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HomeMy WebLinkAbout002-1022-95-100 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and 'Building Division,' Sanitary Permit No: :_ �1 INSPECTION REPORT 404974 0 �"� GENEr2AL 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)). - = (fwA�+ • �p Permit Holder's Name: City Village X Township 'Parcel Tax No: Th ssen, Lee I Baldwin Township 002 - 1022 -95 -100 CST BM Elev: r Insp. BM Elev: / BM Description: ) zo 60 •2D so x.E I LnO TANK INFORMATION ELEVATION DATA Pe TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark �N _ 7 ni �• HQ's I /DO • Z Dosing �jD aD Alt. BM f. - ' �� f�j , � Z /� Aeration �QQ ' dg. Sewer Leis, 1r • 5- 9 .83 Holding S Ht Inlet q • 0 Ito- 7'y TANK SETBACK INFORMATION SUHt Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inle Septic C�/�7s / / DtBottom g ��- �?' a 3r/3 Dosing I ader /Man. 3.3r Aeration Dist. Pipe • 3 l f Holding Bot.System -D � 'o2.SO Fin I Grade « ` PUMP /SIPHON INFORMATION w I C( 12- fi 46 -- �° Manufacturer x A L - L - Demand over GPM .�7 D . ('O odel Number lqo - ,es 0 13W1 • R io /t�• m- ZZ H Li `� • ft 50 Friction � o s System Head TDH • 0 Ft 1 �i -5/fl 103. Forcemain Length ia r r Dist. to Well ' r IoN 'a SOIL ABSORPTION SYSTEM 4 •� - ; /� /. BED /TRENCH Width r Length f No. O Trenches PIT DIMENSIONS N . Of Pits Inside Dia. Li epth DIMENSIONS Sb -V ` SETBACK SYSTEM 70 P/L BLDG WELD LA E /STREAM L ACHI anufacturef INFORMATION CHA OR , Type f yst� d -/ L1, I . -L-- �/ U Mode umber: DISTRIBUTION SYSTEM L l9neder anifold f Distribution 4 / x Hole Size I x Hole Spacing Vent to Air Intake f Pipe(s) l Length l •� Dia4 Length Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No 0 7 OMMENTS: .(Include code discrepencies, persons present, etc.) Inspection #1: �Q / /� Inspecti �� l �' l b � r o�cation: 2536County Rd E Baldwin, WI 54002 (SE 1/4 SW 1/411 T29N RI 6W) NA Lot 1 CQk Parcel No: 11.29.16.1606 ` 1.) Alt BM Description .-AvA '^ 8 - AS/dN9 �QCL,iq QLPI' (v %/yy�/r 2.) Bldg sewer length = a �,,-p ,( e amount of cover = q � � 3, � - 3.) Contour = / _ na /�3. l''^'O;ie - - 5 Use other side additional information. No " 2 :tlnsepctor's Si re '- - �Cert. No. SBD -6710 (R.3/97) p•,`.'�`It["'L 9 (�(,� � 6 S� L ` as36 C � Sanitary Permit Application Safety & Buildings Division Washington Ave. Wa In accord with Comm 83.21, Wis. Adm. Code 201 W. p0 Box 7302 Visconsin See reverse side for instructions for completing this application Personal information ou provide may be used for second Madison, M 53707 -7302 Department of Commerce y p y secondary purposes (Submit completed form to countyif not q) rivacy Law, s. 15.04(1)(m)] state owned.) Attach complete pl s to th c unty copy only) for the system, on paper n less th an 8 -1/2 x 11 inches in size. Counry�, State Sanitary,Permit Number ❑ Check if revision to previous application S# Plan I. D. Number I. Application Information - Please Print all Information Location: Property Owner Name Pr� Location L " Q f /1 S' S Q'7 SC 1/4,54✓ 1/4, S// T.2 ),N, RXE (or) W Property Owner' Mailing dress Lot Number Block Number C7` V o353(P C7174 U City, fate Zip Code Phone Number Subdivision Name or CSM Number C✓l� C /DO Z ( ) �8�� - S'/ 8�3 CS'-- 2236 z C II. Type of Building: (check one) S �a 3 Mee l� Q ❑ City ❑ 1 or 2 Family Dwelling - No. of Bedrooms: ❑ village ❑Public /Commercial (describe use):_ Town of ❑ to - Owned r 0 9.0 Neares Ry �^ a Z) c aWs, mt • S ' X 5 -0 ' oL" MAR 2 7 7002 �•D _ 2S• arcel Taxyl umber( III. Type of Permit: (Check only one box on ine A. Check box on line B f applicable) - -I( . I bo$ A) 1. jjrNew 2. ❑ Replacement EMPUMW 4. 5. 