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HomeMy WebLinkAbout030-2131-19-000 Wisconsin Department ofCom0arce . PRIVATE SEWAGE SYSTEM county: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 479202 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name. City Village X Township Parcel Tax No: St. Joseph Development Corp. St. Joseph, Town of 030 - 2131 -19 -000 CST BM Elev: Insp. BM Elev: BM Description: �� _(�_ J ! � Section/Town /Range/Map No: /f /'n / C$T G � 23.30.20.1073 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic C - Benchmark Q: J3 ► ►1 1 Dosing Alt. B� 0 75 • (,P 5 Bldg. Sewer , k!5 1 16. 75 Holding St/Ht Inlet /d. 96 - z55 St/Ht Outlet TANK SETBACK INFORMATION L TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / Dt Bottom 7Z5 5 45 .2_ Dosing 7 / 1 5 ' / 'T'J / Header /Man. A Q Aeration Dist. Pipe ' Q .61 ` Holding Bot. System o Final Grade PUMP /SIPHON INFORMATION 4 l z�f r e V Manufacturer LJ Demand St Cover ` 47 -3 . al IEr Model Number /) IS / 240 31- Z TDH Lift Friction Lo�ss System H` TD�� Ft Forcemain Length 1 Dia /I Dist. to well / z LID SOIL ABSORPTION SYSTEM BED/TRENCH Width Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /Cj ? Z SETBACK SYSTEM TO IBLDG IWELL LAKE /STREAM LEACHING Manufacturer. r INFORMATION Type Of System: / / :5/ r AA_ UNIT OR UN T Model Number. Q DISTRIBUTION SYSTEM // e CIL zz f'd-aQ., Header /Manifold / � Distribution x Hole Size x Hole Spacing VA f i / Pipe(s) \ / Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center / / _ Bed/Trench Edges \ Topsoil 1p \ Yes N No Yes FE-1 No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 143 Heritage Trail Houlton, WI 54082 (NE 1/4 SW 1/4 23 T30N R20W) Settler's Glen Lot 191 Parcel No: 23.30.20.1073 1.) Alt BM Description = w I 2.) Bldg sewer length = 9Q� A - amount of cover LLL "' ✓�� Vtcer Plan revision Required? Yes Use other side for additional information. 2,-7 �— Date Insep is Sign re Cart. No. SBD -6710 (R.3/97) Safety and Buildings Division County t 201 W. Washington Ave., P.O. Box 7162 l vi sConsi Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) 2 Zd Department of Commerce Sanitary Permit Apph`� an 1. N umber � In accord with Comm 83.21, Wis. Adm. Code, personal info ati ' t G v , -' maybe used for secondary purposes Privacy Law, s 15. ro Vn f � 3 20 roject ddress (if different than mailing address) I. Application Information - Please Print All Information . CROIX COUN Y ZONING OFFICE Property Owner's Name �iel,,� t _ 1� Block # ` 4 1111 J Property Owner's Mailing Address C� Property Locattiio�n, J ✓ /�! J'- t -� r / Section City, State Zip Code Phone Number 7 /) ✓� ��� � �/� rcle II . T pe of Building (check all that apply) let Subdivision Name CSM Number 2 Family Dwelling - Number of Bedrooms 5 I c 1� ` 1 El Public /Commercial - Describe Use /� ❑ State Owned - Describe Use ❑City ❑vinag wnshi f /.v d- G y III. Type o rmit: (Check only one box on line A. Complete line B if applicable) ow _ A ' System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. El Permit Renewal Permit Revision ange of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plum Owner Xe�so6 7 3 /0 IV. Sype of POWTS System: (Check all that appl Non - Pressurized In Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At - Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pre==ching und El Holding Tank El Peat Filter El Aerobic Treatment Unit 11 Recirculating Sand Filter ❑ Recirculating Synthetic Media Chamber ❑ Drip ❑ Gravel -less Pipe ❑ Other (explain) 0 V. Dispersal/Treatment Area formation: ` Desi Flow (gp I Design Soi Application Rate(gpdsf) Dispersal Are Required ( Dispersal Ar o o m eva �o / g -3 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site feel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tankg Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber -p 1 VII. Responsibility Statement- I, the undersigned, a responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's SARLc MAMPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip C e) VIII oun /De artment Use Onl pproved tsapp Sanitary Permit Fee (includes Groundwater Da Issu Issuing nt Signature Stamp Surcharge Fee) Owner eason IX, Conditions of ApprovaMasons for Disapproval SYSTEM OWNER: 1. Septic tank, effluent filter and � bd 2.rw- dispersal cell must all be services /maintained �^ as r mana gement Ian provided Pe a9 P P ded by plumber. 