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HomeMy WebLinkAbout034-1033-60-000 0 to O 3 •o n r_ 0 21 8 3 C �f I m n m m m o C) W a l a cn c, O O d W (A w O7 fa CD W G pD pp N rn N C fD Ln w O• cf Q W a N C�71 r"�r�S 0 0 C7 N N (D -.4 a) ro c c o _-4 7 N O 3 O O N C ? 'I v D A . (D u: ? N 0. CD v w c r o z 0 !`r O CD N 0 0 N O c W W a . O 0OO" " � • N Cr O G n o CD m co a m m _ A W 3 CD A D 0 0 O c iI CD o "No. I CD CD y C D) ro � N 5 z -+ N cr 3 m N CD 9 a 3 z 0 A rZ] 0 N cn N z C A w 05 0 D <m a j a0 m o c m m. am N 3. 0 a 0 �< z CD 0 a CD CD m O N 0 N N O oc 0 O (D � o m O r tv O f a I ° o a �, S Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Buil&.ng DiNion INSPECTION REPORT Sanitary Permit No: 430035 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID N Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. if o f 0 — ID� Permit Holder's Name: City Village X Township Parcel Tax No: Her, Blia I Springfield Townshi 034 - 1033 -60 -000 CST BM Elev: Insp. BM Elev: IBM Description: Section/Town /Range /Map No: CIO �� w ,- C�iT 15.29.15.231A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic w elm ! Benchmark � . 2 ( Z 0 Dosing ` o ew "t ll Alt. BM Aeration • Bldg. Sewer Holding St/Ht Inlet $�op t1 q. 171 St/Ht Outlet D TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic � � ' t � � — Dt Bottom '• r� �1 Dosing Header /Man. 3 •s- S / Aeration Dist. Pipe .t`L , If Holding Bot. System t PUMP /SIPHON INFORMATION Final Gr Manufacturer Demand St Cover /i f r I �t A C • del Number t NCR. . / DH Lift Friction Loss System Head TDH Ft .0 .10 . S 1 •6 Forcemain Length 1 Dia. fl{ Dist. to Well SOIL ABSORPTION SYSTEM 6 EPTOWNSH Width Length f No. Of TiW111111Co PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth MENSIONS /_� (' li-OZ _A SETBACK SYSTEM TO P/L � BLDi I W ' �ELL LAKE /STREAM LEACHI ufacturer. INFORMATION CHAMBER Type Of System: 4- Z6 —* y too �.._.. del Number: DISTRIBUTION SYSTEM J Header /Manifold Distribution / Hole Si 11 x Hole Spacing « Vent to Air Intake �j Pipe(s) 1 / ( t9 ,/ Length •' •� Dia Length � ' 1 Z Spacing M � x Q Z. r^ SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over J Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil N �] Yes [] No [] Yes i-J No COMMENTS (Include code discrepencies, persons present, etc.) Inspection 1: Do J� Inspection #2. / Location: 3027 100th Ave Wilson, WI 54027 (NW 1/4 SW 114 15 T29N R15W NA Lo / n� ^ Parcel No: 15.29.15.231A 1.) Alt BM Description = 5 • 37 2.) Bldg sewer length = ObA.W vt,AK' 1w � •""""" ' `� � PAA*. �� , • / - amount of Cc v r = _ /1 s+► U.rla�l1 "" • T"M''� ` Plan revision Required? Yes No Use other side for additional information. SBO -6710 (R.3197) r Date R. sec 's Si nature �'�, /6 /� / Cert. No. re « Safety and Buildings Division Count 201 W. Washington Ave., P.O. Box 7162 T . CROIX cOnsin Madison, WI 53707 — 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266-3151 0 Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide (TRANS ID # 0 G y secondary purposes y °' — r - s ma yb e used for seco ses Privac Law, s15.04(�in'1"` Pro ect Address (if diffe ent than mailing address) I. Application Information — Please Print All Information 0 2� { tt N v& ProperProperty Owner's Name "''''' " �' -'vU: Parfel# 1 Lot# Block BLIA Y. HER & KON HER 034- 1033 -60 -00 (231A) Property Owner's M ailing Address Pr perty Location 1601 WESTMINSTER STREET �`'- iU !4, �16,Section 15 City, State Zip Code Phone Number ST. PAUL, MN 55101 715/698 -2486 (circle ' ) H. Type of Building (check all that apply) T 2� N; R � 5 E ® 1 or 2 Family Dwelling - Number of Bedrooms 3 Subdivision Name CSM Number N/A N/A 11 Public/Commercial - Describe se ❑State Owned - Describe Use xi7 D 1' �4 ity_ ❑Village (ITownship of SPRINGFI _ 32 III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. 2 New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date issued Before Expiration Plumber Owner IV, Type of POWTS System: (Check all that apply) ❑ Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil KXMound < 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 ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 450 1 ' 1 1 450 450 1 98.1 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank 000 1000 1 WIESER CONCRETE X - Aerobic Treatment Unit Dosing chamber 600 1 1 600 1 WIESER CONCRETE I X VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber s Si g MP /MPRS Number Business Phone Number 1 10: natur BENNIE HELGESON 220292 1 715/772-3278 Plumber's Addre ss (Street, City, State, Zip Code) W1229 770TH AVENUE, SPRING VALLEY WI 54767 VIII. Count /De artment Use Onl anitary Permit Fee (includes Groundwater Date Issued Agent Signatur (No Stamps) W Approved ❑ Disapproved urcharge Fee) ❑ Owner Given Reason for D I X. Conditions of A for Disapproval ' J �, ,,�� SYSTEM OWNER: 3) 3 a�� Q a. R�wLSt 1 Septic tank, effluent filter and �. �. dispersal cell must all be sgrviced I maintained � `�, S e�rs lG&, ' L'tp, as per management plan provided