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HomeMy WebLinkAbout032-2167-48-000 Wisconsin Depar of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Builc{i• ision INSPECTION (ATTACH Sanitary Permit No'. 453077 0 GENERAL liv" IRMATION (ATTACH TO PERMIT) State Plan ID No: Personal information ? ,)u 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: Pinecliff Partnership Somerset Township 032 - 2167 -48 -000 CST BM Elev: Insp. BM Elev: BM Description:�,� ^ 1 Section/Town /Range /Map No: /d r \ 5 \ 26.31.19.1428 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. L 171L, Septic Benchmark Dosing Alt. M (� Cxb v ,,Z<_ Aeration n Bldg. Sewer 117 7 Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet (� (02 64( r Septic / 7 14�li J Q / / Dt Bottom zl - ZS 75,6 C Dosing y -Z i 7 At, ! G I j � t i Header /Man. 16.7 79 4-7 Aeration Dist. Pipe fl,.l9 '0. 47 Hlding . BoW o b "-7 \� , �� Final Gr de PUMP /SIPHON INFORMATIO 1 IT ac, 15 .7 ' 7 I • [ Manufacturer De S Cover 1b 3. e Model Number Ligo3 k L TDH Lif Friction Loss System Head T t ' 146 , 71 � S 1 I ,art Forcemain Leng Dia. Z J/ Dist. to Well /OQ , ABSORP ION SYSTEM BE ENCH Width, ength No. Of Tre es PIT DIMENSIONS No. Of Pits Inside D1a. Liquid pth MENSIONS FJ, /� R � \ SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION A CHAMBER OR Typ; System: COD /�� UNIT Model Numbtr /fy C / \. DISTRIBUTIO SYSTEM Header /Manif 11 Distribution �� 1 r x Hole Size j� x Hole Spacing Vent to Air Intake • �� Pipe(s) r ( I Z \ Length Dia Length Dia Spacin SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of n xx Seeded /Sodded xx Mulched P Bed/Trench Center ) Bed /Trench Edges Topsoil I ', Yes No es No 1 COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: - 7 /�/ b Inspection #2: Location: 633 196th Ave a Some et, WI 540 5 SW 1/4 NE 1/4 26 T31N R19W) Pinecliff 2nd Addition Lot 48 Parcel No: 26.31.19.1428 1.) Alt BM Description = �\� a0`• �� 0� 2.) Bldg sewer length = � + - amount of cover = m\,— a- 1\ l\ Vo Plan revision Required? Yes o Use other side for additional information. ate Date lnsepctor' Slgnatur Cert. No. SBD -6710 (R.3/97) _J Safety and Build4ngNZivision County �� 201 W. Washington AV ., P. x 7162 , ���� Madison, WI 707 -�Z Sanitary Permit Numbe r (to be filled in by Co.) De artment of Commerce (�8) ii- 3151 ,. • • f n , <; Qstah.^.�lan I.D. Number Sanitary Permit Applicat n-; Q In accord with Comm 83.21, Wis. Adm. Code, personal info don ybii'provide may be used for secondary purposes Privacy Law, 315. m Project Address (if different than mailing address) L Application Information - Please Print All Information �' ' # ��� / �°� � • Property Ow er's Na me ` °•,' ( , Parcel k Lot # AtMT T' Property wner's M ai ing Address operty 1#adon x f City, Stn Tin ( "'d, Phone Nurnher I ' (circle T L N; R _ L E• o 11. Type of Building (check all that ,a(�pl') po g „^^ ❑ 1 or 2 Family Dwelling - Number of B drams Subdivision Na m& 11 Public /Commercial - Describe Use = t ✓ - r j U State Owned - Describe Use f 0Q C o&- t -❑City _❑VillageJ2fTownship "' 1 A 1 etc s III. Type of Permit: (Check only one box on line A. Complete line B if applicable), p — 21 -*4 - -6W I � Z j A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. List -wid Permit Renewat 11 Permit Revision d Change of C1 Permit Transfer to New Date issued:...___ Before Expiration Plumber Owner IV. T of POWTS System: (Check all that apply) f .l Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter Rec irculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V Dispemnl/Trentment Area Information: IN Flow (gpd) Design Soil App icadon Rate(gpdst) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation Vi. "Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Unite w / Concrete Constructed Glass New Existing Tanks Tanks 4, Septic or Holding Tank Aerohic Treatment Unit x nosing Chamber VI1. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plurnhcr's a (Pr'nt) Plum is Si a e MP /MPRS Number Business Phone Number 1' u, ber's Addre ss (Street, City, State, zip C )' V11 I, Count /De artmen (else Onlv Approve ❑ Di.samroved Sanitary Permit Fee 'ncludes Groundwater Date Issued h u' g Agent St +Stamps) Surcharge Fee) 35� -__ l (7 Owner ven Rcn.eort for hcninl JV ('� IX CmtdlNnne pprovall - }-- SYSTEM OWNER: 3 � AA C ►�, (�W l S 5�4 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances #a '" Attach complete plans ((o the County only) for the system on paper not less than 91/2 x 11 Inches In size SBD -6398 (R. 01/03) Mrs PF C;op y76- C'o Safety and Buildings Nvirsconsirn 1 10541N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264 -8777 www.commer . issb wwwonsnsin.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary March 24, 2004 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 PLAN APPROVAL EXPIRES: 03/24/2006 Identification Numbers Transaction ID No. 980851 SITE: Site ID No. 671850 Mike Hartman Please refer to both identification numbers, 62ND St above, in all correspondence with the agency. Town of Somerset St Croix County SWI /4, NE 114, S26, T3 IN, RI 9W FOR:. R O A Description: New mound, 4 bedroom residence CnsZ �''` Object Type: POWTS Component Manual Regulated Object ID No.: 947075 � Maintenance required; 600 GPD Flow rate; 22 in Soil minimum depth to limiting factor from original grade; A System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /O1) D RTMENT The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Code� of S AFE 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. SEE GOl2iZE No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. 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 design manuals noted above. • 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 reviewer has attached a copy of the approved revised pages to the index sheet that was provided.) • 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 KIM A 0 CONNELL Page 2 3/24/04 - the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above fmished grade with a watertight cover. 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. 0 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)(1). 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, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 r Fee Received $ 175.00 /,, Balance Due $ 0.00 Patricia L Shandorf POWTS Plan Reviewer, Inte ated Services WiSMART!code: 7633! (715) 634 -7810, Fax: (715) 634-5150, M -f 7:45 am - 4:30 pm pshandorf @commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: MIKE HARTMAN Owner's Name: MIKE HARTMAN Owner's Address: 744 RYAN DRIVE HUDSON WI 54016 Legal Description: SW-- NE-- SEC26-- T31N - -R19W Township: SOMERSET County: ST. CROIX Subdivision Name: PINECLIFF 2ND ADD Lot Number: 48 Block Number: V.T.S. Parcel I.D. Number: PENDING ionally Plan Transaction No.: 0 ED OF COM RCE- Page 1 Index and title TY 9 iNGs Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank SPONDEN Page 5 System maintenance specifications Page 6 Management and contingency plan / O Page 7 Pump curve and specifications - Page 8 PLOT PLAN Designer: KIM A OCONNELL _ License Number: 224263 Date: 03/16/04 Phone Number: 715 - 755 -3145 Signatur . 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 fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 83 -44 -3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of - 36 inches. 600.00 Design Flow (gpd) 14.00 Site Slope ( %) 97.50 Contour Line Elevation (ft) 22.00 Depth to Limiting Factor (in) ' 0.40 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 100.001 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) 1.001 Dispersal Cell Design Loading Rate (gpd/ft 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution 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) 3.00 Estimated Orifice Spacing (ft) = 9.09 ft /orifice 2.00 Forcemain Diameter (in) 45.00 Forcemain Length (ft) Does the forcemain drain back? Y 91.