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022-1054-80-050
Wisconsin De p artment r, Commr e PRIVATE SEWAGE SYSTEM County: St. Cron . Safety and Building Div ion INSPECTION REPORT Sanitary Permit No: 430 7 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: • ( -4 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: Larson, Eugene & Carol I Kinnickinnic Township — 6- 0 S CST BM Elev: C, Insp. BM Elev: T Description:_ Section/Town /Range /Map No 9 ! S 99. s � Z� 19.28.18.30 TANK INFORMATION ELEVATION DATA Q� TYPE MANUFA TURER CAPACITY STATION BS HI FS ELEV. Septic — 14aw /000 Benchmark / Dosing Alt. BM r � �1 W Aeration Bldg. Sewer �, 3 Holding SUHt Inlet 3.6 TANK SETBACK INFORMATION SUHt Outlet l TANK TO --P /L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic n b I ' I 1 n Dt Bottom ` Dosing i V, yLtt �� J � Header /Man. Aeration Dist. Pipe `, ki y� Holding Bot. System Z G g • q .5;, PUMP /SIPHON INFORMATION LL . final Gradeaf a � . �y — Manufacturer Demand St Cover / GPM Model Number MIG �) g t / TDH Lift, Friction • 3q System !fie TDH� Ft N Forcemain Len h Dia y Dist o � II D/ SOIL ABSOIRPtION SYSTEM ( 2 CAL BED/TRENCH Width 1 Length f No. Of Trenches PIT DIMENSION No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 1 Q SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEA HIN actur / INFORMATION CHAMBER R �TC� Ty Of System: / Model Number: , , , „! D T IBUTION SYSTEM (•/ W �►� a/1� Header! n'fold Distribution r / x Hole Size x Hole Spacing nt t� o Air Intake Pipe(s) 7 � Length_ Dia Length is Spacing ( V SOIL COVER q N x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over / Depth Over xx Depth of xx Seeded /Sodded xx Mulched Topsoil Bed/Trench Censer Z Bed/Trench Edges / Yes 0 No [] Yes [ No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: /Z / CJ `f Inspection #2: Location: 232 Cty Road SS River Falls, WI 54022 (NW 1/4 SE 1/4 19 T28N R18W) NA Lot 6 " P rcel No: 19.28.18. 1.) Alt BM Description= y� _ 51 • ��� —� srf7�-�' _ J 12� 2.) Bldg sewer length = 1'�'" b CA r (,t¢ Q�lLt_ - amount of cover 151 H n o J t�r � 7 -C �f'm revis Plan No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's gnature Cert. No. nd 7 ngs tvtsion County K_ 201 W. Washington Ave., P.O. Box 7162 U� ������,� Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) (608) 266 -3151 ' O Department of Commerce State Plan I.D. Number Sanitary Permit App1iCat10R__ 4 - — In accord with Comm 83,21, Wis. Adm. Code, personal informati may be used for secondary purposes Privacy Law,is15.04(1)(4 Project Address (if different than mailing address) I. Application Information - Please Print All Information !(� �s Property Owner's Na me Parcel k / Lot N Block # Property Owner's M ailing Address )� Pr operty Location �� , a� ; �� 4 U6 Jl��/ Ulu �� / " t/ ,.�L t/a ,Section City tate / Zip Cod e Phone Number / / y �� ,A�, I� �� rZb�61 (9 (circle one) Jr C vV (( T UN ; R 4 9 Eorf I . ype of Building (check all that apply) ubdivision Name CSM Number �l or. 2 Family Dwelling - Number of Bedrooms t.b.. / /7 , `� ` f ❑ Public /Cotrunercial - Describe Ue p� � Sv °r`�'< C� � f 6 ❑ State Owned - Describe Use `'�a J "" ""` ❑City_ ❑Village Township of ('� /'UNICI le III. Type of Permit: (Check only one box on line A, Complete lint B if applicable) A. at ew System .N ❑Replacement System ❑ TreamletiUHolding Tank Replacement Only El Other Modification to Existing System ❑ Chan List Previous Permit Number and Date Issued B. Permit Renewal �J'ertnit Revision Change of El Transfer to New Before Expiration Plumber Owner IV. TXpe of POWTS System: (Check all that apply) $ Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculatin ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe i ❑ 0 ier (explain) oAA d* Vf V. Dispersal/Treat ent Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) I Dispersal Area Req isjnrsal Area r ose (sf) ystem Elevation /do S D /C' 9 Q S VI. Tank Info Capacity in Total Number �k 4_ / Manufacturer Prefab Site rt, Gallons Gallons of Uni jZ� Concrete Constructed lust' New Existing n Tanks Tanks 'f Septic or Holding Tank Vit-f1 1 �� Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, t undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plu ber's Na me (Print) Plumber's Si gnatu • MP /MM Number Business Phone Number p 2 Z 6 7 1 2 P 7,7 lum er's Addre ss (Street, City, State, Zip C e) v 4 - - _ za n l VIII, Count /De se Onl Approved ❑ Disapproved Sanitary Permit Fee (include�dwater Date Issued I suin Agent Signature (No Stamps) Surcharge Fee) ❑ iven Reaso Denial Z a JA IX. Conditions of Approval /Reasons for Disapproval ' SYSTEM OWNER: 3> aAA.0- ` S 1 Septic tank, effluent Alter end - ' ,f m� S 1 dispersal cell must all be serviced / maintained l as per management plan provided by plumber. o WL.4_ 2. All setback requirements must be maintained as per applicable code /ordinances. `f �S e Znc % rk, h . Attach complete plans (to the County only) for the system on paper not I •s than 81/2 x 11 in a in size SBD -6398 (R. 01/03) u 6�N� Lisa � s � uN glf� 6 0 050 w �L L 0k ��� �J $ 1 r �4 D Y� u 3 �. " ZZ6S 97 co n� Ivib o/ Pte- P� w /,q� 276597 RECEIVE saccnsin Department of C mmerce OIL EVALUATION REPORT 3 vision,?E Safety A)d Buildi gs Page of OCT & t :cNComm 85, Wis. Adm. Code Attach complete site plan n paper not less than 8 �F,'Z nches in size. Flan must County include, but not limited to: ertia -1 6Q oint (BM), direction and Parcel !.D. percent slope, scale or di en i n I and distance to nearest road. O Please print all information. v iewed y Date /� Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). U3 Property Owner Property Location C vvlt nt N W 114 `j�i 1/4 S l� T Ze N R L E (or W Property Ovme+ Mailing Address — L•ot Block # I Subd. Name or CSM# �q � 3$�� 0 City State Zip Code Phone Number City Village 2Town Nearest Road lbq ).J�'j1C 1`1'41' SSA (� New Construction Use: —Q Residential / Number of bedrooms S Code derived design flow rate S 0 GPD Replacement [a Public or commercial - Describe: Parent rimaterial Flood Plain elevation if applicable N ft General comments and recommendations: �-Dt 1''} = �, ? � r c 1 , ..r� �.'z L'�-�; 3 x f06 -.2.S Lc»vG 3o`r G= 0 - 4 2 -M 2 'n Z Boring # tt ❑� Boring - fa -aeAA ge- io ,,� �St pit Ground surface elev. O ? . O ft. Depth to limiting factor in. Ci w FM• d Soil Applicati Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP_D /ftz in. Munsell Qu. Sz . Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 0 ZO 1 p`1 221Z S l Zfsbti2 m'�r` C�� 3 r �J —bZ l Oti R -S/1(� — 1 `�S �. eSb� Y✓IV�'r _ '�° .q 7 a - Z c, Boring # ❑ Boring ® Pit Ground surface elev. 1 3 3 ft. Depth to limiting factor S in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff #1 •Eff#2 o - 9 �o'l rZ 31 b — \ �s t. es b °I -Z7 1 t L11 Z /y r / S i I Z `�S DMZ )1t'�i� C�-J • S -� •�o y �tz_s s i o li Y16 — L 1 es bk ny - e S S S'S -63 10 ` t t 035 ri1 v F>^ - • S -q - S" !O -Z -t73 Effluent #1 = BOD, > 30 < 220 mg/L and SS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) — Sig atu CST Number Arthur L. Wegerer Ol -lll 220254 = 421S e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number . Alain St. River Falls, R I 54022 S 715 - 425 -0165 PLOT PLAN Pale 3 of 3 Scale 1'=60 ' . t t ^^ n � oo o` ot`i - q'`► �7 y" �i ��c ni f d 8., e � '19 v / y o LL tWaG. S -2 715 -42 — • � 5 •1G5 220254 CST Signature Date Telephone Ito. CST Igo Job NO . Safety and Buildings Division County ` 201 W. Washington Ave., P.O. Box 7162 M adison, WI 53707 - 7162 Sanitary Permit Number (to be tille i by Co.) eonsin Department of Commerce (608) 266 -3151 5 � State Plan I.D. Number Q7 Sanitary Permit Application T�"s. In accord with Comm 83.21, Wis. Adm. Code, personal informati may be used for secondary purposes Privacy Law, s15.04 1)(m) ;R Proje Address (if d rent than mailing address) RECEIVE , I. Application Information - Please t All Information �5 r Property Owner's Name Parcel Lot # o rL B& k tk 66AJ ( �6 L L Al2 - S4tYlazol 0 Property Owner's Mailing Address �(� �Locattiion G u>- \ " �C 6✓ �' /, / A, Section City, Sta e Zip Cod /e�� Phone NuCm�be^r�r r Q �'k Z 715 G ` 5 Tn N; R l V (cEcoe 9NS) Z� .��� IT. Type of Building eck all th El at apply) Subdivision Name CSM Numb 1 or 2 Family Dwelling - tuber of Bedrooms ❑ Public /Commercial - Describ se U 0 ( !(Z! oyc 9 • a ' • El State Owned - Describe Use Wonn ❑City Vil lag Township of i III. Type of Permit: (Check only o A. Comple a line B if appl' le) A. ew System ❑ Replaceme ystem El TreaunendHolding Tan eplacement Other Mo c ion to Exi ig S [em AW B L revio s i i r and Date I e ❑Permit Renewal 7k Permit Revision ❑Change of Permit Tr fe ew Before Expiration Plumber Owner 1 -3 IV. Type of POWTS System: (Check a ll that appl ❑ Non - Pressurized In- Ground Mound > 24 in. of suitabl it ound < 24 in. of suitable soil ❑ t -Gr El Single Pas and Filter El Wetland El In- Ground ❑ Holding Ta ❑ Peat Filter ❑ Aerobic T a ent Unit ❑ Recirculating Sand Filter El Recirculating Synthetic Media Filter El Leaching Chamber rip ' e ❑ Gravel -less Pipe er ( lain) V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design il Application Rat gpdst) ispersal Ar equire (so Dispersal ro sed (st) System Elevation �� e ,0 112 _s Q ZOO i VI. t ank Info Capacity in loial umber P efab Site Steel Fiber Plastic M acturer Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit r Dosing Chamber SL 5 VII. Responsibility Statement- I, the dersigned, assume respon ibility for installation of the POW hown on the attached plans. Phu er's Name (Print) lumber' Signature MP /AIWS Number Business Phones Number }� N C G C Plumber' dress (Street, City, Stat Zip Code LLB a w of VIII. .ount /De artment We Onl Approved El Disa/Given d Sanitary Permit Fee (includes Groundwater Date Issued is Agen ignauue (N it s) Surcharge Fee) l� ❑ Own Reason for Denial IX. Conditions of A oval /Reasons for Disapproval FF STEM OV IN (J / '1 ep nt filter and dispersal cell must all be serviced / Waintained C1 W15t as per management plan provided by plumber. All setback requirements must be maintained Attach complete plans (to the County only) for th ystem on paper not less 1han 81/2 x 11 inches in size SBD -6398 (R. 01/03) a f � �' ' • �� A p �� �� �� � " �a Ib b� � , , �a a , r� ,� x• ti 1; ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 • Fax (715) 386 -4686 EROSION CONTROL PLAN Parcel #19.28.18. -20 Site: 232 C.T.H. SS Lot 6 Kinnickinnic — owners Eugene & Carol Larson � ) owner( s) 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." Comm. 21.125 also requires the building permit applicant and /or landowner to follow erosion control procedures and maintain them until the site has been stabilized. The owner is responsible for notifying all contractors performing construction on this site that an Erosion & Sediment Control (ESC) Plan is in effect and the following activities will be required in order to maintain compliance with the plan: 1. The primary source for construction site runoff will be the house foundation excavation, driveway, and any soil stockpiled until final grading and stabilization has been completed. Septic system installation adds to temporary disturbance, but establishing cover on exposed soils will prevent erosion. Plan to apply seed and mulch as recommended in #5. Maintain existing vegetation wherever possible to minimize sediment movement. Surface drainage is to the northeast, with >100 feet of buffer between the road ditch for Hwy 65 and the proposed construction. 2. Route contaminated runoff into vegetated buffer areas on owner's property by creating temporary diversions graded ALONG CONTOUR between excavation areas and any potential receiving waters (this includes road ditches). Do not allow diverted runoff to be directed onto neighboring properties. (See specification sheet for temporary diversions provided by Zoning Dept.) 3. If builder /excavator grades the site to create temporary diversions (see #2) to contain sediment and leaves adequate vegetative cover to protect areas of concern, installation of silt fence MAY not be necessary. Silt fence or other approved sediment control products will be required if sediment cannot be contained on owner's property with the diversions and vegetative buffers. The POWTS inspector and building inspector will evaluate ESC plan effectiveness and make recommendations to owner for any action required to comply with applicable regulations. 4. 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 access the property during construction. This helps 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. 