HomeMy WebLinkAbout034-1084-70-000
'v my Sanitary Permit Application ST. CROIX COUNTY WISCONSIN
'In accord with Chapert 12 St. Croix County Sanitary Ordinance PLANNING & ZONING DEPARTMENT
P r gj nformation you provide may be used f condary purposes ST. CROIX COUNTY GOVERNMENT CENTER
Q&A
G t [Privacy Law. S. 15.04(1)( 1101 Carmichael Road
1 Hudson, WI 54016-7710
C,QUNN (715)386-4680 Fax (715)386-4686
IDEVK&N complete plans for the system on pape7% x 11 inches in size.
County Sanitary Permit # ❑ Check if revision to pr app ication
0 ZZ41
1. Application Information - Please Print all Information Location:
Property Owner Name sfl~ 1/4 3-t01/4, Sec G~
2 G' 6C-. V-' . e J v T2/' N, R E (o W
Property Owner's Mailing Address Lot Number Block Number
Zq3 6 73 _ v~, A~~ f.~ Y D
City St a Zip Code Phone Numer Subdivision Name or CSM Number
W11 ]
s"/OZT v' l!l~e '0'r` aews Gy
II Type of Building: check one) Erity ❑Village Town of
1 or 2 Family Dwelling - No. of Bedrooms: ~~s c
[A) Public/Commercial (describe use): J I
State-owned Ne rest Roa
ype of Permit: (Check only one box on line A. Check box on line B if applicable)
Parcel Tax Number(s)
1.❑ Repair 2.W Reconnection 3.❑Non-plumbing ❑Rejuvenation
Sanitation -~D SF_7U_
Permit Number Date Issued
State Sanitary Permit was previously issued Z ?
ype of POWT System: (Check all that apply)
❑ Non-pressurized In-ground Mound a 24 in. suitable soil ❑ Mound s 24 in. suitable soil ❑ Mound A+0
❑ Sand Filter ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line
❑ Pressurized In-ground ❑ Holding Tank ❑ Single Pass ❑ Other
❑ At-grade ❑ Aerobic Treatment Unit ❑ Recirculating
Dispersal/Treatment Area Information:
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade
Required Proposed (Gals./day/sq.ft.) (Min./inch) Elevation
`(Std . yZ ((.o W'D 41SG 77, o Z
I. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic
New Existing Gallons Tanks Concrete structed glass
Tanks Ta.n/k~s
O00 C% ❑ ❑ ❑ ❑
O~ 0 ~i ❑ ❑ ❑ ❑
VII. Responsibility Statement
I, the undersigned, assume responsibility for repair/reconnenction/rejuvenation/installation of non-plumbing for the POWTS shown on the attached plans. A
license is not required for terralift repair or the installation of non-plumbing sanitation system.
MP/MPRS No. Business Phone Number
Plumber's Name (print) . Plumber's Signature no stamps):
Lo 0 6,C751--ri
Plumber's Address (Street, City, State, Zip Code) , Y2
III. County Use Only
Disapproved Sanitary Permit Fee Date Issued Issuing Agent Signature (No stamps)
[ Approved Owner Given Initial Adverse 7~ S✓ 6 ~v l / Gi?~~~~~
Determination L• S/ 7 (~~j
IX. Conditions of Approval/Reasons for Disapproval: 6U0 W ~ Z
~l~aPi~(z- 1, ~'ti
vvzt tK.4-r OA/' y 04/c a~tic~ !S 4r
Rev: 8/05
I
Pg ' of t
Private On-Site Wastewater Treatment System (POWTS)
PLOT PLAN: Draw the property with proposed POWTS.
(je f Z ~Jedr aorn
a' S IT,
I. C
CXiS/11 CA qoi
2530 L j S-C , 5yaz'7
` ~ea~ ~e v~s~r,%
MP 73 Ave,,
cl Cat f5 P Y C~ f,2i"Is 0 W! S, -
'7i - 69q -33''7 _~511 oz'7
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF EXISTING SEPTIC TANK(S)
This is to certify that I have inspected the existing septic and/or dose tank
presently serving the following residence:
(Street address) 29,3g" ~lel , located
at: S-/d 1/4, .sl) '/4, Section Z g TownE-(7 N, Range /S W,
Town of St. Croix County Wisconsin.
