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HomeMy WebLinkAbout040-1285-90-000 y Wisconsin Department of PRIVATE SEWAGE SYSTEM county: St. Croix Safety and Bcilding Divi INSPECTION REPORT Sanitary Permit No: p 399596 0 dEN tL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information ou provide may be used for seconds purposes [Privacy Law, s.15.04 m Y P Y secondary P rp I Y 1 ()( )1• Permit Holder's Name: City Village X Township Parcel Tax No: Miller, Sam I Troy Township 040 - 1285 -90 -000 CST BM Elev: ! Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer .3S also' Holding St/Ht Inlet f •q5 �`f `b , TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ? � t � 33 / Dt Bottom Dosing ! Header /Man. C 13 - Z-3 Aeration Dist. Pipe Holding Bot. System l�• t PUMP /SIPHON INFORMATION Final Grade l r Manufacturer Demand St Cover Model Numb TDH Lift on Loss System Head TDH Ft For sin Length Dia. Dist. to well SOIL ABSORPTION SYSTEM Gk it'_D RENC Width Length No. Of Trenc s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ! 1 2 SETBACK SYSTEM TO 2 �P / BLDG WELL LAKE/STREAM LEACHING M fact er: , C INFORMATION CHAMBER OR to�(t ` -&c Type Of System: / r UNIT Model N{arrlbeU v`V'. > 30 2 3 t (h DISTRIBUTIOV SYSTEM Header /ManifolQ ,G , Distribution �HoleSize x Hole Spacing Vent to Air Intake Pil Length ` ' Dia Length Di. Spacing 1 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 ❑ No Fig] Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1, J /ID7-- Inspection #2: Location: 494 Apple Pine Circle Unknown (NW 1/4 NW 1/4 9 T29N R17W) The Orchard ; Lot 29 (� t Parcel�lo: 09.28.1,9.1623 _- n 1.) Alt BM Description = [–� A �j 7E w�+vV �- C btr�(� �� ��"i e^'Q /d` ttbw. � e.�.. 1 40 2.) Bldg sewer length = � 3 , o n Q - amount of cover = c� Plan revision Required? ❑ Yes XNo Z' Z L- 3" ' Use other side for additional information. SBD -6710 (R.3/97) Datd Insepctors Signature Cart. No. ' 7T F M t--T (I e rv, t4 loc f 4, L F V1 Ict + f TAt Do. a o l U v T" Cleo q (J7 A 3 .F i I S sdecy and Buildings Division C . a tt fX 201 W. wesh� 7162 ton Ave.. P.O. Box Vtscons � � 53707 - 7162 a� De artment of Commerce srlitary Permit Number Sanitary permit App&at In snood wash Comm 83.21. Wis. Adm. Code, persos�� m .. ;:, Chteck if Revision be used for Star Plan I.D. Number L Applkstfiion I�osmetbo - Pkns Prlot All Intocrosuion �-- C t Parcel Number Ptoperdl a Name l LG 1 1�. M � � Z �� 2 L I A owner's ilWft W Aadr 1e N R B D zip Cade umber Lot Numbck Number Civ. Star ' �! Subdivisio Number CSM ol (� - 27G5 S THE t� � Day n. T of Building (MM all that applj') or 2 Family► Dwelling - Number of B- ds m 1 s OVillage Domft Use o r'Lo S Nearest Rod T R- 1-t 1 .7 51 frT Stir o i x I CQ eme for Internal uss). Complete line line B if applicable) 13L Type of Permit: (C6eck adz one boat on line A (numbering sch A. ! s==' ! y Rgdaeemeat System 3 0 Replacement of 6 0 Addition to or Camty y d XV K1 Tank Od sum Permit Number Date )=rued B.eCk Permi t Ptevnusly hated < ( scheme 4 for Interrwl use) d . C f �q NtBf r2 s - CAC "f �N G Iv. Type o< Permit: (CMdt an that apply)(numberhtg 3 so ❑ constructed w etland 44�Non PreWUtised Io-G�� 210 Mound 47 ❑Sand Filter 0 P b GWJWirw 410 Holding Talc 4g Single Peas Sl Drip line 46 ❑Aerobic T'reaaaent Unit 49 ❑ Reci rculating 30 0 Other -Grade 43 ❑ Az V. nt Ares jntocmatton: percolation Rate System Elevation Final Grade > Vim) Dispersal Area Dispersal Area Soil Application Elevation Required Proposed Raw(Gals./Days/Sq.FL) Win./Inch) V J'Q m Total Number Mawrfactorer Prefab Site Steel Fiber Plastic VI. Tank Into ( s COMM Contttucted Gun (idloos