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008-2013-02-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTi~CH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: City Village X Township Uld ch, Ja Eau Galle, Town of CST BM Elev: Insp. BM Elev: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding • TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Litt Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. CfOIX Sanitary Permit No: 487983 0 State Plan ID No: Parcel Tax No: Section/Town/Range/Map No: 04.28.16. STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer SUHt Inlet SUHt Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover BEDffRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P(L BLDG WELL LAKElSTREAM LEACHING Manufacturer. INFORMATION CHA UNET OR Type Of System: Model Number. DISTRIBl1T10N SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER Y Procm~ro Rvefame only YY Mnund Ar At-Grade SvstemS Oniv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~ Yes No L] Yes L~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / /. Location: 529 233rd Street Baldwin, WI 54002 (NE 1J4 SW 1J4 4 T28N R16W) IMH Development Lot 2 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ,~~] Yes I~ No ~II , ~ Use other side for additional information. f ' I L_. Date Insepctors Signature SBD-6710 (R.3/97) Inspection #2: 1 1 Parcel No: 04.28.16. T_ i _.-~~~ Cert. No. RECEIVED ~'C'll CGf~"IfI1Gt"C4.W1. ~/~~ ~ / V Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 County .S'7` - C ~ Q ~ ~• ~ • ~ Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) ~m ~ 5 3~G1 Permit Application State Transaction Number In accordance with s. Comm. 83.21(2j, Wis. Adm. Code, submission of this form to the appropriate governmental i i ~~ un t s required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Commerce. Personal information you provide may be used for secondary Project Address (if di a nt than mailing address) JCZ Gj ~ 3 ~ :~ l1 S ~"- u oses in accordance with the Privac Law, s. 15.04 1 m , Stats. I. A lication Information -Please Print All Information ~ 77f}-Z_ ,f~ GtJ /~ (ti Property Owner's Name Parcel # Property yyO~~wne s Mailing Addres Property Location t Govt. Lot Cit State ~ /~~~ ~ ~ ' ~ Z p Code~ Phone Number ~~ ~~,, S(~%4, Section ~. i ~(.-~ ~ ~ 7 ~ ~ li7i' ~~(circl Z e ~ ~ I ./Type of Building (check a that apply) .2 Lot # T N~ R E or t ~ ,~ , 1 or 2 Family Dwelling - Number of Bedrooms `~ 2 Su bdiv i s i on Name y Block # , / y ~ ~ / '7z'tQ~J~A /' ~ ~'~ ~(/~' l ^ P bli / . _ ,- u c Commercial -Describe Use ~ ^ City of ^ State Owned -Describe Use CSM Number ^ V tl~age of ~ , / Uy'Cown of (i~ ~ L III. Type of ermit: (Check only one box on line A. Complete line B ifapplicable) ~ a ~ ~ t; A. ew System ^ Replacement System ^ TreatmenUHolding Tank Replacement Only ^ Other Modification to Existing System (explain) ra~~, s~ B• Permit Renewal ^ Permit Revision ^ Chan e of Plumber g ^ Permit Transfer to New List Previous Permit Number and Date [s ued Before Expiration Owner ~ ~ ~~ ~ ~ jl ~ 2~f s IV. T e of POWTS S stem/Corn onenUDevice: Check all that a 1 ^ Non-Pressurized In-Ground ^ Pressurized In-Ground ^ At-Grade ^ Mound >_ 24 in. of suitable soil ~itound < 24 in. of suitab le so i l // ~~ - 7 ^ Holding Tank ^ Other Dispersal Component (explain) ^ Pretreatment Device (explain) c~ / // ~CC-j1G( i V. Dis ersal/freatmentArea Information: C', ~. Design Flow (gpd) yS'~ Design Soil plication Rate(gpdst) {~ii ~ i a Dispersal re .Required (sf) ys~ Dispersal Ar a Proposed (sf) System Elevation ' , ~ , isa ~ ys o ~qa ~ i~ sz,, mss VI. Tank Info Capacity in otal # of Manu cturer Gallons Gallons Units ~ / ~ „ ~ o -a ~ New Tanks Existing Tanks ~ ~~/~/~n ~~/ /./~i d//-~J r '~ c o y ~ v~ y ~ v~ °J ~ w V R a Septic or Hold ~ Tank /~ /'l /~ ~ /1 / (• V t ~ 6 cjb ~ ~ ..~ ~,~ ~~L/1~1 0 "smg Chamber . l, j ~~ I / esponsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum 's Signature MP/MFRS Number Business Phone Number ~ ~ _ ~ ' ' ' ~ 1r ~ ~ ; ~?c~~ ~'j ~~.5 -~~~-33 7 Plumber's Address (Street, City, State, Zip Code) ~~O ~a~' .~ ~~ca~ v r ~~ 1 -~~OC~~i VII ount /De artment Use Onl ,,r-- Approved ^ Disapproved Permit F~e ~ $ ~ Date sued r ' t"suing Ag t Signa~re ~ ^ Owner Given Reason for Denial ~ / d r, -v~Z2~,~ IX. Conditions ofApproval/Reasons for Dis proval / , (/ -- mil, .Q-r~'~ _~~/~. ~ Gt.~=..~~~'~~'Y~'!.~?~'1 ~d~ Cc`~1.G~2.~ ~-G~h~c~ t ~~. l 1~N~=-~~G~n L~ ~V //~~ _____._ . _,,... ~,.~.,, .,., ..... .... ..... ~.~... y..~ ",,,,.,,, ... ,,,„, ..un~y[!~' ~un PN Cf r40t 1~ ft i{ 1/~ I IOCh~ 5~z% _ _ ~ J/ SBD-6398 (R. 01/07) Valid t ru 01/09 /",°~J-~~/,.{'/iU/ju///t~/(~_ f(,_, (//~l//~[/.~/'~(~[//,~'(„ ~v~(,/~ ,p//~!/7_AVr~/,i/j'lr'i St. Croix County Planning and Zoning ~~Detail Sanitary Information • Thursday, Nonernber 08, 2007 ut (0:37:22 AM Page f of f Computer #: 008-2013-02-000 Sub/Plat: IMH Development Section: 4 Parcel #: 04.28.16.584 Lot: 2 TNlRNG: T28N R16W Municipality: Eau Galle, Town of CSM: 1/4 1/4: ___ NE 1/4 SW 1/4 Owner: Uldrych, Jay 529 233rd Street Baldwin, WI 54002 State Permit: 506389 Issued: 11/08/2007 POWTS Dispersal: Mound 24" or more suitable soi Permit: Renewal County Permit: 0 Installed: POWTS Detail: NA Bedrooms: 3 WI Fund: POWTS Pretreatment: NA IssuerJinspector As Built Plumber Other Requirements Additional Notes Money Owed Pam Quinn NA Hudson, Dale no change in mound plan, just renewal with new $0.00 Not determined No permit number and payment of fee prior to expiration date. Owner: Uldrych, Jay 529 233rd Street Baldwir State Permit: 487983 Issued: 11/08/2005 County Permit: 0 Installed: Issuer/Inspector As Built Pam Quinn NA Not determined No W 154002 POWTS Dispersal: Mound 24" or more suitable soi Permit: New POWTS Detail: NA Bedrooms: 3 POWTS Pretreatment: NA Plumber Other Re uirements Hudson, Dale WI Fund: Additional Notes Money Ovred coming up for renewal per Boldt's plumbing - $0.00 received 11/6/07 for renewal of permit Sri C couNnr 3 8 ~ ~Ovs ~' NO. 506389 STATE SANITARY PERMIT LVI ENEWAL OWNER ~ Z ~ C PLUMBER ~I~ I-~UL?St~~ TOWN OF 1 1J~EC_~,T, AND/OR LOT THIS PERMIT EXPIRES UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION PREVIOUS NO. yg X 983 S2 9 ~ic.# 220tS3 R~_E BLOCK uBDlvlsloN CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permk is to allow installation of the pfirate sewage system described in the permk. (b) The approval of the aankary perrnk is based on regulations in force on the date of approval. (c) The aankary permk is valid and may be renewed for a specified period. (d) Changed regulations will not impair the validky of a sankary permit (e) Renewal of the sanitary permk will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permk is transferable. History: 1977 c. 168; 1979 c. 34,221;1981 c. 314 Note: M you wish to renew the permit, or transfer ownership of the permk, please contact the county authority. AUTHORIZED ISSUING OFFICER -- DATE I D SBD-1)6499 (R.8/00) ~ I o _ -_ ___ _ _ _-- __ ___ I I -~- -- -_ __ _ - - -- _ _ a ~` o I ` -` ~ ~ I ~ ~ `X4/2'!"/ 1~E---~ a ~-~A 55' > ~ ~ I ~~ ~ 11 l,_ ~ > .