HomeMy WebLinkAbout026-1075-30-000 Wisconsin Department of Co't PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division INSPECTION REPORT Sanitary Permit No: 420660 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Nelson, Paul I Richmond Township 026 - 1075 -30 -000
CST BM Elev: Insp. BM Elev: BM Description:
OD, a 10010 t�
TANK INFORMATION ELEvATIO DAT
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic t 16 ��� Benchmar J l0 � -�
Dosing Alt. BM �l b
A -�
Aeration Bldg. Sewer 1a, 0 q3.
Holding St/Ht Inlet J � �t J�
St/Ht Outlet
TANKS TBACK INF
1 9 , 51MAT
TANK TO P/L LDG. Vent to Air Intake ROAD Dt Inlet
Septic .� f J / / Dt Vtt
VYt �
Dosing ? / f-` Header/ n,
Aeration Dist. ron Q
Holding Bot. System
t'1IrA. 5
.r
PUMP /SIPHON INFORMATION Final Grade Inlr'-,`'
Manufacturer �, /j / Demand St Cover
Q G(JC (J -4 GPM TAT 1 d
Model Number 0 ! � 11 t (S' 04
TDH 1 0 Friction System H T � Ft �7LtJ1/
Fo cemain Le Dia. 2 N Dist. tq Well
d I ) PIP zj� �
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Lengt / No. Of Trenches PIT pIDAENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 7 �
SETBACK SYSTEM TO P/LW BLDG IWELL LAKE /STREAM LEACHIN Manufacturer:
> INFORMATION C MBE OR
Model Number:
Type O System: / � `�
�t 6b � 2ts ' E db
DISTRIBUTION SYSTEM
Header /Manifold Distributio x Hole Size x Hole Spacin� Vent to Air i ke
f Z l Pipe(s) y( a� 1 / 1� 1 2
Length Dia Length Dia_ Spacing /
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over epth Over xx Depth of xx Seeded /Sodded xx Mul e
Bed/Trench Center ed [Trench Edges Topsoil Yes E] No Yes � No
n LLJ B
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: � + /2 / (]� Inspection #2:1 L
Location: 1378 140th St New Richmond, WI 54017 (SE 1/4 NE 1/4 26 T30N RI 8W) NA Lot 2 T Parcel No: 26.30.18. 92C
1.) Alt BM Description /��
2.) Bldg sewer length - Z `"! 1, � , � ] C � /
- amount of cover = l/
Plan revision Required? Yes
Use other side for additional information. — --J
Date Insepct s ignature Cert. No.
SBD -6710 (R.3/97)
Safety and Buildings Division Co
m m 201 W. Washington Ave., P.O. Box 7082 ,
isconsin Madison, WI 53707 Sanitary Permit Number (to be filled in by Co.)
Department of Commerce (608) 261-6546 d0 to& v
/ 1
Sanitary Permit Application State Plan I.D. Number
In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide W V & 0 Q
may be used for secondary purposes Privacy Law, sI5.04(I)(m) Project Address (if different than mailing address)
I. Application Information— Please Print All Information CEIVED 1 3 7 8 /v
ST
a Al er's me v Parcel # Lot # Block #
0a
` 7�� 026 't 7S= —0 0
Property Owner's Mailing Address ; ^ Property Location .3 92-C
1/ 1 o :S 77 L a
A E — ' /., t �" �, Section
City, State Zip Code Phone u OG
40` 5 `� - / (circle one)
fl. Type of Building (check all that apply) 7 G�J T N; I
PP Y) _Q E or W
Subdivision Name CSM Number
i or 2 Family Dwelling - Number of Bedrooms
❑
Public/Commercial - Describe Use ✓�� LtC� 1 p� (i j 1
❑ State Owned - Describe Use ❑City ❑Vil ge wnship of
III. Type of Permit: (Check o on li ne A. Complete line B if applicable)
A.
