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HomeMy WebLinkAbout032-2127-60-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix ' Safety and Building Division INSPECTION REPORT Sanitary Permit No: 405081 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: Kelly, John I Somerset Township 032 - 2127 - -000 CST BM Elev: Insp. BM Elev: IBM Description: V '/dU' -A" / TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION B� FS ELEV. T Septic / J Benchmark n Dosing Alt. �M �y Aeration Bldg. Sewdr Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO PIL WELL BLDG. Vent ilntake ROAD Dt Inlet Septic ,' Lj t 2S 4 , Dt Bottom 6 Dosing Hea an. Aeration _r Dist. Pipe Holding / Bot. Syst ryA 1, t /oy.(o Final Gra PUMP /SIPHON INFORMATION (� S 2s4 /-0.2, 97 Manufacturer Demand Cov S OD p. / �S GPM � 0 Model Number i TDH Lift Friction Lo s System Head TfD . Ft � r FOrcemain I Lem tt" ia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length ` No. Of Tr ches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS � lo''l / x SETBACK SYSTEM TO J P/L BLDG IWELL A10 T LAKE /STREAM LEAC Manufacturer. INFORMATIQN Type Of S stem: , f ' �/ / CHAMB OR Model Number / l ` R r �s ,.` IT D TRIBUTION SYSTEM Header /Manifold Distribution V x Hole Size x Hole Spacing Ven�� Intake !� �' I Pipe(s) 1 2 /� L ength Dia L � Die_ Spacing __ ( / O 1 1 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only �+CI 1pipAover Depth Over xx Depth of xx Seeded /SVd / N f pbZ ulched BedlT nch Center C / Bed/Trench Edges Topsoil r!!7 New C Yes [# No ®YeS ®No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 0 /_L_1io Inspection #2: Location: 1644 54th St Somerset, WI 54025 (NE 114 SW 114 9 T30N R19W) Wagner Estates ot •YO Parcel No: 09.30.19.1138 1.) Alt BM Description � u4us r I a 2.) Bldg sewer length = QZt f y�t,¢. /�a✓ Llq� — 5 C0� j� U - amount of cover > .� 3.) Contour= loo. 6 i Plan revision Required? � i Yes � }'NO � Use other side for additional information. SBD -6710 (R.3/97) Date Insepctoes gnature Cert. No. Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 ®ns�n Madison, WI 53707 - 7162 Site Address UU iSc Department of Commerce ✓ f — - 2� ��� 5^ 3 l �`�` r " Sanitary Permit Application Sanitary Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision may be used for secondary purposes Privacy Law, sl5. 1 m I ' I I. Application Information - Please Print All Information D /Zf State I.D. umb r Z � tjv Property Owner's Name Parcel Number 9. 3-0 . 9 // 3 / Property Owner's Mailing Addre s Property Location �� / S/)�t d .✓ d .v CRO1X CO W 'f S� !i: S C I T 3!J N. R I f City, State Zip Code Lot Number Block Number Subdivision Name CSM Number 4V 555- - y - S H. Type of Building (check all that aQply) ❑City y Vl or 2 Family Dwelling - Number of Bedrooms �tIT.� -�- ❑Village ❑ Public /Commercial - Describe Use X'ownship ❑ State Owned PdVAf.7i b/..ST C6ZL ?a P ED415' 1D s56 /n/5f% - Nearest Road /1 G.0 4* Co nf?D 0/L i✓ L& 100 ht`s OfC 6/ 4 f /04 6 � si � ST III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A For County use 1 � New 2 ❑Replacement System 3 ❑Replacement of 6 ❑Addition to stem in Only Existing System B. ❑Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) b l 5T � 4 - 7 w�yh l a 44 ❑Non - Pressurized In- Ground 21 0_ 47 ❑ Sand Filter 50 ❑ Constructed Wetland D 22 ❑ Pressurized In -Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. DispersaMeatment Area Information: _ / S / Y InJU .