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HomeMy WebLinkAbout040-1203-40-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 538769 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)]. Permit Holder's Name: City Village X Township Parcel Tax No: Maule, Anne Troy, Town of 040 - 1203 -40 -000 CST BM Elev: Insp. BM Elev: BM Description: Section /Town /Range /Map No: d 0 b l 60 O CS r 10 j 35.28.19.940 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Z �L) Benchmark �I�J (� �2 ov vz,a Septic t s ° g ��-e ✓ AID Ta W04 I�- Aeration 5 S � Bldg. Sewer i Holding St/Ht Inlet TANK SETBACK INFORMATION st/ Oust /Z 9" TANK TO P/L WELL BLDG. Vent to Air Intake ROAD 5 1 Inlety� I. Septic , Dt��m'^^ I" �� C AC (S D g r eader/ an. Aeration Dist. Pipe Holding Bot. System PUMP /SIPHON INFORMATION Final Grade Manufacturer DoRwd St Cover GPM y� Model Number d TDH Lift Fri on Loss System ead TDH Ft a �-ILL ry - J�j 41-14_5� - Forcemain Length Dia. Dist. to Well ql b 1 � Vz — z - ; SOIL ABSORPTION SYSTEM w S'- 5 teJe � •4 . 5 r7 •!v S t" BED /TRENCH Width / Length No. Of Trenches OIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS > C! 2 3 SETBACK SYSTEM TO Q P/L BLDG WELL LAKE /STREA LEACHING Manufacturer: /) I INFORMATION CHAMBER O f 1�J ►/C� I� Type Of System: 1 6 UN Model Number: J ��n��►� iS � > goo z D TRIBUTION SYSTEM I lid _ei, S Header/ anif Id X � ' !1 Distribution !( I x Hole Size I x Hole Spacing Vent to Air Intake Pipe(s) ! / Length � Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil — - -, // pp Yes !J No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 10 / D / 27 l Inspection #2: Location: 25 Dry Run Rd. River Falls, WI 54022 (SW 1/4 NW 1/4 35 T28N R19W) Cernahous Additidn Parcel No: 35.28.19.940 1.) Alt BM Description =lap of ivtj cyan h ale 2.) Bldg sewer length = Q, `S } Q-�2- I p 7� - amount of cover Plan revision Required? Fs� Yes No Use other side for additional information. SBD -6710 (R.3197) Date Insepctors Signature Cert. No. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 538769 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)]. Permit Holder's Name: City Village X Township Parcel Tax No: Maule, Anne I Troy, Town of 040- 1203 -40 -000 CST BM Elev: Insp. BM Elev: BM Description: Section /Town /Range /Map No: 35.28.19.940 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution T ole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing _ SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes L_j No ] Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / 1 Location: 25 Dry Run Rd. River Falls, WI 54022 (SW 1/4 NW 1/4 35 T28N R19W) Cernahous Addition Lot 4 Parcel No: 35.28.19.940 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑ Yes ❑ No Use other side for additional information. —._ _ - - -_ - -- - -- - -- - - - -- - Date Insepctor's Signature Cert. No SBD -6710 (R.3/97) Jabhlb commerce .wi.gov Safety and Buildings Division County 1111. Washington Ave., P.O. Box 7162 St. Croix ' W i sconsin Madison, W 53W7-7162 Sanitary Permit Number (to be filled in by Co.) epartmen m t of C omerce 53 7 Sanitary Permit Atpplicatio State Transaction u ber In accordance with s. Comm. 8321(2), Wis. Adm. Code, submission of this form to the appropriate vG�nmental Project Address (if different than mailing address) unit is required prior to obtaining a sanitary permit. Note: Application rms for state -owned POWTS are submitted to the Department of Commerce. Personal information you Provi used for secondary 25 Dry Run Road purposes in accordance