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HomeMy WebLinkAbout008-2002-80-000 County: St. Croi Safety and Building Division INSPECTION REPORT Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Sanitary Permit No: 0 538802 (ATTACH TO PERMIT) State Plan ID No. GENERAL INFORMATION Personal information you provide may be used for secondary purposes [Privacy Law, v illag e 4 (1)(m)] . e X Township Parcel Tax No: Permit Holder's Name: City V 008- 2002 -80 -000 Eau Galle, Town of Ronnander, Curtis & Doris Section/Town /Range /Map No CST BM Elev: Insp. BM Elev: BM Description: , G` ' 36.28.16.550B Ida �J TANK INFORMATION ELEVATION DATA STATION BS HI FS ELEV. TYPE MANUFACTURER . Mj CAPACITY q �D !� Septic 1 -yam,._ 3 ✓ t3� Benchmark 5. (0 5 /6 5 .4 /Z)6 W 1 ems- F,14., Alt. BM 7 . � � . a Dosing / o 6.+ 0y F; C. '� Bldg. Sewer ��, $ CJ3, g Aeration 1 L Z K St /Ht Inlet z,7 Holding - St/Ht Outlet TANK SETBACK INFORMATION Vent to Air Intake ROAD Dt Inlet ~ TANK TO �/L WELL BLDG. L.� Dt Bottom Septic .7Jra � PO � _f CF � � - - - - -, _ � Header /Man. Dosing 7 Sa /S� c� 75 Dist. Pipe Aeration Holding Bot. System to. 143. `!- 9 7 Final Grade /&l. PUMP /SIPHON INFORMATION Demand St Cover - 9, d Manufacturer Z 6elt�. GPM Model Number l � 52 29 3. 162 an.� � T TDH Lift / Friction Loss TD y System Head Forcemain , Len th / ' G Diia. ii Dist. to Well Z SOIL ABSORPTION SYSTEM Inside Dia. Liquid Uepth Length No. Of Trenche PIT DIMENSIONS No. Of Pits BEDITRENCH Width DIMENSION 9 S LEACHING Manufacturer: LAKE /STREAM \ SETBACK SYSTEM TO P/L BLDG WELL CHAMBER OR INFORMATION / f UNIT Model Number: i Type Of System: DISTRIBUTION SYSTEM ri I J.;. Lwv C, Hole Size �� x Hole Spacing Ve)J,to Air !mike Header/Manifold y Distribution Z 3 /_ 3 J ' Pipe(s) f �, dl J lD ] Len th Dia acing Length � Dia 9 SOIL COVER x Pressure Systems Only xx Mound Or At Grade Systems Only xx ML ' •hed Depth Over xx Depth of xx Seeded /Sodded Depth Over Topsoil \ ' M1a [ No s Nc BedlTrench Center /� / /1 Bed /Trench Edges ` ' --�. Yes �oTT 'J / Inspection COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: � / Location: 2651 BOSTON AD oodvllle, WI 54028 (NW 1/4 SE 1/4 36 T28N R��i Lot Parcel No: 36.28.16.5506 1.) Alt BM Description = j �o LAJ 2.) Bldg sewer length = ?b - amount of cover 75 Plan revision Required? Q Yes No L - -- — - - Cert W Use other side for additional information. L — Date Ins ctor�s ature SBD -6710 (R.3/97) county: St. Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Sanitary Permit No 0 Safety and Building Division INSPECTION REPORT 538802 (ATTACH TO PERMIT) State Plan ID No GENERAL INFORMATION Privacy Law, s.15.04 (1)(m)]. Parcel Tax No: Personal information you provide may be used for secondary purposes I City Village X Township pp8- 2002 -80 -000 Permit Holder's Name: Eau Galle, Town of SectionlTownlRangelMap No: Ronnander, Curtis & Doris BM Elev: BM Description: 36.28.16.5 CST BM Elev: ELEVATION DATA TANK INFORMATION CAPACITY STATION BS HI FS ELEV. TYPE MANUFACTURER Benchmark Septic Alt. BM Dosing Bldg. Sewer Aeration St/Ht Inlet Holding St/Ht Outlet TANK SETBACK INFORMATION Vent to Air Intake ROAD Dt Inlet TANK TO P/L WELL BLDG. Dt Bottom Septic HeaderlMan. Dosing Dist. Pipe Aeration Bot. System Holding Final Grade PUMP /SIPHON INFORMATION Demand St Cover Manufacturer GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Da Liquid Depth BEDITRENCH Width Length DIMENSIONS LEACHING Manufacturer: P/L BLDG WELL LAKE /STREAM CHAMBER OR SETBACK SYSTEM TO UNIT Model Number. INFORMATION Type Of System: DISTRIBUTION SYSTEM x Hole size x Hole Spacing