HomeMy WebLinkAbout034-1018-80-000
Wisoonsln Department of Commerce SYSTEM
So# and Buildings Division PRIVATE SEWAGE Count
tG 4 INSPECTION REPORT St. G~roix
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Personal irdormson you provice may be used for secondary Purposes (Privacy Law, x.15.04 (1)(m)]. 384281
Permit Holder's Name: ❑ City ❑ vilialle ❑ Town o : State Plan ID No.:
Ja is, John Springfield Township g . T.►oiws, IQ.,
CST 811A Elev.: Insp. BM E ev.: BM Description: arcel Taz No.:
ao -,D' vm , a' ww I z 034-1018-80-000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic ` 66D (o5b Benchmark 2 Ito-o'
Dosing L=p A t. BM co 0.30 I! Or
Aeration Bldg. Sewe /J 34ce alp S)1
Holding St/Ht Inlet , gp
TANK SETBACK INFORMATION St/ Ht Outlet
Vent
TANK TO P / L WELL BLDG. Airito ntake ROAD Dt Inlet q ~
Air
Septic > ZM NA Dt Bottom 111110
Q. Sn q '
Dosing > Zc,O~ NA Header/Man. (e.(.p qp • `
. t7
Aeration NA Dist. Pipe 00
Holding Bot. System
Ioa.o
PUMP/ SIPHON INFORMATION Final Grade v ~(f Q+ C&W
e Manufacturer Demand t Cover
el Number ~,rt•~~GPM l,l~ ,crs..~" 1`f-~Fo I!`f• U~ G
8 TDH Li Loss Friction 1.31 System 2,0 TDH %tO Ft
Forcemai Length -9 11 Dia. 2 „ Dist. To Well it 11
SOIL ABSORPTION SYSTEM D v- ecru
BED / TRENCH Width i Length I Ns•Afen~s~►s PIT No.O its inside Dia. liquid Depth
DIMENSIONS Z• St I M) soli f- DIMENSIONS
SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING ianu rer:
SETBACK CHAMBER
INFORMATION Type O _ n > ~r ` OR UNIT Moe r:
System: M~
L49 1-0*
DISTRIBUTION SYSTEM ti 1 a~ 10, ` ~~s;dta, ~d s /o ~Z"~
Header / ani of Distribution Pipe(s) Hole Size x Hole Spacing Vent To Air Intake
f
length Dia. Length SJri t s~ Dia. Spacing It
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present lam ection #1: D8/0'810( Inspection #2: ---E-
/ LI Plew
Location: 2888County Road E, Glen ood City, W 54013 (SE 1/4 SE 1/4 8 T29N15128
1.) Alt BM Description= 5-1( rwitj r7vv" '10(47. sQ-t (4. N•
2.) Bldg sewer length= qto,o
-amount of cover - la~,,2f'~
3.) contour= `'A ot - 1) -A
A -too 6T.
Plan revision required? ❑ Yes U N0
Use other side for additional infor ati n.
SBD-6710 (R.3/97) Date Inspectors Signature Cert No
• Sanitary Permit Application Safety & Buildings Dit4sion
In accord with Comm 83.21, Wis. Adm. Code 20i W. Washington Ave.
PO Sox 7302
See reverse side for instructions for completing this application Madison, WI 5370-1302
ir:7tV iin Personal information you provide may be used for secondary purposes (Submit wmpktcd form to county if not
oaparrtment arComm*rec+ !Privacy Law, s. 15.04(1xm)) state owned.
