Loading...
HomeMy WebLinkAbout038-1190-60-000 ',MIScros*.DepartmieMof 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. SA 5.04 (1)(m)I. 383942 Permit Holder Name: ❑ City ❑ Villa ❑ Town of: State Plan ID No.: W Ison, Bert Star Prairie Township CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: .o f I I ao . o' Pv C, r Cs• bv,� I 038 - 1190 -60 -000 TANK INFORMATION ELEVATION DATA 13 , 38• ( Q'. 9 - 1 '7 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ap Benchmark fp".3 65 .0 Dosing A It. BM t .s ' Aeration Bldg. Sewer , �U b •s Holding St /Ht Inlet (� 9� • IS' TANK SETBACK INFORMATION St/ Ht Outlet I.4 f '75 TANKTO P/L WELL BLDG. vent to ROAD Dt Inlet Air Intake Septic >� -�jj� (3 ` NA Dt Bottom �— Dosing NA Header / Man. ;q Aeration NA Dist. Pipe T o� 15-.30 Holding Bot. System or w PUMP/ SIPHON INFORMATION Final Grade S Cover Man durer Demand los o (• 3 Model Num r GpFA S TDH Li riction System H Ft Forcemain Length Towel SOIL ABSORPTION SYSTEM ENC Wi dth r Lent t N Trenches PIT No.Of Pits Inside Dia. Liquid Depth 2 IMNI N 1 EN LEACHING Manu adurer: SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM ,, INFORMATION Type O / /� _ CHAMBER a Num r: System: Cb w - `Ko OR UNIT t DISTRIBUTION SYSTEM U�9f8/2- ) Header/ Mani old q Distribution P x Ho Spacing Vent To Air Intake Lengt Q� Dia. Length Dia. �g Spacin SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over tt 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, #1: t,} /19 01 Inspection #2: ` t Location: 1345 214th Avenue, New Richmond, WI 54017 (NE 1/4 SW 1/413 T31N R18W) - 133118977 Northgate -Lot 28 , �1 1.) Alt BM Description = �' � 0, ,;_ a.�� - QX.3w 2.) Bldg sewer length= 13 t7 , p V n - amount of cover = 3(0 -t- . .es' - Lx S4 3 ' - fi ��2 k- ��-°"" ` �. Plan revision required? ❑ Yes N1 No O l9 o d $ - �y) UU other side for y dc�' naI information. L sj ` t " SBD 6 0 (R.3/97) �ii Date Inspedoi s Signature Cert No i O p --7 1d 1 -i - vim ' 1 3 2 14 In Permit Application Safety & Buildings Division In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this,4p 1191 15 Box 7302 Ivi sconsin Personal information you provide may be used for seconld ,6rpost Madison, WI 53707 -7302 Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not � state owned.) Attach complete plans (to the county copy only) for th 'system, or( Paper ,not less than 8 - 1/2 x 11 inches in size. County State Sanitary Permit Number RiChe if revision to previous application StAte Plan I. D. Number I. Application Information - Please Print all Information - L cation: Property Owner Name % T Pr perry Location ' 4 s© /V1 o,,,t,6 rJ= E 1/4 54611 14, S / _ 3 T N, R & (or Property Owner's Mailing Address / Lot Number Block Number ck City, STate Zip Code TPh Number Subdivision Name or CSM Number — – T 5 �" 715 > -5 — 113 45 II. Type of Building: (check one) ❑ city ®' 1 or 2 Family Dwelling -No. of Bedrooms : ❑ Village ❑Public /Commercial (describe use):_ Town of ❑ State - Owned _nn /n Nearest Road 7N U� 09 LY t X, -: t c.kX h Parcel Tax umber(s III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) [ 11 - 7 A) 1. 53 New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System B) Permit Number Date Issued A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) - (tip 19 Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At - grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) r Elevation Y50 325— J / O 6 VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks ❑ ❑ ❑ ❑ d'0 ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on th hed plans. Plumber's Name (print) Pl be 's Signature (no s�s): QDPRS N Business Phone Number T Plum er's Address (Street, City, State, Zip Code) 5Y6 c 2` IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued s ing Agent Sig re (No stamps) 'Approved ❑ Owner Given Initial Adverse Surcharge Fee) Determination X. Conditions of Approval /Reasons for Disapproval: - .