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020-1057-70-275
~ ' n N O N Q 3 ~ G C ~ I °~ a ~ ~ n CD ~ N C ~ fD ~ ~ ~ ~ ~ fD ~ N d ~ ~ C iC C ~ n ~ ~ d O Ip m u> Z D m cam" D ~' ~ ~ W c ~w __ ~ ~. Y-. ~- -,, m N ~. I o ~ _ ~ ~ i ~ o ~ o ~ m i ~ N ~ a o ±i i n~i O p 3 ii ~ O C W (D I d Z CD I O ~ y M N O I ~ ~ ~ D m ~ m a ~y<, a_ N ^' N ~G d O. ~ Z ~ O fl) ' O3 0 0 ~ C N ~ vOi ~ ~ 61 ~ O ~ O O d ~ N C N y ~ ~ O N ~p i 7 Q ~ ~ ~. 7 tD a~ ~ X N fD I a O fD O ~ I O Q- n y ~ '' ~ m o ~ ~ ~ ~ ' ~ c ~ ~ ' m ~ m m ~ _ 3 ^~ _ '~ ~ N ~ ' ' = N CO N O. N N O N O _ p 0 _ ~ V f I O ~I ~ v O O ~ 7 V (7 N y y Obi '., ~ O CJfl ~ C ~ 'I d m T. a m G . . ~ ,° p n~i ' \ N ~ O. ' cT \ 2 '' 0 o 0 0 c y ;i it n r rn = N o ea C < ~, .. ~ v ro v - ' m o O o cn '' ' .. ~ ~ j '' ~ ~ , o w D N y N rn - ~ v O v ' ~ m ~ N v, ~ ~ m _ ~ ~ y .' N Dt A ~ .. A D D o 11 c a fD N S N 7 N A ~ ~ N C ? Z A ~_ ~ .. ~ V ~ ~ 7 fD .. d) I N N W ~ ''~~. RI ~ (O I Z ~. ~ O A ~ + c .. Z i m ~ ~ ~ ~ rn T i C 3 ' d i ' c~ v, o ~ ~ c'~ o d F c o o ~ ~ ~ v 3 n+ ~ m to c 3 r: ', K (n ' Z -1 y ~ O _' ~ 2 N N , C) ~ O O N Crtb ~ LU C O ' w n. ~ N ~ Z ~ cn No ~. ' ~ o C ~ ~ ~p ~ ~, ~ ~ UI . J N o- ~ o ~ ~ 3 0 > > m ,z ~ ~ _N.. ~ o cn 3 `~ o. a oo ~ C7 N ~ N N COO ~ ~ O (T C n I ~ L7 ~ D d a ~ I CD ct„ y N G Cn ~ ~ ~ ~ C O O ~ d ~ ~ C; ^' W CA - I Z o cD ~ o ! I c'1 r us ao ~ CO co ~ y ~ o a ~ v °~ ' o ' ~ ~ y N N ' l D d ~ ~ v v O ~ A w N i (T d ~ (Q ~ I .P i N ~ d 7 .. ~ ' Z i ~ D ~ 7 d ~ 3 m ~ ro ~ m N ' ~7 ~ ~ ~ N r. ~ W ~ d ~ ~' Z N ~ Cp ~ '',,i ~ p -1 N fD Z ~ N C ' _ ~ e~ ~ p_ I ~' ~ 3 o. .. ' ~ N ao~ m N ~ a ~ ~ z '. 'o _' z ~ i o N m i ~ m ~ Z m W ~ ~ ~ O~•~o a ~f° ~~ m a a .-. ~ ~my I (D ~ p [U ~ ~ N T c I rn ,~ O ry ~ O ~ ~ .~ Z a N N > ~ O ~ O ~ ~G D ~' i f C ~ -. A N a fD ~ N ~ to N [U O ~ c ~ ~ N a n 'O i N N N _ 7 N ~ ~ W ~ d ~ n y O S N N wv m °o ~• I m o> 0 m sa O o g b m i o ~- c •, ~~Y~ = ~~ "~uf~-" s~~fz / so v c~,~,~,~,~~~- G.v . f~va,5'a~ ~i. s ~a~~ 3S~ ~Sy~'7 / Wisconsin Department of Commerce SOIL EVALUATION REPORT Page J of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete stte plan on paper not less than 8 1/2 x 11 inches In size. Plan must County S']'C, r~/PO,~~ Include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. p x ~ , ~.vS7 , ~~ , a ~U Please print all inf h: Reviewed by Date i Personal information you provide may be used for ~ rposes (Privacy Law, s. 15.04 (1) (m)). Property Owner ~ ~ ,~ Property Location ,/ ~ ~ E,~ ~r<,, L G G~~~J ~ ~~'M ~~~r,,~ G vL Lot ~j ` 1/4 ~G 1.14 S L~' T ~ ( N R ~~j ` ~ ( E (or) W Property Ownes's MaNing Address _~ /y' ~ .' L_' # Block # Subd. Name or CSM# 8 ~ 9 Cliff T ' S T l_ sr . _ C5M vp~ ~ Pg.. 2 670 City State Zip Cod -- .Ph e k ; City ^ Village ~ Town Nearest Road ~E~/yR hl vf~so,J ~v/. syai - ~'''"'+'G '~ , -.~ ~uvsv ~ h~wt! /Z ~ u 's New Construction Use: ~ Residential / Nu ~f ~ Code derive,~d/design flow rate (a OrU GPD ^ Replacement ^ Public or commercial - e: _~U1~/EX r7~+`1F Parent material Flood Plain elevation if applicable General comments and recommendations: S I T~ T•~S TIT ~E Q U j ~E.S f `7 O (> ,~,~ f~ ~/~ 5 ~/S7`E~ So//S ~~P~ SE,~so.v~t//y Sri- T ~/l' ~ 7~O • - rS~a~ ~~• 3 ~ Boring # ^ Boring X001 (e'Z p(t Ground surface elev. it. Depth to limiting. factor -/ in_ n. Horizon bepth I Dominant Color M Redox Description Texture Structure Consistence - - Boundary Roots Soil Application Rale GPD/fti ~ n, o. ~L unsell ,o yie Zi3 Qu. Sz. Cont. Color sc. Gr. Sz. Sh. /fs,6,~ ,~~~ w 2 f •Eff#1 . y •Eft#2 . ~ a Boring # ^ Boring ~ d ~ ~ (p~ ' /D s. s. s • Plr Ground surfaix± elsly- n n.,..n, /., a...:..__ r__.__ `7 Horizon Depth i Dominant Color Redox Description Texture Structure Consistence Boundary Roots 5oii Appll GP catlon Rate D/fl~ n. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eft#2 z ~.1 •D y~ 3 - _ /D ~p3/ cza2 ko s SL /f iwt f~C c4J . ~ s D•~ io 3 S/EL /fs~ ~' . Z . 3 ~oyR ~Z SyR .~~ • Gill.. ~ . M1 ~~~ ~~ , - - - - - --y - __ _ ~..., ...y. ~ a... ~ .,v ~vv _ ~ vv myn, ~_ - tRluenl$l = 13V~y < 3U mg d TS3 < 30 mg/L CST Name (Please Print) Signature CST Number R ol3E ~!~ Ri•c~ T ~ a z 4 3 7s Address Date Evaluation Conducted Telephone Number 7'ufv~' I q, Z oo I 71.5.3$6,•$/ SS Ulbrtcht Jf Associates Private Sewage Consultants 655 O'Neil Rd. Hudson. Wis. 541)18 ~Uy~ : ,~~ s~f Z Property Owner ~ Z ~ ' ~d S ~ • ~~ • Z ~ v Z Parcel ID # a Boring # ^ Boring GG• Z~ Page of Pit Ground surface elev. 7 7 ft, Q 'S• 'S'~. Depth to Ilmiling factor / d an Boring # ^ Boring ~. Pit Boring # ^Boring ^ Pit 0 ~O Ground surface elev. / ~ tl. Ground surface elev.l-~"~ ry, Depth to limiting factor ~ / t~ Depth to limiting factor ~ Z in. 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 60$-266-3151 or TTY 608-264-8777. .SBD-8770 (R.6/00) • E(fluent #1 = BODY > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 ,_ mglL and TSS < 30 mglL ..~ GD l ~3 Ffw y sr~yy~s~~ /-to u~ p 1~~'ll /D/. ~ a. , .Svyy'~S7~~1~ M ov ~v D Lp,c'~U~ GiN.e /OD• G 2- ~ sO '--~"~` I ~Z r ZY ~M~~' / e % ~b~ ~ S /O a ~ , ~ E ~ ,~,Q ~ 3/y'' S ~'~ I , Lou 3 f~ ~~ ~" ~ / ~a3,/ ~~ l2 ~ ~ ~ ~Plcv ~y 7i ~~ •=1~~~1~P~-rs ~ - ~-~.v~U,~ s ~~~ D~~ ~~ /o~,~~ ~ '- 10~, lob ~ ~~ ~y _.~------~ . ,_'a ~. t~ ;1, sy ~ 1 ~ya~ •33 oo -~ ~~ ~ 1~ I ~ ~.. .,onsin Department of Commerce PRIVATE SEWAGE SYSTEM safety and B~iilding Division s ~ ~ INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)J. 