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040-1231-80-000
Nisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Bullring Division INSPECTION REPORT Sanitary Permit No: 563811 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: Nau, Tom & Susan Troy, Town of 040-1231-80-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 0-1) f l) Cg1 v~tJ 3.28.19.1144J TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic , r _ / •~~2 Bench 2 / O N~ Gv'~..rt~ f V2c c Dosing { h Alt. BM Aeration Vryt Bldg. Sewer 5 Holding Irl St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELD BLDG. Vent Air Intake ROAD Dt Inlet Septi Dt Botto . ~*O' rr'uMy A'~ -f3 Dosi / ) 0 / Heade an. r -i 7 s 7S Aeration Dist. P' q 75 Holding Bot. System qK-Izu ~ d Final Grade f- PUMP/ IPH N INFORrMATION N acturer ema St Cover r~ y -7 GPM t Model Number D 30 an C" 4v 77- TDH Lift Friction floss System Hea TDH Ft ForcemaiR Length I Dia. n Dist. to Well C SOIL ABSO PTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLD WELL LAKE/ST/REAM LEACHIN Manufacturer: INFORMATION CH OR Type Of System: I I S I UNIT Model Number: DISTRIBUTION SYSTEM Q S /,(Qd s CC/() Head /Manifol _ Distribution I x Hole Size _ G x Hole Spacing V nt t Air is ttak r~ S `Pipe(s) /1 ,22 / Spacing 71• U q / a Length Dia Length Dia Jn SOIL COVER x Pressure Systems Only xx Mo wuWr At- ade Systems Only GL~I~ Depth Over Depth Over xx pth of xx See ed/SQdded xx Mulched dflA Bed/Trench Center Bed/Trench Edges psoil R Y s No es 0 No COMMENTS: (Include code discrepencies, persons present, etc.) spection #1: / Z Inspection #2: Location: 689 Buttercup Court Hudson, WI 54016 (NE 1/4 SE 1/4 3 T28N R19W) Country Wood Lot 8 Parcel No: 3.28.19.1144 1.) Alt BM Description - rL-yKf~ 2.) Bldg sewer length A D - amount of cover = Q1 Plan revision Required? F*7~ Yes No 2 (3 G~~ Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. Soi/ zk4x1" • /-o CO- 6e & lor-o~a. S~aXe Sf4s4.-7 >?QU P~oPu'df !3«f~.c~jo C~6 e,89 f-~u.dson, ~J1. Si~O/6 tl ~I 17,F'/ ejlkl See, T?~~l ,Pi9cJ. 0 Tn . ar 7noy, SE • C/bix do-, L D/ A/. # pslp _ /.23/..Bo -Cr-C o.LD- Proposed Alou.,dccEZ~.27'x 9,2.s8 a',sf~„Stc-bon vrled,a. Two(Z) /a.&Vla/,S c- Ot.,C 75~~~w/f'8 `uY~i~GCS S~oaCa~ e ;f. os~' x~ t /fiG Lui/P Scr rFace -e /-e v 16z OFA57lr7C, -33 -<4,, -6o be 96.z5 ' C& a a G 9 '•z born 97- SO'Co» i tp ExSy" , 410, n eJec4.s Colarz6t' ~'lbc,-~ bey n SEc+//~sfaf h ~ ~ i ,ye_o~//p,eJotl/er,Au~}a 83 ExiS~i LJ eks CarncrA;k 41 WO &D be Ex:s~ dos EXiS~»o Bf ~nv~~ona/ well \ ~ d: s/~us4 / er: d t~ « be a 64- Z P~ C, code. S ~N VD, PC 3$3.33, WA r- . FOB ~G 1~ nC~ Wlw' To o{ 33z' Z3 /0 W4- Awe/ Cplne/a~/tauSF. /1.e. cze 4,k. ~5 66, o I off' oar""T'say County Safety and Buildings Division St. Croix a ; 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) P Madison, WI 53707-7162 Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit 2255449 is required prior to obtaining a sanitary permit. Note: Application forms for state-owned P~e submitted to the Department of Safety and Professional Services. Personal information you provide ma ~erJsiyygadgty Project Address (if different than mailing address) purposes in accordance with the Privacy Law, s. 15.04 1 m , Slats. ~m CC((JJ / QCs 1. Application Information - Please Print All Inform Same 0T (D V l G.) Ae- Property Owne i are 20 i Parcel # Susan Nau sr C 040-1231-80-000 W Property Owner's Mailing Address uNry Property Location 689 Buttercup Crt Govt. Lot City, State Zip Code Phone Number NE SE section 3 (circle one) HudWn, WI 54016 651 398-3982 T 28 N; R 19 E or W II. ype of Building (check all that apply) Lot # I or 2 Family Dwelling - Number of Bedrooms Subdivision Name 8 Stock # Country Woad ❑ Public/Commercial - Describe Use na ❑ City of ❑ State Owned - Describe Use CSM Number ❑Village of 40 /x 75 na tt3 town of Trod III. Type of Permit: (Check o one box on line A. Complete tine B if applicable) A' ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) aftevious ermit Number and nke I~ B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New L .7 , 3 , / M -7 9.1:z Bef ore Expiration er 7 J / IV. Type of POWTS System/Component/Device: Check all that opplyf D Non-Pressurized In-Ground ❑ Press / ~,In-Groan t-Grade Mound ? 24 in. of suitable soil Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Corh n, t l ' nt V. Dis ersaVrreat ent Area Informatio S yin-Tech S)FF- a went filter to installed at eftuuen ischar e Design Flow (gpd) Design Soil Application plate( ispersal Area Required (s Dispersal Area Proposed (sf) System Elevation / 1.0 Gpd/sq, ft. ASTM-C33 sand 98.25' at 9" above 450 G 0.6 G d/ . ft. native soil 450.00 s q. ft 450.00 S q. Ft. 97.50' contour VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units New Tanks Existing Tanks ` a; y~l I ✓ul U in A w C7 M1. . 9 Septic or Holding Tank Na 1,000 1,000 1 Weeks Concrete X Dosing Chamber a 800 800 1 Weeks Concrete X VII. Responsibility Statemen - I, the unde igned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) TP, ' ign MP/MPRS Number Business Phone Number James K. Thom son MPRS 30021 715 248-7767 Plumber's Address (Street, City, State, jpZWc) 340 Paulson Lake Lane, Osceola, WI 54020 VI oun /De artment Use Only Permit Fee Data Issued Issuin eat Sign Approved Qwne en Reaso FDenial $ U(~ ~T f IX. Conti sons for Disapproval 1. 