of Taaks New Taub Taub Sap�ie a holding Toot LV 9' ( 5 2 a o �'� - r rr — assume respoa�bility for installation of the POWTS shown on the attached plans. VII, bill Statement I, the undersigned. W/MPRS Number Business Phone Number Phtoaber's Name (Psis[) phunber's Sigmture /�^ Phnnbec'= Address (stteee. City. Star, tip Cade 1 VIII. Corm /De ent Use O Date Issued Issu' Agent signature (No Stamps) water round Solitary Permit Fee (iacludea G Approved ❑ Disapproved Sulcharge Fee) ❑ Owner Given Initial Adverse b s Deco rminuion ' iD V DL Conditions Approv_aUz;7 f DisaIprovttl� Altaa 08 tMas tw tae %-q a adz) for tae sydm M twPa me let. tams 81/2 :11 hwbes In sloe SBT) -6398 (R. 05101) IV r \. - T C) K-c- N a 4,,,7- tt 2- V1 flolO + PEI? fnIT-# rf g 4vT; t► `t , t Zoo 611 Sl� �� l oc ' oo W J z,486 A kc F, I-fw I "ri S t4 ►'►� M It L F ,-e t� V S / Q ,�► R Ih 17 x, k $ co le- 3 G. 4. \ II 1521 Wisconsin Department of Commerce SOIL EVALUATION REPORT page 1 of 4 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations County Attach complete site plan on paper not less than 8' 1 irrch�s:fi ptan must St . Crooc include, but not limited to: vertical and horizon efkrAnaapant (BM) dRectior► and - - -- - percent slope, scale or dimemsions, north a d'tocation a distance to neatest road. Parcel I.D. 040- 1039- 70 -000, ID #9.28.17.133A Please print iiyMrmalillp VC Reviewed By Date Personal information you provide may be u foT9econdary purposes (Privacy s. 15.04 (1) gy Property Owner ' ULL .7 ?Q i Prop" Location Miller, Sam kCO ST c , Govt. Lot NW 1/4 NW 114 S 9 T 28 N R 17 W Property Owner's Mailing Address COU'NTY Lot # i Block # Subd. Name or CSM# 2(>N OFF1Cr P.O. Box 151 29 Plat Of Miller's Orchard City State hone Number �j City _I Village V Town Nearest Road Hudson WI 1 54016 1 j7- 386 - 2 ; 75 Apple pp le Pine Circle 0 New Construction Use: 01 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe. Parent material Glacial outwash _ Flood plain elevation, if applicable na General comments and recommendations: Recommend installing 2 trenches at Tx 90.625', using 29 high capacity BioDiffuser infiltrator chambers at system elev. = 92.50'. Dosing req'd to reach replacement area. Boring # j Boring jj Pit Ground Surface elev. 99.62 ft. Depth to limiting factor > 133 in. Soil Application Rate Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots GPD /ft' *Eff#1 *Eff#2 1 0 -20 1 Oyr4 /4 none sl fill - - - - 0.0 0.0 2 20 -36 1Oyr3 /2 none sl 2fsbk mvfr cs 2f,lm 0.5 0.9 3 36 -51 1Oyr3/4 none Is 1msbk mvfr cs 1fm 0.7 1.2 4 51 -84 1Oyr5/4 none s Osg ml aw - 0.7 1.2 5 84 -94 5yr4/4 none cos Osg dl aw - 0.7 1.2 6 94 -133 1Oyr6 /4 none s Osg dl - - 0.7 1.2 F2 ] Boling # Lj Boring Pit Ground Surface elev. 97.07 ft. Depth to limiting factor >11 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft *Eff#1 *Eff#2 1 0 -9 10yr3/2 none sl 2fsbk mvfr as 7 2f, lmc 0.5 0.9 2 9 -16 1Oyr4/4 none Icos Osg ml aw 1mc 0.5 0.9 3 16 -53 1Oyr5/4 none s Osg ml cs fm 0.7 1.2 4 53 -118 1Oyr6 /4 none s &gr. Osg dl - - 0.7 1.2 -- - H#4 con ' ified sand and gravel - gravel = approx. 15 %. * Effluent #1 = BO ? 