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HomeMy WebLinkAbout026-1099-60-300 b o ) c ) o � E § 2 qb A $c §� K f c u s k ! `k §M° % §e E §a $ \2 f ®� a]o �k �\ƒ p» o � _ c == � §� 0 2 7$ 2 W �f 0 . CDC 2/« §g= c �] 0 d0 ■ t§(« §�K � � z / } § 8 z 7 g / W a B z 2 CD $ \ J a a \ y ƒ \ E \ @ S \ k § a. I o R 3 \ . z 3 \ £ z ¥ .. D 7 $ § 2 e CL 6. ©yak j % 2 { j 1 § o o a z n \ E k k k L F \ E B ¥ t ƒ a a a S $ ` \ 0 U) z \ \ \ @ / § / / / 8 § 0 a � $ m = c CD t 2\/ ) f / § ° k 8@ k .7 2 c E Q k C) k / §.0 f)\ E /$ 2 f\ 7 f/ 0 § R o 2 a 0 - g g E o■ o z- ■ n � ® . I 2 k�2 L: IL o j a ' o 3 Safety and Bui � r y / (ter be ` Pisconsin 20l W. Washington ve., C Madison. WI 3707 2 San* Permit Number filled in by Co.) (608) 2 3151 of Commerce Dep artment to P t.D. Number Sanitary Permit Applicatio �I In accord with Comm $321. Wis. Adm. Code, personal information pro " CROIX CG U TY maybe used for secondary purposes Privacy Law, sIS -04O X ) ZONING pFFI fpro1 adress (ifdiff than mailing address) I. Application Information — Please Print All Information (� 4 ;,) o Parcel N Lot N Block N Property Owner's Name Property Location Property Owner's Mailing Address 7 ,L / 02 / ? y. /., Section Cky. Zip C Number : j Phonc o Tt l� rL Type of Building (check all that apply) � �� Subdivision Name um 2 Family Dwelling -Number of Bodroorns ❑ PubI Conner is1- Describe Use (]City ❑Village ) $r9wnsW of 0 State III. Type of ermit: heck only one x on line Co line B If applicable) ❑Other Modification A. pNew System ❑ Replaearrent System ❑ TreatmentlHolding Tank Replacement Only fication to Existing System S. ❑Permit Renewal Permit Revision El Change of ID Permit Transfer to New List Previous Permit Number and Date Issued Before Expiratfon Plumber Owner misimofPOWTS S em: Check all that a pply) on — Pressurized In -Ground ❑ Mound >— 24 in. of suitable soil ❑ Motmd < 24 in. of suitable soil ❑ At Grade ❑Single Pass Sand Filter ❑ Canstrtictod Wetland ❑Pressurized In Ground ❑Holding Tank ❑Peat Filter ❑ Aerobic Treatment Unit [I Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Leaching Cham ❑ Drip Line 11 Gmvel-less Pipe ❑ Other lain) V. Dis rsalfrrestment Area In ormation: System Elevation Design Flow (gpd) Design Soil Applicati 0 Dispersal Area Required (sf) Dispersal Area Proposed ( ys- 3 Manufacturer Prefab Si Steel Fiber Plastic - O Tank Info Capacity in Number Concrete Constructed Glass Gallons Gallons of Units Ncw Existing Tanks Tanks Septic a Noldin@ Tank Aaobic Trestmern Unit posing Chamber VII. Responsibility Statement - L the undersigned, assume responsibility for installation of the POWTS shown an the a t ta ched Phone Number Pl7* Plum gnature MP/MPRS Number /' Plum s Add (Stn City SS te Zip Code r - VII Count y /De artment Use Only ent Sign re mps) nitary Permit Fee (includes Groundwater Date sued is g Approved 0 Disapproved Surcharge Fee) av j O ❑ Owner Given Reason for Denial fT J V IX. Conditions of Approval/Reasons for Disappro •al � � d 02,Wt/ (}'t( t ,S .S-�m r�-t.� =��,�� /� � s�6 � / '�''isu. -ere_ 0� v-rr d �►S�C 0 �� , Attach Complete plum (to the County aaly) for the system on paper wt tea thaa a1B : tt loch« to airs i SBD -6398 (R. 01/03) 1 PLOT PLAN PROJECT Daniel Groebner ADDRESS 2374 250th st. DeerPark W. 54007 SE 114 NE 1/4S 35 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX MPR5 Byron Bird Jr. 220527 �- DATE 9 -13 -04 BEDROOM 4 CONVENTIONAL XXXX -Grade CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1280 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE fl LOAD RATE •4 ABSORPTION AREA 1500 # of chambers 49 IL BENCHMARK V.R.P Grade at Base of steel stake ASSUME ELEVATION 108 ❑ BOREHOLE (DWELL *H.R.P Same as BM Vent SYSTEM ELEVATION T -1 =97.9 T -2 =97.8 T -3 =97.7 >12" Of Bio Diffuser with Cove 3 1. 