The URL can be used to link to this page

Home My WebLink About008-1083-80-100DepartrxentofCommerce PRIVATE SEWAGE SYSTEM Buildirig Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT} Personal information yoo isrovide may be used for secondary purposes [Privacy Law, s.15.04 (1 }(m)l. Permit Holder's Name: City Village X Township Larson, Scott A. & Barbara Eau Gaile, Town of CST BM Elev: Insp. BM Elev: BM Description: / ~ tt / 4 ti~0~ L..e.~ ~.. TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing `~ ` ~ ~ a~ Aeration .~ Holding ~ ~ T TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing t 1 ~ r Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM ~ Model Number ~ ~ n ~{ (_ ,"~ V J tG ~ TDH L~ Za Friction Los System H ad ~ TD t ~ O Forcemain Length, ~ Dia.Z r/ Dist. to W~ ,~ , i SOIL ABSORPTION SYSTEM County: St. Cr01X Sanitary Permit No: 514979 0 State Plan ID No: Parcel Tax No: 008-1083-80-100 Section/town/Range/Map No: 29.28.16.4440 ELEVATION DATA STATION BS HI FS ELEV. Benchmark ~~~•3 ~d~ Alt. BM (~ ,~.0~ /O`,~ ~ . ~ Bld .Sewer f~, ~ ~` ~ >, t ti SUHt Inlet St/Ht Outlet Dt Inlet Dt Bottom q/~ 3~ Header/Man. G. J f ~s ~~ Dist. Pipe ~, f ` J ~ ~` 6S eot. System -' ~ Final Grade ~, ! ~ ~OD• ~07 St Cover St Cover a.ti~a~ ' /O~ cam. ~'` ~ .?Io 47. 5 ~ BEDITRENCH Width ~ Length / No. Of ench PIT DIMENSIONS ~ No. Of Pits Inside Dia. Liquid Depth DIMENSIONS / /Aa LJ ~ ^~-- ~--- "~~ SETBACK SYSTEM TO P/L BLDG WELL LAKEISTREAM LEACHING Manufacturer: INFORMATION CHAMBER OR ~~ Type stem: a~ ~. > 7J~9 i 7isc ,(/ ~V UNIT Model Number: DISTRIBUTION SYSTEM ~°""~ L~S;~hst ~ex?SO Header/Manif~ i~ Length Dia ~•~ Distribution i/ f ~f~ ~ t Length ` ,' 2 Dia ~+ z`~ Spacing 3 x Hole Size J ~/~ x Hole Spacing / c ~• Z 7 Ven o Air Intak / ~ ~ SOIL COVER / x Pressure Systems Onty xx Mound Or At-Grade Systems ~nlv De th Over Bed/Trench Center 1 ~ 3 De th Over Bed/Trench Edges \ xx De th of Topsoil ~ ~~ xx SeededlSodded xx Mulched ~ r yes [] No ~Yes [ No COMMENTS: (Include code discrepencies, persons present, etc.} Inspection #1: ~ 1 ~ ? / ~ ~ Inspection #2: / / Location: 2248 10th Ave e Baldwin, WI 54002 {SE 1/4 SW 4 29 T28N R16W) NA t 1 ~',,,;.~2. ~ P cel No: 29.28.16.4440 }.)Alt BM Description = ~`"'~' ~ ~~ ~ ` 6 ~ ~lJ /y ~~4 ~,~. ~ ~~ Or..w.1 Q~ 2.) Bldg sewer length = ~ i ~/ '~ ~ J'Q.A~. -amount of cover =.~j(l ~~~ Plan revision Required? [] Yes No I C~~~1 ~- Use other side for additional information. ~1 ~ ~ ~ ~'! i-'j ~ __ _ _ _ i ~~~ SBD-6770 (R.3/97) Date Insepcto Signatur Cert. No. ~•~ O~ f I~cv,S~ rm - Mme., Corstmerce.wLgoV .Safety and Buildings Division County ~ * 201 W. Washington Ave., P.O. Box 7162 ST. CROIX i scons i n Madison, WI 53707-7 162 Sanitary Perm it Num r (to be filled in by Co.) be Department of Commerce ( ~ J 5/ / "'1 Sanitary Permit Application actt f Number 1579420 In accordance with s. Comm. 83.21(2}, Wis. Adm. Code, submission of this n to the appropriate `~ ~o~ll~+e~+nhd. governmental unit is required prior to obtaining a sanitary permit. Note: Applicafion forms project Address (if different than mailing address) POWTS are submitted to the Department of Commerce. Personal information you provide may be used for secondary u ses in accordance with the Privacy Law, s. 15.04(1)(m} ~ ~ I. A lication Information -Plea se Print All Information G .~ Property Owner's Name Parcel # 00$-1083-80- SCOTT & BARBARA CARSON Property Owner's Mailing Address Property Location 2248 10TH AVENUE /'' ST. CROIX COU Govt. Lot City, State Zip Code 11V('rrtTf£'ifiICE SE '/ ,sw ~/a , e8tion 2~ BALDWIN, WI 54002 715-684-3339 (circle one) w II. Type of Building (check all that apply} Lot # T 28 N; R 16 ®i or 2 Family Dwelling - Number of Bedrooms 4 Subdivision Name ~~~~ ~ ~~ ~ ~ ~~ ^ Block # Public/Commercial - Describe Use ^ city of N/A ^ State Owned - Describe Use CSM Number ^ Village of VOL. 11, PG. 2970 ®Townof EAU GALLE III. Type of Permit: (Check only one box on line A. Complete li ne B if applicable} A. ^ New. System ®Replacement ^ Treatment/Ho]ding Tank Replacement Only ^ Other Modification to Existing System (explain) System ------. B ^ Permit ^ Permit Revision ®Change of ^ Permit Transfer to List Previous Permit Nu ber~d Date Issued . ~~' 3 / 7 ,.. ~ ~ ~ Renewal Before Plumber New Owner / " ! ,, 7~ L ~ Ex iration ------ Z /v N~'t/ IV. e of POWTS S stem/Com onent/Device: (Check all that a I ) oil ^ Non-Pressurized In-Ground ^ Pressurized In-Ground ^ At-Grade ^ Mound > 24 in. of suitable soil ®Mound < 24 in. of suitable s ^ Holding Tank ^ Other Dispersal Component (explain} ~ ^ Pretreatment Device (explain} p C~r,~2 f ~ S V. Dis ersaUTreatment Area Information: . S Design Flow (gpd) Design S it Application Rate(gpdsf) Dispers Area R t ed (sf) Dis rsal A a Proposed (sf) yttem Ele tion 5 ~~~~~ 600 1.00 p, ~9U 600 /ate 600 3/// 96~1~ VI. Tank Info Capacity in Total # of Manufacturer A Gallons Gallons Units ~ ~ V ~ a a ~ ~ v Tanks Existing Tanks "" zo H ~ F pa a ~, a vs a. Septic or Holding Tank 1200 1200 1 WIESER CONCRETE ® ^ ^ ^ ^ hosing Chamber 1000 1000 1 WIESER CONCRETE ® ^ ^ ^ ^ VII. Responsibility ment- undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Sign r= MP/MP12S Number Business Phone Number BENNIE HELGESON 220292 715-772-3278 Plumber's Address (Street, City, State, Zip Code) W1229 770TH AVENUE, SPRING VALLEY, WI 54767 VI .Count /De artment Use Onl _ Approved _ Disapproved Permit Fee W Date Issued i Iss ' g Agent ignatur , Owner Given Reason for Denial $ {~~ o f ~ G'~-n./ IX. Conditions of ApprovaUReasons for Disapproval ~ i /. ,~~ I '_ 1~+~ ~~~ ~~ ~ ~li~v ' ` ~ (~ iyYl ~r / v v W Attach to complete plans £or the system anu subuut to me County only on paper not Less than a ui x i i mcnes m size SBD-6398 (R. 01/07) Valid thru 01109 f.~ GlcTe~T~ J'lu~ 1.~ /.~"o_' G.~cd~o/ 5; ~P x~ 6.t c/sc~r~ 6 y a~w~.~~: 0 ;~ ~ ~ ~ i ~ ~ 1, Pto sed "' ~'' ~b nfou.nd a.~ 3f sI.r'/.~.~.87 ~' d~~r~r: ~a~.~.~-» ~rs.~'.rr.~Cs'a.~ !.'/sir y~ sy.. ~~ ~~X' "o r, ~;'cb S S~ tt~'.cf s..~.9.~ -"--fir. ~~ u i ~' r1 ~ ~ ~~ \\\ l `+ ~~~ ,, • •~t \1 ~ '~ ~ • ~ ,, tit r` t`~ ~ • Lam, is u'r~ ~s~.ali c/e~' ~'~.~os~ Sc~,p~'~-6~,Carsor; ~ ~ StG,.zq 7; ZBiff A~''/d at3j ~ A' ,~~ 5*r c~dQS,~'- cad's. < < ~ ~ ~ ~ ~ ~ a~~ s ~ ~° < < s ` : ~ ~ ~ i ` ~` ~ ~ ~ '~ ~ ~ ~, ~ ~~ '• ~• `^r ~ ~ 1 ' M' `• ~ t` Q # ~~'..~ a~ ~~ t ~\ ti` rry~~ pp G % ~~ ` ""-iC ~ /r7e~r~~/a- . G°r/~s: ,s~~CS~rcI'~,ltv:' ,~1~ e~' ~a,:~.ti~ t.c 7~S'~ ~'l~''i~7~r- O~~2 ~j, ~ ~~~ 1~• d.rtl.: ~" o J~~x~~ M yI I f d~~ i k+'.~ i ~in J `.~ N ~ . ~. .~4jppfaX,/aca~`..~ • of yrttf- s." -Faru••w T .be u~'sc~n~res~a/ }~c7Ew~,do~~/. ,,. ,, ~',l~isgrin ~ ~Y1 ~~~ 8° ag< commerce.wi.gov isconsin Qepartment of Gommerce Safety and Buildings 3824 N CREEKSIDE LA HOLMEN WI 54636 TDD #: (608) 264-8777 www. commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Jack L. Fischer, A.I,A., Secretary august 19, Zoos CUST ID No. 220292 BENNIE W HELGESON HELGESON EXCAVATING W1229 770TH AVE SPRING VALLEY WI 54767 A7TN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL . PLAN APPROVAL EXPIRES: 08/19/2010 Identification Numbers Transaction ID No. 1579420 SITE: Site ID No. 722880 Scott & Barbara Larson Please refer to both identification numbers, 2248 10TH Avenue above,. in all comes ondeuce with the a enc . Town of Eau Galle St Croix County SE1/4, SWl/4, 529, T28N, R16W Lot: 1, Subdivision: CSM Vol. 11 Pg 2970 FOR: Description: Four Bedroom Mound System /Replacement construction / 1$% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1196701 Maintenance required; 600 GPD Flow rate; 18 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual- Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual- Version 2.0, SBD-10706-P (N.O1/O1) 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 s145.06, stats. `The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. • 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 ofSec. 145.20(Z)(d), Wis. Stats. • The area within 15 feet horizontally down slope of the dispersal cell shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • Maintenance information must be given to the owner of the tank explaining that periodic cleating of the effluent filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • A copy of the approved plans specifications and this letter shall be on•site during construc~~r~~ ms action b authorized re resentatives of the De artment which ma include local ' dtlOi?Cllly '~l ~0 DEPARTMENT OF COMMERCE .~~ BENNIE W HELGESON Owner Responsibilities: Page 2 8/19/2008 • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.Comm 83.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptab)r to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any ot~ers who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, , ~~~~~~ Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon -Fri, 7:15 am - 4:00 pm j erry. swim@wisconsin.gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ,Friday, 7:00 A.M. To 3:30 P.M. ~~ INDEX SHEET PROPERTY OWNER: SCOTT & BARBARA CARSON 2248 10TH AVE BALDWIN, WI 54002 PROJECT NAME: SCOTT & BARBARA CARSON RECEIVED A U G 15 2008 SAt=6-tY ~ BUILDINGS PROJECT LOCATION: SE 1/4, SW 1/4, S 29 T 28 N, R 16 W MUNICIPALITY: TOWNSHIP OF EAU GALLS COUNTY: ST. CROIX DESIGN: Mound Component Manual for POWTS Version 2.0 SDB-10691-P(N. O1/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) CONTENTS: Page 1: Index Sheet Page 2: Data Entry Page 3: Mound Drawings Page 4: Lateral and dose tank Page 5: System maintenance specifications Page 6: Management and contingency plan Page 7: Pump curve and specifications Page 8: Site Plan Page 9: Soil Evaluation Report Page 10: Existing POWTS Information Name: Benrve Helgeson Sig d Address: W 1229 770th Avenue Spring Valley, WI 54767 Credential Number: 220292 Date: August 13, 2008 V SEE. CGFt SPONUENCE Mound and Pressure Distribution Component Design Design Worksheet S_i_te Information (r or c) _~ R~ Residential or Commercial Design _ __._-- _ 400.00 Estimated Wastewater Flow (gpd) 1.50 Peaking Factor (e.g. 1.5 = 150%) 600.00 Design Flow (gpd) _ 18.001 Site Slope (%) 9_7.54? Contour Line Elevation (ft) ___"_18.001 Depth to Limiting Factor (in) 0.601, In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information _1.0.0.00; Dispersal Cell Length Along Contour (ft) _ 1._00; Dispersal Cell Design Loading Rate (gpd/ft 1? Influent Wastewater Quality (1 or 2) Pressure Disribution Information (c ore) ci Center or End Manifold 3.00 Lateral Spacing (ft) 4, Number of Laterals ,..._... __._.. _ ___----1 _0.1251 Orifice Diameter (in) (e.g. 0.25) ____2.25! Estimated Orifice Spacing (ft) _ 2.00 Forcemain Diameter (in) 135.00 ~ Forcemain Length (ft) 91.371 Pump Tank Elevation (ft) Gi, ', i~t l~/ I ~/ !