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HomeMy WebLinkAbout038-1039-70-300 0 ol ° rr I m o 0 3 $ J 7 f U) 0 � : ©° N , i f _i i d ¢; �§ g § f ` ) @ � pi pi § , « ] ` CD -4 8 § / 2 G @ / § \ k ) E E o E § & ° © R � , e o ® e o: Q ƒ C ? / 3 \ 9 \ @ § CD 9 \ § k: "Who @ @ $ : n r ■ $ 2 E �: ■ g � § .. T z 000 { / 5- 3 ƒ Ch \ / ^ § / 7 17 I \ & -4 ~ ( j / I z \ $ § §0 R g § / CL CD \ [ 2 _ -1 CO) � ƒ 2 CD ( z # m k rT @ . 7 z I Cl) $ / ± ; 0 § & j I � ( c \ 0 % ( 0 \ � ) � $ I > � ¥ � \ � � 2 0 2 ° ) § )o § \ ® k Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count .• $afet'y and Buildings Division y� INSPECTION REPORT ST CROIX 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)]. 324710 Permit Holder's Name: ❑ City ❑ Village IKI Town of: State Plan ID No.: MEDCHILL, Kevin STAR PRAIRIE 7 - TrbrfS, /� CST BM Elev.: / Insp. BM Elev.: BM D escription: Parcel Tax No -: too .0 I lao .0 J 1 JQ.. 038- 1039 -70 -000 TANK INFORMATION 0 ELEVATION DATA A9800603 A �� 31. l8. 170A TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. ql f— Septic Benchmark A/ - o2 r 3 7 'a 1 / 3_ Dosing (N,[2fGs N•C �. �ti. `. ez dti . o Aeration Bldg. Sewer !O. 9T_-32. Holding St/ Ht Inlet 910 TANK SETBACK INFORMATION St/ Ht Outlet • 32 TANK TO P/ L WELL BLDG. Air i to ntake ROAD Dt Inlet ' Air Septic > 5-O > 6-0, NA Dt Bottom iS�L o. S'6 Dosing > 50 ),0 L NA Header /Man. S•O3 �, Aeration NA Dist. Pipe 03 0 SS. o S Holding � 9 Bot. System PUMP/ SIPHON INFORMATION Final Grade !F5 A� Manufacturer Dem d ?' ,� � '^7O ��• Q Model Number at � GPM q H ft '�j Lriction� (,I- System �! TDH _( H n Length Dia. X � st. To Well 7� SOIL ABSORPTION SYSTEM BE TREWjj Width r « Lengt No. Of PIT No. Of Pits Inside Dia. Depth DIMENSIONS r2 DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHIN M a cturer: INFORMATION Type Of CHAMBE a Number: System: >10 710D > ( Ja OR U DISTRIBUTION SYSTEM Length Header/Manifold « Distribution Pipes x Hole Size x Hole Spacing Vent To Air Intake L � D / 3z « Length ,/ ia. 2 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 ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Z << v to r ` C ' ��� `` LOCATIO TAR PRAIRI 9.31.18,NW,SW 2245 10 T T . 4, l / = • 31 �4 3 t . 18 - 14oA) C.4st...r c Z /Y (o /: �.. fr /x L f ly ®� ibwc .,. �,ota•oG � ��- (Sv' �+�� ��� , � / e f L � C� - � I) � G .a-l) C4.1` �) > Cft� Plan revision required? ❑ Yes N No r < Use other side for additional information. as O 9 � SBD f10 (R.3/97) �. Date Inspector's Signature Cert. No. r -in � ;: m c ,�✓�t' b�LceA �i.1,1t� 755- .2 423 —`A V6c Safety and Buld'mgs Division SANITARY PERMIT APPLICATION 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Department of Commerce Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches in size. , S +• C v' O • See reverse side for instructions for completing this application State Sanitary Permit Number y ou p rovide may be used b other g overnment agency X ,ya 1 0 The information Y P Y Y 9 g y programs ❑ Check if revision t previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Numbe 1. APPLICATION INFORMATION -PLEASE PRINT ALL INF RMATION C �R Prope weer Name Property Location ,�1 ( ) I 'I - - ` /l j(�r4 5 a 1/4, S � T .3 r N, R S E (or)�•% Prope Owner s Mail' Address J Lot Number Block Number F 0- a Ci S to Zip Code Phone Number Subdivision Name or CSM Number . ( lsS3�' Q3 I. TYPE OF BUILDING: (check one) ❑ State Owned i ty Nearest Road , El Public 1 or 2 Family Dwelling - No. of bedrooms o Town of 1 III. BUILDING SE: (If building type is public, check all that apply) Parcel Tax Number(s), q 1 E] Apartment/ Condo �/ "" /05 / ^ 7 0 — 0 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 Q Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 Q 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. RNew 2 ❑ Replacement 3. [] Replacement of 4 