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HomeMy WebLinkAbout030-1085-80-200 Wisconsi., Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 538716 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)j. Permit Holder's Name: City Village X Township Parcel Tax No: Klatt, Wes I St. Joseph, Town of 030- 1085 -80 -200 CST BM Elev: Insp. BM Elev: BM Descripti Section/Town /Range /Map No: 0 ro�i l em i 6 o l 0 Z 30.30.19.311 d TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. L 5 dSr /0�)i d Septic 1/ /DOV Benchmark 7 S � ID � r / Y D /u b / 6 4 "'Pd:� Aeration Bldg. Sewer -W G �/ Holding Ht Inlet C L 1 n I � St/Ht Outlet TANK SETBACK INFORMATION —�- TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet J `T Septic ry `. ' D Bott L3 1 f 4 7 129 ' '7 70 1 Sp / Header /Man. �j-f 6., Aeration a-14-I tom Dist. Pipe /Q v AJ Holding - Bot System (0 3 Final Gra e I PUMP /SIPHON INFORMATION Q'L Manufacturer Demand St ov r Da 1 GPM L' (/� Model Number TD H Li 1 � Friction Loss System Head TD Ft Iii L Forcemain Length Dia. LN D ist. to We / SOIL ABSORPTION SYSTEM S ✓ 7. Z S BEDITRENCH Width ength No. Of Trenches PIT IMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS � El & / _i SETBACK SYSTEM TO P/L r JBLDG IWE L LAKE /STREAM ACHING Manufacturer: INFORMATION Typ O System: CH A E R 5 -r � r Model Number: DISTRIBUTION SYSTEM t' Headjr1Manifo1_V, istribution x Hole Size x Hole Spacing Vent to Air Intake f :2 / r Pipe(s) I I S# - J5. 9- L Dia Length Dia Spacing 40 3 !ll - SOIL COVER x Pressure Systems Only xx Mound O At - Grade Systems Only t Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Tops ter: ` f o Fal Yes [R No Q Yes rx-] No C COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: � / / Q 0 nspection #2: 1 ,7- Location: 383 Valley View Trail Houlton, WI 54 (SE 1/4 NE 1/4 30 T30N R1 9W) NA Lot 1 C►r1414.1 �arcel No: 30.30.19.3111 - 1.) Alt BM Description = I `` A^ �`�` / 2.) Bldg sewer length = vN( v 0k - amount of cover = Plan revision Required? 0 Yes No Use other side for additional information. SBD -6710 (R.3197) Date Insepctor's Signa ure Cert. No. Safety and Buildings Division Cody m m 201 W. Washington Ave., P.O. Box 7162 S Ceo / isc0ns n Madison, WI 7 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce Sanitary Permit Applicatlo State Plan LD Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide / S (O (J Z 1 0 may be used for secondary purposes Privacy Law, s15. 1 Project Address (if different than mailing address) L Application Information - Please Print All Informer n 2G� Vol. rCw "' m A; ; �J o Property s Name q Parcel # — Z�J D Block # !,Q L � 03o ­nllmv � Property Owner's Mailing Address g ZONING OFFI Property Location INNING VALLEY 0 115W A 5 %46 v., Section 0 City, State (./ L ? Zip Code Phone Number T /_/©8 carte one) IL Type of Building (check all that apply) ^ T N; RE or4 3 �[!.A 1 or 2 Family Dwelling -Number of Bedrooms 4 Subdivision Name CSM Number ❑ Public /Commercial - Describe Use �f08 ❑ State Owned - Describe Use ❑City ❑Village WTownship of $ T JOSEJ III. Type of Permit: (Cbeck only one box on line A. Complete line B if applicable) A " ❑ New System C4 Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑Permit Renewal ❑Permit Revision 11 Change of ❑ List Previous Permit Number and Date Issued Permit Transfer to New f' _ p �i / Before Expiration Plumber Owner Z 4 /d I / J 7 IV. Type of POWTS System: Cbeek all tbat a r ❑ Nor - Pressurized In- Ground N Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At - Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland [I Pressurized In- Ground 11 Holding Tank El Peat Filter 11 Aerobic Treatment Unit ❑ Recirculating Sand Filter El Recirctilating Synthetic Media Fitter ❑ Leaching chaipber ❑ Drip Line ❑ Gravewess Pipe ❑ Otlier (explain) V. DispersaVl7reatMat Area Information: Design Flow (gpd) Design Soil Application f) Dispersal Area Required (s Dispersal Area Proposed System Elevation so 75 7 / ys 1 q. 70 f VL Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existin 1 00 0 Talcs Talcs W �DfGi ✓ Septic or Holding Tanis 2 W J I ES -E dlg� x Aerobic Treatment Unit Dosing Chamber 16 501 1 6 5- 0 l t S t VIL Responsibility Statement - 1, the undersigned, assume responsibility for installation of the POWTS ahtnva oa tie attaci s. ed plea Plumber's Name (Print) Plum s S , urn MP/MPRS Number Business Phone Number C /-f M i r1' 243760 715 76 D -- OV 8 6 Plumber's Address (Street, City, State, Zip ) 616 15(9 7 HV6 5,D1116R. 1_ VIIL Coun /Dt partment Use On Approved ppro=R Sanitary Permit Fee (includes Groundwater Date ed Issui t Signature o Stamps) Surcharge Fee) for ial (p DL Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 3) �a ✓e.f t r 1. Septic tank, effluent filter and ) i dispersal cell must all be services / maintained l / A4. . as per management plan provided by plumber. 2. All t0back faqWernepts must be maintak Ad as per appiicablt todt / wdnw4es. Attach complete plans (to the county only) for the system on paper not less than 91/2 x 1I inehn in size SBD -6398 (R. 01/03) PLOT PLAN (KLATT Property) ♦ BM1 Elevation = 100.00' Top of 1" Steel lot corner pipe A BM2 Elevation = 98.72' Top of 2" PVC Pipe. ■ Backhoe pits Slope =20% Contour Line Elevation = 99.20' 5.00 Acre Parcel N New 1000/650 gallon septic /dose tank with Polylok 525 effluent filter to be added to the existing 1000 gallon septic tank. v�FV) R jar Scale: V= 40' ` h ti 3� cAeV o. /D GIRLS . Dp p / ESQ T "NK t PumP ae LASED / C1401 Z1 1 Z11 )-C2cC-- (� 70 1 Sq,,3 eLZS' 1,1 Valv4 l ° I •A f .5ou-rtH �RDPrRr`� i- N Safety and Buildings t * Ov commerce.wi. 3824 N CREEKSIDE LA g HOLMEN WI 54636 Contact Through Relay isconsin www.commerce.wi.gov /sb/ www.wisconsin.gov Department of Commerce Jim Doyle, Governor Aaron Olver, Secretary October 21, 2010 CUST ID No. 223760 ATTN: POWTS Inspector JOHN F SCHMITT ZONING OFFICE SCHMITT & SONS EXCAVATING ST CROIX COUNTY SPIA 616 150TH AVE 1101 CARMICHAEL RD SOMERSET WI 54025 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/21/2012 SITE: Identification Numbers Wesley Klatt Transaction ID No. 1868240 383 Valley View Trail Site ID No. 761186 Town of Saint Joseph, 54082 Please refer to both identification numbers, St Croix County above, in all correspondence with the agency. SETA, NEIA, S30, T30N, R19W FOR: Description: Three Bedroom Mound System / 20% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1285127 Maintenance required; Replacement system; 450 GPD Flow rate; 31 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /O1), Pressure Distribution Component Manual - Version 2.0, SBD - 10706 -P (N.01 /01); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code P.0 requirements. colic No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: DF H-RTMEN DIVISION of SF"' L t `, Reminders p • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. SE _ CORFa • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • 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 max include local inspectors. 1 JOHN F SCHMITT Page 2 10/21/2010 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • 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). • 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. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • 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. 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 and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerry.swim@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 828-5902, Monday, 7:00 A.M. To 3:30 P.M. i �II JOHN F SCHMITT Page 2 10/21/2010 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • 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). • 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. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • 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. 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 and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 � Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerry.swiin@wisconsin.gov cc:' Leroy G Jansky, POWTS Wastewater Specialist, (715) 828-5902, Monday, 7:00 A.M. To 3:30 P.M. 0 0, %f ' MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN tc�! Pesicienal Application /l INDEX AND TITLE PAGE Project Name: Klatt Mound Owner's Name: Wesley Klatt -- Owner's Address: 383 Valley View Trail Hou(to n , Wisconsin 54082 Legal Description: SE1 /4, NE1 /4, S30, T30n, R19W Township: St. Joseph County: St. Croix Subdivision Name: Lot Number: 1 Block Number: Parcel I.D. Number: 030- 1085 -80 -200 ; .. ,r Plan Transaction No.: p Page 1 Index and title E recE Page 2 Data entry AND BUILDINGS Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications O NCE Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 New Tank Specifications Page 9 Effluent Filter Information Page 10 Plot Plan Page 11 Septic Tank Maintenance Agreem Page 12 Soil Evaluation Report Designer: John Schmitt License Number: DE 1927 MPRS 22376 Date: 10/12/10 Phone Number: 715 - 760 -0486 Signature: .� Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01101), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) and 1 Pressure Distribution Component Manual Ver. 2.0 SBD -10706 P (N. 0 1/ 0 ) Version 6.0 (R. 04/08) Page 1 of 12 Mound and Pressure Distribution Component Design Design *crk.sheet Site Information (P. or C) R Residential or Commercial Design ` Note: Sand fill (D} calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 83-44-3 in -situ soil treatment for fecal col'rform of <= 36 inches. 1.50 Peaking Factor (e.g. 1.5 = 150 %) 450.00 Design Flow (gpd) i 20.00 Site Slope ( %) ( 99.201 Contour Line Elevation (ft) 31.00 Depth to Limiting Factor (in) 0.60 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 64.30 Dispersal Cell Length Along Contour (ft) = 700 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft) 1= Influent Wastewater Quality (1 or 2) Are the laterals the highes oiP nt in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) C Center or End Manifold 3.50 Lateral Spacing (ft) If N above, enter the elevation (ft) 4 Number of Laterals of the highest point. 0.188 Orifice Diameter (in) Estimated Orifice Spacing (ft) = 7.03 fe /orifice 2.00 Forcemain Diameter (in) i 60.00 Forcemain Length (ft) Does the forcemain drain back? Y � 89.29 Pump Tank Elevation (ft) Enter Y or N 3.25 System Head (ft) x 1.3 9.79 Forcemain Drainback (gal) 10.00 Vertical Lift (ft) 57.74 5x Void Volume (gal) 2.16 Friction Loss (ft) 67.53 Minimum Dose Volume (gal) 0.00 In -line Filter Loss (ft) 41.94 System Demand (gpm) 15.41 Total Dynamic Head (ft) Lateral Diam Selection Manifold Diameter Selection in. dia. o • tioiis choice in. dia. option choice 0.75 1.25 1.00 1.50 x 1.25 x l 2.00 x x 1.50 x x 3.00 2.00 x 1 3.00 x s Gallons /Inch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1000.001 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Wieser Concrete Manufacturer gal /in (enter result in cell B49) Dose Tank Information Effluent Filter Info rmation 650.001 Dose Tank Capacity (gal) l PolyLok Commercial Filter Manufacturer I 17.001 Dose Tank Volume (gal /in) 525 Filter Model Number Wieser Concrete Manufacturer Project: Klatt Mound Page 2 of 12 Mound Plan and Cross Section Views t . ..... J 1/10 B : 3 Observation Pipe : , " . �---t T K 5 .: W .......:.... .:......: i .......:.............:: B .. ... L Mound Component Dimensions A 7.00 ft E 22.80 in H 1.00 ft K Efift ft B 64.30 ft F 9.50 in z 23.94 ft L ft D 6.00 in G 0.50 ft J 3.36 ft W 450.10 (ft) Dispersal Cell Area 1 1989.28 (ft ) Basal Area Available 7.00 (gpd /ft) Linear Loading Rate 1 6.43 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 101.49 (ft) ----► G ♦ H 2 I F Dispersal Cell 100.20 (ft) Lateral 99.70 ft —► Invert Dispersal Celt ....(� :.:.:.:.:.:.:. • " • • • 1 E D ;3 Elevation .:.:...........:.:.:.. 99.20 (ft) Contour Elevation 20.0 % Site Slope Geotextile Fabric Cover Shading Key_' — Dispersal Cell See lateral details on 1� Topsoil Cap FL 1.5 ft t� Page 4 for number, size, Subsoil Cap • and spacing of laterals. © ASTM C33 Sand :6 Z F Laterals are equally Tilted Lay d 0.5 ft Typical Lateral spaced from the ® y q distribution cell's Q Aggregate o centerline in the }--- A bution cell (Ax! Project: Klatt Mound Page 3 of 12 Center Connection Lateral Layout Diagram Force main connection via tee or cross to manifold at any point. Laterals are identical S P Al- 0= Turn -up w1ba1l valve or I{- X-- +IExl2 I x1231 Laterals & force main of PVC Sch 40 clean out pl u g per COMM Table 84.30 -5 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.188 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.03 ft Lateral Length (P) 31.47 ft Orifices per Lateral 16 Lateral Spacing (S) 3.50 ft Orifice Density 7.03 ft /orifice Lateral Flow Rate 10.49 gpm Manifold Length 3.50 ft System Flow Rate 41.94 gpm Manifold Diameter 2.00 in Total Dynamic Head 15.41 ft Forcemain Velocity 4.28 ft/sec Dose Tank Information Locking cover with waming label and locking device and sealed watertight Electrical as per NEC 300 and — 16.28 WAC Disconnect 4 in. min. Comm Tank component is properly vented E-- Alternate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 In. Capacityl 650.00 Gallons Volume L 17.00 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 21. 36 363.17 C B 2.00 34.00 Pump off elevation (ft) C 3.97 67.53 90.20 D 10.901 185.30 D Total 38724 650.00 Dose tank elevation (ft) 3" Bedding uncTer tank. F 89.29 Alarm Manuaaacturer JSeptronics Alarm Model Number _T -1 r Pump Manufacturer 'Zoeller ✓ Pump Model Number L 152 Pump Must Deliver 41.94 gpm at 15.41 ft TDH Project: Klatt Mound Page 4 of 12 Mound S stem Maintenance and Operation Specifications y p p Service Provider's Name P Tom Tyler Phone 715 - 594 -3118 POWTS Regulator's Name Pierce County Zoning i Phone 715- 273 -6747 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in m /L Estimated Flow - Average 300 gpd Maximum BODS 220 mg /L Tank Capacity 1000 gal Maximum TSS 150 mg /L Soil Absorption Component Size 450.1 ft Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and ressure tested every 1.5 years Mound Inspect for ponding and seepage once every 3 years Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. Ali gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished • ......... • • • • • • • • • • • • • • • • • • • Grade 6 -8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral �y Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Klatt Mound Page 5 of 12 i Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General Code shall maintained in accordance with its' This system shall be operated in accordance with Comm 82 -84 Wis . Ad m. and r. 2.0 SBD com manuals SBD - 10691 -P (N.01/01), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ve 10706 -P ( N. 01/01)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a se pump r um tank since dangerous gases may be present that could cause de ath. septic 9 o Septic and pump tank abandonment shall be 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 ht upon the comp letion of service. Any opening deemed unsound, r s and assessment shall be sealed waterti g p P openings used fo se 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. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet fitter shall be assessed at least once every 3 years by inspection. The outlet fitter shall be cleaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the fitter when removed from its enclosure. If the filter is equipped with an alarm, the fitter shall be serviced if the alarm is activated continuously. Intermittent fitter 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. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution SVStem No trees or shrubs should be 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 as protection from freezing. Influent quality into the mound system may not exceed 220 mg /L BOD, 150 mg /L TSS, and 30 mg /L FOG for septic tank effluent or 30 _._.. _Ln•...... � An,.. -r— —# —'aA � movimilm f40¢inn mg /L BOD 30 mg /L TSS, 10 mg /L FOG, and 10 cfu /100 mL for Highly t c .._ _ .:.... _ flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test —kin rho c.,gfgm — incfa0a 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 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continnencv 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(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologic?"; ck?r `saT•`' ^^ a ^• di€ "'s'•! media, and related piping, and replacing said components as deemet± n: See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units Tha infnrmofinn and erhorinla of monononnmanf o 4 me ;n+- -- fnr n.ef�e ��- ^ ^� �n..:roe Q—h — —hir +—t—nt ynits or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 12 SECTION: 2.20.047 ZI l Siv CE / ,f ,7,.7 FMI919 0110 WTA9. sup ersedes Product information presented here reflects n. 108 ltfar� PUM regardng �scxepanaes visit our web site: 1wons� tenses. MAIL TO. P.O. BOX 16347 - Louisville, KY 40256 -0347 SHIP To 3649 Cane Run Road - Iwl5olle KY 40217 -1967 www.zooller.com (502) 778 -2731. 