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HomeMy WebLinkAbout042-1016-40-000 0a* c 2 T ® 2 E @ � . % /ƒ 2 s/ o t m k q i 2 £ 2 } e § - . 7/= 2 0 o OD _ a) ; ` ; 2 B f 5 § 2 G f ! > 2 \ . e I W o E§ o 06 -4 CD / §\ % /� CD c 3 $�k. C / \ \ CO) E 11 ID ■ \ 000 �I �- & z / ■ ■ ■ q : & > & { % V Q R «i { , £ - ■ . m £ " ; 03 y :3 � - § { .. °_ o > o / / /C ƒ § R D I \ § y f , _ ■ R � ; �_ ■ � - \ I §9 § U) ; « a w 0 k �� 2 o FF A z # 2 �l 7 E ro CI\ ; %���,_ q E « a -< ) R =£_E §k%[k\ % -@ 2Sm 4 [& . t CL . � %£ . k � \ A /\ ¥ \ CL m V. 1 ¥ . _ < \ . f \ \ . 8 & ' � Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page _ of , 7 4pboY.and Human Relations Division of Safety 8 Buildings in accord with ILHR 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 S 6 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. _ p APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION R . IEWED BY DATE l( t PROPERTY OWNER: PROPERTY LOCATION Y /f��- / GOVT. LOT s� 1/4 1/4,S T �9 ,N,R/Y E (c� PROPERTY OWNER':S MAILWG ADDRESS LOT # BLOCK # SUBD. AM OR M # 1/0 CITY STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE OWN N REST ROAD New Construction Use Residential / Number of bedrooms 5j [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate gy bed, gpd /ft . y trench, gpd/ft Absorption area required f, 5 - Y bed, ft 7S trench, ft Maximum design loading rate '— bed, gpd /ft " ` trench, gpd/ft Recommended infiltration surface elevation(s) laal �;I?rT � 3�1 & 5 ft (as referred to site plan benchmark) V'* E .Z� — S` Parent material O Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem Q1S ❑U OS ❑U �S ❑U ❑S ❑U ❑S mU ❑S OU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Boundary Roots in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 2 1 P 7 -s c .7- F G S Ground 3 - ,S'- s' O elev. g& / ft. Depth to limiting �factor Remarks: Boring # "2 y 7 �„ 3 S �/ G� .S fic rg k c S .7 Ground rel ft. � S B S� d• ,r Depth to limiting ry C' factor D Remarks: 7 ST CR � CST Name:—Please Print �r �iQT t Phone: Address: ` lJ 3 O_2 -3 `4111 Signature: Date: s 7 2 4 PROPERTY OWNER /h�� 1�i1�1`iocr/ SOIL DESCRIPTION REPORT Page? of_ PARCEL I.D. # t a _ Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Bour>dary Roots Bed Trench %h ng L — L 2"A 502 ul . 5- < .'.. — .22 - to — L /� . S Ground ' L C S -- elev. 'EL ft. -- Depth to limiting factor 5 /o Remarks: Boring # Ground elev. y) -Qd s' — ''� S SG L _ ft. Depth to limiting factor > Y� Remarks: Boring # 0 5 :« E2 Ground d 1 zt / elm ft. Depth to limiting factor Remarks: Boring # Ground 74 o ! i l elev. i ft. Depth to limiting factor Remarks: S13D- 8330(8.05/92) tt L I IF w� l h 1r 7c —vC w _ . 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I n rn �z IQ i�0 A ww L) tD I j ?8•$61 N S — V) 0 Ln o ,., m w 14 co Z �p � p , OD c0 u7 Rol r 0 v T tW pop �� z i s W �l k � 0 Ln A f'7 k co cD !O cb C) S m V� �► �� —s -k a QS Q C) 0) y o �� y m w d io !� i� v i -� 0 CD r z i _ � - -�— �J D kD A 011 P - - I 3 x C7 W w � r S 472.36' 412.07' 395.06' CD ,���1. N00'39'34 "E 1279.49 2 n WEST LINE OF THE EAST lE RODS OF THE SWIM OF THE NEI /4 CD " r 0Z 1 _ 11 r, r C 1 L o z .i 0 Z o � �N d _ N o ;o l7 �, o m� C] < .�C,� Inrrl z z _ r 06,0 .- m CD C3 BEARINGS ARE REFERENCED TO THE �c•1 " °. = EAST WEST 1/4 LINE OF SECTION N - o l3 w z � I� 7, ASSUMED TO BEAR N89'22'00'E ;c Wisconsin pepa"ont of Commerce PRIVATE SEWAGE SYSTEM C linty: St. C Ix Safely at�Buildinp Divisian� : • ��. - INSPECTION REPORT Sanitary Permit No: 4305 8 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No Personal Infomietlon you provide may be used for secondary purposes (Privacy Law, a,1 b,0a (1)(m)), Permit Holder's Name; City Village X Township Parcel Tau No: Bock Donald Warren Township 042- 1p716 -40 -000 CST SM Elev: Insp. BM Elev; BM Description: Secdonrl'own/Range/Map No:, Do ` �� cl'j / � IN I 51-5 T 07.i9,18,99A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATI N BS HI FS EL V. c) , 0 Septic Benchmark 5.9 f9.99 /bo Dosing C � �� Alt. BM Aeration G'1� l Bldg. Sewer _ P f Holding St/Ht Inlet TANK SETBACK INFORMATION SNHt Ou et TANK TO n P /L� WELL BLDG. v to Air Int ake ROAD Dt Inlet Septic / \ 0 � Dt Bottom / 3• G Dosing Heade an. , 0 / S I��, Aeration Dist. Pipe - r - ,p 6 - 7. / - 7- x'00' 9 t Holding Bot. System15 .70 r � / 7 � 7 �00- 3 � PUMP /SIPHON