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HomeMy WebLinkAbout004-1025-20-000Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL ~VFORMATION (ATTACH TO PERMIT) Personal infonnatton you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Brandt, Dou & Ma Cad ,Town of CST BM Elev: I infsp. BM E~ev: ~ BM Description: ~~ c~~ 1 ` TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic iQ " Dosing ~ G U fr i ~ ~ ~XX~^ /Ct- ~~ Holding . TANK S ETBACK IN FORMATI ON TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic / 7 / / / ~f ~j Dosing ' 7 ~ / ~~~ J t / ___. Aeration Holding PUMP/SIPHON INFORMATION ~C ~! Manufacturer ~~, errand GPM Model Number ~ ~~ ~C~ 7~ y i 1 TDH Lif~ 7J J Frictio~ Loss ~ System H ~ ~ Ft TDFj, , Z l l' Forcemain Len th J Dia.Zi/ Dist. to weu ~ ~ SOIL A6SORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 479330 0 State Plan ID No: Parcel Tax No: 004-1025-20-000 Section/Town/Range/Map No: 11.28.15.171 STATION BS ytiZ HI ~~. .z FS ELEV. Benchmark $ , 5 !6$.rj ~~ Alt. BM ,~., .o t...la~jc. OJT * 1' lp•~~ ~/~ Bldg. Sewer ~ ~ ,3 Vc': 3~ 3 St/Ht Inlet 1X ~ _`~ g7. ~~ St/Ht Outlet ~ Dt Inlet ~ ,l Dt Bottom ~ 7g 7 Header/Man. rl , ~' l~° 09 Dist. Pipe Z•yo ~~ „~, 5 Bot. System Z .~ ~L Final Grade r , ~(,~ , ~5. ~ St Cover v ~S.~i 9/• ~3 ~w~-o~~ s•3 ra3. ~c~ 9~.~~ 15.~ 9~•t~ BEDn'RENCH Width ~ Length ~ No. O renche PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ Q I ~ / ~ ~.._.. `-- SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: .~ CHAMBER OR ~ INFORMATION 1 Type f ystem: Z~1 ~ ~ • /~~ / /~ ~J UNIT Model Number: .~_ DISTRIBUTION SYSTEM //d_ r.13 Header/Manifold / /I Distribution ~ f ~ Pipe(s) 1 J 7 L ~ 1 x Hole Size `' ^~ x Hole Spacing ~ Vent to Air Int~ ~ ~ Dia Z Length ~ +~ -Spacing ` ' Length~_~ Dia / I v ~ `~ ROII COVFR ., o.e~~~~re a..~4om~ n.,i.. YY Mn~~nrl nr O}_(~r'AftP S'VS}Pm5 ~nIV Depth Over t Depth Over xx Depth of xx Seeded/Sod xx Mulched Bed/Trench Center / 5Cr Bed(Trench Edges ~ Topsoil i ` es ', ] No , es ['s I No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ / / 4/ IInnds ~ Inspection #2: / /. Location: 432 315th Stre Wilson WI 54027 (NE 1/4 SW 1/4 11 T28N R15W) 40 acres Lot C~~sl.~_ rl~`~' Par`'el No: 11.28.15.171 1.) Alt BM Description = J r 1 -'" ~~~' C,~. t ~- ~ I o ~ 2.) Bldg sewer length = ~p e -amount of cover = ii ~~ ~ ~~" a~ o. g' ~~ _ _ --- - i ---- _ _.._ _ _, -- - -- ~ f _ - Plan revision Required? ]Yes i No G~ ~ , Use other side for additional information. i __ _ 1 ____ , -- - ..-- - --- ---- - - -- -- -- - Date Insepctor' Signa a Cert. No. SBD-6710 (R.3/97) / Safety and Buildings Division County ~- C 1~ ` 201 W. Washington Ave., P.O. Box 7162 .