❑ New System Replacement System Y Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
B- ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
i
IV. Type of POWTS System: C eck all that appl /S p` W Qdtd
❑ Non - Pressurized In- Ground x Plound > 24 in. of suitable soil Mound <24 in. of suitable soil ❑ At -Grade ❑ Singl Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ 9ther (explain
V. Dis ersaL Treatment Area Information: 7 M s !_ i ra `L ro
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area quired (so Disper al Area Proposed (if) System Elevation
40 -Y; 5 ' So �o 77j 3 '
VI. Tank Info Capacity in Tckal Number Manytacturcr Prefab Site Steel Fiber Plastic
Gallons Gallons of Units /f !k` Concrete Constructed Glass
New Existing ^ p
�� �2 � 7 �8�
Septic or Holding Tank Tanks Tanks
Aerobic Treatment Unit
Dosing Chamber GSQ a
VII. Responsibility Statement- I, the undersigned, assume responsibility for i llation of the POWTS shown on the attached plans.
a t's Name (Print) Plumber' gnature MP PRS Number Business Phone Number
�� c> r's / Address (Street, City State, Zi Code) C�
ti
VIII. County/Department Use Onl
pproved ❑Disapproved Sanitary Permit Fee (includes Groundwater ate Issued [ ing Agen Signature (N m s)
Surcharge Fee) } �/ 7
El D
Owner Given Reason for Denial AA j
IX. Conditions of Approval/Reaso f or Disapproval
A-14il+de-n. 3.33
3 S -V Le- wrSd� d Sdt C'r >�trno �CVVlim�c r 2��sw��t� Z f
Attach co to o t n o for the ste o ern less than 81/2 x I1 i cIt in size
SB -6398 (R. 04
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Safety and Buildings
�— 4003 N KINNEY COULEE RD
LA CROSSE WI 54601 -1831
s TDD #: (608) 264 -8777
N *hsconsin www.commerce.state.wi.us /sb
Department of Commerce L ,.. www.wisconsin.gov
�JNTY Scott McCallum, Governor
51 OFFi Philip Edw. Albert, Secretary
NG November 27, 2002
CUST ID No.267341 ATTN. POWTS Inspector
ARTHUR L WEGERER ZONING OFFICE
WEGERER SOIL TESTING & DESIGN SERVICE ST CROIX COUNTY SPIA
PO BOX 74 1101 CARMICHAEL RD
RIVER FALLS WI 54022 HUDSON WI 54016 rM Ty yLa��
P�
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 11/27/2004 Identification Numbers
Transaction ID No. 816009
SITE: Site ID No. 653912
Paul & Jessa Nelson Please refer to both identification numbers,
1378 140TH St above, in all correspondence with the agency.
Town of Richmond
St Croix County
N E 1 /4, NE1A, S26, T30N, R18W
FOR:
Description: Three Bedroom Mound System
Object Type: POWT System Regu ate t ID No.: 883854
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.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems"
SBD - 10573 -P (R.6/99).
• Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area.
Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal
are prohibited.
• The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption
madly area. chs. NR 81 l & 812c
D V I ED A Sanitary Permit must be obtained from the county where this project is located in accordance with the
FCOMMERCE requirements of See. 145.135 and 145.19, Wis. Stats.
rAN LR1N
c Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the
PONDEN 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.
ARTHUR L WEGERER Page 2 11/27/02
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. i
• 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 $ 175.00
Balance Due $ 0.00
Charles L Bratz
POWTS Reviewer 11 , Integrated Services WiSMART 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
TITLE SHEET Page of - 7
/ BOUND SYSTEM
✓ FOR
A 3 BEDROOM RESIDENCE
This plan has been prepared in accordance with the Mound Component
Manual SBD -1057 P and the Pressure Distribution Manual SBD - 10573 -P
C 2. b /,I C cZ. � lqq�
LOCATED IN THE N) 1/4 OF THE P-JV- 1/4 OF SECTION Z b , T 3y N, R 1 S W,
TOWN OF S` % COUNTY, WISCONSIN.
t�QTr Z 0 V= CSH Iry VoL_L6, lxj
y
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 VIEW -CROSS SECTION X0 0
PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT
PAGE 6 of 7 PUMPING CHAMBER CROSS SECTION
PAGE 7 of 7 PUMP PERFORMANCE CURVE Il
PREPARED FOR
'u L f'cvl SkzSSR hJ BLS 0 to
10302 RJX l Z_U J t3Pr�
w0oDt3V12�J� rj t SS1ZJ
PREPARED BY
WECBEF;�EEZZ SCI I L- - TEST I "CC
AND.