5ept~ tank, effluent filter and J I / ,dispersal cell must all be ser*es Imadntadtied ` 4- f ,r ;-5 L,; as per management plan provided.byplumber. i Attack to complete plans for the system and submit to the Coup only ou paper not less than 814 z It inches In sae SBD-6398 (R- 11/11) (.dL . Replacement Mound POWTS Index & Title Sheet Project Name: Nau 3 Bedroom replacement Mound Owners Name: Susan Nau Owners address: 689 Buttercup Court, Hudson, WI 54016 Site address: Same Project Location: Subdivision: Lot 8, Plat of Country Wood Legal Description: NE%,SE'/., Sec. 3, T.28N., R. 19W., Town of Troy, St. Croix Co., WI. Parcel ID 040-1231-80-000 Page 1 Index and Title Sheet Page 2 State Approved Mound Design Page 3 Filter Specifications Page 4 Septic Tank Maintenance Agreement Page 5 Parcel map Page 6 Deed Attachments: Soil Evaluation Report Mater Pl er Restrict Service: James K. Thompson, Dept. of Safe Prof- Tonal Services Credential #30021 Signature: Date: Z-0 :20/,3 Page 1 of 6 Design pursuant to In-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (N.01/01) DIVISION OF INDUSTRY SERVICES Q 3824 N CREEKSIDE LA nu~ D 7 HOLMEN WI 54636 3 ' S Contact Through Relay www.dsps.wi.gov/sb/ www.wisconsin.gov ~ossrors'tS~~ Scott Walker, Governor Dave Ross, Secretary June 13, 2013 CUST ID No. 30021 ATTN: POWTS Inspector JAMES K THOMPSON ZONING OFFICE ACE SOIL & SITE EVALUATIONS ST CROIX COUNTY SPIA 340 PAULSON LAKE LN 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/13/2015 SITE: Identification Numbers Susan Nau Transaction ID No. 2255449 689 Buttercup Court Site ID No. 791488 Town of Troy, 54016 Please refer to both identification numbers, St Croix County above, in all correspondence with the agency. NE1/4, SE1/4, S3, T28N, R19W FOR: Description: Three Bedroom Mound System / 6% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1431599 Maintenance required; Replacement system; 450 GPD Flow rate; 27 in Soil minimum depth to limiting factor from original grade; System(s): EZflow Mound Component Manual, (R. 7/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, 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 COIVDI 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 APP requirements. DEPT OF No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.14 PROFESSIO scats. DIVISION OF IND The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the $ COR 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 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 cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • 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 JAMES K THOMPSON Page 2 6/13/2013 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 Fee Received $ 250.00 Balance Due $ 0.00 erard M Swim Wk POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 j erry.swim@wisconsin.gov (Vote: 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 y SPS Chapters 360-366. JAMES K THOMPSON Page 2 6/13/2013 Owner Responsibnlaties ® 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). 0 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 /~A Fee Received $ 250.00 Balance Due $ 0.00 erard M Swan POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 j erry. swim@wisconsin. gov 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 =`f Fps the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered w' E and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed f4: -f.ly SPS Chapters 360-366. { M'w' • if MV' istY K !7~ Y1AP++M~ EZflow® MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE RECEIVED Project Name: Nau 3 bedroom replacement residential mound MAY 3 0 2013 Owner's Name: Susan Nau DUSTRY SERVICES Owner's Address: 689 Buttercup Crt., Hudson, WI 54016 Property Address: Same Legal Description: NE1/4SE1/4, Sec. 3 T.28N., RAW Township: Troy County: St. Croix Subdivision Name: Plat of Country Wood Lot Number: 8 Block Number na NALLY Parcel I.D. Number: 040-1231-80-000 OV 'D AFE7-YAMD Plan Transaction No.: ~ L SERVICES Page 1 Index and title SERV1CE3 Page 2 Data entry Page 3 EZflow mound drawings Page 4 Lateral and dose tank Page 5 Distribution media CN~ENCE Page 6 System maintenance specifications Page 7 Management and contingency plan Page 8 Pump curve and specifications Page 9 Site Plan Page 10 Attached Soil Evaluation Report Designer: am s- K. Thompson License Number: 30021 Date: 05/25/1 ,J Phone Number: (715) 248-7767 Signature: Designed Pursuant to the EZflow Mound Component Manual Ver. August 20, 2007, SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01, R. 10/12) EZflow Mound Version 3.0 (R. 3/1/12) Pagel of 10 Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design 300.00 Estimated Wastewater Flow (gpd) 1.50 Peaking Factor (e.g. 1.5 = 150%) 450.00 Design Flow (gpd) 6.00 Site Slope _ 97.50 Installation Contour Line Elevation (ft) [ 100.00 Contour Length Available (ft) 27.00 Depth to Limiting Factor (in) _ 0.60 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 6.00 Cell Width (ft) 3, 4, 5, 6, 7, 8, 9 or 10 Only 75.00 = Dispersal Cell Length (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y 7 Pressure Disribution Information network? Enter Y or N (c or e) E Center or End Manifold 3 Lateral Spacing (ft) If N above, enter the elevation (ft) 2 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 2.00 Estimated Orifice Spacing (ft) = 6.08 ft2/orifice 2.00 Forcemain Diameter (in) 40.00 Forcemain Length (ft) Does the forcemain drain back? [~-Y~ 87.25 Inside Pump Tank Elevation (ft) Enter Y or N .5 Forcemain Filter Loss (ft) 6.50 System Head (ft) x 1.3 6.52 Forcemain Drainback (gal) 10.50 Vertical Lift (ft) 67.38 5x Void Volume (gal) 0.80 Friction Loss (ft) 73.91 Minimum Dose Volume (gal) I ?!t7-80 Total Dynamic Head (ft) 30.48 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. o tions choice in. dia. o tions choice 0.75 1.25 x 1.00 I I 1.50 x x 1.25 2.00 1.50 x 71 x__ 3.00 2.00 x 3.00 x Gallons/Inch Calculator (optional) Treatment Tank Information 805.12 Total Tank Capacity (gal) 1000.00 Septic Tank Capacity (gal) 37.00 Total Working Liquid Depth (in) WeeksConcrete ] Manufacturer 21.76 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 805.12 Dose Tank Capacity (gal) S mTech Filter Manufacturer 21.76 Dose Tank Volume (gal/in) STF-100A _ _ Filter Model Number Weeks Concrete _ ]Manufacturer ~-u Project: Nau 3 bedroom replacement residential mound Page 2 of 10 Mound Plan View t . J 1/10 B ' ' ' ' ' • • ' Observation Pipe A 5 W . . - 4~J• : I L Mound Component Dimensions ft A 6.00 ft E 13.32 in H Aft ft K Aft B 75.00 ft F 12.00 in z ft L ft D 9.00 in G 0.50 ft J W 450.00 (ff) Dispersal Cell Area [-111.50 .16 (ft) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View EZtlow Dispersal Area Finished Grade 100.25 (ft) ♦ H . G j 1 F Dispersal Cell 98.75 (ft) Lateral 98.25 (ft)--►+ - ' 6 Invert Elevation Dispersal Cell D : 3 Elevation i •A l .1 :lam l • { : ,i, . ~ ~i .t " a ~ x4{.