INFORMATION o �+ S •b / . Zl Manufacturer Demand t over i GPM Model Number ! / �^�Q� I (� Z% +T. 77 TDH Lilt // Friction Loss System Head TDH t t0-g I & • S Forcemain [Length / DIa. „ Dist. to Well _ [OD 2 SOIL ABSORPTION SYSTEM L VS BEDITRENCH Length r No, Of Trench9s PIT DIMENSIONS No. Of Pits Inside Die. Liquid D h DIMENSIONS /,M ' SETBACK SYSTEM TO P/L BL� WELL LAKE/STREAM LEACHING Manufacturer, INFORMATION 7 �, CHAMBER OR 7 -/ 7 � 7 / / UNIT Model Number, DISTRIBUTION SYSTEM c O HeadeNManif OIgMbutioh x Hole Size x Hole S ng Vent to A ir 1 fake N Pipes) �— 1 Lang kL_ Z _ L Dia 2 Length D /, -�; Spacin a ' SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xt Depth of xx Seeded/Sodded" Bed/irenoh Center Bedlrrench Edges Topsoil ;il Yes (_"� No es No COMMENTS (Include code disrrepencles, persons present, etc.) Inspection # 9 / 3 / 6 Inspection #2: 0 7 /0 Location: 965107th AVe lie Roberts, WI 54023 (SW 1/4 NE 1/4 7 T29N R16W) NA Lot 1� O n Parzel No: 07.29. .99A • ' 1.) Alt BM Description = i� 2.) Bldg sewer length = `T ' - amount of cover = > 5 / yaf 6 / - 4° 4t-7� Plan revision Required? (J Yes No Use other side for additional information, SBD -6710 (R.3/97) Date ineepotor' Ignature No, Z 'd 9tiW N NOIldMM 9030 AVOS:8 W6 * 'd3S Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division,, a IL INSPECTION REPORT Sanitary Permit No: 430528 0 GEI4E!ZAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Bock, Donald I Warren Township 042 - 1016 -40 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: /A) 1 03 hn L 5 .T 07.29.18.99A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Ibv 5. /b6:9l Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet SUHt Outlet TANK SETBACK INFORMATION 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 S - Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length 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 JBLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil i 0 Yes � No [-;, Yes (v&:] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #A: C ? / 3 / Inspection #2: Location: 965 107th Avenue Roberts, WI 54023 (SW 114 NE 114 7 T29N R18W) NA Lot 1 Parcel No: 07.29.18.99A 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes [M No 7-T-7 Use other side for additional information. SBD -6710 (R.3197) Date Insepctor's Signature Cart. No. \ p A ?� °� erd � t : Ti aF �b Pe.bar• so' 000 � rrt L'z goo' diJ /usa /cam /% TWO (a,) laf�.d/s a� /iz i 9B �7 ,a/ V "or,� a�eS S�ac�d at i i Propose d / �icSer�ncrv�.e, Gom6Ao�:h // /07 .b `{l)e-. Qu o d � 91f.sa &Ur LL : l R,/, e.. p ;pe. Eli ✓ = 9 R9�= P poscd ��Srl�, !b Pa C-, -t- 6C igla /a�( g z, �)(C.), ! y L s.attav � . e C; Opv A�(�rcY. /aa oOC lorgaobed dri✓Ct.74 tr 'd 9tr 'ON NOI1UMOO W30 W S:8 W 'L 'd3S,OF9 Safely and Buildings Division y 201 W, Washington Ave.. P.O. Box 7162 $ f SCO/1s»n Madison, w i '53707 - 7162 36 Addres De artment of Commerce (o S 10 fad t Sanitary Permit Appiicati n " Pe /303 In word with Comm 83.21, Wit. Adm. Code, personal t 00 5 2003 111mkillitevislon be wed fo aeco t dr Law as. Was m I. Application Information - Please Plrint All Infoirniiation SMAN Flo I.D. Numttsr ,# ST. CROIX COUNTY °jlg9� TibetS• Proneny Owner's Name Number L9 wr a a G VV-4- d 4,Z - I b 14- V o - a e (. ` ?A Property Owner's Malting Address Property Landon 5 -00 1� ;... 5t • nw. NE 1f • 3 7 Ta I N R ! a City. State Zip Colo Phone Number lot frr Block Nar#oer Suis�rd�r Number H. Type of Buile)lseg (check all that apply) 5 r"' fly idt I or 2 Family Dwelling - Number of Bedrooms S inage a Public /Comore t - pesefibe Use ownshlp LD ❑ Sgle Owned 4 - Nearest Reed / t c loo tAMJ COQ a0"k 1 07 a `' !a-r,4 . 111. Type of Permits (Check only one box on Ilse A (numbering scheme for Internal use). Complete One B If applicable) i A' 1 New 2 1� kepl;leemerA System 3 O Replacement of 6 0 AdMlon to po* COaaty MM TaBk Only 1 B. 0 Check If Sanitary Permit Previously Issued Pernde Number Dale Issued IV. Type of Permit: (Cheek all that apply)(numbering scheme Is ror Internal age) 44 U Non - Pressurized In-Ground MILMound 47 ❑ Sand Filter So 0 Conmueeed Wetland 22 0 PressurIzed In -Oround 41 d Holding Tank 48 Single Paso St 0 Drip Una 4S 0 At -Grade 46 0 Aerobic Ttestinent Unk 49 0 Redwolsdu 30 0 Other V. Dla t•salffreatment Area Informs on - (oD Design Flow (gpd) Dispersal Area Dispersal Area Soil Application F arcallition Ras I Ayaw Blevwthm F Grade Regotred 7— Proposed Rare(Osll.Mayst5q.Fr.) (Min./Inch) / Ble tion / ( ' Goo. X 00 7_ x50/(,4 A wb � � � 1Oo. '0 � VI. Tank Info Capacity M Toad Number Mstmfacturer Prelkb Site Seed bar PI"tir Oalloas Ganoas or Tanks Concrete Comtrucwd lass New erhting Tsob t Septic or fielding Tank _ / Z 17o31na Chamber -2 Sp VII. Resp onsibility Statement 1. the undersigned. asst®e respoadilMly for shown an the attached plant. Phenrtter's Name (Print) Phember's Slgmiute MP R9 Nurnbet Il rho" N0110 9 tcA . 