by plumber. rU� 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system per not less SK2 x SBD -6398 (R. 41103) i i Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 iscons n www.commerce.state.wi.us /sb Department of Commerce www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary July 24, 2003 CUST ID No.220292 ATTN: POWTS Inspector BENNIE W HELGESON ZONING OFFICE HELGESON EXCAVATING ST CROIX COUNTY SPIA W1229 770TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/24/2005 Identification Numbers Transaction 1D No. 889046 SITE: Site ID No. 662441 Blia Her Please refer to both identification numbers, 100TH Ave above, in all correspondence with the agency. Town of Springfield St Croix County NEl/4, NWI /4, S15, T29N, R15W FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 913096 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes (. on 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. The following conditions shall be met during construction or installation and prior to occupancy or use: d ' r RTME General Approval Requirements: SEL i;OR • 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- 10572 -P R.6/99 and the Pressure Distribution Component Manual for Private Onsite Wastewater Treatment S ( ) " stems" C P Y SBD - 10573 -P (R.6/99). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • 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. Stats. • 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. Stat • Comm 83.22(7) A co of the approved plans, specifications and this letter shall be on -site during construction PY Pp p � P g and open to inspection by authorized representatives of the Department, which may include local inspectors. BENNIE W HELGESON Page 2 7/24/03 Owner Responsibilities: • 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). • 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. • Comm 83.55 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. 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 Fee Received $ 175.00 G� Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II, Integrated Services WiSMART code: 7633' (608)789-7893, 7:45 am - 4:30 pm Monday - Friday cbratz @commerce. state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 '� > � t INDEX SHEET�C Sj .l ¢ PROPERTY Ci OWNER: BLIA HER 1601 WESTMINSTER STREET YN ST PAUL, MN 55101 PROJECT NAME: BLIA HER PROJECT LOCATION: NE 1 /4, NW 1/4, S 15, T 29 N, R 15 W MUNICIPALITY: TOWN OF SPRINGFIELD COUNTY: ST. CROIX DESIGN: PRESSURE DISTRIBUTION MANUAL SBD- 10573- P(R/99) MOUND COMPONENT MANUAL SBD- 10572 -P (R 6/99) CONTENTS: Page 1: Plot Plan Page 2: Cross Section and Plan View of Mound Page 3: Mound Deflection rte �V Page 4: Septic Tank & Pump Chamber Cross Section & Specifications >A i Page 5: WLP 1000 /600 -MR Zable Tank Specifications BEY V ' ILDIN g Page 6: Pump Specifications E "DEN Page 7: POWTS Owner's Manual & Management Plan - Pg. 1 Page 8: POWTS Owner's Manual & Management Plan - Pg. 2 Name: Bennie Helgeson Signed Address: W1229 770th Avenue Spring Valley, WI 54767 Credential Number: 220292 Date: July 11, 2003 A, 501 a a D 9� , ���� �M 9g,�a f o p o s per, C o�� �- i ,n pr o S a J / r�c6ecQ 1OC1J /b0 o Gal. q 3 ect Sep lbose 7"a n (L 1� PVC tV �C 9 � .M• too -0 97.0 E I y / 1cCe� f �� s5 lOLA A 9�,0 r - OWNER: BLIA HER • - Page —L of ty System start up shall riot occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one. large dose, overloading the cell(s) and may result In the backup or surface discharge of effluent To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Malntalner to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antiblotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; dlapers; disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products;' pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned In compliance with ch. Comm 83:33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall• I e removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the vold space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN if the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: O A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compactiort and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish asultable replacement area. Replacement systems must comply with the rules in effect at that time. O A suitable replacement area Is not available due to setback andlor soil limitations. Barring advances in POWTS technology a holding tank may be Installed as a last resort to replace the failed POWTS. 