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Wisconsin Department of Commerce County: PRIVATE SEWAGE SYSTEM Safe uilding Division St. Croix - INSPECTION REPORT Sanitary Permit No: ATTACH TO PERMIT) 1� 399 GENE ,L INFORMATION S tate Plan ID No: Personaain rmation you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. / 9.� Permit Holder's Name: /� 4) City Village X Township . n Parcel Tax No: C` r c>v� 30z5 4- 1\14.,,. 6 n.. ft^Q . .; \4^� o/"z -loi - �, - �s�0 CST BM Elev: ∎ Insp. BM Elev: I BM Description: Section/Town /Range/Map No: TANK INFORMATION ,�. 52'7 ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom ' Dosing Header /Man. Aeration - Dist. Pipe Holding Bot. System PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM Model Number TDH (Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well ' SOIL ABSORPTION SYSTEM BED/TRENCH Width 'Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer. INFORMATION . Type Of System: CHAMBER OR UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing L SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded 'xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil 0 Yes in No 0 Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / ' Location: Parcel No: 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? 0 Yes 0 No Use other side for additional information. SBD -6710 (R.3l97) Date Insepctor's Signature Cert. No. Commerce.Wi.gov Safety and Buildings Division County MI 201 W. Washington Ave., P.O. Box 7162 St. Croix SC O fl S i fl Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce i D s 3 S i State Transaction Num r Sanitary Permit Applicat �,.,...� -�"'r' 799440 In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental Project Address (if different than mailing address) unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are submitted to the Department of Commerce. Personal informati• . au .rovide may be used for second d, purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. 12 120 Ave. I. Application Information - Print All Informati i r+EwED Property Owner's Name Parcel # Joseph & David Clennon SEP 2 7 34.30 012 - 1072 -80 -050 Qa Property Owner's Mailing Address Sr. CROIX COUNTY Property Location 1654 Co. Hwy. E PLANNING & ZONING OFFICE Govt. Lot City, State Zip Code Phone Numl` ` SW '/., SE '/4, Section 34 Hammond, WI. 54015 715 - 796 - 2711 (circle one) T 30 N; R 17 E or W II. Type of Building (check all that apply) 0 O _ Lot # ❑ 1 or 2 Family Dwelling - Number of Bedrooms P.o.k— • k jubdvision Name bc;- Block# Iv- Na 31 te.s ❑ Public /Commercial - Describe Use lJ Na El City of ❑ State Owned - Describe Use CSM Number CI Village of 5 x / e p t IsJ�sep Ce N ❑ Town of Erin Prairie III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ' ❑ New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) Y P Y g P Y g Ys ( P ) List Previous Permit Number and Date Issued B. Permit Renewal Permit Revision ❑ Change of Plumber Permit Transfer to New 515008 issued 10/10/08 Before Expiration Owner IV. Type of POWTS System/Component /Device: (Check all that apply ❑ 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) PolvLok PL -525 effluent filter V. Dispersal/Treatment Area Information: 5' X 90' Dispersal Cell Design Flow (gp) Design Soil Application Rate(gpdst), Dispersal Area Requi (sf) Dispersal Area Propo d (sf) System Elevation 450 gpd , 1.00 gpd/sq. ft. ASTM-C33 sand 450.00 sq. ft. 450.00 sq. ft 100.624' at 11" above 0.50 gpd/sq. ft.in -situ soil / 11441 99.70' contour VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units .o o T3 2 New Tanks Existing Tanks i o g to tZ t ..) .)" . v icy t7 5; Septic or Holding Tank 1,000 a 1,000 1 Wieser Concrete X Dosing Chamber 600 Na 600 1 Combination ST/PC X VII. Responsibility Statement I, the un rsigned, ass me responsibili . n nation of the POWTS shown on the attached plans. Plumber's Name (Print) lumb s Sign. . MP/MPRS Number Business Phone Number James K. Thompson .5 MPRS 30021 (715) 248 - 7767 Plumber's Address (Street, City, State, Zip Code) 1 340 Paulson Lake Lane, Osceola, WI 4020 VIII. County/Department Use Only / Permit Fee Date sued Issuing nt Signature / proved ■ s •1 . ; - 4 $ G 5. 08 I E Yen Reaso Denial a a I 7 1 1 IX. Conditions of A roval/Reasons for Disapproval PP :,;I /0/17 / 416 SYSTEM QvYNER: 3) �a.C..A.+ i - Re newe t 1. Septic tank, efifueM•fUterand /o %Vigo /n46 dispersal cell must all be services / maintained / 6 //o/0 $ •. as per management plan provided by plumber. r' .L 2. Ail setback requtr"ements must be maintained � > 6.,�� :4-i arks , t o 6 4'.ck faQ_ 1- e.o1.[, ot..Q, es I lATtachioen t the system and su to the Conn to on piper not 1 7 than 8 112 z 11 inch size �Ja G ib-Cc ' 1.,) .4 . ; S �I`/A.. .l... 1 SBD -6398 (R. 02/09) Valid thru 02/11 F 1 1. 5o,./ Eva./ua.,. c + P.-6- el.e pia -. "o' N 5cate:/ x: ■ K,'c.. e4Aanne Orman 5 'f'5EK1 &c. 34, ' 1 Erie) YOr r; c, 5� . C ?7.0 i ACE.6.rn.: etn;(; n Si "Ad ,A%'' P ne . E/Q,) = ion So e j3Xte '&4.124 vol. Z$'"� 0 ik I 1o Q(. '3°'''r 01) 89 II Derr it. 22. ,B. �, - �.. l?.5 7f ' reba-r. Assu.r,¢d "9.1 0- Zr/40 w� .$c 4. 10 P. ✓, C . e-1 eL` _ /oo. Cry.' . o.,: !d: sc:ael: ' A Pro�005 / %i / Db. 70 prOe0Se -d 0,0 {vice noi' . rnou.7d S, 90 " c/ /5p4r3c_ 36t 913# eec-C. Two (,?.. (liC< .-Q CS 4'C (e5. "denCe 1' (�j5 -' U /1z X --V /8 "ar prosed 1, c c ,w �.P. C' on 6 •, a /propt5_e Se� �' /(�� / m p C J�a�b� w te u l Z - k A-100 e (�/u cnt CO 6f.-/ a..6 out let • S,oa c J ■ B I 87 5°, /06C,;, 3cb'r • 1 .80( 9 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerLl3 er 0 k. Ur l%�l.h h nn Mailing Address go SY O /, 4) /, E �t � �rJ (2)4 (2)4 SAO / Property Address A 1� / ,4ll-e (Verification required from Planning & Zoning Department for new construction.) City /State Parcel Identification Number 4 /2- — /6 7 — O SO LEGAL DESCRIPTION t t - Property Location ,5 /a , . 