30 < 220 mg1L and TSS 30 < 50 mg/L = BOD < 30 mg/L and TSS < mg/L CST Name (Please Print) Sig ure: CST Number James K. T hompson 3602 Address A.C.E. Sal & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 12/27/01 715 - 248 -7767 Prey Owner Miller, Sam Parcel ID # 040- 1039- 70 -000, ID# Page 2 of _4 I 3 I Boring # Boring I _ I w� Pa Ground Surface elev. 99.53 ft. Depth to limiting factor > 137" in. Soil Application Rate Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots GFUft *Eff#1 *Eff#2 1 0 -16 1Oyr3 /2 no sl 2msbk mvfr cs 2fm,1c 0.5 0.9 2 16 -28 1 Oyr4 /3 none Is 1 msbk mvfr cs 2f,1 me 0.7 1.2 3 28 -58 1Oyr5/4 none s &gr Osg ml aw - 0.7 1.2 4 58-82 1Oyr6/4 none s O ml aw - 0.7 1.2 5 82 -90 5yr4/4 none cos Osg dl aw - 0.7 1.2 6 90 -137 1Oyr7 /4 none s Osg dl - - 0.7 1.2 H#6 contains 7.5yr4/4 stains leaching from H#5. F 4 Boring # r j Boring 16 Pit Ground Surface elev. 105.37 _ ft. Depth to limiting factor > 1 10" in. Sal Application Rate Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 1 0 -7 1Oyr3 /3 none sl 2fsbk mvfr as 2f,lmc 0.5 0.9 2 7 -22 1 Oyr4 /3 none sl 1 msbk mvfr aw 2f,1 m 0.5 0.9 3 22-48 7.5yr4/6 none Is Osg ml cs 1fm 0.7 1.2 4 48 -110 1 Oyr5 /6 none s &gr. Osg dl - - 0.7 1.2 H#4 consists of stratified sand and gravel - gravel = approx 20 %. Fr-)] Boring # 01 Boring 01 Pit Ground Surface elev. 105.79 ft. Depth to limiting factor >119" in. Sail Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 2 *Eff#1 *Eff#2 1 0 -11 1Oyr3/3 none sl 2fsbk mvfr as 2fmc 0.5 0.9 2 11 -26 1Oyr4/3 none sl 2msbk mvfr aw 2f,lmc 0.5 0.9 3 26-40 7.5yr4/6 none Is Osg ml cs Urn 0.7 1.2 4 40 -119 1 Oyr5 /6 none s &gr. O sg dl - - 0.7 1. H#4 consists of stratified sand and gravel - gravel = approx 20 %. * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 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. property Owner Miller, Sam Parcel ID # 040- 1039 -70 -000, ID# Page 3 of 4 r Boring # Boring - Pit Ground Surface elev. 106 .59 ft. Depth to limiting factor >117" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtft *Eff#1 *Eff#2 1 0 -11 1Oyr3/3 n one sl 2fsbk mvfr as 2fmc 0.5 0.9 2 10 -29 1Oyr4/3 non sil 2fsbk mvfr aw 2f,1mc 0.5 0.8 3 29-40 7.5yr4/6 none Is Osg ml cs 1fm 0.7 1.2 4 40 -117 1Oyr5 /6 none s &gr. Osg dl - - 0.7 1.2 H#4 consists of stratified sand and gravel - gravel = approx 10 %. F-1 Baring # j Boring Pit Ground Surface elev. _ ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Rats *Eff#1 *Eff#2 Boring i i F-1 # �� vj Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots 2 *Eff#1 *Eff#2 * Effluent #1= BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 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. 3 �3 ■ �,7 eda /ua�'d� ♦ E/e da &cl) � o o 8 Al &29, Sec. , 7i,, Toy. v b3 ' sys� -� 61 �Q ■ Xis � ry� ■ y proposed q ca U e P T� c o : �,'na - c� aresole � �ivt� -� y � ■ 01i,eG't y P� 5 e.�i .� c e tn�p -�'e i �� �r►� - .r' G_ Pa u/,Ie Q �nnSS S�rS�errt��re0. . ti f,. "GF Sanitary Permit Application Safety &buildings Division 201 W. Washington Ave. Z In accord with Comm 83.21, Wis. Adm. Code PO Box 7302 Iv i sconsin Per See reverse side for instructions for completing this application Madison, WI 53707 -7302 Personal information you provide may be used (Submit completed form to county if not Oepertmenr of Commerce [Privacy Law, s. 15 I)(m)] for secondary purposes state owned. Attach complete lans to the coun co o r s etit, on 'a er not less than 8 - 112 x I 1 inches in size. State Sanitary Permit Num eck if revision to previous application State Plan I. D. Number ty S 3 4 s' I. A lication Info mation - Please Print all Infor Location: property Location Property Owner Name N'M ,�1f ` ?E or I�t �� ,t i WI /4 VI /4 Lot Number F Block Number property Ovmer's Mailing Address umber Subdivision Name or CSM Number City. state Zip /) /h :� oe.C LL,di] o pu 4 o gl Lot S v i :� �: I t �i t�U ❑city 11. Type of Building: (check one) r! ❑ Village 1 or 2 Family Dwelling - No. of Bedrooms : 30 - � D 4; tt V Ss 1 I s' FT 1g,Town of Public/Commercial (describe use):_ 0 C C� s — 7 " ❑ State -Owned Q — 3 �' Nearest Road Parcel