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Wisconsin #1 :�yepartmsnt of Commerce PRIVATE SEWAGE SYSTEM Safety_ and Suilding Division ` INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township McDou al, Gerald & Linda I Cady, Town of CST BM Elev: Insp. BM Elev: BM Description: SANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding v � PUMP/SIPHON INFORMATION I Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to well ELEVATION DATA County: Sanitary PerP o: 506294 State PI ID No: Parcel x No: 004- 1018-5 0 Section/Town a/Map No- 08.28.18.126 STATION Bldg. Sewer St/Ht Inlet St/Ht Outlet Bf. System iFinal Grade mug SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia, Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION I I CHAMBER OR Type Of System: UNIT Model Number DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Hir IrItake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes ., No COMMENTS: (Include code discrepencies, pers s present, etc.) Inspection #1: / / Inspection #2: 1 / Location: 438 290th Street Woodville, WI 5402 (N 1/4 SE 8 T28N R18W 0 acres Lot Parcel No: 08.28.18.126 1.) Alt BM DescriptionCf--- 2. Bldgsewer length = - amount of cover = t AV I r I revision Required? � �:� 41 Yes 1 ! No Pan, _ rG�4 Use other side for additional information. Date Insepctor's Signature Cent. No. SBD-6710 (R.3/97) Safety and Buildings Division 201 W. Washington Ave., Box Count), 5' W P.O. 7162 nMadison, W1 53707 - 7162 0 rce (608) 266-3151 Sanitary Permit Number (to be filled in b Co.) �_,1vtV9 d, ry Permit Application State Plan I.D. Number 1, 11 Co .2 1, Wis. Adm. Code, personal information you rovide 3 T. or secondary purposes Pnivacy Law, sl Project Address (if different than mailing address) �39 6441 ormation - Please Print All Information Property Owi)er's NLT 1�(JLA 11111 ) W( I Parcel # Lot Block# - 061ia� Property Own Mallin ddress Ll q& e Property Location A/ '/4, Section V City, State Zip Code Plione Number circle one) C7/ T 2� N RI E or W U 11. LType of Building (check all that apply) Subdivision Naine CSM Number � f�or 2 Family Dwelling - Number of Bedrooms 0 Public/Commercial - Describe Use cff,7%�Alf t2❑ � State Owned - Describe Use L/ OCity—EIVIllage Pf"o"nship of IT]. 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 B. Permit Renewal El Pen -nit Revision El Change of El Permit Transfer to New List Previous Pen -nit Number and Date Issued Before Expiration Plumber Owner -7 3 I IV. Type C�- I A A 11 of POWTS SysteT: Check all that a l jOl L11V rc I U 0 Non -Pressurized In -Ground El Mound > 24 in. of suitable soil bound < 24 in. of suitable s At -Grade El SinglePassSand Filter Constructed Wetland El Pressurized In -Ground D Holding Tank El Peat Filter 0 Aerobic Treatment Unit El Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter El Leaching Chamber El Drip Line Other (e lain) vel-less "X P OPipeEl e-2-7 _<Z4LrY V. Dispersal/Treatment Area Information: I ejvA� It C>eoor J% Design Flow (gpd) Design Soil ion Rate(_zpdsf) Dispersal Areared (sf) 'Dispersal Area Pro osed (st) System Elevation 7' 2 1 1? 3 V1. Tank- Info Capacit/in Gallons Total Gallons Number of Units Manufacturer Prefa b- Concrete Site Constructed Steel Fiber Glass Mastic Ne-.