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HomeMy WebLinkAbout002-1054-10-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL 1~JFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Howard & Vir inia Hel eson Trust Baldwin Townshi CST BM Elev: Insp. BM Elev: BM Description: ~~ ~ ~ ~v ~~ TANK INFORMATION TYPE ~ ` / ~A~FACTURER O~ APACITY Septic ~~> / D ~ O Dosing ~~~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL .~'~" BLDG. V~Air Intake ROAD Septic ,~ ~ ~ ~~/ ~ ~ ~ Dosing ~ k~i v V ~ ~ ~~ ~ ~ ~ ~ Aeration ____~-- Holding PUMP/SIPHON INFORMATION C~'((.f~-~,R-P-~ 1.~~~~Q Manufacturer /~ ~'~,, / Demand ~ ,, ~ ~ ..~/'-U ~-C~ l~U' GPM Model Number ~"~j 2 ~' tU TDH Lift / Friction Loss System d TDH Ft 'S ~ ~ ~ ~ 7 / Force it Length i I 0 Dia. Z' Dist. to Well s > oo,v SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: , 430047 0 State Plan I _ o: (3 Parcel Tax No: 002-1054-10-000 Section/Town/Range/Map No: 22.29.16.334 STATION BS HI FS ELEV. Benchmark ~ ~ / O Z, / Q G ` ~ Alt. BM ~ Y ~ ~ ~ Bldg. Sewer iv•y /. SUHt Inlet ~~` ~~ SUHt Outlet /, ~ Q- Dt Inlet r!~~ Dt Bottom s 3 S - Heade Man. ~ v ~~ , Dist. Pie ~ p /. ~ ' yf -~5 . S~ Bot. System ~,`~ :b ~ ~~ ~S Final Grade .f ~ S , ~ ~". ~1 ~. ~ '1 St Cover ~ ~ / U ~:^- C _ ~ 3. ~ " O~ ~-{auh, G ' G ~' 3 BEDITRENCH DIMENSIONS Width ~ ~ Length ~ h CJ No. Of Jre c/~ hes i ~ ~G/ PIT DIMENSIONS ~ No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL L /STREAM EACHI CH R OR Manufacturer: f ystem: Typ O / / f ~ \ ~ ,-~\ Model Number: DISTRIBUTION SYSTEM v~~C~~ bdX115 ,f>ti ~" /T/n~~-(mss 1 Heade Length anifold ~ Dia_ Distributio~~(/ Length 0 ]`(/ i v ~ ~ Dia /' ~ /' Spacing ~ ' ~ ' x Hole Size ~ ~ x Hole Spacing Z • S / Vent to Air Intake ~ 0 r SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only - y - ~~'s/~P%-'~ Depth Over ~ w '^,' ~ Depth Over xx Depth of xx Seeded/Sodded ulched Bed/Trench Center ' Bed/Trench Edges Topsoil ~ Yes [J No i~] Yes ~] No COMMENTS: (Includ~ lode discrepencies, persons present, etc.) Inspection #1: ~ / 2~/~~Inspection #2: / / Location: 2458 80th Ave Woodville, WI 54028 (SW 1/4 SE 1/4 22 T29N R1~) ~t ~ ~~~ ~ , Parcel No: 22.29.16.3 4 ~~ 1.) Alt BM Description = ~ C~~ 1-- (/ rj~/~~~ //~ / ,~/ ~~ ,~ ~,~~ 2 J Bldg sewer length = ,j~] ~ ~i'~f Yil~~ 1 D "11 ~ ~~') °- a -amount of cover =~~ f sjit~'~/ ~~ ~ tO~P ~~v Plan revision Required? Yes = No ~ I ~ it , ~, Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's ignature Cert. No. ~- L14C ~ ~t.Ex/J ~STC.Jw~ Safety & Buildings Division `\,~ _ - = isco Sanita Permit A lication 1'Y PP Adm Code In accord with Comm 83 21 Wis 201 W. Washington Ave. PO Box 7302 nsin . , . . Madison, WI 53707-7302 DeFartment bf Commerce Personal infom~ation you provide maybe used for secondary purposes (Submit completed form to county if not [Privacy Law, s. 15.04(1)(m)] state owned. Attach com lete lans to the coun co onl for the s stem, on a er not less than 8-1/2 x 11 inches in size. County 5~ C State Sanitary Permit Number ^ Check if revision to previous application _~ -_ r_.. to Plan i. D. Number ~' ~ . r .~ -....~ C3v~r o„ ~, D 86 ~ 6 3 ~- - ~ ac I. A lication Information -Please Print all Information `" .- -° ocation: Property Owner Name ~ ~ // -~~ !7C'( t,Q/~ ~ / " ~ ~ ~~ ~ ~ Z~Q3 ~ ` ' ~Property Location ~ Z . / l.J s G Q~SOl~ (/// /~ Q /~ Jwl/4 >N,R (or W /4,So~TO Property Owner's Mailing Addres Lot Number Block Number Ue ~ . .~, .< < ~ City, State Zip Code Phone um er- - Subdivision Name or CSM Number L~~Doly~ ~/. 54~0~$ ( /S) lc98-dSO~ r1~4_ II T,1•pe of Building: (check one) ^ City ^e GY 1 or 2 Family Dwelling - No. of Bedrooms: .3 O Public/Commercial (describe use): own of ~/~~~ ~ O State-owned III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road ~ ~ ays ~D- ~F • A) 1. w~ New System 2. Q'l~placement 3. ^ Replacement of 4.. ^ Addition to Parcel Tax Number(s) ~ S stem Tank Onl Existin S stem 0~'/OS -/D-G2~ (• ~~~ B) Permit Number Date Issued ^ A Sanita Permit was reviousl issued IV. Type of POWT System: (Check all that apply) --!! ~ Z-`f S ~„~,~ ^ N d W l d i d I d d Fil C d ^ S onstructe et an on-pressur ze ter ~ I~MOUn an n-g~r99un ^ Pressurized In-grouncl/~o.u~~ 9S•~3 > ^ Holding Tank ^ Single Pass ^ Drip Line ^ At-grade `` ~ ^ Aerobic Treatment Unit ^ ecirculating ^ Other: S' D "1~" _ a .l~' V Dis ersaVTreatment Area Information: 1. Design Flow (gpd) 2. DispersalArea 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~ ~.P.