~~~~<~~`~ 1r< <i " " 9 .50 (ft) Contour Elevation 6.0 % Site Slope Typical Dispersal Cell Shading Key See Page 5 Elm Topsoil Cap > 2 Subsoil Cap a a Approved Geotextile Fabric Cover ASTM C33 Sand g (4 2.0 ft 4 Tilled Layer ' Z l f f r: ~f f r 5 f EZflow Media :~"T L•.,:.L• y L•L•L• • ti U) O 0.5 ft a lb - See details on page 4 for number, size, and spacing of laterals. Laterals are located in the 4" gravity distribution pipes as shown on page 5. i Project: Nau 3 bedroom replacement residential mound Page 3 of 10 End Connection Lateral Layout Diagram Place Appropriate Lateral Diagram From Right Below P • = Turn-up v►dttalI valve or clean out plug i I . i 1st ordice located art Z IE x--y~ Orifices point up except every 51h S one points down for drainage. Force main cormection via tee or cross to manifold at any point. Leeials & lorca main of PVC Scb 40 All laterals identical with onloce5 equally spaced. par SPS Table 384.30.6 Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.04 ft Lateral Length (P) 74.22 ft Orifices per Lateral 37 Lateral End (Z) 0.78 ft Orifice Density 6.08 ftz/orifice Lateral Spacing (S) 3.00 ft Manifold Length 3.00 ft Lateral Flow Rate 15.24 gpm Manifold Diameter 1.50 in System Flow Rate 30.48 gpm Forcemain Velocity 3.11 ft/sec Dose Tank Information Locking cover with warning label and locking device and / sealed watertight Electrical as per NEC 300 and SPS 316.300 WAC 4 in. min. Disconnect Tank component is properly vented - Alternate outlet location Forcemain diameter WeeksConcrete Manufacturer 2 in. Capacity 805.12 Gallons Volume 21.76 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 19.60 426.57 B 2.00 43.52 C Pump off elevation (ft) C 3.40 73.91 88.25 D 12.00 261.12 D Total 37.00 805.12 Dose tank elevation (ft) Bedding And Backfill As Per Manufacturer 87.25 Alarm Manufacturer SJ Rhombus Alarm Model Number SJE 1011421 Pump Manufacturer Zoeller Pump Model Number BN151 I V.3 e5 Uas-g -Jv e C,u/UR, Pump Must Deliver 30.48 gpm at 17.80 ftTDH Note: Switches containing mercury may not be used in this system. Project: Nau 3 bedroom replacement residential mound Page 4 of 10 U lowe Distribution Cell Media Layout 6.00 Cell Width (ft) 1.50 Sidewall to Lateral (ft) Distribution Cell Cross-section Arrangements 6 ft Wide (eased" Component Legend ® SR1JA Bundle - 5 ft or 10 ft lengths SR1-12A or EZ 1201A in 5 ft or 10 ft lengths SR3-12H or EZ 1201 P or Gxm SR3-1.2H in 5 ft or 10 ft lengths O 4" Perforated Distribution Pipe With Pressure Lateral Inside • Turnup Enclosure - - - - - Pressure Lateral Bundles are covered with approved geotextile fabric as per the their product approval. Distribution Cell Plan View Layout - Typical 6.00 Cell Width - A (ft) 75.00 Cell Length - S (ft) Center Connection Lateral Layout Diagram Force Main 6 ft Wide Project: Nau 3 bedroom replacement residential mound Page 5 of 10 Mound System Maintenance and Operation Specifications Service Provider's Name 4Jmaes K Thompson I Phone 17151248 7767 _ POWTS Regulator's Name St Croix County Zoning Dept _ I Phone 1(715138_6468_6~ 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 ft2 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 Inspect and clean as necessary at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test periodically Pressure System Laterals should be flushed and pressure tested eve 3 ears Mound Inspect for ponding and seepage once eve 3 years _ 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 EZflow Mound Component Manual Ver. August 20, 2007. 2. Dispersal cell media conforms to EZflow products approved for use with the EZflow Mound Component Manual Ver. August 20, 2007. Media is covered with an approved geotextile fabric. 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 Lateral Ends at Last Orifice Where Variable Length Cleanout Begins Long Sweep 90 or Two 45 Degree Bends Same EZflow S nthetic Media 2.06 Feet Diameter as Lateral s--- Distribution Lateral Lateral Cleanout Project: Nau 3 bedroom replacement residential mound Page 6 of 10 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 [Utlow Mound Component Manual 8/20/07, Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. 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 filter 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 as to 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 Wisconsin Department of Commerce. Pump Tank The dosing (pump) 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. If the force main has a weep hole, it should be noted if it is functional during pump operation, and if not, it should be cleaned. " No one should ever enter a septic or dose tank since dangerous gases may be present that could cause death. 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 BODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS, 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 3 years. 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 4 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 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Nau 3 bedroom replacement residential mound Page 7 of 10 PUMP PERFORMANCE CURVE TOTAL DYNAMIC HEAD/FLOW MODEL 151N52l153 PER MINUTE 14 45 153 EFFLUENT AND DEWATERING 40 ~ 12 \ MODEL 151 152 153 35 152 Feet Martin Gal. Liters GaL Liters Gal. Liters to v 5 1.5 50 189 89 261 77 281 30 1D 3.0 45 170 61 231 70 265 (J o e 25 t5t 15 4.6 38 144 53 201 61 231 20 6.1 29 110 44 167 52 197 6 20 ~ 25 7.8 18 81 34 129 42 159 T 30 9.1 - 23 87 33 115 t5 4 35 10.7 22 85 - - - t0 40 12.2 - - - 11 42 Shut-off Head: 30 ft (9.tm) 38 R (116m) 44 d. (13.4m) 2 6 0145066 0 to 20 40 50 60 1 6o 90 100 GPLt.Of15 LRER6 40 tp 0 110 260 210 3 3 FLOW PER MINIZE 0145MA Model 151 Models 1521153 Swap/y ra6C res d CONSULT FACTORY FOR SPECIAL APPLICATIONS 67132 6114 37/8 45A 327/32 459 • Tuned dosing panels available. • Electrical atternators, for duplex systems, are available and 3714 32713 supplied with an alarm. 4 4 • Variable level control switches are available for controlling 97,E 327n2 single phase systems. • Double piggyback variable level float switches are available l l for variable level long and short cycle controls. t • Sealed Owik-Box available for outdoor installations. See FM 1420. i I l • Over 130•F. (54'C.) special quotation required. 