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HomeMy WebLinkAbout042-1080-30-120 4!V County Sanitary Permit Application ST.CROIX COUNTY WISCONSIN Off Gp .0 in accord with Chapert 12 St.Croix County Sanitary Ordinance PLANNING&ZONING DEPARTMENT Personal information you provide may be used for secondary purposes ST.CROIX COUNTY GOVERNMENT CENTER [Privacy Law.S. 15.04(1)(m)] 1101 Carmichael Road j {►� �f°j® Hudson,WI 54016-7710 (715)386-4680 Fax(715)386-4686 A completeli whs for the system on paper not less than 8-1/2 x 11 inches in size. 0 ary Permit# ❑ Check if revision to previous application 2D4 1. Applicatidp tion-Please Print al formation Location: Property' ame_� L 21114 1/4,Sec o_,, � r tJ .11 N, R 19 E(or) Property Owner's Mailing Address t�, Lot Nugnber Block Number --- - ­73-7----t City,State Zip Code Phone Numer Subdivision Name or CSM Nu ber R W .�y a�3 &,5/- �N� - y�sq fb . 4 g 3 - , ii T e of Building: (check one) =ity ❑Village 5Uown of 1 or 2 Family Dwelling-No.of Bedrooms: ❑ Public/Commercial(describe use): L3 QAAP.►.e ❑ State-owned Nearest Road ll IL Type of Permit: (Check only one box on line A. Check box on line B if applicable) J d 7144 S ZJ �/ Parcel Tax Number(s) i A 1.9f Repair 2.❑ Reconnection ❑Non-plumbing 4.❑Rejuvenation Q So -3o ^ 126 ' Sanitation / Permit Number Date Issued _ ,e'► B) State Sanitary Permit was previously issued Af&3 44 9(/`F 5,- d�'J 0,0 IV.Type of POWT System: (Check all that apply) ❑ Non-pressurized In-ground 1$ Mound z 24 in.suitable soil ❑ Mound 5 24 in.suitable soil ❑ Mound A+0 ❑ Sand Filter ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line ❑ Pressurized In-ground ❑ Holding Tank ❑ Single Pass ❑ Other ❑ At-grade ❑ Aerobic Treatment Unit ❑ Recirculating V.Dispersal/Treatment Area Information: ` 1. Design Flow(gpd) 2.Dispersal Area 3. bispersalfArea 4.Soil A*icafion Rate 5.Percolation Rate 6.System Elevation 7.Final Grade Required Proposed (Gals./day/sq.ft.) (Min./inch) Elevation VI. Tank Information Capaicty in Gallons Total #of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks /J-4v / [9'- ❑ ❑ ❑ ❑ 900 a VII. Responsibility Statement I,the undersigned,assume responsibility for repair/reconnenction/rejuvenation/installation of non-plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the installation of non-plumbing sanitation system. Plumber's Name(print) Plumber's Signature(no stamps): MP/MPRS No. Business Phone Number L-�Ai;-MA A16< 14 v aLc LZ ' A2'7 Z f o "7f S^ 7 4 ✓ g vZ Plumber's Addr ss(Street,City,State,Zip Code) ct(.? L 65 k _ 4J VIII. County Use Only Di roved Sanitary Permit Fee D e Iss ed Issuing ent Sign ture o s s) Approved Owner Gi nil i verse � ZZ C �� // J rnation `J IX.Conditions of Approval/Reasons for Disapproval: (� JA Wisconsin Department of Commerce Cou PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division Sanitary Permit No: - IPA h INSPECTION REPORT 463496 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Peterson, Jim I Warren, Town of 042 - 1080 -30 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: /Dfl 1 9 r A t 29.29.18.457B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 5 Z iob .s /67) Septic Benchmark S. 95 le-r4 Dosing Alt. BM c C 64 N, S; �; 3 .� 7 ✓a� . � Aeration A7— /O � `� Bldg. Sewer J3 • 1 `13.3{ Holding St/Ht Inlet 13 . q 3 . / c t TANK SETBACK INFORMATION SUHt Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet _ Septic -r13 1 725 Dt Bottom Dosing r 2 � ZS $ �$ Header /Man. 5 L Aeration -I J Dist. Pipe 5 Z c /0 Z Holding Bot. System (, .O Jb0 •S Final Grade PUMP /SIPHON INFORMATION �r LS z, Z Manufacturer Demand St Cover 26ji 11 // ems- GPM I � � (p .95 I c T. ' Model Number Z— ?� >� J .,.�-o J r S.9 5 /OZ TDH Lift Friction Loss System Head TDH Ft /�� 32 Z. a l 2-S /5,'93 Forcemain Length I Dia.,i I Dist. to well 73 Z - 7 25 SOIL ABSORPTION SYSTEM BED/TRENCH Width 1 Length / No. Of nches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 8 8 e ---- —_ SETBACK SYSTEM TO c � P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type mo tem: l L I Z ' /615' UNIT Model Number: J V-4 DISTRIBUTION SYSTEM Header /Manifold J t J Distribution I I I / x Hole Size x Hole Spacing Ve to Air take / �2 Pipes) f `� J Length Dia Length Dia l Z Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over I Depth Over xx Depth of ,-1 xx Seeded /Sodded xx Mulche Bed/Trench Center 1 J Z Bed/Trench Edges Topsoil 1 1�4� � 6 �_ 11 Yes (1 No s I _ I No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / O Inspection #2: / 7 GL� Location: 737 107th Str et Roberts, WI 54023 (G 't Lot 2 29 T29N R18W) NA Lot 2 G �` ` "`'� ' Parcel No: 29.29.18.457B t J lr L o c � 6 1.) Alt BM Description =� ` G 1n � 5 0 v 2.) Bldg sewer length - amount of cover = i 1 6 Plan revision Required? I _I Yes No Use other side for additional informat n. Date Insepcto Signat Cart. No. SBD -6710 (R.3/97) l r � Safety and Buildings Division County 1 pi r, 201 W. Washington Ave., P.O. Box 7162 sconsin Madison, WI 53707 — 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 -3151 Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide 0 I q I ► wy ` J+�# may be used for secondary purposes Privacy Law, s15.04(1)(in) Project Address (if different than mailing ddress) I. Application Information — Please Print All Information Pro a Owner's N e Par Lot # Block # U, 1 O Z Property Owner's Mailing Address Property Lo n Ave, ")/­� ST. CROIX COUNT� _ ; ONING OFFICE City, State '/<, '/., Section _� Zi `� � J V ,, I V /� /� }� 1 p Code 7^� Phone Number 3+' 1 ] 56 I V � TN; RE of W J II. Type of Building (check all that apply) l�.h trcl �/ E blic/Commercial "2 Family Dwelling — Number of Bedrooms 4 — �Y� Subdivision Name CSM Number — Describe Use a q — a g r C. = (gyp + 1'�4. ❑ State Owned — Describe Use / ❑City_ ❑village ownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A, New S stem y El Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System B. ❑ Permit Renewal Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Typ of POWTS System: Check all that appl ❑ Non — Pressurized hi- Ground ❑ Mound > 24 in. of suitable soil ound < 24 in. of suita soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand / Filter ❑ L Recirculating Synthetic Media Filter ❑Leaching Chamber ❑ ❑ ❑. Drip Line Gravel -less Pipe Other (explain) C r / �Q �� V. Dispersal/Treatment Area Information: (� • Z- Design Flow (gpd) Design Soil Application te(gpdsf) Dispersal Area Required (sf) Dispersal Area Propose f) System Elevation 7 ✓ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks U (• Septic or Holding Tank ' Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name rint) Plum i r _ MP/MPRS Number Business P one Number Plumber's Address (Street, yy, State, Zip Code) l W VIII, oun / De artment Us64uly Approved Isapproved �fbrDn Sanitary Permit Fee includes Groundwater Da Issued Issuing t Signature (N Surcharge Fee) O E01 n Rea IX. Conditions of Approval/Reasons for Disapproval \ /� SYSTEM OWNER: 3 \ kkk 5"Mc� � q, "N 1. Septic tank, effluent filter and J dispersal cell must all be services / maintained /ltirt jtti as per management plan provided by plumber. (� CA` ✓ be momWW 2. All rW m ordinmors. � � � �t51c�Gr`tQ... !'S GLot.J Attach complete plans (to the County only) for the system on a e not less t 81/2 x 11 Inches i slze Go d CNN S - 8 R.01 /03) I 1 c� X1-2 -1 � `8 O . � o c� Q �. . • � z,s� 1, n. j � LC a,a� 4 1 ( f z " C � + vvc CA --- � � ff 0 �Q.0 a �g p f� `� \�• � � o� , c�� w to vt2 0 Y IJ �I U �xa 2- SCI o e� e,., I r-44 o g Safety and Buildings CO commerce .Wl.gov LA CROSSE WI 54601-1831 TDD #: (608) 264 -8777 isconsin www.w w ww.coe.wi.gov/s sin.go / iscosin.gov Department of Commerce Jim Doyle, Governor Mary P. Burke, Secretary August 04, 2005 CUST ID No.222774 ATTN. POWTS Inspector HENRY F GROTE ZONING OFFICE CERTIFIED SOIL TESTING ST CROIX COUNTY SPIA E4366 353RD AVE 1101 CARMICHAEL RD MENOMONIE WI 54751 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/04/2007 Identification Numbers Transaction ID No. 1161989 SITE: Site ID No. 698206 Jim Peterson Please refer to both identification numbers, 107th Street above, in all correspondence with theagency. Town of Warren St Croix County Government Lot 2, S29, T29N, R18W FOR: Description: Proposed Four Bedroom Mound System - Revision Object Type: POWTS Component Manual Regulated Object ID No.: 1017429 Revision; Maintenance required; 600 GPD Flow rate; 32 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01/01), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 /01); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The approved changes will become an addendum to the plans that were previously approved on May 16, 2005. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD - 10691- P(N.01 /01). • The pressure network is to be constructed in accordance with publications SBD- 10706- P(NO1 /01) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems - Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81)". • 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 POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the fil r �i; d- Access to the filter for cleaning must be provided, per Comm 84 product approval con irits6 ;�� � 1-1 P P 1 RD V E Dk DEPARTMENT CIF rnkA.mrL>rc t HENRY F GROTE Page 2 8/4/2005 • Comm 83.22(7) A copy of the approved plans specifications and this letter shall be on -site during co nstruction and open to inspection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 75.00 Fee Received $ 75.00 Balance Due $ 0.00 Gerard M. Swim POWTS Plan Reviewer - Integrated Services WSMART code: 7633 (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm j swim @commerce. state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 Michael P Rogers, Rogers Plumbing (Plans Mailed To) Jim Peterson - Mound Revision to Trans # 1135007, Site # 698206 Construction Materials and Techniques All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. Construction methods must comply with the following Component Manuals: Mound, SBD - 10691 -P (01 /01) Pressure Distribution, SBD 10706 - P (01 /01) Location: GL 2, Sec. 29, T 29 N, R 18 W Town: Warren County: St. Croix Date: August 4, 2005 Owner: Jim Peterson Address: 2082 Carroll Ave. `� i i i I ST. Paul, MN 55104 ® /V Designer: Henry Grote HENRY F. _. *= � I GROTE =1699 — Signature: OMONIE: — Wis. License: WI D — 1699 -007 Attachments: SBD -10577 - Plan Approval Application SBD -8330 Page l: cover 2: design criteria & calculations 3: plot plan 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail 7: pump curve 8: system management S i=ETY AND BJILDJNGS page 1 of 8 SEE CORRES N©ENCE Design Criteria k �'S Residential Wastewater Contaminant Load: 30 mg/L < BOD < 220 mg/L Anticipated septic tank effluent 30 mg /L < TSS < 150mg/L Fecal Coliform > 10,000 cfu/100 mL Fats, oils, grease < 30 mg/L 4 ' Bedrooms x 100 gal/bedroom/day x 1.5 gallons /day hydraulic load Des' ns In situ designed loading rate gallons /sq. ft. per day Depth to estimated high ground water in. Depth to bedrock b in. Cross slope at system % ^^ Force main length 4� ft. of Z in. Manifold/header length 4 ft. of Z in. Drain -back ° gallons Lateral length @ �� ft. of Z in. Lateral elevation O1 O ft. @ bottom of lateral Lateral hole size ��I� in. @ 3 in. c> ft.) Spacing � _L holes /lateral Z holes total Lateral volume 3 • "d gallons i Total lateral discharge rate gallons /minute @ 2 ft. head Network pressure compensation losses ` � � ft. Elevation difference Friction loss 2 , t ft. @ S gallons /minute Total dynamic head ft. Pump /si�lon �A gpm @ Z ° ft. of head Manufacturer ° e- ` l °'Y Model # Z Dose volume `lb��Z gallons Lift/sip'lion tank Ca M-o _S ° g allons Septic tank ZS"b gallons Effluent filter 0.� vtij O a„ c-o i o $ tz _ �4 QQ f1 Measurement pump on and off ° o in. Height alarm from tank bottom 1 in. Reserve capacity gallons specs. calcs.res Page Z of 4 2 � 1 � � .. . .._ _�.....- . {. ... ._ 1 � �!3 w h •, � 0.v v �� 0.t c9010 ..... ...__._.... 4 co 53 1 S S cl. 40 �o e -4 L� 5:l) 4. z � J C6 lop Z o �; �•� ; fig s,3� Cq��b) � �-fv c zt-L 3 deck `t-d( S 6 t C��ve 46Lt w..A, b S ° ZeL�ati� N OTC, Ne eaA11 ` dH kw, �o" 0.7 3' Y � I � T �cl O z l O . 4� �-- 4 � U ..� � v C o \o S a v ... �: o y �,. al 1 � i b • � � o ... o � r o c. k `o L �.T C2he� VeA f 40 II 1 1 z Q t om`, S \ op t / / r 4 , D I T o f T Q- • �'�� o\ OL S J � J\ y Qom+ � ct i .Ai+ o..� `-' Z � o \ c � 'Y O - Y `�• � MNir� TVA Il.. WEAT►I ERPROOF j .j1.JNtT10N — LOCKING COVER 6cac ulw.. -YN hud 4 ABED . GLICK G�acor�iG�' --� r 7 � � a•e °�c P i o n 7 1b TuRbE D owm SO) 24u %.D. KA,NU = vE qT g` / 4" r A 3d � Har pWQ.avtD a CfLSKET 3ONT'J 1 S`1, BAFFLE 1A� RLL. P �s1 3' o• P in - a 2 ., &Qrw E CT I O ?i4 l}a ()N J UKLIITU[� Rouµo o occ PuRp C �w, BcOCK .a SEPTIC t _PECIFI o 005E TANKS MA►JUFACTURER: IJUMIBER OF DOSES: Z ' PER DAB TA.WK SIZE GALLOWS DOSE VOLUME S� INCLUDING O F1a��r ACKFLOW: ALARM /'lM1UFACTURCR GA��ONS MODEL IJUMbCR: 1 ° 1 �``' � }$3 , to CAPACITIES: A= �°`° WCHC5 Oa C-ALLoi�S SWITCH TyPL: — wa.+�. v..v "�6 IL-z PUMP MAQU FACT URCR: �oQ' L\e'r Q(,-4-Z C ■ � iUCHES OR A ..OUS MODEL QUMOEK, �' p■ 9 INCHES OR 145', Q SA,..Cti� JWITCH TYPE: � 611 `„�� IJOTE: PUMP AWD ALARM ARE TO 6L MIAJIMUM DISCKAR" RATE _GPM ` INSTALLED OW 5EPARATE CIRCL.7S VERTICAL DIFFERENCE OETWCCU PUKP OFF MJD DISTRIDUTIOW PIPE.. FEET I + m INJETWORK SUPPLY PKt&SLIKE 2. g, FCCT�'�"S� + FEET OF FORCE !'AIM X z� FT✓ loo►'<FRICTIOU FACYOR. `' FEET TOTAL Dtl HEAD = � Z FEET Qo IWTERIkJAL. DIMEW61OWi OF TAWK: LEWC,TH `.zl L 9" ;WIDTH .; LIQUID DEPTH r TOTAL DYNAMIC HEAd /CAPACITY HEAD CAPACITY CURVE PER MINUTE EFFLUENT AND DEWATERING N MODEL 152/153 W w MODEL 152 I 153 50 Feel Meters Col. Liters Go! . Liters 153 5 1.5 1 69 , 261 77 ! 291 12 40 152 10 3.1 1 61 1 23t 1 70 265 0 15 4.6 53 201 61 231 30 20 6.1 44 1 167 52 197 z 8 - 25 7.6 34 r 129 1 42 5y 0 30 9.1 23 87 20 35 10.7 -- -- 22 5 5 40 12.2 -- -- �2 4 10 Lock Volv 138.0 Ft. (11 6 p r, 3 4-\, 0 20 40 60 80 100 GALLONS LITERS 0 80 160 240 320 I� ° y. 3 21132 a 5 /8 FLOW PER MINUTE -- -- -� CONSULT FACTORY FOR SPECIAL APPLICATIONS T -3 • Timed dosing panels available. � • Electrical alternators, for duplex systems, are available and supplied with an alarm. Variable level control switches are available for controlling single phase systems. Double piggyback variable level float switches are available for variable level long and short cycle controls. -� -- Sealed Qwik -Box available for'outdoor installations. See FM1420. Over 130 °F. (54 °C.) special quotation required. 1521153 Series 12 /a —__ 152I153 MODELS Control Selection r Model —_ Voits -Ph Mode Amos Simplex Du lex N152 115 1 Non 8.5 1 2 or 3 = BN 152152_ 115 1 Auto 8.5 Included 2 or 3 s __E __230 1 Non 4.3 1 2 w 3 - -'�_ � BE 152 2 Auto 4.3 Included 2 or 3 N153 1 i 5 1 on 10.5 1 2 or 3 BN153' 115 1 Auto 10.5 included 2 or 3 SELECTION GUIDE E t 53 Y 230 1 Non 5.3 1 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float ^ BE 153 230 1 Auto 5.3 Included 2 w 3 switch. Refer to FMO477. o CAUTION 2. See FM0712 for correct model of Electrical Altemator E -Pak. All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10 - 0225 used as a control activator, specify duplex (3) licensed electrician. All electrical and safety codes should be followed Including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA), or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0: P.O. BOX 16347 Louisville SHIP TO: 349 Cane Run Road , KY 40256-0347 6 Manulacturers of. . Louisv8le, KY 40211.1961 QUAL/rY PUMPS SNCf 1,9,78 http: / /www.zoeller.com PUMP l i p 02) 778.2731. 1(800) 928 -PUMP FAX (502) 774.3624 0 Copyright 2000 Zoeller Co. All rights reserved. I - .. System Management Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber, Rogers Plumbing, 715 -235- 1 132, or the St. Croix County Zoning Office, 715- 386 -4680, should be contacted for assistance. General Proper functioning of an on -site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a dose tank or compartment to allow a dose to be accumulated, a pump and controls or automatic siphon, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. 1. If the septic tank is installed prior to sheet -rock and/or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. 2. Install water - saving appliances whenever and wherever possible. 1 Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic or dose tanks are no longer used, they must be properly abandoned. 11. If construction timing and weather could create a frozen infiltration system, weather - proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start-up. 12. If possible, the upslope toe of the mound system should be landscaped with additional fill to blend this area into the upslope natural grade; this will minimize the possibility of the system trapping surface run - off final settled slope should be 2 -3% over the system or 2 -3% diverting surface run -off around the ends of the system. Maintenance 1. The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. When the septic tank is pumped, any solids in the bottom of the dose tank must be pumped, and the filter must be back - washed into the septic tank to remove accumulated material. System use may require more frequent filter cleaning; initial inspections of the filter should be made every 6 months until a minimum time sequence is determined. 4. Periodic observation pipe inspections should be made by the owner to examine the state of the in -situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. 5. if this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Avoid compaction such as vehicle traffic within 15' down -slope of the adsorption system. 