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HomeMy WebLinkAbout032-2176-05-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division ' INSPECTION REPORT Sanitary Permit No: 488130 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: Endie, Susan & James I Somerset, Town of 032 - 2176 -05 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: /DD 6 OA -* / 11.30.19.1490 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing ,5 Alt. BM -4:v,\ Z Sewer t .a5 166. 75 Holding St/ Ht Inlet * 7•T 98 - g5 S t /Ht O utlet �r . 3a 9'T . 5 TANK SETBACK INFORMATION V ent o it Intake ROAD V3 S ' G J� ` * q .7 d (o epic ! ��- 1 `7 j 7' �GV� 2 osing ea er an. 9. �$ q2 . Z kv �6' � rl�- 1 y r7 _7 (06 A eration D ist . Pipe 9.0 T'L • Z� 1 Sz H olding Bot. System / / L7 91 . ZY ' 7 • 3� F inal Gracle PUMP /SIPHON INFORMATION (o•�� 9i I anu ac urer uemana St cover _ GPM /?S3,`7 m odel um a "rn .vle„ � 1 nc Ion LOSS system rlea •31 /1S0 orce ai Lent ia. DIMENSIONS 1 7 Z Z '` w Sr INFORMATION Q, CHAMBER OR' �-f- Co► e ,4, . (o!5 lL7' ! /v- 5U' UNIT �v i ��{-- Z 3 4- Z3 HuddEmMal Illuld -11 Pipe(s) ` \ �d -7 Length i I Dia `� Length Dia ` Spacing ` x Pressure Systems Only xx Mound Or At - Grade Systems Only Bed/Trench ! BedlTrench Edges Topsoil es ] No Yes No If J COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1612 83rd Street Some W 54025 (SW 1/4 SW 1I/.4 11 T30N R19W) Lakeside Estates Lot 5 Parcel No: 11.30.19.1490 1.) Alt BM Description = a 't' 4 ��-- I 2.) Bldg sewer length = Z S - amount of cover = I Plan revision Required? Yes No Use other side for additional information. CtO nature-- SBD -6710 (R.3/97) AA Safety and Buildings Division County 20 Washington Ave., P.O. Box 7162 adison, WI 5370 - Sanitary Permit Number (to be filled in by Co.) Department of Comm Grp E� ��� 3(' Sanitary Permit App ' State Plan I.D. Number cation 2006 �M In accord with Comm 83.21, Wis_ Adm. Code, personal "nforin our td may be used for secondary purposes Privacy s15. 1)(m) Project Address (if different than mailing address) UNTY /& / Z (3 RP • 57' 1. Application Information - Please Print All Information 3 • a Property Owner's Name Parcel # Lot # Block # _'5V 51+ J i"ES 5 Property Owner's Mailing Address Property Location + f AV 2- 3 ni;l s T I City, State Zi Code Phone Number =�� '�.'f" Section h�__ N,IV Q"V C/ '^� /' S 7 V ra ' y Q ' 79q T N; R�E le W I1. Type of Building (check all that apply) S Subdivision Name CSM Number i �l or 2 Family Dwelling - Number of Bedrooms A // El Public/Commercial - Describe Use 1,A k'tSIP25 G' J r19- s ❑ State Owned - Describe Use ❑City ❑Villagc)OT'ownship of I11. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl on - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland Pressurised In Ground []Holding Tank ❑Peat Filter []Aerobic Treatment Unit ❑Recirculating Sind Fitter ❑ Recirculating Synthetic Media Filter Leaching Cham r ❑ Drib= Line Gravel -less pipe El Other exp in) V. Dis ersalfrreatment Area Information: 2 Design Flo (gpd) Design Soil Application Rate( Dispersal Area Required (sf) Dispersal Area Proposed (sf) System E vation S _ /Y„ ,7 195" /.U,, VI. Tank Info Capacity in Total Number Manufactures Prefab Site Steel Fiber Plastic 3 Gallons Gallons of Units t✓t &AA "4 " l� Concrete Constructed Glass New Existing ' -A' C Septic or Holding Tanks Tanks ing Tank 7 Aerobic Treatment Unit V L. Dosing Chamber VII. Responsibility