Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
004-1005-60-000
/ .~sconsin'DepartmentofCommerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes (Privacy Law, s.15.04 (1)(m)1. Permit Holders Name: City Village X Township Ben tson, Robert Cad Townshi CST BM Elev: Insp. BM Elev: BM Description: ~b b TANK INFORMATION ~.. TYPE MANUFACTURER CAPACITY Septic Dosing („ S Aeration Holding TA~ ETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake .~-- ROAD Septic ~ ~ ~ r .~--/ ~/ ~ ~ t~ Dosing Aeration Holding PUMP/SIPHON INFORMATION e~Lt t°.Gt~t 1~P - ~ I~ Manufacturer Demand GPM Model Number ~~ n ( J ~/ ~[~> 7~ TDH Li~ Friction~oss stem He~L S y T H Ft ~ ~ r tp ~j . (p Forcemain Le / Djr'i. f„ Dist. to We~ ~ S ~ SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. CifOiX Sanitary Permit No: 453125 0 State Plan ID No: ~~ ~ ~~ Parcel Tax No: 004-1005-60-000 Section/Town/Range/Map No: 03.28.15.38 STATION 2 ~ r/ 11 ,~Z, ~„FS 7j ELEV. / 00 •a Benchmark ~. G ~- /~O.cw Alt. BM ~~ ~ ~ ~ -D Bldg. Sewer z.~~ Qp~ SUHt Inlet / ~ O C ~'~~ q. SUHt Outlet /+ ~- Dt Inlet Si~ i Dt Bottom oZ./+ ! - ~ j ~ L ~ 4 . ~(~ - Header/Ma~ ,. ~.7 q 9 5, / G Dist. Pipe/~, t% ~~ ~~ Bot. System i /.8/ ~~ as, - Final Grade / -f fi~ ~i7. f3 St Cover .~:~ ~ 97. C., ,. ~~ „ r - ~.~s y3. ~ BED/TRENCH DIMENSIONS Width ~ Length ~1 1 No. Of Trenc es PIT DIMENSIONS ~. No. Of Pits Inside Dia. Liquid Depth .~ V ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CH G Manufacturer: INFORMATION CHA R OR Type f System: \ , ~ ~~ 7 ~ ' D~ , Model Number: DISTRIBUTION SYSTEM e ~h rill®__ ~'~~L/~,. ~ ~ Cp~(D Header/Manifold Distribution x Hole iz x Hole Spacing Ven o Ai I a e --+- N Length_,~_ Dia 2 ~ pipe(s) y/1 / t r ~ Length D Dia_L_ Spacing ~ )+ 23 h , SOIL COVER x Pressure SvstemS t]nty 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 0 Yes ~ No ~ Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~_/L~/ y`'~ Inspection #2: ~/~~r~ Pew i io- P/as/ J(~ Location: 593 ST. Hwy 128 Wilson, Wl 54027 (NW 1/4 NW 1/4 3 T28N R15W) 40 acres lot Parcel No: 03.28.15.38 S ~ (~6~C~ E/~ I ` l.t c1 -~ cam... t '-i m ~; 1.) Alt BM Description = l/" " c+ ~• - ,/ f 2.) Bldg sewer length = ~ S Z` ~''~ `-`•ric' .~ "'' ~L ' ^ s w l `_") z +7 ~1~.t .Q' -.~ z- S 1` ~Q+o®.rc.s 9oaal~~~ f,Qow•^ ~-^ _ ~~ -amount of cover = j 3v - ~-(D ~oae~ ~°~` u~""'~/ X412 n n .. ~rl~..: 1 ~ i ~~ill,~a: M r-~ ---- ---~ Plan revision Required? L~ Yes ~~~;,fdo ~ ~ / ~ /)L/I Use other side for additional information. ~ _ _ l__ _V._-J SBD-6710 (R.3/97) Date f. c~ wl vt ~ ~.1 h Insepctor's ig ture ert~No~(~,,~~ ~' +F.csc- w.~X•C C w'ir o~ Q31~ ~n p'4,.~^°o _ 7/ ~ / ~iA ~ 4 __... ..~ Safety and Buildings Division County St C2e~~ ~ ~ 20l W. Washington Ave., P.O. Box 7082 ,~CO~~I~ Madison, WI 53707 - 7082 (608) 2 Permit Number (to be filled in by Co. De artment of Commerce ~~N ~ N 3 t 2 Sanitary Permit Applicatio ' Stat P ber I. D. Num In accord with Comm 83.21, Wis. Adm. Code, personal information ; u prov~~ Q S ~ f (} / ~ ~i ~%~ ~ u ~ = ~ s . p • may be used for secondary purposes Privacy Law, s 15.04(1) ) ! Project ddress (if different than mailing address) r I. Application Information -Please Print All Information ~ ' ' '~ ZONiNC3(1F~i ~ -. ,y~'- ~ ~ :_~ ~~F Prop Owner's Name Pafcel # ~au#-, a. SloclF#-~, Property Owner's Mailing Address Property Location ~t/ '/ / t ~ '/ Section , State ity C Zip Code Phone Number ., ., ~ / GG/ L ~SG ~2 ~. S ~~ ~ 2 r~ '~/ -_ 7 ~ ~- Ll,/ / ' (~ S~irc e one) ~ ~ t . 