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Home My WebLink About030-1058-40-000 (3) Wisconsin Department of Safety and Professional Services Phone: 608-266-2112 Division of Industry Services Web: http://dsps.wi.gov 4822 Madison Yards Way Email: dsps@wisconsin.gov PO Box 7302 Madison, WI 53707 Tony Evers, Governor Dan Hereth, Secretary September 28, 2023 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/28/2025 MUNICIPALITY: TOWN OF ST. JOSEPH ST. CROIX COUNTY SITE: ROULEAU 4 BEDROOM ELJEN MOUND 747 WEST SHORE DRIVE SOMERSET, WI 54025 SE1/4, NW1/4, S23, T30N, R19W FOR: SITE REQUIREMENTS • A full size 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. A Department electronic stamp and signature shall be on the plans which are used at the job site for construction . The following conditions shall be met during construction or installation and prior to occupancy or use: • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. • Prior to the construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a ¼-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. • 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. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacturer’s recommendations. • Verify property line(s) prior to installation. • Pump Floats to be set and verified per the approved plan . Identification Numbers Plan Review No.: PWTS-092302171-C Application No.: DIS-082338566 Site ID No.: SIT-120764 Please refer to all identification numbers in each correspondence with the Department. CUST ID NO.: 223760 JOHN F SCHMITT 616 150TH AVE SOMERSET, WI 54025 Design Wastewater Flow Value: 600 Bedrooms: 4 Limiting Factor(s): 33 Inches Maintenance Required: Effluent Filter Eljen GSF Mound Component Manual - September 2019 Edition Pressure Distribution Component Manual - Version 2.1 (May 2022-2027) OWNER RESPONSIBILITIES • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper u se 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 and Wis. Admin. Code § 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 prop erty owner must follow the contingency plan as described in the approved plans. 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. 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 o f the responsibility for designing a safe building, structure, or component. The Division does not take responsibility for the design or construction of the reviewed items. Inquiries concerning this correspondence may be made to me at the contact information listed below, or at the address on this letterhead. Sincerely, Katie Petzel Division of Industry Services Phone: 608-574-1189 Email: katie.petzel@wisconsin.gov Fee Required: $250.00 Fee Received: $250.00 Balance Due: $0.00 Refund Expected: $0.00 GSF WI MOUND DESIGN PROGRAM INDEX AND TITLE PAGE Project Name: Rouleau 4 Bedroom ELJEN Mound Owners Name: James & Kerry Rouleau Owner's Address 795 140th Ave New Richmond, WI 54017 Legal Description: SE1/4, NW1/4, S23, T30N, R19W Township St. Joseph County: St. Croix Subdivision Name: Lot Number: Block Number Parcel I.D. Number 030-1058-40-000 Plan Transaction No. Page 1 Index and title Page 2 Data entry Page 3 GSF Mound drawings Page 4 Lateral and dose tank Page 5 Distribution Media Page 6 System maintenance specifications Page 7 Management and contingency plan Page 8 Septic and Dose tank specifications Page 9 Effluent filter information Page 10 Pump specifications and curve Page 11 Plot plan Page 12 Sanitatary System Ownership/Address Form Page 13 Warranty deed Attachment Soil evaluation report Designer: John Schmitt License Number: 223760 Date: 8/27/2023 Phone Number: 715-760-0486 Signature: Designed Pursuant to the GSF Mound Component Manual (N.08/16), and SSWMP Publication 9.6 Design pressure Distribution Networks for STSA (01/81) Page 1 Project: GSF WI MOUND DESIGN PROGRAM DATA ENTRY Site Information R Residential or Commercial Design ®Number of Bedrooms (optional) 600 Design Flow (gpd) 16.0% Site Slope (%) 99.36 Installation Contour Line Elevation (ft) 48.00 Contour Length Available (ft) 33 Depth to Limiting Factor (in) 1.0 In -Situ Soil Application Rate (gpd/ft2) EFF #2 Distribution Cell Information B43 Unit Used 8 Cell Width (ft) 3, 4, 5, 6, 8, 9 or 10 41 = Dispersal Cell Length (ft) 2.0 Dispersal Cell Design Loading Rate (gpd/ft2) 2 Influent Wastewater Quality Are the laterals the highest point in the distribution Pressure Distribution Information network? Enter Y or N C Center, End, No Manifold (Pump to Gravity), or Gravity (No Pump) 4 Lateral Spacing If N above, enter the elevation ft 4 Number of Laterals of the highest point. 0.25 Orifice Diameter (in) (e.g. 0.25) 1.5 Estimated Orifice Spacing (ft) = 13.67 ft2/orifice 2 Forcemain Diameter (in) 150 Forcemain Length (ft) Does the Forcemain drain back? 89 Inside Pump Tank Elevation (ft) 3.25 System Head (ft) x 1.3 10.94 Vertical Lift (ft) 2.55 Friction Loss (ft) 0.975 Add'I Fitting Friction Loss (ft) 17.72 Total Dynamic Head (ft) Lateral Diameter Selection in. diam. options choice 0.75 1.00 x 1.25 x 1.50 x x 2.00 x 3.00 x Septic Tank Information 1200 1 Septic Tank Capacity (gal) Wieser Concrete Manufacturer Dose Tank Information 800 Dose Tank Capacity (gal) 22.24 Dose Tank Volume (gal/in) Wieser Concrete Manufacturer Rouleau 4 Bedroom ELJEN Mound 24.47 Forcemain Drainback (gal) 33.91 5x Void Volume (gal) 58.38 Minimum Dose Volume (gal) 27.96 System Demand (gpm) Manifold Diameter Selection in. dia. options choice 1.25 x 1.50 x x 2.00 3.00 Gallons/Inch Calculator Total Tank Capacity (gal) Total Working Liquid Depth (in) gal/in Effluent Filter Information F- Polylok Filter Manufacturer 525 Filter Model Number Page 2 Page 2 GSF WI MOUND DESIGN PROGRAM GSF MOUND DRAWINGS Mound Plan View IVIUUIIU %rUIIIPUIIV[ IL LJIIIIGIIJw11s A 8.00 ft E 27.36 in H 1.00 ft K 9.67 ft B 41.00 ft F 7.00 in 1 19.40 ft L 60.34 ft D 12.00in G 0.50ft J 4.22ft W 31.63ft 328.00 (ftz) Dispersal Cell Area 1123.56 (ftZ) Basal Area Available 14.63 (gpd/ft) Linear Loading Rate 4.10 (ft) 1/10 B Obs. Pipe Placement Finished 101.94 (ft) —► Grade ,Q a G H 100.94 (ft) F Lateral Invert Dispersal Cell 100.36 (ft) Elevation Dispersal Cell:.. € : 3:::::::.::::: ... .................... Elevation 99.36 (ft) Contour Elevation 16% Site Slope Shading Key Typical Dispersal Cell 1 Topsoil Cap � See Page 5 2 Subsoil Cap o C 2 ft Geotextile 3 ASTM C33 Sand -�O .0 Fabric 1101 4 Tilled Layer > F 5 5 GSF Media & Cell Header v o 0.5 ft 1 /Footer SF A See details on page 4 for number, size and spacing of laterals. Laterals are located in the 4" gravity distribution pipes as shown on page 5. Project: Rouleau 4 Bedroom ELJEN Mound Page 3 Page 3 GSF WI MOUND DESIGN PROGRAM LATERAL AND DOSE TANK End Connection Lateral Layout Diagram Place Appropriate Lateral Diagram From Right Below All laterals identical, with orifices Force main connection via tee or cross to manifold at any point. equally spaced. Orrifices point up except every 5th one points S down for drainage. P Laterals & force main of PVC Sch 40 X X/2 X/2 (per COMM Table 84.30-5) • = Tum-up w/ball valve or cleanout plug Numbers of Laterals Lateral Diameter Lateral Length (P) Lateral End (Z) Lateral Spacing (S) Lateral Flow Rate System Flow Rate 4.uu vnnce vrd"MMI 1.50 in Orifice Spacing (X) 20.00 ft Orifices per Lateral N/A ft Orifice Density 4.00 ft Manifold Length 6.99 gpm Manifold Diameter 27.96 gpm Forcemain Velocity 18.48 Pump Off Height 3.36 . ft ftZ/orifice ft in ft/sec in 6.00 13.67 4.00 I 1.50 2.86 12 Dose Tank Information Electrical as per NEC 300 and Came 16.2EVOC Tank aorrponeit is properly Feted Wieser Concrete Capacity 800 Volume 22.24 Manufacturer Gallons gal/inch Dimension I Inches Gallons A 19.35 430.26 B 2.00 44.48 C 2.62 58.38 D 12.00 266.98 Total 35.97 800.00 A f B C D Man. 7 Bedding under tank Alarm