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002-1028-90-000 (4)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County St. Croix Safety and Budding Division INSPECTION REPORT Sanitary Permit No. GENERAL INFORMATION (ATTACH TO PERMIT) 642207 State Plan ID No Personal information you provide may be used for secondary purposes(Privacy Law.a.15 04 Mimi) Permit Holders Name City Village Township Parcel Tax No Terry M. and Ronda L. Helgeson TOWN OF BALDWIN 002-1028-90-000 CST BM Elev. Map BM Elev. BM Description Section/Town/Range/Map No f 0e i(j;1 i eclat 14.29.16.204B TANK INFORMATION /00 of of Wcl ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION 1 BS�f 1 HI FS ELEV. Septic .jA( \ /��.ry/(� Benchmark •1. 'k I -O/`••0 lal Dosing (Leah I_ � ( t vcrki 1 /2 Oi " I. l07•Vs �6 d d Al)..BM 1�1 SOff i r (n4�,, )•$5 ` •�)- „AerSITor . g.Sewer OdpMD Sp:.-• I i-tff C l6-4i Holding St/Ht Inlet ,✓/ , $UHI Outlete^`I • TANK SETBACK INFORMATION v 1\I•S Al- _ A TANK TO • WELL BLDG. prt}t#17-Rans.Rif •SAD Dt Inlet r Septic I. . ,., l -- Dt Bottom io. 36 71. 31 Dosing Key I Header/Man. u C Aeration _-_-- Dist. Pipe .37S Holding ___-- Bot. System c S 77 0 PUMP/SIPHON INFORMATION kk s ` - Final Grade Manufacturer Dem. d C ver [//yy GPM - d l•. t 1 ' 10‘ Model Number -b x/J Al / TDH ; • . Systemilea. TD <• a11 lQ IA� 7 �J �I� •S� ii Forcemain • 'Dia. n Dist.to Well �"j�f, .7,625 SOIL ABSORPTION SYSTEM BEDITRENCH Width r II rLanpllt0o t lIINoSd Fref2hes talk"!S PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS ``]] SETBACK SYS M TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Ty Syste CHAMBER OR 4 / t *1 760r UNIT Model Number DISTRIBUTION SYSTEIOI f l Header/Manifold rt Distribution , I r l x Hole Size x Hide lap Vent to Air Intake Length Dia Length / Dia I l7 Spacing 5132= f ,,l Dr SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only2r,,/l�yYy'�A/ Depth �� bk . Depth Over xx Depth of xx Seeded/Sodded T t•�xx+Mulched Bed/Tr ch Center 1 T Bed/Trench Edges Topsoil r t `� p ��� yl Yes Li No Yes Na`J 0s K COMMENTS: (Include code discrepencies,persons present,et ) Inspecctionn�#1: Inspectiont/ #2: Location: 2533 CTY RD E 1 f 9 ra�i 4U �C Von I{ tdivcf-i-►t I iv k(/{/ [I`r1.)AltBMDescription=�111{(C.�{I + ,/�` f � 1tl�lIAIt� V"V') L 2.)Bldg sewer length=-(x)5 itA (r -amount of cover= J{ 1211.1b111)( 4 SIA1V4i415i(#1 Of Ct >'scisjlrtq-*.-0—...kv(1 Plan then revision Rfor d U Yes No i /fJ�, ?1j �' 1 j/ / _t_. Use other side for additional information. I t JG , r f/ 5y,//^ SBD-8710(R.3/97) Date a ra SignaNre Cen No. `„1.al 41 t.f;,. N .V^( 1 "-C county 5' -avat 1 V I z. D and B '',' '_' ^t �� 201 W.WathingtonAve P.O. Box 7182 ' CfD S C (L� Madlson,WI 53707-7182 Sanrtery Permit Number(to be tilled in by Co.) snit ,fie n't Applicati State TrartaectiarrNutnbor t be f(•/5.4 In accordance with PS 383.21S2)r1Al ! 'Won of this form to the '.`- ! unit Pt►srs-D82 I o Z iv- `L� L'(1te tS44�- is required prior to • • nt Note:Application forms for state-owned POWTS are :.. . to Project the Department of S simnel Services. Personal information you provide may be used for secondary• Address(if different than mailing address) purposes in accordance with the Privacy Law.s. 15.04(lXm).Stats. 1. Application Information-Please Print All Information Property owner Name 1 Parcel a I Stilt!t/% s0 Al i t 2iN 6 002. IO2e--cio-. � Property Owner's Mail Address f n { Property Location Rct F. City,State aS33 `/�`� Phone Number Gen I 'tl a 11 t �, at.'A f+w 1/4 Section -T Cu 2,' (circle one) B.Type of Building(check all that apply) 4 Lot a T 2 ; R (6 West )C 1 or 2 Family Dwelling-Number of Bedrooms 1 1 Subdivision Public/commercial-Describe use Block a State owned—Described use Na ❑City or CSM Number(V,sli ,34•(l )(Village of (D�: 3131121 ) J Town of T2_'� N Ill.Type of Permit: (Check only one box on line A. Complete line B If applicable) l7 A. New System "kept'acement System? Tteatrment/Holding Tank Replacement Only Y ❑Other Modification to Existing System(explain) B. 0 Permit Renewal 0 Permit Revision 0 Change of Plumber 0 Permit Transfer b New List,P( us revio Permit Numbeer and Date Issued Before Ixpiraion Owner 627 9�q - q/2, I ZDZo , u� IV.Type of POWTS System/Compooeat/Devico: (Check all that apply) tM4' A�^ .2..�D3a / Non-Pressurized In-Ground 0 Pressurized In-Ground At-Orede Mound?24 in.of suitable soil Mound<24 in.of suitable send Holding Tank 0 Other Dispersal Component(exp • 1T_ ( Pretreatment Device(explain) V.Dlsn peaVltatmat Area Information: (p x lee r*J. � (Core�aai. 96.$Z rDesign Flow(gpd) Design Soil Application 0Dispersal Ares Required(a) Dlspenel Area Proposed(al) System Elevation Goa I 600 600 VI.Tank Info Capacity in Total a of Manuhicturer - '$ Gallons Gallons Units- -�1L �11` /�t� t! 9g( New Tdu Exis tine Tanks (iamu, eta bQ.y'1 RG(1/ a• / W WI!SI,2 I Septic Tank 1( jzge{ I Lift Tank Eb0i VII.Respoaslbility Statement- 1,the • - rea for I nos ortbe POW1S ikown on the mac as. Plumber's Name(Prim) re MP/MPRS Number Business Phone Number Lewis Bjork _ ` 253976 715-231-7375 Plumber's Address(Street City,State,Zip .•- E7818 County Road E Menomo ' •751 VIII.County/Departmeet Use Only RTv�Appro ❑ Permit Fyne 1 I At Siy��Frt !v ❑ Rea Denial s 6/7, ; z/ IX.CoEM tloW pprov sapptvral I. STEM OWNER:nk 3) 44_ - eeQ, e l9'�Z yHgu . I.Septic tank,effluent filter and tr,^o`,ten.,",.` i t( / dispersal cell must be serviced/maintained I M�� - n as per management plan provided by plumber. 40 CO-c0-0: .S tit U' M1"o'� �.All setback reqwrements must be maintained S.5.1 a.t.2. 4;1� co/ �^�} �ili-v..1-t- I.) aPPin�i�c.'„�t le s 5") wuc.�jf� `g,¢ �it MA) • r - a—'- -� I r�1 ia.� 12far-b 'L i 5! ') ' FE. t.r`•t w np,,.r P'ss •C,,-...tf9x-wd • CHECK BOX AS APPUCABLE60 ECK %AS APPLICABLE.SOIL EVALUATION 0 Scale: 40' SYSTEM PAGE 2 OF G SITE MAP 7///// 7/, LOT PLAN PROJECT NAME: �/////////4 // �/� M t f�I I��a 1 101+//, DESIGN FLOW tI(i[/ GPD IMR.' 11 fV } .�- / Attach design now calculations for convnarcial plans. PROJECT ADDRESS: L533 �JAT� e oil, 6 Pipe Material I ASTM Standard(Tables 384.30.E 6 384.30-5) '1 _BM C Fr `J Santlery sewer. 4 2 / D-2665 Bm dA 1{ 4 4n t ( c..1►.tI GJ Fare Maln: / oaredptkn r in north by .IMPORTANT: d(%) S. well synod Itl amicable): 0 &a ing an avow Show ground elewtlm contours at suitable liter a e.tl CC: • OOO 0 0 N Now° ^.. ti..-• IN. Oo0D 064621 VIA/ as CI Q� # VS3 914 i lag ... As101011:e00,4" •4 ( ,,s_gass------rp--•„ 1,.. „4„,v1,... II( 14,630) ��07/"Kii 000 . Ti i S O f`v IALog 5 twat PI'e lb° ‘1 1. 5toOe tagtelb 3-'i ,/ 4 BA �i 1 ZS' w aVibe �___.. 4. ci.s. .ice Z E - 2'1 J- = to'`1 4. t1/4Th s — vi.s6 K= 13.1 ©uk \tP W _ L4.I iv% 14 L.