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HomeMy WebLinkAbout042-1086-11-080Vvlsconsin Department of Commerce Safety and Building Division GENERAL INFORMATION Personal information you provide may be used for secondary purposes PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) [Privacy Law, s.15.04 (1)(m)I I Donavin & Jeri Berg TOWN OF WARREN TANK INFORMATION TYPE UFA TURER CAPACITY Septic Iii wLE`56r f Ion Dosi Aerati Holdin 77 TANK SETBACK INFORMATION PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift io ss I System Head TDH Ft Forcemain Le Dist to Vl ell SOIL ABSORPTION SYSTEM (7.31r1, koe LGo.4zL ELEVATION DATA MOM a --j ' , MINQ. ... :.:.:. via i—=M Imo' i • RE DIMENSIONS WMIh �� Length t 99 No. Trench Z PIT DIMENSIONS No. Of Pits Inside Dia Liquid Depth SETBACK INFORMATION SYSTEM TO T pe Of Sy.h ho.o P/L q 2 I BLDG —.2V WELL LAKE/STREAM LEACHING CHAMBER OR UNIT Me ro lloralor.k4 DISTRIBUT191'A $TEM Head an' Ll Distibution x Hole Size x Hob Spacing Vent to Air Intake pi ) w. f Len Dia Len Die Ing SOIL COVER x Praesure Svstems Only xx Mound Or At -Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes [—J— No ,] Yes I]r No COMMENT (Inclute code discrepancies, persons present, etc.) r pection #11 v 122�Za22_ Inspection la 1.) Alt BM Description "M ! —f L Z .Zp / Q9 Y �� r►1C f\1 2.) Bldg sewer length - amount of cover 3) 94& Plan re on Required? 0 as No Use other side for additional information. SBD-6710 (R1/97) ff)&-L P►�¢s � �f ��s ,w..n,.,� �'. Sw.�G, a„Q `1t.ue�-�1G� �j f.GaGtr. yam, paors Spnaturo Can. No. no 6%ers &,� Mle�—urAo-nfie_�—S Tf',a� �•,xL 6elacc e-a.. 2 •D r sfr r. &ar din wLa n Ir�el! --i eBu�r w:LC C%144rn� f4�Oary� . 1 •�1 -) SAN-oaomai - ©1 fit' Safety and Bwkbrtgs Division /JAN 2 6 2021 n�n County St. Croix Sanitary Permit Number (to be filled in br Co.) 201 W. Washington Ave_ P.O. Boot 7162 IMadison, WI V5377;P3/ o x uwncy L A �3 13 i` Development Sanitary Permit Applica t State TraroartionNumber In accordance with SPS 383.21(2). W is. Adm. Code, submission of this form aoih6ipnnroro2nM governmental unit is required prior to obtaining a sanitary permit. Note: Application farms for stateownedPdW1 S''e'eat+.miUed to Project Addrtss (if different than mailing address) the Department of Safely and Professional Servies. Personal information you provide may be used for secondary T'Jt� purposes in socards¢e with Lime Pit taw. s. 15. I m , Stats- ! lA& r uc j 6 , V L A tics lafoleas rmation - Pe Print AN Informatics Properly Owner's Name Parcel r it ' Q XU Donavin & Jeri Berg 042-1 Property Owner's Mailing Address Property Location /r Qr r" i f 1035 70th Ave, tort Lot SW y., NW ySection 31 City, Stale zip Code Phone Number Robertfa W. W23 29 (circle one) _ E o T N; R �q(W IL Type of Baildisa (check all that apply) Y / Lot a Subdivision Name I or 2 Family Dwelling - Number of Bedrooms 3 8� 0.b f�YC�Ovr 5. 