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004-1018-20-000
Department of Commerce PRIVATE SEWAGE SYSTEM d Building Division INSPECTION REPORT iERAL INFORMATION (ATTACH TO PERMIT) • r mal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. ,nit Holder's Name: City Village X Township avitz, Jeff Cadv Township .ST BM Elev: ~Dc~ TANK INFORMATION isp. BM Elev: IBM Description: ids TYPE MANUFACTURER CAPACITY Septic ~ p , /~ J~ Dosing ~~ Aeration Perms.-tLyl.~ ` TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ / , I n_ /v t'om' ~ ~ r f Dosing ~~ 1 ~ ~ ~~~ ~- Aecatier~- Holding - ~, PUMP/SIPHON INFORMATION Manufacturer /~ Demand (}t~ ,_~`. ~j GPM Model Number ~~ %JEc~~~~~11- TDH Lift i Friction Loss System Head TD Ft q ,s~ Forcemain LengthZl Dial l/ Dist. to well ~~ SOIL ABSORPTION SYSTEM J V ELEVATION DATA county: St. Croix Sanitary Permit No: 453169 0 State Plan ID No: Parcel Tax No: 004-1018-20-000 Section/Town/Range/Map No: 08.28.15.123 STATION BS ~~ .Sb HI i~~ri 5~ FS ELEV. e6 Benchmark 5~ ~~~ ~QC Alt. BM r. ' / ?•~ ~~ Bldg. Sewer 7 • ~~ ~7 5 SUHt Inlet g , 3 / ~; ' Z St/Ht Outlet ~ ` ~Jq ~~ ~ ,7 Dt Inlet ~ 4~ ~7 . U$ / Dt Bottom ' ~ ~ ~ ~ / g Header/Man. ~`7/ /ao 1 G Dist. Pipe 4~~V V / od ~ t. System ~ ~, j I ~ ~ F ~ Final Grade 3 `~i~ /or .g St Cover S ZB l~ C` ,.~ .,,r- 5 ~F3 `~~ ./3 ~.~+~ ~ ~1 r, .45 BED/TRENCH Width ~ Length ~ No. Of rench PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ G7 / ~ ~ \ 1 ~ SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: ~ Of t T $ > ype _ ys em: /~ / ~ ~ A' ~~ UNIT Model Number: ~ I~ ~ t% ' ~ /" DISTRIBUTION SYSTEM Header/Manifold t~~~ ~ Distribution ~ ( 1 Pipe(s) _'I ~ Z ~ ~~ i ~ ~ S x Hole Size /~ , x Hole Spacing j ~ ~ V o Air Intake ~ L Length aY Dia Z. Length Dia Spacing ` ~ tJ -~ ,=t_ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Onlv Depth Over Bed/Trench Center / / 5 Depth Over Bed/Trench Ed es xx Depth of il To s xx Seeded/Sodded ~ xx Mulched ~ ~, g ~ p o I ~ Yes ~,;! No es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ v! / ~ / C3 1} Inspection #2: / /_ Location: 413 CTY Hwy NN Unknown (SE 1/4 SW 1/4 8 T28N R15W) NA Lot ~ ~St'~Z. ~~ t;l.J ~ Parcel No: 08.28.15.123 1.) Alt BM Description = PD `~ ~`v c~;,,,,~,5 "~ ~ ~~`~ l~~~V~.r,w~['" v~L~ 2.) Bldg sewer length = ~ ~ Dt~J d K ~- ~ + ~ O ~_ -amount of cover = ~'/d ~S~ 1,tgJ 1c~tr~"- C: r~,~ 5, t Plan revision Re wired . Yes No I ~ ~ `1 Use other side for additional information. I _____ __~ li ._ __ __ _-__ __ _ _ _~ SBD-6710 (R.3/97) Date Insepctor' ignatur ~~~ aF~ f - --~ _ _. c~~'3 ~ `~`~_ Cert. No. Safety and Buildings Division County S ~ ~ ~'' ~ ~ 201 W. Washington Ave., P.O. Boz 7082 , i ~f / lscons~n Matitson, Wi' 53707 - 7082 (608)26!-6546 Sanitary Permit Number (to be filled in by Co.) Department of Commerce S~~ Sanitary Permit Application ' State Plan I.D. Number ~Z~B~ ~,ey-„[s i In accord with Comm 83.21, Wis. Adm. Code, perso a&•-^•°~~^•• ~P'^~•"'° ..- be d f d P i 1 ' Add if diff h i P i may use or secon ary purposes r vacy w, s ~~C ~ `~ ~ ~ ~ roject erent t ress ( an ma l ng address) I. Application Information -Please Pr'nt 11 In tior~ I ~/3 C~' ~ ~~,f , NN Property Owner's Name ~,,. i Parcel # Lot # lock # ~ Property Owner's Mailing Address (L 1 i Property Location ~ /~ ~~ /~ t 3 ~`aC (...sv t~ I .~D'I/ y. JH y. Section U City, State J !~T ~ ~ Gi' ,~'? Y~. > Zip Code/~ L,~C~ ~J G~ / J Phone Numbe~Jr ,gyp 3 S~-y / (l '- , , O T~0 N~ R ~Eca~ ~ s l/~ 0~ II. Type of Building (che all that apply) Gr ~ / 1 Subdivision Name SM umber ~ 1 or 2 Family Dwelling - Number of Bedrooms D ~~~ ^ Public/Commercial -Describe se ~ / ^StateOwned-Descri'oeUse/"/!!Gi'/K~ ~•~~j ~ r~/y~ ^City_^Village ownshipof `f ~ III. T ype of Permit: (C eck only one box on line A. omplete line B if applicable) ~ A' New System ^ Replacement System g ep y ^ Treatment/Holdin Tank R lacement Onl ^ Other Modification to Existin S tem g ys B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T e of POWTS S stem: Check all that a 1 ^ 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 reatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersaUTreatrt(ent Area Intormation: Design Flow(gpd) Design Soil Application e( st) Dispersal Area Requ` d (sf) Dispersal Area Pro sed (sf) System Elevation ~ VI. Tank Info Cap ity in Toter Numbcr anufacturer rcfab Site Steel Fibcr plastic Gallons Gallons of Units Concrctc Constructed Glass Ncw Existing Tanks Tanks Septic a !{okiing Tank La „~~ /r~ 4~ j ~„ Aerobic Treatment Unit ~ r / /l~j /" t/V DosingCtumber .~ ~/ti / ; ,, /~ VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Numbcr Business Phone Number Plumber's Address (Street, City, State, Zip Code) ~~ ~ ~ ~ ~ vti' ~ G> ~! © / Q Gd ! ~~ ~- G VIII oun /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Surchazge Fee) ~j ~ C7 ~ ~ ~ Date sued ~ Issuing A t Sign re tamps) ~ ^ Owner Given Reason for Denial -~v ~ ~ 7 ~~ .g ~ IX. Conditions of ApprovaUReasons for Disapproval 3 /~ G~~~Z~ ~1,,n s7~~ SYSTEM iOWNER: ~.rvt.vwt ,y3,,-z= ~ ~ ~/~- ,Septit~ tank, effluent filter and ~ ~ (,~~i ~2l~ i tlispersal cell must alt be service / maintained ~~~q~i ~' 9~ ~~ ~ as per management plan providt~i by plumber. UU 2. All setback requirements must be maintained ~ ~lL- ~~~ ~ SyS er a 'cable code/ordi nces as . pp p _~ ~_ y fin. Atta comp! a erns (to the County only) ror the system on paper mot less than 8112 z 11 Ineha is siu .I~~ 2565P 25? St. Croix County Occupancy Affidavit ~~ ~.