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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)) TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P!L vVELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMPISIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well EVIL At65UKP I IUN SYSTEM STATION BS HI FS ELEV. Benchmark All. BM Bldg. Sewer St/Ht Inlet St/Ht Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot System Final Grade St Cover BEDITRENCH DIMENSIONS Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR UNIT Manufacturer: Type Of System: Model Number. 11 RIGIJ 1 IIJ114 J T a 1 CM Header/Manifold Distribution x Hole Size Hole Spacing Vent to Air Intake Pipe(s) Ix Length Dia Length Dia Spacing Q%JIL. I vvr_m x Prassura Svetame Aril. xx hill n. All D—.An c...te...e n-k. Depth Over Depth Over Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges psoil ro O Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Location: No Address Available 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑ Yes �] No L Use other side for additional information. SBD-6710 (R.3/97) Date Inspection #1. Insepctor's Signature Inspection #2: HIL Cert. No. o 1s fha ;;. Industry Services Division County 4822 Madison Yards Way ,j T s! o/X Tar, Madison, WI 53705 Sanitary Permit Number (to be filled inby Co.) + P.O. Box 7162 Madison, WI53707707-7162 4 Permit Applicati 'State Transaction Number In accordance 'th SPS 3 , Wis. Adm. Code, submission of this form to aze go 't� is required prio to a sanitary permit Note_ Application fortis for state waed PO bmitted to Project Address (if diffensmt than mailing address) the Department o S and Professional Services. Personal information you provide used for secordary / purposes in acco a with the Privacy Law, S. 15.04(1)(m), Slats. ✓ [. A tication s Information - Please Print All Information 12,111 �%Q rd �JE. Propcny Owner'Namc Tl. rA �/e /n / c/./A/VJ .^.CT-Ct G Property Owner's Mailing Address (JUd- Q7.J-&a'100 Property Location 5 y,o /'S //LLN .ST, Govi. Lot City, State Zip Code Phone Number Awl /V w Yw N tJ Y., Section Q 01,d /,,J 5�/00� T 0?9 N R /G If. Type of Building (check all that apply) Lot # ©I or2Family Dwelling - Number ofBedrooms .J 3 Subdivision Name Block Dublic/Cotumercial - Describe Use # ]State Owned - Describe Use Duty of CSM Number a9-�sy? r0age of 2t'ow11 of 4444w.J ooc-1. o�ozo9 III. Type of POWTS Permit- (Check either "New" or "Replacement" and other applicable on lime A. Check one boa on line B. Complete line Cif applicable.) A. NewSystem 1 µto laccnmt System []Other Modification to Existing System (explain) Additional Prebeaitnent Unit (explain) B. []HoldingTank E]ln-Ground (conventional} i( Mound Ir 2 Individual Site Design�Ou (explain) C. ❑ Renewal Before Revision L]CbangePlumber � fmnsfer to New Owner ist Previous Permit Number and Date issued Expiration tl ICA Iv. Dispetsat/Treatment Area and Tank Information: o tJ iq — r — 0 Design Flow (gpd) Design Soil Application Rata(gpolsf) D persal Area Requited (sf) Dispersal Area Pro d pose (sf) System Elevation 710 Ica /oi.o aj /4a,5,14*1rd.,,. Capacity in Total I # of Mamufacmaer Tank Information Gallons Gallons Units OPP.4Go , Nm Tanks Existing Tanks Rc-1 y9a• c V �' u u m septic or {iWding-'Fmdc J /57SS — /586 ! W/fsEa Loar,e. '� - Dosinyy Ctumber 9So — 910 Loribo �— O ....ratrvuasuwsy uaarcrmcar- h we oaaeragoeo, assume responsibJIiZ.P!!mrta11ado!,0 the POWTS shown on the attached plans. Pltanber's Name (Print) ,, // Plumber' gnattue MP/le K Nmnber Business Phone Number :Ear /9ott E 1 .7.7 //?T 7/S Wg- Y/5Y Q /JOit AO_ Z6 L.CA sr. L) I_ -TV7 Approved ❑ Di vcd Permit Fee Date rssu Is ping gent Signature ❑ Own en for Denial Conditions Approva asettsfrn-9isapptovel S STEMt 1 Septic tank, effluent Alter and X&:lzn� -fCLzt ee-W-C`4L dispersal cell must be serviced / maintained If as per management plan provided by plumber. 2 All setback requirements must be maintained as per applicable code/o.-dinances. �teL✓` 1 S I S ju Zmu. Anach to eompkte plan for the system and sabmlt to the Comaty only an paper not Ian than a 1111 11 inches in size SBD-6348 (R_ 03121) t"o.vya /�t��rE,vs- p4 r/F.4 IV r,1/ IVA), f Q, al 9N, /G 4d / Q lra i of /JAtLO/d/� sl' C.Ga/xCa. 'I I Af 399.5 I PPLC;r PLAN j,,00w SEA` 14AO14SCO ® y Vuc /Jst. bJresfa /sgr�q LoNae lAwl/( PRePesre fAAM F/ELa AnraEd,►Y r r rdl of y lac i //,Or Ga4sS A - 5/;.7 ' off, c�� l/irg� S�ta� car 14" SAS 383. 