Upon inspecti n, I i fy that I have found the tank(s), to the best of my
knowledge, will conform to the requirements of Comm. 84.25, and it (they)
appear(s) to be functioning properly.
Most recent date of inspection or service
Did flow back occur from absorption system? Yes No
(if no, skip next line.)
Approximate volume or length of time: gallons minutes
Tank Capacity: /o O y
Construction: Prefab Concrete Steel Other
Manufacturer (if known): S
Age of Tank (if known):
Permit number (if known)
& 015 0
(Licensed Plumber Signature) (Print Name)
qS ' e _ 0 5'3
(Title) (License Number) MP/MPRS
/y -
(Date)
Form to be completed by licensed plumber (Dept of Commerce Chapter 5
and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin
Administrative Code)
Rev. 9/2008
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer Ife r--
U 4o'ral~ zA5/'r
Mailing Address .0z 7, "'41r"
' h- y/
Property Address
(Verification required from Planning & Zoning Department for new construction.)
City/State * Wi' C.~ . Parcel Identification Number 63
LEGAL DESCRIPTION / r
tionSGt~'/4 S '/4 Sec. g T p N R < J W Town of
Property Loca ! l~ .
Subdivision Plat: o -lay ,Lot #
Volume Page #
Warranty Deed # (before 2007)Volume , Page #
Spec house 0 yes)eno Lot lines identifiablekyes 0 no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
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. Owner maintenance
responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 of the St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master 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.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Safety And Professional Services 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 Planning & Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
I
Number of bedrooms 2-
z Z'4~~
SIG URE OF PPLICANT(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 04/12)
;onsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
N INSPECTION REPORT Sanitary Permit No:
(ATTAC~i 70 F`=RMIT) 453139 0
GENERAL INFORMATION f~, State Plan ID No.
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Rhodes, Marcia Springfield Township 034-1084-70-000
CST BM Elev: Insp. BM Elev: BM Description: / Section/Town/Range/Map No:
'0 <d • G« /u c,• c> I~osvk 40 1 28.29.15.557D
TANK INFORMATION ELEVATION DATA Z aE~1
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark Ps v, :
; e c~ ~o BUG
Tc~ .c c Q1ti~+~A j l c'o . c~
Dosing Alt. BM v
Aeration Bldg. Sewer 3 y )g l
Holding St/Ht Inlet
t...
1'3
TANK SETBACK INFORMATION St/Ht Outlet !S ci'~j
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom
Dosing _0r 76 - Z~ j c," Header/Man. i' 3 L Tl S 35-
Aeration Dist. Pipe cO' ?-7
S / 9q.77
Holding Bot. System
Z sus ~S.o~•
Final Grade
PUMP/SIP ON INFORMATION
Manufacturer 1 Demand G St Cover
/r tj `t rc: , k-C-' e--- GPM _ Z _K. 'z . ` 30 /c-c- Z:7-
Model Number
j Nr►. _3i3 2_~. ~ E
.1
TDH Lift Friction Loss System Head TDH Ft
6-1) yi 4oLA- V" 17p,
Forcemain Len th Dia. Dist. to well /
SOIL ABSORPTION SYSTEM 7Z 5• i~.st 1 C,-.l 3 Z3 75'.C~ 3
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. uid Depth
DIMENSIONS ~;11 r 1^" -
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION Type Of System: CHAMBER OR
F__ j 5 , y I , -kiNIT
Model
DISTRIBUTION SYSTEM (f I q
Header/Manifold Distribution Ix Hole Size Ix Hole Spacing Vent to Air Intake
f ' Pipe(s)
Length 4 Dia Length_ SL Dia z Spacing '7
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 rench Edges / i Topsoil ` Yes No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:-~~// U Inspection #2:
P to V I 1416~f/ 7,
Location: 2938 73th Ave Unknown (Unknown 28 T29N R1 5W) Plat of Hersey Lot 6,7,8 Parcel No: 28.29.15.557D
....J rte; L Z it cl~ S ClSt Z l(
~ L •1 S L~S U r
1.) Alt BM Description = S (-0 ~
2.) Bldg sewer length = Z L4 R ~
- amount of cover = A~. 3
Plan revision Required? Yes i No
Use other side for additional informat~
SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No.
r
I
r ~ w -a s1~ --9
Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162 C ~71t
iscons/in Madison, WI 537 1 F_U ~ k5ani taryPermit Number (to be filled in by Co.)
