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030-2117-40-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 567215 0 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: Burger, Jim & Michele St. Joseph, Town of 030-2117-40-000 CST BM Elev: Insp. BM Elev: BM Description: / Section/Town/Range/Map No: !So, 6 Gd J 19.30.19.965 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 161' ~ J J Dosing Alt. BM /-57 (10 Lob P_1~15 A-J 4:116 a-4-1 Aeration \ Bldg. Sewer Holding W G J~~ St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. ent Air Intake ROAD Dt Inlet Septic 756 / 57 Dt Bottom /I Z 50 9 Dosing Header/Man. c7 71 ` 7 5d S7 ` Aeration Dist. Pipe g 7. Holding Bot. System lJ , f 5 PUMP/SIPHON INFORMATION Final Grade 3.17 -79 } Manufacturer Z ( errand St Cover GPM 106 Model Number Z TDH Lift e Friction koss 1 -4,55 1 System Head TD~'' 2 )Ft 53~v ,37 Forcemain Length~ 1 7- Dia. ' Dist. to Well 7 SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Tr hes PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of m: UNIT Model Number: 7~ bJr (oJ DISTRIBUTION SYSTEM Header/Manifold/ / / Distribution / Ix Hole Size 11 x Hole Spacing Vet Air Inta /I ll-- Pipe(s) t' 7 , ✓ Spacing _3Z 3 Z 3!, Length ~T Dia~~ Length Z7' Dia --/15' SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over jxx Depth of xx Seeded/ dded xx Mu 'c ed Bed/Trench Center 1 ` LO/ Bed/Trench Edges \ Topsoil ' Yes R No es 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 309 144th Avenue Houlton, WI 54082 (NW 1/4 SW 1/4 19 T30N R1 9W) Whit tail Ridge Lot 4 Pa ceI No: 19.30.19.965 t / - 1.) Alt BM Description= G~ Q w 5 o S C.~ 1 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑ Yes No 1v I Use other side for additional information. 1 'r✓ SBD-6710 (R.3/97) Date Insepctor's Signatu Cert. No. Count Safety and Buildings Division cleel /X 4 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison I 0 7 Nil - State Transaction Number Sanitary Permit Application 2~30771o,7 In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to ProjeCct Address (if different than mailing address) for secondary the Department of Safety and Professional Servies. Personal information you provide m d purposes in accordance with the Privacy Law, s. 15.0 1 m , Slats. L Application Information - Please Print All In tion ' 4 Parcel # Prope Owner's Name ,A y 03©-Z 117-Yo-VVO -JAM ~ ' ` ~ S Property Owner's Mailing Address Property Location r t Govt. Lot 5 n c J L l Lf A L 1 p~C City, State zip Code one Number Section 9 ~ ~ D ~ Z circle on eue-TO~ T~N; R! S-_Eo W HII. Type of Building (check all that apply) Lot # t Subdivision Name n ~1 or 2 Family Dwelling - Number of Bedr ms L r ~ q~ ` f ~ ~ ~ I C r/~' 4 , k-, ❑ Public/Commercial -Describe Use Block # W OC ❑ City of ~ CSM Number ❑ Village of El State Owned -Describe Use ® Town of S? - O,$' E 4,W ~X 6J~z5 CV.N C III. Type of Permit: (Checkout ne box on line A. omplete line Rif applicable) A ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ® Other Modification to Existing System (explain) 4 11-fv '01ouN'a Acig List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner -1/ IV. Type of POWTS System/Component/Device: Check all that a 1 ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade 19 Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Pretreatment Device (explain) ❑ Holding Tank ❑ Other Dispersal Component (explain) V. Dis ersaUrreatment Area Information: Design Flow (gpd) Design Soil Application Rate(g sf) Dispersal Area Required (sf) Dispersal Area Proposed System Elevation ~M a. /z- /Z41 46 96.~Y Capacity in Total # of Manufacturer N r. .1 VI. Tank Info Gallons Gallons Units / U New Tanks Existing Tanks , /l /y1 / _ • I a U U con u. C7 s. Septic or Holding Tank /00C W rr y Dosing Chamber ~r_ ©D 60 r l ESC VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS1~shon o Nthe plans. one Number Plumber's Name (Print) Plumber's at L. aolf(v 5ckritc ~ i ZZ376 O 7i,--76014(1 Plumber's Address (Street City, State, Zi Code) (o/~ /JOi v' J~pyzl~5~ VIII. oun /De artment Use Only Perm//it Fee~j Date I ued 2 Issuing ent Signature Approved ❑ Di $ l0~ co Z 7 J.3 ❑ O en Re n for Denial ~ rL IX. Cond11*Wq$easons for Disapproval 3 r 1 .9optic tank, effluent fl<ter and e, (11% dispersal Cell-must all be_ae rv $ / dined as per management plan provided by plumber. 2, iA# setback regl~ements must be ma mtail'tl~d code / orrfina110t1s: Attach to complete plans for the system and submit to the County only on paper not less than 8 U2 III inches in size SBD-6398 (R. 11/11) o~ ETM~T DIVISION OF INDUSTRY SERVICES 5~? o~ 3824 N CREEKSIDE LA Uo~ 9~ HOLMEN WI 54636 3 j SContact Through Relay ~~oA P www.dsps.wi.gov//sb/ www.wisconsin.gov SIScott Walker, Governor Dave Ross, Secretary September 24, 2013 CUST ID No. 223760 ATTN: POWTS Inspector JOHN F SCHMITT ZONING OFFICE SCHMITT & SONS EXCAVATING ST CROIX COUNTY SPIA 616 150TH AVE 1101 CARMICHAEL RD SOMERSET WI 54025 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/24/2015 SITE: James Burger Identification Numbers 309 144TH Ave Transaction ID No. 2307767 Site ID Town of Saint Joseph No. 795536 St Croix County Please refer to both identification numbers, NW1/4, SWIA, S19, T30N, R19W above, in all correspondence with the agency. Lot: 4, Subdivision: Whitetail Ridge FOR: Description: Three Bedroom Mound System / 11% slope / System re-construction Object Type: POWTS Component Manual Regulated Object ID No.: 1449352 Maintenance required; Replacement system; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01101, R. 10/12); Effluent Filter 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. COND No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, API stats. Drpr OF PROPES S/ The following conditions shall be met during construction or installation and prior to occupancy or use: HIV 0) 1SlOlY OF 1 N0 Reminders: • A sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with SEE CORRES 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 SPS 384 product approval conditions. • The area within 15' downslope of the dispersal component shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • All abandoned POWTS components from the original system shall be properly disposed of per SPS 383.33 and NR 113, Wis. Adm. Code. • The existing tank shall be inspected for code compliance. It shall be replaced if it can not be made code compliant. f I JOHN F SCHMUT Page 2 9/24/2013 • 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. • 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. 