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Home My WebLink About040-1268-00-000 Wisconsin Departmgnt of Commerce PRIVATE SEWAGE SYSTEM County:— St. Croix Safety and Bu!Iding Pivisign INSPECTION REPORT Sanitary Permit No: 574315 0 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: Schramski & Fedie, Thomas& Kara I Troy, Town of 040-1268-00-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: W c v-e 16.28.19.1462 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark ,` /0,66 17 . Dosing Alt. BM 146 Aeration Bldg.Sewer w Yid � Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic -7/66 Dt Bottom ZS Dosing Header/Man. / S5 � Aeration J Dist. Pipe 7 Holding Bot. System Z.4 -� Final Grade PUMP/SIPHON INFORMATION 6. t► /6 , c� Manufacturer a V ` GPNand St Cover 166 f z, Model Number / J 7 7,r Y` .1 '� TDH LtFriction Lo System Head Sb TDH Ft 1/ 0 I Forcemain Len g Z6./ D Dist.to Well SOIL ABSORPTION §YS TEM BED/TRENCH Width Length No.O Trenc PIT DIM NSIONS No.Of Ps Inside Dia. Liquid Depth DIMENSIONS /,� SETBACK SYSTEM TO P/L I BLDG IWELL LAKE/STREAM LEACHING Manufacturer: —� INFORMATION CHAMBER OR Type Of tem: 2 S 57 UNIT Model Number: DISTRIBUTION SYSTEM Header/ManifoJd r 1 Distribution x Hole Size / x Hole Spacing i Ve o it Inta / Pipe(s) ` L Length 3 Dia Z Length Dia �' `� Spacing 3 3 . 61 v SOIL COVER 1 x Pressure Systems Only xx Mound Or At-Grade Systems Only "`'" Depth Over Depth Over xx Depth of I� xx Seeded/Sodded Mulched Bed/Trench Center j 5 Bed/Trench Edges Topsoil I 1 _ es No Yes No COMMENTS: (Include code discrepencies,persons present,etc.) Inspections#1:g / [ /�- In pectin #2: / / Location: 561 Chattanoo Drive Hudsoqq WI 54016(SW 1/4 SE 1/4 16 T28N R1 9W) Glover Station 5th Add Lot)01 Parcel No: 16.28.19.1462 1.)Alt BM Description= // ],1 r / • sJ ,�— f�G G 2.)Bldg sewer length -amount of cover= L 6 Plan revision Required? j Yes XNo Use other side for additional information. SBD-6710(R.3/97) Date Insepctor's Sign ure Cert.No. i 5 ' Qm# To p of well Wo 1j ` 1hU' "o �dn7aur bI/�Z/�� •. �� D/a S�Ip(i pfP.- t a,A a$�,I' ICU w ti �XS•j: Sc Y V ti G SEE-CORRESPONDENCE To tQ DESCRIPTION: THIS IS A NEW MOUND REPLACING A SIX MONTH h` OLD SYSTEM. EXISTING MOUND TO BE DISPOSED OF PER 383.30 AND NR 113 SCALE I" — 40' PAGE 8 OF 11 \i County Safety and Buildings Division ST. CROIX +vO 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.) x 1y n, �14 Madison,V�(1 5 i16 !� 2 SS. it Application State Transaction Numb/er�f In accordance with O, Wis. Adm. Code,submission of this form to the appropriate governmental Z L ' `( O unit is required to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are roject Address if different than mailing ad ress) submitted to the Department of Safety and Professional Servies. Personal information you provide used for secondary purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. (� I. Application Information-Please Print All Information Property Owner's Name l� ,o Parcel# TOM SCHRAMSKI Jry. 7&-D/C (.d �(Nl�i�-t 040-1268-00-000 Property Owner's Mailing Address Property Location /. i//_ 2 561 CHATTANOOGA DRIVE Govt. Lot I nI City,State Zip Code Phone Number y, Section rcle HUDSON, WI 54016 N/A T 28 N; R 19 (E or one II.Type of Building(check all that apply) Lot# 4 101 Subdivision Name 1 or 2 Family Dwelling-Number of Bedr ms GLOVER STATION 5TH ADDITION g'tU\�� Block# El Public/Commercial-Describe se N/A ❑ City of ❑State Owned-Wscribe Use CSM Number ❑ Village of M.yA,U f 7131 N/A Ij Town of Tg-()y III.Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System EA Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain) B List Previous Permit Number and Date Issued ❑ Permit Renewal Permit Revision ❑ Change of Permit Transfer to New Before Expiration Plumber 0 ner - / �/Z S/t 3 IV.Type of POWTS S stem/Com nent/Device: (Check all that apply) l!/ ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in.of suitable soil k] Mound < 24 in.of suitable soil ❑ Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) V. Dispersal/Treat ent Area Information: OVA Design Flow(gpd) Design Soil Application Rate(gpds Dispersal Area Required(s Dispersal Area Proposed System Elevation 600 .4 1500 1500 Aft-98.6 9g VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units New Tanks Existing Tanks /� ��e d (/ a U in H cn tt C7 a Septic or Holding Tank 1200 1200 1 IESE X Dosing Chamber 800 800 1 WIESER X VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber's ignatur MP/MPRS Number Business Phone Number PAUL KOEHLER ... /� 225410 715-246-2660 Plumber's Address(Street,City,State,Zip Code) 321 WISCONSIN DRIVE, NEW RICHMOND, WI 54017 VIII ount /De artment Use Only Permit Fee Date ssued Issuin ent Signature Approved pproved $ + / /,7/1 I Li Owner Given Reason for Denial 4 IX.Cond*MO440 Reasons for Disapproval 3� /o `. t �' ;A. `3eptid"tank,ef"nt filter'*W` , (� disOmal celf,must all be sefvlces I nyainlait"d as per mansgement plan provided by plumber. 2 =Alpaafbaclt feq wwft must btt:maintaifld as per COd!'%01�11fi 10�. �7 �i'� 2�M.`� i`' � tN�0.1 C� �c`>4t Attach to complete plans for the system and s6bmit to the County nl on paper not less than 8 1/2 x 11 inches in size 'A rV�OJ'k- U Ctr `QGA.�I�. Yt6MP.D�a�1�Q-T.� SBD-6398(R. 11/11) 1 c PAUL R KOEHLER Page 2 6/27/2014 • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19,Wis.Stats. • Inspection of the POWTS installation is required.Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d),Wis.Stat • SPS 383.22(7)A copy of the approved plans,specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department,which may include local inspectors. Owner Responsibilities: • SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s.SPS 383.54(4)shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of 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 This Amount Will Be Invoiced. �J When You Receive That Invoice, Charles L Bratz Please Include a Copy With Your POWTS Reviewer II,Integrated Services Payment Submittal. (608)789-7893 ,7:45 am-4:30 pm Monday-Friday WSMART code:7633 'Aarles.bratz @wisconsin.gov cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm i �kyARTNP DIVISION OF INDUSTRY SERVICES fop 3824 N CREEKSIDE LA HOLMEN WI 54636 a Contact Through Relay 3 ` e www.dsps.wi.gov/sb/ y 2� qL �r low www.wisconsin.gov �O ss1014 sw Scott Walker,Governor Dave Ross,Secretary June 27,2014 CUST ID No. 225410 ATTN.•POWTS Inspector PAUL R KOEHLER ZONING OFFICE COUNTRYSIDE PLUMBING&HEATING INC ST CROIX COUNTY SPIA 321 WISCONSIN DR 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/27/2016 Identification Numbers Transaction ID No.2414748 SITE: Site ID No. 803254 Tom Schramski Please refer to both identification numbers, Chattanooga Dr above,in all correspondence with the agency. Town of Troy St Croix County SW1/4, SETA, S16,T28N,R19W Lot: 101, Subdivision: Glover Station Fifth Addition FOR: Description:Mound/Four Bedroom/Sloping Site Object Type:POWTS Component Manual Regulated Object ID No.: 1490247 Maintenance required; Replacement system; 600 GPD Flow rate; 23 in Soil minimum depth to limiting factor from original grade; System:Mound Component Manual-Ver.2.0,SBD-10691-P(N.01/01,R. 10/12), Pressure Distribution Component Manual-Ver.2.0, SBD-10706-P(N.01/01,R. 10/12); 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. 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, CO pyl stats. p`pp The following conditions shall be met during construction or installation and prior to occupancy or use: p� OF Rov f 101 Reminders D�,S1ON OF 1 • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. • The existing septic tank must be inspected for structural soundness,size and baffles and must be brought see into conformance with the requirements of ch.SPS 383,Wis.Adm.Code.If it does not conform,a state approved tank must be installed. • Per manual cited above,limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction,excavation,vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank,and a minimum of 50 feet from the absorption area. chs.NR 811 &812c PAUL R KOEHLER Page 2 6/27/2014 • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec.145.135 and 145.19,Wis.Stats. • Inspection of the POWTS installation is required.Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d),Wis.Stat • SPS 383.22(7)A copy of the improved plans specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities: • SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s.SPS 383.54(4)shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of 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 This Amount Will Be Invoiced. When You Receive That Invoice, Charles L Bratz Please Include a Copy With Your - POWTS Reviewer H,Integrated Services Payment Submittal. (608)789-7893 ,7:45 am=4:30 pm Monday-Friday WiSMART coder 7633 V`. harles.bratz @wisconsin.gov cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm i I MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: TOM SCHRAMSKI Owner's Name: TOM SCHRAMSKI Owner's Address: 561 CHATTANOOGA DRIVE HUDSON WI Legal Description: SW 1/4 SE 1/4 SECTION 16 T 28 N R 19 W Township: TROY County: ST CROIX Subdivision Name: GLOVER STATION 5TH ADDITION Lot Number: 101 Block Number: Parcel I.D. Number: 040-1268-00-000 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan ZONALLY Page 7 Pump curve and specifications ROVED Page 8 PLOT PLAN SAFETY AND Page 9 SEPTIC FILTER ANAL SERVICES Page 10 CROSS SECTION OF SEPTIC TANK 4DUSTRY SERVICES Page 11 ALARM SPECS Designer: PAUL KOEHLER License Number: MP 22 Date: 06/11/14 Phone Number: 7152090WPGND Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P(N. 01/01),and both 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.01101) Version 5.1 (R. 06/06) Page 1 of 11 Mound and Pressure Distribution Component Design- Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill(D)calculations assume a 400.00 Estimated Wastewater Flow(gpd) Table 83-44-3 in-situ soil treatment for fecal coliform of-36 inches. 1.50 Peaking Factor(e.g. 1.5 = 150%) 600.00 Design Flow(gpd) 1.00 Site Slope(%) 98.60 Contour Line Elevation (ft) 23.00 Depth to Limiting Factor(in) 0.40 In-situ Soil Application Rate(gpd/ft2) Distribution Cell Information 100.001 Dispersal Cell Length Along Contour(ft) = 6.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality(1 or 2) Are the laterals the highest point in the distribution C Y Pressure Disribution Information network? Enter Y or N (C or E) E Center or End Manifold 3.00 Lateral Spacing(ft) If N above, enter the elevation (ft) 2 Number of Laterals of the highest point. 0.125 Orifice Diameter(in) 3.00 Estimated Orifice Spacing (ft) = 9.09 ft2/orifice 2.00 Forcemain Diameter(in) � 80.00 Forcemain Length (ft) Does the forcemain drain back? t �� 89.00 Pump Tank Elevation(ft) Enter Y or N 6.50 System Head (ft)x 1.3 13.05 Forcemain Drainback(gal) 10.35 Vertical Lift(ft) 90.43 5x Void Volume (gal) 1.29 Friction Loss(ft) 103.48 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 27.19 System Demand (gpm) 18.14 Total Dynamic Head (ft) 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 Gallons/Inch Calculator(optional) Treatment Tank Information 0.00 Total Tank Capacity(gal) 1200.00 Septic Tank Capacity(gal) 0.00 Total Working Liquid Depth (in) WIESER Manufacturer #DIV/0! gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 800.641 Dose Tank Capacity(gal) IPOLYLOCK Filter Manufacturer 22.241 Dose Tank Volume(gal/in) 525 Filter Model Number WEISER Manufacturer Project: TOM SCHRAMSKI Page 2 of 11 Mound Plan and Cross Section Views T : :1/10 B Q: : : J Observation Pipe _ 1 W 1. l B �.' L Mound Component Dimensions Down slope toe extension made. A 6.00 ft E 13.72 in H 1.00 ft K ft B 100.00 ft F 9.50 in z 9.00 ft L [Aft ft D 13.00 in G 0.50 ft J 6.92 ft W 600.00 (ft2)Dispersal Cell Area 1500.00 (ft2) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 10.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 101.48 (ft) G t H j I F Dispersal Cell 100.18 (ft) Lateral 99.68 Invert Dispersal Cell : : .. . . . . . Elevation D �: { ..: ... dA - 98.60 (ft)Contour Elevation 1.0 % Site Slope Geotextile Fabric Cover Shading Key c. Dispersal Cell See lateral details on 10 Topsoil Cap c 1.5 ft Page 4 for number,size, F2 ..,..,,. Subsoil Cap N g and spacing of laterals. © t �: k Laterals are equally ASTM C33 Sand Z F spaced from the 0.5 ft ti Typical Lateral ® Tilled Layer c_ H distribution cell's Aggregate v o ` " A centerline in the A distribution cell(AxB). Project: TOM SCHRAMSKI Page 3 of 11 End Connection Lateral Layout Diagram a �t d irr t t 4 Turn tip vifbartvA6Mort1 0 LPIU0 R P g. PARI.aorafs ulrrasll � � ta �11 Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing(X) 3.08 ft Lateral Length (P) 98.56 ft Orifices per Lateral 33 Lateral Spacing (S) 3.00 ft Orifice Density 9.09 ft2/orifce Lateral Flow Rate 13.59 gpm Manifold Length 3.00 ft System Flow Rate 27.19 gpm Manifold Diameter 1.50 in Total Dynamic Head 18.14 ft Forcemain Velocity 2.78 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and —% 4 in.min. L S �28 WAC Disconnect Tank component is properly vented �— Alternate outlet location Forcemain diameter W EISER Manufacturer El 2 In. Capacityl 800.64 Gallons �- - Volume 22.24 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 19.35 430.28 C B 2.00 44.48 Pump off elevation(ft) C 4.65 103.48 Fl F 89.83 D 10.00 222.40 D Total 1 36.001 800.64 Dose tank elevation(ft) 3" Bedding under tank. 89.00 Alarm Manuafacturer JSRJ RHOMBUS Alarm Model Number IPS PATROL Pump Manufacturer GOULDS Pump Model Number I EP05 Pump Must Deliver F 27.19 gpm at F 18.14 ft TDH Project: TOM SCHRAMSKI Page 4 of 11 Mound System Management Plan Pursuapt�-- S83.54,Wis.Adm.Code General-------------------- This system shall be operated in accordance with Sipe,Y82-84 Wis.Adm.Code,and shall maintained in accordance with its'component manuals[SBD-10691-P(N.01/01),SSWMP Publicatioi,y.6(01/81),and Pressure Distribution Component Manual Ver.2.0 SBD-10706-P(N. 01/01)]and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous asses may be present that could cause death. Septic and pump tank abandonment shall be in accordance with SP POWTS components. 33.33,Wis.Adm.Code when the tanks are no longer used as Septic or pump tank manhole risers,access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound,defective,or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s.281.48,Stats. The contents of the septic tank shall be disposed of in accordance with NR 113,Wis.Adm.Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm,the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment,maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However,if such products are used they shall be approved for septic tank use by the Department of.Gernmeree.Sa.