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HomeMy WebLinkAbout040-1111-50-200 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM county: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 395257 GENERAL INFOj RMATION (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: Bennett, Nora Troy Township 040 - 1111 -50 -200 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 1 Benchmark - otro -33 La?, aD .0 g Alt. BM Z W A, Bldg. Sewer o (S Pt Inlet Jl�k St/Ht Outlet TANK SETBACK INFORMATION ( RL*; TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet CAW Se t' � D� `ra + ~ ICI, of Bottom 16.1e �� • `3 I Header /Man. 2 Dist. Pipe �j. Aeration > t 00 i > �� " T b � 4 1 + Holding T Bot. System Final Grade ('P '7 PUMP /SIPHON INFORMATION* ?.tom ti Manufacturer Demand St Cover � GPM ,ts Model Number Z /1j X 1 9. 81 Qm , 41 t DH Lift , Friction Loss t System Head TDH Ft I 1 t / Forcemain Length ` V e Dia. 2 .r Dist. to well �4 ��� ' I ?i SOIL ABSORPTION SYSTEM ea A �}� �• =ISO' W*1TREq9jP Width Length No. Of Tr rich PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DI NS 1 1 SETBACK SYSTEM TO P/L JBCDG WELL LAKE/STREAM LEACHING Manufac urer: n_ J INFORMATION CHAMBER OR r'' Type Of ystem: + t lam/ _s UNIT Mods um¢er. I D © Y!j I C~ DISTRIBUTION SYSTEM w4,-w- t, Header /Manifold Distribution ��x H iz Hole "ng Vent to Air Intake Lengt Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil D Yes No [] Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:/ o� / Inspection #2: ti Location: 174 Carlson Lane River Falls, WI 54022 (NE 1/4 NW 1/4 29 T28N R19W) NA Lot 1 Parcel No : 29.28.19.452C 5 1.) Alt BM Description 2.) Bldg sewer length = 7 - amount of cover = Plan revision Required? [! Yes XNO Use other side for additional information. 1 �� Date Insepctor's Signature Cert. No. SBD -6710 (R.a/97) 9 � za •tb �s•b �•� ,to •bb ,-- -� �1'L � 9 ,t o •t6 r Safety and Buildings Division Cry �{, i� � � O ���� 201 W Washington Ave., P.O. Box 7162 L Madison, WI 53707 - 7162 Site Address / / De artment of Commerce / (6 SCJ4 Sanitary P ermit Number Sanitary Permit Application In accord with Comm 83.21, Wis. Adm. Code, personal Wormadon you provide ❑Check if Revision may be used for secondary Law, sIS. i m I. Application Information - Please Print All Information State Plan I.D. Number Property Owner's Name p Parcel Number ' S lr dy0- tl/ / SAD -tab 2 92. . ySz Property bivnees Mailing Address Property Location �A U' hon kemf - 9 (� ; S a T OO ( � N R tE City, Stte Zip Code Phone Number Lot Number Block Number � Subdivision Name CSM Number r"" Ps I ffi ao / IV ) H. Type of Building (check all that apply) OCity 1gi or 2 Family Dwelling - Number of Bedrooms OVMage 0 Public/Commercial - Describe Use 9E0WrdWP ❑ State Owned Nearest S'6 / 17 III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. 