~ Yr' 6.50 System Head (ft) x 1.3 7.17 Vertical Lift (ft) ~ 3.71 Friction Loss (ft} ~~ 17.88 Total Dynamic Head (ft} Lateral Diameter Selection /~ in. dia. o tions choice (7 0.75 ~ 1.00 x 1.50 2.00 3.00 x ~_ x x x ___ _ Treatment Tank Information --- ---- 1200.00 ~ Septic Tank Capacity (gal) __ Wieser Concrete ;Manufacturer Note: Sand fill (D) calculations assume a Tabl® 83-44-3"in-situ soil treatment for fecal coliform of <= 36 inches. 6.00 Cell Width (ft) Are the laterals the highest point in the distribution Y ... network? Enter Y or N If N above, enter the elevation (ft) _.__._. _ of the highest point. 6.82 ftz/orifice Does the forcemain drain back? Y . .......... .. Enter Y or N 22.02 Forcemain Drainback (gal) 62.74 5x Void Volume (gal) 84.76 Minimum Dose Volume (gal) 36.25 System Demand (gpm) Manifold Diameter in. dia. o tions 1.25 x 1,50 x ch Gallonsllnch Calculator (optional) 1001_.88,; Total Tank Capacity (gal) 36.00' Total Working Liquid Depth (in) 27.83 gal/in (enter result in cell B49) Dose Tank Information Effluent fil_te_r Information 1001 88' Dose Tank Capacity (gal) ~ SIM/TECH ;Filter Manufacturer i 27.83. Dose Tank Volume (gai/in) STF-100A2 'Filter Model Number Wieser Concrete ',Manufacturer Project: Scott & Barbara Larson 4-bedroom residential POWTS Mound Page 2 of 10 Mound Plan View 1- I_ 1 /10 B • ~ ~ 'Observation Pipe ' 0 ' K ..,. .ti. ;ti. ..,.., ;,,.• ...........:.,;•,• . .7~~ ~ ~t' . B - -. -I- Mound Component Dimensions A 6.00 ft E 30.96 in B 100.00 ft F 9.25 in D 18.00 in G 0.50 ft 600.00 (ft2) Dispersal Cell Area 6.00 (gpd/ft) Linear Loading Rate -~ -+ _fi _l H 1.00 ft K 11.43 ft I 25.11 ft L 122.87 ft J 5.40 ft W 36.51 ft 3111.41 (ftZ) Basal Area Available 10.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 100.81 (ft) +~I H atera I F . • : ~ :: ~ Dispersal Cell 99.54 (ft) L I 99.04 (ft)--- - ~:~ Invert Dispersal Cell :~ ; ~ :~ ~' ~ ~ ~ Elevation E. ~ ~~ • __ __ ~..t.~~.~ ).' ), ,'~,_~L;_! „~_ ., ). ~i __t, ~~K],L i -_ ] `i. ?, i i ) `] -?. -] i ], 1, _?,,_ ~~~Y] -i ...r~.~: ~] -i • i % :ty,~:].~ 4 i. _i., f.:_%. 97.54 Contour Elevation 18.0 % Site Slope Geotextile Fabric Cover Shading Key m ~_ ~- Dispersal Cell See lateral details on 0 -Topsoil Cap o a 1.5 ft ~;" :;: ~ Page 4 for number, size, Q '~~~~ Subsoil Cap ~ c 5 '.'+` • • ~" ~• and spacing of laterals. ASTM C33 Sand ea `0 `~'~"•"' ~'''" Laterals are equally ;~ ~ ' ~'~ ••• ''' F Tilled Layer d 0.5 ft 'Typical Lateral :' spaced from the Q5 .0 Aggregate v ~ ~ ~5 ~.',• I distribution cell's : ~ :'~:' : •~: ~ . ~~ ~~'~ ~ ~~~ . -{- centerline in the ~"- A ~ distribution cell (Ax6). Project: Scott & Barbara Larson 4-bedroom residential POWTS Mound Page 3 of 10 ' 1 ,'1" „` t Pttmp Specifications 'h HP Up to 40 GPM Discharge size l'/~" NPT Solids:'/," maximum Motor Single phase: 115V Materials of Construction Brass/thermoplastic Features and Benefits • Top suction eliminates impeller clogging. • Corrosion resistant ConSIrUCl10n. • Float actuated switch. MEEEPS FEFI • ' zs i j i i MODEL DVP03 .... j .. . ,....._ I c s zo I I s 16 ( ~ j. .~ I .. a e ~ > > to ! 0 ~' 0 5 o, ~......... i 0 5 10 t5 20 25 ~0 75 d0 U.S.CPM 0 2 4 6 8 t011PAs CAPACl7Y MElEll s IfE I In ~ ~ MUDEL:3871. Q ' 20 ... _. ..~ 1 ~ i 25 t ......l .~.._ .. _.... _~._. ... ~._....; , ~_ ~ . .... 6 ' r U $ fP Z ~ ~.. 1 I ~ , ~ j .~ ~ • 10 I 2 .i ._..__f._.... ~ .__...~. .! , ~ ~EP00 1 I ~ s 5 ; ..;.... !.. • .. ,.. i ; ~ , I ~ 1 _ .: r ..............: - ~ - . o . oo ..__... . _.. .. ... iu ~ z ...... o .~.. 2u so so IA14M 't 0 2 ~ B 9 10 I m~M ~ CAPAC1rY ~~ II _ Pump Specifications '/lo and'/= HP Up to 60 GPM Maximwn head to 32' Discharge size 1'/="NPT Solids:'/~" maximum Motor All rnolors feature baA bearing construction. Single phase: 115V Materials of Construction Cast iron Thermoplastic Stainless steel Features and Benefits • EP04 impeller- semi-open design with. pump out vanes to protect mechanreal seal. • EP05 impeller -enclosed design for irnpraved performance. • Rugged glass-tilled thermoplastic casing and base design provides superior strength and corrosion resistance. •Cast iron motor housing for efficient heal transfer, strength, , and durability. • Corrosion resistant threaded stainless steel shaft. • Available for automatic and manual operation. • CSR listed models avail,~ble. All Models are designed for continuous operation and lecture stainless steel hardware. ~.~o~~' Center Connection Lateral Layout Daigram Force main connection via tee or oross to manifold at ang point. E P •=Turn-up+mtballvalve or IEX---;IExr2~xf2~l cleanoutplug I,I Holes drilled on the bottom of the lateral. Laterals are identical Laterals tx force main of PVC Sch 40 per COMM Table 84.30.5 S sL Number of Laterals 4 Orifice Diameter Lateral Diameter 1.25 in Orifice Spacing (X) Lateral Length (P) 49.24 ft Orifices per Lateral Lateral Spacing (S) 3.00 ft Orifice Density Lateral Flow Rate 9.06 gpm Manifold Length System Flow Rate 36.25 gpm Manifold Diameter Total Dynamic Head 1~~-38 ft Forcemain Velocity I ~~ ~~ Dose Tank Information Electrical as per NEC 300 and -~- Comm 16.28 WAC Disconnect Tank component is properly vented Wieser Concrete Ca aci 1001.88 Volume 27.83 Manufacturer Gallons gal/inch A B C D Dimension Inches Gallons A 18.95 527.50 B 2.00 55.66 C D Total 3.05 12.00 36.00 84.76 333.9fi 1001.88 3" Bedding under tank. Alarm Manuafacturer LevelArm Alarm Model Number DLV Pump Manufacturer Goulds Pump Model Number 3885 WE03L Pump Must Deliver 36.25 gpm at 1.38 ft TDH 0.125 in 2.29 ft 22 6.82 ft2/orifice 3.00 ft 1.25 in 3.70 ft/sec Locking cover with warning label and locking device and sealed watertight 4 in. min. ~_ E--- Alternate outlet location Forcemain diameter ~ 2 in. Weep hole or anti- siphon device Pum off elevation (ft) 92.37 Dose tank elevation (ft) 91.37 Project: Scott & Barbara Larson 4-bedroom residential POWTS Mound Page 4 of 10 Mound System Maintenance and Operation Specifications Service Provider's Name ~~l~c.pale_K~`~,e-.~h«N~ • „ -7'7a-3a7~' Phone. (715)~8~4y337 S POWTS Regulator's Name ~ St. Croix County Zoning Phone (715) 386-4680 System Flow and Load Parameters Design Flow -Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow -Average 400 gpd Maximum BODS 220 mgli_ Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 ft2 Maximum FOG 30 mgJL Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound fns 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 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 • Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Scott & Barbara Larson 4-bedroom residential POWTS Mound Page 5 of 10 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code eneral 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 local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shalt 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 filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1!3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution 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 mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L GODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L GODS, 30 mg/L TSS, 10 mg/L FOG, and 10` cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shalt 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. Contins~encv 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. !f the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Scott & Barbara Larson 4-bedroom residential POWTS Mound Page 6 of 10 '~GOULDS PUMPS 90' WE15H 70. E07H 60 50' WEO$ EOSH 40 -WE03 30 ~n'rWE03L ,. 3885 PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. APPLICATIONS Specifically designed for the following uses: • Homes • Farms • Trailer courts • Motels • Schools • Hospitals • Industry • Effluent systems SPECIFICATIONS Pump • Solids handling capabilities: '/~" maximum. • Discharge size: 2" NPT. • Capacities: up to 140 GPM. • Total heads: up to 1 Z8 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- open, non-clog with pump-out vanes for mechanical seal protection. Balanced for smooth operation. Silicon bronze impeller available as 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, BONA-N elastomers. 2002 Gouldz Pumps ~ftecuve October, 2002 c3c85 ^ 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. MOTORS ^ Fully submerged in high- gradeturbine oil for lubrication and efficient heat transfer. ^ Class B insulation. METERS FEET 40r 130 - V~E15HH 1zo, __. _ _ _. 35r ' 110' ...........: ... '_ I, '; WE2QH 30I- 100r ..._.i_..-_;..... 