~ ` Z Name - (Own r) Typed or pnnted being duly sworn ,states, under oath, that: 1. He/she is the owner/part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume I `~ZI Page DO Document Number(DD~ St. Croix County Register of Deeds Office: A parcel of land located in the.5 ~~ %, of thf SV/%. of Section ~_~ T~ N - R 5 W, Town of L St. Croix County, Wisconsin, being duly described as folio (include lot no. and subdivision/CSM or detailed le description): N/LOf ~wyy ESN/'/~ ~ `%v a~ St r/c~ ~~ Sw ~Y o~.fer~i3~ wnsh,~P Z ~ No /a-L. / ,~s~-i/Cr~ /s GJe s"T ST.~20~ x 76 1 693 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO. ~ IiI RECEIVED FOR RECORD 05/05/2004 82:00PM AFFIDAVIT EXElPT # REC FEE: 11.00 TRANS FEE: COPY FEE: 2.00 CC FEE: PAGES: 1 0 ~iJl~t~//, -/oi~ -ao -oQo As owner of the above described property, I acknowledge that the septic system serGing this residence is sized for a bedroom home, or a design flow of ~ gpd. The design flow is calculated by assuming 150 gpd for 2 Individuals per bedroom. There are currently „~ occxapants living in this residence; ~ oocupants are permitted based on the design flow. Therefore the septic system serving this residence is code compliant. However. I understand that if there are intentions to exceed the number of permitted occupants, the system will need to be modified to aooomodate any increased wastewater flows and/or contaminant loads. I also acknowledge that I will make this information available to any future parties interested in purchasing this property. tad this _~_ day of ~ _~ AUTHENTICATION Signature(s) authenitcated this day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not. atN~orized by § 706.06. Wis. Stats.) Tabs iNSTatxrter:rwns oRni=reo sY (Signatures may be authentkated or acknowledged. Both are not ACKNOWLEDGMENT STATE OF WISCONSIN ) )u• St. Croix County. ) Persp~~ally came before me this ~ day of ~ GAD _`1 the above named to me known to be the person(s) who executed the fore9dn9 instrument and adcno~Medge the same. /~ C- -~~ Notary Puaic, stage of Wisconsin My Commission is mianeM. H not, state date: Gate: // - '~` 'Z? •~ i,.._ _ ~ w_ 'G~ ."THIS PAGE Is PART OF THIS LEGAL DOCUMENT - DO NOT ttEMOVE" Jrq~-~^~, yr~I1p~ ,~-~ This U>fbrrnation must be oortpkted by sutxNtter. .tom and PlIY (d ~~• other trdranradorr parrNn~ ctatasa, ~ desa~idorr. etc. may be ptaosd on this (Prat papa d tlrs doouroarrt ormay be ptaoad orr addRlonaf pass of the doeurrrerk 1~ use otthls ooNerpe~e adds one papa to your doeumertt and;fj,00 to ehe rooordJeo tee. bylsoorisiin Sues. Sli s17. p; f ~ EXista}i~~qq ~/cc.dE~ e li /a t~~.-, 0 ~ ,c ~ V `~ 0 4v ~` /~ o ~C = S u.~ .F4 CC {/~ rad2 i 3 ~/P.rY %i'/Y g ca.,! a~ w ~•t'~ y .~ ~' / ~! w,,,,r,O S ~ d¢preSSi~nS 6~'4Pj~ 1'oy. 5/ -(, ~ o d, ~e.n a fit/` 6 y to = B ~ ~ ~', se ~ d ~ Z1. S ysC-tin Cu~~E,ous.r ` ~ ~ S6a.,t<~ u Cs+7 a„ av~ra. '~~a~e o~ 98 90'w."t~ e ~, h-~(c.s~ 8 ~u./o» carp ~ur o ~' Yy 2~/'¢ S~fs•.b/•:s~<d as dtsi~» tv» ~ ¢ fever-Eio». rt^o posedw~ou„d a,~ /9.vyr /07.~ ~w~~ S jr 9/. 36 ~d~Srasr so,.P ccLQ. F'~ls.r ~~ d,'s f'~i bwEia., /~ deis./.r a'C /y ';r slt/.1 ~''~/ Y~ "o~'~ L'ee.s .;oa c<J SyS~-, ~oea-~i'~m mew o~' ~XX~°~s a l~ 4.boue yr,ade. ,gssu.~+ear Qle~ - /o0.c~' 5.t~ba.[-+t' f'f~'c.t', r"+-'I.Qi1~ ~*-S e5'~6lis~ by C'ommDe"I}3, ~3 T46~c1. ,~~~. do~~e. 5! ;q • S. T..rt, 3 03 j~ e~'F'/4 ~rsE farce ~;~ ~ Z i n 8 G~wt o{'~G» ACS. P~op°sed ~~ esa ~ . i~ $r Cur~c.WLP7Sa-MQ ~~ ~ i ~ w;cs<i Gn+e. c.J 1 ooo/soe n~,Q Pµ,,,p chc~••~~cr7 ~.an. b,~,~n S.T./P C. -Eo be / ~ ~ o- /~ usedvs sT ~ //f~~ ~c°' ~ ~/ / ~6e 1 ~1-~Gn~ ', o , j ~ eFF/uc.rG FilEcrcr-~ourtl~. ~ ~ ~~ i/ '~ ~ ~ b4r / ~ ~~ v'' ~ k~°'a~ / ~ / / 3 b~.d~, ~ ~ ~~~1 ~! ~ b r , i 9~. o'~~-~.- O 7 ~ , t ~ __~ ~- p~ (d~'o u a /oe~i~n aF /IGm i vie d F~„ee /,'.~e ~ ~i „ (nod /off L~"~ ~/ ~; ~, rl~y, n~ Ali.. PS.m.: /(a,'/ ~~ v .' /, [,,.~co~„ ~.au~as L Eke . , moo. oo .' ~ g o~ ~ o 9~ .. - commerce.wi.gov i ^ ~scons~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary Apri128, 2004 CUST ID No.220853 DALE E HUDSON BOLDT'S PLUMBING & HEATING, INC. 820 MAIN ST PO BOX 78 BALDWIN WI 54002 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 ly,.,( ~~ ~~~3i~q CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/28/2006 Identification Numbers Transaction ID No. 992983 SITE: Site ID No. 682393 Jeff Kavitz Please refer to both identification numbers, County Hwy NN above, in all corres ondence with the a enc . Town of Cady St Croix County SE1/4, SWl/4 S8 T28N, R15 . escription: Three Bedroom Mound Object ype: omponent Manual Regulated Object ID No.: 954742 Maintenance required; 450 GPD Flow rate;- 25 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/01), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1); Biofilter SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST SAS (01/81) 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, COif?l~llfla stats. ~~ ~ ~~ The