Attach coral) lete fans to the court co only) for the stem on s not less than 8-1/2 x l 1 inches in size.
qty State Sanitary Permit Number v Check if revision to ptevio Pstste Plan I. D. Number
2 r
C, 4/ akA
ri. (!c ation Information - Please Print all Information cad
P tion t -n7--AA 10- erty r Name
L~CEr' 17 L/4 S T,;) N ls: S
a Matliog Address ; j Num Block Number
lea F A----? 6
Ci State Zip Code Phone Number- Cqp( ivisi a or CSM Number
COUIYTy _
II. Type Building: (check erne) _
0- 1 or 2 Family Dwelling - No, of Bedrooms n e
public/Commercial (describe use):_ -
Q (
❑ State-Owned
Nearest Road
r
64
Parcel Tax Numbers 0-y _ Q Z•
III. a of Permit: Check onl one box on line A. Check box on line B if applicable) Z L
A) 1, ❑ New 2• ReplaCentent 3, ❑ Replacement of 4. 5. 6, U Additior to
System S tent Tank Only Existing S stern
B) ermit Num Date sued
❑ A Sani Permit was nevi sl issued
IV. Type of POWT System: (Check all that apply)
O Non-pressurized In-ground *Mound ❑ Sand Filter 0 Constructed Wetland
❑ Pressurized In-ground Q Holding Tank O Single Pass O Drip Lune
d At de ❑ Aerobic Treatment Unit O Recirculating ❑ Other:
V. Dispersal/Treatment Area Information: LA-JOE-r z s 3
I , Design Flow ) . ispetsa Ara 3 . Dtspasal Area 4. Sod Application 5. Percolation Rate 6. System Elevation 7. Final G e
Required Proposed Rate (GalsIday/sq. !t.) (Minlinch) Elevation
~l'D y sv YS~ r j, o
fab Site Steel Fiber- Plastic
f
Information ity in Total of Manufacturer Pre
Gallons Gallons Tanks Con- Con- glass
New Existing crete strutted
Tucks Tanks ❑ ❑
G /Ovv
a a ❑ o
t
VIII. Responsibility Statement
i the undersigned, assume responsibility for installation of the POWTS ah the attached tans.
lu s Name (print P s Signature (n ps : RS 14 a. Susi- e= Phone Number
I IC
Plumbers Address (Street, City, Stale, ZiD Code) 1
/'U Y2 9,211 es)L' AI-2d -,2T Gc? S'y 7~Sl
IX. County/Department Use Only _
13 Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issu ent Signature (No stamps)
Approved [7 Owner Given Initial Adverse Surcharge Fee) ,f
Determination 'f' 3 Z'! - 0 U
X. Conditions of Approval /Reasons for Disapproval:
e'KCS4(n-7 SYS{e.~` (~o ~o~ ~c/!iau~d oII`.ec~ ~er Ce/!i~~w
4 ! NnttirVQoV.ec~~1¢lViCPa ~~r Wla"'raGfke r5 d'GO~ae~dttiYlw-5_
Ap ~t'1 or
mow, ~ J Z. ~d / C
L d p6 w r, Lk)f t e Eau ce- 11.9r
Safety and Buildings
4003 N KINNEY COULEE RD
LACROSSE WI 54601-1831
TDD (608) 264-8777
Visconsin www.commerce.state.W.us/sb
www.vAsconsin.gov
of Commerce
Scott McCallum, Governor
Brenda J. Blanchard, Secretary
June 19, 2001
CUST ID No.224229 ATTN: POWTS Inspector
ZONING OFFICE
KEVIN M LANNON ST CROIX COUNTY SPIA
1313 MATHEWS ST 1101 CARMICHAEL RD
MENOMONIE WI 54751 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 06/19/2003 Identification Numbers
Transaction ID No. 651338
SITE: Site ID No. 631242
JOHN JARVIS Please refer to both identification numbers,
CTH E above, in all correspondence with the agency.
TOWN OF SPRINGFIELD
ST CROIX COUNTY
SETA, SETA, S8, T29N, R15W
FOR:
DESCRIPTION: THREE BEDROOM MOUND SYSTEM
OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 797087
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED.
The following conditions shall be met during construction or installation and prior to occupancy or use:
i
• This system is to be constructed and located in accordance with the enclosed approved plans and with the
"Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.01/O1)
and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION
2.0" SBD-10706-P (N.01/01).
• 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 manual, and section VI of the pressure distribution component manual are complied with. A copy of this
information must be given to the owner upon completion of the project.
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Slats.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Slats.
• Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and
maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.