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 7.34 Forcemain Drainback (gal) 7.50 Vertical Lift (ft) 90.43 5x Void Volume (gal) 0.73 Friction Loss (ft) 97.77 Minimum Dose Volume (gal) 14.73 Total Dynamic Head (ft) 27.19 System Demand (gpm) La Diameter Selection Manifold Dia Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x X 1.25 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons/Inch Calculator (optional) Treatment Tank Information 1260.00 Total Tank Capacity (gal) 1260.001 Septic Tank Capacity (gal) 1 63.001 Total Working Liquid Depth (in) WEEKS IManufacturer 1 20.00 gal /in (enter result in cell B49) Dose Tank Information Effluent Filter Information 800.001 Dose Tank Capacity (gal) JZabel _ Filter Manufacturer 21.761 Dose Tank Volume (gal /in) A100 Filter Model Number WEEKS Manufacturer Project: MIKE HARTMAN Page 2 of 8 r Mound Plan View . . . . . .. . . . . . . . . . . . . . . . . . . . . . . .................................... . . . . ...... . . . . . . .... . ........... J 1/10 B Observation Pipe 3 :❑ ..... ..... _ l ... .... .... .... .. 1 K .. Q A W I I _ B ...........:............:. I 3 : ❑: ........................... ............................... L Mound Component Dimensions A 6.00 ft E 24.08 in H Aft ft K o20.27 ft B 100.00 ft F 9.50 in 1 ft L 1ft D 14.00 in G 0.50 ft J ft W 600.00 (ft Dispersal Cell Area 2306.03 (ft Basal Area Available 6.00 (gpd /ft) Linear Loading Rate 10.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 100.46 (ft) - ---- -► G ♦ H l F Dispersal Cell 99.17 (ft) Lateral 98.67 (ft) Invert Dispersal Cell Elevation E D �....• ........•...;::.• 1 97.50 (ft) Contour Elevation 14.0 °k Site Slope Geotextile Fabric Cover Shading Key m �— Dispersal Cell See lateral details on [] EM Topsoil Cap c 1.5 ft Page 4 for number, rr'r'r "r Subsoil Ca w 0 P size and spacing of �� Q � P 9 © ASTM C33 Sand v 2 F laterals. Laterals are Typical Lateral ® Tilled Layer � c 0.5 ft equally spaced from 5 Aggregate the distribution cell's ❑ ❑ .� . }---- A —* centerline in the distribution cell ( Project: MIKE HARTMAN Page 3 of 8 End Connection Lateral Layout Diagram Laterals centered over the A& 9 dimension 0= Turn-up Yd ball valve or olean outplug I P All laterals are identical Holtz drilled on the bottom of the lateral S equally spaced Force main connection via tee or cross to manifold at any point. Laterals & force main of PVC Sch 40 (per COMM Table 84.30 -5) Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 3.08 ft Lateral Length (P) 98.56 ft Orifices per Lateral 33 Lateral Spacing (S) 3.00 ft If- Orifice Density 9.09 ft /orifice Lateral Flow Rate 13.59 gpm Manifold Length 3.00 ft System Flow Rate 27.19 gpm Manifold Diameter 1.50 in Total Dynamic Head 14.73 ft Forcemain Velocity 2.78 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and - -► C _T omm 16. W 4 in. min. 28 AC Disconnect Tank component is properly vented f-- Alternate outlet location _Forcemain diameter WEEKS Manufacturer _� 2 in. Ca acit 800.00 Gallons Volume 21.76 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 21.18 460.93 B 2.00 43.52 C Pump off e ievabon (ft) C 5.58 121.47 91.67 D 8.001 174.08 - D Total .. ..: 36.76 800.00 Dose se tank elevation (ft) J___ uncTer tank. F 91.00 Alarm Manuafacturer SJ ELECTRO Alarm Model Number JAW 100 Pump Manufacturer G OULDS Pump Model Number WE031 4 i Pump Must'Oeliver I 27.19 gpm 14.73 ft TDH Project: MIKE HARTMAN Page 4 of 8 I Mound System Maintenance and Operation Saecifications Service Provider's Name F 71 KIM A OCONNELL Phone 5 -755 -3145 POWTS Regulator's Name ST.CROIX COUNTY ZONING Phone 715 - 3864680 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 ft Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >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 month) Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Ins ect for ondin and seepage once eve 3 ears 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: MIKE HARTMAN Page 5 of 8 Mound System Management Plan Pursuant to Comm 8314, Adm. Code General and This system shall be operated in accordance with Comm 82 -84 Wis. . Cod state rules pertaining to Systemamaintenance c manuals [SBD- 10691 -P (N.01101) and SSWMP Publication 9.6 (018 and 1)) —e; maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. er used as Septic and pump tank, abandonment shall be in accordance with Comm 83.33, Ws. Adm. Code when the tanks are no long POWTS components. and soundness...Access openings used Septic or pump tank manhole risers, access risers and covers should be inspected for water tigtrtness to for