2. AN senwA requirements must be maintainod L / apsrappwabbcods/ordirances. �,( /�� I 1 Attach complete plans (to the County only) for the system on paper not less thsk SI/2 x 11 inches mi size SBD -6398 (R. 01/03) PL T PLAN PROJECT St. Joseph Development ADDRESS 12415 55th St. N Lake Elmo Mn 55042 NE 1/4 SW 1/4s 23 /T 30 / 0 W TOWN St. Joseph COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 5/20/05 BEDROOM 3 CONVENTIONAL IN- GROUND E6kSSURE CONVENTIONAL LIFT X00C HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE630 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 100' Filter Zabel A -100 ❑BOREHOLE O WELL *H. R. P. Same as Benchmark SYSTEM ELEVATION 92.0/91.6' 4'below qrade Scale is 1" = 40' unless otherwise Heritage Trail noted Plans Designed Using Vent Conventional Powts Manual Version 2.0 > 6» Standard Biodiffuser Well is to meet all of Cover Leaching Chamber setbacks required by with 3 1. 1 ft2 of Area WDNR 6' Long 11" 34" Grade at System Elevation Pro 3 Bedroom House KB _ 25' 20' Huffcutt Combo Tank ell • 50' 0' 5% Slope B -3 20' 2 -3' X 69' cells with >3' spacing Vents 5 , B -1 LBB 51 70' ilt7 Property Line 100' SEPTIC TANK E CHAMBER CROSS SECTION AND SPECIF ICATIONS DUMP C �tEATHEttPROitF y == C �tENT PIPE 12' MIN. ABOVE GRADE JUNCTION F APPROVED ER s IS- FROM DOOR, W INDOW 4R WITH CONDUIT W1 PA LE C & �,tR INTAKE W/ PADLOCK � r FR£�a� E SrIARK�N6 LABE.. FIN�tD GRAD fp .,._.... MIN. INLET (•- ' GAS # `, •`\J�tPP WATER TIGHT SEALS — T — TIGHT - � A SEAL ; JOINTS tlITH FSLTER -- t ALIT APP O PIPE APPROVED $ _ * ON SEND SOIL i PIPE 3 C OFF wo SOLID ^� 9 T - SOIL PUMP 4Ff ELEY . U�c `f - 4 — D It APFROV BEDDING V NDER TANK ,. CONCRETE PAD 3 �. SPECIFICATIONS I S ' . 4, I LV PER DAY _...- ---- -- SEPTIC / DOSE �Mg£R DOSES / TANK MANUFACTURER: DOSE yOLUME TNCLVDING GAL - ! ! GAL. FLOWBACK: TANK SIZES : SEPTIC GAL. DOSE �/' J INCHES .,� CAPACITIES: A GAL. ALARM MANt}FA:WRER;: lz B = . INCHES = �� !MODELiKSER : y SWITCH TYPE: /C �� J INCHES = GAL, � C FACTi#R£R : _ 'INCITES = l J GAL- pUHP MAC D MODEL NUMBER PER I L.RR 15.23 WAC SWITCH TYPE= � GPtf pUMp C ALARM WIRING AS REQUIRED DISCHARGE RATE / (/ FEET DISTRIWTION PIPE � :Z:� FEET EN PUMP OFF AIIB - - - - FEET VERTICAL DIFFERENCE $ET'WE - - - FEET MINIMUM NETWORK SUFFLY PRESSURE F"I FRICTION FACTOR '��� + ---- F££T FORCEMAIN x� TOTAL DYNAMIC MEAD LEN GTH 4i D DIAMETER FU M? T A N K : ---- -�-- -- INTUNAL DIMENSIONS OF LIQUID LICENSE NUMBER: "_IWAT E - SIGNED- /88 FROM BRIAN VAUGHT-PREFERRED PUMP FAX NO. 7154258035 Mar. 30 2005 09:57AM P1 DYNAW., cc , Al 1 T CURVE PI R WNUTF `x :/; 52. /153 EFFLUEN! AND MODEL 15 4 Feet Meters Col. 1 1 i f F. (s GoL i Liters G R j - 5 1.5 45 261 42 2,31 61 2.51 1 10 4.6 36 261"' 25 7 1 —15 20 6.1 _767 64 167 1 52 i 20 129 5A I'jj 25 20 I � 30 9.1 87 3! 35 10.7 ?2 40 121 _7_ eo Shut -off 146d. 30,0 ft. (9-Irn) a It. .6m) Gt'l t ()NS 2 40 jO 1 00 o+eyeeprgrrr 0 so IGO )40 320 7 LOW PER MINUTE tn.soeerzrrQ Model 151 Models 152 1153 CONSULT FACTORY FOR - 6 I/J2 3 7/6 4 5/8 3 27/j?