~ isconsin i Madi ~~~ 608) 51 q Sanitary Permit Numbcr (to be filled in by Co.) Department of Commerce "" ~~9 3 30 Sanitary Permit L~pplle~tiol~ , ao state Plan I.D. Numbcr , " In accord with Comm 83.21, Wis. Adm. Code, personal infgtmation you provide L (zi~A)S. /~' S2S3~ _-~ i may be used for secondary purposes Privacy Law, s15.04(I)(m) ,~, ~ ,'~)IA UC)lIN r roject Address (if different than mai~ address) L Application Information -Please Print All Information k.. ~ L ~ LIL3 Z 31 ~ ~~ Property Owner's Name Parcel # Lot # Block # w er's Mai7ling Addr ss r Property `O Property Location ~ l 2' 31 ~ f ~ S t" ~ '/. Section ~'h tate S City, Zip ode C umber PhoneN , , , rr • J W ~ ~~6~i'1 WQ~ ,, // ~YO2 © ~~-O ~' ~7~~ c rcle c) T ~ N; R~~ o~ Type of Building (check all that apply) II . ~ ~ ~ ~ Subdi ision Name CSM-Nnnrber- j, ~ ~y„ 1 or 2 Family Dwelling -Number of Bedrooms ~ ^ PublidCommercial -Describe Use ~ O ~ ~ ~~ ~tlC ^ State Owned -Describe Use ^City_^Village','fowmship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' ~ New System ^ Replacement System ^ TreatmendHoldin Tank Re lacemcnt Onl g p y ^ Other Modification to Existin S stem g Y B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New Ltst Previous Permit Number and Date Issued Before Expiration Plumber Owner t d v,~ v IV. T e of POWTS S stem: Check all that a I $ X /. 20 = D. ~ ^ Non -Pressurized In-Ground ~ Mound >_ 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Linc ^ Gravel-less Pipc ^ Other (explain) V. 1)is ersal/Treatment Area Information: _ ~~• 2 Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Arca Required (sf) Dispersal Arca Proposed (sf) System Elevation ~~~ ~ ~~~~ ~ ~~ y ~ r~3 ~ ~ , VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank _1 ~~ Q S O .~ Aerobic Treatment Unit ~+ Dosing Chamber _~ ~ VII. Responsibility Statement- t, the undersigned, assume responsibility f installation of the POWTS shown on the attached plans. Plum 's Namc (Prin Plumbe ' Signature MP/MPRS Number Business Phone Number t ~r ~ o~a(~ ~ `~~~- 7?~ - 3"z. Plumber' ~s (Street, ity, State, Code) ~ ~p / n ` VIII. Coun /De artment Use Onl Approved ^ Sanitary Permit Fec (in ludcs Groundwater Datc Issued Issuing Agent Signature (No tamps) ^ Jan Reason for Denial Surcharge Fcc) r~ ~ ~ J ~7,,~ ~ ~C,tJ ` IX. Condition Appro SYSTEM OWNER: • 1 Septic tank, effluent filter and dispersal cell must all be serviced /maintained as per management plan provided by plumber, 2. All setback requirements must be maintained as per applicable code/ordinances. Attach complete plans (to the County only) for the system oo paper not less than SIR x l l inches in size ~~ SBD-6398 (R. 01/03) ~p 1~r~T _J ~.a~ ~1~ S ~..Q~ N ~~ ~~ O r+v~ ~. ... 15 1 ~~ ~~'^ l ort9 ~6 op 4," Srw.r.s ~.~~~ ., ~ s--b 1 ~ '' ~ z « `~ v c ----~ SCC~Qn. Q^O ~'~^G 4U~ bM.A.• .,.~o4~Z~ 1oS,Z~ \ ~------s ~a~,q~ ~ I 3.0°0 v 1 03.2) 3 ~- ~, C 101, 2.. L ~ L/L 1 / o~ ~ N o gz,~ a s~~.L~. gyp'`. (.t.~., ~ ~ ~ '-/ ~ ~ > ~ moo' fi'''n ~.~.s S: J oQ'~ G o _ ~" ~ L 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. com merce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary July 13, 2005 CUST ID No.226524 ROGER L TIMM TIMM EXCAVATING 3128 20TH AVE WILSON WI 54027 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/13/2007 SITE: Doug Brandt 315TH Street Town of Cady St Croix County NE1/4, SW1/4, 511, T28N, R15W ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 Identification Numbers Transaction ID No. 1152538 Site ID No. 701335 Please refer to both identification nunnbers, above, in ail corres ondence