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002-1058-80-000
W isconsin Department of Commerce SYSTEM County: St. Croix , Safety and Building Division PRIVATE SEWAGE SYS • INSPECTION REPORT Sanitary Permit No: 515197 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: Wells Fargo Bank NA, foreclosure _ Baldwin, Town of 002- 1058 -80 -000 CST BM Elev Insp. BM Elev: BM Desc ption: Section/Town /Range /Map No: (OD ,F (/O • 0 `.144. 1 24.29.16.357B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER " H 5 CAPACITY STATION BS HI FS ELEV. s. Septic T,A,, 3 Benchmark Dosing 1 '" ✓4 I. CY /. OD Alt. BM n_ n/ r "1 0-- s... , , d / Aeration Pb(■41,17j ' Bldg.�awer F � G _ yv 7 Holding St/Ht InI t --� IC-31 ?s o f St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet - Ck.t ' Septic Zo , t� ,1SU/ 2S 3 ft ° - t�tt °m (3.(,( /. 7y Dosing (-) - q i5 1 , f __ Header /Man. S. /9 �60 I di I r Aeration _ Dist. Dist. Pipe /oa W1 .al t Holding Bot. System g T+ G.1s'(1 r 5 qq. 7 Final Grade i/ PUMP /SIPHON INFORMATION 3.9 1 At • 4 il " /7 Manufacturer Demand St Cove / . t'S � D /0 ` GPM (� G rt] Model Number n ,\ q ! pr " »'T I �� D fb �} _111 TDH Li (0Z Friction i o ssi System ead TD t ` $ 1 - , % ( h y�j �( J -go r g Y• Forcemain Len / Dia. 1 Dist. to Well y /5-6 / tti �f 'u " / O. r, f ,f% "` ���� llll))))'"' I —/ j5- _ / . . pi SOIL ABSORPTION SYSTEM b ' PSI? k ' . -, 1'3- 1 4 i BED /TRENCH Width / Length / No. Of T ench PI DIMENSIONS No. Of Pits l Ir /r A .;ii. Liquid Depth DIMENSIONS It 7� �� `_ SETBACK SYSTEM TO P /Ll,ij BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHA • ` • OR .....• T /7 Of System: 6 I / 5 /3z. f UNIT Model Number: DISTRIBUTION SYSTEM ktici Header /Manifold ry Distribution ` ./ // x Hole Size / x Hole Spacing Ven� � Air Intake g O % lb z Length � Dia � +w Le p ngth r �� ' • Dia /� 26 Spacing .� "n.10....._ SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only 1 Depth Over / Depth Over xx Depth of xx Seeded/ ded xx Mu ed Bed /Trench Center / i Bed/Trench Edge Topsoil ' Yes No Yes El No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: (1 / 20 / DI p7q Inspection #2: / / Location: 2617 90th Ave oodville, WI 54028 (NW 1/4 NW 1/4 24 T29N R16W) metes & bounds Lot �'�q�, Parcel No: 24.29.16.3578 4-6. 1.) Alt BM Description = C ('a. ti" In crL`S C . rkt -3(/ 0 !/ Cejj t G- J - 2.) Bldg sewer length = ,c/ Cam/ ivy 7/ I , ( 7 6„-,a��itPk+s - amount of cover = / (` `1 y f Pian revision Required? 0 Yes No DI 2b i 3 -*S — Date Insepctor's Si! ature Cert. No. 5710 (R.3/97) r . 4pliamthk commer - - . •� I • S , , ety and Buildings Division County 2 01 W. ashington Ave., P.O. Box 7162 . 61X CIAO/ x I SCO S I 4 f � � ti adison, WI 5 a t " Sanitary Permit Number (to be filled in by Co.) Department of • • me i2 4.v "` ,J. 5/5/ i7 7 State Transaction Number Sa 1 ltar ge • ' _ ■ r I cation 4 In accordance with s. Comm. 83.2 (��t ` I„ w • • • - . is form to the appropriate governmental / 73 (0 9 O unit is required prior to obtainin .. , , - - t Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. *6 / )7 944 I. Application Information - Please Pr' r nformation like' Property Owner's Name Parcel # Cells 4t0 ga4L rA9 0;e4 Ir) 00 ,Q /aCg B a Property Owner's Mailin Address Property Location 6 7 s --7ii e t w / Got Lot 3 57 e;) City, State Zip Code , � PPhone Number .. ad 1/w Y � 1/� Section a� 4i/ s. Co a 7 / 4 , (� / / �I o197 D 7 � O circle on T N; R E II. Type of Building (check all that apply) Lot # �� / � ° ).1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name kfi �¢ Block # ❑ Public /Commercial - Describe Use ❑City of ❑ State Owned - Describe Use / / CSM Number ❑ Village of /6 a- '7/5 ta�lown ofjO /d',a I I. Type of Permit: (Check only one box on line A. Complete line B if applicable) 6 A ❑ New System *'Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) - ❑ Change of Plumber List Previous Permit Number and Date Issued ❑ Permit Transfer to New B. ❑ Permit Renewal ❑ Permit Revision B / efore Expiration Owner , � - IV. Type of POWTS System/Component /Device: (Check all that apply) (0 I it v1 Q1-) r 9R ❑ 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) 41'44 / 4 V. Dispersal/Treatment Area Information: �.