HomeMy WebLinkAbout034-1047-20-000 Wisconsin gepartment of Commerce PRIVATE SEWAGE SYSTEM County St. Croix
Safety and Building Divisiot
INSPECTION REPORT Sanitary Permit No: 399636 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Ip
[ Permit Holder's Name: City Village X Township Parcel Tax No:
Peterson, Bruce Springfield Townshi
CST BM Elev: Insp. BM Elev: BM Description:
TANK INFORMATION ELEVA N DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic -7t) Benc
61 -r _ l�ou l (o ('1 /I
if Dosing ' s 1 Alt. BM r� 1 0 - 4 - T , (� • �$�
Aeration 9
Bld . Sewer 1
Holding St/Ht Inlet I
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic ? 100 t ( Dt Bottom I. b
Dosing " Header /Man.
Lam)
Aeration Dist. Pipe
Holding B. Syste
�5 6to Z l o 3 20 f
Final Grade
PUMP /SIPHON INFORMATION
Manufacturer j Demand St Cover
GPM
Model Number •e �•
VT ► s- /�.�6z 3.9� /o�-�( 1 -�$_
TDH Lift t Friction Loss S stem Head 7TDH Ft
Forcemain Lengt Dia. If Dist. to well
SOIL ABSORPTION SYSTEM
RE H Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIME IONS �I 2
SETBACK SYSTEM TO P/L BLDG IWELL LAKE/STREAM LEACHING Manu
INFORMATION CHAMBER OR
Type Of System: UNIT M Number.
►'v► 1�QD S6�
DISTRIBUTION SYSTEM �_ ,- _'-
Header /Manifold u Distribution / It x Hole Size / x Hole Spacing Vent to Air Intake
�= Pipe(s) 5 , ' l '� 3 / (6 it t
Length Dia Length S s Dia Z Spacing
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 [] N ® Yes ® No
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COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / do -L "' Inspection #2• -�/��- -�
Location: 2957 90th A nue Unkn own (NW 1/4 NE 1/4 21 T29N RI 5W) ,j NA Lot
� j �� � (�'� l ""'. ✓ -`� C1 '�,i� C� . c � k%t _ l VI . cY � !J�� I ✓W( .f'L'Z- ,�.C1 l.�l�
1.) Alt BM Description Ties �6— \ (t (� �• `
2J Bldg sewer length = I k, p ®�- � ��te.� ,�nyty t'�'�•^♦C
- amount of cover 4- O , ;' s . f••r mod[ �: "
3.) Contour= �ol.�o L t 2.ro t. �t'� = Id`l• RA'S �. S (++t waiaQk
I -- - - -- -- i - � j i: tea
Plan revision Required? Noj
X
Use other side for additio ati C
�L_ -_-
1Zn� Z
S/ . -.._ . -- -- - -
3D -6710 (R.3/97) r Date /O —/ Insepctor's Signa � �� 52 Cert. No.
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' Sanitary Permit Application Safety & Buildings Division
t In accord with Comm 83.21, Wis. Adm. -Code 201 W. Washington Ave.
See reverse side for instructions for plication PO Box 7302
Personal information you provide e r e d urposes Madison, WI 53707 -7302
tleparrmairr ofantmar�Q Submit completed form to county [Privacy La ..?�. (m)] � ( p ty if not
state owned.)
Attach complete plans (to the county copy okWth =MqMper no an 8 -1/2 x 11 inches in size.
