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040-1279-80-000
RECEIVED 1-7, Z S. /`3. 1576 (I X) Service Visit Form %ra FEB 2 r ST. CROlx COUNTY 3y 01-N' —,-- White Knight Microb ' ' nocdathr%GeneratorT'" Service Visit Record Owner Name 1`� 1 _ Unit Serial Number U_)k;je,�� Date Visited F-i�,4• ft, -7-01S Field Techniciann�� _ Purpose of Visit 11 �utine Maintenance Customer Concern 2 Week Spot Check Tank Liquid appearance: ✓Translucent Clear Other (specify) Liquid odor: None Z15 rfumed Noxious Other (specify) Bubble Pattern: ormal Abnormal (describe) Unusual observations: Vie, Effluent Filter: Place using to outlet pipe secure Cleaned Hair / Lint buildup Notes: White Knight: Biological Growth Visible Color maple flow through unit Unit Clogged with I noculant replenished Unit removed & cleaned Notes: Air Supply Pump: Outdoor _1:::�'Indoor Hour Meter Reading P-"�Pump Operating Properly �r Filter Clean arm Operating Properly Notes: 30 Soil Absorption System Weather: Precipitation previous 48 hrs Time of inspection Surface Condition: Dry & Firm Soft & Spongy Saturated Breakout / location(s) ��3°,Inches deep from surface Monitoring WellPort: Not Applicable p Dry 30" Inches static water Notes: ,ed 7 i/, Repairs or Modifications Pgrformed: 4°'z Additional Comments: Service Visit Rep e With Property Owner Technician's Signature �- 31 ��/�►_ �� ��- yo- axe i re� FIELD INSPECTION & SERVICE REPORT INSTALLATION AUTHORIZED SERVICE PROVIDER Installation Address: S-3 0141 C,/. Name SONn Owner Name: a ar J` Street: 3—Yo • Le. Mail Address: c�l't/y�v Q Mail Address:,,,&-mQ City /ri c a�S�ir> State c-.)/. zip S'Vd/(o city CQO (G'i State t,.)/. Zip 6-e6ZO i Phone((,/,tjaq,B-B/o/$Fax P h o n e 6115);t d/.8-776,1 Fax e-mail Mt; • C.n, I a-mail a c eseV o/)fj--n ems.het INSTALLATION INFORMATION Model No. Blower Brand and Serial No. Date of Installation Date of last pump-out k Sized EQUIPMENT DETA LED COMMEN'T'S OF SITE CONDITIONS— OPERATION YES NO MAINTENANCE PERFORMED OR REQUIRED Electrical Panels Visual Alarm Operating Audio Alarm Operating (if resent Blower (s): Air Inlet Filter Clean --� Blower Hood Vents Clear ✓ Excessive Noise Excessive Vibration Treatment Unit(s): j Unusual Odor System Vent ^' Pum out Required: ---1 Primary Settling"Zone --� Aerobic Treatment Zone FE F LUENT: LIMIT RESULT —� Estimated Daily Flow naJ --- ! pH (Standard Units) 6-9 S.U. _ ,L Color Clear Temperature Dissolved Oxygen effluent 2 m /L Odor Slightly — j Musty odor not sew" OWNER SIGNATURE TE NICIAN SI URE SERVICE DATE L !�--� Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 569595 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Stanger, Paul & Mary I Troy, Town of 040-1279-80-000 CST BM Elev: Insp.BI Elev: BM Description: /1 / I Section/Town/Range/Map No: (JTV ItI�J• f ti ' ^ 17.28.19.1570 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark g /6Z.9,45 • � 1L z . s R• I N Besinef Alt.BM Aeration 3 Bldg.Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet 97. 5.$S .37 TANK TO P/L WELL BLDG. Vent Air Int ke ROAD 16 / 3 Header/Man. 1 Aeration Dist.Pipe Holding _ Bot.System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM I Z G'11 �QO• Z Mode mber Ca� TD Lift Friction Loss System Head Ft Forcemain Leng Dist.to Well SOIL ABS ORPTIO SYSTEM BED/TRENCH Width Length No.Of Trenches PIT DIMENSIONS No.Of Pit Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L IB15T WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: r UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes H No 2 Yes ❑ No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 483 Omaha Rd H�juddsson,W �S¢016(N 1/4N 17 T28N R1 9W) ,Eag1le Bluff Lot 38 Parcel No: 17.28.19.1570 1.)Alt BM Description= N ��,• We'16�- y` 1 (�'.j le— /► 2.)Bldg sewer length= V n`,� `( to A4— y r� -amount of cover Plan revision Required? ❑ Yes No Use other side for additional informati n. SBD-6710(R.3/97) Date Inse ors Sig re Carl.No. ' ■ So;( eta�u a-��P�, ♦ Ele-da£o� A � Sca/e. Bin Bohm a{ 5,o%h�. 0mahct 83 Asfamtd eler/:= 140.cb, Poo-d /off 3 9 •.'o. �a� R' ell �Q wk'Ze en•,q 1 t we-sollrA 6o,6e%s //ed 6.0-66,7 c 4260 gaA. qa. ..seoE�� `Y EXi sv�9 exA,5- -n /,260 ¢b cd r,-Vr„ e< ,&6C.ea we. dwell fn q asi,IsE eed U � sc1.4lD P,d,C. •�fJi'dX.�ca�"on of WO& o9L", 91-91 �a CA I? A9 /Y1 C,""C/ S�sf eM r p P Y , 2fl-t'/0 County �+ IV Safety and Buildings Division St Croix 1 4 V 201 W.Washington Ave. Box 7162 Sanitary Permit Number(to be filled in by Co.) i t Madi n,�,,LA UN 17 20 14 56 q,5 -,OMMUNITY D IgrrPermit Application State Transaction /fir In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit �T is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law,s.15. 1 m,Slats. 483 Omaha Road I. Ap lication Information-Please Print All Information Property Owner's Name Parcel# Paul&Mary Stanger 040-1279-80-000 '��76 Property Owner's Mailing Address Property Location 483 Omaha Road Govt.Lot City,State Zip Code Phone Number NE '/<, NE %, Section 17 (circle one) Hudson,WI 54016 612 248-8618 T 28 N; R 19 E or W 7o, e of Building(check all that apply) Lot# Family Dwelling-Number of Bedrooms 4 38 Subdivision Name Block# Plat of Eagle Bluff i ❑Public/Commercial-Describe Use El of Na ❑State Owned-Describe Use CSM Number 11 ''7 of L Town of Troy Na III.Type of Permit: (Check only one bog on line A. Complete line B if applicable) oe A* ❑New System ❑Replacement System ❑Treatment/Holding Tank Replacement Only Other ificaf em(explain) d tion ATU&filter canister B. ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New Lts ed Before Expiration Owner #420788 issued 9/26/03 IV.06pe of POWTS System/Component/Device: Check all that apply) Non-Pressurized In-Ground ❑Pressurized In-Ground D Ajt-Grad•e ❑Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil ❑Holding Tank ❑Other Dispersal Component(explain) '/v Si// �01 ❑Pretreatment Device(explain) White Knight WK-40 ATU V.Dis ersal/Trestment Area Information: Symtech STF 100 effluent filter to be installed at pump discharge Design Flow(gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required(sf) Dispersal Area Proposed(st) System Elevation 600 Gpd 0.90 Gpd/Sq.Ft. 666.67 sq.ft. 1,244 Sq.Ft.Existing 95.12' VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units ,� New Tanks Existing Tanks c ;, � $ U V) m V� fs C7 L1+ Septic or Holding Tank 1,260 1,260 1 Weeks Concrete X _Peailfg Chamber VII.Responsibility Statement-11 the 4odersigned,ass me responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber' Signature „J MP/MPRS Number Business Phone Number James K.Thompson - MPRS 30021 715 248-7767 Plumber's Address(Street,City,State,Zip Code) 340 Pa son Lake Lane,Osceola,WI 54020 VI oun /De artment Use Only Approved 11 Disapproved Permit Fee Date Issued Issuing Agent Signature 11 Owner Given Reason for Denial $/5-D, d O &//17 IX. t gl9*#4MrovaVReasons for Disapproval N/�J KI V _.p 1.Septic tank,effluent flter and TrrZ dispersal cell must be serviced/maintained ' � /-t2 7 3 79 as per management plan provided by plumber. 2.All setback requirements must be maintained as per applicable code/ordinances. Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398(R. 11/11) Index & Tilte Sheet - Mound POWTS Rejuvination Project Name: Stanger Conventionsl dispersal cell rejuvination W/White Knight WK-40 ATU Owners Name: Paul Stanger Owner's adress: 483 Omaha Rd.,Hudson,WI 54016 Site address: Same Project Location: Subdivision: Lot 38,Plat of Eagle Bluff Legal Description: NE 1/4 NEW1/4,Sec. 17 T.28N.,R. 19W.,Town of Troy,St.Croix Co.,WI. Parcel ID#: 040-1279-80-000 Page 1 Index and Title Sheet Page 2 Site Plan Page 3 Treatment Tank/ATU installation cross section Page 4 Dispersal Cell Sizing Calcualtions Page 5 ATU POWTS Agreement Page 6 ATU POWTS Service Contract Page 7 ATU POWTS Maintenance&Contingency Plan Page 8 ATU Specifications Page 9 Filter Canister Specifications Page 10 Existing Treatment Tank Certification Mater PI ber Restric d Service: James K.Thompson,Dept.of Commerede<ial#30021 Signature: Date: Page l Of 10 Design pursuant to In-Ground Soil Absorption Component Manual for POWTS,version 2.0 SBD-10705-P(N.01/01) ■ So;( eta/uaf;P.