%- Tanks Existing Tanks Septic ov Holding Tank L41t c Aerobic Tueatment Ullit Dosing Chamber 4c) V11. Respon ' sibility Statement- 1, the undersAned, assum6r sponsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Signature Plum is Signature MWMPRS Number Business Phone Number Plumber's Address (Street, City,-ttate, Zip Ce) V11!. C partment Use qnly my/De ._— Approved El Disapproved Sanitary Permit Fee (Includes GrOUndwater Date .issued is ing Agent gnats e t nps) Surcharge Fee) L1 Owner Given Reason for Denial S'S r �/ IX. Conditions of Approval/Reasons for Disapproval YID Attach complete plans (to the County for the s,*"stem on paper not less than 81/2 x I I inches in sizt SBD-6398 (R. 0 1/03) Da, 6 / ''AL AL AAE!L1 I TOWN OF P.V, 'SEC S� AN D;QR LOT THIS PERMIT EXPIRES I ' "A PREVIOU d L I C. # 2?,'b y7 500 R"RnIVIRUnN (a) 3 NOm J 3 9 Z CHAP R 145.135 (2) WISCONSIN STATUTES The purpose of the sanitary permit is to allow Installation of the private sewage system described in the permit. The approval of the sanitary permit Is based on regulations In force on the date of approval. The sanitary permit is valid and may be renewed for a specified period. Changed regulations will not impair the validity of a sanitary permit Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought and that changed regulations may impede renewal. The sanitary permit is transferable. History: 1977 c.168; 1979 c. 34,221;1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. UTHORIZED ISSUING OFFICER -DATE---i/(0/19 T UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division I INSPECTION REPORT GENERAL IRFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04 (1)(m)]. Permit Holder's Name: City Village X Township McDougal, Gerald & Linda I Cady, Town of CST BM Elev.- Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH I Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County-. St. Croix Sanitary Permit No: 0 State Plan ID No: Tax No: 004-1018-50-000 Section/Town/Range/Map No: 08.28.18.126 STATION BS HI FS ELEV. 'Benchmark Alt. BM Bldg. Sewer St/Ht Inlet St/Ht Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe "B_Ot. System Final Grade St Cover BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth I DIMENSIONS I SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR UNIT Manufacturer: Type Of System: Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:—/—/— Inspection #2: Location: 438 290th Street Wilson, WI 54027 (NW 1/4 SE 1/4 8 T28N R1 8W) 80 acres Lot Parcel No: 08-28.18.126 1.) Alt BM Description 2.) Bldg sewer length - amount of cover Plan revision Required? Yes No Use other side for additional information. Date Insepctor's Signature Cent. No. SBD-6710 (R.3/97) Safety and Buildings Division County 201 W. Washington Ave.. 11.0. Box 7162 t LOA 11111 0 be filled in hv Co) Madison AM nitary Permi4,Pmbc-T (to 1� fliSC4 IV 26n1;r-F.1vF_,n., 77Y7 3 Department of Commerce to Plan f.D. Number Sanitary Permit Application, _ �, �' - hiaccord with Comm 93.21, Wis. Adm. Code, personal information you provide Law, $1 .04(l)(m) Address (if different dum mailing address) may be used for secondary purposes Privacy LLaw,, $I. liject L CRQLX QQ� IWA 1. Application Information - Pkase Print All Infoall O"G OFFICE q Lot N Block # Parcel # Property Owner's Nime Property Owners Mailing Address Location 1/4, Section City, State Z'p Code Phone Number 11) V (em e e, 6(e; T 4a N; R one) W 11. T of Building (check all that apply) SubAivision Name CSM Number 7or 2 Family Dwelling - Number of Bedrooms -!r 4ft PubliclCommercial - Describe Use ity-OVillage QTownshipof 0 State Owned - Describe Use 1. Tripe olyrmit: (Check only one box on line A. Complete line B if applicable) 11-r- ti A. e%v System 0 Replacement System El Treatment/Holding Tank Replacement Only ❑ M)er Modification to Existing Systen, B_ El Permit Renewal ❑Permit Revision ❑ Change of D Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber owncr A- 4 IV. T of POWIS S -1pe _ystem-_ -(Cho&-all that "P!Y) �inle Pass Sand Filter 0 Non —Pressurized In -Ground fflr14:!'oLnd ?! 