~. yso ~. Aso i.o o.s ~- 9.90' 9~'~ VI Tank Ca city in Tot # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks ~~-c ~,-i o - ~o / lveSei Marie ^ ^ ^ ^ n ~,/ ^ ^ ^ ^ VII Responsibility Statement I, the undersi ed, assume res onsibilit f r installation o e POWTS shown on the attached tans. Plumber's Name (print) Plum is Signature ( s ps): MPR-f~No. Business Phone Number o sue, ~ as s ~/s ~~~ sip Plumber's Address (S et, City, State, Z ip C e) , / ~ ~y ~. ~ o~(v CA/C.~/~ GJ~. S C..cror VIII County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issued sui Agent Signatu (No stamps) Approved ^ Owner Given Initial Adverse Surcharge Fee) 3z5 ~0~~ 3 _ Determination IX. Conditions of Approval /Reaso n s fo r Disapproval: ~f ,, (~ ~~ ~ Q 1 - ,- e ~(Nt~T~G/ ~,p ~,R~ (~ mil ~vLCf' 1 ~/ ~ tM~ t ' F .c ~IIo'fe ~ /found SXSfem /Ia5 lzecr, Or.'ti~fad a/an~ Cor, tou.~ aS G'..~OSe~, QS ~pp5Si6/~ W/i.% h'aCtin~:n:nq /'2qui~t d S~bac.ks~~or., St~(/ec~„~ a%rd ~,'iS~'~g S~rste,~ , -~o~p/tsS i ana.~ Qr2Q 62 ~,vee n Pc~.n~0 e%~sn ~lano~ Mound ~ bP ~:'//~o~ ~ o.~ e'Gn f /'t ~h-~,'a~-i off' ~u-n-~ ee u, b..~~r, a9'~ ~~~ i • E/e VQ'L~ior7 e~ _ RQ~~/~3S BS ^ iQ/t~ • 8, n n of Eyi3t~i~9 lve.ll S~c/:.(~ Elew ~ /off pl' (J ^ Bel sh~r o f i'o pose o/ irtou n dQ ~ .ZO.36'.r X08. ~'.a/ S "X 90'd: spe~sa /ce//. FaK~(~r al,-str~ bu.io.~ /Q~tra/s ct~ /y,Z'X `/~/. ~8'w/ /B ' y or.~ ces ., . S~OQG~-dat .Z. S3,' F'zposed cv;esc-r u1~.P-7Sont~ ,o u ~A c%Q.r, bu: ,,, ~ ~ ~~ / ~ E~ciSd'n sa.~ EyYG .~aAA`i • 3 465ar~.,~ 31'`'~r^ sf bald as ~arcode . -__' o /er1C/ow ZOO °~ ~ ^ ~ ~ Sf/'cQ~ t I I ~ ; ~a~a~c . ~ '+ 3 b.~r~m ' I ! 9 7~ ~ I'es;ok+~ee /"~ R-o past d ~, aao~ ~ S.T. ~/~~~/ i¢--icr~ eFFq Ou-t/tt• ~otfom o f ~~ 5; d; AsSumtd qh° a le~``~ ia~. ~t?' • . ~~~ Sow A~.• ~- py. s o~ s. r ~ ~ ~scons~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD lA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary May 28, 2003 OUST ID No.223475 JOE STANG STANG PLUMBING & ELECTRIC PO BOX 263 WOODVILLE WI 54028 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/28/2005 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: Howard & Virginia Helgeson Residence 2458 80th Avenue Town of Baldwin St Croix County SW1/4, SE1/4, S22, T29N, R16W FOR: Description: Three Bedroom Replacement Mound System Object Type: POWT System Regulated Object ID No.: 903645 Identification Numbers Transaction ID No. 867637 Site ID No. 659180 Please refer to both`dentficaton numbers, above, in all correspondence with the agency. The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: Conditions of Approval: • This system is to be constructed and located in accordance with the enclosed approved plans. • 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. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the 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. • Comm 83.22(7) - 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. ~, r,~, ~~~~~~~ ~.. __ JOE STANG Owner Responsibilities: Page 2 5/28/03 Comm 83.52(i)(a) -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 83.52(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. 