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HomeMy WebLinkAbout032-2101-00-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division t INSPECTION REPORT sanitary Permit No: 420713 0 GENERAL INFORMATION (ATTACH TO PERMIT) tate Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)J. ''3? F~6 • / • ) Permit Holder's Name: City Village X Township Parcel Tax No: Brown, Richard T I Somerset Township 032 - 2101 -00 -000 CST BM Elev: Insp. BM Elev: Description: Section/Town/Range /Map No: SM U I LU b 26.31.19.965 TANK INFORMATION ELEVATION DAT TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic (_. Benchmark . 'y• So c� .o Dosing Alt. BM � w - S 2 - 0 1 0 1 - Aeration r Bldg. Sewer {� C2•IS �• Holding St/Ht Inlet Q, �2• g �. c fQl TANK SETBACK INFORMATION St/Ht Outlet C AJ O 1 Zo • ?�' TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet 13.3 3 ' Septic v ! + 7� t 301 Dt Bottom 49 1 Dosing ,� tl �5 Header /Man. Aeration Dist. Pipe } 5 1 2 • �• to Holding Bot. Syste / /� 3 Z B. Z pct' OD 2Z Final Gra PUMP /SIPHON INFORMAATION Manufacturer Demand St Cover GPM Q Model Number o� - K W► ( 3.(P4 ,11 H Liff,, Friction Loss System Head T w Ft 0� ILL �► • so 2 •aq r orcemain Le `� / IDia. It Dist. to Wen (0 �•� SOIL ABSORPTION SYSTEM BED /TRENCH Width r Length No.aelty PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS LID Z) 1.+ J SETBACK SYSTEM TO /L LDG WELL LAKE /STREAM LEACHIN ufacturer: INFORMATION Type Of System: r / CHAMB /1 ISO w J �( -7 /� IT Mo ber; DISTRIBUTION SYSTEM = S• fD S .1c , lc Header /Manifold Distribution y t x Hole Size r x Hole S acing Vent to Air Intake �, O t // P • 5L _� 3 O Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depthof xx Seeded /Sodded x Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes F No ]Yes hI No � x 3 COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1 ^ _y 27 &V 3 Inspection #2 Location: 1940 62nd St Somerset, WI 54025 (NW 1/4 SW 1/4 26 T31N R19W) Pinec' Lot .� Parcel No: 8� 1 Alt BM Description I / �J ��,rvti ��'✓ V0 . 2.) Bldg sewer length = �• �?,. u � Y� , �i , �f �►T ' !�(N•cc,G .gyp - amount of cover = > tf 2- f� (x r pl�n.tk ISO S � 0 Plan revision Required? Yes / � a j t 6 u r ;l � Use other side for additional information. SBD -6710 (R.3/97) Date sepctors Cert. No. r - Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7082 isconsin Madison, WI 53707 - 7082 Sanitary Permit Nuhi er (to be filled in by Co.) Department of Commerce (608) 261 -6546 1 -1 2 0 7- 13 Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide UJ (9 may be used for secondary purposes Privacy Law, s15.A4(t w Project Address (if different than mailing address) I. Application Information - Please Print All Information e's Name ' ° n / Property � � 7 t� Parcel N $� , i `6 _co Owner's Mailing Address Property Location City, a Zip Code Phone Number -4 _ Yti ,mow y'� Section i T � Ni K ..�-,L... B II. Type of Building (check all that aPP1Y) G5 1 or 2 Family Dwelling - Number of Bedroom Subdivision Name r ❑ PublicXornmercial - Describe Use ^T- ❑ State Owned - Describe Use ❑City ❑❑Village jhownship o s cucs - III. Type of Permit: (Check only one box on Hue A. Complete line B If applicable) A. ONew System ❑ Replacement Systaa ❑ Treatment/Holding Tank Replacement Only ❑Other Modilit.atien to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date blued Before Expiration Plumber Owner - IV. Type of POWTS System: Check all that appl ❑ Non - Pressurized In - Ground G� Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At - Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Saad Filter ❑ Recirculating Synthetic Media Filter ❑ Leachin Chamber ❑ D ' Lim ❑ Gravel - less Pipe ❑ Other ex lain V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application t 50 Dispersal Area Required (sf Dispersal Area Proposed (so System