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022-1095-80-130 (2)
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O 0 a W N 7 K N 0 d O ch CD . j •� N m a m 4 o I I o o I s zcn i i I CD a— o CD C N i O CD a0 ON ' I A o b a CD CL ti I I Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPEbTION R•PORT Sanitary Permit No: 430331 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 ( Permit Holder's Name: City Village X Township Parcel Tax No: Anderson, Jamie I Kinnickinnic Township 022. 1095 -80 -124 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 33.28.17.516A24 TANK INFORMATION 'T-f- c ti f' 4 �r'� r� (:A u ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic , i L � ; Benchmark 7 / Dosing 01 / Alt. BM C v Aeration�, (� _ g. ewer ..4 x.33 m2.z3 Holding St/Ht Inlet - !off � ��, �• (��-- TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic /� ®, ��; ? 2— , Dt Bottom p Z•� S 9 � � 30 � �•— Dosing Header /Man. y 9 . 7 Aeration Dist. Pipe Holding Bot. System 'Tp 4, Z PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover n GG u I C-( 5. GPM ]a %� �•� . 7 L1 ro7.G� �•� 9�1 Model Number 7 / } tsT �'i. Z • �O ? S 7 �L TDH Lift Friction oss System e Ft rz_9z rozs�„I -,. �� r� 1•� Forcemain Length 12 ia. i ist. to Well�t, ; SOIL ABSORPTION BEDITRENCH Width engt No. Of Tren hes PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS _t� C,I SETBACK SYSTEM TO P /L BLDG WELL LAKE /STREAM LEACHING Manufa r: I INFORMATION Type Of System: CHAMBER OR , , � G'% UNIT r r •Z O Model Number: DISTRIBUTION SYSTEM ... _........ Header /Manifold Distribution x Hole Size T Hole Spacing Vent to Air Intake �7 C f t Pipe(s) pp a l .. q Length Dia __ Length ( •� Dia 1 Spacing 3/z Z - - -- SOIL COVER x Pressure Systems Only xx Mound Or At Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center �� / Bed/Trench Edges 7 Topsoil ''I Yes No �* Yes !. No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 4 46 / �� Inspection #2: / / �6 i Location: 69 Emerson Valley Drive River Falls, WI 54022 (NE 1/4 NE 1/4 33 T28N R18W) NA Lot 10 Parcel No: 33.28.17.516A24 v 1.) Alt BM Description = S . T CO X17 / /Ve lN e &- +• ,o4, -j(/ ( / 4 ' ) 2.) Bldg sewer length = ^" !�' > J L Q� I � dam. - amou of cover VIA Plan revision Required? Yes No) � 7 / -� - -" -i -- -- - - - -- - -" / "l TL- -- 411 Use other side for additional informs , ��_ j SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No. l — i (a 4 G9 t Safety and Buildings Division County Cj 201 W. Washington'Ave., P.6. Box 7162 sconsin. Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled ifi by Co.) Department of Commerce (608) 266-3151 /436331 Sanitary Permit Application State l an I.D. Number e pns a In accord with Comm 83.21, Wis. Adm. Code, personal information you p ovide RECEI ID# 900248 6L may be used for secondary purposes Privacy Law, s15.04(1)(m) t Add ess (if different than mailing I. Application Information - Please Print All Information S E P 0 4 2003 (o` E►•,,ersan 1L �y r Property Owner's Na the Parcel q Lot M Block ST. CR01X COUNTY JAMIE ANDERSON ZONING OF —10 —80 -124 0 Property Owner's M ailing Address Pvonerm t t; -tI � 215 N 4TH ST ` r t City, State Zip Code Phone Number NE '%, NE '%,Section RIVER FALLS, WI 54022 G S(— 7 (� (circle ) II. Type of Building (check all that apply) T 28 N; R E ort�V P � Subdivision Name CSM Number ® 1 or 2 Family Dwelling - Number of Bedrooms 3 ❑ Public/Commercial - Describe Use N/A 639807 ❑ State Owned - Describe Use Ct 0 ..I " S ❑City ❑Village Township of - -" p i a.� r KI nCKINNIC M. Type of Permit: (Check only one box on line A. Complete line B if applicable) A Q CPO- 71-( I?'r A ' ® Newer ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. C1 Permit Renewal C3 Permit Revision C1 Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that a 1 ) ❑ Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil )a Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter Aero tc re tment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) D * gn Soil pplication Rate(grso Dispersal Area quired (sl) Dispersal Ar a Proposed (sf) System Elevation 450 1 7 1 (�, s�" +'° 450 �(� 450 � (p 96.84 t/ VI. Tank Info Capa tty in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units I f /o A' � _ �U� Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank 1000 1000 1 WIESER CONCRETE X Aerobic Treatment Unit Dosing Chamber 1 600 1 600 1 1 IWIESER CONCRETE X VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plum s Si gnature MP /MPRS Number Business Phone Number BENNIE HELGESON 220292 1 715/772-3278 Plumber's Addre ss (Street, City, State, Zip Code) W1229 770TH AVENUE, SPRING VALLEY, WI 54767 VIII. oust Department Use Onl Approved ❑Disapproved Sanitary Permit Fee (includes Groundwal�r . Issued ing A Sig re ps) %. Surcharge Fee) I� � a / D ❑ Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval 'L (IS SYSTEM OWNS o� ri A 1 Septictank „efflue%filterandCffO �,Q aI UT7” dispersal cell must'all be serviced / maintaired '-/ � 7 ? AA-6 r mana ement an�rovic+ed by plumbelia - ..l�tl.ptback requicments mustm a n��`" '� � � L 4,41) V121.C&tL-1_ � Attac "- y) rr yste to on apw oi than 81/2 xl c - 2Z 0 SBD -6398 (R. 01/03) ark ' 09/22/2003 06:38 6512750678 PAGE 01/01 ST. CROIX COUNTY WISCONSIN ZONING OFFICE �rr lip oil Nis 5T. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 EROSION CONTROL PLAN (715) 386 -4680 • Fax (715) 386 -4686 For 69 Emerson Valley Dr, fKinnickinnic — ownall) ,ramie L. Andersa: Under St. Croix County Zoning Code 17.70(3)(b)5: 'The (Zoning) Administrator may attach reasonable erosion prevention conditions to a pennit approved for issuance." Comm 21.125 also require: 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 Control Plan is in effect and the following activities will be req� ired in order to maimtain compliance with the plan: I. The primary source for construction site runoff will be the house foundation excavation, driveway, and any soil stockpiled until final grading and stabilization is complete. Septic system excavationlinstallation adds to temporary disturbance, but establishing cover on exposed soils will present erosion. Plan to apply seed and mulch as recommended in #5. Maintain existing vegetation wherever possible to minimize sediment movement, An unnamed tributary stream is approx. 200 ft. east of the pro:)osed septic area, running north along the east line of Section 33 (see attached USGS map). 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 r!ceiving waters (this includes road ditches). Do not allow diverted runoff to be directed onto neighboring properties. A specifications for temporary diversions is being provided. 3. If builder /excavator grades the site to create temporary diversions (see 42) to contain sediment and leaves adequate vegetative cover to protect areas of concern, installation of silt fence MAY not be gecessary. 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 POWT S inspector will evaluate ESC plan effectiveness and make recommendations to owner and building inspector for any action required to comply with applicable regulations. 4. Construction equipment and vehicles must utilize a stabilized driveway ac. m. s off public road for heavy equipment, this includes cement trucks, well drillers, and other contractor' vehicles that access the property dining construction. This'helps avoid muddy, rutted conditions that may sl ow 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 it the end of each workday. 5. Stabilize new topsoil cover over septic system with seed and mulebi Immediately alter 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 applixd 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 eov...pliance with the ESC Plan. Please feel free to contact me with questions or to ask for assis cc wn y erosion & s ent control installation. P e ed by: Pamela Soil Erosion In ec r #6650 Owner acknow of ESC PIM r u'r a ts: ' .mac r . �lZz /2003 Pl eK H ode esc. �J- n S IDC,s �yr► ,� _ f ro f owe y M1.0 L, ►S ° I_ N f G � 3 �A, # 2 1 oc. q T o p I o Peck C S�J �0 7 � F�J ( - u - r 1 4 J P �piao, 4e CSG41t 7 A) C'_ 1-ot c //��/� 5 Self c � I'D Cis v �c� k � •7 � Y►1 e1-Sor. V4 11Q' o w\. � M r.- � StA, #2 1 cc). CI T o �, o e l�ej- -, « I P e ck %0 -� C PC' �E' r qo' i r r d D W � g to In G Q C SF o0 cr - ^� Ll- uj � d In Q �o a o @� to F� om , Q o ° of 0°� ix F' d Q�F o V m m Q z z � Lrtf� ° p F(47 p O J J V J J Q 0 N O o - JWW UU � 01 LY 1�.. ow In 03 CD Q W C G w. V)a Q WN O � _ o p , r� m w r cp 2 o O M in NLf) � U J 05 (7 aD_�� r-- p Y �, 80: L < w p r - 06 Z. Q Z U r, 0 mU <���m�s a.rc� a ., Z 0 Z F - J O Q W w Z z J (n H 7_ J „Z* - to I I• 3 • S W A 1 1 W Li I � 1 I 1 I I I ' z i I LtJ i C 1 1 f F- J W J F- y� ° „6i HI `t „95 I I 3 rJ I METERS FEET I ' 8 25 .k' .�. g 20 g 5 z 15 -j 3 O H 2 5 .. 0 0 10 20 30 40 50 GPM 0 4 6 g 10 CAPACITY MIGOULDS PUMPS, INC. 58,ECA FAUS NEW 1C!; G GWS f r I , :dA�)Fl• I , I Ellecdve WOW- onrr•Irv^ ATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE PRWTED W U. I POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 7 0f 8 FILE INFORMATION SYSTEM SPECIFICATIONS Owner JAMIE ANDERSON Septic Tank Capacity 0 g DNA Permit # "1 3 0 3 3 / Septic Tank Manufacturer IESER CONCRETE CI NA DESIGN PARAMETERS Effluent Filter Manufacturer ABEL O Number of Bedrooms 3 O NA Effluent Filter Model A100 12" x 209 C3 NA Number of Commercial Units Q[ NA Pump Tank Capacity 600 al 0 NA Estimated now (average) 300 gal/day Pump Tank Manufacturer IESER CONCRETE O NA Design now (peak), (Estimated x 1.5) 450 gal/day . Pump Manufacturer GOULDS PUMPS INC) NA Soli Application Rate 0.5 al/da V Pump Model .3871 EPO411F O NA Month