I3�S 2C"�3V S�F2V I CE
P.O. Box 74 421 N.Main St.
River Falls, WI 54022
Phone 71.5- 425- 0165a�
Fax 715 - 425- 6864'`�''�'m
C o n dlf
a
RU MEN.
JO N O. o - Z- - Z 61
' System Management Plan p age Z_ of
h Pursuant to Comm 83.54, Wis. Adm. Code �[
� Seoti_ c Tank _t L.�2 0 6� (00
- h n s
T 1
fined b an individual certified to service se t' tanks under s. 281.41, Stets. The contents of the
septic tank shall be disposed of in accordance with is. Adm. Cade. 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.
Pu mp Tank
The pump (dosing) tank shall be ins �
pected at least once every 3 years. All switches, alarms, and pumps shalt be tested to
verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary.
)4mound and Pressure Distribution System
No trees or shrubs should )e planted on the mound. Plantings may be made around the mound's perimeter, and the mound
shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic
(other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the
infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather
installations (October - February) dictate that the mound be heavily mulched 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.
later re r vided with a flushing point at the end of each l ateral, and it is recommended that each
umulaled solids at least once eve man s. hen a pressure testis performed it should be
compared to the initial test when the system was installe 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. 6199)] 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 b& in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as
POWTS components.
Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access
openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed
unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall
be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component.
COntinQe c l 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 shalt 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 brin
operating condition. rY g the system into proper
Questions about the operation or maintenance of this system should be directed to:
The County Zoning-Office at ZS_.3$ -.�j -, l� 6�0 ST- 0BUL
The system installer at —Z 6ggS UT131p�
The tank manufacturer at �DtJ= S _ $CSC, wIE?t3 "
The effluent filter manufacturer at g UD — __ S - 1TZ Z-"
The pump manufacturer at �3ll_ - — -
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Approved Synthetic. Covering
ASTM C33 Distribution Pipe
Medium. Sand
Topsoil �+ -�Fy _W F G EIEV.
3 E ,
b
% Slope
Distribution Cell of Force Main Plowed
2" to 22" Aggregate From Pump Layer
E D .6 Z Ft.
CROSS SECTION OF A MOUND SYSTEM F D, g Ft.
G D S Ft.
✓ , k
I .
Ft. H 1 -D Ft.
V ear Loading Rate = �, Q GPD /LN FT B Z S Ft
Lin
Design Loading Rate= p,3b.GPD /SQ FT I )K) Ft.
� � Somas a�" ►2 �� � 112�t{� y�wY,.,
J Ft.
K Ft.
e— Position L CH . Ft.
of
Force Main
} W 2 Z Ft.
I
� ( - Observation Pipe
K
A
- r x t .
�Distribution `-- Cell of ' "
� to 21
Pipe aggregate
1
Observation Pipe
(Anchor secn=ely)
PLAN VIEW OF A MOUND SYSTEM
Distribution Pipe Layout P e S of 7
.d
Place the holes at the bottom of the distribution pipes
at spacing. Remove all burrs from the pipe and holes.
Extend the end of each laze -al up with the use of Iona turn or 45° Shon to a point within SLR
inches of the 2 n- 11 grade, Te rminat e the ends of the Iate. -als with a valve,:threaded can or
• threaded plug. Provide access from final grade for the valve, threaded dap or threaded pItL.
Laterl Mankid Lateral
x { x x xIZ (xJZ x x { x I x
Lateral Length —t Laterai Length —
Distribirticn Une
IT
C
}
P Ft. Hole Diameter 'je) Inch
S 3 F Lateral 1 Inch(es)
X Z Inches Manifold Inches
Force Main " Indies
l of holes /pipe 19
Invert Elevation of. Laterals 1 19-S Ft.