following conditions shall be met during construction or installation and prior to occupancy or use: DEPARTMENT OF ~ General Approval Requirements: ~ ~ i • This system is to be constructed and located in accordance with the enclosed approved plans and with the SEE CORRESP "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.O1/O1) and the SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST_SAS (01/81) The changes made to this plan on 4/28/04 by this reviewer were acknowledged and approved by the system designer. The length of the cell is 91.36 feet to be constructed along the 99.24 foot contour. • 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. DALE E HUDSON Page 2 4128/04 • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) A copy of the approved plans specifications and this letter shall be on-site during_construction --a _~__ ~_ __-__.___ ,- ---~ -- ~ ..., ~ ... . . Owner Responsibilities: Com~2 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 instal lation/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 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, Charles L Bratz POWTS Reviewer II ,Integrated Services ,(608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@cornmerce. state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 RFC s qp ~/~ '~~F ~,~ FGA ?p 1 OQ MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN ~~`0 Residential Application Vs INDEX AND TITLE PAGE O,~ e Project Name: Jeffery Kavitz 3 bedroom residential mound Owner's Name: Jeffery A. Kavitz Owner's Address: 150 6th Ave. Baldwin, WI 54002 Site Address: XXX Co. Hwy. NN Legal Description: SE1/4 SW1/4, Sec. 8, T.28N., R.15W. Township: Cady County: St. Croix Subdivision Name: Na Lot Number: Na Block Number: Na Parcel I.D. Number: 004-1018-20-000 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 ~~'jry Page 6 Management and contingency plan :~® Page 7 Pump curve and specifications ' Page 8 Site Plan '~~MERCr: Page 9 Soil Evaluation Report ~~ u GS Page 10 Concave Distribution Cell Deflection Calculations '~NOENCF Designer: Dale Hudson Date: 04/19/04 Signature: License Number: Phone Number: 220853 715-684-3378 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 3.0 (03/01/01) Page 1 of 10 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) '. 5.00 Site Slope (%) 99.24 Contour Line Elevation (ft) _ _ 25.00 Depth to Limiting Factor (in) _ 0.40 In-situ Soil Application Rate (gpd/ft2) Note: Sand fill (D) calculations assume a Table 83-44-3 in-situ soil treatment for fecal coliform of <= 36 inches. ibution Cell Information ~7~ 3;, 0.00 Dispersal Cell Length Along Contour (ft) _ _ 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) ___~ 1~ Influent Wastewater Quality (1 or 2) Pressure Disribution Information (c ore) ~ c Center or End Manifold 2.50 Lateral Spacing (ft) 4 Number of Laterals ____ _ _0_.125 Orifice Diameter (in) (e.g. 0.25) 2.50 Estimated Orifice Spacing (ft) _ __ _ 2.00 Forcemain Diameter (in) r 40.00 Forcemain Length (ft) __ 92.00 Pump Tank Elevation (ft) 6.50 System Head (ft) x 1.3 7.66 Vertical Lift (ft) 0.76 Friction Loss (ft) 14.92 Total Dynamic Head (ft) Lateral Diameter Selection in. dia. o tions choice__ 0.75 1.00 1.25 x i x ~ 1.50 2.00 x I x , _ _ -_ 3.00 x _ 5.00 Cell Width (ft) Are the laterals the highest point__ in the distribution Y network? Enter Y or N If N above, enter the elevation~__ of the highest point. ~ _~__ 6.25 ft2/orifice Does the forcemain drain back? ~-Y _. Enter Y or N ~7~ ~ 6.52 Forcemain Drainback (gal) /- h ~ 81.25 5x Void Volume (gal) '7` .~Z 87.77 Minimum Dose Volume (gal) 29.66 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) Treatment Tank Information ~ 760.50 Total Tank Capacity (gal) - G. _-._ 1500.00 Septic Tank Capacity (gal) ~ ___ 20.28 Total Working Liquid Depth (in) IVllieser Combination Manufacturer 37.50 gal/in (enter result in cell 649) Dose Tank Information Effluent Filter Information 760.50 Dose Tank Capacity (gal) Zabel Filter Manufacturer ~-- - 20.28 Dose Tank Volume (gal/in) ~A100 .~ _______ __ Filter Model Number -- ', Wieser WLP750-MR ~ Manufacturer Project: Jeffery Kavitz 3 bedroom residential mound Page 2 of 10 Mound Plan View Observation Pipe K .5. .'. . . .,Q . . . . . . B - - =• • '. L~f•. '. .' : ... .'. .. . . . ......................................... ......................................... ......................................... ......................................... ........................................ ........................................ . ---. ~ ~ L Mound Component Dimensions A 5.00 ft E 14.00 in B ' /,,3~ 0.00 ft F 9.50 in D 1.00 in G 0.50 ft 450.00 (ft2) Dispersal Cell Area 5.00 (gpd/ft) Linear Loading Rate H 1.00 ft z 8.68 ft J 5.76 ft K 8.50 ft L 107.00 ft W 19.44 ft -T -} _~ -1 1230.88 (ft2) Basal Area Available 9.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 101.95 (ft) F " 100.16 (ft) ~ - Dispersal Cell :::[3~ :: ; :::::: Elevation ~I H Dispersal Ce-- ~ 100.66 •D ~ ~ (ft) Lateral Invert 5.0 % Site Slope Shading Key '~ ~ 1^ Topsoil Cap c ~ 1.5 ft 0 ~~~{• Subsoil Cap H g ©[~ ASTM C33 Sand `-° --~: ~~.`~,` Tilled Layer A t ^ ~ ~ v o 0.5 ft ggrega e 5 99 24 (ft) Contour Elevation 1 Geotextile Fabric Cover ,,~~ Dispersal Cell :~: a'.