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, - Fee Required $ 250.00 OV, This Amount Will Be Invoiced. Gerard M Swim When You Receive That Invoice, POWTS Plan Reviewer, Integrated Services Please Include a Copy With Your (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm Payment Submittal. jerry.swim@wisconsin.gov WiSMART coder 7633 cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered a' and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed k " ` by SPS Chapters 360-366. JOHN F SCHNIlTT Page 2 9/24/2013 • A cop, of pproved 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. • 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. 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, Fee Required $ 250.00 This Amount Will Be Invoiced. Gerard M Swim When You Receive That Invoice, POWTS Plan Reviewer, Integrated Services Please Include a Copy With Your (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm Payment Submittal. jerry.swim@wisconsin.gov WiSMART code: 7633 cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Burger Rebuilt 3 Bedroom Mound Owners Name: James & Michele Burger Owner's Address 309 144th Ave. RECEIVED Houlton, WI 54082 SEP 92013 Legal Description: NW1/4, SW1/4, S19, T30N, R19W INDWRY SERVICES Township St. Joseph County: St. Croix Subdivision Name: Whiyetail Ridge 1999 Lot Number: 4 Block Number gEL,, Parcel I.D. Number 030-2117-40-000 Ro~ED Plan Transaction No. Sq'rErYAAr1) Page 1 Index and title AL SERV/CES Page 2 Cover letter Y SERV/CES Page 3 Data entry Page 4 Mound drawings ' Page 5 Lateral and dose tank Page 6 Construction Details Page 7 System Maintenance Specifications NdE1V~ Page 8 Management and contingency plan Page 9 Septic and Dose Specifications Page 10 & 11 Pump specifications and curve Page 12 Pressure filter information Page 13 Plot plan Page 14 Septic tank maintenance agreement Page 15 Warranty deed Page 16 CSM/Plat Attachment 1 Plan for Existing Mound Attachment 2 Soil evaluation report Designer: John Schmitt License Number: 223760 Date: 9/67/2013 Phone Number: 715-760-0486 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SBD-10691-P (N. 01/01) and both SSWMP Publication 9.6 Design of pressure Distribution Networks for ST-SAS (10/81) and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706-P (N. 01/01) Version 7.0 (R. 03/2012) Page 1 r r HMITT & S NS cAVA GINC. 586 Valley View Trail Somerset, W154025 schmittandsonsexcavating.com John Schmitt (715) 247-5706 June 30, 2013 September 6, 2013 The mound soil absorption system at the James and Michele Burger residence 309 144I' Ave. Houlton, WI 54082 was found to be ponding. Upon further investigation it was found that the sand was sealed at the rock sand interface. Just below this interface the sand was clean. Therefore it is proposed that the mound be rebuilt to the design parameters submitted. The pump will be replaced as well as the float switches to meet the new design. Sincerely, John Schmitt Page 2 r Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 383443 in-situ soil treatment for 1.50 Peaking Factor (e.g. 1.5 = 150%) fecal colifonn of 36 inches. 450.00 Design Flow (gpd) 11.00 Site Slope 95.14 Contour Line Elevation (ft) 24.00 Depth to Limiting Factor (in) 0.40 In-situ Soil Application Rate (gpd/ftz) Distribution Cell Information 56.25 Dispersal Cell Length Along Contour (ft) = 8.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/fe) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) C Center or End Manifold 2.67 Lateral Spacing (ft) If N above, enter the elevation (ft) 6 Number of Laterals of the highest point. 0.156 Orifice Diameter (in) 2.00 Estimated Orifice Spacing (ft) = 5.36 fe/orifice 2.00 Forcemain Diameter (in) 50.00 Forcemain Length (ft) Does the forcemain drain back? Y 91.82 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 8.16 Forcemain Drainback (gal) 3.91 Vertical Lift (ft) 75.43 5x Void Volume (gal) 2.07 Friction Loss (ft) 83.59 Minimum Dose Volume (gal) 0.50 In-line Filter Loss (ft) 45.23 System Demand (gpm) 11.03 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 1.00 x 1.50 x 1.25 x 2.00 x x 1.50 x x 3.00 2.00 x 3.00 x Gallons/Inch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1000.00 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Wieser Manufacturer gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 600.00 Dose Tank Capacity (gal) Sim/Tech Filter Manufacturer 16.76 Dose Tank Volume (gal/in) STF-100 Filter Model Number Weiser Manufacturer Project: Burger Mound Page 3 f 1 Center Connection Lateral Layout Diagram Force main connection via tee or cross to manifold at an9 Point. Laterals are identical s I P •=Turn-up wfballvalve or I(- x---+ I+X12 xf2 Laterals Morcemain Sch 40 PVC cleanoutplug per SPS Table 384.30-6 Holes drilled on the bottom of the lateral. Number of Laterals 6 Orifice Diameter 0.156 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.03 ft Lateral Length (P) 27.41 ft Orifices per Lateral 14 Lateral Spacing (S) 2.67 ft Orifice Density 5.36 ft2/orifice Lateral Flow Rate 7.54 gpm Manifold Length 5.33 ft System Flow Rate 45.23 gpm Manifold Diameter 2.00 in Total Dynamic Head 11.03 ft Forcemain Velocity 4.62 ft/sec Dose Tank Information Locking cover with waming label and locking device and sealed watertight Electrical as per NEC 300 and SPS 316.300 WAC 4 in. min. Disconnect --ii-- Tank component is properly vented E. F- Altemate outlet location Forcemain diameter Weiser Manufacturer 2 in. capacityl 600.00 Gallons Volume 16.76 gal/inch A Weep hole or anta Dimension Inches Gallons B siphon device A 17.91 300.21 C B 2.00 33.52 Pump off elevation (ft) C 4.99 83.59 92.73 D 10.90 182.68 D Total 35.80 600.00 tank elevation (ft) 3" Bedding un er tank. 91.82 Alarm Manuafacturer SJE Rhombus Note: Switches Alarm Model Number Tank Alert AB containing mercury may not be used in Pump Manufacturer Zoeller this system. Pump Model Number 98 Pump Must Deliver 45.23 gpm at 11.03 ft T D H Project: Burger Mound Page 5 Construction Details 1. Topsoil and subsoil cap to be removed from top of mound and the south K slope of the existing mound. 