Statement- I. the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) J Plo-ber's Si nure MP/MPRS Number Business Phone Number R . Zc1QRIc�►l zZ� 3 s 7S Plumber's Address (Street, City, State, Zip Code) r ' 2,91 /D cam- ,4 Sp I;V (�— U,q // W1. S Y? 6 VIII. Coup /De artment Use Onl X Approved ❑ Disapproved Sanitary Permit Fee (incl des Groundwater Date Issued Issuing ent Signature Stamps) Surcharge Fee) tven Reas on for nial - f IX. Conditions pprov /Romans cr SYSTEM OWNER: 3J 1 Septic tank, effluent filter and`0� dh �Ex►. er — — SR Sei r�•�, ( SYS dispersal cell must all be serviced / maintaine as per management plan provided by plumber �[ 9 / . o e t.� 0. Q 3 ..D , 2. All setback requirements must be maintained AA9 U as per applicable codelordinances Attach complete plans (to the County only) for the system on aper t less tha 81/2 x 11 inches in size SBD -6398 (R. 01/03) e T PAGE 5 0P3 $G Pti LE j i . � j = co� THIS ORATE PER POWT SYSTEM COMM ®= B�N�- F�/►��F�Cl�• ±CORP 83.44(2)c A PROPER ZABEL ®� $opwfjdT FILTER MODEL # r q•�g 6U 6+S 7 � $ 2 7 �f y � �- Icr, I O I ILIA 32' ,'7O 0' V r/ �� pRivEw�� 102' S 15TE" 4 / Ulbricht & Associates Private Sewage Consultants 2812 1 Oth Ave. f='ova -/ °�� Spring Valley, WI 54767 SvA,vc-yoR.S 1,.oT 0-04NE2 '�'-- PCG' gouTH PRO E'2T'r B q 9 co B3 s M t % 100.00 \J2." -X-p 'SET M2 : 96- 19 Z" RSov Cz jR.4rE= 13 MI. 7 b A130v6 E�RAaE= M a Z. APflRog. RUIA-Un/C7 5JUWF,RELi5V_ /06-0-2- ULBRICHT & ASSOCIATES CO. 2812 10th Ave. * Spring Valley, WI 54767 Reg. Designers of Engineering Systems 715- 772 -3442 Private Sewage Consultants PROJECT INDEX PLAN ID # DATE OWNER .5(>,4yjAJ PHONE 60 `/y 7 ' 4 � `/ 7 ADDRESS /�f' Y3 lev . S T. LEGAL DESCRIPTION L�7` s' S T,� 7 � s Ste Ste, Sic �Z, 7 / AWZ& P>J o 3a .����'os - TOWN OF COUNTY s T' C d f' X CSTM 7 2,4L- zi LOCAL AUTHORITY/ SUPERVISION ST �� 7� e U U JJ PROJECT DESCRIPTION: . /Uzi CD.v S 7X00 71' 0 k-) lot— PA V THIS PO`YNT SYSTEM SHALL - CORPORATE PER COMM. � l 83.44(2)c A PROPER ZABEL �� (�EhT �l �Q (? l C�/+ 1_1LTER MODEL # d . �00 Ulbricht & Associates (1 Private Sewage Consultants 2812 10th Ave. 80 "., W i ft W! 54767 1' P 4� Ce; � s t E Pg.l INFILTRATOR SIZING WORKSHEET w 1 � ^O " P9.2 SYSTEM PLOT PLAN P9.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. Pg . 4 Is F 11 II P9.5 OWNER MANAGEMENT PLANS & ZABEL FILTER SPECS Pg.6 (OPTIONAL) CROSS SECTION AND SPECS FOR DOSING TANK. PG.7 (OPTIONAL) PUMP PERFORMANCE SPECS. The attached plans and specifications are based on "In- Ground Absorption Component Manual For Private Onsite Wastewater Trcaf-mcnf. gxrQ*amo . n (Vurei nn 7 _ f11 gPn_1 07c, -P(Nn1 /ni _ kA � y N_ \ a 5 0 l" ZA { C>Q b m � � � J O m ` n \1 T m ° � m i G m� N 0 N -4- PAGE' 3 OP 3 Sc Pti �•.E ISO _ 30' A = coa't°ouR THIS POWT SYSTEM SHALL ®- BE�'HAKA'RK P'�?CORPORATA R ZABEL PROPER I =ILTER MODEL # . t)o � �9• � Gv ��. -� �( I— 6,14 < T 82- 75 C4 2-5 V) / a � e s 32 i l 50 led �� Q 13iHt oz' S 5TEA -78 Ulbricht & Associates Private Sewage Consultants Fb va D 2812 1 Oth Ave. Svf�vEYvR.S � --- Spring Valley, WI 54767 t_oT �okNE2 'r'-- pcG i S O "_r H P f2 owe 2-r� r- $ t =- cj9•AA-% 82. r 9 F3 M 1 100.00 yz," -MP sE"T $ M2 9 40- 19 2-" ArSOV r C:7R4DE= F3M IJ b A Bove Fa RA = pM2. A PPR09- BUi 5'U EL.E: V- 10 6-02— 12 1 Iff T>P � W r y Vigo SS SEC T ion a� T/r��"��s ," P ,ow Iff j ►iii r 3 y OVER: See Reverse Side for Vent Observation / on Pipe Details. i OWNER's MA fwrzTwnv "OE SEPTIC SYSTEM POWTS (landownejZ) is reponsible for proper operation and maintenance of, this system. Regular periodic inspections and ' servicing i s necessary for the safe healthy operation of-this systems. The owner is required, by code to submit all necessary maintenance /inspection reports to the control Iing, authorities:. SPECIFIC CONTACT AGENTS- ST . CI4fX, C ?LY- 2a r ? (, * Governmental authority/ Inspectors: ,t 71S • 3006 • 7 WoL-1 Licensed responsible for providing an operation/ maintenance- "Users" manual: q * Licensed service / inspection other than installer. cry! f3Aw Reple6-4AI 3 0 Electrician, f pump, electric controls, Wiring units: k0c 7W • IMPORTANT QWNER MAINTENANCE RE UI.REMENTS 1. Winter traffic-.(sledding, shove*ing, etc.) across the area shall not be permitted, or frost can /will penetrate into the cell, freezing up the system. Discontinuos use in the winter (a vacactlon_ trip, resulting in no water use) can -also lead to freeze ups. 2- Water conservation- needs -to be system can be hydrolically overloaded and destroyed. This sys#em was designed for a maximum wastewater flow of (p er gals. daily: 3. POWTS are not'desligned to accomodate wastes from a garbage_- . :. disposal unit, or &ny other unnatural sources of waste. Any intraducti.on of such waste - materials w ill overload - destroY this system. 4. If a power orjtagp► occurs, or a pump fails, it may resu In a temporary overload of effluent bei cell ng pumped into the- , which may adversely impact the cell (ieakkge). It is recommended that a licensed pumper empty the dosing tank, allowing the pump to return to dosing the correct amounts. consult your installer - iihmediately for advice. 5- Neglect of the vegetative-cover erosion preventive {the cells insulation � traffic also can des troy l t a he t systemu r lt IS compaction f1tECESSARY REGULARLY WATER THE OVER A SYSTEM!! Effluent fir: the system beneath IS NOT sufficient alone to maintain a 1 Fovar. 6. Feriodi,c insgeetion$ by the owner, or his agents, is necessary. Inspection i es and Into the s P P ports have been in St Cdr fl y em= on P rated inspecti mound basal a 1 area s e a e e p coon pipes }. cleanout terminals on thefpressurized laterals, at each tip - for flushing and cleaning the laterals out The filr system in the tanks ground cover /mansyst (via a locked above person should an ). Only a licensed properly qualidied €k severe sa €ety risks. thi involves health s y s tem's tre?t� tent cell shall also be regularlya%nspeetede in th POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 PA.E 1NFoRMATI6N SYSTEM SPECIFICATIONS Owner j UE 3 J / / L)/ Septic Tank Capacity 2 / ❑ NA Permit # ^�� al Ld Septic Tank Manufacturer j 1 56 ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model Q 0 ❑ NA Number of Public Facility Units , NA Pump Tank Capacity a l NA Estimated flow (average) g al/day Pump Tank Manufacturer XWA Design flow (peak), (Estimated x 1.5) �p ��} al /day Pump Manufacturer fi�KVA Soil Application Rate . - 7 2 Pump Model �NA Standard Influent/Effluent Quality nthly average* Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD ) 5220 mg /L ❑ A ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids ITS ) <150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality n_-�30m erag Dispersal Cells) ❑ NA Biochemical Oxygen Demand (BOD ❑ In- Ground (gravity) E3 In-Ground (pressurized) Total Suspended Solids (TSS) ❑ NA ❑ At -Gra de ❑ Mound Fecal