�� /5 Design Flow (gpd)Design Soil Application Rat gpdsf) Dispersal Area equired (sr Dispersal Area Propose sf) System Elevation VI. Tank Info Capacity in Total 4 of Manufacturer Gallons Gallons Units a 0 o $ o New Tanks Existing Tanks ` e w Q Y `" 4/ / i`bk 525 a � ,/ v g v, v, 5 a Septic or Etvlt}atridnk K 'mod / � , j � !N �_ r i�l Dosing Chamber V V (/ / ( C/VICrC/ C.- VII. Responsibility Statement I, the undersigned, assu i responsibility for installation of the POWTS shown on the attac plans. Plumber's Name (Print) 41; ature MP/MPRS Number Business Phone Number �� X g/ #Z 74 3 W 4 / 11 , Plumber's Address (Street, Ci , State, Zip Code) r y : ( ; 1 1 ---' _ r -4 Some `t ✓e /U serf, e,. .5 /6 VIII. ounty/Department se Only Approved ❑ r .pproved Permit Fee Date Iss d Issuing ent Signature $‘25. / //9 ❑ •w : ven Reason for Denial tx) �r / 11111111 IX. Conditsg1®easons for Disapproval 3) \ / _ d �� � !. - / . ,10 at/at2 ft7R 1. Septic tank, effluent filter and �ryrn��� I dispersal cell must all be services / maintained /6 � 1 C pl'' k✓ d s �" • as per management plan provided by plumber. 2. All setback requirements mustbe maintained 41 [ _ Q /► _ (� cas pa.k. as per applicable t i ordinances Y J S •h. L. e.�lQ✓In d� Attach to complete plans for the system and submi t o the County o on paper not less than 8 1/2 x 11 inches in size 664a- i_ SBD -6398 (R. 02/09) Valid thru 02/11 A 4 , . Plat Plan __ Page 8of8 P r o p e r t y O w n e r ‘ 1 , 1 1 3 , • s tAR • Legal Description ,,,w /c of -ry t, iw , (except where noted) s2.4, - c i R 16 VO OF - 5i . l,s, sr, IZ, = Backhoe pit North ,,1 h ....--..„ ) It 4 , M SS 2. P a , 4 Cep 1 ' ,,t. yli 0 , 1 (0( , I v � is -0- � a ; S p a (�, G� ^ 4J W W ev r A Jey' z' _0( in as,.; 1 ,t r? Fi'Cl4"4"ktiQ 4740 i 4.i I "/ I I T 41 100.49 I Y Ti /e � _ � T}WLi..s& Ow -rRhtk -ro s. AeAN �oN�� w Q8 � Cc E. X3.33 .3 t.L ciL90 1 g SAS -ottj may vst 1 11 1 1_ I '' Site Location: L J . i .,...___- q.44AQE. X 9 C N c.?; H . 0 $ -. a r , , 4 Page o 8 Plot Plan - .. �' .f Property Owner us t=AR‘0 . EA.otez.r. j Acot , ,ER, 1" = 40 ft. Legal Description A, w t /v DP THe A,w` /c-t , (except where noted). 524i, T Rita v.) sow.v0 or . Aub.,t „1/4), sr. II = Backhoe pit ciene,�L CouJ j vo\s bN s►14 s f � � S North N J S00 64 2 4.2#20 50170 411 . �- tier ill a . . Race, • ,rr+N �� 1 L' l vii - I =^'” too.99' v .t , 3b p i _ o A+ ■ 1 r �q�a ElC.p' ,4 01-0 T tk 'T'o KE. A6tW hoN'EA n • •Pe Q8\ TIEN Come. '5 3.33 3 EL ARN a " as c - G -tw u ,,.., Site Location: x $EL• Z14 ( 51) w t— C a L _ -I • • Safety and Buildings PO BOX 7162 commerce.Wi.gov MADISON WI 53707 -7162 Contact Through Relay i sco n s i n www.commerce.wi.gov /sb/ www.wisconsin.gov Department of Commerce Jim Doyle, Governor Richard J. Leinenkugel, Secretary November 17, 2009 CUST ID No. 224832 ATTN: POWTS Inspector MARY JO HUPPERT ZONING OFFICE HOLLISTERS SOIL TESTING & DESIGN ST CROIX COUNTY SPIA W9875 690TH AVE 1101 CARMICHAEL RD RIVER FALLS WI 54022 -4011 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/17/2011 Identification Numbers Transaction ID No. 1736998 SITE Site ID No. 753147 Jacob Meier Dwelling Please refer to both identification numbers, 2617 90TH Avenue above, in all correspondence with the agency. Town of Baldwin, 54002 St Croix County NW1 /4, NW1 /4, S24, T29N, R16W FOR: Description: Mound Object Type: POWTS Component Manual Regulated Object ID No.: 1248503 Maintenance required; Replacement system; 450 GPD Flow rate; 21 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 Manual - Version 2.0, SBD - 10706 -P (N.01 /01); 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 the component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. R( No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, Cone stats. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to DE DEDE Ei 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. SEE CORR, In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. MARY JO HUPPERT Page 2 11/17/2009 • Sincer Fee Required $ 250.00 Fee Received $ 250.00 / % Balance Due $ 0.00 ' eter E Pagel Private Sewage P1a Reviewer , Integrated Services WiSMART code: 7633 (608)266 -2889 , M - F, 0600 - 1430 Hrs pete.pagel@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726 -2544 , Monday, 7:00 A.M. To 3:30 P.M. Notice: Starting July 1, 2009, no person or entity may engage or offer to engage in construction business in Wisconsin unless they hold a Building Contractor Registration, or equivalent, issued by the Safety and Buildings Division of the Wisconsin Department of Commerce. "Construction business" means a trade that installs, alters or repairs any building element, component, material or device that is regulated under the commercial building code, chs. Comm 60 to 66, the uniform dwelling code, chs. Comm 20 to 25, the electrical code, ch. Comm 16, the plumbing code, chs. Comm 81 to 87, or the public swimming pools and water attractions code, ch. Comm 90. The term does not include the delivery of building supplies or materials, or the manufacture of a building product not on the building site. For further information, go to our website: www.commerce.wi.gov/SB/SB-BuildingContractorProgram.html • t i, 1 2009 EJILDINGS MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: JACOB MEIER Owners Name: WELLS FARGO BANK Owners Address: 3476 Stateview Blvd. Ft. Mill, SC 29715 Legal Description: NW 1/4 of the NW 1/4, S24, T29N, R16W Township: Baldwin County: St Croix Subdivision Name: NA Lot Number NA Block Number. NA Parcel I.D. Number. 002 -1058 - 80 - 000 Plan Transaction No.: 4 ' °'" "" y tr¢ , ui/� /4 , Page 1 Index and title � fr : '� �`� Page 2 Data entry t • - rs' ........ ° °• Page 3 Mound drawings � l1�'� �� 'C f Page 4 Lateral and dose tank �� ��,��� � � Page 5 System maintenance specifications t Page 6 Management and contingency plan "Tr � , i359 Page 7 Pump curve and specifications ENO • �b��: u` Ba Page 8 Plot Plan o/ NG3 Designer Mary Jo Huppert License Number. 1859-007 Date: 11/09/09 Phone Number. (715) 426 -1775 9 Si nature: ��, �. „ ,/ r Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706 -P (N. 01/01) Version 5.1 (R. 06/06) Page 1 of 8 . a Mound and Pressure Distribution Component Design Site Information R Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 83 -44 -3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) colrfom, of <= 36 inches. 450.00 Design Flow (gpd) 3.00 Site Slope ( %) 98.00 Contour Line Elevation (ft) 21.00 Depth to Limiting Factor (in) 0.60 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 45.00 Dispersal Cell Length Along Contour (ft) = 1 10.00ICell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /ft 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest • • int in the distribution Y Pressure Disribution Information network? E Center or End Manifold 3.33 Lateral Spacing (ft) If N above, enter the elevation ft 3 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) 2.00 Orifice Spacing (ft) = I 6.821ft 2.00 Forcemain Diameter (in) 104.00 Forcemain Length (ft) Does the forcemain drain back? Y 92.00 Pump Tank Elevation (ft) 6.50 System Head (ft) x 1.3 16.96 Forcemain Drainback (gal) �a � 6.75 Vertical Lift (ft) 41.55 5x Void Volume (gal) U 1.68 Friction Loss (ft) 58.51 Minimum Dose Volume (gal) / q' 0.00 In -line Filter Loss (ft) Total Dynamic Head (ft) 27.19 System Demand (gpm) 4 + 14.931 Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 i 1.25 x x 1.00 x _- I 1.50 x t _____ 1 _-.. .__ ...._. 