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018-1000-80-110
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division J ~ 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 Moreland, Todd Hammond Townshi CS~(A Elev: Imo. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing u Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic , O t l ~ ~~ i / i Dosing ? ~~ ~ ~ ~S r ~ t ~ ~ t Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number ~~ n_~, TDH Lift Frictio Loss System Head TDH /' Ft Forcemain Length ~ Dia. ~ Dist. to well ^- t~-o 2 , SOIL ABSORPTION SYSTEM BED/TRENCH Width ~ Length ~ DIMENSIONS ~Z•~ SETBACK SYSTEM TO INFORMATION Type Of System: DISTRIBUTION SYSTEM county: St. Croix Sanitary Permit No: 405069 0 St to Plan ID No: ~' O rowtS • 1d • Parcel Tax No: 018-1000-80-110 ELEVATION DATA STATION BS HI FS rsencnrnarK ~ / Alt. B Bldg. Sewer ~ , ~ ~ a ~( cZ ~• SO gS ` t St/Ht Inlet ~, ~~ ro 3 t~ $ ~ q00 ~,~ ZZ Dt Inlet Dt Botto ~ «.zs - ~' ~~ 2 #CZI ` ` N ! ~~, ~ ~ Header an. ~ ~ ~ ~~ ~ f Dist, Pipe Pk ~•S~ r Bot. System ^' ~ (( S S. 33 P•• Z ~ Final Grad \ St Cover Ce ~ ~. Z.O 92. ~2, lsi ~ J I, } ~/ _ o. Of Pits LEACHIN CHAMBER UNIT :3 ~3 Inside Dia. Header/Manifold Distribution i i x Hole Sim f( ~ x Hole Spacing ~ Vent to Air Intake ~.~, Length ~- Dia Pipe(s) .._- Length 0 '~ Dia ~• •~ Spacing j 32 35 •SZ SOIL COVER x Pressure Systems ~nlv xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil i~ Yes LJ No if Yes j] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Q /~/ ~ ~/ Inspection q / ~ CZ Location: 1182 207th Street Hain ond, WI 54015 (SW 1/4 NE 1/41 T29N R17W) Pine La~ Parcel o: 01. 7.4 0 `T'om ~F ~a~.~.~ ---- Nth fv...,,o. ~a,,,.,~., ...~y, 1.) Alt BM Description = a'' ~ 2.) Bldg sewer length = 39 ~~~ ~ N (,3 i~t - amount of over = 7 teT~~'. I' 3.) Contour - RJj • Z.~ r C~/ C' K ~L.~~J J Pan revisio Required? ~I, yes o ~--d-~-~~-~ I~- -\ -------- ---- --- ----- __-_ Use other side for additional information. ~ ` ! ~~ ~_ ~ 'i_ _~~'~"~ - _ - _-- --..___- -_-__-~ L_ __ ~~ ~ (~~ ~f~1,,_ t-•lPate y- Insepctor'sSignatur(e~q p~~ ~ _n ~~11-- Cert. No. D-6710 R.3~S J~-~Wau(aaL..•~L. ~, ~?'7~~ ' ~~/ ' / CS { ~~~~ ~ / [ • J ~+ r ~Y "" ~ u~ ~ ~. ~ / f~lil !l~ CI \ oetr~,itn " Safety and Buildings Division County ~ ~ 201 W. Washington Ave., P.O. Box 7162 ~- CXLO ~ SCO11 SII ~ Madison, WI 53707 - 7162 ` Site Address S 7`~ ~' De artment. of Commerce .5-/ s -pZ S . Z 8 7 Sanitary Permit Application sa~~ Permit Number ~O~D~ In accord with Comm 83.21, Wis. Adm. Code, personal information you ^ Check if Revision tna be used for seco ses Privae Law I. Application Information -Please Print All C'E, rate Plan I.D. Number 't` ' ~31 o To+.c. ro Property Owner's Name ~ ~, 2(102 Parcel Number 1bc~ ~Ay ~1 --, tCxaD ~80 -!(d Property Owner's Mailing Address IX CnUN E ~ Properly Location S ZONWG CJF~d n , .~/~ S K! . ~ Jv~!L; S f' T ZF N, R /_ . City, State Zip C Phone umber Lot Number Block I~lumber , - ~G/ A Subdivision Name CSM Ndn3bei II. Type of Building (check all that apply) .s Ptli-tw y /J 1 or Z Family Dwelling -Number of Bedrooms ~ y~ fyCONra „ ^Ciry ^Village ^ Public/Commer -Describe Use Townshi n y p - _ -- _ ^ State Owned ~~'~`^ ~ '~ ~ N Barest Road ' III. Type of Permit: (Check only one box on line A numbering scheme for internal use). Complete line B if applicable) A' 1 ~ New 2 ^ Replacement System 3 ^ Replacement of 6 ^ Addition to" For County use. S stem Tank Onl Existin S stem B. ^ Check if Sanitary Permit Previously Issued Permit Number Date Issued N. Type of Permit: (Check all that apply)(numbering scheme is for internaluse)~_ ~...f~ , 44 ^ Non -Pressurized In-Ground 21~Mound 47 ^ Sand Filter 50 ^ Constmcted Wetland 22 ^ Pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other V. Dis ersal/Treatment Area fo 'on: Design Flow (gpd) Dispersal Dispersal ea Soil Application Percolation Rate System Elevation Final Grade Reqttire ~~ Proposed R Gals./D s/ (Min.Mc h) Elevation .>Z~Z•~j o?LriZ.,S Z2 f~.Z jvv.-Z VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constntcted Glass New Existing Tanks Tanks Septic or Holding Tank ~ Dosing Chamber U~ ~ `~ J ' ~ VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature P~RS Number MP/M Business Phone Number N ~rn w., `- ~ 2 7i~- 772 ' 3Z Plumber's A dress (Street, City, State, Zip Code) ~ ~~ 2~ _ ~ ~i /J-u~ ~ ors u ~ ~~ VIII. Coun /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater ch F S Date Issued Issuin Agent Signature (No Stamps) ^ Owner Given Inituil Adverse . ur arge ee) ~ / 2 ~ ~ Determination .7 Q ` 1X.~C{o` ditionns of ApprovaUR ~ o>ps for Disappro ~ ~ ~~ ^ ,t S~Cb~ Vw~~ ~ ~ e~'~ /tl 1 /~ ~rrK~iw++~. ~ I Attach complete plans (to the County oNy) for We system on paper not lm then t;1R x 11 inches In size ~S SBD-6398 (R. OS/Ol) '; ,+~ a9 dC..' OL - `art ` w ~.