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024-1043-20-000
o cn O n CO) O 3 v n d r� 0 c c �'' f ! 3 0 CD m m rr 'S A x fn z O W G) Z� w z f0 �� T W O pm C N 01 d 7 7 m y � m 7 m y O Oft N N N c 7 'n 'n > D1 '� .�-. V '0'' 0 N N N N a w Cf o O O O O n N N (D m 10 o; w w1. N V N O N 0 o C 0 c m C O G: C5 O m W O O X O x N O f i f N O O j A V w V b <D d N (A Z D .. N 7 Vt `V � f5 A 0 O W C O �. OD N Ul C O- O( N N N 3 O i C7 O _� 4t (� O O 0 CD O m O V cn m W W D co 0) (A N N w z Q CL 000 0 0 0 °� �• � N Z _ 1 x Ul (n fn >y H C N G7 G7 y O D ID (� P m A lQ N y n CD p I $ e� c N pi o° D D o D D 0 O ry m K CL CL CD VNIA O m O 3 C 3 Oro C fD O O (D CD m I m w N c p Z n c m z m � , O O < N W m I m < o0 c c z 0 r: 0 ': Z U) y m m v 0 a W y W O I m I n 0 X a C tmn OL y N CL C 0 - o' o I � 2 T a t° w c w w e 0 c 0 I — $ o a Q c o a o ti oZ m y v m 0 a x CD m 0 0 x m 'T1 �• z � CD f CL Co a CD y m ^' O cr CD O I I � O O b N O 7 C I m o o CL o a ti Wisconsin Department of Commerce Count PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 96 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be v'.4t�for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Gardner, Patrick I Pleasant Valley, To of 024- 1043 -20 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/rown /Range /Map No: 33.28.17.27962 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR Type Of System: UNIT Model Number. DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing -1 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1712 County Road M River Falls, WI 54022 (SW 1/4 NW 1/4 33 T28N R1 7W) NA Lot 2 Parcel No: 33.28.17.279B2 1.) Alt BM Description = 2.) Bldg sewer length - amount of cover = Plan revision Required? `; Yes =j No i Use other side for additional information. -- -- -- -- - - - I i Date Insepctors Signature Cert. No SBD -6710 (R.3/97) 0 County Sanitary Permit ppl�#gp¢��E(� ST. CROIX COUNTY WISCONSIN in ord Ch rt 1 Croix Coun Sanitary mance PLANNING & ZONING DEPARTMENT Perso for may be use for secondary purposes S CROIX COUNTY GOVERNMENT CENTER G [Privacy Law. S. 15.04(1) m)] N(.11! I ;? ?0 1101 Carmichael Road A ALo Hudson, WI 54016 -7710 (715)386 -4680 Fax (715 386 -4686 Attach comp lete plans for the s stem on er no 1 inch in size. County S ©it Permit # ❑ Check if re I. Application Information - Please Print all Information Location: Property Owner Name 7✓ 3 (R r /� y� i '!� w 1/4 /U 1/4, Sec V'1 G CS � /` z6 N, 1 R E(or _ Property Owners Mailing Address Lot Number Block Number Z __ L C6 1�� ll/` City, State Zip Code Phone Numer Su7 ' ' n Name or CSM ber a ( V� QCs �� 5�oz z /S Z b6 . P>o • �6� 11 Type of - Building: (check one) �r 00i ❑ Village ®Town of 1 or 2 Family Dwelling - No. of Bedrooms: t iS1 ^^9` � // qq / ❑ Public /Commercial (describe use): ` kr,4 S/��'- �/ 4 ❑ State -owned Nearest Road �G 11. Type of Permit: (Check only one box on line A. Check box on line B if applicable) Parcel Tax Number(s) a 0 vo A) 1 Repair 2.0 Reconnection []Non- plumbing 4. ❑ Rejuvenation D X Sanitation z J 3 Z /7 Z? q T Z B) fffi Permit Number T � Date Issued ^ 2 S 6 -State Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) ❑ Non - pressurized In- ground * Mound t 24 in. suitable soil ❑ Mound :5 24 in. suitable soil ❑ Mound A +0 ❑ Sand Filter ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line ❑ Pressurized In - ground ❑ Holding Tank ❑ Single Pass ❑ Other ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required, , Proposed � (Gals. /day /sq.ft.) (Min. /inch) �—��,, Elevatio I. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete structed glass Tanks Tanks S- Ag - 1 ❑ ❑ ❑ 1 ❑ 2— (SU ov L.) L g ❑ ❑ ❑ ❑ I1. Responsibility Statement 1e:rn_k__A_ 1, the undersigned, assume responsibility for repair /reconnenction/rejuvenation /installation of non - plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the installation of non - plumbing sanitation system. Plum is Name (print) Plumber's Signature (no stamp MP /CARS No. Business Phone Number 2 zb 722;_ z Plumber's Address (Street, City, State, Zip Co r5 6 6 -5; t �o� Vlll. County Use Onl Disapproved Sanitary rmit Fee Date Issued Issuin Agent Signature (No stamps) g Approved nitial Adverse t D r t/. /16 IX. Conditions of Approval /Reasons for Disapproval: ,,, , ,� ,� SYSTEM OWNER: 3�`3 G ��" ° _ - 1 Septic tank, effluent filter and ,� -� ` r dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirement must be maintained as per applicable code /ordinances. RCS PLOT 2 PLAN Scale 1"= 4-0 'Page 3 of 7 i C BAlklH b x*�Dn`Zti�L` :Z IOU ry _ P e G Si n tip a hJ . eR Pd cg.. Q D0 Nor, comp 1,01s pnze� _ s �- � Z s t-b a -- 10 r .n bsol 170 rw- s 7 , f t7'r�t 1 ' x0 "' 2 2�f 1. Elevations shown are exist 2. In ing ground elevations unles In* 4" observation pipes with a s otherwise noted. 