Elevation ttil( , 01 VI. Tank Info Capacity in Total umber Mwwfacturcr Prefab Site Steel Fiber YlastiC Gallons Gallons of Units / Concrcic Constructed Glaze New Existing A op Tanks Tanks f�Wee- Septic or Holding Tank Aerobic Trwtmem Unit Dosing Chamber p VII. Responsibility Statement I, the undersigned. a me responsibility for Installation of the POWTS shown on the attached plans. Plumber' ame rint ) Plum e MP/MPRS Number Business Phone Number X�5__ -_;, �_Z) P u 's Address meet, ity State, Zip e) VIII. oun /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued suing ent Signature o ps) ❑ Surcharge Fm) cre oZ/ Owner Given Reason for Denial 1 'I 2 j 027 IX. Conditions of Approval/Reasons4or Disapproval / ec � � I ►�,ua�' r>1at.>1,- fai.� -., s s� • �3. SZ J�,- �i,-k- Geed ca, ate . &n" , . 6'3. 1� -1 Ansca compkie Plans (to the County sal w the system an paper act kss than 81/2 t 11 lathes U site ,;BD -6398 (R. 08/02) y rJ y i ,• � air "f Io,OL` {— - -. __.�. ._ 0 V. wit Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 TD #: (608) 264 -8777 erc Visconsin www www.commerce ons .wisonsin.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary February 19, 2003 CUST ID No.224263 ATTN: POWTS Inspector KIM A O'CONNELL ZONING OFFICE K.O. CONSTRUCTION ST CROIX COUNTY SPIA 504 3RD AVE 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 CONDITIONAL APPROVAL - OY& 7 PLAN APPROVAL EXPIRES: 02/19/2005 Identification Numbers Transaction ID No. 838028 SITE: Site ID No. 655912 Richard T Brown Please refer to both identification numbers, ►qqD 62ND St above, in all correspondence with the agency. Town of Somerset' St Croix County co: NWl /4, SWIA, S26, T3 IN, RI 9W FOR: New mound, 600 GPD' Object Type: POWT System Regulated Object ID No.: 892275 Di of The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes v and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in ' �' =° chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. `'` i The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10691 -P (N.01101) and SSWMP Publication 9.6, "Design Of Pressurized Distribution Networks For Septic Tank- Soil Absorption Systems." • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. Key Item(s) • A copy of this approval letter and index sheet shall be attached to plans that correspond with the copy on file with the Department. Changes to the approved plan must be submitted for review and approval. Failure to properly attach the approval and index page to plans that match the copy on file with the Department may result in enforcement action under s. 145. 10, Stats. Note • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater - particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of TS ex is cleanin of the of uent i ter i s required. The access opening used to service the filter shall to ate at or above fmished grade with a waterhg cover. z_- & a f KIM A O'CONNELL Page 2 2/19/03 Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(i). Consult the Department of Natural Resources for well setbacks and exceptions to the setbacks. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, ope ation - or maintenance of the POWTS. Sincer I Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 'afncia L ndorf POWTS Plan Revie r, Inte ated Services WiSN1ART Code ,'7633' (715) 634 -7810, Fax: (715 34-5150, M -F 7:45 am - 4:30 pm pshandorf @commerce.state.wi.us cc: Leroy G Jansky, , Wastewater Specialist, (715) 726 -2544 I I I I I r MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: RICHARD T. BROWN Owner's Name: RICHMOND T. BROWN Owner's Address: P. O. BOX 731 HUDSON WI 54016 Legal Description: NW- SW- SEC26 -T31 N -R19W Township: SOMERSET County: ST. CROIX , X T.S. Subdivision Name: PINE CLIFF tionall Lot Number: 20 Block Number: NT C ME Parcel I.D. Number: 032 - 2101 -00 SA 7Y AN DINGS Plan Transaction No.: ;RESPOND E Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 PLOT PLAN Designer: KIM A OCONNELL License Number: 224263 Date: 02/14/03 Phone Number: 715 - 755 -3145 Signature - Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Version 3.0 (03/01/01) Page 1 of 8 Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design Note: sand 0 (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 83 - 44 - In soil treatment f or fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coUform of <■ 38 inches. 