# 034 - 1074 -70 Depth Dominant Color Mottles Structure GPDlftz Horizon Texture onsistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 10YR 3/3 3/3 - A 2 m cr mvfr cs lf/m .5 .6 0 -7 m2p 7.5YR 4/6 2 7 -13 10YR 4/4 7.5YR 5/3 A 1 m sbk mvfr cs if 4 5 Ground c2p 7.5YR 5/8 m sbk mfr A _ _ 4 .5 elev 3 13 -23 7.5YR 4/4 7.5YR 5/3 1 104.5 ft Depth to limiting factor 13" Remarks: lac A +4" fi 1 0 -8 lOYR 3/3 - sl 2 m cr mvfr cs lf/m .5 .6 4 m2p 7.5YR 4/6 2 8 -15 JOYR 4/4 7.5YR 5/3 sl 1 m sbk mvfr cs if 4 5 Ground elev 3 15 -25 7.5YR 4/4 c2p 7.5YR 5/8,5/3 sl 1 m sbk mfr - - 4 5 105.0 ft Depth to limiting factor 8" Remarks: lacks A +4" # 6 1 0 -8 10YR 3/3 - sl 2 f -m sbk mvfr cs lf/m 5 6 - 8 -14 10YR 4/4 - sl 2 m sbk mvfr cs lm 5 .6 Ground c2d 7.5YR 5/8 elev 3 14 -28 7.5YR 4/4 7.5YR 5/3 A 2 m sbk mvfr - lm .5 .6 106.6 ft Depth to limiting factor Remarks: 7 1 0 -6 10YR 3/3 - A 2 m cr mvfr cs l f .5 .6 2 6 -11 10YR 4/4 A 1 m sbk mvfr cs if .4 .5 Group c2d 7.5YR 5/8 3 11 -24 7.5YR 4/4 7.5YR 5/3 sl 1 m sbk mvfr - lm .4 .5 106.6 ft Depth to limiting factor 11" Remarks: J fa �w`4 A� Q. /� • �" - '�• � �,I j�H.y i �x4y i t � �" � O1Q.d.. �'1 L a > 1 ov '� Aso ....,... t`• lc �- q�+l a 5 -4- ► 05`.0 � 1 r A .. � ►•s i� � b 3 �� 3 Wisconsit Department of Commerce SOIL, A . Q SITE EVALUATION Page 1 of 3 Division of Safety and 'Buildings r',� omm 83.05, Wis. Adm. Code Attach complete site plan on paper not less 8' i es in e. Plan must County include, but not limited to: vertical and horizontal ref n irection and St. Croix percent sloe scale or dimensions, north arrow I t � h to nearest road. p p d Parcel LD.# 034- 1074 -70 APPLICANT INFORMATION - PI rintAN i rm '�A: Personal information you provide may be used onda rivacy La .04 (1) (m)). Reviewed By Date Property Owner —1 �� 7 erty Location Mouse 1L ' `' Lot NE 14 NW 1/4 S 33 T 29 N,R 15 W Property Owner's Mailing Address \ �;( # Block # Subd. Name or CSM# 2945 HW 12 � `����`� City State Zip ed Fh tuber City ❑ Village ®Town Nearest Road Wilson WI 540 � Springfield I USHw 12 New Construction Use: ® Residential er of bedrooms 3 ❑Addition to existing building ® Replacement [-� Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate .4 bed, gpd/ft' .5 trench, gpd/ftz Absorption area required 1125 bed, ftt 900 trench, fl' Maximum design loading rate .4 bed, gpd/t? .5 trench, gpolftz Recommended infiltration surface elevation(s), 108.7 ft (as referred to site plan benchmark) Additional design / site considerations i nstall 5' x 75' rock bed mound on 106.6 as upslope edge of rock w/ 2. i' sand 811 Parent material loess over sandstone Flood plain elevation, if applicable �� ft S= Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system ( ❑ S M U ® S❑ U ❑ S M I ❑ S® U ❑ S® U ❑ S U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft' Boring# Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 1 0 -7 10YR 3/3 - sil 2 f -m sbk mvfr Cs lf/m .5 .6 2 7 -21 lOYR 4/4 c2p 10YR 6/2 /6 sl 2 m sbk mfr - i f 5 6 Ground elev 92.5 it Depth to limiting factor 7" Remarks: lacks A +4" 2 ' 1 0 -10 10YR 3/3 - sl 2 m cr mvfr cs lflm 5 6 2 10 -18 10YR 4/4 pp - sl 1 m sbk mvfr Cs if .4 .5 Ground 3 18 -28 7.SYR 4/4 e 2 7.5YR 5/3 SO m mvfr - - NP .2 elev — 105.3 ft Depth to limiting factor 18" Remarks: 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 # 8/2/97 222774 150 PROPERTY OWNER: M-sel Lane SOIL DESCRIPTION REPORT Leo Page 2 of _3 PARCEL I.D.