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HomeMy WebLinkAbout040-1120-30-000 o cn o 0 cn o 'v 0 O d f O N C 6t O d con 9 a st � d m 3 '; _3 3 3 _ C � o N < A ems• cn S. z N z O w O O N N p O O co o a m @_ 7 o z Q Z - - -• 1 CID N N J@ J J @ Co J L° O N O N N O- 'J 0 3 N r NO N N A '° ^t 0 0 t� G t) @ J � @ CD N O A O r'"s Q O A 3 d O O O� W O '�: Z'! O d C 0 y C o O `� N O ° n \\ � o i N £ s v A 2 0 A C [p J �\ 07 \ C O s C CL N -U - to N 3 ^ O_ CO O N t0 N -. N a T cn CID a < CD 3 rr C7 l @ T I � N v z 3 co cn N N N N ➢ O O m / O' M 0 0 A O ID N A -� @ .r m N O A rJ 0 N rr °ZZ � O ° z z z z o ➢ m N O N r O 0 �{ CD CID @ ? �- @ @ jy c' n a co a v 3 @ J _ J n O J O ,p Z CD �' c A = I rn a a a z t cn --j w W W It m 00 z CL 3 1 c 3 a ° - o cn 3 3 m �? u z 'O � CID A A N N (D I cn r ➢ 3 = ➢ M @ a @ m a CL � 0 Ll m o n _ T v c @ v c L N N v �. o '2t N ° c ° =r N A N @ CD n 3 0 CID OD c N Q O 00 O O b � J @ @ trp N EA 0 o o � 0 N C PS` s:cc Ems,) Nisconsin�Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division ' INSPECTION REPORT Sanitary Permit No: 399419 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax Johnson, LeRoy Troy Townshi - 00 CST BM Elev: r lnsp. BM Elev: BM Description: � 0 0 1 120. , 0— MO M.`� Icso. -0 ' Pvc = psi tiv I { J TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark tJJ wSe.� 12a� tt, tfv ,a Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet t 0.`18 �I I • q� I TANK SETBACK INFORMATION St/Ht Outlet 1-2 • �'( TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. I 1Z, .10 Aeration Dist. Pipe Holding Bot. System 1� Final Grade PUMP /SIPHON INFORMATION Manufacture errand St Cover cr ! M Model Number 7 TDH Lift Friction System Head DH Ft Forc m Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width , Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS G� � 7,5 SETBACK SYSTEM TO D P/L BLDG WELL LAKE/STREAM LEACHING Manufa INFORMATION CHAMBER OR S S; l w�W Type Of Sy tem: _ ! r I UNIT Model tuber: � . >50 > l too DISTRIBUTION SYSTEM Header/ anifo Distribution x Hole Size le Spacing Vent to Air Intake Pip s) Length Dia ength Dia Spacing 7 100 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of r7e�odded xx Mulched Bed/Trench Center BedlTrench Edges Topsoil Yes No Yes ❑ No COMMENTS' Includ�cgde�iscrepencies, persons present, etc.) Inspection #1:�_/ O 2 /�_ Inspection #2: - - 7 ---- r Location: ` 1b4P G ; ( River Falls, WI 54022 (SW 1/4 SE 114 31 T28N R19W) NA Lot 1 5 'r Parcel No: 31.28.19.494 r T = °19. o _ 1.) Alt BM Description = 3• S I 2.) Bldg sewer length = Q 5 = qg i� - amount of cover = 5 q _ 0 Plan revision Required? U Yes 'No Use other side for additional information.' 1 � t Date Insepctor's Signature 6 �� Cert No. SBD -6710 (R.3/97) � � -z � N � ° -�'T -� �� i � 1 Sanitary Permit Application f Safety & Buildings Division • In accord with Comm 83.21, Wis. Adm. Codd' 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 `Viscons Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce p (Submit completed form to county if not [Privacy Law, s. 15.04(1)(m)j state owned. Attach complete plans (to the county copy only) for the s e h a e t s than 8 - 1/2 x 11 inches in size. County State S P rmit r ❑ C to previo ijc i 'a on State Plan I. D. N ber he F n N /-1- I. Application Information - Please Print all Information Cy) Location: Property Owner Name / v Property Location LS A- l S r , (,t / 1/4 l 1/4, S 31 T ,N, R(/)/(or) W Property Owner Mailing Address - ? © Lot Number Pc Number &* / 1� t 1 ::5 ccu it.;/ City, State Zip Coe Dne > ber Kl Subdivision Name or CSM Number P- 1 11&12 II. Type of Building: (check one) ❑ City ❑ 1 or 2 Family Dwelling -No. of Bedrooms: ❑ Village ❑Public /Commercial (describe use):_ Town of ❑ State -Owned 1 / V r/ Nearest Road Parcel Tax Number(s) , 0 , III. Type of Permit: (Check only one box on li ne A. Check b ox on line B if applicable) a 7,57 - 3a — D O O A) 1. Ci New 2. Replacement . ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only /, Existing System $) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Cheek all that apply) 9f Non-pressurized In- ground 1/ ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment U it ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Informa ' n: it ; 1. Design Flow (gpd) 2. Dispersal Area ispersal Aru 4. Soil Application 5. Percolation Rate 99 ' y • 7. Final Grade Required roposed Rate (Gals. /day /sg4&) (Min. /inch) �� 9 $ , Elevation VII. Tank Capacity in Total # of /Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks, Con- Con- glass New Existing crete structed Tanks Tanks _ ❑ ❑ ❑ ❑ ❑ Q .Res onsi ent I, the undersig ass ume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (print) Plumber's Si nature (no slam MP/MPRS No. Business Phone Number WIL4 114M 0. 4WI2 1 /1 Plumber's Address (Street, City, State, Zip Code) Cv /c / 7 075 r ST P�& IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Is ing Agent Signature (No stamps) AR ' Approved ❑ Owner Given Initial Adverse Surcharge Fee) Determination � t o I X. Cgndit#Rps ' g9y "jgVV@ &1iA& t Vj*Y4bde requirements as proposed on the pl n. 2. Effluent filter to be installed and maintained per manufacturer's recommendations. 3. Well setbacks to be maintained per NR 811 & 812. 4. The infiltrative surface shall not be less than 36 inches below the surface of the ground. SBD -6398 (R. 07/00) r 1 R s; r. t.� y y 3 Q w e A �O � i f Ty � a m3 � m��ma o N Z rn o o o� O N ( n00(n� c ry .8 N A A A V W< W T N ��. OJT W �4ViN�NAK 17 » m W WNW �Wc .dr - D i a 'l CD v � A w r o n OS 4v. N b � %t W W W --- -- ------ s r I Y Qyy M o c>s m � C G E ^ �. I� I l i 1 l � r x m M Ili i N�oa - c T �llilllll v,00 c� Q�Q ' 11ll�ll i - o`� 2 CL i, - TI. Q D 0 C l 111 ilil {i 2 -a B `: N w, 4 U A _ v V) _ CZ J LZ Q I{ liiilll 1 `` 3` fI.J {� I lii illy Ln AA z !I� r Ii I �I► � • Z n �� �� e , � Y • i a ILL s m i� „ �5 POWTS OWNER'S MANUAL 8Z MANAGEMENT PLAN rage of FILE INFORMATION', SYSTEM SPECIFICATIONS Owner //= {, Septic Tank Capacity /a$A gal ❑ NA Permit # Septic Tank Manufacturer w /esF2 ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer - ZA 66C 10 NA Number of Bedrooms ❑ NA. Effluent Filter Model 100 ❑ NA Number of Commercial Units ❑ NA Pump Tank Capacity gal ONA Estimated flow (average) 00 gal/ ay Pump Tank Manufacturer ; 0 NA Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer 12 NA Soil Application Rate ,6z,— /4� /,y ( gal/day /ft Pump Mode! 0 NA NA Month) average* Pretreatment Unit ❑ Influent/Effluent Quality ,�; /����T� Y 530 mg/L ❑ Sand /Gravel Filter [I Peat Filter Fats, Oil 8t Grease (FOG) ❑Mechanical Aeration ❑Wetland Biochemical Oxygen Demand (BODs) :5220 mg /L ❑ Disinfection ❑ Other: Total Suspended Solids ( TSS) 5150 mg /L Manufacturer Pretreated Effluent Quality ` ❑ NA Monthly average* * Dispersal Cell(s) Si3OEc✓ /tiDCl2_� Biochemical Oxygen Demand (BODs) :530 mg/L �KIn- ground (gravity) ❑ In- ground (pressurized) Total Suspended Solids (TSS) s30 mg/L ❑ At -grade ❑ Mound Fecal Coliform (geometric mean) :510 cfu/ 100m1 1 ❑ Drip -line ❑ Other: Maximum Effluent Particle Size inch diameter * values typical for domestic (non - commercial) wastewater and septic tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months year(s) (Maximum 3 yrs.) When combined sludge and scum equals one -third (ih) of tank volume Pump out contents of tank(s) Inspect dispersal cell(s) At least once every ❑ months �,, ¢1 year(s) (Maximum 3 yrs. ) Clean effluent filter At least once every / ?` A months ❑ year(s) Inspect pump, pump controls ez.alarm At least once every ❑ months ❑ year(s) NA Flush laterals and pressure test At least once every ❑ months ❑ year(s) 17 NA Other: At least once every ❑ months ❑ year(s) ❑ NA Other: At least once every ❑ months ❑ year(s) ❑ NA MAINTENANCE INSTRUCTIONS ade by an individual carrying one of the following licenses or certifications: Mast inspections of tanks and'dispersai cells shat( be m Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspectior b must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure tt volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal n pipes