600.00 Design Flow (gpd) 2.00 Site Slope ( %) 99.70 Contour Line Elevation (ft) 31.00 Depth to Limiting Factor (in) 0.40 I n -situ Soil Application Rate (gpd /ft Distribution Cell Information 100.001 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /ft 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution F Y Pressure Disribution Information network? Enter Y or N (c or e) E Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation ft 2 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 3.50 timated Orifice Spacing (ft) _ 10.34 ft /orifice 2.00 Forcemain Diameter (in) _ 225.00 Forcemain Length (ft) Does the forcemain drain back? Y� . 0 I Pump Tank Elevation (ft) . Enter Y or N 6.50 System Head (ft) x 1.3 36.70 Forcemain Drainback (gal) 10.23 Vertical Lift (ft) 90.43 5x Void Volume (gal) 2.86 Friction Loss (ft) 127.13 Minimum Dose Volume (gal) 19.60 Total Dynamic Head (ft) 23.89 System Demand (gpm) Lateral Diameter Se lectio n Manifold Diam Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x 1.25 2.00 x 1.50 x x r 3.00 2.00 x 3.00 x Gallons /Inch Calculator (optional) Treatment Tank Information 800.00 Total Tank Capacity (gal) 1260.00 Septic Tank Capacity (gal) 36.00 Total Working Liquid Depth (in) WEEKS Manufacturer 22.22 gal /in (enter result in cell 849) Dose Tank Information E luent Filter Information 800.00 Dose Tank Capacity (gal) abel Filter Manufacturer 21.76 Dose Tank Volume (gal /in) A100 Filter Model Number WEEKS Manufacturer Project: RICHARD T. BROWN Page 2 of 8 i Mound Plan View T 1 1/10 B observation Pipe 3 K Q � A W B 3. I L Mound Component Dimensions Down slop toe extension made. A 6.00 ft E 7.44 in H 1.00 ft K 7.06 ft B 100.00 ft F 9.50 in I 9.00 ft L 114.11 ft D 6.00 in G 0.50 ft J 5.07 ft W 20.07 ft 600.00 1 (ft Dispersal Cell Area 1500.00 (ft Basa Area Available 6,00 (gil Linear Loading Rate 10.00 (ft 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 1 01.99 ( ft) --- -0 _ H G I ......... F Dispersal Cell ♦ ' 100.7 (ft) Latera 100.20 ft) --► — Invert �—� Dispersal P e sal e I Ele D; 1 i .......... .... 99.70 (ft) C ontour Elevation 2.0 %Site Slope - —� —� -- Geotextile Fabric Cover Shading Key g �— Dispersal Cell See lateral details on Q Topsoil Cap 1.5 ft Page 4 for number, Subsoil Cap Q Q size, and spacing of ASTM C33 Sand F laterals. Laterals are ® Tilled Layer 0.5 ft Typical lateral equally spaced from MEMAggregate • ? the distribution cell's -- A centerline in the distribution cell (AxB). Project: RICHARD T. BROWN Page 3 of 8 End Connection Lateral Layout Di agram a ou y s Laterals centered over the A & 8 dimension ♦= Turn -upwd ball valve oroleranoutplug rFoartoe P als are identical IF x-.—+I Hol es drilled on the bottom of the lateral S equally spaced ruin oonneotion via tee or cross to manifold at any point. Laterals Dc force main of PVC Soh 40 (per COMM Table $4.30.6) Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 3.52 ft Lateral Length (P) 98.56 ft Orifices per Lateral 29 Lateral Spacing (S) 3.00 ft Orifice Density 10.34 ft /orifice Lateral Flow Rate 11.95 gpm Manifold Length 3.00 ft System Flow Rate 23.89 gpm Manifold Diameter 2.00 in Total Dynamic Head 19.60 ft Forcemain Velocity 2.44 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and ----i► Comm 16.26 WAC 4 