Coliform (geometric mean) 00ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ JNA Other: ❑ NA Other: ❑ Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: nth(s) ❑ year(s) y {Maximum 3 ears) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once eve // month(s) every: l� ❑ year(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: /,, month(s) ❑ NA (SJ ❑ year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) /�NA year(s) Flush laterals and pressure test At least once every: ❑ month(s) 4! �NA ❑ year(s) Other: ❑ month(s) At least once every: ❑ year(s) ❑ NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer, Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a .Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code: " All other services, including but'not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Ulbricht & Associates Private Sewage Consultants 2812 1 Oth Ave. Spring Valle WI 54767 I I _ 1 START UP AND OPERATION Page of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting. products or other chemical: that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the content; of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will bt discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls tc restore normal levels within the pump tank. - Do not drive or park vehicles over tanks and dispersal cells. Do nod' drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT @.�. When the POWTS fails and /or is permanently taken out of service the llowing steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83,33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed ot'by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN It the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: l A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption — system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name 24 (Z- I r � Name 13ew e ^� 3 �� Phone �� J /' 7p� ,3 yY Z. Phone 7� 3 Y6 o S ' Z SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name ST. l / x GIXy �— Phone / j Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Ulbri ;ht & Associates Private Sewage Consultants 2812 10th Ave. Spring Valley, WI 54767 CO UN - D Wisconsin Department of Commerce S Gk O AT EPORT Page I of Division of Safety and Buildings in accordance m 85, Wis. Adm. Code County G RO _ Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must S 1 1 X 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. 032- 2- (o - O Y Please print all Information. Re "red by Date Personal information You provide may be used for secondary purposes (Privacy Law. a. 15.04 (1) (m)). Property Owner Property Location _' - T- M Pt a /\/ O W N HO M•S Govt. Lot 5 w 1/4 j u 1/4 S /7—T 3D N R 1 E (or) W Property Owners Mailing Address Lot # Biodc # I Subd. Name or CSI# 140 38 0 2 Sf • LA YE: 5tr->E EF-SiT l city State Zip Code Phone Number ❑ City ❑ village IRTown Nearest Road /1lQW P/ckmo>Jfl WI I 5- 1 (&/2-) 9-efD 71? 50MERSt"'T New Construction use:,(• Residential / Number of bedrooms 3 - 5 Code derived design flow rate -4,4 50 - 7 5 O GPD ❑ Replacement ❑ Public or commercial - Describe: _ s Pmt material F /NE LIEN 5•E• Tr c r - s Flood Plain elevation if applicable t-I /A ft. General comments and AraY Spo' --Tested suitable for A COM"fttlonal Inground system (P.O.W.T.S.) Boring F 1-1 1❑ Boring # r4l Pit Ground surface elev. q 9• a Depth to limiting factor > f! in. Sod Appkation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM . in. Mansell Qu. Sz. Cont. Color Gr. Sz Sh. •Efr#1 •E11#2 1 0 1 o Y(L 3 41 - 2 m M - r n r 3 v+ �p Z - 7-23 1 oYle 3iy - 2 - M K Iro 4 1 45 2 V-F 3 23- 1 DYPO/6 m bK - f l a w I V•F (o 36-79 I AYR 5 N — 5 _ - 2 I . (o t%tzvS? (IN D Ta / L�J # 0 Boring p �L ® Pit Ground surface elev. Depth to limiting factor q I in. Sal Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Mansell Qu. 87. Cont. color Gr. Sz. Sh. •Efr#1 • Eff#2 1 0-12. 