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HomeMy WebLinkAbout040-1125-50-000 1 nsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix F and Building Division Sanitary Permit No: INSPECTION REPORT 137 NERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: onal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. nit Holder's Name: City Village X Township Parcel Tax No: ,Ibelink, Mike Troy, Town of 040-1125-50-000 T BM Elev: Insp. BM Elev: T M Description: Section/Town/Range/Map No: 33.28.19.5238 ANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer 4-4 Holding St/Ht Inlet TANK SETBACK INFORMATION SUHt Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain 17gt771 Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution Ix Hole Size Ix 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 I El Yes 0 No El Yes 70N, COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 530 County Road M River Fal s, WI 54022 (SE 1/4 SW 1/n4 3 T28Nr_R_19W) metes & bounds Lot / Parcel No: 33.28.19.523B 1.) Alt BM Description = P ~ ~`Ox G nS 1' Lo cI6 dt"o f a► <::fav " 2.) Bldg sewer length = Z F-nrcQ, yNri~ t Jn.fD,~s~ ' CCd - amount of cover = A,~ a `j0~~ac,'~.•~ t~jq,~ ~1r (~.d1 GAG ~ ~ Cr ~1 - - - - Plan revision Required? Ej Yes ❑ No to Use other side for additional information. SBD-6710 (R.3/97) Date Insep is Signa Cert. No. County Sanitary rmit Application ST. CROIX COUNTY WISCONSIN In accord with Cha 2 r! County Sanitary Ordinance PLANNING & ZONING DEPARTMENT 00 Personal information yo o e or secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER [Privac aw. . (1 1101 Carmichael Road RE EIVED Hudson, WI 54016-7710 (715)386-4680 Fax(715)386-4686 ttach c mplete plans for the system on paper not less than 8-1/2 x 11 inches in size. NUV IaAyNnitary P rmit # ❑ Check if revision to previous application vl3? Property 114 .s 1/4, Sec 33 1. Applica on In rint at Information rSubdivisiion : LI paw- d l l N, R W Properly Owner's Mailing Address ber Block Number City, State Zip Code Phone Numer Name or CSM Number 4a ! 5S3 S<v II Type Building: (check one) ❑ Village RT rwn of ❑ 1 2 Family Dwelling - No. of Bedrooms: O Public/Commercial (describe use): ❑ State-owned are t R ad It. Type of Permit: (Check only one box on line A. Check box online B if applicable) (t Parcel Tax Nu er(s) A) 11.[R<e~air ❑ Reconnection ❑Non-plumbing . ❑Rejuvenation Sanitation 0 1126 - SO -6:::0' Permit Number D e Issued B ❑ State Sanitary Permit was previously issued / v e cO IV. Type of POWT System: (Check all that apply) Lrf N n~pressurized In ground ❑ Mound a 24 in. suitable soil ❑ Mound :5 24 in. suitable soil ❑ pound A+0 ❑ Sand Filter ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line ❑ Pressurized In-ground ❑ Holding Tank ❑ Single Pass ❑ Other ❑ At-grade ❑ Aerobic Treatment Unit ❑ Recirculating . DispersaUTreatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed (Gals./day/sq.ft.) (Min./inch) Elevation A- L Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks S tic-{ +r - l sw GG„ 0 ❑ ❑ ❑ ❑ P"Inka CAO-In t 0 + 0 0 0 11. Responsibility Statement I, the undersigned, assume responsi ' ty for repair reconnenction/rejuvenation/installation of non-plumbing for the POWTS shown on the attached plans. A license is not required for terralift re it or the ins llation of non-plumbk% sanitation system. Plumber's Name (print Plumber' Signat r (no •lMPRS No. Busine Phone Number s 5--- 3 /s. B'- 776 Plumber's Address (Street, ity, St , Zip Code) Ill. County Use Only rove Sanitary Permit Fee Date Issued Issuing nt Signature stamp ) Approved wner ven Inifia verse '7 < a~ Z(~ O FD2 ination G cJ X. Conditions of Approval/Reasons for Disapproval: Ptfw.~~~ rs ~t fe a„r e~ ~tc¢.. r~a:.~ . f Rev: 8/05 30 ~ ~ E,7i~~ ~a~zerrta%n..Z v ~2 ou t of'G.?~r~cc-mod t t fs~ el ~ 7o Se r~,o /aceol 1 1 i f4o.Ri/. e- /e.{ o rrs'r~ircar~q. 1 a~i o t 77- Coe; nt C4131!~('Ir 4CCe&S ri O.0( pa ( cq- +h. t, oa a [TC]caPY Apprgr. Can4~w-az~ ~-i ~/oca ~ m,c e,~~sfix3 u✓,soersc~/Ge//S !4PPruX /°ca.z~ior, o,C' B-Xi;#•' 7aq -6, be ~e~b "aSiS~ 30 ~ i ou-clof~~c+-~ CneneC.~cd t r `Gds- To 5c ~qa /acca/ t t t ^e • car+nc t ~/.S~i~x aCee.~c rmac~ a ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING w„, p cAo.,,her- This is to certify that I have inspected the septic tank presently serving the /{yap 11z0X111e A4-iC residence located at: SE '/4, Scd '/4, Section 33 , Town ,).Q N, Range 1_W, Town of St. Croix County Wisconsin. Upon inspecti n, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. r Most recent date of service 4f. zf~ 2~p8' Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Capacity: cD W ,es~ Construction: Prefab Concrete ~_Steel Other Manufacturer (if known): A ank (if known):5~~ ~q84 r icensed Plumber Si ature) (Print Name) Qcor~Gr- (Title) (License Number) 14WMPRS A~. z s; xw~ (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the ~1~•~ residence located at: J,E'- '/4, Sk) '/4, Section 33 , Town z~N, Range &,W, Town ofo , 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 Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of service 4~. 'o zco~ Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Capacity: ~0 ~s6m~ Construction: Prefab Concrete Steel Other Manufacturer (if known): Zi.,7 G,.Jr, ;Ag Tank (if known):ensed Plumber Signature) (Print Name) (Title) (License Number) W/MPRS 2 .2-~ (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) I~ - U 2 9 3 3 212 812?69 KATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM 2 - 2000 REGISTER OF DEEDS Document Number WARRANTY DEED ST. CROIX CO., WI RECEIVED FOR RECORD This Deed, made between Michael J. Hilbelink and Thomas B. 11/23/2005 08:00AN Dolder dba Hilltop Partnership Grantor, and Hilltop Partnership. LLC Grantee. WARRANTY DEED Grantor, for a valuable consideration, conveys and warrants to Grantee EXERT i the following described real estate in St. Croix County, State of Wisconsin (if REC FEE: 13.00 more space is needed, please attach addendum): TRANS FEE: 937.20 See attached Exhibit "A" for legal description. COPY FEE: CC FEE: PAGES: 2 Recording Area Name and Return Add W/& 720,0 7.4 7- Ale~x 1~//p / 4& k-j j"le"6 4 -!QI/ ✓C~ ~ 4 0 ~ Z' 1f 6!7- /it V -~-S-3Sb 040-1125-50-000 and 040-1125-70-000 t' S C 7 36 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: easements, restrictions and rights of way of record, if any. 44 this jlfb~d y o venmber 0 D .J 'r * ichael J. Ht Ink * Thomas B. Dolder * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF MINNESOTA ) ) ss. ~ County. ) C/ authenticated this derv of Personally came before me this day of November , 2005 the above named Michael J. Hilbelink and Thomas B. Dolder TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by 6706.06. Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Joseph D. Boles - Attornev at Law * _ River Falls, WI 54022 Notd~ blic, State of Iyi ; n Ps o-Aw MY Commission is permanent. (If not state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) 1-31 -74y / U A ' Names of persons signing in any capacity must be typed or printed below their signature. Cwo, ) =MATHESWMN STATE BAR OF WISCONSIN &,WP OYCELYN WARRANTY DEED FORM Na 2 - 2000 OTARY PteComm. E A II ConC' Ur4 a'5"'P 2 $e AOC-44 4 7 v tC , ~•;s~, c-{ont (45W wPC56WZ T~~ fn be ~¢,F~ "aSis~ 30' , ocr_fof'~enct.~cd t t 14'ea6& To Ze rgolacea/ 1 t 1 /s.,g~o~~•s'~E~ncu'rJ. Cc„crvEe drS{7'i'~ia~ boX C~r,'sb > rolae ~ 1 ~'e•cohnc ~d I~~ I Plb. 1-a • WISCONSIN DEPARTMENT OF HEALTH & SOCIAL SERVICES Division of Health Section of Plumbing & Fire Protection Systems . ON-SITE WASTE- DISPOSAL INSPECTION REPORT Name of Premises Street City' County Master Plumber Address. Owner rv , : Address. ❑ County Permits .Appropriate State Permits j , Type of Building: In Public Single Family or Duplex CHECK APPROPRIATE BOX FOR VIOLATION TYPE OF TREATMENT SYSTEM ❑ Building Sewer OConventional Soil Absorption System ❑ Septic Tank ❑ Conventional System-in-fill ❑ Holding Tank ❑ Alternate Mound System ❑ Seepage Bed ❑ Holding Tank ❑ Seepage Trench ❑ Seepage Pit ❑ Experimental System BRIEF, FACTUAL COMMENTS AND SKETCH: Fq~ T e { y E E 14- 3 1 f ❑ SEE ATTACHED DISCUSSED.WITH PLUMBER ( ) Yes ( ) No SIGNATURE (Voluntary) DATE OF INSPECTION Signature of lnspector White - Inspector Yellow - Local Inspector Pink - Plumber or Responsible Party Plb. t-A WISCONSIN DEPARTMENT OF HEALTH & SOCIAL SERVICES Division of Health ' Section of Plumbing & Fire Protection Systems ON-SITE WASTE DISPOSAL INSPECTION REPORT Name of Premises f< . Street City County Master Plumber vr~ ' Addressl0v: Owner Address;' ❑County Permits Appropriate State Permits Type of Building: 'Public',~,~ : ?,rn~ t 1% ('-i r c 1 ❑ Single Family or Duplex CHECK APPROPRIATE BOX FOR VIOLATION TYPE OF TREATMENT SYSTEM ❑ Building Sewer k~ onventional Soil Absorption System ❑ Septic Tank ❑ Conventional System-in-fill ❑ Holding Tank ❑ Alternate Mound System ❑ Seepage Bed ❑ Holding Tank ❑ Seepage Trench ❑ Seepage Pit ❑ Experimental System BRIEF, FACTUAL COMMENTS AND SKETCH: JAL* r~l e 0I, ' I { 3 3 o { i i S I ~ I E a ~ I i E I E C I ~ € E E~ x ( F t it € i ( i a } s l ~ # E i i ~ mow. _ ! ❑ SEE ATTACHED i DISCUSSED WITH PLUMBER Yes l ! No SIGNATURE (Voluntary) DATE OF INSPECTION rM a ' > f' k` Signatur$of Inspector` White - Inspector Yellow - Local Inspector Pink - Plumber or Responsible Party AS BUILT SANITARY SYSTEM REPORT h 'MER , TOWNSHIP t SEC.,* w T N, R~W 0, ADDRESIS , ST. CROIX C Y, WISCONSIN. .'BDIVISION LOT LOT SIZE r PLAN VIEW -Distances b dimensions to meet requirements of H62.20 } SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM I `F 1 ~ -1 LJ N -r I dicate Mr- thlh -A ' rota j SCALt tPTIC TANK(S) MFGR. CONCRETE STEEL NO. of rings on cover Depth DRY WELL _ l NCHES NO. of width length area .3 r -C no. of line width, length area pt to top of pipe A=GATE FA . 1) - ?4K RATE y AREA REQUIRED tD~ AREA AS BUILT .404 lisclaimer: The inspection of this system by St. Croix County does not imply complete ;opliance with State Administrative Codes. There are other areas-that it is not possible to inspect at this point of construction. St. Croix County assumes no liability for jStem operation. However, if failure is noted the County will make every effort to itermine cause of failure. A.ASES AND OILS SHOGZD NOT BE DISPOSED THROUGH THIS SYSTEM. a `INSPECTOR DATED PLUMBER ON JOB PhuvnVL LICENSE NUIMER . 17.5 REPORT OF INSPECTION - INDIVIDUAL SEWAGE SVSTtM S ani tan y P e tmi -,q/- State S e p-t.4 e LAME Townah.ip -St. Croix County oca.tion s s C-i section Lot N Sub ivi,6ion A PTIC. TANK Size gallona Numbers o6 eompat.tmen-ta ,(e•tance Atom: Wgll Building 12$ alope Highwa.tet 'UMPIN.G CHAMBER Size ja.e,lona .Pump Mana6ac.tuter: Model Numbers tOLDING TANK Size gallon, N'umbex o6 Compa,%tmen,ta " Pumper. Atanm Sy,6 tem Iia,tanee 64om: Well Building 12% alope._ Hi9hwa,te)L 13SORPTION SITE Bed ?S 3 y Tteneh ia.tance Atom: Wetter- Building,4~~? t2$ alope Highwa,tet 6SORPTION SITE DIMENSIONS Width o A ..tench At Requited area At length o6 e•ach tine ~q 6-t Depth oA toek below tile. 4' _ in Number o6 linea~ g 4-4j L Depth o4 tack oven .tite_ s'2. in ToW length o6 ti nea ~1 l At Depth u6 •.tile below g4ade~2-C, in Diztance,betwe:en tines At Slope oA .tench in. pen 100 At r I utiua aG6vjiNxiun area -5, S~ 6.t Type -oA Covet: Paper a.tnaw IT DIMENSIONS- Numb e t o6 p.i..ta Gxavel around pi to yea no Ou.taide d.iame,teK At Depth below inlet At Total aba oKp,t.i o area. At ,Ah.ea kequited At NSPECTED• TITLE Q AIPROVED DATE j 4ZV1 So 198 'l JECTED DATE 198 1ASON FOR REJECTION . i.. ,.w-.wwMM+rvn+►•+w..w. w'~yr•f~.w.wM~ wn . ,w..r..n ...+br v- a ...4'r. W1'.i• ..M ..uw..a'tr•~. m-. • .r.Y. wYM.T .AVr X' sr r:.. i 13857 REPORT ON INSPECTION OF SANITARY PERMIT # r'y'a (1 Name and Address of Permit Holder Person/Persons at Site (2 )Date of Inspection Zau 1 1 ame, re i ense o o a ing p umber Time of Inspection 3 INSTALLATION CONSIST F: ❑ Septic Tank ❑ Seepage Trench ❑ Dosing Chamber ❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System 77MUHMARK:(Permanent reference Point) Describe: Elevation of vertical reference point: Slope at site: (5)MATERIAL AND DEPTH OF SEWER: (6)SEPTIC TANK: Manufacturer: Liquid Capacity: Tank Inlet Elevation: Tank Outlet Elev: # ft to lot or property line: # ft to well: (7)DOSING TANK: Manufacturer: # of gallons: # of gallon pump set for a cycle gallons; total capactiy of distribution lines gallon; size of pump head; gallon per minute horsepower ; brand name of pump and model number Is the warning device installed? ❑ YES ❑ NO Wired? ❑ YES ❑ NO 8 HOLDING TANK: Manufacturer o gallons construction ; depth to the cover ft; If septic tank is being used are baffles removed? YES ❑ NO; ft from residence; ft from well; ft from property line. Type of warning device Is the warning device installed? ❑ YES ❑ NO; Wired? ❑ YES ❑ NO; Locking device on cover? ❑ YES ❑ NO; Diameter of vent and material Distance from building to vent (9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth; ft to residence; ft to well; ft to property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than seepage pit inlet pipe-elevation ft; bottom of seepage pit elevation ft. (10) SEEPAGE BED SIZE: ft width; ft length; tile depth.; lineal feet tile; ft to residence; ft to well; ft to lot or property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches Elevation of tank discharge line entering bed ft. 11 SEEPAGE Total length of seepage trench ft; width ft; tile depth ft; ft to well; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches; elevation of tank discharge line entering seepage trench ft. (12) Has system been installed in area indicated on EH 115? ❑ YES ❑ NO (13) Has system been installed in floodway? ❑ YES ❑ NO Floodplain? ❑ YES ❑ NO DILHR-SBD-6095 N.05/8 Signature of Inspector: State Permit # ~ ~ State and County PLB,67 Permit Application County Permit # for Private Domestic Sewage Systems County ojx6. a *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWN R OF PROPERTY Mailing Address: In S It t 4/0 B. LOCATION: Sly NO '/d, Section , T ,2F N, R E (or) CW2 Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village >-ro y Township C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance 716 Single family Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolati Total Absorb Area Po sq, ft. New Replacement Alternate pecify) Seepage Trench: No. of Linea', Ft. )Nidth Depth Tile depth (top) No. of Trenches Seepage Bed: _4 LengthWidthXdr - -Depth ,3.(.'1 Tile depth (top) 29" No. of Lines Seepage Pit: Inside diaeter Liquid Depth No. of Seepage Pits Percent slope of land- / In Distance from critical slope WATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑ Owners name as Iisted on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil Tester, NAME C;Z at A C.S.T. # and other information obtained from OW 'l (owner/builder). Plumber's Signature MP/MPRSW# . l Phone #yv2.~ Plumber's Address ' PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. F z r a i 3 . 