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Wisconsin Department of CommercK Q PRIVATE SEWAGE SYSTEM county: St. Croix Safety and Building Division •, INSPECTION REPORT sanitary Permit No: 395233 GE INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal 4formation you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. `6 3 / T O NS• �� Peftl it Holder's Name: City Village X Township Parcel Tax No: Jackson, Rick Star Prairie Township 038 - 1149 -31 -000 CST BM Elev: ' Insp. BM Elev: BM Description: l ?• 31 ��. �� / TANK INFORMATION % . ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic MZ /(a C� Benchmark eea 'O0. ' 1 - ' ( �K13�' [ Dosing C LL Alt. BM Z. 6 5 "0• 3S Aeration Bldg. Sewer ct,�� 11 -IT, Holding St/Ht Inlet o/ ` Z G •�/ St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic > 5J t 1 _ Dt Bottom 1 %3.4o Dosing �� H /v Header /Man. Z,�$ �(� "35 Dosing �'9.34' Aeration Dist. Pipe 2•� 9•`l•3S Holding Bot. System •� 9a •4O Final Grade PUMP /SIPHON INFORMATION �'' oo •9 Manufacturer C? :DemAd St Cover G PM Model Number L k . k J �, 'o • I �• I \ ®, Lift I Friction Loss System Head TDH Ft z- 9 3.3o G r Forcemain Len , r , A Dia. K Dist. to Well l SOIL ABSORPTIO B Width Length I P-2 o. Of T- mmeliee• PIT DIMENSIONS No. Of Pits Inside Dia. 1=1 DIMENSIONS 8 38 '� SETBACK SYSTEM TO P/L JBLDG IWELL LAKE/STREAM LEACHING I II a facture, INFORMATION CHAMBER OR Type Of Syste m: � � 5o r � ` 7 y I UNIT odel DISTRIBUTION SYSTEM • Z 3. o I L en eader /Manifold Distribution x Hole Size / x Hole Spacing ent to Air Intake Pipes) �/ �$ 4 Z 3 off -- g th Dia Length 3b • Dia Z Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade stems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded Mulched Bed/Trench Center Bed/Trench Edges Topsoil 10 xx Yes [W No ❑ Yes [k No ( ,, 2 MME T (Include code discrepenci , ,sons present, c.) �r r ection #1: �b /�/ Inspection #2: ! 3 ( / TC ��• ert- G 9r w�Rr . Locatidg "93b rB ave Drive Star Prairie, WI 54026 (SW 1f4 NE 1/4 17 T31N R1 W Wi wam Shores Parcel No: 17.31.18.661 1.) Alt BM Description , 53 �Z A-(eo 6-W. R� 2.) Bldg sewer length= .. 20 \ 3 E - amount of cover = S Pan revision Required? Es Yes KNo gi p. > O � W Use other side for additional information. VVDD 7 Date �Insepctors Signature Cert. No. SBD -6710 (R.3/97) —A r � 2� 7 i oqq Safety W &WdbVs Division Coup ` 201 W. Washington Ave., P.O. Box 7162 Y monsin Maadeaa, wI 33707 - 7162 site D* artment of commerce Sa 5sni Peratlt Numbs ri Pe � r teary Pe rmit App �aq � � , t In unwed whh Comm 83.21, Wis. Adm. Cod a13. m ymm MY be used Cl Check If Revision L Applkagoa Iniotmalien - Fieaaa Petit All REc E�VE D. Number Property owner's Name Nu 3 ) _t � Forcer Numbe 2001 Property Owner's M"Ing Address per, Loottioa 6/ zc&,�.��S 'A &F 'A - s T : 3 2 N R 7 W City, sate Zip Code C Phone Lof;�iumbar ,Mock Number A T� Subdivision Rams CSIA Number II.1npe of Buildh>B (check an that slp*) �,✓ ",' sue, or 2 Ftm* Dweiltng - Number of Bedrooms OViilage D Ptbtic/Calpmett:ial - Dew7ibe use 0 sine owned,, r ctit�� III. Type Of (Check Daly oaa box nee Hsu A (numberb* schema for interned use). Complete lute I It applicable) A. 2 0 Iteptacculaw System 3 0 Raplacameut of 6 13 Addition to For County tees / , 3 / • 7 6 / System I Tank Dpi Existim s y stem 6),3 - 3 — 000 H • 0 Cheek if Settiauy Pwtnd Previously Isetted Penait Number Line Issued IV. Type of Fawskt (Check an that ap*)(=mberina whom is for internal use) 44 0 Nat - Pwaiurlaed In•QrquW pR 47 0 Sand Filter so D Constructed Wetland 22 ❑ Proa wind Le -Ground 41 Holding Tuck 48 © Single Paso' 51 ❑ DAP Line 410 AW=do 46 ❑ Aerobic Trm►tment unit 49 ❑ Reehoula so ❑ ther V. Area lnformM kws DWpa Plow (tpd) Dlq+oz:aI Area Dispersal Area Soil Applicadoa Percolation Rate System Movation "W owe RegAW Proposed Rate(cials.roaya/sg.Fet.) (Miu./1aole) Ekvuton Soo C� oz VI. Tank lhfo ity in Total Number Maeufacturer Prefab sits Steel Fiber Plastic Oasons Qailaos of Tanks Concrete Conetucted O1us New ads*# sum UjIg Sepdc or Hw tet Tok Sam �D &IMMent- L the maderdwat stmobe responsibalty for 3oabdlasion of the POWTS abown on the atteeked PhurMr' Nams (Prklt) Pbmtber'a MP BusineaPd►ona Number BMWs"" (street, C . state. Zip ) Q� D� 2 un Ap*"d 11 'ed Sanitary pannit Fero (includes Groundwater Des Issued 1 Sitaaum (No SUMPS) Cl Owner Ohroc IoM Adverse , ) cz/,, (S I Apprm�al/Reaeuos for Disap ��r ww he �� �..'f Q IiJ h�1- 7S-Cce s?j' —� �row� ('�lc� s w 1 f' �K p /at e .�r1tJ s� %b tl y �dutil?�, IN V�,t �7ti t tbaa , x � � � tr Nss a �/� SH3 .05101 �° �c. �j/�C_ �`T'ti�" �. T ' Q ` Safety and Buildings ` 4003 N KINNEY COULEE RD LACROSSE WI 54601 -1831 TDD #: (608) 264 -8777 www.commerce.state.wi.us /sb N. Visc ons� n www.wisconsin.gov Department of Commerce Scott McCallum, Governor Brenda J. Blanchard, Secretary July 31, 2001 OUST ID No.226900 �E© ? IN (/r : POWTS Inspector SHAUN R BIRD z Sr G>� < ING OFFICE COU BIRD PLUMBING, INC\ = CROIX COUNTY SPIA 1008 192 ND AVE \f . G EC I HAEL RD � 1`., E • ` Y101 CARM C NEW RICHMOND WI 54017 \� /HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/31/2003 Identification Numbers Transaction ID No. 663331 SITE: Site ID No. 633532 RICK JACKSON Please refer to both identification numbers, BRAVE DR above, in all correspondence with the agency. TOWN OF STAR PRAIRIE ST CROIX COUNTY SW1 /4, NE 1/4, S17, T3 IN, RI 8W LOT: 2W, BLOCK: F, SUBDIVISION: WIGWAM SHORES FOR: DESCRIPTION: TWO BEDROOM MOUND SYSTEM OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 804036 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01/01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD - 10706 -P (N.01 /0l). • In the event this soil absorption system or any of its component parts malfunctions sous 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 manual, and section VI of the pressure distribution component manual are complied with. A copy of this letter including instructions and information relating to proper use and maintenance of the system must be given to the owner and each subsequent owner upon completion of the project. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. • Access to the filter for cleaning must be provided per Comm 84 product approval conditions. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required • The proposed tank appears to be located in an area subjected to saturated conditions. Therefore, it must be anchored per Comm. 83.43(8)(g), Wis. Adm. Code to prevent floatation of the tank. Documentation of the method of anchoring and calculations to prevent floatation are to be attached to the plan prior to issuing of the sanitary permit. • The setback of the POWTS to the high water mark of the lake is to be at least 50 feet as established in Comm 83.43(8)(i), Wis. Adm. Code. This shall be verified at time of installation. ( SHAUN R BIRD Page 2 7/31/01 • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). In addition, 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. • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.52(3) The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • 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. • The changes made to this plan on 7/31/01 by this reviewer were acknowledge and approved by the system designer. • NOTE: Plans Submittal; designs that are based on department approved component manuals must include reference to the manual name, publication number and published date. 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 Charles L Bratz POWTS Plan reviewer H- Integrated Services WiSMART code: 7633 (608) 789 -7893, Mon. -Fri. 7:45 AM to 4:30 PM cbratz @commerce. state.wi. us cc: RICK JACKSON r PLOT PLAN PROJECT • Rick Jackson _ ADDRESS 2617 Duluth St. Maplewood Mn 55109 SW 1/4 NE 1/4S 17 /T 1 N/R 18 W TOWN Star Prairie COUNTY St. Croix MPRS Shaun Bird 226900 DATE 7/16/01 BEDROOM 2 CONVENTIONAL IN -GR ND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND )= SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 300 # of chambers none BENCHMARK V.R.P. Top of survey stake ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 99-.4 Plans designed us {n mound Scale = 1/4" = 10' and pressure ma CORRESPOND" �5 - IS Aa version 2.0 Owner owns both parcels Well is to meet all p setbacks found in Comm. 83 System is to be 0 designed so that `° - - -w runoff is diverted o .� -. away from system CD m r System is to be m installed along * the contours Pro 2 B.M. Bedroom 99 Cabin B-1 9 7' 7S �pu� FL ❑ Huffcutt B-& A l f Combo Tank B-3 9 5' 6% �5 c Slope wva CD 44 10 0. Vim. Ki,LJ 15�.k��.0 Squaw Lake Area 15' below Tank is to be properly bedded system is to co"d011Qfl and provided with {ockdown remain APPROVED covers with approved warning undisturbed labels OFD Of 40 .. _ _^ ,J, �� 'R 3�t7i « Noon —hover litter Fabric 4 Ob servatio n a�swation pips Per�orrtted Below Filter Fabric ,aiserl0ulion Pipe AM A C•-33 Son d � ' V - 7 " Topsoli a• +• Stope ��� z Bed Of r�A 2 :� F orCt Mdlr, Flowed Arai„ Raak From Pump Layer Cross Stcligh Of A Mound Systsa+ A be For The Abs or n Are* F S 6 ..Lw.. A .. Ft. S '3 Ft. Ft. K. Ft. / r n `,* L Ft. �k �e.P W .....:.�. Ft J 4Observotion Pipe 7 W H Arrw ..rw-_rrrrw --- ----------- Force Main r r• w���..w� �~ From Puff -- .r.- .....,......... Bed Of Ut B ..............,. p G Distribution B L j P i p* Crain B eak dptervotion Pipe Permanent Mork4w PI Pe or Rode Pion View Of Mound Uein A Bed For Tttt Abipr lion Area PAQC O Perforated pies. fl�1 J 0 n0 Weer �Perto•a +eo �'' Pve Poe Hollis Loseled On iellern, Are Equerry swee P VC Fort. Moan/ I' FtRsr Mats. MILWY re Cornet ien PVC moni lol d Pipe P�Oe 4�;x T ►� �� c� Oislr PiAR i.pyCtlr P F R Fie X I Inch*$ Y Inches Signed. hole Diameter 7 Inch License Number " o�2 9 Lateral " Inch(es) Manifold a2 inches Date: ��� ---�{ — � � ---- . --.-- Force Main " cv ?...., Inches # of holes /pip =a0 Invert ElevAtion of Laterals Q .7 Ft. . raga ur SEPTIC TANK 6 PUMP CliAMBLR CROS SECT A SPECIFICATIONS 4" Cl VENT PIPE �12" MIN. ABOVE GKAFE 4 WEATHERPROOF 2: 25 , FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W1 PADLOCK 8 FINISHED GRADE WARNING LABEL {.Nrr'•w. 4" MIN. 18" IN y C. Z. QdFE RW►Ta+�1 x A } 1 �� fAt* INLET WATER TIGHT SEALS GAS- ; ' :'IGHT PPROVED FILTER ---- -i A SEAL 1 JOINTS WITH -ai APPROVED - I � ALM APPROVED PIPE PIPE 3' B ' ON 3' ONTO ONTO SOLID � � c � � SOLID SOIL SOIL PUMP OFF ELEVI.0 /PT. OFF D 3" APPROVED BEDDING UNDER TANK J % a ONCRETE PAD _ SPECIFICATIO l v � t D44 SEPTIC / DOSE .� TANK MANUFACTURER: NUMBER DOSES PER DAY: TANK SIZES SEPTIC 4 GAL. GAL. DOSE VOLUME INCLUDING 4b 5 F LOWBAC K : .5 GAL DOSE ALARM MANUFACTURER: � s MOCAPACITIES: A = ��SNCHES o yya.s MODEL NUMBER: � �30 GAL. SWITCH TYPE s� B .�.� INCHES s ...�.._... -. C •J INCHES = i L,57 - GAL. PUMP MANUFACTURER: MODEL NUMBER : D 4�; INCHES . q,6 GAL. SWITCH TYPE: � ---- REQUIRED DISCHARGE RATE, GPM PUMP E ALARM WIRING AS PER ILHR 15.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE ^ FEET .3 FEET + MI T,MUM NETWOR SUPPLY PRESSURE . . . . . . . . . . . . _ + FEET F CEMAIN X�FT /LQD FT. FRICTION FACTOR . FEET TOTAL DYNAMIC HEAD FEET INTERNAL DIM£NS 0 8 OF PUMP 'TANK: LENGTH / � -� : ;IJ�TH DIAMETER �._� LIQUID C NSF. NUMBER: SIGNED: 'I E -- • • Performance Data 40 FL 30 IJ Pump Characteristics .o mmd WWI sm"1162 hlelp Nk AelMit Stt OA1 SNEFW 10 4/10 Folload Amp 12 1 6.s am Type AL shedder a Poti►) D 10 N 60 70 G PM �0 hllm re tt3 230 total Dead (low) 10 14 17 1 21 23 iS 30 33 Nft A b0 pm (ml 3. 33 7 i .7 120° F Mm Add T . OPM (US O M) 70 do 'SO �0 30 30 10 0 w" MA A Mswloeer Coos~ A (tan aae) 4. 2.5 1. 1 �s Dimensional Data F s.ad� s an » IM. a-1 r— e6V (10817) 1. Al (fim Kiom In is w. ( Aleck for Fowl card t>s 1�. SJ11M, 2W std. roux) 51 t1z» Ini motional use). taw 401111111111 11 Materials of Construction L �4 va le ImIl. May Dtirlv"�reE 3. X ot for erh0' loll o!e §iA . -w leg SWITCH 4. Dimensions and weighs are SaLko s approft h. Sed FWAK Gr1110ANanac 5r we,: reserve fd . Mit to mice shah Sad S.d Apood 3teo) re�isians to - our. ,aad lhek . Staild�u Steel. s to* - 01lout;notire; unw \ 1... -c , t jyj 4 M 1998 Fopxol '� Pumps, As n , Ohio, RIQ Rom HYDROMATIC °' [ aney Road Ashland, Ohio 41805 Tei: 4)9.299.3042 Fox; 419-267-407 t� i tir pIf�; Web Site: www.peMairpaaap,cam r � � ;.: SALES OFFICES IN ALL mAJOR CITIES AND COUNTRIES umps in the yellow pges of your phone diredwy for you local Dwri6utor fa , fremq: W-02-6680 1 i 98 5M .AI 4 Maintenance and Contingency Plan for a Mound System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Dose Chamber is to be pumped at the same time as the septic tank. 3. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 4. Once every 3 years the mound is to be inspected via the inspections pipes in the at- grade. The laterals are to be inspected via the cleanouts. 5. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 6. Pump and electrical components are to be checked at the time of the pumping. 7. Owner agrees to leave the area 15' below mound undisturbed. 8. The owner agrees to save this plan. 9. Trees, shrubs, and other similiar vegitation are not be planted on system. The system is not be driven over. 10. Effluent Quality is not to excede the requirements found in Comm. 83 Contingency Plan 1. Pump alarm goes off, call pumper and pump out dose chamber and septic tank if needed, then bypass pump float and try pump without float. If this works, float is bad, replace float. If pump still does not work, check power at the pump with a electrical device such as a hair dryer. If no power, check breaker inside house and call a electrician. If there is power, then pump is bad and needs to be replaced by a plumber. 2. If mound fails, determine cause of failure, test another area or remove pipe and sewer rock, retill soil, install new mound system. 3. Replace any other failing components as needed. Important Phone Numbers Plumber: Shaun Bird 715 - 246 -4516 Pumper: Chuck Nutzmann 715 - 248 -3735 St. Croix County Zo ing 715- 386 -4680 Shaun Bird #226900 7/16/01 I POWTS OWNER'S MANUAL ax MANAGEMENT PLAN Page of _ FILE INFORMATION SYSTEM SPECIFICATIONS Owner ' fi f� Septic Tanis Capacity gral ❑ NA Permit F Septic Tank Manufacturer O NA 'DESIGN PARAMITM Effluent Filter Manufacturer e . ) ❑ NA Number of Bedrooms D NA Effluent Fitter Model o O ❑ NA Number of Commercial Units Pump Tank Capacity Bal 0 NA Estktiated flow (average) t5 gal /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer O NA Soil Application Rate 0 pi/day/ft' Pump Model 0 NA influent/Effluent Quality Monthly average* Pretreatment Unit Fats, Oil at Grease (FOG) s30 mg/L © Sand/Gravel Filter 0 Peat Filter Biochemical Oxygen Demand (BODs) s220 mg/L O Mechanical Aeration C] Wetland Total Suspended Solids (TSS) s 150 D Disinfection ❑ Other: Pretreated Effluent Quality 0 NA Monthly average +* Dispersal Manufa cturer (s) Biochemical Oxygen Demand (BODs) s30 mg/L ❑ In-ground (gravity) C3 In- ground (pressurized) Total Suspended Solids (TSS) s30 mg/L 0 At -grade : '� Iound Fecal C !bm tric mean) 510 cfu/ 100ml O Drip4ne h] Other: Maximum Effluent Particle Size Inch diameter + Values typkal for domestic (non - commercial) wastewater and septic tank effluent, * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service but Service Frequeecy Inspect condition of tank(s) At least once every ❑ months .4 year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one -third (iii) of tank volume Inspect dispersal cell(s) At least once every D months `}5l year (MaxLmam 3 yrs.) Clean effluent filter At leastonce every 13 months ,9year(s) Inspect pump, pump controls ax alarm At least once every l7 months yea(s) DNA NO laterals and pma n test At least once every D months years) DNA NW At least once every ❑ months ❑ year(s) NA Men At least once every O months O year(s) NA MAINTENANCE INSTRUCTIONS lnspectim of tanks and disperW cells shall be made by an Individual carrying one of the following licenses or cerdficadons: Master Plumber Master Pkw6er Restricted Sewer, POWTS inspector; POWTS Maintainer; Septage Servicing Operator. Tank Inspections must Include a visual Itispectlon of the tank(s) to Identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually Inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surbr*.' The ponding of effluent on the ground surface may indicate a falling condition and requires the Immediate nodAcation of the iota! regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (%) or more of the tank vokuw the entire contents of the tank shaff be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Adnllnlsa Code. The servicing of effluent Alters, mechanical or pressurized POWTS components, pretreatement components, and any other maintenance or monitoring at Intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority witisln 10 days of completion of any service event. START UP AND OPERATION For rww colisiritctiott, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may Imnede the treatment process and/or damage the dispersal celi(s). If high concentrations are detected have the contents System start up shall not occur when soil conditions are frozen at the lnilltrathre surface, pa— of Dutft WW WtNU pump tanks tray tbi above normal highwater levels. When power Is restored the excess wastewater will be dbdarged to doe fspersal cell(s) In one large dose, overloading the cell(s) and may result In the backup or surface discharge of OMUM . To NOW this *UWon have the contents of the pump tank ,removed by a Septage Servicing Operator prior to restoring POW to the effluent PUMP or contact a Plumber or POWTS Maintainer to asstst in manually operating the pump controls to restore normal levels wi do the pump tank. Do not drive or park vehicles . over tanks and dispersal cells. Do not drive or park over, or otherwise dlsturb or compact, the area within 15 feet dawn slope of any mound or at -grade soil absorption area, Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms, cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; frult and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; DAnft products, Destiddes; sanitary naaklns; tampons; and water softener brine. ABANDONMENT When the POWTS falls and/or Is permanently taken out of service the following steps shall be taken to Insure that the system is properly and sahiy abandoned in compliance with ch. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The Contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumpinR as tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another Inert solid material. CONTINGENCY PLAN If the POWTS f9s and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: G A suitable replacement area has been evaluated and may be utilized for the location of a replacement soll' absorption system. The replacement area should be protected from disturbance and compaction and should not be Infitiged upon by reolred setbacks born existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules In effect at that time. A suitable replacement area Is not avabble due to setback and/or soil limitations. Barring advances In POWTS technology a holding tank may be Installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. if no replacement area is available a holding tank may be Installed as a last resort to replace the failed POWTS. ❑ Mound and atV*& soil absorption systems may be reconstructed In place following removal of the blomat at the hdiitradve surface. Reconstructions of such systems must comply with the rules In effect at that time. < <WARNING> > SEPTIC, PUMP AMP OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN, DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE' OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR tMPA.�.UR1,i.. ADDMOUL COMMENTS POWTS INSTALLER POWTS MAI NTAINER Name a, 1 \, i ✓ Name. ge r Phone j2 Phone 71 SEPTAGE SERVICING OPERATOR PUMPER) LOCAL REGULATORY AUTHORITY Name r �, I rvi '' Standard Erosion Control Plan dAr. 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Name Daytime telephone number Street address, city, zip code Location of the building site (complete as appropriate): f ly PF- `0 3� quarter of Section . Town N., Range �! l Lot Block 6t i e, 3 1, nn Or Street address Instructions: 1. Complete this plan by filling in requested information, marking (.O appropriate boxes, and completing the site diagram. 2. In completing the site diagram, give consideration to potential erosion that may occur before, during, and after grading. Water runoff patterns can change significantly as a site is reshaped. 3. Chapters ILHR 20 & 21 of the Wisconsin Uniform Dwelling Code, the DNR Wisconsin Construction Site Best Management Handbook, and UW - Extension publication Erosion Control for Home Builders can be referred to for assistance in completing this plan. The Wisconsin Uniform Dwelling Code and the Wisconshi Construction Site Best Management Handbook are available through State of Wisconsin Document Sales, 608/166 - 3358. Erosion Control for Home Builders (GW0001) can be ordered through Cooperative Extension Publications, 608/162 -3346. 4. Submit this plan at the time of building permit application. Chock () appropriate bares below, and complete the site diagram with ncoessaty information: 1c b 1, � site Characteristics North arrow, scale, and site boundary. Indicate and name adjacent streets or roadways. ❑ Location of odsting dminageways, streams, rivers, lakes, wetlands or wells. ❑ Location of storm sewer inlets. The gradient and direction of slopes before grading operations. The gradient and direction of slopes after final grading operations. `-. Location of oadsting and proposed buildings and paved areas. ❑ -3e Overland runoff (sheet flow) coming onto the site from adjacent areas. Erosion Control Practices ❑ Location of temporary soil storage piles. Note: Although not specifically required by Code, it is recommended that soil storage piles be placed behind a sediment fence or more than 25 feet from any downslope road or drabwgeway. Location of graven aems drive(s). Note: Recommended gravel drive design is 2 to 3 inch aggregate stone laid at least 7 feet wide and 6 inches thick Drives should extend from the roadway 50 feet or to the house foundation (which ever is less). 7d ❑ Location of sediment fences (filter fabric fence, straw bale fence) or vegetative strips that will prevent eroded - soil from leaving the site. ❑ ` Location of sediment barriers around on -site storm sewer inlets. ❑ Location of diversions. Note: Although not specifically required by Code, it is recommended that concentrated flow (drainageways) be diverted (re- directed) around disturbed areas. Overland runoff' (sheet flow) from adjacent areas greater than 10,000 sq. ft should also be diverted around disturbed areas. ❑ a,Q 1 Location of practices that will be applied to control erosion on steep slopes (greater than 12% grade). / Note: Such practices include maintaining existing vegetation, placement of additional sediment fences, diversions, and re- vegetation by sodding or by seeding with use of erosion control mats. ❑ t Location of practices that will control erosion in areas of concentrated runoff flow. / \ Note: Unstabilized drainageways, ditches, diversions, and inlets should be protected from erosion through use of such practices as in- channel fabric or straw bale barriers, erosion control mats, staked sod and rock rip -rap. When used a given in- channel barrier should not receive drainage from more than two acres of unpaved area, or one acre of paved area. In- channel practices should not be installed in perennial streams. 13 � Location of other planned practices not already noted. I Wisconsin Department of Industry, SOIL AND SITE EVALUATION. REPORT Page _ of Labor and Human Relations ;livision of Safety &Buildings in accord with I LH R 83.!1 �`� � COUNTY Cr- � X Attagh complete site plan on paper not less than 8 1/2 x 11 inches 40 -plan must include,`btAs not limited to vertical and horizontal reference point (BM), directio i % of slope; " %qaW or PARCEL I.D. # dimensioned, north arrow, and location and distance to neares F R I APPLICANT INFORMATION PLEASE PRINT ALL INF B ATE ATE 6 PROPERTY OWNER: p PROPERTY LOCATI 061 "' GOVT LOT 1/4,S T N,R E (o W PROPERTY 0 ER':S MAILING ADDRESS �' , s OT # BL #, $1.18D. AME OR CSM # & r s , A/c L> /'. CITY, STATE ZIP CODE PHONE NUMBER 13CI AGE VOWT N EST ROAD L A) - 6 1 Dr New Construction Use [ Residential / Number of bedrooms [ ] Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate ��- bed, gpd /ft2 gpd/ft Z Absorption area required - bed, ft 3 76 / trench, ft Maximum design loading rate bed, gpd /ft gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations Parent material Oi�. Flood plain elevation, if applicable /✓ ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING T NK U= Unsuitable fors stem EIS U w S ❑ U ❑ S X U ❑ S MU EIS EO U ❑ S 12U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD Boring # Horizgn in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed .................. .................. ................. .................. ................. 