24 in. of suitable sok!7*Vound < 24 in. of suitable soil ❑ At -Grade E) Sg Constructed Wetland ❑ pressurized In -Ground Holding Tank C1 Peat Film 0 Aerobic Treatment unit D Recirculating Sand Filter Cl Recirculating Synthetic Media Filter 0 Leaching Charntia El Drip Line D V el less P0__ A Q Offia (ex iy V. D10spersaffreatment Area Information: Design Flow (gpd) Design Soil Appli t' Rate(pdsf) Dispersal Area R ired (sf) Dispersal Area Propo�o Of) System Elevation ? i Prefab site Steel Fiber Plastic M i�sr Plastic V1. Tank Info Capacity in f Total Number Man Concrete Constructed Glass Gallons Gallons of Units New Ecist g Taaics Tanks SqVIC or Holding Tank j & e-3 C4 Aerobic Treatment Unit r)&LXjC Dosing Chan dxr kz VII. Responsibility Statement- 1, the andersig94 acts r- Hity for InsUllation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber`' ^gnature +PfMPRS Number Business Phone Nu ber 7 i' 40' CA Plumber's Address (Street. CityAltate, Zip COO /415 C'�e 9, � 3 VIlIx.ounly/De'-partment Use Only Sanitary Permit Fee (includes Groundwater Date Issued Is/Sefilg A, Signat r Approval El Disapproved 4� Surcharge Fee) 2 0 Owner Given Reason for Denial e aTps) IX. Conditions o(Approval/Reasons for Disapproval -1 11-S 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber 2. All setback requirements must be maintained as per applicable code/ordinances Attach compkie phm (to the CeaWty on, y) rer the sysim on paper not ka than 81/2 X I I iWilles in size SBD-6398 (R. 01/03) a 1/41 w �� .� �ILI-, kAm, O (,rA- CV- 4c� V�C� tAPI Ol 4 1 t�-Q . c �•6-� w, 4. +- , - � n r*gl- -z- , � (�2 (nctb,� I .-100' commerce-wi.gov n in 41tDepartment of Commerce July'29, 2005 CUST ID No.222774 A TTV.- PO WTS Inspector Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary HENRY F GROTE ZONING OFFICE CERTIFIED SOIL TESTING ST CROIX COUNTY SPIA E4366 353RD AVE 1101 CARMICHAEL RD MENOMONIE WI 54751 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 07/29/2007 Transaction ID No. 1152553 SITE: Site ID No. 692548 Gerald & Linda Mcdougal Please refer to both identification numbers, 190TH Street above, in all correspondence with the agency. Town of Cady St Croix County NW 1 /4) SE 1/4, S89 T28N, R 15 W FOR: Description: Five Bedroom Mound System Object Type: POWTS, Component Manual Regulated Object ID No.: 1027930 Maintenance required-, 750 GPD Flow rate; 9 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Version 2.0, SBD- 1069 1 -P (N.0 1 /0 1), Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01/01); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. Condidi No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, Wft soft Woft K M M M scats. Ar 1J, K The following conditions shall be met during construction or installation and prior to OCCLIpancy or use: D EE QARTMENT 01 ljk OeN OF WTEI Approval Requirements: 0 This system is to be constructed and located in accordance with the enclosed approved plans and with the SEE CORRES "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P(N.01/01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.011 SBD-10706-P (N.01/01). • This plan has an approved Soil Saturation Determination (Transaction I.D. 1085054) associated with the design. All of the conditions for the construction requirements of that approval shall be upheld. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. HENRY F GROTE Page 42 7/29/2005 • Inspection of the POWTS 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. Stat Comm• 83.227(7) A copy of the approved plans, speci ications 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: * Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). * Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. * Comm 83.55 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. 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 Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 10 1. 