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HomeMy WebLinkAbout002-1021-80-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County Safety and Buildings Division St. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar o - Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: ❑ City ❑ Villa e El T6Wn of: State Plan ID No.: Power, Robert & Teri Baldwin Township NAou f p# IZ 32' CST BM Elev.: Insp. BM Elev.: 1BM Description: 4- arcel Tax No.: JL le ao , o . CXL .� C�Z 002- 1021 -80 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATIO B HI FS ELEV. ce Septic LJJ 5 Benchma 3.p !� Dosing W Alt. BM Aeration Bldg. Sewer �•rd(o� 86 Holding St/Ht Inlet `j. f / , q 3 J TANK SETBACK INFORMATION St/ Ht Outlet q, 5 ' e TANKTO P/L WELL BLDG. Aenttake ROAD Dt Inlet Septic > ` &0 ` y r NA Dt Bottom L Dosing 3 Im IS`o f S Iwo' NA Header /Man. Aeration NA Dist. Pipe (.�) 3 /Z �+1� 3 • / I gyp, 6 g ` Holding Bot. System 3 -G ' ( 0 'L --- PUMP / SIPHON INFORMATION Final Grade s Manufacturer a �S Demand St cover � 6 Z � Model Number 5� GPM flc y•v �"� wt ? j. C) �s 3.80 c o . o ' TDH Lift �c, �,y Friction2 •,�� System a.5 TDH V, 3 Ft Aead Forcemain Length 310 Dia. 3 11 Dist.ToWell 7150 SOIL ABSORPTION SYSTEM / T Width r Length r N f TierFies PIT No. Of Pits de Dia. Liquid D EN I N 135 ads DIMENSION SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING [_ ;W I er INFORMATION ,IC T ype CHAMBER Numb System: (In -- NFORMATION > fd� >.Z�' ZaC — OR UNIT S DISTRIBUTION SYSTEM Header / Manifold rr Distribution Pipe(s) q x Hole Size x Hole Spacing Vent To Air Intake Length 3b Dia. 3 Length (oia. l � Spacing 3 /$ 2 4 it 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/Tr nch Center Bed /Trench Edges I Topsoil I ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1• o1 /f'l /obInspection #2: 09 12o / ob Location: 2470 County Road E, Woodville, WI 54028 (SW 1/4 SE 114 10 T29N R16W) - 102916150 1.) Alt BM Description= s o ) 2.) Bldg sewer length= 2 Z - amount of cover = 7 /g u''s ( c^ ,. e- ,, 3.) contour= qg , o �.au�nbC ,I 6� ,,+ IS % 9 41 u ; Plan revision required? ❑ Yes No Use other side for additional information. 1 01 1 2-o j I I J 6 SBD -6710 (11.3197) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: p,.- ....".w......« � .".�«.- ....m... � "��a....<.e. < s...« -pm.. � ...< <.{...m.._,...�< ...:- .mom.... �.we�.iw....a.. « ti...rc.®.�. ®a<�........®..�.. ...+«e..� # ......e..»,..� ....e.�*'� - .<.. +»�...«.m.�..d�,».«�.< , - 4 I < r ? s } r � z E � { , i f 4 , ' " a a s t Sanitary' Per it Application iafety & Buildings Division j 201 W. Washington Ave. In accord v ith Comm 83 2I. Wis. Adm. Code PO Box 7302 `� seonsin !'er See re+erse side for instructions Ior completing this application Madison, WI 53707 -730:' sonal inim mation you provide may be used Rtt secondan purposes Submit completed form to count if no Department or commerce Pri+acy La++'. ,,. 15.041 l)(m)l ( p y I state owned. Attach complete plans Ito the court►+ co p+ on tr . v e n paper not less than 8 -1/2 x I I inches in size. County St itc Sanuan Pernut Num li be ( si r�dt rvious appcation State Plan 1, 1) Number / , ?