~,:a~.. o;t': F :' Typical Lateral :,::,• A See lateral details on Page 4 for number, size, and spacing of laterals. Laterals are equally spaced from the distribution cell's centerline in the distribution cell (Ax6). Project: Jeffery Kavitz 3 bedroom residential mound Page 3 of 10 Center Connection Lateral Layout Daigram Force main connection via tee or cross to manifold at any point. IE P •= Turn-up+m'ball valveor If X-~ cleanoutplug Holes drilled on the bottom of the lateral. S Number of Laterals 4 Lateral Diameter 1.50 in Lateral Length (P) 44.28 ft Lateral Spacing (S) 2.50 ft Lateral Flow Rate 7.41 gpm System Flow Rate 29.66 gpm Total Dynamic Head 14.92 ft Orifice Diameter 0.125 in Orifice Spacing (~ 2.53 ft Orifices per Lateral 18 Orifice Density 6.25 ft2/orifice Manifold Length 2.50 ft Manifold Diameter 1.50 in Forcemain Velocity 3.03 ft/sec Dose Tank Information Electrical as per NEC 300 and -- - Comm 16.28 WAC ~_ ~ Disconnect Laterals are identical ~I Laterals & force main of PVC Sch 40 per COMM Table 84.30-5 Tank component is properly vented Wieser Combination Ca acit 760.50 Volume 20.28 Manufacturer Gallons gal/inch A B C D Dimension Inches Gallons A 19.00 385.28 B 2.00 40.56 C 4.50 91.30 D 12.00 243.36 Total 37.50 760.50 3" Bedding under tank. Alarm Manuafacturer ~LevelArm _ _.. _ _ Alarm Model Number;DLV Pump Manufacturer Goulds Pump Model Number !3871 EP04 Pump Must Deliver 29.66 gpm at 14.92 ft TDH Locking cover with yarning label and locking device and sealed watertight i 4 in. min. F- Alternate outlet location Forcemain diameter ~ 2 in. Weep hole or anti- siphon device P~ ump off elevation (ft) 93.00 Dom se tank elevation (ft) 92.00 Project: Jeffery Kavitz 3 bedroom residential mound Page 4 of 10 Mound System Maintenance and Operation Specifications _. _ _ _ _--- Service Provider's Name Boldt's Plumbing -Dale Hudson ! Phone~715-684 3378 _.._...__..,..__._____ ~._._.,...__.__. _ ._ .__, __ .._. ___ __ . ,.. -._.._ ~__-._ __,_ 1 J POWTS Regulator's Name St. Croix County Zonin ', Phone 715 386-4680 I . _ _ __ _9_ _ . __.. System Flow and Load Parameters Design Flow -Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow -Average 300 gpd Maximum GODS 220 mg/L Septic Tank Capacity 1500 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ftz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Ins ect and/or service once eve 3 ears Should ins ect 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 years Inspect for ponding and seepage once every 3_years_ _._ ... - :~>tr:e Miscellaneous Construction 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 p Threaded Cleanout Sprinkler Valve Box ~ ~ Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Jeffery Kavitz 3 bedroom residential mound Page 5 of 10 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with 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 should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shalt be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. 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 fitter shall be assessed at least once every 3 years by inspection. The outlet fitter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the fitter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent fitter 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 pertormed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical addttives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank tt shall be inspected and serviced as necessary. Mound and Pressure Distribution Svstem No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surtace within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavity 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 GODS, 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is pertormed tt should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal pertormance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if tce leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Jeffery Kavitz 3 bedroom residential mound Page 6 of 10 l Pump Specifications vY ~:; ;0 GPM ~~~s~~~~'arge size P/~" NPT ~_~.~:.~ _ maxlnnlm Motor S _ ~ ,~nase ~15V IVlalerials of Construction ~y92, ;~~ •Ilero~oplasfic TD.h?" Features and Benefits :~,,~~~~cn eliminates ~~iel clogging. _.,~ os~on resistant MODEL DUP03 tk ?0 25 30 75 :0 u S GPM a ~ a ioin~1u CAPACITY MtILNS fLki lol el ~o III z, II 4 p ~ I - U ~ Z a 0 ~; to a z 5 I~ °I °o ~~ ---- --- 9.6G .n1. ~-'1: Pump Specifications ','~~ and ';~ HP Up to GO GPM IVlaximum irea~l !0 32 Discharge size 1'i~" IVPT SOIdS~'!~~ maXalllllli iVlofor All motors feature ball bearing consUuc(lon Slagle phase t 15V Materials of Construction GaS( IIOn Thermoplastic Slalnless steel ~P~,~ n ~•-~~ ~ r S / ~C /' d• Features and Benefits •EPU~ IIII;Jt'l~!- Sil'1-„~ .~._ ~:'nfh p~ur ~~ out inr, ~ __ rnecnan~ca ;e.,_ iul ~luploveu peri~l~~~~ C1SIng a' C ~'~;I~~ ~ ~ _ ~~ , _ . - SupeiiJ~ 5'.'cl'C' i! _I !i SiSl,i".. • ~:iSl Iron in0`.C~r "OIS~' ~j '._~ er1;C1211[ tied' Ir.iIISG_~~ _. _. ;tnCl Cillla'JI~IIC.' +GOIlOSiO~? 'e~i~ ., _ . .._ +P,.'~i'~,lall' t ,r .11 I. ~ ~Si~ I!SI~ ' .. , .... .