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 to the owner and any others who are responsible for the installation, operation or maintenance ol'the PONN/'TS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due S 0.00 Charles L Bratz POWTS Reviewer II, Integrated Services WiSMART code: 76.13 (608)789-7893, 7:45 am - 4:30 pm Monday - Friday cbratzr@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 ail IN, W�;_Istr 0 Gerald & Linda Mcdougal -Mound 6 ZOOS Construction Materials and Techniques eU/��/1���_�� All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. Construction methods must comply with the following Component Manuals: Mound, SBD- 10691 -P (0 1 /0 1) Pressure Distribution, SBD-10706-P (Ol/O1) Location: NW 1/4, SE '/4,Sec. 8,T28N,R 15 W Town: Cady County: ST. Croix Date: July 11, 2005 Owner: Gerald & Linda Mcdougal Address: 387 CTHW B Woodville W1 54028 C,!S' 0.0 Designer: genry Gro HENRY ,... GROTE 7• [)-1699 Signature: IKAF-NOMONIE License: WI D — 99-007 /'t gr S I G /I1111110\ Attachments: SBD- 10577 - Plan Approval Application SBD-8330 Interpretive approval letter, 11/18/04 Page 1: cover 2: design criteria & calculations 3: plot plan 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail 7: pump curve 8: system management page of ANj) fv' J -)OND)ENCZ� E Design Criteria Residential Wastewater Contaminant Load: 30 mg/L < BODs < 220 mg/L Anticipated septic tank effluent 30 mg/L, < TSS < 150mg[L Fecal Coliform > 10,000 cfuJ 100 mL Fats, oils, grease < 30 mg/L Bedrooms x 100 gal/bedroom/day x 1.5 gallons/day hydraulic load Design Calculations In situ designed loading rate/ gallons/sq. ft. per day Depth to estimated high ground water in. Depth to bedrock in. Cross slope at system % Force main length 4 2 ft. of ill. Manifold/header length ft. of in. Drain -back gallons Lateral length @ ft. of n. Lateral elevation 0 2, ft. @ bottom of lateral Lateral hole size 3 Z in. @ in. ft.) Spacing holes/lateral holes total Lateral volume gallons Total lateral discharge rate (0 gallons/minute ft. head NetN,�,,ork pressure compensation losses Elevation difference Fr / *on loss U;�4 41 x gallons/minute Total dynamic head k, 4�' t. � ft. Pump/s,"'Oon � gpm ft. of head Manufacturer Model 4 Dose volume gallons Lift/siol�)n tank '2�A �-Aj gallons Septic tank G'� '�O gallons Effluent filter 0 \' 0". . " !\ j Measurement pump on and off in. Height alarm from tank bottom in. Reserve capacity gallons s pecs.calcs. res Page 2of 7� f us f -- " r A �•� op i c' f-,(r04� • .ram �r t W w ctiO0 1 ol V$') C'' a~t` o i j J -q5 o O(p CLV Jv s 491 cam•, � l � `l - � - .,1 � - n,.,1� I d ��ez a� a. CIL 41, le I- rNj owl 00000/ o 4777, -%r QC. \C., \0 fvj� 4V404� 4..� IL C, Lk-- r� ,�,,� C�, r 1.. .r 3--7 r c • (�►24a6 P v C_ c.� .�.. e.. o� V QA 1� C> tIL 4ph �I ?S�Z SAP- 1 0� Lo 4 -}- a ................. .0� r Q AL VEQT CAP H"C,I. VE�JT PIPE WOW • WEATHER PROOF APPROVED LOCKIMC, > Z5' FRC/%� COOR, JUUCTIDQ BOX MA�JHOLE COVER, A a K � t.% G• - WJJ[)0W OR FRESH \- %:N 16 AIR IKJTAKE GRADE OF Q,, � , COQDUIT-/ 61) PROVIDE r AIRTIGHT SEALT I I APPRC)YED JOIKJT5 W/ p p E I ALARM F-)J V- IJ 1) 1 uC, 771 O>JTO 50Lt[) SOIL 0 � PUMP eA OFF 5LOCK -77 10Tl- �' Z 0 0 80 160 240 320 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS 4 Timed dosing panels available. Electncal altemators, 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 130°F (54°C.) special quotation required. 152/153 Series _Model.