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040-1037-50-200
{ ` Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM County St. Croix INSPECTION REPORT Sanitary Permit No GENERAL INFORMATION (ATTACH TO PERMIT) 600235 State Plan ID No Personal information you provide may be used for secondary purposes [Privacy Law s 15.04 (1)(m)] 2999979 Permit Holder's Name- City Village Township Parcel Tax No GARY 8r MARLENE DUCLOS TOWN OF TROY 040-1037-50-200 CST BM Elev: Insp BM Elev BM Description- Section/Town/Range/Map No 08.28.19.125B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ` Benchmark Dosing Lot Alt. BM Aeration l7 Bldg. Sewer Holding SUHi Inlet . 11, TANK SETBACK INFORMATION St/Ht Outlet 0 TANK TO P/L WELL BLDG. Vent Fur Intake ROAD Dt Inlet Septic Dt Bottom Dosing ~7 y r Header/Man. . Aeration C• J ~ ~ Dist. Pipe 3.0 Holding Bot. System s: s-7 -3 . ooh PUMP/SIPHON INFORMATION Final Grade e Manufacturer Demand S C f-IMIDS GPM VM 8NHO CU .SS b. Model Number FL 5 , TDH Li Friction Lo s System Head Ft Forcemain Len , Dia. .I) Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Le t No. PIT DIMENSIONS No. Of P Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO t 44 L BLDG WELL LAKE/STRE LEACHING Manufacturer. ~ INFORMATION Type y~ste CHAMBER OR U G UNIT Moae' Number D UTION SYSTEM 3 eade andold Distribution x Hole Size Ix Hole Spac~ng Pet Ven o Au intake g Ljl C1 .Z(t j~ f I Len th r Dia Length) Dia _ Spacing -S . 2 SOIL COVE z Pressure Systems Only xx Mound Or At-Grade Systems Only Depth OverC-fiKk Depth Over xx Depth of xx Seeded'Soddec xx Mulched Bed/Trench ter Bed/Trench Edges Topsoii `0r`2 ~_,/y _ es= No / ! Kes No zlv- COMMENTS: (Include code discrepencies, persons present etc.) Inspection #1: F Inspection #2: Location: 424 EAGLE BLUFF DR 1.) Alt BM Description =o? o ~hoV%^_ 2.) Bldg sewer length ynvl 1Nt~~ C10~ 1 ns~u~t~ 1 AS Oc, - amount of covet0~ ti Cover o n AI I fo~i7 l8' s Plan revision Required? ❑ Yes No [ J ~ Use other side for additional information. ~ ~ K7 ~ ~ V (lJ~', Date SBD-6710 (R.3197) Insepcto anature Cert. No. - 1 J. ! 1-~-Ot v) -7 County ,''.Nr:~F'4f Safety and Buildings Division St Croix ry 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) 'ice ~P$+~ 1 Q Lt Madison, WI 53707-716 ~ M Z"545 State Transaction Numbe M Illtary Permit A6CS8l)421WV4XT 2999979 In accordance with SPS 383.21(2). Wis. Adm. Code, submissio , ~cn,mental unit is required prior to obtaining a sanitary permit Note Application forms for state-owned POW I'S are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary -purposes in accordance with the Privac Law, s. 15.04(l xm), Stats. 4LIN -9 424 Eagle Bluff Drive I. Application Information - PI se Print All Information Property Owner's Name a 1 Parcel #f Gary Duclos 040 1037 50 200 Property Owner's Mailing Address Property Location J a , 237 Towns Valley Road, River Falls Govt. Lot 1 City. State Zip Code Phone Number NE y,. SE y4, Section g River Falls WI 54022 circleone) T 28 N: R 14 *orW -Aft 11. Type of Building (check all that apply) L # 1 j . Q,J or 2 Family Dwelling - Number of Bedrooms Subdivision Name Qk ab Block h Eagle Bluff ❑ Public,lCommercial - Describe Use ❑ City of CSM Number ❑ Village of El State Owned Describe Use _ 5 b 27$ ❑ Town of Troy A• III. Type of Permit: (Check only one box on line A. Complete line B if applicable) AJb A. ;UNew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) L.B❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS S stem/Com onentlDevice: Check all that apply) arY%0 ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound ? 24 in. of suitable soil Xg Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Devi7(explain) V. Dis ersal/Crea ent Area Information: ation Design 1ot4 (gpd) Desi Application Rate(gpds Dis rsal Area Rgquired Dispersal Area P) System Elev 600 VI. Tank Info Capacity in Total ff of Manufacturer Gallons Gallons Units New Tanks Existing Tanks ® >67 U o :y h ~D C_ Septic or Holding Tank Weiser 120 1200 Weise x Dosingcnamber Weiser 800 800 L VII. Responsibility to mt - 1, he a ign ssume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print aJ ber's Signature MPfMPRS Number Business Phone Number Countryside Plurtb'ng 10 246-266- Plumber's Address (Street, City, State, Zip Code) 321 Wisconsin Drive, New Richmond WI 54017 VIII. C"ntyfDepartment Use Only Permit Fee Date 1 sued Issuing of Signature Approved SSpp $ 40. /I even Reason for vial e0 IX. Condit asons for Disapproval u5ce - czl+ i, bP ,c s t re as per ,iar aye nen' r ae 7 bV plu,nbe..~.. t /t 2. A6 st !beck fPC4IK ' _PI~ S mUlit t k i'r•ar t Il.f ; j as per appiiwbl-A cty,,, I :rcf-,R' ,e.z. I ~IR.It Attach to complete plans for the system and submit the County only on paper not less than 8 1/1 x I I inches in size SBD-6398 (R. 11/11) , Lot size 2.985 acres 25 foot set back line 50% slope or reater SCALE 1" 40 Ff. 68.9 • NOTE: PROPERTY LINES - - - ARE NOT FULLY SHOWN. 