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HomeMy WebLinkAbout034-1063-20-000 i ST. CROIX COUNTY ZONING DEPART T AS BUILT SANITARY REPORT► Owner 1 CA .q-e_ ' L 6 4/ Property Address _ �g�'] �3cy`1�►•�, Sr c City /State UO o £2d v At 2 ING OpF c Legal Description: `a Lot Block Subdivision/CSM # ,ILL '/4 Sec. �3), Taj`N-RAW, Town of n PIN # 034-/005` SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION Tank manufacturer r1VA I rL.¢A 'e �ST/PC /00 Setback from: House /0 Well ZC P/L Pump manufacturer ,,,olrzt � _ Model - Alarm location c2 `t a- o p 621v Po , Or+ I S . I sly 400 C (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM Type of system: c.1/I` Width 3 Lengt Number of Trenches 1 Setback from: House Well go PAL Vent to fresh air intake yS'' ELEVATIONS Description of benchmark i ,, S_ t evation Description of alternate benchmark Elevation q - Building Sewer `1t' ST/HT Inlet f S• S ST Outlet PC Inlet PC Bottom g Header/Manifold 98 Top of ST/PC Manhole Cover Distribution Lines () c l 6 , 0 () ( ) Bottom of System () [ ©� w () () �+� •0 Final Grade ` Date of installation 7- / 3 /18 Permit number 7 State plan number Plumber's si nature V � License number erg Date I A� Inspector Complete plot plan t Wisconsin Department Commerce PRIVATE SEWAGE SYSTEM Count Safety and Buildings Division y INSPECTION REPORT 9• �ro� GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 32 Permit Holder's Name: f ❑ City ❑ Village aTTown of: State Plan ID No.: m i " "ej CST BM Elev -: Insp. BM Elev.: BM Description: Parcel Tax No.: DD ac-� )0(0 3-Z6-4 TANK INFORMATION ELEVATION DATA Aro ODSS 2) TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic a(GCwd �O Benchm k �,�,� laq Dosing Aeration x BI Holding St/ Ht In et 7 Q5 S TANK SETBACK INFORMATION St/ Ht Outlet Ventto TANKTO P/L WELL BLDG. Aiirintake ROAD Dt Inlet Septic �� �Ofi r N!A, NA Dt Bottom 8 ff/ Dosin ��� �► lg' NA Header /Man. (� 9 Aeration NA Dist. Pipe (o 498,67 Holding �� X >/ r Bot. System Su q7. - 7 PUMP/ SIPHON INFORMATION 07•ec�f Manufacturer ic) �.� Demand 7 Model Number �� �� ZSGPM TDH Lift �. Friction 5 (� System , I TDHCT93Ft oss FFii Forcemain Length O Dia. t R Dist. To Well ead SOIL ABSORPTION SYSTEM I- -B ED — MMENCH Width Length A t No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth EN I N b JU I DIMENSIONS r` '` ^ SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM LEACHING Manufacturer: INFORMATION Type O 't CHAMBER Mo Number: System: 3i OR UNIT DISTRIBUTION SYSTEM Header/ ifold R Distribution Pipe(s) r , / r x Hole Size x Hole Spacing Vent To Air Intake Length Dia - Z Length Dia. f / 1 Spacing` V rr O t 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 g Bed /Trench Edges t 2" Topsoil Ir Cj� Yes ❑ No MYes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) .2$'}7 'i �Avf— �0 /i.tq.�j p19'•2.9• /S A E6 AX /a'a• 18 - �(dw - (6r/►` I- G -&)a 6•77 6 14 - 94. 