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HomeMy WebLinkAbout032-1070-40-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division • INSPECTION REPORT sanitary Permit No: 399471 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: City Village X Township Parcel Tax No: Clarke, Robert Somerset Township 032- 1070 -40 -000 CST BM Elev: Insp. BMElev: 17scription: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION 'J BS HI FS ELEV. Septic , Benchmark Pv tHolding g �� Alt. BM on 1 Bld S wer / Ht Inlet 6 0 S Ht Outle TANK SETBACK INFORMATION L 12 bi . TANK TO P/L WELL BLDG. Vent to Ai Intake ROAD Dt I DwtF (J t Bo Septic / HIS �61k Dosing I �� H eader /Man 37 / G !D Z. Aeration .= , Dist. Pipe c L (J'. �a C2 Holding - Bot. Syst L Z Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St )Cover 671 <S GPM (l 'I n._ jU• b C.laz' ! 1f Model Number 4 ? 4r - - TDH Lift Friction ohs System Head TD � Ft S Forcemain Length Dia. Jy Dist. to well NdT 1A) SOIL ABSORPTION SYSTEM 30 S BEDITRENCH Width Len$th, I / No. Of Tre es PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS C 1 - SETBACK SYSTEM TO 1111 P/L BL WELL LAKE/STREAM CCNAMSER_&� EACHIN fa j INFORMATION Ty Of System: ? } ; Y g� ,/ Model Number. DISTRIBUTION SYSTEM - 5 n j - , ,U Header /Manpid Distribution � 7le Size I x Hole Spacing Vent to Air Intaky Length Dia Length Dia Spacing — (� SOIL COVER x Pressure Systems Only xx Mound Or At - Gra de Systems Only Depth Over 7 f Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center / Bed/Trench Edges G Topsoil / ❑ Yes ❑ No ❑ Yes [] No 1 COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1 (� Inspection #2: Location: 713 191st Avenue Somersej, WI 54025 SW 1/4 SW 114 5 T31N R19W) NA Lot 5 �- ` Parcel No: 25.31.19.346C ( f Z n � r^^ .�f✓ .r! ✓ �!!_� l ?f Y 5'> i (��stx 1.) Alt BM Description = �Myr+� I- NC C f 2.) Bldg sewer length 0 sy .. CSr MU btisc sJbt = f �{ 5 - amount of cover - / 1 � + �G(CK l6Yss �'l �(av G(.t L � `r( C" ' ✓FJ r� �ft2�'_ a J tc ��'zz { ltiS Plan revision Required? Yes ❑ No �5 % 2i U Use other side for additional information. � GC�Iti�-- --J SBD -6710 (R.3197) Date LZ Insepctores Signature Cart. No. i 1 c 7 h L k� /7 ,o k-J) _4-v i I � � Safety and Buildings Division County /`_ 201 W. Washington Ave., P.O. Box 7162 f CrQ 1 pisc , ons n Madison, WI 53707 - 7162 Site Address ent of Commerc - _ f De artm s 6? z' // 7 / 3 s_ � s'c% e Sanitary Per Application Sanitary Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision 3 0 1 ' � / - / may be used for secondary purposes Privacy law, s15. 1 m I. Application Information - Please Print All Information State Plan I.D. Number Property ner's Name R E C E I V E p Parcel Number 03 )- -'/ Property Owner's Mailing Address M Property Location 1 2 1 I St it Q- S ZOO2 Sk ly f . W ',I S T N, R / q E City, State Zip Code �NTY Lot Number Block Number ONING OFFICE Subdivision Name CSM Number orn� { set UU y�� s 1 Z6 517168 H. Tie of Building (check all that apply) amity V 4 9 ❑ 1 or 2 Family Dwelling - Number of Bedrooms —3 V / e ❑ Public /Commercial - Describe Use ownship S e ❑State Owned Nearest Road 172-0\j C4-4-:E5 is C�i� 6�� �� t�l q / ST V e III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. 1 ❑ New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to For County use System I I Tank Only Existing System B. K Check if Sanitary Permit Previously Issued Permit Number D 7 . 0 ed - /, ) ,3 '� b IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use Aj��� — � _./ ��°�p - C/! 4 , �/ �3 O 2 44 ❑ Non - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland D `� S - 0 22 -ressurized In Ground 41 ❑Holding Tank 48 ❑Single Pass 51 ❑ Drip Line G3rJ(¢_ Ch �ZJi 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Dispersal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area oil Application Percolation Rate S stem Elevation Final Grade e9� �Zl Propos te(Gals. /Days /Sq.Ft.) (Min./Inch) '�(/� /D/ Z Elevti n VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks LwV Septic or Holding Tank - DO � r Dosing Chamber 600 I)o X VII. ResponsiblUty Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. P! ber's Name (Print) PL s o f natu MP/MRR &Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) W I - /(-) z VIII Coln /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuin t Signature (No Stamps) - Surcharge Fe) ❑ Owner Given Initial Adverse. Determination v IX. Conditions of Approval/Reasons f r D' approval - ,�itc,.