HomeMy WebLinkAbout034-1050-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County:
Safety and Buildings Division St. Croix
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)). 383
Permit Holder's Name: ❑City ❑ Village ❑ Thwn of: State Plan ID No.:
Debban, Ronald Springfield Township
CST BM Elev.: Insp. BM Elev.: BM Des crop on: Parcel Tax No.:
034- 1050 -10 -000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION 85 HI FS ELEV_
Septic 4000 Benchmark S s
Dosing Alt. BM S
Bldg. Sewer T- 11,25'
ng t Ht Inlet
TANK SETBACK INFORMATION Ht outlet Z
TANKTO P/L WELL BLDG. Vent to ROAD Dt Inlet �S
Air Intake
Septic TZ ' �� „j NA Dt Bottom 3 -3 Z
Dosing } 20 � a
/ � / NA Header / Man. 3. yb Z,
era A
i 3 ya Z
Dist. Pipe •2 2 r. z. 3
y .07-
din Bot. System
9
PUMP/ SIPHON INFORMATION - � - � Final Grade
Manufacturer ((e�r (, Demand St cover
Model Number - M
TDH Lift �riction 14 Z TDH/ Z Ft 1
H
Forcemain Length Dia. Z �/ Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Len No. Of Tre ch s PIT No. Of Pits Inside Dia. Liquid Depth
D IMENSIONS th r S DIME
L anu acturer:
SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM
INFORMATION Typeo CH ER Num er.
System: >ZO / > �S' / UNIT
DISTRIBUTION SYSTEM
Header / Manifold / / Distribution Pipe(s) r ' i x Hole Size / x Hole acing Vent To Air Intake
Length Dia. Z Length - Dia. 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 ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.) QS 91 l
Inspection #1: 7 /,e /4/ Inspection #2: 'll /k
Location: 843 State Highway 128, Wilson, WI 54027 (NW 1/4 SW 1 4 T29N R 5W - 222915346
1.) Alt BM Description = � 0 4 3.' G O we, S
2.) Bldg sewer length = Z9 1 a
- amount of cover = 7 6 ' ) AY a W d r.- G
3.) contour = �, f f 0 = I 5,s— / /
Y•) � s s �n
S c. S4 /, l
Plan revision required C] Yes �q
Use other side for additional information.
31, SBD -6710 (R.3/97) Date nspedor's Sign re
Cert. No.
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Safety & Buildings Division
8 3 S Z 6 Sanitary Permit Application 201 W. Washington Ave.
�/ In accord with Comm 83.21, Wis. Adm. Code PO Box 7302
T See reverse side for instructions for completing this application Madison, WI 53707 -7302
i J'r`C(Twl seen Personal information you provide may be used fQi 4econdary purposes (Submit completed form to county if not
Department of Commerce [Privacy Law, s. 15.0,40i� )] ; state owned.
Attach complete plans (to the county co only) for Fn, on per not less titan 8-1 x l 1 inches in size.
vise n t vious applit atirnr tate Plan I. D. > mher
County State Sani L'emg Nu�n�ber ❑ hec, l , r, r: 1Q j
/x 'jj o O " ' f` , -• ocation:
I. Application Information - Please Print all Information Property Location
Prope Owner Name I /
1 14 4di /4,S N, (or
Z G° h Lot Number Blcek Number
Property O Mailing Address
JJ G �
criy: Ntartber Subdivision Name or CSM Number
City, State Zip C e ------
� y
❑ City
II. Type of Building: (check one) ❑ village
10 1 or 2 Family Dwelling -No. of Bedrooms : ---? I own of
❑ Public/Commercial (describe use):_
❑ State -Owned N t oad
ate' i � 3 - ow
Parcel
III. T e of Permit: Check only one box on line A. Check box on line B if applicable)
5 ition to
A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. Existin S stem
S stem System Tank Onl Date Issued
Permit Number
B)
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that a pp l y ) ❑Sand Filter ❑ Constructed Wetland
• Non - pressurized In- ground [Mound
❑ Holding Tank ❑ Single Pass ❑ Drip Line
• Pressurized In ground t ❑ Recirculating ❑ Other:
• At- de r X '?•S " c.CQ ❑ Aerobic Treatment Unit
V. s ersal re tm r o ti lication Percolation Rate 6 ystem Elevatio Final Grad
Design Flow 2. Dispersal Area ispersal Area 4. Soil APP /inch levation
Required Proposed Rate (GalsJday /sq. ( ) 110 2 -9 0
45 .