3 Do Not Write in Space elo FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application U Fee Paid: State County o-c) Date Permit Issued/Plan -ed ( ate G Issuing Agent Name z Inspection YesNo State Valid# Date Recd 1, county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 • AS BUILT SANITARY SYSTEM REPORT _ JR hi_~A _IIL3~1 , TOWNSHIP SEC. TN, R~W r_13ozDIVISION . ADDRESS , ST. CROI CO TY, WISCONSIN. v , LOT LOT SIZE I PLAN VIEW -Distances b dimensions to meet requirements of H62.20 SHOW EVERYTHING I IN 100 FEET OF SYSTEM a If I j~ i. 1 r - ' i I di~ca e o h rr { SCAL . t (PTIC TANK(S) MFGR. CONCRETE STEEL NO. of rings on cover Depth DRY WELL )'NCHES NO. of width length -area no. of linade width length= area to top of pipe ~GREGATE RATE AREA REQUIRED © AREA AS BUILT lisclaimer: The inspection of this system by St. Croix County does not imply complete :o;pliance with State Administrative Codes. There are other areas that it is not possible ko inspect at this point of construction. St. Croix County assumes no liability for .stem operation. However, if failure is noted the County will make every effort to itermine cause of failure. ASASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. : *-INSPECTOR DATED f PLUIMER ON JOB LICENSE NUMBER 17 L 4 • . REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM t Sank.tany Permit. ? State Septic LAME Townahip St. Cuix County aagtion S F- S GJ Sec-tion jLot M Sub 14vi4,ion ~FPT1C. TANK Si z e, gatlo na Numbers o6 eo mpantmenta )i4.tanc.e 6r.omi -weft Building 12% mope H.ighwater. '(IMPING CHAMBER Size 9aQl.ana Tamp Mana6actwtek _ Model. Number iOLDING TANK , Size arse Nu ?tA .a6 Campa4tmant6 . t , Pumper. A4# 4m System )i4 tanee 6r.am: (0 sui.tca'~tng 12% 4 tOpe~ 8SORPTION SITE Bedl y Trench i.6 tanee 6)Lpm:. Wett Building t2$ a.Cope Hi.ghwatoo 6SORPTION SITE DIMENSIONS Width o6 .trench'6t Requited area 6t Length o each tine_ 6 6x Depth o6 ha eh below Number 06, l.ine4_ Depth uA hock oven in To..taX length o.6 tines 62 6,t Depth o6 ,tile below gnade_ Z 6 in Diz Lance between tinea_ ! 6t Slope o6 -trench .in. pen 100 6z 3 Iuku, . ab6v&,.t.iun area ~v 6x Type o6 Cover. - Papers o straw IT DIMENSIONS- Numb e.4. o6 pats Gravet around pi to yea no Ou..t4.ide. d.iameteh 6 Depth below intet 6t Total. ab4 onpt.ion area 6t .Area nequired 6,t NSPECTED. BV TITLE 'PROVED DATE 198 't JECTED DATE 19 TASON FOR REJECTION 13856 REPORT ON INSPECTION OF SANITARY PERMIT # (1 Name and Address of Permit Holder Person/Persons at Site (2 )Date of Inspection l Time of Inspection ame, re s, tense N(Y. o ns a ing Plumber (3 )INSTALLATION CONS S OF: ❑ Septic Tank ❑ Seepage Trench E] Dosing Chamber ❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System B ermanen reference in Describe: Elevation of vertical reference point: Slope at site: (5)MATERIAL AND DEPTH OF SEWER:-. (6)SEPTIC TANK: Manufacturer: Liquid Capacity: Tank Inlet Elevation: Tank Outlet Elev: # ft to lot or property line: # ft to well M DOSING TANK: Manufacturer: # of gallons: # of gallon pump set for a cycle gallons; total capactiy of distribution lines gallon; size of pump head; gallon per minute ; horsepower ; brand name of pump and model number Is the warning device installed? ❑ YES ❑ NO Wired? ❑ YES ❑ NO ; 8 HOLDING TANK: Manufacturer o gallons construction ; depth to the cover ft; If septic tank is being used are baffles removed? YES ❑ NO; ft from residence; ft from well; ft from property line. Type of warning device Is the warning device installed? ❑ YES ❑ N0; Wired? ❑ YES ❑ NO; Locking device on cover? ❑ YES ❑ NO; Diameter of vent and material ; Distance from building to vent (9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth; ft to residence; ft to well; ft to property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than seepage pit inlet pipe-elevation ft; bottom of seepage pit elevation ft. (10) SEEPAGE BED SIZE: ft width; ft length; tile depth; lineal feet tile; ft to residence; ft to well; ft to lot or property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches Elevation of tank discharge line entering bed ft. 11 SEEPAGE TRENCH: Total length of seepage trench ft; width ft; tile depth ft; ft to well; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches; elevation of tank discharge line entering seepage trench ft. (12) Has system been installed in area indicated on EH 115? ❑ YES ❑ NO (13) Has system been installed in floodway? ❑ YES ❑ NO Floodplain? ❑ YES ❑ NO ail DILHR SBD-6095N. /80 i Signature of Inspector: ~I III I State and County State Permit # PLB-67 ~ Permit Application County Permit # 1 for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: t C~ jel~e v ` 1e 4j ~s. B. LOCATION: '/6 Section T_ N, R_ E (or) W Lot# City Subdivision Name, nea est road, lake or landmark Blk# Village Township C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance Single family Duplex No, of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate otal Absorb Area v sq. ft. New Replacement Alternate (Specify) Seepage Trench: No. of Lineal Ft. Width Depth Tile depth (top) No. of Tr nches Seepage Bed: _X_Length- ha r Width V9 ' Depth 36 " Tile depth (top) ?y `r No, of Line Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land Distance from critical slope WATER SUPPLY: Private Vr Joint ❑ Community ❑ Municipal ❑ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certify,d Soil ester, % NAME J~'^ M 1P 1W C.S.T. # 55-1 .5,Dr~ J and other information obtained from a 6i A 1° (owner/builder). q Plumber's Signature P/MP SW# 3a 5 r Phone #W,-k(7 Plumber's Address- 16 6 "41410 PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. L . d I Do Not Write in Space elow FOR COUNTY AND STATE DEPARTMENT USE ONLY Date of Application ~a (J Fes Paid: State County 49,t Date U Permit Issued/R4jeeted (date) C) Issuing Agent Name Inspection YesNo State Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 j ~ Y 1 Coeljtn j-y o i-4 J? o r 3 8 o rb Q ell fj? b -1 4-1 s p 01- r ryT n r- Al n L • Z; n r ,_.,F T T n h 0-. c '1? Ln to G~ e- R CZy 1A 17 b ` C;'f X=• ...rte.............. 7 -ow RECEIVED OCT 17 1980 Zel- PLUMBING SECTION Department of Industry, Labor & Human Relations Division of Safety & Bldgs. isCOnsln Bureau of Plumbing Platting & Fire Protection P.O. Box7969 Madison WI. 53707 Tel. 608-266-3815 IN ALL C t ES DQIVtd RE TO L'1I1~6 (DENT TION t"tE NAME OF PROJECT I TYPE OF APPROVAL STREET AND NO. i CITY OR TOWN COUNTY STATE ZIP OWNER Gentlemen: Examination of plumbing plans and specifications for the above-mentioned project has been completed. In accord with Chapter 145, Wisconsin Statutes and Wisconsin Administrative Code, the plumbing plans and specifications are approved contingent upon com- i pliance with the stipulations indicated on the plans. Please review your code for the requirements of each code section noted. The architect, professional engineer, registered designer, owner or plumbing contractor shall keep at the construction site one set of plans bearing the stamp of approval of the department. In the event installation of the plumbing improvements or system has not commenced within two years from this date, this approval shall become void and new application shall be made for approval of these plans before work may commence. In granting this approval, the Division of Safety and Buildings does not hold itself liable for any defects in plans or specifications, plan omissions, examination and reserves the right to order changes or additions should conditions arise making this necessary. This approval is based on Wisconsin Administrative Code requirements. It shall be necessary to obtain and fulfill the permit require- ments of the city, village, township or county in which this installation is to be constructed. Failure to obtain local permits will auto- matically void this acceptance. Sincerely, cti~fta+0~ 1~K^~ James Sargent-Bureau Director PLANS REVIEWED BY: DATE: cc: DPS-OWS Owner DILHR Local PI Plumber 14A-R 42) County Mfg. Rep. Bux of kieakh. FaE BrSetvPCe DILHR S913-6099 (N. 06/80) Rec.& Env. Services HILLTOP PAnTNERSHIP 85 GOLDEN VIEW DRIVE ~ LAND LAKE, MINNESOTA ` 5,356 1 f T A - co J • V A~ Z SANITARY PERMIT APPLICATION Safety and Buildings Division Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less county • than 8 112 x 11 inches in size.. 1X • See reverse side for instructions for completing this application State Sanitary Permit Number i C1 I E1 The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION P erty Owner Name Property Location rS ~ 1/4, S T -74& N, R ~GJE (or)S Property Owners Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number ) 4 II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ City Nearest Road ❑ Village Public 1 or 2 Famil Dwelling - No. of bedrooms Town OF _7_jr0IL4 G 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 04b- ❑ Apartment/ Condo a 1 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/ School 8 Mobile Home Park I L4#41 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 Office / Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) jvd8n8iic" Sil A) 1. ❑ New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5.yRepair of an -----System --------System Tank Only______________ Existing System ExtsttngS ste_m_ B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued TcrO • V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation a (3i 6b0 . Z ~G • 3 Feet 100.1 Feet VII. TANK Capacity gallonTotal # of r Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Exist in strutted Tanks Tanks Septic Tank or Holding Tank r V 0 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 60 ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. A4" bews Name: (Print) 4iliilltimbep's Signature: (No Stamps) MPMA~R~'0CR1Q~' Business Phone Number: war am" r/1 - Z F1,40 Iri ej= s Address (Street, City, State, Zip Code): /a Z 0 t. IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved 5 itary Permit Fee (Includes Groundwater Date Issue Issuing RA Signature (No Stamps) dApproved Surcharge fee) ~/J ~~v E] Owner Given initial 1 Adverse Determination X. C ~ r' S F APPROVAL ~VA-L/ REASONS FOR DISAPPROVAL' V SBD-6398 (R. 015/94) DISTRIBUTION'. Original to County. One cuPy To: Safety & Ruildings Divi.ion, Owner, Plumber - I I - INSTRUCTIONS i 11- A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815- To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. - IL Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc:), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county- The,plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s); septic tank(s) or other treatment tanks; building sewers; wells,- water mains/water service; streams and lakes; pump or siphon tanks,- distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county,- E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. SAFETY & BUILDINGS DIVISION i I State of Wisconsin Department of Industry, I,abor and Human Relations August 7, 1993 201 East Washington Avenue P. 0. Box 7969 Madison WI 53707 PARKER & A":SOCIATES, INC. DALE E PARI~.ER 6601 GRAND TETON PLAZA MADISON WA 53719 RE: PLAN 393-02038 FEE RECEIVED: 60.00 HILLT()P MOBILE HOME PARK SE,SW,33,28,19W TOWN OF TROY COUNTY OF ST CROIX SITE DEVALUATION IN LIEU OF GROUNDWATER MONITORING The Department has reviewed the above-referenced submittal. Approval is hereby granted to use the groundwater elevation determined by the certified .:;oil Tester-Soil and Site Evaluator (CSTS) in lieu of the depth to soil mottling for designing soil absorption systems in accordance with the CSTS's installation requirements and recommendations and chapter ILHR 83, Wisconsin Administrative Code. The CSTS's report was submitted in accordance with section ILHR 83.09(7)(a)l., Wisconsin Administrative Code. This approval in no way relinquishes the uses of color patterns to estimate the depth .o high groundwater on any other parcels or portions of parcels. This appro~tal does not include review of the design and size of the systems. All other i:riteria in chapter ILHR 83, Wisconsin Administrative Code, must be met prior to issuance of the sanitary permits by the local authority. All permit:3 required by the city, village, township or county shall be obtained prior to installation. Inquiries :should be directed to me at the number listed belo- ase refer to the p12 i number shown above. Q,~~x t Sincerely, Yy G nsky WastewatSpecialist Seni r~''.~~ Section of Private Sewage (715) 726-2544 Friday's 1443R/ 1 813 D.7997 1 It. 01 /911 l rr- 0 cn 0 0 0 m O' 3 d o d V ° ~;`I• 3 m X O Z N -I a N CD M. 7 Z W -•I w p (y I 01 N O O O y W A N O CT CO 7. N O al C0 M. w 3 CAD O N 3 3 V co 3 O F'D `_OG CD Q H Z cm~ N CD N Z N -1 N I a N w N °D M A N ^ 15 o o o ~r~r•• ` 1 O d O d~ N ~ W O R O =L =L 65 6 I O O Cpl! (n COD N N COD ui fN CD S{ C m I d C <l, ~i C Cr ! Cy (C] CAD tDn a a C 0 N N Q a 0 (a o N to s (}n°;~ N W N ay CD m CD W I CL M a Iw c o. Iw C0n co o i A - 00 ~7 I A OD ~7 R! CO ~O1 j lV O 1 ~ O ~1 (D CO (D CO z 8 0, rA CD CD OD C, O N O a I N O O a l O V V a N w C !r -4 -4 3 4 I ~ I Z7 I_A. 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N O M N N -4 x C, O I X -4 (0 CD N I h N O I O I O b I m m I CD o0 00 00 Nq CD O CD CL CL o lA O 0 N O 0 ti O 3 n C ° d f ° d ° d f° ° `~1 CD (D CD m m CD m v ~ 3 v 3 m m cot x z F O N S Cn L- z Cn O W S -I z Cn z N G) W O W O O y Q CD -P~ O O Cn O= n 3 O Cn 5? co O~ a CL CD G O .R c O N OL co M CD CJ1 'O A •P L]. O• Ut CW 'O Z N it) W N hR► `A\ m f ~ C 3 O m 5 (D CD 7 O co N O 1 01 CQ O O N N O W 3 N ° O 3 N :3 y CT O- O "O 3 Q N r'7 ~O) CO 0 CD A CD 0 0, 0 O (a . CD CD n O = O Q =L O Q7 6 l~ a O m CA N::z O a o = CL 0 CD '.I O O fA N O N N O N (A CCDD O y N 3 3 y CD d Cn l\I ID CD W v D (a o m s G D CL m < D m a (D CD CA L-5, M CL (W a T N (Ci7 0 0 `n o~ a o 0 C:, c c c 0- C: CD O O O O O a n r N CD CD (D (D CD 00 00 (j) CD (VD -4 cn co co Cn O O N C iT ' ;o 3 C O O a) a) u O O O n z O O O a 0 0 0 o **~AI°~o a o :E :E*-n vy 3 -I N N = -i -I 0 ~ CA N 0 i o o c N N N 3 N N N m N cr G G o o v CD Q 9 O D cr O C O M CD m -n CD ID O. d 'O 0) m O - m 'NO = p G1 -yp Sk ~1 CD 3 (D 7 .d. y < .0. N CC ,t to O C N Ct < d IN ! 7 I I a -A, r N N o z o z co o N D D o nNi D CD oz O O D a v O a O ° CD Cl) o o CD w. CCD N C = CD 7 CD 'a) C c COD CD c c CD CD CL i - - a m _ W m m _ 3 = a 3 N 3 _ N c O z w O ° N I m O 'P Z n CL 0 W CD CD (D W m _m 00 CL CL a z o ~0 3 '0 3 a cn N N H 00 O 0 O O N O N O 0 ~ Q a C C) CD C C_ = o a oo a y: a I (fl Q T y 0 3 T N S to O T O tU C O OR C CD - 3 N w 3 Cn y' O 7 3 o ° m o ° o a - N r. O n ° y N o ;r 0 aXy o 3 a) a 0. (D V O Cap 3 Q V V a y V 'i N n O CD A a - - n sv I! i 3 F (D O _ X a b I ~ ° T m x v a A 0 0 0 > > > A ti CD CD CD prp w ~p 0 p 0 p 0 b C) (D 0 (D C) CD C) 0. CL ~I oz, REPO~LISPr,CTICN---INDIWAL S3VAGE-DISPOSAL SYSTEM PRIMARY TRMITMENT consists of _ Septic Tank% Other (Describe) SEPTIC TANK: Distance from: We 'greater Lot Line ft. Building ft. High watermark ft. 12% or reater slope ft. Wetland ft. Cistern.ft. No. compartments Liquid capacity`,gal. EFFLU'UNTT DISPOSAL SY`:T'X consists of Tile field. Seepage pit (s). Seepage Pit or Tle Field: Distance from: Well ft. Building ft. Lot Line ft. ftstern ft. High Watermark of water course ft. Slone 12 or greater ft. Wetland ft. Total length of tile lines ft. Number of lines Length of each line ft. Distance between lines ft. Width of trench in. Total effective absorption area of trench bottom So. ft. F r Depth of filter material below tile in. Depth of filter material over tile in. Cover over filter material . Depth of tile below finished grade in. Slope of trench bottom in. per 104 ft. Depth of bedrock ft. Depth to ground water ft. Number of Pits Outside diameter ft Depth below inlet ft. Lining material Gravel around pit: Yes. No. Total sbsorption area sq. ft. Square feet of seepage trench bottom area required . Square feet of seepage pit area required Inspected b :_y a'-"U Title: tit Approved,- Date (V/z ,19~. Rejected Date ,19 County, Town of _ I'd 71~''y C~ Owner A' L.' Sanitary Permit No. Property Address Septic Tank Permit No. Subdivisio 4iL L f i Form.Plb 67 Wisconsin State APPLICATION FOR PERMIT Division of Health for PURCHASE OR INSTALLATION OF A SEPTIC TANK (Sec. 144.03, Wis. Stats.) A. OWNER OF PROPERTY Type or use BLACK ink. Name Address Street, City, Zip Code 64-4.x~ J, 16;9 B. LOCATION OF PROPERTY WHERE SEPTIC TANK IS TO BE INSTALLED Check 1. City Mail address County one : 2. _ Village llage 46 S V l Give license number held: 0. INSTALLER Wisconsin Restricted Licensed Sewer Plumber Services.2"` Name Addre D. SP FICATIONS OF SEPT /-C TANK NEW TANK_ REPLACEMENT Size in gallons: Ch ck one 1. 