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Home My WebLink About014-1021-10-000n ~ ~ O CD ~ ~ C ~ 00 N ~ O N N O- O O ~ ~ fD U1 O O v ~ ~ N O ~p O ~ O A O N O n N ~ O Q' O ~ O N a z 0 w_ O~ 7 W n z 0 m 0 ~ ~ o '~ ~ ~ ~ d ~ d o a ter ~ A ' I ~ ; . ~ ~ ~ ~ ~ 3 ~ _ II '•<. ~ ~ ~ . \ 1 Zr _ ~ 0 ~ Z N O y z 7~ O O A O S p~ ' T O ~ O O_ (O ~ ~ • ~ ~ N xb ~ N N ~"' -' A 7 p~ N ~ O ~ , ', I~ ~ N . C ~ • O ~p > N i O ', ~~ .~ W ~ O ~p N n O 0 O O ~ ~ 7 N O '~ O O p H ~ n ~ w y O ~ G O 7 A G `G W T7 °o ~ o o rn c ~ =^, O ~ N O a p " ~w O O N I ~i N N ~ N N ', ~ 3 ' ~ C a lr c ~ ; ~~ o. O O O m ~ ~ ' ~ c -p ~ ~ ~ ~ 'I o N D ~y, ~ w ~ Ul V1 fn CT v ~ C ~ O' (~ ~ ~ ~ D O N A O '. ~I ~ '. ~ CO O ~ ~ cQ 3 y d `~ m - ~ 1 N D O O D D fO ~ w m ' r ~ tD v ~ C i CD 3 ~ J N ~~ •p Z n ~ ~ K A Z O .. p 3 ~ ~ ~ '' ~ a ~ '' ~ z 3 a ~ ~ .. ~ ~ ~ A W ~ 'I n (D ~ ~ n O Q S a °~ °> > o:pn ~' v T c co w ~ ~ Z d ~,~~m a O .. N an -o ~ `pj ~ m ~ ~ ~ l i 0 0 ~ O W r V in N p V S ~ ~ n A U7 ~~v ,tea mo~D ' x o ~ `~ N-.. O fA ~ ~ ( N v S ~ W N ~ W O A ~ ~ II N N I p0 1 O C1 b ~ O O ~' ti Parcel #: 014-1021-10-500 o4io2i2oo7 02:38 PM PAGE 1 OF 1 Alt. Parcel #: 09.31.15.139A-50 014 -TOWN OF FOREST Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 09/20/2006 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -GALE, LYNN F LYNN F GALE 2810 CTY RD O CLEAR LAKE WI 54005 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description " 2810 CTY RD Q SC 1127 CLEAR LAKE SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 5.010 Plat: 5273-CSM 21-5273 014-06 SEC 9 T31 N R15W PT SW SW FKA CSM 19-4849 Block/Condo Bldg: LOT 05 LOT 2 (27.563 AC) BEING CSM 21-5273 LOT 5 (5.01 AC) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 09-31 N-15W SW SW Notes: Parcel History: Date Doc # Vol/Page Type 09/20/2006 834892 21/5273 CSM 09/30/2004 775797 19/4849 CSM 08/10/2004 771267 2635/344 EZ-I 03/26/2001 641274 1607/133 PR more... ~nn~ c~ innnneQV Bill #: Fair Market Value: Assessed with: Valuations: Description Class Totals for 2007: General Property Woodland 0 Last Changed: 10/04/2006 Acres Land Improve Total State Reason 0.000 0 0 0 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Total 0.00 Special Charges Delinquent Charges 0.00 0.00 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION ~ (ATTACH TO PERMIT) 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 Gale, L nn Forest Townshi CST BM Elev: insp. BM Elev: BM Description: r ~~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ i/ M r J ~( (~„I"~.-1C~ K f't v (~ b Dosing ~~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air I take ~ ~ ROAD Septic _ ~'~ ~ ~f ~ ~ /~` i ~ ~_ Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer ~' /1 Demand ~/ ~j71 ~ ~ GPM Model Number ~ ~~ ~~ •~, TDH Lift Friction Loss System Head TD Ft Forcemain Length / Dia. Dist. to Well SAIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 405119 0 State Plan ID No: Parcel Tax No: 014-1021-10-000 STATION BS HI FS ELEV. Ben hm~ ~ ~ ~ ~ ~ `, V ( D i 6 Alt. BM r , 5 ~' Ct~ ~ ~ , 2 ~ ~..,+.~ BIc~.,Se er i-r-+- ~ ~. [ ~ ~~ v 3 7. ~ S t Inlet ~~3 ~s-`i S Ht Outlet D Inlet StQ , c7 ~ d ~ ~ ~ ~Q O Bottom U,lx~ a p p / 1 _` to r s~ ,(p Header/Man. ~ ~ ~ d ?^~ L2 -~$ j' Dist. Pipe ~G~ ~ l,I Z=S~ `7, 1 ~~ Bot. System Final Grade ~~~5 t over ~ 7. (05 -~-~~ S, ~ ~ ~y~ i~i~. ~. ~ Q(. ~ S . ED RENCH NSIONS Width / ~ a Length ~ ry~ V No. Of Trenches ~ ~~ PIT IME SIONS ~, No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM AC G CHA ER OR Manufacturer: T f S stem: y y ~ _ f I f ~ ~ }~ \ } ~f1 t ~ D Model Nurp r: DISTRIBUTION SYSTEM ~[{~~ ~~{~ -- ~ ~1 a:.~,lnC! He der/ nifol~ strib io x Hole Si x Hole Spacing Vent to Air Intake ~ _ ~~ k e(s 7 ) ( /t ~ L S v /Z 3 (~ /i ( ~ ' ~ w Length Dia Length Dia l Spacing I SOIL COVER _ „ x Pressure Systems Only ~ xx Mound Or At-Grade Systems Only Over ,.,. ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched ed/T ench Center ~ Bed/Trench Ed es 9 To soil P ,,: Yes ~' No I Yes j No i COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: ~0 / (~/~Z Inspection #2:~/~/~Z~ Location: 2810 County Road Q Clear Lake, WI 54005 (SW 1/4 SW 1/4 9 T31N R15W) NA Lot Parcel No: 09.31.15.139 1.) Alt BM Description =~~~~~ 2.) Bldg sewer length = mom-- ~ - amount of cover = i ~/r __ Plan revision Required? ~:~ Yes i~_' No i /~, /- / ~ ; ' Use other side for additional information. ---~/ __~ ~ ~ _ ~~LL~y(m1 - !ll/flJ~~ ~- __ SBD-6710 (R.3l97) Date Insepctor's Si nature Cert. No. ~~ ~, ~. ~~ .~ r ~~ ~, .~~ s Q b ~~I ~ ,~ .~ ~o~ ~9 ~ yti ~6 ~~a ~. Safety and Buildings Division County ~ s 201 W. Washington Ave., P.O. Box 7162 St Cro1X A~~~~ Madison, WI 53707 - 7162 Site Address Department of Commerce / ~~ld CocG<c~~a- ~~KC Sanitary Permit Application Sanitary P N ~ In accordwith Comm 83.21, Wis. Adm. Code, personal information you provide / ^ ~~ if Revtsian ma be used#'or secort Priv Law, s15.0 1 m L Applicatjon Information-Tease Print All Information State Plan I.D. Number - ~ # ~-ZZIa S, /0. Property owner's Name RECEIV Parcel Number al . 31. ~ S • ~39 Lynn Gale p/c~_ ~oz~ - s0-DOv Property o,~~'s 3diailimg Address ~ ~ ~ '), 5 2002 ' Location PO Box 23 SW'/.; SW'/.; S9, T31N, R15W. t~3 City, State Zip GNING OFF G~O11eN ~ LatNumber BlodcNumber WI Clear Lake - -4106 , Subdivis~ n CSM N 0/f/tls:~ Il. Type of Building (check aD that apply) ^ city X 1 or 2 Family Dwelling -Number of Bedrooms 3 ^ Village ^ PublidCotnmGrcial - Describe Use owu FOrest ^ State Awned r Nearest Road ' p ~- Ct Road Q lII. Type of Pe lt: (Check only one boz on line A (nu eying scheme for internal use). Complete line B if applicable) A' 1 New 2 ~ Replacement System 3 ^ Replacemerrt of 6 ^ Addition to For Comity use Systetn Tank Onl Existin S B. ^ Check if Sanitary Petmit Previously Issued Permit Number Date ~~ IV. Type of Permit: (Check all that applyxnumbering scheme is for internal use)~~~ 14--~Q~p 44 ^ Non -Pressurized In-Ground 21 ^ Mound 47 ^ Sand Filter 50 ^ Caa~struded Wetland 22 ^ Pr Jn-Ga~ound 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line 45 X At-Gra{1e 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other reatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation System Elevation Final Grade Required Proposed Rate{Gals./Days/Sq.Ft.) Rate Elevation (Min.nl~cfi) 450 900 f#2 900 ft2 .5 N!A 95.7 97.49 VL Tank Ingo Capacity in Total Number Manufacturer Ptefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concaete Censtruded Glass New F.xictiag Teaks Turks Septic 1000 1000 1 Skaw Precast X Pump 642 642 1 Skaw Precast X VII. Respon$ibility Statement- I, the undersigned, assmne responsihiHty for htstallatlon of the POWTS shown on the attached plans. Plumber's Name ' t) PI i MP/MPRS Number Business Phone Number Thomas D. Gustum i 227618 715 658-1344 Plumber's Address (Street, City, State, Zip Code) N13450 937th St New Aubum, WI 54757 VIII. Coun artment Dse ~tl9al Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater S d F Date Issued Lsstting Agent Signature (No Star->ps) ur targe ee) ^ Owns Given Initial Adverse ~ ~ 3 Z ~ ~O ZED2- ~ Detetmittatian . , IX. Conditions of ApprovaUReasons for Disapproval op I t~ ~ / ~~ A-u ~b~ ,~.~-- ~.. t~~ ~ ~.~.. f ~~~ 1 Attach complete plans (to the l;ounty only) ror the system on paper act Bess man aii~ : as un;ucs m s~:c Safety and Buildings Division Cota-ty 201 W. Washington Ave., P.O. Box 7162 St CirolX i~consin Madison, WI 53707 - 7162 site Address Department of Commerce hh o~g/d ~OrG>rc~K~ .C~t:'t Sanitary Permit Application Sanitary P ~ s-11 lr, acardwilh (:onun 83.21, Wis. Adm Code, persor-al irdorrnaAian yon provide g ^ tXredc if on ma be used for swoon Pri I.aw, s15. 1 m L Application Information -Please Print All Information State Plan I.D. Number ~- .10• PropeBy Owner's Name REC EIV Par+oel Number q . 