Manufacturer SJE Rhombus Alarm Model Number AB Pump Manufacturer Gould Pump Model Number PE51 Lodang avverwAh warring —labad and loclang device. and sealed wderfight 4 in. I - Pump Must Delivery 27.96 gpm at 17.72 ft Project: Rouleau 4 Bedroom ELJEN Mound oultet location Forcemain dfarnde 2 in V1kep hde or —ar"phon device Rwp off de✓abm (tt) 90 Dosetank devafion (1t) 89 TDH Page 4 8 FT WIDE CENTER CONNECTION GSF WI MOUND DESIGN PROGRAM DISTRIBUTION MEDIA GSF Distribution Cell Media Layout Cell Width (ft) �Sidewall to Lateral (ft) Distribution Cell Cross-section Arrangements Drag appropriate drawing to space below. nentLesend ASTM C33 Sand/Mound Sand — A42 or B43 Module - Lateral Turn -up (contained in Turn -up Enclosure) Distribution Cell Plan View Layout - Typical 8 Cell Width - A (ft) 41.00 Cell Length - B (ft) 10 B43 Modules Required per Row 20 B43 Total Modules Required Center Connection Lateral Layout Diagram Drag appropriate drawing from left to space below. FORCE MAIN '. G.s` p. Y.;: t ..�.. -� .�_. �;; r.•r f. L .S.tity.R� e s..S.jc' .:,3 ry ^a it-.. .f.tr`r.r F` "'( ,+\1.: �a 't ; ��` Vww:�" x � � � �n� �-t'f •• t'ti , k aY- CAe ``� t"h' ay . � A..i•9 jl, r {�,,'� 79 - �"�" - . r ti -. � i P r A r f '4 s � i. r Project'. Rouleau 4 Bedroom ELJEN Mound Page 5 GSF WI MOUND DESIGN PROGRAM SYSTEM MAINTENANCE SPECIFICATIONS Mound System Maintenance and Operation Specifications Service Provider's Name John Schmitt Phone 715-760-0486 POWTS Regulator's Name St. Croix County Community Development Phone 715-386-4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 30 mg/L Septic Tank Capacity 1200 gal Maximum TSS 30 mg/L Soil Absorption Component Size 328 ft2 Maximum FOG 10 mg/L Maximum Fecal Coliform 10E4 cfu/100 mL Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other Service Frequency Inspect and/or service once every 3 years Should inspect and clean at least once every 3 years Test once every 3 years Should test monthly Laterals should be flushed and pressure tested every 1.5 years Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to the standards, have a watertight cap, and are secured in a as shown in the Eljen mound component manual. 2. Dispersal cell media conforms to Eljen products approved for use with the Eljen Mound Component Manual approved August 2016. Eljen media is covered with the manufacturers geotextile fabric. 3. All gravity and pressure piping materials conform the requirements in the state code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail 6 - 8" DIAMETER LAWN SPRINKLER FINISHED GRADE — — — — — LATERAL ENDS AT LAST 4" PERFORATED PIPE __\ ORIFICE WHERE VARIABLE 4" END LENGTH CLEANOUT BEGINS CAP �— DISTRIBUTION LATERAL Project: Rouleau 4 Bedroom ELJEN Mound LATERAL CLEANOUT THREADED CLEANOUT PLUG �)__SAME LONG SWEEP 90 OR TWO 45 DEGREE BENDS DIAMETER AS LATERAL Page 6 GSF WI MOUND DESIGN PROGRAM MANAGEMENT AND CONTINGENCY PLAN Mound System Management Plan General This system shall be operated in accordance with SPS 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals Eljen Mound Component manual August 2016 and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October -February) dictate that the mound be heavily mulched as protection from freezing. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project; Rouleau 4 Bedroom ELJEN Mound Page 7 �w-006=OOZLdIM :��Id 9S1�8—SZ�-008 \ ;anod_iWd -- 00 00 00 ;31v0 05L4� IM 'H00a N301VW 'OL 1MH Sfl 9lL£M iy�NyW 011d3S ? 313/311/3 13§31M W --esmks NMvaO `'� \ +anod=3 � __ - aW-009—OOZ ld'1M � :31va n3a „o-;i .