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032-2044-30-200
SAFETY AND BUILDINGS DIVISION commerce .wi.gov Integrated Services Bureau 13 East Spruce Street Ste 106 INSPECTION REPO RT Chippewa Falls, WI 54729 �t, t www.commerce.wi.gov /sb i (715) 726-2544 sconsin Department of Commerce Aaron Olver, Secretary Date of Inspection: May 12, 2010 Plumber Name and Address: Project Name: Venhor Shaun Bird, MPRS 226900 Use: Residential 1008192 nd Ave Legal Description: SW, NW, 12, 30, 19W New Richmond, WI 54 -17 Site Number: na Subdivision: Lot 2 CSM V. 13, P. 3577 Certified Soil Tester Name and Address: Municipality: Town of Somerset Same as above. County: St. Croix Plan ID Number: na Sanitary Permit Number: 363867 Owner Name and Address: James Venhor 67 85 St Wastewater Flow: 450 gpd Design Capacity 1667 Persons Present: S. Bird, J. Schmitt, T. New Richmond, WI 54017 Schmitt, P. Quinn, R. Yarrington and Owner This onsite soils verification was part of an So this brings us back to the paint. If enough was investigation pertaining to the early hydraulic failure of flushed into the system if could adversely affect the the soil absorption cells. This system was installed in infiltrative capacity of the soil. Low or no biologic mid -2000 by Shaun Bird, MPRS. It began activity in the septic tank could promote similar experiencing operation problems within a year or so. conditions in the soil absorption cell. If aerobic and The installer noted what he felt was a dead septic tank anaerobic bacteria are not functioning well in the cell (i.e. no biological activity) and an accumulation of to decompose organic material then soil clogging solids in one of the absorption cells. He installed an occurs (biomat) and once formed also slows outlet filter in the septic tank and found that it clogged infiltration. up rather quickly. In addition, when the tank was pumped it was noted that a band of paint was coating In either case, once ponding occurs it typically gets the lower sidewalls of the septic tank. Apparently, worse until wastewater either backs up or surfaces. workers had cleaned painting equipment from other jobs in the home. Some paint may have discharged Recommendations include installing a 150% capacity to the soil based system clogging soil pores. replacement system with valves to manage cells (to turn off and on) and a valve to switch between the old Usually, when soil absorption cells fail early on in their system and the new. life one can point to a major installation, soil or operational error. I don't feel that there was either an If there are any questions regarding this report please installation or soil related condition so atrocious as to contact me. cause the early hydraulic failure. There are thin, weak lamellae at and immediately below the system elevation and at greater depth thicker and more dense A zov }} �i bands. The lamellae that are immediately below the 14 ` 4!�� system elevation should not restrict water movement Leroy d Jansk' , VRPSSLWastewater Specialist enough to be the cause of serious hydraulic problems. leroy.jansky @wisconsin.gov E -mail If the bands were much closer to the bottom of the (715) 726 -2544 Voice (715) 726 -2549 Fax system then they could be a problem since I feel they would slow water movement down substantially. cc: ® County ® Plumber ® CST From our conversation, the owner does not seem to ® Owner ® John Schmitt be overloading the system's capacity nor are pharmaceuticals an obvious issue. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 515258 0 (ATTACH TO PERMIT) GENERAL INFORMATION 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: Venhor, James I Somerset, Town of 032- 2044 -30 -200 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: O� GS (' 12.30.19.648C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM F; I Z - l0 9 7, Z(o +n Bldg. Sewer -- Ad Holding /� � Z� /� SUHt Inlet TANK SETBACK INFORMATION SvHt Outlet / y5 ce�p TANK TO P/L WELL #BLDG. Vent to Air Intake ROAD Bt-Intet� 6� W; Coll Sep 60 J Z 3 / Dt Bottom �si►x� / "" i Z-7 /j 1 7 Header /Man. ? I 7 Aeration 3 d J Dist. Pipe -7 •9 Holding Bot. System 3• $L Final Grade ' PUMP /SIPHON INFORMATION 3 , (p Z Manufacturer Demand St Inver e 4 Z GPM t �p J ' Model Numb 6( TDH Li Friction Loss System Head TDH Ft Forcemain I L6RbTh Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width / Length ! INo. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dial. Liquid Depth DIMENSIONS 5� SETBACK SYSTEM TO G P L JBLDG f C WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION 01 CHAMBER OR Type Of System: q UNIT Sq /� Model Number: A0e, DIST RIBUTION SYSTEM n J �g Z3 * ZS = 4lp Header /Manifold .ov Distribution x Hole Size x Hole Spacing Vent to Air I ke 1 L ' Pipe(s) Lengt Dia T Length Dia Spacin 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 41 � /q Bed/Trench Edges \ Topsoil \ Yes 0 No Yes No COMMENTS (Include code discrepencies, persons present, etc.) Inspections #1: / / Inspection #2: Location: 1667 85th Stre New Ne Richmond, WI 54017 (SW 1/4 NW 1/4 1 T3ON R19W) NA Lot 2 Parcel No: 12.30.19.648C 1.) Alt BM Description = t'"� rtw_ �a��- C �' e� C " -" `"S ° i�- 2.) Bldg sewer length - amount of cover = vx ~ 5 Plan revision Required? W Yes (No Use other side for additional informati n SBD - 6710 (R.3/97) Date Insepctor nature Cent. No. Safety and Buildings Division County 0 gton Ave., P.O. Box 7162 s C eo Y MA Ave., - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce _�•- (608) 266 - 3151 51 52 5 Sanitary Permit Applica State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal inf on yo may be used for secondary purposes Privacy Law, s15. lxm) t Address (if different than mailing address) L Application Information - Please Print All Information MAY 1 7 ?01 1(,L 7 �5 Property Owner's Name COUNTY are el # Lot # Block # 8 ZONING OFFIC L PLANNING b 14 � �Nbl - Z0gq - Z00 Property Owner's Mailing Address Property Location 16 6 7 S S Tw 57 - - ?t� E7 — • City, State Zip Code Phone Number •✓ —J� � .' /S �- ` /s, Section t 1C tcl-l111O1Vyo 7 S L /o/ 7 T N, R Eo ) IL Type of Building (check all that apply) ❑ Subdivision Name CSM Number 1 or 2 Famity Dwelling - Number of Bedrooms ❑ Public /Commercial - Describe Use ❑ State Owned - Describe Use ( L---) z ity ❑village hip Same,�SE ®'fowms of IIL Type of Permit: (Check only one box on fine A. Complete line B if applicable) A " ❑ New S Replac S ❑ Treatment/Hold' Tank system ep S ystem mg Replacement Only ❑Other Modification to Existing System B. ❑Permit Renewal E] Pernik Revision 11 Change of ❑ Penult Transfer to New Last Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWT5 stem: Check all that a pply) R Non - Pressuriz In- Ground ❑ Mound >24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Fitter ❑ Aerobic Treatment Und ❑ Recirculating Sand 1 Filter ❑ Recirculating Synthetic Media Filter ❑ L.eaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) .Lets 4 -1 D. Die rsal/Trea ent Area Information: sJ ; Design Flow (gpd) Design Soil Application Rate{ Dispersal Area Required Dispersal Area Proposed { System Elevation e0,0NO or VL Tank Info Capacity in Total Number Manufacturer Prefab Site Sted Fiber Plastic Gallons Gallons of Units /l _ /J 4 14n Concrete Constructed Glass New Existing � y y Tanks Tanks X /$ i iAl i C l� S Septic or Holding Tank / ML /000 Z 606 C GtJ W / t t Aerobic Treatment Unit Dosing Chamber VIL Responsibility Statement - I, the vmdersillned, assume respondbillity for histalladon of the POWTS shorn on the attacked Plans. Plumber's Name (Print) Plumber' S' h MP/MPRS Number Business Phone Number 7 60 Plumber s Address (Street, City, State, Zip ) (4P / / (,o sV rtv VIIL Conn /De partment Use O nly pproved ❑ y Sanitary Permit Fee (includes Groundwater Date ed leaving Agent (Ato ) Surcharge Fee) r C] en Reason for Denial J / 7 IX. Conditions of Approval/Reasons for Disapproval JG � a n r t SYSTEM OWNER: J L e�,gL, 64r6 y: Septic tank, effluent filter and . Qap d' dispersal cell must all be services / maintained Q y / as per management plan provided by plumber. Z. All setback i`eguirements must be maintained e as per Code f ordinettces. �,1.{,,1�,,,,, . ,•. bad• w�.e -. ^ `� Attoch complete plum (to the County only) for the system on paper oat kn tMa el :11 tocbm to else � .3EA4\ �-& r Page 2 of 11 PLOT PLAN (James & Sandra Venhor) ♦ BM1 Elevation = 100.00" Bottom of siding on house. A BM2 Elevation = 97.40' Top of well cap. ■ Backhoe pits Slope= 1.5% Elevation Trenches = 95.00' 2 — 3'x 92' INFILTRATOR Quik 4 Trenches NOTE: 2" 1000 gallon septic tank added to system with Zabel A -100 filter N Bull Run Valve added to alternate between new and old system Scale: V'= 40' t-` `n \ EX/571 N(, 00 oC ID eo o FIELb 6171 Z t G&gOrGt" x/s6�N� BZ I. 57o 3 3�n�oart dALV 5t�o 14®usE N�wT 83 313 ' � COPY Page 1 of 11 CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Venhor Conventional Gravity Septic System Owners Name: James and Sandra Venhor Owners Address: 1667 " Street New Richmond, M 54017 Legal Description: SW /., NE' /,, S12, T30N, R19W Township: Somerset Subdivision Name: 4.65 Acre Parcel Lot Number. 2 Parcel ID Number. 032 - 2044 -30 -200 Page 1 Index and Title Page 2 Plot Plan Page 3 System Cross Section and Sizing Page 4 Filter Information Page 5 Bull Run Valve Information Page 6 &7 Maintenance & Management Plan Page 8 Septic Tank Maintenance Form Page 9 Existing ank Certification g Page 10 Warranty Deed Page 11 CSM or Plat Attachment: Soil Evaluation Report Designer/Plumber.. John Schmitt License Number 223760 Date: May 17, 2010 Phone Number. 715 -760 -0486 Signature ���`/►// Dni®ied pmmmud to the hi-& uod Solt Abwrprtion Componat Mamw for Powrs version 2.0 SBD- 110705 -P (N.01/01). Page 2 of 11 PLOT PLAN James & Sandra Venhor ♦ BM1 Elevation = 100.00" Bottom of siding on house. A BM2 Elevation = 97.40' Top of well cap. is Backhoe pits Slope= 1.5% Elevation Trenches = 95.00' 2 — 3'x 92' INFILTRATOR Quik 4 Trenches NOTE: 2" d 1000 gallon septic tank added to system with Zabel A - 100 filter N Bull Run Valve added to alternate between new and old system f7r Scale: 1 — 40 V) \ �Exis r► N(, OD QC l=tEL6 6l'►'i " Z tXSi►N` G A G£ �000 A s , r. 87- I .Sao 3 8613 �oa�t J LV 5ioP Nous Nfw 6M l 63 3 3' Page 3 of 11 $oil Absomtion System Cross Section 98.20 ft , 4 soha" 40 Final Grade PVC Vat P4;* with V" cap 96.00 ft 95.00 ft. Trench Elevation Trench Eevation 3 ft >3 ft Soil tr n System Plan 92 ft 3 ft 3 ' ft Vent Or Observation Pipe Chber9s Trench 4 4 ' DIL Trench 2 Header Leachina Chamber, Specifications Manufactuer And Model INFILTRATOR Quik 4 ESIA Rating F 20 sq. ft per chamber ESIA Rating 5.8 sq. ft per 2 endcaps DWF 450 gpd Soil Aplication Rate 0.5 gpd /sq. ft 450 gpd DWF + 0.7 Soil Aplication Rate + 20 ESIA= 45 Chambers 2 rows of 23 chambers each. Page 4 of 11 MAINUNANCE 1;)TU A100 TV A300y, A600 " -12 Series F ilters The interval For serytim sepk tarns is set by stye and local code. Thrat#llout the United States there is a wide d9erenoe d opmian on aitiat this mterwaf St�oukJ b� tx�t D9 =1%, agencies two to five y�aars. The Zabel' ice, wtrictt does not irxrease dre fre tr�tcy d servicng for the tank. slrarld be cWarled ' V= tank rs rnamtaiy irispectted and pumped Howemer. otr fifer is set- clewing. Ttre eoMmie+d acts d dw anaeroW organisms on the Zabel filer causes lodged Wiles to drs r tegate and fall to the botltom of the tank. 9 y' filter contains a Smartf icier alarm, you wil be notified by an alarm the filter needs seraXH4 To sawim die ter: 'Servidng anymt pf Ida sh aud tntp be dbnP bya certifecl septic tank pumas arMsbow Locate dre STEM' STEP nL- Remme the tank cam Frr;dy ped die tier and porp the lank i handle and side die nec to pfuverrt any cartrk* out d dwe srsl rDm escaping is tee. the l-ield when the der is remomd. STEP ;r!' '� STEP Insert the filter cartridge bade WhHe hol rig the cartii* am die in d're case making swe the as cess