VII. Tank Capacity in Total # of Manufacturer Con- Coe Steel gt ass Plastic
Information Gallons Gallons Tanks crete structed
New Existing
Tanks Tanks ❑ ❑ ❑ ❑
VIII. Responsibility Statement
I, the undersi ed, assume res onsibili RS No. for installation of the POWTS shown on the attached cans. Business Phone Number
MP/MP
Plumbers Name (print) Plumber's 'gnature (no stamps), 7 -� 3
Plumber's Address (Street, City, State, Zip Code)
Gf 7- 2 3,- 1 4 sT
IX. County/Department Use Only I uin A ent Si cure (No stamps)
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued g g
N(] Approved ❑Owner Given Initial Adverse Su
Determination
X. Conditions of Appr val / asons for Disapprov tKC.tQA�•2 a-r. ,,•, Q� r � c'Ft
tS * 3 —BR.
uAb
Safety and Buildings
PO BOX 7162
MADISON WI 53707 -7162
TDD #: (608) 264 -8777
Visconsin www•commerce.state.wi.us
Department of Commerce Tommy G. Thompson, Governor
Brenda J. Blanchard, Secretary
September 17, 2000
CUST ID No.691727 ti, 12
ppss �'.�,��... '` POWTS INSPECTOR
ARTHUR L WEGERER A r ZO ING OFFICE
421 N MAIN ST 1' u (� ST F�OIX COUNTY SPIA
PO BOX 74 fi , �- 1 JOU CARMICHAEL RD
RIVER FALLS WI 54022 c*} z D�ON WI 54016
RE: CONDITIONAL APPROVAL xOnruv Identification Numbers
PLAN APPROVAL EXPIRES: 09/170�� G C�Fr'!Cc i
Transaction ID No. 435731
is
1 Site ID No. 198893
�i-
SITE: Please refer to both identification numbers,
RONALD & KAY DEBBAN - RESIDENCE above, in all correspondence with the agency.
ST CROIX County, Town of SPRINGFIELD; STH 128
NWIA, SWIA, S22, T29N, R15W
FOR:
Description: MOUND SYSTEM / 450 GPD
Object Type: POWT System Regulated Object ID No.: 761952
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
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.
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.
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 09/07/2000
FEE REQUIRED $ 175.00
FEE RECEIVED $ 175.00
PE PAGEL rF, S LAN REVIEWER II BALANCE DUE $ 0.00
Integrated Service
(608)266 -2889 , 45 - 1630 HRS
PEPAGEL @COMMERCE.STATE.WI.US W-i z cod6t,,763 ;
cc: RONALD & KAY DEBBAN
TITLE SHEET Page of 7
MOUND SYSTEM
FOR
A BEDROOM RESIDENCE
This plan has been prepared in accordance with the Mound Com��Wryt& Bl_ ')(S. G!''
Manual SBD- 10572 -P and the Pressure Distribution Manual ,SBD- 10573 -P
C t_ 6189) Cc -6148
LOCATED IN THE r\)W 1/4 OF THE Sw 1/4 OF SECTION ZZ , T _ Z9 N, R 1 S W,
TOWN OF SP�21fv G 1=I ��p , Si C - \?-UtX COUNTY, WISCONSIN.