�e-V 1- 19_$ , Pump Tank The pump(dosing)tank shall be inspected at least once every 3 years. All switches,alarms,and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution 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 BOD5,150 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 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Pondiing levels shall be reported to the owner,and any levels above 6 inches considered as an impending hydraulic failure requiring additional,more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank,pump,pump controls,alarm or related wiring becomes defective the defective component(s)shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface,it will be repaired or replaced in its'present location by increasing basal area if toe leakage occurs or by removing biologically dogged absorption and dispersal media,and related piping,and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 11 Mound System Maintenance and Operation Specifications Service Provider's Name COUNTRYSIDE PLG Phonel 715246-2660 POWTS Regulator's Name _ Phone *4;6 24&-2.6&n System Flow and Load Parameters Design Flow-Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow-Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 fe Maximum FOG 30 mg/L Type of Wastewaterl Domestic Maximum Fecal Coliform >10E4 cfu/100 m Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once every 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SQ5384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SQS384.30 (6)(i), Wis.Adm. Code 3. All gravity and pressure piping materials conform to the requirements in �.SQ5384, 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 v1 6-8" Diameter Lawn - Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: TOM SCHRAMSKI Page 5 of 11 Page 7 of 8 GOU LDS PUMPS Submersible EffiaiWn ump t , EP04 �Y 3871 EP05 APPLICATIONS •Fully submerged in high ■EP05 Impeller.Thermoplas- ■Bearings:Upper and lower grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically designed for the lubrication and efficient improved performance. construction. following uses: heat transfer. ■Casing and Base:Rugged •Effluent systems thermoplastic design provides AGENCY LISTING • Homes Available for automatic and superior strength and corrosion • Farms manual operation,Auto- canac Starldad ftadstion •Heavy duty sump matic mods include resistance. •Water transfer Mechanical Float Switch ■Motor Housing:Cast iron (CSA listed model numbers end •Dewatering assembled and preset at the for efficient heat transfer, in"C"or"F".) facto rY strength,and durability. SPECIFICATIONS ■Motor Cover:Thermoplastic cam Pur fs is lso Soot kostwed FEATURES rover with integral handle and •Solids handling capability: float switch attachment points. '/4'maximum. ■EP04 Impeller:Thermoplas- ■Power Cable:Severe duty •Capacities:up to 60 GPM. tic Semi-open design with rated oil and water resistant, •Total heads:up to 31 feet. pump out vanes for mechanical •Discharge size:1'/2"NPT. seal protection. •Mechanical seal:carbon- rotary/ceramic-stationary, BUNA-N elastomers. •Temperature: 104°F(4040)continuous 140"F(6040)intermittent. METERS FEET •Fasteners:300 series 10 stainless steel y 30 5GPM _.__,.... •Capable of running dry without damage to $ 2.5 rr components, 25` 0 7 Motor: •EP04 Single phase:0.4 HP, v e 20 115 or 230 V,60 Hz,1550 RPM,built in overload with 5 .. .. . automatic reset. ° 5 •EP05 Single phase:0.5 HP, 0 4 ___.. .._.. _.. . _ EP05 115 V or 230V,60 Hz,1550 3 to _ RPM,built in overload with EP04 automatic reset. 2 •Power cord:10 foot s _ _... standard length, 16/3 SITOW with three prong grounding plug.Optional 20 0 00 . ... . . . . 10 ._. J-1-1 20 . .._ 30... .. . .__ 40......... 50 GPM foot length,1613 SAW with three prong grounding plug 0 2 4 6 e 10 12 Wfi (standard on EP05). CAPACITY Goulds Pumps ®2001 Goulds Pumps ITT Industries Effective May,2001 83871 PAGE 7 OF 11 I 1 Toe Di we 1l lbo "® o�DScs v1 ton -9c7 4L ,ifs .�- SEA-CORRESPONDENCE L <, DESCRIPTION: THIS IS A NEW MOUND REPLACING A SIX MONTH OLD SYSTEM. EXISTING MOUND TO BE DISPOSED OF PER 383.30 AND NR 113 SCALE I" - 40' PAGE 8 OF 11 rjJf� N— INSTALLATION INSTRUCTIONS _ hic, - � s &Wasrewaer P:oCuCs Zabel' A Wsb n 00W&inc PL-525/PL-625 FILTER PL-525/PL-625 FEATURES & BENEFITS Features & Benefits: • Rated. for 10,000 GPD • PL-525 = 525 Linear Feet of 1/18" Filtration PL-625 = 625 Linear Feet of 1/32" Filtration PL-525 PL-625 •Accepts 4" and 6" SCHD. 40 pipe The PL-5251625 Effluent Filter should operate efficiently "Built in Gas Deflector for several years under normal conditions before *Automatic Shut-Off Ball when Filter is Removed requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped or at least every *Alarm Accessibility three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the *Accepts PVC Extension: Handle filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. RECOMMENDED PRODUCTS Polylok PVC Filter Extension Handle Ey t Y Risers&Riser Corers Extend & LokTM' Riser Safety Screens Fitter Alarm Panel and Polylok risers bring your Polylok Extend&LokT"r Polylok safety screens SmartFiltrT"' Control septic tank cover to grade. is a simple, easy to use prevent tragic accidents Polylok filter alarm panels ` This allows locating and solution that can extend from happening by children to servicing your filter easier the inlet or outlet pipe and and pets falling into open and switehs provid a visual and time saving by elimi- make filter and/or baffle septic tank entrances. and audible notification of nating digging to find tank installation a snap. servinding filter and tank entrance. Fits 3"and 4" pipe_ servicing: For a full list of Polylok products please visit our web site at: www.polylok.com PAGE 9 OF 11 D Z ti 53" AS 96" m 41" REQD � z z m c n W O 0 o UP 40" � m 4" CAS a m m � 0 3" 44" 6" „ D F I m I mm m X -n%U D m 36" �o r my - m� D Vl < ? 0 N N V X D UP 38" c m m m > z !O oj c o m a n 39" c z n ° m N � I D I N n -1 A D r r Z Z D N � z D c m m r m XZ m O w n D Z v -1 -� C:m 2 (7 aD N z Mry XE XMvz 0Fv O D °c�i►zN�OC�°��ZOOD° ° �� _- 5z �Fz c° my mnm 2 N D MOO m>p °�.. ��0� N (n N �y (tmi1 -u-, F D O - ANC��C A�mZ� .. NmOf w -00 mN z2 Nm° D ° z Dz DDS COQ '�wN w f-1 O -0 M ao N w v► N A Zi.. ' O s n A m �Ow� p v v °v z colt w =nom Az p N� tnmD I D ��sv v- ?1 CIO z v U x N� ON•• � �rn cno:q I r - s v v O ;o m a < m °w O n y0 z� O< z z OO mom mo -4!-p D O D w m 3 m W O F� 0 A 0 C/) r� OF> r0 rp m —� I C \ s Z --1 m 0 m v m z H D 00� C �Z{A � zz %�v .p �� N O Z n my Ul :U D ivy v0-n O Zl N � z _ O "fl O .. z ° v �� pA z U1 N O m id N -0 �� D 0 3 m A � p .. m r ;o jo IT! p p r D H r 7a O � � m z m A 2 m \o m WI —MR MIERER COtICAETE REV. m DRAWN BY: SME SCALE: 1 4"=1'-0" PRE-POUR: -4 SEPTIC MANUAL W3716 US HWY 10 MAIDEN ROCK, WI 54750 DATE: JANUARY 2010 DATE:. POST-POUR: Z ° REVISED JAN. 2010 800-325-8456 BILE: XP12W/WD-0 PAGE 10 OF 11 - SES Controls Page 1 of 2 Hcn1a Careers Contact t f Search.. SJE-Rhombus SES Controls Build-A-Panels 4 Go 3a c to A'.I Bhp Product Info Features: • Model 111 • Me del 115 Specs • Modes 112 Downloads'. Mode,122 • 1•lode;312 Mod �2' PS Patrol® � • zo 32S Meje 5 S • P:1ooe,113 • 'Mece:1 14 ode 11e Post Alarm With Receptacle for Plug-In Pump f.9 • Mode: 4 Control • Model 31,' • Model 32$ • Intrinsically Safe Post Alarm Provides Convenient Wiring Connection and System Rev Monitoring for Pump Station Applications • Mode TD • Mode=DTD The PS PatrOlg)post alarm system features a built-in high • Mocie:pg water alarm and provides a convenient location to connect all • IFS"M wiring required for a pumping station application. Mode'DP Modei RP • JB Plugger The PS Patrol@ system employs a receptacle to accept either • Ultr Natorl a 120V or 230V pump and/or piggy-back pump switch. Vent • PS Patrol:> holes on each side of the post help prevent moisture • Model 126 condensation inside the post. Available in 120V, 230V and 9 • Starter Boxes VDC models. • .evffI'Starter Boxes • SJc Gil Sootte' • S.if Spo°ter"' :'Auto PS Patrol® Features: • Pedestal rated for outdoor use • Receptacle for 120V or 230V pump and/or piggy-back pump switch • Pull out assembly for easy wiring • Control switch provides alarm activation • Test/normal/silence switch mounted externally for easy operation • Separate 120V alarm and pump circuits • Red alarm beacon • No external cords • U.S.Patent No.7,218,511 Options: • 120V,230V and 9 VDC models • Factory-installed circuit breaker/terminal block • Factory-installed elapsed time meter(ETM)to log pump PAGE 11 OF 11 http://www.sjerhombus.com/ses-controls-build-a-panels-details.php?ID=33 6/2/2014 - SES Controls Page 2 of 2 information(patent pending on ETM wlth plug assembly) • Factory-installed duo alarms to monitor two level conditions(high water alarm and alarm 2 filter) • For a complete listing of available options,please view the backside of the catalog page. CSA Certified Five-Year Limited Warranty PS Patrol® Specifications: 120V_Qr 2.30Y1 oriel ENCLOSURE: 5 x 5 x 48 inches(12.7 x 12.7 x 121.9 cm) ALARM VOLTAGE: 120 VAC,50/60 Hz PUMP VOLTAGE: 120 VAC or 230 VAC,50/60 Hz RECEPTACLE: 120 VAC NEMA type 5-15 or 230 VAC NEMA type 6-15 ALARM FLOAT: SJE SignalMasterOR control switch with mounting clamp ALARM HORN: 83-85 decibels Available Downloads • Catalog Page with'ric€r?g • specifications without Pricing • installation?nstn,ctons_9V k4odet • Installation instructions-120V Mocel • Installation Insiruct ons-120V Model with Breaker • Installation ins'tn:ctioni,-'23V Mode'with FTM • Installation instructions-23GV Model • Features&Benefits • Expedite this Pane'with:Panel!'Express Program • Select Models Available or Quick Ship • We're Proud to Offer a Five-Year Lin;}ted Warrarty Adobe Acrobat is a free download to view.pdfs Visit our downloads section of this website for additional literature. - t rive,.,t :i... er^a;� '-±3F,8-;!42-5:•'S http://www.sjerhombus.com/ses-controls-build-a-panels-details.php?ID=33 6/2/2014 Property owner Thomas Schramski parcel ID# 04126800000 page 2 of 3 Boring# 0 Boring 3❑ Wit Ground Surface Elevation 98.6 ft. Depth to Limiting factor 23 in. Soil ADDlication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QP D/ftZ in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-11 10YR3/3 - SIL 2-m-bk mfr cs 3 f-co 0.6 0.8 2 11-23 7.5YR4/4 - CL 2-m-bk mfr cs 2 f-m 0.4 0.6 3 23-30 7.5YR4/4 7.5YR4/1 c-1-d SCL 2-m-bk mfi gs If 0.4 0.6 4 30+ 5YR4/4 7.5YR416 c-1-f SL 0-m mfr - if 0.2 0.6 4] Boring Boring# Wit Ground Surface Elevation ft. Depth to Limiting factor in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 I *Eff#2 0 Boring Boring# 0pit Ground Surface Elevation ft. Depth to Limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 s Effluent#1=BOD,>30!5 220 mg/L and TSS>30:5 150 mg/L •Effluent#2=BODS 5 30 mg/L and TSS<_30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or Need material in an alternate format,please contact the department at 608-266-3151 or TTY 608-264-8777. Wisconsin Dep �j�vD SOIL EVALUATION REPORT Page 1 of 3 Division of S �-..-mgs In accordance with .Code nn�Q(�v\ county Attach cues pla450vs,er not less than 8'/2 x 11 it in size. Plan must St. Croix Include � horizontal reference point(BIM,(ItteCifd d' Parcel I.D. 04126800000 Percent slo north arrow,and BM referenced to nearest road. S��1 VN\ Please print all information R sewed b Da/te, Personal infe�lon you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)) ty 1 Property Owner Property Location Thomas Schramski Govt.Lot SW 'i. SE 'i, s 16 T 28 N R 19 W Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# 561 Chattanooga Dr. 10101 Glover Station fifth addition City State Zip Code Phone ❑City ❑Village 0 Town Nearest Road Hudson WI 54016 612-308-8080 1 Troy Chattanooga Dr. ❑ New Construction Use: 0 Residential/Number of Bedrooms—_Code derived design flow rate 600 GPD Replacement ? ❑Public or Commercial—Describe: Parent Material Loess over Till Flood Plain elevation if applicable N/A ft. General comments and recommendations: 1 Boring# Boring H Pit Ground Surface Elevation 98.0 ft. Depth to Limiting factor 24 in. Soil ADDlication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ttz in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#i I Eff#2 1 0-12 10YR3/2 - SIL 2-m-gr mf cs 3 f-co 0.6 0.8 2 12-19 10YR4/4 - CL 2-m-bk mfr cs 1-m 0.4 0.6 3 19-24 7.5YR4/4 - SCL 2-m-bk mfr gs 1-m 0.4 0.6 4 24+ 5YR4/4 7.5YR4/2 c-2-d CL 0-m mfi - 1-m 0.0 0.0 F Boring# [3 Boring ®Pit Ground Surface Elevation 98.4 ft. Depth to Limiting factor 23 in. Soil ADDlication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-12 10YR3/2 - SIL 2-m-gr mfr cs 3m-co 0.6 0.8 2 12-23 10YR4/4 - CL 2-m-bk mfr cs 3 m-co 0.4 0.6 3 23-27 5YR4/4 5YR4/2 c-2-d SL 0-m mfi gs if 0.2 0.6 4 27+ 5YR4/4 - SL 0-m mfi - 1M 0.2 0.6 *Effluent#1=BOD5>30:S 220 mg/L and TSS>30:S 150 mg/L *Effluent#2=BOD,<30 mg/L and TSS<_30 mg/L CST Name(Please Print) store CST Number Mark Iverson 46672 Address Date Evaluation Conducted Telephone Number P.O. Box 155 Hammond, WI 54015 Ma 29, 2014 715-796-5664 Property Owner Thomas Schramski Parcel ID# 04126800000 page 2 of 3 ❑Boring 3 Boring# Opit Ground Surface Elevation 98.6 ft. Depth to Limiting factor 23 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 1 0-11 10YR3/3 - SIL 2-m-bk mfr CS 3 f-co 0.6 0.8 2 11-23 7.5YR4/4 - CL 2-m-bk mfr cs 2 f-m 0.4 0.6 3 23-30 7.5YR4/4 7.5YR4/1 c-1-d SCL 2-m-bk mfi gs if 0.4 0.6 4 30+ 5YR4/4 7.5YR4/6 c-1-f SL 0-m mfr - if 0.2 0.6 ❑Boring 4 Boring# Elpit Ground Surface Elevation ft. Depth to Limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 ❑Boring 5 Boring# Qpit Ground Surface Elevation ft. Depth to Limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 I *Effluent#1=BOD5>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD5<_30 mg/L and TSS<_30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or Need material in an alternate format,please contact the department at 608-266-3151 or TTY 608-264-8777. Page 3 of 3 Oft. 24 ft. 40 ft. 80 ft. N BM#1 Top pf well w 100.0 �o �o y^ B-3 9 .6 House h WX s� B-2 98.4 98.6 B-1 98.2 98.0 A� O� N� O • = Ground Surface Elevation BM#E Elevation tion = Bench Mark 00, = Boring Location&Elevation Owner: Thomas Schramski Site Information: Completed By: Mark Iverson, PSS#197 561 Chattanooga Dr. SW1/4, SE1/4, S16, T28N, R19W 680 Larcom Street Hudson, WI 54016 Town of Troy Hammond,WI 54015 St. Croix County 715-796-5664 Phone: 612-308-8080 CST#46672 150.00, 1 "�""' 88. ► w 504. I to z00. N 28'03' µ„ E 50.45 ' 14 1' N 88 IN �8 ASS 150 y 249.49'. 0.58 109,237 S.F. cvi 2 I N 818"101 3!3" 1►Y 39wt1.00' � � 1 �► DRAINAGE 190. I ' N NY � 83 1 ig 196 2.501 ACRES 130' '�' 2.840 ACRES " 7-511 ACAS a i 108,948 S.F. ��' � � 123,713,'2 S.F.� � '!09,395 S.F. _j TEMPO t rr l { Z EASEW !� N 88"'10'36" W 390.00' W► t I ? 42 Ilk. 33 150, L 2.734 ACRES , 10'36" S.F. Zan- 119,071 { TEARY CULOIESAC 28 " 234.00 .. _JQL7X . W.1y 300, 101 � 11C�,4t S.F. t�. � ' 000rr ? 1 � a 1 121 2.503 �j 4momolomm 1OW" Sr. 41 103 Z5 I 1 ACIMS V*7-ACRES : SW 5V 117,053 S.F. i M f,st,.rrr r,ribl.FiiJY 1Ww.Mr+r l4s�+E+�r..., �Mrrr W�l rua.K r+Ri arl►IrKw rKli/�{Y4�i�asNFsrMR■dl+ Kirrr,r,-►,wtl^IM ,rKIY'„ Y+..rwFYpd,Ir.,wrYrNY HI�r 4�rrtir r+,i ..KKi7 ,r•K1Yi RS f ,ir, >► ► 1 N1 ER N� T svim t _ II i N - Il lyu�l l'q r,I I 6V I I nnv 40;V0 VAA 110 080 4000 Zink UKA W WAINGi 4 001 s,r.CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSVIP CERTIFICATION FORM Owner/Buyer d P-) CCAAAM.S /ysw4r. �r Mailing Addrt u C.' Qj „a n AU4 Property Address 5 � G f/44 601A &MC., (vm1fication required ftm piAming&Zoning Departmwt for new construction.) City/State__h/_&/S�ct±.. Gr/� Parcel Identification N* umber LEGAL DESC,&JPTI0N Property Location §A) % , �� 'A,Sec. Id ,T 2 9 N R_& _W,Town of_ 1 Subdivision ::r—1,0"i- „S' iQ 5fi� �. �i .'rn_ Lot#, . Certified Survey Map# ,Volume ,Page# Warranty Deed# 7S /10S.2 ,Volume ,Page# Spec house Q yes 0 no Lot tines identifiable I'I yes Q no S'Y�TEM MAINTENANCE AND OWNER CERTFRCATION 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 dim yearn or sooacr,ifnaeded,by a 1 icemiccd pumper. what you pat into the system can affect the function of the septic tank as a treatmcat stage in the waste disposal system. Owner maintenance responsibilities arc:specified in§Comm.83.52(1)and in Chapter 12-St.Croix County Sanipry(ordinance. The proporty owner agrees to submit to St.Croix County Planning&Zoning Departwnt a certif=tiam farmo siigrted by the owner and by a master phunber,journeyman plumber,restricted plumber or a licensed pumper vorifying that(1)the on-site wastewater disposal rrst3cm is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is Fes,than I/3 full of sludge. Uwe,the undersigped have read the abov*tcquiremmts 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 WiscOmin. Certification stating that your septic system has boon maintained must be completed attd returned to the St.Croix County P181rti118& 74ning Department within 30 days of the three year expiration date. I/we certify that all statements on this are true to the best of my/our knov4edge. T/we atdare the owctat'(s)Of the property dcacribed above,by vittuc;of a ry deed recondW In