Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
004-1018-50-000
County Safety and Buildings Division St.Croix 201 W.Washington Ave., P.O.Box 7162 Sanitary Permit Number(to be filled in by Co.) Madison,WI 53707-7162 PA 10 State Transaction Number i rmit Applica ion �� ����In accordance with SPS 311&t4 Code,submission of this form to the appropriate governmental unit is required prior to obtain', nary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing addres the Department of Safct9 d Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law,s.15.04(1 m),Slats. 438 290 Street 16 I. Application Information-Plea rint All Information Property Owner's Name 4 015 Parcel# Tom&Marla Smith 004-1018�p-000 Property Owner's Mailing Address Property Location 1345 Birch Park Road Govt.Lot City,State Zip Code Phone Number _$E_'/<, Section 8 (circle one) Houlton,WI 54082 715 549-9101 T 28 N; R 15 E or W II.Type of Building(check all that apply) Lot# Subdivision Name 1 or 2 Family Dwelling-Number of Bedrooms 3 Na Na es I,-- taste Block# ❑Public/Commercial-Describe Use I Na ❑City of %.0 CSM Number ❑ Vil e of ❑State Owned-Des ribe Use ` n n Na Town of Cady_ III.Type of P rmit: (Check only one box on line A. Complete line B if applicable) a e- A' ew System ❑ Replacement System ❑Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) B. ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permpit N be an Dat Issued Before Expiration Owner -I �6 IV.Type of POWTS System/Component/Device: Check all that appl �,� El Non-Pressurized In-Ground El Pressurized In-Ground 11 At-Grade ❑Mound>24 in.of suitable soil R ound<24 in.of suitable soil ❑Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dispersaffreatment Area Information: Design Flow(gpd) Design Soil Application Rate(gpds Dispersal Area Required(sf) Dispersal Area Proposed(s System Elevation / 106.00' at 30"above 450 Gpd 1.00 Gpd/Sq.Ft. 450.00 sq.f. 450.00 Sq.Ft 103.50'contour VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units U G Y New Tanks Existing Tanks P o 2 a3 L-j f,64.Dk Sz P.Ui;5 N on w a Septic or Holding Tank 1,200 0 1200 1 Wies r Concrete X Dosing Chamber 800 0 800 1 Wieser Concrete X VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWYS shown on the attached plans. Plumber's Name(Print) Plu r s ignature P/MPRS Number Business Phone Number Dale Hudson !mil MP 220853 (715)684-3378 Plumber's Address(Street,City,State,Zip Code) 820 Main Street,Baldwin,WI 54002 VIII oun /De artment Use Only Approved i[]flf7,venitason Permit Fee Date issued / Issuing A nt Signatur ❑ for Denial $ (P ZS a is Z3 �`t tiX.CondV#9T6 4Q*Xd9"easons for Disapproval f''`Septic1ank,effluent filter and . (�0� .�t�•^S 1,�. dispersal cell must all be servlces/marritairied are- as i� ��� �l �, �N►! 1�" per management plan provided by plumber, t soo)w*requirements must be.MatMafneti n pw tiipplicabllt code`7 ordintinces. Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398(R. 11/11) DALE E HUDSON Page 2 10/8/2014 Owner Responsibilities: • 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. • 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.SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard,the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance.As per state stats 101.12(2),nothing in this review shall relieve the designer of the responsibility for designing a safe building,structure,or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, Fee Required$ 250.00 /�/// Fee Received$ 250.00 G'li Balance Due $ 0.00 rand M Swim POWTS Plan Reviewer,Integrated Services (608)789-7892,Mon-Fri, 7:15 am-4:00 pm WSMART code:7633' jerry.swim@wisconsin.gov cc: Boldts Plumbing and Heating Inc James K Thompson,Ace Soil& Site Evaluations Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm tiYART, o� DIVISION OF INDUSTRY SERVICES T 3824 N CREEKSIDE LA o� lip HOLMEN WI 54636 c v ' Contact Through Relay http://dsps.wi.gov/programs/industry-services y www.wisconsin.gov A�OssroN�tis� Scott Walker,Governor Dave Ross,Secretary October 08,2014 CUST ID No. 220853 ATTN.POWTS Inspector DALE E HUDSON ZONING OFFICE BOLDTS PLUMBING&HEATING INC ST CROIX COUNTY SPIA 820 MAIN STREET 1101 CARMIC1 AEL RD BALDWIN WI 54002 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/08/2016 SITE: Identification'Numbers Tom and Marla Smith Transaction ID No.2460540 438 290TH St Site ID No. 806363 Town of Cady, 54027 Please refer to both identification numbers, St Croix County above,in all correspondence with the agency. NW1/4, SE1/4,S8,T28N,R15W FOR: Description: Three Bedroom Mound System/ 10.5%slope Object Type:POWTS Component Manual Regulated Object ID No.: 1504304 Maintenance required; 450 GPD Flow rate; 6 in Soil minimum depth to limiting factor from original grade System(s):Mound Component Manual-Ver.2.0,SBD-10691-P(N.01/01,R. 10/12),Pressure Distribution Component Manual-Ver.2.0, SBD-10706-P(N.01/01,R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s)referenced above. COND The owner,as defined in chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all code requirements. AP DEPT OF No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, SI PROFESSIO stats. DIVISION OF IN The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders: • 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. SEE RRE • Inspection of the private sewage system installation is required.Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d),Wis.Stats. • A state approved effluent filter is required.Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • The area within 15' downslope of the dispersal component shall remain undisturbed.Vehicular traffic, excavation or soil compaction is prohibited in this area. • A copy of the approved plans specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. DALE E HUDSON Page 2 10/8/2014 Owner Responsibilities: • 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. • 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.SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard,the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance.As per state stats 101.12(2),nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure,or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, Fee Required$ 250.00 ' Fee Received$ 250.00 Balance Due $ 0.00 rard M Swim &4� POWTS Plan Reviewer,Integrated Services (608)789-7892,Mon-Fri, 7:15 am-4:00 pm WiSMART code:7633 jerry.swim@wisconsin.gov cc: Boldts Plumbing and Heating Inc James K Thompson,Ace Soil& Site Evaluations Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm 0. 2014 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Tom & Marla Smith 3 bedroom mound Owner's Name: Tom & Marla Smith Owner's Address: 1345 Birch Park Road Houlton, WI 54082 Site Address: Same ' Legal Description: NW1/4SE1/4, Sec. 8, T.28N., R.15W. - Township: Cady County: St. Croix Subdivision Name: Na OVALLY Lot Number: Na Block Number: Na ROVZO 'AFETY AND Parcel I.D. Number: 004-1018-40-000 44L "ERVICES Plan Transaction No.: U. SERVICES Page 1 Index and title Page 2 Data entry Page 3 Mound drawings ONDCNCE 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 Daily Flow Calculations Page 9 Site Plan Page 10 Attached Interprative Determination Approvl by Jansky Page 11 Attached Soil Evaluation Report by Grote Page 12 Attached Soil Evaluation Report by Thompson Designer: Dale Hudson License Number: 220853 Date: 08/27/14 Phone Number: (715)684-3378 Signature:;al... Z, Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SBD-10691-P(N. 01/01, R. 11/12),and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS(01/81)and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P(N. 01/01, R. 10/12) Version 7.0 (R. 11/12) Pagel of 12 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R1 Residential or Commercial Design Note: Sand fill(D)calculations assume a 300.00 Estimated Wastewater Flow(gpd)' Table 383-44-3 in-situ soil treatment for 1.50 Peaking Factor(e.g. 1.5 = 150%) fecal coliform of-36 inches. 450.00 Design Flow(gpd) 10.50 Site Slope (%) 103.50 Contour Line Elevation (ft) 6.00 Depth to Limiting Factor(in) 0.20 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 120.00 Dispersal Cell Length Along Contour(ft) F 4.00 Cell Width (ft) 0.94 Dispersal Cell Design Loading Rate(gpd/ftz) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) f�^---�- cl Center or End Manifold 0.00 Lateral Spacing (ft) If N above, enter the elevation ft) 2 Number of Laterals of the highest point. _ 0.125 Orifice Diameter(in) �v 1.50 Estimated Orifice Spacing (ft) = 6.00 ftz/orifice Forcemain Diameter(in) _ j 425.00 Forcemain Length (ft) Does the forcemain drain back? C Y N ~' _ 75.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 69.32 Forcemain Drainback (gal) 30.50 Vertical Lift(ft) 54.36 5x Void Volume (gal) 9.80 Friction Loss(ft) 123.69 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 32.95 System Demand (gpm) T6-6-61 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 ._..._. 1.25 _.__.. 1.00 _--� 1.50 1.25 i 2.00 1.50 x x T 3.00 _ 2.00 x 3.00 w Gallons/Inch Calculator(optional) Treatment Tank Information ~800. Total Tank Capacity(gal) 1200.00� Se p tic Tank Ca p aci ty(g al) _ 00 Total Working Liquid Depth (in) Wei iserConcrete ]Manufacturer 22.24 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 800.641 Dose Tank Capacity (gal) �PolyLok Filter Manufacturer T� 'PL-525 Filter Model Number 22.24 Dose Tank Volume(gal/in) Wi eiser Concrete )Manufacturer Project: Tom & Marla Smith 3 bedroom mound Page 2 of 12 Mound Plan and Cross Section Views . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1/10 B " " " " " " " Observation Pipe : : : J :K �' - :ti:' .:: :.1 ..5 A . . . . . . . . . . W . . . . . . . . . . . . . . . . . . . . . . . . . . . ..... . . . . . . . . ♦5 B , , . . I L Mound Component Dimensions A 4.00 ft E 35.04 in H 1.00 ft K Nift ft B 120.00 ft F 9.50 in z 18.45 ft L ft D 30.00 in G 0.50 ft J 8.65 ft W 480.00 (ft2) Dispersal Cell Area 1 2693.43 (ft) Basal Area Available 3.75 (gpd/ft) Linear Loading Rate 1 12.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 107.79 (ft) ---► ,� .... ♦ H I F Dispersal Cell' 106.50 (ft) Lateral 106.00 (ft)--► -- Invert Dispersal Cell [ t Elevation A •Z`i :'K``h.'`� :..'?.?`l•:��`��-� '<�'t .'`.�,;�`<�L�!:�t.•Li, %t`;.;:'.'.lie.' 'ti�'`;�� ..4 ..^1. „� 1•.. /K<4J`�1 4 l i.. ✓' 4 ? 4. {4 +..1 i1 ^•.\'\\.'+`%�{+1{ti`cAY.✓ �. 1.. 