INDEX
PAGE 1 of 7 TITLE SHEET
PAGE 2 Of 7 SYSTEM MANAGEMENT PLAN
PAGE 3 of 7 PLOT PLAN
PAGE 4 of 7 PLAN VIEW -CROSS SECTION
PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT
PAGE 6 of 7 PUMPING CHAMBER CROSS SECTION
PAGE 7 of 7 PUMP PERFORMANCE CURVE
PREPARED FOR
b3
PREPARED BY
WEGEF�EF� SL7 I L . TESTING
AND .
DESIGN SE= I CE
,�g1N�MN
P.O. Box 74 421 N.Main St.
River Falls, WI 54022,�`SCQNS /y
Phone 715 -425 -0165 s X}► '�,,�{
Fax 715- 425 -6864
�GE4Eq
L9 SP
P.O
.W.T.S. JWUP,N.
W.
Conditionally �•
DEP NT COM E CE I�MNR
DI IS N SAF AN LDIN
EE CORRESPOND NCE
W35731
JOB NO. C 0- Zq I
Mound System Management Plan Page Z of
Pursuant to Comm 83.54, Wis. Adm. Code
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the
septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. T rating condition of the septic tank and
outlet filter shall be assessed at least once every 3 years by inspection. Th outlet fi t shall be cleaned as necessary to
ensure r n. The filter cartridge should not be removed unless ns are made o re a in so i ank that
may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if
the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The
septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of
the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise
the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in
the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required.
However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and
Buildings Division.
Pump Tank
The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to
verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary.
Mound and Pressure Distribution System
No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound
shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic
(other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the
infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather
installations (October - February) dictate that the mound be heavily mulched for frost protection.
Influent quality into the mound system may not exceed 220 mg /L BOD5, 150 mg /L TSS, and 30 mg /L FOG. Influent flow may
not exceed maximum design flow specified in the permit for this installation.
The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each
lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be
compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is
required to maintain equal distribution within the dispersal cell.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner,
and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring.
General
This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its'
component manual [SBD- 10572 -P (R. 6/99)] and local or state rules pertaining to system maintenance and maintenance
reporting.
No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and
pump tank abandonment shall be in accordance with Comm 83.33 Wis. Adm. Code when the tanks are n longer used
o s g a
POWTS components.
Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access
openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed
unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall
be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component.
Continciency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition.
If the dosing tank, pump, pump controls, alarm or related wiring ecomes defective the defective component shall be
9 P
immediately repaired or replaced with a component of the same or equal performance.
If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired
or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption
and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper
operating condition.
Questions on the operation or maintenance of this system should be
directed to the County Zoning office or to the
licensed,plumber who installed the system.
l
PLOT PLAN
Scale
Page 3 of 7
1 "= W,p'
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o
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3 u�UM OF !�
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1 2 - _ Foo•y' _ FY It
r
NOTES:
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install 4" observation pipes with approved caps. ( Z required).
3. Septic tank to be \.ppp gallon capacity manufactured by
'M.l1jw �T r`►2ty P►Z�Z/i - 3 i w/`zA'�FZ F: ��--� �r�P `l`�k �ro 9� - LSO stt� w� t1��rL�1� .
4. Bench mark "o U Q
5. Divert surface water around system to prevent ponding at the uphill side.
Page L) U -]
Approved Synthetic Covering
ASTM C33 Distribution Pipe
Medium, Sand
G F El ev. O ?
Topsoil �- H _�,..- .
- -- l q
0
3 E '
b
% Slope
Distribution Cell of Force Main Plowed
2" to 2 %2 Aggregate From Pump Layer
I
D �.9 Ft.
E Z -3Z Ft.
CROSS SECTION OF A MOUND SYSTEM F p Ft.
G p.S Ft.
A Ft. h l . v Ft.
Linear Loading Rate= 6 - oGPD /LN FT B - 7S Ft.
Design Loading Rate= v.'�GPD /SQ FT I 1 y Ft.