with the Privacy Law, s. 15.04 1 m , Slats. I. Application InformationA Please Print All Information k, J" QLLS Property Owner's Name Parcel # & Ann NNe— (y)a,.) Le NA Y 040 - 1203 -40 -000 Property Owner's Mailing Address A.. V 4U71 Property Location 2962 Marine Circle PI T CRO /X CO City, State Zip Code Ci Govt. Lot Stillwater, MN 55082 651 -323- O� /C� SE 1/4, SW %, section 35 (circle one) IL Type of Building (check all that apply) Lot # T 28 N; R 19 E or W ❑ 1 or 2 Family Dwelling — Number of Bedrooms 4 Subdivision Name Block # Cemohous Addition ❑ Public /Commercial — Describe Use Na ❑City of ❑ State Owned — Describe Use CSM Number ❑ village of 20 +-Zo �L� ow Na R n of Troy 3 l�.�t✓ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System eplacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previ Permit Number d Datellssued Before Expiration Owner' Z - /� ( 71 IV. T of POWTS System/Component/Device: Check all that appl Non - Pressurized In - Gr ound ❑ Pressurized h1- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (ex ❑ Pretreatment Device (explain) V. Dis ersal/Tre tment Area Informations In tltrator "Q-4" standard chambers & 3 r. ends s, Wieser filter canister, with Pol Lok PL -525 effluent filter Design Flow (gpdV Design Soil Application Rate dsf) Dispersal Area Required ( Dispersal Area Pro �s/ed (stt) System Elevation 600 d 0.50 d/s . ft. 1200.00 s . ft. 1223.20 s . ft. `` 94.00' VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o d New Tanks Existing Tanks c Y Y a a. U Cn rn w U LL Septic or Holding Tank Na 0 1,200 1 Wieser Co rete X Dosing Chamber Na Na Na Na VII. Responsibility Statement- I, the unde igned, ass me responsibility ns tion of the POWTS shown on the attached plans. Plumber's Name (Print) 1\�lumbqes Sign MP/MPRS Number Business Phone Number James K. Thompson MPRS 30021 (715) 248 - 7767 Plumber's Address (Street, City, State, Zip Code 340 Paulson Lake Lane, Osceola, WI 54020 VII oun /De artment Use Onl Approved 8El �z Permit Fee Date sued Issuing A t Signature r j eason for Denial $ � ' J Z6 � � IX. Conditions of Approval/Reasons for Disapproval SYSTEM gl#NF -R ' I. ;:'Septic tank, filter and dispersal cell must all be servlces / maintained 04 per management plan provided by plumber. Z= *­sel�eck4requ1(emertts must.be maintained as pet amble code / crdinandes'. Attach to complete plans for the system and submit to the County only on paper not less than 81/2 z 11 inches in size SBD -6398 (R. 02/09) Valid thru 02/11 ■ 5o : /pda /c,ca6o�/��6 • / ea It: Le - Anne X Zy (� 26 dr .,-, Low s� opCirnoltocc.s ,4dd�or�, �• /9tj ; T• °F7 -5 crdiv CJ /. o �o -/,2,03 - s/O - coo Se: /.2-8le 615 s F.t'isfl [e7i esc/ Cane�e� � EXisfi�g �arden Dry 8 r � Y y7 ? 1 , �r;c,ePabv A t aarrG : T o {6l`i a , S E. Cv+- rwrof' �. �ssuwud E".1'i'SEin al;sf+�'sQ/ i 1 ;cz.ao. e{ J/. SyGsEeneltN:97.ob , t S lei` _ �oss6: P/oposeFl drs�s�/ e� //. 83 Z,, (;e �cr�i2L Z S ib Q /P1 a6 i 6o 4f = S14Gt�. P.zC,( Conventional POWTS Index & Tilte Sheet Project Name: Miller 4 bedroom Replacement Conventional POWTS Owners Name: Lee & Anne Miller Owner's adress: 2962 Marine Circle, Stillwater, MN 55082 Site address: 25 Dru Run Road Project Location: Subdivision: Lot 4 Cernouhous Addition Legal Description: SWl /4 SEl /4, Sec. 35, T.28N., R. 19W., Town of Troy, St. Croix Co., WI. Parcel ID #: 040 - 1203 -40 -000 Page 1 Index and Title Sheet Page 2 Site Plan Page 3 Dispersal Cell Sizing Calcualtions Page 4 System Cross Section Page 5 System Management Plan Page 6 Filter Specifications Page 7 Filter Tank Cross Section Page 8 Parcel map Page 9 Septic Tank Maintenance Agreement Page 10 Certification for Utilization of existing septic tank Page 11 Waranty Deed Attachments: Soil Evaluaiton Report Mater PI ber Restric ed Service: James K. om son, De 't. of Comm. Credential #30021 Signature: /\ Date: Page 1 Of 11 Design pursuant to In- Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD- 10705 -P (N.01 /01) ■ 5o; /eda /ua.6o��:� ♦ Ex.