and to check for any ponding of effluent on cell(s) shall be visually Inspected to check the effluent levels in the observatio the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum In any tank equals one -third (Ys) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wiscons Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatement components, and any other maintenance or monitoring at Intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemu that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the conter nr tha t;mWsl ramovQd !ay A tentage servidng operator prior to use. i t . past — of System stark up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal hlghwater Levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the celf(s) and may result In the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servking Operator.prior to restoring power to the effluent pump or contact a Plumber or POWT5 Maintainer to assist in manually operating the pump controls to restore ncrmal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells Do not drive or park over, or otherwise d lswrb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental Ross; diapers; disinfectants; tat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting nrroducw. oesticides: sanitary napkins: tamponsi and water softener brine. ARANDONEMENT When the POWTS fails andior is permanently taken out of service the following steps shall be taken to insure that the. system is properly and safely abandoned In compliance with ch. Comm 83.33, Wlsconsin Adminhuadve Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed • The contents of all tanks and pits shall be removed and property dUpos*d of by a Septage Servicing Operator. • After pumping, all tanks and piu shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another Inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provlde a code compliant replacement system: 0 A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be Infringed upon by required setbacks from existing and proposed strucwre, lot lines and wells. Fallure to protect the r eplacement area will result in the need for a new soli and site evaluation to establish a suitable replacement area. Replacement systems muse comply with the rules In effect at that time. O A suitable replacement area Is not available due to setback and /or soil lirilutions. Barring advances In POWTS technology a holding tank may be Installed as a last resort to replace the failed POWTS 0 The site has not been evaluated to Identify a sultabk replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area If no replacement area Is avatilable a holding tank may be Installed as a last resort to replace the failed POWTS. Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the inflltrative surface. Reconstructions of such systems awst.comply with the rules in effect at that time. < < WARNiNG> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. 00 NOT ENTER A SEPTIC, PUMP OR OTHEER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY RE DIFFICULT OR iMPMURI F. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name L5 412L % PG q m3i A/C- Na me AR2r L Phone �G (o Phone SEPTAGE SERVICING OPERATOR (PUMPER ) LOCAL REGULATORY AUTHORITY Name j9peaYL, A) APncy Q %X Z Phony 4' a 5 lion P - �� .onsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 .ision of Safety and'puildings in accordance with Comm 85, Wis. Adm. Code _ County Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Q L j0 - t � z ZQ - 0 0 0 Please print all information Reviewed by EL Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 2• r Property Owner Property Location ` Z Lt )9 Jtj N -�f 1J Y ::M t+ N S UiV ftvt-tot S 13 114 S�' 1/4 S 3 T N R . l9 E (or W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 3 a �q cq-zo N " M 11 — City State Zip Code Phone Number ❑ City []Village ® Town Nearest Road R.lue�r- its I L-,j 1 Sgc) (BLS u 2 S_S6S - Z 1'zoY c fit( ❑ New Construction Use: ® Residential / Number of bedrooms Code derived design flow rate GPD ®.Replacement ❑ Public or commercial - Describe: Parent material L z. ,Pms Flood Plain elevation if applicable ft. General comments and recommendations: 3 L PrC4 C`- Utz C ZfLL Qom � o�= e �t� 'ru �c M'�.1'M�►� 3 6 � �rct -� �-�� © Boring # ❑ Boring ® pit Ground surface elev. 1 Z 0 ft. Depth to limiting factor 9 Q 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 I •Eff#2 1 0 -I 0 3 l z - s i - Z` 3s� z w, rt s^ C S 1 � • S .