4'3 5Crf.44 is ryEr P? n Out Sub 90 FQRGf IYF/.l�/iS `� D 106.5 y 3$ U3 8 x 95 mex cEta c Aa.8/ /yj.,ra f4wrl 101 , 100.5, 74w"g' or %4 -O.JraiA 101.5 April 4, 2022 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2024-04-04 Plan Review: PWTS-042200557-C KENT HOKE PO Box 10 Colfax WI 54730 SITE: Tonya Mertens XXX 90th Ave Town of BALDWIN St. Croix County NW, NW, Sec.19, T29N-R16W Total Amount: $250.00 DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 54304-5211 Contact Through Relay http://dsps.wi.gov/programs/industry-services www.wisconsin.gov Tony Evers - Governor Dawn Crim - Secretary Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDIUSTRY SERVICES + 7,T& SEE CORRESPOND CE FOR: Description: Five Bedroom Mound system 1 Sloped Site Mound Component Manual—Ver. 2.0, SBD-10691-P, (N.01/01, R 10/12), Pressure Distribution Component Manual — Ver. 2.0, SBD-10706-p (N.01/01, R 10/12), 750 GPD, 31 inches to limiting factor from original grade, Maintenance required, Effluent filter, New Construction The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter. Owners shall also receive a copy of the appropriate operation and maintenance manual(s) and be responsible for ensuring that POWTS is operated and maintained in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. A copy of the approved plans specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, l�i+v�r -*!�ell POWTS Plan Reviewer — Wastewater Specialist Department of Safety & Professional Services I Division of Industry Services email: Katie. Petzel(a)wisconsin.gov Cell: 608-574-1189 Page 1 of 9 Private Onsite Wastewater Treatment System Index and Title Page Project Name: ToNYA IYE crciv5- 5- /dam / lau.Jo.. f'ewrs �. 95-W) Owner's Name: It A Owner's Address: 5Yp 41z4# Sr. 1-3AIDw/,J Grit Sy402 Legal Description: N T b1,1 / 9� ,7 F4 /L �✓ Municipality: Town, Village, City of ISA/taAd1W County. ST. C, Lot Number 3 Block Number_ CSMNumber:,?9--4SY-7 Subdivision Name: 94 '" xv E Parcel I-D_ Number. 66d - /a H3 - 810 - 3 ao Page I Index and Title Page Conditionally Page 2 Plot Plan APPROVED Page 3 Cross -Section & Plan View of Mound DEPT. OF SAFETY S RVICESROFESSIONAL Page 4 Pipe Lateral Layout DIVISION OF INDUSTRY SERVICES Page 5 Septic Tank I Pump Chamber Cross -Section & Specifications Page 6 Pump Performance Information Page 7 POWTS Owner's Manual & Management Plan SEE CORRESPONDEWCE Page 8 POWTS Owner's Manual & Management Plan Page 9 Filter Information Name of Designer. leezr /10License#: /y6- 421/l99 Signature: Date: 3- d 9- a a a a SBD-1069I-P (N.01/01) "Mound Component Manual" Version 2 0 SBD-I0706-P (N.01101) "Pressure Distribution Component Manual" Attachment Soil Evaluation Report � PL - . 70,7 r YnNYA M£n TENS- `/0 T4.4,1. NrJI /t//,1, !� d M, /6iJ ,T Sp � � of �JdtOatiNt Sr L.�d/x Ca. � d 96 Ed 14 t:. f /Lt AN J ".5 Puff PLAN `1Rd0esta // WELL AdPd5O fVuc ® Al S-t1A, Idly /NSF. l.J/rtsrn /SgS�9 LowJe rA.J,r �soPetr0 FAarf FiafA /I Af JFdAi 1 I YaP of Y, %uc /tIPE GnA35 s r�fP 5/2-7 f F Z O 0?�5 �5o t Q = OVtJ-S, 5-,4te r LaY AtL SpS 383, 5',j M7,0.44Ks gFr ,t " 40( Sul. Ha Fdnte wAas(/13�� B' f a 4 3 9e y f 3 t t 8 z 9s itotfr LEtL 101 , 100.51 7494-j' dr /Oaf e4. r#WA 101.5 Page 3 of 9 D S £t CROSS-SECTION OF MOUND , = 7 Y £t UPTURNED LATERAL & ACCESS BOX Jr = 4 £t' TOP SOIL OBSERVATION PIPE & WATERTIGHT CAP , GEOTEXTILE FABRIC COVERING DISTRIBUTION LATERAL ( �Y In, sch. 40 PVC D2666) d =_` £t. ASTM C•33 SAND FILL Lateral Invert El.= o 1 S ft H = /. / _ £t TOP SOIL ) a,."> Nvj�, H ' o/, 0 TOE "' F System EL= ft 3Yt Contour El.= 1440,5 ft , ( ' �• " ' ^'-�% • = FORCE MAIN (2" sch, 40 PVC 02665) % SLOPE DISTRIBUTION CELL = 8Y ft x 9S ft = 746 ft2 (0,6"- 2.6" aggregate) Min. Required = 756 r /. a = 756 ft2 A = $ £t. B 9S £t. I =- 7. S £t a X. s. s it K °' 79 £t :Et W 411 sch. 40 PVC ' fibrei wallah p 1pe B M -- _o �2 0'5 it PLAN VIEW OF MOUND 2" Force Main Observation pipe i 95 Observation pipe 5.5J 7,9 �---- IE— K —� -OX � ox 8 A ox 6 ox a, W Distribution Cell $ ` I /. 8 ft (0,6 - 2.6" aggregate) Distribution pipes /S. 8 ft 7.9 �r 96� ( Ag In. sch.40) OX= Upturned Lateral with Access Box Prohibit disturbance and vehicle traffic within 16 ft of downslope toe. Basal Area=_ /SS ftx_ S ft= /`/»•`%ft' Min.Required= 7-f46 + G --= /;Sb ft2 HOLE DIAMETER — 3�/6 in. LATERAL DIA. = in. MANIFOLD DIA. - ��.1 in. F017CIP MAIN DIA.= in. e = yG.S ft. a = y ft. X = i ft. V - __3 ft. PIPE LATERAL LAYOUT OF MOUND (Center Manifold with Aggregate) (s pipe D26 5) r<ev JGs�ee / X�\ ttp,� JG926g51 \rY,r� 3 /FORa r Aoel 5 S\ t�o�e gas` 15 �N- �k x 3 %6 Vast�o`e \ate x3 \ PNdv� 01 3 HOLES LOCATED EVENLY \x'y-;�� ON BOTTOM OF PIPE. a5t�o\g Page Y of 4 Access „Box ' EL r � �V4' P- S Minimum Number of Holes = 7.16 ftZ + 12 Holes 0016 % G Holes/Lateral x _� Laterals = GY (3116") Holes x 0.66 gpm / (3/16") Hole = GPM = SYSTEM FLOW RATE Plf l: VOLUME. = /86 ft. Laterals (total) x , d?a gal/ft, = /r 1 x 5 = 85. 5 GAL = MINIMUM DOSE VOLUME PIPE INVERT ELEVATION = 6/.5 ft. Y3 Page 5 of COMBINATION SEPTICIDOSE TANK CROSS-SECTION (DRAWING NOT TO SCALE) FINAL GRADE MANHOLE RISER & COVER (WSPS W425M & (a), approved (slope gmund surface avray from locking device- & warning label; Extend manhole(s) for proper drainage) manhole riser as necessary.) 4' Mh Sch. 40 PVC Tank Vent BUILDING SEWER kuatedI2•abovegradeor24' r (perSPS 382.30(li)) above Regional Road Elevation rr rr (s6'wver rr MNNHOI.E rr n - rr rr BOTTOM OF INLET ELECTRICAL JUNCTION BOX {comply with SPS 316 and NEC 3001 4' Mm. Sch. 40 PVC Tank Vent located 17 above glade or 24" above Regional Flood Elevation FORCE MAIN <12OPTIONS >4 Y l . Fain Mom 11 " weep • - 11;111 MINIMUM OF 3" OF SUITABLE BEDDING BENEATH TANK & MAXIMUM BURY DEPTH OF 96" Anchoring of tank may be required per SPS 383.43(8)(g) on Plant offpl� Ex, =. 