-i t :31dos W LLJ (Yj Z J Y J L) H Q Z a ,� o z > 0 � C) U = w m0 Zo J Na Q ^w } O Q U v v_ w o w 0° >. L� a.co m vi 0 Z Q CL �+- ►- 0 0 m F UJ �w �U LLI w o°J° ~o J � 0a z a z� � LLI3 HO o J ., �o5 5 3 o a O W d t- m QWW �N O Q\ v y W W Q ce o O L.L.. p s_ 00 J p] 0 V7 M CV I L] Z ZQ �' a/ ¢ a O N Ln s '�M��' 1-W FW w(N MN 00 wp 0z YH 0 a s J Z t M'1 <D L;j 0 . >co LZ wmU O a OZ (n Q F7 m\ o oLLI pv) (%IM .. OF J� ocn OZx Q ZU �x NU Q zo Joy==� ..30= Za zow Q zQOOQww0Ldl�,.I F--° F-N�O O 0 Yw �y O0o LL- w3mU�=J$imJ3 LLI wv D Q ZN �Z V) z z Orp - - J OJ � U H U J Q w V) Q I F- V) a U w „6F O S'do „-V Li„L do Q 0 I IZ d � D - mot. lZ 436f S H z w w Page 8 PAL Inc. Innovations in Precast Drainage ' Zabel" & Wastewater Products A Division of Polylok Inc. PL-525 Effluent Filter PL-525 Filter The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the Polylok PL-525 has an automatic shut-off ball installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off the system so the effluent won't leave the tank. Features: • Rated for 10,000 GPD (gallons per day). • 525 linear feet of 1/16" filtration. • Accepts 4" and 6" SCHD 40 pipe. • Built in gas deflector. • Automatic shut-off ball when filter is removed. • Alarm accessibility. • Accepts PVC extension handle. PL-525 Installation: Ideal for residential and commercial waste flows up to 10,000 gallons per day (GPD). 1. Locate the outlet of the septic tank. 2. Remove the tank cover and pump tank if necessary. 3. Glue the filter housing to the 4" or 6" outlet pipe. If the filter is not centered under the access opening use a Polylok Extend & Lok or piece of pipe to center filter. 4. Insert the PL-525 filter into its housing. 5. Replace and secure the septic tank cover. PL-525 Maintenance: The PL-525 Effluent Filters will operate efficiently for several years under normal conditions before requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped, or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. 1. Locate the outlet of the septic tank. 2. Remove tank cover and pump tank if necessary. 3. Do not use plumbing when filter is removed. 4. Pull PL-525 cartridge out of the housing. 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank. 6. Insert the filter cartridge back into the housing making sure the filter is properly aligned and completely inserted. 7. Replace and secure septic tank cover. 06" Filtration Slots Alarm Switch 10,000 GPD (Optional) .. <�=l Accepts 1" PVC Extension Handle Accepts 4" & 6" SCHD 40 pipe Outdoor SmartFilter'S Alarm Polylok, Zabel & Best filters accept the smartFilter® switch and alarm. Rated for 10,000 GPD 525 Linear Ft. of 1/16" Filtration Slots Certified to NSF/ANSI Standard 46 Gas Deflector Automatic Shut -Off Ball Extend & LokTm Easily installs into existing tanks. Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Tbll Free: 877.765.9565 Fax: 203.284.8514 www.polylok.com Page 9 Wastewater METERS FEET 1 40 10r PE51 35 —► 2 GPM 30 PE41 1 FT Q = 25 u z 20 } 0 J 15 O 1 10 I 5 m MODELS: PE31, PE41, PE51 HP: .33, .40, .50 0 0 10 20 30 40 50 60 70 GPM 80 1 I ' 0 5 10 15 m3/h CAPACITY PERFORMANCE RATINGS PE31 Total Head (feet of water) GPM 5 52 10 42 15 29 20 16 25 0 PE41 Total Head (feet of water) GPM 8 61 10 57 15 46 20 33 25 16 PE51 Total Head (feet of water) GPM 10 67 15 59 20 50 25 39 30 26 35 8 Page 10 N Scale: 1" = 60' 0 60 12090 215 Rouleau 4 Bedroom Eljen Mound SYSTEM PLOT PLAN Project Address: 747 West Shore Drive BM1 Symbol: BM Elevation: 100.00' BM Description:Top of 2" PVC Pipe BM2 Symbol: BM Elevation: 100.33' BM Description: Top of Electrical Transformer Slope Gradient of Tested Area:(16%) Well Symbol (if applicable) Design Flow:600 GPD Attach design flow calculations for commercial plans: Pipe Materials / ASTM Standard Tables 384.30-3 & 384.30-5 4" SCH 40 PVC pipe 2" Sch 40 PVC pipe ASTM-D1785 ASTM- D2665 Notes: See CSM for complete lot 100' = 900' 1 1/2" Sch 40 PVC pipe ASTM-D1785 B3 BM 2 94' 100' 102' B4 96' 98'B2 100' B1 BM 1 98' 96' 94' B5 Greenhouse & garden to be removed Existing Septic Tank & Drain field to be abandoned Existing Garage Existing 4 Bedroom House Deck Garage Bass Lake OHWM 50' Setback Driveway 50' setback from pond Contour line El.