�s�" 9 �a"d< e- Itda6"� • /oc�.�Pr°Per� — "sE:�q Fence%4c /oil ne ! ca /e: Le c "l( Anne /t7,' /�i 25- Z), - 0�� l oa d SccJYyff6E sl S¢c . 35 T. ,ZB�t•, .Q.i9cJ T. �FTioy 5f. Ciai} cam, y, co 1. zB 4 S �7� � s E,YisEl G�i esGr �c�e�c � Exis�in9 �a�d�n se tI �t�.�� - � o \ q� o � � wxsa%Gr e � lots , �ely{or 51SaFF /�; exi Ey. s i 9q ra�@ ✓ ✓ti ►� � ,' � 99.3/' ► t° �'ue�o � ♦o � I N a : To a� S.F •�/oL�u -rage. r/ � A 197, /ert =•os.s�' P/opcs di5Pers4 /ee. //. P - e (3) F s s & 3 X ' ky20 Tn�' /r`rafoi Q-'/ ' I C.4a n bus Z /oer & te4.- rllii - a Z a -Sccr faG�. S ob Qler�R�iGn Eo 6e = 9S�CV`: DISPERSAL CELL SIZING CALCULATIONS 1. (4 bedrooms)(100 gallons estimated flow)(1.5 design factor) = 600.00 Qpd design flow 2. Infiltrative capacity of native soil = 0.5 gpd/sq. ft. 3. Absorption area required: 1,200.00 sq. ft. 4. Absorption area as proposed: 1,223.20 sq. ft. (60 chambers total) Infiltrator "Quick 4" = 20.00 sq.ft. EISA per chamber, Infiltrator "Quick 4" end cap (pair) = 5.80 sq.ft, EISA 1,200.00 sq. ft. — (3 pair endcaps)(5.80) = 1,186.60 sq. ft. 1 1 17Fi R(1 en +? Q, nn — cn 19 ..I..,..,b w r q jre Number of trenches: 3 @ 20 chambers per tre_ nc J hambers total) Trench width: 2.83' Trench length: 82.00' Trench spacing: 8.00' on center Total system area w/ 5' trench spacing: 27.00'x 82.00' Pg. 3 of 11 Soil Absorption System Cross Section ft 99 .zo 99, 60 ft 4" Schedule 40 Final Grade PVC Vent Pipe With Vent Cap ♦_ ft Leaching Chamber t-- 9x a ft System Elevation 2.63 ft S ft ft Soil Absorption System Plan View ft 2.83 ft { 1 6.cn ft Leaching Trench 1 Chambers 4" Dia. Trench 2 Header Vent Or Observation Pipe Trench 3 Leaching Chamber Specifications Manufacturer And Model /�la EISA Rating _;z0, y sq ft per chamber Soil Application Rate 6,5 gpd /sq ft 6x- Design Flow 0.5 Soil Application Rate 20.0 EISA = (PCB Chambers 3 rows of .2- O chambers each. Page of �� Conventional Septic System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD- 10705 -P (N.01 /01). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Septic Tank Septic tank servicing mechanics comply with Comm. 83.54(1)(e). Septic tank to be located within 150' of service pad, with bottom of tank to be <_ 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface within and above the system and will promote frost penetration during cold weather months. Cold weather installations (October - March) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L, BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Effluent flow shall be alternated between dispersal cells on a two -year schedule by use of diversion valve. Effluent to be diverted from new dispersal cell to old cell at 4 year anniversary of new system installation. Old cell to be utilized for a 1 year period. Afterwards, effluent dispersal to be alternated between cells to allow use of each cell for a two year period. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715) 248 -7767 or the St Croix County Zoning Department at (715) 386 -4680. EFFLUENT FOLYdOX FILTERS "The PL -525 has 525 linear feet of 1/16" slots. It has an automatic shut off ball. When Alarm Accepts PVC the filter is removed for cleaning, the ball will accessibility a.lansionh.ndl. float up and temporarily shut off the system so the effluent won't leave the tank. No other 525 linear teat over filter on the market can make that claim!" filtratio n r�uts~ GPD � Rated l 10,000 GPD Accepts e" & 6' SCHD. 40 Pipe "Y, ! r Gas deflector ( _ Automatic shut -off f ball when filter Is removed "The PL -122 has over 122 linear feet of 1/16" lclpl slots. Rated for 1500 gallons per day, and < A.ndl.' „2 -PVD Handte can be manifolded together with other PL- Alarm Switch 122's to double or triple the GPD. It has an AMOML 122 Linear h. automatic shut off ball that stops flow when — ' ° " ., slot, the Fllur ts the filter cartridge is removed for cleaning. Comes complete with it's own housing, no Flher Housing gluing of tee or pipe and no extra parts to oip.Aa buy. 1 Gas Deflector Automatic Shut -Off Ball When Fifer Is Removed From Tenk O rder # Model # Descripti List Price PK -525 PL -525 Effluent Filter System 203.50 PK -122 PL -122 Effluent Filter System 62.50 432„ D LA m� m� rri N N O p X D r, ZD N �iZ r(A D 0 C) O 2° Dr N N N Z' m 371„ 2„ Z m 6 „ p r 2 nm � a rn D = mr D m _ Q Q oz 0 4/ LA m 18" MIN, m D r r r O Z 37 ; 22„ e m p m � o In m Ln D D D N Z (A � I � N D N m cn w m A m D r n fTl X700 ZD Z _ m C m rn -� —� D — (� D r m r— --7 cl) � Om fTl -,n�D D D z r c— cn O_ ---� ul z � cn ' FILTER CANISTER DETAIL SCALE:3 /4° 1' REV NO. onTE. \ ^° MIESER 80HURETE DRAWN BY:SWT Z SEPTIC MANUAL W3716 US HWY10. MAIDEN ROCK, W 54750 DATE: JANUARY 2008 J �° REV. JAN, 2008 800- 325 -8456 FILE: SHEET 13 UNPL A 112 428.84 4 0 1.28 ACFES cv 004 0 OO 1. 26 ACRE 6.8 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer To Am n e Mailing Address Z4GZdr ;n� e -jiClc z�; /�c�Xxi n• �SoB� Property Address -A S' D e v Ag . A-1--d 416_�K �� `` /. - (Verificatiofi required from Planning & Zoning Department for new construction.) City /State abol�e Parcel Identification Number © LEGAL DESCRIPTION Property Location SE 1 /a , 5a) 1 /a , Sec. T .2.8 N R_ 19 W, Town of Subdivision Plat: d✓'/ld Aou15 e "j � � , Lot # . Certified Survey Map # 40 , Volume 40t Page # ila- Warranty Deed # (before 2007)Volume , Page # Spec house ❑ yes Piro Lot lines identifiable Eryes ❑ no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. 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. Number of bedrooms j SIGNATURE OF PLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 09/07) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following reside e: (Street address) ,Z S 4 - �� located at: 5E ' /4, S�J t / Sec ion 25 , Town ,28 A Range _ W, Town of l'a , St. Croix County Wisconsin. Upon inspectio , I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service A , 2 Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or len rth of time : gallons minutes Tank Capacity: Gtr Construction: Prefab Concrete Steel Other Manufacturer (if known): � i '�.,�r ge of T nk (if known): ermit n tuber (if know icensed Plumber Si nature) (Print Name) (Title) (License NumbeWMPRS (Da Form to be completed by licensed plumber (Dept of Commerce Chapter 5 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 9/2008 U. 2 7 9 Q P 4 1 8 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX Co., MI STATE BAR OF WISCONSIN FORM 3 — 2000 RECEIVED FOR RECORD QUIT CLAIM DEED 04/26/2005 10.06AM Document Number This Deed, made between Richard Fox Grantor, and Anne Maule QUIT CLAIM DEED Grantee. EMPT # 8N Grantor