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006-1021-50-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Building Division St. Croix INSPECTION REPORT Sanitary Permit No: 556325 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan 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 Tax No: Rau, Matthew S. C Ion, Town of 006-1021-50-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: tic: P An. i G Ste' 10.31.16.137A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURE 7?, CAPACITY STATION BS HI FS ELEV. Septic L Benchmark /40012 9 Z /09 z / Dosing / Alt. BM CO „r Y! ~to5 Sd~, 5,15 ion Bldg. Sewer F.11,... Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet 4,11 Septic 7 76 / Dt Bottom Dosing 7 /OU ` 70 - Header/Man. _ Aeration = - ~y Dist. Pipe 75 /0 7 Holding Bot. System Final Grade Q PUMP/SIPHON INFORMATION L° / d1z g Manufacturer f Demand St Cover -zOP~.L. , GPM Ii-'r65 I6Z,"3.5, Model Number k> k) /S 6 Z(p .4- TDH Lift /La F Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well 55 1 Z /60 SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Nzr 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 Mystem: / 117 1 125 i / UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size i., /j x Hole Spacing Ve o Air Intake ~ Pipe(s) ~ Z e4 LengthDia Length ~p Dia Spacing_ s- 4 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded 1-10 Mulched Bed/Trench Center M / L't Bed/Trench Edges Topsoil Y ~+I ~ ~'Y' Yes toT Yes [Jl No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 9 / /1/ tz- Inspection #2: Location: 2399 Cty. Rd. H Deer Park, WI 54007 (SE 1/4 NE 1/4 10 T31 N R1 6W) metes & bounds Lpb Parcel No: 10.31.16.137A 1.) Alt BM Description = w 2.) Bldg sewer length = -76 V~..f - amount of cover = ((.•77 j~ to 164., q2 fiW Plan revision Required? ❑ Yes o F9T 2 --~Use other side for additional information. SBD-6710 (R.3/97) Date Insepct Sign Cert. No. Z ~ 0 g c\ o e (ox W a a ~ o ~ Rc a n 31D o c~ o p O A t w N Z o ~ AI `C A C~ ` n C 9~ ti C b 0 Zc W 0 44 'p . C ~ x x~ o n mo~~o~ w T o c ~ 4k u ~ ~~an r h 1 1'~ County 4 Safety and Buildings Division jr ,Qo/ 6 F , d $ gam;a 201 W. Washington Ave. 7162 Sanitary Permit Number (to be filled in by Co.) p S Madison, WI 537 State Transaction Number S; oitermit Application 13 0 In accordance with SPS 389y21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit z is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary ses in accordance with the Privacy Law, s. 15.04(l)(m), Slats. I. Application Information - Please All Information ! , 4. Property Owner's Name / Parcel # rr a 60(o - 16ZI - 50 Property Owner's Mailing Address Property Location /Go o?DG rd "-r Govt Lot (,1374 J City, State Zip Code Phone Number , , section /O .SI' Clr Syo.7~ 715- 17.? (oircleo-~„ o fv~' H. Type of Building (check that apply) ? Lot # T J/N; R. 14 1 or 2 Family Dwelling - Number of Bedrooms J Subdivision Name al- 4,& - c- f Block # Public/Commercial - Describe use ✓ 9 eity f ❑ State Owned - Describe Use CSM Number Viflage of /x -7 9' ~ Town of PLO/t/ III. Type of Permit: (Check only one boa on line A. Complete fine B if applicable) A. ❑ New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Otherr Modification to Existing System (explain) God,-, r /6o , ous Permit Number Issued B. ❑ Permit Renewal KPem it Revision Change of Plumber ❑ Permit Transfer to New List Previous Before Expiration Owner 55,?-3z4 ioZ4 L_. IV. Type of POWTS S stem/Com neat/Device: Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At Grade Mound > 24 in. of suitable soil ❑ Mound <24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis rsaUTreatment Area Information: Design Flow (gpd) 4 Design Sod Application e(gpdsf) Dispersal Area Requir sf) Dispersal Area Pro sed (sf) System Elvation /aa,a so / c yso , f 25 yL 8 S /0/001 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o o v New Tanks Existing Tanks c B 8 m f3 6~~~ a v m~ on w c7 a Septic or Hakhal;ffmok /p00 O 6✓/ESEti ~cv,1~~rE' r~ Dosing Chamber ~dG ~ it v VII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Si MP/N~ Number Business Phone Number To E KF 0?3/3~G 7/S G 7W -S 4 Plumber's Address (Street, City, State, Zip Code) ~~798 ~r4 ~,o. ~S ~u~erro LJ1- S5'73G V our /De artment Use Only Approved ❑ t appro Permit Fee Date slued Issuin errt Signatur Reason $ gS. as ~ 3 o J Z IX. Condit(gpSTftofff4gWeasons for Disapproval / 1. $eptic tank, Oluent filter and ,3J (.Opts', w. ~-S r ~•tq~G t~f~.~ dispersal cell must all be services I maintained CCt~ ~`~t" l as per management plan provided by plumber. 5 PGI~~•.~ d- . 1. Ak sslpack regt*eme lts must be maintained 7 code 1 tird n es. Attach to complete plans for the system and submit to the County only on paper not less than 8 in 111 inches in size SBD-6398 (R- 11/11) ~~~rnaTkF~T Safety and Buildings 10541N RANCH ROAD HAYWARD WI 54843 3 i $ Contact Through Relay P s ` www.dsps.wi.gov/sb/ 9~ w www.wisconsin.gov A ~ 014 Scott Walker, Governor Dave Ross, Secretary August 15, 2012 CUST ID No. 231346 ATTN: POWTS Inspector JOHN HERBERT PELKE ZONING OFFICE PELKE PLUMBING ST CROIX COUNTY SPIA N 6298 ST HWY 25 1101 CARMICHAEL RD DURAND WI 54736 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/15/2014 Identification Numbers Transaction ID No. 2134062 SITE. Site ID No. 782625 ~ Matt Rau Please refer to both identification numbers, pai't Co Rd H above, in all correspondence with the agencyt. 07, Town of Cylon St Croix County SE1/4, NEIA, S10, T3 IN, R16W OtiSpF D FOR: Description: Mound, 3 bedroom residence LOF Object Type: POWTS Component Manual Regulated Object IDNo.: 1386051 Maintenance required; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD-10691-P (N.01/01), Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01101); 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. 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: Key Item(s) • 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. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • Care must be taken to preserve the bench mark during construction or establish a new bench mark with the elevation set to relate to the original bench mark. • The float switch shall be a type that does not contain mercury. 2009 Wisconsin Act 44 prohibits the installation of float switches or relays that contain mercury. • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. JOHN HERBERT PELKE Page 2 8/15/2012 Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per SPS 383.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of SPS 384.10. No fixture, appliance, appurtenance, material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system, unless it is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • Maintain well and waterline set backs per SPS 383.43(8)(i). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. 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. 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 and the POWTS management plan to the owner and any others who are responsible the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Patricia L Shand9r'f POW TS Plan Reviewer , egrated Services WiSMART code: 7633 (715) 634-7810, 5) 634-5150, M - F 8:00 a.m. - 4:45 p.m. pat.shandorf@wisconsin.gov cc: Charles L Bratz, POWTS Reviewer II, (608) 789-7893 , 7:45 am - 4:30 pm Monday - Friday Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety& Buildings will be modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety & Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. I JOHN HERBERT PELKE Page 2 8/15/2012 Reminder • The orientation of the mound system must be such that the longest dimension is oriented. along the surface contour per SPS 383.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of SPS 384.10. No fixture, appliance, appurtenance, material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system, unless it is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • Maintain well and waterline set backs per SPS 383.43(8)(i). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. 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. 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 and the POWTS management plan to the owner and any others who are responsible the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Patricia L Shand?ff POWTS Plan Re sewer , egrated Services WiSMART code: 7633 (715) 634-7810, F 5) 634-5150 , M - F 8:00 a.m. - 4:45 p.m. pat.shandorf@wisconsin.gov cc: Charles L Bratz, POWTS Reviewer H, (608) 789-7893 , 7:45 am - 4:30 pm Monday - Friday Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety & Buildings will be modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety & Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. Private On-Site Wastewater Treatment System (POWTS) Index and Title Sheet Owner: ,W,aa G/I Syaa6 Project Name and System Type: d Tr X,4-! - 3- ec . ly-OW. o Ao w rs ~r a _ S Location: Co. /o. Street Address Legal Deserip on aav of Cy~o,~ Sr. Citoix Ca. ~,~el 71 Township/County ~E . ND to Contents: Page 1: „io~~r ,oro ~r« .SJ1Ga-£r Page 2: _ !'L o r 1-574AV % V Page 3 : lao ss - ~~c r....r ,o,re ~/.r,✓ e F ~9 ~,,ro Page 4: Page 5: - _ _ _ _1~PTic liA.✓.r ~~urP ~i✓o~sQtc CRoss • S B c r/r./ Page 6: ~u,•,~o ~6'ilFoit~s i.,~a! ~~..,,J- Page 7: Oo~rrs o.~...~rs s /z9.Iwmed, iyo.✓.vs£irs.✓r oa,.✓ Page 8: Page 9: Fig re-A 1*1,41,a -r rA rer IAIfo. Attachments: rio.✓ /ZX11.11 T Plumber: Q o W A-4,Cr Signed: ~~t _ Credential Number. Date: sE0 Sd~ - /oL 9/•P /yiuvD Ca/rJlPo,vrvr /7 (/7 .✓4,rL ~ !~£aS~i.✓ .T. O a-f-re , QO'/o70L-P ~~~il~.tta.rE ,~isJ'.iiQsiri,.r Lo.vP~rt•rr/'f,~wNAi ~~/E,~,f~,,,i .~.o 0i b ® M ~t fox ti tAl1 h a ^^C C C W H Al `C A l'a n~ A Irck 0 C V~ Q W It. CP I mod A w~ z`z ~ weo o ~i re a h h v o ` 't ` h lND x N oo:a x.rya,4;t1i Co CF cl + Ct - C+ Ct. Ci. t3 % ro 36 ILA p y AAA H 9 y A of 0 x a s . ct x~ i cn PIP { ` n 1 tit c b * t p L . K ~ ~ b o ~ O Wopd C+ Ci. z ll o h j~ mil` ~ o k ~ O r i` [A „1 w rh K v i ° Vi trj o ~ Page 5 Of 9 SEPTIC TANK E'PUMP CHAMBER CROSS SECTION•AND SPECIFICATIONS ..r Scr. yo. 4" Cl VENT PIPE 12" MIN. ABOVE GRADE WEATHERPROOF FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVERS W/ PADLOCK E FiN~sH~o WARNING LABEL b~Cq,O~ R/sxa {=,4" MIN. lie 18 IN. INLET WATER TIGHT SEALS GAS- l.~Esr TIGHT i VAPPROVED GF-/o A SEAL + JOINTS WITH Fig r~~ APPROVED -B ; ALM APPROVED PIPE B 3' ONTO PIPE 3' ONTO SOLID ' . ON SOLID SOIL SOIL' PUMP OFF ELEV. 9yo FT. -i- OFF RISER EXIT D PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS,- SEPTIC DOSE TANK MANUFACTURER: V/ESff-A odc, -r NUMBER DOSES PER DAY: TANK SIZES: SEPTIC /odo GAL. DOSE VOLUME INCLUDING SG.G t 3.8 DOSE Goo GAL.. FLOWBACK: 92 .GAL. ALARM MANUFACTURER: S. T. E, ~,yo,,►6us_ CAPACITIES: A = a?/ INCHES = 3328 GAL. MODEL NUMBER: TASK AG~c~- Z SWITCH TYPE: B = 2 INCHES = 33 G GAL. /4. 8 CAU, PUMP MANUFACTURER: zoEtcE~ /~/c/r C = 5.S INCHES = 91,J/ GAL. MODEL NUMBER : /S'/ SWITCH TYPE: D = 7 5 INCHES = /.~G•o GAL. REQUIRED DISCHARGE RATE o74,11 GPM PUMP E ALARM WIRING AS PER ILHR 16.23 WAC •VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE 7.4 FEET MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . 3.3 FEET + .35- FEET FORCEMAIN'X 15' FT/100 FT. FRICTION FACTOR. 6 FEET TOTAL DYNAMIC HEAD = S FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH .S3# ; WIDTH 78 ; DIAMETER LIQUID DEPTH 36' A4. C,/ TOTAL DYNAMIC HEAD/FLOW W PUMP PERFORMANCE CURVE PER MINUTE so MODEL 151/152/153 EFFLUENT AND DEWATERING 14 45 153 MODEL 151 152 153 12 40 Feet Meters Gal. Liters Gal. Liters Gal. Liters '"ay 35 g 152," " 5 1.5 50 189 69 261 77 291 = 10- Q 30 - 10 3.0 45 170 61 231 70 265 15 4.6 38 144 53 201 61 231 b e 25 15120 6.1 29 110 44 167 52 197 " 25 7.6 16 61 34 129 42 159 6- 20 30 9.1 - - 23 87 33 125 35 10.7 - - - - 22 85 15 4 40 12.2 - - - - 11 42 L 10 y Shut-off Head: 30 ft. (9.1 m) 38 ft. (11.6m) 44 ft. (13.4m) 0145088 2 5 e Model 151 Models 1521153 10 20 30 40 so eo 70 80 90 100 GALLONS ~ - 6782 - 6782 LITERS 0 40 e0 120 160 200 240 280 320 350 3718 4518 378 458 ~y FLOW PER MINUTE llli 014508A es 37/8 i 378 I O 378 j 371 • Timed dosing panels available. f. a -i • 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 j for variable level long and short cycle controls. Sealed Qwik-Box available for outdoor installations. See 1111116 j 12118 I I FM1420. • Over 130°F (54"C) special quotation required. 415H6 531 SK2444 SK2064 15111521153 MODELS Control Selection Model Volts-Ph Mode Amps Simplex Duplex N161 115 1 Nan 6.0 1 2or3 BN151 115 1 Auto 6.0 Included 2 or 3 E151 230 1 Non 3.2 1 2 or 3 BE151 230 1 Auto 3.2 Included 2or3 "Easy assembly" N152 115 1 Non 8.5 1 2 or 3 BN152 115 1 Auto 8.5 Included 2 or 3 (pump 8 discharge pipe not included.) E152 230 1 Non 4.3 1 2 or 3 BE152 230 1 Auto 4.3 Included 2 or 3 N153 115 1 Non 10.5 1 2 or 3 BN153 115 1 Auto 10.5 Included 2 or 3 E153 230 1 Non 5.3 1 2or3 BE153 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 FM0477. Reduces potential clogging by debris. 2. See FM0712 for correct model of Electrical Alternator E-Pak. Replaces rocks or bricks under the pump. 3. Variable level control switch 10-0743 used as a control activator, specify duplex Made of durable, noncorrosive ABS. Raises pump 2" off bottom of basin. (3) or (4) float system. Provides the ability to raise intake by adding sections of 1 A CAUTION or 2" PVC piping. Attaches securely to pump. Accommodates sump, dewatering and effluent applications. NOTE: Make sure float is free from obstruction. For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. 