1 C riO�iiW6(i(j l�s fH. Block a ❑ City of �iN�AY►CS�- ❑ PubliclCommercial - Describe Use �� ❑ State Owned - Describe Use ❑ Village of Qq Town of Wllffen CSM Number ✓.30 e60i f • O DoC•. M4552. III. Type or Permit: (Check only one box om line A. Complete list B if applicable) A" New System ❑ Replacement System ❑ Treahme t/Noldirrg Tank Replacement only Other Modifimation to F�cisting System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer InNew List Previous Permit Number and Due Issued Before Expiration Owner IV. Type or POWTS S om tlDeviee: Cheek all that apply) Nao-Pressuriaed Ir►{irorad ❑ Presstrmed In -Ground ❑ At -Grade ❑ Mound > 24 is of suitable soil ❑ Mound < 24 in. of suitable wit ❑ Holding Tank ❑ Other Dapersal CornponeM (explam) Device explain) V. Disiiiermillfrreatmad Area Informatios: m Design now (gpd) Design Soil Application Rase(gpdsf) Dispersal Area Required (sf) Dispersal Proposed ( S Elevat l� �a•f `` 450 900 920 3r% 97 ! .5 .50 VI. Task lafo Capacity in Total a of t.� V clan" units Poly-bk 525 '� GallonsFsistia6 New Tanks Tanks N Sapaoerfoldint.l.ick 1000 1000 1 VVfeser ix 000* thaaber .Yawn r dw attaehed Plus. VEL Respowitift Statement- L fte sadardrwik asaw raapaaai fin/r;648443 Plumber's Name (Prim) Pf 'a goatee PIMPRS Number Bad r o Keith Kfludtson Plumber's Addmas (Sheet, City. State, Zip Code) 927 150th St. Roberts,Wi. 54023 VIIL Coat iDe meat Use Oe _ for Si pI Approved 5,�� Z �7.,� 8� ❑ m for I)ertid f DL Cosditisar r . �_,.e o k YSTEM OWNER: 1. Septic tank, effluent filter and maintainedc1l S cell must pe-seryiGed_lumber. a dispersal pi �q management plan provided by p i/ ` 1" as per cat must be maintained as per applicable codeleteete++ee.R—r—" "v r� Sys (M M4 try-wwt(lL I SBD-6399 (IL I1/11) I B6v.-M&6!'TapgfY41R*4Wwl OUW CAW TO 6m Pow owdA*ew4v Noe: Af gaiq wdJamd wm*lln uftak parapa,tar OMM Nall wlPbk Aibkoa la Haw of a S" DHHGns 1'reet Aat Aawn® 3W. - 1W or 9%At' -Raoli�wPtt . 0 Y vac Site Plan For. Donavin Berg Lot 4 of Ca►n Vol. 30 Pg. 6814 i Part the SW -NW and NW -NW - . 31 729N-R18W n Thep. - St. Croix County BOW&4" 0 rz� "B".-roawwm.w Orson" Blil� or M9V \ B#2 - 98.83' or M93' Bfl3 -a,30' or 994.581 4- 4 Md CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Berg Sewer Owner's Name. Donavin Berg Owner's Address: 1035 70th Ave. Roberts Wi. 54023 Legal Description: SW 114 NW 1 /4 S31 T29N R 18 W Township: Warren County: St.Croix Subdivision Name: Lot Number 8 Parcel ID Number. 042-108640-076 Page 1 Index and title Page 2 Page 3 Plot Plan System Sizing & Cross -Section Page 4 Page 5 _ Fitter Specs Maintenance Information Page 6 Management Plan Page 7 St Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber. Keith Knudtson License Number. Date Phone Number 648443 (651) 470-1737 Signature Designed pursuant to the In -Ground SOflAbeerplion Component Manual for POWTS Version 2.0 SBU-10705-P (N.01/01). Page 1 &W.-M&61rTopolJV4"w-Aadwl Opww cqp 7b M Arrow �_AL M . P.ayor.dD►Iwr� Pro ?°st v x� L" `�.' rJ.a • •,,� —. NW: AM - , wmU mW wakrj6w wlp 1 y.srsSBJ.43(4?(p mom w/Pl�k R16bw Dw of !" D1�Gna� lrrt ANSLnmm MUM - 1W or 9%X -smum-ft AWaTMW aw www sawemwf jmkfwy Site Plan For: Donavin Bag Lot 8 of Csrn Vol. 30 Pg. 6814 Part of the SW -NW and NW NW Sec. 31 779N--R18W ^rren T mp. - St. Croix County N.lI' � axew..-lORarar99r.Od' Lot a 1a. "A" Opp ate. Sk" AAr'W MAr nomm" BkM9V 9k2 - 98AS' a M 93' ski - 100M or 99+.5V I Leaching Chamber Soil Abso bon $"tam Cross Section 4' Sd"18 40 PVC Vent Pipe Wlth Vent Cap 4 ft _ ft 100.00 ft �f ^ Final Grade �fl Soil Absorption System Plan View ft 97.00 ft System Bevefion i 4.00 --�--- Leaching Trench 1 ft Vent Or Observation Pipe Chambers r `china Chamber Specifications Manufacturer And Model Infiltcr W EISA Rating 20.00 s4 ft per chamber Soil Application Rate 0.50 gpd/eq ft 450.00 gpd Design Flow + 0.50 Sol Application Rate + 20 EISA = 45.00 Chambers 2 rows of 23.00chambers each.