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HomeMy WebLinkAbout032-2152-00-000 r - -r7000� - - - - - - - - - _- W,isconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division • I . INSPECTION REPORT Sanitary Permit No: 430205 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information jou 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: Parkins, Scott I Somerset Township 032 - 2152 -00 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: p • 0 / 0 , . U 13.30.19.1323 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchma Q -fb �vu D 0 9.0 Dosing � Alt. BM Aeration Bldg. Sewer p D D Holding St/Ht Inlet • —7 3 TANK SETBACK INFORMATION St/Ht Outlet ` O TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. loo Aeration pill -�i[T� Holding Bot. S stem !0 6. •• • to Final Grade L14 •S— PUMP /SIPHON INFORMATION Manufacturer 6emand St Cover GPM Model Numb 6'"Adq TDH l fift Friction Loss System H TDH Ft Force in Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ai BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS C I SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM t ACHING Manufacturer: INFORMATION MBER OR Type Of System: � h t V odel Number: DISTRIBUTION SYSTEM Header /Manifold Distrib x Hole Size x Hole Spacing ]Vent to Air Intake f It Pipe 10E Length Dia Length is 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 C ter Bed/Trench ges Topsoil Yes `!'' No Yes No nn '_ _ COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: V ! Inspection #2: Location: 1574 86th Ave Somerset, WI 54025 ( 1/2 N-/E� 1/4 13 T30N R19W) Nathan Hills 18 ` Parcel No: 13.30.19.1323 1.) Alt BM Description = f 3) � -l� �vjr— ' �S Oi- r-P ri cJ 61� 'j g Le— "hww! 2.) Bldg sewer length = p Al �. I , � Q �( (w S S e,4 WA-4 !?J amount of cover =� 3 �► ,M pto 4 Plan revision Required? s No — L,! IQ ;p Use other side for additi rm ti /I - 1• -��?- Date n e co ignature Cert. No. SBD -6710 (R.3/97) 09/2 2003 9:42 PAX 71.5 488 a248 FOLK COtiTNTY � P- �� � 0 3 00 2 W Safety and Bafldko Dlvielu}i. C @ /►� .20L W.'Wanhington Ave., P.O -B6k 7082 +iii V► M'aoiaon, WI 53707 - 7082 • - Sub Address D8Pi3rt.rnen%.0f Commerce IY - 7 4V4 Saidtaty P ermi t Application. III *=tad with COMM U-21•, Wb- Adm. Cadek ymar ti hOrntdt u you provide Cheek 9 &Vision J ` d Z d !� iae usod acErr I'cir�„s.a.W et3.tl4ftl�t'f - _,.,,,_, L A�p><ltlaflign Lttar,aation I�rintjxtatlicm stare: #run 1-0 Kt mbar :P'tvprxty Qwner'a Nerve f ex, ,,pp Prop" Owmes MaUtu►g Addrats Pzorwly Lurudo, - S ;2 3 z 132,3 W City. Stsde Zip Code Pltaur ,biuttibet Blo* I4undw &I ivisir3 ante C OM P ber 13 l or 'N' Fauuup qwnlfing NumberorBedraaaw __..a. � �y� _ _.._l1 .__ rIV& - - u r,�aiwarr�,��u�ra�!- ,.n�e�'�aee k..X - - - 93 suetoOwnerl . _.._ -. „. .,.. l ih.r.� s t euandt oad '96 IXY. �'ylw oP Pmrm4i (Chts one one hax nn lice A. uuebering is for fu#erns� usts.) (Cot upl Una B� If atppReable.) tw 2 C] Its lnconwnt SIB 3Cl lttpiata tnrut ol6 R Amato yamm T k (?nth _ 1 tin 8 stem County ueE !l. C,¢aie if St+ AWY Permit Previously Issued Parr&.. Number 1]n4e lseuext fV-' '><ypoOf IFOWB;aru: (Chock all that apply, N'umbexing Is rar intemkiI use.) 44;K Noa 4rexsurkwd xn-t3 mad 21 C1 Mound 4t1 17 sand Pilau su L7 Cnnnclrucwd Wedand 22 0 Ptxasarizedhi- Ground 41 U 1loiftTaaS 49 13 Sktgia Pam it 0 Ihlp Linn 45 13 AWratd¢ 46 ©Aerobic Ti-&u treat Milt 49 1 : 7 1 , u! .,latln8 IU DGtlmr V. ,�raaxa A�ep� 1ttP a_rms#iort: � � u � ~� � Q-4064 I . Desl9 t Plow (%Pd) AisparsW Aamm Dispe I Aren Sali (eitlou piwenlaloa ltata Systeus 10 v a ftd O ro , it teoquit Prop(Aet1 1Eatr (C3s1s 1Aays15t; 7:t) (i14i>, J1 xeW F6tevttCiaaa Tsmk Info _ betty in Total tVnmtxr 1vTanuloturee T?rafa6 lcri Stael Plbcr 1�IAst�C +CblllOM (jalions Of TWO �] / Comate. Coratwowd 131m N Fbctnttng /' '[ a) bapt" or Koroltt� 1'atttc Tautks Am" V-U. #0typoliblUty S Wemwt 4 am tindm400d, asmm reepowa tiw tar Im"n op r►t ti a >aC W'[s slwwa an th utmt,ited pleas. Plumbees Name (PdnL) [� ffeele sigmulre MWr Biffilawl; P tn Numb t. � Plutnbae's Atit(au (Street. IMY6 State, Zip Cade) e t Llayc (1 +avail Q pwas � s wttsry i'orwft Foes rwludos flrWtttdwuur �p Ts:,urRt tdng Agent ) Appr 'SIIY6 i rttclui �idvgt'sti'r �tn'cUarlfa .t7et:) ._. _. _ �_ �� ._ IX CauudIdens 0E APPrevaU!'tessatts for bhu � rpa ` _ ." -- -- - 3 >a H" Pv pt'.� SYSTEM OWNER: Sys4- &vh ?� 1 Septic tank, effluent filter and . /r AI _ dJSCS21 GONtxKISt S pro i ,reywtT or estataanpapertttd th►n "x' ur' 6 as per management plan vt e y p um er. / �� � a 2. All setback requirements must be maintained as per applicable code /ordinances. ab -6398 (R.. OV01) `� wisconsinDepartme rce SOIL EVALUATION REPORT Page_Lof Division of Safety and B s in accordance with Comm 85, Wis. Adm. Code ' County � Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must / , include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. — f �j'Z, .— 0 0 - (304 Please print all information. viewed Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). l dll s/ 3 Property Owner Property Location /� "-A Govt. Lot 1/4 1/4 S 1,3 T 3 N R j E (or)40 Property Owner's Mailing Address Lot # Block # � Subd. Nam or CSM# 3L "`' a. A /90 City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road New Construction Use: ❑ Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Pqblic or commercial - Describe: Parent material Flood Plain elevation if applicable ft. General comments ` p / V and recommendations: O : fO S � ❑ Boring �ry F / - ] Boring # 'm Pit Ground surface elev. 2 �. / 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 1 0 .9 3/7 &Z ` A qu> . S 2 - oY,? -5 A 0 W,C IV Ile CtS a," . Z- 3 — ;).9g y /G e F2—] Boring Boring # 1)/. / 7 � Q Pit Ground surface elev. W 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 b- v 3/Z �'� �As, hi a� , ,— VY IN Ef Ll 83 'j * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name (Please Print) Si gnat CST Number Address Date Evaluation Conducted Telephone Number SBD -8330 (R07 /00) 40 v Property Owner Parcel ID # Page - of -� F 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 3 ,es/ y 11,o4,e z 13 .3 / S 0 s� - ,7 A F-1 Boring # Boring ❑ ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I 'Eff#2 ❑ Boring # ❑ Boring El Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) Property Owner Parcel ID # Page Z of 3 Boring # ❑ Boring F ❑ Pit Ground surface elev. , 5- ft. Depth to limiting factor /J' in. Soil ligGon Rate ate 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 CL f �r,�0e',Ci ,rl ��S of 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 F-1 Boring # ❑ Pit Boring ❑ 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 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) u� 1/ 7~ ,& /,, �- SC S13 7'3c:,Nk /9 ZO T I � EcAt ! yo a ? /Dc) po 3, o 94 � J i I ! , I d c I i ot 1 , %a" , . I r ..