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HomeMy WebLinkAbout038-1124-70-000 ■o'■ -o o 0 05 �n 0 J �r / ( { / I ° P. / I / § 9 � \ \ � G \ /a; A ® D §t § ° ° 2) (D e § 2 c ; : 9 . F r a: a ■ E @ z > E m� . E 3> e .• , ; F� i oo$ . 2 \ a k d m / S S n r ■ 2 v M v (D ■ �. 0 § 0 0 0 \ .. c % § % -� { � z 7 & e (A (A (A i' > � { / 7 co � � z � \ I § 7 .. > � \ g :r % \ / 2 CO) m o r ° 0 E . c 3 CD Cl) m C Cr r z �2 i / B 2 n . � � ■ � k CL z R � S � ■ � � $ � / E § $ z k E q j z . % � C.0 � ± � \ 7 . 0 % a � t � B � a � * o » CD § � § �2 , � � Wisaynsih Depp tment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430161 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan I No: Personal inf4.mation you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. Permit Holder's Name: City Village X Township Parcel Tax No: Schuldt, Gene Star Prairie Township 038 - 1124 -70 -000 CST BM Elev: Insp. BM Elev: BM Description: ' A' Section/Town /Range/Map No: C* • t> I • c'1 QlLV �S i e�VkS u�1� I = b Si 30.31.18.5141 AL TANK INFORMATION ELEVATION TA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ' 6� Benchmark ' 0P,P CO • D i Dosing V Alt. BM 11p Aeration Bldg. Sewer • 20 I R1 -sa Holding St/Htinlet .r `l`{"oI TANK SETBACK INFORMATION St/Ht outlet �, gQ 93.90 I TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic I Dt Bottom Dosing �p, ) Header/ i 2 CPO CM /L Aeration Dist, Pipe Holding Bot. System 9 2 , LAD Final Grade � � � • � 1 PUM /SIPHON INFORMATION Manufacturer Demand St Cover GPM �•� Model 44Qber TDH Lift F ' tion Loss System Head TDH Ft Forcemain z ngth Dist. to well SOI PTION SYSTEM Ctt )gA BAD RENCH idth Length No. f Trenc PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIME •� CZ,} SETBACK SYSTEM TO P/L JBLDG WELL I LAKE /STREAM LEACHING Man cturer: Q� INFORMATION CHAMBER OR Lb 10 h Type Of stemv / UNIT Mode Number: 0 it DISTRIBUTI TEM l.� a , pfL. Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake U Pip _%. S I 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 - Mulched Bed/Trench Center Bed/Trench Ed es To soil g p Yes [] No Yes j No COMIIIE TS: (Incl de de discrepencies, persons present, etc.) Inspection #19 � Inspection #2: ----r-- 2y` q� LScatio . 1906 Raleigh Rd Star Prairie, Wl 54026 (SE 1/4 SE 1/4 30 T31N R18W) NA Lot 3 r •, N� Parcel No: 30.31.18.5141 1.) Alt BM Description = � vw ! Q & W 2.) Bldg sewer length - amount of cover = 2� f "ex-p� Gauss -, Plan rev n Req ed? Yes No r ,� j s - �, Use other side for additional information. i. ©,,� � ate S lnse ctors Si nature Cert. No. SB -6710 ( .3/97a -[� � f C G• p 9 I � Safety and Buildings Division County /� 201 W. Washington Ave., P.O. Box 7162 •1 (- 0 J x- vns�►n Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) r V N - -- (608) 266 -3151 �� ( Department of Commerce Sanitary Permit Application A State LD. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you ov'!� may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Address i : erent than mailing address) I. Application Information - Please Print All Information qo/ Pik_ (x ff 1 RECEIVED 1 10 Property Owner's N 1 # Lot # Block # 1 0 Property Owner's M ailing Address operty Location CROIX COUNTY U � tb,�tk,Section City, State Zip Code one / S �% /cir one II..Type of Building (check all that apply) T N; R /�� E r W or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number ❑ Public /Commercial - Describe Use 11 t State Owned - Describe Use x - ❑City_❑Villag of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) 0 3T — Itz i 'cO - 030 A" ew System ❑ Replacemen stem g p y g Y ❑ Treatment/Holdin Tank Re Onl Other Modification to Existin System B. ❑ Permit Renewal t Revisio ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. ype of POWTS