Vent to Air Intake Header /Manifold Distribution Pipe(s) s acin Dia Length Dia P g Length xx Mound Or At -Grade Systems Only X Pressure Systems Only xx SeededlSodded xx Mulched SOIL COVER xx Depth of Yes No Depth Over Depth Over Topsoil ❑ Yes E] No BedlTrench Center Bed/Trench Edges I Inspection #1: / / Inspection #2: I COMMENTS (Include code discrepencies, persons present, etc.) Parcel No: 36.28.16.55 Location: 2651 BOSTON RD Woodville, Wl 54028 (NW 1/4 SE 1/4 36 T28N R16W) metes &bounds Lot 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Cet Plan revision Required? Yes EA No -- No. - -� Use other side for additional information. Insepctor's Signature Date SBD -6710 (R.3197) lip Safety and Buildin s Division County c rr1merce.Wi y 201 W. Wa s hin A P" B s r S � Madisol Sanitary etmit Number (to be filled in by Co.) Department lrf Comm c 0 5 State Transaction Number Application 9 g�' In accordance with s. o e, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you p ;be �for ond ary � I� AV oses in accordance with the Privacy Law, s. 15.0 0(m), Stats. j7 / / I. A plication Information — Please Print All Information Parcel # Property Owner's Name /t} n ^/ _�D - _0OQ ,C 1�4 r is � (` Property Loca�ti / / Property Owner's Mailing Address G I 5:56 ✓) / �T / � S Govt. Lot City, State C19 ` / Zip Code Phone Number AV y.,� Y., Section �� T �� ircle one),. �j / N ; R Eor y� Lot # 11. Type of Building (check all that apply) plc. Subdivision Name WI or 2 Family Dwelling— Number of Bedrooms Block # ❑ Public /Commercial — Describe Use ❑ City of CSM Number ❑ Village of / ❑ State Owned — Describe Use Town of Ill. Type of Permit: (Check only one box on line A. Complete line B if applicable) isting System (explain) A New System �q Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Ex ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued , B. Permit Renewal ❑Permit Revision g Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) aJ ❑ Non - Pressurized In -Ground ❑ Pressurized In- Ground ❑ At -Grade XMound > 24 in. of suitable soil ❑ Mound < 24 in of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) Q VersaVrreat ent Area Information: Di Area Proposed (s System Elevation (gpd) D esign Soil Application Ra gpdst) Dispersalja Reed (st) Pe / �� !/ Capacity in Total # of Manufacturer 2 c VI. Tank Info Gallons Units Gallons U E A Existing Tanks I- ' D � �^J� '- � � ? New Tanks Yw / p /+ G n Septic or Wehliu ,. nk ` Dosing Chamber VII. Responsibility Statement 1, the undersigned, assume responsibility for installation of the POWTS �shown RS Numbe Business Phone Number Plumber's Name (Print) Plumbe s i aturel ,,�q I Plu er s Address (Street, City, State, Zip Code) 39 - rl �le VIII. Count /Department Use On! Permit Fee Date Is ed issuing A e Signature Approved $ pb 9= Reaso Denial ID �1 IX. ConditiQns�rA v easons for Disapproval / _ n -btX5 h 5 faJeu�- SysT 3) C�oM�G J� ! 1 Septic tank, effluent - filter and dispersal cell must all be servkes !maintained Cv�. as per management plan provided by plumber. r t 2., A �b�Ck tegtt)rements must be maintained ? )j � o e e system and submit to the County only paper not less than i 112 t inches in size SBD -6398 (R. 01/07) Valid thru 01/09 Scale: 1 " = 'LOT PLAN Ft. rage 2 of 8 NORTH � ti� . ,r✓✓e� ��� She � sere z#e a�; 0/4 Bowe t � , , �d r S' S i o a ' x 1 , ► ma COO- '- 1. Will meet all Comm. 83 setback requirements 2. Septic Tank�pQGallons Do *e Tank Gallons Mfg. by Wieser Concrete Products 3. Benchmark #1 Elevation 100.0 Description of- lap OF Benchmark #2 Elevation q.