6. ❑ Addition to ile Sy tern System Tar&Q A OFFICE Existing System B) Permit Number 7'�ued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) - k —mo ❑ Non - pressurized In- ground Acmound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals./day /sq. ft.) (Min. /inch) Elevation S o y527 vra 0 /O3. S Z - VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks S /000 /600 ❑ ❑ ❑ ❑ !t `aU a ❑ ❑ ❑ ❑ ❑ VIII. Rfsponsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown o ched plans. Plumber's Name (print) =ig natur o stamps): PRS Business Phone Number ,cirl Cam` / / Z Z /`/ 1 - 21s - 2 G G 7 Plumber's Address (Street, City, State, Zip Code) 7 2 Y� �` S i m-c 1 t-I- " S IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuin Agent Signature (No stamps) Approved ❑ Owner Given Initial Adverse Surcharge Fee) Determination 3 Z S S '�Y i 2M Z X. Conditions of Approval /Reasons for Disap roval: -E.e SBD -6398 (R. 07/00) / : i rV i . M I .. : r i r r . P' _ ; f1 r I' Alft Alt ry iQ • I , r • Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 \ Vksconsin www.commerce.state.wi.us/sb www.wisconsin.gov Department of Commerce Scott McCallum, Govemor Philip Edw. Albert, Secretary March 12, 2002 CUST ID No.221471 A7TN: POWTS Inspector DENNIS J GILLE ZONING OFFICE GILLE TRUCKING & EXCAVATING, INC. ST CROIX COUNTY SPIA 372 140TH ST 1101 CARMICHAEL RD AMERY WI 54001 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/12/2004 Identification Numbers Transaction ID No. 711447 SITE• Site ID No. 641836 Lee Thyssen Please refer to both identification numbers, Cty Rd E above, in all correspondence with the agency. Town of Baldwin St Croix County SE 1/4, SW 1/4, S11, T29N, R16W FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 831755 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. C011 The following conditions shall be met during construction or installation and prior to occupancy or use: APPRC General Approval Requirements: VIEpAWMEW OF of 1 • This system is to be constructed and located in accordance with the enclosed approved plans and with the ��,'�cc"�'I "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01/ CtJta� -�- and the Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD- 10706 -P (N.01101). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Per manual sited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • 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. • The changes made to this plan on 3/12/02 by this reviewer were acknowledged and approved by the system designer. • 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. Stat J DENNIS J GILLE Page 2 3/12/02 • Comm 83.22(7) A copy of he 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. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. NOTE: Plans Submittal; designs that are based on department approved component manuals must include reference to the manual name, publication number and published date. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789-7893, 7:45 am - 4:30 pm Monday - Friday cbratz@commerce.state.wi.us I . t . ., i...... , .._...� ... ... . � a.. e - } F } L... _ _ ._ ,�. t . ..... .... Jk­ h i Y I _ . ., w ....__.. v... _ , _ ._... .. _. ..... r t ` —` - _ _ 9 X 4! - i, - r_ R V E-D 0 ERd - u�' ®+" NJjLt51NG$ i.__.... _ 1 � ,........_.- ... r .. _ - .._.. ... . ._ t ... -1.J i.. 4 ......_ i... _ .. .. ...... .. _. — - -.... .......... ....... y 4 .. .. - _._ - ... , � u up 6✓ bas. '• _ ... � .�_......_ _ ...... .. ... Y . a� .- - .... r.......'... t ... . .... . .... _ __. e7 1 -0 Y ... _ - .......... .._ .. �/ �l v � � ♦ ♦ ♦ / L_.�� ('.. _.. i �l. . 