System: (Check all that apply) n - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In - Ground El Holding Tank El Peat Filter El Aerobic Treatment Unit ❑ Recirculating Sand Filter r 13 Recirculating Synthetic Media Filter -T� Leaching Chamber Drip Line ❑ Gravel -less Pi er (explain) J V. Dispersal/Treatment Area Information: - 10 Design Flow (gpd) Design Soil Application Rate( gpdsf) Disp sal Area Required (sf) Dispersal Area Proposed (sf) System Elev ti on < V j' VI. Tank info Capacity in Total Number Manufacturer Prefab Site teel Fiber I Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank ` Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- 1, the undersigned Aume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's S' nature MP /MPRS Number Business Phone Number /1 / cu,. � 1�/ Plumber's Addre ss (Street, City, S te, e) VIII. Count /Department Use Onl Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date Issued I su" Agent Signature ( Stamps) Surcharge Fee) < El Owner Given Reason for Denial IX. Conditions of Approval /Reasons for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and :!'_ I dispersal cell must all W serviced I maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. 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) i S '1 Test and System PLOT PLAN PROJECT Gene Schuldt ADDRESS 150 montrose olace St. Paul Mn 55104 SE 1/4 SE 1/4s 30 /T 31 R 18 w TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 9/7/03 BEDROOM 3 CONVENTIONAL X00C IN -GROUN RESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 BENCHMARK V.R.P. Bottom of Siding ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL - H. R. P Same as Benchmark SYSTEM ELEVATION 92.1/2.0 3.5 below grade Property Line Plans Designed Using Conventional Powts Manual Version 2.0 130' Vents 1 01 70, B - 2% B - 2 Slope 5' B -3 35' 25' >, B.M. * 5 0' o 5 Pro 3 T Bedroom v , House \0 9 r 2 -3' X 69' Cells with >3' Spacing 0 100' ►� Vent ALong Standard Biodiffuser Leaching Chamber with 31.1 ft2 of Area " 3 4" Grade at System Elevation Raleigh Rd S '1 Test and System PLOT PLAN I PROJECT Gene Schuldt ADDRESS 150 montrose olace St. Paul Mn 55104 SE 1/4 SE 1/4S 30 /;T 1 f R 18 W TOWN Star Prairie COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE9 /7/03 BEDROOM 3 CONVENTIONAL )00( IN -GRORESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 IL BENCHMARK V.R.P. Bottom of Siding ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL sH Same as Benchmark SYSTEM ELEVATION 92.1/2.0 3.5' below Dade Property Line Plans Designed Using Conventional Powts Manual Version 2.0 130' 10' Vents 70' 5' 2% B -2 B' Slope 5, B -3 35' 0 ' 25' >-, B.M. * 5 , a 5 0 , o Pro 3 T Bedroom �n House 2 -3' X 69 Cells with >3' Spacing a� 100' ALong t Standard Biodiffuser o Leaching Chamber with 31.1 ft2 of Area Grade at System Elevation Raleigh Rd Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County d Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must 1 • include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. ewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Q 3 Property Owner Property Location S Govt. Lot 1/4 _J / 1 /4 SS() T, j N R E( ) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# d City State Zip Code -Phone Number ❑ City C3 Village W Town Neare Road New Construction Use: Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or mmercial - Describe: __— Parent material (/ , Flood Plain elevation if applicable Al General comments and remmmendations: j< Ong # Boring Pit Ground surface elev. ft. Depth to limiting factor - v — in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 � -S , r ��- :3 �.