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002-1082-20-000
t, Wisconsin Depa7tment•ofCommerce PRIVATE SEWAGE SYSTEM Safety and Building 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)]. ermit Holder's Name: City Village X Township Holldorf, Brian Baldwin, Town of :ST BM Elev: Insp. BM Elev: BM Description: 5 ~ ~ TANK INFORMATION TYPE MANUFACTURER I~~ CAPACITY Septic T,n. '7 ~ , ~ ; /Ci7p Dosing C ` a,,~ ~ o D ~5O Aeration ~~ Zc/-4.¢~L~ ~°' /~~ Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD J Septic IL ~ yL ~ ~00 t Q / ~O -' Dosing ~Z~ 7Z' bpi b , Aeration 5 / B' Holding PUMP/SIPHON INFORMATION .~ ~ Manufacturer ~~ U~ ~ Demand G Model Number ~~oS ~ g' ~~ TDH Lift ~ • ~ Friction Loss /- Zc~ System Head 3• zs TDH Ft Forcemain Length ~ -gyp Dia. ~ / Z Dist. to well ~ 7 z SOIL ABSORPTION SYSTEM County: St. Croix Sanitary Permit No: 499171 0 State Plan ID No: Parcel Tax No: 002-1082-20-000 Section/Town/Range/Map No: 33.29.16.481 B ELEVATION DATA STATION # BS Z • ~o HI /02 . La FS ELEV. ~ v~ Benchmark z . zo io x.45 ~r`r• z,5 Alt.i lei- Co,>w ~ 5.~ 9(p • Bldg. Sewer SUHt inlet /Z . /b ~. 3s SUHt Outlet ~ ~ Dt Inlet ~ -~ Dt Bottom K.75 g'S.7 Header/Man. ~, 7.3a 95.3 Dist. Pipe * 7.30 ~S 3 Bot. System * ~.~s sy. ~s Final Grade ~ ~ . 3 0 9~ • ,~ St Cover ~` 5 . Zb Ge~n,TOV~ ~.p 93•`¢5 ,I BED/TRENCH Width ~ Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS -7 ~ ~ ~ ~ ` `- ~ ~ SETBACK M N SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: ~ INFOR ATIO Type„Of~ystem: 5 / 5~ / 9O / ~ A _ UNIT Model Number: ^ISTRIBUTION SYSTEM r,1s.~! Header/Manifold i / /I Z Distribution L ~2~ ( t' / / Pi e s ~ ~ , / x Hole Si ~ ~ x Hole Spacing ~~ Ve+~o Air take 1 J ~ th ~Z Dia ~ L J z Dia L S acin Len th ~~~ g 3b G w eng p g g SOII .COVER Y Dro~m.rn Cvefcmc Only YY Mn11nl1 f7Y ~I-(iPaflP SVStBmS OnIIV Depth Over / t d/T h C B 55 Depth Over d/Tren h Ed es B xx Depth of soil To xx Seeded/Sodded xx Mulched ~ er (• renc en e g ` e c p ` ~„~ Yes No es i, No /• 3 a f; COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~~ / 3 / h° ~' /Inspection #2: / / Location: 2377 U.S. Hwy 12 Baldwin, WI 54002 {NW 1/4 NE 1/4 33 T29N R16W) metes & bouCnds1 Loft r n~~/) v Parcel No: 33.29.16.4816 1.) Alt BM Description = ~~G° (_.b~ ~.~ C ~~l ~5 ~ ~ e~ O r~ 2.) Bldg sewer length = ~~~~~ -amount of cover = 7 `~Z ~~ ~ Plan revision Required? Yes No _ ~ , (- Or -__ __ - / ~3~( ~~ Use other side for additional information. ~ `D'ane \o tO Cert. No. I SBD-6710 (R.3/97) r ' Safety and Buildings Division Countys,~ e ~ [ ° ` ~ ~ 201 W. Washington Ave., P.O. Box 7162 ~scons~n Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266-3151 sll9~~ ~~ Sanitary Permit Application P fan I D. Number ' In accord with Comm 83.21, Wis. Adm. Code, personal information you provide n / Q / L ~ !V ~ '~ ~O v~ (O may be used for secondary purposes Privacy !` ` ~ ~ ~ Project Address (if different than mailing address) L.P 1 lP I. Application Information -Please Print All Inform ~ Z ~ ~ Z ~ ~ ~~~' v.s . Property Owner's Na me I l l I ~ ~ f, Parcel N Lot 1/ lock # w / Q ` a~~~ / ST. CROiXCOUN~fY ~~J Property Ow n er's M ailing A dd ress P r operty Loc at ion / `~ ~ ~ ( ~ ~ / ? ~/ / ~ u~ / LLu ` ` ~ J n / lV ~ y CY ~ ~/ ~~ S ti City/`,~Stnate / ! . l ~J/~ f ~Cy ; ~ fi W r Zip Code S~ ~~C7L ~Z.. Pho/ne Nu CO ~ ~ ,~ ~~~ ,, a, on ec ~ ,l `7 / / (circl one) ~ ~$ l II T f B ildi T ~_ N; R G or W . e o u ng (check all that apply) ' ~ ~ ~ r`~' ~~ ~-' Subdivision Name CSM Number or 2 Family Dwelling -Number of Bedrooms n ^ Public/Commercial -Describe Use ~" d/~.d~'S ^ State Owned -Describe Use Lo .rj~ X Ll~i~ py ~ ^City ^Village'~Township of Q5L rvt to III. Type of Permit: (Check only one box on line A. Complete line B if applicable) ~Z -• Z -• ~ -' `~' ^ New S stem y Re lacement S stem ~ p y ^ TreatmenUHolding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner 1V. Ty of POWTS System; (Check all that ap ly) ~ ^ Non -Pressurized In-Ground Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recir lating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) q~, /5" V. Dis ersal/Treatment Area Information: . ZS Design~F~/ ~gpd~ Z Design ~il Application gpdsf) / ~ Dispers~ Ar~ equir ~ C U Disper~ Ar~Propose ~~ ~ ~ System~l~~tion !f V D ,~~ ~ ~ / ` ~ ~ , t VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Seel Fiber PI3S[iC Gallons Gallons of Units Concrete Constructed Glass New Existing ~ Tanks Tanks ~ ~ ~~ Septic or Holding Tank ~ G L ~[ 1 l ~ r ..G ~ ~ ~ J Aerobic Treatmen[ Unit Dosing Chamber 4 f~ t t= Q /~~ J VII: Responsibility Statement- I; the unders' ed; assume responsibility for insta anon of the POWTS shown on the attached plans. Plumber's Na me (Print) r ~ ~b ~ Plum s Si gnature MPRS Number ~ ~ Business Phone Number -~ i e .. 1~- !~ 7 c~ .3 ~ ,~ Plumber's Addre ss (Street, ~ y, State, Zip ode) VIII. Count /De artment Use Onl Approved ^ Disapprov Sanitary Permit Fee (includes Groundwater Surcharge Fee) ~ ~C ~ ~ Date I sued L O Issuing t Signatu ( tamps) ^ er Given Reason fo enial J ~ f J IX. Conditions of Approval/Reasons for Disapproval 3~ (~ 5 ~tM.. ~ O I ~ ~" L SYSTEM OWNER: t~ cv ba ~tcQo t. Septk: trait, effluent BKer and (~ ~ ~ Or . dispersal cell moat a0 be services /maintained as per management plan provided by plumber. ~, /~ ~ y,~ / 2. All setback requirements must be maintained /.~ J ~jr7d(,QG c ~tv~'l5 ~ t~ Lry ~. ~ ~ ~`"`"~. ~^~ / as per ~pikable cede / txdututces. t (~ 11 ni~acn complete plans (to the County only) for the system on paper not less Wan 812 x 11 inches in size SBD-6398 (R. 01/03) ~rl~tr ~o{~~tOr~ a3~~ ~ s_ c-~ WY rZ 1-~4.~~.w:,~1 t..1 i sL S yOn~. N~,yy~ ~IE~lY~ 533~Tay~,~iew -7-0,~ ~. o -~ .3Q ~aw:~ S'r. Crc:~t C-i-Y =.D ~- t~~Z- I~SL- 2tJ- e~00 L okh ~ = Std.?