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HomeMy WebLinkAbout032-2158-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Y • ; INSPECTION REPORT Sanitary Permit No: 408254 0 GENERAL INFORMATION (ATTACH TO PERMIT) ate Plan ID No: - Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Z-9 ` � 3 = W"S. Permit Holder's Name: City Village X Township Parcel Tax No: Johnson, Glen Somerset Township 032- 2158 -20 -000 CST BM Elev: Insp. BM Elev: IBM Description: TANK INFORMATION U ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic � Benchmark ELKS J .9 as:R LID. Dosing Alt. BM Aeration i Bldg. Sewer f Holding t Inlet 12 38 23, S1 t TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet f � 3• z `12. �-o Septic � TD � ^, Dt Bottom � � R -� So � f Dosing } ( j „ CL3 Header /Man. 176 .66 Aeration C 1 I Dist. Pipe / Hol ' Bot. System f Final Grade Lt -( PUMP /SIPHON INFORMATION L- ) u-,11 (Z- __dn' ov DIQ Manufacturer / " nA nn' GPM Demand St Cover 9. l y f C Model Number ,fpm O 6v 31 L_ 2 TDH Lift Friction Los System Head TDH Ft Forcemain Length �S f Dia. p Dist. to Well C ad (.0. 4 � ZZ 2 SOIL ABSORPTION SYSTEM Width Length f l;Z7 � A IT NSIONS No. Of Pits Inside Dia. Liquid Depth MENSIONS / '�� SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING - cturer: INFORMATION Type Of System: �t (i ( AM N OR CR Model Number: DISTRIBUTION SYSTEM c ,D,W) Header /Manifold Distribution l x Hole i e U x Hole Spacing Vent to Air Intake Pipe(s) t� �.� p Length Dia L • ` ` �' - Dia I LZ 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 iii Yes No Yes [', No COMMENTS: (Include code discrepencies persons present, etc.) // i� nspection #1: / �/ t� ?� Inspection #2: ' -�-- -- U ta + Location: 563 170th Avenue Somerset, WI 54025 (NW 1/4 NE 1/4 9 T30N R19W) Roy Ridge Lot 2 � Parcel No: 09.30.19.1362 1.) Alt BM Description= : f .�• 2.) Bldg sewer length = - amount of cover 3. Contour= Plan revision Required? Yes , � No Use other side for additional information. �-O f iillSi_ � SBD -6710 (R.3/97) 1 f Insepctor's Signature Cart. No. Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 Madison, WI 53707 - 7162 Sim Addmss Dep artment Visconsin a —o z �s�'3 Sanitary Permit Application Sanitar Pc t Numbe 22 In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision May be used for secondary purposes Privacy Law, s15.04(1 m I. Application Information - Please Print All Information tau Plan I.D. Number ib2 4�'3 . 16 Property Owner's Name Parcel Number S.G -zo _0 do Property Owner's Mailing Address ,, _j d 2(02 Property Location �� .(Q - -A 'Ai;S 9 T iN,R City, State Zip Code �bJt uUmr r (JE Lot Number Block NyInber Subdivision Name / CSM- Nmrljer J4 U. Type of Building (check all that apply) s S".4" ❑City 1 or 2 Family Dwelling - Number of Bedrooms ❑Village ❑ Public /Commer Descnbc U-- -- ❑Township ❑ State Owned � / tt 4 f Nearest Road — ' << p .0 Ot 5 M. Type of Pe ;E- (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. N For County use I ew 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to System Tank Only Existing sum B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal us 44 ❑ Non - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑,Other V. Dispe rsal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Ra System Elevation Final Grade Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min./Incb Elevation 4 �7 2 7 0 V . Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks / Septic or Holding Tank Dosing Chamber ©d — T s VII. Respnsibflity Statement I, the undersigned, apume responsibility for installation of the POWTS shown on the attached plans. Pl ber' N (P ' ) Plumber's Si Mp/IvIPRS Number Business Phone Number umber's Address (Street, City State, Zip C I _!