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HomeMy WebLinkAbout030-2103-80-000 WidConsin Department of Commerce Count i6ety and Building Division PRIVATE SEWAGE SYSTEM St. Croix INSPECTION REPORT Sanitary Permit No: 405145 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: /.30 - q'103 -DO Stelzer, Larry St. Joseph Township 0 CST BM Elev: In7p. v: BM D escription: lob . d v we y TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark r 1_4 Dosing Alt. BM — OG sr - Aeration Bldg. Sewer ,�3 Z -gY �QZ• � �/ Holding St/Ht Inlet t oo TANK SETBACK INFORMATION St/Ht Outlet . �/ GU• S TANK TO P L WELL BLDG. Vent to Air Intake ROAD Dt Inlet OY,Nti Septic 2 • 7 Dt Bottom Dosing H a er /Man. Aeration Dist. Pipe f ' ,le 3.3 Holding Bot. System ( / Z Final Grade PUMP /SIPHON INFORMATION �. _331 Manufacturer Demand St Cover G p'lz N a (� Model Num r TDH Lift icti oss System Head TDH Ft Forcernr ' Length Dia. SOIL ABSORPTION SYSTEM BEDITRENCH Width 4 11-engt I No. Of Trenc s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ✓ l SETBACK SYSTE TO P/L BLDG WELL LAKE /STREA LEACHI tAanyfact r: INFORMATION Typ Of System: r CHAMBER OR y" / / � UNIT odelNumber. /2r, IBUTION SYSTEM l d�-on Heade anifold Distribution r / . / x Hole Size x Hole Spacing Vent to Air Intake 1 bl Pies nLength Dia L ngth_� Dia / � pacing / S SOIL COVER x Pressure Systems Only xx Mound Or At -Gra Systems Only Depth Over _ , n Depth Over xx Depth of xx Seeded /Sodded r Mulched Bed/Trench Center fir/""_ Bed/Trench Edges Topsoil Yes E No Yes No COMMENTS (Include code discrepancies, persons present, etc.) Inspection #1: / U /3 Z '� Inspection #2: Location: 1307 89th Street New Richmond, WI 54017 (SE 1/4 SE 1/4 25 T29N R1 9W) Dunning & Lew;s' Lot 8 Parcel No: 25.29.19. 1.) Alt BM Description = $'f_c0/Q_ 2.) Bldg sewer length = - amount of cover = Plan revision Required? E Yes V \ Use other side for additional information. �� Q C� T' Date Insepctols a re Cert. No. SBD -6710 (R.3I97) Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 4 D — T, GQe UC N, *iSconsin Madison, WI 53707 - 7162 Site Address ,f�\ De artment of Commerce _ 3 13 SS9 5� , Sanitary Permit Application sanitary Permit Number In accord with Comm 83.21, V is. Adm. Code, personal information you provide L L Check if Revision may be used for secondary purposes Privacy Law, s15. 1 m TU S I. Application Information - Please Print All Information State Plan I.D. Number Property Owner's Name R Parcel Number 03a �t7 ✓r ���2�✓ la3' Property Owneils Mailing Address S Ep Property Location 5-1 UNj t S1: -01! iA; S ZS T N, R City, State Zip Code � Al� " Z �JyfiiKe Lot N ber Block umber �/ Subdivision Name CSM Number /vim Sfv 7/ 366 37 ,9 II. Type of Building (check all that apply) ❑City 1 or 2 Family Dwelling - Number of Bedrooms _ 3 ❑Village ❑ Public /Commercial - Describe Use Township S , ❑State Owned t Nearest Road t k l �s C2l III. Type of Permit: (Check only one box on line A (numberinj scheme for internal use lete line B if applicable) A. 1 ❑ New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to For County use S stem I I Tank Onlv I Existing System B • Check if Sanitary Permit Previously Issued Permit Number . e Issued 067,/ T at 6//0/07- IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 Non - Pressurized In- Ground 21❑ Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Dispersal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rat System Elevation Final Grade Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min./Inch) Elevation 6 y3 (82 a '7 -- ?Z 3 y' '6. VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks { Concrete Constructed Glass New Existing Tanks Tanks �✓ Septic or Holding Tank C Q Dosing Chamber ' r VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP /MPRS Number Business Phone Number / — z- q Plumbef s Address (Street, City, State, Zip ode) UQ GcJi � �tJ 6 Z VIII. Corm /De artment Use Onl Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issu Agent Signature o Stamps) Surcharge Fee) ❑ Owner Given Initial Adverse . � 5Q � Determination © ?