0 a 25~~ z 20,1 a a 1s~ 0 for ,~aa ~ i T~ ~-~~ o ~'~ Single phase: • Built-in overload with automatic reset. • All single phase models feature capacitor start motors for maximum starting torque. •'h and'/~ HP- 16/3 SJTOW with 115, 208 and 230 Volt three prong plug. • 3/a-2 HP - 14/3 STOW with bare leads. Three phase: • Overload protection must be provided in starter unit. •''/r2 HP- 14/4 STOW with bare leads. ^ Designed for Continuous Operation: Pump ratings are within the motor manufacturer's recommended working limits, can be operated continuously without damage when fully submerged, 10 _...- - o ~. 0 10 20 30 40 SO 60 Submersible Effluent Pump ^ Bearings: Upper and lower heavy duty ball bearing construction. ^ Power Cable: Severe duty rated, oil and water resistant. Epoxy seal on motor end provides secondary moisture barrier in case of outer jacket damage and to prevent oil wicking. Standard cord is 20'. Optional lengths are available. ^ 0-ring: Assures positive sealing against contaminants and oil leakage. AGENCY LISTINGS Tested to Ul 778 and CSA 22.2 108 Standards By Canadian Standards C US Association File #LR38s49 Goulds Pumps is ISO 9001 Registered. 1.. ._ ;._ i _ ,.._ , -r _ - - : _ ~T~ j. , .. 70 80 90 100 1 10 120 130 140 t 50 t 60 GPM 0 s ~ 10 15 20 ZS 30 35 m3/hr CAPA N 3G. z s~./o• ri. rr7 ~ ~ ,- rn u na ScMP /y /ti, e rey'ulrco~ o Goulds Pumps ~~~ ITT Industries www.9oulds com ~ t r?u 1~ G.i~c~r.,~/ s. ~~ ~ 6.c ~,/;~,-~r ~c y ~w~~~: 0 ~ ~, t '~ s~ a ~.s ~ dry ~Icr;" ~F- ~Xis~~ ~~crl.•~~+~~ /..2 Q e r ~ ~ ~~ Sc''~' .Cars ~-; /pal, C3~/ ll/~f{TD S~f f/S~J sca.~g Y'~rt~~~dadl~o~ ~'Xi`s~ cls~s~/ c~/%~ b,~ O 9~ . O ~ Q JIFj.7 ~GQ~r I'LiL'r CQQ~@. ~: `~~. M ~ • ~• ~~ 1 ; ~~. ~ ~ . ~ , ~~ ~ ~ O~ ~ ~ ~ ~~~ ~ ~ , + ~ ~ ~ ~ ~ ~ o+1C, ~ P~ ~ ,, • ~ ~ ~~ \ ~ ~ ~` ~ ~, ~ ~ ~ •~ , ~ ~ '. •*+ i +` ~1 C , ' '1~ # ~~ ~ n• ~, M kti` J IQig1 std ~" ~ ~ s~,~o ~/,c. , ~•~ ~ `~. ~ , cA'D °6d~~~°^'~' ~ r ~ .be ~c,oharez{~ .~c~i /~+~ O~ • i79ery,~/~ C'iw+~/, ,e~tSusre~~ kr~:' ~/~ciQ' 1~ a/~cJ: c QS.r.~; ~ i~r~ l,J;EStr Cwrr~• C-X~-s~une ;,~a ° s U w 3~ ~~.t t la~~ ~,{-~ -.~~~,~ S/6re~.,., ga,ce~c. Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATIC~'~LiORT in accordance with Comm 88. Wis. Adm.'~Li ~ ~~ 2056 Page 1 of 4 A.C.E. Soil & Site Evaluations Attach canpiete sfte plan on paper not less than 8'/: x 11 inches in size. Plan must St. Croix indrxie, lwt not limited to: verdral and horizontal reference point (Bful), direaion and Pa percent slope, scale or darrc~t>sions, north arrow, and location and dicta to rr~rest road. 8-1 3-80-0 Please n ~ Re • By Date Persons information you Provide be used far secondary Punk (~~Y , s.15.t]4 (t) (m)). / L /S D (0 Property Owner ~ E C 1 2 Property Location Scott A. & Barbara A. Larson Gait. lot SE 1/4 S 1/4 S 29 T 28 N R 16 W Property Owners Mailing Address ST, CROIX COUNTY Lot # Block # Subd. Name or CSM# 2248 10th Ave. 1 CSM Vol. 11, Pg. 2970 City Stat rp ode Phone Number ~ City J ~Ilage ~ Town Nearest Road Baldwin WI 54002 (715) 684-3339 Eau Galle 2248 10Th Ave. ,~„~ New Construction l)se: ~ Residential /Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial -Describe: Parent material loess over weathered sandstone residuim Flood plain elevation, ff applicable na General comments and recommendations: Site suitable for mound system with 18" of ASTM-C33 sand placed on 97.54' contour. System elevation = 96.15' ~~ goring # ~ Boring r Pit Ground Surface elev. 97.57 fl. Depth to limiting factor 30" in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Corrsister~ Boundary Roofs P D in. Mureell Qu. Sz. Cont. Color Gr. Sz Sh. "Eff#1 *Eff#2 1 0-5 10yr2/2 none sil 2fsbk mvfr as 2fm,1c 0.8 0.8 2 5-22 10yr4/3 none sil 2fsbk mvfr cs 2fmc 0.6 0.8 3 22-30 10yr4/4 none sil 2msbk mfr cw 1vf,f 0.6 0.8 4 30-36 10yr4/4 f2d 7.5yr5/8 sicl' 1 csbk mfr aw 1 of 0.2 0.3 5 36-71 10yr5l8 f2f 7.5yr5/8 vfs Osg di - - 0.2 0.3 H#5 c;orrtains 3/4" - 2" bands of 10yr4/4 Om at " - 10" intervals. Loading rate re acts reduced permeability of horizon associated with banding. Boring # .-~ Boring / Pit Ground Surface elev. 97.54 fl. Depth to limiting factor 1 a~~ in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D in. Murrsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. *E 1 *Eff#2 1 0-4 10yr2/2 none sil 2fsbk mvfr as 2fm,1c 0.6 0.8 2 4-18 10yr4/3 none sil 2fsbk mvfr cs 2fmc 0.6 0.8 3 18-35 10yr4/4 f2d 7.5yr5/8 sil 2msbk mfr cw 1vf,f 0.6 0.8 4 35-47 10yr4l4 f2p 7.5yr5/8 sicl lcsbk mfr aw 1vf 0.2 0.3 5 47-58 10yr5/8 f2f 7.5yr5/8 vfs Osg dl - - 0.4 0.6 * Effluent #1 = BODS> 30 <_ 220 mg/L a TSS >30 < 15 mglL * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/I.. GST Name (Please Print) Signature' CST Number James K. Thompson ~..- 3602 Address A.C.E. Soli & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane. Osoeot 154020 12/11/2006 715-248-7767 Property Owner Scott A. & Barbara A. Larson parcel iD # ~-1083-80-000 Page 2 of 4 Boring # Boring -~ Ll Pit Ground Surface elev. 92.19 fl. Depth to limiting factor 33" in. ~ gppl Rate Horizon Depth Dominant Color Redox Description Texture Stnx;ture Consstence Bourxiary Roots in. Munsell Qu. Sz. Cont. Cobr Gr. St. Sh. *Eff#1 *Eft#2 1 0-5 10yr2/2 none sil 2fsbk mvfr as 2fm,1 c 0.6 0.8 2 5-16 10yr4l3 none sil 2fsbk mvfr cs 2fmc 0.6 0.8 3 16-33 10yr4/4 none sil 2msbk mfr cw 1vf,f 0.6 0.8 4 33-60 10yr5/8 f2p 7.5yr5l8 fst 1 csbk mfi aw 1 of 0.2 0.6 5 60-64 10yr4/4 ~~ f2f 7.5yr5/8 fsi 1 csbk dsh - - 0.2 0.~ Boring # --~ Boring ,~ Pit Ground Surface elev. ft. Depth to Nmiting factor in. ~ application Rate Horizon Depth in. 4~ninant Color Mur>seq Redox Descr~fon Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots "Eff#1 'Eff#2 ^ Boring # -~ Boring ~ Pit Ground Surface elev. ft. Depth to limiting factor in. Sod apai~on Rate Horizon Depth Dominant Color Redox Description Texture Stnx;ture Consistence Boundary Roots in. Mut>sell Qu. Sz. Cant. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 =GODS <_30 mg/L and TSS a 30 mg/L The Department of Commerce is an equal opportunity service provider and employer, If you need assistance to access services or need material in an alternate format, please contact the department at 608-2b6-3151 or TTY 608-264-8777. SBD-8330 (R.o7/00) A.C.E. 591 & SI[2 EV8{I18ti0115 SOIL AND SITE EVALUATION ~p~ page 3 of a PROPERTY OWNER: Scott A. 8c Barbara A. Larson PARCEL I.D.# 008-1083-80-000 A.C.E. Soil & Site Evaluations REPORT MEMO Existing dose conventional dispersal cell located within small isolated deposit of sandy material as per original soil evaluation and sanitary permit. Diversion valve should be installed to allow future use of existing ceA. Insufficient area available to site new dispersal cell within same deposit. Soil surrounding sandy knoll requires the installation of a mound system. Existing tanks can be reused -new pump may be required and installation of in-line effluent filter at pump will be needed. ~/. so ' ~~ ~: o o ~~ ~ , ~ `~ o. ~ o o. °~ d~; ~ ti ~ ~ i ~ , ~ 1 ~ t s ~ ~ i ~ ~ i i ~ 8 ~ ~ ~ i ~ _ ; ~ ~ ~ ~ ` ~ \ w1o'1C~ ~ ~ ' ~ ~l~ ~ ~ ~ ~ '~ ~ ~~ ~ ~ ~ '•, \ ~~ 4 ~~ \ \ ` ~ \ ~~ p • E/Yis~'~~zolC t/cry S cvE~ ~ ~*'bu ra ~a.rs an, N ,o~i ~sM ~rz9~~ SEyys~; n sec.29, ~'zBit ,P/6cJ, T ap ~Pp rte, /e cam,.-6,'0,-~ o,~' EXiSEinc otia~e~SG-/ Ce/% T'.~(~ ti'cnclc.f c.~ S ~X 7S ~ Sy 5~ e ~ eie,~: - ~ofl7.S 4 ~B'~, 0 '~ \ ~ ~ ~ ~ ~° ' \ ~ ~ ~ v ` ` ` ~. 's',s ~~ ~,~' ~ ~ S '`~ ~. ~ ~2 ~, \ ~ ~ ~~ ~ ~ ~ ~ ~ ~ ~ ~ ~~ ~ ~ ~ ~ E,r,,7~' cJ; cscr Cw,c . ' /, u/0~.ed. ~ce,.,~p cl o..i b of ~ tg¢rrc ti l'17ar~~ 7P o~,0a,.,~ Cl~.,,, ~- ` ~, /r1an~,sfl Cd/t/. /,~sS[.c~r+r.~Cl~~`•' =/ob.ct~' v ~~~ • 6. rr(. = Top of ~X~Sd ~,riS~nq p ~Gc~/btJ rr1(/ ~ ~aJ C ~, 1 ~~. d ~~i. , }~1 ~~ D N :~ 09/06/2007 07:12 715684314 EOLDTS_PLBG ~,NTia ..~ ... vi na.u. 1V~YY rtu- Div uv- ~r .it'VAW LV'LVl\11W, ;~'TATEIV,[ENT FOR TJ',~~~..I~ , ~ ` :r'~k-ISTING SEPTIr:' TAiVI~ T~,t51s t0 Cethfy ~~~ ~. .~ o rr Lf}2Sc of ~~-v ~l 1I19peCtlon, I Cernfy .., knowledge, wi11 coy appear(s) to be funs Most recent date of Did flow back occ~~ (if no, skip next lin Approximate volume Capacity: .,. Construction: Pre~~ _ Manufacturer (if Ic1 Age of Tank (if kzi , (Licensed Plumber QS~ (Title) ~- ~ . (Date) r~ cr~~1C tilllk F7rF':' ~'1 S8I'V11J~ tll@ ~~ ~ rn: .. - located at: ~~N, R{ ,~>~;_ ~ ~',', Town ~. ~.:I'b1X ~Olltl~ ~~i ~ '114111. Upon, _ __ r „~,/~), tv t~^~ ~ ~tny ~~.~ Cozn~ ~, ~~~ ~+!th,eY) .- _. ,;• ~- . ~ -. - r •~ •me ~ ,_.. -- ___. r , :sautes PAGE 01 i¢J UU1' • - ` Form to be coxnpic' _ 1 - ~ , i4~'s) ,: t-r licensed dicPnser- su, .=. " `. ST. CROIX COUNTY ' SEPTIC TANK MAINTENANCE AGREEMENT ~~u~~-- ~~~y1'~/~ AND OWNERSHIP CERTIFICATION FORM ~~ j~'l/'~ Ownerr~Btr~er ~~ ~ ~ ~~"'p ~~lZ~ L-/7 ~1 L~ v`~ Gtyyr~~ [~ n Mailing Address _ ~Z~I ~ ~~ ~ - Property Address ~~ a (Verification required from Planning & Zoning Department for new construction.)G U City/State ~!~ ~ ~ ~~, W~ Parcel Identification Number ~~~ ' ~~ p 3 O U -L~ Z~00 Z LEGAL DESCRIPTION Property Location -S~ 1/4 , ~ ~/a ,Sec. ~, T 2 ~ N R ,~ W, Town of ~~~ ~~L-G ~ Subdivision ,Lot # Certified Survey Map # ,Volume ~ ~ ,Page #r ~~ 7~ ~' arranty Deed # ,Volume /~ ~ ? ,Page # ~' ~~ Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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 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 ~_ SIGNATURE OF APPLICANT(5) /-~ 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) ~~ Mound and Pressure Distribu#ion Component Design Design Worksheet S_ ite Information (r or c) -~ __R Residential or Commercial Design __400.0_0 Estimated Wastewater Flow (gpd) 1.50 Peaking Factor (e.g. 1.5 = 150%) 600.00 Design Flow (gpd) _ 97.54; Contour Line EI ation (ft} ___.