'ermit Holder's Name: City Village X Township Dravelin ,Leo Hudson Townshi :ST BM Elev: Insp. BM Elev: BM Description: f / ~ - CS-C-f3 w~ ~ I L~ ~~ tSp . ~ ~ ( ~k 'ANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic ~.x.T ~l S~'fZ Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic } ~ ( ~` J 31 I Dosing Aeration Holding PUMP/SIPHON INFORMATION Number SOIL ABS PTION SYSTEM BED/TREN H DIMENSIONS Width ~~ t Lengti 8~ SETBACK SYSTEM TO INFORMATION Type Of ~st~em~: ~,/ ~~'~/'~ DISTRIBUTION SYSTEM ~m Head DH Dist. to Well p ~ ""~ 7l. k O ~" ~~'j'j I o. Of Trenches ~ 31 P/L BLDG WELL ~o ~{ cis' ~-~ county: St. Croix Sanitary Permit No: 429902 0 State Plan ID No: Parcel Tax No: 020-1057-70-275 Section/Town/Range/Map No: 22.29.19.217030 STATION BS HI FS ELEV. Benchmark ,~D ta(-~ I3~•O~ Alt. BM Bldg. Sewer SUHt Inlet r3. ~S ~-~; 1 SUHt Outlet J,ob / g.~ Dt Inlet Dt Bottom Header/Man. I ~ ~~ ~ ~~ / Dist. Pipe I v I s. l o 1 s:ds ~ ~ •~ Bot. System ~ ~(Q•I ~ ~ G , Final ade: S~~ 5~~ .~ / ,2.~0 St Cover a• so ~I2- _~I O PIT c.tr2(L Depth LAKE/STREAM LEACHING CHAMBER OR UNIT Dlllr~~~- iber: ~' < 1. r7 Header/Manifold ~ j.~ Length Dia~ Distribution Pipe(s) Length Dia pacing x Hole Size x Hole Spacing Vent to Air Intake ~ ^ O f ''[' 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 ~j No ~- ~] Yes ~] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #'I •w1~~ ~-y/ ~J2 Inspection #2: ~7'--Tl Location: 868 Kelly Road Hudson, WI 5401''6 (~SpE 1/4 NE 1/4 22 T29N R19W) NA Lot 3 Parcel No: 22.29.19.217030 1.) Alt BM Description = lam- 5 • ~ • r~~c-+J'~A~~- ~M'¢'r' 2.) Bldg sewer length = 3 [ - amount of cover = > `fZ-~~ 5°' ~ ceu4~'. ~~- - --,I , -- _ __ --- -- ----- -,, - -~-_ Plan revision Required? i~~~ti Yes No ~ (//c ~ ~ ~ ~~ Use other side for additional Information. ___!~S ~ ~ _. -- n ctor's Si nature Cert. No. SBD-6710 (R.3/97) Date I sep g Safety and Buildings Division County ~ M ~, 201 W. Washington Ave., P.O. Boz 7162 ~ rt v ~Y'd ~r ~CO/ I SIO Madison, WI 53707 - 7162 S;x Address De artment of Commerce ~'(o~ ~~•Q-~! Sanitary Permit A lication san;taty Permit Number pp In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ! ~' / / ~ Z ' ma be used for seco ses Privac Law, a15. 1 m Check ~ Revision I. Application Information -Please Print All Informs State Plan I.D. Number Properly Owner's Name ~- Parcel Number ' Property Owner s Mailing Address ~ ~. ~~ Property Location ,~ ~ f 7 t- 3 n ~ S/~ ~f ~C t;/t~/ ~ ST.G~~~)luCUiJ,^~~,,. ~E ~/1~u.SZZTZ7 N R~~ E City, State Zip C - ~ ING1bL-ber , Lot Number 3 Block Number ._,._- Subdivision Name CSM Number II. Type of Budding (check all that apply) ~fjyy,,~ liq- \ '~ amity ^ 1 or 2 Famil Dwell' y mg -Number of Bedrooms ~1_ ~ + t,e ~ W ,S (W ~ Vi lla e ^ T ts~e 4 ^ Public/Commercial -Describe Use g ~~ ~~, , lGi' hi r ~ ' e owns p .ie lo Y~ ^ StateOwned ~-~ren,~G~~3 ~ x ~ ~,S / -C~`O""'b~c/3 '~4,e ~l - NearestR ro-r~ y2 - III. Type of Permit: (Check only one box on line A ( umbering scheme for htt use). Complete line if applicable) `~' 1 New 2 ^ Re lacetnent sum P Sy 3 ^ Replacemctu of 6 ^ Addition to For Coumy use stem Tank Onl stem B. ^ Check if Sanitary Permit Previously Issued Petmit Number Date I ed IV. Type of Permit: (Check all that apply)(ntrmbering scheme is for internal use) 44~Non -Presutriud In-Groin 21^ Mound 47 ^ Sand Filter SO ^ Consavctcd Wetland ^ hessurized In~lrouad 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Reci~cnlating 30 ^ Other V. D tment Area Informat ion: ~„ b ~,. - / o o F / t.. TE/L_._ Z Design Flow (HPd) Dispersal Area Dispersal Area So' Application Percolation Rate System eva ' n F' Grade Required ~ Proposed Rate(Gais./Days/Sq.I~.) (Min./Inch) ~ flevation VI. Tank Info Capacity in .Total Number Manufacturer Prefab Sits Steel -Fiber plc Gallons Gallons of Tanks Concrete Constructed Glass New F.xiatint Tanks Tanks Septic or Holdic~ Tank - 2.000) Ll/ e~i J Q ~- tbsu~g Chamber VII. Responsibdity Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/IvIPRS Number Business Phone Number 1~ a- Ivl~l~o~~ ~-z-~-o 3 ~ t'~z - ~~S /SZ Plumber's Address (Street, Ciry, State, Zip Code)f~ / / ~ ~ ~ D 7 ~ t~u ti ~a {~ 0 of ~/ ~y~~ S° P~ ~.~ C~ r . Coon /De artment Use Onl Approved ^ Disapproved ~~' Permit Fee (includes Groundwater Date Issued suing A Signature (No ) ^ Owner Given Initial Adverse Surcharge Fee ~ ~ ~/ ~oZ ~ ~ Determination - . Conditions of Approval/Reasons for Disap oval i/J ~ ~ 2 `' ~:e.~j1,~) /~-~ h of ~~ ~ ~>y t~/~tlG~-c dtifcoh. w-.....,....~ ...,...,.~ o.,.~~ .o.- Luc r~scem w paper noc wa wa axis i u mcnet 1u tls! L SBD-6398 (R. OS/O1) z i C") V / m v _rn \_ S II FiR" J~~~a 2 ~ 2073 S i~. , ~ CO', ,T ~ 86.. ._- ~~ OFF; _~_ ~ ' D O r m -0 \5 ~_ II ~~ ~ i i ~ ~ ~` i i I I ~' 1\ A ' __1~ r~ cn N Y Yf Q ~ W c ~ ~ rnr ~ Z ~ O ~ w C D r °' 0 ~ O~~ cl~ cn ~mN Oo= 2~f~ ~ ° mc~o ~ ~ O ~ ~ '='INJ o ~ \~O GJ ~ N> (n ~ I U7 m° .,~ ~ ~ ~ o ~ r = ~ o ~ m ON Z~ n ~ ~ ~ ~ f N '--~ ~ ~ ~ ~ r.-' o n ~ ~ ~ ~ ~ O ~ O ~J ~ r D r D Z r Z r T °_ ~ _° C o m ~ I I -~ z Z D D ~ 0 ~ D pip D?o 0DZ mrJ~pZmy N n mo~ mo~ G7 - ~°~~=~o~Or-cn NZm n m ~~rrn~~.. =W~ . ~! ~N D ~ D~~ urn N N N ~<° m ~m~ I u'~'cn~0~ N O~ c i (n D ~! W - : ~ ~ C G~G~ mor ~ n~ m N O N DD m~N c C Z Z D ~ W D m C m ~ O O~ ° ~~ ~~ ~ OI (n O vv :f7 _1 ~ mm O' D ~ m r Z C") O D Z ~ N ,'1 O n ^~ J 0 D~ 0 c a 1 ~ U .... ~. .Q ~~. ~~ ~~ ~ Z/-o3 `a'L~~ht- ~; -P~Rn~:+ ~ yzo~ i~ ~~~EIl~~ \ Jlt~'v L 4 2003 ~~ ~~.0 ~ sT c,~oix.couN~-~r (~ ~ON!wG OrFICE _-°----- ,~~ `~:~~ ~r~~~ / ; ~ ``._ i ~~` .~ ~is `` ~~ '°'~~ ~ / T ~~ \ lG ~~°~ i ~ s ~° ~ ~ ~ ~ ~ .r°~ J a 'O ~~'o c ~ ~' f ~~f- ,~~~ ~q ~ ~ ~ ~.