{ 'Zs — Is u rP�t`S 19v\ �0 �Qxt t rw�n �o +rv�C S� Af �P,t�.` k A wu,v (> ► I X SBD -6398 (R. 07/00) f 1 { i l 1 N I i 1 1 { 1 ; 1 I 1 I i Ru oshO j I � '• i P o 1.. , 1 I //J i`L• E '- 2 { i A ! i I � � t : . • i I i - -� — , : • � t , i f ' i i ' I 1 s - -- -- -- ;..� �� - -- 1311 ; I , I , , it , , e . / r i c , ' r , IT , I , n R t r e 1 — t 1 + TF _._.. �... ._. _.t ... __ +4 i I I t i 1 R i 1 i : 7 i i , i S , } a a t , t a 111 , i R R $ t i 1 + i E i • 1 : i 1 _ I 1 f ; , I f N , : , R � 5 ; I � � f I 1 , i R R w f ` 1 1054 7 ML- EVALUATION REPoOr n Wisconsin Department of Commerce r41w� �J Page 1 of 3 Division of Safety and Buildings /in accordance with Comm tK Wrs P(*.. Code ' Tom Schmitt * Co ntol ?�, Attach complete site plan on paper no ess than 8' %x 1) Inches,i e. Plan must ._.St Croix include, but not limited to: vertical an rizontal reference poir ( direction andL �' `P to r i i percent slope, scale o d meets ores, _arrow, and location and distance to ne t ro8d: • � v , U C4 03$ - 1 90 60 -000 Please 1 infemati . pr►lt �l do ed By i D Personal information you provide may b�ia§k or secondary purposes ftvaey Law, s.15 04 (1) (m)) i S Property Owner ' ; Z �rv;r� , �h? 1CF P Perty Locatio , 3 . Wilson, Bert �i�_ ovt. Lot na 1/4 SW 1/4 S 13 T 31 NR 18 W Property Owner's Mailing Address w / Lot # Block # Subd. Name or CSM# 543 Homestead Trail °� _ _ ..? 28 na Northgate City State Zip Code Phone Number J City ,I Village Id Town Nearest Road Somerset I WI 1 540251 Star Prairie I 214Th Ave. Id New Construction Use: 16 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD j Replacement _] Public or commercial - Describe: Parent material Outwash Flood plain elevation, if applicable na General comments and recommendations: Suitable for a conventional system with a 0.7gpd /sqft rating. Possible system elevation ranges from 96.33' to 92.05'. Boring # - Boring Id Pit Ground Surface elev. 99.63 ft. Depth to limiting factor >154 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 1 0 - 16 10yr3/1 none I 2msbk mfr cs 1f .5 .8 2 16 -20 10yr4/4 none scl 1mpl mfr gw 1f .2 .3 3 20 -28 10yr4/4 none scl 2msbk mfr cw - - - - -- .4 .6 4 28 -32 10yr5/4 none Is 1 msbk mvfr cs - - - - -- .7 1.2 5 32 -154 10yr5/6 none cos Osg ml - - -- - - - - -- .7 1.6 'ts3•�i �� /o3-S�o Boring # =j Boring 0 Pit Ground Surface elev. 100.08 ft. Depth to limiting factor >158 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fr in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 I *Eff#2 1 0 -15 10yr3/2 none I 2mgr mfr cs 1f .5 .8 2 15 -21 10yr3/4 none I 2msbk mfr gw 1f .5 .8 3 21 -29 10yr4/4 none sl 2msbk mfr gw - - - - -- .5 .9 4 29-40 10yr5/4 none Is 1 msbk mvfr gw - - - -- .7 1.2 5 40 -158 10yr5/6 none cos Osg ml - - -- - - - - -- .7 1.6 C& 131 ' Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L ` Effluent #2 = BOD f mg/L and TSS < 30 mg /L CST Name (Please Print) Signalu CST Number Thomas J. Schmitt 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 586 Valley View Trail, Somerset, WI 54025 5/2/01 715 -549 -6651 Property Owner Wilson, Bert Parcel ID # 038 - 1190 -60 -000 Page 2 of 3 3] Boring # Boring I M Pit Ground Surface elev. 