2. Existing rock and laterals to be removed and disposed of properly. 3. Remove any sealed sand and dispose of properly. 4. Extend the south end of mound to dimensions in new design. 5. Plow south end extension using a chisel plow. 6. Rebuild mound to new design dimensions using clean ASTM C33 sand. 7. Rebuild cell to new design dimensions and specifications (orifice size and spacing, # of laterals, length etc.). 8. Replace subsoil and topsoil caps to new design criteria. 9. Install inline effluent filter and new pump. Reset float switches to meet design criteria. Page 6 Mound System Maintenance and Operation Specifications Service Provider's Name John Schmitt Phone 715-760-0486 POWTS Regulator's Name St. Croix County Zoning Phone 715-386-4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ftz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once eve 3 ears Effluent Filter Should inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Inspect for ponding and seepage once every 3 years Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished . • , . Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Burger Mound Page 7 , Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5, 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 8 1 1 D Z 56" AS 84" z REQD m 42" z m c -i D 0 Ll NP o UP 41" a m 4" CAS b 0 m 3" 5" ( r D m 36" I m ° r m~ \ ° 1 a D = N I N ~ UP 38" i m 4" CAS g m s m z C , 41 ~ a O > 39" -Z+ D v m cn I D I m m D r 2 V8 ,no x X Z D a m m m Z ,no 0 0 DMZ O A p$D O~►D ~m~*Imy00pz ~ r c-) o xX ~~Z zvF v v X00 (nn °0 ior°~"iiA:jr O W4 °o mom gx N 0 ~z0 'CAC ~ ~ wcn 4D &nm ANC FD 0 ~c -4 W<mi2C N • ~0 RZ C) so -1~ ZZ -Z' In ~ v x aD DS c D i1D ~ 0 s~ s v a v D a n m~Nr* N moo c~~ o O G z p = r~+ m p cnmD ( DAN Op- CD• o m o c 0 cn N p y ` rn0D mm Dr s s b o O m 4- q m C D m ~ m CD O 'O O m m n ~o z > D D W m W c 0 G p D =~Z >O p A m ow m< o m X Z n ~r c z ZZ zeo CD p Wr N O Oju I rv D Cm vp~ 0m 0 D A-4 o rn m p ;u c O 2 A r Z m ;u z m 4 \(n WLP1000/600-MR x DRAWN BY. SME SCALE: 1/4"=V-0" PRE-POUR: m MHER C®CCAETE REV. n -4 SEPTIC MANUAL DATE: JANUARY 2010 DATE:. POST-POUR: \ Z W3716 US HWY 10 MAIDEN ROCK, NA 54750 ° REVISED JAN. 2010 800-325-8456 FlLe%mom/soo-w Page 9 1 / SECTION: 2.20.035 QLL4L/TV PIA-f-9 91NCE lff7 FMO973 0312 Product information presented ® Supersedes here reflects cn time PUMP !O. 0310 of publication. . Consult ult factory regarding discrepancies or inconsistencies. MAIL TO: P.O. BOX 16347 • Louisville, KY 40256-0347 visit our web site: SHIP TO. 3649 Cane Run Road - Louisville, KY 40211-1961 www.zooller.com (502) 778-2731.1(800) 928-PUMP • FAX (502) 774-3624 COMPARE THESE FEATURES • Non-clogging engineered plastic vortex 98 Cast Iron Series impeller design "FLOW MATE" • Corrosion resistant powder coated epoxy finish (FOR PUMP PREFIX IDENTIFICATION SEE NEWS & VIEWS 0052) • Durable cast construction. Cast switch FOR SEPTIC TANK case, motor, pump housing and base. No LOW PRESSURE PIPE (LPP) sheet metal parts to rust or corrode. AND ENHANCED FLOW STEP SYSTEMS • Castings -All cast iron class 25-30 25000# tensile strength EFFLUENT • Stainless steel screws, guard, handle, arm OR DEWATERING PUMP and seal assembly SUBMERSIBLE• • Float operated submersible (NEMA 6) 1'/2" NPT DISCHARGE p 2-pole mechanical switch • Motor - Permanent split capacitor, 60 Hz, 1725 RPM, oil-filled, hermetically sealed, automatic reset thermal overload protection CID 0 W UL d Ce"i0ed to CSA • Bearings - Upper & lower oil fed cast iron en T°"wd CwSaiderdUL7B Standard 0221 No. 108 • Carbon and ceramic shaft seal • Entire unit pressure tested after assembly. • Watertight neoprene ring between MODELS AVAILABLE • Automatic or Nonautomatic motor and pump housing • % HP,1 Ph.,115V or 230V • Maximum temperature for effluent or • Available with Piggyback dewatering 130°F - 540C Variable Level Float Switch. • Passes'/ inch spherical solids • No screens to clog • Standard cord length 15 ft. (UL Listed) Jul • 1'/z" NPT Discharge (1 X 2" PVC Adapter MODEL 98 included with BN & BE Models) • On point - 9'/" • Off point - 3" • Major width -10'Is" • Height -12" POWDER SIMPLEX AND DUPLEX COATED SYSTEMS AVAILABLE TOUGH- PACKAGED SYSTEMS AVAILABLE Note: The sizing of effluent systems normally requires variable level float(s) controls and properly sized MODEL BN98 basins to achieve required pumping cycles or dosing timers with nonautomatic pumps. 0 Copyright 2012 Zoeller Co. AN rights reserved. Page 10 it TOTAL DYNAMIC HEAD/FLOW W PUMP PERFORMANCE CURVE PER MINUTE EFFLUENT AND DEWATERING 3718 6114 MODEL 98 z5 MODEL 98 4518 Feet Meters Gal. Liters 3718 S 6 20 5 1.5 72 273 10 3.0 61 231 x 15 4.6 45 170 4 15 20 7.1 25 95 4 Shut-off Head: 23 ft(7.0m) I +-+rzzu-+rs wr I I 10 009971 I j i ! 2 5 i i i 0 12+n9 10 20 30 40 50 60 70 80 GALLON I LITERS j .rW 0 80 160 240 FLOW PER MINUTE SK1102 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and Variable level float switches are available for controlling single supplied with an alarm and three phase systems • Mechanical alternators, for duplex systems, are available Double piggyback variable level float switches are available for with or without alarm switches variable level long cycle controls • Refer to FM1922 and FMO806 for temperatures above 130°F 98 Series Control selection Model Volts-Ph Mode Amps simplex Duplex M98 115 1 Auto 9.4 1 4 N96 115 1 Non 9.4 2 or 3 4 D98 230 1 Auto 4.7 1 4 "Easy assembly" E98 230 1 Non 4.7 2 or 3 4 L'p 3 dsct-W pipe riot included.) SELECTION GUIDE 1. Integral float operated mechanical switch, no external control required. 2. For automatic use single piggyback variable level float switch or double piggyback variable level float switch. Refer to FMO477. 3. See FM1228 for correct model of simplex control panel. 