10 New 1 2 ;S Replacement System 1 3 0 Replacement of 6 0 Addition to For County use _ Sy stem Tank Oni Y I Existing stem B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(mmbering scheme is for internal we) 44 J;kNon Pressurized In Ground 210 Mound 47 0 Sand Filter 50 0 Constructed Wetland 22 0 Pressurized In-Ground 4111 Bolding Tank 48 0 Single Pass 51 11 Drip Une 45 0 At -Grade 46 0 Aerobic Treatment Unit 49 0 Recircula ' 30 0 Other V. ant Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade RequirW p5 P!oposed Q ZS. Rate(Gais./Da (Min./Inch) b A�! Elevation 6 Zt /Y A VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Staff Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks 1 S Sepde or Holding Tank Dosing Chamber ! VII. Responsibility Statement- 16 the tnadersfgned, mum responsUft for the POWTS shown an the attached plats. Phtmbees Name (Print) ignautre MP 3 Nun Business Phone Number Phunber's Address (Street, City, Code) �M� Ae fip erv,� Z/1) 21 VIII. !De Pal ant Use Only TA Apptaved ❑ Disapproved SanimY Permit Fee (includes Groundwater Def Q S' Stamps) 0 Owner Given Initial Adverse . Snrchaxge ) _ I , Determination Z Z� . 00 9 �,,� IX. Conditions of ApprovalfReasons for Disapproval / N dee --- D 4 ___l d r ' D a✓ /I'n P 5 e t rcrv` l0 Z — ! 4 Y �Pw. e l <�/.i, 1' 'FIP Ora Q9. �� �G .yx `s.. eever, V- ✓ reSL44ed over /071 o / �' C t/- A 7Ottttt Atfuh P l a S H oW {a complete 1� (to the Dull) for the on pw nd ta, Un z u `wa semi s / �� w�rl s s � � P e� ,�,�� X "0- des �P �� ���� � x �` �.��5' � w �" t �t t � }fir" bers oell 2 PUMP 3 te;;� D Nop 6 Ile x fi 11 6 5v, 166. O' a \ t roP op \)E)y r I FE NNA 61Cnht# T � T-vo r PAGE OF PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS VENT CAP 4 "C.I. VENT PIPE APPROVED LOCKIN WEATHER PROOF JUNCTION BOX MANHOLE COVER W 25' FROM DOOR,���� WINDOW OR FRESH WMIU. I AIR INTAKE GRADE I 4" MIN. � CONDUIT PROVIDE I — -- -- IAILET _T AIRTIGHT SEAL I v APPROVED JOINT A I I APPROVED JOINTS W /C.I. PIPE I III W /C.I. PIPE EXTENDING 3' I I ALARM EXTENDING 3' ONTO SOLID SOIL I II ONTO SOLID SOIL B I I ON C I I ELEV. FT. PUMP —�_ - -� � OFF D CONCRETE BLOCK o 3" APPROVED RISER EXIT PERMITTED 1 3 IF WK MANUFACTURER HAS SUCH APPROVAL�ggD01NCa SEPTIC E SPECIFICATIOP.IS DOSE I ) ` TANKS MANUFACTURER: ^� l PS NUMBER OF DOSES: C PER DAy TANK SIZE: t7,�p l DOSE VOLUME ALARM MANUFACTURER: le INCLUDING BACKFLOW: � °� GALLONS MODEL NUMBER: CAPACITIES: A= ° INCHES OR GALLONS � � � �� 3 � � � C fib = .+ INCHES OR , L'= GALLOLIS SWITCH TYPE: B / PUMP MANUFACTURER: a C = 1 �Q" INCHES OR /� GALLOWS MODEL NUMBER: E l 0 r D = Ll INCHES OR L1LL GALLONS SWITCH TYPE: r ere NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE_GPM INSTALLED 01.1 SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. FEET + MINIMUM NETWORK SUPPLY PRESSURE . , , , . .. . . . . 2.5 FEET + � FEET OF FORCE MAIN X dL F Yo F T.FRICTION FACTOR.. FEET TOTAL DYNAMIC HEAD = ' — ="L FEET INTERNAL NSIONS OF TANK: LENGTH ~ ;WIDTH .--.;LIQUID DEPTH SIGNED: LICENSE NUMBER. 0 22 W DATE: 1 WIRING OF SEPTIC PUMP CHAMBERS Approved Weather -proof Wiring Enclosure Locking Cover and Disconnect Means Outside of and Within 3 Feet of Chamber NEC 410- 57(b); ILHR 16.19(2) &(3) T eaonuit Enclosure may be mounted on a post Sl Cd Grade Min. 4" Opening _J Conduit Required ILHR 16.19(2)(b) NEC 300 -5(d); ILHR 16.190)(c) Manhole Riser 12" Min. NEC 300 -5(a) Ex. No. 4 Separate Pump and Alarm Circuits ILHR 16.19 (1)(a) and (b) CONDUIT: NEC 300 - COND UCTORS: NEC 3 1 0 -7 1. Rigid Metal Conduit 1. OF or USE Cables 2. Rigid Non -metal Conduit 2. Conductors in Approved Conduit 3. Intermediate Metal Conduit (no EMT conduit) Pump Circuit - Alarm Circuit - - - -- — Weather -proof Enclosure ON /OFF Control Circuit Wire ,� \ Nut �►+ II 1! Wire ` I Nut � � 1 Bushing to I Enclosed Protect i Receptacle Wires i I NEC 300 -5(h) � � 1 * After Edward Lawry, DILHR Chief Electrical Inspector ** Not recommended because of possible interchanging of pump & Alarm Plugs. The neutral conductor shall not be common to both pump and alarm circuits as per ILHR 16.19(1)(d). NEC - National Electrical Code ILHR - Industry, Labor and Human Relations Wisconsin Administrative Code 2/86 � � Serb ersible MODEL: 3871 SIZE. 3/4 SOLIDS Effluent Pump RPM: 1550 HP: 0.4 METERS FEET 8 25 7 u� g 20 V 5 z 15 p 4 g 10 2 5 1 " 0 L 00 10 20 30 40 50 GPM 0 2 4 A 6 8 10 12 m /h CAPACITY [j GOULDS PUMPS► I �►� DOW NC GM EIIecUw October, ISM O 1988 Gaulda Pwnpe, ha SPECIRCATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE PAINTED W U.SA. C3871 Wisc Department of Commerce SOIL EVALUATION REPORT Page I of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code _ S�. Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County eM 1 K include, but not limited to: vertical and horizontal referer� 'nt (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, iP lion � �?w , , tance to nearest road. Please print ac>rrF,ation.`' Reviewed by Date Personal information you provide may be u for (Privacy 15.04 (1) (m)). r Property Owner / perty Location N o CZA 3 llv 20 © ' N 1 /4NW1 /4SZgTZ8N R 9E(oiW Property Owner's Mailing Address w:' A! o # Block # Subd. Name or CSM# 1� � �►�2.1�0� � E. s��,� City State Zip Code P ne ❑ City ❑Village Town Nearest Road Tzio BLS L.,i s�l ��) 6 'T - ZO L ❑ New Construction Use: ® Residential /Number o L Code derived design flow rate b C7 GPD H Replacement ❑ Public or commercial - Describe: Parent material S L'f� PrL - r l L L Flood Plain elevation if applicable General comments and recommendations: 'X S( . ZS ' U)\J G w / 9 UuJ 1r pF }x-16 R Cprp)) - C Ir St Z)L�R L- �H- CH S� a I ff fitL P a- �`Q' © Boring # ❑ Boring ® pit Ground surface elev. C C-• Q ft. Depth to limiting facto 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 -8 lb`i, - Z — SC J Z `PIS b12 rti;- Z -lb ti��lz 3l� — • 1 1 wt ��� s cS lv�f- • Z • 3' o�2 31L - si 1 Z4sbk K 4� CS - . SJ S L4 • 3b 4� - �.SYR- 31Y — s 1 ISHfZ31y - S S SAN 1JS 01= S o - n IU U c S - Nc r 1. Z ic-T 1 ?>� F -11 Boring # ❑ Boring ® Pit Ground surface elev. P ft Depth to limiting factor -2 `- 3 in. Sal 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 S1 f Zwl m �' 8 3 39 -Sb EO`11Z �J Ib — l e-.S bk yrt 2 3 l - S ELS 1 O S AUG . Z Nav cc n 41 mum-- 4 S — Pr - r - ie 1 C g Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 _< 150 mg/L ' Effluent #2 = SOD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) natu CST Number Arthur L. Wegerer re � cal -1q9 220254 Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. Plain St. River Falls, WI 54022 715 -425 -0165 Property Owner � ) IV T�"Z -1 Parcel ID # O qO - 11 U — 5 0 —?-00 Page " Z of 3 F�] Boring # ❑ Boring 1f ® Pit Ground surface eiev. 3 ft. Depth to limiting factor 7 b In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM ' In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 ' ZI 3 l X 3 2 I � 31 L _ SO m'9 0 - 5 1 tj+ • s - 5a 30 3 • 3Z_6(� IOy l6 _ L �, e sblz rr�'�. - •�� -� r a Boring # ❑Ct Boring ? -7 [,Cy pit Ground surface eiev. 8 ft. Depth to limiting factor 6 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I •Eff#2 0 -� I o` t tz 3 t2 3� o�F Z % !o `21Z 316 - 3 . 