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HomeMy WebLinkAbout004-1004-50-000~* , ,~ vYgsoonoin Oepeutrner~t of commerce Sa1eq~ alx/BuNdi~s oivislon GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT r~rsolw IrMOrRlaaon you prvNOe may oe assn wr seoaary PmP~ IP~~Y ~. s.taw ftxmfl. X Permit Holder's Name: rty Vr age Town ot: Cad Town M Irup. BM E v.: BM Desa~ptan: TANK INFORMATION TYPE MANUFACTURER CAPACITY s~tac v Dosing Hola~ng-- ~ ~ . TANK SETBACK INFORMATION TANKTO P/L WELL gLpG, ventto Air Mtake ROAD ~'~ 5/SO' ~ ~~~ ~3' - NA posing s ~ > 3S ~ 3 ' >3S' NA _ _- NA Holdirtg~ PUMP/SIPNONINFORMATION k 33 s ~~~ Marwfacturer Demand Model Number 3 3v GPM TDH lift ~, -Z~ friction, ~~, S erl~ ,~ TOH s,sl'ft Forcemain Length ±,t~( i Dia. 2 " IJirt.Towell >~ ~ Sl1N ARSARPTIAN tYSTFM f11~7'RIRI ITIAN SYtTFM ~. ELEVATION DATA St. Cro STATION BS HI FS ELEV. Benchmark f~ , Bldg. Sewer ~. , 3~+ ~ z Ht Inlet . O , 0 of Bottom ~ 1~.~ ~ y Header/Man. ~} , ~~ 9 , Dist. Pipe ~~. 3d Bot. System ~`, Final Grade ~ 1JL ?- ~ ~ -s h 8Ep / TRErICH Widths, Length Z ~ No.O~f Trerxhes No.Of Pits Inside Dia. liquid Dept SYSTEM TO P/L BLDG WELL LAKE/STR acturer: INFORMATION ype System: ~ >/ ~ + ~ - ~ ~ __ BER OR UNIT Num r. He er / Mani o `~ Z ~ '~ oirtribution Pipe(s~ ~ y ~ / ~ ~ I ~ x Ho a Size I ~ / x Hole Spacing I Vent T~!ntake Dia Length Z • Spacing +~ length ~ Dia ~ ~~~ J SOIL COVER x Pressure Svstems Only xx Mound Or At-Grade Systems Only pepth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes No ^ Yes ^ No ber .B . ~ COMMENTS: (Include code discrepancies, persons present, etc.) n~ ` / Ins ection #1 j / / Inspection #2: / / 9 /Oz Location: 3136 50th Avenue, Ive( Falls~,nWI 54022 (SE 1/4 SW 1/4 2 T 8N R1 W) 02 1528q_ 1.) Alt BM Description = '~' ~~ ~,~(i~•`r-- ~~~ ~ ~O~ ~°~ '~s~ 2.) Bldg sewer length = 2 y' ~ ~ ~ N""1~ (,~,Q,S G~~ ~ ~ -amount of cover =» ~ Sw 331~~ 3.) contour = ~'~.?~ ~,, ~ ~ S~ d 1~ Plan revision required? ^ Yes ^ No Use other side for additional information. ~1O fq,~~ Date Inspectr/ors Signature Cert. /No. '~~r t0 ~PR.Je -M~SJ5a9~ (tikl~~.. ~ ~ ~~ `~ ~ `~ ~~~~~ `~ ST~N.~. C~9i~'S ~ 313 6 ' Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. `~SC0/15in See reverse side for instructions for completing this application PO Box 7302 Madison WI 53707-7302 Department of Commerce Personal information you provide may be used for secondary purposes [Privacy Law ] , (Submit completed form to county if not 9 state owned.) Attach complete plans (to the county copy f n paper not less than 8 -1/2 x 11 inches in size. County `Ji C¢-alX State Sanitary Permit Num, r., ,- Ch ~f vision to previous application 8 1 q3 F , ~ ~ ~ State Plan I. D. Number -~u.