-, ♦ E/eda£o� AssuM.cd elect: es Pond a� we 11 e-X4S&'n /,.zoo mi ex S 6--r► /, �p Z ��� dwell �3 ■ dew ,t su{� R✓,C. ,�Jpr4X.�cQL'on of pcpcs`dF'/Eu bu:/d; seu�u: ear;Svc' ds,cursa�Cc// Wtg& Aa Zz- 929 rC�CAi/1Aq /i'�c�vrtG� srSL�ent' r {�, 20-910 .24 W�an�e/t c�radc ,,,�at�t �r 6�ts�n ,�/a��rd✓•L.d lvc�n�j ,ti;s o 14, U 3e eon �d�u Provo a�d b�fF/c �o be14s /kd w K-�O I DISPERSAL CELL SIZING CALCULATIONS 1. Design Wastewater Flow: L4 bedroom)f100 gpd estimated flowx150%design t factor)=600 gpd Design Flow 2. Infiltrative capacity of native soil: 0.9 gpd/sq.ft.eff.quality#1 3. Absorption area required: 666.67 N.ft. 600 gpd/0.9 gpd/sq.ft.,effluent quality#1 4. Existing absorption area: 1244.00 4.ft.(40 Infiltrator High Capacity Sidewinder chambers @ 31.1 Sq.ft.EISA/chamber) Number of trenches: 4 Trench width: 3' Trench length: ,i2.5' Pg. 4 of 10 Document No. 8 2 3 7 2 3 3 Tx:4194134 ATU POWTS AGREEMENT 997320 BETH PABST REGISTER OF DEEDS Owner name and address: ST. CROIX CO., WI RECEIVED FOR RECORD Paul Stanger 06/17/2014 10:33 AM 483 Omaha Rd. EXEMPT #: Hudson,WI 54016 REC FEE: 30.00 PAGES: 1 This indenture,made by Owner and their successors in interest,own a POWTS(Private Onsite Wastewater Treatment System)requiring regular monitoring and maintenance in accordance with the manufacturers recommended Return to: procedures. These procedures must be performed by a manufacturer authorized James K.Thompson service provider licensed by the State of Wisconsin to perform these services. Results of these procedures shall be reported to the appropriate Governmental 340 Paulson Lake Lane Unit as required by code. Osceola, WI 54020 Location of POWTS: Parcel ID#:040-1279-80-000 483 Omaha Rd._Lot: 38 Block: Na ' Subdivision/CSM: Plat of Eagle Bluff. being part of NEIANE'/..Section 17,T.28 N.,R. 19 W.,Tn.Of Tray,St.Croix County.Wisconsin. Parcel Number: 0404279-80-000 POWTS DESCRIPTION: One(l)White Knight WK-40 containing one(1)aeration treatment unit with treated effluent discharged to existing conventional dispersal component. OWNERSHIP RIGHTS AND RESPONSIBILTY FOR POWTS: Property Owner as described holds sole ownership rights and is responsible for insuring inspection,operation and maintenance of POWTS. �j Paul Stanger (Date) Acknowledgement: These named,Paul Stanger,known o me to be the person executing the foregoing instrument. Subscribed and sworn to before me this day of-=u.n e, ,2014. A•RY PUBLIC,State of Wi onsit}�ig05)t `My Commis§ion Expires: September 6,2015 Instrument Drafted By: James K.Thompson Pg.5 of 10 St. Croix County 997320 Page 1.of 1 ATU POWTS SERVICE CONTRACT The proper operation and maintenance of the components listed below will significantly influence the performance and life expectancy of the POWTS(Private Onsite Wastewater Treatment System). This agreement authorizes A.C.E.Soil&Site Evaluations,L.L.C.personnel(Service Provider)or their representative access to the POWTS components during regular business hours to perform regular inspections and routine maintenance of those components. It is herby agreed by and between Owner and Service Provider that in consideration of the payments provided for herein,Service Provider will provide a manufacturer trained and State licensed inspector to perform periodic inspections of the POWTS components as set forth below. Service Provider will prepare a written inspection report after each inspection containing any recommendations for the operation, maintenance,and or repair of the POWTS deemed appropriate by the Service Provider. A copy of the report will be provided to Owner and the appropriate Governmental Unit. Service Provider will supply additional services,parts,or labor only after authorization by purchaser. This agreement does not assume any responsibilities or obligations that are normally the responsibilities and obligations of the Owner and does not cover any costs associated with operation,maintenance and or repair of the POWTS. In no event shall Service Provider be responsible for any special or consequential damages,including but not limited to,loss of time,injury to person or property,or incidental economic loss due to equipment failure for any reason whatsoever. This agreement shall remain in effect for a period of two(2)years from the date of POWTS installation, and will be automatically renewed each year thereafter unless amended or cancelled by either party with 30 days written notice. This agreement may be cancelled by Owner only if replaced by a service contract with another service provider authorized to inspect and maintain the specific POWTS components in question. Purchaser agrees to pay Service Provider the sum Of 125.00 per inspection. Four(4)inspections will be provided over the first two-year period at six-month intervals. Payment for the first four inspections will be included in the cost of the POWTS design. One(1)inspection per year will be conducted thereafter with inspection fees billed at the time of inspection. Additional fees associated with effluent testing,when required,will be billed at time and material cost. POWTS DESCRIPTION: One(1)White Knight WK40 containing one(1)aeration pre-treatment unit,pre-treated effluent discharged to existing Conventional dispersal component constructed in accordance with State Code. POWTS Location: 483 Omaha Rd.,Hudson,WI.,located in: NE 1/4 NE 1/4 of Sec. 17,T.28 N.,R 19 W.,Tn.of Troy,St.Croix Co.,WI,Parcel#040-1279-80-000. - Owner name and address: Paul Stanger 483 Omaha Rd. Hudson, 54016- (Paul Stanger) (Date) Service Provider: A. oil&Site Evaluations,L.L.C. 40 Pauls Lake Road Osceola, 5402 141 I_el4l es K.Thompson) (Date) Instrument Drafted By: James K.Thompson Pg.6 of 10 ATU POWTS Dispersal Cell Management & Contingency Plan Pursuant to Wisconsin Dep't.of Safety&Professional Services 383.54,Wis.Adm.Code General The POWTS shall be operated in accordance with Dep't.of Safety&Professional Services 382-384 Wis.Adm.Code, and shall be maintained in accordance with component manual SBD-10706-P(N.01/01). All local and/or state rules pertaining to system maintenance and reporting shall be complied with. Questions on the operation or maintenance of the system should be directed to the installing plumber,Jim Thompson at(715)248-7767 or the County POWTS Inspector at(715) 386-4680. Effluent Ouality The sewage effluent concentration levels generated at this site will be residential strength effluent as defined by the Wisconsin Dep't.of Safety&Professional Services. Influent quality entering the dispersal component of the POWTS may not exceed 30mg1L BOD5,30 MG/L TSS,and 30 mg/L FOG. Contingency Plan If the septic system or any of its components become defective,the component shall be repaired or replaced to keep the system in proper operating condition. Aeration Treatment Units shall be immediately repaired or replaced with approved components of the same or equal performance. Persistent ponding within the dispersal cell will be addressed by removal of contaminated materials and reconstruction of the mound. Septic Tank The operating condition of the septic tanks shall be assessed at least once annually by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113,Wis.Adm.Code,by an individual certified to service septic tanks under s.281.48,Stats. If the contents of the tank are not removed at the time of the annual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. Any treatment tank opening deemed unsound,defective,or subject to failure shall be replaced. Exposed access openings shall be secured by an effective locking device to prevent accidental or unauthorized entry into tanks or other components. No individual should ever enter a septic tank or pump tank as dangerous gases may be present that could cause death. Start-Up Procedure: 1. Inspect aerator operation to verify air flow,turbulence,monitor water flow,etc.at 30 days. 2. Test effluent samples as needed to determine BOD,TSS,&Ph levels of effluent. Biannual Monitoring&Inspection Procedures: 1. Visually inspect all system components. 