�5L VIII. Count /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date Issued Issuing ent Signature (No Stamps) Approved ❑ Disapproved Surcharge Fee) ❑ Owner Given Initial Adverse Determination 325. l IX. Condit of Approval/Reason pr�1 S � „�- / ��� laca r . eiaw�r ,�•.�— c�eo� � � S� � -��� �' �� od p.ei v�o- wt,� -r wttach complete plans (to the Count? odd) rot the r�stem oa papa not lean than alts x 11 Inch m atre SBD -6398 (R. 05101) 44(v Z .4 11 - Sol. J 17 pi.� 1 1 ` Pa / \ Ze- Safety and Buildings " 10541N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264 -8777 isconsin www.commerce.s i www.wiscon isconsin.gov n.gov Department of Commerce Scott McCallum, Governor Philip Edw. Albert, Secretary July 09, 2002 CUST ID No.224263 ATTN: POWTS Inspector KIM A O'CONNELL ZONING OFFICE K.O. CONSTRUCTION ST CROIX COUNTY SPIA 504 3RD AVE 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 07/09/2004 . Transaction ID No. 762973 SITE• Site ID No. 646724 Glen Johnson Construction Inc Please refer to both identification ° numbers, 170TH Ave - above, in all correspondence with the agency. Town of Somerset St Croix County NW1 /4, NE1 /4, S9, T30N, R19W FOR: New mound, 450 GPD Object Type: POWT System Regulated Object ID No.: 857854 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: CEP • 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- 10691 -P ( N.01 /O1) and SSWMP Publication 9.6, "Design Of Pressurized Distribution Networks For Septic Tank- Soil SEE Absorption Systems." • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The maintenance plan for this system must be given to the owner of the POWTS. Key Item(s) • A copy of this approval letter and index sheet shall be attached to plans that correspond with the copy on file with the Department. Changes to the approved plan must be submitted for review and approval. Failure to properly attach the approval and index page to plans that match the copy on file with the Department may result in enforcement action under s. 145. 10, Stats. KIM A O'CONNEL.L Page 2 7/9/02 Note • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(1). • Holes must be drilled with a sharp bit and all burrs and foreign matter removed before installation. 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall rovide a copy of this letter to the owner and fny others who are responsible for the installation, operatio mainten a of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Patricia L Sha POWTS Plan Reviewer, In grated Se ices WSMART Code: 7633 (715) 634 -7810, Fax: (715 634 -51 , M -F 7:45 am - 4:30 pm pshandorf @commerce.stat wi. cc: Leroy G Jansky , Wastewater Specialist, (715) 726 -2544 t MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: GLEN JOHNSON CONST, INC Owner's Name: GLEN JOHNSON CONST. INC. Owner's Address: 2629 BURL OAK CURVE HUDSON WI 54016 Legal Description: NW- NE- SEC9- T30N -R19W Township: SOMERSET County: ST. CROIX Subdivision Name: ROY RIDGE Lot Number: 2 Block Number: Parcel I.D. Number: ilitioll L r . Plan Transaction No.: ,N1MEN Of COMM ►lD Pagel Index and title 4 of sAF Page 2 Data entry Page 3 Mound drawings SPONGE Page 4 Lateral and dose tank Page 5 System maintenance specifications I „� Page 6 Management and contingency plan (,(/ Page 7 Pump curve and specifications Page 8 PLOT PLAN Designer: KIM A OCO NELL License Number: 224263 I Date: 06/1 _ _ 6/02 Phone Number: 7 15 755 3145 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Version 3.0 (03/01/01) Page 1 of 8 Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 83 -44 -3 in -situ soil treatment for fecal coliform of <s 36 inches. 