3 ~ . ~ r . ~ 34 Lynn Gale pi~_ ~oL(- s0-Opv Prapaty ownc's 1Jlsilimg Address ,, ,/ 5 2002 A. ~ ~y t~auan PO Box 23 SW'/.; SW/; S9, T31 N, R15W. /8 may' Staff Zrp ONING OFF G~011e N ber L.ot Number Block Numbs WI Clear Lake '-'rrs X106 , Subdivis' ~n CSM N ber 4~i/trt.~ 1L Type of Building (check all that apply) ^ cry X 1 or 2 Family Dwelling -Number of Bedrooms 3 ^ Village ^ PubliclConnnGroial- Ihscribeuse own Forest ^ State Owned t Nearest Road ' p ~- Ct Road Q iII. Type of Pe t: (Check only one boa on line A (n ring scheme for internal use} Complete line B if applicable) A' 1 New 2 ~ Replaoanent System 3 ^ Replsoement of 6 ^ Addition to For Comity mx System Tank Onl Eadstin S B• anrtary Pemut Previously issued ^ Check if S Permit Number lea Eti~ed IV. Type of Permit: (Check all that applyxnumbering scheme is for internal use)~~~ A--app 44 ^ Non -Pressurized In~iround 21 ^ Mound 47 ^ Sand Fitter 50 ^ Coa4rvdsd Wetland 22 ^ ir--Gaamd 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Lure 45 X At-Gra(ie 46 ^ tlanbic Treatm~t iJnit 49 ^ Recirwlatmg 30 ^ Other reatment Area Information: Design Flow (gpd) Dispesal Area Dispersal Area Soil Application Pertx>lation System Elevation Final Grade Required Proposed Rste(Gals./Days/Sq.Ft.) Rate Elevatim (1JNn.Asicfi) 450 900 ft2 900 #t2 .5 N/A 95.7 97.49 VL Tank litfo Capacity in Total Number Manufadwer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Cmstruded Glass New Existing Tanks Turks Septic 1000 1000 1 Skaw Precast X Pump 642 642 1 Skaw Precast X VII. ResponxibT<lity Statement- 1, the mtdersigned, assmne responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Pl i re MP/IviPRS Number Business Phone Number Thomas D. Gustum , - 227618 715 658-1344 Plumber's Address (Street, City, State, Zip Code) N13450 937th St New Aubum, WI 54757 V)a Coun artment Use fln Approved ^ Disapproved Sanitary Permit Fee (indudes Groundwater Date Issued Issuing Agent Sigaatttre (No Stags) Stndtarge Fee) ^ Owner Givat Initial Adverse ~ 3 ~~ ~D ~- c Detenninatian • IX. Condit(i~~ons of Approval/Reasons for Disapproval ~~~~ ~ J4-{~ ~t~ba~ b.e.. tnr~.t Os ~ cflOp ~ t` C°aQQ° ~ e'u1'.[1t0+6CP.~ ~ .,`T . _ L C.l. ~t9~1,S. r Attacd coaaptete puns (to uce c:ouaty onty) for use sysum on paper n« Kss aaiao eu~ a u ..m.ca ... ~..~ 08:19 1?156581344 TOM GUSTUM PAGE 03 __.. a ._. _._...._. r rt _I ! ; !!E ~i FI i, is 7 , I i I ,~ v 1 CO Plot Map k D ~S C ~ (((333 ~ g ~` x ~ • •- .`~ ~~~ ~ ` O ~` ` e ` O \ `. '~ `. ds a ~ ~ ~ ~i ~ a .~ ~ ~i I ~ ~~~. ~R~ ~~~~~ K ~ CV ~~~ N7 I~ 1 i i ~.n g° ~~ ~• ~ ` ~ ` ~ i ~ ~ ~ ~ ~ p U ` 7{ ~~ ~ ~~ \ fO • ~ ~~ ~ ~ W ~ i ~ ~, `, 8 ~ i ~ V ~ ~~ ~~~ '`4; ~ ~` -- ~ rya s ~ a ` ~ ,, 8 8 _ $ .a ~ ` ti ~ !--- u M n ^ ~~ ~ ~ Page f of 6 `~' L.~._.. w _ , _ .. _ ~ _ ~ o ~ ~ ~ a isconsin Department of Commerce Safety and Buildings 401 PILOT CT STE C WAUKESHA WI 53188-2439 TDD #: (608) 264-8777 www. com me rce. state.wi. u s/sb www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary April 18, 2002 CUST ID No.227618 THOMAS GUSTUM GUSTUM SEPTIC SERVICE N13450 937TH ST NEW AUBURN WI 54757 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/18/2004 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI .,54016 SITE: Lynn Gale Town of Forest, 54012 St Croix County SW1/4, SW1/4, S9, T31N, R15W FOR: Description: AT-GRADE,3 Bedroom Object Type: POWT System Regulated Object ID No.: 836181 IdentificationNumbers Transaction ID No. 722659 Site ID No. 643080 Please refer to both identification numbers, above, in all correspondence with the agency. The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "At-. grade Component Manual Using a Pressure Distribution System for Private Onsite Wastewater Systems" SBD- 10570-P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD-10573-P (R.6/99). • 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 at-grade manual, and section VI of the pressure distribution component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • A Sanitary Permit must be obtained from the county where this project is located}t~,accordance with