1 { 1. ♦l 1 103.50 (ft)Contour Elevation 10.5 % Site Slope Geotextile Fabric Cover Shading Key -T Dispersal Cell See lateral details on 10 Topsoil Cap o ° 1.5 ft e �- Page 4 for number,size, Subsoil Cap w c ( and spacing of laterals. ASTM C33 Sand Laterals are equally I '' F La Tilled Layer d 0.5 ft :•,Typical Lateral spaced from the y r' distribution cell's © Aggregate o " centerline in the A distribution cell(Ax6). Project: Tom & Marla Smith 3 bedroom mound Page 3 of 12 Center Connection Lateral Layout Diagram l P I IF X—+I+xt2 x12+1 Laterals 8.forcemain Sch 40 PVC per SPS Table 384.30-6 Holes drilled on the Nmorn of the lateral, s Turn-up wttmilvslw or claanoutplug equaj spaced Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 1.50 ft Lateral Length (P) 59.25 It Orifices per Lateral 40 Lateral Spacing (S) 0.00 ft Orifice Density 6.00 ft2/orifice Lateral Flow Rate 16.48 igpm Manifold Length 0.00 ft System Flow Rate 32.95 gpm Manifold Diameter 0.00 in Total Dynamic Head 46.80 ft Forcemain Velocity 3.37 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and " —► SPS 316.300 WAC 4 in.min. Disconnect Tank component is properly vented E— Alternate outlet location Forcemain diameter Weiser Concrete Manufacturer 2 in. Capacityl 800.64 Gallons Volume 22.24 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 16.44 365.59 B 2.00 44.48 C Pump off elevation(ft) C 5.56 123.69 76.00 D 12.001 266.88 D Total 36.00 800.64 Dose tank elevation(ft) 3" Bedding uncler tank. 75.00 Alarm Manuafacturer iSJE Rhombus Note: Switches Alarm Model Number SJE 1011421 containing mercury may not be used in Pump Manufacturer ;Goulds this system. Pump Model Number i3885 WE10H Pump Must Deliver 32.95 g p m at 46.80 ft TDH Project: Tom & Marla Smith 3 bedroom mound Page 4 of 12 Mound System Maintenance and Operation Specifications Service Provider's Name D ale_Hudson Phone 715 684-3378 POWTS Regulator's Name C .St.MCroix County Zoning Dept. J Phone (715)_q86-46801 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 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 480 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once every,3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis.Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis.Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished ••........•••. ............... Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Tom & Marla Smith 3 bedroom mound Page 5 of 12 Mound System Management Plan Pursuant to SPS 383.54,Wis.Adm.Code General This system shall be operated in accordance with SPS 382-84 Wis.Adm.Code,and shall maintained in accordance with its'component manuals(SBD-10691-P(N.01 101,R. 11/12),SSWMP Publication 9.6(01181),and Pressure Distribution Component Manual Ver.2.0 SBD- 10706-P:(N.01/01,R. 10/12)]and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33,Wis.Adm.Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers,access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound,defective,or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s.281.48,Stats. The contents of the septic tank shall be disposed of in accordance with NR 113,Wis.Adm.Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm,the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment,maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump(dosing)tank shall be inspected at least once every 3 years. All switches,alarms,and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter,and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic(other than for vegetative maintenance)on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations(October-February)dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/L TSS,and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS,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 performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional,more frequent monitoring. Continuency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank,pump,pump controls,alarm or related wiring becomes defective the defective component(s)shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface,it will be repaired or replaced in its'present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media,and related piping,and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 12 GOULDS PUMPS Submersible Effluent Pump 3885 PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. APPLICATIONS 9 Shaft: Corrosion-resistant Single phase: ■ Bearings: Upper and stainless steel,Threaded •Built-in overload with lower heavy duty ball bearing Specifically designed for the design. Locknut on three phase automatic reset. construction. following uses: models to guard against •All single phase models ■ Power Cable: Severe duty •Homes component damage on feature capacitor start rated, oil and water resistant. •Farms accidental reverse rotation. motors for maximum •Trailer courts Epoxy seal on motor end •Motels a Fasteners:300 series starting torque. provides secondary moisture •Schools stainless steel. •'/3 and '12 HP-16/3 SJTOW barrier in case of outer jacket •Hospitals n Capable of running dry with 115, 208 and 230 Volt damage and to prevent oil three prong plug. wicking. tandard cord is 20'. • Industry without damage to •1/4-2 HP—14/3 STOW with g • Effluent systems components. Optional lengths are available. bare leads. x 0-rim Assures positive ■ Designed for continuous Three phase: g' P sealing against contaminants SPECIFICATIONS operation when fully •Overload protection must submerged. be provided in starter unit. and oil leakage. Pump •Solids handling capabilities: •'/z-2 HP— 14/4 STOW with bare leads. maximum. MOTORS AGENCY LISTINGS •Discharge size: 2"NPT. H Fully submerged in high- ■ Designed for Continuous •Capacities: up to 140 GPM. grade turbine oil for lubrication Operation: Pump ratings are Tested to UL 778 and •Total heads: u to 128 feet within the motor manufacturer's CSA 22.2 108 Standards P and efficient heat transfer. B Canadian Standards rpH recommended working limits, y • Temperature: ■Class B insulation. can be operated continuously �cp us F le#LR38549 104:F(40'C)continuous without damage when fully 140-F(60°C)intermittent, submerged. Goulds Pumps is ISO 9001 Registered. •See order numbers on METERS FEET S�side for specific HP, 40F 130 ;SERIES:3885 voltage, RPM's 1 WE15HH I SIZE: '/�"SOLIDS zo available. 35t ---- —� RPM: 3500& 110 _ 17501 WE20H ► 5GPM I FEATURES 30I 100 �—sFT -- Z 25 90 WE15H .- r Impeller: Cast iron, semi- °c open, non-clog with pump-out so E1oH varies for mechanical seal 70 E07 H protection. Balanced for ; �0I 60 smooth operation. Silicon 5/{,gp7 ° WE05 bronze impeller available asT� o an option. Qo a Casing: Cast iron volute type 10 30 WE03M for maximum efficiency. 1 20-wE03L _.. ,. . 5 2' NPT discharge. to YI Mechanical Seal: SILICON o °0 10 zo 3o Qo so 60 )o ao yo loo iio 1zo 13o i CARBIDE VS. SILICON 40 150 160 GPM CARBIDE sealing _ L-_--t_._._.t__— ----- ------ ------- -_ g aces. ° 5 10 15 20 25 30 35 5 m3/hr Stainless steel metal parts, CAPACITY BONA N elastomers. 32.45 ,.,,F art%��mu„7S4Pa/y et-� Goulds Pumps 20102 Goulws Pumps ITT Industries Octooer, 2002 wwv,goulds.com w �, p 7 o 9 f � o c� A Q x Mary � . � tide � J-4 -{J O SAFETY AND BUILDINGS DIVISION commerce.wi.gov Integrated Services Bureau 13 East Spruce Street Chippewa Falls,WI 54729 isconsin INSPECTION REPORT F.stat e.wi.us/sb Department of Co �EC Date of Inspection: November 18, 2004 Plumber Name and Address: WI V 2 2004 t Project Name: Gokay NA Use: Residential �T CRuIx COb,'v7 Legal Description: NW, SE, 8, 28, 15W ZONING OFFICE Site Number: 692548 Subdivision: NA Certified Soil Tester Name and Address: Municipality: Town of Cady enry F,. Grote, CST 222774 E4366 County: St. Croix 53rd Ave Menom ie WI 54751 Plan Transaction Number: 1085054 Sanitary Permit Number: Owner Na and Address: illiam Gokay Wastewater Flow: 600-750 gpd W1618 850"Ave Persons Present: H. Grote Spring Valley WI 54767 An onsite soils verification was conducted at the above referenced site as per district policy for all sites with less than four inches of unsaturated soil below the bottom of the A horizon. The intent of this investigation is to confirm initial observations by the certified soil tester (CST) relating to the presence or absence of redoximorphic features in the A horizon and/or subsoil. In-situ soil texture, structure, and consistence factors were also reviewed as they relate to wastewater application rates. Other site conditions such as percent and direction of slope, landscape position, land surface contour length, and surface water hydrology may also be noted and their effects are factors considered in the recommendations and conclusions portion of this report. A typical soil profile at T-1 (near CST B-3)could be described as follows: 00-09" 10YR 3/3 sil, 2f-msbk, mfr, cs. 09-16" 10YR 4/4 sil, 2msbk parting top[, mfr, w/f2f 10YR 6/3 and 5/6 rmfs If a mound system is designed to overcome limitations of a high level of seasonal soil saturation and slow permeability, the linear loading rate should not exceed 4.5 gpd/ft and the basal wastewater application rated should not exceed 0 2 2. The additional basal area will partially compensate fo r e -sloperand prevent wastewater leakage at the mound toe. At least 27 inches of sand lift is recommended when applying mantic tank effluent to the distribution cell of the mound to ensure proper treatment. The longest portion of the mound must be orientated along the contour. The mound shall be constructed to divert surface water around the mound structure as much as possible. In addition, an up slope drainage ditch should be considered if it is determined that surface or subsurface hydrology is improved by intercepting water and diverting it away from the mound site. If there are any questions regarding this report, please contact me. oy G. J sky, stewater pecialist cc: County ❑ Plumber Ljansky@6bmmerce.state.wi.us E-mail ❑ CST ❑ Owner 715/726-2544 Voice 715/726-2549 Fax ❑ Other Property Owner GOkay,William Parcel ID# 004-1018-40-000 Pd 8.28,15,125 Page 2 of 3 F Boring# Boring Pit Ground Surface elev. 98.7 ft. Depth to limiting factor 0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 1 0-11 10YR 3/3 - sil 2 f sbk mvfr cs if .6 .8 2 11-13 10YR 4/4 - sil 2 f sbk mvfr cs if .6 .8 3 13-18 10YR 4/4 f2f 7.5YR 4/6 sl 1 m sbk mvfr gs 1f/m .4 .7 4 18-21 7.5YR 4/4 f2f 5YR 4/4 sl 1 m sbk mvfr gs 1 m .4 .7 5 21-33 7.5YR 4/4 f1 d 5YR 4/4 scl 0 m mvfr - 1 m 0 0 lacks A+4";presumptive limit is 0"; 1 m roots to 29";side seep @ 33" 4] Boring# Boring Pit Ground Surface elev. 99.7 ft. Depth to limiting factor 0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP ' in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 1 0-9 10YR 3/3 - sil 2 f sbk mvfr cs 1 f/m .6 .8 2 9-14 10YR 4/4 f1f 7.5YR 4/6 sil 2 f sbk mvfr cs if .6 .8 3 14-19 10YR 4/4 f2d 7.5YR 4/6 sl 1 m sbk mvfr gs if .4 .7 4 19-24 7.5YR 4/4 f3p 5YR 4/4 sl 0 m mvfr s 1f 2 .6 7.5YR 5/3 g 5 24-40 7.5YR 4/4 c3p 5YR 4/4 scl 0 m mvfr - if 0 0 7.5YR 5/3 lacks A+4";presumptive limit is 0';inclusions 10YR 4/4 sil 7-9';2 vertical 7.5YR 4/6-10YR 6/2 redox features associated w/roots below 9"; 1 f ro is to 36"; no side seep F-5-1 Boring# Boring f Pit Ground Surface elev. 99.6 ft. Depth to limiting factor 0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 1 0-9 10YR 3/3 - sil 2 f sbk mvfr cs 1f/m .6 8 2 9-12 10YR 4/4 f2d 7.5YR 4/6 sl 2 f sbk mvfr gs if .6 1.0 3 12-18 7.5YR 4/4 c7. 