10 kr R 2 /1 — JQ wi gr m -Frr 9 5 2 12 I1) YR_' S 3 30 -91 1D YA 5 ) 4 - 5 0 d 1 Ivf - 1. (0 — �` sv ji t%rz5r FoL)A4 T 22" Bz.R Must #1 = BOD > 30 < 220 ng& and TSS >30 150 mg& • Ef tent #2 = BOD < 30 rtgA and TSS < 30 mglt. CST Name (Please PrIM CST Number JEIVdy 617 , 1715-174 Address 1 ' I V Date Evaluation Conducted Telephone Number Z$ l2 10? I kvE < � _ Rt PZ!�6.7 V A LE'4 nJ t l- 26 -06 (715)77Z- 34'>t2 1 Property Owner I n' "' � V � D Parcel ID # P age 2 of S [] Boring 3 # © Pit Ground surface elev. O %. O O (t Depth to firtdUing factor > g in. Horizon Depth Dominant Redox SW Rate Description Texture Stnxsrae Consistence Boundary Roots GPD/fe in. Munsefl Ou. Sz Cont. Color Gr. Sz Sh. 'Eff#1 'Eft#2 0 '12 I OY1 /1 - 2M r l9'1 5 3 v - F , (� $ 2 1 - Y b `{R 41 �0 - i c l 2 -F M,( I' C s 2 V- .� , (e 3 �`� � °Kt¢ �`�(, - S i C t 2 rn bK r»-F; a w V � I O Y� 5k} _ S 5 d - - 7 l Co EEI FRo5T To 1 "� EJ � # ❑ Bon ❑ Pit Ground surface elev. ft. Depth to 1 TMV factor in. Horizon Depth Dominant a Redox Description Texture Shft Sofl Rate In. Munsefl Qu. Sz Cont. Color Consistence Boundary Roots GPD/ff Gr. Sz Sh. 'Eff#'1 'Eff#2 F-1 � ❑ Boring ❑ Pit Ground surface elev. ft. Depth to IhTMV factor �. Horizon Depth Dominant Redox Sofl Rate Description- Texhue Structure Consistence Boundary Roots GPD/f� in. Munsefl Qu. Sz Cont. color Gr. Sz Sh. 'Eff#1 '011#2 Eifluant #1 = BOD > 30 _< 220 mglL and TSS >30 < 150 mg& ' Effluent #2 = BOD < 30 nV& and TSS < 30 mglL 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. seo.eawtt 6" t PAerE 3 oP 3 ScA' ir..E j = co�T°ov ®_ $Etl MR'S to c�1 B 2 d Q. ti 9 1� W 13. �LppC 32 - 70 3p, � pR1vEW�� 1O RM1 Cl &.A l 102 - 7 f=o v''� Su VeLtvRS DoT Cok�►E2 PCG i 10-3 7 SouT" PRoPe2-r�r $ i �9 -lq-� X3 9 to .4f1 X33 br S F3 M i 100.00 1 y - SE BM2 - 940.19 2" J80VU C-rR40E^ 13Mi. b 4 'ABOVE APPRoX, &"'A-zV1vy s 'ewFP EI-6v= 106-8-2- N'2-' ArcIMS Viewer Page 1 of 1 T R. HuA � 1 1 f BxC2 1489 12 1490 //A 11 S 114 TN SOMERSET OnC2 �i ScD 2 41 6. 64 I 1606 http: //72.21. 230.178/ website /LRPortal /ARCIMS/MapFrame.asp ?PIN= 2/2/2006 ST. CROIX COUNTY " SEPTIC TANK MAINTENANCE AGREEMENT AND , OWNERSHIP CERTIFICATION FORM r Ownsu Ske £ l e Mailing Address IL � 3 rte{ � �- . N ew 2v oW z 4 W Z_ • � � (�' Property Address (Z $ 3 v S+ : Nun fLICI - c k ^ m X S �� , (Verification required from Manning &Zoning Department for new construction.) ; City /State Parcel Identification Number LEGAL DESCRIPTION r ' 1 W Property Location 5 UJ /4 , /4 , Sec. f , T30 N R W, Town of Subdivision li`C�S �5' % `7 S , Lot # Certified Survey Map # /1 , Volume , Page # Warranty Deed # Z 7 3 , Volume , Page # Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & 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 disposal 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 the Department of Commerce and the Department of Natural Resources, State of Wisconsin. - Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my /our