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004-1075-70-200
F7,fetyand epartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix uildi ng Division Sanita ermit No: INSPECTION REPORT 85 GENERAL INFORMATION (ATTACH TO PERMIT) Stat Ian ID 176: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 4 S' Z S Z Permit Holder's Name: Village X Township Parcel Tax No: Burr, Jamie D. & Stacy City Cady, Town of 004-1075-70-200 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 31.28.15.492B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ~V f / Benchmark Dosing / Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet U., !5ew 77 St/Ht Outlet TANK SETBACK INFORMATION T NK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet J Septic Dt Bottom Z7 Dosing Header/Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) LLength 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 EI Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 15 270th Street Spring Valley, WI 54767 (SW 1/4 SW 1/4 31 T28N R15W) NA LT(/1 z / / S Parcel No: 31.28.15.4928 ~ Co fo 1.) Alt BM Description = / 2.) Bldg sewer length = ls~ 36 J ~J F J - amount of cover a J z Plan revision Required? ❑ Yes JNo d Z F3 44 7 Use other side for additional information. /6 Date Insep is Sign re Cert . No. SBD-6710 (R.3/97) CU y O ~ w 3 a cD 0 0 V ch G m Y }}a' O h W m rn c a2 J. LLO p C=7oZ O .m . N w / U wme a 3 Q W . ` ~ m I ! N .C J o W o / l1) - m' fG Cl) !r °o °W w z uvi < Z t/1 p aT,b`~ ° a O N J C.) LL o Q V lACat. O.C V N (9 z w N Q II d O LL. a ~r v o I! a I z c~~ Y J-1 I a.z Q I ! O J^ a~ 4 w O r ! z lam C) to r ~I o 1 QO I°- °r°I I' ca rno¢wl ~o I~III o°^ 1+ a~ Iv~i< `~n~;l I O~- =90 $x '"I co I mQz ¢h Rw o° I r xz IW JV;I rx 0<o0 W JIL 1~ LL .1 0 w I J la,~ o=I Izw 0owoOZl ~-p 0 lob 4 1 I0,C-n ia~l Z ui Q 1~ v;l ~wmooow0' Q Y m O Ica JJ Z OJ(J w j 0 H~ L- -I I~ a❑ec~®®I a a. W Q L-----J 1 E I _0 ; i i o J_a~~J \ a c I w 3 I Q V \ LLI CO) N C " O p at \ \ \ V CL Z \ W J E a`~ a 3~ \\J\ G Z ~ lyj \ L L.\ p t Qu) oy c J1 V' \ \ p -~/f 1 \ 3Q ; _j ILE \ ui ° n 1tlY~ m \ \ \ cn 3 lllJ DJ< \ J_JJJJJ ~ W I -J -J \ N w O~s1o O~iO \ \ \ 4 (D J do~,~~J_J~ \ \ J dJ~J W O cn Q 0 J 2 W \ a \ \ L° PAGE 3 OF 9 SPA County Sanitary Permit Application C ST. CROIX COUNTY WISCONSIN 'dam" In accord with Chapert 12 St. Croix County Sanitary Or, ' ance N' PLANNING & ZONING DEPARTMENT 00.1 Personal information you provide may be used for seconda poses CROIX COUNTY GOVERNMENT CENTER Y [Privacy Law. S. 15.04(1)(m)] J~ O 1101 Carmichael Road Hudson, WI 54016-7710 (715)386-4680 Fax (715)386-4686 Attach complete plans for the system on paper not lessl 1 /2 x 11 inches in size. County Sanitary Perrt~it ~1 ❑ Check if revision to previous p lion 1. Application Information - Please Print all Information Location: Property Owner Name / / ~yI r 5 tii✓ 1 /4 1.~/ 1 /4, SeC 3 e--(/ r~ T Z$ N, R S E (or) W Property Owner's Mailing Address Lot Number Block Number 4S Z705tT6 0-- City, State Zip Code Phone Numer Sub ivision Name or CSM N~mbar ~01 e- w.- S q76? 71S--772- gS'97 II Type of Building: (check one) ak Li~;ity ❑Viliage WTown of 1 or 2 Family Dwelling - No. of Bedrooms: ❑ Public/Commercial (describe use): Ori ~~L. Cad ❑ State-owned Nearest Road ,a U. Type of Permit: (Check only one box on line A. Check box on line B if applicable) d/4 Parcel Tax Number(s) A) 1.0 Repair 2. fd Reconnection 3.❑Non-plumbing 4. ❑ Rejuvenation 00`1-/975--_70-Z00 Sanitation B) Permit Number `S Date Issued State Sanitary Permit was previously issued / ZD 0 IV. Type of POWT System: (Check all that apply) ❑ Non-pressurized In-ground Mound 2 24 in. suitable soil ❑ Mound 5 24 in. suitable soil ❑ Mound A+0 ❑ Sand Filter ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line ❑ Pressurized In-ground ❑ Holding Tank ❑ Single Pass ❑ Other ❑ At-grade ❑ Aerobic Treatment Unit ❑ Recirculating V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade R wired Proposed (Gals./day/sq.ft.) (Min./inch) Elevation pts-1.750 /97 /877 /d Z • 7 VI. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Can- Steel Fiber- Plastic New Existing Gallons Tanks Concrete strucled glass Tanks Tanks ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ VII. Responsibility Statement I, the undersigned, assume responsibility for repair/reconnenction/rejuve ' n/installation of non-plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the in a'on of n-plum ng s nitation system. PI ber' `Name (print) Plumber' Sign tur (n stamp MP/MPRS No. JBusiness Phone Number 1tf D &S Plumber's Address reet, City, State, Zip C de) Vlll. County Use Only Disa roved Sanitary Permit Fee Date Iss d Issuin ent Sig ature o stam Approved Owner G' Adverse 225 DD ` mation ✓ ~✓J IX. Conditions of AP royal/Reasons for Disapproval: ~ Pl"~ s. >QVVi ER 3 o f' 1. 4eptic tank, effkrenV filter and` dispersal cell must all be services ! maintained r asper managetnent plan provided by plumber. 