In. min. Disconnect Tank component Is property vented E__ Altemate outlet location Forcemain diameter WEEKS Manufacturer _ 2 in. Cap acityl 800.00 Gallons Volume 21.7 gal /inch A- Weep hole or anti - Dimension Inches Gallons B siphon device A 20.91 455.06 C B 2.00 43.52 P ump off e levation (ft) C 5.85 127.34 90.47 D 8.001 174.08 D Total 36,761 800.00 Dose tank elevation ft 3" Bedding uncTer tank. ~— F 89.80 Alarm Manuafacturer JSJ ELECTRO Alarm Model Number IHW 100 Pump Manufacturer IGO Pump Model Number WE0311 L Pump Must Deliver 23.89 gpm at 19.60 ft TDH Project: RICHARD T. BROWN Page 4 of 8 M�ou_ng System Maintenance and Opgration SaeclficItl2ns Service Provider's Name KIM A O CONNEL L Phone 715 - 755 -3145 POWTS Regulator's Name ST. CROIX COUNTY ZONING Phone 715- 386 -4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1260 gal Maximum TSS 150 mg /L Soil Absorption Component Size 600 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliforml >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test monthl Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Ins ect for ponding and seepage once every 3 years Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished . Grade 6-8" Diameter Lawn ......... Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: RICHARD T. BROWN Page 5 of 8 - Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated In accordance with Comm 82-84 Wis. Adm. Code, and shad maintained In accordance with its' component manuals ISBD- 10691 -P (N.01/01) and SSWMP Publication 9.6 (01/81)) and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be Inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective looking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an Individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet fitter shall be cleaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions are made to retain solids In the tank that may slough off the fitter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm Is activated continuously. Intermittent fitter alarms may indicate surge flows or an Impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 113 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent fitter is Installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October - February) dictate that the mound be heavily mulched as protection from freezing. Influent quality Into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD 30 mg/L TSS, 10 mg/L FOG, and 10 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the Initial test when the system was installed to determine if orifice dogging has occurred and if orifice cleaning Is required to maintain equal distribution within the dispersal cal. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels . :above 6 Inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continaencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically dogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Se Page 6 of this plan for the name and telephone numb of your local POWTS regulator and service provider :5T'66 Yx -270 A[Al/(T — 1 Project: RICHARD T. BROWN Page 6 of 8 ■rrrrrrrrrrrrrrrr t ■i rrrrrI rrr.MIN� ` • , - lag CCC�'"rC�"iCCrrrrrrrrir �! Ism �"iC'� . - .,, .� rr r..rrrr irrrrrr �r r�.!�r�rrrrrrirrr _�rr.rur�s..�rrrrrrrrrrrrMwr . .rrr�r�r■�r►�r�r`rrirrrr��e�rr� rrrrr,r .!�rrrri►rrrriri►�rrrr�rrr�r . rrrrrrs�rr ►NEir.,r►Nrrrrrr ' r�••••. :!•��rr.�irrrirrr►�r►rirrrrrrir nom• -•�.' •.— •.iii = omanrWOMMUrrr r ■ - •- Sri ►�rr�rr ►rrrrrir ir rirrirc�ri►:rrri.�rrrrrr rrrrrririrrirrtrr�ri ►r.;�.�r�rMEMO ■rrsrrrrrr rrrrrrrrrrrr�rrr 0 ■■■■irrrrrrrirrr :: 'mCC:ICCCC ®CC ®C© 'SIZE 3 /4" Solids' �r ■ r�rrrrr ' irr rrr rrrrrr�i■iriri�'ir ., ■ r�r.