0 T N; R or W II. Type of Building (check all that apply) ~or 2 Family Dwelling -Number of rooms 9 3 ~ Sa~iviseex-PlaAte GSA4-Nuenber- ~ ~ ~ ~ ~ ~ ^ Public/Commercial -Describe Use = ' • -~^~ i ^ State Owned -Describe Use K / ~~ ~ City ^Village I~1'ownship of a III. T ype of Permit: (Check onl one box oo line A. omplete line B if applicable) A' ^ New System eplacement Syst ^ Treatment/i-Iolding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T of POWTS S stem: Check all that a I ^ Non -Pressurized In-Ground _ e ~ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) _ V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank i~ I U L i:~ i ' c. /~ Aerobic Treatment Unit Ibsing Chamber f ~ l ~ ~- VII. Responsibility Statement- I, the undersi ed, assume r ponsibility for installation of the POWTS shows on the attached plans. Plumber's Name (Print) Plum s Signature PRS Number ~ ~ ' '~ Business Phone Number =COY-3'~/ ~ 7 ~,~ ~~•~r ~ S ~%~5 /S Plumb„~r's Address (Street, Ci fate, Zip e) VIII. Coun /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (in Surchaz e Fee) cludes Groundwater Date Issued ~ suin gent Signatur o Stamps) ~ ^ Owner Given Reason for Denial g ~ j~ ~,, lJ -- ,2 3 O IX. Conditions of ApprovaUReasons for Disapproval 3~ ~ ~,~ p,Ur'~ tp„~S C~'~~ CY SYSTEM OWNER: ~ 1 Septic tank, effluent filter and ~~ ~t~~CS ~~' ~E~~-+-~„_13~ „"" _ ~ . dispersal cell must all be serviced /maintained ~~ ~~ CSC o` '.~,~- ~,Q Q as per management plan provided b plumber y . ~ ~ ~ ~ ~ 2. All setback requirements must be maintained ~. tn.~.f"^"' i ~ ~-G.~+~( as per applicable code/ordinar~ce:4 • sC, w~ f~) Attach complete plans (to the County only) for the system\on paper lot less than 81/2 : 1 [ inches in size ~ , SBD 6398 (R. 08/02) / ~ ~ ~-~ ~~~~-~~ ~'~ 1 r PLOT PLAN rScale 1 "_ ~l 0' Page 3 of ~ ~ O `1~-~- I°stl ~ - 3'r'1+b1 = ~L, low ow 'Pr1 Z: ~=UU~1`ilD-Jt`2 cave. ~~ _.r ~,ft-Z ~- ~- . l00 ,p ana c~~C12~'~ ~r~ l..~ti ~~ . ~ ~ ~ ~~~~ O ~ ~ o ~ F o~ n lt-cr OR as ~lS~\Z$`'T~{ZS ~YZ~1 `'~ %'~~ F1 Z~ q3 g • 3, `c; ~ ~ ~ ~N~ y`'1 OF Cpl, L ~~ Nt Qs-ZS' ~~~~ ~s' o~ ~ Z'1 pV \\\ ti` ~~ -y\ sn ' o U' n~ c B.z ~ 8 E S N'P Tti C'. / ~`~~ ~ k x ~~ 3 gD "'g..~~1 ltowtE *3-yt~Z ~w~.~ \\ ~~~~ ~. ~ ~ \ ~"~S >y \'~ .~,~ ~~o~ vs r " ,~ :-. ~~~ oJJ ~~ 9~~ `~S i ~~ NOTES : ._ . I. Elev ions shown are existing ground elevations unless otherwise noted. 2. Install 4" observation 3. Septic tank to be ~b lpip~es with approved caps. ( -Z required). ~ 6S0 gallon capacity manufactured by 4 , $ench mark ~ ; S ~ ph30UN, ~. Divert surface water around system to prevent ponding at the u phill side. ,' isconsin Department of Commerce CUST ID No.267341 December 16, 2002 ARTHUR L WEGERER WEGERER SOIL TESTING & DESIGN SERVICE PO BOX 74 RIVER FALLS WI 54022 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 12/16/2004 DECEIVED ~,~~, `~ ~ Z~~2 ST: Cf~OiX COUNTY ~G~NING OFFICE 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 Scott McCallum, Governor Philip Edw. Albert, Secretary ATTN. POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: Robert Bengtson 593 Sth 128 Town of Cady, 54027 St Croix County NW1/4, NW1/4, S3, T28N, R15W FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 885448 Identification Numbers Transaction ID No. 822387 Site ID No. 654252 Please refer to both identification numbers, above, in all cones