5 elQu. 9 9.3 2 O kaA � q q!4d44t5 4 1 00 1 a 5775k4VI 4b wwt-+ o F 5a %"ak ✓ lave- Vt k f _M !z 3 Plan revision require ? ""0 Yes % No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Si ature Cert. No. i ST. CROIX COUNTY WISCONSIN ZONING OFFICE I NINA, I p ■ ST. CROIX COUNTY GOVERNMENT CENTER " " ■ ", 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386 -4680 NOTICE OF VIOLATION November 20, 1998 NUMBER 98 -V -27 LOCATION: NE Y., NE Ya, Sec. 29, T29N -R15W, Tn. of Springfield, St. Croix Co., WI PIN # 034 - 1063 -20-000 Michael Shimek 2827 80th Ave. Woodville, WI 54028 RE: Failing septic system Dear Mr. Shimek: As required by the ST. CROIX COUNTY ZONING ORDINANCE, notice is hereby given that you are in violation of § 254.59(2) Wisconsin Statutes, COMM 83.01(2)(c) Wisconsin Administrative Code, and Article 15.03 of the St. Croix County Zoning Ordinance. This system has failed under the definition in § 145.245(4)(b) Wisconsin Statutes (category 1). This violation was first noted on November 19, 1998. The violation noted is discharging sewage into zones of saturation. The soil and site evaluation report submitted by Henry Grote (ID #222774) dated April 28, 1998 revealed that the existing system is located in non - compliant soils. An on -site inspection on November 19, 1998 revealed evidence of surface discharge. If fines and or forfeitures become necessary to bring about the abatement of this violation, they will be assessed as of that date in accordance with Chapter 145.12(4) Wisconsin Statutes. REQUIRED ACTION: Within 90 days of this notice, contract with a licensed plumber who will design the septic system and obtain a sanitary permit through this office. The septic system must be installed within 90 days of this notice. Please contact me if you require clarification of this matter. Sincerely, Rod Eslinger Assistant Zoning Administrator Of Safety and Buildings Division v�ia+�ii' n SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County r than 81/2 x 11 inches in size. , 6 tY • See reverse side for instructions for completi this application State Sanitary yP Permit tN Number The information you provide may be u y of rnment ag 6W�QT E] Check TeDion to previous plication lPrivacy Law, s. 15.04 (1) (m)]. 2 State Plan I.D. Number I. APPLICATION INFORMA - E PR T ALL I ORMATION � � Propert wmer ame Pr Location ri /4 /4, S v1 T , N, R Pro e 0 0 7A ,*,.�e r's Mai Address dress Lot Number Block Number City, State Qo.' Zip Code Phone Number Subdivision Name or CSM Number (�� Q ( ) II. TYPE F d2& BUILDING: (check one) ❑ State Owned ❑ it Nearest Road ❑ Village (_' _i Public 1 or 2 Family Dwelling - No. of bedrooms Town of ("l )rl (a 0 III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo � 1 as r5 . g 3 4 A 3 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. ❑ New 2 OrReplacement 3. ❑ Replacement of 4_ ❑ Reconnection of 5_ ❑ Repair of an ------ System -------- System ------------- Tank Only______________ Existing System Existing System 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 11 ❑ Seepage Bed 21 JaMound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Da / 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (s ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) ~-� Elevation j , i Feet eet VII. TANK Capacity . in gallons Total # of Prefab. Site Fiber- plastic Exper. INFORMATION New Existin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass App. structed Tanks Tanks eptic Tank o n BOO 0 j " � f ❑ ❑ ❑ ❑ ❑ Pump Tank /Si er 6 -- (� l /f 1:1 El El 1:1 1:1 VIII. RESPONSIBILITY STATE - MENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans_ Plumb is Name: (Print) Plumber' Signat4j:e: (No St a ps) MP /MPRSW N O.: Business Phone Number: 3�0 35 735 / Plumber's