— - 17,46 Z `\GOP` s,.r,Mr RECEIVED DIVISION of INDUSTRYsEnv s " 9' /0611 N RANCH RD Doled Thaxosh Rs uy ST.CROIX COUNTY COD "/P"'"imaa"r"g01 Tony Damn-o•r•rNr Dom Crh•-Soarste y August 27, 2021 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES:2023-08-27 CONDI77ONALLY Plan Review: PWTS-082102121-C APPROVED DEFT OF SAFETY AND PROFESSIONAL SERVICES LEWIS BJORK DIVISION OF INDUSTRY SERVICES E7818 County E Menomonie WI 54751 ii n p- J - c. SITE: SEE COMESPONDENCE Terry Helgeson 2533 Cty Rd E St.Croix County Town of Baldwin NE'A-NW'/.-S14—T29N—R16W FOR: Description: Mound Component Manual—Ver.2.0, SBD- 4 Bedroom Mound—600 GPD— 10691-P(N.01/01, R 10/12) Replacement-6"to limiting factor— Pressure Distribution Component Manual—Ver. Effluent Filter-Maintenance required 2.0,SBD-10706-P(N.01/01, R. 10/12) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes.The submittal has been CONDITIONALLY APPROVED.This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above.The owner,as defined in chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06,stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • This approval is subject to the conditions of the Interpretive Determination approved for this site on August 27,2021. • USE NO HEAVY EQUIPMENT OR ONLY TRACKED MACHINES TO REMOVE TREES IN MOUND AREA.PLACE SAND ON AREA PRIOR TO REMOVING TREES.LEAVE STUMPS IN PLACE.AFTER TREE REMOVAL AND PLOWING,PLACE 30"OF SAND ON CONTOUR.CHECK TO BE SURE NO COMPACTION HAS OCCURRED DURING TREE REMOVAL J� / •/ Ditch on east side of mound must be maintained.Divert runoff around back of mound toward ditch. • Ensure>3.5'of distal head pressure on each lateral. • All piping and components shall be protected from freezing per SPS 383.43(8)(c). • Care must be taken to set the dose volume as approved in the plan design.If the minimum tether length of a single switch mechanical float does not allow the proper dose volume,two separate floats must be used. • Prior to construction of the dispersal area,check the moisture content of the soil to a depth of 8 inches. Smearing and compacting of wet soil will result In reducing the infiltration capacity of the soil.Proper soil moisture content can be determined by rolling a soil sample between the hands.If it rolls into a 1/4-inch wire,the site Is too wet to prepare.If it crumbles,site preparation can proceed.If the site is too wet to prepare,do not proceed until it dries. • The mound site shall be properly prepared prior to plowing.Any grasses longer than 6"shall be cut short and removed.To avoid matting,any leaves or loose organic matter shall be raked up and removed.Cut trees and shrubs flush to the ground and leave stumps.Avoid operating equipment on the mound site.If necessary,use only tracked equipment,during dry conditions,with minimal passes,to avoid compaction. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec.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. • A copy of the approved plans,specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department,which may include local inspectors. Owner Responsibilities • The current owner,and each subsequent owner,shall receive a copy of this letter.Owners shall also receive a copy of the appropriate operation and maintenance manual(s)and be responsible for ensuring that POWTS is operated and maintained in accordance with this chapter and the approved management plan under s.SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard,the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes.Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance.As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building,structure,or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, CeCe' R CeCe(Elizabeth) Rudnicki Wastewater Specialist/POWTS Plan Reviewer, Division of Industry Services (608)400-3186 elizabeth.rudnickit wisconsin.gov PAGE 1 OF 6 Mound Plan Index & Cover Sheet Component Manual Design References: Version 2.0, SBD-10691-P(N.01/01, R. 10/12) &Version 2.0, SBD-10706-P (N.01/01, R. 10/12) Pg 1 of 6 Index & Cover Page Pg 2 of 6 Plot Plan Pg 3 of 6 Mound Cross-Section & Plan View Pg 4 of 6 Distribution Network Specifications Pg 5 of 6 Pump Tank Specifications Pg 6 of 6 Management Plan _Attachments: Encl�_: Pump Curve POWTS Application for Review Tank Soil Evaluation Report & Site Map Effluent filter Project Name ! Description N 1.t it5OIJ A + O r wUl Owner Name(s): 1�i f�( C to g ISCr.I Phone:11 - 1309 Owner Address: g 5 33 IZci E. Zip: S`i OZ 8 Project Address: SA,V ES Govt. Lot: NE. 114 of N1U.3 1/4, Section f y , T 2,41 N-RILE❑or-WE Township: $gt(stJ110 County: Cto"Zy Project Parcel ID #: QOZ. ' IDZB `9 D - Ooa Designer Information Designer Name: Lewis Bjork Phone: 715 -231 -7375 Designer Address: E7818 County E Menomonie WI zip: 54751 E-mail: lewisbjork@yahoo.com CONDITIONALLY License Number: 253976 APPROVED DEPT OF SAFETY AND PROFESSIONAL SERVICES Remarks: DIVISION/OF INDUSTRY SERVICES CAE&4 Ck-, SEE COIQESPONDENCE Signature. Date: Original dgn.ture required on each submitted Dopy. ylfCHECK BOX AS AogxA&E ECK •%AS APPUCA&L CSt- 3 SOIL EVALUATION le ''•40' ►�� SYSTEM PAGE 2 OF �. SITE MAP Iii�40 i �i% -LOT PLAN PROJECT NAME: V�7///I//// /�� /J ktC�_1 J 1p.lam„ DESIGN FLOW. GPO q IV Attach design flow calculations for commercial plans. PROJECT ADDRESS: Z.5.33 CAA E G Pipe Maierlal/ASTM Standard(Tables 384 30-3 d 384.30-5) 13.4 . 4 ,1eh Elevation. ICO FT Cej/ V s +nary Sewer 4 / D-.4°" 8.1 Deaeipaat ll l 14 '[ f f 441 Fore Man: 2 / o-2se5 CM) Z Well SY IN u�F 0 n bt IMPORTANT: of TewaShow ground elevation contours at suitable in . ah. an mti ppropy tK Is. . Q0000a ti ,— , o OQOO14/1440eL.--?1,044411: (7) OP' ., ,>.0 ffe _, -,1 1(049,44 1 .0#7,:id • o �o o VA , . 0 „ Zia doQI„ I# 5 L--171L Dtwr I rg 3-4 ems- BA P. zs' gnu �' " N°"``' �_ + 9es 4r4-41 E = Z1 "--Z I I ^_ 11•56 K: 13. i *ja I L . W r 174. Z 14 w►tAnr No 0505 Era cc. w PAGE 3 OF 6 igvol > In o NI r'NI U ,Illi u n u u W 0 'A •\• M 1i Lt 0 41. . g ZAi 1 i Y l ', ♦, 1 i ix djI • : �\ a = �: i il�: .' ,.` ., 11I x w u " . \` I I I - •1 r. 9 IX LLI I IW ♦ no" \� # d� 7 � II Ii Z 0 cA z r-w—, joJ I $ T I i Ii ' - , LL o le ♦` • c a *ii II I ii ;; I II �. o i i Sg g1 = I I 11 V I--° 11 Ili i I m N I ..\ 1 i B� I I 52 11 C \t1I I I z $ ♦� W •_ \ I • Io Tiil ;." \ I ri 11 Illii!" `� ! UI1, 1 3 L i g g PAGE 4 OF 6 � ill- -d . N N 1 VAI I. i j. , i i 1 1 i d g f,, ilit4wi ! i ' i ! 