5 /a , Sec. 9 , T 3 6 N R / 7 W, Town of t -/i . Subdivision J , Lot # na . Certified Survey Map # P'rt , Volume 44.. , Page # Warranty Deed # , Volume , Page # Spec house - :41 o Lot lines identifiable ap SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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 this form are true to the best of my /our knowledge. Uwe 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 4111, • . • cf ,,30 /0 S NATURE OF APPLICANT(S) DAT = ** *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) 1111111 111111111111111 11111 11111 I!II 111 State Bar of Wisconsin Form 1 -2003 * 9 1 5 2 1 5 1* WARRANTY DEED 915215 BETH PABST Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD THIS DEED, made be een Richard J, Brown and Roxann Brown, husband and 04/28/2010 08:20AM WARRANTY DEED wife EXEMPT 1 ( "Grantor," whether one r more), REC FEE: 11.00 and Joseph Clennon, a David Clennon; TRANS FEE: 375.00 ( "Grantee," whether mil .r more). PAGES: 1 Grantor, for a valuable c • nsideration, conveys to Grantee the following described real Recording Area estate, together with the ents, profits, fixtures and other appurtenant interests, in St. f/ Croix County, State of isconsin ( "Property") (if more space is needed, please attach Name and Return Address addendum): David J. Estreen The Southwest Quarter • f the Southeast Quarter (SW 1/4 of the SE 1/4) of Section 304 Locust Street 34, Township 30 North, • nge 17 West, except the West 66 feet thereof. Together Hudson, WI 54016 with an easement descri d as the South 33 feet of the West 66 feet of the Southwest Quarter of the Southeas Quarter, Section 34, Township 30 North, Range 17 West, COI " I 81 St. Croix County, Wisc i nsin 012 - 1072 SO EXCEPT a parcel oflan located in the Southwest Quarter of the Southeast Quarter Parcel Identification Number (PlN) (SW 1/4 of the SE 1/4), . ection 34, Township 30 North, Range 17 West, Town of This is not homestead property. Erin Prairie, St. Croix 1 ounty, Wisconsin, described as: The South 110 feet of the (is) (is not) West 84 feet of that cert : in parcel of land as described on Warranty Deed recorded in Volume 1532, page 6 2, Document No. 627784. Grantor warrants that the itle to the Property is good, indefeasible in fee simple and free and clear of enctnnbranc except: easements, restrictions and restrictions, if any, of record. Dated 0 '1 ,Lr r D (SEAL) .. i • Ze2e-pit-7.- (SEAL) * * rd J. Brown (SEAL) 1jA.A (SEAL) * *Ro ann B rown AUTHENTICATION ACKNOWLEDGMENT Signature(s) Richard J. Brown and Roxann Brown, husband and wife STATE OF ) authenticated on A' Z-.-/ 20 ( 0 ) ss. ,Ad I f COUNTY ) *Kristina Deland Personally came before me on TITLE: MEMBER STAI BAR OF WISCONSIN the above -named (If not, to me known to be the person(s) who executed the foregoing authorized by W Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT D • • FTED BY: * Kristina Ogland. Estree & Oeland Notary Public, State of 304 Locust Street. Hud n. WI 54016 My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 * Type name below signatures. INFO -PRO^l Legal Forms 800 - 655 - 2021 www.infoproforme com 1 of 1 4 ..;• AlVco isnsi nDellartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix \ II 'Sa tynd Biding Division S anita Permit No: ; lif INSPECTION REPORT ry v ii � GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No Perstnal 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: Brown, Rick & Roxanne Erin Prairie, Town of 012 - 1072 -80 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 34.30.17.527A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Out TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Ai (take ROAD Dt I ,,, Septic r , Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Be . ystem Final Gr. • - PUMP /SIPHON INFORMATION Manufacturer D and St Cover e.M Model Number TDH !Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length - No. Of Trenches ' 'PIT DIMENSIONS No. Of Pits Inside Dia. 'Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing , SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1842 120th Avenue New Richmond, WI 54017 (SW 1/4 SE 1/4 34 T30N R17W) NA Lot Parcel No: 34.30.17.527A 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes No i Use other side for additional information. Date ' Inse ctors Signature Cert. 9 . No. SBD -6710 (R.3/97) r ' Wiscons P RIVATE SEWAGE SYSTEM County S t. Croix Safety„arV Buikding Division INSPECTION REPORT Sanitary Permit No: 4 61 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: f', V 15 /d t/\__ Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)i, 1 Permit Holder's Name: City Village X Township Parcel Tax No: Brown, Rick & Roxanne Erin Prairie Township 012 - 1072 -80 -050 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 34.30.17.527A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt . .ttom Dosing eader /Man. Aeration Dist. Pipe Holding :ot. System Fin. Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH'Lift Friction Loss !System Head ITDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. 'Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION . CHAMBER OR Type Of System: UNIT Model Number. DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bedfrrench Edges Topsoil Yes 0 No E Yes C No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1842 120th Avenue New Richmond, WI 54017 (SW 1/4 SE 1/4 34 T3ON R17W) NA Lot Parcel No: 34.30.17.527A 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? p Yes C No I Use other side for additional information. I SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. commerce.wi.gov Safety and Buildings Division County 201 W. Washington Av• P.O. Box 7162 St. Croix I s c o n s i ) n Madison, WI —7162 Sanitary Permit Number (to be filled in by Co.) D epartment of Commerce 5 / 5 00 O Sanita Permit A li ca ti o % -'- State Transaction Number pp l' Trans. ID# 799440 In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the approp gove tal unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owne WTS are Projec - Addre ( if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for s ndaiy purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. 3 2 120 Ave. I. Application Information — Ple a Print All Information I — R E' E I V E D Property Owner's Name ' Parcel # Rick & Roxanne Brown OCT `' 0 LOO@ 012 - 1072 -80 -050 Property Owner's Mailing Address I Property Location i Sz 7 � OIX COUNTY J 654 215th �7C� — NING OFFICE 215 Ave. �,_,__-- . _.�:....