2. Monitor existing dispersal cell to determine condition of bio-mat and remediation of hydraulic 3. Evaluate sludge levels in septic tanks and pump contents as required by inspection. 4. Inspect treatment tank outlet filter&clean as needed. 5. Determine dissolved oxygen levels. Collect and submit BOD,TSS&Ph samples as needed. 6. ATU Inspections shall include the following: Blower Unit: Inspect blower unit and air intake,clean or replace filter as needed. Check for excessive heat,noise or vibration. Alarm&/or Control Panel: Test electrical connections,current draw,alarm,pressure switch and high water alarm. Adjust or repair as needed. Treatment Unit: Inspect manhole rings,covers,locks,vents,etc.determine operating condition of the unit by visual observation&measuring sludge volume in treatment tanks. Measure dissolved oxygen,temperature and pH of effluent. Collect effluent samples for B.O.D.,Ph&T.S.S analysis as needed. Replace Bacterial Inoculators annually or as needed. Pg.7 of 10 SAFETY AND BUILDINGS DIVISION Plumbing Product Review COrnmerce.Wi.gOV P.O.Box 2658 Madison,Wisconsin 53701-2658 isconsi n TTY:Contact Through Relay Department of Commerce Jim Doyle,Governor Aaron Olver,Secretary June 16,2010 RE-ISSUED 7/6/2010 i KNIGHT TREATMENT SYSTEMS MARK C NOGA, VP 281 COUNTY ROUTE 51A OSW EGO NY 13126 Re: Description: SEWAGE TREATMENT APPARATUS (Tier 3-downsizing&vertical separation credit) Manufacturer: KNIGHT TREATMENT SYSTEMS Product Name: WHITE KNIGHT MICROBIAL INOCULATOR/GENERATORTm Model Number(s): WK-40 AND WK-78 THIS APPROVAL AND ITS CONDITIONS ARE LIMITED TO USE&INSTALLATION IN NEW POWTS SYSTEM DESIGNS [WK-40:MAX.DWF 750 GALSJDAY;RESIDENTIAL STRENGTH WASTEWATER;MIN.TANK CAPACITY=1000 GAL.or 1.5-DAY RESIDENCE TIME WITH 2-DAY RESIDENCE TIME PREFERRED. WK-78: MAX.DWF 1200 GALSJDAY; RESIDENTIAL STRENGTH WASTEWATER; FOR HIGH STRENGTH WASTEWATER/COMMERCIAL UP TO 1500 MG/L SODS;MIN.TANK CAPACITY= 2000 GALS.or 1.5-DAY RESIDENCE TIME WITH 2-DAY RESIDENCE TIME PREFERRED;FOR MAX.AVG.F.O.Q.SEE STIPULATIONS REGARDING TREATMENT TRAIN] Product File No: 20100070 The specifications and/or plans for this plumbing product have been reviewed and determined to be in compliance with chapters Comm 82 through 84,Wisconsin Administrative Code, and Chapters 145 and 160,Wisconsin Statutes. The Department hereby issues an approval based on the Wisconsin Statutes and the Wisconsin Administrative Code. This approval is valid until the end of June 2015. This approval is contingent upon compliance with the following stipulation(s): • This product must be utilized in accordance with the manufacturer's printed installation instructions and this product approval. If there is a conflict between the manufacturer's installation instructions and the product approval,the product approval requirements will take precedence. • The minimum depth of unsaturated soil for treatment purposes of the treatment/dispersal cell that receives that wastewater from this product must comply with the vertical distance listed in Table 83.443 under Fecal Coliform equal to or less than 10,000 cfu/100 ml column heading. • A copy of this approval letter and the manufacturer's printed installation instructions must be supplied to the buyer of this product. • The outlet baffle of the septic tank,which has this product installed, must have installed an effluent filter capable of filtering particles of 1/8 inch in size or larger. • This product must be installed by a properly licensed plumber. • A state Sanitary Permit must be obtained when this product is installed. • The IOS-500 inoculant must be exchanged at least on an annual basis. SBD-10584-E(NAW97) File Ref:10007010.DOC n 431" 2 n v m� n n m A ul p 0 m i * Z D D D D D A y N m Z Z rm D OCR 2" j rnAr J nr N(A N X07 37 2,. --I 6 O n m W Z r f m .O r A r n D = mD 0 0 O � . \ f rl 18" MIN. m fTl N 'D t D r ILL ri p T r O Z 37" 22" l = N D5 c m 0 m � o ✓� I m D ' Nn D -P� Z V1 > D mm m I(n W m D r n � � O ZD mmn (A � O Tt C m fTl D -I �7 D r M O m m D D D z r- r- � c O --i Z \ FILTER CANISTER DETAIL SCALE:3/4" : I' REV N0, 04 T; ° MIESER COMETE DRAWN BY:SWT ti SEPTIC MANUAL W3716 US HWY10. MAIDEN ROCK, W 54750 DATE: JANUARY 2008 �° REV. JAN. 2008 800-325-8456 FILE:SHEET Q 09 . 91�� ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address)483 Omaha Rd.,Hudson,wl 54017 located at: NE 1/4, NW 1/4, Section 17 , Town 28 N, Range 19 W, Town of Troy , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it(they) appear(s) to be functioning properly. Most recent date of inspection or service Did flow back occur from absorption system? Yes x No (if no, skip next line.) Approximate volume or length of time: unknown gallons 15 minutes minutes Tank Capacity: 1,260 gallon Construction: Prefab Concrete x Steel Other Manufacturer (if known): weeks concrete Al. o ank (if known): 15years,installed 10/03/20#3 ermit ber (if kno 240788 3—.-- James K.Thompson icensed Plumber Signature) (Print Name) MPRS MPRS#30021 (Title) (License Number) MP/MPRS June 9,2014 (Date) Form to be completed by licensed plumber(Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 P�./o o��o Document No. ATU POWTS AGREEMENT Owner name and address: Paul Stanger 483 Omaha Rd. Hudson,WI 54016 This indenture,made by Owner and their successors in interest,own a POWTS(Private Onsite Wastewater Treatment System)requiring regular monitoring and maintenance in accordance with the manufacturers recommended Return to: procedures. These procedures must be performed by a manufacturer authorized James K.Thompson service provider licensed by the State of Wisconsin to perform these services. Results of these procedures shall be reported to the appropriate Governmental 340 Paulson Lake Lane Unit as required by code. Osceola,WI 54020 Location of POWTS: Parcel ID#:040-1279-80-000 483 Omaha Rd._Lot: 38 Block: Na , Subdivision/CSM: Plat of Eagle Bluff, being part of: NE'/4NE'/< Section 17 T 28 N R 19 W. Tn.Of Trod St.Croix County,Wisconsin. Parcel Number: 040-279-80-000 POWTS DESCRIPTION: One(1)White Knight WK-40 containing one(1)aeration treatment unit with treated effluent discharged to existing conventional dispersal component. OWNERSHIP RIGHTS AND RESPONSIBILTY FOR POWTS: Property Owner as described holds sole ownership rights and is responsible for insuring inspection,operation and maintenance of POWTS. 