av era g e* Pretreatment Unit NA InfluentlEffluent Quality g O Sand/Qravel Filter O Peat Filter Fats, Oil & Grease (FOG) 530 mg /L ❑ Mechanical Aeration O Wetland Biochemical Oxygen Demand (BOD 5220 mg/L ❑ Disinfection O Other. Total Suspended Solids (TSS) 5150 m /L Manufacturer Pretreated Effluent Quality Q NA Monthly average" Dispersal Cell(s) Biochemical Oxygen Demand (BOD 530 mg/L ) O In -ground (gravity) O d ressurized) Total Suspended Solids (TSS) 530 mg/L / O At -grade M Mound' Fecal Coliform (geometric mean) 510' cfu/100m1 O Ddp4ine Maximum Effluent Particle Size Y inch diameter ep� kl for `omesttc (non- comnerdeQ wastewater and •• Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every 2 O months Q year(s) (Maximum 3 yrs.) p ump combined sludge and scum equals one -third (Y) of tank volume p contents of tank s out ( ) inspect dispersal cell(s) A At least once every 2 O months Ctyear(s) (Maximum 3 yrs.) Clean effluent filter s At least once every 13 Cjmonths .13 year(s) In Pe P s ct u P• pump m um contro At least once every 13 QCmonths O year(s) O NA least once eve O months years) O NA sure test At le every 3 laterals and pres C . Flush late p Other At least once every O months O year(s) O NA Other At least once every O months O year(s) O NA MAINTENANCE INSTRUCTIONS . Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber Master Plumber Restricted Sewer, POWTS Inspector POWTS Maintainer Septage Servicing Operator. Tank inspections must include a visual Inspection of the tank(s) to identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y,) or more of the tank volume, the a Se to a Servi O r emoved b P all be remo P g 9 erator and disposed of in accordance with ch. NR n re contents of the tank sh all Y entire 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreattment components, and any other maintenance or monitoring at Intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event START UP AND OPERATION, For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may Impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. OWNER: JAMIE ANDERSON Page _8 or„,� Systeiin start up shall not occur when soil conditions are4rozen at the Infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental ftoss;'dlapers; disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to Insure that the system is properly and safely abandoned in compliance with ch. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall' be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: O A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction. and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish asultabie replacement area. Replacement systems must comply with the rules in effect at that time. 0 A suitable replacement area is not available due to setback and/or soil limitations. Barring advances In POWTS technology a holding tank may be installed a st resort to replace the failed POWTS. Th sit has not bee eve ted to identi a suitabl placem are .Upon failure of the PO a soil and i eval lion mu be perfo d to to a suitable rep cement area. re en area is available a ' (ding to m be installed as a last resort to replace the failed POWTS. tZ0 Mound and at�rade soil absorption systems may be reconsWcted in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name HELGESON EXCAVATION INC Name j Phone 715/772 -3278 Phone 715/273 -5811 SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name JOHNSON Agency Phone 715/273 -5811 Phone 715 /386 -4680 1 This document was drafted by the staffs of the Green Lake, Marquette and Waushars County Zoning and sanitation agencies. This document meets the minimum requirements of ch. Comm 83.22(2)(b)(1)(d) &(t} and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. GMW (2/0 1) r-- Wisconsin Department of Commerce SOIL. EVALJJA N REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Sr- e CW tX Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must Include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. �C�VD 1 Iv G percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all infonnation eviewed b Date Personal information you provide maybe used for. secondary purposes (Privacy Law, s. 15.04 (1) (m)). Q3 Property Owner V IS �� el-1. SoN Property Location Pc&A 2) Govt -W N J 1 /4 1/4 S 3Y T Z 8 N R 1$ E(or Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# City State Zip Code Phone Number. ❑ City ... ❑ Village RTown Nearest Road 1Z► v t?'(Z Fft BLS I k,) I S q o LZ (-7 L s) u Z-6 - Li' c� Z 1 t-, 1U1'.