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HomeMy WebLinkAbout008-1077-20-000 Wisconsin l9epartment of Commerce PRIVATE SEWAGE SYSTEM county: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 399512 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: Falde, Verl n I Eau Galle Township 008 - 1077 -20 -000 CST BM Elev: Insp. BM Elev: BM Description: ��. 3,7z- �, e 5" TANK INFORMATION ELEV TION ATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ( /� Benchmark p fCSc r ( / Dosing Alt. BM c� U 4Holdi Bldg. Sewer , / / "I j. 3 !9—It Inlet / 5 St/Ht 1111let r TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ( O , / Dt Bottom Dosing yi ©/ Z Header /Man. y/ O Aeration Dist. Pipe 1� Z Holdin Bot. System 0 CP q, 6 it f inal Grade PUMP /SIPHON INFORMATION 5 Manufacturer Demand' St Cover 3 22 e GPM L Model Number TDH Li Friction Loss System ead TDH S Ft Forcemain ength ia, fi Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. L id Depth DIMENSIONS / ,9 r y ail SETBACK SYSTEM TO P/L BLDG Q• � WELL LAKE/STREAM L G M er. INFORMATION CHAMSE Type Of System: 3 � S © IT Mo ehA imber. DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole ize x Hole Spacing Vent to Air Intake Pipe(s) ee Length ' Dia 1 1 1 7 - Length I Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of eeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil xx S Yes [� No Fill] Yes Fill] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Parcel No Inspection #2:: : E7 2 8.16.402 Location: 2459 20th Avenue Baldwin, WI 54002 (NW 1i4 NE 114 27 T28N R16W) NA Q Lot S P ( D wl rq,�.+�5 1.) Alt BM Description = 2.) Bldg sewer length - amount of cover = 3.) Contour= �/ S 9 / p z J '2� g 3 Plan revision Required? In] Yes N Use other side for additional information. �► SBD -6710 (R.3197) ate Insepctor's Sign re Cert. No. z z ��/✓� o ^ Z !l 3, 0 Sanitary Permit Application Safety & Buildings Division in accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 �SCG111$flt Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 completed Qepartment of Commerce (Privacy Law, s. 15.04(l)(m)J ( Submit P leted form to county if not state owned. Attach complete plans to the county co only) for the stem; o" paper not less than 8 -1/2 x I 1 inches in size. County State Sanitary Permit Number ❑ Ch, , if,#Vision to previous application Stat Plan I. D. Number t- C - O 3 9 s I. A ilication Information - Please Print all Information Location: Property Owner Name Property Location �' !JAA6 /4,S2- ZT2 W Lot Number Block Number in Address Ownet' s Marl - Property g Ci State / Zip Code Phone Num� "` Subdivision Name or CSM Number ty, /�a.CclWin c.J�• S�11� ? �S'...GeBiE - - ❑city II. Type of Building: (check one) ❑ vill 2" 1 or 2 Family Dwelling - No. of Bedrooms : GY?rw of ❑ Public/Commercial (describe use):_ ❑ State -Owned Nearest Road Parcel Tax Number(s)008_ O -2+0 III. T e of Permit: Check only one box on line A. Check box on line B if a2plicabl e �❑ Addition to A) 1. ❑ New 2. eplacement 3. ❑ Replacement of 4. 5 6. ExA Ad d System 5 stem S stem Tank Onl Date Issued B) Permit Number ❑ A Sanity Permit was previously issued IV. Type of POWT System: (Check all that apply) _ • Non - pressurized In- ground - < � ound (� X D ❑ Sand Filter ❑Constructed Wetland 11 • Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line • At-grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: - d z s S G 3 l . Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area r4. oil Application 5. Percolation Rate 6. System Elevation Elevation Grad Required Proposed e (Galslday /sq. ft.) (MinJinch) ys0 5fS0 yso 9 - 7 as 98.8' VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fi Plastic Information Gallons Gallons Tanks Con- Con- S ass New Existing crete structed Tanks Tanks ❑ ❑ ❑ ❑ mow, b,�► y-► -- cPJO / w ( se. cone- ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, assume res. nsibili for installation of the POWTS shown on the attached lams. Business Phone T:urnber Plumbees Name (print) Plumper' Si atare (n ps) M1:11vIPRS No. � 1, Z2So3G (7/ 38G - & 9,7 - *=4s Address (Street, City, State, Zip Code) / 44k✓ d TY016 IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee Date Issued Issuing Agent Signature (No stamps) Approved ❑ Owner Given Initial Adverse Surcharge Fce Determination z X. Conditions of Approval /Reasons for Disapproval: I. Effluent filter to be installed and maintained per manufacturer's recommendations. 2. The existing system shall be abandoned per code requirements (Comm 83.33). i • + Safety and Buildings 4003 N KINNEY. COULEE RD LA CROSSE WI 54601 -1831 TD #: (608) 264 -8777 erc �seonsin www.wisconsin.gov .wis c ons .wisonsin.gov Department of Commerce Scott McCallum, Governor Philip Edw. Albert, Acting Secretary September 25, 2001 CUST ID No.225036 A7TN: POWTS Inspector ZONING OFFICE MICHAEL P MC DONELL ST CROIX COUNTY SPIA 340 PAULSON LAKE LANE 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/25/2003 Identification Numbers Transaction ID No. 675483 SITE: Site ID No. 636030 VERLYN FALDE Please refer to both identification numbers, 20TH AV above, in all correspondence with the agency. TOWN OF EAU GALLE ST CROIX COUNTY NW1 /4, NEIA, S27, T28N, R16W FOR: DESCRIPTION: THREE BEDROOM MOUND SYSTEM OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 811894 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: • 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.01 101) and the SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST SAS (0 1/8 1) • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the Mound manual, and the pressure distribution component manual are complied with. A copy of this letter including instructions and information relating to proper use and maintenance of the system must be given to the owner and each subsequent owner upon completion of the project. • The existing POWTS must be properly abandoned per Comm 83.33 Wisc.Adm. Code. • Access to the filter for cleaning must be provided per Comm 84 product approval conditions. Maintenance information must be given to the owner of. ' the tank explaining that periodic cleaning of the filter is required • 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. • Comm 83.52(3) The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. MICHAEL P MC DONELL Page 2 9/25/01 • 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). In addition, 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. • 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. • 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. Stats. 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/instal lation /operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 � BALANCE DUE $ 0.00 Charles L Bratz POWTS Plan reviewer 11- Integrated Services WiSMART code: 7633 (608) 789 -7893, Mon. -Fri. 7:45 AM to 4:30 PM cbratz @commerce. state. wi.us cc: VERLYN FALDE Y MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Veriyn Falde 3 bedroom residential mound Owner's Name: Verlyn Falde Owner's Address: 229 Co. Hwy BB Baldwin, WI 54002 Legal Description: NW1 /4NE1 /4, Sec.27, T.28N., R.16W. Township: Eau Galle County: St. Croix Subdivision Name: na Lot Number. na Block Number: na Parcel I.D. Number: 008- 1077 -20 -000 Plan Transaction No.: RECEIVED Page 1 Index and title S EP 10 2001 Page 2 Data entry SAFETY C©nd clo n ally Page 3 Mound drawings & B L D G S DIV. = ����� j� Page 4 Lateral and dose tank �,j Page 5 System maintenance specifications DEPMRTNENT OF COMMERCE Page 6 Management and contingency plan D Hcs Page 7 Pump curve and specifications � Page 8 Site Plan �� Page 9 Soil Evaluation Report Designer: Mike McDOnell License Number. 