~, ~ '~ ~ o ~ ~~ ~ w y ~ o T ~} , ,~ :y.L.~ w c)Ci~:~, ~~ \ ~D MN I~ w •Y\\A O Vr./1 ~ ~ I ``~("~~Z~s~L~~~4 ~ ~ b ~ ~ ~ nn _~. 1 j '• ~° ~ r n~ ~~ A C C 1 ~..,,1,.,,~,~ 1^~~"~Q- cOr.~ W~4 TON ~ .~ ~ u.:l...Q sl.;L 1.0 •~.~ ~ .~ ~u' ~ ~!, Pos., ~ 4z.4 ~ ~ s1 oo t' ~ ~ ...~.ll 1a4. -o,. 4 S~ 2a' ~F i ~i` S~I.S~i~ fb' ~~.a~:~ j ~ i L4 ~.S} • ` ~ ~ w12~. letita9 ~l. vo / ~~ ~ \:- i / .~ \ , ` li3• Z.. Pic ~~, 4v tw S ~v ou- wy le a.~ ~ , (. q4.t) z 4' ~' / ~ - - x <<~ ~' r ~,t~ b~A JV -b H ~ ~ N 4~ Qur O ~ ~~ ~ ~ 10l w..a... ~ ~t~ ~,. ~ ~ot~~ ~oe. "' `Ito ...:lQ ~v a°' ~ Z.» fi't' ~ ~. ~ 5~,..,.:L ,~.Q,Q.,. -~ dV.i: ~ .,.e,. S.o(..~, ~R 1..35 K o $ 3 s ai ~.,..,~c a b\ Q.Mq - ---------------- - , S ~ _i --- -_ ~ ~' --- ----- -- --- - -- -- . ,- isconsin Department of Commerce Scott McCallum, Governor Philip Edw. Albert, Secretary May 02, 2002 CUST ID No.226524 ROGER L TIMM 3128 20TH AVE WILSON WI 54027 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 0/02/2004 A7TN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARM[CHAEL RD HUDSON WI 54016 SITE: Todd Moreland l 17TH Ave Town of Hammond St Croix Gounty SW l/4, NEI/4, S!, T29N, Rl7W Lot: 4, Subdivision: Pine Lake FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 849933 Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi. us/sb www.wisconsin.gov Identificatio bets Transaction ID N 31390 Site ID No. 64413 Please refer to both identification numbers, above, in all corres ondence with the a enc . 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(!0), 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: General Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.01/Ol) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD- 10706-P (N.0 I /0 I ). • Per manual cited above, limited activities are allowed in the area l5 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal CQnd 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 • A Sanitary Permit must be obtained from the county where this project is located in accordance with the ~ECQRI requirements of Sec. 145.135 and (45.19, 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. Stat • Comm 83.22(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. ROGER L TIMM Page 2 5/2!02 • Note: The off setting (D) is proposed to be at six inches from the bottom of the tank. The pump pad, along with the legs of the pump, may leave the impellers out of the liquid effluent before the pump off setting is reached. This should be checked at time of construction to insure this condition is not encountered. This setting maybe adjusted, with the inches coming from the reserve capacity area. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner ofa POWTS shall be responsible for ensuring that the operation and maintenance of the PO WTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All 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 Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stars 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 tt~e POWTS. Sincerely, G~1~ Charles L Bratz POWTS Reviewer [[ ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@commerce. state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky , Wastewater Specialist, (715) 726-2544 Henry F Grote ,Certified Soil Testing ,r , , Todd Moreland -Mound Transaction # Construction Materials and Techniques All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. Construction methods must comply with the following Component Manuals: Mound, SBD-10691-P (01 /01) Pressure Distribution, SBD-10706-P (O1/O1) Location: Lot 4, Pine Lake Subdivision GL 3 & SW 1/4, NE 1/4, Sec. 1, T 29 N, R 17 W Town: Hammond County: St. Croix M.. Date: Apri130, 2002 ~ . ~._ ~ ;~`~~~, ~..,, ~~ ~~ Owner: Todd Moreland ~'~ ^ ''` Address: 1560 Fourth Ave. ~ ~ ~'' Baldwin, WI 54002 ~ ` ~~' ~~~ "^.;~ D Plumber: Roger Timm Signature: License # MP S 226524 Attachments: 6748-Plan Approval Application SBD-8330 page 1: cover 2: design criteria & calculations 3: plot plan 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail 7: pump curve 8: system management ~nally .