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018-1098-08-000
Wisconsin Department of Commerce Safeiy and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORM#ATION (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 Loescher, Eldon & Doreena Hammond, Town of CST BM Elev: /tom • ~ Z Insp. BM Elev: Da, g~ BM escription: ~~" -{i7~.~ ~ ' /~N, ~' TANK INFORMATION ~'~lk~l-a- S~¢' ~~ ° ~L~VATION DATA TYPE MANUFACTURER CAPACITY Septic l t~U~ Dosing y ~ GlJ ~ ~ S-D Aeration ~~ Holding ~ ~ TANK SETBACK INFORMATION ,~Tt,t7.~~ ~~ n~rs TANK TO P/L WELL BLDG. Vent to Air Intake R AD '! Septic ~- , !~~ `2 / Dosing ~- > ~ / Aeration Holding PUMP/SIPHON INFORMATION C/l~ Manufacturer Demand GPM Model Number ~V ~,~ TDH Li Frictior s s d Syst em H Ft TD '~ 5 ~ ~ r _ ~ ~P B '~ Forcemain Len t / Dia. A Dist. to Well 2 ~ /~v SOfL ABSORPTION SYSTEM County: $t. CrOIX Sanitary Permit No: 479331 0 State Plan ID No: Parcel Tax No: 018-1098-08-000 Section/Town/Range/Map No: 30.29.17.815 STATION BS ~ ~FS ~ V. Bench r ~ . ~ . '~• 9 0 Alt.^^ /~ Bldg. Sewer 3 0 3 ~ • rimed a ~ ,~ St/Ht Inlet ~~ c~ 7 -off 97- ~~ SUHt Outlet r ! Q/1td ~' ~7 • ~7 Dt Inlet by ~ t ~i(p ~, ~~ 3 v Dt Bottom ~ ~ ~ ~~ ~ 3 •~ Head /Man, ~~ 2 X02. 3 Dist. Pipe ~ ~, .3 •~ ) DZ• 2 [ 7 Bot. System .t~ (~ 7 Final Grade St Cover- , v .3 ~~, - ~t11, ~0'1.~ ~T,1Z j00. 2 w~r~r w r~ ~, ~~ ~/• 7 / ~ •~ BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ Sl SETBACK SYSTEM TO P/L i BLDG WELL LAK /STREAM LEACHING Manufacturer: O CHAMBER OR N INFORMATI stem: Type ~ N b UNIT ~ ~' I~ ~ f ~j~ / ~ ~I~GI Model Number: IIISTRIRlLT1nN SYSTEM L ~1-.1-f _ ~~tio.('i>rv~(-'~ (.. 1 Inrn r ~ .n. -(-~x-t ~.~t. /J k1./10/Lrl. Header/ nifold ,, Length! Dia Distribution ~ 2 J Pipe(s) Length Dia Z~Spacing J x Hole Size x Hole Spacing Vent to Air Inta ~ ~ snu rnvFR v Drnccnrn Qve4nm¢ only YY Mnnntt nr' At.~iPAfIP_ SVStP_n15 OnIV Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center BedlTrench Edges Topsoil ~ Yes ~~ No ~~ Yes ~ °] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ Z.5/ ~ Inspection #2: / / Location: 1530 73rd Avenue Hammond, WI 401x51 (NW 1/4~SW 1~/~4 ~3~0 T~29N R17W) Emeravld/,A/c~rte~s Lot 8 ~f PG%arce/l~N~o: 30.~2,9,.1/7/.8Q15~~ 1.) Alt BM Description - t-(Iri.CM,Ut~ ~~~~w'n'U 7 `° ~ ~ ~~4~`~ ~r'+C. / ~ 2.) Bldg sewer length ~ 9 ~~ - amount of cover = ~ ~ / ~~'~w~ """""` - - ---------- - Plan revision Required? i .] Yes ~ No ~ ~ ~i ~. ~ ~ I~~ Use other side for additional information. ~__ ~ 'a ~~ _-~' --~ __ - - - -- Date Insepctor's ignature Cert. SBD-6710 (R.3797) /b ~-ti.ds~ ~ I nd 8uildinga Div}sign Cou, n~ --`~'~ 201 - .~~G'f~'O l•,iC .~_ isconrsiln W t A" i~}'` ~ ~7 -~~~, ^r', J tti/try' erm,t Number (to ba filled in by t:o. Department of Commerce ~ 't~~; ~3I ~~~- Sanitary Permit Appi~cation ~ JUG 1 ~ 2 ~ PI t LD. Number ~ Cn accord with Comm 83.21, Wis. Adm. Code, persotts! information ye provi tray 5e used for seconds ~ ~e ~ >` j "f. ~~J`-2 302 = ~ ry purposes Privacy I.aw, si3.44(1}(m ' S i ~~'' `~}iX(:t3 - • ~~' pp _ _ ~~ ZONtNGOFF CJl~i~t A ss (if different than nrailtng address) ( ' 1• ,'- ticatiort Information - p1~ pritat AI! Ialfortnatlon ~ `~ Property Owner's Na me ~s3~ ~,~ V~ ~// ~/ arcel M of N Bl ck u Property Owner's M ailing Address Property Locador. City, State ~~~Zip Code Phone Numbr:r '~~ ~~ `~0' ~~ '~ •Section ~a_ .$~~ •/CW! T•e r ~ wJ ~~~d ~l z I (clrcle o `j D. Type of Building (check a1I that apply) ~~- 5~~":~`~ T ~~ N: R,~_E o~ (~~ / _ ~ /~" or 2 Family Dwelling -Number of Bedroams 3 _-l~~~'"^S . Subdivision Name -'_____..._ CSM Number ~_,~ Public/Commercial -Describe Use ~~~~"_~ ~~^~~"_- ~ ~'~~~ ~ 1 ~, _. ~ ~ ,~A~,~Os _ ~~ Sate Owned -Describe Use ____ ~_` ^~ _ _ .~--•_~-_____ ___~_ YCr„_./Q-_.L-L r`JCity ^Village,~,awttship of~~-.1N~yD III. Type of Hermit: (Check only one box on line A. Complete line B if applicublel _ ` ~ iVNew System ~J ReplacemNnt System ~ ^ Treatnkuu'Hotding Tank Repiacement Only~ihrr Modification to Existing System ~ i F.-~ _. 1 ______ _ ~ _ ~• ^ Permit Renewal Q Permit Revision ^ Change of Q Permit `Pransfer to New `List Previous Permit Number arrd Date Issued Before Expiratian Plumber Owtter I._ N• TType of POW'1'S Svstem: (Check all that a 1) (~ ~~~"'--~ ~~D ~ ~ ~_~~ - I cy ,.,._ .. _ ._____- _ _ _- _.___.... _, Mound > 24 in. of swtablr soi ~; Mourul c 2~ in, oP suitable soil C i ~ At•Grade ^ Single Pass Sand Filter ~~ t:ortsuueted Wcrlarxt ^ Pressurized In-Ground ^ Holdirg Ta,tk ~ Peat Filte A abic Treat Unit t1 Recirculating Sarni Filter ~ i Rewircutating Synthetic ]vledia Fi]t~r ^ Leaching Chamber [~1 Drjp Ltne Gravel- ess ,~ ~ Ottsrr (explain] ~'.. nispersal/Treatment Area Information: '' Desi n Flow - - _~~-~~~~~ 1 i y8 (gpti) i IJesign Soil Applicatian Rate(gpdsfi ~Dispetsal ,Area Required (sfj~al Area Proposed (sf) ystem Elevation ~ '1''1. Tank Info Capacity in Gallons 'I'otaJ•~ Gallons Numbcr ( of Unite Ma~,ufacturer i ~~ ~~ ~-f ~ PTefab~ Gotterete Sitr Steel r Fiber i Plastic C.nnstructed ~ Glass _ Septic or #loldin Ta a ~~~ Tanks I'anks~~g ~ ~ ~.