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BM Elev: BM Description: Section /Town /Range /Map No: /0V o T' 06.28,18.91B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. t ! ( • /OD • U /0 6 0 Benchma e c,� � f v x 1 p Z. /00. b Dosing �QU Alt. BM Aeration Bldg. Sewer Holding SVHt Inlet O� o TANK SETBACK INFORMATION SVHt outlet S• TANK TO P/L W L BL Vent to Air Intake ROAD D I�IeL V 1 Septic Dt Bottom Dosing �0 ' Head r /Man. ux 2ZV 2 V � vtso (�•'7b d /..s� Aeration ( I'� —�2� Dist. Pipe �• 7� o/ �� Holding Bot. System F inal Grad PUMP /SIPHON INFORMA / t s 5�, w�- Manufacturer Demand St Cover GPM 1;i;, /D /- 7F Model Number 6, V 32 .s'Y 99 TDH Lilt Friction Loss System H Pad TD� ,Ft -3-0 Forgemain L gth / Dia. _ N D ist. to Wel > 2 � r tu lloni o S IL ABS RPTION SYSTEM BEDITRENCH Width Len th No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS . , �� 70i SETBACK SYSTEM TO 15,L IBLDG IWELL LAKE /STREAM LEA Manufacturer: INFORMATION Typ O System: / / 7 CHA *B"R`0R — UNIT Model Number: DISTRjOUT SYSTEM Head !Manifold Distribution / x Hole Size / x Hole Spacing I \tdnt to Air Intake r/ Pipe(s) // 3 r I ' ; l� 2 ";5 Length Dia Length 7 � Dia I Spacing 1 7 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded 1xx Mulched Bedfrrench Center Bed/Trench Edges Topsoil es 0 Yes No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: / / Inspection #2: o � Location: 515 90th Street Hudson, WI 54016 (SW 1/4 SW 1/4 6 T28N R18W) NA Lot 1 �oC �` J �0� Parcel - :: 06.28..188 B 1.) Alt BM Description = // ' 2.) Bldg sewer length = j,y,� y1.1 - C'6'l!'Y" - amount of cover = - 5 L Plan revision Required? [] Yes o rnature Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's S Cert. No. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix Safety aad Building Division INSPECTION REPORT Sanitary Permit No; 463086 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: Hanstad, James Kinnickinnic Township 022 - 1015 -80 -100 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 06.28.18.91 B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. A 9.0 q Septic / / / U V 0 W,'1 / hm t 1?t li'2 l�1 Ph Dosing � Alt - �d�► -L. l � � Z� � ` t' It B Aeration U Bld Sewer /o Holding St/Ht I nlet Outlet TANK SETBACK INFORMATION TANK TO t P/ Wi WELL BLDG. _ y2n1jo Air Intake ROAD Dt let Septic �' n / 2 1 f Dt Bottom Dosing ' - Header /Man. Aeration Dist. Pipe Holding Bot. System PUMP /SIPHON INFORMATION-Y—QQ, -71? Final Grade Manufacturer / Demand St Cover 4 1 Zoo GPM ZU4 9Z 3.3 Model Number 1 5'i" ��''� N TDH Lift Friction Loss System Head TDH Ft �IQ L ,i /Z 3 � 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 IDistribution 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 SeededlSodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes .'i No Yes a;„ No LJ ❑ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 0 / 0 8 / Inspection #2: Location: 515 90th Street (Boundary Rd.) Hudson, WI 54016 (SW 1/4 SW 1/4 6 T28N R18 P/) NA Lot 1 Parce o: 06.28.18,,918 1.) Alt BM Description = 6ohGL�E+;'G vv"kav4- ��c !/hS�GIJ�'Ytie = 2.) Bldg sewer length = (9Q of - amount of cover = , >G ► wTU�" Plan revision Required? 11 Yes No Use other side for additional information. SBD -6710 (R.3/97) f / Date Insepctors Signature Cart. No. Q� rt �KA ZCOs i Pam Quinn Subject: 463086 Hanstad /Fogerty new tank shots only Location: Boundary RoaCKinc is Twp Start: Thu 1 0/28/200 End: Thu 10/28/200 Recurrence: (none) take pumping agreement along for owner to get signed and submitted i dL 3 g36 0 i f � t0 6 YAW f 1 I t - FOGERTY PLUMBING & PERK TES 28288 McKenzie Rd. Spooner, WI 54801 (715) 635.9609 Fax (715) 635 -5286 // 1 E r�sfr� f 7 /V �4i716ri► CV Cesrfarcfy�e�i(sT le11710 3 2ES�oivs� = T ' d 98Z5S69S T G i 91d I awnld A18390J e8Z = 80 SO G T 430 ....,,�,, ......a...� o..........,..,, . in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include. but not limited to: vertical and horizontal reference Point (BM). direction and Parcel I.D. _ �/ - O.. `� _percent slope, sale or dimensions, north arrow. and location and distance to nearest road. R Date - Please print all information. ` pomw " ym tsowee mar be used #or iraoindaY P A110— ?--V L— s 15 W (t) tm)1 4*� Property Owner Property Location GovL Lot 1K 114'S T _2 N R E (or� L — Z Lot # Black X �rItE a or CSM# Property Owners Mailing Address Sta� umber ❑ GkY L] YI D &T t Road City �y ST 0' beew C�tn,r�on t�se: Residential i cumber or bedrooms 3 Code demred design flow rate ySo GPD [f'Replaeement ❑ Public or commercial - Describe: R Parent materia D l QO-Id SILT � /f'j /, _ z Flood Plain etev-ation if applicable 4 l¢ General cotnments W a&AI A and recommendations: F—/1 Bing * Boring ! 4 Depth t 1 "rtntin9 m ' Sal Application Rate ©Pit Ground surface elev. �„�1 -i•—• Roots GPD /f' Texture Sbucbrrc Consistence Bwxhdary f3 •Etf#1 •Eff#2 Horizon Depth Dominant Color Redo: Desarpbon Gr. Sz- Sh. in MUSS" Gu. Sz. Cont. Color _ _Z Z r L G - .6 .8 I 1 s,-- L 3 -2 - 3 • ei - GL a Boring # Q Boring Ground Widace etev- .IL Depth to imiting bcuv Sol A �� P11 Roos GPDW Horizon Depth Dominant Color RedoxDesaip�n Texture Struclum Corm Boundary •Effilll •Eff#Z in. Munsefl 4u. Sz- Cont. Color Gr. Sz. Sh. Z t Ifit �L / a z wryer � ,rfrr,�t+s�L e 4Urs I r .ri f� s�.vD • ,- > t5o mat. uent,>#2 = BOD, c 30 mg/L and TSS < 3o mat: - - Etfluent #I = SOD, y 30 c 220 rthp/L and TSS _ CST Number CST (NSMI Print) �, Z e Date E Concluded Telephone Number Address Fogerty Plumbing & Perk T stirs z�� 28288 McKenzie R 2 ,vex f wI s 2 "d 982SSE9S T L T ow I awn A-LN390A e82:80 GO LT 400 Page of 3 Parcel 1D d _ Property Owner ❑ Boring > factor ? in c� Rare 3 Boring # [a Pit Ground surface elev. 7 S� ft o � Roots GPDW pan;nanf �� Sz Redox DesriiDt� Terre Structure C Boundary - E1fB 1 - ERp2 • � Depth Gr_ . Sh. MunseB Du. Sz cart. Color 3 L 2 .3 3 - a S<L a ❑ �'i^9 Dep1h to f" ilkV factor _ a in. S Rate Ground rod surface elev. Z 9 ft GPOIN Pit Structure Consistence Boundary Roots Redoz pe�tfon Texture -EffM1 -EINl2 Horizon Depth Dominant color Cr_ Sz. SIL in. Ma p ou. Sz ConL Color . G factor _- -' lion Role 0 Boring Ground surface elev. „ Depth to fat►ifin9 Roots Soil GPD1tF ILl Pit Refloat D�P�^ Texture Structure - Ettft2 Horizon Depth Dominant Cu. Gr. Sz in. Munse Sh- ll Ou. Sz Carl Color i Effluent 01 = BOD, > 30< 220 nrglL and TSS >30 < 1 5 0 un9/L - - Effluent AI2 =. Boo, _< 30 mglL and TSS :5 30 rr4L C o mme rce is 81t equal opportunity service provider and employer. O� Icod�Yt6�8 264 8�� Services os The Department of C lease contact file deparfmc0 need material in an alternate format, p 6 - 01 913ZSS69S T G T 9N I Ewn1d A18300A 0 62:80 SO LT 400 . 1 _ s Fogerty Plumbing �. #221180 ` 282P8 P- AcKenzie Rd. Spooner, WI 54801 ` s - (715) r !!� liaJ�.r/ wrl ✓t D f . L/7 1�• !•� /3s ' sc�+� d O lf[.f 8,rr, sf qe rT i/ir L " • lyiOp 75 LL = �� r.✓� d7_11 �sT ' 4QO ' C'nrye I rte ` �wirE V a Q - )N = C.WL4 S»' . ;R91a4 Hwy S .sfT aF ,�xrs r�r� ysrrsw- � 7. // loo•n ' ® = •�U s Yfl�crs i T�.vKS - c/e AtXE��_ Q = �,�o�s� = v .vE a✓ � s me s � � p�� /� a . = wo�v F.trx� f1vs73 b - -A> "0�T6D /10 ` NNr✓ of parE = oLG � 9J A %f•D 9pR b'd 9BZSSE9STLi JNIawnid A18390J e62 =BO SO LT 430 Safety and Buildings Division County 1 ashinon Ave Bnx 7162 i /{ �S Donsil 26 1' '`7 Y _' F g itary gt Permit Nu�mb -7 (' I �ed in by Co.) Department of Commerce I �/ ( 13 Sanitary Permit App -on Pan LD. Number fta In accord with Conan 83.21, Wis. Adze. Cade, personal inf on you provide maybe used for secondary purposes Privacy Law, s15. 