1 ft ^2 per chamber , 6„ —Grade at System Long 34" Elevation 564' PL B2 226 st 10 BM 4 bed hoes y 30' B3 Garage Driveway 100' O ob pip 100' BI 80' 225' 543' PL Wisconsin Deparanent of D E B E C = �U `SC 10 UATION REPORT Pie of Division of Safety and Baudings Attach cwvlde site plan on paper no inducts. butnot lfal 4d b x vertical and horizontal reference point {BM), Parcel LD. paroent Woos, scam or d merwons, bath a rrow. end bcafion and distance to nearest road. 6— P/ease print all lnfoamation. Re Date Pwsona kftmMon yw p wAO ms c..usea for :R!+rPW (PiivacY Lew, s. 15.04 (1) (m)). Pry Property location �j>'l CYI Govt lot 5,6� 1/4 N R` E Property Oivnees Mapirrg Address Lot # Block # G AS e ;P /1 State Phone Number City 1:1 Village own /' Nearest Road sw Construction U Q RagI0w it / NurttW of bodroom Code derived design flow rate GPD 0 P^*=rn ru ❑ Public or comercial - DescrJ* Pafarm material Flood Plain elevation if applicable ft. G, neral *id ��_ / — a � # pi t Ground surface elev ft. Depth to limping factor : in. r Soil Application Rate I Horizon Depth ikx*w tutor Redox 0010 ption Texture. Shudure Consistence Boundary Roots * . 1 in. - AAunam ou. ft. Corm. Color Gr. Sz: Sh. 'Eff#1 'Eff#2 # ® Borin ' Pit Ground surface alevf ft. Depth to limiting factor `� in. Sop Application Rate Horizon Deph Agrrrirwrnt Color Redpx Qotcripfion Texture Structure Consistence Boundary Roots GPD/fF In. > tlMmsell t u. Sz. Cont. Color Gr. Sz. Sh. _ 'EM 'Eff#2 ' Effluent #1 SOD > 30 1 220 nV& and TS$ >30 _< 150 ffQ& , • Effluent fr2 = BOD < 30 rrV& and TSS <_ 30 mg& CST Norris CST Number Address DaWlEvaluation Conducted Telephone Number I.An M�I.TMMV., • f LLLfff y PMPWty owner c ` i�d �. _.. . Page of ❑ Pit Grourtd surface elov. �R, Depth to limiting factor > in. Soil Avokation Rate Hortson Depth Dorrrinart Color Redox D�sotipbion ' Texture Structure consistence Boundary Roots GPDW h. "" "fliluruseN » » �• Qu. SLCOrLL Gr. Sz- Sh. 'Eff#1 •Eff#2 a soft# ° soft ❑ Pit Ground surface elev. iL Depth to iimding factor in. Soil Application Rate ftUon Deptlt ... Q0airiant Redpx Dgsa iption . Texture. Structure Consistence Boundary Roots GPD/ll= in. Mu nseN Ou. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 BC i r , * Ground surface etpv.' - .. Depth to linAing factor in. Pit' SoU cation Rate Hodson Depb. Oax*w%t Color " ,. Redoz eocr p8on?-, - . ; Texture Structure Consistence Boundary Roots PD/ff In. Mined Ou. Sz. Cont: Color" Gr. Sz. Sh. •Eff#1 •Eff#2 rti cif L.` E; • E*wnt *4 - ", > -30 _ 220 ffVL wW TSS 2-30:S 150 irgll: • Etftuent #2 = BOD <_ 30 ffg& and TSS _< 30 nVL The Depart,gf Commerce it 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 2648777. sso.t�otes'raot ' Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: 463048 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal info6lhation 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: Groebner, Daniel I Richmond Township 026- 1099 -60 -300 CST BM Elev: Insp. BM Elev: BM Description: A,�" Section/Town /Range /Map No: / p � 1:2 U j ., �, o ^_ , A 35.30.18.539A30 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Li (u-,� 3.1� ,03•�� �� Dosing Alt. BM Aeration Bldg. Sewer y,50 <j9 Z43 Holding St/Ht Inlet 5.31 1 ?S ,q7 TANK SETBACK INFORMATION St/Ht Outlet S 59 `j I `T TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ?� / 7 / — Dt Bottom Dosing 'T Header /Man. 7. o7 -7 - , t c 2 Aeration Dist. Pipe � Holding Bot. System $ � Z8 5 •S -3 PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM Model Number T Lift Friction Loss System Head TD Ft Forcemain length Dia. ist. to Well SOIL ABSORPTION SYSTEM 16 q 7 ckkm&lO BED /TRENCH Width Length 8 No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS :3 j©(�s++ „ 2 kre k B �► �� \, SETBACK SYSTEM TO `` P!L ' DG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR ti t Type Of System: / UNIT Model Number: DISTRIBUTION SYSTEM 7 66 ¢- o I 9, 4 v c l 7 Header /Manifold Length �� Distribution I x Hole Size x Hole Spacing Vent to Air to 7-1 Dia "C L i / P engipeth s) \ Dia Spacing \ \ 3rJ �( 6 9 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over / Depth Over xx Depth of xx Seeded /Sodded xx Mul ed Bed/Trench Center 5 Bed/Trench Edges \ Topsoil 3, _l Yes [ No Yes No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: a_� J��/ Inspection #2: Location: 1260 140th Street New Richmond, WI 54017 (SE 1/4 NE 1/4 35 T30N R18W) NA Lot 3 arcel No: 35.30.18.539A30 Seed l c. Gave.. 1.) Alt BM Description = /tJ eec t P -,.J VV 2.) Bldg sewer length /�. - amount of cover - /' i `aS i Plan revision Required? es No 1 �� 0 1 04 ( �j 8� Use other side for additional in rmation. �— —i _ _ SBD -6710 (R.3/97) Date lnsepcto Cert. No. I Sanitary P ermit Application Safety & Buildings Division In accord with Comm 83.2 201 W. Washington Ave. See reverse side for instructions or cots l lidation i PO Box 7302 "Wr sconsin Personal information you provide in be used for second p u osis Madison, WI 53707 -7302 Department of Commerce (Submit completed form to county if not (Privacy Law, s. 5.04(1 ] t/; state owned.) Attach complete plans (to the county c for tlie system, on paper not less thaii 8 -1/2 x 11 in s in size. County / State San rmit N be Che k if revi�i�jpieVaiplicatiop State Plan, . D. Number 3t7 NIN G OF I. Application Information - P lease Print all Information Lo tion: Property Owner Name Pr erty Location P e" , (i t-- 1/4 Ig 1/4, S N, R / 1(or Property Owner's Mailing Address Lot Number Block Number `-( v S O 7Gi -5 / -�; City- State Zip Code Phone Number r CSM Number e 9 ,e ,- 4 �'` C3 (� v l�jP X512 II. Type of Building: (check one) d°PW ❑ Ci ❑ 1 or 2 Family Dwelling -No. of Bedro s: ❑ Village ❑ Public /Commercial (describe use):_ Mown of / ❑ State - Owned l { / Nearest Road fJ/ A 3 I X 47 ' S CA d 0S III. Type of Permit: he only one box on line A. Neck box on line B if e A) 1. PirNew 2. ❑ Replacement 3. ❑ RepNkement of 4. 5. 6. ❑ Addition to System System Tank On Existing Syst B) Perm Num er I Da ed ❑ A Sanitary Per was previously issued (7-G0 JT IV. Type of POWT System: (Check all that apply) i,�NOn- pressurized In- ground ❑Mound and Filter ❑ Constructed tl X ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatme it ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: at 1 210 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4.S pplication 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Z Rate ( s. /day /sq. ft.) Min. /inch) } Elevation ©� h_/ � -9 p rY— - '? % 1 4 7 VII. Tank Capacity in Total # of Manufacturer refab Site Steel Fiber- Plastic Information Gallons Gallons Tanks n- Con- glass New Existing cr structed Tanks Tanks [pie /, � ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersig assume re sponsibility for installation the POWTS shown on the attached plans. Plumber's ame (print) Plumber's 'nature ( stamps): MP/MPRS No. Nines, Phone Number n c co , PliffnyAddress (Street, City, State, Zip Code f 02r G- - IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued suing ent Signature (N stamps) X Approved ❑ Owner Given Initial Adverse Surcharge Fee) Determination X. Conditions of Approval /Reasons for Disapproval: 3) U CLV-q ^ S SYSTEM OWNER: ` brr�e /� - ���� 1 Septic tank, effluent filter and �� —7- 'tr 4'ij dispersal cell must all be serviced / maintained 51 as per management plan provided by plumber. 