TaxNumber(s)dy0_ r QD -ev 9- LP - /1 -/ Z3 III. T e f ermit: Check on ❑ Replacement one box on line A. Check box on line B if a lic6ble 5 6. ❑ Addition to A) 1 New 2. eplacement 3. ❑Replacement of 4. Existing System stem S stem Tank Only Date Issued Permit Number B) ❑ A Sani tary Permit was previously issued r� A* Filter IV. Type of POWT System: (Check all that apply) SO $ )0 b t K U S W.S f F F�i O Constructed Wetland Non - pressurized In- ground L.6AC K ❑Mound Pressurized In- ground ❑ Ilolding Tank ❑ Single Pass ❑ Drip Line 0 At - rode ❑ Aerobic Treatment Unit ❑ Recirculating ❑Other: V tD _ c Dis ersal/Treatment Area Information: R 2. Dispersal Arcs 3. Dispersal Arra 4. Soil Application 5. Percolation Rite 6. Sy�s lilcvation Elevation rode Required Proposed Rate (GalsJday /sq. ft.) (MinJinch) _7 �' d D ✓ ,,� o ✓ S 3 1 - _-7, , Capacil} in Total N of Manufacturer Prc! b Site Steel B ass Plastic Coil Gallons Gallons Tanks Existing crete strutted Tanks Tanks ❑ ❑ ❑ ❑ B; TG Vill. Responsibility Statement 1, the undersis ssume res onsibill± for installation of t1 c POWTS shown on the attached ta Bossiness Phone Number fad I'lu ilxr's Signature tostam ) A� Z Name (I Plumber's mnt) G g V Q ( O Plumber's Address (Street, City, State, zip Code) 7o Yk l 1) 6 ZN'l = 'S cv► IX. County /Department Use Only o stamp ❑ Disapproved S Date Issued Issuing A ent Signature (N P ) Approved ❑Owner Given Initial Adverse �( o Determination X. Conditions of Approval /Reasons for Disapproval: t � ,K t� -���� -�' /� � 6c� wt.4.`�%r� p�v w�a- h- �- �a.ct�c,,r�rs reLv�,r�•r,e ` �� k �;rr it e✓ Sf �� [led �otls ` Q /A ro e &, •l�te✓c sh�f 4e L p Co- y�rr. ►k l�; o r ras�' k/%l w it C�aci � O; v j4 V N C QQ 0 4 ry ) N At 4 X w o L44 q �o "s QO s r BioDiffuser Specffications r-I r-% 7-1 EW 4iW L Knockout Universal 1 1 • • • Sizes Chamber 11" Stan- 14" High 16" High Dimensions dard Capacity Capacity 1407 Wisconsin Department of Commerce SOIL EVALUATION REPORT page t d 4 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code AC.E. Soil & Site Evaluations Attach complete site plan on paper,�(ass thari;8%x 11 inches m size. Plan must County St. Croix include, but not limited to: �tdfionrcxdal reference point.(BM), direction and p I.D. percent slope, scale or dim�th ,'ri arrow, and location and distance to nearest road. 040 - 1039- 70 -000, ID#9.28.17.133A P /erase print �'�tion. Date Personal information you p(vw may b � J#IP s (PftagK w, s. 15.04 (1) (m)). Property Owner 11``°° l Properly Location ( " �'` Govt Lot N W 1/4 NW 1k S 9 T 28 N R 17 W Miller, Sam '�c Cj�'rt Property Owners Mailing ' ' Lot # Block # Subd. Name or CSM# P.O. Box 151 �` ='' ��'�' j 29 Plat Of Millers Orchard city p P I City _j village ej Town Nearest Road Hudson WI _ 7 86 -2769 Troy Apple Pine Circle e/ New Construction Use: _e Residential / Number of bedrooms 4 _ Code derived design flow rate 600 GPD J Replacement I Public or comrnerciat - Descnbe: Parent material Glacial outivash Flood plain elevation, if applicable na General comments and recommendations: Recommend installing 2 trenches at 3'x 90.625', using 29 high capacity BioDiffuser infiltrator chambers at system elev. = 93.50 1 Boring # Boring 16 Pit Ground surface elev. 98.19 ft Depth to limiting factor 135 in. Sod Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft= 'Eff#1 1 0 -14 1Oyr3/2 none sl 2fsbk mvfr gs 2fm 70.5v 0.9 ✓ 2 14 -21 1 Oyr3 /3 none sl 2fsbk mvfr cs 2f,1 m 0.9 3 P-30 7.5yr4/6 none Is Osg ml cs 1fm 1.2 ✓ 4 30 -51 1Oyr5 /6 none s D eg m l gs - 0.7 1.2 ✓ 5 51-87 1Oyr5/4 none s Osg ml gw - 0.7 1.2 ✓ 6 87 -135 1 Oyr6 /4 none s Osg ml - - 0.1-1 ✓ Boring # Boring 11 Pit Ground Surface elev. 99.81 ft. Depth to limiting factor > 138" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIiI= "Eff#'I 1 0 -7 1Oyr3/2 none sl 2fs mvfr gs 2 f 0.6/ 0.9 2 7 -16 1Oyr5 /3 none sil 2fsbk mvfr cs 1f 0.5 0.8.i 3 16 -20 1Oyr4 /4 none sl 2msbk mfr cs 1vf 0.5 0.9 4 20 -28 7.5yr4/6 none Is Osg ml gs - 0.7 1.2 ✓ 5 28 -50 1Oyr5B none s Osg ml Cs - 0.7 1.2 6 . 