�i CrrrCCrrr�rririrrrriru��r ir■ �rrirr� ►�rr�rririrrirrrrrrrrrrir . , rr■rrrr► rrrrri■�rrirrrrrrrrirr�ir r r rrrrrr �rrrrrrrr�rrrrsrrrr irrrrrrrrrrrrr • 18 '�rrrrr ��i CNo MEN rrrriii rrrirrrrHr r' ■INE� ■r•�rrrrrrrr■rrrrrr .err ririrrrrrrrrrrrrr�rrrir "■ rrrrrrrr �rrrrrrrrrrrrr rr rr►�rrrrrr'�i,,,rrrr ■�■��■■� r ►����rrrrrrrrr 'r C■�1 �CCCC';�� ' rrrir�.r CCm�iiirrr�C�r ■��r�rrNOMIN i iiCiiii►�irrir�irrinow rrr rrrrrr►� rrr rrrrrrrrr rrNrirrrrrurr�i rrrrr"'�rirrrrrrrono .. :. . :. .. .. a � q 0 o Jam I � o s� c o i C ITI v y;iW Department of Industry SOIL AND SITE EVALUATION Labor and Human Relations ' Page of 3 Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. 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 ~ �� percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # v .� �� S• APPLICANT INFORMATION - Please print all information iewed b ! Dalbi "' Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Govt. Lot 1/4 1/4,S Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# 1 1 'e2 Ai City Stat Zip Code Phone Number Nearest Road (/ � ❑ �, ViNa9e ®Town JZ New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow t,'QQ_ gpd Recommended de sign loading rate _, bed, gpd/ft ;_ trench, gpd/ft Absorption area required _gy bed, ft? trench, ft Maximum design loading rate i[_ bed, gpd/ft trench, gpd/ft Recommended infiltration surface elevations) 7 ft (as referred to site plan benchmark) Additional design /site considerations ��inL(�i l� W Parent material A.,16114s.✓ _ e1 �,ea Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = unsuitable for system ❑ S CK] U ®S ❑ U ❑ S V1 U ❑ S 09 U ❑ S ®U ❑ S [ u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 13 1,9 4_1Z A114 Ground / Alf elev. Depth to limiting factor Remarks: Boring # , Ground �;s'G8 — elev. ft. Depth to limiting facto; in. Remarks: CST Name (Please P nt) i Signature Telephone No. Address p� Date CST Number S st )J' 4;�2 - 9/_ 3'�� l SOIL DESCRIPTION REPORT PROPERTY OWNER f ` Q Page �- of PARCEL I.D.# Boring Horizon Depth Dominant Color Mottles Structure 2 g Texture Consistence Boundary Roots Y in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench MM 1 Ground elev. /-F� i 't• s . — Depth to limiting factor Lin. Remarks: Boring # 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 # ; y ea Ground elev. ft. Depth to limiting factor in. Remarks: Boring # H: F Ground elev. ft. , Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) J -- .tG!m� 3 7` cao - 9C,�� c' m 1 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner u, Mailing Address Property Address (Verification required from Planning Department for new construction) City/State Parcel Identification Number LEGAL DESCRIPTION Property Location 1 — '/4 „ 1,J %., Sec. r---2� , TLN -R_L�—W, Town of Subdivision ' Lot # Certified Survey Map # , Volume . . Page # Warranty Deed # Volume ) 7,86 , Page # Spec house ❑ yes 0 no Lot lines identifiable yes ❑ no SYSTEM NIA,INTENANCE 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mastor per• journeyman Plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin - Certification thatyour�c s tem has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 da o the three ar ex n date. SI A - 6F -\ APPLICANT DATE OWN CERTIFI we certi that all statements on this form are true to the best of my (our) knowledge. I (we) am (are ) the owner(s) of pro a ve, by virtue of a warranty deed recorded in Register of Deeds Office. SI TURE OF APPLICANT t DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.""" «« 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 vol 1.780PAGF 321 664026 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS . CROIX CO., WI This Deed, made between Richard L. Martle, Jr. and Susan May RECEIVED FOR RECORD Martie, husband and wife i2 8:30 AN I<P.RRANTY DEED EXEMPT I Grantor, and Richard T. Brown and Lori R. Brown, husband and wife CENT COPY FEE: COPY FEE: TRANSFER FEE: 239.70 REGARDING FEE: 11.00 PAGES: 1 Grantee, Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Name and Retum Address Lot 20, Pine Cliff in the Town of Somerset, St. Croix County, Wisconsin. First National Bank of New Richmond �—' PO Box 89 New Richmond, WI 54017 032 - 2101.00 ' Parcel Identification Number (PIN) This is not homestead property. 