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038-1241-14-010
County Industry Services Division St. Croix S 1400 E Washington Ave Stffii' Permit Number (to be filled in by Co.) P.O. Box 7162 Madison, WI 53707-7162 SantaPermit Application Sanitary Sty Transaeritm Number PP P`AFTS-032.2W350-C 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 the Department of Safety and Professional Services. Personal information you provide may be used for secondary PmJeet Address (if different than mailing address) purposesin accordance with the Privacy Law, s. 15. I m , Slats. 901h Surd L Application Jeformation — Please Print All Information Property Owner's Name Parcel it Steve Olson Properties LLC Part of 038-1082A5-020 Property Owner's Mailing Address Property Locoman 441 Timberiane Dr Gov t. Lot NW A, NW A, Section 20 ' City, State Zip Code Phone Number Somerset, WI 54025 � ( le one) T31N RI8Eor? H. Type of Building (check ail that apply) Lot # ® 1 or 2 Family Dwelling — Number of Bedrooms 2 Subdivision Name ❑ Public/Commercial — Describe Use Block # ❑ City of ❑ State Owned — Describe Use ❑ Vii4ade of CSM Number 1145670 ® Town of Star Prairie 111. Type of Permit: Check only one box on line A. Complete line B if applicable) A. ® New System ❑ 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 642294, 3/9/IA22 IV. Typeof 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) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: Design Flow (gpo) Design Soil Application I Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 0.6 Rate(gpdsf) 750 1136 100.111 450 V1. Tank Info Capacity in Gallons Total Gallons # of Units Manufacturer o :' F New Tanks Existing Tanis I Lt U iz Z; &n ❑. C3 n, Septic or Holding Tank 1000 1000 1 Wieser Concrete ❑ ❑ ❑ ❑ Dosing Chamber 650 650 1 Wiesff Concrete ® ❑ ❑ ❑ ❑ VII. Responsibility Statement- 1, the sedersigned, assame responabOlty f®fr installation of Ow,]POWTS shows Am the attached ems. Plumber's Name (Print) Pittmbe " MP/MPRS Number Business Phone Number John Schmitt 223760 715-760-0486 Plumber's Address (Strect, City, State, Zip Code) 586 Valley View Trail, Somerset, WI 54025 VHL Coun /Department Use Only ❑ Approved i[1Disapproved Permit Fee Date Issued Issuing Agent Signature ❑ Owner Given ReasonforDenial S VL Conditions of Approval/Reasons for Disapproval Attach to complete plans for the system and submit to the County only on paper not less [tram a trz x tr mcnes in sue SBD-6398 (R03/14) Oc PS March 8, 2022 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2024-3-8 Plan Review: PWTS- 032200350-C John Schmitt 586 Valley View Trl Summerset, WI SITE: Steve Olson Properties LLC 00000 90'h Street Town of Star Prairie St Croix County NW X NW Y. S20, T31N, R18W FOR: Description: 3 Bedroom — 450 GPD — 24" to limiting factor- Effluent Filter - Maintenance required. 1G1:' N RANCt1 RU HAIV•'AN`)Y'A �,rs!,oC• t Ar?uq/, RMav nt!0 :'SCgw qu. �pyr Jrn<.:.nduYPr SFry,fpc lany rvers Governor nawn Cr.m - Ssu:retary Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE CORRESPONDENCE Mound Component Manual — Ver. 2.0, SBD- 10691-P (N.01/01, R 10/12) Pressure Distribution Component Manual — Ver. 2.0, SBD-10706-P (N.