4. See FM0712 for correct model of duplex control panel or FM1663 fora OPTIONAL PUMP STAND PIN 10-2421 residential alternator system. • Reduces potential dogging by debris. For information on additional Zoeller products refer to catalog on Piggyback Variable Level Replaces rocks or bricks under the pump. Switches, FM0477; Electrical Altemator, FM0486; Mechanical Akemator, FM0495; Sump/ • Made of durable, noncorrosive ABS. Sewage Basins, FM0487; Single Phase Simplex Pump Control, FM1596; Alarm Systems, Raises pump 2' off bottom of basin. FM0732. • Provides the ability to raise intake by adding sections of 1'V2 O CAUTION or 2' PVC piping. • Attaches securely to pump. All installation of controls, protection devices and wiring should be done by a Accommodates sump, dewatering and effluent applications. qualified licensed electrician. All electrical and safety codes should be followed NOTE: Make sure float is free from obstruction. including the most recent National Electrical Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. AWL TO- PO. BOX 16347 Lkxhst48e, KY 40256-0347 Manufacturers of.. LOS SFiP ' :3649 Came Run Road '773- 73 KY 40111-1961 Q PuMaB /iNCE ~9~9 PUMP !O. 021 778 2 73f • 1(800) 92B PUMP ~°"Tr www2x>el/eicom FAX(502) 774-3624 0 Copyright 2012 Zoeller Co. A8 rights reserved. Page 11 1 1 WJM/ ] PRESSURE FILTER INSTALLATION & SERVICE INSTRUCTIONS 1455 Uxamar Drive Toll Free 888-999-3290 Office 231-582-1020 Boyne City, MI 49712 Fix 231-582-7324 Email sales(agag-simtech.com Web www.eap-simtech.com INSTALLATION: When installing an STF-100, screw filter into discharge port of any pump that has a 2" National Pipe Thread. Pumps with a smaller discharge port maybe adapted to fit. When installing an STF-100A2 a tailpiece and male adapter will need to be added to the inlet end of the filter (end opposite of the cap) to the desired height and a 2" union will need to be added to the outlet end (the end closest to the cap & on the side of the filter). Always install the filters in a position where they can be easily serviced. **Always use caution when starting threads to avoid cross threading**. Plumb force main into the 2" sch 80 PVC union. **We recommend that the union remain together during gluing to insure that glue or cleaner does not ruin O-ring or sealing surface". For best performance, if a check valve is installed it should only be after the outlet of the filter. SERVICE: Service of filter screen is dependent on usage as every system is unique. For most residential systems we recommend inspecting the filter within the first year to determine the necessary service intervals for the filter. In high volume systems we recommend inspection within the first 6 months to determine necessary service intervals for the filter. Once the service interval is determined it should be consistent unless something changes in the system. Always inspect the filter screen for any damage or corrosion and replace if necessary. If our STF-101 service alarm switch has been installed and adjusted properly it will alarm when the filter requires service. It should be serviced no less than when periodic pumping of the septic tank and pump chamber is performed. Servicing will be more frequent if using any one of our optional filter socks (600 micron, 150-190 micron, and 100 micron). Check your local health department for septic system servicing recommendations. If the screen becomes clogged before the periodic pumping requirements, a high level alarm or light will indicate the need for service. If system is equipped with a "pump on light" that stays on longer than normal, this also may indicate a need to service filter. To service filter screen, unscrew the 4" cap. Pull filter screen from canister and wash out thoroughly in appropriate location with proper protection. In some cases an additional filter screen allows quicker service allowing the dirty filter to be washed later at the shop. Mobs OW In cold condone the fNw cap may be t to nwn" K*W >Ihe ill W1h a l am or pour warm webr over dw cqp ba n nrovM Once ft ffider is irk hAW O ft t wk d n>Ietibtai w a std ft F and temo ft the cap wN nor be a problem. If the system is equipped with our Service Alarm Switch, the filter screen does not need service until the Service Alarm Switch activates a light or audio alarm. We still recommend that the filter be inspected once a year for damage or corrosion. NOTE: The total dynamic head loss of the system must be increased by 0.5 feet of head to overcome friction loss through the filter. SERVICE ALARM SWITCH The alarm switch is available in three pressure ranges, low head, medium head, and high head. Installation is simple, on SIM/TECH FILTER systems, remove %4" plug from base of filter chamber and connect tube fitting. Next, run the tube up into the tank riser and connect to service alarm switch. The alarm switch is fastened to the side of the riser via the nylon strap provided. Run alarm wire to alarm box. The service alarm switch can be wired with its own alarm or with the high water alarm. Pressure adjustment is made by removing the end plug, and inserting the 7/32 alien. Clockwise increases pressure. One turn equals approximately 3 PSI. The low head alarm switch comes factory preset at 8 PSI and is completely field adjustable within it's range (3 to 24 PSI). We recommend the use of a ball valve when using an alarm switch. Once you have installed the filter and alarm switch, the ball valve can be closed off to simulate a plugged filter so that you can make sure the alann switch is working correctly. ****TRY OUR LID/SCREEN REMOVAL WRENCH. Our wrench holds filter lid firmly and hooks screen for easy removal and installation. Made of PVC plastic. WARRANTY All products are warranted against defects in material and workmanship for a period of two years from the date of purchase. In no event shall GAG SIM/TECH FILTER, INC. be liable for any consequential damages or any labor, material, freight or expenses required to replace, correct or reinstall the product. GAG SIM/TECH FILTER, INC.'s liability is limited to repair or replacement of the part. All warranties are void if the product has been improperly modified, applied or installed, subjected to misuse or abuse. Except as stated herein, there are no warranties expressed or implied, including the warranty of merchantability or warranty of fitness for a specific purpose. EFFECTIVE September 13, 2005 Page 12 Plot Plan N Project Name: Burger 3 Bedroom Mound Legal Description: NW1/4, SW114, S19, T30N, R P.I.D: 030-2117-40-000 Subdivision Name: WHITETAIL RIDGE Lot 8 SCALE. V _ 50' Township: ST. JOSEPH Parcel Size: 3.672 Acres County: ST. CROIX mtour Line Elevation: 95.14 ;ell Dimensions: 8'X 56.25' 4 inch Sch 4=D1785 System Elevation 96.14 Mound Dimensions: 127.37'X 75.64' 2 inch Sch 4Slope: 11% 11/2 Sch 40 A