~.. . Ali ~l/IOC7E~iS cilE' Gc~SIC~l1BCl lOI COIIIIl1UOUS OpE'I~!lOl1 7/~C~ ~Ec`7(UIt' S'(clll)It'SS 5(E'dl I~~iC7'.':~ci!~'- }~. 7 oP /o IvrooE~- ss~ ~~ I ..~/ / e/Q/ali.'~i dY7 P%E • EX~s~.h B~adF e (r /a L78n 0 ~ ,c --~ ~ v ~ S 0 4v ~` /1o~e: Sk.~•Faee made is ve.,-y i~rc~CC~.Ia~ w,~ -' ~ L r ~=G' ~ti~+ ~ _~/ ~k,rnin0 S~ depress.ins 6•F4Pja o,Y• O J -u d~a--,~z.c/' 6 (o = 8 ~ ~',•s.e b~ dc~2~. sysE~•-n ~~-- ~d ~ z Sba,,ted a Lp-,y ~„'av~nct.,~e „~~a.r.(e o~ 98 90'w."t~ e ~ ~ h,~,(c,sf 5~a/on con ~~ o ~' Y9.2~!'¢ Sf~.~/,3,(cd us d¢Si~n ~ ~ a? 1¢vci~~0». -F-~-- /, 0 y o ' ~ ~ - Pro p o sQ.d w, ow, d a.~ /9. VyX /07. ~ ~wi ~ Sjr9/.36'd~~,oksa.Pc~C.Q. F~~u.~~c(~d.'st~ib~.•~Fiv~_ /a Eeia.~.r a t /y "x ~y.Z ~''w/ Y~ "'~'• ~'ee.5 .boa cam! a t .2. s3,' sys~.r, /~~~ Mew ~` ~e¢eds ~« by ~'o n,,,, ~3 Ta 6/c 1. 5!'j~ • 5, T, rY/, 3 03 y P~'f'/k ~rtiE l,ie ~cnv~u! tv y ~,y0 i ~1 B caw~vf'tSan C.S. -y 1'dnc,~ w~ k: Yla~.l ~ n ~I' gbou~ yrode. ~ss~ear eles = /t~0.G2~' .z "sue. ~o~ ~ e. ~arce,ru.~irJ ~ ~Z ~ i' wicsc~ Cc~ne.u~-ooo/SOOrri,Q csrc.waP7sa•MQ ~~ ~ ~ Pµ,,,p cha•n~ uSedQS S.T "'/G~abel~4-~L~~ o /~~~ ~ ~t°' / i/ ~ / °'a/~// ~/ a ( ~ ,/~ ~ Proposed /~~ c ~ ~ 5/0,,~ / 3 b-cd~, ~ `Z~ , ~ ~ i / ~ b proposed ~cL.l_,,, ~cs,'dcncc, r ~ r ~ ( ~ s9.a' 98.0 r 97. o'Co„~o4i ~~ a di o u a /oeoaEiY~, ~ /~, i u~e. d ~o„ce% :re (not /off C%~ !~lE.. PS.,n.: /tai/ir1 ~/ ~' (,Jc~v(~.n ~c~GC ~aS ~ a~~8"~boc.~ fide. Elc~ = /uo.ao.' ~ 8 0~/0 9~ _~5iaoeparvnento~~nduslry, . $0lL AND SITE EVALUATION REPORT Norge ~ ol-~ ' rand Human Rela~oiu Division of Salary 8 Ouildings in accord with ILHR 83.05, Wis. Adm. Code COUMY ST. C fz.0 t x Attach complete site plan on paper not less than 8 1!2 x 11 inches in size. Plan must include, but pARCEI I.D. r not limited to vertical and horizontal relerence point (BM), direction and % of slope, scale or o0y _1p1$_ZO- 000 dimensioned, nosh arrow, and location and distance to nearest road. REVIEWED BY DATE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION PROPERTY OWNER. PROPERTY LOCATION N Z. of Tn ~ S ~ -5W ~ ~~ ~~F"~}2Y EAU ITZ, 1,~-6~Nt~Z ~!4 $tnl 114,S g T Zg ,N,R IS W PROPERTY OWNER':S MAILING ADDRESS LOT Y BLOCK ~ SUBD. NAME OR CSM M iso bT"~ A-vcvu~ CITY, STATE ZIP CODE PHONE NUMBER CITY DVILUIGE OWN NEAREST ROAD AL.!]t~J I~1 S~-/002 C]1Sr 68U-31310 D C.T t-f. ~JI~ New ConsUuction Use 9CJ Residenttial I Number of bedrooms 3 ( (Addition to existing building ~- l J Replacement ( ( Public a commerdal desaibe Code derived Bail 11ow SU Re;.on~l~,~er~ dc~ign Voadirr~ rate r~P bed, gpd/n2 ~._? -bench, gpoln2 Y ~_._ 9Pd , •y Absorption area required -bed, n2 bench, n2 Maximum design baling rate ~_bed, gpdtnz a' Z- bench, gpoln2 Recommended infilUation surface elevations} X33' n (as referred to site plan benchmark) Additional design 1 site considerations T' t~~sr' IZ'' Parent material Co~AU~t-- T/t[ -Flood plain elevation, it applicable /~" _- n $ =Suitable for system CONVENTICPJAL MOUND IN•GROUNDPRESSUflE AT•GRADE SYSTflA IN (BILL o SING T U U =Unsuitable for s stem D 5 ,~I U ~ S D~ ^ S ~U ~ S U ~ S SOIL DESCRIPTION REPORT ~oring # ;M: -;; . t Ground elev. q9~ ft. Depth to limiting factor s~~ Boring # ..~ ::~.: r>:q ~:~..,x. ;::.:i, r3.... Z F' x'~.+~s>t%~s i. Ground elev: ~•~ It Depth to limiting fact Horizon Depth in. Dominant Color Munsell Qu. Sz. Cont Color i D-~d n z Z 8- t 7 to '-I z 3 I~-30 to V 30~3~ 3 GZd 7•SY2yI }( .-nn... o ~nrr ~n~c ~' OAupr_ FROM 17 S - sh C -- Roots G P D/.ft Bed Trt~ ~ -" 0 ..S 0 ~ ~o hemarrc ~ .~• .,..r..~ - - - l Z 0-"7 ~ - r Z z to I o v rt `~~Z --- -- 5t 1 Sr E m 2 ds S GS - -" o S' o. io N~P O, Z- 3 IZ-zD o Y 3/ ~ 5i ( 2 d S CS 0S `Dr . ~/ ~D.z IoV K 3 '_ 51 I 3 rti sb d S('1 fS ~ D,S 0,(0 S z-z f oY 3/ ~ sc~l z msbl d CS 0•y 6, (o zs-~ foY C 2d ~, sit ~+ ~I Z msbl~ dv CS ~ ~~ 30-31c 10 Yrc~'~o .~s,r' 7.:5 C`~ SC Zrr.s d„ h - _ o. .S Remarks: Nome:--Please Prin Phur,~: ~7lS W~7S bq(~"f` QUE., t21V1=JZ FALLS, W= Syc~3.Z Sign~y~ /`~ I ~ `/ Oate: :.1 V l.~`.~' ~ .tic / t ~,(. S(7.>,r ~~~ NiO~~ Texture Structure Gr. Sz. Sh, 5t1 1 sl z si l 3 17 Number: `70 ,~ER7YOWNER J~~,-Uji`z.~~~'~~ SOIL DESCRIP710N REPORT PARCELLD.af 0~{'" 101-ZO-000 0 Boring iJ '~~ j :ate,;. Ground elev. ~'7. l71t. Depth to limiting lacf~ Boring # ..: =x:_ Page ?• of Structure R t GPDl1t Horizon Depth in. Dominant Color Munsell Moores Du. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Bax~y oo s Bed Trerch I _7 (0 YR 2/ r .._ ,S i /Y~ ~ 0~ Z -IZ fo ~ 3 3 Sr I 2rY1 ~ C '' N 0,2 3 !z z(, ~+ - sl 1 ~ Bbl ds~,_ C s l D ~,G `{ z6-3o a . K,~ ~ , CY2yl~ sal 3mab d ~ Q~ J 0, 4 a S 3D-3~ Id VrZ 3~(0 7•.SV~`~~ SGI dh ~ D,S Ground elev. lf. Depth to 6rr~ong !actor Boring # °;r< ~: ~:H ... nmorLc Ground elev. It. Depth to limiting factor Remarks: _ Boring # ..~ v;. a Ground etev. IL Depth to limiting lac for Remarks: ea n_aaaor R.o9r~2t Page 7 of ~_ 7 .J ll 7 1 C 1 Y PLOT PLAtJ Property Owner S~~ K.4-U~Z..,. Legal Description T~{E ~~~zo~~tl~EsvJ~y O~ TAE sW~y ~~-rri~ n1~/z oF•rH~ s~~Iy ~F- T++>= S W' y , 5'EC.• 8, Tzsn), (Z t5 W , -rth.~-J of G'~DY, ST, CRo1K Cpunl7y, ~T~C(~~JS 1~ __ __ 5~ ~oc.