with the a enc . FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1027911 Maintenance required; 450 GPD Flow rate; 28 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Approval Requirements: Co~rdii ~PPR DEPARTM~ENT~i ~~~ I~R+1~N 0~'~-a f~~c • • This system is to be constructed and located in accordance with the enclosed approved plans and with the "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.O1/O1). • 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. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat SEE CORRE' ROGER L TIMM Page 2 7/13/2005 • Comm 83 22(7) A copy of the approved plans specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities: • 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 may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Charles L Bra 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 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Henry F Grote ,Certified Soil Testing I ` RECEIVED Doug Brandt -Mound ~~~ ~ 6 ZOOS sAF~ rLL~ ~ auoLDi Construction Materials and Techniques NGS All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. Construction methods must comply with the following Component Manuals: Mound, SBD-10691-P (Ol/O1) Pressure Distribution, SBD-10706-P (O1/O1) Location: NE `/a, SW `/4, Sec. 11, T 28 N, R 15 W Town: Cady County: St. Croix Date: July 11, 2005 Owner: Doug Brandt Address: POB 279 Fall Creek, WI 54742 Plumber: Roge Timm Signature: .~ License: MPRS 226524 Attachments: SBD-10577 -Plan Approval Application SBD-8330 rage l: 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 .. ~~~a~ y ~,F-CO~~sF~c ~CJ GS ~- ~PONDENC page 1 of 8 f ~ ` M ~ . . e Design Criteria YL'~ Residential Wastewater Contaminant Load: 30 mg/L < BODS < 220 mg/L i Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L Fecal Coliform > 10,000 cfu/100 mL Fats, oils, grease < 30 mg/L 3 Bedrooms x 100 gal/bedroom/day x 1.5 ~ `~ gallons/day hydraulic load Design Calc ulations In situ designed loading rate ~ ~ 3 gallons/sq. ft. per day Depth to estimated high ground water ~~ Zg in. Depth to bedrock ~ sS in. Cross slope at system ~ '~ % ~" `` v Force main length `S-b ft. of Z in. z 4 , ~-S' Manifold/header length ~ ~ ~~ ft. of ~~~ ~- in. c9 ~ Z 3 Drain-back ~~' ~°~ gallons Lateral length Z @ `~ ° ~ ~ ft. of ~~~ Z in. Lateral elevation ~ ° ~ ~ ~ ft. @ bottom of lateral Lateral hole size ~~~b in. @ ~ °r o in. ( ~ ~ ft.) Spacing l ~ holes/lateral ~ g holes total Lateral volume ~ b,~~, gallons Total lateral discharge rate ~S ~ o ~ gallons/minute @ ~~ ~ ft. head Network pressure compensation losses °,~'S~ ft. Elevation difference ~ ~-~ g ft. Friction loss 2 ~ ° ~ ft. @ 2 ~/ gallons/minute Total dynamic head 23,24 - ft. Pump/siphon ~ ~ gpm @ ~ Z S ft. of head Manufacturer ~ ° ~` ~ s ~ 8~ - Model # ~ ~~ ~ sf Dose volume ~ ~ ~ ~a `~' gallons Lift/sl~on tank ~ ~ -~ ~^-- ~ ~ - ~ U° C-o who ~ ~-o gallons Septic tank `' `' `' ~ gallons Effluent filter ~r~~ ~` o~zz-14'~~ crv/ ~~-~~ ~-~-~~ Measurement pump on and off ~ , 5 in. Height alarm from tank bottom ~ ~'~ in. 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Q \ \ ~ ~\ r~ 9.