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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No, 57 365 )' 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: i �G Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Emmert Living Trust, Jerry & Nicoll e Erin Prairie, Town of 012-1050-60-100 CST BM Elev: Insp.BM Elev: BM Descrip' n: Section/Town/Range/Map No: „S"i�>ff;�.�,. ;, �Gov� B s 22.30.17.345B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Sept_ ` /� Benchmark `a/ I d Q U Dosing / Alt. BM Aeration Bldg.Sewer r� . c Holding St/Ht Inlet SG/l yd VCw s p (O TANK SETBACK INFORMATION St/Ht ou t �Gt fec�a� 40r: � TANK TO P/L WELL BLDG. Vent to Air take ROAD DtInlet k Dt Bottom eade/Man.CG ,(J� Aeration Dist. Pipe �J 4D f Holding Bot. ystem 73 Final rad MP/ IPHO NFORMATION ]Tv x ? Z Me9faeurer Demand St Cover GPM , 3, i I F 11 91 Model Number V TDH Lift Friction Loss Sys Head T Ft Forcemain Len Dia. Dist.to Wel SOIL ABSORPTION SYSTEM BEDITRENCH Width I Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 2 SETBACK SYSTEM TO P/L JBLDG WEL LAKE/STREPM"y LEACHING Man facture / INFORMATION CHAMBER OR Typ f System: �° ��y� UNIT Model Number: DIS IBUTION SYSTEM_ .. e (% - _ p� eA Heade anifolp /�_ tion i( x Hole Size x ole Spacing Vent to Air Intake t' " Pipe(s) 3 Length Dia Length � Dia Spacing SOIL COVER x Pressure Systems Only 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 Yes No Yes ! No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: !/ 1471 t/IvInspection#2: Location: 1880 140th AvePal�d�winn,WI 54002(SE 1/4 SSE 1/4 22 T30N R1 7W) NA Lot AJ� ea cel No- 22.30.17�34513 1.)Alt BM Description= ► 1 y'`�� ✓��/j'l VL?3 �-C�( '� CL(/�( D J 2.)Bldg sewer length 'Iy - kGcv�1.- -amount of cover= 3.)Contour Plan revision Required? r Yes 1#/No Use other side for additional (� I r y - information. Date Insepctor's Sign. re Cert.No. SBD-6710(R.3/97) Ti ,4 Y, 13. I-N C.N. El 7 4- 0 oEpannr�lT County �s Industry Services Division 1400 E Washington Ave i C P�71 San itary Permit Number(to be filled in by Co.) Ma2 / /s (� H SSfOI3P1Y•. „';+*°ate y l! J YJ�gC4 itajw Permit Application State Transaction Number In accordance with SP 83.2 2 ,6 es. (t e,submission of this form to the appropriate governmental unit Z T - v 2 is required prior to obtaiit ' mmit. Note:Application forms for state-owned POWTS are submitted to the Department of ty;aariifessional Services. Personal information you provide may be used for secondary Project Address(if different than mailing address) purposes in accoNaRV etli the Privacy Law,s.15.04(1)(m),Stats. p� / I. A lication Information—Please Print All Information / 00 Property Owner's Name Parcel# -/0d Property Owner's Mailing Address Property Location i,� 1 Govt.Lot I J City,State Zip Code Phone Number J_it %,S E '/4, Section z-Z kJ�t<�/w N J'Yu 0 7 7ir-2- y 6 -1'3 7,3 circle one) T 30 N R/� EorW H.Type of Building(check all that apply) Lot# ❑ 1 or 2 Family Dwelling—Number of 110araoms Subdivision Name � �' � ti 'Public/Commercial—Describe Use .?•�t.�,►'�(-����.���-� Block# ❑ City of ❑State Owned—Describe Use CSM Number ❑ Village of ® Town of tf,N 4 i III.Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain) B. ❑ Permit Renewal Permit Revision ❑Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. S S em/Com onent/Device: (Check all that apply) t-Non-Pressurized In-G_rou�nd� Pressurized In-Ground ❑ At-Grade ❑ Mound>24 in.of suitable soil ❑ Mound<24 in.of suitable soil o tC--EJ t e6h r Dispersal Component(explain) Pretrgatrrtent Deyice(explain) 02 b V.Dispersal/Treatment Area Information: Design Flow(gpd) Design Soil Applicatio k; Dispersal Area Required(sf) Dispersal Area Proposed(sfj System Elevation 3c� 4 Rate(gpdst) 7 3 7,_ 87.30 15.3 VI.Tank Info Capacity in Gallons Total #of a 2 ° 2 Manufacturer ro r U h ` Gallons Units g i ' New Tanks Existing Tanks / C f. U in ; � u„ C7 e ti or Holding Tank 7 ,1 dA C7 / lS Gt vim/ ❑ ❑ ❑ ❑ Dosing Chamber ❑ 1 ❑ I ❑ ❑ ❑ VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plum s Name(Print) Plumber's Signature Number Business Phone Number ac kC l�ccwj�,'� 5. 1 Z�0 L_ ?/J- Y91—.53678 Plum er's A dress(Street,City,State,Zip Code) P6 1, K w: 37WS3 VIII oun /De artment Use Only VAPproved ❑ Disapproved Permit Fee Date ssued t-� Iss ' igna rip'l ❑ Owner Given Reason for Denial $ .) `"�� , f ( ( ` « 'L` e✓" / IX.Conditions of Approval/Reasons for Disapproval - L C, ti t Z_. �D —/o��'�S— w v 1�U : ,C a I�- c G� c�_f,13 l L �11 Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 ches in size j J� `� t "z-... C`�' e,'t,G'�t GL� L ,-- ''P.�:�z� ADZ �l�%+ti t`- SBD-6398(R03/14) 9ti4ARTUN DIVISION OF INDUSTRY SERVICES y4' roe 10541 N RANCH ROAD of HAYWARD WI 54843. 