HomeMy WebLinkAbout040-1061-95-100 i
:
Wisconsin Department of Commerce County $t. Croix
Safety and Building Division
Sanitary Permit No:
. r (ATTACH TO PERMIT)
State Plan ID No: 430179 0
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. � -8'�i �D = re-U.. /
Permit Holder's Name: City Village Township Parcel Tax No:
Bohnert, Dale Troy Township 040 - 1061 -95 -100
CST BM Elev: Insp. BM Elev: I BM Description: Section/Town /Range /Map No:
Oa- /bD, O J�Yt/ ✓C �` a 15.28.19.234E
IF
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing L, 61t S &VC Alt. BM
Aeration Bldg. Sewer 1 T D r
T �•
Holding St/Ht Inlet '�• L r
St'Ht Outlet ,
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet �, �•�
Septic a 5 , \ 3 . Dt Bottom 6 6) , ' 3 - D .
Dosing Header /Man.
> 1� > o ( • �s
Aeration Dist. Pipe It 9t
• fv
Holding Bot. System
. en l� •90
R al Grade
W :l ( 6L zF 12 +-AAbZA c buff = oe
IN X
Manufacturer Demand St Cover
GPM �•� 2 q r
Model Number %
T H Lift Friction Loss System Head TDH Ft � d
• a •`{O 2 •coq (o • sn �(o • Z Z. ob . , O q. 0
i orcemain Length t Dia. tt Dist. to Well
Width Length N . Of Trenches No. Of Pits Inside Dia.
SYSTEM TO P/L jBLDG WELL LAKE /STREAM ufacturer:
Type Of System: t ` Mode
M S f , �� ,,, —
Header /Manifold, u Distribution x Hole Size q x Hole Spacing Vent to Air Intake
3 D Pipe(s) t 3 -o
Length Dia L Spacin 1 (� 1 ;? I
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil a Yes No [ Yes L No
(Include code discrepencies, persons present, etc.) Inspection #1: 121 Inspection #2: � / 2 `� 3
308 S Glover Rd Ri T of 1 1 28.1 .234E
1.) Alt BM Description
2.) Bldg sewer length = /_ 4 � `/ 2aO •y(0�� i%`^« - �td b + e-�'
- amount of cover = W to
s4
t'1F-
I -t'< <
ao
l
• to bS - D,�S�
Plan revision Required? Yes ) No - - -
Use other side for additional information. Jp
v"
SBD -6710 (R.3/97) a '�`•CC . S Insepc or's Signature Cert. No.
I I
Safety and Buildings Division County
N VI 201 W. Washington Ave., P.O. Box 7162
Sc onsin Madison, WI 53707 - 7162 Sanita r Permit Number , o be filled in by Co.)
Departmen, of Commerce (608) 266 -3151 V36
Sanitary Permit Application State Plan I.D. Numb .y V/ /
In accord with Comm 83.21, Wis. Adm. Code, personal information you provid Y11 Q ((,
may be used for secondary purposes Privacy Law, s15.04(l)(m) P V Proj ct Address (if differ $t than mailing address)
I. Application Information - Please Print All Information - 50 s 6L-D
Proper water's Na me � r� , �� � ^yY" W v -, - �� Parcel }, Lot k ` Block f1
L 6 � E�(�j c% 0 9s" X"
Property Owner's M ailing Address ' 1 t ' aw Property Location 34
L, CON G lV6 ��-
City, State Zip Code t Phofl mll'er r t�'Section -
' �� S�Q (circle one
T �i"-- = -- N; RE orA
Il. Type of Building (check all that apply)
1 or. 2 Family Dwelling - Number of Bedrooms -� Subdivision Name 1! M Number 9
L1 Public /Cotnmercial - Describe Use yLC� O T O g 3 r /
❑ State Owned - Describe Use ftw 4 � 4G , a& Q Y -7 A COyh�i j ❑City_❑Village ®.Township of 40 y
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A, JLNew System ❑ Replacement System Y p y ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System
B. El Permit Renewal ❑Permit Revision 11 Change of ❑ Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. Type of POWTS System: (Check all that ap ply)
❑ Non - Pressurized In- Ground X Mound > 24 in. of suitable soil _ b 1 ❑Mound < 24 m. of suitable soil ❑ At -Grade El Single Pass Sand Filter
❑ Constructed Weiland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter
❑ Recir culating Syn thetic Media Filter ❑ L ching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) `
V. Dispersal/Treatment Area Information: 2
Design Flow (gpd) Design Soil Application Rate gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
l ail 0 3 71 ri I bd D /M, _' 4/
VI. Tank Info t apacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallows Gallons of Units .= � "'J""` lot Concrete Constructed Glass
New Existing /
Tanks I Tanks
- Septic or Holding Tank °Z /
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume respo sibility for installation of the POWTS shown on the attached plans.
