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HomeMy WebLinkAbout032-2158-40-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453456 0 GENERAL INFORMATION (ATTA 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: Glen Johnson Construction I Somerset Township 032 - 2158 -40 -000 CST BM Elev: Insp. BM Elev: BM Description: _ Section/Town /Range /Map No: 11 /' Z G 5 t 09.30.19.1364 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM �.. (0 WeAl Te., go Z .05 /o z/, 0-5 Aeration Bldg. Sewer 1 2-391 93.7 Holding SVHt Inlet ' Z G �3 '4 d St/Ht Outlet S O TANK SETBACK INFORMATION \ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic /''i j � I � / � � / � > � Dt Bottom Dosing l i f t / 61, /:81 1 / $ Header /Man. / 7 6 Aeration Dist. Pipe S -b /01,1 Holding Bot. System PUMP /SIPHON INFORMATION Final Grade 1 4 1 6 2 1 (, / c.. oJC. / Manufacturer Demand St Cover �� 1d6 z d K p� GPM Model Number (5 3/. TDH Lift Friction Loss System HeacT TD EL / /,5 (j /, 3 i ; 56 1.3 / Forcemain Len th Dia. / I Dist. to Well 5, SOIL ABSORPTION SYSTEM 1 1AV BED/TRENCH Width / Length I No. Of PIT DIMENSIONS No. Pits Ins'd� a Dia. LiquidD pth DIMENSIONS `\ SETBACK SYSTEM TO P/L JBLDG IWE LL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type ystem: / I CHAMBER OR 5 1 � 5 0 / UNIT Model Numbe,�._ DISTRIBUTION SYSTEM Header /Mnifold f Distribution GZ �) I x HpI Size J/ x Hole Spacing Vent to Air Intake Pipe(s) J L Z Length_ Di. Spacing I ! Z 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 ] / - r Bed/Trench Edges \ Topsoil �1 I w � D y Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: T / 7 O spection #2: / I Pl C K Location: 1681 56th Street New Richmond, 1 540017 (NW 1/4 NE 1/4 9 T3 R1 9W) Roy Ri e LL , ot (� _ / Parcel No: 09.30.19.1364 T j 1.) Alt BM Description = ,� g �' �ocS �✓� �^' 1 n`'`om 2.) Bldg sewer length - / T - amount of cover = 7 Plan revision Required? L Yes >(No I �j Use other side for additional information. _ _ a L _ _ _ obm _ Date Insepcto Cert. No. SBD -6710 (R.3/97) f4; � � ... .:! .. I II. / � i �� 1 ..1 C i_ � � � i , ... ' _. -• ._ . . ,�... ,,iL.� t _, .. 1� Safety and Buildings Division County - - '� rDe • �`�201 W, Washington Ave., P.O. Box 7162 j 'C'Y o�� Madison, WI 537Q7 - 7162 in Saturary Permit Number ([o be Riled n by Co.} nt of Commerce (608) 266 -3151 Sanitary Permit Application State Plan I. Number qq - 3 DL In accord with Comm 83,21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, sI5.04(1)(m) Project Address (if ifferent than mailing address) I. Application Information - Please Print AI! Information � 4 sr- P tY ow 's ? It CI✓ 1rOhA Parcel b Lo Block N rt Owner's M ail g Address �) _66C-) Property Location City, State «CII� tk,f� -,,Section �� Zip Cnde Phone Number " � -2 (circle o ) II. Type of Building (check all that apply) -- T 3Cj N; R,E or X1 or 2 Famil Dwelling 3 d Y g •- Number of Bedrooms � ��J Subdivision Name CSM Number Public /Commercial - Describe Use G? 1, ❑ State Owned - Describe Use D I -S7 CAL W q 2_ ��_ 1? SQ � !� V ❑City_�JVillage pown J� dS r III, Type of Permit: (Check only one b o x on line Co to lin B if app A ppli !u New SYstem ❑ Replacement System ❑ i l 7'reatment/Hoiaing Tank Replacement Only ❑r Modification to Existing System B• ❑ Permit Renewal (? Permit Revision a Change of ❑ Permit Transfer to New I List Previous Permit Number and Date Issued Before Expiration Plumber Owner JV�T of POWTS System: (Check all that apply) _ i `� - U Non - Pressurized In- Ground Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil D At- Grade ❑ Single Pass Sand Filter r ❑Constructed Wetland ❑ Pressuzed [u - Ground ❑Holding Tank i -i Feat Filter` Aerobic Treatment Unit C Recirculating Sand Filter ��- ---. Recirculating Synthetic Media Filter ❑ Leaching Chamber D rip Line ❑ G ravel -l ess pipe ❑ Other (explain) !