� Z i0-ZO 10�R. 316 - si ! 2..�sbk tiLs1� c_ lv� • 5 .8 3 zo 3$ X011 rZ 31b - �l -c1 •S `frz 31 � - S � 6'� S9 w1� � ,_. - N 7 l ST CP ❑ Boring # ❑Boring "i ' ZONIl 0 MQ OFFICE N- Z ® pit Ground surface elev. ) 0 . 5 ft, Depth to limiting factor '7 C - �Soii Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bound a do GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 � o -$ Lo"I`L3ZZ _ sil Z`�'Sbyc m"t1- L` S l� •S . � Idll R 31 Z _ sll Z FSb�r c 3�t e lv� •S P - 1 9 3 lq -3 �0`1 -31 — S11 Z'k�Sbk hit y` cg - , S _ 3 9� �•S�231 - S �6r sq m 1 _ �.') <t -? t . ' 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) nature CST Number Arthur L. Wegerer 0 -l 220254 Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. Hain St. River Falls, (7I 54022 g - Z - pl 715 -425 -0165 I Property Owner Parcel ID# 0 1-10 Z.. () — 0 4 0 Page Z- of 3 Boring # ❑ Boring ® Pit Ground surface eiev. l� �- ft. Depth to limiting factor 4 b 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 ItmTR 3 /Z Z -�S lo`i �/b — .s � 31 3 ys - 9 �.s y� y .L F -1 Boring # Boring .J ❑ 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 ill `T S O L L g 1-3 7 !l l Z u w s AJ CA t tZ La t�1 Cl 12 f27DU UU tAJ l.Lp F V v Tn A `b Aj r- ❑ 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 ' 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 (R.6(00) r - - PLOT PLAN Page 3 of 3 Scale 1'= 510 7:�: A) - rjz , c)uo -1 I Z( Z-o -000 1DU.�Z.Lrss , 1 a1 C `T 4l 7-`� - /� ES• � p-L B ;� 4 L. r L 4 ti2-r sT ti c wl� x tI, j i 1 �3wt j = : :(?Z IDU•0 �0'V `��` 7mR L 31q bLA PVC PIPE Wl _ 0- 714 1 - - 1 /t� �• $ -Z-OI 715- 425 -0165 220254 l� CST Signature Date Telephone No. CST No. Job NO. f sconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 rision of Safety and Buildings, in accordance with Comm 85, Wis. Adm. Code lttach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County STS Q_ Ix nciude, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. eercent slope, scale or dimensions, north arrow, and location and distance to nearest road. O qo -1, ZO - ZO - Please print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). perty Owner Property Location L jF Z,O L[ ::To It � 5 oN ftvttot S w 1/4 S 3 T Z'd N R perty Owner's Mailing Address Lot # I Block # Subd. Name or CSM# State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road U�2 Rv-u Lv 1 S 40 ( - 1 LS) '4 2 S- S 6S - Z ` rtr oY -TL� C - u F- t New Construction Use: E. Residential / Number of bedrooms _ _ Code derived design flow rate 8OU GPD 2eplacement ❑ Public or commercial - Describe: ent material L, O RnS 0 y ez T 1 LL Flood Plain elevation if applicable JJ ft. feral comments recommendations: Boring # ❑ Boring ® Pit Ground surface elev. 1 Z 0 ft. Depth to limiting factor Q 0 in. Soil Application Rate rizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlft in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 1 0-1D V)\-t 311 - S O ` Z�3� wi 4 C S 1 � • s • 8 Z �o -ZO vy -m_ sbk c�s�t Ivy •$ 3 Lo 3$ ti>o� 12 3Lb - SO Z 'i' 1 4 -°10 - 1 •S`tR3L� - S� s'r O S9 h1 , • 1 - Boring # ❑ Boring ® Pit Ground surface elev. 100.5 it. Depth to limiting factor '7 `� y in. Soil Application Rate rizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 a -$ VW - sil Z 'sb M - 11 C- S 1� •S ; g Z. - Lo ( laH2 31 Stl 3bi -r A aVi CS IN S0 ZYSbk 1ryl - CS - • S -� 3 9Y '1 SK231 - Sri 6r- 0 S Yl 1 _ c.