--, ( q(.) Page of POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FNi *FORMATION Owner Donavin Berg Permit # 1n. nAn■ YGniV� ❑ NA Number of Bedrooms Number of Public Facility Units '1A Estimated flow (average) �gal/day Design flow (peak), (Estimated x 1.5) al/d Soil Application Rate s aUd t t2 Standard Influent/Effluent Quality Monthly everege• Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODa) 5220 mg/L ❑ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODa) S30 mg/L / q1 NA Total Suspended Solids (TSSI S3O mg/L Fecal Conform Igeometric mean) :rlW cfu/10Om1 Maximum Effluent Particle Sae Ya in dia. ❑ NA Outten: G NA *Values typical for domestic wastewater and septic tank effluent. SPECIFICATIONS VSeptic Tank Capacity gal ❑ NA Septic Tank Manufacturer ❑ NA Effluent Filter Manufacturer o/ _ [ O ❑ NA Effluent Filer Model ❑ NA Pump Tank Capacity gal O'NP` Pump Tank Manufacturer EPA Pump Manufacturer 4-NA Pump Model ler� Pretreatment Unit ❑ Sand/Gravel Filter ❑ Mechanical Aeration ❑ Disinfection ❑ Peat Fitter ❑ Wetiand ❑ Other: ITNA Dispersal Cellls) pn-Ground Igravityl ❑ At -Grade ❑ Drip -line ❑ NA ❑ In -Ground (pressurized) ❑ Mound ❑ Other: Other. ❑ NA Odher ❑ NA other. ❑ NA MAtNTBdANCE SCHEDULE Service Event Service Frequency Inspect condition of tank).) At least once every: ❑ month(sl (Mazimhrn 3 years) 3 aer(s) ❑ NA Pump out contents of tankls► When combined sludge and scum equals one-third (Y.) of tank volume ❑ NA Inspect dispersal call(s) Clean effluent fitter At least once every: At bast once every: ❑ month).) (Maximum 3 Years) eery.) p n nth(s) tl Year( ❑ NA [3 NA Inspect pump, pump controls & alarm Rush laterals and pressure test At least once every: At least once every: ❑ month(s) ❑ year(s) [3monthls) ❑ year).) 91NA "A ❑ month(s) Other: At least once every: ❑ year(sl Other. v - 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 Manteirter; Septage Servicing Operator. Tank inspections must include a visual inspection of the tankls) 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(.) 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 (Ya) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical opressurized esu ed components, pretreatment units, and any servicing at intervals of <_12 months, shall be performed by A service report shall be provided to the local regulatory authority within 10 days of completion of any service event Page Z of 2 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 ca(sl. if high concentrations are detected have the contents of the tanks) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal callls) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or. must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Baiting advances in POINTS technology a holding tank may be installed as a last resort to replace the failed POWTS. �k alua a. '�RDt•l19r1� �o2-/�lN� CoN`'?Ad�'t ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < < WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC. PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POINTS INSTAL 1 ER POWTS MAINTAINER Name Keith Knudtson NaR1° Phone 651-470.1737 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Powers Liquid Waste Name s C ( 7Q�1�(i Phone 715-246-5738 Phone —715— 3SCo— fo This document was dratted in compliance with chapter Gomm 83.22(2)(b)(1)(d)&(f1 and 83.54411. (2) 3 (3), Wisconsin A trative Code• { Filters PL-525 EFFLUENT FILTER 'Pe'L-525 Fitter is rated for Arow 10,000 GPD (gallons per day) +aWCng it one of the largest fitters 40 ts class. It has 525 linear feet of " ? 