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042-1092-60-200
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 567287 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: Wilkens Properties LLC (Jerry's Towin ) Warren, Town of 042-1092-60-200 CST BM Elev: Insp.BM Elev: BM Description: (,� Section/Town/Range/Map o: /63.41 b— Y c5-1 29.18.511B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark /240 T. I 1 /67.58 /63.9 7 Dosial— Alt. BM ex) �u. ( , 9 0. 91. / Bldg.Sewer 6.7,�_ �...0 t'SJ Q' on 611+^ J fawArrigemummE St/Ht Inlet St/Ht Outlet TANK SETBAC INFORMATION TANK TO P/L WELL BLDG. Ve Air Intake ROAD Dt Inlet /5 9Z- Se tic Dt Bottom E� 0J-,'�.9 —VA' -- /$.$G ,•bZ Dosing ea an. / / Header/Man.57 > 56 7/41 , AO ,. b.(# /00. 98' ao. 9 8 Aeration Dist. Pipe 6.40 /6U . 7 g Holding Bot.System 7 2, MO .33 Final Grade PUMP/SIPHON INFORMATION 3.5 /6i,6S Manufacturer /� ^^ Demand k, St over I I (3..OLA d 5 GPtoc i✓ IY LQ Gd s g� otoo lir 414 Model Number u3 " Y TDH (Lift 1 I I�/ FrictioP'LoOs G System Head TD I-11 2..ci Forcemain LengthJ� / Dia.Z U Dist.to Well S. / SOIL ABSORPTION SYSTEM BED/TRENCH Width 1 Length / No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid De tp h DIMENSIONS 3 2/6 ( re,, SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer - --.7t.4' / INFORMATION / / ' CHAMBER OR f"J` t . Typ�tOf System,:� / UNIT 'r C /�/I /f", _ COItatin If 0Y .Q� ( �45 ,/O Model Nymbe 4 J�.....at ivs DISTRIBUTION SYSTEM 6',041— 5'Z d24- Header/Manifold Distribution x Hole Size x Hole Spacing Ve Air Intake Pipes) \ N 2,44�.�/(r/J�� Length Dia Length ' Dia\ 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 BedfTrench Center 3.76 Bed/Trench Edges Topsoil \ 'Yes 0 No Yes El No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: / / Location: 644 Star Lane Roberts,WI 54023(SW 1/4 NW 1/4 33 T29N R18W) metes&bounds Lot 2 Parcel :Af331 .18�51�1 B 1.)Alt BM Description= PV A .a,wNOl.r2 GOB s.�10/\.�X. ell_r — 2.)Bldg sewer length= ,'�t 1OJ 14- e,� CV- GOi1 t.-- . -amount of cover= 674'51 , Plan revision Required? Yes No II/ q (Z / *S7 ‘Use other side for additional information. i J �� /�■�` �v _.__ SBD-6710(R.3/97) Date Insep .r's Si.•:ture Cert.No. I .,t''nri.-.,,,,9..,,,,,, County , /J Safety and Buildings Division �T C'V o i 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.) " i P� M is�l, 53707-7162 A\tiF:YyK_ ar• 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 cV 3 g .5 9,3 9 is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary id. purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. /_'V ���� IA�/ I. Application Information-Please Print All Information �� 1O JJJ Property Owner's Name Ile_ Parcel# A) 0he-ri S Fro,/, Il erllci e_ 4Q ',� Oq2 - /69Z - 66- 260 Property Owner's Mailing Address / 1 �, �qv® Property Location 5//Q 691 r�r n 0,0 qi t Govt.Lot City,State Zip Code Phone Numltft ' ' 31 1 n F ,0 4 W /., 1� W /�<yr Sections') v b�c Y S W J �I 3 L,l, T a N, R ) 7 circle only II.Type of Building(check all that apply) Lot# / ❑1 or 2 Family Dwelling-Number of Bedrooms / /,i Subdivision Name fr ' / / Block• Public/Commercial-Describe Use C-0-29701 e. CC 0 eee/// ❑City of ❑State Owned-Describe Use CSM Number ❑Village of 14/4g63 E Town of �ay ye h III.Type of Permit: (Check onl�one box on line A. Complete line B if applicable) A' ❑New System y iX Replacement System ❑Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) B. ❑Permit Renewal ❑Permit Revision ❑Change of Plumber List Previous Permit Number and Date Issued g ❑Permit Transfer to New Before Expiration Owner 3r3-955 V,3 V�Q IV.Type of POWTS System/Component/Device: (Check all that apply) Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil t ❑Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) .1-1'--^ t a- V.Dispersal/Treat nt Area Information: Jic�i' Design Flow(gpd) Design Soil Application Rate(gpds Dispersal Area Required(sf) Dispersal Area Proposed(s System Elevation /1. 0, 6 ✓ ) r as /a 4 0/ " )Oi9. 3 3 VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units °o 9. New Tanks Existing Tanks / t`'� Atli lak X25 y g it to tz'.e4 CGI'( cL U rn ti vs w C7 C. Set r Holding Tank S -p�/` o')O0 Y Dosing Chamber 9 G O 7-50 1 (V, N ?k, VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumbs 's Signature MP/MPRS Number Business Phone Number C'av 1 ( 45 d d r7 a Pa,SS 9 3l 49,7 1 fc Plumber's Address(Street,City,State,Zip Code) '` ,, ) C VIIIun /D© artment Use { 6l V ei i a J)S L T $4o Z tY P Only / Approved ❑ Dis•,. oved Permit Fee Date sued Issuin gent Signature r Own- :wen •-ason for Denial $ "/75. a 3 /3 /r IX.Con ,, A , -•. /Reasons for Disapproval > GC kiz rewa-aC.. 1: Septiq'tank,effluent filter and 3l rn auu-�xxC..... L viler �` �' dispersal cell must all be servIres/maintained e_>rreeji_ t,,>;44- .Js ( .A-:A—1, ' as per management plan provided by plumber. 2. All sett ack requirements must be maintained �t � n C /n1 .L� as per applicable code/&dinatwce. T # or A ee ✓peet1L ►icr1 Arebt,4-r Attach to complete plans for the system and submit to the County only onnper i t less than 8 v2 11 inches in size t I`5 vt r SBD-6398(R. 11/11) } �� , o t( 1 ✓.Ct' �� a aC Lo u.. 14441 6.4.4_ I Plot Plan Page 3 of7 Property Owner WI c-KE,v,5- 1pr xr,.E5,L 1" = 40 ft Legal Description && jbJq P - OF 5WA (except where noted) otr THAw`l4-, s 34, -rzgN1 i Std, "Mk OF wAteganl� =Backhoe pit 5T. CIZOtY Cbta/t1TYj WtSGof)St1J • 7180 f ? S North • • LL 15.0®f New aaAte .149, TAN4 0b y0� :od X As"17 9 1. .6tr". 95,41D lm e?RE1,,__` 1OZs. 7 , Cp fF' `al j1 ?�►� F17 3 e Atu i i4 •\i.Z ii 3 l g sP+�� ee-rrt- ply ?` 02, 1 t OF a n 1AJ64t1.14L - ,�r�� 104.14 7, Site Location: 1 yl�otirTUro� DIVISION OF INDUSTRY SERVICES CotnitY5 ^Or 7 3824 N CREEKSIDE 36 G ° � 9 ( r HOLMEN WI 54636 V 3 w! a '— Contact Through Relay ` �? K �� www.dsps.wi.gov/sb/ www.wisconsin.gov OAS �� ssloNt+tiSw Scott Walker,Governor Dave Ross,Secretary November 12,2013 CUST ID No. 224832 ATTN.:POWTS Inspector MARY JO HUPPERT ZONING OFFICE HOLLISTERS SOIL TESTING&DESIGN ST CROIX COUNTY SPIA W9875 690TH AVE 1101 CARMICHAEL RD RIVER FALLS WI 54022-4011 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/12/2015 SITE: Identification Numbers Wilkens Properties,LLC Transaction ID No.2325759 644 Star Lane Site ID No. 13456 Town of Warren, 54023 Please refer to both identification numbers, St Croix County above,in all correspondence with the agency. SW1/4,NW1/4, S34,T29N,R18W Subdivision: CSM No. 16/4303;lots 1 &2 FOR: Description: Commercial Non-pressurized In-ground POWTS/2.5%slope/pump delivery Object Type: POWTS Component Manual Regulated Object ID No.: 1455477 Maintenance required; Replacement system; 615 GPD Flow rate; 70 in Soil minimum depth to limiting factor from original grade; System(s): In-ground POWTS Component-Ver.2.0, SBD-10705-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 and located in accordance with the enclosed approved plans and with any component manual(s)referenced above. CONDIT The owner,as defined in chapter 101.01(10),Wisconsin Statutes, is responsible for compliance with all code AppA requirements. DEPT OF SI No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.l 5.06 PROFESSION, stats. IVISION 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 Or SEE CORRESI 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. • 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. Note: Use of a splash plate or some other method to help reduce the velocity of the effluent entering the chambers would be beneficial. It would help minimize the disturbance of any soil at the system elevation. MARY JO HUPPERT Page 2 11/12/2013 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 �1 4 This Amount Will Be Invoiced. �.'