1.25 x x 1 2.00 i i 1.50 x - -- - 3.00 L 2.00 x 1 3.00 x Gallons /Inch Calculator Treatment Tank Information Total Tank Capacity (gal) 3 1000.001 Septic Tank Capacity (gal) ss __ I Total Working Liquid Depth (in) Wieser Manufacturer I gal /in (enter result in cell B49) Dose Tank Information Effluent Filter Information 600.001 Dose Tank Capacity (gal) 1Poltok ' Filter Manufacturer L____ 16.76Dose Tank Volume (gal /in) ! 525 !Filter Model Number Wieser !Manufacturer Project: JACOB MEIER Page 2 of 8 Mound Plan and Cross Section Views T 1/10 B = :- : -: -:- J Ob serva ti on Pi pe • :: ♦--K: p © W ::1: ••'• - : - 1:•: z •—I— -H • L • Mound Component Dimensions A 10.00 ft E 18.60 in H 1.00 ft K 9.51 ft B 45.00 ft F 9.25 in z 9.30 ft L 64.03 ft D 15.00 in G 0.50 ft J 6.94ft W 26.24 ft 450.00 (ft Dispersal CeII Area 868.48 (ft Basal Area Available 10.00 (gpd /ft) Linear Loading Rate 4.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 101.02 (ft) ■ ...:: :..., G t H T F Dispersal Cell 99.75 (ft) Lateral 99.25 (ft) — __ Invert Dispersal Cell ::::�1.: : : :: : : . . . . . . . . . . . . . . . . . . . . . . ........... .. : : E D ::: :::: . . . Elevation .I. � ■� �= ::: 1:11 41"--NN 4 98.00 (ft) Contour Elevation 3.0 % Site Slope Geotextile Fabric Cover Shading Key -0 Q ( l -1°-- Dispersal Cell See lateral details on 0 I �����1 Topsoil Cap Ti. 1.5 ft Page number, e © „ ����z'z Subsoil Cap © 0 and spacing of laterals. ASTM C33 Sand 2 / F Laterals are equally I 1 Tilled Layer 0.5 ft Typical Lateral spaced from the ©I 1 Aggregate ;11 1 © I distribution cell's centerline in the - A } distribution cell (AxB). Project: JACOB MEIER Page 3 of 8 End Connection Lateral Layout Diagram Center the laterals over the ABB dfrnension •o Turn-up wf ball valve or Wwnoutplop < P All laterals are aaerrtioat (F ,c —3. I Holes drraw on the bottom of the Several s • equals spaced J. (per COMM Table 04.30 -5) S y It Face main connection via tee or cross to manifold at ans point- i.seerab s farna main of PVC Soh 10 T • Number of Laterals 3 Orifice Diameter 0.125 in Lateral Diameter 1.25 in Orifice Spacing (X) 2.07 ft Lateral Length (P) 43.47 ft Orifices per Lateral 22 Lateral Spacing (S) 3.33 ft Orifice Density 6.82 ft Lateral Flow Rate 9.06 gpm Manifold Length 6.67 ft System Flow Rate 27.19 gpm Manifold Diameter 1.25 in Total Dynamic Head 14.93 ft Forcemain Velocity 2.78 ft/sec Dose Tank information Locking cover witti warning label and klddng device and 1 1 --' sealed watertight Electrical as per NEC 300 and —► , a Comm 16.28 WAC ( 4 in. min ----- I i D �le� Tank component is properly vented `. - 1 ■ fi F— Alternate outlet 1 P .cation Forcemain diameter Wieser Manufacturer ■ 1::4_11 2 in. Capacity' 600.00 Gallons Volume 1 16.76 gal/inch A Weep Hole or anti - Dimension inches Gallons ---- siphon device A 18.31 306.85 B 2.00 33.52 C d Pump off elevation (ft) _t_ C 3.49 58.51 n 1 93.00 D 12.00 201.12 D Total I 35.801 600.00 Dose tank elevation (tt) 3' Bedding u er tank. 4----- 92.001 Alarm Manuafacturer Tank Alert Alarm Model Number HW101 Pump Manufacturer Zoeller 7 Pump Model Number 98 Pump Must Deliver 1 27.191gpm at 1 14.931ft TDH Project: JACOB MEIER Page 4 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name r Ron's Sewer Service Inc- -1 Phoner (715) 749 -0153 POWTS Regulator's Name 1 St. Croix County Zoning Phone A715) 386 -4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1000 gal Maximum TSS 150 mg /L Soil Absorption Component Size 450 ft Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3years 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 founding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished Grade 6-8" Diameter L awn :.:. : : Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: JACOB MEIER Page 5 of 8 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01/01), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD 10706 -P (N. 01/01)) and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from 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. Puma 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 mounds perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg /L BOD 30 mg/L TSS, 10 mg/L FOG, and 10 cfu/100 mL for highly treated effluent. Influent flow may 9/ 9/ �9 N y not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 8 W • HEAD CAPACITY CURVE rho 0 1/4 r 3o MODEL • 4 5/8 a- 25 g °" �"", 3 5/8 - . ,,,,,,blipr, - i ill. 1 1 . 