_V Dispers /Treatment Area Information: Design Flow (gpd} Design Soil App1' ation Rate( - sf)� p ;speraal Area Re fired (sf) Dispersal Area Pro used (s Elevation VI. Tank Info Capacit in Total Number J-(anufacturer , refs Site J Steel Fiber Plastic� Gallo Gallons of Units Concrete Constructed Glass New Existing t Tanks Tanks Septic or Holding Tank / Aerobic Treatment Unit - _-- _ r Dosing Chamber VII. Responsibility Statemen I, the undersigned, assume responsibility for i llation of the POWTS shown on the attache plans. Plumber's Na me (Print) Plumber's Si gnature P MPRS Number �/ � �% Business Phone Number r/ '/ Plumber's Addre ss (Street, City, State, Zip Code) - - VIII Count /De artment Use O r Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater f pP Da a Issued ssuin Surcharge Fee} p S A t Signal Stamps) ' U � _ Q L� Owner Given Reason for Denial l D 1x• Conditions of Approval/Reasons - - �� p ' -' n �� � ` 4 STEM OWNER: ( ►1/Gfi(�la GCe 7 J r"� , t?/I 1 eptic tank v�/,, � dispersal cell effluent filter and 9�aVr P must all be service @ i� Z I as per management plan provided by plumber. !Ni 57od-e- 2 2. All setback requirements must be maintained as per applicable code /ordinances. fi 3 — 3 J 1� J Mach complete plans ( the County on y) roe the system Paper not less �d�$1/ yi inche size 6398 (R.. 01/03) r� f �6 <7-�e-tf) ` PLO= PL ;�!i . Pace 3 cf - 7 Scale 1 "= SO ' LoT U KA tz q� 1 � 1;4� ass o �(C` gM 2 L O N�y-44, , ?� -S �__- �- --1? -U►�l `mac., _ C O PY NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. (_ Z, required). 3. Septic tank to be 0 3oo 6S Ogallon capacity manufactured by 4. Bench mark • i'L !oo .0' UO iU�> y);= GVTEV,1 SEC_ V�,Ok 5. Divert surface water around system to prevent ponding at the uphill side. Safety and Buildings 4003 N KINNEY COULEE RD commerce LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 It isconsin w ww.com state. ons www.wisconsin.gov Department of Commerce _ Jim Doyle, Governor - / C Cory L. Nettles, Secretary April 30, 2004 MAY L 1; P i CUST ID No.267341 A7TN.• POWTS Inspector ARTHUR L WEGERER L ZONING OFFICE--. r WEGERER SOIL TESTING & DESIGN SERVICE ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY SPIA PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/30/2006 Identification Numbers Transaction ID No. 994322 SI E: Site ID No. 682677 Jeremy and Steph Taylor 0 V -1 Please refer to both identification numbers, TH Street tl.S� G L-n o above, in all correspondence with the agency. Town of Somerset S? 1 �Llr awrjs St Croix County ppwekq/ NW1A, NE 1/4, S9, T3 ON, R19W Lot: 4, Subdivision: Roy Ridge FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 955510 Maintenance required; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual, SBD- 10572 -P (R.6/99), Pressure Distribution Component Manual, SBD - 10573 -P (R.6/99); Biofilter 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 Conditi4411 chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements., No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, NIPIP stats. OE vtttAEµt OF µ0f The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Requirements: SEE • 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). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • 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. ARTHUR L WEGERER Page 2 4/30/04 • 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. Stat • 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 Responsibilities. 