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HomeMy WebLinkAbout042-1079-20-120 o ° , n § % ; ° - k - m - 2 E � m " 0 f 7 o ° & ƒ / m - [ N _ / / k ® Q - § ± § i k ° / 0 i \ 2 E G § § EEC J ƒ g_ m E ° ( g $§£ ¢ < 2 C a CD 0 o a 0 \�� ^ � 3 §_' k T T T I; f o 0 0 § 7 0 \ § § § / § } %E vv SD g E 0 I # / ( k \ \ 7 ƒ / o cn § D \ k ) 0 ƒ § @ = 2 & � J 3 E a k 8' 2 §} 2\ k CO / = f z o � E � R 2 \ f § CO 2 { z 2 k - � f } I \ � . £ � � § , . � 0 & g $ � % � \ � 14 . � � � K ° / § < , � // � �� - Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and BuiKting Division INSPECTION REPORT Sanitary Permit No: 453250 0 GENERAL INFORMATION (ATTAG' l TO PERMIT) State Plan I N o: 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: Maier, Gary Warren Townshi CST BM Elev: Insp. BM Elev: BM Description: Section /rown/Range /Map No: put 29.29.18. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing I Alt. BM ,K, r I •`f 26b "o O Aeration Bldg. Sewer Holding St/Ht Inlet r � S. f3 TANK SETBACK INFORMATION St/Ht Outlet 4, 12- c�s• 2Q' TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Septic f z f 23 r Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System aK 13•�Z _r/ 2? - sir PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM Model Number r i -O TDH Lift Fn Loss System Head TDH Ft 6,&P- Sr• 1 Forcemain gth Dist. to Well SOIL ABSORPTION SYSTEM R Width Length 7 No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia.- Liquid 0epth DIMENSIONS 3 SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR ODtFFLtser -5 Type Of System: ,S713 r ' Zo0 Zt,o `-- UNIT Model Number: DISTRIBUTION SYSTEM Header /Ma ifold Distribution x Hole Size Ix Hole'Spacing Vent to Air Intake V Pipe s) r Length YYY���°°°��` Dia Leng Dia Spacing 7 2-= 7 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 Yes [] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /A Inspection #2: - ` Location: 1015 80th Ave Unknown (NW 1/4 NW 1/4 29 T29N R18W) NA Lot 1 Parcel No: 29.29.18. 1.) Alt BM Description = 2.) Bldg sewer length =3t n 3 - amount of cover = tl -r S+ � � w.Q,d,� l 7 Qd L r rJPl `1'OtA�'�OG_ �...� AQ Plan r ision Required? Yesl No� + - -� p Use other side for additional information. SBD 63\ R Date Inse ctor .$ Cert. No. (R 3/97 eQA— 'rQ/� � j 5__Z j tTLJ\ C J AK• 0 3, w° 1( �^ .. -1 Safety and Buildings Division Coun�ty ` 201 W. Washington Ave., P.O. Box 7162 / l CQA ( is on, M adison, ' WI 537(17 - 7162 Sanitary Permit Number (to be tilled in by Co ) eonsin Department of Commerce (608) 266 -3151 ,�, �' 20 ) r State Plan I.D. Number Sanitary Permit Application In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s15.04(I)(m) c ress (if differe}tt than mailing address) 7� Avd . 1. Application Information — Please Print All Information O 1 s ,,,w Property Owner's Name - - reel Lot # ` B1eek -4- 4 r E/ D 0142- /0 9 ;ZO 000 Property Owner's M iling Address Rverty W cation 03 h � Al ' , /y � I, Section _V_ City, State Zip Code Ph on Numb U I T' - -- -7 CONING OFFI 'E (circ e) Ehrts W 51 3 `� T N; R�E.6 II. Type of Building (check all that apply) CSM Numb I or 2 Family Dwelling - Number of Bedrooms ❑ Public /Commercial - Describe Use pp f ❑ State Owned - Describe Use 42 ❑City_ ❑Village 9_1 ownsbip of UJat NI' 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) .11 A. System System ❑ Replacement System g p Y ❑ Treaunent/Holdin Tank Re 1lcement Onl El Other Modification to Existing System B. ❑ Permit Renewal ❑Permit Revision ❑Change of ❑ Perr_it Transfer to New List Previous Permit Number and Date