5YR/3 sl 1 m sbk mvfr s 1 m .4 .7 7.5YR 5/3 9 4 18-34 7.5YR 4/4 c3p 5YR 4/4 scl 0 m mvfr - 1 m 0 0 7.5YR 5/3 lacks A+4";presumptive limit is 0";ff inclusions 10YR 4/4 sil 6-9"; 3 vertical 7.5YR 5/8,5/3 redox features associated w/roots below 9";1 m roots o 26";side seep @ 28" Effluent#1 =BOD5>30<220 mg/L and TSS>30< 150 mg/L *Effluent#2=BODS<30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330(R.07/00) Certified Soil Testing RIOWAL 2162 Wisconsin Departmen enF SOIL EVALUATION REPORT Page 1 of 3 Division of'Safety and it ' in�accordange with Comm 85,Wis.Adm.Code Certified Soil Testing U V County Attach complete site n n r not less than 8'%x 11 inches in size. Ian must St. Croix include,but not limited andf¢tep�point($M),di ction and percent slope,scale or ms' no rind dista to nearest road. Parcel I.D. -1018 0-000 Pcl 8.28,15,125 Please prTnTIMArortnation. iewe B Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). Property Owner Property Location Gokay,William Govt.Lot NW 1/4 SE 1/4 S 8 T 28 N R 15 W Property Owner's Mailing Address Lot# Block# Subd. Name or CSM# W. 1618 850th Ave. City State Zip Code Phone Number City Village Jd Town Nearest Road Spring Valley WI 1 54767 715-772-3293 Cady 290Th St. V New Construction Use: 14 Residential/Number of bedrooms 5 Code derived design flow rate 750 GPD __]Replacement Public or commercial-Describe: Parent material loess over till Flood plain elevation,if applicable NA General comments and recommendatio s: most soils in study area lack A+4"; inte pretive determination required with state and county approval Boring# LJ Boring Pit Ground Surface elev. 98.7 ft. Depth to limiting factor 13 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 1 0-9 10YR 3/3 - sil 2 f sbk mvfr cs 1f/m .6 .8 2 9-13 10YR 4/4 - sil 2 f-m sbk mvfr cs 1 m .6 .8 3 13-27 10YR 4/4 f2f22pp7.5YR 4/4 sl 1 m sbk mvfr gs 1 m .4 .7 4 27-37 7.5YR 4/4 cT5YRR5/34 scl 0 m mvfr - 1 m 0 0 profile just makes A+4';some 10YR 4/4 sil inclusions 4-9'; 1 m roots to 34';side seep @ 35" Boring# Boring J6 Pit Ground Surface elev. 99.8 ft. Depth to limiting factor 0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Cu.Sz.Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 1 0-9 10YR 3/3 - sil 2 f sbk mvfr cs if .6 .8 2 9-15 10YR 4/4 f110YR 6/2/6 sit 2 f-m pl mvfr cs if 0 .2 3 15-22 10YR 4/4 f2p3p 5Y 7.5YR 4/6 sl 1 m sbk mvfr gs 1 m .4 .7 4 22-36 7.5YR 4/4 cTp 5434 scl 0 m mvfr - if 0 0 lacks A+4";presumptive limit is 0";some 10YR 4/4 sil inclusions 5-11"; 1 f roots to 30";side seep @ 30" Effluent#1 =BOD5>30<220 mg/L and TSS>40<150 m .Effluent#2=BOD <30 mg/L and TSS<30 mgt CST Name(Please Print) Sign ur ." , I CST Number Henry F. Grote �, � 222774 Address Certified Soil Testing a valuate ducted Telephone Number E.4366 353rd Ave.,Menomonie,WI 54751 11/1/2004 715-233-0398 Property Owner Gokay,William Parcel ID# 004-1018-40-000 Pd 8.28,15,125_ Page 2 of 3 F3] Boring# M Boring Pit Ground Surface elev. 98.7 ft- Depth to limiting factor 0 in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture SWCture Boundary. Roots in. Mansell Ou.Sz.Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 1 0-11 10YR 313 - SO 2 f sbk mvfr cs if .6 .8 2 11-13 10YR 4/4 - sit 2 f sbk mvfr CS if .6 .8 3 13-18 10YR 414 f2f 7.6YR 416 sl 1 m sbk mvfr gs 1f/m .4 .7 4 18-21 7.5YR 4/4 f2f 5YR 4/4 sl 1 m sbk mvfr gs 1 m .4 .7 5 21-33 -7.5YR 4/4 f1 d 5YR 4/4 Sol 0 m mvfr - 1 m 0 0 lacks A+4";presumptive limit is 0";1 m roots to 29";side seep 33" F4� Boring# jj Boring 10 Pit Ground Surface elev. 99.7 ft. Depth to limiting factor Q in. Sol APa Rata Horizon Depth nt Color Redox Desaiption Towns Structure Consisterx a WKIary Roots in. Munsell Ou.Sz.Cont Color Gr,Sz.Sh. 'Eff#1 "EfF#2 1 0-9 10YR 313 - sit 2 f sbk mvfr es 1f/m .6 .8 2 9-14 10YR 4/4 f1f 7.5YR 4/6 sit 2 f sbk mvfr cs if .6 .8 3 14-19 1OYR 4/4 f2d 7.5YR 416 sl 1 m sbk mvfr gs if .4 .7 4 19-24 7.5YR 4/4 f3p 5YR 4/4 sl 0 m mvfr gs If .2 .6 7.5YR 5/3 5 24-40 7.5YR 4/4 c3p 5YR 4/4 Sol 0 m mvfr if 0 0 7.5YR 5/3 lacks A+4';presumptive limit is 0';inclusions 10YR 4/4 sil 7-9";2 vertical 7.5YR 4/6-10YR 6/2 redox features associated w/roots below 9", 1 f r is to 36";no side seep a Boring# 3g Boring Pit Ground Surface elev. 99.6 ft. Depth to limiting factor p in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisterm Boundary Roots in. MunseY Ou.Sz.Cont Color Gr.Sz.Sh. •Eff#1 •Eff#2 1 0-9 1OYR 3/3 - sil 2 f sbk mvfr CS 1f/m .6 .8 2 9-12 1OYR 414 f2d 7.5YR 4/6 sl 2 f sbk mvfr gs If .6 1.0 3 12-18 7.5YR 4/4 c2p 5YR 4/4 sl 1 m sbk mvfr gs 1m .4 .7 7.5YR 5/3 4 18-34 7.5YR 4/4 c3p 5YR 4/4 Sol 0 m mvfr - 1 m 0 0 7.5YR 5/3 i lacks A+4";presumptive limit is 0";ff inclusions 10YR 4/4 sit 6-9"; 3 vertical 7.5YR 5/8,5/3 redox features associated w/roots below 9";1 m roots to 26";side seep a 28" I Effluent#1 =SODS>30<220 mg/L and TSS>30<150 mg/L •Effluent#2=80D5<30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,please contact the department at 608-266-3151 or TT'Y 608-264-8777. SBD4330(R 07M) C&-Ukd SOY Testing ti o � a o - v S CIA Zj �, � � Q 90 s � 4 f 1 n , tL 1 f}Ft � 'O N N"'55:58 \ Ft tl`I �I► 3' r •G� 1 /J 'fjf VTR �i "k N44-55:5' ti l N,.41;S5-& PO—lee � k x ,,, I N14?5515 Xq 0I 7 Y. % 1 r - - 1 3-D TopoQuads Copyright®1999 DeLorme Yarmouth,ME 040% Source Data:USGS 50 ft Scale:1:6,400 Detail:15-0 Datum:WGS84 �z. . o Z r 2144 Wisconsin Departmept of Commerce SOIL EVALUATION REPORT Page 1 of 2 Division of Safety and Buildings in accordance with Comm 85,Wis.Adm.Code Certified Soil Testing Attach complete site plan on paper not less than 8'%x 11 inches in size. Plan must County St. Croix reference point BM direction and include,but not limited to:vertical and horizontal po ( ), percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D. 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 MacDougall, Linda Govt.Lot NW 1/4 SE 1/4 S 8 T 28 N R 15 W Property Owner's Mailing Address Lot# Block# Subd. Name or CSM# 387 CTHW B Plus NE-SE City State Zip Code Phone Number City Village Town Nearest Road Woodville WI 1 54028 1 715-698-3569 Cady 290Th Ave. f6 New Construction Use: IM Residential/Number of bedrooms 5 Code derived design flow rate 750 GPD 1 Replacement Public or commercial-Describe: Parent material loess over till Flood plain elevation,if applicable NA General comments and recommendations: 19 pits w/only one pit lacking A+4"; interpretive determination possible in places could lead to mound system w/state&county approval; otherwise no system possible ')Z Boring# .: Boring Pit Ground Surface elev. ft. Depth to limiting factor 31 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. `Eff#1 'Eff#2 1 0-11 7.5YR 3/2 - sil 2 m gr mvfr cs 1f/m .6 .8 2 11-17 10YR 3/4 - sl 1 f sbk mvfr cs if .4 .7 3 17-24 10YR 3/6 - Ics 1 m sbk mvfr gs if .7 1.6 4 24-31 10YR 4/4 - Is 0 sg ml cs lm .7 1.6 5 31-41 7.5YR 4/4 c2d 7.5YR 5/8,5/3 sl 0 m mvfr cs - .2 .6 6 41-45 5YR 4/4 f2f 7.5YR 5/3 sl 0 m mfi - - .2 .6 horizon 5 redox features are stratified @ 31-32&this horizon has inclusions Is;7 additional pits in this area all show lack of A+4"suitable soils;thi area also a possible interpretive site location ❑Boring# I Boring J Pit Ground Surface elev. ft. Depth to limiting factor -in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 generally poor soils lacking A+4"means no suitable system area is possible based on this work without an interpretive determination which requires state and county approval&requires significant additional work w/no guarantee of success Effluent#1 =BODS m>30<220 mg/L and TSS> 0<150 /L "Effluent#2=BODS <30 mg/L and TSS<30 mgr CST Name(Please Print) Sign to CST Number Henry F. Grote 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E.4366 353rd Ave.,Menomonie,WI 54751 10/18/2004 715-233-0398 r A 1 I I ff l 1 N44-55:667 ` r '. 1 rall w: w ,1 NMi55:5' It tl �• /'` a 1 N445-33 () 1 it - ti c � - }' N14�55'167 I •4[ 1� 5 I IQOJ J. yl � 11�:} ,�`O�rC �ev, ca 1►lr,� � � 5 y ,�.��•� I N44'�55 11 '` J i a'•V �,�yt_.iR V'E �� I 3-D TopoQuads Copyright®1999 DeLorme Yarmouth,ME 04096 Source Data:USGS 50 ft Scale:1:6,400 Detail:15-0 Datum:WGSS4 clor o� Z 2144 1 TION REPORT � Page 1 of 2 m 8 Wis.Adm.Code Certified Soil Testing _.._........v...w..�.____..�_.�..._.... -- - - — County x 11 inches in size. Plan must St. Croix rence point(BM),direction and i location and distance to nearest road. Parcel I.D. —mattion. Reviewed By Date ary purposes(Privacy Law,s.15.04(1)(m)). Property Location Govt.Lot NW 1/4 SE 1/4 S 8 T 28 N R 15 W Lot# Block# Subd.Name or CSM# Plus NE-SE ZOMNG 0'-Fr 'r _tone Number City IM Village 0 Town Nearest Road 715-698-3569 Cady 1 290Th Ave. New Construction Use: ." Residential/Number of bedrooms 5 Code derived design flow rate 750 GPD w Replacement Public or commercial-Describe: Parent material loess over till Flood plain elevation. if applicable NA General comments and recommendations: 19 pits w/only one pit lacking A+4"; interpretive determination possible in places could lead to mound system w/state&county approval; otherwise no system possible F'I 2 Boring# Boring Pit Ground Surface elev. ft. Depth to limiting factor 31 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. 