knowledge. I/we am/are the owner(s) of the property described above, by virtue o f a warranty deed recorded in Register of Deeds Office. Number of bedrooms SIG TURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) +D Ulbricht & Associates Private Sewage Consultants 2812 10th Ave. Spring Valley, WI 54767 y A . XATNLEEA N. 4ALS11 K REGISTER OF DEEDS 'C ST. CROIX CO'., it1 STATE BAR OF WISCONSIN FORM 1 - 2000 RECEIVED FO$ RECQRD, Document Number WARRANTY DEED 04/03/2006 03:3011 f THIS DEED, made between TI Magnuson Ent Inc., a Minnesota WARRANTY DEED Corporation, Grantor, and Susan M. Endle and James P.. Endle, Wife and EXEIPT # ~" Husbarid as survivorship" marital,property, Grantee. REC FEE: 13.00 Grantor, ' fpr a valuable ctmsideration, .conveys to Grantee the fallowing TRAMS FEE: 282.00 described real estate' in St. Croix County, State of Wisconsin (the COPY' FEE: Pr ry ) CC FEE: PAGES: '2 SEE ATTACHED EXHIBIT A Recording Area Name and Return Address: Land Title Inc 1900 Silver Lake Road Sui te200 Ne �r?i n Mn 55112 Together with all appurtenant rights, title and interests. 4 0032 - 2176 -05 -000 Parcel Identification Number (PIN) This is not homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except I � - Dated this 24th day of February, 2006. TI Magnuson Ent Inc. * Tim I n, President AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF MINNESOTA ) WASHINGTON COUNTY. ) ss. authenticated this 24th day of February, 2006 Personally came before me this 24th day of February, 2006 the above named Tim 1 Magnuson, the President of TI * Magnuson Ent Inc., a Minnesota Corporation, to me known to TITLE: MEMBER STATE BAR OF WISCONSIN be the person(s) who executed the foregoing instrument and (If not acknowledged the same. authorized by § 706.06, Wis. Stats.) L � �hQ�t,, THIS INSTRUMENT WAS DRAFTED BY *Annette D. Theis Notary Public, State of Minnesota My commission is permanent. (If not, state expiration date: Larry Mountain, Attorney, 1900 Silver Lake Rd #200, New ) Brighton, MN 55112 (Signatures may be authenticated or acknowledged. Both are not necessary.) Notary Public - Minnesota •ames of persons signing in any capacity must be typed or printed below flair signature �• My Commission Expires San 31,2010 ri I of 2 WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1-2000 r + r EXHIBIT A Lot 5, Lakeside Estates, St. Croix County, Wisconsin, together with a 66 foot access easement as shown on the recorded plat and also =Ather with the benefits mntained in eawnalt aXwyat dabed Pt:bnxiry 24, 2006, filed I 2of2 N, .. oo • LOT a '•. >• ".7V 9M LOT ARFA TAKE & DNR 4ME • • 3 .4 ACRES TO G WM NW40131 144.0 L OT 6 • 3.01 ACM ( 31 JO OQ f't.) �br rE LB.O. - W r / if V I r f ubw • f • „- so *ACE Aw �w wmE • • • • • .7E -0 !3 v y S i'o p,4R 17& vnzop yExv T c,/o To/ti y9NsE•v ST. pep 401;V6- /-!/v. G S/ • 3 88 /fo oe Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ! of 3 Division of Safety and Buildings In accordance with Comm 85, Wis. Adm. Code n Attach complete site plan on paper not less than 8 1/2 x 11 Inches i i slze. -� n Include, but not limited to: vertical and horizontal reference point (B ), direction a�i Pkvan" I.D. S 9- percent slope, scale or dimensions, north arrow, and location and if stance to nearest road. Please print all Information. j ?Revie by D e / olb Personal Information you provide maybe used for secondary purposes (Priv 15 - T - 15.04 (1) (m)). Property Owner • Operty oc S // 6141N JefF) _MW Lit_ wW .