1 xm) Prr Address (if different than mailing address) I. Application Information — Print All Information __ 51 5 - 0 S�• Property Owner's Name Parcel # Lot # Block # Prelfe Owner's Mailing Address Property motion �? ' !Lt Y., ma y., Section e City, State Zip Code Phone Number le _ T R_/tE ) H. Type of Builditig eh all that apply) 3 4 CSM NumbeF V or 2 Family Dwel ling — Number of Bedrooms 3 __i=:C- 4 3 R V ❑ Public/Commercial — Descn'be Use C ❑ State Owned — Describe Use 2AA , 4,, U, � wnc ❑City ❑Vil �19fownsnip of III. Type of Permit: (Check only one box on line A. Complete lineB if ap plicable) A. ❑ New System P4eplacement System ❑ Treatmeat/Holding Tank Replacement Only ❑ Other Modificatiou to Existing System B. ❑ Permit Renewal ennit Revision ❑ Change of ❑ Permit Transfer to New List Previous Perrn*t Number and Date Issued Before Expiration t 'K .� (� _ Plumber er IV. im of POWTS S stem: Check all that a ' (I Non --ftessssurvred In- Ground ❑ Mound >_ 24 is of suitable soil Mound <24 m. of svitab1c soil ❑ At -Guide ❑ Single Pass Sad Fitter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip lane ❑ Gravd Pipe ❑ Other (explain) / A V. Dispersalfrreatment Area Information: Q Design Flow (gpd) Design Soil Application Rate(gpdst) I Dispersal Area R *red s Dispersal Area (s() System Elevation IVIM �n S' < <p Fl( S - U 295' yso , /3a i 1 VI. Ir ank Info Capacity in I Total Number Manufacturer Prefab I Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass Talcs Tanks / Septic or rank v Aerobic Treatment Unit Dosing Clamber ! VII. Responsibility Statement - 14 the undersigned, assume responsibiftfor installation of the POWfS s h wo on the attached plans. Plumber's Name (Print) Plum s Signature e __ 11�i1vIPRS Number Business Phone Number /per v o T!S- 6-- omoo Plumber's Address (Street, City, S Zip ) z�.zr.P AS - 1—Y70- 17,37 VIII oun /De artment Use On Approved El Disapproved Sanitary Permit Fee (includes undvr� Date Tssv' gent S" wre (No Stem huge Fce) � 1 ! ❑ Owner G*ven Reason for Denial DL Conditions of Approval/Reasons forDisapprovai YSTEM OWNER: Q 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber 2. All setback requirements must be maintained �/✓gG J ,-,,'as per applicable code /ordinances Attach complete plans (to the County Daly) for the a on mot less than 81 :11 inches in size c SBD -6398 (R. 01/03) bye � �CII h+ 6 II u Y p A � r n R r x a Jam' g M o n H �o C 0� ga bw o c P A �O CA Safety and Buildings 10541N RANCH ROAD commerce.Wi.gov HAYWARD WI 54843 TDD #: (608) 264 -8777 isconsin www.wisconsin.gov isco ngovsbt Department of Commerce isconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary November 29, 2004 CUST ID No.224059 ATTIC• POWTS Inspector ZONING OFFICE KEITH E STONER ST CROIX COUNTY SPIA 23220 WOOD CREEK RD 1101 CARMICHAEL RD SIREN WI 54872 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/29/2006 Identification Numbers Transaction ID No. 1085765 SITE• Site ID No. 692682 Mark Uetz Please refer to both identification numbers, 515 90TH St L above, in all correspondence with the agency. Town of Kinnickinnic St Croix County SW1 /4, SW1 /4, S6, T28N, R18W Lot: 1 FOR: Description: Replacement mound, 3 bedroom residence Object Type: POWTS Component Manual Regulated Object ID No.: 993782 P.1 Maintenance required; Replacement system; 450 GPD Flow rate; 14 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01); SSWMP Publication 9.6 Con Design of Pressure Distribution Networks for ST -SAS (01/81)" All F The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes paRTI and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in of chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. (,tsl=- No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, SEE GC stats. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans and with the design manuals noted above. • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. Key Item(s) • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. KEITH E STONER Page 2 11/29/2004 • Materials shall conform to the requirements of COMM 84. • The existing POWTS must be properly abandoned per s. Comm 83.33 Wis. Adm. Code. • Insulate building sewer per COMM 82.30(11)(c). • Provide frost protection per COMM 83.43(8)(c). A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation /operation. 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 L Balance Due $ 0.00 h Patricia L Shandorf POWTS Plan Reviewer, Integrated Services WiSMART code: 7633 (715) 634 -7810, Fax: (715) 634-5150, M -f 7:45 am - 4:30 pm pshandorf @commerce.state.wi.us . cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 Fogerty Plumbing & Perk Testing, Inc. (Plans Mailed To) MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Mark Uetz Replacement Mound Owner's Name: Mark Uetz Owner's Address: 515 90th Street River Falls WI 54022 (715) 556 -9656 Legal Description: SW1 /4 -SW1 /4 Sec. 6 T28N R1 8W Township: Kinnickinnic County: St. Croix Subdivision Name: Csm Vol. 9 Pg. 2646 Lot Number: 1 Block Number: NA 7AW•T•S- Parcel I.D. Number: d , W o Plan Transaction No.: 0 RCE Page 1 Index and title 7)RRF_SP0NL)E BUILDI GS Page 2 Data entry Page 3 Mound drawings E Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan nn WISC0 Designer: Keith E. St r* .•••" "'•• N`�' /�y ° 'moo ; License Number: Designer# 1575 -007 Date: 10129/04 Y, •'•, phone Number: (715) 653 -2324 Signature: will •• Pura ?it to the � �O Mound Component Manual . ��6rersion 2.0 SDB- 10691 -P (N. 01!01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Version 3.11 ( R. 06/01 Page 1 of 8 r 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 soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of - 36 inches. 450.00 Design Flow (gpd) 5.00 Site Slope ( %) 99.00 Contour Line Elevation (ft) 14.00 Depth to Limiting Factor (in) 0.40 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 70.001 Dispersal Cell Length Along Contour (ft) = 6.43 Cell Width (ft) 1.001 Dispersal Cell Design Loading Rate (gpd /ft 1 I 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 3.22 Lateral Spacing (ft) If N above, enter the elevation ft 4 Number of Laterals of the highest point. 0.156 Orifice Diameter (in) (e.g. 0.25) 2.25 Estimated Orifice Spacing (ft) = 7.50 ft /orifice 2.00 Forcemain Diameter (in) 25.0 Forcemain Length (ft) Does the forcemain drain back? Y 91.50 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 4.08 Forcemain Drainback (gal) G • ? 8.83 Vertical Lift (ft) 62.80 5x Void Volume (gal) 0.56 Friction Loss (ft) 66.87 Minimum Dose Volume (gal) 13.94 Total Dynamic Head (ft) 32.31 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 x 1.50 x x 1.25 x 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons/inch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1000.001 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Weeks Concrete IManufacturer gal /in (enter result in cell B49) Dose Tank Information Effluent Filter Information 805.121 Dose Tank Capacity (gal) JZabel Filter Manufacturer 21.761 Dose Tank Volume (gal /in) JA1 00 Filter Model Number Weeks e s Concrete Manufacturer Project: Mark Uetz Replacement Mound Page 2 of 8 f Mound Plan View ---- - - - - -- -- - - - - -- t 1/1 0 B . .... ..:.:.:. 