J 8 Ft.
K 1 Z Ft.
- L O.9 Ft.
.F� W Z Ft.
^L
J - Observation Pipe
K
8 '
r - — - - - - -- -- - --- -- - - - --� �- max g
o --�- --------------- - - - - -- - -
A �- 'ic, fa -- --
I -�
W 0 -- � —_� — - - Force Main
� Distribution Cell of 2" to 2 2"
Pipe aggregate
Observation Pipe
(Anchor securely)
PLAN VIEW OF A MOUND SYSTEI
Distribution Pipe Layout PA *e S of
c
Place the holes at the bottom of the distribution pipes
at equal spacing. Remove all burrs from the pipe and holes.
Extend the end of each lateal up with the use of long turn or 45 fitting to a point within six
inches of the foal grade. Terminate the ends of the Iaterals with a valvx:threaded cap or
• threaded plug. Provide access from f nal grade for the valve; threaded can or threaded plus,
7 - . 1 CTS L Z:\ OS S _5'�L`(1l� K3
f FT
pvc Fvc Svc
Lateral Manifold Lateral
. �= — T
x x x x x2 x2 x x x x
Lateral Lenath — Lateral Lenqth — p
Distribution Une
11t's1J1F -��
S �OR� r+ Rim
P 3�] Ft. Hole Diameter 3)1 b Inch
S 3- Ft. Lateral " 1 Inches)
X inches Manifold Z• Inches
Force Main " Z Inches
i of holes /pipe lq �.
Invert Elevation of Laterals 103.y Ft.
PUMP CHAMBER CROSS SECTION ARID SPECIFICATIONS PAGE b- OF
VENT CAP
`1"C.L VENT PIPE frT.
WEATHER PROOF P.PPROVED LOCKING MANHOLE
10' FROM DOOR, JU►ICTIOW BOX COVER WITH WARNING LABEL
WINDOW OR FRESH I2�MIU. 1
AIR INTAKE �
GRADE 1
� � �. le•Mlu.
COIJDUIT
IML-ET , PROVIDE —
. �7 AIRTIG1iT SEAL 1 I
1 � I�
APPROVED JOI A Tank construction shall comply I I APPROVED JOINTS
with COMM 83.15 and COMM 83.20 i 111
ALARIA
. I I
I I O N
_ C 1 I
LLLV. 15 FT PUMP ---� "�
NOTtT'- ,� OFF
Pvr'1P ot �o raE- D
fv o Luti.1 �z ��
L`'L._ C2 3 - 25 _ _ � oI Z_ Op' COMCRETE BLOCK
RISER EXIT PERMITTED ONLY IF TANK MAMUFACTURER HAS SUCH APPROVAL 3" ADPf2oVED • gR00i
SPEC,IFICATIOMS
DOSE • T'1 l>LJ ��tt21�1 !� \Z -s 3 T ' L/ - 3
TA1�lK� MAIJUFACTURCR. NUMBER OF DOSES: PER DAy
TANK 51ZE: - ISO GALLONS DOSE VOLUME Z
• S.S. �. p ,S ` &S INCLUDING 6ACKFLOW: 11 � `� GALLONS
ALARM . _/!lA4UFACTUItr -
AODEL NUMBER: 1 Ot lbw - CAPACITIES: A= I S 11-Z I U CHE5OR :0 Z_ GALLOWS --
SWITCH TYPE: 8= Z INCHFSOR 3q GOLLOL15
PILIMP 1AAMUFACTURCR: 7-Z to -LIZ. '3 • C i2'IIJCHE5 OR W" IZD GALLOIJS
MODEL IJUMBER: D- IS- I14CHES C 2311 GALLONS
SWITCH TYPE: ��� ►JOTS: PUMP AND ALAR11 IPtE TO DC`
MIWIMUM DISCHARGE RATE GPM INSTALLED 0!J SEPARATE CIRCUITS
VERTICAL DIFFERENCE OETWEEM PUMP OFF AJJO�DISTIOBUTIOM PIPE.. FEET
+ MINIMUM NETWORK SUPPLY PRESSURE .... .. 3 ` ZS FEET
+ �s FEET OF FORCE MAIN X S- 0 Z F 5�/. o ,, FRiCTI0IJ FACTOR. 3 2-2 FEET
r
TOTAL D!IMAMIC HEAD = FEET
As per manufacturer la.S gal /in. Liquid depth
'4 13/16 7 7/16
HEAD CAPACITY CURVE MODELS 137/139 L-- 6 1/8
4 MODELS 137/139 Ft. Meters Gal. Ltrs. 0
e ( 5 1.52 93 352 0 0 4 13/16
25 10 3.05 79 299 1
zo 15 4.57 64 242 0
6 0
L'l l7 20 6.10 36 136 0 1 1/2" - 11 1/2 NPT
r 1 s I 25 7.62 8 30
4 137139 30 9.14 - -
0 10 Lock Valve: 26 ft.