~~.. ~~ I t c s ~ , /ddb T , G~ ~ ~ erabic Trcaunent Unit Dosing Chansbtr ~,'r! U, ~v_ x~'~""` / f , _ /' ----}.---.--~...._-~~ _ ~__•~-,~i•••••....••...~ ...acciucllt' ii [I18 uYldersi$rltrl, axSW[rr t j Plumbxr's i~a me (Print~~j -~ Plumber's Si gna re '~, a~r 'L,~ - ~f ~ lit G yL1~ Jf'~ yC I ~ Plumber's Addre ss (Street, City, State, Zip Code) ~~ l ~'~~ fur ' ~ llatlon tlf the PQ WTS shown on the attached plans. __ M / PRS Number Business Phoue IVun;ber 1.._._ ~ ~ ~ 9~D ~ ~r5"- - ~8l :mil ~ / VIII, Coun~IDe artnten p~~ ~~ ~~'d,~_`~~^G-.._ S~ ~~ _ ;~ Appravzd ^ D ,,, ;Sanitary Permit Fee ' c,udes Groundwater Bate Issued lssui Agent Signature Mo Stamps) Surcharge fee} ~/2~"" r I.X. Cnaclitbns ~ rav en Aeasan for llreual I' 'f ' `~ ,~"'`^^~ ~'~ Zz/ !-~ ~ _ SYSTEM OWNER:~j~. 19~. ~~ ~ ~ C S`~ 1 Septic tank, effluent fllt~r land ~ ~,,,,~ dispersal cell must all be serviced / meirltained ' as per management plan provided by plumber.. i 2. All setback requirements must be maintained as per applicable code/ordinances. i ~..._ wttarcn complete plruu (w thr County only) rvr the rystorn vn paper not leq [hrn tl/2 : 1 t Y.Y1Th I9nrf .rt n s in.., ~ So,% ec/a/ua~o~,a~ ~ /oca,~ed~prgo .SZ~tt~ •EX~~s~~ ~•-ndi e%>F / ~ L ~pfSGELr~6YDP ~ /DAB ~Ia o,~'EMai'a,~/A~cs .sec 30 Co., cJ/. a Q,~ ~c ~ vs ~3 F~ h m M:d/~t` S . ,E scam ,~/. of ~ `lEu! .IC~.~. \ '9•s~- - 63e- - b~.d a~~ba~cc~~4~ca~ u.x.P 75d -~•tP Pwfi~ ~a.,rbc~ G ~ ~. 3 8~ _ ,~s~. ~ ~ S y 5{c,n A.r eG Y /~R,~asc.d u9test~Cv,~c. ~P 1, ~ -~nQ ~A'b'e-~. V Proposed rr~or.~nd a,~ 20. of x %/.7z'w,~ ton~w~~46t1.4-au ~ ` ~' x 95' ar:sPsrs.~,/ c~N. Two Cs)/a~a/ Q~/Kan'~ R/.~,s~ °.E 5 1 ~ `~4 ~ ce ~ l y'f k. 7~~~ ~ %~ O~; ~ (1J S~9< CeC/ ~°.SJ~ P.U.C. brs:./chi ~. ewi~ Residence / tJ'ee. eer=ioyl~'7.' e / ~ Q p,raAt. ~ , O u ,commerce.wi.gov i ^ iscons~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD lA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi.govJsb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary July 12, 2005 CUST ID No.227990 WILLIAM C SCHUMAKER SCHUMAKER PLUMBING 1070 SCOTT RD HUDSON WI 54016 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/12/2007 Identification Numbers Transaction ID No. 1152302 SITE: Site ID No. 701276 Eldon & Doreena Loescher Please refer to both identification numbers, 1530 73RD Street above, in all comes ondence with the a enc . Town of Hammond St Croix County NW1/4, SW1/4, 530, T29N, R17W Lot: 8, Subdivision: Emerald Acres FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1027715 Maintenance required; 450 GPD Flow rate; 28 in Soil minimum depth to limiting factor from original grade; System: EZ-Flow Mound Component Manual, (N.6/03); Biofilter 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. C031i 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: DERARTMEI OF Approval Requirements: ~~ ~ SEE CORK • This system is to be constructed and located in accordance with the enclosed approved plans and with the EZ FLOW Mound Component Manual (June 6, 2003). with the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems Version 2.0" SBD-10706-P (N.O1/O1). • Comm 83.44(6)(a)2. The orientation of the cell is to follow parallel to the surface grade contours on sloping sites. The upper effective edge of the cell is to follow the 100.83 foot contour. • The observation pipes must be located at a junction point between two EZ-Flow products so as not to create separation of the bundles within a product. • 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 WILLIAM C SCHUMAKER Page 2 7/12/2005 • 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 approvedplans specifications and this letter shall be on-site during construction and ogen to inspection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All 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, ~3 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: James K Thompson , A.C.E. Soil and Site Evaluations Leroy G Jansky, Wastewater Specialist, (715) 726-2544 EZFLOW MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name Eldon & Doreena Loescher 3-bedroom residential mound Owner's Name: Eldon & Doreena Loescher Owner's Address: 49310 Osgood Ave. Stillwater, MN 55082 Parcel) Address: 1530 73rd Avenue Legal Description: Township: County: NWI/4SW1/4, Sec. 30, T.29N., R.17W. Hammond St. Croix Subdivision Name: Emerald Acres Lot Number. 8 Block Number. na Parcel I.D. Number. 