service and assessment shall be sealed watertight upon the completion. of service. Any opening deemed unsound, defe subject failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective- locking 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 fitter 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 alarm, the fitter impending continuous shall be serviced if the alarm is activated continuously. Intermittent fitter alarms may indicate surge flows or an inuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum n 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 p roducts are used they shall be approved for septic tank use by the Department of Commerce. Puma Tank d tank shall be inspected at least once every 3 years., All switches, alarms, and pumps shall be tested to verify proper er The Pump (osmg) _ _.. p. 'cedaaneoers operation. If an effluent fitter is installed within the tanit italiilllbe inspected 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 n the mound s ot since soil compaction may hinder aeration o the nfiltrative�surface within the mound and snow M on them dictate that the mound be heavily mulched compaction in the winter will promote frost penetration. Cold weather installations (October - February) as protection from freezing. 150 mg TSS, and 30 mg1L FOG for septic tank effluent or Influent quality into the mound system may not exceed 220 mg/L BODS, 30 mg/L BOD5, 30 mg /L TSS, 10 mg /L FOG, and 10 cfu1100 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 clogging has occurred and it orifice cleaning is required to maintain equal distribution within the dispersal cell. 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. CQntingency 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 clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of,this plan for the name and telephone number of your focal POWTS regulator and service provider. Project: MIKE HARTMAN Page 6 of 8 1 /r 1 � P t; 0 y v l 3' r y Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 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. R i wed by Date Personal information you provide may be used for secondary purposes ( Privac y w La, s. 15.04 (1) (m)).s 02 .. ._.._,_..... Prope Owner Prroperty Location Cl0vt. Lot 114 1/4 T N R E (or C Property Owner's Mailing Address Li' t # Block # Subd. N e or M# City State Zip Code d Phone Number ( City ❑ Village - 0 -Town Nearest Road New Construction Llse:.Z Residential / Number of bedrooms Code derived design flow rate Gin GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable General comments and recommendations: .L ' r ' Boring # Boring f 1 lCt Pit Ground surface elev. ft. Depth to limiting facto 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 3 6 - s 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 I - Eff#2 / 0 3 L AIZ 3 ; * Efflue #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Nam PI a Pri Signat a CST Number ' 3 Address ` ate Evaluation Conducted Telephone Number SBD -8330 (R07 /00) so,J list /la A - ,A/ R i 6 I 3 36 i 1 I 1 r � I z co.)4", ;, c 9zs I 4:4 a yo 3 } ' /GS 3 o ra 1 Property Owner fC r PS'�� Parcel ID # Page _ of F3-1 Boring # ❑� Boring �o� Ys j Z 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 Ei W�j ' S� — ° 6 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 ❑ 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) II� r ST. CROIX COUNTY SEPTIC TANK MAINTAINANCE AGREEMENT AND OWNERSHW CERTIFICATE FORM Owner/Buyer ► C, f, �7 Mailing Address Q Property Address /,, (V cam rem frees P1amrihgDepartmmt for new canstructim) City /State `' /Q Qf� �,L Parcel Identification Number 3 2 - LEGAL DESCRIPTION Property Locatioa ' /., I /. T�N R W, Tower of . Subdivision G1 y�► Lot# Certified Survey Map# Volume Page Warranty Deed# T�j -'SZ- , Volume 2 `f 2 Z Page 4 4 2 -C Spec house yes no Lot lines identifiable _ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result 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 cart 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 masterplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (I) 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. I/we, 