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HomeMy WebLinkAbout018-1072-50-200 i 1 • Wisconsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM County: INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 344683 Permit Holder's Name: ❑ City ❑ Village ❑ x Town of: Aate Plan ID No.: Bornmann Harold & Patricia Town o f Hammond lJ 16 _ 32-65' CST BM Elev -: Insp. BM Elev.: L Description: - Parcel Tax No.: Off• c�' 10S.0 rwn = C S� (31**Z p endin g TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS V. Septic W✓ (o'e 4oa Benchmark Dosi ng ` Alt. BM BTi 60 ' Aeration Bldg. Sewer qb, Is- Holding St/ Ht Inlet ,3 106 TANK SETBACK INFORMATION u e TANK TO P / L WELL BLDG. Air I to ntake ROAD Air Septic > 5`a r ' NA Dt Bottom IZA Dosing > 5'0 l oll NA Header / Man. Aeration NA Dist. Pipe 10 4.&V s �s Holding Bot. System 6.3 PUMP/ SIPHON INFORMATION Final Grade S Manufacturer Derrland St cover Dl� Model Number GPM Friction S stem p TDH Lift L `.S a,,( TDH \�r Ft Forcemain Length -- ' j Dia. 7 a Dist. To Well S ABSORPTION SYSTEM s' srZ BE TR'Ej#CH Width f Length t N f Tre c e PIT No. f Pits Inside Dia. th DIMENSIONS DIMENSION SYSTEM TO P / L BLDG WE L LAKE/STREAM LEACHI M acturer: SETBACK CHAM INFORMATION Type of > �sf 11 r —, OR NIT Mo ber System: / DISTRIBUTION SYSTEM Header/M N Distribution Pipe(s)� � x Hole Size x Hole Spacing Vent To Air Intake Length � Dia. _ Lengtho Dia. 1-i— 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 I ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 91 Inspection #2: --- Location: 1743 County Road J, Hammond, WI (NE1 /4, NW1 /4, Section 33 T29N -R17W) - 33.29.17._ C�" VAXt (Sr a r � • �euer� 7 ($ r' gyp; Q, l'1'�+r� (� I g u GiDU�lc�c�f � ae FAA,- 0 r �C'S +"U� EC� -rte Plan revision required? ❑ Yes KNo �Q e Use other side for additional information. 10 1 is �q ..6J��re... d SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: Y e I 3 1 ., �w E F E F 4 Mme � m� e,........ s... ...... <_ a. m.:,... ..,�,.. , mm ....ad .... ..m ..e.e ... t t em., F e v ..... S em d e a > w � I e 3 _ F 3 i i z f : a v t 3 as ., w , t e. P 8 { E a � ._._ ,. m g a m.. .. d ,., m . .....,... . , r . ... ..w _ . g...,. _ i P 8 � 8 .9m e a r c L E � s � € .... ., ., �. ..... .... E I E s I F � 1 ` Safety and Buildings Division V i sconsin SANITARY PERMIT APPLIC N 2 01 W. Washington Avenue P O Box 7302 Department of Commerce In accord with ILHR 83. 05, Wis. �Q� Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the syste , ° 'aper of &ss %66 than 8 112 x 11 inches in size. `;' rr/y�t Sta>ae t N u m ber • See reverse side for instructions for completing this applica il6nf 5I },� _ Sahitary Permit Num Personal information you provide may be used for secondary purposes S7 ,''9 ❑ Citeck'iI revision to previous application [Privacy Law, s. 15.04(1)(m)]- 1 L "'jK t State Plen I.D. Number I. APPLICATION INFORMATION -PLEASE PRINT ALL 146A / Property wner Na a pert oca d ljar T 2 r N, R 12 E (cl W Property Owner Mailin Address Lot Block Number City, S to Zip Code Phone Number Subdivision Name or CS�Nu Num �4�016 c zis> 38'� -aim/ G, -3 6 © II. TYPE O F I ING: (check one) ❑ State Owned It( Nearest Road Public 1 o 2 Famil own OF &_A1117 Dwellin - No. of bedrooms 3 ❑ va age 0 �( j ) 111. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. g New 2 ❑ Replacement 3_ ❑ Replacement of 4 E] Reconnection of 5_ [] Repair of an _ - - f - " - System -- - - - - -- System ------- - - - - -- Tank Only -------- - - - - -- Existing System -- - - - - -- ExistlnqSystem B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other I 1 ❑ Seepage Bed 21 MWound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure p� I n n 42 E] Pit Privy 13 E] Seepage Pit O )C 43 ❑ Vault Privy 14 ❑ System- In -FiII i 1a3 , D VI. ABSORPTION SYSTeM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required sq. ft J Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) / Elevati 1- 1 6 7 0 3 �.� ! w' �- ` � Feet / &: 7Feet VII. TANK Capacit gallo Total # of Prefab. Site Fiber- Plastic Exper. INFORMATION New Existing Tanks Manufacturer's Name Concrete st ti steel glass App. Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ VI11. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber' Signature: No Stam ) MP /MPRSW No.: Business Phone Number: L f s " /siP g 7 �,GB z a Plumber's ddress (Street, City, State, Zi C)e): IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved nitary Permit Fee (Includes Groundwater ate ssue Issuin Ag `nt Signat a (No Stamps) Surcharge Fee) pproved E] Owner Given Initial p Adverse Determination �-`� ' (!3 ��� X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS ' 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 -3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. ll. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. Ill. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. Safety and Buildings 2226 ROSE ST LACROSSE WI 54603 -1905 ` * isconsin TDD #: (608) 264 -8777 www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary June 22, 1999 CUST ID No.267341 ATTN: POWTS INSPECTOR WEGERER SOIL TESTING & DESIGN ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY SPIA PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 RE: CONDITIONAL APPROVAL Identifica ' s' APPROVAL EXPIRES: 06/22/2001 AC/� Transaction ID o. 23258 Sit ID No. 17481 SITE: JIM T Please refer to both identification numbers," Site ID: 174814 cc' � ove, in all correspondence with th e agency. cp St. Croix County, Town of Hammon Co Qx NE1 /4, NW1 /4, S33, T29N, R17W p� Facility: Harold & Patricia Bornmann S FOR: Description: Mound System - Three Bedroom Object Type: POWT System Regulated Object ID No.: 475297 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. 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. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 06/14/1999 ` FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 Gerard M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)785-9348, Mon - Fri, 7:15 AM - 4:00 PM jswim @commerce.state.wi.us WiSMART code: 7633' Page 1 of 6 MOUND SYSTEM FOR A BEDROOM RESIDENCE LOCATED IN THE �E 1/4 OF THE N w 1 /4 OF SECTION 3 I ,T Z L N, R W, TOWN OF yQTZ ST'• CRc�UC COUNTY, WISCONSIN. INDEX RECEIVED PAGE 1 of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN JUN 1 4 7999 PAGE 3 of 6 PLAN VIEW -CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT SAFETY B� .PAGE 5 of 6 PUMPING CHAMBER CGS DIP PA GE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR POw on ley m �Q� � F}� tk-� c\A\ sor� �v>v, N C oltdttl 'D, bob NOZ -`Cl� N'L1DS O1V , W 1 S �L ULSp �4 SOMM \ gip \NHS �RSMENFE D FE NCE SEE GURRES PREPARED BY WEGEE�EF2 SOIL TESTING Volts$ Yyy AND. ,CONS I3ES 2 GUi SE[RV I CE O ..••~"""•• 'ji F.O. BOX 74 421 N. KAIN ST. ARTHUR L WEGERER RIVET FALLS. YI 54022 "15 SUSWORTK 715 - 4254165 b41 SIGN s4 JOB» NO. 3 r PLOT PLAN Page Z . of (6, Scale 1 yp ' P 1 oC �l.lpy 9 71ti 2 u J O J 1 %M*1 - L "T 1 ory �u1t.1 p1pE 2 � �. 