Plumber' Na me (Print) Plumber's Si gnature MP /D Number Business Phone Number
Plumber's Addre ss (Street, City, State, Zip C e)
VIII ount /De artment Use Onl
Approved El Disapproved Sanitary Permit Fee (includes Groundwater EDatlssued suing
Surcharge Fee) �
El Owner Given Reas for Denial
IX. Conditions of Approval /Reasons for Disapproval
� sue- ��e��c --� rat. r,���ZuSo ���� f� /u���✓
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)
PLOT PLAN
3 e
Scale 1 " =50' P of �
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PvC- P We w /WN -1
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JOT eom, P ftoT Ufz
III I L>�S`R�� � �zlrA
TAY-) 0 loZ 2d►' qS
t�T U kl� JCE
LINE J 1(
NOTES: t'Z- tows'
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install 4" observation pipes with approved caps. ( Z required).
3. Aeptic to be \Zsy gallon capacity manufactured by W tL:TSCZ_ P bzent
. w LP �Z — MR � I H -LY, ZP�g�L F►L PUv�1,P - S`��. `Itl QF � SO �C. L�.tl ��Q I .
I
4. Bench marks SZ9�E7 ft
3. Divert surface water around system to prevent ponding at the uphill side.
Safety and Buildings
4003 N KINNEY COULEE RD
LACROSSE WI 54601-1831
TDD #: (608) 264-8777
www.commerce.state.wi.us/sb
Viscoftsin www.wisconsin.gov
Department of Commerce - ' D
Jim Doyle, Governor
Cory L. Nettles, Secretary
July 01, 2003
CUST ID No.267341 ATTN. POWTS Inspector
ARTHUR L WEGERER ZONING OFFICE
WEGERER SOIL TESTING & DESIGN SERVICE ST CROIX COUNTY SPIA
PO BOX 74 1101 CARMICHAEL RD
RIVER FALLS WI 54022 HUDSON WI 54016
CONDITIONAL APPROVAL 'f 3Z) 1I-
PLAN APPROVAL EXPIRES: 07/01/2005 Identification Numbers
Transaction ID No. 878618
SITE: Site ID No. 660780
Dale & Angela Bohnert Please refer to both identification numbers
S Glover Road above, in all c orrespondence with the agency._]
Town of Troy
St Croix County
SWIA, SW1/4, S15, T28N, R19W
FOR:
Description: Proposed Four Bedroom Mound System
Object Type: POWT System Regulated Object ID No.: 908753
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 10 1.0 1 (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:
• This system is to be constructed and located in accordance with the enclosed approved plans and with the
"Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N. /O1)
and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems
VERSION 2.0" SBD-10706-P (N.01/01).
• Limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction,
excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited.
• A state approved effluent filter is required. Maintenance information must be given to the owner of the tank
explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided
per Comm 84 product approval conditions.
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of See. 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 See. 145.20(2)(d), Wis. Stats.
• Comm 83.22(7) - 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.