- _ ----• Govt. Lot City, State Zip Code Phone Number SW IA, SE Y <, Section 34 (circle one) Somerset, WI 54025 (715) 247 -5305 T 30 N; R 17 w II. Type of Building (check all that apply) Lot # ❑ 1 or 2 Family Dwelling — Number of Bedroom ell • Na Subdivision Name - ,,.,,, i k- Block # D f � 5 l Na- 38 acre pcl. ❑ Public /Commercial — Describe Use Na ❑ City of ❑ State Owned — Describe Use CSM Number ,r y ❑ Vi e of / ,,n � Town of Erin Prairie 5 A-96 J aii C.iG Q Na , *' III. Type of ermit: (Check only one box on line A. Complete line B if appyable) A. New System ❑ Replacement System ❑ Treatmen oldin Replacement Only ❑ Other Modification to Existing System (explain) Y P Y g T i Re P Y S Y ( P ) List Previous Permit Number and Date Issued B. ii ermit Renewal ❑ Permit Revision ❑ Change of PI `,e ❑ Permit Transfer to New #499206, issued 10/13/06 Before Expiration • er IV. Type of POWTS System/Component /Device: (Check all t • t apply) ❑ Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At ade Id Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) PolyLok PL -525 effluent filter V. DispersaUTreat nt Area Information: 5' X 90" dispersal cell Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (s System Elevation 450 gpd 1.0 ASTM C -33 sand 450 sq. ft. 4 to 450 sq. ft. 100.62' at 11" above / 0.5 in -situ soil li � 99.70' contour VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o _ New Tanks Existing Tanks w o u 2 gU in a c7i wC7 0. Septic or Holding Tank 1,000 - 1,000 1 Wieser Concrete X Dosing Chamber 600 - 600 1 Combination ST/PC X VII. Responsibility Statement I, the and ; igned, assu t- e responsibility for ' e tion of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' Signah} MP/MPRS Number Business Phone Number James K. Thompson r ,.- , / 2 05--- 30021 (715) 248 -7767 Plumber's Address (Street, City, State, Zip Code 340 Paulson Lake Lane, Osceola, WI 54020 -5413 / VIII. County/Department Use Only pproved t i�arp ove Permit Fee Date Is ued Issuing t Signature , , wn wen Re for Denial s 5seic5 /e /6 613 IX. Conditions of Aup v U�easons for Disapproval n n / » ; � SYSTEM QM/ j-) r « C /0 L7 O 1. Septic tank, effluent filter and dispersal cell must all be services / maintained /0143/0 O i • as per management plan provided by plumber. 2. All setback requirements must be maintained ( � , 44 , 1 t t ■ asperaiplirehlitrade /etd _ Gbr. fe" 5 A. S AP . e d i reaci . le a.•n_ ti Attach to complete plans for the system and bmit to the ounty only on per pot less than 8 0111: es in size SBD -6398 (R. 01/07) Valid thru 01/09 Or i/ f ~ � pGC� �' Safety and Buildings Division County t �r 201 W. Washington Ave., F.O. Box 7162 St. Croix 1 �scons�n Madison, WI 53707 - 716 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 - 3151 4/ ZO i-.p Sanitary Permit Application I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide o'ect Addres (if different than mailing address) may be used for secondary purposes Privacy Law i ' I. Application Information - Please Print Alt Information R EN En ././1 � u � /`2 Street Property Owner's Name U L T 1. L 2°B6 Parcel # I .ot # a p r Block # Na Rick &Roxanne Brown S7. CROIX COUNTY 0 /Z• / - SO - Property Owner's Mailing Address Property Location 654 215 Ave. Gov't lot , _ S✓ '''A, _ 56 ''A, Section _ - Y City, State Zip Code Phone Number 7 30 N; R_ _W Somerset, WI 54025 (715) 247 -5305 II. Type of Building (check all that apply) 0X1 or 2 Family Dwelling - Number of Bed • . 3 i Subdivision Name CSM Number ,04 3`6 ..r Pa. rcaO ❑ Public /Commercial - Describe Use ❑ State Owned - Describe Use ❑City_ ❑Village ❑XTownship of _CI A. Q r : -;� III. Type of Permit: (Check only one box on line A. . 1 mplete line B if applicabl A ' ❑ New System ❑ Replacement System g Only Existing ys ❑ Tre•. � ent/I-Ioldin Tank R= acement Ottl 0 Modification to Existi System B. / Permit ❑ Permit Revision Change . ■ it Transfer to New List Previous Permit Number and Date Issued Renewal Before ( Plumber '' , er Ex•iration #420581, Oct. 27, 2004 W. Type of POWTS System: (Check all that apply) ❑ Non - Pressurized In -Ground ❑XMound > 24 in. of suitable soil I ound ' i in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank 4 Peat Filter C. ' erobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ D ' Line ❑ Gravel -less : ' . - ❑ Other (explain) V. Dispersal/Treatment Area Information Design Flow (gpd) Design Soil Application Rate(gpdsf) Di rsal Area Require (sf) Dis • al Area Proposed (sf) System Elevation 450pd / 1.0 gpd sq. ft. - ASTM 33 fill 450.00 sq ft 9DU 0.00 sq ft EISA 100.62' @ 11" above O , 50 q f I 42. 99.70' contour VI. Tank Info Capacity in T6 Num • Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Un Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank 1,000 _ 1,000 1 Wieser Concrete Combination X Aerobic Treatment Unit Dosing Chamber 600 600. 1 Wieser Concrete Combination X VIL Responsibility Statement I, the and rsigned, assume respoo or installation of the POWTS shown on the attached plans. Plumber's Name (Print) 'lumber's : ignature MP/MPRS Number Business Phone Number James K. Thompson I ,, � - MPRS #30021 (715) 248 -7767 Plumber's Address (Street, City, S -, ip ( C Co � f Code) 340 Paulson Lake Lane, Osceola, WI 54020 VIII. County/Department Use Only Approved Sanitary Permit Fee (includes Dat Issu Issuing ent Sign. - r o . 4 Groundwater Surcharge Fee) c b , 8 D6 iv Reason fo nial 1 / IX. Conditions of Approval/Reasons for Disapproval n SYSTEM OWNER: 3) i k.•`5 a. fro,� a ,Q„ Po Ko.•Ac O , ' (JeN, 4— 4 ii��io., 1. Septic tank, effluent filter and f P n 1 /� dispersal cell must all be services / �ol' OW u." //�� 1 Sy6M - 2454- Q4, ,4 /a /z7 O'/ as per management plan provided by plumber. J 2. All setback requirements must be maintained\ D r, y ''.,Q. ///is/t) Z as per applicable code / ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size' 4 ,,,,,,„,..Q . 1 . f o „t GowvwetcQ_. , Ala GedL SBD -6398 (R. 01/03) G 5 %Me l • H Safety and Buildings Division County ., , ` 201 W. Washington Ave., P.O. Box 7162 5'6.,. �oj �( i g /' Madison, WI 53707 - 7162 Sanitary Pennit Number (to be filled in by Co.) X11 (608) 266 -3151 1/ /49/ De t artm - a •+� . m erce � ' • rmit Application State Plan I.D. Number l 6t prd with Comm 8'3.21, Wi. �• .4.1 Code, personal information you provide 1 7 99 4/ go = l +A.+s • / p 9 atCbeused for secon l .ses Privacy Law, s15.04(1)(m) Project Address (if different than n mailing address) 1. p . • •c. , AI - • : tion - Please Print • .. meb ��' /� 0 .�� D V T me' Property Owner's . - � �/(- Parcel tt Lot # Block # fe, , . '�X r r X72 - J 2 -OS0 /C d ann'7�� ' Property Owner's ailing Address Property a ' 5 2/ .: ve • S /, se /, Section 35 City, State Zip Code Phone N umber 5om� - s 5 410 2 (7/5)24/7'53°S- 7/5) 53 circle W / T30 N ; Rr7(P�►W 11.['ype of Building (check a hat apply) or 2 Family Dwelling - Number • :edroos Subdivision Name CSM Number I m U Public /Commercial - Describe Use — _,- ___,____ -_ ___ — i ❑ State (Tuned - Describe Use _ ❑City_ ❑Villagewnship of __ er Prairie. 