�Z IX. Conditions of Approval/Reasons for Disapproval - &,-A_S & 40 ✓n .,e S (S kA-1._ - lo �JU tr o Q a.•aa - Se f se s ddrl f%fA S i d� thus -. 120 w`�� 1 V Attach complete plans (to the County only) for the system on paper not less than 81/2 z 111aches in size SBD -6398 (R. 05101) JOB TIMM EXCAVATING SHEET NO. OF Route 1 Box 192 WILSON, WISCONSIN 54027 CALCULATED DATE Z6 G (715) 772-3214 (715) 386-5443 MPRS 03224 WI MPCA #6% MN CHECKED BY DATE SCALE .......... ........... .................... . ........... .................. .... ........... ........... ........... .......... ........ .. ..................... ........... .......... .......... .......... . . ........... .. .......... .......... .......... .. ........ ..... ........... ........... ......... ...... ................................... .......... .......... ........... .......... .......... .......... .......... .......... ........... ............ .......... ........... ............ .......... . ... .... ........... .......... .......... .......... ........... ........... ........... ...................... .......... . ........ ........... ........... ...... ... .......... .......... .......... ........... ........... ......... .......... .... ........ ........... .......... ........... .......... ........... ........... ........... .......... . .......... .... ........... ........... .......... ..... .......... ................. ...... ................................. ....................... .......... .......... ......... . .......... .......... ............ .......... ........... .......... .......... ........... .......... ....................... .................................. ........... .......... .......... .......... .. . ... .... . ........... .......... ......... ....... ........ ... ........ .. .... . ........... ...... ..... .......... .......... .......... ................... ................................. .......... ......... ........... ........... .......... .......... ........... .......... .................. .......... ................. .. . .......... ........... ........... .......... . .. ................. .. ........ ................... ....... .......... .. .......... .. ........... ................. .......... ....... ........... ........... ... ..... ........... .......... . .......... .......... ........... ........... ........... ........... . ........ ........... ....................... ........ .......... .......... ........... ........... ...................... . ........ .......... .......... ........... ........... ........... ........... .......... .......... ........... .......... ........... .......... ................. ........... ........... ............. .......... ...... .......... ...................... ........... .......... . ........... .......... . .......... ........... ........... ........... ........... ............. ... ........ . .......... .......... ........... ........... .......... ........... ........... ........... ...................... ............... . .......... .......... .......... ........... ........... ........... .......... .. ......... ............... ........... ..................... .......... .......... .......... ........... ........... ...................... . .......... . .......... .................. ........... ....... .. ... 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A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .......... ........... .......... .......... ......... .......... .......... ............ ............................. ........... .......... ........... ........... .......... ...................... ........... ........... .................... .......... ........... ........... ........... ..... ...... ..... .... ..... .......... . ......... .......... ....... .......... ........... ........... ........... ........... ........... .......... ..................... ....................... ...................... ---------- .......... ----------- ........... ........... ........... ....................... ................................... ............. .............. ............. ....... ...... ................ .......... ........... .......... .................. ........... ........... ........................... ........... .... ........ ................ ........... ................... .. ........... .......... ...................... ................... . ..... ............. ....... 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PROOLCT 2541 Nn . GmW, UM. 01471+ To 0MV RM TOLL FREE 14*2MM JOB TIMM EXCAVATING SHEET NO. OF Route 1 Box 192 WILSON, WISCONSIN 54027 CALCULATED BY � + 1 �" DATE (715) 772 -3214 (715) 386 -5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE ...........> .......... :.......... ............ .. ..... ..... ..... ..... ..... ..... ..... ..... ..... ..... .... i i ............... ..... ..... .... .... ..... ..... ..... .... b... ...e.... ....... .... ... I2 ............... .... ..... :. ...:. ..................... .. ... .................... . .... ... ..... ....................... ... :. ........ //'� . ....... ... . .... i :... .... :.. :........ :... ........... .... ........... ..... ......... .. ....... .. d / ..... ........ ........ / 5 . ` .. . ...... ....... ( ... ... .... ........... ................. ........... ........... ---------- ........ ........... .............. ......... .......... ....... ........... . 2 .......... ....... ... .....J... ...... t ... PRODUCT 205-1 �Inc., Groton, Mass. 01471. To Order PHONE TOLL FREE 1.800- 225 -6380 L "ORIGINAL 1583 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division 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. 030 -1067- 401030- 2013 -10 Please print all information. R viewed By Date Personal information you provide may be used for seconds yaw, 15.04 (1) (m)). parr Property Owner � ovt. roperty Location Stelzer, Larry Lot SE 1/4 SE 1/4 S 25 T 29 N R 19 W Property Owner's Mailing Addres P 2 6 2� of # Block # Subd. Name or CSM# 1307 89th St. S� 8 Durning & Lewis Add'n City State Z Cod�e�PlhhrnC��P City � Village .j Town Nearest Road New Richmond WI 017 ZO FFICE St.Joseph i 89Th St. V-'. New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe Parent material sandy /loamy outwash Flood plain elevation, if applicable NA General comments and recommendations: install 2 - 2.7'x 68.42' (St'd- Infiltrator, 22 shells) stipulation 1099 chamber trenches @ system elevation of 92.3 FT-1 Boring # 1 Boring Pit Ground Surface elev. 95.2 ft. Depth to limiting factor > 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure 7 tence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 "Eff#2 1 0 -15 7.5YR 3/2 - sl 2 f -m sbk s cs if /m .5 .9 2 15 -28 7.5YR 4/6 - Is 1 m sbk gs if .7 1.2 3 28 -36 7.5YR 4/6 - s 0 sg dl cs - .7 1.2 4 36 -120 7.5YR 4/4 - s 0 sg dl - - .7 1.2 very occasional gr all horizons _' Borin ❑ Boring # J g tf Pit Ground Surface elev. 96.3 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 *Eff#2 1 0 -10 7.5YR 3/2 - sl 2 f sbk ds cs 1f /m .5 .9 2 10 -32 7.5YR 3/2 - sl 1 m -c abk mvfr cs 1 m .4 .6 3 32 7.5YR 4/6 - s 0 sg dl gs 1M .7 1.2 4 56 -120 7.5YR 4/4 - s 0 sg dl - - .7 1.2 very occasional gr all horizons ` Effluent #1 = BOD 30 < 220 mg /L and TSS >3P < 150 mg /L Effluent #2 = BOD < 30 mg /L and TSS _< 30 mgr CST Name (Please Print) Signs r CST Number Henry F. Grote c 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 7/23/2002 715 - 233 -0398 f. 1 Property Owner Stelzer, Larry Parcel ID # 030 - 1067 - 40/030 2013 - 10 Page 2 of 3 ' 37 Boring # _j Boring Vj Pit Ground Surface elev. 96.3 ft. Depth to limiting factor > 120 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 1 0 -6 7.5YR 3/2 - sl 2 m gr ds cs 1f /m .5 .9 2 6 -20 7.5YR 3/2 - sl 1 f -m sbk mvfr cs 1 m .4 .6 3 2 -60 7.5YR 4/6 - s 0 sg dl gs 1M .7 1.2 4 60-120 7.5YR 4/4 - s 0 sg dl - - .7 1.2 very occasional gr all horizons Boring # _-1 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 I I ❑ Boring # I 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 " 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 Soil Testing • I .T f� ✓ Ao cr s" J Q 1 It J r A p qs .