78.98 BM 1 # 100 BORING 1A 98.30 Q BOREING 16 94.2 Q p BOREING 1C 95.6 Q Proposed house and garage BORING 1D 96:39 Q POLY LOC k IESER 1200/800 I7 4Rs-' 525 FILTER COMBO TANK Q $ C , DRIVE ALL THREE COVERS ON SEPTIC TO BE ABOVE GROUND WITH WAY ; Contour line APROVED LOCKING DEVICE ~ • - GARAGE ON COVERS. Eljen mound sy tem 0 VATI0 PIPES -98.9.E -16 111B-1D Slope 4%\: ' I MOST LIKELY WILL BE BED ROCK BELOW \ B 00 SEPTIC. ADD 6" ` I / SAND MIN. UNDER Vafi~1 QB- PI) SEPTIC TANK. UTILTY EASMENT--- CY .1. CUL DE SAC j 4 BEDROOM SYSTEM FOR PROPERTY LOCATED AT THE NE1/4 OF THE SE 1/4 AND THE SE 1/4 OF THE SEl/4 OF SEC 8 T 28N R19W TOWN OF TROY. ST CROIX COUNTY. CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Gary Duclos Owner's Name: Gary Duclos Owner's Address: 237 Towns Valley Road River Falls Wisconsin Legal Description: NE 1/4, SE 1/4, Sec 8, T28M RI 9W Township: Troy County: St Croix Subdivision Name: Eagle Bluff Lot Number: I I Parcel ID Number: 040-1037-50-200 Page 1 Index and title Page 2 Plot Pian Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: Countryside Plumbing License Number: 225410 Date: Phone Number (715) 246-2660 Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POKrS Version 2.0 SBD-10705-P (N.01101). Page 1 r R3'+fs~~~ DIVISION OF INDUSTRY SERVICES 10541 N RANCH RD HAYWARD WI 54843-6462 Contact Through Relay 131 ice{ http://dsps.wi.gov/programs/industry-services 2www.wisconsin.gov \SS~Ni~ Scott Walker, Governor Laura Gutierrez, Secretary October 04, 2017 CUST ID No. 225410 ATTN: POWTS Inspector PAUL R KOEHLER ZONING OFFICE COUNTRYSIDE PLUMBING & HEATING INC ST CROIX COUNTY SPIA 321 WISCONSIN DR 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016-7708 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/04/2019 Identification Numbers Transaction 1D No. 2999979 SITE: Site ID No. 842740 Gary Duclos Please refer to both identification numbers, Townsvalley Rd above, in all correspondence with the agency. Town of Troy St Croix County SE1/4, SEI/4, S8, T28N, R19W FOR: Description: G_$F-tQ.1T1=d, 4 bedroom residence Object Type: POWTS Component Manual Regulated Object ID No.: 1726762 Maintenance required; 600 GPD Flow rate; 14 in Soil minimum depth to limiting factor from original grade; Systerrt(s*-, Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12), SSWMP Pub. 9.6, Other; Effluent Filter 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. 7 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. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per SPS 383.44(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 SPS 384.10. No fixture, appliance, appurtenance, material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system, unless it PAUL R KOEHLER Page 2 10/4/2017 is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • Maintain well and waterline set backs per SPS 383.43(8)(i). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. 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 c onstruction/i nstal lation/ope rat ion. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Patricia L Shandorf Please Include a Copy With Your POWTS Plan Reviewer, Division of Industry Services Payment Submittal. (715) 634-7810, Fax: (715) 634-5150 , M - F 8:00 a.m. - 4:45 p.m. WiSMART code: 7633 pat.shandorf@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm PAUL R KOEHLER Page 2 10/4/2017 _ is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • Maintain well and waterline set backs per SPS 383.43(8)(i). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Patricia L Shandorf Please Include a Copy With Your POWTS Plan Reviewer, Division of Industry Services Payment Submittal. (715) 634-7810, Fax: (715) 634-5150 , M - F 8:00 a.m. - 4:45 p.m. WiSMART code: 7633 pat. shandorf@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm ~;EIVED GSF WI MOUND DESIGN PROGRAM INDEX AND TITLE PAGE _ Q $ n17 FIERVICF` Project Name: DERRICK /DUCLOS ~ Owner's Name GARY DUCLOS Owne's Address. Legal Description: NE1/4SE1/4SE1/4SE1/4SEC8T28NR19W Township TROY County ST CROIX Subdivision Name: EAGLE BLUFF Lot Number 1 Block Number. Parcel I.D. Number 040-1037-50-200 Plan Transaction No Rage 1 Index and title Page 2 Data entry Page 3 GSF mound drawings Page 4 Lateral and dose tank J' Page 5 Distribution media i Page 6 System maintenance specifications Page 7 Management and contingency plan :E'dc Page 8 Pump curve and specifications f -7 Page 9 1 . / ~r Ar c-, lfl v Sjo.zf; Designer: PAUL KOEHLER License Number MP 225410 Date: 9/5/2017 Phone Number: 715-246-2660 Signature: Designed Pursuant to the GSF Mound Component Manual (N. 08/16), and SSWMP Publication 9.6 Design Pressure Distribution Networks for STSAS (01/81) GSF Mound Version 1 .0 Page 1 o /2 GSF WI MOUND DESIGN PROGRAM INDEX AND TITLE PAGE Site Information R ;Residential or Commercial Design 4Number of Bedrooms (optional) 600 Design Flow (gpd) 40% Site Slope 100.0 nstalltion Contor Line Elevation (ft) p~--- 100 00 Contour Length Available (ft) 14 Depth to Limiting Factor (in) 0.8 jIn-Situ Soil Appliction Rate (gpd/ft2) Distribution Cell Information B43 Unit Used 8 Cell Width (ft) 3, 4. 