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. • The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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 maybe made to me at the telephone number listed below, or at the address on this letterhead. The 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, -~ Gerard M. Swim POWTS Plan Reviewer -Integrated Services (608)-789-7892, Mon. -Fri. 7:30 am to 4:15 pm j swim@commerce.state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 N COMPONENT DESIGI~~ ~~ MOUND AND PRESSURE DISTRIBUTIO ~9 ~~ Residential Application ~~~ ~" ~~ INDEX AND TITLE PAGE ~ ~~ Project Name: Howard & Virginia Helgeson 3 bedroom residential mound system Owner's Name: Howard & Virginia Helgeson Owner's Address: 2458 80th Ave. Baldwin, WI 54002 Legai Description: SW1/4SE1/4, Sec. 22, T.29N., R16W ___~ Township: Baldwin County: St. Croix Subdivision Name: NA Lot Number: ~ NA Block Number: NA Parcel I.D. Number: 002-1054-10-000 Plan Transaction No.: ~(0 7to 3 7 Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Site Piar~ Page 9 Soil Evaluation Report ~l ~-~~ O OG' `~O ~~ Designer: Joe Stang License Number: 223475 Date: 05/12/03 Phone Number: (715) 684-5166 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDi3-10691-P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution.Networks for ST-SAS (01/81) _ n ~ ~ ~' '~"~ ~t r Page 1 of 9 DEPARTMENT Ot t'('ptp rRCE Version 3.0 (03/01/01) DIV1S!QNO AFE7YAd1Dg1y1~O1ND$ SEE GGRRE PONDENCE Mound and Pressure Distribution Component Design Design Worksheet Site Inform ation (r or c) R Residential or Commercial Design 300.00 Estimated Wastewater Flow (gpd) 1.50 Peaking Factor (e.g. 1.5 = 150%) 450.00 Design Flow (gpd) 3.00 Site Slope (%) 95.73 Contour Line Elevation (ft) 22.00 Depth to Limiting Factor (in) 0.50 In-situ Soil Application Rate (gpd/ftz) Distribution Cell Information 90.00 Dispersal Cell Length Along Contour (ft) _ 1.00 Dispersal Cell Design Loading Rate (gpd/ftz) 1 Influent Wastewater Quality (1 or 2) Pressure Disribution Information (c or e) c Center or End Manifold 2.50 Lateral Spacing (ft) 4 Number of Laterals 0.125 Orifice Diameter (in) (e.g. 0.25) 2.50 Estimated Orifice Spacing (ft) _ 2.00 Forcemain Diameter (in) // p~ 30.00 Forcemain Length (ft) 87.00 Pump Tank Elevation (ft) 6.50 System Head (ft) x 1.3 /0~ 9.40 Vertical Lift (ft) ~ . I 0.57 Friction Loss (ft) 16.47 Total Dynamic Head (ft) Lateral Diameter Selection in. dia. o tions choice 0.75 1.00 x 1.25 x 1.50 x x 2.00 x 3.00 x Treatment Tank Information 1000.00 Se tic Tank Capacity (gal) Wieser Concrete Manufacturer Dose Tank Information 760.50 Dose Tank Capacity (gal) 20.28 Dose Tank Volume (gal/in) Wieser Concrete Manufacturer Note: Sand fill (D) calculations assume a Table 83-44-3 in-situ soil treatment for fecal coliform of <= 36 inches. 5.00 Cell Width (ft) Are the laterals the highest oint in the distribution Y network? Enter Y or N If N above, enter the elevation ft of the highest point. 6.25 ftz/orifice Does the forcemain drain back? Y Enter Y or N 4.89 Forcemain Drainback (gal) 81.25 5x Void Volume (gal) 86.14 Minimum Dose Volume (gal) 29.66 System Demand (gpm) Manifold Diameter Selection in. dia. o tions choice 1.25 x 1.50 x x 2.00 3.00 Gallons/Inch Calculator (optional) 760.50 Total Tank Capacity (gal) 37.50 Total Working Liquid Depth (in) 20.28 gal/in (enter result in cell B49) Effluent Filter Information Zabel Filter Manufacturer A100 Filter Model Number Project: Howard & Virginia Helgeson 3 bedroom residential mound system Page 2 of 9 Mound Plan View 1 1/y ~~ ~:. observation Pipe '0' K ~ • •.•,.•,.•ti•ti••.•ti•ti••.• ~ • ~ • ~ •ti,ti,ti•. ,ti,ti.ti•ti•ti•ti•ti•ti•ti••.,ti••.••.•ti . ~.ti. rtirti~tir,•„t,L:;:;r;~ti{tifti{ti{:~ti~tir~.rti~ :;{;ti;;j{;~y,;ti;:~rs,:tir'''• ti:'L:~• ' .:•r• r•:•:.r•:•:•:•:•J-=.~,r•r•r•r•r•r•r•:•:•:•r•r•r•r r•:•:• . {.ti.ti. .. .. ~.ti.ti.5,•ti•5~•L•• . ti•ti ti•ti.•,.ti.ti.S,.ti.ti.ti.•..ti.ti S,.ti.ti. ~•~•~•~. j•:• r•r•r•r•~• f•~• J• f•~•r•~•~• ~ • r• f• r•r•r• f•r. f• f.:• j, r• f• f. 1• B ' F.. i-~. -t J - T A 1 ~- L Mound Component Dimensions A 5.00 ft E 15.80 in B 90.00 ft F 9.50 in D 14.00 in G 0.50 ft 450.00 (ft2) Dispersal Cell Area 5.00 (gpd/ft) Linear Loading Rate H 1.OOft K 9.10ft I 8.60 ft L 108.20 ft J 8.77 ft W 20.36 ft 1223.90 (ft2) Basal Area Available 9.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 98.69 (ft) -- ,ter, i.... G • H ~ .riiii~iii 2 irii~~~~. j /lf//f ft) Lateral Z F , . ; : ; : ; Dispersal~Cell 97 40 ( Invert 96.90 (ft) -- Dispersal Cell :::,3[.,:;:;~;:;:.:;::;:;::~ :::::::::::::::::::::: t Elevation E • D ~ : ~: -.