BM1 Elevation: 100.07 To of Septic Tank Cover BM2 Elevation: Backhoe Pits: NOTE: Sim/Tech STF-100 to be installed on force main. rfoRTN P L ~y s~ ti PRIVL GARAGE 3 grDeool~ t 5aL,i I I 1;X15 r 1NG 37'x 71' M0,4r4n t-10u5 F- 13rnk ro`2MA~~ I I ExTc"AJnr~ AiID RIE6un-r r-xIsT/NG ' , To 37"x 75,(Py' (roe- 1000/(,00 63 E X Te N M D To f lTc li 57,7 •/A.T I I Iil I 1t-x/3T1NC3 f"OUNV) AOo spit/1 TEcIf W6LL , 1 t 1 I 1 © 9S 93 ~ 1 Page 13 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer r5 A rV P tA' 1 C 6-{ EL 8yje&6e 7_771 Mailing Address 0) yy j-y v Property Address _5A A t E (Verification required from Planning & Zoning Department for new construction.) City/State TOA) r wJ Parcel Identification Number c930 -2 7 `y15 `O4C~ LEGAL DESCRIPTION Property Location / y K )'A , SW '/4 , Sec. it? T30 N R-ft-W, Town of 57. j'05 6 .,0 Subdivision Plat: W 141 TFT,4/L R/D&F , Lot # y . Certified Survey Map # , Volume , Page # Warranty Deed # 77 /05_6-e, (before 2007)Volume 2w 3 3 , Page # 63V Spec house ❑ yes K no Lot lines identifiable K yes ❑ no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this f rm 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 warn ty deed recorded in Register of Deeds Office. Number: ybedooms S IGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 09/07) Page 14 U 2 6 3 3 P 6 3 4 -71 NATHLUN H. MALSH REGISTER OF DWS ST. CROIX CO. , MI STATE BAR OF WISCONSIN FORM I - 2000 RECEIVED FOR RECORD Document Number WARRANTY DEED 08/89/2004 10: NAM MAR ; R THIS DEED, made between Tim R. Waalen a/k/a Timothy R Waalen and Traci L. Waalen, husband and wife, Grantor, and James T Burger and Elm Michele L Burger*survivorship marital property, Grantee. REC FEE: 13.09 Grantor, for a valuable consideration, conveys to Grantee the following TRANS FEE: 960.00 described real estate in St. Croix County, State of Wisconsin (the CC FEES' ..Pros..). PAGE: 2 SEE ATTACHED EXHIBIT A *husband and wife Recording Area Nwne and Return Address: Land Title Inc 1900 Silver Lake Road Suite 200 New Brighton Mn 55112 404 61 Together with all appurtenant rights, title and interests. 030-211740-000 Parcel Identification Number (PIN) This is not homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Dated this 30th day of July, 2004. )2;2 * Timothy R. Waalen * Traci L. Waalen s s AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF MINNESOTA ) WASHINGTON COUNTY. ) ss. authenticated this 30th day of July, 2004 Personally came before me this 30th day of July, 2004 the above named Tim R. Waalen a/k/a Timothy R Waalen and * Traci L. Waalen, husband and W66, 4o me known to be the TITLE: MEMBER STATE BAR OF WISCONSIN Person(s) who executed the regoing instrument and ackno ledged the same. (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY *Nanc J. Lentzj Notary Public, State of Minnesota My commission is permanent. (If not, state ex lion date: Greg Booth Attorney i ) 1900 Silver Lake Road, New Brighton, MN 55112 r (Signatures may be authenticated or acknowledged. Both arc not necessary.) NANCY ,l. LENSZ *Names orpersons signing in any capacity must be typed or printed below their signature * NOTARY PUBLIC MINNESOTA mjW MY Comm. Expires Jan. 31. 2005 • WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1-2000 Page 15 U. 2 6 3 3 P 6 3 5 EXHIBIT A Lot 4, Whitetail Ridge, St. Croix County, Minnesota. t• ~ %E - Yr ~E Y YY M 2 Y 8 ~a~~~ ff `E~ - i r 0 a r ) 1 °F Z 1~ N' O < K _ "SONYC (131_tY'1dNft. ( ia"~ U Ilt 0.I I~ i e -0 o i y' 1 a IQ ~~yrw - - to "]N ID IA II _ a HA e arrag' er , -A ZT.Q taeer x sscwos ~ - - - - - - - - - 4q CS r C ~ S L Ic r ~ < ~ .p { 6 SO- zz! !['.III IC da t" 1 } ~j`' F = j Q ` O I € / t4l ~o// F o / 00 of /r' a IS E- ~40 ~I 1 \ s - 1¢.irmr ,1'S'L.tl .0 N <r~r ~.s;.. ~ t~ t. •'Y' ,n kkr p P R"A $ W*SR R as~~ 0 olc A RRP gb k as ""-r Oix Hmn LL.m> ws a Ursa './w, lHt n - OJ f g ¢ !c;'.::•. ~>,n ia. >Kma.>aua. y+a,wx. 7s'ix 4zc8 SikQ gbR'shg R+~~g zgz jog= 1Mjd ~2~~~ kg 'AIIag?t~gspy~~t - c., a ~?$t din y 5 A-Y~ d Sgt ? Y roo' p } r s - ~0. - ~3'S~ s~F ~;~+i^~ ~~X&G E~tpp>13y¢~1S.' 's'+i 'ti 91 Page `t Safety and Buildings ' PO BOX 7162 MADISON 1M 53707-7162 TDD M (606) 264-6777 risconsin ~~~~~.us i Governor Department of Commerce TW►my e. Tlampson, Brw>da J. 8tanchard, Secretary November 17,1999 CUST ED No.267341 A77N. POWTS INSPECTOR WEGERER SOIL TESTING & DESIGN ZONING OFFICE 421 N AMAIN ST ,1 01RCO SPIA ARMICHAEL RD PO X 74 RIVER FALLS WI 54022 HUDSON WI 54016 A RE: CONDITIONAL APPROV I APPROVAL EXPIRES:11/17/Z Transaction ID 27703 r Site ID No. 18414 46 Please refer to bath ideteffica don mss, SITEite ID: 184143 ~i 1F%cl, above, in all correg" wttttte aveii6 ST CROIX County, Town of SAINT ; NWl/4, SWIA, S19, T30N, R19W Lot: 4, EVAN VIEREGGE 144TH AVE FOR: Description: NEW MOUND DWELLING 450 GPD Object Type: POWT System Regulated Object ID No.: 637050 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. The following conditions shall be met during construction or installation and prior to occupancy or use: 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 11/10/1999 FEE REQUIRED S 180.00 J~ FEE RECEIVED S 180.00 DUANE R STEINER, WASTEWATER SPECIALIST BALANCE DUE $ 0.00 Field Operations (608)355-3159, W 7:154:00 PM DSTEINER@COMMERCE.STATE.WLUS T r - ST. CROIX COUNTY ZONING DEP ` AS BUILT SANITARY REPOT . Owner C ! " Property Address - City/State O ,F rt tv a r Ftt E Leal Description: g Lot q_ Block - Subdivision/CSM # If~~I~ e NIAI '/a & '/a, Sec. a, T N-R /9W, Town of _ ©~y 2i (7 --40 ~u 1'.3o,1°1 ~L-s- SEPTIC TANK DOSE CHAMBER HOLDING TANK INFORMATION: Tank manufacturer tdpu,5 e,r Size ST/PC /ft / Setback from: House Lb~ Well 5-6 P/00 Pump manufacturer AVAvIes Model 5 eh H Alarm location 11o~%c ) (HOLDING TAN IMY, t to fresh air intake Water Line Setbacks: Service Ven Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: 4,-d Width Length 7 Number of Trenches Setback from: House 70 Well M, P/L Vent to fresh air intake ELEVATIONS: Description of benchmark H 1 Cs. 69 UC ei,, Elevation Do, d Description of alternate benchmark Elevation I _ Building Sewer ST/HT Inlet ST Outlet PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover 166, 6 7 Distribution Lines ( ) ? ~ , g Z O ( ) Bottom of System ( ) /'t/ ( ) ( ) Final Grade ( ) ( ) ( ) Date of installation Permit number 3~ 3 y~ State plan number Date J J Plumber's signature ~cctC L&, License number o2Z y~ Inspector M W16 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 e- W& o s f r j ` C / INDICATE NORTH ARROW r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division County INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)1. 