5, 6. 8, 9 or 10 41 = Dispersal Cell Length (ft) 2.0 Dispersal Cell Design Loading Rate (gpd/ft2) JInfluent Wastewater Qualtity Are the laterals the highest point in the distribution 'Y Pressure Distribution Information network? Enter Y or N E Center, End or No Manifold (Pump to Gravity) 4 Lateral Spacing If N above, enter the elevation (ft) 2 Number of Laterals of the highest point _0.125 Orrifice Diameter (in) (e.g. 0.25) 3 Estimated Orifice Spacing (ft) = 12 61538 ft2/orifice 2 Forcemain Diameter (in) 40 Forcemain Length (ft) Does the forcemain drain backs Y 88.3 Inside Pump Tank Elevation (ft) 6.5 System Head (ft) x 1.3 6.524675 Forcemain Drainback (gal) 13.11667 Vertical Lift (ft) 35.34335 5x Void Volume (gal) 0.11532 Friction Loss (ft) 41.86803 Minimum Dose Volume (gal) 19.73199 Total Dynamic Head (ft) 10.71007 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Slection in. diam. options choice in. dia. options choice 0.75 1.25 1.00 x 1.50 1.25 x 2.00 I X 1.50 x `X 3.00 2.00 x 3.00 x v~ Gallons/Inch Calculator Septic Tank Information Total Tank Capacity (gal) 1200 Septic Tank Capacity (gal) Total Working Liquid Depth (in) WIESER Manufacturer ]gal/in Dose Tank Information Effluent Filter Information 800 Dose Tank Capacity (gal) POLYLOCK Filter Manufacter 11.82 Dose Tank Volume (gal/in) _ 525 Filter Model Number iWIESER Manufacturer Project DERRICK /DUCLOS Page 2 of ~2 Mound Plan View J 3 ` ~fy! ~ l i Yy~Y rJ/l A I W I 3 B K K L Mound Component Dimensions A 8.00 ft E 25.84 in H 1.00 ft K 10.73 ft B 41.00 ft F 7.00 in 1 11.03 ft L r" 62.46 ft D 22.00 in G 0.50 ft J 7.81 ft V VI ft- 328.00 (ft2) Dispersal Cell Area 780.40 (ft2) Basal Area Available 14.63 (gpd/ft) Linear Loading Rate 4.10 (ft) 1/10 B Obs. Pipe Placement Finished 103.42 (ft) r ► Grade 2 G H 102.42 (ft) F Dispersal Cell Lateral Invert 101.83 (ft)Elevation Dispersal Cell p ❑ Elevation Q3 1 F4] 100.00 (ft) Countour Elevation 4% Site Slope Shading Key Typical Dispersal Cell 1 Topsoil Cap a See Page 5 2 Subsoil Cap o ° 2 ft Geotextile 3 ASTM C33 Sand Fabric 4 Tilled Layer ~a F 5 GSF Media ~ 0 0.5 ]ft 1 v o A See details on page 4 for number, size and spacing of laterals. Laterals are located in the 4" gravity distribution pipes as shown on page 5. Project: DERRICK /DUCLOS Page 3 of /2. Ind Connection Lateral Layout Diagram Place Appropriate Lateral Diagram From Right Below = Turn-up w/ball valve or cleanout plug z - - 1 st orrifice located at Z - X Orrifices point up except every 5th one points down for S drainage Force main connection via tee or cross to manifold at any point Laterals & force main of PVC Sch 40 All laterals identical with orifice equally spaced (per COMM Table 84 30-5) L Numbers of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.5 in Orifice Spacing (X) 3.21 ft Lateral Length (P) 39.26 ft Orifices per Lateral 13 Lateral End (Z) 0.74 ft Orifice Density 12.61538 ft`/orifice Lateral Spacing (S) 4 ft Manifold Length 4 It Lateral Flow Rate 5.355033 gpm Manifold Diameter 2 in System Flow Rate 10.71007 gpm Forcemain Velocity 1.093757 ft/sec 38.52 Pump Off Height 12 in Dose Tank Information , ock'.nq cry,:e- :~Ir r%, labelandlxongde~ce and ~er3nr+l as per tIE 300 , sealed.rater*.ic~it in mn 1 r 1 .rC(1nCl;• 41terr-ate outlet localior Tarrk rx T,onent is propery vented - - - - Forcen-ofn drye fr WIESER Manufacturer I Capacity 800 Gallons r, Volume 11.82 gal/inch t ,J*ep fide o( an;r-siphon den Ce B Dimens on Inches Gallons 1 I A 50.1397609 592.652 B 2 23.64 t C 3.54213418 41.86803 I _ ~rP ~f'vation iftt D 12 141.84 89.3 Total 67.6818951 800 D t (_krefanke!e tlr Pain 3' Bedding under tack 88 3 Alarm Manufacturer ISJ ROMBUS Alarm Model Number PS PATROL Pump Manufacturer IGOULDS Pump Model Number L EP05 Pump Must Delivery 10.71007 gpm at 19.73199 ft TDH Project DERRICK /DUCLOS Page 4 of GSF Distribution Cell Media Layout Cell Width (ft) 2]Sidewall to Lateral (ft) Distribution Cell Cross-section Arrangements Drag appropriate drawing to space below. ► ~l 8 ft de Ei43 E343 Component Legend ASTM C33 Sand/Mound Sand A42 or B43 Module Lateral Turnup (contained in Turnup Enclosure) Distribtion Cell Pland View Layout - Typical 8 Cell Width - A (ft) 41.00 Cell Length - B (ft) 10 B43 Modules Required per Row 