� - 114 S /d1 T 30 N R 19 1&(or)W P tty Owner's Mailing Address Lot # Blodc # S". Name or CSM# T - ,z - 2- /(.O0 W- A 5 p uPIi4 - P1,47 City N State Zip Code Phone Number ❑ City ❑ village Town ` Nearest Road ,PfcA,Aio ui? cv /. syo17 ( 7iS ) iYG •-s3A&6 4vue . P4 New Construction User Residential IF Number of bedrooms 3 Code derived design flow rate ��SD Ott GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material _ 4;V- 4&Nk / om /'& Flood Plain elevation If applicable -� _ —_ ft• General comments and recommendations: • 4 7S /P�<Q U /�ts �9- /youv� s ysr�4f WS" G-- '� oSSi3 /.e ,fie •Tes i.t� G- i.V o dZ S o �s ct, c po ss Z -07 • �,.` # ❑ Boring a Pit � Ground surface elev. ` �• ft. Depth to limiting factor Z s in. Sofl Appkafion Rate Horizon Depth Dominant Color Redox Description Texture Sbucture Consistence Boundary Roots GPDIfF In. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 o - ioyR 3/ L /fsh sti w .3 4 • `/ • s- z T J3 in Yle ---- -- z 11-s d cS 2S-37 75 Yze M 1541 t S/et /fj,tiOr 4*I V ` • Z • 3 5y� i ❑ Boring Q 3 3 -s S . a Boring # Pit Ground surface elev. ft. Depth to limiting factor in. Sol Appl icaSon 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 o is �o %i? 3/ sbf' ds W • y . 2 - o • t o � l G if she S4 eS - • ` r - n /r 40 / S/ ��GG / �s �►►t.e a z' Z 3 Effluent #1 = BOD > 30 < 220 mg!L and TSS >30 < 150 mgA- ' Efluent #2 = BOD < 30 mgft. and TSS _< 30 mglL t! Number 1 CS N,?r!� (Please Print) Signature CST Num 2 2- (P 3 7 Ro/3�R7 Z1 /�/�i�� Address Date Evaluation Conducted Telephone Number 6 Ulbricht & Associates �� - 3 711 •77.2, • 3 y?/Z 2812 10th Ave. y0 03 l 20 Ka • �o • 0�a Spring Valley, WI 54767 c�5 �/ s' See. // A 5e /5,C see. For issuance of permits and designing _ - Z 0 'YS • SD • 0 2. 5 Contact: Ulbricht & Associates s�j /S� SEG / 2 0 3 2 Registered private wastewater consultant and plumbers SEC• 12 — D32 - of s5- yo.om 2812 10th Ave. 4 0 A Spring,, Valley, WI 54767 r 715-772-3442 NM S w c. 2 ? S �v N / w ,d 30-6" / boys• yo•� 1 UINAL , 1 Low -5' Property Owner _ Parcel ID N Page Z ' d 3 © Boring N ° eon �/ " o 5 ft. De S.s. [ pit Ground surface elev. Depth to Nmtting factor � in. SoN Application Bate Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots GPDIIE In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eft12 3 I 7.5 t — sip /fsh .w7 / Z �• i6 Cz SIcL i h • Z /a / P E Boring # p Boring ❑ Pit Ground surface elev. R. Depth to limiting fads In. Sod Appl ication Rate Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots GPD/Pf In. Munsell Qu. Sz. Cont. Cola Gr. Sz. Sh. 'Eff#1 'E1f#2 F Bodng p Boling # ❑ Pit Ground surface elev. R. to limiting fads in. Sort AWkedon Rate Horizon Depth Dominant Cola Redox Description. Texture a Consistence Boundary Roots GPD/fF In. Munsel Qu. Sz. Cont. Color C4. Sz. Sh. 'Eff#1 'Eff#2 F Boring # ° Boring ❑ Pit Ground surface elev. ft. Depth to limiting tads hi. Soil Application Rate Horizon Depth Dominant Cola Redox Description. Texture Stricture Consistence Boundary Roots GPDff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = DOD, > 30 < 220 nxft aril TSS >30 < 150 mglL ' Effluent #2 = BOD, < 30 mg& and TSS < 30 mglt- T — — 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. sen mope.�ool I I to r s vRVF �12 a p� U i 7d� r' Q �yo 4 � o y sa �S d /3 9 �. 0 - � �y S1 pix k Su yti G o � M � q (p S uN� '/ 5-t -e I�V�YT / e,� ►�'�i, M o