5 ie ______...6f__ 14 .,,..,‘, , •••,., -AL) 0 10 �� � �� 4 3/16 2- 5 0 1 1/2 -11 1/2 NPT U.S. GAU.ONS 10 20 -D' .1 t30 40 50 60 70 so trots 1 t I i 0 Eo 160 240 F L 11r PER rata TE Ia00EL 98 60 LE � CYCLE i 11 1 1 • • 1 I I Ilia Feel Canons voters titers 3 n 13 273 1 M W 3.1 231 15 45 4.6 170 20 73 6.1 •s i 2 • Leek 11111.c 23' 0011071 ilip L -f- IR Affilli IIIIIIII, I 4 3/16 111W °..ir-AL-- f ir i . - SKI —.- CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and • Variable level float switches are available for contra ng single supplied with an alarm_ and three phase systems. • Mechanical altenators, for duplex systems, are available • Double piggyback variable level float switches are available with or without alarm svallies. for irmiabW level long cycle controls. SELECTION GUIDE Standard all models - Weight 39 lbs. -'/�z H.P. 1. operated 2 pole mechanical mach, no external control required. Single piygybefit variable level that switch or double piggybadr variable level. 98 Series Control Selectio . float svAl h. Refer to FaM0477.. Model Volts -Ph Mode Amps Simplmr Duplex 3. Mechanical armor 10-0072 or 100075. M08 115 1 Auto 9.4 1 or 1 &7 — 4. see F M0712. for contact model of Electrical Alternator. N98 115 1 Non 9.4 2 or 2 & 6 3�4&5 5. Can+oi switch 100225 used as a conic activator. speaty duplex (3) or (4) float system. 098 2 3 0 1 A u t o 47 1 1 & 7 — & Foie (4) elate J ?ilk, pale6on brae. to watertight conrleGiorw or wired E98 230 1 Nan 4.7 2or2 &6 3or4 &5 simplex or duplex op an. 10 -0002. 7. Two (2) tole J-Pak, for waleright connection or splice. CAUTION Forman on add6oi ZOe plodacts arks b catalog w 1 Vaiable Uwe, Svalches. Ail installation llation of controls, protection devices and .siring should be done by a qualified 14,46477 .131048Q ltadpaialq Fi 649fc geil a.R40 licensed electrician All electrical and safety codes should be billowed incbding the most Single Phase Simplex Pmtpkbaiol. F1119591t Aierm es. Rt0732. recent national Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESiGN For unusual c ondttions a reserve safety factor is engineered into the design of every Zoeller pump. - NAL I& P.O. BOX 16347 -C41- - - fi r's® :L arisldlt KY.4l�6eSf4T S is 36n 64 Run Road J' ∎� theises, KY 40211-1981 ZieruzvAreary — hf4*www.z e,.com Air �tl�P :At- - O t. a r /VEER lACtj '7 cif 4 PALID • Wisconsin Department of Commerce SOIL EVALUATION REPORTS 1 o f 3 Division of Safety and Buildings in accordance with Comm 85, Ws. Adm. Code County ST. CROIX Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must indude, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 002 - 1058 -80 -000 �-� g percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 3 P l e a s e p r i n t a l l information. R ewed b Da Personal information you provide may be used for secondary purposes (Privacy Law. s. 15.04 (1) (m)). L(.70V1 1 / / r / c" Property Owner Property / o PertY Perty Location WELLS FARGO BANK (Buyer: Jacob I l5 .vt. Lot NW 1/4 NW 1/4 S 24 T 29 N R 16 E Property Owner's Mailing Address �+- Lot # Block # Subd. Name or CS! ,,, ,� i I 3476 Stateview Blvd. ((��V� 0 2 00 1 i -- v�.