3. Septic tank to be t04p�o gallon capacity ured , P ( ? reeqg uired). w j N jQ\Z COV I-J/ - 800 manufact 4. Bench mark �'�� ��LU��- � jL e S aUF 0P • 5. Divert surface water around system to prevent ponding at the u ill side. b'd 966L98ESTLT S3WOH Hiboma 1H d6E:90 SO TT ^OW PLOT PLANT Scale I"= 4-0 ' Page 3 Of 7 L a Q y • S E;p17C �.� ��� b�. x.rDceei�l�rL ,r 'Z PUC F M. P V • / �S' -r � -�. _ � _ `_- h , __._• --- O p :; p ON ilJ Iii �: ":.1' _ :.. SOU E` 6 T. 0 tip rL Q Do ►nor Ca" 13 2 b sp" 170 T!� Sr, NOTES 2 1. Elevations shown are existing ground elevations unless oth 2. Install 4" observation pipes with a Braise noted. 3. Septic tank to be t 040 PProved caps. { 2 required). L&J t ' p gallon capacity manufactured by 4. $e ma Cc�✓ Mp Nt - 18010 ZPS� E FLUE�Y , F&tt7" Bench mark Sez "Q j 3. Divert surface water around system to prevent ponding at the uphill side. b'd 966L99ESTLi S3WOH HimomanH d6E :90 20 TT AOW n M O 3 m n t'7 A (D CD Z O W O W O s v < N O N Q) N > > N U :3 y 00 A ^' CYl a p N N c O O CD 7 v A C\7 V N N Q 7 < V N O O O n N 07 N O O N C =, cD O C o O �+ cn z D a N N (D (Q D 0 O. 0 0, T W N 3 a0 N e OOi ` O i v N p Ul � !� 0 o a CD K j N ^or' c X 3 0 rr l�l o Z O O O r r < N Z o o 0 0 N N 3 O1 N 0 N D D o O o a ti• CD W z (D --Iv, Cl) J T M o A � 7 0 fA -1 W W N c W CL � z a ? .Z1 C :: Z r y ;o D a W I � I Q CD o' I v c li o a N Z 0 I i o A I R N C N O O tot a 0 N (D Op W N CD ° ~' ti r ,Wiscons, Department of Commerce PRIVATE SEWAGE SYSTEM Count y Safety and Buildings Division INSPECTION REPORT St. Croix GENERAL INFORMATION • (ATTACH TO PERMIT) Sanitar Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)1. 3842560 Permit Holder's Name: ❑ City ❑ Village ❑ Xown of: tate Plan ID No.: Gardner, Patrick Pleasant Valley Town hip 63802-T = T,oms • I t,,-tk CST BM Elev.:. Insp. BM Elev.: BM Description: Parcel Tax No.: M , I �! 024- 1043 -20 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic p Benchmark 1A '41 o3.3g ]to Dosing `` Alt. BM Aeration / — � — Bldg. Sewe o.o 2- 3 b Holding St/ Ht Inlet S02- 9g, SOY TANK SETBACK INFORMATION St/ Ht Outlet r--- -- TANK TO P/ L WELL BLDG. Ai Intake ROAD Dt Inlet Septic >46 t 5c --- NA Dt Bottom P -(% F3. 6�r Dosing « `` L.� NA Header / Man. Aeration NA Dist. Pipe `f•�B o s� Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade 2 � +s - �oor) 5 Manufacturer el Demand over Model Number MB GPM TDH Liftw*r 0 L oss Ictio%,(,5 Syeste TDH lq,t5IFt Forcemain Length t Dia. H 2 tI 1 Dist.ToWell SOIL ABSORPTION SYSTEM BED/TRENCH Width Len the tNo Of PIT No. Of Pits Inside Dia. Li uid Depth DIMENSIONS DIMENSION SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEAC G nufacturer: INFORMATION Type of A.33` t > � / CH NIT Mode Number: System: DISTRIBUTION SYSTEM ���f L L. � D O 2 Header/Manifold Distribution Pipe s? /� t ole Size x Hole Sp cing Vent To Air Intake Length Dia. Length �"' 'tea. Spacing 3 • Ij f� 2 3 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed/ Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No C ( In de c i dscrep g r n ns ection o sec ion Location: 1712 C Koad M, Kiver rails, wl ?461 �/4 NW 1/4 33 T28N R17W) - 332817279B2 -Lot 2 1.) Alt BM Description 2.) Bldg sewer length= j 1. o Uj - amount of cover = t S "- z YN Y ry C a/ 3.) contour = q� S �CS S ,43 v# Plan revision required? ❑ Yes No Use other side for additional infor atlon. © SBD -6710 (R.3/97) Date Inspector's Signatu a Cert. No l ADDITIONAL COMMENTS AND SKETCH ` SANITARY PERMIT NUMBER: e f cc 3 e r ) [ s a w . § ....... ,g.n„„ w q ....e„e. ....e ..,�.. E..»..............,._ �........... ._..�....., e.. e ^ ...p.e,e,.e.. q ,��mm �- .......... .e... ........ .. ....k®.mm. { i p � t C ®e £ e a s � f E t � t ..m. .., .a.. �, 3 ..d. E ; € E { s I � t � e g F E s.. ea ........ . ......s e. .,..mom... ,.. e. ,....... m..A „.,,,. & .. .,.ri, --4. ......._ � ... .....p....=� .,e .. ... ... ,,.. >.�_.� R �. . w . .— �.. ,....� «, aM� k ww� �.... r , _......., , -_.w.� { W Y € 3 y wa t � �.. .» �� e.,.. « ...„.„. p..e. .- , �€, e e e ----- w t P � t , a w s ..r ���.. ��,,.� 2 ,e t ..,. , �..�,......._ m m�a ... 3 P � 3 AL—, _ F g,®.�,,...,,,,..", E £ m. .. �. £ F Safety & Buildings Division Sanitary Permit Application 201 W. Washington Ave. , PO Box 7302 I f i s consin In accord with Comm 83.21 Wis. Adm. Code Madison, WI 53707 -7302 Department of commerce Persgnal ,information you provide may be used for secondary purposes (Submit completed form to county if not [Privacy Law, s. 15.04(1)(m)] state owned. Attach complete plans to the county copy only) for the 5yaterft-oTVpajxL not less than 8 -1/2 x 11 inches in size. County State anitary P_e 't Number ❑ C s' .tQ a io plication State Plan I. D. Number 3 r I. Application Information -Please Print all Information \�' , Location: Property Owner Name > : Property Location AlUt I&' 1 /4 W /4, S 33 T VN, RfX or,Q Property Owner's Mailing Address ®� Lot Number Block Number sr cru �" L d 1 City, State Zip Code o Fl , Subdivision Name or CSM Number r 'yDaz� � II Type of Building: (check one) ❑ City L] 1 or 2 Family Dwelling — No. of Bedrooms: ❑ Village • , ❑ Public /Commercial (describe use): 0 -Town of ❑ State -owned III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Roe A) 1 1. ❑ New System 1 2. %Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s) q -. 