1y11�4 G Paul Stanger (Date) Acknowledgement: ' These named,Paul Stanger,known o me to be the person executing the foregoing instrument. Subscribed and sworn to before me this Zf day of —�GC,rt 2. )2014. TARY PUBLIC State of W i o ns'm My Commission Expires: September 6,2015 Instrument Drafted By: James K.Thompson Pg.5 of 10 / c 0) o / � � � ƒ 2 T om .. m — 7 � _\ 2 E z t m 2 �- M OD to OD g "$ 4 s ƒ Q e - 7 ° CO - § e [ ƒ j 2 2 fE2 E f © @ § ƒ k © _ _ k E n r CO) z o � ° % & k �- � 0 0 0 / co ) 2 \ \ [ 2 E CD E § 2 C R / g E 3 § .. ! rr E§o ° / \ £ � � g 3 CD 2 7 / z 9 � .. w T m # E § / / 7 G ° 7 2 $ $ ® 2]/002± \JkkM \\ S. \� CL c2, CL . SB =@f W( � ( @ ' @`Cr , 7 � / %¢8« E mm=2R } $ a2(D ƒ mss= _ » m , CD < CD 0 ! - 0CL 10 \�]a{ / 2 E o \ � /CD t % o = ���^ E(D �k V - Wisconsin Departm nt of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix Safety and Building Divisiin A , 1 INSPECTION REPORT sanitary Permit N (ATTACH TO PERMIT) 420788 0 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: City Village X Township Parcel Tax No: Stanger, Paul I Troy Township 040 - 1279 -80 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: U, 0 0. Q, _ 17.28.19.1570 TANK INFORMATION 0 UELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Ben ark 42 f4_X1j'e_ Of /off• /�A Dosing � _ .� Alt. BM J Aeration Bldg. Sewer Holding S t Inlet TANK SETBACK INFORMATION SUHt Outlet TANK TO P/; WELL BLDG. vent to Air Intake ROAD Dt Inlet ,— T _ � Septic r 1 1 r 1 , Dt Bottom Dosing V Header /Man.M H , 74• 2 Aeration Dist. Pipe Tp o � Z -/ / S � 7 Holding Bot. System�n PUMP /SIPHON INFORMATION Final Grade �• C7 9 � `_ 9 Manufacturer Demand qt r GPM Z n Model Numbe TDH jFr ic' Loss System Head TD Ft Forcemain Length Dia. s . to Well SOIL ABSORPTION SYSTEM /D PIT BEDlTRENCH Width 1 + Length No. Of Trenches DIMENSIO S No. Of Pits Inside Dia. Liquid Depth DIMENSIONS .� ,{ SETBACK SYSTEM TO G+ � P/L BLVt t�L. LAKE /STREAM ,-LEACHING anufat turer: INFORMATION Ty Of System- CHAMBER OR t _ /_• " * 2 Model Number: DISTRIBUTION SY TE '{ C � Jf eft vi HDist ribution x Hole Size x Hole Spacing Vent to Air Intake Pipe r J t'l 3; E -0 Length Dia Length �� Dia Spacing o� SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center / Bed/Trench Edges Topsoil L� No Yes J No 1 Yes COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ' Z Y03 Inspection #2: ! ! Location: 483 Omaha Rd Hudson, WI 54016 54016 (NE 1/4 NE 1/4 17 T28N R19W) Eagle Bluff Lot 38 Parcel No: 17.28.19.1570 1.) Alt BM Description = J� w { j / S s4e 0 2.) Bldg sewer length = t .- f pp �po - �( / - amount of cover = _ 3.) Contour � r 'T� lit,..S• Plan revision Required? i Yes Use other side for additional information. _- _;_�__ SBD -6710 (R.3/97) Date -- --- Date Insepctor's Signal re Cart. No. .P B . � .. 7 Pl A / - - 4(,( /k/. _Sl cl � ccJ1 nc� rs� • v y , )4 nubs �� • U wilt r33 0 4 f h �y au Bit - F 1.8 -1 poi e LAI Le Banc), Nla e: { S,a/;.,�. /Essu,ncd 83 QOCL Weil J��. � `Y EXi:3fin9 EXiS %�� /,260 � b�drW.►, Sufic �a� dwellJny 4s /ns't�Ze lCtd � `/ bu.ld;� lol.) 1. - SI 42 4 IN 97 , AG,v� o \ 9z9r \b,'�l�d�. \ \ � f rncurlol - �eM. r ` 'Ie 91 ( f . 3 or3 Safety do Buildings Division Permit A licatio>tt ' zoI w..Waalmin Ave Sanitary y pp PO Box 7302 C In accord with Comm 83.2 1, Wis. Adm. Code Madison, WI 53707 -7302 Department of Commerce Personal information you provide may be used for secondary purposes (Submit completed forth to county if not [Privacy Law, s. 15.04(I)(m)] state owned. Attach com lets plans to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. County State Ssnita ry Pettni r heck if revision to previous application State Plan I. D. Number I. Application Information - Please lPrIptall Informati t Location: Gl Gt P y 0wnerName 1 Property Location p 1/4!1h 1/4 S / Tg0 bl R/0 or Property Owner's Mailing Add ess Lot Number Block Number nlyla CL ::�Co I ST. CRUfX �v City, state lZip Code Psi@ t;WkT Subdivision Na w CSM Number Type of Building: (check one) ❑ Cit l 1 or 2 Family Dwelling — No. of Bedrooms:_ ❑ village �! �� PublidCommercial (describe use): o I own ° l O State -owned III Type of Permit: (Check only one box on line A. Check box on line B if applicable) earest r ad l y� A) I. New System 2. ❑ Replacement 3. ❑ Replacement of 4.. ❑ Addition to Parcel Tax Number(s) System Tank Oni Existing System Q — 000 B) Permit Number Date Issued A Sani Permit was previously issued 7--it 6 -J- V. Type of POWT System: (Check all that apply) Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland Pressurized In- ground ❑ tlolding' rank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V Dia ersaVIrreatm nt Area Information: *i Y d . 1. Design Flow (gpd) 2. spattalAre 3. era spal Area 4. Soil Application 5. Percolation R to 6. System Elevation 7. Final Grad 3 Required Proposed Rate (Gals. /day /sq. Il.) (Min./inch) Elew ' VI Tank Capacity in Total N of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing creme strutted Tanks Tanks C ❑ ❑ ❑ ❑ �❑ ❑ ❑ O ❑ VII Responsibility Statement. I the undersigned, assuimm respon sibilit for installation of the POWTS shown on the attached plaits. Pl�s Na t) Plu er's i pqq. no ttampar MP/MPRS No. Bust"" Phoae Number Plumber's Address (Street, City, State, Zip Cod _ /070 L � VIII CountyADepartnient Use Only ❑ Disapproved Sanitary Permit Fee (Inc udes Groundwater Dat Issued riming Signature s) pproved O Owner Given Initial Adverse Surcharge Fa) G DetErmination a IX. Conditions of Approval /Reasons for Disapprovalt Wa / ^ SYSTEM OWNER: C rnw��3.Sz k , ! 0 — -v A� 6U� 1 Septic tank, effluent filter and 0 dispersal cell must all serviced / maintained as per management pl provided by plumber. as per applicable code /ordinances.�y �3. .,.P,13 . i �l rs /V -4mz" _ :'n �_ �u.m�.e3 _. ' v S�WIV y,8� w/ A boo; vil Qi 40 44 h - VV v l lll' � ME to � __.:... ����� ° � ,.!•te �' � U l _ N N h W '�v '� A► C m N `' u _ W �_�► x cl L L (� t { ' d1 0) \ V = �tl 0! d n 1717 Wisconsin Department of Commerce SOIL EVALUATION REPORT paga 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Sal & Site Evaluations Attach complete site plan on paper not less than 8 x 11 inches i size. County St Croix include, but not limited to: vertical and horizontal reference point ( ), di r E I V E D percent slope, scale or dimemsions, north arrow, and location and ' tance to rarest road. Parcel 1. D. 04- 1279 -80-000 Please print all infonnadon. F P 1 2 2003 B Date Personal iftmabon you Mov& may be used for secondary p ( �s (1) (m)). Property Owner I ST 080*4669idri' Paul Stanger tOFFICE N 19 NE 1/4 S 17 T 28 N R 19 W Property Owner's M�iting Address Lot # Bkx�c # Subd. Name or CSM # 483 Omaha Road 38 Plat Of Eagle Bluff City State Zip Code Phone Number _j City _I Village 0 Town Nearest Road Hudson WI 1 54016 1 Troy I Omaha Road ir/ New Construction Dce: 0 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement J Public or commercial - Describe: Parent material Glacial drift Flood plain elevation, if applicable na General comments and recommendations: Install four trenches at elev. 94.00' using 40 leaching chambers. Previously approved mound site will become replacement system area. a Boring # _{ Boring Pit Ground Surface elev. 101.16 ft. >12 in. Soil Application Rate Depth to limiting factor Appl Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EfI#1 'Eff#2 1 0-10 10yr3/3 none sil 2fsbk ds as 2f,1mc 0.5 0.8 2 10 -36 10yr4/6 none sl 2fsbk dsh cs 1fm 0.5 0.9 3 36 -51 7.5yr4/6 none Is 1msbk ds cw lfm 0.7 1.2 4 51 -72 10yr5/8 &4/4 none "'* f1)0nsbk ds/dsh di if 0.5 0.9 5 72 -128 10yr5/8 &4/4 none Is/si 2csbk mfr - - 0.5 0.9 H# 4 & 5 consist of an unsorted mix of s, Is & sl. loading rate reflects most restrictive conditions found within i rn� 0- ST— S6 T 1a+►�► f4 ` PAC a Boring # J Boring S s I b Ir✓ c�,�,.,o.s bv Pit Ground Surface elev. 96.71 ft. >96" in. Soil Application Depth to limiting factor Applcation a e ' Horizon Depth Dominant Color Redox Description Texture Structure Consstence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I 'Eff#1 'Eff#2 1 0 -12 10yr3/3 none sil 2fsbk ds as 2f,1mc 0.5 0.8 2 12 -29 10yr4/6 none $l 2fsbk dsh cs 1fm 0.5 0.9 3 29-54 7.5yr4/6 none Is 1msbk ds cW 1fm 0.7 1.2 4 54-80 10yr5/8 &4/4 none s/Is/sl 1&2msbk ds/dsh di 1f 0.5 0.9 5 80 -96 10yr5/8 &4/4 none Islsl 2csbk mfr - - 0.5 0.9 H# 4 & 5 consist of an unsorted of s, & al. Loading rate reflects most restrictive conditions found within horizons. Effluent #1 = BOD ? 