6" filtration slots- Like the Ravok PL-122, the Polylok P .:-75 5 h4s an automatic shut P gall installed with every fitter. A'en the filter is removed for :mining, the ball will float up and ser-,poranly shut off the system so me effluent won't leave the tank. %a oth"Iter on the market can ,rake that claim. : FL-525 Maintenance: The PL-525 Effluent Fitter should ' operate efficiently for several years Linder normal conditions before requiring cleaning. ft is recom-mended that the fitter be cleaned every time the tank is pumped or a: least every three years. If the { installed fitter contains an optional alarm, the owner will be notified by an alarm when the fitter needs servicing. Servicing should be done by a certified septic tank pumper or installer. 1/16' Filtrad WU1 KeNVW Fiaf GUM ADD" - Maw" _: ... �. US POw. Not 6.015,466 1. Locate the outlet of the - 5.W1,BW septic tank. 2. Remove tank cover and pump tank if necessary. 3. Do not use plumbing when filter is removed. 4. Pull PL-525 out of the housing. S. Hose off fitter over the septic tank. Make sure all solids fall back into septic tank. *;,Insert the fitter cartridge back into the housing making sure the fitter is properly aligned and completely inserted. 7. Replace septic tank cover. PL-525 ans$aallatdon: Ideal for residential and com- mercial waste flows up to 10,000 Gallons Per Day (GPD). 1. Locate the outlet of the septic tank. 2. Remove the tank cover and pump tank if necessary. _9- Wrrw Um" er0igor arw.Fa.: r4WW a 3. Glue the fitter housing to the 4' or 6' outlet pipe. If the filter is not centered under the access opening use a Polylok Extend & Lok or piece of pipe to center fitter. See page 19-21 for Extend & Lok information. 4. Insert the PL-525 fitter into its housing. 5. Replace and secure the septic tank cover. 00 M1 tl axtisin Deparrilent of Sellety aril Proiessonai 4erviois DiYmm of kedrrstry SWAM ROIL EVALUATION REPORT in aocordance with SPS 385, Wis. Ada. Code A3572 pap_ 1 of _ 4__ Keith Stoner CST Attach complete site oian on paper not less than 81h x 11 inches in size. Plan must County St. Croix - include, but not limited to: vertical and horizontal reference point IBM). direction and or dimensions, nosh arrow. and location and ftlanee to nearest road. Parcel LD. --------- percent slope. scale Peat of 042-1086-20-016 --- Please print all intormetlom Revbw+ed By Oafs Personal vd mnabor you provicle may be used for seaxkb�Y purposes (Privacy Lew. S. 15.04 (1) (m)). Property Owner Property Location r+-of i to `IV - u-) n 4 Domvin Berg -- - Gout Lot NW114. NWt/4. S31, T29N, R18W Property 0-wnWs MwNnQ Address Lot s Bbdr 0 Subd. Nerve 1035 70th Avenue 8 Vol. 30 Pg - --- - CoyPthOne Numbe ❑ city Ylflege ® Town: Near" Road Roberts WI.54023. 