___ p o smiting Factor (in) _ 0_60 !n-situ Soil Application Rate (gpd/ft2) Distribution Cell Information _ _ _y100.00'J Dispersal Celt Length Along Contour (ft) _ _ _ 1.00, Dispersal Cell Design Loading. Rate (gpd/ftz) _ __~ 1; Influent Wastewater Quaiity (1 or 2) Pressure Disribution Information (c ore) !~ ~ ~~ c I Center or End Manifold 3.00 ~~ Lateral Spacing (ft} Number of Laterals 0.125 Orifice Diameter (in) (e.g. 0,25) __ _ 2.25 Estimated Orifice Spacing (ft) _ _ _ 2.00 Forcemain Diameter (in) _ _ __ 135.00 Forcemain Length (ft) ___ 91.37f Pump Tank Elevation (ft) 6.50 System Head (ft) x 1.3 7.17 Vertical Lift {ft) 3.71 Friction Loss (ft) 17$8 Total Dynamic Head (ft) Lateral Diameter Selection ~ in. dia. o Lions choice 0.75 1.00 x 1.25 x x 1.50 x 2.00 x 3.00 x Treatment Tank Infonna#ion 1200.00 Se tic.Tank Capacity (gas) ilNieser Concrete Manufacturer Doss Tank Information (-1001.88 Dose Tank Capacity (gal} _ 27.83 Dose Tan_ k Volume (gal/in) 'Wieser Concrete __. .;Manufacturer ~~`,~ U Note: Sand fill (D) calculations assume a Table 83-44-3 in-situ soil treatment for fecal collform of <= 36 inches. 6.00 Cell Width (ft) Are the laterals the highest point in the distripution ~ Y network? Enter Y or N If N above, enter the elevation (ft) of the highest point. 6.82 ft~/orifice Does the forcemain drain back? Y Enter Y or 1V 22.02 Forcemain Drainback (gas) 62.74 5x Void Volume (gal) 84.76 Minimum Dose Volume (gal) 36.25 System Demand (gpm) Manifold Diameter Selection in. dia. o Lions choice 1.25 x x 1.50 x 2.00 3.00 Gallons/Inch Calculator (optional) 1001.88 Tota! Tank Capacity (gal) _ 36~OOi Total Working Liquid Depth (in) 27.83 gaVin (enter result in cell B49) Effluent filter Information ~SIM/TECH ~ Fiiter Manufacturer STF-100A2 Filter Model Number Project: Scott & Barbara Larson 4-bedroom residential POWTS Mound Page 2 of 10 Mound Plan View i- 1_ ..................................... ... ................................. • : 1 /10 B • ' •Observation Pipe .. r•: •; :•:•: ~• L I Mound Component Dimensions -} -~ -~ -/ A 6.00 ft E 30.96 in B 100.00 ft F 9.25 in D 18.00 in G 0.50 ft 600.00 (ft2} Dispersal Cell Area 6.00 (gpd/ft) Linear Loading Rate H 1.00 ft K 11.43 ft I 25.11 ft L 122.87 ft J 5.40 ft W 36.51 ft 3111.41 (ft2} Basal Area Available 10.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 100.81 (ft) ~I M F • .:::: ' •'••~~~~•~ 99.54 (ft) !Lateral Dispersal Cell .. :';: 99 04 (ft) -- nvert Dispersal Cell 3~ ' ~ ~ ~ ~ ~ : ~ : ~ levation E D ; ~~ r. y!.ti/. fol.?. • , i ~ ~. j,~•L~:_ 4, % ~, '.`/• -~t ~i: ~.:1, ~ I ).~i ~ ill, i ) ) t i 1 `A { ~S 4 J. ~ )~ -: }, _,{• fi ], ji i• 1 ~ ~ i t j~ ;~ •`i• ], 7 i, ~ i "i 7 i i _ ] `i ~, i i ~ ~ y ~x i ] ] ~ ~ i• j, 1 a K 4 ~c tic ~ - • ~:.C ,. •.l•_ ~ . , 4 •„ .. ,~ ,'~:.: •...~ .:.,/..~,~~ ~. ~. =: ~ ... ,. .., •. 1•. 1. •` -,~, ' -` ' `• ~ 97.54 (ft) Contour Elevation 18.0 % Site Slope _ _ Shading Key 1Q Topsoil Cap '~"' Subsoil Cap © ~ • ~ • ~ • ASTM C33 Sand ® `,~`,,~i: Ti!!ed Layer ^5 ~'::•r: Aggregate a ~ °' c °' 1.5 ft c m o N 0 ~ ~ 0.5 ft Dispersal Cell .f~~•.'. ~~~ ~r •s~ ~~RYjti `. ~~ '~;~ c :::~' ~ F ipical Lateral '•:'•: . ,~~~ ~, • A 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 (Ax6). Project: Scott & Barbara Larson 4-bedroom residential POWTS Mound Page 3 of 10 Center Connection Lateral Layout Daigram Force main connection 4ia tee or oross to manifold at any point. P •=Turn-up~m'ballvalve or IE7~--~IEx12~xf2-~I cleanoutplug Holes drilled on the bottom of the lateral. Laterals & force main of PVC Sch 40 per COMM Table 84.30.5 S .sk. Number of Laterals 4 Orifice Diameter 0.125 in Lateral Diameter 1.25 in Orifice Spacing {X) 2.29 ft Lateral Length (P) 49.24 ft Orifices per Lateral 22 Lateral Spacing (S) 3.00 ft Orifice Density 6.82 ft2/orifice Lateral Flow Rate 9.06 gpm Manifold Length 3.00 ft System Flow Rate 36.25 gpm Manifold Diameter 1.25 in Total Dynamic Head 1•x-38 ft Forcemain Velocity 3.70 ft/sec J ~- Ssa'' Dose Tank Information Electrical as per NEC 300 and ---- Comm 16.28 WAC _s-- Disconnect Tank component is properly vented Wieser Concrete Ca aci 1001.88 Volume 27.83 Manufacturer ~_ Gallons gat/inch A 'Dimension Inches Gallons A 18.95 527.50 B 2.00 55.66 C 3.05 84.76 D 12.00 ~ 333.96 Total 36.00 1001.88 8 C D under tank. Alarm Manuafacturer LevelArm __ _ ., Alarm Model Number D!_V Pump Manufacturer Goulds . _. Pump Model Number '3885 WE03L _... _._ J 7• Y~' Pump Must Deliver 36.25 gpm at 17-8'8 ft TDH Laterals are identical Locking cover with warning label and locking device and sealed watertight 4 in. min. E-- Alternate outlet location Forcemain diameter ~ 2 in. Weep hole or anti- siphon device P~ ump off elevation (ft) 92.37 Dom se tank elevation (ft) 91.37 Project: Scott & Barbara Larson 4-bedroom residential POWTS Mound Page 4 of 10 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 [S8D-10691-P (N.01/01) and SSWMP Publication 9.6 (01/81)) and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases maybe 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 filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution 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 mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS, 30 mg/L TSS, 10 mg/L FOG, and 10~ cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determinerf 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. Contins~en~ 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 ifs' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and. telephone number of your local POWTS regulator and service provider. Project: Scott & Barbara Larson 4-bedroom residential POWTS Mound Page 6 of 10 ~GOULDS PUMPS Submersible Effluent Pump ,~ 3885 PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. APPLICATIONS Specifically designed for the following uses: • Homes • Farms • Trailer courts • Motels • Schools • Hospitals • Industry • Effluent systems SPECIFICATIONS Pump • Solids handling capabilities: '/," maximum. • Discharge size: 2"NPT. • Capacities: up to 140 GPM. • Total heads: up to 128 feet TDH. • Temperature: 104`F (40°C) continuous 140°F (60°C} intermittent. • See order numbers on reverse side for specific HP, voltage, phase and RPM's available. ^ 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. MOTORS ^ Fully submerged in high- grade turbine oil for lubrication and efficient heat transfer. ^ Class B insulation. Single phase: • Built-in overload with automatic reset. • All single phase models feature capacitor start motors for maximum starting torque. •'/3 and'/~ HP -16/3 SJT011V with 115, 208 and 230 Volt three prong plug. •'/a-2 HP -14/3 STOW with bare leads. Three phase: • Overload protection must be provided in starter unit. •'/~-2 HP -14/4 STOW with bare leads. ^ Designed for Continuous Operation: Pump ratings are within the motor manufacturer's recommended working limits, can be operated continuously without damage when fully submerged. ^ Bearings: Upper and lower heavy duty ball bearing construction. ^ Power Cable: Severe duty rated, oil and water resistant. Epoxy seal on motor end provides secondary moisture barrier in case of outer jacket damage and to prevent oil wicking. Standard cord is 20'. Optional lengths are available. ^ 0-ring: Assures positive sealing against corit.aminants and oil leakage. FEATURES i Impeller; Cast iron, semi- open, non-clog with pump-out vanes for mechanical seal protection. Balanced for smooth operation. Silicon bronze impeller available as an option. ^ Casing: Cast iron volute type for maximum efficiency. /7 2°NPT discharge. 7"Il, ^ Mechanical Seal: SILICON CARBIDE VS. SILICON CARBIDE sealing faces. Stainless steel metal parts, BUNA-N elastomers, . '- 2002 Goulds Pumps etfe<uve October, 2002 e3885 AGENCY LISTINGS S ~ ~ Tested to Ul 1)8 and CSA 22.2 108 Standards By Canadian Standards C US Association File ~1LR38549 Goulds Pumps is 150 9001 Registered. v1ETERS FEET 40r 130 ..... 'E15Hfi ~ I ~ '?• ~- ~ SERiE5:3885 35~ 120! ._-' . __., _ .. . ~.. _.~..:~.~ ....}_._ _ ~ ~sIZE: '3," s00U0S ...~.......r...._. .r !_ ' .RPM: 50 & 1101 --.' --I .. L. y .1 y - t 11750... WE2QH ~ -L..._ I -- S GPM I . _ _. 30~ 100 ._- 1.. I f i P i i_ l I s ~r 1 w ~. I l ~ i ,_ i _r.,__.~..__ _ = 25 soi~ 1QFr ' _.. ... . ~ I ~~ I , i - ~ ~ , 20' E02H I r ' ... , i 601 ~ ~-___ , . -t-- --•--t ~ ..... t ~ ~ .. F t 5 501 WEOSH ~.. ~ . ..+_ .. .. .._.._ ..' ..., ..... 1........ . ....... 40 ....... .. .. _ ~_ __ ... _ _ _...t .. ....... i 10 30~WEO~M r ~ ~ r r _.~_ _... ;/ _._ .. _. 1 _, , .._ , _ ..._._ ._ ~ ' _ .. o ~ ! 0 0 L... _!.. ~ .. ...i...... ._....._._ . _._..._. .... -.. .... _ _., _.. _ .. 0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 GPM 0 5 10 15 20 25 30 35 m;/hr CAPA TY 3G.zs8•F ~• m;~ ~'irl k,n S~yoPiy ~ e re~'uIr'~ Goulds Pumps ~~~ ITT Industries www.goulds.com ~/ ~ O~ / jl N~ - (/ fir%su` ~exr/~l~s~/,;,~ - rP~'~`..zOS~ - r~ G! c r ~ ~ ~ca,Q .. Sco~~'$ar"daru rCarsor; -?r~'~ 1~/,• e //.moo' ~ ~a~, Gal/e, ~~• Cr~:,r c°~, ~~ G.i~dcor S.EP~ t,.t ~/tarco/+dy awr~.cr, i¢PPrsc.: /rca-,&;v--~ v~' `~ ~ ~X/S~r" Cr%J~erStt~/ Ct/~~fc a ~ o ~ gb.~,~das~cQd+~. o . o `j ~ ~ ° x ~`. ,(°' ~ ~ , ` ~ + t ~ i ~. 1 ~ ~ ~ ~ i ~ 1 ,~ ~ ~ , ~ ~ , , .. 1 ' ,, Pra~sed.r+tvw~d a~ 3G.s/.r ~z.8?' ~ ~r~,P~ ~, ~, , ra/ !o'X ~~' a~f,~cr,5~,/c/~~//. Vic"-~~f ct~`~ ~ ~ ~, .~ d'/ai/v 'b» u-G~ .~ a-. d ~. , a. ~ y. ~~ +A ', ,, `~ ~ \. • q ~ ~ ~ 1 , .~~~, ~. . i 1~ ~ ` s4j,,'~[a R~~ ~ `~ ` `~` ' ~ i ~`~ q - ~ ~ , ~ ~ ,, 'Cr_ ~f r ~p7i~c, /occ~~, 8 u . RS. C.rrc r ~ ,F~v-ee..w~i~i.7e , /, cad CJCA..- ~,," ~ ~ . .b~ c./sca.~ arch Rt 1 ~ g[]WaKC%np~/, Ian .. • ~ a ~ : s' . , _. +~i/;9±4'r~ G..~Irslr C`+ria, EXi;~fi:~ )~ u,,n 6u' c./,~~ ip /0 . ` a .