~ ~! ~~•~3 ~.`~~ _-. L - t~~'~y ~.'es~~- ~ ~ ~ Jbb ~ bP ~~ ~~~ ~ ~~O° "~~ 8 _ J~ 7 ~na5 ~` ~ ~~'~' t° ~~ t s . ..moo 13 - ~- a 3' ~~. {~~ ~. O le~~J ~ "`~ QS 3s... r c~5,~5' ~- 5~ - ~~~t~~~ ~3~IS' R L : ,, L Lit ~ ~ ~- 3 ~~ ~_ ~ ~- r ~4 _ _~~ 5 _ /7; /~ t~ ~ ~~~~ ... -- ~~®~~" i _ ~ ~~~}i t-~ ~e'~~ii ..i ~ a \ ~~~~ r .k $o Q`'-L -- -~ ,gt~i2 ~a ~~~ f C ~ 3' -~ ~ ~~ ~ . . z ~ _ _, a ~. ~L t ~~ i i t i ,_ r -- ~ f ' 1~ p~~~ga~~~ ~rl~v1 ~o~t~~rT a3'7~ v.s. HWY~z C3 S, l c~. ~,.; ,.~ , t,.J c s ~ s ~ ov z N,~,~/y~ ~tE~/Y~ 5 33~T a~n1, R~ ew To,..i r. o -P Zia \ d •..,; •. S't_ Cra>>t c-~'Y ~~.~ d~~~~ ~ ~'~ LOt L. h G ~ ~ ~- 3 ~~ ~_ ~ ~L - ~ r ~~ -~ - ~.,~' '~ ct~, 5 ... /~: /~ t6 ~ ~~~~ ~~ "` ~ - . i -- -. 9 -~' i .- -- - r-- w.'eSe 8 _ (' ~ ~ ~~~s j~i6~t6rr~ m'3" S. ~''~~ ~~~ ~~' ~. ~' - minas Q 3 ~ ~ sJ t .,~o~ t3~- - ~~ ~ _' 3 5, - ~ ~ _`( qS - r ~ ~~t~~~ ~3 ~' _ ~~a~~- .~..._._...n._.____m~..-___ ~ ~ " ~v _ ~~ -- - ~ -~- ;~ ~~~ -~~ ti,.~R b - :~ ~ a ~ f ~ ~'~~ti _ ~`~`~ $ °. -. .+~~ ~a ~S~ i p~~ ~ ~- = ( S I(f ~ ~ t'. ~- a -_ ~~ r ~; r' ; a ~~ i S a ,, Wisconsin Department of Commerce IL EVALUATION REPORT p~ 1 ~ 5 Division of Safety and Buildings m ac:~vraanoe wan t,.omm a~, vvtis. rwm. ~.uue County St. Croix Attach complete site plan on pa er not less than 81/2 x 11 inches in size Plan must . p include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D. 002-1082-20-000 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all i~ormation. Review y Date f i tt / ~~ ° ~ ormat on you provide may be u for .15.04 (1) (m)). Personal in j J Property Owner roperty Location ^ ^ Brian W. Holl orf v(. Lot NW 1/4 NE 1/4 S 3 T 29 N R 16 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 2377 U.S. H 12 City State Zip Code Phone Number ity ~~Ilage Town Nearest Road Baldwin Wi. 54002 ( - U S Hwy 12 ® New Construction Use Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Q Replacement ~ Pubiic or commercial -Describe: Parent material Glacial Till Fiood Plain elevation if applicable ~1/~ ft. General comments and recommendations: Mound System Contour @ 93.45 Note: Page 5 1^ Boring # ^ Boring Pit Ground surface elev. 91.6 ft. Depth to limiting factor 30 ;n. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Dlff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-8 10Yr3/4 -- 1 lfbk mfr cs 2f 0.4 0.6 2 8-21 10YR4/4 -- sl 1 fbk mfi' cs 1 f 0.4 0.6 3 21-30 7.SYR4/4 -- cosl 2mgr mfr cw --- 0.6 1.0 4 30-48 7.SYR4/4 c2d5 sYRS/5 spots sc 2m mfi cw --- 0.2 0.3 2 Boring # ~ Bonng 93.15 21 pit Ground surface elev. ft. Depth to limiting factor in. Soil licatron Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10YR3/7 --- 1 1}bk mfr cs 2f 0.4 0.6 2 9-21 10YR4/4 -- sl lfbk mfr cs 1 f 0.4 0.6 3 21-30 7.SYR4/4 c2d5Ylt5/5 spots cosl 2mgr mfr cw __ 0.6 1.0 4 30-48 7.SYR4/4 c2d5YR5/5 spots ~ 2mgr mfi cw - 0.2 0.3 Effluent #1 = 1317D > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature// ,, ~/ CST Number Thomas W. Gedatus Z$~ fir ,~.~i '+ 962178 Address Date Evaluation Conducted Telephone Number Stang Plumbing & Electric P.O. Box 263 Woodville, Wisc. 54028 g/28/2006 1-715-684-5166 Property Owner Brian Holldorf Parcel ID # 002-1082-20-000 Page of 3 Boring Boring # ®Pd Ground surface elev. 89.95 ft Depth to limiting factor 10 n. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *E1f#1 *Eff#2 1 0-10 10YR4/4 -- I 1>`bk mfr cs 2f 0.4 0.6 2 10-21 IOYRb/3 c2d5YR5/5 sl 2m mfr cs 1f 0.4 0.6 3 21-38 10YR6/3 d~ sc 2mgr mfi cw -- 0.2 0.3 a Borin # ~l Boring f g ~ pit Ground surface elev. 95.35 ft. Depth to limiting factor 23 in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/If in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0_g 10YR4/4 --- I ltbk mfr cs 2f 0.4 0.6 2 8-14 4 sl ltbk mfr cs if 0.4 O.b 3 14-23 7.SYR4/4 --- cost 2mgr mfr cw --- 0.6 1.0 4 23-48 2.SYR3/3 c2d5YR5/8 sc 2mgr mfi cw --- 0,2 0.3 Boring # ~ Boring 95.75 22 ~ ^ Pit Ground surface elev. ft. Depth to limiting factor in, Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/tt= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eif#1 *Eff#2 1 p_g 10YR3/3 ___ 1 lfbk infi' cs 2f 0.4 0.6 2 8-16 YR4/ sl lf~k mfr cs if 0.4 0.6 3 16-22 IOYRS/4 ___ cosl 2mgr mfr cw -- 0.6 1.0 4 22-48 10YR5/4 c2d7.5YR5/8 sc 2m mfi cw --- 0.2 0.3 ...--~ * Effluent #1 = BOD, > 30 <_ 220 rrxyL and TSS >30 < 150 mg/I. * Effluent #2 = BODg <_ 30 mglL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the departtnem at 608-266-3151 or TTY 608-264-8777. SBD-8330Tast (807/00) r ; q '\ X377 v, S, h~wY rZ N w yN1 N r '~~, ~ 3 3~ T z 5 N, rP /6 w Tb w r o -P ~ ~~ d ~ ; ~ S~- C r a°s ~- C -i"y /tea roc i ~ b ~ ©OZ" ID82-Zc~-ooo C57 ~ c~,Z~~Q w, ~ L e ~;m~ ~. ~, ~~3 ~~ ,~ - ~~~~. .l r..n ~_~~„ ~~5 ,~ ~S ~6~t~n~- air S, ~'`~~ 13~ ~~ . ,~nk5 a 3 • ~ s'' ~ ~'-~° 13 ~- ~ ~_ ~ ~q~~~~' R L( (,~ /) 3 s~ r ~ - ~~ ~- .®_ ~5.~ ~ {~ ~ ~~,t~~~ t3 ~~5' 1~ ,~ ' \ ~ ~_3~ _~ ~~ .~ ° ~ ' ~_ ~.~ . -. __ . , i / FC ~ ~Lt F ~ ~ 4i O-i ~ Q~ - ° ~m~ ~~ e 3 ~~ ~~~ ~,' ¢ j Page 1 of Joe: Stang From: Ryan Yarringfion [ryany~CO.Saint-Cnwc.W1.USJ Sent; Tuesday, August 29, 2006 8:51 AM To: stangs~baWwin-telecam.r'Iet Subject; FW: Mound over old system ----Original Message----- From: k~nsky, Leroy [mailboxljanskY~c:ornmerae.stabe.wi.us] Sent: Tuesday, August 29, 2006 6:44 AM To: Ryan YaMng6on ' Subiectr ltE: Mound over old s~tsfiem I think we want to stay away from th A+0 area since we usually want a low LLR and this site is not real long on the contour. If under any part of the mound, the old outfall pipe needs to be cut off and backfi{{ed near its end point. The pipe's depth of cover should generally keep untreated effluent from entering it and cutting it off from the outfall should prevent a surface discharge. Actually, if the seepage pit was removed and backfifled with ASTM C33 sand, the mound could go over the pit too. Leroy G. Jansky, PSS Wastewater Specialist 13 E. Spruce Street Chippewa Falls, V1A 54729 ;715) 726-2544 Voice ;715) 726 2549 Fax _eroy.Jara;lcy(g?VVisconsin.gov From: Ryan Yarrington [tttailbD:ryany~OO.Saint-Cronc.WI.US] Sent: Monday. August 28, 2006 4:09 PM To: ijanskY@oanmerge.statie.wi.us Subject: Mound over oki system Leroy. We have a soil tester working on a n3placement site with some tight setbacks. To the north is the old drywall, do the south(downsloPe) is A+0 conditions and east west are lot lines. 