~ . .. ...... .. .. .. .. .. _. 4 q _ _ _: _ 95.73 (ft) Contour Elevation 3.0 % Site Slope Geotextile Fabric Cover Shading Key '~ ~. ~- Dispersal Cell See lateral details on 1~ _ Topsoil Cap c ~ 1.5 ft ~rtir~f..tir. Y,; •rtirtirtif Page 4 for number, 0 ~~~•~ Subsoil Cap ~ ° :•4;~:tiC~1s:::r ; r.r..f ~ size, and spacing of ~ ~ ~ '~'ti~• •ti:~ ti:~:ti:~; ~• laterals. Laterals are ©~ ASTM C33 Sand ~ r:r- •= •- - r•: F Q ®Tilled Layer ~ ~ 0.5 ft ti ~~ Typical Lateraj .• ~• ~'. equally spaced from Q5 r:r~fs Aggregate v o '~'~~~~ '~f~~~'~'~~•~':~". the distribution cell's ~.- A -* centerline in the distribution cell (Ax6). Project: Howard 8~ Virginia Helgeson 3 bedroom residential mound system Page 3 of 9 Center Connection Lateral Layout Daigram Forae main connection via tee or cross to manifold at any point. P •=Turn-upa~Vballvalvaor IEX~+Fx12~x12~I cleanoutplug I') Holes drilled on the bottom of the lateral. Laterals are identical Laterals & force main of PVC Sch 40 per COAAM Table 8.30.5 S ~k Number of Laterals Lateral Diameter Lateral Length (P) Lateral Spacing (S) Lateral Flow Rate System Flow Rate Total Dynamic Head 4 Orifice Diameter 0.125 in 1.50 in Orifice Spacing (~ 2.53 ft 44.28 ft Orifices per Lateral 18 2.50 ft Orifice Density 6.25 ftZ/orifice 7.41 m Manifold Length 2.50 ft 29.66 gp Manifold Diameter 1.50 in 16.47 ft Forcemain Velocity 3.03 ft/sec ~$`~ose Tank Information Electrical as per NEC 300 and -I- Comm 16.28 WAC Disconnect ~- Tank component is properly vented Wieser Concrete Ca acit 760.50 Volume 20.28 Manufacturer Gallons gaUinch Dimension Inches Gallons A 19.01 385.60 B 2.00 40.56 C 4.49 90.98 D 12.00 243.36 Total 37.50 760.50 3" Bedd A B C D to Alarm Manuafacturer LevelArm Alarm Model Number DLV Pump Manufacturer Goulds -~ Pump Model Number 3885 WE03L Pump Must Deliver 29.66 gpm at 16.47 ft TDH Locking cover with warning label and locking device and sealed watertight 4 in. min. ~- Alternate otrtlet location Forcemain diameter ~ 2 in. Weep hole or anti- siphon device P, ump off elevation (ft) ~-~-- 88.00 Dose tank elevation (ft) 87.00 Project: Howard & Virginia Helgeson 3 bedroom residential mound system Page 4 of 9 Mound Svstem Maintenance and Operation Specifications Service Provider's Name J. Thom son, POWTS#4819 Phone 715 248-7767 POWTS Regulator's Name St. Croix County Zoning Phone 715 386-4680 Svstem Flow and Load Parameters Design Flow -Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow -Average 300 gpd Maximum GODS 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ftz Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other Ins ect and/or service once eve 3 ears Should ins ect and clean at least once eve 3 ears Test once eve 3 ears Should test month) Laterals should be flushed and ressure tested eve 1.5 ears Ins ect for ondin and seeps a once eve 3 ears Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, 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)(i), 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 board 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 Detail Finished •...........•• ............... Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Howard & Virginia Helgeson 3 bedroom residential mound system Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance wtth Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. F~osed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stets. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condttion of the septic tank and outlet fitter shall be assessed at least once every 3 years by inspection. The outlet fitter shall be cleaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the fitter when removed from its enclosure. If the fitter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent fitter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they stall tie approved for septic tank use by the Department of Commerce. PUmD Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank tt shall be inspected and serviced as necessary. Mound and Pressure Distribution Svstem No trees or shrubs should be planted on the mound. Phantings 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 penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the inflttretive surtace within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not excced 220 mg/L BODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS, 30 mg/L TSS, 10 mg/L FOG, and 10' cfu/100 mL for highty treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and tt is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed tt should be compared to the inttial test when the system was installed to determine it orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monttoring. Continaencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced wtth a component of the same or equal Performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surtace, tt will be repaired or replaced in its' present location by increasing basal area if tce leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said cemponents as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Howard & Virginia Helgeson 3 bedroom residential mound system Page 6 of 9 :+: s .r^ Effluent Pump Y,,'~` 't" '~ Tr =i` :Y I Y NEB ~~ 'i .t ,~~ ti ,~'" 5,{,' . CAPACITY Pump Specifications ' . 'n~ough 1'%~ HP ~;; ?c 130 GPM '/lax~'„~am Head to 123' ~~_c'~arga size 2"NPT ~c~~cz '~~ ~raximum Motor ~~~c.aTs feature ball ~~ar~^~q construction. ~: ~~~'? ~~n Single and phase 115. 200. %~~=~ Sn0. and 5i5V. ;~~~~~ole chase models . e .aoac~~tor start motors. Materials of Construction :~ 'on ~'~~~-'~~ss steel r k , Features atitl Benefits ~ •All models feature silicon carbide mechanical seal faces for superior abrasive resistance and extra long life. • Cast iron semi-open non-clog impeller with pump-out vanes for mechanical seal protection. • Rugged cast iron volute type casing adaptable for slide rail systems. • Corrosion resistant threaded stainless steel shaft. • Motor is fully submerged in high quality oil for lubrication antl efficient heat transfer. • Optional silicon bronze impeller available. •CSA listed models available. MEiFflS FEET BF 7~ 20 6E O = SF IS _U 4F 4 i Z 10 >' ~l O Q O z' H 5 o- of Pump Specifications '/z HP Up to 75 GPM Maximum head to 18 Discharge size 2" NPT Solids: 2" maximum Motor All motors feature ball bearing construction. Single phase: 115V Materials of Construction Cast iron Thermoplastic Stainless steel -_ 2 I ~~+ a ,o ,z ~+ CAPACITY Features and Benefits •Glass filled, thermopiast~c vortex impeller with stainless stee~ insert and pump out vanes f,,, mechanical seal protection.. • Rugged glass-filled thermoplastic casing and base design pro~~~rie~ superior strength and corroslc~ resistance. •Cast iron motor housing fnr efficient heat transfer. s,rera.,, and durability. •Corrosion resistant threadaa stainless steel shaft. • Available in automatic and mania. models. •CSA listed models available ur Underwriters Laboratories I All Models are designed for continuous operation and feature stainless steel hardware. 7aF9 9~ Q9'~ ~~~ c z ~h~ ~ ~ou~d s~rs~em has fzeen pr,-c„mod a/~~ Coritoa~-as G'JoseL~, GtS ~pp5Si6/~ W~,%C /f'lain~%n;n9 /`egceir'~ d St~6acXs~'rar~, Sff(/ean Gt-~lOe~ W'iS~i'~4 SYSL4~+'! . .~¢~p/CSS i ona.~ a~eQ bz~w~.-,Pc~.,-~~oehs.-~,6~a~d yio~•,n d ~ be ,~:~/~.o/ ,Ea ore c~~=sif r( ~f.'d~ off' ~~r'f4 ee ~b~.er. • E/e vafio~ -. , e• _ RQ~~i~s gS ~ ~Q/t~ • B. &sf~m of Eyi3t~i>9 ~•..~ell Sid,', Eleµ : !0%?1' (/ ^ Bel she o P~opo.~d~o~dQ~za.3`'x io8.so~~/ S'x 90'd; aoerSa/ceI/. f oK~Cy~ o~,'s't~';bu~%or~ /Q ~e ra/s a ~ /y~"X 5'S/. s8'w/ /~9 - y "or, f: Ces 5~04Ceda~ ,Z, S3' ~I ~ro posed u.~;CSer W~.P- 7SoirGP ~0 a ~A e.I~a.~i bcr: ~ E~ciSd'n so.~ EXis~ny Sep~.'C~an~'. • 3 Q SAr~~n3 A6a~ddGjas~oar'code. c.a/o ~erF/aw to 1~ ~ i ~ ~cv'a~e ~ ~ ~Xi.S~ ~ 99 ~ ~ ~ 3 b.td~oa, i ~ ! 9 7' /'e S:dance ~ Proposed 1,dd0~ .4-icc~ ePf/ E'; Lterce,~ ou-t/L~• (jotz~oY» of 5. d. AsSumLd ~, . 