- SPECIAL APPLICATIONS TIMO dosing panels available. • Electrical 31teMatOrS, for duplex systems, are available and supplied with an alarm. • Variatle level Control SVAIChCS are available fix COftiling single phase systems. • Double piggyback variable level float svfta are available for variable level long and short cycle controls. • Sealed Wk-Box available for outdoor irmwb6ws, See FM1420. • over 130'; (WC.) SPOCi2l "alion required. I ViS815 MODELS co"d S 4 t f I Made Atolls Do 1`15 1 ft &0 1 3 51 115 1 ALft 6.0 Indud 2or3 Et ° 1 no I N 3.2 1 for LSE! 230 1 Atft 12 Included 200 iMTEMP SKAQPA HIS2 1151 No_ 8.5 1 2or W52 115 1 A40 is Included 2or3 50_1 Ron Q I 2or3 BE152 230 I Auto Ir --- 4.3 acludal 20(3 =NJ!R�f TI Nat 10.5 1 2or3 I BN 1531 115 1 Allto 10.5 Included 2or3 SELECTION GUIDE E153 I 2M 200 1. $41e pS9ybal* tradable level 809 MI& or double piggyback vanable level float tj'31 23D 2cr3 switch. Refer to FMD477, IA CAUTIOE] 2. See FW712 for m"W model of Electrical Afternstor E-Pak. Ail 1nv.A1lwii%n of contmis. protealoo dvwkw mod whIrts should be doft by a qualffied 3• Variable Imt witrol switch 10-0225 used as a contrO activator, spar ify duplex (3) rictated electrician. AN efearleal and sO* coda should be followed iftclud" The Most recent National EI*CM4 Cods (NEC) 0411 the occulwallonal 8d* Ind HIM Act (OM)- or (4) 1108t System. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAX 70 PO BOX 7W? :36�4,qr 02" 40211 -1961 1 ravw S IN70' iFi d 7M) 7rwalh-, 4m All eWfe AI-ewwo-A r - Wisconsin Dep artment Commerce SOIL EVALUATION REPORT p Page f o Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County ��, L� Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. o3a — Z 1 / 3 ( — /9 — zb Please print all information. Reviewed y Date / 644 Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 5 �✓ D Property Owner Property Location S To ) ovt. Lot �1 /4 ( 4 T 3 0 N R j p E (or Property Owner's Mailing Address Lot # Block # Subd. Name or QSM# � - / City State Zip C Phone Number ❑ city ❑ Village Town Nearest Road ew Construction Use: esidential / Number of bedrooms _ Code derived design flow rate y J'Q GPD 0`— ❑ Replacement q ❑ Public or mercial - Describe: Parent material Y/ cJ� ' s a Flood Plain elevation if applicable ft. General comments and recommendations: 'S{ -- - � — z Boring # Boring LLjj Pit Ground surface elev. l ft. Depth to limiting factor ///?in. in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 2_ ,� y ., nXIr > v R ® Boring # ❑ Boring ✓ it Ground surface elev ft. Depth to limiting factor/On. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 ff#2 L' % n Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ; 715- 246 -4516 1 Property Owner _ Parcel ID # Page of y � Boring # 6 ❑ Boring g/ oft. Ground surface elev. ` `� o ft. Depth to limiting factor in. mil A Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff �c in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 3- % rc F-1 Boring # ❑ Boring ❑ Pit Ground surface el ft. Depth to limiting factor in. Soil — Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 a Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 i Effluent #1 = BOD > 30 < 220 mg1L and TSS >30 1150 mgA- ' Effluent #2 = BOD < 30 mg/_ and TSS 130 mg/L I 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. SOD -8330 (8.6(00) Soil Test Plot Plan Project Name ST.Joseph Development Shaun rd Address 12415 55th St. N. Lake Elmo Mn 55042 CS #226900 Lot 1 9 Subdivision Settler's Glen Date 5/20/05 NE 1/4 S W 1/4S 23 T 30 N /R W Township St. Joseph ❑ Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Bottom of Siding System Elevation 92.0/91.6 *HRpSameasBenchmark Scale is 1" = 40' unless otherwise Heritage Trail noted Pro 3 Bedroom House B.M. 20' Well ' 50' B -3 20' 5% Slope 15, B -2 B -1 5 , 70' 30' l 0' Property Line 100' Wisconsin Dep fierce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Buildi' INSPECTION REPORT Sanitary Permit No: . 463067 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: St. Joseph Develo ment Corp. St. Joseph Township 030 - 2131 -19 -000 CST BM Elev: Insp. BM Elev: BM Description: /� fb 0 Section/Town /Range /Map No: 1Q� 8M 1 6<s ( ,�,` 23.30.20.1073 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic rr Benchmark Ise,4— AM Dosing Alt. BM LOD AaqtLqn �. Bldg. Sewer X05 Q a.�5 Holding St/Ht Inlet b, C) 6 ` 5 TANK SETBACK INFORMATION St/Ht Outlet \ TANK TO P/L WELL BLDG. Vent to Intake ROAD DtInlet. .