7chc~ 2., Al se~tack req*eme* must be maintained J as per apphcaft code f WdWillairim. rjGwL(' . Rev: 8/05 J.H. LARSON COMPANY/s- 13 ALI 31° Plymouth: 763-545-1717.800-292-7970.763-545-1144 Fax Fairmont: 507-235-5549.800-722-2240.507-235-3181 Fax Sioux Falls: 605-339-1990.800-952-3070.605-339-3189 Fax fA LIMOMIA Watertown: 605-886-6936.800-952-3558.605-886-6965 Fax Hudson: 715-386-2388.800-472-4420.715-386-3746 Fax L/GHT/NG® Eau Claire: 715-834-3111 •800-472-7073.715-834-6051 Fax Hayward: 715-934-2707.877-934-2707.715-934-2710 Fax www.jhlarson.com 09L6-IPC-SIL'Xd Si16-18CSIL'Hd SNOUVA373EOI RIM 0 9IOES LM-P^H'IOI m!^ s.1-9 OZ6Z ivi~rxa r~ix~n •xvwva~unnw •ivlwamsaa :OfN139Vd y rc o ~ u w a o o ■ )OVIS ~s aiwv[ amoad _ = s z ~8a a ^4m o ~p-a 0 O O ai fi e r Ul 4 W . r - ❑ uala MEMO MIND ®®®un mall'on z Z 11 w w. z4 ~4 43 di DD _i- ml- o o _ ! illy ~ ~ i 9g O es _ ® ~ el a~ ~ Q 4i iv LU r m LL u ® J m I 13 4 91O 9 Nb -P H - WI ms ..s -mg o 6Z NVId 13A31 N3A1O1 / NOUVQNrIO3 - ~o r~ v v~~•von •xnwva-u.~nw.ivw~aalsaa :01X139Vd 4 N „ i , , i a~Naaisax xxng moo = ~ ~ ~ z Aovls 9 33NIV( U3105d 0 9 ~ o € ~owm d o°s z z g°;m ~ I ° ~Baa a a C $3g W 10 it a v 34yb j?.3 yg(F u °a °u ~ja° 'V4V• Lai Y ~ i34Q ~ ~ z G oI. z 8W a 4 LL a~ Iry . 8 a u 9 8 i a b kb I ~ Itl o. s.. ~ I 0 3 v I a: I o) 'v t rei L fl l a i ~i rc v p r ! u 3 ° __--~e• _ 1.1__1.1_1.1-I',: I IIIIIII;'i i I b . 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HE°.35§-_ ;§3 $`35 6033 £ S ~ } 3 " 3 ~4 i v°O pt s = tl E Rib 4 3R 2iH !~9 3 _ ip 8 f553 pp 9 ~cRE 5y .3438 § R6 ~ 4~ f"EF E Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: • 515252 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Burr, Jamie D. Cady, Town of 004-1075-70-200 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: e3,v\ 1 CSC 31.28.15.492B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER 5 CAPACITY STATION BS HI FS ELEV. Septic Benchmark wr s~~ P.411 1406 • 5U 164116c-j Dosing I Alt. BM UCS11 e G~.lod ka f. Jo3' o - X0 Pf'~ Bldg. Sewer q• Z /b Holding St/Ht Inlet )z .I g`• 77 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic '766 / (40 1 (Z6 Dt Bottom 5~ 01 94 - Dosing _760' AJA- ILO/ b Header/Man. Z /-40/, Aeration Dist. Pipe Z a , (05 Holding Bot. System C31 Final Grade PUMP/SIPHON INFORMATION 4-Z' /d L . 7 I Manufacturer 61 , Demand St Cover L.,s "01 GPM Model Number ~5 , v / CTb C? E 44- i~ TDH Lift j~ Friction Lo System I ud J TD' ~ t ,361 1 3 Ls Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BED/TRENCH Width ` Length No. Of T nch PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS °-,+5 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of >":i~, / NA- 2knb / UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size I Ix Hole Spacing Ve to Air Intake Pipe(s) Length lia-& Spacing v Length Dia 2 1 --3- 7L SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over jxx Depth of jxx Seeded/Sodded xx Mulched BedlTrench Center /_C, Bed/Trench Edges Topsoil I IBS Q No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1 17-0 16) Inspection #2: Location: 15 270th Street Spring Vajey, WI 54767 (SW 1/4 SW 1/4 31 T28N ►~15W) NA Lot 1 P70 Parcel No: 31.28.15.492B F~ 1~-e.. Cr,.)t?.t.. , !1V1~ciYl ~ ~ Q C 1.) Alt BM Description ex u G Jw~ i 5vz 2.) Bldg sewer length = l \ - amount of cover = / 9d~ ee&,AaL- Q4-- dn~- Z '6~ e4 Plan revision Required? ❑ Yes o~j Use other side for additional information. Date Insepctor's ignature Cert. No. SBD-6710 (R.3/97) C County commerce.wi.gov Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 ST. CROIX } i s c o n s ■ Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) Department of C mm d / 5 Z Sa a Applica State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appr t governmental / W O 21155 unit is required prior to obtaining a sanitary permit. Note: Application forms for -owne OWTS are project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provi used f secondary 270TH STREET ~pn. purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. J 1. A lication Inform n - Please Print All Information Property Owner's Name Parcel # DO' / y /D7J C + 76 r JAMIE BURR 1• ? Zoo Property Owner's 849 200 H STREETg Address P G~O\~ON\~GpF Property Location / q ~Z 2 py1 Govt. Lot NA City, State Zip Code P ber Sw'/a,Sw'/4, Section 31 BALDWIN, WI 54002 Q 684.2582 (circle one) II. Type of Building (check all that apply) Lot # T 28 N; R 15 w ®1 or 2 Family Dwelling - Number of Bedroom 3 t'0 1 g- 73 y~ Subdivision Name 1 NA Block # ❑Public/Commercial-Describe Use AoUs P~a✓~~ / NA ❑ City of ❑ State Owned - Describe Use / CSM Number / ❑ Village of 6 X 79 e-Pll oU 22-5449 J ® Town of CADY III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ® New System ❑ Replacement Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) System B. ❑ Permit ❑ Permit Revision ❑ Change of ❑ Permit Transfer to List Previous Permit Number and Date Issued Renewal Before Plumber New Owner