� I I i I • I , { _ i I i I i . L I _ 1 I I I , , i _ I I I � t 1 a i' r I— I I I I r ' I � { I 1 u I I ' I I I I i , ; I 1� , J _<. 4.._4 n F-A-4 r 1 I L 1 1 a I i 1 ' i I, I r I I ( 1 �. 1 L _ I 10/08/2003 6 1 7152687080 GILLE TRUCKING PAGE 01 i Gll C r TaichK & UAU I NC 0 352 A& STREET Ann ERy, W1 54001 PRONE: (715) 268 -6637 FAX: (715) 268 -7080 Fax To: _ From Fax: Date: Phone; Pages (includes cover): Ca Re: CQ E3 urgent Q For Review ❑ Please Coe mom ❑ Please Reply © Please Recycle -Comments: n A 9 10/08/2003 06:44 7152687080 GILLE TRUCKING PAGE 05 li9/22/9003 XDW 00: -42 PAX TI.S 48$ 9248 Fc1T.i� G'OtiiMrY - A 201 w. WaddRoci A e.. P,CLaak 90a'3 c W1 52 - 7082' pe►pa r�alart•of CQm m ,orae /�' 5/ c' �►rera,Aaefeaon� ss.xt. a%. JaW. rbaa, Pmmwt ►ubrmAdw Ym& pravW p.ee x ebn L AmpUdattoa oemq$ud kla l nadiou = F► l ta. r *v sir lug a ranporg•It,rxala�n V ZIP aC..f± �-^ DA W2W I float Soph ticii t epsly) ri l or 2 a µy ]Ctuw Nymb* Q claw 1q� 1 0 , 7tla(I��mAwrais� DimiAa OYr .., __ • oil! g6 a4,1k 1 .'hypo 6 - 1 f_ (fJrai� en�fiy idea a. liu0 A„ lWwalxxing Ica r #utirn+ll w�eJ � ap]aer ifmo 8. it a�aurabir� . xb »y>tweewne 9ynlrn ec msat eP d p H 3 I 2us rttw+tr Srae - �. t '9radW3rki�mTtPravint�ir�wned parell�b7umbar - � .._•.. J�� j . M�Q N' ova �'rarurl�d�� � ���� +fi�p �dPB �� s'vGCtan�an�tWettaad ��! Aa r! lm ARautd tZi xet4L%S - DDIL , 48 Q slagttl Pau. 151 © DAD Lim 013 A04raft 46 ©Awchlm'[4v+dst mt U14tt 4p D Rm mvb&S 3Q dU111a• M1 pull g In egraW 1 011F _ Plop(" AgplG glloq ParoeJa t+�a utw yataota gl pY a In ysa �• 940 ,*7 .G W T" Total haft Sm Flbf �'IABFIA g1lim C 0110is CMOs& C[+ocrtl�a C�aaeanivltaa t M Mbimuct- 4 ibe act t+4 asiou t r lai for 4r dbv >1rG'PP'l� Owtn1 aD q tawtaard .. n,•_ Dlunabu "o w:re n4 Sl�na� ut�i mi !bane Numbw ' ; T 6 11 .i � «r'i fir= lt• rawo �+a�a. IRIM�, 17 Appfared © owm (Guw a 7GN(Ml Advom S�► Pa otlt Four t70a11kMt1 alwMdw� ter 1 "y v0a 1enM.d Wpg goof swan- 071 fiw'�ur$m psp — . fi�� atApparond/Ra4ssr,+c>Ro�• pa.�j ,....`.^." _- _.— .:. ....�.�.......•,.. 10/08/2003 06:44 7152687080 GILLE TRUCKING PAGE 04 ., ..,... ,. .. •. .. .;. .....E .... : a .., . �. .. ... 1.. _. _ .. . _ .... ! .t. ! , I ; J r ! a I � I FFF , :. ' , :..,•. 1. ' I , 0 a.� ... :rte- [r� I � IN j • I : I .. ¢.. I... . , , , r I I I ' , , :�.�,. i,.:�,,:.. � .:, i... �.. ► ... .. �� �.. 1, � _ � . , j . � . . I , I ar ... �.... ... , L �.... I.. �..... .. i 1, .. .,..., ... .._�.. I I , , ... ,.. .. �. .. .i..... .. ,..�_. ...L t J. , r l.... L.. •j I. .._ I �... I . ,.. _ , I I { 1 I 1 10/08/2003 06:44 7152687080 GILLE TRUCKING PAGE 02 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page --L of Division of Safety ety and Buildings in accordance with Comm 85 Wis. Adm. Code , EParoel ty Attach complete site plan on paper not less than 8 1/2 x 11 Inches in size. Plan must 1 D , Include, but not limited to: vertical and horizontal reference pant (BM), direction and f�Z C7 LL ADO percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal Information you provide may be used for secondary purposes (Privacy Lew, s, 16,04 (1) (m)). Property Owner Properly Location or E �^ Govt Lot 1/4 1!4 S 13 T Q N 9 ( 1� R J ®� Property Ow ner'S Mailing Address Lot # Block # Subd. Nam or C # 2' a� ) Village Town Nearest Road Cit State Zip Code one Number ❑City [] S k..r I I ( I s New Construction Use: ❑ Residential /Number of bedrooms Code deriVed design, flow rate GPD ❑ Replacement I.