2
5
5 ,
13
0
• U.S. GALLONS 10 20 30 40 50 50 70 80 =1 110
LITERS 80 160 240 320 400 1 I 4
0 FLOW PER MINUTE
' 1 SK373
009921
CONSULT FACTORY FOR SPECIAL APPLICATIONS
• Three phase pumps are available in 200/208V, 230V or 460V. • Variable level control switches are available for controlling single and three
• Electrical alternators, for duplex systems, are available and supplied with phase systems.
an alarm. • Double piggyback variable level float switches are available for variable
• Mechanical alternators, for duplex systems, are available with or without level long cycle controls.
alarm switches. • Over 130 (54 °C.) special quotation required.
• Combination starters are available for 3 phase pumps. • Refer to FM0806 for 200 F. applications.
• Control alarm systems are available for 1 phase pumps.
i
137 Series - 47 lbs. 139 Series - 51 lbs. SELECTION GUIDE
Single Seal Control Selection Listl as 1. Integral float operated 2 pole mechanical switch, no external control required.
Model V1 155 Ph Mode Amps Simplex Duplex CSA UL
M737/139 t Auto 10.7 7 or 1 & 8 - Y Y 2. Single piggyback variable level float switch or double piggyback variable level
N137/139 1 Nan 10.7 2 or 2 & 7 3 or 5 & 6 Y Y float switch. Refer to FM0447.
SN137 1 Auto 10.7 - - Y Y 3. Mechanical aftemator M - Pak 10 - 0072 or 10 - 0075. Refer to FMO495
of 37/139 1 Auto 5.8 1 or 1 &8 - Y Y.
E137/139 230 1 Non 5.8 2 or 2& 7 3 or 5& 6 Y 4. Combination Starter. Refer to FM0514. Y
• H137/139 200.208 1 Auto 6.2 1 & 8 Y N 5. See FM0712 for correct model of Electrical Alternator E -Pak.
1137/139 200.208 1 Non 62 2&7 3 or 5 & 6 1 Y I N 1 6. Variable level control switch 10 -0225 used as a control activator, specify duplex
J137/139 200 208 3 Non 2.6 2&4 3&4 or 5&6 Y Y (3) or ( 4) float system.
F137/139 230 3 Non 2.6 2&4 3&4 or 5&6 Y Y
G137 460 3 Non 1.4 2 &4 3&4 or 5&6 N N 7. Four (4) hole J junction box, forwatertight connection for hardwired simplex
G139 460 3 Non 1.4 2&4 3&4 or 5 &6 N N operation, 10 - 0002.
• No molded plug ~Single piggyback switch included, 8. Two (2) hole J -Pak, for Watertight hardwired Pconnection or splice, 10 -0003.