5. Stabilize new topsoil cover over septic system with seed and mulch immediately after installation — do not wait for final stabilization and/or landscaping of entire site to cover exposed soils on the system. If weather will not permit seed germination, a heavy straw mulch cover will prevent erosion until grass /vegetation can get established. Erosion control matting can be applied any time of year and, if installed properly, will provide protection even if seed germination is delayed. The owner of record during site construction will be responsible for compliance with the ESC Plan. Please feel free to contact me with questions regarding erosion & , , w1ime contro allatiok. Prepared by: Pamela Quinn, Soil Erosion Inspector #665054 I i Owner acknowledgement of ESC Plan requirements: f l 1 b /2003 I f t Standard Erosion Control Plan ! for 1- & 2- Family Dwelling Construction Sites I According to Chapters Comm 20 & 21 of the Wisconsin Uniform Dwelling Code, soil erosion control information needs to be included on the plot plan which is submitted and approved prior to the issuance of building permits for 1- & 2- family dwelling units in those jurisdictions where the soil erosion control provisions of the Uniform Dwelling Code are enforced. This Standard Erosion Control Plan is provided to assist in meeting this requirement. Instructions: 1. Complete this plan by filling in requested information, completing the site diagram and marking appropriate boxes on the inside of this form. 2. In completing the site diagram, give consideration to potential erosion that may occur before, during, and after grading. Water runoff patterns can change significantly as a site is reshaped. 3. Submit this plan at the time of building permit applicati PROJECT LOCATION C 7 14" 5 / / wgiy _ Please indicate north BUILDER (3? GL OWNER 1k 6f G (--- i- L c 0 h by completing the arrow. WORKSHEET COMPLETED BY / --4, S -tic. DATE 10/16/6 3 -N- ,,/ SITE DIAGRAM scale: I inch = feet � EROSION CONTROL PLAN LEGEND PROPERTY LINE EXISTING DRAINAGE Nib— TD TEMPORARY DIVERSION FINISHED —� DRAINAGE -� _ LIMITS OF GRADING 41 SILT ' —O FENCE 1 � STRAW 4 i I / BALES rim ' El GRAVEL O VEGETATION l o SPECIFICATION ® TREE I � � PRESERVATION STOCKPILED SOIL i f i \WOS m EROSION CONTROL PLAN CHECKLIST Q Check (✓) appropriate boxes below, and complete the site diagram L Q with necessary information. NN z Site Characteristics 3 a North arrow, scale, and site boundary. Indicate and name adjacent streets or roadways. ❑ Location of existing drainageways, streams, rivers, lakes, wetlands or wells. Location of storm sewer inlets. Location of existing and proposed buildings and paved areas. The disturbed area on the lot. �a Approximate gradient and direction of slopes before grading operations. Approximate gradient and direction of slopes after grading operations. ❑ Overland runoff (sheet flow) coming onto the site from adjacent areas. Erosion Control Practices ❑ Location of temporary soil storage piles. Note: Soil storage piles should be placed behind a sediment fence, a 10 foot wide vegetative strip, or should be covered with a tarp or more than 25 feet from any downslope road or drainageway. Location of access drive(s). Note: Access drive should have 2 to 3 inch aggregate stone laid at least 7 feet wide and 6 inches thick. Drives should extend from the roadway 50 feet or to the house foundation (whichever is less). ❑ Location of sediment controls (filter fabric fence, straw bale fence or 10- foot -wide vegetative strip) that will prevent eroded soil from leaving the site. ❑ Location of sediment barriers around on -site storm sewer inlets. ❑ Location of diversions. Note: Although not specifically required by code, it is recommended that concen- trated flow (drainageways) be diverted (re- directed) around disturbed areas. Overland runoff (sheet flow)from adjacent areas greater than 10,000 sq. ft. should also be diverted around disturbed areas. ❑ Location of practices that will be applied to control erosion on steep slopes (greater than 12% grade). Note: Such practices include maintaining existing vegetation, placement of additional sediment fences, diversions, and re- vegetation by sodding or seeding with use of erosion control mats. ❑ Location of practices that will control erosion on areas of concentrated runoff flow. Note: Unstabilized drainageways, ditches, diversions, and inlets should be protected from erosion through use of such practices as in- channel fabric or straw bale barriers, erosion control mats, staked sod, and rock rip -rap. When used, a given in- channel barrier should not receive drainage from more than two acres of unpaved area, or one acre of paved area. In- channel practices should not be installed in perennial streams (streams with year round flow). ❑ Location of other planned practices not already noted. z W J V a Indicate management strategy by checking (✓) the appropriate box. 4 4 Z Management Strategies [� Temporary stabilization of disturbed areas. Note: It is recommended that disturbed areas and soil piles left inactive for extended periods of time be stabilized by seeding (between April 1 and September 15), or by other cover, such as tarping or mulching. Permanent stabilization of site by re- vegetation or other means as soon as possible (lawn establishment). • Indicate re- vegetation method: ❑ Seed ❑ Sod ❑ Other • Expected date of permanent re- vegetation: • Re- vegetation responsibility of: ❑ Builder ❑ Owner /Buyer • Is temporary seeding or mulching planned if site is not seeded by Sept. 15 or sodded by Nov. 15? ❑ Yes ❑ No ❑ Use of downspout and /or sump pump outlet extensions. Note: It is recommended that flow from downspouts and sump pump outlets be routed through plastic drainage pipe to stable areas such as established sod or pavement. Trapping sediment during de watering operations. Note: Sediment -laden discharge water from pumping operations should be ponded behind a sediment barrier until most of the sediment settles out. Proper disposal of building material waste so that pollutants and debris are not carried off -site by wind or water. Maintenance of erosion control practices. • Sediment will be removed from behind sediment fences and barriers before it reaches a depth that is equal to half the height o f the barrier. • Breaks and gaps in sediment fences and barriers will be repaired imme- diately. Decomposing straw bales will be replaced (typical bale life is three months). • All sediment that moves off -site due to construction activity will be cleaned up before the end of the same workday. • All sediment that moves off -site due to storm events will be cleaned up before the end of the next workday. • Access drives will be maintained throughout construction. • All installed erosion control practices will be maintained until the disturbed areas they protect are stabilized. i I EROSION CONTROL REGULATIONS Erosion control and stormwater regulations can be complex. Local, state and, in some cases, federal regulations may apply. Before construction make sure you have the appropriate permits. LOCAL ORDINANCES Check with your county, city, village, or town for any local