~VED F C011AtE~ ~~ wt.aN ;PpN~ page 1 of 8 f ~~ Design Criteria ~''~'i Residential Wastewater Contaminant Load: 30 mg/L < BODS < 220 mg/L Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L Fecal Coliform > 10,000 cfu/100 mL Fats, oils, grease < 30 mg/L 3 Bedrooms x 100 gal/bedroom/day x 1.5 ~~' gallons/day hydraulic load Effluent filter ~ wl~ ~ ~ - ~ ~ Measurement pump on and off `t • Z in. Height alarm from tank bottom l~'~- in. Reserve capacity ~ ~`~ ~' gallons specs.calcs.res Design Calculations In situ designed loading rate ~ • Z Z gallons/sq. ft. per day Depth to estimated high ground water ~~ ~ ~ in. Depth to bedrock ~ 3 ~ in. Cross slope at system ~ % ~ ~ Y Force main length ~ ~ 3 ft. of ~' in. Manifold/header length ~'~ ft. of in. Drain-back ~ ~ •~ gallons Lateral length ~ @ t ~g.S~ ft. of ~- in. Lateral elevation S ~ ~ •~ ft. @ bottom of lateral Lateral hole size ~3Z in. @ ~y^•sZ in. ( 2'`~ b ft.) Spacing 3 ~ holes/lateral 3 "d holes total Lateral volume ~ fi''`t to gallons Total lateral discharge rate ~ ° •r Z i gallons/minute @ 3' ~ ft, head Network pressure compensation losses ~ ' ° ~ ft. Elevation difference ~~ •~~ ft. Friction loss ~ •~ 4' ft. @ Z ~ gallons/minute Total dynamic head ~- ~ • ~ ¢ ft. Pump/siphon 3 3 gpm @ Z ~ ft. of head Manufacturer ~ ~' "'` ~-s Model # ~' ~' ~ S~ Dose volume ~ ~ ~ gallons Lift/sipf~on tank ~'" ~ ~ ~'" ~ `''~'° - ~''° ~ ~~ ~ ~ gallons Septic tank •~ ~~ 1 `'~° gallons Page Z of ~ r ~c9 O~~ ~ t^1 Yl.. `•0.M~,~ ~~L~O~ J~~AN `~O~ 4 I~iNt.`Ir~ J.n~(~,~~r.~KN //''~~ 1 ~~...h '~~ w...OW~ ~9 (~ (~ I~~ ~ b ~ ~X-0~...q~o ry~ JC.a ...0 ! I V~~ ~, Gam{ '1~~4~ s1' ~' ~, M f. ~ o za ~ ~ / ~~ 1 \~•,. y ~~ z. oo v.~.o ~-e~~ r~~. ~~~~ s ,~ ,~ ~ ~~ ~~ \ ~i . ~ ~\ J~~ ~ `\ 4' ~ <<,..s' ,,.,mot.. b~ ~ 1~ c .y `t 1. •'S w... w. Cq q s~ (V\ ~, a b,<<~o~ ~,n~ ,~ ~,,,; ~„ .,~,, S~ ~„ ~~ x..35 ~ / ~y C~ I` a •-- ~ ~F O O ~ Z Q.~ ~p M. ^ O W ~^"K _--__.. ~~s.~s F ~+w;(~Q / Sea.,.:... Y 7j~ SK~S~~ rl," ~ pae:t J f~ 113' t" Pvc s((~+ 4v ~c~ w~e;v S\ o ~ ~~ ~ G a.4.t> X1.4` L~(,.3) `~ ~ T..1S ~~' ~,~~w I C 11~-N' ~~.. z» u- ~ ~.. ~~~ - _- a I c i ~ Q.,,, . ~ ~ . ~ ~~. a~.Z ~- 10,.,,~ ~ a~ ~... .. ~~t`~+,IL wa..s~~ l ~w~l 3 1rOCk ~~ 0. C~~MI R~t ~~r ~Ji\ow ~rr / o ~ ~ O1 ~ ~ ~ ,~ I RtiTM ~o ~ o ~c t ~'~ 1 w.~S~ \ b s,.~co:1 s«~ ~ s Q.1o.,r ~ ~ e •.~~ S °~ ,, ,,,~ w„ ~'b1~-~"•`` -~-4'•~' .. 10.3'-~~3,Sr 1 ~,~•i'' N o~~~, ~ e~~ x..:51 6 C V ~~ ~ \T ~1 !~ w~~ ~I I -~ 13.0 i P50.~, v ;e~ ~~\~ ~~ \~2,5' `13.0' E-- 1'S~.$ ~. ~', 4 l~ v L c.... y~ t~ ab S aa, v .~ ~+ oh w ¢. \ (~ \ i -~-0 ~~ o ..-. o b r o~1~ 4 1 `~ ~ 'f L'. • ~ hlT O.h ~ Y 4M ~..:...w. ~ ~ ` ~ '~ J i ~ J ~ ~ O S r u c_. IC. `O t-/1 ~o~~~ ~; ~ ~w~~ / ` cI 1 \ 1 ! 3 Z ~ ~~ `-S o ~ 1 .~t a.+. «X cs~. ~.. b o~ o w, l : » c ~ 3 S• SZ. ~ a. N-`~ (2.9 6 ~ J i ~ 4.((~~~ 1 t (~ ~.ti.r» „(~r~ 1w, .~,~~aw.~.1~X t,r„YeQ '~u ~: ww\ w`M.4 a 9 V 0 4 11Q c. T~-~7. `W V w.\ V i.. ~ OJk ~ d M K~K`W~.~ •1 ~v a.~, ~~ ~~ s ' ~.o ~- ~~.~. ti~, s o~ ~ rn ~ ~. ., • k ~'T' 1 J ~ ~C C~ ~ ~.. -LOCKI-JG~GOVfiR'-'~ Lt/A~N iNG ~ ABED . GiWGK D~~G0~~1LGT--~ ~~ ~1~ ..., q 3 ----~ ~4 Pvc ~~~, '~7T P1P6 3~ no kNO-ssuae~~ \ Soy ~ /A~Cf T pW ~vs.Q SKET .'~1~IT" J ~ Ptli. w+ECTIOr~S Cl.ev • ~ 2.'}S~ ~~v. b'~ ~~•~,~~a ', 4 ~ ----~. ~~ ~I 24,, I.U. Mq~l t10LE A \ a C D gAF'FLE: Z" ~~ Fob<~ ~'~.Atw WEATNERPRO~F JUNCTION ~ . w c.~. o ,5~, g„ HU:L 1 AL ..fir-- ON - .~ ~.I ~i Q.Z. Oct PurdP h ~~ COrvGRFT~ 6~oCK i:' Pvc 4" 4 ~ _ Yth~; .-1 ~~.~' q ~~ 4c 3' o*~o lr~G-:.TtrRr_ Gcau-+o 43 Z. ea S ~'' ~~ ~ ~.,.,~ ; ,,. ~ a,~ ~ \ \ . ~ Z l SEPTIC E _ SPEGIFI•CATIOIJ ~~. ~ DO S f ~ ; Q.~ Q.v~ ~, c~ 1 Th1,Jr.S MA-JUFACTURCR: (JUMD ER OF OOSfS: PEK CA: TAIJK SIZ C ; ~ ~~ ~ ~u° _ `GALLOAJS • .pOSC VOLUME ~ ~ cl ~ U ALARM /hMliJiACTURCR: S `~ ~7`''~-~"~~ IAJCLUOIAJfa 6AGKFLOW: G~~~ONS W MOOCL WUIM~CR: • `O, ~-E `~ CAPACITIES A= 33•~ 11JCNC5 OK 3R1'~ "o.~'~:.~. ZO SWITCH TyPC: ~Q,yw~ ""O g c Z" I-JCNCS Oa 23•V ~ G~.~~ti5 `n PUMP MAIJUFACTURCR: iOr't ~ C^ 4~Z IUCHES OH ',c9'o G~~~C~. 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SWITCH TaPC: IJOTE: PUMP AIJO ALARt1 ARC TO BC W c M1IJIMUPI OISCHARGC RATE ~'~'b G-M INSTALLED 0-J SEP/~R~TC CiKC..•'~ ~S ~ ~ VORTICAL DIFFCRCWCf CCTWCCIJ PUMP OFf AAJO OI~TRIDUTIO-J PIPE.. ` ' FEET + MI-uIMUM uETWORK SUPPI.y PRCCSUR E . ;'~ FECT +~,~5~ T / + l~S FCET OF FORC[ MAIIJ X ~_ `_ ~ ,F/ loo IxFRICTIOU FACTOR. - ~J -1-'~4' FEET Z I ,,,, ~ ~ ~ 2 -1 '° TOTAL Dy1JAMIC NCAp `~'~O~ FE.ET ~ ' IJ \o ~ ~~ ,~ S 1,~ ~ I TERA1Au DIMEIJSIOAIR 01 TAAJK: LEAlCs7H ~ ;W~DTN ~.,~LIQUID pEP'rH a ~ 6 P ~ ain _~ Submersible Effluent Pump 3 V / I EP05 III II I p~i~tr~7~~~~~~~~~~ ~I~d~ii „ APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capability: '/a" maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: 1'/z" NPT. • Mechanical seal: carbon- rota ry/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. •EP05 Single phase: 0,5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: 10 foot standard length, 16/3 S1TOW with three prong grounding plug. Optional 20 foot length, 16/3 S1TW with three prong grounding plug (standard on EP05). © 2000 Goulds Pumps Effective February, 2000 63871 • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Auto- matic models include Mechanical Float Switch assembled and preset at the factory. FEATURES ^ EP04 Impeller: Thermoplas- tic Semi-open design with pump out vanes for mechanical seal protection. METERS FEET to~ 9 a °a ~ i v 6 5 0 ~ a 0 ~ 3 1 t 0 ~' 8 ~- g ~~ ^EP05 Impeller: Thermoplas- ticenclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover: Thermoplastic cover with integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING ~" Canadian Standards Association (CSA listed model numbers end in "F" or "C".) Goulds Pumps is I50 9001 Registered. ITT Industries CAPACITY Goulds Pumps ..t System Management Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber, Timm Excavating, 715-772-3214, or the St. Croix County Zoning Office, 715-386-4680, should be contacted for assistance. General Proper functioning of an on-site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. I . If the septic tank is installed prior to sheet-rock andlor painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. Z [nstall water-saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. ~. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly. 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic or pump tanks are no longer used, they must be properly abandoned. 1 1. [f construction timing and weathercould create a frozen infiltration system, weather-proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start-up. Maintenance 1. The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. ;. When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back-washed into the septic tank to remove accumulated material. 4. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in-situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell 5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can befestored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Avoid compaction such as vehicle traffic within 15' down-slope of the adsorption system. 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 0. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run-off into the system area. 11. Warning: Do not enter septic, pump or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and/or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 ~~i ~~ ;, ~~ - ~~~ ~, ~~~ ~ KrS ~ -~y ~~ rug 6t,~-n ~~~ ~d w~*~s e ~~Ci /~ evn rev ~o ~ ,,~.,,~,,,~1 b.~. piriu ~ k.~ 11 SB~N LAND SURVEYING ~ 2920 ENLOE STREET HUDSON, WI 84016 ~ y ' ~l~RIC~~~~` 1521 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page t of 3 Division of Safety and Buiidings in accordance with Comm 85, Wis. Adm. Code Certified Soil Testing County Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. ~1 i ~D ~ -- ~ 1 C~ Please print ail information. viewed By Date Personal information you provide may 15.()4 (1) (m)). ~ ~ ?~ Property Owner Property Location Moreland, Todd Govt. Lot 3 + SW 1/4 NE 1/4 S 1 T 29 N R 17 W Property Owner's Mailing Address 200 Lot # Block # Subd. Name or CSM# 1560 Fourth Ave. 4 Pine Lake City State ip C e ~ City ~ Village ~ Town Nearest Road Baldwin I WI I ZONING OFFI Hammond i 117Th Ave. / New Construction ', Replacement Parent material till General comments and recommendations Use: /) Residential /Number of bedrooms 3 Code derived design flow rate 450 GPD ~~ Public orcommercial -Describe: - Flood plain elevation, if applicable NA : install 4' x 112.5' rock bed mound on 96.3 contour as upslope edge of rock w/ 1.9' sand fill Boring # -.- Boring /; Pit Ground Surface elev. 96.3 ft. Depth to limiting factor 14 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-8 10YR 3/3 - sil 2 f sbk mvfr cs 1f/m .5 .8 2 8-14 10YR 4/4 - sicl 2 f sbk mvfr cs 1 m .4 .6 3 I, 14-26 5YR 4/4 f2d 7.5YR 5/3 scl 0 m mfr - - 0 0 ~- I I I I I Boring # - Boring Y Pit Ground Surface elev. 95.4 ft. Depth to limiting factor min. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 l 0-11 10YR 3/3 - sil 2 f sbk mvfr cs 1f/m .5 8 2 11-23 10YR 4/4 - sicl 2 f sbk mvfr cw 1m .4 .6 3 23-34 5YR 4/4 f2d 7.5YR 5/3 scl 0 m mfr - - 0 ; 0 .--_ I I Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * ffl ent #2 = BOD < 30 mg/L and TSS _< 30 mgt_ CST Name (Please Print) 'gnature: CST Number Henry F. Grote 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 547 4/22/2002 715-233-0398 s Property Owner Moreland, Todd Parcel ID # Page 2 of 3 Boring # _.J Boring E/f Pit Ground Surface elev. 96.3 ft. Depth to limiting factor ~_ in, Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-10 10YR 3/3 - sil 2 f sbk mvfr cs 1 f/m .5 .8 2 10-16 10YR 4/4 - sicl 2 f sbk mvfr cs 1 m .4 .6 3 16-23 ..~ 5YR 4/4 - scl 0 m mfr cs - 0 0 4 23-34 5YR 4/4 fad 7.5YR 5/3 scl 0 m mfr - - 0 0 I '. Boring # W , Boring J~j Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I i f I I ^ Boring # ..~ boring ~i Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 '~ I I I - i I `Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. [f 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. SBD-8330 (R.07/00) Certified Soil Testing i, ., -- • Y ~~ d~- ~ ~ ~ re. \ a~,.~,- ~~l m 7 J~~ w~. ~o~ ~ 1~i..o„ ~1.~ ~..4clC;r ~ 1 ~ ~~D .~rh ~ Ii A w+rOw~1 /• Y f C c/ 6 A.