issued Before Expiration Plumber Owner IV. kpe of POWTS System: (Check all that apply) on - Pressurized In-Ground ❑ Mound > 24 in. of suitable soil ❑ 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 El Leaching Chamber ❑ rip Lin ❑Gravel -less Pipe El Other (explain) V. Dispersal/Treatment Area Information: 5 Design Flow (gpd) Design Soil Application Rate(gpdsf) ispersal Arta Required (sf) ispersal Area Proposed (sf) Sy tem Elevation / ysv .7 D �y� 8� �g y. tom. 29 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Unit 4�I •- -Q (� — Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP /MPRS Number Business Phone Number Av�-X lvoA,11 � 2, - 7 (5 TO- 33 Plumber's Address (Street, City, State, Zip Code) Vlll. County/Department Use Onl Approved Disapproved Sanitary Permit Fe (includes Groundwater Date Issued Is uing gent Signa ur o Stamps) Surcharge Fee) 2 SD �_ El Own Given Reason for Denial � zm IX. Conditions Approva al �y T U4; If,- _ - SKS ", SYSTEM OWNER: 99 50 4� Lmu_ I a r _p - 5t r' — , 1 Septic tank, effluent filter and Ste` ' S � 7� t dispersal cell must all be servlcgd 1-maintained n p as per management plan provided by plumber. 2. All setback requirements must be maintained S ( ��; cd -- ,k , S440a- r YT as as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 1 I inches in size 1 SBD -6398 (R. 01/03) Q - n ;z RO d Frfs Wr �l(evE 7K 4 — 3 3 � Lk 1 �o coF r 7reA)c4- fp�N�� S S f &M.� , �et7. 't'r a N��►es 99 „2 S' C 1107e D ; - A. jvd a Fd N r �mw e o Op - - -- /io---- - - - -gyp � -3 /ply, 0c� ;_r rn .7 NO WARRANTY DEED 1. 3 >EF "Ll' R[!:!H•rNU J �� � STATE BAR OF WISCONSIN FORNI '1 -1982 4 vr: !1SrFA REGISTER'S OFFICE ST. CROIX CO., WI Anthony L. Koshenina and Alice A. Rec'd for Record Koshenina, husband and wife 0 V0 11990 of 11:05 A. AMA ::r,,l r:.,rrant; co Gary W. Maier and Gail F.. , Maier, husband and wife, haldxng as. Refliner of Deeds survivorship marital property_ the fcflnci:: Iescribed real estate ;n St. CrO1X .._ _Couray, st ui «':runain: Tax Farcel No: ... ......... ............... North Half of Northwest Quarter (N'g of NW';), except that part thereof lying north of the Highway, AND FURTHER EXCEPTING that part of the North Half o` `.he Northwest Quarter (N of NW': ;) of Section Twenty -Nine (29), Township Twenty -Nine :North (T29N), Range Eighteen West (R1811), lying Southerly of 80th Avenue (Badlands Road) and Easterly of 103rd Street (Ross Drive). This parcel contains Thirty -five (35) acres, more or less. AND FURTHER EXCEPTING a parcel of land located in the Northwest Quarter of the Northwest Quarter (NW; of NW';) and the Northeast Quarter of the Northwest Quarter (NE'.; of NW? of Section Twenty -Nine (29), Township Twentlt -Vine North !T29N), Range Eighteen West (R18W), Town of Warren, St. Croix County, Ilisconsin, described as follows: Lot One (1) of Certified Survey Map filed the 19th day of October, 1990, in Volume 8 of Certified Survey Maps, Page 2284 as Document No. 463381 , office of the Register of Deeds for St. Croix County, 11isconsin. R� C- P- �6z ffwY /- , -�- I �i(e vE 7A[ — 3 3 �L2 i n �I 7,-eNGk o cc� P r \ v i/ fh�tNc.� S /aeo gal w - kcLo1 E 99..z S' C D i fa �d Q h� Jam' -19� �r 6 � -3 D 7�, oy 4 4 o 4 4a Z r 1421 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 4 Division of Safety and Buildings in accordance with Comm 85, VVis. 