1(800) 928 -PUMP • FAX (502) 774 -3624 COMPARE THESE FEATURES • Durable cast iron construction 151/152/153 EFFLUENT SERIES • Model 151 comes standard with a glass -filled polypropylene base (For Pump Prefix ldenication see News & Views 0052) • Corrosion resistant powder coated epoxy finish • Stainless steel lifting handle DOSE -MATE • Assembled with stainless steel bolts • Non - clogging engineered thermoplastic vortex FOR SEPTIC TANK -LOW PRESSURE PIPE (LPP) impeller design AND ENHANCED FLOW STEP SYSTEMS • Model 151 -1 /3 HP passes W spherical solids cslMI EFFLUENT SUBMERSIBLE • Model 152 -.4 HP passes 3 /4" spherical solids a • Model 153 -1/2 HP passes %" spherical solids 1'/2' NPT DISCHARGE • Motor - 60 Hz, 3450 RPM, oil- filled, hermetically sealed, automatic reset thermal overload protected - - ® Model N152/N153 • Carbon /Ceramic seals High Head C us Effluent • Upper sleeve bearing and lower ball bearing running Ts*dIDULSWndadULM andC in bath of oil SW,dzd M4222 no. 108 • 20 ft. UL Listed power cord with molded 3 -wire plug • 1 %2" NPT vertical discharge MODELS AVAILABLE • BN and BE standard models include a 20 ft. variable N151/N152M153 & E151/E152/E153 nonautomatic level float switch BN151/BN152BN153 & BE151BE1521BE153 • Operates at temp to 130 °F 54 °C n effluent packag ' van. � Rog s � ( ) i • 1/3, .4 81/2 H 115V or 230V applications • All models include a 1 %z" x 2" PVC adapter fitting Note: The sizing of effluent systems normally requires variable level float(s) controls and properly sized basins to achieve required pumping cycles or dosing timers with nonautomatic pumps. POWDER COATED TOUON" PUMP !O. Model BN1521BN153 MAIL TO. P.O. BOX 16347 High Head Louisville, KY 40256 -0347 Effluent SHIP T0: 3649 Cane Run Road Louisville, KY 40271 -1961 (502) 778 - 2731.1(800) 928 -PUMP FAX (502) 774 -3624 Manufacturers of... Z ` QV4Z1rI' P UMPS fl *CE lff ,7�7 p © Copyright 2010 Zoeller Co. All rights reserved. Page 7 of IZ TOTAL DYNAMIC HEAD /FLOW W PUMP PERFORMANCE CURVE PER MINUTE MODEL 151/1521153 EFFLUENT AND DEWATERING SD 14 45 153 MODEL 151 152 153 12 Feet Meters Gal. Liters Gal. Liters Gel Lifers 5 1.5 50 189 69 261 77 291 10 152 10 3.0 45 170 61 231 70 255 30 15 4.6 38 144 53 201 61 231 0 8 151 20 6.1 29 110 44 167 52 197 25 7.6 16 61 34 129 42 159 0 6 20- 30 9.1 23 87 33 125 35 10.7 - - - - 22 85 15 s 40 12.2 - - - - 11 42 4 Shut Head: 30 fl. (9.1 m) 1 38 ft 01.6m) 1 44 fl. (13.4m) 10 0145088 2 0 5 Model 151 Models 152 1 153 10 20 30 40 50 60 70 80 90 100 GALLONS 67132 87(32 LITERS p 40 90 120 160 200 240 280 320 360 3708 _ 4518 37/6 4 so FLOW PER MINUTE _ 014508A 37)8 ( -- f 4 4 CONSULT FACTORY FOR SPECIAL APPLICATIONS i 3718 ® 3718 • Timed dosing panels available - - � I rr NPT • Electrical alternators, for duplex systems, are available and j i supplied with an alarm • Variable level control switches are available for controlling single phase systems • Double piggyback variable level float switches are available i for variable level long and short cycle controls j • Sealed CtMk -Box available for outdoor installations - See 1111116 j 12118 FM1420 j • Over 130 °F (54 °C) special quotation required 415116 $316 151/152/153 Series - -- s1cz,,, slc2064 151!1521153 MODELS control Selection Model volts -Ph Mode Amps N151 115 1 Non 6.0 1 2 or 3 BN151 115 1 Auto 6.0 Included 2or3 El 51 230 1 Non 3.2 1 2 or 3 13E151 230 1 Au 3.2 irlduded 2or3 "Easy assembly" N152 115 1 Non 8.5 1 2 or 3 (purnlp & discharge pipe BN152 115 1 Auto 8.5 Included 2 or 3 not incWded.) E 5 2 Non 1 or 5 Aura Included or3 or BN153 115 1 Auto 10.5 Included 2 or 3 E153 230 1 Non 5.3 1 2 or 3 t3E153 230 1 Auto 5. Included 1 2 or 3 SELECTION GUIDE OPTIONAL PUMP STAND P/N 10 -2421 1. Single piggyback variable level float switch or double piggyback variable level Reduces potential clogging by debris float switch. Refer to FMO477. Replaces rocks or bricks under the pump 2. See FW712 for correct model of Electrical Alternator E-Pak. Made of durable, noncorrosive ABS 3. Variable level control switch 10 -0743 used as a control activator, specify duplex Raises pump 2' off bottom of basin (3) or (4) float system. Provides the ability to raise intake by adding sections of 1 W or 2' PVC piping O CAUTION Attaches securely to pump All installation of controls, protection devices and wiring should be done by a qualified Accommodates sump dewatering and effluent applications licensed electrician. All electrical and safety codes should be followed including the NOTE: Make sure float is free from obstruction. most recent National Electrical Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. -_. © Copyright 2010 Zoeller Co. All rights reserved. x P TOTAL DYNAMIC HEAD /FLOW PUMP PERFORMANCE CURVE PER MINUTE 50 MODEL 151/152/153 EFFLUENT AND DEWATERING 14 45 153 MODEL 151 152 153 1z ao Feet Meters Gal. Liters GaL Liters Gal. Liters 0 35 152 F25 1.5 50 189 69 261 77 291 10- 3.0 45 170 61 231 70 265 4.6 38 144 53 201 61 231 a e 751 6.1 29 110 44 167 52 197 a 7.6 16 61 342 159 6 70 9.1 — — 33 125 35 10.7 — — 22 85 15 40 12.2 — — 11 42 4 Shut -o8 Head: 30 ft. (9.1 m) 44 fl. (13.4m) 014508E 2 5 Model 151 Models 1521153 10 20 30 40 60 60 70 80 90 100 GALLONS 6773? —y.i 6762 LITERS 0 40 80 120 160 200 240 280 320 360 77/8 - 4518 �) 37/8 — 456 FLOW PER MINUTE 1 014508A - - -� 3� CONSULT FACTORY FOR 376 376 SPECIAL APPLICATIONS ® 3718 ® : 37M I + •Timed dosing panels available • Electrical altemators, for duplex systems, are available and I I supplied with an alarm j • Variable level control switches are available for controlling single phase systems • Double piggyback variable level float switches are available j for variable level long and short cycle controls j • Sealed Qwik -Box available for outdoor installations - See 1111116 j 12113 FM1420 j L • Over 130 °F 54 °C sp q uotation re f� q � 41 5 15111521153 Series — — I - —� sK244a sK2064 151/152/153 MODELS Control Selection Model I Volts -Ph Mode Amps Simplex Du plex N151 1 115 1 Non 6.0 1 2or3 BN1511 115 t Auto 6.0 Included 2or3 E151 1 230 1 Non 3.2 1 2or3 F BE151 230 1 Auto 3.2 Included 2 or 3 " Easy assembly" N152 115 1 Non 115 1 2or3 SN152 115 1 Auto 8.5 Included 2 or 3 (pump not t Inncluudede d..) ) d pipe Non or 5 Auto Included or or 611153 115 1 Auto 10.5 Included 2or3 E153 230 1 Non 5.3 1 2 or 3 BE153 230 1 Auto 1 5.3 Included 2 or 3 SELECTION GUIDE. OPTIONAL PUMP STAND PIN 10 -2421 1. Single piggyback variable level float switch or double piggyback variable level Reduces potential dogging by debris float switch. Refer to FMO477. Replaces rocks or bricks under the pump 2. See FM0712 for correct model of Electrical Alternator E -Pak. • Made of durable, noncorrosive ABS 3. Variable level control switch 10 -0743 used as a control activator, specify duplex Raises pump 2" off bottom of basin (3) or (4) float system. • Provides the ability to raise intake by adding sections of I or 2" PVC piping O CAUTION Attaches securely to pump All installation of controls, protection devices and wiring should be done by a qualified Accommodates sump, dewatering and effluent applications licensed electrician. Ali electrical and safety codes should be followed including the NOTE: Make sure float is free from obstruction. most recent National Electrical Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. -- - - -- -- - -- -- - — - - - -- - - - - -- -- - -- - -- - - -- -- - -- - — — — - - -- -- - -- © Copyright 2010 Zoeller Co. All rights reserved. �� 95 b8 — SZ� -008 OLOZ 'Ndf o3SM6 ° Z = anOd -LSOd :31Vo ME AavnNvr TYE OSL*9 IM ')WEI N3alYw M AMH sn 9tL£M ivnNdW OI1d3S n3a �� ®� ���� w o .anOd -38d .o -j =Jv 13iv�s 3ws 'AS NM Vaa 6W 099 /000 Ld1Ah \ Z w 0 LL' d' w = p F- v� U a m Ur. F V m 0 Z � o Lo l o WJ LL (� W F- J w O F- O Z J U Z .. w z Om O zZ Z w� Z H w p v o r J Z C� a °�'' mU v m v co z a (Z 5 z C? m O W a H w a U' � z Z O a o f (n v^ F 0 Q .0 p m� �oc N = R� v o Z.�: Z c a d t() U d d a s M °o Gi = a a - N0 nr I <wtn 0 w� a �ja. CO LL s �= o WW �$ ( (n m /) N h - a a F rn ZZ z o 0 V n N � �� >m w< J a = Zf" } � NW U U� �in W M z F- I- N I- Z J O (n F US — O � M :ii COZ_�F� O 8OW Q W =� m0N 0w wo (n Z JO�==o 3p D UB 0U� ¢ p Oi 0 Z Wa xX > J Z O QOOaW Z Wd{� Q* C9 Q'�iO0 U C9 Z�34 V NO Z3mU x`J`$mM 3 p o Y d W Y D J J p 0 z z >Z U p Z Z J J a- U F H J w w N 1 Q IL w p V H = « Q z a :t w 0 F d w ~� W rl O I w n m F- Ldn _N I I a `O ww d w -i o J 0 8£ w w O m u 6 0 1 ix w Q Sdo u� U O d ` � „Z4 do N \A w U M F- J Q Z u�� w 4038 a .va Sd wJ *6 z Page 8 of 12 ~ INSTALLATION INSTRUCTIONS "V!!! ok,m. PL- 525 /PL -625 FILTER INSTALLATION INSTRUCTIONS Center filter with opening { I� W E J � M x e e Additional pipe or Polylok Extend & Lok Glue for centering. Step 1: Step 2: Step 3: (A) Locate the outlet of the septic tank. (A) Before installation, place the (A) Glue the filter housing on the (B) Remove tank cover and pump tank filter housing on to the outlet pipe. outlet pipe. if necessary. (B) Make sure that the housing (B) Insert the filter cartridge in the is positioned so the filter can be housing, making sure the filter removed from the tank for cartridge is properly aligned and maintenance and service. completely inserted in the housing. MAINTENANCE INSTRUCTIONS WOMEN 1 1. e � e Step 1: Step 2: Step 3: Locate the outlet of the septic tank. (A) Remove tank cover and pump (A) Insert the filter cartridge back if necessary. into the the housing making sure DO NOT USE (B) Pull the filter out of the housing. the filter is properly alighed REMOVED WHEN FILTER IS and completely inserted. (C) Hose off the filter over the septic tank. USE Make sure all solids fall back into the (B) Replace septic t'ge of 12 YY*D CLEA111111M PLTOt j septic tank. PLOT PLAN (KLATT Property) ♦ BM1 Elevation = 100.00' Top of 1" Steel lot corner pipe A BM2 Elevation = 98.72' Top of 2" PVC Pipe. ■ Backhoe pits Slope =20% Contour Line Elevation = 99.20' 5.00 Acre Parcel N New 1000/650 gallon septic /dose tank with Polylok 525 effluent filter to be added to the existing 1000 gallon septic tank. r. iz�y Scale: 1" =40' r c /op M n V) �x�5 iWC GIN S S . -J, TANK t Pump ae LA SED ® � Z1+ j-e2cr= r"Al S 33 5 q,,3 X 81. Z 04 01 q iv X 32 s L�P \ ° sM 13M LI N �= Page 10 of 12 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer L� L . Mailing Address 3 63 VA u,,t✓ < e to Property Address (Verification required from Planning & Zoning Department for new construction.) City /State u � Parcel Identification Number 0,3 0 J `D ar —1f(9 - Z (9 LEGAL DESCRIPTION Property Location ,5Z_ '/4 , N L ' /4 , Sec. ,3 0 , T 3 O N R__Z' � W, Town of Subdivision Plat: , Lot # l Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house ❑ yes ❑ no Lot lines identifiable J yes ❑ no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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 Planning & 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. I /we, 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 Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my /our knowledge. I /we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Numbe ro s SIG A URE OF ICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 09/07) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to cert ify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) , 383 V,4u y V/ 5W Td. located at: 5F '/4, N E ' /4, Section 30 Town 3p N, Range _ W, Town of S% J o5cAH , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service / 0 - 7 Z61 0 Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: /000 Construction: Prefab Concrete �C _ Steel Other Manufacturer (if known): Age of Tank (if known): Z3 A4 Permit number (if known) 9 9'80 ju AIM 5 (LigKised Plumber Signature) (Print Name) ZZ376 0 (Title) (License Number) MP /p— ZZ -Z ©�n (Date) Form to be completed by licensed plumber (Dept of Commerce Chapter 5 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 9/2008 isconsin SOIL EVALUATION REPORT #1638 Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 5 Division of Safety and Buildings Schmitt Soil Testing, Inc. Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM) direction and St. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Please pr►nt all i 1 200 nformation. Re ' By Personal iMormation you provide may be used for secondary purposes (Privacy Law, S. 15.04 (1) (m)). /Do ZZ �D Property Owner Property Location Watt, Wesley Govt. Lot SE1/ , NE1 /4, S30, T30N, R19W Property Owner's Matlmg Address Lot # Block # Subd. N ne or CSMO 383 Valley View Trail 1 Csm 06. 1689 0 30 Lot 01 City State Zip Code Phone Number [ ) city L Village ( Town Nearest Road Houlton 54082 715 - 549 -6375 St.Joseph I Valley View Trail [� New Construction Use: U Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD F Replacement] Public or commercial - Describe: I Parent material Glacial till (Amery Series) Flood plain elevation, if applicable na ft. General comments and recommendations: Area is suitable for a mound system. System elevation is 99.70' based off contour line established at 99.20'. Slope of area is 20%. Depth to limiting factor is 31". F -11 Boring # 0 Boring [� Pit Ground surface elev. 99.76 ft. Depth to limiting factor 31 in. ISoil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eti#1 •Eff#2 1 0-11 10yr3 /3 grsl 2fsbk mvfr c5 2m,2f .6 1.0 2 11 -19 10yr4 /4 — grsl 2msbk mfr gw 1m,2f .6 1.0 3 19-31 7.5yr4/6 grsl imsbk mfr gw 2vf .4 .7 4 31-64 5yr4/4 --- ---- -- grsl Om mvfi — .2 .6 I Soils in horizon 4 are massive with very firm consistence. I E Bo,ing # F] Boring (u] Pit Ground surface elev. 100.26 ft. Depth to limiting factor 32 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture I Structure Consisten Boundary Roots GPD/W in. Munsell Qu. Sr- Cont. Color Gr. Sz. Sh. .E101 FM 1 0-10 10yr3/4 sl 2fsbk mvfr a 2m,2f .6 1.0 2 10-24 10yr4 /4 - grsl 2msbk mfr gw if .6 1.0 3 24-32 7.5yr4/4 --- --- - -- - grsl 1msbk mti gw if .4 .7 4 32 -76 5yr4/4 c1f 7.5yr5/6 ____ 7.5yr5/2 9 MA m .2 .6 Soils in horizon 4 (32 " -76 ") are massive with very firm consistence. ' Effluent #1 = SOD? 30 < 220 m0t and TSS >30 < 150 mg/L • Effluent #2 = BOD <_30 mg& and TSS <_30 mg/L CST Name (Please Print) Signature: g CST Number Thomas J. Schmitt 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted T Number 15 7 �Ph�e 95 2nd Street New Richmond WI 54017 10/6/2010 715 - 247 -2941 ssn.raw OL07/M) Npeftli Owner Klatt, Wesley Parcel ID # 030 - 1085 -80 -200 Page 2 of 5 3] Boring # f� Boring pit Ground surface elev. 96.64 ft. Depth to limiting factor 34 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I 'Eff#1 'Eff#2 j 1 0 -8 10yr3 /3 -- - -- I 2fsbk mvfr Cs 2m,2f .6 1.0 2 8-25 7.5yr4/4 --------- --- - -- grsl 2msbk mfr gw 2m,lf .6 1.0 3 25 -34 7.5yr4/4 --------- - - - - -- grsl lmsbk mfi gw if .4 .7 5yr5/6 4 34 5yr4 /4 flf 7. grsl Om mvfi - - -- - - -- 2 6 7.5yr5/3 Soils in horizon 4 (34 " -74 ") are massive with very firm cosistence. F41 I___l Boring Boring # r pit Ground surface elev. 101.36 ft. Depth to limiting factor 39 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 -10 10yr3/3 - ------ ---- -- sl 2fsbk mfr cs 2f .6 1.0 2 10 -21 10yr4 /4 -- - - - --- - - -- grsl 2msbk mfr gw 1m,2f .6 1.0 3 21 -39 7.5yr4/4 - --- - -- -- sl lmsbk mfi gw - -- .4 .7 4 39 -89 5yr4/4 --------- ---- -- sl Om mfi - - -- -- .2 .6 F-s] Boring # Boring (] Pit Ground surface elev. 92.76 ft. Depth to limiting factor 39 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-9 10yr3/3 - --- - ---- -- grsl 2fsbk mvfr Cs 2vf .6 1.0 2 9 -23 10yr4 /4 --------- - - - - -- grsl 2msbk mfr gw ivf .6 1.0 3 23 -39 7.5yr4/4 _____- __M_____ sl lmsbk mfi gw lvf .4 .7 4 39 -86 5yr4/4 cif 7.5yr6/6 sl Om mfi - - -- - - - -- 2 6 7.5yr6/3 ' Effluent #1 = BOD 30 < 220 mg /L and TSS >30 <150 mg /L " Effluent #2 = BOD < 30 mg/L and TSS <_30 mg/L 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 (R07/00) Gh.rd" G Y reewv. T- Property Owner Klan, Wesley Parcel ID # 030 - 1085 -80 -200 Page 3 of 5 6 Boring # �] Boring ( pit Ground surface elev. 92.46 ft. Depth to limiting factor 24 in. Soil Application Rate Horizon Description Depth Dominant Color Redox Texture Structure Consistence Boundary Roots GPD/ft P P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 1 0-8 10yr3/3 ---- ---- -- sl 2fsbk mvfr cs 2m,2f .6 1.0 2 8-16 10yr4/4 ---------- --- - -- fsl 2fsbk mfr gw 1m,2f .4 .8 3 16-24 7.5yr4/4 ----- -- - - -- sd 2msbk mfi gw if .4 .6 4 24-40 Syr4 /4 clf 7.5yr6/6 sl imsbk mfr Cs - -- .4 .7 7.5yr6/3 _ 5 40 -84 5yr4/4 cif 7.5yr5/6 sl Om mfi - -- ---- -- .2 .6 7.5 r6 2 F-1 Boring # Boring 0 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 F]Boring # ❑ Boring [] Pa Ground surface elev. ft. Depth to limiting factor in. Ell Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Effluent #1 = SOD S > 30 < 220 mg/L and TSS >30 < 50 mg/L • Effluent #2 =SOD < 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 MOM) a a...u.. C. Y...w— ^ r Conducted by: Conducted For: rage 4 of a Schmitt Soil Testing Inc. Name: Wesley Klatt Thomas J. Schmitt, CST 227429 Address: 383 Valley View Trail 1595 72nd St. City, State, Zip: Houlton, WI 54082 New Richmond, WI. 54017 Phone: 715- 247 -294 CSM: CSM 06 -1689 030 -86 Si Lot No.: 1 Date 10 Legal Description: SE 1/4 NE 1/4 S30 T30N RI 9W ■ Backhoe pit Township, County: St. Joseph, St. Croix County ® Bench Mark 1 El. 100.00' Top of 1 "Steel lot corner pipe (SE corner) A Bench Mark 2 El. 98.72' Top of 2" PVC pipe Slope= 20% Contour Line Length 64' Contour Line El. 99.2 0 L Scale I" = 40' p Shed � �ou�c Ea '�- e"'' 79' \ y W t 3!; 1� 020% \ � 3(� � Q rte, / ! o F So��ti P�� y L itt' F CIF ` may t a ` 2s S I p eA �., . } r A w� M� 4 + r d ,* T �'. q iA� IF Ai CL U e . JW #j LL d: _ V e-�, WARRANTY 2198 ; _ ) Tba BrAG "=we !fit ASCOMOglG ! gif iTt>f %� c 'TM P,4DX TV1R) , Made Lhxs ._._ 28. .. of .. .. - ... ST. CROIX CO., WI& t anti ale ;al: L. R�atcrtt#• fo X)a:t,_ ...._ d eta 4th � "'tt " dsearlw;ase F4ria ".. _ .-- -- ---- -__.:. _. ...._..., -.° ... .. ..__ _ - _ _ � l�A t7f el:��� n. . tog it � R.2Q A _ _.._....__....---..._._ .. _..._..__ _. — .p®t-t.. Aa -oi the first part and ...... 3I�.9.�5?i4Y�t..t�na�Ytg._az�c2 nit �5...�.ena1F� §....b�_ cumm�n...- . ,: . -• -- - - --- ptsrt E q_ Of the SeC4nd ) JMTB T V4' ( t n at a a e t b That the said part gg of the first part, for and in o miLlerstion r ( LAWSON, RA.LZIGH 8 MARSHAI.L, A. of tlm sum of__.a++?a •" ^r*t d o+ hsar uaod and valuable - -._ __, I NSbo Laverne Avenue Not°th A 4oI1s1Qe=azava.a t'a "' • : • h °• _..... .. _ . -. �I. ElIDp. MN tT504'� — ___4 1 +r'rX f_&M paid by the w id part..IaSE of tha second Pa-A. the reoeipc wbaeuP Is hereby F mnfe'sed and acknowledged ha Y"a__. iven. granted, bargained. sold, remised. released. aliened. conveyed and confirmad, and by there presents ' rxr+ _ �HkYe : _grant. barirain cell, remise, release, alien, convey and cvnnrm unto tam a:.; d part_ r.f_ the second pa rains and aka fkt�rver, the fQUosving desci'xted real estate situatad in the County ci..._.._._.Ss... tC3CrQ1ii.. .atsc3 Stare of z4'ixo,arta. to•erft' H - A parcial of land located 1n the SE 1/4 of the NE 1/4 of Section 34, T 3vN. L R�9i+T,_Town of St. Joseph, St. Croiet County, Wiseonain, described as follows: T - Conamenci tg at the N 1 corner of said Section 30; thence eu0 9 27' 53"W (assurw.d be4ring of referenced to the N -Sl /4 sectio! line of said Sectiaxx 30, assumed Snf'27'S3 "w) 1b05.ii` - I ale "4-a tY a N -S3j4 si atior. thence Si li ne; t =2 `rr7 ='E 1.:81.47' to the poin point tS .. r, - -- �,.. oAA C7e a7,•tna the arc IN beginning; thence N67°59 ' 44 "E 4b . 