0 lejr 3z ,s j oy, ,-, .s Ground 3 - �' ! 1, v. �t. Depth to �O limiting fac Remarks: / Boring # / 0- a3 Z s� Lf 1' %b - Ground kmv 3 /0.e 5/ , - ' X/ � eyle . Q `/ 't' Depth to X� limiting f 23 Remarks: CST Name:- Please Print ,� 0 p Phone: (7 Z Ge - 7 ,� 16 Address: C A n e. J Signature: Date: CST Number: PROPERTYOWNER SOIL DESCRIPTION REPORT Page — of 3 PARCEL I.D. # `t Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sh. en Bed Trench j 6= ld / e /w /da Elk Ground � 7 SY,^ 4 11 b God ax 94Z /A/, /✓/ AYle �lev Depth to limiting factor J Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. Depth to limiting factor Remarks: SBD- 8330(8.05/92) l • • Soil Test Plot Plan Project Name Will Enright Byro 'rd Jr. Address 643 Farrell St. Maplewood Mn 55119 C 479 Lot 2W Subdivision Wigwam Date 8/ 1/94 SW 1/4 NE 1/4S 7 T 31 N/13 W Township Sta Prairie ❑ Boring O Well PL Property Line County ST. CROIX lk BM or VRP Assume Elevation 100 ft Base of Prope Line Stake System Elevation 99.4 * H R P Same as Benchmark Brave Drive 90' Property Line 105' M. 10' TV' B -1 17' 6% Mound Area lope 85 ' -2 5 ' k4 r N 7 ' N 5 , B 0 r a' 1' c uaw Lake �' / o�( i �e5 -Site Diagram - Note: Any base map of useable scale can be substituted for this sheet. Ak- �7 160 1 ' v O o � W Site Diagram Legend Please indicate north direction PROPERTY �� SILT by completing the arrow. LINE FENCE EXISTING STRAW DRAINAGE BALES TD TEMPORARY l' +.i GRAVEL � DIVERSION FINISHED TREE -' DRAINAGE 13 PRESERVATION I LIMITS OF STOCKPILED GRADING TOPSOIL VEGETATION O SPECIFICATION Scale: AREA 1 inch = feet Indicate management strategy by checking (%0 the appropriate boot Management Strate¢ics ❑ Temporary stabilization of disturbed areas. Note: Although not specifically required by Code, it is recommended that disturbed areas and soil piles left inactive for extended periods of time be stabilized by seeding (between April 1st and September 15th), or by other cover, such as tarping or mulching. Y N Permanent stabilization of site by re- vegetation or other means as soon as possbl 141� ❑ Use of downspout and/or sump pump outlet extensions. n ag- Note. Although not specifically required by Code, it is recommended that flow from downspouts and sump pump outlets be routed to stable areas such as established sod or pavement: ❑ 'Napping sediment during dewatering operations. Note: Although not specifically required by Code, it is recommended that sediment -laden discharge water from pumping operations be ponded behind a sediment barrier until most of the sediment settles out. Proper disposal of building material waste so that pollutants and debris are not carried off -site. Maintenance of erosion control practices. • Sediment will be removed from behind sediment fences and barriers before it reaches a depth that is equal to half the barrier's height. • Breaks and gaps in sediment fences and barriers will be repaired immediately. Decomposing straw bales will be replaced (typical bale life is three months). • All sediment that moves ofd site due to construction activity will be cleaned up before the end of the same workday. • All sediment that moves off -site due to storm events will be cleaned up before the end of the next workday. • Gravel access drives will be maintained throughout construction. • All installed erosion control practices will be maintained until the disturbed areas they protect are stabilized. L _.::.... hereby certify that derstand the aonstructton site erosion control provist0' ' of the Wisconsin Uniform Dwelling Code, and at i accept r nsibil ty forcarrying'out the above erosion oontrol plan as approved<b the code .enfo ' uthor.' Si re o applicant Date A publication of the University of Wisconsin - Extension, Ron Smiss, UWEX Water Quality Education Specialist (12192). ?his publication may be freely duplicated Additional copies are available through the UR X Environmental Resources Center, 216 Ag Nall, 1450 Linden Driv4 Madison, Wl, 53706 6081262 -3652 1 ' EROS1014 CONTROL FOR HOME BUILDERS Preventing Erosion Is Easy Erosion control is important even for home sites of an acre or less. The materials needed are easy to find and relatively inexpensive —straw bales or silt fence, stakes, gravel, plastic tubes, and grass seed. Putting these materials to use is a straightforward pro - cess. Only a few controls are needed on most sites: • Preserving existing trees and grass where possible to pre - =- vent erosion; • Silt fence or straw bales to trap sediment on the down - slope sides of the lot; By controlling erosion, home builders keep our streets • Soil piles located away from any roads or waterways; and waterways clean. • Gravel drive used by all vehicles to limit tracking of mud onto streets; Erosion Is a Costly Problem . Cleanup of sediment carried off -site by vehicles or Eroding construction sites are a leading cause of water storms; quality problems in Wisconsin. For every acre under con- struction, about a dump truck and a half of soil washes • Downspout extenders to prevent erosion from roof into a nearby lake or stream. Problems caused by this sedi- runoff; and went include: • Revegetating the site as soon as possible. Local taxes -- Cleaning up sediment in streets, sewers and ditches adds extra costs to local government budgets. Dredging The expense of dredging sediment from lakes, `k harbors and navigation channels is a heavy burden for taxpayers. °d a Lower property values— Neighboring property values are damaged when a lake or stream fills with sediment. Shallow areas encourage weed growth and create boat- ing hazards. o a -' Poor fishing —Muddy water drives away fish like north -' ern pike that rely on sight to feed. As it settles, sediment _++ smothers gravel beds where fish like smallmouth bass find - food and lay their eggs. •or Qsr �, Nuisance growth of weeds and algae — Sediment carries fer -; tilizers that fuel algae and weed growth. Erosion Con For Hon STRAW BALE or SILT FENCE • Put up before any other work is done. • Install on downslope sides of site parallel to contour of land. • Extend ends upslope enough to allow water to pond behind fence. - SAMPLE EROSION • Bury 8 inches of fabric in trench (see back page) CONTROL PLAN I \ • Stake (2 stakes