Combination Sept4c; and
• PLI•MP CHAMBER CROSS SECTION A?JD SPECIFICATIO ' PAGE OF 7
NEWT CAP WEATHER PROOF
JUIICTIOIJ BOX ,
ti C.Z. VELIT PIPE APPROVED LOCKIMG
M
10' FRO DOOIC, MANHOLE COVER PJIV
:i1MDOw OR FRESH wARtaISJG LN%EL..
wjp 6 - p \ A(R_INTAKE � caraiwtT
8 ' *
�
w f
• Ft N ts�j 6 .mo. � �� � - • • j
( �__ � IB
--------
IIJLET i" PROVIDE f -
�AtRT16HT SEAL f 1
1
Approved ft I Ill Approved
joint -l00 00 I I I joint w/
PVC pipe 1 II ALARM PVC pipe
b I t(
I t
1 f om
LLcrr. Ft I
PUMP -- - - -�
OFF
0
COWULETE
�LLV C 10 00' BLOCK
5'
RISER EXIT PERMI7fE0 OQLtJ IF TAWK MALUFACTURER HAS SUCH APPROVAL SEDOINQ
�BFDD:av�
SEPTIC f SPECIFICATIOIJS
DOSE
TAwKs MAU LIFACTURE R: WLIM5E11 OF DOSES'
PER DAB
TAUK SIZE WOO LLSO GALLOk1S D05C VOLUME r
ALARM MA)rUFAC,TURCiZ: _c" 5 J�L§It ') t, S S I 5ACKfLOW: X36 GALLOWS
MODEL ►.!UMB CAPACITIES: Ac L? UICHES OR 306 GALLOIJS
SWITCH T -4PE: _�ZL -7
8 = Z IRICHES'OR 3 V G(iLL0U5
PUMP !"IAULIFACTURER: GAL DS C= t1JCHE5 OR 13 � GA LLO W S
MODEL IJUMHER: � 0 � GALLOWS SWITCH TYPE: -CU1Z y MOTE: PUriP AMD ALARM ARE TO
MIMIM DISCKARGE RATE (' GPM INSTALLED 0 5EPAPATC CIRCUITS
VERTICAL DIFFEKENCE GETWEEU PUMP OFF AUD- ,D15TRIBUTIOW PIPE.. FEET (0' - )
+ MIIJIMUM METWORK SUPPLY PRESSURE , 6, SO FEET L) Y, i•�)
-f- lS FEET OF FORCE MAIM X 2'd� F o FEET
FCFFUCTIO FACTOR., y a
TOTAL Oy1JAMIG HEAD = '� `° FEET
As per manufacturer gal /in. Liquid depth 38"
Goulds
Submersible
Effluent Pump
3871 EPO4
EP05
APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron
Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer,
following uses: • Capable of running - lubrication and efficient strength, and durability.
• Effluent systems dry without damage to heat transfer. ■ Motor Cover. Thermoplas-
• Homes components. tic cover with integral handle
Motor: Available for automatic and
• Farms manual operation. Automatic and float switch attachment
• Heavy duty sump • EPO4 Single phase: 0.4 HP, models include Mechanical points.
• Water transfer 115 230 V, Hz, 155 Float Switch assembled and ■ Power Cable: Severe duty
• Dewatering RPM, , built in overload with
automatic reset. preset at the factory. rated oil and water resistant.
0.5 'N Bearings: Upper and lower
SPECIFICATIONS • EP05 Single phase: RP , FEATURES heavy duty ball bearing
115 V, 60 Hz, 1550 RPM,
Pump: EPO4 built in overload with ■ EPO4 Impeller: Thermo-
constriction.
• Solids handling capability: automatic reset. plastic Semi -open design
%a maximum. • Power cord: 10 foot with pump out vanes for AGENCY LISTING
• Capacities: up to 55 GPM, standard length, 1613 SJTO mechanical seal protection.
tal heads: up to 24 feet. with three prong grounding CO. SA Canadian Standards Association
•
• Discharge size: 1 NPT. plug. Optional 20 foot ■ EP051mpeller: Thermo- (GSA listed model numbers
Mechanic seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in "F" "A
or C.
rotary /ceramic- stationary, three prong grounding plug improved performance. )
BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged
• Temperature; thermoplastic design provides
104 °F (40 °C) continuous superior strength and
140 °F (60 °C) intermittent. corrosion resistance.
• Fasteners: 300 series METERS FEET
stainless steel. 10
• Capable of running
dry without damage to s 30
components. -
�.
Pump: EP05 a
• Solids handling capability: c 25
3 /4" maximum. q i J.. _ i
• Capacities: up to 60 GPM. _ �± !