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H t ; pr+ 7o v � % Slope Trench Of 2 2 Force Main Plow /lox. d Aggregate Layer Undisturbed D = j,�j 2 f Soil E fi Gross Section Of A Mound System Using F 9 Trenches For The Absorption Area G� A Ft. H �« Signed: B� Ft. License Number: K } Ft. Date: t_ s, lam{ Ft. Ft. I .'lxv Ft. w,LXHFt. C ^ti_ Force - Mound Using Trenches For Absorption Area �°� 03/12/2002 10:37 7152686637 GILLE TRUCKING PAGE 02/02 - 03/12/.2002 09:50 6087859338 SAFETY AND BLDGS PAGE 01 i i Page ! Of SEPTIC TANK 'PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS {WEATHERPROOF - T Vent aba l termfnetQ in. ��� JUNCTION BOX APPROVED ac�eerc ce • •I t' �m WITH 4ONDUIT MANHOLE COVER W/ PADLOCK 6 FINISHED GRADE -- WARNING LABEL yn. MIN. I6" IN - :•� INLET � Fq GAS- t WATER TIGHT SEALS TIGHT '� pPROVI:I) A SEAL' ' i JOINTS-WITH �..$ . l fit r �� -�— i APPROVED PIPE APPR _ B ! ON . 3' ONTO PIPE 3' �YJadel OCR � ' SOLID SOIL ONTO SOLID SOIL. PUMP OFF ELEV. - �,FT• OFF P RISER EXIT • D PERMITTED ONL IF TANK MANUFACTURER HAS APPROVAL Bedded, in accords ee with product approval lmde� C ffi 84.10 CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: NUMBER DOSES PER DAY TANK SIZES SEPTIC GAL. DOSE VOLUME INCLUDING DOSE Q GAL. FI,pWBACK: GAL. ALARM MANUFACTURER: \tpj L , gym CAPACITIES: A m6 = ►. QAL• MODEL NUMBER: SWITCH TYPE: Q-w-+� B = 2 INCHES = sC oC�AL- PUMP MANUFACTURER: i,_ - C = .1 INCHES w f!D•a ( GAL' MODEL NUMBER: 1t Q SWITCH TYPE: D = _\,a "INCHES = .1tv GAL. REQUIRED DISCHARGE RATE la.5 GPM PUMP E ALARM WIRING AS PER ILHR 16.23 WAC MAIgiv,0 Fesr VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBU I PIPE 77R& FEET + MINIMUM NETWORK 5UPPLY PRESSURE . . . . . . - . • . . S,s FEET + Ic ` FEET FORCEMAIN x a.1b a FT /100 FT. FRICTION FACTOR R.So FEET TOTAL DYNAMIC HEAD - Aslfsu FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH 1 _ x•93 LIQUID DEPTH !��_ � to3•� �` � l-�`� - r rOTAL CH XI CIAPAC Mo Y DIEM IT TURIN I AND ORWAIL lroa I Y. 6dEllsrs [1 14 M1 tic ain q.57 7B MAD X1 1 40, .1 4,0 "pi wr T k SO Wip 2B as 18.r� 11 10 tY 4/8 . nu I tA 4 an P 1 17 Pil: j s #m rLow PM. Litmoc -Va c 3 2,90 'A 11 An Mw CONSULT FAV"'ORY HIM SPECIAL APPLICATIONS • an alarm, F - M&ONrilrol MitmmetrS, k.jrdjjplW MIrabrowlaforwimout I ararrro. Ir .- 7 C01111DI alarm 8ptSMS pA I 8V&ll b I phagg PUMPS 411(pd In f S IMpl ex SYMIsib. Soo FMO732. • Irsdablo lava laofftf at Ims are stviable 1b] goritallkq single PlIM Wilma sysbms. ■ E ouble piggyDam ugirw io !oval wr ER MUM 9 rim avo llablolbT Vadabla two( IBM cycle W*Qjs $Pe FW1420. ( $PCIRI POW M! n requMd. float soft Rft to MMM A. MWh gn'M# 08 MON' M-Pel(10410;r2 or S. Saa FMOT12 4 . 0;)cYr(4)ffooteys1aM. duplox Fwjr(4)f0@J-ftftMfth. ur 2 purrip qlar4on jLLt)Wjj IMMOIX or*001 Otop 40 ar im..4 Goibs dLgvM ho ftiw* "Ptqwd the f WMI' 11 11 111 4fifthfut IQFMA 1 arrijIlwA i o uC RFSERVE POWEWD DESIGN Fii unixiijiji 00jjLjjVM7 a reftryo sotY f6totor [a engineered infi th c o f every 7.t V=tpr porn 3. OrM W, pQ, BOX 1689 L KY 4 aft-017 .91ftp M) SV49 aing Run Now of • 4olAw1b, KY 4011 «1997 ai * I (UM) RMT-pUA#p , I q -_.... __... -.._ . ..•..__ . r• 1 r 1 • 1 _ _. � • ... � ._ � .... �._.. � � � r oe . ... - - , ..._. ._ _ -- ._.._�. y , 1 - ,�. .._.. _.,. ..... .. , r- 02/22/02 16:25 FAX 17152467227 IIALLE BUILDERS 4-i-4 GILLS 12103 Labor ' ix HUma1r 4cI atrons - • •� • •� L e, �. u r, 1 v i 1 1. I' u 1 l 1 L _� i __ r. ,, ^.lviSta71i.91 "+al6sy 1L B�lkSrlgs �-_A • ViJUu._! Ut it ord with ILHR 8 3.05, Wis. Adm. Code f =' . ,UN rY 'Attach complete site plan on paper not less than 0 112 x I I inches in size. Plan must include, but ' CXZA LX not kmited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. U dimensioned, north arrow, and location and distance to nearest road. ' 0 � Z - 1 D Z-'3 _ S(3. APPLICANT INFORMATION- PLEASE