per bale) FORM OR 2 \ • Leave no s. Stuff straw between bales or overly sec- FO \ Bap P DWE tions of silt fence. \ • Inspect and repair once a week and after every 1 /z inch rain. Remove sediment if deposits reach half the fence i �\ height. Replace bales after 3 months. I \ O r • Maintain until a lawn is established. SOIL PILES \ • Locate away from any downslope street, driveway, \ stream, lake, wetland, ditch or drainageway. i AREA TO BE TOPSOILED, • Temporary seed such as annual rye or winter wheat is SEEDED AND MULCHED recommended for topsoil piles BY OWNER AT THE HOUSE COMPLETION OF I GARAGE CONSTRUCTION IM T[ GRAVEL DRIVE,. • Install a single access drive using 2 to 3 inch aggregate. \ \ • Lay stone 6 inches deep and at least 7 feet wide from \ the foundation to the street (or 50 feet if less). \ • Use t6 prevent tracking mud onto the road by all — — — — vehkkS R/W LINE • Maintain throughout construction., SEDIMENT CLEANUP S OIL TYPE: SILTY CLAY STREET NAME • By the end of each work day, sweep or scrape up soil SLOPE: 3% tracked onto the road. • By the end of the next work day after a storm, clean up the soil washed off -site. SEWER INLET PROTECTION g' • Protect on -site sewer inlets with straw bales, silt fences o � or equivalent measures (see back page). eam • Inspect, repair and remove sediment deposits after every storm. ee s o o r o m DOWNSPOUT EXTENDERS d ase ani • Not required, but highly recommended. o e 4 ! Install as soon as gutters and downspouts are completed n p to prevent erosion from roof runoff. n Route :wa* -..'i a pa o grassed.or ved:area. • Maintain until a lawn >LS established. IN of Practices ' e Sites PRESERVING EXISTING VEGETATION • Wherever possible, preserve existing trees, shrubs, and other vegetation. EROSION • To prevent root damage, do not grade, place soil piles, CONTROL PLAN or park vehicles near trees marked for preservation. LEGEND . Place plastic mesh or snow fence barriers around trees PROPERTY to protect the area below their branches. LINE N 1 EXISTING — TOPSOIL — — DRAINAGE REVEGETATION —�- TD TEMPORARY DIVERSION Seed, sod or mulch bare soil as soon as possible. DRAINAGE FINISHED — SWALE - -' DRAINAGE LIMITS OF SEEDING AND MULCHING - — GRADING • Spread 4 to 6 inches of topsoil. SILT FENCE * Fertilize and lime if needed according to soil test (or apply 10 lb. / 1000 sq. ft. of 10 -10-10 fertilizer). •� —+ B,� a Seed with an appropriate mix for the site (see table). GRAVEL • Rake lightly to cover seed with 1/ " of soil. Roll lightly. VEGETATION - Mulch with straw (70 -90 lb. or one bale per 1000 C ION ONSTRUCT ® SPECIFICATION sq. ENTsmce/EXrr AREA - * Anchor mulch by punching into the soil, watering or ® TREE by using netting or other measures on steep slopes. PRESERVATION . Water gently every day or two to keep soil moist. Less STOCKPILED watering is needed once grass is 2 inches tall. SOIL SCALE: 1 " =40` PROJECT LOCATION: SODDING . EXISTING CURB PROPERTY OWNER: a Spread 4 to 6 inches of topsoil. AND GUTTER ANTICIPATED STARTING DATE: - Fertilize'and lime if needed according to soil test (or C ANTICIPATED COMPLETION DATE: ANTICIPATED 10 lb. / 1000 sq. ft. of 10 -10 -10 fertilizer). PREPARED BY DATE • Lightly water the soil. • Lay sod. Tamp or roll lightly. • On slopes, lay sod starting at the bottom and work 1 toward the top, overlapping like shingles on a roof. Peg each piece down m several places. • Initial watering should wet soil 6 inches deep (or until i water stands 1 inch deep in a straight -sided container). Then water lightly every day or two to keep soil moist - but not saturated for 2 weeks. o - u If construction is completed after September 15, final seeding or sodding may be delayed. Temporary seed (such as rye or winter wheat) may be planted until October 15. Mulch or matting may be applied after. October 15, if I � weather permits. Straw bale or silt fences must be main- : z> tained until final seeding or sodding is completed in spring (by June 1). . At Sewer °Inle ProtectJ 1 1 1 , C autions Consider public safety when using inlet barriers. These barriers create ponding and mud deposits on streets. Frequent maintenance is essential. After every storm, remove sediment deposits and repair barriers. Repairs may be needed several times a day during major storms. Curb Inlet 1. Place concrete blocks on their Figure 6 —Curb Inlet Block sides around inlet. and Gravel Barrier Block & Gravel Barrier 2• Put a 2" x 4" wood stud through — Curb inlet - outer holes of side blocks to p support front row of blocks. 3. Put wire mesh with half inch openings on outside of blocks. Wide mesa Cover mesh with filter fabric & finer fabric Concrete block Gravel finer extending fabric 12 inches onto Runoff pavement. water with overflow Rin ered water sediment 4. Pile 1 to 3 inch washed gravel on fabric to top of blocks. Sediment Note: Allows overflow to prevent Wire mesh 2" Curb inlet excess ponding. a fitter fabric wood stud Drop Inlet 1. Place concrete blocks on their Figure 7 —Drop Inlet Block sides around inlet. Adjust height of and Gravel Barrier Block & Gravel barrier by stacking rows of various Wire mesh concrete block sizes of block. & finer f abric Barrier 2. Put wire mesh with half inch openings on outside of blocks. - Cover mesh with filter fabric extending fabric 12 inches onto pavement. Gravel finer - - Runoft 3. Pile 1 to 3 inch washed gravel ater wi wee mesh & utter f abric water with ��w Filtere wat er Note: Allows overflow only when water on fabric to top of blocks. z od m! reaches top of blocks. Adjust height to prevent traffic hazards or damage to structures. sediment with grate Drop Inlet 1. Build a frame of 2" x 4" wood Figure 8 —Drop Inlet Filter around inlet. Drive stakes into Fabric Barrier Filter Fabric ground at least 12 inches. 2^ x 4^ wood frame Barrier 2. Dig an 8 inch deep trench w i , outside frame. 4^ maximum 3. Attach wire mesh to frame i 1 2" minimum extending mesh 2 inches into l l l trench. L!- 4. Attach filter fabric to frame Wire mesh m finer fabric extending fabric at least 8 inches _ _ ends into trench. Overlap joint to next of fabric stake. g S between Note: Allows overflow only when water r� 2 stakes reaches top of frame. Adjust height to 5. Backfill and compact soil in trench. prevent traffic hazards or damage to structures. ^- ������ Co � o secl o Co tr f s • : Straw Bale Figure 2 —How to Install a Straw Bale Fence 1. Excavate a 4" deep trench. 