0 Copyright 2008 Zoeller Co. All rights reserved. POWTS OWNER'S MANUAL AND MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner e%op 7-7- ,4a Septic Tank S±pacity oo0 1 ❑ NA Permit # Se tic Tank Manufacturer ~e„ Ict. ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer E-S T- ❑ NA Number of Bedrooms (100 d/bedroom) 3 Effluent Filter Model /o ❑ NA Number of Commercial Units _ Pump Tank Capacity 600 al ❑ NA Estimated flow (average) Sop Uda Pump Tank Manufacturer /X_<.ex Go.~,c.*. ❑ NA Design flow (DWF), estimated x 1.5 S/SO gal/day Pump Manufacturer 20E44 ex p NA Soil Application Rate Pump Model / / ❑ NA ,O ay ft' Pretreatment Unit a"A Influent/Effluent Quality (NA❑) Monthly Average ❑ Sand/Gravel Filter ❑ Peat Filter Fats. Oil & Grease (FOG) < 30 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BOD5) < 220 mg/L ❑ Disinfection ❑ Other: Total Suspended Solids (TSS) Manufacturer Model: Pretreated Effluent Quality El Mo onthnthlly m Average Soil Absorption Component Biochemical Oxygen Demand (BODS) [I In-ground (gravity) ❑ In-ground (pressurized) Total Suspended Solids (TSS) 30 mg/L ❑ At-grade ,$(Mound Fecal Coliform (geometric mean) < 30 mg/L ❑ Drip-line ❑ Other: :510 cfu1100m1 ❑ Dispersal Units - Manufacturer Maximum Effluent Particle Size 1/8 inch diameter ❑ Aggregate Cell(s) Model Calculations: . Soil Dispersal (EISA) or DWF _ Application rate = Area Required s (Aggre ate.Trench Width) # Units or Total Length of Aggregate Trench(s) ysa - /o = YSo - ` = 78 DESIGN CRITERIA ❑ "Design of Pressure Distribution Networks for Septic Tank-Soil Absorption Systems" Publication 9.6 (SSWMP Manual) ❑ "ICC Flowtech Mound Component Manual" Version 1.2 ❑ "EzFlow Mound Component Manual" Version 8/20/2007 ❑ SBD - 10854-P (R.1/12) "At-Grade Component Manual Using Pressure Distribution" Version 2.0 ❑ SBD - 10705-' (N.01101) "In Ground Soil Absorption Component Manual" Version 2.0 ~g( SBD -10691P (N.01101) "Mound Component Manual" Version 2.0 ❑ SBD -10657 P (86/99) "Drip-line Effluent Disposal Component Manual" SBD - 10706-P (N.01/01) "Pressure Distribution Component Manual' Version 2.0 ❑ Other - MAINTENANCE MONITORING. SCHEDULE - MAINTENANCE AND MANAGEMENT Service Event 13e•,ros. Service Frequency Pump/inspect tank(s), inspect dispersal cell(s), clean filter At least once every: Da 13 months M3 ears Other - Inspect um & um controls, alarm, pretreatment unit At least once eve : El months 3 ears ❑ NA Flush and pressure test laterals At least once eve : ❑ months 3 ears ❑ NA START UP AND OPERATION: For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water-saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable✓fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, Page 7 of 9 disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. INSPECTIONS & MAINTENANCE: Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and check for any backup or ponding of effluent to the ground surface and -test all electrical equipment such as pumps and alarms. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with effective locking devices to prevent accidental or unauthorized entry the tanks. When the combination of sludge and scum in any tank exceeds one-third (l/3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Chapter NRl 13, Wisconsin Administrative Code. The outlet fiber(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Solids washed from the fiber shall be retained in the tank Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surfacing. ABANDONMENT: When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. SPS 383.33, Wisconsin Administrative Code. - All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. - The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. - After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or other inert solid material. CONTINGENCY PLAN: If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area render it unusable. Replacement systems must comply with the rules in effect at the time of replacement. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area If no replacement area is available a holding tank may be installed as a last.resort to replace the failed POWTS. Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative _ surface: Reconstruedons-of-such-systems must comply with the rules in effect at that time.. «WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT-OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTAL R POWTS MAINTAH4ER Name 7-ppA/ E4KE /!P- 0?3/ 3 fQL Name o y,~ ELKE ELKS Phone 67.7- S,lIL Phone 57 G72- 5746 SEPTAGE SERVICING OPERATOR (Pumper) - t/.✓K,uo~t.J LOCAL REGULATORY AUTHORITY Name Agency r C.toi Zcwia6 .QE/f. Phone Phone /S" 384- yG 80 Page 8 of 9 'n 0-4 r, Er tft m 15 O .,a rA r+ L fr JJ ~~ac` ~m m }.r G7 ~ { ° R gym. F.r 03 -p BY . O o ma w o ~ = W< n to NCO .r m n 'r o 3 ~0y fy 1yre~! O <04 W m =0 ~ -o y M' 4 m Sm W F~ m r ..m W3~_,moW^a m p m ry 2 T N W W C ■ Q n y, .y t ~c ov W. 9Df ; W 9D - 3m ago' ms D O . 7 N , w w M A N a A Q-•Q J p~ co tl W d - _ m _ - 9"9 M~+ $ 3 "cmr Q~a 7 C w N=~ ~ W ° W c^ w0 mac-~ o = o o m w Q m W m m . W 3 y a m o m w O JUD S S A O •O m m W ID Z m - m S O nO p C t y a - v,~3•W QS - ncO~mw W m m o O -O .t •OT °t n m m }}~~~..J~~ n a.. nt0 p.~N 1J 150. r?oa Cc, + n m o g v o Q m SWS-0, w u r' 2 » Gl c ~ f•►- a 3 m ; 3 ~r CD M 1A n 0 =in w 1 CL m ._•.mm am v tl T- Q o CLa 1 IJ R j a m Sm p 7 O'° m W S~ SD W = c ~3 a Ka Er AD nA , mast" > z 33m - P rd W 1 x WS C t m W S Q Q Wo W m w 3 O m 'O o Q~ 3 W n 0 G N m N M m O n ^ ~ G1 n a' 7 Q x r+ Q >t rt ^ Joao ~ - ~°m l+ a m ~a Q es =0 9v =r 0 x- l CL 3 n C w W CL u m m 1\ ae m. W a m (p = is m go M CL 2: omen so xnm oW S fD fD x i m o.W ° -..W_ ° O m~ m .f~l m m 111 m m Q ° n I'm a i m Tm m 3 » a o m S ~ W ~ ~ mg' 0 L4 L7 y j = O r HOC ° n mQ~ 'o !do ? S j CQ N R m m w O' N y,~ Cr ID 3 ID ~ti 'i+ - O CL o Z rt CD Ilk, S 0a n W ~ m Q. m `c nil .-j: CL Qk 90 to r+ m =r (MD I N d RECEIVED i of -3 Wis. Dept. of safe sfp~aW~ervices SOIL EVALUATION REPO Page Division of Safety an Ildin ` of Cm n c in accordance with SPS 385, Wis. Adm. Code _ CANNING & ZONING OFFICE o~ m .