99.58 ft. Depth to limiting factor >155 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -19 10yr3/1 none I 2msbk mfr cs 1f .5 .8 2 19 -27 10yr4/4 none scl 2msbk mfr gw 1f .4 .6 3 27 -39 10yr5/4 none Is 1 msbk mvfr gw - - - - -- .7 1.2 4 39 -155 10yr5/6 none ms Osg ml - - -- - - - - -- .7 1.2 F-1 Boring # - j Boring f Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # __-j 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 GP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg /L * Effluent #2 = BOD S _ < 30 m g an /L d TSS < 30 m L - _ The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or marl m.t —;ol ;n — aIt—*. f rmot -1.— —t—f thA AA—fm —t of AOR_7(A -1 I G1 — T F0R- 7FA_R777 i y Alt ajg y0 9 1 I -74 o 4,T oyo -, 0 78 #,D Y J I 7 o ' l svx5 kll � e r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Co Croix Safer and Buntings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanita92jt1No.: Personal information you provice may be used for secondary purposes [Privacy Law (1)(m)). ?�F�i� Wame: El cit 11 JJW 1491`116 otownS Ip State Plan ID No.: CST BM Elev.:- ffTT Insp. BM Elev.: BM Description: r arcel 6W 90-60-000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Alt. 13M Dosing Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Vent to ROAD Dt Inlet Air In Septic NA Dt Bottom Dosing NA Header/ Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION i Grade Manufacturer Demand Model Number GPM TDH Lift Friction I System TDH Ft Loss 1 H ead Forcemain Length Dia. Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth D IMENSIONS DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manuf SETBACK CHAMBER INFORMATION Type Of mod Number: System: L OR UNIT DISTRIBUTION SYSTEM Header/ Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. 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 q No i ns No /-CO MMENTS: (Include code discrepancies, persons present, etc.) Location: 1345 214th Avenue, New Richmond, WI 54017 (NE 1/4 SW 1/4 13 T31N R18W) - 133118977 Northgate -Lot 28 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision required? ❑ Yes ❑ No Use other side for additional information. F_ FF1 IJ SBD -6710 (R.3/97) Date Inspector's Signature Cert No. l r e � PT , I 2 ( Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave. N4.9cons, in See reverse side for instructions for completing this application PO Box 7302 Personal information you provide mayale -used fps ondary purposes Madison, WI 53707 -7302 Department of Commerce ) 7, (Submit completed form to county if not [Privacy Law, �. state owned. Attach complete plans to the county copy o (or the systemon E2Lt*6tPvs than 8 -1/2 x 11 inches in size. Coun State Sanitary Permit Number heck it�i to,�i o vio' lion State P lan I.D. Number 15t 2- I. Appli Information - P lease Print all Informat' y Location: Property Owner Name 1 2C�Q� -- Property Location .L .ST CPO t�U `.� 1/4 SWIM, S 13T ? ,N, R or Property Ownees Mailing Address I Lot Number Block Number OFFICE ANI C - 1 0 ne City, State Zip Code o T I Subdivision Name or CSM Number o 51 1J3 F6 H A II. Type of Building: (check one) ✓ ar, Isvt wx ❑ C i ty 0 1 or 2 Family Dwelling -No. of Bedrooms -3 �, _ p ( Villa • Public /Commercial (describe use):_ 11 19Town of • State - Owned 5 7A 0, 1 11A IR Nearest Road A a[ 7 (2 ) 3 X - 1�_ 4 dW S Parcel Tax Number(s) - III. T Ype of Permit: Check only one box on line A. Check box on line B if applicable) �J , 3l 1 A) I. New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) " ( ' RNon- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland • Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line • At-grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation y5_o 37-5 94r 0 5 .B VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks 0 o VIII. Responsibility Statement I, the undersigned, assume res onsibili or installation of the POWTS shown on the attached plans. Plumber's Name (print) Pl is Signature (nos s): RS No. Business Phone Number - Plumber's Address (Street, City, State, Zip Code) IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued I u'ng Agent Si ture (No stamps) 1Approved ❑Owner Given Initial Adverse Surarge F �- Determination Z . 7 X. Conditions of Approval /Reasons for Disapproval: l eis Gfl„� K WA.V P� OAA- 3r7 I 1 I I I I I � I i ; z y 1 4 � I I � I i I 1 � 1 I A oo F. r 2 I i I ; I _ I ; ; + i I LL ; l 1 I i i i � I I f i � t✓E�41'T � l �f � 1 I I • i r 3 I L I : I ' , : { 1 i � : -. - - - - - - - -- -- - ..Y.__.- I '-$} -P - - -- : F I ' 22I� J -- -- L- J-4-- i � � E i � i Z I 7 111t 1 . F - T 1 k A A I V 1 1 1- 1 TA -1. v 1 1 1 i A i � i r I , ! t � � ! i ( Wisconsin Deeartment of Industry SOIL AND SITE EVALUATION REPORT Page I of 3 Lab6r rod Hufnan Relations DivisOn of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 038 - 1055 -10 APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION R IE D X DATE g PROPERTY OWNER: PROPERTY LOCATION v Greenwood GOVT. LOT NE 1/4 SW 1/4,S 13 T 31 N,R 18 { (or) W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # I SUBD. NAME OR CSM # 1416 Third St. CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE DOWN NEAREST ROAD Hudson WI. 54016 ( ) [ New Construction Use [ x] Residential / Number of bedrooms 4 [ ] Addition to existing building j ] Replacement [ ) Public or commercial describe Code derived daily flow 600 g pd Recommended design loading rate • 7' bed, gpd /ft - 8 trench, gpd /ft Absorption area required 858 bed, ft2 750 trench, ft Maximum design loading rate • 7 , bed, gpd /ft - 8 trench, gpd /ft Recommended infiltration surface elevation(s) 96.05 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem KI S O U 12 S ❑ U [2 S❑ Ul �7 S❑ U E S ❑ U ❑ S O U 1 SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots G -7 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench '`' .. 1 ... 1 0 -8 10 r 3/3 none 1 2msbk mfr gw if .5I .6 2 8 - 10 r 4/4 none sicl lmsbk mfr 9W if .3 Ground 3 26 -84 7.5 r 4/4 none cos OSQ ml na na .8 elev. 99 ft. Depth to limiting factor +84" Remarks: Boring # 1 0 -11 10 r 3/3 none 1 2msbk mfr gw if .5 .6 . << 2 10yr 4/4 none sicl lmsbk mfr gw if .3 Ground 3 27 -84 7.5 r 4/4 none cos 0Sg ml na na . "1 .8 elev. 9 9.5 ft. y - Depth to limiting factor l +8411 NOV fq $ i �. COUNTY Remarks: ZONI CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 ` 1 3 '' > Address: 1554 200th. Av . New Richmo d WI 54017 Signature: C� Date: 11 - - CST Number: m02298 1 PROPERTYOWNER Greenwood Enter DESCRIPTION REPORT Page 2 of ` r3 PARCEL I.D. # 038 - 1055 -10 Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tw& <<. >.:.3< > °`,< 1 0 -11 10 r 3/3 2 11 -27 10 r 4/4 none sicl imsbk mfr 9w if .2 .3 Ground 3 .27-84 s 0scr ml na na .7 .8 elev. 9 9.8 ft. v Depth to limiting factor +84 �.