C
C
oll, 1(k
ARTHUR L WEGERER Page 2 7/1/03
Owner Responsibilities:
• Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and
maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.
Comm 83.54(1).
• Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as
required under s. Comm 83.54(4) shall be considered a human health hazard. 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.
• The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is acceptable
to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the
component(s) utilized in the POWTS.
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.
h o are responsible for the
The above left addressee shall provide a co of this letter to the owner and an others wh e p
P PY Y
installation, operation or maintenance of the POWTS.
Sincerely,
Fee Required $ 175.00
Fee Received $ 175.00
Balance Due $ 0.00
Gerard M. Swim
POWTS Plan Reviewer - Integrated Services
(608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm
jswim @commerce.state.wi.us WiSMART code:,7633
cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544
I
I
TITLE SHEET Page I of
FOUND SYSTEM
FOR
A BEDROOM RESIDENCE
This plan has. been prepared in accordance with the Mound Component
Manual SBD -1057 P and the Pressure Distribution Manual SBD- 10573 -P
C2. b /9q� C2. 6lgq�
LOCATED IN THE SW 1/4 OF THE SW 1/4 OF SECTION \S ,T 2,8 N,R 1q W,
TOWN OF , �j`t C� COUNTY, WISCONSIN.
x-01' 1 tip- esr� ) \10 L ,7, pq Zug3
INDEX
PAGE 1 of 7 TITLE SHEET
PAGE 2 Of 7 SYSTEM MANAGEMENT PLAN
PAGE 3 of 7 PLOT PLAN
PAGE 4 of 7 PLAN VIEW -CROSS SECTION
PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT
PAGE 6 of 7 PUMPING CHAMBER CROSS SECTION
PAGE 7 of 7 PUMP PERFORMANCE CURVE
po I PREPARED FOR
+R �
V hlv
a7 �� �Zl V LN� PrL.0 S , 1^1 I S q 0 Z-
PREPARED BY
WEGEE�
ER SL7 � L TEST S NG
AND.
DES I Gfii SaEF:ZV Z CE
P.O. Box 74 421 N.1-Iain St.
River Falls, WI 54022 �C0�
Phone 715 - 425 -0165 ,,,.. «...•S�°Y
Fax 715- 425 -6864 s :•
i AP 1 �fJQ L
wecL
aota r
RLSWOHrw.
L
S j G'9
Iii t'AR7MC Ya f Or LC l.,,_ h;
DlV15�Uh1 of SAFETY ANii t�UiLEiIi� 3S
JOB NO.
SEE GOf1i =��." ONU�_tv(;E
Mound System Management Plan pag Z of - 7
Pursuant to Comm 83.54, Wis. Adm. Code
S•eotic 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. The operating condition of the septic tank and
outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to
ensure 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 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 sludge and scum 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 a triennial 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. The addition of biological or chemical additives to enhance septic tank performance is generally not required:
However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and
Buildings Division.
Pump Tank
The pump (dosing) tank shall be inspected at least once every 3 years. All switches alarms and pumps shall he tested to
verify proper operation. If an effluent toter is mstalied wRhin the tank it shall be inspected and serviced as necessary.
Mound and Pressure Distribution System
No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound
shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic
(other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the
infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather
installations (October - February) dictate that the mound be heavily mulched for frost protection.
Influent quality into the mound system may not exceed 220 mg /L 6005, 150 mg/L TSS, and 30 mg /L FOG. Influent flow may
not exceed maximum design flow specified in the permit for this installation.
The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each
lateral'be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be
compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is
required to maintain equal distribution within the dispersal cell.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner,
and any levels above 4 inches considered as an impending hydraulic failure re uidn additional
q 9 ,more frequent monitoring.
General
This system shalt be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its'
component manual [SBD- 10572 -P (R.-6/99)) arid local or state rules pertaining to system maintenance and maintenance
reporting. . .
No one should ever enter a septic or pump tank since dang gases may b
tank abandonment g 9 y e present that could cause death. Septic and
pump a donment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as
POWTS components.