erosion control ordinances including shoreland zoning require- ments. Except for new 1- & 2- family dwellings, local ordinances may be more strict than state regulations. They may also require erosion control on construction projects not affected by state or federal regulations. UNIFORM DWELLING CODE (DEPT. OF COMMERCE) CONTROLS REQUIRED FOR MORE INFORMATION, CONTACT: • Silt fences, straw bales, or other approved perimeter • Local building inspector measures along downslope sides and side slopes. • Department of Commerce, Safety and Buildings Division, • Access drive. P.O. Box 7162, Madison, Wis. 53707, (608) 267 -5113. • Straw bales, filter fabric fences or other barriers to protect on -site sewer inlets. • Additional controls if needed for steep slopes or other special conditions. STORMWATER PERMIT (DEPT. OF NATURAL RESOURCES) CONTROLS REQUIRED FOR MORE INFORMATION, CONTACT • Erosion control measures specified in the Wisconsin • Department of Natural Resources, Storm Water Permits, Construction Site Best Management Practice Handbook. P.O. 7921, Madison, WI 53707 -7921, (608) 266 -7078. • Measures to control storm water after construction. For more assistance on plan preparation, refer to the Wisconsin Uniform Dwelling Code, the DNR Wisconsin Construction Site Best Management Handbook, and UW— Extension publication Erosion Control for Home Builders. The Wisconsin Uniform Dwelling Code and the Wisconsin Construction Site Best Management Handbook are available through the State of Wisconsin Document Sales, (608) 266 -3558. Erosion Control for Home Builders (GWQ001) can be ordered through Extension Publications, (608) 262 -3346 or the Department of Commerce, (608) 267 -4405. A PDF version of Erosion Control for Home Builders (GWQ001) and Standard Erosion Control Plan are also available at http: // clean - water.uwex.edu /pubs /sheets This publication is available from county UW- Extension offices or from Extension Publications, 45 N. Charter St., Madison, WI 53715. (608) 262 -3346 or toll -free (877) 947 -7827. A publication of the University of UW Wisconsin— Extension in cooperation with the Wisconsin Department of Natural Resources and the Wisconsin "' E xrEnswn Department of Commerce. ©1999 by the Board of Regents of the University of Wisconsin System. Send inquiries about copyright permission to: Director, Cooperative Extension Publications, 201 Hiram Smith Hall, 1545 Observatory Dr., Madison, WI 53706. University of Wisconsin- Extension is an EEO /Affirmative Action employer and provides equal opportunities in employment and programming, including Title IX and ADA requirements. GW0001A Standard Erosion Control Plan for 1 & 2 Family Dwelling Construction Sites h Printed on DNR WT- 458 -96 R- 02- 02- 2M -10 -S Editing and design by the Environmental Resources Center, University of Wisconsin- Extension. 0114 recycled paper Safety and Buildings WEED commerce.wi.gov RECE 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 Iti scO I 'J �� www.commerce.state.wi.us /sb epartment of Commerce �T,, www•wisconsin.gov D ?ONING OFFICE Jim Doyle, Governor Cory L. Nettles, Secretary April 20, 2004 CUST ID No.267341 ATTN: POWTS Inspector ARTHUR L WEGERER WEGERER SOIL TESTING & DESIGN SERVICE ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY SPIA PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/20/2006 Ide Numbers Transaction ID No. 985966 SITE: Site ID No. 681902 Eugene Larson Please refer to both identification numbers, 232 County SS above, in all correspondence with the agency. Town of Kinnickinnic St Croix County NW1 /4, SETA, S19, T28N, R18W Lot: 3, N� L UTIo Wt 4j CS� FOR: Description: Proposed Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 950737 Maintenance required; 450 GPD Flow rate; 33 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual, SBD- 10572 -P (R.6/99), Pressure Distribution omponent anual, SBD - 10573 -P (R.6/99); 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, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the enclosed approved plans and with publication SBD- 10572- P(R.6/99) "Mound Component Manual for Private Onsite Wastewater Systems ". • The pressure network is to be constructed in accordance with publication SBD- 10573- P(R.6/99) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems ". • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally below the mound system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • Comm 83.22(7) - A copy of the a rove -I--- "f ations and this letter shall be on -site durin construction and open to inspection b u o " e tives of the De artment which ma include local inspectors. C ond itionall y APPROVED nFPARTMFNT nF MWAFRr.F * ` ' ARTHUR L WEGERER Page 2 4/20/04 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) - 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. 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. • 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. 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, &4 G-� Fee Required $ 175.00 Fee Received $ 175.00 Gerard M. Swim Balance Due $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm jswim @commerce.state.wi.us WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 TITLE SHEE (��(`�age of 1 MOUND SYSTEM FOR V) ?_ A BEDROOM RESIDENCE This plan has been prepared in accordance with theft d Component 7 Manual SBD -105P and the Pressure Distribution Man SBD 10573 -P C l °C1- -6199 LOCATED IN THE NVJ 1 /4 OF THE S E 1/ 4 OF SECTION \ C � , T N, R 1% W, TOWN OF t ��r�v�LC`R►1JlV1C S�'. ` 1��11X COUNTY, WISCONSIN. INDEX PAGE 1 of 7 TITLE SHEET PAGE 2 Of 7 SYSTEM ? A'NAGE TENT PLAN PAGE 3 of 7 PLOT PLAN PAGE 4 of 7 PLAN VIEW -CROSS SECTION PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT PAGE 6 of 7 PU11PING CHAMBER CROSS SECTION PAGE 7 of 7 PUMP PERFORMANCE CURVE PREPARED FOR iE LPrtz_SDtV Q 0 Svty V Zvi \Z1vLIZ.. 1 ) ; 5Ll`bLZ PREPARED BY W FEE CGEI:;.EFR SOIL . TEST S NC AND . DES S G>TV SERV S CE P.O. Box 74 421 N.Main St. River `roow Falls, WI 54022 Phone 715- 425 -0165 Fax 715 - 425 -6864 .••�""'••• n.e;s A ELLS' %*OFT ws DIVISION AFE7Y AND BUILDINGS - 'q. `,S SEE CORRES NDENCE JOB NO, 0(4 -U ivlouncl Management Plan Page Z of Pursuant to Comm 83.54, Wis. Adm. Code � r Seatic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance I's generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. PUmc 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 maybe 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 for frost protection. Influent quality into the mound system may not exceed 220 mg /L BOD5, 150 mg/L TSS, and 30 mg /L FOG. 