openrg rinse eff the age rifler cartridge - with fresh �+a�r, bang carat# to rinse aligned and at septage material bad W the tank.. hsenW in the case. Replace do septic lm* caA. Nooae: + N ym hawse a Fettered Imssce- Nbdel Fier, be mn and Wray dean d* outlet opemng b*re the Fifer. ; V5 . CWpgtt Q3.1abei d:sfiaes €manatraxt rU� tcrr , y F-Wu N mrmrcd t j am or mom BPS. metr Wtwrotcroi pearls C tv U1 m rrp<^r wcM rat nimybe p" jv Ca 11 for a free ZABEL ZONE" 1-800 -221 - 5742.Or Order Online; www.zab+ekwo.com American Manufacturing Company -- Bull Run Valve Page 5 of 11 AMERICAN ONSITE AMERICAN MANUFACTURING COMPANYp INC. Home About Site Map Products Drip Systems Controls Contact Data Center THE BULL RUN TM VALVE ' WATER-T10HT ACCESS CAP RISER CAP 3 ADAPTER k RISER TUBE VALVE DIRECTION HANDLE The Bull Run Valve'" is designed to split flows to septic d" Ott PORT fields or systems. In addition to the advantages of longer life and easier installation it is the most public 4 " OUT PORT health safe alternating device available for wastewater disposal applications. The use has absolutely no contact with wastewater due to the valve's leak -proof and external operating characteristics. The change over from 4" IN PORT one drainage field to another can be accomplished in less than a minute by simply turning the valve without The Bull Run Valve is available in 4" sch 40 pvc digging or contact with wastewater. and is suitable wherever septic disposal systems are used - In commercial, industrial, and residential applications. OPERATING THE VALVE The direction control handle should be rotated Field Field V o periodically to direct effluent to one or the other No_ 1 No- No- of two septic fields. After removing the screw cap at the top of the riser tube, the valve handle Valve can be turned with the valve key furnished. Positioned ed BULL RUN VALVE on No. I n 2 Complete Valve Kit during during Odd Years Septic Septic Even Years Contains Tank Tank 1. Bull Run Valve body 2. 28" Valve Key 3. Riser Cap Adapter ITEM DESCRIPTION 4. Watertight Access Cap BRV4 BULL RUN VALVE 4" BRVBULK BULL RUN VALVE & KEY ONLY BRVCIRISER BULL RUN VALVE RISER W/ CAST COVER BRVCHUSER - 4" BRVKEY28 BULL RUN VALVE KEY 28" http:// www. americanonsite .com/american/catalog/brv.httnl 5/17/2010 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 6 o 11 FREINFORMATION SYSTEM SPECIRCATIONS owfw James & Sandra Venhor Tank Manufacturer Weeks C. P. ❑ NA Permit # ® Septic ❑ Dose ❑ Holding vol. 1000 gai DESIGN PARAMETERS Tank Manufacturer Wieser Concrete ❑ NA Number of Bedrooms 3 ❑ NA 8 Septic ❑ Dose ❑ Holding vol. 1000 gef Number of Pubic Facility Units ® NA Effluent Filter Manufacturer Zabel p NA Estimated ( a v er) flow 300 gal/day Effluent Filter Model A-100 Design (peak) flow - (Estimated x 1.5) 450 aVda Pump Manufacturer ® NA In Sku Soil Application Rats 0.5 da /fe Pump Model Standard InfluentlEffluent Quality Monthly average' Pretreatment Unit N NA Fats, Oil & Grease (FOG) 530 mglL ❑ Sand(Gravel Ffter ❑ Peat Filter Biochemical Oxygen Demand (BODE) 5220 mgfL ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mgfL ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Manufacturer Biochemical Oxygen Demand (60136) 530 mg1L Dispersal Cell(s) ❑ NA Total Suspended Solids (TSS) 530 mgfL ❑ NA a in- Ground (gravity) ❑ In- Ground (pressurized) Feel Coliform (geometric mean) 510' ckdl 00ml ❑ At -Grade ❑ Mound Mwdmum Effluent Particle Size 4 in dia. ❑ NA ❑ Drip -Line ❑ Other. ❑ NA Other: ❑ NA 'Values tyuical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency inspect concliition of taric(s) At least once every: 3 ® ear s s (Maximum 3 years) [I NA Pump out contents o f [I When combined sludge and scum equals one -third ( of tan, k volume mss) El When the high water alarm is activated ❑ NA Inspect dispersal call(s) At least once every+: 3 ■ y s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: month(s) [I NA 1 . Years ) Inspect pump, pump controls & alarm At least once every: ❑ mon s) ❑ NA ❑ year(s Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) 01W. At least once every: ❑ month(s) ❑ NA ❑ ear(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal ells 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 (pumper). Tank Inspections must include a visual inspection of the tank(s) to identdy any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The dispersal cefl(s) shall be visuaiy inspected to check the effluent levels in the observation pipes and to check for arry 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 treatment 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 118, Wisconsin Administrative Code. Ali other services, including but riot 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 rshm n�mm Page c?f l l START UP AND OPERATION For new.construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals that may impede the treatment process and/or damage the soil dispersal cell(s). If high concentrations are detected have the contents 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 extended power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose and may overload them resulting in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; diWnffectants; fat; foundation drain (sump pump) discharge; 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 an dlor is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Cade: • 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 of by a Septage Servicing Operator. After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: • A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. • A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. 9 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 ANDIOR 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 John Schmitt Name John Schmitt Phone 715- 760 -0486 Phone 715- 760 -0486 SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name Darrell Septic Service Inc. Name St, Croix County Zonin Phone 715 -4 Phone 715 - 386 -4680 6 This rlrr.