�• 0 Bing # �❑ Boring 91 pit Ground surface elev ft. Depth to limiting factor fi� —/�-- in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 �C 9V,--.5V2- .0 -J4 l 3• 0 , 2 3•Z Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 715- 246 -4516 Property Owner _ Parcel ID # Page of F3_1 Boring # ❑ Boring / Pit Ground surface elev. ft. Depth to limiting factor y in. F*Eff#1 Application Rate Horizon' Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#2 o,7f'�Z ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Akppli cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 F-1 Boring # ❑ Pit Boring ❑ Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description- Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff#2 I Effluent #1 = BOD > 30 1220 mg/L and TSS >30 1150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608 -264 -8777. SM8330(RAW) Safety and Buildings Division County 1 = 201 W. Washington Ave., P.O. Box 7162 Madison, �bxled in Visconsin b co.) on, WI 53707 - 7162 Sanitary�e� - n / er (to Y (608) 266 -3151 . J0/ t Department of Commerce State Plan I.D. Number Sanitary Permit Application In accord with Comm 83.21, Wis. Adm. Code, personal informa ysu.4)rwide P�D may be used for secondary purposes Privacy Law, s15. 4(1)(tie Project Address (if different than mailing address) cp R I. Application Information - Please Print All Information f �9p 4r U Parcel # Lot # Block # Property Owner' "'Na me ti T \J e Prop Location Property Owner's M ailing Address � � City, State Zip Cod Phone Number / y�� y �! � r t� T N; R E or II. ype of Building (c all that apply) se S `+' �`^" S ' Subdivisio Name CSM N q 1 or 2 Family Dwelling - Nu of Bedrooms ❑ Public/Commercial - Describe Use J� p of ❑City_ ❑Village ownshi I State Owned - Describe Use to III. Type of Permit: (Check only one bo line A. Complete line B i appy e) .yD : o e - Z - It A. ❑ Treatment/Holding Tank acement Only ❑ odif on to Existing Syst W System C Replacement Syste g Permit Number and t sued B. ❑Permit Renewal ❑permit Revision Change of El mit Transfer t Before Expiration PI r O er -4 of POWTS System: (Check all that apply) A r M P 5 ter n - Pressurized In- Ground [I Mound At -Grade Ingle Titer Mound > 24 in. of suitable so ound < 24 in. of suitable sai i r [J Aerobic t circ g S LJ Constructed Wetland l_� Pressurized In- Ground L l Holding Tan ❑Peat Filter ih 'tJ Recirculating Synthetic Media Filter ❑ ❑ Gravel -less Pi ing Chamber ip e P e x i V. Dispersal/Treatment Area In mation: S st Elevatio Desi n OW (gpd) Design Soil A licat f n Rate(gpdsf) Dis sal d (sf) Dispersal Area Pr f) m O 6 , --I VI. Tank Info Capacity in Total Numb Manufac Prefab Site eel Fib Plastic Gallons Gallons of U Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding 'lank � Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement I, the undersi d, a responsibility for installation of the POWTS sh on the attached plans. ' i MP /MPRS Number Business Phone Number Plumb 's Na me (Print) Plumber re � ����' a Plumber's Addre ss (Street, City, State, Zip it VIII. Count /De artment Use Onlv Sanitary Permit Fee (includes Groundwater Date Issued Issuin Agent S fq namr Approved ❑ Disapproved Surcharge Fee) 2 J v 3 ` ❑ Owner Given Reason for Denial J t/ IX. Conditions of Approval /Reasons for Disapproval c�) }� t�-1 -31I M 111,1 0 1 1leQ ch comple te plans (to the County only) for the system on paper not less than Sl/2 x 11 inches in size 1 . w R' r 'x `S i PLOT PLAN PROJECT Gene Schuldt ADDRESS 150 montrose glace St. Paul Mn 55104 SE 1/4 'SE 1 /4S 30 /T 1 N/ 18 W TOWN Star Prairie COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 7/7/03 BEDROOM 3 CONVENTIONAL XXX IN -GR ND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 684 # of chambers 22 IL BENCHMARK V.R.P. Top of nail in power pole ASSUME ELEVATION 100' Filter Zabel A -100 [:]BOREHOLE O