~Sr C/t0lX Attach complete site plan on paper not less than 8 1 /2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. op` - 14.71- SO - 406 Please print all information. Rev' wed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner /J Property Location Alw)rr d~ Au Govt. Lot SE 1 /4 1WVr1 /4 /p T 3 / N R J! (or No Property Owner's Mailing Address Lot # lock # Subd. Wewie or CSM# City State Zip Code Pho a Number B-eipy QV4kge ®Town Nearest Road CQu.Ljii 377- 8089 a Srv4 X4a1& lJr SOW-' ( 71S ) ,'Y* - 7172 GYz ow t1- I ® New Construction Use: ® Residential / Number of bedrooms 3 Code derived design flow rate yS0 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material ZaESS a u,,A GLAci Z P/-Z a Flood Plain elevation if applicable AIA ft. General comments ~f and recommendations: /O4i~ P°`'~ S> OA`~'~ 449ss ~iELD, 7 SLa®~ / SA..rO L/iT ~E coMriEUO SYS. EL, - /o/, o o,✓ JoO. a ! co~J i'aa.L F_/ 1 Boring # Boring ® pit Ground surface elev. ft. Depth to limiting factor a 9 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft Z in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 D- D t/-1 0 1 S li c~ 0(y _r X 3 1 - a~ .3 - 4 bk ^ s Al ? 7 oM G 9 - y SY, t y/ ~,?d SYR - r6 f s/7- -5/ o GRAB /nJ ' vh'f' Ai'lE LL ~/T Boring # Boring y Fd] ® pit Ground surface elev. 00.0 ft. Depth to limiting factor 4249 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 *#2 / -(o /a a 31Z - I ~A 4 .?v -/3 ° s/ 11~, c s 3 SYNC 41/2/1 - s c s6~ P 4-5 a~ Y .7 -y2 src Y/G d S-xx sAo 5-A S/ o y VI 41 - * Effluent #1 = BOD > 30:< 220 mg/L and TSS >30 < 1 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST N,a~ (Please Print) CST Number /714 W.C.4 . sser7- 975! Address / 4J2 ate Evaluation Conducted Telephone Number ~~d3 1.41X1JAY fir, G, w G6A/.e£ 715. 83`~-~Gld SBD-8330 (RI 1/11) a Property Owner 11,4 77 legal Parcel ID # / page o1 of 3 3~ F Boring # ❑ Boring i J . ® pit Ground surface elev. 971Y ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 70 tf#2 / a- oYR r,/?- /j/ '1v~/' d ro 8 d G - /o )'it 3 / - /oYA !'/3 ~P a? 6/c 8 y .?y-yo SY2 / SrR s +s .~d~irl - - .aZ .L Boring # ❑ Boring F-1 ❑ Pit Ground surface elev. R Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 1 ff#2 L ❑ Boring # ❑ Boring ❑ pit Ground surface elev. R Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. if#1 ff#2 Effluent #1 = BOD , > 30 < 220 mg/L and TSS >30 < 150 mgA. ` Effluent #2 = BOD S < 30 mg& and TSS < 30 mg& The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBr)8330 (RI in t) i a' 00 Pmp" Owner /yArr eAm Parcel ID a patae --.-?-Of 31 Boat g ❑ Bong , ® Ph Gma,d Wrtb @ elev. 7. Y R Depth to imov fir ?'y hr. sal Rate !-Fortson Dele Dominant color Red= Decoct"on Te4m Sbucti►ro Boundary Roots GPOMt z AL Mined Qu. Sc. Cont Color Gr. Sz. Sh. / d - o J 2 - ~ JYV f n. "I AV AP YA Clj 3 - ~0 3 s. n>~~ .t 6 v~ . ❑ ❑ Pqt Ground surface elev. R DWm to !!raft tactnr ~ Role Do"IlMartColoor Redoxawak&n Textum Strucmro :onsistam Boundary Roots soiGPQMt It In. Muneell Qu- St. Cons Color Gr. Sa. Sh. ❑ S-M ❑ ❑ Pit Ground ~am ekv. R Depth m fmdi9 n factor ti Florann DeAlf1 Oerninattt Color Raba Dew". Texture Uruclure kawderm Boundary Roots CAMM it Munsd Qu. S2. Copt Color Gr. Sz Sh. RS2 Bbmt#1 a BOO 30 <22t1 mg& and T3s 3,30:5 1 w MG& • 12111howQ 02 = 8OD 30 _ ngA. end TSS _<30 mglL The Dept. of Safety and Prafasional Services is an equal opportunity service provider and employer. If you need assistaoea to access sar Aces or need material in an alternate format, comact the department at 60&266-3 i51 or TTY thrwo Retsy. 6t'ocwm~nq 9d WHZE:ZO 2TOZ TT -unf b6aV28STZ: 'ON Xdd 118SSUHfI8HH0IW: W089 y H • O L4 L4 r~ H t.4 ~ H C 0 % d o z W r- t as H Q o o ~ z o to% 0 rk, a A ~p\ 6 a o p o N - a r 3 3 It WA rz ~ ~ tR O L 3 0 ° z`o ~ o n; ~ ~ Q\ o n~ ~ O oA ~ Y M~~~ ~ ~ A o 0 A o A ~ r 7 O` V U t/ 1 N ~n l!J !4c, r, 4 90 h a A ~l V O i Z o MAR-23-2912 82:07 PM RON FR I EDELL I+ r I:)+ bb /+.5W;tW 11.101 ST, CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORAM Owner/Buyer /~J'J ~ R a u Malting Address i (p p tot. sr A Property Address `t / (Verification required from Planning it Zon' g Department for new construction.) City/State ,moo Parcel Identification Number =00(0 1 - ~ pDO~ LEGAL DESCRIPTION Property Location , , Sec., pT 3 _N R t {o W, Town of Subdivision Plat: -/UZvn, C/i , Lot # Certified Survey Map # , Volume , Page # Warrantiy Deed # (before 2007)Volume , Page # Spec house is yes R no Lot lines identifiable to yes 0 no SYSTEM MAINTENAN ND OWNT''R CSR=C&Unty 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 throe years or sooner, if needed, by a licensed pumper. What you put into the system can affect the 8metion of the septic tank as a tremnent stage in the waste disposal system, owner maintenance rosponsibilities we specified in §Comm. 33.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning R Zoning Department a certification form, signed by the owner and by a master plumber. journeyman plumber, restricted plumber or a licensed pumper verifyin$ 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 Hall of sludge. I/we, the undersigned have read the above requirements and Was 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 Planning k Zoning Department within 30 days of the throe year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. t/we am/sm the owner(s) of the property described above, by virtue of a warranty dead recorded in Register of Deeds Office, Number of bedrooms_ 4642L'~ 1P"Y j 3 l~s 1;2~ SIGNATURE OF APPLICANT(S) DATE ***Any infornaadon that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. 000 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. 04/07) {11111 VIII{IIIIVIIIIII{IIIIIIIIIIIIN IIi18111N 9 1 5 1 9 4 1 915194 BETH PABST STATE BAR OF WISCONSIN FORM t - 2000 REGISTER OF DEEDS WARRANTY DEW ST. CROIX CO., WI °oaine°`N"~°" RECEIVED FOR RECORD THIS DEED, made between James T. Scannell and, Grantor, 0$/27/2010 03:15PM and Matthew S. Ran, Graff. WARRANTY DEED EXEMPT M Grantor, for a valuable consideration, conveys to Grantee the following REC FEE: 11.00 described real ~e in St Croix County, State of Wisconsin (the "Property"): TRANS FEE: 195.00 The SE V. of the NE'/. of Section 10, Township 31 North, Range 16 West PAGES : 1 EXCEPT Lot I of Certified Survey Map Vol. 4, page 1098. Town of pylon, St Croix County, Wisconsin Recording Aree Name and Roan Address: jt Together with all apptnteoant rights, title and interests, 006-1021-50-000 Pwcd Mentifirsnan Number (PIN) This cs not homestead property. Grantor warrants that the title to the Property is good, indefeasible to fee simple and free and clear of encumbrances except Roadways, easements and restnchar s of record Dated this. 111 * 1 T. Scannell s * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF W46GONM T KCy v- ) COUNTY., d ) ss. . authenticated this rL h P 'Vly came before me this day of i2l° i L-Q the above named James T. s Scannell and to me known to be the person(s) who executed the TITLE. MEMBER STATE BAR OF WISCONSIN foregottrg ms>rumerk and acknowledged the same. (1f not / authorized by § 706.06, Wis. Stab.) THIS INSTRUMENT WAS DRAFTED BY Notary