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run -off into the system area. I 1. Warning: Do not enter septic, dose or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and /or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 Private On -Site Wastewater Treatment System ( POWTS) Index & Title Sheet Owner: r '�Q,1',5 Project Name and System Type: �- �� p r. Location: I S `) ) C) eet Address U e" 6 Leg 1 Description /3— Township /County Contents: Page 1: Sanitary Permit Application Page 2: Plot Plan Page 3: Soil Test Page 4: State Approved Plans Page 5: Septic Tank Maintenance Agreement Page 6: Warranty Deed Page 7: POWTS Owner's Manual Management Plan Page 8: POWTS Owner's Manual Management Plan Page 9: POWTS Owner's Manual Management Plan Page 10: Certified Survey Map Page 11: Copy of House Plans Attachments: Plumber/Designer: Mike Rogers Signed: Credential Number: 225094 Date: POWTS OWNER'S MANUAL MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity gal ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS ` Effluent Filter Manufacturer ❑ NA Number of Bedrooms 100gpd/bedroom ❑ NA Effluent Filter Model ❑ NA Number of Commercial Units NA Pump Tank Capacity J gal ❑ NA Estimated flow (average)* gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), estimated x 1.5* al/day Manufacturer ❑ NA Soil Application Rate ga l/d a Pump Model ❑ NA y Pretreatment Unit ❑ NA Influent/Effluent Quality (NA13) Monthly Average ** ❑ Sand/Gravel Filter ❑ Peat Filter Fats. Oil & Grease (FOG) c 30 mgt ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODs) El Disinfection ❑ Other: Total Suspended Solids (TSS) 5 220 mg/L < 250 mgt Manufacturer: Model: Pretreated Effluent uali Monthly Aver Dispersal Cell(s) Q � ❑ y g a * ** [I In-ground (gravity) E3 In-ground (pressurized) Biochemical Oxygen Demand (BODs) S 30 mg/L Total Suspended Solids (TSS) c3 At -grade `Mound 5 30 m [3 Drip-line E3 Other: Fecal Coliform (geometric mean) �' <10 cfu/100m1 ❑ Leaching Chamber Manufacturer Maximum. Effluent Particle Size 1/8 inch diameter Model Approval Stipulation *Wastewater Flow Verification on and calculations: Soil Application Rate Area Req. e (Other than bedroom based) Absorption Area Credit per unit fi Minimum Number of Chambers ❑ Aggregate Design Flow/Loading Rate= min ** Values typical for domestic (non - commercial wastewater Materials: all materials must comply with WI Adm. Code and septic tank effluent. COMM84 and be installed per manufacturers specifications ** *Values typical for pretreated wastewater. and approval letters. DESIGN CRITERIA ❑ "Wisconsin At -grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et al.1990) ❑ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. Publication 15.22 ❑ . "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publications 9.6 "Design of Conventional Soil Absorption Trenches and Beds ". R.J. Otis — ASAE Publications 5 -77 and "Design Manual — Onsite Wastewater Treatment and Disposal Systems ". EPA 625/1 -80 -012 October 1980 SBD — 10570 —P (8.6/99) "At -Grade Component Manual Using Pressure Distribution" SBD — 10567 P 99 " Ground r_3 (R.6/ } In and Component Manual " ❑ SBD _ - 10705 —P (N.01101) "In Ground Soil Absorption Component Manual" Version 2.0 ❑ SBD 10628 —P (N.6199) "Recirculating Sand Filter System Component Manual" p SBD 10656 —P (N.6199) "Split Bed Recirculating Sand Filter System Component Manual" ❑ SBD - 10572. P (8.6/99) "Mound Component Manual" SBD - 10691P (N.01101) "Mound Component Manual" Version 2.0 ❑ SBD 10595 —P (8.6/99) "Single Pass Sand Filter Component Manual" ❑ SBD - 10657—P (8.6/99) "Drip -line Effluent Disposal Component Manual" KS [3BD - 10573 —P (R 6/99) "Pressure Distribution Component Manual" BD 10706 —P (N.01101) "Pressure Distribution Component Manual" Version 2.0 p-line Effluent Dispersal Component Manual for Multi-flo Onsite Wastewater Treatment Units MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months ❑ year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one -third (1/3) of tank volume Inspect dispersal cell(s) At least once every ❑ months tear(s) ear(s) (Maximum 3 yrs.) Clean effluentfllter At least once every [3 months ear(s) Inspect pump, pump controls & alarm At least once every [3 months ❑ NA Flush laterals and pressure test At least once every 3 ❑ months ears) ❑ NA Valves At least once every r Col months earls) ❑ NA Other: At least once every ❑ months to year(s) NA Page of I START UP For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water - saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Mote: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only P Pte' a that should be discharged into the system. Other non - biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. Ives Valves shall be operated in the following manner: arms Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back -up of sewage into the dwelling or surfacing. INPECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). eptic Tanks Component c o broken hardware identify an cracks identify an missi r b o Tank inspections must include a visual inspection of the tank to fy y g � �Y Y or leaks, measure the volume of combined sludge and scum and to check for any backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one -third (1/3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Chapter NR113, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. \ `ump Chamber/Treatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of the filter. Any service needs or repairs shall be promptly taken care of. In- Ground Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for y evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory r than 75% of the height of the component may n ' at depths ate Y indicate overloading or impending authority. Po dmg p gre ater � P hydraulic failure necessitating more frequent monitoring. Page of � ound, At- Grade, In- Ground Pressure The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. COMM 83.33, Wisconsin Administrative Code. - All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. - The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. - After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or other inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: E3 A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. p A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed a last resort to replace the failed POWTS. Mound and at grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. « WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone Phone SEPTAGE SERVICING OPERATOR (Pumper) LOCAL REGULATORY AUTHORITY Name Agency Phone Phone K:IWPAATAIEH\POWTS OWNER'S MANUAL.doe Page of Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 it's onsin Madison, W1 53707 — 7162 Sanitary ermit Number (to be filled in by Co.) Department of Commerce (608) 266 -3151 3 Sanitary Permit Application I.D. N tuber In accord with Comm 83.21, Wis. Adm. Code, personal information you provid M A Y may be used for secondary purposes Privacy Law, s I5.04(l)(m) Y 1 yro' dr ing address) 1. Application Information — Please Print All Information T CR01 7 ON N Property Owner's Name Lot # Block 4 6y) 4�- Property Owner's Marling Address ro ty Location Zucro I I City, State Zip Code Phone Number ' / <, ' / <, Section irc cle Ul T N; R�E 11. type of Building (che that apply) ^6 5 ; � or 2 Family Dwelling — Num, of Bedrooms a r 0 Public /Commercial — Describe Use o f` re C� & r= $Vf' � \ ❑ State Owned — Describe Use ❑City_ ❑village �bwnship of 1 10 III. Type of Permit; (Check only one b on line A. Complete line B if ap cable) A, ew System ❑ Replacement Sy m ❑ Treatment/Holding T Replacement Only ❑ Other Modification to Existing System B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration umber Owner IV.TypeufPOWTS S stem: Check all that apply) 2 'X + 6'V _t &we IMs WO ❑ Non — Pressurized In- Ground ❑ Mound > 24 in. of suitabX und <24 in. of suitable soil ❑ At -Grade El Single Pass Sand Filter ❑ Constructed Wetland ❑Pressurized In- Ground El Holdint Filtererobic Treatment Unit ❑Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter 11 Leaching Chamb ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (spd) .Design Soil Application Rate(gpdsf) Dispersal Are equired (sf) Dispersal Area Proposed (sf) System Elevation cl VI. Tank Info Capacity in Total fumber M facturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units � � g� �' aim, Concrete Constructed Glass New Existing Tanks Tanks Septic or Bolding Tank ; Aerobic Treatment Unit S Dosing Chamber t t+- 1 t VII. Responsibility Statement 1, the uViersigned, assume r_gsponsibilj installation of the kWTS shown on the attached plans. Pltnllber'sName ( P MP/MPRS Nu Business Phone Number + 1 t Plumber's Address (Street, ity, Stat E�A 1 51 VIII. Conn /Ile artment W Jkl g Approved ❑ Sanitary Permit F (includes Groundwater Date Issu Issuing Ag Signature Stamps) Surcharge Fee����� 110 wner Give Reason fo enia] S IX. Conditions of ApproyaWeasous for Disapproval 3 , O SYSTEM OWNER: n J J 1 1 Septic tank, effluent filter and p c:t l C4 . (�1C t5 V"�a dispersal cell must all be serviced I maintained as per management plan provided by plumber. �e�ntl7��`✓� 2. All All setback requirements must be maintained as per applicable codelordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01 /03) tnncu aie�tQ . 