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HomeMy WebLinkAbout042-1071-70-200 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Buildin uivisio:A INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 479247 0 GENEFJAL INFORMATION State Plan ID No: Personal ii formation 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: Henry, Wade I Warren, Town of CST BM Elev: Insp. BM Elev: BM Description Section/Town /Range /Map No: G in ► GS ( 26.29.18. TANK INFORMATION ELEVATION DATA Loom w. 5.cerw. JA% -,;, TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic w &r=_V•S Z (O Benchmark 7� /6L `7 ' Dosing S Alt. BM / �y� • �r LID Aeration Bldg. Sewer /re•35 �,(ao' Holding St/Ht Inlet r P. � r TANK SETBACK INFORMATION St/Ht Outlet �• � $'�• 2 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet $ o I r Septic 40 Dt Bottom 1 �� � • �� � Dosing , r �r / Header /Man. 3 S-� YO / 1 Aeration Dist. Pipe 3• 1? 31 r Holding Bot. System f T' Fin Grade y PUMP /SIPHON INFORMATION I 1 L o �Se e + Manufacturer Demand St Cover (Z 1 GPM � Model Number GG— Z� �� J r I�� $` ay G(c) a Lift Friction Loss System Head TDH Ft ��•Z Z.zs •So 2 s -9q A - (awe q 7 /0 Forcemain Length, Dia. r7 Dist. to well �` 1 ��,� J 1. ° l f to[ .`is (0- .. SOIL ABSORPTION SYSTEM B Width Length r No. Of Treae'l�es I PIT DIMENSIONS No. Of Pits Inside Dia. iqui th DIMENSIONS CD SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHI anufacturer: INFORMATION CHAMBE O f System: I UNIM M 1 2-( 6*) DISTRIBUTION SYSTEM l.'9 - s� Header /Manifold Distribution r l x Hole Size H x Hole Spacing V Pipe(s) r < 3 • f 7 . Ica Dia Length �$'� 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 �] Yes [ No l� Yes �� No C v. w�CMMNIE7T I�clude code discrepencies, persons present, etc.) Inspection #1: / 7/ Z(o / o s Inspection #2: -7/a - 7 FF'''' Location: 769 130th Street Roberts, WI 54023 (SW 1/4 NW 1/4 6 T29N R1 8W) NA Lot 2 6AS jr e : arc 26.29.18. 1.) Alt BM Description � 2.) Bldg sewer length - amount of cover = z -1- 2 t� T L1 V an T— ision Required? ( "] Yes No t,�► .�� — .���W"' Tt G Use other side for additional information. _ _ s J ._� Date n ep s i ture Cert. No. SBD -6710 (R.3/97) � Fr3�7'S Safety and Buildings Division County . 201 W. Washington Ave., P.O. Box 7162 � r I S consi Madison, WI 53707 - 7162 Sanitary Permit NNumber (to be filled in by Co.) Department of Commerce (608) 266 -3151 _47 Sanitary Permit Application State Pllaann I.D. Number In accord with Comm 83.21, Wis. Adm. Code, persor 3 J o 2 �p = T(�'1S • �, may be used for secondary purposes Privacy w, s1 1 ECE 1 � Y IE ® -Pro Address (if different than mailing addres4 I. Application Information - Please Print All Informatio '� C. T I O/ Property er's Name Parcel # Lot # Week -iYi- 1 4 ZAvl 7 X O ST. CROIX COUNTY _ Property wner's Mailing Add ro e O % +, AA) ' / ", Section _ City, State Zip Code hone Number _ o ir • ' N; R E o II. Type of Building (check all that apply) o s r-r S Mi Subdivision Name CS Number 1 or 2 Family Dwelling - Number of Bedrooms C, El Public /Commercial - Describe Use / S ❑ State Owned - Describe Use ❑City ❑village 19Township of 11I. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System y ❑Replacement System ❑ Treatment/Holding Tank Replacement Only 11 Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner r IV. Type of POWTS System: Check all that a At 0iff u = 2, ❑ Non - Pressurized In- Ground /9 Mound > 24 in. of suitab &oil ❑ Mound < 24 in, of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel - less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) - System Elevation r VI. Tank Info Capacity in Total Number Manufacturer Prefab Site steel Fiber Plastic Gallons Gallons of Units v ���_ (� Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Respon bility Statement- I, the undersigned, a me responsibility for installation of the POWTS shown on the attached plans. Plumber' a Print) l z-rs Si ` MP/MPRS Number Business Phone Number _ Plumber's ddres (Street City, e, Zip tod ) VIII. Coun IDe artment Use Onl 9 Approved El Disa Sanitary Permit Fee(' chides Groundwater Date Issued Issuin gent Signature o Stamps) Surcharge Fee) �� �� _ i El er Given n for Dent IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than Sll2 x 11 inches in size r SBD -6398 (R. 01/03) 00 , , S �� 4 a � O V, G Safety and Buildings ` commerce.wi. OV 10541 N RANCH ROAD g HAYWARD WI 54843 TDD #: (608) 264 -8777 isconsin www.w www.ce.wi.gov/s / Department of Commerce isconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary May 23, 2005 CUST ID No.224263 ATTN.• POWTS Inspector KIM A O CONNELL ZONING OFFICE K.O. CONSTRUCTION ST CROIX COUNTY SPIA 504 3RD AVE 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL'EXPIRES: 05/23/2007 Identification Numbers Transaction ID No. 1135826 , SITE• Site ID No. 698420 Wade Henery Please refer to both identification numbers, 130TH St above, in all correspondence with the agency. Town of Warren St Croix County SW1 /4, NW1 /4, S26, T29N, R18W FOR: Description: New mound, 4 bedroom residence Object Type: POWTS Component Manual Regulated Object ID No.: 1018083 Maintenance required; 600 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 101) F 0 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes Co rl d and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in .., chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, Gf 5A stats. ti The following conditions shall be met during construction or installation and prior to occupancy or use: SEE CORF General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans and with the design manuals noted above. • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. Key Item(s) • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. ote • The changes made to this plan by this reviewer were discussed with and approved by the system designer. The designer proposes to install a Goulds WE0511 H pump to obtain the required gallons per minute flow to the mound. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. KIM A O CONNELL Page 2 5/23/2005 • • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(1). Consult the Department of Natural Resources for well setbacks and exceptions to the setbacks. • Insulate building sewer per COMM 82.30(11)(c). • Provide frost protection per COMM 83.43(8)(c). A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Si Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Patricia L orf POWTS Plan Reviewer, Int rate ervices WiSMART code: 7633 (715) 634 -7810, Fax: (715) 634-5150, M -f 7:45 am - 4:30 pm pshandorf@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 _ J MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: WADE HENERY Owner's Name: WADE HENERY Owner's Address: 775 130TH ST ROBERTS WI 54023 Legal Description: SW-- NW-- SEC26-- T29N - -R18W Township: WARREN County: ST CROIX Subdivision Name: CSM Lot Number: 2 Block Number: �� . « b i a � lY Parcel I.D. Number: Plan Transaction No.: f o coin RcE Y AND B ILDING Page 1 Index and title -- Page 2 Data entry ,ESPOND Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications 1 � Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 PLOT PLAN Designer: KIM A OCON ELL License Number: 224263 Date: 05/04/05 Phone Number: 715 - 755 -3145 Signature. Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Version 3.0 (03/01/01) Page 1 of 8 Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 83 -44-3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of - 36 inches. 