71 f - 3 z2 P t s Add &x (Street, Cibr. Stake. Zip Code) VM Colm!Xj!!2surtmelt Me 00 Approved 0 Disapproved' Sanitary Permit Fee (includes (IrovMwawr D1110 issued Issuing genet Slgee Ramps) (No Surcharge Fax) 13 O Given teldst Adverse , T 0 Deterralloaeto S V " D // Zoi)1 M. Conditions of Approval/Reasons for Disapproval SY TEM OWNER. 1 optic tank, etllusnt llihsr and ispersat cell must all be serviced / maintained s per management plan provided by plumber. ' 2. 1 setback requirements must be maintained as per ppilmoft cudWo, din nM ennipme Phu On me Cosa cob for the spies on paper e el Ina Ilya Ill if bra be st:e SBD -63108 (R. 05(01) i 8 'd Mt 'ON NOIiffl OO M33 NVOS:8 - M 'L 'd3S edar f 4� X j_ Ccorporation 604 IggISon AVe . hfwx a-rAe W1 5#751 715 - 295 1 BG0472 972 fmr • 715 -235 727 DATE. 04 TO: Organization: r fax #: to — r FROM: �^ Re eg ng: Number o page(s) contained In this fax: Page this cover s) Including page This matertet Is intended only for the use of the individual or amity to whom it is addressed, and may contain infoR MIM the(rs t y s " d corifidenlfal- if you are not the intended reci 'enl, you am helaby noMW that any dissemination, distdbufloA, or reproduction of f�his ed � communkagm Is sfrtctly prMrbi w If you hive racarved this communicedon in error, kindly nobly us ilranadiSW by telephone. Comments/Instructions: i eng/ wav • amMects • p/ane ff • Gnw*vrYrmnIa ds • k"d s veyw - jagg%s=pB =htla -N • 1nMrk r s l 'd Mt 'ON NOIld MOD HUD Wd05:8 WZ I 'd3S r Safety, and Buildings Division County Ali 201 W. Washington Ave., P.O. Box 7162 ' C N viscvnsr►n Madison, WI '53707 - 7162 Site Address. Department of Commerce (a a / 4, ? /4-" t Sanitary Permit Applieati n s tary Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal informa on y ��� ma be used for second ses Privacy Law, s15. 1 m Q V e 0 5 2 003 ❑ heck if Revision I. Application Information - Please Print All Information ls Pla n I.D. Number ST. CROIX - 'OLNTY" Property Owner's Name 1 Number 0 I—vt_ " 13 lrr�k_ Ciq�Z- oc Property Owner's Mailing Address y� Property Location 14 i4F - S T N. R if +B► City, State Zip Code Phone Number Lot Number Block Number s Lj , `/o / Sum CSM Number ( 2 /p 3399 , II. Type of Building (check all that apply) i or 2 Family Dwelling - Number of Bedrooms S allege ❑ Public /Comme cal - ,�es-cribe Use ❑State Owned t n t Nearest Road III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. For County use i New 2 ❑Replacement System 3 ❑Replacement of 6 ❑Addition to S stn Tahk On' Existing System B. ❑ Check if Sanitary Permit Previously Issued Permit Number [ Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 ❑ Non - Pressurized In- Ground 21)LMound 47 ❑ Sand Filter 50 ❑ Constructed Welland 22 ❑ Pressurized In- Ground 41 ❑ holding Tahk 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculaft 3o ❑ Other V. Dispersal/Treat ent Area Informa n: 4t A - IOU Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate wtystem Elevation Final Grade Required 1-- Proposed Rate (Gals. /Days /Sq.Ft.) (Min./Inch) ji Elevation / 6 00 0 CIA VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass t New Existing Tanks Tanks Septic or Holding Tank 'P Dosing Chamber '7 .� v VII. Responsibillty Statement- I, the undersigned, asstmie responsibility for Install OWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP PRS Number Business Phone Number: r 1 - 3 ' l Plumber's Address (Street, City, Slate, Zip Code) VIII. Count /De artme t Use Onl Approved ❑ Disapproved ' Sanitary Permit Fee (includes Groundwater Date Issued Issuing gent Signature (No Stamps) Surcharge Fee) ❑ Owner Given Initial Adverse 0 - Determination J V ­7 . / IX. Conditions of Approval/Reasons for Disapproval SY TEM OWNER; 1 eptic tank, effluent Miter and ispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. li setback requirements must be maintained as p er °complete plans (to the County only) for the sMem on paper not Ids than 8112 a 11 Inches In else SBD -6398 (R. 05101) IL o � A ssu,-Ad cl'" = BCD' ' I i o1. So' Propost-d m ou. rtd aE /R3 V x /uo I n ( is persa /CL //. 