— El � lic or commercial - Describe: Flood Plain elevation if applicable �• Parent material W General comments and recommendations: rJ' Boring Z Boring # '2 G In I� ft. Depth to limiting factor . Pit Ground surface elev. Soil Application Rate GPD /W Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#f2 in. Munseil Qu, Sz. Cont. Color Gr. Sz. Sh. D 9 3� r qw' 2 ,esJ 3 41140 S X 79 Boring Q /� Boring # Pq 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 1ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 - Eff#2 d- 7 v aw . 3 /0��5'/�/ ql 2ilm .3 yG oy I it o t2 Effluent #1 BOD > 30 < 220 mg/L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mglL and TSS < 30 mg/L Slgnat CST Number CST Name Ple ase Print) e Address Date Evaluation Conducte d Telephone P one Number Iqa SBD -8330 (807/00) 10/08/2003 06:44 7152687080 GILLE TRUCKING PAGE 06 Property Owner — i? " r", Parcel ID 0 Page o f-? M Boring # [] Boring ❑ Pit Ground surface elev: � ft, Depth to limiting fdotor>/Xr— In, Soil App 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 I Eff#2 0�3 Wz-. PS , 9 Z 3-3o 4W- s AvL F -1 Boring # ❑ goring ❑ Pit Ground surface elev. ft, Depth to limiting factor In. Soll 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 *Eft#2 Boring # ❑ Boring © Pit Ground surface elev. ft. Depth to limiting factor in. Soil Applicabon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftZ In. Munsell Qu. Sz, Cont. Color Gr, Sz. Sh. *Eff#1 *Eff#2 Effluent #1 - BOD, > 30 < 220 mg/L and TSS >30 < 150 mg1L • Effluent #2 = BOD f 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 geed material in an altemaate format, please contact the department at 608 -266 -3151 or TTY 608 -264 -8777. 9t1R-693o (R.07/pp� 10/08/2003 06:,44 7152687080 GILLE TRUCKING PAGE 03 , I . , I. 1 ..1. • r 3 7.3 /9 . i� i i i IJ :. r i I p I i or , i 7. I _. ,....... , ; . I I i. i I r I I I I i i I 1 I I � rl.. .. i . : a , I i ' i Safety and Buildings Division County , 201 W. Washington Ave., P.O. Box 7082 S visconsin Madison, WI 53707 - 7082 Site Address `Department of Commerce # p I Sanit Permit Number Sanitary PerMit E pp C21 1oIfl Sanitar In accord with Comm 83.21, Wis. Adm. Code, personal information you provide Z ( - 302- 65_ ❑ Check if Revision may be used for secondary oses Privacy Law, s15.04(1)(m) 1. Application Information - Please Print All Information State Plan I.D. Number AA Property Owner's Name ,, 3 Parcel hiumber Property Owner's Mailing Address Property L on f , S7$ 23Z -c �✓ f-��; Tao N, R /7 Z, City, State Zip Lp4 e d Phone Number Lot N ber Block Number S vision Name C>;iQ.ATtbar 11. Type of Building (Check all that apply.) as psr S "+^+ ❑City 1 or 2 Family Dwelling - Number of Bedrooms ❑ Village ❑ Public /Commercial - Des ibe Use []Townshi �e S ❑ State Owned �� ,F , Nearest Road III, Type of Permit: (Check only one box an A. Number is for internal use. '(Complete line B, if a cable.) A. New 30 Replacement of ❑ Addition to t` 2 ❑Replacement System G For County use Sys Tank Only tint System B; ❑Check pf Sanitary Pernik Previously Issued Permit Number f D su IV. Type of POWT System. (Check all that apply. Numbering is for in rn use.) " Non - Pressurized In- Ground 21 ❑ Mound 47 ❑ 5an filter 50 ❑ Construct Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 El Siva s 51 ❑ Drip Line 45 ❑ At -Grade 45 ❑Aerobic Tr ent Unit 49 ❑ Re cula 30 ❑ flier V. Dispersal/Treatment Area Information: /CSD Design Flow (gpxl) Dispersal Area Dispersa ea Soil Applic• on