3 t Contact Through Relay 'M www.dsps.wi.gov/sb/ www.wisconsin.gov �A J �OFZSSION F+1 Sw4 Scott Walker,Governor Dave Ross,Secretary November 13,2014 CUST ID No. 222872 ATTN:POWTS Inspector JACQUE M 14AWKINS ZONING OFFICE HAWKINS SOIL TESTING&SEPTIC SYSTEMS ST CROIX COUNTY SPIA PO BOX 2 1101 CARMICHAEL RD LUCK WI 54853 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/13/2016 Identification Numbers Transaction ID No.2475028 SITE: Site ID No. 804217 Emmert&Sons Ag Retail Sales Please refer to both identification numbers, 140TH Ave above,in all correspondence with the agency. Town of Erin Prairie St Croix County S1/2, SW1/4, S22,T30N,R17W FOR: C ON D I Description:Non pressurized in ground,8 employees,6000 square foot retail area,NO floor drains APP Object Type:POWTS Component Manual Regulated Object ID No.: 1511102 Maintenance required; 366 GPD Flow rate; 81 in Soil minimum depth to limiting factor from original grade; Syste FT OF In-ground POWTS Component-Ver.2.0, SBD-10705-P(N.01/01,R. 10/12); Commercial System,Effluent FiltPROFESSIO ,►VISION OF IN The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Co es and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s)referenced above. The owner,as defined in chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all code requirements. SEE COR 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: Key item(s) • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard,the property owner must follow the contingency plan as described in the approved plans.In addition, the owner must insure that the operation,maintenance and monitoring duties as described in the "In-Ground Soil Absorption Manual System" are complied with.A copy of this information must be given to the owner upon completion of the project. • This approval does not include plans for the general plumbing systems or sewer piping leading to the septic/holding tank that may be required for this project. See section SPS 382.20,Wis.Adm.Code,to determine if plan submittal and approval is required. • The gravelless system components must be installed in accordance with the manufacturer's printed instructions, the plan approval,and SPS 383 system sizing criteria. If there is a conflict between the manufacturer's instructions and the plan approval,the plan approval and code requirements will take precedence. Reminder • Materials shall conform to the requirements of SPS 384.SPS 384.10.No fixture,appliance,appurtenance, material,device or product may be sold for use in a plumbing system or may be installed in a plumbing system, JACQUE M HAWKINS Page 2 11/13/2014 unless it is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • Surface water drainage shall be diverted away from the system area. • Maintain well and waterline set backs per SPS 383.43(8)(1). A copy of the approved plans,specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department,which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance.As per state stats 101.12(2),nothing in this review shall relieve the designer of the responsibility for designing a safe building,structure,or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, Fee Required$ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Patricia L Shandorf Please Include a Copy With Your POWTS Plan Reviewer,Integrated Services Payment Submittal. (715)634-7810, Fax: (715)634-5150,M-F 8:00 a.m.-4:45 p.m. WiSMART code:7633 pat.shandorf @wisconsin.gov cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm I - 1-5 Index and Title Sheet i Project: Emmert and Sons Agricultural Supply Sales Owner: Jerry and James Emmert Address: 1881 140t'Ave. Baldwin W154002 Legal Description: SE1/4-SE 1/4 Sec. 22 T30N-R17W Township: Erin Prairie County: St. Croix Subdivision Name: Na Lot: Na Comp.#/Parcel ID: 012-1050-60-100 Y ,'ALL CONTENTS ""b� %V E:-lY AND Page: 1 Index and Title Sheet l L SERVICES X19 Y t Y S VICES Page: 2 Sizing Calculations Page: 3 Plot Plan Page: 4 Cross Sections of Cells 1, 2+3 and Plan View tESPONDENC Page: 5 Management and Contingency Plan ri Attached: Soil and Site Evaluation Form In-Ground Soil Absorption Component Manual Used=SBD-10705-P(N.01/01 R. 10/12) Plumber: Jacque Hawkins License MPRS#222872 Signa Phone#(715)491-5388 Date: 10-27- 4 Page 2 of 5 Sizing Calculations for Emmert and Sons Agricultural Supply Sales Retail store selling agricultural seed,feed and supplies. 6,000 sq.ft. of retail area. 6000 sq. ft.x 70%/30sq/ft. per patron= 140 x 1 gallon or 140 gallons. 8 Employees x 13 gallons= 104 gallons. 244 gal. estimated flow x 1.5 design factor = 366 gallon Design Waste Water Flow Proposed 3 dispersal cells using a .5 soil application rate 3 ft. x 54 ft. for a total of 39 Infiltrator Quick 4 Standard-W Leaching Chambers Septic tank sizing would be: 366 gal DWF x 2.088=765.00 gallons. 1000 gallons proposed. Ln r-7 rJ k—c- % 3 t ----------& CA A -k ' 7�j TA N � 00 � W o , `tS 1 o' ' O y c .__._. _ __i. 100 00 kA PO it cr CrQ qQ Gn 11 i � C F { p. v 'gip''•4 �i �,' � r ° ►d w.�' to �:.,,`• '' '� � `i.