50 - 138 1Oyr5 /4 none s Osg ml - - 0.7 1.2 ✓ Effluent #1 = SOD? 30 < 220 mg/L and TSS >30 < 50 mg/L ' Etfl = BOD <30 mg/L and TSS <--30 mg/L CST Name (Please Print) Signatu CST Number James K. Thompson - — 3 602 Address A.C.E. Sal & Site Evaluations Dlte Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceda, W 54020 4/23/01 715- 248 -7767 111 07 • Properly Ownier Mille Sam Parcel ID # _ 040 1039 - 000, ID# Page 2 of 4 3] goring # _l Boring Pd Ground Surface elm 96.82 -- ft. Depth to limiting factor > 133" in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *EfW2 1 _ 0 - 1O yr 3 / 2 none sl 2fsbk mvfr g s 2f 0.5 ✓ 0. 9 ✓ 2 7 -16 1 Oyr4 /4 none gr. sl 2fsbk mvfr Cs if 0.5 0.9 ✓ 3 16 - 1Oyr5/3 none SO 2msbk mfr cs 1vf 0.5 0.8 ✓ 4 2 -29 7.5yr4/6 none Is Osg ml gs - 0.7 1.2 ✓ 5 29-46 1Oyr5 /6 none s Osg ml cs - 0.7 V 1.2 ✓ 6 46 -133 1 Oyr5 /4 none s Osg ml - - 0.7 X 1.2 ✓ ale R 3 , y 34.2 64pa a F Bones 4 � # 0 PR Ground Surface elm 96.47 ft. Depth to limiting factor >130 in. Soll Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Eff#1 *Eff#2 1 0 -12 1Oyr3 /2 none sl 2fs bk mvfr gs 2f 0.5 0.9 2 12 - 19 1Oyr5 /3 n sri 2fsbk mvfr Cs 1f 0.5 ✓ 0.8 ✓ 3 19 -28 1 Oyr4 /4 none si 2msbk mfr Cs 1 of 0.5 0.9 ✓ 4 -40 7.5yr4/6 none Is Os ml g s - 0.7 1.2 ✓ 5 40 -71 10yr5 /6 none s O s g ml Cs - 0.7 1.2 6 71 -130 1Oyr5 /4 none s Osg m1 - - 0.7 1.2 / � of Q3.3 �, a ,4- �/• s (,�� Boni # i Boring ng to limiti factor - > 126 in. F 5- 1 tl� Pit Ground Surface elev. 95.81 ft Depth limiting Sol Application Rye Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDft *Eff#1 *Eff#2 1 0 - 30 1Oyr3/2 - no sl 2fsb _ mvfr gs 2f 0.5 1 0-9- 2 r 30-39 1 Oyr2 /1 none sl 2fsbk mvfr cs 1 f 0.5 0.9 ✓ F 39-48 1Oyr4 /4 none gr. sl 2msbk mfr Cs 1vf 0.5 0.9 ✓ 4 40-55 7.5yr4/6 none Is O sg ml gs - 0.7 1.2 ✓ 5 55 -93 1Oyr5/6 none s Osg ml cs - 0.7 1.2 ✓ 6 93 -126 10yr5 /4 none s Osg ml - - 0.7 1.2 ✓ of Q3. Z���° a s�•� 7,r * Effluent #1= BOD y > 30 < 220 ngIL and TSS >30 < 150 mg/L * Effkrerrt #2 = BOD a 30 mg/L and TSS <_0 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 fomw. please contact the department at 608. 266 -3151 or TTY 608- 264 -8777. IqO 7 • property Owff Miller, Sam Parcel ID # 040-1039- 70 -OW, ID# Page 3 d 4 6 ] F Boring # Boring - 1/ Pit Ground Surface elev. _ 95 ft. Depth to limiting factor ' >97" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GOOM *Eff#1 *Eff#2 1 0 -11 1Oyr3/2 none sl 2fsbk mfr gs 2fm 0.5 0.9/ 2 11 -23 1Oyr5/4 none s Osg mfr Cs 2f,tm 0.7 1.2 ✓ 3 23-51 1Oyr5 /4 none SOWS Om mfr Cs 1fm 0.0 ✓ 0.2 ✓ 4 5140 1Oyr6 /4 none sl Om mfr gs - 0.3 ✓ 0.5 5 70 -97 1 Oyr5 /4 none Is - - 1 msbk - -- - - ml -` - - - -- - 0.7 1.2 ✓ t-fllri conWft d a straliflad rrriran d fknAel deposits too rnarrenom to ernrrrerate. Site not reooni needed for system irrnNNedon" wnpratIble netwerot�. o Boring # Boring Pit Ground Surface elev. 93.31 ft. Depth to limiting factor > 100 in. Sol gppn Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Ef #1 *Eff#2 1 0 -17 1Oyr3/2 none sl 2fsbk mfr gs 2fm 0.5 0.9 ✓ 2 17 -30 1Oyr5/4 n one s Osg mfr CS 2f,1m 0.7 r 1.2 3 30-82 1Oyr5/4 n one sivaVis Om mfr C5 Urn 0.0 ✓ 0.2 4 82 -97 1Oyr6/4 none sI Om mfr gs - 0.3 0.5 ✓ 5 97 -100 1Oyr5 none Is I msbk ml - - 0.7 1.2 ✓ H N3 c=kft d a 9W WW mb4ura d ftrM deposits too rwarerous to en rneraW . Site r at necanrr+arrded for syalem YrstrI Ik drralsc►errp dt 1 bte nahn of stralffikedw. 