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Home My WebLink About030-2051-40-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 569505 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)). Permit Holder's Name: City Village X Township Parcel Tax No: Ran el, Isadore &Clare I St. Joseph, Town of 030-2051-40-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: 161�) d-;u Co 0-e� 27.30.20.517 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER r .S CAPACITY STATION BS HI FS ELEV. .ti Septic ` dad v Benchmark Dosing - Alt. BM 3-� T e ��-f 3 . 5 75a v J4 15.a$ c? . -7 7 Bldg.Sewer Holding �DwvY�o dDX St/Ht Inlet •�.7 95• rg TANK SETBACK INFORMATION St/Ht Outlet � O TANK TO P/L WELL BLDG. Vent it Intake ROAD Dt Inlet 17.77 y s• IST SeL i 7 /� / _ Dt Bottom OS 1 Header/Man. Dosing —7 l 75 Z4 2-1 19- ZZ 161• �s Aeration Dist. Pipe 3,Z Z d/ G 3 Holding Bot.System a ✓da.SS Final Grade 7. Id Z � - •5 UMP IPHON INFORMATION C �� , anufacturer Zoe Demand St Cover / Model Number [,a 8tj 151 3b� 33 Ca�� J,r' y 5z �xb. TDH Lift y Y/� Friction o ss System He d �� TD j (W Forcemain Lengt / Dia Z/( Dist.to Well 75 SOIL ABS ORPTTION ;YSTEM BED/TRENCH Width Length No.Of tench s PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS L� --� SETBACK SYSTEM TO �•J P/L BLDG WELL LAKE/ST AER M LEACHING Manufacturer: INFORMATION CHAMBER OR Type f ystem: 04, UNIT Model Number: DISTRIBUTION SYSTEM Header/Manif d Distribution S x Hole SizeO Ix Hole Spacing Vent it Inta Lengthy_Dia / Length /4 ZL Dia /�" Spacing 2 . 64 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only L„•j.�..�� Depth Over Depth Over xx Depth of �'' ` xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ' 4— es � No No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: �d /2-4/ lqg Inspection#2: Location: 36 County Rd E H Iton,WI 54082(SW 1/4 NW 1/4 27 T30N R20W) Village of Hoult�,Loft BIk1 t Parcel No: 27.30.20.517 1.)Alt BM Description= v G�bJ�� „ d.. P/S pr JLA 2.)Bldg sewer length -amount of cover= 1 A17sPlan revision Required? No Use other side for additional informati SBD-6710(R.3/97) /1 Date T Insepctor's Sign ure Cert.No. f I •Soil a✓a(KQ�ro✓��r''� �/ EjYi'S�;ny�radt 2/t✓ • !ro ca�cd/DraP..S�4t�t 6c4 e: CXis�%� p0 5 q� Asa afore f cAvr a,Pa e �1:yo�a4LICe!/bo be o• �p akc-i&nedos joyr 66.00' 1 Q 34 C-Adg- 5AS 3$5. --�\ •bi 0 /�don w/. 5510,01 lob Z, 6/�/,/010 A&" Pao pose d 75'0 �a.0.P oc,.yo r o--1�� ' Cod�•/82',j (Sws's�/Ju,�� c.t,�,r,bere,��Syr►iTee�5T6:/ao/{ � i �« SaC.�7,T. 3oK�,P1ou�.,T.t Q��/uenit f!;'/ferct t prcm�0 i �; _ _ 99.Sb' �E.JoSPp�,S�•�-oiJ�Co.,c 030'.2oS 1-f 1-GCS - pe use W;tL /1lw rrtoca,d Corn�+,•.rb. ,,,` �. ;,`j ,NGd.a, wo °(%S,�r,�lb�s 6 -Z' �t e's (e"',f, ,=•i SEir ,, �lit2li✓? 5u-r4ce ele l -6 6e=/DO.6J.' o of T 3bl& At'—k%co✓cr; A so-rn s e c�araje A Le 11 ,raj J kQ JJ ,t lit ,17�� '✓h� ��V� � N TR ' Y Safety and Buildings Division St Croix 201 W.Washington Ave.,P.O.Box 7162 Sanitary Permit Number(to be filled in by Co.) p OCT 14 2014 Madison,WI 53707-7162 A It ors SC Ct®IX COUNTY I A d arilt It State Transaction Number In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to project Address(if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law,s.15.04 1 m,Stats. Same I. Application Information—Please Print All Information Property Owner's Name Parcel# Isadore&Clare Ran el 030-2051-40-000 Property Owner's Mailing Address Property Location 36 Co.Rd.E Govt.Lot City,State Zip Code Phone Number —w '%4,iNW '%4, Section 27 (circle one) Houlton,WI 54082 715 544-6305 T 30 N; R 20 E or W IL pe of Building(check all that apply) Lot# 1 or 2 Family Dwelling—Number of Bedrooms 3 Subdivision Name 2 Block# Na ❑Public/Commercial—Describe Use 1 ❑CitX0f ❑State Owned—Describe Use CSM Number 9 Village of 140111t0a na L7Town of St.Jos_ph III.Type of Permit: (Check only one box on line A. Complete line B if applicable) A. 0 New System "placement System ❑Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) B. ❑Permit Renewal erntit Revision ❑Change of Plumber ❑ List Previous Permit Number and Date Issued Permit Transfer to New 569505 issued 1/17/14 Before Expiration Owner — G• -— _ 17 C t^ IV.Type of POWTS S stem/Com onent/Device: Check all that apply) ❑Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil ❑Holding Tank ❑Other Dispersal Component(explain)�'/ I i2Z'"Z'h=l C �Pretreatment Device(explain) V.DispersalfIrreatment Area Information:§M-Tech STF-100 effluent filter to be installed at effluent pump discharge Design Flow(gpd) Design Soil Application Rate(gpdsf) Dispersal Area1equired(sf) Dis al a pos�ed�f�fj System Elevation 1.0 Gpd/sq.ft.ASTM-C33 sand !�` '`� 100.65'at 6"above z 450 G �.-6 G s .ft.native soil 450.00 s .ft. 450.00 S .Ft. W. contour VI.Tank Info Capacity in Total #of Manufacturer; Gallons Gallons Units ` o New Tanks Existing Tanks (%t•'/ �Iy11�Y` cl~U y 1 h w 0 G, septic or Holding Tank Na 1,000 1,000 1 Wieser Concrete X Dosing Chamber 7 Na 750 1 Wieser Concrete X VII.Responsibility Statement I,the undersigntA assume respossiblft for installation of the POWTS shown on the attached plans. Plumber's Name(Print) N, Plumber's lgn MP/MPRS Number Business Phone Number James K.Thompson , �'� MFRS 30021 715 248-7767 Plumber's Address(Street,City,State Code) 340 P lson Lake Lane,Osceola,W1 54020 VII oun /De rtment Use Only Permit Fee D Issu .Issuing St ` Approved ❑Disapproved 7.a ❑Owner Given Reason for Denial $ I ` 1(71 IX. onditions of ApprovaUReasons for Disapproval, J _ Attach 6 complete plans for the system and submit to the County only on paper not less than 81/2:11 inches in size SBD-6348(R. 11/11) y�'9EpARTtlpNrO� DIVISION OF INDUSTRY SERVICES 10541 N RANCH ROAD p� ( HAYWARD WI 54843 3 F Contact Through Relay ` hftp://dsps.wi.gov/programs/industry-services 9 www.wisconsin.gov A Q sroNA+Sw Scott Walker,Governor Dave Ross,Secretary October 09,2014 CUST ID No. 30021 ATTN.-POWTS Inspector JAMES K THOMPSON ZONING OFFICE ACE SOIL&SITE EVALUATIONS ST CROIX COUNTY SPIA 340 PAULSON LAKE LN 1101 CARMIC14AEL RD OSCEOLA WI 54020 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/09/2016 Identification Numbers Transaction ID No.2464769 SITE: Site ID No. 798840 Isadore&Clare Rangel Please refer to both identification numbers, 36 Co Rd E above,in all correspondence with the agency. Town of Saint Joseph St Croix County SWIA,NW1/4, S27,T30N,R20W FOR: Description:Mound, 3 bedroom residence Object Type:POWTS Component Manual Regulated Object ID No.: 1465457 Revision;Maintenance required; Replacement system; 450 GPD Flow rate; 32 in Soil minimum depth to limiting factor from original grade; System(s): EZflow Mound Component Manual,(R. 7/12),Pressure Distribution Component Manual -Ver.2.0, SBD-10706-P(N.01/01,R. 10/12),SSWMP Pub.9.6; Effluent Filter CON A The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes DEPT and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed PROFESSI and located in accordance with the enclosed approved plans and with any component manual(s)referenced above. The owner,as defined in chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all code DIVISION OF requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. CO The following conditions shall be met during construction or installation and prior to occupancy or use: SEE Key Item(s) • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard,the property owner must follow the contingency plan as described in the approved plans. In addition,the owner must insure that the operation,maintenance and monitoring duties as described in section VIII of the mound component manual are complied with.A copy of this information must be given to the owner upon completion of the project. • The existing septic/holding tank(s)must be inspected for structural soundness,size and baffles and must be brought into conformance with the requirements of SPS 383,Wis.Adm. Code. If it does not conform a state approved tank must be installed. • The gravelless system components must be installed in accordance with the manufacturer's printed instructions, the plan approval,and SPS 383 system sizing criteria. If there is a conflict between the manufacturer's instructions and the plan approval,the plan approval and code requirements will take precedence. • The proposed pump is near its limit with the proposed total dynamic head. If upon installation,the total dynamic head increases,the proposed pump must be reevaluated and may be inadequate. JAMES K THOMPSON Page 2 10/9/2014 r Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per SPS 383.44(6)(a)2. • Limit activities in the area 15'beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of SPS 384.10.No fixture,appliance,appurtenance,material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system,unless it is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. A copy of the approved plans,specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department,which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance.As per state stats 101.12(2),nothing in this review shall relieve the designer of the responsibility for designing a safe building,structure,or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, Fee Required$ 85.00 Fee Received$ 85.00 Balance Due $ 0.00 Patricia L Shandorf POWTS Plan Reviewer,Integrated Services .WiSMART code:7633 (715)634-7810, Fax: (715)634-5150,M-F 8:00 a.m. -4:45 p.m. pat.shandorf@wisconsin.gov cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services(formerly Safety&Buildings)will be modified. Code references with prefixes starting with"Comm"have been replaced with "SPS"to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety&Professional Services.Additionally,all IS(formerly S&B)codes have been renumbered and addressed in a"300"series. For future reference,the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. 036• 7-051- -116 - °CC) Sew Z7 5+. Ja '8 � ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) 36 County Road E,Houlton,W1 54082 located at: SW 1/4, NW 1/4, Section 27 , Town 30 N, Range 20 W, Town of St.Joseph,Village of Houlton , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service October 18,2013 , Did flow back occur from absorption system? Yes No X � Y (if no, skip next line.) Approximate volume or length of time: Na gallons Na minutes Tank Capacity: 1,000 gallon Construction: Prefab Concrete X Steel Other Manufacturer (if known): Wieser concrete ank(if known). 