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 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manual [SBD- 10572 -P (R. 6/99)] 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. Continaencv 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 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 adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions about the operation or maintenance of this system should be directed to: The County Zoning at 1 r j _ 3 6 t 4 b b 0 S1r. . 0 -M lX The system. installer at `l 1 S - Z'13 _ Ll U LlV )UNLSU/V The tank manufacturer at Q3UO 3 -ZS = ' -S Lvl. S The effluent filter manufacturer at Z 'Z'Pr13 The pump manufacturer at t q - Z6 q _: -I t uy ._ _. _ _fir 1 4 OV 5 R T PLOT PLPN Page 3 of `7 Scale 1 " =50' LET Z L /P \ \ �\ LoT 4 CS-s-1 bv- 3$" go vt 6\Z.nu nv i�� LO i 3 \ c+ ,� 5 Za�VC rr•�_ r � F3.? C�rf1"ti►OvT � L� b� i I I r.• SO \L S�CtiIPFIt \S 1 Cl \ iz�-3T ol �' y'vvC NOTES: I. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required). 3. Septic tank to be % JGS gallon capacity manufactured by 10UU / b S o - M IZ) w/ A — � b o p ZC f) 4. Bench mark c, = S lt'�t3oVE 5. Divert surface water around system to prevent ponding at the uphill side. Pace Or -] Approved Synthetic Covering ASTM C33 Distribution Pipe Medium. Sand H g Topsoil F Elev 3 E Ito tf ' D b 6 % Slope Distribution Cell of Force Main Flowed 2" to 2 2" Aggregate From Pump Layer 0 0•S -Ft. E E) ;8 6 Ft. CROSS SECTION OF A MOUND SYSTEM F 0 Ft. G (3. 5 Ft. A Ft. H \.0 Ft. Linear Loading Rate = 6 - v GPD /LN FT B S Ft. Design Loading Rate= ti,y- GPD /SQ FT I \ p Ft. J S Ft. K ° p Ft . � t_LrRa:te Pos.i ti on L ° I 1 Ft. o Force Main W Z I Ft. I I - Observation Pipe c r-------------- - - - - -- --------- - - - - -- -- - - ---� eox A W —_� - -- _ - - - -- Distribution `— Cell of %" to ' " - z 2� Pipe aggregate Observation Pipe (Anchbr securely) IF PLAN VIEW OF A MOUND SYSTEM . T Distribution Pipe Layout p S o` 0 Place the holes at the bottom of the list ribution pi at' equal spacing. p es p P a . .,emove ail burrs from the pipe and 'Hole,.. Extend the end of each lateral up with the use of long tun or 4f' frt;ng t a point within sic inches of the final , Terminate the ends of the late.-�als with a valve can or _ . threaded plug. Provide access from finale for the valve; threaded eap or threaded plug. I T F1cr L — C. C. r I Lateral M.-n=-Id Lateral x x x x!Z x!1 x x x x Lateral Length -� Lateral Length - F Oistriouticn Line � I r C P 3�7 Ft. Hole Diameter 3f l6 Inch S 3 Ft, Lateral " 1 ��y Inch (es X ?y Inches Manifold Z • Inches .. Force Main " Z ch s In e # of holes /pipe Invert Elevation of.LateraIs b : O t. igko•b6= 1Z_S�x�(— S0 GpM r Combination Sept;.c: Tank and ff PUMP CHAMBER CR055 SECTVi AND SPECIFICATIONS' PAGE b OF •VEWT CAP_ WEATHER PROOF _ - -� -� - -� -- JUWCTIOIJ 80X . ti C.I. VE)JT PIPC APPROVED LOCKIIJG Tl C _`tY( 1 1l -> D'1F� 1Q' FROM OOOR, M,l>JHOLE COVER wIV aIWOOW OR FRESH wARtJIWG LPtgEL. AIR WTAK ` S coraDu�r � C��cZp) - r- IrN%s* Qflfte 113'Ml►!. �\-A PROVIDE I - - - -- 7 _ -- AIRTIGHT SEAL (- Approved, go0 -A I i�� Approved joint w/ i i joint w/ PVC pipe ALAAA PVC pipe I b O FF D C04CRETE " BLOCK RISER EXIT PERMIiIED G►JLd IF TAW MAWUFACTURER HAS SUCH APPROVAL 3„ApPQa SEPTIC I SpECIFICATIOUS DOSE t� TA MAQUFACTURER: ct, I QUM$ER OF DOSES: PER DA-" TAMK SIZE.: S 0 GALLOQS DOSE VOLUME A LAR #% MAWUFACTURER: - �`S LaQ - "w SyS "s` I.WCLUDIWG BACKFLOOW: - 1 uZ GALLONS P%ODCL 1-:UMBER: FRw .CAPACITIES: A- `" - (MCHCS OR � � � GALL045 SWITCH TYPE: "E'MC\jy_\-r 8= / IWCWES�OR �� G�LLOUS PLIMP MAWLIFACTUREM LI LZ'xS C: 6 IWCHES OR 1 � 'GA LLO L! s MODEL MUMBEM q1 D= HESOR �" Q � GALLOAIS SWITCH TYPE: �" ��1ZCV��f MOTE: PUHP AMD AKM ARE TO 6E � MIMIMUM DISCHARGE RATE S O - I PM INSTALLED O 5EPARATE CIRCUITS VERTICAL DIFFERENCE OETWEEIJ PUMP OFF AUO..015TR16UTIOW PIPE + 1 IJETWORK SUPPLY PRESSURE -2S FE ( Z Y - 1 3� 'I Z S FEET OF FORCE MAIM X �' OZ F Y oFL FRICTIOU FACTOR.. • Z LFEET ET TOTAL D!JUAMiC HEAD " S -FEET As per manufacturer A1 00 gal /in. Liquid depth 3� � M E40 Series M"M 4/10 HP Effluent and Drain Water Pumps Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 12 35 10 cn 30 � Z 25 8 W X 20 6 O Q 2 0 15 a E— 4 }— O 10 _ H .q.slj 5 ! S .It 2 0 0 O 10 20 30 40 50 60 70 80 90 100 CAPACITY GALLONS PER MINUTE 1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289 -1144 FAX 419/289 -6658 Telex 98 -7443 K3326 7/91 Printed in U.S.A. Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of afety, , Buildings � q�accord with ILHR 83.05, Wis. Adm. Code . C • ST • e2c� UC Attach complete site plan on paper not less than 81/2 1 inches i e. Plan must includ not limited to vertical and horizontal reference point ( ), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. O •� ZuD APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION BY DATE PROPERTY OWNER: PROPERTY LOCATION 1/4 5 E 1/4,S T ,N,R I E(aOW PROPERTY OWNER':S MAILING ADDRESS • T # BLOCK # SUBD. NAME OR CSM # ZZO s� tZ� 6s 3 - ��osm eSM CITY, STATE ZIP CODE PHONE NUMBER CKTTY []VILLAGE ®TOWN ' NEAREST ROAD sTW 6.S " �tUE1Z � . , lJ/ s (-1►s) 14Zs- 6c y �,INJ�j I Aj �jIc ftce-essrnlo°f ten+ ss• [eQ New Construction Use Vj Residential / Number of bedrooms y [ J Addition to existing building [ ] Replacement [ J Public or commercial describe Code derived daily flow b Oo gpd Recommended design loading rate - bed, gpd$ • 3 trench, gpd/ft Absorption area required Soo bed, ft S oy trench, ft Maximum design loading rate `I bed, gpd /ft • S trench, gpd/ft Recommended infiltration surface elevaticn(s) 1 • O ft (as referred to site plan benchmark) Additional design / site considerations w1ov1W w/ 5 5r - top' - mz" eN - r 1V-lu rat \Z' ar- Parent material o 'lz L-t- Flood plain elevation, if applicable NSA It S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U =Unsuitable fors stem El ZIU ®S ❑ U ❑ S ®U ❑ S ®U ❑ S OU ❑ S IrU SOIL DESCRIPTION REPORT Dominant M PD /ft o a t Color Mott Structure G Boring # Horizon Depth D Texture Stu Consistence Bourxl�y Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. B� Trench .' o -tY - Z sil 1 bk W!7�1 Z t4 Lb lo 3 f y — s, l Z` 5)D�T m�'i- •s -� Ground 3 2b 3$ 10`t (L 2_ rns b k m `Ft- C S • 5 el s. 5 ft y 3� �$ .Z.S`lR V/6 — ITS o`M }vl — •q .S Depth to limiting factor $ ti Remarks: Boring # o Z Z 16 - - Z:7. '1 -S L >z 3/� — S [ csby� dlh a, S — Ll 's 3 z 3p, �0 -1Z Ground ' �• ` e lev. n y 3 8 -sz � • S �l'F , -s y R s/a S sz S S K 1z- t v " s I (2or Wl uii,- _ r� ��'�� • Y `, Depth to limiting _ j.I I� I 1999 factor O S 3 > UNSY Remarks: CST Name: Arthur L. We erer Phone' 715 425 - 016 Address: egerer Soil Testing & Design Service -P.O. Box 74 River.Falls,WI 54022 Signature: Date: CST Number. �jil _ fly ,� °19 -1y 9 - -1' �� 220254 PROPERTY OWNER — 'PCCZSON SOIL DESCRIPTION REPORT Page ?