� " _ _' 4. �(Z V1 G City State Zip Code Phone NuWi ei [T 0 Village la Town Nearest Road Ft. Mill, 1 SC 1 29715 I ( ) NIC,...0...mA wN OF FICE 1 90th Avenue pu.,rvN1NO a ZONI Baldwin 0 New Construction Use° Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Q Replacement 0 Public or commercial - Describe: Parent material loess over till Flood Plain elevation if applicable NA ft. General comments ..5 s fi L.t ?'a "--ei and recommendations: >9:i c�.tt f Mound System -- 1.25 ft. sand fill -- 0.6 loading rate / 1, lG { r / v�� u ��z �> z i` �/ Property address: 2617 90th Avenue / �.c: 4 1 Boring # f LL CI Pit Ground surface elev. 98.40 ft. Depth to limiting factor 24 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell \ Q Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0-4 1 10YR2/ ,, cL^LL 4 v c.' 1 2fsbk mvfr cw 3vf -m 0.6 0.8 2 4 -10 10YR2 /2) ,,?y re-r�- <-j W„.,51; 1 2fsbk mvfr as 2vf -m 0.6 0.8 3 10 -18 10YR4/3 – 9 sil 1 3fabk '? ' mfr cw lvf -m 0.6 0.8 4 18 -24 7.5YR3/4 -- sl 2f -msbk mvfr as lvf-m 0.6 1.0 5 24 -34 7.5YR3/4 c2f 1OYR4 /4 Si lf-msbk mfr -- lvf-f 0.4 0.7 Horizons 3,4 & 5 have some gr <1% Ei 2 Boring # Boring 97.90 22 0 Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description I Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color 1 Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0 10YR2/2 -- 1 2fsbk mvfr cw 3vf -m 0.6 0.8 2 4 -9 10YR2/2 – I 2f -msbk mvfr as 2vf m 0.6 0.8 -"---. 10YR4/3 -- — 1 sil bk ? mfr ate' lvf -m 0.6 0.8 4 22-24 7.5YR3/4 f2f 10YR4/4 Sl lf-msbk mvfr as lvf-m 0.4 0.7 5 24 -30 7.5YR3/4 c2d 10YR4 /6 Sl Om mfr -- lvf-f 0.2 0.6 some gr; few cobs Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BOO, < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) • ture CST Number Mary Jo Huppert (Hollister's Soil Testing & Design) v 224832 Address Date Efvafuation Conducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 11 - 07 - 09 (715) 426 - 1775 Property Owner WELLS FARGO BANK (Buyer: MgreR, Parcel ID # 002 - 1058 - 80 - 000 Page 2 3 of 0 SRCOe ) 3 Boring # Boring 0 Pit Ground surface elev. 97.60 ft. Depth to limiting factor 21 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 1 0 10YR2/2 -- 1 3fgr mvfr cs 3vf-m 0.6 0.8 2 4 ' 9 10YR2/2 - -_ 1 2fahk mvfr as 2vf-m 0.6 0.8 3 9-12 10YR4/3 -- sil r. 3fabkJ' mfr CS _ lvf-m 0.6 0.8 4 12-21 7.5YR3/4 -- sl 2fsbk mvfr as lvf-f 0.6 1.0 5 21 -25 7.5YR3/4 f2f 10YR4/4 sl Om mfr -- - -- 0.2 0.6 Some gr; few cobs. 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 GPDIW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring # Ei 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 * Effluent #1 = BOD > 30 < 220 rrg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mgIL 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-8330Test (807/00) Plot Plan for Site and Soil Evaluation Page 3 of 3 Property Owner . ,6,R,,5 gk,.y EK : lekcut Ntta.Ev, 1" = 40 ft. Legal Description m ile% OF T+tt~ MIA) f , (except where noted) say, Tau, sit, W, N,JtJ or 3A+6.nno, ter. 2 = Backhoe pit (volt Cowart w\ sec) t Sktl , A 1 North to N.4 e ill ✓ 2 R 3 J va -t ik v r i P tiO iN -w h � alq4, 7. y 7 J 4. 3 it J fe .I 3 Miztkocs • W' 1 44 tWEIUhiG 0 OtA Tgrak -ry et, MAN toNtD ,y tX \ CoeE V 3.'S3 '3 6L ae.4o s. 1' vr tr Sia -otO , sot u Site Location: X SFC• 24 a w 0 C.T H, 0 ,Z, ,4 r . Plot Plan for Site and Soil Evaluation Page 3 of 3 Property Owner was -ARC 1 " = 40 $v : 3acm� /�t DE R ft Legal Descrin niw/� �� -rte A,w` /, ( except where noted) 2 = Backhoe pit sz�r, TagN R iov�.0 3� w��3 5t c �C Cvexx ry c r Su'3 2 �1ck s North Nr �, Macs � 2y" it y 0. J W I isa 7 -c V _.i..:,...:,:.., w V7 / ? 1 ! ! #2- T6P� R �o , 00 t it bWEiUh►G plp TJ1Nk - co k�E A3t{Ns�oNtiL t1\ PEA CocE 83.33 3 �`: ec aa.Vo g t c lia - 4 tbmoluse it..-t2" Site Location: 4a•4" AQE • x r __, SEC. 24 (,,,. al w ELL , (ibe% -'`�. — � 1i�� LI U ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer Gk(oYj 'n ,Q r Mailing Address 9-6 , - 1' /6* »v . t b V , I/. f kial Property Address 2c/ c76 /9144 1/ i� 0 0 �, to i (,jr- (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number LEGAL DESCRIPTION Property Location /4 , /4 , Sec. , T N R W, Town of . Subdivision Plat: , Lot # . Certified Survey Map # , Volume , Page # . Warranty Deed # (before 2007)Volume , Page # . Spec house - yes L I no Lot lines identifiable i _; yes H 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 Tess than 1/3 full of sludge. 