612-363-4246 Warren OTTh Ave ® Now Construction Use: Residential i Number of bedrooms _ 3 Code dertoed design flow rate - 450- --(3PD [j Replacement Public orcommercial - Describe: Parent materiel -Loan Alluvium over SBIfly r-e-my Sid fits cloed plain elevat a-0f applicable -- 992.2-0 _ ft General commens Propose two 3 x 92' tJor 4 no Onb 1134 a .5 SAR- Center up9bpe oW over the 9W.(U or 1 OO.W contax +oath a SE = 991.08' or land recommendations: 97.00' and center kraw oe1 wen the 993.56 or 99.5G' comer. wlSE = 9W.58 w 96-50'. Centel m staked ors4e. ri � :around mmime dev. - 992-98 It DWh to B nMm facto► --->94 to SW Application Roo 1lormon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots - GPDMF E -r- In. Hansel Clu. Sz. Cat Color Gr. Sz- Sh- 1 A -10YR211 ----- - i-----..2- bk - mfr ---CS 33f O'6--0.8-- 2 B-16 10YR4/3 - I 2f-msbk mli - -95 - 2f 0.6 OX -- - - 3 16-24 ' 10YR4/3 - S1 2fsbk mfr gs 2f 0.6 1.0 - 4 2+29 10YR414---------grIs -- OS9--- r� gs - 1f OJ-- 1-6 - - 5 i 29-50 ' 10YR3/4 sus OS9 nd gs 0.7 1.6 _ 6 i 50-94 10YR5/4 ma's OJ 1.6 Fs ❑ n9 limiting factor >92 in. Rate - - ptt Grotxtd surface ebv. 992.93 h Depth te Application Horizon ' Depth Dominant Color Redox Description Texture Structure Consistence Boundary • Roots . _ GPOMP 'Eft I T-:E in. Munsel Ou. S2. Cant. Color Gr. Sz. Sh. 1j&� 0.8 10YR2/1 - - --- I - .-- 2MSbk rtdr CS 3f-m 0.6 - 0.8 2 8-17 10YR413 - i 2f-m5bk m gs 2f 0.0 0.0 3 17-22 ` 1OYR4/3 - sl 2fSbk mfr gs 2f 0.6 1.0 10YR4/4 --- -- - -- - gr is - - -099 - -- - - -- if----0.7 - rm gs -1.6 -4._-22-27 - - 5 27-M 101M3/4+4/4 - Srs Osp -ffs 11111 gs - 0.7 1.6 6 1 50-55 - 10YR3/4 -_H - Dense barbs - OSg -- ml gs ---- 0.5 _ 1.0 7 5&92 10YR4/4+5/4 i - Srs OSg mi - 0.7 1.6 Efltard •l . BW,> 30 < 220 niWL and TSS >30 c 150 mg1L Affluent r2 - BW 130 rng2 ano I bb q'su mgn- CST Name (Please Print) svoltre: CST Number Keith Stoner 224059 ess AddrKeitih Slornsr CST Evaluation Conducted Telephone Number 23220 Wood Creek Rd Siren.. WI 54872 1019M20 715-566-0900 - sum-a+mramnar Pam Orvner Dqn B f -- Pat N)x Pert of 042-1086-20-016_ Pape - 2_ of -A- El 1_ ] Boring a ® Ground surface elev. 994.58 — tL Depth 10 WrMv factor ?94 in. ap gppy�iprt Rep Hartzon Depth Dominant Color Redux Description Team smxw a Consismancei Botrrtdwy, Roots GPOW 1 in. LONI all Ou. Sz. ConL Cokw Gr. Sz. Sh. 1 Ap 0-9 10YR2/1 - I 2msbk rrrfr a 3F 0.6 0.8 I 2f-msbk rrrfi i 95 2f 0.6 0.8 3 1 21-28 10YR4/43 gr Osg ml gs 2f 1 0.7 1.6 4 1 2" i 10YR4/4+5/4 - Tsrs Osg rrd T 2f 0.7 -- 1.6 Boring 4 Boring 6 ® Pit Ground surface elev. -_ 983.23 -_ ft. Depth ;o limiting factor In. IIScA Application Horizon Depth DondroMColor Redox Description Tazture Structure Consistence Bajndary Roots GPD/W ir.. MurtceM Ott Sz Corrt Color r. Sz. Sh. T—I 0-8 10YR211 - i 2msbk mfr cs 3f-m 0.6 0.8 2 Y B-17 10YR4/3 I s if-msbk mfi gs 2f 0.4 0.6 3 ! 14-42 10YR4/3 -,--- — ---, 2MSbk �MV(r ` 9s i — 0.6 i 1.0 4 42r46 ' 10YR4/3+5/3 - sd 2rnsbk -- - - rrtir - 9s-- 2f 0.4 ' - 0.6 g ; 46-52 : 7.5YR4/3 si *wosbk mfi gs if 0.6 1.0 6 52-69 ' 7.5YR4/3 c205YR5/8 Am mfl - - 0.2 0.6 =8orbtp adjnontt to boring t2 of Shaun Bird sad test from 5119119 Bairtg # Pith Gramd surface abv. __------ it�Pm limiting factor _____ in. ISM Application Roo Horizon Depth Dotrartant Color Radox Desalpdon Texsae Smrestae Consistence Botndary Roots GPD/W In. Munsefl Ou. Sz- Cont Color Gr. Sz. Sh. t Ettluent 71 = BOD5> 30 g. 220 nvj& and TSS >30 < 150 rng/L Efficient 02 - SODS < 30 rng,L and TSS < 30 MWL Keith Slo CST SKI Fury sfRdnn 4) Page 3 of 4 Elev.