ondence with the a enc . The submittal described above has been reviewed for conformance with applicable W15COriSln 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: I ~~~ ~~ General Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the / I ~~~-' "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD-10572-P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD-10573-P (R.6/99). • Per manual cited 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 existing POWTS must be properly abandoned per Comm 83.33 Wisc.Adm. Code. DYED ~ CONNNERCE DE 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. Stat 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. ARTHiJR L WEGERER Owner Responsibilities: Page 2 12/16/02 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 83.52(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. • 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 maybe made to me at the telephone number listed below, or at the address on this letterhead. 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, Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@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 . • This plan has been Manual SBD-1057 P CCZ. blg9.~ LOCATED IN THE ~l~) TOWi1 OF L° I~ TITLE SHEET IfOUND SYSTEM FOR A 3 BEDROOM RESIDENCE Page 1 of ~ prepared in accordance Faith the Found Component and the Pressure Distribution Manual SBD-10573-P • ~ ~ C 2. b L~4~ 1 /4 OF THE NW 1 /4 OF SECTION 3 , T Z8 N, R is 6d, ~` / ST- C~ 1 X COUNTY, WISCONSIN. INDEX ~ °~~'' ?~ v' P - -, ,~ ~F ~°~ ~' ~ AGE 1 of 7 TITLE SHEET c ~ ^,, ~1 PAGE 2 Of 7 SYSTE~1 M~-II~AGEi~1ENT PLAN ~~':.~ 1~ PAGE 3 of 7 PLOT PLAN ~,~ ~ ~~ O PAGE 4 of 7 PLAN VIEW-CROSS ~ SECTION ~-`9"t ~~ PAGE 5 of 7 ,~~: ,:~, DISTRIBUTION PIPE LAYOUT ~ ` `'3 PAGE 6 of 7 PUI•?PING CHAr1BER , . CROSS SECTION ~ .~_ PAGE 7 of 7 PUriP PERFORI.IANCE CURVE PREPARED FOR S~ ~ }t~lG E-ft~'PM 1 Z~', w_~ ~ S o ~l , w I S~. ~ ~.~ PREPARED BY WEGEF~ER - S~ I L .TEST = htG AND . DES I G~V S~RV S CE P.O. Box' 74 421 Id.~fain St. River Falls, WI 54022 Phone 715-42.5-0165 ~~~~ Fax 715-425-6864 ,~~~ ~ wV , fk `3 t • . t'~~ a a F ~j t ss rf q P ~~,,~~((_ R A'~ ~~ .~~ • .... , °~r..~~:h~~. JOB N0. ~2--ZZg . --Mound System Management Plan Page Z of ~ Pursuant to Comm 83.54, Wis. Adm. Code ,` ~fic Tank - ' - The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. Theo •erating condition of.the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. Th ou let filte shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may s oug o e i ter w en removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if . the alarm is activated continuously. Intermittent filter 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 shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pumo 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 it shall be inspected and serviced as necessary. Mound and Pressure Distribution S tem - 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 penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cotd weather installations (October-February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg/L GODS, 150 mg/L TSS, and 30 mg/L FOG. 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 it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occun'ed 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 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shalt be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manual [SBD-10572-P (R. 6/99)] arid 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 with Comm 83.33, W~. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should 6e inspected for water tightness and soundness. Access openings used for service and assessment shat) be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed 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. Contingency 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 shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions about the operation or maintenance of this system should be directed to: The County Zoning -Office at ~ 1S_ 3.~';_~ ~- Lj-6 a0 ~~-, ~.I?,O1X • The system installer at _ ~1•l.S _ b qg _ Z~6 (~ S1~16 • The tank manufacturer at _ ~aU =-~.L_S_ $,~g ~ t.~L~ ~-jZ - The effluent filter manufacturer at $C~ - ~-~-~- S~c~Z. Z~-13~ . The --- -------- - -- -- pump manufacturer at _ --------~3C~-='~ ~}=--C-~-~~----~~LD~ ---------_ - . PLOT PLAN rScale 1 "_ ~l O' -~- ~_ ~ O `1~-~-- I°~tl ~ Page 3 of `3'M ~ l - E:L . ! o~_O 0~ 'A-1 Z. ~u~b 111 ~!J~`2 C~v e . P~ ---- `~1~Z ~- ~- . L Oc~ .p ~ aN c~~JC12-~~ t~~ b ~ rv o ~ N_o~ P Pt-tT OR qa ~lS~l~~z$`~{jS p~yZ~ 8 • . ~~ ~~ 5, \ ~r7~ y"1 OF C~TL. l.. ~\~ \\ ~. G S ~Z S ~ ~. \ 1ST o~ Q Su ' or U~~P~ c g.-L~ C^~tw.4z,~WV~~ ,~.. \\ 35D ",g,.~~f ltowtE ~,,,-#--z ~w~~ ~\\ \.Qs~-1'~ ~ ~ ~ \ ~'~S >y \.\ S/ S' ~~ ~ /. i~~ ~9~~ NOTES : ~ ~- 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required). 3. Septic tank to be ~buy l6S0 gallon capacity manufactured by 4 . $ench mark S ; S ~ i~30V N. 5. Divert surface water around system to prevent ponding at the uphill side. . ' J Approved Synthetic Covering AST~i C33 " Medium Sand Topsoil --~ J~ ~ 3 }G _ .• Page y • Of ~ istribution Pipe F 0 ,. ~~ b S . % Slope Distribution Cell of ~ Force Main 2" to 2 Z" Aggregate From Pump CROSS SECTION OF A MOUND SYSTE;!i G .Elev. q.S •ZS Plowed Layer 0 1•~S t, E Z- Ft. F ~- $ Ft . G o- S Ft. A ~ Ft. ~ N ~-v Ft. Linear Loading Rate= CI • ~GPD/LN FT Design Loading Rate=p_36.GPD/SQ FT • Observation Pipe (2-achor securely ) B SO Ft. •. I 1~ Ft. J `a Ft. K ~ Z Ft. L ~ Ft. . W 33 Ft. ~ -Observation Pipe= w ~---T-- - ~ -- .------_ _ - --- • Distribution ~ ~ ~~~ to 2~" Pipe Cell of a 2 ~ aggregate Position of * Force Main .. L ~t i3 A o--~----X68---- --------- ~~ • PLAct VIETd OF A MOUND SYSTEI4 K ~~~~ ~~ so x ,, Distribution Pipe Layout Page S of ~7 Place the holes at the bottom of the distribution pipes • at equal spacing. Remove all burrs from the pipe and holes. Extend the end of each lateral up with the use of long turn or 45° fitting to a point within six inches of the final Grade, Terminate the eads of the laterals with a valve;~threaded cap or . threaded plug. Provide access from final grade for the valve, threaded can or threaded pIu~. • ~ _~,cC`sg aoY._ T`t P-1 cry L . ~,ZOS S s~~~ iv PVC • Latent Manifold ~'~ C Lateral TI X l X ~~i~~ X( X~ x I X I - l~ Lateral Length - ~- Lateral Length ?~D ~ !~- L'Prt~l V \~ --- P o- _ ~ PrCCSs sojt -~ a-- -- - --c i o-_ ~q P Zy Ft. ~ ~ Hole Diameter ~1 `~ Inch S 3 Ft, - ~ Lateral 1 ~ InchEes) X ~ InchPS Manifold " Z • Inches Force Main " 2 Inches ~. ~ of holes/pipe 1 3 Invert Elevation of.Laterais q S ~ SFt. . b3X~U _ ~t = 5.3 3y~t~ 3 ? -~8 6 P~ `. .. _ ~ - Combination Sept,3.c~•Tank and PUMP CHAMBER CRASS SECTIOtJ AA1D SPECIFICATIOiVS ' ~ PAGE ,~ OF ~. . ~ . _ ' . ;= - .. •VEUT CAP ~ WEATHER PROOF JUUCTIOIJ 80X . ti C.Z. VEIJ7 PIPC ~ APPROVEp LOCKihlG ~ lO' FROM OOOR.. MllUliOLE COVER rvRt~l :iiAIDOW OR FRESH ~ wAR.fJ11JG LP.6EL. .w ~~`6-~~ ~ A~fur~lKE ~ ~ corJcu,r -- ~• ~ I . .... G ~ ~'CO E --- 18'/'lll~l. - ~~ ---------- \~~ ' ~ . _.. _ ~-~ fA1LET i;'~ PROVIDE ~ - __- . •• ~~~ 'j~AiRTIGHT SEAL ~ ~ I t 8 A~LC I I ~ ~ ~ \~//- APProved Z>~8~t u~~ ..