` Q. 1„ 1 O i p ~}p t: (~ }e wa.~ ...ls' S- i ~w,(~ y +~ L4 z.~) • s9 ~ =•s9 t~~ i3 g ~ ~ ft5~~ tZ ~Z ~~ e ~~ "l ~~~e -~ H 1 D~ ~.M V.Q.Ir ~ CR q .s~ I; T~9 } .T~~a ,~_, , r { 1;H~~oe.a 0.. Q.b ~h ~~~ 0 ~~~: ~ ~.~ '', cs ~t~l ~.o~ , ~ ~o ~~ :~st~~~ ~ec~~~ q4.z) `tS.$S L°t (..; ~~ g~.ss ~~~~ _.~ 2 4~' ~r~, ~ QS i ~~1 z ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ` / D~~ ?~c, ~~ Mailing Address 1 f'su,,- F ~ 1~ Property Address ~ ~ ~ ~- a 0 -I ~ ~~'. (Verification required from Planning Department for new City/State ~c.-~~,~.,,~, k~z. Parcel Identification Number D ~1*l ~ l txx5~~ - l1 ~ LEGAL DESCRIPTION Property Location 5 ~ '/<, ~ 1/4, Sec. ~ T~?~ N-RAW, Town of ~/wrK~ua~ Subdivision ~~ v.n ~~ ,Lot # ~_. Certified Survey Map # (o~? 3~ y( Volume ~ .Page # _~~ -. Warranty Deed # _ ~ °7~~ ~ Z~ Volume ~ $~ .Page # ~ ~" Spec house ^ yes;~l no Lot ,lines identifiable,'~1 yes ^ no SYSTEM ~NANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeyman plumber, restrictedplumber or a licensedpumperverifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. /°',°l„~ SIGNATURE OF APPLIC S / 3/ .- ~~ DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLIC T .s / 3 / ~ oe 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 e ?FATE BAR OF WISCONSIN FORM 2- 1998 1 8? ~ P ~ , WARRANTY DEED 6 7 5 9 0 KATHLEEN H. MALSH REGISTER OF DEEDS Document Number ST. CROIX CO. , MI RECfiIVED FOR RECORD This Deed, made between Secluded Land__Company, LLC, a Wisconsin limited liability company 09-10-2002 9:45 AM --•--- _ _._....-- -.._ HHRRANTY DEED --- _ ,Grantor. EXEMPT t Todd A. Moreland 6 Lauri S. Moreland, Husband and _ and Wife as Survivorship Marital Property _ REC FEE: 13.00 TRANS FEE: 83.70 (WI Residents) COPY FEE: -- -- - ------ - _ ,Grantee. CERT COPY FEE: PAGES: 2 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate to St. Croix County. State of Wisconsin: ... ,,i;~Jin;l; .,, See attached for legal description. Nar Pierce County Abstract & Title, Inc. 36r West Main Street Ellsworth, WI Soon Part of: 018-1000-80-ILO Parcel Identification Number (PIN) This is not homestead property. ~) (is not) This is non-marital property for James W. Smith. Grantor hereby transfers all interests in minerals, if any, it may have in the subject property. Municipal and zoning ordinances, any recorded easements, recorded Exceptions to warranties; building and use restrictions and covenants, general taxes levied in the year of closing, and any liens or encumbrances created by the Grantee. Dated this 11th day of February 2002 Seel ed and Company, LL by: (SEAL) - __. (SEA James W. SmithL Sole Mana>~in>; Member (SEAL _ (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) James W. Smith State of Wisconsin, ss. County. authenticated this =L- day of `~~~ Personally came before me this _ day of ,the above named ohn P. Ebben Attorney . - __ TITLE: MEMBER STATE BAR OF WISCONSIN _ _ to (If not, _ me known to be the person who executed the foregoing authorized by §706.06. Wis. Stats.) instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY _-_ ,. _....._ Attorney John P. Ebben __ __ - Notary Public. Stale of Wixonsin _ My commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not _ _ , __ _,) necessary) ~~ 'Names of persons signing in an capancity~ mjust be typed or printed below their sigree,re. CJ`p ~ . I_I "T STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc. WARRANTY DEED FORM No. 2 - 1998 Milwaukee. Wis. (B) PL 414 L.S. t3 U 1870P 179 LEGAL DESCRIPTION PINE LAKE Lot 4 Lot of the plat of Pine Lake recorded at the Office of the St. Croix County Register of Deeds on March 19, 002 in Vol_ um,~,8 of Plats, on Pa~.,9$ as Document No. 673841, located in Part of Government Lot 2, Part of Govemment Lot 3 and part of the Sout west ua er /.) o the Northeast Quarter (NE Y, ), Alf in Section 1, T29N, R17E, Town of Hammond, St. Croix County, Wisconsin. PROTECTIVE COVENANTS I . The Grantees agree that no singlewide or doublewide mobile homes, campers or buses shall be placed upon the premises herein conveyed. "Mobile Homes" includes any and all trailers or structures previously licensed or titled for road use; and trailers or structures with wheels and/or axles attached at any time, whether placed on a foundation or not. 2. The Grantees shall not permit unregistered or abandoned vehicles, trash, or junk to remain on said premises. 3. No accessory buildings such as garages, pole buildings or sheds may be constructed or placed upon the premises until a primary residence with completed exterior is fully constructed. All structures shall have exterior finish, clapboard siding, masonry, or equal quality finish. No tar paper, tar shingles, or tar paper siding. 