-3;5 Description of- �• i� 4. Other- Safety and Buildings 10541N RANCH ROAD commerce.Wi.gov HAYWARD WI 54843 Contact Through Relay i s c o n s i n www•commerce.wi.gov /sb/ www.wisconsin.gov Department of Commerce > Scott Walker, Governor —= 01 ' C4'Dy aul F. Jadin, Secretary July 19, 2011 CUST ID No. 221483 ATTN: POWTS Inspector DENNIS L HEWITT ZONING OFFICE HEWITT EXCAVATING INC ST CROIX COUNTY SPIA 439 SUNSET DRIVE 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 07/19/2013 Transaction ID No. 1973798 Site ID No. 769843 SITE: Please refer to both identification numbers, Curt & Doris Ronnander above, in all correspondence with the agency. 2651 Boston Rd Town of Eau Galle St Croix County NW1 /4, SE1 /4, S36, T28N, R16W FOR: Description: Mound, 3 br res Object Type: POWTS Component Manual Regulated Object ID No.: 1326828 Coll Maintenance required; 450 GPD Flow rate; 26 in Soil minimum depth to limiting factor from original grade; System(s Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual. Versio'A I 2.0, SBD - 10706 -P (N.01 101); Effluent Filter DEPAF SION The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes w _ and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans .and with any component manual(s) referenced above. SEE C The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Key Item(s) • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • The float switch shall be a type that does not contain mercury. 2009 Wisconsin Act 44 prohibits the installation of float switches or relays that contain mercury. • The revised soil test/ additional boring(s) on which this approval is based shall be recorded with the original soil • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. PAGE 1 OF S r —' Private Sewage System Plan Index PLAN I. D. NO. 11�� PROJECT TYPE ?� GALLON MOUND PROP. OWNER r% 9'C /1 nr7 Q n 6/P (� ADDRESS AW l SjJS"7j4/1 6d WOO dItf/A0 PROJ. LOCATION -- COUNTY ��t�11C TOWNSHIP &� 0 LEGAL DESC.4, '�„ SEC. Plan in accordance with Mound Component Manual SBD- 10691 -P (N. 01/01) Version 2.0 and Pressure Distribution Manual SBD- i0706 -p (N. 0101) Version 2.0 PAGE ONE INDEX SHEET PAGE TWO PLAT PLAN PAGE THREE CROSS SECTION & PLAN VIEW O. W.T.S. PAGE FOUR LATERAL DISTRIBUTION PIPE jitionally PAGE FIVE PUMP/SIPHON TANK I R O v E D PAGE SIX PUMP CURVE MENT OF GO CE PAGE SEVEN MANAGEMENT PLAN SAFETY PAGE EIGHT Ma lgcjement Plan - FiRESPON E DESIGNER Dennis Hewitt CREDENTIAL NUMBER 221483 ADDRESS - 439• -Sunset Drive �`Hu Son, Wis. 54016 TELEPHONE 7 Y,5 - 8 2 1-- 4 6 8 DATE U� ✓ CR a// SIGNATURE Page 3 of 8 Ground _Contour Elevation Synthetic Covering System Elevation Distribution Pipe Medium Sand • H G Topsoil F • a % Slope CELL Of -2 Force Main Plowed Aggregate From Pump Layer Crass Section Of :A Mound System E ►� F io It G 6 it LINEAR LOADING RATEGPD/LN FT A Ft. H _" DESIGN LOADING RATE f 4' GPD/SQ FT• Q �' Ft. BASAL AREA NEEDED 114 . S Q FT I ,1,� Ft. BASAL AREA AVAILABLE SQ FT J �� . Ft K Ft. I Ft. W�Ft.. Observation Pipe B ----- —K- --------------- - - - - - - - A I. o W I-- -- - T ---------- - ------ - - - - -- __---- - - - -•- I YY " �� Oistrlb ' utiort Cell 0 f 2�— 2 i Pipe Aggregate /I?Cpl O b s e r v a t i o n Pi Lateral C lean -Outs Plan View Of Mound 1AT AL Absorption Area C014BI14ATIO SEPTIC TANK /PUMP CHAMBER (No Scale) 4" CI Venc Pape ..; cr% .Approved Locking Manhole Cover Approved Cap, 15 4 With Warning Label Attached From 6u; 1j;n9, Weatherproof Approved Junction Box Vent Cap 12" t't i n i Min J— Grade 4" Minimum Quick 18" Minimum Disconnect i i 1/4* Weep 4� Baffle Hole r' 1 Approved Joint 1 N %C.I. Pipe A Extending 3' Filter Alarm 6 Onto Solid Sail Polylok 525 On I? B Approved Joi r. or PVC i w /C.I. Pipe Extending' 3' PUMP'OFF ELEV. 9O��P Off 6' Onto Solid Sc or PVC D Canc. Blccf. 