~ 5 ~t uJe ( C[rr S`~. ~ ! ~ h b ~'c' r' ~ ~[.'L~. l~ - ~ c Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT in accordance with Comm 85, Wis. Adm. Code 2056 Page I of -! A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8%: x 11 inches in size. Plan must County St CrO1X include but not IimRed to: vertical and horizontal reference oint (BM) dir ctio d . , p , e n an peroent slope, scale or dimemsions, north arrow, and location and distance to nearest road. -------•----- - Parcel LD. Pl 008-1083-80-000 ease print all lnlormation. Reviewed By Oate Personal information you provide may be used for secondary purposes (Privacy La~v, s. 15.Od 111 tm)). Property Owner Property Location Scott A. 8 Barbara A. Larson Govt. Lot SE 114 SW 1/4 S 29 T 28 N R 16 W Property Ownets Mailing Address Lot # Block # Subd. Name or CSM# 2248 10th Ave. 1 ~ CSM Vol. 11, Pg. 2970 City State Zip Code Phone Number _____ J City J Village VJ Town Nearest Road Baldwin WI 54002 (715) 684-3339 Eau Gal1e I 2248 10Th Ave. J New Construction Use: yJ Residential / Number of bedrooms _ 3 Code derived design flow rate 4S0 GPD ____ /~ Replacement J Public or commercial -Describe: Parent material loess over weathered sandstone residuim___ Flood plain elevation, if applicable _____na __ __ General comments and recommendations: Site suitable for mound system with 18" of ASTM-C33 sand placed on 97.54' contour. System elevation = 96.15'. Boring # J Boring /) Pit Ground Surface elev. 97.57 _ ft. Depth to limiting factor 30~, in. Soil Applicaton Rate Horzon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots _ (~'PD~' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. _~___-_ 'Eff#1 Eff#2 1 0-5 10yr'L/2 none sit 2fsbk mvfr as 2fm,1c 0.6 0.8 2 ! 5-22 10yr4/3 none sit 2fsbk mvfr cs 2fmc -f- - 0.6 ~ 0.8 3 22-30 10yr4/4 none sit 2msbk mfr cw 1vf,f 0.6 ^^0.8 4 30-36 10yr4/4 f2d 7.5yr5/8 sicf lcsbk mfr aw j 1vf ~ 0.2 0.3 5 36-71 10yr5/8 f2f 7.5yr5/8 vfs Osg dl ~- - 0.2 0.3 I i I I ---~--~----..__... I i -------------... --- -- H#5 contains 3/4" - 2"bands of 10yr4/4 Om I at 6" - 10" intervals. Loading rate reflects reduced permeability of horizon associated with banding. Boring # -I Boring /~ Pit Ground Surface elev. 97.54 ft. Depth to limiting factor ~ S„ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO~t/_--_..__ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 - 1 0-4 10yr2/2 I none sit 2fsbk mvfr ~ as j Zfm,1c ~ 0.6 0.8 --~-~--- -- ---1----, ~----i---- -_. _..---... _. -... _. . 2 4-18 j ----_.-- l 10yr4/3 I none j sit I 2fsbk mvfr ~ cs ~ 2fmc 0.6 0.8 3^ 18-35 ~ _ 10yr4/4 ~ f2d 7.5yr5/$ ~ _ sit }-_ 2msbk mfr i cw _ ~ _ -r- ---- .... -- • - ~ -- - ---...... . 1vf,f 0.6 0.8 4 35-47 ~ 10yr4l4 ~ f2p 7.5yr518 is cf 1csbk mfr i aw -r-----~-._....---~-- 1vf ~ 0.2 •: 0.3 5 ~ 47-58 10yr5/8 f2f 7.5yr5l8 ~ vfs Osg dl - - 1 0.4 ~ 0.6 i -_ - -•- -------- -_ _ . r ~ i \ I 'Effluent #1 = BODS> 30 < 220 mg/L a TSS >30 < 15 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number James i<. Thompson ~5._- 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number - 340 Paulson Lake Lane, Osceol 154020 12/11/2006 715-248-7767 Property Owner Scott A. & Barbara A. Larson Parcel ID # 008-1083-80-000 Page _ 2.._ of ___4.__ ~ 3 ~ Boring # _1 Boring l~! /~ Pit Ground Surface elev. _ 92.19 ft. Depth to limiting factor 33" in. Soil Application Rate ~ Horizon ! Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh, 'Eff#1 'Eff#2 1 ~ 0-5 - 10yr2/2 none sit 2fsbk mvfr as 2fm,1 c ( 0.6 0.8 2 ~ 5-16 10yr4i3 none sit - 2fsbk mvfr cs -------t 2fmc ! ------r____._.._...._.. 0.6 ~ 0.8 3 ! 16-33 10yr4/4 none sit 2msbk mfr cw 1vf,/ 0.6 0.8 4 33-60 i 5 60-64 ~ 10yr5/8 10yr4/4 f2p 7.5yr5/8 f2f 7,5yr5/8 fsl fsl lcsbk 1csbk mfi dsh aw - 1 1vf ~ - ! 0.2 0.6 T__... _....__ 0.2 0.~ ( i I Boring # J Boring ~ Pit Ground Surface elev. ft. Depth to limiting factar in. Sal Aprlication Rate , Horizon ; Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. MunseA Qu. Sz. Cont. Color Gr. Sz. Sh. _ r-- Eff#1 'Eff#2 ~ , i I ^ Boring # J Boring J Pit Ground Surface elev. tt. Depth to limiting factor in. Soil Aoolication Rare Horizon Depth in. Dominant Color Munsell Redox Description , Qu. Sz. Cont. Color ,,Texture Structure Gr. Sz. Sh. Consistence Boundary Roots , 'Eff#1 `Eff#2 I , --T ~ ~ r ( ~ -----.~_~__.....- --- i i I I --•- Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 =GODS < 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 service, ur need material in an alternate format, please contact the department at 608-266-3 l5l or TTY 608-264-8777. SBU•83iU (R.W/00) A.C.E. Soil & Sire Evaluatans ~/, so ' .a `~ 0 ~o ~ ~ ~ I r ~ `o ~ ' o a~, ~ s ~ c i ~ ' ~ ~ , ~ ~ i ~ ~ ~ t ~ ~ ~ p ~ t ~ ~ ~ C ~ 1 ~ ~ 1 1 (7~1~~Q 7l ~ S} l ~ '~ `~ ~~ ~ ~ ~ ~ ~o;/ ed~/uaf ~-, ~J, E S fin,/e.• /c/ =' s~ , ~v~"~.Z OS6 wi /ot/, ~sn~ cr/z97U SE!ysu~ s~G.,zy ~7~it ,P, i6cv. r. EXi'sE:?~ o~i~pe~su-/ ce/% T4:o(.z,J tr'cntfc.S c..E S ~X 7S' 3y Sv e ^l elect: ; Xo~ yS' ~ 18,E o ~~QQ 'tom \ ~ \ ~ ' ~ ~ ,`~ ~ ~~ ` ~ ~~ \ ~ ~ ~ a3 • ~ ~'~ a ~. ' , ~ ``` ` c\ ~,~..~~ ~s , ` 5~ , ,, az, ~ ~ ~ ' •, ~ ~ ~ , c ~~ ~~ ~~ E,~,~~' cJ,'cscr Inc . u1~ aa.~Pu.np cl~o..+ bar ~ ~¢nc ~i ~a~~ •~ T~ ~F~~~ CIS,,, ~ ~ /J9t+rt,~,¢/~ Cr~cr,' /.~SSCtsnte~ L 1G~:' =/ot9.cZ?' c~wE ~~ ¢ /2 cs . 9S, c0 ~ ' . l,,~~e..P, Scpbc. ~n~f', ~ s, ~/, Elc v. = yB. ~ , ~.s~'~~ ~X''s~'~ ~~a~c "C ,~ _L i ~ C~ N _ N ~ `~ -~ N L? N i O -~ a ~ ~ ~• m o N N W O- O ~ ~ t0/i O c0 ~ y O h m oo ~ ~ o p ;a~ Z ~ I c N v : O ~O ~ i~ m _ ~ c ~ a i~ ~~ D m tD ~ z ; a ° 1~ - o N ~v ? 1Q tD c jm cr~o.o < m< o w m n A S~ v v ~.m ~~'Om m o N (D O 'a N _~ a ~ -~ ~ ~ Z O. O- fD ~ CD -" CD LU CO ~ O fD 'O O ~ _O O' O (O ~ n ~ N W O N y .~ N B C ~? N ~ x ~ O 7 .O -O O 7 'O N ~ A ~Cn Q;N p~ 3TO•a O] O p~ N ~ Q (D N a W Q~ ~' O O O O N ~7. O ~ ~ cQ "a c ~- -o ~ ~ o O ' ~ O N O N E ° N (n = I Voy~~m~a3oN• O J~ O N a 0 0 0~ N ao. _•p v N 3 N cn -. ~ X O~ N a, N O 0~ N N~ (D N „ ~ O O co = ~ ~~ a m o ~~ o° o. c'~ N O c °: ~ 3 ~ A ~ ~ m ~ :~ ~: O N? ~ O ~ ' ~ O 00 ? O D ~ N ~ m ~ W ~ a a s v v N N o c~ s sw: D w. ~ 'O v 11 ~ ~ O O O ~ ~ ~ ~ v' N t~A t~A N a' ~ov~, m ~ -• m m .°-' •° ~ d N _ 01 Ut ~ ~ A 7 ~ ° •• N D ~ O a ~ ~ ~ ~~ ~N ~ N N ~ a 7 (Q 0 d ~ ~ a~ 0 3 o N z A ~ 7 C. O v w ~ p m m c, ~ ~ ? N 7 CD n n a D N V~ Z 0 _ -o c ~ a N ~~ 0 m N O O c m Ui 4~ ~,a 0 cA ~O o g o ~~- c~ cn 0 ~ ~ r> p t'~. o .. c .~ O r .cam. m ~ ~. ~ ~ ~ ~*A '0 ~ m m ~; y ~ # ~ 3 K ~ az 0 m W cn c N ,~ -+ ? ~ ~ ~ ~ C n ~ A W ^K O ~ ~ O ~ O O n y ~ d ~ W ~ o ° ~ !~- ar ~ m m a ~ ~ a m O ~ N N '. _ ~ ~ 0 o o s n y r o cn c fD ' td ~ r2 ', ' i t ~ ~ i p p °' ' f D ~y ,, ,,,~~ `s ' t A t n N a ° - ~+ ~ v o ~ ~ ~ ~ d 'n ~r N D/ ~ A ~ ° ° O .. N N O D D o ¢ ~r • N 3 y ~ v N A ~ ~ U1 a Z ~ c ~ A ~ CD .. N W ~ m N W (O a ~ _' ~ O ~ ? ~ o ^' N ~ CC G ~ m i,. a A p~ N ~ ~ 7 O. Z .R D q. N O O ~~ A b ~, o a S ~. r Page 1 of 1 Pam Quinn From: Kevin Grabau Sent: Thursday, March 01, 2007 11:04 AM To: Pam Quinn; Ryan Yarrington Subject: Replacement permit--Scott Larson Hey, just a "heads up", Charlie Bretz called 3/1/07. He is looking at a replacement mound plan for Scott Larson, Town of Eau Galle, 1995 installation. Jim Thompson submitted plans to the state, and shows utilization of existing bed type absorption field via diverter valve. Charlie is questioning the soils on the existing system and is requesting a soil pit verification prior to State plan approval. I put the original file in the "IncompletelDo not file" bin, as we will need to be present at the time of soil verification in the near future. I told Charlie that we would have probably required this anyway. He has put the plans on Hold. ~;, Code Administrator St. Croix County Planning & Zoning 1101 Carmichael Road Hudson, WI 54016 keying@co.saint-croix.wi.us 3/ 12/2007 '~ ~~~HR vv" r.l.~. Jr r ~ `"vNLUNI IVIV t-iC1-'Vtt 1 ~'~~ ,,,,,,,,•,•„ in accord with ILHR 83.05, Wis. Adm. Code Attachcolnplele site plan on paper not less than 8 1/2 x t t ' ian must include, but not limited to vertical and horizontal reterance point (B it ~ n (~ o pe, scale or dimensioned, north arrow, and location and d=stance roe ~+ APPLICANTINFOR~tATION-PLEASE PRINT NFORI~V ~ PROPERTY (JWNER: O lit r 5 ®>1. Y - . „ ,+ L ,~ ~t ~. ~ ~ • PRO LOCATION oo .S E. 1/4 .`, ~ i/4,SZ' 9 T ~ g ,N,R >~, p(a~W PROPERTYNER'S MAlll~ ADa~_E~SS „~~~` ~~"~r i ~,fi ` ~ ~~ SUt30. NAME OR CSM R CITY, STATE 21P CODE / ,' W,' Sh~oDZ P E'Nlti1M8 ,~,,# (7i IBSa~-~3.~ ^VILLAGE OWN u ~Q//e, NEAREST ROAD /O'~ Avg. New Construction Use ~J' Residenpal / Number of j ]Replacement ( J Public or aommerda! describe Code derived daily f{ow 6 on 9Pd Recommended design baring rate .,.~_bed, 9Pd/ft? •~trench, 9P~ Absorption area required "~~~ bed, ft2.3 75 trench, fi? Maximum design bading rate tied, 9PdJft2 trench~,tgpd/(t2~ 5.~, /~ Recommended infiltr ti rf l i 9 ~ a on su ace e evat on{5j • ~ (t ( referred to site plan benchmark) ~^ rem/~ "° Additional design I site considerations u q J~' ~ ~~ ~, S ~~ ors /ZX 7Z,C~ Parent material r Flood plain elevation, it applicable /(/~ S =Suitable for system U=Unsuitable for s stem OONYENTIONAL ~ S ^ U MO(!NO ~ ~ S ^ U INGROUNOPRESSURE S^ U AT-GRADE ~ S O U SYSTE3~.1 1h! Fill D S ~' U HOIDWG_TAF!!C ^ S U Boring # N 1 ,~ -~.~,.:~ yy a:a::~ra:5: Ground elev. ~~'~n. Depth to Gmitirig `actor i~ .~~ Boring # ~~ L~., Y ~~Y ~~. ....~.....s Ground alpy_ ~S~ P~Bn. Depth to limiting factor. ~~~~ r---- SOIL DESCRIPTION REPORT it v I Horizo Depth i Dominant Color M ~~~ Texture Structure ~~~ ~~ Roots GPp/f t~ n. unseil Qu. Sz. Coat Cola Gr. Sz. Sh. g~ T~.~. D - ~` /Ay ~ / S% ~ //~~ ~ V tr lit S !'>'1 • y + 5 ~' '~~ ~ 3 C:`s~~ rh/ ,r Cud Cry •'1 , -~ 5~~ 6v 7.5 ~ y r s m cw •7 - d S ~a7 ~© 5d . ,mss; . ~ __ ~/ •~ +g I~ . 