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 th Department of Commerce and use the Department of Natural Resources, State of Wisconsin Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Office w Zoning Oithin 10 days of the three year expiration date. 77 . a SIGNA� OFFAYPCICART DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of SIGNATURE OF APPLICAITr DATE •�""'* Any mformatim that is muffsprewated may result m the sanitary permit being revokedby the Zmmg Department' Include with this apphcatim a stamped warroty deed from the Register of Deeds office a copy of the cat ed suvey map if refumueairmade m the wady deed : Y,. V� I a� ` h` 1 e�� '� e. U 2422 P rt 28 741752 KATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM 1 - 1999 REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO., WI Document Number RECEIVED FOR RECORD This Deed, made between Stan D. Falkenhagen and Laura L. 09/29/2003 12 :45P!( Falkenhagen, husband and wife WARRANTY DEED EXEMPT # 11.00 Grantor, and Pinecliff Partnership LLC REC FEE: TRANS FEE: 450.00 COPY FEE: CC FEE: 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): Part of the Northwest Quarter of the Southwest Quarter (NW 114 of SW 1/4) Recording Area and part of the Southwest Quarter of the Southwest Quarter (SW 1/4 of Name =1 Remm Address SW 1 /4) of Section Twenty -six (26), Township Thirty-one (3 1) North of Range Nineteen (19) West; St. Croix County, Wisconsin described as The RiverBank follows: Lot 1 of Certified Survey Map filed May 29, 2002 in Volumc 16, P. O. Box 188 page 4308, Document No. 680290. Osceola, WI 54020 L•- Together with the right of ingress and egress over Outlot I of said Certified Survey Map. part of 0 107340 and 042 - 1073 -60 -200 Parcel Identification Number (KN) Together with all appurtenant rights, title and interests. This is not homestead prey ,(i9) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and ordinances of record and will warrant and defend the same Dated this r D r h day of Sep tember 200 * *.-Sta en e * * ra L. Fa enhagen AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. Polk County ) authenticated this day of Personally came before me this 16f4 day of September , 2003 the above named * Stan D. Falkenhagen and Laura L. Falkenhagen TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing i authorized by § 706.06, W is. Stats.) strument and dge�th same. THIS INSTRUMENT WAS DRAFTED BY 0_ t' Priscilla R. Dorn Cutler, Attorneys at Law y Notary Publi of �Vis® Osceola, Wisconsin 54020 My Commissi rq. 1�t. , state expiration date: (Signatures may be authenticated or acknowledged Both are not necessary.) ) " Nwnes -fp=m signing in any capacity must be typed or printed below their signature. ' ormation Proleasionals Company. Fond du Lac, WI WARRANTY DEED STATE BAR OF WISCONSIN eoo- esszozi FORM No. I -1999 Ai I T so po 19 I O M N m <<� : a,�i � 8 i \ r o, 0 H � L7 W V w ' zW ac M W ,. ¢ 0z q 3� r ~ f Q 22 Q..0 �y0 Z Q U WW Of Oq q � T , 2 Q 0 ADWW= %s }yS o g a91 Lj JS p~ Qq 3 w W 'yam Z :Tz1 �N '- WW W �9Z • W A „ ZW W " -4 --� ^+ W q1 ' �` 1- W ti��s hW- MW-a�U N. -.I 1-,• a. W C� ��p� -W m G � a Q 3 z F Z .. f7 W W WO nc rn 1 I 1 F i V w Parcel #: 032 - 2167 -48 -000 10/28/2004 04:45 PM PAGE 1 OF 1 Alt. Parcel #: 26.31.19.1428 032 - TOWN OF SOMERSET Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): * = Current Owner MICHAEL J HARTMAN " HARTMAN, MICHAEL J 633 196TH AVE SOMERSET WI 54025 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 633 196TH AVE SC 5432 SCH D OF SOMERSET SP 1700 W ITC Legal Description: Acres: 3.970 Plat: 2312 -PINE CLIFF 2ND 31/48 032/03 S 31 N R19W PT SE NW PINE CLIFF 2ND Block/Condo Bldg: LOT 48 OT 48 (3. 70AC) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 26-31N-19W SE NW Notes: Parcel History: Date Doc # Vol /Page Type 06/14/2004 765781 2595/191 WD 08/12/2003 734954 9/79 PLAT 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 20,600 Valuations: Last Changed: 07/14/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.970 61,800 0 61,800 NO Totals for 2004: General Property 3.970 61,800 0 61,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00