~ > > ~ ~ a ~ > > 1 I ~ ~ `~3a ' S ~ - aL ~r - ~, _ ~o a ~~ > t7~'. -~ ` ~<n • Tp n~s[,•rve 1 ~I / ~ o cv - ._ ~ ~' ~~ ~ "~- ~~~` : ~ z X19, so (irA.O'S~/ t~ ), . ~-~, _ - r- ~, ~ ~ -, ~ ~ I I I m - -' __ O ,~~ ~~~6 9 ~ -' -6 ,- BUI ING SET CK UNE ~ o "~ ~ \~ 1 ~~ I ` "s~` D.O.. N ~4C S7 10'C3^£ ~ti ,~R 1~tr~ M ~ ~> I~ 01 ~~ ~ ~~~ X ( 1 50' WIDE DRAINAGE ` 1' '' ~ ~ ~0" ' ~ I a ~ 2.8 ACR S r~ EASEMENT. `~ o ` ` -.. '' I 100' I z ti~ / ', ; l '. a OT 2 ~_ p LEA MENT nj ~ z I I HOUSE A.~, acd ~~ ~ Iii ~ P~oya ~Ccn4• ORAiNAGEWAY / 11 ACRE S IL TE ~Ij '' ~ I ~ac.Pi /ca~~e0. ~?~~u7 $86'52'45"E 39$. 7' S.T. iQC. u~,4abt ,¢iul tF'~/k4~f 2S• 2g, z~Sc~. D O.e!~, ~ u I~~ 254 17 ~`` JOINT DRiV WAY ° ~~ b'`~ato ~oF1=~L'l~a,ybtr ~ubc~h ~~ ~ r ~ n ~ rn ow {; :rk~d ~ r II' '52 ~ EMENTI °'. ~ ~yadQ. ' . i N JOINT 86'S2'45"W ~ DRIVEWAY prDP,,~ 3 bcrl~aom 1251.89' Ills I ,• PYe'olCo~ p~D I u,rn fe S,'degce, ~ AS 3034 z~sK/ a.P 4 ~ ~ > u,/d,^ Scwv p4mdGli I ~d, C O1~ 1246 1244 1240 ~,~ ~ ~, J .~ ~ ~, 1242 ~ ~6, ~?~eFF/u ~:neW~cre 6 d 1230 1238 1240 m B.M. TflP OF 1" IRON btlieJ~'n'l~cd yy~~--~It• tlo%osal~t~tdl3o~~R/.t.,, 1242 1244 12 6 133' 33' PIPE: 125Q0' 1234 1236 ''~ to b~ ~ns~l/.tdu~hc~c 1232 ~ L~ I CERTIFIED SURVEY MAP. ZONED AG-RESIDENTIAL I ° •-~ - 11/04/05 FRI 11:34 FAg ?15 386 4686 ~ ~ ~ 1001 ~ 3~ . ~~ Safsty an ildings Division County 201 W. Wash' Av P_O. Box 71b2 ~~~~~~~ Madison, San' Perrnil Plumber (lo be it ed in by Co.) R} 266-. $' 7 De artment of Commerce --- St lsn [.D. Number SaxtYtaly Fermat A~pL tr- In aCCm'd with Comm 63.21, Wis. twin, Codc, prxsoruyl ip rmatior~~f~C 4 / - may be used for secondary purlwstts Privacy 1 nw15.04(1 xtrl) ojcc[ Addr~a (!f different th; :r mailing address) 7 I. Applicslion Iuformatinn ~ Plsssc Print AU Information ( !' `l ~.J ~ ~ ~ ~~~r~ ,L~ J ~ ~"y(f~~j i__ ~- rcrJ u Wr M' Z, Dlotk if Proprrty Ountcr's Namr J / ~ ~-i _ CF~CiIX (/pUN7Y V~ -~ (,tt Iti `,~(/~j~' ZONING OFFICE " _ _ Properly Owrrcr' Mailing Aetdraas - ;~ Property Location ,~.~ s~?F_Y'.c~-G~ `Y`om !I ~~1~' _JY ~ ~~ y.,5fi1 +a. se~t;rn .~- City, State Zip Coda Phor Number II.' pe of Building (check a 1 that apply) csk a3 1 S~~r Subdivision Natrte CSM Number -- ~y`I or 2 Family Dwelling,. - Number oC Bedrooms ~_~,J~ ~~ ~ I j`~~.~ - /`I +~~_ d public/Comrnercial - Descril>< i)se~„_-r_„ ~ ' ~~ c'~~ ^City.~^Yillags owttsni ~+' A/A ~,~e/ ^$Ut1P.QWnCd-DC5Cr16C 1,15C ~ L • JU DJ III. Type of Permit: (Chsck only one box on line A. Complete line B if appiicablc) ~ _ , '~' New System ^ Kcplaccmcnt System ^ TreatmenUHolding l';urk Rq~lacemertt (.7niy ^ Gthcr Modification W Exis + ~ Sysecm List Previous Yatsnit Numbar : c, ! fhitc lsxucd B- (~ Permit RenewAl ^ Y,.h'rnit ltcvisian ^ Ch:mY,,: of ^ Permit Transfer to Ncw 8efgrn Expirat'i'on Pltnnlxr (hvnct !l ~ ` - Iv. T c o(POWTS S tem: Check all that a ply) ' - --^ © Non -Pressurized In-Gmund ~ortnd ? 2~ in. of suipble soil ^ Mound < 24 in. of suitablo soil Q At-t:;rade ^ Single Pass ~ u d Filter n Consbvctcd Wetlmd Cl Pressurized In-Ground ^ Holding lank ~:I Peat Filler ^ Aerobic Treatment Unit ^ Recirculating Sant ! filter 7 ^ t Reeirwlating Syttthetie Media Filter ^ I,~u:hing Chamber (~ Dtip Line ~~ Gruvel•lerw~ Pipe ^ Other (cxplain)~•l1J.1 r ~4 V. Dls ersaUTreatmt:ntAiea lnforrnaGon: - y' ' Drsign Flaw (gpd) (7t:eivn Soil Application ltate(gpdsf} Dispt7s:t1 Arca Requrrrd (e llispet'saI Arca Proposed System EleEle : Lien J ,~ Q - VLTank Info tapacin' in ~ Totai Nn,nhCr anutrruuer Prc1'ab Site S ti t f'ibra Plastic Gallons Gallons rrfUnits Corrucic Constructed Glass Ncw !'.,~~+,+& Tanks 7nnl:„ ~ ~ .,-•° - ... 5optM, M Hnldint: Tail: GL' a l' .~"LY~ -.. { .~ AtrCbiu'frc~tn,cnl Unil . Daaiug C'I~n,lwi O,y ~" O ~ t'a ~ ~ ..,.. - - -.. YII. Resl-oneibility Statement I. the underxi~ned, assu~mr. rCSponsibility ri~r installation of Utc PU~vt'S xbewtr on the attached plan _ _.,,,, Plumbei s Namr. (Print) Plum 's Signature MP/MFRS Nmnbcr IjusinCSS Phor ; ~uml,,cr Ylumbu''s Address (StrCCt. City, State, 'Ltp Code) _ "~ ~ /,~D~ VIII. Count '!Dent BPtmcnt Ilse Unl ~- --~ ~~ Sanitary Permit Fea (i,Kludcs Urourxl~4atcr Llate lsst tssuin n : i>;nat rc ( Stamps Approved ^ Di p $urchargcf+eb) # / 1~~ pb {! I ~~5 ^ O ~ n so for Deni.~rl 'F-{ `7 I/ - - i7-- C:nnditinns of Approval/Rettsons for Disapprroval \ ~ /1 ~ SYSTEM OWNER: ~ J` Cat.bl.t ~-to.nS t ^- cv~rn'a~.~-'L(- i'a J ,. septic tank, etfltleM fNter sod 'P-,~ a,rs' . ;.n t?~~t-c~-~" r.J ~6 5 dispt3fssl CeN ttttaat all ~¢ ttstvloAS / tittWtyYtsd as per manegernent p~ P by Plumber ~i t~(~,n~. v '~"'- . 2. All setback recµtirelnents must be maintained Y l- n as per appliasble code / ofdinsnces. t~ ~tJtnti~ ~ 1/l ~C _ \cx.. (xJ•~ r At/tth complete P~~ Ito the Carat! erdy}for the xystam on pales sot less maa 8t2 x l t iathea 1n aiu ~, f Qrn'6 t SBD-6398 (K. 0 t /03) .~.-r~S ~v ~ 0 ~t commerce.wi.gov isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 7DD #: (608) 264-8777 www. c o m m e rce. wi. g ov/s b/ www.wisconsin.gov Jim Doyle, Governor Cory, L. Nettles, Secretary January 19, 2005 CUST ID No.220853 DALE E HUDSON BOLDT'S PLUMBING & HEATING, INC. 820 MAIN ST POBOX 78 BALDWIN WI 54002 CONDITIONAL APPROVAL _ PLAN APPROVAL EXPIRE ~' ^'~~ ~ 7 SITE: . c ~ ~ti~ ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 Jay & Jan Uldrych _ 233RD Street ~~. `~ ~~`'~' Town of Eau Galle ~,~'~,,Q~~2~'~"' ""~"' St Croix County NE1/4, SW1/4, S4, T28N, R16W Lot: 2, Identification Numbers Transaction ID No. 1102910 Site ID No. 685344 Please refer to both identification numbers, above, in all cones ondence with the a~enc . FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1001108 Maintenance required; 450 GPD Flow rate; 9 in SoiLminimum depth to limiting factor from original grade; System: Mound Component Manual -Version 2.0, SBD-10691-P (N.01/O]); 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: • 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.01/O1) and the SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST_SAS (01/81) Con~~ ,~PP~ DERARI'MEN7' -~ OF SEE CORR~ • This plan has an approved soil saturation determination associated with the design. A transaction I.D. Number 1013376 has been assigned to that approval. t~rfthe<cortdirts~ftti~~.ap~al'~id-?V to I'~,tnipl~da#1`f~e. :p arrstrat.o€t#tAS mound including Q~ lal~tiztg to divertsttrfiat;e. water dlt~inagi~'arou~ci tktt msruttd • Comm 83.54(1)(e) The management plan shalt specifically address the servicing mechanics of a POWTS tank where either the bottom of the tank is located more than 15 feet below the elevation and or more than 150 feet horizontally from where the servicing pad is located. • 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. DALE E HUDSON Page 2 1/19/2005 • 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 • 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 maybe made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, ~: ~~~: ~~ G~ Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@commerce. state. wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 ~~ 9 tt / ~cFi MOUND AND PRESSURE DISTRIBUTION COMPONENT DESK"~ ~'~j8 ~~® Residential Application ~~ INDEX AND TITLE