500 gal. 4. ` 1,500 gal. 7. 4,000 gal. 2. 750 gal. 5. 2,000 gal. 8 _ . 5,000 gal 1/- 3. 1,000 gal. 6. _ 3,000 gal. 9. rover 5,000 gal. give capacity Materials: 1. _4,, efab co crete 2. Poured concrete 3. Steel E. TYPE OF OCCUPANCY 1. _ Single family residence 3. Commercial establishment 5. Other 2. Multiple family residence 4. _ Industrial establishment F. APPROXIMATE NUMBER OF PERSONS SERVED DAILY i G. PERCOLATION TEST MADE 1. Yes 2. No Date F By whom ,.j z (To be completed by County Clerk Date application is filed and fe paid 07 !Permit issued (date) r Permit ber~iS";~ -/J County Clerk Note: The application cannot be considere or filinj /ntil all of the above-questions are answered and the fee paid. County erk will forward application, the fee of $1.00, and Copy (b) of the Permit (yellow copy) to the Division of Health. Checks and money orders should be made payable to the Division of Health. Plb 60 NAME OF BUSINESS„ LOCATION i~ 1 r1 ~/r '°:7w e.C I • fc'tl ! is street or highway c44y_or. t wnship county LEGAL DESCRIPTION OWNER T p.t ?J , Mailing address ,/i zit 5 O 2 ARCHITECT OR ENGINEER Address ZIP .may PLUMBER'.. Address 1. Check appropriate building usage(s) and fill in the information requested opposite each usage listed: Existing building New building Addition -If addition to existing building attach detailed memo for each. O Drive in restaurant . . . . . . Car spaces ( ) Restaurant . . • • . • . Seating capacity 10 sq. ft./person) O Dining hall . . Per meal served Toilet waste Yes No , O Motel O Hotel O Cottages . . . Number of units: 2 persons/unit 4 persons unit TOTAL NUMBER OF UNITS ( ) Churches . . . . Number of persons Kitchen Yes No O Bar or cocktail lounge . . . . Seating capacity (l0,sq. ft./person) ( ) Nursing or rest home . . . Number of beds V),Mobile home park . . • Number of units - dependent (damper trailer) _ - nondependent (mobile home) ( ) Retail store . . . . Number of employees Number of customers (10 sq. ft./person) ( ) Service station Number of oars served daily) ( ) School . Number of classrooms Meals served Yes No Showers provided Yes No O Factory or office building Number of persons (total all shifts~r I ( ) Residence . . . . . . . . . Number of bedrooms ( ) Apartments . , Number of bedrooms Other . . . . . . . . Specify 2. Indicate whether or not the following facilities are oonnecteds Food waste grinder Yes No "r L Dishwasher Yes No X F Automatic clothes washer Yes,-..- No 3. Fill in the appropriate information for the following as indicateds Septic tank capacity planned TOTAL Septic tank capacity required Percolation test results - ATTACH PVX OLATION TEST REPORT SHEET Seepage trench bottom area planned width linear feet depth Seepage bed area'planned width linear feet depth Seepage pit planned outside diameter depth below inlet depth Seepage trench bottom area required linear feet's depth o.}d Seepage bed area required width linear feet depth L, Seepage pit required outside diameter depth below inlot Signature o erson completing forma STATE DIVISION OF HEALTH, PLUMBING SECTION P. 0. Box 309, Madison, Wisconsin 53701 Address-/ Approved: ~/i-- Date: z1 _ta, ll?l a l J U L r'c ) THIS APPROVAL IS BASED ON STATE PLUMBING CODE REQUIREMENTS AND DOES NOT EXEMPT THE INSTALLATION FROM CITY, VILLAGE, T9,P1- SHIP OR COUNTY REGULATIONS OR PEHviIT (OVER) REQUIREMENTS. I c>cnp 0 o (A o g'oc~ d T T I d 3 3 F X I I i ~ ' Z N? Z N = j Z w W O ° q w 0~1 tD ° m o A M. m m o 0 oA O W A 3 -4 00 3 Q ID (D CD (4 CO u, ° CD ° CD I O 0 ~ ~ cn Cn ■t N N f~D 1 j ° W$ to g 3 (l1 7 3 M 7 s7+ fll 7! - O 0 ~1 j C G7 C !JI pj C Gl j, lY In <D Ado 1 cn <yD idol cnzD Sao y y C o N ° n Za, O W ° n L, o m o 0 a O n w Q o o O O ppN~~?I O OD .Z1 A OD ,Z1 rn co bT J J o J ~ ~ J ° I to co CD CD z y O O d N O O CL O fVVO V R N N !r 00 co 000 000 0 00 to (A fn rn I CO) dJ (A 0 1 = ~ CO) CO) CO) o O O _G I a O O O Q T O D co (D ID 9 1 to 90 N I 3 N I 3 N C N N y ?L v U) Cl) c !n • (n X 41 <D N p C I 0 0 .0 c 0 7. I I 7. C N C CD I C N Q Cp d N N N 7 (D CD CL n z 0 I I I ~ fp -I CO W A (D m o w z CL CL °0 $ 0° C/) Co N N f3•R• < O Qj O O p~ om a m CO ¢ m oooi 3 ? a ode ° aN ° 0ryv~ =r o rn o r: CD Q m (D CD o g . O ~.o O m-5L =r -do d c I m c o CD g su c CL fn N OZ CL I ,~OCD p~ -D o OZ d a- a' CD o ~ m I 25' * 0 y 5~ 0- I ? O o 00 q I 7 c°O'~ j ~c ' O Cc G x cfl W RL CD g x CD 0 4t iy w N I NQ •fyD O `A d Cm of o a x m~.o b 7 v d m I y O d ~ ~•O > > o_ 4 CD o c a y o c r X d 3 rno :3.- o CA 0 -4 x C, Y- i ~ O O O tv b CD m cD a 69 0 o0 I o69 69 ~ I o0 O O (D O N O O- 0 p, O d N TK . 3 o7 s o.kv. ~ 1/acoa.+~ y 03 ,o Y 1 J t J L2- 0 CD 2 13- 9" 00 VCACM►~ y J 1 ~D ~jl 03 -cJ N 0 .ol lie M ~ a wr+'t`~Z .7 r' M `r ~ cb J J CD BO , Vtic oaf Eil I r A. 03 -e) jN WIV- t V a+t. G--~ Wit, r O . 7 ri Lj FY TOP J 60 FT VAC.&A+ V) I0+ - ~ , 3 O v ~ J_ r N 0 ~ r ~ `fJ ~ J ~i r ~ O t l -0 CD eo SAFE'T'Y & BUILDINGS DIVISION State of Wisconsin 'Departmentof Industry, l,aborand Ilulnan Itelations ± August 7, 1993 201 East Washington Avenue P. 0. Box 7969 Madison WI 53707 PARKER & ASSOCIATES, INC. DALE E PARKER 6601 GRAND TETON PLAZA MADISON WI 53719 RE: PLAN S93-02U38 FEE RECEIVED: 60.00 HILLTOP MOBILE HOME PARK SE,SW,33,28,19W TOWN OF TROY COUNTY OF ST CROIX SITE [VALUATION IN LIEU OF GROUNDWATER MONITORING The Department has reviewed the above-referenced submittal. Approval i:, hereby granted to use the groundwater elevation determined by the Certified ;oil tester-Soil and Site Evaluator (CSTS) in lieu of the depth to soil mottling for designing soil absorption systems in accordance with the CSTS's installation requirements and recommendations and chapter ILHR 83, Wisconsin +kdministrative code. The CSTS's report was submitted in accordance with section ILHR 83.09(7)(a)l., Wisconsin Administrative Code. This approval in no way relinquishes the uses of color patterns to estimate the depth to high groundwater on any other parcels or portions of parcels. This approval does not include review of the design and size of the systems. All other criteria in chapter ILHR 83, Wisconsin Administrative Code, must be met prior to issuance of the sanitary permits by the local authority. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries t.hould be directed to me at the number 1 ~ fisted below. Please refer to the plan number shown above. Sincerely, YC:y G nsky Wastewat~-~Specialist Seni r Section of Private Sewage (715) 726-2544 Friday's 1443R/ 1 Sf )TV7;R.4IitI~ EVALUATION OF MOTTLED SOIL CONDITION G S7 ~ 7 ~~q3 By Dale E. Parker, Ph.D. Soil Scientist, C.S.T.S. 2 SITE LOCATION: Hilltop Mobilehome Park, 530 CTH M, River Falls, WI, 54022. Located in SE, SW, Sec. 33, T28N, R19W, Town of Troy, St. Croix County. OWNER: Mike Hilbelink, 85 Golden View Drive, Long Lake, MN 55356. The soil is mapped as Santiago silt loam, 2 to 6 percent slopes. Santiago is a well drained soil that formed in silty and loamy deposits over sandy loam glacial till. The landscape is a gently sloping glacial moraine located on a bedrock controlled ridgetop. The land surface is high above adjacent glacial outwash filled valleys. The system site is a nearly level ridgetop with good surface drainage. Current vegetation is lawn grass. A copy of the soil map of the area is attached. A detailed soil profile description for a backhoe pit located near the existing drainfield is also attached. The description shows the glacial deposit was subjected to more water sorting than is normal for a ground moraine. Textures in the subsoil and substratum range from stratified sands, to sandy loam and sandy clay loam. This textural stratification creates a pore size discontinuity where percolating water will hang-up in the smaller pores until the finer material is nearly saturated for periods sufficient to cause redoximorphic features. Water will move into the coarser material only when all but the very largest pores in the finer material are filled with water. This near saturation causes anaerobic conditions resulting in the reduction and re- oxidation of iron minerals and the mottled condition . Water in the soil will not be under a positive pressure and will not enter an unlined auger hole. In -summary, the observed redox features are related to stratified soil textures and reduced vertical permeability and not to actual compete soil saturation. Soil Absorption System Operation The soil absorption system is code compliant for separation from groundwater and bedrock. However, the system is severely ponded and is located in slowly permeable soil. Current code would limit wastewater loading to 0.2 gpd/sq.ft. using trenches and pressure distribution. The gravel bed (at B-2) was relatively free of sludge. A biomat was present at the stone-soil interface but this i appeared normal. A rest period to permit the bed to drain and dry is suggested. I understand aerobic treatment is being considered. However, even with resting and aerobic wastewater the future acceptance rate will be limited because of the slowly permeable soil condition. During the field work there was some discussion of using aerobic treatment for the wastewater from all 17 units and arranging for alternate loading and resting with the drainfield located to the east which seemed to be functioning properly without ponding. This appears advisable. 9(1 • / , Sl CROIX COUNl y' WISCONSIN Silt 1 1 NUMBH' f w I< sl~;z R. 19W ~0 p2 ' r~1 r , o Sad h c 1cY. t .r, liOE ~..i Sal ~-o Q(7i. Ro~~ ~ ~',t+?tyr.•. _M~r ;~•'r'~~'~.°~sB ~ltoE t•~ .RPB .t.:'~ < a R $aB .111 1 a r j l N, JaJlrnv4+•.. o K ink k RoE t.'. j ft• r 7~s✓ 1• ~,~i-> y` r, PIA rte' 'i ~'op, ~ w a - "r. c~.T+~~',r{ ~ J ~ : ttw ✓ ' RPB •Qi PIA Rt>~ 'S«a; atl r»E Y r,{ E a 9Qc SaB _AnD - PIA Pt>C t ~ rxr m C4 T r } •%J: S ~N~'!'R'i•y~r~•J4.. F`~•.t.~~'.1~LV'' -`4 t:-z2/ .bow,,, t. l PIA r t wis 281 Nc8 ~l 41 t t u \_r RPB VIA Ne VIA ~ t. ~'1t -I ~ SIB V t 7 1N I,B Yt> .Y: PIA ~ ( :°RPIA M r `I t .RPE POD NcB PIA rBr.B PIA ' / 3 2 PIA C Nce Y H.A R1A lyp Rrj .1 JeS - NCB v~ 3 PIA `Rn . Oi: '•1{ ~ ~ it? SIB J. , ~ •FV' 1~iL ti.. I~ { NCB / j - yt 1~ Q .l' , ei. Sx?t1B I PIA ' y/ PIA ` •B(ttl ' "h'.-~-iu fi't`. og •F.r NCB ~0ti`ti + Sa8 ~ti ! `~'~y L ~t'~; 1 p!p Z H •i~..._~.~wr~ y ~ ~ ~ eB DaB ReS 1'(1li N•i'1- t. " a "DeP dent of Industry, S OI W N D SITE EVALUATION REP Page I of CW. and Human Relations ion of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. A dimensioned, noith arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY. DATE PROPERTY OWNER: PROPERTY LOCATION Hilltov GOVT. LOT 1/4 114,S T 'NR W PROPERTY OWNER':S MAILING ADDRESS LOT m BLOCK fr SUBD. NAME OR CSM # 85 Golden View Drive _-F. isting Mob Pa r1c CITY, STATE ZIP CODE PHONE NUMBER (]CITY (]VILLAGE 010WN NEAREST ROAD Lon Lake MN 55356 (611 4,76-1867 T o [ J New Construction Use [ I Residential / Number of bedrooms [ I Addition to existing building j 3peplacemeht [ Wublic or commercial describe bite a ress is , ygr3 Falls, W1 N622 2 Code dernred dafty flow 2100 gpd Recommended design loading rate bed, gpolft U trench, 9P Absorption area required,,Q,5np)ed, 1`12 _Z,001pench, ft2 Maximum design loading rate _ 4__2_bed, 9pdm24_3._trench, gp02 Recommended infiltration surface elevation(s) R_siin{f -wed - 96. 3 ft (as referred to site plan benchmark) Additional design/ site considerations Existing bed is at 4611 deerp-_nd in the sel strata. Parent material Loess,/loam and sandy drift. Flood plain elevation, if applicable pmtft S - Suitable for system . cONVENnoNAL T MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem S O U PS ED so U S O U [is U [].S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure nce , Roots GPO/ft in. Munsell flu. Sz. Cont. Color Gr. Sz. Sh. Bed tench 1 A 0-11 10YR 3/2 A+B 11-16 lOYR 4/4 0-6 Ground Blt 16-23 10YR 4 4 elev. 1i2D_1ft 2B2t 123-31 7.5YR 4/4 Depth to 2B3t 131-58 5YR 4/4 * sc limiting factor 2C1 58-78 7.5YR 4/4 strat. f m+ s 109" 2C2 78-10 5YR 5/6+4/4 at field ca is+s Remarks: Boring # 2C3 100-1119 7.5YR 4/4 scl 0 m mfr none N.P.0.2P 13 * In lusio s of 7.5YR W8 weathered minerals. Also, a single 7. YR 4/ coa se silt an very fine sand ba d. Mangans a 7.5YR 5/8 mottles in the upper 2-3" of Ground elev. It. sl scl under the silt. Silt band is not al horizont l and dos not appear to be Depth to co iii tinuo s. Silt and vfs has lmpl structure and woul cause s me re tric ion limiting to verti al pereolati n. factor The 1 wer 30" was ug with hand spade. olomite B was enc unter d at 109" Remarks: T Name: a se p~,t Phone: are E. Parker Ph.D. C.S.T.S. Address: 6601 Grand Teton Plaza • Madison • WI • 53719 Field work on 6-23-93. Signature: w ^ 7A 1 ) Date: A-3/1-93 CST 0 9 PROPERTY4WNER.,/jt,LTnP MA EARd PARCEL I.D. SOIL DESCRIPTION REPORT Page # Boring # Horizon Depth Dominant Color mom Structure in. Munsell Qu, Copt Texture Gr. Sz. Sh. Consiste m Bancbry Roots Bed D n 2 An a ditio 1 pit was d g about 70' So thwest of B-1 at a location bet een e t pond Ed beds. Because o the danger of Gavin onl a v r g Y y gener 1 des ri t' n i Ground provided. Soil materia s are similar o B-1 xcept the sandy cl loan la elev. 101.E more dense nd massive. The bottom of these wo ~s ponded beds is it 36" and i Depth to appe rs to a in this very restrictive layer. This may account, in part, limiting f the' factor pondi g of ffluent in hese beds. Remarks: Boring # The d aw' w' S ste s Ground At th t - elev. ft has b en u ed a] MO Depth to mobil home ac s. vent limiting factor beds Ippear. to 44a4 L--t-h ma n a Remarks: Boring # C1 Red ximor hic features observed in t e soil rofiles t this site a tF S b e e Ground cau ed by textural dif erences and r tricte vertical ercola 'on an not b a` elev. It. sea oval aturation. For example t mottl d conditi n relate to t e si t layer Depth to lay r in -1 is at a v riable depth a d does not incre se with a th here s a factor limiting sea onall saturated c ndition would a at a more unif rm de t exp cted o increase with depth, and w uld e Remarks: Boring # Ground elev. it Depth to limiting factor Remarks: SBD-8330lR AFro9► NO1D3S 9N18OM b ` . ~1a CIO Zr- vi 0861 C 130 a o3A1333a <n C Lr) .sa • s ai . 