1 am going to draw a sketch and fax it over. Is there a problem with a small portion of the system lying over the old perforated overflow pipe? Redox at 21" pine is 64" below grade? Give me a call with Questions Thanks Zoning Terhuic~iNn Sty G~bis C'onut3- 1101 Caavuc~ht~el Rd Hodson, WI v401G ~ 1a-3$6-430 rya ny@co.sa i nt"crox.wi. us q~e ° ~ ~ "l9/2006 / 2 (~ Safety and Buildings commerce.wi.gov t/p ~ _ ` ~ ~ ~~~ ~ ~'" ~ ~ ~q CROSSE WI 5460EE 3D ~ ~ TDD #: (608) 264-8777 i sco n s i n w~.~ommerce.wi.gov/sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary September 13, 2006 CUST ID No. 223475 70E STANG STANG PLUMBING & ELECTRIC PO BOX 263 WOODVILLE WI 54028 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/13/2008 Identification. Numbers Transaction ID No. 1318709 SITE: Site ID No. 718056 Brain Holldorf Please refer to both identification numbers,.. 2377 US Hwy 12 above, in all corres ondence with thew enc . Town of Baldwin St. Croix County NW1/4, NE1/4, 533, T29N, R16W FOR: Description: Three Bedroom Replacement Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1096501 Maintenance required; 450 GPD Flow rate; 21 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1) 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. 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: • This system is to be located and constructed in accordance with the enclosed approved plans and with the component manual(s) referenced above. • 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. • 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. Stats. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the tank filter for maintenance purposes must be provided per Comm 84.25(7), Wis. Adm. Code. • The existing POWTS shall be properly abandoned per Comm 83.33, Wis. Adm. Code. • Comm 83.22(71- A conv of the aonroved nlans. snecifications and this letter shall be on-site durin construction and open to inspection by authorized representatives of the Department which may include local inspectors. P.~.~.-~ ~. Cc~~i~itionc,rlly ~ ~~~ D f1[DA OT~AC-IT (1C !`AAA IJIFQ(`G .. JOE STANG Owner Responsibilities: Page 2 9/13/2006 • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) -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. 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 Safety & Buildings 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 to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon -Fri, 7:15 am - 4:00 pm j erry. swim@wiscons in. gov cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 R'~QND PRESSURE DISTRIBUTION COMPONENT DESIGN 7 2006 Residential Application AUG ~ INDEX AND TITLE PAGE SAFE & BU-I.~-NGS Project Name: Holldorf Replacement Mound Owner's Name: Brian W. Holldorf Owner's Address: 2377 U.S. Hwy 12 Baldwin, Wisc. 54002 Legal Description: NW 1/4, NE 1/4, S 33, T 29 N, R 16 W Township: Baldwin County: St. Croix Subdivision Name: Lot Number: Block Number: '~ Parcel I.D. Number. 002-1082-20-000 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan Page 9 Soil Evaluation Report Page 10 Letter from Leroy Jansky Designer: Joe Stan License Number: 223475 Date: 08/3 06 _ Phone Number: (715) 684-5166 Signature: ~ Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) Version 4.01 (R. 09/04) - Page 1 of 10 D1VlS~(~PJ ~F SAFETY AN[7 i3Ull ~fNGS _E ~;ORF~ES ONDENCE Mound and Pressure Distribution Component Design Design Worksheet Site Inform ation (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) 7.00 Site Slope (%) 93.45 Contour Line Elevation (ft) 21.00 Depth to Limiting Factor (in) 0.40 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 65.00 Dispersal Cell Length Along Contour (ft) _ 1.00 Dispersal Cell Design Loading Rate (gpd/ftz) 1 Influent Wastewater Quality (1 or 2) Pressure Disribution Information ~,3~ /~ -~y , (c ore) a Center or End Manifold 3.47 Lateral Spacing (ft) 2 Number of Laterals 0.188 Orifice Diameter (in) (e.g. 0.25) 3.00 Estimated Orifice Spacing (ft) _ 2.00 Forcemain Diameter (in) 75.00 Forcemain Length (ft) 84.70 Pump Tank Elevation (ft) 3.25 System Head (ft) x 1.3 9.75 Vertical Lift (ft) 1.35 Friction Loss (ft) 14.35 Total Dynamic Head (ft) Lateral Diameter Selection in. dia. o tions choice 0.75 1.00 1.25 1.50 x x 2.00 x 3.00 x Treatment Tank Information 1000.00 Septic Tank Capacity (gal) Wieser Manufacturer Note: Sand fill (D) calculations assume a Table 83-44-3 in-situ soil treatment for fecal col'rform of <= 36 inches. 6.93 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. 10.24 ftz/orifice Does the forcemain drain back? Y Enter Y or N 12.23 Forcemain Drainback (gal) 58.19 5x Void Volume (gal) 70.42 Minimum Dose Volume (gal) 28.84 System Demand (gpm) Manifold Diameter Selection in, dia. o tions choice 1.25 x 1.50 x x 2.00 3.00 Gallons/Inch Calculator (optional) 650.00 Total Tank Capacity (gal) 38.00 Total Working Liquid Depth (in) 17.11 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 650.00 Dose Tank Capacity (gal) Zabel Filter Manufacturer 17.00 Dose Tank Volume (gal/in) A100 Filter Model Number Wieser Manufacturer Project: Holldorf Replacement Mound Page 2 of 10 Mound Plan View 1_ ..................................... l 1 /10 B~ • 'Observation Pipe ' Q .. ... .. ..... K. .... .. ............. O ~: 1 I L -~ Mound Component Dimensions -T -~ _~ -! H 1.00 ft K 9.85 ft z 11.49 ft L 84.71 ft J 6.30 ft W 24.73 ft 1197.56 (ft2) Basal Area Available 6.