'Eff#1 -Eff#2 1 0-11 7.5YR 3/2 - sil 2 m gr mvfr cs 1f/m .6 .8 2 11-17 10YR 3/4 - sl 1 f sbk mvfr cs if .4 .7 3 17-24 10YR 3/6 - Ics 1 m sbk mvfr gs if .7 1.6 4 24-31 10YR 4/4 - Is 0 sg ml cs 1m .7 1.6 5 31-41 7.5YR 414 c2d 7.5YR 5/8,5/3 sl 0 m mvfr cs - .2 .6 6 41-45 5YR 4/4 f2f 7.5YR 5/3 1 sl 0 m mfi - - .2 .6 horizon 5 redox features are stratified a 31-32&this horizon has inclusions Is;7 additional pits in this area all show lack of A+4"suitable soils;thi area also a possible interpretive site location F-1 Boring# __j Boring Pit Ground Surface elev. ft. Depth to limiting factor —in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W I in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 `EW2_ generally poor soils lacking A+4"means no suitable system area is possible based on this work without an interpretive determination which requir state and county approval&requires significant additional work w/no guarantee of success Effluent#1 =BOD5>30<220 mg/L and TSS> 0<150 m /L "Effluent#2=BOD <30 mg/L and TSS<30 mgt! CST Name(Please Print) Sign to : CST Number Henry F. Grote 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E.4366 353rd Ave.,Menomonie,WI 54751 10/18/2004 715-233-0398 2367 Wisconsin Department of SOIL EVALUATION REPORT Page t of 3 Commerce in accordance with Comm 85,Wis.Adm.Code A.C.E.Soil&Site Evaluations County Attach complete site plan on paper not less than 8'/z x 11 inches in size. Pla St. Croix include,but not limited to:vertical and horizontal reference point(8M),directio percent slope,scale or dimemsions,north arrow,and location and distance t( Parcel I.D. 004-1018-40-000 Please print all information. Reviewed By Date Personal information you provide may be used for secondary purposes(Privacy Law,s. Property Ownei Property Location Tom&Marla Smith Govt. Lol NW 1/4 SE 1/4 S 8 T 28 N R 15 W Property Owners Mailing Address Lot# Block# Subd. Name or CSM# 1345 Birch Park Road Na Na Na City State Zip Code Phone Numbei City Village ✓ Town Nearest Road Saint Joseph WI i 54082 1 (715)549-9101 Cady 1 40Th Ave. ✓ New Constructior Use: ✓ Residential/Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial-Describe: Parent material Glacial Till Flood plain elevation,if applicable na General comments and recommendations: Site previously received interprative approval by Jansky,Trans.#1085054. This eval. intended to confirm soil consistancy with previous evaluation. 1-T] Boring# Boring ✓ Pit Ground Surface elev 103.45 ft. Depth to limiting factor 14" in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPD/ft' in. Color Qu.Sz.Cont.Colo Gr.Sz.Sh 'Eff#1 ff#2 1 0-8 1Oyr3/3 none sil 2fgr mvfr as 2vf,f 0.6 0.8 2 8-14 1Oyr5/4 none sil 2fsbk mvfr cw 2vf,f 0.6 0.8 3 14-23 7.5yr4/4 f2f 7.5yr5/8 fsl 1 msbk mfr - 0.2 0.60.3 2 Boring# Boring Pit Ground Surface elev 101.45 ft. Depth to limiting factor 12" in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPD/ft' in. Color Qu.Sz.Cont.Colo Gr.Sz.Sh *Eff#1 'Eff#2 1 0-10 1Oyr3/3 none sil 2fgr mvfr cs 2vf,f 0.6 0.8 2 10-12 1Oyr5/4 none sil 2fsbk mvfr cw 2vf,f 0.6 0.8 3 12-15 1 Oyr5 14 c2d 7.5yr5/8 sil 1 msbk mfr cw - 0.4 0.6 4 15-21 7.5yr4/6 c2d 7.5y5/8 scl Om mfr 0.0 0.0 `Effluent#1 =BOD 5 30<220 mg/L nd TSS>30<AO mg *Effluent#2=BODS<30 mg/L and TSS<30 mg. CST Name(Please Print) Signa re: CST Number James K.Thompson S 3602 Address A.C.E.Soil&Site Evaluations Date Evaluation Conducted Telephone Numbei 340 Paulson Lake Lane,Osceola,WI 54020 7/24/2014 715-248-7767 Property Owner Tom&Marla Smith Parcel ID# 004-1018-40-000 Page 2 of 3 a Boring# Boring Pit Ground Surface elev 103.50 ft. Depth to limiting factor 13" in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPD/ft; in. Color Qu.Sz.Cont.Colo Gr.Sz.Sh 'Eff#1 'Eff#2 1 0-9 10yr3/3 none sil 2fgr mvfr as 2vf,f 0.6 0.8 2 9-13 10yr5/4 none sil 2fsbk mvfr cw 2vf,f 0.6 0.8 3 13-23 7.5yr4/4 f2d 7.5yr5/8 fsl 1 msbk mfr - - 0.2 0.60.3 ❑ Boring# Boring Pit Ground Surface elev ft. Depth to limiting factor in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GP /ft; in. Color Qu.Sz.Cont.Colo Gr.Sz.Sh "Eff#1 'Eff#2 Boring# Boring Pit Ground Surface elev ft. Depth to limiting factor in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPD/ft; in. Color Qu.Sz.Cont.Colo Gr.Sz.Sh 'Eff#1 `Eff#2 Effluent#1 =BOD 5>30<220 mg/L and TSS>30<150 mg `Effluent#2=BOD 5<30 mg/L and TSS<30 mg. The Department of Commerce is an equal opportunity service provider mid employer. If you need assistance to access services or need material in an alternate format,please contact the department at 608-266-315 I or TTY 608-264-8777. SBD-8330(M7100) A.C.E.Soil&Site Evaivaacns M .Sc.�e✓a/Cca�'�.r�/dr� E. ♦E,C/' t;•, lac% elg✓ X � 9 y 1% z361 Yom/� la�S'r�s� 49.5' 1 � r / � Ida y/' r r ► r r ► ► S/oPt ► / ; /' 9/fiyA Sys zx.� / ' ► r ��`' i/ i i f al : Toro a�'/f'y Sc�•'f0 BS9�, r i /�s45 ! � ► r r ! r s i r s i ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FO Owner/Buyer Mailing Address /3 J� B1-r-G L / RY' 1b0 Property Address 2,610 5t, (Vefiai)n r eq uired�from Planning&Zoning De art n for new construction.) mUU — � s 0City/State fa LEGAL DESCRI TION 15 Property LocationIVIA) '/4 ,SF 1/4 , Sec. , T 2ff N R F W, Town of Subdivision Plat: , Lot# Certified Survey Map # �[ ,✓� , Volume , Page # Warranty Deed # T724/ 6 / (before 2007)Volume , Page# Spec house❑yeXno Lot lines identifiable yes❑no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in§SPS. 383.52(1)and in Chapter 12 of the St. Croix County Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&Zoning Department a certification form,signed by the owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is less than 1/3 full of sludge. I/we,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth,herein,as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St.Croix County Planning&Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this orm are true to the best of my/our knowledge. I/we am/are the owner(s)of the property described above,by virtue of a warr ty deed recorded in Register of Deeds Office. Numb r f bedrooms j�' oiktx IGNATU F APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV.04/12) 994147 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI STATE BAR OF WISCONSIN FORM I -2000 RECEIVED FOR RECORD WARRANTY DEED 03/31/2014 11:53 AM Document Number EXEMPT # NA THIS DEED, made between Gerald L. McDougal Jr. and Linda A. REC FEE: 30.00 McDougal,husband and wife, Grantor,and Thomas R.Smith and TRANS FEE: 801.00 Marla R. Smith, as trustees of the omas R. Smith and Marla R. Smith PAGES: 2 Trust Agreement created by trust instrument dated July ,,2 9,Grant—ee **The above recording information Grantor, for a valuable consideration, conveys to Grantee the following verifies that this document has described real estate in St. Croix County, State of Wisconsin (the been electronically recorded "Property"): &returned to the submitter SEE ATTACHED EXHD3IT A Recording Area Name and Return Address: Land Title Inc. #501870 2200 W County Road C,Suite 2205 Roseville,MN 55113 Together with all appurtenant rights,title and interests. 004-101840-000,004-1018-50-000 Parcel Identification Number(PIN) This is not homestead property. Grantor warrants that the title to the Property is good,indefeasible in fee simple and free and clear of encumbrances except Easements,Restrictions,Reservations,Roadways and Rights of way,if any,of record Dated is 28 day of March,2014. * rald c u al inda A.McDougal * * AUTHENTICATION _ ACKNOWLEDGMENT Signature(s) eUti STATE OF WISCONSIN ) �.' ST.CROIX COUNTY. )ss. authenticated this 27th day of December,2013 Personally came before me this 28th day of March,2014 the jNiB00 '2�labove named Gerald L.McDougal Jr.and Linda A.McDougal, s� �ff husband and wife to me known to be the person(s)who executed TITLE:MEMBER STATE BAR OF WISCONSIN """ ' � the regomg instrument and ow]]edged the same. (If not, authorized by§706.06,Wis.Stats.) Merl ee J.Bune THIS INSTRUMENT WAS DRAFTED BY Notary Public,State of Wisconsin My commission is permanent. (If not,state expiration date: Larry S.Mountain,Attorney at Law 10/17/2077 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) 'kNames of persons signing in any capacity must be typed or printed below their signature St. Croix Collr4 9Gd4W ff&FP 1 of 2 STATE BAR OF WISCONSIN FORM No.I-2000 LT File No.501870 EXHIBIT A Parcel orthwest Quarter(NW 1/4)of the Southeast Quarter(SE1/4)in Section 8,Township 28 North, Range 15 West,Town of Cady,St.Croix County,Wisconsin. Parcel 2: The Northeast Quarter(NE 1/4)of the Southeast Quarter(SE1/4) in Section 8,Township 28 North, . Range 15 West,Town of Cady,St. Croix County,Wisconsin. t i I St. Croix County 994147 Page 2 of 2 i gs�S[-T�SL uHd z NVId 1aA31 NIVW 91mm—PIH-101 ms WWG Q 1VIMMKO31HO11-AIIKVA-UlnN-IVLIN3ClS3d 01 INd INA qsj goNaGISITU IuIws VIdVWIY)OiOI Eli -----------........... ----------------------- 00 9F IY ----------------- ----------- ------ ------ - ------------- --------- Im O.M S SfG6-ISCCIC'Hd 91MC LN—*PIH-101-PIS'1,-ry 0261 NVI,113A31 IMAM/NoUvc[ln()j 1,3*d3mnoj J.H911•AVWV+LLInw•lWN3NS3H :OJNI Md ? = tv 6z ayylyg& Q Q p a Q o3 9 V b b, v U � 1 b � b ............................. II iR a % ti 8 -��r• k A 1, b 6 # An –__––I –––___– V �1 LJa � -� .-... .i. l•V/ I r Y ' b ' R a 0 a I' • � �aamra.avxr� I ^I ry , ^� I I � I o. Wisconsin'Jepartmont of Commerce PRIVATE SEWAGE SYSTEM County: Safety an*d cuilding Division INSPECTION REPORT Sanitary P70,15: 506294 GENERAL INFORMATION (ATTACH TO PERMIT) State PI ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)). Permit Holder's Name: City Village X Township Parcel x No: McDougal, Gerald & Linda I Cady, Town of 004-1018-50 0 CST BM Elev: Insp.BM Elev: BM Description: Section/Town e/Map No 08.28.18.126 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg.Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bot Dosing WSystem Aeration Holding Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist.to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold IDistribution x Hole Size x Hole Spacing Vent to Ar Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil [1Qj Yes i�"± No ! Yes No COMMENTS: (Include code discrepencies,perso s present,etc.) Inspection#1: / / Inspection#2: / / Location: 438 290th Street Woodville,WI 5402 (N 1/4 SE 8 T28N R18W 0 acres Lot Parcel No: 08.28.18.126 t4, ' 1.)Alt BM Description= (� J / (/{!t'��-�^ � [/� �/!'(� 2.)Bldg sewer length amount of cover J V J f )� ( � -D-7) Plan revision Required? _; Yes ;WW1 No /� Use other side for additional information. ' Date Insepctor's Signature Cert.No. SBD-6710(R.3/97) t Safety and Buildings Division 201 County qtr ~_ „ _ G J (~ ~ ~ . W. Washington Ave., P.O. Box 7162 I / Madison, WI 53707 - 7162 Sanitary Permit Number (to be filed in bbbyyy,,,CoJ ~ ' D r o m rce (608) 266-3151 /~.