'Two e2.) lau�o -�s a� /h'X 98.67' w/ y "ori eeS S�QCed i Propo wr esc/ 5cp i .b 98.soYCor+�our 17 f y 6ealrdo Q Py Ap (3rcX. loda'�;o* oF/Jroaoseo/ -Wvct,-2a Safety and Buildings ' = 10541 N RANCH ROAD HAYWARD WI 54843 '► s TDD #: (608) 264 -8777 er \*6consin www.wisconsin.gov .wis c ons .wisonsin.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary September 30, 2003 CUST ID No.222781 ATTN.• POWTS Inspector ZONING OFFICE HENRY J NECHVILLE ST CROIX COUNTY SPIA 967 HIGHWAY 65 1101 CARMICHAEL RD ROBERTS WI 54023 -8510 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/30/2005 Identification Number Transaction ID No. 919926 SITE: Site ID No. 665326 Donald Bock Please,refer to both identification numbers, 1067 107TH Ave above, in all correspondence with the agency. Town of Warren St Croix County SWIA, NEIA, S7, T29N, R18W FOR: New mound, 600 GPD Object Type: POWT System Regulated Object ID No.: 921607 _ } J YP Y g J The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. '� -- c The following conditions shall be met during construction or installation and prior to occupancy or use: ' General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10691 -P ( N.01 /01) and SSWMP Publication 9.6, "Design Of Pressurized Distribution Networks For Septic Tank- Soil Absorption Systems." • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. Key Item(s) • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. HENRY J *' ' -LE Page 2 9/30/03 • Maintain well and waterline set backs per COMM 83.43(8)(1). Consult the Department of Natural Resources for well setbacks and exceptions to the setbacks. • Insulate building sewer per COMM 82.30(11)(c). A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. l The above le addressee shall provide a copy of this letter to the owner and any others whQ are responsible for the installation, o eration or ma' enance of the POWTS. Sinl�{, Fee Required $ 175.00 // Fee Received $ 175.00 � Balance Due $ 0.00 C` Patrici S�tando POWTS Plan Rev ewer, tegrated Services VSMART co de >'7633' (715) 634 -7810, Fa . 15) 634 -5150 , M -f 7:45 am - 4:30 pm pshandorf @commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 r MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Don Bock 4 bedroom residential mound Owner's Name: Don Bock Owner's Address: 604 Prairie Dr. North Hudson, WI 54016 Legal Description: SW1 /4NE1/4, Sec. 7, T.29N., R.18W. Township: Warren County: St. Croix Subdivision Name: CSM Vol.12 Pg. 3399 Lot Number: 1 Block Number: na r't y Parcel I.D. Number. 042 - 1016 -40 -000 f a MERCE E�11 Dv Np BUILDING Plan Transaction No.: b s Page 1 Index and title RF Sp6j4D !CE Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications f Page 8 Site Plan Page 9 Soil Evaluation Report Designer: Henry Nechville License Number: 222781 Date: 08/26/03 Phone Number: 715 - 749 -3322 Signature: 2 Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Version 3.0 (03/01/01) Page 1 of 9 Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 8344 -3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 % coliform of - 36 inches. 600.00 Design Flow (gpd) 8.00 Site Slope ( %) 99.77 Contour Line Elevation (ft) 35.00 Depth to Limiting Factor (in) 0.50 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 100.001 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /ft 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (c or e) a Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation (ft) 2 Number of Laterals of the highest point. C 0.125 Orifice Diameter (in) (e.g. 0.25)_ 2.50 Estimated Orifice Spacing (ft) = 7.50 ft /orifice 2.00 Forcemain Diameter (in) _ 35.00 Forcemain Length (ft) Does the forcemain drain back? [ 91.