County 1 State S1 �ermit Number Clreck Ifrevious a a on State P)an J2 D. 1jumber
I. Application Information - Please Print all Informati Location:
Property Owner Name Property Location
Property Owner's Mailing Address ott unber�l /4, S Ta1 Blo k Numbeer
C'>
City, State Zip Code dm4er Subdivision Name or CSM Number
II. Type of Building: (check one) ., ❑ City
L�- 1 or 2 Family Dwelling - No. of Bedrooms : _ - 3 7 ' ' �' / ❑Village
❑ Public /Commercial (describe use):_ O� Town of l
❑ State -Owned r 1 0 "
MENtu Nearest Road
a s
7o,61 4-IQQ S - L 6 _Q ( �� - P cel T8x Nur bgp ). r 07 0 d
III. T e of Permit: Check only one box online A. Check n line • a e 51 /, " j Z2—
A) 1. ew 2. ❑ Replacement 3. ❑ Replace m tP 4. 6. ❑ Addition to
System System Tank Onl _ i E Sy stein
B) Permit a �� Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply) ,j.,/ 1
❑ Non - pressurized In- ground KL•Mound S Sand Filter ❑ Constructed Wetland
❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade ❑ Aerobic Treatment Unik ❑ Recirculating ❑ Other:
V. Dispersal/Treatment Area Informatio Ta` e 1 p[ 1
1. Design Flow (gpd) 2. Dispersa Are 3. ersal Area it Appli don 5. Percolation Rate 6. System Elevation 7. Final Grade
Required M'w Proposed Rate (Gals. /day /sq. ft) (Min. /inch) Elevation
y S`� j9 _Sr .sz . a 1D3.
VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel. Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete strutted
Tanks Tanks
1 __T ❑ ❑ ❑ ❑ ❑
VIII. Responsibility Statement
I, the undersigned, as sume respon sibility for installation of the2QWTS shown on the attached plans.
Plumber's Name (print) Plumber' Sig (no -" /MPRS No. Business Phone Number
Plumber's Addres treet, City, State, Zip Code) J
je :In 1 r. f.:r C
IX. County /Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Iss ' g Agent Sign re (No stamps)
K Ipproved ❑ Owner Given Initial Adverse SurchWge Fe S e) dp ' /D %, Determination
X. Conditi Approval /Reasorys for�Dtsappr va� W I` d� /� / /�•
it AV SBD -6398 R07 /00
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Safety and Buildings
4003 N KINNEY COULEE RD
LA CROSSE WI 54601 -1831
TDD #: (608) 264 -8777
I �c0ns n www.commerce Wsconsin.gov
www.wisconsin.gov
Department of Commerce
Scott McCallum, Governor
Brenda J. Blanchard, Secretary
May 22 2001
CUST ID No.225094 ATTIC• POWTS Inspector
ZONING OFFICE
MICHAEL P ROGERS ST CROIX COUNTY SPIA
N4563 320TH ST 1101 CARMICHAEL RD
MENOMONIE WI 54751 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 05/22/2003 Identification Numbers
Transaction ID No. 642198
SITE• Site ID No. 629758
SITE ID: 629758, BRUCE PETERSON Please refer to both identification numbers,
ST CROIX COUNTY, TOWN OF SPRINGFIELD; 90TH AV above, in all correspondence with the agenc
NW1 /4, NEIA, S21, T27N, R15W
FOR:
DESCRIPTION: THREE BEDROOM MOUND SYSTEM
OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 792503
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:
• 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.01 101)
and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION
2.0" SBD- 10706 -P (N.01 101).
• 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 state approved effluent filter is required. Maintenance information must be given to the owner of the tank
explaining that periodic cleaning of the filter is required.
• 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. Stats.
• The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption
area.
MICHAEL P ROGERS Page 2 5/22/01
• 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.
• 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, DATE RECEIVED 05/08/2001
FEE REQUIRED $ 175.00
FEE RECEIVED $ 175.00
Charles L Bratz BALANCE DUE $ 0.00
POWTS Plan reviewer II- Integrated Services
(608) 789 -7893, Mon. -Fri. 7:45 AM to 4:30 PM
cbratz @commerce.state.wi.us WiS cgde: 7633
Bruce Peterson - 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 (O1 /O1)
Location: NW 1/4, NE 1/4, Sec. 21, T 24 N, R 15 W
Town: Springfield
County: St. Croix
Date: May 7, 2001 CpnadOnQffy
Owner: Bruce Peterson APPROVED
oEPAWtrOFCOwERCE
..S:GOF $ �i.oiKo
Address: 328 CTHW F � ...l.