l Expiration 1 1,44 IV. Type of POWTS System/Component/Device: Check all that apply) Gv ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ® Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) 1f V. Dispersal/Treatment Area Information: 1 __1 - 1.114 04k 11 Design Flow (gp Design Soil Application Rate(gpdsf) Dispersal Area Required Dispersal Area Propos %s~ System Elevation 450 G~ 694/I a 5 0 ~7. /O f iv VI. Tank Info Capacity in Total' #,of Manufacturer F z Q Gallons Gallons Units ¢ U a H w - w New Tanks Existing Tanks Septic or Holding Tank 1600 0 1600 1 WIESER p~ 446 ® ❑ ❑ ❑ ❑ Dosing Chamber ❑ ❑ ❑ ❑ ❑ VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number BRADY DAHMS 220355 715.235.0651 Plumber's Address (Street, City, State, Zip Code) HALVERSON BROS., INC. - 1020 NORTH BROADWAY - MENOMONIE, WI 54751 VIII. County/ eartment Use Onl • ~ :(A"verff4~ I d Permit Fee Date Is ued Issuing A e Signature pproved _ O`wn r Denial $ . Ofl ~ 1b IX. Condit gTf j I [Mp Reasons for Disapproval 3) 60^g 44 h ~S sd--4 ~ro Leg,." 1. Septic tank, effluent filter and dispersal cell must all be servtces / maintained axe- w 1~ g p ~`^^r as per management plan provided by plumber. 2. AN i0ack requirements must be maintained art pit SWIG ble CO& f Cl'dlnir : Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398 (R. 01/07) Valid thru 01/09 C> rn w w a r`~ co 0 p m W~ 0) ~ ..Z w `C'' J uTi ~ LLO ~o0 z.~ Z o v 0 Q m O W o W '0 m w W:n / w m O V 0 w 1,. ~o ° O Mc C; --..A, Z C/) Q Lo gFC~w U H _ X w C) U) w o wo / / c f a ~w AY0 ~x4l. 0 ~ i 00 V W U / U) z w CL If vz 30 I a 1 J ~ h _ m / w 9L I! it o o r _ _ Y r ~Q } aNl I ¢z of gQ f 0~ I~' oml to aioY~l ao Igo F^'i i.. Z_~ml CO -V&ag0LLR c rn , xz I yl I«ma~°~ol ~ i ! Iwo 3cs51 IW °OO~oI J' C O J to is sal 10 C'n l 1 Q c L C7 Im3 o~I Immo ZOO0I E J_O W mJ ~---J L~ aQx~®®J x J LL 06 L) _j a W I \ Z x c J-. ~~J .1 CO) v` \ ` \ UJI CO) O p m \ • y \ {i CV C**j \ 0\ W 2 Y g uw Lu ~ F d \ O a y 2 \ Q. t1 O i ~ \ \ y d d to \ \ W ~ \ \ JJJ , J_IJJJJ ` \ W JJJ.IJJ a JJ~s~,s~IJJ j -j JJJ \ \ 00 ~ J~JJJ M m o JJJ a if J o g U) ¢ 0 J CL 1L \ O \ t~ - - - - - (1338-LS (RIZZ 6) - - - - - - - ~ - - - PAGE 3 OF 9 w 3:: CL 00 LU tq s tq m w z x r, rCl) Z Q ! c LLo w ccwr v,.~zN ❑ / O Lt 2' N N~ 0 m We J o mwWo cl~ C9°. to ~LLZ~ M O V L) J! o ° 0C, Z C) N zW Lli X lA r ~o U) ~ww0 0 w rJ O ul m 0 Q fY. ❑ ~QjSxy~. ! 00 z 3 CD W ! J z w C~ w -i C7 V I o z to v / ag o vc~ f~JS Q r rl =LL mLU w w J 3 a ! o Uz o Q r ' J F I' ! w..o y _ _ r 00 w v I} J-1 I a z Q I 4 i r CD Z I x wl to ~o}ol o D o to o a I ~¢wl Q:o ao Z_LL~ml o< CZ) & 0 LL x ~t I ~z ~I-ma~D~v~ Z.p CD ~ 1( Z l~ ~ j fA) I~~ J J rC H S w l ~Q ( 1flH I i I I l3 ~Cl IW=oo"ol w J I~~ o=I IzWoowoozl i -f_ In Q~ Q_f lox sal lCM3~aa~~¢I ~-N C9 Imp 831 Imm`a~'ozoovl CL LLI ~n J-~V= l d Y -I~I -a Lu I \ Z = c Q y ` \ \ J H _ .o \ \ CL LU -U) F b E \ U) ❑ _ \ \ \ o N p \ \ O 0 # T \ \ ii. N - \ \ 0\ w 0\ m \\J\ E X. t w FLU m LL\ o la- m Q U3 oOO LIL c < Z \ at =j w a c m \ \ \ 3 U) ui I _j _j aw JJ~~~,soIJJ \ W J J o~o~;,~ !6 C9 M m o JJJ j CD 3~ z \ p \ \ CL ~ w -J O \ \ \ I PAGE3OF9 Safety and Buildings commerce.wi. 10541N RANCH ROAD gOV HAYWARD WI 54843 Contact Through Relay isconsin www.commerce.wi.gov/sb/ www.wisconsin.gov Department of Commerce Jim Doyle, Governor Richard J. Leinenkugel, Secretary July 07, 2009 CUST ID No. 227819 ATTN: POWTS Inspector WILLIAM J BERGH ZONING OFFICE GEO TECH SOIL & SITE EVALUATION ST CROIX COUNTY SPIA 4255 PRAIRIE VIEW RD STE 2 1101 CARMICHAEL RD CHIPPEWA FALLS WI 54729 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/07/2011 Identification Numbers Transaction ID No. 1682155 SITE: Site ID No. 749372 Jamie Burr Please refer to both identification numbers, 270TH St above, in all correspondence with the agency. Town of Cady St Croix County p'~ W SW1/4, SW1/4, S31, T28N, R15W Con,f iti FOR: A Description: Mound, 3 bedroom residence r r Object Type: POWTS Component Manual Regulated Object ID No.: 1231760 pEPARTME(~: F SAFE Maintenance required; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD-10691-P (N.01/01), Pressure Distribution Component L Manual - Version 2.0, SBD-10706-P (N.01101); Effluent Filter SEE CORF;E The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: 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 section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • The proposed pump is near its limit with the proposed total dynamic head. If upon installation, the total dynamic head increases, the proposed pump must be reevaluated and may be inadequate. • The bottom of the distribution cell shall be level per the Mound Component Manual. The "D" dimension shall be a minimum of 12". The maximum finished slope of the mound surface shall not have a slope ratio steeper than 3:1 per the Mound Component Manual • A component specified in this POWTS design requires servicing at an interval of 12 months or less. Pursuant to s. Comm 83.21(2)(c)5, Wis. Adm. Code, if any part of a POWTS requires servicing or maintenance at an interval of 12 months or less, a notice of the need for such servicing or maintenance must be recorded with the deed for the property. If the maintenance or service notice has not been recorded, a sanitary permit can not be issued by the sanitary permit issuing agent. WILLIAM J BERGH Page 2 7/7/2009 • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(1). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. • Insulate building sewer per COMM 82.30(11)(c). • Provide frost protection per COMM 83.43(8)(c). f 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 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. Beginning October 1s`, 2008, small wastewater holding tanks with estimated flows less than 3,000 gpd that are based completely on approved POWTS component manuals must be submitted to the appropriate governmental unit and will no longer be accepted by the Safety and Buildings Division for review. Please refer to s. Comm 83.22, Wis. Adm. Code for further information. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Patricia L Shandorf POWTS Plan Reviewer ,(Inte ated Services WiSMART code: 7633 (715) 634-7810, Fax: (715 634-5150, M-f 7:45 am - 4:30 pm pat. shandorf@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. Brady Dahms , Halverson Bros (Plans Mailed To) WILLIAM J BERGH Page 2 7/7/2009 • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(i). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. • Insulate building sewer per COMM 82.30(11)(c). • Provide frost protection per COMM 83.43(8)(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. '4n 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. Beginning October 1", 2008, small wastewater holding tanks with estimated flows less than 3,000 gpd that are based completely on approved POWTS component manuals must be submitted to the appropriate governmental unit and will no longer be accepted by the Safety and Buildings Division for review. Please refer to s. Comm 83.22, Wis. Adm. Code for further information. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 - Fee Received $ 250.00 ~ Balance Due $ 0.00 Patricia L Shandorf POWTS Plan Reviewer j Inte rated Services WiSMART code: 7633 (715) 634-7810, Fax: (71,5) 634-5150, M-f 7:45 am - 4:30 pm pat.shandorf@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. Brady Dahms , Halverson Bros (Plans Mailed To) Yom Soa Tmw ak S D% E `1e Proudly Serving the Chippewa Valley Since 1994 eC 1,08" 834mPERC Client: JAMIE BURR 849 2001h Street- Baldwin, WI 54002 MOUND COMPONENT- USING AGGREGATE Reference Component Manuals: Pressure Distribution Component Manual SBD-10706-P (N.01101) - version 2.0 Mound Component Manual SBD-10691-P (N.01101) 0 version -2.0 Job Site Location: 270th STREET Legal Description: SW 1/4, SW Sec. 31 T 28 N, 15 W Town: CADY County: ST. CROIX ~Np~N F / l~ Designer's name and license William J. Bergh (License o. 577-007) I the and rsigned state that these plans we designed pNb`~ ~'v. nd submitted under my authority. ~ Designer's signature: 1 ~A~ J•sj = W Z 00 Designer's mailing address: 4255 N Pr 'rie ew Road, Suite 2 8~ H Chippewa F WI 54729 0 RG' /r ~Z v •O? Designer's contact information 715-723-5555 voice ti4*010t4* 715-720-1101 fax 715-577-6838 cellular email: billy@wastewaterpros.com Contents Page 1 cover sheet Page 2 system calculations Page 3- site plan Page 4 cross section of mound component Page 5 plan view of mound component & distribution lateral schematics Page 6 pump chamber x-section schematic Page 7 pump performance curve Page 8 maintenance & contingency plan Page 9 maintenance & contingency plan Page 1 of 9 4255 S. Prairie View Road, Suite 2 • Chippewa Falls, WI 54729 LOCAL: (715) 723-5555 FAX: (715) 720-1101 w w w. w a s t e w a t e r p r o s. c o m SYSTEM CALCULATIONS USING WIESER TANKS residential dwelling with total of 3 bdrm calculated at 450 qpd design wastewater flow LLR (linear loading rate) 60 gal/day/ft DLR (design loading rate) 0'6 gal/sgft/day 75010 minimum basal area depth to limiting factor 24 inches system area cross slope -16% percent forcemain length 110 feet using 2 inch - SCH 40 PVC manifold and/or header length 3 feet using 2 inch - SCH 40 PVC forcemain volume 18.0 gallons length of each lateral 37.00 feet using 1 112 inch -SCH 40 PVC total number of laterals 4 invert elevation 101.50' (bottom of lateral). orifice diameter 0.1875 tenths/inches 101.00' system elevation distance between orifices 24 inches or 2.0 feet total orifices per lateral 19 total orifices all laterals 76 lateral volume (each lateral) 3.4 gallons 12.54 lateral discharge rate system discharge rate 50.2 gallons calculated at 3.25 distal pressure x 1.3 ft. vertical lift 8.0 feet friction loss in the forcemain 5.5 feet calculated at 50.2 gal/min discharge rate TDH (total dynamic head) 16.8 feet minimum