1 -I- D 4 x 6 \-- �. Ii+\ 411 1 1 UJ \ Ilf 0 i a C) 1:4" 1 I x - Cia3 n hew \\N i \N 11 W r q MI ii //` C 0 Jilt D L 1 i ,/, .._ \'-'1" lit till t _ it ::::. f:;. . ,,• :•.:,? ,. .., . t • PAGE 5 OF 6 SEPTIC / PUMP TANK SPECIFICATIONS 421 V,nt (No Scale) •1011 from e .0 E . �tY Ainv2 f Mow S9 3IEd NEc 3300 EMabW ud Flood simian -+--• E4nd manhioie rime as mammary.WaiIMrome APPro.d '•"'Jurcron Box IMPORTANT: vans as Apr WM Lab& a. Mmetiod Anchor Ulf sa necessary c 1� / (�WOn pursuant to SPS 383.43(B)(9) - rr Min.or 2.0 II above \/ 17 Ebiah yFlood)nirraacn Mack o.00n,.r1 I v wain.�2, gal fin sj_T . Oaa°q 9Q.�4 1Depth(In) Volume(gal) A 18 tf00.3 Z * I � Growl � rahaB 2.0 yti•ya _ [C] 110 .3 1 D [z _ On i • S �. I Icl PUMP-OFF �� Imp Tank Liquid Level a InPun >t,—ott . ELEVATION = ft I� Force Main Diameter = 2 In i l ca+nn. INSIDE BOTTOM ea,i ELEVATION = r"�1Oein••aT•� Force Main Length = ISD ft (1J Force Main Void Volume = 2A•3 gal � � Vertical Head =� ft Ivel IS + Min. Supply Head = 3.5. ft [C] Total Dose Volume (TDV) = 40 3gal/dose 13 + FM Friction Loss a 395— L(5.total lateral void volume<TDV Ic 0.2X design Sow) ft +(force main dralnbadl volume) + Fitting Loss' a ••1s ft (min wrpply heal z 0.3) MIN. PUMP DISCHARGE RATE _ � 1 gpm = TOTAL DYNAMIC HEAD = I l.1Sft _, PUMP TANK: SEPTIC TANK(S): Volume = �(" gal Total Volume= ,ZS� gal Manufacturer. WI t•SE`L Manufacturer(a): Lit tSer2_ Pump Manufacturer. Zoeller Pump Model: N152 Install approved effluent filter at the septic tank outlet (s..ataewd pump cori..) Immediately upstream of the pump lank Inlet. Controls/Alarm Manufacturer. SJERombus Filter Manufacturer Orenco ✓ Controls/Alarm Model: AB Filter Model: FT-0822-14B Float switches containing mercury are Prohibited. PAGE 6 OF 6 Mound Management Plan IMPORTANT; The owner of this mound system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384,Wisc.Admin. Code. Pursuant to SPS 383.52(2),Wisc.Admin. Code,this system shall be considered a human health hazard If not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52(3),Wisc.Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow gpd; BOD5 S 220 mgL''; TSS 5 150 mgL"1; FOG 5 30 mg1 1 Jnst»ctlon Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors(i.e.odors, user complaints, etc.) o mechanical malfunction(i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s)and any distribution appurtenance(s)(i.e.,distribution/drop boxes) o neglect or improper use(I.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding In distribution Dell prior to dosing o dosing Irregularities(i.e., pump re-cyding,float switch settings, etc.) o electrical components(i.e.,wiring, connections, switches,controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure-compare to design specification) o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and doss tank(s)shall be pumped by a certified septage servicing operator Moaned under s. 281.48 Wis. Stets. when the volume of solids In the tanks)exceeds one-third(1f3)the liquid volume of the tank(s)or as required by local ordinance. Disposal of contents shall be pursuant to NR 113,Wisc.Admin. Code. o Effluent Rhoda)shall be inspected every 3 years end shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. o Distribution laterals shall be flushed once every 3 years or when necessary. System maintenance reports shall be submitted to the proper local government unit In accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Lewis Bjork Family Septic Service phone: 715-231--7375 Local government unit: 5f. C4.o c c 6 Phone: 4°1 . 516- ! 9 ti`d Local government unit address: et1f141AAAAAtAkt t. t CL ZIP: Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1),Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383,Wisc.Admin.Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384,Wisc.Admin. Code. Conslnaencv Plan In the event that any failed treatment component of this POWTS cannot be repaired,It shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed mound dispersal component may be re-constructed within the originally approved area after removal of all failed components. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33,Wisc.Admin.Code. 150 Series ERluent Pumps Zoeller Pump Company hnpc:r/www.zoetlerpumps.com'en-ndproducts'sump-effluent-pumps.'ef.. Cr) tx PUMP PERFORMANCE CURVE MODEL 151/152/153 50-, 14 - 45 153 12 - 40 35 = 10- 152 30 - - a g 8 25 151 J 0 6- 20 - 15 4- 10 2- 5 0 < l 10 20 30 40 .0 60 70 80 90 100 GALLONS LITERS 0 40 80 120 160 260 240 260 320 360 FLOW PER MINUTE 2ors 2R1n018, 10:05AM Maintenance Instructions OEN 01114411-111143 Biotube° Effluent Filter How to Clean Your Effluent Filter To ensure your effluent filter is functioning properly,it should be inspected every year.Under normal conditions,your effluent filter will function for several years before cleaning is necessary.The filter should be cleaned when it becomes clogged enough to restrict normal flows out of the septic tank.Ate minimum,the filter should be cleaned whenever the tank is pumped. Most people prefer to have a septic tank service provider take care of filter maintenance and cleaning.You can find a septic tank service provider in the Yellow Pages,under'Septic Tanks&Systems?Or you can contact your county health department for a list If you wish to inspect and/or clean your effluent fiker yourself,be sure to dress properly.Wear full-length pants end shirt, shoes,gloves,and goggles ar glasses.Then follow these instructions: 1. Remove the access lid to your septic tank by unscrew sokt - ing the stainless steel lid bolts with hex head wrench 4111' 1 • 1. provided.If your lid is above ground,it will be easy to • find.If it is buried below ground,find the marker that •'` indicates its location. 4 2. Remove the filter cartridge ms` g by grasping the tee handle and lifting it out of its housing (see photo 3. Spray the cartridge tubes with a hose to remove any t material sticking to them(sea photo 21 Ensure the three orifices in the optional flow modulation plate inside the !' filter are clear of any debris.Make sure the rinse water phi V.Remove the filter cartridge by lifting it out of its runs back into the tank,but do not allow solids material housing. to fall into the open filter housing. 4. Rrmly place the cartridge beck into the housing. _ 5. Some effluent filters cone veldt an alarm that activates when the fitter needs cleaning.If you have an alarm, , check to make sure it is working by kiting the float with a stick An audible horn should sound.The alarm panel is normatty mounted on the side of the house or a %•• in the garage. • Noise If your effluent filter doesn't have an alarm system ; end you would like one,call your local septic system installer. 