� r` or ✓ b 7 004 1-4 M ° qm �L tp N cr �cc Safety and Buildings Division County ST C 201 W. Washington Ave., P.O. Box 7162 N vi s c ohsin Madison, WI 53707 - 7162 Site Address ce 1 3 0 sr. Sanitary Permit Application Sanitary Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision � 5 / L /s — may be used for secondary purposes Privacy La s15. 1 m I. Application Information - Please Print All Information State Plan I.D. Number Property Owner's Name 1 Parcel Number I ( 5 t-'2 X30 - o!o `7_ yo Property Owner's glailing Address / J UN 0 5 20OZ Property Location S4 SL`' IA; S ZS T Zqt. N,R 1� City, State Zip Code FFICE Lot Number Block Number B /1/ ��// / Subdivision Name CSM Number /veld 6VZ) /7 4 74:� - wi, 37 0 ocwrtar +�LeuJi H. Type of Building (check all that apply) � �- � ❑City 91 or 2 Family Dwelling - Number of Bedrooms 3 i`'u ❑Village ❑ Public /Commercial - Describe Use ATownship ❑ State Owned earest Road 47 9 III. Type of Permit: (Check o one box on line A heme for i�t Off. Co fete line B if applicable) A. 1 ,New 2 El Replaceme ytem 3 ❑Rep f 6 oAddi For ty use. System Tank Only E Nis B. ❑ Check if Sanitary Permit Previsued Permit N r Date Issued IV. Type of Permit: (Check all that app (numbering scheme is f e)�y �10 t 44 Non - Pressurized In- Ground 21❑ and 47 /El ter 50 ❑ Constructed Wetland 31.0 j f •� 22 El In- Ground 41 ❑ Ho ' g Tank 48 ass 51 ❑ Drip Line /1Vi- 3d 45 El At -Grade 46 ❑ Aerob Treatment Unit 49 ating 30 Other V. Dispersal/Treatment Area Information: ILO L I (-a- Design Flow (gpd) Dispersal Area Dispersal KN—bjf tion Percolation Rate Syste El vation Final Grade Required _ Proposed �ys/ (Min.11nch) ��?¢r ( Elevation 5 � 3 /D 3, VI. Tank In fo Capacity in Toral ufacturer Prefab Site Steel Fiber Plastic Gallons Gallons Concrete Constructed Glass New Existing - Tanks Tanks Septic or Holding Tank /Cv P Dosing Chamber VII. Responsibility Statement- I, the linderilled, assume r jr installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumbe Signature P/MPRS Number Business Phone Number v �n7 ` o�a� (o 74 77Z- - 3 2-1 Plumbe s Address (Street, City, Slam, Zip C e) JR t-4 'le o 2 VIII. Coln /De artment Use O Approved Disapproved Sanitary Permit Fee (includes Gmuindwate Date Issued Ls ent Signature (No Stamps) Surcharge Fee) C� & C] Owner Given Initial Adverse . o<o� S- �� U Determination lx. Conditions of Approval/Reasons for Disapproval e -3 0 cow;,,a� - �so�. d a �7 caa rs a-r n ale rte P ill eSS adaL��cvt �-Q b on n p ✓�� 3 a,(ro-:tic.- 4*io ��-+ �'k• cacr� v+� n (v0 °7 - Sys4 e- �Q�/• �I ! !! l vt4 s k a-f r to 3. o' - ,4 , / Jei -, 4,y l ,/ Attach complete plans (to a County only) for the system o a pap not less than 8 z 11 Inches In size 6�'lc�vn. hlusr � �jiJS Px 7�-, EC�� U�`7J?`� : (r7LYZ SfI � (rr. SBD -6398 (R. 05101) ��. ��`� �� � •a ... .. � G I x s JOB LGVry $le /zei- TIMM EXCAVATING SHEET NO. OF Route 1 Box 192 �-�� WILSON, WISCONSIN 54027 CALCULATED BY DATE G (715) 772.3214 (715) 386 -5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE ......... 5.......... ...................... . >.. .... .... ..... ..... ..... ..... .... ..... .... ..... ..... ..... .... .... .... .... .... ..... ........... .......... .... ... ..... ..... ..... ..... /gv 37 ........... :........... :........ .... .... ..... ..... .... .... ..... ..... ..... .... .... ..... ..... .... ...:... ... ....... ......... .. ..........:..........:......... 1........... ............................... ..... .... x: ............. L: ... d' .. ... . ... ... . ...... .. gj ;. '.... . .- �,....` j ........... �� �. 3 ��.. ..... ff ..... ..... ........ . ... . ...... .. L loa / .. .......... ... ; . ........... 3 ...... .... .,. .... .... ...... . ... .. ... . ... ( .. ... .............. .. ..... ..... .. s �........ . Q ..... ....... .... t c �Q r ... � . � _. .... ..... ... .... ..... ........, -..... ......... ... ' .. ....... .... .