20 B43 Total Modules Required End Connection Later Layout Diagram Drag appropriate drawing from left to space below. FORCE MAIN 8 FT WIDE - CENTER CONNECTION Project: DERRICK /DUCLOS Page 5 of Mound System Maintenance and Operation Specifications Service Provider's Name Phone POWTS Regulator's Name Phone System Flow and Load Parameters Design F low Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BODS 30 mg/L Septic Tank Capacity 1200 gal Maximum TSS 30 mg/L Soil Absorption Component Size 328 ft2 Maximum FOG 10 mg/L Maximum Fecal Coliform 10E4 cfu/100 ml Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test monthly Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once every 3 years Other, Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to the standards, have a watertight cap, and are secured in a as shown in the Eljen mound component manual. 2. Dispersal cell media conforms to Eljen products approved for use with the Eljen Moun Component Manual approved August 2016. Eljen media is covered with the manufacturers geotextile fabric. 3. All gravity and pressure piping materials conform the requirements in the state code. 4. Tillage of the basal area is accomplised 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 6 - 8" DIAMETER LAWN SPRINKLER FINISHED GRADE- - THREADED LATERAL ENDS AT LAST 4" PERFORATED PIPE CLEANOUT PLUG ORIFICE WHERE VARIABLE 4" END LENGTH CLEANOUT BEGINS CAP LONG SWEEP 90 OR - - - ' TWO 45 DEGREE BENDS SAME DIAMETER AS LATERAL DISTRIBUTION LATERAL - - LATERAL CLEANOUT is Project: DERRICK /DUCLOS Page 6 of !2 Mound System Management Plan General This system shall be operated in accordance with SPS 82-84 Wis. Adm Code, and shall maintained in accordance with its' component manuals Eljen Mound Component manual August 2016 and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death Septic and pump tank abandonment shall be in accordance with SIPS 83.33, Wis. Adm Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective. or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s 281 48, Stats The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm Code The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from 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. if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System 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. The pressure distribution system is provided 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. Podding 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 toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project. Page 7 o 17- Wastewater - x.N. METERS FEET 10 9 30 5 GPM ' 8 2.5 FT 25 7 Q W 20 Q } 5 15 4 Q ~ EP05 3 10 2 EP04 5 1 0 00 10 30 40 50 GPM 0 2 4 6 8 10 12 m3/h CAPACITY MODEL INFORMATION Order NTP Volts Amp~BrCircuit I eaker'~Phase I Flo at Switch! I LCord oschar on MLOn i m MLOff m MBasinm MSoI ds SWeig'h t e Level Diameter Size Ibs/k l I Plu EP0411 0 10 Manual Manual 20 / 9 1 No Switch Piggyback FF 041 1 A Wide-Angle 10 P11 2" b" 1 5" 21 / 9.5 115 12 20 Plug 20 1 EP041 1 F `1 ' 61, Manual Manual 6 15" 20 / 9 1 4 I I No Switch g - EP041 1 AC Wide-Angle 20 1 Yz° 12" " 15" 21 / 9.5 9 FP0412 1 Plug / 10' 1Manual Manual 15" 20 / 9.1 230 6 0 N. Switch EP0412F Plug i 20' 1 Yz' Manual Manual 15 " 20/91 No Switch EP051 1 F Plug / No Switch 20' 1 Yz" Manual Manual 15" 221 10 115 13 20 EPo511AC .5 Piggyback/ _ Wide-Angle 20' 1 12" 6" 15" 231 10.4 EP0512F 230 6-5 10 Plug / 20' Manual Manual ! 15' i - - 22 / 10 -e 'e~ Lot size 2.985 acres 25 foot set back line 50% slope or rester SCALE 1" 40 FT. 689 ~.._..-t._.._.._.._.._.._.._.._.._.._.._..,.._. - - _ NOTE : PROPERTY LINES - - ARE NOT FULLY SHOWN. 78.98 - BM1#100 BORING 1A 98.30 Q , _ : _ BOREING1B94.2 88.98 ~ • - © - - - BORE] NG 1C 95.6 Q Proposed house and garage BORING 1D 98x39 Q ` POLY LOC ESER 1200/800 97 4R 525 FILTER C MBO TANK Q B CDRIVE ALL THREE COVERS ON SEPTIC TO BE ABOVE GROUND WITH Contour line _ WAY APROVED LOCKING DEVICE GARAGE ON COVERS. Eljen mound sy tem 0 VATPO PIPES a A \ ' y -16 Slope 4%~ MOST LIKELY WILL ~o I ~ BE BED ROCK BELOW B 00 SEPTIC. ADD 6" SAND MIN. UNDER Q SEPTICTANK. UTILTYEASMENT--- CUL DE SAC i 4 / 4 BEDROOM SYSTEM FOR PROPERTY LOCATED AT THE NE1/4 OF THE SE 1/4 AND THE SE 1/4 OF THE SE1/4 OF SEC 8 T 28N R19W TOWN OF TROY. ST CR IX COUNTY. J W U _ J [a t CD z J W C~ o I S Q N N O U _ I S# ss C-li ILA g Z p v cn U O F- ar: EU U O O a O a - O Q i _ - -W 0 V U N U CD J M M W Cl) Cl) _ > ! E U-1 O U I co U E C.0 I-~-_- . p N M 9 U _ M co =i '.6 N _ O ~J 1 I N O LO U - O N U) \ CD z a_ 0 W d c) \ ~ Z w7~ Q U W _ W Z - w.. i I I co 06 F- UJ W Z co O W U 0 W U S QO F-c!) U ~ J O J Ur W m Z Z Zv U) W co~ - - ~I 0 a vv w, ~ w = c~ o d - - v \ f- z W c~ Q- C7 > W L o O - - z LL. c~ a. c= W U) -J m