1511152/153 Series it 1tlis 1 Qits l 15111521153 MODELS Control Selection Model Volts-Ph Mods Am sim lex Duplex l M s Ire BN1 115 1 Nan .0 1 2 or 3 814151 115 1 Auto 6.0 Included 2 or 3 E151 230 1 Non 3.2 1 2 or 3 BE151 230 1 Auto 3.2 Included 2 or 3 SK2444 SK2064 N152 115 1 Nat 8.5 1 2 or 3 BN152 115 1 Auto 8.5 Included 2 or 3 E152 230 1 Nan 4.3 1 2 or 3 BE152 230 1 LAuto 4.3 Included 2 or 3 N 153 115 1 Non 10.5 1 2 or 3 BN153 115 1 10.5 Included 2 or 3 E153 230 t 5.3 t 2 a 3 SELECTION GUIDE BE153 30 1 5.3 Included 2 a 3 1. Single piggyback variable level float switch or double piggyback variable level float A CAUTION switch. Refer to FM0477. Ai: installation of controls, protection devices and wiring should be done by a qualified 2. See FM0712 for correct model of Electrical Alternator E-Pak. licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA), 3. Variable level control switch 10-0225 used as a control activator, specify duplex (3) or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO P.O. BOX 16347 © ~~Itisrttes'~/V o Louisville, : KY 40256-0347 Manufachxers of.. ~ Ar SHIP P T T0: 3649 48 Cons ane Run n Road Louk0b, KY 40211.1961 r1Wj7r AWRY SA'CE /y9y PUMP !O. (502' 778-2731 02) 7B4 36 928-PUMP httpJ/www.zooJler. com 40 Copyright 2004 Zoeller Co. All rights reserved. of/D co) • -Sail PJ/Q/ccCLn/O, f • /-a CaEelorv. SEaXe 5 Lt S4. J 17a u ro~oper~y G89 Q«f~we<yo Cr6• ~icdsvn, c.J/. 5Oi6 t~ p LoE B ~/rt~op~'vu~iy 0 Tn . off' Troy, 5E. Comdr ~'o•, A4 00510 ~ east ~ -oposed /~'loci„dtc-EZ.1.27'x 9,2. 58 v7/ (o'k >S'doSpeW-S&1 Cell w.t~k 6oF/ocv a(,S cc bon NQe.d,a. Two(.) /0-&eo./,S x 46 MCx 7St?.Z~w/y8'cur-•i~us S,aaCed ;e•a Cui/PScu face a %e 14 i Clb a E 9 ..Q.So&-t 97• SO'Ccr7 -,60 w.' r d / i l9rcty P v J~ / lo~ / ~ 6,X;SFin c,.Jte~s 4i Co~crc6t 1 i ~ ~op/0 uq~1 C/iaclr , i dC~~(~.yc. o/ i1t,v.L~oeNtr~9cu+~i ~r 83 4 ux) S-cp~c;t~ Ea be °i ~c u s cd. ~O' lo, E41s61 dos bea6~•+ 2 P v Q coc~¢. 5c NtiD• PS 983.33, WA c 3gz'y3 A/~. Qi.n'I. ~ ~~omo{ /awct /¢dc/5.d i~q a~ E, Cc rn er a f if oou.Sl. E/r ri- 9s BG. a o Ir SIM/TECH FILTER FILXER Sim/Tech Filter The GAG Sim/Tech Filter is unique to the industry, engineered to provide maximum protection for your sanitary pressure system. • 'ta The Sim/Tech Filter has been designed as an effluent filtering device to r ~~a assure small holes in the distribution piping remain unclogged. Pressure distribution systems are very effective in treating effluent, but only when holes remain open. Many of these systems only partially fail, causing r contamination of ground water long before the system shows any visible signs of distress. Placing a filter just before entering the forced main is a simple solution. The filtering device installs by simply screwing onto the discharge port of any effluent pump, thereby filtering out contaminants before they enter the + distribution system. Thus, maintaining even distribution of effluent. The GAG Sim/Tech Filter protects any pressurized system including: Sand Filters - Spray Irrigation Systems - Pressurized Chambered Systems ` Recirculation Sand Filters - Mound Systems S ast~ ~rtstallcttion - ,Low /Rairtt.ertanee - ScortoYnicttl - Sxtertds 4e 4 ~zain~ield - JYYtp?oves -5-' tt(ertt rlualitt( 6t( assu2irt~ even 'Z)i9tzi6utiort - ~'d<<t( nvr Z~#uertt Su6Y,,tensi6le temps - (2ayt 6e used i),i both 7leside7iti d and eor,tYne7cial f{pplicatiorts JV Order # Model Description Lis Price STF-100A2 STF-100 GAG Sim/Tech Filter (field assembly) to8.95 rpasc- wit The STF-110 has well over 1/2 mile of filtration media with over 319 cubic inches of open area to eliminate clogging. The 2,215 square inches of filtering surface allow a flow rate of over 1200 GPD, filtering to 1/16 inch diameter. This incredible' amount of filtering surface is achieved through the unique shape of each - triangular bristle, which more than doubles the filtering surface, with no uniform J holes or slots to plug. - A Order # Model Description- List Price STF-110 STF-110 Disposable Septic Tank Filter (yellow bristle) 23.8c 6-S ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Susan Nau Mailing Address 689 Buttercup Crt., Hudson, WI. 54016 Property Address Same (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number 040-1231-80-000 LEGAL DESCRIPTION Property Location N E '/4 , S E '/4 , Sec. 3-IT 28 N R 19 W, Town of Troy Subdivision Plat: Country Wood , Lot # 8 Certified Survey Map # Na , Volume Na , Page # Na Warranty Deed # 5V 41~ ( - (before 2007)Volume , Page # S Spec house OyesEno Lot lines identifiable ❑ 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 §SPS. 383.52(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. 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 Safety And Professional Services 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 form are rue 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 ecorded in Register of Deeds Office. Number of bedrooms 3 /Y2-t1-u- Ufa' /f3/ /.3 SIGNATURE Off 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. 04/12) ~ ° y2T.8Btr~ S06 30 E 3ty.35 152.6'5' in m e SO$ "S6 il m 23p t ` ^ r n I W ~ ~ ~ ~ ~ gt.Op~ goo, 1 i I ~ i N~t • r t I I ~ 00. I ~ 1 ti~s~ 1`~58oa5?6 /owr` 58►y46:, STATE BAR OF WISCONSIN FORM 2 - im WARRANTY DEED DOCUMENT NO. ttTrtanun n cTn1tT ES CRO)X CO., W1 _ EP 9 1998 conveys and warrants to THOMAS G. NAU and 8;00 AM husbanan w fe suriyorshi 12ropecty, er DeerN WIS SPACE RESERVED FOR RECOADINn DATA the fdlowing described real estate in St . Croix NAME Count AND "AN ADDRESS T-- y, ~/j~- Slate of Wisconsin: I I Lot 8, Plat of Country Wood, Town of Troy, ` &L st•AI- St. Croix County, Wisconsin. A ~Vpy j 040-1231-80-000 PARCEL IDENTIFICATION NUMBER TRAPSFER ~EE This is not homestead property. (is) (is not) F-Ptionto warramies: easements, restrictions, rights-of-way and covenants of record, if any. Dated this 21St day September A.D., 19 98 Richard n- Stout (SEAL.) (SEAL) • fit (SEAL) (SEAU AUTHENTICATION ACKNOWLEDGMENT Signatutew State of Wisconsin, ~ authenticated this day of 19 St. Croix' County- , Personally came before me this _ 21- day of Pnuttlitt opt~l?JYTr 19,_,_,,., the above named plplr Public Ric a d 0. tout TITLE: MEMBER STATE BAR OF WISCONSIN State -cons]" (if not, authorized by 9706.06, Wis. Scats.) to nit kno to be the On who executed the foregoing instru and ackn dg same. THIS INSTRUMENT WAS DRAFTED BY Janet P. Stout -W R3 A uhea ~Ti Hudson, Wi. 54016 Navy Public, county WIS. (Signatures may be authenticated or acknowledged. Both are not My commission i nailer. (I c~itatign date: necessary) $ 9 ) • Names of persons signing In my aapaaUy should by typed or printed below tIui sgnawres WARRANTY DEED STAIR BAR OF WISCONSIN YY W40 Lap/M*Co.. Wa Form No. 2 - 1902 Mloswm VAS. 19 - kakL I V E D RA I Wisconsin Department of CommJJN 2 0 20113 SOIL EVALUATION REPORT 2328 Division of Safety and Buildings Page 1 of 3 in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations ST CROIX COUNTY Attach complete site plan on paper not Wi lhan 8% x 11 Inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (s% direction and St. Croix percent slope, scale or di"Mions, north arrow, and location and distance to nearest road. Parcel I. Please print all information. 