17 The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a ' hol (#,fig tank may be Installed as a last resort to replace the failed POWTS. IV Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules In effect at that time. « WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS y POWTS INSTALLER POWTS MAINTAINER Name HELGESON EXCAVATION INC Name JOHNSON SANITATION Phone 715/772 -3278 -Phone 715/273 -5811 SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY ' ' - Name JOHNSON SANITATION Agency ST CROIX COUNTY ZONING Phone 715/273 -5811 Phone 715/386 -4680 This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and sanitation agenda& This document meets the minimum requirements of ch. Comm 83.22(2)(b)(1)(d)&M and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not , uarantee the performance of the POWTS. nk" amri - i ~ >v fv i r r 1119P l` l� Wisconsin Department of Commerce SOIL EVALUATION REPORT page of Division of Safety and Buildings in acoordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must Cow �� ,l 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 ewes by Date Per*wW kkfonroWn You provide mey be used for secondary purpom (Pdv*cy Low. s. 15.04 (1) (m)). Property Owner Property Location L lyeef GovL Lot l'r f 1 /4 if 1/4 S aT p;2 7 N R 1_:r f W4 W Owner s Mailing Address ^ Lot # I Block # I Stbd. Name or CStM fate Zip Code Phone Number ❑ City ❑ Village ^ P0 Town Nearest Road 9 _ /`°/ Al) 9, �9 i � � Avg f , A'Ye, 14 New Construction Use: 0 Residential / Number of bedrooms Code derived design flow role GPD ❑ Replacement ❑ Public or commercial - Describe: _ r Parent material Flood Plain elevation if applicable ----ft. General cmvnents i and recommendations: i �-L.. �'3.y `{(�f) Id • �ourrs n�,' /- h- af-,'� Sur��e., vn �v� ' 6� L e r ` °' &1Xk L� ,i Att - d ycvfi dtJ b a# Boring pit Ground surface elev. % . ' .z it. Depth to limiting radon 1 9 7 in. a Soil icatiorr Rate Horiam Depth Dominant Color Redox Desc Texture Structure Consistence Boundary Roots GPDft? in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. I 'Eff#1 'Eff#2 3 / - S .7 e A b, IN MC. .S IV I � 5 � a # pit Ground surface elev. ft. Depth to limiting factor g S in. Soil Application Rate Hortwn Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Elf #1 - Eff#2 V 4) /A 3 : i ;2M ' k . to L- ;2 AlAM M r I � ` 4 : i r T • Effluent #1 - BOD > 30 1 220 mg& and TSS >30 150 mglL ' Effluent #2 = SOD 1 30 mg/L and TSS 1 30 nVL CST Name (Please Prim) In CST Number C-1- ,e LC J Sly! / 7` 7- 3 Address Date Evaluation Conducted Telephone Number / 1 7 4 ) AV ��'/3 Property Owner `/� ��� Parcel ID# A �� � '- � � Page 9 of 3 10-7-1 F15 Boring # C] Boring Boris b (A Pit Ground surface elev. 9! � ft. Depth to limiting factor in. � Rate Horizon Depth Dominant Color Redox Description Texture Structure ConsistencFBoundfta Roots GPDIfF in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. •Eff#1 OEM tJ l jv SL M 6 3 , — o l� M i /V r d o 3 i .t h S vF 0-agAlAo 511 L Boring # ❑ Boring F ❑ Pit Ground surface elev. ft. Depth to limiting factor lo• Sop Appli cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell t]u. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring F-1 # Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. sop Application Rate Horizon Depth Dominant Color Redox Description. Texture Struckire Consistence Boundary Roots GPD/fF In. Munsep Ou. Sz. Cont Color Gr. Sz. Sh. `Eff#1 'Ef✓*#2 Effluent #1 - SOD, > 30 < 220 nV& and TSS >30 < 150 mgA- • Effluent #2 = BOD, 130 mg& and TSS 1 30 mglL 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. seauwta.sact cUr , Ito rsx �va�o rqs� Fo a I 1 e�Aen A` d� � �k��� $�I'.° a �va� dGC�b I � � 1 _ � I � I� � 1 ! I J I I r - I r I� ° F� f �_ i r it i I � � � d ope c ry�vd-��` e� i_._� [ -� 1 - 7 L � �A� - �� I I� i j; I I i OA I J -1 t s I I , ! I I ' - I , ! I � � I I I ! jl) - � - 17 I i+ f I I � } r _ -- I - -?- - - - s 7 i ! - ! - - - -- -_- J - - -� - - - -� L -- - ._�- - - - - -- -- - -� - -- I 1 Marion Standaert Subject: 430035 - Blia Her /Helgeson plowing Location: Springfield Twp. Start: Fri 8/812003 10:00 AM End: Fri 8/8/2003 11:00 AM Recurrence: (none) This is a revision from in- ground to mound that you already inspected with Bennie - I couldn't find the permit and the blue folder was empty. Need to have Marion locate the paperwork!! 0,. t ) LA-1 VSO(k.Q_OfV-�O� C dvJIr 4 1 SAFETY AND BUILDINGS DIVISION Field Operations Bureau 13 East Spruce Street 1 *hsconsin INSPECTION REPORT Chippewa Falls, 54729 www.c ommerce.s to tate.wi.us Department of Commerce •r:,. ,, Date of Inspection: June 10, 2003 lum er Name and Address: Project Name: Her Property Bennie Helgeson, MPRS 220292 Use: New Residential i' 2003 W1229 770 h Ave Legal Description: NW, SW, 15, 29,15W, , Spring Valley, WI 54767 Parcel Number: 034 - 1033 -60 -000 ; ,r ' Subdivision: Ce ified Soil Tester Name and Address: Municipality: Town of Springfield Gale Smith, CST 222234 County: St. Croix 3228 Hwy 170 Glenwood City, WI 54013 Plan Transaction Number: NA Sanitary Permit Number: 430035 Owner Name and Address: Blia and Kon Her Wastewater Flow: 450 1601 Westminster St Persons Present: K. Grabau St. Paul, MN 55101 An onsite soils verification was conducted at the request of county inspector, Kevin Grabau. The installing plumber questioned the suitability of the soil conditions prior to installing the system. One soil pit was evaluated in the vicinity of the