Hudson, WI 54016 SEE CORREBPONDENC
Plumber: Mike Rogers
Signature: C
License # MP 225094
Attachments: 6748 -Plan Approval Application RECEIVED SBD - 8330
M A Y - 7 2001
page 1: cover
2: design criteria & calculations
3: plot plan
4: system cross section
5: plan view, lateral detail
6: pump tank exit detail
7: pump curve
8: system management
page 1 of 8
I
I
I
I
v Design Criteria
Residential Wastewater Contaminant Load: 30 mg/L < BOD < 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 < BOD
Septic tank + "highly treated" effluent 30 mg/L < TSS
Fecal Coliform < 10,000 cfu/100 mL
3 Bedrooms x 100 gal /bedroom/day x 1.5 Oro gallons /day hydraulic load
Design Calculations
In situ designed loading rate x.21 gallons /sq. ft. per day
Depth to estimated high ground water in.
Depth to bedrock in.
Cross slope at system �'`S� %
Force main length ck 4 ' ft. of in.
Manifold /header length ft. of in.
Drain -back S 3 gallons
Lateral length Z @ SS ft. of L in.
Lateral elevation x'03' b ft. @ bottom of lateral
Lateral hole size 3 �t� in. @ in. ( ft.) Spacing
t I holes /lateral 3 holes total
Lateral volume ° z` gallons
Total lateral discharge rate gallons /minute @ 2 . 5 � ft. head
Network pressure compensation losses 3.2 s '�'�� ft.
Elevation difference t �' S�S� ft.
Friction loss ft. @ z�� gallons /minute
Total dynamic head 1p' Y ft.
Pump /sip)ton 4 K r gpm @ Z ft. of head
Manufacturer `� �� ��- Model # S >s r 4
Dose volume gallons
Lift/siphon tank 6'h' gallons
Septic tank t 0%?1t:) g allons
Effluent filter ' t
Measurement pump on and off S' in.
Height alarm from tank bottom in.
Reserve capacity 4- 4 0+ gallons
specs.calcs
Page Z of
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SEPTIC t SPEC.IFVCATIOKIS
DOSE Vl9 C g
T^W,.S MA,JUFACTURCR: IJUMDER OF DOSES: PCK Omen
TAWK SIZE; 1 6
_ GALLOWS ..DOSE VOLUME
ALARM MIWUFACTW&ER: S� yTk���� IAICLUDING SACKFLOW: (,AL LONS
^00CL ►JUNfiCK: 1 e 1 1-} CAPACITIES: A WCHES OK C.ALLO�.
SWITCH T ��` " l l' L 2 t.
B IAICNES OR (�A.LLC�,S
PuMP I4AQUFACTURER: _ -- � ""` s
C • ` iULHES OK GA L 0 ki
MODEL uUMDCR: Sµ v",' 40 D■ 6 WLHES OR CALL ✓I
SWITCH TyPC; V � Q ' Y " IJOTE: PUMP AMD ALARM ARC TO OC
MI►JIMUM DISCMA1t6C RATC _GPM IN5TALLE0 OW SEPARATE CIkCLITS
VERTICAL DIFFEKEM OETWC[IJ PUMP OFF AIJO OISTRIbUTIOW PIPE.. FEET
+ MIul?AUM WETWORK SUPPLY PRfCS;URE .. . . . . 2 �� FLET
+ FEET OF FORCE MJ►I►J X "" F /pprtFRICT101J FACTOR. -� r ��EET � '�
TOTAL OtIWAMIC. HEAD = 1 ' � FEET
IIJTERklAL DIMEW61OWS Of TAUK: LEI.IGTH ,WIDTH �� ✓;LIQUID DEPTH '
�a Q
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• • D et a ik , ,
Performance Da
40
30
Pump Characteristics
ir LhA seder e
Mkn,nd M1o" s1ICF401A1 SN�4iMR
Ax wo* Mla hk WHOM SM OA2 10
Her wer 410
FeN
It 63
AW*r Sw" Pole 4
R.PJL 153111 0 10 20 �, 30 40 so 60 IO
Mseee 1/t GP
WNW 115 1 234 t 1 Head (fine) 10 14 I7 21 23 21 30 Ss
"W" 60 (m K. F 5.2 6. 1 0.7
1 v.twq 120 &L Fleii hft
GPM (US am) 70 60 SO 40 �0 10 0
IIfJIAA A
�Islee Qtrn A ( rye 1.
e Dimensional Data
SeR1s KWAI 314!