Public, S of]JWeeetrsitt'-~-'~„~~c My commission is permanent, (If not, state expiration date: Michael H. Foredo, Attorney ) (Signatures may be annbaNcsteu or A=W*kdged. Bath are vvt neeessery.) •Nnees of darsme sWvg ar aey awacuv hart m typed or brinbed babes loon rtpo.a.e AMY MOUSER a MY COMMISSION EXPIRES F 9t' r OCttlllet 8, 2011 WARRAM,D66D STATE BAROf'Yt9[.'oNS1N - - I ct}l11mercem.gov Safety and Buildings Division County 201 W. Wash' Ave., P.O. Box 7162 5 C e-0 I X i r* 53707-7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce 'L ' Sanitary Perm A don State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code,; fissi n of m t o the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal infayc.be.1 or secondary 2 purposes in accordance with the Privacy Law, s. 15.04(l)(.1- tats. CID tj I. Application Information - Please Print All Info ation Property Owner's Name Parcel # Property Owner's Mailing Address Property Location 1 L O ~LUC~~ S ST. CRUX NON"Flt 7 A) / ~ Govt Lot City, State Z Section :~r-lA1Z. -N-0-121 cz 154 ~~lFa C (r7~ Z~ J ~ ~ ~ (circle o T 1_E rW II. Type of Building (check all that apply) Lot # ~_N, R Al or 2 Family Dwelling-Number of Bedrooms Subdivision Name Block # ❑ Public/Commercial - Describe Use f f ❑ City of ❑ State Owned -Describe Use CSM Num r `A '1 Village of Town of l..`♦ l~ b N III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' ~ New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that a 1 11 ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. ofsuitable soil Mound < 24 in. or suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersalfrreatment Area Information: Design Flow (gpd) Design Soil Applicati n Rate(gpdsf) Dispersal Area Re aired (sf) Dispersal Area ed (sf) System Elevation i .25 ~5o t , a ~ 4~ 7s~ ,,7,;q VI. Tank Info Capacity in Total # of Manufact r Gallons Gallons Units New Tanks Existing Tanks or a~ y R ca a U in m rn i% C7 W septic or Holding Tank 100c) ~e S K A V) m Dosing Chamber (1000 - o VII. Responsibility Statement- I, the undersigned, assume res sibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plu Signatu MP/MPRS Number Business Phone Number 130fJ , rRti%&Sp0t.L. `LZ(~5b4- '~1 ~(o3`Z -30?1~ Plumber's Address (Street, City, State, Zip Code) X41 43~ AJ'~ , ~~R~r~ l~Tl ~4-~E,'~ ►2 VIII. oun epartment Use Only Permit Fee Date s 1 wing Agent ignature. Approved ❑ Disapproved $ / ❑ Owner Given Reason for Denial Z 54 LC vw~ L IX. Conditions of ApprovaUReasons for Disapproval Ai,VY1't SYSTEM OWNER: - 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. rpp ~ ~s A maintained 2. Ali setback as per applicable CO~e/OfO11~aLfeS he system and submit to the County only on paper not ten than g 1/2 x 11 inches in size lif SBD-6398 (R. 01/07) Valid thru 01/09 A J SITE PLAN 4w) .5 '91V q~ IRS 4 ti C ao,:34 IL ~m x /I 3; 1. a0V.)` e-) 0 py boU e BNB Bench Mark EL 100.00 Tor-+ of IjL`pJc pip z P 4 BmZ (~A~~. C FLA C, ICJ(o "ap~t~'Csz.~~ 9k.f~!S uinM -Foy`a"3a ;s Pozd-u AND Comm b4 . to fa, Ti pe 5.1 PC' Sei"%%Z ComG.TAOK Of M -MLI A L US 60 W~ ~as~ ~,P~ Iv fiLTo~ tt L i #Jd Fits it Hd s S9 'To'TAaMC -T qz.z a~;~s~.~a~.~. C~a is~~+a~-~~n ~aR C.c ►~n ~2, I fto~c~s D W06LL, I,.,c~~.ATtr~N .~u a~+a.~ Paa.~.g Safety and Buildings 10541N RANCH ROAD D ~9s HAYWARD WI 54843 3 ! $ a Contact Through Relay 9 P S www.commerce.wi.gov/sb/ www.wisconsin.gov \ F~ssrovx~s Scott Walker, Governor Dave Ross, Secretary March 12, 2012 CUST ID No. 226564 ATTN: POWTS Inspector RONALD E FRIEDELL ZONING OFFICE FRIEDELL PLUMBING ST CROIX COUNTY SPIA 1419 13TH AVE 1101 CARMICHAEL RD BARRON WI 54812 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/12/2014 Identification Numbers Transaction ID No. 2059118 SITE: Site ID No. 777021 Matt Rau Please refer to both identification numbers, Co Hwy H above, in all correspondence with the agency. Town of Cylon St Croix County SE 1/4, NE 1/4, S10, T3 1N, RI OW FOR: Description: Mound, 3 br res Object Type: POWTS Component Manual Regulated Object ID No.: 1360878 Maintenance required; 450 GPD Flow rate; 21 in Soil minimum depth to limiting factor from ori ginal grade; System(s): O Ezflow Mound Component Manual, (R. 8/07), SSWMP Pub. 9.6; 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. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code ptV~s~~~' GF SP requirements. J No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06 SEE COR, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Key Item(s) • 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. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • The gravelless system components must be installed in accordance with the manufacturer's printed instructions, the plan approval, and SPS 383 system sizing criteria. If there is a conflict between the manufacturer's instructions and the plan approval, the plan approval and code requirements will take precedence. • The float switch shall be a type that does not contain mercury. 2009 Wisconsin Act 44 prohibits the installation of float switches or relays that contain mercury. • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of•the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. RONALD E FRIEDELL Page 2 3/12/2012 Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per SPS 383.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of SPS 384.10. No fixture, appliance, appurtenance, material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system, unless it is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • Maintain well and waterline set backs per SPS 383.43(8)(i). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. 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. 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 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 Patricia L Shandbrf POWTS Plan Reviewer', Integrated Services WiSMART code: 7633 (715) 634-7810, Fa)(.' (715) 634-5150, M - F 8:00 a.m. - 4:45 p.m. pat.shandorf@wisconsin.gov cc: Charles L Bratz, POWTS Reviewer II, (608) 789-7893 , 7:45 am - 4:30 pm Monday - Friday Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety & Buildings will be modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety & Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. r EZFLOW MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Rau Owner's Name: Matt Rau Owners Address: 160 206th St Star Prairie WI 54026 (715)248-7172 Legal Description: SE NE S10 T31N R16W Township: Cylon County: St Croix Subdivision Name: Lot Number: Block Number: _Parcel_ I.D. Number - OQ6-1 Q21.