�. M Swim I When You Receive That Invoice, •. TS 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. MARY JO HUPPERT Page 2 11/12/2013 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 • This Amount Will Be Invoiced. �e�. M Swim 4 When You Receive That Invoice, • S 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. y. t Pg / of 1 itil Private On-Site Wastewater Treatment System(POWTS) e,/1/. Index and Title Sheet oc Owner: LllucE v s ' rio P i�s l� �c� S Project Name and System Type: CPA)d tom-rto AA I.- .XN°-CC,ROUA)0 '�1 5 co CA AL--M Location: (4,yy srAA 1-A-AC Street Address LOT 2 CSN1 1(1 1430 3 5W,A., or :x . up/. 5-#4. '-iz` . _ ' W Legal,vescription WA-win/ C fk0 t)( Township/Coup Design Criteria(Check one) . Holding Tank Component Manual: In-Ground Soil Absorption Component Manual: SBD-10571-P(6/11/1999) ❑ SBD-10567-P(R. 6/1999) ❑ SBD-10855-P(3/2007)Version 2 (SBD-10705-P(N.01/2001)Version 2 Contents: Page 1: ZNCse)( AND-f%Tt - Et t Page 2: PLA A) V le v1/4.1 -AND. C Le.U Lf4T i OA) S Page 3: PLOT Pt-AA) + 5A Page 4: 'FoW OwNEt;'5AARA)tAAL /Uk,ANA MEN7 ri...lifj 'ON At it. 'r p ,. I/ (/03 Page 5: S�yANO Page 6: PuM P DA K sPEc:5/CAL-CAA-Kt tO N '� iSTRy:ViCS` elille Page 7: PkM P TA AK Page` 7A PUMP co RU o/VO"NiE Page 9 / ; ti 5;iv.. CAA. ;i' ; .•: : SEPTIC- TANK AAA lA)1 A A AroktighttAIT A140 1•-n 0; pt�.�.it1Ee- •P GIt°tt FtGR'C1OiJ .F012M ( Be s ) .«....�• Co.uJ1 Y 69111.d r So IL TesT % Ali v. ,_!� A . : .' ' y . 0 t-t tkPP r Signed: r . ., � i -*.�. et- .:. i g 5'3-00 r7 Date: /t- '`t+miiiiiiiiiil;0:, 4 PLM VI CA0.5s- c-TioN) - • to,) U1/41}. dcs? iv. VAIl - L 0 Fl LTIZA-44R 41V 0 334 ° - -TREN6-14 Opel vxd,q(b-Ais Water tight cap CAW notedal Odyinal grade I. 1441 iLbscbss Eds.eeN■E Top of •I 11111111=111w.. leachin9 III Repair couplings chamber im.40( ii Nelabt atIchn9 .9(%-prk et...J/161..33 chamber _I—la sku sail---r- linstmest Ps timbal by Tibia 61443 'Bar(3/8-min.dia.) eilPegsd BD CO Lianas bow -Observation pipes 1. 4 ZF-5 PE66 ' Ft.A.mes 10 tri_e_, 2.0 •TPt tivt PIZ FLOO1 bkUQ Si • I •_ - AL zc ,ei • eAksromt. ,-s ,rreR t- TOTAL- /0 00 x 1.5 beiit, LoW PEAK Laka tr. "' •-:;1=F- - ZSaZ 1 1:5*,: -.2070 OR 62 x .2og /Ter-AL , 12 3ix 1.z44-2 Fok PAIR OF EAU er4,e5 3 .. 2.1• -retpa_ Lei1/446.Tii tnikarc vik-regN ¶ i FLWMAJ5 5 51t, FRA tA,/ 6ACK Fi .J.VATEr4"AL_ -re ITE FER mt)ElooitliquyektrAAA-Aiwt. Poi-V-Ok I& Te 3& A-A6ED- .70 WV,S741/ 7-774* IvEvu PIAAIP TAN k. 750Ittaiti 1476'ivia-Z ihaii 2.0f f .Kre.0 3 I /11. -631(1,577A16,-17.771-NA 445 BtEd Rni4_, -13.- 3643 P A4 Pat) A-Ab 1A15P5e-tE4 )3V PLEAMBEK ° Plot Plan Page 3 o,f'7 Property Owner WI EN.s 11pr' ,criE6, L.4 1 1 1" = 40,ft Legal Description 6-5m it Jq+ - . PAtz:r OF sw`/q (except where noted) mow' s 34- -rz A. R i SO -roe o 0 =Backhoe pit 5T CRot�r cakjWY, kAASCI n)SSJJ 7180 North lc yv \\NNI11.10,, . . artstsea- 3/4117-1 . k146 orb 15,,6" Ai ew IA)le:atir 'Or sew Vila t M) t.$ °tt. ° --...,-,..._ 16,490 At,r," ?Or i.' 1 . "g 1 ii sottTN pit- .T` 1A16R4un1D. 'c' /�� f04¢147' 'Q }— #`r;i/t?pf 'l e p f(JU'.rl'r , Site Location: See. 5 &g (YL e 1 1/4v,.. � • RL-ili EI ° /0-30-I Pia-1) _ . C � Property Owner Wky 1" = -.I Legal Description Let t z, cc 1(0)y 6, P. r or (except where no " 1) 5,44 OF Tfte 4WA. S54,Tvtiv4 -KI$1,.)f --rcwA; 0 - iy1At2FR ,..iv'.a ST. C RDMx CC .L wry, (AILED!.) st.J. North . : t , 0:9 •A f(J d` / ti w4ukk - I 1 It' • kiyi. . - 4%/hl � �`, � 4- c. I. ✓�Avet_ I .1 I ,p; 04- 40w _ i I i 1 1 • ... / ,f 4sry _ aU' _ Fll 50 , 1 . ) ilisi 1iMU/14 .v . i y,,i, we . 1 i SB1 7 Cc L' * o utti p( _T .Evi : td//�3�t� _ . U ` ,Lu Feb-26.2013 01:22 PM St. Croix County Plan/Zoning 715-386-4686 POWYS OWNER'S MANUAL & MANAOIMINT PLAN F•01.011.. TIM SYSTEM MiCIhe1GATIONS Owner W 1 U<eni S t, o 1.1.CC.- Septic Tank Cepaoigr IJ 00O gt ANA Permit I Septic Tank Manufacturer 1 Cl NA DDS PAR Effluent Akar Manufacturer ALAI L0 l< DNA Number of Bedrooms DNA Effluent iffier Model ( 6 0 NA Number of Public Facility Unita Cl NA Pump Tank Capeotty 750 tea Cl NA E tlmsted flow(average) cavort_ Pump Tank Manufacturer _ 107C NSA Dssign flow(Pak), (Estimated x 1.5) gam. Pump Manufacturer &O 13 0 NA Boil Applloation Rote govdaw t' Pump Model .____ E 0 31 I M 0 NA Standard Influent/Effluent Quality Monthly average" Pretreatment Unit YNA. Fate,Oil&Grease WOG) 590 ma D Send/Gravel Peter CI Peat Filter BbsihemIcan Oxygen Demand (DOD,) s22O mg/l- Cl NA D Meohanial Aeration Cl Wetland Total Suspended Solids (Tte) 6150 mg/L Cl Disinfection 0 Other: Pretreated Effluent Guilty Monthly overage Dispersal.Coll(a) Cl NA Nochendoal Oxygen Demand (ODs) 530 mg/L )In-around (gravity' U In-Ground(prey ) Total Suspended Solids (TSS) 530 mg/l. A''NA Cl At-Grade Cl Mound Fecal Cofform (geometric meant 510'ofu/l 00m1 0 Drip-Line 0 Other: Maximum Effluent Particle Size ) In dim. 0 NA other: DNA 3 ate' Cl NA Other: NA "values typical for dame tk wastewater end sotto tank effluent. t�tlMrs DNA MAINTENANOE SCHEDULE- Servke Event Swiss Fregtleeoy _ Inspect condition of tinkle) At least once mery: 3le1 (liasdmtan S,ywra) a NA Pump out contents of tinkle) When combined sludge and strum equals anathlrd(l(i)of tank volume 0 NA. Inspect diapering ceille) At lent toe every: 3 la mantilla) (Maximum a years) CI NA Clean effluent fifty u At lust ono.every: r DNA inspect pump,pump controls b_alarm At lent one every: ,/ Ye s) ) DNA Riots!sterols and pressure test At least once every: �Iy ANA _ gG molt • At least once every: Yes) ST NA 'Caen 4 NA MAC 1N$TRUCT10NS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following limns or oartifloathtaa Master Plumber; Mester Plumber Restricted Sewer; POWTS Inspeotor; POWTS Mshhtslner; Sepipe 8evioing Operator. Tank inspections must holuda a viand Inspection of the tinkle)to Identify any missing or broken hardwire Identify any crooks or leeks, Measure the volume of combined sludge aid scum end to check for any back age or pending of effluent on the ground san/aoe. The dispersal cdl(s) shall be visually Inspected to cheek the effluent levele hit the observation pipes and to cheek for any pending of effluent on the ground surface. The pending of effluent on the ground surface may indicate a failing condition and require The immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum In any tank equals onadtlyd (lc) or more of the tank volume, the entire contents of the tank shall be removed by a 8eptage Servicing Operator and disposed of in accordenee with chapter NR 113, Wisconsin Administrative Code. All other servitres,including but not limited tithe servicing of effluent filters,mechanical or pressurized components,pretreatment ent units.and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.. A service report shag be provided to the local regulatory authority within 10 dove of oompletion of any service event. Feb-26;2013 01:22 PM St. Croix County Plan/toning 715.386.4686 r--. 