225036 Date: 09/05/01 Phone Number. 715- 386 -8692 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 (03/01101) Pagel 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 300.00 Estimated Wastewater Flow (gpd) Table $344•3 in -situ sal treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of - 36 inches. 450.00 Design Flow (gpd) 6.50 Site Slope ( %) 95.80 Contour Line Elevation (ft) 21.00 Depth to Limiting Factor (in) 0.50 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 90.00 Dispersal Cell Length Along Contour (ft) = 5.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpde) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (c or e) c Center or End Manifold 2.50 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) 2.50 Estimated Orifice Spacing (ft) = 6.25 a /orifice 2.00 Forcemain Diameter (in) 60.00 Forcemain Length (ft) Does the forcemain drain back? Y 86.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 9.79 Forcemain Drainback (gal) 10.55 Vertical Lift (ft) 81.25 5x Void Volume (gal) 1.14 Friction Loss (ft) 91.03 Minimum Dose Volume (gal) 18.19 Total Dynamic Head (ft) 29.66 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia o lions I choice in. dia. options I choice 0.75 1.25 x 1.00 x 1.50 x x 1.25 x 2.00 1.50 x x 3.00 2.00 j x 3.00 x Gallons /Inch Calculator (optional) Treatment Tank Information 602.82 Total Tank Capacity (gal) 1000.00 Septic Tank Capacity (gal) 51.00 Total Working Liquid Depth (in) Wieser Conc. combo. Manufacturer 11.821 galAn (enter result in cell B49) Dose Tank Information Effluent Filter Information 600.00 Dose Tank Capacity (gal) Zabel Filter Manufacturer 11.82 Dose Tank Volume (galfin) Al 00 Filter Model Number Wieser Concrete Manufacturer Project: Verlyn Falde 3 bedroom residential mound Page 2 of 9 Mound Plan View T .0 . J 11 F K B Observation Pipe 3 0 A W B F . r �. . .. ................ I ..................... L Mound Component Dimensions A 5.00 ft E 18.90 in H 1.00 ft K [ Aft ft B 90.00 ft F 9.50 in 1 10.68 ft L ft D 15.00 in G 0.50 ft J 6.38 ft W 450.00 (fe) Dispersal Cell Area 1411.49 (ft Basal Area Available 5.00 (gpd/ft) Linear Loading Rate 9.00 (ft) 1110 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 98.84 (ft) ---► H ow' G lfriir/ /�rifr I F r Dispersal Celi 97.55 (ft) Lateral Later 97.05 (ft)—► — Dispersal Cell Elevatio . E D 3 ' 95.80 (ft) Contour Elevation 6.5 % Site Slope Geote)Qile Fabric Cover Shading Key Dispersal Cell See lateral details on $. � Dis p 1� Topsoil Cap 1.5 ft Page 4 for number, Subsoil Cap 0 0 � t� ; �C� � size, and spacing of ASTM C33 Sand F t6 1 ° / `` laterals. Laterals are '1 Typical Lateral C� Tilled Layer = 0.5 ft equally spaced from 05 Aggregate a c the distribution cell's centerline in the distribution cell (AxB). Project: Verlyn Falde 3 bedroom residential mound Page 3 of 9 I Center Connection Lateral Layout Daigram Force main connection via tee or cross to manifold at ang point. Laterals are identical I P Lir e= Turn -up va'ball valve or (E X— >IEx I x12->I Laterals & force main of PVC Sch 40 clean out plug per COMM Table 84.30 -5 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 44.28 ft Orifices per Lateral 