+-- \ 4~ fll~ NC J Z5 ~1 0\ t 1 tO ~ ~-~C ~ ~ ~~B ~ ~.~ e ..., ~ mss. o g ,,., ~o~....1 ~~ .~ ~ ~ a~ ~ s ~~ ~ ~- -- __ - ;:e;~. 1 'r Grade, elev. -----> 4" PVC soh 40, 3' onto solid ground 24" 2.D, r~aruoLE x. ~- ~JQ.~..;~ -LfJCKING~C0V6R -~ ~c/Ai1'N CMG ~ /~BE~ , Q~iCK O~~C.OVVICT-~ 4~ " Fort~r - Mn~H WEATNERPRC~c JON`,,`n ~. f~ ~ ; `~~ I ~ / ~~~ T ~~ 4" PVC ~~ $ch 40 vent r- -~ 2 ' ~~ ;~ ,,,,~.~ r -_-__~. ~ ~- ~ \13.5 `~ r+oc6 !iW ~vLD A , 4" PVC ~'QSXF.T 3b1~rJ ~ Q,, rFLE / I ~sch 40, ~}LL p~/~, ~ ~+r 1 Al 3' onto 1 solid c~-wEUT~o-+S ~~ `'^/ ~~`,Q, ~ -\v-o T ON ~ ground L~Q~, C 1~`T~v ~n 0w"C1.a.~ ~T.S" ~I,, g ~ ~~ ~ Y ~ H P. h L ~O ~F l~ • F`= c~ gZZ-14 +3a P~ ~ q ~. C oNcae E-r~ ~LG~, b~oCK SEPT~c R _ SPEG~FI•CATIOIJ$ ~~' `` OOSC T' T~uK: M^uUFACTURCR: ~ ,~p'~' uUMDER OF OOSCS: S' ~ _• per day T^~.JK 51ZC : ~ ~" -~Crd GALUO-JS • .DOSC VOLUME 1 A~ARP'~ r1IWUFACTUR[R; S `~ ~}~ ~c-i~~~ IIJCLU011JD OACKFI.OVJ: ` ~~ ~ ~4 gallons P'~ODCL -.1U1hOCR; • \ ~ i 1'4 ~'`~ CAPACITIES; A c\g.~ IUCNfS CR ~\ 0'nb gallons SwiTCN TyP(; ~'~`'`` "`b 33.SZ allons 8 = Z' ~uc-+ES oa 9 PUMP /yA1JUFACTURCR; may` C, a ~°~~/_~-~CHES OR\~p'~~.~ ga110ns MooCL uuMDCR; ~~~-l tiPo 5' ISo,gcir 0 ~ ~ INt HES oR gallons )WITCH TyP[; V'^Q~v.KV .,. 1J0TE: PUMP A-JD ALARI~ ARE TO Cc MtutMUr1 DISCMARGC RATC z~'~ GPh\ INSTALLED Ou SEPnRA1~E circuits YL0.TIC~.L 0iFFCRC1JCf DCTWC[U PUMP OF- AUO OISTRIDUT101J PIPC., ,~`'~ FECT + ^',~+uiMUM -JETWORK SUPPLY PRCCLURC 2'S FCCT~O'~~ + `SO FEET OF FORC[ MAI-J X ~_3~ FFT,/ 2~0q ~S~ IoorcFRICTl0u FACTOR.-• FEET ~ p _ TOTI~L Oy/.1AMIC HEAD ~ Z3'2..4-- ~ t ff.ET ., '' 3 ~ ~, 11JTER1.1A~, 0IMEIJ6101J>; •Of TAIJK~ LE-.lG7N l~~ ;WIDTH--~g -.LIQUID pEPTH •• ~GOULDS PUMPS Submersible Effluent Pump 3 V / ~ EP05 APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capability: 3/a" maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: 1'/z" NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. •EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: l0 foot standard length, 16/3 S1TOW with three prong grounding plug. Optional 20 foot length, 16/3 S1TW with three prong grounding plug (standard on EP05). • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Auto- matic models include Mechanical Float Switch assembled and preset at the factory. FEATURES ^ EP04 Impeller: Thermoplas- tic Semi-open design with pump out vanes for mechanical seal protection. METERS FEI 10 9 a x _u O 0 6 s 4 3 z 0' ^EP05 Impeller: Thermopfas- ticenclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover: Thermoplastic cover with integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING ~' Canadian Standards Assodation (CSA listed model numbers end in "F" or "C".) Goulds Pumps is ISO 9001 Registered. iT _. __ 2.s Fr .~- ~_..~_ __.__._._.__........ 25 i ___. , , _ _ _. _ ... _ _ , _.. EP05 10 ---..__..._...;..._.....~._...._ _._..._._..... ...__-_ _____..._ ____ __._..__,_..._.. _„......_ . ............ i . _ ... :.. _EP04 __r -- s 00 10 20 30 40 50 GPM y~ 0 2 4 6 8 10 12 m3/h c.~,PACITv Goulds Pumps © 2000 Goulds Pumps Effective February, 2000 83871 ~~.