the requirements of Sec. 145.135 and 145,19, Wis. Stats. ,~? C Ql1~jfl~ ~~ ' • Inspection of the private sewage system installation is required. Arrangement ~f~r ' hall be made with the designated county official in accordance with the provisions of Sec. IOVb/~~~ .. Stats. N Of Sqr S~~ ~ . THOMAS GUSTUM Page 2 4/18/02 A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/instal l ation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Julia aLewis-Osborne POWTS Reviewer 2 ,Integrated Services (262) 548-8638, Fax: (262) 548-8614 j lewis@commerce. state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 04/16!2002 08:19 1715658134.4 '~ oonrDkb alb pt~r m pier not teas Nran H4i>:11 rrcAae b Ids. Purl musi COUnIy Micti+CS, L,rA rat IYnibd b: Yafllcal end tlofttorllai 16feralae poYit (B~, dradon arb St Ci101k parmnt ebpa, ale a dmanraiora, rardr army, end Ioalerr 9~d dietarro. b n6raasal road. Paroal I.D. Plaatra pIMR rW /nlbr/n~krn. Reviao~ed By Dare Pwra~l Norer~rMr tsar perlAr elan is urea er~eday PaRrr+e (~Y 6aR a.1SA1(1) pnp. Propetbr Owner Pt~operb LOOet{On Gale L nn Govl.loi Na SWtN SVN1M g 9 T 3l NR 15 W ProPeny Owry~a Msiieq Ad0leeg l.ot N etodc ~ Subtl. Nprrw or CSNMr- P.O. t3ou 23 Na Ne N/A City Stare Zip Cone Ptlorle Number ~ CiOr )M Vitiaps ~ Towr1 Nearest Goad Char !.eke 1IVI 54005 71rrZ63.41pS Forest 1 Cot+ttl- Road D Sl New Consbuction use: ~ RraweerrpW ~ Nutiaar d bedrooms 3 cods eefived deslpn flow rare 4S0 fdPD ~ IReplaoenteot l~ Pu4ric or oDnrrflsrdal- 0aevtes: Parent material glacial dll ord sBndsUDne Fxaod olalrt elevapon, if applkk~bla n/a General mrffrtrenrb ar-d reoornrnendati ons: Addandunt ~ soil East submitbd 58-00, Borinp * ~ ~~ ~ Pit Cirnund Srrlaoe elev. $5.5 R. peplN ro IgnMnp feC6or 37 In. 5ci ADdka~bn Rato Mbrazon Dept;- Dornrranl Gdar liedox Daautllron Tasiure Stn~rre Conelebrrm Boundary Roots in. rlyn99~ Qu. &t. Ca-l lobr Gr. Sz. B1. 1 1 0$ 10yf312 none sil 2msbk nMr as 2f,1 m 0.6 0.8 2 8-20 t 0yr5~ none sil 2msbk mfr ar 1 m 0.5 0.8 3 2428 7,5yrd/4 none ell 2msbk mfr cw - 0.5 0.8 4 28.37 7.5yr4/6 none sl 2mabk mvlr err - 0.5 0,9 5 7~2 10yr5/l3 `~~ ~n~g n sl 2msbk mvh - - 0.5 0.9 ' Etlluant N1 ~ BOD > 30 <_ 220 mDn- and TtiS >30 <_ 130 mp/L ' Effluent ~ o BOD ~ 30 rtfyL and TSS _30 mp/L CST Name (Please Print) ST Number Tom GusEum 227818 Address Gustum Septic t;entoe Doss C-vslustlon Condtxesd Teleptrone Number N13s50 807tH t8i., New Aubrxn, W16+r787 4/17J02 715658~13A4 TOM GUSTUM PAGE 1552 yylemns;n Oeperfirrent d Corrrnwerce SAIL EVALUATIONI REPORT ~. 1 ~ 2 Dirrir{fyn d Sedsiy end Btidirrr~ in aooorda-K>a wM1 Comm 86, Wis. Adr~ Code Ciussam sepsc 3ervlesa .~~a1y -F~~ - jYA~~ gU~ p~ ~~S . `~. ;_~ ... ~., J~I'V~L 04/16/2002 08:19 17156581344 TOM GUSTUM PAGE 03 ~ . Plot Msp ,; ~~~ I` ~ J S ~_~___~, ~_,..,-, ~! ~ g ~o '~ _ ' 5 . ~ ,,, _ $~ ~ Z s = 8 ~~ ._ ~ ~ u u a ^ ~...- a ~` .~ U. D C ~ Ggi F g ~` ~D x ;~. a w! ~^ ~I .~ ~ ~' ~ ~~~ ~ o: ~~+~~ _ -~ ~~~~~ = .~ 1<K~ N I ~~~ ~~ N) I¢ I ~.n 4 W ~.~ ~~ ~A b 8 !~ -, __.. . _ Pie fi oaf 6 I `~' ~, ~ ~` ,,. At Grade Cover Page pg, of s RECElVE® APR - 8 2002 SAFETY & BLDGS. DIU. 4 Project Name: Gale 3 Bedroom At Grade Owner's Name Lynn Gale Owners Address Box 23 Clear Lake, WI 54005 Legal Description s'w ~ '/., ~ ~ '/. Sec~9~ T 31 N, R 15 w ~ Township Forest County Saint Croix ~ Subdivision Lot# Pame11D# Table of Contents ~~ 1 Cover page 2 At-Grade Sizing Calculations 3 Pressure Distribution Layout and Dynamics 4 Dose Tank Calculations/Pump Curve 5 Management and Contingency Plan 6 Plot Map total # of pages: 6 Designer Name: Tom Gustum License #: D1201 Date: 4/5/2002 Ph. #: 715-658-134 Signature: At-Grade Design Methods Used per "At-Grade Component Manual For Private Onsite Wastewater Treatment Systems" (Version 1.0) SBD-10570•P (R.6/99) pas " Psesrswe Qistsibutron Component snanuai for Private Onside Wastewater TreaMent Systems" (Vessifln 2.0) SSt)-10706-P (N 01!01) I Spreadsheet prmrided tiy: ~iW~risement N12486 