�d Z52 3 Design Flow (gpd) Dispersal Area Dispersal Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min.11neh) Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel I Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature /WRS Number Business Phone Number l,u �I a Plumber's Address (Street, City, State, Zip Code) c l� S' �/ VIII oust /De artment Use Onl Approved Sanitary Sanitary Permit Fee (includes Groundwater Date Issued Is Age Signature (No Stamps) Surcharge F ) < El Owner Given Initial Adverse Determination 1X. Conditions of Approval/Reasons for Disapproval /s,44Agrw Q 1 �- � SVA � & �L AttaeL complete (t o a County ail,, r a,�em oa pater not, t pis P� SBD -6398 (R. 05101) 2` � Safety and Buildings 4003 N KINNEY COULEE RD LA Vi sconsin RECEIVED CR WI54601 -1831 TDD #: (608) 264 -8777 www.commerce.s i www.wiscon isconsin.gov n.gov Department of Commerce MAY 0 9 2002 Scott McCallum, Governor ST. CROIX COUNTY Philip Edw. Albert, Secretary FFICE May 06, 2002 CUST ID No.267341 A7TN: POWTS Inspector ARTHUR L WEGERER ZONING OFFICE WEGERER SOIL TESTING & DESIGN SERVICE ST CROIX COUNTY SPIA PO BOX 74 1 101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 ST 020 oc CONDITIONAL APPROVAL � PLAN APPROVAL EXPIRES: 05/06/2004 Identification Numbers Transaction ID No. 732038 SITE: Site ID No. 644287 John Kelly - 54TH St Please refer to both identification numbers, Town of Somerset above, in all correspondence with the agency. St Croix County NEI/4, SWI /4, S9, T30N, R19W Subdivision: Wagner Estates - lot 10 FOR: Description: Proposed Four Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 850351 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10572 -P (R 6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10573 -P (R 6/99). • 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. Slats. • 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. Slats. • Comm 83.22(7) - 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 may include local inspectors. Owner Responsibilities: • Comm 83.52(1)(a) - 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). P.4.W.T.S. Conditionally Apponvim ARTHUR L WEGERER Page 2 516102 Owner Responsibilities Continued: • Comm 83.52(2) - 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. • The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is 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 scats 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 to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Gerard M. Swim POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm WiSMART code: 7633 jswim @commerce.state.wi.us cc: Leroy G Jansky , Wastewater Specialist, (715) 726 -2544 i __ r — . TITLE SHEET Page of BOUND SYSTEM FOR A y BEDROOM RESIDENCE This plan has been prepared in accordance with the Mound Component Manual SBD -1057 P and the Pressure Distribution Manual SBD - 10573 -P C2. 'a /qa� Clz. 6199� LOCATED IN THE 1/4 OF THE Sw 1/4 OF SECTION � Y T 30 N, R 19 W, TOWN OF a. (� z1ZSF -T ST. L COUNTY, WISCONSIN. Lo l tp o F w ( KjEZ 1:-:s - - -- - INDEX PAGE l of 7 TITLE SHEET PAGE 2 Of 7 SYSTEM MANAGEMENT PLAN PAGE 3 of 7 PLOT PLAN PAGE 4 of 7 PLAN VIEW -CROSS SECTION PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT PAGE 6 of 7 PUMPING CHAMBER CROSS SECTION PAGE 7 of 7 PUMP PERFORMANCE CURVE PREPARED FOR Zt� LL`f -- - ; sIlm U�Z , M K) PREPARED BY WEGEr-<ER SL7 I !_ TEST I NG AND. L?ES 3[ C-StV SF=RV I CE P.O. Box 74 421 N.Main St. River Falls, WI 54022 �tf�ltttNq�� Phone 715- 425 -0165 CrONs Fax 715 - 425 -6864 ,...»