Register of Deeds Office. Number of SIGNATURE OF APPLICANT(S) DATE ***Any information that is mintprosented may result in the sanitary permit being revoked by the Planning&Zoning Department,**t Include w ttli this application a recorded warranty doed ftm the Register of Deeds Office and a copy of the certified survey V"if reference is made in the warranty dcod. (REV.VMS) II IIIIII(fllllllifllllll(II III 8 2 0 7 2 8 5 ocument Number WARRANTY DEED Tx:4171014 991726 BETH PABST THIS DEED made between Brushy Mound Partners, LLP, a REGISTER OF DEEDS Wisconsin Limited Liability Partnership ("Grantor") and Thomas A. ST. CROIX CO., WI Schramski and Kara A. Facile, husband and wife, as survivorship 01/21/2014 3:12 PM marital property, ("Grantee"), EXEMPTV: NA WITNESSETH, that the said Grantor, for valuable consideration REC FEE: 30.00 conveys to Grantee the following described real estate in St. Croix TRANS FEE: 190.50 County, State of Wisconsin: PAGES: 1 Recording Lot One hundred one(101) Name Plat of Glover Station Fifth Addition in Area Name and Return Address the Township of Troy, St. Croix County,Wisconsin '�- 040-1268-00-000 (Parcel Identification Number) This is not homestead property. Dated this 16th day of January,2014. on De ' aeI R. ens AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ST. CROIX COUNTY Personally came before me this 16th day of January, 2014, authenticated this day of 20_ the above named Michael R. Stevens and Ronald L. Derrick, as partners of Brushy Mound Partners, LLP, a Wisconsin Limited Liability Partnership to me known to be signature the persons who executed the foregoing instrument and type or print name acknI edge the s me. TITLE:MEMBER STATE BAR OF WISCONSIN (if not, signature authorized by'706.06,Wis.Stats.) type or print name amm to d Notary Public St. Croix County,Wisconsin. THIS INSTRUMENT WAS DRAFTED BY My Commission Expires:October 14,2017. i Michael R. Stevens persons-Names of si nin Brushy Mound Partners PO Box 4 P 9 gin any capacity should be typed or printed below their signatures. New Richmond, W I Tatum 54017 Y Lloyd Notary Public State of'Wisconsin St. Croix County 991726 Page 1 of 1 I Parcel #: 040-1268-00-000 07/07/2014 04:46 PM PAGE 1 OF 1 Alt. Parcel M 16.28.19.1462 040-TOWN OF TROY Current ❑X ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner THOMAS A SCHRAMSKI 0-SCHRAMSKI,THOMAS A KARA A FEDIE C-FEDIE, KARA A 561 CHATTANOOGA DR HUDSON WI 54016 Property Address(es): *=Primary " Districts: SC =School SP=Special 561 CHATTANOOGA DR Type Dist# Description SC 4893 SCH DIST RIVER FALLS SP 0100 CHIP VALLEY VOTECH Notes: Legal Description: Acres: 2.535 SEC 16 T28N R1 9W SW SE LOT 101 GLOVER STATION FIFTH ADDITION Parcel History: Date Doc# Vol/Page Type 01/21/2014 991726 WD 07/15/2002 684104 1926/553 LC Plat: `=Primary Tract: (S-T-R 40%160%) Block/Condo Bldg: "07-094-GLOVER STATION 5TH ADDN 040-0 16-28N-19W SW SE LOT 101 2014 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 11/09/2009 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.535 95,400 0 95,400 NO Totals for 2014: General Property 2.535 95,400 0 95,400 Woodland 0.000 0 0 Totals for 2013: General Property 2.535 95,400 0 95,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Departmer`. of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 563854 0 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: Brush Mound Partnership LLP, c.o Michael R. Troy, Town of 040-1268-00-000 CST BM Elev: Insp. BM Elev: BM Descript~o/n:, tl / Section/Town/Range/Map No: l 6 1(~ Crr~ 16.28.19.1462 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic_ Benchmark -'7 / / • Ci Dosing Alt. B -fi-k / Aeration Bldg.. Sewgr,_, c Holding Ht Inlet vl TANK SETBACK INFORMATIO SUHt outlel-n TANK TO P/ WELL BLDG.. Vegt to Air Intake ROAD Dt Inlet lic v"`- Septic Dt Bottom Dosing t, Header ,a Aeration Dist. Pipe 3 • Z.y~ rr Holding Bot. S s rk/K Oi Final Grade 3 t PUMP/SIPHON INFO ATIONt`h Vwv~ l /6 Manufacturer Demand St Cov t -7 7 r /0 -2. Model Number GPM -77 3g. lcwe~ TDH L'ft. Fri on oss System He TDH Ft Forcemain Length Dia. Dist. to Well f / -5 i vl L / t t SOILABSORPTIONSYSTEM coA BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO C P/L BLDG WEL LAKE TR M L CHIN Manufacturer: INFORMATION CHA OR Type O S stem: ~5 I Ll Model Number: DISTRI ION SYSTEM Heade nifo istribution ` . x Hole Size x Hole Spacing Vent. o Air Int e I Pi a s) xx r Length Dia I ' t; ength l Dia Spacing SOIL COVER x Pressure Systems Only Mou d Or At-Grade Systems Only IXJC Depth Over Depth Over xx Depth f , xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topso', ` 0 Yes No ® Yes 1 No 6" L ~7 COMMENTS: (Includ,~ discrepe s, persgnSreent~ et ) In ction #1: / l/ t' spection #2: i Zy I Location: 561 Chattanooga Drive Hudson, WI 54016 S 1/4 iSE 1/4 16 T2 R 9W) Glo er a o 5th Add Lot 101 Parcel No: 16.28.19.1462 1.) Alt BM Description D f ryZ~ YwC'Lt~.l-'\ LC @'~ Q~~' -~'G i/ g ~7SGf6'U~~ 2.) Bldg sewer length = GCS t ~ 1 hn'"1 / / _ (47 7rt/t ^ - amount of cover = ! Y~ r r~ ` f7 FJL, Plan revision Required? 5-11 Yes No / ~ - Use other side for addition information. (,I J SBD-6710 (R.3/97) r /te r Insepctor's ig~ature _ ~ Q~ Cert. No. Sanitary Site Plan Page 8 of 8 For: Brushy Mound Partners LLC Lot 101 of Glover Station 5th Add. SWl/4-SE1/4 Sec. 16 T28N-R19W Town of Troy - St. Croix County 0 30 so _ CIL of Chatmnooga Drive Graphic Scab (F-> 1 inch s So tt Lot 101 2.53Acres I l Building SkbayckArea Proposed 4 Bedroom Ho U i Garage P/L 4"Sch. ! (U W UP w/a Poly-Lok J srYrar ~ 7, A 7 (0 Pnopas Sch 4oF.M. 201.00' b 0 h 'n J 100.50' Proposed 8'x 75'Mound,047ersal Cell w/a System Blev of 101.50' 100.00' 1fic" C1~. V 00' 41. B1 I M L S ^ Benchmaia located aid vierifted by staff. g Z / P& r A ( II" ~Oc Z A BM = Top of 71' High 3/4" Diam.PVC Pipe w/IVLHigh PVC Marker Pipe EM =Same ASSUMED ELEV. = 100.00' BM#2= Top of 9 inch high PYCPipe w/3.9,Jt. Hfgh PYCMm*erPlpe r, ~ ~ tf' i! Wisconsin Department of Safety and Professional Services: Homepage Page 1 of 1 Customer Details Name JASON C BARNEY Contact Info CLEAR LAKE,WI 54005 Specific contact information is not available for this customer. Credentials listed for BARNEY, JASON C The continuing education information displayed here may not be accurate due to reporting, entry, or web retrieval errors. It is a credential holder's responsibility to keep track of their continuing education credits. • Black=Approved. The credential is currently valid and is not ready for renewal. • Blue=Renewal Application Sent. A renewal application has been sent to the credential holder. This does not guarantee that the credential is currently valid. • Red=Expired or Other. The Credential has expired, the application is pending or the record has been locked. The credential holder should contact the credential unit if they wish to reinstate the credential. I Click on credential name to display the actual courses recorded for this continuing education cycle. CE Hours Total CE Credential Needed to Total Hours Hours Needed Type Expiration Renew Accumulated Required By Journeyman 03/31/15 4.5 19.5 24 12/30/14 Plumber Plumbing 05/02/05 ~0~ 01/31/05 Apprentice http://apps2.commerce.wi. gov/SB_Credential/SB_CredentialList?cust_id=68 8791 10/28/2013 i ~ •"=VysPAM County Safety and Buildings Division SE IA tl 'ar - kI 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) p S Madison, WI 53707-7162 5 ~ State Transaction Number Sanitary Permit ApplicatC ZZ-7 2005 In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to he appropriate gov mental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned RC&T bmitted to Project Address (if different than mailing address) the Department of Safety and Professional Servics. Personal information you mi. U ed for secondary 5& ? / / purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stars. 4 I-rq (~1'~rf 1. Application Information - Please Print All Information CO 10 tt Property Owner's Name 5 . • Parcel # 4 v r d f -oo •0D6 Property Owner's ling Address Property Location ~Q y e / Govt.Lot/oL City, Zip Code Phone Number & Sri." Section circleoni}~ T N; 11. 