30 < 220 mg/L a TSS >30 < 150 L ' fluent #2 = BOD -S mg1L and TSS <-0 mg/L CST Name (Please Print) Signature CST Number James K. Thompson 3602 Adder A.C.E. Sal & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 9/52003 715 - 248 -7767 Property Owner Paul Stanger Parcel ID # 04-1279 -80 -000 Page 2 of 3 F31 13oring # I Boring lM Pit Ground Surface elev. 97.38 ft. Depth to limiting factor >95" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -8 10yr3/3 none sil 2fsbk ds as A 1 mc 0.5 0.8 2 8 -25 10yr4/6 none sl 2fsbk dsh cs 1fm 0.5 0.9 3 25 -50 7.5yr4/6 none Is 1msbk ds cw 1fm 0.7 1.2 4 50 -72 10yr5/8 &4/4 none s/Is/sl 1&2msbk ds/dsh di 1f 0.5 0.9 5 72 -95 10yr5/8 &4/4 none ISM 2csbk mfr - - 0.5 0.9 H# 4 & 5 consist of an unsorted mix of s, Is & sl. Loading rate reflects most restrictive conditions found within horizons. Boring F-1 # Boring � Pit Ground Surface elev. ft. Depth to limiting factor in Sal Application Rate Horizon Depth in. *Eff#1 *Eff#2 Y , S 4 p PD ❑ # , , 1 l,C •� 7' G L I� r` (Q(Z�I� Sal Application Rate Horizon Depth D Sw- -- 1 *Eff#2 in. ten,. mac. �.orn. Uaor Gr. Sz. Sh. Eff# * Effluent #1 = BOD s' 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. uu��J.� A xa /e: / s� Banc : 8o C�o� o { s,d n�. O rrt a ti4 �_ X83 Assumzd �oad q well l , � a t vq�C q a Ej�iSv�� /,260 6 cd rWr., dwells y as;n,ptrt�C�ol � `/ � d bio /d; ,� sz,�e.° - 31 ■ q Ci 2 \`. /o/.o' Aa ��dc -� /oo•o' �` � � �� 2 �p �ace�na�✓t� S�,s�c -rY, Qr� a r�u fir, c� Syst eM C/ 3 ar3 r RECEIVED HOLDING TANK SERVICING CONTRACT S E P 10 2003 Contract Date ST. CROIX COUNTY -I ZONING OFFICE This contract is made between the Holding Tank Owner(s and Pumper's Name t,.a i(`lloa%ao - f 'mot` c/L. � �x}�`�K,,�"� � � , - >J �-� � �. � �c�.� ►o�. We acknowledge the installation of (a) holding tank(s) on the Ppowing property. Provide legal descriptions:) .C...OT �' L ' LC�f O 0 - -ODD 3 M A,f D h'U o 17. Z . 11. LE -------------------------------------------- 1. The owner agrees to file a copy of this contract with the local governmental unit that has signed the pumping agreement required in Comm 83.52(1)(c) I. Wis. Adm. Code and the approved Holding Tank Component Manual. This agreement will also be filed with the St. Croix County Zoning Department. 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local governmental unit that has signed the pumping agreement and to the County, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the huh, inL tan -, c. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volume in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with local governmental unit and the County named above within ten (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) Owner's Signatures) Subscribed and sworn to me on this date: Todays Date Pumper's Name (Print) Pumper's Signature Notary F ublic Signature el� M6� aN l-3 /_6S Pumper's Registration Number Commission Expiration /,5 ANDREW W. CARLSON NOTARY PUBLIC- MINNESOTA, My Commission Expires Jan. 31.2005 ■ M Safety dr Buildings Division 201 W. Washington Ave. Sanitary Permit Ar�tlicatlon Po box CO 7302 f�sjrn In accord with Comm 83.21. Wis. Adm. Code Madison, WI 53707 -7302 Department of Commerce Personal information you provide may be used for secondary purposes (Submit completed form to county if not [Privacy Law, s. 15.04(1)(m)) state owned, Attach complete Plans to the county copy onlyl for the s ten on p aper not less than 8 -1 /2 x i I inches in size. County ._ State Sanita Permit Number O Check if revision to previous application State Plan I D. Nu 9 J �' 39 = 10.*° I. A lication Information - Please Print all Information Locatlo : P y Owner Name - - -- - - -- Property t.ocation � �sz � A PR 1 1 2003 �� _ 1/4 rt/4 S T N R� E or Property Owner's Mailing Addr s - - - -- — - -- - - - - - -- - -- - y Lot Number 81oek Number I-() �.L_ -- � ST. CF 01 � NI Y 3 /AA City, Suite Zip Cale ✓ Done Number Subdivision Nnm or CSM Number « lu 11 Type of Building: (check one) aS Pr ft�r. ❑ ci 1 or 2 Family Dwelling - No. of Bedro nos: r 13 Village O PubliclCommerciai (describe use): t� 92 n 9. op 1 0r'l'ow o O State -owned -- - III Type of Permit: (Check only one box on line A. Check box on line N if applicable) Near t Road® /1 Gt, A) 1 • 6�Ncw System 1 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s) System 'Tank Only I. Existing S stem B) -- Permit Numher O A Sanitary Permit was previously t ev ed IV. Type of POWT System: (Check all that a ) O Non -pe` ssurized in- ground Mound ❑ Sand Filler it W pcPressurized in- ground Itolding'Tank ❑ Single Pass , rip Line O AI -grade ❑ obic'Treatrncnl unit ❑ Recirculatin Other: V Dls ersaVTreatment Area Information: i •Design Flow (111 2. spenslAres 3. Dispersal Area 4. Soil icallon S. Percolalion Rate 6. System Elevation 7. Final (trade Required Proposed Role ,ols./ a h.) (Min. /inch) Elevation G00 Goo �Ob -5 �A -. -� 30 . D 9 Vi Tank Capacity in Total q gr Manufacturer Pre Site Steel Fiber- Plastic Information Gallons Gallons 0ks Con- Con- glass New Existing crele structed '1'aruks Tanks ..... U � / � Cx �� S r ❑ ❑ D ❑ V11 Respon ibllity Statement 1 the undmiltned, assume tesportill it for i atioa of the POW'TS shown on the attach p lans. Plumber's N t) Plumber's Si ); , T-- P%MPRS No. Business Phone Number Plu L - - - -- - ----- --- .- - -L- -- �U (Street, City, State, Zip Co VIII County/Departm nt Use Only D Disapproved Sanitary Pennit Fee (Includes groundwater hate Issued Issue Agent Signahrre (No stamps) B O Owner Given Initial Adverse Surcharge Fee) 3 J Determination IX. Conditions of Approval /Reasons for Disapprovalt 5.ex "r a c-�C /'e- � ►�nsn�t rv,K•e� � ,nn - � 5 c,� �s tip � iM a�,�. � � f� ►vtau a+ti��� r � 501 Q(�Q /kCtLC ♦ E/eda�,'o,7 " , OrnahQ \ 83 Poad /ot 3? � , I A� - Pro posed WC I I l q • qa . Pro posed dwell bl q it S blli ldi nj sewe,,, p 9-9. Sep tic, taa -A e I A- 1490 eFCIuent Frt Proposed 8a� �P. a� ou¢1ex• �q Pump chomb¢t 9 . A5741 303V f? ✓.C. eh 8ff' /uent /ine. U->d„dt'j Proposcdt Moand ¢t .2 71 /53 r 83.y w/ 9 X 64.67 ,disPerso/ cell. 5iX( \ \ \ � OP°''" /aEcia/sa E <'j2 X3.2.SS'wYyBr or' ,4-«.5 SPaccd a& 310.' \ \ 9.49 925 80 ' I . SA .: T pf \\ r ��i e. Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 vmw.cornnnerce.state.wi.us/sb www.wisconsin.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary March 04, 2003 CUST ID No.222904 ATTN.• POWTS Inspector ZONING OFFICE JAMES W BOUMEESTER ST CROIX COUNTY SPIA 1070 HWY 35 N 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON Wl 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/04/2005 Identification Numbers Transaction ID No. 843384 SITE: Site ID No. 656273 Paul Stanger Please refer to both identification numbers, Town of Troy above, in all correspondence with the agency. St Croix County NE1A, NE 1/4, S17, T2 8N, R19W FOR: Description: Proposed Four Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 893537 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans. • Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the septic tank outlet filter is required. The access P g P g P q opening used to service the filter shall terminate at or above finished grade with a watertight cover. • 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 coup official in accordance with the provisions of Sec. 145.20 2 d Wis. Stat g county P O( )� • Comm 83.22(7) 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. Owner Responsibilities: • 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). • 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 f p _ l -rl�man health hazard. C all;? APP rft RUVIL-kI JAMES W BOUMEESTER Page 2 3/4/03 Owner Responsibilities Continued: • Comm 83.55 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. 