~~ ~~ ITT Industries ~~ ' 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, Timm Excavating, 715-772- 3214, 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. 10. If septic or dose tanks are no longer used, they must be properly abandoned. 11. If construction timing and weather could create a frozen infiltration system, weather-proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start-up. 12. If possible, the upslope toe of the mound system should 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. 1 1. 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 Wisconsin Department of Industry, SOIL AND SITE EVALUATION Lb~uor and Human Relations Division of Safety and Buildings with s. ILHR 83.09, Wis. Preliminary -Soils Only Attach complete site plan on paper not less than 1/2 x 1 inc es in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Page 1 ~ 3 APPLICANT INFORMATION -Please print all information. Re ' wed by Date Personal information you provide may !me used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ ^ ZZ Property Owner Property Location Doug Brandt Govt. Lot NE 1/4 SW 1/4,S 11 T 28 ,N,R 15 )(R)(iir) W Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# PO Box 279 City State Zip Code Phone Number Cry Nearest Road I Fall Creek, WI 5442 I (715 ~ 877-3351 ^ City LJ Village ~] Town I 315th St. ~~ ~] New Construction Use: ~ Residential /Number of bedrooms 3 Addition to existing building ^ Replacement ^ Public or commercial -Describe: Code derived daily flow 450 gpd Recommended design loading rate ' 4 bed, gpd/ft2 .5 trench, gpd/ft2 Absorption area required 1125 bed, ft2 900 trench, ft2 Maximum design loading rate •4 bed, gpd/fl~ .5 trench, gpd/ft2 Recommended infiltration surface elevation(s) 1~'2 ft (as referred to site plan benchmark) Additional design/site considerations install 4' x 95' rock bed mound on 103.2 as upslope edge of rock w/ 1' sand fill Parent material loess over SS Flood plain elevation, if applicable plq ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank u = Unsuitable for system ^ s ~] u ®s ^ u ^ s ®u ^ s~xl u ^ s ~7 u ^ S ~ ~J u Boring # 1 Ground elev. 103.2 ft, Depth to limiting factor 3?in. Boring # .t 2 Ground 1~~~~2 ft. Depth to limiting factor CAII nFSCRIPTIAN REPORT Horizon Depth Dominant Color Mottles Structure i C t d B R ots GPD/ft2 in. Munsell Ou. Sz. Cont. Color Texture Gr. Sz. Sh. ons s ence oun ary o Bed ,Trench 1 0-5 10YR 3/2 - sil 2 f sbk ds cs 2f .5 '.6 2 5-23 10YR 3/2 - sil 2 m sbk dsh cs 1f .5 ..6 w/ common G si coats on peds, ~-- ccasiona gr & cob - ' 3 23-34 7.SYR 4/4 - is 1 m sbk ds cs 1f .7 '.8 4 34-44 7.SYR 4/4 f2d 7.SYR 5/8 sl 1 m sbk mvfr - .4 ~--~-~ ' Remarks: 1 -9 10YR 3/2 2 -24 OYR 5/4 - sl 1 m sbk vfr cs 1f 4 3 4-28 OYR 5/4 - 1 1 c sbk vfr cs ~ 11p~~° 4 .5 w/ common y si coats on peds '~~ 4 8-45 .SYR 5/6 c2 10YR 6/2 cl m fi - - --~ , n. RemarKS: 3ST Name (Please Print) Sign to `/ "' '` Telephone No. Henr F. Grote . Address Date CST Number PO Box 57, Knapp, WI 54749-0057 8/96 3065 .~ • lp .~ .~ PROPERTY OWNER Doug Brandt PARCEL I.D.