pump discharge 50.2 qpm at 16.8 TDH (total dynamic head) pump manufacturer L GIANT model number 9EH 5 x lateral vol. + forcemain vol. 86.1 alg Ions 82.5 actual dose (total-forcemain) pump tank model 600 actual tank size 653.64 gallons septic tank model 1000 actual tank size 1087.32 gallons manufacturer of tank/s WIESER pump float on/off measurement 6 inches alarm float from bottom of tank 16.0 inches gallons/orifice/dose 1.09 inches orifice density 5.92 Page 2 of 9 MOUND COMPONENT CROSS SECTION (typical) (DRAWING NOT TO SCALE) 4" OBSERVATION PIPE >12" SOIL TO PROMOTE SUITABLE PLANT GROWTH DISTRIBUTION CELL DISTRIBUTION LATERAL(S) SYNTHETIC MATERIAL INVERT ELEVATION = 101.50' 1 / >12" UNDISTURBED SOIL & VEGITATION 10" 0 0 0 0 o 0 FORCEMAIN 12" ELEVATION = 100.00, 23.5" fill material ASTM C-33 42.9' PLOWEDITILLED AREA 1.0' 3.7' 6.0' 16.1' 4.7' 19.0' 29.7' CUBIC YARDS OF AGGREGATE (minimum) 15 CUBIC YARDS OF SAND (minimum) 120 SYSTEM AREA SLOPE ~16% SYSTEM AREA LONGITUDINAL (long axis) SLOPE NA EFFECTIVE BASAL AREA (SQFT) 1875 DISTRIBUTION CELL 0.5" - 2.5" washed hard aggregate, 6" below & 2" above distribution lateral(s) ALL MATERIAL & PIPING SPECIFICATIONS AS PER THE MOUND & PRESSURE DISTRIBUTION COMPONENT MANUALS PAGE 4 OF 9 PLAN VIEW OF MOUND COMPONENT (typical) * All piping & material specifications per the Mound & Pressure Component Manuals 47 15.0' AGGREGATE DISTRIBUTION CEL 1.5' DISTRIBUTION 6,0' 3.0' LATERAL(S) L 1.5' 9.9' X ~00/, OBSERVATION PIPE(S) 19.0' 75.0' 9.9' 94.80' Distribution laterals terminate 6" from the end of the distribution cell ® Access box covering threaded plug at the end of each distirbution lateral DISTRIBUTION CELL EFFECTIVE BASAL AREA //X N DISTRIBUTION LATERAL (typical) * All discharge orifices are located on the center bottom line of the distribution lateral <s° final grade final grade cs" threaded cap 1112" DISTRIBUTION LATERAL threaded cap access box access box 3.0' OF 2" SCH 40 MANIFOLD 37.0' 24"-I ~24"-+12" X~2 X--+ 1-Y~ last orifice located 1 74.0' @ end of lateral 1st orifice Discharge orifice diameter 3116" = 0.1875 X spacing 24" Number of orifices per lateral 19 Y spacing 24" Total number of orifices (all laterals) 76 X12 spacing 12" (DRAWING IS NOT TO SCALE) PAGE 5OF9 COMBINATION SEPTIC TANKIPUMP CHAMBER X-SECTION (DRAWING NOT TO SCALE) MANHOLE RISER & COVER FINAL GRADE {per COMM 84.25 (7) & (8)} (slope ground surface away from manhole(s) for proper drainage) ELECTRICAL & ALARM SUPPLY (electric & alarm wiring must be BUILDING SEWER installed on separate circuits) {per COMM,82.30 (11)} 4* VENT PIPE UL APPROVED ELECTRICAL JUNCTION BOX FORCEMAIN MANHOLE MANHOLE 18" min. MANHOLE < . properly sealed BOTTOM OF INLET (invert elevation) f when not used (wastewater level)----- INLET AaTYr~//~~//j~j ALARM FLOAT ON FLOAT B ' 4" INLET PIPE FILTERED + - OFF FLOAT (tee or baffle) APPROVED EFFLUENT FILTER EFFLUENT A elev = REQUIRED ON OUTLET 93.50' MINIMUM OF 3" OF SUITABLE BEDDING BENEATH TANK PUMP PAD EFFLUENT FILTER POLYLOK OR EQUIVALENT COMPONENT Tank Manufacturer WIESER DWF (daily wastewater flow) 450 GPD Septic/Pump tank model WLP 10001600-MR Number of daily doses -5.5 (DWF / actual dose volume) Alarm manufacturer S.J. ELECTRO Alarm model number HW 101 Forcemain volume 18.0 Type of float switch MERCURY" Actual dose volume (gallons) 82.6 (total dose volume - volume of forcemain) Effluent pump manufacturer LITTLE GIANT PUMP TANK CAPACITIES Effluent pump model number 9EH Reserve above alarm 18 inches = 301.68 gallons Alarm float above on float 2 inches = 33.52 gallons (C) Minimum pump discharge rate (GPM) 50.2 On/Off float measurement 6 inches = 100.56 gallons (B) Off above bottom of tank 10 inches = 167.60 gallons (A) Vertical lift (pump off to distribution lateral) 8.0' system head (distal pressure X 1.3 feet) 3.25 PUMP CHAMBER DIMENSIONS Friction loss in the forcemain 5.5 Length 150.0" Width 84.0" Total dynamic head (TDH) -16.8 Liquid depth 36.0" Gallons per inch 16.76 PAGE 6OF9 cam'` G E ' I ` i Y~la+ f Specifications MODEL CAT. SOLIDS SITE RUNNING PERFORMANCE'(GPM @ READ) SHUTOFF P.S.I. P®C.CAO. WEIGHT DIMENSIONS NO N0 IIMNG HP UOITS (MR; k) AMPSFNATTS 5' 10' IF, 20' (FL) (FL) (WS.) (HxLx.1N) 9EH-CIM 509330 LILVA 4110 115 3/4 13.D 1000 71 68 6D 49 32 13.B 20' 27 9.11 01.60834 9EH-CIM 509340 UUCSA 411D 230 3/4 6.5 1000 71 BE 60 49 32 13.8 20' 27 9.11 Y. 11.64 x 8.94 9EH-CIA-RFS 509350 LILWA 4110 115 314 13.D 1000 71 66 6D 49 32 13.8 20' 27 9.11 01.648.94 9EH-CIA-RFS 509360 UUCSA. 