PAGE ~~~~C ~S ®~~C>' Project Name: Ja 8~ Jeanette Uld ch 3 bedroom residential mound s Owner's Name: Jay & Jeanette Uldrych Owner's Address: Site Address: XXX 233rd Street Legal Description: NE1/4 SW1/4, Sec. 4, T.28N., R.16W. Township: County: Subdivision Name: Lot Number: Parcel I.D. Number: Plan Transaction No.: Eau Galle St. Croix Proposed CSM 2 Block Number: Na Pending from 008-1011-15-100 Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications ~OjllJl y Page 6 Management and contingency plan ~~ Page 7 Pump curve and specifications ~~ Page 8 Page 9 Site Plan ~ CoMMFRCr: Soil Evaluation 8~ Interpretive Determination Report NG3 SPpNa~CE Designer: Dale Hudson License Number: 220853 Date: 01!06/05 Phone Number: 715-684-3378 ~ ~~~~ Signature~~ ~ ~ Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01!81) Version 3.0 (03/01/01) Page 1 of 9 Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c} R Residential or Commercial Design Note: Sand fill (D) calculations assume a _ C $00.00 Estimated Wastewater Flow (gpd) Table 83-44-3 in-situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150%) coliform of <= 3r, inches. 450.00 Design Flow (gpd) 5.00 Site Slope (%) ~----- 1248.50 Contour Line Elevation (ft) r 9.00 ! Depth to Limiting Factor (in) ------ ~° ~:'~ : :Itu Soil Application Rate (gpd/ft2) Distribution Cell Information 112.50 Dispersal Cell Length Along Contour (ft) = 4.00 Cell Width (ft) '; 1 .00 Dispersal Cell Design Loading Rate (gpd/ft2) __ _ ~~ 1 ~ Influent Wastewater Quality (1 or 2) Are the laterals the highest point ~ - ~- in the distribution j Y Pressure Disribution Information network? Enter Y or N (c or e) ~ c Center or End Manifold 2.00 Lateral Spacing (ft) If N above, enter the elevation (ft) ------- 4 Number of Laterals _ of the highest point. ~ ~_ 0.125 Orifice Diameter (in) (e.g. 0.25) _ 2.25 Estimated Orifice Spacing (ft) = 4.50 ft2/orifice 2.00 Forcemain Diameter (in) _ _475.00 Forcemain Length (ft) Does the forcemain drain back? ~__. 1221.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 29.25 Vertical Lift (ft) 16.55 Friction Loss (ft) 52.30 Total Dynamic Head (ft) 77.48 Forcemain Drainback (gal) 70.87 5x Void Volume (gal) 148.35 Minimum Dose Volume (gal) 41.19 System Demand (gpm) Lateral Diameter Selection in. dia. o tions choice 0.75 ~ I 1.00 1 - - 1.25 - -- x - -- X 1.50 x 2.00 ---_ _ --__ -'1 x ~ a 3.00 - -----__ x Manifold Diameter Selection in. dia. o tions choice - ~ ^ - 1.25 x x ' _ __ 1.50 x --.___ 2.00 x ----- 3.00 Gallons/Inch Calculator (optional) Treatment Tank Information 1085.37 Total Tank Capacity (gal) '_ 1000.00 Septic Tank Capacity (gat) __39.00 Total Working Liquid Depth (in) Wieser WLP1_OOOMR] Manufacturer 27.83 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information j 1085.37 Dose Tank Capacity (gal) Zabel Filter Manufacturer 27.83 Dose Tank Volume (gal/in) A100 Filter Model Number a-_ _____ Wieser WLP1000-MR Manufacturer Project: Jay & Jeanette Uldrych 3 bedroom residential mound Page 2 of 9 Mound Plan View 1_ 1 /L ~ B : • Observation Pipe ' 0 ' f. ~• B _ - - - - - - - - •~ ~-~ I A 4.00 ft B 112.50 ft ~G~,t3. ' `27a~} in ^f Jj - I A I L Mound Component Dimensions E 29.40 in F 9.25 in G 0.50 ft H 1.00 ft K 12.36 ft I 13.13ft L 137.23ft J 9.18ft W 26.32ft 450.00 (ft2) Dispersal Cell Area {gpdfR~'#:ir~ear Ming Rate '1g27y39 (fly Basat Antis Available 11.25 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 1252.52 (ft) ~ ~I H ateral T F ,.::::' Dispersai~Celi 1251.25 (ft) L 1250.75 (ft)--- - ~ : ~ Invert Dispersal Cell ;[~; ~ ~ '~'' ~ Elevation E ~ ~ D ~ ; ~; Shading Key 1~ ®Topsoil Cap }f{}{ Subsoil Cap ASTM C33 Sand Tilled Layer r:::: ~ Aggregate 5.0 % Site Slope ~ 'O c _ c 1.5 ft ~ o a 0 ~ ~ 0.5 ft 50 (ft) Contour Elevation Geotextile Fabric Cover See lateral details on Page 4 for number, size, and spacing of laterals. Laterals are equally spaced from the distribution cell's centerline in the distribution cell (AxB). Project: Jay & Jeanette Uldrych 3 bedroom residential mound Page 3 of 9 Center Connection Lateral Layout Daigram Force main connection Via tee or cross to manifold at any point. Laterals are identical P 5 ~k • =Turn-up wf ball va Ive or IE X ~ IE><f2 I xl2~l Laterals & Force main of PVC Sch 40 cl eanout pl u g per COMM Table 84.30.5 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orfice Diameter 0.125 in Lateral Diameter 1.25 in Orifice Spacing ()C) 2.27 ft Lateral Length (P) 55.62 ft Orifices per Lateral 25 Lateral Spacing (S) 2.00 ft Orifice Density 4.50 ft2/orifice Lateral Flow Rate 10.30 gpm Manifold Length 2.00 ft System Flow Rate 41.19 gpm Manifold Diameter 1.25 in Total Dynamic Head 52.30 ft Forcemain Velocity 4.21 ft/sec Dose Tank Information Electrical as per NEC 300 and -~ ~,_ Comm 16.28 WAC _`,,,,_ ~ Disconnect Locking cover with warning label and locking device and sealed watertight i 4 in. min. Tank component is properly vented Wieser WLP1,000MR Ca acit 1085.37 Volume 27.83 Manufacturer Gallons gal/inch A B C D Dimension Inches Gallons A 21.21 590.25 B 2.00 55.66 C 3.79 105.50 D ~ _ _ ~ 12.00. 333.96 Total 39.00 1085.37 er tank. Alarm Manuafacturer `; LevelArm Alarm Model Number'DLV Pump Manufacturer Goulds ~__ -- __ ____ --T------------~ Pump Model Number ~3885_WE10H_ , Pump Must Deliver 41.19 gpm at 52.30 ft TDH E- Alternate outlet location Forcemain diameter ~ 2 in. Weep hole or anti- siphon device P, ump off elevation (ft) ~--'- 1222.00 Dose tank elevation (ft) 1221.00 Project: Jay & Jeanette Uldrych 3 bedroom residential mound Page 4 of 9 Mound Svstem Maintenance and Operation Specifications Service Provider's Name ~ Boldt's Plumbing _Dale Hudson Phone!715-684-3378 Phone ~ _ - -- POWTS Regulator's Name St. Croix County Zoning,____ ~ 715-386-4680 Svstem 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 ft2 Maximum FOG 30 mgJL Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Freguencv Septic and Pump Tank Effluent Fitter Pump and Controls Alarm Pressure System Mound <>!~ is Ins ect and/or service once eve 3 ears Should ins ect and clean at least once eve 3 ears Test once eve 3 ears Should test month) Laterals should be flushed and ressure tested eve 1.5 ears Inspect for ponding and_seepa~e 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 mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished .~~~~,........ _~. ............... Grade \ , 6-8" Diameter Lawn ~./_ ~ Threaded Cleanout Sprinkler Valve Box ~ Plug or Ball Valve Distribution -___ _ __~ Lateral ~y Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Jay & Jeanette Uldrych 3 bedroom residential mound Page 5 of 9 Mound System Maintenance.and Operation Specifications Service Provider's Name Boldt's Plumbing -.Dale Hudson Phone 715-684-3378 POWTS Regulators Name St. Croix County Zonin Phone 715-386-4680 System Flow and Load Parameters Design Flow -Peak 450 gpd Maximum Influent Particle Size Estimated Flow -Average 300 gpd Maximum BOD5 Septic Tank Capacity 1000 gal Maximum TSS Soil Absorption Component Size 450 ftz Maximum FOG Type of Wastewater Domestic Maximum Fecal Coliform Service Frequency Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other 1/8 in 220 mg/L 150 mg/L 30 mg/L >10E4 cfu/100 mL Ins ect and/or service once eve 3 ears Should ins d and clean at least once eve 3 ears Test once eve 3 ears Should test month) Laterals should be flushed and ressure tested eve 1.5 ears Ins ct for ndin and seepage once eve 3 ears Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3: All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold boarcl or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and he{p reduce frost penetration. Lateral Turn-up Detail Finished .