4. All structures erected shall be promptly and expeditiously completed on their exterior, including paint or stain, on any exterior surface above the foundation within six months after construction is commenced. 5. The main residential structure(s) must have a minimum of 1,500 square feet of living space. 6. Should any improvements on the premises be damaged by casualty, or become unsightly through wear and tear, the same will be promptly razed, or restored to a neat exterior appearance in line with the building requirements above set forth. 7. There shall be no hunting or discharge of firearms on the premises. 8. The land is restricted against commercial timbering and commercialization. 9. The Grantees are prohibited from placing advertising signs of any nature upon the premises. 10. The foregoing protective covenants may be superseded by previously recorded restrictive covenants, or by local and county zoning regulations. 11. The foregoing protective covenants may be amended, subject to the following: a) Such amendment shall be in writing; b) The amendment must be approved in writing by the owners of atwo-thirds majority of the parcels in the subdivision; c) The amendment shall be recorded. 12. The foregoing protective covenants shall run with the land and shall be binding on the Grantee(s), their heirs, successors and/or assigns. 13. The Grantees understand that they have standing to sue for enforcement of the foregoing protective covenants. Enforcement is primarily Grantees responsibility after half of the parcels offered for sale by Grantor in this project have been sold. 14. to the event any portion of the foregoing protective covenants is judicially deemed invalid then the remaining portion of said protective covenants shall remain in full force and effect. ~ttlt>t,aa 3.679 Acres PC-I D (8/23/01) ~~~ ~,%", 6°'_ b~ Ea3CE31E~'S OFFICE ST. CROIX C0.'a''IS. rarxs~au~l`L. R~rd ~~.~ n~~~ ~ ~~ ~~~1`O~ ' e ~ O~O/ ~'~ ~~,. .~G~ ~ ,, ~~~ Gtr' '~ ~ Q ,~' U` ~~~ PQG°34 OO [~ d04 9 C6o~Uv1 ~'IOf~_£g3Q pLQC~3G Z iC~ I '~ I a ~9 i o ~~ ( m -~ I~ I i 0 ~~ I m I~ I • . ~~ I ~~ I I I BENCH MARK: TOP I OF 1" IRON PIPE, ELEVATION 1177.9 I T ,~ ~; ~~~~' ©~,~g ,. Qp,~o~Q,, Z ,~3y I a ~~ I ,3~i i i i'A1' ~'v =~ i i.~2~ ~ m b j ~zy~ ~- 9r . ~ N~ ~e°; ~~~' ~ LOT S 1.451 ACRES" "' - - - /(e3.192 sc~. Fr.> ~ ~ - ~ ~ TO MEANDER UNE 1.701 ACRES ~ 9 TO EDGE OF WATER /~ ~- DRAINAGE •--•- 1 ~~ . /• i / ~~/ ,2~~1, 2 P I 1 ~ \ \~ ~ I ~~~~ ~ U _N LOT 4 ~ ~ ~ I Q 3.879 ACRES ~ I (160,245 SO. FT.) i I ~ i ~ I ~ I I ~ I N ~ I ? ' ~ I -•--• ~ 33' 33' .~.~ _._.._._•-•-.~ 6 ~ i LOT ! ~) 1.475 ACRI (64,252 SO. TO MEANDEF ~ ~ 1.81. ACR TO EDGE OF V STORM WATER ,POND HIGH WATER i 'ELEVATION = 1143.0 4' ~ ~ _ g??°2 ~q_d0n_4__9_ c '57.43' ---------~ SOO°16'09"E N89'°44'31 "E I ~ ~ LOT i 1.768 ACRE ~I (76,997 SO. • ~ TO MEANDEF ( 1.84s ACR I TO EDGE OF V ~ • tJ ~ ~ LOT 3 I ( 1.545 ACRES ' ~ (87,307 SD. FT.) ,, i TO MEANDER LINE 1.621 ACRES i. ~ TO EDGE OF WATE I I , ~ '~ ~ ~ N89°44'51 "E 945.57' ~ ~ S89°44'S 1 "VN 491.03' ~i °~ I BENCH MARK: TOPJ OF 1' IRON PIPE, 117TH AVE. ELEVATION 1153.1 -" -' r ~ MG~1CPdQ~4GD ~[n~D`~ ~ j ~ --------- / \ :URVEYOR': CERTIFICATE '501` 33.0 t>fTiLTTY EI- NO POLE C asTUwe ~ uNE. THE i sas.sZ of THE usE c THE AREA. LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF HAMMOND COMPUTER NUMBER 018-1092-04-000 Parcel Number 1.29.17.736 OWNER NAME: First TODD A & LAURI S Last MORELAND PROPERTY ADDRESS: Hse # 1/2 PD --Street Name-- Type SD Apartment 1182 207TH ST SECTION 1 TOWN 29N RANGE 17W'/4160 NE'/<40 Line Description Line Description TOTAL ACREAGE 3.679 PLAT PINE LAKE SUB LOTS 2/6 018/02 LOT04 BLK 01 SEC 1 T29N R17W PT PT NE 1/4 15 02 PT GOV LOT 3 & PT GOV LOT 4 16 03 PINE LAKE SUBDIVISION LOT 4 17 04 3.679AC 18 05 19 06 20 ~ 07 21 ` 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1-General, F4-Prev. Parcel, F5-Next Parcel, F7-Valuations, F8-History, F10-Exit Pagelofl From: Steven Fisher Sent: Tuesday, February 04, 2003 2:42 PM To: @Zoning Department Subject: Hold Permits on Pine Lake Subdivision Please withhold the issuance of septic permits related to Pine Lake subdivision until the followin items are resolved: • A Chapter 30 permit is issued from the DNR. • The dedicated public roadway is constructed. I will be requesting that the Town of Hammond withhold any building permits until these items a completed as well. Jane/Shay would you please flag appropriate files. 2/4/2003 ~~~ Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT Page ~ of m aoc:oraance wpm wmm oa, vns. r+wn. wuc County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size Plan must s T C ~?O ~ . inGude, but not limited to: vertical and horizontal reference int (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, an ~ nce to nearest road. Please prinf all 1 r ~~r • n. -' ~~ Reviewed b Date y Personal information you provide may be used f w ary p osa*Privacy Law, s.