&imont wad rlrahad by tho ctnffc of tho rrPPn 1 akP Marnita"s- And Waiiehnra r:ramty 7nninn anef 33anitatinn nnPnriPa in rmmr6anrP with rhnntPr ST. CROIX COUNTY PWe 8,of 11 SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer J A tK E5 V E W-1 Og Mailing Address 14 6 - 7 8 5 S Tom' E t: 7 Property Address 54 M c �11 (Verification required from Planning & Zoning Department for new construction.) City/State N C W R t C 141 110 t J b k rParcel Identification Number 0 3 `Z O q V - 3Q - Z OO LEGAL DESCRIPTION Property Location, 5 LA) 1 /a , NE 1 /a , Sec. 1Z, T 3.Q_N R 9 W, Town of 5041 15e5& - 7 - Subdivision , Lot #--7--. Certified Survey Map # , Volume , Page # Warranty Deed # Co Z 0'? 5q , Volume / 5 I , Page # 36 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 I= than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards sex 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. I/we 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 of a warranty deed recorded in Register of Deeds Office. Nu7= fT SIGNATURE OF APPLICANTS) 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. ft" Page 9 of 11 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) 16,67 SST" Sr ME W kccI4. located at: SW '/4, hJ6 '/4, Section /Z - ,Town - 30 N, Range Iq W, Town of go 01 fe5& , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service - - Z 0, Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: 1000 Construction: Prefab Concrete K Steel Other Manufacturer (if known): CE •K S C �d Age of Tank (if known): /0 L Oe,41Z 1> Permit number (if known) (I Plumber Signature) (Print Name) Z Z3 7& D (Title) (License Number) MP -/7- z o o (Date) Form to be completed by licensed plumber (Dept of Commerce Chapter 5 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 9/2008 , . Pll E poi. x.501 360 620954 STATE BAR OF WISCONSIN FORM 2 - 19" KATHLEEN H. WALSH REGISTER OF DEEDS r WARRAh= DEED ST. CROIX CO., WI This Deed, made between Cyrella A4. Flandrick, a single person, RECEIVED FOR RECORD Granter, and F. James Venhor and Sandra Venhor, husband and wife, 04 -10 -2000 10:30 AN as survivorship marital property, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee E � Y DEED the following described teal estate in St. Croix County, State of Wisconsin (The CERT COPY FEE: "Property"): COPY FEE: TRAM9FER FEE: 105.00 Lot 2 of Certified Survey Map filed December 23, 1998, in Volume 13, page R PAGE FEE: 1 .00 3577, Document No. 594356, being part of the Southwest Quarter of the Northeast Quarter (SW -1/4 of NE -1/4) of Section 12, Township 30 North, Range 19 West, St. Croix County, Wisconsin. Recording Area Name and Return Address Bank of New Richmond P O 128 New Richmond, WI 54017 032- 6Ll.30.300 Parcel Identification Number (PIN) This is not homestead property. Exceptions to warranties: Subject to ail easements, restrictions and covenants of record. Dated this day of rNlr'l>.1� , 2000. •C M. Flandrick r s AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) /l )as. ' CI i l( County ) authenticated this , day of 2000. Personally came before me this 15 day of 2000 the above named C' ti r�ilo. /V1.4 rig ? ..... to me known to be the person(s) who, C -4 tWd'the Foregoing instrument and sekttowledge the same. ; Py V a �/ TITLE: MEMBER STATE BAR OF WISCONSIN P (If not, authorized by § 706.06. Wis. Stets.) THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of Wisconsin 't ^ Ronald L. Siler My Commission is permanent. (if not, "on date: VAN DYK, O'BOYLE & SILER, S.C. Post Office Box 127 Rj0Mgj1d- W1 54017 (Signatures may be authenticated or acknowledged. Both are not necessary.) N ��'SOIL VALUATION REPORT #1627 . Mi scons� Department of Commer �O� rda ce with Comm 85, Wis. Adm. Code County Page 1 of 4 Division of Safety and Bu ings MAY '� Schmitt Soil Testing, Inc. Attach complete site plan on per not.le �($3t; a in size. Plan must St. Croix include, but not limited to v on I andaA (BM), direction and percent slope, scale or d d distance to nearest road. Parcel I.D. imen o ion an 032 -2 30- 00 Please print all information. Revie By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 3 Z )' �b Property Owner Property Location Venhor, James & Sandra P Govt. Lot W1/4, NJ/4, 12, T30N, R19W Property Owner's Mailing Address Lot # Block # Subd. Name orFCSM# 1667 80th St. 2 CSM 13/3577 City State Zip Code Phone Number City ❑ Village 0 Town Nearest Road New Richmond WI 1 54017 1 715 - 246 - 4669 1 Somerset I 85Th St. ❑ New Construction Use: Z Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Z Replacement ❑ Public or commercial - Describe Parent material Outwash Sand (Sattre series) Flood plain elevation, if applicable na ft. General comments and recommendations: Replacement area is suitable for a conventional system with 0.5 g d /sqft rate. Possible system elevation ranges from 93.2' to 95.0'. Slope is 1.5 %. F 1-1 Boring # El Boring ,1 Pit Ground surface elev. 98.43 ft. Depth to limiting factor 106+ 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. *Eft#1 *Eff#2 1 0 -11 10yr3 /3 none sl 2fsbk mvfr as 2vf .6 1.0 2 11 -19 10yr4/6 none sl 2msbk mfr gw 1vf .6 1.0 3 19 -24 10yr5 /6 none grsl 3msbk mfr gw lvf .6 1.0 4 24 -32 7.5yr4/6 none grs Osg ml gw - - - -- .7 1.6 5 32 -61 10yr5 /6 none grcos Osg ml gw - - - - -- .7 1.6 6 61 -106 10yr6 /4 none s Osg ml - - -- - - - - -- .7 1.6 t r ❑ 2 Boring # Boring Z Pit Ground surface elev. 98.48 ft. Depth to limiting factor 100+ in. Soil Application lication 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 1 0 -11 10yr3/3 none sl 2fsbk mvfr as 2vf .6 1.0 2 11 -20 10yr5 /3 none sl 2msbk mfr gw ivf .6 1.0 3 20 -30 10yr4 /6 none sd 3msbk mfr gw 1vf .4 .6 4 30 -35 7.5yr5/6 none grls icsbk mvfr gw - - - - -- .7 1.6 5 35 -55 10yr5 /6 none s Osg ml gw - - - - -- .7 1.6 6 55 -77 10yr6/4 none Osg ml cs - - - - -- .5 1.0 7 77 -100 10yr5/6 none ' cos Osg ml - - -- - - - - -- .7 1.6 * Effluent #1 = BOD 5 > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD s30 mg /L and TSS S mg/L CST Name (Please Print) Si n• ture: CST Number Thomas J. Schmitt 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond, WI 54017 5/12/2010 715- 247 -2941 SBD -8330 (R.07 /00) Property owner Venhor, James & Sandra Parcel ID # 032 - 2044 -30 -200 Page 2 of 4 Boring # ❑ Boring Pit Ground surface elev. 98.16 ft. Depth to limiting factor 104+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD 1ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Efl#2 1 0 -9 10yr3 /2 none sl 2fsbk mvfr as 2vf .6 1.0 2 9 -17 10yr4 /3 none sil 2msbk mvfr gw 1vf .6 .8 3 17 -24 7.5yr4/6 none Sid 2msbk mfr gw 1vf .4 .6 4 24 -30 7.5yr5/6 none gr cos lcsbk mvfr gw - - - - -- .7 1.6 5 30-49 7.5yr5/6 none grcos Osg ml Cs - - - - -- . 