1 /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. Uwe certify that all statements on this form are true to the best of my /our knowledge. I /we am /are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 3 A ,, - e - t 11,18.,0 GNATURE OF PPLICANT(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) 11111 1IH1 11111 11111 1111111111111 IIIIII (1111111 * 9 0 2 4 7 7 1* 902477 SHERIFF'S BETH PABST Document Number DEED REGISTER OF DEEDS ST. CROIX CO., WI Drafted by: Duncan C. Delhey RECEIVED FOR RECORD 08/21/2009 11 :OOAM Return to: Gray & Associates, L.L.P. SHERIFFS DEED Attorneys at Law EXEC t /44 600 North Broadway REC FEE: 11.00 Suite 300 CC FEE: 3.00 Milwaukee, WI 5320 PAGES: 1 Pan t 002 - 1058 -80-000 Parcel Identification Number RE: Wells Fargo Bank, NA v. Erik M. Peterson, et. al., Case No. 08-CV -1107 /1— Pursuant to a judgment of foreclosure entered in this matter, the subject premises was sold at auction to the highest and best bidder, Wells Fargo Bank, NA. Therefore, the sheriff does hereby grant and convey unto said successful bidder, all of the following described land, located in the County of ST. CROIX, State of Wisconsin, to wit: Part of the Northwest Quarter of the Northwest Quarter (NW % of NW' ), Section 24, Township 29 North, Range 16 West, Town of Baldwin, St. Croix County, Wisconsin, described as follows: Beginning 868 feet East of the Northwest corner of said Section 24; thence South 512 feet; thence West 170 feet; thence North 512 feet; thence East 170 feet to the point of beginning. D SHERIFF - (Strike the inappropriate title) STATE OF WISCONSIN ) )ss COUNTY OF ST. CROIX) 1 t 1111.‘_ /� _ n . [�r`/�,/ Personally came before me this O( day of , 2009, the above -named J•�CII /S 6 /`7 ovt �• , personally known to me as the officer d • .'f ' ed + ■ ve, and who executed this document vs—the—sheriff—or on behalf of the sheriff of this county. 1� 3 J. Martell ;p Pub' :c , Notary Public ,1e of Wisconsin ST. CROIX County, Wisconsin consin / My commission expires: O� 4 b 1 of 1 commerce.wi.gov Wisconsin Fund - Owners Private Onsite Wastewater tsconsin Treatment System epartment of Commerce Application Replacement or Rehabilitation Safety and Buildings Division Financial Assistance Program Instructions For Property Owners: TO BE COMPLETED BY COMMERCE You may apply for a grant award for up to three years after you have received a determination of failure and after you have obtained a sanitary permit. Complete Part A of this form, attach evidence of your annual income explained in Section #7, and return those items to the sanitation or health department office in the county where the property is located. PART A. TO BE COMPLETED BY THE PROPERTY OWNER Please print. Owner* Owner Owner Owner Owner Owner Address City, State, Zip Code Telephone Number 2Co l`1 go oo&L.) k\Jz- ( 15 ) ,.zo - 3374, *Grant awards will be issued in the name and address of this If there are additional owners, attach documentation listing all owner. owners. 1. Is this application for a principal residence or a small commercial establishment? Principal Residence (Complete both if applicable.) Small Commercial Establishment If applying as a principal residence, do you occupy this residence 51 % of the year? 410 No NA If applying as a small commercial establishment, do you own and occupy the small commercial establishment? Yes No NA 2. If applying as a small commercial establishment, what is the name of the small commercial establishment? Description of Small Commercial Establishment (farm, restaurant, etc.): 3. Has there been a change in ownership of the principal residence or small commercial establishment served by the failing system within the last three years? No If yes, please explain: -- ?