tested area of CST Gale Smith. A soil profile description follows: 00 -09" 10YR 3/2 sil, 2f -m sbk, mfr, ac. 09 -15" 10YR 4/3 sil, 2mpl, mfr, cw. 15 -24" 10YR 4/4 sl, 2m -cabk, mfr, gw. 24 -84" 2.5Y 7/4 and 7.5YR 4/4 weakly consolidated SS BR, with f1 -2d 7.5YR 5/8 Fe nodules. Does not pass knife penetration test. This site appears to be mapped as an Arland silt loam by the USDA in their detailed soil survey. This soil series is typically underlain by weakly consolidate sand stone bedrock at a depth of 24 -40 inches. The limitation at this site is weakly consolidated sandstone bedrock, and a possible seasonally perched groundwater condition. The major limitation is bedrock (BR). The degree of density and cementation is such that a distribution cell installed too close or within this material will fail in a short period of time. Options for this site include looking elsewhere for soil conditions that are more suitable, or the installation of an above grade system such as a mound. If there are any questions regarding this report, please contact me. ��V/d L roy G. J sky, Wa wtt alist Ljans ky@m mmerce.state-mail 715/726 -2544 Voice 715/726 -2549 Fax cc: County Plumber ful CST Owner ❑ Other 06/12/2003 19:22 715- 726 -2549 S &B CHIPPEWA FALLS PAGE 01 SAFETY AND BUILDINGS DIVISION Field Operations Bureau 13 East Spruce Streel Chippewa Falls, WI 54729 N *iscons i n I NSPECTION w N REPORT w.commeres.sta Department of Commerce Plumber Name and Address: Date of Inspection: June 10, 2003 Bennie He) eson, MPRS 220292 project Name: Her Property W1229 770"' Ave Use: New Residen Spring Valle Y, WI 54767 Legal Description: NW, SW, 15, 29, 15W Parcel Number: 034 - 1033 -60 -000 Certified Soil Tester Name and Address: Subdivision: Gale Smith, CST 222234 Municipality: Town of Springfield 3228 Hwy 170 County: St, Croix Glenwood City, WI 54013 Plan Transaction Number: NA Owner Name and Address - . Sanitary Permit Number: 430035 elia and Kon Her 1601 Westminster St Wastewater Flow: 450 St. Paul, MN 55101 Persons Present: K. Grabau An onsite soils verification was conducted at the request of county inspector, Kevin Grabau. The installing plumber questioned the suitability of the soil Conditions prior to installing the system. One soil pit was evaluated in the vicinity of the tested area of CST Gale Smith. A soil profile description follows: 00 -09° 10YR 3/2 sil, 2f -m sbk, mfr, ac. 09.15" 10YR 413 sil, 2mpl, mfr, cw. 15 -24" 10YR 4/4 sl, 2m -cabk, mfr, gw. 24 -84" 2.5Y 7/4 and 7.5YR 4/4 weakly consolidated SS SR, with f1 -2d 7.5YR 518 Fe nodules. Does not pass knife penetration test. This site appears to be mapped as an Arland silt loam by the USDA in their detailed soil survey. This soil series is typically underlain by weakly consolidate sand stone bedrock at a depth of 24 -40 inches. The limitation at this site is weakly consolidated sandstone bedrock, and a possible seasonally perched groundwater condition. The major limitation is bedrock (BR). The degree of density and ce of ntaat is such that a distribution cell installed too close or within this material will fail in a short p er i od Options for this site include looking elsewhere for soil conditions that are more suitable, or the installation of an above grade system such as a mound. If there are any questions regarding this report, piease contact me. roy G. J sky, Wa water S ialist 1LJanskyG mmerce,state -wi.0 -mail 7151726 -2544 Voice 715/726 -2549 Fax cc: County Plumber CST Owner ❑ Other Post-IC Fax Note 7671 zo � - A- pap s .JAr4s ' Zo�LN Phons N Pl+one A FeY I Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings In accordance with Comm 85, Wis. Adm. Code County SX , Attach complete site plan on paper not less than 81 es Plan must include, but not limited to: vertical and horizontal r (8Mt);Al on and Parcel I.D. / percent slope, scale or dimensions, north a ar�l9aatfon and distance to I arest road. O Q3 b DO Please print a n ' rma �' Reviewed by Date Personal information you provide may be used dory P +� Law. s. "�15 041) (m))• Property Owner r Property Location Rt ? n �u��1 �,1 1/4 �C 11/4 S� 7 T.2 N R �� � W .. •� Property Owner's Mailing Address y LGt;# Block # Subd. Name or CSM# City State Zip Code Pbond Number City Q Village go Town Nearest Road aQ New Construction Use: Residential / Number of bedrooms Code derived design flow rate �'4 GPD ❑ Replacement //❑ Public or commercial - Describe: — =- - -• — Parent material A e /A Flood Plain elevation If applicable &A ft. General comr.►ents and recommendations: a Boring # ❑ pit �3 9 2— ®Pit Ground surface elev. � ft. Depth to limiting factor � in. Sa'I Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. 'Eff#1 I 'Eff#2 0 A14 & M IrIv GS e S Bori ❑ Boring # ❑ng ❑ Pit Ground surface elev. . 4 .2 ft. Depth to limiting factor 9 6 in. Soil Application Rate Horizon Deptit Dorni Color Rodox Description Texture Structure Consistence Boundary Roots GPD/fF In. Munsell Qu. Sz Cont: Color Gr. Sz Sh. 'Eff#1 I 'Eff#2 2 - l -az to — ! 