Address (Street, 5ity, State, Zip Code): �S 7 LU IX. COU TY / DEPARTMENT USE ONLY ( ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate Issued is ge Signature (No Stamps) X A roved Surcharge Fee) Adverse Determination / pp ❑Owner Given Initial �O oC� I Oa F X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R. 05/94) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber Safety and Buildings 2226 ROSE ST LACROSSE WI 54603 -1905 I Scons n Tommy G. Thompson, Governor Philip Edw. Albert, Acting Secretary Department of Commerce November 06, 1998 CUST ID No.5176 A7TN.• Rod Elsinger ZONING OFFICE RED CEDAR PLUMBING & HEATING ST CROIX COUNTY N4676 471 ST 1101 CARMICHAEL RD MENOMONIE WI 54751 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 11/06/2000 IdenlificatioiiNuinbers;°'.. Transaction ID No. 185517 Site ID No. 161555 SITE: Please refer 1"o bbth*ideiitificahonrnubb'grs,` Site ID: 161555 above; m'all'correspbridencc, with the agency. St Croix County, Town of Springfield NE1 /4, NE1 /4, S29, T29N, R15W Michael & Kathy Sshimek FOR: /9 Description: Mound Revision Object Type: POWT System Regulated Object ID No.: 429213 ` !l The submittal described above has been reviewed for conformance with applicable Wisconsin. _ ive Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED., The following conditions shall be met during construction or installation and prior to e-ecupa, or u e:. "' • A Sanitary Permit must be obtained from the county where this project is located in accor a rth the requirements of Sec. 145.135 and 145.19, Wis. Adm. Code. • 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(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 10/28/1998 FEE REQUIRED $ 60.00 DENNIS R SORENSON ,WASTEWATER SPECIALIST FEE RECEIVED $ 60.00 Field Operations BALANCE DUE $ 0.00 (608)785-9336, MONDAYS 7:OOAM- 3:45PM DSORENSON @COMMERCE.STATE. WI.US Safety and Buildings 2226 ROSE ST /� /'� LACROSSE WI 54603 -1905 I SCOT I SI / 1 Tommy G. Thompson, Governor Philip Edw. Albert, Acting Secretary Departmen of Commerce November 06, 1998 CUST ID No.5176 ATTN: Rod Elsinger ZONING OFFICE RED CEDAR PLUMBING & HEATING ST CROIX COUNTY N4676 471 ST 1101 CARMICHAEL RD MENOMONIE WI 54751 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 11 /06/2000 Identification Numbers Transaction ID No. 185817 Site ID No. 161555 SITE: Please refer to both identification numbers,' Site ID: 161555 above, in all correspondence with the agency. St Croix County, Town of Springfield NE1 /4, NE1 /4, S29, T29N, R15W Michael & Kathy Sshimek FOR: Description: Mound Revision Object Type: POWT System Regulated Object ID No.: 429213 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. Adm. Code. • 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(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 10/28/1998 FEE REQUIRED $ 60.00 DENNIS R SORENSON ,WASTEWATER SPECIALIST FEE RECEIVED $ 60.00 Field Operations BALANCE DUE $ 0.00 (608)785-9336, MONDAYS 7:OOAM- 3:45PM D SORENSON @COMMERCE. STATE. WI.US Michael & Kathy Shimek - Mound Revision to Transaction # 181036 • 0/U Location: NE 1/4, NE 1/4, Sec. 29, T 29 N, R 15 W Town: Springfield County: St. Croix OW Date: October 27, 1998 ;f Owner: Michael & Kathy Shimek Address: 2827 80t Ave. Woodville, WI 54028 I Plumber: Kevin Lannon Signature: License # MP 