#k Boring # 3 Ground elev. 103.0 tt. Depth to limiting fa~~or in. Boring # .. i i `..::: Ground elev. ft. Depth to limiting factor in. Boring # ~.;,~; Ground elev. n. Depth to limiting factor in. Boring # Ground elev. tt. Depth to limiting factor SOIL DESCRIPTION REPORT Page 2 of ` 3 ~ Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Rooms 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench 1 0-6 10YR 3/2 - sil 2 f sbk ds cs 2f .5 .6 2 6-22 10YR 5/4 - sl 1 m sbk mvfr cs 1f .4 ~ .5 3 22-32 7.5YR 4/4 - sl 1 m sbk dh cs 1m .4 .5 4 32-55 5YR 4/6 f2d 10YR 6/2 scl 0 m mfi - 1f NP ; .2 Remarks: Remarks: Horizon Depth Dominant Color Mottles T t Structure n i n t C B nda Roots D~ in. Munsell Qu. Sz. Cont. Color ex ure Gr. Sz. Sh. o s s e ce ry ou Bed ,Trench Remarks: ~~ .~ ,~ 'n' Remarks: SBDW-8330 (R. 08/95) r ~p ~~re+.~T -1 ~o~ ~~ICU N~; - 5~..~_l\~Z'g-13 • ~ ~-., N ~ ~ ~ we S,o ~~~~~ ~.~.. t....11,. ~ b ~k ~( ~ -,- ~~ ~ ~ o;. o~ `?~ ~3 - Z ~3 ~.s ~ -v .r --~' • ti t(`l (~.,~~ ~«~ o~ ~ ~ ..~~~ Q~~ Sa.... ~ ~so.o~ [~- , b we k1~ •, X10 $i.~a z..~~a.~. o(.~~.., 3 0~ 3 -- ... ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OwnerBuyer Mailing Addr~ Property Address 5 fk (Verification required from Planning Department for new City/State ~J 1 ~SQY~ L~ ~ Pazcel Identification Number d©~ 1O ~ ~ - ~ ~- ~d LEGAL DESCRIPTION Property Location ~ ~%4, ~j~ '/4, Sec. ~~ T 7~N-R_~W, Town of Subdivision _ ~v ~ ~d ~ ~ ~.e ~~Ce.~ Lot # ~---- r---------- Certified Survey Map # ~ ,Volume .Page # Warranty Deed # ~~ Z 3 `~ Volume 2- ~"`~~ .Page # 22 ~" Spec house ^ yes Q~ no Lot lines identifiable ~J yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site 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 Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 ys of the three yeaz a piration date. / ~ / ..5 SIG A APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the operty described a ve, by virtue of a warranty deed recorded in Register of Deeds Office. R ~ / /W SIGNA APPLICANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed OWNERSHIP CERTIFICATION FORM U 27y0P 227 STATE BAR OF WISCONSIN FORM 1 - 1998 WARRANTY DEED Document Number i This Deed, made between 'fa<}~1~711D7~ ~i¢/yl / L y , Grantor, and _ 7~0 u C°, b. /!5 .~ _ A.JIo ,C~f12 ~ ~ .C7 h' A11~ [~'T __ ~_ __ - _ __ __ Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in ~~ ~, RD I,,r Cro~unty, State of Wisconsin (the"Property"): (SCt- iQTTAC•~ft'.D ~~^~oAL -C~~CR,/~-J'",O,a)~ (Parcel No. 004-1025-20-000) The East Half of the North Half of th Southwest Quarter (E %2 of N '/s of S W '/a Of Section Eleven (11) Township Twenty- Eight (28), North Range Fifteen (15) West, St. Croix County, Wisconsin. Together with all appurtenant rights, title and Interests. 7 6 6 2 3 9 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIK CO. , MI RECEIVED FOR RECORD 01/31/2005 03:30PM MARRAHTY DEED EXEPPT N REC FEE- 11.00 TRAIiS FEE: 84.00 COPY FEE: CC FEE: PAGES: 1 -- !ie ~~Name and Return Address f~ee.~at~tS ~~. ~t.st/t/!7T o. ~dX X79 c, ~ C~e~eK, Gt3~ s~~Yz -- _, l ~ ~ arcel Identification Number (PIN) _ ~`.'