� Attach complete pl ant (to the County only) for the system on papa not less than 81/2 x 11 inches In size SBD -6398 (R. 05101) C " 397Y71 PUMP' CIIAMIIF:R CROSS SFCTIOII Atli) SPECIFICATIONS Vent Cap WeathLr Proof Approved Locking Junction Box Manhole Cover 4" C.I.- -- 12" Min Vent Pipe ; Final 4" Min Grade ' �! Conduit 18 n Min 18" Min -- , - - - -- " - - -- i •11 Approved Inlet Joints w/ C.I. Pip e Extending Approved Joint w/ 3' Onto I ''� ,.I. Pipe I ,,; Solid x t e n d i n g l' �; A Ground b' Onto ' solid Alarm i ',� -- ,round On -- .Pump --_ - Off �7f lrf^ Concrete Block D /D S1'1 TANK PUPI1' / � lanufacturer: Wei S'er Manufacturer: l r$ rank Material Mod cl NumUur rank Size: Callons Switch' Tyro a Total Dynamic Ile ad: Ft. CAPACITIES Pump Discharge Rate: GPM Total Daily Effluent: Gallons I 020. " or 3 r 8 Gallons 14 u mh e r of 1) ouc9 : Per Day 1 • a or 3 -3 .S Callons Dose Volume:' j I Z- s wIea out Gallons or Callons No tea: 1. Sec pump curve for or _ f(e�.40 Cnllonn ndditionnl performance Total I'ank information. rapacity Required _ 603..1,, Cn11ona 2. Pump and alarm are to be inatrilled on ucparat circuil ALARM au per ILIIR 16.1 WAC . 'Innuf ncturer: ve AlQorw- 'lodel Number: .witch Typc. page of ME40 DIMENSIONAL DRAWING MW50 DIMENSIONAL DRAWING --- ON uD _I I 0 E w 14.76 E "OFF" r N Lo �9.. T T M 1= 6. 6.25 E - -- T F 1 -1/2" NPT i ® (38.1 mm) • Discharge of M _ 9.04 J M I O • • L _ 5.66 1 F-- - - 5.44 (144mm)� 11.68 11.42 (296.5mm) I' ME40 PERFORMANCE MW50 PERFORMANCE CAPACITY LITERS PER MINUTE CAPACITY LITERS PER MINUTE 0 100 200 300 400 500 0 50 100 150 200 250 300 350 30 10 40 12 25 35 6 10 30 W w F w 20 W W W W W 8 M LL 6 IL 25 2 2 Z G Z Q 15 C 20 6 Q S Q = = S H 4 Q O 15 4 H 10 O ' � O 10 2 2 5 5 0 0 10 20 40 50 60 70 80 90 100 0 0 0 0 20 40 60 60 100 120 140 CAPA TY GALLONS PER MINUTE CAPACITY GALLONS PER MINUTE 23833A275 11 - — Ak i -T l MYERS LIMITED WARRANTY F.E. MYERS warrants that its products are free from defects in material and workmanship for a period of 12 months from the date of installation or 18 months from the date of manufacture, which- ever occurs first. During the warranty period, and subject to the conditions hereinafter set forth, F.E. MYERS will repair or replace to the original user or consumer parts which prove defective due to defective mate- rials or workmanship of MYERS. This remedy is exclusive and is the only remedy available to any person with respect to such MYERS product. Contact your nearest authorized MYERS distributor or MYERS for warranty service. At all times MYERS shall have and possess the sole right and option to determine whether to repair or replace defective equipment, parts or components. Start -up reports and electrical system schematics may be required to support warranty claims. This warranty is effective only if MYERS supplied or authorized control panels are used. LABOR, ETC. COSTS: MYERS shall IN NO EVENT be responsible or liable for the cost of field labor or other charges incurred by any customer in removing and /or reaffixing any MYERS product, part or component thereof. THIS WARRANTY WILL NOT APPLY: (a) to defects or malfunctions resulting from failure to properly install, operate or maintain the unit in accordance with printed instructions provided; (b) to failures resulting from abuse, accident, or negligence; (c) to normal maintenance services and the parts used in connection with such service; (d) to units which are not installed in accordance with appli- cable codes, ordinances and good trade practices; or (e) if the unit is moved from its original instal- lation locations, and (f) unit is used for purposes other than for what it was designed and manufac- tured. RETURN