~s ,~~: ~O196/3 I. Application Information -Please Print all Infor 'atibn Location: Property Owner Name _; , A .t , , . Property Location mod? /7 ~P ~"1 Y ~ ~ 6 GP~~' ~ 1/4 s1c~1/4, S 2 T Z~N,12~.SE (or)vv Property Owner's Mailing Address ~ .F~tG~ Lot Number Block Number NGO ~~~ ,yc... s' ~ ~~"" ,, Z~ ~ City, State Zip Code r ` ~,: ` Ptlece ~~ . ~ Subdivision Name or CSM Number ,,. II. Type of Building: (check one) ^ City ~" 1 or 2 Family Dwelling - No. of Bedrooms :J~ ^ Village }Town of ^ Public/Commercial (describe use):_ ^ S to-Owned ~~ 9 , Z O Neazest Road t~ ~lv 5 ~ x ~ . Z ' ~ ~ Pazcel Tax Number(s) III. Type ermit: (C ck my one bo on line A. Check box on line B if applicable) d ~j 'Q - () O O A) 1. w 2. Replace t 3. ^ Replacement of 4. 5. 6. ^ Addition to S tem System Tank Only a , aZ (s 8 Existing System B) Permit Number Date Issued ^ A Sanitary rmit reviously issued IV. Type of POWT System: (Check all that apply) ~ ~a. p- -(O~p , ^ Non-pressurized In-ground QI' Mound ^ Sand Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At-grade u ~ , ^ Aerobic Tr atment nit ^ Recirculating ^ Other: ~ D I.9 zz ~~ s 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 ~ ~ i d Required ~ Proposed Rate (Gals./day/sq. ft.) • (Min./inch) J Elevation ~ ~ ~ ~ac~o ~ . Z ~ ~~. ~~ g 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 ~ j~u~ Cl ~ `oo ~ ~ ^ ^ ^ ^ ^ VIII. Responsibiltty Statement I, the undersigned, assume responsibility for installation of the POWTS shown on t attached plans. Plu is Name (print) Plumber's Signature (nos ): MP o. Business Phone Number ~.~ ~~ ~~.~- ~ `~~ ~ ~/ 9 7i~s` • z ~3 - `~~/c~2 Plumber's Address (Street, City, State, Zip Code) ~ 2 ~ r ~ ~ Ct ~ /l ~~1~ IX. County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) ~1,Approved ^ Owner Given Initial Adverse Surc ge Fee) ~ 2S ~ 00 I ~ 2 2 Determination - - j ~ . X. Conditions of Approval /Reasons for Disapproval: ^'".. ~~st' 6,~- ~(oa.u~~mn~ a.S ~ cam- •~n.ctnN-~S' . 5e~~~a*k. -~ ~""',~o'.~ ao~ 5` ~` ~ ~-~~5~~ , ~ Q ~ n Lw~. pK~(~&1~. ~ hQ,aa ~,ea.~52 1 c~ e'^~ ~~ ~ ~~ i~" S.K-~ ,e- ~usl-"~be., ct.laon~ ,~s1,~ " _ -, _ J i ~c ~ . --~~~q ,re~.s E-~c,t lZQe °~. °^. Po.rc~. i` s a. 5~~ -~- N.sw~.B..i" ,ntusr R„ -t>~~t--ate.. ~;c..t-.,,,lc...~~~~,o~,~-,(~'(,~r t s cam' .n~.Q.~J a.,+.d~ •~-~u,.~-at•tKed( SBD-6398 0/R 7070 0> aS Qe.~ W~~~~~`S rec~.~~v.Q-a~-1~+~-s . ,. ..~Q~ ;: ~ _i~y d b~_ P~o~ PiN~ ~O . ; -., . ~1s~ _~~ s ~ ~ ~- ~~~ R ~.s w : - . _. -r - ~~ ~ ~ i _.. __y . ~ ~ ~ ~ _~ _ _ _ _. ~ ~ ~ I -., - --- _ .. --~~- - -- - ~i ~ ~' 5 ~~ ~N q 3.8 Coy, ~~~.• ,~~`~~ ~ ~ 1 t i ~ _ ~ _ - ~ I ~ ..~.. __"~__._-... _. ~ ..._ ~._. ~-,~~~ i slo,,.~ Sv ~..,,,;., c /~,if 1 _- ~j~ ~ ~. w ; ..,.~. ~ ,.,,o - ~ ~ ~-~ ~-a,.t~ - '- 4t~ ~ p'o~ .Qe ___ 1 V\ c ----- -~~~'.~:~r~'c t$l~ tf X33 A y y~-~ ~. __. -_ Sral~ I, yb a~~di~ ~~,/2, ~s . 13 IQ Q.b4~~ar( PaJ ~ 3of `~ •, .: ~:._ _ ~ ~ iscons~n Department of Commerce Safety and Buildings 10541 N RANCH ROAD IiAYWARD WI 54843 TDD #: (608) 264-8777 www.commerce.state.wi. us/SB Scott McCallum, Governor Brenda J. Blanchard, Secretary March 06, 2001 CUST ID No.231491 A7TN.