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 • The 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. • Components and soil removed from an existing drain field shall be properly disposed of so that there is no risk to public or environmental health. • 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, jo;�ur� 20-wz�y Joshua Rowley POWTS Plan Reviewer, Division of Industry Services (715) 813-9111 Joshua.rowleyLa)wisconsin.Kov MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Olson Lot 2 90th Street 3 Bedroom Mound Owners Name: Steve Olson Properties, LLC Owner's Address 441 Timberlane Drive Somerset, WI 54025 Legal Description: NW1/4, NW1/4, S20, T31N, R18W Township Star Prairie County: St. Croix Subdivision Name: Lot Number: 2 Block Number Parcel I.D. Number part of 038-1082-95-000 Plan Transaction No. Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Attachment Index and title Data entry Mound drawings Lateral and dose tank System maintenance specifications Management and contingency plan Septic and Dose tank specifications Effluent filter information Pump specifications and curve Plot plan Sanitary System Ownership/ Address Form Warranty deed CSM Soil evaluation report Designer: John Schmitt License Number: 223760 Date: 3/1/2022 Phone Number: 715-760-0486 Signature: Z Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SBD 10691-P (N. 01/01) and both SSWMP Publication 9.6 Design of pressure Distribution Networks for ST-SAS (10/81) and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706-P (N. 01/01) Version 7.0 (R. 03/2012) Page 1 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design 300.00 Estimated Wastewater Flow (gpd) 1.50 Peaking Factor (e.g. 1.5 = 150%) 450.00 Design Flow (gpd) 5.00 Site Slope (%) 99.11 Contour Line Elevation (ft) 24.00 Depth to Limiting Factor (in) 0.40 In -situ Soil Application Rate (gpd/ft2) Distribution Cell Information 75.00 Dispersal Cell Length Along Contour (ft) _ 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) 1 1 Influent Wastewater Quality (1 or 2) Pressure Disribution Information (C or E) ClCenter or End Manifold Lateral Spacing (ft) Number of Laterals Orifice Diameter (in) Estimated Orifice Spacing (ft) _ Forcemain Diameter (in) Forcemain Length (ft) Pump Tank Elevation (ft) 3.00 4 0.188 2.50 2.00 80.00 88.00 System Head (ft) x 1.3 Vertical Lift (ft) A Friction Loss (ft) In -line Filter Loss (ft) Total Dynamic Head (ft) Lateral Diameter Selection in, dia. I options I choice 0.75 1.00 1.25 x 1.50 x x 2.00 x 3.00 x Treatment Tank Information 1000.00 Se tic Tank Capacity (gal) Wieser Concrete IManufacturer Note. Sand fill (D) calculations assume a Table 383-44-3 in -situ soil treatment for fecal coliform of - 36 inches. 6.00 Cell Width (ft) Are the laterals the highest point in the distribution Y network? Enter Y or N If N above, enter the elevation (ft) of the highest point. 7.50 ft2/orifice Does the forcemain drain back? r Y Enter Y or N Forcemain Drainback (gal) 5x Void Volume (gal) A Minimum Dose Volume (gal) System Demand (gpm) ManiUlDiameterSelectionin. di choice1.25 1.50 x 2.00 3.00 Gallons/Inch Calculator (optional) L_ jTotal Tank Capacity (gal) Total Working Liquid Depth (in) gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 650.00 Dose Tank Capacity (gal) POLYLOK Filter Manufacturer 17.00 Dose Tank Volume (gal/in) 525 Filter Model Number Wieser Concrete Manufacturer Project: Josephson Construction Lot 2, 3 Bedroom Mound Page 2 Mound Plan and Cross Section Views T L Mound Component Dimensions A 6.00 