7 1.6 6 49 -78 10yr6 /4 none fs Osg ml Cs - - - - -- . 5 1.0 7 78 -104 10yr5/6 none cos Osg ml - - -- - - - - -- .7 1.6 C r5 H F-1 Boring # Boring ❑Pit Ground surface el v. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description T xture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 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/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 " Effluent #1 = B00 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) Schmitt Soil Testing, Inc. Page 3 of 4 Conducted by: Conducted For: Schmitt Soil Testing Inc. Name: James & Sandra Venhor -Thomas J. Schmitt, CST 227429 Address: 1667 85th St. 1595 72nd St. City, State, Zip: New Richmond, W154017 New Richmond, WI. 54017 Phone: 715 -247 -2941 Subd.Name: CSM 13/3577 Signature Lot No.: 2 Dare /-� © Legal Description: SWl /4 NE1l4 S12 T30N R19W ■ Backhoe pit Township, County: Somerset, St. Croix County ♦ Bench Mark 1 El. 100.00' Bottom of siding on house A Bench Mark 2 El. 97.40' Top of well cap Slope= Scale 1" = 40' E x �(V' QCi4,►,tt p� 7, sl y i l u d R� �'"� AR E /0 801 N PtA 3 7 ttrs [ , . �/ y �♦ �.O Z ' ��� ,T �'<?� ,.,� 1. r�k� *- ,� �,. x �2 � � } N � Y I � �� y � � � � ° �'"� , 5,+�✓ ��,�j'h - ..A �'" ., �' � • Iii; V� F V S. K Rk V @� q F x I� R .~k F ' S�Y � 1 i 2 ¢ l in >b #' FILED Z DEC 2 3 1998 ► KATHLEEN H. WALSH G Register of Deeds 5 SL Cron Co., WI CERTIFIED SURVEY MAP Located in part of the Southwest Quarter of the Northeast Quarter of Section 12, Township 30 North, Range 19 West, Town of Somerset, St, Croix County, Wisconsin. Prepared for and at the request of: OWNER: Cyrello M. Flandrick � —NORTH 114 CORNER 1914 Raleigh Road j SEC. 12 -30 -19 New Richmond, WI 54017 �l (ALUM. CO. MON.) Drafted by. Krlstl A. Eylandt UNPLATTED LANDS +�kaN D LANDS o NORTH LINE OF THE SW ,e ��t�► C�� -- p. �' - - -- i I r\ 114 OF THE NE 114 to RONALD F. "' 3 JOHN�ON ION I � p ;+ Ann F - F, Y, Co I ;� LOT 1 o WI �I N CERTIFIED SURVEY MAP < ' S-;... _ j �' • -1 0 � � VOLUME_12 PAGE 3388 I LOT z C.S_M. N89'37'57" E 660.07' o� VOL_ 11 PAGE 3205 ' 627.07 of i TOTAL AREA oj Uj i l I N 202,623 SO. FT. - al } W i N I oI o 1 4.65 ACRES ° of o cn N Cr rn I oI o AREA LESS R.O.W. ,°,� F- rn M M i Q 192,492 SO. FT. Q� 'o N ,. (n! � I j 1s33.00': J 4.42 ACRES al v 0 0 t zl ' N89'37'57 "E 660.07' � o 0 o =1 3 10 627.07' N � 'v W �IOI0 I -� : � oE`o j U m I N °. Co TOTAL AREA .� c °amo apI ;v a � I N C 202,623 SQ. FT. .9, E >, c c 3 0 0 oI o a ' �• 4.65 ACRES o N c �� N r i' I w �I � w L AREA LESS R.O.W. o X o l WI i I N rrn r° N �: 192,492 SO. FT. "� n o N a o n_1 i I N I N 4.42 ACRES ao �; o a C T m a� a O� C3 I O I O m: O a� v a ° z Z N89'37'57 "E 660.07' VVi E 0 Jj Z I I 627.07' w e o , (D OBI I I \ \ I c c. I r TOTAL AREA c o 202,710 SO. FT. ^ , i I I o o I ; 4.65 ACRES o'a a I I 0 I 0 " ~ AREA LESS R.O.W. o U) o a o j �I 1 192,578 SO. FT. N a ; v o+ _ m , c 4.42 ACRES CDC � o j U J PLAT OF NORTH I I I i 627.07' °a o BASS LAKE ESTATES j I S89'39'1 9'W 660.07 U NPLATTED LANDS OF OWNER t a o lI d .Lw 33.00' _ _..— .._..— ..— ..�.._..— ' JOB #97108 (R14) �` n C14 SOUTH LINE OF THE SW 114 OF THE NE 114 zz v ' N � O � j Z UNPLATTED LANDS LEGEND —SOUTH 114 CORNER County Section Corner Monument SEC. 12 -30 -19 of Record (ALUM. CO. MON.) • Set 1" x 24" Iron Pipe weighing a minimum of 1.13 pounds per linear foot. 200 0 200 O Found 1 Iron Pipe I NO TH Prepared by I A BC E GRAPHIC SCALE 1 1 SCALE IN FEET: 1 inch = 200 feet LAND SURVEYING & CIVIL ENGINEERING Phone No. (715) 246 -4319 BEARINGS ARE REFERENCED TO THE NORTH -SOUTH 1/4 109 East Third Street, P.O. Box 325 LINE OF SECTION 12, TOWNSHIP 30 N., RANGE 19 W. • New Richmond, WI 54017 WHICH IS ASSUMED TO BEAR S00'28'20 "W. Sheet 1 of 2 Vol. 13 Page 3577 f In k I S io 1 ` ` f ` Safety and Buildings Division `N9.`0/1S //1 SANITARY PERMIT APP ? 201 W. Washington Avenue P O Box 7162 Department of Cpmmerce In accord with Comm 83.05, ' . d �1,._, Madison, WI 53707 -7162 • Attach complete plans (to the county copy only) for the sys n p tgt ss ;c ty / than 8112 x 11 inches in size. • See reverse side for instructions completing this applic St �S nitary Permit Number 3�"7 ��� .. yam,^ Personal information you provide may be used for secondary purposes 5Y GFO) if revisloonTo p ►e�io . a Ic n [Privacy Law, s. 15.04 (1) (m)]. e an Review Transaction Number I. APPLICATION.IN FORMATI N - PLEASE PRINT ALL I Property Owner Name �" rt r! >m� &,�,, 1 �Z T , N, R ( W Property Owner's Mailing Address Lot Nu Block Number City, State 6/ Zip Code Phone Number Subdivision Name or CSM Number 3 J r7 II. TYPE OF BUILDING: (check one) ❑ State Owned !t Nei rt ; Public or 2 Family Dwelling m - No. of bedroo ❑ vlllageOF o /X III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) , 30 . f0 G 1 ❑ Apartment/ Condo G� 3 —, ?Od 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church / School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 2. E] Replacement 3, E] Replacement of 4_ E:] Reconnection of 5, C] Repair of an ___System __ System ------ __ Tank Only__ _____ ____ ___ Existing System -------- Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 30 E] Specify Type 41 ❑ Holding