LO Elf =D JQQO:D Cr) ddb=Oco- /J - - -OT --1010 ---ELEVATIOW~102~7 \ Aow- 43K` d,3 $ BRING F3-113 -Cool Dz4 EFVATION=1 25. BORING B -2C ELEVATION= 1033.2 - / y ® qL L~(3a 1I X BORI G B- IA k LLE ATfON -1026.3I TE~Mr ORARY JORING 13-213 / C -L-DE-SAC / .,LEVATION 1.2 R -60' 5' fi ~d ar7 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner GARY DUCLOS Septic Tank Capacity 1200 gal 13 NA Permit # Septic Tank Manufacturer WIESER ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer POLYLOCK ❑ NA Number of Bedrooms 4 ❑ NA Effluent Filter Model 525 ❑ NA Number of Public Facility Units EXNA Pump Tank Capacity 800 gal ❑ NA Estimated flow (average) 400 gal/day Pump Tank Manufacturer WIESER ❑ NA Design flow (peak), (Estimated x 1.5) 600 gal/day Pump Manufacturer GOULDS ❑ NA Soil Application Rate •8 gal/day/ft2 Pump Model EP05 ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter = Biochemical Oxygen Demand (BOD,) 5220 mg/L EX NA ❑ Mechanical Aeration ❑ Wetland ELJEN Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection EXOther: SYNTETIC j Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODE) <_30 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) <_30 mg/L ❑ NA ❑ At-Grade 13 Mound Fecal Coliform (geometric mean) <10" ctu/100m1 ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Y8 in dia. ❑ NA Otter' ❑ NA Other: ❑ NA Other: ❑ NA *'Values typical for domestic wastewater and septic tank effluent. Offer' ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once eve ❑ month(s) (Maximum 3 ears) ❑ NA rY 3 CKyear(s) y Pump out contents of tank(s) When combined sludge and scum equals one-third (Y,) of tank volume ❑ NA Inspect dispersal cell(s) At least once eve 11 month(s) (Maximum 3 years) ❑ NA 3 CXyear(5) - 11 ❑ month(s) Clean effluent filter At least once every: 1 ElCyear(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA 3 ayear(s) Flush laterals and pressure test At least once every: ❑ month(s) 13 NA ❑ year(s) AS NEEDED Other: At least once every: ❑ month(s) El ❑ NA - year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector, POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent fitters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page Z of III START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the 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. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 63.33, Wisconsin Administrative Code: 0 All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by 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 another 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: ❑ 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, 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. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS j technology a holding tank may be installed as a last resort to replace the failed POWTS. T alua H'. idemi a o g nk ' Le ' e ai aR D4113 17~~D /z- lJ$l~ ~h1STR(l~"l t~ mAy ❑ 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 GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name COUNTRYSIDE PH.COM Name COUNTRYSIDE PH.COM Phone 7105-246-2660 Phone 715-246-2660 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name DARRELS SEPTIC SERVICE Name S-r• Gkb ( Phone 715-425-1025 Phone 3E(P- (p~D This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. DIVISION OF INDUSTRY SERVICES 10541 N RANCH RD HAYWARD WI 54843-6462 r~ Contact Through Relay $ http://dsps.wi.gov/programs/industry-services www.wisconsin.gov Scott Walker, Governor ~~OFLSS ,h~ti I aura ruti6rrez -Secretary Emailed 9/13/2017 September 13, 2017 CUST ID No. 225410 PAUL R KOEHLER COUNTRYSIDE PLUMBING & HEATING INC 321 WISCONSIN DR NEW RICHMOND WI 54017 REQUEST FOR ADDITIONAL INFORMATION SITE: Gary Duclos Townsvalley Rd Identification Numbers Town of Troy Transaction ID No. 2999979 St Croix County Site ID No. 842740 SE1/4, SE1/4, S8, T28N, R19W Please refer to both identification numbers, above, FOR: in all correspondence with the agency. Description: GSF to mound, 4 br res Object Type: POWTS Component Manual Regulated Object ID No.: 1726762 Maintenance required; 600 GPD Flow rate; 14 in Soil minimum depth to limiting factor from original grade; System(s): Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12), SSWMP Pub. 9.6, Other; Effluent Filter The submittal described above has been placed on HOLD and the review and approval is pending subject to receipt of the ADDITIONAL INFORMATION and/or revised plans requested by this letter. Upon receipt of the additional information and/or revised plans, the plans will be reviewed for compliance to applicable Wisconsin Administrative Codes and Wisconsin Statutes. The following must be corrected/revised and accompany the resubmittal: • Boing 1-D has an elevation far off