# 034- 1074 -70 Depth Dominant Color Mottles Texture Structure onsistence Boundary Roots GPD� Horizon in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 0 -7 lOYR 3/3 - sl 2 m cr mvfr cs lf/m 5 6 m2p 7.5YR 4/6 2 7 - 13 l OYR 4/4 7.5YR 5/3 sl 1 m sbk mvfr cs if .4 .5 Ground c2p 7.5YR 5/8 _ _ 4 5 elev 3 13 - 23 7.5YR 4/4 7.5YR 5/3 A 1 m sbk mfr 104.5 ft Depth to limiting factor 13" Remarks: lac A +4" 0 - l OY 3/3 _ - A 2 m cr mvfr cs _ 1 f/m 5 6 m2p 7.5YR 4/6 2 8 -15 IOYR 4/4 7.5YR 5/3 sl 1 m sbk mvfr cs if 4 5 Ground elev 3 15 -25 7.5YR 4/4 c2p 7.5YR 5/8,5/3 A 1 m sbk mfr - - 4 5 105.0 ft Depth to limiting factor 8'• Remarks: lacks A +4" 6... 1 0 -8 l OYR 3/3 - sl 2 f -m sbk mvfr cs l f/m .5 .6 .............. 2 8 -14 10YR 4/4 - sl 2 m sbk mvfr cs lm .5 .6 Ground c2d 7.5YR 5/8 elev 3 14 - 28 7.5YR 4/4 7.5YR 5/3 A 2 m sbk mvfr - lm .5 .6 106.6 ft Depth to limiting factor 14 " — Remarks: 7....' 1 0 -6 10YR 3/3 - s1 2 m cr mvfr cs if .5 .6 2 6-11 10YR 4/4 - sl 1 m sbk mvfr cs if .4 5 Ground c2d 7.5YR 5/8 elev 3 11 -24 7.5YR 4/4 7.5YR 5/3 s1 1 m sbk mvfr - lm .4 .5 106.6 ft Depth to limiting factor 11" Remarks: c�34 - 0 34 1�1� - Nw- 1 ;- 2q�t ttitM% ( V\ ka Vl! V M 1t Q�g y -Sy �OTa � 1� -S 1 ♦ +��. 4•t �4�0 I 4 r� �t•s i� a �3_ b W, 00mmew %0. I VOL ^ � • i,ttlp • 377 #R I R :3 647 THIS DEED. made between _? E. Johnso and _._. �j _.MQSiS / fE � t],. � _ * n"aawr_�l�it OL ht�e�?� o 8 A J • tenAAtJL Grantee, W t n e a se t h , That the said Grantor, for a valuable consideration _Cn^_ -dollar--and- .other valuable c ansideratiAA WTURN To conveys to Grantee the following denctibed robot et:tate in County. State of tt'iccontatn. ., The Northwest Quarter of the Northwest Quarter ' (NW 1/4, of NW 1/4) and the East One -half of the Northwest Quarter (E 1/2 of NW 1 /4) of S ection Tax Key No. Thirty -three (33), Township Twenty -Hine (29) North, Range Fifteen (15) West, except: Commencing at the No corner of the Southeast Quarter of the Northwest Quarter (NE 1 /4 'of NW 1 # / ): thence East 4 rods; thence South 9 West'28 rods to West line of said £ outheast Quarter of Northwest Quarter (SE 1/4 of NW 1/4); thenca,North 28 rods on said West line to place of beginning. Y *_ This Deed is given in accordance with the terms of that,, certain Land Contract dated May 1, and recorded May 8, 1975, at 8:30 a.m. in Volume 523, page 123, Document No. 326940._- 4 bS is n �,- This not _ --._ _ ,home -ste A prop ert, (in) (is not) y, Together with all and sirvulur Ill, h,•u d;l.,�,,•n• „nd . :mcrs thereunto belonKinK; And Grantor wattanta that the bile is 1{nrui, indefeasible ut 1- `.,mple .end tree and clear of encumhf ce!t except S and will warrant and defend the � ame. y Dared this . 