—of 3 PARCEL LD. # _ UZZ - ly S %,I - 80 Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft :..: :`:t in. Munsell Gr . Sz Sh Consistence Roots T ,:.., Qu. Sz. Cont. Color . . . Bed re rxh �' 3 ?< Zm S w, PIS a-.S ..:............ Z to -fy - t•s.YIZ 3!y — sl 1 wtsbk Ct, S Ground 2S elev. &s ft. y ZS - 33 10`12 SL 1 ImS6 h1'f�- pth to S 33 -qy - 1 , SYR 3/Y _1,SyR S/b S� �� h1'FI eg •3 , y i iting actor 6 UU lo-irz // Remarks: Boring # - :"xk`` d -t S ►oyR 3!z sib Z�s �'� �w S ;.; , toti 3� '�. r'} Y — s ,J Zsbt� ,,��� � _ a S (, 3i: •v.... n...... i Ground .3 Z� -�l3 �•Sti2 �Ly _ L 1 �sbk h�l'F►.- Cs � a� � .S elev. % 1ZI.0 ft. -� .g S IR S el 1 �S 6h ln'FI- - Z I .3 i Depth to i limiting factor I Remarks: Boring # i Ground elev. f t. i Depth to limiting i factor Remarks: 3oring # i E around ,lev. ft. )epth to imiting actor Remarks: — r - r j PLOT PLAN Pa of 3 SCALE 1 "= 50 ' LET Z U, 7i 4 . �t^'ItF� - fit. ioZ6'orJ SPi�t:� 3 /c.(" DIW. PvC �IDN k / u1''M r �6 \ CSR w 9 8 5 �O v.IOT' CsrtgltT Z zs �o�STuRA Rt1S Pfitt"�j M S I It OL 5 S I I I / Zs �Ul�owt o� TR�Iv c h► " _ . to V.0 �• rte, C - - 1 `` U wKA .. "V ELL �q -t X18 -3 zzolsy CST Signature Date Signed Telephone No. -� n � CST ## GENERAL ST. CROIX COUNTY, WISCONSIN NEW TXSCR01 REAL ESTATE TOWN OF KINNICKINNIC COMPUTER NUMBER 022 - 1054 -80 -050 Parcel Number 19.28.18.302A -08 Claimed Date Re- certified / / Relate Number: OWNER NAME: First EUGENE O & CAROL J Last LARSON CO -OWNER Mailing Address 47 SUNVIEW DR City RIVER FALLS State WI Zip 54022 - Type Vol Page Doc # Rec.Date Type Vol Page Doc# Rec.Date HISTORY WD 2445/ 136 745069 10/29/2003 CSM 47/4636 744504 10/22/2003 PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name- Type SD Apart t Post Office School District: 4893 - SCH D OF RIVER FALLS Special District: (1) 100 - (2) - (3) - CHIP VALLEY VOTECH Plat Code: Last Changed on: 04/21/2004 Book Number: 1 SECTION 19 TOWN 28N RANGE 18W %160 SE 1 /440 NW Map Number: 00 - Sales Area: Parcel Control 0 TAXABLE Number of Units: ZONING: Permit Number: Type: Bank Numbers: Delete? F4 -Prev, 175 -Next, 176- Legal, F7- Value, F8- History, F10 -Exit, F12 -More i ' Safety and Buildings Division County C Q / p 201 W. Washington ., vi Seonsin Madison, WI 3707 Sam ry Permit Number (to be filled in by Co.) Department of Commerce (608) 2(6-3151 1-1-3q -} Sanitary Permit Applieatio 3 00 State Plan I.D. Number j D In accord with Comm 83.21, Wis. Adm. Code, personal informatio you " COUNT may be used for secondary purposes Privacy Law, sl5.04( (m) ZONING OFFICE Proje tAddress -if ifferent th dress) I. Application Information - Please Print All Information Z G� 0 S� Property Owner's Na me Par N _ b of # Block ft 6 d- CA-p L. AR.So z ,s o z� Property L Owner's M ailing Address r //�) A perty Location � (,D /a, 1 /4 Section City, tat / e ] Zip Cod�e Phone Number u 6 V V�iz f Z / trcle o�[e) ICI(. Type of Building (check all that ap ) T N; R�E or t I�}-} or. 2 Family Dwelling - Number of Bedroo / Subd ue s r 6 s 9 Z gr ,9 ❑ Public /Commercial - Describe Use L V4 ❑ State Owned - Describe Use Z 1 ) 4 ❑City_ ❑Village ®Township of t;rj jM /G kt .d e— III. Type of Permit: (Check only one box on line Complete line B if plicable) { A. System T 7w y ❑ Replacement System ❑ eatment/Holding T Replacement Only ❑ Other Modification t ' t(ng Syste B. El Permit Renewal ❑ Permit Revision ❑ Chan of rOwpn'e nit Tr ansfer to List Previo Pe [ [nb Date Issued Before Expiration Plumber IV. Type of POWTS System: (Check all that apply) IX Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil Mound < 24 in. of suit? soi At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Ta Peat Filter ❑ AerobV Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter eaching Ch ber Drip Lin ❑ Gravel-less Pie ❑ O hiq (explain) V. Dispersal/Treat ent Area Information: y 3 aA.,v,„ Design Flow (gpd) Design Soil Application Rate(gpdsf) Dis ersal Area Requ ed (sf) Di ersal Areaq3 d (sf) System Elevation VI. Tank Info Capacity in Total Num Ma fa rer Prefab Si Steel Fiber Plastic Gallons Gallons of U is fl �/� /�� Concrete Constructed Glass New Existing k/ Tanks Tanks t / Septic or Holding Tank /0M O % Aerobic Treatment Unit Dosing Chamber EJJ � J VII. Responsibility Statement- I, the undersi ied, assume responsibility for installation of the OWTS shown on the attached plans. Plumb is Na me (Print) Plumber' Si gnature MP /MPRS Number Business Phone Number Plumber's Addre ss (Street, City, State, Zip e) 66 t-V n fL 4-- VIIIL, County Department Use 0 Approved Disapproved Sanitary Permit Fee [ncludes Grquydwater D3t Issued ing nt Signatu Stamps) Surcharge Fee) 00 I l 6 ❑Owner Given R son for Denial IX. Conditions of Approval /R t mft ons for Disappr TEM OWNER; � / F1 1'Icr! eptic tank, effluent filter and �3: I1 o4 Wv) ispersal cell must all be serviced / maintained 111` s per management plan provided by plumber. V Gvrz 0 II setback requirements must be maintained SyS�� as per applicable code /ordinances. W/ 3. q3-( L -?- - /� Attac c�p}ete plans (to he County enl) for the sy tem on paper not less th 1/ x 11 inches in siz SSD- 639'8L(R.O1X)` t[�j r v o� dd 6o, v� ol LA/ �L/ 6 . YVI 17 I c� io n cro_ vv a� Q� • 4� g� a 1p3 �j ti� v yx lG� \ QvG C A-16 M y. • . ti Combination Sept;ic.,Tank and PUMP CHAMBER CROSS SECTIONI A,uD SPECIFICATINS - VEQT CAP l WEATHER PROOF JU►JCTIOIJ 5OX . i C.T. VEfJT PIPE APPROVED L OCKIIJG FROM QOOK, MAtJHOLE COVER 1vCTt1 � waRrJlu4 L.r�6EL.. - 'iIUDOW OR FRESH Cp�putT �+�sP�Cj101J P lP� A.l_R IuTAKE c j w l PrtCiT1 s ti - M,rr? 1•: PROVIDE 11JLE T i &,iF.TIC.K SEAL. ' . I (�� APPROVED JOIN% A APPROVED JOIIJT ZPI$sL ail �R ( I I W /C.l, ?I PE I"C W /C.T. PInOF Tank construction i (I ALARM shall comply with I I( ILHR (;3.15 and 33.20 a I I o►J I PUMP �_ OFF D [ 1 ) C D CONCRETE @LOCK t 3" ARf'k�•: ;RISEfL E XlT PERf'%1T(ED OIJL'd IF TAWK (AAJJUFACTUREK HAS SUCH p, PPROVAL 6FOOtN4 SEPTIC F SPECIFICATIOt.]S DOSE W liF� T—'7z COKjC jju^b[R OF DOSES: PER DAB TA1lrC MAQUFACTU9CCR.: TA)JK aIZC:, /IM 65 GAL.LOk1S D05E VOLUME / ALARM MAIJUFACTURl4R: 5,�,��L O :J�-1 �1 JtJCLUOIAIG 6ACKFI.OW: I� . GALLONS MODEL QUMBER: tot N CAPACITIES: A= g AjCHE50K GALLOU5 SWITCH T!�PC: �A E�Z 5 = L IIJCHES'OK 1 L_ GrLLOUS PUMP MA3JUFACTURCK: 1'" l.'-f C= G IUCHES OR IALLOLIS MODEL 1JUM5ER: ;,G14 c ! _y D- itdC HE5 OR / CALLOUS . 