411 D 23D 314 6.5 1009 71 fib 60 49 32 13.B 20' 27 9.11 x 11.64 x 8.94 FLOW- LITERS/HOUR Construction 0 1000 20100 30001 Motor Housing Epoxy Coated Cast Iron impeller Material Poly Carbonate 30 10 imp eller T e Closed Vane Volute ABS w 7.5 w Power Cord SJT~V-A ,20 Mechanical Shaft Seal Nitrile with `carbon and A 5 ceramic faces Q O w w Fasteners Stainless Steel 10 2.5 Shaft Stainless Steel Bearings Upper Sleeve and Lower 0 o Ball Bearings 0 20 40 60 END D FLOW- GALLDNS/MINUTE PUMP PERFORMANCE CURVE {+(Tn r• Sk 115V 60HZ x3Jl - r Little Giant Pump Co. PO Box 12010 Phone: 405.947.2511 Okla. City, OK 73157 Fax: 405.951.5674 1S0 9DD1 CERTIFIED W%'W.L!tt1.eG1a I I~p.C0M E., Form 995235 - 01 /DO POWTS OWNER'S MANUAL MANAGEMENT PLAN PERMIT NUMBER: Owner: JAMIE BURR-270TH STREET POWTS Maintainer: Geo Tech Soil & Site Evaluation - Chippewa Falls, WI 715-723-5555 Local Regulatory Authority: St. Croix County Zoning Department - Hudson, WI 715.386.4674 POWTS Installer: H & H Plumbing Inc. - Colfax, WI 715-962-4155 Septage Servicing Operator DESIGN PARAMETERS Influent/Effluent quality (values typical for domestic (non-commercial wastewater and septic tank effluent) Fats, Oil and greases (FOG) <30 mg/L, Biochemical Oxygen Demand (BOD) <220 mg/L, Total' Suspended Solids (TSS) <150 mg/L Soil loading rate (SLR) =-0.6 BASAL SYSTEM SPECIFICATIONS The components of this septic system are intended to serve a three-bedroom (450-GPD) single-family residence. The components include: a Wieser model WLP1000/600-MR septic/pump tank (with an approved outlet filter and Little Giant 9EH effluent pump, alarm & controls and a 75.0' x 6.0' distribution cell within a mound POWTS component. All components must comply with WI Adm. Code COMM 84 and be installed per manufacturers specifications and approval letters. DESIGN CRITERIAL o SBD -10572-P (R.6/99) "Mound Component Manual" ✓ SBD -10691-P (N.01/01) "Mound Component Manual" Version 2.0 o SBD -10570-P (R.6/99) "At-Grade Component Manual Using Pressure Distribution" o SBD -10567-P (R.6/99) "In Ground Absorption Component Manual" o SBD -10705-P (N.01/01) "In Ground soil Absorption Component Manual" Version 2.0 o SBD -10573-P (R.6/99) "Pressure Distribution Component Manual" ✓ SBD -10706-P (N.01/01) "Pressure Distribution Component Manual" Version 2.0 MAINTENANCE & MANAGEMENT Inspect the condition of the treatment tank(s) and dispersal cell(s) a minimum of every three years. The septic tank contents must be removed in accordance with Chapter NR 113, WI Adm. Code when the combined sludge and scum equals one-third (1/3) the tank volume. The effluent filter(s), effluent pump, controls & alarm and distribution lateral(s) should be inspected annually to ensure maximum performance. Lateral inspection/maintenance should include flushing of the laterals and pressure testing. START UP For new construction prior to use of the POWTS check treatment tank(s) for presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage-servicing operator prior to use. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of wastewater will affect the performance and longevity of your POWTS. The installation of water-saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also, the brine or waste from water softeners, iron removal units, and other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. The system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit peels and seeds, bones, and food solids such as those produced be a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkins, condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics (medications), solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain regular steady flow by spreading the laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the unit may cause it to freeze up. o Valves Valves should be operated in the following manner ✓ Alarms Alarms should be tested on a regular basis by the homeowner. If an alarm sounds, contact an individual licensed to serve POWTS. There is normally a one day reserve capacity under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surface discharge. Page 8 of 9 INSPECTIONS Inspections shall be made by a person carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule) ✓ Septic Tank Component Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks of leaks, measure the volume of combined sludge and scum and to check for any backup or surface discharge of effluent. Access openings used for service of assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental of unauthorized entry into the tank. The outlet(effluent) filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank during cleaning. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating properly. ✓ Pump Chamber/Treatment Tank(s) Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must me made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of the filter. Any service needs or repairs shall be promptly taken care of. ✓ Mound, At-Grade, In-Ground Pressure The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. COMM 83.33, Wisconsin Administrative Code. All piping to tanks and pits shall be disconnected and the abandoned pipe opening sealed. The contents of all tanks and pits shall be removed and properly disposed of be a Septage Servicing Operator. After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or other inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system. o A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure(s), lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. o A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. o The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ✓ Mound and At-Grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OF OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. Page 9 of 9 REC En #2427 QOIL VALUATION REPORT Page 1 of 3 Dep7Z":and rce in acco nce with COun Wis. Adm. Code valuation, LLC DiviuiidinsMAY 0 3 2010 1 j Geo Tech Soil & She E Acn M't 1 in in size. St Croix inGude, but not limited ib: int fBN{), dtredioonn an rcel i. percent slope, scale or dl end distance to nearest road. 004-14"2:M Please print en. ~v By Date s ] Personal kriormetlon you provide may aty purposes (Privacy Law, s. 15.04 (1) (m)), property Owner Property Lacatron BURR, JAMIE Govt. Lot NA SW114, 114, S31, T28N, R15W Property Owner's Malting Address Lot# Block# Subd. Name r CSIM NA 22 849 200TH STREET 1 -5449 City State Zfp Code Phone Number City ❑ Village ®Town Nearest Road BALDWIN WI 64002 715.684.2582 Cady 270TH STREET ® New Construction Use: ® Residential 1 Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement ❑ Public or commercial - Describe: NA parent material RESIDUUM Flood plain elevation, if applicable NA ft. General comments install a 1 T sand fill mound component. MMdrrom basal SLR = 0.6 (eff". system elevation =101.00'. and recommendations: !.J Boring # ❑ Boring ® pit Ground surface elev. 98.00 ft Depth to limiting factor 27 Soil Application Rate Horizon . Repth DominantCalor Redox Des iptlon Texture Structure Consisten. Boundary - Roots. Gam. Munsell Qu.:Sx..Cortt. Color Sir: Sz :Sh " 1 0-9 IOYR 212 NONE SIL 2 F GR MVFR CS 2F,1M 0.6 0.8 2 9-27 10YR4/6 NONE SIL 2 M ABK MFR CS IF 0.6 0.8 3 27-40 10YR 3-4/4 C31) 10YR 5/3 SIL 1 C SBK MFR - IF 0.4 0.6 7.M 5 a Boring # Boring © pft Ground surface elev. 99.00 ft Depth to limiting factor 24 in. Soil Applir~tion Rate Horizon : ':Depth . Domirsant'Color. ;Redox Description Texture Structure . Gbnsisten. :Baoundary Roots GPDlfP In. Munseii `Clu.'Sz Corit ::Color:: Gr..Sz,-Sh. 'Et.1 'Eff#P 1 0-10 10YR 2/2 NONE SIL 2 M GR MVFR CS 1F-M 0.6 0.8 2 10-24 10YR 4/6 NONE SIL 2 M SBK MFR GS IF 0.6 0.8 3 24-30 - R 0 CEM IF 010 0.0 Efihuent #1= BODb> 30 < 220 mg& and TSS >30 < 160 ' Effluent #2 = BODs < g/L and TSS <_30 mg/L CST Name (please Print) Signature: CST Number William J. Bergh 227819 Address Goo Tech Soil & Site Evaluation, LLC Date Eva ndu Telephone Number 4266 N Prairie View Road, Suite 2 Chippewa Falls, M 54729 6/15!2009 16-723-5555 _ seuss3opr.oarooi F 4-PropertyOwme4r BURR, JAMIE Parcel ID# 0041075-80-500 Page -1 -of 3 ❑ Boring limiting factor 2$ M. Boring # Pit Ground surface elev. 100.00 fL Depth to it Application Rate Horizon Depth Dominant.Color °Redox Descriptlon. 'Texture Structure Consistence Boundary . Roots GPD1Ft' in. Munsall Qu. Sz. Cont. Color Gr. SL-Sh. 'M1 *EtT#2 1 0-10 10YR 2/2 NONE SIL 2 F GR MVFR CS 2FAM 0.6 0.8 2 10-28 10YR 4/6 NONE SIL 2 M ABK MFR CS IF 0.6 0.8 3 28-36 10YR 4/46 MD 10YR 5/3 SIL 1 C SBK MFR IF 0.4 0.6 7.5YR 5/8 ❑ Boring ❑ Boring # n Pit Ground surface elev. ~1L Depth to limiting factor in. it Applk:ation Rate .Horizon ".Depth 'Dominant-C61or -Redox:pescription Texture Wuctuue Consistence Soundary ,Roots GPD/ft= An. Munseli Qu. Sz. Coat Color Gr. SL.Sh. *EW1 'Ef #2 ❑ Boring # El Boring n Pit Ground surface elev. 8. Depth to limiting' factor in. Soil Application Rate = . Texture Structure . Roots GPDfft2 :Horizon. -Depth Dominant Color -RedoxDestx~ton Consistence ;Boundary in. 611unseN:. 'Qv. Sx •:Corri Color Gr.:Sz. Sh. "Eff#1 'ER#2 " Effluent #1 = SOD s> 30 S 220 mg/L and TSS >30 <_150 mg1L " Effluent #2 = BODE 30 mg/L and TSS c 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. 2you need assistance to access services or need material in an alternate fotn 4 please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (IMAO) Geo Tech Soil & Sipe Bpak*Uon, U.C a W c*> I Ig Sr t So -A, ~ t ! J r l r..J W ~ gJ J + ~ _lo a ~JJ =Jj ~ J°- a JJ It J o ~JJ CL ui F- 0 E.. \ \ _a CO) fOt. D ~ ~ \ IOC N \ m \ ` ~`4` CZ\ \-,n J Wa_ J \ ♦ J.JJ _l \ ♦ . I_j ~eli_~ o~ JJJ w Q \ oc \ ♦ - - - (133?! LS Q b)-~-- - - - - - - PAGE 3 OF 3 r w ui a Q w zo U0~ F- Q~ O w zcna a Z<m Q20 www a-W~ v~ H X r r 0 N c W ~ z U ~L (u 2 L N ~ r n V E r CL O a c 'c N I ~ c c m a D c 0 0 2 ct r 0 U) Ji ii 855956 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 09/05/2007 03:OOPM CERTIFIED SURVEY MAP Y-1 - PAGEW 3449 REC FEE: 13.00 CERTIFIED SURVEY MAP COPY FEE: 3.00 PAGES: 2 Located in port of the Southwest Quarter of the Southwest Quarter of Section 31, Township 28 North, Range 15 West, Town of Cady, St. Croix County, Wisconsin PREPARED FOR: o N~~SV~ EUGENE & AUDREY GEIGER Found West Ouorter Corner UNPLA 7-TED LANDS _ _ Sec. 31-28-15 The Bearings are Aluminum Monument referenced to the West Line of the S00*26'08-E Southwest quarter 1403.40' North Line of the of Sec. 31-28-15, Southwest Ouor(er of assumed to bear I of NOO 26'08 "W G I'• 'I the Southwest Ouorter N89°5129E 756.35' N20107'15'E 83.97_','. I' I- - N89•5129 "E 446.02' w I LOT 1 o I 435,600 Sq. Ft. 3O 10.000 ACRES C .