18 Lateral Spacing (S) 2.50 ft Orifice Density 6.25 fe /orifice Lateral Flow Rate 7.41 gpm Manifold Length 2.50 ft System Flow Rate 29.66 gpm Manifold Diameter 1.50 in Total Dynamic Head 18.19 ft Forcemain Velocity 3.03 ft/sec Dose Tank Information Locking cover with waming label and locking device and sealed watertight Electrical as per NEC 300 and - -► Comm 16.28 WAC 4 in. min. Disconnect component is property vented �— Aftemate outlet location Forcemain diameter Wieser Conc. combo. Manufacturer �_ 2 in. Ca ac' 600.00 Gallons Volume 11.82 galAnch A Weep hole or anti - Dimension Inches Gallons B siphon device A 28.9 342.56 B 2.00 23.64 C Pump off elevation (ft) C 7.78 91.96 87.00 D 12.00 141.84 D Total 50.76 600.00 ir – J ♦ Dose tank elevation (ft) 3" Bedding un er tank. 86.00 Alarm Manuafacturer LevelArm Alarm Model Number DLV Pump Manufacturer Zoeller Pump Model Number #98 Pump Must Deliver 29.66 gpm at 18.19 ft TDH Project: Verlyn Fatde 3 bedroom residential mound Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name J. Thompson, POWTS INSP.#4819 Phone 715 - 248 -3271 POWTS Regulator's Name St. Croix County Zoning Phone 715- 386-4680 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 Tank Septic Cap 1000 al Maximum TSS 150 mg /L P P �Y 9 Soil Absorption Component Size 450 ft' Maximum FOG 30 mg/L Type of Wastewaterl Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) PressureSystem Laterals should be flushed and pressure tested every 1.5 years Moundl 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 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 I �''y Long Lat er a Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Verlyn Falde 3 bedroom residential mound Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals (SBD- 10691 -P (N.01/01) and SSWMP Publication 9.6 (01/81)] and kxcal 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, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The fitter cartridge should not be renwved 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 alarm, the fitter shall be serviced if the alarm is activated continuously. Intermittent fitter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent fitter 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 qual vty into the mound system may not exceed 220 mg/L BOD 150 nVL TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD 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 tt should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal 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 Rs' 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* of this plan for the name and telephone number of your local POWTS regulator and service provider. 5 Project: Vedyn Falde 3 bedroom residential mound Page 6 of 9 HEADICAPACITY CURVE EFFLUENT and DEWATERING WARNING: Model 18514185 should not be subjected to less than 30 feet 1 Dfl. TOTAL DYNAMIC HEAD/CAPACITY PER MINUT E I L9 14014110 16 114 16 1 Ill IJ4iLl 65N 1!1161 16S 14S"I &&AIA6 1 61 1161 __ 1 I7 m I" CAI Um. G11 L" GaL L1% G11 l Gal l Goi l GO LkL GAL L". G,; Ch G., L" Q'I L. Lt, GII t. 1,S 16 41 28 . )4 104 13 163 _72 213_ 13_152 M 354 M 401 t, 231 61 21I 11 220 M 1,41? ISS IS 1?0 21 11 121 61 211 7 _9 so 341 0o�7 8 11 ljl 61 231 so no "I mg I S 1 6 1S 0 Z 4 3 1 Aw Is 135-- J 4 L- -- 7 11 7 -s� Z --L- 1 -- !o 227 0 W SID 14 2 SJ7 20 2 S 1 11 2S Is A Ix T3 274 3io $1 Z21 60 221 220 116 SIS 110 f () 1 25 7.112 i0 43 210 74 211 $7 211 S9 221 S1 229 IN 444 111 V J I 1S 190 I — — 13G 30 1 14 13 701 65 244 $5 2IS1 Sa 220 90 SAO S I U0 121 444 l i 12 4, 1 15 JO 40 1111 30 lilt 46 174 16 In 33 zet 15 261 5, no to$ 1S 1'0 125- - 21 so 33 12 - 5 1 1 S& - 219 - 5 - 8 -- 22 -0 1-0--3341-17 1 - -4 3'� 1 1 AS 17C 10 1e19 I is $7 43 161 36 )11 11 221 11 111 11 3 AS "9 1 20 - 70 21.11 _10 Ill 10 38 52 117 51 111 70 2t 5 1S , 7! 