°' � 1 ��' n �'D , i Nppv� a jig H p tltltl000 ! \ J� } 6 o cco Cs' N s v i 00 11 11 1� 1� CD W 0o O W O O I I O O - � 2 The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm,the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge 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 an 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. Pump Chambers When Used The pump chamber also requires monitoring once every three years or the time of problem, complaint or failure. Inspection should include checking the dose rate,volume and frequency. Warning: The dose chamber may fill due to flow continuing during pump malfunction or power outages. One large dose when the power comes on or when the pump is repaired may cause the dispersal system to have problems. In this situation,the pump chamber should be pumped by a licensed pumper before pump cycling begins or other measures shall be used to dose the component with only the proper amount of influent. This may include manual operation of the pump controls until such time the pump chamber has reached its normal level. Septic tank and Pump chamber 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 to the tank Warning: No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment or holding tank may contain lethal gases,and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be accordance with SPS 383.33,Wis Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept commercial wastewater from a commercial facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation should be assessed at the same time the septic tank filter is inspected or tank servicing. The inspection shall include recording levels of ponding, if Page 5 of 5 (1-3) Private Onsite Wastewater Treatment System In-Ground Management Plan Pursuant to SPS 383.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS). Shall include information and procedures for maintaining the system within the parameters of SPS 383 and 384,and the conditions of approval by the department,agent,or governmental unit. The approved plans and permits for the system will be filed with the county zoning or health department. This management plan complies with SPS 383.54,Wis.Adm. Code,and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems(Version 2) SBD-10705-P(N.01/01 R. 10/12) Table 1: System Design Specifications Sanitary Permit Number Number of Bedrooms Na Design Flow(GPD) 366 Soil Absorption Component Size(s q. ft.) (3 3'x 54' leaching chambers Septic Tank Capacity Gal. 1000 Pump Chamber Capacity Gal. Na Type of Wastewater Commercial Retail Store) Table 2: Soil Absorption Component—Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow-Peak(GPD) 366 366 Max.Influent Particle size NA 1/8 Inch Maximum BOD 5 (m g/1) NA 220 Maximum TSS(m 1) NA 150 Maximum FOG NA 30 Table 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Outlet Filter Should inspect once a year and clean as needed. Pump Chamber Inspect once every 3 ears- if applicable Soil absorption Component Inspect with effluent filter or tank maintenance cycle Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under sec. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code(Servicing Septic or Holding Tanks,Pumping Chambers,Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches,Privies, or Portable Restrooms). + 3 any,in the observation pipes,and visual inspection for any evidence of surface discharge from the component. On steeply sloping sites,areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary,but is difficult or impossible to repair until weather conditions improve. In general,soil compaction over this en into the soil and dispersal cell which may lead to duce diffusion of ox � Y component will re oxygen Pe Po more intense,and earlier,clogging of the soil. Planting of deep rooted trees and shrubs directly over or within 10 feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. Contingency Plan In the event the inspection of the dispersal components identifies ponding of effluent within the dispersal cells.The effluent quality shall be sampled immediately to determine if the wastewater strength has elevated above system parameters.Effluent samples will be taken from the septic tank or dose tank if applicable by the POWTS Maintainer or other credentialed individual licensed by the state to perform such work. The samples shall be submitted to an accredited lab for analysis.If the initial tests come back higher than the original design standards a monthly testing protocol should be established to determine average wastewater strength.During this time the septic and dose tanks shall be used as holding tanks to allow the dispersal cells a chance to rest and reduce any further saturation. Once average wastewater strength is determined options can be discussed to rehabilitate the system.Options typically available are the addition of dispersal cells where sizing would be based on wastewater strength or by choosing to lower the wastewater strength by the addition of an aerobic treatment unit.This would effectively remove the majority of the wastewater streams components that caused the dispersals cells to clog in the first place.Typically applying this highly treated wastewater to the dispersal cells has the capability to rejuvenate dispersal cells with early signs of failure. In the case of septic or dose tank component damage,measures shall be taken to repair or replace the tanks to their original operating condition. Upon complete failure of the distribution cell component,the system shall be inspected to determine the cause of failure. Steps taken to repair or replace the in-ground dispersal cells may involve the removal of a bio-mat,which would require cleaning or replacement of the distribution network as well as replacing the leaching chambers and clogged portions of the insitu soil.This would require an individual site design. Component Owners Contact List Jacque Hawkins /Plumber 715 491-5388 St. Croix County Zoning 715 386-4680 Skaw Concrete Products New Auburn WI 800 924-8625 Septic Pumper Powers Sanitation 715) 246-5738 Wis.Dept.of Safety and Professional Services SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with SPS 385,Wis. Adm. Code County C) 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. Q�� /0 Ja r00— R�viewed Please print all information. Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). Property Owner Property Location Govt.Lot 1/4 ''1/4 S LZ T 30 N R /I E(o Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# / 0 RV l' City State Zip Code Phone Number El city Village QTown Nearest Road ,5y oo 2- ( 9/,f)Z Yl,fr73 - ;,4 q1 r-; c / Y p Ct V C New Construction Use:❑ Residential/Number of bedrooms—7-� Code derived design flow rate J�o GPD Cwt—� SLtlJ/.� c�f l ff� Y fI. ❑Replacement Public or commercial-Describe: Parent material _1 F�(lood Pl�ain elevation S if app�( /able OcG Sl. {t ° l YVft.° T;0 General comments and recommendations: l3. �94 S �t �ry. /�-rh �`I- �8• ioaL 88 c7a �3 f 30 El Boring ❑ Boring# in• q �..pit Ground surface elev. ��' / ft. Depth to limiting factor �8� Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft x in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. * ff#1 ~* ff#2 C;)- st o PC y/,3 — e_i ,76,E V-4- 7- 5. Boring# Boring nO. (o 7g ® Pit Ground surface elev. 7 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. * ff#1 " ff#2 Yv 7.s Yiy �,� os� .�-,� s /r *Effluent#1 =BOD 5>30<220 mg/L and TSS>30 <150 mg/L *Effl0ah #2=BOD <30 mg/L and TSS <30 mg/L CST Number CST Name(PI se Print) Signature Q Address 0 Date Evaluation Conducted Telephone Number P.� . � �.uck, !�� .S��,S•'3 /o -� ! -iY ��3-y9/ - 388 Property Owner Parcel ID# Page Z of 3 (� E] Boring Boring# 9D_ j„P Depth to limiting factor ��Z in. �„pit Ground surface elev. ft. P g Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundary, Roots ff#1 GPD/f2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. d 5-a a Boring# Boring </• ✓ ' Pit Ground surface elev. `1 J ft. Depth to limiting factor >� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence oundary Roots * fF#1 GPD/f2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. lx, as d,po, • � Le VA - ? ❑ Boring# Boring Ground surface elev. W. ft. Depth to limiting factor in. ® Pit Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots ff#1 GP $ in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. �f,L as / C 1 11ye7 64 v s t � •��- _ � s may% a--. s �����- ����- - .- �� . �, Effluent#1 =BOO e>30<220 mg/L and TSS>30 <150 mg/L Effluent#2=BOD 5<30 mg/Land TSS <30 mg/L The Dept.of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,contact the department at 608-266-3151 or TTY through Relay. SBD-8330(R11/1I) i i N � o ._ .0 v J Q l �f b N � z T ZN 1 Z �� 9�pi.RTa,f7YT � County � . y °� Industry Services Division �Y � »X 1400 E Washington Ave Sanitary Permit Number(to be filled in by Co.) P.O. Box 7162 Madison,WI 53707-7162 �?L���� '5X4 Av � !ON y it A State Transaction Number In accordance with i $ : (V1Q���m.Code,submission o form to the appropriate governmental unit 35 Z& S is required prior to o sanitary permit. Note:Application forms for state-owned S are submitted to the Department of S y and Professional Services. Personal information you provide may be used for secondary Project Address(if different than mailing address) purposes in accordance with the Privacy Law,s. 15.04(1)(m),Stats. �Q�o i/��V � I. Application Information-Please Print All Information ( __�(; Property Owner's Name �� Parcel# C5�2 rr,�,t� �,�� ��-s �— a C � 1 —6Yu Property Owner's Mailing Address Property Location /68 1 / T l� -�� 6?v F Govt.Lot • /) City,State Zip Code Phone Number f� '/<,,f '/4, Section Z/,- Z vL 75 (circle one) T L Z N'10 ; R 17 E or(?)II.Type of Building(check all that apply) ,MIL' of# El l or 2 Family Dwelling-Number of Bedrooms S t�� Subdivision Name 21 Public/Commercial-Describe Use(A e, . xi l!-x Block# ❑ City of ❑State Owned-Describe Use ❑ Vi f �5 ,�^ CSM Number III.Type of Permit: (Check only one box on-line A. Complete li B ifapplic ble) A. 1K New System ❑ Replacement System ❑ Treatmen 1 g Tan ep m t er Modification to Existing System(explain) B ❑ Permit Renewal ❑ Permit Revision ❑Change ❑Pe t an o New List Previous Permit Number and Date Before Expiration Plumber Owner IV.Type of POWTS S stem/Component/Device: (Check all that 4PIY400, b y ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade Pr Mound>24 in.of suitable soil ❑ Mound<24 in.of suitable soil ❑ Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(exp am V.Dis ersal/Treatme Area Information: t Design Flow(gpd) Design Soil Application lo,4 Dispersal Area Requir s� Dispersal Area P oposed(sfj System Elevation Rate(gpdsf) 5e -1/ A v Asa 112 VJ-�D 1 /d 6 7 VI.Tank Info Capacity in Gallons Total #of a ° Manufacturer w U Gallons Units New Tanks Existing Tanks q,i G;r/4 �/ p U v y rn w C7 p. Septi r Holding Tank /CIO a I w�YY''r) a ` ❑ ❑ ❑ ❑ sing Cham r (pG A ❑ ❑ ❑ ❑ ❑ VII. esponsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plu is Name(Print) Plumber's Signature MP umber Business Phone Number ac LL QV-K;t, r I I 27-Z-e7•z 71S Plum er's Address(Street,City,State,Zip Code) VIII. oun /De artment Use Only Approved ❑pidwgva Permit Fee Date sue Is Agent Sign a re O Give on for Denial $ � t� �/� /4 Conditions of Approval/Reasons for Disapproval &,14,'" ;ti de. rd,�,� �,t�.