1 O D` 6 k h 1 N k SS QF PeT LA is ' t=fwm MOUK- NOTES . 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( required) 3. Install 4" observation pipes with approved caps. ( Z required) 4. Septic tank to be t I6o0 gallon capacity manufactured by w\�s�Z cci) -V-Cm L-vL\�C-T - 1600 5. Bench Marks SWE- pj 6. Divert surface water around system to prevent ponding at the uphill side. Page Approved Synthetic covering IFI l c 33 Distribution Pipe Medium Sand H G F Topsoil = - -_,__ Ele v. \'0y,0 — J � - - -,- D 3 E „ - u b ej % Slope Bed Of 2"- 2 %2 Force Main Plowed Aggregate From Pump Layer D \•v Ft. Cross Section Of A Mound System Using F o 3A Ft. Ft. A Bed For The Absorption Area F •8 G 1-o Ft. A S Ft. H \ -S Ft. Linear Loading Rate = GPD /LN FT B ( 1 - 7 Ft. Design Loading Rate =' GPD /SQ FT Ft. J - 7 Ft. K Ft. � L _ct Ft. _ C..vro Main W 31 Ft. L Observation Pipe �--- 8 K 71 0 A I� - - -- ----- - - - - -- ----------------- - - - -�I W o �---- Force Main Distribution Bed Of 2 "- 2 z Pipe Aggregate Observation Pipe Permanent Markers (Anchbr securely) z - Plan View Of Mound Using A Bed For The Absorption Area Page Hof 6 Perforated Pipe Detail / 0 End View Perforated End Cop. � °fie PVC Pipe Install permanent *marker �o <` s o�` at end of each lateral Holes Located On Bottom, Are Equally Spaced PVC Force Main Q PVC Manifold Pipe Dist( .lion Pipe Lost Hole Should Be I Next To End Cop End Cop P zo- 6 Ft. Distribution Pipe Layout S y Ft. X 3'3 Inches Y 3 b Inches Hole Diameter liy Inch Lateral I Inches Manifold Z Inches Force Main " Inches # of holes /pipe Invert Elevation of Laterals Ft. � X.1.17 = � • l y-�(_ 3 2-.7b 61?� Place lst hole 101 " from center of manifold with succeeding holes at -%' intervals. Last hole to be next to the end cap. - - Combination - Septc; Tank and PUMP CHAMBER CROSS SECTION AIJD SPECIFICATIOMS PAGE 5 OF VEIJT CAP WEATHER PILOOF JUIJCTIOAI 90X `i' c. 1. VENT PIPE � r', APPROVED LOCKIIJG 1O' FROM DOOR, M&WfiOLE COYER w1V .JIIJDOW OR FRESH WARtJIIJG t.i4<jEL.. A�IMTAKE S �L 102,E b M GWi 0a 18' MIiJ. 11� 41Pt PROVIDE I -- - -- IW LE T � AIRTIGHT SEAL I I APFI:OVED JOIIJT 3AF�`�s A I I I APPROVED J0114T. I III w /c.I. rIPEI'Oc W /C.I. PIPEaR Tank construction I 11 ALARM shall comply with I I I ILHR (83.15 and 33.20 I I Ow c •I I LLCV FY P OFF PUMP - -� ._. ` 0 C0IJCRETE 'fL�V • r'y Z • 00 I BLOCK 3" APPRd RISER EXIT PERMITTED O►JL!J IF TAIJK MAIJUFACTURER HAS SUCH APPROVAL BEDDING SPECIFICATI0LIS SEPTIC f w��CT- 1 DOS JR MAIJUFACTURCR: W �t ut eowckzz� uUMbER OF DOSES: 3- 56 PI K DA! TAWK SIZE: l V y C� j b00 CALLOUS DOSE VOLUME Z ALARM MAIJUFACTUR.ER: S - 7 :S" 1 0P�TLO S`fSTtt} IwCLUDIIJG6ACKFLOW: `33 GALLOWS MODEL IJUM6ER: 10I Nw CAPACITIES: A= L $ INCHES OK 301 'O GALLOU5 SWITCH TtJPC: 5 = Z IUCHES`OR 3 3 ' 4 4LLOUS PUMP MANUFACTURER: ZQ�'L�1Z y` C- IU[HES OR 133 '$ GALLOU5 MODEL NUMBER: qa 1) a INCHES OR `� GALLONS SWITCH TYPE: ►D M CU12- OTE: PUMP AMD ALARM RC TOO 15L I MIAIIMUM DISCHARGE RATE 3 � ,6 G PM INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFEREIJCE DETWEEU PUMP OFF AUO.D15TRIBUTIOIJ PIPE.. � $� FEET + m MCTWORK SUPPLY PRESSURE . . . . . .. . . . . 