3 J . . . . . . Observation Pipe Q ' 1 K. — T 5 A W •...I . L . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....... . . . . . . . . . . . . . . . . . I .......... I .............................. . ........ 1 —4-40 L Mound Component Dimensions A 6.43 ft E Elft in H 1.00 ft K 11.36 ft B 70.00 ft F in z 12.16 ft L 92.71 ft D 22.00 in G J 8.15 ft W 26.75 ft 450.1 0 (ft Dispersal Cell Area 1 1301.59 (ft) Basal Area Available 6.43 (gpd /ft) Linear Loading Rate 1 7.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 102.63 (ft) —► G H F = =' Dispersal Cep 101.33 (ft) Lateral 100.83 (ft) Invert Dispersal Cell ' : d . Elevation E D ::::: :: ::::::: : :: : s .: • . .. • e f. . " .... � .... . x . �• ' x ,A x x 1 x A A x A A x Alld l a x A � x .! A A x A A �A� x A " A � A ! } ��. r . � �.��.. •. -•. ... • 4 ... 99.00 (ft) Contour Elevation 5.0 %Site Slope Geotextile Fabric Cover Shading Key CL Dispersal Cell See lateral details on Q Topsoil Cap c ii 1.5 ft m Page 4 for number, size, Q } llff Subsoil Cap w c and spacing of laterals. ©0 ASTM C33 Sand :6 F Laterals are equally Z 0.5 ft °m Typical Lateral spaced from the 0 Tilled Layer c w ren I distribution cells 05 "re�Q:• Aggregate 0 "� 5 I " r t centerline in the A * distribution cell (AxB). Project: Mark Uetz Replacement Mound Page 3 of 8 Center Connection Lateral Layout Daigram Force main connection via tee or cross to manifold at any point. Laterals are identical I P S i= Turn -up m ball valve or-- 3IExl2 I 021 Laterals & force main of PVC Soh 40 cleanoutplug per COMM Table 84.30 -5 Hales drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0. 154 in Lateral Diameter 1.50 in Orifice Spacing (X) 36 Lateral Length (P) 34.22 ft Orifices per Lateral Lateral Spacing (S) 3.22 ft Orifice Density 7.50 ft /orifice Lateral Flow Rate 8.08 gpm Manifold Length System Flow Rate 32.31 gpm Manifold Diameter 0 in Total Dynamic Head 13.94 ft Forcemain Velocity sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and —► Comm 16.28 WAC 4 in. min. Disconnect _ Tank component is properly vented :•: �— Alternate outlet location Forcemain diameter Weeks Concrete Manufacturer 2 in. Capacit 805.12 Gallons Volume 21.76 gal /inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 19.93 433.61 C B 2.00 43.52 P ump off elevation (ft) — t C 3.07 66.87 92.50 D 12.00 261.12 D Total 1 37.001 805.12 il I 1 Dose tank elevation (ft) 3" Bedding uncTer tank. 91.50 Alarm Manuafacturer IS. J. Electro Alarm Model Number I 101 -01 H Pump Manufacturer I Goulds Pump Model Number [iM71 EPO4 Pump Must Deliver 1 32.31 gpm at 13.94 ft TDH Project: Mark Uetz Replacement Mound Page 4 of ' Mound System Maintenance and Operation Specifications Service Provider's Name T ri- County Sanitation Phone 715 386 -0114 POWTS Regulator's Name St. Croix County Zoning Office Phone 715 3864680 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 450.1 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 month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Ins ect 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. 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: Mark Uetz Replacement Mound 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) and SSWMP Publication 9.6 (01181)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 113 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 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. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Mark Uetz Replacement Mound Page 6 of 8 Page 7 of 8 X GOULD S PUMPS Submersible Effluent Pump 387 EPO4 EP05 A o- Fult submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower APPLICATIONS g rade g e turbine oil for tic enclosed design for heavy duty ball bearing n Specifically designed for the lubrication and efficient improved performance. construction. following uses: heat transfer. is Casing and Base: Rugged • Effluent systems thermoplastic design provides AGENCY LISTING • Homes Available for automatic and superior strength and corrosion Canadian %mlards Aw,,wn • Farms manual operation. Auto- resistance. - • Heavy duty sump matic models include m Motor Housing: Cast iron (CSA listed model numbers end • Water transfer Mechanical Float Switch for efficient heat transfer, in "C" or • Dewatering assembled and preset at the strength, and durability. P� factory. colds ,nps is ISO 9001 SPECIFICATIONS ■ Motor Cover. Thermoplastic FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. '/4" maximum. ■ EPO4 Impeller: Thermoplas- m Power Cable: Severe duty • Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant. • Total heads: up to 31 feet. pump out vanes for mechanical • Discharge size: 1'/2" NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary BUNA -N elastomers. • Temperature: 104 (40°C) Continuous METERS FEET 140OF (60cC) intermittent. 10 • Fasteners: 300 series stainless steel 9 30 s GPM • Capable of running 2.5 rr dry without damage to 8 components. 25 a 7 W Motor: _ • EPO4 Single phase: 0.4 HP, `—' 6 20 115 or 230 V, 60 Hz, 1550 s built in overload with > RPM, b o 15 automatic reset. a 4 EPOS • EP05 Single phase: 0.5 HP, o 115 V or 230V, 60 Hz, 1550 `' 3 10 RPM, built in overload with EPO4 automatic reset. 2 • Power cord: 10 foot s standard length, 16/3 1 SJTOW with three prong grounding plug. Optional 20 ° ° 0 10 20 3o ao 50 GPM foot length, 1613 SJTW with three prong grounding plug 0 2 4 6 8 10 12 m (standard on EP05). CAPACITY G oul d s Pumps ITT Industries ®2D01 Goulds Pumps <& Effective May, 2001 83871 I b rA � rA is t; b 0 d m r x w g w O I I Z Q 4b bCLR�SC' n V A y�C d r 00 00 �q ... c z N 0 $ o sw v o ° 0 x ° ° o ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer J MA 03- (�- �N s r ar C) Mailing Addles A0 13 l• -� A tj • 4 �� 3 Ren awto„i e. W l ref '1 Property Addr ew Is 4 � U +A S A ( Verification required from planning Dep rttnent for new construction.) City /Statt Parcel Identification Number Os 1— /o/ S' fp — 44 0 _ LEGAL DESCRIPTION Property Location rrtj %. , Cr&/ Y Js , Sec. _ , T N Rf -W, Town of Subdivision - , Lot # Certified Survey Map # °� 5 D a l Volume Page # VV— Warranty Deed # 7 2 S Y 7 I - , Vol ante zL t!, f Page # fk _• Spec house yr» Lot lines idcm0able 0 no ky TIEMMAI MMANCE v Improper use and maintccance of your septic system could result in its pretasum failure to handle waWM Proper miitttaaaee consists of pumping out the septic tank every three years or soon,[, if needed by a licensed pumper. What you put into the "an can Mel the function of the septic nark as a treatment stage is the waste disposal system. Owner ossiataarsaoe raspoo dWj'dw we specified in j Coamtn 93.51(1) and in Chapter 12 - St. Croix County SWUM Ordinance. The property owner agrees to submit to St. Croix County Zoning Depwb=K a cortificatioa fo. signed by the owns and by a master plumber, j oumeymao plumba, restricted plumber or a licensed pumper verily ng that (1) the on -site wastewater disposal system is in proper operating condition antd/or (2) Acr inspection and pumping (if necessary), the septic tank is less than 1:3 fitU of AMP. Itwe, the undersigned have read the above requirements and sgroe to maintain W privau ac disposal VOM with drc standards set forth, heroin, as set by the ,Department of Commerce and Ste Department of Natural Resources, Stale of Wisconsin. Certification atatirtg that your septic system has boos noiai insd roust be eo.upleted and returned to the St. Croix County toning Departm oat within 30 days of the roe year expiration date SIGNA LA"ILJTC DATE OWNERCERUELQ certify that an one are true the best of myiour knowledge. Uwe amlare owaer(a) of the deserebed a e y din Register of Deeds OtHce t — r?7i o 5� SIGNATURE OF APPLICANT DATC •� "��• Any intenration tbal is rolarepresented may rasult in the sanitary permit being revoked by the Toning Department. Include with this application a stamped warranty dean: ftom the Register of Deeds Office and a copy of the certified survey amap if reference L made in the warranty dead. 