4~ ~ -tit Lr) !nu I:. U v :L - 1 ti d _ _ Jf v `T r_ t r-• v ~ ~ C,r` c r~ 9 4 U ` J O•. , d - o.y i- ~4 Wisconsin bepartment of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION 299151 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: HILLTOP MOBILE HOME PARK TROY CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 040-1125-50-000 TANK INFORMATION ELEVATION DATA - TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet Vent TANK TO P/ L WELL BLDG. A ir Ito ntake ROAD Dt Inlet Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System I PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Loss Head Forcemain Length Did. f Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake 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 ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 33.28.19.523B,SE,SW 530 CTY HWY M P I I I I o oz-4, stem of- 0.. Cie& e r' 'Gbv 5e~'cn ilia Plan revision required? ❑ Yes ❑ No it Use other side for additional information. b SBD-6710 (R 05/91) Date Inspector's Signatur Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations March 23, 1995 201 East Washington Avenue P. 0. Box 7969 Madison WI 53707 ULBRICHT & ASSOCIATES ROBERT ULBRICHT 655 O'NEILL ROAD HUDSON WI 54016 RE: PLAN S95-00554 FEE RECEIVED: 200.00 HILLTOP TRAILER PARK SE,SW,33,28,15W TOWN OF TROY COUNTY OF ST CROIX AEROBIC TREATMENT UNITS. The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. The Aerobic Treatment Units shall be installed as per the approved plans and the manufacturer's recommendations. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, en th Stiemke Plan Reviewer Section of Private Sewage (608) 266-8230 7:00 to 3:45 Mon. thu Fri 7864R/ 1 ~c• ST CROIX $BDA- 997 IR. 10/841 I' wsc ire Departrnent of Industry, Sol ND SITE EVALUATION R E P fW. Page I of LaWand Human Relations 14 Ion of Safety a Buildings in accord with II-HR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Hill GOVT. LOT 1/4 1/4,S T ,N,R W Rp. 33 PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUB D. NAME OR CSM # 85 Golden View Drive CITY, STATE ZIP CODE PHONE NUMBER []CITY OVILLAGE OWN NEAREST ROAD Lon Lake MN 55356 (611 4.76-1867 Tro [ ] New Construction Use Residential / Number of bedrooms [ ] Addition,to existing building I Weplacemeht ( Wublic or commercial describe Site address is , y r falls, Code derived daily flow 2100 gPd Recommended design loading rate bed, gpd/ft~ ~ • 3 trench, gpdAt2 Absorption area required ,10_,- . bed, ft2 -1,oO f*ench, ft2 Maximum design loading rate n bed, gpd/ft2_D~3_trench, gpd1ft2 Recommended infiltration surface elevation(s) Exist;ing-End= 96.3 • ft (as referred to site plan benchmark) Additional design /site considerations-F.isti., hed is t- 46" deep and in the ee_at Parent material Loass/loamy and sandy drift. Flood plain elevation, if applicable Nt ArP14 It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem Q S ❑ U S O U PS Ely PS ❑ U ❑ S U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont- Color Gr. Sz. Sh. Bed Trench v A 0-11 10YR 3/2 1 ' A+B 11-16 10YR 4/4 Ground Blt 16-23 10YR 4/ -ict 2fabk mfr 0-& 0.5 4 elev. 100-it. 2B2t 123-31 7.5YR 4/4 sl lmsbk mfr 0.4 10-5 Depth to 2133t 31-58 5YR 4/4 * scl s limiting factor 2C1 58-78 7.5YR 4/4 strat. f m+cs 0 S9 ml I gN none 0.7 0.8 109" 2C2 78-10 5YR 5/6+4/ 4 at field ca is+s 0 siz I ml, aw none 0-4 1:0.5-' Remarks: Boring # 2C3 100-109 7.5YR 4/4 scl 0 m mfr none N.P.0.2 * Inclusions of 7.5YR 6/8 weathered minerals. Also, a single 7. YR 4/ coarse silt an very fine sand ba d. Mangans an 7.5YR 5/8 mottles in thtupper 2-3" of Ground elev. ft sl scl under the silt. Silt band is not al horizontal and dappear to be continuous. Silt and vfs has lmpl structure and woul cause tric ion Depth to . limiting t o verti al percolate n. factor The 1 wer 30" was ug with hand s ade. olomite B was end at 109" Remarks: CST Name:-PI e se Pt Phone: Da~e )inParker Ph.D. C.S.T.S. (608)833-3133 Address: 6601 Grand Teton Plaza ■ Madison WI ■ 53719 Field work on 6-23-93. Signature: Date: CST Number: 6-30-93 CSTS # 2 i II PROPERTYOWNER dItLtoP 1711 PAVI SOIL DESCRIPTION REPORT Page 2\` PARCEL I.D. t Boring # Horizon Depth Dominant Color Mottles Texture Structure CorML, Bourd3y Roots GPD/ft in. Munsell QU. Sz. Cont. Color Gr. Sz. Sh. Bed ta--d 2 An a ditio 1 pit was d g about 70' Southwest of B-1 at a location bet een the t pond d bed g. Because o the danger of caving only a vary l des ri t' n t Ground provided. Soil materia s are similar to B-1 except the loa la is elev. 101.x, more dense and massive. The bottom of these two ponded t 36" and i Depth to appears to a in this very restrictive layer. This may account, in part, for the limiting factor pondi g of effluent in hese beds. - ~ i Remarks: Boring # The d awin with DTT.HR 1D# - s s t e s wer! installpd. Thin draw* --k to chow he-104&A;j Q46--of R md-41 Ground At the t' elev. has b en u e ft. Depth to mobil home ac limiting beds bDz)ear factor imay n a Remarks: Boring # Red ximor hic features observed in the soil _profiles t this s'te a aF5 o be cau ed by textural differences and restricted vertical ercola 'on an not b a' Ground elev. seasonal saturation. For example t mottled condition relate tot a silt layer ft. Depth to layer in 11-1 is at a variable depth and does not increase with depth-where s a limiting sea onall a at a ae saturated condition would more unif rm deDtIWJ nd would factor exp cted o increase w'th depth. Remarks: Boring # i Ground elev. ft. Depth to limiting facto r IL I Remarks: SBD-8330(8.05/92) I EVALUATION OF MOTTLED SOIL. CONDITION G SY~' .I'q3 By 7 Dale E. Parker, Ph.D. Soil Scientist, C.S.T.S. 2 SITE LOCATION: Hilltop Mobilehome Park, 530 CTH M, River Falls, WI, 54022. Located in SE, SW, Sec. 33, T28N, R19W, Town of Troy, St. Croix County. t OWNER: Mike Hilbelink, 85 Golden View Drive, Long Lake, MN 55356. i i The soil is mapped as Santiago silt loam, 2 to 6 percent slopes. Santiago is a well drained soil that formed in silty and loamy deposits over sandy loam glacial till. The landscape is a gently sloping glacial moraine located on a bedrock controlled ridgetop. The land surface is high above adjacent glacial outwash filled valleys. The system site is a nearly level ridgetop with good surface drainage. Current vegetation is lawn grass. A copy of the soil map of the area is attached. A detailed soil profile description for a backhoe pit located near the existing drainfield is also attached. The description shows the glacial deposit was subjected to more water sorting than is normal for a ground moraine. Textures in the subsoil and l substratum range from stratified sands, to sandy loam and sandy clay loam. This textural stratification creates a pore size discontinuity where percolating water will hang-up in the smaller pores until the finer material is nearly saturated for periods sufficient to cause redoximorphic features. Water will move into the coarser material only when all but the very largest pores in the finer material are filled with water. This near saturation causes anaerobic conditions resulting in the reduction and re- oxidation of iron minerals and the mottled condition . Water in the soil will not be under a positive pressure and will not enter an unlined auger hole. In summary, the observed redox features are related to stratified soil textures and reduced vertical permeability and not to actual compete soil saturation. Soil Absorption System Operation ' The soil absorption system is code compliant for'separation from groundwater and bedrock. However, the system is severel ponded and is located in slowl severely y permeable soil. Current code would d l lim mit wastewater loading to 0.2 gpd/sq.ft. using trenches and pressure 't distribution. The gravel bed (at B-2) was relatively free of sludge. A biomat was present at the stone-soil interface but this appeared normal. A rest period to permit the bed to drain and dry is suggested. I understand aerobic treatment is being considered. However, even with resting and aerobic wastewater the future i acceptance rate will be limited because of the slowly permeable soil condition. During the field work there was some discussion i of using aerobic treatment for the wastewater from all 17 units and arranging for alternate loading and resting with the drainfield located to the east which seemed to be functioning properly without ponding. This appears advisable. 0 - N ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT A FOR UTILIZATION OF AN,EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently CO f$J e4 serving the 4/-M. w.-st located at: -5,o5- 1/4, 1/4, Sec. 3 , T_Z_a_N, R_9 W, Town of 777k-;o 1.4 Upon Inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. ) Last time serviced 5 19 Did flow back occur from absorption system? YesY_No (if no, skip next line) Approximate volume or length of time: gallons minutes Capacity: /,,500 %a j, Construction: Prefab Concrete X_Steel Other Manufacurer (if known): Age of Tank (if known): R G C (Signature) (Name) Please Pr t Lw&tg &am~6t 7117~'j 6vsk~WiW (Title) (License Number) ~cl, -A (Date) Form to be completed by licensed plumber (x.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary Permit) Certification: In accepting the above statement regarding existing septic tank condition.. I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name Signature _);~bt V1, XNN u rv-3 5/88 . . b 20 tae ,.-~.s3SCo lur, (a.~~e, r►'1t1 A 17-) 1 - W7 (j4) (Giz) VY-02-Z3 (4 IZ~ 7 5~~3~ CW~d~tS cc►,~c~ s""e~e.i`5,crr~Ynre { r -S 2- o 4 ~r . ~3eGor ~r'l ski. .~rscrQ-7~ _ _ c✓ a . S {l ( V J 30 CC~~t bt } 1 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations - Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but 51, 'C"eol' X not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or -y- PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. ON Si'T 4V114 f 1704/ APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION vS 12' 93 REEV•IEWEDBY JON DATE PROPERTY OWNER: i//To10 -r'4iex PROPERTY LOCATION -Xlf, GOVT. LOT 1/4 1/4,S T N,R E (or) W PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # ~S Go/D~,•J !/ice ~P • t CITY, STATE ZIP CODE PHONE NUMBER EICITY []VILLAGE MOWN NEAREST ROAD L0G- Li4KF ~l ~v, SS 3S & ((e/24 5176 - 1A, 7 [ ] New Construction Use[ J Residential /Number of bedrooms Addition to existing buNildin o Replacement [X) Public or commercial describe l0BiXF . building Code derived daily flow gpd Recommended design loading rate z bed, gpd/ft2 3 trench, gpd/ t2 Absorption area required ' bed, ft2 trench, ft2 Maximum design loading rate • S bed, gpd/ft2 G trench, gpolft2 Recommended infiltration surface elevation(s) s 3 ft (as referred to site plan benchmark) Additional design / site considerations SEA Z Parent material ACS J~O ' Slf as llt5 Sat. a Flood plain elevation, if applicable N• ~J- • ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FlLL HOLDING TANK U = Unsuitable for system ❑ S MU ®S ❑ U ❑ S Z1 U O S ,QU 0 S ®U ❑ S SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounclay Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed reach / ~ti D ~ 3 z, f, s6k 40 r/fif' is Zf' - S , ~ -y oy"e i S • G Ground 3t `~-3 7 7-S YA y S , 5 b,e; (P. f /Z S /U f elev. ft. (3 1. 7-56 /D l~ S S Depth to F~ 3 -O "5^ 75 YX y sl limiting factor sc/ / , , ZIP ,v Remarks: r,2 If G'`fOST If SSi~U~ /~l/ S f`il°UG74U~° Boring # yle 3 Si/ 2, nr 6h iw, fie S 3 Uf $ • , Z,. /D ye y /uf 2 -3 , as , 13, 7 s z,f,sb,t /~OfP- Ground , elev. f3,.. 30-So S/ 3, M^ (3 n~. ~F r . S ft. C D - Ps 5 y,P ~/y SGl 1, f R l u~ ,v(~ Depth to liactorg ~Zo-v 92 kj 0 ~4 WOO 6: ~0 I7G C011,f i0 e / S~ HN S!L ~0~~ :i SMAZZ S, /N C L tJ i G A.~ S 6,,457- s%9&w t// of Bj C~ A,06- A, f - `4,p S~7 1116 Remarks: i' CST Name:-Please Print Phone: 71c 3 P 6 Address: HOMESITE SEPTIC PLUMBING CO. h k 11-13 CST M o 2 y~Z Signature: ROBERT ULBRIGHT Date: CST Number: WIS. MASTER PLUMBER LIC. NO. 3307 M.P.R.S. MINN. IMSTALLER & DESIGNER LIC. NO. W663 9 10 A4 X ~F tiny 130 jej!~- Ally 13 1 PROPERTYOWNER SOIL DESCRIPTION REPORT Page Lof 3 PARCEL I.D. Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boulfty Roots GPD/ft in. Munsell Qu. Sz. Cont Cola' Gr. Sz. Sh. Bed tends (j- f 1. ~0 ge3 sy 1. f, 5-hit t~-, f2 S if 5- 1 6 y/e 2, tM, SAK nv~fR CS /U-f- , S G Ground 7'S YR 7/(/ s 69 441 1f 1,V" c s , 7 , 60 ele`". 4v -yr-I 141 Depth to e y ~O Jf~ip y ~p 5C 1 ' N✓l AM X- f i ~ r Al P N 1° limiting ; factor /fD i 204 f4 T v fi°~ s p .1.1 Remarks: h1y1r17.ov /3 s i4 ffaDGE ' /~OD~r o~ S•f,up 5'/ Boring# 0-12 /O ye 3/y 2.~f, 5h,t~ -fl( S S .s s ye y Ground / elev. /f D /fi ZO~v /t S /Ll n pD Ore 2 15 4~ s UGC /ln .p O Gl~~' S ,o= Depth to limiting S~ ' T OEM Y!! 0 G ~E ell factor c y Ps s YC y - SG/ n.►1 ~~f' Np N~ Remarks: 7d-y C " ~1r /SO `j/f p rr0-y /i.y r✓~ L /3~ NpS Boring # 13 ~ U•v f~~jQi~~ ~i~o-M d i Zo Ground elev. ft I Depth to limiting factor Remarks: Boring # Ground elev. j ft Depth to limiting factor Remarks: 00M "'Into ArAnl)% ~fi ~~S - off.,v o ti of sT1lA-6- y s ~o ~ 7- Sf, T~'a die fiPov~~ s%s 7ZF'-ti , /3 v 7- a-v cs/ 4 ~ y 4( .5al/1,67 i'F f}oD~' ~/'o-r~.~t w,~a~ y 5'h o Ut L "TS ~•v 3 T~~~-v Alf a J N z~ t w g;g N ' X:5 om rnZ 2 ~ CA 5-4 w iDt Q IMiT CIO ;V4, ~ovB~E p b i ~ GviDE wwrr It. L • ~,-1 Q T b t ~ I L N Imo.. I in L 1 ~ o I N N I -f► y~ w ! r IRr \ R) I ~ N~ N H it I Q!1 y Rr I w 41 y r sn epa " o inaustry, OIL AND SITE EVALUATION REPORT Page / of La Z bor and Human Relations Division of Safety & Buildirxls in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but ' PARCEL LD # I.D. # not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. oN 5tTE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION VwilfirIFT/oAd, REVIEWED BY DATE 12- 23 71'M TkaAr SO,✓ PROPERTY OW ER: PROPERTY LOCATION / X/10- ~l GOVT. LOT 5E 1/4 s~ 1/4,S 33 T ~ N,R E (or) W P70,pERTY OWNERS MAILING ADDRESS V,~ LOT # BLOCK # SUBD. NAME OR CSM # fr'5 4-01blE"v CITY, STATE ZIP CODE PHONE NUMBER (]CITY ]VILLAGE E TOWN NEAREST ROAD L!l ty(r L~4K~ . VN 553SG (40/2-) 5176 - IP4 7 Ted /f cv '"M [ J New Construction Use [ J Residential / Number oH*dmoms = S o M~f Addition to existinbuilding Rep Dement 14] Public or commercial describe MDl3~'/E" 1~~YE ,~f}iQ~ Jtf Code derived daily flow /S, oov gpd Recommended design loading rate ed, gpd/ft2 each, gpolft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft 2-each, gpd/ft2 Recommended infiltration surface elevation(s) /V f~ ft (as referred to site plan benchmark) Additional design / site considerations Parent terial .15;65 Flood plain elevation, if applicable /V ft G r S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for system O S 1g] U ®S ❑ U O S ®U ®S O U O S 91 U O S 29U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench c ?t 69 -G /o ye f/2 Z. -f 5,0,4t, n* -le i . s . G ASS :F x-17 /o ))e- f`I~ S. / 2., f, Sh< /w~ fie G' S Zf S G Ground elev. Yo -7-S /R o ft. 0" v f/ ,vP .uP c Depth to fa~corg ov /3 b ys ~,y STi' G-- D~.iw -64 e-,p ,ev ~c - Remarks: Boring # A•'~ ~j'riii<v. AL Ground elev. 4- Pt X / GO *l T&J-' A19 l Aq f /i! e1 ft. Depth to limiting 7kk t O~/S NO 7- factor W ,PO l1 D CD.vt1 Ti'D.rJij L S~/ s E'"! iE Remarks: ~t!JOf! O 'oe tom. fUiiPE 0+ I-l0 aW40 1YA40 S/,5 ' CST Name:-Please Print '-'OMESITE SEPTIC PLUMBING CO. Phone: 7/f= 3 ~~O ~~~5 DWN WiS_ W16 _HU Address: ROBERT ULBRIGHT I ^ ER PLUMBER Signature: LIC.-NE). 3W M:Rff;&- Date: CST Num er: i 2"t•Gt/ ``w w", ,i., ER DESIGNER LIC. NO. 006W l~- 23 ' 1~Z L y 'L- PROPERTY OWNER SOIL. DESCRIPTION REPORT Page Of PARCEL LD.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bax>d3y Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 4:~ t In. Ground elev. ft. Depth to limiting ri factor 1 Remarks: Boring # 1 Ground elev. ft. 'r Depth to limiting factor Remarks: Boring # i' Ground elev. ft. Depth to limiting factor Remarks: Boring t> <ti Ground elev. j ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) , b ~ ,c Z r/ 4 K C 1 I~ .e• o Mpg . 