8 ] F Ong # _j Boring Pit Ground Surface elev. 94.29 ft. Depth to limiting factor >95" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ' "Eff#1 *Eff#2 1 0 - 14 1 Oyr3/2 non sl 2fsbk mfr gs 2fm 0.5 r 0.9 ✓ 2 14 -29 1Oyr5 /4 none 5 'f\ Osg mfr Cs 2f,lm 0.7,/ 1.2 / F5 29 - 1Oyr5/4 none sivsVls Om mfr Cs 1fm 0.0 0.2 4 77-89 1Oyr6/4 none si Om mfr gs - 0.3 0.5 89 - 95 1Oyr5/4 none Is 1ms mt - - 0.7 ✓ 1.2✓ H#3 consists d a stratified ntbdm d idol deposits too rnrrmux to en �ipa Agt,recorrrrurtded forsystsr+ trterdieYan dme tD unprorNaMble -MAN trot rr * Effluent #1= SOD 30 < 220 nxyL and TSS >30 < 150 mgIL * Effluent 42 = BOD <30 rtg& and TSS <�0 mglL The Department of Comnnerce 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. ■ 50. l Ohs erVa� cry • Ss; I P unSc�i�ab /� {o� �• Coo 0 /ot 2 9 6zc.9, 7n.oFTioy, S& . Cro i x Co., C X. O7 le 67 8Oa>� 3�c E1 ae� maces • o- Sy OB ,0 ,M0. S prk�C �r c es r i� o, y S {ems ■ $ 2 B3 r a . B 31 9B Q ■ � 0 Pc bar. E /e✓: =9B 5 k s � ■ Q Be 7o oF-�6 red reload. Assumed I Q I ev' y s y ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND / OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Z 4 T Z._ Property Address 1 4()\'J L P C (Verification required from Planning Department for new construction) City/State U 5 0 I Parcel Identification Number LEGAL DESCRIPTION 7 Property Location ' /., ' /�, S T N -R � Town of " , %Mivision !'t i b �.( f�•- . Lot # • Certified Survey P Ma # 3 �/r3 , Volume . Page # S Warranty Deed # �° 3 a`� 9 , Volume 5 . Page # IZ3 Spec house W ❑ no Lot lines identifiable R yes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof 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 masterplumber, journeyman plumber, restricted plumber 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, asset 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 St. Croix County Zoning Office within 30 days of the three year qcpiration date. i ( / A OF APPLICANT DATE .. .0 -N NER CERTIFICATION 1'(we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of d a , by virtue of a warranty deed recorded in Register of Deeds Office. SI ' ATU ' RE O PLICANT 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 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) �© o Estimated Flow - Average (gpd) C.) Septic Tank Capacity (gal) t z_ S<�' Soil Absorption Component Size (W) 5 r, PT z Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) �r 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 se and outlet filter shall be assessed at least once every 3 years by inspection. T e outle filte shall be cl e an ed as nec to -ne sL re proper operation. The filter cartridge should not be removed unless provisions are made to retain solids 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 1/3 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 component's 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. Th; s s Q s sfiQ •+� �o _ Bc �o� / o vs Ttia-- / 1 0 f a LV�A� 6jc OSve 7"-s- 3 TIC, g <` G/�► u ce Gumm Zon;hq 3 _ p • STATE BAR OF WISCONSIN FORM 7 - 1998 632796 ' TRUSTEE'S DEED KATHLEEN H. WALSH Da,erM VOL 1555►IG $7. CROIXOCO., WI DANIEL S. SOLBERG AND KARLA J. SOLBERG RECEIVE) FOR AECIRII 11-01 - 2000 8:30 AI TRUSTEES IEEI as Trustee of EIENPT 1 SOL BERG DANIEL S. AND KAR A 1. SOLBERG REVOCABLE CERT COPY FEEL TRUST DATED APRIL COPY FEE: ' TRANSFER FEE: 2110.30 RECORPIN6 FEE: 10.06 for a val It consideration conveys without warrant