018-1098-08-000 Plan Transaction No.: ~E~~,~~a ,Ut 0 5 2p05 e ~ ~~a~ap ~~~~S ~~ ~ ~; a ~. ~ i ~~ Page 1 Index and title Page 2 Data entry Page 3 EZFIow mound drawings Page 4 Lateral and dose tank Page 5 Distribution media Page 6 System maintenance specifications Page 7 Management and contingency plan Page 8 Pump curve and specifications Page 9 Site Ptan Page 10 Soil Evaluation Report Designer: William Schumaker License Number: Date: 06/16/05 Phone Number. Signature: f.~ 227990 §. ~'~, ._,r' ~~ =.~tF~c ~'GS ~'Z`_ ONpENC (715) 386-3121 Designed Pun~uant to the FZFIow Mound Component Manual (N. 06!03), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01!81) EZFIow Mound Version 1.2 (R. 02/04) Page 1 of 10 EZFIow Mound and Pressure Distribution Component Design Design Worksheet Site Inform ation (r or c) r Residential or Commercial Design 300.00 Estimated Wastewater Flow (gpd) 1.50 Peaking Factor (e.g. 1.5 = 150°x) 450.00 Design Flow (gpd) 4.00 Site Slope (°k) 100.83 Installation Contour Line Elevation (ft) 28.00 Depth to Limiting Fador Vin) 0.60 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 6.00 Cell Width (ft) 3, 4, 6, 7, 9, or 10 Only 1.00 Dispersal Cell Design Loading Rate (gpd/ftz) 1 Influent Wastewater Quality (1 or 2) Pressure Disribution Information (c or e} a Center or End Manifold 3.00 Lateral Spacing (ft) 2 Number of Laterals 0.125 Orifice Diameter (in) (e.g. 0.25) 2.50 Estimated Orifice Spacing (ft) _ 0 Forcemain Diameter (in) 40.00 orcemain Length (ft) nside Pump Tank Elevation (ft) 6.50 System Head (ft) x 1.3 (,~.Cl 7.50 Vertical Lift (ft) 0.54 Friction Loss (ft) 14.54 Total Dynamic Head (ft) Lateral Diameter Selection in. dia. o ions choice 0.75 1.00 1.25 x x 1.50 x 2.00 x 3.00 x Treatment Tank Information 1000.00 Septic Tank Capacity (gal) Wieser Concrete Manufacturer Dose Tank Information 750.36 Dose Tank Capacity (gaq 20.28 Dose Tank Volume (gaUn) Wieser Concrete Manufacturer Note: Sand fiA (O) cak,ulations assume a Tat~le 83-44-3 in-sihi sotl treatment for fecal coliform of <= 36 inches. 120.00 Contour Length Available (ft) 75.00 =Dispersal Cell Length (ft) Are the laterals the highest point in the distribution (~Y network? Enter Y or N If N above, enter the elevation ft) of the highest point. 7.50 ft~/orifice Does the forcemain drain back? ~- Y Enter Y or N 8.52 Forcemain Drainback (gaq 46.75 5x Void Volume (gad 53.27 Minimum Dose Volume (gal) 24.72 System Demand (gpm) Manifold Diameter Selection in. dia. o tions ch ice 1.25 x 1.50 x 2.00 3.00 Gallons/inch Calculator (optional) 750.36 Total Tank Capacity (gaQ 37.00 Total Working Liquid Depth (in) 20.28 gaUn (enter result in cell 649) Effluent Fitter Irt,fonnation Zabel Filter Manufacturer A-100 Fitter Model Number Project: Eldon & Doreena Loescher 3-bedroom residential mound Page 2 of 10 Mound Plan View 1_ 1 /10 B • " • Observation Pipe '0 ' K • •..•..,..,..,ti.•..ti,.•,.•,,.ti.,,.•.•ti.•..ti.•.•ti••.••.;•.;ti;ti;ti;•.;ti;ti• .•ti; • . ~. .~B .(. ....~~ .................................... ..... .................................. Lf• . ......................................... ......................................... ......................................... ......................................... ......................................... ........................................ .----_. .~ _~ -. t L Mound Componerrt Dimensions A 6.00 ft E 10.88 in B 75.00 ft F 12.00 in D 8.00 in G 0.50 ft 450.00 (ft2) Dispersal Cell Area 6.00 (gpd/ft) Linear Loading Rate H 1.00 ft K 8.36 ft z 8.20 ft L 91.72 ft J 5.80 ft W 20.01 ft 1065.34 (ft2) Basal Area Available 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 103.50 (ft) +~I H T F t : ; D- cell 102.00 (ft) Lateral 101.50 (ft)--~ ~ 6" ~ Invert Elevation Dispersal Cell :~ : ~ ~ ~ ' ~ ~ t Elevation E ~ ~ D ~ ; ~; .... ..... .......- .• .. .. .• .. .. .. .. .. , . •: • •• •. =.~ .• ~L 'y'~ "~ ~ ~ "• ~- - ~ 100.83 (ft) Contour levation 4.0 °~ Site Slope -#- Typical Dispersal Cell Shading Key ~ a I See Page 5 10 ®Topsoil Cap -°re c 2 0 ft Geotextile Fabric Cover ~~~~~ Subsoil Cap ASTM C33 Sand v © C] m -#- :tirtif~j''r r~f'~~r• tirti srti f• F ® ~,``.. =~ Tilled Layer -` ~ 0.5 ft 'ti:'ti:' :.ti,ti,tir. •tirti~,~r Q50 EZFIow Media ~ ~ --,~- 'f'r' . r' •f •f ~ _i._ ~--- A -# See details on page 4 for number, size, and spacing of laterals. Laterals are located in the 4" gravity distribution pipes as shown on page 5. -T -~ _~ -i Project: Eldon & Doreena Loescher 3-bedroom residential mound Page 3 of 10 End Connection Lateral Layout Diagram Place Appropriate Lateral Diagram From Right Below • =Turn-up wlbal I valve or alesnoutplug ~- P - Z ~ 1st orifice beaked ek Z ~ X-~I Orifices pd~ ~ except y 5th S orle points down for drairceige. _ _ ~ Fore¢ main aorrmcxion pia tee or cross to man~old at any