Septic or pump 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 a tank or component.
Continaencv Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition.
If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be
Immediately repaired or replaced with a component of the same or equal performance.
If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired
or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption
and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper
operating condition.
Questions about the operation or maintenance of this system should be directed to:
The County Zoning at 15--3 ( �, 0 ST <12 -UVA
The system installer at �L— Z.�3_y�l�u - 1ULSON
The tank manufacturer at g D0-Z Z.S. _ LAJ1Z':S(
The effluent filter manufacturer at $h�0 - ZZ��_ S Z Z,"�'�
The pump manufacturer at tot - ZSLi - ► ITY )"1 Q)Z-s
PLOT PLAN
Scale 1"=501
Page 3 of
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C a��o�.iZ « tiio (LoT LI AJ
NOTES: NZ ►ou.s'
1. Elevations shown are existing ground elevations unless otherwise noted.
2. Install 4" observation pipes with approved caps. ( Z required).
3. ltic tank to be �ZSV gallon capacy manufactured by W 1N�` LP 12'SO - M�Z r H _ltio ZPsB� F1L � i�
> IftAC )1.j ' a 1 2 - - 1 So ni. PrL L�jt Es%kTI_ .
4. Bench marks Ss'oV�
�. Divert surface water around system to prevent ponding at the uphill side.
Page ! Or
Approved; S Covering
ASTIH C33 Distribution Pipe
Medium Sand
Tcpscii _ js
c. - _r E1ev. l 00 S
3 „
- u
b
Slope
Distribution Cell of Farce Main Plowed
z" to 2- Aggregate From Pump Layer
D
E \ • 1 49 Ft.
CROSS SECTIO>ti OF A MOUND SYSTEM F O,' Ft.
G 0- S Ft.
A G Ft. H l- u Ft.
Linear Loading Rate= q.O GPD /ILL*i FT 8 6 - 7 Ft.
Design Loading Rate =O 37 GPD /SQ FT j S Ft.
Ft.
1
. K q Ft.
, n
L 8 S Ft.
u- w Z 9 Ft.
�} Observation Pipe
E K
A o -- -- --- 8 - -- --- - - - - -- ------ - - - - -- - ---- --
w �- 6, Force Main
- f__ -. - --
Distribution
Pipe Cell of to 2�
aggregat
Observation. Pipe
Ulac�cr securely)
- PLAN VIEW OF A MOUND SYSTEM
Distribution Pipe Layout Page of
Page
Place the holes at the bottom of the distribution pipes
at equal spacing. Remove all burrs from the pipe and holes.
Extend the end of each lateral up with the use of long tumor 45 ° fitdn; to a point within six
inches d the final grade. Terminate the ends of the laterals with a valve,:threaded cap or
. threaded plug. Provide access from final grade for the valve, threaded cap or threaded plug.
-
T-t T 1 cry L �_KzzS S
PVC P�j^
Lateral Manifold P
X x x x x/2 x!2 X X x X
Lateral Length — Lateral Length —
Distribution Line
— — o
M rru I Fc»
S
PVC t(ZE n P,
Z
P 3 3 Ft. Hole Diameter 1 � Inch
5 3 Ft Lateral 1 Inches)
X Z Inches Manifold Inches
Force Main " Z Inches
of holes /pipe �1
• Invert Elevation of.Laterals o Ft.
PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS PAGE 6: OF 7
VCWT CAP
4"C.1- VENT PIPr
-fr WEATHER PROOF APPROVED LOCKING MANHOLE
III ' — ZO 1 FROM Door, 7 JUIJCTION BOX - COVER WITH WARNING LABEL
WINDOW OR FRESH 12'MIU.