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 St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. Pending Please print all information. viewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m))._0 Property Owner _" , Property Location Maier, Gary & Gail Govt. Lot na NW 1/4 NW 1/4 S 29 T 29 N R 18 W Property Owner's Mailing Address r ; 7 Lot # Block # Subd. Name or CSM# 749 -103rd St A " r, ' 9 "� i� G4 1 na CSM# Vol. 8 Pg. 2284 City ate Zip. Code Phone Number City _J Village se Town Nearest Road Roberts I 1 54pr f , t .49 -34 Warren 103Rd St ✓� New Construction Use: ✓J Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD f Replacement I Public or commercial - Describe: Parent material Knolls of pitted outwash Flood plain elevation, if applicable na General comments and recommendations: Conventional system, system elevation 99.25ft. Trenches spaced and depth to code 6.00ft below grade. Boring # Boring sti Pit Ground Surface elev. 105.25 ff. Depth to limiting factor 130 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -12 10yr3/1 none sil 2msbk mfr cs 1f .6 .8 2 12 -28 10tr4/4 none sicl 2msbk mfr gw 1vf .4 .6 3 28 -41 10yr4/4 none scl 2msbk mfr gw na .4 .6 4 4 -72 7.5yr4/4 none sl 2msbk mfr gw na .6 1. 5 72- 0 7.5yr4/6 none ms osg ml na na .7 1.6 Boring # I Boring N' Pit Ground Surface elev. 105.25 ft. Depth to limiting factor 130 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 1 0 -6 10yr3/1 none sit 2msbk mfr cs 2f .6 .8 2 6 -17 10tr4/4 none sicl 2msbk mfr gw lvf .4 .6 3 17-40 10yr4/4 none sl 2msbk mfr gw na .4 .6 4 40-42 7.5yr4/4 none Is osg mvfr gw na .7 1.6 5 42 -130 7.5yr4/6 none ms osg ml na na .7 1.6 > < / TSS >30 < 150 m /L * Effluent #2 = BOD < 30 mg /L and TSS <30 mg /L * Effluent #1 BOD 30 220 mg /L and g 5 - CST Name (Please Pri =Signa7tur CST Number David J. Steel 248956 Address Steel's Soil Service Inc. Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 4/23/2004 715 - 246 -5085 * Effluent #1 = BOD? 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < mg /L and TSS <30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 264 -8777. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ` of 2— FILE INFORMATION SYSTEM SPECIFICATIONS Owner 0. Septic Tank Capacity 000 a l ❑ NA Permit # �25 0 Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model _ ❑ NA Number of Public Facility Units NA Pump Tank Capacity a l IJ'l IAA Estimated flow (average) 3CO al /day Pump Tank Manufacturer Design flow (peak), (Estimated x 1.5) SQ gal /day Pump ManufacturerA Soil Application Rate + 7 al /day /ft2 Pump Model A Standard Influent /Effluent Quality Monthly average* Pretreatment Unit A Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD _ <220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Disp I Cell(s) ❑ NA Biochemical Oxygen Demand (BOD S30 mg /L In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L 12 NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: NA Other: ❑ Nq Other: q * Values typical for domestic wastewater and septic tank effluent. Other: q MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑rjo nth(s) (Maximum 3 years) ❑ NA 3 9 ears) Pump out contents of tank(s) 0 u— When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 0 rupri 1(s) (Maximum 3 years) 11 NA ❑�aonth(s) ❑ NA Clean effluent filter At least once every: ' year(s) ❑ month(s) q Inspect pump, pump controls & alarm At least once every: ❑ year(s) ❑ month(s) Flush laterals and pressure test At least once every: ❑ year(s) Other: ❑ month(s) At least once every: NA ❑ year(s) Other: ErINA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on 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 (Y 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 chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, 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. GMW (4/01) Page 2_.