9/.0 n z Tank Manufacturer. QIC564 C6,0eAErS_ Daily Wastewater Flow (DWF): _ 7.s0 GPD Septic(Pump Size: /38S/74-0 Izallons Number of daily doses: S. 3 i /S. 9 -7 Alarm Manufacturer. S 1 E. AVb wA&5 Force main v Model Number. Y-A,aK AL ft r (volume:/.ZS ft x .143 gaUft = aG. y gal Switch Type: /s%EG//R,J. e,s'L Actual dose volume: /61. i gal - v76. °/ gal = /9J. / gal (total dose volume _-volume of force main) Effluent Pump Manufacturer. 1/ me Gina r Model Number. `l Ec Minimum Discharge Rate: /.7, 2Y GPM Vertical lift (pump off to lateral invert) ........ _--- /0. S it System head (distal pressure ].s x f.3 ft): 3.3 ft /.t S ft Force main x 3.7 Y100 friction factor Y L ft Filter friction loss ................. ..................... ft Trig, nvnnmic. Weed (TOW): ig - N a DOSE TANK CAPACITIES: Reserve above alarm d 1.5 in = 537 S' gat (D) Alarm float above on float cZ in = 50 gal (C) On/Off float measurement 4.5 in = 1.dl.5 gal (B) Off above tank bottom 8 in = 200 gal (A) DOSE TANK DIMENSIONS: a Length /83.5 in Width /0/ in Outlet height 3S in Geltonalnoh is. D EFFLUENT PUMPS PI. C 6r 9 10 ■_�► 711 1 •r-r_ 1-11� 1 I ste Gk%S 11T■TP�il�li Cover Epo)Cy-coated cast" Motor Mousing Epoxy -coated Gst kon ImpelerMatetial Themmpiasticelastomer Impe9erType Non -clog VbbAe Epoxy -coated cast•kon Motor Shaft Steel MedaticalShaltsea . Nitnie with carbon andcemmie taees fasteners Stainless steel Upper skltered skm and lower ball bearing Power Cord SJTW"Sffow •a�snmxra of m 9B:-0/.NF aM 9HAl modtic o TO m m 1w so so m so (AP601 4 M * Franklin Electric HOMMtaa]] UNA I wmtmftQrdrmi POWTS OWNER'S MANUAL AND MANAGEMENT PLAN FILE INFORMATION Owner TDIV Y4 rEws Permit # DESIGN PARAMETERS Number of Bedrooms (100 d/bedroom) Number of Commercial Units Estimated flow (average) Songal/day Design flow (DWF), estimated z 1 S 750 nal/da Soil Application Rate /.0 gaYday fe Influent/Effluent Quality (❑ NA) Monthly Average Fats. Oil & Grease (FOG) -< 30 mg/L Biochemical Oxygen Demand (BODs) < 222 0 mg/L Total Suspended Solids (TSS) _< 150 ulg/L Pretreated Effluent Quality (Z NA) Monthly Average Biochemical Oxygen Demand (BODs) < 30 mg/L Total Suspended Solids (TSS) < 30 mg/L Fecal Coliform (geometric mean) _n0 cful100ml Maximum Effluent Particle Size 1/8 inch diameter SYSTEIIT SPECIFICATIONS Septic Tank Capacity 595 ❑ NA Septic Tank Manufacturer W /ESE,c <*",L ❑ NA Effluent Filter Manufactmrer Q aE.;Z6 ❑ NA Effluent Filter Model crb8Z?- Hd ❑NA PumpTank Ca aci 30 al ❑ NA Pump Tank Manufacturer W rci" L,wzA, ❑ NA Pump Manufacturer 11rra I»,a.ir ❑ NA Pump Model E L ❑ NA Pretreatment Unit ( ® NA) ❑ Sand/Cuavel Eater ❑ Peat Filter ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection 0 Other_ Manufacturer Modeh Soil Absorption Component (❑ NA) ❑ In -ground (gravity) Cl In -ground (pressurized) ❑ At -grade 0 Mound ❑ -line ❑ Other_ ❑ Dispersal Units —Manufacturer ❑ Aggregate Cell(s) Model Calcubtions: Soil Dispersal End Cap (Dispersal Unit EISA) or DWF- Applicationmte=AreaReauired -EISA - (!much Width) =4 Units orTotal Lenath of Trench(s) 750 1.6 = 750fr` - = 8I = 9S (Aea f�') yam❑ "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publication 9.6 (SSWMP Manual) ❑ "ICC Flowtech Monnd Component Manual" Version 1.2 ❑ "EzFlow Mound Component Manual" Version 12JISP-017 ❑ SBD - 10954-P (R1/12) "At -Grade Component Manual Using Pressure Distribution" Version 2.0 ❑ SBD - 10705-P (N.01101) "In Ground Soil Absorption Component Manual" Version 2.0 �9 SBD-10691-P (N_01/01) "Mound Component Manual" Version2.0 ❑ SBD - 10657-P (RR6/99) "Drip -line Effluent Disposal Component Manual" ❑ SBD-10700-P (N_01/01) "Pressure Distribution Component Manual" Version 2.0 ❑ Other- =.Y,Y YT n.v w mrrr.�N s,a*rF a nm lvrelV n r_�:1uIENT JYIHLIIlLllff i\l.. L' ice, Vi\as\/J111,V uai Service Event Service Fr uencv Pum f ect s inspect dispersal cell(s), clean filter At least once eve : ®i 3 months II 3 ears ❑ Other - , Inspect controls, alarm retreatment Will At least once eve ❑ month! NA Flush and pressure test laterals At least once every- ❑ months M 3 Mears ❑ NA START UP AND OPERATION: For new construction, prior to use of the POWTS check treatment iank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s)_ if high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use_ System start up shall not occur when soil conditions are frozen at the infiltrative surface_ The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of yoorPOWTS_ The installation of water -saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc - This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils. vegetablelfruit peels and seeds, bones, and rood solids such as thosa produced by a garbage disposal should be minimized. Toilet tissue, is tthe Only 0' j yapti ttmt mount uc wscuaigca nuu me sysio i,_ ouic...w-t+�.