224229 Attachments: 6748 -Plan Review Application SBD 8330 - see previous apg 1 (_ 1 page 1: cover �- 2: ,calculations 3: plot plan 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail 7: pump curve page 1 of 7 SystN Calculations One family residence 3 bedrooms Loading rate 0 '1 9 gallons /sq ft per day Depth to ground water �� Z in Depth to bedrock 3 ° in Cross slope $ Force main length ft of Z in Manifold /header length 4 ' ft of Z in Drainback �� gallons Lateral length 2 @ 4-s o ft of � 11 L in Lateral elevation �' ft (bottom of pipe) Lateral hole size �l4- in @ � ' in ( S ° f t) spacing \O holes /lateral, -2- holes total Lateral volume 53'Z g gallons Total lateral discharge rate Z3 ` gpm @ ft head i Elevation difference ' ft i Friction loss ft @ z� gpm Total dynamic head ` ft Pump /sion 2 - c \ gpm @ Z ft of head Manufacturer Model M Sw Zr Dose voluxge 1 2 j gallons Lift /si"on tank `��^'�� �""`�'� ` " , gallons Septic tank , gallons Measurement pump on & off �'� in Height alarm from tank bottom 1S `� in Reserve capacity 3 g� t gallons calcs page Z- of a to Z LU Ir 0 lu Q t Q U 1 3 t 4 9 W a. r 4 W D ^ r 4 d G LA Ol A N a � to r r r d Y ed Z 1 2 LA jr 1 !A� jd I /L.vt 4 1 1 ~ C��rt a�t nn �• a o tXs.u. 1 R1 4 � / 1 w►�a \ 6 Z•� � 15 •7 ko o � _. �- I S :9M � -) . - -• ` �� n J , --� � Q� ....��Q.K 1: O was : K Gr- .a.r{Q i PRIVATE SEWAGE SYSTEM i Condl DIViSIAN OF SAFE Y AND BUILDINGS - SEE CORRESPONDENCE T �F �� 1��3 =L T , , ,(` l A a�ofl wt��`N 1�' a. r�Y.� ��.�V�.` Y�.�A ••►�r1Lpr1 Kr:vM+�o i:...1 �i�. • t � t 1 ` t � v�,, o` 1vMV }ter �••t.'l♦ � `� �'6o�,:+t 1��1= V��i� Cv�d jd6ally APPROVED PVC scS. 40 DIVISION Of SAFEPI AND BUIUDINGrS SEE CORRESPONDENCE I .� ��� 2 PvC i� q•O • 4.p � 4v c. t... •••tea r....« Wo I t►T 0.�► f��� Lr► O p y `: b O. O A Q V ( S ' C7 1 l � a� s 0� e, FoR4- wenT1IERPaouF LOCitime COVER JUNCTION dolt WiI4N" cm. twwww6aft"N'* -T QIIItK o�°corvaCT --� c-, •- POWs .I. PIPG 3 p Nolsiup"D 4 "c.t. SO 24 0 %.D. YJ'NT ouaw MAC MIN. /IA/.ff zZ.o �NRalta A c.s. vl� BAFF6.64 3' two A►L psm IS EcTlo�+i —fi • ri ow �, GS puNP s' � o � o �oRRESP I• TIOLIS SEPTIC c OOSC TA W AS MAUUFACTURCK: ~�� IJUMOER Of DOSES: PER D" TAWK SIZC : ` � ' V os O 6^LLOUG DOSE VOLUME �h. MAmurAcruI �. S �.� � � INCLUDIN BACK /LOW: `� I CoALLONS MODCL QU^JgClt: 1 O 1 ~ ``' CAPACITIES: A= '� WCIIES OR ' GALLOWS SWITCH T:IPt: �"`�'• "' �..�� Bu INCHES OR 34 GALLOAIS PUMP MAIJUFACTURCR: �`���"' I}4 �." ' C • �'� iWCHES OR ` GALLONS MODEL UUMIOCR: 1 `��1 t �� 0 INCHES OR �n Z GALLOWS SWITCH IrWPC: "" � �._ NOTE: PUMP AUO ALARM ARE TO &L MIL114 14M p,LSCKA RAT Z S GFIA INSTALLED OLI 5EPARATE CIRCUITS i VERTICAL D1FFERCMLi K& TW[CN PUMP OFF ASIA caTR10UTIOU PIPE.. FEET + ......... . . MIU1h1 UM w K " °3 2.5 FEET (�,�TWORK ' WP1�t.y PRESSURE + l J FC,T OF PORCC MAIM X o nFRICTIOU FACTOR. FEET 2- ' TOTAL DVWAMIC, HEAD 1 ° �� FEET IIJTERWAL DIMELJSIONS Of TANK: LEW4TN 1 �_;WIDTH 6 ;LIQUID DEPTH >> '4 yy� I • , � 1 � 7`. fk Performance Data 32 Pump Charact Pmp /Motor Unit SabnlerAle Monad Models SW25M1 SW33M1 1 24 Aetomatk Models SW25A1 SW33A1 1/3 HP Horsepower 1/4 1/3 16 Fell Load Amps 8.0 1 10.0 1/4 HP Motor Type Shaded Pole (4 Pole) R.P.M. 1550 a Phase 0 1 Voltage 115 ° Hertz 60 0 10 20 30 40 50 60 CAPACITV•U.S. G.P.M. Operation lotermittw Temperature 120 °F AmWext Total Need (foot) 4 6 8 10 12 14 16 18 20 22 24 NEMA Design A 1/4 NP 44 41 36 33 29 26 23 18 12 6 0 1051111011011 Class A GPM 1/3 NP 47 45 43 40 37 34 30 26 22 16 10 DhKharge Size 1-1/2" NPT Solids Haadliag 1/Y Dimensional Data Udl weigh 30 lbs. 1. At &MUMAS in r Power Cord 18/3, UN, 1 W dL 3.1/2 sore 2. Cm*w d &vsxim ■w (20' oplioaal) ♦ -1n --�{ Vary t I/t rock 3. Not (a comirud a pwpu 1 -1/2 NPT w11KS WIM 3-tn DISCHARGE + Donva ms and �K ore Materials of Construction Q S. 0n/00 W 01110101110 Handle Steel 1n c. we rwrve do rigM to Ldlrkatin 09 DielectricOB crake end ow produces oed Nrr Motor Housing Cost Ir a VWKWM WAOW Qoke cos hu I 9Wft Steel Mocha" Sod Fmc Cwba /Cw mk Shah Sod Sod B*. Amod W Steel S"Wess steel PUMP 11.1/8 10 °N 9- I /2 V " 3lMYe DISCHARGE HEIGHT Lower Bow4 Row Ildl gooft 3 -1/2 Strainer /Base Pkntk 3 PUMP Off Fostoaors V'Itohdess Steel AURORA /HYDROMATIC Pumps, Inc. - I W Bony Road, Ashland, Ohio 44805 (419)289.3042 Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings d Comm 83.05, Wis. Adm. Code Attach complete site plan on paper not less than i% x 1.1 In o .r I atza. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D.# APPLICANT INFORMATION - Please print all information. 034 -1063- 20-000 Da iy Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Shimek Michael & Kathy Govt. Lot NE 14 NE 1/4 S 29 T 29 N,R 15 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 2827 80th Ave. City State Zip Code PhoneNumber ❑ City ❑ Village ®Town Nearest Road Woodville Wl 54028 715- 698 -2505 S rin field 1 80Th Ave. New Construction Use: ® Residential / Number of bedrooms 3 []Addition to existing building ® Replacement ❑ Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate .5 bed, gpd/ft .6 trench, gpd/ft` Absorption area required 900 bed, fF 750 trench, fF Maximum design loading rate .5 bed, gpd/ft= .6 trench, gpolft= Recommended infiltration surface elevation(s) 97.7 ft (as referred to site plan benchmark) Additional design / site consideration s i nstall 5' x 75' rock bed mound on 95.2 -95.7 as upslope edge of rock w/ 2.5 -2' sand fill Parent material loess over till Flood plaiii n elevation, N applicable NA ft S= Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system EIS ® U ® S El El S ®U ❑ S ®U ❑ S ® U El ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft° Boring# Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench ................. ....1.... 1 0 -9 10YR 2/2 - sil 2 m cr mvfr cs 2flm .5 .6 2 9 -20 lOYR 5/4 m2p 7.5YR 5/8 scl 0 m mfr - if NP NP Ground elev 95.7 It Depth to limiting factor 9" Remarks: Lacks A+4", this area ................. .................. `....,2 1 0 -3 7.5YR 3/2 - sil 2 m cr mvfr cs 2flm .5 .6 2 3 -12 ' 7.5YR 3/2 - sl 2 f sbk mvfr cs lf/m• .5 .6 Ground 3 12 -17 l OYR 4/4 - sl 2 m sbk mvfr cs if .5 .6 elev 95.7 it 4 17 -30 10YR 4/4 c2 ?.5YR 5/3 Ell 2 m sbk mv& - 5 .6 Depth to L- limiting L T- factor P!'pr ,- - 17" t (.A . Remarks: j R0 10 v --. -r CST Name (Please Print) Signature: \ 1014--wtvill — Henry F. Grote Address P.O. Box 57, Knapp, WI 54749 Date C u j \ of 4/28/98 2227 r o d ar v( Ir . C/+ o co ; \ d a rA r 0 C4 G o $ d i � � a .J v = i� �� 0 ,ao Y � 3 3 ti _7 I LA Pot Ir p cr C l _ C� �14 L,4 je ci co vi p 0 d 4 L4 Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 Division of,Safety and Buildings omm 83.05, Wis. Adm. Code Attach complete site plan on paper not nint(il Plan must Coun include, but not limited to: vertical and horizo I re rectio n and St. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D.# APPLICANT INFORMATION - Please print all Inform 034 - 1063 -20 -000 ation. Reviewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.14 (1) (m)). Property Owner Property Location Shimek Michael & Kathy Govt Lot NE 14 NE 1/4 S 29 T 29 N,R 15 W Property Owner's Mailing Address Lot # Block W--"e or CSM# 2827 80th Ave. City State Zip Code PhoneNumber ❑ City Village ®Town Nearest Road Woodville WI 54028 715- 698 -2505 Springfield 80Th Ave. New Construction Use: ® Residential / Number of bedrooms 3 ❑Addition to existing building ® Replacement ❑ Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate .5 bed, gpd/fts .6 trench, gpdff Absorption area required 900 bed, fP 7 - 0 trench, ff Maximum design loading rate .5 bed, gpd/ftt .6 trench, gpdff Recommended infiltration surface elevation(s) 97.7 ft (as referred to site plan benchmark) Additional design / site consideration s . nsta11 5' x 75' rock bed mound on 95.2 - 95.7 as upslope edge of rock w/ 2.5 - 2' sand fill Parent material loess over till Flood plai n elevation, if applicable NA ft S= Suitable for system Conventional Mound In- Ground Pressure AT - Grade System in Fill Holding Tank U= Unsuitable for system EIS N U ® S❑ U ❑ S ®U I ❑ S® U ❑ S ®U ❑ S® U ' SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color Mottles Structure GPD/fts in Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench ................. 1,..: 1 0 -9 10YR 2/2 - sil 2 m cr mvfr cs 2flm .5 .6 2 9 -20 10YR 5/4 m2p 7.5YR 5/8 scl 0 m mfr - if NP NP Ground elev 95.7 It Depth to limiting factor 9" Remarks: Lacks A +4" • avoid this area ................. .................. 1 0 -3 7.5YR 3/2 - sil 2 m cr mvfr cs 2fl m .5 .6 2 3 -12 ' 7.5YR 3/2 - sl 2 f sbk mvfr cs If/m• .5 .6 Ground 3 12 -17 10YR 4/4 - sl 2 m sbk mvfr cs if .5 .6 elev 95.7 it 4 17 -30 IOYR 4/4 c2 NYR 5/3 A 2 m sbk mvfr - l m .5 .6 Depth to i r limiting , factor 17" � s , r/a s Remarks: CST Name (Please Print) Signature: Henry F. Grote 1e - 81 Address P.O. Box 57, Knapp, WI 54749 Date '. '',!✓ST Nu , # 4/28/98 268 r4 ' Ir s , 6 c c Si ✓ -' A f a to 3 3 LA Ir of 'f Q � A �j � �' r _ 4 � CA ,; to � a • o e d 4 [1 � � x = ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND / OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address _g�� �'d� (� y 1 1J0 Property Address (Verification required required from Planning Department for new construction) City /State Parcel Identification Number QA 119(23 -7-0 LEGAL DESCRIPTION Property Location %., YVC ' /a, Sec. 9 ' 1 T,� q .. N -R,/,�W, Town of Subdivision , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # s 0 9 a , Volume — , Page # 440 Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ 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 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 ligree 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 tion date. SIGNATURE O AP ICANT rot ,C�� DATE OWNER CERTIFICATION O � 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 abo e, by virtue of a warranty deed recorded in Register of Deeds Office. SIZARtURE OF A DATE C * * * * ** 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