23 years,installed 5/24/90 • ermit mber (if known) 135495 5_ James K.Thompson icensed Plumber Signature) (Print Name) MPRS MPRS#30021 (Title) (License Number)MP/MPRS November 18,2013 (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 I` e 4 7 EV10wo MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Rangel 3 bedroom replacement mound Owner's Name: Isadore&Clare Rangel Owner's Address: 36 Co. Rd. E Houlton, WI 54082 Property Address: Same ' Legal Description: SW1/4 NW1/4, Sec. 27, T.30N., R.20W. Township: St. Joseph County: St. Croix Subdivision Name: Village of Houlton Lot Number: 2 Block Number: 1 Parcel I.D. Number: 030-2051-40-000 1TIiONALLY Plan Transaction No.: PROVED SAFETY AND S Page 1 Index and title ZAL ACES Page 2 Data entry SE Page 3 EZflow mound drawings Page 4 Lateral and dose tank Page 5 Distribution media Page 6 System maintenance specifications E E Page 7 Management and contingency plan Page 8 Pump curve and specifications Page 9 Site Plan `� Page 10 Attached Soil Evaluation Report �J Designer: James K. Thompson License Number: 30021 Date: 9/13/ Phone Number: (715)248-7767 Signature: s- Designed Pursuant to the EZflow Mound Component Manual Ver,August 20,2007, SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS(01/81)and Pressure Distribution Component Manual Ver.2.0 SBD-10706-P(N.01/01, R. 10/12) EZflow Mound Version 3.0(R. 3/1/12) Pagel of 10 Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design 300.00 Estimated Wastewater Flow(gpd) 1.50 Peaking Factor(e.g. 1.5= 150%) 450.00 Design Flow(gpd) 1.00 Site Slope(%) 100.151 Installation Contour Line Elevation (ft) 100.00 Contour Length Available (ft) 30.00 Depth to Limiting Factor(in) 0.60 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 6.00 Cell Width (ft) 3, 4, 5, 6, 7, 8, 9 or 10 Only 75.00 = Dispersal Cell Length (ft) 1.00 Dispersal Cell Design Loading Rate(gpd/ft2) 1 Influent Wastewater Quality(1 or 2) Are the laterals the high estpoint in the distribution Y Pressure Disribution Information network? Enter Y or N (c or e) E Center or End Manifold 3 Lateral Spacing (ft) If N above, enter the elevation ft 2 Number of Laterals of the highest point. 0.125 Orifice Diameter(in) (e.g. 0.25) 2.00 Estimated Orifice Spacing (ft)= 8.08 ft2/orifice 2.00 Forcemain Diameter(in) 50.00 Forcemain Length (ft) Does the forcemain drain back? 91.25 Inside Pump Tank Elevation (ft) Enter Y or N 0.00 Forcemain Filter Loss (ft) 6.50 System Head (ft)x 1.3 8.16 Forcemain Drainback(gal) 8.90 Vertical Lift(ft) 67.38 5x Void Volume(gal) 1.00 Friction Loss(ft) 75.54 Minimum Dose Volume(gal) 16.40 Total Dynamic Head (ft) 30.48 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x x 1.25 2.00 1.50 x x 3.00 2.00 x 3.00 x i Gallons/inch Calculator(optional) Treatment Tank Information [--7-5-0.36 Total Tank Capacity(gal) 1000.00 1 Septic Tank Capacity(gal) 1 37.001 Total Working Liquid Depth (in) Weiser Concrete ]Manufacturer 20.28 gaVin (enter result in cell B49) Dose Tank Information Effluent Filter Information 750.361 Dose Tank Capacity(gal) Filter Manufacturer 20.28 _Dose Tank Volume(gal/in) STF-100A _- Filter Model Number Weiser Concrete__]Manufacturer Project: Rangel 3 bedroom replacement mound Page 2 of 10 , � 4 Mound Plan View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . t 1/10 B :.....:.....:...:... . . . . . . . . . . . : : : J K. :: ...� Observation Pipe 5 A W . .. . . . . . . . . . . . . . . . . . . B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . * ' . . . . . . . . * . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I • L Mound Component Dimensions A 6.00 ft E [Aft in H 1.00 ft K A18.20 ft B 75.00 ft F in z 6.37 ft L ft D 6.00 in G J 5.83 ft W ft 450.00 (ft2) Dispersal Cell Area 1 927.84 (ft2) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 1 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View EZtlow Dispersal Area Finished Grade 102.65 (ft) --0 t H I F t Dispersal Cell 101.15 (ft) Lateral 100.65 (ft)--► 6" Invert Elevation Dispersal Cell Elevation D ' 3 L A { � Y `i..1... 100.15 (ft) Contour Elevation 1.0 % Site Slope Typical Dispersal Cell Shading Key See Page 5 M=� Topsoil Cap a I 2 Subsoil Cap o Approved Geotextile Fabric Cover ASTM C33 Sand y 0 2.0 ft 1 4 Tilled LayerZ Wow Media ° 5 0 0.5 ft See details on page 4 for number,size,and spacing of laterals. Laterals are located in the 4"gravity distribution pipes as shown on page 5. Project: Rangel 3 bedroom replacement mound Page 3 of 10 End Connection Lateral Layout Diagram Place Appropriate Lateral Diagram From Right Below 14 P •= Turn-up ntb311 valve or cle3nout plug Z 1st orifice located at Z IE X-3, Orifices point up except every 5th S one points down for drainage. Face main connection via tee or cross to marjold s any point. Laterals b fore#main of PVC Sth 40 AN laterals iderdical with orifices equally spaced. per SPS Table 3s4.30- Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.04 ft Lateral Length (P) 74.22 ft Orifices per Lateral 37 Lateral End (Z) 0.78 ft Orifice Density 6.08 ft2/orifice Lateral Spacing (S) 3.00 ft Manifold Length 3.00 ft Lateral Flow Rate 15.24 gpm Manifold Diameter 1.50 in System Flow Rate 30.48 gpm Forcemain Velocity 3.11 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and '--► SPS 316.300 WAC Q in.min. Disconnect Tank component is properly vented E--- Alternate outlet location Forcemain diameter Weiser Concrete Manufacturer 2 in. Capacity 750.36 Gallons _ Volume 2018 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 19.28 390.90 8 2.00 40.56 C P ♦ ump off elevation(ft)—f C 3.72 75.54 92.25 D 12.00+ 243.36 D Total 37.00 750.36 Dom se tank elevation(ft) Bedding And Backfill As Per Manufacturer 91.25 Alarm Manufacturer SJ Rhombus Alarm Model Number "SJE 1011421 Pump Manufacturer Zoeller Pump Model Number B.N151 Pump Must Deliver 3-0-74 8-1 g p m at 16.40 ft TDH Note: Switches containing mercury may not be used in this system. Project: Rangel 3 bedroom replacement mound Page 4 of 10 Uflowo Distribution Cell Media Layout 6.00 Cell Width (ft) 1.50 Sidewall to Lateral (ft) Distribution Cell Cross-section Arrangements 7 ft Wide (9(va"Me Component Legend ® SR1-7A Bundle-5 ft or 10 ft lengths SR1-12A or EZ 1201A in 5 ft or 10 ft lengths SR3-12H or EZ 1201 P or SR3-12H in 5 ft or 10 ft lengths O 4" Perforated Distribution Pipe With Pressure Lateral Inside • Turnup Enclosure - - - - - Pressure Lateral Bundles are covered with approved geotextile fabric as per the their product approval. Distribution Cell Plan View Layout - Typical 6.00 Cell Width -A(ft) 75.00 Cell Length -B (ft) Center Connection Lateral Layout Diagram Force Main --y - - - - - - - - - - - - - - - - - - - - - - - - 7 ftWide - — — — — — — — — — — — — — — — — — - -- - — — — —A End Manifold Project: Rangel 3 bedroom replacement mound Page 5 of 10 Mound System Maintenance and Operation Specifications g l- _ Thompson _ Phone rJ?71POWTS Re ulator's Name S. Croix County Zoning Deli_,. _______ Phone 15Z386-4680 Service Provider's Name Jmaes K. System Flow and Load Parameters Design Flow-Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow-Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Inspect and clean as necessary at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test periodically Pressure System Laterals should be flushed and pressure tested every 3 years Mound Inspect for�onding and seepage once every,3 years 0 t _� _ Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap and are secured in as shown in the EZflow Mound Component Manual Ver. August 20, 2007. 2. Dispersal cell media conforms to EZflow products approved for use with the EZflow Mound Component Manual Ver. August 20, 2007. Media is covered with an approved geotextile fabric. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis.Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished Grade •.• • 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Lateral Ends at Last Orifice Where Variable Length Cleanout Begins Long Sweep 90 or Two 45 Degree Bends Same EZflow S nthetic Media Diameter as Lateral 2.06 Feet ♦—Distribution Lateral Lateral Cleanout Project: Rangel 3 bedroom replacement mound Page 6 of 10 Mound System Management Plan Pursuant to SPS 383.54,Wis.Adm.Code General This system shall be operated in accordance with SPS 382-84 Wis.Adm.Code,and shall maintained in accordance with its'component manuals(EZflow Mound Component Manual 8/20/07,Pressure Distribution Component Manual Ver.2.0 SBD-10706-P(N.01/01)and SSWMP Publication 9.6(01/81)]and local or state rules pertaining to system maintenance and maintenance reporting. Septic and pump tank abandonment shall be in accordance with SPS 383.33,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 fitter is equipped with an alarm,the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment,maintenance personnel shall advise the owner as to 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 Wisconsin Department of Commerce. Pump Tank The dosing(pump)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. If the force main has a weep hole, it should be noted if it is functional during pump operation,and if not,it should be cleaned. 'No one should ever enter a septic or dose tank since dangerous gases may be present that could cause death.'"" Mound ang Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter,and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic(other than for vegetative maintenance)on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations(October-February)dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L 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 3 years. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner,and any levels above 4 inches considered as an impending hydraulic failure requiring additional,more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank,pump,pump controls,alarm or related wiring becomes defective the defective component(s)shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface,it will be repaired or replaced in its'present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media,and related piping,and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Rangel 3 bedroom replacement mound Page 7 of 10 PUMP PERFORMANCE CURVE MODEL 151/152/153 TOTAL DYNAMIC HEAD/FLOW 50 PER MINUTE 14 153 EFFLUENT AND DEWATERING t2 40 MODEL 151 152 153 31, 152 Feet Meters Gal. titers Gal. liters Gal. Ulm 10 ii 5 ib 5o 189 69 261 77 291 10 3.0 45 170 61 231 70 265 o e 25 151 15 4.6 38 144 53 201 61 231 s20 8.1 29 110 44 187 52 197 iT 25 7.8 18 81 34 129 42 159 30 9.1 -- 23 87 33 125 1a 35 10.7 22 85 4 10 40 12.2 42 Shut-off Head: 30 ft.(9.frill 38 ft.(11 brn) 44 ft.(13.4m) 2 5 0145066 0 f0 20 30 40 50 60 7 0 e0 BO 1 GN1ON4 LITERS 0 40 80 1 160 24o 0 3 360 FLOW PER MINUTE D1asom Model 151 Models 1521153 CONSULT FACTORY FOR U SPECIAL APPLICATIONS - 67/32 37 re 6 Y8 3 27132 4 SB •Tuned dosing panels available. _ •Electrical alternators,for duplex systems,are available and supplied with an alarm. 3716 327132 •Variable level control switches are available for controlling \ � g � I 31/8 single phase systems. ---� •Double piggyback variable level float switches are available for variable level long and short cycle controls. •Sealed Owik-Box available for outdoor installations.See FM1420. •Over 130'F.