~~ L O~ 2 ~/ ~ ~l ry Permit Application State Plan LD. Number t h Co .21, Wis. Adm. Code, personal information you rovide ~(~~~t r ~ " ~ ~ lj G G~,K~ IX ~QW~ or secondary purposes Privacy Law, sl xm Project Address (if different than mailing address) ormation -Please Print All Information ~~~ ~ ~v `,r J Pro rty Owner's N me ~. ~ ~ ~~ ~- ~ L r ~ ~ ~c ~ ~ Parcel # Lot # Block # ~a~ /o~~-sz - o~ Prr~perry~ ~ er'~Maitin ~ ~ ~ t Pr~~ Location [~ '/ ~' ~ ity State C Zi C d ~ , ,, /., Section r ~,/ q 1 f/'~ '"C/ '/ ~ ~ / j p o e 9 5~ t5 ~ Phone Numberp / ~ ~~6 Y ~ ~- ~ _ l ` Vv i t l t (i < / , arc e one) //ll T 2(Y N W ~V ~-C~--o Rl ~ E II_ Ty,Int of Building (check all that apply) or ; Subdivision Name CSM Number or 2 Family Dwelling - Number of Bedrooms ~ ~ ~ Public/Commercial -Describe Use S~~ r~ ~ ^ State Owned -Describe Use ,- ,,~~ ^Ciry ^Village L7lownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' ~ New S stem y ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B• ~ Permit Renewal Before Expiration ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New Owner List Previous Permit Number and Date Issued ~ , ~ ~// j/Z ~ ~ ~ ~~ t ~ ~/ IV. T of POWTS S stem: Check all that a 1 (J'(j ~ ^ Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil IO~Iound <24 in. of suitable so ^ At-Grade ^ Single Pass Sand Filter Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unii ^ Recirculating Sand Filter ^ Recirculatin S nthetic Media Fitter ~~ g y ^ Leaching Chamber ^ Drip Line vel-les Pipe ^ Other (e plain) V. Dis ersal/Treatment Area Information: ~ ~ Design Flow (gpd} Design Soil Applic ion Rate(gpdst) Dispersal Area Re wired (sf) Dispersal Area Pro osed (sf) System Elevation ' S'7, l ~ ~ 2 2 57~ 39~ ~ $-~ -3o f a 2 ~ 25 VI. Tank Info Capaci m Total Number Manufacturer refab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Noldin_ Tank ,~ ! ~~ tF 1 e ~ Aerobic Treahnent Unit ~,v e ~ ~ f3i v~ic. 1.~ ~ v Dosing Chamber /, V ~ 4 U VII. Responsibility Sta tement- I, the unders' ned, assum r s nsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) ~U e S't~ Plum 's Signature ~ PRS Number ~ 2,3Y~S- Business Phone Number ?~ S -6~~ -~-~ 4 6 Plumber's Address (Street, City, tale, Zip C e) / 1 ' ~ ~e O /~~ ~~ ~ ~/Gc~ v ~' S ~~ G , . VIII. C nt ~/De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Is mg Agent gnat e ( t nps) ^ OwnerGiven Reason for Denial Surcharge Fee) ~j ~ / dU ~S S ~ (G) / Q' IX. Co(/~nditio,,nslolf. A+pprJov~na~7V,Rleas~ons for~D~isa~pp~roval ~ /f ~J /~~ ~ (~ ~ ~2~ ~ G~(~ W~'1 G~~~~1T-O ~ / ! !/V / -~ C.r1:.e%/~C //~~L~~~~ JI~.I~/t'l ~t~ , .. . wrracn compere puns ito the county only) for the system on paper not less than 812 x II inches in size L~~ wr a~ 7' /~ SBD-6398 (R. 01 /03) ST• C~d~,~couNrr NO. 5os294 STATE SANITARY PERMIT RENEWAL PREVIOU NO. 3q Z y3 • O W N E ~ ~ ~ ~~ C R 145.135 (2) WISCONSIN STATUTES L,~~ !~~ (a) The purpose of the aaniary permit is tD allow installation ro) PLUMBER LIC.# 2Z3 TOWN OF • SEC j-~ , ~~~~ LOT BLOC THIS PERMIT EXPIRES UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW - VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SUBDIVISION of the pfirate sewage system described in the permk The approval of the sanitary permit is based on regulations in force on the date of approval. The sanitary permit is valid and maybe renewed for a specNied period. Changed regulations will not impair the validity of a sanitary permit. Renewal of the sanitary permk will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. The sanitary permit b trensferebb. History: 1977 c.188;1979 c. 34,221;1981 c. 314 Note: ff you wish 1o renew the permit, or transfer ownership of the permti, please contact the county authority. UTHORIZED ISSUING OFFICER -DATE I O T SBD-06499 (R.8/00) Wisconsin Department of Commeme PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL IN.~ORM74TION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township McDou al, Gerald & Linda Cad ,Town of CST BM Elev: Insp. BM Elev: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to well 0111 ARC~IRPT1[11U SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 4 0 State Plan ID No: t0 Parcel Tax No: 004-1018-50-000 Section/Town/Range/Map No: 08.28.18.126 BS HI Alt. BM Bldg. Sewer SUHt~ SUHt Outlet Dt Inlet Grade Cover BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING AMBER OR Manufacturer. INFORMATION CH Type Of System: UNIT Model Number. nICTRIR11T1(1N SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing Cnll rn\/CD .. n___.....,, c....a.....~ n..~.. .... ru...~.,'1 nr D4_(.rarla Svsfamc OnIV Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~ Yes ~ No ~] Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1 1 Inspection #2: / /_ Location: 438 290th Street Wilson, WI 54027 (NW 1/4 SE 1/4 8 T28N R18W) 80 acres Lot Parcel No: 08.28.18.126 1.) Alt BM Description = 2.) Bldg sewer length = -amount of cover = Plan revision Required? [ I Yes I~ No Use other side for additional information. ~ ~ `~ i- Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) Safety and Buildings Division GwntY ~ n 2L f 20l W. Washin on Ave., P.O. Box 7162 ~ 1. rc~y Permit (to be rruea in by co. ) Mad ) ~~ ~ • ~s~iQin.~« ( ~ ~ ~ Department of Commerce k Plan I:D. Number Sanitary Perlmit Applic 'on~~i ~ ~Ut~~ ~~~ ~_3 -_ ~ y2 S~y~ f l p r In accord with Comm 83.21, Wis. Adm. Code, persona l .04(l xm) j~ Address (if ditfaatt than mailing address) /.1 ' may be uses Tor aecorrdary purposes PrivaGr r 1 P ~} q /~'r 1. Application Information - Ph'srx Priat AU Informs Q ~ G OFF1tE ~ 3 0 0~ ! V S~t Property Owner's N me Parcel # Lot ~ block p ~ ~ ~d C ~ ~ ~ ~ ~ ~ ~~ ~- ~ > property Owner's Meiling Address - Location , ,~i Ciry, State / r Zip Code Phortc NumtG+er ~ ~~t. f ~~ G d fi 1 j/.C ~ ( S ~G 2 '~ ) =~ 7~= ,` S ~ T"`!!! ~~N; R /,~~~ N- ) 11. T of Building (check all that apply) gu ;S;m, Ntw-e CSM Number ~ Q~~~~` ,t „ ,, f or 2 Family Dwelling - Number of Bedrooms G~~ ~ %cx~ ~ w ~ ^ publidCommcrcial - Desrxibe Use ^Village ~'ownshi of ity _ ^ State Owned - ()ascribe Use 111. Type of P rmit: (Check Daly one box on rise A. Complete Nne B if spplieabk) 4 • A' ew S~Stem ^ Replacement System ^ TreatntatdHolding Tank Replacement Onty ^ Other Modification to Foisting System ~ List Previous Permit Numbs artd Date Issued ""'~~ B. ^ pertuit Ratewal ^ permit Revision ^ Ct-ange of ^ Pamir Transfer to New Before E.~piratiat Plumber / Owner [/ IV. T of POWTS S C g that "" ~ ^ Non -Pt~urized {n-Ground >_ 24 in. of suitable soi ound < 24 in. of suitable soil ^ At-Grime ^ Single Pass Sand Filter ^ Coustntcted Wetland ^ Pressurized h>/Gtoattd ^ Holding Tank ^ Past Filter ^ Aerobic Treaunent Unit ^ Recirculating Sand Filler ^ RecircuMting SynUletie Media Filar ^ Larch' Chmnber . ^ Drip Luce ^ veFttss 0 OttMer i V. Dis tsaU7'neatment Area ittfornattioa: arm (~ System Design Flow (gpd) Design Soil Appl' IZa~ Dupa~l Area R fired (sf) Disposal Elevation l ~2 ^ ~ 5 ~ z 5 / ~ s v ~ I S~ d . . Vl. Tank Info Capacity in Toml Number Man facturer ab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Exiatiag Tanks T>mlcs S~iC rr ttawi~ Tank ~ ~j tr/t' P S~ Aerobic Treatmcm Unit ~ T Obaag t:Yaiindier ~ U L t VII. Responsibility Statement- 1, tMe as assrtuae ~r hutdlstioa of tfe POWTS sUowa oa the attached / C/ gn~ure Prim) Plumber' Ilumber's Name ( ' - B ~ '"( ~ /I !1 /a r ~ S ~ ~ l 5 ` ` ^~ e Plumber's Address (Strew, Ciry rate. Zip VI11 .oaaty/De rtmeat list Oa roved ^ Disapproved Sanitary Permit Fee (includes Gmuadwata ~ d Issued 1 ng~re ( ps) A ' pp Surcharge Fee) ~ ~[~ S ~ ~~ O ~ 2 ^ Owner Given Reaswt far Ddtial T ~, /1 /~~ ~ ~ S~ 1X. Conditions of A provsUReasnns for Disapproval ~ ~ 1 Septic tank, effluent filter and (/(X,C~ ~R (/h~~ ~~ /~Z~ ed / maintain d ~~ (~ rvi ll b t l ll i c a e se ce mus spersa d ~ s per management plan provided by p umber ~ ~ ~ '~~" ~d - 2. All setback requirements must be maintained as per applicable code(ord[nances. ~~ ~~~~"~,~~ ,~~ i~ (f__ . Attadi ~k rtes. {n me t:•aaiy eery) for Me sysba .a twer at te,. sra alias x t! iaAa to tdae J a ~~ SBD-5398 (R. 01/03) v~ p y -~-1 ~,/~ 1 ~ i 0 a~ 3 ,~ ~ ,~ ~ i J ~/ D° /.. ` ~~ ~ s~ ~J 0 ~ (/ 3 l s a 0 '~ao r r .• c a ~~ Q ~ ~ ~J u \ ,..a ° \ \. e ' ~ N ,3 ~ .a~ ~~ .. S.. 3 '' J ~' ~ ~ ~~ n ~: ~; ~` .. ~~ ~ ~~~ ~ ~ Y ~ Q' O ~ ~ h .... u s J ~ s° o i 0 n ~ I N c ~`~i P } ~ i x r ~~ s..y ~ ~ u _ ~ '~^ #~ ~"~ ~~ ~~~ ~ ~ ~ ~~ 1 ~ c„f C.=~Y ~I i ~ _ 0 ii ~I I3 1 I i ~~ cr ~ ,., 9 l c ~~ ~p } \ f ' , s ---~1 ~ a o ~fi ~ s ~ I J a 1 \o r commerce.wi.gov isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary July 29, 2005 CUST ID No.222774 Town of Cady St Croix County NW1/4, SE1/4, S8, T28N, R15W FOR: Description: Five Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1027930 Maintenance required; 750 GPD Flow rate; 9 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual -Version 2.0, SBD-10691-P (N.01/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/01); Biofilter ATTN: POWTS Inspector HENRY F GROTE ZONING OFFICE CERTIFIED SOIL TESTING ST CROIX COUNTY SPIA E4366 353RD AVE 1101 CARM[CHAEL RD MENOMONIE WI 54751 HUDSON Wi 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/29/2007 Identification Numbers Transaction ID No. 1152553 SITE: Site ID No. 692548 Gerald & Linda Mcdougal Please refer to both identification numbers, 290TH Street above, in all corres ondence with the a enc . No person may engage m or work at p um mg m t estate un ess tcense o s y p p , stats. The following conditions shall be met during construction or installation and prior to occupancy or use: DE RTMENT 01 Approval Requirements: ~~IJ~` OF El Go • This system is to be constructed and located in accordance with the enclosed approved plans and with the SEE CORRES "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.O1/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.O1101). 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. 