6 cord the date that you inspected and/or cleaned A101 z Spier eve cartridge tubes with.nose. Re your filter on the form that follows.If you checked the alarm or made any other observations about the tank or system,include that information under'Notes.' 7. Attach access lid by placing it on the riser,matching the openings in the lid with the bolt catches.Insert lid bolts into catches end tighten with hex head wrench rear, provided. s...es 701 ^Irenco Technical Data Street 8-in. to 15-in. Dia. Biotube Effluent Alters Applications Standard Models Dance*8-inch to 15-inch Blob te`Effluent Fillers are designed b FTO854-36,FT1254-38,FT1564-36,FTO822-148.FT1254-38AR remove solids from effluent leaving commercial eepbc tend.They can be used In new and aiding tank". Product Code Diagrams General Ft (]-,, Orarroor 8 htclt b 16 Ytc1r Blolibe�Meat Filers'we used b Improve �� .... the Godly of effluent offing a commercial( " ' w++h+� mg*lank.The Moltke " - rerwraerrrrr cartridge fits mpl ay in the vault Exile removable ix metri.wto ,the handle assembly snips Into the noeefue In rid top al Vie vault,and the °M r.�i` .a..r�. tee handle can be Wended for wry removal of the terh OE A UN wry...a1w Inlet'model(seep.2)le enable to bw�rofl.Inks.An optiortat side r`..-rI PIM 1111169 rail system,availed.on hyper models,"impalas hrehYt iris on and pro ::•tww.w, tank access fa servicingr.. •rR r M+1 y{q M• a�q tl. 11 Horde mam* nr•.a�erc r,I10411..1111. w• Now p.Nq y 41 : I kw"fbatarrat4 u+�gw� r� rWtime L. ' ill (erdereo seperatrl» 1 Manhir' r�rarrt�uiiw ir rat rw+rrr�r ' a.www .t�rtrnrra• 11748 •rra...�r rr err 4- 1:0-, Po«tong 1rrr rr rwwarr lr p"a OM••a1rrarw1={fu "wo -- arrrw 111111111Sulam roltPt= Iota On 'cane a.■mamma • 'IIIII w •MI u.1r.�it Net tholes rra~i�a`wwwwww - a•aaaamer.lo 11101004e•rhr I Suwon°m¢ng ` Materials of Construction • II, Vase PC POI Pefflnd PVC view Set view Sawn 0 sad went e MO MOWS •awe Mew ear n nnwe axons Iweir nu11W fI S w rr.na,r^raa Wry Shaer,ay*.w mom Metal w gear w 1141dlrr rdfian Wm eey Ooee syean.•as,a14 Airway Ara,erMiti o.of OS UM•astkswa se•e41-410 444.•wawrmoa.owa rmsrs+ra arr.sa,•ean7 Pip 1 et2 lc al W ! �rti"�'.•.`,...."..-._./L' — .yam. ''�. t/' ~�.� c L N. pa U If 2- -15 lii — fir' �'---, ra ID Rf C `m m c cm, o ., * �_.- _ 0 * 4-1 ),,--• e,.....,� 1.y 1 I v-I 0 (� C t :J ;vl- I100 .12/ 11.• m l N" •� , o I.ditI r 1 .- 0. • _ . er 4 _—.I"ter __J t. J/ i fI. - - / ;/ d'" .7 ri;+% ...7 c - 441472\ 1.-Air '- --' ''' - . �df Mgt i a I . .<4 ;i A. Wisconsin Department ofCormrra SOIL EVALUATION REPORT Pegs I of 3 Division of Safety and Buildings In accordance with Comm 85,Wis. Aden Code CA)untYAttach complete site plan on paper not less than 8 1/2 x 11 inches In size.Plan must s4. CLOs fndud,.but not limited to vertical and horizontal reference point(BM).&action and Parcel I.D. percent skips,scale or dimensions,north arrow,and location and distance to nearest road. °cam - p zs+ Qo• cos Please pint all inliormdlon. R,%Aewed b1' Date Personal information you pia may a wed for secondary purposes(Privacy Lew,a.15.a(I)(m)). 1 Pa:lowly Location ProperryOwrtmr 1/4 S Gott.Lot (�B 1/4�� litT N R I6 a W p�,op.,y� ,1 gld�.,a Lot r Block tl Subd.Name or MAY 1533 c.•4 Qd E. sty Zip Coda Phone Number Dlty V IDTP", DTP" Nearest Road ILJ�ithil4 1 19-b2ei Us")9'r1.43o t Aistia 1 G C a • s a • s s - us.° Residential/Number of bedrooms Li Cods d.rwsd design now rats Gm GPO Gil Repleooment 0 Public or commercial-Daeabs: Patent materiel IOW IOU& 44ll Flood Plain aleva8on If applicable ft. General consents and recommendations: B1— 0 D SOrIng Q pit Gf«x,d«xrace elay. qG.,_R. Depth to limiting factor 4 in. Sod Application Rale Horizon Depth Dorrtkwnt Color Rados DaatxlptIon Texture Stnoture Consistence Boundary Roots GPO In. Mosel Du.Sz. Cont.Color Or.Sz.Sh. 'EIM1 'Ef102 I 2 4-1b IOU:9 z. 44 1041.01e, s;1 24 4gic, a,,,_ _t. Z F- . c .s 3 Jo-6 I014.' 11 re it sit. ' 1* pa'kii2r i../A- — • ISZ I aOrl"g s ID pit Ground wren,slaw. CI f0 R. Depth to limiting factor 47 in. Sal Ate Rata Horizon Depth Dominant Color Redo(Desorfpllon Tahoe Structure Carleton°, Baxndery Roots GPDIR in. Mural Qu.Sz. Cont.Color Gr.Si.She .EMI .ENV 4 0.6 Io Sit 3 e L, Zr . 6 •B - ri'I L L ;.7+ 751it'1G 5:1 2 wNli c.,4 if • 4 •os •Effluent s1 .BODE>30 f 220 mg4.and TSS>30< •Mont a2•BOO,<30 mgt.and TSB<_30 mg& CST Name(Plasma Pitt) CST Number Lewis Biork fork 253976 Address Evaluation Conducted Telephone Number E7818 County E Menomonie W1 54751 1•29.Z1 715-231-7375 �tI1(soft 3 Properly Owner Percy)ID a . ^ ��� �0 ' OOG Pape a B-3 goring e e Pit Ground surface elev. _R- Depth to limiting lector _h• Sou Application Rats Horizon Depth Dominant Color Redox Deealption Texture Structure Consistence Boundary Roots GPDAf , in. Mutael Qu.Si Cont.Color Gr.Sz.Sh. 'Ef al 'E1N2 I 07• 1011.s s;1 , t rr►.►v- CI> r..F .G . 8 2 7-1L lO'$t Z ;2.4. tO(I s. sit 3tsiot. MAMA aye , itP . c Ai . , . Boring* I Boring Q pit Grotrd surface elev. It. Depth b Wing factor k1. Sou Application Rate Horizon Depth Dominant Color Rados Description Texture Structure Conatelence Boundary Roots GPM" In. Munseli Qu.Sz. Cad.Color Gr.Sz.Sh. 'EfN1 'EIN2 Bortrg e 9 ikiling Ground surface Nev. ft. Depth to Mfg factor in. l Sol AppMutIon Rate Horizon Depth Dominant Cott Rados DericriPfton Texture Structure Consistence Boundary Roots GPM M. Munel au.Sz. Cone Color Gr.Bz.Sit TOP 'ESN2 4 Eflkrent e1•BOO,>30<220 apt and TSS>30<150 mg& •Effluent a2=BOO,<30 m ll and TSS<30 my. The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in en alternate format, please contact the department at 608-266-3151 or TIY 60B-264-8777. S504)30Tw(5.•7 I CHECK SOX AS AOSUCASLE.24, ECK••%AS APPUCASIE. C� �` SOIL EVALUATION �''° ' =40' /A SYSTEM PAGE 2 OF G SITE MAP 0 ���ir �ii� 'LOT PLAN //i/i/fi7ii� �i/J� G� �� `PROJECT NAME: �0, DESIGN �� 4`tp4 �? E J„ Attach design flow calculations for commercial Wens. PROJECT AOORESS; 25 33 �jp r, Pipe MeteA&'ASTM Standard(Tables 984.303 8 384.30-5) 4 D-2665 �..,/� Santry Sewer. BM Symbat s '1. BM El.vaecn too FT �� Face Main 2 / D-2665 BM D.rwlpeere I A s 14 4 ( �34t JMPORTANL YdCR.roil,Dv Slops Oradea(%) Wall Symbol IX app.CaF ). 0 ..w.l.p.nmeow Stow ground elevation contours at suitable at Testae his on to SWOPA.ih.. • OOOO O �, a O 0 OoO p., A.-0 0 Alflit0E?L'4-1 Ow ----lir 1 _ 4- .4•Al .. .44 1 4.6)143 '"teroo . ,. Um e e 264 1 t 510te gm' ic ur ..., 1 ,S• 21' 6K. }b„ �- 4S lid v31 ZS' ". E : Z'1 3- - to."1 1 I1.56 n . K,. IS.' 