E] Reconnection of 5. Q Repair of an Syfstem-------- System______ __ Tank Only______________ Existing System _ Existing System B) Q 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,XMound 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 Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) P70', sed (s . ft.) (Gals/da /s . ft. Min. /inch Elevation �S0 Y ) ( ) 4 _ / � �–� / i Feet -^ Feet VII. TANK Capacity in gallons Total # of Prefab. Site Fiber- Ex p er. INFORMATION New Existing Gallons Tanks Manufacturer s Name Concrete Con- steel glass Plastic A p p strutted Tanks Tanks IcTank g an 060 bi 'ee KS 0 1:1 ❑ E] 11 Lift Pump Tank X s El VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: (No ps) MP/MPRSW No.: Business Phone Number: 5s' Plumber' Ad ress (Street, City, State, Zip Code): G` ` IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundw ate Issued Issuing Agent Signature (No Stamps) Surcharge Fee) 7 ®Approved []Owner Given Initial iy 9� ov 66 Adverse Determination v�- X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-a= (Ft.11AIS) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, phunber Safety and Buildings • 15837 USH 63 HAYWARD WI 54843 -8107 isconsin Tommy G. Thompson, Governor Department of Commerce Philip Edw. Albert, Acting Secretary November 30, 1998 CUST ID No. 138693 ATTN: POWTS INSPECTOR WILLIAM L PFANNES ZONING OFFICE 103 W 1ST ST ST CROIX COUNTY PO BOX 552 1101 CARMICHAEL RD DRESSER WI 54009 HUDSON WI 54016 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 11/30/2000 Identificajpa.Wupbers Transaction ID I< 194795 SITE: ST CROIX COUNTY, TOWN OF STAR PRAIRIE Site ID No. 1643 NW 1/4, SW 1/4, S9, T31N, R18W Regulated Object Id No.: 438062 KEVIN MEDCHILL RESIDENCE Please refer to both identification numbers, above, in all correspondence with the agency. FOR: DESCRIPTION: MOUND SYSTEM OBJECT TYPE: POWTS The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes 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. The following conditions shall be met during construction or installation and prior to occupancy or use: 1. System construction shall be in accordance with the changes made on the approved plans. 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 11/16/1998 FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 eroy G. nsky, stewater S ialist BALANCE DUE $ 0.00 Field Operations Bureau (715)726 -2549 Fax (715)726 -2544 Voice WiSMART code: 7633 Ijansky@conimerce.state.wi.us MOUND SYSTEM DESIGN INDEX AND TITLE SHEET Project KEVIN MEDCHILL Owner KEVIN MEDCHILL P•O•W'T.S' CO i rionatty Address 881 DORMAN ROAD HUDSON nFpARTMENT OF COMMERCE DIVI N OF SAFETY AND BUILDINGS W1 54016 Legal Description NW- SW- S9- T31 -R1 C RRESP ENCE- Township STAR PRAIRIE County ST. CROIX Subdivision Name NA Lot No. NA Parcel ID Number Plan Transaction Number I c - 1 7 9 Index and title sheet Page 1 Mound calculations Page 2 Mound drawings Page 3 Pres. dist. calcs. and laterals Page 4 TDH and pump tank drawing Page 5 gmtrUrDe 7 Designer WILLIAM PFANNES License Number i 138693 Signature Phone No. 715 -755 -3962 Date ® , / S T No6c- Tampering with this file by unauthorized persons is prohibited. Deliberate= modification win result in disciplinary action under s. 145.10, Wis. Stats. Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)J. SBD- 10462 -E (R.05198) Pagel of MOUND SYSTEM DESIGN Complete red boxes as necessary. 1000 gpd maximum design flow. Inch - pounds Metric or n n Replacement system? Residential or commercial? c (r or c) (y ) �� p y Creviced bedrock site? n Slope Wastewater flow rate 450 _ ;gpd 1703 Lpd Depth to limiting factor 24 Jn 61.0 cm In situ soil infiltration rate. 0.4- ;gpdM - -24.4 Lpolm` Contour line elevation 99.1 ft 30.21 m Use standard fill depths? x OR Design depth? =in 0 cm Place X in box to use standard depths (24 and A +4 inclusive) OR specify design fill depth. r- - - - -• c 0.125, 0.156. 