(54•C.)special quotation required. 15111521153 Series 11,+716 121118 151H521153 YODELS Control Selectlon -r Yodsl volts-ph Mods Amps Simplex Duplex N151 115 1 Nan 6.0 1 2 or 3 BN151 115 1 Auto 6.0 Included 2 or 3 E151 230 1 Non 3.2 1 2 or 3 BE151 230 1 Auto 3.2 Included 2 or 3 SK2144 SK-1064 N152 115 1 Non 8.5 1 2 or 3 Bii 115 1 Auto 8.5 Included 2 or 3 E152 1 230 1 Non 1 4.3 1 1 2 or 3 BE152 230 1 Auto 4.3 1 Included 2 or 3 rE1 53 115 1 Non 10.5 1 2 or 3 153 115 1 Auto 10.5 Included 2 or 3 53 230 1 Non 5.3 1 2or3 SELECTION GUIDE 153 30 1 Auto 5.3 Included 2 or 3 1. Si,igle piggyback variable level float switch or double piggyback variable level float O CAUTION switch. Refer to FM0477. All installation of controls,protection devices and wiring snoutn he done by a qualihed 2. See FM0712 for correct model of Electrical Alternator E-Pak, licensed electrician.All electrical and safety codes snoulu re toiloweu including Ine most recent National Electric Code(NEC)and the Occupational S3faly and stealth Act(OSHA). 3. Variable level control sWltch 10-0225 Used a6 a control activator,specify duplex(3) or(4)float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. AIAILTO:P.O.BO�RR'47 l"To.16,KY 402 Manufacturer;of.. SHIP T0:3649 Cane oad k,KY 402 1 ��7u7�uTrPul+vs SN�f/9,99 ® (502)71&2731.1(800)928 PUMP 4 httpJ/wwwzoellercom FAX(602)774.3624 0 Copyright 2004 Zoeller Co.All rights reserved. P . � Sa•/t✓a/ua�`n ban% �Soi/e✓a/ua6�o•�/�i� �► E,r.�b,'ny��adc �Icd, • Goca�edU,oraP.s+4t�'e ,p�"23sY ex,,3-&7q PowTs q� �sao/orttGart,Pan�e/ el;yo�sCe!/bo 6e o a 6a4 aloneda s pti' GG.cn' A 5 As 3$g. -- U //o�r<an,CAI. 5Sso6Z �r 1.,oG1, 61,e/,/o/&4 w//a-e6w, Pao past d 75o J- 'P Kr►�o r o--�` t ' Gov 14 /e 63 (s'^�`s�m4 Syin7e-c4,5TF-.AVA t t �" SaC. T,T. 3oN;P1ow.,Ta.oP Q�F/uen�' �';/fe%t pa.nj4 j � �i �_ _.. 99.Sb' �E.�7oSfI°�,•j�.ClbiXC.a�c�! a1,sc�ia��C. la N/. 0 030-aoS/-flo-,Az I 1 ' 66V o.,1/acres V t Exis '!� I-OV-0 U q04 40iesv I Propo 5C-d fAou.do4, /8.2o'X� ./d y G z?S, oncree To /�CCons/e ed-/o ustW,t� Alm Mou.,d co,,,par,on•6. , ;,j N1Gd�.t. wo ES �J d;st�i bG t;b,,ls�c..rls 4� E.ele.: QEin�ut of i .r 00144=K.m, lye K �yxz' y�`ror� cr t cadet 7.o wood P• :o- Ao.EooE:r�t • o c{ 3 bsd! /yls�h%to✓w:•.�(rsw rnt QssidirleL eye.! ��aD.ad,• _.._ g Ow�nq� M U EXI�i.��[veld ( V tke �i N 2354 Wisconsin Department of SOIL EVALUATION REPORT Page I of—3 Commerce A.C.E.Soil&Site Evaluations : . -- in accordance with Comm 85,Wis.Adm.Cod( Attach complete site plan on paper not less than 81/2 x 11 inches in size. Pla County St. Croix include,but not limited to:vertical and horizontal reference point(BM),directio — percent slope,scale or dimemsions,north arrow,and location and distance t< Parcel I.D. 030-2051-40-000 Please print all information. Reviewed By Date Personal information you provide may be used for secondary purposes(Privacy Law,S. -"� ` +rill Property Owner Property Location V Isadore&Clare Rangel Govt.Lot na SW 1/4 NW 1/4 S 27 T 30 N R 20 Property Owner's Mailing Addres Lot# Block# Subd. Name or CSM# 36 Co. Rd. E 2 1 Village Of Houlton City State Zip Code Phone Number City Village ✓ Town Nearest Road Saint Joseph WI 1 54082 1 (715)549-6305 St.Joseph Co. Hwy E & State St. New Constructior Use: ✓ Residential/Number of bedrooms 3 Code derived design flow rate 450 - GPD ✓ Replacement Public or commercial-Describe: Co. Hv«,E& Stale St. Parent material Glacial Till Flood plain elevation,if applicable Na General comment: and recommendations: Site suitable for mound system w 6"of ASTM-C33 sand. Contour to be 100.15' Maximum available contour length=75'. / �t. 11, J 4 6� 2' 1� F-T-1 Boring .�-'2�L° _f �G-rv2 L'`^✓U,< Y1,G ' Boring# -- ✓ Pit Ground Surface elev 100.13 -ft. Depth to limiting factor — 32 in Soil Application Rate, Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPD_/ft- in. Color Qu.Sz.Cont.Colo Gr.Sz.Sh 'Eff#1 j Eff#2 1 0-12 10yr3/2 none sil 2fgr ds as 2fm1c 0.6 ! 0.8 2 12-32 10yr4/3 none sil 2fsbk ds cw 2fm1c 0.6 0.8 3 32-48 10yr4/4 f2f 7.5yr5/8 fsl 1 fsbk dsh cw 1 vf,fmm00 2 0.6 -- ---- ----- ----- - ---t---- -----1 4 i 48-69 10yr4/4 f2fd 7.5yr5/8 scl 1csbk ds 0.2 0 3 -- --- ----- -- 172 Boring# Boring ✓ Pit Ground Surface elev 99.26 ft. Depth to limiting factor _30_-in. Soil Application Rata Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar 1 Roots GPD/ft;_ in. Color Qu.Sz.Cont.Colo Gr.Sz.Sh `Eff#1 j 'Eff#2 1 0-11 10yr3/2 none sil 2fgr ds as 2fm1c 0.6 1 0.8 2 11-30 10yr4/3 none —� sil 2fsbk ds cw 2fm1c 0.6 r 0.8 3 30-38 10yr4/4 ( f2f 7.5yr5/8 fsl lfsbk dsh cw lvf,fm 0.2 j 0.6 4 38-44 10yr4/4 f2fd 7.5yr5/8 — scl lcsbk ds - 0.2 0.3 I 'Effluent#1 = BOD 30<220 mg/L an SS>30 150 mg Effluent#2=BOD,<30 mg/L and TSS<30 mg. CST Name(Please Print) Sign ure: CST Number James K. Thompson -- �-- —_- 3602 - -i Address A.C.E.Soil&Site Evaluations — < Date Evaluation Conducted Telephone Numbe+ 1 340 Paulson Lake Lane,Osceola,WI 54020 11/2/2013 715-248-7767 Property Owner Isadore&Clare Rangel Parcel ID# 030-2051-40-000 Page 2 of 3 F3 ] Boring# ✓i Boring Pit Ground Surface elev 99.03 ft. Depth to limiting factor 35" in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPD/ft; in. Color Qu.Sz.Cont.Colo Gr.Sz.Sh •Eff#1 •Eff#2 1 0-10 10yr3/2 none sil 2fgr ds as 2fm1c 0.6 0.8 2 10-35 10yr4/3 none sil 2fsbk ds Cw 2fm1c 0.6 0.8 3 35-45 10yr4/4 f2f 7.5yr5/8 fSl lfsbk dsh Cw 1vf,fm 0.2 0.6 4 45-51 10yr4/4 f2fd 7.5yr5/8 scl lcsbk ds - - 0.2 0.3 Borin g 'A -c/ _ } !� Boring# ✓ Pit Ground Surface elev 99.03 ft. Depth to limiting factor 38" in. Soil Application Rat -Naftzon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots PD/ft' in. Color Qu.Sz.Cont.Colo Gr.Sz.Sh •Eff#1 •Eff#2 1 0-8 10yr3/2 none sil 2fgr ds as 2fm1c 0.6 0.8 2 8-38 10yr4/3 none sil 2fsbk ds Cw 2fm1c 0.6 0.8 3 38-50 10yr4/4 f2f 7.5yr5/8 fsl l fsbk dsh Cw 1 VUrn 0.2 0.6 4 50-56 10yr4/4 f2fd 7.5yr5/8 scl lcsbk ds - - 0.2 0.3 5 Boring# Boring c L 7-C `1 � �Ttt /✓1��. I � r� ' �1 ✓ Pit Ground Surface elev 99.71 ft. Depth to limiting factor 36" in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPD/ft- in. Color Qu.Sz.Cont.Colo Gr.Sz.Sh •Eff#1 •Eff#2 1 0-10 10yr3/2 none sil 2fgr ds as 2fm1c 0.6 0.8 2 10-36 10yr4/3 none sil 2fsbk ds Cw 2fm1c 0.6 0.8 i 3 36-46 10yr4/4 f2f 7.5yr5/8 fsl lfsbk dsh Cw 1vf,fm 0.2 0.6 4 46-57 10yr4/4 f2fd 7.5yr5/8 scl lcsbk ds - - 0.2 0.3 *Effluent#1 =BOD 30<220 mg/L and TSS>30< 150 mg •Effluent#2=BOD J<30 mg/L and TSS<30 mg. The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,please contact the department at 608-266-3151 or TTY 608-264-8777. SAD-8330(R.0?100) A.C.E.Soil&Site Evaluations • 50'I e✓a/ual&`n 6ar,:�q EXi�aG:riy yade Ott/ • Locc�><ed�D�aP•S>&e�e 5ca ,Py�',z3SY E,t,s�� Poems q� --Xsaa6,e Of Ga;rc&'-1,2,1 cl;yo&-5Z(Ce!1Eo6e °' 3G C'o &.4- aAanebnecdois Pti' L�.u'>' �a�on CAI. 5140BZ - `�I iaa.o D Lot Z, (3/�'•;�/aa<o� clfvr>, Pao past d 15'0 '-'&P P a,.+ro r o--i I God E Aidi(Sw�Wr1u•14F� c vmberw/Sy„1Tec4 STF--/ooA I i 'o Sae.2r,- 3ox;,olow.,T.6f' ei(F/ue,,16 t;/f ,-a.6 pjcMto `� Cnoi�CCa,ua! d,scjtar�C. I I iI /pc/ 030-ao.S/•f10-410 I I I� �jGnq O.��GCrGS 7 Ii i I Ij 1 ExiSfi /,ot7o q�. cJ,cSv ;i PfoP6 5Gd Mo /AX-O x19o.i6'"y 7S C.OnLlGlct S�pl�/�Eon�t!To 6e _ t i I d,s�rsa./ee//u>�"/i,�i•, E�/c�,.,►d;s�';bw-�'oy /'e use W',:L •r` /j!u) HZoG•+dCorH`Jd>'�eh'�. � �., �J IHCdi4. wo��is�i'.b�s.i�,b1V,lQ�cr-a.ls alb' ESE.je a64osl /6 c i . 0�t/a:`=9sa?' wood pa.�:o- no.>�ooE;nJt -9yd �psr�� • o af' 3bs }� Atx,,h%owev; �Q as• rns Qss d�tL `� e 4e% �SAD.ad.• ___ � � �s A4!'age C1 (J EXl. r19 GUe l� V ke 8 H N awl P5. 9a�' /o County I Safety and Buildings Division St.Croix a 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.) �y �► Madison,WI 53707-7162 b Oil itary Permit Application State Transaction Number In accordance wi 383 (2), I!Adm.Code,submission of this form to the appropriate governmental unit 2352069 is required prior to ing a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary ses in accordance with the Privacy Law,s.15.04 1 m,Stats. Same I. Application Information—Please Print All Information Property Owner's Name Parcel# Isadore&Clare Ran el 41tek, 030-2051-40-000 t 1-7 Property Owner's Mailing Address Y14AII , Property Location s 36 Co.Rd.E sr 4?0? Govt.Lot City,State Zip Code Phone NuilYM CC)IJ / SW_'., IOW_'/. Section 27 (circle one) Houlton,WI 54082 715 549-6305 T 30 N; R 20 E or W II. g of Building(check all that apply) Lot# Family Dwelling—Number of Bedrooms n3 2 Subdivision Name Block# 44 C ( Na ❑Public/Commercial—Describe Use 1D U }�Y ❑City of ❑State Owned—Describe Use CSM Number ill of 1-IOU1tOn na Gk wn of St.Joseph I1I.Type of Permit: (Check only one box on line A. Complete line B if applicable) A" ❑New System Q46placcrnerit System ❑Treatment/Holding Tank Replacement ly a Modifi o xt ystem(explain) B. ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Trans N List Previous Permit Number and Date Issued Before Expiration Owner 5 S- S /D IV.Type of POWTS System/Component/Device: Check all that apply) ❑Non-Pressurized In-Ground ❑Pressurized In-Ground ❑A Ull nand>24 in.of itable ❑Mound<.*M.o suitably it c ❑Holding Tank ❑Other Dispersal Component(explain ( �/ Devi din) V.Dispersal/Treatment Area Information. -Tech STF-100 effluent filter to be installed at effluent puinp disckariV Design Flow(gpd) Design Soil Application Rate(gpdsf) Dis tsal Area R tre s a 0 Gpd/sq.ft.ASTM-C33 sand 4_t _ /3 7/ 100.00'at 6"above 450 G 0.6 G s .ft,native soil 450.00 s .ft. 450.00 F.R.S 99.50' contour V1.Tank Info Capacity in Total #of Manufactu Gallons Gallons Units ',- /�C U H New Tanks Existing Tanks i/V� ` *1� T; w Septic or Holding Tank Na 1,000 1,0 1 Wieser Concrete X 0 7 Dosing Chamber 1 Wieser Concrete X 5 Na 7 50 VII.Responsibility Statement- the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumbe s Signature MP/MPRS Number Business Phone Number James K.Thom s MPRS 30021 (715)248-7767 Plumber's Address(Street,City,State, ode) 340 Pa lson Lake Lane,Osceola,WI 54020 VIII.Xeoun /De artment Use Only pproved ❑Disapproved Permit Fee Date Issu suing Agent St ❑Owner Given Reason for Denial $�QZ5/ �rl1�71, D l� 2 DL oval/Reasons for Disapproval < < `, � IDr 8�: �dr�c�Ge�o S 2� 1.Septic tank,effluent filter and ` dispersal cell must be serviced/maintained �� os� as per management Ian rovided b lumber. ' / �`�/ P 9 P p YP � fwd P:s � �� 2.All setback requirements must be maintained iv c e co us for the sys sn t to the Couuty oaFy on paper not less than 9 t/2 a 11 i ches in SBD-6398(R 11/11) 9ti2�T+�y DIVISION OF INDUSTRY SERVICES -0 5�� roe 10541 N RANCH ROAD kn P HAYWARD WI 54843 3 Contact Through Relay p www.dsps.wi.gov/sb/ s' 4Q www.wisconsin.gov �O SS1014 � Scott Walker,Governor Dave Ross,Secretary January 08,2014 CUST ID No. 30021 ATTN.