1641 3 - Z a - 000 System I Tank Onl Existing System 3 ;, L $) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) 1 ❑ Non - pressurized In- ground W Mound Q �>< �� i) ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At - grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V Dispersal/Treatment Area Information: 1 — ,S" 57 (f 3 3 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Perco ation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation L l 15 VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks AL 0 S t, L-C 1 0,rp VII Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (print) Plumber's Si ature (no stam s): MP/MPRS No. Business Phone Number Plum ber''s� Address (Street, City, State, Zip Cod e) ,,/ VIII County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) Approved ❑ Owner Given Initial Adverse Surcharge Fee) Determination f; z IX. Conditions of Approval /Reasons for Disapproval: s M.2r.k�� �ci. rC ►' S Y G .�,,�Q,7"c 49a�. S Safety and Buildings 4003 N KINNEY COULEE RD LACROSSE Wt 54601 -1831 TDD #: (608) 264 -8777 $ s t *is C onsi \ \ www.comme www.wisco s gov Department of Commerce Scott McCallum, Governor Brenda J. Blanchard, Secretary May 08 2001 CUST ID No.691727 ��� ATTN.• POWTS Inspector ARTHUR L WEGERER ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY SPIA PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 RE: CONDITIONAL APPROVAL Ide N o. ti 38027 Nu mbers PLAN APPROVAL EXPIRES: 05/08/2003 Transaction ID No. 638027 Site ID No. 628612 SITE: Please refer to both identification numbers, SITE ID: 628612, Harvey Mathews above, in all correspondence with theag St. Croix County, Town of Pleasant Valley SWIA, NW1 /4, S33, T28N, R17W FOR: Description: Three Bedroom Mound System Object Type: POWTS System Regulated Object No.: 788678 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. 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 the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10572 -P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD - 10573 -P (R.6/99). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound manual, and section VI of the pressure distribution component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • 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 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. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installarion/operation. ' ARTHUR L WEGERER Page 2 5/8/01 w 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. Sincerely, DATE RECEIVED 04/12/2001 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 7:15 AM to 4:30 PM jswim @commerce.state.wi.us WiSMART code: 7633 t Safety and Buildings 4003 N KINNEY COULEE RD ` LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 I �cOn�I f www.commercesto www.wiscsconsin.gov Department of Commerce t , : Scott McCallum, Governor Brenda J. Blanchard, Secretary May 08, 2001 CUST ID No.691727 ATTN.• POWTS Inspector ARTHUR L WEGERER ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY SPIA PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/08/2003 Identification Numbers Transaction ID No. 638027 Site ID No. 628612 SITE: Please refer to both identification numbers, SITE ID: 628612, Harvey Mathews above, in all correspondence with the agency. St. Croix County, Town of Pleasant Valley SW1 /4, NW1 /4, S33, T28N, R17W FOR: Description: Three Bedroom Mound System Object Type: POWTS System Regulated Object No.: 788678 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. 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 the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10572 -P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD - 10573 -P (R.6/99). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound manual, and section VI of the pressure distribution component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • 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 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. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. ARTHUR L WEGERER Page 2 5/8/01 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. Sincerely, DATE RECEIVED 04/12/2001 FEE REQUIRED $ 175.00 %�•(/'K FEE RECEIVED $ 175.00 Gerard M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services 608- 789 -7892 Mon - Fri 7:15 AM to 4:30 PM jswim@commerce.state.wi.us WiSMART code: 7633 i TITLE SHEET Page \ of MOUND SYSTEM FOR A 3 BEDROOM RESIDENCE This plan has been prepared in accordance with the Mound Component Manual SBD- 10572 -P and the Pressure Distribution Manual SBD- 10573 -P C(Z_ b /qq.) CR. 6199� LOCATED IN THE Sw 1/4 OF THE tQtJ 1/4 OF SECTION 3 3 ,T 1 -% N,R 11 W, TOWN OF S--, CV-Gy X COUNTY, WISCONSIN. INDEX PAGE 1 of 7 TITLE SHEET PAGE 2 Of 7 SYSTEM MANAGEMENT PLAN PAGE 3 of 7 PLOT PLAN PAGE 4 of 7 PLAN VIED -CROSS SECTION PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT PAGE 6 of 7 PUMPING CHAMBER CROSS SECTION R PAGE 7 of 7 PUMP PERFORMANCE CURVE PREPARED FOR 1 SAFETY & BLOGS DIV. RIV_z - _l- t`S W t s�luZZ PREPARED BY WECGEF=:ZEFZ SO I L TEST I NCG AND. DESIGN SEF?V = CE P.O. Box 74 421 N.Main St. River Falls, WI 54022 Phone 715- 425 -0165 Q e� A !;�►j, Fax 715 - 425 6 P T 7 APT'I" ��_ C oillitlit i �ti:i (_£tEH A P1 OVEQ Ap 0EPARIM ENT of COMBUR GS otvrsl ,.