ft E 15.60 in H 1.00 ft K 8.83 ft B 75.00 ft F 9.50 in - 9.15 ft L 92.65 ft D 12.00in G 0.50ft J 5.98ft W 21.13ft 450.00 ](ft Dispersal Cell Area 1136,03 (ft2) Basal Area Available 6.00 (gpolft) Linear Loading Rate 7.50 (ft) 1110 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 101.90 (ft) I F 100.61 Dispersal Cell 100.11 (ft) —► — :: Dispersal Cell ; D g Elevation (ft) Lateral Invert 4 a 99.11 (ft) Contour Elevation 55..0—% Site Slope Geotextile Fabric Cover Shading Key c. I Dispersal Cell See lateral details on C, 1 5 ft Page 4 for number, size, 1❑ = '" Topsoil Cap 2 c ® and spacing of laterals. Q ,...,,. Subsoil Cap Z Laterals are equally © ASTM C33 Sand F spaced from the d 0 5 ft Typical Lateral distribution cell's ❑Tilled Layer c (A o Aggregate 14 _1___ © centerline in the A _,* distribution cell (AxB). Project: Josephson Construction Lot 2, 3 Bedroom Mound Page 3 Center Connection Lateral Layout Diagram y r" .. r '-r _ --_ r� ; rr, inrr_'Id it ,nu pour c_'n:e rr�arn c;'nnr: _ P 0= Turn -up va'ball ,3lwi% or I�x--L::I_ :Ia3n -Ut0UQ Holy; dnll«d :'n rh« b',rrr-m _d rh« I it«t al L S L.yOFr.1I40 F11'rr- r rr P' Table - I I �, Number of Laterals 4 Orifice Diameter Orifice Spacing (X) 0.188 in 2.53 ft Lateral Diameter 1.50 in 36 69 ft Orifices per Lateral Lateral Length (P) 3.00 ft Orifice Density ft2/orifice Lateral Spacing (S)F m Manifold Lengthft Aft/sec Lateral Flow Rategp System Flow Rategpm Manifold Diameterin Aft Total Dynamic Head Forcemain Velocity Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and — 0 4 in min SPS 316 300 WAC Disconnect �— E--- Alternate outlet Tank component is properly vented location Forcemain diameter 2 in. Wieser Concrete Manufacturer Capacit 65000 Gallons A Volume 17.00 gal/inch Weep hole or anti - siphon device Dimension Inches Gallons B A 20.51 348.63 C Pump off elevation (ft) B 2.00 34.00 4---- 88.92 C 4.73 80371 p 11.00 187.00 D Total 38.24 650.00 pose tank elevation (ft) 88.00 3" Bedding un er tank. Alarm Manuafacturer SJE Rhombus Note Switches containing mercury Alarm Model Number r 1036378 may not be used in this system. Pump Manufacturer Zoeller __� — Pump Model Number 152 39.32 g p m at 17.50 ft TDH Pump Must Deliver Josephson Construction Lot 2. 3 Bedroom Mound Page 4 Project: Mound System Maintenance and Operation Specifications Service Provider's Name John Schmitt J Phone F 7-1-53760-0486 POWTS Regulator's Name St. Croix County Zoning IPhone 715-386-4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound n!ralr Service Frequency Inspect and/or service once eve 3 ears Should inspect and clean at least once eve 3 ears Test once every 3 ears Should test month) Laterals should be flushed and pressure tested eve 3 ears Ins ect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 3 All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished •..••.•.•••••' Grade � J 6-8" Diameter Lawn ----- Sprinkler Valve Box Distribution Threaded Cleanout Plug or Ball Valve g Sweep 90 or Two _ _)egree Bends Same Diameter as Lateral Project Josephson Construction Lot 2, 3 Bedroom Mound Page 5 Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General This system shall be operated in accordance with SPS 382-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01, R. 10112), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706-P (N. 01 /01, R. 10/12)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383 33, Wis. Adm Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281,48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The 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 necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October -February) dictate that the mound be heavily mulched as protection from freezing. 