from the rest of the borings. You will need to reconcile the bench mark elevation on the certified soil tester's plot plan and the designer's plot plan. • Label the contours on the designer's plot plan. • The mound must follow the shape of the contour. • Add the contact names and numbers to the management plan. Generally, the service provider is the installer and the sanitary permit issuing agency (usually the zoning office). • REMEMBER to sign each revised page and date it. Include your credential number. Sending an index page for these corrections is not required and will not meet the signing requirements. Send your re-submittal into the address listed above, unless otherwise noted, and the department will review the resubmittal within 5 working days of receipt date. Please include a copy of this letter with your resubmittal. Designer shall identify plan revisions by a readily discernible means such as shading, highlighting, hatching or clouding the changed areas prior to plan re-submittal. Failure to do so may delay review. I • PAUL R KOEHLER Page 2 9/13/2017 If the above requested information and/or plans are not received within 30 business days of the date of this correspondence, this submittal will be returned denied. No fees will be refunded, and a new fee, application form, and submittal of plans/specifications will be required should you desire to continue with this project. The code in effect at the time of new submittal would apply. If you have any questions, after reading the above comments and related code sections cited, please call me at the telephone number below. Sincerely, Fee Received $ 0.00 WiSMART code: 7633 Patricia L Shandorf POWTS Plan Reviewer, Division of Industry Services (715) 634-7810, Fax: (715) 634-5150 , M - F 8:00 a.m. - 4:45 p.m. pat. shandorf@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm St Croix County Spia - Zoning Office DIVISION OF INDUSTRY SERVICES 10541 N RANCH RD HAYWARD WI 54843-6462 Contact Through Relay http://dsps.wi.gov/programs/industry-services yt, P S wwwmisconsin.gov Scott Walker, Governor ~O L s7o~~t I aura GIitadrre7, -qecretaw Emailed 9/13/2017 September 13, 2017 CUST ID No. 225410 PAUL R KOEHLER COUNTRYSIDE PLUMBING & HEATING INC 321 WISCONSIN DR NEW RICHMOND WI 54017 RF l1T TP QT P"D A -Mr-1 TI"N A T INFORMATION . QU_ S SITE: Gary Duclos Townsvalley Rd Identification Numbers Town of Troy Transaction ID No. 2999979 St Croix County Site ID No. 842740 SE 1/4, SE 1/4, S8, T28N, R19W Please refer to both identification numbers, above, FOR: in all correspondence with the agency. Description: GSF to mound, 4 br res Object Type: POWTS Component Manual Regulated Object ID No.: 1726762 Maintenance required; 600 GPD Flow rate; 14 in Soil minimum depth to limiting factor from original grade; System(s): Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12), SSWMP Pub. 9.6, Other; Effluent Filter The submittal described above has been placed on HOLD and the review and approval is pending subject to receipt of the ADDITIONAL INFORMATION and/or revised plans requested by this letter. Upon receipt of the additional information and/or revised plans, the plans will be reviewed for compliance to applicable Wisconsin Administrative Codes and Wisconsin Statutes. The following must be corrected/revised and accompany the resubmittal: • Boing 1-D has an elevation far off from the rest of the borings. You will need to reconcile the benchmark elevation on the certified soil tester's plot plan and the designer's plot plan. • Label the contours on the designer's plot plan. • The mound must follow the shape of the contour. • Add the contact names and numbers to the management plan. Generally, the service provider is the installer and the sanitary permit issuing agency (usually the zoning office). • REMEMBER to sign each revised page and date it. Include your credential number. Sending an index page for these corrections is not required and will not meet the signing requirements. Send your re-submittal into the address listed above, unless otherwise noted, and the department will review the resubmittal within 5 working days of receipt date. Please include a copy of this letter with your resubmittal. Designer shall identify plan revisions by a readily discernible means such as shading, highlighting, hatching or clouding the changed areas prior to plan re-submittal. Failure to do so may delay review. PAUL R KOEHLER Page 2 9/22/2017 Sincerely, Fee Received $ 0.00 WiSMART code: 7633 Patricia L Shandorf POWTS Plan Reviewer, Division of Industry Services (715) 634-7810, Fax: (715) 634-5150 , M - F 8:00 a.m. - 4:45 p.m. pat.shandorf@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm St Croix County Spia - Zoning Office l DIVISION OF INDUSTRY SERVICES 10541 N