point. Laterals ~ force main of F'VC Sch 40 All laterals identical w311 orifices equaYy spaced. (per CONNA Table 84.30-5) Number of Laterals Lateral Diameter Lateral Length (P) Lateral End (z7 Lateral Spacing (S) Lateral Flow Rate System Flow Rate 2 1.25 in 74.19 ft 0.82 ft 3.00 ft 12.36 gpm 24.72 gpm Orifice Diameter Orifice Spacing (X) Orifices per Lateral Orifice Density Manifold Length Manifold Diameter Forcemain Velocity 0.125 in 2.53 ft 30 7.50 ft2/orifice 3.00 ft 1.25 in 2.52 ft/sec Dose Tank Information Electrical as per NEC 300 and -- Comm 16.28 WAC ~_, ~ Disconnect Tank component is properly vented Wieser Concrete Ca acit 750.36 Volume 20.28 Manufacturer Gallons gaUnch Dimension Inches Gallons A 20.37 413.17 B 2.00 40.56 C 2.63 53.27 D 12.00 243.36 Total 37.00 750.36 ~- A B C D Min. 3" Beddinsa under Alarm Manufadurer LevelArm ~ - ' Alarm Model Number 101 DLV Pump Manufacturer Goulds 3871 _ ~ ~~ Pump Model Number EP04 Pump Must Deliver 24.72 gpm at 14.54 ft TDH Locking cover with warning label and bcldng device, and sealed watertight i 4 in. min. ~~ F- Aftemate outlet kxxtion Forcemain diameter ~ 2 in. Weep Hole or anti- siphon device P~ umP off elevation (ft) 94.50 •Dose tank elevation (ft) 93.50 Project: Eldon & Doreena Loescher 3-bedroom residential mound Page 4 of 10 EZFIow Distribution Cell Media Layout 6.00 Cell Width (ft) 1.50 Sidewall to Lateral (ft) Distribution Cell Cross-section Arrangements Drag appropriate drawing to space below. 6 ft Wide ®® ®® ® 6" EZFIow Bundle - EZ0601A, 5 or 10 Foot Lengths 12" EZ:FIow Bundle - EZ1203H, 5 or 10 Foot Lengths ® 12" EZFIow Bundle - EZ1203HP, 5 or 10 Ft Lengths ~ 4" Distribution Pipe With Pressure Lateral Inside ~ Tumup EnGosure - - - - Lateral Distribution Cell Plan View Layout -Typical 6.00 Cell Width - A (ft) 75.00 Cell Length - B (ft) Center Connection Lateral Layout Diagram Drag appropriate drawing from left to space below. Force Main Mound Svstem Maintenance and Operation Specifications Service Provider's Name (N Bill Schumaker ~ Phone (715) 38&3121 POWTS Regulator's Name St. Croix County Zoning Dept. ~ Phone (715) 386-4680 SYStem Flow and Load Parameters Design Flow -Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow -Average 300 gpd Maximum BODS 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ftz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service FrepuencY Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other Ins d and/or service once eve 3 ears Should ins d and clean at least once eve 3 ears Test once eve 3 ears Should test month) Laterals should be flushed and ressure tested eve 1.5 ears Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the EZFIow mound component manual. 2. Dispersal cell media conforms to EZFIow products approved for use with the EZFIow Mound Component Manual approved 6/3/03. EZFIow media is covered with an approved geotextile fabric. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Tum-up Detail Finished •..~~~........ ............... Grade ~8" Diam~er Lawn ~/_ Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve ........ ........ ......... ....... ........ ........ ......... ........ Lateral Ends at Last Orifice Where .......... ... Variable Length Cleanout Begins ~`~'~~s :~`S"s's`5-'~.~~s- s'S-~-`~~~s Long Sweep 90 or Two 45 Degree Bends Same EZFIow Media Diameter as Lateral 2.13 Feet ~ Distribution Lateral • ~-- Lateral Cleanout Project: Eldon 8~ Doreena Loescher 3-bedroom residential mound Page 6 of 10 Mound System-Management Pian Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 824 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [EZFIow Mound Component manual 6/3/03 and SSWMP Publication 9.6 (01/81)) and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from tts enclosure. If the filter is equipped with an alarm, the fitter shall be serviced if the alarm is activated continuously. Intermittent finer 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 blobgical or chemical additives to enhance septic tank pertormance 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 verity proper operation. If an effluent filter is installed within the tank tt shall be inspected and serviced as necessary. MQUnd and Pressure Distribution Svstem No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended sirx:e 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 muk:hed as protection from freezing. Influent qualtty into the mound system may not exceed 220 mg/L BODs, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS, 30 mg/L TSS, 10 mg/L FOG, and 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 tt is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is pertom>Bd tt should be compared to the initial test when the system was installed to determine if orifice Dogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes wtthin 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. C~tinaency 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 pertormance. 