~ ~~, , ti° ~~Fri ~~ ~ ~ ~~ 6 ~~ y ~ ~ ~~ ~ ~9 ~~~~~ ~° ~- S o ti ~. ~r ,~ ~ s e,~ ~a % ~ ,~ \~ .R ~ o \ ~0 ~`e tiC /~ O ~ ~, ~,~ _ ~~ ~ ~ V ~' `s' c_ B ~ ~~ ~ ~ °~ o ~ti r' F .. ~ B. SE DoT .S'T~KE iii ~. _ HEAD/CAPACITY CURVE 1 f -"--- T07AL DYH gMIC HEAD/CAPACITY PER MINUTE - EFFLUEHi AHO DEWATERING _.,_~,z oa IJ).Iw la1 ~e) lee lee len ~u h Cd In Off. In CJ LT OK Lee Ov ln. _ Or lr.. Or lri G..I J,~-_----- Iz 77 a77 lo. as Ice wl el L11 el L11 j u 7x ,~~--- N' Y- )/ el 7J1 1D J00 100 071 al Ab el L')1 SJ ~ ly /n2^" s~ a5 u ~17o e. au vl ~. ao 2a7.- e0 m --- ~--`---~- sa Le 1.7 >ti .: . 67 7S '>U J6 1Je u 010'. 69 7h e0 22) --~--•--.~ W ZN IN DI!' .a: ' 1 JO )/_2D0 e) ' 211 ~ 60 221 ~---'-^"_ _ __ eb ; a./1 68 7D0' W ?ID 90 ' Ja0 S.1 ,L"L' ~ , ~ ___ _~. b '171 b .177 66 3~a 7s 21J ~yl J371 ipe y7i ,y, yq ,'--'-_'-_ s 21 50 ~ ~ 176 el 191 H a1. _ Sa L~JI Y; ~ ____. _ ~ ~; I I ~ 6 7 U l e l _ )e I x be 270 j -_--_ 1~ b I I 1 10 Od 6J 177 I 6 ~ - .. y:" 19J _ )7 Ilt i 7 I I-.~ -_.._ T.--___ I I e! I 7' • - -7J ?0 6A ee' 17 7J~ _- IIS' DI ~-___ EFFLUENT & D Warning: Model 185 shou ~ u~j~c!ec ; - than 30 feet TDH. ~_. 9 ~ Note: For Head Ca acify~on~Mode'2003 s,- . column-explosion oof m, , ,ear ? •; g ~1.~~~r~(,OUNi ' SEWAGE &DEWATERING - ~~~ Ira e6o Sao a,o WARNING; P,1odel 293 should not be sup ecte: to less i~an 15 fee' T~ •~ ~ ~ -------- -T--T --1~--~ I I _ T ~ ii I TOTAL DYNAM~,C HEAD/CAPACITY PER MINUTE ^~ SEW6IGE ANO DEWATERING 5 t -~ -----~_.-,__~.__ .. ._ ~~ -- _T_____~_.-.__.__.. - __.-__ _ ~ SERIES 7e7 761 717 7e1 J17 7N 797 7i1 i e 791 ~-"' -.-• .-- fi ~ Gel. ure Gal Ure Gel lve G11. Un. GII. Un. Gel Un. G.1. Un. Ge. l I ` G l Gel ss _ '----1 I s I s7 90 7.1 17e eee lae le. lae ue I - -- ~ -- I )0 19a Ieo ael Iw sJO _ 19e rl7 77_ e•_ -- -'-------~-- --.__~~ 10 ]0a 60 77) B9 JJ7 89 ]J1 e9 ]]/ 95 760 16e BD6 111 169 le.. 56)~*J ~- 1s 1 57 77.5 Ba 50 IB9 50 1B9 '~- -~- 50 IB9 BJ 7)e 175 511 106 w1 I)Q 197 I a5 675 '. ~e X . _. -. _____ _ __ __.._. 1_~ 70 610 10 70 10 76 10 7B ]7 175 106101 ~~-"----__. De JJJ 119 r5," 150 566 5E S]e i _n 7 e2 -- - I )0 9 11 _ 76 76B 6e 15 i IOa r0_~ 176 s • s ~-- B r - , I IS6 __ 10 17.19 ~-___ ._ )~ I'~ ~ I SO I s 7__- .__ -_ ____ 5 19 SC B' 9_ 7=a - _. _ .~ --_-__T-r--^:_ '~ 60 1B 19 ~ -.j-- -)e 710 PS _ __ '. 70 71 J~ __._'9 _._ s; 7~~.._ . -__ _-__.____ __. ~_ Lae vel.e 1e 71 5-~ 71 6' I -.--_____- 71 B' 76' ]5~ 17' SC ~ r,7 ., ..: ~ --- ------- I I ~ I ~ _ - i --- --- - ' -I-=' I ' I ~ ~ 1 - ~ ~ 2 9 ] -------{ - -------- - -- -- ~ '. i - -- __ - •- --- I -_ __ ~, ~ 182 - _ ~~ _1~ . ! -- ~_.-_, 292 I -- , --~ •_-_•--•--. I -- . 282 288 - ' 287, 288 284 291 2SS ~- ' ,.~ _ 1~ ~~ ~ ~ ~ I I ~~ )0 aC I 50 60 1 7 _-__ i 0 BO 90 100 110 120 1)C le0 150 180 170 180 190 200 210 210 270 --- I a ^ e--- -~--- I I -. y___-_ - ,0 210 )2 _'f.---T_~_--~--_--~-----~--... _. 0 t0v /BV S60 6a0 720 B00 BBG -. ., .. ~ _.\ _ y ~ Pump Chamber Calculations -~ 3. Pump se ection. 'Manufacturer:., Zoeller Model number: 98 : , Minimum discharge sate required: 30.00~~ Pump will'discharge 60.0 gpm @ 10.51' TDH 4. Dose chamber: ' - .: 123 zSo Manufacturer & capacity: Wieser concrete combination ST / PC liquid depth: 36.00 16.76 al./inch 603.36 al. actual ~iz~ng: ..~~~_ ._.__...._.,.,._::. _....._ _,._- .. . A One da 'holding~capacity 17.95 = 300.79 Qal. B) Alarm setting: 2.00" _ 23.64 gal. C) Dose volume + flow back: 5.55" = 93.07 'gal. (400ga1./4 doses per day) +(.164)(130') = 121.32 gal. min. D) Reserve storage: 10.50" = 175.98 gal. 2. Total dynamic head:: Min. supply pressure 0.00' Vertical lift 8.58' friction loss 1.93' Total dynamic head = l 0.51' '; 1 l . Force Main: 2.. , Diameter Length 94' - Flow rate r ; 30.00 Q'dl./min. :_:, .: :Friction loss :._. ~. 1 93' _ _ .. - -..; , _(94')(2.OSft /109ft) ,:,1.93 ft ~~ .. _~:-~ ,.-~ .~.: _ ~ ..-a ... ,_i .: .. ,. r~ .. TOTAL 36.0" = 603.36 gal. *; ~~ ~.. ~\ \\ ~\ __ _ . - ~- . . Hof#3 ~~~~(/~ ~Zz--r°3~ ~) ~ `~ ll`' r ~~~~•~ V S l~Fwy .~~~ ~ ~~ n Sr. w ~e`.~ I v.• I 3-3Xs~,sr~4~~ ` ~Z Ta~~i 1 ____________ _____ T. Q . H1- To ~° °~ I ®~~ L. Q v Qrq ~ m.~i ~ S ~~O ~ I~ a~~~y ~U' ~r- T~ ~~ 1 i s ~ /~ ~ i S~ o -~ I ~~ ~u~~~~ ~~~ . ~~ ~~, W°~ ~ , i ~ ,~ '~ ST. w zelo~l I b 3- 3 X 8 ~,.~ ~ r-,- , rt ~w~, I cf3p, ~s' T. Q . rr1 • Td p ~~ {<<.. P..~ _ (02..x/7 ` -~- ~, n.~ Wisconsin Department of Commerce Division of Safety and Buikfings SOIL EVALUATION REPORT in accordance with Comm 85. Wis. Adm. Code 1646 Page 1 of 3 A.C.E. Soil & Ske Evaluations County Attach complete site phan on paper not less than 8'/ x 11 inches in size. Plan must St. Crooc include, but not limited to: vertigl and horizontal reference point (BM}, direction and Parcel I D percent slope, scale or dimemsions, north rulfgw and locxt-~ i ~on and distance to nearest road. - . . 020 7-70-275 Please print ill infrt~~ I ~ f G_ ~ 1 (t) (m)) id f d e ~ ~ R B D#te ` (~ . Personal information you prov e may be us or secon ~ s. d ary PmP~ t ~Y d`~ ~3 Property Owner ' ;` ;,',~ ? - . ~ ~ 2oa3 P operty Location Leo Draveling Lot SE 1/4 NE 1/a S 22 T 29 NR 19 W Property Owner's Mailing Address > ; n ~;.~ ; y # Block # Subd. Name or CSM# 515 Co. Hwy. UU '~..