~ This J5 11c9~ homestead property. „ / (is) (is not) b~ Grantor warrants that the title to the Property is good, Indefeasible in fee simple and free and clear of encumbrances except Dated this 3 ~ day of ~/t1 r>L U Oi r (/ , z Q ~_~ %~~~~Id~~C-.~'_ ~^~~1~11~1 (SEAL) ~ ~ (SEAL) '~" r~ ~, ~-M1~vY° (SEAL) (SEAL) fJ o w 6 it A 5 E~ L'T- RA~d,OZ AUTHENTICATION Signature(s) _ f ~~~F,N H, ~~ ~~; ..,~-,.,~,eY.-~ - `r f Q r, O7. autheittitC~ oF' * ~~~ t ~~ TITLE: ME ~ WISCONSIN (If not, '" t authors ~ ~ ~ ~Vis. Sta[s.) < '~~~. , THIS INSTRUMENT WAS DRAFTED BV ~ ,Lt ~F~, ~aett,~,nC'Zr (Signatures may be authenticated or acknowledged. Both are not necessary.) _ _ _ _ _. _ __ __. 'Names of persons signing In any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 1 - 1998 ACKNOWLEDGMENT State of Wisconsin, ss. ~/~ ~.`h~~_ _ County. Personally came before me this _~~~___ day of ---.~Q.~ at r. , ~eo3 ,the above named ~~ ~V r s ~ ty-SrGY ---- T/J H ~ --_-___ _.___..- ~ex or ~. a rzr n.t' ~- ~- to me known to be the persol~___ who executed the foregoing instrument and acknowledge the same. 1~-~t~~ t~_.~/~ l~~_--- Notary Public. State of Wisconsin My commission is permanent. {If not, state expiration date: ~~ . 3. ~ o o ~ -T----• ~> Wisconsin Legs Blank Co.. Inc. Milwaukee, Wis. ~~ CADY PLAT T-28-N • R-15-W E (Landowners) V See Patio 112 For ABditloaial Names. f , SPRINGFIELD PAGE 42 2700 ' ` 2800 2900 60th AVE 3000 3100 3200 3300 Daniel & I Mark Ftaotey clmla $ sT s Naaeth Clifford & o°o Eve17n Anne ~ MueBe[ Guy R rote- gsmneB lmdahr Alice Lee $ r OMeaza 80 84 Leonard I E. IKn w 4o a~ 99 3e Lund 114 ~ Norma C ;ia Trust 5 8 N Pauline t xermmlk ° $ ~~ S L aar,aape BNreB Stole a'. liamld a~ ~~ P^•1 RDN L S~~ u1 VlOkk ~ S ~ ,tear- ~ inx~is- H ~ N ~ Trust >~~ 56th ; s c0 amaa' I ~~ m 140 I a eo isof ao bw 20 .0 AVE B Stevwa T~ vnbas ~I x w Donald @ 5 AVE John 89 '~ '~ Gay 4 g~ E yynn ~ a ~ etal 100 9;atbryo 150 17I s9 ~ ~ n6 rdee I m ~ ~a0 ~ R I r- t BBdanl 70 Wallecverd 82 O La rm~e 33 112 ~sr a~36rmsFtp 41 194 .°, m 53rd VE 99 53rd A E 94 Nye Deed GateaO~t a ~, fe9tle a CBfford & Ebenezer roseem Beeky sin o ~0a I atarr Atiee Ruckler oNda Oaks Inc gg e"'~, 24 x'b~:e ,s ~°aa 35 ss se E xr.>- ~ ursaw GO 33 33 Bat`r 33 Lund 65 32 1z 50 . - CBfford sn ~ ~g 50th Formostaae F a ~ s ~ eatrp wraa~dt D~aM TA I~.ois a 8: ~~ ~ Stuart 8t Doris Farms USA 72 Shawna m ~ p rs = so ~ aaryry80 Goss 80 ~ n coama Lund 120 ~ +,ppf ~ ~ Peterson uorda o Callahan M dine ~ -- leHtt7 wer°~-'° Her!<er James ~., w ss „ 2'~ Te Trust Rex Gmn- fl°- a °' 40 ovoln I p, dd sue- , 40 45th VE Y Ronald 8: 120 160 Stociunan war 40 107 .n 78 >ramr Brenda ~ 1 3a ,oseph a I E Ardtur ~~ ~s GMraury ~ JoA9m Jata nx.rk Darin ° r dt Audrey e0 tau "))ss 9s ter `cws~m Johnson Daniel & Kim ~ Menter 153 20 ~+o )OIBH 120 I TraPP 133 i~~e11r~ *+ 'w b 128 & Diane Ofstle 1 I Ronald Kavits ,u„""°,,,, 90 Bee &WP ~m Julie ~ yy~p~ TAnderson I i ~ ~~ 105 40 °a°`r eo 79 3_83 wns 1 110_ 39 _ _ 79 Baer 70 so _ ao nefe 40 80 120 40th VE _ _ . - ~- 8 rY owrJs. awu 3 9iL- zn ry ~ c~9mx Rlrba9d a _ _ ~ _ - _ _ _ 3 Gre o 7o rmr s3 a 9o I a M omds a wcaara s ~~ 8: Taza a uvom awrsr xsx«a. a Linda ,., arY aomoo a saxasa room- xoum- xem s laM .