2.50 FEET U 5 4 F FEET OF FORCE MAIIJ Z '� /OFLFRICTIOIJ FACTOR_. O FEET TOTAL 091JAMIC HEAD = S FEET DIAMETER — Pump chamber INTERLIAL. DIMEWSIOW� OF TA$JK: LEAIGTH ;WIDTH ;LIQUID DEPTH, BOTTOM AREA 231= GAL /INCH GAL/ INCH AS PER MANUFACTURER = 1 •� Z. 0. HEAD CAPACITY CURVE 3 7/8 s 1/4 MODEL "98" 4 5/8 �{ 30 0 25 ® ( 3 5/8 6 0 ® O _v F + � O ` 43/16 F 10 5 1 1/2 -11 1/2 NPT 0 U.S. GALLONS 10 20 30 40 1 50 60 1 70 80 lffL -RS 80 160 240 0 FLOW PER MINUTE TOTAL DYNAMIC HEAOIFLOW PER MINUTE EFFLUENTANDDEWATERING CAPACITY 12 HEAD UNITSIMIN FEET METERS GALS LTRS 5 1.52 72 273 10 3.05 61 231 15 4.57 - 4 5 170 4 3/16 20 6.10 25 95 I Lock Valve 2T SK1102 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and • Variable level float switches are available for controlling single supplied with an alarm. and three phase systems. • Mechanical alternators, for duplex systems, are available with • Double piggyback variable level float switches are available or without alarm switches. for variable level long cycle controls. SELECTION GUIDE 1. Integral float operated 2 pole mechanical switch, no external control required. Standard all models - Weight 39 lbs. - '/2 H. P. 2. Single piggyback variable level float switch or double piggyback variable level, 98 Series I Control Selection float switch. Refer to FM0477. EE98 Volts -Ph Mode Amps Simplex Duplex 3. Mechanical alternator 10-0072 or 10 -0075. 115 1 Auto 9.4 1 or 1 & 7 — 4. See FM0712, for correct model of Electrical Alternator, E -Pak. 115 1 Non 9.4 2 or 2 & 6 3 or 4 & 5 5. Control switch 10 -0225 used as a control activator, specify duplex (3) or (4) Float system. 230 1 Auto 4.7 1 or 1 & 7 — 6. Four (4) hole J -Pak, junction box, for watertight connection or wired -in 230 1 Non 4.7 2 or 2 & 6 3 or 4 & 5 simplex or duplex operation, 10 -0002. 7. Two (2) hole J -Pak, for watertight connection or splice. CAUTION ForinfomwtiononaddRiofWZoegerproducts refertocatatog on Combination Starter, FMO514; Piggyback All installation of controls, protection devices and wiring should be done by a qualified Variable level Switches, FM0477; Electrical Altemator, FM0486; Mechanical Alternator, FM0495;Sump/ licensed electrician. All electrical and safety codes should be followed including the most Sewage Basins, FM0487; and Single Phase Simplex Pump Conbol/Alarm System, FM0732. recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). L RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. - MAIL To. P.O. sox 16347 Louisville, KY 40256-0347 Marndacltlmys of.. SHIP is v 3649 Cane Run Road Lv LoI�IftKy4ozff -fss1 lluurrPuuPSSNC� /999 z . P!/MP CO. (502) 778.2731. 928 -PUMP FAX (502) 774 -3624 _ wii .sonsin Department of Industry S.OI L •-AND -SIT:E EV-A LU ATI O N 'R E P O RT ` Page "_�► tabor 'and Human Relatrons - • Divisionofsafety& Buildings in accord with ILHR 83.05, Wis. Adm:'Ucle COUNTY Attach complete site plan on paper not less than 81/2 x I I inches in size- Plan must include, but- united to vertical and horizontal reference point BM , direction and % of slope, scale or PARCEL I.D. # not I Po ( ) dimensioned, north arrow, and location and distance to nearest road. mil$ - IR - APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION R IEWED BY DATE PROPERTY OWNER: G Q0}Z.G E PROPERTY LOCATION W �2s : PPt`nZl Z t'A' - V?zp Y'l 0 - S .114 N W 1/4,S 33 T. Z-9. ,N.R \ E ( W PROPERTY OWNER':S MAILING ADDRESS - LOT # I BLOCK # SUBD. NAME OR CSM # loo 6 $ , t!N tiz-o�> 0 S CSwI CITY, STATE ZIP CODE PHONE NUMBER []CITY ❑VILLAGE MOWN NEAREST ROAD NUR`fT} lSty'1 Sgtylb (7l� }381 -01tj] " C1lv !