Tank tpk_ page Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit i LL 43 Vault Privy 14 [] System -In -Fill z j j, Tr VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7..Final Grade (sq. ft.) Proposed (sq. ft.) (Gal Requlr d s/ y /sq. ft.) (Min. /inch) Elevation �j Q 7 ? V Feet )7, "r Feet Capacity VII TANK in Ca g gallons Total # of Prefab. Site Fiber- Plastic Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass App. New Existing strutted Tank Tank Septic Tank mg an x pQ ❑ ❑ El 1:1 ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ 1 ❑ 1 ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's ' ature: (N mps) MP/MPRSW No.: Business Phone Number: � � 6 7 >.t ysI Plumber's Address (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued lss ` ge Signature (No Stamps) (Approved E] Owner Given Initial Surcharge Fee) l /ZA �/ Adverse Determination 6 7&6 G /t, X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R.12/99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2 Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wiscor►sin Administrative Code will be applicable. 3. lilt revisions to this'perMit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions toncerning your onsite sewage system, contact local code administrator or the State of Wisconsin, Safety and _Buildings Division, 608 - 266 -3151. To be complete and accurate this sanitary permit application-m -ast include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to oe installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 o' 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County / Department Use Only. Complete plans and specifications npt smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water serv; -e; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas, and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications `or pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and p amp manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. I 8� s i f N O � � o' H�• � �o,.,a �fs.� 3 f 1 1 � , Q N � � o � ' 1 e ll c F Safety and Buildings Division 201 W. Washin Avenue V iscons SANITARY PER ./41P_,.1 N g \ - P0 Box 7162 -�� , Department of Commerce In accord with Co , wis. A*. Code �- Madison, WI 53707 -7162 • Attach complete plans (to the county copy only) for s�istem not less` County A than 8 112 x 11 inches in size. • See reverse side for instructions for completing this ppficat , tate Sanitary Permit i A. Personal information ou rovide ma be used for seconds `,y ST 3 Coq y p y second purposes - CAUNN 1 [I Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. v ZOt`F1NG OfF4CE State Plan Review Transaction Number I. APPLICATION INFORMATION - PLEASE PRINT AL "" Property Owner Name / P° A 5/ Z N, R E T, Property Owner's Mailing Address Lot Number Block Number Qty, State � } Zip Code Phone Number Subdivision Name or CSM Number 11. TYPE OF BUILDING: (check one) ❑ State Owned ❑ !tr Nearest Ro Public or 2 Family Dwelling - No. of bedrooms own of v - `- 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) ��. I q.. t oy'" +e c 1 ❑ Apartment / Condo O�.Z d 1 �� -3e 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1-,E3jdew 2 ❑ Replacement 3. ❑ Replacement of - 4 ❑ Reconnection of 5, ❑ Repair of an System - System ------- - - - - -- Tank Onl_r -------------- Existing System -- - - - - -- Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 1 24ff Seepage Trench 22 ❑ in- Ground Pressure 42 ❑ Pit Privy t'f ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill - j K 7t LI VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade �j Required (sq. ft.) Proposed (sq. ft.) (Gals/ ay /sq. ft.) (Min. /inch) Ele ation 5 C�i'� 6 - , ,S Z �J ; Feet i 0 Feet Cap acit y VII. TANK in Ca gallons Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank 1 QdQ ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ I ❑ ❑ 1 ❑ ❑ ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumb is Name: (Print Plumber' r Sta ps) MP/ ^ P U W No.: Business Phone Number: Plumber' A cldr ss (Street, City, State, Zi ode): /)f IX. CO / DEPARTMENT USE ON V ❑ Disapproved S itary Permit Fee (includes Groundwater D ate Issued Issuing Agent Signature (No Stamps) P Approved f Owner Given Initial Surcharge Fee) Adverse Determination S X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6396 (R.1 2/99) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber — INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable, 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. if you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608- 266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply - IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information- Fill in the capacity of every new /or existing tank, list the total Gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material, Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number wi th appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County / Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be sub-pitted to the county. The plans must include the following: A). plot plan, drawn to scale or'with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. W isconsin Department of Commerce S OIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau oY Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach.complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County < . include, but not limited to: vertical and horizontal reference point (BM), direction and V ,{ r p 1 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. # C�? 