OR REPLACED COMPONENTS: Any item to be replaced under this Warranty must be returned to MYERS at Ashland, Ohio, or such place as MYERS may designate, freight prepaid. PRODUCT IMPROVEMENTS: MYERS reserves the right to change or improve its products or any portions thereof without being obligated to provide such a change or improvement for units sold and/ or shipped prior to such change or improvement. WARRANTY EXCLUSIONS: As to any specific MYERS product, after the expiration of the time period of the warranty applicable thereto as set forth above. THERE WILL BE NO WARRANTIES, INCLUDING ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR ANY PAR- ' TICULAR PURPOSE. Some states do not allow limitations on how long an implied warranty lasts, so the above limitation may not apply to you. No warranties or representations at any time made by any representative of MYERS shall vary or expand the provisions hereof. LIABILITY LIMITATION: IN NO EVENT SHALL MYERS BE LIABLE OR RESPONSIBLE FOR CON- SEQUENTIAL, INCIDENTAL OR SPECIAL DAMAGES RESULTING FROM OR RELATED IN ANY MANNER TO ANY MYERS PRODUCT OR PARTS THEREOF. Some states do not allow the exclusion or limitation of incidental or consequential damages, so the above limitation or exclusion may not apply to you. This Warranty gives you specific legal rights and you may also have other rights which vary from state to state. Direct all notices, etc. to: Warranty Service Department, F.E. Myers, 1101 Myers Parkway, Ashland, Ohio 44805. Myers® F.E. Myers, 1101 Myers Parkway, Ashland, Ohio 44805 -1969 419/289 -1144, FAX: 419/289 -6658, TLX: 948 -7443 Printed in U.S.A. 6/95 23833A275 09/26/01 WED 12:31 FI3 715 386 4886 ST CRS CO ZONING IM 002 way and Buif dinS s Division '"•' ^"" v 101 W. Washington Ave., P.t?. Has 71tF1 � • (, J Madkou, Wl 53707 - 7162 Sib Address Dep artment of Commerce t Sanitary Permit Application Smalma PervoltN"mber In w=W wjib Comm 83.24. Wis. Adm. Code, p -mal Wo mationyoo ptvv;& ❑ Cheek If Revision NJ bt used nt!m Uw,S 1 I. Ap!plludaSt Itll'et'matian - Please lrmt All Wwmtttltm • — 11.1 L _ Property Owner's Name `t l� -L Clar Prop" owner's Mailmt Address hui t o e 5 l g l 5? i4ve. w zs T31 N . s ow. Stw T Zip t cam Pttame Dumber Lot NwAber �/ Block Number �,m �,r�ct ► • 5�f oz5 ' n Name GSM Nmaber wJ. I/o l . 10 - pl . - V75 - 517 �v $ II. Typ of Building (ohedr all that apply) g — XI or 2 vemily Dwelling - Noma cc Bedeoones ❑ Pubt ac mmarebl -10 mdbe use orvndb ❑ atm Owned Nr�maStlRaad `"i I s � ✓� 1IL Type of Veemits (Cbeok anly ono box on line A (numbering selteme for Internal nw). Campli ti ilea B if applicable) ~ 7 New 13 1�eemem 413151" 7 0 Raplaeemeot of 1 , 6 0 Addition to Far CamSty an S aemn Tsok Onl - B- 0 Cbmk It Saalwy Permit PrevJo dy hausd peewit Number Dan IaSrted IV. Tpe of Pasaftt (Check all that apply)(mmlbK%g scheme It for Internal use) 44 Non Prenudzed In-070 210 Mound 47 O Swd Faces so ❑ Cauwcted aedand ' PnSarrixcd k4bound J 410 Holding Ult ed 0 54le Pees sl ❑ Drip Lim 45 ❑ At4awty 45 0 A ctvbic Treemat Unk 49 ❑ Rwirculating 30 0 0dw 4 aA a .re V. at Area Information W 1 41' A ;I. D Flows (tpd) Pisptnel Area Dispersal Ana Sol Applicadoa Percolation RaM SyMat Movadoa Final Grade s©o si4• RSSeI ) atin.►Imh, Plavadon 50 7 I ---- 9/ -�' qti. � A TU& We Cow* in Total Nau"I Manataopuar Pttdkb Sib Steel Fiber Plastla ( t9dloas Oallow of Tadw c000eeb nm Oomaued (dots `til�l�)�r11��111� Wow TAnim Tub /400 J�oo l GUer IC VEL iblil Stateimestt- I, the wadaftneid, ■ roar ie KAIdcn of the PQ1s Skesn Sa the attoe6ed plumber's Name Wes) r'� Business Pbone Nombc r dtU d. IX <<st 7/5 - t-/z5 -55C/V Phanber's Address (Strut, City. Satre, zip Cade) Oaa 9 q 6A c 5{" • l Ver Fa ils , W 1 54o ZZ sou m ties o ub y� A � S 0 o aninry Ps[mit RA (° ' Omondaeter Date lSSrted Agent Siatmetes (No 5dwmpS) °°� Lc(is�q . ❑ owner Given In[dai Adverse �� Ming" 1. lSe�Wl t�beRWs a a anrmaf e nta nee er manufacturer's recommendations. 2. Floodplain mapping = Zone "C" 3. All setbacks to system and residential structure must meet applicable code requirements. 