7 s. START UP AM OPERATION For new oonstruodon,prier to u e of the POWTS*heart treapne t tenets)for the prewar of painting preduste% Tither aRSmloais that may impede the treatment process and/or damage the dispersal collie). If high concentrations are detected have the contents of the tank(*)removed by a septege servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cells) in one large dose, overloading the cents) and may result in the backup or surface discharge of effluent. To avoid this situation have the oontents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks end dispersal cells. Do not drive or park over, or otherwise disturb or compact,the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat•, foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products;pesticides;sanitary napkins;tampons;and water softener brine. ABANDONMENT When the POWTS fails and/or le permanently taken out of service the following steps shall tie taken to Insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33.Wisconsin Administrative Code: • All piping to tanks end pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Saptage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their oovs s removed and the void space filled with soil,gravel or another inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a cods compliant replacement system; D A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be Infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. D A suitable replacement area Is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soli and site a evaluation must be performed to locate a suitable replacement area. if no replacement area Is available a holding tank • may be installed as a last resort to replace the failed POWTS. D Mound and at-grade soil absorption systems may be reconstructed In place following removal of the blomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that tine. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name )-tease Name CAW__ i-IEt Phone v5/-5qZ- g59 y Phone 4251 92-- d'sqy SEPTAGE SERVICING OPERATOR(PUMPER) LOCAL REGULATORY AUTHORITY Nome 1Vs SF1NM SIEICV lCk 'TAW None 5T. CROW )UJU1 y zoN NG Phone 7/5. 71 9-des 3 Phone -713-- 3V.,-41410 Mi ,41 soPal,11t/Itfi ACaE k of • ::, 0 5 SECTIDN AND SPECIF(CAT(Q•'�1S _ . . PL1M� CRAM R CR 5 ,,,._r V E k3T CAP YeGT.VENT PIPE WEATHERPRCICr ,aPPROV D Lt3GY•UIG jwjri©h1 8DX rhANHOLE CO'I R WITS ? z5' FtoP1 DOOR, I2'HILl. V.1AE1b1G LAEs:J. Wihloaw oR FRESH t i AIR Ii.tTAKE 1 GRADE 1 -I-1 tr Mta 1. r' * 15'RM. • CO1.JDU1T -_ -�� lettlfd. •v",,,.....\....,. : sr— .46.-____mar. NI J ON / PROVIDE i ` • 0g ii - —4:=3 •.i;,ARTfC HT SEAL I I I APPROVED J011.17 A I I i I APPROVED .10iIJT5 W/C.I. PIPE I i I j W/C.I. PIPE EXTENDING 3' - I I (I ALARM EXTE1JDHUG 3' 4UTo SOLID salt I I I lo ONTO SOLID spit 6, ii I i rou _ - C3 • I 1 ELEV.412-igill FT. -J - PUt ' OFF 0 ► • V' -- COMCRETE 51.004_ RISER EXIT PE.RMr1TED OULH IF TALIK MANUFACTURER HAS SUS APPROVAL B" (}PPRaVEh 6E1)DI1.IG unde.r rfi.tatc. SEPTIC E SPEC.IFICAT1[311.15_ DOSE �r. � 1�.1umBER OF DOSES: II r PER DAM TAiI1C5. MA1JUFACTURE ::- TAN.IK SIZE- � .GALLOLJS DOSE VOLUME I4JCLUfl1IG 3ACKFLOW: 7". y' GALL0lS ALARM MALIIUFACTUFL R r R+ 0u> , 4s /'toOE t. 1.11.UNIEE>S'- 11-- A LI CT cAPACrES: A.= -21 !NEN'FS DR 955( Gk1.1.0.5 !WITCH T9F5.• •.1A1-24,4AN 5_ 2- INCITES oR oA,LLO>US PUMP MAOUFACTURCR: ..GOW-bS C= 3'I MOMS OR .f4411 GALLOUS MODEL 1.1UMBER t eo-511 M D a `D INCHES OR 2O2. ' GALL0115 SWITCH TgPE' .,.1vlCCN.uU'LC L.- MOTE: PUMP MUD ALARM ARE TO iE. I r imirAUM DISCFI:t'RGE RATE NA GPM INSTALLED d1�1 SEPAR1tTE CIRGt}iTS 1 paR 5PS ce1' VERTICAL DIFFEREMCE 6E-r AJtiJJ% PUMP OFF AUD DI5TRIBUT£OA.t P;FE.. $3,45. FEET -I- /1IUJLHUUM METWORK SUPPLE PRESSURE . • . . . . . . . SK FEET TA1v> r et_ Ica. I =YZ.b"#1 Imo':'�� �f ± 3& FEET OF PORC MAIM X Z•.5g F X0 FT.FRLCT1O1.1 FACTOR._ -'7r71 FEET -�- e/5. TC"'j t D!;,",r"1'"1t I!'AD = e Fr•,:::/- "da 6' H 37/, . .F TFLT}!A OIMC1-15_1D a -F TAJt. CI$TFi x 11410 tl •j LIQUID AEPT 750 DNS 37"_ z 0.2 gayl,�. Fr -c►ee,vjAIn!xO4/t•3 0gaze-c.4-5 FcLVvr3gcrt �'9 Fi-cw6Atr'i< -. 66.e�r d mss Aaii b: //_j/ /3� ZQ� Si`�� c� pi4Y 'J �,,// 35- zw-s t.-_-i? IFAtoe_ 7or7 A A Az 54" AS REQUIRED 84" o g 42" �o 8 - z a n 4I .1.7i -_ 'tg 3" I ' S" >4 o I i.2 U -_ \ 2 >I /o r v c nom" E II I g a 44)" a > g -1 N> m P " .. . z p>z ° , �' 04. I ! *f; SQ > 0 C00 0 Ogg > s ewe XX Ca Z p C'i" t ��,n A Sp2020 \ m P g g 5.44.F 222 1 g -1 m SQ -t ,rnz -2 i x yyN Oaf �''QOO P gPiw tVA 1/408; Z > O N I A t Q 0 \ S� •a C. N yp > � • O Ul Si Qv .� Z ii C fJ1 v�v+ P 2 m X . i > O t *1I x o OH > v z m m y F �p-g1 03 g ` r C aZ - - .‘ .. 71 V) 1 u) (4 - In 70 C .. g g i- P (n 0 co C% m v11I.P750-MR DRAWN BY: WCP ISA . 1/4"14-0* E-POUR: Ji!i !J!P!T E n -+ SEP11C MANUAL 750 DATE: DO/00/00 DATE:. T-POUR: zo 800-325-8456 FILE: V750-11R g:gav %,,rw 1 1 Ike i ✓' I L.4111UC1 l I Certormance _ , e • turves Pumps 4747-7 M*1 M PUT �`�: ::::iiiu - - - — ,o .!1!�11111111.11111111111 ILaJi! -- . , -- • if) 1:41111010ningRahMin____ _._ _.it_ ___ . .. . 1' � �--t -1 t0- c 1r� rr..r r► _- r— s - :ti o■rr�■rrnii.:�9■ , ■r■■rriiiiiii" -I-Li,-,_..- 0 10 ZO 30 40 50 60 70 80 90 103 t 10 120 GPM I 10 20 30+a+At 0 CAPACITY * GOURDS PUMPS. INC. sac.,was►tw K,•a.+.• MUMfat7 120,, _I I_. MODEL„3885 33- 1II} rrr M r_ SIZE �l Solids 110 ►\ II-- f T ■ ' 3° - 1°°Inallallalliall allialla t_. _______ ala 26- eo a■a-1.►_ ■■ 1 r ISM. 1111 ■W0 la . ■ovaNg■ II ±± ll i ! !i t- . 4°1411.11911M31.11111111101 11_,_..._.. i_t_ um 3°armomommous Ewe_ __ ___i__ _rm. �°•1i ier■■r m ■iii■ 1 _I._ ■■ $ - •r■_• _E f _.�_.- N lo -1 M f. -- E ■ ■ C 0_ 0 J Rau OOPM 0 10 10 30 40 s0 00 10 �, w �W t1 . 0 10 ---::0 w tent CAPACITY Kamm•MA.1546.1m 0.1000 Pww� C30a, Vur1-KEn1S Oct-19-2010 01:59 PM St. Croix County Plan/Zon ng 715-386-4686 1/1 ST. CROIX COUNTY SEEPTIC TANK MAINTENANCE AGREEMENT AND � OWNERSHIP CERTIFICATION FORM Owner/Buyer _ �G1ji c) Ikt 5 9,'✓i C. Mailing Address , Q 0 X YU tt) 1�C, Z3 Property Address % -j CUB l_.cr yt.L VA JTS �Tt' S Lf(J2-3 (Verification required from Planning&Zoning Department for new construction.) City/State ,r1S J Parcel Identification Number _ /(112.- -260 LEGAL DESCRIPTION Property Location I/q .f ;IJ 14 .Sec. ,T N R W,Town of Subdivision Plat: ,Lot# Certified Survey Map# ,Volume ,Page#_ Warranty Deed# (before 2007)Volume ,Page# • Spec house yes no Lot lines identi€iabie 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 verttying that(1)the on-site wastewater disposal system is in proper operating condition turd/or(2)after inspection and pumping(if necessary).the septic tank is less than 1!3 ma of sludge. 1/we,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth,herein,us 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 he completed and returned to the St.Croix County Planning& Zoning Department within 30 days of the three year expiration date. 1/we certify that all statements on this form are true to the best of my Iota•knowledge. I/we am/are the owner(s)of the property described above,by virtue of a warranty deed recorded in Register of Deeds Office, Number of bedrooms SIGN,f' h 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.08/D5) 5b-7 z$-7 C" 6qz-169z-t00 -- aat� 33 , Z5. tS � v !! � ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certif that I have inspected the septic tank presently serving the G r �i zs LL C residence located at: _ '/4, W w '/4, Section__ Town N, Range_)y W, Town of (� St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of service ja- g j'1_9 - ---) -3. Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete Steel Other Manufacturer (if known): Age of Tank (if known): oat (Licensed Plumber Signature) (Print Name) ��o.ss (Title) (License Number) MP/MPRS (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings `* accordance with Comm 85,Wis. Adm. Code p % ST.CROIX Attach complete s;,� •1= •• per n s than 81/2 x 11 inches in size.Plan must include,but not Ii t•:vert• nd horizontal reference point(BM),direction and A, Parcel • 042- 1092-60-200 percent slope,sca ., di nsions,north arrow,and location and distance to nearest roaly°/ � • Please print all information. R•ev�e .y Date , A j Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m))T lvAQi _.. fr° ) 1 12 3 •: 4 M •d ' Property Owner Property Location }, � 4 WILKENS PROPERTIES LLC Govt.Lot ---SW 1/4 NW 1/4 S 4 T 29 N R 18 E(or)W Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# P.O.Box 66 2 -- CSM 16/4303 ' City State Zip Code Phone Number J J"ity D Village [Town Nearest Road Roberts, I WI I 54023 I ( 715) 760-4444 Star Lane 'Warren 0 New Construction Use Residential/Number of bedrooms Code derived design flow rate 615 GPD a Replacement 0 Public or commercial-Describe: Towing&Truck Fleet Service Parent material sandy outwash(pg.55) Flood Plain elevation if applicable NA ft. General comments Conventional In-ground trenches--0.60 loading rate and recommendations: Replacement of system required due to expansion of secured storage area. 1 Boring# El Boring 0 pit Ground surface elev. 102.37 ft. Depth to limiting factor 70 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-6 10YR2/2 -- sil _ 3fabk ds as 2vf-m 0.6 0.8 2 6-14 10YR3/4 — sil 3fabk dsh cs 2vf-f 0.6 0.8 3 14-52 7.5YR4/6 -- is lf-msbk dl cs lvf-f 0.7 1.6 4 52-70 7.5YR3/4 -- sl 2fsbk ds -- -- 0.6 0.8 9*,11 14;1 W D Boring 2 Boring# 103.97 88 ® Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff? in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-14 -- -- fill -- -- -- -- -- -- 2 14-28 10YR2/2 — 1 3fabk&gr ds as lvf-m 0.6 0.8 3 28-48 10YR3/4 -- sil 3fabk dsh CS 2vf-m 0.6 0.8 4 48-60 7.5YR3/4 -- Is lf-msbk dl cs lvf-m 0.7 1.6 �� 5 60-88 7.5YR3/4 — IG6 ' O s Osg ml -- -- 0.7 1.6 Some cobs/ one stone. itif 15t *Effluent#1=BOD5>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BODS<30 mg/L and TSS<30 mg/L CST Name(Please Print) Signa /'/'V CST Number MARY JO HUPPERT,Hollister's Soil Testing&Design J 224832 Address Date Evaluation ucted Telephone Number W9875 690th Avenue, River Falls,WI 54022 09- 10- 13 715-426-1775 Dec 03 13 12: 04p Hol1ister 's Soil Testing 715-426- 1775 p. 2 Property Owner �°'�Wilkens Properties LLC Parcel ID# 042-1092-60-200 Page 2 of 3 3 Boring# u Boring 101.37 86 ]= pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. "Eff#1 "Eff#2 1 0-8 10YR2/2 -- I 3fabk&gr ds as 3vf-m 0.6 0.8 2 849 10YR3/3 -- 1 lf-mabk ds cs 2vf-m 0,4 0.6 -3 19-41 7.5YR3/4 0 sil 3fabk dsh cs lvf-m 0.6 0.8 4 41-55 7.5YR3/4 -- t sl 2fabk ds cs lvf-f 0.6 1.0 ' 0.7 1.6 5 55-86 7.5YR3/4 0 is Osg ml as -- 6 86-90 7.5YR3/4 f2f 7.5YR4/6 is Osg ml -- -- 0.7 1.6 Boring# Boring pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD!ftt in. Munsell Cu.Sz. Cont.Color Gr.Sz.Sh. "Eff#1 'Eff#2 Boring# Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff in. Munsell Cu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 *Eff#2 'Effluent#1=BOD5>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD5<30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,please contact the department at 608-266-3151 or TTY 608-264-8777. SBD.5330T.t(12_07l00) Plot Plan for Site and Soil Evaluation Page 3 of Property Owner k 3 1,zop m-I E- LZ 1" = 40ft. Legal Description && ibJ43a "tsar OF 5w`/ (except where noted)` g of TNiii-A dt-ii 5 34, -rzeMi R160, rotAN OF vvAlegeAJI _Backhoe p it 5T, CROW COt4NTY) 4tAscon)5■11 . North iC 96.00 r- Dt • tPK eft) , j t.•Wiz. 09412.-10'OF •SRK ,,c IA/F qU' °o - #1-v� 104.-14 u Site Location: ASgt(1i56b` \ 0 :§ 0 _ w 0 ts \ - \ $ E N k U) \ 0 MO $ 2 \ ) » e � \ k L k ) ] �9 I CL 0 E \ § \ \ 2 4 \ @\ _\ k2 2 ) kf =k�f /C L c U)0 m � 0 uEfk0kEL �t§\E0.f 7�.w800£ f � z \§� z § @ / \ k 2 + \ k / k \ \ e m & � ` 5 # Q 2zz f .. } I § § 0) { G ) 2 f \ (L E %2 $ a - % ■ a § 2 a a a c # E } k k b k E b } � -� 4.; a a a CL 0 § § \ k ƒ \ 2 � > § § = E � / -ƒ 0 + # ƒ 7 ƒ 8 2 ` 2 ` E _ � _ -J LO Q © 6 » % 8x88 k8 §% ® & 2 a § § 7 S { § f f % / § § , = 2 � k \ o z / ) � \ � ■ � ■ k « % � L I E 2) k a § Lon k 0 a 2 0 w u Parcel #: 042 - 1095 -90 -000 09/29/2005 07:47 AM PAGE 1 OF 1 Alt. Parcel #: 34.29.18.530A 042 - TOWN OF WARREN Current ',Xj ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 11/03/2004 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - NATIONWIDE LIMITED PARTNERSHIP, ANNEXED ANNEXED NATIONWIDE LIMITED PARTNERSHIP Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 15.480 Plat: N/A -NOT AVAILABLE SEC 34 T29N R1 8W 15.48A SW NW N OF HWY Block/Condo Bldg: 94 ANNEXED ('04) NKA 176 - 1075 -04 (597) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 34- 29N -18W SW NW Notes: Parcel History: Date Doc # Vol /Page Type 12/29/2004 783686 2723/027 WD 11/03/2004 778856 2688/461 AMEND AX 08/30/2004 772963 2646/001 ANNEX 07/23/1997 1164/483 WD more... 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 04/15/2005 Description Class Acres Land Improve Total State Reason Totals for 2005: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 042- 1092 -60 -200 09/29/2005 07:43 AM PAGE 1 OF 1 Alt. Parcel #: 33.29.18.511 B 042 - TOWN OF WARREN Current Xj ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - WILKINS, DAVID E & SHANNON C DAVID E & SHANNON C WILKINS C - WILKINS JERRY & DONNA WILKINS JERRY & DONNA 657 N MAIN ST RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description 644 STAR LN SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 7.180 Plat: 4303 -CSM 16/4303 042/02 SEC 33 T29N R18W PT SW NW BEING CSM Block/Condo Bldg: LOT 02 16/4303 LOT 2 7.180AC EZ -U- 1377/391 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 33- 29N -18W SW NW Notes: Parcel History: Date Doc # Vol /Page Type 06/30/2003 728108 2295/391 WD 06/24/2002 682499 1915/326 VAC 11/12/2001 661835 1760/504 EZ -U 05/04/1998 578429 1320/375 WD 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/14/2003 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 7.180 110,000 395,000 505,000 NO Totals for 2005: General Property 7.180 110,000 395,000 505,000 Woodland 0.000 0 0 Totals for 2004: General Property 7.180 110,000 395,000 505,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 042 - 1092 -60 -100 09/29/2005 07:44 AM PAGE 1 OF 1 Alt. Parcel #: 33.29.18.511A 042 - TOWN OF WARREN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - ZOLDAN FAMILY OHIO ZOLDAN FAMILY OHIO C - PARTNERSHIP PARTNERSHIP 555 M L K JR BLVD YOUNGSTOWN OH 44502 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 638 STAR LN SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 3.370 Plat: 4303 -CSM 16/4303 042/02 SEC 33 T29N R18W PT SE NE BEING CSM Block/Condo Bldg: LOT 01 16/4303 LOT 1 3.370AC EZ -U- 1377/391 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 33- 29N -18W SE NE Notes: Parcel History: Date Doc # Vol /Page Type 08/21/2002 687646 1952/537 WD 06/24/2002 682499 1915/326 VAC 05/29/2002 680247 16/4303 CSM 11/12/2001 661835 1760/504 EZ -U more... 