PRI14T ALL INFORMATION REVIEI'IEDBY DATE PAOPfiATY 0 K., — PROPERTYLOCATION GO VT S l� 114 Sr) IKS I T Z( ,N,R L E ( PROPERTY OWNER` :S MAILING ADDRESS • LOT a BLOCK 5U80. NAME OR CSFA p OW CITY, STATE ZIP CODE PHONE NUMBER QCiTY ]VILLAGE QCOWN NEAREST ROAD pQ New Construction Use K Residential / Number of bedrooms j Replacement j Public a commercial describe I 1 AddiGQn to existing building Code derived daily Rout 10S) Q gpd Recommended design loading rate bed, gpolp - 3 bench, gpolll Absorption area required SOO bed. 11 S Ou trends, it Maximum design loading rate • Z bed, gpd/11 ' 3 trench 2 Recommended infiltration surface elevations t Q1 'A - Cy ' gP I Additional design! site considerations Muv w tt (as referred to site plan benchmark) l Z . the ti V ' K 6 „x; WJ M 1 N I m(im 1Z. or- S"6.b �__lLk- Parent maledal L-o owem S _n LL i Flood plain elevation, it applicable M. fl . tt U Suitable for spilem CUNV MOlklll IN•GFtOt1NtJ VRESSURE AT- r3AADE SYSTEM M FlLL HtllDltlfa TANK U Unsuitable I s stem ❑ S o u ®S O u ❑ S IF) U O S o u ( O S �U ❑ S ®tf SOIL DESCRIPTION REPORT 3oring # Horizon Depth 'Dominant Color l Mollies Texture 'Structure GPp /tt in. Munsell I Qu. Sz. Cont Color Gr. Sz. Sh. I Co'�s�slence &exxL�y Roofs Bed rendr 1 i o S J uHsz 31 s i 1 z.'�SUk wt - a, s . S • S ZS Lo' -ttz y!y s ! ] around 3 2S -31 `1. S `L RL- V1 5 H tc X 13 s Q� JA - dev. fL l l )epth to miting tctor 2.S' � I , p Remarks_ oring # - } o -S 1 %x 3 L - sit Z,�CSb m'Ft- c-, .- z Yly - - � I r sbk &S < 1� i t o�., c 1� _ . 3 . �# found s . ev. . � t1 'Pth to iidng , Remarks: STNamo :-- PteasePrint Arthur L. Wegerer PtrOnB 715 - 425_0165 853: gerer Soil resting L Design Service -p.0. Box 74 River Falls,WT. 54022 ' lignuilae: q • __.. !4 ����� X19 -Zg 3 - R Dale: l _ (� I . . CST Numbar: 220254 �L /2,2/0L 16:25 FAX 17152467227 BALLE BUILDERS GILLS IM 05 ]PEl`M OWNER r 7LIL DESCRIPTION REPORT Pegs 3 - It 3 WEL I .D, 0 00 10 " . 3O ring # F Depth Dominant Color Mottles —� tiu GP z /ft In. Munseil Ou. Sz. Cont. Color Texture Structure Consislenoe Y Roots �- Gr. Sz. Sh. Bed �Trerdi 3 `- 3l� ., s i 1 Z. S bh wk:+t- 810 L r ,'� 1� sy rash , und 2`1 - u -7 -S 'l I vt ti Uw► a k'1 ~ • 3 r, _y df: to Ing x Remarks: WE L2 OIL ind h to -- ng r Remarks: ig # 3 id Ito L -7-1- ............ .... . ................ Remarks: g# d IL to F • Remarks: _ s Q2/22 16 :25 FAX 17152467227 HALLE BUILDERS GILLE 1M04 PLOT PLAN page 3 of 3 SCALE I"= t_) • G"'1� t*tgq 9 r &- �s i 1 - bo � o� eu►r►p trc� I wou��p ELOq &_ oUQJ co�tvuR taw .Io3.0 o r _rVMVC4 A LLej • Luq[ o + - - i0Vu... • �l 4 o , p .r+ y MI qq - Zq,3 _ A 0 � - -_Z CST Signature Dale Si reed { } 4 2. S -n 1 ti 9 Telephone No. CST # I�M.,�ound System Maintenance and Qooration IRPSID02 Service Provider's Name DENNIS GIL.LE Phone 268 -6637 POWTS Regulator's Name S7'� .ZONING Phone 3g(, - 6 �O 8vstern Flow and Load Parameters Design Flow- Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL so rrice Ff usncv Septic and Pump Tank Ing2ad and/or service once every 3 XMM Effluent Filter Should inspect and clean at least once VM 3 years Pump and Controls Test once every 3 y ears Alarm! Should test months Pressure System Laterals should be flushed and tested ev 1.5 years Mound Inspect for a a once ev S rs Other Misaellaneoas Canstrvation andMatedgis stand I. Observation pipes are slotted and materials conform to Table Comm 84.304, have a watertight cap, and are secured In as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(1), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold hoard or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Dotall Finished Grade ... . 