__0 �— 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'chemicals that may impede the treatment process and /or damage the dispersal , cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. _ During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(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 Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb 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 floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or 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 chapter Comm 83.33, Wisconsin Administrative 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 properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits 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 fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: 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 structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable 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 available 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 infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER tt POWTS MAINTAINER Name {• EC/l�, Name xN1- ck ,4 1 v- Phone y 9" Phone 7 (r— T � 9-- 33 z SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name oA"3 S 1L W EIS .S1ri V. G € Name �S� Cr x C o &k IV 0 Phone — 719 —0/ Phone 7 This document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM (Buyer Mailing Address Property Address 'Ro (Verification required from Planning Department for new construction- City /State ©6 r fis 1,t1 2 - oz -� Parcel Identification Number D `/ / � � , LEGAL DESCRIPTION property Location 1 /4, '/4, Sec. T-aLN - Rj , Town of 12 a L L>- , Subdivision , , Lot # Certified Survey Map # . Volume __,.Page # g y Warranty Deed # 1 160 3 76 0 , Volume Page # g� Spec house ❑ yes 2 Lot lines identifiable B yes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof yo ur s system could result in its premature failure to handle wastes. Proper maintenance septic sys consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mastc.rplumber, joumeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the 011-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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 Office within 30 days of the three year expiration date. SIGNA OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the ,property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIG A RE OF APPLICANT DATE * * * * ** A Formation that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ^ 7 6 3 9 4 9 VOL 18 PAGE 4759 KATHl. IN H. MXLSff REGISTER OF DEEDS ST. CROIK Co., MI CERTI FI Eta S V RVEV MAP 05 /261 200F4 0323300RPH LOCATED IN PART OF THE NW1 /4 OF THE NW1 /4 AND IN CERTIFIED SURVEY NAP PART OF THE NE1 /4 OF THE NW1 /4 OF SECTION 29. T29N, REC FEE: 13.00 RI 8W, TOWN OF WARREN, ST. CRODC COUNTY, WISCONSIN COPY FEE: 3.00 INCLUDING PART OF LOT 1 OF CERTIFIED SURVEY MAP PAGES: 2 RECORDED IN VOLUME 8, PAGE 2284. BEARINGS ARE REFERENCED TO THE ST. C(//�yEOgTq / CROIX COUNTY GPS NETWORK. LOCg O S00 °00'41 "E 1322.87 dap ?t ��1_D� SHEE ON Z Z 800°00'41 "E 1289.81' Soo°oo'ai ^E 33. n WEST LINE OF 1255,41' 34,x0 iM a THE NW1 14 IN. o ► Q I I rs r i M APPROVED ► ST. CROI CCXJNW ' � I zi t��Rsi Plar"V Zanki4 and Parka Commntse I d 1 , o MAY 2 6 2004 M —1- ;u i p z N ix* recorded within 30 days of o i (� = m approval daft approvvai Wrap be — - � V I S A . �.