11 4,z� As C � Sm• J7 �`� (.O.. � _ -• �` � X0-`2 1 � ' _ }��° W Yak 1p�'.ov N � e-Al \� , vet o w ` u O G Z�z Kevin Grabau From: Swim, Jerry oswim @commerce.state.wi.us] Sent: Monday, May 23, 2005 9:37 AM To: Kevin Grabau Subject: RE: drip line design question btzhsepa.gif Network Blitz Bkgrd.gif Hi Kevin, - Good questions: 1. The dripline elevation of 99.5' is universal throughout the system. In addition, Henry is proposing to use pressure compensating emitters. These emit the same flow rate no matter if there is any elevation difference in the dripline or not. This makes it easier for both you, me and the installer. This type of emitter is more expensive but it certainly is worth the extra cost in my eyes. 2. You are correct in your second thought also. Henry has a pretty good spread sheet to help you figure things out. One of the items on page 2 of 15 is the total length of the dripline. When you don't review too many of them, his spread sheet and the manual together allows you to figure out key items. His figures support a .3125 gpd /sf; (960 total dripline length /80 = 12 lines that are 2' apart. He could use a higher soil loading rate (.7 gpd /sf) since he using proposing pretreatment, but he elected to play it safe and use .3125 gpd /sf. Please let me know if you have additional questions. Thanks! Jerry - - - -- Original Message---- - From: Kevin Grabau [ mailto :KevinG @CO.Saint- Croix.WI.US] Sent: Friday, May 20, 2005 10:40 AM To: jswim @commerce.state.wi.us Subject: drip line design question Hello Jerry, I am reviewing the application for a drip line system. The Transaction 1135007. My question: This system is using pressure compensating emitters. Is this system using a universal system elevation of 99.5, or is the system elevations different since there is a slight slope to the site. I just want to make sure we are ready for the inspection and understand the design. Also, there are two zones, each consisting of 480' of drip line. Since 1 we have two zones, then we have 960' total drip line. Is this system then using a two foot cell width to bring the total square feet to 1920 I thinks so, but this is the first drip design I have seen, and I just lent my drip line design book to another plumber! Thanks for your help. Have a great day. Kevin Grabau St. Croix County Zoning Department 1101 Carmichael Rd Hudson, WI 54016 715.386.4680 keving@co.saint- croix.wi.us Zoning Department Web Page < http: / /www.co. saint - croix.wi.us /Departments /Zoning /default.htm <http: / /www.co. saint - croix.wi.us/ Departments /Zoning /default.htm> > 2 Safety and Buildings commerce.wi. OV 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 isconsin www.commer i s co sin.go www.wisconsin.gov Department of Commerce Jim Doyle, Governor Mary P. Burke, Secretary May 16, 2005 CUST ID No.222774 ATTN: POWTS Inspector HENRY F GROTE ZONING OFFICE CERTIFIED SOIL TESTING ST CROIX COUNTY SPIA E4366 353RD AVE 1101 CARMICHAEL RD MENOMONIE WI 54751 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/16/2007 Identification Numbers Transaction ID No. 1135007 SITE: Site ID No. 698206 Jim Peterson Please refer to both identification numbers, 107th Street above, in all correspondence with the agency. Town of Warren St Croix County Government Lot 2, S29, T29N, R18W FOR: Description: Proposed Four Bedroom POWTS w/a pretreatment unit and drip -line dispersal Object Type: POWTS Component Manual Regulated Object ID No.: 1017429 Maintenance required; 600 GPD Flow rate; 32 in Soil minimum depth to limiting factor from original grade System(s): Drip -Line Dispersal Component Manual SBD- 10657 -P (N.6/99), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 /01); Aerobic Treatment Unit, Biofilter 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. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following prior to occupancy or use: conditions shall be met during construction or installation and o g 8 p P Y • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Drip -Line Effluent Dispersal Component Manual for Private Onsite Wastewater Treatment Systems" SBD - 10657-P (N.6/99). • The pressure network is system is to be constructed and located in accordance with the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems Version 2.0" SBD- 10706 -P (N.01 /01). • The pretreatment unit must be installed in accordance with the manufacturer's printed instructions, the plan approval and Comm 83, Wis. Adm. Code requirements. If there is a conflict between the manufacturer's instructions and the plan approval, the plan approval and code requirements will take precedence. • Comm 83.52(3), Wis. Adm. Code The activities relating to evaluation and monitoring POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • Comm 83.21(2)(c)5, Wis. Adm. Code The application for sanitary permit shall be accompanied by documentation indicating that all items requiring maintenance of 12 months or less have been recorded with the deed for the property. If there is no evidence this has been done, the sanitary permit can not be issued. • 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. i? Q.W.T.S. Conditionally APPRnlirn HENRY F GROTE Page 2 5/16/2005 • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • The dosin-e sequencing- shall be field calibrated to ensure that the system dose and timer settings are accurate. • Comm 83.22(7) - A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 &406_� Fee Received $ 175.00 Balance Due $ 0.00 Gerard M. Swim POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm WiSMART code: 7633 jswim @commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 • Jim Peterson — Drip Dispersal System Construction Materials and Techniques All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. Construction methods must comply with the following Component Manuals: Drip Dispersal, SBD- 10657 -P (6/99) Pressure Distribution, SBD- 10706 -P (01/01) Location: GL 2, Sec. 29, T 29 N, R 18 W Town: Warren County: St. Croix RECEIVED Date: April 18, 2005 MAY 0 5 2005 Owner: Jim Peterson SAFETY & BUILDINGS Address: 2082 Carroll Ave. St. Paul, MN 55104 Designer: Henry Grote HENRY F. GROTE :* D -1699 Signature: NOMONIE WIS. License: WI D- 14-007 46 11111 Attachments: SBD -10577 - Plan Approval Application SBD -8330 Page 1: cover 10: filter specifications 2: design criteria & calculations 11: filter install detail 3: drip system spread -sheet calculations 12: control panel detail + 4: plot plan 13: Head loss chart 5: plan view, drip lateral detail, typical 14: general system management 6: drip cross section, typical 15: system specific management 7: pump tank exit detail 8: pump specifications 9: pump curve page 1 of 15 DEPARTMENT OF COMMERCE DIVISIO SAE U A D BUILDINGS S E .ORRES NDENCE Design Criteria ` LS Residential Wastewater Contaminant Load: 30 mg/L < BOD5 < 220 mg/L Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L Fecal Coliform > 10,000 cfu/100 mL v Treated Residential W m < B D Wastewater Contaminant Load: 30 mg/L BO D5 Septic tank + "highly treated" effluent 30 mg/L < TSS Fecal Coliform < 10,000 cfu/100 mL Bedrooms x 100 gal/bedroom/day x 1.5 u-o gallons /day hydraulic load Design Calculations In situ designed loading rate gallons /sq. ft. per day Depth to estimated high ground water in. Depth to bedrock in. Cross slope at system b �� % h Supply line length 4 Z- ft. of in. Return line length 3 ft. of in. Drain -back gallons Total drip line length ft. of \ �Z in. Drip line manufacturer �' R �¢, t-4, Drip system model Emitter type Number of emitters -- L- o e.. Flow rate per emitter gallons/hour Total discharge rate gallons /minute o e Minimum calculated flow gallons /minute 0 Total developed system head 4'�.� ft. Pump 9 gpm @ 2 � � ft. of head Manufacturer e.-4 O Model # 7 Dose volume gallons Septic tank gallons/ ATU treatment tank gallons ATU manufacturer C o Model # Pump tank � " gallons Measurement pump on and off 2 o inches Drip.specs.calcs Page �, of i 05/16/2005 07:08 FAX 715 233 0398 Certified Soil Testing LaX Commerce 121 003 Drip Calcs, Peterson Dose Volume Description Length Diameter Void volume Total _ ft in gal/ft gal # Number of laterals 3 Lateral length (not in void calc) 160 0.5 0.01 1.6 Drip line le ngth = # laterals x length 480 0.5 0.010 4.8 dist end - pressure tubing 15 0.5 0.010 0.15 Supply end - 6 0.5 0.010 0.06 Drip system void 5.01 Minimum dose - 6 x void 30.06 Supply manifold, from control unit (Z 2) 42 1 0.041 1.722 Ret ma nifold, to control unit Z 2) 93 1 0.041 3.813 Filter volume, 22 cubic inches 0.0952 1 gal_- 231 cu in Farce main if present 0 Total dose (minimum required) 36.6902 gallons Cycle Calculations # Emitters flow /emitter flow flow al /hr gal/hr gal/min Lat len / 2 = # emitters per lateral 80 0.611 48.8 0,813 Drip length /2 = # emitters 2401 0.61 146.4 2.440 Return flush flow = # laterals x 2 gal/min 6.000 Total flow 8.440 Cycle length (min) = dose /flow 14.63 minutes -T Head loss @ 8.440 gal /min Length Diameter Loss /ft Loss ft in ft ft Drip system, longest lateral @ 16" 160 0.5 16.0 * Manufacturer specification Longest lateral wl no manuf spec 0.5 0.0 use if manuf spec loss /ft = 0 Hydraulic unit loss @ 9 gpm 7.0 Supply manifold @ 8.44 gpm 42 1 0.0543 2,2806 PSI Filter (0.6 psi *) i 1.386 0.6 _1 psi = 2.31 ft Force main 0 0 0 Head: pump to control unit 6 Head: control unit to far supply end 4.5 Head: lateral distal minimum 0.1 Subtotal, system head 37.2666 System losses (30 %) 11.17998 Total head loss (ft) 48.45 feet Total head loss (psi) = ft/2.31 20.97 psi 0 � l,va X - i� `� O � c�o� ' (qa� 2� 4L as / z si A ve, T I _ e o 1 �ri m w•7ro �.. 