•POWTS Inspector JAMES K THOMPSON ZONING OFFICE ACE SOIL&SITE EVALUATIONS ST CROIX COUNTY SPIA 340 PAULSON LAKE LN 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 01/08/2016 Identification Numbers Transaction ID No.2352069 SITE• Site ID No. 798840 Isadore&Clare Rangel Please refer to both identification numbers, 36 Co Rd E above,in all correspondence with the agency. Town of Saint Joseph St Croix County SW1/4,NWI/4, S27,T30N,R20W FOR: Description:Mound,3 bedroom residence Object Type:POWTS Component Manual Regulated Object ID No.: 1465457 Maintenance required; Replacement system; 450 GPD Flow rate; 30 in Soil minimum depth to limiting factor from original grade; System(s):EZflow Mound Component Manual,(R.7/12),Pressure Distribution Component Manual- Ver.2.01 SBD-10706-P(N.01 101,R. 10/12), SSWMP Pub.9.6; Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s)referenced above. y'.r l `r®� GF The owner,as defined in chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. SEE C The following conditions shall be met during construction or installation and prior to occupancy or use: Key Item(s) • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard,the property owner must follow the contingency plan as described in the approved plans.In addition,the owner must insure that the operation,maintenance and monitoring duties as described in section VIII of the mound component manual are complied with.A copy of this information must be given to the owner upon . completion of the project. • The bottom of the distribution cell shall be level per the Mound Component Manual. The"D"dimension shall be a minimum of 6". The maximum finished slope of the mound surface shall not have a slope ratio steeper than 3:1 per the Mound Component Manual • The gravelless system components must be installed in accordance with the manufacturer's printed instructions, the plan approval,and SPS 383 system sizing criteria. If there is a conflict between the manufacturer's instructions and the plan approval,the plan approval and code requirements will take precedence. • The existing septic/holding tank(s)must be inspected for structural soundness,size and baffles and must be brought into conformance with the requirements of SPS 383,Wis.Adm.Code.If it does not conform a state approved tank must be installed. JAMES K THOMPSON Page 2 1/8/2014 �4 Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per SPS 383.44(6)(a)2. • Limit activities in the area 15'beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of SPS 384.10.No fixture,appliance, appurtenance,material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system,unless it is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. A copy of the approved plans,specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department,which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance.As per state stats 101.12(2),nothing in this review shall relieve the designer of the responsibility for designing a safe building,structure,or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, Fee Required$ 250.00 Fee Received$ 250.00 Balance Due $ 0.00 Patricia L Shandorf POWTS Plan Reviewer,Integrated Services WiSMART code:7633' (715)634-7810, Fax: (715)634-5150,M-F 8:00 a.m.-4:45 p.m. pat.shandorf @wisconsin.gov cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services(formerly Safety&Buildings)will be modified. Code references with prefixes starting with"Comm"have been replaced with "SPS"to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety&Professional Services.Additionally,all IS(formerly S&B)codes have been renumbered and addressed in a"300"series. For future reference,the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. i Replacement Mound POWTS Index & Title Sheet Project Name: Rangel 3 Bedroom replacement Mound Owners Name: Isadore&Clare Rangel Owner's address: 36 Co.Rd.E,Houlton,WI 54082 Site address: Same Project Location: Subdivision: Lot 1,Blk 2,Village of Houlton Legal Description: SW'/4NW'/4,Sec.27,T.30N.,R.20W.,Town of St.Joseph,St.Croix Co.,WI. Parcel ID#: 030-205140-000 Page 1 Index and Title Sheet Page 2 State Approved Mound Design Page 3 Pump chamber cross section Page 4 Filter Specifications— 'TK Page 5 Septic Tank Maintenance Agreement Page 6 Parcel map Page 7 Deed Attachments: Soil Evaluation Report Mater P beJRes *cted Service: James K.Thompson,Dept.of Safety&Professional Services Credential#30021 Signature: Date: Page I of 7 Design pursuant to In-Ground Soil Absorption Component Manual for POWTS,version 2.0 SBD-10705-P(N.01/01) EZflow® MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN l4esidential Application INDEX AND TITLE PAGE Project Name: Rangel 3 bedroom replacement mound Owner's Name: Isadore&Clare Rangel Owner's Address: 36 Co. Rd. E Houlton, WI 54082 Property Address: Same i Legal Description: SW1/4 NW1/4, Sec. 27, T.30N., R.20W. Township: St. Joseph County: St. Croix Subdivision Name: Village of Houlton Lot Number: 2 Block Number: 1 Parcel I.D. Number: 030-2051-40-000 -D Plan Transaction No.: �A:�r rY SERVICES ➢i�i�,L ��RSERVICES Page 1 Index and title jNDU Page 2 Data entry Page 3 EZflow mound drawings Page 4 Lateral and dose tank Page 5 Distribution media -P F PO NU) N Page 6 System maintenance specifications JRRESPOND Page 7 6pump Management and contingency plan v�� Pa e 8 curve and specifications- Pa 7�- Page 9 Site Plan Page 10 Attached Soil Evaluation Report Designer: mes K. Thompson License Number: 30021 Date: 11/1_ 9/ ` Phone Number: (715)248-7767 Signature: S— Designed Pursuant to the EZflow Mound Component Manual Ver.August 20,2007, SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS(01/81)and Pressure Distribution Component Manual Ver.2.0 SBD-10706-P(N.01/01, R. 10/12) EZflow Mound Version 3.0(R. 3/1/12) Page 1 of 10 i Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design 300.00 Estimated Wastewater Flow(gpd) 1.50, Peaking Factor(e.g. 1.5 = 150%) Design Flow(gpd) 0.601 Site Slope(%) –99.-561 Installation Contour Line Elevation (ft) 100.00'Contour Length Available(ft) 30.001 Depth to Limiting Factor(in) 0.601 In-situ Soil Application Rate(gpd/ft2) Distribution Cell Information Cell Width (ft) 3, 4, 5, 6, 7, 8. 9 or 10 Only Dispersal Cell Length (ft) Dispersal Cell Design Loading Rate(gpd/ft2) 1] influent Wastewater Quality(1 or 2) ig p Are the laterals the highest es t oint in the distribution Y Pressure Disribution Information network? Enter Y or N r (c or e) E Center or End Manifold Lateral Spacing (ft) If N above, enter the elevation (ft) Number of Laterals of the highest point. Orifice Diameter(in) (e.g. 0.25) 2.00 Estimated Orifice Spacing (ft) ft2/orifice 2.00 Forcemain Diameter(in) 35.00 Forcemain Length (ft) Does the forcemain drain back? Y 91. levation (ft) Enter Y or N C, V, —LU Forcemain Filter' Loss(ft v (ft)6.50 System Head (ft) x 1. 5.71 Forcemain Drainback(gal) ✓ -8-25 Vertical Lift(ft) 67.38 5x Void Volume(gal) 0.70 Friction Loss (ft) 73.09 Minimum Dose Volume(gal) 15.45 otal Dynamic Head (ft) 30.48 System Demand (gpm) I�.qe Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. o tions choice 0.75 1.25 1.00 1.50 1.25 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons/inch Calculator(optional) Treatment,Tank Information Total Tank Capacity(gal) iLl 000.00 1 Septic Tank Capacity(gal) -�00 Total Working Liquid Depth (in) Concrete, Manufacturer 20.28 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information ] Dose Tank Capacity(gal) !Sym Tech Filter Manufacturer 20.281 Dose Tan_k Volume(gal/in) STF-100A Model Number L%eiser Concrete-,-, Manufacturer Project: Rangel 3 bedroom replacement mound Page 2 of 10 Mound Plan View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . t J Observation Pipe K �� .5. A . . . . . . . . . . . . . . . . . . W . . . . . . . . . . . . . . . . . . ......... . . . . ... B I . • L Mound Component Dimensions A 6.00 ft E Aft in H 1.00 ft K 7.55 ft B 75.00 ft F in z 6.18 ft L 90.09 ft D 6.00 in G J 5.91 ft W 18.09 ft 450.00 (ftz) Dispersal Cell Area 913.71 (ft) Basal Area Available . 6.00 (gpd/ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View EZflow Dispersal Area Finished Grade 102.00 (ft) ----0 ♦ H F Dispersal Cell 100.50 (ft) Lateral 100.00 (ft) iii 6" Invert Elevation Dispersal Cell ' ; Elevation D : 3 Q A ' 3 y K ,t A 4 9 .50 (ft)Contour Elevation 0.5 % Site Slope Typical Dispersal Cell Shading Key See Page 6 Q= Topsoil Cap � ��• 2 """" Subsoil Cap c o Approved Geotextile Fabric Cover ASTM C33 Sand to 2.0 ft # 4 [ Tilled Layer ° m ?'f ?� '' :? 5 'r:? F 5 EZflow Media t �:�` ;::; See details on page 4 for number,size,and spacing of laterals. Laterals are located in the 4"gravity distribution pipes as shown on page 5. Project: Rangel 3 bedroom replacement mound Page 3 of 10 End Connection Lateral Layout Diagram Place Appropriate Lateral Diagram From Right Below F P •= Turn-up%?b3ll valve orcle3noutFaug 1 st oritice located at Z I� )C--y; Otif ce;,paint up except every 5th S " one points dovvri for de-ainage. I Face main connection tie a ter or doss to mawold at any point t;,erals 4 force mom of PVC Sch 40 All laterals uierdical•yw4h caihces equally spaced. per SPS Table 384 30-6 Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.04 ft Lateral Length (P) 74.22 ft Orifices per Lateral 37 Lateral End (Z) 0.78 ft Orifice Density 6.08 ftZ/orifice Lateral Spacing (S) 3.00 ft Manifold Length 1 3.00 ft Lateral Flow Rate 15.24 gpm Manifold Diameter 1.50 in System Flow Rate 30.48 gpm Forcemain Velocity 3.111 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and SPS 316.300 WAC 4 in.min. Disconnect `—t� Tank component is properly vented iz Alternate outlet location Forcemain diameter Weiser Concrete Manufacturer _� 2 in. Capacity 750.36 Gallons Volume 20.28 gal/inch A _ Weep hole or anti- Dimension Inches Gallons B siphon device A 19.40 393.35 B 2.00 40.56 C P� ump off elevation(ft) C 3.60 73.09 9 2.25 D 12.00 243.36 D Total 37.001 750.36 Dose se tank elevation(ft) Bedding And Backfill As Per Manufacturer 1 91.25 Alarm Manufacturer SJ Rhombus Alarm Model Number SJE 1011421 Pump Manufacturer Zoeller / Pump Model Number BN151 r ' 1 dQ U�-�� ' l/Ua°�Ch !hG2Q Vvt 1/�r�= Pump Must Deliver 1 30.48 gpm at F 15.45 ft T D H -� a .5, ✓ S�wt-kct' 14-er Note: Switches containing mercury may not be used in this system. Project: Rangel 3 bedroom replacement mound Page 4 of 10 Uflow® Distribution Cell Media Layout 6.00 Cell Width (ft) F7750 Sidewall to Lateral (ft) Distribution Cell Cross-section Arrangements @semi" 6 ft Wide Component Legend ® SR1-7A Bundle-5 ft or 10 ft lengths SR1-12A or EZ 1201A in 5 ft or 10 ft lengths SR3-12H or EZ 1201 P or SR3-12H in 5 ft or 10 ft lengths 0 4" Perforated Distribution Pipe With Pressure Lateral Inside Turnup Enclosure — — — — — Pressure Lateral Bundles are covered with approved geotextile fabric as per the their product approval. Distribution Cell Plan View Layout - Typical 6.00 Cell Width-A(ft) 75.00 Cell Length-B (ft) Center Connection Lateral Layout Diagram Force Main 6ftWide - - - - - - - - - - - - - - - - - - - Manifold *F; — — — — — — — — - - — — Project: Rangel 3 bedroom replacement mound Page 5 of 10 Mound System Maintenance and Operation Specifications Service Provider's Name Jmaes K. Thompson Phone (715)248-77671 POWTS Regulator's Name St. Croix County Zoning Dep't Phone;(715) 386-4680] System Flow and Load Parameters Design Flow-Peak 450 gpd Maximum influent Particle Size 1/8 in Estimated Flow-Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ft' Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Inspect and clean as necessary at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test periodically Pressure System Laterals should be flushed and pressure tested every 3 years Mound Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap and are secured in as shown in the EZflow Mound Component Manual Ver. August 20, 2007. 