__. ~-~' 'r FiCi= 3 CSM Vol. 15, Pg. 4164 City State Zip Code Phone Number J City ~ Village 1/ Tovm Nearest Road Hudson ~ WI 54016 715-386-5386 Hudson U.S. Hwy 12 & Kelley Rd. New Construction Use: ,~ Residential /Number of bedrooms 6 Code derived design flow rate 900 GPD Rep cement ~ Public or commercial -Describe: Parent material Glacial outWash Flood plain elevation, if applicable na General comments and rec~nmendations: Install 3 trenches at elev. = 86.00' using 42 leaching chambers. Each trench to be 3' x 87.5' using 14 chambers per trench. ~- ~~ # ~ Boring > 136" i /J Pit Ground Surface env. 92.53 ft n. . Depth to limiting factor Soil Application Rate Horizon Depth Domimant Cobr Redox Description Texture Structure Consistence Boundary Roots GP D/ft~ in. Munselt Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-22 10yr32 none sil 2fsbk mvfr cw 2fm 0.5 0.8 2 22-41 10yr4/4 none sil 2fsbk mfr Lwv 1fm 0.5 0.8 3 41-60 10yr5/4 f2f 7.5yr5/8 sil 2msbk mfr aw 1f 0.5 0.8 4 60-136 10yr5/4 none s 0 sg dl - - 0.7 1.2 I r ~ /~~ ~~ Comm. 85.30( applied (24" rule) to discount Redox. concentrations observed in H#3. System must be installed >12" below mottled soil ~~ # ~ Bonng /J Pit Ground Surface elev. 92.73 ft. Depth to limiting factor > 130" in. Soil Application Rate Horizon Depth in. Dominant Color Munsetl Redox Description Qu. Sz. Cont. Cobr Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GP 'Eff#t D/ft~ 'Eff#2 1 0-21 10yr32 none sil 2fsbk mvfr cw 2fm 0.5 0.8 2 21-30 10yr4/4 none sil 2fsbk mfr gw 1fm 0.5 0.8 3 30-43 10yr5/4 none sil 2msbk mfr cw 1f 0.5 0.8 4 43-50 10yr5/4 none Is 0 sg dl cvl- - 0.7 1.2 5 50-130 10yr6l4 none s 0 sg dl - - 0.7 1.2 Discorrtinuos 7' band of SyrM4 s observed at 7 ' - "irN~W corner of soil pit. Color pattern is indicative of iron oxide deposition cresting concretionary band s decompose .Color pattern does not indicate saturated soil condition. ' Effluent #1 = BOD ~ 30 <_ 220 mg/L an TSS >30 < 1 Effluent #2 = BOD < 30 mglL and TSS < 30 mg/L CST Name (Pl~se Print) Signature CST Number James K. Thompson 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane. O a. WI 54020 622003 715-248-7767 property Owner Leo Draveling Parcel ID # 020-1057-70-275 Page 2 of 3 Bonng # ---~ Bonng if Pit Ground Surtace elev. 92.62 ft. Depth to limiting factor > 137" in. Soil Appligtiwi Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Cobr Texture Structure Gr. Sz. Sh. Consistence Boundary Roots 'Eff#1 `Eff#2 1 0-18 10yr2/1 none sil 2fsbk mvfr cw 2fm 0.5 0.8 2 18-28 10yr4/4 none sil 2fsbk mfr gw 1fm 0.5 0.8 3 28-40 10yr514 none sil 2msbk mfr cw 1f 0.5 0.8 4 40-52 10yr5/4 m2d 7.5y45/8 sil 1 msbk dt aw - 0.2 0.3 5 52-137 10yr6/4 none s 0 sg dl - - 0.7 1.2 Comm. 85.30(3)2 applied (24" rule) to discount Redox. concentrations observed in H#4. System must be installed >12" below mottled soil. ^ Bonng # -~ Bonng Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Cobr Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots `Eff#1 'Eff#2 Bonng # J ~~ J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon De th Dominant Color Redox Deswiption Texture Structure Consistence Boundary Roots p in. Munsell 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/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. ~': J ~ Proposed (o b ed ~ co.y~ i~e si d e,z ~: ~l dip Iz~ 9~l.0' Y3.o I~ic2~. d ~;,,~5 I'° P on I~ a I ~ I3 b~:dr~mS) al \ (~'`' u.n~t J 9~ 6'7' ~ ~ h . I n ~~ i 83 e.nc.hY~'~arK ~ /1wl 1~ I ~, ~n lo'`Qe,d.P~ntree. ~ l R I C I d' I r, I O 3 O I N ~' w~ _- -- ~ ~ I Qep/ace.,, a-,-,~ 5y tf ~m I ,4~ea ~ 1 • ~ ho aPpirelab/~ S/ope ~~ou~~ Sys~.+, y38. /S ' ,q~a,ne~d e lei /~.~~ i G(. J. h~ ~y , ~~ ,~ AIb. 3,m. ;Top oQ EelePlw~e ~¢d. ~ ,C~//ey ~o~ cre~ =~oz.~~~ ~"~ 3 °f' ~ Sc; t.e/a/ua.~on p, t b/0.2~03 ~e~~ `~ ~~yb r `Jor ~ ¢ValGCa~io~7 I P; t z/o~/~s i ~ E'/el/Gtfi on I Scale: / ~: s~0' ii I ~ ~~ i \ G .~T' lJG kk Safety and Buildings Division County ® ~' ~ ' 201 W. Washington Ave., P.O. Box 7162 C Qp! C ,~ CO~S'I~ Madison, WI 53707 - 7162 Sine Address De artment of Commerce ~~. $ ~,~ Sanitary Permit Appli ~Aber ~~ Permu No , I ~ ~ O O N I N OZ ~ , T2~ / Z In accord with Comm 83.21. Wis. Adm. Code, persotnl rmatjpgpypr~aip~?{7 1S ^ Check if Revision ton be used for ses Priva Law, s15. 1 m I. Application Information -Please Prlnt All Information ~OOZ L i ddd Plan I.D. Number ~ 8 3~-slf i- ~T.~vtt~,~, ~~~ Property Owner's Name 1 Number Property ow~r's Mailing Address !~ r . rty Location q ~~/C ~S G`~ ~ ~ Cif ~,[; S 2ZT Z/ N. R S Ciry, State Zip Code Phone Number Lot Number ~ Block Number i Subdivision Name CSM Number vvso l~ W ~ yo/ ~ ~~~- ~~~~ ~ s n1 ~.1. is ~ `i l ``~ II. Type oP But~ding (check all that apply) _ ^ 1 or 2 Family Dwelling -Number of Bedrooms ~. ^ Public/Cotnmercial - nbe Use f?A ~v 0 °`~i ~5 ~ 93 ~ P . Ce~,~O--f ° ^ Srate owned Neatest Road ~ III. Type of Permit: (Check only one box on line A (nnm scheme for terns( use). Complete line B if applicable) A' 1 ew 2 ^ Replacettient System 3 ^ Replacement of ^ on m For County use stem Tank stem B. ^ Check if Satritary Permit Previously Issued Permit Number Date Issued IiV. Type of Permit: (Check all that apply)(ntimbering scheme is fo in ase) 44 ^ Non -Preswrized In-Ground 2~ound ^ S filter 50 Co etland 22 ^ Pressurized In-Ground 41 ^ Holding Tank ^ Single 51 ^ Drip Lim 45 ^ At-Grade 46 ^ Aerobic Ttroamunt Uni 49 ^ Rec' 30 ^ Ottur Y. tment Area Informat ion: f}--(o9 Design Flow (gpd) Dispersal Atea Dispersal Area it Application etcolation Rax stem even n Final Glade 9 ~~ Required Proposed Gals./Days/Sq.Ft.) ' ./Inch) Or~• z ~ / Elevation ~j't~ Ajo o .. 3 ~1' 1. ~ L.. VI. Tank Info Capacity in Toeal N Manufacturer Prefab Site Steel Fiber pia~c Gallons Gallons of T oncrete Constructed Glass New Existing Tadrs Tsdcs Septic or Holding Tank - /ZS ~p ~ wIZ1~Sq/' w t ~s /~ lod y~ •,` Dosing c6ambet ZSo ~ ~~ s e-r VII. Responsibility Statement- I, the undersigned, an„~.e respoast'bility for installation of the POWTS shown on the attached plans. Phttttber's Name (Print) Plumber' Signature MP/MPRS Number Business Phone Number Phu»ber's Address (Street, City, State, Zip e) D .