Pumps must be operated in upright position.
phase units CAUTION
Three
p require a control switch to operate an external magnetic or combination starter. All installation of controls, protection devices and wiring should be done by
a qualified licensed electrician. All electrical and safety codes should be
PiggybadcVariable L
For information on Level Zoeller products refer t Switches, FM0477: Elec tr, catalog a icalAltema t Combination starter, F ltema- followed including the most recent National
Electric Code (NEC) and the
evelFlatrtor ,FM0486;MechanicalAltema- Occupational Safety and Health Act (OSHA).
tor, FM0495; Alarm Package, FM0732; and Sump/Sewage Basins, FM0487.
RESERVE POWERED DESIGN
For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump.
MAIL TO. P.O. BOX 16,347
rzr Louisville, KY 40256-0347 Manufacturersof..
SHIP TO. 3649 Cane Run Road
Louisville, KY 40211.1961 Q�aurr Par+as SINCE /939
PUMP !O. (502) 778 - 2731.1(800) 926 -PUMP
FAX(502)774 -3624
Wiscbpsin Department of Commerce SOIL EVALUATION REPORT Page l of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County ST _ 1.x
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 0 S O— 1 0
Please print all information. _ Reviewed by Date
Personal information you provide may be used for secondary pu e _ a y �ar,g4 t1) (m)).
Property Owner C ; k'l ocation
B U�l 1Z = Rill ! �� ' 1/4 S W 1 /4 S 2 -? T Z� N R 1 S E (o W
Mai i Lot # k # Subd. Name or CSM#
S1 0S � - ,J r
Cl ty State Zip Code Ph umber [] City ^
� Dw� ! t ST CR ❑ ty/ r. ❑ Village ®Town Nearest Road
V C0 z (� L` a � �� Av S t= t � � s Tr1 � Z
New Construction Use: @ Residential / Number of ,d(o. s'�--* - ' derived design flow rate L4 SO GPD
❑ Replacement ❑ Public or commercial - Dees( e*
Parent material C� L f't t ) o 'T )1.t Flood Plain elevation if applicable N A R
General comments
and recommendations: I"1gUt�J� 1�)� (� l ` 4 . - )S A �p1S�12 \$U`1ZU'� 4` w�1^ -1 1,V 1•9 OF Sll v
F 71 Boring # ❑ Boring
® pit Ground surface elev. Q q • Z ft. Depth to limiting factor
- Z� Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz
in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
3 Z 3 _ b S `� 2 3� ��� � •s `t 2S l L 1 e-S b 1Z M-Pl- nlAj
-S
a Boring # ❑ Boring
® pit Ground surface elev. C1 ' • ft. Depth to limiting facto in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
o- g tio`2vL3
Z � —t4 l�`223�� Sl1 Z�Sbk �)- �S 1v� •5 -�
3 1 27 S`t231�
` 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) Sigpature CST Number
Arthur L. Wegerer EL - a oo-Z�II 220254
Address ' g e r e r Soil T e s t i n g & Design Service Date Evaluation Conducted Telephone Number
421 N. Hain St. River Falls, WI 54022 -Z — 715 -425 -0165
Property Owner "L) Parcel ID # 0 3 y 0 --� Page �- of 3
Boring # ❑ Boring
® pit Ground surface elev. 1 O 2 • ft. Depth to limiting factor
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft'
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
1 v -� 1o�R Utz - sL 1 �sbk � �S Z� . S
Z -lZ 1 D`�R 3/b 1 Z�'Sbh ln�t F- CS lU`� • S . Cal
3 1 z_i 8 ,.syfZ 3 �y — 1eSbk wt v�h 0- s 1vp ,
tip- 3- SLIZ ,l u '1�1 '>.S�iRSIS L O�, Y>7 - Pl- � • 3 . S
❑ Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD 1ft
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
F-1 Boring # Boring ❑
El Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft'
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
• Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608- 264 -8777.