4. Well setbacks to be maintained per NR 811 & 812. Arran► ebm¢ A� M ffie COB" GOW tbt Ow M E w WNW -W ter ties nM s 11 tanhta in doe SBD -6398 (R. 03101) .1 l • ��y( •T s . y I i Ir � .• C. ,r -..1 f. � ;d .. ' ..a 1 . • �.) < +.. �t - �� ! •.i<tt`y ,� •L •� .i �i i1 i It � r fV OCT ,vn1 d o y , a �i s Lu ip I , �L r ° a d ` r o Y � O W y } a R � .ti m 'A' - W 0', Wisco Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Ws. Adm. Code County :5/, 4:�, r a' 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. 03a— d v 7 a —L6P Please print all information. Re iewed by P G7� �� �Af Da S�J Y P Y secondary P (Privacy m� Personal information you provide may be used for seconds purposes Privac Law, s. 15.04 (1) ( )). � Property Owner Property Location 5 u GI4L �^ Govt. Lot �� 1 /4 , �1 /4 S 2 S ` N R E (o Property Owner's Mailing Address Lot #� Block # Subd. Name or CSM# i t -7/ � — -- CSC e/.& I 0 City State Zip Code Phone Number [] City ❑ Village Town Nearest Road New Construction Use:mtesidential / Number of bedrooms Code derived design flow ra GPD ❑ Replacement ❑ Public or commercial - Describe: ` Parent material Gt'�4 �,G'1 Flood Plain elevation if ap�10r ft• General comments - - - T7 A -],) 1 "_ �T t L .� and recommendations: F L ` f���'c�1'– L`lL c:LL`s ^j ;77Lit�S ; r'; :�' A/C–� F/-] Boring # F1 Boring ° ' j ^ (� — 'C � i S Pit Ground surface el v. ft. Depth to lime ing factor in. _. . _ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bou'hda '-- Roois GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Jb N qty Boring # � Boring Pit Ground surface ele . �ft. Depth to limiting factor ��� in. Soil Application Rate Horizon Depth Dominant Color Redox Des Texture Structure Consistence Boundary Roots _ GPDAf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. _ `Eff#1 - Eff#2 10 " 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 Na (Please Print) r Signat CST Number Add Date Evaluation Conducted Telephone Number 1 1 1 . Property Owner GCY P �L • � rcel ID # Page of Boring # ❑ Boring 1 O 3 Pit Ground surface elev. 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 Gr. Sz. Sh. *Eff#1 'Eff#2 oL— . A �?< �b as at. a Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in — SoTlApplication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 Boring Boring # Ground surface elev. ft. Depth to limiting factor in. F ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlf? 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 altemate format, please contact the department at 608 -266 -3151 or TTY 608 - 264 -8777. SBD -5330 (R.07 /00) Property Owner + Y Q r o - Parcel ID # Page of Boring# ❑ Boring PC pit Ground surface elev. "/ - Q . Depth to limiting factor ��� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ,- - a aS aI• a 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/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 a 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/ff 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 - 2648777. SBD -8330 (R.07 /00) yam Soil Test Plot Plan Project Name Susan Clark Byr Bird 3r. Address 715 191st ave Somerset Wi. 54025 M #220527 Lot Subdivision csm Date 8/ 6 / 2001 County CROIX S W 1/4 S E 1/4 S 2 5 T 31 N /R W Townshi N. So m e r s et Boring Q Well PL Property Line# Alt. BM top of Tel. Ped Elv. 99.3 ,BM or VRP sume Elevation 100 ft top of Tel Ped System Elv. 91.2 H.R.P. same as BM PL , 3 bed house Garage Driveway C cal ack 15' Ba�.�% ww'"d' it, 1 qa.� 30,E ! �, 20' So , B B2 M 1 r , Q aS B3 30' 95' 272' PL r STEINER PLUMBING & ELECTRIC N8230 945TH STREET RIVER FALLS, WI 54022 (715) 425 -5544 (715) 425 -8818 FAX OPERATION AND MAINTENANCE MANUAL A. The component owner is responsible for the operation and maintenance of the component. The county, department or POWTS service contractor may make periodic inspections of the components, checking for surface discharge, treated effluent levels, etc. B. Design approval and site inspections before, during, and after the construction are accomplished by the county or other appropriate jurisdictions in accordance to ch. Comm 83 of the Wis. Adm. Code. C. Routine and preventative maintenance aspects: 1. Treatment and distribution tanks are to be inspected routinely and maintained when necessary in accordance with their approvals. 