-O LrJ 2: I a r• I w o p Excluding R. 0. W. e I ° I w .3 425.456 Sq. Ft. I n j i z V io 9 Se rArea' 9.767 ACRES ewe j - 66' Shored Driveway Easement 03 I r- `O I$ ~-x,3300• 1198.83' ~ ,O rn N89'33 *52 E 1231.83' iCn - LJ! J! I LOT 2 I 435.600 Sq. Ft. (n 10.000 ACRES w jb oci Ipv Excluding R.O.W. rn ~O o I ti Septic „ 423,692 Sq. Ft. N ro I _v: Area; 9.727 ACRES N I I ~ I I n I I UNDERGROUND PETROLEUM PIPELINE o I g I ° J 198.92' j _ S88'S2'33 "W 1231.92' - - o I i. N00'26 '08-W c 577.37 N Found Southwest Corner - Sec. 31-28-15 SyJ..- ' o Aluminum Monument UNPLA TTE(: LANDS µ{41111 IFBIt1NF/i,.,, SSG Q N LEGEND MARK F. Set 314 inch x 18 inch 5 MAiSTROVICH O Rebor weighing 1.50 = S_2624 Ibs./Iineor loot. EXCELSIOR. MN • Found 1- Iron Pipe Q Found Section Corner Mork F. Mois tro vich, S- 2624 50' 3uilding Setback Line Posse Engineering, Inc. 200 0 200 2003 O Nei! Rood Hudson, WI 54016 SCALE. 1 INCH - 200 FEE T 1 of Project No. 8.99-06 This instrument drafted by J. Molzek SHEET 1 OF 2 Dote: Vol.22 Page 5449 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 4C.-VV%. 2. G'j r f, Mailing Address Property Address 5 Z`7p (Verification required from Planning & Zoning Department for new construction.) City/State & ,'Parcel Identification Number 40 • 1675. 76 - 266 LEGAL DESCRIPTION Property Location Sec. 3 , T V9N R /5 W, Town of t. Subdivision Plat: , Lot # Certified Survey Map # 2 Z' 5~1 , Volume Z 2 , Page # ✓~5~,~ Warranty Deed # S ?n Y/,5 (before 2007)Volume , Page # Spec house i yes / no Lot lines identifiable J yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary). the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. [/we ain/are the owner(s) of the property described above, by virtue ~of a warranty deed recorded in Register of Deeds Office. Number of bedrooms C / /91GNAT RE 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) ~~i1! 1111! i1il11111! lift! lull Illl 1111!! llll !11! State Bar of Wisconsin Form 2.2003 * 8 6 0 4 1 5 2 WARRANTY DEED 880415 KATHLEEN H. WALSH Aocwnent Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD TM9 DEED, made between Eu ene -L Geiger and Audrey G. Geiger, husband 08/21/2006 11,OOAM and wife WARRANTY DEED EMT 1 .00 . ("Grantor," whether one or mote), and Jamie D. Burr and Stacy Ti`. Burr, hnsbaud REC FEE: 13 and wife - - TRANS FEE; 288E.00 PAGES: 2 ("Grantee," whether one or more). Grantor for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant [recording Area interests, in St. Croix _ County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): WLSTconsin Credit Union See Exhibit attached hereto and made a part hereof. 860 Cedar ST PO Box 135 Baldwin, WI 54002 4-1075-7o zo ,004-1075-$0-000 nation Ntmtbcr MN) This is not homestead property. (is not) Exceptions to warranties: Easements and restrictions of record. Dated ! cyst h (SEAL). (SEAL) * * Eu e L Geiger (SEAL) 1 14 (SEAT,) * r Audrey G. er AUTHENTICATION ACKNOWLEDGMENT Si s) 6-UA&AAC e ~ STATE OF WISCONSIN ) f ) ss. authenticat on ST. CROEK COUNTY) f-- - Personally came before me on 1j,sr'l IS , ~ : t qG >r, the shave-named Eugene L Geiger and Audrey G. Geiger TTTI,E: MTs'MBfiTt STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. StaL § 706.06) instrument and acknowledged the same- T141S INSTRUMENT DRAF"MD I1Y: • Thomas A. McCormack Thomas A- hWormack Notary Public, State of WISCONSIN Baldwin W154002 _ My commission (is permanent) (C%3ds=scxxxxxxxxxxxxxxxxx ) (Signatures may be authentkated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ®2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 *Type name below sigma, INFOM- LeaO FmrmF • (agplB &=1 - Wg-famn.mm Z0 39dd 9VJW30 998ZB6991L Z5:L0 0Z0Z/L0/b0 MMZBZT A 1. Part of the South Half of the Southwest Quarter (S ;~i of SW 4) of Section Thirty-one (31), Township Twenty-eight (28) North, Range Fifteen (15) West described as follows: Lot 1 of Certified Survey Map recorded September 5, 2007, in Volume 22, Page 5449, as Document No. 859956, TOGETHER WITH AND SUBJECT TO 66' Shared Driveway Easement as shown thereon. AND 2. Part of the South Half of the Southwest Quarter (S ;I of SW ILA) of Section Thirty-one (31), Township Twenty-eight (28) North, Range Fifteen (15) West described as follows: Outlot A of Certified Survey Map recorded July 30, 2008, in Volume 23 of Certified Survey Maps, Page 5547, as Document No. 879220, office of the Register of Deeds for St. Croix County, Wisconsin. i Doc> 3 600 60 39VJ 9b3W30 998ZB699TL Z9:L0 010Z/L0/h0 04/07/2010 07:52 7156982855 OEMFAB PAGE b4 jW j m*k r r wr~rr~+rrh~ r UOOfZ00@J Xyd Z'v: Gt OIOZ/6Z/E0