05 i' 0 • 4 i ' i A E p ~ \ O W I { , C , C 1I S m Srs "t"h is tr: st site N'O'D"' APPR O D ORIGINAL i i f - F^r~ • / 41.4 f. i a'~i s "y O . N REPORT OF IMSPECTI01-1--1NDIVIDUAL SE"MACE DISPOSAL SYSTEM Sanitary Permit ~ State Seen is ~ u £ AI~~ TOWNSHIP G ~ 8t. Croix Co my S`?PTi TA7TV, ize J190 a gallons. "umber of Compartments Z ]Distance From: TJell 30b ft. 12 0 or greater slope ft wilding ~-)at . Wetlands ft ~ghwa eft. DISPOSAL SYSTEM Tile Field or Seepage Pit(s) Distance Frog: Well 3 -f* 11'/. or treater slope ft Building ft. Wetlands &1 f; A F1PLD zixwater_ :it. Total length o lines ft. .lumber of lines. Lengt% of ft. Width of the trench 4 _ft. Total absorption area. -1,85G -Y200 sq. ft. Depth 47 2- 01. rock belotl7 ti./le ai4`in. Depth of rock over ;tile in. Cover over rucle, Pnnt-A, ~ f r ~ , - ,'L~ •1 / ~71 trench -2 in n 101 EL. i)e )Lh to Bedrock ft. Death to ,-round water{ ft. lumber of nits Outsize diar._ieter ft. Deptli below inlet ft. Gravel around pit: yes no. Total absorption area sq. ft. Square feet of seepage trench bottom area required Square feet of seepage nit area required I't inspected by: Titlc-: " ~ Approved Bate 1977. Reiected Date 197 0 e Z~ State and County State Permit # PLB67 Permit Application County Permit 3 for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED `1~ Date Approval Received from State if Required St Plan I.D. A. OWNER OF PROPERTY Mailing Address: 7--'7Z B. LOCATION: '/4 U-) Y4, Section T N, R E (or) W Lot City Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCUPANCY: 'Commercial *Industrial *Other (specify) *Variance Single family Duplex No. of Bedrooms No. of Persons D. TYPE OF APPLIANCES: Dishwasher YES NO Food Waste GrinderYES_NO # of Bathrooms-- Automatic Washer YES NO Other (specify) E. SEPTIC TANK CAPACITY Total gallons No. of tanks *Holding tank capacity Total gallons No. of tanks New Installation Addition Replacement _ Prefab Concrete *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2) 3) Total Absorb Area sq. ft. New` Addition Replacement *Fill System Seepage Trench: No. Lin . Feet Width Depth Tile Depth No. of Trenches Seepage Bed: Length Width Depth Tile Depth No. of Lines Seepage Pit: Inside diameter Liquid Depth Tile Size Percent slope of land Distance from critical slope I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certifie Soi! T , NAME C.S.T. # and other information obtained from (owner/builder). d ~j Plumber's Signal MP/MPR # Phone *X& Plumber's Address t-~- PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). 6) 9.s Do Not Write in Space Below FOR DEPARTMENT USE ONLY 0 J Date of Application 0 Fees Paid: State 00 County Date 5;3 F Permit Issued/ (date) Issuing Agent Name _ Inspection Yes No Valid# Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 6/1/76 W n 1► -4 44 (AJ -41 t-r cA> i - Q << r to I V~ TIN t. ( I { C- Q fe i3 i ril :tj - - 1-4 c RECEIVEDk - > OCT 17 1980 n Po e'' PLUMBING SECTION I ' State of Wisconsin \ DEPARTMENT OF HEALTH AND SOCIAL SERVICES ` DIVISION OF HEALTH 6 1976 MAIL ADORES 5: P. O. SOx 309 j MADISON, WISCONSIN 53701 IN REPLY PLEASE REFER TO: SECTION OF PLUMBING AND FIRE PROTECTION SYSTEMS t 3, 'lea. WAwto 27 aver Lraluv l 34"2 Plan Identification No. 1604409 Dear Sir: Re: Uttrs Court 'il* U-C. ,ftbil4k N Pax* S soot" Di #m. 33 11" bM* of TV" (f. 00047) This is to acknowledge receipt of your plans and specifications for the above- indicated project. When referring to this plan in the future, it will be absolutely necessary to utilize the plan identification number assigned to the yroiect. The spaces below indicate if proper fees have been submitted or if more information is required. Providing plan review is not completed within thirty (30) days, a permit to start construction may be issued if requested. See Section R 62.25, Wisconsin Administrative Code, for limitations in reference to permits to start construction. Preliminary plan review for determination of fees does not hold the department liable in the event additional fees may be required upon complete plan review. Preliminary review indicates the plan review Fee required is $ .1 Fee received is $ 60 0 Plan accepted for review. Fee is being returned because of II Overpayment M underpayment. Providing one of the two categories above is checked, please remit correct total fee in one payment. Indicate plan identification number on remittance. No fee has been remitted. Plans submitted with no fees will be held in abeyance until remittance is received. Indicate plan identification number on remittance. t__! Additional information required. See attached Plb. 100. The permit to start construction will not be issued until 30 days after requested information is received and accepted. Q Plans being returned. See attached Plb. 100. Sincerely, cr~cc/. as-es A. 3arg Chief 3AS:fjs f , lix, .t L i~ F. L Y 4, - Y FiL' y r 1,'r St J3 r JA S`~ n T = +~stt R ra1.f 1"Slops. for -th iMti lli F d' ~n r~it#~"Clt+1~5*, i~~s~INish1.'+ltiflt~s~ ~I e. Jt lists ilrrl~r+s fir, the f1j"tft Pta+j 414 ctftart# , Ot=Cme t' ~ Como Wth the stipulat i l is Ro1 x' tto rig co". sect lova;, P i "S* rivl raw yaire' . f+ tw, lon noted loaf UAY ti) 3 Tom ~M►,.~1rsAltnst.;,~rofo~sta~t ~l~~'i X0!'1 ~ ~r~ ptw~ k , trtatQr shat p,•ot th* aws wctfoa 04 Ovia t, 1wrrlog the *to* of ei*rwsl of the rtmeet. "int instal It%Ion' of tt~s ptwbte~s~~~` s ;t let' the hy Wad , $t a#76. ' tht; f ~ ""al "Ir 1 Ni!~t t . ~ ar+ ip►pMtrr+ss, tla►it bit ~hi►.'h~ iy~orat #~t.f.~► l~+tro ~ r`~, s.~ *i1l I MUM A t '!IIl1Et tl11#,.Mp ~'~ga►a1. tt[1 st ¢f wot~, 3 OtN' tllstal lottoN~0 nowvw"m Of 1A, 'Y n ~ -Ai too, t a w w fir apt1 tilt r";>afhFi► +L~.+'=i this ~t t # ¢ E t l►t d~► is ► ar a Ps# + s Ohio y r il# this k a= A ~F _ ,y n r w,4 - _ o ~f A Sa~ _ set VOrt INWOQUIA 0", ~t1~. 4~ t~Z.~IttiC ~ r I~r.~►t urns ~ ~Y~ rgh~s~ri rl~s t _ J m _ rs fl x ~ ' r 7 . g. ~ •r '4 ~ .t xgAti y m ~ 'y - 4 ,~r ,-fit 2 x ~ - ~;r a~1 F ~ vi # 1 - i a _ _ v • 4 ~ .....t .:3 _ yet..: ~ 4 f ' J State of Wisconsin \ DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH MAIL ADORES S: P. O. SOX 309 MADISON, WISCONSIN 53701 ftwour 2, 1t! 776 IN REPLY PLEASE REFER TO: SECTION OF PLUMBING AND FIRE PROTECTION SYSTEMS Ko il, Inc Routs 4 Plan Identification No. 7Box 27 ltivsx IN110, t2 $442 Dear Sir: Re : Cott' o Court (Nmeer: X*Wil, Inc. mobile, ne Park 4 Seusas Dispossl Slk $Vk $33 32U g1 Tom of 1 - St. Croix This is to acknowledge receipt of your plans and specifications for the above- indicated project. When referring to this plan in the future, it will be absolutely necessary to utilize the plan identification number assigned to the project. The spaces below indicate if proper fees have been submitted or if more information is required. Providing plan review is not completed within thirty (30) days, a permit to start construction may be issued if requested. See Section H 62.25, Wisconsin Administrative Code, for limitations in reference to permits to start construction. Preliminary plan review for determination of fees does not hold the department liable in the event additional fees may be required upon complete plan review. Preliminary review indicates the plan review Fee required is $ e (f Fee received is $ 25z~v Plan accepted for review. Fee is being returned because of II Overpayment Q underpayment. Providing one of the two catagories above is checked, please remit correct total fee in one payment. Indicate plan identification number on remittance. No fee has been remitted. Plans submitted with no fees will be held in abeyance until remittance is received. Indicate plan identification number on remittance. Additional information required. See attached Plb. 100. The permit to start construction will not be issued until 30 days after requested information is received and accepted. Plans being returned. See attached Plb. 100. Sincerely, a~ccco~~1 asses A. Sarg Chief JAS:fjs r PJJJ. ' 160 Lev. 9/76 Department of Health & Social Services Division of Health Section of Plumbing and Fire Protection Systems In reply, please refer to Plan Identification Number 7G Q y ~08 Re : The plans indicated above have been given a preliminary review and the following data is either missing or needs clarification. Please submit the additional information as indicated and checked below. Upon receipt of this additional data, plan review will be continued. I. Plan Submission ❑ No sets of plans and one set of specifications required. ❑ Three sets of plans required of SEWAGE DISPOSAL SYSTEMS ONLY. ❑ Plans shall be sealed or stamped. See Section H 62.25 (2) (a), Wisconsin Administrative Code. ❑ Affidavit Sent. Additional information requested shall be sealed, stamped or signed, as noted above. All information requested below shall be submitted in replicate unless specifically noted below. ❑ Plans not clear, legible or permanent. II. Privat Sewage Disposal Systems ❑ PLB 108 (Appl ation fdr the u of a alternate system) ❑ Cross section of mound. ❑ Pipe lateral layout for alternate system. ❑ Plan view of alternate system ❑ Soils description not adequate. Reconduct soil test. ❑ Plans indicating lateral distances from building, well, lot line, lake, stream, watercourse or water distribution piping to the septic tank and to the drainfield. ❑ Lot size and ground slope. ❑ construction detail of septic or holding tank if site constructed, including dimensions and liquid capacity or the manufacturer of the septic tank to be used. ❑ Construction detail of the soil absorption system, including a cross-section of the disposal field. ❑ Profile of holding tank. ❑ Legal description of property in which systems are installed and prominent landmarks. ❑ Agreement documents signed by owner and local unit of government (holding tank). ❑ Reason for installation of holding tank. (Soil test or statement from county) ❑ Soil boring and percolation test form EH 115 completed by a certified soil tester. ❑ Complete data relative to anticipated use of building Plb. 60 (3 copies). ❑Manufacturer of lift pump(s) including pump curves or manufacturer of automatic siphon including size and average flow rate G.P.M. ❑ Detail of lift pump tank showing pump(s) or siphon. Including size of tank, draw doom and construction detail if site constructed. ❑ Calculations for total lift pump discharge head and gallons pumped per pump cycle. ❑ Size length depth of forced main. p~ ~q II 7 Ze'*141.2 ` I. Reduced 9ess &e Zone-Type Bac low Preveoer V / ❑ Elevation and location of valve in building. /rte' ❑ Detailed piping diagrams. ❑ Flow rate. ❑ Valve size, model number and manufacturer. ❑ Signed inspection and service agreement between owner and testing representative. SEE OTHER SIDE 'V IV. Private Interceptor Main Sewer (sanitary and storm) i ❑Calculations (all pipe sections) (flow rate). ❑ Input (population). []Elevations of all piping and manholes. ❑ Profiles of system or complete finished contours. ❑ Number and type of plumbing fixtures for each building. (Include all floor drains and equipment). ❑Calculations for all drainage fixture units in each building. []Type of buildings (usage). ❑ Copy of maintenance agreement by owner. ❑ Copy of easement for sewers on public or other private property. []Letter of acceptance from proper authority indicating approval of the sanitary system and connections to the public sewerage system. Building Sewers - Building Drains -Drain Waste & Vent []Floor plan showing building drain. []Statistics for sizing. []Sizing requirements of all piping, including risers and isometric diagrams. []Grade, slope or pitch. []Elevation relative to connections along with terrain elevations. []Manhole locations. ❑Cleanouts and locations. []Venting. []Traps. []Materials and specifications. []Ejector size and specifications, []Capacity of grease interceptor and size of sinks contributing thereto. E ]Plot plan showing building sewer and water service. VI. Water Supply, Distribution and Service []Floor plan showing water distribution system. []Size of pipe and complete calculations. (See instruction for plan review). []Material specifications to include fittings, pipe, fixtures, etc. ❑ Complete valving specifications. ❑ Pressure at pub).ic supply or supply tank. ❑ Capacity of pump . ❑ Capacity of storage tank. ❑ Method of draining system when not in use. r ❑ Provide risers, details, and isometric diagrams. ❑ Indicate method of backflow protection. VII. Plastic Acid Waste []Three copies of piping diagram. []Request for use by owner or architect. []Specifications of piping and fittings. []Acid neutralizing or dilution basin detail. []Piping plan layout and isometric drawings. ST. CROIX COUNTY ZONING DEPART AS BUILT SANITARY REPORT> Owner ^ f Pro a Address 5 City/State a n& 1 MAI 55 3,50 OFRCE Legal Description: Lot - Block - Subdivision/CSM t/4 57/ `/4, Sec. 33 , T,k N-Rf3W, Town of Trt3u PIN # SEPTIC TANK DOSE CHAMBER HOLDING TANK INFORMATION: G Wo , Tank manufacturer Well-ev Size ST/PC 9wo / Setback from: Housed-7f Well~/°t~ P/L Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road S' Vent to fresh air intake Water Line d .3 1) Meter location Alarm location Po si 8 t, Ile 1cP ~n n -raft k SOI SORPTION SYSTEM: Type of system: Width Length Number of Trenches Setback from: House Well P/L Vent to fresh air intake ELE TIONS: Description of b hmark Elevation Description of alterna enchmark Elevation Buildin ewer ST/HT Inlet ST Outlet PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines } O ( ) Bottom of System O O ( } Final Grade ( ) Date of installation Permit number 3$8 State plan number o2©J'S r2z Plumber's signature Q~ License number ~.Z ri" X51 Date 3 14 /oo Inspector Complete plot plan 4 . ; NOTICE: Please provide the following: A plan view sketch showing everything within 100 feet of the system. ' 4Two horizontal reference points to center of septic tank manhole cover. Show alternate benchmark, if applicable. {t PLA~ VIfEW ® 1 ti i~ I a IY~ q a 4 4 fi yA c - ~ al ~-9 I it Y t 'r . • p o I Z,. fh I i 1,7 I 1 ~S 1 I~ y I, re 1 f t 1 ' • t~ 111 INDICATE NOS' I`,'AR'OW .ae~f f Ii 7 17ce °I~S23~a Wisconsin Department Commerce PRIVATE SEWAGE SYSTEM County: n- - Safety and Buildings Division INSPECTION REPORT -SA ,---I~t61 x GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar PermmitpNo.: Personal information you prgvice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 3 o O Permit Holder's Name: ❑ City ❑ Village [0,;Pbwn of: State Plan ID No.: 31? 1 CST BM Elev.: Insp. BM Elev B Descr tion: Parcel Tax No.: -A- Z A f . (J40 - I a-S -So TANK INFORMATION ELEVATION DATA ~10~3oS ' TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic _ BenchmarIO/ ,36 3 ~(~,.rt " Dosing ~2 c-(- 7,7Z } Aeration Bldg. Sewer Holding ~~~~✓G. - S 'IHt Inlet TANK SETBACK INFORMATION $f/ Ht Outlet 7,.. 7 ?5 TANK TO P/ L WELL BLDG. vve Intake ROAD f~t Inlet 77 06 ok Septi _ NA _D ~ott6rfi'- Dosing NA Header / Man. Aerafion NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer emand Model Num GPM TDH Lift Lriction terp Ft y Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED / TRENCH width Len o. ches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS IM N I LEA anu acturer: SETBACK TO P / L BLDG WELL j LAKE / STREAM ZH+~ INFORMATION d e0 CHA R Mode Number: System: 0R" NIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) aeie~i71"""" hFeleSpacing Vent To Air Intake Length Dia- Length ""Drag Spacing,,. f' SOIL COVER x Pressure Sys my xx Moun-d'4#S~stems Onty, Depth Over De ver xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil E] Yes El No ❑ Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) C Y ~ ~ ` r ,,x , ~y7/}~iy.