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Home My WebLink About040-1011-50-000 \ o \ 2 § � f & j 2 0 % I � } ~ � � � \ � k I k R E # E a� ) 2§% 2 ® �2 \ - 0 \ ( � 73/ ! § \ ) 2 c / � c q \ § } � $ \ � EE 2 f 8 co � c I20 � k ) E \ q 0 k \ 3 @ / e z t 2 . ^ 4) 1 t I R f _, E £ , K K ■ ® 000 z � \ C,4 g �2 0 o z � 'I / / 0 w 7 2 \ \ E I� / @ a z 2) ± % 4) 2 4 z m 2 @ & I / E §/ o f 7 G 2§ § t? � § ) � m \ So 7 § � 2 k00 L o 9.5 g 4) 6 e & a g e « 7 0 z/) 2\ 2 2 g k 2 i CL k k j a �o & 0 Wisconsin Department of Commerce I & PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division i Sanitary Permit No: INSPECTION REPORT 404919 0 GENERAL INFORMATION (ATTACH TO PERMIT) 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 Weiss, Kevin I Troy Township 040 - 1011 -50 -0100 CST BM Elev: Insp. BM Elev: BM Description: �-„q T� too' 6m� TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI j FS ELEV. Bench Septic �...��•S Cz S� (P� i zs4K I s 'ZODZ �pt +� c6. �F'F �dD.O Dosing Alt. B Bldg. Sew r \ 9 s• 2 �7. ) �0 Aeration J SUHtI t � Holding t TANK SETBACK INFORMATION st/Ht oUtl TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt In et Se Dt Bottom I ,� � Z , Header /Man. Dos y � '+9 3�` D / V Dist. Pipe W W b Iding But. System 7 I t 1 ;/� Final Grade PUMPISIPHON INFORMATION %f Manufacturer Demand St Cove GPM Model Number Z 9 ' ,� ►�r�. �o�- oK 3 y. 3 k ro� � :1 q I � TDH ift Friction Lo ps Syste Head TDH Ft t I i 1.11) 5.2 S z2. n �� 5 /y 10.E 14 (07 ; E l Forcemain Lent Dia. ,, Dist. to Well (0 .; nn¢ 2 k:T: 9S 12.33 �� 1 SOIL ABSORPTION SYSTEM - c ED Width Length Of TleaeheS PIT DIMENSIONS No. f Pits Inside Dia. Liquid Depth -DIM ENSIONS v ill o. f a "s SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING CHAMBER OR Ma ufacturer INFORMATION Type Of System: 1 � UNIT Model Nu 4 - > � 5 DISTRIBUTION SYSTEM LV -to ►"r Header /Manifold Distribution V x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length _ Dia Length Dip Spacing SOIL COVER x Pressure Systems Only xx Moun Or At rade S stems my Depth Over Depth Over xx Depth of 1 xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ;• Yes No s O COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: Inspection IIp'nvs "�p�ection #2:, Location: 672 Tower Road Hudson, WI 54016 (NW 1/4 SE 1/4 T28N R19W) NA Lot 2 - D k O �o rarcel No: 03.28.19.460 (I"1 �'1-Q 1.) Alt BM scription 2.) Bldg sewer length - amount of cover 3.) Contour = 45N �1 p T . Use other t s de for additional information. �r Date n poor' ignature Cert. No. SBD -6710 (R.3197) 7 (a a rrsc Sanitary Permit Application_ 3 Safety &Buildings Division In accord with Comm 83.21. Wis Adm. Code & 1// �� 201 W. Washington Ave See reverse side for instructions for completing this application 19 yy �� PO Box 7302 ` isconsin personal information you provide may be used for secondary purposes Madison. WI 537(:7 -730"' Department of Commerce (Privacy Lam, s 15.04(I)(m)J (Submit completed form to county if r state owne,. Attach complete plans (to the count\ cop) only) for the system. on paper not less than 8 -1/2 x I I inches in size. County r C State. P,�ii umber ❑ Check if revision to previous application State Plan L D. Number �� 7� , 4 f 3o LApplication Information- Please Print all Info t'dA -4 ' --- Location: Property