1231- 0-000 Personal information you provide may be used to Rev By Date secondary purposes (Privacy l.ew, s. 15.04 (1) (m)). (i Property Owner Susan Nau Property Location :689 Govt. Lot NE 1/4 SE /4 S 3 T 28 NR 19 W roperty Owner's Malting Address Lot # Block # Subd. Na or CSM# Buttercup Crt. 8 na Country Wood city State Zip Code Phone Number J City J Village OM Town Nearest Road Hudson WI 54016 (651) 398-3982 Troy Buttercup J New Construction use: a Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD 16 Replacement J Public or commercial. Describe: Parent material Glacial Outwash Flood plain elevation, if applicable Na General comments and recommendations: Site suitable for mound system with 9" of ASTM-C33 sand placed on 97.50' contour. Infiltrative surface elevation to be 98.25'. Boring # J Boring 0 Pit Ground Surface elev. 99.21 ft. Depth to limiting factor 42" in. APplkation Rate Horizon Depth Dominant Color Soll Redox Descri ption Texture shwure Coruisterue Boundary Roots G AP in• Murrseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 2 0yr3/4 2fsbk mvfr 1 T42-747.5yr4/6 Oyr3/2 gnone 2fgr mvfr cw 2f,1 m 0.6 0.8 cw 1vff 0.6 0.8 3 .5yr4/6 $1 msbk mvfr cw - 0.4 0.7 4 .5yr4/6 is Osg ml cw - 0.7 1.6 5 Osg ml 0.7 1.6 . Cap lary fringe o bserved -at-49---L.- Boring # J Boring ✓J Pit Ground Surface elev. 95.93 ft. Depth to limiting factor 27" in. Horizon Sos Application Rate Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPppP in. Munsell Qu. Sz. Cont. Color. Gr. Sz. Sh. 'E 1 'Eff#2 1 0-11 10yr312 none $il 2fgr mvfr cs 2vf,fl 0.6 0.8 2 11-16 1Oyr4/3 none sit 2fsbk mvfr gs 1vf,f 0.6 0.8 3 16-30 1Oyr4/4 none sit 2fsbk nvfr cw - 0.6 0.8 4 30-42 1 Oyr4/4 fad 7.5yr5/8 sil 1 msbk mvfr - - 0.4 0.6 aturated flow observed a " _Capilary fringe obse at 7"- recommend using 27" as depth to limiting factor. ' Effluent #1- BOO? 30 < 220 mg/L nd TSS >30 < 1'50 mg/L ' Effluent #2 = SOD < 30 mg/L and TSS 130 mg/L CST Name (Please Print) ignatu CST Number James K. Thompson y 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola WI 54020 5/23/2013 715-248-7767 Property Owner Susan Nau Parcel ID # 040-1231-80-000 Page 2 of 3 Boring # J Boring IE_✓1 Pit Ground Surface elev. 97.58 ft. Depth to limiting factor 36" in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Application Rate m. Mum Qu. Sz. Cont. Color Gr. Sz. Sh. 1 ' "EffEff#2 # 1 0-9 10yr3/2 none sil 2fgr mvfr CW 2f,1 m 0.6 0.8 2 9-17 10yr3/4 none sil 2fsbk mvfr CW 1vf,f 0.6 0.8 3 17-36 7.5yr4/6 none gr sl 1 msbk mvfr Cw - 0.4 0.7 4 36-44 7.5yr4/6 W7.5yr5/8 Is Osg MI Cw _ 0.7 1.6 5 4472 7.5yr4/6 f2f7.5yr5/8 Is Osg ml - - 0.7 1.6 Saturated flow observed at 44". Capilary fringe observed at 36". a goring # _1 Boring _1 Pit Ground Surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Stnrcture Consistence Boundary Roots in. Mwr$eil Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring # -1 Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Roots •Eff#1 GPDW 'Eff#f2 ' Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 m The Department of Commerce is an equal 0 5 _ g/L and TSS <_30 mg/L access services or need material in an alternate forma please contact the department at 608-266-3151 ordTTY 608-264-8777. SBb-8330 (R.07100) A.C.E. Sod & Ske Evaksab" ■5a/a✓a/aQ 01110;6 4;n9 e1w.. 7C4 "23.28 Sus4n ~'lacc ,o~op. D 1089 ~cC~Ccc~vCr~. f~~ds on, ,,J/. Sf~O/(o Led& of Caccnf~~cJiod Tn. a~ 77,-1r, SE.e~'OiJCa,Li1. b.e7ny ~.O~ctertS wcarK~ 4~, V -y~ of lower we / Sao.I * E1~=9s 8G' 8~~ EIS E; wcs,('s Corgi crtfx crao ~ .~T , c! 83 E~~~4:~ u>ec~'s~Co~+u+c~e8c~~~44~~ ~'r q1a ~ ~b~ 4~, Cdr w, ol, OWTS dg's crY4/ o \v~~ 81 . ~ na(on aSPv C~ac1G . EXisfing wc~r , o To 0 Ait, 4x ST. CROIX COUNTY ZONING DEPA AS BUILT SANITARY REPO i A. ~ rll r Owner /o ryt rVa G~ Property Address City/State "wJ c~~Nr ~(JUNTY Legal Description: rA17"GOFFICE Lot Block Subdivision/CSM # %4 %4, Sec. T N-R W, Town of 3 Z . rT(/V~ SEPTIC TANK DOSE CHAMBER HOLDING TANK INFORMATION: Tank manufacturer G-.e s Size ST/PC 100o /gad Setback from: House Well *74/ PAL 5 Pump manufacturer 6 &&.QA Model E~p S/ Alarm location yacs-a (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: Tewh Width 3 Length 75 Number of Trenches Z Setback from: House 0L_ Well I/5 " P/L 6_ Vent to fresh air intake 11A0 ELEVATIONS: Description of benchmark /'ila`i.~~~ ozr~, / L •u/rr~✓ Elevation /0 o Description of alternate benchmark Elevation Building Sewer ST/HT Inlet ST Outlet PC Inlet PC Bottom Header/Manifold Top of ST/PC Manhole Cover Distribution Lines ( ) ( ) ( ) Bottom of System O O ( ) Final Grade ( ) ( ) ( ) Date of installation Permit number State plan number Plumber's signature r 7-4 License number 2Z kS Z V Date Z/?o/4G Inspector f`m Complete plot plan Q 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 N r~ 1 i A\ vjOc +1 o eve l t h~ I 5`I° G:" - L INDICATE NORTH ARROW PAGE OF PUMP CHAMBER CROSS SECTIOhj J AUD SPECIFICATIONS VENT CAP 4"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUMCTIOnJ BOX \ MAMHOLE COVER 25' FROM DOOR, \ WINDOW OR FRESH I2 h4"~ I AIR INTAKE GRADE CONDUIT 11~ rNI_.F_ r PROVIDE I _'7'~ AIRTIGHT SEAL Ir I { APPR.O`✓EG JOINT A I III APPROVED .IOWTS W/C.I. PIPE. I III W/G2. PIPE EXTENDIKIC. 3' I II ALARM EXTENDING 3' ONTO SOLID SC;B I I ONTO SOLID SOIL { I { O KI C I I I PUMP--- OFF D CONCRETE BLOCK RISER EXIT PERM17FED GAJLy IF TANK MANUFACTURER HAS SUCH APPROVAL SPEC.IFICATIOMS SEPTIC AMC) ,p DOSE TAnJKS MAIJUFACTURER. (J'J.