^.. ,.. , -. ... ..... ... PRODUCT 215-1 Inc., Groton, Mass, 01471, To Order PHONE TOLL FREE 1800 - 2256380 l 1 I a N.� nnyy Jilt. l 4 Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page I of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. rrc)ix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 030- 1067 - APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWS BY DATE PROPERTY OWNER: PROPERTY LOCATION James Durninq GOVT. LOT SE 1/4 SE 1/4,S 25 T 29 N,R 19 kor) W PROPERTY OWNER':S MAILING ADDRESS LOT # I BLOCK # I SUBD. NAME OR CSM # 7217 Courtly na Durning & Lewis Addn. CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ]TOWN IN EAREST ROAD Woodbury, M. 55125 (612)739 -5208 St. Joseph Ct . Rd. " A " �c ] New Construction Use [x] Residential / Number of bedrooms J [ ] Addition to existing building (] Replacement ( ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rat 5 bed, gpd/ft .6 trench, gpd /ft Absorption area required 900 bed, ft 750 trench, ft Maximum design loading rate _ bed, gpd /ft trench, gpd /ft Recommended infiltration surface elevation(s) 101.80 ft (as referred to site plan benchmark) Additional design/ site considerations alt site system el = 100.00 Parent material stream terrace Flood plain elevation, if applicable na ft rU= Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK Unsu itablefors stem ®S E3 L) ®S ❑U ®S ❑U ®S ❑U ®S ❑U ❑S CRU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Roots W D/ft 2 Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ed jTrench '> 1 0 - 10 r3 3 nongn q1 2m--hk Mfr 9W 1 2 10 -22 10 r4 4 none sil lcsbk mfr cfw if .2 .3 Ground 3 22 -84 7. r4 6 none ms osa mvfr na na .7 .8 elev. 105 ft. Depth to limiting factor +84 Remarks: Boring # 1 1 0-12 10 r3 2 none sil 2msbk- mfr qw 2f .5 .6 2 12 -21 10 r3 3 none sicl lcsbk mfr Qw if � .2 1 . � .3 Ground 3 21 -45 5 r4 4 none is os mvfr na .7 elev. 4 45 -84 7.5 r4/6 none ms osg ml n .7 .8 10 ft. Depth to limiting factor Q /� S LY " LJ 04 Remarks: ,r ST CROfX CST Name: -- Please Print Gary L. Steel Phone: 715 - 246 - 620 z�ft to Address: 1554 200th. Ave New Riolond, WI 54017 Signature: Date: 5 -13 -97 98 i PROPERTYOWNER James burning SOIL DESCRIPTION REPORT Page 2 of I PARCEL I.D. # 03 1067 -40 Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. / d Trench 1 0 -10 10 r 2 10 -20 10yr4 /4 none sil lmsbk mfr gw if .2 .3 Ground 3 0 -5 7.5yr4/6 none 1 fs Osg mvfr gw na .6 -84 elev. 4 51 7.5yr4/6 none cos Osg ml na na .8 10 Depth to Sum. �S 3 ' I:u2Qg� S - G�o limiting factor C +84 Uk- Remarks: Boring # 1 0 -20 10 r3 3 none sl 2csbk k < 4 .5 r4 6 non Ground elev. 10 ft. Depth to limiting factor +80 Remarks: Boring # 1 0 -12 10 r3 5 2 12 -30 10 r4/4 none sil 2msbk mfr Cfw if .6 Ground 7 - elev. 10 ft. ,]L Depth to limiting S �� �4 �2 , factor '. +82 f 43` �,a.C.Q� ir.e L� Gt Gf!� (p " }a 3(D r Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 James Durning New Richmond, WI 54017 MPRSW 3254 SE4SE4 S25- T29N - (715) 246 -6200 town of St. Joseph lot #8- Durning & Lewis Addn. N 1 =40' BM.= top of 21 pvc pipe C el. 100' Alt. BM.= nail in tree C el. 101.50' of Z' P . ki 1� � S s' Gary L. Steel 5 -13 -97 ST CROIX COUNTY SEPTIC C TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address ZA � his Property Address 3 07 (Verification required from Planning Department for new construction City/State & M �1 parcel Identification Number 030- /o� - 7- 0 LEGAL DESCRIPTION Property Location 5 N %4, y 4, Sec, Ls , T Z N -R 1 _1_W, Town of 5 Subdivision A'r -h ( oz L �s —� , Lot # 5 . Certified Survey Map # Volume , Page # Warranty Deed # Volume O Page # 2 " R 8 f Spec house ❑ yes XL..no Lot lines identifiable ❑ yes ❑ no SYSTEM M_AilUTNANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St, Croix County Zoning Office within 30 days of the three year expiration date. .. l o =? SIG TUBE OF AP ICANT � �/ 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 owners) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. 