2. Inspections of the component performance are required at least once every three years. These inspections include checking the liquid levels in observation pipes and examination for any seepage around the mound component. r' ", 3. Winter traffic on the not permitted to avoid frost penetration and to minimize compaction. 4. A good water conservation plan within the house or establishment will help assure that the 44ouad component will not be overloaded. 1^^ � j " ' k D. Diagrams of components and contact people 1. Diagrams of all components and their location. Page 5. plot plan 6. lateral layout 7. plan view and cross section 8. pump tank N t A 9. pump curve Al I t< 2. Names and phone numbers of contact people A. local public health office -7' N�dson �� �s) �►3��{esc� �! •Croi�t Co�r�,l.�r 10 STEINER PLUMBING & ELECTRIC N8230 945TH STREET RIVER FALLS, WI 54022 (715) 425 -5544 (715) 425 -8818 FAX B. tank manufacturer Weiser concrete 1.800- 325 -8456 C. pump manufacturer Myers D. tank pumpers Darrell Dunn 715- 425 -1025 E. installer Steiner Plumbin 715- 425 -5544 3. Information on periodic maintenance of the component. Alai -push test SW periodically, if it fails to work check with installer p1mi -(see attached sheet) fi6u -in septic tank will need to be cleaned periodically by license pumper or installer distribution cell -check for water or soft spots around or on top. if any are found call installer 4. Notice that the dose chamber, if one is utilized, may fill due to flow continuing during pump malfunction or power outages. One large dose when the power comes on or when the pump is repaired may cause the mound component to have problems. In this situation, the pump chamber should be pumped by a licensed pumper before pump cycling begins or other measures shall be used to dose the mound component with only the proper amount of influent. This may include manual operation of the pump controls until such time the pump chamber has reached its normal level. E. Performance monitoring must be performed on mound systems installed under this manual: 1. The frequency of monitoring must be: a. at least once every three years following installation and, b. At time of problem, complaint, or failure. 2. The minimum criteria addressed in performance monitoring of mound systems are: a. type of use. b. age of system c. type of fill material used. d. nuisance, factors, such as odors or user complaints e. mechanical malfunction within the system including problems with valves or other mechanical or plumbing components. 11 f - STEINER PLUMBING & ELECTRIC N8230 945TH STREET RIVER FALLS, WI 54022 (715) 425 -5544 (715) 425 -8818 FAX f. material fatigue or failure, including problems with valves or other mechanical or plumbing components. g. neglect or improper use, such as exceeding the design rate, poor maintenance of vegetative cover, inappropriate cover over the mound, or inappropriate activity over the mound h. installation problems such as compaction or displacement of soil, improper orientation or location i. pretreatment component maintenance, including dosing frequency, structural integrity, groundwater intrusion or improper sizing. j. dose chamber maintenance, including improper maintenance, infiltration, structural problems, or improper sizing. k. ponding in distribution cell, prior to the pump cycle, is evidence of development of a clogging mat or reduced infiltration rates 1. siphon or pump malfunction including dosing volume problems, pressurization problems, breakdown, burnout, or cycling problems. m. overflow /seepage problems, as shown by evident or confirmed sewage effluent, including backup if due to clogging. 4. Reports are to be submitted in accordance with ch. comm 83, Wise Adm. Code. REFERENCES "Wisconsin Mound Soil Absorption System. Siting, Design and Construction." Converse, J.C., and E.J. 