WELL - H.R.P. Same as Benchmark SYSTEM ELEVATION 89.5/89.4 4.5' below grade Plans Designed ing Property Line Conventional is Manual Ve n 2.0 30' B -5 B -4 30' '`Vents 2 -3' X 69' is with >3' Spacing a., 2% Slope B -3 r Pro 3 bedroom 33' 33' house 75' Vents 30' 20' T B -2 30' B 100' a Vent a� >6 » tandard Biodiffuser o of Cover aching Chamber At with 31.1 ft2 of Area 6' Long 11 " " Grade at System Elevation .54 M. 168' 110' Raleigh Rd rM a jp i �yY Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code = County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must ' include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel .D. percent slope, scale or dimensions, no ow, and location and distance to nearest road. Please pri t all �x"I'a` ewed by Date you provide may be u ed for seconds y () ( )) Y Pr Y 7 Durposes nvac s. 15.04 1 m. Personal information 3 Property Owner Property Location 2 003 G t.1 ovt. Lot S j [ 1 51/4 S ,SOT 3 � N R E( ) W Property Owner's Mailing Address Cn, '\J T,1 Lot # B�# ubd. Name or CSM# J IC U 2 3 city State Zip Code Phone um r ❑ city ❑ Village C3TdW Nearest Road New Construction Use Residential / Number of bedrooms _ Code derived design flow rate !Z.$ GPD I ❑ Replacement ❑Public or commercial - Describe: Parent material Flood Plain elevation iff applicable /y: an recommendations: ndations: �`'`- v �!/. lY ,�[�G!✓ �`>!l /� �j &V L440% C �I FMBoting # Boring /�� rZi 13 pit Ground surface elev. ft. Depth to limiting factor L-,�- 0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I - Eff#2 r A i a Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 1 220 mg/L and TSS >30 1 150 ' Effluent #2 = BOD 1 30 mg/L and TSS < 30 mg/L CST Name (Please Print) CST Number Si Bird Plumbing, Inc. Shaun Bird 226900 Address Date valuation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 715- 246 -4516 I Property Owner _ Parcel ID # Page of F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil — Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # E] Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # Bo pit Boring ng . ft. ❑ Ground surface elev . Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 i Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD 130 mg& 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. 580.8730 (8.6/00) f REPORT ON SOIL BORINGS AND S AFETY & BUILDIN DIVISI !AN ND PERCOLATION TESTS (115 MADISON W 537 ELATIONS Pill (H63.09(1) &Chapter 145.045) LOCATI N: 4 S Z /T31 ,/ SECTIO : �/� f (or TOWNSHIP /M LITY: LOT NO.: BLK. N .: SUBD ISION NAME: COUNTY: ER'S BUYER'S NAME 0 LING ADDRESS: S21. AaAJ USE 15ATES OBSERVATIONS MADE NO. BEDRMS.: COMMER I L DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Eg Residence �New ❑ Replace RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN- GROUND - PRESSURE: SYSTEM- IN- FILLHOLDING TANK: RECOMMENDED SYSTE (optional) ©S ❑u ©S ❑u aS au EIS ©u EIS [AU e2w 1, ,J �7 If Percolation Tests are NOT require DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL D PTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) / J f B- B -,� - B' Y ' Al j f� B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTER SWELLING INTERVAL -MIN. PERIOD 1 PERIOD 2 PERIOD PER INCH P _ ,L P_ , C P- 3 L P P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent r of land slope. SYSTEM ELEVATION 7/) f a' - 14 —i AF LAS 1. f i W --& ,� • fi r .� ._ -- � — _ . - I I+ _ I I f s [ a I E ITA ICAQ'I I, the undersigned, hereby certify that the soil tests reported on this forrr were made by me in accord with the procedures and rr;z Aecified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAM ( rint : TESTS WERE COMPLETED ON: AD S: CERTIFICAT O NUMBER: PHONE NUMBER (optional): .S � CST SI A R DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester, L I LHR-SBD-6395 (R. 02/82) — OVER — — — S N 9 7 INSTRUCTIONS FOR COMPLETING; FORM 115 - SBD - 5395 To be a complete and accurate soil test, your report must include: 1. Complete legal description, 2. The use section must clearly indicate whether this is a residence or commercial project; 1 MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; B. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred. A separate sheet may be used if desired; & Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain, elevation) does not apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st — Stone (over 10 ") BR — Bedrock cob Cobble (3 - 10 ") SS — Sandstone gr _ Gravel (under 3 ") LS — Limestone * s — Sand HOW — High Groundwater cs - Coarse Sand Perc — Percolation Rate rued s — Medium Sand W — Well fs -- Fine Sand Bldg — Building r Is — Loamy Sand > — Greater Than *sl - Sandy Loam < -- Less Than *1 — Loam Bn - -- Brown *sil — Silt Loam BI Black si — Sill. Gy — Gray cl — Clay Loarn Y — Yellow set — Sandy Clay Loam R Red sicl Silty Clay Loam mot - Mottles sc — Sandy Clay w/ — with sic Silty Clay fff - few, Mine, faint C Clay Ci: -- COrnmon, coat se pt Peat rnrn Many, mediurrr m Muck d — distinct p — prominent HWL — High water level, Six general soil textures surface water for liquid waste disposal BM — Bench Mark VRP — Vertical Reference Point TO THE OWNED; This sail test report: is the first step in securing a sanitary permit. The county or the Department may retluest verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be submitted to the appropriate local authority in order to obtain a perrnit:. The sanitary permit must be obtained and posted prior to the start of any construction. I Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan 1. If system fails, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715- 246 -4516 St. Croix County Zoning 715- 386 -4680 Pumper Tom Mondor 715- 246 -5148 Shaun Bird #226900 I e , ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer tie (d /- Mailing Address ) f5C) M o ,,j 7 - af-)j a l S`/ K ( t" ni Property Address 49-LE i Rd (Verification required from Planning Department for new construction) City /State 30 rY1EAS 51' L Q, K Parcel Identification Number 039 r/- 70 - c oo LEGAL DESCRIPTION Property Location f S C '/,, Sec. 3 C'� , T / N -R W, Town of ��✓ZA� �� Subdivision Lot # vice#` r172 ' Certified Survey Map # 7 , Volume 0 , Page # 2,3 q (�> . Warranty Deed # Ll ?6 9e'0 Volume `� . Page # 7 Spec house yes ❑ no Lot lines identifiable yes ❑ no SYSTEM MAR + NANCE Improper use and maintenance of your septic system could result m its premature.fadure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeymanplumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal 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 Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed. and returned to the St. Croix County Zoning Office within 30 ys of the three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION 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. U a fl 6 l? /03 SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed DOCUMENT NO. W ARRANTY DEED y This srAcs asssaveD Iop nccoPlD1Ne DATA j STATE BAR OF WISCONSIN FORM 8 -19ft - - 48098 -- -VO1._ G Vin. X71 j. REGISTER'S OFFICE i POUGLAS STROHBEEN and MARGARET STROHBEEN, j CROIX CO., WI .......... ST. husbarid and wife .. " " " "" ' Reed for Record ........... ....::....................`::::::::::::::::::::::::::.::::.::::.. ............................... a MAR 2 51992 .. y............ts to .... EUGENE... E., ... SCHMIDT .................. I 2:10 P. M t co nvoys and warrants a „ -,,,,, . ........ ..an. -. individual ...........................................