4 , r . �� 2 � 0 V, �) Ui / l 0 � �1, 1z' SIGNATURE LIC DATE Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. •••'•• •• Include with this application: a stamped warranty deed from the Register of Deeds office J a copy of the certified survey map if reference is made in the warranty deed POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of Z FILE INFORMATION SYSTEM SPECIFICATIONS Owner L,/3�Z - L Septic Tank Capacity ®Q a l ❑ NA Permit # � Septic Tank Manufacturer �� ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model A-- - /D 0 ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity N a l ❑ NA Estimated flow (average) 3o a al /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer ❑ NA Soil Application Rate 6t�- (03 Q 6 0 gal /day /ftz Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit A Fats, Oil & Grease (FOG) :_30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 6220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solid (TSS) :5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispe al Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L n-Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ 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 tank(s) At least once every: 2 �j ❑ nth(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 ❑ m onth(s) (Maximum 3 years) ❑ NA Inspect dispersal cell(s) At least once every: ­,7- UVyear(s) i ❑ m nth(s) ❑ NA Clean effluent filter At least once every: l ar(s) Inspect pump every: ❑ year(s) ❑ month(s) g7 KA Ins p p, pump controls & alarm At least once eve �" ' ❑ month(s) LLMA Flush laterals and pressure test At least once every: ❑ year(s) Other: At least once eve ❑ month(s) p,RA every: ❑ year(s) Other: ❑-t 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 round surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the 9 P 9 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 !912 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. r " Page Z of 7/ Y START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) 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 pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or: must be taken, to provide a code compliant replacement system: • 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 Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. �0 . t �o�D- 609140 GO Jr8,7s29 STATE BAR OF WISCONAN FORXI 1 - 1982 J WARRANTY DEED x DOCUMENT NO. JAMES J. DURNING and H �EGi3`'f� Of FILE Thi..s Deed made between ST. CROIX CO., W1 SANDR J. L �'RN ING, husband and wife Rs'd !ur ^4corrd Grantor, 'SEP 2 8 1998 and .. LARRY H. STELZER and PATR S. sTELZER, ht.s5and 0 and wife as joint ten Rs st !e Grantee, Witnesseth That the said Grant,x, for a va!u;.ble considerati S CroiX THIS SFACE RESERVED FOR ! 2CORDING DATA conveys to Grantee the following described teal estate in _ - -. - County, State of Wisconsin- NAME AN RETURN ADDRESS Barry C. Lundeen MUDGE, PORTER, LUNDEEN & SEGUIN,S.C. Post Office Box 469 Hudson, Wisconsin 54016 i 030- 1067 -40 030 - 2013 -10 PARCEL IDENTIFICATION NUMBER o iscon ruing & Lewis Addition t o the Town of St. Joseph, St. Croix County, A SEER This is not i mestead property. (is) (is not) Together with all and eMnguiar the hereditaments and a lrtenances t'Iereunto belonging; And James J Durning and Sandra J. Durning _ warrants that the title is good, indefeasible i� Tee simple anu free and -lear of encumbrances except — none s and will warrant and defend the same. September 98 Dated this 25th day of p - l9 (SEAL) (SEAL) J. DURNING i (SEAL) (SEAL) SANDRA J. DU ING AUTHENTICATION ACKNOWLEDGMENT Signatures) games State of Wisconsin, SS. _ [Aunty. - O CPO'a ? rn �� 4 a m O U j CD TREET � I 0 CD S w. x = " °" -12m n0 190 U 00 ol 40 Z C1 ' �' > o ul � A 10 _ � C tp ' � av>iam� vO V• I > n f I Z r m i �^ m - W LR W O ! 2 O � tr O O IV Z No m n NO n x Q N n O �m OD It 8.5' NOO ° I3'• N A /1 r 399.84' 257.6?' V N00- 13 -40 "W 657 .51 EAST LINE OF THE SEI /4, SEC. 25 1972. N m mm �n 0 Z2 BOTH ST. ;_,a►i�uJ N � �� I Q o I r I � 83RD < CC < ` C 0 w N C m 9•g w r v- I Of�Z I Z — rn rn rn I I