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 tce leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Eldon & Doreena Loescher 3-bedroom residential mound Page 7 of 10 ~,~~ GOULDS PUMPS • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. 3Q~1 EP04 o . EP05 APPLICATIONS Saecifically designed for the r'ollowing uses: • Effluent systems • Homes • Farms • Heavy duty sump • NJater transfer • Dewatering SPECIFICATIONS • Solids handling capability: • Capacities: up to 60 GPM. • Total heads: up to 31 feet • Discharge size: 1'/z" NPT. • P.~echanical seal carbon- rotaryiceramic-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, 1 15 or 230 V, 60 Hz, 1550 RPM, built in overload with ,~ automatic reset. -~-, •EP05 Single phase: 0.5 HP, 115 V or 230V, 60 Hz, 1550 RPM, built in overload with autemaUC reset. • Power cord: 10 foot standard length, 16/3 SJTOW avith three prong grounding plug. Optional 20 foot length, 16/3 SJTW with three prong grounding plug (standard on EP05). s 2002 Golds Pumps _ife:*.~e 5e;r,ember, 2002 X3071 5ubmers~ble Effluent ~um~ 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. ^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 ~.nd lor~r~r heavy duty ball bear ng construction. AGENCY LISTING SP' Canadian S[andard~ Asscc.ato~~, Goulds Pumps is I)0 90U? kegisteri d __ _._ . _ _ -__._ . _ . I.._... _.. -_._ _ . R ~ ~ - 10 - ~-- --- - - - - I 301 -----_ 'L _'_ _ _~,.._ _. -_..- ~I ir_- ~ r-5G'rM 8 Q 7 i. _ ' ' _ w , _ ~ ~. -.. ~ 6 20 --- - t--- -- - -- - I ~ /~ a _. '_ _ ;- 5 - +---- - - - - -- --- - .j - Q 4 _ .. .- ~ EN05 -. o II ~ 3 10F I ~....... .. .. - .. - - t- - _._ _ ___ - --- - I ~ ~ 2 i ~ _.-. 1 _. -....- _. - ... _. ! EP04 .. . 1 __ ~._- __ ~..__ __... 1 . ;_ . .._.. _ _. 0 OQ 10 ZO 30 10 50 GPM .ZS~•7.2~yo.~n. M%n%ma,n Sapp/y-^a.de ~' a.~rcd ' ---~- - 0 2 4 6 8 10 ' i n ,' h CAPACITY Goulds PurnE~s ~~ ITT Industr;es v ~~ ~ So,% evb/uav~'o~ ~'~ ~ /aca.~ed~prgo .sz4~~ • EX~~~~ ~.ad~ efe U 3 .s9• Lo~•SG~~j9ro~?, /0~6 .a/a ~ of'E~ro,~'a,~'~Fcres .sec 30 T, a~~a-i~rnonc~ .~•~~,c d \ ~,~ ~ ~c ~ cs P3 O~ V7 O\ \ M:d/it S . ,f ssum c7ev! c ic~.a7; \ 9•so 9 _---g3e" Wiscot-sirr Deparhnerrt of Commerce Division of Safety arxi Buildings SOIL EVALUATION REPORT in accordance with Comm 85. Wis. Adm. Code 1925 page 1 of s A.C.E. Sal & Site Evaluations County Attach complete site plan on paper rat less tl>an 8;4 x 11 inches in size. Plan must St Croa include, but rat limited to: vertical and horizontal reference point (BM), direction and percent slope, scale a dimensions, rarlh arra~v, and location and distance to nearest road. Parcel LD. 018-1098-08-000 Please pI711L` a/l iM`ormatlon. Reviewed By Date P'ersot~al iniorrnation you provide mey be used for aeoorbaY purposes (Privay Law, s. 15.04 (1) (m)). Property Owner Property Location Eldon ~ Doreena Loescher Govt. Lot NW 1/4 SW 1/4 S 30 T 29 N R t7 W Property Owners Malting Address Lot # Bkxdc # Subd. Name or CSM# 49310 Osgood Ave. 8 Plat Of Emerald Acres Cdy State Zip Code Phone Number J City ~ Village /J Town Nearest Road Stillwater ~ MN 55082 Hammond 1530 73Rd Ave. /_! New Cor>strtrction l1se: ~ Residential / Number of bedrooms 3 Code derived design flow rate 450 J Replacerr>ent Public or commercial -Describe: Parent material Glacial drift over weathered sandstone bedrock. Fkrod Pain ~~, ~ applique na General c«nments and reaomrrrendations: Site suitable for mound with 6' x 75.0' dispersal cell. Minimum system elevation = 102.50' at 8" above 101,83' contour. GPD J Pft Ground Surface elev. 101.15 ft. pepth to limfing factor 28" in• a# ~~~ Sal Application Rate Horizon Depth Dominant Cobr Redox Description Texture Sfnrcture Consistence Bourxiary Roots GP D/ft' in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-12 10yr'32 none sil 2fsbk mvfr cs 2f,1 m 0.6 0.8 2 12-17 10yr4/4 none sil 2fsbk mvfr gs 2vf,f 0.6 0.8 3 17-28 10yr5/4 none sil 2msbk mfr gw 1vf,f 0.6 0.8 4 28-36 10yr5/4 f2d 7.5yr5/8 sid 1 msbk mfr - - 0.2 0.3 Heavy 10yr 812 sib coats observed on ped faces in horizons fk4 & 5. i # J ~~ J/ Pit Ground Surface elev. 101.32 ft. Depth to limiting factor 37° in• Sal Application Rate Horizon Depth Dominant Color Redox Description Texhue Structure Ca>sistence Boundary Roots GP O/fP in. Munsell Qu. Sz. Cad. Cokx Gr. Sz. Sh. 