Comm 83.54(1). In addition, the owner is responsible for submitting a maintenance verification report
acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate
for the component(s) utilized in the POWTS.
• Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as
required under s. Comm 83.54(4) shall be considered a human health hazard.
KEVIN M LANNON Page 2 6/19/01
• Comm 83.52(3) The activities relating to evaluation and monitoring mechanical POWTS components after the
initial installation of the POWTS in accordance with an approved management plan shall be conducted by a
person who holds a registration issued by the department as a registered POWTS maintainer.
• The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating
to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and
maintenance manual and/or owner's manual for the POWTS described in this approval.
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.
Sincerely, FEE REQUIRED $ 175.00
FEE RECEIVED $ 175.00
6 &Z /Zw~- BALANCE DUE $ 0.00
Charles L Bratz
POWTS Plan reviewer II- Integrated Services WISMART Code:' 7633
(608) 789-7893, Mon.-Fri. 7:45 AM to 4:30 PM
cbratz@commerce. state.wi.us
cc: RED CEDAR PLUMBING & HEATING
John Janis - Mound
Transaction #
Construction Materials and Techniques
All materials must comply with Comm 84 and be installed in accordance with manufacturer's
specifications. Construction methods must comply with the following Component Manuals:
Mound, SBD-10691-P (01 /01)
_ Pressure Distribution, SBD-10706-P (01/O1)
Location: SE 1/4, SE 1/4, Sec. 8, T 29 N, R 15 W
Town: Springfield
County: St. Croix
Date: May 31, 2001 n
s Fc
Owner: John Janis
FIy "os 40
Address: 2888 CTHW E
Glenwood City, WI 54013 Zoor
Plumber: Ke in Lanno Q~j~
Signature:
License # MP 224229
Attachments: 6748-Plan Approval Application
SBD-8330
page 1: cover
2: design criteria & calculations Conditionally
3: plot plan APPROVED
4: system cross section
5: plan view, lateral detail DEPART UM of coWERGE
MOF
6: pump tank exit detail
7: pump curve
8: system management
page 1 of 8
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Design Criteria
Residential Wastewater Contaminant Load: 30 mg/L < BOD5 < 220 mg/L
Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L
Fecal Coliform > 10,000 cfu/100 mL
Treated Residential Wastewater Contaminant Load: 30 mg/L < BOD5
Septic tank + "highly treated" effluent 30 mg/L < TSS
Fecal Coliform < 10,000 cfu/100 mL
Bedrooms x 100 gal/bedroom/day x 1.5 gallons/day hydraulic load
Design Calculations
In situ designed loading rate 10•~ t gallons/sq. ft. per day
Depth to estimated high ground water in.
Depth to bedrock in.
Cross slope at system %
Force main length C 3 ft. of Z in.
Manifold/header length ft. of in.
Drain-back ' Z gallons
Lateral length Z @ ~s•S ft. of in.
Lateral elevation ft. @ bottom of lateral
Lateral hole size ~t in. @ 31'•n in. ( 1-0 ft.) Spacing
\ °t holes/lateral 3 holes total
Lateral volume 1 °•2-~ gallons
Total lateral discharge rate 2 S' $ gallons/minute @ ft. head
Network pressure compensation losses ft.
Elevation difference 3 ft.
Friction loss • t ft. @ Z S~ gallons/minute
Total dynamic head 2 g ft.
Pump/siphon 2 b gpm @ ft. of head
Manufacturer 1 w► ~t Model # L o
Dose volume gallons
Lift/siptnn tank jL% t ovo - Loa C o 6 vO gallons
Septic tank \ Olr%:> gallons
Effluent filter
Measurement pump on and off in.
Height alarm from tank bottom .3 in.