Owner Name Property Location ' d L EIV �, /Y�l i 4 L ll4, S j T47N. R o H' Property Owner's Mailing Address ( Lot Number Block Number 7 td IVA City, State Zip Code ! yT C Wo ne Number Subdivision Name or CSM Number 701 Vid 2 - Pf II Type of Building: (check one) ❑ City • I or 2 Family Dwelling – No. of Bedrooms ❑ Village • Public /Commercial (describe use) Town of -� • State -owned / /d y III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road ref A) 1. P(New System 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s) System Tank Only Existing System 473 — /d /I —S0 — 600 B) Permit Number pate issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System ,,( (C y h�eeck all that apply) -�f • Non - pressurized In- ergSyrtd � �1 Mound ❑ Sand Filter ❑ Constructed Wetland • Pressurized In- ground / ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade fo ❑ Aerobic T t eroc reatment U it ❑ atin �, n ^ 0,6 Reci � g Other: _ V Disper reatment Area Information: 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. S stem vation 7. Final Grade Required Proposed Rate (Gals./day /sq. ft.) (Min. /inch) Elevation y7 . 37 - r. 5� VI Tank Capacity in Total k of Manufacturer Prefab Ste Ste Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed t Tanks Tanks CJ k C,(` O ❑ ❑ ❑ goo �� Il // ❑ D D D A l Respollisibility Statement I, the undersigned, assume res onsibilit for installation of the POWTS shown on the attached plans. kmber'slkddrc,ss m rs Name (print) Plu er's Signature (no ps): MP/MPRS No. Business Phone Number wv (Street, City, State, Zip Code) l a� �V 1 �e d - z VIII County/Department Use Only O Disapproved Sanitary Permit Fee ( ludes Groundwater Date Issued Issuing Agent Signature (No stamps) Approved ❑ Owner Given Initial Adverse Surcf� Fee) r Determination � a.� , , ?W92. kta;m. IX. Conditions of Approval /Reasons for Disapproval: t. SBD -6398 (R. 07/00) f 1 i Ott ej . i�.',�YE• {�� .)•E R.,� ri,i ' � i7'f ! ,.lt^ \.:�: t►�� %.� '•[► , t "��'^ { i•: �$ '��. 't1%vM �� `�la �' ; V Rl.' .`i w. t .4� y . ia�' �.� S_ " l �l.i. -!• �� t 1r�f�� if �! -.f . «' A : '�t,rJ t "X'! �'t f lii�°0• °••?14'.<x.fl,f'�t: j..iL• .'.r, • i I ;A N �- D r 4 � � .mo I if M dd /e loo lb- 1 ` m s ��o .► =_ u V ; X J CL r Safety and Buildings 10541 N RANCH ROAD 1\ HAYWARD WI 54843 VA TDD #: (608) 264 -8777 Mir sconsin www.commerces i www.wiscon isconsin.g n.gov Department of Commerce Scott McCallum, Governor Philip Edw. Albert, Secretary February 22, 2002 CUST ID No.226524 A7TN: P0WTS Inspector ZONING OFFICE ROGER L TIMM ST CROIX COUNTY SPIA 3128 20TH AVE 1101 CARMICHAEL RD WILSON WI 54027 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 02/22/2004 Identification Numbers Transaction ID No. 709430 SITE: Site ID No. 641371 Kevin & Kari Weiss Residence Please refer to both identification numbers, Tower Rd above, in all correspondence with the agency. Town of Troy St Croix County NE1/4, SE1 /4, S3, T28N, R19W Lot: 2, Subdivision: Csm V2, Pg 904, # 361985 FOR: New mound, 600 GPD Object Type: POWT System Regulated Object ID No.: 830272 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes ~1 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: r General Approval Conditions: l • This system is to be constructed and located in accordance with the enclosed approved plans and with the C "u , l "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD -1 -P ( N.01 101) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD - 10706 -P (N.01 101). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • 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. Stats. • The maintenance plan for this system must be given to the owner of the POWTS. Site Specifcc Conditions: • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. ROGER L TWA Page 2 2122102 • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirernents of COMM 84. • No part of the distribution cell is on a concave slope. • The bottom of the distribution cell shall be level per the Mound Component Manual. • The maximum finished slope of the mound surface shall be equal to or less than 3:1 per the Mound Component Manual. • Maintain well and waterline set backs per COMM 83.43(8)(i). • The designer proposes to install a state approve outlet filter to achieve the requirement of wastewater particle size. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the septic tank outlet filter will be required. The outlet filter shall be installed per product approval stipulations. • Provide frost protection per COMM 83.43(8)(c). A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. 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 addresse e a copy of this letter to the owner and any others who are responsible for the installation, opera ' nor maintenanc of the POWTS. Si �� Fee Required $ 175.00 `/ Fee Received $ 175.00 Balance Due $ 0.00 Patricia L Shandor POWTS Plan Reviewer, In ated rvices WSMART code:7633 (715) 634 -7810, Fax: (715) 634-5150, M -F 7:45 am - 4:30 pm pshandorf@commerce.state.wi.us cc: Henry F Grote Kevin & Kari Weiss - Mound 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 (0 I /01) Pressure Distribution, SBD- 10706 -P (01 /01) Location: Lot 2, CSM v 2, p 904, # 361985 NW 1/4, SE 1/4, Sec. 3, T 28 N, R 19 W Town: Troy County: St. Croix Date: February 20, 2002 Owner: Kevin & Kari Weiss Address: 320 Knollwood Drive Hudson, WI 54016 Plumber: Roger Timm�� Signature: B pgNGS License # MPR 226524 ENOE Attachments: 6748 -Plan Approval Application SBD -8330 page 1: cover 2: design criteria & calculations 3: plot plan 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail 7: pump curve 8: system management page 1 of 8 t 1 Design Criteria t U'S Residential Wastewater Contaminant Load: 30 mg /L < BOD < 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 Bedrooms x 100 gal/bedroom/day x 1.5 ( 0 0- C.) gallons /day hydraulic load Design Calculations In situ designed loading rate (D' 3 -- gallons /sq. ft. per day Depth to estimated high ground water '- Z 9 in. Depth to bedrock 71 2 9 in. Cross slope at system s - Z % w Force main length ft. of Z in. Manifold/header length 3 ft. of z in. Drain -back t ` t- gallons Lateral length 4' @ S ft. of �� Z in. Lateral elevation 3 ° t• 9 ft. @ bottom of lateral Lateral hole size �� b in. @ in. ( "+ ft.) Spacing 3 holes /lateral S Z holes total Lateral volume Ar gallons Total lateral discharge rate gallons /minute @ Z •s ft. head � e l twom pre s w compensation losses ft. Elevation difference tm•ta ft. Friction loss ft. @ gallons /minute Total dynamic head ft. Pump /sip� 3 n S gpm @ ft. of head i 1 Manufacturer Model # s Dose volume ` �r gallons Lift /sWn tank W e Q, 1�r V"O gallons Septic tank SK — C° gallons Effluent filter $ T �_ Measurement pump on and off in. Height alarm from tank bottom in. Reserve capacity SZb gallons specs.caics.res Page Z of O D� � � c/t p � 3 ✓ 0 a rA 9 ; I a j' 41 ;� , 3 n 3 V .