RANCH RD \ r HAYWARD WI 54843-6462 Contact Through Relay http://dsps.wi.gov/programs/industry-services www.wisconsin.gov Scott Walker, Governor ~~~ssroN~/ 1 allra Clitibrrez, Serra}an September 22, 2017 CUST ID No. 225410 PAUL R KOEHLER COUNTRYSIDE PLUMBING & HEATING INC 321 WISCONSIN DR NEW RICHMOND WI 54017 REQUEST FOR ADDITIONAL INFORMATION SITE: Gary Duclos Townsvalley Rd Identification Numbers Town of Troy Transaction ID No. 2999979 St Croix County Site ID No. 842740 SE1/4, SEI/4, S8, T28N, R19W Please refer to both identification numbers, above, FOR: in all correspondence with the agency. Description: GSF to mound, 4 br res Object Type: POWTS Component Manual Regulated Object ID No.: 1726762 Maintenance required; 600 GPD Flow rate; 14 in Soil minimum depth to limiting factor from original grade; System(s): Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12), SSWMP Pub. 9.6, Other; Effluent Filter The submittal described above has been placed on HOLD and the review and approval is pending subject to receipt of the ADDITIONAL INFORMATION and/or revised plans requested by this letter. Upon receipt of the additional information and/or revised plans, the plans will be reviewed for compliance to applicable Wisconsin Administrative Codes and Wisconsin Statutes. The following must be corrected/revised and accompany the resubmittal: • You have not used the same bench mark as the certified soil tester. Did you reshoot the elevations of the existing borings? • On your description of 13-1D the elevation is shown as 100.0' On the plot plan it is shown on 98.19' contour. • Your design says the controlling contour is 100.0', but that contour doesn't appear to be in the test area. Send your re-submittal into the address listed above, unless otherwise noted, and the department will review the resubmittal within 5 working days of receipt date. Please include a copy of this letter with your resubmittal. Designer shall identify plan revisions by a readily discernible means such as shading, highlighting, hatching or clouding the changed areas prior to plan re-submittal. Failure to do so may delay review. If the above requested information and/or plans are not received within 30 business days of the date of this correspondence, this submittal will be returned denied. No fees will be refunded, and a new fee, application form, and submittal of plans/specifications will be required should you desire to continue with this project. The code in effect at the time of new submittal would apply. If you have any questions, after reading the above comments and related code sections cited, please call me at the telephone number below. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer bL_4<_i__cS Mailing Address Z-225 .7 /G title Vl~ LL{ l VIZ Property Address4 ---A i, Li. / (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number l 27 = % LEGAL DESCRIPTION Property Location t' '/-0 , Vi, Sec. C;~ , T Z~_5 N Ri"i W, Town of Subdivision Eft -qu~ L r ' f-#---- Lot # Certified Survey Map # , Volume , Page # Warranty Deed Volume , Page # Spec house ye (no Lot lines identifia yes~1 no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 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 Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on s form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue o a w anty deed recorded in Register of Deeds Office. Number of bedrooms S AT 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, 08105) vis . Dept of Safety and Professional Serm.(s SOIL EVALUATION REPORT Page Division of Safety and Buildings in accordance with SPS 385. Ws. Adm. Corte County ,t crow Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include. but not limited to vertical and horizontal reference point (BM), direction and Parcel I_D- 040-103,-~0-200 percent slope. scale or dimensions.. north arrow. and location and distance to nearest road. Please print all information. Reviewed by Date xma!I,)n you p-vid< -I, n" :d ix _a. ~onaary Property Owner Property Location i E] E Govt. Lot s` 1/4 " 1/4 S T N R E (or) W Property Owner's Mailing Address Lot » Block # Subs. Name or CSM# I City State Zip Code Phone Number EICity Village own Nearest Road tro v New Construction Use Residential / Number of bedrooms 4 _ Code derived design flow rate GPD Replacement ❑ Public or commercial - Describe Parent material Flood Plain elevation if applicable ft General comments ILANI) 110RIVG . CONFIRM 1,,( Mil: PRIOR SOIL TI:SF. NL1.DLD . ANOTHER IIN I_ I \l(A I and recommendations. LO('l ION OF SY IL\1 I O I lil-: A\ ES I .:AS \1I NCH AS POSSIBLE--. 