• Total heads: up to 31 feet. s 20 • Discharge size: 1IR NPT•
z 5
• Mechanical seal: carbon- a 15
rotary/ceramic- stationary,
BUNA -N elastomers. 4 EP05
• Temperature: OR 3 10 3f -f 4
104 °F (40°C) !
140 °F (60 °C) intermittent. 2
• 5
1
• 0 00 10 20 30 40 50 GPM
0 2 4 6 8 10 12 m�/h
CAPACITY
®1995 Goukls Pumps, Inc. Effective May. 1995
- - --
s
1228
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3
Division of Safety and Buildings in accordance with Comm 85, W is. Adm. Code Steel Sal Service
Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Cron(
include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D.
percent slope, scale or dimemsions, north arrow, and ration and distance to nearest road.
026 - 1075 -10
Please print all information. Reviewed By Date
Persons information you a may be � �Y P41 p ��Y t i K I' "f'�'lt4 (1) (m)).
Property Owner g Priperty Location
Nelson, Paul & Jessa j W. Lot NE 114 NE 114 S 26 T 30 N R 18 W
Property Owners Mailing Address Lot # Block # Subd. Name or CSM#
10302 Fox Run Bay 2 not Vol .16 Pg .4361
City State ZipCode Phone (Number City Village Town Nearest Road
L06010'6 -r /�7n 561N A-651436:4612- Richmond 140Th St
New Construction Use: le Residential / Number of bedrooms 3 Code derived design flaw rate 450 GPD
jo Replacement °`0! Public or commercial - Describe:
Parent material outwash plains and stream terraces f=lood plain elevation, if applicable na
General comments
and recommendations: Mound design, system elevation 99.50ft based on contour line elevation 98.50ft.
a
Boring # Boring
Pit Ground Surface elev. 98.80 ft. Depth to limiting facto 36 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD1W
*Eff#1 I *Eff#2
1 0-9 10yr3/2 none sil 2msbk mfr gw 1vf _5 .8
2 9 -16 10yr4/4 none scl 2msbk mfr gw na 0 .6
3 16 -36 7.5yr4/4 none Is osg mvfr cs na .7 12
4 3 8 7.5yr4/4 c2d 7.5yr5/6 sl 2msbk mfr cs na .5 _9
5 48 -72 5yr4/4 c2d 7.5yr5/6 scl ore mfr gw na .0 .0
6 72 -96 5yr4/4 c2d 7.5yr5/6 scysl om mfr na na .0 .0
Boring # a Boring
JIM Pit Ground Surface elev. 98.80 ft. Depth to limiting factor 41 in. Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKe
*Eff#1 *Eff#2
1 0-6 10y►3/2 none sil 2msbk mfr gw 1 of .5 .8
2 6 -16 10yr4/4 none scl 2msbk mfr cs na -40 .6
3 1641 7.5yr4/4 none Is osg mvfr gw na .7 1.2
4 " 41 96 5yr4/4 c2d 7.5yr5/6 scl ore mfr na na .0 .0
* Effluent #1 = BOD 5> 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD S mg/L and TSS < mg/L
CST Name (Please Print) Signature: CST Number
David J. Steel � 248956
Address Steel Soil Senvce Date Evaluation Conducted Telephone Number
1564 CR G Richmond, Wt 54017 11/13/2002 715 - 246 -5085
Property Owner Nelson, Paul & Jessa Parcel ID # 026- 1075 -10 Page 2 of 3
3] Boring # Boring
Pit Ground Surface elev. 97.40 ft. Depth to limiting factor 48 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft'
*Eff#1 *Eff#2
1 0-6 10yr3/2 none Sil 2msbk mfr gw 1vf .5 _8
2 6 10yr4/4 none sicl 2msbk mfr gw na 4) .6
3 16 -32 7.5yr4/4 none sl 2msbk mfr gw na .5 .9
4 32-48 7.5yr4/4 none Is osg mvfr gw na .7 1.2
5 C 8 5 5yr414 c2d 7.5yr5/6 slAs 2msbk mfr Cs na .5 .9
6 65-96 5yr4 /4 c2d 7.5yr5/6 scl om l mfr na na .0 .0
F—I Boring # j Boring
Pit Ground Surface elev. ft. Depth to limiting factor in. � App1e Rate
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDIW
*Eff#1 *Eff#2
F — I U"Y Boring # ' � Boring
Pit Ground Surface elev. ft. Depth to limiting factor in. Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/W
*Eff#1 *Eff#2
* Effluent #1 = BOD 5> 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
Page 3 of 3
STEEL'S SOIL SERVICE
David J. Steel 1564 Cty Rd GG
CST- POWTSM Paul & Jessa Nelson New Richmond, WI 54017
Lic. 4 248956 NE1 /4,NE1i4,S13,T30,R18W (715) 246 -6200
Town of Richmond, St. Croix Co. (715) 246 -5085
Lot 2 Vol. 16 Pg. 4361
Legend
1" = 40'
N A = Benchmark EL I MAM
% Top of I z" pvc pipe
�" �� • = Alt Benchmark EL 100.10Ft
Top of 1 /2" pvc pipe
❑ = Borings
Boring Elevations
B1= 98.80Ft
40 �',� B2 = 98.80Ft
B3 = 97.40Ft
B4 = 00.00Ft � t Y
9
17�
f
b
� ,ob
f 4-1
1
SIQ fr
?� r
P
°5lcr
w'C �-
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X
P.