1.50 Peaking Factor (e.g. 1.b = 1bU %) ( I 450.00 Design Flow (gpd) e nn A:a, nl ., ini \ a.vv Vito vlvNv k iul 95.50 Contour Line Elevation (ft) 32.00 nAnth to I imitinn Factor (in) 0.40 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 76.001 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /ft 1 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest po int in the distribution F Y FFU55ura Di>sribLIUVII iniunndiiun Iwiwulk? Enter Y or N (c or e) IE� Center or End Manifold I 3 nni I afarai Cnaninn /H1 If N ch=ic cn4cr tho alawatinn !k\ 2 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.0. 0.25) 3.00 Estimated Orifice Spacing (ft) = 9.00 ft /orifice 2.00 Forcemain Diameter (in) 35.00 Forcemain Length (ft) Does the forcemain drain back? Y 87.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 5.71 Forcemain Drainback (gal) 8.50 Vertical Lift (ft) 67.38 5x Void Volume (gal) 0.34 Friction Loss (ft) 73.09 Minimum Dose Volume (gal) 15.34 Total Dynamic Head (ft) 20.60 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options c hoic e In. dia. options choice 0.75 1 .25 x 1. UU 1.5U 1.25 x 2.00 x cn o nn I.�w %% A V.VV 2.00 x 3.00 1 x Gallons /Inch Calculator (optional) Treatment Tank Information 800.00 Total Tank Capacity (gal) 1000.001 Septic Tank Capacity (gal) 37.00 Total Working Liquid Depth (in) WEEKS � IManufacturer 21.62 gal /in (enter result in cell B49) Dos Ta nk Information Efflue Filter Info rmation Onn nn r oGa Tank n..pacit /gal, 7..h..1 CiW... �A..... .i.. s...... vvv.vv vvuv Tan C apacity �yar� avvl luvl malIvrvvwvl 21.761 Dose Tank Volume (gal /in) JAII 00 Filter Model Number WEEKS Manufacturer Project: GLEN JOHNSON CONST, INC Page 2 of 8 Mound Plan View 1 1/10 B J Observation Pipe . 3 :: .: ..:: K X. A ,. B ,. I 3 ....................:.......:. L Mound Component Dimensions Down slop toe extension made. A 6.00 ft E Aft in H 1.00 ft K 7.33 ft B 75.00 ft F in I 9.00 ft L 89.65 ft D 6.00 in G J 4.67 ft W 19.67 ft 450.00 (ft Dispersal Cell Area 1 1125.00 (ft') Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 1 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 97.79 (ft) ---► I t ........ . ............. G I1" 1 F Dispersal ceii ::::::::::::::::::::.. 96.50 (ft) Lateral 96.00 (ft) —► • — Invert Dispersai C.eii Elevation E �:�.������::::•. .......... .50 ) Contour Elevation 5.0 %Site Slope Geotextile Fabric Cover Shading Key & R T— Dispersal Cell See lateral details on j Topsoil Gap c .5 r "i Nage 4 for number, IT " " " Subsoil Ca I I f �- -� P I Q size, and spacing of M, ACTRA 1-33 S4n R 1 1 1..... , ,� ..,...l. C r- iat ai -Q. Latt aro ai o 0.5 ft Typical Lateral Tilled Layer II equally spaced from 751 �"'T' Aggregate v o the distribution cAtl'a r---- A ----�� centerline in the distribution cell (AxB). Project: GLEN JOHNSON CONST. INC Page 3 of 8 End Connection Lateral Layout Diagram aterals centered over the A & 9 dimension ♦: Turn -up W/ be 11 valve orolennoutplug P All laterals are identical x Hol es drilled on the bottom of the lateral 3 equally spaced Foroe main oonnootion via tee or oross to manifold at ang point. laterals 4c force main of PVC Soh 40 (per COMM Table 84.30.6) Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 3.06 ft Lateral Length (P) 73.44 ft Orifices per Lateral 25 Lateral Spacing (S) 3.00 ft Orifice Density 9.00 ft /orifice Lateral Flow Rate 10.30 gpm Manifold Length 3.00 ft System Flow Rate 20.60 gpm Manifold Diameter 2.00 in Total Dynamic Head 15.34 ft Forcemain Velocity 2.10 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watedtight Electrical as per NEC 300 and —i Comm 16.28 WAC 4 in. min. Disconnect _ Tank component is property vented :z 4— Alternate outlet location Forcemain