353248 Permit Holder's Name: ❑ City ❑ Village ❑ Tgwn of: State Plan ID No.: Viere e Construction, St. Joseph Township o2 03 CST BM Elev.: Insp. BM Elev.: BM Descri tion: Parcel Tax No.: r~~ cr Poe, f' CST pending TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION ' BS HI FS ELEV. Septic 4AA9 ✓ VD0/6av Benchmark 4~, ZI /vq z( OD a, Dosi ng Alt. BM Aj_ - 94 ,gZ Aeration Bldg. Sewer At) Holding St/Ht Inlet Q,6~~ S,SO TANK SETBACK INFORMATION St/ Ht Outlet - Vent TANK TO P/ L WELL BLDG. AirIto ntake ROAD Dt Inlet Air Septic % 5'0 r _X NA Dt Bottom f235 g1•$2r Dosing L` NA Header / Man. 35' ,$21 Aeration NA Dist. Pipe ,35~ b ,$Z, Holding Bot. System 8' air , PUMP / SIPHON INFORMATION Final Grade -A ,r Manufacturer Demand St cover 00 W .p:1- r Model Number m 3l'1GPM Mid = San +w,. 1 q.zt~ I OD'a r TDH Lift ~,33 Friction Systema. TDH8.2, Ft i~ Forcemain Length 5-0f Dia. FF.2 " Dist. To well SO ABSORPTION SYSTEM BED Ph Width I Length t Of s PIT No. Of Pits Inside Dia. Liquid Depth EN 1 N DIMENSIONS SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Typeo CHAMBER n t ~ ` Moe Number: System: ) OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe ss-.`, x Hole Size x Hole Spacing Vent To Air Intake kto tv 41 Length 4qw at Dia. Length~• a. 2 Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed/Trench Center Bed Edges f- Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: IL/ f / Inspection #2: 1 Location: 309 144th Avenue, Somerset, WI 54025 (NW 1/4 SW 1/4 19 T30N R19W) - 19.30.19. Whitetail Ridge -Lot 4 1.) Alt BM Description = Dosing tank manhole cover = 8.0' above dosing tank bottom. 2.) Bldg sewer length = house not in yet -amount of cover = %P%L6_ IS- + se V, P.S- Cam' 3.) contour = 95.0', shot at 9.2 at HI = 104.21. ~c~ t~sPQ hews'e- g;UA Q h,.• - `'ti`s P. & 5!kA044-1- S~ IKraK -f"~`~ L.- 1 q 4 L1)P ew Plan revision requlrld' . ❑ Yes ❑ No Use other side for additional information. Y SBD-6710 (R.3/97) Date Inspector's Signature Cert No. If6consin Safety and Buildings Division SANITARY PERMIT APPLICATION 201 W. Washington Avenue P O Box 7302 Department of Commerce In accord with ILHR 83.05, Wis. A d~; s , Madison, W1 53707-7302 • Attach complete plans (to the county copy only) for the syste q ap r nQoLess County than 8 112 x 11 inches in size. c ro l`- • See reverse side for instructions for completing this applica o_ State Sanitary Permit Number bt y !'tl E Z tin Personal information you provide may be used for secondary purposes -°j ❑ Check if revision revious application [Privacy Law, s. 15.04 (1) (m)]. 6 i" CP", A ti C)tJtt71 State,Pla"n I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL I IQWFI Property Owner Name Property Locati,orr," ' q~ +494W O l~~/ . 1 4; S` T 30 r N, R 1'7 Property Owner's M ili g Address Lot Block Number I a0$ Game Ka on i o ntf~ I City, State Zip Coe Phone Number Subdivision Name or CSM Nu n W-T S4 10I (o ('71S) Vc! 1 td. G II. T PE F BUILDING: (check one) ❑ State Owned Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms Town OF III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 6-976- ?417-10 --WD 1 ❑ Apartment/ Condo I I~1- 30 - Lq c 6 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 8 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 5 ❑ Hotel / Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ANew 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System _ System Tank Only Existing System Existi129 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 'f 11 ❑ Seepage Bed 21 )<Mound 30E] Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22`❑vln-Ground Pressure g r 1( q-+ 1 A do 42 ❑ Pit Privy 13 ❑ Seepage Pit f 43 ❑ Vault Privy 14 ❑ System-In-Fill ( e is-, t) VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade S~ Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 1157 3 9`6, Feet '7,7,4' Feet VII. TANK Cain gallons Total # of Site Fiber INFORMATION Manufacturer's Name Prefab. Con- Steel - Plastic App- New Existin Gallons Tanks Concrete strutted glass Appp. Tanks Tank Septic Tank or Holding Tank / r ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber 1=00 k ® ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plu er's Signature: No Stamps) MP"FR5d1F(de.: Business Phone Number: TO Uj_ . -~a s 5~s i ~~5- ya 5~ Plumber's Address (Street, City, State, Zip Code): Sq_h sn& Iv all W - 5g6ZZ_ ,R _S I IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sar~tary Permit Fee (Includes Groundwater ate Issued Issuin Agent Signature (No Stamps) `Approved ❑ Owner Given Initial ~Q( Surcharge Fee) Adverse Determination 3as-.~ X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.1 11197) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS R ' 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3151. 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. 11. 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 online A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale-or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. h Safety and Buildings . PO BOX 7162 MADISON WI 53707-7162 TDD (608) 264-8777 *isconsin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary November 17, 1999 CUST ID No.267341 ATTN. POWTS INSPECTOR WEGERER SOIL TESTING & DESIGN ZONING OFFICE 421 N MAIN ST -r'°i~~+ ST CROIX COUNTY SPIA PO BOX 74 'y~ g..'