► t C_lr_t Q M I C I LFM N1'k v K LL D R. ® New Construction Use: ® Residential / Number of bedrooms Code derived design flow rate L[ ,S O GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material 1-13 �_r% S OV X12 0 K-t I. Tr-- _ Flood Plain elevation If applicable N A fL General comments -- . and recommendations: OVri�D LA JI 10 `Y_ gS � 1STIt_t LtU 17 e - e (- eo Boring a Boring # ' _..._ ® pit Ground surface elev. O t - S ft. Depth to limiting factor 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 16 Lip 3lz sit Z'F�sbk vh`f �s "S � .8 Z � -is 1�`t2�16 � s>> Z`�sbk h1`A- �S 1'F •S • g 3 1 S -Z -S y R3 1y q 6 VP- 6 l - _ QS RR _ - - -o .n F 71 Boring # ❑ Boring ® Pit 'Ground surface elev. S • 7 ft. Depth to limiting factor Z 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 � a -to toK1z3cz ._ _ sit z-�sbl M mss_ n, Z I 10 -iii 10 -t L316 - sir Z -ab►z M- 6- CZ 3 14- ta�2 tz-3/b S ; i Z�►� sblz n1'F-r- -- 5 . g3 VIVI Z -3b >.o�.�s c1r� �- Syczsl s; C . ter,,, , h�'f "� -' - ..., . _•O . _ . >> ' Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 _< 150 mg/L ' Effluent #2 M, :< 30 mgL S 130 mg/L' CST Name (Please Print) g V umber Situ Arthur L: We' gerer ot. `� Z p -2.54 Ad dress W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Alephone Number 421 N. Main St. River Falls, 4II 54022 1Z.- �� _o'd - -7 -425 -0165 1 Property Owner UN Parcel ID # Al l Page Z- of , , 5 Boring # ❑ Boring ® Pit Ground surface elev. ft. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant,Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft= in. Munsell Qu. Sz. C ont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 J 0- jr y R l Z — s 1 l Z jF*b c Vn `Fl- Z - 13 1DY R�l6 - sJ�l z- 'F'sb►z m`Fl- cs 1 .-s g 3 13 - zo 1 Sy1Z 1 - Z s►�k 'FV es , �i , b F 3 e ° _ - � t,>'v N S l Jo is ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 - Eff#2 ❑ Boring # ❑Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/it= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 • Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg& The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD -6330 (86/00) PLOT PLA Page 3 of 3 Scale 1'= ZO' 3q' _ LL - S /g' Dt ►l _ t Rory _ I'`Ob . :. _.. : � � I J c3►�tE-Z - �t _ goo .q ' c�i Top. o f 11 4 y D `� —ti-�v ru o r a cos Ppv�-r O1z l3Mtt-2 1lJ & � I cs 3 It 'L S p.. o a W J . d FRiTL�TC- - -1_pt _LYT - -- s T:_: s _' Fi?-iJ 1 m OUiv ,,�� ;.__•.. � x sip a� LI Jf S t CRO!x i CQUNty / M Z �ly_Qp 715- 425 -0165 220254 •OQ _ 3y 3 CST Signature Date Telephone No. CST No. Job NO. Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of Division of Safety and Buildings I in accordance with Comm 85, Wis. Adm. Code County s r• (am lx Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must Include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. G percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal Infomnation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner U 6 �� Property Location PVM SON Gov W 1U1til 1/4 MW 114 S 3Y T Z�5 N R Z$ E (or Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# city State Zip Code Phone Number_ ❑City _. E] Village RTown Nearest Road RI U f?tZ tS k,I S tj o 2.Z 1 (71S) L4 2.6 - q. Zl 1 -c1 1U LsM0'*L,5O)Q V PrI - lt"7 DR. ® New Construction Use: g Residential /Number of bedrooms Code derive_ d design flow rate LL S O GPD ❑ Replapement ❑ Public or commerclal - Describe: Parent fiaterial In M O V La12 tZ�O L O K'I l l'L Flood Plain elevation if applicable N A R General comments and recommendations: "OQ � LA JI l o "Y_ qS Boring # ❑ Boring -- — _ ® Pit Ground surface elev. �) - S ft. Depth to limiting factor _ Z y in. _ .. .. _ - _ .._ _ _. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft Munsell Qu. Sz. 'Cont Color Gr. Sz. Sh. w _. •Eff#1 •Eff#2 / z .. � s) t Z.'(ZSb k vn�._ �s � s $ Z -ls 3 1 S _z S vx3ly - s i c l Z►riB b m s� �g - _ _. b z_3Z ID`1RiS _ LSRR .n LJ Boring Boring # _ ❑ _ - - ® Pit -Ground surface elev. S 7 ft Depth to limiting factor Z S in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 � D -14 lD`- l•tL3�2' _. ... _ Sii Z�sb�.. .�� CS �.� ,.�_. ._�..... Z 0 - 101-t r 316 - sib Z�'sbiZ h1`c1- CZ 1 �- 3 ' 1$ ZS 1a'trz. 6 Z4►t A& ZS -3b A '1ttSty 01 1a'1- S`1CL.Slt ._.. .. C. • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L - CST Name (Please Print) �g to CST Number .� ,.. ..,��° Arthur *�L¢ tJegerer ..a - - �"� 220254` Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. Hain St. River Falls, WI 54022 1Z.- �� _Op 715 - 425 -0165 S 5 a' Precision Exca PAGE a2 � nn 2 i ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMEN "' AND OWNLRSMIP CERTIFICATION FORM A C 1 � 0 �� - Address ; 2 1 5 (VeriGcapda requ'irod from Plaiminb De artmeai for' new construction) Parcel Identification Numbe t ZY O� ":c.r:•;a.r : ocxtson -� f., h ' y.