3~~'~ god Aye. -~ _ py. s o~ p Wiscon3in Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT ~nnnr.a~nnn wi4h r`n..,m A~ IA/ic Arlm (nriu 1635 Page 1 of 3 A.C.E. Soil & Site Evaluations County Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I D percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. . . 002-1054-10-000 Please print all information. Reviewed By Date Personal information ya provide may be used for secondary purposes (Privacy law, s. 15.04 (1) (m)). Property Owner Property Location Howard & Virginia Helgeson Govt. Lot SW 1/4 SE 1/4 S 22 T 29 N R 16 W Property Owners Mailing Address Lot # Block # Subd. Name or CSM# 2458 80th Ave. na na Na City State Zip Code Phone Number J City _J Village ~ Town Nearest Road Woodville ~ WI 54028 715-698-2504 Baldwin 80Th Ave. _f New Construction Use: 1/ Residential /Number of bedrooms 3 Code derived design flow rate 1/ Replacement Public or commercial -Describe: Parent material Glacial outwash Flood plain elevation, if applicable General comments and recommendations: Install mound system at elev. 96.90' at 14" above 95.73' contour. 450 GPD na Boring # J Bober Pit Ground Surtace elev. 95.47 ft /~ . 24" Depth to limiting factor in. Soil licetion Raie App Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GP 'Eff#1 D/ft= 'Eff#2 1 0-8 10yr32 none sil 2fcr mvfr as 2f,1m 0.5 0.8 2 8-24 10yr5/4 none sil 2fsbk mfr cw 2f,1m 0.5 0.8 3 24-31 7.5yr4/6 f2d 7.5yr5/8 sl 2msbk mfr cvv 1f 0.5 0.9 4 31-38 7.5yr4/6 m1d7.5yr5/8 gr.sl lmsbk mfi - - 0.4 0.6 Boring # J Boring Pit Ground Surtace elev. 95.07 ft. 22~~ in. Soil lication Rate 1/ Depth to limiting factor APp Horizon Depth in. Dominant Color Munsell Redox Description Du. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GP 'Eff#1 DIft' 'Eff#2 1 0-11 10yr32 none sil 2fcr mvfr as 2f,1m 0.5 0.8 2 11-22 10yr5/4 none sil 2fsbk mfr cw 2f,1m 0.5 0.8 3 22-36 7.5yr4/6 f2d 7.5yr5/8 sl 2msbk mfr cvv 1f 0.5 0.9 4 36-45 7.5yr4/6 m1d 7.5yr5/8 gr. sl 1msbk mfi - - 0.4 0.6 ' Effluent #1 = BOD ~ 30 < 220 mg/L and TSS 30 < 150 mg/L t #2 = BOD <30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sig ure: CST Number James K. Thompson '~`-- 3602 Address A.C.E. Soil 8 Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake lane, Osceola, WI 5/82003 715-248-7767 P(rop~erty owner Howard & Virginia Helgeson _ parcel ID # _002-1054-10-000 _ 3 I •Boring # _' Boring -- /: Pit Ground Surface elev. 94.77 ft. Depth to limiting factor 25° in. Page _ 2 _ of __3 Soil Application Rate Honzon ~, Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ~ GPD/ft2 __ ' ` ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh Eff#2 Eff#1 , 1 I 0-10 ', 10yr3/2 none sil 2fcr mvfr as 2f,1m 0.5 ', 0.8 10-17 10yr5/4 none sil 2fsbk mvfr cw 2f,1m 0.5 ' 0.8 '-,-- 3 ~ 17 25 I 10yr4/4 none sil I 2fsbk mfr cw 1f 0.5 '~, 0.8 _ _ 4 ' 25-35 ''~, 10yr4/4 i f2f 7.5yr5/8 sl 1 msbk mfi - i - ' 0.4 ~ 0.6 5 35-49 I, 7.5yr4/6 j m2d 7.5yr5/8 ~ ~ g . sl 1 msbk r ~ mfi I -- ~ __ -- _~', 0.4 0.6 -- --- - I - i ---- -- I, - - - --- -- - -- ~ i - i ~~ l} I Boring # Boring / Pit Ground Surface elev. 96.52 ft. Depth to limiting factor <10" in. ~ Soil Application Rate Horizon ! Depth , in. I. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh Consistence Boundary Roots SzPQ/ft2 _ ~r 'Eff#t 'Eff#2 1 ~ 0-10 ~, 10yr3/2 none sil 2fcr mvfr as 2f,1m i 0.5 0.8 - , 2 ! 10-17 ~ 10yr5/4 m 1 d 7.5yr5/8 sil 1 fsbk mvfr cw ~ i 2f,1 m ; 0.5 0.8 3 !; 17-25 10yr4/4 m2d 7.5yr5/8 i sil 1 msbk mfr cw 1f I 0.5' 0.8 fi _ ~_ - - ---- i 1 I ~--- - -- - - -- ii --T-----~ I r-_ _ _._ _ -- ,I I ~ I Boring # __! Boring - - / Pit Ground Surface elev. __ 96.61 ft. Depth to limiting factor 0" in. Soil Application Rate Horizon ! Depth ! Dominant Color Redox Description I Texture i Structure Consistence Boundary Roots ___ SzPp/f/~' ___. ` j in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh Eff#2 `Eff#1 1 ~'I D-10 I 10yr3l2 m1f 5yr4/6 sil ~2fcr~ mvfr as 1 2f,1m '~ 0.5 , _0 8 0 8 0 5 ! 2f 1 2 0-17 ! 