~ d/ lei v~soN. ~/ S D /~ . Cotm /De artment Use Onl Approved ^ Disapproved ~~5' Permit Fee (i~ludes Groutdwater Date Issued Issuing Agem Sigmture (No Stamps) Sutrharge Fee) ^ Owar Given Initial Adverse ~ 32~ ~ Determination ~ ~ lX. Conditions of Approval/Reasons for Disapproval ~; I ~ n ~ ~e~e~w-~..vi : ~ ~-. wk~- ~ r,no~.~.-~~o-~...9.1) ~ ,4.;i-{z~,~,IL -t~~'t~~ .-+^~~.- s ~ C ,P y p ~~ ~ R,~.o-crc~adJ ~ ~,,`,.,,..... ~.er-. k t~ ~ l: ` a ~ Md I r` V ~ ~P~ P~ tw roe ~:ouot7 amy) [or the zystem m p.per not tm than stn x 11 Inches to size SBD-6398 (R. OS/OZ) s isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary February 19, 2003 CUST ID No.225036 MICHAEL P MC DONELL MILLER CONSTRUCTION 1070 HUNTER RIDGE RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 02/19/2005 Id Transac n SITE: Site ID No. Leo Draveling Please refer 868 Kelly Rd above, in al Town of Hudson St Croix County SE1/4, NE1/4, 522, T29N, R19W Subdivision: CSM: Vol. 15, Pg. 4146, Doc. No. 655354 FOR: Description: Proposed Six Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 891994 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 entific on Numbers ID .837547 identification numbers, ~ndence witlithe aeenc~ The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans. • Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the septic tank outlet filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • Comm 83.22(7) - A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: Comm 83.52(1)(a) -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). ~."~ ~;~, ~ y~~~~ MICHAEL P MC DONELL ~i e Page 2 2/19/03 • 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. • The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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, oneration or maintenance of the POWTS. Sincerely, Gerard M. Swim POWTS Plan Reviewer -Integrated Services (608)-789-7892, Mon. -Fri. 7:30 am to 4:15 pm j swim@commerce.state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky ,Wastewater Specialist, (715) 726-2544 ~. r MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application ~~ INDEX AND TITLE PAGE ~ ~~~ ~~ ~~~ ~ Project Name: Leo Draveling 6 bedroom residentail mound ~ ~, '~ ~~~._,,, ~ ~ ZQ®Q v ~~- ~J ~~ Owner's Name: Leo Draveling '`'°~-W ~ ~pp I Owner's Address: 515 County Hwy "UU" Hudson, WI 54016 Pcl. Add.: 868 Kelley Road Legal Description: SE1/4 NE1/4, Sec. 22, T.29N., R.19W. Township: Hudson County: St. Croix Subdivision Name: CSM Vol. 15, Pg. 4164, Doc. #655354 Lot Number: 3 Block Number: na Parcel I.D. Number: 020-1057-70-275 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Soil Evaluation Report Designer: Mike McDonell License Number: 225036 Date: 02/11/03 Phone Number: 715-386-8692 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) Version 3.0 (03/01 /01) y, P„~, Page 1 of 9 GENAf2TMEN"( Ot CON~1`AERCE D VIS-ON OF SAFETY AND BUILGiNGS SEE CORRES O ENCE FEB-18-2003 08:24 AM A.C.E. Soil & Site Eval 715 248 7764 .' .i Mound and Pressure Distribution Component Design Design Worksheet Sits Infonnatlon -- (r or c) R Ragidential or Commercial Design Nola: Sarid fill (D) calcuiatlorn aesurre e 600.00 Estimated Wastewater Flow (gpd) Table ~-3 in~ltu aal treatment for fecal voliform d ~ 38 lnetma. 1.50 Peaking Factor (e.g. 1.5 = 15096) 800.00 Design Flow (gpd) 6.00 Site Slope (%) 93.75 Contour Line Elevation (ft) 32.00 Depth to Limiting Factor (In) 0.50 to-situ Soil Application Rate (gpd/ftZ) Dlstrlbution Cetl Information 120.00 Dispersal Cell Length Along Contour (ft) = 7,50 Cell Width (it} 1.00 Dispersal Cell Design Loading Rate {gpd/ftz) 1 influent Wastewater Quality (1 or 2) Are the laterals the highest nt in the distribution Y Pressure Dlaribution Information network? Enter Y or N (c ore) c Center or End Manifold 2.50 Latest Spacing (ft) If N above, enter the elevation it 8 Number of Laterals of the highest point. 0.125 Orifice Diameter (In) (e.g- 0.25) 2,50 Estlmat Orlflce Spacing (ft) = 8.25 ftZ/orifice 2.00 Forcemain Diameter (in) 123.00 Forcemain Length (ft) Does the forcemain drain back? 83.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 20.38 Forcemain Drdinbadc (gal) 10.75 Vertical Lift (ft) 113.20 5x Void Volume (gal) 8.55 Friction Less (ft) 133.59 Minimum Dose Volume (gal) 25.80 Total Dynamic Head (ft) 59.32 System Demand (gpm) Lateral Diameter Selection in. die. o ions Choice 0.75 1.00 1,25 x x 1.50 x 2.00 x 3.00 x Treatment Tank Information 1250-750 Se is Tank Capactty (gal) Wieser Concrete Manufacturer Manifold Dia~metsr S election in. dia. ~ ions choice 1.25 1.50 x 2.00 x x 3.00 Gsllonallnch Calculator (optional) 1280.07 Total Tank Capacity (gal) 47.00 Total Working Liquid Depth (In) 28.81 galM (enter result In cell B49) Dose Tank Information EfNuent Filter Information 7280.07 Dose Tank Capacity (gal) Zabel Filter Manufacturer 26.81 Dose Tank Volume (galrn) A100 Filter Model Number Wieser Concrete Manufacturer P. 02 Protect: Leo Draveling 8 bedroom residentail mound Page 2 of 9 FEB-18-2003 08:25 AM A_C.E. Soil & Site E~al 715 248 7764 .• r Mound Plan Vlew 1 J10 B ~ ~opesrvedon Pipe :Q : J . z~, ~ .r.r.s. r~d~ r,r ti A r r' r r" a ti ~ {~ti.ti:.,S{.ti.ti~`a:$:tir.'~' •ti•~f ,.~;f}r;~.r:r~ftir'•l7'•f;ry5rxr.}.s: ,~.r.r.f.J 1• ,r.~.1 1;"~1•~. •. ;.ti.. } . ti.; :''"•~ ~~~•7SS'itf:r:r7r~r '.'~}~j~}:rti~•tir7f7 Ts.r.r..• _ ,r.r t l• f.r• 'rTf ~. W g .._-~. • _ •~• .LJ ~ _ --.