�.. G rL n'.�. e e �✓` s /,,,`� G. 4-r_J `'i 0 f Z Attach to complete plans for the system and submit to the County only on paper not less t n 8 1/2 x1A inches in size SBD-6398(R03/14) JACQUE M HAWKINS Page 2 7/30/2014 t • Materials shall conform to the requirements of SPS 384.10.No fixture,appliance,appurtenance,material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system,unless it is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • Maintain well and waterline set backs per SPS 383.43(8)(i). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. • Insulate building sewer per SPS 382.30(11)(c). A copy of the approved plans,specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department,which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance.As per state stats 101.12(2),nothing in this review h s all relieve the desi gn er of the responsibility for designing a safe building,,structure,or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are re le for the installation,operation or maintenance of the POWTS. Sincer , Fee Required$ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Patricia L S an orf Please Include a Copy With Your POWTS Plan Reviewer e ervices Payment Submittal. (715)634-7810, Fax: (70,M-F 8:00 a.m. -4:45 p.m. WiSMART code: 7633' pat.shandorf@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services(formerly Safety&Buildings)will be modified. Code references with prefixes starting with"Comm"have been replaced with "SPS"to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety&Professional Services.Additionally,all IS(formerly S&B)codes have been renumbered and addressed in a"300"series. For future reference;the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. II 9n'�TkE� DIVISION OF INDUSTRY SERVICES T° 10541 N RANCH ROAD �y r HAYWARD WI 54843 Contact Through Relay www.dsps.wi.gov/sb/ www.wisconsin.gov o � sroNAti'� Scott Walker,Governor Dave Ross,Secretary July 30,2014 CUST ID No. 222872 ATTN.•POWTS Inspector JACQUE M HAWKINS ZONING OFFICE HAWKINS SOIL TESTING&SEPTIC SYSTEMS ST CROIX COUNTY SPIA 2659 150TH ST 1101 CARMICHAEL RD LUCK WI 54853 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 07/30/2016 Transaction ED No.2435268 Site ID No. 804217 SITE: Please refer to both identification numbers, Emmert& Sons Ag Retail Sales above,in all correspondence with the agency. 140TH Ave Town of Erin Prairie St Croix County S1/2,SW1/4, S22,T30N,R17W FOR: CONDIT Description:Mound,6000 square foot retail area, 8 employees Object Type:POWTS Component Manual Regulated Object ID No.: 1494342 APP Maintenance required; 366 GPD Flow rate; 22 in Soil minimum depth to limiting factor from original grade; Sysl: MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Commercial Application INDEX AND TITLE PAGE Project Name: Emmert and Sons.,%Supply Retail Store Owner's Name: Emmert and Sons Owner's Address: 1881 140th Ave. Baldwin WI 54002 715-246-5573 Legal Description: S1/2-SW114 Sec.22 T30N-R17W Township: Erin Prairie County: St. Croix Subdivision Name: Lot Number: Block Number: Na�7)NALLY Parcel I.D. Number: )VEC �F ETY AND Plan Transaction No.: NL SERVICE WR Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Site Plan f, Page 9 Sizing Calculations � �� Designer: Ja2que Hawkins License Number: MPRS#222872 Date: 07/06/14 Phone Number, -j-3,6 Signature: _____ Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SOB-10691-P(N.01/01),and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS(01/81)and Pressure Distribution Component Manual Ver.2.0 SSO-10706-P(N.01101) Version 7.0(R.0312012) Page 1 of 9 Mound and.Plressure Distribution Component Design Design Worksheet Site Information (R or C) C Residential or Commercial Design Note: Sand fill(D)calculations assume a 300.00 Estimated Wastewater Flow(gpd) Table 383-44-3 in-sftu soil treatment for 1.50 Peaking Factor(e.g. 1.5=150%) fecal coliform of<=36 inches. 450.00 Design Flow(gpd) 2.00 Site Slope(%) 99.00 Contour Line Elevation (ft) 22.00 Depth to Limiting Factor(in) 0.40 In-situ Soil Application Rate(gpdlftz} Distribution Cell Information 75.00 Dispersal Cell Length Along Contour(ft) = 6.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate(gpdKe) 1 Influent Wastewater Quality(1 or 2) Are the laterals the highest point in the distribution F Y Pressure Disribution Information network? Enter Y or N (C or E) E Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation ft 2 Number of Laterals of the highest point. 