� � 4.v . C( g .9 , 3 01 � o aQ w. 9 tQ .4 � R� \ to � o k ,a,1w 22.1• a v 3 , 4 j v l i I -- �— tzz.t�� t In do eA r �} •c�' I I 4••.0' � l•0 2.a� ` T.c�' I I �.b' i • ai l l0 1 � o\ e. S o .... 1 .'� � � .�� c�,.�'t a..v `p o � o �. \ ; •+ +�.� � �-g .�„ CL� � 't' � • J f' VEUT CAP `"C,I. VEN)T PIPE WEATHER PROOF APPROVED L.00KIAIG > ?-5' FROM DOOR, JUUCTIOAI BOX MAIJHOLE COVER �Z W ARNIN WI f 1JQOW OR FRESH A Q 12t— ` AIR ItJTAKE GRADE I a\w..,�o z 4„ COWDUIT �-'— • PROVIDE AIRTIGHT SEAL APPROVED E OIAJ TS W I I ALARM EXTEAIDIUG 3' ONTO SOLID SOIL ou I PUMP —.� OFF ¢ \ay. �8ci.q _.e��. BLOCK .. r 7 "� 111 g o ., I l i I I — M OD EL 1 1 M OD EL : Submersible Effluent • i n � GOULD5 Pump Specifications MF!E FS .f E: 10 GPM �r,rge size 1';, NPT 30 maxliI]Um Motor .` _se 115V ,,o. Materials of Construction Q Features and Benefits • — - - 'Irla?es a _ CAPACI'Y mooE� ovPOS Pump Specifications Features and Benefits Up to GO GPr MaxlniuWm leaCl :0 32 Discharge size 1 IJPT • t� �, -_ .. SUICIS == Motor • P Ai! motors K as 30 u s GPM beartllg COr ?Sl( hllas? CAPACITY Materials of Construction C:�st iron r a � . �iiE JEaiCl1eC1 Of Conllnuo 1S l8 1Ol, (3r1d 1 3.,jr� �,',7 I 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, Timm Excavating, 715- 772 -3214, 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. I . 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. 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. r 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. 7. Avoid compaction such as vehicle traffic within 15' down -slope of the adsorption system. S. 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. 1 1. 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 i i ORIGIKI b 1481 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Certified Soil Testing � Attach complete site plan on paper not less than 8'G x 11 inches in size. Plan must County 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. 040- 1011 -50 -000 Please print all information. viewed By Date - Personal information you provide may be used for secondary purposes (Privacy Law, S. 15.04 (1) (m)), Z— � �, Property Owner Property to loft Weiss, Kevin & Kari Govt. Lot NW 1/4 SE 19 S 3 T 28 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 320 Knollwood Drive 2 1 V2, P 904, # 361985 City State Zip Code Phone Number City { Village 16 Town Nearest Road Hudson I WI 1 54016 1 715 - 386 -7581 Troy I Tower Road V New Construction Use: k Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe Parent material loess over dolomite Flood plain elevation, if applicable NA General comments and recommendations: install 6'x 104' rock unit mound on 98.8 contour as upslope edge of r ck w/ 0.6' sand fill F-T] Boring # Boring Pit Ground Surface elev. 97.1 ft. Depth to limiting factor in Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence undary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -4 7.5YR 3/2 - sil 2 m gr mvfr gs 1f/m .5 .8 2 4 -10 7.5YR 3/2 - sil 2 f