#ekJ . C• ► NUMBER OF DOSES: PER DAy TANK ;,IZE : GALLOMS DOSE VOLUME ALARM MANUFACTURER: El e,Ir& INCLUDING BACKFI.OW: ~2C GALLONS MODEL IJUMBER: Aw CAPACITIES: A=IMCHES OR SZd GALLONS SWITCH TYPE,: /~VrCat~ gca f? g = 2 INCHES OR y0 GA'_LOUS PUMP MAMUFACTURER: [S~n~ C=~._WLHES OR ZZ~ GAI_LOUS MODEL NUMBER: P4 4(d - D- INCHES OR /':~U GALLONS SWITCH TAPE: - a~G 110"12 NOTE: PUMP AND ALARM ARE TO BE ON SEPARATE CIRCUITS PUMP DISCHARVE RATE 7b GPM 7-69 FEET VERTICAL DIFFEKEMC[ B~WECA! PUMP OFF AND DISTRIBUTION PIPE.. FEET + MIIUIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . AW-4 r- FEET + -0 FEET OF FORCE MAIN X / looFr.FR1CTI0u FACTOR.. * Z FEET = TOTAL OtJUAMIC. HEAD = 71 f~l FEET IAITERKIAL DIMEWS1ONG O TAUK. LENGTH i2v ;WIDTH ;LIQUID DEPTH SIGNED:____. LICEOSE NUMBER: ZZ'~s DATE: -117- Goulds Submersible Effluent Pump 3871 EP04 / EP05 APPLIQAtIONS • Fasteners: 300 series • FWs y submerged in high ■ Motor Housing: Cast iron $pecifi y designed for the stainless steel' grEde turbine oil for for efficient heat transfer, liovtri • Capable of running lubrication and efficient strength, and durability. 0 uses: dry without di ma to heat transfer. • Efflu~t 'stems ry ■ Motor Cover: Thermoplas- Hom components. tic cover with integral handle Motor: Available for automatic and Farrl~ manual operation. Automatic and float switch attachment • Heavy-duty, sump • EP04 Single phase: 0.4 HP, ! models include Mechanical points. WatePrfransfer 115 or 230 V, 60 Hz, 1550 Floae Switch assembled and ■ Power Cable: Severe duty bewatedn' g - --RPM,;built in overload with presat at the factory. rated oil and water resistant. automatic reset. ■ Bearings: Upper and lower SPECIFICATIONS • EP05 Single p+tase: 0.5 HP, FEATURES heavy duty ball bearing 115 V, 60 Hz, '1550 RPM, Pump: EP04 built in ovedozd with ■ EP04 Impeller: Thermo- construction. • Sollds,handling capability: automatic reset. plastic Semi-open design aXimum. • Power cord: 10 foot with dump out vanes for AGENCY LISTING • Capachies: up to 55 GPM, standard length, 16/3 SJTO mect-anical seal protection. 1. Canadian standards Asudatlon Total heads: up to 24 feet. with three prong grounding m EF05 Impeller: Thermo- • pisc&rge size: 11/2" NPT. plug. Optional 20 foot I (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with P last c enclosed design for end in "F or AC rotary/peramic-stationary, three prong grounding plug Improved performance. BUNA-N elastomers. (standard on EP05). ■ Craing and Base: Rugged Temperature:_ thermoplastic design provides i 040F (400C) continuous supexor strength and 140°0 (600C) intermittent. corrosion resistance. k, • Fasteners, 300 series METERS FEET k stainless steel. 10 Tom- iR -,;Capable, of running • dry without damage to s 30 -4. 6GPMA components.. , 25 FT Pump; EP05 e • Solids handling capability: c 25 34",maximum. a 7 - - W • Capacities: up to 60 GPM. _ • Total h0ads: up to 31 feet. a 6 20 R Dischat 'e;slze:11h" NPT. ~ s - _ - i - _ - - • `Mecheiiloal seal: carbon c: 15 µ rotary/ceramic-stationary, a BUNA-N elastomers. - - - . l_- • Temperature: 3 10 1040F (400C) continuous 140°F (600C) intermittent. 2 _ 5 h 0 oc 10 20 30 40 50 GPM t 2 ~ 6 8 10 12 nN/h CAPACITY I.,Q91996 c wWS Pumpa, Inc. Effective May, 1995 83871 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM ' Safety and Buildings Division CountyST. CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary*W4lj.: Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)]. iWit H'hOold 9 Name: E~ fp Village ❑ Town of: State Plan ID No.: AA i x CST BM Elev.: Insp. BM Elev.: BM Description: Parcel ~0~ Td4~P~1231-80-000 TANK INFORMATION ELEVATION DATA A990o008 - g,k ,i TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 3?" Septic S ~cr c ( , Benchmark l Dosing Aeration Bldg. Sewer Holding._. St/yMf Inlet 12Z TANK TBACKINFORMATION St /b►f Outlet TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet /LrS% Septic NA Dt Bottom Dosing NA Header/Man. 7 'gyp" 7 jd j~ Aeration NA Gist-Ride- 7' / 7//fy! Holding Bot. System 9 PUM-P~/ SIP-Hid-IfORMATION 0 Final Grade Manufacturer Demand rv~ e ~w 2-'o4-, s 9 0 Model Number GPM TDH Lift Friction System TDH Ft Loss Forcemain Length Dia. H Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth N DIMENSIONS Z DUVLENSI SETBACK SYSTE TOE P / L BLDG WELL LAKE / STREAM f INFORMATION Type O ; Cam, CHAM_ Model Number: System: , nT v-/.c & E ~(0 7 ;,'I OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) dj_ x HQIe Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. ng SOIL COVER x P "e Systems Only xx Mound Or At-Grad systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Tren er Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (include code discrepancies, persons present, etc.) fA5 LOCATION: T 'ROY 3.28.19,N8,SE 689 BUTTERCUP COURT - COUNTRYWOOD LOT 8 f ^!j ~J rF t G - r' f r 1 ` ~?r j~ o C~Q.k-- ~P~CfLPk.. cnrt C~j'.~!~+ L_ '-•2 ~ Gn ~ics ~ ~ _ ~ -r p Plan revision required? Ves7[] No y._._ Use other side for additional information. V11,3199 )C SBD-6710 (R.3/97) Date Inspecto ' Si nature Cert. No. ,.C , : .-t~ , . ~ • r y~ ,4J r~t~t~~~ 5~ ~...p~ ~ r r 1- ~ t r' . ~'f °~j..:.-, (t _ i. f a~ µrv~ G G~ v C~+ ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I I r ♦ Safety and Buildings Division Visconsin SANITARY PERMIT APPLICATION 201 W. Washington Avenue P O Box 7302 Department of Commerce In accord with ILHR 83.05, Wis. Adm.'Code Madison, WI 53707-7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. ~'I • C/c X • See reverse side for instructions for completing this application State SanitarysPPeoerrmiitt Number Personal information you provide may be used for secondary purposes ❑ Check if r s on io preilar~pplication (Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Propert Owner Nam.~/ Property Location , N, R /,F filet il- 1/4 s 1/4, S 3 T Z Propert Owner's ailin V C L, Lot Numb Block Nu ber IVA City, Sta e Zip Co e ` Phone Num er Subdivision Name or CSM Num r D2? 1.c/ J~ 0/!P ( ~r II. TYPE F BUILDING: (check one) ❑ State Owned city Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms .3 o Village OF DC d v Crx.