20 A F G S v-. • B e C q V�L Y\-0: r Z _ u. `/�, Effluent #1 = BOD > 30 1 220 mg& and TSS > _ 150 mgA- ' Effluent #2 = BOD < 30 mgll and TSS 1 30 mglL (Please Prktt ignature CST Number 7 Address Date Evaluation Conducted Telephone N 838 �y o 13 Property owner T _ ,?N y 91S 4C O e Parcel ID # ` �•�. � — 4 �0 Page 2 of y� a# ° Bori ng 3 pit Ground surface elev. 7 <.J R OePth to IimitMg factor in. SoA ication Rate Horizon Depth Dominant Color Redox Description Texture Stnxxure Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 I •Eff#2 / S s. -- Ms.6 v AS M , 8 o L 6/� G v >r M M rR CS — 0 YA 6 S M . r Scrim F # ° Sorhv ❑ Pit Ground surface elev. ft. Depth to Gn MV factor in. SOP tion Rate Horizon Depth Dominant Color Redox Description Texture Structure C;cwjstence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •01#2 F BMkV ° Borim ❑Pit Ground surface elev. ft. Depth to lirruting factor in. • SoU Application Rate Horizon Depth Dominant Color Redox Description. Texture Struck" Consistence Soundary Roots GPD/ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 • Effluent #1 = SOD, > 30 1220 mglL and TSS >30 _< 150 nV& • Effluent #2 = SOD, < 30 mg/L and TSS 5 30 mglL 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. saosuoae.400l . 1- 1 v # - - - -- �- — , I� r � a R N - - — - o S, t i - - y � _ 8 M lo 0, o � Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 ST CROIX SCOnSrn_ Madison, WI 53707 - 7162 t \ Sanitary Permit Number (to be filled in by Co.) Department of Commerce (60$) 266 -3151 300 Sr Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, sl5.04(1)(m) Project Addre f different than mailing address) I. Application Information - Please Print All Informatio E EIVED # a� I + tk%t Property Owner's Na me Par ce Lot # Block # BLIA Y. HER & KON HER MAY 9 2 0 - 1033 -60 -000 Property Owner's M ailing Address r perty Location 1601 WESTMINSTER STREET sT. cROix COUNTY _ IOW 'A 15 City, State Zip Code ST. PAUL, 55101 715/698 -2486 (circle one) T 29 N; R __J_�_ E o> W& II. Tyrpe of Building (check that apply) Aft 1 or 2 Family Dwelling - Nu Bedrooms Subdivision Name C Number mbe ❑ Public /Commercial - Describe Use ❑ State Owned - Describe Use y_ ❑Village [kr, w ( f EL 4 1 14ff' Ar III. Type of Permit: (Check only one box line A. Complete line B if 10 licabqr A ' ® New System ❑ Replacement System ❑ TreatmentfHolding T Replace ent Only El ther Modific n to xisting sty B. ❑ Permit Renewal ❑ Permit Revision \ange f / wner and to ed Permit Transfe to w t e mit Num Before Expiration IV. of POWTS S stem: (Check all that apply) Non - Pressurized In- Ground 11 Mound > 24 in. of suitable so' ound < 24 in. of suitable soil ❑ At -Grade le Pass S d Fil ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holdin ank at Filter El Aerobic Treatment Unit ❑ trcootin a to ❑ Recirculating Synthetic Media Filter +K Leaching Chamber Drip Line Gravel -less Pipe El Oth a plai V. Dispersal/Treatment Area Information: - wo C- Design Flow (gpd) I Design Soil Application Rate(gpdsf) Dis sal Area Required Dispersal Area Proposed (s em Elevati 450 .5 900' 900 A 90.4 VI. Tank Info Capacity in Total umber anufacturer Site St lactic Gallons Gallons of Units crete C tructed lass New Existing Tanks Tanks Septic or Holding Tank 1000 10 1 WI CON o4% Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, tifundersigned, assurK responsibility for installation of the POWTS shown on the 4Khed plans. Plumber's Na me (Print) Plumber's Si gnature MP /MPRS Number Busine hone Nu r BENNIE HELGESON 220292 715/ 32 Plumber's Addre ss (Street, CityJNte, Zip Code) W1229 770TH AVENUE SPRING VALLEY, WI 54 _ Count /De artme se Only fX,l Approved ❑ Disa oved Sanitary Permit Fee (includes Groundwater Date Issued Issui ent Signature (N Stamps) i Surcharge Fee) 1�1 ❑ Owner Given Reason for Denial Z?- S IX. Conditions of Approval/Reasons for Disapproval s�5 ( 4 l 4Q.r a c.ts-v, �W "� S, 4e Attach complete plans (to the County only) for the system on paper not less than 8112 x 11 inches in size SBD -6398 (R. 01/03) a c p 1 B a 9L e r. - e .y z Y�, F lo - Pfaln e 4.e. (�j /4Dfli , � Ix � I i 1 h �lv� s i S -- -� = - - - - - - _ _ -_ _ � _ EIS �"�. �'' ✓, 1 j C h 6 ?rS f f5 ham.' �s Proip of.eA 3 Be 4, G3a�ce icQ�r tr�e �t Ch 1.16-ers CC 1 - Y III o i v1 a tr . I U - o.