rcolation Rate ystem Elevation Final Grade Required Proposed Rate(Gals. ays /SgTQ ( . /Inch) Elevation ir VI. Tank Info Capacity in Total Number Manufacturer Vrefab Site Steel Fiber Plastic Gallons Gallons of Tanks Crete Constructed GIass New Existing Tanhi Tanks ( t � lli l clor Holding Tank /mod - Dosing Chamber .L VII. Responsibility Statement- 1, the undersigned, assume rq&usibifity for install• . of the POWTS shown n the "attached pleas. Plumber's Name (Print) Plum is Signature M141dPAWNumber Business Phone Number Ufn , ' V "'Ad 8= 46 3 7 Plumber's Address (Street, City, Slate, Zip Code) L f9(_ 3s1R6 77z l yo' s .T A" Q,4 VIII. Count /De artment Use OnI Disapproved Date Ls sued Issuing gent Signature (No Stamps) Surcharge A Approved ❑ Owner Given Initial Adverse Su rchar ermrt Pee (includes Groundwater Determination ge Fee} Z� .�-- p 200 IX. Conditions of Approval/Reasons for Disapproval 4 e - Mt SeAm-k Al#a complete plans (to the County only) for the system on paper not less than 8112 x 11 laches is size SBD -6398 (R. 0.5 101) �e i � ;• *�. �,- _, . I .. a l Z C' -rte � /4. I W�_ NN';5 /Z 7-3a krR6k,-' - S00t4e : : Lam- - I I I I I j I J i I I i I I i I - i T I i i I I I I 1 1 1 I I I 1 I I i i I i 1I I � I I I, �ld % /�a s c �rl�in ZI2 /��I_ ►/ 14 ,IICS /3 7 Atrf i r� 304 1 it 4&+In • i ,�.� o we /d0' •- 425 G _ r , Q Z� /00 i l l s I I � i i jr`os 1J�.c i l I i � I A i i , I I I I i a� ' I i ! f I i I i �C I 1 i - - - � a � i I _ I ��i 1 -_ i � � i � � ,. 1 _ ., . _ �� � i I , } i i � �. :. � ' � I i I I I - _ _ _ __ _ I I i � � I � 1 i i I I i I � i I i i i i I I - I �. - it I ; i I i i _ �--- � -- - 'I � _ I .T -_ � � _, i ' � I i �. � � I i i i I i I - - , __; � ! i ', r _ __ __ i ;, i i i � - - � � � I� ' � , � ' '�� i _ i - - � � _ I i � i i I � I 1 � i i ' i' i I j � � __ � I - I i i �� �� j - � I I �, '.. '.. i �, !. i I I I ` I i i i i i �- i ., i i i i � _, i l i � � � � I � __ � � � � __ __ i i '� , - __ _ I _ _ I � I I _. � t i _� I � , 4 �� l � � � I . -. �, I i ', i _'I i i _ ._ ( Zc L Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Divisigrt of Safety and Buildings In accordance with Comm 85, Wis. Adm. Code County c Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must ��• r 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. e ti ' Please print all information. R ev) ved by Date Personal Information you provide may be used for secondary purposes {Privacy Law, s. 15.04 (1) (m)), 3 Property Owner Property Location / Lot 14g de�j /4 S l3 T 3 9 N R / E( Property Owner's Mailing A ss 71% lock # Subd . Name ame or CSM# City State , Zip Code Phone Number F] City I] Village Town Nearest Road Construction use sidential / Number of bedrooms Code derived design flow rate GPO ❑ Replacement [] Public or commercial -Describe: Parent material yl� � .� Flood Plain elevation if applicable _ IV )A General comments Q o. v and recommendations: `mil) ���i�� / Boring Ffl Boring # " 9 ,rl� //�/ i 10 it Ground surface elev. F --- ft. Depth to limiting factor /�'' in. i tlon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 3 O o✓i Boring # ❑ Boring ;a_Pit Ground surface elev. o ft. Depth to limiting factor C/ in, - � Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh, "Eff#1 I `Eff#2 3 S 0.O Z og " Effluent #1 = BOD > 30 < 220 mg/L and TSS >3 150 mg /L ' Effluent #2 =130D < 30 mg/L and TSS < 30 mg1L CST N &_ `nom /) ignnturc „ 1 �-o Nut71b� j Y// .