` 1 Septic S If �1 T T , `5 . 1 DtBottom J` , Z , Dosing Z�j 5 J � L5 r 15' Header /Ma �.D r Aeration J Dist. Pi �/// ll •� 0 Holding Bot. stem PUMP /SIPHON ' al Grade ON INFORMATION 5 �D q, Manufacturer �� GPM ad Cover 1.75 71 (6 s Model Number O l' I W 1 q.7 TDH Lift .`k Friction Loss System `d TD t T -z- , q G ' T 1 -! Forcemain Len 5th j Dia. Z �� I Dist.toWell r SOIL ABSORPTION SYSTEM BEDITRENCH Width / Length No. Of Trenches PIT DIME ZDNS Of Pits Inside Dia. Liquid Depth DIMENSIONS irs L SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM L "TIN! Manufacturer: INFORMATION CHA ER OR ► �` J Type Of System: U T Model Number: 60^LeA br CIS& DISTRIBUTION SYSTEM / ) ec� c�.� Z Z ►`a� — �� Header /ManifolfJ / Distribufi x Hole Size x Hole acing Vent to Air Inta 4 Plpe(s) \ ?i✓e . ✓� Length Dia 1 Length Dia Spacing SOIL COVER x Pressure qfstems Only xx Mound Or At - Grade Systems Only G Depth Over Depth Over xx Depth of xx Seeded /Sodded j xx Mulched Bed/Trench Center Bed/Trench dges Topsoil \ `� Yes ::: No �' Yes [� No COMMENTS: (Include code discrepenci s, persons present, etc.) Inspection #1: / / Inspe n #2: / / Location: 143 Heritage Trail Hooulltton, WI 54082 (NE 1/4 SW 1/4 23 T30N R20W) Settler's Glen Lot 1 19 Parce o: 23.30.20.1073 1.) Alt BM Description = �"`�� J � � Qa x v� 2.) Bldg sewer length I J amount of cover . rV P - �^•�: 1-- ` _ Plan revision Required? i Yes No + / _Q L,( Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's nature Cert. No. Safety and Buildings Division County N V I sconsin 0V 201 W. Washington Ave., P.O. Box 7162 `7 r el D %;e Madison, Wl 53707 — 7162 Sanitary Petmit Nub (to be filled in by Co.) Department of Commerce (608)266 3151 30(o7- Sanitary Permit Application , r - °- � �) LD. N umber In accord with Comm 83.21, Wis. Adm. Code, personal ' may be used for secondary purposes Privacy Law, s T5.1) k Address (if different than mailing address) 1. Application Information — Please Print All Informatio ' r4 , t-� ,-6( . Owner's Name Parcel Lot # Block # Property 1 G t iIX F1G St os & 6k PeL)4 Le �e�, t Z�N��ac o� Property Owner's Mailing s Property lion Z� t S % N t3mP.ijLf . t/ t/, section :2.S city, state Zip Code Phone N'u'mber n� S���F3 !— T -% N R ) H. Type of Building (check all that a ly) r� "?rs I�'I or 2 Family Dwelling — Number of +� v s Subdivision Name CSM Number ❑ Public/Commetcial — Describe Use ❑ State Owned— Describe Use ❑City_❑Vill Wnship of Ill. Type of Permit: (Check only one box on line Complete line B if app le) 0 30 — ;2 1 31 — I — aCb 1 1 3 ) A- ON. System ❑ Rephuxnment System jS T lacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ e of Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Tyin of POWTS Systew. Check all that a 1 ' K lon — Pressurized hm -Grand ❑ Mound > 24 in of suitable soil < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized la- Ground 11 Holding T P Filter [I Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculat Synthetic Media Fdta ❑ Chamber Line [.1 Gravel -less Pipe Q Other (explain) V. Dispersal/Treatment Area Information: X Design Flow (gpd) Design Soil Application Rabe(gpdsf) Dispersal Area Req (sf) ispersal Area Proposed (at) System Elevati VI. Tank Info Capacity in Total Aumber manufactlibler Prefab Site Steel Fr astrc Gallons Geilans of Units �� - S o Concrete Constructed Glass Ncw Existing Tadta Tads selxic or iioldiva iladc jpOtr! Aerobic Ttcumcnt Unit Dosing Chamber VH. Responsibility Statement - 1, the qfdagiped, ponsibtlity for installation of the PO S shown on the attached pleas. P1 G y wz, 'e S' z.T.S 7a SF Plumber's Address (Street, City, State, 4 VILL County/Department Use Approved ❑ Disappro Sanitary Permit Fee includes Groundwater Date Issued Issuing ` Sr (No Stamps) Surcharge Fee) ❑ Owns Gi Reason for Denial 25�—' Z3 ?srJD 1X. Conditions of ApproviRestions for Disapproval SYSTEM OWNER* 1 Septic tank, effluent filter and cbosle✓'J A dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Atteew