Reserve capacity gallons
specs.calcs
Page Z of g
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DOSE 'rA J. MA►JUFACTURER: WUMDER OF DOSES: PCK pAy
TANK SIZE. GALLONS ..DOSE VOLUME
ALARM MASJUFACTURER: S V'k L,, Vv, IMCLUOING 6AGKFLOW: GALLONS
MODEL NUA4EK: 1 ° 1 CAPACITIES: A= 3~.3 WCHES OK 4QO'g GALLOUS
SWITCH TYPE:~~~
~ B = Z IUC►+ES OR Z3.V ~ CALLOUS
PUMP MAQUFACTURER: C • ILXKES OR G} GALLOuS
MODEL NUMBER: S. \A
vr- D~ ~ INCHES OR X0`42 GAllOU,~,
SWITCH TdPE: \MQ.V6.4v " MOTE: PUMP AUD ALARM ARE TO DC
MWIM\UM DISCNARGE RATE Z GPM INSTALLED OW SEPkaATE tlctcuiT;
VERTICAL DIFFEILEWCE 6ETWECIJ PUMP OFF AU0 013TRI&UTIO/J PIPE.. ~FEET
+ MWIMUM NETWORK SUPPLY PKtSSURE . . . . . . . . . 'Z ~r FLET
+ FEET OF FORCE MAIW f~
Io01tFRICTIOW FACTOR. .~I''i ~ FEET
TOTAL OyUAMIC. HEAD = \ Z__~ _ FEET
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IIJTERNAL DIMEW61OWS OF TANK: LEAIGTH ;WIDTH iLIQUID DEPTH
~q~,` 6 F $
Details Engineering 1
Pump Characteristics Performance Data
/Meror utdt Stebmwil h I • 31
Adam* NFedals SNEF30AI
mart•0•" .30
FoN Load AW 8.0 a >o _ _
Nbter T shied Fo1a p ) w
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KUM0edga A urnlfew.d ° ' 25.10 1
inseratw Cass A
%5&004 She 1-1 /2' Nn [now Total NsHSd foot 4 i 12 16 40 44
sow Haan 3/4.11%W OPM M.Sj 44 =6 211 23 12 0
Um W*kt 30 Its.
Iowa Cord 14/3„ S)TK 20' std. Dimensional Data
lee) L~qqM ~n~11k) 1e11110110111 lA.
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p 1949 H dromait' Pumps, Ashland, Ohio. AI! R' Reserved.
IF,° NYDRDMATIC4) -Your AuthanzedLocal Disnibutor-
1840 Sony Roca AsNenti, Ohio 44105 Tel: 419.1893017 fox 4189114017
Web Sit: wn.pentdrpuingom
SALES OFFKES IN ALL KWON CITIES AND COUNTIIIES
item 0: W-02-8360 1208 iM lu1
System Management
Management of this system is critical. As a condition of approval of these plans this system management section must be
reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems
develop with the adsorption system or any other system components, the installing plumber, Red Cedar Plumbing, 715-235-7341, or the
Dunn County Zoning Office, 715-232-1401, should be contacted for assistance.
General
Proper functioning of an on-site disposal system, "septic system," is significantly dependent on the volume of water which flows
into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the
better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and
contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or
compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water
in a manner to protect ground water quality and public health.
1 . If the septic lank is installed prior to sheet-rock and/or painting, pump the septic tank before normal use begins to ensure adherence
to contaminant load design criteria.
2 Install water-saving appliances whenever and wherever possible.
3. Repair even small water leaks as soon as possible.
4. Never pour grease or oil down any drain or stool.
5. Garbage disposals are not recommended; if you must have one, use it sparingly.
6. No paper products other than tissue should go into the system.
7. No chemicals should go into the system.
8. Avoid surge flows of water; try to spread laundry throughout the week.
Maintenance
1. The septic tank must be inspected every three years by a properly licensed person.
2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume
equals one third of the tank volume.
3. When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back-washed into
the septic tank to remove accumulated material.
4. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in-situ soil adsorption cell.
Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption
cell.
5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany
their specifications.
6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump.
If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve
capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or
two days should pass before any necessary repairs can be made.
7. Avoid compaction such as vehicle traffic within 15' down-slope of the adsorption system.
8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system.
9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth.
10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run-off into the system area.