0.156 Orifice Diameter(in) 2.33 Estimated Orifice Spacing(ft)= 7.03 fe/orifice 2.00 Forcemain Diameter(in) orcemain Length(ft) Does the forcemain drain back? -Y 90.00 Pump Tank Elevation(ft) Enter Y or N 4.55 System Head(ft)x 1.3 26.10 Forcemain Drainback(gal) 9.67 Vertical Lift(ft) 67.41 5x Void Volume(gal) 4.01 Friction Loss(ft) 93.51 Minimum Dose Volume(gal) 0.00 In-line Filter Loss(ft) 34.46 System Demand(gpm) 18.23 Total Dynamic Head(ft) Lateral Diameter Selection Manifold Diameter Selection in, dia. options choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x x 1.25 2.00 1.50 x x 1 3.00 2.00 x 3.00 x Gallonsiinch Calculator(optional) Treatment Tank Information Total Tank Capacity(gal) 1000.00 1 Septic Tank Capacity(gal) Total Working Liquid Depth (in) Skaw Precast I Manufacturer gaVin (enter result in cell B49) Dose Tank Information Effluent Filter Information 642.33 Dose Tank Capacity(gal) Best Filter Manufacturer 16.47 Dose Tank Volume(gal/in) GF-10 Filter Model Number Skaw Precast Manufacturer Project: Emmert and Sons Ag Supply Retail Store Page 2 of 9 Mound Plan and Cross Section Views r 1/10 B : : : -'Observation Pipe -�';'-. J K ' A 1 AL.J.+• 't W G B I. I L Mound Component Dimensions Down slope toe extension made. A 6.00 ft E [AO.50 in H 1.00 ft K 9.06 ft B 75.00 ft F in 1 9.00 ft L 93.11 ft D 14.00 in G ft J 6.96 ft W 21.96 ft 450.00 (fe) Dispersal Cell Area 1125.00 (fl?) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 7.50 (ft) 1110 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 101.96 (ft) H �Il7 �- !'! • 100.67 (ft) Lateral F Dispersal Cell Invert 100.17 (ft)--► Dispersal Cell :SC : : . := Elevation :ate - f c ,r ].e y •t� �i r y 99.00 (ft)Contour Elevation —2.0--%Site Slope Geotextile Fabric Cover Shading Key I Dispersal Cell See lateral details on a 1 5 ft T Page 4 for number,size, Topsoil Cap c c and spacing of laterals. 2 r/rrrrr Subsoil Cap '� ° Laterals are equally ql a6 ASTM C33 Sand F spaced from the :{ Tilled Layer 0- ft Tvp��l Lateral distribution cell's © Aggregate o centerline in the A ___* distribution cell(Ax6). Project: Emmert and Sons Ag Supply Retail Store Page 3 of 9 End Connection Lateral Layout Diagram Caters Drat+s �sTur -upwta+tivaArraMnatpluov,"tl A 4i�wnsion oil AHlatoralsaHidwAicsl lEX F�alasdriNWsrntKrAt}RtGtreoftl+rtatetat 5 egaatiq spaced og"Mmaiin acasm OOrt"4 t0v M cross to maWold at anil Do . Laterals a forcemain Sch 40 PVC per SPS Table 38#.30 6 Number of Laterals 2 Orifice Diameter 0.156 in Lateral Diameter 1.50 in Orifice Spacing(X) 2.37 ft Lateral Length (P) 73.47 ft Orifices per Lateral 32 Lateral Spacing(S) 3.00 ft Orifice Density 7.03 ft2/orifice Lateral Flow Rate 17.23 gpm Manifold Length 3.00 ft System Flow Rate 34.46 gpm Manifold Diameter 1.50 in Total Dynamic Head 18.23 ft Forcemain Velocity 3.52 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and % 4 in.min. SPS 316.300 WAC Disconnect Alternate outlet Tank component is properly vented location Forcemain diameter Skaw Precast Manufacturer 2 in. Ca aci 76742.33 Gallons �- Volume 16.47 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device B 2.00 32.94 Pump off elevation— C Z5 10,3 91.00 D 12.00 197.64 D Total 1 39.00 33 642. Dose tank elevation(ft) 3" Bedding uncTer tank. F 90.00 Alarm Manuafacturer SJE. Rhombus_ Note: Switches Alarm Model Number Tank Alert 1 J containing mercury may not be used in Pump Manufacturer Goulds �� this system. Pump Model Number I EP05 Pump Must Deliver 34.46 gpm at 18.23 ft TDH Project: Emmert and Sons Ag Supply Retail Store Page 4 of 9 Mound Svsbem Maintenance end C)Rgabon Specifications Service Provider's Name (� Powers Sanitation Phone 715-246-5738 POWTS Regulator's Name St Croix County Zoning Phone 715-386-4680 Svst9nn Flow and Load Parameters Design Flow-Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow-Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 1 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 fl? Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Colifo >10E4 cfu/100 mL s rvics Freausncv Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test monthly Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Ins t for ndin and see a once eve 3 ears Other Miscellaneous Construction and Materials Standards 1, Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis.Adm.Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis.Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished ............... Grade vl Threaded Cleanout 6-8" Diameter Lawn ---� :- Plug or Ball Valve Sprinkler Valve Box Distribution Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Page 5 of 9 Project: Emmert and Sons A g Supply Retail Store Mound System Management Plan Pursuant to SPS 383.54,Wis.Adm.Code This system shall be operated in accordance with SPS 382-84 WiIS.�m.CCode,andibu e# Camp reed in Mawr Ver.with SW component t manuals[SBD-10691-P(N.01/01),SSWMP Publication 9.6(01181), 01/01)]and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be pment that could cause death. Septic and pump tank abandonment shall be in accordance with SPS 383.33,Wis.Adm.Code when the tanks are no longer used as POWTS components. {� r htness and soundness. Access openings Septic or pump tank manhole risers,access risers and covers should be inspected water tig 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. Qer+t!c Tank The septic tank shall be maintained by an Individual certified to service septic tanks under s.of the ,Stets. The contents ft 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. provisions The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not r i removed unless n alarm,the are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the finer is