• � f7 Address Date Evaluation Conducted , 01 Telephone Number Property owner Parcel ID # CJ ! Page of 01 ��=V Boring # ❑ Boring t Ground surface elev. , ft. Depth to limiting factor in, Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu, Sz. Cont. Color N Gr. Sz. Sh. / 3/2 Eff#1 Eff#2 90.0 D 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 'Eif#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor In. Soli Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 ' Effluent #, = BOD > 30 < 220 mg/L and TSS >30 <,50 mg/l_ ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg& 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. sBa83� tR.o�,�y 1 ' Soil Test Plot Plan Project Name Brian Boardman Sha d Address 824 East 11th St. New Richmond Wi 54017 49 #226900 Lot Subdivision Nathan Hills Date 10/30/01 W 1/2 NE 1/4S 13 T 30 N /R W Township Somerset ❑ Boring 0 W 11 PL Property Line County ST. CROIX IL BM or VRP Assume Elevation 1 ft-- Top of nail in oak Tree System Elevation 90.0 *HRPSame as Benchmark Alt. BM —Base of Road Sign Qa 87.5 Soil test was done to satisfy zoning requirement, test may not be suitable for owner's desired building location 97' 98' M 96' o 35' 2% � Slope 0 * B.M 100' a 5 ° B- 70 B -1 tn 70' c" Alt. Pro Town Road POWTS OWNER'S MANUAL & MANAGEMENT PLAN page of PILE INFORMATION SYSTEM' SPECIFICATIONS ' 90 mill I Owner �OB �.' Septic Tank Capacity �C�d O al 0 N Permit OZn,� Septic Tank Manufacturer CI NA D 51 i41itA E ERS Effluent Filter Manu facturer © NA Number of Beckoom, a CJ NA Effluent Filter Mo del Alec, Q N Number of Publio Fac ility Units . Ft NA Pump Tank Cap aolty gal PMA Estimated Flow {average) al /da Pump 'Tank Manufacturer A, Design flow (peak), ( Estimated x 1.6) gal/day Pump Manufacturer 0131A Soil Applicat Rate gal /day /fi Pump Model OVA Stand'erd Infiueriv/Effluent Quality . M * Pret ment U nit y average �! A Fats, Off & Grease (FOG) 530 mg /L a Sand /Gravel Filter © Peat Filter Biochemical Oxygen Demand (BODd 5220 mg/L © NA Q Mechanical Aeration 13 Wetland Total Suspended Solids (TSS) 5 1 50 m g /4 0 Disinfection Q Other: Pretreated Effluent Quality Monthly average � Dispersal Cell(s) _ El NA Biochemical Oxygen Derr ad (801) a0 ing /L KIn- Ground (gravity) Cl In- Ground (pressurized) Total Suspended Solids :696) 580 mg /L 13 NA Q At 0 Mound _ Fops[ Conform (geornetft Mean) s10 cfu /100iril _ Q Drip -Line 0 other: Maximum Effluent Particle Size Y in dia, (l NA Oilier. CI NA Other; 0 NAs Othar; 0 NA *'Values typical for darnestio wastewater and septic, tank effluent. Other' Q NA M OHE ULE Servioo Event Service Fregvorccy mcn�Chts Inspect condition of tank(s) At (east once ev earls (Maximum 3 years) 13 NA Pump out cantents of tamk When combined sludge and scum equals one -third (Y of tank volume Cl NA month(s) J inspect dispersal oell(s) At least once every., WVear(s) (Maximum. 8 years) C7 NA 'Clean effluent filter At least once errs ear rs s) ery. 3 z me ( p NA ? Q monthisl Inspect pump., pump controls & alarm At least once every: P ear. Flush laterals and pressure test At least once every, Q RNA month(s) Qthor; At least once every: Q years? �NA C1t' ai: JA 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 inSpeotion 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 call(s) shall be visually inspected to obeck the effluent levels In the observation p)pes and to check fcr any ponding of :effluent on the ground surface. The ponding of