1 b' h 1 1' d t do o b the De artment er s 145 06 ~Ofit~l~h • This plan has an approved Soil Saturation Determination (Transaction I.D. 1085054) associated with the design. All of the conditions for the construction requirements of that approval shall be upheld. • , Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. HENRY F GROTE Page 2 7!29!2005 • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83 22(7) A copv of the approved plans specifications and this letter shall be on-site during, construction and oven to inspection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 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 maybe 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 POWT5. Sincerely, Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@commerce.state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Wi5MART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 ,~ ~~c~/~~ • ~~~ ~ 06 Gerald & Linda Mcdougal -Mound Si9FF~~ ~~Og Construction Materials and Techniques 8(~~~~rih~y` All materials must comply with Comm 84 and be installed in accordance with manufacturer's specificatigns. Construction methods must comply with the following Component Manuals: Mound, SBD-10691-P (01 /01) Pressure Distribution, SBD-10706-P (O1/O1) Location: NW '/4, SE `/a, Sec. 8, T 28 N, R 15 W Town: Cady County: ST. Croix Date: July 11, 2005 Owner: Gerald & Linda Mcdougal Address: 387 CTHW B ~~unu,i,~~i,r~ ' Woodville, WI 54028 A,~a,* ~~ ~5, l~i,~ Y ~ '` ~" Designer: • NENR '" eery Gro GRATE Signature: p_1699 ~ ~ , MENpMONtiE ~ License: ~~ wtis. 'Q. ~.: WI D - 99-007 '~ GN~~~` O~ ` ~~ Attachments: SBD-14577 -Plan Approval Application SBD-8330 Interpretive approval letter, 11/18/04 Page 1: cover 2: design criteria & calculations 3: plot plan 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail 7: pump curve 8: system management -~,! ~~y -~~ ,~ ::~' ~*." ~4NV uitC page 1 of 8 +~ Design Criteria ~''n Residential Wastewater Contaminant Load: 30 mg/L < BODS < 220 mg/L Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L Fecal Coliform > 10,000 cfu/140 mL Fats, oils, grease < 30 mg/L S Bedrooms x 100 gal/bedroom/day x 1.5 ~S~ gallons/day hydraulic load Design Calculations In situ designed loading rate/ o• ~~ gallons/sq. ft. per day Depth to estimated high ground water ~~ ~ in. Depth to bedrock ~ `~° in. Cross slope at system ~- Force main length ~ ~ 2. ft. of z- in. Manifold/header length ~'~ ft. of -' in. Drain-back ~ ~ ~ 3 gallons Lateral length ~ @ 4 g ~~~~ ft. of ~ 1 z in. Lateral elevation s ~ ~ ~ ~,-~-s~ ft. @ bottom of lateral 3z Lateral hole size in. @ 3~~ 3,Iza in. ( ft.) Spacing 3 Z holes/lateral ~ 4- holes total Lateral volume ~ `~ ~ ~ ~ gallons Total lateral discharge rate ~~'S b gallons/minute @ ~• ~ ft. head Network pressure compensation losses ' ~ ft. Elevation difference ~.Z-S ft. Friction loss ~,~~ 2 ~k 2,sg~jar~-, 2 ~ g~ i ft. @ 3S gallons/minute To la dynamic head `~-~ C( ft. `~Pumplsi~lon S ~ gpm @ `~~ ft. of head Manufacturer ~°~«~- ~ Model # 1 ~ Z- Dose volume ~ ~ ~' ~~ s gallons Lift/si~bn tank ~'~ ~ ~ w ~ ~' ~ ~ M ~ ~ ~~ gallons Septic tank ~ ~, ~ ~ ~ ~ - ~ ~ ~ ~-~o ~ ~ ~' gallons Effluent filter p Y Q^^~o F ~ ~ ~ 2.'L ~ ~ 4- 'Q ~F1 _ Measurement pump on and off S ~ ~ in. Height alarm from tank bottom ~ ~' o in. Reserve capacity S'Sb+ gallons specs.calcs.res r~* Page ~` of ~ . •, V.~ %~ i `~ ~~ 3 ~ ~ 'n /\ ~~ (Y~ 6 C'~ U ~ s~ ~J ~ ~ ~ ~ 3 L S c rr n 7 0 s J /~ ~0 a ~~ _. , J } --a J { j ~ ~ ~ ~~ 9 ~ ~ o 5 ~J 3 r ao r a o .r~ v L~ :~ ~~ 1 0 J 3 ~ .~ ~ ~°.~ s.. 3" ri ~~ :~ . t', 3 ~~ g~ . ~ V ~ ~j {~ w ~ N S r :o v t~?° 1 ,, ~. c m ~~ ~ ~~ 9 ,~~~ ti. ~'~ \ i .~ ,4 ` ~ J sY ~~ { fl ~ ~ c `'~ ~~ ~ ~ ~~ ~ ~r ~ ~ ~~ ~ ~ ~ o ~ 7 0 3 ~ ~~ ` ; s° ~ ~ 1 p ~ ~ ~ ~ ~ _ ~--~ ~ X ~ -~ c 4~ u ~ # ~ ~ #~ ~ ~ ~ ~ ~- .~~ I ~ ~~~ ~ -~ ~-~ o ~ ~ ~ o ` \~ ~~~ -~ y~~ ~'}, s i ..-~~ °~ ~ 1 . ~~ T ~ ° s ~w~~ r ~~~ ~,~ ~, .. . ~ ,~ ~. ~^ s ,, S v+ n~ ~ ~-..-J 3 ~~ a a .. ~ 4 rl ~ - m ~ ~~ ~ ~f ~ 1 Q a 0 r :, - - . ° ~. ~ .. q ~~;~N . `.: v~ v t' S . ~ ! Q. ~.. t ova ' '. ~ I ~~ ~~ ~/L' ~, ~ t ~.. ~..j,~ a.~~ ~ w ~l ' ` ` pp `1 0.e O V ~ ~.. w 0 tv \ ~ ~i ~ 11 ' 1 , 1~Z.2j / / ~ ~- t~tr-~ ` o , + o,p t ~ 1 1 ~.~,5, ~~~3 ~ ~.~yl w-.9l ~ ~ b i~bco;1 ` 1Ly~ ~( ~, ° w. `W >S o.v..` 1 crc~, o ~-' ~._..._.._...~'~ - cs~o _.~_3. ~ 2.5'S' 1'`1 0~~', , M ec~ ~~ ate! k~~ ~0~~ = ~.~i 3~ ~~ ~ ~\, l ,~' ~ ;' . \ ~: ` w v~ v i G. ~M. ' I~ -~1I ~ ~~ ~~ ~.1 ~' ~f , c(' ~, i 22. S `~ , - - 22 , S' ~ ~ ` ~ -I „~~s ~ I __ --j .'~ ~ z. ~ z~ ~ d ~ ~4,z~ I E-- ~2~<4'r ~-. L • ~, = 3.~,~5P~~1~~ I~ao~.aQ ~- Z2- (~Sjc Zaa S a... ~ .~, o~. ....m ys3~ ______ l- ~..1v. v ~ yi i~V~~•w~"O~ ~~"~~ t~ t. ( ~ QVC S~ 40 ~o.. a. t. wa.: h +' Z P u G S aJ~1 ~j `C` e..~Q t h its ~ ,~.~ O~,.Q., l ..~ a,..SZ ``~' . ~,~~ z P~ ~ z ~~ 4v l ~. ~..SZ ~" h ~, _ I ~ l J Z ~l 01 a; o .~ \ w. T QJr ~ ~Q,y,J~v Vo 1 ` O ~.. \ :..Q.. ~ ~ i \ Z ~ l l ~ ~' ~ J 4 a.a `Vo~a, ~7v~~a.c.4 ~~.~., ,,. "~ era\vc bo}c O-ti ...: v w.~0.w~ \I,_ ~~.~ ~oT ~ n / ` s o~ ~ --~- _ _ `i~~C.I. VENT PIPE WEATHER PROOF ~ 25' FROM DOOR, JUAICTIOA! BOX WIIJDOW OR FRESH ~Z1 AIR IIJTAKE GRADE ~ o.~ea-. 1 O 1~ COIJDUIT ~-- ,. tl ~. +o ~-e~ }: . ~r. ~. ; v~ APPROVED LOCKI~JG ~MAIJHOEE COVER v"~/ w A ct N~ N ~ LAS~t~. V ~'~, \~~ \ ~ ~ ~. ,I 11~ PROVIDE ~ AIRTIGHT SEAL ~ ~ ~ ,~ 1c, ~t- 5,+x.0 ..,. ~ ~~ ~ Crf1t.S , E~~S l?Ry ~ 2 ~~ O" I `~ u ~-e-~~ j h ~ (~ ALARM v i ,~- ~ --~--- r I .. _, PUMP -• -. ~ q ~~ ~9 ~ ~~ _. DLOCM ,__ ~ '~~ ~ ~ D ~ _ a. ._ . ; i __ __ ... _.. 1~ ~ i i I ~ s sill I ;` ~ +i Q.. '~p ~I u APPROVED JOIAITS W/ PIPE EXTEIJOIrJG 3' OA1T0 SOLID SOIL ~~ a~ ~ ~ ~ ~ ~ ~~ ~~ ~ ~ ~1 ! d~ I ~~ ,_ t i i ~ ~ . ~ ', ~` ,~' 0 w x v a z r 0 a 0 80 160 240 320 FLOW PER MINUTE TOTAL DYNAMIC HEAfS/CAPACITY PER MINUTE EFFLUENT AND DEWATERING MODEL t52 ! 153 Feel Melers Gol. Users Gal. Users 5 1.5 69 26t 77 29t 10 3.1 61 23t 70 ~ 265 15 4.6 53 201 61 I 231 ' 20 6.1 44 I 167 52 ' 97 25 7.6 34 ~ 129 ~ 42 ' S9 30 9.t 23 ~ 87 ?3 ~~. -- 35 10.7 -- -~ Z2 -cam-- 40 t2.2 -- -- 't ~~ LOCk VOlve: 38.0 FL (lt,6m)'i<sG ~; !'?,er-~', U,ERS 0 • HEAD CAPACITY CURVE MODEL 152/153 w 50 t53 2 40 152 30 8 20 kJ 4 t0 A G 20 40 60 80 10 GALLONS T N ~., CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Owik-Box available for'outdoor installations. See FM1420. • Over 130°F, (54°C.) special quotation required. 152/153 Series Model_ __ Volts•Ph Mode /un Sim lex Du I Nt52 _,tt5 t Non 8.5 1 2w Brt t 52 _ _ t t 5 t I . Auto 8.5 Included ~ 2 or Et52 _230 t Non 4.3 1 2or _ B_E t52 ~ 230 t Auto 4.3 Included 2 or N 153 t t 5 1 Non 10.5 1 2 or 3 27/3 -~---- -T it ~ ~_~ F jt_ `ls ~.- i2 •~/s: ~: ~ i _ --- f -~ o~.soe scow BNt53 u5 1 Auto 1os Included 2or3 SELECTION GUIDE E t 53 230 i Non 5.3 1 2 a 3 BE t 53 230 1 Auto 5.3 Included 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0417. o CAl1TIC!H 2. See FM0712 for correct model of Electrical Alternator E•Pak. All installation of conVOls, protection devices and wiring should be done by a quailfled 3. Variable level control switch 10-0225 used as a control activator, specify duplex (3) licensed electrician. All electrical and safety codas should be followed Including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). Or (4) float System. d RESERVE POWERED DESIGN ~~ For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0: P.O. 80X 16347 Louisville, KY 40256-0341 Manuracmrers of . SHIP T0: 3649 Cane Run Road ~ Louisville, KY 40211.1961 QVaI/TY PUMPS SNCE ~j~,9 PUMP f0. 021118.2731.1(800) 928•PUMP http://www.zoeller.com FAX (502J 714.3614 © Copyright 2000 Zoeller Co. All rights reserved. ..` System Management Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber or the St. Croix County Zoning Office, 715-386-4680, should be contacted for assistance. General Proper functioning of an on-site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a dose tank or compartment to allow a dose to be accumulated, a pump and controls or automatic siphon, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. 1. If the septic tank is installed prior to sheet-rock and/or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. 2. Install water-saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. ] 0. If septic or dose tanks are no longer used, they must be properly abandoned. ] ] . If construction timing and weather could create a frozen infiltration system, weather-proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start-up. l 2. Note: the upslope toe of the mound system must be landscaped with additional fill to blend this area into the upslope natural grade; this will minimize the possibility of the system trapping surface run-off; final settled slope should be 2-3% over the system or 2-3% diverting surface run-off around the ends of the system. ,. ` Maintenance 1. The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. When the septic tank is pumped, any solids in the bottom of the dose tank must be pumped, and the filter must be back-washed into the septic tank to remove accumulated material. System use may require more frequent filter cleaning; initial inspections of the filter should be made every 6 months until a minimum time sequence is determined. 4. Periodic observation pipe inspections should be made by the owner to examine the state of the in-situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. 5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Avoid compaction such as vehicle traffic within 15' down-slope of the adsorption system. 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run-off into the system area. I l . Warning: Do not enter septic, dose or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and/or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 ~- •. `. commerce.wi.gov isconsin Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary November 18, 2004 CUST ID No. 222774 HENRY F GROTE CERTIFIED SOIL TESTING E4366 353RD AVE MENOMONIE WI 54751 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/18/2006 SITE: William Gokay Town of Cady, 5t Croix County NW 1/4, SE 1/4, S8, T28N, R15W FOR: Object Type: Soil Saturation Determination Object ID No.: 993281 Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi. g ov/sbl www.wisconsin.gov ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 I Identification Numbers ~ Transaction ID No. 1085054 Site ID No. 692548 Please refer to both identification numbers, above, in all correspondence with the a>?encv. The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: 1. Approval is hereby granted pursuant to s. Comm 85.60(2), Wis. Adm. Code, to estimate the depth to seasonal soil saturation based on an interpretive determination process. Approval of the interpretive determination negates the requirement in s. Comm 85.30(2)(b), Wis. Adm. Code to designate the ground surface as the higest level of soil saturation when redoximorphic features are less than 4 inches below the bottom of the A horizon. 