~~~~~........ ............... Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Jay 8~ Jeanette Uldrych 3 bedroom residential mound Page 5 of 9 Mound System Management Plan Pursuant to.Comm,83.54, Wis. Adm. Code en I This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01 /01) and SSWMP Publication 9.6 (01 /81 )) and focal 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 presets that could cause death. Septic and pump tank abandonment shall be in accordance wtth 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 acadeMal or unauthorized entry into a tank or component. Septic Tanll The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at I~st once every 3 years by inspection. The outlet fitter shah tie cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the fitter when removed from its enclosure. If the fitter is equipped with an alaml, the f+iter 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 excee<Js 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 pertonned to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank pertormance is generalty not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. pro Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shat! be tested to verify proper operation. If an effluent fitter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution Svstem No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and muk;hed as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD5,150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS, 30 mg/L TSS, 10 mgJl FOG, and 104 cfu/100 mL for highly treated effluent. Influent fk-w 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 lt is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is pertormed tt should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 8 inches considered as an impending hydraulic failure requiring addfional, more frequent mon'doring. 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 components} shall be immediately repaired or replaced with a component of the same or equal pertormance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, tt will be repaired or replaced in its` present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Jay & Jeanette Uldrych 3 bedroom residential mound Page 6 of 8 ~GOULDS PUMPS ^ Shaft: Corrosion-resistant , stainless steel. Threaded design. Locknut on three phase models to guard against component damage on accidental reverse rotation. ^ Fasteners: 300 series stainless steel. ^ Capable of running dry without damage to components. ^ Designed for continuous operation when fully submerged. 3885 PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. APPLICATIONS Specifically designed for the following uses: • Nomes • Farms • Trailer courts • :Motels • Schools • Hospitals • industry • effluent systems SPECIFICATIONS Pump • Solids handling capabilities: '/" maximum. • Discharge size: 2"NPT. • Capacities: up to 140 GPM. • Tota{ heads: up to 128 feet TDH. • Temperature: 104`f (40°Q continuous 140°F (60°C) intermittent. • See order numbers on reverse side for specific HP, voltage, phase and RPM's available. FEATURES ^ Impeller: Cast iron, semi- cpen, non-clog with pump-out vanes for mechanical seal protection. Balanced for smooth operation. Silicon '~~~' bronze impeller available asri an option. ^ Casing: Cast Iron volute type for maximum efficiency. 2'' NPT discharge. ~ Mechanical Seal: SILICON CARBIDE VS. SILICON CARBIDE sealing faces. stainless steel metal parts, EUNA-N elastomers. ~:_ 2002 Goulds Pumps Eriective October, 2002 E:335 MOTORS ^ Fully submerged in high- gradeturbine oil for lubrication and efficient heat transfer. ^ Class B insulation. METERS FEET 40 130 1zo 35 110 ~nl_ 100 0 90 = 25 8~i `a zo~ - 60 15 50 ED H. 40 ' 10 30 ---~ - - -- - 5 20 uuE~ -~- -, - to . - ~ --~ - i 0 00 10 20 ~ 30 Subnners~bfe Effluent dump Single phase: • Built-in overload with automatic reset. • A11 single phase models feature capacitor start motors for maximum starting torque. •'/3 and'/z HP - 16/3 STTOW with 115, 208 and 230 Volt three prong plug. • 3/4-2 HP - 14/3 STOW with bare leads. Three phase: • Overload protection must be provided in starter unit. •'/i-2 HP - 14(4 STOW with bare leads. ^ Designed for Continuous Operation: Pump ratings are within the motor manufactures recommended working limits, can be operated continuously without damage when fully submerged. Y Bearings: Upper dr~ci lower heavy du.ry bail beanrc construction. ^ Power Cable: Se~(re d.:t,~ rated, oil and water resistan-. Epoxy seal on motor end provides secondary moistt~re barrier in case of outerjace~ damage an(I to preveit oil wicking. Slandaro cord is ?0. Optional lengths are avail~o ~. ~ 0-ring: Assures positive sealing against conruninants and oil leak:~ye AGENCY LISTINGS ~ Tested to L"L 778 and CSA 22 Z 1~~3 Stnnc.uj_ 6y Canadian S;ar.o::na AssuciaUOn ~ ~~ File ftLR38519 Goulds Pumps is ISO 9001 2egisteraa. I ~~ Ir ~R~r~ i~o~€ -~-- ! - ---~5 GVM i ~ i I-- ~ - ' ~-- - - --, - -r- - I r - - - i . ~SfT - -- L. T I __ 1 f _., -j-~ -~_ i _, ~ - --~~ ~ ~ ~~ --- T _.~ ; _, ;_ ; _ ~ , . ---~-- -- i - F - ~ ~ -~' - I i - i -~-Y-- - -- - - - - ..-- . - r ~ - -- - - I!r __ T~ r - ... I 1 r --. _...- T - ~ ~ - - + + ---j- - ~ r - - ; . ~ - - - - --- __ \r '~--- r T.~ __~.~ j .-; ~j --- - ~- ~ I . _.L - --. :..:..~ --- 50 60 70 80 _ 90 100 1' U 120 13C 14G 1 SO t GO GPrn >r~-- _-~-- -- 0 5 10 15 20 25 30 35 m~;'hr CAPACITY ~/ y/./9~.P,m.rrl,I~~'mr,~+Y,SuPi°~S'rQEer~~%~ Caou~dS Pumps <,~/ ITT Industries www.goulds.com w 70~ n P~. r o _ _ __ _. ~~~~ I ~ ___ __ _____ __ o I I ~ Exs~;~ ~ ~ ~8 od.~e~o,~- - I ~ ~ r died - ~4as;o~~Qi>< ~I ~~ ~--- -~1~E-~ ~ o S'~A- )' 55' I ~ ~ ~~ >> s~ > > > > r' r' ~ ~ ~ ~ s ~ s - ~ - ~aL ~ _ ~ ~o ~ ~ ~ ~ ~ ~a n ~ Tp a>rSc~.rue~ A ~ o ~ - ~ _ ~ `m a~ .~ ~ `, k.~ : r, z~19, so'(irA.a'.So;l t~aP, ~~. ~ _ - - - _ r- I I ~ _ _ a~ ~ti~~ 1~~6 ~ - --~ BUI ING SET CK o - ~ ~~~ ~`~~ ~ `~ ~, + Z - LINE I I ,~, - ___ ~ c ~` "' ~ `~~ ~ 1 ~y°~ rtl~~ -- 35.4/' ~ o I 50' WIDE DRAINAGE o 6 ~ I a I z 2.8 ACR S ~ EASEMENT. ~ _ , ~ a -- '-5 ~ Ep, MENT ~ 0 ~~/ bcd ~~ DRAINAGEWAY / .11 ACRE ~IT ~ ~ 5 Z I I HOUSE ~~ Prepo v~Ccn4' I S IL 1E ~ I w~Ni ~6co ~ bi?m~cn S86'52'45"E 398. 7' S.T. ~C. ~ ~ab~ f~-~rf1 t~~B/[t4~f ?S• 25• z ~~ 0 6.~~ u .h II 1254 p ~ JOINT DRIV WAY ~' 6`io~o ez~oFl=~@lrsn-6U; ~6[i~ ~~( ~ 252 EMENTI N JOINT 86'52'45"W 1251.89' ~ DRIVEWAY bid/~c~n Propns~d 3 ~`AS 303/ z~sK/ a.P O ~~~~ ~ U0'• res,d~~ce. ~ . °u'N 1246 1244 1240 ~~ > > Rd. a u,ld, ~J Sewa. / p4i"P ~' ~! r ~ 1242 ~~ ~~~, ~~ReFF/u I;,,ewJ~e ~ 1230 1238 1240 v, '~ B.M: TOP OF 1" IRON bt/no~a "l~cd 9~~~• 1244 t(ntnsrtl~t~l3o3/A/.C„ 1236 1242 12 6 33' 33' 1232 1234 PIPE. 17.50.0' to be lnS~ba~/1duJ~tC~c ~ ~(8'bclDu) ~b~7~icd~rd. ~ ~ ~ CERT-FIED SURVEY MAP ZONED AG-RESIDENTIAL 1 ~~"W~~ ~ ' commerce.wi.gov i ~ ^ ~scons~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.state.