~. ~ l f_ fi - r.l {t-.i~ .t.,~f~' ~ r ~ - t'Y" r Lam' . E• y,~'"`. ' f t'.,~•~'t Plan revision required? ❑ Yes [~o Use other side for additional information. t SBD 6710 (R.3/97) Date Inspector's Si nature Cert No- L ` SANITARY PERMIT APPLICATION 201 safety W. and WashinBuilt dings Avenuen ` Vftcoiisin P O Box 7302 In accord with ILHR 83.05 Wis. Adm. Code Department of Commerce Madison, WI 53707-7302 • Attach complete plans (to the county copy only) for the system, on paper not less Count than 8112 x 11 inches in size. j • See reverse side for instructions for completing this application State Sanitary Permit Number 338?33 Z Personal information you provide may be used for secondary purposes ❑ Check it revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION -2D34?1 (P Property Owner Name Property Location 5E 1/4 5W 1/4, S _33 T 01 g , N, R~N Property Owner's Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number Lor, Lo-Ye. M 0 1.5535(o II. TYPE Or-BUILDING: (check one) ❑ State Owned E3 164y, Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms Town of 7"r-o Cou M III. BUILDING USE: (If building type is public, check all that apply) Parcel Taxx'N)umber((s) 1 E] Apartment/ Condo ~v Y 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/ School 8X Mobile Home Park 12 Q Service Station/ Car Wash 5 Q Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. Q New 2 Replacement 3. Q Replacement of 4. Q Reconnection of 5, I] Repair of an System System Tank OnlyExisting System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental other 11 ❑ Seepage Bed 21 ❑ Mound 30 Q Specify Type 41'5!tHolding Tank 12E] Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13E] Seepage Pit 43 ❑ Vault Privy 14E] System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) _ Elevation t a 0o Feet 4''-' Feet V{{. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing structed Tanks Tanks I i Tan 600Q el_seX ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Signur : (No _ Stamps) r P/MPRSW No.: Business Phone Number: Ta-u- . e t s. rjel a a 5-4/'5-/ ~7is ~a5- ~ Plumber's Address (Street, City, State, Zip Code): W Cty ~ f~j ~Cc::4,- v~r C 1s r oaa IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate ssue Issuing A ent Signature (No Stamps) ® Approved ❑ Owner Given Initial Surcharge Feel 3aD ob r~ ~r Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber a , INSTRUCTIONS t 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the.; county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3151. y To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete #:of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model a 9d pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 5 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. x -0 I 7 x;$ s -sp s 0 13 IS ('11 -ment NpinberMar. I.D. No. HOLDING TANK AGREEMENT 593849 This agreement is made between the govemment unit and holr'i tank ownerfs . one and Return Address l CIPI& / A,4e S~-3S~o T. C OIX CO., WI reel identifier number (PIN) Agreement ate 1958 0 i is 'S-0 00 0 Is :vcmmenW Unit Holding Tank Owner(s) p~ • !S f '~'t+t~.►.~~~ t~ia.ta.tn. c acknowledge that application is being made for the installation of (a) holding tank(s) on the tie near efi C+eds Ilowing property: (Provide legal land description. Use reverse side if additional space is needed) SEE- #d2!:r_1'k#F61 L.ZG r that continued use of the existing premises requires that a holding tank be installed on the propet.y for the purpose of proper containment of sewage. i.vo, the property cannot now be served by a municipal sewer, or any other type of private sewage system as permitted under Ch. ILHR 83, Wis. Adm. ,de, ur Ch. 145, Stata. 4 an inducement to the to issue a sanitary permit fur the above described property, we agree to do the following: Owner agrees to conform to all applicable requirements of Ch. ILHR 83, Wis. Adm. Code relating to holding tanks. If the owner fails to have the holding tank properly serviced in response to orders issued by the governmental unit to prevent or abate a human health hazard as described in a. 254.59, State., the governme :tnl unit may enter upon the prvperLy and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by a. 6r 60, Stats. The owner Agrees, pursuant to a. ILHR 83.18 (10), Wis. Adm. Code, to have a water meter installed in a new building or new structure. The water meter shall be installed by a plumber authorized by the State to conduct such installations, with said installation complying with State regulations and manufacturers specifications. The owner agrees to be finally responsible for the purchase, installation, maintenance, and repair of the water miter, and agrees to allow the governmental unit to enter the above described property on a regular basis to read and/or inspect the water meter. Owner agrees to pay all charges and cost incurred by the governmental unit for inspection, pumping, hauling, or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. The governmental unit shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the d to of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costa and charges may be placed on the tax roll as a special assessment for the abatement of a human heath hazard, and the tax shall be collected as provided by law. The owner, except as provided by a. 146.20 (3) (d), Stats., agrees to contract with a person who is licensed under Ch. NR 113, Wis. Adm. Code, to have the hoi,i.ng tank serviced and to file a copy of the contract or the owners registration with the governmental unit. The owner further agrees to file a copy of any changes to the service ontract, or a copy of a new service contract, with the governmental unit within ten (10) business days from the date of change to the service contract. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code, who shall submit to the governmental unit and the county on a semiannual basis a report in accordance with a. ILHR 83.18 (4) (a) 2., Wis. Adm. Code, for the servicing of the holding tank. In the case of registration under a. 146.20 (3) (d), Slats., the owner shall submit the report to the governmental unit and the county. The governmental unit or county may enter upon the property to investigate the condition of the holding tank when pumping reports and meter readings may indicate that the holding tank is not being properly maintained. This agreement will remain in effect only until the governmental unit responsible for the regulation of private sewage systems certifies that the property is served by either a municipal sewer or a soil absorption system that complies with Ch. ILHR 83, Wis. Adm. Code. In addition, this agreement may be canceled by executing and recording said certification with reference to this agreem the existence of the certification to be determined by reference to the property. ,JOHN LL SHANNON SR This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. Th 11YItl)Qh4MMM4g$MM- to the register of deeds, and the agreement shall be recorded by the register of deeds in a manner which will ioptiiihlrs to be determined by reference to the property where the holding tank is installed. ,wncr(s) Name(s) -Please Print vovcmmenW Unit Official Name - Ylease Print Subscribed d sworn to before me on this dx'e: r' U .7 / %lt)e :arited Owner(s) SignaturrcO Gove xnW Unit Official Title -Please Print Notary Public ~Mt12VY~0.K mental Unit Official Si ature M commission ex Tres s raped by Per-AW information you provide may be used for secondary purposes (Privacy taw, s.13.04 (1 xm)l. HOLDS iVG TANK SEROCIt4G CONTRACT Contract Date ~ this contract is made between the Holding Tank Owner(s) Name(s) and t Ptxnpers Name / 1'I T / t We acknowledge *he insta ation of (a) holding tank(s) on the following p rty: (Provide legal descriptions:) %'-~/cam 70x0 1~ro' &L~ S.3 ~fA 'All _ cJt°~ s7• l~l S~G3~ 1. The owner agrees to file a copy of this contract with the local governmental unit that has signed the pumping agreement required in Ch. 1LHR 83.18(4) (b), Wis. Adm. Cede and with the County of _ 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 tha h-' iing tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local governmental unit which has signed the PumPm9 agreement required by s. ILHR f 83.18 (4) (b), Wis. Adm. Code, 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: r a. The name and address of the pers..,, responsible for servicing the holding tank; i b. The name of the owner of the holding tank; 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 volumes 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 the local governmental unit and the Ccunty named above within ten ( t G} busress days from the date of change to this service contract. ~Ow~n}er(s) Name(s) (Print) i Owner's Sionatur_(s) t ' j Subscribed and swum to me on this date: ~~LX/NYC r r / f _ G / l /xff/ff-L- 17 70 Today's Date Pumper's Name (Print) i Pumpers signature Y ! ! ~,lOHN L. SHANNON SR ~ JI NO?1WY PI;BIIG - MINNt:50TA .Itt Corm tc~r~s .lr: ~t, PumPeis Re9is'ation d nr I i;ommission Expiration Drafted by _ VOL Lands in St. Croix County: Part of SE6 of SW+ of Section 33-28-19 described as follows: Commencing on S line of said SE: of SW; 305 feet E. of SW corner thereof; thence E. on said S. line 628.4 feet; thence N 04°33' W. 200.6 feet; thence W. 573.0 feet; thence S. 100.0 feet; thence S. 21°28' W. 107.5 feet to Place of Beginning. Also other land SUBJECT to roadway easement over E. 1 rod of N. 100.0 feet of said parcel and 1 rod easement as described in Warranty Deed in "425", Page 61. Part of SE4 of SW` of Section 33-28-19, more 14° fully described as follows: Commencing at the SW corner of said SEA of SW! ; thence go E. (assumed bearing) along the S. line of said Si! of SWI a distance of 933.4 feet; thence N 04'33' W. a distance of 200.6 feet to the Point of Beginning of the parcel to be herein described; thence W. 573.0 feet; thence N. 300.0 feet; thence S. 89°54'00" E. a distance of 548.60 feet; thence S 04°33' E. a distance of 300.0 feet to the Point of Beginning, the above described parcel containing 3.86 acres, more or less. t 4 31 A S r ~ ~q d r a o.. O O a 71- - 0 a ~U VAN t K i - -Q T O Cit i i ~ 0 I Safety and Buitdings ' 2226 ROSE ST r LA CROSSE WI 54603-1905 Nvi SCOT I si I Tommy G Thompson, Governor Philip Edw. Albert, Acting Secretary Department of Commerce December 22, 1998 CUST ID No.267341 ATTN.• POWTS INSPECTOR WEGERER SOIL TESTING & DESIGN ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 12/22/2000 Identification Numbers Transaction ID No. 203816 Site ID No. 165459 Please refer to both identification numbers, SITE: Site ID: 165459 above, in all correspondence with the; agency: St Croix County, Town of Troy SE1/4, SWIA, S33, T28N, R19W Hilltop Mobile Home Park FOR: f Rrf Description: Holding Tank t,E VE8 Object Type: POWT System Regulated Object ID No.: 443510 st CRO~ `1.Q The submittal described above has been reviewed for conformance with applicable Wisconsi~l Vative Coode~' , F/C~ y and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupan r use ' • 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. • It is recommended that the utility company associated with the overhead line shown on the plan should be contacted to be made aware that construction activity such the sewer/tank installation is proposed beneath the existing overhead lines. • This approval does not include plans for the general plumbing systems or sewer piping leading to the septic/holding tank that may be required for this project. See section Comm 82.20, Wis. Adm. Code, to determine if plan submittal and approval is required. 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/instal lation/operation. WEGERER SOIL TESTING & DESIGN Page 2 12/22/98 Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 12/21/1998 14 FEE REQUIRED $ 100.00 FEE RECEIVED $ 100.00 (!G and M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)785-9348, Mon - Fri, 7:15 AM - 4:00 PM jswim@commerce.state.wi.us WiSMART-:code: 7633 Pa ge I ofd HOLDING TANK ' !-~~Lt.`CbP wlo~t~L ~owtE P~Zlrc LOCATED IN THE SE 4 OF TEESW 41 OF SECTION 33 , T Z8 N, ILL-w, TOWN 'OF S-. C'~Lo tX COUNTY, WISCONSIN. OPP OEt % INDEX PAGE 1 of 4 TITLE SHEET- PAGE 2 of 4 CALCULATIONS PAGE `3 of 4. PLOT PLAID PAGE 4 ,of 4 HOLDING TANK SECTION alb colidliton y aF ~OMMEK~EN~S 4 i'"p~PARjMEN ET N g~ p1V1S10 -NCE ESpO PREPARED FOR SEE GUK~` 5 Goy-b~1 V I ~YJ L,ptiG L~~~ l~tV ss3.S~ c0A~ PREPARED BY ARTHUR L. ? WFGEHCR = j P3',SP ELLSriORTH, vils. LtilECEF~ER SQ I L TEST I NC AND Z7 E S I (BP4 S;IE E=ZV I c :E=-: I G'S ~~d► P.O. BOX 74 421 N. KAIN ST. LzZ~~ q~i RIVER FALLS. MI 54022 " 715-4254165 98 JOB NO. -3z I CALCULATIONS Page Z of This holding tank system will serve 4 mobile homes at the Hilltop Mobile Home Park. The existing system is comprised of 2 septic tanks with a drywell and a conventional drainfield which has failed. Due to soil and site conditions, holdingtanks are required. All existing tanks will be abandoned as per code. ANTICIPATED WASTEWATER 4 mobile home sites at 300 gpd each = 1200 gpd. HOLDING TANK CAPACITY 1200 gpd X 5 day holding capacity = 6000 gal minimum required. Two 3000 gal Wieser Concrete Products precast concrete holding tanks will be installed in series. i 30 of +rt~-- ~ iA) f I l 4 zo 1 1 J f ~ 1$'`ftzt313 ' Ph1Z4c.lN G t~ ~ i /r 41 ~O D ~ ? +j o a D ,E a rn~ v • c > 10 V) a • E C) r- U •r-- CL ~ O O 1~ O 0.\ X C 3c W O v ov U 4J W u sow cQ C -14 f i c .v J s. ~ u tm U o c p J • C r-{ C b L 'd •r O ~ O rp cb O O a C >3 a a m r O L CL n • •r rL C1 C1 Z d3 Q U c co O U! o _ v L 4- it ~ O N 1 ~ N O I Y p U D r E tJ r- L 4-1 CL CU LD Qy z _ trYJ ~ C7 N J r ~ 0 ~ cr, •r , o N o N (A X • • s. ' ~t LaJ O L 1] CL - L u J 9 C) r O Cl i F-~ O > N +1 N u Z CK Q 3 c3 Z U •r b L 0 D 4- I+- u w O X _ O bN O Nan 0ao0 ~b ¢ ;cc to 03 U- a.. a c w xr v a b b~N O f- S- o ¢ z 2: N 0 •r L w ~ W O L 0 U ::G CYO Ca J +3 U • LL Q J O Q b e r ~ N F- d z c7 U 3 7 C _ C Q1 •r ~ r-- r Cn Cl. t cm +J #0 r0 CJ , 3 N Wisconsin Department of Commerce SOIL AND SITE EVALUATION divisionbf•Safetyand Buildings Page of Bureau of Integrated Services in accordan tt 3.09, is. Adm. Code Attach complete site plan on paper not less than 81/2 x 11 n6h in S144. Plan must County include, but not limited to: vertical and horizontal referen ~i ft (BM),ii Q~ percent slope, scale or dimensions, north arrow, and I i nd distance to ne fidst road. Parcel I.D. # L~ f i 9c? eye - //1 APPLICANT INFORMATION - Please print j forM8tbr7;R0ix Reviewed by Date Personal information you provide may be used for secondary purpo es vac SVQUNN (1) (m)). Property Owner Prop lion L {2YL j0 ` 1/4 1/4,S T N,R E (or) W Property Owner's Mailing Address Block# Subd. Name eWoSM#- C~OL ru V=E'vj M j3 C•,E ZZA422 /rf -Z40A COUAT City State Zip Code Phone Number F1 City El Village [Z Town Nearest Road 10. /w 2 ) - S Or ❑ New Construction Use: ❑ Residential / Number of bedrooms Addition to existing building 10 Replacement JZ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, e -trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpdfft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound ~ In-Ground Pressure AT-Grade System in Fill Holding Tank U U = Unsuitable for system ❑ S O u ❑ S ❑ U❑ S O U El S 0 U ❑ S U S El SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench F 2 ZLEK Ground elev. Fi Depth to D 'rN L limiting factor in. Remarks: Boring # _ t j N T L F Ground elp", ~ j Depth to limiting factor , r-3 in. Remarks:4"SM(0I_= 71f rS C,"I-P OF i6-4b l Ufl-ez) Gv /.zLG , CST Name (Please Print) Signature Telephone No. ZT!z Address Date CST Number T s Sd L SOIL DESCRIPTION REPORT L/ PROPERTY OWNER Page _2 , *of ' 7 1► PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed , Trench L-3j _ /LrF .s Ground 3 _ T ~,ele y.'