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 96.49 (ft) -- }}} }~,.. G * H ,~ . s}}f}}}}}} 2 }}},+}}}}s, j . } J }}}}}{.. T F . ~ : ~ : ~~ ~~~~~ 95.20 (ft) nvteral Dispersal Cell 94.70 (ft) --- - I ert Dispersal Cell 3~ ~ ~ ~ ~ : ~ Elevation E ~ D : : ~: ..... ~~ _..~1.. _ .... ~...~....... 7.0 % Site Slope Shading Key 10 Topsoil Cap }}}}} Subsoil Cap © ~ • = : = • ASTM C33 Sand ._,A"~• a"~,~ Tilled Layer ~5 :~:•._:~ : Aggregate A 6.93 ft E 20.82 in B 65.00 ft F 9.50 in D 15.00 in G 0.50 ft 450.45 (ft2) Dispersal Cell Area 6.92 (gpd/ft) Linear Loading Rate '° a ~ Dispersal Cell ~ 'ii c 1.5 ft ~a ~ ~ ~ 0.5 ft Typical Lateral ~ c ~- A 93.45 (ft) Contour Elevation Geotextile Fabric Cover See lateral details on y- Page 4 for number, size, I and spacing of laterals. F Laterals are equally spaced from the distribution cell's centerline in the ' distribution cell (AxB). Project: Holldorf Replacement Mound Page 3 of 10 End Connection Lateral Layout Diagram Laterals centered aver the A & B dimension ~ =Turn-up wi'bsll valve or cfeanoutplug e P All laterals are identical ~E X---~' Holes drtlled on the bottom of the lateral { equally spaced Farce main connection via tee or crass to maniFald at any paint. Laterals & Farce main of PVC Sch 40 [per COMM Table 84.30-5j Number of Laterals 2 Orifice Diameter Lateral Diameter 1.50 in Orifice Spacing (X) Lateral Length (P) 63.42 ft Orifices per Lateral Lateral Spacing (S) 3.47 ft Orifice Density Lateral Flow Rate 14.42 gpm Manifold Length System Flow Rate 28.84 gpm Manifold Diameter Total Dynamic Head 14.35 ft Forcemain Velocity Dose Tank Information Electrical as per NEC 300 and --~ Comm 16.28 WAC ~_ ~ Disconnect Tank component is properly vented Wieser Ca aci 650.00 Volume 17.00 Manufacturer Gallons gal/inch Dimension Inches Gallons A 23.09 392.58 B 2.00 34.00 C 4.14 70.42 D 9.00 153.00 Total 38.24 650.00 A B C D under tank. Alarm Manuafacturer SJE-Rhombus Controls Alarm Model Number Tank Alert 1 Pump Manufacturer Goulds ./ Pump Model Number 3871 EPOS Pump Must Deliver 28.84 gpm at 14.35 ft TDH 0.188 in 3.02 ft 22 10.24 ftz/orifice 3.47 ft 1.50 in 2.94 ft/sec Locking cover with warning label and locking device and sealed watertight i ~4 in. min. ~ Aftemate outlet location Forcemain diameter ~ 2 in. Weep hole or anti- siphon device P• ump off elevation (ft) 85.45 Dose- tank elevation (ft) 84.70 Project: Holldorf Replacement Mound Page 4 of 10 ~~~aaas cps .~ .... ~~ ~~ . ~, .,~ .~ .~ - •~~ ~.~. •c~.a~e~,4m68s~. •~aa~..Rti~it~. -~ .~ ~F~v . 18~F~giMa~illeat ~~easa~~ sled - .~¢ ~ y~ '~~P~~fR 115 or 2301 64 H~,155D i81Yl.biitiowwffi '~~~ 115Y~s2~5t1#f~ 1558 I~biitiRa+siloadwih ~~'~~ ~~~ ~ ~5~~~ ~~ 1~ ~~ .~ ,~~~ ~~~ ^eo~t~~- ~~~~~ ~~~ .~uisimi ~ .~ x ~ ~ .~ s --3! 3 ~! .~~ ~'" . _ ~- c~.a,.~ #~. ~ ---j---- _ __ -- - -- ~ - .. ~ ! - i _ >/ ~.._..~._ --~ --- - -~- -- - - -T. _. __ ~- -sr+os -- 7S ' i Series .7V a z s ~s~ s Pas e'~ o~ I 0 ~ . a~ f~01,~5 rrr Mound System Maintenance and Operation Specifications Service Provider's Name Joe Stan Phone 1-715-684-5166 POWTS Regulator's Name St. Croix Coun Zonin Phone 1-715-386-4680 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 450.45 ftz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Freauencv Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other Ins ect and/or service once eve 3 ears Should ins t and clean at least once eve 3 ears Test once eve 3 ears Should test month) Laterals should be flushed and ressure tested eve 1.5 ears Inspect for pondin and see a e once eve 3 years Miscellaneous Const,~uction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, 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 ~~ 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box ~ Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Holldorf Replacement Mound Page 5 of 10 Mound System Management Pian Pursuant to Comm 83.54, Wis. Adm. Code n I This system shall be operated in acxordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance wfth its' component manuals [SBD-10691-P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one shoukl ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shalt be in acxordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS componenrts. 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 kodcing device to prevent actdental 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, Stets. 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 leaned 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 finer when removed from its enclosure. ff the filter is equipped with an alarm, the filter shall be serviced ff 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 perforated 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, ff 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. ff an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution Strstem 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 infiRrative surface within the mound and snow compaction in the winter will promote frost penetration. Colo weather installations (October-February) dilate that the mound be heaviy mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS, 30 -n9/L TSS, 10 mg/L FOG, and 10'' cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow spetfied in the permit for this installation. The pressure distribution system ~ 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 deternine if orifice clogging has ocxumed and ff orifice teaming