`gym •g' I G EE GORR JOB NO. O 1 37 Mound System Management Plan Page Z of Pursuant to Comm 83.54, Wis. Adm. Code , Septic 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 is 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. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's s penmeter, 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 long used POWT g as S c omponents . P 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. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component 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 '71.5- 386 - y o Sr- C The system installer at - )is - Cn£3 `/ - 1? * L1 m S S . The tank manufacturerat ( 6 00 32S-Nsto K)VeltEle The effluent filter manufacturer at `BOO - ZZf -S7YZ Z.r - L The pump manufacturer at 800 - ��`� — hU Z0 ELL eR NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required). 3. Septic tank to be I ppp /boo gallon capacity manufactured by w t �Z C.UNC(2� �J /i�,00tt. t� t800 Zr�3�z � LU&�jT }•-1LI 4. Bench mark ,:-I, Sezz ► Ove- �. Divert surface water around system to prevent ponding at the uphill side. PLOT PLAN Scale 1"_ L ' •Page 3 of 7 • • 3 BpRh/ Y X KJ L lilt J•• S�nC -fit bhp x�r 1�R hI�TL L 1E.-z..*10% S'ot= Gr N _ �a► 2'r P v C F. M. A S r _ \ r r.►'goU eq. Po L� _ q y && z - E�_106-3 ofQ C.oRfve2 of tZCV4- /? 0 Nor c0w1pry-e1' No 4 O lZ W S ru va i s to-zT)N G ks lli'1S P1Ze Pra,P1 v'oyveU F}S Q O 1 bSQI -- - NOTES : - 1 . Elevations shown are existing ground elevations unless otherwise noted. 2 . Install 4" observation pipes with approved caps . ( Z required) . 3 . Septic tank to be ft0 /60o gallon capacity manufactured by 1 CAA./ � 1/ .1() t 80 o z.en3aL=PFLu Ewi- 4 . Bench mark s = S Pr.t3oVE 5 . Divert surface water around system to prevent ponding at the uphill side. • Page Li•Of 7 • Approved Synthetic Covering - ASTN C33 - Distribution Pipe Medium Sand s'sasie Topsoil _ap c--_- --. ,� Elev. ' . q. O \ 0. % Slope . • ( Distribution Cell of Force Main Flowed • Z" to 2 Z" Aggregate From Pump Layer 0 l • S Ft. EZ .y Ft. CROSS SECTION OF A MOUND SYSTEM F o. Ft. G 0. 5 Ft. . A 9 Ft. - H 1-0 Ft. Linear Loading Rate=471 .0 GPD/LN FT B Sc) Ft. . . . Design Loading Rate=0,36 GPD/SQ FT I ) Jo Ft. J -7 Ft. . K 1Z Ft. • A7-txenotc Position L y Ft. of n W 3? Ft. Force Main L -Observation Pipe �' I - -8---�—• -- —. / K . . : \ sv.... Distribution - to 2%2" Cell of z Pipe aggregate Observation Pipe • . (Aachbr securely) f r • r PLAN VIEW OF A MOUND SYSTEM _ - , • Distribution Pipe Layout Page S of 7 • Place the holes at the bottom of the distribution pipes . at equal spacing. Remove all burrs from the pipe and holes . Extend the end of each lateral up with the use of long turn or 45°fitting to a point within six inches of the final grade. Terminate the ends of the laterals with a valve,:threaded cap or . threaded plug. Provide access from final grade for the valve,threaded cap or threaded plug. I cc`ss ao _ . C7 7`11='.1 CT__L U.S3S S s ` Q N • PVC P\1C PV C. . � Lateral ManifoldLateral x x x x I xQ xrz 1 x Latx xxLateral Lenoth— eral Length — p Distribution Line om— L'Ert V\E1.v -- 14 P. "I IR-CCarjr-1c b0y� o- — L- c'CCS•t I ——o —hP1-1.11Fflu IS a—-- i 1 o—— - GQ re- \JC �oQCC 1"1R1N • P Z-Y Ft. Hole Diameter 1/� Inch ------_. • • S 3 Ft. - Lateral " I - Inch(es) X �3 Inches Manifold " a • Inches Force Main " 2 Inches - • I of holes/pipe 13 Invert Elevation of.Lateraisq-SO Ft. 13xo. qlt = 3.33x 6 = 1/. 98 6P'7 _ - Combination Se .4c; Tank and PUMP CHAMBER CROSS SECTION AMA SPECIFICATlOAIS ' PAGE G OF 7. ` WEATHER PROOF . -NEWT CAP - JuIJCTIOW BOX . ti C.I. VCMT PIPC AFPROVED LOCKIMG 10' FROM - 0 - 0 - 0 OOR. TAANHOLE COVER Wt'M AhUDOW OR FRESH wA(iN11JG LN EL,, ua3P10U P iPE A.LR IUTAKE cosaculr w /il'tCLT Gtp � t - ' Fl iei 1SifEb G �t DE 18' PUI,l. ---- - - - - -- It3 � ---- - - - - -- iWLET i PROVIDE I — •• 'a AIRT16HT SEAL v 841=FL�S � I� I Approved zfaf-L � I I I Approved joint w/ - ieOo I III joint w/ PVG pipe ALARM PVC pipe - - I II I i ou C I I q z.83 I • LLEY. fT PUMPS - -J OFF D CO►JCitETE -� Q. Z , G , 3 BLOCK • RISER EXIT PERMITTED O►JLy IF TAWK MAIJUFACTUREIZ HAS SUCH APPROVAL 3NAPPRO" BFOfl i N4 SEPTIC +i SPEGIFICATIOUS DOSE TA ki KS MAIJUFACTURER: IJUMBER OF DOSES' PER DAB TAWK JIZE: L000 160b GALLOWS DOSE VOLUME z ALARM /'lA)JUFACTURCR: MCLUDING BACKfLDW: lbb ` 6 GALLONS, MODEL ►DUMBER: i`J� �iW CAPACITIES: A= 1'6 WCHESOK 301 GALLOfJs SWITCH TAPE: - I" (FJ cJ -x?