\r�`l� S K New Construction Use [x] Residential / Number of bedrooms 3 [ ] Addition to existing build'mg j ] Replacement [ ] Public or commercial desaibe Code derived daily flow U Sk"N gpd Recommended design loading rate bed, gpd$ — trench, gpd/ Absorption area required 3 bed, ft 31 S trench, ft Maximum design loading rate IS bed, gpd/ft trench, gpd1(t Recommende$ infiltration surface elevation(s) % y • It (as referred to site plan benchmark) - Additional design site considerations t-A 1,�1 0 1 ` to 9_D M I "J l Hum 1 0 F S A - A"b F=( « gn �� Parent material \-.o mss Flood plain elevation, if applicable NA ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ❑ S NU IRS ❑ U ❑ S OU ❑ S ®U ❑ S ®U O S IrU SOIL DESCRIPTION REPORT Depth Dominant Color Moities Texture Structure Roots GPD /ft Boring # Horizon in. Munsell - Qu. Sz. Cont. Color Gr. Sz. Sh. Boundary Bed rmnch O -1 14`ilZ JIZ JL� Z- ►�'LS�D ►t'1 CS • uv Z -n - vrz) �►TL- 1 t, — t 1 z ►' c- Ground IO. [Y - `� Ica Sb l� U cS S ' L W y 3 , A -S - 1 Io -fV s-5 f ��.S ` oV my� •`� : S Depth to e-0 ry S 1 • S y P— y! g _ Z �Uj1 limiting Remarks: Boring # 1 27 - z g �o '\z s�6 i 3 �`{ 2.$ SO 10`t2 Z- `7iZSJ8 �jt O� >tit '• S Ground i elev. 10 fL - I D0 10 limiting s factor , � zs Remarks: T Name:-- f'Iease Pratt Arthur L. W e e r e r Pine 715-425-0165 [ V e m a%rer Soil Testing & Design Service. -P.O. Box 74 River.Falls,WI. 54022 *nature: Date: CST Number. . C vl2 G l 9 -13 - 220254 PROPERTY OWNER �'-U 1L]�TR SOIL DESCRIPTION REPORT Page?- of 3 PARCEL W. # O tS 10 -- I Z - S D Boring Horizon Depth Dominant Color Mottles Structure GPD /ft in. Texture Consistence Boundary Roots . Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends WL vK cS S 6 � ♦ 4 st. 2, � s bar wt �, �.S � • 5 • b Ground 31Y elev. _ wo fin. uy-S7 1.S y tz • !y � z .s �� s/� ��s Q1 Depth'to 1U Sly limiting oti►., factor u U" Remarks: Boring # n Vo rm "" , j I Ground i eleV. it. i Depth to i limiting factor i. Remarks:. Boring # tM , q 4 { i Ground i elev. ` . ft _ i. II ' Depth to - limiting factor i Remarks: Bo rin � g [ # i 1 Ground „' elev. ft. Depth to limiting factor Remarks: _ rnfl n7�Inln :.r '1, . PLOT P LAN Pa 3 of . 3 SCALE 1`40 ' o- S LI SO 7 � P l - i t3r�tE -I • �i..toy 9 rt.Ltio y s .3 s.l 6 \ s9" c�wtiiv2 �., 1 03.O' 6 9, ' \ by / / t`N, 1 J V bo `NOT ct�r�cT a .'L z � � u J \ Co�zNL'R. �1rovSE ZO Q� 1'�'I' LAST 2..5' t ►�ul• -t w1Uuw1� , zzoI 5'i ( 715 ) 425 -0169 JIMMOM CST Signature Date Signed Telephone No. CST # ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailin g Address 410 � — ✓ti O �' TI Property Address 2 y 3 e Ty gc� L° 7 3 (Verification required from Planning Department for new construction) City /State Parcel Identification Number LEGAL DESCRIPTION Property Location � %4, 4fid ' /t, Sec. 33 , T_ZLN -R_2_LW, Town of tsyt o�� Subdivision , Lot # Certified Survey Map # ID �7 ��� , Volume /-3 , Page # 33 Warranty Deed # ©. �� , Volume S� Page # Spec house ❑ yes OFno Lot lines identifiable LFyes ❑ 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 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 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. Uwe, 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. SIGNATURE 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 owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. ��'e /// 9 SIGNATURE OF APPLICANT DATE * * * * ** Any information 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 co V01. 