3" of Beddin 4 Under Tank-/ Lateral Volume ld6 IA, O /1(0 Cal Min. Dose. (5 X Lat. Vol.) Cal. Max. Dose (20' of DWF) Cal. Noce: Pump and Alarm Are On Separate Circuits Flowback ����x, Cal. Max. Dose 'W /Flowback Cal. Tank Manufacturer: WIESER CONCRETE PRODUCTS Tank Size- Septic /Pump: D ' G allons Alarm Manufacturer: S. J. ELECTRO Model Number: 101 RICH WATER Capacities: A inches or ,&V,4 Gallons Pump Manufacturer: - r_ + B 2 inches or Gallons Model Number: - 9T - + C inches or Gallons Minimum Discharge at + D inches or Gallons ftbi'11G46 X.46 9'00- Total ..... _ _,, inches or Gallons Vertical Difference Between Pump Off and Distribution Pipe: / /,d Feet Minimum Required Supply Pres re :.........................+ 3.3 Feet Feet of Force Main x Friction Factor /100 Feet: + 2 Inch Diameter Force Main Total Dynamic Head: ... = /�,' Feet Internal Tank Dimensions: Cal. /Inch, Liquid Depth POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _ __ or 4�_ FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity 1 000 11 NA Permit 11 � al Septic Tank Manufacturer 'Wieser ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer pol ❑ NA' Number of Bedrooms 3 ❑ NA Effluent Filter Model 525 ❑ NA Number of Commercial Units 1 NA Pump Tank Capacity 600 g al ❑ NA Estimated flow (average) gal /day Pump Tank Manufacturer ❑ NA Wieser Design flow (peak), (Estimated x 1.5) 450 gal /day Pump Manufacturer ❑ NA — Zoeller Soil Application Rate gal /day /ft' Pump Model ❑ NA Influent /Effluent Quality Monthly average* Pretreatment Unit IN NA Fats, Oil & Grease (FOG) <30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD <220 mg /L ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) <150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality * Manufacturer y NA Monthly average Dispersal Cell(s) Biochemical Oxygen Demand (BOD <30 mg /L ❑ In- ground (gravity) ❑ In- ground (pressurized) Total Suspended Solids (TSS) <30 mg /L ❑ At -grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip - line ❑ Other: Maximum Effluent Particle Size % inch diameter * Values typical for domestic (non- commercial) wastewater and . septic tank effluent. MAINTENANCE SCHEDULE * * Values typical for pretreated wastewater. Service Event Service Frequency Inspect condition of tank(s) At least once every 3 ❑ months X year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one -third (% of tank volume Inspect dispersal cell(s) At least once every 3 ❑ months SI year(s) (Maximum 3 yrs.) Clean effluent filter At least once every 2 ❑ months # year(s) Inspect pump, pump controls & alarm At least once every 3 ❑ months R year(s) ❑ NA Flush laterals and pressure test At least once every 3 ❑ months 0 year(s) ❑ NA Other: At least once every ❑ months ❑ year(s) M NA Other: At least once every ❑ months ❑ year(s) N NA MAINTENANCE INSTRUCTIONS: Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground durYace. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (% or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatement components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION: For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. RECEIVED Wisoonsin Department of Comme SOIL EVALUATION REPO$ -A 111) 1 4 Division of Safety and Bui dings J U L 1� n t t nce h Comm 85, Wis. Adm. Code page Attach com lete site I n County St. Croix p p 1 inches in size. Plan must include, but not limited point (BM), direction and percent slope, scale ordimensions, north arrow, and location and distance to nearest road. Parcel I.D. 008- 2002 -80 -000 Please print all information. eview / Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location ❑ ❑ Curtis &Doris Ronnander Govt NW Lot W 1/4 SE 1/4 S 36 T 28 N R 16 E (or) W Property Owner's Mailing Address Lot # Block # Sulxl;Name:or CSMrY 2651 Boston Rd. COY State Zip Code one Number ity Vllage own Nearest Road Woodville Wisc. 54028 ( 715 778 - 5831 Boston Rd. — E21 1 G42111 E] New Construction useEl Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement ❑ Public or commercial - Describe: Loess Flood Plain elevation if applicable fl General comments 9 l�U and recommendations: 10" Mound /v / N 7 - V art �Q Contour Elevation @ 102.2 !J J A;d' � a Boring # Boring Q woo Y ❑ Pit Ground surface elev. 98.50 ft. Depth to limiting factor 31 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -7 10YR3/3 - sil lfsbk mfr cs 3 0.4c 0.6 2 7 -17 10YR4/3 -- sil 1 fsbk mr cs 2 0.4c 0.6 3 17 -31 10YR4 /4 - -- scl 2msbk 4 31-42 10 4/4 c2d5YR5 /8 mfr cw 1 0.4 0.6 sc 2msbk mr cw 1 0.2 0.3 a Boring # ❑Boring 97.10 /��• 2-0 �� 7 26 Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *EfW 1 0 -6 10YR3 /3 - -- sil lfsbk mfr cs 3 0.4c 0.6 2 6 -15 10YR4/3 -- sil lfsbk mfr cs 2 0.4c 0.6 3 15 -26 10YR4/4 scl 2msbk mfr cw 1 0.4 0.6 4 26-38 10YR4 /4 c2d5YR5 /8 sc 2msbk mfr cw 1 0.2 0.3 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) ignature CST Number Address Thomas W. Gedatus 962178 Date Evaluati Telephone Number Stang Plumbing & Electric P.O. Box 263 Woodville, Wisc. 54028 ��•• 6/20/2001 715- 684 -5166 � // -- .11. T IlN 1 -1 Property Owner Curtis & Doris Ronnander Parcel ID # 008- 2002 -80 -000 P age 2 of 4 L— D Boring# Boring la 3. Z.S T, cr, J Ground surface elev. 100.25 ft Depth mfing factor 34 ® Pit in. Soil Appli cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I *Eff#1 *Eff#2 1 0 -8 10YR3/3 - -- A lfsbk mfr cs 3 0.4c 0.6 2 8 -18 10YR4 /3 - -- sil Ifsbk mfr cs 2 0.4c 0.6 3 18 -34 10YR4 - -- scl 2msbk mfr cw 1 0.4 0.6 4 34-48 10YR4 /4 c2d5YR5 /8 sc 2msbk mfr cw 1 0.2 0.3 T- Boring# Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 * Effluent #1 = BOD > 30 a 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg& 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- 8330Too (R.07/00) W e ti► •. t �ict RY\ cin Cc, � C- t • I \4 — D j , , . tf l = i I x` =* O Cl Y- Z O O U - O D 0 ` tt �— Y + lz n 4 cj CQ ct C 4 5 13 ra Z { T a E3/Al L 100. r f r r- (3-3 -2 i O's . 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Grant Locations L7 % Admin & Political Boundaries L G9 Land Descriptions & Cadastral L3 Recreation & Trails LJ C Map Indexes CJ [__ Forests & Landcover Lj Transportation tJ Imagery & Basemaps P NAIP 2008 Color Air Photos r NAIP 2008 Color Air Photo Info r NAIP 2005 Color Air Photos r NAIP 2005 Color Air Photo Info r Older Air Photos r Digital Topographic Maps r Older Photos -24K Topo Merge r Older Air Photos - Coverage r Older Air Photos - Info Scale: 1: 1,500 Quick View: Select a location I DNR Maps & Aerial Photography I DNR GIS Overview I Division of Water I Comments on this website Pad , q b-0.4 http : / /dnrmaps.wi.gov /imf /imfjsp? site= SurfaceWaterViewer.floodplain 6/22/2011 / /� 1, , ; „ ,l � l r ;/ �, ;, � � •' j �� _. ��� l ✓ /��� � ll� , /�� ii, it � l \R \RR \RR� " � �%� �I I II � l,►...�I '',� � �� dD I ' dffIljljlj �I Iil�l illl � 1 I','' ,�I�iIIIIIIIIII�I�I�iIIIII lil�lllll�lll�l�ll I'I�I II�I�III�IIIIII�I�IIIIIIIIIII�I�I�III�II�IIIIIIIIIIII�I�I�I�IIIII�I�I�IIIIIIIII�I�IiIIIIII�I�I�I�lllll�' �I�I�I��I�I�Illlll�lillll�l�llllllll ll' llllll�i�l�illllllll�l�ll�l�lllllllllll�� vi iioiiie_� �` I IIIIIIIIIIIIIII�IIIIIIIIIII�' IIIIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�IIII���IIIII! 