211 ire. �t�i4�Z1 —, •—e ear t,ea rn 1. All dwWons in I
AN (Netric for
rawer CtKd N /!, SJ1W eri. tr nrn interr1*141 use).
qDr mr 2. COelpoeelll dltle dons MR
M ateri als of Constru
inch.
3. Not for oonsttvdbn purpose
Jelb low 1 1 3.718 ' """"rr" unlect tMifled.
!him coo b" � '50o1+ 4• Dimensions add nefyhts ere
hn (JAN tlpprtlXlMie.
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aK«it«iad Seel No / , 5- We reserve the righ to make
Shalt Sed Sd Oeeho AOWIXW Sled revisions to ow probd and their
Sid" Steel spedfiarticas without notice.
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1998 Nydromatie Pumps, Ae loud, Ohio. All Righn Reeerved
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�," j f HYDROMATIC - Your Authorised col Distribi,tor
1840 Itanty Rood Oland, OW 44805 Td: 819.211•9042 Fox: 419.281-4037
Weh Sh: www.peeidrpunp.mm
SALES OFFItxS IN All MAJOR CITIES AND 0)tINTRIES
Refer to "Pumps' in tiro yelow ptyes of yoer phone directory for your local 01arlbulol --
ItemB: W-02-66801199 5M ?4inl U p
• 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, Rogers Plumbing, 715 -235 -1132, or the St.
Croix County Zoning Office, 715- 386 -4680, 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
I
Wisconsin bepartment 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 8 112 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. 1. / . 3 2'2-
Please print all information. R viewed by Date /
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). , G1 12Q D
Pro erty Owner Property Location
Govt. Lot t4,i,j 1/4 f4 C 1/4 S T Z i N R / 5` E (or) W
Property Owner's Mailing Address Lot # I Block # Subd. Name or CSfM
. i h -_-
-r
City State Zip Code Phone Number ❑ City ❑ Village Town Near t Road
J j New Construction Use: Residential/ Number of bedrooms 'o Code derived design flow rate GPD
❑ Replacement ❑ P ublic or commercial - Describe:
Parent material _ fJ LA-C d l I I t - 1 _ / Flood Plain elevation if applicable At 4
�cS ft.
General comments 1L V \� �: 1 - se - , Ya YLflSftT1 �z SKY1'ae-
and recommendations:
❑
Boring # Boring ,
pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff #2
- /t�YK6 _ `Si. f1 , 7S ble" nor ( 4 c.4
4� - � .s Y b c ,• '' 's s� I� ' rh 5 � K'. I' •-- Q : � . � N
5 -1 Boring # C] Boring
R1 pit Ground surface elev. ��• / ft. Depth to limiting factor 3 in.
Soil App lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/if
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
-i 3 fib' k' > L Z. rn �bK r� fi r� c �� 0.4 4
z L3 3S 2.5 Y G l.S' PZ A C °, 1 -� s. (. 1 r' s b K_. rl-S r.. r LJ
Z.5 � I S Y,, L e;/ f. -y Sid � �+� l y .r. -' n \
Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST me ( - i a e CST Number
Address Date Evaluation Conducted Telephone Number
i
1 l
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Property Owner _ Parcel ID # Page _� of
a Boring # ❑ Boring (�
Pit Ground surface elev. r ft. Depth to limiting factor in.