~•'r ~ D~ -t x oalE,. ~ ~• 8 z ~ x pRoPEx r y uN e- 1.,`' 0 ~' D f ~D - ~'~` Z- ~ hA~ »~~~ uKH Signed CST ~ U~^"J ~ ^1 370'7 Date^SEPT ~a 1999 ~i i WHO Legend : ~=~ ~~~ Np~-£~j BM = ®# I -SAKE /til 6 ~~ wow l~r ~S~~~u•EC3~mU~1D ~SSUM~D /Ov~0 ~ ~ Z -y PA~u for ~D~Cy' P"~ ^ = soil boring w/backh e SITE r~J ~~~ ' `~0 ,4cy,E5 ND COMM S3 SE~U''o~..w ~N~S HOLLISTER'S SOIL TESTING Mary Jo Hollister W9875 690~F~ Avenue River Falls, WI 54022 (715)42b-1775 FAX: 426-4827 April 5, 2004 State of Wisconsin Dept of Commerce Plan Review Department RE: Soil report for Jeffery Kavitz, Town of Cady, County of St. Croix A Soil and Site evaluation report was conducted on September 20, 1999 at parcel # 004- 1018-20-000 located in the SE'/. of the SW'/<, Sec.8, T28N, R15W. A moderate, medium platy structure was observed in all the pits at a depth from 7 to 17 inches. The structure was already broken up into a fabk. The platy structure can be overcome by chisel plowing at a depth of 12 inches. if you have any questions or comments, please call. Sincerely, Mary Jo Hollister CST #224832 Distribution Cell -Concave Deflection Worksheet Jeff Kavitz 3 bedroom residential mound SE1/4 SW 1/4, Sec. 8, Tn. of Cady, St. Croix Co., WI. Site Information: 1. Design wastewater flow: 450 gpd (3 bedroom)(100 gaUbedroom)(1.5 peaking factor) 2. Depth to limiting factor: 25" 3. Land slope: 5% 4. Infiltrative capacity of soil at system elevation: 0.40 Bpd 5. System elevation: 100.16' at I S" above 98.90' contour. Dispersal cell sizing: 450 sq.ft. required (450 gpd / 1.0 gpd/sq.ft. ASTM C33 med. sand) Cell length (B) 90.0' Cell width (A) 5.0' Dispersal cell deflection: 1. Percent concave deflection: (5' defection/88' down slope effective cell length)(100) _ 5.68% 2. Adjusted cell length: [(5.68% x 0.00265) + 1] x 90' contour effective cell length = 91.36' 3. Actual cell length along contour = 91.36'. ~~ / D a~ I O ST CROIX COCINTY SBPTIC TANK MAI ~AI~GE AGREEMENT OWNERSHIP CERTIFICATION':FORM Owner/Buyec ' Mailing Address ~r!C ~~ ~ ~ ~ ~ ' ~, ° ~ `r-c~ /"'!/1, Property Address ~ ~~` ~ /~ (Vcrificatioa rcquitrd from P for new construction) J ~ i City/State ~PQ y' Parcel Identification Ntunber ~CS~ /t~Or~ Zp " ~P~ X,EGAL DESCRZP"X'XON -ia3 Property Location ~~y,, ~'j~? y,, Sec. ~ , T~3 N-R~W, Town of ~Q Subdivision Lot # Certified Sarvey Map # Volume ,Page # w~cy needy Gam/ ~ ~ 9 Volume/__L__z..~, Page # 7~~ Spec ~otzse ^ yes ~o Lot lints identifiable Q yes ^. no SXS'IEM~~i'AI1~TI'ENANCE - - I~vpauseandmain:tcaaa~ocofyomrupticsysGcmcouldnsaltiaitsp~fa~unto~andlewastcs.Propcr~aai~~aape ooarists of pampiag oat tfLC septic taalc evrrY 4hnx y~ oc sooner; if aeczdod by ~ ~oeased what yon, pat into the system eaaaffoct~e of one septic tanlcu.a trctbm~atstag~e ia~e ~aste'i3' . _ Tb~ pc+opaty- oar agues to sabmit~to St. (~noiz Zonmg Department i _oatificatioa farm, sigaod by the Dance and by a • p7°~Y~p ~~dplambcrori FuOCasodpampcrr~ring tfiat (Ij the oaaite wastewaterdssposal system is m P~ opaaiing oa:adrar (2) tfter inspeaiort and pmmpiag,(ff nocessazy), ~ septictank-is less .tom u3 -tan of sladgc. . I/wo, the tmaeizigR~oa have read ma above rcgair~ents tad tgc+x to ffio p~~ age disposal system with the standards . set forth, ~, •as set by wa Dcpartn~at of Cie tad tho Dcpactimea;t of 2latacal R,csoarctfi state of Wisconsin.. t.ertYf`„icaiioa ~S t~ ~ ~c sy~m ~ beta maintainod must be camplctod tad rctum,od to ~c St. C~oix.t:amty Zoning Office within 30 dayrof the ~ dam. 9 ~a OF APP DATE OwNER• CERTIITCAZTON _ I (we) oatify that tIl statcauuts oa this form ate tine to the best of my (our) imowledge. I (wc) am (are) the owner(s) of anty flood reooridod in litegister of Deeds OtI•ice. L ATE may exult is the sanitary permit being rcvokod by the Zoning Department. *'"" " Indudc Frith this applics-tioa: a stampod wanaaty flood fxnm the Rcgislcr of Dcods office a copy of the. certified survey map if ncfcxruee is made in the waeranty decd ~•~1.1~2iPA~.~ 4G0 STATE BAR OF WISCONSIN FORM 1 - 1982 WARRANTY DEED DOCUMENT NO. ~ This Deed, made between JON L. MORK, a single person Grantor, and JEFFREY A. KAVITZ. a sinrzle person Grantee, Witnesseth, That the said Grantor, for a valuable consideration __ conveys to Grantee [he following described real estate in St . Croix County, State of Wisconsin ~C~ 1 949 KATHLEEN H. WALSH REGISTER OE DEEDS ST. CROIX CO., WI RECEIVED F~ RECORD 04-25-1999 9:45 RM AARRANTY DEED El0]IPT M CERT COPY FEE: COPY FEE: TRANSFER FEE: 144.00 REWRDING FEE: 10.00 PAGES: 1 /~ d:. Tl11S SPACE RESERVED FOR RECORDING DATA NAME ANp RETURN ADDRESS ,C~v~ r'9 Gia a 004-1018-20 004-1OI8-30 PARCEL IDENTIFICATFON NUMBER The N-1/2 of SW-1/4 of SW-1/4 and the N-1/2 of SE-1/4 of SW-1/4 of Section 8, Township 28 North, Range 15 West, St. Croix County, Wisconsin. This is not homestead property. (is) (is not) Toge[her with all and singular the hereditaments and appurtenances thereunto belonging; And Jon L. Mork warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except - none and will warrant and defend the same. Dated this 23rd day of (SEAL) (SEAL) Signature(s) AUTHENTICATION authenticated this day of 19 ACKNOWLEDGMENT State of Wisconsin, ss. St. Croix County. Personally came before me this ? ~rA day of _~pri 7 192, the above named Jon L. Mork TITLE: MEMBER STATE BAR OF WISCONSIN (If noc. ~,Fy~ a 1!