3ts-6`i tir'�41Z Vi _ L 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 - 1 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1' •Eff#2 Se fir s Q ( F •, L 31,. 1 + - nom �. ,. .. , -. 4 ,�!• . � � r , • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD, < 30 mg/L and TSS < 30 mglL 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: '. SB"30 (RAW) PLOT PLAN Page 3 of 3 Scale 1' =y,o' , prD N54_�Ofl -1Lo 3.3 ti�� 3 g . x �.� ( "_�C.t3T ► N G � o'er � Lyn bT?- ft F-1 k L,P o - - tibop 6'�-L. � U 0 H N. 'PBj - -�I 715- 425 -0165 220254 CST Signature Date Telephone No. CST No. Job NO. Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ) of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code l>C Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County S�r• 0-M 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. L4 (D 111 `, 9 za() Please pf:Int 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 N 1/4 N W 1/4 S Z' j T Z,g N R 9 E (o W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village 21 Town Nearest Road R1 \JfZ RCLuL I,-j1 I s (71S) q16 - 16gI 'r 20Y CPr�ZLl sON LN, ❑ New Construction Use: ® Residential / Number of bedrooms Code derived design flow rate GPD [� Replacement ❑ Public or commercial - Describe: Parent material G Lf-�� R•L -r- I LL Flood Plain elevation if applicable Yy A ft General comments and recommendations: (� t;E_TLLL$ S(, . ZS ' Lpyv6 /ti/ 9 U> j ll OF 4 C Pfd l'a'y S)- �'Jl/v' L er�S:. CPt�t)2 ° .LL, ZUSt FO P R•m �3 o — k r e.�Lcs © Boring # ❑ Boring ❑ pit Ground surface elev. C t C t• fL Depth to limiting factor 2 — 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 —8 lb4 R -3!Z — S J - Z �S Wt R- Gg Z -lb Lo�li�l� - �) 1 \ ask cS lv� • Z- •3 3 1b 3)O t.o L4 Sl - ).S 'Irz NY - s I l C-Sb m �A, Ck1 - • � 6 S $� Z .S Lf Z 3L - Sasl o s9 m l - •� Z e0 " V c V S- N r I C-T V 4 r —Z-1 Boring # ❑ Boring ® Pit Ground surface elev. ft Depth to limiting factor `} 3 in. Soil Application Rate Horizon Depth Dominant Color or Redox Description Texture Structure Consistence Boundary Roots GPD/ftz --- . In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Eff#1 Eff#2 j 0- 113 l04 R3 Z — St Z `F s bl2 hl`Fir GS ti� ,S 9 Z" 1D 39 l�`t231 — si 1 Z MA Vr w)`{� CS 1v� • S •8 3 39 -S� �O'11Z.S(�b - � leSbk yn� LS _ .�j • b ' y b -�13 Z .S•1� 3� - S dd S I � Nu�c�• S iR� .f31 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) ggnature CST Number Arthur L. We�erer 220254• Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. Hain St. River Falls, WI 54022 715 -425 -0165 Property Owner Parcel ID # 5 (3 Page Z of 3 Boring # ❑ Boring p 1 ® Pit Ground surface elev. dl 0 3 ft. Depth to limiting factor _ �o In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots I GPD /W In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 0 -8 *vs ..3LZ sit Z, — 0 --% •5 Z E 3 2 10 %Z-31L — s i I Z-Sbk -S - 4� F-11 Boring # rT❑ Boring t,�1 Pit Ground surface elev. ft. Depth to limiting factor 67 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 O- $ 1O`-t 3L2 — S1 Z`��9 316 — s 11 7, `�S b1�t 3 31S vl _ L 1vii 8 b M F-1 Boring # ❑ Boring ❑ Pit Ground surface ele4. ft. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure i Consistence &Boundary Roots GPD/ft' In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 � Pr S I S o t L Pr S-7 MAJ _ L L L COD i V L s 2r ) Z�lV L% IM V M-Ve7 o 1Z eQ k. Pti S UQb !h1 k 1 FU T U )) F 1 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. SBD4330 (RAW) PLOT PLAN Pa'e 3 of 3 Scale 1 the " 0 10 ILI S' ti 1r— J • loop 6'�.. k wezL Y �� '7 - 0- UJ v Cw � tz i per, . . Pj -3 -�I 715- 425 -0165 220254 CST Signature Date Telephone No. CST Rio. , Job NO. n 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 arameters of Comm 83 and 84 and the conditions of approval b the department, agent, P � PP Y P � 9 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) Estimated Flow - Average (gpd) Septic Tank Capacity (gal) Soil Absorption Component Size (ft) p Type of Wastewater s j o t Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) Q 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 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 Management Plan for a Septic Tank and Soil Absorption Component filter is equipped ed with an alarm, the filter shall be serviced if the alarm is activated continuously. q 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. Cro1K 1 �e,e eI te 3 ST CROIX COUNTY SP-PTIC TANK MAINTENANCE AGREEMENT ` AND OWNERSHIP CERTIFICATION FORM ( "Cr uyer /`I 6 it 1010 e Mailing Address 0 . Property Address _ ilk h Q (Vccificatiou mquimd from Phming Mputmcat for new cons(ruction) city/State t P l.�' ° S Parcel Identification Number ��AL DES Property Location h %, No y, Sec. a � T � N R J W. Town of IAG Sabdivtsion DUI. / ' 3,20 Lot # Certified Smvey Map # Volmne w . ]?age # Warranty Deed Volmne S�l� rage # 10 Spor, .hoase 13 yes no Lot lines identiftle 0 yes O. no SX5"1F..11t11 �4N(� - . Ts a° � ..... �� . e maftepa nftartd=scp60u*CmyftwyC=OC P c icfoLaadle�axz�s .Pa+opa�aasia�Ocaaaoe earnaffad�e oftlic ifi�oadodbyt t p ecumd Wlratynapatt.ibmbo tinesystau tc tins- :�ge�a�evrssfe&sysattysbrai, .. - . �oaaaera<grocxto abmoct'to St �T���foan, signori 6y�eovenexaadby: - isPodplambaoc =Troaasod Qiat (1�6aeonantc�ruteavatcrd�Ispsr +cam oP=&C aad/(rv) hex =dp .C¢' .dw s b*js 1=&= Ili- ullofidadge. . � dc db><v�c,aad tEre above sadag�ue � tie pdratie uvrsge disposal systraawiRh 61a tibcadav�ds '' °��' Hof sad ncOf Kdmml Rm=cs.. Stm of W 0=6ficaffia 62ty0muPdCSY'katha st c= makfti aodtamstbccawtrWaud=hmcdto&cS't -OoixCocmtyZ*dwgOfr=wUWa30 drys•oftba6= dtt- 1h3�.._ SEGK&TURE OF APPLICANT DATE MCAUON I (wc) f6fy that an at *a=& on this foan am tmc to do bat of my (our) Imo Po�Y d od aabow, by virtue of a W$e I (we) (are) the oa�nuax(s) of w�ty flood tnoocidod fa �gisGcr of Roods Office. 481 .B OF DATE «ss «ss AV iafommtiom that is mis tod may =* is the "mite Eft bdug wvokcd by the Zoning Dcpartwmt- « «..