0.188, 0.219, Center or end manifold a (c or e) Hole diameter ; 0.25 f in 0 0 28 1. nr 0 313 Inch onN. Lateral spacing 5.00 ft Use 0 lateral spacing for trenches. Estimated hole space 2.50 ft Not a final calculation. Number of laterals 2 F Pump tank elevation 94.5 ft Outside bottom of tank. Forcemain length -0fi.0. `ft Forcemain diameter 2.0 in 1.5 2, 3 or 4 inch only. _'7v 2.067 in Actual I. D. Fl, l r :,•,ia 1/8 =0.125 114=0.250 SYSTEM SOLUTIONS Inch Metric 5132=0.156 9/32=0.281 Estimated daily flow 1 450 Igpd 1 1703 JLpd 3116m 5/16=0.313 7132 = 0.219 Absorption cell Design load rate & area 1.2 gpd/ft 375.0 ft` 34.84 m` Linear loading rate (LLR) 10.0 gpd/ft 124.0 Lpd /m Design width (A) 8. 50 ft 2.59 m Cell length (B) 45.0 T t 13.72 m Depth of cell (F) 9.5 24.1 cm Sand filter Upslope fill depth (D) 12.0 in 30.5 cm Downslope fill depth (E) 1 14.0 lin 35.6 cm Basal area required (gpolinfiltration rate) �1� _ M Supporting components Topsoil depth 6.0 in 15.2 cm Subsoil depth at center 12.0 in 30.5 cm Subsoil depth at cell wall 6.0 in 15.2 cm End slope toe length (K) 10.13 ft 3.09 m Up slope toe length (J) 7.90 ft 2.41 m Down slope toe length (1) -449 ft i , 4.0 -2-8f- m Total mound length (L) 65.26 ft 19.89 m Total mound width (W) 25.88 ft ;:� 7.86 m Project: KEVIN MEDCHILL Transaction Number: Page 2 of 7 MOUND PLAN VIEW observation pipes (typical) J A = 8.50 ft 2.59 m m A� B = 45.0 ft 13.72 m J = 7.90 ft 2.41 m W I B K t�,�,' 1= -9-9 ft m K = 10.13 ft 3.09 m — F - 6 - 5 — .2 - 61 ft m typ. obs. pipe (anchored securely) I = down slope dimension = absorption cell (AxB) J = up slope dimension = plowed area (LAN K = end slope dimension 6" (152 mm) T MOUND CROSS SECTION oil ca b sus p D = 12.0 in 30.5 cm lateral topsoil G H E = 14.0 in 35.6 cm invert 100.60 ft - - • F = 9.5 in 24.1 cm elev. 30.66 m F G = 12.0 in 30.5 cm T ASTM C33 H = 18.0 in 45.7 cm D Sand Fill y Sys. F 1 - 00 - 1 - - 01 ft elev. 30.51 m 99.10 ft contour 30.21 m elev. 2 % ---� slope D = upslope fill depth plowed layer E — downslope fill depth Note: Absorption cell media will consist F = aulso rption cell depth of aggregate and pipe with laterals G = subsoil + topsoil depth at cell wall centered aeross AxB media. The cell H = subsoil + topsoil depth at cell center media is covered with geotextile fabric. Designer notes: Project: KEVIN MEDCHILL Transaction Number: Page 3 of 7 PRESSURE DISTRIBUTION CALCULATIONS Absorption cell Inch-pounds Metric Width (A) 8.5 ft 1 2.59 Irn Length (B) 45.0 ft 13.72 m Lateral specifications Number laterals 2 Holesllateral 17 holes Lateral length (P) 42.67 ft 13.01 m Hole diameter 0.250 in 6.35 mm Lat. dis. rate 19.81 gpm 1.25 Us Sys. dis. rate 39.62 gpm 2.50 Us Hole spacing (X) 32 in 81.3 cm Lateral diameter Pipe diameter Design options Design c hoice Designer must 1 in (25 mm) Place X in red "X" one choice 1 1/4 in (32 mm) box of chosen from the options 1 112 in (40 mm) x X diameter. provided. 2 in (50 mm) X -- 3 in (75 mm) X Manifold diameter Pipe diameter Design options Design choice Designer must 1 in (25 mm) X' one choice 1 114 in (32 mm) Place X in red from the options 1 112 in (40 mm) x box of chosen provided. 2 in (50 mm) x _x diameter 3 in (75 mm) x 4 in < f G1; mnrl x Clistribution system contains: 2 Lateral(s) LATERAL DIAGRAM - END CONNECTION 'lace correct lateral diagram by clicking in one of the drawings at right and dragging the diagram into this area. L ateral s centered overt the A & B d imension Last hole drilled next to end cap en - Cap P Mmain cal Ir JC�� Holes drilled on the bottom of the lateral s equallg spaced • tion Ana tap or cross to mani fold at any paint. Laterals & foroe main of PVC Soh 40 . = permanent end marker (per COMM Table 94.30 -5) Inch-pound Metric Lateral length (P) 42.67 