is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be ttedced for effluent ponding. Pondirtg level shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Corrttnoencv Plan if the septic tank or any of its cemponents become defective ffte 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 defeditre 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 wiN 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 replatng said componerrts 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. Project: Holldorf Replacement Mound Page 6 of 10 sT. cxo>~ covN~ SEPTIC TANK MAINTENANCE AGRiT AND OwnerlBnye;' ~-J~~~ T ~~ Mailmg Address i~ 3 CBRTIFICATION FORM Property Address (V required fi+otn Plsamng & Zoning Dep~rt~ ~ new cotishtrction.) ,/~ G k,~ r `1 ~ Parcrd Identification Ntunbe~t Ll~ CRIPITON l _ %s , „ ~ %s ,Sec. ~~ , T N R~W, Town of ~~~ ! °~ ~`' 'c `~ Property LOCgtlOn ~ V ~ ~~ St>bdivisian _ ,Lot # Cert~ Stirvep Msp # , Voitune , PaSe # w~ty De:~a #, ~` ~ 2 ~ `1 , vow ~ ~ 3 ~ , P~ 23 ~ Y~ ~ Trot lines ~ yes nd Iu~opcr use and of yotnr septic system could resell in its pretnat~e fa>~C to handle wastes. Prober anoe of pumping oar the tank every three yeats ar sooa~ if needed, by a Iicrosed pumpee: What you ptrt itno the system can atTect the futtdion of flx sq>tic teak as a tt+~ttnenR she ffi the waste disposal system. Owner woe n~o~ibilities are m §Cwrgn, 83SZ(1) std in f~pt~ l2 - St. GYonc Caaaty Sanitary Ordinance. The owner agrees to submit tD St: (:rout Gouaty Flaming & Zoning DepatcE+me~ a ~, signed by the owner std by a mssbar pht~er, journeyman phraober, rued phnntini or a lick pumper vetifyi~ lbat (2) the on-site wastewater disposal system is is proper opaatit~ eanditiaat and/or (2) afbn inspection and g (if neoeasaty), the tank is k~ thm 1J3 full of ahtdge. Uwe, the undtxsigood have read flm abtrve regamnamants and agree to the ptiiv~e searage disposal system wifl< the standaasls set i~ot~it, hesein,.as set by the Deptstmtatt of CamaoOetce and the Departtmtffi of Nasal R+esoan+ees, Sd~e of Wieoam~sio. Caa stating that your septic system hm btxn mandainod tno~ be completed and ret~oed tin the Sr. t~ County Plaoming ~ Zoning Depestnrosd wifllist 3o dabs of the thine year espi~aa date. . lfae that all on this fionn are tree to the best of mry/our knoaletigG. Uwe am-are the awna(s) afthe paopaiy died abt>.ne,'by vatne of a watratoty deed tetiaoeded in Register of Deeds Offtee. N of bedrooms TURF OF APPLI S /~~d~ DATE """Any irt£otrnaBdioa that is mist~epaesented may tenth in the saucy ptxntit baiag revoiood b9 rite Plmtittg ~ Zotmog Depalment "'°~ . Iiachde wish 8ris ~ a recorded vtarrattty deed fYO~m flee Rego of Deeds Offux and a ~ of the etxtifiod atuvey map if refermco is tttsde in the ~vana~y deed. ~• ~ Wisconsin Department of Commerce SOIL EVALUATION REPORT p~ 1 ~ 5 • Division of Safety and Buildings m acx:oroance wart t,omm oa, vvis. ream. ~.auG ~My _- St. Croix Plan must er not less than 8 1/2 x 11 inches in size Attach cem lete site lan on a p p p . p inGude, but not limited to: vertical and horizontal reference point (BM), direction and Paroel I.D. 002-1082-20-000 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location ^ ^ Brian W. Holldorf Govt. Lot NW 1/4 NE 1!4 S 33 T 29 N R 16 E (or) W Property Owner's Mailing Address Lot # Blodc # Subd. Name or CSM# 2377 U.S. Hwy 12 City State Zip Code Phone Number ity ~vllage own Nearest Road Baldwin Wi. 54002 ( 7~5-684-3465 U S Hwy 12 New Construction Use Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacerr~nt ^ Public or commercial -Describe: Parent material Glacial Till Flood Plain elevation 'rf applicable Nr~ ft. General corrvrlents Mound System and recommendations: Contour @ 93.45 Note: Page 5 1^ Boring # ®Boring Q pit Ground surface elev. 91.6 ft. Depth to limiting factor 30 in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ig in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-8 10Yr3/4 --- 1 llbk mfr cs 2f 0.4 0.6 2 8-21 10YR4/4 -- sl 1 fbk ~' cs 1 f 0.4 0.6 3 21-30 7.SYR4/4 -- cosl 2mgr mfr c~,~, __ 0.6 1.0 4 30-48 7.SYR4/4 c2d5 5Y1t5~5 spots sc 2m mfi cw -- 0.2 0.3 2 Boring # u Boring 93.15 21 Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/f~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-9 10YR3/7 --- 1 lfbk mfr cs 2f 0.4 0.6 2 9-21 10YR4/4 -- sl lfbk mfr cs 1 f 0.4 0.6 3 21-30 7.SYR4/4 c2d5YR5/5 spots cosl 2mgr mfr cw ___ 0.6 1.0 4 30-48 7.SYR4/4 c2d5YR5/5 spots sc 2mgr mfi cw --- 0.2 0.3 - tmuent ii1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Thomas W. Gedatus ~ 962178 Address Date Evaluation Conducted Telephone Number Stang Plumbing & Electric P.O. Box 263 Woodville, Wisc. 54028 g/2g/2006 1-715-684-5166 ATT f~1'~A TAB/M' Property Owner Brian Holldorf parcel ID # 002-1o82-2aooo 2 4 Page of _ Borin # V Boring g ~ pit Ground surface elev. 89.95 # Depth to limiting factor 10 in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/tf? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10YR4/4 -- 1 l fbk mfr cs 2f 0.4 0.6 2 10-21 10YR6/3 c2d5Y1L5/5 sl 2m mfr cs if 0.4 0.6 3 21-38 10YR6/3 m2d5Y1t5/8 sc 2mgr mfi cw ~ 0.2 0.3 a Boring # IJ Boring 95.35 23 pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/t~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0_g 10YR4/4 --- 1 lfbk mfr cs 2f 0.4 0.6 2 8-14 / sl llbk mfr cs if 0.4 0.6 3 14-23 7.SYR4/4 --- cosl 2mgr mfr cw ___ 0.6 1.0 4 23-48 2.SYIt3/3 c2d5YR5/8 sc 2mgr mfi c~'~' -- 0.2 0.3 Boring # ~ Boring 95.75 22 ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil ligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0_g l0Ylt3/3 -__ 1 1 tbk mfr cs 2f 0.4 0.6 2 8-16 4/ ___ sl llbk mfr cs if 0.4 0.6 3 16-22 10Y1L5/4 -__ cosl 2mgr mfr cw --- 0.6 1.0 4 22-48 10Y1L5/4 c2d7.5YR5/8 sc 2mgr mfi cw -- 0.2 0,3 * Effluent #1 = BODg > 30 < 220 mglL and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mglL and TSS < 30 mg/l. The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330Test (R07/00) r~~a'~ W. ;oil d~f~ X377 v, S, tf wY rZ ,~, Id ~~~~ w ;s ~~ s yvoz. ~ w yy~ N ~ '%~ 5 3 3~ "7" Z 5 N , ~ /~6 ~ Tbw r o `P F3q~dv;~ S ,~ . ~. roe ~- C_-!"Y i~a rye l ~ D ~ OpZ^ lpS2 -2c~--ooo _ !