5WITCH TYPE: � -� � - Q iJOTE: PUMP ANO ALARM ARE TO CL MwIMUM DISCHARGE RATE �� GPM ` � j INSTALLED 0�7 SEPj+RATE CIRCUITS VERTICAL DIFFEKEMCF DETWCEU PUMP Off AIJ0..D15TRIBUT101J PIPE- ` `✓ FEET i- t ►IWMUM ►JCTWORK SUPPLY PRESSURE , . , , ..... FEET + AM FEET OF FORCE M X /�F Yj0 QfL FKICTIOU FACTOR - . FEET TOTAL CyQAM(C. HEAD = ' " 7 FEET As per manufacturer gal/in. 'f < E U 6CAv C— CA-2o , PQJZ 0 Aj M E40 Series 4/10 MP Effluent and Drain Water Pumps Performance Curve MODEL ME4O EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 12 35 10 U) W 30 tL Z 25 8 Z Q N 20 6 J 'a 15 Q t-- 4 0 10 5 2 0 0 0 10 20 3,0 40 50 60 70 80 90 100 CAPACITY GALLONS PER MINUTE F.E. Myers, A Pentair Company • 1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289 -1144 FAX 419/289 -6658 Telex 98 -7443 K3326 7/91 Printed in U.S.A. r iv � • n f � V � m c N . 3 �- CD Q a � • P co cD \ �+- INVERT 7 ) C Q 1 I Nom+ n � O 3 �7 �15a r v D O r O 0 L� ^ "1/ v cx � v G�o i� a Q� 4� k gA �D �� b tie sit I � `M...v 4f 1 } # I ,J J f I J / I � R . ST CROI K COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSH[P CERTIFICATION FORM owner/Buyer (�, l-> n e Gl r U 1 C( r� Mailing Address V Property Address (Verification required from lanaing Department for new construction) S City/State Parcel Identification Number 0 D Qq — 16 0 4-6 & lv4 " LEGAL DESCRIPTION * 362-A Property Location V. '/4, Sec. T4�LN -R„W, C" Subdivision a , v r r " Lot # Certified Survey Map # (�.� ��ay / 9�1 Volume Page # Warranty Deed # . Volume . Page # Spec house ❑ yes P, no Lot lines identifiable iK yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system, The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masWplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. O /3 U3 SIGMA OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the roperty described above, by virtue of a warranty deed recorded in Register of Deeds Office. X jad-d=L /0 /311 / tl SIGNAqUM OF APPLICANT DATE « « « « «« Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.""" •� Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed w. UL 6 j5itJL 4- Cq-k o Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567 - P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number () ® "�- Number of Bedrooms 3 Desi n Flow - Peak (gpd) t Estimated Flow - Average (gpd) Septic Tank Capacity (gal) Soil Absorption Component Size (ft Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) If 6� Maximum Influent Particle Size (in) 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a ear and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic flank 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 (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). 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 « R Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep- rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. co As C Q -+ 715 6 4 4 7 C O 3 N U 2995 P 136 STATE BAR OF WISCONSIN FORNNI 2 - 2Gii0 KATn� zt( H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO.. '41 This Deed, made between Todd M. Larson and Angela Larson, RECEIVED FOR RECORD husband and wife Grantor, and Eugene O. Larson and Carol J. Larson, 10/29/2003 08.15AN husband and wife as survivorship marital property Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee WARRANTY DEED the following described real estate in St. Croix County, State of Wisconsin (if EXEMPT I more space is needed, please attach addendum): REC FEE: 11.00 of a of Certified Survey Map in Volume 17 of Certified Survey Maps, TRANS FEE: 150.00 e 4 , as ocum — en t um er 4504 filed in St. Croix County Register CCCPFEE: of Deeds office on October 22, 2003, being located in part of the Southwest PAGES: 1 1/4 of the Southeast 1/4 and Northwest 1/4 of the Southeast 1/4 of Section 19, Township 28 North, Range 18 West, own of Kinnickinnic, St. Croix County, Wisconsin, being Lots 1 an 3 )of that Certified Survey Ma recorded in Volume 1 age o t. Croix County Certified Survey aps. Recording Area Name and Return Address Eugene O. and Carol J. Larson 47 Sunview Drive River Falls, WI 54022 0 Z Z- lost' -8o - too Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: easements, restrictions and rights of way of record, if any. Dated this $" day of October 2003 ._ rC r M L- � fx A A o� a * * Togg M. Lars n r. * Angela La on '� "` Q `''� 't 41. AUTHENTICATION ACKNOWLEDGMEN� '�..,' J ;. Signature(s) STATE OF WISCONSIN )SS.Zm' ♦. a � . County. ) G - authenticated this day of Personally came before me this October , 2003 the uarite� � Todd M. Larson and Angela Larson * TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by §706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Joseph D. Boles - Attorney at Law MAAAIOYV River Falls, WI 54022 Notary Public, State of l�I SCO ft 5 f n SCO ft 5 f % My Commission is perm ent. Q[f ot, tate expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) f , . limp 114 Names of persons signing in any capacity must be typed or printed below their signature. NOTA IG ,(800)655 -2021 www.infoprofonns.com WARRANTY DEED STATE RM N . FO PIERCE COUNTY, WISCONSIN MY COMMISSION EXPIRES APRIL 1, 2007 > r` -- - NORTH 1a CORNER ` - - - -- S , CERTIFIED ( SECTION 19. � r 98 N; AGE 40` fN� (Q --- EP 0- SURy_EY ,MAP P 20 T 28N, R 18 W �, - '/ new lei are ecRNrniu QT�RS1 VOLUME 15, o; (O.B.O.'S) tom„ cenat�ea by tl,;s MoNumsm � COUNTY ).B.O.' S T.RU1 YK /0\ land &visicn_ MOT W N 33 01 0 ,� 388'36ZO'W316 _.— 3 ' v, - -- q ,c LOT2 bb �FSS a Z LOT_i "' �•� `�y LOT 4 -� � 1.t�T2 CO f � 2 • X . y . 7.W - z�1 • WESTLAYE 100.00' 15.00' s (OB.O S�I / N 89°38'20 T COWAWS *� W 219 0' V ft LOT 5 -OT 3 * ©, W 1,180,486 SO. FT r� O.B.P.) C,� / / , 220 S T H. "65° ti OR 27.100AC. 5 // / j RIVER FALLS, M 54M O (1,164,984 SQ. FT. OR 28.744 AC. / m OCCLUDING RIGHT OF WA)} 1 e>. p 17 W LOT 6 CONTAWS 157,875 Z SQ. FT OR 3.624 AC. rpb, � � Z` BEARINGS ARE REFERENCED J .., TO THE NORTH SOUTH IN CERTIFIED SURVEY MAP; /� a r 29 A& R IS WK AS c - �- - -- -" / 3 / Q N 01 W. a VOUIIRE 14, PAGE 380- BA RN / h / SCALEW FEET 1'= 300' i SORHLFEN _ J a � nr�RTtii.rvESrwi4 -sEtk � �t�, � � � . [� W 1 2 3 C D BARN G4g- g END L � . u ., �, y / LEG ra fq 0 - / q," INDICATES f -1/4' O.D. x 24 PIPE SET (MIN. WT. - 1.13 LBA.F.) RIVE ' —/ / • INDICATES 1• IRON PIPE FOUND (OWNED BY !./ a SOIL BORINGS (PROPOSED SEPTIC SYSTEM) SECTION CORNER MONUMENT (AS NOTED) PLATTER —x INDICATES FENCELINE 0 i/•`/ DATED: SEPTEMBER 19, 2003 AN EROSION CONTROL PLAN WILL BE c� y l REQUIRED BY THE ST. CROIX ��5 • �,�, ` COUNTY ZONING OFFICE