2. Place bales in trench with bind- Fences ings around sides away from the - r. ground. Leave no gaps between Figure 1 —Cross Section bales. of Straw Bale Installation /� ? •y " �� �"•' �- low ale y i• ��� I w I' Wid Staked and Entrenched Binding Wire Straw Bale 3. Anchor bales using two steel re- or Twine Compacted Soil to Prevent Piping bars or 2^ x 2" wood stakes per Filtered � I�(i i Sediment Laden bale. Drive stakes into the ground 4. Backfill and compact the Runoff I II I I I Runoff at least 8 ^. excavated soil. Source: Michigan Soil Erosion and �� f "_ ' ' , / � f • ' 1 / Sedimentation Control Guidebook, 1975. Silt Fences Figure 4 —How to Install a Silt Fence 1. Excavate a 4" x 4" trench along 2. Stake the silt fence on downslope Figure 3 —Cross Sections the contour. fabric into the trench. 8" of of Trenches for Silt Fences Fitter Fabric J� 1� till= 4" _ Flow 4 1 q I--' IIIII1 Flow 3. When joints are necessary, over- ' "ench pl�� 11 lap ends for the distance between 4. Backfill and compact the two stakes. excavated soil. Fitter Fabric --► 4" � <�' 4. Source: North Carolina Erosion and Sediment Control Planning and Design FIOw Flow Manual, 1988. Gravel Entrance 1. Install as soon as possible after Figure 5 —How to Install a Gravel Entrance start of grading. / O 2. Use 2 to 3 inch aggregate stone. Hard surface road Sol or distance 3. Drive must be at least 7 feet wide to foundation and 50 feet long or the distance to the foundation, whichever is less. V minimum depth 4. Replace as needed to maintain 6 inch depth. . V •. 1 Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 N visc , onsin I { www.c ommer ce.state.wi.us/sb gov Department of Commerce In Scott McCallum, Governor Brenda J. Blanchard, Secretary h July 31, 2001 1_ Y�Et' �'�«: CUST ID No.226900 �, p ,, `A POWTS Inspector SHAUN R BIRD j. r ZONING OFFICE ` BIRD PLUMBING, INC ` ' t ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMIC14AEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/31/2003 Identification Numbers Transaction ID No. 663331 SITE: Site ID No. 633532 RICK JACKSON Please refer to both identification numbers, BRAVE DR above, in all correspondence with the agency. TOWN OF STAR PRAIRIE ST CROIX COUNTY SWI /4, NEI /4, S17, T31N, R18W LOT: 2W, BLOCK: F, SUBDIVISION: WIGWAM SHORES FOR: DESCRIPTION: TWO BEDROOM MOUND SYSTEM OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 804036 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 /01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD- 10706 -P (N.01 /01). • 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 manual, and section VI of the pressure distribution component manual are complied with. A copy of this letter including instructions and information relating to proper use and maintenance of the system must be given to the owner and each subsequent owner upon completion of the project. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. • Access to the filter for cleaning must be provided per Comm 84 product approval conditions. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required • The proposed tank appears to be located in an area subjected to saturated conditions. Therefore, it must be anchored per Comm. 83.43(8)(g), Wis. Adm. Code to prevent floatation of the tank. Documentation of the method of anchoring and calculations to prevent floatation are to be attached to the plan prior to issuing of the sanitary permit. Q • The setback of the POWTS to the high water mark of the lake is to be at least 50 feet as established in Comm 83.43(8)(1), Wis. Adm. Code. This shall be verified at time of installation. SHAUN R BIRD Page 2 7/31/01 • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). In addition, 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. • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.52(3) The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • 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. • The changes made to this plan on 7/31/01 by this reviewer were acknowledge and approved by the system designer. • NOTE: Plans Submittal; designs that are based on department approved component manuals must include reference to the manual name, publication number and published date. 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 construct ion/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 Charles L Bratz POWTS Plan reviewer II- Integrated Services WiSMART code: 7633 (608) 789 -7893, Mon. -Fri. 7:45 AM to 4:30 PM cbratz@commerce.state.wi.us cc: RICK JACKSON Safety Buildings Division Coup FN Vis os 201 W. Washington Ave., P.O. Box 7162 Madison, WI 53707 - 7162 • _ be artm6nt of Commerce 3(p Arwko Sans Permit A SWWr Permit Number pP a In tttmot+a Whit (;Deese 83.21, Wi Aam. cone, .yaU MY be wrd pri T sls ANOV- �' . `, ❑ Check if Revision I. Appantim Informat�a - Please PsWt All p L � etas Pycs .>D. Ng r Property Owner's Name l�zc a� J UL 3 2QQ Parcnt Number J 1 �- Ptoperiy Owner's Mti ial Atklnas - S Property Loaooa L LC1�c S�- 2dNM(i 'E V it • S 7 T 3 N g 4 city. Stele Zip Code C pbow Lo�Number ,�Socic Number 0 - Subdivision Nsate CSM Number ! W, 9 w0 " S II. Type o(BtlildtoP (chedt all that apps¢), a rc dun, of 2 Family Dwelling - Number of Bedrooms ❑Viilsge ❑ PO WCommetoW - Describe Use 0 Slue Owned Nearest III. Type of Phrmit: (Check otaly one box an tins A (numbering schane for internal use). Complete line S 1t applicable) A 2 0 Replacement System 3❑ Fm h use YSOM Replacement of 6 ❑ Addition m S B • ❑ Cbselt if SW" PON* Pmvim* Issued Permit Number Date loosed IV. Type of Pbemkr (Check all that sp sehense is for internal stns) 4f• 0 Noe - Pmw4daed in-arcum pe 47 ❑ Sand Palter SO ❑ Constructed Wetland = ❑ Freawrised In- Gi 41 ❑ aaaing Tank ifs ❑ Sh*k Pain 510 Drip Line 4s O 46 ❑ Aerobic Treataxnt Unit 49 ❑ !!!ke!jd M 30 Cl DdIer V, Rh2jgHjMDjjjpM Ara Informatlonr ff Desipn Flow Wo Din I Area DispstW Area Soil Application Percolation Rate System Stevatlon Flail Grade ReWhmd Re t3ais./Ds s/ .Fe Proposed ae( Y Sq ) (Min./IACh) Rlevation S oo �,� o s G V1. Task A,& Capacity in TOW Number Manufactumr Prefab byte Steel Fiber Plastic Gen" Oalioaa of Tanks Concrete Constructed Oka New e Tub 9rpdc or do ft T ak Tsalu Chudw X30 VII. sa I, the for b wWWon a< the POW M down an the attsehed Phtmbsr' Natty (Prht) Plnrnber's I►4P Business Phone Number ,x PiutoWs Addten (Street, CW. State, Zip ) lu" A vW 0 vulpPw'b Sanitary Penrrb Foe (ixludes Grouedwater Dare Issued Sipoaa— (No Saw") ©OWw Given IWU Adverse , � ) �' l RIMMiEft ��� // as DL 7 7 , Y��es.e � �p�ro= 09, k'►- 7S Gx.