10yr5/4 m1d 7.Syr5/8 sil ' 1fsbk mvfr cw . m . ~ , ---+---- 3 i, 17-25 10yr4/4 m2d 7.5yr5/8 sil 1 msbk mfr I cw i 1 f 0.5 0.8 ----+ ---- -- f -- ---~-t---..--- --~- - --t-- 1 ---- ----- - i -; - - -- --- - - - ~ - --- - t-- --+ r-- ------_ - -~ ', ', i - ! ~I ! ' Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mg/L `Effluent #2 = BODS< 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. Q9'~ ~~~ c • E/e t/a-~ioi7 ~. , e~ _ RQ~'~i~3s gS ^ ,qif . 8. ~,~,-~ of EX~s~~g c.~e(l Sid;,(' Eleµ = /o/.7J' (/ ^ Bel shed o B- .c ^ qty ~~ ~O ~ ill ~ 9S. ~ 3 E i'S do-9 Soi/ ,~ EXiS ~i'~ 5e~i'C'~A11~ yy oQrcodc. 46ana(dhas • ~~~/~ , . ^ `~ S*sc4m $ 3 ~ ~w~a~c EXi.S{ n9 ~ 3 6.~d~Xom ~' ~ ~nc.~, h1ar~: C3ot~om of ~' S. ~% ~4s,5umtd ~,° G° e IeJ~`~ icy. a?' . 39n ~.~ goy Ave. _~ _ p5.3 0~3 Wisconsjn Department of Commerce Division of Safeiy and Buildings SOIL EVALUATION REPORT in accordance with Comm 85. Wis. Adm. Code 1635 Page 1 of 3 A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8'/ x 11 inches in size. Plan must County St. Croix include, but not limited to: vertigl and horizontal reference point (BM), direction and D Parcel I percent slope, sale or dimemsions, north ar road. . . 002-1054-10-000 Please print all i form By e Personal information you provide may be used dary purposes (Privacy l.aw, s. 15.04 ( ) (m)). ' ~ 03 Property Owner Pro Location Howard & Virginia Helgeson _ Govt. t SW 114 SE 1/4 S 22 T 29 N R 16 W Property Owner's Mailing Address ZONING OFFICE Lot# Block# Subd.NameorCSM# 2458 80th Ave. nor Na City State Zip Code Phone Number ~ City ___j village _J/ Town Nearest Road Woodville ~ WI 54028 715-698-2504 Baldwin 80Th Ave. „__.j New Construction lJse: /~ Residential / Number of bedrooms 3 Code derived design flow rate /j Replacement _.~ Public or commercial -Describe: Parent material Glacial outwash Flood plain elevation, if applicable General comments and recommendations: Install mound system at elev. 96.90' at 14" above 95.73' contour. 450 GPD nor ^ Boring # _ i Boring /; Pit Ground Surface elev. 95.47 ft. 24~~ Depth to limting factor -~ in. Soil lication Rate App Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0-8 10yr3/2 none sil 2fcr mvfr as 2f,1 m 0.5 0.8 2 8-24 10yr5/4 none sil 2fsbk mfr cwv 2f,1m 0.5 0.8 3 24-31 7.5yr4/6 f2d 7.Syr5/8 sl 2msbk mfr cw 1f 0.5 0.9 4 31-38 7.5yr4/6 m1d 7.Syr5/8 gr. sl 1msbk mfi - - 0.4 0.6 a Boring # _! Boring /J Pit Ground Surface elev. 95.07 ft. Depth to limiting factor 22" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh_ *Eff#1 *Eff#2 1 0-11 10yr32 none sil 2fcr mvfr as 2f,1 m 0.5 0.8 2 11-22 10yr5l4 none sil 2fsbk mfr cw 2f,1 m 0.5 0.8 3 22-36 7.Syr4/6 f2d 7.5yr5/8 sl 2msbk mfr cw 1f 0.5 0.9 4 36-45 7.5yr4l6 m 1 d 7.5yr5/8 gr. sl 1 msbk mfi - - 0.4 0.6 * Effluent #1 = BOD ~ 30 <_ 220 mg/L and TSS 30 < 150 mglL t #2 = BOD < 30 mg/L and TSS <30 mg/L CST Name (Please Print) Sig ure: CST Number James K. Thompson '~`~ 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 5/8/2003 715-248-7767 Property owner Howard & Virginia Helgeson Parcel ID # 002-1054-10-000 Page 2 of 3 Boring # -- i Boring 1/; Pit Ground Surtace elev. 94.77 ft. Depth to limiting factor 25" Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr3/2 none sil 2fcr mvfr as 2f,1m 0.5 0.8 2 10-17 10yr5/4 none sil 2fsbk mvfr cw 2f,1m 0.5 0.8 3 17-25 10yr4/4 none sil 2fsbk mfr cw 1f 0.5 0.8 4 25-35 10yr4/4 f2f 7.5yr5/8 sl 1 msbk mfi - - 0.4 0.6 5 35-49 7.5yr4/6 ~--- m2d 7.5yr5/8 gr. sl 1 msbk mfi - - 0.4 0.6 Bonng # _) Boring /I Pit Ground Surtace elev. 96.52 ft. Depth to limiting factor <10" Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr3/2 none sil 2fcr mvfr as 2f,1 m 0.5 0.8 2 10-17 10yr5/4 m1d7.5yr5/8 sil 1fsbk mvfr cw 2f,1m 0.5 0.8 3 17-25 10yr4/4 m2d 7.5yr5/8 sil 1 msbk mfr cw 1f 0.5 0.8 Boring # ~ Boring . _/~ Pit Ground Surtace elev. 96.61 ft. Depth to limiting factor 0" Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 "Eff#2 1 0-10 10yr3/2 m 1 f 5yr4l6 sil 2fcr mvfr as 2f,1 m 0.5 0.8 2 10-17 10yr5/4 m 1 d 7.5yr5/8 sil 1 fsbk mvfr cw 2f,1 m 0.5 0.8 3 17-25 10yr4/4 m2d 7.5yr5/8 sil 1msbk mfr cw 1f 0.5 0.8 * Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SOr~Q{~Q~L(Q~i'p~ ~r'C • E/e ~/Q-~io~ It1 e•/, RQ~~ir3s Q9'~ ~~~ ~' F es ^ 8- ~ ~ ~~ yt.