+�yd�t+"= �`A•"'"""�"" e` condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, Page 7 of I Paae _$ Of T_ drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction ofsnow over the dispersal unit may cause it to freeze up. INSPECTIONS & MAINTENANCE: Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber. Master Plumber Restricted Sewer, POWTS Maintainer_ or Septage Servicing Operator (per the attached Maintenance Schedule). Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify arty cracks or leaks, measure the volume of combined sludge and scum and check for any backup or ponding of effluent to the ground surface and test all electrical equipment such as pumps and alarms. Any defects shall be promptly corrected. Exposed openings grater than 8 inches in diameter shall be secured with effective locking devices to prevent accidental or unauthorized entry the tanks. When the combination o f sludge and scum in any tank exceeds one-third (1 /3) or more of the tank volume, the entire contents of the tank shall be removed by a Septago Servicin.0 Operator and disposed of in accordance with Ch. NR 113. Wisconsin Admin. Code. Specific servicing mechanics must be provided if vertical is>15 feet or if horizontal is>150 feet and instructions to be provided below. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Solids washed from the filter shall be retained in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surfacing. ABANDONMENT: When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that die system is properly and safely abandoned in compliance with Ch. SPS 38333, Wisconsin Admin. Code: All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel, or other inert solid material. CONTINGENCY PLAN: If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area renders it unusable. Replacement systems must comply with the rules in effect at the time of replacement. O A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology n holding tank may be installed as a last resort to replace the failed POWTS. �i The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS_ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions o fsuch systems must comply with the rules in effect at that time. A-ANNLNGIM SEPTIC, PUMP, AND OTHER TREATMENT TANKS itLAY CONILAN LETHAL GASSES AND/OR F4SUM, CIENT OXYGEN. DO NOT ENTER A SEPTIC. PUniP, OR OTHER TREATMENT TANK CINDER ANY CiRCUMSTANCES. DEATH MAY RESULT_ RESCUE OFA PERSON FROM THE INTERIOR OFA TAN K 14L•iY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS: POWTS INSTALLER Name: i tr0/4�5- /W- .��// 9 Phone: /S G 7- y/SS SEPTAGESERVICING OPERATOR (Pumper) Name: Phone: POWTS MAINTAINER Name: t LuNiS/dL Phone: x1s, LOCAL REGULATORY AUTHORITY Name: .jp Phone: 7/S 384- YLBo O`. 9 ./" 9 Maintenance Instructions teosass-s>t�a Biotubeg Effluent Filter How to Glean Your Effluent Filter +c ansere your ai uent filter is iurctiowng properly, it snouid se nspee:e.; evary year. U .cer normal conditions, your effluent !lter will funetion for several years before cleaning is necessary. The filter should be cleaned when it becomes clogged enough to restrict normal flows out of the septic tank At a minimum, the filter should be cleaned whenever the tank :s Gum pad. Most people prefer to have a sepds tank service provider taae care of filter maimenarce and cleaning. You can find a seu c tank sarJ'ce provider in the yellow Pages, urde- Saprc Tanks & Systems: or you car contact your county health cenarinentfor a Fs*.. it you %vise to inspect and?or clean your effluent -iher yourself, ms sure to aress proparly. Wear folk -length pants and shin. shoes, gloves, and goggles or glasses. Tien follow these instructions: 1. Remove the access lid to your septic tank by unscrew- inc the stainless steel lid bolts with hex head wrench provided. If your lid is above ground, it vvill be easy to find. If ft is buried below ground, find the marker that indicates its location. Z. Remove the filter cartridge by grasping the tee handle and kiting it out of its housing (see photo 1). 3. Spraythe cartridge tubes with a hose to remove any materal sticking to them (see photo 21. Ensure the three orifices in the optional flow modulation plate inside the filter are clear of any debris. Make sure the rinse water rims back into the tank. but do not allow solids material to fail into the open filter housing. 4. Frmfy place v ,e cartridge back into the housing. 5. Some effluent filters come with an alarm that activates when the filter needs cleaning. if you have an alarm, check to make sure it is working by lifting the float with a stick. An audible horn should sound. The alarm panel is normally mounted on the side of *he house or in the garage. Note. If your affluent fiher doesn't have an alarm system and you would Ike one, call your local septic system installer, i. Record the data that you inspected and/or cleaned your fiher on the form that follows. If you checked the alarm or made any other observations about the tank or system, include that information under'Notes. 