11. Warning: Do not enter septic, pump or other treatment tanks; death may result because they may contain lethal gases or insufficient
oxygen.
Contingency Plan
Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring
may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54
(2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing,
and/or installation of additional treatment components or conversion to a holding tank may be necessary.
Page 8 of 8
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1317
Wisconsin Department of Commerce SOIL EVALUATION REPORT page 1 of
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Sal & Site Evaluations
County
Attach complete site plan on paper not less llwilfi 8.1% x 11 inchwin size. Plan must St. Croix
include, but not limited to: vertical and ontal r~fPrencepoint(BA1tla.flirection and Parma I.D.
percent slope, scale or dimensions, elagaw, and location'and, \ tahc`e to nearest road.
#6 034-1018-80-000 ID# 08.29.15.128
Please purl Infgrm 1~• g Date
Personal information you provide eased for secbrlday0BrAe'(Privacyx, s~15.04 (1) (mp. zod
s--
Property Owner T r; property Location
Paul Brandt ovt. Lot SE 1/4 SE 1/4 S 8 T 29 NR 15 W
Property Owner's Mailing Address ",JN ry at # Block # bd. Name or CSW
2888 Co. Hwy. E_ ZONIN(aaFFICE
Tam Nearest Road
City State , p olC(e Phone Nu J City ~j village e
Glenwood City WI - 09 Springfield Co. Hwy. E
New Construction Use. Residential / Number of bedrooms _ 3 Code derived design flow rate 450 GPD
Replacement Public or commercial - Describe:
Parent material Glacial Till Flood plain elevation, if applicable na
General comments
and recommendations: System elev. = 100.0' at 21" above 98.25' contour.
Boring # a Boring z u
❑ ! Pit Ground Surface elev. - 96.89 ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots GPD/it2
1 0-9 10yr3/3 none sl 2fsbk ds as 2TfO. 0.9./
2 9-21 7.5yr4/6 none Is imsbk ds cw 1.2
3 21-28 7.5yr4/6 none Is imsbk ds aw 1.2
4 2-42 10yr5/3 Q0.5yr5/6 scl 2mpr mfi cw - 0.4 0.6
5 42-51 2.5yr5/4 mr22p1Dyr6/ & cl Om mfi - - 0.0 ✓ 0.0-',
2~] goring # Boring
1M Pit Ground Surface elev. 97.13 ft. Depth to limiting factor 16" in. Soil Application Rate
Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots GPD/ff'
1 0-9 10yr3/3 none sl 2fsbk ds as 2f,1m 0.5.✓ 0.9/
2 9- 6 10yr4/4 none A 2msbk ds cw 2f 0.5 •
3 16-26 10yr5/4 f2c17.5yr5/8 sit 2msbk ds aw - 0.5 0.8
4 26-38 10yr5/3 f2f7.5yr5/6 cl 2mpr mfi cw - 0.4 0.6
5 38-45 2.5yr5/4 m2p1pyr5/6 & cl Om mf - - 0.0 , m ✓
m2p1Dyr6/2
* Effluent #1 = BOD 5' 30 < 220 mg/L and TSS (30 <_1 50 m4L nt #2 = BOD5< 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) S' ature: CST Number
James K. Thompson _ 3602
Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number
Osceola, WI 54020 9/29/00 715-248-7767
property owner Paul Brandt Parcel ID # 0341018-80-000, ID# _ Page 2 of
F Boring # L-j Boring Pit Ground Surface elev. 100.04 ft. Depth to limiting factor _ 15" in. Sal Application Rate
3
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots MIT
*Eff#1 *Eff#2
1 0-10 10yr3/3 none sil 2fsbk ds as 2f,1m 0.5/ 0.8-/
2 10-15 10yr4/4 none fsl 2msbk ds cw 2f 0.5 0-9-/
3 15-24 10yr5/4 f2d7.5yr5/8 sl 2msbk ds aw - 0.5 0-9/
4 24-39 10yr5/3 f2p10yJ2 cl 2mpr mfi cw - 0.4 0.6-/
5 39-45 2.5yr5/4 m2p10yr5/6 m2 lp Oyr6/2 & Cl Om mf 0.0/ 0-0-/
a Boring # Boring
Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots GPD/ft= _
*Eff#1 *Eff#2
i
Boring # Pik Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate
Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots _ GPDW
*Eff#1 *Eff#2
- - - -
* Effluent #1 = BOD 5 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 <_30 mg/L and TSS <,30 mg/L
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer ~O N Aj
A~f PAYYI JA R>/i
Mailing Address ;W)6 C ouN7 y j?oAl-> E
Property Address '5kMF- 'r
(Verification required from Planning Department for new construction)
City/State 6L64WCCr> L:d W1 _ Parcel Identification Number 031 -101 -50-(end
LEGAL DESCRIPTION
Property Location ':~F_ %4,_ '/4, Sec. , T_~LN-R_J~_W, Town of 43wit';,".a
Subdivision MIA , Lot # Certified Survey Map # , Volume , Page #
Warranty Deed # , Volume , Page #
Spec house ❑ yes 'A no Lot lines identifiable 10 yes ❑ no
SYSTEM MAINTENANCE
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
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (l) 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 kgree 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
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the three year expiration date.