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/14/2003 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 3.370 55,000 0 55,000 NO Totals for 2005: General Property 3.370 55,000 0 55,000 Woodland 0.000 0 0 Totals for 2004: General Property 3.370 55,000 0 55,000 Woodland 0.000 0 0 Lottery Credit: Claim Count 0 Certification Date Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 0 cn 0 3- o d 3� ID CD 1 3 n O Q,. m n N CCn 7 CO O O O N U) N. O I W coo CD °i [D O U ' CO O CD CD ° o °o c CD ' v o h Ln CA a�3 gfn ?, ° o o !� CD us CD CO ,o a o Cy CD CO y CO a CD CL o y , N 0 00 3 Q o o ! O to cD o n r cn CD y O oho C.0 3 . 0 • Q l�l • lZ Z O � O O M p Or o O � <^�� 06 cn w cn ° C 0 ° ': w rn Qo �. c g N CD m o a CD CL w cn I z c z g 01 O D 7� o a CD I I W z CD A ? (D 0 N ' ,�• y ? 7 n V 1 O 7 C � CL Z O p H CD I w CD ! � , I ox - Ca 3Fxva c 7 cn n p G Lq CD Q 3- tD C a= 3 o a CL N° o �° f y N =O 4 F cn <n o y n N 0 p cn 0 N a ti O N T � O � o (D CD 0 o y Parcel #: 042 - 1092 -60 -200 01/07/2005 09:11 AM PAGE 1 OF 1 Alt. Parcel #: 33.29.18.511 B 042 - TOWN OF WARREN Current OX ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * WILKINS, DAVID E & SHANNON C DAVID E & SHANNON C WILKINS WILKINS JERRY & DONNA WILKINS JERRY & DONNA 657 N MAIN ST RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 644 STAR LN SC 2422 ST CROIX CENTRAL SP 1700 W ITC Legal Description: Acres: 7.180 Plat: 1487 -CSM 16/4303 042/02 SEC 33 T29N R18W PT SW NW BEING CSM Block/Condo Bldg: LOT 02 16/4303 LOT 2 7.180AC EZ -U- 1377/391 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 33- 29N -18W SW NW Notes: Parcel History: Date Doc # Vol /Page Type 06/30/2003 728108 2295/391 WD 06/24/2002 682499 1915/326 VAC 11/12/2001 661835 1760/504 EZ -U 05/04/1998 578429 1320/375 WD 2004 SUMMARY Bill M Fair Market Value: Assessed with: 38686 573,900 Valuations: Last Changed: 07/14/2003 Description Class Acres Land Improve Total State Reason COMMERCIAL G2 7.180 110,000 395,000 505,000 NO Totals for 2004: General Property 7.180 110,000 395,000 505,000 Woodland 0.000 0 0 Totals for 2003: General Property 7.180 110,000 395,000 505,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount 018 - RECYCLING SPECIAL ASSESSMENT 15.00 Special Assessments Special Charges Delinquent Charges Total 15.00 0.00 0.00 680247 Q l5 VOL 16 FAGE 4303 KATHLEEN H. WALSH .M 2 Q W REGISTER OF DEEDS ST. CROIX CO.. VI ST. CROIX COUNTY ed iied Survey Map No . 4303 RECEIVED FOR RECORD SURVEYOR'S RECORD 4303 05 -29 -2002 10:20 A olume 16 , Page ('FRTTr=n SURV ..ar BEING A PART OF THE SOUTHWEST 114 OF THE NORTHWEST 1/4 OF SECTIONREECC • 15.00 34 AND THE SOUTHEAST 1/4 OF THE NORTHEAST 1/4 OF SECTION 33, CAGES: 3 AND ALSO THE NORTHEAST 1/4 OF THE SOUTHEAST 1/4 OF SECTION 33, TOWNSHIP 29 NORTH, RANGE 18 WEST. TOWN OF WARREN, ST. CROIX CO. WI. BEING ALL OF LOT 1 OF CERTIFIED SURVEY MAP RECORDED IN VOL. 10. PAGE 2854. APPR(WrrED W 1/4 Cor. ST. CROIX COUNTY Sec 33, T 29N - R 18 W PREPARED FOR: Planning zoning and Parks Committee Berntsen Alum. Mont. Robert Holdsworth \ I TMI Properties Inc. MAY 2 9 ZOOZ S 622 Star Lane "N' � Roberts Wisconsin, 54023 If not reCorded within 30 days of th ) I �� as approval date approval shall be N0 AC Nl7• ' - — - — null end void ce 0�3 f 45 , Note: The parcels on this map are subject I ^ 8 � 9� No �' °' to state and county laws, rules and regulations °; Ac cess (i.e. wetlands, lot size, access to parcel, Etc.) I N « > >. � �o •••�.,D ! before purchasing or developing any parcel contact ,40 4 79 2' the St. Croix County Zoning Office for advise. Z C LEGEND oo A .:. pro A F"• 0 0 � �A �P'-- $ ......... Government Corner (as noted) \? 1b, � r 0 ■ \� �j ap I WU �W S I O V . - ' * o a sa o..........Set 3/4" x 24" O.D.rebar welghin I' �•` --I L ti 1.502 lbs. /lineal ft. N I °° `,' � `, � �� s�, s `'s, •..........1' O.D.Found iron pipe � :2 c ��`,��• v Septic Vent ' -- s� 241.44' $� 9. - - - SOO'13'05 "W 290.95 East line of Lot 1 CSM itn " 1 SCALE: 1" - 200 Vol. 10, P.28� I I -r N00'09'00 "W E 1/4 Cor. 3 0 �\ 007.36' Sec 33, T29N - R18 Reset from previous surveys I IGO � 400' \ a 0' 200' Set 3/4" Reba r IrD c), �� w ' ,.q�� i2 50 , .Tp / / I 100, �- � T o � K9.5° !� A, n w i � / 3a ' J WN O L IA r / 1^ rn 9.99' 1 ° i A a kz v o SOO 13'05 "w ,' i a I Qi 888888 88 X - " -- k _00 0 / y a La so. to . o v �o :� N w ? i4 v a p enterline of the o , co East bound lane 1 -940 North is referenced to the East -West 1/4 N v 5 ° ;' line of Section 34, which is assumed to $ 'o 6. • + a o No ' bear N89 0 51'05 "W. ^ A N / ■ s • ■ i ■ �i ■ C C- C / 0 A V G r q // �" rb � , 4 10 1 ., _ _ _ A I ,' o Note: OUTLOT 1 is non - buildable because of • -4 - t - o D � o�� slopes grater than 20% with a net buildable .� W I o, ;' `�� area of less than 1 acre. Also the Lot area is M I 0,' � less than Township Zoning allows. Parcel #: 042 - 1092 -60 -000 01/07/2005 09:06 AM PAGE 1 OF 1 Alt. Parcel #: 33.29.18.511 042 - TOWN OF WARREN Current ❑ ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 2 Tax Address: Owner(s): * = Current Owner RETIRED NUMBER TMI PROPERTIES INC " TMI PROPERTIES INC, RETIRED NUMBER Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 2.000 Plat: N/A -NOT AVAILABLE SEC 33 T29N R1 8W SE NE S OF HWY 94 EXC Block/Condo Bldg: THAT PT W OF THE HWY EZ -U- 1377/391 NKA PT CSM 16/4303 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 33- 29N -18W SE NE Notes: Parcel History: Date Doc # Vol /Page Type 11/12/2001 661835 1760/504 EZ -U 05/04/1998 578429 1320/375 WD 07/23/1997 1058/353 LC 2004 SUMMARY / This parcel will not get taxed. It exists soley Assessed with: \ for parcel history tracking purposes. Valuations: Last Changed: 07/31/2002 Description Class Acres Land Improve Total State Reason Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 042 - 1095 -95 -000 01/07/2005 09:05 AM PAGE 1 OF 1 Alt. Parcel #: 34.29.18.530B 042 - TOWN OF WARREN Current ❑ ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 2 Tax Address: Owner(s): " = Current Owner RETIRED NUMBER TMI PROPERTIES INC * TMI PROPERTIES INC, RETIRED NUMBER Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 10.250 Plat: N/A -NOT AVAILABLE SEC 34 T29N R18W 10.25A SW NW S OF HWY Block/Condo Bldg: 94 /EZ -U- 1377/391 NKA PT CSM 16/4303 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 34- 29N -18W SW NW Notes: Parcel History: Date Doc # Vol /Page Type 05/29/2002 680247 16/4303 CSM 11/12/2001 661835 1760/504 EZ -U 05/04/1998 578429 1320/375 WD 2004 SUMMARY j' This parcel will not get taxed. It exists soley Assessed with: }} for parcel history tracking purposes. Valuations: Last Changed: 07/31/2002 Description Class Acres Land Improve Total State Reason Totals for 2004: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2003: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ~ ST. CROIX COUNTY 7 9 BONING DEPARTMENT MCNT l� /cam` AS BUILT SANITARY REPORT ,,�, RECEIVED Owner Address S E P 3 0 1%8 City /State , d ST CROIX COUNTY ZONING OFFFU Legal Description: Lot Block Subdivision/CSM # ' / ,,_ ' /,,, Sec., T N -RgW, Town of /, °fir„/ PIN # i095 SEPTIC TANK — DOSE CHAMBER — HOLDING TANK INFORMATION Tank manufacturer Size ST/PC / Setback from: House J Well ZV P/L zlee Pump manufacturer Model Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: ,!1 t to Width _zL_ Length s' Number of Trenches Setback from: House � Well 'N� P/I, ; s 7 / Vent to fresh air intake ELEVATIONS Description of benchmark z / / Elevation /FV, o Description of alternate benchmark f /�„� Elevation Building Sewer ST/HT Inlet 9, ST Outlet �� PC Inlet PC Bottom 5s' 2 99 Top of ST/PC Manhole Cover 9,3, 9� Distribution Lines Bottom of System( ) ,9-S9-2 ( ) ( ) Final Grade ( ) LC2D. 7 () ( ) Date of installation rmit number ._ /9SS' State plan number Plumber's signature License number t' s Date Inspector Cornpletc plot plan • Wisc6nsin Depart of Commerce PRIVATE SEWAGE SYSTEM Count y Safety and Buildings Division INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary : Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ❑ City ❑❑ Village Town of: State Plan ID No.: RAILER MARKETING INC. WARREN CST BM Elev.:- Insp. BM Elev.: BM D escription: Parcel Ta o.: 1 vo Oc� b S4M( - Q OIL- 1095 -95 -000 TANK INFORMATION LEVATION DATA A9800343 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Se I W D Benchm Z �, �S $Do 4M g 1zeA+e •g3 /Oos -06 Aeration �- Bld ewer Bldg S Holding St/Ht Inlet n4 -?D • 5 TANK SETBACK INFORMATION St/ Ht Outlet 11.11 'D , TANK TO P/ L WELL BLDG. A ir ir I to ntake ROAD Dt Inlet c 0� A �•� 0 / • � epti K.1 j4 v` .. NA Dt Bottom Dosi NA Header /Man. Aeration NA Dist. Pipe Z, -7 8', Holding Bot. System PUMP/ SIPHON INFORMATION WA Final Grade Manufacturer C -7vu IId c, Demand ) { •�n1 (�� Model Number Wt() 3 ( 1 � �{ � ,� 7 g�• �g TDH I Lift Friction Fyrstem3ZS TDH �, t Loss Forcemain Length 49 Dia.` 2 " Dist. To Well SOIL ABSORPTION SYSTEM 1146 BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid De th DIMENSIONS 6 1 g5 I DIMENSION SYSTEM TO P / L BLDG WELL LAKE / STREA LEA HING Manufacturer: SETBACK CHA ER INFORMATION Type N/ /'^ OR UNIT Model c Z,I 1 q 5 DISTRIBUTION SYSTEM Header/Ma ifold Distribution Pipe(s) x Hole Siz x Hole Spacing Vent To Air Intake Length Y Dia. p• Length Dia. ` ! 2 Spacing � X�/ y �- n SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center 1 �� Bed /Trench Edges 12 Topsoil G M -Yes ❑ No [ 'Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: WARREN 34.29.18.530B,SW,NW 644 STAR LANE C ). — �� &eIVi le " 4A S,) G,vwS4Me F011K l h 1 'A1v'7 0 00A Plan revision required ?' E] Yes Z No Use other side for additional Information. �$ SBD -6710 (R.3/97) Date Inspecto s Signature Ce=.No SANITARY PERMIT APPLICATION Safety ��gtonA Di Visconsi P.O. Box 7969 Department of Commerce In accord with ILHR 83.05, Wis. Ad m. Code Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number The information y ou p rovide may be used b other g overnment agency programs 3�5�ss Y P Y Y 9 9 Y P 9 ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I. Q. Number I. APPLICATION INFORMATION PLEASE PRINT ALL INF RMATION IZ Property wner Name Property Location k rrV t 1 /4, S T , N, R (or V Prop y O n is Mail i Addre s Lot Number Block Num r City, Zip Cod Phone Number Subdivision Name or CSM Number IL E F BU ILDING: (check one) ❑ State Owned C] It� Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms 0 Town OF - - Z 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) _ -- 1 ❑ Apartment/ Condo 0 14,2 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 64 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. Ig New 2. ❑ Replacement 3_ ❑ Replacement of 4_ ❑ Reconnection of 5_ ❑ Repair of an System ________ System _____________ Tank Only 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 fo Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: j 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./ ch) Elevation Feet Feet Capacit VII. TANK in Ca gallon Total # of Prefab. Site Fiber- plastic Exper.. INFORMATION New Existin Gallons Tanks Manufacturers Name Concrete Con- Steel glass App. structed Tanks Tanks Septic Tan or Holding Tank ❑ ❑ ❑ ❑ ❑ IALL p Tan /Siphon Chamber l — 11 El El ❑ El VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for instal tion of the onsite sewage system shown on the attached plans. Plumber' ame (Print) Plumber's ign ��( to s MP/MPRSW No.: Business Phone Number: i - asd Plumber's Address tree , City, S e, Zip Cod 1h W C ,U _ IX. - COUNTY/ DEPARTMENT USE ONLY []Disapproved Sanitary Permit Fee (Includes Groundwater ate I ssued IssuingA nt gn urg(NoStamps) 'ta Approved ❑ Owner Given Initial ft Surcharge Fee) Q 2 Adverse Determination ©0 1 V X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: S lFtlt/B6) DISTRIBUTION: Original to County. One copy To: Safety 8 Buildings Division, Ownw. rkavilm Safety and Buildings 15837 USH 63 HAYWARD WI 54843 -8107 N visconsin Tommy G. Thompson, Governor Department of Commerce William J Mccoshen, secretary June 30, 1998 CUST ID No.224263 KIM A O'CONNELL 504 3RD AVE OSCEOLA WI 54020 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 06/30/2000 TdentificatinNubers �..'..,..... '' Transaction ID No. 112835 Site ID No. 13832 SITE: Please refsr b�rthidentiflcat�tt nuwaabers; Site ID: 13832 above, in all correspondence with. fife agency. ST CROIX County, Town of WARREN; INTERSTATE 94 & HIGHWAY 65, WARREN SWl /4, NW1 /4, S34, T29N, R12W TRAILER MARKETING INC INTERSTATE 94, WARREN FOR: Description: NEW MOUND Object Type: POWT System Regulated Object ID No.: 29311 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. This plan approval is for a 375gpd mound. The following conditions shall be met during construction or installation and prior to occupancy or use: • This plan action is subject to designer comments on the plan • Correspondence Note: • Maintain well setbacks per Comm. 83.15(4) & 83.10(1). ROM • The orientation of the mound system must be such that the mound's longest dimension is perpendicular to the Condit direction of maximum slope. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to APP inspection by authorized representatives of the Department, which may include local inspectors. All permits DEPA MENT Q required by the state or the local municipality shall be obtained prior to commencement of DIYis W construction /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address SEE CORRES on this letterhead. Sin IRA DATE RECEIVED 06/26/1998 FEE REQUIRED $ 180.00 T , LAN REVIEWER FEE RECEIVED $ 180.00 Integrated Services BALANCE DUE $ 0.00 (715)634-3026, M - F 7:45 AM TO 4:30 PM TBRAUN @COMMERCE.STATE. WI.US MOUND DESIGN INDEX AND TITLE SHEET I Project TRAILER MARKETING INC Owner TRAILER MARKETING INC Address %� , �,r /Z Y WALTON KY /f; Legal Description SW -NW 34 - T29N -R18W Township WARREN County ST. CROIX Subdivision Name Lot No. Parcel ID Number Plan ID Number 112835 INDEX SHEET PAGE ONE MOUND CALCULATIONS PAGE TWO )VE MOUND DRAWINGS PAGE THREE PRES. DIST. CALCS. S LATERALS PAGE FOUR r COMMERCE PUMP TANK DRAWINGS PAGE FIVE f PUMP CURVE PAGE SIX PLOT PLAN PAGE SEVEN ,JONDE)" Designer KIM A O bNNELL License Number Signature Phone No. 715 - 755 -3145 Date 6 -24 -98 Notice: Tampering with this file by unauthorized persons is prohibited. Deliberate modification will result in disciplinary action under s. 146.10, Wis. Stats. SBD- 10462 -E (R.04197) Page 1 of 7 MOUND DESIGN Complete information in red framed boxes as necessary. (y or n) n Is the s stem over creviced bedrock? Slope 2 % Wastewater flow rate 375 gpd 1419.4 Lpd Depth to limiting factor 29 in 73.7 cm In situ soil infiltration rate (code) 0.5 gpde 1 20.4 Um Contour line below the upslope edge of absorption cell 96.95 ft 29.5 m Use standard fill depths? r x I OR Designer speed depth in _ 1cm Place X in box to use standard depths (1Z 24, A+4 inclusive) OR specffy design fill depth. Center or end manifold a 1(c ore) ft e) Estimated hole space 4 Not a final calculation. Lateral spacing eft Minimum dose >= 10 times void volume Use a o lateral spacing for trenches. Pump tank elevation 83.95 ft Outside bottom of tank Number of laterals I 2 Force main diameter 2 in Force main length t l�dft Force main actual dia. 2.067 in SYSTEM SOLUTIONS Inch - pounds Metric Cell media "x" one only. Estimated daily flow 375 gpd 1419 Lpd x Aggregate and pipe Chamber and pipe Absorption cell S Design load rate & area 1.2 gpdAk' 312.5 ft 29.03 m2 �;,y ✓, "� t; ,o ;���,• /Fe ,1o�,�.r Linear load rate 7.1 gpd/ft 88.0 Lpd /m / >� -�.� j Design width (A) 6 ft 1.83 m Cell length (B) 53.0 ft 16.15 m �t Depth of cell (F) 9.9 in 25.1 cm rc / : Yys`' yr�� fee Sand filter Upslope fill depth (D) 12.0 in 30.5 cm r> �, , � C/� ig 4 Downslope fill depth (E) 13.4 in 34.0 cm Basal area required (gpd/infiltration rate) 750 ft 69.68 m Supporting components raj,• Topsoil depth 6.0 in 15.2 cm ,l Subsoil depth at center 12.0 in 30.4 cm Subsoil depth at cell wall 6.0 in 15.2 cm . •�• /09X�s y., End slope toe length (K) 10.2 ft 3.11 m Upslope toe length (J) 8.0 ft 2.44 m ja „ T,,.,* Downslope toe length (1) 9.4 ft 2.87 m Total mound length (L) 73.4 ft 22.37 m Total mound width (W) 23.4 ft 7.13 m Project: TRAILER MARKETING INC Page 2 of 7 Plan I.D. 112835 MOUND PLAN VIEW observation pipes (typical) J _ 23.4 ft O` A A= 6.0 ft 1.83 m W 7.13m — O 6= 53 ft 16.15m __ = -- B _ K J = 8.0 ft 2.44 m 1 = 9.4 ft 2.87 m K = 10.2 ft 3.11 m L = 73.4 ft 22.4 m tYP obs- PIPe A X B refers to absorption cell width and length (anchored securely) J = upslope width I = downslope width K = end slope dimension 6' (150 mm) MOUND CROSS SECTION fi , D = 12.0 in 30.5 cm topsoil G H lateral subsoil cap E = 13.4 in 34.0 cm invert 98.5 ft F = 9.9 in 25.1 cm �� 30.02 m see note F G = 12.0 in 30.4 cm elev. H = F18.01in 45.6 cm D E ASTM C33 Sand Fill Sys. 98.0 ft elev. 2 — 98 - - 71 m 7- 97 - .0 - 1, ft contour 2 12 im slope Note: Absorption cell media will D = upslope fill depth plowed layer consist of aggregate and pipe E = downslope fill depth or leaching chambers and pipe F = absorption cell depth as specified �x Aggregate G = subsoil + topsoil depth at cell wall at right. Chamber H = subsoil + topsoil depth at cell center Designer notes: If aggregate is used, it is covered with code compliant materia Project: TRAILER MARKETING INC Plan I. D. ### Page 3 of 7 PRESSURE DISTRIBUTION CALCULATIC"'i Absorption cell Inch-pounds Metric Width (A) 6 ft 1.83 m Length (B) 53.0 ft 16.15 m Lateral specifications Number laterals 2 Holesllateral 13 holes Lateral length 50.0 ft 15.2 m Perforation dia. 0.25 in 6.4 mm Lat. dis. rate 15.15 gpm 1.0 Us Sys. dis. rate 30.30 gpm 1.9 Us Hole spacing 50 in 127.0 cm Lateral diameter Pipe diameter Design options Desi choice Designer must l inr25 r; ,, Pla X in red "X" one choice 1 1/4n/32 mm X box of chosen from the options 1 1ran/4o mm X x diameter. provided. 2inf50 mm X 3inr75 mm X Manifold diameter Pipe diameter Design options Des ign choice Designer must 1 in25 mm "X" one choice 1 1 /4in/32 mm X Place X in red from the options 1 1i2n/40 mm X box of chosen provided. 2inJ50 mm x diameter 3in/75 mm X 1 4n/1 00 mm X Distribution system contains 2 lateral(s). LATERAL DIAGRAM END CONNECTION Place correct lateral diagram by clicking in one of the ::. wings at right and dragging the diagram into this area. _ _ - — end c - atera s centere over t — A� dimension last Mote drilled ne xt to end c I ap P pF corwo ls are identical I<- X--�I Holes drilled on the bottom of the lateral S equally spaced • main cofM wOti Via tee or Cross to manifold at any point. Laterals & force main of PVC Sch 40 • = permanent end marker (per COMM Table $4.30 -5) Inch - pounds Metric Lateral length (P) 50.0 ft 15.24 m Lateral spacing (S) 3 ft 0.91 m Manifold length 3 ft 0.91 m Hole diameter 0.25 in 6.35 mm Lateral diameter 1.5 in 40 mm Number of holes per pipe 13 Invert elevation of laterals F 98.5 Jft 29.92 m Project: TRAILER MARKETING INC Plan I.D. 112835 Page 4 c, Total dynamic head System head = 3.25 ft 0.99 m Vertical lift = 13.60 ft 4.15 m Are laterals the highest point in the Friction loss = 2.34 ft 0.71 m system? Yes 'X here. U Total dynamic head = 19.19 5.85 m If no, what is the highest elevation Dose Volume downstream of pump? Lateral void volume = 10.6 gal 40.1 L Force main drain Minimum dose = 106.0 gal 401.3 L back to tank? C)e one) Drain back = 25.8 gal 97.7 L x Yes Dose volume = 131.8 gal 498.9 L No Typical Pump Chamber Layout In combination with state approved treatment tank Tank construction as per Comm 83.20(3) WAC. approved manhole cover weather proof w/warning label and padlock grade levels junction box —� grade levels quick disconed __— __.— \ alternate - -- 4" vent pipe electric as per NEC 300 and outlet Comm 16.28 WAC location 18" (46 cm) min. i i ?wall of pump approved 0 outlet chamber or combination T ' joint tank A 1/4" vmeP Grade levels alarm on hole as pump tank manhole = 4' min. above finished grads pump on B necessary pump tank man. =100 mm min above finished grade vent = 12" min. above finashed grade pump 84.9 ft �C - vend = 300 mm min. above finished grade off elev. 25.91m D 3 " (75 mm) of bedding under tank and anchor tank as necessary 84.0 ft Pump tank elevation 25.6 1 m bottom of tank Tank specifications: WEEKS Pump tank = 19.04 gal /in Pump tank volume = 800 gal Capacities: Inches Gallons A= 25.1 477.8 Pump manufacturer: IGOULDS B = 2 38.1 Pump model number: IVYE0311M C= 6.9 131.8 D= 8 152.3 Project: TRAILER MARKETING INC Plan I.D. 112835 Page 5 of 7 v ertormance ' ,:f k La M " I u Ic I , II Pumps ?-Se z J r turves METERII FEET 90 -L -- --- ' 10DEL 3815 25 _ _Y__ S1ZE /. Solids 60 WE1SH —{. 70 20 WE10H - �- ----t - - -� — 0 WE07H 50 F- 15 -- — - T —H — WE054 10 WE03M r ._ T WE03L - - - - --}-- lu 77 � o L 0 i - - 0 10 20 30 40 50 60 70 60 90 1G0 110 120 GPM L i —L - 0 10 20 30 m'Ih CAPACITY ( a:71i.. Is': A7. w�e. J7 ,�➢•+N4 ,t 4' '..'.1 '�S ♦ i. i. �: .F � 4":Y�� �. �° r �GOULDS PUMPS. INC. � 4 METERS FEET 120 MODEL 3885 __,- SIZE 3 '4" Solids 110 WEISHM 1 'r 100 —. 25 60 - g 70 60 - - �- -- -- o -- — ~ WEO5HN 15 50 1-- 10 - _ - =- 0 0 90 40 S0 60 7G c, to •W 11� ti0 GPM p 10 20 • 0 10 : J 30 m'!h CAPACITY Eagcww jury. f wu • 1 W8 Op110a Pump, Inc. C7111` ,��G,e.� /��rd�h/ �stti/y- /tic %,•.>�'�� l - 7.