220 mg/L BODS. 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 Influent quality into the mound system may not exceed mg/L B005, 30 mg/L TSS, 10 mg/L FOG, and 10" cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell, hecked for effluent ponding. Ponding levels shall be reported to the owner, an any Observation pipes within the dispersal cell shall be c levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continaencv Pian 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. begins to discharge wastewater If the mound component fails to accept wastewater or ter to the ground surface. it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units ment devices such The un its informatiattachedon and as schedule o f manas a d aretco and maintenance dered part the pretreat manageme t plan for sthis sylsterm treatment units or disinfection eparate Page 6 Project: jw-oS9-0ooldlM 311399tv8—SZ`i-008 o0/00/00 31Vo osL4s IM 'Nooa N3oIVw bl xMH Sn 9LLCM anod-lSod doM Ae NMVao 31393063 IM31M anod-3ad = V/t :TIVOS 31Vo n3a „o-,l x W N � LLJ 7 In Q .. p to W m CC L � a LAJ ao �JO � O Q O W zz a m '- Ln U N o poles- Z X �� < a a z* a a z o f- �� W p ' =J V O O O U F z� O w a vi m m u- w w Q rr) o I Q W z 2� 0 O O nn L.L (n e- e M 00 J - N s H M O Q F la1 m O V) r W (n c0 N co (n O O = LLJ z 0 Z � d NwW N O w�n Or�NNLN In W O U) a n FOLi m� pj ZO�O p ow CL Q p QFwmz O=zc (5 QU L) OUQ O * m Op W NOWWZzm Z W i= a O OU r i ZJ Z - r - J Q W V) Q H In Q �- c) z W L II � II I II I II v i� II II L \✓ II II II II II II II „ti----I_{—_ A I II N I 11 / 1 I II II II - w II O II II � Q II w II m II - II II / lam\ II li I I II I��----\ /----�J T-f J U Q W N I ,L a I r N a U d w m U z O U w w In W r U Q z O 0 Op In W D U Q38inO3a sd o \ _. ivnNVV4 011d3S w o 8vq-oS9-OOOId-lM " \ 0 W J cm 0 0� � a m } m �' Ln Q a � Z C) w o o 3 3 o z 3OLL o °` Q W W a a o a I I I I I II I II L I I „K do I I I I I I I I I I I I I I I 1 I I I I I 112 Page 7 In r Z W W 0 w f\ N N I U mi N Q O W W U x W or O r W W O r O W U Q tL Z Q W Q In 4 r !!T Im inage Zabel Dins on or Paiy ok 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. 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 1 Alarm Switch (Optional) 10,000 GPD i � Accepts 1" PVC Extension Handle Accepts 4" & 6" SCHD 40 pipe is 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 Outdoor SmartFiltert Alarm Extend & LokT" Polvlok, Zabel & Best filters accept Easily installs the SmartFilter® switch and alarm. into existing tanks. Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll Free: 877,765.9365 Fax: 20,284,8514 www,polylok.com Page 8 2 FLOW PER MINUTE 014508A CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available • Electrical alternators, for duplex systems, are available and supplied with an alarm • Variable level control switches are available for controlling single phase systems • Double piggyback variable level float switches are available for variable level long and short cycle controls • Sealed Qwik-Box available