... l ,a. ~ 1101 CARMICHAEL RD RIVER FALLS WI 54022 ~w HUDSON WI 54016 RE: CONDITIONAL APPROV4 9 APPROVAL EXPIRES: 11/17/201--; Identifica • s Transaction ID o. 27703 Site ID No. 184143 SITE : MGOP. above,in all orrespond correspondence with the agedcy. Please refer to both ST CROIX County, Town of SAINT Site ID: 184143 ~ ia~dT>K . NW1/4, SW1/4, S19, T30N, R19W Lot: 4, EVAN VIEREGGE 144TH AVE FOR: Description: NEW MOUND DWELLING 450 GPD Object Type: POWT System Regulated Object ID No.: 637050 The submittal described above has been reviewed for cpnformance 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. The following conditions shall be met during construction or installation and prior to occupancy or use: 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 11/10/1999 v tti-~ FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 DUANE R STEINER, WASTEWATER SPECIALIST BALANCE DUE $ 0.00 Field Operations (608)355-3159, W 7:15-4:00 PM DSTEINER@COMMERCE.STATE.WI.US WiSMART code: 7633 Page 1 of 6 MOUND SYSTEM LZ FOR _A 3 BEDROOM RESIDENCE i` LOCATED IN THE NW1/4 OF THE sUJ 1/4 OF SECTION 1q T3o N, R W, TOWN OF 5 . QR"LX COUNTY, WISCONSIN. INDEX PAGE 1'of 6 TITLE SHEET 3 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 PAGE 6 of 6 PUMP PERFORMANCE CURVE P o'ioria~~y PREPARED FOR Cori ~O oMM~~~DNGg ~Q t of a~,~ - SM N I tiy^' Pt17' V1EGS E pEPPR~S ~~v VL~TR:~6E C(NKYS -u cO ~S 1V ~N~F pO~pENG~ ZU$ IvR C1~cRGaU v0t _ GORES _ ~v~Sa JV , _t^J l 5 ~l. ~l t~ . - SEti PREPARED BY WE(3 Ef=;cEF;Z E3 C3 = L . TEST = NG , t °~:••,•C®".r ®AND AND. d✓ DES I (SI%A SER%..v ARTHUR L ! F.O. 801 74 421 K. KAIN ST. w cESeR }i G-15 P RIVEN FALLS. VI 54022 ~Jw sRTM 715-425-010 I G14 ~~yp> t S-99 JOB NO. C)) S • PLOT PLAN Page Z o f b Scale 1"=4W WNW ~ L~T~ - - - Pti7wAoSED L! NE J' l v 1` \l 12 S i t 1_Z_ V1_ art !~-Z 110 Z 3 Bb~T~" ~1 a g1, °►S ,dPV to or- %0 Pv _1j) oR ~ coa"►Drtr-T Tti'l3 ~n~1'A aonr~ of Aa® CTL. 46_a loo,O' ON "HtGt{, alq blA. PVC ptpE ►tiJIL . ~.oG'~oro Sh;"Tc~ s:~t~ 1 "=800' r _tiJL'1 4.1U _31C PTLemT `SQ c,_ 3 Av . Z oM_._ ~"t~Vk?4 P'fwD Ri" tSt`rj~3T 1 ~ S ' ~►`t-owl Ty~►k_ c`'~-~ v ® \ • ~ ~~►V.-~l► . S b r' Hve , ,o a D0., L11S NOTES: •1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. V required) 3. Install 4" observation pipes with approved caps. ( Z required) 4. -Septic tank to be tiooo)boo gallon capacity manufactured by 5. Bench Marks S - "via 6. Divert surface water around system to. prevent.ponding at the uphill side. Of b Page' 21 i 103 r Approved Synthetic Covering ~Prs7-" C.33 Distribution Pipe Medium Sand Topsoil F Elev. °l b 3 E b 1\ % Slope Bed Of 2~- 2 %2 Force Main Plowed Aggregate From Pump Layer D I.p Ft. Cross Section Of A Mound System Using E \'b8 Ft. A Bed For The Absorption Area F o-b Ft. G `•O Ft. A $ Ft. H I- b Ft. Linear Loading Rate=R-S-IGPD/LN FT B Ft. Design Loading Rate= o-38.GPD/SQ FT I 11 Ft. J 7 Ft. K ),Z Ft. Position L I Ft. of Force Main W 3Z Ft. L Observation Pipe B K r-- - - - - A I - W ~o ----------------------.I Distribution Bed Of 2p- 2 21 Pipe Aggregate I Observation Pipe Permanent Markers (Anchor securely) Plan View Of Mound Using A Bed For The Absorption Area- Page Ll Of Perforated Pipe Detail ®t:~ 0 End View Per foroted / . End Cop ~\ty" PVC Pipe o~S Install permanent-marker at end of each lateral Holes Located On Bottom, Are Equally Spaced S Q PVC Manifold Pipe + PVC Force Main Distri ution Pipe Last Hole Should Be Next To End Cop End Cop P 2 2. S Ft. Distribution Pipe Layout S 4 Ft. X Inches Y 3 10 Inches Hole Diameter try Inch Lateral Inch (es) Manifold Z- Inches Force Main Z Inches # of holes/pipe 00 Invert Elevation of Laterals 9 LS-13 Ft. ~xl•l1 =°t-3bx~= 37.gq CPO, Place 1st hole 1$'tfrom center of manifold with succeeding holes at 16' intervals. Last hole to be next to the end cap. Combination Sept:ic;Tank and PUMP CHAMB R CROSS SECTION AND SPECIFICATIONS PAGE S OF j -VEtJT CAP WEATHER PROOF JUUCT101J 60X 'i'C.I. VENT PIPC , APPROVED LOCKING - - - MANHOLE COVER rNty _.10 FROM DOOR, wARtJIU6 .ilmoow OR FRESH AjR WTAKE r-cwc~olr r I 5r(h~X ~ l a• Mlu. re"rttW.\ 74~~---------- y~►1.7 eetl~o1Q Pisa l~l PROVIDE I IMLET AIRTIGHT I SEAL 3 tyFFLtS 1 I I APPROVED JOIAIT A ( I ( APPROVED JOiAJT: -4t / , W/C.2. PIPEoR Tank construction I I(( W/c.z. PIPE p'c ALARM ( I ( shall comply with ILHR 1,3.15 and 83.20 O j 1I ( I o►J c I I LLEY. FT. PUMP--_ --j ` OFF 0 COUCRETE ~LkU 8 q • O O lSLOCK RISER EXIT PERMITFED DULY IF TAUK MAIJUFA.CTURER HAS SUCH APPROVAL 3,•Rp~~U B>=pD I N ra. SEPTIC f SPEC.IFICATIOKIS l.pCT IbOI~ DOSE TAI.1►C MANUFACTURER: WLj~S(TL C:uwc4t j QUMBER OF DOSES: PI:. R DA-j TANK SIZE: 1000 1 L-102 GAL.LOMS DOSE VOLUME Z ALARM MAUUFACTUF I`R: S'S'A Ztty S )WCLUDIIJG OACKfLOW: b GALLONS MODEL WUMBER: 10 ( t1w CAPACITIES: A= I a IMCHES OR 301'0 GALLOy5 SWITCH TyPC: YnkHsl~u" g= Z IIJCHESOR 33•~ G~LLOU5 PUMP MANUFACTURER: M`-tTMS C= 8 IUCHES OR 133.8 GALLOUS MODEL MUMBEM S~' y D- $ INCHES 09 GALLOQs I-OINc>,- : 60z.0 SWITCH TYPE: ~'1E UR-QJ IJOTE: PUMP AMD ALARM ARE TO 5L MIAIIMUM DISCKARGE RATE 3'1•~ GPM INSTALLED OW 5EPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEU PUMP OFF AUD-015TRIBUTIOU PIPE.. $3 FEET + miwimum METWORK SUPPLY PRESSURE/, . . 2-52 FCET -F ,-S FEET OF FORCE MAIN X Z_1~f F/ loort.FRICTIOLI FACTOR. 3'" FEET TOTAL OtJUAMIC. HEAD = 11'3°1 FEET Pump chamber DIAMETER IIJTERi.IAt_ DIMEIJSt01l OF TAt.IK: LEtJGTH ;WIDTH - ;LIQUID DEPTH BOTTOM AREA - 231= GAL/INCH AS PER MANUFACTURER = lb -TZ: GAL/INCH TOTAL HEAD IN FEET 1176/1, 9LVDI O Ul O Ul O (NJl O o - o N O ~ m ~ f O D -U D C,4 N H ° _D D n - Gl~ A O c n O z N All .41 Cn - o `n -o G) m fil- m ° iU N H ~ Z 3 O C H ~ Z o m C N m co 0 T-1 I W N O co O W e O O O TOTAL HEAD IN METERS Wisconsin Department Relations Industry, Labor and Human Relati SOIL AND SITE EVALUATION REPORT Page N of 3 - Divis;orll of Safety Buikfings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inche size. Plan must include, but not limited to vertical and horizontal reference point (BM nor6b41ope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance n~ % r o 3 O _;oy,CO- l0 APPLICANT INFORMATION-PLEASE PRI ~ONF RbA4TION IEWEDBY DATE (-21_ PROPERTY OWNER: PROPER; LOCATION EN Pt NJ GG ttil',J v4 S W 1/4,S 1L~ T 3 p N,R E PROPERTY OWNER':S MAILING ADDRESS. v I CH01X L0TI1v BLOCK Af SUBD. NAME OR CSM;t \Z 08 iVf q-ltF 6 W L p C: _ W `f ~1tiT~`T~L ~ZvJ 6e CITY, STATE ZIP CODE 0 NUi1M *CE 01/ILLAGE EFOWN NEAREST ROAD ~voSW . LQ 1 S'4 of oT- S'~ ~~-5'b1 P 1C~s~ ~D New Construction Use W Residential / Number o ' [ ] AddibQn_ to existing building j j Replacement [ J Public or commercial describe Code derived daily flow gpd Recommended design loading rate - '4 bed, gpd1ft2 .3 trench, gpd1ft2 Absorption area required - bed, ft2 - trench, 112 Maximum design loading rate • 14 bed, gpd/ft2 • S trench, gpd1ft2 Recommended infiltration surface elevation(s) 8E ~Mtnl t~ ft (as referred to site plan benchmark) Additional design / site considerations ",:~\-1 bEM LG fy Parent material Lo ss OQ1- Tr Flood plain elevation, if applicable 1~1 1~ ft S = Suitable for system CONVENTIONAL MOUND IN GROUND PRESSURE AT GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ❑ S ®U ®S 13U_ ❑ S O U I 1 S ®U ❑ S (RU 13 S ®U SOIL DESCRIPTION REPORT Depth Dominant Color I Mottles Structure ` I GPDIft Boring # Horizon I Texture Consistence Bourclay Roots 2 in. Mum ell Qu. Sz. Cont Color Gr. Sz. Sh. Bed /ft 4 j 1 0- ti>J~~ ~I z - L z-~sb)iz 2 q 1~ trwLt1Z VI - ) 1eSbk `rnv ~'r e1~ - .