'Tyler. Publication 15, 22, Small Scale Waste Management Project., I Agriculture Hall, University of Wisconsin, Madison, WI. 09/22/00 FRI 14:46 FAX 715 386 4686 ST CRX CO ZONING lbool ST C ROIX COUN'T'Y SEPTI TANK MARMWANCE AGR.EHUMT AND O nWINMLSW CERTIFICATION FORM Owner/Buycr �obe man Adder t Cc 1 �x e L��' 5V096 (Vmficatim mphcd from Plaooiag Depatusent for new co=Mwd* i Pared IdaMlfication Number Q3 3 _j L, p — qD LEGAL DESCRIPTION Property Lotion i rdd.t %., � V,, Sec. 45_, T,&LN - -R _aW, Town of j L Subdivision .ti. . Lot # . CerWAd Survey Mttp # _ 511-?q428 . Volume /0 . .Page # Wan"ty Deed # ,S 2 )j , Volume � •—� Page # — --. —._ Spa house ❑ yes 9 no Lot limos identifiable P yes ❑ no Improper ore atd tmria�snaofyonr meptia system could tbralt in its peeauturo faibu'e tD bsodle . PmPer coo*% of pumping oat &a apuc tank every these yon or samm% if n=dod try a Hacasad prmtpa. %lW y= iA Taco the can affect &0 function of the np& teak a a "&am t stage in the waste dispoad sya4eat. The pwpaty owner agn= to rAwn to St Croix Zonog Depuft eat a Mica fon . sigaad by tare owtrer and by a mawpkmba,l pbmbm m*ictedplamb er a Iic="Pmwa ve i* ft *M (I) dw ou-de sywM a la #rope operating condition and/or (2) after inspection and pwaping (if swessiuy), the septic tank is lost Ikea I/3 foil of sludge. Nwa, the undersigned have rand the abaft wgmataients and agree to wab ain the prfvata wwage disposal system witk the stmduds sot falk. Lorain► as set by die Depa tmad of Comm em and aw Deprrt ce of Naomd Resourcm State of WbPOWw C. tdflcdWu g%ti* that your septic system has been maitrtdned mast be completed and r humd to dx St Croix Caurity Zoning Office wldit 30 days of the d"t yeor expintioa data WO NATURE OF APPLICANT DATE OWNER CERTiFXC�ITION I (we) attify do all statments on this foot► are flue to tht bent of my (our) knowledge. I (we) am (are) tks ownet(s) of dw de cnl)ed above, by vKtae of a warranty deed recorded in Register of Deeds Office. / Ce 9 17610 1 SIGNATURE OF APPLICANT DATE s.srr• being scvoked by the Zoning Department s ssss: Any itrfan+stioo that it niir�.tsptrsented may result in the sanitary pettnit ss Indads with Was applicola 4 a stamped warranty deed ftm die Register of Deeds office a copy of Ike cadw many ma}► if rdbrsnos it tt ab in the watt UW deed ` STATE BAR OF WISCONSIN FORM 3 - 1998 QUIT CLAIM DEED G5�401 !;fl'i l-li_EEN H. WALSH 1M AGE 61,8 REGISTER OF DEEDS Y.I Document Number RA MP AGE P :, (. C R p I X CO., WI RECEIVED FOR RECORD This Deed made between Susan M. Clarke 09 -25 -2001 10:30 AM QUIT CLAIM DEED Grantor, ?IE'T # and Robert O.and Audrey H. Clarke CERT COPY FEE: il' Y FEE: TRANSFER FEE: 48.90 RECORDING FEE: 11.00 Grantee. PAGES: 1 Grantor quit claims to Grantee the following described real estate in St. Croix .County, State of Wisconsin: ReGOfdislg ASF.a Name and Return Address Robert O, and Audr Clarke q0 No • g1ST A V r IN DULA I MN 6 "bg Q Part of the SW1 /4 of SW1 /4 of Section 25- T31N -R19W, described as follows: Lot _ 032 107_0 - 40. -00 5 of Certified Survey Map in Vol. 10, Parcel Identification Number (PIN) Page 2775. This 16 1 4 UT homestead property. (is not) i I i Together with all appurtenant rights, title and interests. Dated this day of September 2001 0, a 0j g6'e'- (SEAL) _ (SEAL) _ (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, SS. Coun . authenticated this day of Personally came before me this day of c<00 the above named * .Sr�.sgb ,� rKP TITLE: MEMBER STATE BAR OF WISCONSIN ''��"�� to (If not, . � me known to be the person who executed the foregoing authorized by §706.06, Wis. Slats.) to instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY , p " � • C71 t /r,U-- --�6 -- -- - - -- -- y ;' •••••• Notary Public, State of Wisconsin �y M commission is permanent. (If not, state ex Y ;ration date: P P (Signatures may be authenticated or acknowledged. Both 552 11ot l �sl o necessary.) ` Names of persons signing in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. QUIT CLAIM DEED FORM No. 3 - 1998 Milwaukee, Wis. I I 517968 CERTIFIED SURVEY MAP Located in art of the South Half of the Southwest