~. ~` L ~~%~!i ~~ ,pI ~ r D ~ a a ~ 0 ~~ ~~ 9 3~ _ r_q~i~~ ~htc5 t~-~- ~~ Rs~35f ~ .- ~~~~~~~ ~3``~~ R ~- _ ~~~~~:- -~ _.__....$ ~ ~ v V' ~~ Lot L:r,a ~~t5 .~`.`_ ~ ~' ~ ~: , .- ~ ~ - d / ~ ! .~ "~ /' ~' ~~~ .., , gel ®~ ~ `~~~ _ •i ~ o°. ~ ~ .~ ~~k $'':''~, .~2 ~o~s~ . jt E [ ~ i j ~ ~ ~ - -- f . :_ 1 c~ ;` ~..! ~~ . , ', .BOA ~~ Frgm: Ryan Y~gton Iryany~~--C~oioclM•USl SenC Tom, august 29, 2006 8:51 AM To: ~ g FW: Mound surer old system 'room: Y. ~ [: Thy. p 29~ 200G 6:44 AM ~ Yarringl~on RE: Mound oNer old system think we wan# #o stay away from th A+0 area since w c~ ~i end baclcfii ed neaa its end poin#. nThe pipeQS dep#i'~ of cover shoulder any part of the mound, the old outfatl pipe needs to be Eenerafly keep untreated effluent from entermg it and cutting i# off from the outfall should prevent a surfaEe discharge. Actually, e Lepage pi# was removed and backfilled with ASTltA G33 sand, the mound could go over the pit too. ;eroy Q. Janskil, P`SS 13 E Spruce ;ttippeMra Fatis,lAA 54729 715) 726-2544 Voice 715) 726 2549 Fax ~anoy.Jansky®tW~'Ansin.gov From: Ryan Yarr~on [rt:rya~ry4~70.S~nt-C;no6t.MR.US] Sarrt» Mondaq-, Au~st 28, 2006 4:09 PM To: wt.us 9u Mond over okt system ~Y- We have a so9 testat' worlang on a r+epla~oexnent site witty some tight seffiades. To the north is Ure old dryw~eN, ~ the soufh(opej is A+0 t~ondrtions and east west are lot des. I am going to dnsvr a S and tent it over: ~ there a problem with a ~ ~ ~ hM+g aver the old perforated onrerflow Pipe? Redox at 21" pipe ~ 64' below grade? t~ve me a cati wOh Questions ~Alllll~ Z~E'CIIIIIS'•1tL11 ~f~ G~11DLT ~^'~'+'°7 ll41(iic~+l Rd. Hudson, WI 54016 . i l.J-386-4680 ryany_@cosaxwiu `~ `' ~Q~e o ~o.~ ~ l C~ o -F J 829/2006 ' _ ,i 1 ; ~(?>^F L-~~t.. {v~ N~ i ~FR 9'9fldAi37~ ~~F~ !i TMI'1 la)i [:L AES?'?a~_) F09 Ri~Z)F~:NG DJ.TA sT~,T~ $~~ o~ wisct~~l~ rcx~l a-~ l -..°~°~---~--.,........_ ___ ;~ ~ J~, .. - Scott V. Nelso ?~, a single pessofl ~~ ~(~~ 1 ~ ~9~~ ,~ L 10; i5 A.:,~ i ' ~~ ~ r ~~L ~ ~ conveys and t~.;rran~d to . . Brian W. Hollci~arcf,.-_a .si~l~le _ ~ ~., ~~ ! it V ~. ..~~ ~_ pe.f~P~i ....... _ ----~.~,~ ... . ..... .- .__ ._----_ ........... .. .... a't~ ', /0 i~- '; the following d2aeribed rea; estate in .. ..St.. Croix.--.... .... ... CounrY. ~~ _ -: - - stet= oC w'ix-.~nsin; 'i Tax ;!'argil ti~:.---•°---•- -----------••---- !'; 't Part of NoictY:east Qi~rta~' of Nca~t~e:~a:=t ~;:~~ter (NEB of Nom) of S€~rytion Tfi~trty-Thee ;~ (33), Tos~ip T~~-~;tiy-?line r~~h (T29~1), l~~age si:acte~-~ ~t (F23.6+~;, de;;crlbt-~ as follow: Co.~r~cir.~ at the Nv.~ttr~~:st (I~) c~e+rner of said NC,rthaast Quarter of Northeast Qua~k~r (N~;~ of IdE~); t?~e.~e South (S) orl Wept (w) line of saic *lortheast ~j Q+.~arter of Nort'r~ea~t Quarter (N~ of NEB,) 33.03 ~~<t to Sly line oi= Stsate Trunk Hgh-~~y "12" and Point ag Beginning, th~n~ S ~7 22'20"E said Sly line 125.0 '~ fee'; ttse.~7ce Scraath (S) 354.0 feQt; t":C:L' N 87 22' 20"ia' 125.0 feat to West (W) line ii of said Not~thea;~t Q-rter of iv'o.rthF~~t Quarter (Ny'~ of N'~a); t~,en~ North (N) on 'I said West (W) line 354.0 feet to Pr+irt of Be~inl~in4. j~fi ~`- - ji This --~5 ._.._.....-... hon32stead property. (is) Exception to w•ari•anti2s; 1'~S~Y~.pl~a ~Cifl restrictimis of r~'D;rt~. Rated this ...2„:~- -..---- -- day of _ --._~~..,t - _ _ .. , 19. 95 . ;; ._ ........- - ---- - - -- - - - -(SEAL) ~. `G~`T~ ~ .~i~l`". "". .~E?~L) _ott V. Nelson .- ._ --------------- -------- -- - ------ - - --- ---(SEAL) s AVTY~~&sYTICATIf?N autheaticated thie ........dap ~* '° -- - -- -._ ........ ... .. ... . . ___..._ .(SEAL1 ACHi4i{fi~i,Eli ~~ii~NT STATE OF WISCONSIN •-----..St..-._Gr5liac-....._.County. Personally carne before me this ....~~.."`...._day of 19_.95, the above named , ~~ Y.. ~ ~ M' ~n,- i ,~* .~ commerce.wi.gov Wisconsin Fund - SC~ n S ~ n Owners Private Onsite Wastewater Treatment S stem Department of Commerce Application y Replacement or Rehabilitation safe and Buildings Division Financial Assistance Program Instructions For Property Owners: Y ' TO BE COMPLETED BY COMMERCE' ou may apply for a grant award for up to three years after you have received a determination of failure and after you have obtained a sanitary permit. Complete Part A of this form, attach evidence of your annual income explained in Section #7, and return those items to the sanitation or health department office in the county where the property is located. PART A TO B E COMPLETED BY THE PRnPFRTY nwAIGR pio~~o nrin+ Owner* Owner Owner ~' 1 ~ -~' O er ` ` \ q ~ \~\Q\\\J~j . Owner Owner Address Ci ,State Zip Code Telephone Number 7 7 H~ S' ~ z ~ ~ ~ ~ 2 3 7/~ ~ (~ b ~ n 1~,~' S~~az f -~3 5~~~- r~ *Grant awards will be issued in the name and address of this If there are additional owners, attach documentation listing all owner. owners. 1. Is this application for a principal residence or a small commercial establishment? 