{ ( 56' -Cr ` e IM (61V bl f � S wt� �' FK P /•�� �H fi/ e s; lb {l y S �s+�tiY,�w� w vycto fh . M as ce e a i ry Gab) Car W gabu !� pops! MOR Iwo =,'994e 7 � M 1! tike � r �/� 3 X01 � U _` 44- Z ,I OWL jU STATE BAR OF WISCONSIN FORM 3 — 1982 K ATHLEEN 655 HWALSH QUIT CLAIM DEED REGISTER OF DEEDS DOCUMENT NO. + I. ,� �J r� PAGE ST. CROIX CO., WI RECEIVED FOR RECORD Home Inc. a Minnesota, 08 -29 -2001 3:20 PM QUIT CLAIM DEED EXEMPT N quit- claims to Richard C Jackson, a single person CERT COPY FEE: COPY FEE: TRANSFER FEE: 69.00 RECORDING TEE: 10.00 PAGES: 1 the following described real estate in St . Cro ix County, State of Wisconsin: THIS SPACE RESERVED FOR RECORDING DATA Lot 1, Block F, Wigwam Shores, St. Croix County, Wisconsin, and that part of Brave Drive that NAME AND RETURN ADDRESS lies between the Northly extension across Brave Richard C. Jackson Drive of the East and West lines of said Lot 1. % Airflo & Associates and 2617 Duluth St That partlof Lot 2, Block F, Wigwam Shores Maplewood, MN, 55109 Addition, St. Croix County, Wisconsin, and that part of Brave Drive that lies East of the 14 .30.000 West line of said Lot 2 and its Northly 038.1149.31.100 extension across said Brave Drive and West of a ARCEL IDENTIFICATION NUMBER line drawn parallel to and 88.25 feet East of the West line of said Lot 2 and its Northerly extension across said Drive II This 1 s homestead property. (is) (is not) Dated this 10th day of August (SEAL) (SEAL ohn A. Luge , p es. (SEAL) (SEAL) I' AUTHENTICATION ACKNOWLEDGMENT i Signature(s) State of f'�Qxaioci�2#T; Minneso a II ss. S �✓ County. authenticated this day of , 19 Personally came before me this 10th day of o u s t , X 2 0 0 , the above named ohn A. Luger TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Slats.) a known to be the person who executed the foregoing rument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY John A. Luger D N. St. Pau 1, MN, 55109 tary Public, _ County, "MN (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date: necessary.) 30,tA - 31 W� � • Names of persons signing in any capacity should by typed or printed below their signatures STATE BAR OF WISCONSIN Wisconsin Lop Blank Co.. Inc. I QUIT CLAIM DEED Form No. 3 — 1982 Milwaukee, Wis. f ST CROIX COUNTY SEPTIC TANK NiAIN"TLNANCE AGREEMENT AND. OWNERSHIP CERTIFICATION FORM Owner/Buyer '�E Mailing Address 2 j � A Property Address r I V (Verification required from Planning Department for new construction) City /State Parcel Identification Number LEGAL DESCRIPTION Property Location %, ,&IF yf, Sec. T_,3LN - R W, Town of Subdivision /tip i'�'' J Lot Certified Survey Map # . Volume �— , Page # 6 K7 Warranty Deed # a e 3 , Volume / Page # Spec house 0 yes �o Lot lines identifiable es 0 no SYS = MAINT MNCE 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 master plumber, 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 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 of the three year exp' on SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on taus form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, bye' a of a warranty deed recorded in Register of Deeds Office. /;z7e/ 0 SIGNATURE OF APZACANT DATE * * * * ** Any infortnation that is mis- reprosentcdmay result in the sanitary permit being revoked by the Zoning Department. * * « * *« ** Include with this application: a stamRsd warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed I V• ?poi,:' ° ~' 900 \J O� so ° , i' 113 °00' .7 T • o E o e R,AV __ ----- ,yo c • •s 66.0 � • O �} 6.6 • � e) * ° M We ° T .6 122. ti *�. a �'4 96°06 I ~_ PTO ~ O 76. I6 °� �� ♦ p O 121.37 �N e ke ft 00 6 NN O i• o - Ml p 0 Iii p Z c o 4 IISe06, r a ♦ -010 0 2 ♦.y 00 �° •� z in .! . en N 1'2 3 �� � � i ♦ o N Z • •1 - 3 �0. o 6 9 66.00'. b � . _ 3 . h of /, ��• r 0 ( _N as oh W •od > ° e �sf O ei • a O \ a 0 0 �: x I y � 12 295 A 1 9 6 I I 10 992 670 2�.20 I ,F � 9 374.0 /3 6 68 1 II \ 295 A 10 ��/ II v — 7 667 Q' / 2 : 3 66 14 6 -6.6Q ' 6 , 4 � - ; 2 m 663 WIG WA M 1 SHOI?f / S W 659 - S W IX4 - N — — — � 8� y C °tea. 7 SS 656 51 657 ,� X655 = 6 650 6 4 N 3 '8 653;. 65� 9ro�zc� = 5 14 64% 282.6 j _�Q► 1 3 2 3 295 B �� �� ' 13 64 I 295 C �_ ' c `rvre -- t2 a 647 � SFC. 17 t 15 Fl \@Cllr 4, • 1 - bzt_ - , DOCUMENT NO S rATE OAR OF VII ;ONSIN FOAM 2--IM THIS SPACE RC.SEAVED FOR RECOSIMNG OAIA WAORANTY DEED fCE SE Hnme Tnn. a Minne�, t o a ion ReddtdrFxord -- �P r t MAY 1 1995 jJ10:30 A. Convoy$ and warrants to Richard Jackson JI_� • - `_ 3GSS Joppw /4d the toilowing Jescribed real estate in St_. rrnix County, r • i r s State Of WisWnsir, T" Parcel No:_. All of Lot 2, Block "F ", Wigwam Shores, EXCEPT that part of Lot 2, Block "F ", Wigwam Shores in the Town of Star Prairie, end that part of Brave Drive that lies E of the W line of said Lot 2 and its Nly extension across said Brave Drive ..nd W of a line,dravn parallel to and 88.25 feet E of the W line of said Lot 2 and its Nly exte across said Brave Drive. ii �E This is not homestead blowy (is) pe Net) Exception to Warranties: Dated this d ` Home C. "A) AL JAVA- Luger, l f riii l s. ff� L) (SEAL) AUTH,Nta @CATION ACKNOWLEDGMENT S*'wWrots) &TAT*OFVnM=WM to >� Ramsey co .NTH j autl+vtloaNd this day of _.: , 1 Vereonafly came Wore me th is.— day of I _ . 19, the above named A--- Lugar. TITLE: MEMBER STATE BAR OF WISCONSIN Of not to me known to be the parso who Vwuted the authorized by i 706.0b, W1S. StNf+,} l toregof+q W{Nrument and acknowledge the tame- _ TWf. INSTRUMENT VIA$ OPIAPT90 aY . i CountT ilmkw". tSiSrsai ;ies bs ssshen {igteN! or acknowledged. 4ioth My Car , „,aton k , • M. no. . (Iris 1 VIM a;i_ea owrapon are not necessary.) i 'NirnOf of Dar30n� Hong M 40 1 " --IV anoutd by 1YPOd Or N "inied bsiOSr ~ N$nNwas. WARRANTY OEtd STATF S Aa OP fJOko Tot F fit •.; a �- fees W114, P.O. ON to20S, d'