2. Dispersal cell media conforms to EZflow products approved for use with the EZflow Mound Component Manual Ver. August 20, 2007. Media is covered with an approved geotextile fabric. 3. All gravity and pressure piping,materials conform to the requirements in SPS 384, Wis.Adm. Code. 4. are i Tillage of the basal g a s accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Lateral Ends at Last Orifice Where Variable Length Cleanout Begins Long Sweep 90 or Two 45 Degree Bends Same EZflow Synthetic Media Diameter as Lateral 2.06 Feet 4 Distribution Lateral '-0,14 Lateral Cleanout Project: Rangel 3 bedroom replacement mound Page 6 of 10 I I Mound System Management Plan Pursuant to SPS 383.54,Wis.Adm. Code General This system shall be operated in accordance with SPS 382-84 Wis.Adm.Code,and shall maintained in accordance with its'component manuals[EZflowMound Component Manual 8/20/07,Pressure Distribution Component Manual Ver.2.0 SBD-10706-P(N.01/01)and SSWMP Publication 9.6(01/81)]and local or state rules pertaining to system maintenance and maintenance reporting. Septic and pump tank abandonment shall be in accordance with SPS 383.33,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 as to 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 Wisconsin Department of Commerce. Pump Tank The dosing(pump)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. If the force main has a weep hole, it should be noted if it is functional during pump operation,and if not,it should be cleaned. ****No one should ever enter a septic or dose tank since dangerous gases may be present that could cause death.— Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter,and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic(other than for vegetative maintenance)on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations(October-February)dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODE, 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 104 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 3 years. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional,more frequent monitoring. Continuency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank,pump,pump controls,alarm or related wiring becomes defective the defective component(s)shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface,it will be repaired or replaced in its'present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media,and related piping,and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Rangel 3 bedroom replacement mound Page 7 of 10 r� PUMP PERFORMANCE CURVE MODEL 151/1511153 TOTAL DYNAMIC HEAD/FLOW I ;o PER MINUTE 14. 41-i EFFLUENT AND DEWATERING 121 40 MODEL 151 152 153 Fi 10-� 35 t5: Feel Metes Gal. uters Gat. Liters Gal. liters /FY1�t I 'w 30 __ _ 5 1S 50 189 69 261 77 251 10 3.0 45 170 61 231 70 265 / 0 8 151 15 4,6 38 144 53 201 61 231 20 6.1 29 110 1 41 167 52 197 20 25 7.6 16 61 1 34 129 42 159 . t� �`•� 30 9.1 — _ 3 87 33 125 !i • 35 10.7 — 22 85 4 T.d7 • ` ao 12.2 - - - - 11 42 w — Shut-off Head: 301L(9.1m) 38 h.(11.6m) 1 4a 8.113.6m) 5 1 0145088 0 10 20 40 50 e1 70 m 90 100 C:110N3 LITERS 0 40 80 0 180 200 240 280 310 3 FLOWPERMIWTE �i,>1-.4;'nU.rn �Vyy fie ' Model 151 Models 1521153 CONS-I L T FAI TORY FOR ,�7 rr''�� } / `� i M�i!'11 C..P't 1—I'L.I�.1`�TIU ; 6782 61A 71e �4 5'6 � 327712 � -t--159 •Timed dosing panels available. Electrical alternators,for duplex systems,are available and F-x supplied with an alarm �1 •Variable level control switches are available for controlling \ 1 37f8 2 327 single phase systems. Double piggyback variable level float switches are available t for variable level long and short cycle controls. •Sealed Owik-Box available for outdoor installations.See ' # FM 1420. 13 i Over 130'F.(54'C.)special quotation required. !'+' � 117Vi6 12 to 1 ,a t,1.;2 .S3 5eres 15111521153 YODELS Control M_odel VVdts-Ph Mode ! Amps s~- "implex 1--Duplex - ! N151 1 115 1 Non 1 6.0 I 1 243 B51, 115 1 Auto N7 1 6.0 j Irduded 2 4 3 Ei51 1 2330 1 Nan 1 3.2 1 243 BE1512-u0 1 ; Auto i 3.2 Included 2 a 3— su2444 - SK20M N152 1 115 1 Nan_ti 8.5 1 - —To—r3'- o 3 BN1521 115 1 1 Auto 8.5 Irduded 2 a 3 E152 fl t i Nan 4.3 1 243 BE15 t i Auto 4.3 Irduded 243 N153 1 i Nan 10.5 . 1 !2 4 3 BN75 1 Auto 10.5 IMUded--t—1 or E153 i 230 1 Han 5 1 I [a3 SELECTiON GUIDE 6E153 i 30 1 Auto 5.3 Induded�-2 a 3 1. Single piggyback variable level float switch or double piggyback variable level float o cAUTIDN switch. Refer to FM04T7. p7cieci:cn a0mes an,:inna sn= vl^as acne n;•3 nca!i!ird 2- See FM0712 for correct model of Electrical Alternator E-Pak 1r nr ir.tile, a,.,,,•.,...i n, .J_• 3.Variable level control switch 10-0225 used as a control activator,specify duplex(3) or(4)float system. DESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. ..._.....-_.......... .._. --..... _.... ---- --- ------ --._.__....._.. .._._.__.._.. -.._.._..... ..... NAIL Tot P.O.130x,6347 .. ...._.. . j / , 1(151)L7111.t.oukvilk,ICY 40256-OJ41 Mpnufa rersat.. Q �'/,/r/p6�� fIIPTO:3840 Cane Run Road iy'li/VVar IPTo-Ilexy402,1-,96, SNCE1939hap J/wwwaoaf,crcom 1•, 7,321 PUMP P!/NJP !O. FAx(5011 7743624 _-.__ ._..._._._ 0 Copyright 2004 Zoeller Co.All rights reserved. P SIMITECH FILTER Sim/Tech Filter of The GAG Sim/Tech Filter is unique to the industry, engineered to proviae 1: maximum protection for your sanitary pressure system. The Sim/Tech Filter has been designed as an effluent filtering device to .YIN. assure small holes in the distribution piping remain unclogged. Pressure distribution systems are very effective in treating effluent, but only vihen holes remain open. Many of these systems only partially fail, causing f� contamination of ground water long before the system shows any visible signs of distress. - Placing a filter just before entering the forced main is a simple solution. The filtering device installs by simply screwing onto the discharge port of any effluent pump, thereby filtering out contaminants before they enter the distribution system.Thus, maintaining even distribution of effluent. The GAG Sim/Tech Filter protects any pressurized system including: Sang Filters - Spray Irrigation Systems - Pressurized Chambered Systems Recirculation Sand Filters - Mound Systems 4 ctsl( Jr15t4i((atio;1 - ,C_OW Zxterlds (i fie o' (�7aiJl�ie(c� - J)Yq170ves �' �lc<eYlt �autlitl( 61f even rist7i61.(tiO)t Carl ��j.�jlct�rlt �ubrrlu7si6(e �uYJ1ps - 6e ccsed irl 6otdt `ResideYltia( arld 3 COYYIY11e7CCa( ��J�J((ClitlUYlS .3 Order # Model Description List Price STF-100A2 STF-100 GAG Sim/Tech Filter(field assembly) 463.9_ S]U//T The STF-110 has well over 1/2 mile of filtration media with over 319 cubic inches of open area to eliminate clogging. The 2,215 square inches of filtering surface r . allow a flow rate of over 1200 GPD, filtering to 1/16 inch diameter. This incredible . ,:.. amount of filtering surface is achieved through the unique shape of each triangular bristle, which more than doubles the filtering surface, with no uniform M holes or slots to plug. Order# Model Description List Price STF-110 STF-110 Disposable Septic Tank Filter(yellow bristle) 23.5: ft ci.� . Sc,�¢da/ua.�'ar,/�c"E L c r�pw J v 7't i 9' • �CL��!llG�% S�zcZ fF 4,1 t�rvreSC Ib��Wl,d L �e.. �.�� 5aelure e✓C!are A u,-,4 e/ Lo�1, /,//,�/oyc.a� s err cps X83. ...fiovC a �2 I � u`�..x�.,°7 L -j �ro asa 1��eSeiCEnttl tl 7'304y �.W C,y 7—,,. �ySG'�i•ntou.r �� I ;� �'aS' ep P Cld, C ,: „ 3rF-iu� ;ear u, o3o-?Asi'-rcizr 990/° p6:c e, To-e reeonn[� ed�it de'ing 4/a e(es t ae,Jmawsrd e0!yt cne-nt• ✓ ttSQ u%° P base .Llo / E5E%�»a to d c lei:a��nvzr4 Die °x"..f yoor e Woo ti L�pG b- c,-FoU�:n✓cS. 9y 06 deuC Y ; � � ��,o o�S.T./Il'fa.,dale Cmre•^. o � 3bcdroo.., Q�sdcr�2, p e �el2,,olu%r,a�Jec1;,5'�i.E'. ----- /oca-�e-�✓ > �G��*M-, �`le�! =io%;a.' ,9araac �Jra`�GedsySf�n /octt-E'��. 7 Ep:56", Lotif 3w a� C� C� lop 2354 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings in accordance with Comm 85,Wis.Adm.Code A.C.E.Soil&Site Evaluations Attach complete site less than 8%x 11 inches in size. Plan must County include,but not I' ' a horizontal tal reference pant(BM),direction and St.Croix percent slope, north arrow,and location and distance to nearest road. Parcel I.D. 2051-40-000 P e pint all information. Review Date Personal i You Provide may be used for secondary W 5.0 (Privacy law,5.14(1)(m)). _7 ZO Property Owner Property Location ,Q 1',A Isadore&Clare Ran el Govt lot no SW O Nv 27 T 30 NR 20 Property Owner's Mailing Address Lot# Block# bd.Name o rvW 36 Co. Rd. E 2 1 CNojxc Village Of Houlton City State Zip Code Phone Number _j City _J Village yJ Town arest Road Saint Joseph WI 1 54082 1 (715)549-6305 St,Joseph I Co.Hwy E&State St. New Construction Use: 16 Residential/Number of bedrooms 3 Code derived design flow rate 450 GPD SM Replacement J Public or commercial-Describe:Co.Hwy E&State St. Parent material Glacial Till Flood plain elevation,if applicable Na General comments and recommendations: Site suitable for mound system with 6"of ASTM-C33 sand. Contour to be 99.75' Maximum available contour length=75% Boring# J Boring jej Pit Ground Surface elev. 100.13 ft. Depth to limiting factor 32" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots /Q° in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. -Eff#1 I -E 1 0-12 10yr3/2 none sil 2fgr ds as 2fmlc 0.6 0.8 2 12-32 10yr413 none sit 2fsbk ds cw 2fmlc 0.6 0.8 3 32-48 10yr4/4 f2f 7.5yr5/8 fsl lfsbk dsh cw lvf,fm 0.2 0.6 4 48-69 10yr4/4 f2fd 7.5yr5/8 scl 1 csbk ds - - 0.2 0.3 Boring# J Boring 16 Pit Ground Surface elev. 99.26 ft. Depth to limiting factor 30" in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu.Sz.Cont,Color Gr.St.Sh. •Eff#1 -Eff#2 1 0-11 10yr3/2 none sil 2fgr ds as 2fm1c 0.6 0.8 2 11 730 10yr4/3 none sit 2fsbk ds cw 2fm1c 0.6 0.8 3 30-38 10yr4/4 f2f 7.5yr5/8 W lfsbk dsh cw 1vf,fm 0.2 0.6 4 38-44 10yr4/4 f2fd 7.5yr5/8 scl 1 csbk ds - - 0.2 0.3 'Effluent#1=BOD?30<220 mg/L a d TSS>30 150 mg/L *Effluent#2=BOD S30 mg/L and TSS S30 mgr. CST Name(Please Print) Signal re: CST Number James K.Thompson 1--- 3602 Address A.C.E.Soil&Site Evaluations pate Evaluation Conducted Telephone Number 340 Paulson Lake Lane,Osceola,WI 54020 11/2/2013 715-248-7767 Property Owner Owner Isadore&Clare Range) Parcel ID# 030-2051-40-000 Page_2 of 3 H I Boring# ej Boring t J Pit Ground Surface elev. 99.03 ft. Depth to limiting factor 35" in. Sod Application Rate Horizon Depth Dominant Color Redox Descril ion Texture Structure Consistence Boundary Roots GPDge in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-10 10yr3/2 none SO 2fgr ds as 2fm1c 0.6 0.8 2 10-35 10yr4/3 none sit 2fsbk ds cw 2fm1c 0.6 0.8 3 35-45 10yr4/4 12f 7.5yr5/8 fsl 1fsbk dsh cw 1vf,fm 0.2 0.6 4 45-51 10yr4/4 f2fd 7.5yr5/8 scl 1 csbk ds - - 0.2 0.3 1 T-1 F-1 Boring# I Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Stnrcture Consistence Boundary Roots in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 F-1 Boring# J Boring Pit Ground Surface elev. ft. Depth to limiting factor in. SW Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu.Sz.Cont.Cola Gr.Sz.Sh. *Eff#1 *Eff#2 *Effluent#1=BODS>30<220 mg/L and TSS>30<150 mgt "Effluent#2=BODS<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 608-266-3151 or TTY 608-264.8777. SBD4330(8.07/00) A.C.E.5011&Ste EvakJaWn5 �e- o� • o/d if. 5:he'Cew rtee- JGr1.0 � jo,/¢da/ua.