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary July 23, 2004 CUST ID No. 224832 MARY JO HOLLISTER W9875 690TH AVE RIVER FALLS WI 54022-4011 ATTN: AOWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/23/2006 Identifcation Numbers Transaction ID No. 1013376 SITE: Site ID No. 685344 Jay & Jan Uldrych Please refer to both identification numbers; Town of Eau Galle, St Croix County above, in all comes ondence with the a enc. . NE 1/4, SW 1/4, S4, T28N, R16W Lot: 2 FOR: Object Type: Soil Saturation Determination Regulated Object ID No.: 964928 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: 1. Approval is hereby granted pursuant to Comm 85.60 (2), Wis. Adm. Code to estimate the depth to seasonal soil saturation based on an interpretative determination. This approval and determination negates the requirement in Com 85.30 (2) (b), Wis. Adm. Code to designate the ground surface as the highest level of saturation when redoximorphic features are less than 4 inches below the bottom of the A horizon. 2. At least 27 inches of sand lift on top of a 9 inches minimum of unsaturated in-situ soil for adequate treatment and dispersal is required. 3 . Tate: ba>lad spil ~pplcatiel't rate shalt `be fl:3 gpd/ft^2, ett;d the linear lctatli~g.r 4.O ~cUft~t - 4::, Chisel plttwitag toad of I2 inches itttmediately prior to semi placerm,stt a'regdire4•tci improve vertia~ vv>~ter ~tQir~~t a `i>$ sot solum. 5. Landscaping up slope of tJae txi~wtd atxl on tht maitnd itself shall be iriCorporate~ (tt'~ ttte, di+i+~t•~urface water drain a arairttd the mound system. )rxamptes include an'up stripe grassed vrmt~i .~~..,, . 6:1 up slope t at each end. 6. This approval shall remain valid unless the site is altered in such a way that the depth to soil saturation would change of if saturated conditions were observed for seven consecutive days at depths less than 3 feet below the infiltrative surface of the POWTS distribution component. 7. This approval in no way relinquishes the use of color patterns to estimate the depth to high groundwater on any other parcels or portions of parcels. 8. A copy of this approval letter and attachments must accompany the mound system plans for this site. ' c MARY JO HOLLISTER Page 2 7!23/04 A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. If plan index sheets were submitted in lieu of additional full plansets, a copy of this approval letter and index sheet shall be attached to plans that correspond with the copy on file with the Department. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, j~ Lero G. ns Wastewater S eci.~7ist Y kY> P Integrated Services Bureau (715)726-2544 ljansky~a commerce.state.wi.us Fee Required $ 100.00 Fee Received $ 100.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G. Jansky, Wastewater Specialist, (715) 726-2544 (i01_.(_IS-f-Lf~~.S SOIL ~T-("S-(-INt:~ Mary,Jo Hollister W9873 690`~'/.lvenue River Falls, WI 34022 (713) 426 1775; fax 426 - 4827 Interpretative Determination IZepart 15 ,'une 2004 Property Owner: Jay and Jan (~Idrych Location: NE ~~ SW ~,4, Sec.4, T28 N. R ~ 6W, Town of Eau Galle I'roPosed 2 lot CSM INTRODUCTION: ~9~F~- 'I~ 'J~y C~/ I>. ~~ s'~p~ Q "~ ~~O ~~ 1p133'76~~ P.O.W.T.S. Conditionally /APPROVED DEPARTMENT OF COMMERCE d11/IS1 N Of SAFETY AND BUILDINGS E CO RESPON ENCE On 30 May 2002, a soil evaluation report was PerFormed by this certified soil tester on the Property owned by the (,Ildrych's for a proposed 2 lot certified survey map. The (~Idrych's already had a sail test completed on the northwest comer of the property that was approved for a one foot mound system. Later, they decided to divide the 8 acres into 2 lots. The soil report submitted on 30 May 2002 showed an A+ 4 site. t-Iowevcr, an onsitc conducted by Pam Guinn,jt. Croix County Zoning and ~,eroy ,}anksky,jtate `/Mater Waterspecialist concluded that the site has mottling~ust below the A horizon at a depth of nine inches. G)=OLOGICAL t115TORY: As we know, this area in Wisconsin is an area of the Glaciated (~cgion which occurred 35,000 to 5o,o0oyears ago. This caused erosion, deposition, stream erosion and other processes. Wisconsin is divided into five natural regions which are related to land by the use of plants, animals and 6y man. Also the boundaries arc determined by soil texture and structure in the underlying rocks. St. Croix County is located in the Western (,IPland which is underlain by Ordovician dolomites. (Martin, L. (1965). The Physical Geology of Wisconsin, (,Iniversity of Wisconsin Press, Madison, Wisconsin). Page 2 - ULDRYCII This Part of St Croix County was formed 6y. ground moraine deposits from the Wisconsin stage of glaciation. The parent material at this site is loess overglacial till. LOCAL HYDROLOGY: This land area is located within the Lower Chippewa River ~asin which includes theE,au Gallo River. (St Croix County j~evelopment Management Plan; Physical Features Analysis Pg. 2-t 1.) The ~au Gallo River is located two and one-half milts due west and flows at a southerly direction. Much of the groundwater is recharged from rainfall. Rainfall amounts for this area are based on readings from ~aldwin Waste Water Treatment Plant located 2 2/3 miles northwest from this site. The attached topographic map show the land sloping to the west and the moraine west is sloping to the cast. The low lying area inbetween the moraines is an area that tames and holds water. This area is 438 feet westerly from the tested area. This area is indicated on the copy of the cjoil Survey map as a `jlcybcr g series which is poorly draincd soils on foot slopes and in drainage ways ofground moraines. The tested area is mapped as Santiago silt loans that have a depth to seasonal high water table greater than five feet. SOIL MAPPING: As indicated in the `-foil Survey of St Croix County, Wisconsin Published by the jvational Cooperative Soil Survey the area tested is mapped as a Santiago silt loam with 2 to 6 Percent slopes that arc wel) drained soils on ridges and foot slopes of ground moraines or on Pittcd glacial drift and thcsc soils formcd in silty and loamy scdimcnt and in the underlying sandy loam till. The Qrdcr is an Alfisols and is classified as Typic Glossoboralfs. These soils arc formed mostly under broadleaf deciduous forest and where drainage is not restricted from the water table. SOiL CONDITIONS AND SURFACI=. WAT)=.R FLOW: Page 3 - ULDRYCII The `foil evaluation Report submitted by this certified soil tester encountered some gravel and a sandy clay loam texture at 18 inches. Rcdoximorphic features are observercd at 9 inches. There were no dense conditions observed. After a rainfall amount recorded at the ~aldwin Waste WatcrTreatment Plant of 1.5 inches within a seven day Period, three hand borings were observed on 24 May 2004. No standing water was observed in any boring. A hand