7. Attach access Itd by placing it on the riser, matching the openings in the lid vrith the bolt catches. rose-t lid bolts into catches and tighten with hex head wrench provided. Photo f. Remove the filter cartridge b y fitting it our of its housing. Photo a Spray die cartridge tubes with a hose. _ Rix CS ( lL1 U l �l Vifisoonsin DepartmMtoLSalety_o feS`�oryy Semces p �Page 1 of 3 DmsionofIndustry S�;: = - -- - SOIL -1 t� � 241in accordpncewith SPS 385. W1s Adm Code County St Croix Anao6 complete 34e plan on paper not teas than 6 1r2 a 11 inche9 in size Plan must Include. but not limited to vertical and horizontalreference point (814), direction and percent slope. Parcel I D VAA ell r 00Z imI � scale or densions, north arrow, andCatl o lotnearest road. 62C202!'36-Wo _ - Ref 9M3 `Please print all information- Red by rDa q a Personal information you provide may be used for seconds (Pnv Law, s 15 040)(m)) Property Owner Property Location Ed i-s Carol Frame I Govi. Lot NW '% NW 'X S 19 T 29 N R 16 E (or) W 1I Property Owners Mailing Address — -- Lot ;--[Block # y Subd Name or GSM# t. 7.117 g0`"Ave _..--- ProPoaed I Na Pr0Posed CSM_ ! Ct:y State Tao Code Phone Number ' ElcityElVillage Town Nearest Road LBaldwtr. WI _ 54002 ---, ! (715) 684-2119 I Baldwin I Hwy 63 _ ® New Construction Use ® Residemtal/Numberofbedrooms 3Code derived design flow rate 4s0GPD 3e-vJel-f- s. L ❑ Replacement ❑ Public or commercial - Descnbe ./ Parent material Glacial till Flood Plan elevation d applicable na ft. ZL Jt General comments and recommendations Sde suitable for mound POWTS Recommended infiltrative surface elev to be 101 D(r at 6" above 100 50' Contour j i 1 1 Boring # ❑ Boring Q Pit Ground surface elev. 99 90 ft. Depth to limiting factor 36 in. 1:n.16rvrllr�tinn Rote i Horizon Depth In. 1 0-12 Dominant Color + Redox Description Texture i Structure Consistence : Munses Qu Az. Cont Color ; Gr. Sa. Sh Boundary — Roots GPD/Ff _ j 'Eff#1 'Eff#2 l I06_ I0.8 110yr3r3 none sit 2fgr mvfr _Low 2vf,f 2 10yr3,16 none scl 2rsbk mfr tse tvf t 04 06 -12-26 --j1 3 _ 126-36 7.5yr4/6 Porte sl I tcbk mfr cw 0_4 - 07 4 36-54 7.Syr416 m2d 7.5yr5/8 sl I Om +_ mN - - 02 06 ' i 2 Boring # Horizon Depth Dominant Color In i Munseli i 0-11 --: 10yr3.J3 .-2_— 11-23 10yr3:6 3 2331 i 7 5yr4)6 4 31-61 7 5yr4l6 ❑ Boring ® Pd Ground surface elev 100.87 ft Depth to limiting factor 31 in Redox Description Texture Structure i Consistence Boundary Roots I GPD1Fr Qu Az Cont Color Gr Sz Sh ) Eff#1 I -E none s11 2fgr mvfr ca 2vf.f 06 08 none scl 2fsbk mfr ON 1 1vf i 04 06 none I sl 11Cabk ; mfr gw ; 0.4 07 f2d 7 5yr516 sl _ Om mfi - - - -. 02 1 06 Effluent #1 = SOD. > 30 5 220 fL I rid TSS > 30 5 150 rL ' Effluent #2 = BOD > 30 5 220 Land TSS > 30 5150 CST Name (Please Print) $!gnature — CST Number James K Thompson T6i,� a y ^ �- 30021 Address ✓hate Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola WI W20-5413 January 29 2018 rTtot 24e-7707 • SOD-8330 tR041151 3 Bering 0 ❑ Boring ® P4 Ground surface elev 100 16 R Depth to limiting facto�30 tionzon Depth In Dominant Color Munsell RedoxDeunption Qu Az. Cont Color Texture Stnxxure Gr. Sz. Sh. Consistence Boundary Roots GPD/FtZ . •Et 1 ,ERfi2 1 0-18 t 0yr312 none I 2fgr mvfr cw 2vf f 0.6 08 2 18-32 10yr4/4 none srcl 2fsbk mh cw 1vf 04 06 3 32-44 7.5yr4/6 f2f7 5yr5/8 sl 1csbk mfr - 04 07 ❑ Boring a p Boring ❑ PR Ground surface elev. _ fL Depth to fimding factor _ in FSa-Iftvbcartpon Rate Horizon i Depth In Dominant Color Munsell Redox Description Qu Az Cont Color Texture Structure Gr Sz Sh Consistence Boundary Roots GPD/Ft2 •EIM 'Efnf2 u Boring k ❑ Boring ❑ PA Ground surface elev. _ fl. Depth to lending factor _ in cna anrdr fen P fn Horizon Depth In Domman Color Munsell Redox Description Ou Az Cont Color Texture Structure Gr Sz Sh. Consistence Boundary Roots GPw -EMI .Efts2 r - — i ' Effluent #1 - BOO. > 311 S 220 mg/L and TSS > 30 5150 mg/L . Effluent 82 = ROD, > 30 5 220 rig/L and TSS > 30 5150 mg/L 1so'# yV sa[-c4vAt pat. As j"^cd a tc✓ -xoro' 30 ` Br r of ` + .l nl r �= I T • n,2 ! 31 1 r + I � r ! { I f I I as + + ( r + + ioo.ea' conCe+t/' iw.sa' iaa' Pei *2 Sn3 fed %rpJ Fn..� Pr�oaua( e.Swt ��s,.. 0�1 gcc�r sct. r4. T Z9/[., .SE..Crok to., r�7� gsxsstd � c.Cd !a qc 2 APPLICATION FOR REVIEW Complete allpages- - SPS NOTE: Personal information you provide may be used for secondary purposes [Privacy Laws.15.04(1)(m), Slats.) Private Onsite Wastewater Treatment Systems Division of Industry Services ❑ Plans to be E-filed. Provide SharePoint User name below: Far plan status. Check our website at btjffiw%yd.uov Email technical code questions to Egipg PowfsTerllft>}_ - 4oy Several counties have been delegated certain authority to review plans in lieu of Division of Industry services. For a current list of those counties and their designation check our webste at htta:1/3sosun_onv 1. Project information - Fill in all known information_ Conf/rrrration of assignment to a reviewer. ProjecdShe Name: TONYR / / E,c Yg NS I Transaction ID: Location, Number & Street of project (d unknown, indicated nearest road) ir0 =* Legal Description: /(!!) IVA), /9, County ❑ City ❑Village ® Town of AtG✓i✓ 2. After plans are reviewed, please: (check all that apply) ❑ Call customer 1, 2 (circle