6.8" Diameter Lawn _ i, it Threaded Cieanout Sprinkler Valve Box Plug or Ball Valve Distribution ... Lateral Long Sweep 90 or Two 45 Degree Bends Some Diameter as Lateral Project: LEE JULIE THYSSEN Mound System Management Plan Pursuant to Comm 83.54,1Ms. Adm. Cody General This system shall be operated In acaardanoe with C orrm 82-84 WIS. Adm. Co* and shall maintained in accordanos with W conponar>t manuals ISBD- 10691 -P (N.01/01) and SSWIVIP Pubdcatlort 9.6 (01181)] and local or state rules pertaining to system maintenance erred Maintenance reporting. No ors should ever enter a sotto or puartp tank since dangerous gases may be present that could cause death, Septic and pump tank abartd0ruttertt shalt be in aecandanoe with Come 83.33, Wes. Adm. Code when the tanks are no longer used as, h'OWfS components, Septic or pump tank Manhole nears, access moans and covers should be inspected for water tightness and soundness. Access openlrgs used for seMce end assesstnarit shall be sealed watertight upon the c ompWon d service. Any opening downed unsound, detective, or subject to failure must be replaced. FVosed access q)wrgs greater than 8-Inches In diameter shall be secured by an of Fecit ar tooling device to prevent Occidental or uradthorized entry Into a tank or eomponsit Ism Tank The septic tank shall be maintained by an kxk4dual cWUfled to service septic tanks under s. 281.48, Stets. The contents of the septic tank shall be disposed of in ecaondartce wlth NR 113, Wis. Adm. Code. The operating condition of the septic tank and cutlet filter shall be assessed at least once every 3 years by lnspegtlon. The outiat filter shall be cleaned are necessary to ensure proper operation. The filter cartridge should not be remuoueod unless provisions are mtede to retain solids in the tank that may slough off the tiller when rammed from its enclosure. If the filter Is equipped with an damn, the flier shell De serviced If the alarm Is activated contlnuouusly. Intermittent filter alarms may Indicate surge flows or an impending continuous alarm. The septic tank shall hens Its Gonterris removed when the volume or sludge and scum In the tank sccesds 1/3 the Ilquki Wurr a of the tanit if the consents d the tank are not removed at the time of a triennial sesspsment, maintenance personnel shall advise the owner or when the nett service needs to be performed to maintain lass than nrreodnntm scwrn and sludge accumulation in the tarik. Tate addition of bkrlogkx d or chemical additives to enhance septic tank performance is generally not required. HOwei►esr, if such products are used they shall be approved for septic tannic use by the Deparbrsrtt of Commsroe. Bno Tank The purP (dosing) tank shall be Inspected at least once every 3 years. All switches, Otarms, and pumps shall be tested to verry propusr operatioh. If an effluent nil ter is installed within tha tarn it shall be Inspected and serviced on necessary. VIOU end Pressure Dlstrlb_utlen Sya r► No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penstnOW. Trallo (other than for vegetative mtalni ananee) on the mound is not recommended since $oil compaction may hinder aeration of the Infiltrative surface within the maid ad arrow aampsction in the winter will promote frost penstraUom. Cold vmsthar Installations (October- February) dktB* that the mound be hosing mulched as pnotacdion from freealro Influent qudily Into the mound system many not sx0sed 220 mglL. BOD mrgll. TSS, and 30 mgrs. FOG for sspfdo bank effluent or 30 mWL. BODs, 30 mg4- TSS,10 mWL FOG, and le cfLV100 mL for highly treated effluent. influent flow may riot exceed m w utrn design flaw specified In the permit for this installaHcn. The pressure distribution system is provided wflh a flushing point