quit claims to Grantee the following described real estate in St. REC FEE: 11.00 Croix County, State of Wisconsin (if more space is needed, please attach TRANS FEE: addendum): COPT FEE: CC FEE: PAGES: 1 SEC 35, T28N, R19W 1.3 ACRES, SEC 35, T28N, R19W, 1.28A CERNOHOUS ADD. LOT 4 Together with all appurtenant rights, title and interests. Recording Area Name and Return Address Anne Maule 0� 25 Dry Run Road River Falls, WI 54022 040- 1203 -40 -000 Parcel Identification Number (PIN) This is homestead property. Dated this �� day of kr. 2005 . . * Anne Maule * Richard Fox M Y AUTHENTICATION ACKNOWLEDGMENT ,���� STATE OF WISCONSIN ) Sign; _ authenticated this 13 day of L 2005 ) ss. Personally came before me tti9''d/ry o 2005 TITLE: MEMBER STATE BAR OF WISCONSIN the above named to me kno `-0 th6 8 who tg e• (If not authorized by § 706.06, Wis. Stats.) execute the foregoing instrument" esln lede tltd she. :v: THIS INSTRUMENT WAS DRAFTED BY � r -j Gherty and Gherty, S.C 328 Vine Street, Hudson, WI 54016 �" • Q . tary blic, ate of Wisc irk �'�.'•, Q : 4 (Signatures may be authenticated or acknowledged. Bath are not necessary.) No My Commission is permanent. (If, ngf, stet pxVirat oft.4atq- " S *Names of persons signing in any capacity must be typed or printed below their signature. QUIT CLAIM DEED STATE BAR OF WISCONSIN FORM Na 3 — 2000 P // Cie -- Wisconsin Department of Commf4' SOIL EVALUATION REPORT 2245 Page 1 of 3 Division of Safety and Buildings in accordan it omm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations e^�, Attach complete site plan on paper not less than ' , Rp hes in si Plan must County St. Croix include, but not limited to: vertical and horizo point (BM), ion and percent slope, scale or dimensions, no ocation and distan to nearest road. Parcel I.D. 040 -1203 0- 0 Please nformatt ' \ Review # Date Personal information you provide ay be used for nd3 yr �u po . 5.04 ( (m)). s Property Owner G`�O\1.Oa\C, Property Location Lee & Anne Miller �. Govt. Lot SW 1/4 SE 1/4 35 T 28 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or SM# 2962 Marine Circle Q� 4 Cemohous Addition City State Zip Code Phone Number J City Village a Town Nearest Road Stillwater I MN 1 55082 651 - 323 -3491 Troy 1 25 Dry Run Road __f New Construction Use: Ael Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD toll Replacement J Public or commercial - Describe: Parent material Flood plain elevation, if applicable Na General comments and recommendations: Site suitable for conventional POWTS dispersal cell with 0.5 gpd /sq.ft. /day loading rate. Proposed system elev.= 94.00 ". Existing dispersal cell elev. = 97.06' Boring # I Boring 16 Pit Ground Surface elev. 98.62 ft. Depth to limiting factor >110" 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 -21 10yr3/2 none sil 2fcr mvfr cw 2fm,1 c 0.6 0.8 2 21-41 10yr4/4 none sil 2fsbk mvfr cw 2fm 0.6 0.8 3 41-47 7.5yr4/6 none Is 0 sg ml gw 1vf,f 0.7 1.6 4 47 -94 10yr5/4 none s 0 sg ml aw - 0.7 1.6 5 94 -99 10yr4/6 none Ifs 0 sg ml aw - 0.5 1.0 6 99 -110 10yr5/4 none s Osg dl - - 0.7 1.6 Boring # Boring ✓J Pit Ground Surface eil 9 .11 ft. Depth to limiting factor >106" 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 -20 10yr2/1 none sil 2fcr mfi as 3vflfm 0.6 0.8 2 20 -27 10yr3/4 none sicl 2fsbk mfi cs - 0.4 0.6 3 27 -31 7.5yr4/6 none sl 1 msbk mvfr Cs - 0.4 0.7 4 31 -39 7.5yr4/6 none Is 0 sg ml cw - 0.7 1.6 5 39 -51 10yr3 /6 none Ifs 0 sg ml cw - 0.5 1.0 6 51 -106 10yr5/4 none s I Osg dl - - 0.7 1.6 A �1 Effluent #1 = BOD 30 < 220 mg/L