-5Q-0B0 JED- - - - - Plan Transaction No.: J\y~N~s Page 1 Index and title - Page 2 Data entry ~ENC Page 3 EZFlow mound drawings 3tiSP01, Page 4 Lateral and dose tank / Page 5 Distribution media Page 6 System maintenance specifications Page 7 Management and contingency plan Page 8 Pump curve and specifications Page 9 Filter Page 10 Site Plan Designer. Ron Friedell License Number. 226564 Date: 02123/12 Phone Number: (715)637-3020 Signature: Designed Pursuant to the EZFlow Mound Component Manual (N. 06/03), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) EZFlow Mound Version 1.2 (R. 02/04) Pagel of 10 EZFIow Mound and Pressure Distribution Component Design Site Information 4 r> Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00; Estimated Wastewater Flow (gpd) Table 83-44-3 in-situ soil treatment for fecal 1.501 Peaking Factor (e.g. 1.5 = 150%) colifom, of 36 inches. 450.00 Design Flow (gpd) 15.00 Site Slope 9860 installation Contour Line Elevation (ft) rt 100.00 Contour Length Available (ft) 21.00 Depth to Limiting Factor (in) 0.60 In-situ Soil Application Rate (gpd/ft?) Distribution Cell Information 0 Cell Width (ft) 75.00 = Dispersal Cell Length (ft) m1.00 Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? cry Center or End Manifold EA.00 Lateral Spacing (ft) If N above, enter the elevation ft Number of Laterals of the highest point. O 0.125' Orifice Diameter (in) (e.g. 0.25) 2.00 _ Orifice Spacing (ft) = 6.25 ft2/orifice 1.50 Forcemain Diameter (in) ` 50.00 Forcemain Length (ft) Does the forcemain drain back? Y 7-86-.0-01 Inside Pump Tank Elevation (ft) -may 6.50 System Head (ft) x 1.3 4.59 Forcemain Drainback (gal) 8.17 Vertical Lift (ft) 67.44 5x Void Volume (gal) 3.85 Friction Loss (ft) 72.03 Minimum Dose Volume (gal) 18.51 Total Dynamic Head (ft) 29.66 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. o bons choice in. dia. o bons choice 0.75 1.25 x 1.00 x __..M 1.50 x x 1.25 x - 2.00 1.50 x x._,.__.. 3.00 2.00 x 3.00 x Gallons/inch Calculator Treatment Tank Information Total Tank Capacity (gal) 1000.W Septic Tank Capacity (gal) Total Working Liquid Depth (in) Skaw Manufacturer gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 600.00 Dose Tank Capacity (gal) Best _ _ Fitter Manufacturer 16.47 Dose Tank Volume (gal/in) GF 10~ Filter Model Number Skaw w _m Manufacturer Project: Rau Page 2 of 10 Mound Plan View 1 1/10 B J Observation Pipe : 5 A •3 L Mound Component Dimensions A 6.00 ft E 25.80 in H A5.69 ft K 11.10 ft B 75.00 ft F 12.00 in 1 ft L 97.20 ft D 15.00 in G 0.50 ft J ft W 31.60 ft 450.00 (ft) Dispersal Cell Area 1943.18 (fe) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 99.25 (ft) * H j G F Dispersal Cell 97.75 (ft) Lateral 97.25 (ft)- 6" Invert Elevation Dispersal Cell Elevation E.•;`-.. - D 96.00 (ft) Contour Elevation 15.0 % Site Slope Typical Dispersal Cell Shading Key d 3. See Page 5 1Q Topsoil Cap o c Geotextile Fabric over © Subsoil Cap 0.0 2.0 ft ASTM C33 Sand 4- 0 Tilled Layer c 0 0 F ❑ EZFlow Media o -i A See details on page 4 for number, size, and spacing of laterals. Laterals are located in the 4" gravity distribution pipes as shown on page 5. Project: Rau Page 3 of 10 Center Connection Lateral Layout Diagram Force main connection via tee or cross to manifold at any point. Laterals are identical qP -IF Orifices point tap, except every 5th one P points down for drainage. S Turn-up Yd ball valve or I<- X ~ I<-xt2 +I Laterads & Force main of PVC Sch 40 clesnoutplug per COMM TaWe 84.30-5 Number of Laterals 4 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.10 ft Lateral Length (P) 36.75 ft Orifices per Lateral 18 Lateral End (Z) NA ft Orifice Density 6.25 ft2/orifice Lateral Spacing (S) 3.00 ft Manifold Length 3.00 ft Lateral Flow Rate 7.41 gpm Manifold Diameter 1.50 in System Flow Rate 29.66 gpm Forcemain Velocity 5.38 ft/sec Dose Tank Information Locking cover with warning label and locking device, and sealed watertight Electrical as per NEC 300 and Comm 16.28 WAG 4 in. min. Disconnect _ Tank component is properly vented E- Alternate outlet location Forcemain diameter Skaw Manufacturer 1.5 in. Capacity 600.00 Gallons Volume 16.47 gal/inch A _ M, ;r t&,ry Weep hole or anti- Dimension Inches Gallons B siphon device A 23.06 379.74 C B 2.00 32.94 Pump off elevation (ft) C _4.37 72.03 89.58 D 7.00; 115.29 D Total - 36.43 600.00 Do♦ se tank elevation (ft) Min. 3" Bedding under tank. 89.00 Alarm Manufacturer Septronic_ Alarm Model Number 101___ Pump Manufacturer Goulds Pump Model Number PE 51 Pump Must Deliver 29.66 gpm at 18.51 ft TDH Project: Rau Page 4 of 10 EZFIow Distribution Cell Media Layout 6.00 Cell Width (ft) 1.50 Sidewall to Lateral (ft) Distribution Cell Cross-section Arrangements .111V 6 ftWide Component Legend ® 6" EZFIow Bundle - EZ0601A, 5 or 10 Foot Lengths 12" EZFIow Bundle - EZ1203H, 5 or 10 Foot Lengths 12" EZFIow Bundle - EZ1203HP, 5 or 10 Ft Lengths 0 4" Distribution Pipe With Pressure Lateral Inside 0 Tumup Enclosure - - - - Lateral Distribution Cell Plan View Layout - Typical 6.00 Cell Width - A (ft) 75.00 Cell Length - B (ft) A-' Force Main - 6ftWide Center Manifold - - - - - - - - - - - - - - - - - - - - - Project: Rau Page 5 of 10 Mound System Maintenance and Operation Specifications Service Provider's Name Friedell Plumbing_ _ Phone ['(715)637-3020 POWTS Regulator's Name _ _St Croix County Zoning Phonel (715386-4680 1-11 J System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 if 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 eve 3 ears Effluent Filter Should inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test month! Pressure System Laterals should be flushed and pressure tested eve 1.5 ears 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 Comm 84.30-1, have a watertight cap, and are secured in as shown in the EZFlow mound component manual. 2. Dispersal cell media conforms to EZFlow products approved for use with the EZFIow Mound Component Manual approved 6/3/03. EZFlow media is covered with an approved geotextile fabric. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Lateral Ends at Last Orifice Where Variable Length Cleanout Begins Long Sweep 90 or Two .45 Degree Bends Same EZFIow Media Diameter as Lateral 1.25 Feet 4 Distribution Lateral Lateral Cleanout Project: Rau Page 6 of 10 I J Mound System Management Plan Pursuant to Comm 83.64, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [EZFlow Mound Component manual 6/3/03 and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment 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, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet 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 fitter 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 perforated to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, 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 BOD5, 30 mg/L TSS, 10 mg/L FOG, and 10° 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. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal 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 dogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Rau Page 7 of 10 HGOULDS PUMPS Submersible Effluent Pump PE SPECIFICATIONS MOTOR FEATURES Pump - General: General: ■ Corrosion resistant • Discharge: 1'h" NPT • Single phase construction. • Temperature: 104°F (400C) • 60 Hertz ■ Cast iron body. maximum, continuous when • 115 volts ■ Thermoplastic impeller and fully submerged. • Built-in thermal overload pro- cover. • Solids handling: '/2" tection with automatic reset ■ Upper sleeve and lower maximum sphere. • Class B insulation. heavy duty ball bearing • Automatic models include a • Oil-filled design. construction. APPLICATIONS float switch. • High strength carbon steel ■ Motor is permanently Specially designed for the • Manual models available. shaft. lubricated for extended • Pumping range: see PE31 Motor: service fife. following uses: • Mound Systems performance chart or curve. • .33 HP, 3000 RPM ■ Powered for continuous • Effluent/Dosing Systems PE31 Pump: • 12.0 Maximum amps operation. • Low Pressure Pipe Systems • Maximum capacity: 50 GPM • Shaded pole design ■ All ratings are within the Basement Draining • Maximum head: 25' TDH PE41 Motor: working limits of the motor. • ■ Quick disconnect power • Heavy Duty Sump/ PE41 Pump: • .40 HP, 3400 RPM standard d length, Dewatering • Maximum capacity: 60 GPM • 7.5 Maximum amps cord, heavy 20'duty 16/3 SJTW with • Maximum head: 29' TDH •PSC design NEMA 5-15P, three prong, PE51 Pump: PE51 Motor. 115 volt grounding plug. • Maximum capacity: 70 GPM • .50 HP, 3400 RPM ■ Complete unit is heavy duty, • Maximum head: 37' TDH • 9.5 Maximum amps portable and compact. • PSC design ■ Mechanical seal is carbon, METERS FEET ceramic, BUNA and stainless MODELS: PE 31 PE41 PE51 steel 40 PE~s1 4 _ HP ■ .33, .40, so Stainless steel fasteners. 35 10 2 GPM - AGENCY LISTINGS 3Q _ iFT D a ~ = 25 _U - * r , T C S a 20 r_' Tested to UL 778 and } - - - - _ - - - - - CSA 108 Standards 4 N'. J By Carkdw Std a i , AssoaaGon 15 Foe #LR38549 t F- } + i y i r -r - + t - LJL 1': Goulds Pm 4 s is ISO 9001 Registered. T 10 - a T _L.. < - 5 FY i , - T LLLLL 0 0 0 10 20 30 40 50 ; 60 i 70 GPM 80 0 5 10 15 m3/h Goulds Pumps CAPACITY ©2002 Goulds Pumps ITT Industries ' Effective November, 2002 BPE31/41 r s r j 2 J - - ..L J J r ^ LJ.a U J O ~ CJ v O bA n U x y u 1. rr 03 T ry r, ~ C'J Cry, ea ~ Q? a~ c L O ct, Qn y z r ~ C O ~ ey ~ ~ M G.za c O 04 ~ U U. cu C.- U U !f!0 'Jy O rte. O O 7:1 LU > C it p ri) C. CJ3 O 3 ;-Vo i~ R t; SITE PLAN 440' , 195 i ` Cl y/v\, U.~ 46 - HQ dab / 4l X034 ti DQw Po 1 3 041. CAM-1:7 p¢.Ap,U.OOj& a N r.~ ~t~s1~1S1d1~ 2.~ !5 p BMA Bench Mark EL 100.00 5 Top or, 7-J Bm2 IJA, FLAG, t 'Cs~ ~ 9 ~f.fr!5 C~~+M P~2 o~ `~►3~ 'Pl'r~~ 1 P~ p o Comm 54,1C) fua Ty p~ 5"T ~PC, J~iA~ IUiJG~Iot~U~At. C,jm6r,-TA4K of N*'Oj' 'LIA USe-0. :JrsW~~ r i,iad FR.dm Wdsa4 -To JCAWK -To II'~1c~u~ x15 D~sPaa.sr>~ Caw- pa R. Um wk &2- ..%)ej 3 •!o X R l .'L d v es rt. as ti.L I Ro CrS~D U)Cl,.l., ~.r~~AT►vN p SOIL EVALUATION REPORT Page of ~rysconsin Department of Comm Code County C t t and Buildings Wis. Adm. tJ-~ Division of safety r ante with Comm 85, U 000 t~'L► - not less than 8112 x 11 in Me in M~ ia,ro~ on and Pa~, • {D " , Attach complete site plan on paper ` Date include, but not limited to: vertical and horizontal reference Po Revue q- 1, / 2,- percent slop, scale or dimensions, north arrow, and location and distance to nearest road. tint It in Please p on You a'O aW s, 5.04 (f) (m))• Personal informati vide may be used r seoo P operty location N R 1 E (Or)~ ~ Fi I ~ ~ ~ 1 V owner vt. Lot 5 1 !4 114 S or CSM# T ,~Q Q Property MA R # Block # Subd. Name is Mailing Address A Village ®Tovm Nearest Road Property ST. gRgiX trgliNlY L~ i.t~~~ S~ ~ Cdy ❑ ~ ~ WK State ZP C CJ )ZGPD ' Code derived design flow rate New Construction Use: ' Residential ! Number of bedrooms ft - e- [J Public or commercial - DescribeFlood Plain elevation d app licabl ❑ Replacement _ ~G'~~-"•' Parent material _ o y~ r,3 t~ Q ,,mac vli-e 66 P General comments 5~ ~m C q 0 and recommendations: MO I) ~D l.,~t~~ _ i factor - in. Soil lication Rate Boring ft Depth to limiting GpD/ff Horizon Depth Do inantColor Boring # pit Ground surface elev. Consistence Boundary Roots *E Texture Gr. Sz. Structure Redox Description Sh. '01#1 m ~7S ~ in. Munsell Qu. Sz. Cont. Color rvl _ 12mGbI Z '7,5~c x.s~c2 2 S c,1 01_" M factor _-t+- in. Soil lication Rate 0 poring ft Depth to limiting GPDlfF Boring # Ground surface elev. Roots *Eff#2 Pit Texture Structure Consistence Boundary *Eff#1 Redox Description ' O Depth Dominant Color Gr. Sz. Sh cJ ( S tM" Horizon in Munsell Qu. Sz. Cont. Color TV) LI ab ~'S b G I CO-- 21M 3 i-5(v 2 ~y~ Efflu #2 BOD e- 30 mglL and TSS ,30 mglL C BOD > 30 < 220 mg/ L and TSS >30 150 mglL CST Number * Effluent #1 = Signature CST Name (Please Print) 7 -:5 Telephone Number 111 o R..1 ~ f Date Evat ton Gonducte -:ja21~ n -RRvrJ .5U Address 1+1q 1.3-1144z. Vp, Y.171 MAR-25-2912 02:07 FM RUN FRIEDELL 1t71n'rb3f+3bZia ST, CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Ma-lWe-W Rau Mailing Address C> 2ote ST A Property Address G e (Verification required from Planning dt Zon' g Department for new construction.) City/State Parcel Identification Number dote " I = 10 " ooo GAL DESCRIPTION Property Location Jig_ , til4 Sec. JP, T 3 _N R t Iv .W, Town of C_~(,n r4 Subdivision Plat:.' Lot # Cert fled Survey Map 0 , Volume , Page # Warrauty Deed # '71 (before 2007)Volume , Page # Spec house 0 yes R no Lot lines idemitlable K yes ❑ no SYSTEM MMUNAN`CF AND OWM CERTIFICATION Improper use and maintenance of your septic system could result in its premature faiture 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 f motion of the septic tank as a trennnent stage in the waste disposal system, owner maintenance responsibilities are specified in $Comm. 83.52(1) and in Chapter 12 - 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 hove read the above regltirements 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 Planning A Zoning Department within 30 days of the three year exp"usuion date. t/we certify that all statements on this form are true to the best of my/our knowledge. 1/we anVare the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office, Number of bedrooms 4~~ ze 44 3 /as i~ SIGNATURE OF 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. 