at the and d each',t�al, ad ft is reoomrrs3 xW that each i bud be flushed d accumu doled solkis at least orce every 18 nanths. Wham s preesure test is performed it should be compared to the initial test when the syswn was Isstaded to determine if orifice clogging has occurred and if orifice dew" Is required to rrreintaln equal distribution within the dispersal cell. Observation pipes within the dispersal call shay be chacked for effluent pw ding. POnding levels shall be reported to the owner, and any level above 6Inches Considered as an krf ding hydraulic failure requiring additional, ,more frequent rrgoltogng. 2h If the septic tank or any of its components become defeo ivettank a� shay be repaired or replaced to keep the system it proper operating cxrrrcelon. If the dosing tank, dip, pump controls, alarm or related wiring becomes defective the defective componen<(e) shad be krimadetely nsp*W or replaced with a component or the sam or equal performance; IW It the mound component fails to accept wastewater or begins to discharge WOOR OW to the ground surface, I will be repaired or replaced I present 1000on by increasing basal stall If tos teekage occurs Or by removing bkalagioally clogged absorption and dispersal media, and related plpkg, and mp'acltg sold components as deemed necessary to bring the system Into proper opereting condition. Sae Page 5 of this plan for on name and telephone number or your IwA POWTS regulator end service provider. Project: LEE JULIE THYSSEN Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page \ of . 3 Laborggnd Human Relations g .— bivin of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code r - � COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but ST • c 4u LX not limited to vertical and horizontal reference point (Blot); drectipn and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRI* ALL IN (.11,1,1N R IEWEDBY DATE '.� 2- PROPERTY OWNER: ? PROPERTY LOCATION ' 6 LLIV N LC�� N 6gYF L�F S 114 SK 1 /4,S l) T Z0 ,N,R L E (oro PROPERTY OWNER'.S MAILING ADDRESS • " , y ' LOT # BLOCK # SUBD. NAME OR CSM # _ _ CITY, STATE ZIP CODE PHONE N F ❑VILLAGE [3TOWN ' NEAREST ROAD Woo�v���. ,mil S�t (�►�)z6s_ �zt.3 -' ��� -Owt�, eo�r.m� � ' pQ New Construction Use [>q Residential / Number of be'`i�' ­' . _ I [ ] Addition to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow bu 0 gpd Recommended design loading rate — bed, gpd/ft • I trench, gpd1ft Absorption area required Soo bed, ft2 S 1)U trench, ft Maximum design loading rate Z- bed, gpd /ft ''S trench, gpd/ft Recommended infiltration surface elevation(s) �O y.- O It (as referred to site plan benchmark) to Additional design/ site considerations M OVw_� w/ Z U ' K-b3 'Lo" W/ r-1) AJjMA 4 1Z of SAXb F►tr Parent material Loess but*2 S ` - R u- Flood plain elevation, if applicable V, .) • It S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem EIS O U ®S ❑ U ❑ S ®U ❑ S 0 U ❑ S ELU ❑ S Ulu SOIL DESCRIPTION REPORT c ( Boring# Horizon Depth Dominant Color Mottles Texture 'Structure GPD /ft2 Consistence Roots in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. g�I Tterrh 6 OR I XU 1 0 -S tw-l 31Z - s i 1 Z'(�s _ s 1 .2 Ground 3 2S -3Z '�.S - S 2 313 s ow, �1 - .3 ,4 -- elev. G Z .ft. Depth to limiting factor 2.S " Remarks: Boring # o -S tb-m_ 3 Lz - sir Z -�sb�L rn�. a-S _ ,s •� .5 Z viv - s i I l Sbk cQS V) cs — • - Z € . 3 .2- Ground S ` R 3 ! 3 S fx 11 ; •�f elev. It Depth to limiting factor Remarks: CST Name: — Please Print Arthur L. We erer Phone: 715- 425 -0165 egerer Soil Testing & Design Service -P.O. Box 74 River Falls,WI. 54022 - Signature: �• 94 _Z°t 3 - Date: `1 G CST Number:. '- 22025 L F PROPERTY OWNER 1"1 L�f`1 N SOIL DESCRIPTION REPORT Page 7 PARCEL I.D. # UpZ-- � Q2.3 - 30 Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft in. Munsell Qu. Sz. Cont. Color Consistence Boundary Roots ;; >;<. > > Gr. Sz. Sh. Bed Tiir I .3 u 1Z 3 CZ s t 2 `F S b k w��, du S — • 5• s' z 6 -Z- �o �� �t s�'� `F sbrz cR s h c S - - Z • 3 , z round 3 2� -3 �.