_ 1. Application Information - Please Print all Infor ;itibn Location: Property Location Property Owner Name a," l rE'1 /4.S/8 T,Z J,N, RI o Lot Number Block Number Property Owner's Mailing Address " �? City, State lip Code ` bee Subdivision Name or CSM Number II Type of Building: (check one) - �' O City �,( ❑ Village r 1 or 2 Family Dwelling — No. of Bedrooms: �[dRiatevt� I�Town of ❑ Public/Commercial (describe use): L �'t 13 State-owned III Type of Permit: ((Check only one box on I• e A. Check box on line B if applicable) Nearest Road A) 1. O New System Replacement 3. Replacement ol• 4. ❑Addition to Parcel Tax Nu rer(s) S+'stem Tank Oniv Existin S stem B) Permit Number [3 A Sanitary Permit was reviousl� issued IV. Type of POWT System: (Check all that a pp l y Imo Sand Filter ❑ Constructed Wetland ❑ Non - pressurized In- ground Mo ❑ Pressurized In- ground ❑ Holding Fank ❑ Single Pass ❑ Drip Line ❑ At- r de t ❑ Aerobic Treatme ni ❑ Recirculatin ❑ Other: , g 3 pu - 22" s o•ql :_ V Dis ersaVTreatment Area Information: 1. Design Flow (gpd) 2. DispersalArea 3 Dispersal Area 4. Soil Application 5. Perco[al(on'Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals /day /sq ti.) (Min. /inch) Elevation VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks zc�► 4A le)---L ❑ ❑ ❑ ❑ w� VII Responsibility Statement I, the undersi ned, assume res onsihility for installation of the POW" hown on the attached tans. Business Phone Number Plu r' � ame in Plumber's Signature (nn -,lamps): Kot}'fAAPRS No. oge`"jiumn & Perk Tes ing _ '� � f 2 /�d'� G J Plumbe s d iess treet, late, "Lip Code) Spooner, WI 54111 VIII County/Department Use Only Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) 13 Disapproved Approved ❑ Owner Given Initial Adverse Surcharge Fee) q�5'uc7 Determination IX. Conditions of Approval !Reasons for Disapproval: Li �loocl�l� -�n.• Wk`�c Zsac G JoL Aye p / ' �oo -�p�2) �o�e�tad VJan c�e� � +� ?yf'� . �f 5'l ZoZ. -4- Q�d Jt.,c•4'+u? �- �� A � �- �. _ - yc J w�:1tivd p¢tr wwn•.c�..3.vior�r�ctvr RRD -6348 (R. 07/00) �� b ✓;�1�.�S;kS R� )p 1 �' ©oar• -.S y y C fiy eW �a 5-q 0o Z -102 1 °I d p� q o c,c VIC� czle I i l Safety and Buildings 4003 N KINNEY COULEE RD LACROSSE WI 54601 -1831 All TDD #: (608) 264 -8777 Nli v6consin www.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary August 15, 2000 CUST ID No.691727 ATTN.• POWTS INSPECTOR ARTHUR L WEGERER ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY SPIA PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08115!2002 Identifi n Transaction o.412324 f f Site ID No. 19 p e refer to both identification numbers, SITE: a av in all correspondence with the agen Site ID: 196587, Teri Power c ,— r 7 St. Croix County, Town of Baldwin _ ll n i -- SW1/4, SE1/4, S10, T29N, R16W 2000 FOR: ST CRO�IX Description: Four Bedroom Mound System ccwN*v ZONING OFFI E % � � Object Type: POWT System Regulated Ob cfI�,I�To.: 754319 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: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10572 -P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10573 -P (R.6/99). • 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 mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • A septic filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the septic filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. ARTHUR L WEGERER Page 2 8/15/00 Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. SiOerard ely, DATE RECEIVED 07/28/2000 FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:15 AM to 4:00 PM jswim@commerce.state.wi.us WiSMART code: 7633 TITLE SHEET Page of MOUND SYSTEM FOR A BEDROOM RESIDENCE This plan has been prepared in accordance with the Mound Component Manual SBD- 10572 -P and the Pressure Distribution Manual SBD- 10573 -P LOCATED IN THE SLR 1/4 OF THE SE 1/4 OF SECTION 10 ,T Zct N,R )� W, I TOWN OF �p�1,p}�)L{� ST'd e -��1)C COUNTY, WISCONSIN. INDEX PAGE 1 of 7 TITLE SHEET PAGE 2 Of 7 SYSTEM MANAGEMENT PLAN PAGE 3 of 7 PLOT PLAN PAGE 4 of 7 PLAN VIEW -CROSS SECTION PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT ,,p 6 PAGE 6 of 7 PUMPING CHAMBER CROSS SECTION �A X000 PAGE 7 of 7 PUMP PERFORMANCE CURVE v�Oy i� PREPARED FOR • Tai ER PREPARED BY WEGEF;ZEF;Z SO I L . TEST X NG AND . ICES I C3" SERW2 CE P.O. Box 74 421 N.Main St. NO River Falls, WI 54022 Phone 715 - 425 -0165 Fax 715- 425- 6864:' ' : AgTNUp l wEGEHEA DD/S t rx�swoarK, C n difi0l "a EID E�CE 1W { o r COMM ptiN6S DEPAR D� tio O CE E CG �K�SP JOB NO. �d " SYSTEM.MANAGEMENT Page Z of 1 Management and maintenance of this system is critical to its proper operation and longevity. The system owner must be provided with a complete set of plans including the management section. GENERAL Proper functioning of any type of on -site waste disposal system is dependent on the amount of water entering the system and the quality of the water. The lower the volume of water and the lower the level of contaminants, the more efficient and longer lasting, the system will be. Typical system components include a septic tank to settle out -and break down solids, an effluent filter at the septic tank outlet to filter out small particles, a pump tank with an effluent pump and controls and an absorption cell to dispose of the water in a manner which will protect the groundwater and public health. RECOMMENDATIONS 1. Install water saving devices when and where possible. 2. Repair any water leaks as soon as possible.. 3. Do not pour greases, oils, chemicals such as paint or paint thinners into the system. 4. If you have a garbage disposal, use it sparingly. 5. Do not dispose of any paper products other than tissue into the system. 6. Try to avoid excessive flows of water in short periods of time Spreading clothes washing throughout the week is recommended. MAINTENANCE 1. The septic tank should be inspected by a licensed pumper every three years or less and pumped if necessary to remove solids and scum. 2. The effluent filter must be cleaned periodically to remove any accumulated particles. It should be washed back into the septic at 6 month intervals or as per the manufacturer's recommendation. 3. Periodic inspections at the observation pipes should be made by the owner to determine if any ponding is taking place in the absorption cell. Also check for any seepage to the ground surface. If consistent ponding or seepage is noted, a licensed plumber should be contacted. 4. This sytem.contains an alarm which must be installed on a separate circuit from the pump-. If the alarm activates, minimize water use and contact a licensed plumber immediately. CONTINGENCIES Monitoring of the volume and effluent quality may become necessary if problems develop. Monitoring must be done as per the requirements of COMM 83.54(2). Pumping and disposal of wastewater by a licensed puper may be necessary while analysis and repairs are made. 1. Failed mound systems may require removal and disposal of the existing sand fill and replacing it new sand or installing an aerobic pre - treatment unit to reduce or eliminate any clogging mat.that may be present. 2. In- ground soil absorption systems or at -grade systems may require the installation of an aerobic pre - treatment unit or replacement of the system. Additional site and soil evaluations may need to be done and additional plans may need to be ,prepared and approved by the Safety and Buildings Division of the Department of Commerce. - 3 . 7 7 ' o XQT eOM? -'7 a�� ` *S PjtY1 / \ 1 IfL4.8 �s; 33 , 3oS' of 3�` Pt,e C! L f C2 L V+ �� ZEST LWlaL OF 90 M\7 a t�z e et T—d.j 8r��f _ E'1 . 06 au hiP > Bwi ► - . 