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CROIX COUNTY �- WISCONSIN ZONING G OFFICE ST. CR91X COUNTY GOVERNMENT CENTER �, NN�MMNNNN - M�■ � 1 Q ZQdQ 1101 Carmichael Road • - Hudson, WI 54016 -7710 -= 6 , sT 0 "" ) 386 -4680 Fax (715) 386 -4686 wut \ UEST FORM " y SEPTIC INSPECTi�ON/ Wig Please specify desired test ri j�2h s) &remit a�pcp� application. Outside water lines are often turned off during winter months, making access to the home necessary. Please make arrangements with this office to insure that entry can be gained. erW er (VOC's) $200.00 55.00 ❑ Nitrate r (Nitrate & Bacteria) $ & Bacteria retest $15.00 Q'V�late ❑ Water (Lead concentration) $ 21.00 �1 Owner. C-7. TO S oh Requested by: hejA { - A» tv 21 �� j�J Address: uvt ( J Address: 2 S �a ran r �• /Wsom, ,d s�o� _ 4 Pau! , s�rc 9 Telephone M (` ) cf-2-0-(pS4 3 Telephone #: Property address (Fire # & Street): cr'/S 90 St , 14- UAV14 Cd L SZ 4 0 ( O '4 S- '/,,S � N, R _ 1� W, Town of Krhn� >L Location � � /, � .�� T Computer #: a'� - �'� I� $ 6(��_ Parcel #: (o- ?� I S • � i A _- Realty Firm: Lock Box Combo: Closing Date: / Zs O TO BE COMPLETED BY PROPERTY OWNER E *PROVIDE A SKETCH OF HOUSE &SEPTIC SYSTEM ON REVERSE OF THIS FORM Water sample tap location: I V75 r -& Is the dwelling currently occupied? ❑ Yeso If vacant, date last occupied: I l/49 Age of septic system: Septic tank last pumped by: Date: Previous Owner's Name(s): Have any of the following been observed? ❑ Yes ❑ No Slow drainage from house. ❑ Yes ❑ No Sewage back -up into dwelling. ❑ Yes ❑ No Sewage discharge to ground surface or road ditch. - ❑ Yes ❑ No Foul odors. Other comments relative to system operation: I certify that the above information i complete and true to the best of my knowledge. OWNERS SIGNATURE: DATE: PLEASE SEE REVERSE SIDE 0 y 0 3 v 0 r� .� d �/1 CD a ... 0 g 3 X cn z cn v 3 z o O. 0 tv CD N N O 0 su O N N O tD 7 O N lye, 3 CAD N 0-4 C 1 CD CD CD D ` m CD (� N \ t2. N p n N c0 m ;c O � A C 7 C j 0 C 3 C CD 0 j co O ok N O 0 7 0 CU 7 F CD 7 "! O -0 3 7 j 0 -0 3 7 ]• N n N O N N C 0 N 40 p W 0 O 3 3 cn z cn D (n Z U) D m a e CD c�' D c o N CD cn D a N N d cn C C: Q Q N W a CD N W ' O co 3 O O 3 O O o s CL cl O CD O N CO CO p C N N w W 3 ,. 6 N o �+ Oro O z o z O O O a Y j 0; o m C) o m � z <� z to N �_ �; N ;u D N •+ CD CD 3 N^ w CD C CD r T a G FL � O K N CD O_ K w A ? A O N A 0 N d• c CD O- N 1 fD C1 I C CD ty 0 co � CL a 7 O z z K — 0 o C W c+ a Sh 7 CD 0 j K c 7 cn'O fD O c 7 fn -o CD O 7 a C 7 p' C�O 0 7• 25' (nN S O a O O N fD p� 0 R 7 N p 0 0 0 C i CD N N N p_ CD N CD N N a n C D o N� o D c N� o w �Ca3 0 �� -100.3 0 �' 0 a J� O N N 3 3- C T O N N 3 o o 0_ CID o 3 0_ p 0 (D N 0 N 0 N N =h 00 N w A z O A O C co d�• a C W0�• fD G 7 7777 7T� N CD W 7 v 7 (D W 7 ( O y 0 y 0 O < O fD G) CD :E N G) cD :. a Z 3 N S 3 CD 3 00 3 < � O Cn O O O N w G E En x N 01 C D D 3 O C c O N 7 -0 C1 O c E' O N 7 - 0 O- CD N. . N . 5 71 N (1 y. cn c < O x O_ N O CD (n A CU j 0 O_ N O CD ? N >' 7 �1 0 CL to x CL cp 3a Z 4 �C CD D < 3az a - O 0 7 CD O O 3 O= fD O O C M 0' CC Vi > 7 t CL O C0 N > > y o =r. a 0 s. a O .0-. N N ` j 0.+ c CD O CD `G : CO 3 x 0 0 O N 3 x 0 0 m N c 3 o c Wi n o 3 c :3 =7h CD m m aCC m -n m v o -0 0 � � m F; CD C N o o 3 a CD o o 3 a F' aav QCLCL s a o CD p (p Z p n CD N N O 7 0, CD N O 7 o CD vv 0 n CL o O N N O N CD A 3 3 0 0 N CD C ~ q O O O O O O ~ C a O O CL O O s. ti STC — 104 AS BUILT SANITARY SYSTEM REPORT OWNER JG�wes ADDRESS Sf5 qa" S 06, 2 f - I F. j13 g0 /OD CSC I - gl3- - 1l o SUBDIVISION / CSM# rJ l?- LOT # w 0 SECTION�T ,2 9 N -R W, Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM M v 0 1400'( 7 i g5 INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ALTERNATE BM: Tbn q �.�o, \! E Cc,,.t.- Po k q,� SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION se /ego Manufacturer: Liquid Capacity: nk 960 Setback from: Well House Other Pump: Manufacturer Model # Size Float .. seperation .. Gallons /cycle : Alarm Location - - 4 .SOIL ABSORPTION SYSTEM 4: Width: Length , S Number of trenches Distance & Direction to nearest prop. line: Setback from: well: House 1 S Other �L ' ELEVATIONS A' Building Sewer ST Inlet; ST outlet. PC.inlet PC bottom Pump Off Header /Manifold Bottom of system Existing Grade Final grade { DATE OF INSTALLATION: -'� PLUMBER ON JOB: LLCENSE; _NU.M_BER; A - INSPECTOR f'"" �`3/93:jt. -,fa -; Lf1i it artr t I n I3NIC 6.28 l&&WW' I.&REET County: Labor a.VL Human Relations INSPECTION REPORT Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Permit Holder's Name: ❑City El Village [Town of: State Plan ID No.: Insp. B M EIev.: BM Description: Parcel Tax No.: 1 5 J��:� _ ,�� TANK INFORMATION LEVATION DATA A93000776, ,, TYPE MANUFACTURER CAPACITY STATION BS Hl FS ELEV. Septic �, ,., Benchmark /vo Dosing ;- Aeration Bldg. Sewer Holding St /Ht Inlet 13,0; y_ba. TANK SETBACK INFORMATION St /Ht Outlet 13, g q Y TANK TO P/ L WELL BLDG. Airi to ntake ROAD Dt Inlet /3. c l t/ Air I 8• Septic �qD ) /00 dg/` 1/8' NA Dt Bottom 175 85, Dosing > >�� a 5 >�5 NA Header/ Man. Aeration NA Dist. Pipe a , /o6, ( Holding Bot. System , ty 166.b3 PUMP/ SIPHON INFORMATION Final Grade Manufacturer :�9W4 Demand ; • . , U ql Model Number ki /e,7 GPM TD H Lift l S Friction Heaem S TD44 Ft Forcemain Length Dia. 3 /1 Dist. Towel SOIL ABSORPTION SYSTEM BED/TRENCH Width / / Length �, No. Of Trenches PIT No. Of Pits Inside Dia. iquid Depth DI MENSION S 7 &)- DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manuf turer: INFORMATION Type O CHAMBER Moe Number: System: %Yt G v_ OR UNIT DISTRIBUTION SYSTEM Header Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia- Length 4 / Dia. r yr: Spacing v/ / qQ If ) l SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over A xx Depth Of xx Seeded/ Sod4ed- xx Mulched Bed /Trench Center Bed /Trench Edges la Topsoil O'Yes ❑ No tq-�es ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION KINNICKINNIC 6.28.18.91 SW,S TH STREET 4 Plan revision required? ❑ Yes M Use other side for additional information. SBD -6710 (R 05/91) Date Ins cto( Si ature Cert. No. ADDITIONAL COMMENTS AND SKETCH i SANITARY PERMIT NUMBER: SANITARY PERMIT APPLICATION couNTY L I OILHR In accord with ILHR 83.05, Wis. Adm. Code STATE SAN TARY PERMIT -Attach complete plans (to the county copy only) for the system, on paper not less than / j 8%x 11 inches in size. 1:1 Ckeck revisio us application -See reverse side for instructions for compl eting this application. STATE P N I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. fi c7` s PROEERTY OWNER PROPERTY LOCATION t'l a 4 a S w� Y4 S (�► %a, S T. , N, R 1 (or) W PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # S `to tv w C14 STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER t I. TYPE OF BUILDING: Check one CITY NEAREST ROAD I ( ) ❑ State Owned VILLAGE WWN OF: kin�r,,��k�,w<< q t sr ❑ Public ®1 or 2 Fam. Dwelling #l bedroom R ELTAX NUMBER( S) 111. BUILDING USE: (If building type is public, c eck all that ap O ((q j s _G p 0 1 ❑ Apt/Condo 2 ❑ Assembly Hall 6 Medical Facility /Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 El Merchandise: Sales /Repairs 11 ❑ Restaurant/Bar /Dining 4 ❑ Church /School 8 H Mobile Home Park 12 ❑ Service Station /Car Wash 5 ❑ Hotel /Motel 9 Office /Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ❑ New 2. X Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System j Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously i sued. Permit # — Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 11Aound 30 El SpecifyType 41 El HoldingTank 12 ❑ Seepage Trench 22 11 n- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit 3 ressure 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2, ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) P OPOSED (sq. ft.) (Gals /day /sq. ft.) (Min. /inch) ELEVATION o rt � � 50 1�2 S 0 1. 5 3 106 0 6 Feet / U Feet VII. TANK CAPACITY Site in gallons To 1 # of Prefab. Fiber- Exper. INFORMATION New istin Gall ns Tanks Manufacturer's Name C oncrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank 1000 p v ( i c Lift Pump Tank/siphon Chamber QL! d [ c �S C tl n VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for inst illation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumm�ber' Signature: (No Stamps) MP P�o.: Business Phone Number: C Ar� tt5t (1ct zr 3 �/ S �t )7S Plumber's Address (Street, City, State, Zip Code): 1 04 -2 S VwcL ; , IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved Sanitary F ermit Fee (includes Groundwater a e Issued Issuin Agent Signatu Stamps) Approved El Owner Given Initial 0 Surcharge Fee) Adverse Deter ination v ✓ �✓ X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1., A sanitary °permit is valid for two (2) years. 2. '; Your sAnitaryipermit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. '3. � All revisions to this permit must be approved by the permit issuing authority. 4. - ChAhdes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608 -z66- 3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete ## of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested in ##1 -7. VII. Tank information. Fill in the capacity of every new and /or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. _ GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground - water contamination investigationsand establishment of standards'. 7 SBD -6398 (R.11/88) • SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations PRIVATE SEWAGE PLAN APPROVAL Western Regional Office 2226 Rose Street LaCrosse, Wisconsin 54603 CARL P HEISE 1024 S MAIN ST RIVER FALLS WI 54022 RE: Plan Number: S93 -40195 Date Approved: April 30, 1993 Gallons Per Day: 300 Date Received: April 29, 1993 Project Name: RAY, JAMES & ELAINE Location: SW,SW,6,28,18W Town of KINNICKINNIC County: ST CROIX The lumbin plans and specifications f is project have been reviewed for ons or th r p g p p p J compliance with applicable code requirements. This approval is based on Chapter 145, Wisconsin Statutes and the Wisconsin Administrative Code. The plans are stamped 'conditionally approved'. This approval is contingent upon compliance with any stipulations shown on the plans. All items that are noted must be corrected. All permits required by the city, village, township or county shall be obtained prior to construction. The licensed plumber responsible for this installation shall keep one set of plans with the department's approval stamp at the construction site. The installer shall notify the appropriate inspector when inspections can be made. This approval will expire two years from the date approved or if a sanitary permit is obtained, it will expire the day the initial sanitary permit expires. The Section of Private Sewage has reviewed these plans for private sewage system code requirements only. These plans have not been reviewed for the code requirements set forth in Section ILHR 82 for general plumbing or in Chapters 50 -64 of the Wisconsin Administrative code. This approval is for the following components only: - REPLACEMENT MOUND Inquiries concerning this approval may be made by calling (608) 785 -9348. Sincerely GERARD M. SWIM Section of Private Sewage Division of Safety and Buildings PPP039 /0009n/16 cc: Private Sewage Consultant SRD -6423 (R. 61 /e i ) M 1 MOVE THE EARTH :. AILPORT EXCAVATING 1042 South Main RIVER FALLS, WI 54022 CARL P. HEISE (715) 425 -2175 Owner Q L -.. MOUND SYSTEM FOR A BEDROOM RESIDENCE LOCATED IN THE w OF THE �� _kja�i OF SECTION �, T RAW, TOWN OF k;w , __ S7. CKOi�i _ COUNTY, WISCONSIN. INDEX PAGE 1 of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN .PAGE 3 of 6 PLAN VIEW -CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 3 of 6 PUMPING CHAMBE2 PAGE 6 of 6 PUMP PERFORMAN:E CURVE PREPARED FOR JAMES - ELAINE PW 5 H40SOU W ( 54016 PREPARED BY � ` - (mil f �la,�• CARL P. HEISE CST -3314 MPRS -3373 1042 SOUTH MAIN RIVER FALLS, WI 54022 p, 2 Plod" ?LAN Bo * Aeve- IP v ` l� SCALs t ". qo 14 ph • v f3 8 v� 8► p,ltt t8 a v2 col !i L et $oX. Q `JSMhK t:Z. 100.0' oY 5 ��C53 Cor» paoT PaS'yr.rt 0.bo w eEKS gtoL. -I Soo 9a� P--f chawlbo w c0k,s p�L i000 9w1scp'fe� • Tap tonCw7c fo,r�.�4�'�0� oL.98.� H oene. ©G'4:yT To , i � ./ ID a' e.n °ems r, ofd• �� •,s10 of SR D WELL. s� 6°aa Ap��vEn Synthetic Covering isiribution Pipe Medium Sand I • ^..., _. Topsoil �..,..... ��c . o E 100.0 pFil"VATE C id tionitty Bed Of Z — 2 ;i Forc'e Main Plowed Aggregate From Pump Layer Deq. OF itv)tISTRY, LABOR 6 JJWSAN RMATIONS t) DIVIS ON OF SAF NI) BUILDINGS � Cr Section Of A Mound System Using E ---'� SEE PONDENCEA• .TKEgC0. For The Absorption Area F G 1 "0 fit". i -sFt. H l.�. ' Fi'• r� oTF ; Qeea,,se oi' T�- s4"tra. rC4 '•'t.� -r-�— $0;)S S ex�i To: ey1 Ft. w► basal a to A- 7o +1 j Ft.' g pc J , _ Ft. "54 K• 13 Ft. L 8e:�, Ft. -f or e- - m ain T OC....tlw W 6 Ft. eN1 c,f MAN L J Observation Pipe ---., I B K Distribution Bed Of Z�— 2' Pipe Aggregate Observation Pipe Permanent Markers A05 a Plan View Of Mound• Using A -Bed For The Absorplion Area 91 9 T r ff t F at cwa w� ML�� it.cr �Gr+�'►cwaa� M a► ke r ' P 15''frm, EtiJ a'1 62.49T ROLE T.u.c 1 &NV chr t X x IS ��v♦ 11016 I' P 6n ROME E D A— —)14 L aTFQAL DIA L .rC �.V • PAG E OF PUMP CHAMBER CK055 SECTION AMD SPECIFICATIONS ' - VEIJT CAP ►J 4 q y�C.I VENT PIPE WCATHCK PROOF APPROVED LOCKIWG 55 ' FROM DOOR, JUAICTIOW COX ' MAIJHOLE COVI`K It'MIU. .�; 2 INDOW OR FRCSH I AIR IUTAKE I -`' GRADE } 4 AIM. Ie'MIIJ. COUDUIT — �= "; IO'PIIN. � co �t�1 oC �. IIJLET n T SEAL -- -- ON& ism APPROYCO JOIWT A I I I APPROVED JOIIJ 11{1I� I W IV w /4.x. r,PC � a� BUS as I ► I /c =. PIPE CXTENDIIJ6 3 1 pusisl , I II ALARM EXTE DIIJCo ' OUTO 60L10 &OIL o fit. S OF ' t l i - I i ON LLCY: _ _ J . Or F CO&iCRETC BLOCK 3" IIPPRflv RISER EXIT PERMITTED OIJLy IF TANK `MAUUFAGTURi~R HAS SUCH APPROVAL. gE SEPTIC , __SPEC_IF'ICATI0 S I~F KS CohC Prn� q �b•�� ,. T TANK MAQUFACTURCM. Z IJUMBER OF DOSES: PEE DA4 c TANK WZC:��" V GALLO DOSE VOLUME r AL MAUUFACTURER IucLUOIN 6ACKr�.ow: r - U G ao GALLONS MOOCL IJUM6CR. Wo V CAPACITIES: A =�UJCHES OR ,444.09 C,ALLOU3 �c SWITCH TyP6: $ = INCHES OR / °,q GALLOltIS U ?.0 FLL�YL C +' 5 INCHES OR 101. bMCO1J F'UMP MAIJUFAGTURCR : ... , C{ S MODEL mumuR: =R� Du - 1 2,.