111. "Type of Permit: (Check only one box .. line A. Complete line B if applic e) A. New System ❑ Replacement Syste• g' placement Only Existing Y L7 ❑ Treatment/Holding Tank • lacement Onl ❑Other Modification to Existin System B. 1 Permit Renewal ❑ Permit Revision 0 Change of F 'ermit Transfer to New List Previous Pennit Number and Date issued Before Expiration PIu •er 4wner '1_I 2.0 I IV. Type of POWTS System: (Check all that apply) Li Non - Pressurized In- Ground {'"Mound > 24 in of suitable soil 0 ound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In -Ground ❑ Holding Tank ■ ' .t Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching mber ❑ l' Line , 7 Grav-1 I ess P ine p Other (explai V. Dispersal/Treatment Area Information: C / )( — • f'& i -7 � - �� b = /1.0 Design Flow (gp) Design Soil Application Rate( pdsf) D spersal Area Requi • (sf) Dispersal Area Proposed (sf) �Syste Elevatio coYta�+r: v„70 . �/SO$.�O.d. 0.50 ;41.1,C, . S. o opt l s y IM SoIC C ersa ce •iro.dz' VI. Tank Info Capacity in Total .mber r Manufac - Prefab Site Steel Fiber ! Plastic Gallons Gallons :f Units Concrete Constructed Glass New Existing Tanks Tanks A Septic or Holding Tank , ceb ..... / l w; user Cc„ cr Aerobic Treatment Unit Dixsing Clembcr I I � 6f , CO / I Ferri k ina 2►-• S .T. /// ✓ VIL Responsibility Statement - 1, the un• rsigned, assume responsibility for installation of the POWTS twn on the attached plans. Plumber's Name (Print) PI '. berlSignature • ' /MPRS Number Business Phone Number fi / / , k/� e ,8 // a e// / „ .225036 (6,i2� -/927 ber's Address City, State, Zit .ode) /O 76 ,i,'.n .l_,er'f` ,I AgOa c� A elseh u.7 /. sy0 / G, V111. County/Department Use 0 _ Approved ❑ Disa prnved Sanitary Permit Fee includes Groundwater Date Issued lssui., • gent Signat r (No Stamps) Surcharge Fee) 7 ❑ Owner Given eason .r 0 Denial t 2-4- i • - 24tC r % M. A .. 0 0 I.X. Condition• of Approv 1 ' . -.- - -. :. • . • . SYSTEM OWNE 3) I'u5 cCl_ -" ► . , . - 1 , . 1 Septic tank, : u filter and tr1 c „ 0 . dispersal ce must st all be serviced / maintained d c., \ m� t -� p as per ma gement plan provided by plumber. V" _ 2. All setbac requirements must be maintained (v�,..,Q S • , i as per applicable code/ordinances )!(% t-,: ■ 1 P `� ae,'1 .• '' : �?P Attach complete plans (to the County only) for the system on paper not Tess than \ n 81/2 t 11 inches in size , (� L f on ) I` A 4Q W X— 6 1� l z f SBD-6398 (R. 01/03) r -}— . - �`t°c2 � "`'°"`-. A 5E - 4.-4,5 r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division s INSPECTION REPORT Sanitary Permit No: • 420581 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: Brown, Rick & Roxanne Erin Prairie Township 012- 1072 - 80-050 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE ANUFACTURER CAPACITY STATION ':S HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewe Holding St/Ht I -t S 't Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic or, Dt Bottom Dosing ma Header /Man. Aeration Dist. Pipe Holding -_ =„' Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand t Cover . GPM Model Number TDH Lift Friction Loss INIF . TDH Ft Forcemain Length Dia. Dis o Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. •f Pits Inside Dia. 'Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEA G Manufacturer. INFORMATION CHAMBE • R Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distributio x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes El No 0 Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1842 120th Avenue New Richmond, WI 54017 (SW 1/4 SE 1/4 34 T3ON R17W) NA Lot Parcel No: 34.30.17.527A 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = 3.) Contour = Plan revision Required? VA Yes 0 No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. s Sanitary Permit Application tiOn Safety & Buildings Division ` . In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. S ee reverse side for instructions for completing this application PO Box 7302 lsco resin Madison, WI 53707 -7302 Personal information you provide may be used for secondary putpos (Submit completed form to county if not Department of Cammecce D-= [Privacy Law, s. 15.04(1)(m)] j S t, f t '� — 'f0� state owned .)_ Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. Co State Sanitary Permit N ber ❑ Check if revision to previous application State Plan D. N e mbee 1 � � ,� s 0S . CE i1C 7 � � � � � � � 1 � - � � I. Applicaon Information - Please ot all Information ' Location: Pro Owner Name � j� —..----- Property Location 0 /C I -Ci � o a�x n� !°" Q " - " w 1/45e , S 3 f T R` qr� W 2 w '" '1 �? J Property Owners Mailing Address 1 Lot Number Block Number City, State y � Zip Code r �� Naunbdk S �.2 , ....,- .,.,, „,,,, Sub• • ion Name or CSM Number S c�G 54 ; (.(� /. .6” c7 ZJ ( 7/ 7 S3.• .. city j�tf/�� A H. Hype of Building: (check one) 2 ,/ } a / ,2_,GL�rt �C ❑ viii e l or 2 F. • Dwelling - No. of Bedrooms : own of ❑ PubliclComme . '.1 (describe use):_ Err t) �I ^Q ❑ State -Owned est Road d f l /jib ' 5' '/''•'I0 q Ir .} oa ' ,,z - (, rI .Sa.- � /l R.4" D = /1 // or a / 2 ( ar. I Tax N mber(s)O/ — /072 —80 — 0G0 III. Ty o mit: (Check . one box on line A. Check box on line B if appli s s le) 3q- 30 -1`7 5 4 A) Ita•I■ew 2. ❑ R . .cement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Qy Existing System B) Permit Number Date Issued ❑ A Sanitary Permit was previousl • sued ` IV. Type of POWT System: (Check all th. appl 4 I Cons •cted Wetland ❑ Non - pressurized In- ground filter ■ ound le 1 Co Dr' fine ❑ Pressurized In -ground ❑ • o sing ank ❑ ngle Pass s • er: ❑ At-: -de ❑ Aerobic Treatme' nit a V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal • . 4. Soi pplication 5. ercolation Rate i. S 0 � Elevation ' oGrade Required Proposed SGv)+ to alsJday /sq. ft. (MinJinch) /•p -ice Sod , 5 - , a. 45 .4% S .. , ,lb, .S 4 . .- � VII. Tank Capaci ' in Tota ' # of s anufa 'turer Prefab ` Fib Information Gallons Gallons Tan �X / Con on g .s - New Existing ,� c strutted epm 6 aY1 Tanks Tanks I i 1 � :serm• iiv ji dA A 0 ,-,,,-14.r...1 .1b P.,...,, c x. • 6,40 — 60 r %TO pr' VIII. Responsibility Statement ,' I, the undersigned, assume responsibility for inst. :tion of the POWTS shown on the • . ched plans. Business .one Number Name (print) Plumbe 's Sir .cure s l MPS /II ne // l j (' `( I ,_ so3� ( 4386 -165a Plumber's Address (Street, City, State, Zip Code) /070 ,i%,i , , °as . c0/. 57 / - IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Dat f � on Issued ssuin: Age Signatur 1 stamps) [/Approved ❑ Owner Given Init Adverse Surcharge Fee) $ �� c0 I. gs / ,` -1 '' /� ` j�C.!/i/!n.