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). • 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. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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 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 ZXZ,el Balance Due $ 0.00 J Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789-7893, 7:45 am - 4:30 pm Monday - Friday cbratz@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 I _ TITLE SHEET �lE'Ct of `l BOUND SYSTEM FOR APR 2 7 2064 A 3 BEDROOM RESIDE RAFE7y p D' '+ n This plan has been prepared in accordance with the Mo�i�i"(�d��,0nent Manual SBD -1057 -P and the Pressure Distribution Manual SBD - 10573 -P Ccz. ' Ci Clz. (Z 1 9R LOCATED IN THE Nw 1/4 OF THE Ntt 1/4 OF SECTION 9 , T 30 N, R 19 W TOWN OF SC�WLL_�Z,S m COUNTY, WISCONSIN. Loi y OF R_Z -r __1ZtC) 6L INDEX PAGE 1 of 7 TITLE SHEET PAGE 2 Of 7 SYSTEM MANAGEAENT 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 PU14PING CHAMBER CROSS SECTION PAGE 7 of 7 PUMP PERFORAANCE CURVE PREPARED FOR ZL ri�`r° pj'�D NzA U LrtL- 1 =f l,C S , v `� b z-Z 11y r7� PREPARED BY L: WECGEF;tEF:;." SOIL . TEST 2 N(3 ,oMMERCE AND. )IU DINGS i�ES Y GF'V SEF :ZV I ( ? .'ONDENC P.O. Box 74 421 N.Main St. River Falls, WI 54022 , Phone 715 - 425 - 0165'' Fax 715- 425 -6864 �- �'" "�•.�. s o -�r,n K;s"0 Tr . iS gds , 4t' 1 t� �� ! �_� 40 ai06410 y_Zb Y JOB NO. C) U — LS FLOT F��`i Pace 3 cf Scale 1 "= SO ' L oT u ryt:F O F C<LL a $.s 1 V S t J �A s , 3' Ffujm NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( 2 required) . 3. Septic tank to be t ppo /6S Ogallon capacity manufactured by C CAJ Cis w L�> l W o /G S O 4 . Bench mark �21oo — lop t));: g �k 5. Divert surface water around system to prevent ponding at the uphill side. Pace Of Approves S nthetic Covering - ASTH C33 Distribution Pipe Medium Sand t • H 1 apsoli -» - .;�...• �� IG gl a 8 • E p . 3 _ b . °a Slope Distribution Cell of Force Main Flowed I " to 2'," Aggregate From Pump Layer •� Ft. E Z Ft. CROSS SECTION OF A MOUND SYSTEM F 0- Ft. G 0• S Ft. A Ft. N \-O Ft. Linear Loading Ra = D /ILLY FT 8 SO Ft. A a" Design L oading GPD /SQ FT I I q Ft. ` J h Ft. K l0 Ft. e �c L -1 3 Ft. Lr Fo r r- rat - �� YY � 1 Ft. - Observation Pipe E K Ac-- �-- - -� 8 - - -- --- - - - - -- -------- - - - - -- --- - -- 6 Force Main %a-, O 1��0 S l T� Distribution Pipe Cell of � to 2 = Ir 1 aggregate Observation. Pipe (Ancsbr sec=ely) - PLATT VIED OF A MOUND SYSTEM Distribution Pipe Layout Page S of 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 Iona turn 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 7 -t P � (_ C ZOS S S ``nQ 1y L LIP ' at2ral PV C Manifold Lateral x x x x x11 x!Z x x I x I x Lateral Lenoth — Lateral Length —"p Distribution Line o- _ rr Z;S soX --0 ht';iJ1Fc:� S PVC F=oQ � >7 i P Z y Ft. Hole Diameter Inch S Ft. Lateral ) Inches) X Inches Manifold 1 / ZInches Force Main " Z Indies # of holes /pipe �3 Invert Elevation of.Laterals -O Ft. yc _ - Combination Sept.;ic;Tank and PLiMP CHAMBER CR055 SECTION AND SPECIFICATIONS' PAGE I& OF NEWT CAP WEATHER PROOr ' JUUCTIOW BOX 'f 'C.Z.VEIJT_PIPC APPROVED LOCKIM6 lO' FROM DOOR, MA3JHOLE COVER IJIV _. - - - - - -- - •il WA?-SJIJJC LN EL. '►�oow OR FRESH l AtR MTAKC � S cc,aputr C� CL�c�D� 4 Mw 334 t ir�tsH -ems 6tr�tvE ( � �. le'/�lu. - -- f PROVIDE I -- AIRTIGHT SEAL ( I Approved, CI joint w/ I III jo int PVC pipe I II ALAAA PVC pipe b - T I i OM �.; q I PUMP J I` Iff b OFF C - RISER EXIT PERMITTED GLIL!� IF TAWK MAIJU'FACTUR%R HAS SUCH APPROVAL REDO: „AA?