-_ ^1152 BN 152 E 152 BE 152 N 153 152/153 MODELS _ volts -Ph Mode 1i5� _Non 115 1 Auto 230 1 Non 230 1 Auto 115 1 i Non Control Selection Am Simplex Duplex 8.5 1 2or3 8.5 Included 2 or 3 4.3 1 _ 2 or 3 4.3 Included 2 or 3 10.5 1 2 cx 3 BN 153 _ E 153 T ^BE 153 _ 115 _230 230 1 Auto 1 Non 1 Auto 10.5 5.3 5.3 Included 2 or 3 1 2 or 3 l Included 2 or 3 [o CAUTION] All installation of controls, protection devices and wiring should be done by a qualified licensed electrician. All electrical and safety codes should be followed Including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). TOTAL DYNAMIC HE4/CAPACITY PER MINUTE EFFLUENT AND DEWATER►NG MODE.I i 152 153 Feet MetersT Col. I Liters i Col i ���ters 5 1.5 69 261 77 29' 10 3.1 61 I 231 70 265 15 4.6 53 2�J 61 231 20 6.1 44 34 167 129 52 42 Q7 9 25 7.6 30 9.1 23 ! 87 35 10.7 40 12.2 -- -- .ock Volve: 38.0 F! ;1 ' 6-n) " 44 C 014508 I p -�.. 3 2 7 1 3 2 —T.�-- 4 SELECTION GUIDE 1. Single piggyback variable level float switch or double piggyback vanabie level fioat switch. Refer to FM0477. 2. See FM0712 for correct model of Electncal Alternator E-Pak 3. Variable level control switch 10-0225 used as a control activator, specify duplex [3; or (4) float system. ca � — RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 15347 Louisville KY 40256.034 7 Manufacturers of fJ' v SHIP TO: 3649 Cane Run Road •" r Louisville KY 4021i• 1961 �Z.4117r PUM'OS (502) 778-2731- f (800) 928-PUMP http://www.zoeller.com / fJ/V/� ��. FAX 5Q2 714.3624 ( ) a Copyright 2000 Zoeller Co. All rights reserved. System Management Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber or the St. Croix County Zoning Office, 715-3 86-4680, should be contacted for assistance. General Proper functioning of an on -site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a dose tank or compartment to allow a dose to be accumulated, a pump and controls or automatic siphon, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. 1. If the septic tank is installed prior to sheet -rock and/or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. 2. Install water -saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic or dose tanks are no longer used, they must be properly abandoned. 11. If construction timing and weather could create a frozen infiltration system, weather -proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start-up. 12. Note: the upslope toe of the mound system must be landscaped with additional fill to blend this area into the upslope natural grade; this will minimize the possibility of the system trapping surface run-off; final settled slope should be 2-3% over the system or 2-3% diverting surface run-off around the ends of the system. Maintenance 1. The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. When the septic tank is pumped, any solids in the bottom of the dose tank must be pumped, and the filter must be back -washed into the septic tank to remove accumulated material. System use may require more frequent filter cleaning; initial inspections of the filter should be made every 6 months until a minimum time sequence is determined. 4. Periodic observation pipe inspections should be made by the owner to examine the state of the in -situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. 5. if this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Avoid compaction such as vehicle traffic within 15' down -slope of the adsorption system. 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run-off into the system area. 11. Warning: Do not enter septic, dose or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and/or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 commerce.wi.gov isconsin Department of Commerce November 18, 2004 CUST ID No. 222774 HENRY F GROTE CERTIFIED SOIL TESTING E4366 353RD AVE MENOMONIE WI 54751 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/18/2006 SITE: William Gokay Town of Cady, St Croix County NW 1/4, SE 1/4, S8, T28N, R15W FOR: Object Type: Soil Saturation- Determination R Object ID No.: 993281 Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary A 7 T'N: PO WTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: 1. Approval is hereby granted pursuant to s. Comm 85.60(2), Wis. Adm. Code, to estimate the depth to seasonal soil saturation based on an interpretive determination process. Approval of the interpretive determination negates the requirement in s. Comm 85.30(2)(b), Wis. Adm. Code to designate the ground surface as the higest level of soil saturation when redoximorphic features are less than 4 inches below the bottom of the A horizon. 2. The estimated highest level of prolonged soil saturation approved under this determination is 9 inches below grade. At least 27 inches of sand lift on top of 9 inches of unsaturated, in -situ soil is required for adequate treatment and dispersal. 3. The basal soil application rate for the mound shall be 0.2 gpd/sf, and the linear loading rate 3.75 gpd/ft. 4. Chisel plowing to a depth of 16 inches immediately prior to sand placement is required to improve vertical water movement into the soil solum. 5. 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. HENRY F GROTE Page 2 11718/2004 6. 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. 7. 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. S. 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. If plan index sheets were submitted in lieu of additional full plansets, a copy of this approval letter and index sheet shall be attached to plans that correspond with the copy on file with the Department. 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 Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state scats 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. Sincerely, Leroy G. Jansky, Wastewater Specialist Integrated Services Bureau (715)726-2544 Voice (715)726-2549 Fax lj ansky@commerce. state.wi.us Fee Required $ 100.00 Fee Received $ 100.00 Balance Due $ 0.00 WiSMART code: 7633 commerce.wil-gov isconsin 41 rDepaft*M of Cmm"w Date of Inspection: November 18, 2004 Project Name: Gokay Use: Residential Legal Description: NW, SE, 8128,15W Site Number: 692548 Subdivision: NA Municipality: Town of Cady County: St. Croix Plan Transaction Number: 1085054 Sanitary Permit Number: Wastewater Flow: 600-750 gpd Persons Present: H. Grote INSPECTION REPORT SAFETY AND BUILDINGS DMSION Integrated Services Bureau 13 East Spruce Street Chippewa Falis, WI 54729 Y AN rce AWL" j7 statemi.us/sb fECEI n Plumber Name and Address: NOV 9 2 2004 ST. CRU;X ZONING OFFJCE rti ed Sofl Tester Name and Address: my F. Grote, CST 222774 E4366 153rd Ave Mnom ie WI 54751 enom Owner Naa and Address: Ilr m illiam Gokay W1618 850'h Ave Spring Valley WI 54767 An onsite soils verification was conducted at the above referenced site as per district policy for all sites with less than four inches of unsaturated soil below the bottom of the A horizon. The intent of this investigation is to confirm initial observationt by the certified soil tester (CST) relating to the presence or absence of redoximorphic features in the A horizon and/or subsoil. In -situ soil texture, structure, and consistence factors were also reviewed as they relate to wastewater application rates. Other site conditions such as percent and direction of slope, landscape position, land surface contour length, and surface water hydrology may also be noted and their effects are factors considered in the recommendations and conclusions portion of this report. A typical soil profile at T-1 (near CST B-3) could be described as follows: 00-09" 10YR 3/3 sil, 2f-msbk, mfr, cs. 09-16" 1 OYR 4/4 sil, 2msbk parting to pl, mfr, w/ f2f 1 OYR 6/3 and 5/6 rmfs If a mound system is designed to overcome limitations of a high level of seasonal soil saturation and slow permeability, the linear loading rate should not exceed 4.5 gpd/ft and the basal wastewater application rated sh"U not -exceed 0.2 The additional basal area will partially compensate or eec-rrTd prevent wastewater leakage at the mound toe. At least 27 inghes of san maWed when a2P ying septic lank eMent to the distribution cell of the mound to ensure proper treatment. The longest portion of the 'I - - mound must be orientated along the contour. The mound shall be constructed to divert surface water around the mound structure as much as possible. In addition, an up slope drainage ditch should be considered if it is determined that surface or subsurface hydrology is improved by intercepting water and diverting it away from the mound site. If there are any questions regarding this report, please contact me. JoyyZG!-;Jqnsky, Viistewate pecialist' Ljansky@60m merce state - wi us E-mail 715[726-2544 Voice 715/726-2549 Fax cc: County ❑Plumber CST ❑owner F-1 Other • 'AL ORIGIN :r»r � � 2162 Wisoonsin Depadmn SOIL EVALUATION REPORT Page 1 of 3 Division of'Safety and it ' pcoordange w.4h Comm 85, Wis. Adm. Code Certified Soil Testing Attach complete sibs not lass than 8% x 11 inches in size. County indude, but not limit Q# CgD�oph P;;rto and St. Croix percent slope, sale orParcel I.D. -i i.".0-000 Pcl 8.28,151125 Please p n Wmatton. B Date Personal in m 6w you p ovWe may be used for sec rKWy puF wn (Pmacy Law, s. 15.04 (1 ) (m)}. 76okay�, y Owner Property Location INiilism Govt. Lot NW 1 /4 SE 1 /4 S 8 T 28 N R 15 W Property Owners Mailing Address Lot # Bk)ck # Subd. Name or CSM# W. 1618 850th Ave. City - State Zip Code Phone Number City Village Is Town Neamst Road Spring Valley WEL 54767 715-772-3293 Cady 290Th St, Fjg New Construction Use: Residential / Number of bedroom* 5 Code derived design flow rate 750 GPD ` Replacement Public or oommercal •Describe: Parent material loess over till Flood plain elevation, if applicable NA General comments 1111 and recommendati s: most soils in study area lack A+4"; inte retive determination required with state and county approval AZt.�_� 14/.v ?16 �A 1 spring # JW Boring I M Pit Ground Surface elev. 98.7 ft. iting factor 1 in. Sod Application Rate Depth to airn Horizon MEMNON Depth in. Dominant C w Murtsell Redox Description Qu. Sz. Coat. Color Texture struc#um Gr. SL Sh. Wera Boundary Roots 'Eff#1 1 0-9 10YR 3/3 - sil 2 f sbk mvfr cs 1 f/m .S .8 2 3 9-13 13-27 1 OYR 4/4 1 OYR 4/4 - sill 2 f-m sbk mvfr cs 1 m .6 .8 f2f 7.5YR 4/4 sl 1 m sbk mvfr gs 1 m .4 ; .7 4 27-37 7.5YR 4/4 c?5YR 5434 scl 0 m 1 mvfr 1 - 1 m 0 0 i rro-OTSto pro a ust makes +4 ; sorne s ; 1 rn ; -side- seep Boring # A Boring ja Pit Ground Surface elev. 99. $ ft. Depth to limiting factor 0 in. Sod Application Rate Horizon Depth in. Dominant Color Murisd Redact Description Qu. SL Coat. Color Ta Ue Structure Gr. Sz. Sh. Conststenoe Boundary Roots f'f# 1 2 1 0-9 10YR 313 - sill 2 f sbk mvfr cs if .6 .8 2 9-15 10YR 4/4 7.5 YR /6 f1 I OYR 6/2 sil 2 f-m pi mvfr Cs 1f 0 .2 3 15-22 1 OYR 4/4 ff2p 7.5YR 4/6 sl 1 m sbk mvfr gs 1 m .4 .7 4 22-36 7.5YR 4/4 c .5YR 513a scl 0 rn mvfr - if 0 0 -lacks +4";presumpt a fimftCr; some I OYR 4/4 sil inclusions 11 ; 1 f roots to 30n; s e seep Q 30" ' Effluent #1 = BODS> 30 < 220 mg/L and TSS > < 150 ' Effluent #2 = BO < 30 mg/L and TSS 5 30 mgL "AMEMEMEMECST Name (Please Print) Sign u CS Number Henry F. Grote 1 222774 Address Certified Soil Testing volua ucted Telephone Number E. 4366 353rd Ave., Menomonie, Wl 54751 ��, 1/1 /20715-233-0398 ��p b Y �5r =� I•i j1 T Ul.k.A.11.11 "A r> 7030,0 9 7� T �.t;�r►7 J � � /4n t (� • ate► �� , O +~') low VON, t �,��� dot �.,� ;-1 , Ir i.a 1 fi . // i-% /,'r 7 � / d% 1 Eno--�—r� JVa *OV �� 1 