1va.o'o� �p of NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observat�'.on pipes with approved caps. ( Z required). 3. Septic tank to be 5A\ \1 gallon capacity manufactured by 1'`11 �`tL l , Z - - 7 " t Fi 40z, (cwt p `�Ytx�ic `M EE l 000 Grp W Le:s e2 — j" . 4. Bench marks S EIEF m 5. Divert surface water around system to prevent ponding at the uphill side. Page 0 _] Approved Synthetic Covering ASTM C33 Distribution Pipe Medium. Sand Topsoil F Elev. ld Z 2 3 E " b 3 % Slope Distribution Cell of Force Main Plowed 2" to 2- Aggregate From Pump Layer 0 Z - Z Ft, E Z a`6 Ft. CROSS SECTION OF A MOUND SYSTEM F 0. ?3 Ft. C O. S Ft. A Ft. H \.O Ft. Linear Loading Rate= 4 -M GPD /2 FT f3 Design Loading Rate= 0A9.GPD /SQ FT Ft, l O Ft. K `3 Ft. dl tnrn�+c Pneitinn L �I Ft. W 33 Ft. J < Observation Pipe $ �---- K �— — ---- - - - - -- --� rAec�ss C-� -------------- - - - - -- -------- - - - - - -- - - - - - -- � 3oX - 0 -- A `� - - ��b H E 7F W orce Main 0�FOSI t'E �A Distribution \-- Cell of 2" to 2- Pipe aggregate 1 Observation Pipe (Anchor securely) + PLAN VIEW OF A MOUND SYSTEM Distribution Pipe Layout Page S of _7 Place the holes at the bottom of the distribution pipes at equal spacing. Remove all burrs from the pipe and holes. Extend the end of each lateral up with the use of long turn or 45° fitting to a point within six inches of the final grade. Terminate the ends of the laterals with a valve,: threaded cap or . threaded plug. Provide access from final grade for the valve; threaded cap or threaded plug. pvC FbC PVC Lateral Manifafd Lateral x x x x x!2 I V2 x x x x = Lsteraf Lenath — Lateral Length — P Distribution Line h Ys 1 F-c7 � s R1? : r•+ fiH�J • YOQC> P1f11N P 6 -7 Ft. Hole Diameter 18 Inch _. S 3 Ft. Lateral " 1 1 LZ Inch(es) X ?� Inches Manifold - Inches Force Main " inches # of holes /pipe 3' _ Invert Elevation of- Laterals 1oZ.7 Ft. ILIX u -ql = 1 S.aq X `>r= S5'. spl~j ' PUMP CHAMBER CROSS SECTIOM AMD SPECIFICATIOMS ' PAGE 6- OF �] VEIJT CAP 'i'c.L VENT PIPC 7T WEATHER PROOF APPROVED LOCKING MANHOLE 10' FROM DOOR, JuuCTIOU BOX COVER WITH WARNING LABEL WIM01OW OR FRCSH I2�MIll. AIR INTAKE GRADE • �. IB'MI)s. COWDUIT -- ___ IZ3�MIAI. �� -- - - -- PROVIDE I -- IAlLl =T AiRTIIiNT SEAL APPROVED JOI A Tank construction shall comply f !(( APP ROVED.IOIIV TS with COMM 83.15 and COMM 83.20 ( f ( f f f ( ALARA f f ON C f I E? 1, ^ LLE11: FT. PUMP � OFF . 0 $ 3, 0 0 t CONCRETE BLOCK 3" AAPRQvEA RISER EXIT PERMUTED OWLy IF TANK MAUUFACT HAS SUCH APPROVAL ggDpt SPECIFICATIOUS DOSE TAWKS MAUUFACTURCR: �1 �Tc_ �31�1CC�`t� IJUMBER OF DOSES: 3 ' 6 PER D" TANK 51ZE: 1 0 O GALLONS DOSE VOLU AE t ALARA .._/!IAyUFACTURCR: S }Z(� SY� t S.. . IWCLUOIWCs O ACxrlow? MODCL wumBCR: LOl CAPACITIES: A= IMCHE50R GALLOIJS SWITCH "PC: 3= Z WCHES OR SS- 4LLOM5 PUMP MANUFACTURCR: Go U LAS C-- 1 c) IIJf.HE5 OR Z� 3GALLOSIS MODEL !J(1!KlIER: 3$ S W k 07 N Du IitICHES OR 'ISO's GALLONS SSnlITCH TYPE: L'US2-y MOTE: PUMP AMD ALARM AR TO OL `i MIIJIMUM DISCHARGE RATE Ss GPM IN5TALLED OM SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWCEU PUMP OFF AA)0_DISTRIi5UT10N PIPE lg,' FEET + M)AJIMUM NETWORK SUPPLY PRESSURE .... ..... .. 