•• s' [ndudc trlth this appticaUon: a ttampod wa mtq flood boom the RC&istcr of Doody otI'ice a COPY of dr- ouffied ttttYcy map if mf== is made in the watraaty decd r ,von 1550PAGi 183 KATHLEEN H. WALSH REGISTER OF DEEDS TRUSTEE'S DEED Document Number ST. CROIX CO., WI RECEIVED FOR RECORD Glenn Hoberg, as Trustee of the Glenn Hoberg Revocable Trust, an 10 -12-2000 9:30 AM undivided one -half interest and Georgia Hoberg, as Trustee of the Georgia Hoberg Revocable Trust, an undivided one -half interest, for a valuable TRUSTEES DEED consideration conveys without warranty to Nora C. Bennett, a married EXEMPT D person, Grantee, the following described real estate in St. Croix County, CERT COPY FEE: State of Wisconsin (hereinafter called the "Property"): TRANSFE 375.00 1 of Certified Survey Ma y RECORDING FEE: 14.40 Lot One () y pin Volume 12 of Certified Survey PAGES: 1 Maps, Page 3261, as Document Number 560004, filed in St. Croix County Register of Deeds office on May 28, 1997, being part of the NE' /4 of the NW' /4 of Section 29, Township 28 North, Range 19 West, Town of Troy. Recording Area Name and Return Address C, L. Gaylord Attorney at Law P $ox 46 River Falls. WI 54022 040 - 1111 -50 (Parcel Identification Number) This is not homestead property. Dated this �Zr day of c , 2000. i� (SEAL) L z — /)L (SEAL) - Glenn Hoberg, Trustee (SEAL) f — (SEAL) "Georgia H berg, Trustee AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ST. CROIX COUNTY Personally came before me this �� day of authenticated this day of 1 2000. mcAn \0c-, 2000, the above named Glenn Hoberg, as Trustee of the Glenn Hob e Trust and Georgia Hoberg, as Trustee Signature Hoberg Revocable Trust, to me known to ersQns who executed the foregoing instrument a the'*.. Type or print name same. TITLE: MEMBER STATE BAR OF WISCONSIN (If not, C. L. Gaylord, otary P lic, St Me of Wi z authorized by § 706.06, Wis. Stats.) My commission is perm ent. Q�) 0'�. ' THIS INSTRUMENT WAS DRAFTED BY . C. L. Gaylord Attorney at Law 'Names of persons signing in any capacity should be typed or P. O. BOX 46 printed below their signatures. River Falls, WI 54022 � MQ y 2LF� .C,y / �s�n iz/3z �an1 8 19 91 ► Rec!s 0 I 560004 00s v >> CERTIFIED SURVEY MAP WANDA C. CERNOHOUS Part of the Northeast 1/4 of the Northwest 114 of Section 29, Township 28 North, Range 19 West, Town of Troy, St. Croix County Wisconsin. NORTH 114 CORNER SEC. 2922 T 28 N R 19 W (BERNTSEN CAP) I M UNPL A T TED L ANDS - - -S 89 0 52'30 "W 339.//' - -- Zz h y 306.11' Z� LOT Q I 130,828 OOLUD ACRf.S NS R/WJ NC JI 33' QW Q` Oy0 115,455 SO. FT. OR 2.650 'R ACRES W (EXCL UO 1NS R /W) 33' 2 4 O (n a , W \� O U CORN I 1 i W Z CLEANOUT kj Z W /J LU 0 r VENT C h W � h � tAi -{ � ` 44 �I lV WELL f� !� cj NEAO I ►.) m Q O Z I N \sF O O J 9- DRIVEWAY �/ I h �' OWNER - /24.49' ��n� S B5° 45 ' 46 " WANDA C. CERNOHOUS 174 CARL SON LANE 33 a : RIVER FALLS, WIS. Note: This parcel is being 3 s� ji created for purposes of farmland consolidation. LEGEND V. M I 1NDICATtS 1 24 "/.RON PIPE S ET I SOUTH 114 CORNER O (M /N. WT. — 1.13 L BS. /L /N. FT.) SEC 29, T 28 N, R 19 W ,��t/111tIt� (2 IRON PIPE) INDICATES COUNTY MONUMENT FOUND ``���� � \S O NS'/ t oi� ,, (AS NOTED) V" LA OPHY rn • W •• x CD �vv e� 1713 + IVER FALLS,,.-* 144 • �� WISC: 0 0 2e 50 100' oo �, �Q L .,�Eq ........ •• LAO SCALE 1 = !DO / 7/ ( • •0•# 81618 9.. +` '7 Dated: April 1.6, 1997 Laurence W. Murphy "Revised this 21st ddy of Registered Land Surveyor May, 1997." This Instrument Drofted by Mork W. Peavey Sheet ! of 2 Sheets Vnl 17 Pant- 3261