600.00 Design Flow (gpd) 4.00 Site Slope ( %) 96.70 Contour Line Elevation (ft) 24.00 Depth to Limiting Factor (in) 0.60 In -situ Soil Application Rate (gpd/ft Distribution Cell Information 100.00 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (c or e) E Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation ft 2 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 3.00 Estimated Orifice Spacing (ft) = 9.09 ft /orifice 2.00 Forcemain Diameter (in) 95.00 Forcemain Length (ft) Does the forcemain drain back? Y 85.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 15.50 Forcemain Drainback (gal) 12.53 Vertical Lift (ft) 90.43 5x Void Volume (gal) 1.53 Friction Loss (ft) 105.93 Minimum Dose Volume (gal) 20.57 Total Dynamic Head (ft) 27.19 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x X 1.25 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons/inch Calculator (optional) Treatment Tank Information 1260.00 Total Tank Capacity (gal) 1260.001 Septic Tank Capacity (gal) 1 58.001 Total Working Liquid Depth (in) WEEKS I Manufacturer 1 21.72 gal /in (enter result in cell B49) Dose Tank Information Effluent Filter Information 800.00 Dose Tank Capacity (gal) IZaW Filter Manufacturer 21.76 Dose Tank Volume (gal /in) [Al 0 Filter Model Number WEEKS JManufacturer Project: WADE HENERY Page 2 of 8 Mound Plan View T 1/10 B . . J ... Observation Pipe 1. l p A . . ...:......................... ............................... z L Mound Component Dimensions A 6.00 ft E 14.88 in H Aft ft K 8.74 ft B 100.00 ft F 9.50 in z ft L 117.47 ft D 12.00 in G 0.50 ft J ft W 20.77 600.00 (ft Dispersal Cell Area 1 1463.07 (ft Basal Area Available 6.00 (gpd /ft) Linear Loading Rate 1 10.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 99.49 (ft) ► G ♦ H 1 .,lllllfffflffflN! � lfflf /fffflllll! .. I F rsa� Cell ! 98.20 (ft) Lateral atera 97.70 (ft) -♦ -- Invert Dispersal Cell ....M :...:.:.:.:.:.. ......:.. ......... -..... t Elevation E 96.70 (ft) Contour Elevation 4.0 %Site Slope Geotextile Fabric Cover Shading Key m �, I - Dispersal Cell See lateral details on 0 Topsoil Cap c a 1.5 ft Page 4 for number, c © ,ff.::f Subsoil Cap �' o size, and spacing of Cd ® ASTM C33 Sand F laterals. Laterals are ® Tilled Layer La m 0.5 ft Typical Lateral y equally spaced from �5 Aggregate the distribution cell's * A centerline in the distribution cell (AxB). Project: WADE HENERY Page 3 of 8 i I End Connection Lateral Layout Diagram Laterals centered over the A & B dimension Turn-up ball valve or P .► Ail laterals are identical I<- x ---->I Hales drilled on the bottom of the lateral equally spaced S Force main connection via tee or cross to manifold at ang point. Laterals & force main of PVC sch 40 (per COMM Table 84.30 -5) Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 3.08 ft Lateral Length (P) 98.56 ft Orifices per Lateral 33 Lateral Spacing (S) 3.00 ft Orifice Density 9.09 ft /orifice Lateral Flow Rate 13.59 gpm Manifold Length 3.00 ft System Flow Rate 27.19 gpm Manifold Diameter 1.50 in Total Dynamic Head 20.57 ft Forcemain Velocity 2.78 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight 28 Electrical as per NEC 300 and -► Comm 16. WAC 4 in. min. Disconnect _ Tank component is properly vented i Altemate outlet location Forcemain diameter WEEKS Manufacturer _r 2 in. Ca acit 800.00 Gallons Volume 21.76 gal /inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 21.11 459.30 B 2.00 43.52 C P� um off e levation (ft) C 5.66 123.10 F _ 85 - 567 D 8.001 174.08 D Total 36.76 800.00 Dose elevation (ft) 3" Bedding uncTer tank. 85.00 Alarm Manuafacturer JSJ ELECT Alarm Model Number I HW 100 Pump Manufacturer IGOULDS Pump Model Number I WEQ34*t O-$/ J 14- Pump Must