diameter WEEKS Manufacturer _r 2 in. Ca acit 800.00 Gallons Vnh imo 1 71 7A nail /inch A Weep hole or antim I Dimensionl Inches I Gallons B � � siphon device A 18.58 404.22 "T- B 2.00 43.52 C I ( I Pump off e levation ^ (ft) C 1 4.191 91.141 D I I( I I I 88.00 D 12.00 261.12 I,�j —jl T .. _ l 36 A 00 I I I U lcr l I I OUV.UV i r I Do tank elevation ft '4" Rarqrlina i�n_cr lank, i R7 Qn C Alarm Manuafacturer JSJ ELECTRO Alarm Model Number HW 100 Pump Manufar hirar r, n i ii ns Pump Model Number IW E031 1 L Pump Must Deliver 20.60 gpm at 15.34 ft TDH Project: GLEN JOHNSON CONST. INC Page 4 of 8 Mound Svstem Maintenance and Operation Specifications Service Provider's Name KIM A OCONNELL I Phone 715- 755 -3145 POWTS Regulator's Name ST. CROIX COUNTY ZONING I Phone 715 - 386 -4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ft Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliforml >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 ears mounaj inspect for ponaing and seepage once eve �3 y ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished ...•�•......••. ..............• Grade � � .................. 6 -8" Diameter Lawn r Threaded Cleanout :.... Sprinkler Valve Box Plug or Ball Valve �........': u1stribution .............. . Lateral Lonq Sweep 90 or Two 1 1 45 Degree Bends Same Diameter as Lateral Project: GLEN JOHNSON CONST. INC Page 5 of 8 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained In accordance with its' component manuals [SBD- 10691 -P (N.01/01) and SSWMP Publication 9.6 (01 /81)] 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. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, State. 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 fitter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter Is equipped with an alarm, the filter shall be serviced If the alarm is activated continuously. Intermittent fitter alarms may Indicate surge flows or an Impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System 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 heavier mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODs, 30 mg/L TSS, 10 mg/L FOG, and 10 cfu/100 mL for highly treated effluent. 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 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system In proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, It will be repaired or replaced In its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. G EN JOHNSON T. a of Project: L CON S INC C Page 8 P rm Submersible Efflunt e erf o ence Curves Pumps METERS FEET - -I MODEL 3885 25 SIZE 3 /4" Solids E 15 H 70 I 20 - WE 10H __.� -__ _ ...._r._._ — .. .....F -.... i.... _ ...;........_ - I - J 50 15 � W E 051-1 -,.�- — -- t-- I ---• 10 j 30 ' 20 E03L I i 5, _ - _ 0 0 - 0 2T 30 40 50 60 70 80 90 100 110 12C GPM p L 10 20 30 m "� CAPACITY f� (� GOU LOS PUMPS, INC, S&KA FA" rEW rock OWL, METERS FEET 35 120 T -- I-- .._.._.._..I MODEL 3885 110 wE,sH SIZE 3 /4" Solids 30 00 -- r 90 25 80 - —r 4-• a 1 70 I 20 O � ~ � 50 WE05HH -J-1 I V 15 ' I 40 +1 1 i 10 ; 30 20 - -1- — 5 10 _ I .r O 0 ter. 0 10 20 30 40 50 60 70 80 90 100 110 120 GPM — 20 30 m)/h CAPACITY 1 01985 Goulds Pumps, Inc, EM00ve Jury. 198: ww Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of 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 S- f. Cm) include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. e ' wed,by n D to Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). AP f Property Owner Property Location Govt. Lot AIVJ /4 ' vg - � U tq T Yip N R E (ort�l Property Owner's Mailing Address nn Lot # Block # City State Zip Code Phone Number ❑ City ❑ Village D Town Nearest Road - v e r- /S G✓l 15 MS Y Z(o 9 83/ �tJ oe, [�) New Construction Use: P Residential /Number of bedrooms 3 _ Code derived design flow rate ySU /fin O d GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material ri I 1 Flood Plain elevation if applicable General comments O and recommendations: y s-{ m e l e (r, 9 G ele� i •s d ('o✓L v f U p'S a Boring # ❑ Boring ® Pit Ground surface elev. , 3� 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. S"z�.S,h. 