De artment of Commerce 45 3 /2 ( 7
Sanitary Permit Applic ion e Plan I.D. Numbe 93 0 . S . ►p. "
In accord with Comm 83.21, Wis. Adm. Code, personal info Lion f p&ov]de9 2004 G i 1O S S
may be used for secondary purposes Privacy Law, sl .04(1)(m) oject Address (if different than mailing address)
sz: rR wNT'
I. Application Information - Please Print All Information .7ONING OFFICE
Prope Owner's Na me Parcel k Lot k Block #
Property Owner's M ailing Address
Property Locatio~nj" )
City, State Zip Code Phone Number
clt~ Y .1 L -S / 0,2 ~ 1l (circle one)
U. Type of Building (check all that apply) T % N; R /3-_E or®
911 or 2 Family Dwelling - Number of Bedrooms j Subdivision Name
IM iNhild
❑ Public/Commercial - Describe Use - V. 3
11 State Owned - Describe Use ❑Ciry_❑Village owns
>i It
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. ❑ 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: eck
❑ Non -Pressurized In-Ground Mound > 24 in. of s ' e s ' ❑ Mound < 24 in. of suitable soil ❑ At-Grade ❑ Single Pass Sand Filter
❑ Constructed Wetland ❑ Pressurized In-Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter
❑ 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
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 ) /0 ,v ( C
Aerobic Treatment Unit
Dosing Chamber G,
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Na me (Print) 4um s Si g nature MPRS Number Business Phone Number
2e -
Plumber Ad re ss (Street, City, State, Zip Code
VIII. County/Department se Only
Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued ZiAA.-, Agent Signatu (No Stamps)
Surcharge Fee) C
El Owner Given Reason for Denial L ~ 1) J _
IX. Conditions o pprov al
SYSTEM OWNER:
1 Septic tank, effluent filter and
dispersal cell must all be serviced) maintained
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per, applicable code/ordinanf es
Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size
SBD-6398 (R. 01/03)
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Safety and Buildings
4003 N KINNEY COULEE RD 54601-1831
4 NIfisdonsin LA CR DOSSE D 6108) 264-8777
www.commerce.state.wi.us/sb
Department of Commerce www•wisconsin.gov
Jim Doyle, Governor
Cory L. Nettles, Secretary
October 27, 2003
CUST ID No.220355 ATTN: POWTS Inspector
BRADY DAHMS ZONING OFFICE
HALVERSON BROS ST CROIX COUNTY SPIA
1020 N BROADWAY 1101 CARMICHAEL RD
MENOMONIE WI 54751 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 10/27/2005 Identification Numbers
Transaction ID No. 934840
SITE: Site ID No. 667337
Shane & Cherri Peterson Please refer to both identification numbers,
2938 73RD Ave above, in all correspondence with the agency.
Town of Springfield, 54027
St Croix County
, S28, T29N, R15W
Lot: 6,7,8, Block: 10
FOR:
Description: Three Bedroom Mound System
Object Type: POWT System Regulated Object ID No.: 927567
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.
The following conditions shall be met during construction or installation and prior to occupancy or use:
General Approval Requirements:
• 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.01/01)
and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems
VERSION 2.0" SBD-10706-P (N.01101).
• 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.
Con(A
• 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 APP
DEPARTMENT
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the aN 0 SA"
requirements of Sec. 145.135 and 145.19, Wis. Stats.~
SEE CORRE
• 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
and open to inspection by authorized representatives of the Department, which may include local inspectors.
i
BRADY DAIAMS Page 2 10/27/03
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
c onstruction/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
Balance Due $ 0.00
fC~ Lf.t7 Gi 1.6 "'l
Charles L Bratz J
POWTS Reviewer II , Integrated Services WiSMART code: 7633
(608)789-7893 , 7:45 am - 4:30 pm Monday - Friday
cbratz@c ommerc e. state. w i. us
cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544
Henry F Grote , Certified Soil Testing
G
&~~O Shane & Cherri Peterson - Mound
S Transaction #
Construction Materials and Techniques
All materials must comply with Comm 84 and be installed in accordance with manufacturer's
specifications. Construction methods must comply with the following Component Manuals:
Mound, SBD-10691-P (01/01)
Pressure Distribution, SBD-10706-P (01/01)
Location: Lots 6, 7, 8; Block 10, Wilson plat
Section 28, T 29 N, R 15 W
Town: Springfield
County: St. Croix
Date: October 29, 2003
Owner: Shane & Cherri Peterson
Address: 293873rd Ave.
