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Home My WebLink About008-1024-90-205TYPE MANUFACTURE CAPACITY Septic 1 y� Dosing J1 Aeration Holding TANK SETBACK INFn0UAT1nuI TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic � ? I Coo Dosing tt tL u -v 3 } too Aeration Holding PUMP/SIPHON INFORMATION ema GPM 33 tI SYSTEM / Length TO L ►1N/I y iYI 11STRIBUTION.SYSTEM Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes (Privacy Law, sA 5.04 (1)(m)l Permit Holder's Name: City Village Township Kurt C. & Kirstin M. Peterson TOWN OF EAU GALLE CST BM Elev: Insp. BM Elev BM Description: W ' ( •0 , } TANK INFORMATION ELEVAMON DATA STATION BS HI FS ELEV. Benchmark All. BM Bldg. Sewer t Inlet rSUMOutlet let Dt Bottom Header/Man. Dist. Pipe 411110 9�t•�t� p r Bot. System Final Grade St Cov fLrh w CHAMBER eadertManif ' Distnbulion ><HdeS G ipe(s) 9 I / ( x Hole Size Spacing Vent to Air Intake sngl Dia Length_ Dia_L Spacing L 0 3A6 J� 3 ( k � OIL COVER Center •rar Depth Over Bedrrrench Edges %X Mound Or Al -Grade M Depth of T, Yes [ -.,] No COMMENTS: (Include code discrepancies, persons present, etc.) Ins clion #1: ��//� nspeci Location: 492 233RD ST 1.) Alt BM Description = / �I 2.) Bldg sewer length amount of cover = > Plan revision Required? Yes No p Use other side for addilional informal: n. �Y/4 u, SBD-6710 (R.3197) Data Insepctors Sig Yes U No� #2-9��7/ZmZ Ja (-fr�� Cart. No. 1 w CAA, , _ a... a. pY County arvww sty and Buulbgtps Dtwlton 5+ Cho,. y 201 W Washington Ave.. P.O. Box 7162 Sanitary Prnroin Number (to be filled b) Co I V Madison, WI 53707-7162 ,. Willazz I St,y ermit Applicat &A6 S'a"T"'s""°"""'"b" In a000r with p9-3�{- k Cude, submission of this form note govemmeni l unit � ROM - O (v2Z O 1 ZIT -C— Project -- is required r 0.otltatH nary permit. Note Application forms for state-owned ►mitted to the ery and Professional Services. Personal information you provide may be used for secondary Address t if different than mailing address) purposes at accordance with the Privacy Law, s 15 I m Stets. S�e- 1. Application Information- Please Print All Information Property Owner's Name n PEN10-2AI- Parcel M— Vulft I Q6bSll UT Property Owners Mailing Address Propeny Location S� Lot �p N rhI/4i —irdeone) City. Stale 1 Zip Code PhoneGorr. Number li'r11AitIN ,9--5 T L8N, R � West 11. Type of Building (check all that apply) Lot a I or 2 Family Dwelling - Number of Bedrooms �_ subdivision Public / commercial - Describe use Block a State owned -Described use Na ❑ City of 91village of G a A 11;L CSM Number Town of III. Type of Permit: (Cheek only one on line A. Complete line B if applicable) A. New System Rcplae:emeat Srstcm Trcabnent/Holding Tank Replacement Only ❑ Other Modifkation to ExisGag system (explain) X B. ❑ Permit Renewal ❑ Permit Revision ❑ Changeof Plumber ❑ Permit Transfer to Ncw List Previous Permit Number and Date Issued FIV. Before Expiration Owner Type of POWTS System/Componeat/Devlee: (Check all that apply) Non -Pressurized In -Ground ❑ Pressurized In -Ground At -Grade Mound > 24 io. of suitabk soi Mound < 24 in. of suitable soil Holding Tent: ❑ Other Dispersal Component (expl _^ ❑ Pretreatment Device (explain) V. DispenalrlYeatment Area Information: X en / _ .O Design Flow Igpd) Design Soil Application Rai f) Dispersal Area Required (st) Dispersal Area Proposed (st) System Heyation 1 U-30 1 VI. Tank Info Capacity in TOW a of Manufacturer Gallons Gallons Units r OfQA/t..LO Nloi T1 '� I.err faakr. Exiarng ianlu Septic Tank 12.SO 1. kJt is 4L Lift Tank r st VII. ResponsibilityStatement- I, the utderaigaed ■e bilf la Uades of the rO%-IS ebw•n on the attached as Plumber's Name (Pnm) PI r' acre MP/MPRS Number Business Phone Number Lewis Bork 253976 j 715-231-7375 Plumber's Address (Street, City. State, Zip Code) E7918 County Road E Menomonie. 51 Vlll. County/Department Use Only Approved %S ❑ [)i v Permit Fee Due Issued Im m Signehuc ❑ Osv for fknul ' Z022 IX.Conditioeso pprov 1 -5) 0.�_/ 5 n � t Y 5C— �`Ybw�� EM OWNER: ,,/ n- tc tank, effluent filter and 4)�,4�C&ftC IM 8C K Q 0-Ak LAI, w f dis ersal cell must be sQrviced / mai_ntslne as per management plan provided by plumber. All as per applicable code/ordinances. Ttln �Fort+An*sa '{V SBD-63981 R. I I /I I ► (01 �rn�s°�-^''"v"'" -f /� rA04tr CHECK BOX AS APPUCM E. N0 SOIL EVALUATION Scale: k itr SITE MAP ° PROJECT NAME: J pA re]n�5l L — z.5 PROJECT ADDRESS: 4 1 Z LJ3r MS f _ BM Symbol: + ��11BM Elevation I L1JCJ FT N BM Descrlptlan. R• M c) 4 Slope Gradlent (%) of Tested Area: Well Symbol (d applicable). d C1fAf0C * p n r-- WS ImIc" mnh W drawlnp an armw on the appropote Ina. CHECK BOX AS APPLICABLE. 'SYSTEM PAGE 2 OF�j PLOT PLAN DESIGN FLOW: GIM GPD Attach design flow calculations for commercial plans. Pipe Material f ASTM Standard (Tables 384.303 d 3B4.30-5) Sanitary Sewer. ! Fixc Force Main IMPORTANT: Show ground elevation contours at suitable intervals. MA4ie �1„�� a53g-76 L-1 Q v a50s y .l Ftfv► W � �.I �`^ 92.1s af, GOpv a". . %'&VAA1 gal June 20, 2022 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2024-6-20 Plan Review: PWTS-062201283-C Lewis Bjork E7818 County Road E Menomonie, WI SITE: Peterson 492 233nd St Town of Eau Galle St Croix County NW X NW X S9 T28N R16W FOR: Description: 4 bedroom 600 GPD — 24" to limiting factor- Effluent Filter - Maintenance required. DIVISION OF WDUSTRY SERVICES 10541 N RANCH RO HAYWARD WI 54[43}[4[2 hpp Udsps w.[odpropramahnduetryferwres www wowmmn pov Tony[Vere-Dovernor Do" CAM - Searetaa Condftloneyy APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES 01- SF:E CORRESPONDENCE Mound Component Manual — Ver. 2.1(May 2022-27) Pressure Distribution Component Manual — Ver. 2.1 (May 2022-27) "New Manuals go into effect 7/1/2022 and submittals need updated Manual The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. 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: Reminders • The site shall be properly prepared prior to plowing. Any grasses longer than V shall be cut short and removed. To avoid matting, any leaves or loose organic matter shall be raked up and removed. Cut trees and shrubs flush to the ground and leave stumps. Avoid operating equipment on the Mound site. If necessary, use only tracked equipment, during dry conditions, with minimal passes, to avoid compaction. • Components and soil removed from an existing drain field shall be properly disposed of so that there is no risk to public or environmental health. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec.14S.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • 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. • 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. Owners shall also receive a copy of the appropriate operation and maintenance manual(s) and be responsible for ensuring that POWTS is operated and maintained in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • 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 Industry Services 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 and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, I =0 Joshua Rowley POWTS Plan Reviewer, Division of Industry Services 715-634-5124 Joshua.rowley@wisconsin.gov PAGE 1 OF 6 Mound Plan Index & Cover Sheet Component Manual Design References: Version 2.0, SBD-10691-P (N.01/01, R. 10/12) & Version 2.0, SBD-10706-P (N.01/01, R. 10/12) Pg 1 of 6 Index & Cover Page Pg 2 of 6 Plot Plan Pg 3 of 6 Mound Cross -Section & Plan View Pg 4 of 6 Distribution Network Specifications Pg 5 of 6 Pump Tank Specifications Pg 6 of 6 Management Plan Attachments: _ Pump Curve POWTS for Review Soil Evaluation Report & Site Project Name / Description u a Wff&b rJ - rl/ 0000 Dv5lyf� Owner Name(s): V,01 � Pt}Jx)r� Phone: 2�-.�9 Z -Ste' Owner Address: H91 01331%ci 5� RAIcWW '-AM Zip: 54 609, Project Address: �::)Myyxir Govt. Lot: NW 1/4 of (Av`j 1/4, Section 09 T Z13 WR�_Ell or Wo Township: &A GAL%. County: Si . e—a0�)t Project Parcel ID #: _ DQS~ IIz24 40 UT Designer Information Designer Name: hLW;5 �40t-�,1. DesignE E-mail: License Number: Remarks: "Yy1 P ?�3116 Phone: IS -�1 --1375 Zip: d340 51 Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES Signature: 1 Date final signature required on each submitted Copy. AAW" " AW f SEE CORRESPONDENCE S-19-LDzz CHECK BOX AS APPUCABLE. 640 SOIL EVALUATION Scale: ;A a' SITE MAP D PROJECT NAME: 12570 PROJECT ADORESS !11 Z LJIr IV�S r N BM Symbo, + .�((8M Eleiabon 11-JE-J FT BMDeacnpuon �2zTT-M. L'A ��'•'.'� _ Slope Gradont I°Al of Tesled Ar" 'Nall Symbd (d applicable) (D akmxL* Pkn ors w CHECK BOX AS WPU.ABILE. "SYSTEM PAGE 2 OF PLOT PLAN DESIGN GLOW (iino CPO Attach design flow calculations for commercial plans. �i Pipe Material 1 Sewer-1- Sta- es 384.3�]6( 384.305) V Sanitary Server ^ ! I vIV S Force Main I Inoiuu noun h pfaWllQ M armr w pr app w" w IMPORTANT Show ground elevation contours at suitable intervals a53g�6 IL I 11 U v D"a;1P.!D aw 92. 92 -IT el� .233'd Sf�c� r r 0.50 TO 2.S WASHED AGGREGATE (min. 6.0• berm1h distrtbutbn pipe - m1n.2.0- over distribution Pipe and covered with appro.ed synthetic fabric) DASTM C-33 SAND FILL Pbwed Surface SINGLE -CELL MOUND DISPERSAL AREA D= 1. ft PZA MIN. 6.0' OF TOPSOIL COVER E _Z ft min. 1.0 ft System Elevation = 13 •l S ft Lateral Invert Elevation = q 4 ZS ft min. 0.5 ft l f r r--o �!— -- o t I L - it Surface Contour % Slope —� Elevation = 91 �ft (Show force main mandW and flush valve locations on plan view.) CROSS SECTION VIEW (No Scale) PLAN VIEW (No Scale) L� • 0 Schd1 a0 J = ft 7.S ft PVC Lateral laves) (typical) _+_ _ _ _ _ _ _ �_! _� r—------- — -- — — -- � i L----- •---------------------------------_ 1K--------� B = -7150_ it ft MWm) Bend as necessary to follow contour DOWNSLOPE TOE L= ft Prohibit disttabance and vehicular trafk within 15 feet of downslope toe. D Q M W O T M Reset Pum DISTRIBUTION NETWORK SPECIFICATIONS (No Scale) FLUSH VALVE DETAIL (No Scale) Orifice in — — Valve Box Lateral Spacing Center of Threaded Cap (insulation optional) S = ft Head Testing / (optional) r Shield orillces for graveness appketions / S Ball Valve (optional) 1 1°I (riser pipes oPOD") Lateral Length (P) _ % 2 ft '0 Schdl40 PVC Manifold , 0'0 Schell 40 — VCTorce Warn (slope to pump tank r- for drain -back) Fist Orifice (typical) Laterals to be level Schell 40 PVC Lateral 0 = in (typical) _ a5 Number of Orifices per Lateral - orftes equsly, spaced: (check a) OR b) belowl Orifices alve e) abng bottom or lateral equally spy b) n Swig cop of bend Assembly \ a" bottom of leteral with every _ 1h hole (typical we detal) facing down last Orifice (typical)OrifioehSp�l ng (X) _ �in LATERAL INVERT ELEVATION = 9L} . 2 - ft (typical) Orifice Diameter = 3I16 in OBSERVATION PIPE DETAIL (No Scale) Screw-T(�e) W 'v sip cap(nxilcfned FkniNned Grade a seeded) 400 PVC Pipe TOP"Cover Tap of pipe to lenni►ele (mil. t foot) at or above timid grade (4) 19-4 Z' x 60 slots 9b , Arg Device infiltration Surface Orifice Discharge Rate = • "o gpm Number of Laterals = Z- Lateral Discharge Rate = wn TOTAL DISCHARGE RATE = 33 GPM (typical) First Offte (bpi) END MANIFOLD Check (typical) CONNECTION applicable box. I Mangold First Odfloe (dw POO opts) D� (typical) 1\ J x f1=XNfXrj2 �7� x(IYPk'�) CENTER MANIFOLD -n (deer Mangold CONNECTION rn PAGE 5 OF 6 SEPTIC / PUMP TANK SPECIFICATIONS (No Scale) 4'0 Vart Pipe >1011 from sukwv Electrical nuel owry>ly wth 12' W. or 2.0 l Wove SPS 316 and NEC 300 EstWinhed Flood Elevation W"&Wp ool Exund manhole now as neoKtery. OWN* �� Junebon Box v"x Cap Approved Louycnp Mervwle IMPORTANT: wtn wam Alwhed ) Anchor tank(s) as necessary Co<dut pursuant to SPS 3133.43(ft) t' Mn. or 2.011 Wove / Ea4buahed Food ElevMlon 11yp�) Fniohad Onwe Awbghl Seal .. Gulck Disconrna CAPACITIES C L943 V1 gaVinTv 4 * T A Tr IF *Pump q Tank Liquid Level = in Force Main Diameter = in D _ I Force Main Length = Ic ' 3-App� 8'15 2S.6 Force Main Void Volume =gal [C] Total Dose Volume (TDV) 00 9� gal/dose L (5X total lateral void volume <_ TDV s 0.2X design flow) + (nonce main drainbacc volume) ell MIN. PUMP DISCHARGE RATE = gpm PUMP TANK: Volume = &Q tt gal Manufacturer. liji LL'L Pump Manufacturer: ev L. Pump Model: I S L (see saad»d pump Cure) Controls/Alarm Manufacturer: 'fi5Et0VI4W, Controls/Alarm Model: A 11 Idea Float switches containing mercury are prohibited. 1a'Mln. �— Approved done wah Approved Pita 3 a onto Scud Ground (twice!) PUMP-OF00 F ELEVATION = 0 1 ft . INSIDE BOTTOM ELEVATION Vertical Head = 1 �ft + Min. Supply Head =��ft + FM Friction Loss = ft + Fitting Loss' = ft '(min. supply head x 0.3) = TOTAL DYNAMIC HEAD =eft SEPTIC TANK(S): Total Volume = i'Le];0 gal Manufacturer(s): W i LS Install approved effluent filter at the septic tank outlet immediately upstream of the pump tank inlet. Filter Manufacturer: sr^Tf CUNJLb �I Filter Model: - DM- ' [4 D ' PAGE 6 OF 6 Mound Management Plan KUDIA The owner of this mound system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383 52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flown Gin gpd; BOD6 S 220 mgL-'; TSS 5150 mgL-'; FOGS 30 mgL-' Inspection Checklist INSPECT EVERY 3 YEARS type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities (i.e., pump re -cycling, float switch settings, etc.) o electrical components (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tanktsl shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids In the tank(*) exceeds one-third (113) the liquid volume of the tank(*) Or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent filtertsl shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. o Distribution laterals shall be flushed once every 3 years or when necessary. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.58 Wisc. Admin. Code. �Report any component failure or malfunction to: /� ^� Name of individual or companyhtta_l�.Z/D�Q ��i�Ct, Phone:��J �31'73 'v cap l —V` 0 Local government unit: 5 L '/'n ! Phone. is -196 YW O Local government unit address: ZIP: 5A I Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384. Wisc Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed mound dispersal component may be re -constructed within the originally approved area after removal of all failed components. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. ;D srnesd;111uenl Pump% Awlier Pump Lompam httN:. wNw.zocllerpump�.cum cn•na'prudurIN aIII p-CMILICni-pump%cl ui Uj W PUMP PERFORMANCE CURVE MODEL 151 /152/153 50 14 1 45 T' 12 - 40 a 35 z 10 V152 30 a z 0 8. 25 151 J H g 20 o 15 A 2 10 5trt"1-"C� 01__ - T I i ' 20 30 40 50 60 10 80 90 100 10 GALLONS — --T-- -- -T--- -i — — - - LiTCas V - - -- 4U �— 80 -- ,— 120 160 200 240 260 320 360 FLOW PER MINUTE 2 ?1,2111A. In 0' A 0 W N a0 W 1' _00 C I III j 4" CAST-A-SEALV. I/ it , IT I III t III ij I ,' it FILTER OR I it BAFFLE jl j I 4' CAST -A -SEAL 4- VENT .0 IL _ TT 'L • I'.I M U I CL U O, r1 I .I 0. I • h n PUMP PAD WLP1200/800-MR TANK SPECIFICATIONS DIMENSIONS: WALL: 3" BOTTOM: 3" COVER: 6" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 53" LENGTH: 13'-8" WIDTH: 8'-0" BELOW INLET: 41" LIQUID LEVEL: 36" WEIGHT: BOTTOM 14,800 LBS. COVER S.17O LBS. INLET AND OUTLET: 4" CAST -A -SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN. SEE DETAIL #10 (OTHER STATES SEE CHART) LIOUID CAPACITY: 33.46 GALAN (SEPTIC) 22.24 GAL/IN (PUMP) LOADING DESIGN: B'-O" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC / HOLDING / PUMP OR SIPHON COVER: MIX DESIGN /8 (NO FIBER) TANK: MIX DESIGN #9 (SMALL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT#AESER CONCRETE REVIEWED BY REVIEW DATE IIDRAWINGS APPROVALTED FOR11 APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED 81: 1r -�W-. OF MANUFACTURED TO MEET OR EXCEED ASTM C-1227 %A;scA tin DOPWVT nt of Safely and Professional Services Page 1 Of 3 Drvrsion of Industry Services SOIL E ALUATION REPORT In socordance MO Attach complete me plan on paper not loss than 8 V2 x 11 Indres v but not limited to vertical and horizontal reference point (BM), direct sub or dimensions. north arrow, and location and distance to noon Please print all Inforrrratlon. Personal inlermatim you provide may b0 used for socor diary purposes SPS 385, We Adrn. Code County _ see Plan must include, St Croix on and percent slope, Parcel I.D. road. 006-1024-90-205 it 006.1024-90-230 Rat 62625 Reviewed by Date Law. a. 115.041111frinlill.-- P"Nrty Localbn ❑ OVVL LCIWN % NW % SOOT 2a N R 16 E (or) W Property Ownw Peterson Family Trust - Dennis Peterson, Executor -- - Prapei Owner's Maisrp Address 492 23V St. Lot 6 02 a 03 Bind S No SuW Name or CSW -- CSM Vol. 13, Pa. 3681 CRy Stale Zip Coda Phone Nurr Baldwin VW 54M (715 336 mir 182 (] City O Vrtape ® Town Nearest Road Eau Gslle W-1 Ave. Cj NewCWSVuction Use ®Resider"/Nt ntWof bedroom ® Replscement ❑ Public or corrsnereW - Dear fW: Parent material Glacial till General comments and rsoonvi endabons: Site sultat)ls for mound PC contour. t t derived design flaw rile QQQ GPD Flood Plan elevation if appicaob U h WTS. Recommended Infiltrative surface elevation to be 93.76 at 17" above 92 75' v 93 Q0, R. Depth to limiting Fedor 25" in - Sod AggkMian Rate eptttxe Stniclute C*Uislanco I Boundary Roots It Gr. St, Sh. 'EIIre1 'Et1112 2/gr do n 2vf,f 0.6 0.8 ® pit Ground surface ek Morizon i D40 In. Dornin6ef Color Murals Reft Description Ou. Az. Cont. Color 1 0.9 10yr3f6 r110fre --- 2 9-13 10yr4m none I of 2fsbh crrlr am 1vf,f 0.4 0.6 3 13-25 7.Syr4/4 Nora A I I""ft mv* ON, lvf,f 0.4 0.7 4 25-M 7.5yr4/4 IN 7.5yr5m I 1 1" ninef'r Car 0.4 0.7 6 35-46 7 Syr4l7 m3p7.5yr6/8 I I Orn m6 0.2 0.6 ��--,--�� 6 ❑Boring _ I ® Pt Ground surface ele v 2LU ft. Depth 10 limiting factor 25' in Soil Application P40 flortzon Dapfh In. Dornhent Color Muneall Redox Descrotlon Qu. Az. Cont. Color eKture Structure Gr. Sz. Sh. ConsiaMrtoo Boinldery Roots GPDffP 'EfIRt 'Eflr2 1 F2 0-6 IOyr3/4 none - I 21gr MO* a 2vf,1 0.6 10.8 8-13 10yM14 none 2fsbk ndc aw 1VU 0.4 0.6 3 13-25 7.*4/4 norm s I I I tmsbk mvtr ow 1vf,f 0.4 0.7' 4 25.40 7.5yr4M f2d 7 Syr" l msbk nfyfl 0.4 0 7 J Effluent In BOD, > 30 s 220 Ind T55 > s 160r T88=30 s ISO CST Net (Plasse Print) James K. Thompson ro �— CST Number 30021 �- - Address 340 Paulson Lake Lane, Osceola. Vile 54020-5, Eveluelxxp Jurpe 04 2021 ondu -- Telephone Number - 15 246-7767 J St -a330 (ROVI5) I Borirg s ❑ � 3 1 ® P4 Ground Surface Um t Depth to Grllptg lador 14 in. Soil Aooeestion Role rHorizon D"01 In. Dm*WM Color RWW Description Mun"I Qu. At. Cart Color rextum Struoli re Gr. St. Sti. Consistence Boundwy Roots GPD/Fe -Eflst 'EIM 1 0.10 t0yrm none W 21V mvfr `Y ca 2vf.f 0.0 0.6 2 10-17 iop" none id 2fW* "Wir 0111 ivf,f 0.4 0.6 3 17-24 7.5yr4/4 rwm tyl Imam* mvfr ON tvf,f 0.4 0.7 4 24-30 7 5yr4/4 f2d.5yT" ei 1rrUm* mvff taw 0.4 07 5 30-47 7.5yr4/4 map 7.5yr516 el Om rnh 0.2 0.6 tjonrtq ` 0 Boring ❑Pit GrwaW surface elev. Depth to lauting factor ^ in. I Sd Aooicatioe hale Dorninard Color PAdox Description Murwe* Ou Az Cont Color --low 1s70fY1q • O f�OfMlO ❑ Pit Ground surface eb__.__ v It Dep61 to lirAft factor y in. AM AnabrAtion Rate ' Effluent 01 = SOD. > 30 s 220 mgrL and TSS > 30 5 150 mg/L ' Efnuent 02 - 800. > 30 S 220 rngrL and TSS > 30 s 150 rrg/L C Lod'A A-0t3 .�:/ wt/sa6d:// pelt • Loc.��.-.P.st�td'i �.�1ers 044wso.% ,�•.�+yT•ftst E,r•3�•� f/s.r.E�n .tdy.iF •l7,sa' F+....eGa6rM, fri�if�+� t*.e6. btaJ.wdwwr a:p. WAS MS.33 � r i i ,gwdgiL,./ofa 2I3 (6e�j0%ned %r►Eo w S! !( /Aare/ fal+ wJ.+ti tAC We ivaC rc dots%ng i spar 454534.4 7b � �x�jFna v,.� - res�.�b•� r � • ti f6.I�A!•' ' � � of/d 1lnR o 5*4 Ott t � 1 ` lt004 �I 6 3 aF? ST. C R O IU NTY SANITARY SYSTEM File #:Office Use Only OWNERSHIP/ADDRESS FORM cr awZI"21 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. OWNER/BUYER INFORMATION Owner/Buyer Kurt Peterson Mailing Address 492 233rd St v City/State/Zip Baldwin, WI 54002 Phone Number (required)715-579-5050 Email Address Parcel Identification Number 008-1024-90-205 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location NW /4 , NW 1/4 , Sec. 09 . T 28 N R 16 W, Town of Eau Galle Subdivision Plat: Lot Z 3 Certified Survey Man # 1030995 Volume27 Page #6224 ( Warranty Deed # 1139129 f 10 3(3 0 Y (before 2006)Volume . Page # Number of bedrooms 4 Spec house 0 yes ■ no Lot lines identifiable ■ yes 0 no OFFICE USE ONLY New Property Address Kl)�_ (Verification of new address required from Community Development Department for new construction.) (Staff Initials) (Date) This form must be submitted with all Private Onsite Water Treatment System (POINTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey mop if reference is made in the warranty deed. Community Development Department — Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cdd@sccwi.gov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi.gov Wvision in ices I Page 1 of 3 Division of I SOIL EVALU�'!P;�RT J UN 17820211dance with SPS 385, Wis. Adm. Code County St. Croix Attach complete sit plan orSpaQgb1 inches in size. Plan must inGude, but not limited to: v rtiab"bpf(iBM), direction and percent slope, Parcel I.D. scale or dimensions, noce to nearest road. 008 1024-90 205 & 008 1024-90 230 Ref #2625 Please pint all information. sewed by I [3at.L Property Owner Property Location ❑ Peterson Family Trust - Dennis Peterson, Executor Govt. Lot NW %. NW '/4 S 09 T 28 N R 16 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# i 492 233r° St. 02 & 03 Na CSM Vol. 27, P . 6224 City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road Baldwih WI 54002 715 338-2482 1 Eau Galle W Ave. ❑ New Construction Use: ® Residential/ Number of bedrooms 4 Code derived design flow rate 6000 GPD ® Replacement ❑ Public or corn r�rcaa.aI — Describe: Parent material Glacial till 5" Flood Plan elevation if applicable na ft. General comments and recommendations: Silt suitable for mound POWTS. Recommended infiltrative surface elevation to be 93.75' at 12" above 92 75' contour. ` ^✓ ,/ r I 1 I Boring # {'- Bonn LJ ® Pit Ground surface elev. 93.00' ft. Depth to limiting factor 25" in. l Horizon Depth In. Dominant Color Munsell Redox Description Qu, Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft' •E1f#1 "Eff#2 1 0-9 10yr3/6 none sil 2fgr ds as 2vf,f 0.6 0.8 2 9-13 10yr4/4 none sG 2fsbk mfr cw lvf,f 0.4 0.6 3 13-25 7.5yr4/4 None $1 1msbk mvfr cw 1vf,f 0.4 0.7 4 2 35 1 7.5yr4/4 f2d 7.5 r5/8 sl 1msbk mvfr c W 0.4 0.7 5 35-45 7.5yr477 m3p7.5yr5/8 sl Om mfi 0.2 0.6 2I Boring # ❑ Boring ® Pit Ground surface elev. 91_32' ft. Depth to limiting factor 25" in. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft' •Eff#1 _ -Eff#2 1 0-8 10yr3/4 none sil 2fgr mvfr cs 2vf,f 0.6 0.8 2 8-13 10yr4/4 none sG 2fsbk mfr cw 1vf,f 0.4 0.6 3 13-25 7.5yr4/4 none sl tmsbk mvfr cw 1vf,f 0.4 0.7 4 2540 7.5yr4/4 f2d 7 5yr5/8 sl 1 msbk mvfr 0.4 0.7 Freimnr Al v ann n "an < win m../I �.W Tee , ah < 1 an --a • cm.-__, ._ .1n - en - inn __n CST Name (Please Print) igna re CST Number James K. Thompson 30021 Address Dale Evaluation Conducted Telephone Number 340 Paulson Lake Lane Osceola, WI 54020-5413 June 04, 20; 1 715 248-7767 JtlU-mmu (K04f15) .;r, Ong# ❑Bonng �� ® Pit Ground surface elev. 92.53' ft. Depth to limiting tiD Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 w •Ef i •EfW2 1 0.10 10yr3/6 none sil 2fgr mvfr cs 2vf,f 0.6 0.8 2 10-17 10yr4/4 none sd 2fsbk mvfr cw lvf,f 0.4 0.6 3 17-24 7.5yr4/4 none sl 1msbk mvfr cw 1vf,f 0.4 0.7 4 1 2 30 7.5yr4/4 f2d.5yr5/8 sl lmsbk mvfr cw 0.4 0.7 5 30.47 7.5yr4/4 map 7.5yr5/8 sl Om mfi 0.2 0.6 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. _ ft. Depth to limiting factor _ in. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots n� La lI! W GPD/Ft2 •Ef1#1 'EtfaX2 I I Boring 0 El Boring ❑ Pit Ground surface elev. Depth to limiting factor Q in. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots IA ~I f LW GPD/Ft2 TM •Eth{2 Effluent #1 = BOD, > 30 S 220 mg/L and TSS > 30 s 150 mg/L ' Effluent #2 = BOD, > 30 S 220 mg/L and TSS > 30 5 150 mg/L a e" sb-h-I �— ajeY ,Lot.L 4.oE3 // e/t/GtaL•en Pi•t 19'Y .+ yvK d a I&A • Lo /orep.56Lei EtiJd%r� E/cfisfen at'�pof Ssu+a'`'� 97,e0 i'E on, Efi�-s£MJ Sb�e l,�,oyr-c to.C� btabendn�� arp. asm Ms.33 i /-o+ES 2 { 3 6e4o,AGd ; r) 60 a S;^,' c c(tal �nby,c%:n .�� e�dt iSSKG �G �o t{�P�sF+escJ pOta)9S Crosslc on-& Lot3. i i t t e.• � �dr � �� AJi4MWiI.6r; EXi3l^�j f 6ta 0,dor,ed 'v QspcY QSRs3eCi33 � tx�Sfn�FcHawr -toEd I y+� of/d 3c. I 1 \ � ,I \i y9'ybP� rhea /. •ram l ` � I �-3of3 STATE S OWNER ilAAM k ei el" TI PLUMBE TOWN THIS PERMIT EXPIRES NO. 644741 PERMIT MENEM PREVIOUS NO. BLOCK Or SUBDIVISION ISSUING OFFICER CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow Installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations In force on the date of approval. (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not impair the validity of it sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may Impede renewal. (f) The sanitary permit is transferable. History: 1977 c.168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. - DATE eA UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (RI1/20)