2. All setback requirements must be maintained Rs per annlicghlp rndP1ardin;;nrP..q SBD -6398 (R. 07/00) I PLOT PLAN PROJECT Daniel Groebner ADDRESS 2374 250th st. DeerPark w. 54007 SE , NE 1 /4S 35 iT 30 Nat 18 w TOWN Richmond COUNTY ST. CROIX MFRS Byron Bird Jr . 220527 ATE 9 -13 -04 BEDROOM 4 CONVENTIONAL XXXX rade CO ENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 0 LOAD RATE .4 ABSORPTION AREA 1500 # of chamb s 49 IL BENCHMARK V.R.P Grade at Base of steel stake ASSUME ELEVATION 100' ❑ BOREHOLE O WELL sH.R.P. Same as BM f t Vent SYSTEM ELEVATION T- 1=97.9 T - 2=97.8 T - 3 --97 >12" of Bio Diffuser with Cov 31.1 ^2 per chamber pt at qyStem , 6" Long 34" Elevation 564' PL 226 10' QL 10' st 4 bed hour b 100' r Garage Driveway ' b ij .� A k 120' � 125' B2 BM tow O IP*l 10' B1 543' PL - PLOT PLAN PROJECT Daniel Groebner ADDRESS 2374 250th st. DeerPark Wi. 54007 SE ,114 NE 1/4s 35 / T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX MPRS Byron Bird Jr. 220527 ATE 9 -1 3 -04 BEDROOM 4 CONVENTIONAL XXXX rade CO ENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1 260 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE a LOAD RATE • 4 ABSORPTION AREA 1500 # of chambers 49 BENCHMARK V.R.P Grade at Base of steel stake A SSUME ELEVATION 100' ❑ BOREHOLE (DWELL *H.R.P. Same as BM Vent SYSTEM ELEVATION T- 1=97.9 T -2 =97.8 T- 3=97.7 >12 Of Bio Diffuser with Cove 3 1. 1 ft A2 per chamber 61 Cirrade at System 6" Long 34" Elevation 564' PL 226 10' 10' st 4 bed hous 1 100' \ � Garage Driveway � ob pi 1 120' 20' 20 125' / B2 60' BM 10' B% 543' PL ORIGINAL 1852 i Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Dir,sion of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Certified Soil Testing Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must County St. Croix 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. 2.83 acre CSM pending _ Please print all information. eview ' 8 a e Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Bonte, Ron Govt. Lot SE 1/4 NE 1/4 S 35 T 30 N R 18 W Property Owner's Mailing Address Lot # Block # Subd. Name or CS A# F P 1 6 2003 1011 170th St. 3 U' 17 p Pr pose § CSM City State Zip Code Phone Number City Village own New st RM CROIX COUNTY Hammond WI 1 54015 1 715 - 796 - 5240 Richmond FFICE ✓i New Construction Use: jo Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement] Public or commercial - Describe Parent material loess over till Flood plain elevation, if applicable NA General comments ,. 