AIR INTAKE I
GRADE I
LoN
COAIpuiT ` --
IMLE:T PROVIDE I __ --
AIRTIGHT SEAL i
APPROVED JOI1JTl A I', APPROVED JOINJTS
I I�
i � IC I
�LARA
• I I
a I I
I I ON
c I
` LLEV a!—'25F T
_J
PUMP -., - OFF
D
e?L q 3. (3 O I COLICKETE DLOCK
• �- RISER. EXIT PERMITTED OAILy 3" APPRovED
IF TAWK MANJUFAGTURCR HAS SUCH APPROVAL
���LLL .
5 P E C I F I C AT I OKJ S
0059
•rrA,�S MALIUFACTURCR: w1EnM �t1>y UIUMBEA OF DOSES' S 3 PER DAy
TANK :+IZL: WLP'1 - r't �Z GALLOWS DOSE VOLUME Z
ALARM . - 3", S 3 ICLUDIIGo DACKFLOW �Z 1 •� LL
_MAyUFACTUp R. U �'1 ` (t�^iS N
. GA ONS
AODEL WumBCit: 1W liw - CAPACITIES: A - Z2 WCHES OR y S- C O GALLOIJ3 --
SWITCH TYPE: 'Y B - / INCHES OR 4 D' 6 G�LLOLIS
PUMP MAMUFACTUR£R: �� �� 5 C s 6 I u CHE5 OR VL1 --7 GALLONS
MODEL NUMOER: C t D= IMCHESOR GALLOWS
3W1TCH TYPE: h'�LQC 1J�2�f MOTE: PUMP A)JD ALARM ARE TO DE
MIIJIMIJM DISCHARGE RATE Z GPM INSTALLED OW SEPARATE CIRCUITS
VERTICAL DIFFERENCE OETWEEIJ PUMP OFF AISO_01STRIBUTION PIPE.. , ' �'s FEET
+ MIWIMUM NETWORK SUPPLY PRESSURE , . .. .. . , 6 SO _ t FLCT 9 O Y- 1 3)
i
♦ _ SS FEET OF FORCE MAUI X 3 S9 F �C tLFRICTIO&I FACTOR. —_ * 21 -
TOTAL Oy1JAMIG HEAD
As per:>aanufacturer �ZO • gal /in. Liquid depth 3j h
r
M E40 Series
4l10 HP Effluent
and Drain Water Pumps
Performance Curve
MODEL ME40 EFFLUENT PUMP
CAPACITY LITERS PER MINUTE
0 50 100 150 200 250 300 350
40
12
35
10 N
W 30 W
H 25 6
Z
C] ~H
= 20 6 W
15 is 757 J
� yl•B2
2
5
0 0
0 10 20 30 40 50' 60 70 80 90 100
CAPACITY GALLONS PER MINUTE
f.. 1101 Myers Parkway, Ashland Ohio 44805 -1
�:.. 923
419/289 -1144 FAX 419/289 -6658 Telex W7443
K3326 7/91 Printed in U.S.A.
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County
Attach complefe.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 I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. d y — \z
Please print all information eviewe by Date
Personal information you provide may be used for nary a v 4 (y� (m)), ��
Property Owner Prop rty Location
St.J 1/4 SW1/4 S S T N R Iq E (or W�
Property Owner's Mailing Address "d v Lot Block # Subd. Name or CSM#
ZZ3 ItiJ_ C S \ CSM U DL 1 , ZAg3
City State Zip Code one Np�, c r - ❑ ity ❑ Village 2 Town Nearest Road
rz�u F�-us +tit s�[o zZ c1 L0, VJ 1�� S . Gw u Z2 tzD
[>C] New Construction Use: IL Residential / Number of bedrooms _ L� Code derived design flow rate _ & O GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material Flood Plain elevation if applicable IV 1cli• ft,
General comments
and recommendations: Z�G)�M �1ti1� Y�OU}v� �� X b y- OLSilZt' BV L -� �,
y-1 1. -J L r-f UM F/u-
E Boring # ❑ Boring
Pit Ground surface elev. 9 g - 7 ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz
in. I Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
o -q' lo,►ZZlz — s 1 z >- v`fi. e 1 . S . ' 8
Z - toy n- S
3 3B- S5 - 1RYly �L� 1uLI 2613 s! i o� — , O • Z
IT - 1 Boring # ❑ Boring
® pit Ground surface elev. 0 fL Depth to limiting factor 3 9 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
sit u 's -�
Z q -3q 316 - s iI z b>c m� - eS 1 w► • -�
3 3q -6U - �•S�2yly �P1.� to�126c3 s! ► � v,,, �1 - .� • 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
CST Name (Please Print) na CST Number
Arthur' L. tdegerer �. D.Z - 220254
Address W e g e r e r Soil T e s t i n g & Design Service
Date Evaluation Conducted Telephone Number
421 N. Hain St. River Falls, WI 54022 1 O 3 Q- uZ -715 -425 -0165
Property Owner Parcel ID # L1 Page Z of 3
Boring # ❑ Boring
® Pit Ground surface elev. q ' S ft. Depth to limiting factor '7 s 6 in.