1 yp/e u, i3uilding (check all that apply) Lo 8 R E o1 M Subdivision Name ❑ 1 or 2 Family Dwelling - Number of Bedrooms _ L__/1 6k a+d v~ fi • s~~'. ❑ Public/Commercial - Describe Use A ❑ City of ❑ State Owned - Describe Use , CSM Number ❑ Village of >l 75 /ga an ~ I I Town of III. Type of Permit: (Check only one box on li9n/e A. Complete line B if applicable) A. kNew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that a l v ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade A Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treat nt Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Regd d (sf) Dispersal Area Propo d (s System Elevation OQ do S o l boo -Z(o 1,00 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units U v New Tanks Existing Tanks t o y 9 C3 'C O {®k Sz aU co~ V) wC a Septic or Holding Tank / 8 (J 2 06 , Dosing Chamber 0C) OW , x fil a", VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Sig re MP/MPRS Number Business Phone Number ~r~ l azsyid 7is aw Plumber's Address (Street, City, State, Zip Code) VIII. County epartment Use Only pproved rov Permit Fee D)te,. slued Issuing ent Signature O ::Given for Denial $ Z~ " 7 1 IX. Conditl3M TEtMp"NMeasons for Disapproval C ! ~t°t c3 OvK t . ` 5eptiC tank, efflufant filter i 3~ ✓ t ¢ a Rs eJ s dispersal cell must all be.serv . `Ytriatnteesed as per management plan provided by; plulll" t S H,t c1 2. SAN setback refit wfients must, be r per applic" code l ordi<,a tm* ~G4-e,, (`L as Attach to complete plans for the system and submit to the County only per of less than 81i x 11 in h 1n s' 7~.. t~,t.~s prt~~. SBD-6398 (R. 11/11) g p ARTb V~pn DIVISION OF INDUSTRY SERVICES 141 NW BARSTOW ST FL 4TH ~~2tiI WAUKESHAWI 53188-3789 3 K Contact Through Relay 9 www.dsps.wi.gov/sb/ www.wisconsin.gov °ssroNn~s~ Scott Walker, Governor Dave Ross, Secretary July 19, 2013 CUST ID No. 664713 ATTN.- POWTS Inspector TIMOTHY JAMES DEYOUNG ZONING OFFICE COUNTRYSIDE PLUMBING AND HEATING ST CROIX COUNTY SPIA 1823 215TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/19/2015 Identification Numbers Transaction ID No. 2272005 SITE: Site ID No. 792909 Brushy Mound Partners LLC Please refer to both identification numbers, Lot 101 Glover Station above, in all correspondence with the Town of Troy agency. St Croix County SWl/4, SE1/4, S16, T28N, R19E Lot: 101, Subdivision: Glover Station 5TH Addition FOR: Description: Mound, 4 bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1437938 Maintenance required; 600 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); 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. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" 91313-106" NO and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment SysteA 41 '~I► SBD-10706-P (N.01101). Dep pnov PR T OF s o The building sewer and distribution network piping shall be of mai lLQ'on gF~and 384 .30-5, Wis. Adm. Code. P ION, ► In the event this soil absorption system or any of its component parts *cmplet ;,t ate a health hazard, the property owner must follow the contingency plan as described in t n addition, the owner must comply with the operation, maintenance and monitoring duties as descri tion VIII of the mound component manual. A copy of this information must be given to the owner up1 of th e project. All holding/treatment tanks are to comply with SPS 384.25(7)(a). TIMOTHY JAMES DEYOUNG Page 2 7/19/2013 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 SPS 384 product approval conditions. A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. Owner Responsibilities: • SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4) shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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 Julia Lewis-Osborne POWTS Reviewer 2, Integrated Services WiSMART code: 7633 (262) 397-6005, Fax: (608) 283-7481 julia. lewisCawisconsin. gov 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. MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application `/1V o INDEX AND TITLE PAGE JUL 12013 Project Name: Brushy Mound Partners LLC Lot 103 1/Vp~S 1 h t~~~+}rry^ Owner's Name: Brushy Mound Partners, LLC Owner's Address: P.O. Box 445 New Richmond WI 54017 Legal Description: SW1/4 of the SE1/4 Sec. 16 T28N-R19W Township: Troy County: St. Croix Subdivision Name: ralQver Stati 5th Addition Block Number: Na Lot Number: tO-*1268--00-000 Parcel I.D. Number: Plan Transaction No.: Page 1 Index and We Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan I Designer. Tim De Young License Number: MP# 664713 Date: 06/24/13 Phone Number 715-246-2660 Signature: G -f "AIVO a rRYR~~CFS Designed Pursuant to the $ Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), and both ERVICE$ SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01 Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/0 RESPOND Version 7.0 (R. 03/2012) Pagel of 8 ENCE Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 383-44-3 in-situ soil treatment for 1.50 Peaking Factor (e.g. 1.5 = 150%) fecal coliform of 36 inches. 600.00 Design Flow (gpd) 4.00 Site Slope 100.50 Contour Line Elevation (ft) 24.00 Depth to Limiting Factor (in) / 0.50 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 75.00 Dispersal Cell Length Along Contour (ft) = 8.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) C Center or End Manifold 4.00 Lateral Spacing (ft) If N above, enter the elevation ft 4 Number of Laterals of the highest point. 0.156 Orifice Diameter (in) 2.00 Estimated Orifice Spacing (ft) = 8.33 ft2/orifice 2.00 Forcemain Diameter (in) 90.00 Forcemain Length (ft) Does the forcemain drain back? Y 89.00 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 14.68 Forcemain Drainback (gal) 12.00 Vertical Lift (ft) 67.44 5x Void Volume (gal) 2.80 Friction Loss (ft) 82.12 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 38.77 System Demand (gpm) 19.35 Total Dynamic Head (ft) 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 x 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) 1200.00 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Wieser Concrete Manufacturer gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 800.64 Dose Tank Capacity (gal) Pol Lok Filter Manufacturer 22.24 Dose Tank Volume (gal/in) PL-525 Filter Model Number Weiser Concrete Manufacturer Project: Brushy Mound Partners LLC Lot 103 Page 2 of 8 Mound Plan and Cross Section Views t -1/10B J Observation Pipe yL•L ti L:•°L:L L•L•4 L L L L L L••i"L•y yL•L:•.•L L:vyvL L :L:L L•L~ y L•L•y:1 7 K 1 . f r .f f'r f r.f.f.f•f•l•r.° d• f•fK•r•f°. f•d•d•r.r~°•' r•r. r•r r•f•f.f• 4:L 1 S: S L 4 y:L y.L•L•L•L•L• L:L•L•L••.•4yy ~Yy4•L aL•y:ti:ti•yL:4:y • yyL•L . •f• f•d•r•r•f•d•J•r•d•f•f• •f•r•f•1•.• ..d•d•f•r•f•d•d•. r•d•r•r•J• . •L•L•.•L•4•L•L•L•L• • 5 `•L• •L••.• •L•L•y •y4•L•yL .•L•L•L L •S•y.•L•L•L•°+L•L•.•L 4 L ,7';d r r•f~f•'.•..r.r..r.f; r•r.r.r.r.sr r r r; :'~'::"et:": ":'t'r'r':'{'r'.. °f'f°::: . y 1 L•.•L•4 L•L~ L S;• L L L L L L L L L L 4 L L y y y L y y L L:°. L .•L i..; rs•r.r.r•:-•r.. ,r".. .f.° ...:r.. ,r.d... ..r.r.d...d.r; }.d...r.,•.r.r.f. W f. 1. B UiJ. ' I L Mound Component Dimensions ft A 8.00 ft E 15.84 in H Elft ft K Eilft B 75.00 ft F 9.50 in z ft L ft D 12.00 in G 0.50 ft J W 600.00 (ft ) Dispersal Cell Area 1267.76 (ftz) Basal Area Available 8.00 (gpd/ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 103.29 (ft) G ♦ H . F Dispersal Cell 102.00 (ft) Lateral 101.50 (ft) - Invert Dispersal Cell 131 i i : i i:: Elevation D s &x 4 M14NNZI~ 100.50 (ft) Contour Elevation 4.0 % Site Slope Geotextiie Fabric Cover Shading Key i - Dispersal Cell See lateral details on 1 Topsoil Ca a 1.5 ft L ti•L;L;t•L L L ti.y L L L•L.L Page 4 for number, size, Q rrr//!f/ Subsoil Cap a o and spacing of laterals. d.d.~.. ASTM C33 Sand iaaf ^:~r~r 4i^',ti. 