�1�/✓ it "J�'�� �Q�:,E 7�� 7 l I I i f ,SUNFi �:ZK 2 I q i " Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel 1. D. # a/ZZ - / 0 9 2. - Coo APPLICANT INFORMATION - Please print all information. ed by Date Personal infomration you provide maybe used for secondary purposes (Privacy law, s. 15.04 (1) (m)). Property Owner Property Location T Govt. Lot 1/4 1 /4,S T ,N,R �or) h �o Property Owners Mailing Addre Lot # I Bloc # Subd. Name or CSM# City - State Zip Code Phone Number El city 4 Village ® Town Nearest Road ® New Construction Use: ❑ Residential / Number of bedrooms Addition to existing bui ling ❑ Replacement IM Public or commercial - Describe: Code derived daily flo gpd Recommended design loading rate , ' _ - - bed, gpd/ft � trench, gpd/ft Absorption area required 012 bed, ft Z& trench, ft2 Maximum design loading rate - gpd/* , trench, gpd/ft Recommended infiltration surface elevation(s) . 27 95 ft (as referred to site plan benchmark) Additional design/site considerations Parent material /� `f� Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system ❑ S m U 0 S ❑ U [- .10 u 1 0slZu ❑ S 2111 ❑ S [l 11 SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench ,2 Zg2 i 1 Ground 1 r elev. Depth to 6 limiting factor Remarks: Boring # Ll Ground — — elev. V,16 ft. d s Depth to limiting factor ,min. Re arks: CST Name PI se Pri Signature _ � _ Telephone % o. C Address Date CST Number S� 1 r 9 GuN7�cuB" 3Ls' ' i��d7�5 �� �e. �Prt .�ll�o (�redk�,e1s /U3D,b9,� r� ze �t w ass wise ;in Department of Industry SOIL AND SITE EVALUATION / Labor and Human Relations Page of J Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and 4911 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # ;,te r �o,�D�r s • a {moo . 5 yZ ioy.5 : F_5 APPLICANT INFORMATION - Please pri rma r ` � Reviews by Date Personal information you provide may be used for seconda as (P S. 15.0-((1 )). /2, . q Property Owner -�-• Pr Location � Q cJ M S� w A L +�{ c Go . ' SK/ 1/4 A&41/ ,S 3' T —7 ,N,R X6 E (o6 Property Owners Mailing Address N �, Lot `- Block# Subd. Name or CSM# --� Q� p� T el !b .2 3 s Hwy s =; s City State Zip Code ham► Numb �fJG Nearest Road ity V' lage. Town RoQe �T"s (,JI . Syoz3 ( ? .. ' 3.. , N -y' New Construction Use: ❑ Resi ential / Number of bedrooms Addition to existing building A/ El Replacement ublic or commercial - Describe: ie% . MyeX- ZV"Z — z Z - PO T& O TY►K --I- r;ti /o L Code derived daily flow gpd 2 Recommended design loading rate bed, gpd/ft ' trench, gpdffl Absorption area required ? bed, 0 trench, ft Maximum design loading rate — bed, gpd/f trench, gpd /fi Recommended infiltration surface elevation(s) ' C- 42 e- P4 . 3 ft (as referred to site plan benchmark Additional design /site considerations SATE TESTED i &- poiP>�s H ou,a 4 syS T . Pe *T 6:�e404iEF Parent material 5C5 &o Co i t�_ 10,4/4y SE 4 f1ev7-S Flood plain elevation, if applicable ft N S = Suitable for system Conventiona , Moun, In- Ground P AAT GGride System in Fill Holding Tank U = Unsuitable for system ❑ S LJ U ❑ U ❑ S L7 U L� S ❑ U ❑ S El S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench I / o - /o 10Ye L 2, •f5 6,4!� / -fR Ground S L T 6 rc S S. • (o e'lev. Depth to S � b /yN �/ • S limiting 7 S y/,4e S factor 50— in. '5 Remarks: Boring # o . log 31 a -Is! e , v% -Fie es i 7C .5 � F Z O L Z h �►� cs S. G 3 A /o vle MCP Si L. � S V h. Ground �Q 7/� 0 0 -.S /0& 30 ft. 7• S „ SL. 1 /W17/ • amt' J&P 5'Y o 9 � Depth to '/0 Z S 4 { 1 /* vT / N limiting d factor 50—in. Remarks: 1 ` CST Name (Please Print) � n � 7i _ // Signature/ � Tel hone No. s• ! Address 6 ,1 J Af,e %L 0 /lp Date'/ 11 ' '7 z. � � N 1 1 O V 1 O t \� N . Q w T O� O C ap �� Q P° eo 0 o ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �,�,� ; L Mailing Address </ Property Address -� (Verification required from Planning Department for new construction) City /State � � L. J� Parcel Identification Number 242 ;i 9_5r '9 _�— LE GAL DESCRIPTION Property Location '/4, '/,, Sec. 1 N -R W, Town of Subdivision , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # 7Sl Z2 , Volume ,1 , Page # Spec house I yes ( no Lot lines identifiable ® yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned haver the above requirements and agree to maintain the private sewage disposal system with the standards e e s set b e Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification ste has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 a ex ' ate. APPLICANT DATE OWN S E I ION (w c at statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the s , by virtue of a warranty deed recorded in Register of Deeds Office. SIG A' RE F APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed lid. 9 1 Piu17 5 J Document Number WARRANTY DEED _ RE01Sfi€RT"WFTCE - This Dead, made betw. James H. Schwaleri. a ST. CROIX CO. W? single person, Grantor, and TMI Properties, Inc., Grantee. acs Witnesseth, That the said Grantor, for a valuable MAY 0 4 1998 consideration conveys to Grantee the following described 08:30 A. M real estate in St. Croix County, State of Wisconsin: ' . M ...sk 0-!J1 W. That certain parcel of land located in the SW -1/4 of the NW- 114 of Section 34 and the SE -1/4 of the NE -1/4 of Section 33, Township 29 North, Range 18 West, Town of Warren. - R.2raiM ^"°' St. Croix County, Wisconsin, more fully described as Nt1! V4 Rse�rr, follows: Commencing at the East 1/4 comer of said Section � 33, the POINT OF BEGINNING, of the parcel to be herein 10 described; thence N89 (assumed bearing on the EastAlVest 1/4 line of said Section 33), a distance of 401.9T. to the Easterly P.O.W. of S.T.H. '65'; thence N17 -CE 177.21' on said R.O.W.; thence N56°38'05'E 573.24' on the 042- 1095 -95 and 042- 1092 -60 Southerly R.O.W. of Interstate Highway "94% thence (Parcel I&wtilcation Number) S86 324.44' on said R.O.W.; thence S54°30'39'E 671.84' on said R.O.W.; thence S47°12'39'E 107.78' an said R.O.W.; thence S89*%'24'W 1079.10' on the East/West 1/4 line of said Section 34, to the POINT OF BEGINNING. TR ANSFER This is not homestead property. Together with all and singular the hereditarnerrts and appurtenances thereunto belonging; And James H. Schwalen warrants that the title is good, indefeasit a in fee simple and free and clear of encumbrances except easements, restrictions, and rights -of -way of record, and will warrant and defend the same. Dated this �>i . day of May, 1998. ' arnes H_ Schwalen w w AUTHENTICATION ACKNOWLEDGMENT Signatures) STATE OF WISCONSIN ST_ CR#= COUNTY Personaty came before me this /-Tf- day of May, 1998, the above nawbed James H. Schwaien to me known to be the authenticated the day of 1998. person moho exer�rted the foregoing instrument and admwrled9e the same. Signature Type or print name -... -V ! - ( ( e TITLE: MEMBER STATE BAR OF WISCONSIN Type fiGiPf.L D • I� F�tl E� 1 (If not, Notary Purhic, State of W' c nsin. authorized by §706.06, Wis. Stats) My co ion expires � � 0 c 2 0 J , R ; 3 � §_ � � � ■ / $ E ° § 2 m g B \ 2 \ P. § 7 \ \ B k t § i 0 (D >� C m CD \ m g — r & 9 § £ 2 § f o § § n r CA � I § & % �. 0 0 0 8 • Oro 0 o w � I % § (A (A Ch K § c � o v , 0 2 co § .. E c >/ @ 7 @ % C 2 3 co k /� M cr. § 9 � m § w CL § z § § § 7 2 2 CD ° CL � CL § } c 0 ( ca � � � $ � ƒ � A � k 0 » CD t , �