to PAGES' 1 E. MILLER, A SINGLE PERSON !, RocrY"A,va Grantee. the following described naal estate In ST. CR County. i NainesnelReturnAddreas State of Wisconsin: SAM MILLER P.O. BOX 151 PART OF-THE NWk OF THE NA AND THE SA OF THE NWk AND THE HUDSON, WI 54016 NEk OF THE NWIE AND THE NA OF THE NEk AND THE NWIC OF THE SWk OF SECTION 9, TOWNSHIP 28 NORTH, RANGE 1.9 WEST, TOWN OF TROY, ST. CROIX COUNTY, WISCONSIN AND MORE PARTICULARLY -- DESCRIBED AS FOLLOWS: BEGINNING AT THE NORTHWEST CORNER OF 040 - 1038 -60 040 - 1039 -60 -000 SAID SECTION 9, THENCE S00 "E ALONG THE WEST LINE OF 040 - 1039- 7n -nno SAIDNA 2626.30 FEET TO THE WEST QUARTER CORNER OF SAID I�arniktanttscatlo^rk+'a' SECTION 9; THENCE S00'45'32 "E ALONG THE WEST LINE SWk OF SAID SECTION 9 150.31 FEET: THENCE S56'24 "E 70.00 FEET: THENCE N59'15'17 "E 850.85 FEET THENCE ON AN ARC OF A CURVE TO THE RIGHT 102.10 FEET AND WHOSE RADIUS IS 403.00 FEET AND CHORD BEARS N07'32'30.5 "W 101.78 'FEET; THENCE N00'21'49 "E 569.05 FEET; THENCE 588'45 11 W 250.00 FEET; THENCE NOO'50'54 "W 350.92FEET; THENCE S88 "W 512.29 FEET; THENCE N00'50'54" 100.00 FEET; THENCE N88'57'07 "E 250.31 FEET; THENCE NO3'10'51 "E 202.31 FEET; THENCE N32 "W 95.25 FEET; THENCE NO2'24'54 "E 136.96 FEET; THENCE S87'34'25 "E 198.63 FEET; THENCE S01'54'33 "W 149.41 FEET; THENCE N89'46'50 "E 148.76 FEET; THENCE S2'27'16 "W 256.95 FEET; THENCE N88'57'07 "E 1065.55 FEET; THENCE N89'12'30 "E 325.61 FEET; THENCE SOO'47'30 "E 10.00 FEET; THENCE N89'12'30 "E 554.46 FEET; THENCE N01 "E 587.22 FEET; THENCE N55'31'03 "E 651.90 FEET; THENCE N38'09'35 "W 413.25 FEET; THENCE S89'31'02 "W 142.03 FEET TO THE NORTH QUARTER CORNER OF SAID SECTION 9; THENCE S89'12 "W ALONG THE NORTH LINE OF THE NWk OF SAID SECTION 9, 2666.45 FEET TO THE POINT OF BEGINNING, SAID PARCEL CONTAINS 96.52 ACRES AND IS SUBJECT TO ANY EASEMENTS OR RESTRICTIONS OF RECORD. .I Dated this ay or OCTOB 2000 . (SEAL) I (n/ ISF�U �d j jOwO /���0 I DANIEL S. SOLBER KARLA J. SOLBERG rtatw T now 1 i AUTHENTICATION ACKNOWLEDGMgNT +W State of Wisconsin, %a. Cautl ,� P(tOr�Uy came before me this ay of !: authenticated this ay of the above named TITLE: MEMBER STATE BAR OF WISCONSIN V to , (If rat, me known to be the person L who executed the foregoing aulhorlaed by 5706.06, Wis. Suu.) I trument and acknowledge thLe VMS INSTRUMENT WAS DRAFTED BY Ow M -_- H EYWOOD6 CARL, S.C. 204 LOCUST STRFFT _ S= W WtsCOAY Notary Public. State of Wisconsin HUDSON, WI 54016 N ry � My commission Is permanent. (If n t, state expiration ate: (Signatures may be authenticated or acknowledged. Both am not 5 � - - 1 - necessary) • N. of P, me" m Mr np,nty ma M t"W a Prtttue Iww ttwr ,r,wum TNU;TEE'f DEED STATE IIAa OF WISCONSIN w.Ker•w Logo UM c e K FORM No } - 1 eN ta..v wr we I ' t LO LM co ' \� \ 0 ■ eee� co Lm ...d *. ' = I$al i q. y `�' It x e ,t � o � O � LLI N Jii' LM cc .y� w W M LO - - N - ---- -em �,we • Lvc, ' Y Q �, _� Q �► /11 LL 00 ` LL- LO F 0 m - i ll ,LOOU .C1M f S ..er.�Ltos .,f A� 7.K.•LlOV yy • r t•J , 9 Y t Y Q ry N �j •�• y w I rN \�`: 1 Y!1 � it � � !: Y` t I o O " •� `•r'' It �s � f� Yt `F ?� •� ��k t� d SN r ,ti; a 3� .! °, •� .+ !� 1 "smooS "w, y De'a»b r/r •. A )X' 'St+r ),rC.OLOOS .00 Kt: J. i � 'ARTMENT. I i I I I I I NORTH LINE NW 1V4 SECTION 9 2666.E 5' S89 I 287.60' / 5.95 316.45 361.95'. 151.45' / 55' POND HWE = 854.20' 4 N 8 42 E 9 2'24' E 125 � t 172.29' § E L0 39' DRAINAGE L ot " 18.72' N ASEMENT 114513 / OT 31 3 / N 80'40'42" E cn / / 2.6 / 109052 Sq. Ft. u N.B. z / / / / w /\ 2 .50 Ac. o N.B. 2.06 AC. N.B. 8E o �� I / \ N.B. 89629 sq. ft o cn 1094 2.51 Ac. N.B. 2.33 AC. N.B. 101345 sq. ft. clq 36.17' DEDICATEE 2 2.88 ' _ \ \ \ \ \ LOT // 3 0 / "cJ9*rJ3" WO � �•� / THE PURL 22.8 \ / 6 228 .41 9 0 59 - 53 - ._. 