'o:•~Pg1 Laterals are equally f F spaced from the Tilled Layer c 0 0. ft Typical Lateral L ti:• .f 1°•. distribution cell's © Aggregate c;fLa.::tipi?ti:.:ti": 4:w4 L: L :L~4:y: •~Li'` °°~.:y:L:S:S.:".'L centerline in the - A } distribution cell (AxB). Project: Brushy Mound Partners LLC Lot 103 Page 3 of 8 Center Connection Lateral Layout Diagram Force main connection via tee or cross to manifold at any point. Laterals are identie at P s Turn-upwtbsllvalve or (f-X--4'(rxYl x/2-)I Laterals Morcemain Sch 40 PVC cleanoutplug per SPS Table 384.30$ Holes drilled cm the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.156 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.10 ft Lateral Length (P) 36.75 ft Orifices per Lateral 18 Lateral Spacing (S) 4.00 ft Orifice Density 8.33 ft2/orifice Lateral Flow Rate 9.69 gpm Manifold Length 4.00 ft System Flow Rate 38.77 gpm Manifold Diameter 1.50 in Total Dynamic Head 19.35 ft Forcemain Velocity 3.96 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and iii SPS 31 ..300 WAC 4 in. min. Disconnect -1- Tank component is property vented E- Alternate outlet location Forcemain diameter Weiser Concrete Manufacturer 2 in. Ca acit 800.64 Gallons Volume 22.24 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 18.31 407.16 B 2.00 44.48 C Purnpoffelevation (ft) C 3.69 82.12 90.00 D 12.00 266.88 D Total 36.00 800.64 Dose tank elevation (ft) 3" Bedding under tank. 89.00 Alarm Manuafacturer SJE. Rhombus Note: Switches Alarm Model Number Tank Alert containing mercury may not be used in Pump Manufacturer Goulds this system. Pump Model Number EP05 Pump Must Deliver 38.77 gpm at 19.35 ft TDH Project: Brushy Mound Partners LLC Lot 103 Page 4 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name Powers Sanitation` Phone 715-246-5738 POWTS Regulator's Name St. Croix County Zoning Phone 725-386-4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 ftz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service frequency Septic and Pump Tank Inspect and/or service once eve 3 ears Effluent Filter Should inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound ct for ndin and seepage once eve 3 ears e Other 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 mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 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 0 fees. Grade vl 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Brushy Mound Partners LLC Lot 103 Page 5 of 8 Mound System Management Plan Pursuant to SPS 383.64, 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 [SBD-10691-P (N.01/01), SSWMP Publication 9.6 (01181), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment 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. §2ptic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure, If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance .personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent finer is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution Sitat 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 BOD5, 30 mg/L TSS, 10 mg/L FOG, and 104 cftd100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Corttinuencv 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 some or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 8 • Page 7 of 8 HGOULDS PUMPS Submersible Effluent Pump EP04 3871 EP05 APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically designed for the lubrication and efficient improved performance. construction. following uses: heat transfer. ■ Casing and Base: Rugged • Effluent systems thermoplastic design provides AGENCY LISTING • Homes Available for automatic and superior strength and corrosion • Farms manual operation, Auto- canad m Sta xWds RSSI)d8lon • Heavy duty sump matic models include resistance. • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in "C or "F".) factory. strength, and durability. SPECIFICATIONS ■ Motor Cover. Thermoplastic Gonda hrrp is ISO qW1 Bemoaned. FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. '14" maximum. ■ EP04 Impeller: Thermoplas- N Power Cable: Severe duty • Capacities: up to 60 GPM, tic Semi-open design with rated oil and water resistant. • Total heads: up to 31 feet, pump out vanes for mechanical • Discharge size: 1'h" NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40cQ continuous METERS FEET - 140°F (60"C) intermittent. • Fasteners: 300 series 10 stainless steel. 9 30- SGPM • Capable of running dry without damage to a 2.5 rr components. zs o Motor: _ u • EP04 Single phase: 0.4 NP 6 20. , - ' 115 or 230 V, 60 Hz, 1550 RPM, built in overload with s automatic reset, a 4 t s... c S • EP05 Single phase: 0.5 HP, Eros 115 V or 230V, 60 Hz, 1550 3 10 RPM, built in overload with _ EP04 automatic reset. z • Power cord: 10 foot standard length, 1613 1 SJTOW with three prong grounding plug. Optional 20 ° °o 10 a20 30 Lo so Gann foot length, 16/3 SJTW with three prong grounding plug s a 0 2 a to is m/h (standard on EP05). CAPACITY Goulds Pumps ® 2001 Goulds Pumps ITT Industries Effective May, 2001 Mj 83871 Sanitary Site Plan Page 8 of 8 For: Brushy Mound Partners LLC Lot 101 of Glover Station 5th Add. SW1/4-SE1/4 Sec. 16 T28N-R19W Town of Troy - St. Croix County 0 30 60 _ G CIL of ChaMwooga Drive nphio Boats (!wt) 1 inch Bo & Lot 101 ~y 2.53 Acres Building Sedww*Area Proposed 4 Bedroom Home L Garage P/L ed 4" Sch. 40 Bldg. Sewer Proposed Wieser Concrete IiM2001800-AR w/aPoly-Lok PL-525 Filter Proposed 2"Sch. 40FM. 101.00' 100.50' Proposed 8'x 75'Moand Dispersal Cell w/a System Elev. of 101.50' 100.00' 99.00' 4% #2 BM Benchmaria located and #2 Aed by staff. A BM P2 A BM = Top of 7" High 3/4" Diam.PVC Pipe w/3.7fLHigh PVC Marker Pipe * H" -Some ASSUMED ELEV. = 100.01' BM#2= Top of9 inch high PVC Pipe w13.9JL High PVCMarkerPipe W 390.00' t U9 8 U9 L Ag' L20.58' 1. t 88010036.4 5.93 CHATTANOOGA DRIVE . 67.6 0.0 ESAC OTE 4. 7so, 101 2.535 ACRES 110,405 S.F. 100 .503 ORE 0*# 1109#038 S.Fol 102 2.687, ACRES 117,053 S.F. 5001 Z 14 50, .mil ~l ~fk q~#a 14 A 1Ffis~fM~+Yk~~r{~µ~+p!'~At ~w(ci7~+i+iEi##9P~i F~fsii~[~a sKtw'Nr~rrr ff~~+lf #1f +rs ♦YSSitr~Aic is Y11it~f iFr~it~l~sA •91'c#;f~ •A~e iit~ki~ d~.a•s.a ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer UL-C Mailing Address PO 1L 474C7~~/ 1~ r/1+C1►-Lf, \4V% 540.0 560 / GIn«~=-~-~ .1~ Property Address -1 MQ 42 (Verification required from Planning & Zoning Department for new construction.) irz~f City/State SC:i r W ( Parcel Identification Number ' LZto - 6 d a LEGAL DESCRIPTION Property Location 5W '/4 , 5:= % , SeJ ~Q , T- -9 N R I g W, Town of d Subdivision 5 Q Lot # Certified Survey Map # , Volume , Page # Warranty Deed # '0 Z~ Volume , Page # Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary, Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition andlor (2) after inspection and pumping (if necessary), the septic tank is less than 113 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 Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your 'septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form, are true to the best of my/our knowledge. Uwe amlare the owner(s) of the property described above, by virtue a warranty d recorded in Register of Deeds Office. Number bedro &5G4NXTU * LICANT(S) DATE Airy information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) 0-2006 1,1:07 FROM River Valley Abstract TO 17152464948 P.02 r f STATE BAR OF WISCONSIN FORM 1 - 1999 REGIIE H. D REGISSTTER R OF DEEEDS EDS. WARRANTY DEED ST. CROIX CO., WI Document Number RECEIVED FOR RECORD This Deed, made between C. M- Bye, iadividttally, and Dennis PL 01109/2004 09: 45AN and Sandra C- Schultz Revocable Trust, Dennis R. Schultz and Sandra C. Schultz, Trustees WARRANTY DEED EXEMPT # 17 Grantor, and Brushy Mound Partners, L.L.P., a Wisconsin limited REC FEE: 11.00 partnership TRANS FEE: COPY FEE: CC FEE: PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (The "Property"): M I Reoordl Area Name and Return Address Lots 72, 82, 83, 84, 92, 93, 94, 96, 97, 98, 10 2 an over M. Bye 410, Station 5th Addition, Town of Troy, St. Croix ty, Wiscr^~ _ 258 Riverside Drive - P.O. Box] 67- River Falls, W1 54022 040-1265-10-000,040-1268-00-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) This deed is given in satisfaction of that certain Land Contract between the parties dated June 5, 2002 and recorded in the office of the St. Croix County Register ofDeeds on July 15, 2002 in Volume 1926 of Records, page 553 as Document No. 684104 Additional PIN numbers: 040-126840-000, 040-1268-20-000, 040-1266-10-000, 0404266-20-000, 040-1266-30-000, 040-1267-10-000, 040-1267-20-000, 040-1267-30-000, 040-1267-50-000, 040-1267-60-000, 040-1267-70-000, 040-1267-90-000 Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear at encumbrances except easements and restrictions of record and will warrant and defend the same. Dated this day of ~./~o.