'p vk., W I. L4.3 14. l/� L - 12G• 2 t2r /Poo ?A4 gi,s' NO o S - Er'al9aL ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) S33 c.1.1 e,(, E (.3 o-LL located at: OE. '/<,A).k) 1/4, Section 14. , Town 29- N, Range I W, Town of B4(___ , 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 SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service I Sj 2- Did flow back occur from absorption system? Yes No$ (if no, skip next line.) Approximate volume or length of time: 1SJ/\ gallons N/; minutes Tank Capacity: 2r) Construction: Prefab Concrete / Steel Other Manufacturer (if known): (jtc,-a cdL Ag Tank (if known): Zyt,A,e Pe ber (if own) ,� LcW'S - d Plumber Si ature) (Print Name) (M,P 29 3 97 (Title) (License Number) MP/MPRS 6/30/1 (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 .vynnr4,Ar DIVISION OF INDUSTRY SERVICES 10541 N RANCH RD Court Through Rs/ay '_ hOpJhYpawi. • wMW.wi•oont++.yov ` f Tony Evers-Dovr•or 0011611 Com-Norrary August 27, 2021 CONDITIONAL APPROVAL SOILS SATURATION DETERMINATION Plan Review Number: PWTS-082102121-C LEWIS BJORK Count CONDITIONALLY County E7818 E APPROVED Menomonie WI 54751 DEPT OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SITE: Terry Heigeson 2533 Cty Rd E te64 St.Croix County SEE COESPONDENCE Town of Baldwin NEY.-NW X-514—T29N—R16W The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s)referenced above.The owner,as defined In chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06,stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • Approval is hereby granted pursuant to s.SPS 385.60(2),Wis.Adm.Code,to estimate the depth of seasonal soil saturation based on an interpretive determination process completed by Lewis Bjork,Certified Soil Tester(CST)and his recommendations. • This approval is Limited to the soil characteristics within the tested area. This approval is based upon best management practices and does not warranty the functioning of the system. Water conservation,wastewater disposal practice and system maintenance will aid in the longevity of the system. • On-site visit was conducted by CeCe Rudnick', DSPS on July 12,2021. • The estimated highest level of prolonged soil saturation approved under this determination is 6 inches below grade. At least 30 inches of sand lift on top of 6 inches of unsaturated, in-situ soil is required for adequate treatment and dispersal. • The basal soil application rate for the mound shall be 0.32 gpd/sf,and the linear loading rate 6.0 gpd/ft. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches.Smearing and compacting of wet soil will result in reducing the infiltration capacity of the soil. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire,the site is too wet to prepare. If it crumbles,site preparation can proceed. If the site is too wet to prepare,do not proceed until it dries. (.4.)5 Chisel plowing to a depth of 12 Inches immediately prior to sand placement is required to improve vertical water movement into the soil solum. L% Landscaping up slope of the mound shall be incorporated into the POWTS design to prevent surface water from concentrating along the up slope edge of the mound and to divert surface water drainage away from the system. • This approval shall remain valid unless the site is altered in such a way that the depth to soil saturation would change or if saturated conditions are observed for seven consecutive days at depths less than 3 feet below the infiltrative surface of the POWTS distribution component. • This approval in no way relinquishes the use of color patterns to estimate the depth to high groundwater on any other parcels or portions of parcels. • A copy of this approval letter and attachments must accompany the mound system design for this site for purposes of plan approval and sanitary permit issuance. A copy of the approved plans,specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department,which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. 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 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, CeCe CeCe(Elizabeth)Rudnicki Wastewater Specialist/POWTS Plan Reviewer, Division of Industry Services (608)400-3186 elizabeth.rudnicki@wisconsin.Aov INTERPRETIVE DETERMINATION REPORT Property Owner: Terry Helgeson 2533 County Road E Woodville WI 54028 NE -NW— 14 29N 16W TOWNSHIP OF BALDWIN ST CROIX COUNTY WISCONSIN This report prepared in accordance with Wisconsin department of Commerce Administrative Code. 385.60 (1) (7) Prepa • Lewis Bjork, CST# 253976 g_6-ZoZ( Lewis Bjork LLC E7818 County Road E Menomonie, WI 54751 Phone: 715-231-7375, cell 715-308-2173 Fax: 715-231-7376 E- mail lewisbiorkPvahoo.com CONDITIONALLY APPROVED DEPT OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE CO PONDENCE Conclusions, Recommendations why this proposed mound system will treat and disperse residential wastewater on this site 1. Existing properly functioning mound systems have been installed in relatively close proximity to this proposed mound site . Most recent across the road @ 2566 county road E Woodville , June 17th 2018 2. Seasonally saturated soil conditions do not occur in the upper 6 inches of the soil profile as indicated by the absence of redoximorphic features. 3. The A horizon in the proposed system area is Munsell color 7.5 YR 3/2 to 10 YR 3/2 which indicates an organic matter content nominally of 25 g/kg in the range of 20-30 g/kg or 2.5 percent. This level of organic matter is indicative or relatively good drainage and aerobic conditions. (Tyler presentation, Reading shallow Soil Saturation, Chippewa County) 4. The relatively low level of organic matter indicated by the Munsell value of 3 would facilitate observation of high chroma redoximorphic features in the A horizon. The general lack of observation of these features in the A horizon is strengthened by the low organic matter content which lends further evidence to a conclusion that at least six inches of soil is present which is not periodically saturated for more than six days. 5. No hydric soil indicators are present in the observed system area soil pits; this conclusion is based on particularly careful review of the indicators for All Soils and Loamy and Clayey Soils. There is no hydric vegetation in our proposed area, when in lower elevation areas hydric vegetation is present closer to County " E " . 6. System area pits demonstrated root penetration to depths of 10-16 inches; such depths are not expected in soils which remain saturated for significant time periods. 7. The small scale cross slopes of 2% is better than none for lateral movement of effluent down-slope via the more permeable upper soil horizons and away from the mound system without surface ponding or surface discharge. 8. The available length is 127 'allows for a lower liner loading rate and enhances the ability of the system to allow effluent to infiltrate the in situ soils along a contour without a surface discharge. 