'nci al Residence (Complete both if applicable.) Small Commercial Establishment If applying as a principal residence, do you occupy this residence 51 % of the year? Yes No NA If applying as a small commercial establishment, do you own and occupy the small commercial establishment? Yes No NA 2. If applying as a small commercial establishment, what is the name of the small commercial establishment? ~a ~-- Description of Small Commercial Establishment (farm, restaurant, etc.): 3. Has there been a change in ownership of the principal residence or small commercial establishment served by the failing system within the last three years? Yes No If es, lease ex lain: 4. As the owner, are you a licensed plumber or contractor engaged in the business of installing private onsite wastewater treatment systems? Yes No 5. Will a portion of the replacement system be funded by another program? Yes o If es, a lain: 6. How d' you hear about the Wiscon nFund-Private Onsite Wastewater Treatment System Replacement or Rehabilitation Program 0 ~ 1:l_. Yv~ 7. Evidence of i me. If you are applying as a ipal residence, attach a copy of your federal income tax return for the year of or prior to the determination of failure. If you were married and filed separate forms, you must also include your spouse's return for the same year. You must include evidence of income for each owner and for each owner's spouse. 1f you are applying as a small commercial establishment, submit a copy of your federal profit and loss form for the year of or prior to the order or determination of failure. If you or any owner (fisted above did not file an income tax return, contact your governmental unit for further instructions. Evidence of income will be ke ton file at the ovemmental unit and is sub'ect to verification b the De artment of Commerce. Property Owner's Certification. I certify that, to the best of my knowledge and belief, the information I have provided on this form and all attachments are true a correct. Owner's Signature Date Signed Co-Owner's Signature Date Signed ~`~~ ~~ '~~ ~ 1, arsunai °irormauon you prowae may oe usea ror secondary purposes (Nnvacy Law, s. 15.04(1)(m)j. SBD-9163 (R. 02/2005) f. '~e PART B. TO BE COMPLETED BY THE GOVERNMENTAL UNIT ' 1. VERIFICATION OF OWNERSHIP On the document used to verify ownership, do the names match those on Part A of this application? If no, please attach additional documentation explaining. Yes No If the applicant answered yes to question 3 on Part A of this application, did the applicant(s) own the property when the order or verification of failure was issued or the system installed Yes No and incur the Est of replacement? ' ~ ~ ~ Document or P;~ a ( fa.ti ~ Document used to verify ownership: Number: 3 / Z 3 7 2. Is a public sewer available to this property? Yes No 3. Has a previous grant been awarded for this property under this program? Yes No 4. Principal Residence evidence of income. Please indicate applicable annual family income: $ ZZ ~ I $ c7 __._ "b Federal income tax form ~byb, Line 3~ ,Year 2ab5 OR Affidavit of ,Year ~, Small Commercial Establishment evidence of income. Please indicate applicable annual gross revenue: $ Profit & loss form used: ,Line ,Year 5. Date of the Order or Determination of Failure: 5e ~P Z~ ZOC~(o When was the existing failing system installed? Pri to 12-1- lot~ 2-1-1969 to 7-1-1978 Vertical distance from the bottom of the existing infiltrative surface to a limiting condition: 0 to Less than 24" 24 to Less than 36° Equal to or greater than 36" 6. Private onsite wastewater treatment system failure u ,d b discharge of sewage to (check all that apply): urtace water or groundwater ....... ..................................................................................................... Category 1 A zone of saturation ............. ............................................................................................................ A rain .............................................................................................................. Category 2 The surface of the ground ..................................................................................................................... Category 3 Back-up of sewage into the structure served ....................................................................................... At-grade 7. This request is for what type of replacement system: Conventional If this request is for a system not listed at the right, please explain: ___ Experimental Holding Tank und P sure I n-gro res o und / / 8. Uniform Sanitary Permit Number ~~~ ~ 7l Date Issued 9/ /J`/ ~ (o Plan Approval Number f ~.s ~ ~ 3 / ~ 70~ /Sk- ~ ~ 7~Sa5 ~ Date Approved 5 ~-. 13 ZA~Co Ex eriment A royal Number -`- Date A roved '-'~ 9. After reviewing this application, I have determined the applicant to be: Eligible Ineligible If ineli ible, reason ineli ible: 10. Govemmental Unit Representative's Certification. I certify that I have reviewed and verified all information provided on this form and attachments and that the are true and correct to the best of m knowled a and belief. Signatur f Authorized Governmental Unit Representative Title Date Signed '~ ~ Q (~ S-f~~ • zZ ~ commerce.wi.gov Wisconsin Fund - S C~ n S ~ n 071"Bllt Private Onsite Wastewater Treatment System Department of Commerce Worksheet Replacement or Rehabilitation safe and t3uitdin Division Financial Assistance Program Owner's Na``m//e~': ~ ~ : GoveCCrnmental Unit ~~j(~ ~ I ~L~~ oo yy ~J~• ~t/~ WIMP PART 1. GRANT FUNQtNG TABLES In Sections B-F, the number of bedrooms determines the grant award. To use the grant funding tables for small commerci establishments, divide the estimated dail wastewater flow rate in allons r da b 150; round off to the next hi hest whole number, and use the result for the number of bedrooms. A Site evaluation and soil testin Grant amount $250. $ B. Installation of a replacement anaerobic treatment component. Number of Bedrooms Grant Amount 1 or 2 ..................................................................................................:...........................