� •: �, k SEPTIC F 5PEC.IFICAT10QS DOSE TAMKS MAQUFACTUR.CJ �tF Z COUGzI'S"N fJL1M$En OF DOSES: y' g3 w I b06 / b S 0 FER OA_ TAIJK SIZC: GALL0QS 005E VOLUME ALARM MAtJUFACTUR:.R: S•S �2� ;�{g� St�` II.ICLL'OIIJG 6AC.KfLOW: \ u Z GALLDI�S MODEL ►.LUMBER: kC$ 1 H'w .CA ?AC: ?ic: 1 � W C HIS 1J_H_S OR 3 GALLOt; S WITCH TyPC: 1'1ER.CvR`-r : Ac e = �` ti:CHEi GR �J Gj�LtO►1S PUMP MAWUFACTURGR: 6,13 - S MODEL NUMBER: C= W[HES OR 1yZ GALLOWS D= Z IAICHES OR U GALLOWS SWITCH TYPE; ?N \1ZCVltf MOTE: PUMP AV AFARM ARC Z0 C� MIAIIMUM DISCHARGE 'RAT: 1'°ll� uFM IN57ALLE0 '0W SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEW PUMP OFF AWO..DISTRIBUTIOIJ PIPE..��'�� FEET •t- MILJIMUM NETWORK SUPPLY PRESSURE b • 0 F EET + y 5 FEET OF FORCE r'tAIN X z ' N9 FT/ fLFRICTIOU FACTCR_. �'� FEET TOTAL OyNAMIC. HEAD 1 ' y 9 -FEET As per manufacturer gal /in. Liquid depth 3g +1 Goulds iDv - 7 °r Submersible Effluent Pump �� u 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, Capable of running lubrication and efficient strength, en h and durability. following uses: 9 9t � g • dry without damage to heat transfer. •Effluent systems ■Motor Cover: Thermoplas- • Homes component ,.. Available for automatic Motor: and tic cover with integral handle • Farms manual operation. Automatic and float switch attachment • Heavy duty sump • EPO4 Single phase: 0.4 HP, models include Mechanical points. • Water transfer 115 230 V, Hz, 1550 Float Switch assembled and ■ Power Cable: Severe duty • Dewatering RPM, , built in overload with automatic reset. preset at the factory. rated oil and water resistant. • EP05 Single phase: 0.5 HP, ■ Bearings: Upper and lower SPECIFICATIONS 115 V FEATURES heavy duty ball bearing 60 Hz 1550 RPM 9 Pump: EPO4 built in overload w ith construction. ■ EPO4 Impeller: Thermo- • Solids handling capability: automatic reset. plastic Semi -open design /4" 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. SP Canadian Standards Association • Total heads: up to 24 feet. with three prong grounding • Discharge size: l'h" NPT. plug. Optional 20 foot ■ EP05 Impeller: Thermo- (CSA listed model numbers • Mechanical seal: carbon- length, SJTW with plastic enclosed design for end in " F" " " or AC . rota /ceramic -stati three p rong improved performance. ) ry •nary, � e , gnun�ing plug 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. io • Capable of running - -- t -- -- -- dry without damage to s 30, components. ^� + , zsFr V 5GPM 1 Pump: EP05 8 - - -- - -- - - - --, • Solids handling capability: a 25 i -- eT maximum. a • Capacities: up to 60 GPM. = I 1 • Total heads: up to 31 feet. 6 20 • Discharge size: 1 NPT. • Mechanical seal: carbon- 0 5 rota /ceramic - station ry a , ry 4 { { I —i BUNA -N ela stomers. -- - -- E • Temperature: 3 10 104 °F (40 °C) continuous 140 °F (60 °C) intermittent. 2 5 �- 0 00 10 20 30 40 50 GPM 0 2 4 6 8 10 12 W CAPACITY Cc 1995 Goulds Pumos, Inc. Wisconsin Department of Commerce SOIL EVALUATION REPORT Page _ of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 112 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. O 3 Please print all information. eviewed b Date Personal information you provide ma5 be us (ma y Law, S. 15.04 (1) (m)). Property Owner Property Location Govt. Lot 114& f` 114 S T 30 N R E (or)Q Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# , City State Z( Cod ?ONI i ❑ City El Village Town earest Road S a t ru.. r d C) S a/ / [� New Construction Use: Residential I Number of bedrooms _3-f- _ Code derived design flow rate. ,( �L 0 C GPD ❑ Replacement ❑ Public or commercial - Describe: _--- _---- __�--- -_ - - -- Parent material (� — ___ - -__ Fbod Plain elevation if applicable ____�f/__ - -_ - -_ ft• General comments and recommendations: -Sys {- e lam. ts v, D ('o vr ��e V ` 7( 0, ° 51 Boring Boring # Pit Ground surface elev. g� ft. Depot to limiting factor _� _ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/flt In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh_ 'Eff#1 'Eff#2 6-(0 3/3 5,, �• k. M-f r to r - S �l ,,, s J✓i �, C �✓ �v 3 SL 4 3'nak mfr - S r� S _ 07t Boring # Boring ® pit Ground surface elev. Ao %76 ft. Depth to limiting factor _ in. Soo Application Rate Horizon Depth Dominant Color Redox Ddscription Texture Structure Consistence Boundary Roots GPDKF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 a fe - — ,,� sb Z -3L lo ,, /& 2M cs — Effluent #1 = BOD > 30 220 mg/L and TS5 >30 < 150 rrg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si lure ` i CST Number "a t" S1 110 - �'s 3 So Address g J ' I Date Evaluation Conducted Telephone Number 7/ 76 0 Z� �jUh S Parcel ID # �' '� __�a } - - - - -- Page -- L of Property Owner __—_—_—.^_—_—_--- ❑ Boring �-, :L6 y � Boring # Ground surface dev. t� _ h• Depm m limiting tador 4Z_— in• So A l Soil iication Rate 3 -� Pit _ Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary .Roots •EGPD/fPEff#2 in. Munsell Qu. Sz. Cont. Cc,kir Gr. Sz. Sh. Z -L /lo S 0 w- ❑ Boring El Boring # ft. Depth to limiting factor _— = in. ❑Pit Ground surface elev. _ __ ^__- Soil Application Rate Horizon Depth Dominant Color Redox Description Texture mn Structure Consistence Boundary Roots •EGPD/ft2Eff #2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ❑ Boring ❑ Boring # Ground surface elev. - _- - -_ - -_ f . Depth to limiting factor ____— in. ❑ Pit Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Eoundary Roots GPDlf? in. Munsell Qu, Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD 30 < 220 mglL and T5S >30 < 150 mglL ` Effluent #2 = BOD < 30 mglL 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, p7case contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. sno -8330 (R.ovun) PAGE3OF 3 NAME: SohAS "" LOT #_LEGAL DESCRIPTION :dial / / -L T �o ,N,R, ff— E(or))p SCALE: 1 "= l u,e (---- ELEVATION: 100 BM 1 DESCRIPTION: -6 ot U rccn �,w�P (j BM 2 ELEVATION: g4? BM 2 DESCRIPTION: SYSTEM ELEVATION: b SYSTEM TYPE: (V\ (10AA -vr et . q (R _� 20` or n Qe 5 po w I � � SIGN TUBE: { f DATE: � � ��� Q z 'F► -��, Svc/ PAGE 3 NAME: LOT-9 _LEGAL DESCRIPTION410 1 / 4 LE 1 /4,S -LT-3b N,R,ff—E(or)Vp SCALE: I "= �7o r nI ELEVATION BM I DESCRIPTION: 4 l e o Ife r � �7c BM 2 ELEVATION: BM 2 DESCRIPTION:__ SYSTEM ELEVATION: SYSTEM TYPE: ._ \ ri y ,A _ �G✓V vY' � q U Q& ` r � 0 \ 9-7 `✓ SIGN TURF: { � DA T E: G1 t �I 1 Wsconsin 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 -5 include, but not limited to: vertical and horizontal reference point (BM), direction and I I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Revie Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.14 (1) (m)). ADD Property Owner Property Location I k tuuz p C.f A C t^ Govt. Lot '() W 1 3 UN� N R l/ E (or) Property Owner's Mailing Address U Lot # Block #1 rE City Statev Zip Code Phone Number ❑ City ❑ Village [Town N arest Road IA'y -cy - J : � H.S t✓! Soyyv -rs- , [2 New Construction Use: [R Residential I Number of bedrooms 3 `t' Code derived design flow rate y IS 11 O d GPD ❑ Replacement E] Public or commercial - Describe: Parent material "' _ L Flood Plain elevation if applicable General comments S y jf - rte Z k V, 9� 3 d and recommendations: F11 Boring # ❑ Boring ® Pit Ground surface elev. 97. 