- Determinati X. Conditions of Approval / • . Sons for Disapproval' c /����/f . J � /�.r�, ,,,, 3 sGt add 6 9, /02,03 My l — C&a.4• / l�44m --- r ,A.L/ , ..• • , , . ,' 3 • 3 Safety and Buildings . • 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 i sconsIn www.commerce.state.wi.us /sb Department of Commerce www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary November 01, 2002 CUST ID No.225036 ATTN: POWTS Inspector MICHAEL P MC DONELL ZONING OFFICE ACE SOIL & SITE EVALUATIONS ST CROIX COUNTY SPIA 340 PAULSON LAKE LANE 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON W1 54016 CONDITIONAL APPROVAL L 2 d / PLAN APPROVAL EXPIRES: 11/01/2004 Identification Numbers Transaction ID No. 799440 SITE Site ID No. 652496 Rick & Roxanne Brown Please refer to both identification numbers, 120TH Ave , (4/Z above, in all correspondence with the agency. Town of Erin Prairie St Croix County SW1 /4, SE1 /4, S34, T3ON, R17W FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 877658 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in Conditi chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. �wr® �i � The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Requirements: ' /4 - f NO MENT� • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound mponent Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01/01) SEE CORRES Co and the SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST_SAS (01/81) • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. • The changes made to this plan on 11/1/02 by this reviewer were acknowledged and approved by the system • degner. MICHAEL P MC DONELL Page 2 11/1/02 Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday cbratz@commerce.state.wi.us cc: Leroy G Jansky , Wastewater Specialist, (715) 726 -2544 • MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application (/ INDEX AND TITLE PAGE 9.c► O ,:' Project Name: Rick & Roxanne Brown 3 bedroom residential mound 4ti - . A � Owner's Name: Rick & Roxanne Brown e 4 6 " ) Owner's Address: 654 215th Ave. / 4 0 Somerset, WI 54025 Legal Description: SW1 /4SE1/4, Sec. 34, T.30N., R.17W. Township: Erin Prairie County: St. Croix Subdivision Name: na Lot Number: na Block Number: na Parcel I.D. Number: 012 - 1072 -80 -050 Plan Transaction No.: m olly Page 1 Index and title NNED Page 2 Data entry : COMMERCE Page 3 Mound drawings tAN ILDINGS Page 4 Lateral and dose tank Page 5 System maintenance specifications PONDENCE Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Soil Evaluation Report Designer: Mike McDoneil License Number: 225036 Date: 10/05/02 Phone Number: 715- 386 -8692 Signature: Vit€ % /742/4 Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Version 3.0 (03/01/01) Page 1 of 9 Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 83 -44-3 in -situ sal treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) �rfo� <= inches. 450.00 Design Flow (gpd) 3.00 Site Slope ( %) 99.70 Contour Line Elevation (ft) 25.00 Depth to Limiting Factor (in) 0.50 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 5.00 Cell Width (ft) 90.00 Dispersal Cell Length Along Contour (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? Enter Y or N (c or e) e Center or End Manifold 2.50 Lateral Spacing (ft) If N above, enter the elevation ft 2 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 2.50 Estimated Orifice Spacing (ft) = I 6.25Ift /orifice 2.00 Forcemain Diameter (in) 100.00 Forcemain Length (ft) Does the forcemain drain back? I Y 93.50 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 16.31 Forcemain Drainback (gal) 6.62 Vertical Lift (ft) 81.25 5x Void Volume (gal) 1.90 Friction Loss (ft) 97.56 Minimum Dose Volume (gal) 15.01 Total Dynamic Head (ft) 29.66 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x x 1.25 2.00 1.50 x x 3.00 �� 2.00 x 3.00 x ej tt il ip bc p 0-1 Gallons /Inch Calculator (optional) Treatment Tank Information 602.82 Total Tank Capacity (gal) '' 1000.001 Septic Tank Capacity (gal) 51.00 Total Working Liquid Depth (in) ✓ j Wieser Conc. combo.IManufacturer 11.82 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 600.00 Dose Tank Capacity (gal) Zabel Filter Manufacturer 11.82 Dose Tank Volume (gal/in) A100 Filter Model Number � Wieser Concrete 'Manufacturer Project: Rick & Roxanne Brown 3 bedroom residential mound Page 2 of 9 ti, Mound Plan View T � J • � 10 : : • : ::::::: : ::::: : : : . Observation Pipe. . . ' 3 _ W F. • • • B 0• • • • . • . • . • . • . • . • . • . • . - . • . - . • . • . • . • . • . • . • . • :: . • . • . • . • . • : • . • . : . • . • . • . • . • . • . • . : . : . : . .• . • : .1 .+— Mound Component Dimensions A 5.00 ft E 12.80 in H 1.00 ft K 8.35 ft B 90.00 ft F 9.50 in 1 7.77 ft L 106.70 ft D 11.00 in G 0.50ft J 6.08ft W 18.85ft 450.00 (ft Dispersal Cell Area 1149.73 (ft Basal Area Available 5.00 (gpd/ft) Linear Loading Rate 9.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 102.41 (ft) P. ..l!! /rr.. G H !� .!!!l! 2 !!!!!!lam I F !!!! .. : ~ 101.12 (ft) Lateral Di spersa l C 100.62 (ft) : 0 • • :« Invert Dispersal Cell . . . 0 Elevation E i.. ?..!. .. I. t :lf'.2 it }. '.,/�_1. ".e.A, A-?--?. x. . '4'.-,. , __'•2k/ "-!_ , ,1.- A '. J 4 99.70 (ft) Contour Elevation 3.0 % Site Slope Geotextile Fabric Cover Shading Key m o 1- Dispersal CeII See lateral details on M _ Topsoil Cap c .� 1.5 ft • 'f,.; ;•s Page 4 for number, © Subsoil Cap a ° :;:**',...4:*:;*** size, and spacing of 1® ASTM C33 Sand Z • ,:•`•` F laterals. Laterals are f :``.1 Tilled Layer c ® 0.5 ft : ` T yp i cal Lateral r equally spaced from IZI FF .7:14 Aggregate o �'f °::::. ' the distribution cell's A ---4 centerline in the distribution cell (AxB). Project: Rick & Roxanne Brown 3 bedroom residential mound Page 3 of 9 End Connection Lateral Layout Diagram Laterals centered over the A & B dimension • = Turn -up wt ball valve or el eanout plu g • All laterals are identical 1,<- x-->I 1 Holes drilled on the bottom of the lateral s equatlg spaced i Force main connection Via tee or cross to manifold at any point. Laterals & force main of PVC Soh 40 (per COMM Table 84.30-5) Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 88.55 ft Orifices per Lateral 36 Lateral Spacing (S) _ 2.50 ft Orifice Density 6.25 ft /orifice Lateral Flow Rate 14.83 gpm Manifold Length 2.50 ft System Flow Rate 29.66 gpm Manifold Diameter 1.50 in Total Dynamic Head 15.01 ft Forcemain Velocity 3.03 ft/sec Dose Tank Information Locking cover with waming label and locking device and -- sealed watertight Electrical as per NEC 300 and ---► L S z Comm 16.28 WAC Disconnect 4 in. min. Tank component is properly vented 0=0 El C <-- Alternate outlet location 1 I Forcemain diameter Wieser Conc. combo. Manufacturer :: 0 2 in. W iff00�6 Capacity 600.00 Gallons gal/inch,/ A Volume 11.82 gal /inch Weep hole or anti- Dimension Inches Gallons B i siphon device A 2y:5' 20.87 341-26 3 36 sr B 2.00 23.64 C i Pump off elevation (ft) _t_ C 9. 