5 ; t ttsrte a i:: t.,o�et » - - - - _ _ • -- - P, of a 900.00' radius curve concave to the Southeast whose chord bears N75 "E {� -- 244:2.1'; thence N83 E 281.61 thence Northeasterly 9.18' along the arc of �1 .a 500.00' radius curve concave to the Northwest whose chord bears N83 "E 9.18'; ! thence S28 25 "E 409.23 thence SBIr'11' 41"w 525-75'; thial - .c< ::26021' ci "tj A0!x,All to the point of beginning, ccntal -Ung 217816 square feet (5.000 acres), more or less and being subject to Town Road right -of -way o,t tit= N v rth as shown. r.n this roars. r and also being subject to all easements, =estric"ons and cove_nant_ :of record. (( (IF NECESSARY. CONTINUE DESCRn-TION ON REVERSE SIDE) " Together with all and singular the bereditaments and appurtenances thereunto belongini or in any wise appertaining; and all the estate right, title, interest.::laim or demand whatsoever, of the said part _es_.of the first part, either in law or equity, either in possession or expectancy of, in -and to the above bargained premises, and tLeir hereditattv_nts and appurtenances. To Have -and To Hold the said premises as above described with the hereditaments and appurtenances, unto the said port- les..of the t second part, - - and to..their....heirs and assigns FOREVER. - And the esdd_.... Edward_ Klan,_... JZ._..ancl..S.usan.L...K1att... Ytuslaand..and..wife.- °_.. _..... ° ........... .._.__...._ _._. .. z, ........ ......._............ ............................_.. ....... ... ... ...... ..... ................. .... ...................... ... ....................... ... ....... ............ . ....... ....... ............_....... } for txl @A7R VaS. ..ah kix ........ ._ ......... _..,heirs, executors and administrators, do ...............covenant. grant, bargain, and agrc•e to and I with the said part- A.Caof the second part...Allei,r ... ............heirs and assigns, that at the time of the ensealing and delivery of these presents 1 ....... _dXja ...... .... ........... well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and dear from all incuntbrances whatever.......P- XCSpt ... a S ...stated...above. ......... .... _ and__ Qf._. zfwcazt3 .......... ................ . . ......... ,. ........ 1 ............. . ..................................... .: ................. ............... .................... ----------- ------- .... ------------- -__ .................... I........... ­­ ....................... - and that the above bargained premiseu in She qu;et and peaceable possession of the said part -imr -of the second part,..ies.heirs and assigns, against all and every parson or persons :awfully claiming the whsle or any part thereof,..LlVey - ....... will forever WARRANT AND DEFEND. 1 In Witness Whereof, the said part ;.es_of the first part ha-Y8__lereunto met _.. their... hands__- / _.and seal. -__..- .this... ,28th• „_, day of .... .... .Atigl: a`r_ ..... _ ..... ., A. I7., 19_ �6.... �� — SIGNED AND SEALED IN PRESENCE OF , mo d l��•v ' � /s t7 -1 ��_► (SEAL') I Edtcard Klatt Jr. �i y _ + (SEAL) -- ------ ......................... Susan ... L__. u3. atz .............. . -....................... u (SEAL) .... ........... .._ .......... _ ....................................... ............................... (SEAL) MINNESOTA - .................................. ............................... - I STATE CDT VPff86 s` O Washington. ............................. ............................... County.) ° P ersonally came before me. this .................... 28 th....... ... day of _..._.. August...... ....... ........ ......... ..I—. A. D., Edward Iflat_t, : Tr. and Susan L. K. att.,. .u3 wife the above named..._...__.._......._..... ... { ........... ..............------..___....... ._..._......................... _. ... to foregaing inst-unient 2nd acAnow lodged the %.tine. G 96 JAMIM t'tt;sAMr r'tr[xre. — M;NNESOT .. Theodora L . Yeuiert e � WASHINGTON COUIaTY NOTARY 1 i .......... . .................. ............................... I %V 'My Commission )expires fan 2't, t "vat fItAL 'rt.:e !pw ument drat v - _ _ _ .; - .__ v (:ta sh lRn.tGn __...._. -- County. t VCXX' - f tibl.c . ....... . LAWSON, RALEIGH & MARSHALL, P.A. 0 Lake g Phone: ( 6-12) 777 -&3f;C t �-- LSxt -ra 3'!.3! t!! td eb. WI•ew.•tn Sa�tutca oro.rarr tn.r rt rn•rrum r• ro be .,...a.. a� t' S4- -e � !e!- art! -tom �. r.n.� »rr.n rhrr.on rh. n�..o f 1 ....�_ .,r.. "+ tM•_ wttaaffiaus and nerary). { 9 WARRANTY DEED —STATE OF WISCONSIN. FORM NU. r ataiiiiia CERTIFIED SURVEY MAP Located in the SE 1 /4 of the NE 1 /4 of Section 30, T30N, R 19W , Town of St. Joseph, St. Croix County, Wisconsin Surveyed for: Ed Klatt Rt. 1 St. Joseph, WI 54082 N 1T CORNER APPROVED SECTION 30 T30N R194 ♦W h&: AUG p A. b o`y b iY Q J = 0 SF. "?OIX �:_t; . b OMP4.NEN51W PA.VS �LANNING ty 3 AND ZONING COMMMEE it A< S89 "E 4! b 1481.47" k 4, t Q N67 ~`. ��NC 8.78' VALLEY'° ~ � - �'= � m 7 - 9 e e N67 389 44 "E ~� 1 rR411 N @ @•x.26' S I/4 C0R. rcHT 'OP. SECTION 30 POINT OF BEGINNING w A Y LAN f 3 38 age O � t 41 In 01= LOT t 217,816 SQUARE FEET (15.00 ACRES) Nl Q a INCLUDING RIGHT -OF -WAY �� • 198,654 SQUARE FEET (4.561 ACRES) G' ¢ Z Z, EXCLUDING RIGHT -OF -WAY N Q` O O. PILED d at AUG 8.1986 _+ Y , AM amt N ni 6WEdof a s a SCALE 1N FEET 1 "a loo L q @. SO o loo zoo �Np 73 6 991 aVPd 9 awnTOA n �j dD dD 138 '1.9 All 881 e8'I 9NINS131A 3dld NOMI ONnom u fZX�,i dVD N3S1N1138 '13Ni100 N01133S S g � 3 � DESCRIPTION A parcel of land located in the SE 1 /4 of the NE 1 /4 of Section 30, T 30N, R 19W, Town of St. Joseph, St. Croix County, Wisconsin, described as follows: Commencing at the N1 /4 corner of said Section 30; thence SO "W (assumed bearing referenced to the N -S 1/4 section line of said Section 30, assumed 50 "W) 1606.11' along the N -S 1/4 section line; thence S89 "E 1481.47' to the point of beginning; thence N67 0 59 1 44 "E 46.75'; thence Northeasterly 244.97' aln the arc of a 900.00' radius curve concave to the Southeast whose chord bears N75 47 "E 244.21'; thence N83 281.81 thence Northeasterly 9.18' alom the arc of a 500.00' radius curve concave to the Northwest whose chordbears N83 03'52 "E 9.18'; thence S28 "E 409.23 thence S81 "W 528.75 thence N36 "W 409.83' to the point of beginning, containing 217816 square feet (5.000 acres), more or less and being subject to Town Road right -of -way on the North as shown on this map, and also being subject to all easements, restric- tions and covenants of record. I, James E Rusch, registered Wisconsin Land Surveyor, hereby certify that I have surveyed and mapped the above described property; that such plat is a true and correct representation of the exterior boundaries of the land surveyed; and that I have fully complied with the provisions of Section 236.34 of the Wisconsin Statutes, the St. Croix County Subdivision Ordinance, and the Town of St. Joseph Subdivision Ordinance to th best of my professional knowledge, understanding and belief. ,'1g1111p/y F s E . Rusch GON ssional Surveyor �.• �•►� Rusch Surveying, Inc. JAMES E. 407 Second Street RUSCH s Hudson, WI 54016 S Nud Q /818 F, ��� ���• S�RJ; ;'�� This map ishereby approved by the Town Boar f the Town of . Joseph. ate Carolyn Bar ette, Clerk CURVE DATA TABLE C entral Chord Chord Arc T C g Curve Radius e Angle Length Bearing Length Bearing 1 900.00' 15 244.21' N75 "E 244.97' N67 "E 2 867.00' 15 235.26' N75 "E 235.98' N83 3 500.00' 1 9.18' N83 "E 9.18' N82 "E 4 533.00' 2 22.53' N82 "E 22.53' N81 "E Volume 6 Page 1689 e. 1C n CO) O ;' - 0 n d O y O 0 O K (D f O C n -1 N z O co W �. O W O N O N oo CD j J d 3 C c_ z N L7 O co 0 N �_ O ti CD CD CD CO y vii N N N Q x O N 3 j C c0 O O ry N n Oo O 3 " f a No � H < to O (D CD o C _ ��� ,a, m cs y CO a � c _ m N ci C ) W 'I N N = N " d. W L 4 O = -� co t0 O ao 00 c N -4 -4 g a z O O O M Z -0 JE o Z p L r Lr cn < z a �vvN! O O N N N 3 Ot OD fD O CL N z zwz O EN D m o 0 0 ° D m CD CD N c N N C N N C 7 CL ET Z m p Z m co — X w CL a C 3 0 M w o W m m o 6 z o' 3 Z O » z N z m CD A I w � CL I � a o T 3 v c z a O O cp N N c y I � a I t r A I � nl O ' N O O v A 0 LA O CD O CD ° o CL M f. Form -STC -104 AS BUILT SANITARY SYSTEM REPORT OWNER W cs Kin-tt TOWNSHIP SEC. 30 T _N - W ADDRESS ST. CROIX COUNTY, WISCONSIN SUBDIVISION N LOT I LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM i i 18x5,3 $M=100.0' —35 J ,. PpPp4 i ClE»NOU� yy /,SyI o 0 3 B::DRocn IV HO ME P\\ INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used 3 ��� c ��ll b Elevation of vertical reference point: 0V. U Proposed slope at site: SEPTIC TANK: Manufacturer: W F F k $ Liquid Capacity: I000 Number of rings used: - i Tank manhole cover elevation: q j� Tank Inlet Elevation: 1 3.0 Tank Outlet Elevation: 1 3.03 Number of feet from nearest Road: Front 1 0 Side 1 0 Rear ,O 310 feet 1 From nearest property line Front,0 Side,0 Rear, ® gj t,p�� feet Number of feet from: well 61 building: ao (Include this information of the above plot plan)( 2 reference dimensions to septic tank) I'l SEE REVERSE SIDE I PUMP CHAMBER Manufacturer: Liquid Capacity: Pump Model: Pump /Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: - Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, Ft. Number of feet from well: Number of feet from building:"" q q -7 (Include distances on plot plan). lTt !(Z - All — si.�t- as 89.gq. SOIL ABSORPTION 7STEM 103.15 ��a� Bed: Trench:� Width: , 0 Length: 3 Number of Lines: Area Built: qS J Fill depth to top of pipe: 93 t - Number of feet from nearest property line: Front, t O Side, O Rear , r ht. J U Number of feet from well: to Number of feet from building: 'd (Include distances on plot plan). SEEPAGE PIT Size: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: . Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, 0Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated:? Plumber on job: License Number: 3/84:mj DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABOR & Hj1MAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.C. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 SE,NE,S30,T30N —R19W CONVENTIONAL ❑ALTERNATIVE StatePgnWlD.Number: Town of St. Joseph ❑ Holding Tank El In-Ground Pressure El Mound Valley View Road NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Wes Klatt 208 WI St. N. Apt. 209, Hudson, WI 54016 1'3v Z - A -97 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. ELEV.: nj I I U�,a -w rr�.Q 1 0 J, U __] Name of Plumber V M nitary P /MPRSW No.: County: Sa Permit Number: Richa rd Hopkins 1059 St. Croix 92480 SEPTIC TANK /HOLDING TANK: MANU CTURE LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER C — R OV ED: PROVIDED. 93, \( } g 30� 3 YES ❑NO DYES DK,40 BEDDING: VENT IA.: VENT MA L.. HIGH WATE NUMBER OF ROAD: PROPERT WELL: BUILDING: I VE TO FRESH ALARM: - LINE' , 1 / AIA INLET: FEET FROM DYES NO ` DYES ^ NO NEAREST t� DOSING CHAMBER: MANUFACTURER: BEDDING: LIQUID CAPACITY I PUMP MODEL. PUMP /SIPHON MANUFACTURER. WARNING LABEL LOCKING COVER PROVIDED PROVIDED: ❑YES ONO E] YES ❑NO [!] ONO GALLONS PER CYCLE: N PUIP A CO FRO ERATIONAL NUMBER OF PROPERTY WELL 9 ILDING VENT FRE rH (DIFFERENCE BETWEEN FEET FROM LINE AIR INLET: PUMP ON AND OFF) Y S ❑NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil mo st e t th de th of p owing LENGTH DIAMETER MATERIAL AND MARKING or excavation. (If soil can be rolled into a wire, on uctio sh II cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH: LENGTH t NO. OF DISTR. PIPE SPACING. COVER INSIDE CIA / SPITS LIQUID BED /TRENCH TRENCHES MATERI PIT ✓ r DEPTH -• DIMENSIONS �j '�j ✓' GRAVEL DEPTH FILL EPTH DISTR. PI P' DISTR. PIPE DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: V NT TO FRESH RELOW PIPES: ASO E COVER EV. INLET ELEV. END: /'� /� Q PIPES: LINE t) C l� AIR INLET. RI �. NEAREST J O ` Ito .l I tJ� MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the cri eria for medium sand. TIONS MEASURED. ❑YES ❑NO SOIL COVER I TIEXTURE PERMANENT MARKERS OBSERVATION WELLS DYES 1:1 NO DYES ❑NO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED I DEPTH F TOPSOI SODDED SEEDED MULCHED CENTER: EDGES. f ' DYES ONO DYES ONO DYES ❑NO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH: LENGTH: NO.O LATERAL SPACING. 1 GRAVELDEPTIABELOW PIPF. FILL DEPTH ABOVE COVER. BED /TRENCH TREry HES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERIAL: NO DISTR CIS R. PIPE DISTRIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV.: DIA.: ELEV.. PIPES DIA.: ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING: DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED LANS ❑YES ONO OYES ❑NO COMMENTS: PERMANENT MARKERS: J OBSERVATION WELLS: NUMBER of PROPERTY WELL: BUILDING: FEET FROM LINE DYES ❑NO ❑YES El NEAREST -- -- 1.. Sketch System on �� `. Retain in county fife for audit. Reverse Side. \d SIGNAT E LE DILHR SBD 6710 (R. 01/80 Z, qtz j,4Z oning Administrator .' a �ILHR SANITARY PERMIT APPLICATION COUNTY In accord with ILHR 83.05, Wis. Adm. Code STATE ANITARY PERMIT # —Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NUMBER 8% x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES O NO PROPERTY TJNR PROPERTY LOCATION es S �, '/ L ' /a, S T , N, R E (or PROPERTY WNER'S LOT I S T N MBER BLOC UMBER SUBDI,VI I N NAME / ��i 1 ' 4 N 19 MP T , STjATE ( ZIP CnDE PHONE NUM ER VILLAGE : T E T ROAD, E OR LAN Cr S.6 9 �'' II. TYPE OF BUILDING OR USE SERVED: - o — /Q Number of Bedrooms if 1 or 2 Family i OR ❑ Public (Specify): c� cc,! III. PURPOSE OF APPLICATION: (Check only one in ¢#1. Check ## 2,3 or 4, if applicable) 1. a. X New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit ## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner /building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in ##1 and only one in ##2) 1. a. D 4 Conventional b. ❑ Alternative C. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In -Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. XSee a e Bed b. ❑ Seepage Trench c. ❑ See age Pit 2. PERCOLATION RATE 3. ABSORPTION AREA 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: ( inutes er inch): REQUIRED (Square Feet): PROP D (Square Feet): Feet X Private ❑ Joint ❑ Public VI. TANK CAPACITY Site .in all Total ## of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tanker ' ❑ Lift Pump Tank/Siphon Chamber ❑ I ❑ VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Pri t): PluEbr Signature: (No Stamps) , MP /MPRSW No.: Business Phone Number: V c k iq it H' "I I W k I 144=j�w I ON ' IM-) 0 Pruinbe r' Add s (Street, Stat ,Zip Cod p N e of D signer: Hw k) Aj_� VIII. SOIL TEST INFORMATION Certified Soil Tester (CS ) Name CST # CST's ADDR SS (Street, ity, Stat Z' Code) Phone Number: 2( 16 s �l WIL�so?,,N W i j c \SVd _( )3Yc!�jOaO IX. COUNTY /DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee Groundwater ate Issuing Agent Signature (No Stamps) A roved ❑Owner Given Initial � �t Surcharrg^e Fee 1a Q PP Adverse Determination 1L)��' 7 �V 1 � r J X. COMMENTS /REASONS FOR DISAPPROVAL: SBD -6398 (formerly Plb -67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber I INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT APPLICATION , TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4 Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608 - 266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owners name and mailing address. Provide the legal description where the system is to be installed; 11. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; II!. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1 -6; VI. Tank information: Fill in the capacity of every new and /or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift /siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County /Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater b'.i Ground Wa included the creation of surcharges (fees) for a number of regulated practices which Wisco €n e can effect groundwater The surcharge, took effect on July 1, 1984. All of the water iha? buried Teaa 5L1tB is used in your building is returned tc the groundwater though, your soil absorption u ; system or the disposal site used by your holding tank pumper The °nonfes colle;.ted through these surcharges are credited te) the groundwater f nd adminis- terec by the Department of Natural Resources. These funds at e Used for rnon toy ii ig ground- t water, groundwater contamination investigations and establishrm7rit of standards Groundwate!, it's worth protecting. S3D -6396 (R.0&'36) s'. AI It)R SANITARY PEIUrri' S T c This application form in to be completed in full and signed by the owner(s)Hof the Z ; + property bel.ng developed. Any iciadeg"ncius will only result in delays of the permit issuance. Should this duvel,upkent'be Intended for.resale by owner /contractor, ( spec�it, �" �d and com pleted when "the property s house"), Chen a second t.cn alc I c L ( P P Y i ._� .';..,, . said and submitted to th'L�� oL'1`.Lre will, �.hu` appropriate deed recording. mu - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner of Property e �� Location of Property Section �L`� T N - R W t ' Township Mailing Address - �.�.� ` Q 1 FIRE 1 D I N Subdivision Name Lot Number Previous Owner of Property w�`�Y A , � S LOA`y L. !9LA - Vi r Total She of Parcel Ila cf- � 040 C Date Parcel was Created. AkfiV s W su . Are all corners and lot lines identifiable ? Yes No Is this property being developed for resale (spec house) ? Yes A No �7 1tti Volume / �`� and Page Number as recorded with the Register of Deeds Y { t „ INCLUDE WITH THIS APPL.ICA'1'1ON ONE OF THE FOLLOWING c r{ :o ' 1. Warranty Deed 2. Land Contract + 3. Other recordingd filed with the Register of Deeds Office 'iIlr),', In addition, a certl f od uurv{.{y, If nvo 1 1 ab l u, would be helpful so as to avoid d1 My sWE of the reviewing pr{{cuon. It tho dnvd dvncrll{CJon references to a Certified Survey, Map, the the Cc:rti f I u Ill run I I �� 1'llllr nllil I I 111111r hc! C'uclu a.rl;Cl. Yi "a2 o,t ?'yj ,r t.' ilrll'� 010111 Q t111ri rlCATION 41 t .�_._ I (We) cen.t16 y that a l' l' e.tct.i,eme t.ts on t ft i.a 6ohm aae hue to the best o 6 my knowledge; that I (ate) am (tvLct') tfie� oivttn (s) o6 the pn.opetty dUo ibed in -this tEdstFr�a in6ond .t.ion 3 604m, by Vlktue OK a tctnalan ty decd aeconded in the 066.ice 06 the N Coun,tykgietea o6 Pewit al Dttettmat, Nn, ' SS Z; and that I (we) pneaen,GCy oun he p�tci��osc�cf ea -f. e. 60; 40 srwrtge rW,spos system (on I (we) have a ' — ' 4 � , " ,� obta,Lned an casement, to hu tci..th the above., Mcaibed pn.opehty 6 , oh. the P conhtauctior, o6 said 4l/ tem, {n d the snme has been dAy ahcoadedin the 066.ice ` '�;'�`• r , No 06 the CourLty Reg"cs�t:c c o6 Uu'r15, as Uu .ccnc..tta 700, SIGNATURE C OWNER SIGNATURE OF C0-0WNER (IF APPLICABLE) G, 0 7 3 _ _ _ DATE SIGNED DATE SIGNED , WISCONS REAL ESTATE TRANSFER RETURN Wisconsin Department of Revenue • Name ress and Social Security Number of Grantor Name, Full Address and Social Security Number of Grantee Eclw^xd Klatt, Jr. & Susan L. Klatt Worley R. Klatt i Debra J. Klatt Route 11 BOX 480 208 Wisconsin Street, Apt. 0102 St. Joseph, Wisconsin 54082 Hudson, Wisconsin 54016 Is grantor related to grantee? (B or M © Yes ❑ No Name and Add(g5s co whic t bill h std he sent Weslo E. alatt & Oonra .