=99.36' 31.63'x60.34' mound w/ 8'x41' ELJEN cell 150' 2" SCH 40 PVC Force Main Proposed WLP1200/800-MR Septic/Dose Tank Property Line Bass Lake Property Line Property Line Bass Lake 890 OHW OHW OHW Flood Elevation = 890' (890'= 90') Existing Well 16% Slope File #: ST. CRoix _-LINTY SANITARY SYSTEM Office Use Only OWNERSHIP/ADDRESS FORM created2/2021 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. If you would like to view your issued sanitary permit online, you can do so by using the Property Files Scanned weblink. OWNER/BUYER INFORMATION owner/Buyer James & Kerry Rouleau Mailing Address 795 140th Ave City/State/Zip New Richmond, WI 54017 Phone Number (requ Email Address (required 715-781-4973 Parcel Identification Number 020-1476-01-000 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location SE '/a , NW 1/4, Sec. 23 , T 30 N R19 W, Town of St- Joseph Subdivision Plat: NA Certified Survey Map # metes & bounds Warranty Deed # 1156789 Number of bedrooms 4 New Property Address (Staff Initials) Lot # Volum Page # (before 2006)Volume , Page # Spec house 0 yes O no Lot lines identifiable ■ yes 13 no OFFICE USE ONLY (Verification of new address required from Community Development Department for new construction.) (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 cdd cusccwi.gov 1101 Carmichael Road, Hudson, WI 54016 715-245-4250 Fax www.sccwi.aov Page 12 State Bar of Wisconsin Form 7-2003 TRUSTEE'S DEED Document Number II Document Name THIS DEED, made between Thomas J. Spaniol, Jr. and Colleen M. Spaniol as Trustee of Thomas J. Spaniol, Jr. and Colleen M. Spaniol Living Trust dated January 3.2008 ("Grantor," whether one or more), and James V. Rouleau and Kerry A. Rouleau, husband and wife as survivorship marital property ("Grantee," whether one or more). Grantor conveys to Grantee, without warranty, the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): See attached Addendum 1156789 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 08/01/2022 03:38 PM EXEMPT#: REC FEE 30.00 TRANS FEE 3,600.00 PAGES: 2 **The above recording information verifies that this document has been electronically recorded St returned to the submitter Recording Area Name and Return Address Ronald L. Siler Williamson & Siler, S.C. 201 South Knowles Avenue New Richma®d, WI 54017 030-1058-40-000 Parcel Identification Number (PIN) Dated //.b.` y. v - (SEAL) �� ! %� (SEAL) *'titomas J. Spa' , XI Trustee � % *Col een 11. Spaniol, l'iU�- ! ,1 (SEAL) * (SEAL) AUTHENTICATION Signature(s)Thomas J. Spaniol, Jr. and Colleen M. Spaniol authenticated onJuly 27.2022 *Ronald L. Siler TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. COUNTY ) Personally came before me on the above -named to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. Ronald L. Siler of Williamson & Siler, S.C. « 201 S. Knowles Avenue, New Richmond, WI 54017 Notary Public, State of Wisconsin [M Commission (is permanent) (expires: ) This notarial act involved the use of communication ter o ogy. (Signatures may be autbenttestod or acknowledged. Boib are not aotenary.) NOTE: THU IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD sE CLEARLY IDZ"FIED, TRUSTEE'S DEED O 2820 STATE BAR OF WISCONSIN FORM NO.74003 Type name below signatures. (REV. 2030) Page 13 St. Croix Countv 1156789 Paae 1 of 2 ADDENDUM Parcel 1: Part of Government Lots 6 and 7 of Section 23, Township 30 North, Range 19 West, Town of St. Joseph, St. Croix County, Wisconsin described as follows: From the Northwest comer of the Southeast Quarter of the Southeast Quarter (SE '/4 of the SE 1/4) of Section 22, Township 30 North, Range 19 West of due East a distance of 2,701.05 feet; thence due North a distance of 614.0 feet; thence due East a distance of 279.5 feet; thence N21 °20'E a distance of 887.0 feet to point of beginning for parcel to be conveyed herein; thence N33°20'E a distance of 377.7 feet; thence S76°40'E a distance of 410 feet, more or less to the shore of Bass Lake; thence