220th St, BoyoeviNe, WI 54725 Ph: 715-643-6068 email: 3ba~3badvisement.com I At-Grade Sizing Calculations Project Name: Gale 3 Bedroom At Grade Site Conditions Private Dwelling or Commercial: p (P or C) Slope: 1 # of Bedrooms 3 Depth to limiting factor: 39 in. Absorbtion rate of in-situ soil: 0.5 gallft2/day Effluent quality Eff#1 • Max BOD effluent value: 220 mg/1 Max TSS effluent value: 150 mg/I Design of the Distribution Cell System Design Flow: 450.0 gal/day Distribution cell credit width (A): 10.00 ft ~ 6p Distribution cell length (B): 90.0 ft Area of Distribution Cell: 900.0 ft2 / Contour Elevation: 95.70 ft ,/ Page 2 of 6 Design of Entire Component Upslope Width added to A (E): 2.0 ft Total Width of Distribution Cell(C): 12.0 ft.~ Perimeter Beyond Aggregate (D): 5.0 ft Overall Width of Component(V1n: 22.0 ft. Overall Length of Component(L): 100.0 ft. Elevation of Lateral in Cell: Height of Component Over Lateral: 15.5 in. Height Over Rest of Cell: 13.5 in. Final Grade of Component: 97.49 ft Observation Pipes Location from end of cell: 15 ft At-Grade Plan View ~D~ ~ ~ Observation ~ B ~ p Pipes C I B l~ r-, L - I At-Grade Cross Section Final Grade Lateral Invert Synthetic Fabric Cover Material Distribution Cell System Contour P,~ ~ 4`~ Observation Pipe d ~ ~ y 6 a D t ~ e .. ~ Tilled Area ~ 9°4 a° ' e a' ° e 6 ~ a ~ ~~ . E o C A D--~ r`-~ Slope Notes: Distribution cell aggregate to comply with Comm 84.30{6)(1) Synthetic Fabric covering on cell per Comm 84.30(6)(8) Distribution Cell to have minimum 6" aggregate below lateral and 7' above. At-Grade ~ ~ ~8 s or s Pressure Distribution Calculations Project Name: Gale 3 Bedroom At Grade Lateral Layout Lateral/Manifold Design Lateral eievatit~n: 98.2 ft .Lateral diameter: 1'~ ~ ln. Rows of Laterals: 1 Lateral to upper cell edge: 2 ft Manifolrt type: Center • ~ ~ ~ ~ Lateral discharge rate: 15 m Orifice diameter: o,lss • n. System discharge rate: 30.31 gpm # of Laterals: 2 Distal Pressure: 2.5 ft Lateral Length: 44.5 ft ,/ ~ ~ ~r Orifice Spacing/Distribution ~ ~ac~ Fort;,emain Friction Loss ~ p Orifice spacing (~: 23.73 Inches Forcemain length: li~~~ ~y' 75 ft ~~ Orifices per lateral: 23 Forcemain diameter: 2 ~ In. Avg. ft2/prifice: 19.57 ft2 Friction loss in forcemain: 82 }{ Avg. Lin ft/Orifice: 1.957 Lateral Side View Manifold ~-Lateral ~ Lateral x '~ x '~ x '~ x '~ x ~+ x x '~ x '+ x~ x ~+ x ~~ x 2 2 Lateral Length ' Lateral Length Lateral Plan View {-~~ Lakeral Length '- I Turn-up wlball valve ar cleanouk plug g o Orifices on bottom of lateral equal~r spaced PVC laterals and forcemain to comply with specifications per Comm 84.30[2ue] Clean Out Detail Glean-out plug Grade f- or ball valve Sprinkler Box Long Sweep 90 OrtwO ~5~5--..~_ Observation Pipes 6" Minimu~ ~hlater tight cap or plug Note: Closet CoNar may be used in pJeae of 319" bar ~3}fk" Bar .~ ~~ At-Grade Septic, Pump and Dose Tank Project: Gale 3 Bedroom At Grade Tank Information Pump tank manufacturer: Pump tank size/model: Pump tank ga~nch: Tank bottom elevation (inside) Septic tank manufacturer: Septic tank size/model: Skaw Precast 642 15.47 88 Skaw Precast 1000 Pump and Filter Pump Manufacturer: Little Gian Pump Model: 9EH Effluent Fitter: I Note: Access opening of sufficient size vided to aNow removal of titer. Opening to ~mvnate at or above gra e. Pump Tank Diagram 1Natertight Locking (,over 4 inch ~j With Warning Label iriish~~ .Minimum Grade Alternate f . Outlet ~ Loartion D o main ~ V+feep HoIE or Anti- Siphon Qevice Elea. per Gomm 7 6.28 and' iyl=c ~~o A .. 8 c ~~.~`~P D u Dosage Volume Does forcemain drain back to tank? I-J Lateral void volume: 9.4 gal ft Dosage to absorbtion Cell: 47.0 gal Forcemain volume: is c13.1 gal Total dosage: ~z `60.1 gal ways a or s Total Dynamic Head Are laterals highest point? if not, enter highest elevation: 0 ft System head (distal x 1.3) 3,25 ft ~/ Vertical Lift ("D" to lateral) 7,20 ft So Friction loss in forcemain: 1.48 ft / Total dynamic head (TDH): 11.93 ft Dose Tank Levels In. Gal A Reserve 21.'3. 