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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) 1 V-i 00 o ( j~'~ d o~ N G' P rr 06 r t P r r' t ' Z p 9 d~ r o r r r_~ pp r ff"y 10 4-1 ~ N f p t Lei r- O A .P p A f V, D V3 C4 tv ol~l c 1 v g 3 W N 7, Q i i 4-1 p ~ F P ~ N N 1 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 Page of g N rv C~ DI j + Rl- o ~ r1' E-1 3 ~.P w t C. d CA M j J t^ J ~ ~ d I + o d -.f QS ~o ~ fl" s M C'~ o s > J 1 tl I \J v 1 J ~ y o 9o j u ej -N s u i ~ r^ f j ty N ~ 4 Pt L~IL Ow 3 ~ Z. V- `Zs 6 4(O o v It .Q %146-4 1 0 0 nn q9•a ~ 1 ' 1 h i,.k*t o A s S- 2S• b', r °I c s~ o yet doc r r o i 'f . O i VVV i i.p• p C> • 4` ;P,4 c- o`. t&.rv.~-t... N c ~•1 I, ~~►z Pvc. s~, 40 1 ` KV``h N~1 .••rI }~~r b..~ ~ Cr.~yy }p CiK~ ~MO~. 42C JJJ QvL S`~ g-o 4b QR a Z ~oQc~ 1"~ R w ' ~ k t'~" L'~C' Ca WEATHEaPt?OrJF N .nJ CT 10 N LO.CKI►JG~GOVfiR ~ QWGK 0«CDUVACT--1 Ka.Ct 1z 4" 7777777777777rr77,777,~,;'77,,.77 171177'11'7 DIP6 3' Pvc no ND►bTuAB-ED Sol L. 24" I.n, ~I G" 40 v~ GLE MAl1u k3.~. wc'~ P I 20,x., HUa j'A. ~aovto A I L c 4 SKET 30lR'J W F L E, AL ' 3' ow-c G D LPG d i uK.'u;c ~.r 10 ?4-% CA rj Elev. 2,4 :h Owt'1.a- S•O `t 3 0 ocF PwyP COwr.R~c ~LGv. bc0CK CC 2 . o 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+ , . • Aalaemtit Fi{edeh SNEFAOA{ ~ ~ I ~ Hattapewer .SO FDdt load ADSSre 6.0 r.._~ slw~ee r.{e t+ s R.►JA ISO i Yak lls ! Hato GO I I i i a0 SI lettlpeniwe 140'f AilWu+t w~hus.u,A D L NENIA Desife A uws/S«sr D s iruss{otlee 43eas A 0iackar She 1-1 /2' MR (Slow Total NOW OWL 4 i 12 14 ZO 24 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 a •w •tn 1. Y Awrone w irldws. Materials of Construction Ip, r,. Healli SMWn: S1W ~ wiy 11n'mfk my •.1~ 3. Dal kr sanoua+w perm ubrtt CIA DWKtrk Of mks WAW a,+r c.~oe eatMen Melot Hea Coot iron v►1 s. al/o11 Iws1 aWsew co Cost keg 4. we MWV4 60 * it wok. W40M a m prlhwl 0ed 1140 Sid* $1W Syedtmiao.fttia+l e1S1Ce Mlesior" SW Foul: WW@/Cmmk SAafi Soal saw bdrt Aoorked steel mss Iw w F * c3a1) (An Intl Skm gzJ z -•Y~ tiw b~ Lower kw* YAO Rsw tall godn 1911M F1oto fir s as s~•vD (161 ►u~6~ loos Fagiooorai 1bnN W* Fa:tetNtl Stdeless Steel LOO ill C 1999 H dromclic' Pvmps, Ashlgrna, Cho AP R• Is Amewd. I91- HYDRQMATIC " - Yon, Aul6orak lord (NwHb ftr - ImEff2mmm 1840 8anty Rod AsWaed, C6 44105 Col: 414.284.9042 hr, 414.211.4017 w1b W. wws+.p1Owrpvwp.CDm vzw'~ 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 3 `i od rt 0 1 -b- N3 ,n 'r CA a o- P i u m , Y o rte. to i p d r OS ~O d S to 1 JO f 1 k ; J ~ Z - n 1 n o C~ C~ > N J 9 d r^ M' N ~ 11/13/03 Tits] 12:18 FAX 715 j `jsg VAVJ. W~ool k BT CROW[ couw" SEMC TAIL &tAngrMN AmM AND OWNiWAM CBItTIIt'lCAT1ON FO M owmes"w bbift Add" Pmptty Addnm (Vaasoadoa 9040b d fi Phmirs Defa bomt fm caw tyisttlaco? ,~--1'enoel Ideo~Sicatioa rim y -ll - )y Ptopcdty I ow dim h r:: <c.