� Sec. T.. N -I W, Town if �1Nri tck1Nia� L t # 0 _,. ;iried Survey Map # k-398 Volume � I;fage 1! �Ca 11) , Deed ? `� I q Volume 1 , rap q 40It "- Y-- no Lot lines identifiable yet D no t�zn�ctWIC Sad meintenanceof your:cptie system could result in its pretnaturmt'aihuo to haadk waracs. Ptopar waitsu man )f pumpia,S out the saptfa tattlt Ovary tarco years of rooter, if needed by a licensed pamper. Whitt you put taco dw ttystem �:cc2 :ae fu►aeova of the Septic tank as a trtoatement stage in the waste disposal ■ye$"& x'aa P -*Perry owaar ajrces to submit to St. Croix Zoaks Vcpanment a cereficatioo form, 6g7oe4 by the owner WA by a a : *: a; umber, jduracyr►ta[s plornber� mstdeted pWmber or a t+ytttetm► --^ : * opnx firing coaditton and/or (2) aRor taVactioa acrd pumping (if oacenary), We tepee suk k lau "A 0 ft+ll of alwv. ' -mac, she : Aderaaood Move read tl,t: above [equirtmonts and Same to maiotala the ptivw sewalto dfMMI tyrwm With the ataddasaa :sous, as set by" Depsmumorcommercc Rod tba.DopaAmcsat ofNaturai Rcco+ua•ne, Stec OrWbamie. Cet$Seatfoo 1 " %.I^ ycy.r acetic tyatem &as beep maintained must be completed and tetumed to the St. Croix Gousuy Zowng, Odiao WAk S4 -r� y �r expiration date. g�26� 03 APPLICANT DA7 t' : l:YZ CEI27C7FYCA_ TIQN twC) certify ftl all gtatcmenu on W.2 form Are true to tan best of my (out) ]roowic dao. i (WV) am (w) the a*WO) of de9c 00 above, by virtue of n warranty deed recorded in Register of Me& QW,ce, G3 r` = 4 - CP APPLICANT DATE - •' - w 'r� ^c rz a lob of Aa MIS- represented way ruvit in the sanitary permit bciagroVokt; d by dw Zoning Daparnawt, 6 this Wlication: a ttzmped warranty deed from the Resister of Deeds of lar I Copy of the certified JWyer mop if rcnrcti o is made In 1;he wartaaty deM PAGE 04 "Ja: }9M'4air«J 'i1Crn R rn.:�a.v , . . a!_ t. a�-... a....... . ,..._.... ............. ......•.. __ I:f"v?Y - V'r +i.Spq.'aS'ki" %tme..n v n,., n. ,- .u.....,.«..n ...�....._.rti :.. ,. a .w. JiM ?'UeM/ya•ds1UiWIeYXbM "'i, , I \`L D r E 5 2001 f 39f307 ttvi w CERTIFIED SURVEY MAP Locoted in part the Np 1 /A.nf the NE 1/4 onst the SE 1/4 of the NE 1/4 of Section s3, and th W�F 1 /4,of the NW 114 and the SW 1/4 of th I JW 1/4 of Section 21 Township 2 es i p o�vIIRfs;"Ri�T'II�"9�E -Town o�RlnnTck nnTc�roix 1�CVn9i lei Lot 3, Certified Surve Ma recorded u y p, r In Volume 9, Page 26 (1, of Certified Survey Map LEGEND 0 .1 200 O 'Denotes 1 Bich by 24 Inch Iron o L— — J pipe monument set, weighing -C 1.62 lbs. ptzr lineal foot. o • Denotes i 17th Iron pipe mdnumerit o y SCOie 1 inch = 100 feet found uni ism shown otherwise. °m �( R ) Bearings and distances recorded f.. W C.S.M. V01. 9, Page 2610. � 0 3 V I The NE D)r, of Sec. 33, _ o� T. 28 N., •R 18 W , . — z ^ F ound St, Croix Coi.lnly Monumeni / e a b 0 Let 1 The E, floe of 4E 1/4 Sec, 33 —. ' o a , S G.S.M. Vol• 5, Po (Le _126 I 1 -� r - 33 JJ -- — — — — -- S (2'{2'45' 6 07"E 377.44) del CNl i ,0 N i/ E 37 1.33 i �^ .—) p+0� :5 o > r —,. Under Ground Electric 3 J� 4 (/} �? r + Approximote LocnHon. fence- -L �ry � 1 dl h I 0 1 Q1 N Lot 10 " y 01 1 r 87264 sq. it +/_ 3 C h y 1.5 wire fence [] . 64 2.003 Acres + /-- �\ (R (� , 41 1 "f Pr Mound 5 1- 01 'm — ' 3� f 27 i col �1 N7f > c, tl� Saw Bark lrne f t39.9 ly o l r 1 J w o � i Z, 0I 7 Ng i z N 4 2 45' µ Lot 3 C.S.M Vo ^ - 610 g e - g Pa 610. y T. -- 2 2 eM S"e11i1e' 0131 Septic Drain rleld Veni— I N�,N h Q N W 1 Lod; 9 J The SE car, t-at 3 I 1 154304 sq, it + — �° [;.S.M. Vol 9, Page 2610. W ! 3.54? Acres +/ 33 JJ well 1 373,93 j 1 N 8 238 1 g 7 ?52306,W 375.54 I j Of N63.02'10 -W 253.38 ) I j Cot 4 1 C S.M. Vol. g p ! so 1111rfitr o e 3 t � ; ir,,� - ---- - - - -g— 261�P1 R�VEU G O 5 A S` ��, ' SL CROIX COUNTY c I rN ``� V _ ' •-" r Pionolne Zorina and Parks Committao ^.r I_Ar .L Zeal Ifnolr I OcOnIOd W 1171n _ aDDrovol tl ao da or .7f Sha x 1 .� 4 .rle approval shell be i !I Vill i ( The E 1/4 cor, or Sec. 33. ' / �tti� Four T. 28 N...R. ---- �Ilw1 15A� d SL Croix Counl Mon 41 y ument Instrument Drafters By, Alion L." Everson — Shee f 2 sheets Cth 983 09 U� � a 9 \` 1 p /65 , innicki is o r ❑ - 9 . - � 151I96G 94 67 _ _ �— 16 \- - O u - ownhall• 952 � ,o \ - get 939 _ - - 936 I C U - 00 o o J 932 _� iJ 927 'BR 943 O A 920 / 000 23 21 a `�"J , �� e- 0 ; o 982 � L 958 w re v C /G v` 7 942 r — 979 - -� \ 87 _ _l _ I �' 986 S`1 1 p 1013 ZY O San C K 4 K I .N 9B 1 �C 35�, r /r3 ° II ,109 - too too 1 ST I � 1124 7 / 1033 r 1 1 !/00 - r� 2 p56 , i o 94/ X/152 — —� 957 o o `Fork South IIpO /; / 928 '945 C n l l 944 i .� ,. 11 • jany OCD o V A �. � 4 988 /rzz / I ` \ I V \ v ' II ° - : -- �� ho _'� /r���. �itS50 $I I �' � Jr h� �• �1 C] w j ! r` l ►y[4� "Lv L M. �,L S CD I flD �to p C'v CH 04 La o f f � * . - - c c r-. E NM rn a C d i CD + 4 tam li ''" 1$ _ -c' .fir C t 6` - ---- -� -- cM 3 1U h q q rd Erosio .. � Control Plan for 1- 2 gamily Dw elling Con Aructlon According to Chapters ILHR 20 & 21 of the Wisconsin Uniform Dwelli ng Code, soil erosion Sites control information needs to be included on the plot plan which is submitted and approved p rior to the issuance of building permits for 1- & 2- family dwelling units in those Jurisdictions whe the soil erosion control provisions of the Uniform Dwelling Code are enforced. This Standard Erosion Control Alan 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. 