'Eff#1 I "Eff#2 I d - lo �d j Zn -uL,r� �r CS I. r S Z /o- 16 fc I - () cs r�3 to F/F7.5 r LO 5L k t — _ Boring # ❑ Boring p pit Ground surface elev. / f' ft. Depth to limiting factor 3S i n. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 51 l 2,r-,a r c;5 14 5 's I O 2.rYN5bk ry r c.s - � 10 r��o r F 75 y l3 Sc 3m 6k ' 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) gno lure CST Number Address Date Evaluation Conducted Telephone Number zi/ o �m t, w/. s 'Y a2 y /� - o ��s - / ; z- -yam I _ SBD -8330 (1107/00) Property Owner 1 i �1QGQ� Parcel ID # Page 2 of 3 Boring U L 22 Boring # /i 716 ft. Depth to limiting factor J� in. �. Pit Ground surface elev. g —T— 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 Z i 3 - 32 I o r 4 y S i Zm51 tnn-�'t- C- 3 r 5 �t /3 s� 3m5bk r F-1 ❑ Boring # Boring pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ 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 I 'Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD -8330 (R.07/00) PAGE_a_OF NAME tY h ►^ LOT# Z- LEGAL DESCRIPTION ?/W X tiE X ,S � T 30 ,N,R, / Y E(orY� SCALE: I"= y0 1 BM I ELEVATION Z� D BM I DESCRIPTION k oI evc- BM 2 ELEVATION j$, yU BM 2 DESCRIPTION �np 6�_P✓C- S -� ' SYSTEM ELEVATION U ALTERNATE ELEVATION ,l/ /* CONTOUR ELEVATION S D i 3 S ° L Q a X v o 5 .5 SIGN &M E ��� DATE ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM 'Owner /Buyer Mailing Address � ), Property Address (Verification required from Planning Department for new construction) City/State s >v���:� ��,� Parcel Identification Number LE GAL DESCRIPTION Property Location , ' /,, A '/ Sec., TZ6) N -R_2� W, Town of Subdivision Lot # Certified Survey Map # , Volume , Page # Warranty Deed # Cki , Volume 19/0 , Page # S­4�'o Spec house M yes D no Lot lines identifiable R yes O no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposa I system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by is Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certificanon stating I t yo septic s s m has been maintamed must be completed and returned to the St. Croix County Zoning Office within 30 AZT days t 4 e th ee car ration date. SI NA on PPLICANT DATE OWNER CERTIFICATION I (we entry th all statements on this form are tnre to the best of my (our) knowledge. I (we) am (are) the owners) of the p erty esc 'bed a o e, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE O APL CANT DATE " "'• Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. " "'• •• Include with this application: a stamped warranty decd from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed t , U 1910; 590 STATE BAR OF WISCONSIN FORM 2 -1999 6 8 1 6 Qt 5 WARRANTY DEED KATHLEEN H. NALSH Document Number REGISTER OF DEEDS ST. CROIX CO., YI This Deed, made between Jame D. He and Al C. N yhage n RECEIVED FOR RECORD - - -. — 06 - 17 -2002 8:30 AM IIARRA O DEED Grantor, and Glen Johnson Construction, Inc., a Minnesota _ EXEMPT i rp C ooration, REC FEE: 13.00 - - - -. _ TRANS FEEc 960.00 — .. _. COPY FEE: Grantee. — CERT COPY FEE: Grantor, for a valuable consideration, conveys to Grantee the PAGES. 