'Eff#1 `Eff#2 1 0-9 10yr32 none sil 2fsbk mvfr cs 2f,1 m 0.6 0.8 2 9-22 10yr4/4 none c~jl 2msbk mvfr gS 2f,1m 0.6 0.8 3 22-29 10yr4/6 none sl 2msbk mfr cw 1fm 0.6 1.0 4 29-37 10yr5/6 none s Osg ml cw 1vf,f 0.7 1.6 5 37-44 10yr7/4 t2f 7.5yr5/8 fs 0 sg ml gw 1 of 0.5 1.0 6 44-58 10yr7/4 m2 SSBR Om mfi - - 0.0 0.0 ined to be SBR as determined by resistance to penetration. ' Effluent #1 = BOD ~ 30 <_ 220 mg/L and SS >30 < 150 ' E #2 = BOD < 30 mg/L and TSS <~0 mg/L CST Name (Please Print) re: CST Number James K Thompson S`--- ~~ Address AC.E. Sal 8 Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceda. 54020 6/15/2005 715-248-7767 Property owner Eldon & Doreena loeSCher Parcel lD # ols-logs-os-ooo Page 2 of 3 # J Boring 3 ~~ 1/ Pit Ground surface elev. 99. so ft. Depfh to limfirtg factor 31" in. SoJ Application Rate Horizon Depth Dominant Cobr Redox Desaipton Texture Stnrcture Consistence Bourxfary Roots in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-12 10yr32 none sil 2fsbk mvfr cs 2vf,f 0.6 0.8 2 12-23 10yr4/4 none sil 2msbk mvfr gs 2vf,f 0.6 0.8 3 23-31 10yr4/6 none sl 2msbk mfr cwv 2vf,f 0.6 1.0 4 31-38 7.5yr4/6 t2f7.5yr5/8 s Osg ml Cori 1vf,f 0.7 1.6 5 38-51 10yr5/4 m2d 7.Syr5/8 sid 2msbk mfr - - 0.4 0.6 Heavy siN Coates observed on ped faces in H#5. Boring #_J Boring J Pk Ground Surface elev. ft. Depth to limiting farxw in. Sal Application Rate Horizon Depth Dominant Cobr Redox Desaiption Texture Stricture Consisterxx Boundary Roots in. Mansell Du. Sz. Cori. Color Gr. Sz. Sh. `Eff#1 `Eff#2 ~ # J ~~ J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Appliption Rate Fbrzon Depth Dominant Cobr Redox Description Texture Stnrcture C«isistence Boundary Roots in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent #2 = BODS < 30 mg/L and TSS <30 mg/t_ 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. .' \ Qi:) ~C ~ \ Q.r P3 P'~ \ \ id'(idlOfi b~ ~7CV; - l~.~,~ 82 •/ 9'~~--- " _---g3~' ~ "'_ -- ----------- --------- ~a7.oo' ~ju El eU - Ko td= 5 5-t ern Con ia~. 80' ~ ~ or ,~~ 5/ope ~.rak~L ~ SyS{c,n A~'"tLt s v L 4L~.Q.M.: 1'~4;I ;n lam' e~d« ~ /oca.~d~prgo Sztt~ ~ EXi ~S~~q ~ radi e% r~ 4 ~OCx.,tC.r~BYOf ~ /OMB A/a of'E.nc~-a,~/~crts .sec 30 h 1 VY~or>Sm~Deparhnerrt of Corturrerce Division d Safely and ~~~~I~~~ SOIL EYALU PORT ~# ~ ~ i` ' witiYscdr~{~~,, w `~ 1925 page 1 ~ 3 A.C.E. Sal & Site EvaNrations ~~ Attach site plan an paper not than ~~ x yi 3b~t~ 1~ m St Crobd include, but rat united to: and _ action \~/ , ~ Pard~l I D percent sbpe, sd~e a dmemsiorrs, north to est road. / . . 18-1098-08-000 P/ea8@ p/%IflB/l1/Ifd/Itla~OJf. R ~ Date Personal idannarion You pavide may be used for secondary WP~s l~Y law, s. 15.04 (1) lm)). p ~ 0~0 S~ Property Owner Properly Location Eldon & Doreena Loescher ~- Lot NW 1/4 SW 1kl S 30 T 29 N R 17 W Properly Owner's AAaiLing Address lot Block # Stud. Name or CSN~ 49310 Osgood Ave. 8 Plat Of Emerald Acres Cily State Zip Code Phone Number ~~ Cily _J Y~age ~ Town Nearest Road Stiluvater ~ MN 55082 Hammond 1530 73Rd Ave. /~ New Ca>structiort ~~ tI Residenfi~ / Nurrrber of bedrooms 3 Code derived design flow rate 450 ~ Replacerrlertt J Pubec or corrnnerdtial - Descr~e: Parerrt material Glatt drift over weathered sandstone bedrock. Flood plain elev~iort, if applicable na Gerterat cornrtrer~ and nExorrxrter>d~or>s: Site suitable for mound with 6' x 75.0' dispersal ceN. Minimum system elevation =102.50' at 8" above 101.83' d~ntour. GPD a Pit Growrd Stsfiace elev. 101.15 ft. D~ ~ yg fir 28" m. ~~ Sod AppYcation Rai Horizon Depih Dominant Cobr Redox Description Textrrre Structure Consistence l3ourrdary Roots GP D/ ft~ rcr. Mur>SeM Qu. Sz. Com. Color Gr. Sz. Sh. 'Eff~1 'Etftf2 1 0-12 10yr'3/Z none sd 2fsbk mvfr cs 2f,1 m 0.6 0.8 2 12-17 10yr4/4 none sd 2fsbk mvfr gs 2vff 0.6 0.8 3 17-28 10yr5l4 none sti 2msbk mfr gw lvgf 0.6 0.8 4 28-36 10yr514 f2d 7.5yr5/8 sid 1 msbk mfr - - 0.2 0.3 Heavy 10yr' 6/2 silt des observed on pad faces in horizons #4 8 5. Q Boring ~ ~ ~B tr Pti Growid sw~face elev. 101.32 tt. pepth to uniting factor 37" ~- Sotl Applicaoion Rate tior¢on Depth Domerant Cobr Redox Description Texttce Stnrctrue Consistence t3oundary Rom GP D/ftz ar. Mansell t]u. Sz. Cord. Cabr ~. Sz. Sh. 'Effr1M 'EtT#2 1 0-9 10yr32 none sti 2fsbk mvfr cs 2f,1m 0.6 0.8 2 9-22 10yr4/4 none sil 2msbk mvfr gs 2f,1m 0.6 0.8 3 22 29 10yr4/6 none sl 2msbk mfr cvv 1fm 0.6 1.0 4 29-37 10yr5/6 none s Osg ml cvlr 1vf,f 0.7 1.6 5 37-44 10yr7/4 t2f 7.5yr5/8 fs O sg ml gw 1vf 0.5 1.0 6 44-58 10yr7/4 m2 SSBR Om mfi - - 0.0 0.0 b be 'rred by resistance to pertetr~on. ' EHtuerrt #1 = BOD ~ 30 < 2al) mglL and SS >30 < 150 ' E #2 = BOD < 30 mglL and TSS <~?0 mg/L CST Name (Please Print) CST Number James K Thompson ~- 3602 Address AC.E. Sal 8 Stie Evaklatia-s Date Ev~ttation Conducted Telephone Nurr~er 340 Paulson lake lane. Osceola. 54020 6!15!2005 715-248-7767 Property O~ Eldon & D~oredl0 Loesdler Parcel ID # 018-1098-08-000 Page 2 of 3 Pti Ground Surface elev. it. ~ to limtiin9 factor 31" in. ~ gppliptior- Rate Har¢an Depth Doma~d Cdor Redax Description Texture Stnxrdre Consistence Bourd~y Roots in. tMNxrsefl Cu. Sz. Cont. Cabr G;. Sz. Sh. 