~'. ~iY.'\I~.+~. authorized by >i706.06, Wis. Stars.) ~ ~ n to me known to be the arson who executed the foregoing ..,T a-e~ z•.,r_ •ir,/~~r,`C~Ft'+1~'instniment d ackn ge the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Barry C. Lundeen ~ A • MUDGE, PORTER, LUNDEEN & SEGUIN, S. C. St. Croix Count Wis. 110_ SPrnn rl Rt rpF+t a HrrclSO,n, Wi a onain 54016 Notary Public, y (Signatures may be authenticated or acknowtedged. Both are not M co mission is ermanent. (IC noc, state expiration date: necessar)t) ~ • ~~) • Names of persons s~gnlnK ~n any' capantq 5fiould by typed or panted below rhea signawres. S TATF. BAR OF WISCONSIN wiaconain Legal BIeNC Co., FnC. WARRANTY DFPU Puna No. 1 - 1962 Milwaukee. Wia. (SEAL) Wisconsin ,9aparunent o1 Industry. SOIL AND S 1 T E E V A L)d'R~`J b N REPO R tabor and Human Relations Division, or salary a buildings in accord with ILHR t~`0,~ • Wis. Adrrrt:•Code r~ Attach oompleta site plan on paper not lass than 8 t/2 x 11 inches in~si~s. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of Slppa,~scala or ' ~, , dimensioned, north arrow, and location and distance to nearest roads ; ~.. Page r of ST. C(LOt ~ PARCEL I.D. r coy -to~8-zo- o00 aGViGwFn av DATE, APPLICANT INFORMATION-PLEASE PRINT ALL INFORMA ~irJN „_.. ~5'; Z~ ro PROPERTY LOCATION ~J of Tr e s PROPERTY OWNER: ~r~~~y Kf4V ITZ„ >I~~, ~~ •~ ~ t11,S g 7 ZS .N.R 1S W ., SUED. NAME OR CSM r PROPERTY OWNER':S MAILING ADDRESS LOT i So 6TH av~vuE' CITY, STATE 21P CODE PHONE NUMBER ^CITY ^YILLAGE OWN NEAREST ROAD GT ti. ~1 A1 . At..Dt,J rtil 5(702 ~1fS1681-t-3131p tJ New ConsUuction Use ~ Residential / Number of bedrooms 3 ( )Addition to existing building ___ ()Replacement ( ) Public or commando! desaibe . Code derived daily flow .Sb gpd Recommended design boding rate n1P--bed, gpdm2 t~~z trench, gpolft2 n2 Maximum design boding rate ~_bed, gpoltt2 a ~ Z- Uench, gpoltl2 '^ ~S tr ch , Absorption area requir 33' ft (as referred to site plan benu~cnark) '7' i . on(s) Recommended infiltration surface eleval Additional design! site considerations At_ow AT tF.JtsT` )Z'r l~ R l e Parent material COLA ~~- Flood plain elevation, if applicab S = Suitable fOr system CONVEMIONNL ~ U MOUND ~ S ^ IN•GiiOUND PNESSUAE A1•GRADE U ^ S U ^ S ~ SYSTFJ+r IN FILL ^ S U HOLDING T ^ S U U =Unsuitable for system ^ S , . or:~~ nocrotoTtflA1 pFRf]RT Boring # ,•.. „.,.ys,~ .~ °l <,:y :g: x<:,: %va Ground elev. 99~ ft. Depth to limiting factor j~ r r- Boring M ...x. .::<:; .S^~ ::~. ~~f a~,. ~'r GPD/ft Horizon Depth in. Dominant Color Munsell Moities Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence 8artday Roots Bed Trerxtt D-~ ~ sll m d S - OS 0 o .Z g-I'7 0 ~-1 Z ~" Sr Z ds~, C ~ NP 0. 3 1~- 0 to v ~ -' si 1 .3 ~sb d cs ~ o .S o,lo 3o~3b o s ~•SvR 1 .~ 1 sb )~ dv --- ~' 0.2 ~ 0,3 . ~.,,, t, nr.,.-.-~ =anon ~'_.~r;"• S~:~r ~~U~t_ FIt'4^^ l7 -~L --- ntatiarw . - - z ~ 511 m ds - os'o.~ t 0-~ to R . .~ 7-r z I O v 12 `~~2 ^- S~) 2 S C_S -"' 1J`P 0. Z- 3/ -'" s~t l 2 d s cS o.S ~ z7~ 3 fZ-zo o Y . y X0-2 IOY K 3 -" 51 1 3 ~ Sb d 5('1 ~ ~ 0•~ O~ID o Y 31 -' scl 2 m Sbl d CS J p.~t 6• s z-2 l {o ? 5-3U IOY C 2~t 7. 5~f y sC` Z mSbK c~U CS ~ 0. . 30 -310 Io ~f t2 3/b 7..5 tC y SC Z ~-r~s b1 ~'l Grotutd elev. ~4,~5 ft. Depth to limiting tact ,~ N Remarks: p+f- /~D le. R~ u c>e F~ Is..s t..~r 5y i ,. de: CST Number: ~~pr. 20f f 9Q M03`70 5sc Cor-1 wt QC.G'G} J0.v~. ~ ~ LDOQ~.sYi~~`~ „PRJPEHT`foWNER Ulr~, ~E~~ SOtt. DESCRIPTION REPORT PAt~CEl.L.D.rr Oo`•(^-IC~~'-ZU-000 Boring # ~:.~.~:w ~„~ "~`~;,:. >~. "> ~~ y .•.`~w'' . ~.: Ground elev. ~7.17(t. Depth to Limiting tact~6 Boring # .~ of v:.a..,. .~ ~: <~ il~ yA' :•% Page ~ o! ~, Horizon De th ~ in. Dominant Color Munsell Moafes Ou. Sz. Cont Color Texture Svucture Gr. Sz. Sh. Cans~sten~ Bo~Y toots GPOHt Bed Trend t -7 }a YR Z~r --- S~ I 3 n1 S 0, Z _jz la ~ 3 3 - Si 1 Zr+~ ~ ~ N ~,Z 3 t z z~ ~F -- sr ~ sb dsl, c s ~~ ~~~ `~ 2(,-30 o tv~ , cV2`Il~ SGI 3msb d Qw ~ 0.4 0 S 3~-3~ }Q VR 3~(0 7•SV~y~ ~c'1 dh ~ U.s nnnia~n~. - Ground elev. tt. Depth to smiting !actor Boring # f.;-;;~ :: ~: ,~ ~.>< z>.< :, Ground elev. Depth to limiting }aCLDf Boring # ~.. .~, ncniairv. i,.,...,.t,.. ~::y ,~ s; r ~z v>;; £' 3'siR.:~X:....H. Ground elev. It. Depth to limiting !actor Remartcs: S8D•e330(R.aS/42) v PLOT PLAN Property Owner ~'~~j2~~~(TZ~ Legal Description Tf{E /~~z 0~7HEsvJ~y O~ 7f-1~ SVJ~`~ R~"t'H'E. N'/,~,- QFTHS S~~I4 DF- THE Sw~~~-i~ 5~• `~, TZBI.J, 215u7~ ~ of CJ~DY, ST, CRO~x CAuN,ry, uT~Ct~NS l~- - Z .l 3 0 1 ~--~'p. GT+~1. N/~ ; 070 ~ Szl~ I.OC la-r ~ O~ "1 N {~2oQO~~ rJ ~-1~us~ ~oc~o-r~ ~N i~ IZSI NoRrt+i 0~ $2 Page~_ of ~_ ~~ ~ ~ Legend : / _ '~ ~,1(C~1~ NEST 6p HM = ®# 1 - SPIKE !tit 6 ~~ Woar~ ~T ~ S ~ ~ A.ap U ~ f3,e~~tJ 17 /}sSU/v~p,L~ 100.0' ~ ~ Z -y agau~ ,tou D~(~~~'~ ^ = soil boring w/backh e 51TE cN C~R~~ _ ~-~/~ ~4c/CES N o CAMM 8 3 S~T6~R~~,y~ ~.L. qq ti~ ~ ~~ ~~ ~S', s~ V'v ~~~ ! ~L qR. t-~ 83 D ~.