9 109035 Sq. Ft. / © �/ S 78 2s .89'59'53jM'�1�\� 2, \ \ 2.50 Ac. / / ��� B 2.50 N.B. sq. ft. / /'�� 3 /a/ LOT 20 117229 Sq. Ft. a`i����h�O 2.69 Ac. \ 2�0 \ / / � % K 9 e• + 109688 Sc N.B. 2.57 AC. `� �� \. `� / �� Q�� // 5 J ;, 152 A N.B. 111750 s q ft. ti . /�, ',� �b• / �a � \ R" P �� ��ti• 968.5 � w use' S`89 ` 211.83 S 89'3 N.B. 2.36 f >t N.B. 102923 \\LOT 10 228.E 112247 Sq. Ft. \� �-- - - - - -- 2. 9 \C. \ 18 \ \\ 15 198.63' N.B. .59 AC. ` I I CR7'�d'7� "� IN. 11277 sq. ft. J H RiaHwAY sErmm THE ORCHARI AS PER WISCONSIN ADMINISTRATIVE CODE TRANS 233 NO IMPROVEMENTS OR STRUCTURES ARE ALLOWED BETWEEN THE RIGHT -OF -WAY AND THE SETBACK LOCATED IN PART OF THE NORTHWEST OF LINE IMPROVEMENTS INCLUDE BUT ARE NOT LIMITED TO SIGNS, PARKING LOTS, PART THE SOUTHWEST 1/4 EC THE OF C PARALLEL DRIVEWAYS, WELLS, SEPTIC SYSTEMS, DRAINAGE FACILITIES, ETC.. R 5 PART CERTIFIED SURVEY MAP RECORD! OF THE NORTHWEST 1/4 OF THI BEING EXPRESSLY INTENDED THAT THESE RESTRICTIONS SHALL CONSTITUTE A 5 OF CERTIFIED SURVEY MAP RECORD! RESTRICTION FOR THE BENEFIT OF THE PUBLIC ACCORDING TO SECTION 236.293, PART OF THE NORTHEAST 1/4 OF THE WISCONSIN STATUTES AND SHALL BE ENFORCEABLE BY THE DEPARTMENT OF THE NORTHWEST 1/4 OF THE NORTHE TRANSPORTATION. CONTACT THE WISCONSIN DEPARTMENT OF TRANSPORTATION NORTH, RANGE 19 WEST, TOWN OF TF DISTRICT OFFICE FOR INFORMATION. THE PHONE NUMBER MAYBE OBTAINED BY CONTACTING YOUR COUNTY HIGHWAY DEPARTMENT. I I I I SR C tS� 1 FOUND 3" ALIMINUM MONUMENT CORNER SECTION 9 NORTHWE SMP %� �/ I I NORTH LINE NW 1 SECTION 9 2666.5' S8912'35 252.60 287.60 a�' J - 1 / ,/ Ol Y2a'E .''* M017a1 - , , i72.2C a N LOT 2f ' '' LOT 32 OT 31 13 LOT 29 M e .7, E 114513 Sq. F CSM_LOT 3 / / 109052 S 2.63 Ac. Sq. Ft. VOL_ 9 PAGE 2603 , / / I / , / / h / 2.50 AC. 1 N.B. 1.98 AC 12 / / n / / ` N.B. 86124 sq- / / / N.B. 2.06 AC. ni I / / // I o / \ N.B. 89629 sq. f� N 119902 Sq. Ft. o I 2.75 AC. p / / / O 'IT / 10 ----- - - - - -- N.B. 2.41 AC. 2.$1 AC. w / N.B. 105181 sq. ft. N.B. 2.33 AC. ` w N.B. 101345 sq, ft. o° -- 170_12' - - -- 96.71' _ �Zi �T' LVl /90 / / 00 -------------- -- m0 SFUT RO A I e95953' W®� , f ® DE �Eweu DTO --a X66' E A S E M E N e s9s�� � ,' / 228 .,1. _ 9 \ 109035 Sq. Ft. / S X179 42 N n -- 169774 292.02, - - - -/ 2 `\ 2.50 AC. N � /� \� \\ N.B. 2.50 AC. LOT 26 ~ N.B. 109035 sq. ft. / / ^� /+ TEMPORARY CUL -DE -SAC 1172 2 9 Sq. Ft. 9 *S EASEMENT (REMOVE UPON L 9 2.69 AC. \\ \ 4 WESTERLY EXTENSION ((n o \ * q� \\ / ' '72 Vie. s /tiJ 10968�Sq. Ft. ROAD) w N.B. 2.57 AC. ��• Jy 2 52 AC. z N.B. 111750 sq. ft. / J r q> I � O I \ �_ _ y \ \ \ \ \ S\ ` y am. � w �osze' s ern n w ( • 211.e}' S 6979'2e E N.B. 2.36 AC. y �\ ' \ F , s \ N.B. 102923 sq. ft. \ ^ \LOT 10 ` \ * \ a Q \ �\ 3 24 0) \� h \ \ • 228.61' z z N — — .112.1.7 Sq. Ft. F �c - - - - - -- - - `O r 1e72 *3, w 2.,59 \c. - - - - - w \ 198.63 N.B. \`2 ,59 AC. 7 ? w 587 "E N.B. 112747 sq. ft. J V) rn n DEEDED BY 149.41' S01*5433 "W ae'I LOT 11 I 't AFFIDAVIT L LOT 8I 160 u `✓ z \ 171954 Sq. Ft. o ; 1 11626 Sq. F \ / -- 3.95 Ac. m N 2.56 Ac. 148.76' N89'46'50 "E r — — — 3 N.B. 3.95 AC. Z CSM VOL_5 io — N.B. 171954 sq. ft. ° PAGC 1300 95.25' N32 "W o N N M CaM VOL .1 N N.B. 2.56 AC. O P9G�.11� O F N.B. 111626 s . ft. 2 N in Z M a1 p 502.64' N N - - - --- - ----- - - - - -- - - — — — — — 250.31' N88'57'07 'E _ 100.00' Noo 2.30' N W 88'45'3e'E R.A. 51 - - COUNTY HIGHWAY FF 2.30' N f 512.29' S88'57 "W — — — - - — — — — - - -- - -- -- - - - - -- _ - - - - 235.64' 276.65' + UATrH IIWF