• POWTS Inspector ZONING OFFICE THOMAS C FISHER ST CROIX COUNTY SPIA N324 CTY RD D 1101 CARMICHAEL RD EAU GALLE WI 54737 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/06/2003 Identific rs Transaction ID N 619613 Site ID No. 626947 SITE: Please refer to both identification numbers, SITE ID: 626947, RON HYBBEN above, in all corres ondence with the a enc . ST CROIX COUNTY, TOWN OF CADY; 50TH AVE SE1/4, SW1/4, S2, T28N, R15W FOR: REPLACEMENT MOUND, 450 GPD OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 782952 P Q'.~ Conc~it~ 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 1. chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. r ~.~rrnnENr o The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: ~'~~ ~~ SAFET' ... - ~"'~ciRESI • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Ei~luent for Private Onsite Wastewater Systems" 5BD-10691-P (N.O1/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD-10706-P (O1/O1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the properly owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • 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. • The maintenance plan for this system must be given to the owner of the POWTS. Site Specific Conditions: • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area I S' beyond the down slope edge of the mound per Mound Component Manual. • This system is designed for wastewater strength with monthly averages of less than or equal to 30 mg/L of fats, oils and grease, 220 mg/L of biochemical oxygen demand and 150 mg/L total suspended solids. THOMAS C FISHER Page 2 3/6/01 • The maintenance plan must be expanded to include a maintenance schedule for the pump chamber (i.e. servicing [pumping) and inspection, testing electrical connections, etc.) and maintenance of the soil absorption cell (i.e. what activities may or may not take place on and around the mound system, i.e. traffic, plantings, etc). • Abandon failing system per COMM 83.33. 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. 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. _._.-~----, Sincerely, F`ATRICIA L SHANDORF POWTS PLAN REVIE R TEGRATED SERVICES (715) 634-7810, FAX: (71 634-5150 , M-F 7:45 AM - 4:30 PM PSI-IANDORF@COMMERCE.STATE. WLUS DATE RECEIVED 03/01/2001 FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 BALANCE DUE $ 0.00 WiSMART code: 7633; cc: RON HYBBEN s ~w Ron Hybben -Mound Transaction # Construction Materials and Techniques All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. Construction methods must comply with the following Component Manuals: Mound, SBD-10691-P (01 /01) Pressure Distribution, SBD-10706-P (O1/O1) Location: SE 1/4, SW 1/4, Sec. 2, T 28 N, R 15 W Town: Cady County: St. Croix Date: March 1, 2001 Owner: Ron Hybben Address: 612 Fourth Street, N., # 5 Hudson, WI 54016 Plumber: ~isher Signature: Cfi--'~ 1,.,.