(A.ratc. r" \ ` IQ I q 4. As the owner, are you a licensed plumber or contractor engaged in the business of 3 s installing private onsite wastewater treatment systems? Ye o 5. Will a portion of the replacement system be funded by another program? Yes If yes, explain: 6. How did you hear about the Wisconsin Fund - Private Onsite Wastewater Treatment System Replacement or Rehabilitation Program? 7. Evidence of income. If you are applying as a principal residence, attach a copy of your federal income tax return for the year of or prior to the determination of failure. If you were married and filed separate forms, you must also include your spouse's return for the same year. You must include evidence of income for each owner and for each owner's spouse. If you are applying as a small commercial establishment, submit a copy of your federal profit and loss form for the year of or prior to the order or determination of failure. If you or any owner listed above did not file an income tax return, contact your governmental unit for further instructions. Evidence of income will be kept on file at the governmental unit and is subject to verification by the Department of Commerce. Property Owner's Certification. I certify that, to the best of my knowledge and belief, the information I have provided on this form and all attachments are true and correct. Owner's Signature Date Signed Co- Owner's Signature Date Signed 1/11 ( Pers al information y provide may be used for secondary purposes [Privacy Law, s. 15.04(1)(m)]. BD -9163 (R. 02/2005) PART B. TO BE COMPLETED BY THE GOVERNMENTAL UNIT 1. VERIFICATION OF OWNERSHIP On the document used to verify ownership, do the names match those on Part A of this application? If no, please attach additional documentation explaining. Yes No If the applicant answered yes to question 3 on Part A of this application, did the applicant(s) own the property when the order or verification of failure was issued or the system installed Yes No and incur the cost of replacement? Document used to verify ownership: Number: Document or Page 2. Is a public sewer available to this property? Yes No 3. Has a previous grant been awarded for this property under this program? Yes No 4. Principal Residence evidence of income. Please indicate applicable annual family income: $ Federal income tax form , Line , Year OR Affidavit of , Year Small Commercial Establishment evidence of income. Please indicate applicable annual gross revenue: $ Profit & loss form used: , Line , Year 5. Date of the Order or Determination of Failure: When was the existing failing system installed? Prior to 12 -1 -1969 12 -1 -1969 to 7 -1 -1978 Vertical distance from the bottom of the existing infiltrative surface to a limiting condition: 0 to Less than 24" 24 to Less than 36" Equal to or greater than 36" 6. Private onsite wastewater treatment system failure caused by discharge of sewage to (check all that apply): Surface water or groundwater Category 1 A zone of saturation A drain tile or zone of bedrock Category 2 The surface of the ground Category 3 Back -up of sewage into the structure served request is for what At -grade 7. This re q type of replacement system: Conventional If this request is for a system not listed at the right, please explain: Experimental Holding Tank In- ground Pressure Mound 8. Uniform Sanitary Permit Number Date Issued Plan Approval Number Date Approved Ex. eriment A. 'royal Number Date A. . roved 9. After reviewing this application, I have determined the applicant to be: Eligible Ineligible If ineligible, reason ineligible: 10. Governmental Unit Representative's Certification. I certify that I have reviewed and verified all information provided on this form and attachments and that they are true and correct to the best of my knowledge and belief. Signature of Authorized Governmental Unit Representative Title Date Signed