and SS >30 < 150 g/L Effluent #2 = BOD <30 mg /L and TSS < 30 mg/L CST Name (Please Print) ignature: CST Number James K. Thompson 3602 Address A.C.E. Soil &Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 5/14/2011 715 - 248 -7767 Property Owner Lee & Anne Miller Parcel ID # 040- 1203 -40 -000 Page 2 of 3 3] Boring # J Boring Pit Ground Surface elev. 97.68 ft. Depth to limiting factor >102" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I *Eff#1 *Eff#2 1 0 - 16 1 Oyr2 /1 none sil 2fcr mvfr cs 2fm,1 c 0.6 0.8 2 16 -33 1Oyr4/4 none sil 2fsbk mvfr cw 2fm 0.6 0.8 3 33 -63 1Oyr5/6 none s 0 sg ml gw 1vf,f 0.7 1.6 4 63 -68 1Oyr4/6 none Ifs 0 sg ml aw - 0.5 1.0 5 68 -84 1Oyr5/4 none s 0 sg ml aw - 0.7 1.6 6 84 -88 1Oyr4/6 none Ifs Osg dl aw - 0.5 1.0 7 88 -102 1Oyr5/4 none s Osg dl - - 0.7 1.6 F-1 Boring # -j Boring �r Q'X _I Pit Ground Surface elev. U 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 # J 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 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. SBD -8330 (R.07 /00) A.C.E. Soil & Site Evaluations Soi / Q (/Q/L(Lt.60•� �Ji � ♦ Exc1�.' 9ra,alt e /l�a��' • loca,�properl� — j�- �c.'s�inq rewe%nc f'/oi�&ae 1 Ca /e: 11 Le c Anne lei /�Ci 25 Z)e y )e .., )od.d Low flof'�'irr/o�ou.S add zS'o.�, •2.i9� T, oF7 -5 crei y , C'o/. >yo/0- /,ZA3- SAO -a%D 27SA0 U er,/sfl iCiest/Cmcre�t EXis><i�gYardc", 2G��af, Y ' �� be /'LCo'nnlc.�ej, 0 o �x�s � 1 � off.• q� E "� aSP/ta /� olrivcWay \� r i � I exls �Je! � p`1�. l r � :9,7 1' � r 5 E Cv.�rJ�r o f' e, ,�SSuw•taa/ / � � /60. Gtr." cc W. S sEe.n a lur : 97. a( LE � B.i►1.' d�a�ov�'s,cl.�q i ) 9771 I s �. 3 o{'3 O 6 o M o 0 � I N I N I j I! j I x EO B N �O CA N C z c z li O {i O m _ O 3 O c 3 a v N .- U v CL m a) z iii Z > d d d m W to N > I' a m � I O Z c 7 w 5 d E c N 3 3 O O. ry N N a w N N � N N n m o (D Q z = z z m z y _ N N - 7 d C N O Wl N 0 0 C. O. Lo 0 N V1 !A to = o tq N N 1-- av . a a a � a �a a H a.+ 7 Q1 O N 7 O N LL O 0)� N �JUI! o z ' o 0 0 > Q N 0 O O O w O O O . .O O a O o a M m N rn v M N N y a y C E ca O p O U W O O O O O ,� N U N N N N V - 0 0 0 CAS O 0 O C N O C N e N �� N N N O O � N > N 1 0Oj r O O C N °' (O L r ao ~ n y N C - O p O ~ O c c ` f0 �v O m T O 20 N Z VNi Z S (n • ' O M F- '', LO O Z w z I d O vs m R € a L 4 CL d a tr qv E ` ' c :: p v 0 _1 A qu C) a 2 .'l 0 v V • AS BUILT SANITARY SYSTEM REPORT , �'��Z� , TOWNSHIP SEC. T N. R W .Q. ADDRESS f t'ST. CROIX COUN WISCONSIN iyy VISION BDI . 'y ; -,'� � � ':, `- 4 , LOT4LOT SIZE PLAN VIEW -Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM N :PTIC TANK(S)� �yG �MFGR. CO CRETE STEEL NO. of rings on cover L Depth i, DRY WELL TENCHES NO. of width length . area �kb no. of lines ��_ width__? ' lengt area �jQ/{� , depth to . top . of pip RK RATE AREA REQUIRED � ° [� AREA' AS' BUILT sclaimer: The inspection of this system by St. Croix County does not imply complete npliance with State Administrative Codes. There are other areas that it is not possible inspect at this point of construction. St. Croix County assumes no liability for .,tear operation. However, if failure is noted the County will make every effort to termine cause of failure. ,-ASES AND `OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. ~ INSPECTOR ivy DATED �' r PLUMBER ON JOB 1!!� - LICENSE NUMBER z E SYSTEM RFPod RT OF 'INSPLCTION INDIVIDUAL SEWAG San.itaty Penm.it • State Septic (���,�,��ti_ � St. Ctcad,x County NAME -- rownsh.ip_ Section locaiaC _ - SEPTIC T ANK Size � -�l_ _ gaZtons • Number a6 Compantments I Distance Ft om: Wett i • 12% otc gn.eatex z nape it 8u.itd.ing it. Wet.Q.and,6 Highwatetc {� . DISPOSAL S YSTEM. 