`7 <l - • Effluent #1 = SOD > 30 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L IT Name {Please Print) " af�re O 1- 1 � 5 CST Number Arthur L. Wegerer 1_ 220254 - kiress Wegerer Soil Testing & Design Service Date Evaluation Conducted Telephone Number 121 i1. Hain St. River Falls, WI 54022 a -Z -of 715- 425 -0165 PLOT PLAN Page 3 of •Scale 1' 1 1 Z G ZO - =000 gM't� -1 / S u 'nr7.pil" 1` R � ° -tio \ �-�P�:e�^'1t'J�l' 'D1ZA•j,V1=i�D �5 \ v� B �-1°al"tr.1G 11 r - ' L4 31DtiLM sEVN I 4ziwtkZ x Tk wdu S.I.. I _ , - A -PVC PIPE' klj._CA' 19 #F-Z O "• 715 -425 -0165 220254 • S •1_l�1 'CST Signature Date Telephone IJo. CST loo. Job NO. Property Owner f" 3 SO N 1 Parcel ID # d L4 o rzo -- Z o— 15 U Q Pa Z - o f 3 F1 Boring # ❑ Boring ® pit Ground surface elev. I0 t4• 0 ft. Depth to limiting factor 4 b in. Soil Application Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •E b -8 totirZ3tz sil Z� s bk m`Fr cs 1� s Z $ -y S IoYR X16 — si l Z�sbk m`Ft- C S iU -S 3 �t - CI -- I -S I 1 31y Boring ❑ F-1 9 Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft; in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 I •Ef Q() i E36 ) - VWe - . So I _S IM U W S JV t�, R U U L Jj=1Lk; 6/%1 FLU Fv Z 2 v a T G b it >_-t . Boring # Boring r elev. F ❑Pit Ground suface h• Depth to limiting factor In. Soil Application I Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 *EM • 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 services or need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608- 264 - 8777. SBD4330 (R.6(00) I ST CROIX COUNTY SEPTIC "I'ANK MAINTENANCE AGREEMEN 1 AND OWNERSHIP CERTI FICA _110N FORM 0wncrfB1Jycr L4:S22Y �✓,4�tJCy I D� e.1 _- __...__. -.. Mailing Address _ _ �j L T _ C'i�G(r Property Address 2 W e t z &) ) (verification required from Planning Department for new construction)_ City/Stale (j - Z ° 9(6r" Od 0 Parcel Identification Number I,,EGAL D ESCRItTIO N Property Location J"ltJ %.S ' /,, Sec. _, 1 J9 N -R/ _W, Town of 71 Subdivision �� l � Lot tt Certified Survey Map ft _ Volume „_ %�, Page to Warrant Decd ft Volume .!6S Pa e 0 y — - - - -- g Spcc house.. F] yes X no Lot lines identifiable �4_ yes L� no SYST MA.I NAN(, Improper uar and inaintenanceof your septic system could result in its premature failure to handle a sic" P; ­l cr rnaurtenancr cori_sists of pumptng out the septic tank every three years or sooner, if needed by a licensed punipri What vuu tn,t 111to the s;stcr, can affect the function of the septic tank as a treatment stage in the waste disposal system. The prvpenty owner agrees to submit to St. Croix Zoning Department a eemficahoa form, signed by the o Tici and h� a master plumber, journeyrrianpitnnber, reatrictedplurmber or a licensedpumper verifying that (1) the on - site wastewater disposal systcm is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than I!' fot! of sludgr Uwe, for undersigned have read the above requirements and agree to maintain the private sewage disposal systcm with (h.: staudar:.f; set forth, hererr, as set by the Department of Cortuneree and the Department of Natural Resources, State of Wisconsin CerufiCat m stating that your septic system has been maintained must be completed and returned to the St. Croix C ounty Zoning 01Tice within iii days the the. a year expiration date Si( ;NA URF ( APPLICANT DATE O WNED CERTT ION 1 (we) certify that all statrments on this form are true to the best of my (our) knowlr_dgr I ,r„ ­­­W J the p o city d scribed ahovc, by vutrc of a warranty decd recorded in Register of Drrds 011 SIGNA URp ) AP NT DA 1 E Any rnl0irnahon that IS mla- roprerrenlGd may reSUII in the sanitary permit being revoked by the Loriuip; ticpartmrnt ...... Include with this appticatlon a stamped warranty decd from the Register of Decds office a copy of the cemfied survey map if reference is made ill the wananty decd 08/31/2001 07:30 PAX 8517592081 BEI /CAC X001 — iG • VOL 1653 AGE 47 647�4�AL KATHLEEN N. t�IRLSH REGISTER OF DEEDS TRUSTEE'S DEED ST CROIX CD -, YI (tmYED FIR RMD Nancy S. Johnson, as Trustee of the Audrey J. Schweizer Irrevocable D6- 05 -2D01 9:30 M Trust. for a vaiva�e consideration conveys without warranty m Leftoy W Dt�D 9 Johnson, Jr, and Nancy S. Johnson, husband and wife as SurvivorshiP marital property, Grantees, the following described real estate in