2 / (SEAL) +- -- - Ruth , E. Joh on (WAl.) (SEAL) :. AUTHENTICATION ACKNOWLEDGMENT Signs a authenticate t1p _i7 1 !av of STA OF WISCONSIN a4. County. f'er onally came before me, this _.day of * � the above ri6mcd `,VTiTLE: MEMBER STATE IlAft ov H IS( rt�til; p.. . (If not, authonzr•d be ,uh 14,. Wis .tit:,t� I ' This instrument w:,s dr:,tt,•d h% k' .- R.OM=.. G. WALTER !n mob know to bn th.• !'rtin, - . ^ P , who executed t he tore Attorney at Law m tram nt ,n.1 ,Lkis,,w!vdKed the same. 75 taro 4a*' $Gar+- Leroy p'°r" ° s a�rrise johmon sloe 40 Seim Haines N y 40 80 am U 1 orest & a N 240 111 s ,^1 � 93 Jennifer �+ Robert r w >)revv 99 a .� 3 O o id Matthew & met Paw atth& john & Harold N 52 sOBhlke [arson eenettdall Jarvis ndt GP 1 7 C 4e�c Y o9ich 40 4B 25 E V �!O LLI Marian E cola Y= ul & routs err & Herr a a N O e 3g �hua Yana Farms amu I warty ym rng 40 �i Inc 67 sen 39 u r1 � 2 � arO° &Susan Edward & u o. Gtda& ° Jerry J a wu Gensler Jr Donna w► N Yang f O $ W IOWA a Wollack eat so 16 3 g F Sham alle Fr 224 H � Chong Farms cads & Ratl C reek ans W Wa rren m 12 Da S eetaall I Inc 660 Boy 3s gg m o C. i°o & lone 3S N N James 318 S en — I 74 XJn ao Frye 37` Q Fern Clo 40 90th AVE m o 40 73 i . c= i� D� es Dab Mahoney o5he°elia prueterson Tsuefu tabert Charles la �r, 36 a 120 Scott 4400th 79 39 B 174 l .'— & usan 2. v O �'" 8z Nancy �� B �d Thomas t Mims p o` Z ao Bloom 80 85th Colburn v ; Q / wam 75 AVE 100 4 1011 9 1 Laurence O raata D &R 20 Rickard o0 Ka,h- O ohnson I29 ON & Diana aS ' L&E 20 Ronald Michelle. a 120 [ Mavis ° +' 40 Fortune g K 1_20 a snag Hugh Debban L & iam� 154o�n � °' ''`n`- �P,� o -� �- 159 y� Lec o° Mellott 97 1 + , Ew G H by EO co epttm" r 80th AVE N,y Johne Charles „ttiesy _ w 3Reark a L" Ma _ 1I= 60p� altas t �CNfeat' .0 1H o ° r X40 a pu $ o Seim Julianne & I Smith v � Donald 90.00 �� _ k w XU 36 v, (7 0o e 3'y 189 Frederick Implement 1 3 Lenertz , a Co O Olson U 3. o 4 3s n 127 "41 N 109 OU oo 40 o Irene Do i 12 . 2 Leroy L t ^ 38 ° Da S I m >+ toffs 10 Low Dan ov- u { 75 u a t 40 40 a V C o Robert 3 qq u Qg ° Robert 72d n 4 Dale /� Rb V u &Linda �� o u" Snyder AVE & Kim g �+ O VM g 21 K A ' ZafZ Y M etal Heimke / ° 34 36 40 ti Reuben Donald o Mabel _ Richard ! H�e n NN 00 Thompson 0 20 Hagen t n 78 40 Trust 207 1 N 35 ha on Avila b �- 2 e� o m ss S 7 9chterhof Sig < F - 75 x w F+ Store 42 t C 19 E &Avis David 3 udo It S Eitland Eilef- M ry ^ F Frances v a & M K N ° p�C Son 7 c L Kromrey, ° Erickso _ y a X Harold Ann • y s.'tj 168 0 o awes & pp n /fi N Q" L 00 jj @ ©I ttyl ��+ Y �y N C�i Q DlbOra f �O 04 ed 3 ^ 6 4p TrLLtt G a�a i3D deom 40 P, i 60th AVE CADY PAGE 24 t RB 's 04 Uc a r WILSON, WI and Dis ! Dry Vans - Reefers - Augers - Hoppers - Brokerage Dry, Refri Phone: (715) 698 -2442 and C. Fax: (715) 698 -2962 Toli Free: 1 -800- 219 -6926 107 Hagen Drivf "some Phone: (715) 698 -� i • A vn C oo Z m E:1 , o m i m M - n - mn 70 m r - m i D tt� Z d x C/) Z • c O ► z c Cn 4 -n O 00 ; C O Z ;a � .j N O ?� Z Z z ' a z x 0 C7 r C O m CA �r _ CA Z v Z. N � X - m m C N 70 O C 0 z O _ 0 v m z O c M NC X. � z rn ■ ■■ S 3 �g� a a o a o m O = ° -off. T. W o� ,, n c • s Q $ Z - C rn A d am= O IE a z >