-L( 8= Z I U CHES'OR 33•S G{1LLOWS PUMP MAIJUFACTURCK' ZuE-LL�2 (20, C= _ G IUCHES OR GALLOIlS MODEL IJUMBEK: O f 8 ' • D. )0 INCHES OR ) 67, 6 GALLOWS SWITCH TYPE: — CC/IZLI DOTE: PUMP AWD ALARM RE TO 6L �y MIIJIMUM DISCKARGE RATE 3l_gg GPlA INSTALLED bU 5EPARATE CIRCUITS VERTICAL DIFFEKEMCE DETWCEIJ PUMP OFF AU0,.015TR15UTIOW PIPE.. b' FEET + MIW IMUM METWORK SUPPLY PRESSURE , .. 6 " SD FEET CS_Oxi. 3K + i FEET OF FORCE MAIN X Z F %oFLFRICTIOIJ FACTOR-. x'33 FEET TOTAL DtIUAMIC HEAD = )3 -SO .FEET As per manufacturer 16 . gal /in. Liquid depth 6_• pv� �FV:"Z F:-� "CE =or 7 U) CC HEAD CAPACITY CURVE 3 7/8 -'- 6 1/4 30 MODEL "98" 4 5/8 �{ 2s ( 3 5/8 = 6 0 1 v �v` aD + -4 0 I 4 t O 4 3/16 10 , 2 3 L4 8 5, 1 1/2 -11 1/2 NPT 0 • U.S. GALLONS 10 20 30 40 50 60 70 80 LrrERS I I 80 160 240 0 FLOW PER MINUTE TOTAL DYNAMIC HEAD/FLOW PER MINUTE EFFLUENTANODEWATERING CAPACITY 12 HEAD UNITSIMIN FEET METERS GALS LTRS 5 1.52 72 273 10 3.05 61 231 15 4.57 45 170 4 3/16 20 6.10 25 95 Lock Valve 23' SKI 102 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and - Variable level float switches are available for controlling single supplied with an alarm. and three phase systems. • Mechanical alternators, for duplex systems, are available with • Double piggyback variable level float switches are available or without alarm switches. for variable level long cycle controls. SELECTION GUIDE Standard all models - Wei ht 39 lbs. - 'h H.P. 1. Integral float operated 2 pole mechanical switch, no external control required. 2. Single piggyback variable level float switch or double piggyback variable level, 98 Series Control Selection float switch. Refer to FM0477. Model Volts -Ph Mode Amps Simplex Duplex 3. Mechanical alternator 10 -0072 or 10 -0075. M98 115 1 Auto 9.4 1 or 1 & 7 — 4. See FM0712, for correct model of Electrical Alternator, E -Pak. N98 115 1 Non 9.4 2 or 2 & 6 3 or 4 & 5 5. Control switch 10 -0225 used as a control activator, specify duplex (3) or (4) 098 230 1 Auto 4.7 1 or 1 & 7 — float system. E98 230 1 Non 4.7 2 or 2 & 6 3 or 4 & 5 6. Four (4) hole J -Pak, junction box, for watertight connection or wired -in simplex or duplex operation, 10 -0002. 7. Two (2) hole J -Pak, for watertight connection or splice. CAUTION Forinbmatanon additional Zoellerproductsreferto catalog onCombinatanStarler, FMO514 :Piggyback All installation of controls, protection devices and wiring should be done by a qualified Variable LevelSwitches, FM0477; ElecbicalAftemalor, FM0486; MechanicalAltemator ,FM0495;Sump/ licensed electrician. All electrical and safety codes should be followed Including the most Sewage Basins, FM0487; and Single Phase Simplex Pump Control/Alarm Systems, FM0732. recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL To: P.O. BOX 16347 Vii.. L&AMWe, KY 40256-0347 - Manufacfarers of . SHIP T0: 3649 Cane Run Road Louisville, KY 40211 -1961 Q!/AL/TY S NCE I9.99� r PUMP !O. (502 ) 778-2731 .1(800)928 -PUMP FAX(502)774 -W24 W:t=nsin Department of Commerce SOIL iA`I UATION ;REPORT Page I of 3 Division of Safety and Buildings L in accordance with C rn.,$5, Wis. Adm�de �`- Co my Attach complete site plan. on -paper not less than 8 1/2 x 11 i e'y in size P140 mu�Y' q s ST- Q- tX I include, but not limited to: vertical and horizontal reference p int dir tion and .,�. Pardel I.D. P ercent slope . scale or dimensions, north arrow, and locatio and -t� n�a � est ri? � Z y- 1C���- Z Please print all information .� �� Revie d ` Date Personal information you provide may be used for secondary purposes Priv Law, 15.04)). Property Owner FIFoperty Location . 4 l z � 1 \j E M 'Prr4 LzL-1 S ° Sl^J 1/41' )Uj1 /4 S 3 I T Z 8 N R 1 E (o' W Property Owner's Mailing Address , Lot # Block # Subd. Name or CSM# t tZ Cuukrlt rte Z - es M V L) , °i 6 City State Zip Code Phone Number ❑ City ❑ Village J� Town Nearest Road U O r- w I I S L(o u ( lS) Y ZS - S 7 T' L A S 1" V l L.�"Y < j . `n+ 'M New nstructi Use: Q Residential / Number of bedrooms 3 Code derived design flow rate L4 S C3 GPD ® Replacement ❑ Public or commercial - Describe: Parent material C•�L - ,`T C L PrL TL.LL Flood Plain elevation if applicable ne ments and recommendations: Mpvhk-� w/ 9 ,x SO' �tS`T1ZVQVl) lb1J C..QZ.L , Y"! Nt"V" )b (3 LL. Boring # ❑ Boring ® pit Ground surface elev. 3 ft. Depth to limiting factor 1 8 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I u - to I re- 3 12 - S11 YY'L v -S .� 3 1 -Z9 Y ZV CL�- -- 7.sUt>ZS�� stcl tesb �.iF CW , Z . 