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CURTIFICATION FORM
Ownerl'Buyer
Mailing Address I 1 O - A t? L t d LJ l 5 U?
Proptx±-, P.ddress _t 14 O - SA
(,Verification required from Planning ntttnepartment for new construction)
City/State L Parcel Identification Number _ Q 2- (. — ) 01 S - ) C)
LEGAL DESCRIPTION
Property Location :SE Y., - y,, Sec, 2-L, T 3o N -R. 18 W, Town of ALM
Subdivision Lot # 2-
Certified Survey Map # ( 8 Volume Page it 1
Warranty Deed # 76 l Volume Page #.
Spec house ❑ yes no Lot lines identifiable 0 yes 0 no
SYSTEM MAINTENANCE
Improper use and Wa intenA e- of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatateut stage in the waste disposal system
The property owtut agrees to submit to St. Cmix Zoning Department a certification form, signed by the owner and by a
master T
plumber, journeyman pbratber, resinctedplumber or a licensedpomper verifying that (1) the on4te wastewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is kss than 1/3 full of sludge_
Uwe, the undersigned have read the above requirements aad agree to utaiataia the private sewage disposat system with the s4mdards
set forth, }Mein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certif cation
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of three year expiration date.
SIGNMIRZE OF APPLICANT _ l T
DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge, I (we) am (are) the ownct(s) of
tAprty add above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIG ATURE OF PPLICANT 1 T
DATE
**'^** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. •" "•
" Include with ( Ili' application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
"ov 15 02 11:318 David J. Steel 715246iC85 P.1
1228
Wisconsin DepartmwtofCornmFwoe SOIL EVALUATION REPORT pag ; at 3
Division of Safety and BiOngs in accordance with Comm 85, Wis. Adm. Ccde St eel Sol Seam
Attach compiere awe pion on paper not leas Than 8% x 11 mchsa m cze. Pw nwsr CoWdy
' 8t. crooc
jizLds. but nut headed to: werttcal and herizoatal rwietence Da6a (BMl, d'eection and parcel I.D. pormA slope, sofa Dr da emsiorts, noAh array, w bdymn and dlstauxs to reewt
road. 026-1075 -10
✓'lease piiruam informo don. Rewieured By Dale
PmsmtliMon rabm pt* ma ybeusedtaeswcasedari (Pivwytar,,.1504 (1)
Propeaty Owner Prop" Location
Nelson, Paul Jana GWA. lot NE 1k NE 1# S 26 T 30 N R 19 W
Property Owner's Mai ng Address tot 4 Siock i1 Subd. Name c CSW
10302 fox Run Bsy 2 na Vol .16 Pg .4381
city n State Zip Code P :one Number City a;; village It T Nearest Road
C06a .l.r /T' r 55129 1.651.4338 - 4812 R1dh=nd 140Th St
t -_ New wonsttuctiat Um iJ/ Rostdonfial i Number of bedrooms 3 Cade dwweddes* fk w rats 450 GPD
i� Repiaowwt `j Public or commercial - Describe:
Patent materiat outwash plarns and stisam graces Flood plain elawtkx if appkcabkr no
Cienaral comrrer4s
arM recammeMetions: Mound design. system elevation 99.50ft based can contour kne elewavan 98.SC t.