PRIOR TO • "• •- 3 �y CONSTRUCTION ON THIS LOT LAURE E M H • t ,`� SDI Q / Tim D6PAR TATION HAS Ac ' 1713 W IN IN . GRANTF-D A SPECIAL E7WTION To TRANS 233 iwlLLe wl ' • .0 0 elff / / FOR THE E=nW DRNHNAYACCESS AS SHOWN Q , ` ON TH6i MAP. ANYLAND DIVISION, CHANGE W LAND • SOUTH 114 CORNE�t •'• •.... • •• Q `1 SECTION 19, LoT1 \t USE ORFUTMHt6 MY PROJECT MAYRRXM?E LAND �- 3 I / A PUBLIC ROAD INTERSECTION OR RELOCAT OF ION T28 N, R 18!W k l THE ORNEWAY TO ANALTERNATIUE PUBIC ROAD BERNTSEN o (FOUND a° � / / AT THE DISCRETION OF THE DEPARTMENT. THIS INSTRUMENT DRAFTED BYJERALD L. LARSON SHEET I OF 3 curve Table C urve Radius Arc CAngle Central A Chord Bearing Chord Back Tangent Front Tangt No. Leu Len Length 1 -2 58727' 66.18' 06 S 66 03' 27.5" E 66.14' S 69 17' 09" E S 62 49' 46" E 34 1 1980.08' 384.80' 11° 08' 05" . S37 - 44V'35.! " W 384.20' S 43 18' 38" W S 32=333" Deserioti,'on That certain parcel of land located in part of the Southwest Y4 of the Southeast %. and Northwest '/, of the Southeast '/, of Section 19, Township 28 North, Range l 8 West, Town of Kinnickinnic, St. Croix County, Wisconsin, being Lots 1 and 3 of that Certified Survey Map recorded in Volume 14, Page 3806 of St. Croix County described as follows: Certified Survey Maps, more fully Commencing at the South %, corner of said Section 19; thence N 01 °23'41" W. (assumed bearing on the North-South %a section line of said Section 19), a distance of 182.05' to the Southwest corner of Lot i of said Certified Survey Map, the Point of Beginning of the parcel to be herein descri being bed; thence along the West line of said Lot 1, N O l °23'41" W, 1983.96'; thence along the North line of said Lot], N 89 °38'20" ' E, 211.05 {recorded as S 89 °02'4 0" E); thence continuing along the West line of said Lot 1, N 01 "23'41" W, 445.23' (recorded as N 00 °30' 10" E} to a point thence the centerline of County Trunk Highway "SS,,; thence along said centerline, N 89 °37'23" E, 470.03'; thence along the West line of Lot 2 of said Certified Survey Map, S 00°22'37" E, 450.49'; thence along the South line of said Lot 2, S 89 °43'00" E, 115.0'; thence along the East line of said Lot 2, N 27 °39'40" F, 410.67' to a pot of way line of said County Trunk Highway "SS "; thence along said Southerly right of way line, on a the o curved line concaves to the Southwest, having a radius of 587.27' and a long chord bearing S 66 ° 03'27.5" E, 66.14'; thence along the West line of Lot 4 of said Certified Survey Map, S 27 °39'40" W, 325.78'; thence along the South line of said Lot 4, S 46 °41' 19" E, 236.62' to a point on the Northwesterly right of way line of State Trunk Highway "65 "; thence along said Northwesterly right of way line, along a curved line concave to the Southeast, having a radius of 1980.08' and a long chord bearing S 37 ° 44'35.5" W, 384.20'; thence continuing along said Northwesterly right of way line, N 68 °32'47" W, 69.17'; thence continuing along said Northwesterly right of way line, S 18 ° 35'30" W, 433.33'; thence continuing along said Northwesterly right of way line, S 19 °36' 10" W, 1251.07'; thence S 89 °57'46" W, 154.49' to the Point of Beginning, containing 1,338,361 square feet or 30 725 acres, being subject to an easement for County Trunk Highway 4C SS111 over Northerly portions of said parcel as shown on this map, the joint driveway easement as shown on this map, and to all other easements and restrictions of record. State of Wisconsin) ` County of Pierce) I, Laurence W. Murphy, Registered Land Surveyor, do hereby certify that by direction ofthe Owners, Todd M. and Angela Larson, I have surveyed and divided the lands shown hereon in accordance with official records, Chapter 236.34 Of Wisconsin Statutes and the Ordinances of St. Croix County and that this map and description are a true and correct representation thereof. Dated. September 19, 2003. ,r CONg NOTE: Each parcel shown on this map is subject to State, County, ' and Township laws rules and regulations (i.e. wetlands minimum �ouREnicE n„u sh;i lot size, access to parcel, etc.). Before purchasing or developing * 13 any Pal, contact the St. Croix County Zoning Office and the Be "'v"-' -E•: Town of Kinnickinnic. �- `^" • 4� p LAND 8 THIS InrsTZUA#8vrnR4FrED BYJERALD L LARSO/v SHEET 2 OF 3 ACCESS RESTRICTION CLAUSE "All lots and blocks are hereby restricted so that no owner, possessor, user, licensee, or other person my ha any of direct vehicular ingress from or egress to any highway lying within t h e right -of -way of State Trunk f ihway "65", it is expressly intended that this restriction constitute a restriction for the benefit of the public as provided its. 236193, Stars., and shall be enforceable by the department or its assigns. Any access shall be allowed only by special exception. Any access allowed by special exception shall be confirmed and granted only through the driveway permitting Nocess and all permits are revocable." Witness die hand seal of said owners this Z day of ©G�' O b 2�1� . 2003. Todd Nt Larson Angela Larson State of Wisconsin) County of Pierce) Personally came before me this day of , 2003, the above named Todd Nt and Angela Larson, to me known to be the persons who executed the foregoing instrument, and acknowledged the same. Notary Public My commission expires HIGHWAY SETBACK RESTRICTIONS (Applies to areas adjacent to S.T.H. "65") "No improvements or structures are allowed between the right -of -way line and the highway setback line. improvements include, but are not limited to, signs, parking areas. driveways, wells, septic systems, drainage facilities, buildings and retaining walls, it being expressly intended that this restriction shall constitute a restriction for the benefit of the public according to Section 236,293, Wisconsin Statutes, and shall be enforceable by the Department of Transportation. Contact the Wisconsin Department of Transportation for snore information. The phone number may be obtained by contacting your County Highway Department." NOTE REGARDING NOISE LEVELS "The lots in this land division may experience noise at levels exceeding the levels in S. Trans. 405.04, Table 1. These levels are based on federal standards. The Department of Transportation is not responsible for abating noise from existing state trunk highways or connecting highways, in the absence of any increase by the department to the highway's through lane capacity. S,iS GONS�� Z 0 Q .0 LAUREN • Q C • • MUR S OY+ 0<-e'-A4L* r : S 13 • 54: Cr0i)e C*,;ey Zvn.*Y�q a nnnu�.� a wa. 7 J . . 4Y O LANG SHEET 3 OF 3 THIS INSTRUMENT DR41 -7 BY JER4tD L tARSav