3 a Boring # ❑ Boring ® Pit Ground surface eiev. g ft. Depth to limiting factor Zo in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I o -9 1 - tR- 3tZ - sl 1 Z'k 6 k m`f-- � 1 v-� - 's 8 Z q - z.o ioyo Vb - s;f z` sb rnf-- �s - • s -$ 3 x sVP SZa s) cl ) 6k m Z -3 ' 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) — S? ature CST Number Arthur L. Wegerer O 1 -37 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 3- 1 -01 715 -425 -0165 Property Owner 1 1: ` S Parcel ID # Z L4 - 1 0 1 /3 - 2p Page Z of 3 Boring # t❑ Boring �I Pit Ground surface elev. 3 L- - 7 ft. Depth to limiting factor Z Z 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 1 0 - L 0 10`123LZ si 1 Z sj M `F� 44 1`F S ,8 2 10 zZ 10 3!6 si ( Z �' rh`�1- cS 1 v �F • -8 F-1 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/ft' 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/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD -8330 (R.6/00) PLOT PLAN Page 3 of 3 4 Scale 1' =q v' x "e- L LL rLt -J EEL L _ 1 ^7 � a� •S 5 ti rL LUp : _o 0►U KUfv< g -3 t'1'I30 U � G Z.0 UXID 1 10 PtW e2 or-J O-QP_ � of � I Di) NOT 4 o�z �t sh,�zn 1- Ali'! S Pt1Z�9 � O z 0 1 715- 425 -0165 220254 01 -37 CST Signature Date Telephone Into. CST No. Job NO. I Wisconsin Department of Commerce SOIL EVALUATION REPORT dNision of Safety and Buildings Page of 3 in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on papet not less than 8 1/2 x 11 inches in size. Plan must County Include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Z L / _ 1 Please print all information. Reviewed by 7 Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). �— Property Owner Property Location L 6evL -Lat S UJ 1/4 >UttJ1 /4 S 3 3 T 2 N R 1 8 Property Owner's Mailing Address ,, '7 E (o W Lot # Block # Subd. Name or CSM# r l`q lZ COUa,1�Y r'? r, Z - C- -S-I VOL. Lj �, 01 b y rzllu State Zip Code Phone Number [] City C] Village � Town Nearest Road 0? F k11 I S q0 Z ( - 1 IS ) cE ZS - ! o S 7 T-�' L \ SPr7.j' ' v A - t_tT'Y I 'M u ❑ New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate S p GPD ® Replacement ❑ Public or commercial - Describe: Parent material L - Pr'CLP L TLLL Flood Plain elevation if applicable fJ tq General comments fL and recommendations: ri' 1 Wh"C4 i t-'1! g '}L SO �lS`i�Z�QV CAL Yet !!v L m y M ) b ° 6t= S 1�,� FI LL, Boring # ❑ Boring a g �. 3 ® pit Ground surface elev. ft. Depth to limiting factor ° l$ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 C7 — LD`12 3 l -Z v 'F - s 2 - ►8 -�5 )o�lz3tl; - sl) Z-�Z v►Ler �S - .s .8 ✓ YI Ct'FZSL1 2 S B sicl L est vn CW - .Z -3 zg -Y� �.s yR y i y H cl 1 csbs� m'Fs- - . z . 3 ✓ El Boring # ❑Boring - ® Pit Ground surface elev. g $ • ft. Depth to limiting factor z0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz In. Munseii Qu. Sz. Cont. Color Gr. Sz. Sh. •Eft #1 'Eff#2 9 - 20 LO `-t2 3!6 - sil 2` sbk YV2 f1- 'n-S 3 . 2 - 0 .z , 9 , — SV - r yl 'Pi e Sla Slcl LcS6k mfi- e _ ,Z. '3�. y zq -�! 7 S�Q �!! � r c 1 csb wt�F� -_ _ , Z 3✓ Effluent #1 = AM > 30 < 220 mg/L and TSS >30 _< 150 mglL ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mglL Si CST Name (Please Print) b sre CST Number Arthur -'L...Wegerer :(. 0 ) —a7 20254 220254 Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 11. Bain St. River Falls, . WI 54022 3_ 1_01 715 -425 -0165 L Property Owner Parcel ID # Page Z of 3 Boring # ❑Boring ' Pit Ground surface elev. �1 L- 7 ft. Depth to limiting factor 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 . 0 -10 10`11Z -N LZ LS 1 S,. ,$ ✓ Z !0 2Z 10 34 S 1 I Z 'Fs bk h1 `�f- c-S 1 U `� • S • $ ✓ 3 , zz 39 -1 - S Y&V/ 5 1 (� �S Lip- 5 /a s Ic 1eSb �� - • z � . 3 . ❑ 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 s Boring # ❑ . Boring i ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence I Boundary Roots GPD /ft= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 ' y ; •Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent ft2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 - 8777. '.• SB"330 (R.6M) PLOT PLAN Page 3 of 3 Scale 1' =4 v' z '" t t- - �' S �P11C ZZ't� e/ c 7 IO U/ o /a S ' -, , , \. �/ r 5"!40 lu1--D - 001J CMAJ(z CF Da N 4 o�Z. L�IS?u�Z,t3 �T ' J ,o \\ 2 CT K 1 -1 _01 715 425 -0165 2202 O1 54 -37 CST Signature Date Telephone No. CST No. Job N0. ST CROIX COUNTY SEPTIC TANK MAINTENANCE, AGREEMENT AND OWNERSIM CERTIFICATION FORM Owncr/I3uycc �i¢�s?iYY,�' �7 �I_ ,�°��, Mailing Address /d Property Address (Wrificatioa requittd from Planning Dcpartncat for new construction) CitylState Parcel Identification Number _ O :� 0 c 13 - dt O 0 � LEGAL DESCRIPTION Property Location ;, P)GJ %, S ec. , T-22N RRW, Town of ✓�Z --.c (� /� LZ z y Subdivision Lot # - Z Certified SmTey Map # _3 Volume page # 6 Warranty Deed # �' y Volume l 3 3 _ Page # =� SpcQ house ❑ y esA no Lot lines idwtifiabl.� yes ❑. no CSTF,M' ANCE • Iatpropa�scarad�y ,�ooaldt�altmits to Itandlewastcs.Pi+opaa�o�e ooasis(s of paampmg oat the septic task ey,ay thtte yc= Orman= if arkd by at Ii=sed p= What you p t.iato tlla system csa aff�cd�te,fzm�ctioa of t� scptt,c- taakss: ti�tm���at5e �stediI.sysbcm, - . - •. p agrees to - to St (coat T6aiag Dgia � iL foam, signod by �u 4 v= zud by a is is P = stdctodphmi= oriLUccasedP= Pw�Ymgtbat (IjStcca�ttc�d'igw=lsystcm- Pwper oP=L&g eoaditioa and/or (2) afttcr M 0dpuMPi4g.0 f Y). tc septiatank is 1= ton W fa of "sludge. Vow . � od tazmearad the abovr � � to a=aaiat:ia tfrbc ptivatc scarragc disposal systtmt wifti tha standards faA b=in. vs sd by do Dgauna t of a and the Dgmftacat of N&t=l Rrsom=s. Statc of Wi9oonsin.