9. The site is acceptable for a mound septic system with a minimum of six inches of unsaturated soil for treatment and dispersal of treated wastewater effluent as allowed by Comm 383.44 (3)(b)1. 10. The observed 6 inches of redoximorphic-free natural soil will allow treated effluent to be assimilated into the subsurface without ponding on the ground surface. 11.Site preparation requires removal of trees in dry weather only followed by deep chisel plowing to at least a 16- inch depth. Add 4" sand before tree removal . 12. Additional fill landscaping soil shall be added to the up- slope area of the mound structure filling the concave, upslope area behind the pole shed up slope the mound. 13. Mound construction requires 4" of sand lift placed on the basal area then plowed into the grounds surface and then more sand added to 30" depth. Construction must take place under relatively dry conditions. This 30" depth of sand creates an effective sand filter and can be expected to produce a treated effluent with less than 30 mg/L of both BOD and TSS and fecal coliform concentrations of <10,000 cfu/100m1 14. The rock cell in the mound structure shall be 6 'by 100' for a linear loading rate of 6 gallons per day per foot for a 4- bedroom residence. 15. The sand basal area loading must be a maximum of 0.32 gallons per day per square foot. . . . • 1 . • 1, At, r' 1 ' ‘•••.-----•.• . I 's.............;_. -.....,1/4._ I •it :.".. ' , ,L,-„.; .701.111b6 • as RA . . ' .r. .. . 2`..... ........... 4 .. ,69.-..,.._....... , • ,i ; "?..= ,-; .P. 8 ;.... v , . .. . c _ .c , . .14. • it - - • •13r:'- h- , . 0 - ..., .r j • I .: I— .. "%ls.,..,._....4,‘„,..ot.'1/4„, .,'7„,_.1 - , 1. C. ' 11 a V I : .— l•. .. E5 :i.•' ! A., ....11, ' • -0 kr. ' ! CO c T. .... ) . e = ... . - i ‘...e.--. ....." 2 • ---• iH-. 1... \...N.. .4-,1 e CO *• ^ ,,,r,..,)ii CiNt L- 7g 1 tcc.`ec.4); •— _-...-.•x 4 .-..7. 1111111,1.. 1.t. =.. .•• _..L ..-.0 --•..•... no- ----/—""------ --- • 1ta 1..,..'.... r."i 1 14 , 1.t. . . ,k....... ,. c-...,.... I • ,. , ..-' ., 2 ' , • A. kJ'. 4 . ‘..44S....".? ,,/ r 5.'"'°''V°4. ''.. - 1111\112 CO . 8 .• r" ..- i'..•'..." Ir..." I 53 4 1 ! = ' *,• / cr . . ,!„; ...}5. .f'.7 '''. :" ...-- I .. 1 ' ( .; i . •!.....1:k-iO4,-,,5..:„..iy :-..-_-•,,.. z..,: .; .- . J ,r - - i-.. .. -. . . -.14 r mis,..:.,,-r„y ''^r...t' •••,;;le. Nir • , .."''ir AU ii , ....IF 2.,:,-;., a Soil Map—St.Croix County,Wisconsin s ttti n fir a Aso aD 91®l93 a0 MOM a®ao IWO aaaro BIM op awn p AV015'11 E i.. i i r ,, , i 1 4a•aSN 1 /P aSN 58710 956793 671303 aesao 169510 5400 Me MOM 3 3 hi Map Sale:1:1,470 rp rated on A exert(SS-x 11')9met. b a N Meters a 0 20 40 eo >27 Beet A Map DMlectbn:Web Nestor Comer 000rda�:WGSB4 Filpa m:u1M zone 15N vK.ss+ = Natural Resources Web Soil Survey 8/27/2021 Conservation Service National Cooperative Soil Survey Page 1 of 3 Soil Map—St.Croix County,Wisconsin Map Unit Legend Nip Unit Symbol Map Untt Name Acres In AOI Percent of AOI MA ,Capltola muck,0 to 2 percent 2.1 18.09b elopes,very stony FnB Freeon sit loam,2 to8 percent 2.4 20.3%] slopes MaB Magnor sill loam,0 to 4 7.3 81.7%1 percent slopes Tebbe for Arm of Interest 11.8 100.0% uslan Natural Resources Web Soil Survey 8/27/2021 daill Conservation Service National Cooperative Soil Survey Page 3 of 3 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I d 1 Division of Safety and Buildings in accordance with Comm 85,Wis. Adm Code Counlys}• OZO; Attach complete site plan on paper not less then 81/2 x 11 incites M size.Plan must Parcel I.D. include.but not limited to:vertical and horizontal reference point(8M),direction and OO percent slope.scale or dimensions,north arrow,and location and distance to nearest road. ' 10 ZB-Q0• r�Date Meas. print all Information. Reviewed by Per$onsI itormatwn you rxovids may IH used for ssoo dsry purism's(Prey tans.a IL%(Il(m)). I Properly Owner Property Location .`., // • ,r�• l,a�,� eA,,,, Govt Lot me. t/1�1111 1/a ST 29 N R 16 }W Property comets Lot e I Bbdt. (31bd.Name a CSMN 2511 G1 7�Q p Cods Phone Number pcny Vllape 'DTown Nearest Road city ` S 4.) lhalk I6r 19'b7el(Tic)97/13 .YN.1 1 Cool n , woo R antsl r Number of bedrooms y . Code derived design tow rate GiReplacement GPO ❑ Pubic or rt. arrrGr Parent material I ,i4S sum per is Flood Plain elevation A aptlM�a• General comments and reaomm.ndations: B.l i Scrim; B Groundsuttee.elev. Q ing lor 1G ft. Depth b limiting factor in. Soil gppYptfort Rolls • pit Horton Depth Nutrient Color Redox Descnption Texture Sbuciurs Consistence Boundery Roots GPDAP Gr.Si.Sit. 'E11at 'OM in. Murteeti Qu.Sz. Cont.Color � Cy u ` . Arg 154 in' t ell z 4it, rw�. .8 Z S;I 24 mac. w.%i. « zE . G 2 4 ID l0'K. Z. �r tow.Wt - • -- t J. .. lilt. M a 1. ■�■ --terMI ■ ...._... sass-- ^ 9 �_In. Sol , bon E. ��a O pit Gravid surreal Nev. R. Depth to limiting�� GPO/ �e D '' e. Redox Desaiption Texture Sure Consistence Boundary Roots Qu.Si. Coat Color Gr.Sz.Sit. IIIIIIIIIIIIIIII Mill _ • l •valiant Kra Bop 130 mitt end TSS_<30 milk . • Eakrem At •Bop >30:220 rt1gIL and TSS>30 5 •_ , CST Number CST items(Prase Print) 411111111 is Bjork 253976 Lewis BorkAddress • E,stion Condtrged Telephone Number 715-231-7375 E7818 County E Menomonie WI 54751 144 7 Z) „. -„ ,... PropeAy Owner 1441111 Parch ID X Celt -1O2 - 40 • coo Page 2 or 3 B-3 Boling fl 11/4441r' n El pit Ground surface elev. 'TI n. Depth to limiting factor 4 .W. Sol Appicetlon Rate Hotlzon Depth Dominant Color Redox Daeodptlon Texture Structure Consbtence Boundry Roots GPM? in. Wheel' Oki.Sz. Cont.Color Gr.Sz.Sh. _ •ERa1 'Efln I d? • 10' s 5;l ter rN�N- C 1,F .4 . $ 2 7 IL I3{/t. •c 2k 10140 .. S/I 34 mac. MAL OW . le . c . Q • BOMB N BorMg • pit Ground surface elev. It. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Dsealplon Texture Structure Consistence Boundary Roots GPD/If h. Munsell Qu.Sz. Cont.Color Gr.Sz.Sit. 'Efak1 'VW Bonito a9 • Bwing Pre Ground surface limiting elev. n. Delimiting factor in. Sok nook/ikon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPWIf in. Muneea Ou.Si. Cant Color Gr.Sz.Sh. •Efikt 'E4*2 •Musa e1 •BOO,a 30_220'not and TSS>30<150 mgn. 'Effluent a2•BODE_30 mp#.and TSS<30 mot. The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or nerd material in an altercate format, please contact the department at 608-266-3131 or TTY 608-264-8777, saw,Hrr tt1.o,ao' CHECK BOX AS AoPUCABLE.X ECK •X AS APVUCABIE. C ,mil SOIL EVALUATION Scale: '''40' IAA SYSTEM PAGE 2 OF G SITE MAP D � 80 %riri� 7/ `LOT PLAN wizrz,wzr, r1 GG� 11'/ PROJECT NAME'. �D V� DESIGN FLOW GPD !, t 4L So_1 1/� Attach design flow calculations for commercial plans. PROJECT ADDRESS Lf 5 33 CJAp E , G Pipe Material/ASTM Standard(Tables 380.30-3&384.30.5) � 4 D-2665 6/0Synbol '�' BIMel..