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M _ nd dF>iG( L��:ia aw..Z2s ?,.•vier ht�Sk�*tG�: ' 4S arlci cap fe "ax1t� a j oiFt ter,,ts t ( ''., _. Grantee.! - %V-it 3e -9sLg I. That the said Grantor, zor a va cens i d araLtion-_ ! -of- ane dol��t .and other .r�t�a� -_. +�. motion - conveys to-t.rantee the tollnwing described `reel eatAte_in 4ounty`; State of Wise_nsin: I 6TiB OflFandew. See Attached Exhibit - "A i'�: • /t.. �_��� 1 � � Q = .�. .... — T&% Parcel No:l � - I; :deed s in anti ,faction of that cPrtaan land cotltrat t dafied September 29 Y979 �t and r�"r i at ''11 r}5; A ICI•.: =on .Oct�r 3 1979 in Volume 6,02, 'page 165 &1 66`: This 1r deed .a.s also in ;.satisfaction of the .;assigmnent cif thb land contsaat af�reln�nticMlsd said.;assagrmlent. -dates October 1'9th,1985 and recorded on, October 11 1085 _at St30A.M:. " If I 1Thts __:ice Zjpt:. 11 - - homestead - property. .. I Together wIt1 all and singular the Fieredltamentlt ana appurte ev �� 2n fo belontCing And :. GjZ aIltOr de • _ . ea . wai rants than the title Is good Infsible. in fee aimple -and free - Kl clear of encubrances except 9 m = f and• will warhart and defend Daced this :.,.23rd.. day. of _.____.Januax}t ....... ..... ... ............ . -a .......:... (SEAL) �.: • c. � .. _ ._...... (SEAL) " � �,v1L` � PS°...��1t 53 . (SE AL G ) 2 .: . .�.... (SEAL) - V4 ae p- a ,dean .- .,.. ' 11 ALITHENTI- G`A7�' - Ia1Y :... .:. _.;AC$'N.0WL)JD0mENT t Slgmature(,a) o£ -- Dbn --B� _Gavlc :and. - - -: -. STATE OF WISCONSIN . ,Thonlpspn 3 as. f ... . .. ............. County. 1 authe ti this c a of_ ^ .... 19.9.Q- Personally came before me thin ______ _ _______day- of xI . ........ . ............ ..................... 19........ the above named r - •- __• -• -- :._ ._..__.._..- • -• -•.. . .............. •--- ••---- •_..._. ;TITLE : MEMI}�'R STATE BAP OF WISCONSIN ;} sutnorized by § '706.06" *is Stints ) to the known to be. the person _ who executed the u foregoing. Instrument and acknowledge the same. TH Is t S7 R Vhf It NT'WA 6n.. r"�Eb e D3.ane L Gav r Atto ic rne I -• - Y 344 "....- •• -• -.. • .............................. ...•.._...._......-- .._........ � � spring �Fa3ley, ;.. . 54'76 Notary Public ........ _...._. _County; Wis. {` { Iy;nature4 may Tie mithenticated or acknowled Roth sly Coii:misi, ^,n i =_ permanent. (if not, state expiration �I are not necessary.) date: I! .'NamM Of per •oii3- i:.ifn...q :r. any._SiQ ,.Y lhs. �d i• ` !.i.c o: > -!ne.d hm— their MA. — tur•s. t a•'ATF ORM 1 1982 §IN --- -- Stock No. 13001 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Cure - s 96walaak .�"/ .�eo / Mailing Address �'J / 7Gd � " Property Address —S CAS 0122i1 (Verification required from Planning & Zoning Department for new construction.) ppy��__//� City /State f1�GPJC� �r�� � Parcel Identification Number ©� �� 6U_ AM LEGAL DESCRIPTION f �I Property Location /4f/ , '/a , Sec. 3�O , T XF N R_A�W, Town of 25�_a Ak' Subdivision A Lot # Certified Survey Map # , Volume , Page # Warranty Deed # Volume , Page # �! Spec house yes no Lot lines identifiable es 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 §Cotmn. 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 tp 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 2�1J lL SIGNATURE OF APPLICANT(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. 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