for outdoor installations - See FM1420 • Over 130OF (54°C) special quotation required 15111521153 MODELS Control Selection Yolis-Ph Mode Amps Simpiex Duplex 15 1 Non 6.0 1 2 or 3 15 1 Auto 6.0 Included 2 or 3 230 1 Non 3.2 or 3 230 1 Auto 3.2 included 2 or 3 115 1 Non 8.5 1 2 or 3 115 1 Auto 8.5 Included 230 1 Non 4.3 1 2 or 3 230 1 Auto 4.3 Indude 115 1 Non 10.5 2 or 3 115 1 Auto 10.5 Included 2 or 3 230 1 Non 5.3 or 3 230 1 Auto 5.3 Included 2 or 3 TOTAL DYNAMIC HEADIFLOW PER MINUTE EFFLUENT AND DEWATERING MODEL 151 152 153 et Meters Gal. Liters Gal, Liters Gal. Liters 5 1.5 50 189 69 261 77 291 10 3.0 45 170 61 231 70 265 15 4.6 38 1" 53 201 61 231 20 6.1 29 110 44 167 52 197 25 T6 16 61 34 129 42 159 30 9.1 - - 23 87 33 125 35 10.7 - - - - 22 85 40 12.2 - - - - 11 42 Shutoff Head: 30 ft. (9.1m) 38 ft. (11.6m) 44 ft (13.4m) Model 151 5 7r32 378 - - 4 5t8 e 3 718 37re i 11 41116 - � � 415itfi 1 L -- -- SK2444 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. 2. See FM0712 for correct model of Electrical Alternator E-Pak. 3. Variable level control switch 10-0743 used as a control activator, specify duplex (3) or (4) float system. 0 CAUTION 014508E Models 1521153 - 6 712 T5 4 5r6 3718 371a '- 1 112' NPT I 8 SK206t sy assembly" Ip & discharge pipe not included.) Reduces potential clogging by debris Replaces rocks or bricks under the pump Made of durable, noncorrosive ABS Raises pump 2" off bottom of basin Provides the ability to raise intake by adding sections of 11/? or 2" PVC piping Attaches securely to pump applications Accommodates sump, dewatering and effluent NOTE: Make sure float is free from obstruction. For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. m Copyright 2010 Zoeller Co. All rights reserved. Page 9 File S: SANITARY SYSTEM S"I. ChOIX �(�IIN'I'l' office Use Only OWNERSHIPIADDRESS FORM Created 21202' 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 Steve Olson Properties LLC Mailing Address 441 Timberlane DR City/State/Zip Somerset, WI 54025 Phone Number (required) 715-410-0436 Email Address (required) losephsoncustom@yahoo.com Parcel Identification Number 038-1082-95-I O2-0 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION �< , Property Location NW , NW 1/4 , Sec. 20 T 31 N R 18 W, Town of Star Prairie Lot # 2 Subdivision Plat: CSM 7060 Certified Survey Map # 1145670 Volume 31 Page # Warranty Deed # ---(before 1147034 S (before 2006)Volume Page # III- ec house yes 0 no Lot lines identifiable ■ yes 0 no Number of bedrooms 3 p OFFICE USE ONLY New Property Address 2 &` -7 ` C) 7 —H T (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 1101 Carmichael Road, Hudson, WI 54016 715-245-4250 Fax Page 11 State Bar of Wisconsin Form 7-2003 TRUSTEE'S DEED Document Number II Document Name THIS DEED, made between Charles M. Brvse as Successor Trustee of Everett F. Cloutier and Adeline Cloutier Trust dated November 24, 1"3 ("Grantor," whether one or more), and Steve Olson Properties, LLC a Wisconsin limited liability compan* ("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): Lot 2 of Certified Survey Map filed December 21, 2021 in Vol. 31 of C.S.M., pg. 7060 as Doc. No. 1145670 located in part of the Northwest Quarter of the Northwest Quarter (NNV.4 of the NVd'/.) and pan of the Northeast Quarter of the Northwest Quarter (NE% of the NW/A) of Section 20, Township 31 North, Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin. Dated La, P,, 1 -1 ��- (SEAL) • Charles M. Bryse, Successor Trustee AUTEENTICATION signature(s) authenticated on TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706,06) THIS INSTRUMENT DRAFTED BY:& St Croix County Abstract & Title Co., Inc. by Samantha Olson at the Direction of the Grantor. SO ! 