-a L Mound Component pimsruiions A 7.50 ft E 10.50 in N 1.00 ft K 7.3$ ft B 120.00 ft F 8.25 In z 7.57 ft L 134.75 ft p 8.00 In G 0.50 ft J 4.62 ft W 19.85 ft 800.00 (ft~) Dispersal CSI Area 1$08.82 (ft~) Bassi Area Available 7,50 (gpolft) Linear Loading Rate 12.00 {ft) 1/10 B Obs. Pipe Placement Mound Croaa Section Vlew Aggregate Dispersal Area Finished Grade 96.02 {ft) -~ H ' 1t»~ril 2 1NI//J ////// ...._..... 1 .. / / ~1/J F o+apersai ce++ 94.75 (ft) Lateral 94.25 (ft)-- - _ invert Disperse{ Cell :~ : = : ~ : ~ : ~ . - ..... . Elevation E• _ : D; ~~~~~-... ^'`'` " "~ " " • • ~ ~ ~ Contour Elevation °k Site Slope .Q S G~extiie Fabric Cover Shading Key ~ ~ ~ -• ~ -- T Dispersal Cell See lateral details on r b f 0 ~ Topsoil Cap /f,,/ Q ®Subsoil Cap c ~ o z 1.5 ft " ;,.r.; r.S.l:s•J.'.: ~ . ;~~[ ~"•. ~'"' ~+~"" ~f:`~ r;r• : f': . , e or num Page 4 size, and 'n of space g [,~':'~ ASTM C33 Sand `~ ~ a ~ . r• r, . r r r, f. .. .. ... -~~tirti F ~'"'"~' ~` "'''"• •''' TYpica{ I.at®rat .,.i.r :, 5 ft 0 erals. Eateries are l8t aced from ll s Titled Layer ~ m c ; , . . r;•,~;.••,:f.x:f•a;s:r:r • ;.ti.•..,,.w.t""'`" s . equa y p distribution cell's h ~.ti.y r.; .,~. Aggregate ~ o r. f". •x•r.rY"'r•~. f.r ~._,_ e t ~---._ q ---~...--* centerline in the distribution cell (AxB). P.03 Projects Leo Driveling B bedroom residentall mound Page 3 of 9 FEB-18-2003 08:25 AM A.C.E. Soil & Site E~al 715 248 7764 t Center Connsctlon t~fllteral Layout Daigram Force mal n oonr»atia+ Wa ra or orosf to manifold at art! poN+t. Laterals ere iOeMio ai I P ~- ~=Turn-upwfbrllvehre or (FX~IF~ ~2~I Lamals6cfarcemain~PYC8oh40 of ae noutplu 7 per G'QMM+t 7abla $~1.30~'~ Holtic drilled on the bortem of the lateral, Number aF Laterals 6 Lateral Diameter 1.25 In Lateral Length (P) 59.22 ft Lateral Spacing (S) 2.50 ft Lateral Flow Rate 9.89 gpm System Flow Rate 59.32 gpm Total Dynamic Head ~25W. SO f it Orlflce Diameter Orifice Spacing (X) Orifices per Lateral Orlflce Density Manifold Length Manifold Diameter Fortemain Velocity dose Tank Information Electrical as Per NEC 300 arld ---~ Comm 16.28 WAC J„~_ Dieconnatt Tank Component Is properly vented Wieser Concrete Ga I 12130.07 Volume 28.81 Manufacturer Gallons galnnch Dimension inches Gallons A 213,13 700.135 S 2.00 53.132 C 6.87 184.48 D 12.00 321.72 Total 47.00 1260.07 A B C D Alarm Manuafacturer LevciArm Alarm Model Number DLV Pump Manufacturer Zoeller ~~~ Pump Model Number 181 __ Pump Must Deliver 69.32 gpm at 25.80 ft TDH 125 in .52 ft 24 5.00 ft 2.00 In f3.06 ftl lodging darer virsr, vrarning labs, and locking aevk:e and sealed watertight 4 in. min. -~~ E------- AkdTlata outlet IOCetlon Forcemein dlerrte0er ~ 21n. Weep hole or antl- sfphon dev~e P. ump df elev~iat ft ~--_'- $4.00 +poss tank etev~ion (it) $3.00 P. 04 Project: Leo Draveling f3 bedroom residentall mound Page 4 of 9 '. Mound System Maintenance and Operation Specifications Service Provider's Name J. Thompson, POWTS INSP.#4819 ,! Phone 715-248-3271 _ POWTS Regulator's Name St. Croix County Zoning_ _ ~ Phone; 715-386-4680 System Flow and Load Parameters Design Flow -Peak 900 gpd Maximum Influent Particle Size 1/8 in Estimated Flow -Average 600 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1250-750 gal Maximum TSS 150 mg/L Soil Absorption Component Size 900 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Ins ect and/or service once eve 3 ears Should ins ect 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 mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 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 Turn-up Detail Finished •.. ......... ................ ..• Grade \ ' :::::::.::.:. .:.:.:. 6-8" Diameter Lawn ~ ~ . . ~ . ' . ' . Threaded Cleanout Sprinkler Valve Box . ~ ; ~ : ; ~' ~ ~ ~ ' ~ ~ ~ ~ ~' ~ Plug or Ball Valve Distribution ~ Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Leo Draveling 6 bedroom residentail mound Page 5 of 9 ' . Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals (SBD-10691-P (N.01/01) and SSWMP Publication 9.6 (01181)) 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, ar 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 fitter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, 'rf such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound 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 since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS, 30 mg/L TSS, 10 mg/L FOG, and 10° cfu/100 mL for highly treated effluent. Influent flow may not exceed ma~amum design flaw specified in the permit for this installation. The pressure distribution system is prov+ded with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if 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: Leo Driveling 6 bedroom residentail mound Page 6 of 9 FEB-18-2003 08:26 AM A.C.E. Soil & Site Eval 715 248 7764 P.OS •' -* HEADICAPACITY CURVE UENT ~ DEYVATER{NG TOTAL dYNAMIC HEAOlGAPACITY PER MINUTE ''~ ~ EFFL ` 1ia1 „ aE,aaa it w +srna ,ew+al +ea<auat ,.w,w +IONIab +alaw ~'" - - FT ~: o,~ oAL ., aaL ca• oa• ~ w~ '. ow ::: :: '. .. ~. .lo e i,aY eJ 163<' 7t :0)g,a f7 Otl'^< 1de ='eel"' 01 -'7L1~ 01 :;6ja u :`Y!Y" , of 105 :w to se 1Y! el !ff • n ~ too ox N 1. N . ee . `"" ~ le lv ~ :' es trQr` ee ~ el 31ee :: ao .e1E a AtT se !7a' ~ " 20 ~,~ .. z .. 33 '1f0,.. • >t tli :, 0f ev0 ~ S! !'!~~' e0 ~ cx : < a, _ -J f -_ 26 7~-.It t< , u,; 0 '~0"' , Tt ~- 67 ,~#0::: f0 ..:: ~ 9~ ~,~3d: _ ~.;~ Yu ! I ]0 "!«tY '..: _., ::, ee s.dA-; 66 SMf~_' JO n~q'f 90 a,; _31 ,.'a~.:..' ..:,. na ~ e0 ...1{r7k :»..>., 37 IA:., JJ ,a:1A: : st > ~ ~ ::.. .,:. a4 ~ - eo fes~ es ar 4J y,»4 ' se ' 1~If a fem. !lw 7, is a :• :: : ~ . ~ ~t,u S ~ m 1 ~ a .u u :.rl~ el aa~.: rf, :.vav<. . ,: y hj.., T;- - ~ - ~tl i I Od 2e~3t _ ., _ _ is ,. Ot s6 .1r0 ss~YNr' s4 .