� »., his, RfiTFfly c ' WEGEfi<A 1 6915 P EUSWORT- e r r M i ti Vdr 'r' lir Mril � DEPARTMENT OF COMMERCE � � SiON OF WLDINGS '�� SEE CORRESP DENCE S. L-OZ JOB NO, Mound System Management Plan Page Z of Pursuant to Comm 83.54, Wis. Adm. Code Seotic Tahk T The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. 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 filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should n t be removed unless rovisions are made to retain solids in the tank th may sloug o ove rom it If the filter is equippe wi an alarm, t e i e serviced if us y. ntermittent filter 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 113 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, Safety and Buildings Division. Pump _Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps 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 S stem 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 for frost protection. Influent quality into the mound system may not exceed 220 mg /L 6005, 150 mg /L TSS, and 30 mg /L FOG. Influent flow may not exceed maximum design 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 when the system was installed 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 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manual [SBD- 10572 -P (R. 6199)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. 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 openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, 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. Continaencv 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 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 biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions about the operation or maintenance of this system should be directed to: The County Zoning-Office at _ l S — 3� �j _ b PJ0 ST- L 6 Z - U � X The system installer at The tank manufacturer at 8i- Vo S 6 LU1� The effluent filter manufacturer at The pump manufacturer at 10-_ LL6Y GOULt- - _ - PLOT PLAN . -Page 3 of 7 Scale 1 F�vC a V � Q d o N v R JF u vm OF 0 9' G % 9 J /d L- /// / � pK W�,S' D �O F-IL0� -t IMUVr�►� - -- mo w. v 1 - EL, wo•o'w o 1 'D1A PvC. _PIPE - N NOTES: I. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required). 3. Septic tank to be Z /born gallon capacity manufactured by f - I B00 Z�Q F LIZ 4. Bench mark SEl� pot 0yE 5. Divert surface water around system to prevent ponding at the uphill side. Page Or • Approved Synthetic Covering ASTH C33 Distribution Pipe Medium Sand Topsoil - _ H = -"`r " _JG F Elev. I O 1. 0 3 E . % Slope Distribution Cell of Force Main Plowed z" to 2- Aggregate From Pump Layer D k,O Fi. E Ft. CROSS SECTION OF A MOUND SYSTEM F b Ft. G y•S Ft. - A Ft. F. i, p Ft. (,vU Linear Loading Rate GPV FT B l 7 Ft. LI LI Design Loading Rate =6.39GPD /SQ FT j l Ft, J Ft. K Ft. A Position L 8 Ft. a r Force Main W 2 Ft. L ' - Observation Pipe 0— f - - - - -- -- - - -_-- — A - - --� o --�- -- 8 - - -- --- - - - - -- - - -------- - - - - --- - -- Vy e —� 6 - - - - -- -- - - -- ------------------- - Distribution • ipe Cell of z „ to 2 P aggregate Observation Pipe ta►ac�br S�aY� PLATT VIEW OF A MOUND SYSTEM Distribution Pipe Layout Page S of Page Place the holes at the bottom of the distribution pipes at equal spacing. Remove all burrs from the pipe and 'holes. Extend the end of each lateral up with the use of long tum or 45 fitting to a point within six inches of the final grade. Terminate the ends of the laterals with a valve 'threaded cap or . threaded plug. Provide access from final grade for the valve, threaded cap or threaded plug. - T`tPlCTi L . �:\ OS S�cTtO pvC FuC �vC Lateral Manifold Lateral X x x x x2 x2 x x X x Lateral' Lenath — Lateral Length — Distriht icn Line • P �� � t}C.