~t5.04 (1) (m)). Property Owner j i Property Location J ,~ C 1. d ~ p y Ii=,N ~. Govt. dot .. S W 'i/4 ~ 1/4 S ~ T e7~ N R ~ ~ fir) W Rroperty Owner's Mailing Address.., '_ ~ ~ <,~ " Lbt #' r Block # Subd. Name or CSM# . r;: . d, ~!X ~l ~ ~'c~ws ' L~r +_ CSM yo1.. $ .Pt, .a~3 S City ' State 'p Code , ~ .`.:, on ~ ^;City village own Nearest Road New Constriction Use: ® Residential i Numbe Code derived design flow rate ~ ~ GPD ^ Replacement ^ Public or commercial -Describe: Parent material }l 1~ Ci/ ~- 6. '1'r r>_ Flood Plain elevation if applicable ft. General commerrts U 7T-,~,~~ ~ Fri /~ M OaJ>rt~ ~ ST~I~') . and recommendations: S Y © Boring # ~ Boring L pit Ground surface elev. d 3 a1- ft. Depth to limiting factor '/ ~ in. Soli licadon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftT in. Munsell Qu. Sz Cont. Color Gr. Sz Sh. 'Eff#1 •Eff#2 ~ D-ro 7rS /s '~ Sri msr~K bs~ X~,~ ) ~ ~r 3 1 -~! ~ ~~ - L vh S et Jh,GI , yl ~ ® Boring # ~ Boring '/ ® Pit Ground surface elev. 3. ft. Depth to limiting factor ~ in. Soil lication Rate Horizon Depth Dominant Color Redox Desription Texture Structure Consistence Boundary Roots GPD/iP in. Munsell Qu. Sz. Corrt. Color Gr. Sz Sh. 'Eft#1 'Eff#2 ~ ~- 0 3l3 S l L, Yh i Ib St-! ,~2S ~ S , ~ J -30 s' ''l ~ ~ ~ L Im Nd' N t3' • Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mg/L ' Ertluent fx1 = BOD < 30 mglL and TSS < 30 mglL CST Name (Please Print) Signature CST Number d tiSOnr ~ 00 Address Date Evaluation Conducted Telephone Number °)'~ 1 a N~ s .~ / .~~7a ~'- Ib-o his'-gs'9- 9.s~~ q ~ Property Owner.s~ L Z U b ~~' J-J~} Nth CO, parcel ID # Page a of 3 Boring # ~ Boring ~ pit Ground surface elev. ~/G~ ft. Depth to limiting factor ~` in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft: in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. •Eff#1 `Eff#2 ~/ ~/.3~ ~1/G C b s't'ir k/G t: ,~- -,~ g~ rh./r ~ ~ .1Y ~ -v 4' a Boring # ~ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Deplh Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/tY in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. •Eif#1 •Eff#2 ^ Boring # ^ Bodng ^ pit .Ground surface elev. ft. Depth to limiting factor in. " Soil A icatlon Rate Horizon Depth Dominant Cot Redox Descxiption . Texture Structure Consistence Boundary Roots GP b/ff in. Munsell Qu. Sz Cont. Color Gr. Sz Sh. •Eff#1 •EfffF2 • Effluent #1 = BODs > 30 < 220 mglL and TSS >30 < 150 mglL 'Effluent #2 = BODs < 30 mglL and TSS < 30 mglL 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. SB0.8330 (R6I00) ,~ 1-19 T ~ q~~ •. g7.~ Via' , Ra S: IO~ta•_ Id/.~' ,~ lb3.a~ a~ ~'~ `~- ion a , - J C3 • q~ ~~ WI. ~0 ~ .O~f ~•o~ i ~~s _~ N s ~~~ ~ Y /~o~, ~~ lpd~04'OS ~ pU[~1-) ~° S ~ r~ p~1-,~-Iv I` dOr 1 d T ill .~ e~~- ~ IS ~~~ = ~o' i~n.~zss d~~rh~n~s~en~kb ~. ~, r S lfrlr4 r ~ ~- Tf~~' ~ I N' ~" cQ D x ,F~.r.~ Foy tdr'~'L' ~~...104.0 ~ ~ ~• a ` t) 77~, pv~~ 4~0~~ ~~~ ~~~- csr~ aaoo~`~ _. _,~, ;~-~ ~_ June 12, 2002 Mike Sliva Secluded Land Company, Inc P. O. Box 99 Barron, WI 54812 Re: Pine Lake Subdivision Dear Mr. Sliva: ST. CROIX COUNTY WISCONSIN 70NING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 • Fax (715) 386-4686 The Zoning Office has been informed that road construction and house construction have taken place on the above subdivision prior to the installation of erosion control measures on the site. This is in violation of the Erosion Control Plan approved by the Land and Water Conservation Committee on September 4, 2001, which states that storm water ponds and overflow drainage ditches are to be constructed first along with appropriate erosion control measures, prior to any roadway construction. St. Croix County Subdivision Ordinance provides that financial guarantees be submitted to ensure the proper construction, installation and maintenance of required roads, utilities, erosion control measures, and other improvements. The County has the authority to utilize these guarantees to see that improvements are properly constructed and completed. It is imperative that you, as the developer, take immediate action to correct the violation noted. By Friday, June 21, 2002, you are to have installed the appropriate erosion control practices, and have them inspected by the Land and Water Conservation Department. On June 11, 2002, yourself and Peter Kling of the Land and Water Conservation Department, agreed upon the following actions: Install two rows of silt fence in the ditch upstream and two rows of silt fence in the ditch downstream of the culvert along 117th. Straw bales will also be added as extra protection. 2. Install silt fence around the east side of the dirt pile along, east of the temporary driveway. 