8 d ft. Depth to limiting factor Z - in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 a-� /o r3 /y /M 59 wrr G Z _ /o y/y - GS I msci Yn+'I- .3 936 iv 6 7, S" y� Z Boring # ❑ Boring p ❑ 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 /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 C -S Z ►} -30 a v y13 GL ►11k m Fr C -- , "- /0Y `// FI F7.S r Y/6 G L. m56� Wt�� -- , 6 ' 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) n lure CST Number AL-acounA -= -- Q Address Date Evaluation Conducted Telephone Number I 1 , wi s `7 AG -° z /�S`- z y -0908 SBD -8330 (R07 /00) Property Owner /V Q Parcel ID # /O d/ Page of © Boring # ❑Boring f pi{ Ground surface elev. ft. Depth to limiting factor �_ in. Soil Application Rate Lnzon 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 o_ /oyr3 _ S,I Zolwe ►mfr- cS ,5 . & k 1-7-o id, /3 - e, /_ Z b S - . 6 F-1 S Boring # ❑ Boring ❑ pi{ Ground surface elev. ft. Depth to limiting factor in. oil 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' El 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 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 TIT 608 -264 -8777. SBD -8330 (8.07/00) PAGE 'r, OF NAME LOT# `7 LEGAL DESCRIPTION Vw X VE Z ,S q T 30 ,N,R, / 9 E(or) SCALE: 1 " = BM I ELEVATION Z�iO• a d BM 1 DESCRIPTION 7 iQ 4 - + BM 2 ELEVATION O BM 2 DESCRIPTION ] SYSTEM ELEVATION ALTERNATE ELEVATION p- CONTOUR ELEVATION q . 5 o b Z 0 � t Slab ` 6- � v 0 -e- s., SIGNATURE __�> DATE ZQ -0e - - mo y stem Management Plan - 7 Pursuant to Comm 83.54, Wis. Adm. Code Page Z of Septic Tank 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 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 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 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, Safety and Buildings Division. 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 S tem 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 io 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 8005, 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. ( 9) arid local or t reporting. _ 6/9 ) sate rotes pertaining to system maintenance and maintenance 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 at 194 The system installer at E 1N�YtL� The tank manufacturer at — 7 a2ZS i 2. The effluent filter manufacturer at e pump manufacturer at - — 3 - ST CROIX CO UNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CER OR — Owner/Buyer e-,) Mailing Address Property Address (Verification required from Planning Department for new construction) Cit Lam �— ty c arcei Identification Number 3� — �_ S�' Q-00 LEG" DESCRIPTION � %, � ' 13& Property I.ocation. a / , Sec. 3C�� ._ `i' . T N -R � L_ Town of 2 dyrz e�� � Subdivision _ _ vier„ _ Lot # _. Certified Survey Map # . Volume . Page # Warranty Deed # ...1 4�L Volume y/4 , Page # Spec house ❑ yes A no Lot lines ide ntiflable� yes ❑ no 'fS'I'R'idi MAIM1!TA_lyCl� Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance c0usiats of pumping out the septic tank every three years or sooner. if needed by a ricensed pumper. What you put into the system can affect the Amcdon of the septic rink 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 masterplumber, journeymanpltunbe.r, restrictedplumber or a licensedpumper verifying that (1) the on -site wastewaterdisposal 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. Vwt. the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set fotth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has bees maintained must be completed and returned to the St. Croix County Zoning Office within 30 days the throe year expi ration d ate. F S10#AYLMB OF APIMICANT ME I (we) certify