~...qrr • l~' FF~E pnST ZZO ~ Z- +,1pT D15Z u+C$ SOUTH P/eOPEKT S! UN Z ~ ~' g I SG~- X Signed CS ~ /11 3707 Date 5~~ zO„~, 19 9 q St. Croix County Zoning Detail Sanitary Information Thursday, November 18, 2004 at 8:47:53 AM Page 1 of 1 Computer #: 004-1018-20-000 Sub/Plat: 40 acres Section: 8 Parcel #: 08.28.15.123 Lot: TN/RNG: T28N R15W Municipality: Cady Township CSM: 114 1/4: N 1/2 SW 1/4 Owner: Kavitz, Jeff 413 County Hi ghway NN Wilson, WI 54027 State Permit: 453169 Issued: 05/05/2004 POWTS Dispersal: Mound less than 24" suitable s Permit: New County Permit: 0 Installed: 11/09/2004 POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: Unknown Notes Insaector As Built Plumber Other Requirements Additional Notes Monev Owed Ryan Yarrington NA Hudson, Dale $0.00 Signed Off: Yes Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 11 /9/2007 Parcel #: 004-1018-20-000 11/18/2004 08:39 AM PAGE 1 OF 1 Alt. Parcel #: 8.28.15.123 004 - TOWN OF CADY Current ^X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): * =Current Owner " ItAVITZ, JEFFREY A JEFFREY A KAVITZ 420 CEDAR ST 43 BALDWIN WI 54002 Districts: SC =School SP =Special Property Address(es): Primary Type Dist # Description SC 0231 BALDWIN-WOODVILLE AREA ~/ ~ C N SP 1700 WITC Legal Description• Acres: 000 Plat: N/A-NOT AVAILABLE SEC 8 T28N R1 N1/2 SW SW & N 1/2 SE SW Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 08-28N-15W Notes: Parcel History: Date Doc # Vol/Page Type 04/26/1999 601949 1421 /400 W D 04/16/1999 601396 1419/179 WD 07/23/1997 592/91 07/23/1997 503/370 7And CI 1MMeRV Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Description Class AGRICULTURAL G4 UNDEVELOPED G5 Totals for 2004: General Property Woodland Totals for 2003: General Property Woodland Last Changed: 05/24/2004 Acres Land Improve Total State Reason 4.000 400 0 400 NO 36.000 14,100 0 14,100 NO 40.000 14,500 0 14,500 0.000 0 0 40.000 1,600 0 1,600 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ~GOULDS PUMPS Submersible Effluent Pump 3885 PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. APPLICATIONS Specifically designed for the following uses: • Homes • Farms • Trailer courts • Motels • Schools • Hospitals • Industry • Effluent systems SPECIFICATIONS Pump • Solids handling capabilities: '/4" maximum. • Discharge size: 2" NPT. • Capacities: up to 140 GPM. • Total heads: up to 128 feet TDH. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • See order numbers on reverse side for specific HP, voltage, phase and RPM's available. FEATURES ^ Impeller: Cast iron, semi- open, non-clog with pump-out vanes for mechanical seal protection. Balanced for smooth operation. Silicon bronze impeller available as an option. ^ Casing: Cast iron volute type for maximum efficiency. 2" NPT discharge. ^ Mechanical Seal: SILICON CARBIDE VS. SILICON CARBIDE sealing faces. Stainless steel metal parts, BUNA-N elastomers. ^ Shaft: Corrosion-resistant , stainless steel. Threaded design. Locknut on three phase models to guard against component damage on accidental reverse rotation. ^ Fasteners: 300 series stainless steel. ^ Capable of running dry without damage to components. ^ Designed for continuous operation when fully submerged. MOTORS ^ Fully submerged in high- gradeturbine oil for lubrication and efficient heat transfer. ^ Class B insulation. METERS FEET 40 130 120 35 110 30 100 c 90 = 25 80 V 70 a zo 0 60 15 50 ~ 40 10 30 5 2 10 0 0 Single phase: • Built-in overload with automatic reset. • All single phase models feature tapacitor start motors for maximum starting torque. •'/s and'/z HP -16/3 SJTOW with 115, 208 and 230 Volt three prong plug. • 3/4-2 HP -14/3 STOW with bare leads. Three phase: • Overload protection must be provided in starter unit. •'/~-2 HP-14/4 STOW with bare leads. ^ Designed for Continuous Operation: Pump ratings are within the motor manufacturers recommended working limits, can be operated continuously without damage when fully submerged. ^ Bearings: Upper and lower heavy duty ball bearing construction. ^ Power Cable: Severe duty rated, oil and water resistant. Epoxy seal on motor end provides secondary moisture barrier in case of outer jacket damage and to prevent oil wicking. Standard cord is 20'. Optional lengths are available. ^ 0-ring: Assures positive sealing against contaminants and oil leakage. AGENCY LISTINGS ® Tested to UL 778 and CSA 22.2 103 Standards By Canadian Standards C US Association rile #LR385d9 Goulds Pumps is ISO 9001 Registered. _ E H _ __ ._ __ _. _ __ __ __. ___j _i_T ~ -_. __ _.._ _ __ r -- i- _- - 51 { i _i~ __. 51 - --- -- - - - --- -- -- -_ - _. . _ t i - - - R !_ ~_ _~ ~. - -- --- - --- --- --- - - -_ -_ - FT s f _'- -~_-_ ~ . - -- - -_ -_-. -- -- --- --- - -- -- --- - --- i --- - - -I- _ (_..~ - _ __ .~_,_. -+._ _.1 - _. -- -- - -- - --- -- --- -- --- -- --- --- --- -- - -- -- -- -- - - -- ~ _ :: a - ~ _ ~_ ~ _.. a -- --- -- --- --- -- -- --- - - --- - - --- -- t _ - ' ! - ~ a- - ~ - - ` --- b - --- - --- --- - ___ _.. - ---- -a -- -- -- +- 1 , - -- - x. ___- _ -- -- -- _-- __ __ _ __ _ __ _- ___'R -- - - - - - - - ~ -L_ __~_ ~ __! -r-~-+ - . - _ __ _ -- -- -- --- -- - f __ __. + i - t- - __ -_ -- --- . ___ __ _ ___ ___ ____ _. i__ .. -- Y .~ ~ {. -. - .,_ ~ -- - j . _ 0 RTES. 3885 'M. 3500 & 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 GPM 10 15 20 25 30 35 m3/hr CAPACITY Goulds Pumps C~~ 2002 Goulds Pumps Effective October, 2002 www.goulds.com 83885 4~~ ITT Industries