- ), Grp. -cP -e Cle te. y Sv _gi - ��1 -1_ 0 J Cj 4/ �P D % _ s— I-oa 1 900 90 CL one �� It = 16 c ©v►,e C e i l = / LI C In a_ l� e rrg �Sl' C, k 5 • • POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of • FiLE INFORMATION SYSTEM SPECIFICATIONS Owner BLIA Y . HER & KON HER Septic Tank Capacity i ono g a l, ❑ NA Permit # t1 Septic Tank Manufacturer WIESER CONCRETE❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ZABEL ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model A -100 12" x 20" 13 NA Number of Commercial Units W NA Pump Tank Capacity oge t!f � al LEI NA Estimated now (average) 300 gal/day Pump Tank Manufacturer ETNA Design flow (peak), (Estimated x 1.5) 450 gVda . Pump Manufacturer CI NA Soil Application Rate , 5 gaVdaytft Pump Model M NA Influent/Effiuent Quality Month verage• Pretrea t Unit NA Fats, Oil & Grease (FOG} 530 m O Gravel Filter ❑Peat Filter echanical Aeration ❑ Wetland Biochemical Oxygen Demand (BOD 5220 m Disinfection ❑ Other. Total Suspended Solids (TSS) 5150 mg/ A Manufacturer Pretreated Effluent Quality ®NA Monthly avera Dispersal Cell(s) Biochemical Oxygen Demand (BOD 530 m LJ in- ground (gravity) ❑ In -ground (pressurized) Total Suspended Solids (TSS) 53 g/L ❑ At -grade ❑Mound Fecal Coliform (geometric mean) ' cfu /100m1 ❑ Drip-line ❑Other Maximum Effluent Particle Size Y Inch diameter Values typical fo (non- commerdan wastewater and . •• Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every 9 ❑months CH year(s) (Maximum 3 yrs.) Pump out contents of tank When combined sludge and scum equals one -third (Y,) of tank volume Inspect dispersal cell(s) At least once every 2 ❑ months C$year(s) (Maximum 3 yrs.) Clean effluent filter At least once every I; ( ❑ months f21 year(s) lnspect*pump, pump controls & alarm At least once every ❑ months ❑ year(s) ED NA Flush laterals and pressure test At least once every ❑ months ❑ year(s) ❑ NA Other At least once every ❑ months ❑ year(s) ❑ NA Other: At least once every ❑ months ❑ year(s) ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer, Septage Servicing Operator. Tank inspections must Include a visual inspection of the tank(s) to identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the Immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreattment components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintanner. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION. For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. I OWNERS: BLIA Y. HER & KON HER • Page of W System start up shall,not occur when soil conditions are frozen at the infiltrative surface. During power outages um tanks may fill above normal hi hwater levels. When power is restored the excess 9P 9 pump Y 9 Po I I in one large dose overloading the cell and may result in the wastewater will be discharged to the dispersal cell(s) (s) g g {s ) Y backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, area within 15 feet down slope of an mound or at -grade soil absorption the a p y -g area. P Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss;'diapers; disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to Insure that the system is properly and safely abandoned in compliance with ch. Comm 83:33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tan It and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks d pits shall be excavated and removed or their covers removed and the void spa filled with soil, gravel or a ther inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repa d the following measures have been, or must betaken, to Ida a code compliant replacement system: • A suitable replacement area has b n evaluated and may be utilized for the locatio a replacement soil absorption system. The replacemen rea should be protected from disturbanc d compaction, and should not be infringed upon by required setback om existing and proposed structure lines and wells. Failure to protect the replacement area will result i e need for a new soil and site uabon to establish a suitable replacement area. Replacement systems st comply with the rules i ect at that time. • A suitable replacement area is not available to setback and/or s imitations. Barring advances In POWTS technology a holding tank may be installed as a t resort to repl the failed POWTS. • The site has not been evaluated to identify a suita replace area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitabl pla ent area. If no replacement area Is available a ' holding tank may be installed as a last resort to replace iled POWTS. • Mound and at -grade soil absorption systems may be re n ucted in place following removal of the biomat at the infiltrative surface. Reconstructions of such syste mus omply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS M CONTAIN LETHAL SSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREA ENT TANK UNDER AN IRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INT IOR OF A TANK MAY BE DI . ULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name HELGESON EXCAVATION INC Nam JOHNSON SANITATION Phone 715/772 -3278 Phone 715/273 -5811 .. . SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name JOHNSON SANITATION Agency ST CROIX COUNTY ZONING OFFICE Phone 715/273 -5811 Phone 715/886 -4680 This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies. This document meets the minimum requirements of ch. Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. GMW (2/01) Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings In accordance with Comm 85, Wis. Adm. Code minty Attach complete site plan on paper not less than 8 1 , Plan must include, but not limited to: vertical and horizontal (! M) %. on and Parcel I.O. / percent slope, scale or dimensions, north a Lion and distance �tq arest road. O Q b D D Please print a rma Reviewed by Date Personal information you provide may be used Law. a ,15.04 1) (m))• Property Owner , r of 2 ���Z Pr6pertyLocation V e / s e �... GovC,Lot 114 kJ1 14 S /,T,2 9 N R f� MW W Property Owners Mailing Address. , t;# r Block # Subd. Name or CSM# .. W so WM City State V Zip Code Nur rb ; . City Q Village Q; Town Nearest Road 9 MN c6 S S� t iv ,C- ' O New Construction Use: Residential / Number of bedrooms _ Code derived design flow rate _� J GPD ❑ Replacement Public or commercial - Describe: _ Parent material G 44 G L Hood Plain elevation if applicable ft. General comments and recommendations: i SS S c 7/% 1 Bonng # ❑ Boring ® Pit Ground _ surface elev. t73.9 ft. Depth to limiting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Stru Consistence Boundary Roots GPDM In. Munseff `Qu. Sz Cont Color Gr. Sz Sh. •Eff#1 I 'Eff#2 2 - .2.2 V R e . 1 20 Ai & Mord G S _ p SIX Y d k M E 9 L , t ® Boring # ❑ Boring ❑ Pit Ground surface elev. 7,2, 0 2 ft. Depth to limiting factor 9 6 in. Soli Application Rate Horizon Depth Dominant Color Redox Description Texture I Structure tune Consistence Boundary Roots GPDM In. Munsel Qu. Sz Cont: Color' Gr. Sz. Sh. •Eff#1 'Eff#2 o // 0 S 6 MeAR A S yM F S I , l i M Z — — r j q 0- 441 12- 2e �v Eftkd #1 = BOD > 30 220 mg& and TSS >30 1 150 mg& • Efliuerit #2 = BOD < 30 and TSS < 30 mg/l. t CST Name (please Ptir� , f ignature CST Number L 7— Address Date Evaluation Conducted Telephone N D 1r1q4jX 1 0 LuoD d� i7'` - /,? 0 / Z0 - - .2/-5 - 838 Property Owne `7 z 6 / SG Q Parcel ID # © 7 ' �D3�' b O – 4 p p Page Of FYI �ng# El Boring Pit Ground surface elev: ft Depth to limitlng factor - J_=_1 in. Sod ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDhY in. Munsell Ou. Sz. Cont. Colo' Gr. Sz. Sh. •Eff#1 •Eff#2 / © v A a , 8 M M GS 0 YA 6 S' a So , ing # ❑ Boring ❑ Pit Ground surface elev. fL Depth to ruing factor in Horiz Dep th Don Cola Redox SOU lication Rate Description Texture Stn."n Consistence Boundary Roots GPDIff In. Munsell flu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 •Eff#2 F # Cl Boing 11 pit Ground surface elev. ft. Depth tD limiting factor In. Sal ication Rate Horizon Depth Dominant Redox Description. Texture Structure Consistence Boundary Roots GPDfff In. Munsel Ou. Sz. Conk Color Gr. Sz. Sh. •Eff#1 'Eff#2 Effluent #1 = BOD, > 30 1220 mg1L and TSS >30 < 150 mglL • Effluent #2 = BOD, 130 mg/L and TSS < 30 nV/L The Department 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. seaww ,. - v S - 91 � 8 p3. M - e � � f Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 81 a names; Plan must County include, but not limited to: vertical and horizontal r enoa pdnf (BM)i1ir on and p I.D. percent slope, scale or dimensions, north arro argdwSieation and distanco to' crest road. Please pint a . � i ma Reviewed by Date Personal inforrnabon you provide may be used esulbndary p s Law, s.,1S.04�11) (m)). Property Owner s r Property Location Govt. Lot IV 1/4 Y0 /4 S T.,2 N R M" W Property Owneelf Mailing Address - r�pq� * Lot # ; Block # Subd. Name or CSM# .I '�• r - City State V Zip Code Number City ❑ Village go Town Nearest Road qs MN o c6 Si°� ��►✓ e lea A v New Construction Use: 0 Residential / Number of bedrooms Code derived design flow rate O GPD ❑ Replacement �] Public or commercial - Describe: i Parent material Ir ,4 d / A A / L L Flood Plain elevation if applicable ft. Gen=J comments and recommendations: Y A5 e M Boring # Boring [] y3 q G (� pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDift= in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 0 0 31a Mv S a 2. - - 2 16 V el JO AZ& I MEA , _ D, 3 1 ___ S e — 1 d Boring # ❑ Boring d- ❑ Pit Ground surface elev. - 4Z ft. Depth to limiting factor 6 in. Soil Application Rate Horizon Deirtii Dominant Color Redox Description Texture structure Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff42 a- /1 O a 6 2 M 1 if M Z f Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print � Signature CST Number L Address Date Evaluation Conducted Telephone N mber 3a 1 d t�aa d �iT� i -1,5 o / 7,C .2 ' Property Owner ./eel/_ gl SGr O e� Parcel ID # -3 � O � � � �� Page � of FT Boring # ❑ Boring ® pit Ground surface elev. � ft, Depth to limiting factor _- Z _ in, Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 AS M e G 26,4 11 , 6 M MFR Cs' — IF D 6 F ❑ Boring # E] Boring pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff #1 'Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 Effluent #1 = BOD > 30 1 220 mg/L and TSS >30 1150 Mg& ` Effluent #2 = BOD < 30 mgA- and TSS 5 30 mglL 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-9330 (8600) } 4 - D Property Owner e U Q l sC e e, Parcel ID # y / 33 P Of — T 0 Boring # q � ® Pit Ground surface elev. i?d� ft- Depth to li nbv factor _1.:L__ in. M*Eff#1 tion Rate Hor izon Depth Dominant Col Redox Description Texture Structure Consistence