__ INCHES OR .2184... GALLOlJ6 SWITCH TYPE: - ME��.�4.1�`L u.TE.: PUMP AMD ALARM ARE TO BE ' I �. 2 IN5TALLED OW SEPARATE CIRCUITS MINIMUM DISCHARGE RATE GPM " r .V ERTICAL. DIFFERENCE DETWELU PUMP OFF AIJD..DISTRIBUTION PIPE.. FEET t= /'tI1JIKUM NETWORK SUPPI.tI PRESSURE .. ... .. 2 . 5 FEET ' h..1 FEET OF FORCE MA11J Y, .l 6 Y F t,FRICTIOW FACTOR..._.1. 0 6 FE �''..:.. TOTAL oyuAMl » C_AQ. '•18:3 FEET . . . .. ..... .y_W� WTERNAL. DIMEIJSION OF TAUK: LENGTH - ;WIDTH __._.._. j LIQUID DEPTH - 4 18:2 61aL /. "t air_��rn�_ � ' 'LICE►JSE I.IUMHCR __3,M n.1•c• 4•')R 1 .r`e L a 5 r 4y �; r. � �Y..TM 'W.. '. h'` ' � . " �� .� �q o � E� W t � 115 34 110 32 105' - 30 100 — 95 28 i 90 ' r 26 85 WENT 24 8o MODEL 3� a 75 MOD L 189 ITERI NG 22 70 165 zo 65' A 18 60 Ir J 55 16 1 50 MODEL 183 MODEL 14 45 188 12 40. 35 10 MODEL MODEL 30 137, 139 185 8 25 620- MODEL 16 1 15 MODEL A 4 '97 , 'i 10 2 MODE ' 5 53, 55 57,5 0 GALLONS 20 30 40 50 60' 70 80 90 100 110 LITERS 0 80 160 240 320 400 FLOW PER MINUTE 8 �2. NDUS flyl TRY , OF REPORT ON SOIL BORINGS AND SAFETY &BUILDINGS I NDUS, DIVISION LABOR AND P.O. BOX 7969 PERCOLATION TESTS ( 115 1 MADISON W153707 HUMAN RELATIO \ / (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TOWNSHIP /MUNICIPALITY: LOT NO.: BLK. NO.: SUBDIVISION NAME: W/4 SW� /a /TaeN /R 18K (or) KiwN ki w N i t, IV � COUNTY: MAILING ADDRESS: ST Cool :3AW�S 4EL41wE R S15 qO 'rH HUDSON :54ollz USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PR FIL DESCRIPTIONS: I PERCULATION TESTS: Residence ❑ New � Replace ry 4 -22 -93 4-29 -4 OW SrrF Gl� 2 1 M 7HOM950N 4 -23- RATING: S= Site suitable for system U= Site unsuitable for system ONVENTIONAL: MOUND: IN- GROUND - PRESSURE: SYSTE IN- FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) , MIS 2U 23 EA E c ®U � Zo E]S 17,JU I MOu lvL2 w,-rl � $a If Percolation Tests are NOT re wired DESIGN RATE: 4 I If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: tV4 I Floodplain, indicate Floodplain elevation: WA PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- I 4o gA.O(o 3 1 0- 8' @ks�� 8- ,3 ° g�5r�13- 40'RdBnSCL w�Y'h vr,oNlsaTl3 o�q'CS>4s:1 q - IS "�3r,s ;J15-42QdCitiSt:L w,tl ,,,,r,l „� -r,s� B -2 42 49.06 I5 a-4 $.:I q- /(x'(3 B- 3 q 9 q �i. G(o 3 �!o B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIOD2 PERIOD PER INCH P. I I 0 5 j8 S/s 5 �9 .46 P - 3 0 9 Z L 53 P- ) 0 4: °b 9 /16 5 P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 1 o(o w �_ z_ � s _z( y �, � Q �, • -gym L_ try Ioac t -- - I -- - - - - —r— -- co go AA t i z i I �^ i , N E i j �C I fic, i C 8�to wcLL I, the undersigned, hereby certify that the soil tests reportil on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: �_GI.r1 A N�(56 1-Zq- 93 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 1 9 tA'�w `� �► lit 33 715-925 -z lI)s CST SIGNATURE: e4l ) 1 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 10/83) — OVER — INSTRUCTIONS FOR COMPLETING FORM 115 - SOD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use soctiori must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; P Y 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Boll Separates and Textures Other Symbols st — Stone (over 10 ") BR — Bedrock cob — Cobble (3 - 10 ") SS — Standstone gr — Gravel (under 3 ") LS — Limestone 's — Sand HGW — High Groundwater cs — Coarse Sand Perc — Precolation Rate med s — Medium Sand W — Well fs — Fine Sand Bldg — Building Is— Loamy Sand �* — Greater Than 'sl — Loamy Sand < — Less Than '1 — Loam Bn — Brown 'sit — Silt Loam BI — Black si — Slit Gy — Gray cl — Clay Loam Y — Yellow scl — Sandy Clay Loam R — Red sicl — Silty Clay Loam mot — Mottles sc — Sandy Clay w/ — with sic — Silty Clay fff — few, fine, faint 'c — Clay cc — common, coarse pt — Peat mm — Many, Medium m — Muck d — distinct p — prominent HWL — High water level, surface water Six general soil textures BM — Bench Mark for liquid waste disposal VRP — Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. J S T C - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER /BUYER -�1R.wt � A . Tr- 4 EIQ i V.e Ora ADDRESS 5 � S 90 S f - FIRE NUMBER -:5� CITY /STATE - 4ULCS0>ti Ly I ZIP S70 / �2 PROPERTY LOCATION: SLL) 1/4, StO 1/4, SECTION LW TOWN OF RNN'lC , St. Croix County, P'fk" LQ ].,o. OZZ - lUl - SU - 0on ;;tJBDIVISION V%_ 10, , LOT NUMBER_±- - _ 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 septic tank pumper. What you put into the system can tiffect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and ( 2) after inspection and pumping ( if necessary) , the septic tank is less than 1/3 full of sludge and SCUM. I /We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix Co. Zoning Officer within 30 days of the three year expiration date. SIGNED : DATE: c ' St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor,(spec house), thenia second form should be retained and completed when the property` -is sold and submitted to this office with the appropriate deed recording. ------------------------------- Owner of property �.JCl Yv_e 4. I� ��. 4 / ivt (F Gl CY Location of property S b ) 1 /4 S bJ 1 /4, Section N - R_.L j 9_W '.Township I 'hV1I VA o' k C Mailing address Address of site S�� ` �1G� �� /� � -50)'` j L`�� f0 Subdivision name �-� 0. _ Lot no. VI Other homes on property? yes No Previous owner of property 6ec) T "ne_y - yy I,Vy Total size of parcel a 2) A Date parcel-was created a Are all corners and lot lines identifiable? _ Yes No Is this property being developed for (spec house)? Yes No volume 3 and Page Number - 7647 1 as recorded with the Register of Deeds. ------------------------------------------------------------------------ INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the best of 'rwp (our) knowledge that -1-(we) att (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. 35 (,yg 7 , and that 1- (we) presently own the proposed site for the sewage disposal system or -I- (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of County Register of deeds as Document No. V'�G. _ Si ature of ap icant Co- applicant �7 - Date o# Signature Date oV Signature t Y , • , „ x i 1 7 , r , n e p ± j F a F ti ST. CROIX COUNTY a 1 WISCONSIN h K . ZONING OFFICE ST. CROIX COUNTY COURTHOUSE 911 FOURTH STREET • HUDSON, W154016 4 - - - (715) 386 -4680 April 28, 1993 Division of Safety and Building Bureau of Plumbing P.O. Box 7969 Madison, WI 53707 To whom it may concern: An onsite soil investigation of the James Ray Jr. property, located in the SW1 /4 of the SW1 /4, Sec.6, T28N, R18W, Town of Kinnickinnic, St. Croix County, WI., has been conducted with the assistance of Carl Heise, CST# 3314. This onsite revealed suitable soil for onsite sewage disposal to a depth of 12" while meeting the requirements of the A + 4 rule. This site should be suitable for a replacment mound septic system having 24" of sand fill. Should you have any questions, please feel free to contact me at this office. Since ely, a es K. 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Box 7162 1, *isconsin Madison, WI 53707 — 7162 Sanitary Pamit Nu o befilla in by Co.) (608) 266 -3151 L � O 6 Department of Commerce Sete Platt I.D. Number Sanitary Permit Application o�rC�r,�i�c Sq3 _ 1 s In accord with Comm 93.