3 �L- 30-300 APPLICANT INFORMATION - Please print all information Reviewed by Dat Personal information you provide may be used for secondary purposes (Privacy law, s. 15.04 (1) (m)). ��j2 Property Owner Property Location , Jc, --Q U Govt. Lot 1/4 4,S l - T 3�,N,R 9 E (or) Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# City State Zip Code Phone Number Rd Nearest Road � ❑City ED To �t eJe / t' D/ ( ) a Nearest ew Construction Use: residential / Number of bedrooms Addition to existing building ❑ Replacement El Public or commercial - Describe: Code derived daily flow '5� `, � gpd 77 Recommended design loading rate ' � bed, gpd/ft 'trench, gpd/ft Absorption area required / � bed, ft J trench, ft/2� Maximum design loading rate / 7 bed, bed, gpd/ft V trench, gpd /ft Recommended infiltration surface elevation(s) ,% S. ft (as referred to site plan benchmark) Additional design /site considerations /� -a'�D ✓ vi�o .Sd - Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mo nd In- Ground Pressure AT Grade System in Fill Holdin Ta U = Unsuitable for system ❑ U ❑ U ❑ U ❑ u ❑ S ❑ S 0 u SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft g Texture Consistence Boundary Roots yx in. Munsell qq Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Ground 4 Ord l�T.F o ,'l Depth to � limiting `?�r9 u , ..r -� �ti b f ���SS 4 fac or S ��w �17 in. Remarks: Boring # fl w ✓� .lam C'�- S' Ground ; Depth to , limiting factor ,7,S --S n. Remarks: CST l� (Please Print) 'nature Telephonp�� � � Q Ad dress ' i Date l CST Number 6 _6 _ SOIL DESCRIPTION REPORT PROPERTY OWNER Page of PARCEL I.D.# Boris # Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench w Ground ��� .S 61 Depth to p3 limiting factor S Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # ; Ground elev. ft. Depth to limiting factor in ' Remarks: Boring # Ground elev. ft Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) PLOT PLAN PROJECT James venhor ADDRESS 1110 180th Ave New Richmond Wi 54017 SW 1/ NW 1/4S 12 /T 30 / 19 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/6/00 BEDROOM 3 CONVENTIONAL XXX IN -GROUN PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .8 ABSORPTION AREA 572 # of chambers 18 BENCHMARK Y.R.P. Base of Shed Siding ASSUME ELEVATION 100' ❑ BOREHOLE (D WELL *H. R. P. Same as Benchmark Alt. BM Top of White Stake @ 100 SYSTEM ELEVATION 85th St. 2L.- idewinder High apacity Leaching hamber with 31.8 t ^2 per chamber 34 Grade at System Elevation VA I ��q Pro 3 300' y ( � � � utl U r Bedroom Shed House ( to Pot t11Q -`dIZ * B.M. 40' Cpwt . 1 0' 2% 40 r 30 T Slope Alt. 10 30' 30' -2 a, 5 0 B -1 Vents B -3 2 -3' X 56' Trenches with 6' Spacing 100' 4 4 �' � Rep A 0 , V b° � � V 4r •' � PLOT PLAN PROJECT James Venhor ADDRESS 1110 180th Ave New Richmond Wi 54017 SW 1/4 NW 1/4S 12 /T 3 N/R 19 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 4/30/00 BEDROOM 3 CONVENTIONAL XXX IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .8 ABSORPTION AREA 572 # of chambers 18 IL BENCHMARK V.R.P. Top of White Stake ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark Alt. BM SYSTEM ELEVATION 95.2 Top of Wood Stake @ 98.2 Alt. � B.M. 230' Pr operty Line 36 6' B -4 30' -2 Rep A Vents 0' 4% 75' B -3 S lope 2 -3 , 6 Trenches p e with 6 Spacing 35' w 0 -1 0 B -5 30 15 , 10' S c� Pro 3 Vent Bedroom House 12 „ Sidewinder High Of ver Capacity Leaching Chamber with 31.8 6' Lon 16" ft ^2 per chamber 3 4� Grade at System Elevation 660' Property Line Soil Test Plot Plan Project 'Name James Vehnor Sha Address 1110 180th Ave New Richmond Wi 54017 CSKM #226900 Lot 2 Subdivision ------- Date 6/6/00 S W 1 /4 N W 1 /4S 12 T 30 N /13 W Township Somerset F1 Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Base of Shed Siding System Elevation 93.0 *HRP Same as Benchmark Alt. BM Top of White Stake @ 100.0 85th St. AL 300' Pro 3 Shed Bedroom House B.M. 40' 40' 2% 5' Slope 30' k B 30' 30' -2 - 15' B -3 100' l Rep A I� ` Soil Test Plot Plan Project' Name Cyrella Flanderick Shaun Address Raleigh Drive N Ri Wi 54017 CSTM #226900 Lot 2 Subdivision -- ----- Date 1 SW 1/4 NW 1 /4S 1 2 T 30 N/R 1 9 W Township Somerset FI Boring 0 Well PL Property Line County ST. CROIX IL BM or VRP Assume Elevation 100 ft. Top of White Stake with Orange Ribbon System Elevation 95 .2/94.0 * H R p Same as Benchmark Alt. BM Top of Wood Stake @ 98.2 Alt. * B.M. 230 660' Property Line 0' 36' 36' B -4 30 ' -2 R ep A Pri A 0' 4% 75' B -3 5' Slope L5' 0 B -5 30' r c Pro 4 Be�room House 660' Property Line 5 IPA 6 �.i0 0 - 620954 • STATE BAR OF WISCONSIN FORM 2 - 1995 KATHLEEN H. W ALSH REGISTER OF DEEDS WAI&RANTY DEED ST. CROIX CO., WI This Deed, made between Cyrella M. F'landridt, a single person, RECEIVED FOR RECORD Grantor, and F. James Venhor and Sandra Venhor, husband and wife, 04-10 -2000 10:30 AN as survivorship marital property, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee YARRANTY DEED the following described real estate in St. Croix County, State of Wisconsin (The CERT FEE: "Property'): "Pro COPY FEE: 145.00 Lot 2 of Certified Survey Map filed December 23, 1998, in Volume 13, page R :IN6 FEE° 14'00 3577, Document No. 594356, being part of the Southwest Quarter of the Northeast Quarter (SW -1/4 of NE -1 /4) of Section 12, Township 30 North, Range 19 West, St. Croix County, Wisconsin. RecordinR Aron Name and Return Address Bank of New Richmond P 0 128 New Richmond, WI 54017 032 -2 0d4 3a2a0 Parcel idenntiation Number (PIN) This i 1 O i t _ homestead preptrV. Exceptions to warranties: Subject to all easements, restrictions and covenants of record. Dated this 31 day of M t . 