351.3 ~ B Pump off to Atarsn 2.4 32.9 C Total Dosage 3.~ 60.1 ~?, D Effluent depth for pump 12.0 197.6 Total Capacity: 39.0 642.0 Pump Curve: Little Giant 9EH FLOV- LITERS/FOUR W W W Pump must be capable of: and head {pressure of: 2 30.3 GPM 12.0 ft to Vl 7.3 g r W S 5 A 2 as 0 20 40 60 SO Little Giant FLUY!- GALLONS/MINUTE 9EH PUMP PERFORMANCE CURVE 115V 60HZ At Grade Management Plan pursuarh to comet 83.54 W. a. C. pages of 6 Owner's ResponsiiNiity: The component owner is responsible for the operation and maintenance of the component. The county, department or POWTS service contractor may make periodic inspections of the oomponents, checking for surface discharge, trued effluent levels, etc. The owner or owner's agent is required to submit necessary maintenance reports to the appropriate jurisdiction and/or the department. Septic Tank: Septic tank(s) are to be inspected routinely and maintained by department approved individuals when necessary in accordance with their approvals. The use of chemical/biological "treatments" is not required or recommended. ff such additives are used, make sure they are approved by Department ofi Commerce, Sa#ety and Buildings Div.. Effluent filters are to be removed & cleaned as necessary, with provisions to keep solids from passing the septic during removal. No more than 1/3 of the usable tank volume may be occupied by sludge/scum. 3 year inspection: If tank has greater than 1/3 volume sludge, tank contents must be emptied and disposed of in accordance with NR 113 Wisconsin Administrative Code by an approved individual. If the inspector does not recommend pumping of the septic tank, then the owner must be notified of when pumping should be done as to not exoeed 1 f3 sludge volume. Septic tank should be routinely inspected to be watertight and of good repair. Pump/Dose Tank If an effluent filter has been installed in the pump/dose tank, it must be removed & cleaned as necessary, with provisions to keep solids from passing to the mound component during removal. The pump, #loat switches and alarms must be inspected at least every three years for proper operation. Pump/dose tank should be routinely inspected to be watertight and of good repair. At-grade and Lateral System The at-grade system component must remain free of ponded surface water prior to pump operation. If 4 inches or more water level is detected in the observation pipes, the owner must be notified of possible problems/faiiure. The designed daily flow capabilities of the component should never be exceeded. Trees and any akher deep rooted vegetation should never be planted, or allowed to grow anywhere on the component Activities OTHER than mowing/maintenance (i.e. excessive walking, pets, vehicles, etc...) could compress the component and reduce it's absorbtion capabilities and/or possibly cause it to freeze in winter conditions. Lateral distribution pipes should be flushed out/tested every 18 months using the cleanout points at the end of the distribution .laterals to remove scum that may clog orif'sces. Perforryia~ce Monitoring: Pertormance monitoring must be done at leasf once every three years following the installation or at the time of a problem, complaint, or failure. Contingency Plan. If the septic tank, pump tank or any of their components therein (including floats, alarms, pumps, etc) become defective, the defective tank or component must be replaced immediately to ensure that the system can operate as designed. If the at-grade component cannot accept wastewater or ponds wastewater to the surtace, the component must be repaired or replaced in it's current location by either: extending basal toe to provide added absorbtion area; or by removing the clogged bacterial mat,aggregate cell, and distribution piping within the cell and .replacing said components in order to return system to proper working order as required. IF ,i,l