►< Remarks: Boring # 1 0 -12 1 3 3 none 1 2msbk mfr w if .5 .6 4 >< 2 12 -27 10 r 4 4 none sici lmsbk mfr gw if .2 Ground 3 27 -84 7.5 r 4/4 none os osg ml na na .7 .8 elev. 9_q_9 — Depth to - limiting L factor Remarks: Boring # 1 0 -12 10yr 3/3 none 1 2msbk mfr yw if .5 5: .6 12 -28 10 r 4/4 none sicl lmsbk mfr gw if .2 .3 Ground 3 28 -84 7.5 r 4 4 none r osg ml na na .7 .8 elev. 9 9.7 ft. Depth to limiting �3 g factor Remarks: Boring # Ground elev. j ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) r r ~ STEEL'S SOIL SERVICE Gary L. Steel Greenwood Enterprises, Inc. 1554 200th Ave. CSTM2298 NE4SW4 S13- T31N - R18W New Richmond, WI 54017 MPRSW -3254 town of Star Prarie (715) 246 -6200 lot #28- NorthGate This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. N 1 =40' BM.= top of 1" pvc pipe C el. 100' Alt. BM.= top of 1" pvc pipe # el. 100.40 X is N ? v G aR k a/ 23' -121 � 41 Gary L. Steel 11 -2 -98 3 -06 -1995 8:02PM FROM P.6 r�Hwa.•.+e�.wrb,n ah nw.ra�r, 0421L AnY ,11 C C'VALIIAI IVly ncrWn 1 t dA 8tdldk+gs in accord with ILHR 83.05, Wis. Adm. Code Attach oo nrptet site pl an on Paper not Igyis than 61/2 l[�T1 ";inches i size. Plan mull intrude, but a St. Croi i rat liirnkad to vertical and horizontal reference poi rR � diri+elion and %af. abpe'. scale or PARCEL I.D. e d;mencioned, north arrow, and location and esstmreearesi road.: 038- 1055 - APP(.ICANT.INFORNAT90N- PLEASE Pp,!) ALL " TION I OBY DATE PROPERLY OWNER: I PWI14N LOCATION µ ms' 1. ? cg1Ff. OT t/4 Sid t /4,S 3 T 31 .,NR for) W _ 18 fs t PROPEFnY OWNEFr.'S MAILI ApDRe% SS `� , y LOTS BLOCK * SUED. NAME OR GSM e 1416 07Y, STATE ZIP CODE ILIAGE 5drowk NEAREST ROAD ( New Commidon lase ( Residential / Number of '- _ 4 ( Addit n b exislitng build V 1 Re0ammenf [ ] Public or wmfrwciW describe Code derived daffy low 600 gpd Recortrnended design biding race - 7 bed, gpd* - bench, gpdX Ab area rgo 858 tied, ft2 750 trench, R t x um design'bading rate . - . 7 . bed, gpd/ft .8 tomb, UW . Reoofirrlended infiltration suMl a elevadon(9) 96.05 11 (as referred to site plan benchmarlq . Additlortrti design 1 site aortaideralllm zia parent marterial out — Flood plain elevation, it applicable Y ^ it S - $uiwe br symnr CONVOMONAL MOUND 1441A "o PA ESSURE AT-GRADE syerEm IN FILL TANK u- unsuitable W stern Y7 s. O u U S 0 U Cat S o u RI S O u KI S❑ u 0 0 s lieu SO►L DESCRIPTION REPORT Boring # Horizon Depth Dominant Color hllotlles Texture StruCtt,re Elo rdW Rte GPOIft in. Munsell QU. Sz. Cont Color Gr: Sz. Sh. Bed Tieridt 1 1 d -8 10 z 3 3 pq 2 msbk ndfr gy if .6 nme sicl IMbk mfr if .3 Groum 4 rime CO ml na na .8 99.x._ ft a -1 �m • fimAng fAliDr ' +84 Remarks: Boring # 1 d - 11 10 3 3 none �_ 1 _ 2msbk mfr caw if .6 2 ic1 ln* mfr if .3 Grolstd 3' - 5 r C ml na na .8 elm. gad it Dmlh b Mmiting factor Remarks: CST Name: -- Please print L. Stae1 Pba t: 715 -246 -6200 AddRss: 1554 200th. AvA New Richmg&Wl 54017 .. ' Signatate: Dare: 11 - - er: CST Numb M=98 Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number Number of Bedrooms Design Flow - Peak (gpd) S"a Estimated Flow - Average (gpd) ro Septic Tank Capacity (gal) l Soil Absorption Component Size (ft) i Type of Wastewater DorWestic �5 Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Componen Design Flow - Peak (gpd) �p Maximum Influent Particle Size (in) 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septi and outlet filter shall be assessed at least once every 3 years by inspection. Th utlet felt shall be cleaned as necessary to ensure p ro operation. The filter cartridge shou not be removed unless provisions are m to p er P 9 retain solicis in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component 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 scum and sludge in the tank exceeds 113 the liquid volume of the tank. If the contents of the tank are not removed at the time of an 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. 