7 f 35 . ~~ ~ ~ ` Remark' s: _ ' 1 • • ~ ~`5 ~0 ~ /moo ~ S-' ~ /n/t'Y' QS C»~ ° ~ } • 5 --~--- ~ b r'~ Orman. / o nemarics: + ~ ~ (' ~. 7V lit ~S G! ~... Pfione: ,,,7 / S ~ $y' .~ 3 7 g Address ~z© Sionature:~~~ COUNTY PARCELI 1 R Y AT r ~ ~ J Dale: CST Number: J`~/ 7- 5 - 9~ 3 ~t 13 Boling # .~ f.~:a s ~ ~~ ~r. Ground elevr '~~8 n. Depth to limiting >ac~3', Boring # 1:.q .u %:c l`{ ~~ S Ay Y Ground elev. Vii- y~ n. Depth to limiting (actor ,,~ 2S Boring # >,Vy>,~.,_~,. ~~> • fHy S.`S ~" ~~ S ~;. ~~~~ Ground elev. 9~%1~ Depth to `limiting .~'~~ ~~ Boring # :.x,_:._:::~::: ~> ~ ~~~~ GfOUnd elev. ~Z= $ Il. Depth to limiting laclor ,, t~orizo Depth in. Dominant Color Munsell Mottles Qu. Sz. Cool Color Texture Structure Gr. Sz. Sh. Consistence ~r~ry toots ,~- , , ti 3 3 29-.s"y 7, s ms s r,~ I cw e~' •''7 •$ ~ YS 7 5 `~ .... S~ ~' ~Im~ G~ ~'7,,$ S `fig' ~ ~ 56 ~ ~ ~ cs °~a~ c~ •7 •$ ~ G~-73 0 ~ s~G -- ~s s ~ ~ ~ •~7 • ~ 2:~' ~ `' 2! ~ ~i Remarks: I ~ o -~ vY~P Non ~ l s: / ~ Y~r Q ~ rr~ • `~ • ~ H@mar1CS: ~-5 ~ Z, s'-~9 /oYR `~~~ s: -~ ~v r ct,J cm • `l ~ •5 3 Z9-7~ is I~ 5 ~ m~ r~ ~ c~' • 7 = • $ Remarks: 7- 3 ro YR 4) /Vo rZ ~ S,' ~ v r G. W ' `~ • ~~ 3z- " 7•sY y c z 7-syR / sc ~ s rn-~~ c ~ ~ `~ • 5 .. ~ __- Remarks: ~~^' -~ ~~P e~ r /~BUn ,.,y~~ ~Co~ ~4rsc/~, ~9 Nwy- 63 oldw~ ~, .~., , . ~`/-3339 r s~G.z9 S.~t SE y sw~ 7gNR~~~ r a .,a n. lJ~- ~, ~ esT 3y~3 '7- io - ys Q~~ r - 95-~s' r~Z- 9~-08 B3 - - 8 N.E, Pa~;~r ~ea ~~~~ Y ~oo ~/e ~re Q ib~~ ~~ , .a .;, .., r ~sL~ ~~ /ooo~a~ C~ia»'1 Q~~' V Pa rn P P c , I (' ~'rON n p4 Su ~'"r Q C C: E~w, 8.8.;2 p ~ I I I ~ I m N 7 n~ 'z o v, o N i ~ m - ~ ° ~ d m ~ N c ~ 7 a ~ ~ (D 7 I °o cfOO ~ ~' ~ m ~~ n 00 I OD ~ a o m ~" D (D ( N I ~ ~ ~ c~ N W c _ I N ~ C.""' I I O W of ~ D { N I A O C I O =~ T w 3 N ~ O 7 CD v' 3 I 4 I ~ I N 7 Q I a I I =~ v O_ I O 7 3 m I ~ C W (D O. Z N 7 I ~ N I m I I I o 7 I Q I O~ N Z O I I ~ I I ~tio 'I~ ~~ C dom ~ '' o 3 . . ~ 7 C1 'v ` ° m ~ m ~0 ~ 3 -~ 3 r ,~ ° ~ m m o m ' p N '. I C ~ IV OD ~ ODD 7 ~, ~' + N O , rn a cn i m w o ~ ~ o0 N ~ F C7 O N ', ' 7 ~ N C ~ '. I O d te m a. ° . ' a s D 0 o m ~ ~ 7 C (J 7 N ~ \ W (O (fl 07 ~ o d o '. ' CA ~ C c il c n ~ 'i 3 r• a ~ G ! C1 i : '. ~ A , ~ ~ Z N (A fA oo ',i ° D ~ O D N _ ~ d '~ ~ ~O ~e = ~ co Of 3 y °' A 7 w o ~ D ~ , m N C N fD Q 7 i 2 A c ~ 7 Q A •• 'i 2 O ~ 7 .. N N m t 0 W ~ ~ ' ~ ~ ~ Z Q 1 O ~ ~ j ~ rn S N G Z ~ A f T I I ~ Q. I ~~ I ~ I I c I o 7 I ~ i I o ~ O ! 'I d U m :: ee :3 0 -t 0 '~ ~r~xy' 1• O ~• O • O A .~ A n ti N O V A ~O pp l;~ A w r cn a ~~~~ac~ Cp1"1'1r11t~IrGG,yyj,gDV Safety and Buildings Division County ~ ~ 201 W. Washington Ave., P.O. Box 7162 - ,. p.p i ~~~„ ~ • ^ v ~ v ^ Madison, WI 53707-7162 Sanitary Permit Number Sto be filled in by CoJ f C i} ep artmert t o ommerce f Sanitar Permit A lication Sta ransactionNumber y pp p In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate gove tal ~ 7 unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS a Project ss (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary ur ses in accordance with the Privac Law, s. 15.04 1 m Stats. ~( / I. A lication Information -Please Print All Information / ~' Property Owner's Name ~Gn ~Lt r Q Y'R ~QY'~© Parcel $' - /08.3 ~ ~~d ~ .000 Property Owner's Mailing Address ~ Pr Location ~ ' "i( j~ ~/' h' T e/G . ~~~~ ~~ ovt. of City, State ' 7 ~ t ~ Zip Code ~ /' Phon Number S' y,, ~ ~ /<, Section i l s Y~~ `~./~ ~/ ~Q / ~ 'J ~~ ~ ~ (c rc e on~,}~ T ~ N; R~ ~ o J Il. Type of Building (check all that apply) Lot # J I Subdivision Na me 1 or 2 Family Dwelling - Number of Bedrooms ~ t / ~ l S~ ~' k # Bl /v~ -- i~ ~ ~ oc ^ Public/Commercial -Describe Use / ^ J~~ ^ City of ~ ^ State Owned -Describe Use ~g~ CSM Number ^ Village of . ~ ~ 1 '/ ~ 'f ~~~ •G / Town of III. Type of Permit: (Check only one box on a A. Complete line B if a pplicable '~' ^ New System Replacement System ^ Treatment/Holding Tank Repla ent Only Ot t 'on to g st explain) B• ^ Permit Renewal f E i B ti ^ Permit Revision ^ C ge of Plumber ^ Pe it Transfer to Ne O s re ous Permit Num and ate issued ~ ~ ~'~ " ~ S ore ra e xp on r 7 , ~ Z / IV. T e of POWTS S stem/Coin onent/Device: Check al at a ^ Non-Pressurtzed In-Ground ^ Pressurized In-Ground ^ At-Gra ~ Mo d > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ~~ ^ Holding Tank ^ Other Dispersal Component (explain) ^ Pretreatment Device (explain) V. Dis ersal/TreatmentRrea Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal rea q ~ ed (sf) Dispersal rea Proposed (sf) System Elevation ~ VI. Tank Info Ca city in Total # of nufacturer o Gallons Gallo Units o_ ,y ~ 9 ~ N T k E i i T k `~ f'~t%Y+ j~r y ~ ~ ~ R ew an s x st ng an s ,~~ / o a U 2 'v'~ y ~ rn ` ° i;. C7 a. T Z Septic or Holding Tank / % OO I~ ~ ~ Dosing Chamber ~ f OO~ ~.~ VII. Responsibility Statement- I, the undersigned, assume resp sibility for installation of the POW shown on the attached plans. Plumber' (Print) s Name Plumber's Signat PRS Number Number Business P ho n e / x ~5 C ~ S~~ ~~-y ~ J ' / ~J c7 l 7~$ ~' Q 0 l ~ da ~ 4~ c UC1 Plumber's Address (Street, City, State, Zip Code) VIII. ount /De artment Use On! pproved ^ Disapproved Perini ee ~ / $ Date Issued ~ Iss ng Agent gnature ' „ ^ Owner Given R enial / ~" . / ~ U onditions of App ea~ (or Disa~prova j1(-'~/L'"j'~A ~ S ~ Q~K ~ X. ;~y~7~-v ^" ""' C` d ~ 7 - ~~F ncr~ ~ YSTEM /' . - 1 Septic tank, effluen ~r and ~~~ ~ `~ ~ ,~ - /~~~,%y~ ~ ~rzu~ dispersal cell must all be sewiee ned ~~ ~ ~ /~~, l d by e m t id b l p er. e u as N r anagemen an Nrov N r/' ~~ e. ~t f-- -' ' "' "'M"" Alt cR18 f'jnpTete plan's roe ih`e'sys~em and submit tot a Courtly only on paper not less than 8112 x 1 inches in size ~ as per applicable co a/orc~mances. ,~ ~; Lt ~..o -- SBD-6398 (R. 01/07) Valid thru 01/09 cGr' ~~~, ~/ ~ y ~ j ~ ~~ ..~ commerce.wi.gov ^ ^ ~sconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary March 13, 2007 CUST ID No. 220853 DALE E HUDSON 820 MAIN ST PO BOX 78 BALDWIN WI 54002 ATTN:• POWTS Inspector ZONING OFFICE ST CRO]X COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 .Identification Numbers Transaction ID No.1373928 SITE: Site ID No. 722880 Scott & Barbara Larson Please refer to both identification numbers; 10TH Avenue above, in all cones ondence with the a~enc ~. Town of Eau Galle, 54028 St Croix County _ SE1/4, SW1/4, 529, T28N, R16W Lot: 1, Subdivision: CSM Vol 11 Pg 2970 FOR: Description: Mound /Four Bedroom /Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1120160 Maintenance required; Replacement system; 600 GPD Flow rate; 18 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1); Biofilter CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/13/2009 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 defused in chapter 101.01(10}, Wisconsin Statutes, is responsible Por compliance with.all code requirements. Coi,,te 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 priox to occupancy or use: ~ FP~~ ON Reminders S~ C< • .This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. • The changes madevn red to this plan on 3/13/07 by this reviewer were acknowledged and approved by the system designer. Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The existing septic and pump tank must be inspected for structural soundness, size and baffles and must be brought into conformance with the requirements of ch. Comm 83, Wis. Ad .Code. If it does not conform, a state approved tank must be installed. yI't/r~~.~~u ~•~~ ~~~,~ ~-/~~-h, DALE E HUDSON Page 2 3/13/2007 • 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 POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec.145.20(2)(d), Wis. Stat • Comm 83 22(71 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 pernuts 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, ~%~~~Z~ ~~~y ~~ Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 ; 7:45 am - 4:30 pm Monday -Friday charles.bratz@wisconsin.gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: James K Thompson , A.C.E. Soil and Site Evaluations Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ,Friday; 7:00 A.M. To 3:30 P.M. ~r ~~C~~~E FEe 2 8 Q MOUND AND PRESSURE DISTRIBUTION COMPONENT DESK~'EJ'y ?SDI Residential Application & (f/ INDEX AND TITLE PAGE ~ 1~~~~,~' Project Name: Scott & Barbara Larson 4-bedroom residential POWTS Mound Owner's Name: Scott & Barbara Larson Owner's Address: 2248 10th Ave. Baldwin, WI 54002 Parcel Address: 2248 10th Ave. Legal Description: SE1/4 SW1/4, Sec. 29, T.28N., R.16W. Township: Eau Galle County: St. Croix Subdivision Name: CSM Vol. 11. Pg. 2970 Lot Number: 1 Block Number: Na Parcel I.D. Number: 008-1083-80-000 Plan Transaction No.: Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Designer: Dale Hudson Date: 02/23/07 Signatur ~ ,~ ~~ Index and title Data entry Mound drawings Lateral and dose tank System maintenance specifications ;n~lly Management and contingency plan ~D Pump curve and specifications Site Plan ~~ Co1~MERCE Soil Evaluation Report ~ tEq~g Existing POWTS information _ ~SPONDI~N _ License Number: 220853 e~ Phone Number: (715_) 684-3378 /~ 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 4.01 (R. 09/04) Page 1 of 10 Mound Svstem Maintenance and Operation Specifications Service Provider's Name Dale Hudson Phone. (715) 684-3378 POWTS Regulator's Name ' St. Croix County Zoning Phone {715j 386-4680 Svstem Fiow and Load Parameters Design Flow -Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow -Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 ftZ Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mounc 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 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 Lateral ~i. Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Scott & Barbara Larson 4-bedroom residential POWTS Mound Page 5 of 10 . 1 ~ , ~ o y p g~ c d c ~ ~ 3 n 3 ~° H. ~ m ~ m ~o ~ ~ m ~ w ~ ~ ~ ~ ~ ~ ~ ~ ~ I ~ I ~ ~~ m o~ o ° a v ~ w cNO °o ~ ~`!• I ~' ~ ,w O ~ C IJ OD H I ~ ~ Q '" G ~. m ~° ~ m ~ ~ L7 p0 o ~ O Q ~ I ~ ~" ~ ~ j ~' j ~ _ ~ ~ m e w ~ a ~ ~ ~ ° A ~ O ~ I OD OD 3 ~ ~ ~ Q. O N ~ ~ O ~ ~ 1 I 3 4! to ? ~ Qp ~ O O ~ r~ !~ ~ltl I ~ I - N N O ~D G ~ (~Viy ~ N . ~v I ~_ ~ ~ a ~ o o D ~ _ I ~ N co o cn co m o a ~ cn ~ N o c - ~" ~ ~ ` ~ i ~ ~ ! ~ ~ I r. O O O ~ °Y ~ • I a o 2 Z7 ~ ~ ~ A C -, Z O ~ ~ N ° I v N m~ t o ~ ~ D o I ° ~ m v ~ v m v N N ~ ~. ~ o ~ 3 I ~ m m = ~ ~ cQ ~ I m ~ 3 ~ w °_' N S c ~ .. ~- N I Z Z o o o I ~' O D I o I = ~ ~7 ~ ' ! ~ ~ I N • I m ~ N ~ I I ~,, ~ a Z ~ ~ i o Z c~D y I ~ 1 rn 1 ~ ~ ~, ~ c~ I ~ ~ n. A~~ I I ~ N ~ N I ~ RI N O I o. ~ ~ ~ _' Z i' I `\ ` °o ~ ^' ~ N ~ ~ I 1 Ul Z 1 I ~ I A a` I I Q ~ m Q ~ I ~a I a ~ . i ~ N ~ I I I ~ I o- I I ~ i a ~~ ~! ti I N c o I i I ~ ~ ~ a c w I m oQ ° ua O ~"' v I ~ ~ o Y I O i ~+ ,Wiscon~~;i De~~rtment of Industry, -Labor and Human Relations Safety and Buildings Division GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) Per i~ O s N ^ City ^ Village ~ Town of: i SCOTT S N r CST BM Elev.: Insp. BM Elev.: BM Description: ~ /O~ ~ s ~ ~ ftu.~, TANK INFORMATION v `JELEVATION DATA TYPE MANUFACTURER CAPACITY Septic ~ ~ ~ ~ Dosing ~l~(.Q~~~ Aeration Holding , TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Airlntake ROAD Septic ~3U ~ ~ -/ /a ~ yak ' NA Dosing /7~v' >~S~ id ~av~ NA Aeration NA Holding PUMP /SIPHON INFORMATION Manufacturer ~ Demand Model Number ~~~ ~~ ~~ vL~ GPM TDH Lift/~(.~9~ Lriction~ ~~~ System S' TDH 1`6.~~t Forcemain Length (~U ' Dia. a t~ Dist. To Well s 5~ SOIL ABSORPTION SYSTEM County: ST. CROIX Sanitary Permit No.: State PI o.. Parcel Tax No.: STATION BS HI FS ELEV. Benchmark on / /oo Bldg. Sewer St1Ht Inlet /7a8~ ~a,8~~ StlHt Outlet ,~,~~.' 8a.93' Dt Inlet Dt Bottom ao, ~ y' ~ 9. 3 i Header !Man. ,g S' 9 ~l. a ` Dist. Pipe ~ , per ' 9 Y. / ~ Bot. System c/ S ' a , 7 Final Grade BED /TRENCH Width Length No. Of Trenches PIT No.Of Pits Inside Dia. Liquid Depth IMEN I N ~~ g ~ ~ DIMEN 1 SETBACK SYSTEM TO P 1 L BLDG WELL LAKE /STREAM LEACHING Manu acturer: INFORMATION Type O -~1~,~:~ 3 / ~ 9'` ' `' ~ ~ CHAMBER Mo a Num er: System: ~-~-e.,Q ° f / SCY i4- ? OR UNIT DISTRIBUTION SYSTEM Header f Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOtI COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: EAU GALLE.29.28.16W, SE, SW, 10TH AVENUE Plan revision required? ~ Yes ^ No Use other side for additional information. /5 9 ~ ~ ~,, , ~,~ ~, '~ (~ ,~ ~ SBD-6710 (R 05!91) Date I or's Signature Cert. No. r~r-~ 7 CAp11TARV DFRMIT OpPI Itf_OTIIAN 1J ~~L.~~ In accord with ILHR 83.05, Wis Adm. Code couNTY ~ STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than i 11 i h i 8' 4 a L~() rJ g ^ n x nc es n s ze. / to previous application Check if revisio -See r6Verse Sld@ fOr If1StrUCtIOnS fOr COmpleting thlS BppliCation. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION. PROPERTY OWNER Sco ~ctr so >~- PROPERTY LOCATION 5~ %a S~ %s, S Z 9 T g, N, R /~ ~ (or W PROPERTY OWNER'S MAILING ADDRESS ~y9 ~w ~ ~3 LOT # ~~ BLOCK # ~~ CITY, STATE ZIP CODE PHONE NUMBER Q SUBDIVISION NAME OR CSM NUMBER S3 j u 11. TYPE OF BUILDING: (Check one) CITY ~ NEAREST ROAD ^ State Owned VILLAGE ~~ ~Q 1 fe ~ 1~JVl~ ~ ^ Public ~ 1 or 2 Fam. Dwelling-#~ Of bedrooms ~ AR EL NU ER ) III. BUILDING USE: (If building type is public, check all that apply) nog, ~d 83 ~ gD ~~ ~ AptlCondo 1 ^ . 2 ^ Assembly Hall 6 ^ Medical FacilitylNursing Home 10 ^ Outdoor Recreational Facility 3 ^ Campground 7 ^ Merchandise: SaleslRepairs 11 ^ RestauranUBarJDining 4 ^ Church/School 8 ^ Mobile Home Park 12 ^ Service Station/Car Wash 5 ^ Hotel/Motel 9 ^ Office/Factory 13 ^ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ~ New 2. ^ Replacement 3. ^ Replacement of 4. ^ Reconnection of 5. ^ Repair of an System System Tank Only Existing System Existing System B) ^ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ^ Seepage Bed 2i ^ Mound 30 ^ Specify Type 41 ^ Holding Tank Seepage Trench 22 ^ In-Ground 42 ^ Pit Privy 12 ~ 13 Seepage Pit Pressure 43 ^ Vault Privy 14 ^ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE nc h~ ELEVATION REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./i / / ~~~ ~5~ O ' g /~77 ~z' J~ Feet 9S Feet VII. TANK CAPACITY in allons Total # of ' N f Prefab. site C Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks acturer ame Manu s Concret on- glass App Tanks Tanks structed Se tic Tank or Holdin Tank Za ~ ~ ZOD ~ G ~'SG r.S Lift Pum Tank/Si hon Chamber OOQ /OOD // VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): ~ J l ~ ~ Plumber's Signature: (No Stamps) s4~ ~~ MP/MPRSW No.: ~ z9 Business Phone Number: 7~s ~g~-3378 . f s~w uo a c ~ ~ ~ Plumber's Address (Street, City, State, Zip Code): IX. COUNTY/DEPARTMENT USE ONLY ^ Disapproved Sa i a Permit ee IlSurchargerFee) water a e seas Issuing Age t S' nat re (No mps ~ Approved ^ OwnerGivenlnitial ~~~ /°~ Ad e e D to min tin X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly PIb~7) (R. 11/88) DISTRIBUTION: Original to County, One CORY To: Safety & Buildings Division, Owner, Plumber s ., INSTRUCTIONS -'~ ~ • •'~ ,: 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. - II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide a!I information requested in #1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the iota! gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for a/I septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vlfl. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8'/z x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; we(Is; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies colle~;#ed through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6398 (R.11/88) - ~ - .+~~.... r1~vu .>l r G r`Y HLl-N 1 IV(V tttYVti 1 _ . . U ~ l.. H R in accord with ILHR 83.05, ws. Adm. Code Attach complete site plan on paper not less Than 8 1/2 x 11 ' Ian must include, but ' not Gmitsd to vertical anti horizontal releronce point (B rr $ n ~' o e, scale or dimensioned, north arrow, and location and disiance roa 1~ APPLICANTINFCR~IATION-PLEASE PRINT NFOR I~I COUNTY PAACEU.O, rr REVIEWED 8Y DATE PROPERTYCxNNER: ~ ~,/f ~ ~ ~ " ~ pR0 LOCA710N ' ~ p r 5 r`, , GO .S ~ 114 S 1/4,Sz 9T ,2 g ,N,R J~, ~(a ~W PROPERTY CkVNEtfi'S ivWLING ADDRESS ~;ts =.~ ~ r,~ ,t'~ r 5~ ~- ~~ G . ~ ~ }~,~t ' SUBO. pAME OR CSM t w ,. -.~ - k 3 ~ J CITY, STATE ZIP CODE P EfiA,16d8 ,r„ I .' LJ, ' S'yad ~ bi ~8~ •-3~ ^VILLAGE OWN G' /I NEAREST ROAD /O ~ 4 u a ~ i v~. ~ New Construction Use ~' Residential / Number of j ]Replacement ( ] Public or commeraal describe Code derived daily lbw 60o gpd Recommended design badulg rate , ~~bed, gpd/ft2_~trench, gpd/ft~ Absorption area required ~~~ bed, ft2 3 7S trench, ft2 Maximum design bad'utg rate bed, gpoltt2 trench, lft2 9Pa I ~ ~ S Recommended infiltration surtaoe elevation(s) 9 ~ • ~ c it ( referred to site plan benchmark) ~^ re.~f ° C Additional design 1 site considerations /'7o a r. el c~ l f P ,,. ,•~ q 1`'e~ /~ ~,~ ~ ~e S , ~~ ors /ZX 72,E Parent material Flood plain elevation, it applicable /(/~a S =Suitable for system U=Unsuitable tot s stem ~~~IONAL J~ S^ U A~t0UN0 ~ ~ S ^ U NFGROUNOPRESSURE S^ U AT{'iHADE S^ U SYSTB~A rH FILL ^ S .®' U HOLOWG TANK ^ S U SOIL DESCRIPTION REPORT Boring # ._w N /' Ground elev. ~.s'~n. Depth to limiting ;~ '~ Baring # ,...-~-.-tea:.; cJ Z Ground pt~_ ~~ • d~tt Oepih to smiling ~I Horizo Depth Dominant Color Nbt>ies Texture Structure ~~~ Y Roots GPD/ft in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. Bed Trerxt ~ ° ' S ~pY Z i S'r' ~ -~ v •~'r ca s r~ • `I ~ 5 3 Z7~`f 7.5'Y . /'y s- ;. rn ~ G w C •7 . $ I Remark' s: ' L s-Lb ~o_yR 4~ sl /c,sd~ .~~~,~ c~ c~ •7 •~ I Remarks: w r Hama: Haase rrtm ~ Q /P y, 1V u lNS d Yom. Phone: Sgnalur~ Dale: - ~ ~ / / CST Number: '-5-95 3~J3 Boling ~ -ate .. S $ 3 ~- r::~.~< ~f:~ Ground elev. ~~g ~. Depth to limiting ~~~3•. Boring # :, ~~ S~y Ground elev. Depth to limiting (actor ,, 25 Boring # {~J-N.- . <--~ S ~~ ~y Ground elev. 9i~~tc 'I W Depth to limiting ~~~~ Boring # ~:v:.~;~:::~:z Kt~ ;~ f~ ~; Ground elev. ~z~8n. Depth to limiting factor ,, ~~ Horizo Depth in. Dominant Celor Munsell Mollies C;u. Sz. Cont. Color Texture Structure Gr. Sz. Sh. ~~~~ ~~ - Roots , fs ~ 2 '~`~ 3 ~$ cs rev ~ cw cm •7-` •$ _ yg ~ 5 y , s ~8-6o s ~ $6 ~ - ~ cs -r~~ c~ -7 '8 ~ 6b-73 io S~G - ~s s ~ ~ ~ • 7 • ~ Remarks: .~ ~ S-Z5 10 ~~3 on ~ .5' rnv~' ~- ~ c . •7 . S ~l -d9 '7~5' ~ `~ Y c 7.5 S~S- C ~ Sb ,,, • cf . J~ Remarks: - ~ n-5 _ ... /pYl~ Z ~ /done - _ ' 3 Z9-7~ is J~ s ~ m~ ~ ~ c~' • -7 , $ Remark s: ~ a -~ ~a v~ Z ~ Nor ~ I s. ~ ~w c •y•5 -7 - 3 /o YR 4 ~ ~) /V D 7'd es Sr ~ V Y' G (.t,~ ° y . !,' 3 ~ z3-3Z 32- " ov~e `~/3 '7~sY y Noy ~ c z 7-syR / SG ~ b r? v ~a-~~ cw c ~ c •'7 •8 • `~ . 5 ., Remarks: l3nr,'~..,cc' 'aj`'6 G7rP ~ar /ridunO~ ~/7~' ,-~-r,pf~ -- ~_ / vo" ~e a ~' ~' ~oo A~~ G~' ~~ea a ~ - 9y.82 az - 9~•y~ „_ ,.~ Q. D~~- ~~~u Q~ ~S. " ~Co~ G-4rso/~, 5~9 N~y• 63 Q ~dw : n.~ w ; . ~8y-3339 SSG. Z9 S.•t, SE y sw% ~SNRl6cJ ...,rQ~-ti. (~, ~~- ~. ~P G~z 9 ~ s T 3y~3 ~-io-9s a~M . x - /oo ~ v' 13Z - 9'08 133 - 97.8 ~ N.E, Pa~~r ~~a,,, f Y (~c/ c o cYe p~ ~re Q az o , zz zy~ R~ PNmP Ctia,~~~r r i G~I~V. $•S•Z~ .' ~Go~ G-Clrb~'O J^-,i PAS. F / J F L purr~P CHA/^.e.R CRU55 SEC~'.0'J ANG ~°ECIFICA"~ IO"!5 VE1~1T CAP `i"C. I. VE'UT PIPC ~ 2~' =~C+^1 DOOR. WINCOW iR P'RESH AIR INTAKE WEATHERPROOF .