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 5.71 Forcemain Drainback (gal) 8.77 Vertical Lift (ft), 90.53 5x Void Volume (gal) 0.81 Friction Loss (ft) 96.24 Minimum Dose Volume (gal) 16.08 Total Dynamic Head (ft) 32.95 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x x 1.25 2.00 1.50 x x 3.00 2.00 x 3.00 x Gal lons /Inch Calculator (optional) Treatment Tank Information 757.64 Total Tank Capacity (gal) 1250.001 Septic Tank Capacity (gal) 47.00 Total Working Liquid Depth (in) Wieser Concrete I Manufacturer 16.12 gal /in (enter result in cell 649) Dose Tank Information Effl Filt Information 757.641 Dose Tank Capacity (gal) JZabel Filter Manufacturer 16.121 Dose Tank Volume (gal /in) A100 Filter Model Number Wieser Concrete Manufacturer Project: Don Bock 4 bedroom residential mound Page 2 of 9 Mound Plan View T FKK 1/10B 'Observation Pipe . 0 J A 5 • r,r•r�r,r,r r�r r, r, r; r;r•r•r• r,r . r r r •r; � I . . . .. ....... • Mound Component Dimensions A 6.00 ft E 11.76 in H 1.00 ft K 7.60 ft B 100.00 ft F 9.50 in z 8.97 ft L 115.19 ft D 6.00 in G 0.50 ft J 4.33 ft W 19.30 ft 600.00 (ft Dispersal Cell Area 1 1496.71 (ft Basal Area Available 6.00 (gpd /ft) Linear Loading Rate 1 10.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 102.06 (ft) ---► G H ' .ri�rrfiif 2 rrfr�rti. . . .r�fliii i r . �f.. F ; ::: Dispersal Cell 10Q.77 ( I • (ft) Lateral 100.27 (ft)- — Invert Dispersal Cell Elevation E D: a K 99.77 ft Contour Elevation 8.0 % Site Slope Geotextile Fabric Cover Shading Key $. T Dispersal Cell See lateral details on 1� Topsoil Cap o a 1.5 ft ; ; ";,;,, Page 4 for number, Subsoil Cap g r. (ti: ti size, and spacing of © • r " r . ASTM C33 Sand , "• ti '" ..•• " F laterals. Laterals are 0.5 ft �, Typical Lateral Tilled Layer ; ; • .- equally spaced from ❑5 :�::f� Aggregate v o • ? °r' �.;. °:� a the distribution cell's A * centerline in the distribution cell (AxB). Project: Don Bock 4 bedroom residential mound Page 3 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name H. Nechvi lie, MPRS #22278_1 Phone 7 15- 749 -3322 POWTS Regulator's Name St. Croi County Zoni I Phone x715- 386 -4680 System Flow and Load Parameters Design Flow- Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1250 gal Maximum TSS 150 mg /L Soil Absorption Component Size 600 ft Maximum FOG 30 mg /L Type of Wastewater 1 Domestic Maximum Fecal Coliform I >10E4 J cfu /100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Lat erals sho uld be flushed and pressure tested every 1.5 ears Mound Ins ect for ponding and seepage once ev ery 3 years Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished • ............. _� ............... Grade \ ,� 6 -8" Diameter Lawn _ Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral ��. Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Don Bock 4 bedroom residential mound Page 5 of 9 : Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry Into a tank or component. Septic Tank The septic tank shall be maintained by an Individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of In accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet finer shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the fitter when removed from Its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have Its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next ' service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be Inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is Installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD 150 mg/L TSS, and 30 mg /L FOG for septic tank effluent or 30 mg/L BOD 30 mg/L TSS, 10 mg/L FOG, and f0 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified In the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the Initial test when the system was Installed to determine if orifice clogging has occurred and If orifice cleaning Is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 Inches considered as an Impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of Its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component falls to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Don Bock 4 bedroom residential mound Page 6 of 9 HEAD CAPACITY CURVE -Iw EFFLUENT MODELS 314 _ - -- - - -- -- - - -� 140 42 — — * � , f - � — ; - -� — G CAUTION Model185 /a185shou� -� �,3s �— —� — riot be subje to less than 30 feel TD-1 40 18 -{ 125 - --- 1 - F - - t - ;2o- — �__- f --I- -1 _ 36 -I 191 }2 105 30 95 - - 2B-j 90 _ - 26 - 85 a 166 --I--j-y-- 'rte ---�- 24 BO 165. 416 -� q 22 0 1g 60 63, 3163 189. 