Deliver 27.19 gpm at 20.57 ft TDH Project: WADE HENERY Page 4 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name KIM A OCONNELL ] Phone 715 -755 -3145 POWTS Regulator's Name ST CROIX COUNTY Phone 715 - 386 -4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1260 gal Maximum TSS 150 mg /L Soil Absorption Component Size 600 ft Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once every 3 years Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished ............... Grade 6 -8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: WADE HENERY Page 5 of 8 ` Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment 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. 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. The operating condition of the septic tank and outlet fitter 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 fitter 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 fitter 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. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent fitter is installed within 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 as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5, 30 mg/L TSS, 10 mg/L FOG, and 10 cfu/100 mL for highly treated effluent. 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 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency 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(s) 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 absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: WADE HENERY Page 6 of 8 r r rr rN■rNrrr ; :: :. rrrr■■■ rrri■r ®r�,�yr' _ Nownwom ' UNIT • ' � . rrrurcuc��i►�r�;rr�wr, �■rr�c►�r��rru�i► ' ■ ■■r � \!rrr ®rrs ■■rrr moo �!rrrr■■rrrr■W■■ • . ■■rrrr MODEL :: SIZE 3 /4" Solids � rr rrrr■ rr�r rrrr WWWWWWON rrrr► �rrvdi i :. rr r�ii rrr�►�e■�iii �iirr■r i� rrr rrrirr�■rrr ■rrrr r. ■■��■� ■irrr�rrirr .. • i. ,� �■ ■■rrrrrrrr r■ rrr► ■�:rri■r■�■rrr■r■r�■ • rr �'� riG:::ii :::r a�r�r�rrrrrr M rr■► ■rr WONN W . . . . . :. .. .. . . . ' 1 0 1 7:s a 1603 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Steel's Soil Service, Inc. Attach complete site plan on paper not less than 8 %x 11 inches in size. Plan must County t. oix include, but not limited to: vertical and horizontal reference poiry direction and – Q percent slope, scale or dimensions, north arrow, and location d n nearest road. Parcel I.D. — d O pending Please print all infon�natfon. ^ evie Date h Personal infRrmation you provide y Property Owner Property Location Hen q, Wade Zd Blair Govt. Lot na SW 1/4 NW 1/4 29 N R 18 W Properfy Owner's Mailing Address D EC G 7 2004 Lot # Block # Subd. Name r CSM# /�/ 9d 775 130th St na r Acres City State Zip CM a City _j Village iM Town Nearest Road Roberts WI ONI FFI Warren 130Th St 16 New Construction Use: yI Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD I Replacement J Public or commercial - Describe: Parent material End moraines, ground morarines, drainageways Flood plain elevation, if applicable na General comments and recommendations: Mound design, sysetm elevation 97.70ft based on contour line elevation 96.70ft M sm Boring # I Boring Pit Ground Surface elev. 97.00 ft. Depth to limiting factor 32 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *EfW2 1 0 -12 10yr3/2 none sil 2msbk mfr cs lvf .6 .8 2 12 -32 j Oyr4 /4 none sicl 2msbk mfr cs na .4 .6 3 32-60 7.5yr4/4 fl f 7.5 yr5 /6 sl om mfr gw na .2 .6 4 60 -120 5yr4/4 c2d 7.5yr5/6 sl /scl om mfr na na .0 .0 P Boring J # Boring N" Pit Ground Surface elev. 97.00 ft. Depth to limiting factor 32 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 I *Eff#2 1 0 -12 10yrr3 /2 none sil 2msbk mfr cs 1vf .6 .8 2 12 -32 10 r4/4 none sicl 2msbk mfr gw na .4 .6 3 1 32 -60 