2. The estimated highest level of prolonged soil saturation approved under this determination is 9 inches below grade. At least 27 inches of sand lift on top of 9 inches of unsaturated, in-situ soil is required for adequate treatment and dispersal. 3. The basal soil application rate for the mound shall be 0.2 gpd/sf, and the linear loading rate 3.75 gpd/ft. 4. Chisel plowing to a depth of 16 inches immediately prior to sand placement is required to improve vertical water movement into the soil solum. 5. Landscaping up slope of the mound shall be incorporated into the POWTS design to prevent surface water from concentrating along the up slope edge of the mound and to divert surface water drainage away from the system. . . •.i HENRY F GROTE Page 2 11118/2004 6. This approval shall remain valid unless the site is altered in such a way that the depth to soil saturation would change or if saturated conditions are observed for seven consecutive days at depths less than 3 feet below the infiltrative surface of the POWTS distribution component. 7. This approval in no way relinquishes the use of color patterns to estimate the depth to high groundwater on any other parcels or portions of parcels. 8. A copy of this approval letter and attachments must accompany the mound system design for this site for purposes of plan approval and sanitary permit issuance. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to .inspection by authorized representatives of the Department, which may include local inspectors. If plan index sheets were submitted in lieu of additional full plansets, a copy of this approval letter and index sheet shall be attached to plans that correspond with the copy on file with the Department. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state 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. Sincerely, Leroy G. Jansky, Wastewater Specialist Integrated Services Bureau (715)726-2544 Voice (715)726-2549 Fax 1 j ansky@commerce. state.wi.us Fee Required $ 100.00 Fee Received $ 100.00 Balance Due $ 0.00 WiSMART code: 7633 commerce.wi.gov isconsin Department of Commerce SAFETY AND BUILDINGS DIVISION Integrated Services Bureau 13 East Spruce Street INSPECTION REPORT r-.. c~wr c~~mmeraFe.lstate w5usisb RECEI Date of Inspection: November 18, 2004 Project Name: Gokay Use: Residential Legal Description: NW, SE, 8, 28, 15W Site Number: 692548 Subdivision: NA Municipality: Town of Cady County: St. Croix Plan Transaction Number: 1085054 Sanitary Permit Number: Wastewater Flow: 600-750 gpd Persons Present: H. Grote Plumber Name and Address: NA 9~lmiV ~ ~ 2~~4 :~T. CRuIX CUu'v ZONING OFFICE Certified Sol Tester Name and Address: enry F; Grote, CST 222774 E4366 53`d Ave Menom~ie WI 54751 Owner Na and Address: Illiam Gokay W1618 850th Ave Spring Valley WI 54767 An onsite soils verification was conducted at the above referenced site as per district policy for all sites with less than four inches of unsaturated soil below the bottom of the A horizon. The intent of this investigation is to confirm initial observations by the certified soil tester (CST) relating to the presence or absence of redoximorphic features in the A horizon and/or subsoil. In-situ soil texture, structure, and consistence factors were also reviewed as they relate to wastewater application rates. Other site conditions such as percent and direction of slope, landscape position, land surface contour length, and surface water hydrology may also be noted and their effects are factors considered in the recommendations and conclusions portion of this report. A typical soil profile at T-1 (near CST B-3) could be described as follows: 00-09" 10YR 3/3 sil, 2f-msbk, mfr, cs. 09-16" 10YR 4/4 sil, 2msbk parting to pl, mfr, w/ f2f 10YR 6/3 and 5/6 rmfs If a mound system is designed to overcome limitations of a high level of seasonal soil saturation and slow permeability, the linear loading rate should not exceed 4.5 gpd/ft and the basal wastewater application rated should not exceed 0 2 Qp Z The additional basal area will partially compensate or e -sbp,~arTd prevent wastewater leakage at the mound toe. At least 7 inches of sand li iS recommended when appl ing mantic tank effluent to the distribution cell of the mound to ensure proper treatment. The longest portion of the mound must be orientated along the contour. The mound shall be constructed to divert surface water around the mound structure as much as possible. In addition, an up slope drainage ditch should be considered if it is determined that surface or subsurface hydrology is improved by intercepting water and diverting it away from the mound site. If there are any questions regarding this report, please contact me. oy G. J sky, stewater pecialist cc: Ljansky@ mmerce.state.wi.us E-mail 715/726-2544 Voice 715/726-2549 Fax ~ County ^ CST ^ Other _ ^ Plumber ^ Owner ~~ Wisconsin Departmen er~ xNSOIL EVALUATION REPORT Division of'Safety and II ~ In arrnrrlannw with Cnmm RF VUic Arlm Cnrla 2162 Page 1 of 3 Certified Soil Testing ! IV W V - County Attach complete site n n er not less than 8%: x 11 inches in size. ;Plan must St. Croix include, but not limited and ~t ~f¢(e~~pint bBM), di coon and ~ percent slope, scale or ms' , no fh-~'~~ r@nd distan to nearest road. Parcel I.D. -1018 0-000 Pcl 8.28,15,125 Please pnn n oi~<rna on. iewe B ~ Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Gokay, William Govt. Lot NW 1/4 SE 1/4 S 8 T 28 N R 15 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# ~ W. 1618 850th Ave. ~~ City -- State Zip Code Phone Number -City Village Town Nearest Road Spring Valley ~ WI 54767 715-772-3293 Cady 290Th St. New Construction Use: ~ Residential / Number of bedrooms 5 Code derived design flow rate 750 GPD _) Replacement _ Public or commercial -Describe: Parent material loess over till Flood plain elevation, if applicable NA General comments and recommendatio s: most soils in study area lack A+4"; inte pretive determination required with state and county approval v ~t ~ Boring # - Boring ~! Pit Ground Surface elev. 98.7 ft. Depth to limiting factor ~ 3 in. Soil Application Rate Horizon Depth Dominant Color Redox bescription Texture Structure Consistence Boundary Roots GP DIft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10YR 3/3 - sil 2 f sbk mvfr cs 1f/m .6 .8 2 9-13 10YR 4/4 - sil 2 f-m sbk mvfr cs 1 m .6 .8 3 13-27 10YR 4/4 f2f 7.5YR 4/4 sl 1 m sbk mvfr gs 1 m .4 .7 4 27-37 7.5YR 4/4 c~SyR g~34 scl 0 m mvfr - 1 m 0 0 profile just makes A+4"; some 10YR 4/4 sil inclusions 4-9"; 1 m roots to 34"; side seep @ 35" Boring # Boring Pit Ground Surface elev. 99.8 ft. Depth to limiting factor ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10YR 3/3 - sil 2 f sbk mvfr cs 1f .6 .8 2 9-15 10YR 4/4 ~ lOYR 6/2/6 sil 2 f-m pl mvfr cs 1f 0 .2 3 15-22 10YR 4/4 f2p 7.5YR 4/6 sl 1 m sbk mvfr gs 1 m .4 .7 4 22-36 7.5YR 4/4 c~SYR 5/34 scl 0 m mvfr - 1f 0 0 lacks A+4";presumptive limit is 0"; some 10YR 4/4 sil inclusions 5-11"; 1 f roots to 30"; side seep @ 30" * Effluent #1 = BODS> 30 < 220 mg/L and TSS > 0 < 150 m * Effluent #2 = BOD < 30 mg/L and TSS < 30 mgr CST Name (Please Print) Sign ur : . CST Number Henry F. Grote ~ ,~ 222774 Address Certified Soil Testing a valuate ducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 11/1/2004 715-233-0398 Property Owner GOkay, William Parcel ID # 004-1018-40-000 Ptl 8.28,15,125 Page 2 of 3 Boring # Boring Pit Ground Surface elev. 98.7 ft. Depth to limiting factor 0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 1 0-11 10YR 3/3 - sil 2 f sbk mvfr cs 1f .6 .8 2 11-13 10YR 4/4 - sil 2 f sbk mvfr cs 1f .6 .8 3 13-18 10YR 4!4 f2f 7.5YR 4i6 sl 1 m sbk mvfr gs 1flm .4 .7 4 18-21 7.5YR 4/4 f2f 5YR 4/4 sl 1 m sbk mvfr gs 1 m .4 .7 5 21-33 7.5YR 4/4 f1d 5YR 4/4 scl 0 m mvfr - 1m 0 0 lacks A+4";presumptive limit is 0"; 1 m roots to 29"; side seep @ 33" Boring # --- Boring Pit Ground Surface elev. 99.7 ft. Depth to limiting factor 0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0-9 10YR 3/3 - sil 2 f sbk mvfr cs 1 f/m .6 .8 2 9-14 10YR 414 f1f 7.5YR 4/6 sil 2 f sbk mvfr cs 1f :6 .8 3 14-19 10YR 4/4 f2d 7.5YR 4/6 sl 1 m sbk mvfr gs 1f .4 .7 4 19-24 7.5YR 4/4 ~P SYR 4/4 7.5YR 513 sl 0 m mvfr gs 1 f .2 .6 5 24-40 7.5YR 4/4 cap SYR 4/4 7.SYR 5!3 scl 0 m mvfr - 1f 0 0 lacks A+4";presumptive limit is 0"; inclusions 10YR 4/4 sil 7-9"; 2 vertical 7.5YR 4/6 - 10YR 6/2 redox features associated w/ roots below 9"; 1 f ro to 36"; no side seep is ^ Boring # Boring ~; Pit Ground Surface elev. 99.6 ft. Depth to limiting factor 0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ' in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-9 10YR 3/3 - sil 2 f sbk mvfr cs 1f/m .6 .8 2 9-12 10YR 4/4 f2d 7.5YR 4/6 sl 2 f sbk mvfr gs 1f .6 1.0 3 12-18 7.5YR 4/4 c2p SYR 4/4 7.SYR 5/3 sl 1 m sbk mvfr s g 1 m .4 .7 4 18-34 7.5YR 4/4 cap SYR 4/4 7.SYR 5/3 scl 0 m mvfr - 1 m 0 0 lacks A+4";presumptive limit is 0"; ff inclusions 10YR 4/4 sil 6-9"; 3 vertical 7.5YR 5/8, 5/3 redox features associated w/ roots below 9";1 m roots 26"; side seep @ 28" ' Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. $BD-8330 (R.07l00) Certified SOiI Testing f ao a s :o v 4 1J1 / o v \ ~ tin r~ ~ // ~ ~ ~ ~. ~ ~ ~ ~ ~~ n a ~ \~~ i d ~.% `~ ~ ~ -- ~ ~ s ~ ; 9 %' i s ~ ~' ;, 0 z ~-- ~ ~ ~ S ~ p `.~ ~~ _..=- _.~ ~-~ ~ ',p ,n .~ `' ~' ~ ~ ~ ~~ D `~, s ~~ ~. '~~ c3 ~ a ~~ :j s~/~ ~ c/0 0 J~ s 1 ~Q t e~ ~~~ ~~ ~ ~i ~ ~ .:c _+ n .~ ~~~ _ J^^ S Y ~~ ~/ ~ \ C *'/ fl c c, ~ ~~ o ,~ a c o ~~ ~ ~ o ~ c~ ~~ a s ~ ~~ ~ ~ c ~~ ~r-^`j d ~ 9 t s ~ v_ s ~ ,'' ~ ~ ~$ ~~ ~ 1 ~~ .\ o ! ~ ~ q `~ r ~ ~ ° a :J ~° ~ ~ ~ ~ 3 ~ a ~ ...y ~ ~ .~ . ,,..~' ~ ~~~ 9~ T v ~-~~s' i~ a go r s ~, a ~ }~ \N M~ r' ~/ ~, d~~ ~ F~~ ~"" ~ v~Y by r/~ ± G Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT in arenrtianca wi4h Cnmm RFi Wis Adm Cede 2144 Page 1 of 2 Certified Soil Testing County Attach complete site plan on paper not less than 8%: x 11 inches in s¢e. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I D percent slope, scale or dimemsions, 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. t5.Od (t) (m)). Property Owner Property Location MacDougall, Linda Govt. lot NW 1/4 SE 1/4 g 8 T 28 N R 15 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 387 CTHW B Plus NE-SE City -- State Zip Code Phone Number City Village ~ Town Nearest Road Woodville ~ WI 54028 715-698-3569 Cady 290Th Ave. V! New Construction Use: ~j Residential / Number of bedrooms 5 Code derived design flow rate 750 GPD Replacement _f Public orcommercial -Describe: Parent material loess over till f=lood plain elevation, if applicable NA General comments and recommendations: 19 pits w/ only one pit lacking A+4"; interpretive determination possible in places could lead to mound system w/ state & county approval; otherwise no system possible 'I 2 Boring # _ _ Boring 31 in. ~!, Pit Ground Surface elev. ft• Depth to limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DHt2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-11 7.5YR 3/2 - sil 2 m gr mvfr cs 1f/m .6 .8 2 11-17 10YR 3/4 - sl 1 f sbk mvfr cs 1f .4 .7 3 17-24 10YR 3/6 - Ics 1 m sbk mvfr gs 1f .7 1.6 4 24-31 10YR 4!4 - Is 0 sg ml cs 1 m .7 1.6 5 31-41 7.5YR 4/4 c2d 7.5YR 5/8,5/3 sl 0 m mvfr cs - .2 .6 6 41-45 5YR 4/4 f2f 7.5YR 5/3 s1 0 m mfi - - .2 .6 horizon 5 redox features are stratified ~ 31-32 & this horizon has inclusions Is; 7 additional pits in this area all show lack of A+4" suitable soils; thi area also a possible interpretive site location ^ Boring # -Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 generally poor soils lacking A+4" means no suitable system area is possible based on this work without an interpretive determination which requir state and county approval & requires significant additional work w/ no guarantee of success Effluent #1 = BODS> 30 _< 220 mg/L and TSS > 0 < 150 m /L 'Effluent #2 =GODS < 30 mg/L and TSS < 30 mgC CST Name (Please Print) Sign to CST Number Henry F. Grote ~ 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 10/18/2004 715-233-0398 ;,:: .r fr^~ 1 _ - ` `(~Oy~r ~ w bb . }'rye 1 Y ~ 4y f ~a ~ ~ r I ~ ~.. N41°-55:86 ~ I ~' ~ 1 ~ ` .~r ` i ~ ! r~ ~ ~ '~f I l ~ • ty I ~ f r f1 ~tTk Z't'«.}{ ~ ~ I ' i1 ~- r ~ 1 } ~ f ' _ -~ ~h 1 j _ ~._ 1 j ~~s NM'-55:5' . ti 1~1 ~ ~. `' ti ~~ ti .. S ~ ~ ~ ~S~ ~`~ S ~~ _ I ~ f y~ . l - J ! /~~ r f~~ I 1 f t ~ _ ,r +, / •~ f f + ! f NM ~5-3 f. _ k x ~y ~ ~ ,r~ 1 .~ , .r ~ r t , ~ ~ i x ~ c (~ I ' ~wia~v~J ~ ~ I (( i S ref ~'~t ~~ I r f{ ~([ ,4 r ~ I ~ 5 I I ~ ~ -- ~- ~.Q O I '~ ~ j ~x , $ r, •~_ "~~ ~..~,.. I ~ : + . ~ ~ ~ -~ r. '• i _ ~. -- til ~ ~ : ~ :` ~ i ` 5 , ~, ' ~ o ~rC 1 1 rv', ~. lit r.. ; ~ 1 ) ~ t, I ~ • I 5~ ~ I r e l' ~ ` ~ 11 ~ ~v J~„,4 i'a u'C y r~ 1~ ~ ~ J 5 ' I I f ~ .. _, ;. .~ ~` _ ~_ , 3 '~.1 3-D TopoQuada Copyright ®1999 DeLorme Yarmouth, ME 04096 Source Data: USGS f ---250 ft Scale: l :6,400 Detai1:15-0 Datum: WGS84 (~ 2144 ~"' "` ` ~-----~--- I TION REPORT __._.a._.~.~ ,.~._~_ -------~ Page 1 of 2 ~~ m- ~^~~_ ~, _ _____ ~m 8 Wis. Adm. Code Certified Soil Testing .~_.._..._.~,.-_._w,__...._~.~_...~ - - County x 11 Inches in s¢e. Plan must St. Croix ,rence point (BM), direction and '®°'"'"""'~+` ~~.~~-~~,~,5 ~, ~~~ i location and distance to nearest road. Parcel I.D. --~-m8tion. Reviewed By Date Q • ary Purposes (Privacy Law, s. 15.04(11(m))• Property Location ? ~~ ~ Govt. Lot NW 1/4 SE 1/4 S 8 T 28 N R 15 W -----°- R'~ Lot # Block # Subd. Name or CSM# Plus NE-SE ZOMN(, C}i=F~C`t: ~ lone Number _', City Village , Town Nearest Road __~_~~__._ __ _ __,~ -" 715-698-3569 Cady 290Th Ave. ~ New Construction Use: Residential / Number of bedrooms 5 Code derived design flow rate 750 GPD _ Replacement Public or commercial -Describe: Parent material l oess over till Flood plain elevation. if applicable NA General comments and recommendations: 19 pits w/ only one pit lacking A+4"; interpretive determination possible in places could lead to mound system w/ state & county approval; otherwise no system possible 'I 2 Boring # _ 1 Boring 31 /~ Pit Ground Surface elev. ft. Depth to limiting factor in• SoN Appligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft' in. Munseii Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-11 7.5YR 3/2 - sil 2 m gr mvfr cs 1f/m .6 .8 2 11-17 10YR 3/4 - sl 1 f sbk mvfr cs 1f .4 .7 3 17-24 10YR 3/6 - Ics 1 m sbk mvfr gs 1f .7 1.6 4 24-31 10YR 4/4 - Is 0 sg ml cs 1 m .7 1.6 5 31-41 7.5YR 4/4 c2d 7.5YR 5/8,5/3 sl 0 m mvfr cs - .2 .6 6 41-45 5YR 4/4 f2f 7.5YR 5/3 si 0 m mfi - - .2 .6 horizon 5 rdox features are stratified @ 31-32 & this horizon has inclusions Is; 7 additional pits in this area all show lack of A+4" suitable soils; thi area also a possible interpretive site location ^ Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fN in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 generally poor soils lacking A+4" means no suitable system area is possible based on this work without an interpretive determination which requir state and county approval & requires significant additional work wl no guarantee of success * Effluent #1 = BODS> 30 < 220 mg/L and TSS > 0 < 150 m /L 'Effluent #2 = BODS < 30 mg/L and TSS < 30 mgt'_ CST Name (Please Print) Sign to e: CST Number Henry F. Grote ~ 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 10/18/2004 715-233-0398 f K a, a-~ 0.,..q a.~` '"' ` L e~ 1 1 w... -~l l~ 7.,' S E - S$ - ;S$ ~ ~:S w ~ `• ~ (~p~. • W l ri J~ r .~ t~ D NNa55:86~ ( ~r tL`t w`. f' w ~ ~ ~f r ~ f . 5 ~ f~~ ~t}~ ~ ~ ~ ~ I t ~ 1 ~ i - r~ ~ ~ ~ /~` ~ t•eh ZZZ~ri~ ~ v_ ~ ~ ~ i f ~ ~ _ ~ 1111 ~ ~~~ ~ ~ t NM~55:5 ~~ I ~ 1 ' ~.lr ~~~~ ~ ~1~ ~1~` /~~ ' `7~ .{ T 7 +~ `JJ f+ /r'J /J ~ M f~ Y _ T ~ r ~ , ~ _ _ f l ~f - ~+ 1'' + ~ N44i55-33 ~ •'4~~ Q ~ ~ ~ ~ _ I ~ -.. ~ ~' f " ~ L ~ 7 k ~ ~ J ~~~~ ~ 'fie ~ ~ jtf N44g5596~ . ~ •k _ _.. _. .. .. ., .. t f t 5 I l ' A ~ ~QD f~ -~ - I ~ ~ : ~ ~` ~ C t -35 ~-' , '\ ~ ~ ~ i ~ ` o . ~1 ~: a v1 ~a gat r.~ ~ ~ ' .~ ~` ~ ~ e N44'~55 r 1 , ; 1 ~ { ~~ ~ w ~.ae., Ssut o ~ ,~ ti .• I y ' ' r t) ~ ~ ~ ~ __ _ • ., ~ ~ ~ ~7~ . ~~ ~. _~ ~_ _ ~ , ; -~~ ~ 3-D TopoQuads Copyright ®1999 DeLorme Yarmouth, ME 04096 Source Data: USGS ~----250 ft Scale: l :6,400 Detail: 1S0 Datum: WGS84 (~ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT OwnerBuyer ~ ~~~'"~" ~ L' ~h ~~' Mailing Address ~~Gr ~` S~~~cE /"C //G ~'/ C/ d" d~ G G -- le ~~ Property Address City/State ~~ (Verification required from Planning Department for new ~Gridv~rl ~~ AND OWNERSHIP CERTIFICATION FORM ~~ . LEGAL DESCRIPTION Parcel Identification Number ~ ~ ~- ~~ ~ ~- 4~0 Property Location ~ %<, ''/~ '/,, Sec. ~ , T ~ ~N R ~ ~W, Town of v ~' " Subdivision ~ Lot # ~Q G%i:1 ~~ Certified Survey Map # ~ ~ y ~' G l ~ Volume ~~~~` ,Page # -~r~~ Warranty Deed # _ ~~~ ~~ ~ .Volume ~'~ 3U ,Page # 3 ~ ~ Spec house ^ yes ~'no Lot lines identifiable ~ ^ no SYSTEM 14ZAINTENANCE Improper use and maintenance of your septic system could result in its pn~mature~failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, jounneymanplumber, restrictedplumber or a licensedpumperverifyingthat (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary}, the septic tank is Less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Deparhnent of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and ntumed to the St. Croix County Zoning Office within 30 days of the three year a iration da / g/ Q ~ A OF PLIC DATE OWNER CERTIFICATION I (we) certify that alt statements on this form are tnie to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described a ve, by virtue a warranty deed recorded in Register of Deeds Office. ~/ 0/~ S ATURE OF APPLICANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a ropy of the certif:ed survey map if reference is made in the warranty deed ~~ U 2730P 382 ~g4e`~s ~3 KATHLEEN H. NALSN REGISTER OF DEEDS ` ST. CROIX CO.. NI STATE BAR OF WISCONSIN FORM 2- 2000 RECEIVED FOR RECORD Document Number WARRANTY DEED 81 / 12!2@05 12: 45Pli NARRANTY DEED THIS DEED, made between Richard Francis Gruber, Jeanne Marie EXEMPT # Limell, Patricia Ann Benson, Gregory Paul Gruber, Deanna Mary Gavin, REC FEE: 13.08 Anita Lynn Gokey, Catherine Joan Kloster aka Catharine Joan Kloster and TRANS FEE: 771.88 Francis Joseph Gruber, Grantor, and Gerald L. McDougal Jr and Linda A. COPY FEE: McDougal, husband and wife, as Survivorship Marital Property, Grantee. CC FEE: Grantor, for a valuable consideration, conveys and warrants to Grantee PAGES: 2 the following described real estate in St. Croix County, State of Wisconsin: SEE ATTACHED EXHIBIT A Recording Area Name and Return Address: ~l~O Edina R Title 1 400 S. 2nd S uite l 15 r •,•.,' Exceptions to warranties: Hudso 154 "~`~ Easements, restrictions and rights-of--way of record, if any. 4 42 004-1018-40-000 & SO-000 Parcel Identification Number (P[N) This is not homestead property. Dated this 30th day of December, 2004. - -~ - -- * F ncis Jose h Gruber * Catherine Joan Klost aka Catharine Joa Oster Deanna M ry avin ~ ( / /~ * Anyita L G e ,/ r~ .~-~'~!~ ,~..4•f~-•c /9"Z'j'C' ~i~- h-c.~ _ /y~oy+fA~ /'L ~ ~'-T~` * Gregory Patrl Graf - b~ * Patricia Ann Benson -T * Jearute Marie Littrell * Richard Francis GtGber AUTHENTICATION Signature(s) Metro Legal Sen'ices EDTiZET 44884' A ay54/b ~~;~ 339339 authenticated this 30th day of December, 2004 * TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Peterson, Fram & Bergman -Steven H. Bruns 50 East Fifth Street, St. Paul, MN 55101 \4 SRR ANTY r1FFh cTerG apR OF WISCONSIN FORM No.2-2000 (Signatures maybe authenticated or acknowledged. Both are not necessary.) v Y STATE OF WISCONSIN ) PIERCE COUNTY ) ss. U 2?3OP 383 ACKNO WLEDGME:YT Personally came before me this December 30, 2004 the above named Francis Joseph Gruber, ail - person, Anita Lynn Gokey, a married person, Deanna ary Gavin, a maiTied person and Francis Joseph Gruber, attorney in fact for the following individuals: Richard Francis Gruber, a married person, Jeanne Marie Littrell, a married person, Patricia Ann Benson, a married person, Gregory Paul Gruber, a married person, and Catherine Joan Kloster aka Catharine Joan Kloster, a married person to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. Jalme VanHouten 1(~ ~ ~ Notary Publio t'I /lVvf a Jlf lA ~ o I jn State of Wiscon8ln *J ime VanHouten I ary Public, State of Wisconsin ~y comnussion is permanent. (If not, state expiration date: 7/27/2008 _ _ ) EXHIBIT A Parcel 1: Northwest Quarter (NW '/.) of the Southeast Quarter (SE 'J,) in Section 8, Township 28 North, Range 15 West, St. Croix County, Wisconsin. AND Parcel 2: Northeast Quarter (NE'/,) of the Southeast Quarter (SE'/,) in Section 8, Township 28 North, Range 15 West, St. Croix County, Wisconsin.