$� A 1 2- 111 91 S� �� oM `1 •� ,y elev. X 03.1 ft. i e limiting factor j Remarks: Boring # - Ground = i elev.. ft. Depth to - limiting I factor I Remarks: Boring # Ground _ elev. f t. Depth to limiting factor j Remarks: 3oring # 2k t t around I alev. it. )epth to imiting actor Remarks: — PLOT PLAN Pa 3 of 3 , 1 "= • Gatz_ B. qs' f is i I TT��ff c� \Z. � tS�1 \LLB I I I o!D � � I w000� a 1 4s- oPOtil Co�`�vR �� . lo3.p' o r. - ry k o v c4t.:tr d • �hU • W �L.O � l` �wl�t�1_ _ -= �= ,- c►u:o' oti_ F��_l-kIGN;= ���DIr1=.�P���?LZs I 7 � A �i o • h1 � -ZSp Tw 5T. �U�� • E y l9 -2 a3 _ A ../ z.ZoZSy oC • G- ( 715 ) 423 CST Signature Date Signed Telephone No. CST # ST CROIX COUNTY SEPTIC ''ANK MA[NTr1,NANcE AGREEMENT AND j Q OWNERSHIP CER FORM owner/Buyer Mailing Address Property Address a 5 3(� C o w %4 (Verification required from i Planning DJbpartraent for new construction)__ _ � V City /State J Parcel Identification Number OLg , Z, - 102 3- :?D - 1 00 L EGAL DESCRIP1I1Q Property Location 1 /4, 5 1 /,, S( e. , T27--N-R, W, Town of Subdivision , Lot # Certified Survey Map # 62,2 3 ( 2_. _ 'Volume �, Page # Warraniv Aced # Volume ,�� 2 . Page # 3 Spec house Cl yes 0 no Lot lines identifiable 0 yes ❑ no SYSTEM BIAR ENANCE Impropause and maintestanceof your set pc system could result in its premature failure to handie wastes. Proper mziutaaan consists of pumping out the septic tank every tbri a years or sooner, if iitedod by a licensed pumper. What you put into the system can afftet the f mcdon of the septic tank as a tmv tmeut stage in th waste disposal system. The property owner agrees to subujit to St. Croix Zoning Department a certification form, signed by the tr mcr and by a masterplumb -or, jm ueymmplumber, restrietedpJ< umber or a licenitAputoper verifying that (1) the ou -site wastewater disposal system is in proper operating couditinn and/or (2) after in: �eetion and primping (if necessity), the septic wk is less thin 1/3 full of sludge. Uwe, the undersigned have read the above require hents and arco to maintaia the private sewage disposal system with tht standards set forth. herein, as Set by the DeparUnent of Cotc' otme and the Departniont of Natural Resourcea, State of Wisoonsirl. Cet'tif "lion stating that your &optic rAtran ties been maintainer I must be completed and retuned to the St. Croix County Zoning Office Within 30 days o t he three year expitat'on date. SIGNA OF APPLIG D ATE OW NER CE It CJHCATION J_6C2q� I (apt) ceztafy that all statements on this i ►rm Ire true to the best of my (our) Ioaowledge. I (we) am (are) the owner(&) of tiic property described above. by virtue of a warn zty deed recorded in Regktor of heeds Office. -- - 02 , SIGN OF A PLI A247' DATE •" «• A.Ay information that is mis•representcd a ay result in the sanitary permit being revoked by the Zoning Department. •••••• Include with this application: a stamped wart rnty docd from tho Register of needs office a copy of the c, r ifsed survey inap if reference is made to the warranty deed K VOL 1512 PAGE 73 623295 STATE BAR OF WISCONSIN FORM 2.1998 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI Da ument Number RECEIVED FOR RECORD 05-18 -2000 1:45 PH This Deed, made between Glenn Malcein and Joan Malcein, husband and wife IMRRANTI DEED EXEMPT M CERT COPY FEE: Grantor, COPT FEE: and Lee J Thyssen and Julie L. Thyssen, TRANSFER FEE: 154.80 husband and