0g) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this 30th day of November 2001 + + Richard L. Martie, Jr. „ + Susan May Martie AUTHENTICATION ACKNOWLEDGMENT Signature(s) Richard L. Martie, Jr. and Susan May Martie, STATE OF WISCONSIN ) husband and wife ) ss. St. Croix County ) authenticated this day of Personally came before me this 30th day of Noyemhe' 1 2001 the above named Richard L. Martie, Jr. and Susan Ma + Martie TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (if not, instrument and ack owledged the same. authorized by § 706.06, Wis. Stats.) \ o C THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogiand Notary Public, State of Wisconsin Hudson, W154016 p JULI My Commission is permanent. (1f not, state expiration date: (Signatures may be authenticated or ac na�vle *Y.t3 Odtft�n 04/07/02 ) • Names of persons signing in any capacity must be typed or printed below their signature. u+ ormm w Fmfo wY ws company, Four du L.. wa eoo.esszoit WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 - 1999 I N81 °31'02„ W 9 O , G �Fp \� 3.05 / i� 2 ?3 35, � � I � 9�F i 32,8 CK ••� O — 5 10' 19 i9 • 2.90 ACRES 126, 322 S ?,�, • • 0. FT. 7s0 7 / �` '�, • • 3.2± ACRES INCLUDING LANDS BET ,A WEEN MEANDER LINE AND A0 1 a � ms s, �, 0 WATERS EDGE. •L \ 3 ` 4. \ 9� • 0 `��\ 9 Z �CA ' 0, ° 29 s\ h 6• 9 \ N 6 ��' `26 • •� V� dol 2 0 HIGH WATER o �� � OF 10/05/95 t?�� � 300 ACRES O� 130,683 SO. FT. \ 'L Inc 9 �V toe o � a 0 1p 4 1 goo' 200 300 SHEET 2 OF 4 SHEE / r ' ° J � � ■ � � � � � ¢ ƒ ( $ 0 \ 7' ƒ § § �- » E k n E 5 4 2 7\ / \( ƒ 8 m 2 n _ :0§) ■ Q = g c E % @ ■ � ,I § ° w E § _ © g / > £ c q� \ \ 58f a N _ z //, f E S 3 E co W � CD ■ _ ( E z o o o / Oro a � G o § ■ ■ ■ o $ / E ° R ( Po E £ � \ ■ � ) / # & , z .. & c z = ,- r , > o E$ a Z ; = D 7 ! m ) \cD Q Cl) / ] [ 2 0 z } §_ 2 2 C CD / � § \ 0 ® Q. 3 ƒ § % \ } / { Z \ CD � f k / 0 § s G k k % CD � @ ƒ %� 2 $ } $ { > � � $ \ ƒ ! � 2 � { 0 � � @m w � ki � �2 WN lA /� x �tf (.t Ire t /a C • Wiscopsirt Department of Commerce SOIL EVALUATION REPORT Page ;* Division of Safety and Buildings 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. Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Prop y Owner Property Location l �• Govt. Lot V 1/4S 114 T' 1 N R 1 E (or Property Owner's Mailing Address Lot # Bloc # Subd. Name o Cam., e 3 � C ity Sta Zip Code Phone Number ❑ City ❑ Village Town Nearest Road New Construction Use Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable REC ft. General comments and recommendations: APR 2 3 2002 ST. CROIX COUNTY Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor � in. T . 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 X �� G - �� C AIL Boring # F1 Boring jo 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. C nt. Color Gr. Sz. Sh. *Eff#1 *Eff#2 20 Al d s G.� -s `- * Efflu, t #1 = BOD > 30 mg /L and TSS >30 _< 150 mg /L Eff Iyent #2 = BO 5 < 30 mg /L and TSS < 30 mg /L CST Name P ase Old Signature CST Number s Address Date Evaluation Conducted Telephone Number SBD -8330 (R07 /00) I / - Property Owner c i �.CSi'� /�" Parcel ID # Page of Boring # ❑ Boring A F Z Pit Ground surface elev. 6 P ft. Depth to limiting factor �f3 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 V /,1 -�241)4 a -> 02 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 # ❑ Boring [I 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 = 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) 0 o t S a \ 1 I 4. 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