12 an greaten �sta p e Distance F&om: WeQ�.__ f t W ettand-s Ft. 8u.i.2d..ing .. Highwatt.n --- -� . FIELD DIMENSIONS: _ b 6 z. De. th a in. w.�.dth � tne ;� ch � Depth � hack below Cite Leng o each tine_ 6t• Depth o6 xo ck ov t.iZe .i n• umbel o6 Depth of ,tie be ow gnade n. "o ta2 '.eng`h a6 .2i.n?s t• Stope a6 trench 7- in pen 100 . j ' { y t. Depth to bedrock e .istanc�: between i�.rte -s abso&bt.ion ateclgQ Depth to groundwater fit. Requited axea �t2 Type o� Covet: r p; ; P �; e n to St•�aw PIT DIMENSIONS: Gtcave.t around pits yea no Numben of pk outside diame e& Depth below .in.�et_ bt• 2 z Total ab,so &Lbt.ion atcea _, fit A Area .�cequ.itced it rn bdSTPECTED 8Y C TITLE ____ APPROVED , DATE_'- 19 7 �. REJECTED , DATE 197 n i H II Rev. 9/78 PERCOLATION TESTS REPORT ON SOIL BORINGS AND P WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 LOCATION: 5tJ %, -S6 %, Section—a ,T`4N,RAE (or) , Township or Municipality Lot No.�, Block No. County ��X ub ivision ame Owner's /Buyers Name: _L N SF Mailing Address: TYPE OF OCCUPANCY: Residence No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW REPLACEMENT ALTERNATE SYSTEM,, / OTHER DATES OBSERVATIONS MADE: SOIL BORINGS 7 /V PERCOLATION TESTS nA115 X �� / ,e�r� SOIL MAP SHEET 6 1 0 NAME OF SOIL MAP UNIT Df>ft<6 rR ' — /GLn PERCOLATION TESTS TEST HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- DEPTH CHARACTER OF SOIL SINCE HOLE HOLE AFTE INTERVAL MIN /IN BER INCHES THICKNESS IN INCHES 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P- P- P- f aM P- E e T 6e- ftoc - P- P- SOIL BORING TESTS DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEST TOTAL DEPTH TEXTURE, MOTTLING AND DEPTH TO BEDROCK NUMBER INCHES OBSERVED ESTIMATED HIGHEST IF OBSERVED IN INCHES B- N B- q E N e > 0 - j I OKgrj �. B_ (QS ' o -) K�� i - -4 "s -,Qa 6rj '51- 0.9 - A -Z IL,S 4 6 L5 PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on tfil he location and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy .Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. /) r t e ( F T � - r'0o� r � k �k i r _� v PL 67 State and County State Permit it � Permit Application County Permit # for Private Domestic Sewage Systems County *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: AL— M D056-RRO�3!�, Ck Z3 I A N C 1�i�6 RIVET cLs B. LOCATION: -5 Y SF '/4, Section 36, T�23 N, R E (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village CERmAAcose Am © 9 Q Towns miryu 7n � A� r�y C. TYPE OF OCCUPANCY: *Commercial *Industrial ther (specify) Variance Single family _x Duplex No. of Bedrooms 4.1 No. of Person D. SEPTIC TANK CAPACITY 17,00 Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured -in -Place _ Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured -in -Place Other (Specify)— E EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New *-- Replacement Alternate (Specify) Seepage Trench: No. of t. —Width De Tile depth (to ) — No. of Trenches Seepage Bed: — Length 4 Width _L —Depth i depth (top No. of Line 2 Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land Distance from critical slope WATER SUPPLY: Private Joint ❑ Community ❑ Municipal ❑ __ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Certified Soil Tester, NAME F C.S.T. # and other information obtained from U (owner uild Plumber's Signature PRSW# Phone # 4/,Z o Plumber's Address dC <- PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. F { M. E 3 t i a_ .m,._. j, E 4 L