eemplete plasm (to the County only) for the system ea paper not Is" twin 81 /2 s 11 laewes In size SBD -6398 (R. 01/03) T.L. Sin" Plumbing Inc. s - r .?a S lro tX �. E5609 708th Ave. Phone: (715) 285 -2644 Menomonie, WI 54751 Fax: (715) 235 -2592 www.tlsinzplumbing.com E` C �v w� �b "b7eo ° 1'9 l�o� "mac r �r. P coo 0 pN .o�Owt�.wTl T' PZ►J. T.L. Sin Plumbing Inc. s - r .TaSepk S Cro , x e'o. E5609 708th Ave. Phone: (715) 2635 -2644 Menomonie, WI 54751 Fax: (715) 235 -2592 www.tlsinzplumbing.com i n, � w O --fir a �o 11 r `tr I • Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County . Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all i _ Re 'wed b Date y Personal information mation you provide may be used for arf f JO&ak* w, s.1 .04 (1) (m)). Property Owner P rty Location �J 8 (� G Lot 1/4 1/4 S 2-2) T 30 N R 2D E (or W Property Owner's Mailing Addfdss Lotw Block # Subd. Name or CSM# � � z b Ski /l ' -.�!u� '' ► Ste- r���s G �� City State Zip Code °"" City ❑ Village W Town Nearest Road 11 0jakf - MN 556g (Zo I) 43a - I q J h w 3 New Construction Use: tP Residential 1 Number of bedrooms Code derived design flow rate y S (O // U GPD ❑ Replacement / ❑ Public or commercial - Describe: _ 0 V +t Jcr S h - Flood Plain elevation if applicable ✓rte/ Parent material n General comments S s /� ✓►,� �� J , `� 3 a and recommendations: y 7 a Boring # ❑ Boring Pit Ground surface elev. qq ft Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'E02 D-1 lC-) 3 �� ' Z ►rr�o bk r C- S I v 5 $ ( 3 M - 134 10 'A I -- s m Boring # Boring 1 pit Ground surface elev. -ILL. .00 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description iTextur Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 'Eif#2 0--12 I� 5 r CS 10 _ 1 1,2- ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < ISO mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) S• ature � 25 2 Nu 2 �� d � �\� Dat��luation Conducted Tel hone Number 1 Property Owner 0ja tr I Q4 (-' HO rme S Parcel ID # Pale 2 of 3 a Boring # • ❑Boring • 2 • Pit Ground surface elev. C lq . t)o ft to limiffng factor In. Horizon Depth Dominant Color Redox Description Texture • Struchrre Consistence Bou Soil Application Ra In. Munsert Ou. Sz. Coif Color rY Roots GPD/il� GO. Sz Sh. 'Elf #1 'Eff #2 - t 2rna& CS I v •'� IQ 4 �, s I'cl 2mSbk - 3 c5 -► IU yl� F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rai Horizon Depth Dominant Color Redox Description.,.... • Texture Structure Consistence Boundary Roots GPD /ft= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 I Boring # ❑ Boring ❑ Pit - Ground surface elev. ft Depth to limiting factor In. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary oots Soil Application Rat, N GPD /ft In, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Elf #2 • ' Effluent #1 = BODS > 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. Sao•1770 (Xor=) r r i PAGE�OF� NAME LOT# LEGAL DESCRIPTION-�w X SL Z SL � 130 N R Z 0 E(or'o SCALE, 1 "= �a BM I ELEVATION I00,0 BM I DESCRIPTION 1z�F a� Ova P' BM 2 ELEVATION (3y BM 2 DESCRIPTION to a� SYSTEM ELEVATION `IS 30 � SYSTEM TYPE C'a✓t v e �'o,�� t -1- — CON'T'OUR ELEVATION � • ou /ov. � Lo I " v 0 6 0 i ti SIGNATURE DATE Z�" G POWTS OWNER'S MANUAL 8L MANAGEMENT PLAN Page of _ FILE INFORMATION SYSTEM SPECIFICATIONS Owner > e r �© Ct Septic Tank Capacity 11DOO ga l ❑ NA Permit # t 30� Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer v ❑ NA Number of Bedrooms ❑ NA, Effluent Filter Model NA Number of Commercial Units 4!r'NA Pump Tank Capacity gal O NA Estimated flow (average) 3D� gal /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) 4 Sb gal /day Pump Manufacturer ❑ NA Soil Application Rate :7 gal/day/ft' Pump Model . 