II ~f ~ ~ ~ ~ m m C ~~j, ~`' ~ 3 3 O ~ ~ a> (~ o 0 ~ ~ ~ U` ~ ~ Z O O (~ ~ ~ 8 Ltl J o ~ ~ N ~, w W ~~ ~~ ~~ ^ ~~ ' ~ m 0 v ~ ~ Plot Map ~ - Z ~, ~ U a ~ ~ ° a o~ Y Y ~ s qq (7 lrl J t ~ p ~ C X O ~ ~ ~ II ~ N ~ W Q ~ ~ v 01 a~+ O N O 2 .o ~ Y F~ U ~ °~ v ~ q3 O O ~ ~O C o ~ U ~_~ U o° ~ w Z ~ . ~ rn ` ~~ ~ •~` ~ ~ ~` O w o U `~ ` ~ ~ •~ ~~ O a o` Q u~ ~ ~ ~ ~` c`~ ~ rn ~ m ~ ~ ~ ` ~` ° ~` o a Q 'v O ~ a ~ ` ` i `` ~ Q -o Q ~ ~` ~~ Q to ~. `~~ ~ o ~ ~ rn ~ ~`~ ~`~ O ~ °:C~ c ` x~ - U ~ ~ ` U ~` Z Q U\ ` i` ~ ~` v ~ `~ ~ ~ . m rn `~ . W C° ` ` ` ~ ~ ` ~ ~ ` o m ~ ` ` . o`~n ~i ~`~ ` ~ ~ m v `` ~ m ` ~ ~ 10 0 ~ ~ ~ ~~ ` rn ` `~ ` ~ ` c \ ~ ` ~` J ~ ~` ~ ~ ` ~ ~ ` ~ ~ Page 6 of 6 ~° m Wisconsin Department of Commerce SOIL AND SITE EVALUATION ~li~ision gf Safety and Buildings Page of `Bureau of Integrated Services in,accordanc~.;Il, ~ 3.09, Wis. Adm. Code ~~ <~. `~ ~ ` ' ~~=ti ` County Attach complete site plan on paper not less than 8 1/2 x 11 i c~e5.~n size. ~ mist ,~~~ 1 include, but not limited to: vertical and horizontal referenc ini (BM),~dltelbt'iEha('~ep~i ,5/ , percent slope, scale or dimensions, north arrow, and locat~n and distarice to nearest road. `; Parcel LD. # APPLICANT INFORMATION -Please print all information ~E ~ '~ Re iewed by Date .~ Personal information you provide may be used for secondary purpos~s'(Privacy Law ~~E}~l j1~, ~). ~..., f _ ~.-~ , mQM_ , hAAm, ~fl _ Property Owner ~ /~ ~1 Property Owner`s ~~Aailing Address City rivNci.~x 4~ wig Ciovt.lo ~ 1/4~(,r/f/4,S T3 ,N,R E State Zip Code /Phone Number /. 7/ I S5~/Jl2 11/l~) ~~~ Block# Subd. Name or CSM# r ^ City ^ Village Town Ne/arest Road ~0~~ I ` C!'i/f~ ,^ New Construction Use: idential / Number of bedrooms ~ Addition to existing building I Replacement /^ Public or commercial -Describe: Code derived daily flow ~~~gpd Recommended design loading rate ~~ed, gpd/tt2 ~ z trench, gpd/tt2 Absorption area required 3~r bed, ft2~ ~~trench, ft2 / Maximum design loading rate / Z bed, gpd/ft2~trench, gpd/ft2 Recommended infiltration surface elevation(s)~s~ ors .c.~ "~ (~ 7 ft (as referred to site plan benchmark) Additional design/site considerations - ,r ~ G Parent material ~ Q S = Suitable for system Conventional Mound U = Unsuitable for system ^ S U ^ U ^ S SAII I~FSCRIPTI~N REPORT Boring # I I Ground ele ~s ~ ft. Depth to limiting ~j` in. Boring # I~ Ground ~le ~ft. Depth to limiting AT ~ ^ u I ^ ~ ~ ^ s ~.L..~ C~.~~ ~ I Zooo Horizon Depth Dominant Color Mottles Structure i d B R t GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. stence Cons oun ary oo s Bed ,Trench ~'~~ ~ ~ ~s C, ,~ /f pl s, !' / -Y .• S c.r w~s~ , ~ , . y y ,. ~- s, ~ p ~' ti ~ ,~° Sri Remarks: ~- .~ .~ .~~ . -~- ai 3 ~ ~ ~~ '°" r '~~ f /" •r ar' .~ .~- for in. Remarks: CST Name (Please Print) Signature ~ Telephone No. / .i--~ // / J Address Date CST Number PROPERTY OWNER PARCEL I.D.# Boring # Ground 9~ott. Depth to limiting r in. SOIL DESCRIPTION REPORT Page ,Qf - , e - Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench l ~ r3~~-- ~ ,~ C'.~ o~.~.~. . 5 ~r 8 ~ s ~' ~~ . 7 ;,~ r----- , Remarks: Boring # ~_ Ground elev. ft. Depth to limiting factor in. Boring # Ground elev. ft. Depth to limiting factor in. Boring # Ground elev. ft. Depth to limiting Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench Remarks: factor 'n' Remarks: SBD-8330 (R. 07/96) .r .~ •S~ .~ ~ - Soil Test Plot Plan Project Name Francis Humpal Estate Sha Address 1919 280th St. ~ _ Emerald Wi 54012 STM #226900 Lot ----- Subdivision ------- Date 5/8/00 S W 1 /4 S W 1 /4S g T 31 N/R 15 W Township Forest Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post with Orange Ribbon System Elevation 96.7 or 95.7 *HRpSame as Benchmark Alt. BM Top of Steel F Orange Ribbon @ ~' 65' *B. A1M Please note: a onsite inspection by the 10' county is required to install a at-grade 5' system at this time. If a mound system B-2 is installed or code changes occur this will not be nescessary. 