dug pit to the depth of 24 inches was also observed with no free flowing water. Qn the same day, a site located 3 miles south which had a soil saturation determination on Simi{ar soil conditions was observed. Two observation pipes at that location had 1 O inches of standing water. The depth of the two holes were twenty-four inches. This site was approved in Qctober 2003 to a depth of t O inches for a mound system. ,also observed are many newly constructed sites within a milt south on lower lying land with mound systems. These areas are mapped as the same soil types. Man has influenced the topography of the area with the construction of `jtate Trunk Highway 94. The (,~Idrych property borders the south side of the freeway. The same moraine had been cut with an area of approximately t oo feet wide and an a{ovation of 20 feet. This would also influence the groundwater that is tamed to the site. The soil profiles show a 1 OYR3/2 to a depth of 9 to 1 1 inches with no redoximorphic features. Perching is not taking place in this horizon for any considerable period of time. PROPOSAL CORRECtION NEEDED 1.) The depth of the approved sand be at least 2.25 feet. SEE CORRESPONDENCE A mound system at this site would provide ade9uate treatment for the wastewater with these recommendations: 2.} The mound system be designed long and narrow with a linear loading rate 4.o gpd/ft. Pagc 4 - ULDRYC(1 3.)(ncrease the slope areas around tt~e mound system to increase absorption areas. RespectFully submitted, ~~~~~ IViary ,10 (-(ottistcr CST zz4a3z RE.PERENCE.S~ t •} Martin, L• (1965)• L ~ sisal Bolo of isconsin. (,university of Wisconsin Press, Madison, Wisconsin. 2.) Soils. (university o~ Wisconsin ~ducation Courses. 3.)St. Croix County Development Plan. ~/olume Two; ~aclcground Studies. ~ sisal eatures nal sis. 4.) Soil Survey of St. Croix County (t 978). (~nited States Department o~~¢riculture Soil Conservation Service and Research Division of the College o~~riculture and Life Sciences, (,university ol-Wisconsin. wisooasin Department of Commerce SOIL EVALUATION REPORT Page ~ of 3 Dlvislon of Safety and 8uitrftngs in accordance with Gomm 85, Wis. Adm. Code ~y Attach complete site plan on paper not less than 91/2 x 11 inches to slze. m ~ ~~x l irxx:it.rde, but not Nmtted to: vertidl and horizontal reference pokit {8M). di parcel I.O. ~ P~D ~ ~/ percent slope. scale or danenslons, north arrow. and loceilton and distance Please t sI! -`°"°~--I ~ ~ Date Personal information you provWe may bs u d for c lav~, s. 15.01(1) (m)). Q~ ~ ~~ ~ 1 ~'~S 1 ~- L ,S~t`f UI~DRy~-1 toperiY tJwner+s MaNing Address F~ ~.i;.s. i wt JUL 1 5 %004 '7t5 )4Z.5- 85 Property tacauon W ~ "J-tn. 1,. E - n1E 1ia5W ua s y T Z8 N R Ito lot # Btodc # Subd. Name or CSM# -- c~ln p~nuv~ ^ ^ Village Town Nearest Road ~u ~>~~~ t Z33'~ sT ~0~ ~~ ,~ New t;onshuctlon Use: I$ Reslderdlal / Number of bedroon>s .,_,,,,~ Code derived design flow rate !„~ _ GPD ^ Replacement ^ PubOc a comrnsr~ciai -Describe: Parent material _._()~~ TN-L Flood lion tF de ~ ~~~ , General comments s M 0, . ~,AOta~r Rfk r sA1~DF L ~ and nrc>onm~endatlons• MptA 'rJJ 4~E W t,pp~5 'to I.:y AROUND MOtAA1D LON~r N~'R~W SV M ) S~1CRtsll,9lD S LiJ6W TiEYORT ~O'R ao1t.'l~'EV~bt01J auJa WEW BDR ~ FO Pit Ground surface elev. 'Q$. ~ e. Depth to ~rNdn9 factor ~ In. ~ ~ ~~ # ~ ~9 Horizon Depth Dominant Dolor Redox DesrYiption 7exhre Stnrdure Consistence Boundary Roots PDT' in. MunseY pu. Sz Gortt Color Gr. Sz. Sh. 'E(f#1 "Etf#2 i 0-lv IpVt23la• -' 1 -m er 0.S -eD Uti a.8 Z b~ to VR 3~Z --- 5t ~ -m Y m~tfY' v~ 0 ~ •$ 3 q-)'S IOVK4 y Ry~h to bft i -l mfr 0~ IV4 0.~ 0.8 `I 3-Ib IoYK`! y rr ' ~ o t. st l~'-l.ab' m~r A.5 1 -w~ D.4 S Ib-2 tov S/s .s ~2 to +-It stl 1-~-La r'rKr -~ -f o CS E v~eL t`-t C'1 Borirw U avnng rt Pit Ground surface elev. 4 2 ft. Depth >b Ikf>Hing favor in. Horizon Depth Dominant Redox Descxiption Texture Structure Consistence Boundary Roots in. Mtx>SeN Qu Sz CoM. Color Gr. Sz Sh. ~ Rate GPaV~ 'Etf#1 •Eft#2 1 O--"I 10 V K 31 Z `" S 1 ~ ~-- v l r ~ 3VF- 3 ' lo- t t o ~+ t y ~ tc`/t -f- m-Er- Qs z~'F v, , ~ ~-I-1~! v 4 t0 c ~ y b/ St ~ _ r ~t~J 1`tf=m b•4 r S IS-Z1 T.5 y/ ~s a5 ` Io ~ - i ~ t O~~l d4 ' EftlUent #1 = BqD > 30 < 220 mgll_ and TSS >30 ~ 15U mg1t. - ralwe¢ ac = ow ~ .w rryra. o w. . •• a- CST Name (Please Print) furs t~T Number ~0 H t»l. S-t'rE. ZZ ~ A~~ Date Evaluation Conducted TtriepFane Number W9a?5 b90+~'AVe, vE FAta.s wr 5yo2Z o-5~ p4 L'7i5 y2b-1'17S •- Property owner (~ l,-b RyC}-} Paroel to # ~PENDi NG-} page 2 ot..~_ (~ ~ (.'S_,_~ Big # ^ B°dng Pit Gnwnd surface elev. _~,~ it. Depth to ~Mfing fac#or' __i,L___~ in. SoN Rate Horimn Depth Dominant Redox Oesctiptfon Texture Stnrchxe Consisterxae Boundary Roots GPDI(f in. Mu>sep 11u. Sz. Cont. Color Gr. Si Sh. •Etf#1 'EtT#2 1 0_g i tr1 z -- 11 3rF m ~-cA O.G O~ 8 y- 8-11 O _ -rn r 0.8 3 11-1 04 4 !o ~1 ~t ~ -L Y' S 1`r~- ~ D.$ 4 -ig V yi! yI iD4 ~/ 51 ~ -l ~r W -m 0. 0. . S -Z3 7$4 yf 7,5`1 y loV l SCI i M bK S l~• ^ Pit Ground surieoe elev. , YD g, Depth to 8mitinp tailor IZ ~• ~p Rate Ho-izon Depth Oominarrt Color Redox Description Texture Structure Consi~enoe Boundary Roots GP D/IF in. Mruriefl tau. Sz Cont. Color Gr. Sz. Sh. 'Etf#1 'EB#2 ~ D- tDY~Z,'~2 - .3-1 ~-+h v- ors 31F o.b 0.8 3 12- a tom-`t/ ~ ' ~rf 6;1 ~ 0. ~. ~+ s1s ~.! s~ 1 M 4 a ^ ^ Pit Ground surtece elev. ft. Depth tti fim&!ng tailor In. ~°'~# ° . sal Rate Fbrizon th De Dom~ant Redox Description Texture Sfruchre Care<roe Boundary Roots p in. Munsefl Qu. Sz Coat. Cdor Gr. Sz Sh. 'EtT#1 'Efi#2 " EtAtrent #1 = BOD, > 30 _< TIO rngll. and TSS >30 < 150 mglL 'Effluent #2 = BODE ~ 30 mglL and TSS < 30 mcyl 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 608-266-31 S ] or TTY 6l)8-264-877. SBDd)IO (R.6A0) r I I~ ~ I 1~! U V Pa f'~O~~il' OV41~~: ~l~J c_ii 5fl I.~G~M7: !"-5~0 ~¢XCE~°1' w+t~ ~' ~1 - fF'~ OF / ~1Zou0 TDW PVG P/PE /0 ABOY~6KOWl1 0l S,5 ,S.t [~-soy, eo~u w~ a /lr ~ S No cohwt s~ S~~~x ---L-- /r ~ ~ SGRItJE,S-~1D ~ ~ 98• bo ~ ~ ~~ ~5 Z'3 3 - ~ !L a a v- So ~ ~o-v~ gl•~p0 k ~C 'Sa ~ sEt ~CK u N~ C~ P '~l U ~~) y $ nB ~r~ ~`---~~ m i ~ I ~g- C .Sot~'ra4 ~RoPEr~~I uro'E 1' ~'~ '~AV~~ k us. yy ~ 51Gt-~n C51 224832 - -- nA1~: ~-2y-1~/ State of WisFtinsin Dep9rtment of Commerce Safety & Buildings Division Bureau of Field Operations Inspection Date / / /~IfU~ u L ~/2~i ~E-f- - ~~1 t~~ Master Plumber Name and Address Leroy G. Jansky INSPECTION Department of Commerce REPORT 13 E. Spruce Street Chippewa Fa{is, WI 54729 (715) 726-2544 Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04(1)(m)J. Address or Legal Description City/Township County ~~T 1 ~5M aster P umber Firm Name and Address Plan LD. No. Sanitary Permit No. Tester Owner's Name and Address. Licensed Person's. Name(s) and License Number(s) Q I u~ tau 5 GUS S4 JZ2 .. -- t , Page ~ Of ~ Signature of Responsible Licensed Person (only one needed) - Signatur of Plumbing Consuitant/Private Sewage Consultant COp12S t0: ~ Check all 1 ~-" ~- OrlglnaL• that apply/ `. SBD-8192 (8.12/98) District ~° S&B 0 Rlumber ~ Owner Coun /Local Ins ~ Otherr -~~ ~, ;~ l_~" ftM~ru~w^ Memo to File From: Pam Quinn ST. CROIX COUNTY