~, License # MPRS 231491 Attachments: 6748-Plan Approval Application SBD-8330 page 1: cover 2: design criteria & calculations 3: plot plan 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail 7: pump curve 8: system management l rS, ~~aly ~/ _~n~~~\ ~~~ ~ ~/~ page 1 of 8 •~ ~ Design Criteria Yt"S Residential Wastewater Contaminant Load: 30 mg/L < BODS < 220 mg/L Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L Fecal Coliform > 10,000 cfu/100 mL W ~ Treated Residential Wastewater Contaminant Load: 30 mg/L < BODS Septic tank + "highly treated" effluent 30 mg/L < TSS Fecal Coliform < 10,000 cfu/100 mL ~ Bedrooms x 100 gal/bedroom/day x 1.5 ~~ gallons/day hydraulic load Design CalcuYations In situ designed loading rate o • Za gallons/sq. ft. per day Depth to estimated high ground water zi 1~ in. Depth to bedrock ~ 3 ~ in. Cross slo eats stem ~ °/ p Y ~~ Force main length Manifold/header length 2.S Drain-back ~ ~ • g Lateral length ~ @ `tO•~ Lateral elevation 4 ~• ~ Lateral hole size 3~~ b in. @ 1' °'° ``~ holes/lateral ~ ~ Lateral volume ~ ~• ~ b Total lateral discharge rate Z 9 • e4 Elevation difference ~ 3'`$~ Friction loss ~' 3 ~° Total dynamic head ~ °g ~ ~- ~ Pump/si~on ~ gpm @ Z Manufacturer ~'~ ~~ °'^~ ~ ~;z Dose volume ~ ~ Lift/sip~on tank ~" ~ ~'~'~ ~ ~~ ~ ~ ~'O ~ ~.~ Septic tank ~ ~ ' ' ~' Effluent filter ~ ~ ~ "~ `}O Measurement pump on and off ~ Height alarm from tank bottom ~ t°' Reserve capacity ~t S + specs.calcs 0 ft. of z in. ft. of Z in. gallons ft. of ~ ~ z in. ft. @ bottom of lateral in. ( s' ° ft.) Spacing holes total gallons J gallons/minute @ 3 "' ft. head ft. ft. @ 3'° gallons/minute ft. ft. of head Model # S t~ ~ ~ gallons b "'O gallons ~ ~''~'~ gallons m. in. gallons Page Z of ~ -. J ~- ~ I Di p -_ ! Sir /~. ~-,~- ~. ir; Sao ~~. 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QvIGK Dl~t~l~-G7--1 ~~~ y ~, °t b 6" -~- coGao ,~ > 4,, Fla,., -----~ ~ ~4 PYc 1..4 i 4° pIPG 3' \ n0 NO-STUa6E0 Sot L. 2d'' 2.D. `~ r1a-,ua,F .... iMU r avrc~ oWaovtQ A 3~ SKI=T 3>~~Er, ~_ g~FI.ES ~ P~ a 1 a~~ CIEv, C ~ `~~v : h Ow- a. goo ~~ D ~ ~~ ~ u~ 21, 11 ~O'RC Lr ~(ylw WEAT'NERPROpF ~.TU N CT I O N &~c i'~ ~~wt,.o N LcL I I~ Pur(P Go~/t.RET'c 6~oCK TJ/i7%7i/7 \ 4~ 4 o _ vEti~j ,~ q q' P~ S.-~ 40 3' ono IiKp:.rutc. ~aouwo ~` ~~'-. SEPTIC E SPEGIFI~CATIOt`1S OO S C ~ 1.19 ; ~~ ~ T - ~ / ~ A ~~S MA-IUFACTU0.CR: IJUMDCR OF pOSCS: PEK D~~ TA1JK SIZC: ~~~~~'"° 6ALLOAJS •.DOSC VOLUME c j ALARM MA-.-UiACTUiICR: S `\ ~~~ `<-~'~` ~ IIJCLUDIAI6 6AGKFLOW: (TALI O~1S hOpCL I.JUN!lCR: . \ e l 1-1• ~ ~ CAPAGITIC$: A= 31 IAICHCS OK \~"} WLLOuS SWITCH Ty-[: ~~~` "l~D Z P ~ " $ e IIJCMCS ORS CALLOUS ~ 'I ~ UMP MAAJUFAGTURCR: 'O ~'~ C ~ ~O IULHCS ON ~ G~L~OuS ,~ MODEL -JUMDCR: S\~~ ~ D~ ~ ~OiQ~' INI:HES oR G~IIGu~ SW~TCN TtiPE; ~Q'1ji~~ " IJOTE: PUMP A1JD ALA0.M ARC TO OC MIIJIMUM DISGHARGC RATE~_G-f~ INSrALLED ou SEP^RATC CIKCu~To F O TICAL D ` ~ I R V FCRCIJCC ~CTW[CW PUMP Off AUO OISTRI~U71 0AJ PIPC.. 3~~ FEET + MiuIh1UM -JETWORK SUPPLY PRCLZUR C ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ FLCT TT // + ~~ FCET OF FORC[ MI-IIJ X ,~~/pp~EFKICT101J FACYOR. '._ ~~~ FEET ~ ~~ ~~~ ~ ~ w = TOTAL Dy1JAMIG HfAp ~ ~'}I FEET ,} ~. IIJTCii1JAL DIMCIJSIOAJt •0/ TAIJK: LEIJ67H \ r ~ ~ /1 S 1~~ --~ ;. ..