2000. *Cy,d M. Ph drick ' t t AUTHENTICATION ACKNOWLEDGMENT Signantrt(s) STATE OF WISCONSIN ) ss. County ) authenticated this _ day of .2000. Personally came before me this 15 day of C� - is , 2000 the above [tamed C� re ilt, M �lctrtdr�e�� ••• to me known to be the person(s) who eW {Id1be foregoing + instrument and ui;nowiedge the samy. TITLE: MEMBER STATE BAR OF WISCONSIN (if not, v authorized by § 706.06, Wis. Stats.) • II THIS INSTRUMENT wAS DRAFTED BY Notary Pubfic, State of Wisconsin f ^4 Ronald L. Siler My Commission is permanent. (if not, on date: VAN DYK, O'BOYLE & SILER, S.C. Post Office Box 127 New Richmond. W1 7 (Signatures may be authenticated or acknowledged. Both are not nwessary. ) ST CROIX COUNTY SBPTIC TANK MAINTENANCE AURBEWNT AND OWNERSHIP CERTIFICATION FORM i owaar/Buyer Mailing Address rrapedy Addre (Variflrlttion required flm Planning Department for new construction) aty/State Parcel Identification Number D 3 2-- _ 20 `{ `� — 30 ` z m Property / Location �� y ` 1, 2 T_ ,-"R,2W, Town of Subdivision Lot # .. ,. Cerdfled s urvey Map # / �� . volume Page # 3 Warirttnty Deed 2 9 5 . voluin page # Spec house Q 7 Lot Lines identifier © no Lpproper we and maiatensaceof your stpec syaoem could result is ids premature Was to htu dlewastaa• Proper M$ft consists of pumgftg cut the septic tonic every thtea years or sooner, if needed W a licensed pumper: What yott put into *e can affect the flmcdon of the septic tunic as a treatment stage in the waste disposal system. The property owner agrees to submit to St Croat Zoning Department a certification facet, signed by du oarasx sad by a VM p1wher, journeyman plumber, nWrietsd or a Houma & ,=*a'verifying that(i) the on she wastewateedispoed system is is proper oparati * conditioa and/or (2) altar inspection and powping (if necessary), the septic tunic fs less than 1/3 AM of sht*- Ywc, the under:iped have read dw above requirements and agree to maintain the private scwsge disposal system with 6e sdmdat* set forth, herda, as set by the Department of Commerce and the Departnunt of Natural Resource, Stun of Wiscoiaia. Certlflcsdon stating that your septic lzas been maintained must be completed and returned to the St. OMbc County Zoning Office witbin 30 da of the tbuaoo year riots data. TURS OF APPLICANT DATE 4WNF (we) cetli that au statements on this form are sue to the best of my (our) lcnowtadgn. i (we) 'Am (are) the ow'neds) of tit property a by virtue of it warranty deed recorded in Register of Dead$ Office. TUBE OF APPLICANT /DATE ws « «« it •sass« Any inforniatioa that is nus -nom rosy result to the sanitary parer' being revoked by the Zoning DeparM «' Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed I W isconsin , Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM Count y INSPECTION REPORT St. Croix •GENERAL. INFORMATION (ATTACH TO PERMIT) Sanitary Permit No -: Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)). 363867 Permit Holder's Name: ❑ City ❑ Village ❑ TOWn of: State Plan ID No.: Venhor, James I Somerset Township CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.: • O r c� . o SGe S = �3*�1 032 - 2044 -30 -200 TANK INFORMATION E VATION DATA 0t o TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Qee" Benchmark 1 1mO Oa .0 Dosing Alt. BM C,(o'f 99•`(5 1 Aeration Bldg. Sewer s. (D� ct�,0 Holding St! Ht Inlet ,gyp cis, 30' / T K SETBACK INFORMATION St! Ht Outlet TANK TO P! L WELL BLDG. Ventto ROAD Dt Inlet —` Air Intake Septic ��a0' 6' —� NA Dt Bottom Dosing NA Header / Man. 6 • `f 9`f • fof Aeration NA Dist. Pipe Holding Bot_ System L 3.3a PU IPHON INFORMATION Final Grade - ? . Zo Manufacturer Demand St cover To Model Number GPM TDH L' Friction Sy TDH Ft Loss I ead F remain Length Dia. H Dist. To Well SOIL AB RPTION SYSTEM B�D't NC Width Length � N f renches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN D IM E N S ION S �v� Man f arturer ' i SYSTEM TO P! L BLDG WELL LAKE/STREAM LEACHING SETBACK�' CHAMBER e O r e Num er: T � INFORMATION yP System: o pltj 0 ♦ 3 OR UNIT u DISTRIBUTION SYSTEM Header / /Manifold k Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. ia. acing Sfl 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 ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: aG 13 Inspection #2: Location: 1667 85th Street, So�merset, WI 54025 (W 1/4 NW 1/4 12 T30N R19W) - 12.30.19.648C -Lot 2 1.) Alt BM Description= 'S�°"'"�c� 2.) Bldg sewer length = ^ f(o 0 f J - amount of cover 3) C�) Imo - "L' Plan revision required? ❑ Yes CR No Use other side for additional information. o, 2 SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH ' SANITARY PERMIT NUMBER: } r � f r � r E € } 1 F k t g z l I s � k N _ � 1 Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of4ntegrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and �", C {O ;X percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # e r1 APPLICANT INFORMATION - Please print all information. Revf by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location l t �,C ch ✓u Govt. Lot c 1 /4 /4,S /a T :30 ,N,R ``� E (or� Property Owner' ailing Address Lot # Block# Subd. Name or CSM# l' City State/ Zip Code Phone Number ❑ City ❑ Village , F?_�j Town Nearest Ro d / ,New Construction Use: gResidential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow t'500— gpd Recommended design loading rate bed, gpd/f? �L o trench, gpd/ft Absorption area required 359 bed, ft ft 7 bed, d/fl � trench, d/ft Maxim loading rate � gp gp Recommended infiltration surface elevation(s (as referred to site plan benchmark) Additional design /sitee considerations / Parent material �cY.4114L Flood plain elevation, if applicable ' t✓Lh ft J S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system S ❑ U KS ❑ U 'RS ❑ U *Q S ❑ U ❑ S U ❑ S ,,® U SOIL DESCRIPTION REPORT Boris # Horizon Depth Dominant Color Mottles Structure GPD /ft 9 Texture Consistence Boundary Roots in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench ,I �S 4 7C S Ground O � Depth to limiting factor Remarks: Boring # Ground 3 =; ST CRD Depth to , ` . '� Ost%GOF I limiting `t factor 1414jin. Remarks: CST Name (Please Print) S' a e Telephone No. —'e Address Date CST Number 'L I ol� Y SOIL DESCRIPTION REPORT PROPERTY OWNER �r r 1l Page of PARCEL I.D.# Boring Horizon Depth Dominant Color Mottles Structure 2 g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color (� Gr. Sz. Sh. p Bed Trench Ground 3 4. Depth to limiting factor pp S ,Q 2 Remarks: i Bonng # � SLI Lg Ground glen, ft. Depth to limiting factor 7�in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # 1 1 21 C, ms6� Ground ele °1�ft. Depth to limiting factor 7�2Qin. Remarks: Boring # E 1 Ground elev. ft. , Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96)