number)- ❑ Requesting party will pick up a Mail plans to customet 10 2 (circle number) - •Refers to customer number from below. Previous Related Trans. ID: Estimated Completion Date: Assigned Reviewer. Assigned Office: — Mail to your office of choice below. La Crosse, Green Bay NOTE: We reserve the right to re -distribute plans to another office if needed to reasonably balance turnaround times. Check builAfterui.mr for next available review date 3. Complete the following designer/ownedrequesting information. Utilize the check boxes when designer, owner or requesting party is the same to avoid repeating information. Designer Information (Customer 1) DSPS First Name leEN7- ,//Last Name Customer Number //.L M/�-.z2Yi99 Company Name f/FN �cu.vb�.rG Address Po. 'd ax /o City Latfrx State l,Ir SY73a Zp+4 (9 digits) Phone Number E-mail address Cell phone (area code) �S 9Ga-Y�SS �orlir��u�r6� ca��''axrdi � Check if applicable ❑ Owner Other Please Specify Below (Customer 2) DSPS First Name Last Name Customer Number %6NYA 1tfEA.rE1y3 Company Name Address SYa /,iiat,k+ Sr. City State Zp+4 (9 digits) /lAt101J.W 1.)T sydsz Phone Number E-mail address Cell phone (area code) Check if applicable or specify relationship Information and Plan Submittal Checklists. To request electronic plan review complete the appropriate application forth and e-mail it, along with your registered SharePgint usemame to DSPSSBPkwiScheduteVWmco :sk aav_ If plans are being submitted via paper, they will be assigned to a reviewer after receipt at a DSPS office_ Submittal checklists can be found in each applicable component manual appearing on the POWTSprogram page under Publications POWTS Comaonerrfs Manuals Holmen/Onalaska Area DSPS Green Bay DSPS 2850 Midwest Or Ste 104 2331 San Luis Place Onalaska, W154650 Green Bay, WI 54304 608-785-9334 920-492-5501 Fax. 608-785-9330 Fax920-492-5604 Email: 0sosSbP1anSchedu1e42W.00y Email: DsosSbPlanSchedulefdtwi.gov Make Checks Payable to: Division of ❑ Check box to Designer signature SBD-10577 (R 3119) s OR sign below TOTAL AMOUNT DUE S �L• °s Review Code 7633 S. POWTS SUBMTTAL(elleck all that apply— incomplete forms may result in orocessina delays) ® NEW ❑ Aerobic Treatmerd Unit(s) ❑ Chlorinator ❑ Tank Replacement Only ❑ REPLACEMENT ❑ Datmnwcia) system ❑ UV Disinfection Unit ❑ Add Effluent Filter SYSTEM TYPE(S) NOTE: Submit separate sheets for each system R submitting multiple systems on the same site Enter Fee ❑ Revision to previously approved plan f85.08 ❑ Miscellaneous Review (Le, repucwnenl of a septic tank, addition of an affluent filter or pretreatment device to an sslsting system, etc.) SBWty ® Component Manual Allitreati ore apPmved ❑ et At -Grade Competent Manuel - Ver. 20. S8dR 10854 (N.03I07, V12) Design Wastewater Flow It SPS 0 (2) (3PreViwrJy under y. ❑ In -ground Component Manuel - Ver. 2-0. SSO-10705-P (N.01101, R 10112) Gallons Per day Design wastewater flow of the proposed syste c ® hound Component Manuel —Ver. 2.0. SBU-10891-P (N.0IMI. R 1W12) 7S0 Q o0 ❑ Pracwne Distribution Component Manual — Vw. 2.0. SBD-10708-P (N.01101, R 1 W12) 1.000 gpd or less $250.00 ❑ Other -Please specify GIRD 1,001 —2.00D gpd S 325.00 2, W 1— 5 DOD 9N S 400.00 ❑ SO Based Individual Site Design' One or more treatment components are not previously approved under s. SPS 384.10 (2) or (3} ❑ At Grade (Individual site deaigNdeviation from component ❑ Net-Presswizsd "mound Design march fs and use of components wiUout product ❑ Pressurized inground Wastewater Flow in approval): Cl Mound ❑ Drip{da Gallons Per day Design wastewater now of the proposed system: ❑ Constructed Wetlands GPD 1,001) gpd or less $450.00 • Documentation must be provided to support treatment and dispersal claims. In a Separate 1,001— ZOOO epd S100.00 stalemen4 provide rationale for the project and attach supporting documents (castle sections. test Z001 —5.000 gpd S750.00 grew than 5,000 gpd S9D100 reports, technical papers, research articles, etc) Pitts $0.08 for each Salon over 50M gpd State-owned facilities: HolddN g tanla prewaoapproved under s. SPS ❑ Holding Tank. Component Manual. Ver. 20. SBD-10855-P 04.03W, All 12)• Design Wastewater Flow in 3B4 x3 Design wastewater flow of the Gallas Per day ' Non -state owned Commercial and Residential Holding tanks that completely Utilize grin manual S,000 gpd or less $90.00 end have an estimated daily flour of less than 3000 gallon per day must be submitted to the GPD 5,001-10„000 gpd S150.00 appropriate govammental unit for meow Instead of Me Department. Isee SPS 383.32(3)(a)] greater can 10,0W gpd S225.00 ❑ Holding Tank Individual Site Design% (I.e. site corstmcled, c5 day holding rapacity. Co -Design Holding tanks including site constructed tales NOT mingled wasteuwter. etc.) W Flow In approved under s. SPS 384.10 (2) or(3). Design ivastevater Bow ofse the propod system: Design Please sOerifY Gsteaer day 5A00 god or less 51ti0.00 - Documentation must be pmwded to support m the rationale for the project. In a separate sfateenL great - god $300.00 please include all code