~ Leon r~ rsxg Peter9on C9ren nmm 77 amm nmdw e1 ~ ao Mocriwn 80 +o ao Must 1zo N s°"°e $ Allan ~ Ronald Michael EN&R o~ eg m~a.ow ~e 8 r~ $ Jo & 9 asbaae ~ ~_ $ Carla leas Betty m ~ ~ ~a am 719 I m e<Brenaa oconnen ~ ~' us `""".: wheeler 39 ,o tl ~ R sx 4 8 tv Is ,~ a"°"`p„x1 Riek ~a R BO lwu~n F pP^~l ~ ~ ames& ~ S l n .'• gg ° ° 99m- : ~- N ~ Nd3Op 120 Andeo- _ ~~ Johnson 119 ~~ c%s 40 ~ ''" ~~ ~ m ,~m w a ~m LLL~~~------ ~,~;, pp ty~ ,ig~ aawa !a !9 V Gerald .~ ~gy~ ~1aa glo~ito 4 ~ a Lawrence 8: 9 U iS. m ~ ~ V ~ ~ ~ ~° eO d ~ a 1a_o g _~ 60 ~ ~ ~ u tl 6 S0 MmeQ +o ~ eo x L'la 238 w O ~egand 78 H rlon 80 M y X10 (~ O> o"~ 01 sn ar`'s ~ ~ 4e sow yes se.w~. a o Norma - - _ _ ~ 1 ^n a "^ 30t AVE 2 Ster& Kleln«tc&r ends a~ w'0 e°y f1 ~ re"mr°s "' Olson 20 Robert sa`auanirua ~ ,. $ ~ @ Mar & J~n 80 padacdd 80 w eo..e a ~ ~ ~ G 50 non & & Patricia ,F Walter & ~~ s" w 7th AVE ~ a" Shelly P~~pn ~F, $~~a 3~ MBler ohn& Dean Delmaz& ~ ~a ~~ g~ gUdrua James m~ oQ Faber ,, h~~ & eb t Timm Mazlene r 20 N Za9seso 681aa 0 ,,,, ~ ~ Romo 78 119 z I 78 EBi~boe 80 HoBdorf ~ ~ °' 40 70 NN r`0vwio' 25t AVE ~ o. Eug~e :s ~~ I a ~ Ronald 4 TM $ ta+a r Norm & a ~ roll zz Chores a °$ Gerald & & Judith s"`~Q ~-1 edan LM a r rn Marlem mom- Barton Victde Battu ~ Swtt 8c Olson 80 wiDt ao ff 40 eo z Truesdell gp 220 ie°is Lamb ~ Boger & Glam a 75 5 0 Lvvl1e Brian Gregory p omde $fn~ eggy Dennis Klebneyer Hrr9~stpton ~ ~ `" l~9ristop- & Ray Buc~hanla DH pe Timm, 80 BleBen 90 _ 170- - - - _80 Hampton 190 hersoa 79 Wang 80 53 80 80 so - _ - _80 r8A z3 20t AVE Ann ~9F ~ ~6<V~ele av~ia+< 7nvls oyce ~ a xare lawbs ~~ AllanA ~.~ •" rrealoft cr.ov<3 't>mo37 n 80 No g '¢ Hugh 40 Trust 138 Tamera 9 _~ Mary Hampton Harold « Robert ~~ Faber can ~t . m..a ,~ Alan A S Frye & Joy Moldenhauer T~,m °o~"r e1in~ "r"°"` B80 112 208 89 Z Hol 78 208 ^ 90 '~ 10 'o James lane pile '^ ao t°°. ~ m - °°° JudIH9 Rex Trttrt taz `s~ ti9a~on Raasch Lee acbeds ~~ ~~ oas m e tl rasmiu~mee Judith g Grn qo ~ ~ 0 King oQ 97 36 3s Acres s0 ~ El' 1 3 !ao°` gg B~ ~~Genz o a ama cordon -_tnc an 8 ~~ pJru ~9 '3~~ s mleex stringer Bran- ~ Timm a ~ Timm a m 70 ~_ 16 ~~so ltmt ~ 120 0er °° 66 1 110 39 38 ss 39 ~ 53 3 p g r 22 7 S 10th AVE ~ ~~ cxai' g a°o H 8 $ TR Zovg a W ~ a IKwaod ~pRI G LLE y , •- B p, ~ ~ xer x tl p'~ &~~ I 40 75 ~ M I 3B 39 N n Richardson ~~ u~ tt roNara ~ F,~, ers ,$y #a.gg Grdber xDore ~f-~ ~ V tl g SehuHZ 3 s Rithatd 4 ~ "°^°- 953 ~+ ~ rdsma I• Ste ~ e1i I ~ ~ cNi 229 Weber G ~G~J so 1 I df ~,Q ~ ~' Rod Ili V `B F' 77 ~ PP - oD s rd o 30 ro o ° li*eGory wmN+• „ ~ ~ O IaHN x~.'t'. ~2 128 Timm ~~~ u ~ aZimmermm 3 80 114 3 ~.m Eva S3 m m 29 Let 50 w.u Stxphen Keph m Gei'~r;,l~_ Yi Amundson Bndley N aaowa @ h- a ~ g .~ I Hughes a Atres ~dS~ 9o"'i°r" oZ RaPP~B 80 ~ 40 aa~ ^~ ~ 160 / 9 N , 77 ~ Inc 160 80 so s7 r g - - - - FREIBERG RD s PIERCE/ST CROIX RD PIERCE CO. "SPECIALISTS JN FLAVORED NATURAL CHEESES" UPS SERVICE WEEKDAYS Over 90 Varieties of Cheese ~"s) n2-4218 Fax: (715) 772-4224 ~~ GIFT ITEMS -COOKWARE OPEN 9-5 EVERY DAY FACTORY & CHEESE GIFT BOXES 126 Highway 128 SH~PPE~ 'NC• BCheese Mailed Anyrv pure, AnytfineY Wilson, Wisconsin 54027