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 application, PROJECT LOCATION 0i irfL rrrQPs BUILDER Pis"* indcalo north OWNER rn,� pE , S��3 5 by Cornploan91n# arpW WORKSHEET COMPLETED BY �ccl t� o� � DATE 'S -- c 1 SITE DIAGRAM - �- N -- r Scale: finch = —feet I EROSION CONTROL PLAN LEG ...��, PROPEAry LINE _ l .4 Y , ExlsruuO DRAINAGE YD TEMPORARY DIVERSION I --�- -T _ _,- FINISHcD - DRAINAaj LIMITS Olr GRADINO SILT FENCE - ,-�- -♦ STRAW I SALES 4 T GRAVEL I l O VEGETATION IL SPECIFICATION ® TREE PRESERVATION STOCKRLEO � 301L P rn/1[`1�lAi f/1j1��Qn n� ©m rHFCKUSIr r ' Z Management Strategies Temporary stabilization of disturbed areas. 's Note: It Is recommended that disturbed areas and soil plies left inactive for extended periods of time be stabilized by seeding (between April 1 and September 15), or by Diner covOr, such as tarpinry or mulching. Permanent stabilization of site by re- vegetation or other means as soot, as possible (lawn establishment). • Indicate re-vegetation method: treed 0 Sod C) Other • Expected date of permanent re- vegetation: • Re- vegetation responsibility of: Z) Builder [} Owner /Buyer • is temporary seeding or mulching planned If site is riot seeded by Sept. I5 or sodded by Nov. 15? t7 C7 No L Use of downspout andior sump pump outlet extensions. Note: It Is recommended that flow from duwnspouts and sump pump outlets be routed t 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 ut; 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 imrne- dlately. Decomposing straw bales will be replaced (rypircal bale life Is three months). • All sedirr•,ent that moves oft -site due to construction activity will be cleaned up bafPre the end of the saute workday. • All sediment th,1t 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 raintained until the disturbed areas they protect are stabilized, rot more assistance on. plan preP4raticn, refer tc the Wisconsin Uniform Dwelling Code, the DNR Wisconsin Constru(tion site 5,w monogement Hondb,ok 111d M--Extension publication Erosrcat Con(tvl for Horne auNder•. The Wisconsin Uniform DN1 Code :nd the I'ViscaMir Constrwiicv) 5ite Best Monagement Handbook are avail ble thro the ;rate of Wisconsin OocumVnt saes, (608) 266.3558, ugh iro:ron Control for Hume euilderj rc;y 'Q001) can he ordered through Extension Publlcatlons, ([rotl) 262 -3946 or the Z Check (✓) appropriate boxes below, and complete the site diagram Q with necei`tisrliefnformatlon. Q O Site Characteristics North arrow, scale, and site boundary. Indicate and name adjacent streets or roadways. Location of existing drarnageways, strums, rivers, lakes, wetlanos or wells. Location of storm sewer inlets. N, Location of existing and proposed buildings and paved areas. r ' The disturbed area on the lot, Approximate gradient and direction of slupss before grading operations. Approximate gradient and direction, of slopes after grading operations A ug} Overland runoff (sheet flow) coming onto tJie site from adjacent gross. Erosion Control Practices Q Location of temporary soil storage piles, vR Note: Soil storage piles should be placed behind a sediment fence, a 10 foot wide vegetative strip, or should to covered with a tarp or more than 25 feet from any downslope road or drainageway. pty Location of access drive(s). !* Note: Access drive should have 2 to 3 inch aygiegate .;tone laid at least 1 feet wide and 6 Inches thick. Drives should extend from the roadway 30 feet or tot the 4 house foundation (whichever Is lass). SIb Location of sediment controls (filter fabric fence, straw bale fence or 10- foot -wide 'f vegetative strip) that will prevent eroded soil from leaving the site. Location of sediment barriers around on -sitt. storm sewer inlets. Location of diversions. Note: Although not specifically required by code, It Is recommended that ccncen• trated flow (drainageways) be divered (re- dlrected) around disturbed areas. Overland runoff ; sheet flow)from adlartnt areas greater then 10,000 sq, ft. should also be dsverted around disturbed areas. Location of practices that evil! 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, +E_ Location of p that Will control erosion on areas of concentrated runoff flow. Note: Unsobillzed drainageways, ditches, diversions, and inlets should be protected from eroslon through use of such pruc. as In-channel fabric or straw bale barn rs erosion control mats staked sod and rock d -(op. Wien used, a 4 give.- in-channel barrier should not roceive drainage f rom more than two acres of unpaved area, or one Acre of paved area. !n - channel practice. should not be installed In peronnlal streams (streanis with year round flow). y � m t. Indicate rnanagement svate b gy y checking ✓the a .