Wilson, WI 54027
Plumber: Brady Dahms
Signature:
License # MP 220355
Attachments: 6748-Plan Approval Application
SBD-8330
page 1: cover
2: design criteria & calculations
3: plot plan
4: system cross section "O"ad y
5: plan view, lateral detail ,DYED
6: pump tank exit detail OF COMMERCE
7: pump curve M"ZILL-DING
8: system management
SPONDENC
page 1 of 8
i x,
Design Criteria
Residential Wastewater Contaminant Load: 30 mg/L < BOD5 < 220 mg/L
Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L
Fecal Coliform > 10,000 cfu/100 mL
Fats, oils, grease < 30 mg/L
3 Bedrooms x 100 gal/bedroom/day x 1.5 4 S,° gallons/day hydraulic load
Design Calculations
In situ designed loading rate 0.4 gallons!sq ft per day
Depth to estimated high ground water in.
Depth to bedrock in.
Cross slope at system %
Force main length 3 " ft. of 2 in.
Manifold/header length y ft, of Z in.
Drain-back 5 S~ gallons
Lateral length 2 @ S 4 ft. of in.
Lateral elevation 9 °~•s~ ft. @ bottom of lateral
Lateral hole size in. @ 3 ° in. ( 3 ft.) Spacing
19 holes/lateral 3 S holes total
Lateral volume IT. 9 3 gallons
Total lateral discharge rate Z S• g gallons/minute @ ft. head
Network pressure compensation losses
Elevation difference
Friction loss n Z ft. @ gallons/minute
Total dynamic head ft.
Pump/sip} on 2-9 gpm @ Z ft. of head
14
S u t 3 0
Model #
Manufacturer
Dose volume ~3 4 gallons
Lift/siphon tank ~^D' Coy~ao Co"" gallons
Septic tank gallons
Effluent filter
Measurement pump on and off 5'.0 in.
Height alarm from tank bottom 6. ° in.
Reserve capacity _S 119. Z. gallons
specs.calcs.res
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SEPTIC E _ SPEC IFI'CATI0QS
DOSE '
TAW - .S MALWFACTURCR. 6o-,c, QU.MBCR OF DOSCS; PEk 0.~
TAWK SIZC : 1 ~O `GALLOWS DOSE VOLUME
ALARh MWdUFACTUKLR: IIJCLUOIWG OACKFLOW
NODCL WUAAD[R: CAPACITIES: A= 20'" WCHES OK 33r.2.
5wiTCH TJPIL: WCHES OR
PUMP *AAQUFACTURE Pt : UCNCS OR g;'$ ;,A.
MODEL LJUMOCR: ~4 e D~ 9 INuHE5 GR I~'g¢ 3A,_~
SWITCH TbPC; " DOTE: PUMP AUD ALARM ARC TO 6E
MIWIMUM DISCKAIt" RATC 2 , _G►M INSTALLED OW 5EPONRATE CiKC..
VORTICAL DIFFLRCWCE OCTWEEW PUINP OFF A►JO DISTRIDUTIOW PIPC.. FEET
+ Mi~jiKUM WETWORK SUPPLY PRESSURE Z'1 +Ob'-
+ 30 FE ET OF FORCE MAIM X 1~ 3 2 F/Ipp rtFKICTIO►J FACTOR. O' LL FEET S~
TOTAL D'IV AMIC HEAD - wo'%-} FLET
r ILITERWAL 0IMCWb10Wfb OF TAWK: LCW(v'fH 14.4 ;W DTH ~g11 iLIQUID DEPTH
8
~Av~ 6 oil.
s Engineering
Pump Characteristics Performance Data
► /Nbter uwi SUwwSA1+ , . •
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Hattapewer .SO
FDdt load ADSSre 6.0 r.._~
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Som$ w"jb q 3/4' 09v W GPM f{i's•) ~44 =6 29 23 12 0
Ush Wolglt 301ts.
rower Cad 15/3, SJ1W, * aaL Dimensional Data
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Materials of Construction Ip, r,.