09/07) 9 1 5 1 9 4 1 915194 BETH PABST STATE BAR OF WISCONSIN FORM I - 2000 REGISTER OF DEEDS DoewnentNuaoer WARRANTY DEED ( ST. CROIX CO., WI RECEIVED FOR RECORD THIS DEED, made between James T. Scannell and, Grantor, 04/27/2010 03:15PM and Matthew S. Ran, Grantee. " WARRANTY DEED EXEMPT ~ Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St Croix County, State of Wisconsin (thee REC FEE: 11.00 "PropW): TRANS FEE: 195.00 The SE Y4 of the NE '/4 of Section 10, Township 31 North, Range 16 West PAGES: 1 EXCEPT Lot 1 of Certified Survey Map Vol. 4, Page 1098, Town of Cylon, St Croix County, Wisconsm Rm"ding Area Name and Rsdum Address: Together with all appurtenant rights, title and interests. 006-1021-50-000 P=d ldeafificat"Number(PUN) This is not homestead property. Grantor warrants that the title to the Property is good, indefeasible m fee simple and free and clear of encumbrances except Roadways, easements and restrictions of record. Dated this. 312S/I * J s T. Scannell + s r AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF 9146GOMM T KCB ) COUNTY. 1_14C: ) ss. . authenticated this Perms Iy came before me this C ~ day of n LGf fC M , i L-0 the above named James T. Scannell and to me known to be the person(s) who executed die TITLE: MEMBER STATE BAR OF WISCONSIN foregoing fnstrvment and acknowledged the same. (If not. authonzed by § 706.06., Wis. StatL) x l THIS INSTRUMENT WAS DRAFTED BY Notary Public, S of.Vieeensin" J ~~Cc MY commission rs permanent. (If dot, state expiration date: Michael H. Forecki, Attorney (Sigaanaes may be aufhenucbteo or ae1bWWWogw. Bo& am a« neeesamy) ,~~Z P t IN- of tetrads srpug m -v aroacar must be WW or drama Haiow ben sigmt®e =%i8 AMY MOUSER MY COMMISSION EXPIRES OCIOW 8, 2011 4t WARRAMI)EED STATE RAR GW V SCONSrri Parcel 006-1021-50-000 03/30/2012 04:12 PM PAGE 1 OF 1 Alt. Parcel 10.31.16.137A 006 - TOWN OF CYLON Current 191 ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner 0 - RAU, MATTHEW S MATTHEW S RAU 160 206TH ST STAR PRAIRIE WI 54026-5722 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 1127 SCH DIST OF CLEAR LAKE SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC 117 Legal Description: Acres: 30.000 Plat: N/A-NOT AVAILABLE SEC 10 T31 N R16W 30A SE NE EXC P137B Block/Condo Bldg: (LOT 1 CSM V 4/1098) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 10-31N-16W SE NE Notes: Parcel History: Date Doc # Vol/Page Type 04/27/2010 915194 WD 04/27/2010 915193 TI 03/22/1971 304240 470/37 WD 2012 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 06/10/2010 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 10.000 1,800 0 1,800 NO AGRICULTURAL FOREST G5M 20.000 30,000 0 30,000 NO Totals for 2012: General Property 30.000 31,800 0 31,800 Woodland 0.000 0 0 Totals for 2011: General Property 30.000 31,800 0 31,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04/17/2001 Batch PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 020-1479-03-300 04/04/2012P AGE 1 E 1 OF A 1 P 1 Alt. Parcel M 36.29.19.3024 020 - TOWN OF HUDSON ST. CROIX COUNTY, WISCONSIN Current ❑X Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 09/25/2007 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - BAST, KERNON J & DONALDA J SPEER- KERNON J & DONALDA J SPEER- BAST 948 LABARGE RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 866 YOST DR SC 2611 SCH DIST OF HUDSON SP 1700 WITC Legal Description: Acres: 2.000 Plat: 11-023-COTTONWOOD SOUTH LOTS 1/26 020-07 SEC 36 T29N R19W PT SW SE COTTONWOOD Block/Condo Bldg: LOT 03 SOUTH LOT 3 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 36-29N-19W SW SE Notes: Parcel History: Date Doc # Vol/Page Type 09/26/2007 861243 AGREE 09/25/2007 861165 11/23 PLAT 01/28/2005 786109 2739/316 WD 10/30/1998 590369 1371/572 WD 2012 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 05/07/2008 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 2.000 300 0 300 NO Totals for 2012: General Property 2.000 300 0 300 Woodland 0.000 0 0 Totals for 2011: General Property 2.000 300 0 300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 of _ Property Owner A Cl Parcel 1Q # Page _2_ F,3_1 Boring # ❑ Boring 9 ® pit Ground surface elev. (p•a ft. Depth to limiting factor _2-4' in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 "Eff#2 I --q 1c 514- ~ t 2msb1< 1 2 2 9- L 7 5-A7_ W 3 i Z m i • to 2 41 I -ts !f a- to 2- _n,4r; 8 SGi OIn Mvcl O rJ Z,`J°f23 2 ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Solt -Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 *Eff#2 ❑ Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Applicati Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I * 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. S8D-8330 (K.(j71(N)) PAID SOIL EVALUATION REPORT 1 Z- V%sconsin Department of Coms Page of Division of Safety and Building r ance with Comm 85, Wis. Adm. Code C Rv Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must county I include, but not limited to. vertical and horizontal reference point (BM), direction and Paroef- 111. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ' 1 U~1 - 5 CJ UC~U Please print fil in :ftevie Date VV Personal information you provide may be used seco OAaaw, s. 5.04 (1) (m)), Property Owner j~ P operty Location m Kff T 1 A J MAR O. Lot 50 1/4 0 e 1/4 S 10 T b i N R I C E (ore Property Owners Mailing Address of # Block # Subd. Name or CSM# 1 ~ 'Lc~ -rt, S T PLANUIKIn ST. CROIX COUN7Y - City State Zip C ❑ City ❑ Village ® Town Nearest Road ~►a~~ W- ( -3 1 -12 C~wti C5v WW-1- q New Construction Use: 0 Residential / Number of bedrooms _ Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material 01,itb, J tj Flood Plain elevation if applicable ft. General comments and recommendations: Moo V JD m t, til p L 1(~ ,J~ d'~ lL~x K v.-e U io Il F -il ❑ Boring Baring # pit Ground surface elev. ft. Depth to limiting factor 2.~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/M in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 ---b O 5 11 2msbk M-Vj 85 b-A 4 b 15-16 2 -7-51PWI-A 51( ZMob f to •S ^(0 2.5YI2.3 z.5~c2 2 S G 1 G>-v, im d 6 Boring # Boring Pit Ground surface elev. q (0 ft. Depth to limiting factor _ in. Soil Appi ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1-0-6 to'f>Z 5 2 Sb rn-fi S tm4 . (o S 2 1 1518, to 2 rn alp CAS ! m - , to 3 i--% Z54Patl 2•s~t2. q. Z Om nn t! I d d * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Efflu #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print), Signature CST Number G Q.i Address Date EvaI lion Conduct Telephone Number 141 °l l3T~A~'~. ~A~'~rJ W L. ti 10 11 L~ 15 !O3`~ - 3~7,a r SITE PLAN PROPERTY OWNER : M AM ~ A J PROPERTY LOCATION: V+ 0~ l4 i ow w 132-0 qo, /c, ~5 " / B~ ~ DR. dam' > X00 -To R w 1h)9% 5 7 13 N 1 -60 O BM BENCHMARK: EYy\z q,).~5 I~A,L r=LAGl% 1~1 "Popp9: &BORE HOLES: on F edell #226564 itIIuf 1, ►s rJ 2 L 12 ~0 AG(2 i