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy I.aw, 111 5-040 X111) Project Address (if different )harm mailing address) S/� GI B .EL s - T � 1. Application Information — Please Print All Information Parcel N Lot N Property 1 ocauon Block N Pro O wn" am X22 — Property Owner's Mailing Address q /ST- �, i 3 �3 Section ( 7 City, State TZ-4/ Code Pha / n Number p1 / 76-1 V 35� �L3� T ?i0 N: R EolW J II. T of Building (check all that apply) /'� (��577�� Subdivision Name CSM Number 1 or 2 Family Dwelling —Number of Bedrooms 11 �� l "' ' ' 3516 �p a O Publk/Commercial — Describe use ^ . -- Qy;(t ownship of C O State Owned — Describe use r , "p'vr C p x 2' IQ. Type of Permit: (Check only one box on line A. Ce line B if applicable) A. O New System ❑ Replacenent System reatrrmramt/Hol in Tank R Only_ ❑ other Modification a Existing System Number an Da Issued B. ❑ Permit Renewal ❑ Permit Revision ❑Change of (I Permit Transfer to New List Previous Permit d te Before Expiration Plumber Owner 1 1 3 13 lV.t of POWTS System Check all that a O Non — Pmsudaod_-Ground ❑ Mound > 24 in. of suitable soil ound < 24 in. of suitable soil ❑ At -Grade Single titer bt Constructed Worland ❑ Pressurized In - Ground ❑ Holding Tank t ter Aerobic Treatment unit ❑Rea r Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip U ❑ C,ravd - less Pipe ❑ Odw (expl ) V. Disversalfrreatment Area Information: I Area Pr ad (sf) System Eleva n Design Flow (go) Design Soil licsaion Rau (MxM Dispersal Area oquinai (sf) Dispetsa l'r � Zs� 15' 2�' Il /00 -0 3 00 ! • Z l ab Site Sted fiber Piastre VI. Tank Info Capacity in Total Number Manufacturer Concrete Constructed Glass Gallons Gallons of Units New Existing Tanks Tanks Septic Holding Tank d[itJ Treatment Unit [/l/ Dosiag mber VII. Responsibility Statement - 1, the undersigned, assume respo isibility for lostallatiou of the POWTS shown oa the attacked plrmas �y ° 9 WIp/MPRS Number Business Phone Num b Plumber's Name (Pri nt) Plumber's Signature 2 2 I/ d 7 / 5- tiO 3 Z O v .� p Plumber's Address (Street City, tale, Zip Code)_ VIII. ount y /De artment Use Only mps) Sanitary Per►it Fee (includes Groundwatcr Date sued Is nng Agent igna re Approved D Disapproved Surcharge Fee) ❑ Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval // as� n � act {<u 61/2 iocber in s Ci � r � G �� 7 6 eampkte p4m (to the County )for the` Ml�' ?,&J wiZo/ �. SBD -6398 (R 01/03 AXIS ` �' 7t4 Q y P� of ( PIoT PLAN SCALD ! " :4a� Or t b 9 r2latL o S 93 - 40 1q 5 �V C 8 •pi1Zt la a ve r��C i+� PO �•- C.,f11c ?o)!i Lot Barw A Ssar.r 51, 0 R3 or S?w1 & (53 Con Pas'y�, C ^�l V �- �rj/�c.� ,r•�r/. above• w $00 gal pr.)" clumb round 1 wccks p�L ioaa gtlscp *•C, ToP GonCw'! fowJ-No" &L. 98.'1 yo++C, 70 6c •�r.r c SYS fl jotlat ..P0 ma Ono p `! ,SAf� pND Ou �.S LT,E � Dom' 15 u/ 0 D W MOVE T E-ARTH AILPORT EXCAVATING 1042 South Main RIVER FALLS, WI 54022 CARL P. HEISE (715) 425-2175. Owner MOUND SYSTEM S 9 3 40 1 FOR A BEDROOM RESIDENCE LOCATED IN THE W W S OF THE �_ S OF SECTION /, T Rt8W TOWN OF k;Wjg,�,��i� , _ ST. C 201x _ COUNTY, WISCONSIN. INDEX PAGE 1 of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN .PAGE 3 of 6 PLAN VIEW -CROS 3 SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CHAMBE 2 PAGE 6 of 6 PUMP PERFORMAN :E CURVE Y . PREPARED FOR JA M E S yELAK RA's - 5i5 g47N. - HOSOu W (- 5401b Y_ L A a� l.C��.G� PREP ARED 0 Y -CARL P. HEISE CST -3314 MPRS -3373 1042 SOUTH MAIN RIVER FALLS, WI 54022 County Sanitary Pennit Application ST. cROIx COUNTY WIS cool In accord with 15.04 St. Croix County Sanitary Ordinance ZONING OFFICE Person al information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER (Privacy Law. S. 15.04(1)(m)) v. 1101 Carmichael Road Hudson, WI 54016 -7710 ( 15)386.4680 Fax 15 6 Attach complete plans for the st per an 8- t less than &1 x 11 inche s in ize. County Sanitary Permit # ❑ 41' re sion previous applicapon; 4 ocl� 1. Application Information - Please Print all Information 0 Property Property Owner Name ZONING u�FFI E 1!4 114, Sec 2 /� T N, R ,P E P ees Mailing Address Lot Number Block Number I v s /J't/. City, State Zip Code Phone Numer or CSM Number If Type of Building: (check one) amity ❑ Village IWT6wn of ❑ 1 or 2 Family Dwelling - No. of Bedrooms: ❑ Public/Commercial (describe use): ❑ State -owned Nearest Road 11. Type of Permit: (Check only one box on line A. Check box on line B if applicable) �.�• Parcel Tax Numb r(s) A) 1 1.0 Repair 1 2.AR - Reconnection l 3.ONon-plumbirig . ❑Rejuvenation Sanitation ".X l m — //J o — /Od B) Permit Number Date Issued ice state Sanitary Pemut was previously issued ... V . Type of POWT System: (Check all that apply) ❑ Non-pressurized In- ground [Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At - grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other . Ohzpersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed (Gals. /day /sq.ft.) (Minfinch) Elevation '?V.0 . Tank Informs ion Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks —4 O? v Y. d �ti�C I 9k ❑ ❑ ❑ ❑ L d — d - UL- ❑ ❑ ❑ ❑ 1. Responsibility Statement i, the undersigned, assume responsibility for repair /reconnenction/rejuvena ' stallation of non- plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the installation of non - plumbing lion system. Pknr4ees Name (print) Plumber's S' atur s : 10P /MPRS No. Business Phone Number Plumber's Address (Street, City, State, Zip Code VI II. County Use Only Disapproved Sanitary Permit Fee Date Issued Issuing Agent Signature (No stamps) ❑ Approved Owner Given Initial Adverse Determination DC. Conditions of Approval /Reasons for Disapproval: c 1 1 v I ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer, 7 - - X -- A, eAyjo Mailing Address i� "14n IV 9 � j JI EXi N F sn 6 Property Address S © �— (Verification required from Planning Depfirtment for new construction.) rT City /State .-4/z ,-Les a= Parcel Identification Number LEGAL DESCRIPTION C. � Property Location - , r&L % a , = rte/ '/4 , Sec. y , T Z/' N RyW, Town of Subdivision , Lot it �. Certifed Survey Map # �a'� , Volume � , Page # . Warranty Deed # 775 7 2. , Volume Z6,grZ , Page # If f Spec house yes Lot lines identifiable to 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. Owner maintenance responsibilities are specified in Comm 83.52 and in Chapter 12 - St. Croix County Sanitary Ordinance. sP P § 1 () P tY �' The property owner agrees to submit to St. Croix County 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 statin g your septic tics Y stem has been maintained must be completed and returned to the St. Croix County Zoning P Department within 30 days of the three year expiration date /dedin SIGNATURE OF PLICANT DATE OWNER CERTIFICATION Uwe certify that all statements on this form are true st of my /our knowledge. I/we am/are owner(s) of the descri d above, b v' of a warranty deed rec egister of Deeds Office 10 / /�lt�cS SIGNATURE OF APPLICANT DATE * * * * ** Any information that is misrepresented 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 and a copy of the certified survey map if reference is made in the warranty deed. �t U 2 6 6 4 p 1 9 8 STATE BAR OF WISCONSIN FORM 1 — 1998 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO.. WI Document Number RECEIVED FOR RECORD This Deed, made between Kent N. AMdtson sin ale and Kevin W. 09/2a/2004 10:00AH Heastrom, single , Grantor, an James R. Hanstad , WARRANTY DEED Grantee. EXEWT 11 Grantor, for a valuable consideration conveys to Grantee the following described real estate in St. Croix County State of REC FEE: 11.00 TRANS FEE: 645.00 Wisconsin (the "Property'): COPY FEE: CC FEEt PAGESt 1 Recording Area Name.aod.