`4 <S 1 Ground 3 Z6 S~ ~S`223ly tS~RS~`d L lS ow, Nn - •3 elev. q8,-7 It o►.► %.J S W C`-`( s~ o S a F 1 S . Depth to limiting factor ZI N Remarks: Boring # 10 1okR1z - 1. z~sbk w►v~t. c-+.v - • s • 6 z Z t r, bit ~ - `~s 1 Z-m s bl~ vet- e1,~ • S < 6 i 3 38-S3 ~Sv 1z 31~.Sti2SIB si I 1es~~ ~ •z1 -3 , Ground elev. RS-` It Depth to limiting factor Remarks: CST Name:-Please Print Arthur L. We erer Phone: 715-425-0165 dress: egerer Soil Testing & Design Service-P.O. Box 74 River.Falls..K. 54022 Sgnature: _ Date: CST Number. - -q'7 -99 220254 I I PROPERTY OWNER _ V \~:TCr-!IGG SOIL DESCRIPTION REPORT PARCEL LD. # T~ - p - 0 3 b _ 1 py D - t 0 Page Z of Boring # Horizon Depth Dominant Color Mottles Structure in. Mu sell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots GPD/ft i,.,;.;...... p _1 p l p `12 Bed Trench clti • s • b Z l0 3z 1 y 2 3/ 6 - s 1' I ~b>< m 'rt l- w Ground 3 32_S JD `/IZ 3/ t elev. 6 •S~ tGZ S1~ S 1 L c Sb~C h1 `F{- - • Z 3 L- S It. 3 Cp AJ-S po Yz OF 1 p k t)- Y/ u y}, s 1 Depth to limiting i factor J Remarks: ! Boring # Ground elev. r It. t Depth to s limiting factor f Remarks: Boring # i Ground elev. It. ! Depth to limiting factor Remarks: Boring # it Ground 't elev. It. Depth to limiting factor Remarks: - PLOT PLAN Page of 3 SCALE 1"= L1~' I Lu-r C l oT nnv11 oSZ I 1t~l.cls s Bwt~Z J)Oj ev:h S w ~~Z}._ L0 00.0' oN Gtr, 3fuY b1R. PVC p1PE~ t.?/LM-H, I ~oep~o~ Sh-"t~H ~ sl~ 14~~~' h i45Tk Y ` l~ly.`511 Hv'e - b c zzalSy ,I[il ItL (715 ) 425-n7 (,5 CST Signature D ate Signed Telephone No CST # `dr a lationwus Labor and Human Relations SOIL AND SITE EVALUATION REPORT Page of 3 Division of Safety b Buildngs in accord with ILHR 83.05, Wis. Adm. Code COUNTY S~ , e-2J`X Attach complete site plan on paper not less than 8 1/2 x 11 inche size. Plan must include, but not limited to vertical and horizontal reference point (BM ~f sslope, scale or PARCEL I.D. P~~ p~ dimensioned, north arrow, and location and distance / 01 O . 1o`IA- LO APPLICANT INFORMATION-PLEASE PRI C INF RIATI0N REVIEWED BY DATE PROPERTY OWNER: PROQ R LOCATION EN 1~-M i;~-GG 1/4 S L.l} 1/4,S 11~ T 3 0 N,R E (0911y PROPERTY OWNER':S MAILING ADDRESS • s is LOT BLOCK # SUBD. NAME OR CSM ST C ~Z o8 ~~M~P 6oN Lo ~Rolx CITY, STATE ZIP CODE 0 NUI QF ICE []VILLAGE ®fOWN ' NEAREST ROAD 1rvoSW 1 S 1 b- n `t New Construction Use Residential / Number 0-fix ' ' (J Addition to existing building j ] Replacement [ j Public or commercial describe Code derived daily flow gpd Recommended design loading rate • y bed, gpd/ft2 •3 trench, gpd/ft2 Absorption area required - bed, ft2 trench, ft2 Ma:dmum design loading rate bed, gpd/ft2 • 5 trench, gpd/ft2 Recommended infiltration surface elevation(s) -m 'S ~ Nt1n/t~ ft (as referred to site plan benchmark) Additional design / site considerations p`-t 1b, kT-5 lG Jy NM Parent material Lo Qs.S out T-, LL_ Flood plain elevation, if applicable ~ ~ ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN RLL HOLDING TANK U = Unsuitable for stem ❑ S ®U I ®S ❑ U ❑ S 2 I ❑ S E U ❑ S [RU ❑ S ®v SOIL DESCRIPTION REPORT Depth Dominant Color Boring # Horizon Mottles Texture Structure Consistence Bourxby Roots GPD/ftin. Munsell I Qu. Sz. Cont Color Gr. Sz. Sh. Bed nerd 2 q Zb io~ccZ ~!!y _ _ t Ground 3 Z6 Sy -)-SLR- 31y L•S~ tzS1 `t; L l s o`M ` - • 3 elev. Ca .'1 ft / J S W ~~'1 sp o S n 1 S Depth to limiting factory Remarks: Boring # o -10 1 n`1 7 31 Z L Z`~s b k `n't V ~t- G.v - , S El Z to-~a Lb~t~-~~ 1 Z~nsbh Y>,v 4r et,~ s 6 Ground 3 3$ _S3 ~ S ~ li 31 ~ . S titZ s!~ s i S 1.~°-S~ 1c ri, 'F1- - • z .3 elev. ,!S-` Depth to limiting factor Remarks: T Name:-Please Print Phone: Arthur L. We erer 715-425-0165 egerer Soil Testing & Design Service-P.O. Box 74 River.Falls,WI. 54022 Signature: Date: CST Number.. .~'1y~ •~9- q,7- y ~1--15~`~ 220254 I PROPERTY OWNER _ V \~Z GG SOIL DESCRIPTION REPORT . PARCELI.D.# T-T• p~ oJb_ lpyp _10 Page, Z of 3 Boring # Horizon Depth Dominant Color Mottles Structure r~< } in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots GPD~ft 1 tiOH2 3/Z S ~ Z,~ Sb~ frn 1 Bed Trench . .;:<<<:::: L tp 3Z t p y 2 3/(, S ' b Ground 3Z_s )o rz 3/6 -S\-Ip- sjg S t t t,-Sbvc m elev. Z 3 q 1. S 3 Co Aj-S po h of 10 k . Depth to limiting I factor 1 3 Remarks: Boring # Ground elev. ft. Depth to limiting factor i t Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # ~ Ground elev. ft. Depth to limiting factor Remarks: . i `rl n'riM f..r . PLOT PLAN Page 3 of 3 SCALE 1"= L1~ ' 1.OT _ PTtv~os~ C LltJ" Lvi \4_ 1ZS~f l~q't,L 9 g s gr IA--Z- J) a ~=v rL tai n~►.,,~ . • ~ S.3 am%h 1 W 2 \ J f- 3►`'1'4t-1 , ~L_ l/vp~(o.p' ON `~"~-~tGl-{, 3JUK ~t~, PVC p11~E ~.l/t:f~~ I.oCP~10~ SR"'T'cli S~~ 1~=800' r ~VSTT~ V ~O 9 X802 r}.1 ~ c Z 20 z S y (715 ) 425-n1 csS CST Signature Date Signed Telephone No. CST # r t ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND ]j OWNERSHIP CERTIFICATION FORM I Owner/Buyer ' Mailing Address &a,!2z 42 a 4224 Property Address / (Verification required from Planning Dyyp nt for new cons on) L' Lj~1 'fB /51 i / I1 : y ~i City/Sta2 Parcel Identification Number LEGAL DESCRIPTION Property Location Sec. T N-R 4~ W, Town of U Subdivision f-r T ~1 A ,-al9 L-e , Lot Certified Survey Map # . Volume , Page # Warranty Deed # &A g , Volume 4t4 Page # 20~ Spec house ❑ yes IX no Lot lines identifiable%ges ❑ 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 syste has be en maintained must be completed and returned to the St. Croix County Zoning Office within 30 days o e three year a lion date. I ATURE APPLI DATE OWNER CERTIFICATION I (we) certify tha ll statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pro de cri a ove, by virtue of a warranty deed recorded in Register of Deeds Office. XGWATLWff PLIC DATE Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. 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