St. Croix CM COPT FEE- County, State of Wisconsin (hereinafter called the "Propert 0: COPY 1 of C.S.M. filled &2&80 in Vol. 4, Page 981, Reg of Deeds' Office, D ING FEE: 10.00 St- Croix County, Wisconsin, being part of the SW's of SE% of Section 31- 28-19. Rowrti A(� Nano and Realm Address C. L. Gaylord Attorney at LOW P- 0. Box 48 Rivet Fails, WI $0022 090- 1120 -30 (Paroel Me tw -Vion Number) TNs is rot homed ~nY. Datedthis 4th day of June 2001. (SEAL)' 'Na S. Johnson, e (SEAL) (SEAL) • ACKNOWLEDGMENT: AUTHENTICATION STATE OF WISCONSIN Slgnetiure(s PIERCE COUNTY Pwwrmly torte bdera me ttis filth day of June 2009, the above named Nancy S. autt>enticated this day of �, 2001. Johnson, as Trustee of the Audrey d Sehwe¢sr hrevocable Trust, to me (mown to be the person who exeoueed the foregoing instrument and acknowledge the same. - Type or P t nacre • L. 'lord . Notary Pie • s iesioruErtpls� TITLE: MEMBER STATE BAR OF WISCONSIN My comm S perm (If not, a S:� • euMoBted by § 706.05, Wis Stets.) Q 'Names o1 persons signing d any Y gfoud ' ••'� THIS INSTRUMENT' WAS DRAFTED BY Pdn� balown� sVwh fta. ' C. L. Gaylord Attorney at Law P. O. Box 46 River Falls, WI 54022 1NFORMAYM PR4FEMON"COMPAW MV OV V-C w W"55.2M • y r � r POEM NO. 985•A ...R ` M.0 MiiUrfprpiry� � � \ FILED AUG 28 JAMES O' CONNELL, Rpbtn of A••dr � 54 tfoix Carnty, 1S Wboondn ''fir CERTIFIED SURVEY MAP DESCRIPTION I, Arthur L. Wegerer, registered land surveyor, hereby certify: That in full compliance with the provisions of Chapter 236 .34 of the Wisconsin Statutes and the:proVisions ~of the"St. Croix County Subdivision Ordinance and under the direction of Rollin Schweizer (Family Trust) owner of said land, I have surveyed, divided, and mapped said parcel of land, that such plat correctly represents all exterior boundaries and the subdivision of the land surveyed; and that this land is located in the SA of the SE4 of Section 31, T28N, R19W, Town of Troy, St.Croix County, Wisconsin, to -wit: Commencing at the S4 corner of Section 31; Thence N1 °42 along the N -S Quarter Section line 614.32 to the point of beginning: Thence continuing N1 °4214$tIE along said line 700.00 to the NW corner of the SW4 of the SE4 of said Section,; Thence S$8 "E along the north line of said .forty 470.00?; thence Sl °42 "W 320.00t; Thence S37 0 03 1 5$ "W 466.64 Thence N$$ °24 200.00 to the point of beginning. Contains 6.37 Acres subject to C.T.H. "F" right of way over the westerly portion thereof. [Dated thi day of A-61C . ,19$0. �. I I Arthur L. Weg rer I I R.L.S. 963 { -75'-1 NORTH LINE SW -SE i I S88 ° 2443 "E 470.00 ���� "trrrrrrryr�� 1 �� U . 4Z 3 8 0.6 O " 19 0 I 9 ` •••.••� �� 0 3 1 b � • I °D ARTHUR L ., • 1 ! WEGERER I O O N • . 0 1 N 5-963 • Z I C; 1 "t M° t ELLSWORTH p $ WIS. • I 1 i� cn O _ I 75.3 LOT 3eao,, ,,•�,�►��N . .•••O� �•. •....• �. 1 — 1 6.3 7 AC. SEC . L I N E r�h,,0 S U RV� ��•��,, U I W 1 ►rrr4rtl��t W 1 m 5.00 AC. R.O.W. LINE U) I 1 wI I ro a: °_ I 1 (0,14) 0 Z tK O W E CO 0 ZI eI,1 0, U - 4 g u ' I 8 = 5 SC A LE 1 = 200 1 N 88124'43 "w 0' 100' 200 400' 290.00 U- *i I ..I 7 5 =►+ O = SET 1 "BY 24" IRON PIPE WEIGHING ~� I 1.13 LBS. PER LINEAL FOOT. +ca, APPROVED I W I AU G 19 1980 00 V .. :,OIX Coue4y o N CO r •.: tcVSIVE PAIK$ PiAMi4;N 0 rJ:14N40 COMIMITT94 Vol. 4 Page 981 z S 1/4 COR. SEC. I SOU L INE SEC. 3 1 , T28N, R1 31,T26N,R19WI THIS INSTRUMENT DRAFTED BY Parcel #: 040 - 1120 -30 -000 01/09/2007 09:42 AM PAGE 1 OF 1 Alt. Parcel #: 31.28.19.494B 040 - TOWN OF TROY Current IX'' ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner LEROY W JR & NANCY S JOHNSON O - JOHNSON, LEROY W JR & NANCY S 19 CTY RD F RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 19 CTY RD F SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 6.370 Plat: N/A -NOT AVAILABLE SEC 31 T28N R19W 6.37 AC IN SW SE LOT 1 Block/Condo Bldg: OF CSM IN VOL IV PAGE 981 ORD Tract(s): (Sec- Twn -Rng 401/4 1601/4) 31- 28N -19W Notes: Parcel History: Date Doc # Vol /Page Type 06/05/2001 647349 1653/47 TD 07/23/1997 1213/370 QC 07/23/1997 694/503 