'Eff#1 •Eff#2 1 0-12 10yt3/2 none sil 2fsbk mvfr cs 2vF,f 0.6 0.8 2 12-23 10yr4J4 none sil 2msbk mvfr ~ Zvff 0.6 0.8 3 23-31 10yr4/6 none sl 2msbk mfr cw Zvf,f 0.6 1.0 e 4 31-38 7.5yr4J6 f2f 7.Syr5/8 s Osg ml cw- 1vf,f 0.7 1.6 5 38-51 10yr5/4 m2d 7.Syr5/8 sid 2msbk mfr - - 0.4 0.6 Heavy sYt observed on ped faces in H#5. 1 1 ew_ s ' '~ Bor~tA ~.,.. ~ m '~ ~ j Pd Grarard Surface elev. ft. Deptl~ to limiting factor in. ~ q~~ ~ Fbr¢on Depth Dominant t',olor Redox Descrpfion Texhxe Sfn>ciure Consistence Roots ~. AMxrsefl t1u. Sz. Cord. Cobr Gr. Sz. Sh. 'Etf#1 'Eff#2 c...:.... ~ firing Effiuer~t #1 = BOD ~ 30 < ~0 r~ and TSS >30 < 150 mg/L • Effluent #2 = BODS<30 mglL and TSS <~0 mglL The Deparixnent 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 TTY608-264-8777. r • /oca.~ed~Jr'go s~r~ ~ EXiJ~~q ~.zadi e%,f 3 .sy' ~'EMara,~./.f~~s .sec 34 4,~ ' ~c ~ vs e~~ ~ ~ m ~ h \ M~dlo6 b~t'e. fissu.,ud c7er~ - ~a~,~o., i r 4+~'--- - _ I g3.' ~ ___ ---------___ -- --------- /~.oo~ 2 ion ~u. ~~QU, ' /m ~-S S Sf n'1 io0.8=~ /oo.iJ3, /cv.8o ,,//~~ / V2 _,_.-~_-___-_-~--- --------= o~Sp' ,~~ 5/op~ .~r~ y c. „~ S y 5{e,n f~''" s V L `1.1 ,4 Lb.,6.rY1 ~ ~Q~' i /1 ~j' C ~C~tr tr«. EIuF ~id~F.YI: ~, 303 ` ~ / ~ i 1 Wisconsin Department of Commerce Division. of Safety and Buildings ,\ SOIL EVALUATION REPORT ~~ ~ Vv~ Page ~ of 3 111 O\.WIYGIII.r. YYiVI VVI11111 VJ, rvw. nuu~. vvuc County ~ CrUi Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must . ~ include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print a!I information. Reviewed by .. , Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location "TOI~-I Govt. Lot ~w 1/4scr/ 1/4 S?j0 T Lg N R j ~-E (or~ Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# I a ee Tr~ ~ ~mer~zld ~reS City State Zip Code Phone Number ^ City ^ Village ®Town Nearest Road 73 ! ( I 54q-( vl ~-I-O-( I-E an I , 4 / so'~ S~ ~ ) ~ , m , ,~,~ [~ New Construction Use: ~ Residential /Number of bedrooms 3 _ y Code derived design flow rate ~/ ~O~/ r!v 4 d GPD ^ Replacement ^ Public or commeraal-<Describe: Parent material ,~l ~ ~ ~ _ Flood Plain elevation if applicable /~/ / I'T ft. Ger-eral comments S ~C I'll e ~ e 1/ ~y and recommendations: ~` I Boring # 1^~ Boring ~ (; ~~ b _._ LT. pit Ground surface elev. _ ft. Depth to limiting factor ~ -_ in. sr ~- ~V C it Appli Uon ate Horizon Depth Dominant Color Redox Description Texture Structure Consistence B`piir~clary GP ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ' ~ t, ff#2 I 0 -lZ Ib 3~Z - 5i i 2mc,..bk rr,~-~ ~5~~~.~. i ~ _~.~ ~: . ~ Z ~ 2 -3D (b r y I `~ - s i I Zm bk rY~-1-r c - . 5 - S 3 p-4s ID,~~ylc~ CZ¢~ -1.5 r ~I ~ s~ ZmSbk ~r - - . 5 - `~ a Boring # ^ Boring 0 Pit Ground surface elev. ft. Depth to limiting factor 2 ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 *Eff#2 I o-~~ iU 12 - s; l Zm rr>-~r- ~5 I ~~ - 5 . 8 Z 11-29 I~f - k m-~r ~s - 5 .8 3 Z9- ~1 D y/ P ~~5 r `~/~ s~ m-~r - ~- * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 _< 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CS Name (Pleas riot) 'nature CST Number n ,er- ~- ~- 2 s3 30 Address Date Evaluation Conducted Telephone Number 2-IJ3 FSb~' S~. ~~r7x~~ ~CJI 5~d z,s- l z -~ ~-a ~ ~7~s~Z~r ~ yQO~' ~~ Property Owner ~ l I Ul~~ Parcel ID # Page ~ of Boring # ^ Boring i ® pit Ground surface elev. _ _ ft. Depth to limiting factor 2~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 ~ D -9 1 Z "! Z.rr~h ~ c I v ~ 5 -8 Z -Ls ~o ~ I si / 2nn k t- ~ -- 05 . 3 5-3g i 4l CZ ~.5 ~~ L ~< ~ ~ _ . 5 ^ Boring # ^ Boring pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon De th Dominant Color Redox Description Texture Stratton: Consistence Boundary Roots GPD/ftz p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ^ Boring # ^ Boring pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mglL 'Effluent #2 = BODS < 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. SBD-8330 (R.07/00) ~'~` ,: Property Owner ~ 1 I UL~~ Parcel ID # Page ~ of Boring # ^ Boring - - - ® Pit Ground surface elev. ft. Depth to limiting factor 2~ in. Soli Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munseli Qu. Sz. ConL Color Gr. Sz. Sh. *Eff#1 *Eti#2 ~ D-9 I Z "1 2 ~'t- c Iv ~ 5 ' g Z -Ls ~0 4 Si / Zm ~ r ~ - 05 " 3 --3g ~ 4/ CZ ~.5 `~ L k ~ ~ ~ 5 " ^ Boring # ^ Boring pit Ground surface elev. fL Depth to limiting factor ~ in. Soil Applicaton Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 ^ Boring # ^ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox [?ascription Texture Structure Consistence Boundary Roots GPD/ftz in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Efff#2 * 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. 