wife as survivors iP marital property RECORDING FEE: 10.00 PAGES: i Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix State of Wisconsin: L of Certified Survey Map, filed in V olume 19 9 o Survey Maps on ,page 3544 a Document Recording Area No. 622362 ,_ located in the SE 1/4 of the SW 1/4 and Name and Return Address in th a NE 1/4 of the SW 1/4 of Section 11, Township 29 North, Range 16 West, Town of Baldwin RETURN TO: TITLE ONE 70619TH STREET SOUTH HUDSON, WI 54016 002 - 1022 -95 -00 (NESW) 002 - 1023 -30 -000 (SESW) Parcel Identification Number (PIN) This is not homestead property. (is not) Exceptions to warranties: easements, roadways and restrictions of record Dated this - `day of Z4 � •ZM3 * * Glenn Halce J * *JT Malcein AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ) ss. St. Croix County Per rally came before me this day of authenticated this day of he above named Cl nn ale and Joan (If not, Malcei * TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person who executed the foregoi instrument and ack owledged the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY * Tra L. rner Michael H Forecki Attorney Notary Public, State of Wisconsin Eau Claire Wisconsin My C fission is r a tent. (If not, state expire' n d te: (Signatures may be authenticated or acknowledged. Both are — 7 not necessary.) •Names of persons signing in any capacity must be typed or printed below their signature. Notary Public STATE BAR OF WISCONSIN Statis of Wisconsin W.%RRANT't DEED FORM No. 2 -1998 Produced wdh ZpFohm by Venison Inc. 18025 Fifteen Mile Road, Clinton Townahip. Michigan 46035, 000) 393 -9905 r �Ce ?I Premier Grwp rpb l'Nh 5t. HWfon WlSNnb'_lal Poore. (71 S))aa -8207 I`s< (7I5)3a6fia54 ' '� • • FORM NO. 91SA 62262 4n KATHLEEN H. WALSH REGISTER OF DEEDS Stock No. 26273 ST. CROIX CO., WI N RECEIVED FOR RECORD poll 440 Pill 2� T I N SURVEY W .5 QOOO V CERT COPY FEE: a1 hlal COPY �'pLSN'FEE. N 01 NO RECORDING FEE: 12.00 PAGES: 2 CERTIFIED SURVEY MAP NO. 3844 VOLUME _ 14 , PAGE 3844 LOCATED IN THE SOUTHEAST 1/4 OF THE SOUTHWEST 1/4, AND IN THE NORTHEAST 1/4 OF THE SOUTHWEST 1/4, SECTION 11, TOWNSHIP 29 NORTH. RANGE 16 HEST, TOWN OF BALDWIN, ST. CROIX COUNTY, WISCONSIN PREPARED FOR DRAFTED BY: GLENN MALCEIN DONALD M. CLARK UN PLATTED LANDS yIH PO BOX 162 CIS 2565 C.T.H. E :Z s���� Ns N87'49'37W 1015.47' I * DONALD M. %i So . CLARK 'S W I S -1580 f'1.MENOMONIE,�3 WI •' w °° LOT 1 _ • O F 0 ••' O SUFI � O. d cz 1,114,346 SIX FT. c I 4 �l I z b 3 RV02,640 SIX FT. z >'= 3 I N 0 1,11706 S0. FT. 3 � 3-..21-00 Z- C23.s33ACRES) N z,W N LOT 1 LESS RV w �p ©VED N N o •` ' — " —' N4RTH LINE DF THE SE -SV ° Planning Zoning and ParkS Cmmm;' . "8T1T43 W — — — • • — • — • . — . Z — NV -SE O SW-SE MAY 0 3 2000 N If not recorded within 30 days of approval date approval shall be S86- 24'03 "E 533.33' nu0 and void 66 — 463 - 23 — ' --- 1 S8674'03'E ' v we N y ; N — N AI LOT 2 o W � FT. M w 8 S8. FT, u) 3. y ° N J �. N hl I 3 RV�EG.31 S 4'1 E . v�:vr fl r z l w SG. FT. 836,379 S C19.66*ACRES) N Z LOT 2 LESS RV N C41 \Z O r, z i .cw% ( i SOUTHWEST CORNER SEC.11 729N R16W 100' SETBACK LINE _ _ _ _ _ _ I , , _ FWD. 1' STEEL BERNTSEN S 7.01'. + N87 . 11'26'V 3 .4 SURVEY NAIL _ o N87 426.40' C T.H. E '2637, 318,88' A 4 ' $ '8 p -__ E T �,� __liall _.- I . 41— i N87 7 - •' —" - SOUTH LINE OF SW 1/4 SEC. 11 AI i i V1,�PT• C BEG. SOUTH 1/4 CORNER LEGEND ( 5/ `'� I A SEC.111 T29N, R15W GOVERNMENT CORNER AS NOTED L � i� ��� � FWD. STEEL F7I RJ/ BERNT EN SURVEY NAIL • SET, 3/4 "X24" STEEL REBAR „ ' E I I rI SCALE:1 =300 WEIGHING 1.502 LBS. E+ G� PER LINEAL FOOT. CEDAR CORPORATI(XN 150' 300• Goo' 604 WILSON AVENUE ], ZI ENOM�� 1 54751 A I PAGE 1 OF 2 Vol.14 Page 3844