Quarter of p Z Section 25, Township 31 North, Range 19 West, Town of Somerset, St. Croix County, Wisconsin. Bearings are referenced Prepared for and at the request of: to the west line of the Lindale Development Corporation SW; assumed to bear 964 192nd Avenue N00 0 40 1 07 "E. New Richmond, WI 54017 N00 "E 2640.37' — / R/W N00 23' 24 "E 66.00'— � .r- 66.00'— WEST LINE OF THE SW 1/4 - ' b Ulm 676' 55 S.T. H. ; ; 3 511 - - 1897.82' r - �o Z m ,' y co cj w ,' /9 = -4 70 g m 9 19. �Zo z r O��l/� 2 3 D 4 Ew e o / r 1 w 0 (M r ° ti , yD 7. I O � �I V v/ y O• a6' Cb ••tN A 0 N O /0) nN $,.x S : ° I< 1( ZN� `` bOi 100' m #A 10D 0 i 'N — — — X0=1' ' 9�8� 55. , �' 0 ► . 0 _ A 1 rn Z Z (D (D O O 0 t i z C IC s m m m� :3 rt 0 z tf G) 1 m I� IQ IC7 �► C ro O n O O H to 0 N to D OD w � W !" N *� (D N aj Qj P. 7 1 O) jr 1u) m m w ° a 2# r N� o w N (1 d :t cr z D w a k 2 a m I� at v nv, I "I' Iw •? O t0 m 2 :d O W M m 0 1 O (D z !� MAST ( INE OF SW1 14 -SWV4 A ti _ _ N' X 1 F 1 V O y -- w _._ a = rt mo ro n Js O --- �— — ap IC O " Yr �l — r v= m 0 O vm i- O N H Z 1r b N D CO v > W SOO.23' 24" W 429.63' .4 ,0� 1> W. I W m o g _ I m v� -4 0 I I m "' 1m £ c 74 1v C 1 y Q Icn !� m N r a A o Iv z m T 1v p C z sir 1W 10 m m ? Ica N. �• 0 w m jr IS N d W Jm W co WX 1 p r V m N m ro r•1 O O N O En N00° 56� 19 "E 639.51' o A > N v JuI� a ,�9� 1 ~ m 590,69, REC. AS NO.30'E 626.10 (e - y rt S9 .I P o ' S01° 02' 19 W 59 j S i . G:.G1 COUNTY r °i r z x o _mvehens a Plannk o�; N' I-D �', a a Zonin and 1 O In m Fa:ks Co ttee 01 y A 2 M • p 10_3 jr IC/) o D E: not r orded 1 ; within days of _ t m 1O 1 1 'o approv t deft ED approval hall be vu 1 wy \— -- - 6 26.66' - - - ntrl & void JUN 17 1994 0' 'CONNELL ?oo S01 "W 702.14 dAMESO� O EAST LINE OF THE SE 1/4 OF THE SW 1/4 a z � '� St Ctdlc tb.� 1N1 � N z m VOLUME 10 PAGE 2775 DRAFTED BY' DJZ 0 7 \ a 0 CD 0 \ \ D . 3.f \ f g __-0 z z o w o j e m o / e @ } n / § a , i. m E \ ] K o + § \ § CD < a . / 7 -� E 3 c E¥ _/ 2$ f § a a > / ] ` o & « ;§§ s§ s m E o 0 A § = a \ : E \ \ % 0 § E � � / \ V k � o � j \ / c 2 m@ a 2 \ � 3 ƒ \ G / C c \ \ 0 n r ) " . \ } T T S ` \, \ z 0 0 0 . \/ \ j\ 7 I \{ k Cr J M 7§\ k ° 2 ° J / IA _ \ § CL z \ & t \ \ 0 \ 0 ® / { } k c g \ + 3 0 , CD R \ k / / k \ z $ 0 w � \ k CL z tl) � \ ƒ \ $ � < / . . � } § \ . � \ n \ z % \ ƒ � \ � ) � m � < § � \ � \ � \ \ � 0 ƒ j < \ / \ ƒ \ { ' \ # i _ Wisconsin Departm ent of Industry, Labor aqd Hu ma Relations SOIL AND SITE EVALUATION REPORT Page of „Difrision of Safety &Buildings in accord with ILHR 83.05, Wis. Adm. Code I 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 % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROP RTY OWNER: 7 PROPERTY LOCATION / GOVT. LOT 1/4 1/4S T-31 N,R V(or)&V PROPE TY OWNER':S MAILING AD RESS LOT # I BLOCK # SUB 9. PME OR CSM # �f CITY, TATE ZIP CODE PHONE NUMBER OCITY OVILLAGE LYOWN tARE T ROAD (/ p(j New Construction Use [xj Residential I Number of bedrooms [ ] Addition to existing building [ j Replacement [ ] Public or commercial describe Code derived daily flower gpd Recommended design loading rate _ bed, gpd /ft gpd/ft Absorption area required aS_ bed, ft -57 tr nch, ft Maximum design loading rate ___ bed, gpd /ft gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations " Parent material - Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND I AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitablefors stem O S ❑U JZS OU ❑U ®S ❑U 0 ®U ❑S 181U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bairbry Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trer>ch 1 Ground J _ r elev. ft. j 6 _ Depth to limiting fact Remarks: Boring # Ground elev. ft. Depth to limiting factor 7 Remarks: CST Name:— Please Print Phone: q A ddress: Signature: Date: CST Number- PROPERTY OWNER SOIL DESCRIPTION REPORT Page of. , PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Ground elev. ft. c 9,1 1A At 14 Depth to limiting factor > 9/ Remarks: Boring # G round / elev. _ ft. Depth to limiting factor > 90 Remarks: Boring # J7 S.? Ground ZZ elev. D Depth to limiting factor Remarks: Boring # <ti Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) i A)ZI44 - � ✓�co� ✓� ��rPPv��tT sk %f� Sid s y�l�✓�t /9�✓ -3 s sf I i -e x� S G D y% ••1�W1 \11.1111IV11V1 YY1 JY V1Y — N00 "E 2640.37' — / R/W N00 23' 24 "E 66.00' 66.00' \� 0 WEST LINE OF THE SW 1/4 . D w�>E - - 676.55 S.T. H. 1135 1897.82' -- - $ r 1rqE m - oA/ 1 m w7, y \ W�YA 8 mzz 1 '_4 i0O W / e90 z1 BO I .O �� 99 AZ � 2 3y 9 s3•• £mA 0 I rO\ O (N ` o o Z I �iy , ti °0 oZ�� H Is p 0 YP� (� o 0 w w 7 k \1�`\) O to 0 P N -A x 's 1 '/ Z C- ' 70 I< in 1# -N 9 I I `D -I 1. v��, I o I 1 W .. I� I� �o� oall � to 2 65 • x OIIV. O f ro — —�0= -- S% 5 O►• 0 x"' m �ncnroMro r I O 10 N'A D� w W W N (D r a a n Z CD x I Ul m W � cn x A w 83 N; I A Iw I + o N a "Q A _ Z EAST LINE OF SWI /4 -SWV4 � _ ` N � -� FI PI ro 0 O -- _ - - - d x IC 0 I••( Nr 7 o r Iz :3 0 m I m O A z Iv Z = n \I m Ir 'b CO :0 In D w SOO' 23' 24" W 429.63' N O ID P. I 0 0\ I y - `' '" 1 m M W x m 0 cn O 1 p z m x Im £ G �I I� m m Io fD O 1 v ; I N IG) m D N m r• a w ;z Ir \L] 1 ��ID y to O IZ P. I� j� k31 "I IO 7 G M Jr- ICD 10 cmi to = ly ` r• �. w m I � IZ 1— IF D O f c A Jm N E O\ W Ib J., N � N � .� ro IN m1 eN ro A r CD 10 Nm NZ- ....1 (� N00 56' 19 "E 639.51' y to a F - m pA �N -4 r• � REC. AS NO' 3O'E 626.10' UI m 7 rf RFC-AS N O 'E 593.10' 4� 591.76' m a S01 02' 19" W 641.01' A 01 A o Z m to m X O O 1 N I D r -I -' I< " ° I IG) Ip In A z 1 100 it ICn t EAS T f A s -I (AIA -- _ 6 26.66' z 01 25' 44" W 702.14' 00 LINE OF THE SE 1/4 OF THE SW 1/4 ZIZm IO N2 OM A D MAY 2 0 1996 5 MAY CROix COUPiTY SURVEYOR'S RECORD FILED � AP? , 2 9 X996 CERTIFIED SURVEY MAP ?, KpTHtEENH.WAL of Deeds S Located in Part of the Southwest Quarter of the Southwest Quarter and part of the R,;a,,;�r St Croix CO., W1 Southeast Quarter of the Southwest Quarter all in Section 25, Township 31 North, Range 19 West, Town of Somerset, St. Croix County, Wisconsin. Being Lot 7 of Certified Survey Map recorded in Volume 10 Page 2775 WEST LINE OF THE SW 1/4 WEST 1/4 CORNER SEC. 25 -- N 00'40'07" E 2640.37-- - 1 Ir- Prepared for and at the request of I - o IC 10 Lindale Development Corporation L I i0 i0 iN F 964 192nd Avenue 1 : I�, New Richmond, WI 54017 o DOUGLAS J. ti / s ;j Z co LA NCER y 2 �� "I o c,, Drafted b James M. Broult M , S -2145 * \ `s-�. d� �o�' M ;U D 0 Sul / ty � � r O � 7 Q Ln ;u TI '�l � C t� C 10 I� © �� O O 7 7 3 rt m �� p 7 m / I 1r I 10 O a a a a A p 1� 1 - j goo' J a w : $ r x fn Z �� IP ISO I I� lo ICJi �� Z y 3 P^ fi 0 G7 0 O Do ' i� i� I �9 / N 02'17'43 "'E 0 n j o r or 07 O I� IJ I. IN �6'S r , -i c V - . 0 G I w NI 2�2 Qv 2.74.99' I = w CA S �— — — — — • /' p0 m C7 I Z I Z a ' I p z j Q 1 �� �G (n p o f O o N N M V Z A AC^i QV i0; �a) a V N j ° a z tp I I� tJ. : ' 1 r- i I a Iii, Ir- m 1> 1 I Cn Ui m� I 1 \` N I 0 I P to I IJ ICY) 1 -- — —I p I I-I I i Z o I � I '� I m 0 1 0 429.63' M i< i� j N 00'23'24" E M (D I� O GRAPHIC SCALE a 0 i W j 0 50 150 300 450 600 0) z I N 00 -,I= N 00 -- — — —1— -- � I I D O W CCi ( IN FEET ) A I� Lh 1 Inch - 300 ft. a A 11 cn OD N M co APPROVED a 1 11 N i R =N 00'30'E 626.10' IN _ Ot 639.51 _ Z �4� N 00'56'19" E i � v Q � o r i S O N �- -- -- Q �- -- 590.69' -- R N ..� APR 29. i"r1 � N > -- 591.76' -- 2 C m m -- 641.01 -7 ia� m�� rn I � S 01'02'19 W I ; `� S,T . cRoIX COUN�f ° ZO OI u R =N 00 593.10' I , z - o � i z a C -os�ln ro�ensive S O t� m Cn V' 1 g Zoning and m 0 o f io 0 d OD j Parks CaM m y 1 1- 1(A y �! f if :eat record" o x within 30 elEly�s m D I I m µ I approval - d*% m` � / t oo 1 % vprOV S lhigibb v Z V) i� --- 626.86 ' --- 1 � i M C S. 1/4 CORNER SEC. 25 _ Z Z c) m JOB # 3195 S 01'25'44" W M O [ A & E LAND SURVEYING EAST LINE OF THE SE 1/4 OF THE SW 1/4 PHONE # (715) 246 -4319 X m VANi P.O. BOX 325 NOTE: The parcels shown on this map are subject to State, County and Township 109 EAST 3RD STREET laws, rules and regulations ( i.e. wetlands, minimum lot size, access to parcel, NEW RICHMOND, WI 54017 etc.). Before purchasing or developing any parcel, contact the ,St. Croix County Zoning Office and the appropriate Town Board for advice. Sheet 1 of 2 VOLUME 11 PAGE 3085