Southerly and continuing along the shore of Bass Lake Southeasterly, Southwesterly, Northerly and Westerly to a point which is approximately 50 feet due East of point of beginning; thence West a distance of 5.0 feet, more or less to point of beginning. Parcel 2: TOGETHER WITH a perpetual easement for roadway purposes as set forth in Easement recorded in Vol. 464 of Rec., pg. 14, as Doc. No. 301656. Parcel 3: SUBJECT TO a perpetual easement for roadway purposes over, across, and upon the Westerly 30 feet of the above described property as set forth in the Quit Claim Deed recorded in Vol. 502 of Rec., pg. 245, as Doc. No. 318146. St. Croix Countv 1156789 Pace 2 of 2 fix'l _ Drtrtyr�rnttdWis. SOIL EVALUATION FtWORT d ; e p in accordance with Comm 85. s. Adm. Cade Professional Services AttaClicl�o�mplete site plan on paper not less than 8Y2 x 11 inches in size. Plan must 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. Please print all information. Personal inromuction you provide may be used for seconderY purposes (Prn'aq Law, s. 15.04 (1) (m)). Property Owner Property Location Rouleau, James & Kerry Govt. Lot 6 & 7 Property Owner's Mailing Address Lot # Block # 795 140th Ave. County #2275 Page 1 of 4 Schmitt Soil Testing. in -- St. Croix Parcel I.D. 030-1056-40-000 Reviewed By Date SE1/4, NW1/4, S23, T30N, R19W Subd. Name or CSW City State Zip Code Phone Number l-I City [! Village j Town Nearest Road New Richmond WI 1 54017 1 715-781-4973 1 St.Joseph I West Shore Drive New Construction Use: [ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD [] Replacement ❑ Public or commercial - Describe: Parent material Outwash Sand (Plainfield Loamy Sand) Flood plain elevation, if applicable W (8901 fL General comments Area is suitable for a 6 inch mound system. System will require advanced treatement or an Eljen type mound because of the limited and recommendations: area. Contour line elevation is 100.1 T. Slope of the area is 16%. Boring # LJ Boring 1 IL;•) pit Ground surface elev. 100.26 ft. Depth to limiting factor 33 in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Soil Application Rate GPDfft' *Eft#1 *Efi#2 1 0-13 10yr3/2 none si 2mgr mvfr as 2f,2vf 0.6 1.0 2 13-33 10yr5/6 none s Osg ml as 1vf 0.7 1.6 3 10yr4/6 m2j 5'Syr25/6 sil 2fsbk mfr cs 2f,2vf 0.6 0.8 F33-58 4 58-66 10yr5/4 none grs Os9 ml as ----- 0.7 1.6 5 66 96 10yr5/6 iron s Ogg � ml — --- 0.7 1.6 T71= ❑ Boring # L.a Boring . Lj pit Ground surface elev. 100.26 ft. Depth to limiting factor 96+ in. Safi Application Rate Horizon Depth in. Dominant Color Munseli Redox Description Qu. Sz. Cont. Color Texture Structure'Consistence Gr. Sz. Sh. Boundary Roots GPDKe ff#1 •Ett#2 1 0-14 10yr3/2 none s) 2mgr mvfr as 2f,2vf 0.6 1.0 2 14-36 10yr5/6 none Is Os9 ml a lvf 0.7 1.6 =336-68 10yr5/6 none s 099 ml as if 0.7 1.6 4 68-96 10yr6/4 none Ifs 059 mi ---- ----- 0.5 1.0 . cda ...1 a, - Gf1rl t. zn c 7" rnnA and TSS >30 < 150 mtvL - rmuenl sc - C JW4 _av 11FWL YIN 1 w =w "W— CST Name (Please Print) Signature. CST Number 227429 Thomas J. Schmitt Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd St. New Richmond, wl 54017 8/4/2023 715-7M1978 1 Property Owner Rouleau, James & Kerry Parcel ID # 030-1058-40-000 Page 2 of 4 3 Boring Boring # Pit Ground surface elev. 95.27 ft. Depth to limning factor 43 in. Soil Application Rate Horizon Depth in. Dominant Color Munseil Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/1112 'EH#1 -Eff#2 1 0-7 10yr3/3 none si 2mgr mfr as 2m,2vf 0.6 1.0 2 7-29 IOVr4/4 none sl 2fsbk mfr gw 2f,2vf 0.6 1.0 3 29-43 7.5yr4/6 none gris Osg ml cs lvf 0.7 1.6 4 43-64 10yr5/6 m2d 7.5yr6/6 7.5yr6/2 sii Om mfr Cs ----- 0.0 0.2 5 64-78 10yr4/4 map 7.5yr6/8 Ifs Osg ml ---- ---- 0.5 1.0 4] Boring # Boring Pit Ground surfaoe elev. 101.76 ft. Depth to limiting factor 95 in. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft2 •Etr#1 •Efr#2 1 0-7 10yr3/2 FILL I 2mgr mvfr as 2f,2vf 0.6 0.8 2 7-12 10yr3/4 FILL sl 2fsbk mfr gw lvf 0.6 1.0 3 12-36 10yr6/3 none fsl Om mfr gw 2f,2vf 0.2 0.5 4 36-50 10yr4/4 none sl 3msbk mfr gs ---- 0.6 1.0 5 50-61 10yr5/6 none Is Osg ml cs ----- 0.7 1.6 6 61-95 10yr6/4 none IN Osg ml as 0.5 1.0 7 95-105 10yr5/6 c2d 7.5yr6/a 7.5yr6/2 VfsI 2mpl mfr ---- 0.0 0.2 5 51 F- [j Boring Boring # E Pit Ground surface elev. 101.36 ft. Depth to limning factor 36 in. Soil Application Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft2 •Eff#1 'Eti#2 1 0-12 10yr3/2 none sl 2mgr mvfr as 2vf 0.6 1.0 2 12-36 10yr5/6 none s Osg ml as ----- 0.7 1.6 3 36-66 10yr5/6 c2d 7.5yr6/8 7.5w6/2 lvf5 Osg ml as --- 0.4 0.6 4 66-71 7.5yr4/6 m2d5.syr6/6 sil Om mfr as ----- 0.0 0.2 5 71-86 5yr4/4 m2d 7.5yr6/67 5 r6 i sl Om mfr --- --- 0.2 0.6 - 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 $mice$ or need material in an alternate format, please contact the department at 608.266-3151 or M 609-264-8777. sao-a»o is mroo) aohmat trot) Talwa trr. �• 0 v V/ m m m �� .O A E _ 1 m ��_ 3 �� m E m L ® O T �s 5 a O Ilz--�� — o � t m `m `o � ga u n m mmr„ wE U m6. O U%ic � 00 Q U V/ W U)Y mJ _ O '�, .�•� YW QY �• �g N .OW�• ,_._..� O '• •m 'CIOCO /. �/' �•� W �� •��'I-` 6 ID w DEW ! j — •�• •� �� ' Oz> m O= w =wo ` 1 1 Z) 1 o C� LLJ O r- 1 ' 1fOcn a 0 ED •. 1 p N ` N m O 1 % m •� w Q � 1 • � O / � o •� °' OW qt5J L) Z/ a u1 _j w a� <C, O—iU Q�Q w2 aLL U En c rn Lo" W O LL n� z cn LL 0 a U 9 L � O N 't O O O M O > ~ NWM 't N 2� o o 6 0 06 N OI ! �� O N U) to O�Ui�� Y mi �,� i0-HW �O a�Q CO 'U m 0: w zl a Y. of C) m O�� (U!J N,W 04co LL Y < J �O Z4- O M r w V,� C) CDOO � U� -0�U O F- U N NNQ o 2 I ° cn z wmm �p 04 � cELopti a) >c WO o w I z o mmU 0 corn U-r�Z .IT tiC7n� O �� v UaoL N o)oIUe LD V10£Wed N Scale: 1" = 60' 0 60 12090 215 Rouleau 4 Bedroom Eljen Mound SYSTEM PLOT PLAN Project Address: 747 West Shore Drive BM1 Symbol: BM Elevation: 100.00' BM Description:Top of 2" PVC Pipe BM2 Symbol: BM Elevation: 100.33' BM Description: Top of Electrical Transformer Slope Gradient of Tested Area:(16%) Well Symbol (if applicable) Design Flow:600 GPD Attach design flow calculations for commercial plans: Pipe Materials / ASTM Standard Tables 384.30-3 & 384.30-5 4" SCH 40 PVC pipe 2" Sch 40 PVC pipe ASTM-D1785 ASTM- D2665 Notes: See CSM for complete lot 100' = 900' 1 1/2" Sch 40 PVC pipe ASTM-D1785 B3 BM 2 94' 100' 102' B4 96' 98'B2 100' B1 BM 1 98' 96' 94' B5 Greenhouse & garden to be removed Existing Septic Tank & Drain field to be abandoned Existing Garage Existing 4 Bedroom House Deck Garage Bass Lake OHWM 50' Setback Driveway 50' setback from pond Contour line El.=99.36' 31.63'x60.34' mound w/ 8'x41' ELJEN cell 150' 2" SCH 40 PVC Force Main Proposed WLP1200/800-MR Septic/Dose Tank Property Line Bass Lake Property Line Property Line Bass Lake 890 OHW OHW OHW Flood Elevation = 890' (890'= 90') Existing Well 16% Slope F N f in C o K A Q a' d _ J L.1 V G D D m O G O� A p� m O C •- OGC+ N C G v W y Aso Ei S O County Industry Services Division St. Croix Sanitary Permit Number (to be filled in by Co.) S - 1400 E Washington Ave P P.O. Box 7162 S Madison, WI 53707-7162 Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit Project Address (if different than mailing address) is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary 795 140'h Ave. purposes in accordance with the Privacy Law, s. 15.04(I)(m), Stalls. I. Application Information - Please Print All Information Property Owner's Name Parcel # 030-105840-000 James & Kerry Rouleau Property Owner's Mailing Address Property Location 795 140i6 Ave. Govt. Lot SE'/., NW '/<, Section 23 (circle one) City, State _7 Zip Code Phone Number New Richmond, WI 54017 T30N R19EorW H. Type of Building (check all that apply) Lot # ® 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name ❑ Public/Commercial - Describe Use Block # ❑ City of ❑ State Owned - Describe Use ❑ Village of CSM Number ® Town of St. Joseph Ill. Type of Permit: Check onlyone box on line A. Complete line B if applicable) A. ❑ New System ® Replacement System ❑ Treatment/Holding Tank Replacement Only ElOther Modification to Existing System (explain) ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued B. Before Expiration Plumber Owner IV. Type of POWTS S stem/Corn onent/Device: Check all thatapply) ❑ Non -Pressurized In -Ground ❑ Pressurized In -Ground ❑ At -Grade ® Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ® Pretreatment Device (explain) Eljen V. Dis ersaUTreatment Area Information: Design Flow (gpd) Design Soil Application Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 600 Rate(gpdsf) 600 1124 100.36' 1.0 VI. Tank Info Capacity in c o Gallons Total Gallons # of Units Manufacturer w o U 2 2 ;, d a; y y New Tanks Existing Tanks a U iz N U) Septic or Holding Tani: 1200 1200 1 Wieser Concrete ® ❑ ❑ ❑ ❑ Dosing Chamber 800 800 1 Wieser Concrete ® ❑ ❑ ❑ ❑ VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. --iPlumber's Plumber's Name (Print) Signature MP/MPRS Number Business Phone Number John Schmitt 223760 715-760-0486 Plumber's Address (Street, City, State, Zip Code) 586 Valley View Trail, Somerset, WI 54025 V111. County/ eartment Use Only ❑ Approved ❑ Disapproved Perrrllt Fee Date Issued Issuing Agent Signature ❑ Owner Given Reason for Denial $ IX. Conditions of Approval/Reasons for Disapproval to complete plans for the system and submit to the County only on paper not less than S 1Y1 111 inches in size SBD-6398 (R03/14) - Industry Service Division County St Croix Sanitary permit Number (to be filled in by Co.) p s _ 1400 E Washington Ave F P.O. Box 7162 S Madison, WI 53707-7162 Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit 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 Services. Personal information you provide may be used for secondary 747 West Shore Drive purposes in accordance with the Privacy Law, s. 15. 1 m , Stats. I. Application Information - Please Print All Information Property Owner's Name Parcel # James & Kerry Rouleau 030-1058-40-000 Property Owner's Mailing Address Property Location 795 140'" Ave. Gout. Lot SE %., NW %,, Section 23 City, State Zip Code Phone Number New Richmond, WI 54017 (circle one) T30N R19Eorw II. Type of Building (check all that apply) Lot # ® 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name # ❑ Public/Commercial - Describe Use Block ❑ City of ❑ State Owned - Describe Use ❑ Village of CSM Number ® Town of St Joseph Ill. Type of Permit: Check only one box on line A. Complete line B if a licable A. ❑ New System 0 Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued B. Before Expiration Plumber Owner 78800.58/1978+ IV. Type of POWTS System/Component/Device: Check all thatapply) ❑ Non -Pressurized In -Ground ❑ Pressurized In -Ground ❑ At -Grade ® Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ED Pretreatment Device (explain) Eljen V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 600 Rate(gpdsf) 600 1124 100.36' 1.0 VI. Tank Info Capacity in Gallons Total Gallons # of Units Manufacturer a U 6 :: d a New Tanks Existia mg Tanks CC U in H in ir, C7 C. Septic or Holding Tank 1200 1200 1 Wieser Concrete ® ❑ ❑ ❑ ❑ Dosing Chamber 800 800 1 Wieser Concrete ® ❑ ❑ ❑ ❑ VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation ofthe PONM shown on the attached plans. Plumber's Name (Print) PI r' S' att reMP/MPRS Number Business Phone Number John Schmitt 223760 715-760-0486 Plumber's Address (Street, City, State, Zip Code) 586 Valley View Trail, Somerset, WI 54025 VIII. Coun /De artment Use Only ❑ Approved ❑ Disapproved I Permit Fee Date Issued Issuing Agent Signature ❑ Owner Given Reason for Denial S IX. Conditions of Approval/Reasons for Disapproval Attach to complete plans for the system and submit to the Uounty only on paper not less man a I it i mcnes in size SBD-6398 (1103/14)