�tiS bfljS hi'si11Fc� -^. S 1 O— - ��uC �'o2C� 1"1H1f� P 33 Ft. Hole Diameter 1 `� Inch S 3 Ft. Lateral ) - Inch(es) X - 24_ Inchps Manifold Z Inches Force Main " Z Inches > of holes /pipe }`1 Invert Elevation of.Laterals \0 \.sFt. Combination Sept,3.c; Tank and PLjMP CHAMBER CR055 SECTIOIJ AMD 5PECIFICATIOIJS PAGE OF � NEWT CAP I WEATHER PROOF • JUUCTIOW 90X . ti C.I. VENT PIPE APPROVED LOCKIMG lO , FROM DOOR, MAIJHOLE COVER P-)1V �iJUDOW OR FRE5H s ti "AR�IU` L�6EC.. ti+-�sP r PIPE ALR INTAKE S cor.�Dutr • w Gtp � � t G zPro C I 18' /yl1►J. WNW �� ----- - - - - -- UJLET PROVIDE I — `•'` �AIRT(GHT SEAL . ► v Approved ZPSs� -� A �iI Approved joint o I joint w/ PVC pip J j �/ R —So ( II ALARM PVC pipe - II a I I I i oIJ C I I CLEY fL _� 7 PUMP —� OFF D COUCRETE BLOCK �- R15ER EXIT PERMI 3' TfED OIJLy IF TA1JK MA1ruFACTURE:R HAS SUCH APPROVAL��� SEPTIC F SPEC.IFICATIOUS DOSE TAr' KS MAW UFACTURC R: w l /� Z CEl�le WUMBER OF DOSES: S' PE.R OA. TAl`MK SIZE: -_ `ZOO L bU 2 GALLOAIS DOSE VOLUME r ALARM 1AAIJUFAC7UFLCR: S S' ��CT}Z_ S�S� �'ZS 1ti1CLUDIIJG 6ACKfLOW: GALLOMS MODELL wuMBER: 1 W - VALJ CAPACITIES: A= `a y0b_3 IUCHES OR CALLOUS SWITCH T.JPC: Y" O-U�?- - - $_ 2 ' IWCHES Qq. LLOUS PUMP !"IAiJUFACTURER: �OVL C C: IUCHES OR 3 'y GALLOUS MODEL WUMHER: Po'S � D= � � INCHES OR ZZZy GALL0A75 S IT _0� i W C H T y P E: �`'1 �1ZC -U T�T{Ct- = 43 UOTE. PUMP AMD ALARM ARE TO U MIIJIMUM DISCKARGE RAT �� •��- CpM INSTALLED OW SEPARATF CIRCUITS VERTICAL DIFFEREIJCE DETWCEIJ PUMP OF 15TIZIBUTIOU PIPE.. 7 FEET b + MII,.rIMUM METWORK SUPPLY PRESSURE . 6.50 ' F � CET �.bxt. 3� - __ S FEET OF FORCE MIN X 3'Sq F �o FCFRICTIOU FACTOR -. �'q) FEET TOTAL QyIJAMIC HEAD S �FEET As per manufacturer gal /in. Liquid depth, �� �I Goulds iR — T °i_ • Submersible Effluent Pump 3871 EPO4 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following uses: • Capable of running lubrication and efficient strength, and durability. • Effluent systems dry without damage to heat transfer. ■ Motor Cover. Thermoplas- • Homes components. tic cover with integral handle Available for automatic and • Farms Motor: 'and float switch attachment Single phase: 0.4 HP, Heavy duty sump • EPO4 Sin manual operation. Automatic points. • • Water transfer 115 , built in overload with 230 V, Hz, 155 models include Mechanical Dewatering RPM, Float Switch assembled and ■ Power Cable: Severe duty • automatic reset. preset at the factory. rated oil and water resistant. SPECIFICATIONS • EP05 Single phase: RP M, , FEATURES ■Bearings: Upper and lower 115 V, 60 Hz, 1550 RP heavy duty ball bearing Pump: EPO4 built in overload with ■ EPO4 Impeller: Thermo- construction. • Solids handling capability: automatic reset. plastic Semi -open design /a maximum. • Power cord: 10 foot with pump out vanes for AGENCY LISTING • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. % Canadian Standards Association s * Total heads: up to 24 feet. with three prong grounding EP05 Impeller: Thermo- • Discharge size: 1 NPT. plug. Optional 20 foot (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in "F" or "AC ".) rotary/ceramic- stationary, three prong grounding plug improved performance. BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 °C) continuous superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10 • Capable of running O '"` dry without damage to s 30 components. Pump: EP05 s • Solids handling capability: 0 25 3 /a' maximum. z • Capacities: up to 60 GPM. U 6 20 • Total heads: up to 31 feet. • Discharge size: 1 NPT. - • Mechanical seal: carbon- o 5 rotary/ceramic - stationary, _j BUNA -N elastomers. 