21 S30877 1147034 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 01/14/2022 01:01 PM EXEMPT#: REC FEE 30.00 TRANS FEE 510.00 PAGES: 1 * *The above recording information verifies that this document has been electronically recorded & returned to the submitter Rmvrdmg Area RFIT.IRN TO St. Croix County Abstract & Title Co.. Inc. 575 N. Knowles Ave., Suite WB New Ricbrnond. W1 54017 039-1082-95.000 (part of), 038-1082-80-050 mart of) Parcel Identification+ Nttmba (PTN) , 40TAR y `may 9�F ........... �C-D�`�` OF 1N I SG� �rrruut�ttt� ACKNOWLEDGMENT STATE OF WISCONSIN ) ) ss. St. Croix COUNTY ) Personally came before me on 'TA k 1 2 the above -named Everett F. Cloutier and Adeline Cloutier Trust dated November 24. 1"3 — Charles M. Bra se, Successor Trustee to me nown to be the person(s) who executed the foregoing in run ent and ack owledged the same. i Notary Public, Sta f Wisconsin My Commission (is permanent) (expires: 5 (Signatures may be authenticated or acknowledged. Both are not necessery.) NOTE: THIS IS A STANDARD FORM. A O 20oOD STATE ICATION OF WISCONSIN OR''M SHOULD BE CLEARLY ID FORM, NO. 7•2903 TRUSTEE'S DEED • Type name below sipyfanures. Page iz St Croix County 1147034 Page 1 of 1 otioL —I5--' Z jo L aBed 0L9S17L L Alunoo xlojo 7S 0 0 � y � O cn =z O g U V) z ui Z O O U CC K Lli Q j Q L {.I Z — Z Q LL � Ll_ O /A O V / 4 t- w Qz W sm ex LLJ 7D 1'� r_ Z r— 3 W =O U �z O M Z � S = LL 7 00 cl: f w ~ N Z o� Cnn w Z W �S N W U 05 cr �UNag ��d¢ rv= Z w0 �U �1 u�l �r i �I i W r ,99 �I Z I rg VJm N ooNpq � �^ W � r C N V4I !V r y 5 > GC. L X6'90b — _. 00'OVV II 1H AVM � ,i '15H10606-� �I 0 O w a ¢ h LLQzLL, LU m Z ~ Z O WQW = o 11yhm F- N 1.� L) U E :S39Vd 000E =33A 3321 09oL =3'E)Vd TE :3wniOA dVW A3Awns a3I-AI1M37 Wd 5Z:E0 TZOL/TZ/ZT GUOJ3t1 Tloi 03AI3731d IM ''03 xroko -is S0330AO V315I9au 159Vd H139 OL95VTT ZiOT133HS�+ OWCITCT a..nnLnF-OOS-- In 2 CL C u E E� .JC vi C U 0• Vl c c° —' v a E C w O G= m ee O d .� K c N pu o q ex dN �C5 C A C 0 N d o —° E. °� u E v m c o c 05 n c 2 E w a c ¢ a� 30 Cf WI C/I MN - b/I 3N 3N/I HInOS--� mt r• I a� d 9 2� o � i d � �ect,�n3�ez�� ' O G W_ 'I O Z _ r m 0 b+ U� N rl �QC N 1� � y z 3 N .8b'9TEI I3..5£,TOvUUN_ 133a151I106 i 3NI7 !l31N33 13132!1S _H_l06 � � ®l __ _ I i ____—_ - - 6ri I r v� Z c O p LL w j 2 o0—c U z cc Z 2 W Q G 0 0 0 m p S o Y2� w 0 — z ? o 0 3 p O ? a N Q O z Z Z Z O G o o �� c w �I w 0 • O a� S J 1 O O 1` tiM C O a O{ G 111 v T �_3 0 J H 7 z � ' � `+Page 13 02079 .� Department of P6RT9 )( 2 Z ' "` SOIL EVALUAIIQE Page 1 of 4 = r Safety ! -, inr � 2 �Q24 accordance with Comm 85, Wis. Adm erode Schmitt Soil Testing, Inc. _ = Professional Sin s } County Attach complete site plan on paper not lesc.than 8% x 1 hes in size. Plan must Croix include, but not limited to: vegiral arxT horizontaMference point (BM). direction and Parcel LD. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. pad of: 038-1082-95-000 Please print all information. R Date �p Personal information you provide may be used for seoondary purposes (Privacy Law, s. 15.04 (1) (m)) Property Owner Property Location Govt. Lot NW1/4, NW1/4, S20, T31N, R18W Cloutier, Everett & Adeline -Trust Property Owner's Mailing Address Lot # Blodt � Ar CSpp 1108 Spruce Steel 2 _ CSM Pending Approval L`jty State Zip Code Phone Number City Village Town Nearest Road New Richmond WI 1 54017 651-756-9633 Star Prairie 90Th Street New Construction Use: Residential !Number of bedrooms 4 Code derived design flow rate 600 GPD _ Replacemeif Public or commercial - Describe: - - a f.r+i/t 1 a%&,% NA .. Parent material Glacial Till (Santiago -Antes Silt Loam Series) Flood plain elevation. if applicab{e X General comments Area is suitable for a mound system. System elevation is 100.1 T based on the contour line established at 99.1 V Slope of area is and recommendations: 5%. Depth to limiting factor is 2` 1 Boring # Boring Ground surface elev. 99.21 ft. Depth to limiting factor 27 in. Soil Application Rate Horizon Depth Pit Dominant Color Redox Description - - - Texture Structure Consistence Boundary Roots GPDIft' *EMI jn, Munsell Qu. Sz. Cont. Color Gr. Sz Sh. sl 2mgr mfr as 2f,2vf 0.6 1.0 1 0-10 10yr3/3 none _ « 2 1 10-16 10yr4/4 none 9r51 2fsbk g w 2vf 0.6 1.0 - 3 - 16-27 7.5yr4/6 none 9 1k_ mfr gw _ lvf 0.4 0.7 - 4 A7 7.5yr4/6 c2d 7.5yr6/8 7.5ta6/2 fsl lmsbk - -- mfr gw ----- 0.2 0.6 '7 _ m2d 7.5yr6/8 imsbk mfr _-_ ---- 0.2 0.6 5 47-76 7.5yr4/6 - Boring # Boring Ground surface elev. 99.21 ft. Depth to limiting factor 27 in. Soil Application Rate I I L_J Depth Pit Dominant Color Redox Description - Texture Structure Consisten Boundary Roots GPD/ft' •Eff#t `EfM Horizon Munsell Qu. Sz. Cont. Color Gr Sz. Sh rn. sl 2mgr mvfr as 2m,2vf 0.6 1.0 1 ' 0-10 10yr3/3 none _ __ - - 2msbk mfr gw 2vf I 0.6 1.0 2 10-18 10yr4/4 none sl -- - -- - g� lmsbk mfr gw ivf 0.4 0.7 3 18-27 7.5yr4/6 none 4 27- 7 7.5yr5/6 m2d 7.5yr6/8 7.5yr6/2 g� - - 0m - mfr - as --- 0.2 0.6 - - -- - mad 7.5yr6/8 VN lrrtpl mfr -- ------ 0.2 0.6 5 37-72 7.Syr4/6 - - 7.5yr6/2 -- Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 <30 mg/L and TSS <_30 mg/L CST Number CST Name (Please Print) Signature 227429 Thomas J. Schmitt Date Evaluation Conducted Telephone Number Address Schmitt Sal Testing, Inc. 9/25/2020 715-760-1978 1595 72nd St. New Richmond, WI 54017 Ssn,eha ra AX) f Property Owner Clouti�Everett & Adeline -Trust Parcel ID # 038-1082-95-000 F Boring Boring # ; Pit Ground surface elev. 97.7- ft. Depth to limiting facto Horizon Depth Dominant Color Redox Description Texture Structure Consistence, in. Munsell Qu. Sz, Cont. Color Gr. Sz. Sh. 1 0-11 10yr3/3 none sl 2mgr mvfr 2 11-24 10yr4/4 one al 2msbk mfr 3 24-36 7.5yr4/4 — --- m d 7.5yr62/8 g� lmsbk tttfr 4 36-72 5yr4/4 - - m2d 7.5yr6/8 7.5yr5/2 - Vf51 lmpl - mfr -- — _ Page 2—of 4 in. Soil Application Rate ndary Roots _G_PD/1112 'Effaxl 'EfI#2 as - 2m,2vf 0.6 1.0 gw ivf 0.4 0.6 gw lvf 0.4 0.7 --- ------ 0.2 0.5 Boring Boring # pit Ground surface elev. _ ft. Depth to limiting factor in. Soil Application Ri Horizon �nl Dominant Color Redox DescrMe iption Texture Structure Consistence' Boundary Roots •Et�t GPD Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I Boring to limiting factor in. Soil Application R; Boring # pit Ground surface elev- _ - ft. - - FHorizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ';_ �Efft GTEtflf2 In. Munsell Qu Sz Cont Color Gr Sz Sh Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 <_ 30 mg/L and TSS -00 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 formal. please contact the deportment at 608-266-3151 or ITY 608-264-8777. 