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. SHD-8330 (R.07/00) . _.. ~- r PAGE 3 OF~ NAME !J~ LOT# c~S T EGAL DESCRIPTION ,Uw ~~~ ,~3G T Z~ .N.R. / ~ ELorYCI) SCALE: 1"= /~J ~ BM 1 ELEVATION /00. 0 BM 1 DESCRIPTION ~p a ~ / ~®uG BM 2 ELEVATION j~', ~ BM 2 DESCRIPTION ~p a ~ /, ' ~vC SYSTEM. ELEVATION 9~ O d SYSTEM TYPE rYlounc4 S~r~~tn%1 CONTOUR ELEVATION ~~ d U Y~ a Q -- . g~ 2 N I _ ~+ - f ~~ ~ SIGNATURE ,~ _ ~~%= r - DATE S~ // C~~ sT cRO~ covNTY SEPTIC TANK MAII~IBNANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwutrBuycu ~. ~ o r. -+-- ~ ©R~ L- ~ ~ s c~2 (Z_ Mailing Address ~~~ Property Address ~ ~ S3c~ ~ ~ ST lbw al`+~s~' (V~gtian required from Platwiag Department for new City/State Parcel Identification Number _ 4/$_~0 98- O~ Oz~~B(S) ~P'~Y L,ocationl~ W y., S ~ %., Sec.3 o T~N-R ~ ~ W, Tawn of ~m~. Subdivision ~-~~ cz~~ c~ ~c.~~.s g Lot # C.ertifled Survey Mag # ~,,,,, .Volume .Page # Wnrrnnty Deed # 7l, ~ ~~~ .Volume „~~~" ,Page # ~.3 _ Spec house D yes ~ no Lot Tines identifiable ~ yes D no ~t~?'~M 11~~nAlvc~ Iaopropor uaa sad maintenaacx of your septic system could result in its premature failure to handle wastes. Proper maintenance ooosists of pumping out the septic tank every three years or sooner, if needtd by a licensed pumper. What you put into the system can affect ffia fuaetioa of the optic tank as a troatmont stage is the waata disposed system. The property owner agrees to submit to St. Croix Zoning Department a certification farm, sigaea by the owacr and by a nusborplumber, journeymaaplumber, rastrictedptum6er or a liccaaed pumper verifjri~ng that (1) the on-site wastewater disposal system is in proper opecatiag condition and/or (2) at3er iaspoctiou sad pumping (if' nocossar}-), the aoptic tank is loss than iI3 bull of sludge. ~"a. the uadmsignod have read the above rcquireaieats and agree to maintain the grivata sewage disposal system with the standards set forth, hareia, as set by the Department of Commerce and the Department of Natural Resources, State of Wiacansin. Certification stating that your septic system has been maintained must be complatod and retuzned to the St. Croat County Zoning Office within 30 days of the thra year oxpiratioa data. _~~ ~ QNATURB O AP ICANT DATE ~1,~, ~R CER'~~ I4N " t (we) catif~r that all atatemaats on this form are true to the best of my (our) knowledge I (wc) am (aro) the owner(s) of the properly described above, by virtue of a warranty deed recorded in Register of Deeds Otlice. tsIC3NA1'IIRS OF APPLICANT DATE ssss•s Any infornution that is m3s-rapreseated may result in the sanitary permit being revoked by tt~e Zoning Dapaslmant. *«*`«« «« Include vrlth tWt application: a stamped wamaty deed from rho Register of Deeds office a Dopy of the oertitied atrrvey mop ff reference is nude is the warranty deed J 216 8 f' ~i 73 STATE BAR OF WISCONSIN FORM 2 - 1998 t WARRANTY DEED Document Number This Deed, made between __ RTl'HART~ ('1 _ CTfITTT grid .TANF.T P _ STOUT __ ', hu~aYtand and wi fPi __ _ _ - __ _, Grantor, and RT.f)!~N .T T.f1F RC`HFR anr9 __LT(~RFF.NA jy T.CI F.SCHT+'.$,_ . Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate In R t ('rp i ~r -County. State of Wisconsin: Lot 8 Plat of Emerald AC~s, Town of Hammond, St. Croix County, Wisconsin. ~'~- ~ ~/~'~-t" (SEAL) Janet P. Stout __ Parcel Identification Number (PIN) This is not homestead property. (IS) (is no[) Exceptions towarrantles: easements, restrictions, rights-of-way and covenants of record. Dated this 5'F` day of March 2003 ~~-~'~L O t ~ (SEAL) *~ Richard O. Stout AUTHENTICATION Signature(s) (SEAL) authenticated this day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06. Wis. Stats.) DEBORA!~ A. STAYBERG Notary Public THIS INSTRUMENT WAS DRAFTED BV State of Wisconsin Janet P. Stout '1353 Awatu]see Tr Hudson, WI 54016 s 7 1 2 8 8 3 HATHLEEH H. MALSH REGISTER OF DEEDS ST. CROIX CO.. WI RECEIVED FOR RECORD 03/12/2003 08:30AM EXEMF°T >Y REC FEE: 11.00 TRANS FE£: 209.70 COPY FEE: CERT COPY FEE: PAGES: 1 r7.q r~iir a Ar Name and Return Address 018-1098-08-000 ACKNOWLEDGMENT (SEAL) State of Wisconsin. ss. St _ Croix County. Personally came before me this .S ~ day of March _, 2003 ,the above named g; r-harA n Stnt~t and Janet P _ Stt~t~t _ _ to e known to be the persons who executed the foregoing ~istrument and acknowledge the same. . - , Notary Public, State f Wisconsin My commiss n i permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not _~ ~~b .) necessary.) • Names of persons sigNng in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal 8iank Co.. inc. WARRANTY DEED FORM No. 2 - 1998 Milwaukee. 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