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address le e e- e LtJ(A 4, Property Address �i (Verification required from Planning Department for new construction) T City/State itl LEGAL DESCRIPTION Parcel Identification Number 00c(_ ovo Property Location V4 '/4, Sec. T �9 kNk-R 1'k W, Town ©f L U Subdivision Lot # 6 V �_��Certified' Survey Map # V Volume Page # Warranty Deed # %rL1 Volume a9- ,Page # 3 � � Spec house 0 yes Ono Lot lines identifiable &5es El no SYSTEMMAINTENANCE Improper use and maintenance of your septic system could result in its premature, failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year ex iration da r7 % 4,17: 7 IL6 k ' SIGN'AfURE OF A�PPLICAN`0 DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described a 3ve, by virtue a warranty deed recorded in Register of Deeds Off -ice. S ATURE OF APPLICANT DATE * * * * * * Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department.****** Include with this application.- a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed V � s Document Number U 2 7 3 0 P 382 STATE BAR OF WISCONSIN FORM 2- 2000 WARPANTY DEED THIS DEEM, made between Richard Francis Gruber, Jeanne Marie Littrell, Patricia Ann Benson, Gregory Paul Gruber, Deanna Mary Gavin, Anita Lynn Gokey, Catherine Joan Kloster aka Catharine Joan Kloster and Francis Joseph Gruber Grantor, and Gerald L. McDougal Jr and Linda A. McDougal, husband and wife, as Survivorship Marital Property, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: SEE ATTACHED EXHIBIT A Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this 30th day of December, 2004. :Zk�lclAw * ERncis Jase h Gruber f Aa�o Deanna Miry gavin i * Greaou Paul Gruber * Jeanne Marie Littrell AUTHENTICATION Signature(s) authenticated this 30th day of December, 2004 TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY �74s Ae+4B4sz5 KATHLEEN He WALSH REGISTER OF DEEDS ST. CRO I K CO,, WI RECEIVED FOR RECORD 01/12/2005 12:45PH WARRANTY DEED EXQNPT # REC FEE: 134,00 TRANS FEE: 771.99 COPY FEE: CC FEE: PAGES: 2 Recording Area Name and Return Address: .tkk+iro Edina R Tti ie 400 S. 2" d S uite 115 Hudso 154 4 2 004-1018-40-000 & 50-000 Parcel identification Number (PIN) This is not homestead property. * Catherine Joan Klost aka Catharine Joa oster �* Anita Lnn Go- ey * Patricia Ann Benson A _A1914 -A - �A�- f 4:e'ar-�00 -j. id *Richard Francis G bet Peterson, Frarn & Bergman — Steven H. Bruns 50 East Fifth Street, St. Paul, MN 55101 - W A, R 9 AbtTy nv_ Es? -.�T�AR OF WISCONSIN (Signatures may be authenticated or acknowledged. Both are not necessary.) al Sew ices ,.geiro Leg84 A EDIT a48 39 42s4 b NND 3313 FORM No.2-2000 \3 U 2730P 383 ACKNOWLEDGMENT STATE OF WISCONSIN } PIERCE COUNTY Personally came before me this December 30, 2004 the above named Francis Joseph Gruber, a 5 l person, Anita Lynn Gokey, a married person, Deanna ary Gavin, a married person and Francis Joseph Gruber, att me in fact for the follow vidiials Richard Francis Gruber, a married person, Jeanne Marie Littrell, a married person, Patricia Ann Benson, a married person, Gregory Paul Gruber, a married person, and Catherine Joan Kloster aka Catharine Joan Kloster, a married person to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. Jaime VanHouten Notary Public Sty of Wisconsin ------------- *] ime VanHouten N ary Public, State of Wisconsin My commission is permanent. (If not, state expiration date: 7/27/2008 } EXHIBIT A Parcel l : Northwest Quarter (NW '/. ) of the Southeast Quarter (SE 1/4 ) in Section 8, Township 28 North, Range 15 West, St. Croix County, Wisconsin. AND Parcel 2: Northeast Quarter (NE '/4) of the Southeast Quarter (SE '/4) in Section 8, Township 28 North, Range 15 West, St. Croix County, Wisconsin.