4 — I� z M�� �� \;..4 OC W;s. lOr- al o� b U (S -t u, i o o So o� l J o I t C s � Y 1 � � of I• � a x v °CA d J d_ f � J � ♦ d J � � �,, r L 2 -} � i t i i � d f a 's 2 d qo E--- i4 f } r n xvF t r kNOTOR .p NPT Bypass Min Unit Motor PEA Check Disch Intake Orifice Liquid Length Length Length Valve Conn Height Height Level e I H P A B C D E F G M c r r T E P 1 2.50 1 1 5 88 53 1 3 41 3 9 1 00 12 03 20 69 20 00 TEP -50 -230 x. 88 33 13 41 3 � 1 1 00 12 03 u _ 20 69 20 00 TEP12 -75 -230 ?e ^ 66 15 66 3 94 00 3 16 24 07 22 00 a2 ;. i r EP 12 100 - 230 1 6G 5 7 91 3 94 1 00 14 25 27 - 1 24 00 EP2v -50 -115 d8 53 41 3 94 1 25 12 03 20 69 20 00° TEE ti P20 50 -230 _ 88 53 13 11 3 94 1 25 12 03 20 69 20 00 s { FT � ` k TEP20 -75 -230 66 16 41 ; 94 1 25 13 16 24 82 22 00 7EP20 -106 -230 1 10 11 75 18 41 3 94 1 25 14 25 27 91 24 00 -- x ' TEP20 50 230 12 22 11 3 9.1 1 25 17 62 35.28 30 00 - - - - -- -- AV TEP25 -75 -230 C 66 15 07 3 94 1 25 13 16 23 48 25 00 Ab TEP25 -100 -230 1 3 c 5 1 17 67 3 91 1 25 14 25 27 1 i 27 00 TEP25 -150 -230 1 ;2 1 12 21 56 3 94 1 25 17 62 34 43 32 00 AEP35 -100 -230 1 39 ' 1 75 16 64 N A 2 00 14 25 27 14 2700 -- - -- M AEP35 -150 -230 1 36 01 15 12 20 89 N A 200 17.62 34.76 32 00 vn I 3.75" M OT OR OIA. Service Entrance to Y Locked Winding Max Max. Cable Lengtr, ;n Fee Max Rotor Resist. Fuse /CB for AWG Copper Wire Size Soe..­ MOael HP Volt GPM Amps Amps (Ohms) (Std. Trip) 12 10 8 6 TEP12 -50-11 5 2 12 0 64 4 1 0 -1 3 30 160 250 TEP12 -50 -230 23C 12 6 0 32 2 4 2 -5 2 15 650 1020 — TEP12 -75 -230 230 12 8.0 40 7 3 0 -3 6 20 480 760 TEP12 -100 -230 1 230 12 9 8 48 7 2 2 -2.7 25 400 63C TEP20 50 115 5 20 12 0 64 4 1.0 -1 3 30 160 250 - -- - — - TEP20 -50 -230 230 20 6 0 32 2 4 2 -5 2 15 650 1020 c' TEP20 -75 -230 230 20 8 0 40 7 3 0 -3 6 20 480 760 TEP20 -100 -230 1 Z'S 20 9 8 48 7 2 2 -2 7 25 400 630 - - . -- - TEP20 -150 -230 1 23U 20 13 1 56 8 1 5 -1 9 35 310 -180 TEP25 -75 -230 23G 25 8 U 40 7 3 0 -3 6 20 480 760 27T TEP25 -100 -230 1 _'30 25 9 8 48 7 22 -2 7 25 400 630 ?z� TEP25 -150 -230 1 - PT, 25 13 1 56 8 1 5 -1 9 35 310 •180 AEP35 -100 -230 1 230 35 9 8 48.7 2.2 -2 7 25 400 630 AEP35- 150 -230 1 230 35 13.1 568 1 5 -1 9 35 310 480 AERMOTO k � R F 12 GPM 20 GPM 25 T 400 2 yA 1 X 360 A L 320 4 yA H 280 1 HA A 240 4 . ° zoo 1 60 .1 HP N 120 F E 80 E T 40 0 2 6 8 10 12 14 16 18 20 0 3 6 9 12 _ Galions Per M,rn„te 25 GPM 35 GPM 20 T 200 o r� A _ T ,80 , 2 A L 160 1 t/2. Hp H 140 Lfyp E A 120 1 HP ° 100 3iq Hp N 80 F 60 E E 40 T 20 0 0 8 12 16 20 24 28 32 36 40 0 6 12 18 24 3C _ Gauons Per Minute „ � Manlual Disc Filter Technical information I o r T low— FILTER APPLICATION RECOMMENDATIONS HEA L O ® ®® ®® EM .. N it NMI 111 fg Iei+r.,vA i+mdasYtiva4 -�.... 111[ WWW 1!lb6t6u 4 111 - 111� � - 111� sun Chart Legead a0fiLQ.,Qg" River, ditch, pond, lake or reservoir water Well water containing sand only '8-Qa,:a�z Municipal supply MANUAL DISC FILTER PARTS Part Description minim?m I � - t4 't2r Substitute XU with proper mesh size. Netaf►m USA - Delivering Total Growing Solutions Dripperlines a Filten a Vo&es a Air Vents a Sprinklers a Automation a Technical Education I NE ' ForAorkukure, Landscape, Greenhouse i Nursery USA PRECISION IRRIGATION- For more information call your Authorized ® Netafim USA Dealer or call Netafim USA Customer Ser vice at ( 888) 638.2346. {� I n 0 A024 2/01 .. [ ARKAL• FILTRATION SYSTEM INSTALLATION 1. FILTER MAYBE INSTALLED EITHER VERTICALLY OR HORIZONTALLY. 2. USE TEFLON TAPE ON FILTER END CONNECTIONS. �` •— ,7 — — — 3. NEVER USE SPANNERS FOR TIGHTENING THE FILTER COVER. \ MAINTENANCE IF THE FILTER RINGS ARE COVERED WITH LIME DEPOSITS THEN REMOVE THE ELEMENT AND TREAT WITH CHLORIC ACID. °- _ ^ ^- '7' T . DI .... . SM ANTLIN G I. TURN OFF THE WATER 2. MAKE; q ; �"RE IS RELEASED FROM THE FILTER. 3. UNSCREW THE COVER FROM THE FILTER BODY. 4. PULL OUT THE EILTERELEMENT. 5. MOVE THE SEALING RING T . THE END OF THE SPINE. 6. FLUSH THE RINGS WITH THE WATER JET. — 1 ASSEMBLY 1. VERIFY THAT THE TIGHTENING SPRING IS PLACED AT THE BOTTOM OF THE FILTER COVER. 1 —s 2. ASSEMBLE IN REVERSE ORDER 3. TIGHTEN THE COVER BY TURNING THE FDQNG NUT CLOCKWISE AND DONT OVER TIGHTEN. —t PART LIST — a NO. CAT. NO. DESCRIPTION MATERIALS � 1 25110103 GAUGE PORT NUT SINGLE UNM R.P.P. —6 2 5006 0004 GAUGE PORT SEAL SINGLE UNM EPDM 1 3 2500 0100 FILTER BODY BSP R. JL 2500 0101 FILTER BODY N R.P-k 4 2507 0100 FILTER ADAPTOR RING R.P.A. 5 2507 0102 ELEMENT RETAINING RING PBT 6 20101 DISC SET P.P. —7 7 2502 0100 SPINE R.P.A. 8 5002 9004 90x4 O -RING N. R - 9 5044 0010 , COMPRESSION SPRING S. . 10 25010100 FILTE3t COVER R.P.A. 25019110 TRANSPARENT COVER p, 11 2506 0100 FDQNG NUF: rv; • ; R ;/1, O - • 12 5054 0008 w ' TAP + BRASS 13 21101 FILTER ELEMENT P — 14 2530 0115 1' -Ihu FILTER WRENCH R.P.A. 15 2208 0001 FILTER BODY COMPLEX ESP 2208 0002 FILTER BODY COMPLEX NFr — 10 MATERIALS: R.P.P. - REINFORCED POLYPROPYLENE R.P.A. - REINFORCED POLYAMIDE S.S. - STAINLESS STEEL P.P. - POLYPROPYLENE N.R. - NITRILE RUBBER 11 P.C. - POLYC4RBONAT CC v . [ @JARKAL 14 FILTRATION SYSTEMS Bet Zera, Emek Hayarden, 15135, Israel. Tel: (972) -6- 677 -5140 Fax: (972}6-677 -5476 E -mail: flltersoarkal.com http://www.arkal-flbm.com m.com I - ti } i g, i DRIP SYSTEM PACKAGE SPECIFICATION ?' CONTROL 0 The control has a Noma 4X rated enclosure with hinged Inner door, removable aluminum backplate for component mounting, IEC rated pump contactor, adjustable pump run timer, high level peak enable circuit, Hand -Off -Auto K" Now n� _ toggle switches for all operations, pump run 0 0 light, indicator lights, separate control and pump ®� ®� breakers, control fuse, and finger -safe terminal blocks with a neatly bundled. wiring harness. The Control,. unit is.:U L. �.° f.. Mfg iid LABELED. The m(croprocesso manual override capability to complettel p ate the ° PW M KM Me I m[: .a UM system while bypassing'"`mtcoprocessor' TUBING AND FIELD FITTINGS o Pressure compensating emitters with tubing in 1,000 feet rolls with specialty insert fittings and PVC flex tubing is provided ready to glue to shedule 40 PVC supply return pipes. - HYDRAULIC UNIT INSERT (HU) The hydraulic unit is mounted in the pump tank riser. The Control valves are preassembled to be wired to a junction box suitable for connection to the control terminal strips. All wiring is connected outside the pump tank in a suitable junction box. PUMP FLOAT ROD W /FLOATS The pump is a hp, 115 volt, 1 phase effluent pump with quick disconnect. Included in package is a shut off valve, quick disconnect, check valve, and adapters, no weep hole should be placed in pipe. Vertical float installation is recommended as shown. ACCESS HATCH AND. RISER t Light weight riser and lid is an available o Lion .'• •. >.' ' is f, )r•.. Jl •.�''`d wort KOM ...�. a • • r.r 1t 1Y rw� American Manufacturing Company, Inc. P. 0. Box 549, Manassas, va 20108 - 0549.....1- 800 - 345 -3132 www.americanoncfte.com 1'@ 10:47 2154125347 AMERICAN MFG CO PAGE r2 AMERICAN MANUFACTURING CO. "Pere- Rite" Drip Systems P E CENTR UNIAULIC CHART 3A CHART 2A FIELD FLUSHING FLOW vs HEAD LOSS 1 w Op Hoy p F� W Zfftr� 50 7 16 NIT ft - 60 7 16 70 7 16 5 2 4 0 7 16 6 2 4 90 7 16 7 3 5 100 7 16 8 4 6 110 7 16 9 5 7 120 7 16 1 0 6 9 1 30 7 16 140 7 16 12 7 11 ,C 150 7 16 13 8 12 160 7 16 14 9 13 15 10 16 170 7 16 = 180 7 16 16 12 19 190 7.4 17 17 14 22 O 200 8 18 18 16 24 �O 210 8.6 20 19 18 27 20 9.2 21 20 20 28 230 9.9 23 21 21 40 10.5 24. 22 22 25 0 11'.2 26 23 23 260 12 28 24 24 270 12.7 29 25 25 280 13.5 `31 "p"T "`'"""""''.�'a°`"Olt'""""'' 290 14.3 33 15 gpm Hyd. Unit — Typical Single Family Home 300 15.2 35 Max. 4 zones, 4800 I.f. 310 16 37 20 16.9 39 330 17.9 41 340 18.9 44 350 1 19.9 46 360 20.9 48 370 22 51 380 23.1 1 53 390 24.2 56 AMERICAN MANUFACTURING CO. 400 25.4 59 "I? ft w�au M s"` M-4"°" 0 am rM owe Netaflm 0.5 ", PC emitters was 24 inch emitter spacing oar °w syrMu war v _ • System Management • , Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber or the St. Croix County Zoning Office, 715- 386 -4680, should be contacted for assistance. General Proper functioning of an on -site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a dose tank or compartment to allow a dose to be accumulated, a pump and controls or automatic siphon, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. 1. If the septic tank is installed prior to sheet -rock and/or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. 2. Install water - saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Treated septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic, treatment or dose tanks are no longer used, they must be properly abandoned. 