Soil Application Rate
Horizon Depth Domiripnt Color Redox Description Texture Structure Consistence Boundary Roots GPD /11:
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 •Eff#2
fib
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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 /ftz
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2
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 /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
I
I
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.
580.8330 (R.6100)
I 1
A
PLOT PLAIT Page 3 of 3
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CST Signature Date Telephone No. CST No.' Job NO.
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3
Division of Safety and Buildings
• in accordance with Comm 85, Wis. Adm. Code
Attach complete.site p
han on paper not less than 8 1/2 x 11 inches in size. Plan m County
ust
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. C) 5
Please print all information Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
6evt -Let- S 1/4 Sw 1 /4 S S T Za N R E (or W
Property Owner's Mailing Address Lot # - BIock # Subd. Name or CSM#
w- c g-i-, cs M v C)' - 1 , F� ZO g 3
City State Zip Code Phone Number ❑ City ❑ Village 0 Town Nearest Road
S . G"w u
[� New Construction Use: Residential / Number of bedrooms L4 Code derived design flow rate 6 0 O GPD
E] Replacement ❑ Public or commercial - Describe:
Parent material _ LO Flood Plain elevation if applicable yz�l ft
General comments
and recommendations: \Z. - h2 {;j�J�
)'tl l A4 UM 6 ° U>= S fop Fic..(_ -
LUrv`CUv1Z
100,0
D Boring # Boring
Pit Ground surface elev. C l 0 1 - -7 ft. Depth to limiting factor �`� in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2
0 -q l o`.l IZ Z t Z
3 38 -SS •SLlRVIV 10LI rL owe �.�1 - • � 2
Borin g # ❑ Boring
Pit Ground surface elev. 0 ft. Depth to limiting factor 19 in.
Soil Application Rate
Horizon Depth Dominant Color Redoz Description Texture Structure Consistence Boundary Roots GPD 1ft
in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 - •Eff#2
v cw 1� -l�n •S •�
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• Effluent #1 = SOD, > 30 < 220 mg/L and TSS >30 _< 150 mg/L • Effluent #2 = B013 : < 30 mg/L and TSS < 30 mg1L
CST Name (Please Print) Pri atyre CST Number
Arthur• L. Wegerer a f i(. D Z`l4 -1 220254
Address W e g e r e r Soil T e s t i n g & Design Service Date Evaluation Conducted Telephone Number
421 N. Bain St. River calls, WI 54022 10 - -715 -425 -0165
Property Owner � -- �j Parcel ID # to 0 - 1 U 6 J — 1 ) S - 1 b 0 Page Z of 3
Boring # ❑n� Boring +
lbt Pit Ground surface elev. 6
q Depth to limiting factor 7 S 6 in.