~ y4, sec. _ T '~'a~►n o~ ~n ~;'~,L~~ cads" sumy map # vohmlO _ .Pages r_ W"T mty Deed # _ Vole 2 3o Tags # spec hmn O yes fa an Lot lime i mffablo 12 y4m O no =9SM GfYaw epdaWatammAdsemkiniispm=Mm ftoWmahUmm aq~aiw dpamtipiep vat Ats Mrde hale m9 tbaa Pans a meow. if aMei "by a S mmd l I . DPW 7w pw iab tbs sytdm am Wk l the 000m eMs aapfo teak as is aeatmw atada raft i s&* dhgmd g a TAW pmpwW awm apnea to mbmit to SL Ock Zaa*e Dapemtaet a eaati&Wm farm. tipM by *a owaae ad by s tttaalttcpipnbayjoutatapattnpiaatbea:tteofai~edplombat aRaliowteapnmper mst(1)At:apt-siAawatee aft apadvilooto is iQpiapes vpa~ oosdt'tioa at►d/atr a~tx iaapeodos aawt ptet~igg C~~+tY)•~ aeptUt: mac b lea tam y/3 6ai1 eBslaa~ tm~ ~ ~ttsieltod attrs to~~ ttbaiae sagnletateata aed aDtea p atola0m tbtr ptttaMs ~ dlapatal ~ ~ tta atr,adatda teRlballt. imaiq, apt saalty tba Dgtaafaaatttatt7amwaoe ad dta D~atZlaod ltoaoe.oet.'.tiltt of Witoaoaio. ~mtl~ia~ta Us6et =dft=dmtbcc=M wd=d=w=dswOnSLCYviv CA=wMm t60Mot:w101 20 6" ohm SIMUM tS CW APPLICANT DATB f D 3 i ) esedty d%W as etk Bomar ata trot w *o best of my (apt;) Imawloap. I (we) am (as) dw 9vA%m a) Of tlta • woammy deed zeootded a Raga W Doody OMm 60 Or APPMAM TB Amy iadba wd= drat is misxpP-,meam l► ses ae is the wnit.typettait beYS aerdcs4 by the T~ooittd Dopsa<taaat. " Ud "VIM &M ttpptieadm ai $%WP d W==W decd Bacot dw RrslAu ad Deady vas 11 aapy of *0 as MW SoMay map it tteftea mods: m In wWW" dead • _ U ~ 3 O p '7427'=31 • 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 I \ ~1 ~ ~ sr ~se 9 o •n I 7rr l{!< r b ~ . Teo, -7 7,9 V-7 'J ^ l\ ay CID Ilk rr 60 Qs - b ~ ~ r •1'i ~ \ ~ R' - v ~ ~ t7 c-- _ f0 P 0 I I • a• ~ ~ v1 a a \ ' !n \(a1 o ~ l \ ~r.~ frn • o ' 14 N r , a. 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O p po e~-r- ~(►+r~~ 3 O N l~► 7 N j O C to =3 U) (A - C W O 'r3 V W a O D w m a w 3 W a 3 o con ° < j~~ CD CD z C) L O A -4 C ( N NO CD N' C7 r N (D 0 4a o "a M CL 0 0 0 z 0 o z * * * o aQ s C C' N N y Q0 N 3 a T'a G 07 0 !►i N M D N O7 d 0 O (D <D D N N N 3 d CD m 3 N z c D D o v O O CD N ~ • a N O o c 3 w o a 3 m z j N N o c rp z fD N p 0 n a p z O ' St CD ,n 3 O (n O O ~ co W a z o 'a N '6 A 0 w N n _ m O O N C N d CD ~^p a) Q• C 7 0 'D fp G y - O SU C ~~0 0`0 o c. o~;N OD y' fD O, O N x 74 cn a) a 4 C N po 09 , O t ~nom' a OL 6 0 °A c o ((D 0 0 O 0 3 o f o - en CD ° m (D 3 SN ti O O O tv o CD CD o 0 cp a O m CD a cfl O O C:) CD O L ti v 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 0 4) o C7 o 10 9 53 "0 7! 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