5 7-89 0 7793,26 1 94.501 D 12.00 141.84 D Total 01.1.76 ( 600.1: .....w. m 0 ow _- D Dose tank elevation (ft) " :edding un•ertank. 1 93.50 Alarm Manuafacturer LevelArm Alarm Model Number DLV Pump Manufacturer Zoeller Pump Model Number #98 I Pump Must Deliver L 29.66jgpm at ( 15.011ft TDH Project: Rick & Roxanne Brown 3 bedroom residential mound Page 4 of 9 ' Mound System Maintenance and Operation Specifications Service Provider's Name J. Thompson, POWTS INSP.#4819 Phone 715 - 248 -7767 POWTS Regulator's Name St. Croix County Zoning Phone 715- 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 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 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. AU gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished Grade 6 -8" Diameter Lawn . • . Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution . . . • Lateral �► Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Rick & Roxanne Brown 3 bedroom residential mound Page 5 of 9 HEAD /CAPACITY CURVE . W W HEAD CAPACITY CURVE ' EFFLUENT MODELS i I - - I r I I I l J - -. V TOTAL DYNAMIC HEAD /CAPACITY PER MINUTE EFFLUENT AND DEWATERING __ SERIES 6749 97 96 137.139 161 763 166 166 lab 1a1 t61 I f \ FT 64 Gat Ur/ Gal Lie Gal. Lars Gal. Lai Gal L17 Oat 1.06 Gal Lis. Gat Lim Gat Un. Gal u Lis. G. s. I S 1 43 163 56 212 72 273 1 561 106 401 61 67 156 5171 l0 5 34 129 46 174 61 231 79 300 100 376 01 227 61 2 1 69 ' 220 141 660 151 672 k � 15 19 73 36 133 46 .170 312 01 344 60 227 231 00 61 277 237 68 22D 166 6 66 220 142 .537 144 549 _ 20 6.70 16 67 26 96 36 128 62 310 69 223 60 y17 64 220 136 616 140 630 5 T 6% 1111111IN ■ j , - 26 20 7.02 Qa 720 126 414 133 633 0' W 66 244 66 20 ?30 90 340 W 220 121 461 1 2 4a1 1219 40 - - - I , , ■ 2 1.71 33 122 66 2 66 29 64 220 1 96 114 471 60 16.24 21 1 80 >J 126 61 191 91 W 2119 W 210 W 241 341 100 379 11P .. ' - ■1 � 0 ,1429 16 67 43 161 30 -.130 199 220 71 209 46 322 30 114 10 34 62 197 61 193 70 2661 80 24.38 _. __ ; .. _ �' „' N W 45 170 b 106 Sr 20+ . link ■, 17.49 32 121 2 1 37 143 ' T 1 r 10 30.48 1 11 21 1 r 79 - 16} 110 3200 7 70 1 JD - __ • -. �■■, x W Lock 19.26' 2376' 23' 20' 60' 80' 57' n 73' 116' 97 7 __ ._ 1 �! ail 111 EFFLUENT & DEWATERING ,,_. __:___ IIII,1 11111■111_ \I Warning: Model 185 should not be subjected to less 3 G_ — allillillMa than 30 feet TDH. �� i "■ AL189 Note: For Head Capacity on Model 112, industrial o a :�► , • III column-explosion proof pump, see FM 219. : - - - ono zussammem - ---,-, 5 55, 7,59 — 13 139 SEWAGE &DEWATERING GALLONS i:, ,..__ 0 4 01 50 601 70 601 90 1001110 120 1130 140 1100 160 1 WARNING: Model 293 should not be subjected LITERS 60 760 240 320 400 480 560 640 to Tess than 15 feet TDH. W -29. CAM. 1177 q //7 a .5C(4d& art* re9Cc //td 1 r T i'"J 7J 1 10 l I - 1T 1 1 1 r 1 1 1 1 24 80 — — TOTAL DYNAMIC HEAD /CAPACITY PER MINUTE 1 SEWAGE AND DEWATERING 22 75 �■ 1 T � SERIES 262 266 267 2_68 7 182 244 292 297 294 795 I 70 FT_ 64 Gal. Los , Gal urs. Gat Los Gal. Ors. . Gal, Llrs. Gal. Urs. Gal Lln. Gal. 177, Gal urs Gai urs — 20 5 1.52 90 341 128 484 128 484 128 484 130 492 180 881 140 530 196 142 225 852 — 65 - `M. 10 305 60 227 . 89 337 89 337 89 337 95 360 158 598 124 489 787 685 205 776 15 457 22.5 85 50 189 50 189 50 189 63 238 - 135 511 106 401 130 492 ' 765 625 185 700 18 __ 60 _- ,. - 20 6 10 10 38 10 38 10 38 33 125 106 401 88 333 119450 150 568 168 636 _ 25 ��., _ _70 55 30 9.62 78 288 68 257 106 401 - 1 76 515 15] 520 9 14 43 163 47 178 _ 90 340 121 , 140 530 40 72. 19 16 5 19 50 189 94 356 n5 435 1 50 7524 —___ ___ __ ____ _ - -_ 50 2 20 8 50 Elir, _ 60 I879 17 49 14 __ 70 21 34 T 25 95 45 - Lock Valve 18' 21 21.5' - 21.5' 26' 35' 42' S0' 62 77 12 T . 40 ,,■ ,. ` , , 10 T . J5 ► .■M.■"'II■■■■■ 30 111111k�11111111„ ■,. ,.■.■ 25, ,511■„ ii...._ _11111111111,1411111111711141.1 15 11 262 266, 257, 268 284 294 295 7_ 1 1 1 — 1 GALLONS 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 170 180 190 200 210 220 230 i ----- + - - - _ � . - - -. _ LITERS 0 80 160 240 320 400 480 560 640 720 800 880 4. 7° ,4? 50,"/ Eve �<a- ;:,, - -, I. . Eleva - , R l 5,/e:/ ...._ Q,-c - 444,ca rre aro-)r 5toYY SeV, 5 c-e. 3 83 �3o4;ne. i7c<).,T.,.o,7 ■ Erfn 4,:e , .5t, • C,z; r/7.ac, 3 (AD/, Qlti.6. Ylgil i n / Pec1 , k � pS low s ,rte 8�1 Ziµ � / 3� 5 1 0 P� , Qc, '3Ob " cr • TM #, a. . .: al �� - Ass u,,¢d 9'� �y Zr "Sc . top ✓. c . elegy = /o 7. cr). . °" Id'n 5` ".per. \ q er•oposee/ /8. SS' /06.7 Proposed . c- . • �'vrce main. Maur,d W/ 5 A 90" C1/5 3 6cd r Corn dj c' e,L(. Two (2) (a-Z`< i a &5 c,..-c- CeS "dencc. I ' f ds� o Propo 1,000/6co � ab P. C r`a� �ropo a Se0- c P � - ba,..� Porn cha,b-k/' amble A -/0o e c01.(er) - 6 — CO ;cr a.6 ou-t let, s4.0a ccL✓ a t --) 2 Li. • BI B7 z 50u. /0 . 6(,ne - 300' Z. • • ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner. K,'c1< t k-bXartne ern Mailing Address 6055 LAD/. 5'5!O 2S • Property Address /. 6 ri' 4 .. / ( e at iog,requir ed fiyom Plannin Department for new construction) a va, .e.,/?(J A/67— City/State Parcel Identification Number O /2 —/072 - 80 -DSc) 3z4. 30. t 1. a-1 LEGAL DESCRIPTION Property Location 5U) i /4, S E 1/4, Sec. 7 7 , T . N -R ( / W, Town of E',,? *air 1'6 . Subdivision ✓( , Lot # Certified Survey Map # ✓14 - , Volume , Page # — . Warranty Deed # , Volume 153 2 , Page # L 2 Spec house ❑ yes Lot lines identifiable 0 y s ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 da . f the three ar exp' • ;on date. X A. 4/ , L �l X 1/ 11 yl •204. / SI t NATURE O,/• ' PLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of I _ • roperty described ab • ve, by virtue of a warranty deed recorded in Register of Deeds Office. • S GNATURE`1' APPLICANT DATE * * * * * * Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * * * ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01/01) and SSWMP Publication 9.6 (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 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, Stets. 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. 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 flaw may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that 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 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Rick & Roxanne Brown 3 bedroom residential mound Page 6 of 9 • rr' 1572 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 4 • Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Cade A.C.E. Soil & Site Evaluations County Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. ' / - T - d 2 3StO / /c/ 012 -107 -80 -050 � Please print all ihforma - 'ewed Date �/ 7 Personal information you provide may be u for sec (R1 Jae w, s. 15. (1) (m)). 7 / / /, /2(44 11 / //Z /Q �� Property Owner Pr Location V ' ,r( �'/ Richard & Roxann Brown or, 1 0 R 2002 Go . Lot SW 1/4 SE 1/4 S 34 T 30 N R 17 W Property Owner's Mailing Address Lot Block # Subd. Name or CSM# 654 215th Ave. ' ST. C`.y(;.X Col) , ' City State Zip ode P "_ -' J City J Village Town Nearest Road Somerset 1 WI 1 54025 1 715 247 - 5305 Erin Prairie 1 120Th Ave. ry N Construction Use: yM Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD J Replacement J Public or commercial - Describe: Parent material Glacial Till Flood plain elevation, if applicable na General comments /_ ��� p" and recommendations: Install mound system at 11" above 99.70' contour. -- c25-4 7° / t1=T& ? $ 1 Boring # -.-J Boring e Pit Ground Surface elev. 101.44 ft. Depth to limiting factor <11" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft *Eff#1 *Eff#2 1 0 - 10 10yr3/2 none sil 2fcr mvfr as 2f, lm 0.5 0.8 2 10 -15 10yr5/4 m2d 7.5yr5/8 sil 2fsbk mvfr cw if 0 - 0.8 3 15 -20 10yr5/4 m2d 7.5yr5/8 sil 1 fsbk mvfr cw - 0.2 0.3 4 20 -32 10yr6 /4 m2d 7.5yr5/8 scl Om mfi - - 0.0 0.0. 2 Boring # Boring N Pit Ground Surface elev. 96.15 ft. Depth to limiting factor — 17" m. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft *Eff#1 *Eff#2 1 0 -11 10yr3/2 none sil 2fcr mvfr as 2f, lm 0.5 0.8 2 11-17 10yr5/4 none _ sil 2msbk mvfr cw If 0.5 0.8 3 . / 17- 1 10yr5 /4 f2f 7.5yr5/8 sil 2msbk mvfr cw - 0.2 0.3 4 21 -27 10yr6 /4 m2d 7.5yr5/8 scl 2msbk mfi - - 0.0 0.0. - - - 'ns observable on scl ped faces in H#4. * Effluent #1 = BOD ? 30 < 220 mg/L and TSS 30 < 150 mg/L t #2 = BOD < 30 mg/L and TSS <30 mg/L CST Name (Please Print) Sig - ure: CST Number James K. Thompson ,- -,� mss-- -- 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI , s 0 7/31/02 715 - 248 -7767 • Praperty Owner Richard & Roxann Brown Parcel ID # 012- 1072 -80 -050 Page 2 of 4 3 Boring # Boring I Pit Ground Surface elev. 97.12 ft. Depth to limiting factor 24" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft *Eff#1 *Eff#2 1 0 10yr3/2 none sil 2fcr mvfr as 2f, 1m 0.5 0.8 2 8 -14 10yr5/4 none sil 2msbk mvfr cw lfm 0.5 0.8 3 14 -24 7.5yr5/4 none sl 2msbk mfr cw 1fm 0.5 0.9 4 24 2 7.5yr5/4 f2f 7.5yr5/8 sl 2msbk mfr cw - 0.5 0.9 5 32 -36 10yr6/4 m2d 7.5yr5/8 scl 2msbk mfi - - 0.4 0.6 Sand grains observable on scl ped faces in H#4 / & 5. Borin ��-�' v J `r"' � ` 7‘}-1P42 144-4914').t-c4 4 Bering # i + Pit Ground Su ace elev. t\ 8.95 ft. Depth t limiting fact 28" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft *Eff#1 *Eff#2 1 0 -8 10yr3/2 none sil 2fcr mvfr as 2f, lm 0.5 0.8 2 8 -14 10yr5/4 none sil 2msbk mvfr cw 1fm 0.5 0.8 3 14 -28 7.5yr4/6 none sl 2msbk mfr cw 1fm 0.5 0.9 4 28 0 7.5yr4/6 f2f 7.5yr5/8 sl 2msbk mfr cw - 0.5 0.9 H#4 consists of an unsorted mixture of 2msbk 7.5yr4/6 sl & 1 msbk 7.5yr4/6 Is. Redox. concentrtions apear within Is pockets at interface with sl. Sand grains observable on sl ped faces. 5 Boring # J Boring iI Pit Ground Surface elev. 100.41 ft. Depth to limiting factor 14" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft *Eff#1 *Eff#2 1 0 -18 10yr3/2 none sil 2fcr mvfr as 2f,1mc 0.5 0.8 2 8 -14 10yr5/4 none sil lmsbk mvfr cw 1fm�0.0 0.3 3 14- • 0 10yr5/4 f2f 7.5yr5/8 sil 2msbk mvfr cw 1f 0.5 0.8 4 200 -27 7.5yr4/6 none sl 2msbk mfr cw - 0.5 0.9 5 27 -36 7.5yr4/6 f2f 7.5yr5/8 scl 2msbk mfi - - 0.4 0.6 Sand grains observable on scl ped faces in H#5. * Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD <30 mg/L and TSS < 30 rng/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. . ' roperty Owner Richard & Roxann Brown p arcel ID # _ 012- 1072 -80 -050 Page 3 of 4 6 Boring # Boring SS N' Pit Ground Surface elev. 99.70 ft. Depth to limiting factor 30" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlft *Eff#1 *Eff#2 1 0 -11 10yr3/2 none sil 2fcr mvfr as 2f, lm 0.5 0.8 2 11 -22 10yr5/4 none sil 2msbk mvfr cw 1fm 0.5 0.8 3 22 -30 7.5yr4/6 none sI 2msbk mfr cw 1fm 0.5 0.9 4 30 6 7.5yr4/6 f2f 7.5yr5/8 sl 2msbk mfr cw - 0.5 0.9 Sand grains observable on sI ped faces in H#4. 7 ng # Boring w 99. 82 ft. Depth to limiting factor AP in. iI ' Pit Gr nd Surface elev. � Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft *Eff#1 *Eff#2 1 0 -10 10yr3/2 none sil 2fcr mvfr as 2f, lm 0.5 0.8 2 10 -18 10yr5/4 none sil 2msbk mvfr cw 1fm 0.5 0.8 3 7.5yr4/6 none sI 2msbk mfr cw 1 fm 0.5 0.9 4 (1,7 7.5yr4/6 f2f 7.5yr5/8 sI 2msbk mfr cw - 0.5 0.9 Sand grains observable on sl ped faces in H#4. Boring # Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft *Eff#1 *Eff#2 * Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS <30 mg/L 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. /s 72 • . 1 S0,7 82 k I 5ca /e : /'- K,'cX'( 4 xa4#i roWn 5WYY56 5 .c. 34 8 3 • 17 ye.. i7c.J. n, of Edo 4t2/ • e, •C ta 97.oq AC�•brrt: Kq;/ rn Sl' Peo/ P,ne. E7,2µ = ioiso 9° 3 I510 - P iet � 0 ,7°1 o 11 q ty 997 d elegy _ /OO• C). 9q '' t9 S • • B1 RECEIVED Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 isconsin 1 TDD #: (608) 264-8777 usisb �,�' ")� � 2002 www.commercestate.wi.us /sb De Department of Commerce uvww.wisconsin.gov p ST. CROIX COUNTY ZONING OFFICE Scott McCallum, Governor Philip Edw. Albert, Secretary November 01, 2002 CUST ID No.225036 ATTN: POWTS Inspector MICHAEL P MC DONELL ZONING OFFICE ACE SOIL & SITE EVALUATIONS ST CROIX COUNTY SPIA 340 PAULSON LAKE LANE 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/01/2004 Identification Numbers Transaction ID No. 799440 SITE: Site ID No. 652496 Ri oxanne Brown Please refer to both identification 120TH A /Y/Z numbers, above, in all Town of Erin Prairie correspondence with the agency: St Croix County SW1 /4, SE1 /4, S34, T3ON, R17W FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 877658 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01/01) and the SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST_SAS (01/81) • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c MICHAEL P MC DONELL Page 2 11/1/02 • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors - • The changes made to this plan on 11/1/02 by this reviewer were acknowledged and approved by the system designer. _ , _� c�r.� G�C �L �� — 17- 44 -14_, ; Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation /operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. 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. i MICHAEL P MC DONELL Page 3 11/1/02 • • Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday WiSMART code: 7633 cbratz @commerce.state.wi.us cc: Leroy G Jansky , Wastewater Specialist, (715) 726 -2544 1 , 13 1 1 I 1 ..c .... c) I cy) , _________ ______ ___ ,... ‘,. f., — i . ...0) ;310. co co co ..... _ 1 . - . . 130 1 1 1 i I I - : 1 1 12% • 1 co I ! ___ •-• I ; ! 1 ! 1 ; i i I 0 1 I 1 ! ! I ; 1 1 ! I ; 1 • ! , ) - 7 - i y o 1 I 1 1 I 1 I i LK I 1 , 1 _ 1 ' _________ i . — [ —1 I . / 1 i ' I 1 ' f\" I i I ■ ',\, ' I , I 1 ts k 1 q l r ( . 7 . ; 21 1 1 t`g -14) . , 1 i i. 1 i 1 7....4 • I 1 *'- I ' I . ' ! I ! ' - 7 - - 1 7 I 601 in 1 .I I i el co ! ! :--------- 1 \__ : . . . •11 . ! I I 160 , •11 I 4.1 i , I i 1 1,,/' 1186• • • 6 • - -- . , _ Wiscdnsin�epartment of Industry, SOIL AND SITE EVALUATION REPORT Page i of 3 Latlor Ad uman Relations •Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code • COU4104 10 Attach complete site plan on paper not Tess than 8 1/2 x 11 inches in size. Plan must include, but r A T not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or „rj D. # 4 a I4 dimensioned, north arrow, and location and distance to nearest road. %ir i 'il_ Val, ,/'.10, APPLICANT INFORMATION- PLEASE P' NT ALL INFOR ATION � ; 4- � � ' F/CL , PROPERTY OWNER: + uyer '�4 /r V PROPERTY LOCATION /� t, . .. GO •T 5 kJ 1/4 y �' � r or • • � _ .. •"�Id :' I ' .-:„.../............., A D ESS v OT # BLOCK # SUBD. ��j• • ,, e - • - - CITY, TA E ZIP CODE PHONE NUMBER TY ❑VILLAGE J i• N �, •1' ' 'i', ' 7/ L4. - .5. / J ,. °SAD /!� ( / ± -� St 9 -,5%79 j 1 i /v Pr's ; r ,',� 11-ve- [ slew Construction Use [>f Residential / Number of bedrooms 3 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 1 /5: 9 gpd Recommended design loading rate ' .5 bed, gpd/ft ' 4 trench, gpd/ft Absorption area required 'Too bed, ft 7s trench, ft Maximum design loading rate . -S bed, gpd /ft G trench, gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan nchmark) Additional design / site •• siderations ref / ' i ...i0 / i � 0 / ./ / " y17 � Parent material irid,r '' 1 S k I Sw ," /' AP Flood plain - evation, if applicable i / ft "' , S = Suitable for system CONY ZONAL HIiND IN -GROU r PRESSURE AT- GRADFL S S 129ULL ❑ S NG TA K U = Unsuitable for system ❑ SU LAS ❑ U ❑ S ❑ S I�tJ ESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench O ?/ 9-17 fo roc- 5/4 /[Jars 1 2. A'''Ale #4 1 ,'5 L /� Gl�l s Ground 3 /7: /D y/G '1/6 l J ' G Zl� s / le Se �'' IC' Cr") — , # . S° elev. 3 ivi 'i� ft. Y L � 3 ° N L i,6 SYt stir 2 .5)1/1 S/ it 5 1k 01 tit c -- .y .3 Depth to 5 3 � 6o"`d y t 5-y / f- c/i a � 3 / N43 ,A✓ — -- -3 .9 limiting factor 3 Remarks: Boring # i a - / 2 - 9 /O y �/Z �org / 2 I$Bk t r 4- 4-41 / I _-S . L ..: _ L 42 21 r i y, % ` kto / 2� s4t pa -r',- C' it _5 .6 Ground ' 2 i- �S / � /l Ajo • i / S.Z /C iii fie G — Ground pp l e . ft. y5O /©Y /yA, sy4 s�4' 2,S> S / /4j r ss,�''G kiss - -- ; 3 .5 Depth to limiting fatttprl '' Remarks: CST Name: — Please Prin l , G a.e / 1 , a G1 Phone: 7 5 3 �. e q 02 Address: ! ' t / 1,?,„ C /07 0 �y 35 N 561-. AP S L Signature: .,® � _� / / D e: CST Number: i� ,�,�!. / L/a..- �,��j �ir��q s 3Yy 7 PROPERTY OWNER SOIL DESCRIPTION REPORT Page •13-. of ' PARCEL I.D. # • ' Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/t2 in. Munsell au. Sz. Cont Color Gr. Sz. Sh. Bed Trench 0R, 0 104 /OK $ A joee.-- 1 7 /het Alb- 4v 11- 4 3 e , f 1 shk - I Mle 57. rut/ Ground 3 If-3 A? yi 5' 9 Ate.- S 1 .4. 5 ptil .A.) elev. 4- 2.9,76,.. 5 1 , 1* s4.Ne.– v — — Depth to limiting faclir Remarks: Boring # rai-91 Ground elev. ft. Depth to limiting factor Remarks: Boring # "SI S • Ground elev. ft. Depth to - limiting factor Remarks: Boring # 0 Figad Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) ` X PG 3de K k NP, cotvK it poww l,:- o 63 j 8m y „5 l � yr► 1 Z . ,d0. d ' So ' 1 F - 1 -: 41-4/ poiA)tic L.' frit 101.4)0-5 > ' 1-4,4 0 01, hot ?).4- s po D A I I 1 il-'1 Ni) O. I `1 c e 14 -\'' I IZvt i}rc 1 l / /s I 1 v • pfl N IL r ; J 9 j X9963'7 /o CERTIFIED SURVEY MAP N1/4 Comer of Section 34 Located in the NE 1 /4 of the SW 1/4 and the SE' of the (County nail found ) SW 1 /4 of Section 34, T3ON, R17W, Town of Erin Prairie, N 00° 02' 33" E 2,633.51 St. Croix County, Wisconsin. -- UNPLATTED LANDS N 89° 57' 18" E 661.13 LANDS OWNED BY: '` Y �`" a' " " ` " MARK &MINDYLUX '� EAST -WEST I/4 �' 1842 120 AvennA _ SECTION LINE Hammond, WI. 54015 ' 6 DB • GRANBERGSURVEYING Scale 1" = 300' ,�\ Z 1239 C.T.H. "E" �� o New Richmond, WI. 54017 � '\ 7 < 5, Job No. 99-008 O 0. o 01 \� '�� Bearings referenced to the South line of the ni 4 O SW' /4 of Section 34, assumed S89°43'01 "W. , „ ° p, ai r ro WI SCALE IN FEET 1 I” = 300 r 0' 150' 300' 600' 900' Cl..' m Z� LOT 1 co o 1,747,452 square feet o in ° o 4 (40.116 acres) ° NOTE: because the parcel shown hereon is co including R. -O. -W. r•2 over 35 acres it is not subject to those o' 1,725,635 square feet w provisions set forth under Chapter 18 of the w _ _( 39.615 acres ) _ St. Croix County Subdivision Ordinance. M excluding R. -O. -W. Also, no approvals are necessary from the M N Town Board of Erin Prairie or the St. Croix o m septic area County Zoning Office for the creation or sale o 0-• of this parcel. Z '-- rn ❑ .shed LA NOTE: The parcel shown hereon is subject to x. '' �2 State, County and Township laws, rules and 1-0 regulations ( i.e., wetlands, access to parcel, etc. ). `dwelling _ Before purchasing or developing any parcel G) (p >'r�v' Iy contact the St. Croix County Zoning Office and g4-2-7, 1 -�/ m the approp Town Board for advice. J _ � O LEGEND t rn 1Z 4 - Indicates Section Comer Monument . 44� \N i `i' (as noted ) 5 o Indicates 1" X 24" iron pipe weighing 1.13 • lbs. / lin. ft. set. \\ -- O� \ VI - Indicates fence o 10D' ROADWAY SETBACK LINE a f I U Li N 89° 43' 01" E 1,983.42 M _ N 89° 43'01" E 661.14 Vs • 120TH AVENUE r • -S 89°_431_01 _661.142 SW Comer of Section 34, , �� 'O - ( Alum. Mon.) South line of the SW 1/4 S1/4 Comer of Section 34 UNPLAT T _ E _ D _ LAN D _ S _ T3ON, R17W ( Alum. Mon. ) ... SHEET 1 OF 2 VoI.13 Page 3614 k -4,