191 _11 14. 1 A $3 7C -2-6 -104-� 90 27AI 12 121 2 1 17 1 1 s ilg too 30,41 2 0 ILOO 7 26 30 1 14 U5-- 130 29.62 10 . 214 2' 1115 26 16 ir 1 00 29 1 86, a1 86 20 —_8S 85 1 E35, so 2 75-- 4 15 2 N. 70-- E3 4 4189 4 5 2 40-- 140, 188, 40_ 188 J - 4 ---- 30-- d — 25-- 13 139 4185 /9 140 I 4 4 J- 2 It 4 43 48 48 53,55 98 161 ' 57,5 4 161 0 2 U !,0 40 -- �0 601 7 U 80 1 90 100 �1 1 0 1 2 0 �1 3 0 1 40 150 16 j,cZS 80 16C 240 320 400 480 560 640 FLOW PEI? MINUIE 5 1 r u, Note: For He�d Capacity on Model l �, industrial column- explosion pr000f pump, see FMO219, P ' Aye ti • E /ec/ao� b' f I 5ca � I �f � /Sla� SYS�r►^� i7� 6� Q ban d LO( as fOer code lyn fla nw /7 e; s.z'?, Tn. L 3 '10 P. V. c. d ,4 3 c,u,er: P,o�osed �,�0 /600.! /ors ComhinaE,bn S.T.�pC. 3 bcd 2a be /,4 -iad e Arlo e-, 6 4 S.T,occt/e lesfdwue well;Avat 9ic ' P p u M, p hour 63 -- _ 2 "Sek.vo P. e� - ��G i � � � �_ f0 /GLM1Qin Sft ✓t!J 9QrQ�C — ��^_c"L� 8.Z 'J�c�i AsScemCct =—A 5: 1I p /a, e Y v_ = 9,772' Ntac-4;ne Sid j 1461 Wisconsin department of Commerce SOIL EVALUATION REPORT page 1 of 3 Division of Safety and Buildings with Cormn 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations 1 Attach complete site plan on p n 8 % :' t xl I in in size. ounty e. Plan must St. Croix include, but not limited to. v tal reference point ), direction and percent slope, scale or dim north an W ion and fence to nearest road. Parcel I.D. - � "0 008- 1077- 20 -000, tD#27.28.18.402 PI Hint all \ --------------------------- - - - - -- ---------------- `_ By Date Personal Informatlon you ?may *"v secondary (Pmaq Law. s. 15.04 (1) (m)). 1 Property Location Ve n F aal d e r d� ST �p0� ' Govt Lot NW 1/4 NE 1/4 S 27 T 28 N R 16 W Property Owners Mailing Add G Lot # Block # Subd. Name or CSM# 229 Co. Hwy BB City S City Village ✓ Town Nearest Road Baldwin WI *684 - 2230 Eau Galle 1 2459 20Th Ave. ✓ New Construction Use: ✓ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Descxibe: Parent material Glacial Till Flood plain elevation, if applicable na General comments and recommendations: Mound system elev. = 97.05' at 15" above 95.80' contour. a Pit � �� # ✓ Pit � Ground Surface elev. 94.78 ft. 21" in. Sot De�t1 to limiting factor Application Rnte Horizon Depth Dominant Cots Redox Description Texture Structure Consistence Boundary Roots GPDRP 'Eff#1 *E 1 - 0 -11 10yr3 /3 none sil 2%bk ds as 2f,1m 0.5 ✓ 0.8 2 11 -21 10yr6 /4 none sit 2msbk ds cw 1 0.5 0.8/ 3 21 -24 10yr5/4 f2d 7.5yr5/8 sil 2msbk ds aw if 0.5- 0.8 4 - 2440 7.5yr4/6 f2d 7.5yr6/8 sl 2msbk dsh gw - 0.5 0.9/ 5 40-63 7.5yr4/6 f2d 7.5yr6/8 sl 1 csbk mfi - - 0.4 ✓ 0.6 ✓ Boring # Boring ✓ Pit Ground Surface elev. 94.65 ft. Depth to limiting factor 24" in. Sat Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots 'Eff#1 PD /ft= 1 0 -8 10yr3/3 none sil 2fsbk ds as 2f,1m 0.5 ✓ 0.8 ✓ 2 8 -20 10yr4 /4 none sil 2msbk ds cw 1fm 0.5 0.8 r 3 20 -24 10yr5/4 none sil 2msbk ds aw 1f 0.5 0.8✓ 4 24 -34 7.5yr4/6 f2d 7.5yr6/8 sl 2msbk dsh gw - 0.5 0.9✓ 5 34 -51 7.5yr4/6 f2d 7.5yr6 /8 $l 1 csbk mfi - - 0.4 0.6 ✓ " Effluent #1 = BOD ? 