equipped filter shall be serviced if the alarm is activated continuously. Itermittent fitter alarms may indicate surge aws or an impending continuous III alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 113 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 Was than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However,if such products are used they shall be approved for septic tank use by the Department of Commerce. The pump(dosing)sing))effluent tank filter is urtse inspected the least nk n shall be 3n a all s serviced in switches,alarms, necessary.m�shall be tested to verify proper operation. If Mound and Pressure No trees or shrubs should be plated on the mound. Plantings may be made around the mound's perimeter,and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic(other than for vegetative maintenance)on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the wing will promote frost penetration. Cold weather installations(October-February)dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODE, 150 mg/L TSS,and 30 mg/L FOG for septic tank effluent or 30 mg/L BODE,30 mg/L TSS,10 mg/L FOG,and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral,and it is recommended that eadr lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if ortfice cleaning is required to maintain equal distribution Within the dispersal cell. frequent � er,an any Observation pipes within the isp rs mhY checked d effluent dn. o ig shall levels aove 6 inches considered impending g fare requiring more orin 0a2l�lifctt 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. ely If the dosing tank,pump,pump controls,alarm or related wiring becomes defective the defective componetts)shall be immadiat repaired or replaced with a component of the same or equal performance. if the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface,it will be repaired or replaced in its,present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media,and related piping,and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POINTS regulator and service provider. P Units The information and schedule of mananagemet and maintenance for pretre atmant devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Page B of 9 Project: ' Page 7 of 9 ITT GOULDS PUMPS Wastewater PERFORMANCE RATINGS COMPONENTS Total Head Gallons Per Item Description (ft.of water) Minute No. EP04 EPOS i Impeller 5 53 — 2 Base 10 6 10 46 62 3 Pump Casing 8 15 36 55 4 Mechanical Seal 7 20 21 46 5 Ball Bearings 6 25 0 33 6 0-Rings y ;:. 30 — 11 7 Power Cord 5 8 Oil Filled Motor 4 3 9 Motor Housing) 1 Stator Assembly z-- 10 Motor Cover METERS FEET 10 SGPM _...._.... 9 30' 2.5 FT 8 25' 0Q 7 i x U 6 20 5 15' Q 4 I EP05 I O _l 3 10' EP04 2 1 5 0 00 10 20 30 40 50 GPM 0 2 4 6 8 10 12 m'/h CAPACITY 3 a t Z v a �a mss' _ _ a Ira 1. a IQ -� -ly c� Q tj i Page 9 of 9 Sizing Calculations for Emmert and Sons Agricultural Supply Sales Retail store selling agricultural seed,feed and supplies. 6,000 sq. ft. of retail area. 6000 sq. ft. x 70%/30sq/ft. per patron= 140 x 1 gallon or 140 gallons. 8 Employees x 13 gallons= 104 gallons. 244 gal. estimated flow x 1.5 design factor = 366 gallon Design Waste Water Flow Proposed 6' x 75' mound cell using a design flow of 450 gallons for an added safety factor and to allow for growth of the business. Septic tank sizing would be: 366 gal DWF x 2.088=765.00 gallons. 1000 gallons proposed. I I', Property Owner Parcel ID# Page "� of r,31 Boring Boring# Pit Ground surface elev. ft. Depth to limiting factor_in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure bonsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. ff#1 tff#2 z z 9 sy�e '7y L 41 s k/-sr VA- - . z to Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. —go—ilApplication Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. ff#12 F-1 Boring Boring# Ground surface elev. Pit ft. Depth to limiting factor in. ❑ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. * ff#1 ff#2 'Effluent#1 =BOD 5>30<220 mg/L and TSS>30 <150 mg/L `Effluent#2=BOD 5<30 mg/L and TSS <30 mg/L The Dept.of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,contact the department at 608-266-3151 or TTY through Relay. SBD-8330(R 11/11) t- Page of �Us.Dept.of Safety and Professional Sen{icAs� 't'�'ti SOIL EVALUATION REPORT Division of Safety and Buildings ��Cj 1 t11ce "PS 385,Wis. Adm. Code County Attach complete site plan on e %1'e anB 1/2 x 11 inches in size.Plan must include,but not limited to:v `horizontal reference point(BM),direction and Parcel I.D. percent slope,scale or di sions,north arrow,and location and distance to nearest road. Please print all information. Revie by Date [�J Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). / 7 Property Owner Property Location S�Z Z�' ,i tlr-J c!D N S Govt.Lot 1/4SW 1/4 S Z- T, D N R /7 E(or W Property Owner's Mailing Address Lot# Block# Subd.Name or C W / Y8 I j /0 avE City State zip Code Phone Number ❑V !e a,®Town Nearest IRV 1, j Yd (j/.S- ) Z Yk�•5'73 16a Id w 1 l �j New Construction Use:❑ Residential/Number of bedrooms Code derived design flow rate GPD ❑Replacement ❑ Public or commercial-Describe: Su ' ` ` e 1�Lf�1 f J I Parent material flood Plain elevation'if applicable ft General comments &,4*i J G(�,r'k (o, 000 S' 79,,k'-70 :-' -�a T7 4->���✓ 2 l y0 /�W _ /�+/d G�✓/ and recommendations: 8 �� to �'�s x J 3 /3'? /�Y �l -T`-�-a 1 �-�`.,,,►.