�: ° ICJatt 208 Wisconsin Street, Apt. #102 Hudson, Wisconsin 54016 PART I - PROPERTY TRANSFERRED County of: Check proper box and enter name of municipality Street address of property transferred ❑ City Route 1 St. Croix ❑ St. Joseph Village OF:....- .. --.-• - .-- •-•-- .._ -- . St. Joseph, Wisconsin ❑ Town Yro9rn8$ip Legal Description (Fill in legal description in space below or attach 2 copies of full legal description from instrument of conveyance) EX HIBIT A - - I arcel of land located ir. the SE 1/4 of the NE 1/4 of Section 3C, 7 30N, 9W, Town of St. Joseph, St. Croix County, Wisconsin, describes as follows: Cola "encinc at the N 1/4 corner of said Section 30; thence SOq'27'S3'W ;assumed bearing referenced tc t-he 1: -Sl /4 section line of said Section 30, assumed SCo27'53 "W) 1606.11' alone the N -S1 /4 sectior. line; Cience Sl✓9 0 32 "E 1481.47' to the point or beginning; thence N6 "E 46.75'; thence taortheasterly 244.97' along the arc of a 900.00' radius curve concave to the Southeast whose chord bears N75 0 47'35 "E 244.21' thence No3 E 261.61'; thence Northeasterly 9.18' alone the arc of a S00.00' radius_ cane concave to the Nortnwest whose chord bear_ N83 "E 9.18'; ) thence 526 " E 409.2"; *hence S61 "W 526.75'; thence N36 "W 409.8_' _ to the point of beginning, containinc 21781E square feet (5.000 acres) , more or mated Jess anc being subject to Town Road right -of -way on the North, as showy, on this Ira;., yes anc also being Sul-ject to all easements, restrictions and covenants of record. as ` ❑ 2 thru 7 Units , ".... -- ❑ 8 or more Units c. Feet of Water Frontage ` I Estimated ❑ i PARTIII - TRANSFER j 1. ❑ Sale 2. [A Gift 3, ❑ Exchange 4. ❑ Deed in satisfaction of L.C. dated 5. Other Explain -04 Here PART IV - COMPUTATION OF FEE 1. Total value of REAL ESTATE transferred (purchase price, etc.) ... ............................... $ 7 2. Ownership interest transferred IN Full ❑ Other (Explain) 3. Fee ............................. EXBM$T 4NO, B) 4. In your opinion, was this sale or transfer made at fair market value? ❑ Yes ❑ No LJ No opinion (ff no or no opinion, Explain -044 Here) 1 (We) declare under penalty of law, that this return (including any accompanying schedule) has been examined by me (us) and to the best of my i (our) knowledge and belief it is true, correct and complete. Sign Signature of Grantee or Agent Date Here WME 1 1 9 -3-86 ' Document No. Vol. (Reel, Page (Image) Date Recorded Date and Kind of Conveyance LEAVE 4W5 752 4 TH Parcel Number 19 19 County Code District Code AREA BLANK A 8 C D E F t Office 2 Field 3 Use 4 Reject - [ I I Ratio Consideration T T - - -- ....... .......... _..................._..... ..................._........... (SEAL) MINNESOTA 1 ss. . ...................................................... STATE OF WIBR hint ----------- - --- ---- -- Was ...._._..........g..._ ..._.on .................. County 1 I Personally came before me, this ........... ..... y of .......... ................. August............. I............................. A. D., 19­1 the above named ........Edward Klatt, Jr. and Susan L. Klatt - and wife________ ________ _ __ __ ........ - i ....._ .................... ................... ...... ...... .. ...... ....... I............................. to a foregoing instrument and acknowledged the same. THEODORA I. PEULEN _. %/ 9 NOTARY PU BLIC - MINNESOTA NOTARY •- - . •- -- -• . -• -- - WASHINGTON COUNTY I Theodora I . Peulen My Commission Expires Feb. 21, 1991 6EAL This ent sirs tad } W MN >' Notary Public.....-....WA, 9., 1in 9t ;QA .....................County, VMX LAWSON, RALEIGH & MARSHALL, P.A. 3880 Laverne Avenue North ... . My Commission (Expires) ( Is) ....................... ............................... I ............... Lake Elmo, MN 550'42 ...... Phone: (612) 777 -69 (Se tlon 59.51 (1) of the Wisconsin Statutes provide, that all Instruments to be recorded shag have plainly printed or typewritten thereon the names of the grantors, smut —, witnesses and notary). WARRANTY DEED —STATE OF WISCONSIN. FORM NO. 1 N. C. e"ue co.. suatear I UMENT NO. WARRANTY DEED STATE OF WISMNSLN-FORM I Book THIS SPACE RLWVED FOR RECORI)MG DATA "52 PAU "S REOISTERS OFFICE D 19_.. bet..e . ..... Rdwarja Klatt.� J_r... And._-5_U*.an L. Xlatt . .......... A THIS INDENTURE, Made this ?Pth ............. day of.. .-August .... ............................... ST. CROIX CO., WIS. 1! * Recd. for Record this 4th ............. ....................... ............ _ ............................. ............ day Q a D. 19,8b ........ ... ......................... ....... ... - ................. Q�t 8:30 A . M, ................ .................... ........................................... ....... .................... part i.eA of the first part and ........... 8"WW of DOW@ p j.o.int a n d... no _t --- a ten iD . common , .. .... .. .... .. .. .... .. ... . . ....... par t..i s ..... of the sec o n d pa rt, RETURN TO W I t n e a a e t It, That the said part..-APS-of the first part, for and in consideration LAWSON, RALEIGH & MARSHALL, P A. of the sum of PAP --pq44K va luab le . _ .- .. - - -- .. 3880 Laverne Avenue North q9_n.s.i.d_era.t_ion.s to .... them in h_aP.d_,__. -------------------- --- __ --- ------------------ _ - Lake Elmo, MN 55042 6 ........ .. .. .. .... . -- ---- -- ---- -- --------------- _ ------------ ----------------- _--------------_ D XXXXxxxXXi2K16al0 paid by the said part-AeS.of the second part, the receipt whereof is hereby li confessed and acknowledged, ha. VP . ..... given, granted, bargained, sold, remised, released, aliened, conveyed and confirmed, and by these presents give, grant, - bargain, sell; remise, release, alien, convey and confirm'unto said - part._.:U!S.uf the second part,theikkirs and assigns forever, the following described real estate situated in the County of ........... St- Cr.Qix ........... and State of Wisconsin, to-wit: A parcel of land located in the SE 1/4 of the NE 1/4 of Section 30, T 30N, R19W, Town of St. Joseph, St. Croix County, Wisconsin, described as follows: Commencing at the N 1/4 corner of said Section 30; thence S0 (assumed bearing referenced to the N-S1 /4 section line of said Section 30, assumed S0 1606.11 along the N-S1 /4 section line; thence S89 0 32 1481.47' to the point of beginning; thence N67 46.75'; thence Northeasterly 244.97 along the arc of a 900.00' radius curve concave to the Southeast whose chord bears N75 244.21'; thence N83 E 281.81'; thence Northeasterly 9.18' along the arc of a 500.00 radius curve concave to the Northwest whose chord bears N83 9.18'; thence S28 409.23'; thence 581 528.75 thence N36 409.83' to the point of beginning, containing 217816 square feet (5.000 acres), more or less and being subject to Town Road right-of-way on the North as shown on this map, and also being subject to all easements, restrictions and covenants;of record. (IF NECESSARY, CONTINUE DEsc:RipTioN ON REVERSE SIDE) Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining; and all the estate light, tit:, interest, claim or demand whatsoever, of the said parties of the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises, and their hereditaments and appurtenances. To Have and To Hold the said premises as above described with the hereditaments and appurtenances, unto the said part-Les--of the second part, and to_their ---- heirs and assigns FOREVER. And the said - EdWard._Klatt,,.._Jr..._and Susan.. L...Klatt, husbartd--and...wife . ...... ................................................ --- --- --- -- * ----- ----- - * - --- ----- --- ----- * ---------------- ------ -- ---- - ---- ------------- ------ * ------------­------------ --- --------------------------------------- -- ---- for tt1ems_e1_Ve.9_,....thejz ...... . . . .. ........_..... executors and administrators, do ........... covenant, grant, bargain, and agree to and with the said part-i-P-Sof the second part,..__t11e1.r ----------_--- heirs and assigns, that at the time of the ensealing and delivery of these presents are ......... ............. well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and clear from all incumbrances whatever eXr-ept...as stated-above .............. .............. ............................................. ...... ........................ .......................................................... ............................. ......... ........... ..................... ....... - - - -- . ..................................................................... .................................................. .......................................... and that the above bargained premises in the quiet and peaceable possession of the said par-LieS.of the second part_ieSleirs and ass ss,gns, against all and even• person or persons lawfully claiming the whole or any part thereof t1le-Y will forever WARRANT AND DEFEND In Witness Whereof, the said part--iP.S.of the first part ha-ve.