7.5yr4/4 f1 d 7.5 yr5 /6 sl /scl om mfr na na .0 .0 * 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) Signature: CST Number David J. Steel 248956 Address Steel's Soil Service, Inc. Date Evaluation Conducted Telephone Number 994 200th St., Baldwin, WI 54002 12/9/2004 715-6845680 Property Owner Henery, Wade And Blair Parcel ID # Pending Page 2 of 3 3 ] F Boring # J Boring Pit Ground Surface elev. 94.60 ft. Depth to limiting factor 24 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -12 10yr3/2 none sil 2msbk mfr cs 1vf .6 .8 2 12 -24 10yr4/4 none sicl 2msbk mfr cs na .4 .6 3 24-48 5yr4/4 f1 d 7.5 yr5 /6 scl om mfr na na .0 .0 F-1 Boring # I 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 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring Boring # � g F Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP 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. STEEL'S SOIL SERVICE INC 3 of 3 David J. Steel Wade & Blair Henery 994200 th St. CST - POWTSM SWl /4,NWl/4,S26,T29N,R18W Baldwin, W154002 Lic. #248956 Town of Warren, St. Croix Co. Bus.(715) 684 -5680 4 Acres, Pending Fax.(715) 684 -3449 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of this test may or may not be as shown, as permanent lot lines were not established at the time the soil test was conducted. Legend N i 1" = 40' = Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe • = Alt Benchmark Ele. 100.05 ft Top of 3/4" pvc pipe ❑ = Borings Boring Elevations B 1 = 97.00 ft B2 = 97.00 ft j B3 = 94.60 ft B4 = 0.00 ft Q 7 � VLA- �-� L � 7r ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer AnCLA Mailing Address Property Address 7 tP 9 3 0 � � - (Verification required from Planning Department for new construction.) City /State r�v I Parcel Identification Numbe LEGAL DESCRIPTION V Property Location 1 /4, ' /a ,Sec., T c1 N RA-W, Town of Subdivision , Lo 02 01 9 Certified Survey Map # �9�b�� , Volume Page # Warranty Deed # (�� , Volume /, Page Spec house U yes no Lot lines identifiable yes U no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix County Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Department within 30 days of the three year expiration date. SIGNAT APPLICANT DATE OWNER CERTIFICATION I/we certify that all statements on tlus form are true to the best of my /our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNAT ICANT DATE * * * * ** Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** Include with this application a stamped warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. Parcel #: 042- 1071 -70 -000 01/05/2005 10:07 AM PAGE 1 OF 1 Alt. Parcel #: 26.29.18.404B 042 - TOWN OF WARREN Current [X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * BLAIR A & WADE C HENRY HENRY, BLAIR A & WADE C 775 130TH ST ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 775 130TH ST SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 8.430 Plat: N/A -NOT AVAILABLE SEC 26 T29N R18W 12A IN W1/2 NW1 /4 LOT 1 Block/Condo Bldg: CSM VOL 4/989 EXC 3.566AC TO CSM 6/1509 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 26- 29N -18W Notes: Parcel History: Date Doc # Vol /Page Type 09/12/2000 629691 1541/578 QC 07/23/1997 1125/575 WD 07/23/1997 909/207 07/23/1997 757/412 more 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 38439 261,500 Valuations: Last Changed: 10/22/2001 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 8.430 58,700 171,400 230,100 NO Totals for 2004: General Property 8.430 58,700 171,400 230,100 Woodland 0.000 0 0 Totals for 2003: General Property 8.430 58,700 171,400 230,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 516 Specials: User Special Code Category Amount 018 - RECYCLING SPECIAL ASSESSMENT 15.00 Special Assessments Special