6 FEET .f. 305 FEET OF FORCE MA X F Y or tFRICTIOU FACTOR. FEET TOTAL OyUAMIL HEAD = $ FEET As per-manufacturer 0 3 gal /in. Liquid depth 36__� �`Ji`�l�' PE1ZF JGE CUiz1�E _P� -7 W= _ Z uouias Submersible r � Effluent Pump 3885 -------------- t � r it si APPLICATIONS • Overload protection must smooth operation. Silicon can be operated continuously Specifically designed for the • be provided in starter unit. bronze impeller available as without damage. following uses: Shaft: threaded, 400 series an option. ■ Bearings: Upper and • Homes stainless steel. ■ Casing: Cast iron volute lower heavy duty ball bearing • Farms • Bearings: ball bearings type for maximum efficiency. construction. upper and lower. g p ■ Power Cable: Severe duty • Trailer courts 2" NPT discharge a da pt able • Power cord: 20 foot y rated, oil and water resistant. • Motels for slide rail systems. • Schools standard length (optional ■ Mechanical Seal: SILICON Epoxy seal on motor end • lengths available) Hospitals leng. CARBIDE VS. SILICON p provides secondary moisture Single phase: •Industry • % and Y2 HP —16/3 SJTO CARBIDE sealing faces. barrier in case of outer jacket • Effluent systems Stainless steel metal parts, damage and to prevent oil with 115 V or 230 V three BUNA -N elastomers. wicking. SPECIFICATIONS Prong plug. • ? / < -1' /z HP —14/3 STO with ■Shaft: Corrosion - resistant ■ 0 -ring: Assures positive Pump bare leads." stainless steel. Threaded sealing against contaminants • Solids handling capabilities: Three phase: design. Locknut on three and oil leakage. W maximum. • Y2 -1 Y2 HP —14/4 STO phase models to guard • Discharge size: 2" NPT. with bare leads. On CSA against component damage AGENCY LISTINGS • Capacities: up to 128 GPM. listed models — 20 foot on accidental reverse rotation. • Total heads: up to 123 feet length SJTW and STW ■ Motor: Fully submerged in SA Canadian Standards Association TDH. are standard. high -grade turbine oil for • Mechanical seal: silicon lubrication and efficient heat I underwriters Laboratories carbide -rotary seat/silicon FEATURES transfer. carbide- stationary seat, 300 ■ Impeller: Cast iron, semi- ■ Designed for Continuous series stainless steel metal open, non -clog with pump - Operation: Pump ratings are parts, BUNA -N elastomers. out vanes for mechanical seal within the motor manufacturer's • Temperature: protection. Balanced for recommended working limits, 1041 (40 continuous 140 °F (60 °C) intermittent. METERS FEET • Fasteners: 300 series 90 I i SERIES: 3885 stainless steel. • Capable of running d 25- a0 �^ — sizE:3i.• P g ry w et i i RPM: VARIOUS without damage to ( rrSCPM I — components. 70 MlE1 5 FT 1 j Motor a 20 so Single phase: • Y3 HP,115 V, 200 V, 230 V, Y2 i 1 i 60 Hz, 1750 RPM; HP, z 15 so s I y j 115 V, 60 Hz, 3500 RPM; 0 40 WEO5H I '/2 HP —1'/2 HP, 230V, WOM I , I 60 Hz, 3500 RPM. ° 10 30 • Built -in overload with WE03L ; automatic reset. s 20 • Class B insulation. Three'phase: 10 •'/2 HP — 1'/2 HP 200/230/ 0 0 1 460 V, 60 Hz, 3500 RPM. 0 to 20 30 40 50 so 70 ao 90 too 110 120 130GPM • Class B insulation. o io 2 30 i 0 m CAPACITY ®1995 Goulds Pumps, Inc. Effective May, 1995 11 B3885 Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 visconsin wwuv.commerce.state.wi.us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary August 15, 2000 CUST ID No.691727 ATTIC POWTS INSPECTOR ARTHUR L WEGERER ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY SPIA PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 / HUDSON WI 54016 RE: CONDITIONAL APPROVAL ` Y j Identification Numbers PLAN APPROVAL EXPIRES: 08/15/201 y i ransaction ID No. 412324 to ED No. 196587 SITE: ' l _ lease refer to both identification numbers, Site ID: 196587, Teri Power 2000 ove, in all correspondenc e with the, en St. Croix County, Town of Baldwin ST COU YNrY �. SWIA, SE1/4, S10, T29N, R16W LCXViNG C3FFICE � FOR: Description: Four Bedroom Mound Systerr3 T 1 Object Type: POWT System Regulated Objet 5 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: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10572 -P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10573 -P (R.6/99). • 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 mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • A septic filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the septic filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation /operation. ARTHUR L WEGERER Page 2 8/15/00 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 07/28/2000 FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 erard M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:15 AM to 4:00 PM jswim@commerce.state.wi.us WiSMART code: 7633 . • r 4sconsin Department of Commerce SOIL EVALUATION REPORT Page / of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must X 7 , <& include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Q —ey Please print all information. Review by Date Personal information you provide may used for riva led ( w, s. 15.04 (1) (m)). M t� �2 g Property Owner roperty Location 0 .� Cn .Lot k) J 1/4 _VE 1/4 S T N RZ E (orio Property. Owner's -Mai i, g Address Block # I Subd. Name or GSM# City /State Zip Code hon mtTer ity ❑ village_ Town Nearest,Road, ❑ New Construction use: Q( Residential ! N droom Code derived design Row rate GPD Replacement /❑ Public or corrZ - D s it I Parent material a A"E'DAI sZL r LDII wl Flood Plain elevation if applicable il/ it ft General comments and recommendations: C01VAPalc 'OF Xilx F/I ❑ Boring 6' Bon # Pit Ground surface elev. . 2 ft. Depth to limiti ng factor J Z i on Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bounda PD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 vi A4 4EA .2 nt 3 — L A1,0 W ` t I I A r C L -'— IN 7a� F2_1 Boring # ❑ Boring Pit Ground surface elev. • 2 ft. Depth t0 limiting factor in. Sod 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 L r�S alt ` ._ / — A If Alib �- 3 _ �3 L I • flluent #1 )[BOD, > 30 < 220 mg/L and TSS >30 _< 150 mg/L • E aril #2 = BOD 30 mg/L and TSS < 30 mg/L • - CST Name (Please Print) nature a —*—" CST Number . �k J_ i t .64 �/ 0: � I I a Address Fogerty Plumbing & Perk Testing Date valuation Conducted Telephone Number 28288 McKenzie Spooner, WI 54801 Property Owner _/ GiC,r " L Parcel ID # JOP - /00 Page Z of Boring # ❑ Boring Pit Ground surface elev. F7, d _ ft. `i�epth to IfmNin factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Qnsistence Boundary Roots GPD/ft In. Munsell Qu. Sz. Cont. Color r ._ (4. Sz. Sh ' •Eff #1 •Eff#2 2 L S .l 3 ' -d 3 L e — F-1 Boring # ❑ Boring ❑ pit Oroynd surface elev. ft. Depth to limiting factor 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 7 ;» I Boring Al ❑Boring ❑ Pit Ground surface elev. it. Depth to limiting factor in. sa Application Rate Horizon Depth ' `Dominant Color Redox Description Texture Struchire Consistence Boundary Roots GPD/tN 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& 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. SBD4330 (RAMO) Fri, 0 u 1: I h 3 yi v N W �m oo N c^ Q 4 a cd �' .�. N v � `� t � i t V V tE M � 1 M � t it It i 1 . ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner Awyer Mailing Address Property Address (Verification required from Planning Department for new construction) City/State 44 � , g4 �r y Y0A1 Parcel Identification Number D D LEGAL DESCRIPTION Property Location Sat/ -V4, _5 /K %., Sec. l© , T N -R W, Town of 194 ------ . ' Subdivision - Lot # Certified Survey Map # Volume . .Page # Warranty Deed # _ ,29755"9 , Volume y , Page # -Z�L Spec house 0 yes C7 no f1��- ��'� Lot lines identifiable yes 0 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 mastprplumber, joumeymanplumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 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 days o the year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property de bed above, by virtue;of a warranty deed recorded in Register of Deeds Office. y / ? SI NATURE 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 Secoll" part, heirs and assigns, against all and every person or persons, lawfully claim the whole or Tiny part thereof, will forever WARRANT and DEFEND. 11'1 Wftllf�ltl Mbrrrof, thu said par. of the firs pare hand and seal this 1 day of A. D.. I Si gned an eRled in Presence of . ............ . . ........ . ...... (S e_il) ...... _ .. . ........................ (Sea]) . ..... ........... ..... (Seal) .. .. ......... ... Watt of Mforonotn, ss. ........................... ..._...._...._... ._...._...._........... Personally came hefore me, this :!ay of A. 0., 19 the above named to me known to he the person who execute the f r n i ,ig i ri.,;trflrnerit / ai7 (I rO C k rl ('Wlrdged the Same . .... . .......... Notary Pijhlic, Corinty, Vliscov My conitnission expires A. D.;` Drafted by . ... ... . ..... ..... .......... �-. IN.B.—Ch. 69 Wis. Stts. pm�ldm th-t r,ll 1—t--t. to be, ­­dwd n h.11 fu. r ,W ,l, . ..... -it-,­ rend Q) A 0 IL IL 0 a 4_1 Ij -4 Cc C4 Ns /-L Witrru4 D**& - Common Boren MATE OF WIBCONMN) ww os nn.e b 99 0 CI&I" Bo k S tAd& e r s am 238 WI etat M6 form . I � _- ---- _- - - - - -- - � 297459 aooK 454 da of , A. D., 1969 . This Indenture. Made this June y between Donald Strobush and Shirley Strobush, husband and wife and each in their own right, part 1 eEbf the first part, and Robert PJheeler Power, Jr. and ''erri Snell Power, husband and wife and as joint tenants, part ie!bf the second part II �.iliftnt¢Ottt: That the said part ies of the first part, for and in consideration of the sum of Twenty-five lr.ousar:d and n0/100 ----------------- - - - - -- Dollars l ies of the second art, the rece whereof is hereb to thorn is hand paid by the said part P P y I confessed and acknowledged, have given, granted, bargained, sold, remised, released, aliened, conveyed j and confirmed, and by these presents do give, grant, bargain, sell, remise. release, alien, convey and confirm unto the said part 1 e of the second part, their heirs and assigns forever, the following described real estate, situated in the county of St. Cro,x and State of Wisconsin, to -wit: i South Half of Q (S,` of 5E of Section 10, Township 29 Nortn, ii nge 16 , s t . I '! 'Cogrt4rr with all and singular the hereditaments and appurtenances thereunto belonging or in anywise appertaining; and all the estate, right, title, interest, claim, or demand whatsoever, of the said part 4 s of the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained and their hereditaments and p appurtenances. P Teo t?dbe drib to t?olb, the said premises as above described with the hereditaments and appurtenances, unto the said part -es of the second part, and to their heirs and assigns FOREVER. 43nb tt�t gdtD o� "�� -� - -�' ; usr a �ri_ey Strobush for '' -eir heirs, executors and administrators, do covenant, grant, bargain anc•' agree t0 and Wltl7 tF1 C" Said part `J es ` of'tbe second p art, their - heirs and assigns, Ihat at the time of-. , - the ensealing and delivery of these presents t:ey are well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and clear from all incumbrances whatever, and that the above bargained premises in the quiet and peaceable possession of the said part ies of the I i