~✓w~y~ - . Dennis R. Schultz . C. IVL B f : Ianara C. Schultz AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN 1 Signature(s) ) ss. St. Croix County.) / Personal!), came before me this Le day of - authenticated this day of d. vl_VQ✓'^~~ the above named Dennis R. Schultz, Sandra C. Schultz and C-AL Bye . `,~edrl ttn7..rry. TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the persoq(s iro.eat d (ire f• q ng (If not, i ment and acknowledge the elate.' u authorized by ¢ 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY - C. M. Bye s Attorney at Law Notary Public, State of Wisconsin-., • ' ' k4y Commission i ; c~ent. (Ifndt;1.0 _ se~issaitop date ZStgnZures may be authenticated or acknowledged. Both are not - - - necessary.) -Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED SrATa a" OF wlscotiam FORM Na I - Of - INFORMATION PROFUSSIONALS COMPANY POND DU LAC. WI 8e0-655-1021 TnT01 P 1717 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of .3 Labor and Human Relations Division of Safety 8 Buildings in accord with ILHR 85:05 Wis Adm. Code COUNTY S-7. c.,~ o lX Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan=r'fidst`n'$clude, but.' not limited to vertical and horizontal reference point (8N% direction and % of slope,; cO , PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION R DATE a ti U~ PROPERTY OWNER: TY LOCATION - e L~ f~L/D lJ)'J\-S Sc~iuc Z t SW 114;k,~,E 1/4,S I-6T Zb,N,R l~j E( W PROPERTY OWNER':S MAILING ADDRESS. LOT # BLOCK %SUBD. NAME OR CSM # Z58 tz~u 2S lDE ~2.LUE 101. G ~ S~`1~DlU 5 ~ A-~~ . CITY, STATE ZIP CODE PHONE NUMBER ❑CITY_ VILLAGE OrOWN ' NEAREST ROAD i?--lU (EZ ~-S twl Sgol:L S) q ZS al 61 -T-\Zz,--f p(J New Construction Use Residential / Number of bedrooms y [ J AdditiQn to existing building [ J Replacement [ ] Public or commercial describe Code derived daily flow b 00 gpd Recommended design loading rate --!y bed, gpd/ft2 - trench, gpolft2 Absorption area required SOO bed, ft2 SOO trench, ft2 Maximum design loading rate -S bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations N'1 1~utv-'~, W /a , x 6 3 M )A.r V-6" Or- SPnvj FILL Parent material Ln t--SS e'Ut?12. -n LL Flood plain elevation, if applicable {V ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT GRADE SYSTEM IN FILL. HOLDING TANK U= Unsuitable for stem ❑ S O U ®S U ❑ S O U ❑ S Q U ❑ S [9U S I"U SOIL DESCRIPTION REPORT Depth Dominant Color I Mottles I Structure I I GPD/fBoring # Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Bard3y Roots Bed rerldi 1 1 0_'6 tit, ~I2 31~ - s 1 z~ sbk ~►~F>- t~ • s .6 Ground 3 1~~$ --~s lift 31cf - L 1 eSbl2 m`f 1- w _ - • S elev. cg. fL y' z~-b3 S Li L 3!y -s~trzslB o >n`F; - 3 f - Depth to limiting factor Remarks: Boring # 6-9. ) 0 `1 R 3! Z - S 2 1 Z`Psb wl`~l- c_ 1~ -S • 6 Z 9 - z.S. 10`22 ~l 6 S i) Z'Fs b)z mfi- e S - - 5 3 ZS -31 7 -S `i 2 ~1~ - ` 1 cSb}z In fi- - . S Ground elev. y 3J-~ 1 S X12 3!y kJZ.SIY voo•S fL Depth to _ limiting factor Remarks: FT-Name.--Please Print Phone: Arthur L. We erer 715-425-0165 ' egerer So'1 Testing & Design Service-P.0'. Box 74 River•Falls,WI 54022 . Signature: Date: CST Number, ~0 -1a3- L0 1 S rp • ~ 0 220254 PROPEMYOWNER _~3`-t~ lSC+N LTZ SOIL DESCRIPTION REPORT Page?- of PARCEL W. # pE?~JOI h/6 Boring # Horizon Depth Dominant Color Mottles Structure in. Munsell Qu. Sz. Cont. Color Texture Consistence Bour>dary Roots GPD/ftGr. Sz. Sh. Bed rerxh 3~ i I Z sb k e-S sal Z`Psb~ m~,- . s - b Ground 3 Zb-yO •S `1{2- 31Y - L ZeSbli yn~Qy • .S elev. 00-5 It. L/ Uo-bl S Lirz 3~y F -,..sYeSA. L rn'Fi 3 .S! Depth to limiting la ro p Remarks: Boring # Ground elev. -ft. Depth to - limiting factor Remarks: Boring # I?q Ground elev. -ft. Depth to limiting factor Remarks: 3oring # around ;lev. It. )epth to imiting actor Remarks:. PROPEM'YOWNER _C3~1 ISC /y L`f-Z SOIL DESCRIPTION REPORT Page? of PARCEL I.D, av pF]`l~l h) G Boring # Horizon Depth Dominant Color Mottles Texture GPD/ft structure in. Munsell Qu. Sz. Cont. Color Consistence Boundary Roots Bed rencfi 3 x t~ 1u R 3l z- s i I Z sb S? 1 2-`Psbk M-C- . s Ground 3 26-y0 S 7{Z 31Y - 10-5 m.`{'► - .s elev. ct9s it. L/ L4()-b) S LY 2. aey F •sYeslt L o rn~F; - .Y Depth to limiting factor t_ p { Remarks: Boring # Ground elev. It. Depth to - limiting factor - I I - i -L:::]= ff 1 71 Remarks: Boring # i3:~ :i Ground elev. It. Depth to f limiting factor Remarks: 3oring # around ,lev. fl. )epth to imiting actor Remarks: _ Wisconsin Department Relations Industry, Labor and Human Relati SOIL AND SITE EVALUATION REPORT Page I of 3 Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but- ST C'~ 1X not limited to vertical and horizontal reference point (Blur), direction and % of slope, scale or PARCEL I.D. # pp~~ W G dimensioned, north arrow, and location and distance to nearest road. ' APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION C'kA1' $ C flj~ -V_:)EQm \S S CHU L. Z GBV;.-6 SW 1/4 SE 1/4,S J.6T Z,(E~,N,R lg E(or W PROPERTY OWNER'.S MAILING ADDRESS. - LOT 4 BLOCK # SUBD. NAME OR CSM # Z 58 1Zlv~ZS 1DE X21 UE l01 - G STnOki S F rb~ . CITY, STATE ZIP CODE PHONE NUMBER EICITY ~VI~E _U0WN ' NEAREST ROAD 1~W~-'(2lJ-S w1 S~LoZZ_hIS) ~iZS- $161 New Construction Use kJ Residential / Number of bedrooms y [ J Addition to existing build"mg [ I Replacement [ J Public or commercial describe Code derived daily flow b 00 gpd Recommended design loading rate bed, gpolft2 - trench, gpd/ft2 Absorption area required SO() bed, ft2 SOO trench, ft2 Ma:amum design loading rate -S bed, gpd$ -b trench, gpo1ft2 Recommended infiltration surface elevadcn(s) ti"- 1 _ S ft (as referred to site plan benchmark) Additional design /site considerations M out tti ► / 8 ' x 6 3' M 1w 1Z,° OF - S~j FU L L. Parent material Ln ZZ3 t U M M L L Flood plain elevation, if applicable _ N;- It ku =Suitable for system COWDNTIONAL MOUND "ROUND PRESSURE AT-GRADE IN FILL HOLDING TANK = Unsuitable for stem 11 S 0 U I ®S 11U ❑ S Q u I❑ S [9 ❑ S O U I D S IRV SOIL DESCRIPTION REPORT Borin # Horizon Depth Dominant Color Mottles Structure GPD/ft g in. Munsell I Qu. Sz. Cont Color I Texture I Gr. Sz. Sh. I Cons>stence 113curxbry I Roots f 1 0~$ Lt) ITL 3 IZ _ Bed rerrh s ~ 1 z~ s 8-~~ 31c~ - S1I -ablz rn'fr cs~ -S Ground Lix 31t f , LI . S elev. ~g. tL y z,I-63 S LyP •/y ~.s~lZsls oVln - • 3 i - Depth to limiting factor E__ I ILI Remarks: Boring # , 0 9 l `1 R 3!Z - S 1 I Z'~Sb1r Y~l`fl LA -S • 6 Z Z 9 zS. 10`t2 ~l6 s'i ! Z`FSb1z )vcfi- e S - -S Ground 3 zS-3 I 7-S (Z ~l`f - ~ L cSblz 1n'~i- ~w - - L1 = • 5 elev. aJ ~l S LlV_51y S Liz 5/8 C;,,,, Depth to limiting factor Remarks: CST Name:-Please Print Phone. Arthur L. We erer 715-425-0165 ' egerer So' .Testing & Design Service-P.O. Box 74 River Xa11s,WI. 54022 Signattue: Oo-~a3- Lo 1 Date: 5- ~'4 CST Number.. . ..BO 220254 PLOT PLAN Page 3 of 3 SCALE 1"= SO ' ZIVr z%A~-7" J-\ tv0o6 A ~~~1 V G D J 1 *L- L L LD V_a `-o►~ `t k L G 4, 31 V . ~1A PVC [h~ ~J7 _ I /-KN t n~ t-f2 - 0- v'o.p'ON art [-~IG4, 1pUC PI PG' W/ 3 q' ~ G Ct P v C l~flC2..k.~2.. ~ ~ PE. ' i i olo ~.~uo$ ~Su ~.z 3i 85" S•I ~p V • S ~l.~lq 5 Zg ~ \ ~0-~~0~•5 Ott-2., $3 rrzs' / orZ ~LSttiIrL3 00_lo3-tiol z.zazS4 S -0o (715 ) 425-0169 r_ CST Signature Date Signed Telephone No. CST #