13-1 ~ Boring Boring # I D 17 pit ' Ground surface elev. lIlU ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft in. Munsell Qu Sz. Cont. Color Gr Sz. Sh. ff#1 ff#2 A 0-8 10YR S1L ',I ABK %1V'FR :AB 3FV-C 13 -14 10 Y'R 4 6 SIL 31 -%1A13K %11:R C\A' K SK L 3-A1AE3K D11 CW > S ( 14-29 10 1"R 4 `d ( 30 - LSIW ❑ Boring # F]Boring Pit Ground surface elev ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft in. Munsell Qu- Sz. Cont. Color Gr. Sz. Sh. ff#1 *Ifff#2 Effluent #1 = BOD _ > 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent #2 = BOD . < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si e CST Number PAUL R. KOEIILER _2~11U Address Date Evaluation Conducted Telephone Number 321 \VISCO\Sl DRI\ 1. N F, RICHAIOVD r/n9 )017 ~I>-24t,-2660 r ~SL ( ~L- ~ 77 066 ' /Q6) Wisconsin Department of Commerce SOIL EVALUATION REPORT Page _1_ of -3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code OI County C~ ct~ Attach complete site plan on paper not less than 8 1/2 x 11 inches In size. Plan must ✓ l) include, but not limited to: vertical and horizontal reference pgkL(BM), direction and Parcel I.D.-~'; UJ percent slope, scale or dimensions, north arrow, and location apdolv~tance to nearest road. ' Please fi !),information. ew y Dat Personal Information you provide may be/(~dW'tdr secondary purposes (Privacy 4ew\, 15.04 (1) (m)). Q roperty Location Prop" Owner „'Yap, ~7 FEV R~ 1 r r e~-tat SE 1/4 -5F- 1/4 S T z N R 1 Q 1.4@rrW Property Owners Mailing Address Lbt # Block # Subd. Name or CSM# X CSAg- 429 ~~=~►~!S = / C ty State Zip Code Ph Mqr' 'c - ❑ City ❑ Village Town Nearest Road NL005DN W1. 5Y 01 E4 (1i5 386-3 27 ro New Construction User Residential / Number_ofbedroorns _HCode derived design flow rate GPD Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation iF a _pl'cable ff• General comments `1 ST >r M ~Qjyt y►n~(JE a l J ~rf~tR and recommendations: MOuN~ S qx (,7 C0010Uq, LIQ't 1027 ~ f"' cu Z bic g~ EL V T1 ►0 2R-$ / u K~ 2S~it 6~r~~ ~H t~F2Gt r'~d ~~c~y Boring ,r Y " Frost 1A Boring # 64 Pit Ground surface elev. Gt <i.`~ ft. Depth to limiting factor In, Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/Ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-4 R z - 't 1 aab m s b -ca 0.5 .8 5- 3fr Z g_W inv u s f I a dT4r of 4-c0 0•6 of 3 14-29 - - tsIIR - 2~r~-m - 1] Boring 1 Q Boring # ~ Plt Ground surface elev. ft. Depth to limiting factor In Soil Application Rate H De th Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF Horizon P in. Munsell Qu. Sz. Cont. Color Gr. Sz. S-h. 'Eff#1 'Eff#2 0-~ 10Y ~/Z - 5t +abK mAr ab 1-r-O,S z -7 -14 y yIb - i -ma.bK mF ct,J Zdf tD S O.Ff I,SBR 'r''' 3 y 35 - - Effluent #1 = BOD > 30:< 220 rng/L and TSS >30 < 150 mg/- ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) nature z CST Number MAK Zo HaLL47tiS c ;ZLL( 3 Z Address Date Evaluation Conducted Telephone Number v IVS ~RO~'~vE Rev 1?_ F~t_t5 1~~ y;y0zz 2-z4-DI 7l5)4Z6-I Property OwnerE?ZE EfJ Parcel ID it POND 1 fJG _ Page 2 of FTC] Boring # ❑ Boring it -{ii f/QpS'I~ Ej pit Ground surface elev. ft. Depth to limiting factor _ 19 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fi in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0-7 / y 212 s'l1 3 abK iM41 (t -co 0.5 0.8 Z- 10 yt7y I - , nab fr 0-0 zjf-cA o.S 0.8 - 2JC-m - 3 q_ 750% LS ge, ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. _ ft. Depth to limiting factor in. Soil A Iication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD, > 30 < 220 rng/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. SBD-9370 (8.6100) l \ \.LIE, ~Cgl 9 1010 1020 BORINGS 1C \ ELEVATION-14025.71 01.5 i \ EL10Z6~- \ I \ \ \ 1026.8 / r g1n e3i oj. BORING B-1 B kp 9 EL ATION=1 25. / BORING B-2C \ ELEVATION= 1033.2 Aa AL-BOkl x 1033.6 \ E res l , b BORI G B-i9 A ELEVATIONf=1026 / T MPORARY / C L-DE-SAC ORING B-213 EVATIONT,19.~1.2 R 80 I ' 75' p \ 690 G 6 ~p32• \ \N~ vN / , N88°3726"E 346.48' - i 93p 960. 970 . L07.1 \ l 2.9 - M01CRES ` t~'- _ a4o=loss-5o 2aQ O W 00'... Q E z 990 rn r/1 U Q a :7Z0Z.. in a U U NORTH A'w ?010,, _ ELEVATIONS SHOWN ARE NAVD 1988 DATUM. i t ._15.0 SCALE: . 39:5 15.0 ?p, 0 50 100 0 PROPOSED HODS 12.5 143' LEGEND LrS.........,. 1-01 c6 1 1 Zp0 ...t .5 .1 z 0 co -o . p m X =WOOD LATH OR PIN FLAG SET - qp 0 ° 2.0 ao =WOOD HUB SET AT 10' t z.o s OFFSET, 15' OFFSET, OR ON BUILDING EXTENSION 0 FOUND 1-1/4" IRON PIPE T.O.H: TOP OF WOOD HUB ELEVATION o T.O.P.- TOP OF IRON PIPE ELEVATION o SETBACK LINE: o 75' FRONT 25' SIDE 25' REAR - " - - - - IV UTILITY EASEMENT N, PROPERTY ADDRESS: 424 EAGLE BLUFF DRIVE TEMPORAR HUDSON W1 54018 CUL-DE-SAC N'T 3• 3 l Q, 1~~ • 1 v cf MAM n ,M VAM DERRICK CONSTRUC11ON aft kA an him fted olmm en In o LOT 1, C.S.M. V. 15 PG. 4124 sm ~ n Ims o~x '~1 ra na~ror to neoi•am S_C. 8 -128t\'- 19W TOV^' 0= TROY ST. CROW COUNTY, WSCONSN In n DN rtt fiW,101 r nv its HOUSE STAKEOUT PLAN Auth• Conswung/associates S&N band Surve*g xe mum „ o f ,A,T.