sbk mvfr gs 1m .5 .8 3 10 -21 10YR 4/4 - scl 2 m sbk mfr gs 1 m .4 .6 4 21 - 9 10YR 414 - scl 0 m mfr cs - 0 0 5 29+ LSBR occasional L gr & cob in horizon 4 Boring # Boring Pit Ground Surface elev. 98.8 ft. Depth to limiting factor 32 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 -4 7.5YR 3/2 sil 2 m gr mvfr gs 1fim .5 .8 2 4 -8 7.5YR 3/2 - sil 2 f sbk mvfr cs if .5 8 3 8 -16 10YR 4/4 - scl 2 m sbk mfr cs 1m .4 .6 4 16 -32 7.5YR 4/6 - scl 2 f sbk mvfr cs - .4 .6 5 32+ LSBR LS gr & cob in horizon 4 - increasing concentration w/ increasing depth " Effluent #1 = BOD 30 < 220 mg /L and TSP >30 < 150 mg /L " Effluent #2 = BOD < 30 mg /L and TSS < 30 mg'L CST Name (Please Print) gn ture: CST Number l Henry F. Grote i 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 2/12/2002 715 233 - 0398 l i, Property Owner Weiss, Kevin & Kari Parcel ID # 040- 1011 -50 -000 Page 2 of 3 F3 I Boring # Boring j Pit Ground Surface elev. 98.8 ft. Depth to limiting factor 33 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 1 0 -5 7.5YR 3/2 - sil 2 m gr mvfr cs 1f /m .5 .8 2 *� . 7.5'F,t 3/2' , , c - sil 2 f sbk mvfr cs if 5 8 3 9 -22 10YR 4/4 - scl 2 m sbk mfr cs Inn .4 .6 4 22 -33 7.5YR 4/6 - scl 2 f sbk mvfr cs - .4 .6 5 33+ LSBR LS gr & cob in horizon 4 - increasing concentration w/ increasing depth Boring # --I Boring ❑ Pit Ground Surface elev. ft. Depth to limiting factor Soli Application Rate in, Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD& in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 ❑ Boring # — poring ..1 Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. 'Eff#1 `Eff#2 ` Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777. SBD -8330 (k.07 /00) Certified Soil Testing r , r 14 jc . i c c o .� s C1 �-' L — J s A 4 ul a (Y 2 Vt INI 9 s s > > »s u v I I , ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer -V n I' e'c5g Mailing Address 3 a.a v1011 D r Property Address .., T�Za.se ✓ lu lf"�' , � ? "? ` (Verification required from Planning Department for new construction) City /State elsat'1 Parcel Identification Number V /0//– 5� " tJz) 0 LEGAL DESCRIPTION Property Location W V ) t /•, � � '/,, Sec. � , T _ZR`N-R_L Town of r Subdivision Lot # Z Certified Survey Map # d96 , Volume Page # d Warranty Deed # iO , Volume 1 T Page # Z32- Spec house 0 yes "S no Lot lines identifiable 1' yes Q no SYSTEM MAINTENANCE 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. The property owner agrees to submit to St. Croix 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. Uwc, 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 rcturued to the St. Croix County Zoning Office within 30 day of the three year expiration date. ' /,,., L�L:�j SI NATUREE 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 owners) of th operty described above, by virtue of a warranty deed recorded in Register of Deeds Office. SI NATURE 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 dOb =£O tsO 0 1-4z) 'O trO_d i VO i 734 PAGE 232 STATE BAR OF WISCONSIN FORM 2 -1999 Es�3$s>ES9 WARRANTY DEED KATHLEEN H. WALSH Document Number REGISTER OF DEEDS ST. CROIX CO., WI This Deed, made between Mickie A. Burt , a /k /a RECEIVED FOR RECORD Micki Ann Burt 10-09 -2001 9:30 AM WARRANTY DEED Grantor, and Kevin Weiss and Karl Weiss, husband and wife, EXEMPT