,i 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 I 'Eff#2
z 21 - 7 2- . 4 is 3 F 5,L % J yr 5i bK ni "1 — CS ,C> 0. 0
Q ,
zz -94 z.sY 3 -r- C4 cL ,� -y m �.� 0.Q>
® Boring # ❑ Boring (�
pit Ground surface elev. % 7. Z ft. Depth to limiting factor__ in.
I Applicatio Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz, Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
A ° 16 yip,3 K 6
1 - V s y� C.-. 0 b, .0 • 1jY
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/ff
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mgA- ' 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 (8.6/00)
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ORIGINAL'
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Wisconsin0epartmentofCommerce SOIL EVALUATION REPORT Page I of 2
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Certified Soil Testing
Attach complete site plan on paper not less than 8% x 11 inches In size. Plan must C oun ty St. Croix
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. 21.27.15.322
Please print all Information. ewed By Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). "429/0
P roperty wner Property Location
P eterso n, Bruce Govt. Lot NW 1/4 NE 1/4 S 21 27 N R 15 W
P roperty Owner's Mailing Address Lot # Block # Subd. Name or CSM
328 CTHW F
City State Z ip Code Pho Number Cit Village W Town Nearest Road
Hudson WI 1 54016 715 - 38 Springfield 90Th Ave.
New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
Replacement Public or commercial - Describe
Parent material loess Flood plain elevation, if applicable NA
General comments
and recommendations: install 4'x 112.5' rock bed mound on 101.8 contour as upslope edge of rock w/ 1.3' sand fill
Ff I Boring # IN Boring
Pit Ground Surface elev. 101.8 ft. Depth to limiting factor 24 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
1 0 -10 10YR 3/2 - sit
2 10 -24 10YR 4/4 - sl
3 24 -28 10YR 4/4 f2p 7.5YR 5/8 sl
H anCl Doting extend system en on i Foved con,60
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 N ame ease nn big US I Number
Henry F. Grote < <.� 222774
Address Certified Soil Testing Date Evaluation Conducted Telephone Number
E. 4366 353rd Ave., Menomonie, WI 54751 4/17/2001 715 - 233 -0398
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FROM FAX NO. : May. 23 2001 10:46AM P3
. ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Bayer
Mailing Address 2 E, C ) -
Property Address �;Z [ S C �Q f"cy e
(Verification required from Planning Department for new construction)
Citylstate Parcel Identification Number
LAGAL DESCRIPTION / /�
Property LocationA w Y., V., Sec. 2L_ T2LN - R / S W, Town of S , vl ! , e /L►'
Subdivision n l z* 5 d4j &L j Lot #
Cerdfied Survey Map # _ _ Volume . Page #
Warranty Deed # 0 , Volume Page # 3 70
Spec house d yes ❑ no Lot lines identifiable ❑ yes ❑ no
SYST P6 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
masw plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic. tank is less than 1/3 full of sludge_
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days '� the n � three year expiration date.
i�14M X„ " l L l
SIGNATURE OF APPLICANT DATE
OWNI{:R. CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. 1 (we) am (are) the owner(s) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
�7/�MIX `1 � 5
SIGNATURE OF APPLICANT DATE
0 Any information that is cnis- represented may result in the sanitary permit being rovoked by the Zoning Department. ••" " "+
0t 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
• � 6174'76
KATHLEEN H. WALSH
• STATE. BAR OF WISCONSIN FORM 2 - 1998 REGISTER OF DEEDS
WA
RRANTY DEED ST. CROIX CO., WI
RECEIVED FOR RECORD
Document Number c
01-26 -2000 2:30 PM
This Deed, made between WARRANTY DEED
Tsuefu Yang EXEMPT N
CERT COPY FEE:
Grantor, COPY FEE:
TRANSFER FEE: 264 "00
and B ruce T Peterson a single p erson RECORDING FEE: 10.00
PAGES: 1
Grantee.