4 ! ! �! . 87 - — EP05'- • Temperature: i 104°F (40 °C) continuous 3 ,o i 140 °F (60 °C) intermittent. 2 1P - — 5 I I 0 0 10 20 30 40 50 GPM L L 0 2 4 6 8 10 12 h CAPACITY C 1995 Goulds Pumps, Inc, Effective May, 1995 83871 r i Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County 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. 3 2, -7 lb Please print all information. R ewe by Date �- � /G , Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 6 y Property Owner Property Location 16V T e 1` Govt. Lot W E 1/4,S& j 1/4 S T;50 N R / E (or)® Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road tV LSS1 I ( I -15iy`to so " W New Construction Use: 0 Residential / Number of bedrooms _ Code derived design flow rate Vsb 7 0 4 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material I .I j lood REeF E&licabl General comments s y ele I/ /0 0 - Q t-' and recommendations: 'A'a/J41u1 y 2 , 1 , � V 99. od � MAY 0 6 2002 � /o /. a ' w�/.o C ✓ �' �� 5T. CROIX COUNTY Boring # ❑ Boring F pit Ground surface elev. r 70 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. *E *Eff#2 4-/3 3/z 5L Z L Ivy Z 1 L5 I cS 1, Z 2 t6 rJe, F 5 r 5 (, . - F L - 1 Boring # ❑ Boring CC�� [ pit Ground surface elev. �/0 ft. Depth to limiting factor Z J in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 SL Z r C- 5 t v 5J. 9 )0 41-414 5 A—IfE '--ftlm� - /. Z FZ 5 r y Sc.l 2m ' 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) Signature CST Number r-. 25 3.30 9 Address Date Evaluation Conducted Telephone Number 213 40'� - 7 - 'IM P � T Property Owner l t Parcel ID # Page of Is Boring # Boring �j� ft Depth to limiting factor in. ®--Pit Ground surface elev. g Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Efffi2 G1 _� 3 Jl._ 2wa1b -� c 5 (v l o v �o I �. 2 ► �t 4 � . C� 3 F2,P - 7.5 � q- S Boring # Boring Pit Ground surface elev, ft. Depth to limiting factor in. F-1 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 a Boring # Boring Ground surface elev. ft. Depth to limiting factor in. ❑ pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu, Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 • Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L I 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. I I SBD -8330 (807/00) r v PAGE OF NAME rle l� TOT# /O LEGAL DESCRIPTION UE Y S1 ,S I i.-To ,N,R, /9 E(orW SCALE: V= y6 BM I ELEVATION IM - O BM I DESCRIPTION r QuC BM 2 ELEVATION f;?, -'/0 BM 2 DESCRIPTION I a +"" / &C 5 v /a4, � r SYSTEM ELE V ATION C� ALTERNATE ELEVATION , A .� CONTOUR ELEVATION f q QO � 1 u a 0 i c C B w 4 i e c SIGNATURE -' - �� DATE • ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM owner/Buyer— Mailing Address / S ,S'���.� Address St X S So An y S, e� <` Property 1 — - required from planning onstnrctioar} (Verification requ S Department for new c Ci ty /State Parcel Identification Number -1- ( — CM IX-GAL DZIC Property Location �- `14, a V4, Sec - : TAN -R W, Town of �a ers� . Subdivision Lot # Certified Survey Map # _____...,.,__.... . Volume Page # r - �--- -- Warranty Deed #� . Vo�ume /� ?