WISCONSIN ZONING DEPARTMENT ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 Phone: (715)386-4680 Fax (715)386-4686 Date: 4/22/04 Re: Soil Report verification on-sites (4/15/04 and 4121/04) On April 15, 2004 I performed on-site inspections for proposed CSM sites to verify soil reports submitted for system installations in soils documented as meeting the A+4" restriction for mounds. On Apri121, 2004 Leroy Jansky, Regional Wastewater Specialist and myself visited three of the four sites to follow up on my inspections. The following is a brief summary of our findings: Site #1 Jamie Langer Lot 1 CSM# 637772 V. 15/P. 4028 - SE %4 NE 1/a Section 32 T28N R16W (Town of Eau Galle) -The soil tests submitted by Adam Schumaker (9/24/00) are not suitable for A+4" conditions. Due to the delay in using the reports, the site has been hayed and benchmarks/soil test pit locations have been obliterated. The general location for hand borings were documented in my notes and I used the dimensions shown on Adam's plot plan to find approximate tested area. The site contours were not properly represented on the plot plan and the slope is more concave than expected. Three hand borings were dug, all with prominent mottling found @a 10" in massive sandy loam below the A-horizon. Soil profile descriptions are attached. An interpretative review or groundwater monitoring would be necessary for this tested area, but there may be other locations on the property that can be investigated. The owner will have to contact a soil tester that can do A+0" determinations before a mound design can be reviewed. Site #2 Steve Lynum/Jeremy Wildner - NW'/4 NW Y4 Section 26 T28N R16W (Town of Eau Galle) -The soil report prepared by Lewis Bjork 2116/02) did correctly identify mottling at <A+4", but this condition was overlooked during the mound plan design and state plan review process. It was discovered during county sanitary permit application review. Lewis excavated another test pit next to his original B1 for my inspection and I found that distinct mottling was evident @ 11 ". Lewis concurred with this finding, as did Leroy Jansky. However, Mr. Jansky took time to examine 2 borings farther south and uphill from the original tested area, finding that the soils would just meet the A+4" requirement for a standard mound using component manual version 2.0. Steve Lynum and Jeremy Wildner were present and were advised to contact the soil tester and have a revised plan developed to send to the state for review and approval to move the proposed mound septic system to the acceptable area. Site #3 Jay UldrXch proposed CSM - NE '/a SW '/a Section 4 T28N R16W (Town of Eau Galle) -Mary Jo Hollister had completed a soil report in May 2003 that separated the Ap horizon into 2 parts, but that doesn't count toward the A+4" minimum requirement. I dug three hand borins to verify soils near the test pits indicated on the soil report plot plan. I found prominent mottling @ 9" (just below the A horizon) near B1, @ 12" near B2, and faint mottles between 11- 18" near B3. An Interpretive determination will be required to support a design for a mound with <A+4" and additional area needs to be tested to provide room for a larger mound using a lower linear loading rate. Site #4 Roger/Tom Christianson proposed CSM - SE '/4 NE '/4 Section 34, T28N, R18W (Town of Kinnickinnic) -Carl Heise prepared three reports for this CSM (3/5/04) and I checked soil conditions on Lots 2 & 3 using the existing test pits; I removed backfill and exposed fresh soil along the excavated walls. I found his descriptions to be accurate regarding depth to mottling, although B 1 on Lot 2 appeared to have some redoximorphic iron deposits below the silt loam A horizon at approximately 10". This may have been tension-related due to the loamy sand layer observed at 8" -17". His site plans were completed properly so I could identify the borings reported, but there were some excavated pits not reported and the installer will have to make sure that the mound is placed over acceptable borings at the contour indicated on the soil report. Even if the soil tester "doesn't like" the pit, it should be described and/or noted on the site plan to avoid confusion or worse, installation of a system in the wrong soils. During the 4/21/04 site visits, Leroy Jansky concurred with my findings that the Uldrych and Langer parcels will need further soil investigation, saturation determinations, and designs developed for <A+4" mound systems. ' +. SOIL EVALUATION REPORT Page_ ~-~ ~ Wisconsin Oepartmeni of Commerce 0lvlslon of Safety and Bulldinga in accordance wlltt Comm 85, WIs. Adm. Code Cry ~ ~,~x Attach oompiate s)te plan on paper not lase than B 112 x 11 Inches In size. Plan must include, but not Umlted to: vertical end horizontal reference Point (BM), direction and parcel I.O. r ~•-.,c1 percent sSopa, scaja or dimensions, north arrow, and location and distance to neatest roed• Revle66ed b ` f ~~ tN ~ ate Please print a t`r~n / ~~,~ 5~- ~' Penonel Inrormalbn you Orovids rosy bs ueed to sound br~6 t*w e. 15. (1) (mjy. ~~ r Property Owner Prop rty Location ~~~ i~.~DRyck1 JUN 0 5 200 NE ,145W 114 S y T Z8 N R Ib ~lW property Owne(s Malling Addresa B p Sutx3. Name or CSM# .~ ~~~ ~iR~vE ST. CROIX COUNT CSM p1NDtNC~'' Slate ads try (~ Village Town Nearest Road City rd cJ-} ; R~v~tZFRus wt 54ozz (~t5 4z -gsa5 ~u ~A~-'~ I_r~nZ3 Code derived design 11ow rate ~..-+~sa,.r GPD J$1 New Construdlon Use: ~ Reaidentlat 1 Number of bedrooms .`.~ L.,i Rspla"•emert ^ PubJc a comrnarYleJ -Describe: _~ - ~~~_ R. parent matettat .~~tt-a-- Fiood Plain elsvarton if applicable ~...._._11~-.~._- Generat oorrunents 5 C.~AC)r ate 'R A't~ l ,9 Z r SP~Nn ~ t t-r-- arld recommendations: ~~ SV~~-~ G' 5y~t"~,M 21... t pC).50 Q [] Boring Boring. # ~ Ground surface elev. _ Q$, U~ it. D®pth to Ilmfting i Pit ador .__t_._,Z` _,._ ~-• Soil ticatian Rate Roots GPDIff Fiortzon Depth Dominant Color Redox Desr~iption Texture Structure Consistence Boundary '~~' .E~ in. Munsett Qu. Sz. Cont. Color Gr. Sz. Sh. t p-I o 10~lt23~Z "-- 1 -m ~ _cU QS a.$ . r ,J{ 0.5 .~d 3 ~-1~ lOVK4 ~ -- Si -L m-~r O..s lv4 0,5 . ~{ `5-ib io`!R4 y t y o ~ s 4~- ab' m r QS Iv _,M 0.z 3 5 Ib-2D lovt25/.~_ .s ~2 Ito ~- sti ~-L m~'r -' -f t7rz Bonng # ~--~ Boring 2' ~ Pit Ground aur}ece elev. _g,Q, L5 R. Depth to Iknltlng factor ~_~._,~ in• rat cation Rat. Horizon Depth Oomtnant Cdo Radox Description Texture Structure Consistence Boundary Roots GPD/fP •E~y ,E~ in. Munsall Qu. Sz, Cont. Color Gr. 5z. 5h. t 0^"! lOvic 312 ''. S. ' _ rn vf'r QS 3YF-c •5 z- 7- i V 3 Z ~ 't - v tt S zJ~- fl,5 `~ ~ -4 = fi-Fr ~.s z~ co o .S 3 to - t ` o G ~ b et ` r r[.l.J t'~-M rZ ~~ 4 ~-1 ~ V ~ S 18-21 1 7 `~! 7,5 G ~ tl? ~ SG ~-- t 0~Z br ..nr . . on .....A .~nA 7CC c 3n malt_ ' ERluent e 1 = 800 > 30 S 2Zt] rt+yt_ ens I S:i >;w ~ r ou mgn ~•,,~~.^ ^_ --- - -- CS7 Name {Please Print) Signature CST Nwnber ~ ate Evaluation Conducted Tebpf>one Number W9B?5 b9a'~``AVe,, Rlyt:.~,'FAuS WI 54t)2Z OS-30-off L-~iS~ y21o-t"17S Property owner ul"b~y~-+-} .._,.. P.rca1 tQ K cP~-h1C>~~ Page Z of 3 ^ ~'~ # u >3~n~ ~ ~ pit Ground surface elev. _,~.