�fd �.w� ��6 dw-/' F I Boring Boring# �. Z ® Pit Ground surface elev. ft. Depth to limiting factor Z Z in. Soil Application qRate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. * ff#1 * ff#2 /nXsi� — �, r Z�l.s6k ,✓f� s 1�' • C� 8 Vk Boring# Boring l to Pit Ground surface elev. 78• J ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. * ff#1 * 02 Z- i 3 /�y c ri — s; / sdK ���- as 3 13C-112y leY t Y13 j✓ • b *Effluent#1 =BOD 5>30<220 mg/L and TSS>30 <150 mg/L *Effluent#2=BOD <30 mg/L and TSS <30 mg/L CST Name ase Print) / Signature 4 CST Z Number 8? d�0.14 K" Address Date Evaluation Conducted Telephone Number 4 s`� �v a 4-,h St C k �'• SPT3 - Js'8 SBD-8330(Rl l/11) Property Owner Parcel ID# Page 1-2 of Boring# ❑ Boring Q ® Pit Ground surface elev. U ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Donsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. * ff#1 *W2 F-1 Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft Z in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. * 01 * ff#2 Boring ❑ Boring# Pit Ground surface elev. ft. Depth to limiting factor in. ❑ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. * ff#1 102 i I II i I I *Effluent#1 =BOD 5>30<220 mg/L and TSS>30 <150 mg/L *Effluent#2=BOD 5<30 mg/L and TSS <30 mg/L The Dept.of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,contact the department at 608-266-3151 or TTY through Relay. SBD-8330(811/11) J V Q �1 f r C � O q O � C-1 r A C b r Q �� �• 2 e 7 C G ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address /R / p gliC i,� ,`,�. riit� ; �j y a o Z. � � Property Address c �� A JC; (Verification required from Planning&Zoning Department for new construction.) 612 -165c)- City/States �� Parcel Identification Number O LEGAL DESCRIPTION Property y Location E 14, , Sec. z z' , T N R / f W, Town of Subdivision Plat: L3 , Lot# Certified Survey Map # , Volume , Page# Warranty Deed # f�j �Z (before 2007)Volume , Page # Spec house 1.1 yes X,no Lot lines identifiable '-yes[_1 no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1)and in-Chapter 12-St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning&Zoning Department a certification form,signed by the owner and by a master plumber,journeyman plumber, restricted plumber or a licensed pumper verifying that(1)the on-site wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is less than 1/3 frill 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 Planning& Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s)of the property described above,by virtue of a warranty deed r corded in Register of Deeds Office. Number of bedrooms /V d/--4C + S NA URE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) 6051262 State Bar of Wisconsin Form 3-2003 Tx:4036223 QUIT CLAIM DEED 952204 Document Number Document Name BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED,made between DENNIS D.EMMERT and GRACE E.EMMERT, 03/09/2012 12:44 PM Trustees,under the DENNIS D.AND GRACE E.EMMERT LIVING TRUST EXEMPT#: 8 dated March 29, 1993, ("Grantor,"whether one or more), REC FEE: 30.00 and Jerry L.Emmert and Nicolle L.Emmert,Trustees or their successors in trust PAGES: 1 under the JERRY L.AND NICOLLE L.EMMERT LIVING TRUST,dated April 5, 2010,and any amendments thereto,and * ("Grantee,"whether one or more). Grantor quit claims to Grantee the following described real estate,together with the Recording Area rents,profits, fixtures and other appurtenant interests, in St.Croix County, State of Wisconsin ("Property") (if more space is needed, please attach Name and Return Address addendum): Joseph P.Earley Earley Law Offices An undivided one-half interest in the West 610 feet of the East Half of 539 South Knowles Avenue New Richmond,WI 54017 the Southeast Quarter(E 1/2 of the SE 1/4)of Section 22, Township 30 North,Range 17 West. Part of 012-1050-60-000 and part of 012-1050-90-000 Parcel Identification Number(PIN) *James A.Emmert,sole Trustee,or his successors in trust,under the JAMES A. This is not homestead property. EMMERT LIVING TRUST,dated March 29,2010,and any amendments thereto, (is)(is not) each an undivided one-half interest,as tenants in common. Dated January t 0 ,2011 (SEAL) �/� )U►� (SEAL) * *Dennis D.Emmert,Trustee (SEAL) C� (SEAL) * *Grace E.Emmert,Trustee I AUTHENTICATION ACKNOWLEDGMENT F;; Signature(s) STATE OF WISCONSIN ) authenticated on )ss. ST.CROIX COUNTY ) * Personally came before me on ��tc/I vCcry [Q, 201 TITLE:MEMBER STATE BAR OF WISCONSIN the above-named Dennis D.Emmert and Grace E.Emmert, (If not, Trustees, authorized by Wis.Star. §706.06) to me known to be the person(s)who executed the foregoing instrument an ac ovule d the same. THIS INSTRUMENT DRAFTED BY: Joseph P.Earley,Attorney at Law ���,�� � p hy- Notary lic,State of Wisconsin dOSEP My Commission(is permanent (expires: ) Notary Public (Signatures may be authenticated or acknowledged. Both are not necessary.) V(1(SI �� SIDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. A E O 2003 STATE BAR OF WISCONSIN FORM NO.3-2003 ' namE below signatures.