30 ❑ NA Influent/Effluent Quality Monthly average* Pretreatment Unit NA Fats, Oil 81 Grease (FOG) s30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter x220 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODs) p Disinfection ❑ Other: Total Suspended Solids (TSS) 5150 mg/L Manufacturer Pretreated Effluent Quality ❑ NA Monthly average ** Dispersal Cell(s) Biochemical Oxygen Demand (BODs) s30 mg /L It In- ground (gravity) ❑ In- ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ At -grade ❑ Mound Fecal Collform (geometric mean) :510 cfu/ l 00ml ❑ Drip ❑ Other: Maximum Effluent Particle Size A inch diameter * Values typical for domestic (non - commercial) wastewater and septic tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of ta nk(s) At least once every ❑ months years) (Maximum 3 yrs. ) Pump out contents of tank(s) When combined sludge and scum equals one -third (1i) of tank volume Inspect dispersal cell(s) At least once every / 3 ❑ months It year(s) (Maximum 3 yrs.) Clean effluent filter At least once every A / ❑ months dryear(s). D' #� AY Inspect pump, pump controls 8Z.-alarm At least once every oZ / 3 ❑ months &yea ❑ NA Flush laterals and pressure test At least once every ❑ months ❑ year(s) NA Other At least once every O months ❑ year(s) NA Other: At least once every ❑ months ❑ year(s) NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include,a visual inspection of the tank(s) to identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels In the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Ys) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatement components, and ,any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb, or compact, the area within 15 feet down slope of any mound or at- grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and,vegetable peelings; gasoline; grease; herbicides; meat icraps; medications; oil; Dabntine products; pesticides; sanitary napkins; tampons: and water softener brine. ABANDONEMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to Insure that the system Is properly and safely abandoned In compliance with ch. Comm 83.33, .Wisconsin Administrative Code: • All piping to tanks and pits shall. be disconnected 4nd the abandoned pipe openings sealed. The contents of. all tanks and pits shall, be removed and properly disposed of by. a Septage Servicing Operator. • After pumoing, all tanks and pits shall be excavated and removed or: their covers removed and the void space filed with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ttr'A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be Infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area.. Replacement systems must comply with the rules in effect at that time. O A suitable replacement area is not available due to setback and/or soil limitations. Barring advances In POWTS technology a holding tank may be Installed as a last resort to replace the failed POWTS. O The site has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. O Mound and at-grade soil absorption systems may be reconstructed In place following removal of the bbomat at the infiltrative surface. Reconstructions of such systems must comply with the rules In effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMPOR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR tMpncctRS.�.. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name � L s <,dz.. �G,ab /.cl�. Name J C. J."Q z Phone 7!f 23r Zc. 44 1 Phone '7 /S"— L3S ~ 26 SEPTAGE SERVICING OPERATOR (P UMPER) LOCAL REGULATORY AUTHORITY Name Agency !i exo ie &0 ZISiLr/ Phone Phone S "I' CIZOIX Ct) L'N'I`l; SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Ow•ncriF3uyer St. Joseph Development Corporation Mailing Address 1 241 5 - 55th Street North, Lake Elmo, MN 55042 Properly Address 143 h ar . (Verification required from Planning Department f ew construction) CitylSta,, Town of St Joseph, WI Parcel Identification Number See Attached D ped cD3o - 131 -/9- o�roC• 1 a �3� LEGAL DESCRIPTTON Propetty Location NE %,, SW Y,, Sec. 23 . T 30 N -R 20 W. Town of S Joseph SuMvision Settler's Glen , Lot # 1 1 CertMed Survey Map # 'olttme Page # Warrant Deed # 7 0 0 5 6 9 