Boundary Roots rt! in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. •Eff#2 �rs.1 /Kv AS M , � F J O L 6k 6 S' v If I�UZ44 - s F Boring # ° Boring [] Pit Ground surface elev. fL Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDftF In. Mtmsell Ou. Sz. Cont Color Gr. Sz. Sh. •Eff#1 •Ert#2 ❑ Bodrg# ° Doring ❑ Pit Ground surface elev. ft. Depth to limiting factor 'n. W Appl ication Rate Horizon Depth Dominant Color Redox Description. Texture Stuct re Consistence Boundary Roots GPOM In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 • Emu" #1 = BOO > 30 <_ 220 ffv& and TSS >30 < 150 mg& • Effluent #2 = SOD, < 30 mg& and TSS _< 30 nVL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or contact the need material in an alternate format, please department at 608- 266 -3151 or TTY 608 -264 -8777. aso-uwt+rsao> T 0 aep I A IV de, ' � _ Lf Les �" -- - -- � - -- -- -. __ �_ _ A, hr -A ti - 1- - - -. -_ - I - - - - - - -! - - -- j -- a -- -- -1 I L LT I I I i ! I i } I I- r I I _ I I i I i r MAY -01 -03 10:11 AM P. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM ownerBu er 1 e / 111 �1 A 1 , I Y Mailing Address -�7 — &0 1 Property Address 30-, t 0 (Verification required from Planning Department for new construction) Cit Parcel Identification Number a � lfG �3�D - z7oo LE GA E SCRIPTI�I Property Location '��t 14 , Sec. f 5 , T o�_N.R. _W, Town of fi � Lot # �- ��o , Subdivision 1 Certified Survey Map �! , Volume Page # � /tS'3 S Page # O 3 Warranty Deed # h° , Volume Spec house ❑ yes W no Lot lines identifiable W yes ❑ no SYSTE M MAIN ENANCE Improper use and maintenance of your septic system could result in its premature failure m hand h iste o u P ro p er consists of pumping out the septic tank every three years or sooner, if needed by a licensed pump Y p ut into the sys can affect the fi motion of the septic tank as a treatment stage in the waste disposal system. The property owner abiecs to submit to St. Croix Zoning Departsaeat a certification forn', signed by the owner and by a disposal syste alaster plumber, journeyman plumber, restricted plumberors licensed p f peces a thc tank 113 fu of ludge� is in proper operating condition and/or (2) after inspection and puma inS (' ry)• 1 -,vc. due undersigned have read die above requirements sad agree to maintain Natural ResoutcesaState of Wis onsin. Certifie doll ict forth, herein, as set by the Department of Commerce and the Departmen 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 p x � pirstion date. �— DATE il OF APPLICANT OWNER CE CATIO \' i (wc) certify that all statements on this ` l (our lulawledgt:. I (%%.c) am (are) the owaer(s) of of Deeds Office the property described a ove. by virtue of a ws . r^ L DATE SIGNATURP OF APPLICANT ...... 'y infar—&don that is rrtis- "presented may reautt in tho sanitary permit being raVoked by the Z0121118 Department. •• Ynciude with this application: a stamped warranty deed from the Rogistt;r of Deeda Office a copy or the cartinod awvey map lr rercrencis is made in the warranty deed Of 1835 STATE BAR ORWISCONSIN FORM 2 -1999 KA T HL-'EN H. WALISH Document Number WARRANTY DEED REGISTER OF DEEDS Ti . ;RO I X CO., €! I This Deed, made between Jerry L. Biscoe, a married person REGE iVr'Er FOR KCGRD 12 :3 002 9 :3!: Ah VPRRANTY DUD Grantor, and Blia Y. Her and Kou Her, As Joint Tenants `EMpT A CET COPY FEE: COapy FEE TRANSFE�FEE: 210.00 i?rG�Rt3IRG FEE: 11.00 Grantee. RES.- I 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 Return Address The West 330 feet of the E'h of the NW '/< of Section 15- 29 -I5, the SW '/. St 1(1 :�iAT90NAL BANK Of BALDWIN of the NW '/. of Section 15 -29 -15 EXCEPT the Wes 661 feet thereof, St. $0 11111 Croix County, Wisconsin. f 4 t nr w' /,� I S' !d 9 90 a St 034- 1033 -60 -000 Parcel Identification Number (PIN) This is not homestead property. %) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this ZS day of February 2002 A erry L. oe * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN 0 - %NO 1 ` , County ) ss. ) authenticated this day of (]C�, Personally came before me this 6 day of February 2002 the above named * Jerry L. Biscoe, a married person TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be'!.4 VCrs Onjs) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument dco "' edg e s THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland J ` - '� -- Hudson, Wi 54016 Notary Publid,. te. `df@Tijj' O6 fsuii My Commissiofl ;9.; . n ent4 ot, state exp' ation date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ; k * Names of persons signing in any capacity must be typed or printed below their signature. , .. +liirormation Prafassiona(s c ompany, Fond du Lac, w1 WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 -1999 i 5 0 3 C1�3 /T`3 q1 �- ' o , v Z �o o F 100TH 96/45 - 1 0,4- �/� /10 Ol f3 L J f a OL. 'o=- -- I 1193/243 NE 114 -N W 114 'oB _ � /84 I 230A 229 1129/90 A� SW 1/4 NW 114 SE 1 /4 — 114 231 B 231 A 232 1175/94 1193/243, I 1193/243 1129/90