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 the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption components operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep- rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. 3 ST CROIX COUN"T"Y SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Bi k ! Property Address 3 1 0� 1'4 +' (Verification required from Planning Department for new construction) City /State &Ly R, c mlm o j !LQ Parcel Identification Number njA LEG DESCRIP'lCf, N Properly Location NE V4, -,&L 'K, Sec. l3 . T 31 N -RAW, Town of 57A 1- "jE Subdivision N0 TN 2 .4T _ . Lot # _. Corltiled Survey Map # . Volume . Page # Wan=ty Deed # ro 3 /S5 . Volume �, f . Page it ,^ Spec horse ❑ yes 0 no lrot Tines identifiable IN yes ❑. no • . Ittq�etrrseaadt�ooeof7roar�ksysteaiopa1dtrwltmitspre •�lunetobaa�dlewastes.Pmpex consists of pamI g oat dw sepdo tame evay ft= yea or wain if wx4W by a licensed pumper. Wbst you pat ido ftsydem camagxtdo of tire sepf c tardc as a tioa motstage do wasto- disposalsydom. "IU pvvcgW ownm spas to submit to St. (roue Zoning Dquuma t a cetfificaem tacw, signed by do -own= %07 a dohm lxtinst�edph mberort ccosedpamparvcdfy dAt(t)tboa eite�diq�ossisy�0aie is in proper opera ft condition aadlor Ci) after bqmgmand P B.(� )• tba septic tank is less tLaa I/3 Stll of gUdge- ywe„tin Fousipad readtbo above zequk=qesft and agm to maintain do private sewage disposal system Vft do sWadatdS let fork hmin,•as set by the Department of Canmem and the Dot of Natural Reso=cc% State of Wisoonsia., Ceefts statiag>! N& septic system inns born maintainod must be completed and redimed to St: iat�oix.t,ounty Zoning Office wltbin 30 days of year mphadon dale. , flEr 11RF3ICi'Ili�'T �' :; QWNRR• CRRTII�T��QN I (ire) certify flat all statemeaft on this focar are we to the best of ray (our) Imowledge. I (we) am (are) the owVKS) of the above, Ky of a warranty dad recorded in RegkW of Deeds Office. err tom: , sesa+e � information that is n&4eprrseated may result in the sanitary permit being revoked by the Zoning DeparwmL `' a•• •' Inclu& wt* tuts applkationt a at=* wumty dad fiver rho R,egistar of Deeds otftoo a copy of the certified survey map if refmace is made In We warranty decd STATE BAR OF WISCONSIN FORM 2 — 1982 WARRANTY DEED "11100431L 5-5 WALSH DOCUMENT NO. VOL 1 62 1PAGE 47 KATHLEEN H. RE DEEDS �sIER OF DEEDS - - - -- - -= - - -..._ ,_ - - -- __.- - - - - -- ST. .CROIX CO., WI GR EENWOOD ENTERPRISES, INC. Grantor RSCENED FOR RECORD 04 -18 -2001 1:30 PM :VARR+OM DEED EXEMPT D conveys and warrants to — $Lu r-tAn--K.- WJ- son -and ._J. Jane R. SULM FEE COPY iT;— ,.s=ue ^T, — hus band dind O e, Grantpp 4NMR iFEE: 68.70 RECORDING FEE: 10.00 Rp6E+8ew� 1 THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS the following described real estate in ^ St Croi County, State of Wisconsin: U(,AK A Tdt-e. 440 S. Lot 28, Northgate, St. Croix County, Wisconsin 1, 4AT Ir- 3 18 ?l6 038- 1190 -60 -000 PARCEL IDENTIFICATION NUMBER This homestead property. (is) Exception to warranties: Easements, restrictions and rights -of -way of record, if any. .._. _ _ . ,,... , . - xis.=- �- :- •ti:,,,y:N;,� Said Iot owners; ` Ri•.hmord and s1 impact their roil-1. X t!� 03.0 I 1007-0 - X i i 3 98.86' logs a �Q I O ' 38E 9 07'26" E 3645.6 { I 1 001. i 1 -J +J8 • 13 :3 o ❑ o , a q +) t1.3'yi ( (l03 i X 1009.1 , O Q x Ic X tJ 1008.0 tt ' 3 "# - ° Z9 Ac` f 188 139' 48 4 9 x 1003.8 50 � N n 117. A-c- A e_ . - Y