-.s1� w��1 FT �/ Force Ma PI cur Sewer f . 2 D-2685 s BM oncipBon: ais1 64 itu. I wal y Inplu:*nugn r1 JMPORTANT: Slope Grease (1♦1 Z. We1I Synetl;e epNcablel. 0 °mono an rrou. Show round eleraron contours at suitable - • of Testae Mu m rv.ppropme Int- 1 • O0000 0 00000 N.414#41a.'.' JfIM1r \ i ti/ ^n 0 .d7I•, 34 f ♦ o 0 •. ,,00 eW • 01".. ZA4 t Awe t •S 3-Ct.-N---1y pi, Z s' w 44 a Banta. �_ } �•� 4 4 3- = ►o:� i I.- = 1ZG• Z. I�/� IL 4913.6' NO 05(35 5rghat. ST. __C....120111110,111UNTY SANITARY SYSTEM FIIOffice Use Only ligiemmiailiss - OWNERSHIP/ADDRESS FORM Created WW1 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health,your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. OWNER/BUYER INFORMATION Owner/Buyer Terry Helgeson Mailing Address 2533 County Rd E City/State/zip Woodville, WI 54028 Phone Number(required)715-977-1309 Email Address (required) Parcel Identification Number 002-1028-90-000 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location NE'/4 , NW '/4 , sec. T 29 N R 16 W, Town of Baldwin Subdivision Plat , Lot#I. Certified Survey Map#Ped, 133-68/ (Doc..#) , Volume 5 , Page # 1341 Warranty Deed # 387818 (before 2006)Volume 673 , Page*172 Number of bedrooms 4 Spec house D yes ■ no Lot lines identifiable • yes 0 no �/ OFFICE USE ONLY New Property Address / �f' `— sd e a'(Verification of new address required from Community Development Department for new construction.) / / (Staff Initials) (Date) This form must be submitted with all Private Onsite Water Treatment System (POWTS)applications. New System:Include with this form 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. Community Development Department-Land Use Division 715-386-4680 St.Croix County Government Center 715-245-4250 Fax cdd@sccwi,gov 1101 Carmichael Road, Hudson,WI 54016 www,sccwi.gov , • Wisconsin Department o Commerce T O 2 c0�l OIL Division of Safety and Bu .irgs OC I Y v T Page l o} 3 In accordance with Comm 85,Wis. Adm. Code ll tx County D""brsT. CrzZ, Attach complete site pla on pap6itri(rl�y, :. dies in size. Plan must include,but not limited to vet .1,•. ^,renoe point(BM),direction and Parcel I.D. slope,percent toots scale or di - ons,north arrow,and location and distance to nearest road. �L � ��2g� �, Please print all Information. Reviewed by Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). 1 Property Owner Property Location El El 'mitt Nd ! Govt Lot 1 a 1MOW 1/4 Slit T A N R (6 E(or) Property er's Mailing(�ddr es Lot# Block# Solid Name or CSMI} 2533 ceb Qd 6 City tate Zip Code Phone Number Qity Vllage QTown Nearest Road 10/],,d111u1 IU 19 2a ails') beI'i3e1� _ lf.i.) 1 Ce E El Use 0 Residential/Number of bedrooms q Code derived design flow rate GPD Ea Replacement El Public or commercial-Describe: Parent material I0f45 bU z 44 LI Flood Plain elevation if applicable 1t General comments u and recommendations: 0.542-e 50 A -rot. 11 I. G 'iki C ' oy„��. '0 &Z� `( l s > . - j B-I Boring# ❑ Boring i^ , —✓►� v Pit Ground surface elev. CI6.5 ft. Depth to limiting factor (o 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 X4 & rb 1Mt I3 Sii 2 41(1 Mi L Cy LF . 6 • S 2 4-Lb ID'f 1z 42_1 loth,6k , s.1 24 41.c Vila, c} zr . 6 . is 3 Jo-Ic ft7t5 '11 .M1 5Y. 4/4 'ad if — — — — BZ * 8 Q/ LI Pit Ground surface elev. 1 `� ft. Depth to limiting factor rp in. Scii ica bon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDRP In. Munsell Qu.Sz. Cont Color _ Gr.Sz.Sh. 'Eff#1 'Ef##2 4 o-6 I04t.313 5i! 3', p _pia- e , . 6 . s 2' 4'I2- 104 Zlz f24 7.514. k 5:I 2 (. c-s zF . 4 '6 1 •Effluent#1 =BODE>30<220 mg/L and TSS>30< •Effluent#2=BOOS<30 ng0..and TSS<30 mg/ CST Name(Please Print) re CST Number Lewis Bjork Lewis Biotic 253976 Address Da a Evaluation Conducted Telephone Number E7818 County E Menomonie WI 54751 '7 29-21 715-231-7375 Property Owner 0L1 1 Parcel ID# 004 (0251-• C10 • 000 Page 2 of 3 B-3 Boring# D„ring ID pit Ground surface elev. cl.C, ft. Depth to limiting factor 6 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 G7 • 104ki s;l r 14+414- cs, r-F 4 8 2. 7- IZ I04t z.._ .Cz4 40404_ sJ1 344.64. ww(A t— . . G . e 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/if in. Munsell Qu. 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 GPD/ff in. Munsell Qu. Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 • 'Effluent#1 =BOO,>30<220 rng&and TSS>30<150 mg/L 'Effluent#2=BOD,<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. SBD433UTen(a O7, ) CHECK SOX AS APPLICABLE ECK-.X AS APPtJCABIE. �•• SOIL EVALUATION Scala: 40 /�i SYSTEM PAGE 2 OF ri iyz40 SITE MAPfli� �/% 'LOT PLAN/� �� 'f ` PROJECT NAME: Jff`//j//l/ /,o, ,/�/// DESIGN FLO✓V (I(!) GPO lLf I i`�� !�/ Attach design flow calculations for commercial plans. PROJECT ADDRESS. L533 E o h Pipe Material/ASTM Standard(Tables 384.30-3 8 384.30-5) 7 v ,�/� F Seiner 4 / D-2665 BM 3ymbd: 1BM Elevation �w 1 FT `J Sanitary Face Mein: 2 r D-2685 BM Description L+'_I• 64 4f' ( 4.)4( y Irdraie north oy IMPORTANT: Slope Gredbn (%) Z was Symbol or applrebMi 0 amwingen arrow Show ground elevation contours al suitable intervals. of Teried Arai on tM eppropAle K gQQOOQ O /� 0 0wiNta,,,,,AiLt. 0 06 s �/ Lie ,/,',#' . . -if. • i //l IF-41le ei•W 9144 Plk . 0 0, ,0 0 „ Vg a-----'1. ? %- aml ( ..1 fit- t , 1- 5We. loomilb 3.' i P2 LS' w q9 Violas. (---N--_ _ } -Rio:, •` E ' zl r 3- = tom tz•s6 1 — e V....- 13•I ©ut ktr) 1 4/ 7 L - 126. i • r: w Z a° ■ a a ; 1 1 A O .use E ; oe p t � o u ea a E� P. O_ c , H 3 Q �+ Y • a ^� o,� V O e'3; 1 ! 9 gs a S by NVab p Mao 9 1111! if, t E-4 r:4 I � 8 a w O W4O , m iII1I aa oiiii4 ea wgM 44 rV 311 • 4 00 u Y i °,�° a , s. tt Fni/1 o e � A s` � i.�a � �� s4 A. III I w lc) z w z H 2 ic--.) g 4 9 ion-, g 41 6 g o w w , , Z z t H .4 ci ci) c34 e '—' V A Z 'Mis iZ O 4 p Q o . w.. g R.:1 Ez 4c E-1 o U r )1- z 0 c4W CA x r Em* V ~ O \OL.kO 8 LII!t N N w O Ow w it r:4 4.4 g\ SW �_ i 1.1 N w Z _O x 4 -.ENT NO. WARRANTY DEED THIS SPAOS a••fRYaD FOR RCCORDI"e DATA - STATE BAR OF WISCONSIN FORM H—IDEA 387E118 o I-��7 VOl 6 (c� PA E2 - REGISTERS OFFICE ST. CROIX CO., W ...Aonovan..John)eton Roc'd. for Record Mlis 16th day of Rwnt AD. 19 83 a: 11 :25 A conveys and warrants to ..Texxy...&.._.13e1gAHQm...ai?.5l._.RRnSIA...I_a .fialgooDn.,...huAbArxd..,ansl..wi.fA_R_6 i.o. ]fit- tenants Reamer fat2L. the following described real estate in St.. .Croix State of Wisconsin: Tax Parcel No: A part of the Northeast 1/4 of the Northwest 1/4 of Section 14 , Town I 29 North, Range 16 West, Town of Baldwin, County of St. Croix, more particularly described as follows: Commencing at the N 1/4 corner of said Section 14 : . Thence N 860 58 ' 58" W, 576. 