SBD -8330 (R.6100)
PLOT PLAN Page of
✓Scale
� Q
a
tSL LOZ. �
0 1
s 13 • _`�
O I
28'
n
01\.1 Q I - )(SH, 31 w /Lfm.
d, 8 -2 X4715- 425 -0165 220254
CST Signature Date Telephone No. CST No. Job PTO.
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page l of 3
Division of safety and Buildings
in accordance with Comm 85, Wis. Adm. Code _
County S ��W lx
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 03 f _ 1 SO— 1
Please print all information. Reviewed by 7 Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner C WC2 -L� S t"1 � Z) U L J Property Location
Gov- -hot Mw 1/4 SW1/4 S I T ll� N R l S E (o�W
Mailing Address Lot # Block # Subd. Name or CSM#
City State Zip Code Phone Number .
��D kJ! � ( ) City Village Town Nearest Road
kQ t S y W Z -) l S b � V 2$ Sb S p 1ZL Al S � V S�'> } `Z. '�
[� New Construction Use: ® Residential / Number of bedrooms Code derived design flow rate Lt S (Z) GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material S l_PT� L 4 -7tLk Flood Plain elevation if applicable {v A ft.
General comments
and recommendations: Ml>v1� Wf 6 l ��s - tAS1"1216vn(YJ CZLL 1,Jlk -/ ,7A, 1. ' OF= SP-A
Boring # ❑ Boring
Q pit Ground surface elev. a • 2 ft Depth to limiting factor Z- 3 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
Z
IT
) - l0`2IZ 3 L b - s i 1 Z' S�k
3 Z3_ 6 S`�23L �t� �•S�irzSL L t0,Sbk mfr ew ,y .b
Boring # ❑ Boring 6 "
® pit Ground surface elev. 1 ft. Depth to limiting factor A _ in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/11
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
o_ g Loy �z X11 Z` as Z yn F-& -Zq
M �4- cS 1v1 •S •�
lj Z7 3 S`G2 3L ti L O va h2 �>^ - -S
' 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) Sigpature CST Number
Arthur L. Wegerer OO - 220254
Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number
421 N. I•iain St. River Falls, WI 54022 `a- ZZ — O(3 715 -425 -0165
Bvli�Z= bES�d1N
Property Owner Parcel ID # 3 1 S ��l (� page of 3
Boring # ❑ Boring
® Pit Ground surface elev. l0 Z• ft. Depth to limiting factor 15S in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2
1 0 - � 10�-► R � Zz _ si,1 �s bk wl -F►- �S z �(' . S .
Z -12 1 D`tR 3/ b j Z� S bh 1+�1 y, cS 1U'P - S . 43
-3 1z -18 -2.x 3/ k vKV�c- e s lv� • �! , b
S tie 3! �p �.stiRS�B L yr� '�►- . 3 . S
Boring # ❑
F
g 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 /ftz
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
F-1 Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608- 264 -8777.
SBD•8330 (A.6N00)
• PLOT PLAN Page t> of �
Scale 1'= L) , ,) '
i Yom` P ^U;�` Lt.y�
I
I
� fo
I
X19.4,7 `= to
o � sn,� a •nn� t'rrz.�
I
OTV q
-LINK 2 - �_ 1 �� • y' - ' -.�' - t K 'l R .. N I K
8 -2 0 425 -0165 220254 O0- - a ,
CST Signature Date Telephone No. CST No. Job NO.
i \
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner[Buyer
Mailing Address ? /_ • f �
Property Address �� 3 ST H a �
(Vcrifrca(ioa required from Planning Department for new construction)
City/State Parcel Identification Number 6) -3 - lazy , � _A
LEGAL DIES
Property Lo ' n %,' /<, Sec. 2 T
_N RAW, Town of ;3 PR 1 NG - F/� 4b
Subdivision
Lot # -
CaMed SOxvey AUp # Volume
Warranty Deed 9 b 3 ys(3 Volume
Page #
SPCQhOuse 13 y a ( Lot Imes idea0able. firy ❑. no
SYSTf f3t�r4�y�rnWaNC
oa so OfY syztuuooaldnxaltiaitsp c iaaeto�aadlewastcamp rma anoe
can afroctthe , fpm 6= of the taaY ""T throw or ¢needed bq a iiccased What yua pat.into system
�� UEL tt:g�e m �e �riastedrspo�a .. - - _
p 7 ogres to submit to St QQjc ZjXft
Dqi i , eati5Cation fowa, dped by 8re own= and by a
is is �
ndedplumbaroritUc =sedpuarpa� �
ying(1)t eomaitewastewatcxduposdSystcrm.