~uucTloti aox 12"M I U. I I 1 I COIJOUIT ~-- APPROVED L7Cit!l.:G MA~1HOl_E COVEi~ GRADE 18" M I A1. ~ I-JLET APPROVED JOINT W~C.2. PIPE EXTENDIIJfs 3' O-JTO SOLID SOIL ELEV. $Z''2o FT. T d 0 Y~ MItJ. •V ~ \\~~ PROVIDE I AIRTIGHT SEAL I I PUMP ~~~~ []~. ~ COUCRET7< 6LOCK ! ~; I I ~ ~~~ ~I~ II' /APPROVED J01 ~ ICI w/C.I. PIPE': (~ ALARM EXTE>`I01-JG I I ONTO Sot10 S ~~~~" I I OFF I . I ` ~- RISER EXIT PERMITTED OIJLy IF TARIK MAI.IUFACTURt`R HAS SUCH APPROVAL SEPTIC E SPECIFI•GATIOI~IS oosE ' TAUKS MANUFACTURER: LJ~/~SG:Y'S IJUM6ER OF DOSES: PER DAy TAA11( SIZE : ~°Oa GALLOAIS 005E VOLUME _ ALARM MA-JUFACTUR¢R: S'J Q~~ec~ro INCLUDIIJC, 6AGKFLOW: ~ GAtton MO01`L -.IUMb6R: • ~7 CAPACITIES: A z~'~Z INCHES OR -~Sr~f~'Ly GALLO!: SWITCH TyP[: ~~4°+'" G urY g . Z_ INCHES OR ~F7•b?-GAtLC1. PUMP MANUFACTURER: C~ocG C=G' fUCH£5 OR~~~•z GALtO-. MODEL AIUMDEIC: `~/~~-3 ~~ p ~ /Z INCHES OR~ 5'7 GALLOA SWITCH TYPE: ~C/'C~-t-y~~/ DOTE: PUMP A1Jp ALARM ARf TO bE • MIIJIMUM DISCHARGE RATE -3 ~ GpM ~~I,N~S.T~ALLED OA1 SEPARATE CIRCUITS VERTICAL. DIFFERENGF 6ETW¢¢N PUMP OFF ANO OlSTR1~UTtON PIPE.. L~~~ FEET + M11uIMUM 1~JETWORK SUPPLY PRESSURE . .. '2..~5~ FEET + ~~~ FEET OF FORCE MAIfJ X ~,sy F~p~FRiG710U (ACTOR...,=i FEET _ TOTAL Oy1JAMiC HERO = ~~'z FEET INTERNAL DIMEIJSIOAIZ OF TAIJK: LENGTH ~/ ;WIDTH ~;LIQU10 DEPTH ~2'' ~,~/ p ~~ SiGiJEO:-~~`'~' ~• "~~~a~.~ L.ICENSE XIUMBER: ~~'66Z9 ~'7~ ~j, 4~ DATE:_L _ ~~~erformance curves METERS FEf'' ~~ ~~ J H F 15 101 51 0 CAPACITY GPM J 30 m'/h GOULDS PUM P5. I NC. ~. t=u,5 ~>,~ ~~e METERS 35 30 25 0 uQi = 20 H O F- 15 10 5 FEET 120 110 100 90 7 i MODEL 3885 SIZE 3/a" Solids WE15HH i 80 1 0 60 ~ WEOSHH 90 30 20 0 0 0 10 20 30 40 50 60 70 tfU yU IW i ~u ~N aarm L -- -- ------~-- _L_ ~ 0 10 20 30 m'/h CF?ACITY Effective July, t985 01985 Goulds Pumps. Inc. C3885 Submersible Effluent Pumps ?.f? V ~ 0 10 20 30 40 50 bu iu «, s, ~~.., , ... .__ 0 10 ~ 3TC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER ,~G v~ ~ ~ Q ~^ SO Y~ ROUTE/BOX NUMBER 't7~'~R a7u~y ~.~ FIRE N0. ~27 g j-- CITY/STATE ~~~W ~~~- LJ~' ~ ZIP J`r ~DDZ_ PROPERTY LOCATION: ~~1/4 ~,,rr-~ 1/9, Section ~9 , T Z g N, R 1~ W, Town of Gcau ~'ct ~ 1 ~ , St . Croix County, Subdivision ~/1' Lot No. /~~ 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 SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of $3000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978, St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning 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 (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. IJWE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the tandards set orth, herein, as set by the Wisconsin Department of Natural R urces. Ce ication form must be completed and returned to the St.Croix Co ty Zoning ice within 30 days of the three year expiration date. SIGNED ~~~ (/ // (lJ'~l /''' DATE_ ~ ~~ ~~ St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 59016 (715) 386-9680 Sign, Date, and Return to above address ;,• ', . . ~' ~~ 1 199~~ ~~~ ~N~,wr~ ~ Z ,~,•cN~~~oio~ 531858 ~ 'o J CERTIFIED SURVEY MAP GERALD A. G.ARSON REVDCABLE LIVING TRUST °art of the Southeast 1/~ of the Southwest 1/4 of Section 29, Township ?8 North, Range 16 West, Town of Eau Galle, 5t. Croix County, Wisconsin. N //4 COR. SEC. 29, TYBN, R/6W; / 3/4 "IRON BAR SETJ ~ Indicates 1" x 24" iron pipe weighing 1.13 lbs./lin. ft. set. UNPLA T T ED LAND S ~ e `/-~/'- Indicates fence. ^ N 90.00'00"E s//.9D~ y R() Indicates previously recorded data. 9' ~ m ~ O O ~ b N ' o ~ L O T l ~' W z ~ o Q o r2. aoo ACRES '" J ~ q 922,TP3 S0. FT. ~ M ~ O //. 6! 3 ACRES EXC. ROAD R.O. W. 00 ' lO ~ O q 503, B 43 S0. FT. 7 ~ O ~• h N h ~ O Q M . J "' ~ 0. l 2 ~ SW COR. SEC. 29, T YBN, R /6W .'( /."IRON P/Pf t: •. •FOUNOI 4 ~, 2 /0/. 4P ~ . N 9G ' S L(NE SW //4 ROAD SETBACK L/NE ---- --- ~ D. ~ N90.OD'00"E 511.5} \ 9 / /. 90' 70 00 W Y6/2.9P'R/SB9•J9'49~"W 26/2 l0 TH AVE.~`33~6~6' UNPLA T T ED LANDS SCALE /"+Y00' • - O 9d /OD' SO-0' 300' 400' 900' 600' 700' This instrument drafted by Laurence ,W. Murphy t ~ h 3 a ~" 2 o . ~ ~ O O O W C q 2 = ~ ~ ~ W ~ a h Q h J W Q ~ (` W Z Q ~ N Jtfl 3 1 ~}~ J 0. u 2 h , Q N ~' `:R~)iX COUNT`{ ~ z m ~on:urehvr~siva Pl~rsnir ..~ ~ YOfllflq erld ~ Q o Partcs Commutes ~ a If not recorded ~ithM 30 days of approval date approvabsheHbo ! r/ SJ/4 COR. SEC•P9,TY8N, R/6 W, ^~&VO~Ci / 3/4 "fAON BAR f0UN01 ,tttltll t t I t /rah/'f `~~~~~~SCi O NSA ~~i~i :' ~'• ~ i ~~LAURE ~~ 37 ;~,, smWMU ~ t ~' ~ ,i-. ~~'~c'~:. ' . WIC... ~ .Q~ ' ~f •. , ~., CERTIFIED SURVEY MAP GERALD A. CARSON REVOCABLE LIVING TRUST fart of the Southeast 1/4 of the 5outhwe~~t 1/4 of Section ?9, Township ?f3 North, Range 16 West, Town of Eau Galle, St. Croix County, Wisconsin. Description: That certain parcel of land located in the Southeast 1/4 nF the Southwest 1/4 of Section 29, Township ?8 North, Rance 16 West, Town of Eau Galle, St. Croix County, Wisconsin, more fully described as Follows; Commencing at the South 1/a corner of saidoSection ?_9, the °OINT OF BEGINNING, of the parcel to be herein described; thence N 90 00'00"W (assumed bearinc on the South line of the Southwest 1/^ of said Section ?9) a distance of 511.50' (recorded as S 89059'49"W); thence N 0303T'5C1"W 1024.00'; thence N 90000'00"E 511.50; thence 5 0303'7'50"E 1024.00', to the °OINT OF BEGINNING, containing 12.000 acres, !rein;; subject to easement over the Southerly 33.00' thereof for town road purposes and also being subject to easements of record. NOTE: The parcel shown on this map is subject to State, County and Township laws, rules and regulations (i.e. wetlands, minimum lot size, access to parcel, .etc.). Before purchasing or developing any parcel, contact the St. Croix County Zoning Office and the appropriate Town Board for advice. State of Wisconsin) County of Pierce) I, Laurence W. Murphy, Registered Land Surveyor, do heresy certify that by direction of the Owners, Gerald A. Larson Revocable Living Trust, I have surveyed and divided the land shown hereon in accordance with official records, Chapter 236.34 of the Wisconsin Statutes and the Ordinances of St. Croix County and that this map and description are a true and correct representation thereof. Dated; July 7, 1995 This instrument drafted by Laurence W. Murphy JUti ~ ~ ,~y~ ```,~~1111111111~~,'' ~~~~~`~~SC ~ N`S/ ~~~~ ~ Y ~ •••••• 'V' • ~ _: ••l.AUR N ~ rn W M P ~ ?~ S „13 ~s: .• ~:•,~: ALLS ~ i 9 '••. WISC, Q~ ~~ • v • ~~urence W. Murphy Registered Land Surveycr ,~. ~ 8 T C - 100 ' This dpplication form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. ------------------------------------------------------------------- Owner of property ~co~` LQrso n- Location of property~_i/4 Sl,J 1/4, Section 2.9 ,T Z8 N-R /lo W Township ~w Ga,1~~ Mailing address `fy q /~1~y ~3 , 3a1~~; ~ , LJ,'. S.yooZ- Address of site _ ,~~~ g /D~i4ye . 1~3a fo~w ~ y.., . ~. ~. S~d~~ Subdivision name /V~( Lot no. NA other homes on property? Yes X No Previous owner of property G'e rc~l ~ ~ArsOr`' Total size of property /~ ~QGr-e5 Total size of parcel _ 1Z__~C_~^ Date parcel was created Are all corners and lot lines identifiable? ~_Yes No Is this property being developed for (spec house) ? Yes X No Volume //3 9 and Page Number ~~ as recorded with the Register of Deeds. INCLIIDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY pANER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form,. by virtue of a warranty deed recorded n the office of the County Register of Deeds as Document No. ~3 3 5/Lj and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the offi~ of the /Cp'unty Register of Deeds as Document No. gnature of Applicant ~~~~~1 Date of Signature Co-Applicant ~~ -~~ Date of Signature ~ ~ r . , • • y" ~~ DOCUMENT No. STATE BAR OF WISCONSIN FORM 10-1982 TH15 SPACE RESERVED RoR RECORDING DATA TRUSTEE'S DEED C n - 533,~1~ vni 1.1~ ~ 9 PAGE ~ l 1 Donald L. Larson ----------------------------------------------------------------------------------------------------------------- ----•---•---------•---•-------•- - - -------- ----------••--,----,--------._ as Trustee of •-the Gerald Larson Revocable Living Trust for val ble cons'deration convey •tho t warra ty t ______________________________ ~coi;~ A. ,arson anc~ ~ar`~ara nA. °Larson, ------Yiusb-ari-d-•ancl•--wife ~--Tiold-i:rig--as•-survivo-rsYiip---•--- --------------------------------------------------------------------- ------mar•i-t a-1---property - - - - - -------- -----------••-------•---- -*- ------•---------------------Grantee, ------5-~ :- ~ r o i x the following described real estate in _______________________________________________ County, State of Wisconsin REGISTER'S OFFICE ST. CROIX CO., WI Reed for Record S EP 7 Z~95 at ~o:so A.M Regi~tar of Deeds RETURN TO i ~ _^'a ~C6'~/ ~Cl.rtOAl.r yy9 `fill-~~ ~ c~ 3 Tax Parcel No : ........................._._. Part of the Southeast Quarter of the Southwest Quarter (SE4 of SWQ) of Section Twenty-nine (29), Township Twenty-eight (28) North, Range Sixteen (I6) West, Town of Eau Galle, St. Croix County, Wisconsin, more particularly described as follows: Lot One (1) of Certified Survey Maps filed July 31, 1995, in Volume 11 of Certified Survey Maps, at Page 2970, as Document No. 531858. 3 a ~~~~ ,.,. ~~ ~~ 95 Dated this ----...----.----------•--------------- day of ------- -- ----------•----•-------------------.._..----------------, 19.-------• ..------•-•--...---• ...........................•-•----._...----•-----(SEAL) -•---~;,j~'~i><2~~-f~----~!'a_.._.-(SEAL) ,~ Donald L. Larson Trustee ~ Trustee AUTHENTICATION Signature(s) --•---••--•---...--•-•-•------.....-•------•---........_ ACKNOWLED(a;MENT STATE OF WISCONSIN St. Croix r_ `_ ~ ss.