Charges Delinquent Charges Total 15.00 0.00 0.00 Parcet #: 042 - 1071 -90 -000 01/05/2005 10:04 AM PAGE 1OF1 Alt. Parcel #: 26.29.18.405A 042 - TOWN OF WARREN Current [A] ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): ` = Current Owner * GEORGE P & LYNNE A BLOOM BLOOM, GEORGE P & LYNNE A 1347 CTY RD TT ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 11.920 Plat: N/A -NOT AVAILABLE SEC 26 T29N R18 8.34 W NW EXC PT TQ Block/Condo Bldg: CSM V 4/989 & EXC 797.32 FT AS IN 45/ PARCEL 1 CSM 6/1509 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 3. 566ACRES15XC PT TO C SM 11/3245 26- 29N -18W f Notes: Parcel History: Date Doc # Vol /Page Type 04/10/2002 675966 1870/397 QC 05/23/2000 623482 1513/09 QC 07/23/1997 707/490 07/23/1997 702/502 more... 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 38443 Use Value Assessment Valuations: Last Changed: 07/11/2003 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 11.920 1,800 0 1,800 NO Totals for 2004: General Property 11.920 1,800 0 1,800 Woodland 0.000 0 0 Totals for 2003: General Property 11.920 1,800 0 1,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel' #: 042 - 1071 -95 -000 01/05/2005 10:03 AM PAGE 1 OF 1 Alt. Parcel #: 26.29.18.405B 042 - TOWN OF WARREN Current FX ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner MARK D HAMLIN * HAMLIN, MARK D 110 CTY RD TT ROBERTS WI 54023 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 W ITC Legal Description: Acres: 24.160 Plat: N/A -NOT AVAILABLE SEC 26 T29N R18W 24.16 A THE S 797.23 FT Block/Condo Bldg: OF THE SW NW AS IN 645/185 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 26- 29N -18W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 645/185 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 38444 Use Value Assessment Valuations: Last Changed: 07/11/2003 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 23.660 3,800 0 3,800 NO UNDEVELOPED G5 0.500 100 0 100 NO Totals for 2004: General Property 24.160 3,900 0 3,900 Woodland 0.000 0 0 Totals for 2003: General Property 24.160 3,900 0 3,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 CERTIFIED SURVEY MAP t JOHN A.W. & CLARICE E. GRAHAM ` Part of the West 1/2 of the Northwest 1/4 of Section 26, Township 29 North, Range 18 West, Town of Warren, St. Croix County, Wisconsin. o Indicates 1' x 24 iron pipe weighing 1.13 lbs. /ft. set. 8 `C) (b '-v cOR' si c, z �, 9 o Pit F� �o m 0 S, O O /!il O Al C//!i! E ivTJ � �� 2,8 38 •O O• � �-' �k ti. 40 Z _. 0 I o \ w (� 0� 0 � 2 APPROVED S � , 1980 � 1s ST. CROW COUc•TY Q r.OMPAe��ENW 1 . fAW4 ri,u"u O N I I /Z� O AG• c�E S MAD loe4oG C-0*" E to I o0 0 ..������ ° "S•' o ••. ti W W I gl �� ',c' JAMES L. o 1541-w-' 578 K ATHLE EN H. W SH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD DOCUMENT NO. QUIT CLAIM DEED 09- 12-2000 8:00 AM QUIT CLAIM DEED EXEMPT M CERT COPY FEE: Mary A. Gall, quit claims to Blair A. Henry and Wade C. Henry, her life COPY FEE: estate in the following described real estate in St. Croix County, State of TRANSFER FEE: 1.50 W 15COriSlri: RECORDING FEE: 10.00 PAGES: 1 Lot One (1) of Certified Survey May in Volume Four (4) of Certified Survey Maps, Page 989, filed in St. Croix County Register of Deeds Office on September 23, 1980, being part of West Half of Northwest Quarter (W 1/2 of NW 1/4) of Section Twenty-six (26), Township Twenty-nine (29) North, Range Eighteen (18) West, Town of Warren, Except Parcel I of Certified Survey Map in Volume 6 of Certified Survey Maps, Page 1509, St. Croix County, Wisconsin. RETURN TO This is homestead property. Blair A. Henry and Wade C. Henry 7775 - 13& Street Roberts, WI 54023 Tax Parcel No. 042- 1071 -70 -000 Dated this /� day of August, 2000. Mary A. Gall Acknowledgment