effluent, on the ground surface may indicate a falling condition and requires the Immediate notification of the local regulatory authority. When the combined aacurmulation of sludge and scum in any tank equals one -third M or more of the tank volume, the entire contents I accordance vntentS of the tank shall be removes try a 5egtegc� Servicing operator and disposed of �! rdan with cha p "T NFl 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 VVItlain 10 days of completion of airy service event. GMW (4/ ©1) START UP Ai' D OPERATION Page — of For new construction, prior to use .of the iPOWTS check treatment tank(s) for the presence of painting products or other c4aryilcaitc that may irnpads the trghtment orocass and/or damage the dispersal catlis). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up snail not occur soil conditions are frozen at the infiltrative surface. !luring power outages pump tanks may fill above normal•highwater levels. When power is restored the excess wastawater will be discharged to the dispersal collie) in one large dose, overloading the collie) and may result In the backup or surMod-dlsdharga of effluent. To avoid this situation have the dontants of the (sump tank removed by a Septage ServlOing Operator prior to restoring power to the effluent pump or contaot a Plumber or POWTS Maintainer to assist in manually operating the pump 00(trols to restore normal levels within the puMp tank. Do riot drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within I S 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; condorns; cotton swabs; degreasers; dental floss; .diapers; dltiinfeotiants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gxsolltte; grease; herbicides; meat scraps; madloatlons; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS falls ai W /or 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 Coda: • 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 Septaga Sewlaing 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 inart solid material. 00 PLAN If the POW 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 sail absorption system. The replacement area should be protect-ad from.disturbance and compaction and should, tfdt be ihf.r1. iggd �uprin by required setbacks from existing and proposed structure, lot lines and wails. Failure to protect ills replacement area will result In the need for a new sell 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 writable replaoement 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 replacs the felled POWTS. ❑ Mound and at -grads soil absorption systems may be reconstructed in place following removal of the blemat at the Infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNIN(a> > SEPTIC, PUMP AND OTHER TREATMENT "TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN, DO NOT E NTER A SEPTIC, PUMP OR OTHER T)Rr:ATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. APDITIONAL COMMENTS w POWTS IN. R POW MAiNXAiNER Name Nama Phone _ 3 ..�. Phone SEPTAi3E SERVICING OPERATOR (PUMPER) LOCAL R 6DULATORY AUTHOPJTY Name Name 2py /H Ph one E mane 7i 3�6� y6Sd This document was shafted In compliance with chapter Comm 83.220ub)(1)(dMIT) and 83.154(l). 