A - -- • CERT COPY FEE: _ COPY FEE: TRANSFER FEE: 240.00 RECORDING FEE: 11.00 - - PAGES- I Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area That part of NW I/4 SE IA Sec. 3- T28N -RI9W described as follows: Lot 2 Name and Return Address of Certified Survey Map recorded in Vol. 4 of Certified Survey Maps, page KRISTINA OGLAND 904 as Doc. No. 361985. ATTORNEY AT LAW P.O. BOX 359 HUDSON, WI 54016 040 - 1011 -50 -000 Parcel Identification Number (PIN) This is riot homestead property. (X (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this ! — day of _ September _ 2001 + Mickie urt a /k /a Mieku An Burt AUTHENTICATION ACKNOWLEDGMENT Signatures Mickie A. Burt, a /k /a Mic STATE OF WISCONSIN ) ¢ Bur - ... )ss. County ) catO -C - day of September 2001 N � Personally came before me this day of the above named "A 1tilst+ua nd Tif ER'S�ATE BAR OF WISCONSIN - - - bE r to me known to be the person(s) who executed the foregoing " instrument and acknowledged the same. authorized by C 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Notary Public, State of Wisconsin iludso WI 54016 My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ) • Names of persons signing in any capacity must be typed or printed below their signature. trdorma wn Pror aaamnals company. Fond du r ■c, wn STATE BAR OF WISCONSIN 800-655 -2021 WARRANTY DEED FORM No. 2 - 1999 �1 I I IF FORM NO. 985-A ti CERTIFIED SURVEY MAP R RECOR0E0 AS CINTER OP SECTION a N unf.ef Y4 s 09.4e'9w yNFL_ATTEO LANCa aO e. o POINT OF BEGINNIN9 t o ' yo• 207, 18' 800. O ,ea' a 400 49'W i12 ACCESe f 132 . Al l S e - 2 9.4141 -� ep• 0, o ' • � N 4— [ - -� � I/4 CORNER e.■O■ AC. INCLOOINe EA8f9E 7f 24tT ACRES se ■ ° 3 ,�• ITe•} / SECTtON,3 2.Ita AC, E1lOL UOINB .T 29 N, R 19 W w 4 g r o o fAtfN[NT OR f eElTIC •• —~♦ ' :1. -e00' f. '' // �� • �' lVtTtN I - r FOR LOT ! - N lN4t'[' _4 1 ` \`7 �r �A O ° i � '2!4.00' — . a 1 \ �� •O • yt, a 0 4 ea ° 22 aa' NOA7NERL RANT. b 00� \ OF -WAY ,LINE NW--SE — LLEGEND-- IN '' - SECTION CORNER MONUMENT BERNTSEN CAP a , r • I" IRON PIPE FOUNO 0 200' 400' _ a I "X 24' IRON PIPE WEIGHING 1.68 LBS. /LINEAL FOOT SET w ".' SOIL BORINGS o q EXISTING FENCE U W 2 O NnTE: Lot 1 dnes not coincide with that description c'ecarded � 0 in Volume 558 page 199 because of roadway re- alignment after the original description was recorded, e CURVE DATA TABLE Curve Radius Chord Chord Central Tangent No. Length Length Bearing Angle Bearing 1 108.30' 85.66' 863 "E 46 0 35'30" S87 0 09'29 'E 2 592.00' 419.01' N72 'E 41 887 "E 3 1367.00' 162.94' N48 "E 6 ° 50' N51 4 273.not 78.79' N53 ° 03 1 21 "E 16 N44 Thiq instrument was drafted by Scott B. Lohman NOTE: Borings on Lots 2 and 3 are shown to infoT•m interested parties of the only suitable sites for septic systems on those lots. 9 � APPROVED F ►! ED REC 19 in o W ` 11001111 8� of ST, cQOIx c Z Volume 4 Page 904 ,onsin Department of Commerce 7 �� : ion of Safety and Buildings SOIL EVALUATION REPORT 3 in accordance with Comm 85, WIS. Adm. Code Page / of Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must Include, but not limited to: vertical and horizontal reference P oint BM County _ �/ Percent slope, scale or dimensions, north arrow, P C�a,'^ ( t direction and and location and distance to nearest road. Parcel J.D. 00 D. '� Please