-eft. Depth to limiting E OC~C ,ST`Orf/C factor ' .~Z--in. f/ /ZfO j E I/E o Tv1 ?e o dtLf Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots ID in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Boring # ~t Ground elev. ft. Depth, to limiting factor n., Remarks: Boring # Ground elev. ft. I ' Depth to limiting factor in. Remarks: SBD-8330 (R. 07/96) ~'r Z ~ 0 7 b ~ D 3 r 1 ~ iRll i ~ o M I G n o rte- ~ ~ ~ L. iz w w N I~ i ILI j - Ll~ I s ~ ~ p i / ,f9v~Fs z SEC~~R lsw~' SCyFiN,E' Fm/~ T.e~rLO,es 1, 3, y, s 14AIF /SE/-) y~VIf) RCA/ WVe9Sr1YA1 k 4-=4T7Pvt:rv1.:= le ve wLED~E O~ TA4"4OIR couyeT. ~3 GbFS NOT ~yvuJ w /~E.e~~wffi~T l'Ie/~.x v1z ,rs c ovvrcT~'~J To - sus~ ec7s - s r9czQss lffr sE,~v-rc~ /zo~v l 7-0 7-#4 s.~ /x'6'4-7-l eR fZ01~ 13EAI, .veA r c,4AI ~Rcsc~vr'~y v,EXr7,jzY 7'14~g coivAl.--,c 7-xoA) . Z"F- CO IO XIB-C ]""gyp A) FOfZ TRA1'LO/C 7h- t C- ~Tje€ tT -zs T/9~A) Co ivrtl,~cTE T ©iv,~ sF~T.z`c T~ov l~ .4ti~ TC' a ARy W CGS s . T/K c T /ks ~4/zE a 3 E,z U.r"c zN FD 4/L 47`l~E/Z TR,q,,r[.p1?s ,¢~B/Z,~v~ T'a l3 c~v. S~YovcL.U ~LSd .dF ®P16TEV 7`ff* d3F~SED onl /17Y ~I~ST Ub iv~s FOX- -4- 'wo ow,v zrj7 E So ' ~r vlsry Tiv,* 27' avv uw /~SS~r~ri,p 7',o/V Td '~t' 13~0~B/v LrNE .r~v~-tr~tJ'-,ES M~ v tE'~,cJ Bl- Cc~R~,~'Ni l~e.s~iU ~.x~'cv 4 cc Ar,r~oN ,,p rvd r-c z fr . s ~f i~ox 30 ` c ~zv c ~t,~p 67- 4-eA 7- " Go~r/~. Z cc9©uGJ~ fixX 7#A > (o~~ e TiYE 714-11~Lox- zZ L©c,*7- Ev o iv E?- 7?qE Ai-4•za1 -~F Aq&-rw C- o( I?oX ~t -13R~'CfFT S ~o/2ryt9(~ Fo GrNA Tf~.~ SC CDc Ap F z OF TffE FrEL~ - *7- l S7~/v A'-r, e ~ Tv T~/~ fr~cTSs,[) E F. ~F~ D l.~T~G . .t~,►/o cJ 7-elfT ?IL--S I-InrNT u ws Allsv 7` .E FzcLV ,~.vp ,D~.c' .Ta y~p,er~v~ • Tifi~T "ST,¢Iv71 ?Z7E - IIoQ /t`Nl~ 2 80~`ff -zW!)J-rl4r,-'L) 7a CW4AFNT AV14, 9~ie/j~%-A T 7-#I# r int by: E=DINA REALTY WAYZATA 612 476 5333; 03/29/99 12:59PM; jetFax #236; Page 2/3 ' I ST CA= COUNTY SUTIC TANK MMNTUNANCE AGREEMENT AND O'WNEfiSH!!' QERTIFICATION FORM Owner/Buyer t-&c e 1,Vk G C j7~ /%r/ Mailing Address Property Address (Verification required from Platming Dpartment for new eonsttuetiotr) City/SEate P105- S' !'tercel Icljcu(ificatiotz NtttztUcr •`00 0 LEGAL, DILSCIi1PTION Property LQCaiian t/,, , S "N-R W, 't'own of Subdivision Lot It Certified Survey Map Volume Warranty Deed 1~ 0 Voimue ~~OZ l U Spec house ❑ yes 11 no Arot fines identifiable ❑ 1 SYSTM M NTENANCE Improper use and i aintenauceof your septic system cejuld result in its pretr,aturc Tail consists of pumping out the septic tank every three years or sgoner, if needed by a licensed .let you put into the system can VUbct ttte function of the septic tank as a treatment stage ip the waste disposal system. The ptoperty owner agrees to submit to St Croix Zopiug Dapartntent a cettification forth, signed by the ownerAnd by a masicr, plumber, iourveyruan plumber, restricted plumber or a 1 icrnsed pumper verifying that (1) the on-site wastewater disposal system !s in proper operating condition and/or (2) after inspection and Vunipiug (if necessary), the septic tank is less (limn 1/3 full of sludge. Uwe, (he undersigned have read the above requirements and agl,ce to maintain Me ptivate sewage disposal systent with the standards set forth, herein, as set by the Department of Commerce and th4 Department of Natural Resources, State or Wisconsin. Certification stating, that your septic'systeru has been maintained must be cor#pteted and returned to the St. Croix County Zoning Oflicc within 30 jde s of the three year a pirati dat S NAIZ IRR Or APPI.It~AN1' DA'I'11, OWNER CEWT I (wv) certify that all statements on 11iis form are ttue }o the best of my (our) knowledge. I (we) milk (arc) the owner(s) of the raperty described abov by • u of a warranty decd recdrded itt Register of I)ecds Office. ,G ATUR OT PPI.. ANT UA'M ree* Any inforttiation that is tnis repteseated n=y result itt Q}e sanitary pcnilit bein revoked by the Zoning Department. s+ t•«e i Include with this application: a stamped warranty decd fireiki the Register of Deeds office a copy of (lie certified survcy map if reference is trade in the warranty decd lent by:; EDINA REALTY WAYZATA 612 476 5333; 03/29/99 12:59PM;jWh #236;Page 3/3 '----"cocuMENT NO. ~J WARR~LNTY DEED I THIS SPACE RESERVED FOR RbCORDING DATA I I STATE BAR 'OF WI CONSIN FORM 2 - iz I' e ~.94t13 ~.,~r -76 Pact 5z ST. CROIX CODL, ws ti L.M_C. Enter I'rises of Beldenva Ie Inc lst - I~ec~~l. for RecoDecrd k. Mik D.1 0 a Wisconsi... Corporation 1 •Z" 6 . i I( 55 . ' conveys and warrants to i.nk_..an.d----------..• ! ....Th.nmas..-B....Do-1d-er.,---d-/ b./-a..11 i.l.l.t.a~.--Pa.rtRer.sh i_p ii t ~f "I., • . Michael Hilbelink I I, ~ R"u"H T6 1020 N. Brown Ed. I. i , Long Lake, MN 5535 I I the following described real estate in E4lti40y, Counties r State of Wisconsin: ~ Tax Parcel No: ` Lands in St. Croix County; Part of SET of SW1cif Section 33-28-19 described as follows: d- Commencing Commencing on S line of said SE4 of SW; 305 feet E. of SW corner fry thence E. on said line 62$.4 feet; thence N 04°33' W. 200.6 feet; thence W. 57 ,0 feet; thence S. 100.0 feet; thence S. 21°2$' W. 107,5 feet to dace of Beginning. Also other land SUBJECT to roadway easementiover E. 1 rod of N, 100.0 feet of said parcel and I.rod easem~nt as described in Warranty Deed in "425", Page 61. ./Fart of SE4 of SW4 of Section 33-2$•-19, more fully described as follows:` Commencing at the SW corner of said SE4 of SW4j thence go E. (a0sumed bearing) along the S. line j of said SE4 of SW4 a distance of 933.4 feet.; thence N 04°33' W. a distance of 200,6 feet to;the Point of Beginning of the parcel to be herein described; thenjce W. 573.0 feet; thence N. 300.0 I feet; thence S. 89°54'00" E.I, a distance of 548.60 feet; thence S 04°33' E. a distance of 300.0 feet to the Point of Beginning, I` the above described parcel !ontaining 3.86 acres, more or less. (qee Attached) This S- P.Pk....... homestead property- i $ge 4 if x61Q (is not) ~j Exception to warranties' Existing h''ghwsys, easements, rights of way S~ 0i and restri.cti.ons of record. Dated this ............_1 day of ! November........_.._......_............., lp$6.._. C.M.C Enterp ices o Be.denville, In harles E. Grimsley, President _ _ (SEA By re •(SEAL) e; j. , . Marlene 0. G.r.. ey, Secretary i AUTRKNTICATION I ACKNOWLSDOWRNT Signature(s) STATE OF ]s~t~ G I R G N Y A ' S Ss. syh >xthentie$ted this ________dsy of 19.-_:._ personally cache before me this _...of I1,R!f.~iq.~?_lfS 10.6-.- the above named Ilax-], F • G r _~l y...s~.Etd_..Ma• . _ e n e ....Q.._..G r i~t x~. X-------------- TITLE. MEMBER STAVE BAR OF WISCONSIN (If net, author r• Iced by $ 146 .Qfi, Wis. SLats.) to me kngNxL to be the person who ex"ated the foregoing ih&y7gnt and aeknowWge the same. 'rHl$ INSTRUMENT WAS DRAFTED BY fr Es t r een • A t torn e,y •David J r • i tom' I: 621 2nd St., Hudson WI 540I6 f - Notaryr ~-j t.1:'.•..:_..t4L[[ WesU (Signatures may be authenticated or acknowledged. Bot My Cope his per neut. (If not, sta expiration y mm, are not necessary.) ate; - ,e_77• /If } 19.g&-) COMMI •Names of V4MOrA •lentW in any Oap"ity sbould be typed or printedlbeiow theirs Men 4 1047 STATE BAR OF VVISCON$IN .y/~~w ILCMi11r rCar.p~ = FORM No. 2 - 1583 Stock No. 7 13002 FAX ST. CROIX COUNTY ZONING OFFICE 1101 Carmichael Road Hudson, WI 54016. (715) 386-4680 DATE: _ I gy-i I--1 TO: Fax Number: 5 - 2vL1 - Co 8 Name: Tian FROM: Fax Number. 386-4686 Name: ~S fi y1 Number of Pages Including Cover Sheet IF COMPLETE AND LEGIBLE INFORMATION IS NOT RECEIVED, PLEASE CONTACT: NAME: 4d ~hc- 1'j TELEPHONE NUMBER: 7 i .rn 9T FOX ZONtN QRFtCE qq~~ v J c F~ A - ~ +s .S ' o I ~ s~ ,.J fop •r,, c~w v 4 / - TIN F J 3 W O co. . £ o o - o + O p,. O n S p tc Q P, T P 3 9 ~o i State of Wisconsin 1 DEPARTMENT OF NATURAL RESOURCES West Central Region Headquarters Tommy G. Thompson, Governor 1300 W. Clairemont Avenue George E. Meyer, Secretary PO Box 4001 7OFNATURAL Scott A. Humrickhouse, Regional Director Eau Claire, Wisconsin 54702.4001 [DEPT. RESOURCES Telephone 715-839-3700 FAX 715839-6076 TDD 715-839-2786 May 14, 1999 (MI CEIVED 1 Mike Hilbenlink 999 ~ St. Croix Co. Hilltio Courts Mobile Ho Ctaax FID # 65601404 µTM Public Water 85 Golden View Drive GpFFi Long Lake, WI 55356 Subject: Water Supply Sanitary Survey and Notice of Non-Compliance Dear Mr. Hilbenlink: A sanitary survey of the well and water system was conducted on April 13, 1999 at above community water system. The purpose of the evaluation is to compare the condition of the system with the standards established in Wisconsin Administrative Codes NR 809 for Safe Drinking Water and NR 811 for Operation and Design of Community Water Systems. Notice of Non-Compliance A holding tank POWTS (Privately Owned Wastewater Treatment System) has been recently installed about 175 feet from well # 2 without prior plan and variance approval from the Department of Natural Resources. Wis. Adm. Code NR 811 requires a minimum separation distance of 400 feet between an other-than-municipal well and a POWTS. The Department can not issue a variance after the fact. The holding tank system was installed to replace a failed septic tank and drain field system in the same location according to the Department of Commerce approved plans dated 12-22-98. Because the holding tank system is improvements over the failed septic tank and drain field system, the Department will not ask you to remove the holding tanks. However, you are put on notice the location of the holding tanks is in non-compliance with NR 811 and this may affect future water quality monitoring requirements. This could be loss of monitoring waivers or more monitoring for certain contaminants. If you have any questions concerning this matter, please call me at 715-839-3773. Sinc~er~ely~: Tun Hanson Water Supply Specialist cc. Tom Aartila -Baldwin Larry Schaefer-WCR Robert Punches Rod Eslinger-St. Croix Zoning Office Lee Boushon-DGl2 Laurie Boehlke-WCR Quality Natural Resources Management Through Excellent Customer Service r Rece=ved: 5/17/99 11:30AM; 715 425 7314 EDINA REALTY WAYZATA; Page 2 MAY-17 99 10:24 FROM:F K TRUCKING 715-425-7314 TO:612 476 5333 PAGE:02 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer L L v ?A-?-Tt KE C 1 uz IF- L(N- Mailing Address S t_l7 9-(,j V JCA_tJ V N SS 5 Property Address 6,3c) C f'- D t\ 1~ I S (Verification required from Planning Department f r new construction) i City/State 2t lj~~ L Parcel Identification Number Q' (~s U d b LEGAL DESCRIPTION Property Location ! S-~E_ '/4,,'/4, Sec. T_ j2LLN-R W, Town ofU l Subdivision . Lot # Certified Survey Map # . Volume . Page # Warranty Deed # . Volume . Page # Spec house ❑ yes ❑ no Lot lines identifiable O yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we. the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 f the three year a iration k. SIGNATURE OF CANT DATE OWNER CERTIFICATION I (we) certify thMt #11 statements on tbiSjp~ln are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of rty described ve, b o a eed recorded in Register of Deeds Office. SIGNATURE OF ICANT DATE •et*** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. •'•'s0 00 Include with this application. a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed COMMENT FORM FOR FILE DATE: /'37 p.Yi OWNER NAME: d~~l PROJECT NAME: Gf'i~t6r~ ~✓Gt~ (G ✓ C~ v,~ ~rol~✓ y7~'~33 ADDRESS: ~27~-T COMPUTER PARCEL INFORMATION: Wt,~fi f~E ~~r f ~"~~EU7 A t~,►D -r'of2 1~~~~.Tb~' ~2AL- 2T is lac y,vtlj~ ~~v,.-►~ c`'~~ r~vw~uvc~ ~©2+~.~='Czi ~kF.is w~Cf~' G~ 1 V State of Wisconsin 1 DEPARTMENT OF NATURAL RESOURCES West Central Region Headquarters 7 Tommy G. Thompson, Governor 1300 W. Clairemont Avenue George E. Meyer, Secretary PO Box 4001 I ONSIN Scott A. Humrickhouse, Regional Director Eau Claire, Wisconsin 54702-4001 DEPT. OF NATURAL RESOURCES Telephone 715-8393700 FAX 715-839-6076 TDD 715-839-2786 May 14, 1999 (Revised May 17, 1999) Mike Hilbenlink St. Croix Co. Hilltop Courts Mobile Homes FID # 65601404 85 Golden View Drive Public Water Long Lake, WI 55356 Subject: Water Supply Sanitary Survey and Notice of Non-Compliance Dear W. Hilbenlink: A sanitary survey of the well and water system was conducted on April 13, 1999 at above community water system. The purpose of the evaluation is to compare the condition of the system with the standards established in Wisconsin Administrative Codes NR 809 for Safe Drinking Water and NR 811 for Operation and Design of Community Water Systems. Notice of Non-Compliance A holding tank POWTS (Privately Owned Wastewater Treatment System) has been recently installed about 175 feet from well # 2 without prior plan and variance approval from the Department of Natural Resources. Wis. Adm. Code NR 811 requires a minimum separation distance of 400 feet between an other-than-municipal well and a POWTS. The Department can not issue a variance after the fact. The holding tank system was installed to replace a failed septic tank and drain field system in the same location according to the Department of Commerce approved plans dated 12-22-98. Because the holding tank system is an improvement over the failed septic tank and drain field system, the Department will not ask you to remove the holding tanks. However, you are put on notice that the location of the holding tanks is in non-compliance with NR 811 and that the location of the holding tanks may affect future water quality monitoring requirements. This could mean a loss of monitoring waivers or more monitoring for certain contaminants. If you have any questions concerning this matter, please cal 15-839-3773. 1 Sinicerel~ Tun Hanson Water Supply Specialist cc. Tom Aartila -Baldwin Larry Schaefer-WCR ZCYVIAt GOP PAQE~ Robert Punches , J Rod Eslinger-St. Croix Zoning Office Lee Boushon-DG/2 Laurie Boehlke-WCR Quality Natural Resources Management Through Excellent Customer Service Ttt-C~~Itq 5~111[~t~st1''' VF: ~i 1029 C NINIsc 'Fo: Rod Usciinger Assistaart Luring Adudrdstratur a St. Cm-Ax (:aunty Zoning Subject: Hilltop 'frailer Park The following are the dates of pumping at the Hilltoi a Uctober. '1'ailers from 28 through 24, with 28 being u 7,'i down to 24 on tha wrner, August 14- urywell between trailer 25 & trailer 24( lot drainileld on lot 33 - approximantly 200 gal. August 18- Septic tank between trailer 28 & 27 - 1000 gala ~r 20 & 25 - 1000 gal., drywell between 25 & 24 - approx. 'K 24 -approx. IOU Kai. A $ August 28- Septic tank between 25 27 - 1 UOU gal., Septic to 26 25 - 1 UUU Sal., drywell between 25 & 24 - approx. 8UU gal., drain field u.aaer 24 : Approx, 50 gal. Sept. 4 - Septic tank between 28 & 27 - IUUU gal., septic tarok betweett 26 & 25 - 1000 gal., drywell between 25 & 24 - $00 gal.. Nothing left in driazMald. . Sept. 17- Septic tank between 28 & 27 - IUUU gal., septic tank betwoW ZO & 25 - IUUU gal., drywell between 25 & 24 - approx. 