+~ r ~~ !~i Ogee„r~ Cl~re~ctecistics /I''"~+ le"~11dr Me»~ Rta+leek Awo.ark Ma+et. S'le"r~b SNtF10M1 i11041M1 S11ET40A1 sNaf4oA: Ihr 4 10 fr1 ~ 19 i.S MNk SI~.1 tAtM 4 fielrll R,r.M. Issa nNe. t+er wlp tls ss, FNrte i0 T eTSMn 120' f Mu. FteM NeMA A I~.rw d~ A S>:e 11 llrT sepde 3 4• !i Ot. feewr CKd I! i~0~ppjr petL Materia#s of Cont:trut~on el~~~.~.~rrwwa hwt~ ^ o..~.. ,0 I 30 ~ 20 10 ° io 20 30 4o so 60 ~a GPM TrFpl Fled (tirN- 10 14 17 ZS ~S 4ta SO ,S er 4" !wi S .7 liPM (US O)PMti 70 60 SO 40 30 40 10 0 see i. 1. A11 dimeesions in IAcMs. (I~letrlc for iiierrlatioeol uses. 2. CorrQoeerlt 11eleAASions mar vory 3 1/i Inch, 9. Not kr cantrodbn purpose uniecs cerNAed. 4.Oieu:1-sloee and vrai9hts ere approldrnete. 5. W~ reserve the rl t ro Hake rorisioes ro our p rd and !heir spedflmfioas rrkflout notice. I~ 1996 hydrOtnafiC" Pumps, Ae ond, Ohio. al! fll9hrs Restrved HYDROMATIC ~ -Your Au+horisod tocol Dishi~oro' - 1110 Bancy Rood lshlond, Okio 41805 TAI:119.46!•9012 fox:119.2i1.1061 Weh Sih: rww.peehirpunp.can 1+ • . SALES OtfIQS IN AU MAJOR OT1E5 ANO OJItN1Rl~ ~ !~ ;~ ', ~ ~ Refer +o "Pumps' in +-o yelow popes of yaer phone directory for your lecoi Oigrlhulo+ /~~ - ^ Memar: W-04•d~680 1198 SM 'ot~ U O • Dimensionait Dpto ,.~- ~ . ,/ System Management Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the homeowner, and the homeowner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber, Tom Fisher Plumbing, 715-285-5671, or the St. Croix County Zoning Office, 715-386-4680, should be contacted for assistance. General Proper functioning of an on-site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. 1 . If the septic tank is installed prior to sheet-rock and/or painting, pump the septic tank before normal residential use begins to ensure adherence to contaminant load design criteria. 2 Install water-saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grew or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly. 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. Maintenance 1. The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back-washed into the septic tank to remove accumulated material. 4. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in-situ soil adsorption cell. Quarterly inspections are recommended, and a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. 5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for residential systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and/or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 . ' ~~, , 1269 Wisconsin Department of Commerce SOIL EVALUATION REPORT p~ 1 of 3 Division of Safety and Buildings ,,, ~~.,..