55 1 4189 a 50 14 12 40 ,Bd. 40, --jj 35 4140 u83 0 � - - 30 185, 8 1 17 4135 - � // b.0 6 20-- y-� -T- _ a o I T T# 8 i 66T- _ _ 5}.57 98 0 U.S. GALLONS 10 20 30 40 50 60 70 80 90 103 110 120 1 3 0 140 150 1 6C LITERS BO 160 240 320 Z Aau 560 8 0 FLOW PER k'INUTE rI ", TOTAL DYNAMIC HEAD /CAPACITY PER MINUTE EFFLUENT AND DEWAfLRINC Mooe• 53/57 98 137 140/4140 .6'/4161 163/4163 165/4161, 185/4185 16,/4'.46 188/4188 189/4189 9' 'I. Meters Cal. U15. Dot. Lim Got. d1l. Col. WIS C jI. Urs. Col . l s. Col LI s C.I. Lbs of .I s LJI lvs Col. L: o L: 5 1.5 43 163 72 273 93 352 91 344 100 379 5t 231 ' 61 231 -- - 8 - - Ist 549 145 549>� a r l " 1C 3.1 34 129 61 231 79 299 84 318 93 352 61 ?31 6 23 >6 -} _1 C I 4 53, 140 530 4 r I:? 15 4.6 19 72 45 170 64 242 76 288 05 322 60 227 61 23'. F 220 � ISS 507 135 511 a 1J0 2C 6.1 25 95 36 136 68 257 J9 299 59 223 60 227 1 >6 2rO 128 483 13t 396 4 1 'D 25 7 6 8 30 59 223 70 265 57 216 59 223 6 120 1 122 362 125 473 45 110 - 3C 9 -1 49 185 62 235 55 2C6 , 58 220 85 }22 ib 220 1 116 339 120 45< 45 Ii0 :0 12.2 21 79 45 170 a6 172 ! 55 206 70 2fi5 76 2e0 04 393 109 4I3 1 4 5 - i - 170 50 15.2 20 76 33 125 j 50 189 51 193 >A_ 220 90 341 97 367 45 1:3 60 18.3 15 57 39 lab 32 121 i8 22 0' 1 _ 269 85 322 05 1 70 21 -3 j 23 81 1 4 34 i2 T t97 193 69 261 45r cJ T'7 - 2-44 0 38 5 170 8 106 51 191 45 1 0 30 ?Z< ! 31 117 2 8 34 129 45 1.) :OC 50.5 -. 6 rt-' 60 - 17 -- 64 aC Ijl 10 32.01 4 15 3C r it a :IL' 1 56.5 - 2C 8 LaCk Vor.e: 19.3 IL (5.9m) 23 IL (7m) 26 IL (7.9m) 1 46 f1. (14m) 56 IL (17.1 m) 66 II (201m) 86.5 II. (26.4m) 7S tt (223 1 (347 ),91 '1. (i77m1 110 It. (335m 137 I T 15m.) _- L t n 4y . MEMBER ry \ i F_ A U I SUMP ® � • -.� Yom. �a.. A ,,FRS AS PUA4^uFRS.:SSN WOMAN 1 M. Rl 5 4 f, © Copyright 1998 Zoeller Co. All rights resorved. 0 A � ` o � � J � YY1ar r To aF /'ebar. O l io.7.So proposed a'� /9- �X / /S. /9w.� ��.Sp� x quo' d; sPcrsa /cc /% Tw o of lyi'z Y8.67 c,)/ "or, Ce5 SPa ceol ■ w- z �y P� o �oose d / r9' cuscsci�c►+tra>t Comb�a�'vr, // ��' / Sep Etc fo �►K /l�u., cha" � orb` o /O 7 t( 0 Y'y2 (�roposcd yl�' • f/O 4e /aZ 4S�Gi' �'PrrlM. � 7 laces oo' /Jr000 seo/ dr,,vec.a 1708 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page t of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations County Attach complete site plan on paper not less than 8'/ x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and -- - -- - -- - -- — percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. 042 - 1016 -40 - 000 Please print all information. -- - - - - - - -- - -- - — - - _ __ R eview ed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (n* Property Owner Property Location Don Bock Govt. Lo! SW 1/4 NE 1/4 S _ 7 T 29 NR _t8 W_ Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# T P I 604'Prairi Dr. North 1 I - -- CSM Vol. 12, 9. 339 ------- - - - -_- City State Zip Code Phone Number JI City 1 Village ✓ Town Nearest Road Hudson WI 1 54016 1 715 386 - 3238 Warren 1 1067 107Th Ave. New Construction Use: J Residential / Number of bedrooms 3 _ Code derived design flow rate —_ 450 GPD J Replacement I Public or commercial -Describe: Parent material Glacial Till _— Flood plain elevation, if applicable na General comments and recommendations: Install mound system at elev. 100.27' at 6" above 99.77' contour. a Boring # I Boring Pit Ground Surface elev. __ 99.85 __ ft . Depth to limiting factor -- - 3 - -_in. Soil Applicaton Rate I Horizon Depth Dominant Color Redox Description i Texture Structure Consistence 3oundary Roots GPD /f;' { m. Munsell Qu. Sz. Cont. Color Gr Sz. Sh. 'Eff#1 `Eft#2 1 0 -12 10yr4/3 none fsl 2fcr _ — ds as 2f,1 m .. 0.5 0.9 none sl 2 fsbk dsh cw 2fm 0.5 0.9 12 -28 10 r3/3 2 y 3 i 28 -35 10yr5/4 none sl 2msbk dsh aw 1 V 0.5 0.9 35 -58 10yr5/4 m3p 7.5yr5/8 sicl 1 esbk mfr - 0.2 0_3 i I Boring # l Boring — - - - - _ Depth to limiting factor pplicar - 42 in. Soil A�en Rate ✓i Pit Ground Surface elev. 9805 ft. _ Horizon I Depth Dominant Color Redox Description Texture Structure Consistence Boundary ' Roots GPD / 8? in. Munsell Qu Sz. Cont. Color Cr. Sz Sh 'Eff#1 'Eft#2 1 0 -14 10yr4/3 none N 2fcr ds as 2f,1m 0.5 0.9 14 -24 10yr3/3 I none sl 2msbk dsh Cw 2fm 0.5 0.9 3 r5/4 none j sl 1esbk 24-42 10 y - dsh aw - 1vf &f 0.4 0.6 - - - - -I I - _42-68 7.5yr4/6 f2d 7.5yr5/8 strat. Ifs i 1 csbk mvfr - 0.4 0.6 i l ' Effluent #1 = BOD ? 