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 158676 402,900 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 6.370 79,500 288,000 367,500 NO Totals for 2006: General Property 6.370 79,500 288,000 367,500 Woodland 0.000 0 0 Totals for 2005: General Property 6.370 79,500 288,000 367,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 145 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 • AS BUILT SANITARY SYSTEM REPORT , TOWNSHIP SEC T N R I W •G• ESS , ST. CROIX C 'TY WISCONSIN. - 3DIVISION , LOT LOT SIZE PLAN VIEW r 7 8� -Distances dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYST %� V F ' - ti I dicate orthi Arr* SCA Lt: I ,tPTIC TANK(S) ± MFGR. j x a4AL - CONCRETE STEEL NO. o rings on cover Depth DRY WELL E+'4CHES N0. of widt length area _ :.j no. of lines width length area � � � �,GREGATE d t to top of pipe • ?"R(C RATE AREA REQUIRED C' AREA AS BUILT 4- _ltwlaimer: The inspection of this system by St. Croix County does not imply complete ;s;pliance with State Administrative Codes. There are other areas that it is not possible ,* inspect at this point of construction. St. Croix County assumes no liability for Stem no '� operation. However, if failure is noted the e Count will make ever effo Y y t to termine cause of failure. OSASES AND OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. `INSPECTOR DATED L L Ytt'_ PLMMER ON JOB v a LICENSE NUMBER • f 1 4 ,1 r c .. t i ss r'S: , t + r REPORT OF INSPECTION - INDIVIDUAL SEWAGE SYSTEM San.i.taxy Pexmit State Septic NAME Town4hi St. Cxo.ix County Loca ion , ,IA) Se�ti.on� lot N Subdivision SEPTIC TANK Size /600 gallons Number o6 compan.tmen.t4 i Vi6tanee 6xom: Wets Building 12$ slope Highwate - PUMPING CHAMBER , Size gat _.. ump Manu6ae.tuxex Model Numbers HOLDING TANK Size gall on4 Iml Compaxxmen 4 " Pumpex A.Q. tem Dis tance 6xom: Well Building 12% slope_ Highwa.ten ABS ORPTION SI Bed Txeneh > 7 OiA Lance 6xom: W ell Buy ed.ing X i +' .. 129 slope r— Highwatek ABSORPTION SITE DIMENSIONS ' r Width o zx ench _ ,j 6t R area „ 3 c7 6t Length o each tine 70 6t Depth o6 x ock below tile G i N•umben o6.•l.i -.es Depth o6 rock oven .tile Z in Total .length o6 tines 7 6t Depth o6 tile below gxade 2-C i Distance between .Linea 6x Slope o tx ench. — .in. pen 100 6t � Tutu.' ab &ption area 3S0 6.t Type o6 Cov Paper ox .tx " y PIT DIMENSIONS Numb en o pits et axound p its _ yes no Outside d.iame,ten 6 , : 4a pth b e:l.ow inlet Total To-ta.l ab4 oxp•t.ion area 6,t A x ea xeq uined "' 6t INSPECTED TITL i APP OVED DATE 19 8_ REJECTED DATE 198 REASON FOR REJECTION r J VA56 REPORT ON INSPECTION OF SANITARY PERMIT # 0 k;;25 (1) ame and A dress of Permit Holder Person /Persons at Site (2 )Date of Inspection Time of Inspection ame, Aaaress, LIcense No. OT installing Plumber �i ,-_� moo? 3 ( 3 )INSTALLATION CgXSISTS OF: ❑ Septic Tank [ Trench ❑ Dosing Chamber ❑ Seepage Pit ❑ Seepage Bed ❑ Holding Tank ❑ Fill System EN ermanen reference Point) escri e: Elevation of vertical reference point: Slope at site: (5)MATERIAL AND DEPTH OF SEWER: (6)SEPTIC TANK: Manufacturer: Liquid Capacity: Tank Inlet Elevation: Tank Outlet Elev: # ft to lot or property line: # ft to well: (7)DOSING TANK: Manufacturer: # of gallons: # of gallon pump set for a cycle gallons; total capactiy of distribution lines gallon; size of pump head; gallon per minute horsepower ; brand name of pump and model number Is the warning device installed? []YES ❑ NO Wired? [:]YES ❑ NO 8 HOLDING TANK: Manufacturer # of gallons ; construction depth to the cover ft; If septic tank is being used are baffles removed? YES []NO; ft from residence; ft from well; ft from property line. Type of warning device Is the warning device installed? ❑ YES ❑ NO; Wired? []YES ❑ NO; Locking device on cover? ❑ YES (:]NO; Diameter of vent and material ; Distance from building to vent (9) SEEPAGE PIT SIZE: # of pits; ft diameter; ft liquid depth; ft to residence; ft to well; ft to property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than seepage pit inlet pipe - elevation ft; bottom of seepage pit elevation