~ o, ~ ~~ ~ B~ Ey~3~~q ~e 11 ~. ~ E i3d'n $ov/ E,YiSfj'n Sc~,-C'~/!~': ~Ll , 9S. M 3 Q So~~•n 3~1m s~ ba n ~ as ~arco~dc . • ~ ~a~erF/awto ^ °~ SfrcQ~n B3 ~ara9c EXi.S~ ~ yy ~ 3 6.edr~Io~r 95oJ' f Sr~Ce, ~ ~ l ~e ncl, h1ar~: Uo~rn o f "~"~ s; d, flssumt.d ° C1' a -e~'`~ icy. a?' ~ 31n god Ave. _~ p5. 3 o f 3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM (Buyer ins Q ~/G~ Mailing Address o?f S8 fj4~ }~`c.2 • i~ c+~Ui /~e Gc~~ $'~o2B Property Address ~~rnP (Verification required from Planning Department for new construction) City/State Parcel Identification Number 60a - /OSS/-/lJ- Gf:~ ~• 33 `f> LEGAL DESCRIPTION Property Location SCe~ '/., ~E '/a, Sec. ~ T ~~N-R j~ W, Town of ~i Subdivision ~~ ,Lot # Certified Survey Map # ,Volume , ,Page # Warranty Deed # `~ ~~ sY~ ,Volume _ ~ D 9 .Page # ~~ ~ Spec house ^ yes Ld'no Lot lines identifiable ~s ^ 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 agrecs to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeymanplumber, restrictedplumber or a licensedpumperverifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standazds 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 of the three yeaz expiration date. ( 1 ~.~~ 5 / ~l ~ ~ X SIGNATURE OF APP ICANT ~ 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 described above, by virtue of a warranty deed recorded in Register of Deeds Office. ~r^~ ~~ SIGNATURE OF APP CANT k ~ l ~l 0 3 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 ooct-MEr7r No. WARRANTY DEED STATE BAR OF WISCONSIN F4R:N '1-198Y r ~ 4'7150 Yep yQ~~P~cE 1 ~3 ffiadley Helgeson, Brian Fielgeson and Qleryl tiovde The ~ Howard and Virginia Nelgeson _ ...... cony cs a d ~":I ra is to .. ~'rtls~ cja~.~ -- ... . ............ ._- Bradley T~elgesoii and-~rian ~ ... . ~Fielges~n, Co-Trustees the following described rest estate in .JCte. ~~ix ...County, St:, a o'' ~~ isconsin: TN!9 4-A~-t MC y[RVCD FAR RED, t)R:)INO DAfA REGISTER'S OF~1Ct ST. CROIX CO., WI Recd for Record JIJL 1 ~ 1991 ci 10:45 fi.M a ~,~ Repishr of Ceeds RETURN t0 Ta: Farcel No :............ The West Half (W 1/2) of the Southeast Quarter (SE 1/4) of Section Number Twerlty Trap (22) , Township Tweslty Nine (29) North, Range Sixteen (16) r~lest. This oanveyance'is fee exempt according to Wis. Stats. 77.25(16) This 1S nOt .- .homestead prcperty. _._.. - .- (is) Exception to warranties: easements and restrictions cf reo~rd C T~ I ' i h - ~ d• ~ f ~1 Ltd 19 91 .t _-.. ~~ ~~15~'t\, ~ -~.-~<~ --~'~o"'~ _ _ _ _ . _ (SEAL) ~ _ I S E A L j ffiadle Helgeson ~ ffii~lgeson . y _.- . _.-_ . AUTHENTICATION Signature(s) •--..1~'dL~.~..FI~~S!~S(.rtt,...Hx'~~3I1......... I~elgas<.n and Ci;e~yl Ilovde // --- - - aut 7cated this .K?..~day of-.//L.C~.y ............. 19..9. '--- .J...Seiebster.---•---------------------------------------------- TITLE: 'VIE~IBER STATE BAR OF WISCONSIN (If not- ------------------- --•------------•----............-•----.. authorized by ~ 706.06, Wis. >tats.) ACHNOWLEDGMENT STATE OF WISCONSIN ' s,. -•---•-----••-----,---}-....- -•-----County. Personall • came before me this ................day of ..............................•--- - --- ~ 19----•--- the above nameli to me known to be the person .....-..-_. who executed the foregoing instrument and acknowledge the same. T4i3 INSTRUMENT WAS DR 4FTED BV •, , ,. j - ,,,, c~.~....: - - 'ignatures may he authenticated or acknowledsred. Beth not necessary.) i... ............................ ... .......-...---- ........ ..-.... ... .....-... Notar~~ Public ....--.- . _......_ _ - -_._....._ .Counts. Wis. qty Commission is permanent. (Ii not, state expiration date: - ... ------------ - - ....... . . .. ... . 19.- _.) ins aiF,nin~ in nnY c®Pac it9 ahouirl Ix [YPtr: or t~rinted brlnw th•~ir ~iR nnca rex. oa 3TA'CE HAR OF WISCONSIN Wirrnnsin L~xxl ISlnn4 1'0. Orr FORM ?70. 2- Itly'2 - ~; .: ,... ~, k~•... a'!c_