30 < 220 mg/L an TSS >30 < 150 mg/ Effluent #2 = BOD < 30 mg /L and TSS <30 mg/L CST Name (Please Print) ignature: ; -- - CST Number J ames K. Thompson ___t t 3602 Address A.C.E. Soil & Site Evaluations D to Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, 1VI 54020 8/13/2003 715- 248 -7767 ' -Property Owner Don Bock Parcel ID # _ 042_1016 -40- 000 _ _ Page _ 2 3 3] F ^ J Boring Boring # vi Ground Surface elev. __._98. __ ft. Depth to limiting factor 39" — in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh 'E ff # 1 `Eff#2 1 0 -12 10yr4/3 none fsl 2fcr ds as 2f,1m 0.5 0.9 2 12 -20 10yr3/2 none fsl 2fsbk dish Cw 2fm 0.5 0.9 3 20 -39 10yr4/4 none sil 2msbk dsh aw 1 V 0.5 0.8 4 39 -52 10yr5/4 f2d 7.5yr5/8 sil 1 csbk j mfr cw - 0.2 0.3 5 52-61 7.5yr4/4 f 7.5yr5/ scl 1 csbk m fi - 0.2 0.3 1 1 F Boring # J Boring - —39" — -- 1/ Pit Ground Surface elev. __ 9 9 •� ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. i Munsell Qu. Sz. Co nt. Color Gr. Sz. Sh 'Eff#1 'Eff#2 1 0 - 11 10yr3/4 none fsl 2fcr ds as 2f,1m 0.5 0.9 2 11 -21 10yr5/4 none scl 2msbk dsh cw 2fm 0.4 0.6 3 21 -39 10yr4/6 none grIs 1msbk ds aw 0.7 1.2 4 39 -54 10yr4/6 f2d 7.5yr5/8 gr Is 1 csbk j mfr M 0.7 1.2 5 54-64 5yr4/4 f2d 7.5yr5/8 scl lthinpl mfi j 0.2 0.3 j ❑ Boring # J Boring - -_ - - - -- J Pit Ground Surface elev. _ -- ft . Depth to liriting factor in. Soil Application Rate Horizon Depth j Dominant Color Redox Description Texture Structure Consistence Boundary Roots - OPLt' —_ —_- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh 'Eff#1 `Eff#2 I I I i � I Effluent #1 = BOD ? 30 < 220 mg /L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you r:Q-,cd assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 of TTY 608 -264 -8777. a 7016 5 ca /e : / 60' �8ir� � \\� ■Soil ¢ da lcc2f'o��� E \�\ � Eleda f7'on . /oca.76e.ol Prop..56z"(k \ r¢ bay. A ssu.►te,r! Q � g 99, 7c" h ioK sz' Lk g : TP of - /07 ys p ✓,e. /�iNe ✓e. o � E le v; _ 97.96. Qc� 00 h fa? SO' 9 L ND r II 1708 Wisconsin Department of Commerce SOIL EVALUATION REPORT p age 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8 11 inches in size. Plan must County St. Crob( include, but not limited to: v i JBM directi on and percent slope, scale or dime sions, �e tlrepecrpdiq�eY: nce to nearest road. Parcel I.D. R C \.r C t V t� LJ 042- 1016 -40-000 Plea print all information. g Date Personal ffft mebon you may be used for Low, s. 15.14 (1) (m)). B f ve ✓. I I 2AT 3 Property Owner Property Location Don Bock I ST. CR IX COUN Govt. Lot SW 1/4 NE 19 S 7 T 29 N R 18 W Property Owner's Mailing Addrefs ZONING OFFICE Lot # Block # I Subd. Name or CSM# 604 Prairie Dr. North 1 CSM Vol. 12, Pg. 3399 City State Zip Code Phone Number �j City _j Village iM Town Nearest Road Hudson WI 1 54016 1 715 -386 -3238 Warren 1 1067 107Th Ave. IM New Constnictim Use: A Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD I Replacement _j Public or commercial - Describe: Parent material Glacial Till Food plain elevation, if applicable na General comments and recommendations: Install mound system at elev. 100.27' at 6' above 99.77' contour. Boring # _j Boring 16 Pit Ground Surface elev. 99.85 ft. Depth to limiting factor — 35 _ — in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Ef1#1 'Eff#2 1 0 10yr4/3 none fsl 2fcr ds as 2f,lm 0.5 0.9 2 12 -28 10yr3/3 none sf 2fsbk dsh cW 2fm 0.5 0.9 3 28 -35 10yr5/4 none sl 2msbk dsh aw 1vf 0.5 0.9 4 35-58 10yr5/4 m3p 7.5yr5/8 sicl lcsbk mfr - - 0.2 0.3 a Boring # –j Boring Pit Ground Surface elev. 98.05 ft. Depth to limiting factor 42" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fts in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff1Q 1 0 -14 10yr4/3 none fsl 2fcr ds as 2f,1m 0.5 0.9 2 14-24 10yr3/3 none sf 2msbk dsh Cw 2fm 0.5 0.9 3 24-42 10yr5/4 none sl 1csbk dsh aw 1vf &f 0.4 0.6 4 42-68 7.5yr4/6 f2d 7.5yr5/8 strat. Ifs 1 csbk mvfr - - 0.4 0.6 • Effluent #1 = BOD 30 < 220 mg/L an TSS >30 < 150 mg/ Efft = BOD < 30 mg/L and TSS <_W mg/L CST Name (Please Print) ignature: CST Number James K. Thompson 3602 Address A.C.E. Soil & Site Evaluations Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola,*V 54020 8/132003 715- 248 -7767 Property Owner Don Bock Parcel ID # 042-1016 -40 -000 Page 2 of 3 3] Boring # --i Bing 01 Pit Ground Surface elev. 98.08 ft. Depth to limiting factor 39" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -12 10yr4/3 none fsl 2fcr ds as 2f,1m 0.5 0.9 2 12 -20 10yr312 none ( %I 2fsbk dsh CW 2fm 0.5 0.9 3 20-39 10yr4/4 none sil 2msbk