that all statements on this form are true to the best of ray (our) knowledge. I (we) am (are) the owner(s) of roperty described above, by virtue of a warranty deed recorded in Register of Deeds Office. �& NAIIME O DATE " °' Any information that is this- represented may result in the sanitary permit being revoked by the Zoning Department. Include with this application: a thumped warranty deed from the Register of Deeds office a copy of the eertifled survey reap if reforenoe is made in the wartanty deed �j U 1910 r' 590 STATE BAR OF WISCONSIN FORM 2 - 1999 Es 8 1 $ Ld 5 Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX Co., MI This Deed, made between Jame D. He and Al C . N yhage n RECEIVED FOR RECORD 06 -17 -2002 8:30 AM -- WARRANTY DEED Grantor, and Glen Johnson Constru Inc a Minnesota EXEMPT • C orpora t ion, REC FEE: 13.00 TRANS FEE: 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 0 0 Parcel Identification Number (PIN) This _ is not homestead property. (3t) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this 4- day of — Jun e 2002 *J me D. Henry ■ _. + Allen C. N yhagen AUTHENTICATION ACKNOWLEDGMENT Signature(s) James D. H enry and Alle C Nyhagen STATE OF WISCONSIN ) ss. t County ) authenticated this ` 1 da of Ju . - — - " -` - " "— Personally came before me this day of _ the above named + ristina 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 Q 706.06, Wis. 3tats.) THIS INSTRUMENT WAS DRAFTED BY + Attorney Kristina O_ gland H udson, WI 540 - - - - -- Notary Public, State of Wisconsin __ _ 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 signature. information Professionals company. Fond du Lac. wi STATE BAR OF WISCONSIN eooBSS -zozi WARRANTY DEED FORM No. 2- 1999 EXHIBIT "A" Lot 1 of the Plat of Roy Ridge Estates excepting the following: Commencing the Southwest comer of Lot 1 of the Plat of Roy Ridge Estates; thence S89 1'44"E 221.13 feet along the South line of said Lot 1 to the point of beginning; thence S89 1'44'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 °41'50"W 60.01 feet to the point of beginning. Also including the following: i That part of Lot 4 of a Certified Survey Map recorded In Vol. 15, Page 4239 at the St. Croix County Register of Deeds Office, further described 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 °11'44 "E 220.97 feet; thence N01 0 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 Ridge Estates excepting the following: Commencing at the Northwest comer of Lot 2 of the Plat of Roy Ridge Estates; thence S01 263.92 feet along the West line of said Lot 2 to the point of beginning; thence SO1 °41'50"W 60.01 feet along said West line; thence N89 1'44"W 40.00 feet along the South fine of said Lot 2; thence N01 WrE 60.01 fe et:-. 9°11'44 "E 40.00 feet to the point of beginning. Lots 3, 4. 6, 7 and 8 f the Plat of Roy Ridge Estates, ALL in St. Croix County, Wisconsin_ — cw ` c p Nbl rr G • v i ' \\ HW4V169E 277.51' w O ■ L w a 1 66.68' J ` t.7 to 94 �°� �� -,\ m M i s Z o Y A ` r ` ' - �_ o b s It, , -� •'~'• I co v X44' 4E5 3 ca - L13__ t f- mom a�o.6a� ° eo.otr 527.4 BLOCK DISTANCE 1264.08' 1 EAST LINE OF THE NW1 /4 OF THE NE1 /4 80"7 297.06' i aQ� V -co r - rrr O vo wrra �O I -- - - -- WN�ptOV 01Cn? W NCO m I 1 Z, O N0 VZO tt8ZJ NEAAOZZ VNO �� $;to.,oaocnoomrn 419" ; rn o cr m• W c;+ n tr .+ o o c �o -j -j -s • c�id 'a►cn�� ddg6 - w •A v 3 m (t1 r (r 0 tit Of N RO tC tO �I Q J Z C C fO N ° �► IG ,� $ A- C N vN�Nf�WONIJ�O°DtWC�CWf"`Ojf W .O�tOnDNGZ2 A� GA OZ G jA 7 C,►p�C lo � m ° � :j rn : f Ri r^ � r* m :rE re m r r•i m O M 8 9 `�° � � Z � 1" 0 0 m= �A n c in �o on w ? Y n _ .. L�l L � _