- ca6fica&m Y uP t hu boca aaaiatamod rst be eompEdod nerd rctamod to the SL Qvix.Coamty Zoaiag within 30 days-of the throe yrar expiration �, SIGMA OF APPLICANT DAZE OWNER CERT CA I (We) certify that all stag on this form are tnae to tic best of my (oar) kaowiedge. I (we) am (arc) the owam(s) of the PrOPCOY <k=Uaod above. by virtue of a wamtnty dood recorded in Register of Dceds Office. 4S, � A OF / /Z_/ o DATE st « « «« Any information that is mist todmay rou& is tic sanitary Pmt being mvokcd by the Zoning Department. s'`"" •� Iactade WI(It this application: a ttaaaped waaaaty dood from the Rtcgister of Doody office a Copy of the cettifed tutvey trap if miereacc is trade in the warranty decd _V L 1633 PAGE 286 STATE BAR OF WISCONSIN FORM I - 1999 6446917 WARRANTY DEED KATHLEEN H. WALSH Document Number REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Harvey L. Mathews and JoAnn RECEIVED FOR RECORD Mathews, husband and wife 05 -07 -2001 8:30 AM Grantor, WARRANTY DEED and Patrick J. Gardner EXEMPT I CERT COPY FEE: COPY FEE: TRANSFER FEE: 522.00 Grantee. RECORDING FEE: 10.00 Grantor, for a valuable consideration, conveys to Grantee the following PAGES: 1 described real estate in St. Croix County, State of Wisconsin (the "Property") (if more space is needed, please attach addendum): Lot Two (2) of Certified Survey Map in Volume Four(4) of Certified Survey Maps, Page 964, as Document No. 365226, filed in St. Croix County Recording Area Register of Deeds Office on July 3, 1980, being Name and Return Adoress located in the Southwest Quarter of the Northwest Quarter (SW 1/4 of NW 1/4) of Section Thirty -Three (33), Township Twenty -eight (28) North, Range Seventeen (17) West. St. Croix County Wisconsin. Mkt W 5 te�� 024 - 1043 - 20 - 000 Parcel Identification Number (PIN) Together with all appurtenant rights, title and interests. This is homestead properly. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Roadways, Easements, and Restrictions of Record. Dated this 30th day of April 2001 . * HHarvey sYYla-�h S(tJ Q7'wrJ �� oivd � �` oAn �Iatt;7exe M0. 1 - h e - L.t__3 S AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ) ss. St. Croix County. ) authenticated this day of Personally came before me this 30th day of April 2001 the above named Harvev L. and TITLE: MEMBER STATE BAR OF WISCONSIN JoAnn s (Y) A-: , V\ ew= (If not, to me known to be the person s who executed authorized by §706.06, Wis. Stars.) the fare rng instrum / acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY a_- ! z ,M_ r�? " Kay V. Palm v Palm Michael H. Foreeki, Attorney Notary P ubIIC NotaPub lic, State of Wisconsin Eau Claire Wisconsin Const Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both December 12 2004 .) WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1 -1999 -Names of persons signing in any capacity must be typed or printed below their signature. Produced web ZipFO w by RE Fa SNaL LLC 1 8025 Fdtaen Mil. Rwd, Clinton Township Mkhigm 48036. (800) 383 -9805 Aiwmy WOW H For ki 1830 Br kcu Avg F CW,, WI 54701 -4627 Phone: (715) 835 -1029 Fsx' (715) 835.4112 01187090.UFD CERTIFIED SURVEY MAP CALVIN WANG Part of the Southwest 1 of the Northwest 1/4 of Section 33, Township 28 North, Range 17 West, Town of Pleasant Valley, St. Croix County, Wisconsin. o Indicates 1 x 2 iron pipe weighing 1.13 lbs /ft. set. � it/�O ° OOOO�E 808.00• i8 Ff.3VC E r oe h ,o 0mQ CA GO'7 —z V� I I /O A G D s .0 .9G�E5 �1 O I O 8. A lVkr). �1 v C¢.75A,c u--5,V6) 0 Q 0 I. • 0 U ��`_ = �O' °° 0 � n / O Subr i to non - enforcing WISCONSIN ADMINISTRATIVE BUILDING State of Wisconsin municipalities for new 1 PERMIT APPLICATION Safety and Buildings Division and 2- family dwellings (Wis. Stats. 101.63 (7) & 101.65 (3)) 5 � SEE INSTRUCTIONS ON BACK OF SECOND PLY Personal information you provide may be used for secondary purposes. [Privacy Law 15.04(1)(m)] r Last me First Name Middle Initial Street Address City State Zip Code Telephone- No. (Include area code) Building Address Subdivision Name Lot # Block # Legal Description Parcel No. 1/4, 1/4, Section T N, R E o0w ❑ 1 Family ❑ Forced Air Furnace ❑ Radiant Baseboard or Panel ❑ Heat Pump ❑ 2 Family ❑ Boiler ❑ Cen AC ❑ Other: Nat. Gas L.P. Oil Q Elect. Solid Solar Space Heating ❑ ❑ ❑ ❑ ❑ ❑ Water Heatina ❑ ❑ ❑ ❑ ❑ ❑ ❑ Site Constructed ❑ Concrete ❑ Masonry ❑ Treated Wood ❑ Manufactured to the WI UDC; not U.S. HUD code) ❑ Other (specify): Livin area = ` ! S uare Feet I vouch that all the above information is correct, and understand that the issuance of this permit is for administrative purposes only. I understand