STATE OF MINNESOTA ) I^ ) SS COUNTY OF Personally came before me this 1 9"' day of 2000, the above named Mary A. Gall, to me known to be the person(s) who ecuted the foregoing instrument an a owledge the same. Notary Public ` My commission is permanent. (If not, state expiration date: 20 � THIS INSTRUMENT WAS DRAFTED BY: DAWN E. WOLD Notary Public Anastasi & Associates, P.A. 3 Minnesota 6120 Oren Avenue North my co("nu ion Expires ran. 31. Stillwater, MN 55082 CERTIFIED SURVEY MAP LOCATM IN, PART OF THE NW1 /4 OF THE NWI /4 AND IN DART OF THE SWI /4 QF TH NWI /4 OF SECTION 26, TION, 1118% TOWN OF WARREN, ST.' CROIX COUNTY, WISCONSIN. BEING PART OF LOT 1 OF A CERTIFIED SURVEY MAP RECORDED IN VOLUME 4, P AGE 989 AT THE ST. CROIX COUNTY REGIST'ER OF DEEDS OFFICE. SURVEYOR: PREPAR FOR: DOUGLAS J. IAHL.ER BLAI A. HENRY do S & N LAND SURVEYING' INC. WADE C. HENRY 2920 ENLOE SMEET 775 130TH STREET n , NW COR, HUDSON, WI 54016 ROBERTS, WI 54 1A m SEC. 26 fq �"- 6B' WIRE. PRIVATE DRIVEWAY EASEMENT RIVEWAY 00 7.80 -e 4.815 ACRES 4~463 ACRES SCE. FT.) EXC. R/W ' DRIVEWAY .� SHED w { SEPTIC -- e ARx t I WE4 � ! c SHED .� DECK m AR9A t { 11677 "E 440.70' 33,05 I '`! - 5 1 - rn L-T .� .� 33'33' �,. -- 33.00' 1» I N$+9 °4$'45 "W 440.00' wf ! (N89 52'30" E) UNPLATTED LANDS LEGEND' DOUGLAS J. FOUNp STEEL ZAHLER SURVEY MARKER SM45 FOUND] PK NAIL HUDSON, M /'4 COR. IS. SEC. 26 FOUND 1 -1/4" OUTSIDE DIAMETER IRRON PIPE a SET 1" OUTSIDE DIAMETER BY 113 LAS. PER LINEAR WEI OT s..wwaauwv .h!!`T6 AI'N/ tittL o lo 7'3Es CEO 157 VOL 19 PAGE 4990 KATRE= H. WALSH REGISTER OF DEEDS WI RECEIVED kFZORD CERTIFIED SURVEY MAP 06/03/241105 03:iMPH LOCATED IN PART OF THE NW1 /4 OF THE NWt /4 AND IN PART OF THE CERTIFIED SURVEY MAP SW1 /4 OF THE NW1 /4 OF SECTION 26, T29N, R18W. TOWN OF WARREN, REC FEE: 13.00 ST. CROIX COUNTY. WISCONSIN. BEING PART OF LOT 1 OF A CERTIFIED COPY FEEs 3.00 SURVEY MAP RECORDED IN VOLUME 4. PAGE 989 AT THE ST. CROIX PAGESs 2 COUNTY REGISTER OF DEEDS OFFICE. SURVEYOR: PREPARED FOR: DOUGLAS J. ZAHLER BWR A. HENRY do S & N LAND SURVEYING. INC. WADE C. HENRY m N 2920 ENLOE STREET 775 130TH STREET ch NW COR. HUDSON, WI 54016 ROBERT% WI 54023 SEC. 26 s NPLATTED LANDS x= �� - U -------- -- - - -- N9� g -------------------------- 66' WIDE PRIVATE DRIVEWAY EASEMENT � m S89 48'45 "E 44 0_0 0 ' -DRIVEWAY Z 589 0 "w 407.00 � - - - - - -- ` 7O � 16 6' 1 - f - 33.00. LOT 7 s_ C r I " L 4.815 ACRES 0 Q .. :.............. .......... j (209 735 .463 ACRES O I , (194.399 SO. FT.) EXC. R/W b Dr- RIVEWAY � N \ SHED i ��1 m E� Iii i z c • SEPTIC I M o Z WEL� ) AR — _- - - - - -- 00 t..y ♦ o I g I SHED `' o I '� °- rn HOB OD o POOL � I rn v g I I DECK : , a- Z I I*1 ARCA pip ` 27' 407.6440.70' = O It AL I� m c v� 4 z LOT 2 b w DRIVEWAY I i (157.709 SO. FT.) I ti ► I+ 3.340 ACRES (145.486 SO. FT.) I EXC. R/W l .1 N89'48'45 "W 440.00' pp W /s I (N89 52'30 "E) y UNPLATTED LANDS LEGEND y DOUGL _3 J. FOUND STEEL ZAHLER * ® SURVEY MARKER S -2145 FOUND PK NAIL HUDSON, JWLI/4 COR. IS. 28 FOUND 1 -1/4' OUTSIDE DIAMETER IRON PIPE SET 1' OUTSIDE DIAMETER BY 1 13 I WEIGHIN LBS. PER LINEAR FOOT 1. ROADWAY SETBACK LINE CALE IN FEET 1" = 150' (100 FROM RIGHT — OF — WAY) FENCE O 150 ( ) RECORDED BEARING AND /OR DISTANCE STRUMENT DRAFTED BY: WILLIAM KANE AL SOIL BORING 6478 -01 DATE: 3/2/2005 SHEET 1 OF 2 SHEETS Vol. 19 Page 4990 .. l Im �, -� S 3 0 �� � ��� � �° s �ti COMPOSITE CURVE` 8TA- RIITE' CAPACITY LITRES PER MINUTE p 50 100 150 200 250 300 350 400 450 500 550 I `�I 90 Fy s 26 y 24 22 70 20 to 60 FC�� \ i is 0 W 50 I 14 12 r �-- 40 / 30 r ,�+ ,n h " k A y PJ• I I 9 4 10 -.. M',. 0 p 25 50 76 100 125 150 Z7. 1 CAPACITY GALLONS PER MINUTE NOTE. Please see page I I for STEP lyjus Series perrormance curves. nn