� and � I I �I 1ldlo m - p�a - - 33' 33� l W V pp �ce 7J p z 6: O A 0 : I y z �a tn: m > –I 00 0 I i ( Nzm w of I e c d l N N00 °42 1 E 1243.48' 52.84' I n ' .55' ► 1b. 1" 283. 28a.7a 283. I N 3 254 " I N I N N ► ' ' I °�' `� ► `c8 n $ ` z co a I t o I Z i p C7 N n, 1 v r cn c>j n ro N m ;0 1( 'io II� C m F ' n ... ,' a....' >3E 0j N 852.96'' I I i t '� I N — +284_81' — 284 0 �3 .42'_ 284.73' ,��•, Q °' 01 "03'47 "E 8S2_SO' 103RD -- - T t I --- I5 _ _D 6Q_Mn_D� n �o o z m I 6' I LEGEND 0 0 3 W a C I I tT-1 I B ALUMINUM COUNTY SECTION CORNER 1 Z M C = Z 2 W t�d't MONUMENT FOUND i Cn >X -n D Z O 3/4"X 18" IRON REBAR SET, WEIGHING 1.50 A Z C m I i t LBS PER LINEAR FOOT, I f ti � " Z � g :V M �t� -A N C 70 i� ' 0 1 5/8" O.D. IRON PIPE FOUND cp 2p 1! � 0 EXISTING POWER POLE m I — PROPOSED DRIVEWAY SOIL BORING Z C7 THIS INSTRUMENT DRAFTED BY EDWIN FLANUM SHEET I OF 2 SHEETS JOB 04 -36 DATE 4 -7 -04 Vol 18 Page 4759 Jessie Nye Subject: #453250 Nechville - Maier Location: Warren, Lot 1, 1015 80th Ave Start: Fri 10/15/2004 4:00 PM 1 End: Fri 10/15/2004 5:00 PM Recurrence: (none) 29.29.18. 1 h� AQ ti� Wisco artment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Saf>g4y ing Division INSPECTION REPORT Sanitary Permit No: 453250 0 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)J. Permit Holder's Name: Village X Township Parcel Tax No: Maier, Gary City Warren Towns CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: CST BM Elev: Insp. BM Elev: 7 29.29.18. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ' `L s Benchmark Dosing lY Alt. BM G / b, & u ,re Zvt� . Aeration Bldg. Sewer 3.� Holding St/Ht Inlet 3 9� TANK SETBACK INFORMATION St/Ht Outlet ( Z TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 4 � t �.� �^ Dt Bottom Dosing Header /Man. Aeration- Dist. Pipe I J Z , 4D �Z. Holding Bot. System PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM Model Numbe TDH Lift F Ion Loss System Head H Ft Forcemain ength Dist. to well SOIL ABSORPTION SYSTEM - BED/TRENCH Width Length N Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia, Liquid Depth J DIMENSIONS 1" SETBACK SYSTEM TO P/L DG IWELL LAKE /STREAM LEACHING Me factur _ 3 INFORMATION CHAMBER OR Ty e Of System: UNIT Mod umber. o -'>, ?ot, > 2.4C) DISTRIBUTION SYSTEM Header /Man Di Distribution x Hole Size x Hole Spacing Vent to 'Intake Pipe( Length 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 BedrTrench Center Bed/Trench Edges Topsoil 0 Yes g No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: , Inspection #2: Location: 1015 80th Ave Roberts, WI 54023 (NW 1/4 NW 1/4 29 T29N R18W) NA Lot (�(� P : 29. 9.18• 1.) Alt BM Descnption 2.) Bldg sewer length - amount of cover Plan revision equired? eln Yes 0 Not Use other side for additional information. Date Insepctors Signature Carl. No. SBD -6710 (R.3/97) Z 1421 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 4 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 St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. Pending Please print all information. viewed By Date Personal information you provide may be used for secondary purposes (Privacy taw, s. 15.04 (1) (m)). - � Property Owner . IC r Property Location Maier, Gary & Gail Govt. Lot na NW 19 NW 1/4 S 29 T 29 N R 18 W Property Owner's Mailing Addres Q ) t J Lot # Block # Subd. Name or CSM# 749 - 103rd St 1 na CSM# Vol. 8 Pg. 2284 City i te Zip Phone NNm0er J City J Village a Town Nearest Road Roberts 54W,3 � � 749 Warren 103Rd St IM New Construction Use: iol Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD J Replacement J Public or commercial - Describe: Parent material Knolls of pitted outwash Flood plain elevation, if applicable na General comments and recommendations: Conventional system, system elevation 99.25ft. Trenches spaced and depth to code 6.00ft below grade. Boring # J Boring Im Pit Ground Surface elev. 105.25 ft. Depth to limiting factor 130 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 1 0 -12 10yr3/1 none sit 2msbk mfr cs 1f .6 .8 2 12 -28 10tr4/4 none sicl 2msbk mfr gw 1vf .4 .6 3 28 -41 10yr4/4 none scl 2msbk mfr gw na .4 .6 4 4 1 -72 7.5yr4/4 none sl 2msbk mfr gw na .6 1. 5 72- 0 7.5yr4/6 none ms osg ml na na .7 1.6 z a8 S - / 7 Boring # J Boring 1/ Pit Ground Surface elev. 105.25 ft. Depth to limiting factor 130 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 1 0 -6 10yr3/1 none sil 2msbk mfr cs 2f .6 .8 2 6 -17 10tr4/4 none sicl 2msbk mfr gw 1vf .4 .6 3 17-40 10yr4/4 none sl 2msbk mfr gw na .4 .6 4 40-42 7.5yr4/4 none Is osg mvfr gw na .7 1.6 5 42 -130 7.5yr4/6 none ms osg ml na na .7 1.6 Effluent #1 = BOD? 30 < 220 mg /L and TSS >30 < 150 mg /L Effluent #2 = BOD s30 mg /L and TSS <30 mg /L CST Name (Please Pril Signatur : CST Number David J. Steel - �� 248956 Address Steel's Soil Service Inc. Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 4/23/2004 715 - 246 -5085 Property Owner Maier, Gary & Gail Parcel ID # Pending Page 2 of 4 31 Boring # I Boring 1/ Pit Ground Surface elev. 103.25 ft. Depth to limiting factor 130 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 -8 10yr3/1 none sil 2msbk mfr cs 1f .6 .8 2 8 -16 10tr4/4 none sicl 2msbk mfr cs 1vf .4 .6 3 16 -25 10yr4/4 none scl 2msbk mfr gw na .4 .6 4 25 -47 7.5yr4/4 none sl 2msbk mfr gw na .6 1.0 5 47 -84 7.5yr4/6 none ms osg ml cs na .7 1.6 6 84 -130 7.5yr4/6 none cos osg ml na na .7 1.6 � � e F-1 Boring # J Boring `� u Se S __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 GP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # =i 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 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD 5 > 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. 04/27/2004 09:41 7157491719 NORTHLAND SURVEYING PAGE 01 CERTIFIED SURVEY MAP LOCATED IN PART OF THE NWI /4 OF THE NW1 /4 AND IN PART OF THE NE1 /4 OF THE NW1 /4 OF SECTION 29, T'29N, RI OW, TOWN OF WARREN, ST. CROM COUNTY, WISCONSIN INCLUDING PART OF LOT 1 OF CERTIFIED SURVEY MAP RECORDED IN VOLUMES, PAGE 2264. 1======. Z Z/ I BEARINGS ARE REF6RENCEOTO NF ST. m C(/gyE�rq / /�n CROIX COUNTY GPS NETWORK, LOCgT O ..,-S00'00'41'E 1322.11T w _ °_ mw- SfiEE)� Z M 800*W41'E 1289.81' S00'0041'E 33. • . E 9 y WEST LINE OF 1255.41' 34.40' — n a THE NW114 S l r S Q M l ! ;g1 ZI I ;00 I ,. , � 1 ml_I ; m iSjlo' 'd dpi I M O Q � 33' i l ! g o 'I I I CI I s I � I �I j - I, s NW 4 23M 1243.49 33 I .0.- .: -•. I` I 35284• . FCI 209.55' 284 289.40' N00°42"JWT I 383.84' l�) n N N N I _ I• R1 Z " m N N ' Z I I E 2 Z > ° `� M l ,r `&r' I � M � �:. ,�� � BO ' 'jig ,y 8 >n ` I �S A Ig Q c 41 s� N y -i _ ® °e of i '� 1 I I �:........_.. �......m...N '$I� p t - 1284 81 b NOt'03Y7'E !79 t —+ 7 264.3' a _ _ N01MV47*6 792_27 1 44aDD_ LS(tl�1D3 r m z LEGEND o�X 1 �� ON B ALUMINUM COUNTY SECTION CORNER � m m O Z z 1° I MO x Y-n 0 Z I p a T A Z Z fn e , 0 314'X 18' IRON REW SET. WEIGHING 1.60 a C ul � ( LOS PER LINEAR FOOT. j m C 3 O I I ' • 1 5/8' O.D. IRON PIPE FOUND 4 C A) EXISTING POWER POLE Z ' PROPOSED DRIVEWAY n THIS INSTRUMENT DRAFTED BY EDWIN FLANUM SHEET 1 OF 2 SHEETS JOB 04-36 DATE 4-7-04 J .. _. • '�;