-... ............................... ap ...............••--............................................................... ............................... ;! ° (t�ph(e►of t< I .................................................................................. ............................... .... .... ........................................................................ ............................... .. .............................................. .................... ... the following described real estate in ........ S. t-. ..Cr.Q ..................Count State of Wisconsin: Tax Parcel No: I Lot 3 of the attached Certified Survey Map, dated June 17, 1991, i' located in Section 30, Township -31- North, Range -18 -West, r I� li Town of Star Prairie, St. Croix County, Wisconsin. �I i t ; l I' EEE�- ' This ....... -is not homestead property. { (is) (is ...... not) i� Exception to warranties: r l �.e`�- .Z..__...... day of ........... JanuarY .......................... 91... ! Dated this -....- . fs” is I I' ....._ (SEAL) ....." ."...A.rC ^'..'!..`..!'. .................... (SEAL) ,DOUGLAS STROHBEEN I' i ! .................................. ............................... l' ............... (SEAL) AL) �+ iI .MARGARET STROHBEEN i1................ .--- ................. .. .. ............................... jl �! AUTHRNTICATION ACHNOWLHDOMBNT Signatun(s) ................. ......................... . ..... STATE OF WISCONSIN es. ........ .... ..... _ ........................ .................................... 51t...e�iZO1X.... _..... County. ... g,! authenticated this ........ day of ........................... 19 ..... Personally came before me this ..... of - -janua xy ....................... 18.9.1.. the above named r ... - ................................... .......................... sln r r et..- Strohbeen ... ... ......... ... ........ ........ ...... - ........ . ...... j 3 z vR M I N Jill t� t1 �tk AU 3 1ggJ.. �9�ster or �` ' �FLL 472999 sL cr°& TIFIED SURVEY MAP N • �iA VOLLIME a - PAGE 2 LOCATED IN THE SOUTH HALF ,OF-THE SOUTHEAST QUARTER OF SECTION 30, TOWNSHIP -31- NORTH, RANGE -18 -WEST, TOWN OF STAR PRAIRIE, ST. CROIX COUNTY, WISCONSIN. PREPARED FOR: Douglas and Margaret Strohbeen R.R. 4, New Richmond, Wi. 54017 PREPARED BY: Lee Villeneuve, R.L.S. R.R. 6, Box 150, Menomonie, Wi. 54751 I " =I00 LEGEN SCALE IN FEET = ST. CROIX COUNTY ALUMINUM MONUMENT 3/4 INCH, x ' 2 4 INCH IRON RE -ROD WEIGHING 160' O 50 100 1.502 POUNDS PER LINEAL FOOT SET. = 1 INCH IRON PIPE FOUND. MAP BEARINGS ARE REFER- = 3/4 INCH IRON RE -ROD FOUND. ENCED TO THE SOUTH LINE OF SOUTHEAST ; QUARTER OF SECTION 30,.T-- 31' =N, R - 18 - W, ASSUMED TO BEAR NORTH -89 49'25"-WEST. C U R V E D A T 1 to 2 2 t o 3 1 to 3 Central Angle = 17 0 34 1 32" 11 0 26'24" 29 0 00'56" Radius = 240.07 feet 240.07 feet 240.07 feet Arc Length = 73.64 feet 47.93 feet 121.57 feet Chord Length = 73.35 feet 47.85 feet 120.25 feet Chord Bearing = S -82 0 16'06 " -W S -67 0 45 1 38 " -W S -76 0 32'54 " -W Back Tan. Brg.= N -88 °56'38 " -W S -73 0 28'50 " -W N -88 0 56'38 " -W Fwrd.Tan. Brg.= S -73 0 28'50 " -W S -62 0 02'26 " -W S -62 0 02'26 " -W � I VE = 984 + OMON1 „`j Q' UN PL A T TED LAND •�, •. � 1 ���`,•` Su qN� 25.04' vro 53 t ' _ °37 X 27 V� J 2 . f Q/ - L 0� / j/ -011 46,7741 SQUARE FEET h _ i 38,121 SQUARE FEET in ' (. 4i h (SQUARE FEET VOL 2 o EAST OF MEANDER h' 62,49 EAST OF h LINE ' o ME'AND R LINE B 5� , y 0`�29 R ( N - 88 ° 56'18 " - W � SOUTHEAST yt' 187.40 ��' N 8i? 8" W 202.22' h CORNER OF - 89 49 25 i N-03°1445 - E 39.16 ;- _SECT ION • 30, (VpLAT�EfolA2N5. 2T °67'3i" Z - - 7-31-N, R -IS -w _W 3 -. III SOU 14 CORNER 7 -1 /� .M ` - _ - - N RF 30, T - N, / / / � SOUTH LN: SE 1/4 1046.09' VOLUME 8 PAGE 2396 PAGE I OF I SHEET J