Grantor, for a valuable consideration, conveys and warrants to Grantee
the following described real estate in
St. Croix
County, State of Wisconsin:
The North Half of the Northeast Quarter of Section Recording Area
21, Township 29 North, Range 15 West, except part
to St. Croix County for highway purposes, recorded Name and Return Address
in Volume 229 on page 99 as Document No. 190433A RETURN',;! I TITLE ONE
706 19TH STREET SOUTH
HUDSON, WI 54016
Q. 034 1 47- 10-000 034 -10+ 20 -000 VQ CD
Parcel titicatio mbe PIN)
of hom roperty
(is) (is not) 2
32
Exceptions to warranties:
easements,roadways and restrictions of record
Dated this day of Q
* Tsuefu Yang --'
«
AUTHENTICATION ACKNOWLEDGMENT
l, STATE OF WISCONSIN )
) ss.
Signatures) St. Croix Court
Personally came before me this day of
the above named
authenticated this day of_______,____,
j
-
* to me known to be the person _ who executed
TITLE: MEMBER STATE BAR OF WISCONSIN
If ng instrument and acknowledged the same.
(If not,
authorized by § 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY • Turner
' Notary Public, State of Wisconsin
Michael H. Forecki Attorne
state expira
Eau Claire Wisconsin M ommissi n is petma t. 1 not, t date:
(Signatures may be authenticated or acknowledged. Both are 1`In'y L. TUrr19f J o
not necessary.) Notary PUbIIQ
of persons signing in any capacity must be typed or printed below their signature.
Names pe STATE BAR OF WISCONSIN
WARRANTY D FORM No. 2 -1998
DEED
Proeucetl with ZipFarm'" ny Venisdt Ire. 70025 Fifteen Mile Roatl. Glnlon Townehp. M�d+igan 40035. (000) 363.9005
Phone'. 1715)386 4207 rix'. 17151 )Il6"6651
Cemury 2 r Premier Grmp 706 19th 5i, Hudsun W 1 54016 ' -161
� N
10 AI L' HI7AVCAPA'l1Y
HEAD CAPACITY CURVE - 'r -i Mft;Tt
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MODEL 152/16.3
Fuel Me-lax Col. 1. iterE. ..4) 1 j•s
40 Zil
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W PER ]ANME � �--�—
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Timed closing panels available,
- Eieretrical alternators, for duplex systems, are available and supplied with
an alarm
- Variable level control switches are available for controlling single phase
systems.
• Double kgytack variable level float switches are available for variable
level long and shod cycle ocintrols.
# Sealed Qwik-Box available for outdoor Installations. See FIV111420.
• Over 130'F. (60C.) special quotation required.
IUM53 series
jW#LS
C"WIL" fit
Modal �.' voftl�ph I slow)" Duo= 1/h
8NI52 11Q .. .,_ 1 Auto 8.5 Included 2 or 3
E152 230 1 NO 13 11 2w3 Elm W
IFEl -- 'ik 1 AU110 included 2or3
N1W 116 1 Nan 1 2or3
ON153 115 1 Am Will Includod 2C43 ISELECTJON GUIDE
E153 230 i Non f 3 I 2or3 1. SVO pinybwk vorWm lovel 4wt switch or double piggyback variable level floal
BE IS3 J = -. 1 Auto Inmed 200 switch. Refer to FM0477,
2. See FW712 for corned model of Electrical Altemsior E4%k.
An installation of convols, ~on ilevlces and Anne should W 0one oy a Quawmed 3, vadable level control twitch 10-0225 used as a control activew, specify duplex (3)
ocanssd slaciriclao. All oloctical and *#Ialy oodea should he follovad including the most
recent i4tignsl E16MC Code (NEC) and the Occupational &OWY and Heam Ad (OSHA), or (4) float MOM
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor Is engir*ered Into the design of every Zoeller pump.
AWL M: P C. BOX IO367
• L&Awlb, KY 40256-0347
O SHP TO: $649 Cwjw Rw RwJ
Loukvib,KY 40211496f Z[9U71 S,7.9'
FAX (3(rlj 114-3624
APO 16021 774�27jf • I (adq 92"ump
0 Copyright 2000 Zoeller Co. Ail rights reserved,