I 1 ! g a ;`s;l am. rig
I I A Pit Ground Surface ele% 98.80 n. Doo to timUni; factor 31 in. Sad Apg "c , Rake
ttaeen 0#0h Demi N1 Color RedaiDewaptwe Textue sbwt a Con 6wce day s GPDW
'Ef l I - EfW
1 0 -9 10yr= none so 2msbk mfr ;M tvf 5 _8
2 9-18 10yr414 none scl 2msbk Mir E N era .4 .6
3 16 -36 7.5yr4/4 none is cap mrfr (s era .7 1.2
4 36-48 7.5yr414 c2d 7.5y606 31 2msbk n1rf 6 era .5 .9
5 48 -72 5yr4/4 e2d 7.5yr5/8 sdl om mfr t N no .0 .0
6 72 -06 Srn4 /4 c2d 7.5yr5/6 scdsi am mfr r s na .0 .0
8009 is L swa
if PH Ground Surface slew 98.80 1 om th t l factor 4 In Sd App A*m Raw
Horeai Depth Oommaet Color Raft Dew*im Textire SVudm Camiewme Sou fiery Roots GP"
'Elfdi'I 'E1gs2
1 0.6 10yr3/2 none al 2msbk mfr c a 41r1 .5 .8
2 5-18 1Oyr4 14 none SO 2mok rnfr 16 no .4 .5
3 1134 1 7.SYMM- none h3 osg MVN f N no .7 1.2
4 41 -96 5yr4 /4 c2d 7.5yn516 od otn mil ,a na .0 .0
Efluent $1= SOD d' 3D < 220 mglL and TSS s 30 a 150 mglL • ;?Akw t 112 a �-- 9009 <_30 erg& and TSS -4_.V M
CSTNow(PloneePrirtq Sigrtedn CST Number
David J. Steal , e7 248956
Address Sled Shc Serwioe� Date Ewduatios Conduct d Telephone Number
15" CR GO. New Riclrrrlatld W151017 1111312002 715 - 246 -SMS
l
Z00 'd r++eSb r 8D.' �Z 004S9bzSL4 _r il.LV6b3x3 '1 -10b)t
J 2078,' a 0
STA'L'E BAR OF WISCONSIN FORM 5 • 1999 7 0 1 9? 9
PERSONAL R.EPRESENTATIVE'S XATHL EN H. WALSH
Document Number DEED REGISTER OF DEEDS
ST. CROIX CO. , WI
Patri� ck Rose, as Personal Representative of the estate of Patricia B. Rose RECEIVED FOR RECORD
( "Decedent"), for valuable consideration conveys, Without warranty, to Patti 12/ 1212002 88:30A1!
A. Nelson and Jessa A Nelson husband and .rife Grantee, the followi
described real estate to St. Croix County, State of Wisconsin (the "property) EXEMPT #
(if more space is needed, please attach addendum): REC FEE: 11.00
SE I/4 of NE 1/4 of NE 114 of Section 26, Township 30 North, Range TRANS FEE: 539.70
IS West, Town of Hammond, St. Croix County, Wisconsin further COPY FEE:
described as follows: Lot 2 of Certified Survey Map filed August 34, CERT COPY FEE:
2002 in Vol. I6 N PAGES: 1
page 436! as Document o, 688845.
Recording Area
Nance and Return Add
V
le a d_e_j� _8R_1k_
Personal Representative by this deed does convey to Grantee a)i of the estate 026-10 75 -10
and interest in the Property which the Decedent had immediately prior to Decedent's Parcel Identification Number (PIN)
death, and all of the estate artd utterest in the Property which the Personal This is not
Representative has since acquired. homestead property.