~~....o,.,crr, r.,.,,.., n~ w~~ n~.,, r~ Gustum Septic Service County Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan must St. Crooc include, but not limited to: vertical and horizontal reference pant (BM), direction and ' Parcel I D tance to nearest road. Rand percent slope, scale or dimemsions, north arrow, a . . , 11 1 ~ ~ Please print all ' ~i: - ~~ ~ eviewed B~, Date ndary purp~(Privacy LevP; s,1 04 (1) (m)). Personal informatan you provide may be u f ~ ~ z ~Ci < Property Owner P.r Location ~ Hybben, Ron Gtivt Lot n/a SE t/4 SW t/4 S 2 T 28 N R 15 W Property Owners Mailing Address r r '.~ ~ ~~~Q ~-et Block # Subd. Name or CSM# 612 4th Street N. #5 ~-, ST R i ~ /a n/a N/A City State a Pho~ChltaA'1Qer i ° :: City Vllage Town Nearest Road 2UNIr~G QFFt~ Hudson WI 715-381-967 Cad 50Th Ave. New Construction Use:. Resi h(u 3 Code derilned design flow rate 450 GPD ~ Replacement ,;,;,,f Public or commerc-a - ascribe: Parent material loess Flood plain elevation, if applicable n/a General comments and recomrrlendations: Recommend mound system along 94.2' contour. BM 2= 94.4'. Part of 28.5 acres. Site address is 3136 50th Street. Boring # Boring ~'~ Pit i 4 ~, Ground Surface elev. 94,2 ft. Depth to n• ~ limiting factor - ~ Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft2 1 0-5 10yr2/2 none sil 2mcr mvfr as 3f, im 0.5 0.8 2 5-9 10yr4/2 none sil 2msbk mvfr cw lf,im 0.5 0.8 3 9-14 10yr5/3 none sil 2msbk mfr 1:W - 0.5 0.8 4 14- 8 10yr4/4 c2 7 5 1 05/8 /2 sil 2msbk mfr cw - 0.5 0.8 5 18-26 10yr4/6 "'~PS~~ jg/2 sicl 2msbk mfi - - 0.4 0.6 Boring # ~ Boring Pit Ground Surface elev. 93.8_ ft. Depth to limiting factor ~in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft= 1 0-6 10yr2/2 none sil 2mcr mvfr as 3f, lm 0.5 0.8 2 6-il 10yr5/3 none sil 2msbk mvfr cw 2m,1co 0.5 ~ •$ 3 11-15 10yr5/4 none sil 2msbk mfr cw im 0.5 0.8 4 15- 1 10yr4/4 yr6 c27 55/8 /2 sil 2msbk mfr cw - 0.5 0.8 5 21-30 10yr4/6 m~pg~~j6g/2 sicl 2msbk mfi - - 0.4 0 • (p `Effluent #1 = BOD S> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 =GODS < 30 mglL and TSS <~0 mg/L CST Name (Pl~se Print) Signature: ~/~, CST Number Tom Gustum i _l~ 227618 Address Gustum Septic Service Date Evaluation Conducted Telephone Number New Aubum, wI 54757 8/11/00 715-658-1344 prey O~~ Hybben, Ron _ Parcel ID # •~ ~ , per' _ 2 of 3 Ong # d Boring Pit Ground Surface elev. -__ ~•? _ ft• Depth to limiting factor 17 in. Sal Application Rate 1'-_ Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' I *Eff#1 *Eff#2 1 0-7 10yr2/2 _ - __ none__- _ ~ sil _ ~ __ __2mcr __-_ I mvfr i _-_- as tI, - 2f, 2m ' 0.5 0.8 2 7-12 -- _. 10yr4/2 __ ---- 4 none j -__ __ sll 2msbk ~ __..___ mvfr _ cw 1 2m,ico ~ 0.5 _ 0.8 ____ 3 12-17 ~ 10yr5/3 none sil i 2msbk I -- ~ mfr ' cw lm 0.5 0.8 4 17 20 -- -- 10yr4/4 c2-3d10yr6/2 7 gig/g sil 2msbk mfr cw - 0.5 0.8 m p10yr6/2 5 20-30 10yr4/6 7_g~g/g . __ sicl -- 2msbk _- mfi ~ - - 0.4 ~ 0.6 _ _ - _ ---- ~~ # ~ Borng Pit Ground Surface elev. ----_-_ -- ft• Depth to limiting factor in. Sal Application Rate pep p Boundary Roots _._. __CPDliit_....