Soil Application Rate
Horizon Depth Dorttgpnt Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
—a 10`12 z l S i Z� fib-
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y L)l -5b lo'-i2 Y A
F -1 Boring # E] El ❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2
F-1 Boring # ❑ Boring
El Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
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 (RAM)
-' PLOT PLAIT ,. Page 3 of 3
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CST Signature Date Telephone Ito. CST No: Job NO.
06 /11 /00 FRI 13:12 FAX 715 386 4666 51 QKJL W LUN1NG *--j.iv.
ST CROIX COUNTY
. SEPTIC TANK MAIIJ'I` NMCS AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
owner/Buyer - la
Mailing Address � FC / c 0
c
Pro Address �4. / ��`� -�✓- /C S 6 " QA_ 12 P
(V required from Planning Dep artment for new eaastrucuon)
city/State
?VL,P � c� �(� /� Parcel Identification Number � �� z` 2� ���
EGAY. DESCRIPTION � Z'i t-f
Property
Location V•, �w' /,, Sec. (� , T� -R�'w, Town of ��>
Lot # �-
S �
A Volume � � . Page # d
Cerfifit'.d Survey Map # _ � �7 S l ,(
Z_ Z Z . z 2 Page #
Volume
Warranty Deed # -
Lot lines identifiable Yes ❑ no
Spec house 0 yes�no
SYSTEM ENANCE
Improper use and maintenance your septic system could result in its premature failure to handlle west n Pu per maintenance into the
=sists of pumping out the septic tank every three years or so0 ner. if needed by a licensed primps Y P
can affect the function of the septic tank as a treatment stage in the waste disposal 65 01
t a certification form. s"rgned by the owner and by a
- The P roperty owner agrees to submit to St. Croix Zoning Depsrtmen that (1) the on site wastewaterdisposal system
mastczp joumeymanPlumbcr+ restrictedplumbacoral tank is less than 113 full of sitrdge.
is in proper operating condition and/or (2) after inspection and pumping (if necessary). the septic'
runts and agree to maintain the private sewage disposal system with the standards
I/wc, the undersigned have Head the above requite of Z`iatural Resources. State of Wisconsin
must be comp Certification
set forth, hcrcin, as set by the nepaztzacat of Commerce and the p De a nd returcud to the SL Croix County Zoning Office within 30
stating that your septic system has been maintained completed a
days of the three year expiration date-
i� �t � DATE
�IGNAT O
OWNER CEIt'I'IFICATION our kuowlcd e ( ) ( arc ) I we am the o wzset(s) of
I (we) certify that all statements on this form are true th i n t of tcr f needs Office.
the property described above, by virtue - Of a warranty deed record S
PATE
$I�3NATURI3
OF AYYLiC =ANT
Any information that is mss represented may result in the sanitary permit being revoked by the Zoning Departm
•• Include with this application: a stamped warranty deed, from the Register of Deeds office
a copy of the certified survey map if tt- fatonoe is made in the waaanty decd
l 22 337 -7
STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH REGISTER OF DEEDS
Document Number WARRANTY DEED ST. CROIX CO., WI
RECEIVED FOR RECORD
This Deed, made between Halvorson Homes, Inc., a Wisconsin
05/21/2003 09:30A![
Corporation,
WARRANTY DEED
EXEMPT ll
Grantor, and Dale R. Bohnert and Angela D. Bohnert, husband and REC FEE: 11.00
wife, TRANS FEE: 224.70
COPY FEE:
CC FEE:
PAGES: 1
Grantee.
Grantor, for a valuable consideration, conveys to Grantee the
following described real estate in St. Croix County,
State of Wisconsin (if more space is needed, please attach addendum):
I
Recording Area
That part of SWIM SW 114 Sec. 15- T28N -RI 9W described as follows: Estreen & Ogland /
Lo ertified Survey Map recorded in Volume 7 of Certified Survey ^� 304 Locust Street LL
'M aps, page 2093, as Document No. 447519. Together with a 66 foot wide Hudson, W1 5401 q
1 M
private road easement as shown on the subject Certified Survey Map.. V
040- 1061 -95 -100
Parcel Identification Number (PIN)
This is not homestead property.