� Page # a� Spec house © yes no Lot lines identifiable Byes E3 no . il buptqa use ad =duu Dance of your septic system could result in its premature failure to handle wastes. Proper maintemme the system consists of pumping out the septic tmk every duce years or sooner, if needed by a licensed pumper. What You par y can aff ect the Pitnotioa of the septic tank sea treatmaat gV in the waste disposal syst= t to St. Croix Zoning Department a certifes:Yon form, signed by the owner and by a to submit sal s tern The proper owner agrees P r that the on -site wastewater ye masterplumbes, j plumber, restrictedplumbor or a licensed umpe � 1 pt tank is leas than ter Pull of sludge" the is in proper operating condition au&or (2) after inspection ad pumping (' have read the above requirements and agree to maintain the private sewage disposal system with the standards 1 /w ° the �� of Natural Resources set forth, , State of Wisconsin. Certification mein+ a sot by the gyegtmemt of Commerce and t Department Office within 30 etatk* that your septic system has been maintained must be compIeted and returned to the 9t" Croix County Zoning days o e ar xp' date. DATE F SN 5 A -- T1 I are that all statements on this form are true to the best of my (our) knowledge. I (we) am (ATE) the owners) of ( } Gerdy deed recorded in Register of Deeds Office. � property dGacribed aba e, by virtue of a warranty l� DATE SI A OF I:ICANT permit being revoked by the Zoning Department. + * + * ++ Any information that is snis- represented may result in the san itar y + * Include with this sppliCatlon: a stattnpGd warranty decd from the Register of Deeds office a copy of the certified survey map if reference is trade in the warranty deed U 1870 P `f 25 675973 KATHLEEN 11 VALSH State Bar of Wisconsin Form 2 - 1952 REGISTER OF DEEDS DOCUMENT NO. W ARRAN TY DEED ST. CROIX CO.. VI RECEIVED FOR RECORD 32- 2127 -60- 000 -11 -2002 Parcel 04 ldatificalion Numbs (PQ� 9:25 AN Nottingham Development, L.L.C., a limited liability company under the EIE�PT alt laws of the State of Minnesota, convoys and wan to John P. Kell and REC Y FEE: Dawn R. Kelly, husband and wife the following described real estate in St. TRANS FE E. 11, 00 143.70 I 'I Cr cafe of COPY FEE: : CERT COPY FEEL Lot 10, Wagner Estates, Town of S rncmet, St. Croix County, Wisconsin. PAGES. 1 I This is not homestead property. 7M SPACF RE VgD FOR RECORDING DATA Exception to warranties: any easements or restrictions of Name and Return Address: record, if any. Land Ti W, Inc. Dated this 15th day of March 2002 1900 Silver Lake Road #200 New Brighton, MN 55112 , N Devel in L.L.C. (SEAL) (SEAL) (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF MINNESOTA ) SS. COUNTY. WASHINGT'OI3 authenticated this 15th day of March, 2002 Personally came before me this l5th day of March, 2002, the above maned GREG JOHNSON aP RESIDFNT _ w ofNottingham Development, L.L.C., a limited liability company under the laws of the State of Minnesota, to rue known TITLE: MEMBER STATE BAR OF WISCONSIN to be the persons) who executed the foregoing instrument on (If not, behalf of said company, and acknowledge the same. authorized by $ 706.06, Wis. Scats.) THIS INSTRUMENT WAS DRAFTED BY Gregory C. Booth (Signatures may be authenticated or acknowledged. Both are not necessary.) Notary Public, Co , Minnesota 'Names of persons signing in wrl capacity should be typed or printed below stir signatures. My Commission Expires: �qy/ NANCY J. L E N Z i0 NOTARY PUBLIC- MINNESOTA My Comm. Expires Jan. 31, 2005 • I wiscansin6 apartment ofCommerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, W is. Adm. Code + A.C.E. Soil &Site Evaluations Attach complete site plan on paper not less than 8'/2 x 11 inches in size. Plan must County include, but not limited to: vertical and hor reference pant (BM), direction and St. Croix I'll percent slope, scale or dimensions, north arrow, and kxation and distance to nearest road. Parcel I.D.