print -alllnro /�!l•,SC� . ►►►►atiOn. Personal information YOU provide m Reviewed by Proper Y be used for secondary purposes (Privacy Law, . s 15:OA 1 Dal@ Pr Owner (� (m Property Location Property Owner's Mailing Address ; Govt. Lot /vw 1/4 SE, 3 e &72- 7 �wE/2 /Q!i • Lot # Block # 114 S TZ S N 9 Subd. Name or CSM# R /" 411 (or) W City State Zip Code Phone Number 2, CS/41 3 5 3 ,F/ Y U� 3 7 �vD,jow ! Syo1 7l Cit �� s, 3 G " � 39Z 3 ❑ Y ❑Village ®Town N Road ( d(o N ear ., New Construction Use mb Residential / Nuer of bedrooms ❑ Replacement C . ❑ Public or cornmgrcial = De scribe: we li d 41 rat jQ e �Zr Parent .mgt @rial D GPD General comments _ /l!f 4(� and recom mendations: /CS 'v�- �— �t h Plain �lD� PPlicable N � ft. ST C44CIx / i ZONING ❑ Boring # ❑Boring ZONG OF Pit Ground surface elev. 9j" Horizon De - -- -- ft. Depth to . P Dominant Color Redox Description i -- in. stence Bounda In. Munsell Texture Structure Cons Soil Ap licalion Rate Qu. Sz. Cont. Color ry RooIS o • Y Ze V�p Gr. Sz. Sh. GPD /ft= •E1f#1. 10Y4 EIf #2 a s lee • 3 s rT- zs- E,l, Boring # ❑ Boring s Pit Ground surface elev.�b Horizon Depth 2 - pth Dominant Color n9 factor __ � in. In. Re Depth to limiting Description Texture Soil Munsell Qu. Sz. Cont. col Consistence Bounda Application Rate O • -7 IaY�t'. /3 Gr. Sz.LSh. rY Root's GPD/ft2 • .1d /Q G 2 'Et( #1 "Eff#2 • 6 ly (0 3 c o y z ee m o - 7 , S T . 3 4 G tiGO (> Effluent #1 = BOD > 30 < 220 m CST Name (Please Print) A and TSS >30 < 150 mg /L R0,460 — • Effluent #2 = BOD < 30 mg/L and TSS _< �lml C4 Signature 30 mgA. Address ST Number Date Evaluation Conducted ZZe3 S Telephone Number Private Sewage Consultants 655 O'Neil Rd Hudson, Wis. 54016 •s�,(� . za 0? I�yAL Property own er / / � OyO • / s L J Parcel ID # Page of N7 Boring # ❑ Boring 176- K pit Ground surface elev. ft. Depth to limiting factor Z 5 In. fJ• F Soil Application Rate Horizon Depth Dominant Color Redox Beseription Texture Structure Consistence Boundary Roots pp'Ic' (� In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff #2 / 0 ./0 /Oy,P3 /3 z . 0.•13 yo ,P3/ ( 4 c . 3 0 Ls io y,e --= SL, i�sh,� R/1 Boring # ❑ Boring Cjs �� sss : , Y Pit Ground surface elev. II fl. Depth to' limiting factor S in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fl In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Z 5 ioY f� f H o rs .SiL s ��;° S E Boring Boring # ❑ fJ 7� y Pit Ground surface elev. �, ft. Depth to limiting factor Z� in. e Soil Application Rate Horizon Depth gominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 / - 0.// by re 3/3 L .2-fshle d s c_r f s.. . 2 //• �S /o We / f.S,6 /�'1 � a- r � , L ' �'S .�t>� O �'/C EitJ U. z�'72 ... Effluent #1 = BOD > 30 < 220 mg& and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/!- and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider 4nd 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 -261 -8777. soo- e��o�kFioo). m I 1 v D N � i c N 'N4 N , w !� 1 d 'h w 0 ti V% - I � � � m /� 0 M ,., — m rO X S 4° OWE 309.40' p , ;u -� �-- � � tA fo z an Z o z G) m 0 o ° c� 1 o -- o 'v tr m Z i t�I G1 Z '0 :0 1 6 6 �� op HOUSE N m 3 a cn - _v rn rn !° 0 j C'1 'p :U 1 a a►t f M o� 'rr rn o o m C rn Z 2 Im m 0 I1� / Z = rn i 2 2 ° r - 3g' 44.. 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