CK) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated this day of May 2003
Halvorson Homes, Inc.
* * By: Chad Halvorson, President
+
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Halvorson Homes, Inc., by Chad Halvorson, STATE OF WISCONSIN )
President, ) ss.
County )
authenticate day of May 2003
Personally came before me this day of
the above named
I
+ Kristina Ogland
TITLE: MEMBER STATE BAR OF WISCONSIN
i (If not, to me known to be the person(s) who executed the foregoing
authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same.
THIS INSTRUMENT WAS DRAFTED BY + _
Attorney Kristina Ogland Notary Public, State of Wisconsin
Hudson, 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. Information Professionals company. Fond du Lac, WT
STATE BAR OF WISCONSIN 800-655 -2021
WARRANTY DEED FORM No. 2 - 1999
MA
44 Y E
'75 3
] 19 JANFS �'CON1989�
. A DP�hra HELL. 9
CERTIPIEO SURVLY MAP
RICHARD 0. MLOE _
Part of the Southwest 1/4 of the Southwest 1 14o Seotiun 1.5, 'rownehip 28 North,
m ° Rplige 19 West. Town of Troy, St. Croix County, Wisconsin.
� ```o �ttfutuin, y � y'
Owner's Address: Route 1
°
W Prescott, 4;I 5 ti 4
4 •Indicates 1" iron pipe found. ;' ENCE
c h Olndicates 1" x 24" iron pipe m i dry► LAUR R
u weighing 1.13.lbs. /it ft, set, _ S
m u
c kIndicates 3/4" iron pipe A ND Io d, 2 N LLS,; >�
WIS J
N - -+.,�� q •..... • ' S `�`.
O TJ UN% 4e'EI p0 4 0•°° �N \ �.* LAND 0:".�
P% / ° \c
�„p - ems �\ P a o m_ \ \ ro Laurence W. Murphy
6 / 5 ,/µ 1 E 13
'A Y 05 \N_ ° - p0 � Registered Land Surveyor
jS / 3 es - 6 9 ' pY ° pt 005 P P� 3 ' \ ....� . .
k04 4 „E D� I�� DZ \ \�
�6 5 91 01 �L ID ED qu D�� 02 10 1 c Dated 2 -9 -87
N6 s' 1 ��+ �0t D1 °% I1 6� 2 ,W 2 0 8 ' \ Revised: 3 -21 -87 3
L \
LO 2 �'Bpr 4/ 46
E�563.652' y
P. 762 ACRES \ .
5 \ v+
/zO,J/O so. fr.
NEr � 2.304 ACRES \ Z
/OO, .3 4 5 50. FT.
o ° _ 01• 1
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9 \. t O
0
NOTE.' LOTS /,2 ^ N -'S 6 ' 1491 °� EpS Eµ
AN ES D 3 MUST b /6''' opD o
ACS OFF 11 M R
0 Vfi ROAD ° M / � , fftI �* o�w` "• \
Ar'P,R G Lo r 3
~ DAD. EASEMENT" y NO If IRON P /PE /N 2.541 ACRES
S7uNP N07 OR/VPN / /O, 667 SO, fT.
t rL USN NET • 2.006 ACRES
SO. F7. \
Z ~
Z
696./7' \
496./T' \
200.00' - 460.0°' 6./ '
S 67. 98'17 "W
S LINE SW 114 S //4 COR. sEC. /9, T26N,R 19W,
UNPLATTE
SIY COR. SEC. /S, T2BN, R/9 W, L AHpE IcouNrr suRveroR's NON./
- --"'-" — "—
7COVN7r SURVErOR'S
SCALE I "+ 100'
Vol. 7 — :?age 209 o do' /oo' 150 2OO 3O°'
Certified Survey Maps,,, ----�
St' Croix County, Wisconsin .�..
APROVED
SHEET or 2
MAY 0 3 1589
; C MIX COmy