�on bvrinc� It 99 ar ; y9,5c' p�opost.-el ty(�wnd a E - - o9'e yb,oy I".)/(o')r AV r r-o� 1 ee/%Tevo(� fi93/' /afc�a�S a f(1�rr7yx.2' i I i �x,sE:�o d,3P�sa/Ce//a7-' 'LY`8"or,'�'c6s S,aaced I I /1'X 3y To 6e o6a„da eX St/ay.a7�t G~+�or�2 Qz �) as,oxr y"y ;- i o0o cpl� w:r,sc��„c�v�c �°CJ, a3o-Los/-�o<1z �j 99.0/' �jeo6ic �. e, ,6e ,-eeo rnec�d4e (iLiiKj o.'//acfe s ruse w;-H- le..)mound ea-evnrn t• V/ i -se%na,4 d e.lei:a.E-rver4 ofe 9906• �/ �z�I y.��y i Wow pa�,b-no�ob�;nUS. Tpo.�S.T./Y(•�.��o/e Cor/e.^. EX,'s r4 ,455amc d e/,e o � 36ed�oo», dg"e- :To o{ E/��=io%ice.' garage P�o�cdSysf.�n /ocr-E�m. 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POST-POUR: W3716 US HWY 10 MAIDEN ROCK WI 54750 -' Z ' \O REVISED JAN. 2012 800-325-8456 FlLE: n1r750-MR ��. �0T 4 ' • '• 1. . ;�. N• a�,`,� �° • A ~ '� X11 n i� h 'e �q• • i �, , w, y. ^4 �e�i• ,n Da �,`�`l e♦ h ^i cRi t1 A `o P.C. �, n ^� `��•j rte, ^, r h; y ^ �1 So ta IN ell ILI lk tv nl �• t• i - n a Ir Cu MCA-- Nt ' � STREET. •� ' ' � .. �•a... (f,} •• ' 'i'jirvT � � ••,. y t• d' • '� srREE'7';• ,�, Y, 1�. ,.T:rdx %i .Ya✓. 7rS. 'Xdr, 4.-rdr y V.4r aS E 4 �5 6 o•f4?I ST.CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Isadore & Clare Rangel Mailing Address 36 Co. Rd. E Property Address Same (Verification required from Planning&Zoning Department for new construction.) City/State Houlton, WI 54082 Parcel Identification Number 030-2051-40-000 LEGAL DESCRIPTION Property Location SW '/4, NW '/4, Sec. 27 ,T 30 N R20 W,Town of St. Joseph Subdivision Plat:Village of Houlton - &ack J ,Lot# 2 Certified Survey Map# Na ,Volume Na ,Page# Na Warranty Deed#653924 (before 2007)Volume 1700 ,Page#337 Spec house 13yesao Lot lines identifiable❑yesE]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§SPS.383.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&Zoning Department a certification form,signed by the owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is less than 1/3 full of sludge. I/we,the undersigned 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 Safety And Professional Services 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. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s)of the property described above,by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedroo s 3 SIGNA OF APP CANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department.*** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV.04/12) so><'7 | DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 WARRANTY DEED KATHLEEN H. WALSH VOL 1700PACE337 REGISTER OF DEEDS Andrew J. Bratz and Ruth A. Bratz, ------ RECEIVED FOR RECORD COPY FEE: tnesseth, That the said Grantor, for a valuable considerati.__� PAGES: I conveys to Grantee the following described real estate in NLCTUFM TO County, State of Wisconsin: Tax Parcel No: Houlton, Except the East 19 feet thereof, RETURN TO: St. Croix County, Wisconsin. Burnet Title 7550 France Ave. S. First Floor Edina, MN 55435 ATTN.- Post Closing Central This Together with all and singular the hereditaments and appurtenances thereunto belonging; And warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except and will warrant and defend the same. .... --- -----------------_---- ..A.A.�r�ew J.' at Personally came before me this __A7.........day of MBER STATE BAR OF WISCONSIN to me known to be the person ------------ who executed the foreg Ile now d (Ignature ticStocad o7a= My Commission is permanent.(l no state expiration are not necessary.) ji ji WARRANTY DEED STATE BAR OF WISCONSIN Wiseansin Legal Blank Co. Inc. o ~ o h oz o o 0 N b 0 y Y ~ C Z N ~J O m \1 LL c O N y 3 Cl) v y o Z E N Z = O cc a Z C) d d r- co a m N (n O 0 z U O Z d' c V O N fn F- aci Z c E -2 NN C f6 N O O O N 0 4) z o Q o Z co N ~ Z c FL i '70 N ~ C7 c N O o W O d m N N y ~ a 0. (D L) a N 000 z •~v caaa ~i 0 0 0 ~ O N ~1 N N J w rn rn } O Cl) cc N O O O 0 C) O U) IU) C 0 ~ cn co N O C, M 0 c 0 N C y N 3 c E O Ct O' r H O N N 0 0 0 o I c u a O o~ LO L (Ii ~C ~ - N N O Lo O N N y0 N C 7 N c Lo O M o O a) N i> c L n O V7 l6 O •O N p m O H O Z G (n v~ R a EL d CL .c `iii +te+ o t'w d c _1 A 0 a m 3 10 o v~ U Parcel 030-2051-40-000 02/16/2005 03:54 PM PAGE 1 OF 1 Alt. Parcel 27.30.20.517 030 - TOWN OF SAINT JOSEPH Current k ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * RANGEL, ISADORE C & CLARE J ISADORE C & CLARE J RANGEL 36 CTY RD E HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 36 CTY RD E SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 0.410 Plat: 2111-HOULTON SEC 27 T30N R20W LOT 2 BLK 1 EXC E 19 FT Block/Condo Bldg: 1 LOT 2 VIL HOULTON Tract(s): (Sec-Twn-Rng 401/4 1601/4) 27-30N-20W Notes: Parcel History: Date Doc # Vol/Page Type 08/15/2001 653924 1700/337 WD 07/23/1997 1092/254 WD 07/23/1997 890/614 07/23/1997 876/54 more... 2004 SUMMARY Bill Fair Market Value: Assessed with: 6146 180,300 Valuations: Last Changed: 07/09/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.410 50,000 127,400 177,400 NO Totals for 2004: General Property 0.410 50,000 127,400 177,400 Woodland 0.000 0 0 Totals for 2003: General Property 0.410 23,000 106,500 129,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 121 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ST. CROIX COUNTY WISCONSIN ZONING OFFICE I I N O R N N N• ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 ` (715) 386-4680 August 18, 1994 ~ ~ ~ O✓ Andy Bratz .03 100 South Robert Street 9-7 3 D- 2D S/ / St. Paul, Minnesota 55107 Z RE: Septic Inspection for John Thoennes located at 36 County Hwy. E, Houlton, WI 54082 Mr. Bratz: An inspection of the septic system on the property of John Thoennes located at 36 County Road E, Houlton, WI , was conducted August 17, 1994. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every thee years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Sincerely, Mary Jenkins Assistant Zoning Administrator js { L-Y) IV- 99 ST. CROIX COUNTY WISCONSIN - ZONING OFFICE N N N N N N M N _ ■low ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road a Hudson, WI 54016-7710 (715) 386-4680 SEPTIC INSPECTION / WATER TEST REQUEST FORM Please specify desired test(s) & remit appropriate fee with application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure that entry can be gained. 0 Water (VOC's) $185.00 XSeptic $50.00 ❑ Water (Nitrate & Bacteria) 45.00 0 Nitrate & Bacteria retest $15.00 Owner: ~o~rn I. `/\c)CAvte_,5 Requested by: A'Ay C$rti~ C/o A(ZC.tS Address: 36 e-z,,„a} w~4 Address : /dG 5 Ro berg- S4 ov ~ {-6ti. w 1 I P 5-1-16 T,),, 5f f,4L j ✓Yl ~ u ryeso~ ~ ZIP S S-16 7 Telephone (7/5') ~-Yg~ S4'3a Telephone NQ: (6/a) a91-qr..-,X0 Property address (Fire N4 & Street) : 36 Co~~. E y 2c~ E Location: Sec. , TN, RW, Town of I-.6 Q Realty firm: &)(A Lock Box Combo: AjV~ Closing Date: i TO BE COMPLETED BY PROPERTY OWNER PROVIDE A SKETCH OF HOUSE & SEPTIC SYSTEM ON REVERSE OF THIS FORMS Water sample tap location: Is the dwelling currently occupied? Yes ❑ No If vacant, date last occupied: Age of septic system: 3 vrS Septic tank last pumped by: r Date: Previous Owner's Name(s): -di dd Have anyof the following been observed? OY ON Slow drainage from house. OY ❑N Sewage Back-up into dwelling . .OY ON Sewage discharge to ground surface or di16;h., ❑Y ON Foul odors. Other comments relative to system operation: I certify that the above information is complete and tr e best of my knowledge. OWNERS SIGNATURE: DATE: ti 4 1/94 OWNERS DRAWING OF HOUSE & SEPTIC SYSTEM LOCATION P/P45 I 0oc P, P25 ON 6 ho, AT G TO BE COMPLETED BY INSPECTION AGENCY System design &/or permit on file? ❑Yes ONO Soil series per SCS Soil Survey: sheet # Type of soil absorption system: OBelow grd OAt-Grd OMound Approx. size 'X ❑Gravity ODose OPressurized Ft.2 ❑Bed OTrench ❑Dry Well ❑Holding Tank 00utfall pipe OBSERVED DEFICIENCIES OOther ❑Unknown Septic tank / Setbacks: OHouse V ❑Well ✓ ❑Prop. line ✓ ❑Other Dose tank Setbacks: ❑House ❑Well ❑Prop. line [.Other OLocking er arning label OP p/Floats ❑Alarm ❑Elec. wirin Soil Absorp ion System / Setbacks: ❑House ✓ ❑Well ✓ ❑Prop. line ✓ OOther ❑Ponding: K4F),-U ODischarge: General comments: INSPECTORS SKETCH OF SYSTEM LOCATION i i iJ all, Inspector '"Ol'Z-u J Title COMMERCIAL TESTING LABORATORY, INC. '514 ileiolin Street, P.O. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 FAX-715-962-4030 ST. CROIX ZONING REPORT N0.2 4075:/01 RAGE 1 ST. CROIX COUNTY REPORT DATE: 5/03/93 COURTHOUSE DATE RECEIVED. 4/29/93 HUDSON, WI 54016 ATTNS THOMAS C. NELSON OWNER: John Douglas oenne5 LOCATION: 36 Cty Rd, E, Ho COLLECTOR: M« Jenkins DATE COLLECTEDS 4-28-93 TIME COLLECTED: 3240pm SOURCE OF SAMPLE: Outside faucet DATE ANALYZED S 4--29-93 TIME ANALYZED.24#00pm COLIFORMt 0 /100 ml INTERPRETATIONS Bacteriologically SAFE NITRATE-NS 12 ppm Above 10 ppm exceeds the recommended Public Dr4nking Water Standard. Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L 9 ~O 0 uD Z~ C, f Q 2 of•\NDEVFNpEHl LAB TECHNICIANS Pam Gane a`'y Se ~ C 3 WI Approved Lab No. 19 4 :S A Meares "LESS THAN" Detectable Level Approved by'. ® PROFESSIONAL LABORATORY SERVICES SINCE 1952 n20 ~ ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th Street Hudson, WI 54016 Telephone - (715)386-4680 C~ The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion _Q this form ia gssential -2-q that jUm pro e~ rtv can be located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received.. / WATER TESTING----------------------------FEE: $ 35.