SI ATURE
APPLICANT DATE
"It
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 Deeds Office.
r,
~ yc!~~ - SIGN TURE OF PLICANT 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
Y 1592nGE501
vol.
639341 i
STATE BAR OF WISCONSIN FORM I - 1998 KATHLEEN H. WALSH
WARRANTY DEED REGISIER Of DEEDS
5T. LROIX CO-, WI
Document Number RECEIVED FOR RECORD
This Deed, made between Paul Brandt and Cheryl OP-28-2001 9:30 AM
Brandt, husband and wife WARRANTY DEED
EXEMPT tl
Grantor, CERT COPY FEE:
COPY FEE:
and John F. Jarvis and Pamela J. Jarvis husband TRANSFER FEE: 569.70
and wife as survivorship marital property RECORDING FEE: 10.00
PAGES: 1
Grantee.
Grantor, for a valuable consideration, conveys to Grantee the following
described real estate in St. Croix County, State of
Wisconsin (the "Property"):
The Southeast Quarter of the Southeast Quarter
(SE1/4 of SE1/4), Section 8, Township 29 North, Recording Area
Range 15 West, Town of Springfield.
RE'PURN TO: TITLE ONE
706 19TH STREET SOUTH
(41r w/b 5 d Sl ~vU HUDSON, WI 54016
(41r 034-1018-80-000
Parcel Identification Number (PIN)
This is homestead property.
(is) (is not)
Together with all appurtenant rights, title and interests.
Grantor warrants that the title to the Property is good, indefeasible in fee simpl- and free and clear of encumbrances except
Roadways, Easements, and Restrictions of Record.
Dated this day of
r
P Poo
" Paul Brandt
c9~ cos
• a 1 Brandt
AUTHENTICATION ACKNOWLEDGMENT
STATE OF WISCONSIN )
Signature(s) ) ss.
St. Croix County. )
Personally came before me this day of
authenticated this day of the above named
Paul Brandt and
Cheryl Brandt
"
TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person s who executed
(If not, thLoing ument a acknowle dged the same.
authorized by § 706.06, Wis. Slats.)
THIS INSTRUMENT WAS DRAFTED BY
Michael H. Forecki, Attorney otary Public, State of Wisconsin
Eau Claire Wisconsin My Comon is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are
not necessary.) Kay a ill
Notary Public
Qfata of
'Names of persons signing in any capacity must be typed or printed below their signature.
STATE BAR OF WISCONSIN
WARRANTY DEED FORM No. 1-1998
Produced wins ZipForr py VenNOft Inc. 1W25 Fifteen Mile Road, CiMon Township, Michigan 48035, (80D) 383-9805
Attorney Micheal H F-0 1930 Brecklt Ave, EwC ,r WI 50701-4627 Phone:(715)335.1029 Fa. (715)8)5.4112 .4443 15 UFD
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