-9M.61'Top of314- Re -Rod wl Soil Test Site Plan ormW Cap For: Donavin Berg �42 Lot 8 of Csm Vol. 30 Pg. 6814 To 67th Amm Part of the SW -NW and NW -NW Sec. 31 T29N-R18W � �D"ve'"ay Warren Tnsp. - St. Croix County lot.00' l00.00' 9➢.f0' P2 BMEIev. - 100.00'or 994.08' Mir 1 1 �B z Garage Proposed Three 9910 S' Bedroom Home L.B 0. - - 99e.20' Mor 3% Note: mabu do well and waterlhte setbacb per SPS 383.43(8)0) BM . N&M w/Plfab Ribbon in Bass of a 511 DDHGreeo Treat Post \ * HRP - Satae ASSUMED ELEV. - 100' or 9 C", tober 7th, 2020 - BwA6oe Pis AKdY E. 8tooer CST# 224M I N.W.E. - 992,20' Stormwter Easement Bow dart' ♦ BM Lot 812.77 Acres open Gross Slope Stormwser Emement 98.00' o 992.08' Bird Sol! Tess to determine the sutrabllry ofsoUs for she corwmiction of a private sewage system. B 14 Elevation Data B#1 = 98.90' or 992.98' 3#2 - 98.85' a 992.93' B#3 - 100.50' or 994.58' B#4 = 99.15' or 993.23' gItPATION PLAN P r� 9 MAIN LEVEL FLOOR PLAN OwwBuyer ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM 7.•t r /1 -w e Mailing Address 1035 70th Ave Property Address (vale-✓ � Pis e� zoning v wor boa.) City/State Roberts WI. Parcel Identification Number 042-1086 �$O I.F.[:AL DESCRIPTION Property Location SW 1/4 , NW '/4 , Sec 31 29 N R T 18 W, Town of Warren Subdivision Plat: Cottonwood Lot tl 8 C rdfad Survey Map # 1 1 C t{ S 5 2 , Volume 30 , Page g 8 1 y # l l l 9-9 2- j (before 2007)Volume _ , Pagewmrtwtr� Spec Iwunoyealoo Lot lines identifirble®yes❑oo SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could mutt is In pteant re ham � ms . pro� maintenance consists of pumping out the septic tank every three yeah or rower, if seeded. by W hat Yoa put the system can afixt the function of the septic tank as a usoeraaoe stage in the waste disposal system. owner maintenance responsibilities we specified in ¢SPS. 363.52(1) and in fJapler 12 - SL Croix County Sanitary Ordinance. to submit to St. Cmia County Planning & Zoaisg apartment a certifstmtion form signed by the T property Pram agrees umber, restricted P u the (1) the on -site owner and by a moaner plumber. jourrseymas d lumber or a licensed pumper �8 c tank is wastawaset deposal system is in propm Operating condition asNor (2) a8a inspection and Pumping Cif wary)• the septi less than 1/3 full of shtdge. i ere hhave tad the above rogvu meats and agrm to amatam the Ptivw sOw dead system with the Uwe, the undersigned Of Natural Resources. standards eel loth, herein. sa set by the Dapartraaut of Safety And professional Services and the Dcpartrsue+rt State of Wisconsin. Certification sbft & t your septic system has bow maintained must be oampleted and returned to the St. Croix County planning t yoidag Depvtmat wEWn 30 days of the throe yens expurauon does. Uwe craft that all suxemsets on this form are am to the best of mylour knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Offi c. Number of bedrooms 3 SIGNATURE O PLICANT(S) DATE ***Any information that is misrepresented result in the sanitary permit being revoked by the Planning R Zoning Depervnent. •'• y Include with the application a recorded wartaoty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REv, o4112)