1454PAGE 97 1649746. KATHLEEN H. WALSH REGISTER OF DEEDS Document Number WARRANTY DEED ST CROIX CO ., WI RECEIVED FOR RECORD George J. Gardner and Linda M. Gardner, husband and wife, conveys and 09 -02 -1999 10:30 AM warrants to Harold R. Bornmann and Patricia A. Bornmann, husband and WARRANTY DEED St. Croix County, State of described real estate in o wife the following d , g � EXEMPT li Wisconsin: CERT COPY FEE: COPY FEE: TRANSFER FEE: 21.00 RECORDING FEE: 10.00 PAGES: 1 Recording Area Name and Return Address Thomas A. McCormack 740 Main Street Baldwin, WI 54002 0/ (Parcel 2mber) Part of the Northeast Quarter of the Northwest Quarter of Section Thirty -three (33), Township particularly Twenty -nine North (T29N), Range Seventeen West (R1 7W), more p y described as Lot 3 of Certified Survey Maps, filed August 24, 1999, in Volume 13 of Certified Survey Maps, page 3709, as Document No. 609185. Exception to warranties: all easements and restrictions of record. This is not homestead property. Dated this C� day of 1 1999. k4_� 7 *George J. rd er,, � J '• Q/1L����C11/c * *Linda M. Gardner AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ST. CROIX COUNTY Personally came before me this A day of 1999 the above named George J. Gardner and Linda M. authenticated this day of Gardner, husband and wife, to me known to be the person(s) who executed the foregoing instru the same. p� r signature2��- vy type or print name signature type or print nameb TITLE: MEMBER STATE BAR OF WISCONSIN (If not, Notary Public St. Croix Count?,,,Wisconsln authorized by §706.06, Wis. Stats.) My commi ip�n its permanent. ' (#,not, state expiration date: THIS INSTRUMENT WAS DRAFTED BY Thomas A. McCormack 'Names of persons signing in any capacity should be typed or Baldwin, WI 54002 printed below their signatures. Information Professionals Company Fond du Lac, Wisconsin 800- 655 -2021 N r � , l� 0/ 2 FILED 6 AUG 2 4 1999 ► 3 ot G09185 0-MLEEN14-0M St,CroucCo »� 4 S T, CERTIFIED SUR VET' MAP George Gardner Part of the Northeast 114 of the Northwest 114 of Section 33, Township 29 North, Range 17 West, Town of Hammond, St. Croix County, Wisconsin. - - - -- _C._T. H. "" NO L /NE NW //4 1` o ' T ' ~' 3-- S 8 ° 5B 58 E v: -SB9 °58'58 "E� 2390.73' -- -P 1 66.0 ,� . T ORTH //4 CORNER NORTHWEST CORNER � I .697o7-7 - � / rf /5/.44 _ - ECT T, /ON 33, 29 N -, W. R. /7 - S 89 ° 58'58 "E 2608./8' -- 9 IM 66 M -- 2/745• -- FND. 8ERNTSEN NAILI SECT /ON 33, r29N., R. /7W. �) er l / FND. SERNTSEN NA /L) S 89 ° 50' 45 "E 66.0/' /5/.45' DRIVEWAY - -- 2/7.46' -- ✓O /NT DRIVEWAY EASEMENT o 66 ! OWNER'S ADDRESS - I I /00' B /NG SETBA 1747 C. T. H. "d �- LOT 2'1" HAMMOND, W/ 54015 �r a �I I Q I DWELL ING a i a p CON TA I ° SO. FT. OR 1.4 / A . O -' -4 (56, 638 S0. F OR p I �b /.300 AC. EXCLUDING ti °1 a ROAD RIGHT OF WAY) I W' ' N89 "W �� N bi 3 151.44 LOT 3 U J �' CONTAINS 43 LELE SCALE /N FEE T / = /00 �'. I I , , zI I - SO. FT. OR /.003 a I 0 20 50 /00 200 1 I 66 00 m BEARINGS ARE REFERENCED TO THE NORTH L /NE OF THE j NORTHWEST 114, SECT /ON 33, T. 29 N., A/7 W., ASSUMED I AS S89 °58'58 "E. j I �I � M •1 LEGEND M M \ O SET 1"X24 "IRON PIPE (MIN. WT. 1.13 LB -IL.F) - - FENCE L INE 1 ss. o/' ,�� 151.44 i FOUND / IRON PIPE - � - - - -- N 89 ° 58'58��W 0 SOIL BORINGS ����� Zh `�. , 'LAUREN a m W MUR y : a '� 1 13 • ER ALLS, r �/ i r SOUTH I14 CORNER • WISc. , SECT /ON33,T.29N.,R. /7W. 4 i /9 .........• • - `Q� ,� IFND. 2 "IRON PIPE/ •,; • L A N TH IS INSTRUMENT DRAFTED Y ✓ERALD L. 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