ft. (10) SEEPAGE BED SIZE: ft width; ft length; tile depth; li.neal feet tile; ft to residence; ft to well; ft to lot or property line; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches Elevation of tank discharge line entering bed ft. 11 SEEPAGE TRENCH: Total length of seepage trench ft; width ft; tile depth ft; ft to well; ft to ordinary high water mark of lake or stream; ft to edge of slopes greater than 20% falling away toward lakes, water courses or drainage ditches; elevation of tank discharge line entering seepage trench ft. (12) Has system been installed in area indicated on EH 115? (]YES ❑ NO (13) Has system been installed in floodway? ❑ YES ❑ NO Floodplain? ❑ YES ❑ NO DILHR -SBD -6095 N.0 /80 Signature of Inspector ' R State Permit # �93 7 State and County ,P L B 67 Permit Application County Permq # for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I-D. # A. OWNER OF PROPERTY Mailing Address: T M e V ply s Vlh sZ. C'),pr l B. LOCATION: - TW % S %, Section ?/, T2& N, R� E (or) � Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) Variance Single family )_ Duplex No. of Bedrooms No. of Persons D. SEPTIC TANK CAPACITY 4 ,0 00 Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concret Poured -in -Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured -in -Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New 4 Replacement Alternate (Specify) Seepage Trench: - X No. of Lineal Ft. 47jo_ Width _ Depth-IL_Tile depth (top)-ZLLNo. of Trenches Seepage Bed: Length Width Depth Tile depth (top No. of Line Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits �/^ Percent slope of land Ip �6 ' 7e Distance from critical slope & WATER SUPPLY: Private N Joint ❑ Community ❑ Municipal ❑ O wners name as listed o EH 115 i othe than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Certifi d Soi Tester, �✓' ty NAME �` '� ,l' L e G �' e r C.S.T. # J / and other information obtained from W e (owner/builder). Plumber's Signature mft� w" P /MRRS)(U# Phone # - a�t'� Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. s < E } >. ,. ..,. .s, ...... — . ...., .. ,... . _...,. _ ._ _.. s f E 3 ' E E t I _ Do Not Write in Space Below FOR COUNTY AND STATE DEPARTMENT USE ONLY Oki Date of Application Fees Paid: State $, County ?a`�, D ite Permit Issued /Rejected (date) /�' �G Issuing Agent Name Inspection Yes _k_No State Valid# ' Date Recd 1. county (white copy) 3. owner (green copy) DIVISION OF HEALTH, P.O. BOX 309, MADISON, WI 53701 2. state (pink copy) 4. plumber (canary copy) Revised Date 7/1/78 i ,, EH 415 Rev. 9178 ' REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION ' /a, %a, Section ,T�Z_N,R L� Ems*) W, Township ep Mwmieipekry Lot No. , Block No. County �T• COX Subdivision Name 9wasos /Buyers Name: "II_' fife Mailing Address: PY S• T A $T. V- FLS ; W1- Svoak TYPE OF OCCUPANCY: Residence irr No. of Bedrooms 1 COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW " REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS �� Z3J �C7 PERCOLATION TESTS SOIL MAP SHEET NAME OF SOIL MAP UNIT - kkMR T� SATOma PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE ' NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTEF INTERVAL MIN /IN BER 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P— P— v sl P— P— P— C SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B 1 0 7 �Z e ? �. 4�1 s • In j is' VA S / a • %k ej, 1.1 j a � B- 2 7 1-No,vE 7 '>2 16• . S >irt B- . z N0A.0 J I § ti S 9 B- S '72 lVuA,e ? _22 1b• 94 1 t5 • of A Liz B- - 7 ice, -1 -7 - Z h I t of PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy b�`1>f .Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. 1yE �P pFEevR,lp� � •. F 4 � . E s a M 3 E 3 i 2 N * a ' so a.; — §— t ?�- L -. _ f e f ..., ._,«,. .,. ....me _ ...... ..,> � I, the undersigend, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and location of test holes are correct to the best of my knowledge and belief. , Name (print) .1'I�t3� �—� ��G� Certification No. S Address S Xl '1`s Z w!. 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