0 & 0, Wiseoristn AClritlnilttrative Lode. r ST CROIX COUNTS' SEPTIC TANK MAINTENANCE A %3REEMENT AND OWNERSHIP CERTIFICATIOA FORM Owner/Buyer � n Mailing Address r J�� aka Oe J as 5 yvZS Property Address (Verification required from Planning Department for new 4;onstruction) City /State Parcel Identification Nui aber O 32 - - 2-I S - °a - om T. 3vo LEGAL DESCRIPTION Property Location i/ 'I4, % <, See. 1 , T 3 () N -R / , W, Town of k T Subdivision /JA L 5f' �1K �Y� , Lot # _6 Certified Survey Map # �— , Volume , Page # Warranty Deed , Volume , ,Page # 19 Spec house ❑ yes ❑ no Lot lines identii iable ❑ yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its pro mature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed b) a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste dispo 11 system. The property owner agrees to submit to St. Croix Zoning Department i certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri Tying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if neces cary), the septic tank is less than 1/3 full of sludge. I I/we, the undersigned have read the above requirements and agree to maintain th4 private sewage,disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of N p:mral Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and return d to the St. Croix County Zoning Office within 30 days f the three year expiration date. '1J / ?1 /D3 SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my ( knowledge. I (we) am (are) the owner(s) of thje rryscribed above, by virtue of a warranty deed recorded in Register rf Deeds Office. { 71 2r /a3 SIGNATURE OF APPLICANT DATE * * * * ** * * * * ** An information that is mis -r resented may result in the sanity rmil being revoked b the Zoning Y eP Y sanit Pe g Y n$ P ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if referena is made in the warranty deed U' 1874P 193 STATE BAR OF WISCONSIN FORM 2 - 1998 6 7 C� S 6 3 • WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS Doculn Number ST. CROIX CO., MI This Deed, made between Nathaniel Stephen Enterprises, LLC, a RECEIVED FOR RECORD Wisconsi Li mited Liability Company, 04 -18 -2002 8:30 Ali -- 6ARRAM DEED Grantor, and Scott R. Parkin and Rachel L. Parkin, husband and wife, EXEMPT # REC FEE: 11.00 TRANS FEE: 216.00 COPY FEE: CERT COPY FEE: Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: Recordinst Area Name and Return Address First National Bank of New Richmond Lot 18 Plat of Nathan Hills F irst Addition in the Town of Somerset. PO Box 89 C� New Richmond, WI 54017 Parts of 032-204640 & 032 - 2046 -30 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: municipal and zoning ordinances and easements of record. Dated this 12th day of April 2002 NATHANIEL STEPHEN ENTERPRISES, LLC . By: Brian K. Boardman, Member AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) ) ss. Signature(s) ST. CROIX County. ) Personally came before me this day of authenticated this ! day of April 1 2002 the above named Brian K. Boardman, as Member of Nathaniel Stephen Enterprises, LLC TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, instrument and ac nowledge the same. authorized by § 706.06, Wis. Slats.) THIS INSTRUMENT WAS DRAFTED BY Judith A. Remington, Remington Law Offices e C. D P.O. Box 177, New Richmond, WI 54017 Notary Public, State of Wisconsin (Signatures may be authenticated N U i3 H My Commission is permanent. no , s ate cxptratloH �_ necessary.) Icy "Stacw ut Wisconsin 04/02/06 -Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 - 199$ INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 900. 655.2021 O r use♦ • � �� .. 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