11. If construction timing and weather could create a frozen infiltration system, weather - proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start-up. Maintenance 1. The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. When the septic tank is pumped, any solids in the bottom of the treatment or dose tank must be pumped, and the filter must be back- washed into the septic tank to remove accumulated material. System use may require more frequent filter cleaning; initial inspections of the filter should be made every 6 months until a minimum time sequence is determined. 4. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 5. Avoid compaction such as vehicle traffic within 15' down -slope of the adsorption system. 6. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 7. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 8. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run -off into the system area. 9. Warning: Do not enter septic, dose or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and/or installation of additional treatment components or conversion to a holding tank may be necessary. Page 14 of 15 • . ' System Specific Maintenance Treatment System 1. The aerobic treatment unit blower should be periodically checked and the inlet screen cleaned approximately every six months or after any periods when debris such as leaves or mowed grass might have been air -borne in quantities. 2. The aerobic treatment unit should never smell septic; if unusual odor occurs, notify the installing plumber,. 3. Annual inspection of sludge depth in the septic (trash) tank and in the treatment tank is recommended. 4. Unusual noise from the blower unit should be referred to the installing plumber. 5. Manufacturer's specifications for initial inspections every six months for two years must be followed; follow -up inspections required at yearly intervals. Drip System 1. The filters for the drip system should be inspected and cleaned, if necessary, by the installing plumber. 2. If the alarm sounds or indicates a problem, notify the installing plumber. 3. The alarm system should be checked at least annually to verify proper operating order. 4. The supply and return manifold should be flushed every three years by opening the clean-outs and using a pressure washer. Page 15 of 15 05/16/2005 07:09 FAX 715 233 0398 Certified Soil Testing Lag Commerce 0001 Jim Peterson Mound — Addendum Transaction # 1135007, Site ID # 698206 Drip Pump Timer Clarification The minimum dose based on system volumes is 35.6902 gallons which would result in a timed dose of 14.63 minutes (minimum). The design dose is 53.62 gallons which corresponds to a pump enable -to pump off setting of 2.0 inches. The design dose requires a timed dose of 21.98 minutes for a clock setting of 22.0 minutes. Each zone has 240 emitters each of which will emit 0.61 gallons per hour for a zone flow rate of 2.44 gallons per minute. At a tinted dose of 22.0 minutes the zone will accept 53.68 gallons which is 1/11.177 of the daily design dose. The total number of doses needed in 24 hours at full design load is 24/11.177 which calculates as 2.1472 hours or 128.8 minutes. Since the dose itself occupies 22 minutes, the time between doses should be set at 128.8 -22 = 106.8 minutes. Conclusion: Dose enable to dose off setting is 2.0 inches. When dose is enabled, the timer on setting is 22.0 minutes. After each dose, the timer off setting is 107 minutes. The alarm will be set at 15 inches below tank high water level to give a reserve volume of 402 gallons. Allowable surge volume is a minimum of 9.0 inches or 241+ gallons between the alarm setting and the drip enable setting. ' O LUATION REPORT #2201 Department of Commerce dan with Comm 85, Wis. Adm. Code Page 1 of 3 Division of Safety and Buildi gs Certified Soil Testing, LLC Attach complete site plan on pa r not �$3�1a � 8 1i� nntt11� County ches size. M) Plan must St. Croix include, but not limited to: vertic and horizontal reference point , direction and percent slope, scale or dimensio s, Wort to nearest road. Parcel I.D. SF��jWFdPE 1fQn and istance 042 - 1080 -30 -000 Please rint sewed By Dat ,y— Personal information you provide may a used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Q Property Owner Property Location Peterson, Jim Govt. Lot 2 1/4, 1/4, S29, T29N, R18W Property Owner's Mailing Address Lot # Block # S # 2082 Carroll Ave. t c- City State Zip Code Phone Number City [:]Village ® Town Nearest Road St. Paul MN 1 55104 1 651 - 644 -1623 Warren 107Th St. ❑ New Construction Use: ® Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD �! Replacement ❑ Public or commercial - Describe Parent material loess over outwash till Flood plain elevation, if applicable NA ft. General comments install 8'x 78' rock cell mound on 100.0 contour as upslope edge of rock w/ 0.5' and recommendations: sand fil or drip dispersal w/ highly treated effluent (recommend FAST system) Boring # Boring Pit Ground surface elev. 99.0 ft. Depth to limiting factor 36 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure . Consistence Boundary Roots -GPD/ft in. Mu 1 ' " Qu, - 8z Cont Color *Ef #1 *E ff#2 1 0-6 10YR 2/2 - sl 2 m gr mvfr gs 1m .6 1.0 2 6 -14 10YR 2/2 - sl 1 m sbk mvfr gs 1m .4 .7 3 14 -29 10YR 3/3 - sI 1 m sbk mvfr gs lm .4 .7 4 29 -36 10YR 4/4 - s 0 sg ml Cs lm .7 1.6 5 3 - 10YR 4/4 f3f 10R 6/2 s 0 sg ml - lm .7 1.6 7.5YR 4/6 horizon 3 sl is light, almost Is; 1 m roots to 60'; perched water table @ 88" FT] Boring # Boring ® Pit Ground surface elev. 100.0 ft. Depth to limiting factor 37 n. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft= in. Munsell Qu: Sz'. Cont. Color *Eff#1 *Eff# 1 0 -6 10YR 2/2 - sl 2 m gr mvfr gs im .6 1.0 2 6 -12 10YR 2/2 - sl 1 m sbk mvfr gs 1m .4 .7 3 12 -24 10YR 3/3 - sI 1 m sbk mvfr gs lm .4 .7 4 24 -30 10YR 4/4 - Is 0 sg ml gs lm .7 1.6 5 30 -37 10YR 4/4 - s 0 sg ml Cs lm .7 1.6 6 37 10YR 4/4 f2f 7.5YR 5/8,4/6 s 0 sg ml Cs lm 7 1.6 7 50 -70 10YR 4/4 c3p 7.5YR 5/8 s 0 sg ml - 1m .7 1.6 10YR 6/2 * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mgL CST Name (Please Print) Signat e: CST Number Henry F. Grote 222774 Address Certified Soil Testing, LLC Date Evaluation Conducted Telephone Number E. 4366 353rd Ave. Menomonie, WI 54751 4/9/2005 715 - 233 -0398 SBD•8330 (R.07 /00) Property Owner Peterson, Jim Parcel ID # 042 - 1080 -30 -000 Page 2 of 3 73Boring # ❑ Boring Z Pit Ground surface elev. 98.6 ft. Depth to limiting factor 56 n. Soil Application Rat Horizon Depth Dominant Color: R o - ftscrilption ` = xtui8; Structure'.:: 0,offl i t6nee Boundary Roots GPD /ft' Qu. z:Liiitt. (.`Qfor G 'Eff#1 "r. Sz. Sh. *Eff#2 in. Munsell 1 0 -5 10YR 2/2 - sl 2 m gr mvfr gs lm .6 1.0 2 5 -14 10YR 2/2 - sl 1 m sbk mvfr gs lm .4 .7 3 14 -26 10YR 3/3 - sl 1 m sbk mvfr gs lm .4 .7 4 26 -32 10YR 3/3 - Is 0 sg ml gs 1m .7 1.6 5 32 -40 10YR 4/4 - s 0 sg ml gs 1m .7 j 1.6 6 40 -56 10YR 4/4 - s 0 sg dl Cs lm .7 1.6 7 L SSBR 4 Boring # J Boring �{ Pit Ground surface elev. 100.0 ft. Depth to limiting factor 50 Soil Application Rat Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 *Eff#2 1 0 -5 7.5YR 3/1 - sl 2 m gr mvfr gs lm .6 1.0 2 5 -25 7.5YR 3/3 - sl 1 m sbk mvfr gs lm .4 .7 3 25 -50 10YR 4/4 - s 0 sg ml Cs im .7 1.6 4 50 - 55 10YR 4/4 f2d 7.5YR 4/6 s 0 sg ml - lm .7 1.6 pit to 18" then hand boring ❑ r J Boring #� Boring Pit Ground surface elev. 98.6 ft. Depth to limiting factor 32 Soil Application Rat Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff #1 *Eff #2 1 0 -4 7.5YR 3/1 - sl 2 m gr mvfr gs 1m .6 1.0 2 4 -22 7.5YR 3/3 - sl 1 m sbk mvfr gs lm .4 .7 3 22 -32 10YR 4/4 - sl 1 m sbk mvfr Cs im .4 .7 fld 7.5YR 4/6 4 32 -44 10YR 4/4 10YR 6/2 sl 1 m sbk mvfr - lm .4 .7 pit to 18" then hand boring I > > *Effluent #1 BOD 30 < _ 220 mg /L and TSS 30 < mg /L Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) Certified Soil Testing, LLC c�42- 1��go - 3o -.coo �98r�) dC.ar o �S 30 M Il e 4- koT \r�0.o Vs QQ L /LC > C�fQV.tZ — 4 1/ 1 �!�.�Q � pr Z. Private On -Site Wastewater Treatment System ( POWTS) Index & Title Sheet Owner: JjnOT4e Project Name and System Type: 4 15 -A amon YY1c - " / Acn iC. Tv Location: � frc Q,+ u ' � Street Address VA 3 2!