p C000aditioa and/or (2) after inspection ad pmpping Y ), the scptictanlc•is less $raa M full of •sludge.
tbl- Ildarignrdbavc -:tad the above t and to maim�e
� � � Deparbmeat of Nanrcal Sewage disposal � � &c staadai�ds
� yaw ups sY m has hero mai�iaed anzst be y arcs; State of Wasoonsin- Ccr6. ,eafioa
da of tie lotion date. O0 � ntumcd to the St. t�vix.Coumty Zoning 0>ce within 30
X S'GH&UME Od
OF Arrrlc.ANT
DATE
0 W1�ER G`E!b CA2TON
I ( ) oatzfy that all statcmwts on this form are true to the best of my (our) knowledge. I (we) am (arc) the owncr(s) of
ve, by virtue of a warranty deod rtoordkd in Rcgistcr of Dodds Office.
C ) MIWM OF APPLICANT
DATE
t *t4�4� Amy iIIforIIlatiOa that is miS
may result is the sanitary permit being revoked by the Zoning Departmeat. 004440
sa Include wlth this apptiCAtloa: a stamped wu urty deed from the Register of Deeds office
IL copy of the certMod survey map if mi'ereacc is made in the wuraaty deed
.1564PAG 58 K A TH LEEN H
REGISTER Document Number
WARRANTY DEED ST. CROIXOCO., WI
RECEIVED FOR RECORD
Charles Dow, a/k/a Charles W. Dow and Mary L. Dow, husband 12 -01 -2000 11:50 AN
and wife, conveys and warrants to Ronald D. Debban and KA, WARRANTY DEED
Debban husband and wife, holding as survivorship marital EXEMPT R
property, the following described real estate in St. Croix County, CERT COPY FEE:
State of Wisconsin: COPY FEE:
TRANSFER FEE: 864.00
RECORDING FEE: 10.00
PAGES: 1
Recordina Area
Name and Return Address
Thomas A. McCormack
102010"' Ave.
PO Box 21
Baldwin, WI 54002
034- 1049 -50, 034 -1 50 -10,
034 - 1050 -20, 034 -10 0 -30
(Parcel ldentification er)
l
Southwest Quarter (SW %) of Section Twenty -two (22), Towns ' y -nine (29) No ange
Fifteen (15) West.
Exception to warranties: all easements and restrictions of record.
This is not homestead property. Dated this day of L , 2000.
,',�r
*Charles W. Dow
bl " -�
* *Mary L. D
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN
ST. CROIX COUNTY
Personally came before me this —A-6 day of ,
2000, the above named Charles Dow, a/k/ W. Dow
authenticated this day of and Mary L. Dow to me known to b e' prjo s) who
executed the foregoi g instrument o doge ,the
same. 'f
signature
P
type or print name signature A
TITLE: MEMBER STATE BAR OF WISCONSIN type or print name N t :
(if not, Notary Public St. Croix County, Wiscofti�if1�'' �..•;' ;
authorized by §706.06, Wis. Stats.) My commission is permanent. (if not.
, state dkpipppAA date:
THIS INSTRUMENT WAS DRAFTED BY
Thomas A. McCormack 'Names of persons signing In any capacity should be typed or
Baldwin, WI 54002 printed below their signatures.
Information professionals Company Fond du Lac, Wisconsin 8008552021