� {: 9 ( ) WroWlate box. i3 Ray av HAI- 0- °I" pp o 2 Sumner wN Marcella 4 — O J Thomas L 1 &OS N&J 20 _1 N K &D i °a ' S Van- DAN 14 (n / '& Mary Kaa Lueck , 0) COULEE Jones ° a cn !3W 1 Beek M vow Marvin � AI,, 20 3 TRL 157 2 r j` 1Judje w0 21 zt 73 4 F Johnson 1 180 45 „ 1601 D&D Rai aC Cha[ks ^ W$G L. Q Randy °ur p P 3 B Havel s a A� c� z G 7 M ^ helm O & Jana Fl , �° 3z m B > 65 160 w h ppenheimer 266 , FeyereLun 65 SS 107 a t„a ue 4 r s7 H rust �a Mark David ttiva 37 1 p 39 ir"Y F Y the ,, & �2 � STEEPLE DR I dle�a & Maryy & eema.y solnnlY- one a Kaman a shwas aulsar Kam*9" w I yy 1 p L 41 _ 53_ 110 Ne - W�dun W A II I I V a_ R K�1 _1 �] 3 S 5 F� "'°` 4p _8 2 �_ 'b - - R&M 4 O f undue a G tr Michael P &j n 3 to I a Farms a ° s &sctmat tr G 1a 1 John Z Gerald 2 s s Harol Inc a @ 3 d; 40 codas- 1 1 ., Nickelson ,uw Emholtz © 1 Morro 1 F 117 :, d / z In 00 0 Agronomics I 31 T& tr ti ° ^ R Lease 66 , i g 1 o � u / 222 122 z � Y J 154 186 2 ' : T v 1 o TOWN HALL Da sp 00 o'Oo a T7 ' w au 4 00 1RD tr F & Jeffrey 2 WuR Mani $ Q CL -ft LU i° a .S 77 $ s c � Esther Christensen 9 vER River d b " Gerald a w7 an v m Nnrman w V 44 & Fuller b u 5 a/nain �+, Donald w . �?� Georgiam Trust ' Inc 72 3 so Diane ill a a In a A 1n Ktr�nnn 1 & Gloria m ro A Rider PB & K&K Kmadr { °h "" A o + - w X91 Mueller 208 J ah�,_112 Jr 57 2 _ 154 BR 1s _ 39 53 _ — -�rQ - - 1i 40 "tom - - Ross & ` - - z ^� can ET 80t E Terese� tr Screa- John Bette dorf 1 ( 2 31 mas & b Tho 1 0 w Fuller Ma y i H 80 4 o_ LL F- ton 4o q ` F ( �aau 1 WIODB °DB ^� Leif & �� 102 �o Ne was Dale & N s NN� 79 �"� 26 lac Partners t) e QDB Rebecca �NN\G tr 0 140 Fly 1 Rita 4 ° s s 3 Da5 40 zo 1 � 120 z so � Dela�huerta D HORT 176 t 40 ac - a ° K ans o Howard K &V 0D Daniel z tr c 11 m " .-, -p & J ia an 14 Madsen D 15 R & 53 �p„ , r " oward & Ann Ma m R Zoerb f &W T uan 30 RIVER n tr o Gordon Rc Krumwiede /aM s 31 a M 4a 6 o 04H W DR I" v w 40 Griffey 1 100., F 11 - m cR s q� m w w gg : ° 111�. t Da 2 ; , o ' , Kt st Z D a I ° � fl F m cli < Linda 16 9 DS 0 �a F9 1 - 35 _ _ w R o m 5 _ 53 _ 37 - 3 ABen & - — ° 250 _801 w_ a Hebert g 7 tr wihna 18 / R8K Keith & Leota ° JJ ry cinch ^' rk K C T &J NE Debora Andrea r�, u+' Nywee° s 1 Ter Rs 15 Andrea u(L Gil ""' RB & w 1 ocE ,�} �h 2 36 Taut 33 Q B 5 40 ari xt 65 6 9 rn1 m ` tl " FN44 1 Q 2 C ¢ Trust ounty 29 I LK tr O tr G 17 , Y � MY 1 1 a nT 1S p ] r roix 8 2 3 c Alk . ' x .Sj� 40 B J � CN 21 10 RaB 1 2'7 a m- Roll rah & Ja et z } a s - } lemon 9� 11 tr uN y e Jerry z st„rp 1 M Bauer i' 'c&Jane a ca 94 2 113 2 N' ¢ o ,axw m Cr & O F ' 315 R F tr 5 bet k 41 Hinz 38 37 W i m 40 0 w O cc ad Vernon _j Stanley G 91 Adeline a r B to Ken- Hat:y Joan & M HaK zo David 1 A Tana Peskaz Peskar Rose �, RP Peskar p A7 1 Hinz ¢ Pestar Ardis - RaY Gaon 39 _ I 67 Bd °�3 2 104 316 Yunker z 10 ` ' F amily 9 D° 35 Kr 0 aLB 12 3 _ 9 y o. m &PA 14 6 21 40 39 1 Janet Cudds 1 u } P N ^ -s 14 r; dith 1 ° 0 o a e R amie. Christ cudd Mobile 65 Gerald n. z " tr �" Jorgen- , .� 1n T M Dean Trust 62 Home Court 1 & Carol w 33 40 23 o uio vas LE o 73 SOn 54 40 ¢ W " 40 B 40' cK a Williams m c, , Pa & KxB 1 9 lker a s l ° e� a 1 L C ' avid Debra & & Alice Wa 1 Z Ovsak t 31 Hanson , C m = &G =� O RIVER 35 TH 26 110 TS1 M Ralph � Gramm 1 aS o XS FALLS 1 n S Tucci 55 40 39 4C1 40 " 196 2 Kamen 1 l &Ruth ,a Dadrne 0 00 Grace 1 A Dean j 65 ^"" Miller 9 Lee Nichokon '° P J Nelson Bergserig C ."."" ? — 130 L 40 1001 4o x7 �Ov 141 _ _12 — — — COTTONWOOD LN PIERCE CO. ` The Kinnickinnic River � Land Trust Rick McMonagle Executive Director 715- 425 -5738 phone 219 N. Main St. 715 -425 -5771 fax PO Box 87 KinniRLT @pressenter.com River Falls, WI 54022 Conserving natural resources and scenic beauty in the Kinnickinnic watershed Safety and Buildings • 4003 N KINNEY COULEE RD • LA CROSSE WI 54601 -1831 TD #: (608) 264 -8777 Nvisconsin www.wisconsin.gov .wis c ons .wisonsin.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary August 28, 2003 I CUST ID No.220292 ATTN: POWTS Inspector BENNIE W HELGESON ZONING OFFICE HELGESON EXCAVATING ST CROIX COUNTY SPIA W1229 770TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/28/2005 Identification Numbers Transaction ID No. 900248 SITE• Site ID No. 664012 Jamie Anderson Please refer to both identification numbers, Emerson Valley Drive above, in all correspondence with the agency. Town of Kinnickinnic St Croix County NWl /4, NW1 /4, S34, T28N, R18W FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 917668 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10572 -P (R.6/9 and t he "Pressure Distribution Component Manua eatment Systems" -- SBD- 10573 -P (R.6/99). ____ __-- ._. -_— Note: Per Comm 83.21(2)(c)5, Wis. Adm. Code, if any part of the POWTS managemen maintenance at an interval of 12 