sections, lest reports, technical papers, reMrch arUcW, etc.) GPD 10 Mrn 10,000 god 5450.00 greater Union ❑ Sod SaOnetiou DOWMffk tim Ration. (us'shg observation pipes) ❑ Interpretive Defemneatan $240.00 ❑Fapefimenlal System (One timaddlWrid fee). Submitfee for iodwidualsystem as par apgopnale above system type) Experiment Number_ 5400A0 Priority Review (enter same amount as norm, review fee listed above) $ _ Enter Total (rounded to the nearest dollar) $ SSD-10S7r (R 3119) ST. CRO NTY SANITARY SYSTEM File #: Office Use Only OWNERSHIP/ADDRESS FORM c,+eared zrrozr Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. If you would like to view your issued sanitary permit online, you can do so by using the Property Files Scanned weblink. OWNER/BUYER INFORMATION Owner/Buyer Mailing Addre City/State/Zip W 1 ✓1, LkUr ``(i}04 Phone Number (required) 1 \ �' S A " b38a` Email Address (required) Ino P.w a (0Q1q�CL 1 (_IJY -1 Parcel Identification Number dU:- - /0(43 40 306) (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location t4VJ1A ,IJf 14, Sec. _ft, T 2 N RJ[O W, Town of i3A2J ell Wth Subdivision Plat: Lot # 3 . Certified Survey Map # 100 20 `j Volume �q Page # (-5"42 Warranty Deed # Oq 0 0 31 (before 2006)Volume Page # Number of bedrooms Spec house 0 yes 0 no Lot lines identifiable 0 yes 0 no q OFFICE USE ONLY New Property Address Ay?, (Verification of new address required from Community Development Department for new construction.) _f `i 21/2-2 (Staff Initials) (Date) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. Community Development Department - Land Use Division 715-386-4680 St. Croix County Government Center cdd@sccwi.ciov 1101 Carmichael Road, Hudson, WI 54016 715-245-4250 Fax www.sccwi.aov I MWrIrNmTRIWIYll1E W&mtl1OXFMmm.]YaWMMM.•iMF AI4R1Yip .iminR � WmIRICmY w.CG9mWRMIfITEMxCV1EEQ1mNYKl IXMI.XMF m WIW . emn R. rarer - mnR Imvreooer*a a ima.raramm.axuccaunewc«ouauwumcm�rxrawur.w raw ma .snrt. wreaama nevmmrtl weRmitlmmnvmw�u a nararaiwrmiwmuumanoXurmvumeoanaw�.weeRNafa nEvmm BE�.o enavanruluvawrioaxrocuiroarawmm�l MlF r. Vflllflp A4FAR B.VENEM WIrICP.e W WLm1Fa111EM9NrtFlMMCam1Fg9CU 0.Yrl LCrrMaiXMNR rp1XGiM WA.EXi4O fgMMINarIg44ip.rytlN DR4VMBY: aCIWO.M WrtNIRXICXWittCfB m {a I � i I 1 K I I W 1 r 4�FE � 1 ausnowwa o �E I 9 _ lit $ I � W silly I I I I . auvm j I I N reoureowNr • � °7 g I I eou�c; e I I care T � L l E I 4 I wm.°a I nbm. wm mood ` 1 I waemtlsmmmraomemiuf�o. � I I a TYP FQI 1NOATION r)FTAII yA= 1 a*e. mr.ra� 1 I ..wmw.far I I I m�a lIw•ral 1 XXXfr OR• r, 1 R 1 N S I a.muwwa = i 5 I rrawn �„ f I Ca1L R0. t 1 �Ff 1 ° � Inrcunec 1 i-'a.-f Xcv I TYP FRFARINA WAI I r)FTAII rm.Irm-.dr uX•-err 6 FOUNDATION PLAN "�"A3 ----------------------------------- --------- I 1 I I I I I 1 � I I 1 I 3 I I I I 1 I 1 evamrnnoxe sr .s—ewrwxaiwx I I I I I I warm I fee ra I era fm�nw`w...°nev.E k R fx I I I ve ,oPdtY[O :Stl WCt REVIEYET., MTE,i,.IDi] rpKx INNn. REVIBEO Eip lof .AwNR. MTE Y}]O]] REVI RETIM MTE: UNYMRY. �y1�Xm ca � ePjij i • s Q ���j PY TS } ff Z a Y q � w !$ WxMME ARCH D nRYWA OP NING DETAILS WO448ST IDlllm.l'SI pre n.II1VY•YSI raM Iva•. ral F„ F -------------- MAIN FLOOR PI AN WrarPcwrEw BM6IX IPGxFFERFH]F OFII:IIIPIRTI xy1f9 � Rer.mauETfm w„Miieowo L iRN1MR<ION oowerwoRwNrE, oR -0.CCNM PFRrtWIPNNf iOJpiTB1i fe OC.NV ® LNwfOI W0008„XIEIIMLPMEl opr,ruurrwrTNro 4L WxSNL49FYW NlVRL WMIPNEIH Nmregaeo. ® fsalow IWMOIEE w000nl•nwwruax EpINNWLrW41Wp mwnr�moflwwwn a"ENsrw�m EOT1piE0 WPNBIxIK1VWLPx1LL KNiWIMANIYMFATNEp IOYrMmON40EP0^MOPRYxA.1119RLi MTq NpTE aV wrW BR/CWR PMIfIHTYPIGL LxIFBEmMERWIr MTEG. © �I�—va>rO�wv�rn ea,a r WTCXE I u ,m• u i � • � aJ yyI w.l.c. tll 4 yl Enrro i_ I fuucrsN RI rE • n � N 1 p � � vx r yr ,oe ?—eya? n,,•�•a rtr� e :f�nv.r ..oe _ � 4naol s EfrElNalr• ::';'. ram �IfI➢b v MKTER R}: a�• MIYR rr 0•ETN h R l v.rwwq WYI ? • _ at? OWNER'9• x ; F ENTRY •.IIN�—M1tl p O E x � —}a,?' IVY? yp • T T 1 § EXTRr f]i4pUp>q` NrTNMTY IEINrt 1Mm •Y Y Z axaxmE L ROlram MKTER BORNO O=TxR�Wllq�lm s e � S POflCN •�d, „,� . O ISryLEMr S..'� S6 M S S � � oMAoe � ,raurl•REru rrwwu Mr '> � f• > h iprR� • s v W+ u qI I .uG„`�I.M.xvc uW 0 R.P , naly rxr��TY�N�R © v. valR O C rR1W1YDNX IEMmXHMRXOIF s s BEDROOM. BEOIIBOM] �_ 6 N ?p9 I f 4 W.M. r. nIR valR MTN] rr --ra OF w e II N�raax r.e—i—rR <wx.a xa irurm D]xuxieexmm 6 UNFINISHED UTILITY/BTOxRGF BEDEOOM � --- IM' I I I I I I I I i � I 1 I 1 I I I I I I I I I I I 1 I 1 I J I 1 i —_. _ _ J I I I I� I I I I NIrNL 6ET wn:lama u_w_wa_ -�uaaa n, fOIK MIWIID .]>YM BEVBEO BEfa amoa ®mEr .vw :ieenn, BEvIem DEra xoo= wre]oara rsvlso]ETa wTe duwx er: I I I I I I I i wxamL W044M I wn: 213/2022 I 8C4! 11aT 11R' TYI I I I alEEn w C -o Wisconsin Depart i ices Page 1 of 3 Division of Industry SOIL E JUN 21 20%acco nce with SPS385,Ws. Adm. Code County Attach complete site pla on paper not less than � ,1/2 x 11 inches in size. Plan must include, but not limited to: vertica and ho"jB ), direction and percent slope, St. Croix Parcel I.D. Va.4 W r 00 'Ref scale or dimensions, no aap le¢am to nearest road. 9a6-402T`- 0 #2503 Please print all information. Revviee d by 71 Personal information you provide may be used for secondary ourooses (Privacv Law. s. 15.04(1)tm)1. �G�l �` .