$500 3 .................................................................................:.............................................550 4 ..............................................................:................................................................ fi50 5 ...................................................:...........................:.......................:....................... 725 ............................................................................................................................... 750 7 ...................................:............................................................................................875 8 o e r mor ............................................................................................................................950 $ C. Installation of a dosing component, lift pump or siphon: Number of Bedrooms Grant Amount 1 or 2 .........................................................................:..................................................$1,100 3 or 4 ........................................:.....................................................................................1,200 5 ~ ~~ or more ......................................................................................................................1,250 $ O. lnstalla6on of anon-pressurized and in-ground pressure POWTS treatment or dispersal component. Percolation Rate Design Loading When Properly Filed Rate in Gallons wlth the Governmental Per Square Each Additional Unit Before 7-2-94 Foot Per Day 1 2 3 4 5 Bedroom: Minufes Per Inch °~--' 0 to less than 10 0.7 or more $ 925 $1,200 $1,400 $1,450 $2,100 $250 10 to less than 30 0.60 to 0.69 925 1,200 1,400 1,800 2,175 250 30 to less than 45 0.50 to 0.59 1,375 1,550 1,650 2,000 2,225 300 45 to less than 60 0.49 or less 1,375 1,900 2,200 2,250 2,275 300 $ E. Installation of an at-grade or mound POWTS treatment or dispersal component. Each Additional Tvge of Design 1 2 3 4 5 Bedroom: At-Grade $1,975 $2,350 $2,350 $2,925 $3,025 $275 High Groundwater Mound 2,600 3,150 3,525 4,250 4,775 300 High Bedrock Mound 3,300 3,850 3,975 4,500 4,725 350 *Slowly Permeable Mound 3,250 3,600 3,600. 3,975 4,775 375 Mound with less than 24" of suitable ~ ~~ $ Soil or reater than 12% slo e. 3,050 3,450 4,000 4,550 4,550 375 *A slowly permeable mound may be designed using percolation test results property filed with the county before 7/2/94. A slowly permeable mound is defined in s. Comm 83.23(1)(b) as having a percolation rate of greater than 60 minutes per inch and less than or equal to 120 minutes per inch, or having a soil loadin rate of 0.3 or less. f. Installation of a POWTS Holding Component. Each Additional 1, 2 or 3 4 5 6 7 8 Bedroom: ~, Grant Amount: $2,500 3,150 3,225 3,625 4,200 4,750 $400 $ ~+.A++,o, .+...,..~,auan~ yvu N~w~uC ~i~ay uC weti rw sewnaary pUrpOSeS tYnVaCy Law, S. 15.U4tlxm)f. SBD-9167 {R. 02/2005) PART 9. GRANT FUNDING TABLES continued G. Installation of a Replacement Exterior Grease Interceptor by Gallon Capacity. Gallons: Up to 1,249 1,250-1,499 1,500-1,749 1,750-1,999 2,000 or more i Grant Amount $550 $650 $750 $800 $900 $ Amount Requested H. installation of an Experimental System. For Installation: If you are requesting funding for an experimental system, please submit a copy of the Wisconsin Fund $ pre-approval letter along with a copy of the plan approval letter and experimental approval letter containing corresponding identification numbers. Amount Requested For Monitoring: List the total cost of the experimental system and monitoring that is being requested separately at the $ ri ht. Co ies of aid invoices must be submitted with this uest. 1. Installations not Covered by the Grant Funding Tables. The Department on acase-by-case basis reviews installations not covered by the Grant Funding Tables. tf you are requesting funding for an installation not covered by the grant funding tables or listed in Sections A-H, please explain your request here, attach a copy of.the paid invoice showing the cost of the item, and request 60% of the cost of the installation at the right ~Q TOTAL PART 7. $ ~J ~ PART 2. GRANT AMOUNT CALCULATIONS ~ ~v A Enter the total from Part 1. $ ! B. Is the applicant a licensed plumber or contractor who installs private onsite wastewater treatment systems? If yes, enter 2/3 of the amount from section A or $4,667, whichever amount is less. ._--- If the a ticant is not a licensed installer, ca the amount forward from Section A. $ C. !f this application is for a small commercial establishment and the annual gross income of the business that owns the small commeraal establishment is less than $362,500, this is the total grant award. Carry the amount in Section 8 fonnrard to section F. If this application is for a principal residence and the annual family income of the owner(s) is less than $32,001, this is the total grant award. Carry the amount in Section B forward to section F. if this application is for a principal residence and the annual family income of the owner(s) is between $32,001 and $44,999, I'tst the amount in Section B here and go on to section D. If this a lication is for an a rimental s stem, ca the amount in Section B forward to section F. $ D. Enter 30% of the amount by which the applicants annual family income exceeds $32,000. Annual Family Income Subtract - 32 000 Subtotal X .30 = $ E. Subtract section D from section C. This is the maximum grant amount for this applicant. Carry this amount forward to section F. (The amount in sections E & F must be at least $100 to be eligible for any grant award. 1f the amount calculated is less than $100, enter $0.00 in section F. $ ~I "`~ F. Total grant award requested for this a licant u to the maximum of $7,000. $