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HomeMy WebLinkAbout022-1009-60-900 r Wisconsin De?artment of Commerce Count Safety and Bviloing Division PRIVATE SEWAGE SYSTEM St. Croix INSPECTION REPORT Sanitar Permit No: 506322 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: Becker, Shane Kinnickinnic, Town of 022 - 1009 -60 -900 CST BM Elev: Insp. BM Elev: BM Description: QQ Sectionlrown /Range /Map No: V><1�, �,,ST' 04.28.18.57A90 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic VA to . / Loa Benchmark s.c,�.. Dosing , � J Alt. BU, SeI� Cal, on Bldg. Sewer ' Holding SVHt Inlet 11. $� CIO.% L TANK SETBACK INFORMATION St/Ht Outlet TANK TO I P/y WELL BLDG. Vent v Air Intake ROAD Dt Inlet Septic /44AAQ'^ A q t - 5 Dt Bottom Dosing !� ,� Header /Man. Z•T� /d7. Z. Aeration Dist. Pipe (f � � l In r Holding Bot. System 3• Ib is 6 . 7 PUMP/SIP INFORMATION Final Grade Manufacturer � Demand St Cov /45.(0 GPM � aC . ,1 Model Number �r 3�, 77 JT , q . g lL� TDH 1 1-ift 1 Fricti n Lo System H�a ; T � t Forcemain Length j Dia. Z r Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width ength / No. Of�.TT{{ench PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ca / L 75 40 ~' - �— SETBACK SYSTEM TO P/L B BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Tye f System CHAMBER OR / .5- . y . _. /t UNIT Model Number: DISTRIBUTION SYSTEM 644 - Header/Manifpld a Distribution q r/ / x Hole Size x Hole Spacing Velii►to Air 194 � J �L 6 Pipe(s) 1 1-engt h_ Dia �� L Length 3 b' -7J Dia /' ZS Spacing r 1 �"' �,� A 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 6 7, Bed/Trench Edges Topsoil � � �w / I t"r� es E] No .I es 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /6/ 3 b 6 KInspection #2: Location: 532 Valley Court R berts, WI 54023 (NW 1/4 SW 1/4 4 T28 18W) NA Lot 2 V P a� cel �t o: 04.28.18.5 eA- 1.) Alt BM Description 7 = � 2.) Bldg sewer length = VVV �.rasCJ� - amount of cover = Ve, A�- A4 n" 4-0 -7 ,sue Plan revision Required? ❑ Yes No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor' ignatur Cert. No. i Lc;: .gov Safety and Buildings Division Comity 201 W. Washington Ave., P.O. Box 7162 St Croix i s i n Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) 5 6 (4 3 ZZ Sanitary Permit Application State / Trransacti - on Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental / Z / 3 P8 unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS am Project Address (if differft than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary purpos in accordance with the Privacy Law, s. 15,04(l XMI Stats. ;0 5 3 Z Vet 11 6 1 + — . L Application Info — Please Print All Info a I ' Property Owner's Name arcel # Shane Becker 4 2 -10 o 9'-G"o — 1 00 Property Owner's Mailing Address J SEP y Location ST. CROIX COUNTY 38 Heritage Blvd Govt Lot V W 1 /,, SW 1 /S Secti City, State Zip Code Phone Number (circle one) Hudson WI 54016 612 685 -5274 T�g N R j SS II. Type of Building (check all that apply) ok � Lot # ® or 2 Family Dwelling — Number of Bedroor s 4 4� Z_ Subdivision Name 1 Z .. 5 a . ,0 5 / � Block # Y 5 ❑ Public/Commercial — Describe Use City of rr..- ❑ Stat7Owned 4Describe se CSM Number G 2 �, ❑ Village of k 7� / ►1 Clow— o U ® Town of Ktklpl1 f(i1'INi IM Type of Permit: (Check only one box on line A. Complete line B if appfic le) A New System Replacement D Treatment/Holding Tank Replacement Only Other Modification to Existing System (explain) System B. Permit Permit Revision Change of Permit Transfer to List Previous Permit Number and Date Issued Renewal Before Plumber New Owner Expiration IV. Type of POWTS stem/Com nentJDevice: Check all that apply) U Nan - Pressurized In- Ground Pressurized In- Ground At -Grade 0 Mound > 24 in. of suitable soil U Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device exp am) i V. Dispersalffreatment Area Information: a Design Flow (gpd) Design Soil Application Ijete(gpdsf) Dispersal Area Require�fj Dispersal,r a s o S ystem Elevation 600 ,/ 0- �/ 1000 ( 1067 7 VL Tank Info Capacity in Total # of Manufacturerr Gallons Gallons Units New Tanks Existing Tanks 1 00 F, (� x �i Septic or Holding Tank 1200 1200 1 Wi r Concrete b Dosing Chamber 800 800 1 Wieser Concrete VII. Responsibility Statement - I, the mdersipted responsibility for iostagation of the POWTS shown on the attached plain. Plumber's Name (Print) Pl b 's Sigma MP/MPRS Number Business Phone Number Darrell Hubbell l MPRS 221073 715 307 -1630 Plumber's Address (Street, City, State, Zip Code) N7988 92& St River Falls WI 54022 VIII. Conn /De artment Use Onl oved _ ' — ve Permit Fee Date I ed Issuing at Signat er ' n Reason rDeniai $ / OO ' dp 7 / / 6.7 DL Condi"ff4VXgrersons for Disapproval 3� + rerrb r � l�u. CIAR 1. Sept tank, effluent filter and J /+� / ne(`w..: dispe rsal cell must all lag services J mafntakted e l I_ as per management plan provided by plumber. 2. AN setback requirements must be maintained Attach to complete plans for the system and submit to the County only on paper not less than 8 N z 11 Inches in sire 1 .,.� �' � 4..,,,, , �,� is < <. � t, . r. - �,.., ,. a. ; , ., r, ' Plot Plan Pages of $ e Property Owner V AZl Kor---R t spy 'f)WVT--P : I » = 40 ft hem xW4 Legal Description t z, csnn v on- ►g , Pte. 4g gZ, (vxdW w NW 14 or- - tee sv)A z y tV3 eviN of � � �� ; �tt Kt�.I1Ji�l�i�tnJi� �'� C �.o�x P� ul� - ri/ w�SCON North 1 F .,o? d iv f r w 6 i or IIWE r Sovcr ply- f }sv� nn�a �0o.00' Site Location: �e -4 x E Plot Plan Page S of $ Pro Owner VAAZIeac R� it s Property � -- Legal D u T z, CSM VOL. V? , Qr+. yg 8Z (excep wham note t n = Badhoe h 14 0r- - rr\E S`N`P+ S y TZg �$v3 'TOv�N Or- P K�n1�1��l�tn!n/►e �� CTO%)c PaULN V WISCONS1� North p 60 0 8 ELF -OD a t P � 1� . W gar �s l P �'P r' -jop 01: IWE r s p,act � ply ?`� Mrcp \00. Site Location: SeC.4 h x Safety and Buildings commerce.wi.gov RECEIVED 4003 LA CROSSE WIC060LEE 3D TDD #: (608) 264 -8777 AUG I t 1 4 2007 www.commerce.wi.gov /sb/ Department of Commerce ST. CRUX COUNTY Jim Doyle, Governor Mary P. Burke, Secretary August 09, 2007 CUST ID No. 224832 ATTN: POWTS Inspector MARY JO HOLLISTER ZONING OFFICE HOLLISTERS SOIL TESTING ST CROIX COUNTY SPIA W9875 690TH AVE 1101 CARMICHAEL RD RIVER FALLS WI 54022 -4011 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/09/2009 Identification Numbers Transaction ID No. 1427318 SITE: Site ID No. 7 28850 Shane Becker Please refer to both identification numbers, Valley Court above, in all correspondence with the agency. Town of Kinnickinnic St Croix County NW1 /4, SW1 /4, S4, T28N, R18W Lot: 2, Subdivision: Valley Ridge FOR: Description: Mound / Four Bedroom / Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1146093 Maintenance required; 600 GPD Flow rate; 28 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 101); Biofilter 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. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, C01141 stats. 5 ?" The following conditions shall be met during construction or installation and prior to occupancy or use: �� ir ngpARFMEN' Reminders sA! • This system is to be constructed and located in accordance with the enclosed approved plans and with the SEE CORR component manuals listed above. • 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 POWTS 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 MARY JO HOLLISTER Page 2 8/9/2007 • Comm 83.22(7) A copy of the approved plans specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities: • Comm 83.52 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 rantin this approval the Division of Safe & Buildings reserves the right to require changes or additions should g g Pp h' g g q g 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 charles.bratz @wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. iL ,.� MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN PSG `''d Residential Application INDEX AND TITLE PAGE S Project Name: SHANE BECKER Owner's Name: same Owner's Address: 38 Heritage Blvd. Hudson, WI 54016 Legal Description: NW 1/4 of the SW 1/4, S 4, T28N, R1 8W Township: Kinnickinnic County: St. Croix Subdivision Name: Valley Ridge Lot Number: 2 Block Number: NA Parcel I.D. Number: 022 -1009 - 60 - 900 Plan Transaction No.: ��GO� Page 1 Index and title �.•`� 's Page Page 2 Data entry w �; te a • ••.• . Page 3 Mound drawings v Page 4 Lateral and dose tank r • MARY JO • ••: Page 5 System maintenance specifications "dr7il,Arj HOLLISTER Page 6 Management and contingency plan 1859 Page 7 Pump curve and specificationsD RIVER FALLS, ; Page 8 Plot Plan of CoMlN •� WI : Jam► FSIG SPONDE E Designer: Mary Jo Hollister License Number: 1859 -007 Date: 08/04/07 Ppone Number: (715) 426 -1775 Signature: <.S 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 -SAS (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 L Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Send fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 83 -44 -3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliforrn of <= 36 inches. 600.00 Design Flow (gpd) 8.00 Site Slope ( %) 106.00 Contour Line Elevation (ft) 28.00 Depth to Limiting Factor (in) 0.60 In - situ Soil Application Rate (gpd /ft Distribution Cell Information 75.00 Dispersal Cell Length Along Contour (ft) = 8.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/fl?) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest oint in the distribution Y Pressure Disribution information network? Enter Y or N (C or E) C Center or End Manifold 4.00 Lateral Spacing (ft) If N above, enter the elevation ft 4 Number of Laterals of the highest point. 0.156 Orifice Diameter (in) 2.00 Estimated Orifice Spacing (ft) = 8.33 ft /orifice 2.00 Forcemain Diameter (in) 76.00 Forcemain Length (ft) Does the forcemain drain back? Y 99.00 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 12.40 Forcemain Drainback (gal) 7.17 Vertical Lift (ft) 46.83 5x Void Volume (gal) /.' 2.37 Friction Loss (ft) 59.23 Minimum Dose Volume (gal) �1 0.50 In -line Filter Loss (ft) 38.77 System Demand (gpm) Z' 14.58 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x x 1.00 1.50 x 1.25 x x 2.00 1.50 x 3.00 2.00 x 3.00 x Gallons /Inch Calculator (optional) Tre Tank Information Total Tank Capacity (gal) 1200.001 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Wieser I Manufacturer gal /in (enter result in cell B49) Dose Tank Information Effluent Filter Information 800.001 Dose Tank Capacity (gal) I Best Filter Manufacturer 22.241 Dose Tank Volume (gal /in) BTGF 10-8 Filter Model Number Wieser Manufacturer Project: SHANE BECKER Page 2 of 8 Mound Plan and Cross Section Views 1 1/106: :::::::::::::: ... J 1�.. Observation Pipe . L? .r T A W — •: 3 :. .:•:•: -:•: .:.:.:.:.:•:':.:..:•:•:•:.:•: : L - -— Mound Component Dimensions A 8.00ft E 15.68 in H 1.00ft K aft ft B 75.00 ft F 9.25 in z 10.17 ft L ft D 8.00 in G 0.50 ft J 4.69 ft W 600.00 (ft) Dispersal Cell Area 1 1363.08 (fe) Basal Area Available 8.00 (gpd /ft) Linear Loading Rate 1 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 108.44 (ft) —► G * H ........ ............ i F r 107.17 (ft) Lateral Dispersal Cell 106.67 (ft)—► — Invert i r I Ce ll 3 D spe sa Ce : .•.:� :.:.:.:.:.:.:: .: :: E D 3 Elevation ...�.....• ................. x tt r rcrrltt��tMnMh�r4�trr�c�11�n1zh�t1�� , �.M�r�ctcrr1.1 , .1 4 1• lh� �r l rt��� 1 �1�1 �l�t tr 4 t r4 h 1 t l��1 { ^rut 106.00 (ft) Contour Elevation 8.0 % Site Slope Geotextile Fabric Cover Shading Key 4 � . - T Dispersal Cell See lateral details on 1❑ _ Topsoil Cap a 1.5 ft Page 4 for number, size, Subsoil Cap a 5 '.. and spacing of laterals. ASTM C33 Sand '.rr? f Laterals are equally r• Tilled Layer m 0.5 ft ::r Typical Lateral spaced from the Aggregate distribution cell s centerline in the A * distribution cell (AxB). Project: SHANE BECKER Page 3 of 8 Center Connection Lateral Layout Diagram Force main connection via tee or cross to manifold at any point. Laterals are identical I I? S •= Turn -up wf ball valve or I< X —IEx�2 xr2�l Laterals & Face maw of PVC Sch 40 deanoutplug per COMM Table 84.30 -5 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.156 in Lateral Diameter 1.25 in Orifice Spacing (X) � Lateral Length (P) 36.75 ft Orifices per Lateral 18 Lateral Spacing (S) 4.00 ft Orifice Density 8.33 If/orifice Lateral Flow Rate 9.69 gpm Manifold Length 4.00 ft System Flow Rate 38.77 gpm Manifold Diameter 1.25 in Total Dynamic Head 14.58 ft Forcemain Velocity 3.96 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and —i► Comm 16.28 WAC Disconnect 4 in. min. Tank component is properly vented < E— Alternate outlet location Forcemain diameter Wieser Manufacturer �_ 2 in. Ca aci 800.00 Gallons Volume 22.24 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 19.31 429.41 C B 2.00 44.48 P ump off elevation (ft) C 2.66 5913 100.00 D 12.00 266.88 D Total 1 35.971 800.00 1 1-- Dose tank elevation (ft) 3" Bedding uncTer tank. 99.00 Alarm Manuafacturer I Tank Alert Alarm Model Number JHW 101 Pump Manufacturer JZoeller Pump Model Number 198 Pump Must Deliver 1 38.77 gpm at 14.58 ft TDH Project: SHANE BECKER Page 4 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name J Darrell's Septic Service Phone 715 425 -1025 POWTS Regulator's Name St. Croix County Zonin Phone (715 386 -4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 fe Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency I 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 month Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once every 3 ears 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. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished �„ ............... Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: SHANE BECKER 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 fitter shall be serviced if the alarm is activated continuously. Intermittent fitter 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 fitter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution Svsftm 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 flow 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. Continnency 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 J //O 0 1/4 W W HEAD CAPACITY CURVE MODEL -9fr 4 5/8 -+1 3o i a ' 2s ® ! W = 6 2F I v ED TD4 . O 4 10 N 4 3/ 16 8 0 2 s 1 1/2 -11 1/2 NPT U& cµ Lp 10 20 31 41 so 6o T 1 am 0 ^ 160 240 FLAW MODEL 98 60 CYCLE Feet Gallons Meters Lib" 5 72 1.5 273 to s+ %1 23+ u �s �s 170 12 m 25 61 gS Loe41A+MC ?3• 091971 4 3/16 31""a CONSULT FACTORY FOR SPECIAL APPLICATIONS Bechicai alternators. for duplex system. are ava8aMe and - variable level float swdches are avilable for coMroftla supplied with an alarm. and three phase systems. ' Mechanical allemal3ors for duplex systems, are avallable - Double piggyback variable level float switches are available with or without alarm switches. for variable level long cycle Controls. SELECTION GUIDE Standard all models -Wei h# 39 lbs. -'h H.P_ 1. tng r�aoata 2 pole nacha ticat .ttoead�cawdrequired. 2. S rWe ptWbac k ww able level float swill or double piggi l variable level. "SWISS coaboi selectoton floetswMdt. Refa'b FMOM MOM Voitr pp I Mode AmWe DUPINK 3. Mechanical afternalor 1114)072 or 100075. M9B 1115 1 1 Auto 9A 1 or 1 & 7 -- 4. see MOM, for - - - -' modei of i= iecbirai Akerneior. - kjL -- j 115 1 Non 9:4 2 ar - 3 or4 & 5 _ & Control switch 10 used as a cm activator. specW duplex (3) or (4) 00 1230 1 Auto 4.7 1 or 1 & 7 — s. Faw (4) hde J-Pak. Mcgm bm far rid aaeheclion or wt e" e96 1230 1 1 Nan 4.7 2 or2 & 6 3 or4 & 5 simplex or duplaa operadon.10.000Z. 7. Two (2) hole J -Pak. for waterlight corwHKAton or spNce. CAUTION Rri l Sounanaddri9adZederprodndsmbrt9 cat" an FlMili & Vaiabb herd SwicirM All installation of controls, protection devices and :ming should be done by a qualified 810477: BeddealAhlrinl9r: F1191 l6t1reefi99im1Arrah119r,F119195c FS- H __FU018P licensed electrician. All electrical and safety codes should be followed Incitullng the most Sr�ePltilie599plettPrpptbn19t1 F1r159QAtaw9ysbahs RMt32 recent National Electric Code (NEC) and the OccupatkmA Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual Conditions a reserve safety factor is engineered into the design of every Zoeller pump. /MR TOt P.a ow we 1+mtfataflliKY.4Q?�i�3lT Af99tied9Arsd.. O SMPrD: 3Bl9G>erel3mrioed La9btiR KY 40pfl -198/ y /�tto+s SAW Amy M 1 rr�4.1112r - PRD2Err B>✓ ,eR fir : 2 o� 4 RECEIVED Wisconsin Department of Commerce SOI EVALUATION REAWb 6 2007 Page 1 O f 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Co le E 1 COUNTY T. CROIX Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and - 1009 - 60 - 900 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. R awed b Date Personal information you provide may be used for secondary purposes (Privacy Law, S. 15.04 (1) (m)). Property Owner Property Location ■ ROGER & SANDRA VAN BEEK (Buyer: Shane Becker) Govt. Lot - - -- NW 1/4 SW 1/4 S 4 T 28 N R 18 E (or)W Property Owner's Mailing Address Lot # Block # Subd. Name CSM# 5 (Y c"� a / _ - 578 S.T.H. 65 2 -- alley Rtd e City State Zip Code Phone Number []City VIlage ■ Town Nearest Road Roberts, WI 1 54023 715 749-3757 Valley Court I Q New Construction UseE] Residential / Number of bedrooms 4 Code derived design flow rate 6 00 GPD Replacement ❑ Public or commercial - Describe: Parent material loess over limestone Flood Plain elevation If applicable General comments Mound System -- 0.67 ft. sand fill -- 0.6 loading rate and recommendations: Property address: 532 Valley Court F] Boring # ❑ Banes a Pit Ground surface elev. 105.15 ft. Depth to limiting factor 28 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 0-4 7.5YR2.5/2 — sil 3fgr &sbk ds cw 2vf -m 0.6 0.8 2 4 -12 7.5YR2.5/2 -- sil 2fa&sbk dsh aw lvf -m 0.6 0.8 3 12 -21 7.5YR3/3 cl 2fa &sbk dsh cb lvf-f 0.4 0.6 4 21 -28 7.5YR4/4 _ sl 2fsbk dh ai lvf-f 0,6 1.0 28 -33 ROCK 2 Boring # Boring 107.15 28 ❑ Q Pit Ground surface elev. ft. Depth to limiting factor in. DiEKplication 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 I *Eff#2 1 0-4 7.5YR2.5/2 — A 3fa &sbk ds cw 2vf -m 0.6 0.8 2 4 -12 7.5YR2.5/2 - sil 3fabk dsh as lvf-m 0.6 0.8 3 12-28 7.5YR4/4 - cl 2fabk dh aw lvf-f 0.4 0.6 4 28-32 ROCK * Effluent #1 = BOD > 30 220 mg/l. and TSS >30 < 150 mg/L * Effluent #2 = BOD 130 mg/L and TSS 130 nV/L CST Name (Please Print) re ` CST Number Mary Jo Hollister Hollister's Soil Testing & Design) 224832 Address Date Evaluation Conducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 08-01-07 (715) 426 - 1775 Property Owner VAN BEEK, Roger (Buyer: Becker) Parcel ID # 022 - 1009 - 60 - 900 Page 2 of 3 Boring 3 Boring # S Pit Ground surface elev. 105.75 ft. Depth to limiting factor 28 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 -4 7.5YR2.5/2 -- sil 3fa&sbk ds cw 2vf -m 0.6 0.8 2 4 -12 7 5YR2 5/2 __ sil 2fa&sbk dsh as lvf -m 1 0.6 0.8 3 12-22 7.5YR3/3 -- sil 2fabk dh cw lvf-f 0.6 018 4 22-28 7.5YR4/4 -- sl 2fsbk dsh aw -- 0.6 1.0 28 -35 ROCK El Boring # [ Boring pit Ground surface elev. ft. Depth to limiting factor in. Sal ication 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 I *Eff#2 I Boring Boring # Ground surface elev. ft. Depth to limiting factor in. Pit Soil ication 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& and TSS >30 < 150 mg& * Eftluent #2 = BOD, < 30 mg/L and TSS 130 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 (IL09 /00) Plot Plan Page 3 of 3 Property Owner UAN3 •ROCr � sp'.) I 40, ft Legal Description LoT z, C SM V OL ) , Pte. wg $ (except where noted) Nw`�4 oF- "s SW'h S y, Tz.1 N, ,R \t%4, "TOyJAV OF Q = Bac kwtoe F ft Kll S"T CT-D%A MUM V01SCOMSIM North LET .00 o j t, to5.75 `�v d N *1 °o II>' � r �e Ld L Ir75 IS i "S..P• )Pj JoP C 50�rt � P��- r f�SSw Mt.A \ 00, 0 T 33�you' Site Location: _ sEe,y . C Y � 0, � t �r 4 TYR. * __ 83 r D02GE 3 4 1 g APPROVED BY 2 . VOL 21 PAGE 5265 s TOWN OF KINNICKINNIC 1 Cr NR AKE, , KATHCEEK H. wa -- DATE: ' •. wt REGISTER OF DEEDS OQ`� ST. CROIX CO., MI .., i.J �y�SURV� r 1 5 R ECE I VED F OR 01:35PH CERTIFIED SURVEY MAP REC FEE: 17.00 THE WEST LINE OF THE SW 1/4 OF SECTION 4 COPY FEE: 5.00 BEARS SOO'39'44 "W AS REFERENCE TO THE ST. PAGES: 4 CROIX COUNTY COORDINATE SYSTEM D rP m—�i UMFD �q ll 4fsDD LANDS - - - - -- > --I m m C SOO'39'44 "W 2644.54' z m 0 (A o` n WEST UNE OF THE SW1 /4 j PARCEL ON g C7 r�* NOO 39'44 "E 877.16' I MOIL. 2009 - PCG. �� -------_-- 22 t 445.11_ -- - - - - -- %i °� �y��• o� Z !Q�P I I � �I� N ;mss• PICK CA N ei z'+ � �y+1 p r i;s. w w �z4kpwm09v - P, 3I m ��N A w "'� rn > •-� O & � cis w a in '' i ' 439.34' , � 1 n Z > r zz . . cn Z cn I q t r c) Zo z 2 F NOO'42 08 E -4 < o �I [ p m���� ��° 401.91 37.4 ' O_�z � q N N N N N> >�CCvi r S. R0 C zi� I; w 8 A ° =� CC�[CCC���C�� { vvr p�yp! I C A -1. 0 m O v N m � ° O V m- i y 3 '- -i y AClr m m �� m $ r Z Vro O 1 \ n ��� Z U CA I TI to �N 6�D� cgs m co 'A' I� Cz nZm -cr I �� �. v �� fi ; 1 CA dc I X m N of o c n o O �cm O I I 6 m o �' I t ' I ' ms � . s C ...........: v — O 29t • S ` A �CB (A Z C� g 00 '54'42 "W 477._ c " c� I I= m m LOT 4 EAST LINE OF THE S00 W N O N I Z n NWt /4 OF THE SWi /4 36.16 �v O O f'.) I ' O C.S.N. ON VOL. 20 PG. 51776 w N iv o �� O Q N % 00N .�. I i�O n" x N N ODN O O oD rn F ZE I�3 CAD N Z Z Z N O I �Om Q ;<-� rri 0= 1 !2 DID. F; IMP J= Q _ Z Z Pu > cn o n Z �.t o� � I � c'�� Z �_� R1 z' A °p rn co rn O m x� � zA Z� mC Z �rQi p c°n�0 of rS,' 'm m m ma o c: c g a., n Om z r•i c Z w m `r*l rm C) II D C >R 0 2� z �o = m -Z-1 r Z O c c_n 67� C� SHEET 1 OF 4 1of4 Vol 21 Page 5265 I I ' , 1 , I ' I ' 1 — I I O , I I j w ' I --- ----- - - - -- C 34 - - R - O. 1' -I'-b - - 2 - I I 1— 1 x 4' -0� - - - - -- -, L L -- ( - - - - - -- - - --- - -- 2 LSL ulu - -- --- - - - - -- ' NIro ip - - - - - -- - - - -- o ' I I Q I 1 7 11/16" I Lou I N I 1 Fut, Bedroom of � ♦ O �4,, 9 Clg. (� I 1 ---- ' I 1i 2 Ply 9 1/2" LSL - -- -- -- - -- _ _ 2 Bearfnq Wall - - ol i � u11 , mIU I , � 01 Fut. Bath ' e cl Fut. $edroom 0 2 �' Q g x 12' -10" 14 I ' 10" Poured Wall I ' 1 S' -O" H f gh ' � 4 x 8" Footing o ° ♦ , ♦ o , ♦ ° I e r------ - - - - -- ' ♦♦ ♦ _ 1 j ♦ • - -___ I 0 1 O ♦ I 1 4 ��011 , - - - - -- -- -- ----- -- -- ---- -- ' • _ - -- I�J 1 4 d-� • ' N Parcel #: 022 - 1009-60-900 09/10/2007 03:34 PM PAGE 1 OF 1 Alt. Parcel #: 04.28.18.57A -90 022 - TOWN OF KINNICKINNIC Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 08/30/2006 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - VANBEEK, ROGER A & SANDRA L ROGER A & SANDRA L VANBEEK 576 TROY ST RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 532 VALLEY CT SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 2.074 Plat: 5265 -CSM 21 -5265 022 -06 SEC 4 T28N R18W PT NW SW FKA OUTLOT 1 Block/Condo Bldg: LOT 02 CSM 20 -5023 FKA CSM 20 -5176 OUTLOT 2 (35.218 AC) BEING CSM 21 -5265 LOT 2 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) (2.074 AC) 04- 28N -18W NW SW Notes: Parcel History: Date Doc # Vol /Page Type 08/30/2006 833418 21/5265 CSM 03/21/2006 821144 CSM 03/21/2006 821142 WD 10/25/2005 810256 2915/100 WD more... 2007 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 08/07/2007 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 2.074 300 0 300 NO Totals for 2007: General Property 2.074 300 0 300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer -Shan d �r I'1, i - (�,r BeLK(f� Mailing Address 31 L q P b lvd - +fiu d son , W ) 54 ()1t,0 Property Address 5 3 oZ, , (Verification required 6m Planning & Zo ' g Department for new construction.) City /State Parcel Identification Number Qv7c� - l DE -� tOD " 1 LEGAL DESCRIPTION Property Location N W 1/4 S W 1 /4 , Sec. � , T Z$ N R W, Town of 1 C-K 1 ►'U C- . Subdivision , Lot # Z 5Z j Certified Survey Map # , Volume , Page # Warranty Deed # , Volume , Page # Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I /we certify that all statements on this form are true to the best of my /our knowledge. 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 b rooms r 4 /)a / 67 SIGNATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) �k ; , 1 �I�IIA IIII� III�1 IIII� �I�I� II��I �I�� ■II�■I I��� I��I * 8 6 0 2 1 7 1 State Bar of Wisconsin Form I -2003 660217 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number Document Name ST CROIX CO., WI RECEIVED FOR RECORD 09/11/2007 10:30AM THIS DEED, made between Roger A. Van Beek and Sandra L. Van Beek, husband WARRANTY DEED and wife EXEMPT # ( "Grantor," whether one or more), REC FEE: 11.00 and Shane S. Becker and Jennifer K. Becker, husband and wife TRANS FEE 216.00 PAGES: 1 ( "Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ( "Property ") (if more space is Name and Return Address needed, please attach addendum): River valley Abstract & Title, Inc. 1200 Hosford Street, Suite 201 Hudson, WI 54016 Part of the NW '/ of SW ' /4 and Part of the NE '/4 of SW '/a of Section 4, Township File # 2695769 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin, being more particularly described as follows: Lot 2 of Certified Survey Map 022 - 1009 -60 -900 recorded August 30, 2006 in Volume 21, Page 5265 as Document No. 833418. Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, restrictions and rights -of -way of record, if any. Dated September 7, 2007 (SEAL) (SEAL) * * Roger . Van Beek (SEA ,, (SEAL) * a dra L. Van Beek AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) 14�- T16T"vi n un�r ) ss. authenticated o N OTARY PUBL IC St. Croix COUNTY ) STATE OF WISCONSIN * Personally came before me on September 7, 2007 , TITLE: MEMBER STATE BAR OF WISCONSIN the above -name er A. Y.In Beek and Sandra L. Van Beek (If not, to nown be the rson(s) who executed the foregoing authorized by Wis. Stat. § 706.06) i trument d ac le the same. THIS INSTRUMENT DRAFTED BY: Attorney Doug Berg ary Public, State of Wisconsin 1200 Hosford Street, Suite 201 Hudson, WI 54016 y Commission (is permanent) (expires: 6 — 0�d ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED © 2003 STATE BAR OF WISCONSIN FORM NO. 1 -2003 * Type name below signatures. S T CRD�X CO PLANNING & ZONING I EROSION & SEDIMENT CONTROL PLAN Site location: 532 Valley Court, Lot 2, Town of Kinnickinnic Owner(s): Shane and Jennifer Becker Parcel ID #04.28.18.57A -90 Code Administration 715 - 386 -4680 Under St. Croix County Zoning Code 17.70(3)(b) 5: "The (Zoning) Administrator may attach reasonable erosion prevention conditions to a permit approved for issuance." In Land Information addition, Wisconsin Uniform Dwelling Code Comm. 21.125 requires the building permit Planning applicant and /or landowner to follow erosion control procedures and maintain them until 715 - 386 - 4674 the site has been stabilized (Uniform Dwelling Code Comm 21 is available on -line at: www. commerce. state. wi .us /SB /SB- DivCodesListing.html) Real Property 715- 386 -4677 The Owner of the above parcel is responsible for notification of all contractors performing construction activities on this site that an Erosion & Sediment Control Plan is in effect and the Recycling following activities will be required in order to maintain compliance with the plan: 715 - 386 - 4675 1. Maintain existing vegetation wherever possible to minimize erosion and sediment movement. The primary source for construction site runoff will be the house foundation excavation, driveway, well drilling, and soil stockpiled until final grading and stabilization is complete. Septic system installation adds to temporary disturbance, but establishing cover on exposed soils will prevent erosion. Apply seed and mulch as recommended in #4 below. 2. Install construction entrance before any excavation begins!! Construction equipment and vehicles must utilize a stabilized driveway access off public road for heavy equipment; this includes cement trucks, well drillers, and other contractor's vehicles that require access to the property during construction. Avoid muddy, rutted conditions that may allow contaminated runoff to reach waterways and /or drainage ditches. Property owner must repair damage to ditches resulting from multiple access points and sediment tracked on public roadways must be removed at the end of each workday. 3. Do not allow contaminated runoff to be directed onto neighboring property or into surface water conveyances. Create temporary diversions graded ALONG CONTOUR between excavated areas and any potential receiving waters (this includes driveway & road ditches) by routing contaminated runoff into vegetated buffer areas on owner's property. (Refer to specification sheet for temporary diversions available from county). 4. Stabilize exposed soils (septic system included) with seed and mulch immediately after installation - do not wait for final stabilization and /or landscaping of entire site to establish permanent cover on the site. When late - season weather conditions will not permit seed germination, a heavy straw mulch cover will prevent erosion until vegetation can be established. Erosion control matting can be applied any time of year and, if installed properly, will provide protection even if seed germination is delayed. ST. CROIX COUNTY GOVERNMENT CENTER 1 10 1 CARMICHAEL ROAD, HUDSON, W1 540 16 715 386 - 4686 FAA Page Two — ESC Plan Acknowledgement Form The owner of record during site construction will be responsible for compliance with state and county code requirements as specified in this Erosion & Sediment Control Plan. Please feel free to contact me with questions regarding erosion & sediment control product installation. PLAN PREPARED BY: RYAN YARRINGTON, ZONING TECHNICIAN #683475 4 Owner acknowledgement of ESC Plan requirements: //2007 (Please sign and return original ESC form to Planning & Zoning Dept. A copy is attached to the owner's permit and maintenance agreement, which is given to the plumber at time of permit issuance.) Copies provided for excavation contractor, plumber, and town building inspector ST. CROIX COUNTY GOVERNMENT CENTER 1 10 1 CARMICHAEL ROAD, HUDSON, W1 54016 715 -386 -4686 FAA