-- Honzon th Dominant Color Redox Descri lion Texture Structure Consistence ~ *Eff#1 *Eff#2 _ ~ _ _ - I -- - - - - -I - -- - -- I - --- ---~ - ~- I_ _ _ __ - , ~ _ _ _ _ } _ ~ f - ---- -~ _ -- -- - ---- -- -~ _ - -- - --_ _ _ _ _ 1 i I l ~ ~~ # ~ eonng ;,~ Pit Ground Surface elev. ft. Depth to limiti factor _ in. Soil Application Rate Horizon p' Boundary Roots _ -_fPD/8=.- --_-- Depth Dominant Caa Redox Descri tron Texture Structure Consistence 'Eff#1 *Eff#2 ' 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 Departrnent 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 608-264-13777. I, '. ~,~,~ °W ~b~~, Pfo~ P~a~ ~~ ys~r~- ~ ~.~- ~~ 17~o~S~J~ W Z, ~D 1~6 .~~ sc~ ~`~~ ~ T 8~ R 151' Tin ©F ~a y ~~ ~ro~' Cam, ~~G f't d ~('css ~'rr~v~ 9y ' ~~~~ l ~or?ou t Le n ~~icTr~~C, ~h~c ~ a~~~ ~'~ ~t,Jf~ ~ ` Gr~CY) ~~ ~t.. Grouted ~~ ~'~ SrR K~- J ~ f' f~t~J r f 1/~ 9,.~ ~~kJd C ~G 71 ~L~ V ~sca(c1:f/a -_ _ - i - __ ~~~ 516P" sy.~ ~. ~~ ~ ~~~6i~ tt~~~s~i~ ho~~, ~~ ~ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~,.~2~ ~' Y 8 ~ ~ /~ ~ 2 ~ ~~S" Mailing Address Y Property Address tau) i'd/ '~ -' ~''~~ (Verification required from Planning Department for new co ctioa) ~ , / (~ ~ City/State Parcel Identification Number 4 ©~`~ Ib n 7 "~O~ p0 C~ LEGAL DESCRIPTION Property Location ~ %., -~ `/., Sec. ~~ T ~ ~ N-R~W, Town of ~~~ Subdivision Lot # Certified Survey Map # ,Volume _, Page # Warranty Deed # ~~ 2 ~ ~ ro ~ .Volume _ ~ .Page # Spec house ^ yes (~d" no Lot lines identifiable ~' yes ^ no SYSTEM MAIIVTENANCE Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic teak 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 master plumber, journeymanplumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system is is proper operating condition and/or (2) after inspection and pumping (if necessary), the septtc 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 standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stn ' that your septic syst m n maintained must be completed and returned to the St. Croix County Zoning Office Rnthm 30 da f the year exp' do te. ~~~ ~ a~( SI ATURE OF APPLI DATE OWNER CERTIFICATION I (we) certify that a stn a ents on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of p pc d 'bed abov , b rtue of a warranty deed recorded in Register of Deeds Office. D ~ ~o ~ SIGNATURE OF APPLI ANT 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 ti yr,!I. ~53~PAGE 55 G2SS68 STATE BAR OF WISCONSIN FORM 2. 199g Y,ATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEED5 ST. CROIX CO., WI Document Number RECEIVED FOR RECDRD This Deed, made between James N. Elsenpeter and OA-2B-E000 10:00 AM Barbara Elsenpeter, husband and wife and Andrew P YAkRAHTY DEED Jensen, a single person E%EMDT tl Grantor CERT COPY FEE: , and Rondell s. Hvbben a single person COPY FEE: TRANSFER FEE 1b5 00 : . kECDRDING FEE: 10.00 PAGES: 1 Grantee . Grantor, for a valuable consideration, conveys and warrants to Grantee the folleaine described ---' cr~i: The East Half of the Southwest Quarter of Section 2, Township 28 North, Range 15 West, Town of Cady lying South of Interstate Highway 94 "'L"~.