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. An overpayment of $5.00 was paid. As of today's date, our records indicate that a refund in the amount listed in the FEE portion of this letter is due. Department policy requires that for any refund less than $50.00, a written request must be made to the office in which the plans were originally submitted to. The refund will be sent to you under separate cover. Please expect a 6 -8 week time for fiscal processing. Refunds will be made to the payer. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 225.00 Refund Amt $ 50.00 Gerard M. Swim POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm WiSMART code: 7633 jswim@commerce.state.wi.us cc: Leroy G Jansky, , Wastewater Specialist, (715) 726 -2544 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Paul Stanger 4 bedroom residential mound Owner's Name: Paul Stanger Owner's Address: 3580 Linden Ave. White Bear Lake, MN 55110 Parcel address: 483 Omaha Road Legal Description: NE1 /4NE1/4, Sec. 17, T.28N., R.19W. Township: Troy County: St. Croix Subdivision Name: Eagle Bluff Lot Number: 38 Block Number: na Parcel I.D. Number: 040- 1279 -80 -000 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings VI CCEIVEa Page 4 Lateral and dose tank GV Page 5 System maintenance specifications EB 2 8 2003 Page 6 Management and contingency plan Page 7 Pump curve and specifications SAFETY & SLDGS DIV Page 8 Site Plan ` Page 9 Soil Evlauation Report Designer: Jim Boumeester License Number: 222904 Date: 02/21/03 Phone Number: 715 - 386 -1794 Signature: l »._ Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Version 3.0 (03/01/01) Dtr'A!<rMENT Ur coF� 9 e 1 of 9 ;WRCr Pa IVISION AUJF SAF Y AND BUILDINrS SEE co[t R S ONDENCE- Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 83 -44-3 in -situ sal treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of <- 36 inches. 600.00 Design Flow (gpd) 13.00 Site Slope ( %) 928.00 Contour Line Elevation (ft) 40.00 Depth to Limiting Factor (in) 0.50 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 66.671 Dispersal Cell Length Along Contour (ft) = 9.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /ft 1 I Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (c or e) c Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation ft 6 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 3.00 Estimated Orifice Spacing (ft) = 9.09 ft /orifice 2.00 Forcemain Diameter (in) 40.00 Forcemain Length (ft) Does the forcemain drain back? Y 923.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 6.52 Forcemain Drainback (gal) 5.08 Vertical Lift (ft) 89.60 5x Void Volume (gal) 0.65 Friction Loss (ft) 96.12 Minimum Dose Volume (gal) 12.23 Total Dynamic Head (ft) 27.19 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 x 1.25 x 1.00 x 1.50 x x 1.25 x 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons /Inch Calculator (optional) Treatment Tank Information 805.12 Total Tank Capacity (gal) j_; Lb)l Septic Tank Capacity (gal) 1 37.001 Total Working Liquid Depth (in) Weeks concrete I Manufacturer 21.76 gal /in (enter result in cell 1349) Dose Tank Information Effluent Filter Information 805.121 Dose Tank Capacity (gal) Zabel Filter Manufacturer 21.761 Dose Tank Volume (gal /in) A100 Filter Model Number Weeks concrete I Manufacturer Project: Paul Stanger 4 bedroom residential mound Page 2 of 9 Mound Plan View - T 1110 B • . . ............... . . . . . s J Observation Pipe 3 . K � W J. B . . •• �: . :: z L Mound Component Dimensions A 9.00 ft E 20.04 in H ft K 8.63 ft B 66.67 ft F 9.50 in I EAft ft L 83.93 ft D 6.00 in G 0.50 ft J ft W 27.43 600.00 (ft Dispersal Cell Area 1571.07 (ft) Basal Area Available 9.00 (gpd /ft) Linear Loading Rate 6.67 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 930.29 (ft) - -► ,......f.. G * H F : : = : = Dispersal Cell 929.00 (ft) Lateral 928.50 (ft) — Invert Dispersal Cell ::::: ; :::: Elevation E D :: ; :: � :::::::::::: . r. r �, /.. {. {. , . ] . . i _,i •_i .3 •_i . -i, i, i..] ; • i 1 }. ]. _ ::], .J: , ._i. . 1. 1. ] ..a. .:{ { ] { {~ { __: 4 �.._ /•._�: l•._._ '•:':.. •.c _ •.: ..r •__ : ,{ •� ,. M1 +,f : •._ _ . . . , .f .:._.._ ...�' - -- - - - .__�,_. _ , _- __ l._ ._ .-_ ' 'ti ' '- 928.00 (ft) Contour Elevation 13.0 %Site Slope Geotextile Fabric Cover Shading Key o• I — Dispersal Cef See lateral details on FI] _Topsoil Cap c .a 1.5 ft Page 4 for number, © �� Subsoil Cap w `o i P 9 :size, and s acin of ASTM C33 Sand :: laterals. Laterals are ® . _ x Tilled Layer d 0.5 ft Typical Lateral equally spaced from ❑5 :•r�rs Aggregate er o �:the distribution cell's I— A —� centerline in the distribution cell (AxB). Project: Paul Stanger 4 bedroom residential mound Page 3 of 9 Center Connection Lateral Layout Daigram Force mai n connection via tee or cross to manifold at any point. Laterals are identical S t P s • = Turn -u p vwbalI valve or 1F X ---+ IEx?rxf2+JLate,.ls & force main of PVC Soh 40 of ea n out pl u g r COMM Table 84.30 -5 Holes drilled on the bottom of the lateral. Number of Laterals 6 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 3.10 ft Lateral Length (P) 32.55 ft Orifices per Lateral 11 Lateral Spacing (S) 3.00 ft Orifice Density 9.09 ft /orifice Lateral Flow Rate 4.53 gpm Manifold Length 6.00 ft System Flow Rate 27.19 gpm Manifold Diameter 1.50 in Total Dynamic Head 12.23 ft Forcemain Velocity 2.78 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and -► Comm 16.28 WAC Disconnect 4 in. min. Tank component is property tented mac-- Alternate outlet location Forcemain diameter Weeks concrete Manufacturer 2 in. Capacityl 805.12 Gallons Volume 21.76 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 18.43 400.94 C B 2.00 43.52 Pump off elevation (ft) C 5.57 121.30 923.92 D 11.00 239.36 D Total 1 37.001 805.12 Dose tank elevation (ft) 3" Bedding un er tank. 923100 Alarm Manuafacturer LevelArm Alarm Model Number DLV Pump Manufacturer JZoeller Pump Model Number 198 Pump ust Deliver 27.19 m at 1 ft TDH P 9P 0 Project: Paul Stanger 4 bedroom residential mound Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name J. Thompson, POWTS Maint'r #30021 Phone 715 - 248 -7767 POWTS Regulator's Name St. Croix County Zoning Dep't. I Phone 715 - 386 -4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow -Average 400 gpd Maximum BOD5 220 mg /L Septic Tank Capacity gal Maximum TSS 150 mg /L Soil Absorption Component Size 600 ft Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 ears Mound Ins for ndin and seepage once eve 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished •����� • *00000s0* Grade \ 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve . . ... .. Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Paul Stanger 4 bedroom residential mound Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and cowers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once 3 by inspection. The et fitter h all be cleaned as necessary to ensure proper operation The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the fitter when removed from its enclosure. If the filter is equipped with an alarm, the fitter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosin shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. _! If a felt uent is in stalled within the tank it shall be inspected and serviced as n --• Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since sal compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October - February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD 30 mg/L TSS, 10 mg/L FOG, and 10" cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Paul Stanger 4 bedroom residential mound Page 6 of 9 I , HEAD /CAPACITY CURVE W EFFLUENT &DEWATERING TOTAL DYNAMIC HEAD /CAPACITY PER MINUTE w SERIES 5739 98 1371179 16114161 16314163 16514165 18514185 1861/186 /8814188 18914189 I i0 F7. GAL 1Tk::: GAL LTIt, GAL LTIR GAL .LYIRL GAL LTR GAL i'LTR GAL LTR: GAL LTR;: GAL LTR:: GAL LTRI 33 105 5 1,52 43 167:'i 72 213::: 93 362:: 401 61 431 58 2X 155 sat: 155 #8Tr 10 3.OS 74 ' 129'' 61 23f 79 '299 : 100 57d 61 ::311 61 ii 23'1 'i'. 58 320:: 146 151 00 15 4,67 19 72 45 170 64 242: 91 344 60 Y27 60 ;227 :: S8 210 142 337.: 145 648 95 20 At6 25 95 36 136 ! 82 310 59 2n:. 60 1227 58 136 1 110 2B 25 7E2 8 311 7! 480 S7 216 59 2x3 58 320 128 484.; 133 563 90 70 9.11: 65 316 55 z66 58 90 58 121 121 481's 2a es 40 12.19 46 473 46 :f72 55 216 75 as 58 320 105 347::: 114 471 SO 15.24 21 90 0 33 112S 51Ei 191 58 419:1! 58 220:% 90 3+F1':'. 100 3781: 2+ 8 60 $5 :<s7 a :, 161.::': 36 {36 >> 58 �: 71 29l' 6s JJ 75 70 21.74 3 0 1I4 10 38 52 Y8T S1 493 70 465i'. 22 7 0 B 80 fi. 4186 2438: 14 53 45 {70' 26 106: 54 204. 90 2743 72 121.; L 2 8 ! 37 140.' 165. 100 .36.48 65 416 21 79 by 110 7xA 7 26 '< 8 30? 1E Lock Valve: 19.25' 23' 26' 56' 66' 87' 73' 115' 91' 112' 55 0 63. WARNING: Model 185/4185 should not be subjected to 416 50_ than 30 feet TDH. 14 '. .g NOTE: For Head Capacity on Model 112, Industrial 12 4D column - explosion proof pump, see FMO219. 35 1 85,4185 10 30 89,4189 25 I a 20 q 61,4161 15 Td.H ID 5 99 42 53.55 137,139 0 57,59 U 5 GALLONS 10 20 30 40 50 60 70 60 90 100 110 120 30 lap 150 1fi0 LITERS CO fb0is 1K1. 11 100 AN(i 360. 6+Q.. SKS413 O FLOW PER A1M6TE W,17 'm 407 SkA.04y r -ie SEWAGE & DEWATERING TOTAL DYNAMIC HEAD /CAPACITY PER MINUTE >� 4 75 2- :: SERIES 266 267 268 282/4282 28134261 292/4292 29L/29J 294/4294 295/4295 7 - FT. 8t Gal. Litt{ Gal.i>ti9 Gal. L" Gal. Ltry:' Gal. Liryi Gal.Ltry.; GaLLtry:; Gal. Lary. Gal. [fry Gal. Ltn, a0 -65. 5 t.32 90 :341 128 1St 128 484!' 128 484.1 130 492E 180 661?. 133 301" 196 ° ?42 225 p S5 10 3,06 60 .2x7 69 337 89 737.: 89 397> 95 no 1S$ 696:: 116 479:': 181 1686 205 778 ,6 - 15 4147 22.5 86 so te9 50 1 " 50 189:, 63 238:' 135 6111 100 314` 130 497 165 36 165 700. ' 20 6.49 10 38 10 38:' 10 38< 33 125: 106 401. -: 83 322` 119 459 150 368 168 836 6 >s sX 25 ':::4 .82 76 289- 86 250': 106 401 136 .ISIS 153 565. w JO :;:9.14 !3 163 :: K 174 90 140 121 ;466 140 530 i 14: .. ' fx ' i0 26 98 50 4D 189 94 X156 115 475. 58 ':10 89 137. 35 60 ;16.29 11 !' 49 59 22E: < i0 30 70 ::41'74 25 95 0 e 293 4293 Lock Valve: 18' 21.5' 21.5' 21.5' 26' 35' 39' 50' 62' 77' 25 sI 20 WARNING: Model 293/4293 should not be subjected to zez.4z6z less than 15 feet TDH. 15- 4 '- ::10 84,4284 :2... I6I 292,4292 - 5 1 -L 266. 67, 6B 294.4294 -- p 295.4295 1 �a05,4405 1 U 5 GALLONS 10 20 30 4p 50 60 70 80 90 100 110 120 130 140 150 160 I1701BD19171 2X0 2101 220 23DI 240 250 I26C 210280 290 J300 31C JZO 33p 340 350 36p 37C 380 390 <p0 4'0 00 160 7w 520 w0 480 560' sw 920 + } - -jTl 1 800 '680 960 1NO 1120 9 1200 Iilm 1360 : 1 440 1520 FLOW PER MINUTE SK553 A 70F9 r ■ ♦ E /eda� o� 83 OrHa hQ goad n Pro posed we H A' IV q ea u Proposed ¢ bcdrao.,, dwell;nq bui 1 d; T seta e.r: propos'e'd. IVy�.,C9o.P. Sep � c, to n K�.•}l 1 A_Jeo efFluenb Frl q Pr opose d g a6 ou.�let•• �o o0 �q ..P. � Pump c hamb 4 "AsT� 30351 �? ✓, e. gA'lueot line. dOdtd Propos rKoui -t 27 3 "x83.93 a� w/ I 'x 66.6 dlsPersa/ cell. SiX(o � \ g3 oP /ar`G/a/ at lyi "x 3.2S.s'w/`gN or;o4 5 10aced \ \ \ 9Z Y1 TlOot'�1 u 6 e✓ .e. �+cd I P � A Assu i ) i . B. ol . : To OP p� 3 1v pipe. \ 9.23 "Contour - JUIL CVHLUHI IUN KtHUKT Division of Safety and Buildings Page I of 3 in accordance with Comm 85, Ww. Adm. Code Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County ST• L° 20 lK Include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D.jDw 6 Please print all infonnation Reviewed by Date Personal information you provide may be used Wsecondary purposes (privacy Law. s. 15.04 (1) (m)). Property Owner C�'�•� S . Property Location � C11V 1JlEtt DQk)ELOR" (!OZPo)RA -UO , GOYL E >Z 1/4 MV 1/4 S 1 -7 T ZS N R 2 q E(o W Property Owners Mailing Address Lot # Block # Subd. Name orb l l8 0o ti O��1v S I TZ4 N E, S v i7� ) v o 3 — kE'pr(S LE 18 City State Zip Code Phone Number ❑ City .. ❑ Wage ® Town Nearest Road N ss VY9 cI63) 1 -57 -z56a Tt2.oY © New Construction Use: Residential / Number of bedrooms .�_ Code derived design now rate bOQ E] Replacement Replacement ❑ Public or commercial - Describe: " Parent material pV /Q, r r Flood Plain elevation If applicable Q A General comments fL and recommendations: R•Mtj lM &t) h 1n,gOVND l,Jl q �� 67 'b \3`C gv�o,� � l � l►'ty 6" OF SQrKA> Ft I_t_ �'I►J 4j'T1Ui�l Mt Gtfl BE f0i Pir -G .... . w/ © Boring # ❑ Boring pit Ground surface elev. qzt4. ft _ Depth to limiting factor L4 Z In, Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots SaI Ap plication Rate In. Munson Ou. Sz p`'1 . Cont. Color Gr. Sz. Sh. GPD/ttz V1Z312 'Efi#'1 •Eff#2 — Si Z`�s rilfi- Ct u • - . s 3 ZS -qZ - i.SYri3/y - ► 1�Sbk yvtu cg .Y , b 4 �tZ =6S S yR I& IMS /B s14 L law, — , .� ED i 1 Boring # t[C]� Boring CCU Pit . Ground surface elev. _Z?;Z g, Depth to limiting factor y In, Soll Horizon Depth Dominant Color Redox Description Texture Structure Consistence'°'p�ption Rate in. Munson' • Ou. Sz. Cont. Color teary Roots GPWtt* Gr. Sz Sh. •Eff#'t , 'Efl'#2 o - 1.Z 1tmTL 11 Z � • tZ -ZS l0 yR �6 - Si I - 2'P -sbk L �, 61 w� v ,- e i� — . q •b y - 40.-1 • Einuent #1= BOD > 30 1220 mg/L and TSS 40 _< 150 rO, • Effluent #2 = BOD < 30 mg/L and TSS < 30 nWL. CST Name (Please Q S — 11 Arthur L • �We erer 00 31 s - 3$ - CST Nu nber 220254 . Wegerer Soil Testing &.Design Service La " mMu ""O K. Main St. River Falls, WI 54022 TelephaleN 16 5 • 1 � —S - CjQ 715 -425 -0165 Property Owner Qy41`11i11�1t- � 7�� �11'ic ! Pat rel ID a:'J �/ �3 Pzy6 L a ^� # ❑ Boring �j pig` W VP . suns - m eler•. -` ! il. 7ept �q UInI lnp factor 140 In• 1 w,N AppYCatidn Rata Hodim Depth D0 COI�r Redox boadpkin Textum sYue m Ccr.;hienm Boundary , !3RO -- i.� }� _ G:'f31R In. Munsell Or;. 3'. Cons. Color _ _ Gr. S.L. 5h. . _. .. + — 'Emp! h`lT11112 •�------ •-- -- — s j 1 2. w, sb tin �h e.S -- . S - � D 9 M4Z Z.-f 04AJ 3 o z.$ l0 art WY lC54t m v fl, S SLf wy +I '7.S SA S L t�V%. c • d =0 8odrg S a ©Pit Ground surface alsv. n. Depm u) Nm1U++p iaclor Sall ApplEesUan Rate Horizon Depth Dominant Color Redux DesalpOw ' Texture Structure Conslslenae Boundary Aocts GPDItI= in. Mansell ttu. Sz. Cont. Color Car. 8z Sh. *001 '01111 E RO&g 11 ❑ ac ring surt ee alay. _ . - -- .... % Depm to Wr kq factor In. SG dicallon Rata HmIzorl Depth Dorn mirst (blot RwjwA Losurut l�� �.O.tJl3 ; • U CtC- I !i t :3.7 7 x ! i�u� N a r; " Roots 0, � iti. Mllnsall Qu, Sz. Gant. Color , f pis %01 T111112 s + Rffk nt 01 ° BOD > 3o a 22a ng0L and T')S a -3' ► t - 1 50 OWL + Etllu d 02 BGCI a 30 mpll. mW T83 t 30 99% 'Ibe Deparlmeat ofCosttmerce is as equal a}�co.