that onsite construction inspections will not be performed by the municipality, but that the Uniform Dwelling Code, Chapters Comm 20 -25, still applies to all new 1- and 2- family dwellings and must be complied with. I understand that the issuance of this permit does nQt relieve me of compliance with other applicable codes and ordinances. A licant'§ Si ; ature Date Signed MUST BE COMPLETED BY THE MUNI BEFORE FORWARDING PLY 2 TO THE STATE DIVISION OF SAFETY AND BUILDINGS Town ❑ Village ❑ City ❑ County f: SBD -8254 (R.2/00) Distribution: ❑Ply 1 -Issuing Jurisdiction ❑Ply 2 -Municipality Forwards to State If New Dwelling ❑Ply 3 - Applicant MUNICIPALITY FORWARDS TO STATE WITHIN 30 DAYS IF NEW DWELLING 1 INSTRUCTIONS The owner, builder or agent shall complete and provide all required informatio$ the, application form down through the Signature of Applicant block. This data is used for statewide statistical gathering on new one- and two - family dwellings, as well as for local administration. Prior to submitting this application to the municipality, obtain any necessary sanitary or zoning permit from the county. After completing this application, submit it to the local municipality having jurisdiction. Plan review or building inspections will not be performed by the municipality. PERMIT REQUESTED: • Fill in building address. • Fill in legal description of lot, subdivision name, lot number and block number. PROJECT DATA: • Fill in all numbered project data blocks (1 -7) with the required information. All data blocks must be filled in, including the following: -------- - - - - -- ----------------------------------------------------------------------------------------------- 1. Type - Check only "1- Family" or "2- Family" if that is what is being built. In other words, -do NOT use this form if only a new detached garage is being built, even if it serves a one or two family dwelling. 2. HVAC Equipment - Check only the major source of heat, not any supplemental sources. Mark central air conditioning if present. Only check "Radiant Baseboard or Panel" if there is no central source of heat. 4 4. Complete type of construction. Use this form for site -built homes or homes built to the WI UDC requirements. Do NOT use this form for a manufactured home that was built to the U.S. HUD requirements. 6, Living Area - Include any finished area including finished areas in basements. For two - family dwellings, include total combined areas. 7. Estimated Cost - Include the total cost of construction, but not cost of land or landscaping. SIGNATURE: • Sign and date application form. --------------------------------------------------------------------------------------------------------------------- ISSUING JURISDICTION - This must be completed by the AUTHORITY HAVING JURISDICTION. • Checkoff MUNICIPALITY STATUS of issuing jurisdiction, such as town, village, city or county. • Fill in MUNICIPALITY NUMBER OF DWELLING LOCATION. If issued by a county, indicate the specific municipality number where the dwelling will be built. • Fill in name of person issuing permit and date building permit issued. PLEASE FORWARD SECOND PLY WITHIN 30 DAYS AFTER ISSUANCE TO (You may fold along the dashed lines and insert this form into a window envelope.): Safety & Buildings Division P O Box 2509 Madison, WI 53701 -2509 mSOOnsin Departrnent of Comffwce PRIVATE SEWAGE SYSTEM Safety and Mx** gs Division C ounty: INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information yod provice may be used for secondary purposes (Privacy Law. x.15.04 (1)(m)). 384256 Permit Hold er's Name: ❑ City 0 Vi laXe Q Town of: State Plan ID No.: Ga dner, Patrick Pleasant Valley Townsh p CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 0 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing kit. BM Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Air Intake to ntake ROAD Dt Inlet Air I Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot_ System PUMP / SIPHON INFORMATION _ Final Grade Manufacturer Demand t Cover Model Number GPM TDH I Lift Friction System TDH Ft Loss Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No_ Of Trenches PIT No. Of Pits Inside Dia. Liquid 5eplh D IMENSIONS IMNI N SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manu acturer: SETBACK CHAMBER INFORMATION Type M e Num r: System: OR UNIT DISTRIBUTION SYSTEM Header/Manifold i I Distribut n Pipe(s) I x Hole Size I x Hole Spacing I Vent To Air Intake Len Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench EdgesTopsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present igWection #1: / / Inspection #2: / Location: 1712 County Road M, River Falls, WI 54022 (SW 1/4 NW 1/4 33 T28N R17W) - 332817279B2 - Lot 2 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = 3.) contour = Plan revision required? ❑ Yes ❑ No l �L— Use other side for additional information. L I I SBD -6710 (R.3/97) Date inspector's Signature Cert No