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $185.00 (For VOC'S) SEPTIC SYSTEM INSPECTION-----------------FEE: $25.00 (Determines if system is properly functioning at.time of inspection) PROPERTY OWNER'S NAME: .30K~A nbv~\)I.s , A49_4,VU_A n PROP. ADDRESS : _l0 A11,U 1 ~ . CI Y -to\ Legal Des ri do 1/4 of the 1/4 of Section - , TAN-_P.?Z Lot Number Subdivision, Q4 011' G U FIRE kUMBER LOCK BOX N R ~(-7 Color of house Realty sign by house?~{ZIf so, list firm: PLEASE INCLUDE, IF AT ALL POSSIBLE, A HAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET. Testing of residential water require: a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be gained. Firm or individual requestin services:_M WlQ,1rl l hk+WSlh Telephone Number REPORT O B SENT TO: A& bb SY011, CLOSING DATE: signatur COMMEUTAL TESTING LABORATORY, INC. 514 Main Street, P.O.. Box 526 Colfax, Wisconsin 54730 715-962-3121 800 - 962 - 5227 FAX - 715 - 962 - 4030 ST. CROIX ZONING REPORT NO.** 36187/01 PAGE 1 ST. CROIX COUNTY REPORT DATE: 1/29/93 COURTHOUSE DATE RECEIVED: 1/28/93 HUDSON, WI 54016 ATTN: THOMAS C. NELSON OWNER: John Thoennes LOCATION: 36 Cty Rd. Houltan COLLECTOR: M. Jenkins DATE COLLECTED. 1-27-93 TIME COLLECTED: 10:15am SOURCE OF SAMPLE: Outside faucet DATE ANALYZED'1-28-93 TIME ANALYZEDS2:OOpm COLIFORM: 0 /100 ml INTERPRETATION: Bacteriologically SAFE NITRATE-N: 11 ppm Above 10 ppm exceeds the recommended Public Drinking Water Standard. Coliform Bacteria/100 ml Nitrate-Nitrogen, mg/L { LAB TECHNICIANS Pam Gane Of.1NOEVENpEMl WI Approved Lab No. 19 V Zg a C Means "LESS THAN" Detectable Level Approved by: d 5 O PROFESSIONAL LABORATORY SERVICES SINCE 1952 ST. CROIX COUNTY ZONING OFFICE St. Croix County Courthouse 911 4th Street Hudson, WI 54016 Telephone - (715)386-4680 The St. Croix County Zoning Office offers the service of septic and water inspections to Lending Institutions, Realty Firms, and private individuals. Completion pt this form •i.g essential -z-q that _the property can 12a located. Please provide the following information, enclose appropriate fee made payable to St. Croix County Zoning Office, and mail, along with form to the above address. Testing will be done as soon as possible after fee and form are received.. WATER TESTING----------------------------FEE: $ 35.00 (For nitrates and coliform bacteria) WATER TESTING FEE: $185.00 (For VOC'S) SEPTIC SYSTEM INSPECTION FEE: . $25.00 1/ (Determines if system is properly functioning at.,time of inspection) PROPERTY OWNER'S NAME: ~UIf\ l/~ U - 1 ► (~-Qyl {ti-Q PROP. ADDRESS: CITY Legal Description 1/4 of he 1/4 of Section OL-7 , T_'36 N-R~ Town of Lot Number Subdivision: ~G-/ -7 FIRE NUMBER LOCK BOX NUMBER Color of house Realty sign by house? If so, list firm: PLBA.SE INCLUDE, IF AT ALL POSSIBLE, A MAP,i.e,COPY OF PLAT BOOK, WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEEP. Testing of residential water requires a sample that is fresh. If the home is vacant, and has been so for some time, the water line must be purged by running the water for several hours before the test can be conducted. WINTER TESTING: Many times water lines are turned off, or sill cocks are turned off, making access to the home necessary. If this is the case, please make proper arrangements with this office to ensure time when entry may be ,g~anined . Firm or individual requesting services: I lA ,y( t, AW 4vh~o Telephone Number AliL REPORT TO BE SENT TO: CLOSING DATE: O r k R Signature ° -k A ST. CROIX COUNTY r WISCONSIN ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, W154016 (715) 386-4680 i January 27, 1993 Miclelle Dunckel MidAmerica Bank 600 - 2nd St. Hudson, WI 54016 Dear Ms. Dunckel: An inspection of the septic system on the property of John D. Thoennes, located at 36 Co. Rd. E, Houlton, WI was conducted on Jan. 27, 1993. At the same time a water sample was obtained for testing. The results of that testing will be sent to you as soon as we receive them. At the time of inspection, the sanitary system appeared to be functioning properly. The inspection of this sewage disposal system was based upon a surface inspection of said system, and did not involve any excavating or chemical analysis. Accordingly, there is the possibility of hidden defects in the system not discoverable by this inspection. This does not in any way warrant or guarantee the continued proper functioning or operation of this system. It is recommended that the system should be pumped once every three years. Therefore, the prolonged life of this system may be dependent upon proper maintenance of the system. Should you have any questions, please contact his office. S i cer-e.1 Mary J. Jenkins Assistant Zoning Administrator cj Form - S T. C - 106 i AS BUILT SANITARY SYSTEM REPORT `OWNER" J'Spstl ENNES • TOWNSHIP - ~7 Jbse-^4 SEC. '-?P T -?O N-R .9,0 W ADDRESS ST.`CR61X COUNTY WISCONSIN 3 2 7.3 0- 20. 5 + SUBDIVISION LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of ICHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM " P~PG~~QTY .Zi/v~ • • ~3 '/j8/vc y MArAK i :1193 r, , r, w~ pI~ I I' i I I I l C, d'N /P I ~i.•s..+rii.U•.r.. L' L.GrV. X00 04.0 N J. Din • S : ! •~•~lvK Gv /Te"Y`' r - - - /v1: l.V •3 ~C'iIs r cX: ~/~wc.~ u T a , .r c : ! t :.i `I ! ~/1S' ' Q I ..f-/N SP~c• I f • ► • t /•(~i¢GL° r } r • : t7Q ~~D!VViwOe•./-(.y(~TI.7',~' /".~GJ~.• ; } ~nsr G✓CLL ~/.w~ /V INDICATE NORTH ARROW BENCHMARK: . Describe the vertical reference point used 1 / pdv ~;p~ hT,V Elevation of vertical reference points /00 ' Proposed slope at sites SEPTIC TANKS Manufacturers. • -✓nE5LI~ie Liquid Capacity: -'00o Gi4t-, '••••+-Numbex of rings used: 1/1 Tank manhole cover elevations 9G• 9G • Tank Inlet Elevation: L-V ' Tank Outlet Elevations Number of feet from nearest Roads Front,W Side Rear, I . O feet • From nearest-property line s Fro • nt, Side ear, nSide feet Number off set from. well building: (Include this information of..the above plot P l4n ) (2 reference dimensions to septic tank) SEE REVERSE STnR PUMP CHAMBER Manufacturer: Liquid Capacity: -.Pump Model: Pump/Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: •Number of feet from-nearest property linen'. Front, O Side, O Rear, Ft._•_ r 'Number of feet from well: Number of feet from building: (Include distances.on plot plan). SOIL ABSORPTION•SYSTElH n r Bdd:• • 4, V. 30 Trench: . Width: /•e' ° Length: • 3•? -.-Number 'of Lines: Area Built Fill depth to top of pipe: S Number of feet ftom nearest property line: Front, O Side, &"r, 0 lt.~3 (Number of feet from well: N or of feet from building: (Include di tances on plot plan). SEEPAGE PIT Sise: Number of pits: Diameter: Liquid depth: 1 Bottom of seepage pit elevation: Area Built: t Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytemsl (C eck one). HOLDING TANK Manufacturer: Capacity: i Number of'.rings used:•Elevation of bottom of tank: • Elevation of inlet: Number of feet from.nearest property line: Front, O Side, © Rear, OFt.- Number of feet from well: Number of feet from building: Number of feet from.nearest road: Alarm Manufacturer: a' Inspector:. ' Dated: S o?-~ Plumber on job: License Number:~'s -s'-3gs 3/84:nij ' Form-STC-106 AS BUILT SANITARY SYSTEM REPORT OWNER'' pc 1 / E,uwE_~_ TOWNSHIP , S T ~SE ~i l SEC. ' 2 T 2( ) N-R ADDRESS ~~~✓au~ro.,. ST. CROIX COUNTYO WISCONSIN ~ 1. ! SUBDIVISION LOT LOT SIZE ~L~IJ _ PLAN VIEW 4 -to 11 Distances and dimensions to meet requirements of ILHR 83* SHOW EVERYTHING WITHIN '100 FEET OF SYSTEM ' YiPa~G~7'i •Ziv~ .13 `y•.' 51.9: t:i4 r R l ~ ~ _ . ...r::.ll..r.. L= L adv. Joo "Je 04,0 t.... i~i~~ i I CAS, N<~T' ~uT~GT or /PBS/a , f-l~cXJ C'~~~~~T ~ omits i i "KGT/OIJ L^ /T/f ~iL° r :t: PtyO TY JAISoo /aam~d!v 4 r ef T~ Lt. r J rl . ; / INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used / poA" lniOt hT La? CcCGUCIe Elevation of vertical reference points /00 ' •'Proposed slope at site: SEPTIC TANKS Manufacturer: ~i ~C -Liquid Capacity: /0o p ~,aF~ '',"Numbet of rings used: Tank manhole cover elevation: ~ 9qG ' • Tank Inlet Elevation: W./3 Tank Outlet Elevation:_ Q•~_ Number of feet from nearest Road: Front,wide,~ Rear t . • • . • O.-'9~5 _ feet Prom nearest- property line s . Front,OSide,0Rear,feet Number of feet frow, well building: _/9._~_ (Include this information of-the above plot plan)( 2 reference dimensio• • ns to septic tank) SEE, REVERSE SIDE D~ARTIV16MT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & B~LDI ON LABOR & HUMAN RELATIONS DIVISION LAB BOX ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION P.O. 7969 MADISON, WI 53707 State Plan I.D. Number: SW 4, NWT , Sec . 27 , T30-R20 El CONVENTIONAL ❑ ALTERATIVE (If assigned) Town of St. Josep10 Holding Tank ❑ In-Ground Pressure ❑ Mound E O ts11T LDE ADDRESS OF PERMIT HOLDER: INSPECTION DATE: q S- ` Ronald Thoeness 497 Co. Rd. E Hudson WI 54016 ~y 90 QTC~ BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Za a Bros. Inc. 3395 St. Croix 135495 SEPTIC TANK/HOLDING TANK: MA UFAC URER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: eS ~a-0 -~~ES ❑NO ❑YES ff::rNO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ALARM: FEET FROM LINE: 1 AIR INLET: ❑YES NO 11 ❑YES NO NEAREST 7 5 2 i DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ❑YES ❑ NO ❑YES ❑ NO ❑YES ❑ NO GALLONS PER CYCLE: UM AN T LS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF 7YES ❑ NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire, construction shall cease until MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: WIDTH: LENGTH NO. OF DISTR PIPE SPACING: kISTR INSIDE DIA.: # PITS: LIQUID BED/TRENCH TRENCHE ' ' PIT DEPTH:/ DIMENSIONS GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: NUMBER OF PROPERTY W ELL: BUILDING: VENT TO FRESH BEL W PIPES: AB COVEERINLET E V. ENpEET FROM LIN AIR IN ET: s i NEAREST MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ❑ YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ❑YES ❑ NO ❑YES ❑ NO DEPTH OVER TRENCH/BED DEPTH OVER TRENCH/BED DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: CENTER: EDGES: ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO PRESSURIZED DISTRIBUTION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEV.: ELEV.: DIA.: ELEV.: PIPES: DA.: ELEVATION AND DISTRIBUTION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO INFORMATION APPROVED PLANS ❑ YES ❑ NO ❑ YES ❑ NO PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: COMMENTS: FEET FROM LINE: j ❑ YES ❑ NO ❑ YES ❑ NO NEAREST No I a. ~9 Retain in county file for audit. Sketch System on Reverse Side. - TITLE ;J SBD-6710 (R. 06/88) 17W111 :l' kl(", SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code Cou STATE SANITARY PER OT # -Attach complete plans (to the county copy only) for the system, on paper not less than ❑ 2 CZ 8% x 11 inches in size. Ch l evlsion o pr_ ous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION. PROPS TY OWNER PROPERTY LOCATION '/a y✓'/a, S T 30, N, R ab E (o W PROP TY OWNER'S MAILING ADDRESS LOT BLOCK 4~9r7 n. CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAM CS NU ER 11. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD OWN ❑ State Owned ILLAGE ~ ❑ Public D~1 or 2 Fam. Dwelling-# of bedrooms PAR LT NU R O~~ O T III. BUILDING USE: (If building type is public, check all that apply) C 77 o e u, 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/Nursin Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/Car Wash 50 Hotel/Motel 9 ❑ Off ice/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1.1K New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 511 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 110 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 140 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 REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) ELEVATION e2 f0 1 410 /Ssa?.,C7 ll `r/4 ?Q L,T -SO' Feet `f g -A? ' Feet VII. TANK CAPACITY Site in gallons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks strutted Septic Tank or Holdin Tank /Oo0 / E F]_ F1 F-1 Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's nature: (No Stamps) MP/MPRSW No.: Business Phone Number: &os . c . S 3395 t7~S 38'6 -~8'S'o Plumber's Address (Street, City, State, I. 7 A Co/de): 40 Sc~ti Lv t ~~U IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued Issui g Agent Signature (No Stamps) ? Approved ❑ Owner Given Initial Surcharge Fee) ~0' Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber 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: L 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 all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. Vill. 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'h 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; wells; 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 collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and bstablishment of standards. SBD-6398 (R.11/88) • z~' ~ ~ tit ~ ~ `~l ~ ~i }emu, A,` ~7j ^ ~ rl )`l l ~ ~ , ^r 0 r ^ cr 1 n + n N e1 n ♦ I's o' M ~ ~ `"q ~ ~ ~ Q .gyp' ~ h ~ ~ ~ ~ ~ ~ INN ♦ I I` w \ ~ 4 • STREET, • ~ ' 4 a C v AP t ^ 3j h ` . T C11 .cu ft . t STRE .~uz ''r. z63. ' nor, ~ ~ DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS II~DIJSTF~.Y;' CC DIVISION LAYOR BOX HUMAN REDLATIONS PERCOLATION :TESTS (11J) MADISON WI 53707 e-"E'JA&k L-d'T Z (ILHR 83.0911) & Chapter 145) LOCATION: SECTION: TOWNSHIP/ 'I OT NO.:BLK NO.: SUBDIVISION NAME: 1/ 1/ i7 /T3o N/RzdLlllor Si ~ostP>J NQt~LTON COUNTY: MAILING ADDRESS: ,4CP0tx I NoTvy S USE DATES OBSERVATIONS MADE NO. BEDRMS.: ICOMMERCIAL D RIPTION: DESFRIPTIONS: IPERC7L STS: Residence RI F-iNew ❑Replace 36(96 4 Z746 v '50 I~G RATING: S* Site suitable for system U- Site unsuitable for system ~T EN O LT CONVST❑U. IMOUND:DU IN-GROUlVUR:S,S I ~ U LIHOLDI OS IID Ifl PPeerrcolation Tests are NOT required LS DESIGN Q RATE: CC. If any portion of the tested d area is in the , / under s. ILHR 83.09(5)(b), indicate: t_ASs '71 lFloodplain, indicate Floodplain elevation: AIA PROFILE DESCRIPTIONS BORING TOTAL DEPTH T GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTHi*. ELEVATION OBSERVED EST. HHIG9_EST_ TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 18"Bcs,c.-r-S 43'8r.,iFS /~"6QN~'S-FG+t cch B- ( 1o.< - 71-7- ? /o.S~ 24 $aw eswG~ a cs t G B- Z Q.33 .9~2~ r4at4c > 9.33 n"&FsTS 23"8~►FS ~6''gaN~'S 7-$eurMs Z7~B M f6* e_gitCA1% Ze" e C .4 e> it B- q.Sg 97 7_ >nbNLr > 9,58 IZ"&~STS 30 8Ri11~'S ~~~u~Y~S S ~ ~a~'Gvl~?b I Q0$am CS44k Cob Co^ :S BeNes G,t Cob e B- 4 jbaZ , 9,i,1% owl /O-~S B;$L~T~ z2"3>ItuFY ZZ iQu4Y~s a 16 ekNFS S~ ~b CDC 2/ C@R~u CSYC~~ 34"$e.,cs c,R B- /o 33 g89i3 arses z~"$IeN 2r "3ati Fs tjr'WtF ~•33 ~'~BawFS+Cob 39` c$~N CSY&O. B- ~cFT PERCOLATION TESTS EST DEPTH WATER IN HOLE TEST TIME DROP I WATER LEVEL-INCHES RATE MINUTES NUMBER AFTERS WELLING INTERVAL-MIN. PER190 1 P RI D P PER INCH P. ) ssa r'6 1197-to /O /'/4 /Y 4 04 e P- Z S-Ro NO f4 d CM. /b to /74 P- 3 6 No E 7. 0 / 1'14 / ' 4 P- P EL Yerio Wr PE0'4L P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION. 9Z.3 f I a I AMV ARC A-r Nl~ ~T Co~Nit R T EL AT IfaN = /00 oU ~ ~Z- 44 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): t TESTS WERE COMPLETED 4AZ\jGy JoIKNSbI JOUkrsor1_S_vIa\tQ/,N4 Atp*, Z 11% AD RESS: CERTIFICATION NUMBER: PHONE N MBER(optional): S~cAN r 1Ju 464N Qr SAO 1 b '3 414 6-~~80 CST SIGNAT E: :IfikrQ2~i~ I DISTRIBUTION: Original and one copy to Local Authority. Property Owner and Soil Tester. DILHR-SBO.6395 (R. 10/83) - OVER - STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT- St. Croix County 4~/BUYER K°rt~~d . I HOEF"f (t ROUTE/BOX NUMBER 46k1 C_~ut iy FIRE NO. CI CITY/STATE - 1-{~I6SO-t W kSCQ S~~.► ~fIU 1~° ZIP S-`(6 ( PROPERTY LOCATION: 1/4 1/4, Section , T N, R W, Town of ~~S,,..t. Croix County, Subdivision 16e1L ~lAT'_ 0(- 00 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. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. t SIGNE ` DATE t cl o St. Croix County Zoning Office St. Croix County Courthouse 911 4th Street Hudson, WI 54016 (715) 386-4680 Sign, Date, and Return to above address ;a 1 1 • APPLICATION FOR SANITARY PERMIT STC-100 This application 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 > Location of property 1/4 1/4, Section , T N-R W Township -PH Mailing address `A co c o c rt~.lb:C5 -0 Aj Address of site UB't Z C UL o C= "6UU Subdivision name Lot number Previous owner of property ( 1 Total size of parcel 1S_ r T Date parcel was created Are all corners and lot lines identifiable? __~_Yes No Is this property being developed for resale (spec house)?-X-Yes No Volume and Page Number as recorded with the Register of Deeds. INCLUDE 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 OWNER 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 warrant deed reco ded in the Office of the County Register of Deeds as Document No. ~^'S&446 ~ ; and that I (We) presently own the proposed site for the sewage disposal system (or I (we) have obtained an easement, .to run with the above described property, for the construction of said s tem, and the same has been duly recorded in the Office the Count Re ate o Deeds, as Document No.~~ Si nature of Owner Signature of Co-Owner (If Applicable) A J'4z t I j qo Date f Signature Date of Signature ( 3 pfG F1 y}ft+~p?5*R~pa?~rsd">vl'~yN{Ir~ty411i7a' d `y S' ,DOCUMENT NO. per ~tr N r_?~ WARRANTY DI:RD k rtes • VQ~ STATE,QF wISCO(~BIN-FORM r, SK,~C 64619 TN~IStiPACE RpLRVLq.FOR RECORDING DATA av•iiy ,i REGISTERS-:4FlCE ;'y 3tre° CR THIS INDENTURE, Made this ? th 5 XCC:.~ da of 80 between y . June A 1~ Recd. A... for Record lhls~~•t h '"iE' Joseph'Ha3.trejean and T~oraine e ;f ' d - ~'latrejean »hu:iband and wife cry of •Tttt~.D.198p 7...... 3 _ ea - at 11 •OU art . • $ .p of the first Partr and , { Jaxno s 01C fiilnohy'e 'lwnaa a single man' onne7„L"~ _ Register oD~ede la 1 H••M ..part .X of the, second art 1 Witnesseth, That the said art_.ieis of p _p »tl~e.first art- for`and iw P n consideration of the sum of _ - I ACTtIpN TO f F4£& Y..Five, H - -Dollars to..._.them in hand paid by the said Part_...ZY» ` of the second part, ,the receipt O gedr have whereof is hereby confessed and acknowled given, granted,, bargained, sold, remised,; released, aliened conveyed and confirmed,-arid by, these presents-do . give,,grant`"'bar,>a1in; sell;' remise,'relec, alien, convey, and confirm unto the said part._._Y_,:. of the second art assigns forever, the following described real estate, situated in the County of.. ,Ste Croix heirs p is and S and I ti ti~ rc ~1; rate of~Visconsin, to•w_ it,(l Lot 2p Block 11111# Flat of Houlton, EXCEPT E 19 feet thereoft t, 3 - i t d q 6,; I,'aj•_ ~ ~ ~ C~ i R j II ! ( n FEE (IE•,NEOEISSARTt CONTINUE DESCRIPTION ON REVERSE aiDE) a }t~ ijv 4i Together with all and singula; ; the hereditaments and appurtenances thereunto ! belonging or, in any wlse4Ps~ rah appertaining; and, all the estate, ,right, title, interest, claim or demand whatsoever, of, the, said part..,.3es. of the `lr stn I# ; first partr-either,inJAW-pt equity, Cj p oc_e~cpectancy>of, in-and-to the,above-bargained'Lpremises • . their hereditaments and appurtenances. To Have and to Hold the; said premises as above `described, with the hereditamentr and appurtenances, unto n tl the said part ...JAM. of the second part, and to ..his...... } g~ theirs and:assigns FOREVER t= k ~ And the said Josg A..a:. g .ttll'~~.fl~A I~ud_ 'i~» 71~. MaJ.~r~J.~. 77 »Ta j . _ - for.. m Y.SIs9,}..t•~ t~t~:. » 3, ~x: ,thy q.() • 'heirs .executors and administrators, do covenant grant' bargam and agree to and with the said part-..»Y » of the second art heirs and assigns that at the time of they { I : °r > ensealing and delivery of these presents ......1.~ well, seized of the premises above described, as ~ of good, sure, perfect, absolute and indefeasible estate of inheritance in` the law, in fee simple, and that the same are r t' I ( r,~, free and clear from all incumbrances whatever ~.xc~t~t.ur>tsa:s~s [~R'#tgl~gt~.~~o?~.» •"22 !!,-•-l~ll'.e..313,..xo~axxias~.. xi...th~.~ . e_Q, ..t a. ~e ;~tex 9,K_Peedm..:~or St C Co ~;?~,i t..3.Q,...19.34 and that the above bargained premises in »h ' "sec the quiet and peaceable possession of•the said ~part Z of.tha -secoi}d part, UA heirs and assigns,"against all and every person or persons lawfylly claiming die„whole or any artx thereof, ......21Qy will forever' WARRANT AND'DEFEND. ` In Witness Whereof, the said part.AU...'of the s y1,{(~~A i f t} sea1S..., ~~t7„-, first pat ha...X13..... hereunto set hand- and this.:, ' dap. of A F I SIGNED AND SEALED IN PRESENCE OF -?X. ••G.G:,4 ' -(SEAL),,, Jose A 1'laitre can`' . s " 7 (SEAL)q,i. • ( + 5 {im SEAL) R{ [+0,~ State of Wisconn, ' 8o -•-'siCounty personally came before me, this....7. i~»... day of............... P the» above' StA.» named ~xalac _ Jcf s ph_.A ora iri A, D , 19 4 Maitre~en..~nd L a I. 1~laitre~ean,o..husband and wife' to me known. to be•the personR.-who-executed»th T s ,t Yfareg ing n m t and ackn led th a 99 THIS INS) ~t RiIMEt(TW/►6 DRAFTED BY 3o j rien , J sThose J Erie II - J. ~•Q NSEAix Notary Public, ~►~?.tat...~'tx:R~aK.,.._.. e Hudso r - , County, Wis My commissioq (CIPUM ~IS)-•»-.•~$1 (SecPoN.PkI_ (i? of the Wisconsin Statutes provides that all instruments to be recorded shall have plainly typewritten -T thereon ' the names of the grantors, grantees, witnesses and notary. Section 59.313 similarly roQmtes that the name of the person whoor goveto t idental.agenty which, drafted such instrument, shall he printed, typewritten, stamped or written thaeoa in a legible manner.) WAIiItANTY DEED STATIC' OF WISCON31N \V FORM so. Y - lnronRln Los nl Dlnnk Onmpnnr , Milwaukee. Wla• ( Job 30624