� d` C- Bnnitt Title 7;;U 1-rance Ave. S. Pint Floor Edina. \(1 5` AT i -: 1'0a '_'ku >irt� Centro.} 022 1015 80 100 Parcel Identification Number (PIN) This is homestead property. (is) (is not) A parcel of land located in part of the Southwest Quarter of the Southwest Quarter (SW Y. of SW '/4) of Section 6, Township 28 North, Range 18 West, Town of Kinnickinnic, St. Croix County, Wisconsin, described as follows: Lot 1 of a Certified Survey Map dated June 5, 2000 and recorded July 26, 2000 In Vol. 14 of Certified Survey Maps at page 3910, as Document No. 627099. Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except ,s`�'�, Dated this day of September 2004 (SEAL) (SEAL) Kent N. Arndtson Kevin W. Hegstrom (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, WENDY SWATZINA } sq. authenti�it�aP Ti O 0 N F VW �f( S St. Croix County Personally came before me this day of September 2004 the above named Ke nt N. Arndtson. sirmle and K vi W Heastrom. si nale * to me known to be the person who executed the TITLE: MEMBER STATE BAR OF WISCONSIN foregoing i trument and ac nowled the same. (If not, — authorized by §706.06, Wis. Slats) THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of VVisconbln Coldwell Banker Burnet 1301 Coulee Road My commission is permanent. (If not state expiration date: 4 -46979 WI 54016 AA�L 1A , (Signatures may be authenticated or acknowledged. Both are not necessary.) ' Names of persons signing in any capacity must be typed or printed below their si nature. • ��M W COO. SFC. 6, TtdN, R.IB, . ► � o �', �" a � ,W UNPLA T, TaE'p L A N1 y xD ! BERNTSFN NA/ L �'Q.l ! , S .O _ ` 4 S 8q•3a•Qa /JOS.42' 0 h , Z6. OZ. 3 T1. s6 • �'� 96a: F4' t. sao•a's ?•w (130:79% '� � � to � , . �) •l �E w N•74' 3 ?' ?8'� 8 ?.t 4' l 6 i DWELL � ._, � •�+ � p.'�t�. / ice YEWAY 8 N d 0.7 . .. fj i via �. �I o Z,0r� ALL BEAR /NGS.R" . PA G, Of t"NE SW 114 OF` d NO/ N . DoT Z SCALE ; t4 � . �'* -^•� -�M . O '39' 100• . X00• � 300' N 89.4 4'ZZ •W 397. TY• ZB. 02 G3 t 1345: 01! .I I . 16.01 sy1.T0'. t Airs. 3/' IS L INE S W 114 !AIM SW CDR. SEC. S, T28N, R/d W, . N)9 . 44 • ZZ .W �� IBERM''8EN ALUM. CAP PD./ UN �A T T� U L•!Q: I PARTII�ENT OF REPORT ON SOIL BORINGS AND SAFETY &BUILDING INDUST Y, DIVISION LRBOR AND PERCOLATION TESTS (115 MADISON WI 537 9 53707 HUMAN RELATIONS (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: OWNSH UNICIPALITY: OT NO.: BLK. NO.: SUBOI VISION NAME: /TAN /R ►�E for N -,j N c�tiN ) C sw �/ Nw �/ 6 — -- COUNTY: MAILING ADDRESS: �-01� ` b�0x (Z q S'• e5�4z1x v-1 - -s - co - A)v sow) sum w L USE ES OBSERVATIONS MADE �i NO. BEDRMS.: COMMERCIAL DESCRIPTION: 1 PERCOLATION TESTS 129ttesidence ❑New - Replace 9 RATING: S= Site suitable for system U= Site unsui for stem 0)J S 1`T - e II - TZxI /U ) o _ I O - B 9 ONVENTIINAL: MOUND: IN- GROUND - PRESSURE: S EM -IN -FILL OLDING TANK: OMMENDED SYSTEM: (optional) ❑ s N ❑U El OU I ❑ 1 ')� u r .. � — m G N CiRvv RATE: E: If Percolation Tests are NOT required D If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: N' N. Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GR UNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- S'7 10 -O 1Jt�,j � L4 3 S F 6 E Z. e F Z B- Z 4y N•t\ • �, ZZ �f B- 3 LA lol.S t, 3�. B- 59 S1 �I B- B- PERCOLATION TESTS DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD 1 PE D 2 PE RIOD PER INCH P- \ Z 1v ) 30 51a %.I see L/ a P- Z 2.2 NO 30 3 /K I `Ill b 4 P_ c6 1 IJtt_ ZS P- P- P- PLOT PLAN: Show locations of percolation tests, soil borings and thg dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. 7b QE Nzxs l j G, 11ES1 QN (S fJ $ i SYSTEM ELEVATION �v • �' of so\ H Lz2 v� i oo, 0' c '%O . �� _ , _ _ w _ _� � > _ _� _ _ _ s �� ;�.�-,a -sue - �.o!�►s► .� I E s All O N _ I d ... 4 1 rJ _ 71 1 P) i } _. ti __�� ,', r' I 4 0 , ._ � _ ,... _ _ y`. _ O Akio � OAF/ C sum y o , I, the undersigned, hereby certify that the soil tests reported on this form were made by m with the procedur and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the f k �owledge belief. p °" q NAME (print): AND TESTS WERE COMPLETED ON: nESIGN SERVICE ADDRESS: CERTIFICATION NUMBER: PHONE NUMB ER (opt ional): cSY ouo s�6 71S- �fZS -o!6 s RIVER FALLS WI 54022 CST SIGN 715-425 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. PP'5 DILHRSBD -6395 (R. 10/83) — OVER — INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suita¢ility rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing scale is prefered. A separate sheet may be used if desired; 6. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all apropriate boxes as to dates, names, addresses, flood plain data, percolation test exemption, if appropriate; 10. It the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and yur certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st — Stone (over 10 ") BR — Bedrock cob — Cobble (3 - 10 ") SS — Standstone gr — Gravel (under 3 ") LS — Limestone 's — Sand HGW — High Groundwater cs — Coarse Sand Perc — Precolation Rate meds — Medium Sand W — Well fs — Fine Sand Bldg — Building Is— Loamy Sand > — Greater Than 'sl — Loamy Sand < — Less Than '1 — Loam Bn — Brown 'sil — Silt Loam BI — Black si — Slit Gy — Gray cl — Clay Loam Y — Yellow scl — Sandy Clay Loam R — Red sicl — Silty Clay Loam mot — Mottles sc — Sandy Clay w/ — with sic — Silty Clay fff — few, fine, faint 'c — Clay cc — common, coarse pt — Peat mm — Many, Medium m — Muck d — distinct p — prominent HWL — High water level, surface water Six general soil textures BM — Bench Mark for liquid waste disposal VRP — Vertical Reference Point TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. I I SOIL DESCRIPTION FORM Attach Soil Pro lu Location Na On a Su arsto Sheet► CL O tj L.1 s 01 1 LINEAR LOADING RATE: -- PLIRPOSE : FO 91 NI L- "SORF FIND SYS'T0.1 SLOPE: DESCRIPTION D Y �tR`4'L`�l weGE�'Ct•e12 ASP ECT: -- �j� `q g q CURRE DATE NT LAND U L few (V COUNTY /STATE: % - T (Zm.\ X CZV 1j L - ) I VEGETATIVE COVER: C' TZ-pi-`S 4 LOT DESCRIPTION \-T OF � t. w 1/y Se 6►zaN: R1gW DRAINAGE CLASS LOCATION: TI�LJN p� �cIN lG GALLONS SO. FT. PER DAY: see 1130 - m laG.Awk/ PARENT MATERIAL (s ) /DEPTH r SOIL SERIES: 4 , HORIZON DEPTH MATRIX COLORS MOTTLES TEXTURE STRUCTURE CONSISTENCE CLAYSKINS/ PORES ROOTS PII -BOUNDARY REMARKS (in.)- most Gr. Sz. Shp COATINGS v Q 0 Iofp- 313 - si 1 l)A Sb )nv�►- s q - 316 C3 s \ N S °la 5 (z.q stn. 7 VAI �. 1 s�1c rn �� wlslwTS o scl w Y3 - ).5`c\,-- VIL C Z. (L c i 5 m t �3u�21 G Z o - zmm -! z - s 1 1 � Sbtc Y+n c s c) --z3 Si 1 1 Sb� m �, s6-,e r�r� �� w Z3 A - rf\ o Z m p•\ ) V Cs Zm 3bk >^ si certTS 5``� 1 i m 5 O /Q �- 36 -�4� �•5`124��C, �rnZP �� 0 ! SY Y l q SPOT of= C o -lC� 10`2 CL 313 - s l�s�k ,�„ v�►. cS 10 - ►o'- tcz.316 - 31*) zmsbk m `3'-,j Y"L'F1- CAFE O-AC S3 -S°l � Lk Zli* c O vv, Y-, '�t _ t� Sl S S_. SS OTHER SITE FEATURES /NOTES: LIMITING FACTORS /DEPTH: Signature Date CST M l IL 4 HORIZON DEP111 MATRIX COLORS MOTTLES TEXTURE STRUCTURE CONSISTENCE CLAYSKINS/ PORES ROOTS PII •BOUNDARY REMARKS Rio Q Gr. Sx. Sh COATINGS h i r I OTNER SITE FEATURES /NOTES: T'hGe of Signature Date CST M LIMITING FACIORS /DEPTH: I