2 following described real estate in St. Cr oi x _ County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area (See Attached Exhibit "A ") Name and Return Address t. I4 ,wj >K�l Pt 032 - 2 - 60.00 Parcel Identification Number (PIN) This _ is not _ homestead property. (>E) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. V 1. Dated this day of Jun - 2002 • J mes D. Henry • Allen C. N yhagen AUTHENTICATION ACKNOWLEDGMENT Signature(s) James D. H enry and Alle C Nyhagen STATE OF WISCONSIN ) ss. o-1 County ) authenticated this i of Ju 2002 ` -- — ' —' Personally came before me this __ day of the above named • Kristina Ogland - — - — TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing - - -- instrument and acknowledged the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY • _ _ Attorney Kristina O gland Notary Public, State of Wisconsin H udson, WI 540 My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) _._ .. _---) Names of persons signing in any capacity must be typed or printed below their signaturc. Info Prcraubnais company. Fond du Lao, wl STATE BAR OF WISCONSIN SW455 - 2021 WARRANTY DEED FORM No. 2 -1999 591 EXHIBIT "A" Lot 1 of the Plat of Roy Ridge Estates excepting he followi n9 ng Commencing the Southwest comer of Lot 1 of the Plat of Roy Ridge Estates; thence S89'01 1'44"E 221.13 feet along the South line of said Lot 1 to the point of beginning; thence S89 "11'44'E 180.00 feet along said South line; thence N01 °41'50'E 60.01 feet along the East line of said Lot 1; thence N89 180.00 feet; thence S01 0 41'50"W 60.01 feet to the point of beginning. Also including the following: That part of Lot 4 of a Certified Survey Map recorded in Vol. 15, Page 4239 at the St. Croix County IY of Deeds Office further described cribed as follows: Beginning at the Northwest comer of Lot 4 of a Certified Survey Map recorded In Vol. 15, Page 4239 at the St. Croix County Register of Deeds Office; thence S01 59.72 feet along the West line of said Lot 4; thence S89 "E 220.97 feet; thence N01 °41'50'E 59.72 feet; thence N89 11'44"W 221.13 feet to the point of beginning. Lot 2 of the Plat of Roy id Estates excepting Y 9e p ng the following: Commencing t . g the Northwest comer of Lot 2 of the Plat of Roy Ridge Estates, thence S01 °41'50'W 263.92 feet along the West line of said Lot 2 to the point of beginning; thence S01 °41'50"W 60.01 feet along said West line; thence N89 1'44"W 40.00 feet along the South line of said Lot 2; thence N01 0 41'50 "E 60.01 feet; thence S89 °1 1'44 "E 40.00 feet to the point of beginning. Lots 3, 4, 5, 6, 7 and 8 of the Plat of Roy Ridge Estates, ALL In St. Croix County, Wisconsin. 6 233.00 0917'45' S48' C4 167.00 51'53'36" S27'11'53 "W 146.14 151.25 • C5 233.00 51'53'36" N271 V53' 203.89 211.03 7 233.00 37'58'28" 1420'109 "E 151.62 154.43 8 233.00 13'55'08" N46'11'07 "E 56.46 56.60 C6 167.00 123'21'56" N08'32'17 "W 294.03 359.57 C7 233.00 29'54'56" N551547 "W 120.28 . 121.65 C8 233.00 04'41'50" N37'57'24"W 19.10 1910 SW1910'E 2596.34' - (s69 93 i_TOT_H AVENUE S88°1 S'10'E 998.1 T' NORTH LINE OF THE NE1/41 BENCH MARK: TC so REROD, E'. 170TH AVENUE S88°1 8'10•E 932.49 -- - -t` - -- -- - -- -- -- -- - -- -- -- •-- •-- • - -• -- -- - -- -- 1 --•- •- i H.W.L = 940.0 H.W.L = I I — • — — • — /� — � � rte --*�. �\ t' LOT 1,-- , / �.''•-`` � 3.015 ACRES I 1 WIDE (131,327 SO. FT.) I ry - DRAINAGE EASEMENT I •A I 3. M.� PA 942.0 OT Z (131,50450: Ff.) � IXISTING DRIVE TO BE REMO� 3.010 ACRES M.R.�.l. i I 1 (131,113 SO. FT. 401.13 97.22' N89° 1'44"W 498.35' _ "9v 2p' WIDE 801 03ri M ti n DRAINAGE EASEMEN nP OR�1A . . om 201.59' -�- 589°11'4CE 388.09' � ;. �. WIDE 76 SETBACK FROM / DRAINAGE ORDINARY HIGH --4,` 2(Y WID N ENT K DRAW EASE TER MAR � 'r C� \l • y(! WA �\ EASEM \ 4 T -_ C5. 3.060 ACRES •� L10 do . . (133275 SO. FT.) �� 1 .� \ ! \°` It