~ ~~~ ~~~~J Exceptions to warranties: easements, roadways and retsrictions of record Dated this ~~ day of ~ ~ ~._ ,~~- * drew P. Jensen __ C,S ~_(~ ~(}~ N.~~.w Y, ~ev~5'.~ - AUTHENTICATION Signature(s) authenticated this day of , * TI-fLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stets.) THIS INSTRUMENT WAS DRAFTED BY Michael H. Forecki Attorney Esu Claire, Wisconsin (Signatures may be authenticated or acknowledged. Both are not necessary.) Re~:ording Area Nana and Retum Address WESTCONSIN CREDIT UNION PO BOX 308 RIVER FALLS WI 54022 A2~' ooa-loos-so-ooo Pa1ce1 Identification Number (PIN) Ttis is homestead property. (is) (is not) 2- 2~• IS . 2 $~- ' allm>>e--s N. Elsenpete /~ _ C '~cf~A~SL'Y3 . aJ. ~. ,1~[I o *Barbara Elsenpeter ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. St. Croix County, per;Qnally came before me this r~ day of ~ he above named James N. E enoeter and Barbara I;lsenpeter Andrew P. Jensen to me known to be the person who execined the foregoin,; instrument aid acknowledged the same. ~_-/~ * Tracy Turner Notary Publ.c, State of Wisconsin My Commi<.sion is rrttan t. (I state expiration date: Tracy L. Tumer Notary Public ~~ •Names ofpersons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2.1998 PrctlucW wiN ZipFam'" by VerU501t hc. 1(1025 filleen Mib Roaa, Cinlon TowtKllip, MKhpan 46035. (600)383-9905 AOOrn<Y MichselHFOrtcki IBJO Brackq, AVe, Eau Claire Wl Sa]OIA62] Phdx-: 1]I5)8J5-3029 Fax. (]13)815-9112 ,. ,Y . Pump Characteristics /Motor Unit Srbla~rslbb Monad Models SW2SM1 SW33M1 Aatooatk Modos SW2SA1 SW39A1 Horsopowa 1 /4 1 /3 FaM toad : a.o lo.o Motor TTp~ Slladod Pol o l4 polo) R.P.M. ~ 1 SSO Pks~ 0 ~ 1 Vdtoao 11 S Hirt: 60 Oparatba btandttMt ToaporatYra 1 TO°F Aarblat NEMA D.siga A lasalatia Class A Disdaraa SW 1-1/2' HPT saM~ 1/r udt wd/w so is. Pawar Cord 1 a/3, S1Tw, l o' std. (20' apt~d) Materials of Construction Hoadlo Stal OM DioMctrk OM Moto Hw Cast ka Ca Cast k Morjooird Siolt Sod Sod Faa~s: Carina/Graadc Sod aadT: Aoadl:od Stod Sprig: Stalalas Stod ws: Iwa-N stk U Ira:o Slooro lower Raw IoM StraiaK Ns• Plastk fasta~ars Stddas Staal ", ~.... Performance Data 24 113 P 18 //1 HP o. ~' e 0 o to 20 4o so so CAPACITY .8.O.P.M. Coto! 8~ad lf~~t) 4 6 8 10 1 Z 14 16 18 40 Z~ Z4 1/4 NP 44 41 36 33 29 46 43 18 1Z 6 0 6PM 1/3 NP 47 45 43 40 0 Zb 22 16 10 Dimensional Data ~1ti _ ~ t'(~tt~ ~'r i~lAu &1/2 sore 0 ~. 'jQ®` 2' ~h n~.'.w ..,R ~C~ ~ 3. ~rn ~~.~~ 1.1/2 PT .qqj 3-1/2 ISCHARGE'~V ~ wghk r~ Lam' "- ~ oarrN ~ .~ioe w~ 8 -•-- ~ ~. w. ~wrw Ilr igAl a }~ ' ~ mYt~ graiaM k+Mlf a.wa-Ml llr. tipwlwrw.+lar.ow PUMP 11.1/8 lo•Ire °N e•li2 DISCHARGE HEIGHT 1/27313" 3•i/2 i G FP+ AURORA/NYpROMATIC Ptvmps, Ins. 1840 Mbttoy Road, Ashland, C9hb 44805 (419-489.304? t ~..-- ~- ~ S96-Nbp6`_