58 feet to the point of beginning; jl Thence South 641.00 feet: Thence N 860 58 ' 58" W, 256.76 feet; Thence North 641. 00 feet; I Thence S 860 58 ' 58" E, 256 .76 feet to the point of beginning. I Said parcel contains 164, 352 square feet (more or less) 3 . 77 acres I1 (more or leas) . 1. li it 7'RANSFF,B I• S 13Ao n This ...is...not property.homesteadFEE (is) (Is not) ' II Exception to w les Ij �I r II D his day of September , :9.8.3._. . ... - -- --•- (SEAL) (SEAL) .,• ...Donouan._..7clh on • (SEAL) (SEAL) • . AUTHENTICATION ACKNOWLEDGMENT Signature(a) Donovan__aohnsom STATE OF WISCONSIN .ram as. County. ))) suthent this b day ot..SQpt: trotte ..83 Personally came before me this day of T- __ , 19 the above named •_.__.Iohn...G__..Nea gen. TILE: MEMBER STATE BAR OF WISCONSIN aIf uth riaad by ✓s 106.06, Wis. Stag.) to me known to be the person who executed the foregoing instrument and acknowledge the romp. THIS INSTRUMENT WAS DRAFTS°SY •I:ah:a..G_....19astiiaglin a 1 .A.LAw.+Ili WI 54002 Notary Public County, Wis. (Signatures may be authenticated or acknowledged- Both My Commission is Permanent.(If not, state expiration are not necessary.) date: , 19 ) *Nooses of parson' .hiss. In any capacity Should be typed or printed below their .IRneturw. KIESINI.oo„e,�® srwrvo AI Nor WISCONSIN Stock No. 13002 '�Jo p / FOAM NO.NS• 2627 • 387681 CERTIFIIED`S RVEY MAP NO. Being part of the Northeast 1/4 of the Northwest 1/4 of Section 14, Town 29 North, Range 16 West, Town of Baldwin, Countyof St. Croix, State of Wisconsin as of Certified Survey Maps, Page 13L1 as Certified Survey Number ld?1CriDed in Volume it NW COR. -(�� Q SEC.14sTH -R16 !` C.T.N. � HQS NORTH LINE NW I/4 E 0 90 100 ISO11111111 200 iiii RI NW ants.. MAUR I "— 0FOU4D r IRON PIPE I gg CAP MONUISi�N 1 L • QT 16 .332 SO.FT.* 3 ACRES* WI H OUT R/W '514.081 SO.FT.t 3.34 4. BEARING REFERENCED TO THE II AEOER CT/ON 14 1 9N R.I6w.ASSuUMED r I , o 0. 1 Z: g. i 1 c-:1-- E], 4 APPROVED EXISTING SEP 0 71983 - SE.CROIx cOu:.1 Oo I r►rrwve .Alas n.. .o MO ZOW IO COMT•IIT I U 1 I • 238.78' N8g•S6'Sg•W • . 4TTED LADS B 14 ��41114` LEON R s �11 NE 1303 _ S•13O E MENOMONIE, WAS. f AY�I !IF . "1 SURVCO* SHEET 1 OF 2 Volume 5 Pare 1341 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) located at: '/, '/,, Section , Town N, Range 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 SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: Construction: Prefab Concrete Steel Other Manufacturer (if known): Age of Tank (if known): Permit number(if known) (Licensed Plumber Signature) (Print Name) (Title) (License Number) MP/MPRS (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 YesoonenDupsenentofComerce PRIVATE SEWAGE SYSTEM ea Safety raid eaddng Diriabn St. Croix INSPECTION REPORT sAnit ey I'enni No GENERAL INFORMATION (AT I ACH 10 PL NMI i) 624969 vote Par ID No Personal eeerrr xler you provide^nay I.used for seonda'y et/mesas IIY sedgy I sew s 16 tM 114n II Perrot Holder's Mese csy wage Iuw•,1sp l'e•cel le.Ni, Terry Helgeson TOWN OF BALDWIN 002-1028-90-000 CST BM Lev lose BM Lev NM Desuesunit) Serelontl,avr,RanpeRvtao No 1) 0f_ We I 1 14 29.16 204E TANK INFORMATION t� ELEVATION DATA TYPE MANUfACT 0^ '� ' I APPACIIV STATION NS HI rs CLCV •Sept" IN 1 ESE 1 `� Benrhtnn.l S. i d3. Ic O. o �: C. 0 PA nor. i Alt NM areration fIcTCe : t�al�IQ�S e b•p 9� a cif Hd�utg r �� Get 9.2 45 .D TANK SETBACK INFORMATION SOU C)utbl TANK 10 r Pt NIEI.I BLDG sa,:T.A It!me ROAD Le Inlet Sep c +5u (nr7 I 1)1 Bottom II .8 °(l Li DOang 951 — Heade.rllar Aaratr 1 - \`` Cast Pepe Holding Bog System 1-,rue Grade ` PUMP/SIPHON INFORMATION Manufacturer Demand Si r c c — GPM Model Number top, r FncGm Lost System Head tUI. Forcamm 'Length IUm refs n wa SOIL ORPTION SYSTEM olCErl Wdm tergT ho tx T,en.nm PII1RM, LHI E NIIONS via As Ir,i1 ., nee'Hole fEata CK SVS TEM TO 1!'t BLITG -WE LI. I er a1fpINAT10N p System CHAMSEA OR ertyri UMIT 1 hu•M DISTRIBUTION STEM Me.1de'dUaMold '4Q, txmen .H. tu.' —.IMA,Spa:my V•W m As Intaice I vq9+ der_ ,e.qt .`... Diu Spe n,g SOIL COVER a Preesur system y ex Mound a AM•Graee Systems Only Dope thee Oepe'Over ..Rape.ul -., S,.+l.v 1:orkl ai ..1.1crkhM Bed'Tn•+tlt Ceram BedTrencn Edges I. soil K Ye, No Yes r'10 COMMENTS (Include code dnuopercres persona present,do i Inspect«,a 1 ' A lG I I/talc, I„sped en 42 Location 2517 CTY ROE E X 1St/}(� 1��{� �f� At( 1 )Alt BM D.uripton- J tam ol 2)111dp sewer length'•r4S 1 -arrtounl of cover >42" oC corn Or al I Plan revision Required? 1 . Ylls vmaU JI/1n .USo other sidefor adderwi YNormaUoil / ,ii ' tS�K✓� SBO47!O(a agr) -�-o i( 1ifl a Nl0 Dula . Irl!e! !ro'o 61W {taut VMp Nti. spr nri pCvrr►bGQ. t- r _ 611N - Z o - IZ9 .5f. tV u. o Industry Services Division —. t• ,�'� 1 Y fi 2�9Q 14O0 E Washington Ave cana�n t'a�w i NnmberAn M'IIMa)mlrl Co 1 't L PO1�Box 7182 �Z c c� Madison l 537• • 16 1 pt_ 51 Croix County irb • :I t1 •omit Application L_____ In ewadlnee with 4PS 141 21121.W t. Adw. Code ,uPmnb.(..1 or IN.form to the syrueiosir rt.. ,r,w,rnl urol .a requs Ma'to.11amtcg a trlt(ntl paters Vac Arrilcalwn roots Um ttalo-m.7rc.1 P(1WTS re w►m.tted a Prq•..t Address tot different tllnn m..Urq ddreal the Dersetnca of%ekry end Prokataavl Savo Penned m(vtmcdmn Voir puuJe man hr used tin sccendat ulweortianet%WilkPfl .c law b ISI I n Su1. —_____-__—__.. �6yry� I A.,M asl..I.r. Meow-FlM PAW All Midst WIIM -__-- -"__ _ --_ . n .l'. '"� . --- -._ Pn.pnte .e. .N.ne / /_ esokil 4... 8 Pipnet 4 M,w, I Add,,.... P..perll I..•c.inn (�► RS31J3 (A y RD .Y•.1 Iot Cil e - '... .Y.• . SCC110n i L1E. W= r;er This Nua 910" sn- MO* , ,Z9 n it 14 E w II ype.fBella'. kaN WHO op1Y1 ta• Subdnelon None '', Iol7t weir )wellns-Mambo ofBNroerr_- _ �_- ❑ILMIcALnnextal-IkxnitrLc O(Mn•.l .__ .- . ' (AM N ❑4dl.gc of ❑talc )veM1- Mar•1h lose 1..1 nt v. 513t • 14 bp et hire* (Cheek oh us eas as Ha,A. 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Morellos-I.On Qatar t.t Y ItrWMbu ehM POSVI%IMwa am*s eelae.taManlier i Name P mil 1 MP/MPRSponlet PMweMtnl.aLewis Bjak I 253076 715.231-7375 N1eMor•s Adams Moen (it, Male 7.uCndel tit EMI County E Menomonie W164751 — NMw.•1 re--1 le I•. .1 Lu, p At/cal%heat r Apr. 0�••(r now f (oSU� "/zr 0.... ` IX.f_nOWNEe ....f..Orgpwt.l ;) S (� J„� tys • S STEM OWNER 1� � ��r"J au:Zak � 1 Septic tank effluenttiter.rd q) r{ j.._.� drspe-sal cell mat be se v.ed I mamtai.^.nd as per tnanagernen1 plan provided by plumber �` d0 I 2 army ns per applala non —+�n ' ! �LO ( w. .a — 1 _ r sir( 31)1 Sys l 4o 6 �� ' I - i