• ~l . :;... _ ~ .. a . _ ~ Inn ... ':~: ' ,..,. .. :.: 170 a7.0e : .. ~,: ' ~ ~ ~ ~ ~ ,.: T .:M:.: ... ;. . 0 ~ s:0,'.; ~ LKYINW: f0.70' ><S ffi ee' 6i' er lY 115' Of' 11J' ' ~;~:':: es : s WARNING: Model 185!4185 should not be sub jected to ::::<: ,e leas than 30 feet TDH. ~~ . NOTE: For Head Caparity on Model 112, Industrial „ ~~ column-explos+on proof pump, see FM0219. .moo ' 1e~,,, es ? : J0 - ta .1 lYY,11 W I D n- - -- ... 7n ~ 1e1.,1e1 .. . s: A, :_:. ro • - - - 1ee,.1~ .v .. ~ vv_ 'i ~ iia. ]T,,Je us oi~w.ls k ~ .a : a 0' ' o ;: w 5 y 0 ' o w R .o$~,Sa ~ ~ 'o~,~,~,, ta 1 o ~lf5 w m 11m e SKB/7J ~ :. .::;: > 7 80, ., .. ~~;; ' .iDItE ,<o'se"F6RPas:~ ~.:a~ i eys v naer ~a w,un - SP. 32 G.P,nt. ~trnimun, skr7/h~ Werra r~+ceired 11 Ill~~ll a larm . lellaa~lr >a:: Ip., .. .IRn ~ .1f.. a w.~ `o ~i~ 3e7 ~ Y717A7 :.: , lee, ns. ea xM..TS, a .. I9~.4Ja5 . Il `.. CMI OMS 10 7VI Y aV 50 60 )V tlY On 1M I I f V I!O I1]V 1 W 'A 160 101M10 SOV J1 L'N !] ?aV 7nn 7fn rA e .. a' "' .nIJ,... ,110 "74b ~ aka ~~. '400' ~ .,;:MaO ~ aFn ,101C fllNa rrR riWi,[ ]7U ],n l'In J.Y ]tla ' ]an aM " ....17fq.. D. , ,.1sea: ~taa ... 1310 SKS60 pg. T m~~ ~. ~r Proposed well 0 J~' D~. ~~,a ~~ Q ~~~ Pro/JOSed ~, 23'Z~ / 15~ 9 v~ Co,n bJ~.f%cr! Proposed i,,~sv8so, pun,pchambu: Proposed mound ~E /9. ~9 ;r /3f!7S' ~ ~ w/ 7.S~X /,2~.0' d,s~c~sa/ ce/% 5iX (~~ __~~ d%stribu-Eio~ /a~e~q/S at l~ "X 59.22' ~ ~`,'~ %~ori {;'ees Spaced ~~ 2.5~,'~,z~lP~~4~a~.c/~ I A r (° ~~ ~~ az ~ L_ 930 ~ 5or / ¢ualcca~Eio~ p; ~ ~ Eia~ Z 5ca/e: / ~- ~O' I~~~d ~1 (~;ne5 A I~ Z ~~ J I ~ ~~ IA 83 11 3 e,nc.h velar K ~ J1 ~~ .n ~o~'Qe.d,P~ntree. A~krne-d e led: _ /GY~.~' y3B. /S ' AIE,.3.m.: ToP of ~e.lephone P2d. /~e~. -~o~ cre~ ~ lo2.y7, „ /z „ Q~.,go~9 ,~ „ Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8'/: 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 dimemsions, north arrow, and location and distance to nearest road. Please print all information. e Personal information you provide may be use Property Owner Leo Draveling ____ Property Owner's Mailing Address 51_5 Co. Hwy. UU City State Zip for seco~~~S~S r~~ [~, s. 15. a. Pr Go ~T (~R(llk' ('_ L ode P F~~~IeF I CE _ (1) (m)). Location ~ By 1614 page 1 of 3 A.C.E. Sal 8~ Site Evaluations St. Croix 020-1057-70-275 Date t. Lot __SE 1M NE 1/4 S 22 T 29 N R 19 W # Block # ~Subd. Name or CSM# 3 CSM Vol. 15, Pg. 4164 City _ j Vit{age / Town Nearest Road Hudson I WI 54016 715-386-5386 Hudson i U.S. Hwy 12 & Kelley Rd. 1/ New Construction Use: ~ Residential /Number of bedrooms 6_ _ _ _ ._ Cade derived design flow rate 600 GPD ,J Replacement ~ Public or commercial -Describe: Parent material Glacial drift __ Flood plain elevation, if applicable na General comments and recommendations: Install mound system at elev. 94.25' at 6" above 93.75' contour. Boring # J Boring 72" ' /J Pit Ground Surface elev. __ 93.22 in. Soil Application Rate ft. Depth to limiting factor Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIftz j *Eff#1 *Eff#2 1 0-6 10yr3/2 ~ none sl 2fsbk mfr as 2fm 0.5 0.9 2 6-30 10yr4/4 none j sl ~ 2msbk mfr ~ aw 1 fm 0.5 0.9 ( ^ _ 3 32-58 10yr2/1 - none 1 2msbk - mfr ~ gw 2fm 0.5 0.8 4 58-72 10yr5/4 none sic! ~ 1 msbk I mfr --- i aw --- 1 f ------ 0.2 ---- 0.3 - g 72-86 - 10yr5/4 - m2d 7.5yr5/8 sic! ~ 0 m ~ mfr aw - 0.0 0.2 6 86-98 ~ 7.5yr4/6 none s ! 0 sg i~ dl ~ - - 0.7 1.2 2 oring # ~ Boring Ground Surface elev. 92.72 ft. ~~ ~ Pit _ Depth to limiting factor -_ > 110 _in. Soil Application Rate on Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft' ' ~ *Eff#1 *Eff#2 1 0-17 10yr3/2 none I ~ 2fsbk mvfr cw _ 2fm - 0.5 -- 0.8 - 2 17-30 -_ 10yr4l4 none sit ~ 2fsbk i mfr gw 1fm i 0.5 0.8 3 ! 30-44 10yr5/4 none sil 2msbk ~ mfr aw 1f ~0.5 0.8 4 44-98 j 10yr5/4 none s 0 sg dl gs ---- i - 0.7 1.2 5 98-110 10yr6/4 none s _ j 0 sg i dl _ ~ - - 0.7 1.2 i i `Effluent #1 = BOD 5> 30 <_ 220 mg/L and TSS >3 < 150 mg/L * Effluent - ODS< 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signal CST Number _ James K. Thompson 3602 Address A.C.E. Sal & Stte Evaluations Date luation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 2!6/03 715-248-7767 ~roperrly d`inmer Leo Driveling Parcel ID # __020-1057-70-275 __. __ Page _2 . _ at 3 __ Boring # --~ Boring ~/ / Pit Ground Surface elev. 94.34 ft. Depth to limiting factor 3~an Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ~ *Eff#1 *Eff#2 1 0-6 10yr'3/2 none sl 2fsbk mfr as 2fm 0.5 0.9 2 6-30 10yr4/4 none sl 2msbk mfr aw 1 fm 0.5 0.9 3 32-58 10yr2/1 f1 d_ 5vr5/8 _ sil 1 msbk mfr gw 2fm 0.2 0.3 4 58-72 10yr5/4 f2f 7.5yr5/8 sicl 1 msbk mfr aw 1 f 0.2 0.3 5 72-8ti 10yr5/4 m2d 7.5yr5/8 sicl 0 m mfr - - 0.0 0.2 ^ 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 T _ *Eff#1 *Etf#2 I Boring # ~i Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots _ *Etf#1 *Eff#2 I * Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 =GODS < 30 mglL and TSS <30 mglL The Department of Commerce is an equal opportunity service provider and employer. if you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3 2 5 l or TTY 608-264-8777. . s ~ . ~, , Proposed 1o bed~c~om i"e5i da-,z6~ t~l dk~o I~~ (3 ;rb~«:c~ rt.i~m S~ 9yo' 93.0 1 a~ 1 l ~~ ~, 1 N I c 1 ~I ~ I a rl z ~~ 0 ~I ~~ ~ w~ ~ ~, 3~ ~I1 X38. /S ' ~ 5or~ QValcca..