~ III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) ; j Zq. I q . 1 114 1 ❑ Apartment/ Condo C9 v 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 5 ❑ Hotel/ Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box online A. Check box on line B, if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ______System ___System_____________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 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12j Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill 3 3x75, , ` `C.Efr 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 Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq_ ft.) (Min./inch) Elevation 'y 1 -75"o 7,5L> 7~' d Feet , Feet VII. TANK Capacity gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App- Tanks New Existing structed Tanks J p eptic g an da0 / G~~¢e, C /P ❑ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber too It s ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumb 's Name: (Print) Plumb s Signature: (No S mps) MP/MPRSW No.: Business Phone Number: JCS Plumber'/Add ress (Stree , ty, State, Z 14 ipode)~ ~dt IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued IssuingyyyAAArrrgent Signature (No Stamps) I& ki Surcharge Fee) r -Approved E] Owner Given Initial l Adverse Determination L~ X. CONDITIONS OF APPRO AL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11197) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber r 4 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, Safety and Buildings Division, 608-266-3151. To be complete and accurate this sanitary permit application must include: 1. 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. 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 mainstwater 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. Gc. TIMM EXCAVATING cos SHEET NO. ~ of Z Route 1 Box 192 WILSON, WISCONSIN 54027 CALCULATED BY DATE (715) 772-3214 (715) 386-5443 MPRS 03224 WI MPCA #696 MN CHECKED BY DATE SCALE", ' i........... i...............................;. > < ..i...................,. j xt F _ d" . _ -r- x 3 . _ t T _ a . e"D . °N w _ f c r -t' o c . \ N a w N w PRODUCT 2051 ~Inc., Groton, Mass. 01471. To Order PHONE TOLL FREE I-M225-00 l JOB TI M M EXCAVATING SHEET NO. 2 of 2 Route 1 Box 192 J^ WILSON, WISCONSIN 54027 CALCULATED BY DATE I' 9L ~T (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE i i . , I i...........:..................... I .....................5.............................._ ...........i........... I ...........s........... < I r . . 'C r o _ l DIY ~ II PRODUCT 205-1®Inc., Groton, Mass 01471. To Order PHONE TOLL FREE I-M225-M Wisconsi rDepartment of Commerce SOIL AND SITE EVALUATION Page 1 of __3 givision of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Certified Soil Testing Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and 7651t Croix - percent slope, scale or dimensions, north arr location and distance to nearest road. parcel LD.# i 36-7069 APPLICANT INFORMATION - )7Hnt all fnformadon. Personal information you provide may be ary rpoaes (Privacy Law, s. 15.04 (1) (m)). eVl Wedgy Da Pr rty Owner c` Property Location Nau Tom z ,`7 Govt. Lot NE 1/4 SE 1/4 S 3 T 28 N,R 19 --W Prope Owners Mailing Address Lot # Block # jr. Name or CSM# ountry Wood rty 16120 North Sixth St. ST caai, 8 y - - - Lakeland City ❑T ioage Town Nearest Road Tower New Construction Use: idii `11-1,444 of bedrooms 3 []Addition to existing building Replacement Public or commerdal describe Code Derived daily flow 450 9Pd Recommended design loading rate -5 bed, gpd/fN •6 trench, gpd/W Absorption area required 900 bed, ft= 750 trench, ft2 Maximum design loading rate .7 bed, gpd/ft' -8 trench, gpd/ft' Recommended infiltration surface elevation(s)._ 94.0 ft (as referred to site plan benchmar Additional design I site considerations install 2 - 3' x 72' Sidewinder, Hi-capacity 'turtle-shell" trenches Parent material sandy/loamy outwash Flood lain 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 1Z ❑ U ® S❑ U X S❑ U S❑ U ❑ S XU LL; S X U Depth Dominant Color Mottles Structure GPDM2 Horizon Texture CBoundary Roots - , Boring# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I Bed Trench 1 0-3 10YR 3/3 - sil 2 m cr ds cs 2flm j .5 _ _6 2 3-10 10YR 3/3 - sil 3 m sbk ds cs if .5 .6 Ground 3 10-22 IOYR 3/4 - sil 2 m sbk dh cs~ if .5 .6 elev - - - - 98.0 It 4 22-38 lOYR 4/6 - sl 2 m sbk dsh cs if .5 .6 Depth to 5 38-52 5YR 4/4 - moos 0 sg ml cs - .7 .8 limiting 6 52-68 7.5YR 4/6 - mcos 0 sg ml cs - .7 .8 factor - > 80'7 68-86 1OYR 3/4 - mcos 0 sg ml - - -7 •8 Rena 1 4 '-"0~3 IOYR 3/3 - sil 2 m cr ds cs 2flm .5 .6 2 2 12 r 10YR 3/3 - sil 3 m sbk ds cs Im .5 .6 Ground 3 12-24 l OYR 3/4 - sil 2 m sbk dh gs If .5 .6 elev 98.0 It 4 }-40 10YR4/6 - sl 2 m sbk dsh cs 1m .5 .6 5 40-71 5YR 4/4 Depth to - mcos 0 sg ml cw - 7 8 limiting 6 10YR 3/4 - mcos 0 sg ml - - 7 .8 facto > 88' _ Remarks; CST Name (Please ht) Signature: hone No. Henry F. Grote 715-665-2681 - remTie o> estmg D to CST Number Ref # Address 1? O. Box 57, Knapp, W1.54749 18/12/1998 222774 1068 PROPERTY OWNER: Nau, Tom SOIL DESCRIPTION REPORT Pa 2_ of 3' r-, ® ge PARCEL I.D.# Certified Soil Testing, Horizon Depth Dominant Color Mottles Texture Structure nsistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rench 3 1 0-5 10YR 3/3 - sil 2 m cr mvfr cs 2flm .5 .6 2 5-13 10YR 3/3 - sil 2 f sbk dsh cs lm .5 .6 Ground elev 3 13-31 1OYR 4/6 - sl 2 m sbk dvh cs if .5 .6 99.4 ft 4 31-56 7.5YR 4/4,4/6 - s 0 sg ml cs - .7 .8 Depth to 5 56-62 5YR 4/6 - s 0 sg ml cs - .7 .8 limiting factor 6 62-80 10YR 4/6 - s 0 sg ml - - .7 .8 > 80, Remarks: Ground elev Depth to limiting - factor Remarks: Ground elev Depth to limiting factor - - Remarks: Ground - elev Depth to limiting factor Remarks: N k ' O ~ i c`t A 4 ~ tAs , de f N 0 ~Aj o 4 4 r? > ~ o v FA L N ~ d M f I M ~ ty~~ n! I ~ ~ v 0 i I I ~ ( y o4 w ! ~ 777iii N r ~ `Wisconsin Department ofIndustry, SOIL AND SITE EVALUATION REPORT Page 1 of -3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code on, COUNT J Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but . Cr a not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PA .D. # R& t dimensioned, north arrow, and location and distance to nearest road. pending APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION R ED AT PROPERTY OWNER: PROPERTY LOCATION 0OV"TY Richard Stout GOVT. LOT NF 1/4 SE 1~4, T W PROPERTY OWNER':S MA!I.ING ADDRESS LO BLOCK # SUBD. NAME 0 1353 Awatukee Trl. ro na Country W q CITY, STATE ZIP CODE PHONE NUMBER ZQMTY E]VILLAGE NTOWN REST P OAD Hudson, WI. 54016 (715 549-6731 Troy Tower Rd. [:j New Construction Use [x ] Residential / Number of bedrooms 3 [ ] Addition to existing building j I Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 4 bed, gpd/ft2 •5 trench, gpd/ft2 Absorption area required 375 bed, 112 375 trench, ft2 Maximum design loading rate • 4 bed, gpd/ft2 . 