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SAUS O FFKIS 1N Akl NUU01 CRIES AND COUItUS
J
' 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, Halverson Bros. Plumbing, 715-235-0651,
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 tank 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.
9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans.
10. If septic or pump tanks are no longer used, they must be properly abandoned.
11. If construction timing and weather could create a frozen infiltration system, weather-proofing with plastic sheeting and heavy mulching
may be required to maintain a functional system at start-up.
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.
T 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
ORIGINAL 1915
~r
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Certified Soil Testing
County Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. - $ .10
0 S 4--1o$~ o-Ov-
Please print all information. R iewed By ate °`r° Dat~j
Personal information you provide may used fo 75-w et 15.04 (1) (m)). ~T
I I
Property Owner Property Location
Peterson, Shane & Cherri Govt. Lot 19 19S 28 T 29 N R 15 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
2938 73rd Ave. 6, 7, 8 10 Wilson Plat
City Stat Zip Coeh~r?_ r City Village 16 Town Nearest Road
Wilson WI 54027 `-71577 Springfield 73Rd 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 8'x 57' rock cell mound on 97.9 contour as downslope edge of rock w/ at least 07 sand fill under
upslope edge
are F<-s
Boring # Boring u
❑
16 Pit Ground Surface elev. 97.5 ft. Depth to limiting factor 28 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 0-9 10YR 3/2 - sil 2 m gr ds cs 1f/m .5 .8 (r,
2 9-16 10YR 4/3 - sil 2 f sbk ds cs I m .5 .8
3 16-28 10YR 4/4 - sil 2 m sbk dsh cs if .5 .8
4 28-30 10YR 4/4 f2d 7.5YR 5/8,5/3 sil 2 m sbk dsh cs if .5 .8 -
5 30-36 7.5YR 4/6 - sl 0 m mvfr cs - .3 .5 Z
6 36-42 7.5YR 4/6 - sl 0 m dvh cs 0 0
7 42-56 10YR 8/1 - fs 0 sg dl cs - .5 .9 S'
a Boring # Boring
Pit Ground Surface elev. 97.5 ft. Depth to limiting factor 28 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP5-W
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 -Eff#2
8 56-78 10YR 8/1 - fs 0 m dh - 0 0
horizon 6 is weakly cemented, generally resistant to penetration as is horizon 8; both are effective BR
Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mgt
CST Name (Please Print) Signature: CST Number
Henry F. Grote ` --W ~222774
Address Certified Soil Testing Date Evaluation Conducted Telephone Number
E. 4366 353rd Ave., Menomonie, WI 54751 8/8/2003 715-233-0398
i
Property Owner Peterson, Shane & Cherri Parcel ID # Page .2 of -3
,
a Boring # Ji Boring
Nj Pit Ground Surface elev. 97.9 ft. Depth to limiting factor 36 Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QPDjft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2
1 0-10 10YR 3/2 - sit 2 f-m sbk mvfr cs 1f/m .5 .8
2 10-36 10YR 4/3 - sit 2 m sbk mfr cs if .5 .8 (r,
3 36-52 7.5YR 4/6 f2p 7.5YR 5/8,5/3 sl 0 m mfr cs if .3 .5
4 52-75 10YR 4/4 _ Is/s 0 sg ml cs - .7 1.2
5 75-80 10YR 8/1 - fs 0 sg ml - - 5 9
37 Boring # Boring
4!', Pit Ground Surface elev. 97.4 ft. Depth to limiting factor 28 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 0-11 10YR 3/2 - sit 3 m gr ds cs 1f/m .5 .8-
2 11-28 10YR 4/3 sit 2 f-m sbk dsh cs if .5 .8
3 28-36 10YR 4/4 f2p 7.5YR 5/8,5/3 sit 0 m dh cs 1 m 0 ! .2 -
4 36-43 7.5YR 4/6 Is 0 sg ml gs 1M .7 1.2
5 43-61 7.5YR 4/6 - s 0 sg ml as - .7 1.2
6 61-77 10YR 8/1 - fs 0 m dh - 0 0
horizon 2 has common gy si coats on peds; horizon 6 is generally resistant to penetration, effective BR
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
I
I
i
' Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS 130 mg/L and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SBD-8330 (R.07/00) Certified Soil Testing
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• STATE BAR OF WISCONSIN FORMI 1 - 19 s 4 ? KATHLEEN H. WALSH
REGISTER OF DEEDS
WARRANTY DEDD ST. CROIX CO., MI
Document Number RECEIVED FOR RECORD
This Deed, made between Shane D. Peterson and Cherri Peterson, 10/07/2003 1 t : 30AM
husband and wife,
WARRANTY DEED
EXEMPT #
Grantor, and Marcia Rhodes, a single person, REC FEE : 11.00
TRANS FEE: 180.00
COPY FEE:
CC FEE:
PAGES: 1
Grantee.