3. Install silt fence between the west side of the temporary drive and the south side of the abandoned driveway. This will catch runoff from the west side of the temporary driveway. Page 2 June 12, 2002 Secluded Land/ Pine Lake Subdivision 4. Install two rows of silt fence in the south ditch of the existing driveway, just east of the intersection with the temporary driveway. Straw bales will be added for extra protection. This will catch runoff from the east side of the temporary driveway. You and your engineer must work cooperatively with the Department of Natural Resources during the Chapter 30 permit process to ensure compliance with their requirements. If these items are not completed by June 21, 2002, citations may be issued in accordance with St. Croix County Subdivision Ordinance 18.23 Violations and Penalties. Additionally, financial guarantees maybe utilized to obtain compliance. Until compliance with the approved erosion control plan has been obtained, and the appropriate DNR permits issued, sanitary permits will not be issued for additional residences proposed within the subdivision. Should you have questions or concerns, please feel free to contact this office. S' erely, Mary J Jenkins Assistant Zoning Administrator C: Peter Kling, St. Croix County Land & Water Conservation Department Ken Peterson, Chairman, Town of Hammond Eunice Post, Department of Natural Resources Steve Wlodyga, Pine Lake Association File ~ ~ ~scons~n Department of Commerce RECEIVED MAY 0 6 2002 ST. CROIX COUNTY ZONING OFFICE May 02, 2002 CUST ID No.226524 ROGER L TIMM 3128 20TH AVE WILSON WI 54027 ATTN: POWTS Inspector Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi. us/sb www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/02/2004 SITE: Todd Moreland 117TH Ave Town of Hammond St Croix County SW1/4, NE1/4, Sl, T29N, R17W Lot: 4, Subdivision: Pine Lake FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 849933 -Identification Numbers Transaction ID No. 731390 Site ID No. 644138 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: General Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.O1/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.O1/Ol). • 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 • 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. Stat • Comm 83.22(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. ROGER L TIMM Page 2 512!02 • Note: The off setting (D) is proposed to be at six inches from the bottom of the tank. The pump pad, along with the legs of the pump, may leave the impellers out of the liquid effluent before the pump off setting is reached. This should be checked at time of construction to insure this condition is not encountered. This setting maybe adjusted, with the inches coming from the reserve capacity area. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All 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 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, Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@commerce. state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky ,Wastewater Specialist, (715) 726-2544 Henry F Grote ,Certified Soil Testing isconsin Department of Commerce RECEIVED I~iAY U 2 2002 ST. CROIX COUNTY ZONING OFFICE May 02, 2002 OUST ID No.226524 ROGER L TIMM 3128 20TH AVE WILSON WI 54027 ATTN: POWTS Inspector Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce. state.wi. us/sb www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/02/2004 SITE: Todd Moreland 117TH Ave Town of Hammond St Croix County SW1/4, NE1/4, S1, T29N, R17W Lot: 4, Subdivision: Pine Lake FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 849933 Identification Numbers Transaction ID No. 731390 Site ID No. 644138 :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: General Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.O1/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.O1/O1). • 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 • 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. Stat • Comm 83.22(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. ROGER L TIMM Page 2 5/2/02 • Note: The off setting (D) is proposed to be at six inches from the bottom of the tank. The pump pad, along with the legs of the pump, may leave the impellers out of the liquid effluent before the pump off setting is reached. This should be checked at time of construction to insure this condition is not encountered. This setting maybe adjusted, with the inches coming from the reserve capacity area. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All 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 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, Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@commerce. state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky ,Wastewater Specialist, (715) 726-2544 Henry F Grote ,Certified Soil Testing