Volume blo Page # r U Spec house 0 yes 0 no I.ot lines idcntifiable fl'q, yes 0 no SYSTEM MALri' ENAl . Improper use and ray. ateaance of your septic system could result in its prcmatumfidlun to handle wastes. Proper fiance consists of paatping oat the septic tank every three years or sooner. if needed by a licensed punsixr. What you put into the system . can affect The function of the septic tank as a treatment stage is tine wiste &sposal syst= The: property owner agrees to ohmit to St. Croix Zoning Dcpatmeut a cafiification fawn, signed by the owner tmd by a nzstcrpiumberjoumeyrnan phmAxz, restzictaipb=ber or a lioerucdpumper verifying Strut (1) the on -site wastcwaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the staadutis set forth, herein, as set by the Department of Commerce and the Department % of Natural Resources, State of Wisconsin. C=tifi. ratios stating that your septic system has been maintained meat be completed and returned to the St. Croix County Zoning Office within 30 da expiration date. SIGNATURE APP CANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I. (we) am (P=) the O%Mct(s) of the property above, by virtue of a warranty deed recorded in Register of Deeds Office. SI ATURE & APPLICANT DATE Amy information that is mis- represcatedmay result in the sanitary permit being revoked by the Zoning Department. " Include with this application: a stamped warranty decd from the Register of Deeds office a copy of 6c certified survey map if rtference is made in the warranty deed i li. J 2065P 5`J8 QJ m5r KATHLEEN H. WALSH Document Number TRUSTEE'S DEED ST. CROIX , W, HENRY J. LENTZ, as Trustee of The Henry J. Lentz Family Revocable RECEIVED FOR RECORD Trust Agreement dated May 24, 2000; and Bernice A. Lentz, wife of 12/02/2002 01:00Ph Henry J. Lentz, for a valuable consideration conveys without warranty to EXEWT # ST JOSEPH D VE OPMFNT CORPQRATIn a Minnesota corpor goat n, Grantee, the following described real estate in St. Croix TEA FEE: 13.00 County, State of Wisconsin: TRANS FEE: 4590.60 ty COPY FEE: CERT COPY FEE: PAGES: 2 See attached addendum. This is homestead property Recording Area Name and Return Address LAND TITLE, INC �. 1900 E::- OAD PIE.7 ERi;:r,'�:,:., 14N 55112 Ffil.@ NO. 030- 2032 -50 -000; 030 - 2032 -10 -000; 030 - 2032 -70 -000, 030 - 2033 -20 -000; 030 - 2033 -40- 000;030- 2043 -10 -000 (Parcel Identification Numbers) Bernice A. Lentz, wife of Henry J. Lentz, joins in this conveyance to relinquish any homestead and marital property interests, but does not join in any of the warranties. Dated this day of 2002. 'Henry J. L Trust - 'Bernice A. Lentz AUTHENTICATION / ACKNOWLEDGMENT Signatures) 2 Gr y� STATE OF WISCONSIN 1 f` V Y !?= A , LQ .�2 ST. CROIX COUNTY .11 Personally came before me this _ day of authen ' ted t is h day of w 2002, the above named Henry J. Lentz, as Trustee of the I Henry J. Lentz Family Revocable Trust, and Bernice A. Lentz, to me known to be the person(s) who executed the signature foregoing instrument and acknowledge the same. F " 6 L i type or print name TITLE: MEMBER STATE BAR OF WISCONSIN signature type or print name (If not, authorized by' 706.06, Wis. Stats.) Notary Public St. Croix County, WI THIS INSTRUMENT WAS DRAFTED BY My commission is permanent. (If not, state expiration date: ) Robert F. Wall 'Names of persons signing in any capacity should be typed or printed below their signatures. Lentz TrusteesDeedStiosephDe velopment -02 J 2 0 6 5 P 599 Property Description - (Henry J. Lentz Family Trust /Grantor to St. Joseph Development Corporation, Grantee) A PARCEL OF LAND LOCATED IN PART OF THE NW 1/4 OF THE S W 1/4, PART OF THE NE I/4 OF THE SW 1/4, PART OF THE SE 1/4 OF THE SW 1/4, PART OF THE NW 1/4 OF THE SE 1/4, AND THE SW 1/4 OF THE SE 1/4 ALL IN SECTION 23, AND IN PART OF THE NE 1/4 OF THE NW1 /4 OF SECTION 26, ALL IN T30N, R20W, TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN; DESCRIBED AS FOLLOWS: BEGINNING