�tututy +.vi: s p►ovidxx Bpd e��p'.a;�x. IPyou Sneed assistllaoa to ate morviaac or or need material in an altetnate forma', ; J=Se c:arlt? Gt ft de}seciment at r08-s�6 -3131 6084 -8777 - 26. aeowopr.r+ool NOV-22 -2002 13:33 CONTINENTAL DVLP CORP t 763 757 25 P.09i09 Scale P -ti t ds , r 'a fi Uir s sm- i ~-,mss. �9( Cft K% ns *f �� , oQ. Lt - .S-p() 715- 42ST0165 20254 C?+p- 31S --3$ CST Signature Date Telephone Mo.' CST No. Jab N0. TnTCI P AQ Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings in accordance with Comm 8; ism;' Coun �' Attach rgmplete site plan on paper not less than 8 1/2 x 11 inch ia . Plan ust ~ ' ST• C,tZ� 1�C include, but not limited to: vertical and horizontal reference poi ( dire �� r .' Pa I I.D. wDl/`J G percent slope, scale or dimensions, north arrow, and location r�d�(stance toad. Please print all information ' � RWi kwed by Date Personal information you provide may be used for secondary purposgs l dy.,y Law, s. 1 .04 (1 m -- Property Owner Q- {t Qez .S . Co 0 {Z PWjtt , ocation CU�`C1N - ���1 -OPl�7 C�12 POY . :aba t e` � k�•,' 03 1/4 S �`1 T Za N R l9 E (o W Property Owner's Mailing Address Lots .., .- ?I Ck # I"Subd. Name or ZBW 118 00 1 LDEENj S 111eFT M E , S v t'Tis ) v'0 r� . ;.. � � — (S LE e L.UF1' City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road 3L�)v t�i I MNJ 1 55 4 Y 9 1 ( -) 61) - 1-5 - 7 b a - 1 1 O)" I i4 R RoA� ® New Construction Use: JRJ Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement 0 Public or commercial - Describe: Parent material L.t2ZI3 OUEQ /fd `� L-L Flood Plain elevation if applicable General comments , and recommendations: t M V11 &J t) f) M` UN`j 1 'K 6 VtjKj elffLL ftA I AJ tP1Utj 6" of S f= t LL. O7TIUXJ MtGtfr 8E I w tZr\ ItU ho) ° CELLS, _ �Ps eN tu Y -) s I wtiG_ F Boring # ❑ Boring pit Ground surface elev. c l Z-• �, ft. Depth to limiting factor L1 -L_ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 j D -1. Z. t0`llZ -3 — Sl) Z5bIz. wt`� GS - •S .`c'� Z l'Z t.0 Y li 316 -- S 1 1 3 ' Mil <!L'i - • s . �, 3 Zs -4z �.s� — s I 1 eSb k 1M u-F>^ �s _ - . b 4 v z:6$ S 2L 3/v �'��' - �• s1 d L mow, ` — .o . F-?-1 Boring # ❑ Boring ® pit . Ground surface elev. 3 Z Z- Z fL Depth to limiting factor_ �0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ft in: Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 - *Eff#2 O -kZ Iu --tYL 31 Z Si l Z s bk vv �, 1'L -2.S l o y t.2 37 6 - S j 1 2.'F �,-A., � - , s • � ZS-�Io z.s�� 31 - L L bk M V'F1.• d-w — • q ' b V f3 -o S 1 31y -Fly �.S Lt� -3/p, . _� . aV " w .v . o Effluent #1 = BOD, > 30 220 mg/L and TSS >30 _< 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) OO _ 31 S - 38 - CST Number Arthur L:"Wegerer 220254 Address W e g e r e r Soil Testing & .Design Service Date Telephone Number 421 N. Main St. River Falls, WI 54022 JI - 715 -425 -0165 Property Owner Qu4wl Mt„ - bN . t, P . Parcel ID # pEJQbI N 4; Page Z of a Boring # ❑ Boring ❑ Pit Ground surface elev. OtZ-Q - ft. Depth to limiting factor L 4 0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 0 -9 1'2 2 q -ZA 1 d `t Il 3/ 6 — S; -28 l o�r� y/y �.Syay/ — ,( 1cs� mb s 40 SQ IN 7,S Sl$ L 0V1 c ��N • o � i F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I •Eff#2 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor In, Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I •Eff#2 • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD -6330 (86/00) PLOT PLAN Page 3 of 3 Scale 1'= ' 4D LoT 3°� Do T Is 37 L lzS_8 5"41601 31V b[R 1 aZq � s S' o I \� no c P ere - r t-H NL 4 O2 b1SlU� `nf1.S �CYZ -��`A �3 _' �• S' 715 - 425 -0165 220254 UCH- 31S -3� CST Signature Date Telephone No. CST No. � Job NO. 03/12/2003 09:00 4596792 PAUL STANGER PAGE 01 BUUMEESTLH EXU 7192779620 09/11/09 Oi :24pm P. 001 S'1' C'ItU1,1( Gt /11lV'1'Y - SIIPTIC' TANK MAIN'I'13NANl'f3 A01t Wtvilim' AND OWNERS111P CPRIWICA'17I0N FORM Qwner/au er Y Mailing Address Ave sue- -- -, _....- - -•--- _ -� — Property Address 4 ..� (Verification required frmn Plertoing [)apartment ftN new consb1tctiun) P - to GitylSldo _7 7.p IsArQe� Identificaticm Nu11111cr Froperty Location L3L y., Y.. Sec. 1 �. 'rN -Ia q W. cowtt �f Subdivision E'Q �3k4- Certlfled,8urvey M1kp g Pogo H Warraaty Deed R Page M Speo how ❑ yet no Lot lines idea ifiable yea ❑ rto °� We w1 m�Mteoattcoof yews septic system could result in its premature failure to handle wastes. Proper eaaialeseaer, 08 p out as septic tank every three years or "*Der, If needed by a licensed pumper. What you put late ire syotea Reed" of 60 septlo tank ae a gteattnent ■ ile In The waste disposal gdenr. 'the p owner epees to' submil to St. CrO Zoning Departe�teat a certlftoatinn form, ■lgoed m to Ib� °a *. * Meyrirsa phus .K tatrioiedphrarber er a licensed pumper verifying that (1) dw oo- by the otthler lad by ehe ed by NerdlsOeeel "sun a e p c0 ° 0 a a ( 2 ). t lad pwep (ifaetoassry), the septic tank Is ley W � f vqe, ON tssdstslgaed bare read On abov #ad agne to maintain site private eewego disposal l� e tbllk lYeteltt a set by the Depth sod tl>,e Deppvnaet of Natural Aesoursee, 6tste otQ�lpeatlbw dM >OW ONFU ay'nie0 has bow most be comp leted and released to the St. Croix Co days of rice three yule e dale. ►may Zook* Oeta w11lL 30 SIONl1'tVAB OF AF!*LICAIYP. DATI � 1(we) MVfY that all stalemeals on ' 9 1 *4 � ere 11110 to the best of my (out) knowledge. 1 (we) am (ate) die oentes(e) of 77 scribed Rbowe by vfrtve of r<,�r deed recorded In Register of ihedr Otflce, , frt �Q $It)ItT/('I'tA18 01r' APPLICANT . DATE �• s Any lefmmatlon t1ts1 b rule -r r ep EU4rowU in the sRattetr permit being revoked by the Zonift Depechaeat, 0600 •• Intlada vrllh this r llcali eta Pp en: a ttyred.tllnrgstyr deed Gem the Register of Deeds voice a ropy of dw o"Red ■ttrvey map It refmcpce In made In dte warranty dead i1 2201 P 512 -7 16 - 746 State Bar of Wisconsin Form 2 - 1982 KATHLEEN H. WALSH REGISTER OF DEEDS DOCUMENT NO. WARRANTY DEED ST. CROIX CO., WI RECEIVED FOR RECORD 020 1279 80 000 04/10/2003 03:00PK Parcel Identification Number (PIN) WARRANTY DEED Kissner Homes, Inc., a Minnesota corporation conveys and warrants to EXIDPT # PTul L. Stanger and Mary E. Stanger husband and wife, survivorship REC FEE: 13.00 marital property the following desc Ged real estate in St. Croix County, TRANS FEE: 344.40 COPY FEE State of Wisconsin: CC FEE. PAGES: 2 SEE ATTACHED EXHIBIT A This is not homestead property. Exception to warranties: any easements or restrictions of THIS SPACE RESERVED FOR RECORDING DATA record, if any. Name and Return Address: Dated this 7th day of April, 2003 Land Title, Inc. 1900 Silver Lk Rd #200 New Brighton, MN 55112 lssner omes, I c (SEAL) (SEAL) Gre ssner, President (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF MINNESOTA ) SS. WASHINGTON COUNTY. authenticated this 7th day of April, 2003 Personally came before me this 7th day of April, 2003, the above named Gre g Kissner, the President of Kissner Homes, Inc. a Minnesota corporation to me known to be the person(s) �P Pe * who executed the foregoing instrument and acknowledge the same. TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Gregory A. Booth, Atty, 1900 Silver Lk Rd #200, New Brighton, MN 55112 Notary Public, Washington County, Minnesota (Signatures may be authenticated or acknowledged. Both are My Commission Expires: not necessary.) 0 *Names of persons signing in any capacity should be typed or printed below their signatures. ANNETTE D THEIS NOTARY PUBLIC - MINNESOTA e my Comm. Expires Jan. 31, 2005 ■ 3 5 330 . 0 4r! aD Z / S 01 14" E c / 306.34' Cr LA Z N (D d u / ! Y 0r S qD / ' Opp 00 ow V • ii �1r0 l / 0 000 0, •� 4 ` x 1�5 • li 1 " db �M L __