dsh aw 1vf 0.5 0.8 4 39- 52 10y1514 f2d 7.5yr5/8 sil 1 csbk mfr cw - 0.2 0.3 5 52-61 7.5yr4/4 f2d 7.5yr5/8 scl 1 csbk mfi - 0.2 0.3 4] Boring # I Borin 0 Pit Ground Surface elev. 99.64 ft. Depth to limiting factor 39" Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GE /ft= in. Munsell Qu. Sz, Cont. Cob Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -11 10yr3/4 none fsl 2fcr ds as 2f,1m 0.5 0.9 2 11 -21 10yr5/4 none scl 2msbk dsh cw 2fm 0.4 0.6 3 21 -39 10yr4/6 none grIs 1msbk ds aw - 0.7 1.2 4 39 -54 10yr4/6 f2d 7.5yr5/8 gr Is 1 csbk mfr cw - 0.7 1.2 5 54-64 5yr4/4 f2d 7.5yr5/8 scl lthinpl mfi - 0.2 0.3 ❑ Boring # Borin Pit J Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I * Effluent #1 = BOD y > 30 c 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SEPTIC'TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM ( &;er Mailing Address U O � S C' J' Property Address (Verification required from Planning Department for new construction) City/State Parcel Identification Number Q `� - /0 I4:, o v v 0 LEGAL DESCRIPTION Property Location L_ '/4, J ' /., Sec. . T t N -R W. Town of Subdivision , Lot # Certified Survey Map # Z�7 D °' Volume 1,-2, - , . Page # 3 3 79 Warranty Deed # - ;�3 2 g 1 , Volume 2 33 1 , Page # 2 Spec house ❑ yes.0 no Lot lines identifiable 14 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 mastor plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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 days of the three year exp 'on date. a3 SIGl TORE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the perry described abo e, by virtue of a warranty deed recorded in Register of Deeds Office. f SI 04ATURE OF APPLICANT DATE ** * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** «« Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed J 2339P 124 732891 STATE BAR' OF WISCONSIN FORM 3 - 1998 KATHLEEN H. WALSH QUIT CLAIM DEED REGISTER OF DEEDS ST. CROIX CO., WI Doc11TBnt Number RECEIVED FOR RECORD This Deed, made between nb t _ and Tttri11 __ 07/30/2003 12:15PM Mello as joint tenants. QUIT CLAIM DEED EXEMPT v 8 Grantor, '! REC FEE: 11.00 and Donald C. and Tani M. Rnink as TRANS FEE: ioint tenants, COPY FEE: CC FEE: PAGES: 1 Grantee. Grantor quit claims to Grantee the following described real estate in St. Croix .County, State of Wisconsin: i; Recording Area Name and Return Address (� Lot's described on certified survey map filed �prtalcl t�. and _ants /✓ ecember 30, 1997, with the Register of Deeds, St. Croix 60 / r — 1j2. N o County, Wisconsin, and recorded as Volume 2, Page 3399._ Said lot is located in part of the SW 1/4 of the NE 1/4 �uG�Jolt� (c�,' Sy/p and part of the SE 1/4 of the NW 1/4 all in Section 7, Township 29 North, Range 18 West, Town of Warren, St. Croix County, Wisconsin, and said lot being 9.114 acres. OYa 0A -J/ mod Parcel Identification Number (PIN) This /V-C homestead property. (is) (is not) ('e,efrf r= r�Su.z�� x4p Vol la Page X399 7� ocuvltt'K.�' /UD- g7o53 9 Together with all appurtenant rights, title and interests. Dated this day of -3y (SEAL) L j/O (SEAL) (SEAL) (SEAL) Af AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, 1I C fo i k County. J authenticated this day of Personally came before me this 3U i day of Ju I U _, the above named ober4- L mr lin +- I tLt+: i te 0 M ello TITLE: MEMBER STATE BAR OF WISCONSIN to Of not, me known to be the person S who executed the foregoing authorized by §706.06, Wis. Slats.) instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY SF► r� i `s n A J. \ �o c c� 0 %td fQ �a� be /1 �O y 661 e- �R. /I� o B�Q,tf �'11Et3ry P tic. State of Wisconsin dt pUbiL Ission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not 9 j ✓�� l X00 ) necessary.) • Namas of persons signing in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. ft. QUIT CLAIM DEED FORM No. 3 - 1998 Miweukae, Nits. L s FILED D EC 3 0 1997 ► �� 5 7 053 9 5 KATHLEEN H. 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Z ° o Z r D CI M, o -n UNPLATTED LANDS = z � ----------------------------- r., ° � `� � 0 ' r < oho O w cnm . z O wQ`m Z;" o ( ''I 70 C ;0,:-;o m o -- I BEARINGS ARE REFERENCED T❑ THE WOE W - ° ru > v n ° = EAST - WEST 1/4 LINE OF SECTION +a (i czz C3 £ 7, ASSUMED TO BEAR N89'22'00'E £ate m Ln<a °w z on ru £ THIS INSTRUMENT DRAFTED BY ED FLANUM JOB NO. 97 -138 w Vol. 12 Pac_ -e 3399