months or less, the activity must be recorded with the d has not been recorded, a sanitary permit can not be issued. \ • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. COI) fl • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption /� area. chs. NR 811 & 812c APP DEPARTMENT • A Sanitary Permit must be obtained from the county where this project is located in accordance with the OF requirements of Sec. 145.135 and 145.19, Wis. Stats. ---- ` C SEE CORRE • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) A copy of the approved plans specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation /operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may 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 $ 100 0.0 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services W SMART code: 7633 . (608)789 -7893 , 7:45 am - 4:30 pm Monday -Friday cbratz @commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 JLl 1 v" PV(-VENT PIPE 12" MIN. ABOVE GRADE & WEATHERPROOF 2:25 FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHADLOCKV�R FINISHED GRADE WARNING LABEL L ri%a- MIN. 2+J g Oe6ERW+TI'onl INL T-I N • PIPE '��� 18 M IN. ET WATER TI I � SEALs GAS - TIGHT `)APPROVED FILTER A SEAL JOINTS WITH �_ ALM APPROVED PIPE APPROVED $ B ' ON 3' ONTO PIPE 3' (a xt� SOLID SOIL ONTO SOLID C I ' SOIL PUMP LEV . �q�O FT. —#•— OFF D 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS L�rr��S SEPTIC / DOSE ~- �, �/ X TANK MANUFACTURER: � TANK SIZES: SEPTIC inn0 GAL. DOSE VOLUME INCLUDING DOSE /` GAL. l,S- �6G1.FLOWBACK: 33 S:� GAL. ALARM MANUFACTURER: .,T FIo�{vo S �P�S CAPACITIES: A = I INCHES = 30 1, GAL. MODEL NUMBER: 16 I Hw g = 2 INCHES = _ s..2 GAL. SWITCH TYPE: �M °,��� .� i" nn C = INCHES = /� S-C GAL. PUMP MANUFACTURER: t!�bca 1 Cpl MODEL NUMBER: P0-4I(F D = 1 INCHES = GAL. SWITCH TYPE: l c - Fl oes{ REQUIRED DISCHARGE RATE � M GPM PUMP & ALARM WIRING AS PER ILHR 16.23 WAC FEET VERTICAL DIFFERENCE BETWEEN PU PIPE - 3y FEET PRESSURE + MINIMUM NETWORK SUPPLY • • FEET + �1/ FEET FORCEMAIN X �..? FT /100 FT. FR F DYNAMIC HEAD • _ / ,2 FEET WIDTH DIAMETER INTERNAL DIMENSIONS OF PUMP TANK: LIQUID 6 3 (f - / Pe , r. 1) pi", - rez -4 5� e, Slve SIGNED: LICENSE NUMBER: DATE: 1/88 BENNIE W HELGESON Page 2 8/28/03 • Comm 83.22(7) A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation /operation. In 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 $ 1 0.00 i Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@commerce.state.wi.us cc: Leroy Jansk Wastewater y y, 5pecralrst, (715) 726 -2544 INDEX SHEET PROPERTY OWNER: JAMIE ANDERSON 417 E MAPLE STREET RIVER FALLS, WI 54022 PROJECT NAME: JAMIE ANDERSON PROJECT LOCATION: NW 1/4, NW 1/4, S 34, T 28 N, R 18 W MUNICIPALITY: TOWN OF KINNICKINNIC COUNTY: ST CROIX DESIGN: PRESSURE DISTRIBUTION MANUAL SBD- 10573- P(R/99) MOUND COMPONENT MANUAL SBD - 10572 -P (R 6/99) CONTENTS: Page 1: Plot Plan Page 2: Cross Section and Plan View of Mound Page 3: Distribution Pipe Layout Page 4: Septic Tank & Pump Chamber Cross Section & Specifications Page 5: WLP1000 /600 -MR Zable Tank Specifications Page 6: Pump Specifications Page 7: POWTS Owner's Manual & Management Plan - Pg. 1 Page 8: POWTS Owner's Manual & Management Plan - Pg. 2 Name: Bennie Helgeson Signed,, _- Address: W1229 770th Avenue Spring Valley, WI 54767 .ply Credential Number: 220292 Date: August 8, 2004 D Y COMAfERC E �0 D1l 133 SPpNDENCE QWVtr V, SO e ]J► i�t 4o E y►lerso� Ua lle Dos Qra eosel 3 - "oc i 1 No vv e- y, r� Cav 1 - _ - s�•P� j l� Q -C I e f « l Pest , . � s • �oV I- PVIE' C- Ro& 1� .a r OLI) e �l�wti e. A c� Q�sc Page Of Synthetic Covering Distribution Pipe Medium Sand /-e Topsoil -_ H --- - F G �� ` d 9 3 E , leu !� % Slope , SSY Ccll Of 2 2 2 Force Main Plowed Aggregate From Pump Layer D 1. 3 Ft. Cross Section Of A Mound System Using E 0,9V Ft. A Bed For The Absorption Area F 78 Ft. G Ft. A Ft. H ! Ft. Signed: B y Ft. boo License Number: K i/ 7 Ft. Date: L Ft. J Ft. iT _p.,S' Ft. Force Main W 3 �? Ft. L 1 Observation Pipe ------ - - - --- - -- ------ -- - - -- - -- - - --+ % L cot h A -- - - - - -- - - - -- ------------------ - - -- W1 - -- - - - - -- ----- ----- - - - -•I Distribution 1 0 f Pipe Aggregate 1 Q Observation Pipe C'lca.r o«� !J / Ar A x7 Bex- �7Sa- = /SO 7, 5 Plan View Of Mound Using A Cell For The Absorption Area ���� n �e.w ; �p rn ► R n d P -r `moo n _ _____�,— �3 � F' C )ear Perforoled P lp• Osloll End VI�� PO(loroled ' o``o �y` PVC Pipr C r �laO' n Bottom ' Holes Located o ,)W are Equally Spaced 5 Q Pvc Force •hICIA F.om Pump - jP PVC ' blonllold Pips e �'P� -4.�5 �� OiclrlDullon..• Plpr Distri bution Pipe Layout R 7� S X Y y Hole Diameter �_ Inch Signed: " Lateral " _ Inch (es) License Number: ^ Manifold Inches Dace: ry Force Main " o` Inches i,VVCe`r 15I•eo. 97, 3 i� -- .. T .4 - o-` Al V„ "c r o� 4- �Io1•e S