� T � Q $ J, ) Legal Descriptio U rreAll Township /County Contents: Page 1: Sanitary Permit Application Page 2: Plot Plan Page 3: Soil Test Page 4: State Approved Plans Page 5: Septic Tank Maintenance Agreement Page 6: Warranty Deed Page 7: POWTS Owner's Manual Management Plan Page 8: POWTS Owner's Manual Management Plan Page 9: POWTS Owner's Manual Management Plan Page 10: Certified Survey Map Page 11: Copy of House Plans Attachments: Plumber/Designer: Mike Rogers Signe Credential Number: 225094 Date: I 1 / 6 s POWTS OWNER'S MANUAL MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity s �gal ❑ NA Permit # 3 Septic Tank Manufacturer [3 NA DESIGN PARAMETERS` Effluent Filter Manufacturer C t_'A4_ CZ 1 NA Number of Bedrooms 100gpd/bedroom [3 NA Effluent Filter Model FT L 2; -Al 7 NA Number of Commercial Units NA PAP Tank Capacity � 'L gal ❑ NA - Estimated flow (average)* gal/day Pump Tank Manufacturer �; 11 6 - NA . flow (peak), estimated x 1.5* aUda �P Manufacturer NA Design (P ) g y Pump Model 6P 12 - ❑ NA Soil Application Rate al/day fe Pretreatment Unit NA Influent/Effluent Quality (NAM. Monthly Average** p Sand/Gravel Filter ❑ Peat Filter Fats. Oil & Grease (FOG) 5 30 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODs) 220 mg/L E3 Disinfection er: fa-S+ Suspended Solids ( Total Sus TSS p ) < 250 mg/L Manufacturer: Model: 6 ; �i�g Dispersal Cell(s) Pretreated Effluent Quality Monthly Average * ** ❑ In-ground (gravity) ❑ In- ground (pressurized) Biochemical Oxygen Demand (BODs) 30 mg/L ❑ - de ❑ Mound Total Suspended Solids (TSS) 5 30 mg/L rip * e [3 Other: Fecal Colifonn (geometric mean) < 10 +cfu/100m1 eaching Chamber Manufacture Maximum Effluent Particle Size 1/8 inch diameter Model oval Stipulation *Wastewater Flow Verification on and calculations: Soil Applic 'on Rate d 11t Area Req. (Other than bedroom based) Absorption Are dit per unit ft2 Minimum Nur6ber o bers ❑ Aggregate De ' g Rate= min ** Values typical for domestic (non - commercial wastewater Materials: all mate ' must comply with WI Adm. Code and septic tank effluent. COMM84 and be installed per manufacturers specifications ** *Values typical for pretreated wastewater. and approval letters. DESIGN CRITERIA sconsin At -grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et.al.1990) "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. blication 15.22 "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publications 9.6 ❑ "Design of Conventional Soil Absorption Trenches and Beds ". R.J. Otis - ASAE Publications 5 -77 and "Design Manual - Onsite Wastewater Treatment and Disposal Systems ". EPA 625/1 -80 -012 October 1980 ❑ SBD - 10570 -P (8.6199) "At -Grade Component Manual Using Pressure Distribution" ❑ SBD - I0567 -P (R.6/99) "In Ground Absorption Component Manual" ❑ SBD - 10705. -P (N.01101) "In Ground Soil Absorption Component Manual" Version 2.0 ❑ SBD - 10628 -P (N.6199) "Recirculating Sand Filter System Component Manual" ❑ SBD - 10656 -P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual" t] SBD 10572 -P (8.6/99) "Mound Component Manual" ❑ SBD 10691 -P (N.01 101) "Mound Component Manual" Version 2.0 ❑ SBD - 10595 -P (R.6199) "Single Pass Sand Filter Component Manual" 'jitiBI) - 10657 P (8.6199) "Drip -line Effluent Disposal Component Manual" ❑ SBD - 10573 P (R 6/99) "Pressure Distribution Component Manual" ❑ SBD - 10706 -P (N.01 /01) "Pressure Distribution Component Manual" Version 2.0 ❑ Drip -line Effluent Dispersal Component Manual for Multi-flo Onsite Wastewater Treatment Units MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months year(s) (Maximum 3 yrs.) Pump out contents of tanks) When combined sludge and scum equals one -third (1/3) of tank volume Inspect dispersal cells) At least once every ❑ months ear(s) (Maximum 3 yrs.) Clean effluent filter At least once every l ❑months year(s) Inspect pump, pump controls & alarm At least once every ❑ months year(s) ❑ NA Flush laterals and pressure test At least once every ❑ months Ayear(s) ❑ NA Valves At least once every l .❑ months l�;year(s) _'NA Other: r I` .� 1 i t At least once every ❑ months year(s) - A Page of START UP For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water - saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non - biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. Valves Valves shall be operated in the following manner: Alarms s should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back -up of sewage into the dwelling or surfacing. INPECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). Septic Tanks Component Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one -third (1/3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Chapter NR113, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating- ,Pump Chamber/Treatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of the filter. Any service needs or repairs shall be promptly taken care of ❑ In- Ground Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any re evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reporte d to the regulatory ry authority. Ponding at depths greater than 75 1 /4 of the height of the component may indicate overloadtg or impending hydraulic failure necessitating more frequent monitoring. Page of , f `Mound, At- Grade, In- Ground Pressure The- inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. COMM 83.33, Wisconsin Administrative Code. - All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or other inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site .evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. « WARNING>> ' SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR UVWOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name (At OQ Name Phone - / S. 2.3 - (13 2 - Phone SEPTAGE SERVICING OPERATOR (Pumper) LOCAL REGULATORY AUTHORITY Name Agency C"m f l) /!d Phone Phone KAWPDATAIEHIPOWTS OWNER'S MANUAL.doc ' Page of r ST. CROICK COUNTY SEPTIC TANK MAIPTAINA�NCE AGREEMENT AND OWNERSHIP C1ERTlli+'ICATE FORM Owner/Euyer j4f" CS JeA4 PL— T6P-5 -Cl\� Mailing Address ab %2 C AIr roU Av c-:Lq f 5(- 55104 ✓ Property Address Q` /•! -f1 �, -.5� -� ( raph a fro Plao®ng De�rutmmt far new omaftttdim) Vetifcatim d o City/State Parcel Identification Number O 2 - - 3 o - � LEGAL DESCRIPTION Property Location `K. M. Sec. T:AN -RA Town of � 61 I �Z Subdivision Lo'( o tZE GertD Lot# — o U E L- J Certified Survey Map# , Volume Page Volum 7 -E' 3 Page / Spec house yes 2� no Lot lines identifiable yes no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result 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 ftmction 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 wastewater disposal system is in proper operating condition andior (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 th Department of Commerce and use the Department of Natural Resources, State of Wisconsin Certif cation stating that your septic system has been maintained must be completed and returned to the St. roix County Zonin ce within 10 days of the three year expiration date. �0-5 SIGN TURE OF APPLICA.rrr 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 owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. j e-n,.cV 3 a 3" °s SIG TURF OF APPLICANT DATE *****• Any mformsum that is amwepr enzed may result i8 the santary pm" bmg revokedby the Zmmg DgMUn" " «. Include wth this applicatim a tamped wwraoty deed from the [Rena of Deeds office a copy of tfre ow fW atavW =W if ta ftmm i Fmob in dw wwrmty dud Parcel #: 042 - 1080 -30 -000 05/19/2005 04:48 PM PAGE 1 OF 1 Alt. Parcel #: 29.29.18.457B 042 - TOWN OF WARREN Current i X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * HAROLD O- ESTATE PETERSON PETERSON, HAROLD O- ESTATE 2082 CARROLL AVE ST PAUL MN 55104 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 737 107TH ST SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 20.000 Plat: N/A -NOT AVAILABLE SEC 29 T29N R18W 20A ALL G.L 2 E OF HWY Block/Condo Bldg: EXC LD DESC TO G. W. THOMSON AS IN VOL 190/445 ORD Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 29- 29N -18W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 190/445 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/22/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 20.000 100,000 35,800 135,800 NO ®0m Totals for 2005: General Property 20.000 100,000 35,800 135,800 Woodland 0.000 0 0 Totals for 2004: General Property 20.000 100,000 35,800 135,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Form No. 27- M —DUIT CLAIM DEED Minnesota Uniform Conveyancing Blank. (1978) _7 9 .ER 12) ,9 9 Individual (s) to Individual (s) 7 8 3 P Q 1 S XATHLEEN H. WALSH I REGISTER OF DEEDS No delinquent taxes and transfer entered; Certificate ST. CROIX Co.. WI of Real Estate Value ( ) filed ( ) not required RECEIVED FOR RECORD Certificate of Real Estate Value No. I 04/13/2005 10:00A)I ,19 QUIT CLADS DEED EXEMPT * 8 REC FEE: 11.00 County Auditor TRANS FEE: CC FEE: by PAGES: 1 Deputy STATE DEED TAX DUE HEREON: $ Date: Ju1V 12 19 92 O *,Q _ 1096 - 30 - 000 (reserved for recording data) FOR VALUABLE CONSIDERATION, Harold O Peterson an unremarried w; dnwP1' , Grantor (s), (marital status) hereby convey (s) and quitclaim (s) to TamP4 R pt- errsnn Grantee (s), real property in St_ Croix County, described as follows: is cons'in All that part of Government Lot Two (2), lying East of the highway running across the same in Section Twenty -Nine (29), Township Twenty -Nine (29) North, Range Eighteen (18) West, except the following: Commencing at a point in the center of the North and South Road, running through said Lot 958.8 feet South of the North line of said Lot; thence East parallel with the North line of said Lot 219 feet; thence South 80 feet more or less. to the Lake Shore; thence southerly along lake shore to South line of said Lot; thence directly West along the South line of said Lot, 240 feet; thence North 151 feet to center line of said road; thence Easterly and Northerly along center line of said road 597.2 feet to point of beginning. This is non - homestead propery. C C1L (if more space is needed, continue on back) together with all hereditaments and appurtenances belonging thereto. /):, C Affix Deed Tax Starno 11tire STATE OF MINNESOTA _ ss. COUNTY OF Ramsey The foregoing instrument was acknowledged before me this 1 2 day of July , 1992 , b Harold O. Peterson, an unremarried widower Grantor (s). NOTARIAL STAMP OR SEAL (OR OTHER TITLE OR RANK) i t 1 SIGNXTUkk OF R AKI G C WLEDGMENT 1 • Tax Statements fo ertY to thls inst—ant should FRED A. KUEPPERS !R be sent to (Ineiude name dsess of Orontes): NOTARY kiwlc —mliii li DAKOTA COUNTY 1 0 my tense. ftR'_s Me,. 31, 1"7 • rvtinrwMnhMrowve THIS INSTRUMENNT WAS DRAFTED BY (NAME AND ADDRESS): i Kueppers, Hackel & Kueppers 1350 Capital Centre 386 Wabasha Street North I St. Paul, MN 55102 .Return To: ,The First National Bank PO Box 89 ;New Richmond, WI 54017 �� ♦ R-18 -W WARREN PLAT T 2 9 -N R See Page 112 For Additlonal Names. ., (Landowners) RICHMOND PAGE 48 Gar E E Rl £ C►arence & & Connie & Inc 78 ameUnitd \8 M 7 ao ' Sow _ 6a _ 65 o Mueller C� t{ t �^ Hntg Club Inc 118th o E 1s 6 AVE ohn I 158 T� 158 275 Nickelson Vernon a c e C Nelson Louis 114th iu r • v,m9A1�°u• w g && - Y AVE T Maloney g 3 ]20 r aq rqy �� zin rave w tr °+ Greenfield a n 180 O 7 154 318 240 N 3J tr ` �39 a Brtese� - 216 s 39 w Dale & 110th AVE cN 3o y e � o Frands 110t VE o tr Ns a a „ 'Jeff 8c Kenneth & C' ��" � Cyn Pamela Ronald Fr ecick LLCC 78 S n 60 e '.„ i ,,,,. + Ramo Hetink z Meyer e 107th AVE Ma e•y Wesley & Inc .N u N � aty !! ! w 3 8andall a g S 310 120 74U3t ae n Frederick m 1 aP E10. — l oanne sa m` x s ,0 160 4C Rnsmar AVE B ° Farms aymond & Thomas Gordon Patrida Nona 'o Truesdi6 Inc I 104th ; .40 , $ SuBwold ° ! 14 2 160 47 AVE 0 160 as 3 M1 4 w 138 x ' + 200 raNS so 150 160 ,f 100th AVE Butl d g s 8 i n 145 u avid & A" Walter VanBeek 15 ' " � oa s� T• es a 60 Kenneth r NechvIDe S0 80 5 I I St Croix Vly h ST cKenna Frederick tr Heary 1-b. m Girl I Scouts o 96t \ Nechville Eugene B & 195 u 96 ; au 80 Viola F& 1 q G tr a 168 rm Tepe Delores 1 J illis 232 I d 6 e- Land er c s Dean & 1Yttst z S� te Farms David & ] �.- Diane 1 Corp M O Camille $town .c McKenna w is ZA ZI Holden Trust ° EM as o " 2a 150 160 12 11 240 316 + N 3 tr Q 80 119 , 78 x s 344 x btueeer Tom - ^ 2 00 Z 10 C ° JP v r " Nrzps 4kc 8arbag W 'a 37 N f8" 6 Farms u V ,! Rohl Eugene g8,g t Carpenter Inc Yp� ht ar 10 3 Newda Bergh g 2 c 'R 5 RF a Fmty 44 - 3 34 Placid Iand 8 rloroety 54 b3 11 s zs "v o LP 139 160 78 e 4 CompaDY ) 79 I th VE 148 1 1 { Earl n 8 ro ` 158 ' 132 H Fml eltta Gardiner & s S�'" `,, sr— 31 116 Pechuman epth w y"o a s g a A th Ltd y violet y 1` 1 Muk !o S m Farms AVE 67 "�° Prtnr 122 Graham 2,;. 154 �.. Z Inc I Grace & + °f s v, a 9 w X 163 108 3 TT ` 307 T i Gan g „ • >a tan , e tr , c & c 21 x James & $ s pL - O 9 + ss & e itet ro orrb Ruth aaua W e& George 1Conual Phillip & 99t e h G.0 ,8 s- , ;R pp ,+. Ka z Bloom Honor 30 Oeggy ST E� Mat 34 o u 8 w : � � 8 s 2 }� 65 Millet a 80 Hater 40 � w a I D art 6 „'_ t ro s �: H 2 160 Trust o enert. P a p m 239 s9 Donald & 41 tr z Sr Earl 98 ana etal Edle Anderso 4 b math Pechuman Gl ry & hem 110 Z+ 6. a IO�f P �°^ Etbect 61 40 164 wr '1't1st1N KeN6a nl 5 �' s And son D 11 Hudson x anma LAKES : arm ! 187 80 9 6$ s� m.xaoe p 70th AVE S "� !o R & S 60 143 enwv r 6 Solimar ^'g 1 have ro Reed - 1 85 Nees w6 : 1 3 ark 75 0 80 tr x 39I Dorwes -- 7Lree JO die g p 4 Leo as IC g7 ~ Sonnentag Peskar c / Farms z Sim Iand 4 1 FamOy Inc ]. c s f �l LN X ehazd & 132 � "�'o Bn a N ' ^ �• G vvi s 223 tr 2 LM 115 160 h' 110 Inex40 saN qq 64t u S en' * 95tH" No rn°d°° 1 °q tr !! u 9 I 99 'STAR Andrew & 3H / Dean & q Iand� mdr 8 RobeRa LN Rose Glenda r "Ni N noes cattle 31 l" ° � 1 +6 B�ed�ou�e as U eI� Rudesill °; Hansen' Brenda Steven ECKER L ewes v N !o t ° m a CO 64 tr ♦ Bray & ' p n9 w LN tr a Peskar 92 • O N.re 4 rn x3 F a Anne aOm a al.ar 194 •ban I.werK !o S 6+3tpe + Butler u ,, 8 Nr.o. lw.. 26' 126 176 She 36 soy z r6 tr Nd��l� 60th AVE KINNIcia IC PAGE 18 856A Hwy. 65 ROBERTS GROCERY j P.O. Box 14 Roberts, W1 54023 Phone 715 - 749 -1718 MEATS • GROCERY • PRODUCE Fax 715- 749 -1719 HOURS: Monday- Saturday 7:30 a.m. to 9:00 p.m. NorthLand Survey Inc. Sunday 9 :00 a.m. to 6 :00 p.m. Boundary Surveys • Certified Survey Maps • Major Subdivisions • Topography S ' � (716) 749- 3840. Edwin Flanum Michael Erickson ROBERTS. WISCONSIN RL.S. No. 2487 R.L.S. No. 2592 Parcel #: 042 - 1080 -30 -120 04/14/2008 08:05 AM PAGE 1 OF 1 Alt. Parcel #: 29.29.18.457B -12 042 - TOWN OF WARREN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 09/06/2007 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - TRAUDT, DEE J & SANDRA M DEE J & SANDRA M TRAUDT 737 107TH ST ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description ' 737 107TH ST SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 10.190 Plat: 5450 -CSM 22 -5450 042 -07 SEC 29 T29N R18W PT GOVT LOT 2 BEING PT Block /Condo Bldg: LOT 04 CSM 20 -5129 LOT 1 NKA LOT 4 CSM 22 -5450 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 29- 29N -18W Notes: Parcel History: Date Doc # Vol /Page Type 09/06/2007 859961 22/5450 CSM 08/30/2007 859627 WD 07/18/2005 800499 2844/402 EZ -U 04/13/2005 792099 2783/015 QC more 2008 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/14/2007 Description Class Acres Land Improve Total State Reason Totals for 2008: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 n N O 9 v n o d 3 o c m 0 'D •'• v c 3 O A cn t W N N (D • 7 7 (D CAO (D fD (D .7 O N m w rn a o O a Ch —I ^t c. O A' W 1 C n (D � o 00 p p CD 3 > > 7 N N O O N . O ? 7 O A w ttt --- CD D In a 0 C-) 0 0 c� f s _ CD w c/> N N OZ 0 0 n O C cn cn N a 0 3 .. v v v O O O co ai N N o A D O cr v v Cn N N N A N AO N d 6 N ! (D - (D W (O (D 23 N 3 m Ul o O 3 z D D o O � z- 0. (CD m S c m q N I N p Z (D A Z O Q M 7 N cn 03 v 0 CD CL O a `; z o 3 ^' c (p Z < (D A � o�oo1 > C W N 3 N 3 Q C O O O - G r C ` _ 0 O S O p, 3 (D N v c O N O. (D - 3 O -• O N Z d -w n 7 N K� � C fD N O N .. co N N CD O CD 3 N V 7 O 2 ID (D N (D N A N o T (D Er (D <. (O ( CD O O O N L N N -n (D O v 3 x 'p O O Q (D (D N o A tt CL N n O O N 3 (D D) Op y j ti � O b �� O D-Z z5 O cs� O o O 0 O- + v �7 . 81 464 V0 LPAGE5129 XAT H. M7L--W - -- REGISTER OF DEEDS RECEIVED FOR . RECORD CERTIFIED SURVEY MA , 12/20/2005 01 :40PM IED SURVEY HAP LOCATED IN PART OF GOVERNMENT LOT 2 OF E. 13. 00 SECTION 29, T29N, R18W, TOWN OF WARREN, ST. COPY FEE: 3.00 PAGES: 2 �n a CROIX COUNTY, WISCONSIN; BEING THAT LAND �}� i o DESCRIBED ON DEED VOLUME 2783, PAGE 015. lf7 rn M = PREPARED FOR: SURVEYOR: M 2 n JIM & JEAN PETERSON DOUG ZAHLER p z 2082 CARROLL AVE S & N LAND SURVEYING, INC. g� X y cn n °O ST. PAUL, MN. 55104 2 ENLOE STREET �FYgR M ~ m HUDSON. WI 54016' rQ� of a cn A C.S.M_._ VOL. - 3, PG._ 899 �� 0 � „ - -- LO T 4 LOT 3 _i_ LOT 2 _ i_ LOT 1 - J 0 7TH - STREET -- ---- -- - - -- ' _co 2'02 7 W 314.5 - - - - -- f461'05 WW 644.26' - - �2 138.06' 506.19' V O 1• .... .. m ....�.. ....... °.,,°•. Z ...... ... ............................... .. .r... l ...� .3 O In zz i• p Q x m ITT O r O fJ O 4� 0 N NN � _Z1Z 1 m N R Z� mp mm IQ 0 M mm vi V \ gm mm p m c �A °^ 0 I• t 1 m� �n� F m O z� cf z" L� 11 . 1\ ` v, � o " cn m � m m e 1 v ICv 1 j 'T I I � m °' m m vyV -' µ 1 1 (a7 ;v A ` O -0 a fJ O Im �-. 0 Z v _ 00 to m-t Q O m m p 8 ra qq V ac \ D o D o y r 1 A o bx .LZ'9±63�90 , -cL �J - _ - N m C F r v m 0 s s M I _ 1 m$r vrmm m m \� �• • 1 r I m�TO �� q m 'qr a a o c �� o mo NC F� � < O \ m �c i Z D vx�N O r c Z Z Z Z �� Z OZ D 2L7t �mm� c 1� mm In _ a v -� m 0 IZ m mo v o �� g t 8 A- N �� p czi� 7otn m ;ZO= Ip �� -z 1 1( x !) y �nmaz Z m z 2. C O- aoi z ro z M m Qr t X CD So m � z 1 BEARINGS ARE REFERENCED TO THE EAST -WEST 114 LINE OF m m m m Z SECTION 29, ASSUMED TO BEAR // ^ • m d A a ; -i N89 "05'00 "E m Z A Z m EAST LINE OF GOVT. LOT 2 ° o S00'53'04 "E 166'+ ^� SHEET 1 OF 2 SHEETS Vol 20 Page 5129 Parcel #: 042 - 1080 -30 -100 02/07/2007 11:55 AM PAGE 1 OF 1 Alt. Parcel #: 29.29.18.457B -10 042 - TOWN OF WARREN Current X' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 12/20/2005 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner JAMES R PETERSON O - PETERSON, JAMES R 737 107TH ST ROBERTS W154023 Districts: SC = School SP = Special Property Address(es): ` = Primary Type Dist # Description " 737 107TH ST SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 12.220 Plat: 5129 -CSM 20 -5129 042/05 SEC 29 T29N R1 8W PT GOVT LOT 2 BEING Block/Condo Bldg: LOT 01 CSM 20 -5129 LOT 1 (12.220AC) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 29- 29N -18W Notes: Parcel History: Date Doc # Vol /Page Type 07/18/2005 800499 2844/402 EZ -U 04/13/2005 792099 2783/015 QC 01/25/2005 785727 2736/292 PR 07/23/1997 190/445 2007 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/31/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 12.220 80,000 246,600 326,600 NO Totals for 2007: General Property 12.220 80,000 246,600 326,600 Woodland 0.000 0 0 Totals for 2006: General Property 12.220 80,000 246,600 326,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 10/03/2006 Batch M 06 -15 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00