(is not)
Dated this `j th day of �2C 14 vat �, pY . 2tt02
* Patrick Rose
Personal Representative Personal Representative
AU TRENT ICATION ACKNOWLEDGMENT
Signature(s) Patrick Rase, personal representative of the STATE OF WISCONSIN
_.. - )
Estate of Patricia B. Rase
ST. CROIX County )
authenticated this day of '2002
Personalty came before me this 1'2 t j day of
?C e + A6E' r 2002 the above named
Patrick hose, personal representative of the Estate of Patricia
B_ . Rose
TITLE: MEMBER STATE BAR OF WISCONSIN ' --------
(If not, -
authorized by TO6.06, Wis. Stats.) th -
to e known to be the person(s) who executed the foregoing
§
instrument and acknowledged the saint;.
THIS INS'FRUMENT WAS DRAFTED BY �,,(sp�, �,_ ��-• - �-Y—��
Ann Brose, Estreen & Ogland
304 Locust Street, Hudson, WI $4016 Notary Public, State of
(Signatures may be authenticated or acknowledged. Both are not tteeessary.) My Commission is permanent. (If no1jmt ate:
" Namra of persons mgrting in any -p-ity must be typed or printed below their si nature.
g Information Protcssioeals Co., Fond du L5 W f
PFRSONAI. RENtE5ENTATIVE'S DEEn STATE BAR OF WISCONSIN, 8(lU 655 202t
FORM No: 5 - 19"
3_
6 8 8 8 4 5
VOL 16 PAGE 4361
KATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
08 -30 -2002 11:10 A
CERTIFIED SURVEY HAP
CERTIFIED SURVEY MAP REP FEE: 13.00 COPY
PAGESFEE : 2
trida Rose Estate
Located in the Northeast f the Northeast 1/4 of Section 26,
T 30 N, Rkw6 Richm0 , St. Croix County, Wisconsin
ST. CROIX COUNTY
lanninn 7.nninn and Parks Committee
AUG 3 0 2002
If not recoroed within 30 days of
approval date approval shall be Nod cagCorner
alratrffi �uyCorner Sin 26, T 30 N, R 18 W
Section 26, T 30 N, R 18 W UNPLATTED LANDS (Found Bentsen Ahntinunt Monument)
(Set Raihomil Spdre from _ _ S 89 0 43'23" E 2621.00'- - - I UNPLATTED
S 89 °4 '23" S Centerline
North Lin NE 1/4 S ection 26 AVENU
§8 ' E 627.70' A „
OWNER-
LEGEND
------ .--------- • - - - - -. A. � �6 Patrieio Rose Estate
Indicates 1 "O.D. x 18" Iron Pipe Set o c(0 Pa&a Rose
O
(Min. wt. -1.13 lbs./lin. ft.) A 1378140th ST.
8 New Richmond, K. 54017
• Found 1" Iron Pipe
v
0 Section Corner Monument �r for 1 I ° LOT 24
(as noted) I *A `
9930&RESOR432551 SQ. fl.
A Soil Boring `O ( IAa .
9 054ACRESOR 394378SQ. F w'
(sra. Rlwj �
Zi N
5 M O a N
W l N 89 0 43'20" W 655.23' ~ W;
N ce
626.36' 1 N c ;
Q g1 a 0;
° oo GONS/00� dl o°OO d im 2
Z , o
o o
' -
• LAURENCE • D �I � 3 W
W. D
MURP Y • �eP�� N�
Pm •• IvER • tell o
ni AL
LS, o J Q 1)r y ai
QL W1.
�0 J 01
" C Uj
ii ND �b Barn as hed a LOT 25 OC.
�p o0
DATED- 02 Lor Z
9.930ACRE 2540SQ, f
9.482ACRESoR 413,026 SQ. fr.
(Ra. k1w)
South Line NE 1 /4-NE 1/4 E4 J7 `.•�t�
N89 °43'17" 655.22'
(Recorded as N 89° 3'01" W) - - —
UNPLATTED �Np�. I _
Scale in Feet 1 " = 200' i JOT -1
CQQr111f1edAyrysy. — 4P
200 100 200 N 4ot2'
0 I1L41�m1a4�P_a�.�
Bearings are referenced to the East line t FmA Quoter Comer
of the NE 114 of Section 26, recorded Section 26, T 30 N, R 19 W
bearing S 00 °19'25" W. (Found Berntsem Aluminbm Monunent)
This Instrument Drafted by Mark W. Peavey SKEET l OF 2
Vol. 16 Page 436