40 Acre Parcel 55' 1% Slope 35' B-1 120' 30' ouse is 5 ihabitable 55' d is beyond epa~r _ 50' B 3~ 25 80 County Rd Q W ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHII' CERTIFICATION FORM OwnerBuyer Mailing Address Properly Address ~ L~~ v (Verification required from Planning Department for new construction) CitylState ~ l ~'- o' ~- ~ ~~~ ~~~- Pazcel Identification LEGAL DESCRIPTION properly Location v [~ `/., ~ '/., Sec. ~~ T, ber g • 3/ • /S`, / 3 W, Town of /co re s r`-" Lot # ~- Subdivision _ Certified Survey Map # /~~' ,Volume ~ .Page # ~ l Z-~ ~ , Volume 1 ~ ° ~ ,Page # ~ 33 Warranty Deed # ~ Spec house ^ yes ~ no Lot lines identifiable ^ yes ^ no SYSTEM MAINTENANCE Improper use and maintenanceof 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. ent a certification form, signed by the owner and by a The property owner agrees to submit to St. Croix Zoning Departm mastCrplumber, journeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on-site wastewaterdisposal system is is proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office v~nthm 30 days the three year expiration date. /Z % ~ ~ SIG ATURE O APPLICANT ATE OWNER CERTIFICATION y g ( ) the owner(s) of I (we) certify that all statements on this form are true to the best of m (our) knowled e. I we am (are) the perry described above, by virtue of a warranty deed recorded in Register of Deeds Office. _ off- ~fi-dZ- I ATURE F APPLICANT DATE ***+'** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed VOL ~Ut)~PAf,E ~ ~~ S2'ATE BAR OF WISCONSIN FORM 5 - 1999 6~ 12?4 PERSONAL P~PRESENTATTVE'S KATHLEEN H. WALSH Document Number DEED kEGISTEk OF DEEDS ST. CF:OIX CO., WI James Cress kECEI~VED FDR REGARD 03-25-2001 9:30 AM as Personal Representative of the estate of Francis J. Humpal, a/k/a Francis p~{gDy~ REPRESENTATIV Humpal EXEMPT D CERT COY FEE: CDPY FEE: ("Decedent"), for valuable consideration conveys, without warranty, to Lynn F. TRANSFER FEE: 210.00 Gale, a single person RECDRDING FEE: 14.00 PAGES: 1 ,~ I~.~ Grantee, the following described real estate in St Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area The Southwest Quarter of Southwest Quarter (SW '/. of SW '/.), Section 9, Township 31 North of Ranee 15 West. Township of Forest, St. Croix County. Wisconsin except Name and Return Address the conveyances of land for highway purposes recorded in Volume 257 of Records on Oakey & Oakey Abstract page 77 as Document No. 193074 and Volume 302 of Records on page 185 as Post Office Box 126 Document No. 239180. Osceola, Wisconsin 54020 c7 014-1021-10-000 ~ ~ • 3 ~• ~~. ~3~ Personal Representative by this deed does convey to Grantee all of the Parcel IdentificationNwtrber(PIl~ estate and interest in the Property which the Decedent had immediately prior to This is not horrtestead property. Decedent's death, and all of the estate and interest in the Property which the ~) (is not) Personal Representative has since acquired. Dated this i 5th day of Nlarch 2001 Personal Representative AUTHENTICATION Signature(s) authenticated this day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUN1ENt WAS DRAFI'® BY Priscilla R. Dorn Cutler; Laux Cutler, S.C. 108 Chieftain Street, Osceola, WI 54020 (Signatures may be authenticated or acknowledged. Both are not necessary.) * Names of persons signing in arty capacity must PERSONAL REPRESENTATIVE'S DEED * James Cress Personal Representative ACKNOWLEDGMENT STATE OF WISCONSIN ss. ST. CROIX County, •.~' ', • Personally came befare me„this 1~ t ^'siay of March _ ~',. , ZOQ>sL~ - 't'ke 3rbove ~daxrred James Cress _` - L ~. to me known to be the persorr~s)`who'~xecuR~ed-_;fie foregoing instrume and acknowledged tliGSamfe;~ ~ '~ ,,~` * BEVERLY A GORE Notary Public, State of Wisconsin My Commission is permanent. (If not, state expiration date: 9/2/2001 .) or printed below their signature. STATE BAR OF WISCONSIN FORM No. 5 - 1999 Information Professionals Company. ForW tlu Lac, w eoo~ss2ozi