~„ h, tJoptn to ttmidng lector ~..... in• Soit ~~ Reta Horizon Depth Dominant Color Redox beacrtption Texture 3uuctura Conalatence Boundary Roots GPO/If in. MunseA Du. Sz. Cont. Gdor Gr. 5z. Sh. 'Ettpi 'Effll2 ~ 0-`~ lov 3z --" ' 1 3f-m r r rf-ca O,S o,8 ~- Q-1 -- -rn r v~ ,5 0~8 3 ll-l V V ~-~- ~i ~ -L Y' S l~f-tD ,5 U,$ ~ -ti8 y yr y cl 1 ~~ S-~ ..~a. ~Y -t'r1 O,Z 03 S l - Z3 '7 5 ~ ~~ ~. SY y t t) i' -SCE 1 t'r- bK .--- _ z l~• 3 ~~~°" (~ aodng ^ Pit Ground surface elev. ~, ft. DeP~ Io ttmlting factor In. ~ ~~ ~~ Horizon Depth Dominant Color Redox t)escrfptfon Texture Structure Consistence Boundary Roots GPD/ff in. Munseu Qu. Sz Cont. Color Gr. Sz. Sn. 'Effitt 'EMK2 8oring p U goring ^ Pit Ground surface elev. _-r..~ it. Depth to limftlng factor - ~• X11 tfon Rate Horizon Depth Oominant Cdor Redox Dsauiptlon 7ezhue Structure Consistence Boundary Roots GP in. Munaetl Qu. Sz. Cont. Color Gr. Sz. Sh. 'EfUtt 'Ef[#2 • EtAuent tti = BODr > 30 < 220 mgA. end TSS >30 ~ 150 mglL ' ERluent p2 s gQpr c 30 mg1L and TSS < 30 mgrl 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 dcpanmcnt at ti08-266.31 S 1 or TTY 608-264-8777. SBD•tllOt~-•~) «, lam{ /'l.~ i~]1 tl1 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer A~i \,~.1 2~.,, c,l~- Mailing Address Property Address ?oy (Verification required from Planning & zoning Department for new construction.) ~/-"~ City/State ~ ~„~ ~,,,, t r, ~j Parcel Identification Number ~~-, =T-~;. - j ~-_l n ~ LEGAL DESCRIPTION Property Location ~ 1/~ , ~ 1/4 ,Sec. ~, T ~~N R ~ ~W, Town of ~~U C~ A7_t_E Subdivision ~ M ~ ~ny~L~~ n~ ~~' . ,Lot # _~. Certified Survey Map # ,Volume Page # Warranty Deed # (~ `~,~ C,:~ ~ ~ ,Volume ~ S ~ 8 ,Page # Spec house yes no Lot lines identifiable ye no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its prennature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §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 andlor (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 Deparhnent 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 & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms ~_ 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. 08/05) VGi. 153C7PAGi 498 STATE BAR OF WISCONSIN FORM 2 - 1949 Document'Numbet WARRANTI' DEED This Deed, made between RICHARD LOUIS TORGERSON & ROBERT TORGERSZIR - Grantor, and Jay Uldtych and Jeanette Uldrych, husband and wife Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): 39ao Lot One (I) of Certified Survey Map in Volume Fourteen (14) of Certified Survey Maps, Page 3.iz26, as Document Number 627316, filed in St. Croix County Register of Deeds Office on July 31, 2000. Being located in the Northeast Quarter of the Southwest Quarter (NE '/, of S W '/,) of Section Four (4), Township Twenty Eight (ZS) North, Range Sixteen (16) West, Town of Eau Galle. 629C?S~ KATHLEEN H. WALSH kEGISTEk OF DEEDS ST_ GRDIX CO_, WI RECEIVED FOR RECORD Oi)-30-2DOD 1:3D P!i YARRAHTY DEED EXEIIRT li CERT COPY FEE: CORY FEE: TRRMSFER FEE: 60.00 RECDRDIkG FEE: 10.00 PAGES: f Recording Area Name and Return Address ~.- >dt CROEt~MiI.tEY7111tE .>fIC. PO~A PALJi~r YA S{tl2it AO-Cy,~~ oos-loll-lo-ooo t`1~iC.lA ooSr-Ioit-r~-iov Parcel Identification Number (PIN) This is not homestead property. QE) (is not) Exceptions to watTartties: Easements, restrictions and rights-of--way of record, if any. Dated this a`~ ~J day of August ZOOp Signature(s) AUTHENTICATION authenticated this day of , NE M. gARF30M ~ I.lotasy Wisconsin TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristintr Ogland Httdson, WI5401d {Signatures may be authenticated or acknowledged. Both are not necessary.) c~~ ~.% RICHARD LOUIS TORG S ~.,-~,.r~'fi12c, fry.,/ --- ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. ST CROIR County ) Personally came before me this ~~~ day of August 2000 the above named RICHARD L I ER~~~tOBERT TORGERSON to me [mown to be the person(s) who executed the foregoing instrument and acknowledged the same. • ~ ./~'" Notary Public, State of Wisconsin Ivly Commission is permanent. (If not, state expiration date: /o persons signing in any capacity must be typed or printed below their signature, ~nramiatwn vroraeaJOrwa Company. Fond du tae, YN SPATE BAR OF WISCONSIN eoo-sss.~oZr WARRANTY DEED FORM No.2- 1999 ~_____ 11v1~~sT _ - ~-~~_ -- __A ~ _ 60' S5' I _ ~ !Y T/~r ~ i IO ~.`1``` ~_ I I CENTERLINE OF EAST BOUND LANE ` j ~-, tJ ~ ~` I ~~ I ~ ~,.,~ I ~ ~ ~. ........ ~ \.1. ..... I 1 .. ......., - ti. ~ ~: I ~ ~ i2 -''----..- 8UlCDING SfTBACk LlNf •...~.- _.,;•„• ® ~.. \• .` ~`'~ ,.. i '- - O "~' ~.. I W ~~ I to ., y ~'0 j H~ ate.... O5 O -'I ~...~,,,~ ~ ~. Iry I~ LOT 1_C_S_M.ry l ~j~ S78~ x LOT 1 ~ _~ _,~ _ '~ ~3"E I M , 100' 1 ~ 2.98 ACRES h `, B.M. TOP OF 1 O ~ 1 129 634 ~' ~ ~ `°°.. ~ 355.4 j~ I PIPE: 1249.5' I i NOUSE ~ -~- _ .. -~`, S86'S2'45"E ~ ~ a ~v / ~ ~ ~ ` LOT 2 ~-~~'~ I 0 150.15'. I 469.09 ~ ~~p~'~' /~ Z ~ ~ ~ JOINT DRN~WAY I ~ ,318.94 4.93 ACRES I ~ I EASEME I ~ i ~ PAGE 3920 °~/yo ~,`~ 1Q~ 214,578 SQ. Fl: I '0 ~ ~ 150.15' 1 ~ I `° ~~ ~' ~ry I -~ I ~~-- 86'52'45 "E ~ ~ 58.65 52.56' l N86'S2 45 ~ i O 1251.89 523.49' O SOUTt! LINE OF THE NE i/4 OF THE SW 1/4 ~ i 33'I 33'I B.M, TOP OF 1" IRON ________ i i i PIPE: 1250,0' ~ i~ I I r I i~ I I ~ I .CERTIFIED SURVEY MAP ~ ~ ~ ~ ~ UTI Lf ~ ~ VOLUME 14, PAGE 3855 ~ NO POI - - - - ~ N THE IN. OBSTRU I THE DI; ~ VIOLATII I ~~gC01ys~ FOR TH ~ HAVING 1306.99' ~ R . ~ ~._._._._._._ s~~ _._._ ~ < rm~ a 11 t ~ ~ t t y M ~T. o ~ -. < `ay~ ~1~ h ~ S ~~ OO~ 1. p p i W ~~ O~i1N xx O~ t = W _ ~r 1~ ~r F.1. ypN s .. ~ ~~ ~~ a ~ Q ! ~~i1 ~< O~ ~ ~~ W W ~ ~ k-'N ~ >~ F 4V ~ t~ ~= ~ zo - ~ti '~'~' ~ /-f- - ~ ff ~ 00 ~2 ~Y 1 •p =C ~b .1 .1 ~Wy<T ` ~i Wy !Ot is~ ~1p3`~ ~ t< W~ - G N I~ e I ~~ ,UNPLATTEO LANDS I j rr ~ ......................! ~ , ~, I 1 'ice `~ • ``~ I ~M~ Ili,` t~_~~ ~ •il ~ ~ ~~ Q i ~~. ~ I a O ~ I ,S/ '1 1 ~ =~ Q ~ ~ I / ilk i ~ ~•- N 2 1•~ ~. ~ 1 r 1 ~~ J LY ~' ~ ' ~ '/~ i 1• ~ ~ O =~ O ~• ~ ~ I ~ I III A' / I I o~ a: a: ~ w ~ t: ~ ~ ~ I ,t'~ `~a' ~ III IIII I « ~ y M _ ^ ~ I ~ 1„-~ .1 ggK~- N ' 1, • F ~ I`I III ~ ~ ~ a W 3~i 1 'lll II` ~ %=' yr rr I ~ ~s~.% i ., II III e a ~ '"`i ~~ I ~ '°• IIII ~' ,I ~ ~~, ~ ~ 1 . k 1 i ~ I ~s~ • ~I~~1 a - -- .- , w I I ~ j.--,.,.... ; I 1 1 I 1 I 1 1 y 1 I I J--_~ .........~ K • - 1. ~T1W,~p~~'~yI I :1 1 • 1 I `r ~ ~ •..~.- `I i1 N• i 1 ~~Ij11L011N ~KT~AC} L IIK ~ ~ i _b _ 1 1 11 ~~l 1 233RD - - - - - C ~ :.:;. _ ~- r; i.,_ _ I '~°~'°•` - - -. STREET ------I{-- ~ -~-=~~ - ~ ~ ~ `~ _ 4 _ _ Iwws:• i.•E i ~~~ lt- ----~--- --~----~--==-=-----~ MEiTL11E0f71ENE-SW ~~ I y ! I ~ Q ~ I ,1 I I CERTIFIED SURVEY MAP ~~ I ~ ~ ......................._.............................. I ~~ i ~ ! I VOLUME 14, PAGE 3885 ~ , I I ...............................»..................... ~I;fi I ~ I ZONED AG-RESIDENTIAL o W _~ w~ N 'f? J w IW ~ • ~_ ~~s a -I~ 1 ~~ '~ 3 34 O Dy W i^~ yy~ p ~~ 8~ ~~ti ~• o ~+«- :ga .. $ i;.a:, p2 -11~1: J j ~~b ~ ~~~ __j s $~~ ~~ ass ~ ~J ~_ O >< a8 . 1~ ~~ _ •.1 o i W K )r W ~~ ~~ W ~w W W 1 0 )w 2 i W ~~ #~ ~€ rte..,,- .; ;,;x: ~t . 1 ' ~y.., . ;ia t:f; i . •.'~ : 'kr:' . i:; '~~~'~, ,•, i. ..•~ t