--.bereunto set. theiX_handS and seal this...2qt�b._. day of .......... ., A. D., 19...$4 --• SIGNED AND SEALED IN PRESENCE OF ?'� (SEAL) 7 EdtyarqKqatt, Jr. / ............... — ( -- _(SEAL) --_-------_ -------------------------------------------------------------- ----------­- Kla'tt . . ..................................... 02% (SEAL) wa ­ .... . ........................... . ................................... . ...... ..................... I ....................... .............. .... ............. ............... (SEAL) MINNESOTA STATE OF WISCOMOK ...................................... ....................... . .......... ............ ..Washington . .............. ...C ounty. S& ............ _ ........... ... P ersonally came before me, this ........... ..........28th................. -- day of ._.... -•-- .......-- ..... _A!AgRst ........................................... A. D., 19._ �. the above named and Susan L K.l.att.,_hu.��.b.and an . d wife ... .. .. ......................................... ............ ..... .. . ... t . .. --------- .............. .. ........................................... ................................................ .. ........... ........ ........................ .... . ......................................... 0 e foregoing instrument and acknowledged the same. THEODORA V PEULEN NOTARY T PUBL OT N A2 LIC - MINNESOTA ? 2U WASHINGTON COUNTY Theodora I. Peulen T VI V , M 'y Commission p NOARY . ..... . . . ....... _ ....................................................... . ....... J M y Comintissio?n Expi�res$ Feb. 21, 19 81 1 0 SEAL This ins , I v MN drat Notary Public .......... WO.Zhinstan .......... .......... County, VMX LAWSON, RALEIGH k MARSHALL, P.A. 3880 Laverne Avenue North Lace f166 KM 55'642­ .................................... My Commission (Expires) ( 1s) --.................--•- -......... Phone: (612) 777-6960 of the (S-0.1 59.51 ( " , 1)of the whico" i a statutes Providee that 811 IoNtrument► to be recorded hall have plainly Printed Of OPewrlttea thereon the:1 . Antritors. grant* witnesiies and notary). WARRANTY DEED-STATE OF WISCONSIN. FORM NO. I S TC - 105 r r .A" H SlEPTIC 'TANK MAfNTLNANCL ACItEEMLN'1' o. St. Croix County : 0 OWNER, /BUYER Yves J pebL' K.Cry. -f ROUTE /BOX NUMBER -� Fire Num b .er CITY /STATE- 'r��1oD6 PROPERTY LO 'C A T;ION: 4, . 4, SeCtiun ,'1' N, R i 'Town of ��,-� . ��pQ� St Croix" County," }' Subdivision Lot ,number ' Improper use and maintenance of your septic system eould_resuLt in its pren►ature failure to , handle.wa* tes. Prulier maintenance can r<} {S N silts .of pumping out the.�sepCic tank every tl `year "s o.r soon,e - i f needed, > by a licensed : s u ) t i c t a n k " " gum ejr Wiiat you put into the sys tent can affect .the" f'un_ction of the sv:i?tic "-tank as•" -a treat went stage "1►i the waste disjosal system. Y' SC Croix County residents n►a b_c elibible to recelv0., a brantr °for -... .. a•_ maxi'mum . of 60% tof the, cost of ,replactuient of a' fail nl; ,syste►n; f k " which was t.n operatrion 4ptior to :July` 1, •'1078 St" ('rxx Caunt;y a'cc epted thi "s 0to r'an► itt" A'ub "ust 'of 1980 wxt the ; requ li "` i r e►n en a t rt `t a ;. d • • ,. A. .a+ uwnersc of € ell n w sXstei ns k abree :to ,keep th6Ir�s systems. properly` ie property .owner abrees� to submit `to St ruix Cou11 Y l.o►►in� a C ce'rtificati6n form,, signed liy". tha owner "and b:y a - :n►ast:er p uinber, journeyman' "plumber, restriceed plumber ur a ,1!icensed "pumper ver1 fyinb 'that (1),,:tlie'on -site wa'stewate'r d,i5pusal syateui' is in proper` , , operating c, ndition'and' (2) ,aft.er 'inspection ;and pumping (if ','n'ec essary), the septic 'tank i "s be " s lessl than ,1/3 "ful`1 of sludge and scum: Certification form, will' .e nt, approxiniat61 30 days prior to three "year expiration. `o E I_ /WE, the undersigned,. have "•'read the.. above requirements and agree CA to maintain the private sewage disposal system in' ac with H the standards set forth, herein, as set. by the Wisconsin' ".Depart w went- of Natural Itesources Certif�cat.ion corm must be completed and' returned to the St.' Croix "Count's Gonin Office within.`30days .; of the three year expirat date {s i J #M SIGNED L DA�1.E ' .... w'"� t St. Ctloix C;►unty Zoning Off "ice P.:0. E -ox 96 r Hammond, ,Wl 54015 - .. 715 -7S -2239 or 715 -425 -8363 Sign, date and ,return to above address - s� t DEPAF TMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS .IWUS'TRY, DIVISION LABOR AND PERCOLATION TESTS ( P.O. BOX 7969 HUMAN RELATIONS \ / MADISON, WI 53707 (H63.09(1) &Chapter 145.045) LOCATION /��/ SECTI ������ � TOWNSHIP/ OT NO.: BLK. NO.: SUB ISIQN NAME: S *or)W . lose l) COUNTY: OWNER' BUYER'S NAME: MAILIN ADDRESS: C ro i A 1 ;2 GJ ;S[on S 1 5� i4 m � S� USE DATES OBSERVATIONS MADE I ND. TS.: 1 COMMERCIAL DESCRIPTION: IPROFI � Dt PTIONS: PERCOL TESTS: Residence New ❑Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: ❑� IN -GROU� ❑� RE: SY -IN -FI LL HOLDING TANK: R � EC �� v � �� SYST l� ( � C' k If Percolation Tests are NOT required DESIGN RAT 4 If any portion of the tested area is in the �► ) under s.H63.09(5) (b), indicate: 2 6 • t o / f ss l Floodplain, indi Fl elevation: ! V PROFILE DESCRIPTIONS BORING IOTA DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH +N! ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- 1 �� ��p 45 7) y, 5 s/ ' B- J04 R b . U 8 1 ' &'S/ it '3 7 8 2 9n S/ 4-jr, Z •4 V K5 �� 5 Wfl B- 3 Id���� 9b.Olo > IO, yb� , 76 w5r, /,7S ,mss / � / / 7s'Rsl �f� Olef 5 s , B- 50` B/ s �^ /.o?S'�r�s /d r a?, 33� S d Q r. sJ 4 a r B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD 1 PERIO 2 PERIOD3 PER INCH P_ I y�" None 1 a S 8' a y "7/) U 9, 10 P_ 8 3 " 10 9 11 to 9.0 P- 3 y cbt P -_ P- P PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION _4--- e Tre 0 I _ y o l _ -- ----- -I r 1 m. -� v� f I Clal � r� e e- Ile I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE C MPLETE ON ADDRESS: CERTIFICA ON NUMB R: PHONE NUMBER (optional): 'a �, • �� � CST S N U OF f DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 02/82) — OVER — INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be acomplete and accurate soil test, your report must include. 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3. MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be crsed'if desired; 8. Make sure your benchmark and vertical elevation reference point a tt clearly shown, and are permanent; 9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain, elevation) does riot apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10 ") BR - Bedrock cob - Cobble (3 - 10 ") SS - Sandstone gr - Gravel (under 3 ") LS - Limestone; * s - Sand HGW - High Groundwater cs Coarse Sand Perc- Percolation Rate med s - Medium Sand 'W - Well fs - Fine Sand Bldg - Building Is - Loamy Sand > -- Greater Than sl - Sandy Loans < - Less Than *1 - Loam Bn Brown * sii - Silt Loam BI -- Black si - Silt Gy - Gray cl - Clay Loam Y Yellow scl - Sandy Clay Loam R - Red sicl - Silty Clay Loam mot - Mottles sc; - Sandy Clay vu,` - with sic - Silty Clay fff few, fine, faint t t c flay cc - common, coarse pt - Peat nam. - Many, ine'(Eum rn - Muck d - distinct p - prominent HWL - High water level, Six general soil textures "„ surface water for liquid waste disposal BM Bench Mark VRP - Vertical Reference Point TO THE OWNER This soil test report is the, first step it , ) securing a sanitary hermit. The county or the Department may request verification of this sail test in the field prier to pert issuance. A comr)lete set of plans for the private sewage systern and a permit application must be subrnitted to the apl - )rohriate local authority in order to obtain a permit. The,sanitrary permit must he obtained and hosted prior to ter,. stz,Vt of any corIstt'uction. . L. - 6 7 P L O T A N O S S SECT I_ ..1\1. . PROJECT PLUM 13E k N A M E _ 1\1 A E— , ich a- r r lcJ. o �vs o C AT 1 0 N_-_1 - I_ C E N S E =f PLO 1 - [\d A P 31 y r � , ABw► k) , 3013.E 3 14 Bm= Stee I P +pe �;'' � ' `� �N 9Rd• Next i - o 1 e ruck Pos" i000 O ��• SA O = Bovz Sites et K C hJe Sues �". �► °' -k= A l l (NYk ;,: • ��x53 � z ► fo VRlfey View �� Pa � �, ARc �6 coiteol Ne x ► o �s { 8L 0 ..: s o .: h _n U FRESII AIR . NLE'.I'S AND OBSERVATION PIPE CROSS Si. CTION Approved Vent Cap Minimum 12" Above ,/ ��N�' 92A�� Final Gra de_,._�__q� ►t 4" Cast Iron Above Pipe Vent Pipe To Final Grady - - - Marsh Hay Or Syntheti Covering Min. 2" Aggr_ ey`i l Over Pipe Distributioi ��! .— Tee Pipe Aggregate Perforated Pipe Below Beneath Pipe <---Coupli Terminating At Bot l -om of System CERTIFIED SURVEY MAP 1 SCALE M FEET) d 25 50' 100' 200 300 LEGEND *SECTION CORNER MONUMENT r 1 IRON PIPE FOUND .O I ° X 24 IRON PIPE WEIGHING NI/4 CORNER 1.68 LBS. /LIN. FT. SET. SECTION 30 0 0 W a � O 2 a W 3 _L�NPL�ITTED LQN��_ � i s. u e VALLEY ~ iv 0 -) 'A to D C ro IY v �a o ° N� 2 1 9 6 �E %n B ° z o N 6S •35 X 26 d am = °v 1 a S o �Z m 0 ° LOT I ir I> O° 250.757 SQ. FT. t� - 1 -1 (3.757 ACRES) U) )o INCLUDING RIGHT- w H � OF-WAY. G . o Iz W W ) M 6'� SS W 12 M ) w in m S es.Qe oomw s41 ss _oldPI.A TULLA". §- ........ ........ I