30 < 220 mg/L and TSS > < 150 mg/L ' E - BOD <_30 ng/L and TSS <_30 mg& CST Name (Please Print) Sig re: CST Number James K. Thompson 3602 Address ACE Soil & Site Evaluations D Evaluation Conducted Telephone Number 340 Paulson Lake Larne, Osceola, WI 54020 9/1/01 715- 248 -7767 Property Owner Verlyn Falde Parcel ID # _ 00& 1077- 20= 000,ID #27.28.16.402 Page _2 — of - _3_- F3 Boring # - ! ✓Pit Ground Surface elev. —_ 96.63 _ __ ft. Depth to limiting factor 22" ___ in. Soil Application Rate Horizon I Depth Dominant Color Redox Description Texture Structure Consistence I Boundary Roots *Eff#1 *Eff#2 1 I 0 -7 10yr3 /3 none sil 2fsbk ds as 2f,1m 0.5 ✓I 0.8 ✓ 2 a 7 -22 10yr5/4 none sil 2msbk ds cw Urn 0.5 ✓ 0.8 3 22 -25 10yr5 /4 f2d 7.5yr5/8 sil 2msbk ds aw 1f 0.5 i 0.8 4 25-36 7.5yr4/6 f2d 7.5yr6/8 sl 2msbk dh gw 0.5 ✓I 0.9 ✓ 5 36-53 7.5yr4/6 f2d 7.5yr6/8 sl 1 csbk mf - 0.4 ✓ 0.6/ I ; Boring # Bori Pit Ground Surface elev. _ ft. Depth to limiting factor - in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots L __ _ SPQIft' *Eff#1 'Eff#2 i i 1 -- -- -- - ------ -- - - 1 - - _ _ -__ I _ __ -_.__. ❑ Boring # 1 Boring ; Pit Ground Surface elev. _ ____ ___ ft• Depth to limiting factor _ in. Soil Application Rate Horizon Depth i Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 I� ? I Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD <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 contaLt the devartment at 608- 266 -3151 orTTY 608 -264 -8777. d � ys S 0, eV6 /44a�i6 h A E /evao� ca b� tt 3 aban don C& &S per code . I tl' ► n 1 a /fie e ,-op. nwlie s.z7, r,,. o� 3w 3 AL b 3 6 cd I'esrdence We11 ; r'o' puw,P hoes ez 5;dl . Ass ,&•ncd e1e /00.cc E L act&m o-P 9. 72' p� 3 o�3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Ills 1., n AZ(AL Mailing Address Z � Co. �wY Property Address 2 - `1 � ZO �/E •, &I ilA &,) I SSFGdZ (Verification required from Planning Department for new construction) City /State Parcel Identification Number 008 - /07 7 - ck�y LEGAL DESCRIPTION Property Location f) 0 V4, P L V4, Sec. 2L7 . T I N -R. _ W, Town of &Q-0 QA Subdivision Lot # `— Certified Survey Map # , Volume , Page # Warranty Deed # , Volume , Page # Spec house ❑ yes C-tio Lot lines identifiable es ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNATLJkE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. 14 / SIGNAT OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed �5y DEED RECORD VOL. 298 WARRANTY DEED. STATE OF WISCONSIN —FORM No. 9 This Indenture, Made b Hilda Plelson 22b6'44 grantor , of St. Croix County, Wisconsin, hereby conveys and warrants to Vcrlyn L. ;aide grantee of St. Croix County, Wisconsin, for the sum of Six Thousand and No /100 Dollars tho following tract of land in St Croix County, State of Wisconsin: The North West Quarter (NWT) of the North zast quarter (NF- and the North Half (NI) of the South West Quarter (SW�) of the North East Quarter (NE1) all in Section Twenty— seven (27) Township Twenty —eight (28) North of Range Sixteen (16) West, subject, however, to Easements heretofore granted to Dairyland Power Cooper,itive and now of record in the office of the Register of Deeds of St. Croix County, Wisconsin. � ( Can.) IN WITNESS WHEREOF, the said grantor ha s hereunto set her hand and seal this 9th day of February A. D., 19 50 . Signed and Sealed in Presence of Hilda Nelson (SEAL) S.Swenumson Hilda Nelson S.Swenumson Newman Strumstad (SEAL) Newman Strumstad _ (SEAL) STATE OF WISCONSIN, ac. (SEAL) zo ♦ E /eva b� V I � 4/ / a bando ned as per Ceole. !/er tild P ,-op. nwl7e; s.z7 Tn. a� Fau Caa / %� S6• croi�C �; 350 (t 3 Pao p c sad ,.. vo P raeo sed !, e/oo /goo �.! /cr, ��':s6%►, Corn Am a&ro S.T.�pe.� 3 bcd �'�lEerci r, ocd It 4 . reS well;nS;de 9i,o' P PALMY p It o us ■ 2 "Sch.vo jo C. , .� '� .� _ 1 - 7�'O /LC►MKin S�CQ ✓I-d t 94rQ,sl.. Q yo , 73&5 --�■ flu 8'Z 5#c�.i ✓1q. ASSccmGc� E 8. l3 ot�orn o{' 5; lI p ac-4 S tc_d �� of