~io7 p; t ~ E'levcrf%on 5ca/e: / ~: ¢O' ~`~c2~. d ~; n Cs A I~ Z I~ a I c~, n C~' I 3~.n~hwt~~C ~ n~•I in 10''Q~d,PlntrCe. ~~t~,rtzd e lei/: /LL7.AD' ,a,~t. 3.m. ;Top c Eelepho~e ~o¢d. u. ~. ~w~ " /z -, P5 3 of 3 L~,_o D.au~l;k~ ~ ~ C/o tG ., Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: Svstem Desian Specifications Sanitary Permit Number °-~oZ Number of Bedrooms !v Design Flow -Peak (gpd) Sao Estimated Flow -Average (gpd) ~~ Septic Tank Capacity (gal) 12so 7 sv C. o Soil Absorption Component Size (ftZ) Sao Type of Wastewater Domestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow -Peak (gpd) c~ Maximum Influent Particle Size (in) 1/8 Maximum BODS (mg/L) 220 Maximum TSS (mg/L) 150 Tab le 3: Maintenance Scnedu~e Septic Tank Inspect and/or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years 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 (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The ut et filter hall be cleaned as nece~aan~ t~ an~ure proper operation. The filter cartridge shou 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 . ~ ~ Management Plan for a Sceptic Tank and Soil Absorption Component 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. 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 the tank. 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 of holding tank may contain lethal gases, and rescue of a person from the interior of the Tank maybe difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, 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 domestic wastewater from a residential 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 must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or 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 component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 ,, -- ,~ ~ Management Plan for a Geptic Tank and Soil Absorption Component >~ Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. T~,, s .5.~ s ~ S ~~s 5K~ 3 ST CROTX COUNTY ,; ~ ~ SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer L~ v ~~ ~ ~~. ~ ~ K _ .. ~. Mailing Address S- ~ S e ty T-/e CJ ~ Property Address ~~$ k ~.. (Verification required frorli Planning 1epartment for new construction) - f`-'1 City/State _~ (i/~ Parcel Identification Number ° ~' " /~ S7'' 70- 2 ~,f LEGAL DESCRIPTION Property Location ~ ~ %<, ~ %<, Sec. zy . T Z9 N-R~Town of -f~°~D~ °/y Subdivision C S /Yl ~ ~ /,S f'q • y ~ ~P Lot # 3 Certified Survey Map # CA s S ''S ~ y ,Volume ~ ~ ,Page # ~~ ~ 7 . Warranty Deed # ~~ -S' `~ 7 ~ ,Volume Z ~ a $ ,Page # ©a ~ Spec house ~] yes ^ no Lot lines identifiable ~ yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition andlor (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. OYZ,e~ e._ SIGNA URE OF APPLICANT 9 DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE ss««ss Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** «• Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed a r; ,r Document Number U 2108P 00~r r i ,. . STATE BAR OF WISCONSIN FORM 2 - 1999 WARRANTY DEED This Deed, made between Alfred C. Schultz and Marian J. Schultz, husband and wife, Grantor, and Leo A. Dravelin , A w.arr;e.d Persr~ Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Part of the SE1/4 of NE1/4 of Section 22, Township 29 Nort ange 19 West, St. Croix County, Wisconsin, described as follows: of f Certified Survey Map filed August 31, 2001, in Vol. 15, Page 4164, Doc. No. 655354. ---- o2a l os7-7o-27s _ Parcel Identification Number (PIN) This is not homestead progeny. (,1~) (is not) Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any, n~ Dated this _ ~ day of Janua i Signature(s) `\ I AUTHENTICATION authenticated this day of _,_ 2003 ' * fred G Schultz 1 + Marian J. Schultz ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. St. Croix County ) Personally came before'me this ___~,~ day of January 2003 the above named Alfred C. Schultz and Marian J. Schultz, husband and wife, TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stets.) THIS INSTRUMENT WAS DRAFTED B~ Attorney Kristine Oeland (Signatures may be authenticated or acknowledged. Both are no 705475 KATHLEEN H. MAL5H REGISTER OF DEEDS ST. CROIX CO. , tiiI RECEIVED FOR RECORD 01/13/2003 08:30AM EXEMPT i REC FEE: 11. @0 TRANS FEE: 252.00 COPY FEE: CERT COPY FEE: PAGES: 1 Recording Area - Name and Return Address ~• ~ ~~ to be the blic, State of Wisconsin fission is permanent, (If uted the foregoing state expiration date: ~~ ~) • Names of persons signing in any capacity must be typed or printed be ~(hgapjaA re. WARRANTY DE~;D STATE BAR OF WISCONSIN FORM No. 2 - 1999 Information Professionals Company, Fond tlu Lac, WI aoo-sss-zoz~ +ii . ~ ~ ,~ I ~„ Es5~5~5.4 KAtNLEEN H. I~ALSN REGISTER OF DEEDS ST. CROIX CO. WI RECEIVED FOR RECdRD 08-31-2001 8:45 All _ ~ COPY FEE: 4.00 RECORDING FEE: 14.00 i CSM VOL. 12. PG. 3462 CC I NT ' S ~ TRA j L ~ ~33 33' --- -- ....:.~ ~ ......................... u... w n- ~~a ~ x N 400.38' R.A.'.~ ~ _ :.`'' m ~m-i ~o ~ ~ m~ ~ ~~ O ~ Xmn~ 0 w ~ ~ O rmD ~ 0 x .~ ''. ' ~" o r z cn ^ O m ~"'' ~ ! (n y m w 0 cn ~ ~ (` to ;. Dm x ~ r~ R ~ ZS ' ~ e ITe 't7 ~ ~ O . •~ r ., ;, ~b • ~ •. N ao A [+7 ~~r ~~~ ~ ~ NI Z IN u,m d 107 ~ 07 3: z~ ~... S O OZm r' ,~~'~rertiet~~+~'~ r -.A ~ rte' N ~' •O ~°•~ -it's t*7 -A-1 0~ m ~' N Z v -0' n .A ~? '~ n cn v L ~' J ~,,, ~ ~.~ ~ m I o .A .n N ~m • cn x o S00° i I'42'E ~ '~ °im 1' -~ -~-; 'v o o °i_ 333.92' _ m= ~ nzm l.N -O ~ i aw O O C `J ~( a,wi ~ ? w} ~v~ zn~~ ~ ~ •v • ~ .A. I ~ o • u to I rv m ~ ~" S00'02'S7'W ~ . 'v N ~ ~. NSA m-o < n~i < as.oo• n r" n D .i~ 'p i .°' z mgr ~zcc _ b ~ ,~ ~ ~ m m "~ ~o: m ~ D ~ 3: N ~ ~ mz- o~m ~•: m m rn s ~_ SETBA_CK w ~ w °• ~ o ~ m 66.02' u z a+ - LINE • ~w `^ ~ o -+ ~ z soo•o2's7'w a -+ o :owo ~, I "'. o rn o o o ~'• 333.50' ~ ~ o '~ v 206.70' 126.80' ~ ~ O ~^ 6 O • 33.00' $. 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