5 trench, gpd/ft2 Recommended infiltration surface elevation(s) 103.16 ft (as referred to site plan benchmark) Additional design/ site considerations system el- based on contour line of el. 102.161, Parent material limestone uplands Flood plain elevation, if applicable na ft S = Suitable for system I CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for svstem 1:1 S ® U I ES C3 U EIS ®U ❑ S ®U ❑ S CCU ❑ S CCU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence I Boundary Roots GPD/ft in. Munsell Du. Sz. Cont Color Gr. Sz. Sh. Bed Trencft '`t...,l....'> 1 0-12 10 r3/3 none 1 2msbk mfr 9w 2f .5 .6 2 12-28 10yr4/4 none sicl 2msbk mfr 9w if .4 .5 Ground 3 128-36 7.5yr4/4 none scl 2msbk mfr 9w na .4 .5 elev. 102.6gt. 4 36-60 7.5yr4/6 2p57.5yr5/8 sl lmsbk mvfr na na .41.5 i Depth to limiting factor 36" Remarks: Boring ing # 1 0-11 10yr3/3 none 1 2msbk mfr 9w 2f .5 .6 2 11-22 10yr4/4 none sicl 2msbk mfr 9w if .4 :'.5 Ground 3 22-38 7.5yr4/4 none sl lmsbk mvfr 9w na .4 .5 102 v. ft. 4 38-60 7.5 r4/6 c2 7.5yr5/8 sl lmsbk mvfr na na .4 .5 Depth to limiting factor 38" Remarks: CST Name.=Please Print Phone: Gar L. Steel _ 715-246-6200 Address: 1554 200th Ave. New Richm _ _ cstM02298 Signature: Date: CST Number: PROPERTY OWNER Richard Stout SOIL DESCRIPTION REPORT Page ~2 of ' 3 PARCEL I.D. pending l G P D/ft Boring # Horizon Depth Dominant Color Mottles Texture I Structure Consistence Bar>ck3ry Roots m. . - Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed tTrench 3 1 0-13 10 r3/3 none 1 2msbk mfr cs 2f .5;.6 2 13-28 10yr4/4 none sicl lfsbk mfr gw if 1.3 .3 Ground --3' 28-33 7.5yr4/4 none sl lmsbk mvfr gw na .411.5 10I762 c2p ft. 4 33-55 10yr4/4 7.5 r5 6 scl m na na na n `n Depth to limiting factor 33" Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # around elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. i ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) K STEEL'S SOIL SERVICE Gary L. Steel Richard Stout 1554 200th Ave. CSTM2298 NEQSEq S3-T28N-R19W New Richmond, WI 54017 MPRSW 3254 town of Troy (715) 246-6200 lot #65-Country Wood N 1"=40' EM.= top of 1" steel pipe C el. 100' Alt. BM.= top of 1" steel marker pipe C el. 102.8' i 3 c9d ~ 0 1 - %U M d v- Per, V P v 1\0~ Gary L. Steel 10-28-95 ST CROIX COUNTY SEP'T'IC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer. 7T&NN A- SSZLA*) N A ~ Mailing Address 1tpXap V6 SE 41 I 914wli"-A tnn0 Property Address (pSq L,t}g c..u (Verification required Rom Planning Department for new construction) ` - t3~-ooO City/State 4uD<Mw . W; Parcel Identification Number. 0090-1-23 LEGAL DESCRIPTION Property Location r/0' '/A, S~ Sec. 3 , T o?8 N-R W, Town of '-240`1 Subdivision V-Mci Lot # Certified Survey Mal) # , Volume , Page # Warranty Deed # 5!2,Q `f J , Volume 13 5 9N , Page # 5 Q(A Spec house ❑ yes 0 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 ont 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, jolly neyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (Z) alter inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above regnirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the IDepartment of Conmrerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning office within 30 days of the three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION e I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (w) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. inctnde 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 I ~`~~~~3 oarF ~i~6 v VOL 87461 STATE BAR OF WISCONSIN FORM 2 - 1982 f WARRANTY DEED ;I DOCUMENT NO. RE~I DER 5 „~JF'f'!CE RICHARD 0 STOUT i ST. GRID) -X C0., AP/1 Rntld ^ . i'ac~rri - - SEP 2 4 1998 conveys and warrants to , THOMAS G. NAU and SUSAN J. NAU, t X500 husband-and wif_e___s__urviv_o_rship mar_it_al. p~ 6ALA propet~t Re Isfnr of Deeds j - ( - - I THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the following described real estate in St . Croix County, GIGLc_ State of Wisconsin: S~ N. ( Lot 8, Plat of Country Wood, Town of Troy, /ac, St. Croix County, Wisconsin. I 040-1231-80-000 PARCEL IDENTIFICATION NUMBER i TRAN SFER $ FEE This is not homestead property (is) (is not) Exception to warranties: easements, restrictions, rights-of-way and covenants of record, if any. I Dated this 21St day of Septentloer A.D., 19 98 Richard O. Stout (SEAL) (SEAL) AA iIL" (1) '~Aruj_ (SEAL) (SEAL) I AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. St. Croix County. authenticated this day of 19___. Personally came before me this 2 g day of co,,f-off 19 , the above named r Plaiilin Richad 0. Stout Notary Public - 'llTLE: MEMBER STATE BAR OF WISCONSIN State O t "'nnSlt► (If riot, _ authorized by §706.06, Wis. Stats.) to me kno n to be the. son who executed the foregoing I instrurn and ackno dge he same. ' THIS INSTRUMENT WAS DRAFTED BY 71 ' Janet P. Stout I 1 2 5 3 A w t-u"Q 'T'om - + I Hudson , W i . 54016 Notary Public, County, Wis. (Signatures may be authenticated or acknowledged. Both are not My commission i narrent, (i t, sta expiration date: g d ~U19 > necessary.) - j _ ij Names of persons signing in any capacity should by typed or printed below their ognatures Wisconsin Legal Blank Co ,Inc. , S'IA11'. BAR OI' WISCONSIN WARRANTY DEED Form No. 2 - 1982 Milwaukee, Wis. °nj Q / u'f W qol o oD O i s co In v / ° f / 527.98 N I °'OO'IE . S06 30 3?5.35 152.63 / U _ / / U N ` N / N (3) ` dc ~ . I N o0 s S08 581 0 OD 00 I F- I W ~ I LLB I Q N O/ ®87.00 n o c th P LIC UB 1\ ~ °0 f Sp8 °a 8 tf) r~ca~. ~O 4L, 100L, 0, C2 h / I \ / 1 IN, I ~ 33 v~ I so 0 OD I eo 110 Coe 049 ~•~b.