Grantor, for a valuable consideration, conveys to Grantee the
following described real estate in St. Croix County, State of
Wisconsin (The "Property"):
Recor in Area
Name and Return Address
Lots 6, 7 and 8, Block 10, Original Plat of Village of Hersey, St. Croix County, W CREDIT UNION
Wisconsin. 86 0 0 Cedar SIN ar Street - P.O. Box 136
Baldwin, WI 54002 ` n
034-1084-70,034-1084-80,034-1084-90
Parcel Identification Number (PIN)
This is homestead property.
(is) (is not)
Together with all appurtenant rights, title and interests.
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except
easements and encumbrances of record.
Dated this day of October 2003
« . Shane D. Peterson
~~~nk L IrlYS'~~
•Cherri Peterson
AUTHENTICATION ACKNOWLEDGMENT
STATE OF WISCONSIN )
Signature(s) ) ss.
St. Croix County, ) ~r
Personally came before me this -Af-_ day of
authenticated this day of October, 2003 the above named
Shane D. Peterson ark4& Qlwy*JVIgteraon C%A
TITLE: MEMBER STATE BAR OF WISCONSIN 1
to me known to a sonl~eYect~ed the foregoing
(If not i ent and a T edge th • j
authorized by § 706.06, Wis. Slats.) t L -
THIS INSTRUMENT WAS DRAFTED BY « • •
James H. Krave, Attorney at Law
Glenwood City, WI 54013-0304 Notary Public, State of StA1
(Signatures may be authenticated or acknowledged. Both are not My Commission is permanent. (If not, state expiration date:
necessary.) C3 -
.Names of persons signing in any capacity should be typed or printed below their signatures
WARRANTY DEED STATE BAR Or WISCONSIN
FORM Na 1 - va
INFORMATION PROFESSIONALS COMPANY FOND DU LAC. WI 200.65S.2021
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Parcel 034-1084-90-025 07/10/2008 09:16 AM
PAGE I OF 1
Alt. Parcel 28.29.15.557E-10 034 - TOWN OF SPRINGFIELD
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - RHODES, MARCIA
MARCIA RHODES
2938 73RD AVE
WILSON WI 54027
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 2936 73RD AVE
SC 2198 GLENWOOD CITY
SP 1700 WITC
SP 7070 SPRINGFIELD SAN DIST #1
Legal Description: Acres: 0.000 Plat: 01 -055-HERSEY VILLAGE& LANDING LOTS 034-188
SEC 28 T29N R1 5W LOTS 8 BLK 10 VIL Block/Condo Bldg:
HERSEY ALSO PT OF ABANDONED 294TH ST
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
28-29N-15W
Notes: Parcel History:
Date Doc # Vol/Page Type
10/15/2003 743686 2435/581 MISC
10/07/2003 742791 2430/147 WD
1020/188 QC
743/394
2008 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 06/15/2007
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.000 2,000 13,550 15,550 NO
Totals for 2008:
General Property 0.000 2,000 13,550 15,550
Woodland 0.000 0 0
Totals for 2007:
General Property 0.000 2,000 13,550 15,550
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch 115
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
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