62 -133 (UO'V and recommendations: install shallow conventional trench system w/ system elevation 2' below surface contours @ �0.4d /sg ft loading r iy+� dt�Qhi S� Qr r - " "N aj - 3 fLh FF1 Boring _j Boring em SOV / 04-- Pit Ground Surface elev. 97.5 ft. Depth to limiting factor > 67 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 -4 10YR 3/2 - sil 2 f sbk dsh gs 2m1f .5 .8 2 4 -12 10YR 3/2 - sil 2 f -m sbk dh cs 1 m .5 .8 3 12 -35 7.5YR 3/4 - sl 2 m sbk dh gs 1 m .5 .9 4 35 -52 7.5YR 4/6 - Is 0 sg di cs 1 m .7 1.2 5 52 -67 10YR 5/4 - s 0 sg ml - 1m .7 1.2 2 Boring # � Borin g Pit Ground Surface elev. 100.0 ft. Depth to limiting factor 63 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPE/ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I - Eff#2 r, 1 0 -5 10YR 312 - sil 2 f sbk dsh gs 1f /m .5 .8 2 5 -11 10YR 3/2 - sil 2 f -m sbk dh cs 1 m .5 .8 3 11 -24 7.5YR 4/3 - sil 2 m sbk dh gs 1m .5 .8 v 4 24J-6 7.5YR 4/6 sl 1 m sbk mvfr cs 1m 4 6 5 56 -63 5YR 4/4 - sl 0 m mfr cs .3 .5 6 63-73 5YR 4/4 fad 5YR 5/2 sl 0 m mfr - .3 5 ao Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 50 mg /L ` Effluent #2 = BOD S 30 mg /L and TSS < 30 mgr CST Name (Please Print) Signature: CST Number Henry F. Grote i 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 4 6 9/13/2003 715- 233 -0398 Property Owner Bonte, Ron Parcel ID # 2 .83 acre CSM pending Page 2 of 3 3 ] Boring # _j Boring 1!d Pit Ground Surface elev. 100.0 ft. Depth to limiting factor > 86 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -5 10YR 3/2 - sil 2 f sbk dsh gs 1f /m .5 .8 2 5 -11 10YR 3/2 - sil 2 f -m sbk dh CS 1 m .5 .8 3 11 -26 7.5YR 4/3 - sit 2 m sbk dh gs 1m .5 .8 4 26k 7.5YR 3/4 - Is 0 Sg dl as 2m .7 1.2 5 37 -86 5YR 4/4 - sl 0 m mfr - .3 .5 L"7 IT' Boring # i 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 ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 r` I i I ❑ Boring # Boring j Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2� I i i i I I 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.07 /00) Certified $oil Testing l Property Owner Bonte, Ron Parcel ID # 2 .83 acre CSM pending Page 2 o f 3 _ BM oring # Boring $ WA Pit Ground Surface elev. 100.0 ft. Depth to limiting factor > 86 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPON in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 1 0 -5 10YR 3/2 _ sil 2 f sbk dsh gs 1f /m .5 .8 2 5 -11 10YR 3/2 _ sil 2 f -m sbk dh cs 1 m .5 .8 3 11 -26 7.5YR 4/3 - sil 2 m sbk dh gs 1m .5 .8 4 26 -3 7.5YR 3/4 _ Is 0 sg dl as 2m .7 1.2 5 37 -86 5YR 4/4 - sl 0 m mfr - - .3 .5 F� Boring # - - Boring _j Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 I I ❑ Boring # Boring _j Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon I Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 I � i I I i ` Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L • Effluent #2 = BOD 130 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.07 /00) Certified Soil Testing C> oG t r �r o / I _ 9 N �+ ss e 0 f / f s , w rc d i f v 4 CA G IT r J w j i r� 1 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of i FILE INFORMATION SYSTEM SPECIFICATIONS Owner . r� O 17 c,,.. Septic Tank Capacity a l ❑ NA Permit # 0 Septic Tank Manufacturer G� f� ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity a l ❑ NA Estimated flow (average) al /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) __ e__ al /day Pump Manufacturer ❑ NA Soil Application Rate al /da /ft2 Pump Model ❑ NA Standard Influent/Effluent Quality Monthly verage* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L -Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended So lids (TSS) _ <150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510` cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tankls) At least once eve ry ❑ onth(s) (Maximum 3 years) ❑ NA ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cellls) At least once every: 13 month(s) (Maximum 3 years) 11 NA Clean effluent filter At least once every: ❑ month(s) ❑ NA ❑ year(s) ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ year(s) ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: ❑ year(s) Other: At least once eve [3 month(s) [3 NA every: ❑ year(s) Other: ❑ 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 entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, 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. GMW (4101) I Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tanks) 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. System start up shall not occur when soil conditions are frozen 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 floss; diapers; 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. ABANDONMENT 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 chapter 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 um in all tanks and its shall be excavated and removed or their covers removed and the void space filled with P P 9. P 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: 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 a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ 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 as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed 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 AND /OR 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 C r / Name y p� ph s tir Phone Phone 3 -0 3 s ? SEPTAGE SERVICING OPERATOR (PU PER) LOCAL REGULATORY AUTHORITY Name "4- Name o Phone l Phone v �� This document was drafted in compliance with chapter Comm 83.22120M)OM and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address 4a 'e- � — (Verification required from Planning Departmen for new construction.) City /State Parcel Identification Number 026 - 10 9 9 - 6 e - 3 006 • S '4' " 30 LEGAL DESCRIPTION Property Location S� ' /4 , J& '/4 ,Sec. ; T _�N R�W, Town of X r �1 me Subdivision �- , Lot #. Certified Survey Map # Volume 1 , Page # �� U Warranty Deed # :Z 7 , Volume , Page # Spec house yes Lot lines identifiable yes SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in § Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Depa within 30 dais of the three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION m Uwe certify that all statements on this form are true to the b est of my /our knowledge. Uwe am/are the owner(s) of the propert escriW abo , by 'irtue of a warranty deed recorded in Register of Deeds Office �, F n l ! SIGNATURE OF APPLICANT DATE * * * * ** Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** Include with this application a stamped warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. 2583E 5 p6 7E,4177 � STATE BAR OF WISCONSIN FORM 2 - 1999 WARRANTY DEED KATHLEEN H. WALSH Document Number REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Hombuilders. LLC RECEIVED FOR RECORD Grantor, 05/28/2004 10: 00AN aq��J-G rftbaer Grantee. WARRANTY DEED rancor, for a valuable consideration, conveys and warrants to Grantee EX9PT g the following described real estate in St, Croix County, State of Wisconsin REC FEE: 11.00 (if more space is needed, please attach addendum): TRANS FEE: 129.00 That part of SE % NE x /4, Sec. 35- T30N -R18W described as follow C � ° CC C OPY F ESE: Certified Survey Map recorded in Vol. 17 of Certified Survey PAGES: 1 Maps ea a 4640 as Doc. No. 745128. St. Croix County, Wisconsin. Recording Area Name and Return Address WESTCONSIN CREDIT UNION P 0 BOX 269 NEW RICHMOND WI 54017 26- 1099 - 60-000 Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this ---- 2,1 day of May , 2004 Hom u � il � d • er L LC '.