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Box 7162 Madison, WI 707 7162 MAR 0 9 02 ry P mit Applicatio SL"ib wte Tnil►saction Number the ►itisrequiredpri —C 32Z00In-c- In a+arrJanix lift 'PS 8 : fsubmission of this li>mi to approlxtate govern Prulect nddress (if different than mailing address) aApplicatiom Corms for statetivineJ Pl)W 1'S are submitted to i i the Department of Sates and Professional Services. Personal intormation you provide may tic used for setxindan purposes in accordance with the Pnv++acv L as 15 040 KM).Stats J �O �� �� 1. Application Information - Please Print All Information Property (Mrier's Name 1E Parcel 4 Pan of038-1082-45• V- Steve Olson Properties l LC Z7q f��-}��/ PntpeAy Location Property (hvncr's Mailing Address 441 Timberlane Dr Govt. Lot N\k '..- S.bi �- Section 20 i lrl'Ic tone) City, Stall !_i Code Phone !sumlx r P�i m Soerset. �41 '40-li f "I \ R 18 E IL Type of Building (check all that apply) I.ot a 2 Subdivision Namewms ®1 or 2 I-atnil} Dwelling - Number of edn1 as t�.! star- t�'tS T" — ❑ Public,Commercial - Describe U _ Block;: ..-- ❑ City of ❑ State Owned - thscribe Use _-_ _ � �� CSM Numbc v 31 ❑ Village of l oven of Star Praise I I1. e o m Check only one box on line A. Complete line B if applicable) ❑ Treatmentil luldin Tank Replacement (fitly ® Replacement System f P (❑ Other Modification u+ Existing System (explain) x. Nev,eSysten i Permit Revision C has c of ❑ Permit Transfer to New List Previous Permit Number and Date Issued ❑ 1 Rene+val ❑ ❑ g �( B. ertnit Before Expiration Plumber 1 Ocaner !/ ^ IV. Type of POWTS System lCom portent! vice: (Check all that a Iv) ❑ Non -Pressurized In-(iround ❑ Pressurized In-Ciround ❑ At -Grade ® Mound 24 in of suitable still ❑ Mound < 24 in. of suitable soil ❑ HolJmg I ask ❑ (fiber Dispersal l ompunent xplain i ! ❑ Pretreatment [ vice (explain) V. Dispersal/Treatment Area Information: �� CL Dispersal rv! Area Required Intl Dispersal Area Pro{ ef31sf1 System Elevation Design Flow (gpd) Design Soil .Application 100,1 1' 0"6 Rate(gpdsl) 450 C acit� in V1. Tank Info' t I i9 Gallons total M of Q Manufacturer U is Gallons Units ^ New Tanks Existing Tanks Septic or I folding Tank 1000 1000 1 U ;-- Concrete El El I Dosing Chamber 650 650 1 W ieser Concrete V11. Responsibility Statement- 1. the undersigned. amwme respimsiMlity for installation of the HT IS show" on the attacked plans. MPAIPRS Number Business Phone �Nw-nlbw Plumber's Name IPrinti Plurvt+er.y sie�tature C 71 i-760-U186 John Schmitt Plumber's Address (Street. City_ State. /Ip l ode) 586 Valley Vie% Trail. Somerset. W'1 54025 �'111. Count /De artment Use Only Permit Fee rlm Isawd is um Agent`19natuTe A Approved ❑ 1 rove 7� q ❑ (hvrtcr (liven Kean lilt Denial S T (J �- LN O� lK 1\. Conditions Appro , U 1 3) SYSTEM OWNAt ' - twj J. Septic tank, effluent filter and t — f fro vt dispersal cell must be_ser_ri9ed Imaintained �, p�,t.�v+,lw[ � � s��tti` C� as per management plan provided by plumber. ;A�o rill �riitp( as per applicable code)MillIAl kte plans for the +ywat and wrloit to the ( "+wan ealy toe Pape alit lift. tha t + I I iacbes is size SBD-6398 I R03/ 14)