�//v �D7at/q p //�� Property Owner Property Location ✓ ✓ ❑' Ed & Carol Frame Govt. Lot NW '% NW '% S 19 T 29 N R 16 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 2117 90'" Ave. proposed Na Proposed CSM City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road Baldwin WI 54002 (715) 684-2119 Baldwin Hwy 63 ® New Construction Use: ® Residential / Numberof bedrooms 3 Code derived design flow rate 450 GPD ❑ Replacement ❑ Public or commercial — Describe: `! Parent material Glacial till Flood Plan elevation if applicable na ft. ZC Jt General comments and recommendations: Site suitable for mound POWTS. Recommended infiltrative surface elev. to be 101.00' at 6" above 100.50' contour. FI1 Boring # El Boring L 1 ® Pit Ground surface elev. 99_90 ft. Depth to limiting factor 36 in. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Fe 'Eff#1 'Eff#2 1 0-12 10yr3/3 none sil 2fgr mvfr cw 2vf,f 0.6 0.8 2 12-26 10yr3/6 none scl 2fsbk mfr cw 1vf 0.4 0.6 3 26-36 7.5yr4/6 none sl tcbk mfr cw 0.4 0.7 4 36-54 7.5yr4/6 m2d 7.5yr5/8 sl Om mfr 0.2 0.6 CBoring # ❑ Boring ® Pit Ground surface elev. 100.87 ft. Depth to limiting factor 31 in. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Fe 'Eff#1 'Eff#2 1 0-11 10yr313 none sil 2fgr mvfr cw 2vf,f 0.6 0.8 2 11-23 10yr3/6 none scl 2fsbk mfr cw 1vf 0.4 0.6 3 23-31 7.5yr4/6 none sl 1csbk mfr gw 0.4 0.7 4 31-51 7.5yr4/6 f2d 7.5yr5/8 sl Om mfi 0.2 0.6 ' Effluent #1 = BOD, > 30 s 220 mg/LlWpnd TSS > 0 s 150 m /L ' Effl nt #2 = BOD, > 30 <_ 220 m /L and TSS > 30 s 150 m /L CST Name (Please Print) James K. Thompson !gnat a -i,- - CST Number 30021 Address 340 Paulson Lake Lane, Osceola, WI 54020-5413 ate Evaluation Conducted January 29, 2018 Telephone Number (715) 248-7767 bbU-6ssu (rtu4n5) Boring # ❑ Boring ® Pit Ground surface elev. 100.16 ft. Depth to limiting factor 30 Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD1Ft2 `Eff#1 I 'Eff#2 1 0-18 10yr3/2 none I 2fgr mvfr cw 2vf,f 0.6 0.8 2 18-32 10yr4/4 none sicl 2fsbk mfr cw 1vf 0.4 0.6 3 32-44 7.5yr4/6 f2f7.5yr5/8 sl lcsbk mfr 0.4 0.7 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft' 'Eff#1 `Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. _ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 `Eff#1 'Eff#2 Effluent #1 = BOD, > 30 5 220 mg/L and TSS > 30 5 150 mg/L ' Effluent #2 = BOD, > 30 5 220 mg/L and TSS > 30:5 150 mg/L x1.VoPromp,ot. As Sumo -al a Lev 016CAO 15D'i 300 '' Br r ■l 1 , I , r 8'I l I rr ai I r I r CpTEOcff � 50,'/e✓a16-16cn r"b e EX: sE n V1 �r% acfe ev! Ke.J.' #,2Sa3 Ede mod/ r--O" . ArcpOStd C-6014-4,. toe/ 00o2-/of/3-60-ao (� bt; n ".63 aces s �ou.74t 7, aF &-1drC-;,n, grassed{-&Cd lanf Z ;4 pw...s/ga1 'tl�"J 3y5&IP-aW-eA J 1-3 INDICATES SOIL BORING LOCATION FOR SOIL TEST CERTIFIED SURVEY MAP LOCATED IN THE FRACTIONAL NW )'4 OF SECTION 19, T29N, R16W, TOWN OF BALDWIN, ST. CROIX COUNTY, WISCONSIN. BEARINGS REFER TO THE NORTH LINE OF THE FRACTIONAL NW Y. OF SECTION 19. LINE BEARS 587°51'34"E, ST. CROIX COUNTY COORDINATE SYSTEA NW CORNER, SECTION 19', STEEL SURV(cY �' S MARK NA „/, I NAIL / " - ------------------ FOUND) \03 �3i J I I NORTH LINE OF THE NW Ya L- Z39.49' { ' i a I { v ' N I I in I i O 40.. i ? i 1587"51'34"E j I I 189.44' i 50' D, C5m-.1o(8-OS9 F��J1�DD JUL 0 2 2018 St. -- ix Courty Comm' n' y Deveiooment SCALE IN FEET 0' 100' 20C' 1" = 200' C.S.M. I 55�� YoL_ Pea Pa_ p p I I ( on I 1 g .......,,. HOUSE 587'51 ----399.47'----C 4"E 949.78' f� LOT 3 217,808 SQUARE FEET WELL n B.M.o (5.00 ACRES) SEPTIC W INC.UDING �6FtT'-0E-WAY I VENTa f M 204,625 SQUARE FEET ACRES) �46 (4.70 ❑EXCLUDING / 3*� �RAINAGE�� RIGHT-OF-WAY 10 __ , ^!N0�4> W92 gN 41 32' m " -a9pi APPROXIMATE ORDINARY - S! HIGH WATER MARK - ' a.3 -- LOT 2 738,013 SQUARE FEET(16.94 ACRES) APPROXIMATE INCUUIDING RIGHT-0E-WAY FLOOD PLAIN FEMA 719,8525QUARE FEET(16.BMACRES) MAP NUMBER EXCLUDING RIGHT-OF-WAY Z 55109CO405E✓/ ' 1 494.20' ®I, 50I N87050'33"W m (RFCORDCD AS ri Z�� ' >8 •'L�'U9"E 494.50';, ZINZ. ' ��G1 I v , Wzi LE68�D N H n SECTION CORNER i Fo i (AS NOTED) ui Z 31 • 1.3" DIAMETER IRON I i L PIPE FOUND - - I ' I ® 0.75" X 18" D20N REBAR WEIGHING 1.502 LBS. / I LINEAR FOOT SET -.-� FENCE WY, CORNER, I SECTION 19 i (ESTABLISHED FROM TIES OF RECORD) 587'51' 34"E 161,73' 1138.83' I I I —1------------ a587"51'34"E 397.39. ; W, CORNER, SECTION 19 (1" STEEL SURVEY MARK NAIL FOUND) LAND..W..... W... SS SOLL JOSEPH GRANBERG EDWARD FRAME DRAFTED BY: JWG OLUTION$ 1428 134TH AVENUE 2117 90TH AVENUE JOB NO. 100-533 SHEET NEW RICHMOND, WI 54017 BALDWIN, WI 54002 DATE: 06/26/18 1 OF 2 QOIX couNN STA OWNE PLUMBER S 140 IT 'Av BLOCK NO. 641958 IZY PERMIT E PREVIOUS NO. 22M199 SUBDIVISION b�E�CJ CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (i) The sanitary permit is transferable. History: 1977 c.168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the coup& authority. ISSUING OFFICER - DATE I woZz.. SS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (R11/20)