800 gal. ,Sept. 30 - Septic tank between 28 & 27 1 UUU gal., septic tank bemwd 2b & 25 - 1()110 gal., drywell between 25 & 24 - approx.8UU ,gat., draintleld under 24 4pprox. Su. Oct, 9 - Septic tank between 28 & 27 - 1000 gal., septic tank betwy g 26 & 25 - 1000 gal., drywell between 25 & 24 - approx. 800 gal., very little in drainfiold.; Oct. 19 - Septic tank between 28 & 27 - I UUU gal., septic tank bti;* jO & 25 - l UUU gal., drywell between 25 & 24 - approx. 800 gal., nothing, in dra#.00. Oct. 28 - Septic tank between 28 & 2Y - 1 UUU pl., septic tank bgtwwi n 26 & 25 - 1000 gal_, drywell between 25 & 24 - approx. goo gal., nothing in draitlfle 4. ST. CROIX COUNTY WISCONSIN ZONING OFFICE N N p a ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 September 9, 1998 Mike Hilbelink Hilltop Trailer Court 85 Golden View Drive Long Lake, MN 55356 RE: Failing septic systems at the Hilltop Trail Court (Lot 33) Dear Mr. Hilbelink: As you are aware, the above referenced septic system has been failed under Wisconsin Statutes 254.54(2), Comm 83.01(c) Wisconsin Administration Code and Article 15.03 of the St. Croix County Sanitary Code. The failing septic system is connected to the four trailers to the west of Lot 33 and it is unknown if this system serves Lot 33, too. The system was discharging septic effluent to the surface of the ground. You were sent a notice of violation dated June 26, 1998, allowing 90 days to obtain a permit and to have a replacement system installed. Onsite soils verification by Dave Fogerty (ID #221180) on August 14, 1998, revealed that the trailer on Lot 33 is located on top of the drainfield which is failing. This is a violation of the setback standards of the state sanitary code. The setback distance for a mobile home to a drainfield is 15 feet. The trailer on Lot 33 shall be removed immediately. Lot 33 shall NOT be used as residential lot in the future. The onsite verification by Dave Fogerty confirmed that the existing system does not meet the appropriate (3 foot) vertical separation to limestone bedrock. Introduction of untreated sewage effluent too close to or into bedrock, such as limestone, can be a serious threat to groundwater quality and public health. REQUIRED ACTION: • The trailer on Lot 33 shall be removed immediately, and the septic system serving the four trailers must be abandoned and replaced with a code complying system. • If this trailer is moved elsewhere within the trailer court, documentation will be required to show that the system the trailer is connected to meets the state sanitary code standards. I Page 2 Mr. Hilbelink 9/9/98 RECOMMENDED ACTION: • Purchase additional land to locate a replacement septic system area for the trailer court. Please call if you have any questions regarding this matter. 7Esl ly, iger Assistant Zoning Administrator cc: file i ST. CROIX COUNTY WISCONSIN ZONING OFFICE r w„p,„~ _ y ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson WI 54016-7710 ry (715) 386-4684 NOTICE OF VIOLATION No. 98-V-16 June 26, 1998 Mike Hilbelink 85 Golden View Drive Long Lake, MN 55356 RE: Hilltop Trailer Court: Failing septic serving lot 33. Dear Mr. Hilbelink: On April 9, 1998, the St. Croix Zoning Department determined that the septic system serving lot 33 in the Hilltop Trailer Court, located in the SE SW Sec. 33, T28N-R19E, Town of Troy, (Cty M., River Falls, WI 54022) is failing. This system has failed under the definition in § 145,245(4) Wisconsin Statutes. The inspection revealed that the septic effluent line serving lot 33 is not functioning properly and is discharging to the surface. The effluent appears to be coming from beneath the trailer and discharges to the surface near a concrete pad. As required by the SAINT CROIX COUNTY ZONING ORDINANCE, notice is hereby given that you are in violation of § 145.20(2)(f) Wisconsin Statutes, Comm 83.03(3) and Article 15.04 of the Saint Croix County Zoning Ordinance. The violation was first noted on April 9, 1998. If fines and or forfeitures become necessary to bring about the abatement of this violation, they will be assessed as of that date in accordance with Chapter 145.12(4) Wisconsin Statutes. REQUIRED ACTION: Within 30 days of this notice, contract with a certified soil tester to have a soil evaluation conducted which will determine the type of septic system needed and its location. Give the results of the soil evaluation to a licensed plumber who will design the septic system and obtain a sanitary permit through this office. The septic system must then be installed and placed in service within 90 days of this notice. Another alternative would be to abandon this lot. If you have any questions regarding this issue, please contact this office. Sincerely, e"'12vt- Rod Eslinger Assistant Zoning Administrator cc: file ST. CROIX COUNTY WISCONSIN ZONING OFFICE 11 a a r r a a p ST. CROIX COUNTY GOVERNMENT CENTER rM~6 1101 Carmichael Road F - z Hudson, WI 54016-7710 - (715) 386-4680 NOTICE OF VIOLATION No. 98-V-16 June 26, 1998 Mike Hilbelink 85 Golden View Drive Long Lake, MN 55356 RE: Hilltop Trailer Court: Failing septic serving lot 33. Dear Mr. Hilbelink: On April 9, 1998, the St. Croix Zoning Department determined that the septic system serving lot 33 in the Hilltop Trailer Court, located in the SE SW Sec. 33, T28N-R19E, Town of Troy, (Cty M., River Falls, WI 54022) is failing. This system has failed under the definition in § 145,245(4) Wisconsin Statutes. The inspection revealed that the septic effluent line serving lot 33 is not functioning properly and is discharging to the surface. The effluent appears to be coming from beneath the trailer and discharges to the surface near a concrete pad. As required by the SAINT CROIX COUNTY ZONING ORDINANCE, notice is hereby given that you are in violation of § 145.20(2)(f) Wisconsin Statutes, Comm 83.03(3) and Article 15.04 of the Saint Croix County Zoning Ordinance. The violation was first noted on April 9, 1998. If fines and or forfeitures become necessary to bring about the abatement of this violation, they will be assessed as of that date in accordance with Chapter 145.12(4) Wisconsin Statutes. REQUIRED ACTION: Within 30 days of this notice, contract with a certified soil tester to have a soil evaluation conducted which will determine the type of septic system needed and its location. Give the results of the soil evaluation to a licensed plumber who will design the septic system and obtain a sanitary permit through this office. The septic system must then be installed and placed in service within 90 days of this notice. Another alternative would be to abandon this lot. If you have any questions regarding this issue, please contact this office. Sincerely, d''' wt, Rod Eslinger Assistant Zoning Administrator cc: file ST CROIX COUNTY ZONING DEPARTME_ Complaint Form Date received: 4- L~ - Complaint number:- - Staff receiving complaint: Name of complainant not mandato + L r Address: Old. F4 k7, )24~4/ V-1US ! ( Phone: 4IR 5 - L41& KM fi 3 ? Nature of complaint: (;LVt S SiJ St e... 3 1 e w AV (_9Vd -11-2 S -,570 ~W _ kR ce Abztt1K-1k- (0a)ql&-1867 c-1 Ti, S'S C7ofcJe~yj Uztj bra)CL&IA-6336 6DA, U4 rah s Code Section Violated: Complaint forwarded to Pd on Inspection date: /sg Findings of inspection/::t-4 33 - Se -HZ fi,~4 lr [/+t 4A OK A-0 ja:t~na °~G ~i wo .a w , Photos taken ❑ yes ❑ no, include photos with file. Citation issued: Date complaint was forwarded to Corporation Counsel for legal prosecution: Compliance date: Staff Signature: 895-00554 ULBRICHT & ASSOCIATES CO. 655 O'Neil Road - Hudson, WI 54016 Reg. Designers of Engineering Systems 715-386-8185 Private Sewage Consultants PROJECT DESCRIPTION One of a mobile home park's several conventional drainfields (installed 1980, DILHR S80-05094) is failing (periodic ponding). The failing drainfield consists of 2 twin beds each measuring 301x95' (5700 sq.ft.), serving 7 mobile homes (presumed, per licensed pumper, to be spaces #39,40,41,42,43,44,45). Code derived daily wasteflow is 2100 gals. Two adjacent twin drainfields (each 421x100') serving 10 units (presumed to be spaces #34,35,36,37,38,47,48,49,50,51) is still functioning normal. In order to provide for continued reuse, or rejuvenation of the failing system, soils were evaluated by CST #2, Dr. Dale Parker, in the presence of Leroy Jansky, DILHR. In lieu of groundwater monitoring, soils were approved by DILHR (Plan Approval S93-0238) for continued reuse. Established: there is more than 3.0' between the existing systems and actual seasonal saturation. The owners propose to attempt rejuvenating the failing system depending on a MULTI- FLO WASTEWATER TREATMENT SYSTEM. This aerobic system, discharging extremely treated oxygenated effluent/water, will be incorporated into the existing system. There is absolutely no other available space to site a replacement system. Owners should be awaRe and understand that there is no guarantee that any aerobic treatment system can always successfully recover and restore a failing system. SPECS Per Multi-Flo Corp. recommendations: 1. Existing precast septic tank "A" will be reused as a t-ombination trash & lift/dose tank. Installer shall provide that tank is code compliant (e.g. vent, locking manhole cover, proper wiring, etc. shall be corrected as needed and brought up to all current codes). 2. Two new state approved precast distribution boxes shall be set and bedded perfectly level to equalize flows into/out of the two new aerobic treatment tanks. 3. Existing dose tank "A", 600 gals, shall be abandoned per ILHR 83.03(2). 4. Two new alternating raw sewaGe lift pumps shall be installed per ILHR 83.15(5)(b) in lieu of a one day holding capacity. This arrangement will protect against sewage back-ups as a result of a single pump installation failure per 82.30(10)2. 5. Owners shall provide that a licensed pls::aber af:: to each of the 7 mobile ;?.oir:es, a water meter with a remote display for monitoring individual home flows. PROJECT INDEX DILHR Plan I.D. # S95-00554 Date March 23,.1995 _ Owner Hilltop Mobile Home Park Phone 612-476-1867 Address c/0 Hilltop Partnership. Mike Hillbelink, Principal. 85 Golden View Dr. Lonq Lake, Minn. 55356 Legal Description S.E.1/4, S.W. 1/4, Sec. 33, T28N, R15W Town of County St. Croix C.S.T. Installer Dr. Dale Parker CSTS #2 Local Authority/ Supervision St. Croix County Zoning. Pg.1 PLOT PLAN VIEW Pg.2 EXISTING SYSTEM PLAN VIEW & EXISTING SYSTEM CROSS SECTION Pg.3 MULTI-FLO AEROBIC TREATMENT TANK SPECS Pg.4 DOSING CHAMBER CROSS SECTION Pg.5 PUMP PERFORMANCE SPECS ~Hirnur u W `t f it t M = IIIIr/ Y.,le ORIGINAL MW ~ '-,,~'ed!ps I G h/nU111ptN1M _ 00554 V Q ,000 M .Z J J h 0 W 3W v~ ~/ill orv I ~ o` t~. ~ ~ W M Q fh 2/7 I~ a 12 Az L7 7-31. JryIVd'CI .001 X , Zh ti ! eta ® moo? -----------,--T , v /S 'nr~ 6h eh Gh * ! do ' 04 A~l • cu O Q W a. ac 0 i o 1- ~ -400 W 0 N 2 Vn R, X +V 0 o l 3 ti WIZ O h 5-00554 , o W W W} J uj ti Z < c m N a N ~ N U O O to 4u 04 40 00 i o i~ o ~ Z o IQ W 0 j 0 C W 1i ~ ri z CL O r r S 5 2 cr. LA 0 Q Z -V. W Q W Q W 1- N LL 0 ria W3 - U J ;T 0 x c W i'U 17 m Z Z J O L J V 1 W LO cr. NO W NQ WQ Z V > m W QU NQ W CL N co ~ cc W W z au ♦ © z Z~~ 0J ~W J¢ WW ,~'~0 Jye a9 N m d Z W 3 W F- Q`~ Q ' oo J %J 95=005~o4 O O ~ N ~N co ( w (n CJ Jlcv ~ M LU r CL Ac N v- w u A ` Ln N w vi v c v~ IPL- ~c W ti C~ oo00/ NO .ti ti's ~~pos n `-A4 q o y W Q M o - -i N I X91 M = l1) lz~o I 00 r f ~ NJ 2 M i I -sll i 0 0 L- - ----------I ~ W 13, N S95-00554 PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS PfFcE of S VENT CAP 4'*C.I. V0JT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MAWHOLE COVER / 25' FROM DOOR, w/ 4VIftA) JA) - 1A136 WINDOW OR FRESH 12"MIU. I AIR INTAKE ) IE T/ON GRADE I 4" MIIJ. 18"MIN. COFJDUIT-- 7• f \ o w \ PROVIDE I Y~Y INLET AIRTIGHT SEAL I I I Z, 35 I pG I III I III APPROVED JOINTS APPROVED JOINT A INy,~a~,K I III I III W .I. PIPE W C.I. PIPE U WDIMG 3' '~~K I II ALARM ( II ALARM 5 E EXTENDfNG % 00 ~J! I II I II 01~~Q SoIID SOIL 0WT0 SOLID SOIL r Qas fig, 3ti _ I LLEV. FT. PUMP -_J 9F F s O ~(A~ K 'gLppj,~ lr ~ BLOCK ~o~ 5e~`~ f IE VA f io'~ • RISER EXIT PERMITTED C)QL'J IF '=AWK MAMUfAC"":.%R`R P,'" SUCH PR 1j~dc G t3E/~~v D - SPEC.IFICATIQKJS 4-Ala TR,45)V DOSE : Q PER DA-4 / TAMK MAMUFACTURER CUMBER OF DOSES 2 00 O '(1 TANK SIZE: GALLONS DOSE VOLUME 2~ / r7V rF~P~'J ItiICLUDIAIG BACKFLOW: GALLONS ALARM MAMUFACTUPIER: 64 /2-07 MODEL NUMBER: D' 0'L * CAPACITIES: A=~~ -IWCNES OR GALLONS 7" B= Z INCHES OR S GALLOWS SWITCH TYPE: C) PUMPS MANUFACTURER: 2'5 IIJCHES OR GALLOAJS z / MODEL NUMBER: Z4- 7 Yz /ftP D= INCHES OR GALLONS SWITCH TYPE: ~~~,f/~,i r M~,P~U/t'// `~DAT NOTE: PUMP ARID ALARM ARE TO BE MI INSTALLED ON SEPARATE CIRCUITS MINIMUM DISCHARGE RATE Z~ GPM . BPS S~{C S VERTICAL DIFFERENCE BETWEEM PUMP OFF ARID DISTRIBUTIOU PIPE.. /2 FEET f~,~ + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . FEET (CAC(A- 1 Of P' ' + v FEET OF FORCE MAIM Y, /'/O F>1/0OFtFRICTi0M FACTOR.. FEET (~~rls Z 8 ~jFI FEET TOTAL 09MAMIC. HEAD = z%Xi'Sf/,06- INTERMAL DIMENSIONS OF TAUK: LENGTH z - ;WIDTH z -)LIQUID DEPTH 72 sP>~cs - r9 ~T> ~t/.~tTiti U-- U~/ S ry// S>E D . irrr /iE2C a~ / 1,~i1~ eele ivo G- Dv7_46 T eA F- S~411 -~f' N 0 T~ J` sYrP6_16-G 62v 2 2 U - o.- T-/ AfZF e , r ~ ~ • 5~ HEADI CAPACITY CONTROLS " i "E-Pak z CURVE Electrical ~ O Alternator f - Specify voltage, phase, and H.P. Of pumps when ordering. An electrical alternator is used on a duplex pump application } where automatic alternation of the pumps is desired for added 177 protection in residential or commercial applications. With one pump operating to handle normal flow, a second pump becomes operational in the event the water level continues to rise. The built in alarm system, a standard feature, will sound when the second pump becomes operational (3 float system) or independently (4 float system). Consult factory for special applications UL listed V CandA,an StandarAS Assoc ApprOVal avaaahle SEWAGE and DEWATERI NG W W - 0 0 5 Y 4 F LL W i 24 90 - - - - - - 75 22 70 - 20 65 _I 18 60_ - - MODEL- - - - G 295 _ W 55 + 1 - I- 16 Q - L-~ - --1 C) so 14 MODEL Q - - Z 45 294 z C 12 --40-- MODEL 35 - - - - Q 293 - I - I - f- 10 30 MODEL + - - - t- 264 MODEL 6 20. _ 262 10 MODEL a I 2 5 267, 268 - - 3260 Old Millers Lane 0 GALLONS 10 20 30 40 50 60~ 70 BO 1 1 90 100 110 120 130 140 150 160 *0 160 190 P.O. Box 16347 l l G-~- Louisville, Kentucky 40216 LITERS 0 80 160 240 320 400 480 560 640 720 (502) 778'271 r FLOW PER MINUTE ' ~EWi4GE and DEWATERING pumps 26 and 611268" Cast Iron SOdOs HEAD CAPACITY i Y2 H.P., 1 Ph., 115V or 230V. UNITS/MIN • Non-clogging vortex impeller design. Feet Meters Gal. Ltrs. • Passes 2 inch solids (sphere). s 1.52 126 464 • 267 series features a 2" NPT discharge. 10 3.05 es 337 • 268 series features a 2" female - 3" male com- 15 4.57 so 169 l bination NPT discharge as part of the pump. 20 6.10 10 39 • Float operated, submersible (NEMA 6) mech- Lock valve: 21.5• anical switch. • Automatic reset thermal overload protection. Canadian Standards U~ listed SP Assoc. Approval • Stainless steel screws, bolts, handle, guard, arm available and seal assembly. 266 - state of • Switch case, motor and pump housing, base and Wisconsin approved impeller are of cast iron- N267, non-automatic, available packaged with a piggyback mercury I NOTE: SC-2225 M268 Pictured NOTE: No UL listing for 200-208V/1 Ph. Hoar switch. Mercury float switches are ~llable for N268. pumps: