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010-1073-90-000
ST. CROIX COUNTY ZONING DEPARTME AS BUILT SANITARY REPORT ���� Owner Property Address �l0 / �'"' '�' t '' a9� ,f- City /State '9i4- d �,r� ti G✓L 5 1,4 0 o z - - � ST c*olx h couNTY ZMIt4GaFFIM Legal Description: ,� < y Lot Block Subdivision/CSM # +.I S� '/< Sr ' /�, Sec. 3� , T 3� N -R /� W, Town of �C�d PIN # J/D SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer /yiow��ftch Size ST/PC /0P Setback from: House/ Well P/L po Pump manufacturer Tyr -, Model ;bO Z5 Alarm location Pweo-vT (HOLDING TANKS ONLY) Setbacks: S c o d Vent to fresh air intake Water Line Meter location Alarm loca ' n SOIL ABSORPTION SYSTEM Type of system: P Width Length Number of Trenches Setback from: House a5 Well /aDt P/L �' Vent to fresh air intake ZS ELEVATIONS v- Description of benchmark ° `�'�� �°D " ®' /i`�% STfv Elevation Description of alternate benchmark Elevation / 0- 7 , 7/3 9G , 7 T Outlet PC Inlet 1 S Building Sewer ST/HT i nlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines Bottom of System Final Grade O O ( ) Date of installation &///1 Per it number State plan number Plumber's signature License number //0 / Date 71 Inspector Complete plot plan NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW i 1 I I 1 ZS ► ► to y l INDICATE NORTH ARROW < Y Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-: ST. CR IX Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 344536 Per i i �,�la�p� JERRY ❑ city A L D Town of: State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Ni Parcel Tax No.: 010 - 1073 -90 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �,�1 -- � f- p Benchmark S' , too , o r Dosing r-- (, n, yy f �6 /.01.3 Aeration Bldg. Sewer 7,4 2.' q 7, Holding St /Ht Inlet TANK SETBACK INFORMATION 5 TANKTO P/L WELL BLDG. Vent to ROAD B+ -Jet Air Intake Septic > )rte 3 r NA Dt Bottom 1. Q2. Dosing `` �` u S r NA Header /Man. Aeration NA Dist. Pipe /•�O� X03 . o Holding Bot. System V 2- PUMP/ SIPHON INFORMATION Final Grade Manufacturer ` emand �(,vVe.� 5 ,06 �g Model Number W 2 s V�& GPM TDH Lift �p.Y I Frictii nq j, Systems TDH 3,y4 L oss r Forcemain Length ( ` Dia. Z " Dist. To well SOIL ABSORPTION SYSTEM Width / Length i No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I N I DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK CHAMBER INFORMATION Type Of model Number: System: M L 2 S 7 /w OR UNIT DISTRIBUTION SYSTEM Header / Manifold << Distribution Pipe(s) / « x Hole Size x Hole Spacing Vent To Air Intake Length ia. Z Length 'ZO Dia. 2 - Spacing ��V ►�� SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only x Seeded/ Sodded xx Mulched Depth Over Depth Over xx Depth Of x Bed/ Trench Center Bed /Trench Edges Topsoil E] Yes [I No F] Yes E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: EMERALD 30.30.16.450B SE SW 2104 130TH AVENUE ®SA . Plan revision required? ❑ Yes No Use other side for additional inform tion. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: E m t e. s i i { { _ .. ............ ,,..... ,,, .. {.. ....,,._ ,. ..,... �..,._. , . .�.... .,� «ma ..,�,,.....,. ..... ,. ... . ., ..., ,., �.. ,., .... {. _ .n. t e { € F { j e e� E e { e d 3 d { .... .,w., e a ........ � e , vew , rz ,. .»... .,.. e.,.. ,.m S.. .... ,..w.,. ,: �... , _, v. A d i S . a t r { r� v { ? S s, , r e e. € i 3 e„ . amp ., { ®� ,e a �ma e Q i .me .{.,.... WO a s a ¢ r 7 t E { { ,.e a { i T Safety and Buildings Division S ANITARY PERMIT APPLICATION 2 01 W. Washington Avenue Visconsin In accord with ILHR 83.05, Wis. Adm. Code P O Box 7302 Department of Commerce Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. 5r �/ C / v • See reverse side for instructions for completing this application State sanitary Permit Number Personal information you provide may be used for secondary purposes [] Chec3reGisi�o�n v pr s�?..tion (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATIQN INFORMATION - PLEASE PRINT ALL INF RMAT! N Z S 2 Property Own r Name Property Location �� /- s = � 1/4 <,W 1/4, S _fe T 3a r N, R /(, E (or)& Property Owner's Mailling Addr Lot Number Block N u�er X11) 1 1� Cit,y4tate Zip Coe Phone Number Subdivision Name or CSM Number r oim tvL 6 7 400 ;2- ( 62 II. TYPE OF BUILDING: (check one) ❑ State Owned ❑ C it y Nearest Road Public 1 or 2 Family Dwellin -No. of bedroo ❑ Town or�E � III BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 010-10 1 ❑ Apartment/ Condo • 3 ° - 1 -1 - 0� 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash S ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ❑ New 2. (w Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System______r ystem____ _________TankOnly______________ Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 In Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 43 Vault Pr Pi ❑ 13 E] Seepage t 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Requ ed (sq. ft.) Proposed (sq. ft.) (Gals/da /sq. ft.) (Min. /inch) Elevation >r S�QD o Q�r3� Feet /05 Feet VII. TANK in Capacit allo Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturers Name Concrete Con - Steel glass Plastic App New Existin structed Tanks Tanks r � Septic Tanker g.Taak l DDC� o1 7=P ID ❑ ❑ 1 ❑ 1 ❑ ❑ Lift Pump Tank /$+haa.Ch=hpr & ago ILL( ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility fjinstallatjpin of the onsite sewage system shown on the attached plans. Plum be ' ame: (Print) Plumbe "s i a o Stamps) MP /MPRSW No.: Business Phone Number: AKP13 94 1 4 Plumber's Address (Street, City, St Zip Code): 15 01 70 S' !' �,-5 -/0 fo GJ.t 7 J`/ IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate ssu Issuing S n ur (No Stamps) Surcharge Fee) 40 '7 proved ❑Owner Given Initial bC� /�� Adverse Dete rmination *j X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R .11197) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber w INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. _The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safev and Buildings Division, 608- 266 -3151. To be complete and accurate this sanitary permit application must include: L Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type.of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. , VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vill. Responsibility statement. Installing plumber is to fill"in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. Safety and Buildings 2226 ROSE ST LACROSSE WI 54603 -1905 - TDD #: (608) 264 -8777 ,sconstn www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary June 23, 1999 CUST ID No.139462 ATTN.- POWTS INSPECTOR ZONING OFFICE TODD L SINZ ST CROIX COUNTY SPIA E5612 708 AVE 1101 CARMICHAEL RD MENOMONIE WI 54751 -5520 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 06/23/2001 Identification Numbers Transaction ID No. 232599 Site ID No. 161586 SITE: Please refer to both identification numbers, Site ID: 161586 above, in all correspondence with the agency. St. Croix County, Town of Emerald SE1 /4, SW1 /4, S30, T30N, R16W Facility: Jerome & Judy Kamrowski FOR: Description: Mound System - Three Bedroom Residence Object Type: POWT System Regulated Object ID No.: 475330 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Slats. • 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. Slats. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 06/14/1999 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 erard M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)785-9348, Mon- Fri, 7:15 AM - 4:00 PM jswim @commerce.state.wi.us Wi1♦'�I cow p7b3 Sf, Jerry and Judy Kamrowski - Mound Transaction # Location: SE 1/4, SW 1/4, Sec. 30, T 30 N, R 16 W Town: Emerald County: St. Croix Date: May 18, 1999 RECEIVE[) JUN 14 1999 Owner,: Jerry and Judy Kamrowski +��,�, & BLQGS Address: 2104 13 0th Ave . DILL. Baldwin, I 54002 Plumber: Todd Si Signature: License # MP 139462 Attachments: 6748 -Plan Review Application SBD 8330 SBD -7615 Easement i page 1: cover - Co 2: calculations � ME `p,Ncs 3: plan `, `��ENA 4: s Y stem cross section ps�p� sA 5: plan view, lateral detail o�5i0 ©�NGE 6: pump tank exit detail 7: pump curve page 1 of 7 • " syst ®m calculations One family residence bedrooms Loading rate gallons /sq ft per day Depth to ground water in Depth to bedrock ' 3 in Cross slope % Force main length ° ft of Z in Manifold /header length N ft of in Drainback 1 gallons Lateral length 1 @ R 0.0 ft of Z in • s� ft bottom of pipe) Lateral elevation ( P P ) Lateral hole size X14'. in @ in ( 5 ' 0 ft) spacing pct holes /lateral, ` q holes total Lateral volume ` 4.-:�6 gallons Total lateral discharge rate Z Z ' 2 gpm @ Z '� ft head Elevation difference '� ft Friction loss 0' q °l ft @ gpm Total dynamic head 4 ' S ft i Pump /siptVn � gpm @ 1 � ft of head Manufacturer Model # . S Dose voluTe } l' 3 gallons f a llons Lift /si�on tank 9" Septic tank ~ �� gallons Measurement pump on & off q ' �O in Height alarm from tank bottom in Reserve capacity �°'� gallons calcs page of , 3 ¢.ter a. ��.Q ,Lawro•+ -Stc:- ���,s J 1��. Z10 \3. A..t Oto-1o�T•�I� All N S w.v r co i , S`* " ,o.�,;t�.a 31.x. �� `" S ti o• 1 S.o- �r.:•� koR.c�e �o r� �••0 1 b'� �o �So: CL l I ?o �� b S o��o`y �uo.b•g4.q �. to� � �I•1rwQ.► � � � L �4yo 1 '�O .J 6l 2�.�• IfL � s.b �•. •io� ..�A: �v\ }(� l3�'� 4 6 a 1. ") Cl VZ/ N o � 3.1 � S�i-�o ...� ��� �'"1 "/ +�-Q'1 a �•.4,r � � �- � �- � � oL � ' S t1 S '1��t.w► �'v-o 4 S• � '�, � }: ova reC 46 0vtw 4X4.v, tQs.v, 1 Lo A w►ta.�l ` \ �o S ..� c o :1 1 ..,..... t wo.b--c4.q 3 2 26.1 - %O w `` _ o l J�� "Al a t — 30.x` dr L "SA . .� ..r p; 4 PV.0 c... .� 01o� :a.bv.�'F�u -. •....`LL �.. vJoo� -. o f r.c.1r. b�, N.�.. l.� �,...a fi n,,,,,.a..,..�s z. s' ow, a.S►, o s r 0-\ l IP 1 I T �A i I � .. .1. ....' _ _ ' .. T Y e t AA. CJL. N-) g-A- .5 Roaa- ir FA ^I f4 " wE,,naEapaouF LOCKING * COVER JU NCTION &4c QWCK W+1C.O�IVJeCT�"1 4" C.T. %vd%p rwl pvtMw(# cl� c� .I. PIV+E 3' TO NDI6TURaD L 24" I.D. V9 WT 13EI�M/ M/ytIaOLE MIN. BiMS _ _ 2 0 LV+�Q A C.2. Pw :KET .—Ira BAFFLES � AL 3' owro Dt/i► ON — wlolszv wr ECT101ii � j GaoI+�O p b" Co�vueFrE . �.FV 6r,oCK SEPTIC t SPEtl DOSE TAWKS MAnIUFACTURCR: � � ~� WUMbER OF DOSES: PER 0" TAWK SIZE: � `�' L° � "L.LONS DOSE VOLUME "3 ALAKn MA►IUFACTLIIRCR: 4L" C- IAICLUDIIJ& OACK /LOW: GALLONS MOOCL WUM4[R: °1 H w CAPACITIES: A= 1o•Q� wCH[S OR 4 6 ' q GA LLOMs SWITCH TUrc: �"`�'`"" g = L INCHES OR l4 GA LLO WS PUMP MAMUFACTUR ��"` k C• ct ' I ° INCHES OR 11,3 CALLOUS MODEL )JUMPER: `S 2'S 0• (-, INCHES OR A � Z GALLOWS SWITCH TAPE: MOTE: PUMP AWD ALARM ARE TO DC MI DISCKAR" RAT 2 6 r INSTALLED O 5EPARATE CIRCUITS VERTICAL DIFFEREWA DETWC[W PUMP OFF AUD 013TM ISUTIOIJ PIPE.. 11 1 FEET + MIAJIhIUM NETWORK SUPPLY PRESSURE ... . . .. . . . . 2 5 FLET ♦ �� FEET OF FORCC MAIN X t WoortFRICTIOW FACTOR. A ._'c FEET TOTAL DJWAMIC HEAD = 1 � FEET IIJTERAIAL, DIMEN6tOAJt 0/ TANK: LEM(PTH ._;WIDTH ;LIQUID DEPTH 1� lb Performance Data Pump Charac teristics 32 Pum /Motor Unit m s61e Manual Models SW25M1 SW33M1 d L 24 Automatic Model SW 25A1 SW33A1 Q 1/3 HP x Horsepower 1/4 1/3 f 16 Full Load Amps 8.0 10.0 1/4 HP Motor Type Shaded Pole (4 pole) R.P.M. 1550 o e Phase 0 1 Voltage 115 0 1 1 1 1 1 Hertz 60 0 10 20 30 40 50 60 CAPACITY -U.S. G.P.M. Operation Intermittent Temperature 1201 Ambient Total Head (feet) 4 6 8 10 12 14 16 18 20 22 24 NEMA Design A 1/4 HP 44 41 36 33 29 26 23 18 12 6 0 Insulation Class A GPM 1/3 HP 47 45 43 40 37 34 30 26 22 16 10 Discharge Sue 1 -1/2" NPT Solids Handling 1/2" Dimensional Data Unit Weight 30 lbs. I. All dunensans n inches Power Curd 18/3, SJTVI1, I W std. 3-1/2 5 -7/8 2. Component din easious may (,�, � ) 4 -i/2 --{ ray t mn inch 3. Not fa caehuction purpae 1 - 1r2 NPT unless certified A3-L1/2 DISCHARGE q Dimensions and rnighA are Materials of Construction opp<o Boa S. OR/Off level adjustable Handle Steel 6. We reserve do right to Lubricating 09 Dielectric Oil mode mrisiom to ow produm and their Motor Housing Cost Iran s oWns noke Pum Casing t Iron Sha ft Mechanical Semi Foos: Carbem /Cert m k -. Shah Seal Seal Rodp. Anodized Steel Sprimg: Stainless Steel _'"W, B. -N PUMP 11 -tr8 10.1/8 ON Impell std 9 -1/2 upperBearing Bronze Sleeve IGG&I DISCHARGE HEIGHT Lower Bearing Row Bab Bowing f __T Strainer /8050 Plastic 3 3 -1/2 PUMP FF Fasteners Stainless Steel O • AURORA /HYDROMATIC Pumps, Inc. 1840 Bartley Road, Ashland, Ohio 44805 419 289- t ) 304 2 4Wiscomin Department of Commerce SOIL AND SITE EVALUATION Page I of 3 - _ Division of Safety and Buildings _ - if`i accord with Comm 83.05, Wis. Adm. Code Certified Soil Testing Attach complete site plan on paper not less than SY2 x11, ihcbei Wize. Plan must Count include, but not limited to: vertical and horizontal reference point (BM), direction and y St. Croix percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. — - -- -- APPLICANT INFORMATION - Please print all information. Parcell.D.# 010 1073 - 90 R -- -- - -- Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Wt9---- Property Owner Property Location el Kamrowski, Jerry & Judy Govt. Lot SE 1/4 SW 1/4 S 30 T 30 N R 16 W Pro Owner's Mailing Address Lot # Block # Subd. Name or CSM# 2104 130th Ave. City State Zi Code PhoneNumber ❑City Villaga ®Town Nearest Road Baldwin WI 54002 715 684 - 5575 Emerald 130Th Ave. New Construction Use: ® Residential / Number of bedrooms 3 ❑Addition to existing building ® Replacement Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate • bed, gpd/ft 6 trench, gpd /ft Absorption area required 900 bed ft- 750 trench, ft Maximum design loading rate • bed, gpd/ft • tr ench, gpd /ft Recommended infiltration surface elevation(s) 102.35 ft (as referred to site plan benchmar install 4'x 95' rock bed mound on 100.6 - 99.9 design line as upslope edge of rock w/ 1.75 +' sand fill & Additional design / site consideration easement from t Parent material loess over till Flood plain elevation, if applicable NA ft S= Suitable for system Conventional Mound In - Ground Pressure AT Grade System in Fill Holding Tank U= Unsuitable for system El ®U N S U ❑ S N U F1 N U C; S N U L S U Depth Dominant Color Mottles Structure GPD /ft Boring# Horizon in Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consisten Boundary Roots - - - -- Bed Trench 1 F,: 1 0 -6 IOYR 3/2 - sil 2 f sbk ds cs If/m .5 .6 2 6 -16 10YR 5/4 - A 2 f sbk mvfr cs lm .5 .6 Ground 3 16 -22 1 OYR 514 fl d 7.5YR 4/6 A 2 m sbk mvfr cw I m .5 .6 elev 100.1 ft 4 22 -32 7.5YR 5/4 f2d 7.5YR 5/8 is 1 m sbk dsh - - .7 .8 Depth to limiting -- - - -- - - factor Remarks: �t 1 0 - 10YR 3/2 - sil 2 m cr ds cs If/m .5 .6 2 3 -10 r 10YR 3/2 - sl 2 f sbk ds cs lm 5 .6 Ground 3 10 -16 IOYR 5/4 - sl 2 f sbk ds cs lm 5 .6 elev -- - - - -- _ 99.9 ft _ 4 16 - 26 10YR 5/4 fl d 7.5YR 4/6 sl 2 m sbk mvfr cs IM .5 .6 Depth to 5 26 -36 5YR 4/4 - scl 0 m dvh - - NP .2 limiting factor Remarks: CST Name (Please Print) Signature: Telephone No. Henry F. Grote 'x,715-6 one No 1 Address ertm to om estmg # i - -- -_ — Da te CST Number Ref P.O. Box 57, Knapp, WI-54749 12/5/1998 222774 1078 PROPERVY. OWNER: Kamvowski, Jerry & Judy SOIL DESCRIPTION REPORT ® p 2 Of 3 PARCEL LD.# 010- 1073 -90 Certified soil Testing P GPD/ft2 De th Dominant Qu. S Mottles Color Gr. zt Sh. Boundary Roots i— __ _ - Horizon Texture onslstence Bounda BeddT Trench 3 1 0 -3 10YR 312 - sil 2 m cr ds cs lf/m .5 .6 s -_• 2 3 -10 1OYR 3/2 - sl 2 f sbk ds cs lm .5 .6 Ground Gro Gro 3 10 -16 lOYR 5/4 - sl 2 f sbk ds cs 1m .5 t . 12d 7.5YR 579 elev 100. It 4 16 -28 IOYR 5/4 7.5YR 5/3 sl 2 m sbk mvfr cs lm .5 .6 Depth to 5 28 -38 5YR 4/4 - scl 0 m dvh - - NP .2 limiting _ factor 16 " - -- - - - -- - -- I Remarks: - Ground elev Depth to limiting factor ups ope toe will encroach about into town right of way so an easement rom fFie town will tie needed fo do so J previous wor on i par MEMO s1 u o us w similar sons o is repo (limiting factors - Remarks: c me on east will terminate 25+L-from- housc -- - - - - -__ _ Ground elev Depth to limiting - - - -- - -- - factor - Remarks: Ground -- — - - - -- - - - - - -_ _ - - -- -- _. elev Depth to limiting factor - - t - - -- _ Remarks: __ r' - S Z. \ok 15� a�- O►�o- lo��•�t..� S is • Sw lo - I to �..� a„�..e T'1►t Z t1 Z•�t 1 0 dLi.r \ t I + � A Rah (.! 00.4) O.V. V , q #I.,� R CS q� V ca C k s 1� a'� �,,.�.�. � S d �a,,,,,�,. I Ski s �•a,. � 1 +o .o � - 6e1 CS � o� 3 Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page I of 3_ - Division of Safety and Buildings 83.05, Wis. Adm. Code Certified Soil Testing Attach complete site plan on paper not less t 7nt i rm( an must County include, but not limited to: vertical and horizonta referonoe M)ion and St. Croix percent slope, scale or dimensions, north arrow � nd distance to nearest road. ' \ oo (,., Parcel I. D.# 010- 1073 -90 APPLICANT INFORMATION - P s' prttrill' atl >!rrform tlon. - Personal information you provide may be Us =06rdary py(" (Pdvft-k W* s. 15.04 (1) (m)). view By Date T(1 `i �, G L. Property Owner � �` " . ti Property Location Kam rowski, Jerry & Judy I . Lot SE 1/4 SW 1/4 S 30 T 30 N R 16 W Property Owner's Mailing Address' ` ' F ! i lot # Block # Subd. Name or CSM# 2104 130th Ave.i,- City State City n Village ®Town Nearest Road Baldwin WI 5 602 =3575 " Emerald 130Th Ave. New Construction Use: ® R;skiebtial l' Nun rooms 3 [ to existing building ® Replacement F Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate .5 bed, gpd/ftz .6 trench, gpd/ftz Absorption area required 900 bed, fts 750 trench, ft- Maximum design loading rate .5 bed, gpd/ft' .6 tr ench, gpd/ft' Recommended infiltration surface elevation(s) 102.35 ft (as referred to site plan benchmar insudl 4'x 95' rock bed mound on 100.6 - 99.9 design tine as upslope edge of rock %v/ 1.75 +' sand fill & Additional design / site consideration easement from tomm t Parent material loess over till Flood lain elevation, if a licable NA ft le for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank table for system El U ® S❑ U El Z U ❑ S X U ❑ S Z U ❑ S X U Depth Dominant Color Mottles Structure GPD/ft Boring# Horizon in Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. C Boundary Roots --- --- - - -- Bed Tr enc h ench 1 1 0 -6 1OYR 3/2 - sil 2 f sbk ds cs lf/m .5 .6 2 6 -16 1 OYR 5/4 - sl 2 f sbk mvfr cs 1 m 5 6 Ground 3 16 -22 IOYR 514 fld 7.5YR 4/6 A 2 m sbk mvfr cw lm 5 .6 elev - - -- - - - - -- 100.1 ft 4 22 -32 7.5YR 5/4 f2d 7.5YR 5/8 is 1 m sbk dsh - - .7 .8 Depth to limiting - -- -i - - -- -- _ -- factor - -- -- Remarks: -- - -- - - -- - -- - -- - - - £; = 1 0 -3 l OYR 3/2 _ sil 2 m cr ds cs 1 f/m .5 .6 2 3 -10 10YR 3/2 - sl 2 f sbk ds cs l m .5 .6 Ground 3 10 -16 im 5/4 sl 2 f sbk ds cs 1m .5 .6 elev — 99.q fit 4 16 -26 l OYR 5/4 fld 7.5YR 4/6 A 2 m sbk mvfr cs I m .5 .6 Depth to 5 26 -36 5YR 4/4 - scl 0 m dvh - - NP .2 limiting -- -- -- factr 16 . Remarks: CST Name (Please Print) Signature: Telephone No. Henry F. Grote 71 665 -26 81 Address Certified of esttng D to CST Number Ref # P.O. Box 57, Knapp, WH 54749 11/511998 222774 1078 =rte; PROPERTY OWNER: Kamrowski, Jerry & Judy SOIL DESCRIPTION REPORT ® page 2 of 3 PARCEL I.D.# 010 - 1073 -90 Certified Soil Testing pth Dominant Color Mottles Structure _ GPDIft= E:!in. Munsell Q u. Sz. Cont. Color Texture Gr, Sz. Sh. onsistence Boundary Roots - -- Bed TTrench k' 1 0 -3 10YR 3/2 - sil 2 m cr ds cs 1 f/m .5 .6 2 3 -10 10YR 3/2 - sl 2 f sbk ds cs lm .5 .6 Ground elev 3 10 -16 10YR 5/4 - sl 2 f sbk ds cs lm .5 .6 100.6 ft 4 16 -28 10YR 5 / 4 7.5YR 5/3 sl 2 in sbk mvfr cs lm .5 ! .6 Depth to 5 28 -38 5YR 4/4 - scl 0 m dvh - - NP .2 limiting - -- factor 16 - Remarks: Ground elev Depth to limiting factor ups too will enmech a In o own 11Iway so aneasement om the town will be needed - to do so I Remarks: 1 u r n r parcel r i o w similar sons o is repo imp mg ac rs L is cramped fbi space but downskype cant will term Matc 25 F. Ground - - -- elev Depth to — -- - - - - - -- - - -- limiting -- factor Remarks: Ground — -- - - -.- - elev t Depth to limiting factor , I — I Remarks: • LAO 2104, 010- %o:VL• S� _ Sw _10. 3 �•1to �.a � I O ..,, M •, L �IlJ1r aJL.� P j nn ., � ]fir fir. '�` o y� Sa.. (\ yYt Z t1 7r•�• � �3 t b� {�, dCi�w / T o � !- i9 a � A RwC.� w►•�� (,S w�.v5 Cl Z,.A,• YiK eAw w. �a+� �et •t f a -� �o `B 3,1 p z��.�o «..� ��� �► "Y a�-s a r.a. � � -+�.�. � ...., Safety and Buildings 2226 ROSE ST lA CROSSE Wl 54603 -1905 Visconsin Tommy G. Thompson, Governor Philip Edw. Albert, Acting Secretary Departm o Commerce October 09, 1998 CUST ID No.267341 ATI'N.• Rod Elsinger WEGERER SOIL TESTING & DESIGN ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 10 /09/200 — Identifica #ion Numbers Transaction ID No. 181149 ECEIVED Site ID No 161586 SITE: cr 7 r Please refer to bout �d �ntfficatton xlurxlb R exs,; Site ID: 161586 above, in ail correspondence with the St Croix County, Town of E era d ST Cqp� 19 98 ry a en SE1 /4, SW1 /4, S30 T30N, R COUNTY Jerome & Judy Kamrowski ' ;Ce FOR: 3 '�4 Description: Mound ?� Z Object Type: POWT System Regulate o.: 429392 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Adm. Code. • 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(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation /operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 10/02/1998 FEE REQUIRED $ 200.00 DENNIS R SORENSON , WASTEWATER SPECIALIST FEE RECEIVED $ 200.00 Field Operations BALANCE DUE $ 0.00 (608)785-9336, MONDAYS 7:OOAM- 3:45PM DSORENSON @COMMERCE. STATE. WI.US Page of 6 MOUND SYSTEM FOR A BEDROOM RES S `� �'�► ��.. �S 1 61J �p - PU � S B D l �.1�1 LOCATED IN THE Sa 1/4 OF THE S W 1/4 OF SECTION 3D ,T 3u N, R W, TOWN OF !&T - <t" L,4 COUNTY, WISCONSIN. i INDEX ; s PAGE 1 •of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW -CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CHAMBER PA GE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR a Mk b SUDS•( � vwSk z1Oy 130 TH 6VE�Jvta Q � �-- � W i N , l�.� ► S Ll OU Z PREPARED BY WESEFR FZ S; C3 S L TEST I p-4 C-3 `SAFES AND. IDES z Carte \1 CcON���' F.O. BOX 74 421 K. KAIN ST. Cril •~ RIVE. FALLS. V1 54022 ARTHUR L 715 -4225 -4165 w o-s E S p BILSVV�iF "' 1 G�� JOB NO. - Page Of - Approved Synthetic Covering C- 33 Distribution Pipe Medium Sand H s= G Topsoil -- - =_= F Elev. 10Z_C) 3 E " b S % Slope Bed Of ',-"-2 2 Force Main Plowed Pf`IVATE SEWAGE SYSTEM Aggregate From Pump Layer Conditiona D Z -o Ft. APPR OVED Cross Section Of A Mound System Using E - Z , V Ft. DIVISION OF SAFETY AND B F 0 - b Ft . t111�DIN8S A Bed For The Absorption Area G 1-0 Ft. A T-) Ft. H l.S Ft. EE CORRESPONDENCE g 7 9 Ft. )near Loading Rate= Q:5 GPD /LN FT Design Loading Rate= p•q.GPD /SQ FT Ft. 10 Ft.. K _ Ft. L 1 �3 Ft. 1�a nn W - 14 Ft . L r 711 0 TOb servation Pipe —,,,\ - - - - K - -- --- - - - - -- - - - --• Force Main W ° ------- —� ----- - - - - -- — - - - -- I Distribution Bed Of 2 . � „ - 2 z Pipe Aggregate Observation Pipe Permanent Markers (Anchor securely) Plan View Of Mound Using A Bed For The Absorption Area Page �" Of 6 Perforated Pipe Detail 0 End View Perforated End coo. PVC Pipe Install permanent 'marker - ° o� ° at end of each lateral Notes Located on Bottom, Are Equally Spaced i Q S PVC Force Main e PVC `" 1 Manifold Pipe Distn ution Pi e Last Hole Should Be I Next To End Cap End Cap P 3 p Ft. Distribution Pipe Layout S 9 Ft. PRIVATE SEWAGE SYSTEM X L1$ Inches Conditionally Y Inches Hole Diameter y Inch APPROVED Lateral " PIV Inches DIVISION OF SAFETY AND BUILDINGS Manifold Z Inches Force Main " Inches SEE CORRESPONDENCE # of holes /pipe $ Invert Elevation of Laterals -S Ft. VV r _ I Place lst hole ZV u from center of manifold with succeeding holes at LIt intervals. Last hole to be next to the end cap. PUMP CHAMBER CROSS SECTIOW AMU SPECIFICAT'ICIMS PAGE s OF 6 VCUT CAP H "C.I. VEIJT PIPC WEATHER PROOF APPROVED LOCKING MANHOLE JUIJCTIOU BOX COVER WITH WARNING LABEL 1 O' FROM DOOR• it mu. WINDOW OR FRESH AIR IIUTAKE Cr R_ DE A i y'MIIJ. z q G t � � le•i+uu. COQDUIT PROVIDE I - - ---- . IIULET � AIRTIGHT SEAL 11 v Tank construction shall comply I I APPROVED JOIN APPROVED JOUJT A P Y I with ILHR 83.15 and ILHR 83.20 i i�) ALARM I I I I ON C f i - - . 4i 6 •.9 I LLEV. FT. PUMP i � ° ,� OFF 0 85 o COUCKET[ BLOCK 'J 3" AAPRovsc RISER EXIT PERMI - fED OMLy IF TANK MANUFACTURCK HAS SUCH APPROVAL gEpplµG SPECIFICATIONS DOSE TANK MAIJUFACTURCR : w1 Clll.1L �2 �3 . HUMBER OF DOSES 3' °Z PER Dhu TANK bIZE: 2'SD GALLONS DOSE VOLUME t 3zo.0 S,S.CL .O SjS`T�LS INCLUDING DACKFLOW: GALLONS ALARM PAWFACTURfwR: I MODEL AIUMBER' l� } w CAPACITIES: A= 1 I WCHES OR 5 �" y GALLONS SWITCH TYPE: 1`1 C.l1�Z' 5= Z IIJCHES OR 53.3 6rLLOWS PUMP MAIJUFAGTURCR: Z Q �L'L-� C _ \ Z IIJCHES OR 2 GALLOWS MODEL NUMDER: � 6 S D= N INCHES OR 3ZU,0 GALLOWS `ti = 1 7_66. - 7 SWITCH TUPE' �Z�`�� MOTE: PUMP AND ALARM ARE TO D E MINIMUM DISCHARGE RATE 3 GPM INSTALLED OU 5EPARATE CIRCUITS "`'VERTICAL DIFFERE 5ETWE E W PUMP OFF AUD.DISTRIBUTION PIPE.. �b' S - P RIVATE SEWAGE SYSTEM + MIN IMUM NETWORK SUPPLY PRESSURE .. .. ..... . 25 0 Fi onditionally V FEET Of FORCE MAIN X Z "� + 4 F� �Z•6b goo FLFKICTIO►.I FACTOR.. p ROVE D .... TOTAL D!JWAMIC. HEAD = ■ DIAMETER 1X VIgON OF SUtlY Aid NRNM INTEKLIAL. DIMLW51010 i OF TAIJK: LEM&TH ;WIDTH L QUI DE T ..�.�� BOTTOM AREA — - 231 SE WW�RPONDENCE AS PER MANUFACTURER = ZC_ U7 GAL /INCH to TOTAL DYNAMIC HEAD /. 8 3/4 i Single Seal o HEAD CAPACITY CURVE FLOW PER MINUTE Automatic Design MODEL 161/4161 - 163/4163 - 165/4165 EFFLUENT AND DEWATERING 1/2 MODEL 161 4161 163A163165/4'115 I Wei '� ' FT K GN. URS. W- IV& GAS.. LTRS. . 2877 90 : ... _ ' 5 152 100 376 61 231. 61 231 to 3A5. 93 352 60.5 229 60.5 226 4 i 15 457 85 322 60 227. 605 .229 ' "24. _ `x/4165 `' zo 6.io.: 76.5 297 59 223 60 227 - , 25 - 7.62 7o, 265 57 216 59 223 .. = 21) 70 b 9.14 615 233 55 206 56. 220 -, _ 6 11/1.2 v 63 4163 40 12.19 45 170 46 172 55 205 So 15.24 20 76 33 125 50 189 1 z t6 60 1e26 is sr >a 145 .5 85 ( 1 1 /Z' - 1 1 / 1 2 1/2 18'T 0 50 70 21.34 22 r - 11 NW (OR) 80 24.35 to 38 3' - 8 NPr. 12 40 90 27.43 I TMI p 100 b.48 ~ IAGK VALVE: 56' 66' 66.5' a 20 008920 4 7 10 �� 18 9/16 I 1 '^ �� •- � '° 4� 0 U.S. GALLONS 1 10 20 30 40 50 60 70 80 90 100 110 LITERS 6 0 80 160 240 320 400 SKA374 FLOW PER MINUTE Standard all models' 20 It. cord - %H.P. 161 MODELS 4161 MODELS Control Selection Listings a - SingkSeal DoubleSear Volts Ph Mode Amps Simplex Duplex CSA UL 4 e 3/4 ' Mi61 - 115 1 Auto 15.5 1 or 1 &9 Y Y � 1/2 Ni61 N4161 115 1 Non 15.5 2or2 &8 3or5 &6 Y Ynt I D161 - 230 1 Auto 7.5 1 or 1& 9 Y Y E161 E4161 230 1 Nan 7.5 2 or 2& 8 3 or 5& 6 Y Y 4 • H161 - 200 -208 1 Alto 8.8 1&9 Y N • 1161 ' 14161 200.208 1 Non 8.8 2&8 3 or 5& 6 Y N 4 • J161 ` J4161 200.208 3 Non 6.4 2&4 3 & 4 or 5 & 6 Y Y • F161 ` F4161 230 3 Non 52 2 &4 3 &4or5 &6 Y Y I t 1/2• -11 1/2 WT r - 11 1/2 NPT (OR) • G161 ' G4161 460 3 Non 2.9 2 &4 1 3 &4or5 &6 Y Y I 3' - 6 NPT I Standard all models - 20 iL cord - H.P. 163MODELS 4163MODELS Control Selection Listings shigieseiil Doubiesear Volts - Ph Mode Amps Simplex Duplex CSA UL i I Mi63 - 115 1 Auto 15.0 1or1 &9 Y Y Ni63 N4163 115 1 Non 15.0 2or2 &8 3or5 &6 Y Y(l) D163 - 230 1 Auto 7.5 1ori &9 Y Y zo 7/1 E163 E4163 230 1 Nan 7.5 2or2 &8 3or5 &6 Y Y • H163 - 200-206 1 Auto 8.5 1&9 Y N 1163 ' 14163 200.208 1 Non 8.5 2&8 3 or 5&6 Y N 6 sKAt4,s J163 ' J4163 200-208 3 Non 6.0 2& 4 3& 4 or 5& 6 Y Y Y Y Y Y F163 ` F4163 230 3 Non 4.8 2&4 3& 4 or 5& 6 • G163 ' G4163 460 3 Non 2.9 2 &4 3 &4or5 &6 Standard all models• 20 It. cord -1 H.P. SELECTION GUIDE 165MODELS 165MODELS Control Selection I istin 1. Integral float operated mechanical switch, no external control re- SingleSeal Do"Seal" Volts - Ph Mode Amps Simplex Duplex CSA UL quired. D165 - 230 1 Auto 102 1 or 1 &9 ky variable level, float switch. Refer to FMO477. Y 2• Single piggyback variable level float switch or double piggyback E165 E4165 230 1 Non 102 2 or 2A 8 3 a 5 & 6 Y 3. Mechanical aftemator Wale 10-0072 or 10 -0075. H165 - 200.208 1 Auto 12.6 1&9 N 4. Combination starter. Refer to FM0514. • 116.5 • 14165 200.206 1 Non 126 2&8 3 or 5 & 6 N 5. See FM0712, for correct model of Electrical Alternator, "E - Pak". • Ji65 ' J4165 U5753 Non 7.5 2&4 3 4 & s Y 6. Vari able level control switch 10-0225 used as a control activator, with F165 ' F4165 Non 7.4 2 & 4 3 & 4 or 5 & 6 Y 'E - Pak" aftemator, 3 or 4 float system. • G165 • G4165 Non 3.7 2&4 3 & 4 or 5 & 6 Y Y 7 SIMPLEX CONTROL BOX 10- 0333,115/200/23OV, I Ph. max. 2HP BA165 • BA4165 Nan 3A 2 & 4 3 & 4 or 5 & 6 N N use one(1) single piggyback wide angle variable level float switch OR ' No Molded Pwy two (2) 10 -0225 variable level control switches for level control. Doawe s eal pumps are avaN* with optional tnashx sensors. Sal Fal:alctor light waftle in NEMA 1 or NEMA dx Mara panels. 8, Four (4) hole "J Pak", junction box, for Watertight connection orwired- al uL rsted um &ako;e "iii 2a i v p4. in simplex or duplex operation. 9. Two (2) hole' J - Pak"J unctionbox ,forwatertight Connection orspl ice. CAUTION For information on additional Zoeller products refer to catalog on Combination Starter, FMO514; Piggyback An Installation of controls, protection devla6 and **Ing should be done by a mad Variable Level Switches, FM0477; Electrical Aftemator, FMO486; Mechanical Alternator, FMO495; Sump/ kewede � )c Cofts - Sewage Basins, F140487; and Single Phase Simplex Control and Alarm Systems, FM0732. RESERVE POWERED DESIGN For unusual conditions a reserve safe factor is engineered into the design of eve Zoeller um � N . P P safety 9 9 III Wisconsin pnt of Commerce SOIL AND SITE EVALUATION Division of lety and Buildings Page of aurae rrcea Services S3 �tla' ; jd • , with s. ILHR 83.09. Wis. Adrn. Code Attach ow its srte plan on paper not $ i e:•Plan must Courtly include. bt :ft li mited to: vertical (8M � and s percent sk , scale or a and location and dlsta nearest road. Parcel l.t?. APPLIC, rT INFORMATION Plgase ptit 6 iPffiforma Reviewed by Date COIJNT r . Property or "f'Cl`�1 �;l.� °1rc . / Property Lwation Govt. Lot jy 114 5A)11a.8 .?G T30 M 16 E t0 Property C nee Lot!! Block# j Subd. Nance# or 0SMff w d; ?/ `et ic City State Zip Code Phone Number 0 city ❑ Village [I T ovffi Neatest Road ❑ New( Mruction Use: EgResidentfal / Number of bedrooms Addition to wMng building Roma rant ❑ PubUc or commercial - Describe: Code der J daily flow +� S - 47 gpd Recommended design loading rate 'me ted, gpd/A • - trench, gpdM Absorptic urQa required Wip ed, ft ? S wench, ft Maximum design loading rate ? _pad. gpd* - L - 4 trench, gpd* Recomm lad Infiltration surface el evation(s) /40 • ft (as referred to site plan benchmark) Adritiotta: wigntsite considerations 92 fL n , u X Parent m rial dij6.0 -a .'eY / /3 te17`rc) er - Flood plain elevation, if applicable it S = Crbie for system Conventional Mount In -Ground Pressure AT -Grade System in Fill Holding rank U= ;t&.We for System 0 s 9 u ® S❑ u El ®u [ CIS [mu ❑ s O u [Is ® u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Boats GPD,%2 Mun in. seil 4u. Sz. Cons Color Gr. SL Sit Bed , Trench 1 1 • / o -• 0 z ,,X 3 ---- -- ^ L ;9 b s 'S , .a Ground ,� y .� �. 1' fir' 2 nr 6 �'""^ • S elAv. - Depth to - limiting . factor Remarks: Boring # Ground elev. - Depth to - , tim{ting ., factor (4,,,_11n. Remarks: CST Name 'lease Print) Signature Telephone No. Address Data CST Numbet r - • r� Wisconsin Department of commerce SOIL AND SITE EVALUATION l 3 Division of Safety and Buildings � Page of Bureau of Integrated Services -6 in with s. ILHR 83.09, Wis. Adm. Code county Attach complete site plan on paper not an 8 irY;si2e:�, Plan must include, but not limited to vertical ontal (BM) " and ` percent slope, scale or dimensions, , and location and list nearest road. CYn x i `�- Parcel I.D. # ✓.�n 2 9 1998, APPLICANT INFORMATION Phase prktilphforma Reviewed by Date COUNTY Personal information you provide may be far ' 15.04 (1) (m)). Property Owner Ll Properly Dion £ Z Govt. Lot _1-;F 1/4 - j A. 1IKS 3? T go AR l6 E (orko Property Owner's Mailing Address Lot # I Bkx*# I Subd. Name or CSM# y T1 A z/ -e eD0- V.P city State Zip Code Phone Number ❑ qt ❑ Village Town Nearest Road l W,,d w, 1 ( ) 4�F I / ❑ New Construction Use: [31ZIesidential / Number of bedrooms J ? Addition to existing building Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate SS bed, gpd4F , ! trench, gpd* Absorption area required 37.s bed, ft 37 5 trench, ft Maximum design loading rate t! bed, gpolll . - trench. gpdM c Recommended infiltration surface elevation(s) /DD • 9 0 ( 01.951 r ft (as referred to site plan benchmark) Additional design/site considerations . - v v f f 9 r ' . 0. -v) Parent material Z5-4a -c /,x / 06V7 w at SGr Flood plain elevation, rf api e ft S = Suitable for system Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ S 0 U Q S El u ❑ s ®u ❑ s ®u ❑ S ®u CI S ® U SOIL DESCRIPTION REPORT Boling # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/tt2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench I 0--8 a k1 f 3 L 2 mab/rl JP ; Ground _,? y -:ZJ 7,. h y c 5 elev. Depth to limiting factor in. Remarks: Boring # 13 3 i G - �2 o PX Y'/ � s ' ,,6 I-- Ground elev. �ft• , Depth to limiting factor Remarks: CST Name (Please Print) Signature Telephone No. 4), `/l a c 4 u -, . 4 ev 7 i S-- 3FG 3l-a Address Date CST Number SG l mot! ✓ o ..1 �` �'d/ Z4 �� 22 7 C y'tJ SOIL DESCRIPTION REPORT PROPERTY OWNER Page of PARCEL I.D.# Boring Horizon Depth Dominant Color Mottles Structure 2 g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench Ground elev. Depth to limiting factor Remarks: Boring # Ground elev. ft . Depth to ' limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. Depth to limiting factor -in. Remarks: Boring # E3 Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) 0 I c htio 11 I � � k x s� �D R im / To pe,= <• Ta fr G Al,' 2A A F4 c v !00, ° 104 Y ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �� 4 rb v-) S lL L A Mailing Address _ ;Z (D ) Q ' ( <_ Property Address L i ✓► W I: 6 4 V C) - z- (Verification required from Planning Department for new construction) ICA- City /State Parcel Identification Number t o /y rl 7.3' LEGAL DESCRIPTION r Property Lccaticr. �L ; Sec. 3, T N k J i%v, "Town of C_;V' Subdivision Lot # Certified Survey Map # , Volume , Page # Warranty Deed # , Volume , Page # Spec house ❑ yes ® no Lot lines identifiable ❑ yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic syster„ has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. _��Zlg r�� 9 IGNATURE OF APPLICANT D TE 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. *-, IGNA OF APPLI ANT D E * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed Document No. PLOW E PECTION AND ENFORCEMENT EASEMENT 6.06C)Ea.S KATHLEEN H. WALSH This indenture made by Town of Emerald ST. C ROIXOCO., WI hereinafter called grantor, RECEIVED FOR RECORD conveys to the State of Wisconsin. Department of Industry, Labor & 07- 01-1999 2:20 PM Human Relations. Bureau of Plumbing, hereinafter called grantee, for valuable consideration, lumbin inspection and enforcement EASEMENT P 9 P parcel (s) of real estate in EXEMPT N rights. for the following described pa CERT COPY FEE: St. Croix County, State of Wisconsin COPY FEE: 2.00 TRANSFER FEE: iprovide i egal description or location of property) Jerry & Judy Kamrowski RECORDING FEE: 10.00 PAGES: 1 property, part of SE1 /4, SW1 /4, Sec. 30, T 30 N, R 16 W, Town of Emerald, Parc ID # 010 - 1073 - 90, about 6' into town R/R for - - -- - Return to Jam- (� V upslope d irt of mound system without interferring w/ road ditch T ro n can i i I This easement is granted as required by the grantee for the approval of a plumbing system under Ch. 145, Slats. This easement is intended to apply to any common ownership plumbing system that may result if the property which is subject to this easement is ever subdivided. The plumbing system covered by this easement is described as follows: A mound system serving the residenc a t 2104 130th Ave. w h e r e t he up d irt t w ill e ncroach about 6 feet into the town R/W By virtue of this easement, the grantor(s) and their successors in interest are responsible for the operation and maintenance of a. lawfully functioning plumbing system serving the property subject to this easement. This easement shall run with the land. If a common ownership plumbing system results from the subdividing of this property in the future, the joint owners of such a system may fulfill the obligations of this easement by joining with others to cause the plumbing system to be operated and maintained by a single entity with sufficient legal powers to levy and collect assessments for such operation and maintenance. Examples of such entities include, without limitation, a condominium association, a property owner corporation as described in s. 779.70, Stats.. a lawful private sewerage district, a municipal sewerage district or a private utility district charged with the operation of a lawful private sewage system. T he provisions of this instrument may be entorced uy any owner ui pt oper ry served by the plumbing sysien described in this easement and may also be enforced by the grantee, any successor agency, or the local governmental agency responsible for enforcing the regulations pertaining to the plumbing system described above. The rights acquired do not grant the public the right to enter the above described area for any purpose. The rights acquired do not grant the State of Wisconsin, or its agents, the right to enter the above described area except for the purpose of inspection and enforcement of said rights. Grantor(s) Name(s) (Pant) Grantor(s) Signatureis) Subscribed and sworn � before me on this date: 1111 C KICA 14 -,f 4061g aw� &L4 My commission expires: ec, 0 SBO. 7615 This Instrument we; drafted by the Stale of Wisconsin Department of Industry, Labor and Human Aetatl s, Bureau of Plumbing. IN. 01/66) �r�/s o/xnrwe��xyu roxm � - /vo� _ � � � �^0`�� oocuwswr*o. .~.-�.^'�^..~~'`�,^ ' ' Herbert Zacharias and Donna M. 7acharias, an j� .� ux.*T,^xJ °ra,onu /^ _Jerooue B~_8azozuwski and-JuditlL__- _G_._iIamzuusc1,�.jousbaod aod_���� ' ._-___-'-__ .°.smA,�E^csp~`FnFl,�A Fit 'O"owun°fA NAME ^,00Ex,°w^caocss ,xcfoov°mgu'm"»"Jw"/a"`, it) --- --- _-_�t~-C�o�u__-_--___- suuv|x"mnu^, L ' "*�'E� D,N' NcM6En'� � ` ; The Sk of 8w of Section 30, Township 30 North, Range 16 west' ILI - ` �e ` This �asementa *od restrictions of records. � Dazed /l�ls�� _day ,<__ _, ` ------------ - --- _' (SLkU $c�u -H e r, ^ _rSEAL) mcu` ^_)ouzua__ __---_--- AU IHLr;cICaTI0m aCBN0vvcsuGmENr ~ � Signature(s) State of Wisconsin, » ---------'-----�---------------�-' ------ ' /' "° = _ cuun' / � u"i»,o^�^,"u this _-__--u/,�.'r_- , w-__ n �x:,� x" 'h.^ --__~�``_--_ .h`� ,' 19-98.. the above mm, d ------------� ----'- - -'------ -- Becbe�%--__�Coc��cim�_ d Donna M. orLs. MEMBER S!.c c BAR .xx ]scoM'N � (if ou.______ ' x"m^'c'u`y»rm'w,wl' ^`lV'xn, '^�v*,Person o � T* / Na `Romcwr WAS (*~'r�ne' _tamar_&.-_Mc'nrmazle,'__ ------------� n� Wl540(L2__- wL)C�` ,yu�� _-_-_��_(-���=�co^w�v�, � � ��m��^�����^���� � � �� �n*� is � � .,.o+l ^ �=` �.u�.`*^oTp�����^��~° � I =x^ , I � ? 7 ? ƒ 0 / § ■ ; 0 { J » °� « I x z E z 0 X m co 2 �- � & f $ a , o / CD > § 9 e ,� a§ E ( p B: m \ / 2 » o a ` ® @ ® k , o , m E L 2® o a Q a E\ i j® w :A, t \ \ / 2 9 @ / \ \ \ \ \ \ 2 O 3 0 (] \ a @ / m e � ¥ E 2 \ ' 6 y q @/� \ aj ( \ ] \ ® ° / \ ` � \ z G G n r(A o o= E\ o c co � E> E 0 Cl) k k k \ Z w » § v f � � ■ � —� m 714 \ \\ 7 o g m\ m 0 o E ` § \ 2 8 \ § � & § \ j z 0 } > > o £ o \ m \ / ( �- I co J ° — R & < \ U j ::t z ƒ z / 0 ) 0 E P e \ \ / 4 0 { 0 _ \ / \ i to \ ° 0 \ > e < CL � CL � - { § § 0 \ CD z 0 \ � t , \ � \ \ \ 7 � j 2 � \ \ _ o \ \ � \ 1 Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page I of 3 division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code It Certified Soil Testing Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must Counr/ include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. APPLICANT INFORMATION - Pleas I 1 11" don. Parcel LD.# 010 - 1073 -90 Personal information you provide may be used for JP s. 15.04 (1) (m)). Reviewed By Date j / Property Owner i operty Location Kam lr� r owski, Jerry & Judy ' FCE IEO . r SE 1/4 SW 1/4 g 30 T 30 N R 16 W Pro Owners Mailing Address F 3 7 t # Block # Subd. Name or CSM# 2104 130th Ave. c.. g ft City State ' Code lifer City n Villaga ®Town Nearest Road Baldwin WI 2 5575 a Emerald ! 130Th Ave. ❑ New Construction Use: ® (d �ia s 3 ❑Addition to existing building ® Replacement ❑ Publl be Code Derived daily flow 450 gpd Recommended design loading rate - bed, gpd/W .6 trench, gpdW Absorption area required 900 bed, fe 750 trench, fN Maximum design loading rate - bed, gpd/f? .6 t rench, gpd/ft' Recommended infiltration surface elevabon(s) 102.35 ft (as referred to site plan benchmar install 4'x 95' rock bed mound on 100.6 - 99.9 design line as upslope edge of rock wi 1.75 +' sand fill & Additional design / site consideration case-eat fro,„ ,,,L„ Parent material loess over till Flood plain elevation, if applicable NA ft S= Suitable for system Conventional Mound In Ground Pressure AT - Grade System in Fill Holding Tank U= Unsuitable for system ❑ NU ® S❑ U ❑ S® U ❑ S U ❑ S U ❑ S X U till IT FION KEPUK 11 Depth Dominant Color Mottles Structure GPD /ft' Borin Horizon Texture Consistence Boundary Roots - - - --- Tr - 9# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed � Trench 1 0 -6 10YR 3/2 - sil 2 f sbk ds cs 1 f/m .5 .6 L 6 2 6 -16 10YR 5/4 - sl 2 f sbk mvfr cs im .5 .6 Ground 3 16 -22 10YR 5/4 fld 7.5YR 4/6 sl 2 m sbk mvfr cw lm .5 .6 elev — - -- 100.1 ft 4 22 - 32 7.5YR 5/4 f2d 7.5YR 5/8 is 1 m sbk dsh - - .7 .8 Depth to limiting - - - - -- - - - - - -- — - -- - factor Remarks: 1 0 -3 10YR 3/2 - sil 2 m cr ds cs 1 Gm .5 .6 2 3 -10 10YR 3/2 - sl 2 f sbk ds cs Im .5 .6 Ground 3 10 -16 10YR 5%4 - sl 2 f sbk ds cs Im .5 .6 elev - - -- - - - - -- r --- -- _- g_ g 9,ft 4 16 -26 10YR 5/4 fld 7.5YR 4/6 sl 2 m sbk mvfr cs lm 1 ! .5 .6 Depth to 5 26-36 5YR 4/4 - scl 0 m dvh - - NP .2 limiting factor Remarks: CST Nand (Please Print) Signature: Telephone No. Henry F. Grote 715 -665 -2681 — t f esttn � - -- -- - -' -------- —.__ -- Address Certified o g Da CST Number f # P.O. Box 57, Knapp, W1- 54749 12/5/1998 222774 1078 PROPS ? Y OWNER: Kw=wski, Jerry & Judy SOIL DESCRIPTION REPORT P 2 __ - of ge . 3 ® PARCEL I.D.# 010 - 1073 -40 Certified Soil TeWling Depth Dominant Color' Mottles Structure GPD/ft' Horizon in Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. onsistence Boundary Roots - Bed TTrench ` 1 0 -3 l OYR 3/2 sil 2 m cr ds cs 1 f/m .5 .6 3 " 2 3 -10 10YR 3/2 - sl 2 f sbk ds cs lm .5 .6 Ground 3 10 -16 10YR 5/4 - s1 2 f sbk ds cs lm .5 .6 elev 100.6 ft 4 16 -28 10YR 5/4 7.5YR 5/3 sl 2 m sbk mvfr cs IM .5 .6 Depth to 5 28 -38 5YR 4/4 - scl 0 m dvh - - NP .2 limiting factor 16' Remarks: Ground elev Depth to limiting -- factor ups lope toe will encroach about into town n9 ht of way so an easement om the town will neeife to do so i Remarks: preVIOUS w r o n u o similar sons o is repo imi mg factors — roni house - - -- Ground elev Depth to limiting -- _- -- _ -_,__ _ _ _---- _ factor Remarks: I Ll - Ground elev Depth to - - - - -- - -- — — — limiting factor Remarks: ' • 4 1 1 �,.r OI.- � u. \�tao..r ` o a.�,,, Z�10� \�V �..� �►O- �o�'i•�t� S1'e 1to%0 �. � O w v� •, L w ab aX.eX Y Tvt Z t1 14 4 �•.(yi, o �(2¢ dG: w� d'+ t �-O Qt A-M aiA 4-1 N r rs�,: des � t �► Rw V w. � K Q•� ►01.4 33 � a.ts�.....�C -• ► �g ..,.:1e.. �+ 1' 03'` . 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