AT THE SOUTH QUARTER CORNER OF SAID SECTION 23, THENCE S89 0 59'28 "E ALONG THE SOUTH LINE OF THE SE 1/4 OF SAID SECTION 23, 1329.95 FEET TO THE EAST LINE OF SAID SW1 /4 OF THE SE 1/4; THENCE N00 °05'53 "W, ALONG LAST SAID EAST LINE AND THE EAST LINE OF THE NW1 /4 OF THE SE 1/4, 2662.66 FEET TO THE EAST -WEST QUARTER LINE OF SAID SECTION 23; THENCE S89 °5749 "W, ALONG SAID EAST -WEST QUARTER LINE, 1103.88 FEET; THENCE S00° 15'03 "E, ALONG THE EAST LINE OF LOT 2 OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 3, PAGE 711, AND THE SOUTHERLY EXTENSION THEREOF 541.62 FEET; THENCE S89 °44'57 "W 349.84 FEET; THENCE N00° 15'03 "W A DISTANCE OF 100.00 FEET TO THE SOUTHWEST CORNER OF SAID LOT 2; THENCE ALONG THE SOUTH LINE OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 4 PAGE 944 S89 0 44'57 "W A DISTANCE OF 699.66 FEET TO THE WEST LINE OF LOT "A" OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 4, PAGE 944, AT ABOVE SAID OFFICE; THENCE N00 °15'03 "W, ALONG LAST SAID WEST LINE, 445.55 FEET TO SAID EAST -WEST QUARTER LINE OF SECTION 23; THENCE S89 °57'49 "W, ALONG SAID EAST -WEST QUARTER LINE, 1107.54 FEET; THENCE S00 °17'14 "E A DISTANCE OF 304.14 FEET; THENCE N89 °4P28 "W A DISTANCE OF 404.95 FEET; THENCE S00 °171 4 "E A DISTANCE OF 1025.47 FEET TO THE NORTH LINE OF THAT PARCEL DESCRIBED ON DEED RECORDED IN VOLUME 562, PAGE 563; THENCE N89 1 05'35 "E ALONG LAST SAID NORTH LINE, 1222.12 FEET TO THE EAST LINE OF SAID PARCEL; THENCE S00° 15'40 "E ALONG LAST SAID EAST LINE, 1352.12 FEET; THENCE S02 °52'23 "E, ALONG LAST SAID EAST LINE 1324.16 FEET TO THE SOUTH LINE OF SAID NEIA OF THE NW 114 OF SECTION 26; THENCE N89 °55'00 "E, ALONG LAST SAID SOUTH LINE, 66.08 FEET TO THE WEST LINE OF LOT 1 OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 5, PAGE 1352, AT ABOVE SAID OFFICE; THENCE NO2 °52'23 "W, ALONG LAST SAID WEST LINE AND THE WEST LINE OF A PARCEL RECORDED IN VOLUME 623, PAGE 331, 1325.87 FEET; THENCE NOW 15'40 "W, ALONG LAST SAID WEST LINE, AND THE WEST LINE OF LOT I OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 2, PAGE 348, 521.61 FEET TO THE NORTH LINE OF LAST SAID LOT 1; THENCE S89 °53'49 "E, ALONG LAST SAID NORTH LINE, 894.17 FEET TO THE EAST LINE OF LAST SAID LOT 1; THENCE SO4 °28'32 "E, ALONG LAST SAID EAST LINE, 523.40 FEET TO THE SOUTH LINE OF THE SW 1/4 OF SAID SECTION 23; THENCE S89 0 53'32 "E, ALONG LAST SAID SOUTH LINE, 107.05 FEET TO THE POINT OF BEGINNING. PARCEL CONTAINS 162.778 ACRES, SUBJECT TO RIGHT -OF -WAY FOR S.T.H 35164 AND C.T.H. "E" AND SUBJECT TO ALL OTHER EASEMENTS, RESTRICTIONS, AND COVENANTS OF RECORD. i 'RTN i40.dt' i° i i ...Ar .. ... ........ . p^ �i H.W.LI -908.0 LOT LOTr Is = s s 000 LOT a 1s0.6M I0. fT. 1 3.000 S O - F 1 LI.O. -006.0 r \ 3.000 ACM = eca. FT. 1 L10.•006.0 ' \ 130.651 go. FT. LIM-006.0 j r 1 HW,L -903 H \\ ....................... iraieeiieaal .............. ............... . / ................................. ... / oPIAlr+acaE \ \V / / FA3oy� I LOT �IIo AGtEB ~> dl / � :' hLW.L -903.0 1 190,711 /o.Fr. LB.O. -906.0 .. \; \ / .,, LM ' a *19o•72FT• ` \• \ !( L oO7'00`/ :� If \ \ / +� al 13oa91IaFT. 8 �/ 1 �_ LOT 1 " `\ DPLUNACiE l5A6EAENto '� ` \ I l LOT 12 l 180 80. FT. \ c, ` 1 OO em FT. 1 `� \ \ '#� • � 1 Lso. -996.0 1 kL -903.0 1 I -N \ % �� I LOT 18 \ , • I &002 ACFE9 •. \ \3 0.760 30. FT. `F . \ \\ •' // �'�y � OAAn SAT 13 _ \//`' � : A ••' '! '\ y fie, \ I ` low AOFM '8; LB.O.- •o •� \ �� G \ _ 130. 80. FT. uq. 0. -006.0 LOT 17 t�o K'• \ � i' Nr�wn sm Fr. M rywrNne1ae11�PlowTS \ \\ ' : ' ,:. w LOT 16 // •�� 6Z "°'C \ ' a000ACPM STATE W MSC \• UOmsm FT. \ � COUNTY OF ST. aWDDSS. JlEOkTNL � I, CIERYL A. SLMD, KIM THE DULY ELECTED, 9UALOrIO AND ACT" *; ' TREASURER OT ST. CRODt 8 COIRI o UNREDEEMED 11F%8Y TAB AND NO U /6 \� RECORDS M MY OFFICE 1W }� UlEEIED ��, TA%ES at SPECIAL ASSES�T THE LAND DVCLUDED M THE PLAT OF SETTLERT GLEK . DAZE •. \ \ '• • COUNTY TREASURERt \ \' • \ �•t ICWLE N PBET T -100 SHEET 3 OF 6