# 1, _ APPLICANT INFORMATION - Please print al " ormation. 032- 2034 -95 W #9.30.19.6@6- Personal information you provide maybe used for second urpose (Privq w, s. 15.04 (1) (m)). iew d By Date , t ✓ Property Owner roperty Location I& L/ Ga len Schillin , Bu er: Gre Joh G. ut. Lot NE 114 SW 1 S 9 T 30 N,R 1 9 W Property Owner's Mailing Address <� j' I - Loth Block # Subd. Name or CSM# 498 150th Avenue 0 Plat Of Wagner Estates City State ip.Code PhoneNdmberf':. EVillage ZTown Nearest Road Somerset WI 4025 715- i Somerset 5071, Street New Construction Use: erltiafA e?WWrol 4 ❑Addition to existing building ❑ Replacement Pu or commercial describe Code Derived daily flow 600 gpd `� 1 mmended design loading rate 5 bed, gpolft .6 trench, gpd/ft Basal area required 1200 bed, ft 1000 trench, ft Maximum design loading rate .5 bed, gpd/fF .6 trench, gpd/ft Recommended infiltration surface elevations) 98.3' at 12° above 97.3 contour. ft (as referred to site plan benchmark) Additional design / site considerations Parent material Glacial till Flood plain elevation, if a ic able na ft S= Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system [IS 0 u M s❑ u ❑ S U ❑ s ®u ❑ S® u ❑ S® u SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPDft{2 Boring# Horizon in Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed TTrench 1 1 0 -8 1Oyr4 /2 None sil 2fcr mvfr as 2f 0.5 0.6 2 8 -17 10yr5/4 None sil 2msbk mfr cs if 0.5 0.6 Ground 3 17 -27 7.5yr4/6 None scl 2msbk mfr cw if 0.4 0.5 elev 96.28 ft 4 2709 1 7.5yr4/4 None sl 2msbk mfi aw if 0.5 0.6 Depth to 5 39 -50 5yr4/4 f2f7.5yr5/8 sl 2mpl ` mfi limiting ; factor gg• Remarks: — — -- -- — 2 1 0 -9 1Oyr3 /3 None sil 2fcr mvfr as 2f 0.5 ! 0.6 2 9 -14 10yr5 /4 None sl 2msbk mfr cs If 0.5 0.6 Ground 3 14 -30 7.5yr4/4 None sl 2msbk mfr cw if 0.5 0.6 elev 96.30 It 4 30 -37 5yr4/4 f2d7.5yr5/8 sl 2msbk mfi aw - 0.5 0.6 Depth to 5 37 -52 1Oyr5/3 mld7.5yr4 /6 sil Om mfr - - &�O2 limiting factor 30 . Remarks: — CST Name (Please Print) Signature: Telephone No. James K. Thompson 715- 248 -7767 Address A.C.E. Soil & Site Evaluations Date CST Number Ref # 340 Paulson Lake Lane, Osceola, WI 54020 5/8/00 3602 1229 PROPERTY OWNER. Gaylen Schilling, Buyer: Greg Johnso SOIL DESCRIPTION REPORT ,zzs Page 2 of 3 PARCEL LD.# 032 - 2034 -95 IM9.30.19.606 AC.E. Soil & Site Evaluations Depth Dominant Color Mottles Structure GPDKF Horizon in Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. �o nsistence Boundary Roots Bed Trench 3 1 0 -7 10yr4/2 None s1 2fcr mvfr as 2f 0.5 0.6 2 7 -16 10yr4/3 None sl 2msbk mfr cs I f =5, Ground elev 3 16 -31 7.5yr4/4 None A 2msbk mfi cw I f 0.5 ! 0.6 98.14 ft 4 31 -68 7.5yr4/4 f2d7.5yr5/8 scl Om mvfi - - NP 0.2 Depth to limiting k3cf 31" - -- — - - - -- - -- - -- Remarks: Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: ` n t, wart• • To (� o ic rv( eta.P {e.-,ce P9. 3 oF'3 07 !d . eric.k ark: To oFl ■ ,50 06servci�•o- • Eleda�:on • lo6 56aec BIZ - �4--X- axis-l'-V Ancelm( ■ p' 410-1- /o CS4 'Tq, o�' 51. CIOiX( 83 g� (� 9730 h Z�OGe r- h �j C �.L -de- ate. 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