ft 13.01 m Lateral spacing (S) 5.00 ft 1.52 m Hole spacing (X) 32 in 81.3 cm Manifold length 5.00 ft 1.52 m Hole diameter 0.250 in 6.4 mm Lateral diameter 1.50 in 40 mm Forcemain diameter 2.00 in 50 Imm Project: KEVIN MEDCHILL Transaction Number: Page 4 of TDH and Pump Tank Drawing Total Dynamic Head Operational head 2.50 ft 0.76 m Vertical lift 5.50 ft 1.68 m Are laterals the highest point In the Friction loss F7+76* ft —4.42 m system? Yes "x" here. Total dynamic head m If no, what is the highest elevation Dose Volume downstream of pump? Dose is > 10 times lateral volume Forcemain drain Lateral void volume 9.0 gal 34.1 L back to tank? ("x" one) Minimum dose 112.5 gal 425.9 L x Yes Drain back 7.0 gal 26.5 L No Dose volume 119.5 gal 452.4 L Typical Pump Chamber Layout In combination with state approved treatment tank. Tank construction as per Comm 83.20(3) WAC. approved manhole cover with weather proof warning label and locking device grade levels junction box -� gm� levels disconnect alternate 4" vent pipe electric as per NEC 300 and �- outlet Comm 16.28 WAC location 18" (46 cm) min. V all of pump approved �. chamber or outlet joint combination tank A Provide 1/4" weep hole or anti- alarm on siphon device as necessary pump on B Grade levels pump 95.1 ft � - pump tank manhole = 4" (10 cm) off elev. 29.0 m minimum above finished grade D - vent =12" (30.5 cm) minimum above finished Fade 94.5 ft Pump tank elevation 3 " (75 mm) of bedding under tank 28.8 m bottom of tank Tank manufacturer WEEKS Pump tank capacity 19gal /in Pump tank volume 80Wgal ' Pump manufacturer zoehle Inches Gallons Pump model number 98 _ c A 29.8 566.5 '° B 2 38.0 Alarm manufacturer TANK ALER � ] m C 6.3 119.5 Alarm model number DLV I p D 4 76.0 Project: KEVIN MEDCHILL Transaction Number: Page 5 of town Cf S u it Pr� r � e to' n AA1+ a o � � a � C7 o o � �f 9� ti HEAD CAPACITY CURVE 3 7/e 6 1/4 0 MODEL "98" 4 5/8 30 8 9 I 25 3 5/8 8 20 ♦ -�- O 15 4 3/16 s 4 10 1 1/2 -11 1/2 NPT 2 5 0 20 3 U.S. GALLONS 10 0 40 50 BO 70 80 LITERS 80 160 240 0 FLOW PER MINUTE TOTAL DYNAMIC HEADIFLOW PER MINUTE EFFLUENT AND DEWATERING 12 CAPACITY HEAD UNITS/MIN FEET METERS GALS LTRS 5 1.52 72 273 10 3.05 61 231 [J 7, � 15 4.57 45 170 3 5/16 20 8.10 25 95 1 y Lock Valve 23' CONSULT FACTORY FOR SPECIAL APPLICATIONS • Electrical alternators, for duplex systems, are available and • Mercury float switches are available for controlling single and supplied with an alarm. three phase systems. • Mechanical alternators, for duplex systems, are available with • Double piggyback mercury float switches are available for or without alarm switches. variable level long cycle controls. SELECTION GUIDE Standard all models - Wei ht 39 lbs. - 1 /2 H.P 1. Integral float operated 2 pole mechanical switch, no external control required. 9 2. Single piggyback mercury float switch or double piggyback mercury, float 96 Series Control Selection switch. Refer to FMO477. Model Volts -Ph Mode Amps Simplex Duplex 3. Mechanical alternator 10 -0072 or 10 -0075. M98 115 1 Auto 9.4 1 or 1 & 7 — 4. See FM0712, for correct model of Electrical Alternator, "E -Pak ". N98 115 1 Non 9.4 2 or 2 & 6 3 or 4 & 5 5. Mercury sensor float switch 0 -0225 used as a control activator, specify D98 230 1 Auto 4.7 1 or 1 & 7 — duplex (3) or (4) float system. 6. Four (4) hole "J -Pak ", junction box, for watertight connection or wired -in E98 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. �i CAUTION For information on additional Zoeller products refer to catalog on Combination Starter, FM0514; AM Installation of controls, protection devices and wiring should be dons by a qualified Piggyback Mercury Switches, FMO477; Electrical Alternator, FMO486; Mechanical Alternator, licensed electrician. All electrical and safely codes should be followed including them ost FM0495; Alarm Package, FM0513; Sump/Sewage Basins, FMO487; and Simplex Control Box, recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). FM0732. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO. P.O. BOX 16347 \ Louisville, KY40256 -0347 Manufacturers of ... `� OELLER Oi 3HIP TO: 3280 Old Millers Lane _ Louisville, 1(8 0 �ji.__ _ _ _ I� A� (501) 778 -2731. 1(800) ) 928-PUMP � s7� fir AN FAX (502) 774 -3624 7 Wisoonsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of : Labor and Human Relations Divi §i -gin of Safety & Buildings in accord with ILHR 83.05 �oe COUNTY rZ �y i r Attach paper not less than 8 1/2 x 11 inches in p p on Ian site complete a ' . m � t include, ti. St. Croix p p � � -, not limited to vertical and horizontal reference point (BM), direction �c f slope a14,or PARCEL I.D. # , dimensioned, north arrow, and location and distance to nearest roa,..,r t; - APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY.WCATION Kevin Medchill GOVT. IQT ,NW 1/4 SW' 1/4,S9 T 31 N,R 18 ,Wr) W PROPERTY OWNERS MAILING ADDRESS ;I.QT:# ' ' BLOCK A SUBO. NAME OR CSM # 881 Dorwin Rd. , - na CITY, STATE ZIP CODE PHONE NUMBER ' Y1LLAGE RFOWN NEAREST ROAD Hudson, WI. 54016 'V15)386 -1308 Star Pra 100th. St. �j f ] New Construction Use [x] Residential / Number of bedrooms 4 [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate • 5 bed, gpd /ft .6 trench, gpd/ft Absorption area required 500 bed, ft 500 trench, ft Maximum design loading rate _ bed, gpd /ft trench, gpd/ft Recommended infiltration surface elevation(s) 100.10 ft (as referred to site plan benchmark) Additional design / site considerations system el based on cnnt line of el 99 101 Parent material pitted glaci al drift Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL I HOLDING TANK U = Unsuitable fors stem 11 S 37 U OS ❑ U El S [lu ❑ S R1 U ❑ S ❑ U ❑ S :E1 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BoaxrJary Roots GPD /ft .................. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench ................. .................. ................. .................. ................. .................. 1 } 1 0 -6 10 r3 3 none si 1 2 2 6 -15 10yr5 /6 none s' Ground 3 15 -24 10 r5/6 none sil lfsbk mfi 9W na .2 .3 elev. 1 00. O ft. 4 24 -50 .5yr4/4 none scl m na na na Depth to limiting factor 24" Remarks: Boring # 1 0 -12 10 r3 3 none sil 2 2 `}' 2 12 -27 10 r5/4 none sil 2m 3 27 -67 7.5 r4/4 none locl n �.2 Ground elev. ' e ft. Depth to limiting Remarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 Address: 1554 200th. New Ricbrnon(YWLSM. 54017 Signature: Date: 10 -22 -96 CST Number: m02298 A LLZ4 V A STEEL'S SOIL SERVICE Gary L. Steel Kevin Medchill 1554 200th Ave. CSTM2298 Nw4SW4 S9 T31N - R18W New Richmond, WI 54017 MPRSW 3254 town of Star Prarie (715) 246 -6200 t N 1 =40' Bn.= top of 1 pvc pipe @ el. 100' Alt. Bn.= nail in tree C el. 103.85' V� Ste ; v Q rUe' q0 , 'L J f V ' Gary L. Steel 10 -22 -96 c ' f ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM i Owner/Buyer Ke v n c, n Mailing Address . : C'1 Property Address 2 (Verification required from Planning Department for new construction) City/State Parcel Identification Number 16 3 9 - -7U LEGAL DESCRIPTION Property Location N r /4, 5 Lk 1 / 4, Sec. �, T 3 N -R / 6 - W. Town of � � prc. I-? Subdivision Lot # Certified Survey Map # Volume �"� , Page # 1 7 Warranty Deed # _ S� S5 - Volume 1 , Page # 3 77 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, restrictedplumber 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. 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 day r )FA the three year xp' do date. NATURE 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 p c}perty described ab ve, by virtue of a warranty deed recorded in Register of Deeds Office. J / 1z- o 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