-7— �t�j //T. etc *---- - - - -.. ... ... .......___ Y Fletch, Member -- - - --- - •- •• - -• - -- ..... ... -- ...... ............... ................ ---- - - - - -- - -• -- ........ -._... AUTHENTICATION ACKNOWLEDGMENT Signature(s) Hombuilders, LLC, Jay Fletch, Member STATE OF } ) ss. County } authenticated this v 1 day of May 2004 Personally came before me this day of the above named *Krishna land - -_ _ -_ -- _.. _T.�.. -- • -- -_ _..... _ - •-- ------ ........... _._--• .......... -- -------------------------- -------------- •- ----- •- • -• -•- --- •-- •------ • -•- -•- ......... ............. --- ............... TITLE- MEMBER STATE BAR OF WISCONSIN (If not. T---•-- ___ ------- - .._. . ..... to the known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristine Ogland « Hu dson., WI 54016 Notary Public, State of My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) I .) * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co.. Fond du Lac, w[ STATE BAR OF WISCONSIN 800.655 -2021 WARRANTY DEED FORM No. 2 -0" I _ ' p 745128 XAT�PH G 4640 REGISTER OF DEEDS ST. CROIX CO. YI RECEIVED FOR fiSCORD 10/29/2003 11s00AM CERTIFIED S URVEY MAP �- �-�. COP - - Y FEES 3.00 CERTIFIED SURVEY MAP PAGES: 2 LOCATED IN THE SE 1,14 OF THE NE 114 OF SECTI 35, T30N, RISK TOWN OF R I CHMbNO, ST. CR01 X COUNTY, WISCONSIN. ,PREPARED FOR RON 80NTE NE CORNER OF SECTION 35. (FOUND 3 .-4'REBAR NOTE: BEARINGS ARE REFERENCED TO THE EAST LINE NOTE NO ADDITIONAL PLATTED LOTS AMY OF THE NE Ie4. (ASSUMED TAKE ACCESS THROUGH THE 66' WIDE BEARING BASED ON GLOBAL PORTION OF LOT 2 UNLESS ALL POSITIONING OBSERVATIONS). STRUCTURES CONFORM TO APPLICABLE LOT 4 SETBACKS AND COUNTY ROAD STANDARDS 44 APPR ARE ACHIEVED. o'Y. 8T. CROIX COUNTY P" zwkig and P eft CwmMIN I a �� � . OCT 2 g 20(13 UNP0TTP "'I {:4'' EAST L I NE OF THE NE 114 I i ( . It sot Waded MOM 30 days of I ( 33 84XOW data approval shall be S89' 49' 15' E 968.81' 597.57' 1 aw 371.24' 3 564.57' 33. 00' �' O7 "`3 o LOT 1 _ N 3.00 ACRES 1130,716 S0. F T. 100" 8. M. TOP OAF P I PE g a 2.84 AC. EXC. R/W oil J000.40' 123,507 S0. FT. �: ( ....................... cn LOT 2 = L80.993.0' :33. 564.4 5.21 ACRES N89 09'W 597.48': � ....................... ;C 2 226,930 SOFT. S89 597.45' : 66. 2 8 w 5. 16 AC. EXC. RiW 3 r • 224, 752 SO. FT. 564. 45' :33. • ro :a LB O•ae 6. o' a o L OT� A w ` g 3. 00 A m: aD l �o ►v is 130, 894 SO. FT. OiJ m 2. 84 AC. EXC. RiW 1,.: Q�p ;1► '�, �f 2 123 664 S0. FT. • `� 3T2. 19' e� L�0.989.0' 33.0 m ) C - o, 5 4.37 w "' e* S89 OF E` 969.56' H w 4 ' 597.37 t\ a ro DRAINAGE' WAY -'' e R4 ` ` ` 1. wq I & pp LOT 4 �J0 _ ,� ,o•, : u • W �w ..:....... ei• f i . �. 2: a�+ ;a u 7.48 ACRES �\ F4f „ �! 325, 823 S0. FT. ` �1 7.23 AC. EXC. R/W ei• io ,�\ �. v 1*.Q�...� 314,736 SO. FT. 426!.39' L80.991.0' Js�. 33.00' 93 7. 06' r34. ae' ...................... S8a• 53' 08• E N89 08' W 970. 06' E -W QUARTER LINE W 1 /4 CORNER Of E I �4 CORNER OF SECTION 35. (SET SECTION 35. (FOUND CONCRETE NA I L ). tJNP� -ATT D.. k A $ SURVEY NAIL). :t B. M. 998.00' 1 NOTE NO OWNER OF RESIDENT SHALL DO ANYTHING WH ICH WOULD I y INTERFERE WITH OR CHANGE THE WATER DRAINAGE EASEMENT. THIS • INCLUDES BUT IS NOT LIMITED TO BUILDING UPON, OBSTRUCTING, co AL TEPING, FILL INC, GRAD I.NC, EYCA:'ATINC, C^ 3iRi.VNC. I� O • SET 1' 0. D. X 18' IRON PIPE JAMES M. R 'a Wf I GH I NG 1. 13L BS PER L I NEAR FOOT. WEBER EBE (� PROPOSED DRIVEWAY LOCATION Q 1 ' • 200' 9tio 0 SHEET t OF 2 JAMES M. 804 0 100 200 400 LANDMARK SURVEYING, INC. 2003071A THIS INSTRUMENT DRAFTED BY JIM WEBER DATED Vol 17 Page 4640