~ - ~ ~~I APProved joint w/ ~ _~,~pp ~ ~~I joint w/ PVC pipe ALARM PVC pipe a -~ I~ ~ I 1 I ou c •~ I ~LEYg~. oofx . __j . PUMP ~ OFF 0 • COIJCRETE . ~Z.~'v . ~ 86. b0 I ~ BLocx 1: ~• RISER EXIT PERMITfEO 01JLy IF TA1JK MAUUFACTURER HAS SUCH APPROVAL 3"APf'RotiFp ~6t:D0:N4 SEPTIC F ~ SPECIFICAT101~15 DOSE • TAUKS MAfJGFACTURCR: ~~~~~- eO1lJL°-~-~"~, jJ~gER OF DOSES: - S PER pAy TAfJK SIZE : ~~ U~ 6 SO GALLOAIS DOSE VOLUME r i+LARP'1 MAi.3UFACTURGR: _S`s• ~•~`CR. S'~.S`~-tS IAICLUD11J6 6ACKfLCw: lOZ GALLON: MODEL 1.luM8ER: LU I L`FL~ CAPACITIES: A_ ~ SWITCH TyPC: ~L~e-CJ(2._Y 1~ IAJCHES OR30~~~j CALLOUS 8 = Z IIJCHES pR .~ G~LLOA15 PUMP MAIJUFAGTURER: GUV 1,..,US C= ~ IU[HES OR ~'~ ~'GALLOUS MODEL IJUMBER: ~~~~ D= ZZ ZIT{ I-~ICHES ORS GALLOlJS SWITCH TYPE: - ~ ~~LC°-Ui2-~/ WOTE: PUMP AUO ALA~M`AR TO"6`Cbb MIAJIMUM DISCF{ARCaE RATE ~ l`~8 GpK INSTALLED OA1 SEPARATE CIRCUITS VERTICAL DIFFEREIJCE DETWGEU PUMP OFF AUO..DISTRI8UTI0-J PIPE.. $', S FEET ~~ ~- nlulMUM uETWORx SuPPLy PRESSURE , , , 6- SO FEET \~ -~xl° 3) -~ lS FEET OF FORCE MAIIJ X ~~ l f F~oFEFRICTIOU FACTOR_•o'33pEET TOTAL. Oy1JAMIC. HEAD = 15 "S~ -FEET As per >;tanufacturer l'~.Q gal/in. Liquid depth 3gti ., ,.. j,~.~ t ~ ;`~f, Goulds Submersible i~E ~~ ~~ ~ Effluent Pump ~ r~ u 3871 EP05 APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS Pump: EP04 • Solids handling capability: 3/<° maximum. • Capacities: up to 55 GPM. • Total heads: u to 24 feet. ~, J • Discharge size 11/2" NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: - 104°F (40°C) continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Pump: EP05 • Solids handling capability: 3/a' maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: i'/i' NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°G) intermittent. J • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz,1550 RPM, built in overload with automatic reset. • EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: i 0 foot standard length,16/3 SJTO with three prong grounding plug. Optional 20 foot length,16/3 SJTW with three prong grounding plug (standard on EP05). METERSIIFEET 10F 0 a W U a z } 0 J iQ 0 • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Automatic models include Mechanical Float Switch assembled and preset at the factory. FEATURES ^ EP04 Impeller: Thermo- plastic Semi-open design with pump out vanes for mechanical seal protection. ^EP05 Impeller: Thermo- plastic enclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover. Thermoplas- ticcover with integral handle 'and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING SP• Canadian Standards Association (CSA listed model numbers end in "F"or "AC".) ' ! , ~ g ~ 30 ~ i ! ~ 'C ~ i ~ . . .v ~'~ ~, I r _ _ ~. i i ~ 'i' .- -5~.~ i 25 . i __ i _._.G... ~ _ - ~ - ~ t 20 i i ~ I.. 15 ~ i ; I i i _. ' EP0 I ~ ! ~ 5 ..~ 10 i i i 5 ~ 31.E - 0_ ~ l0 20 30 40 50 GPM 0 2 4 6 8 ~ 10 12 m°/h CAPACITY ®1995 Goulds Purtq~.s, Inc. Effective May, 1995 63871 Wisconsin Department of Commerce ' ,Div-ision of Safety and Buildings SOIL'EVALUATION REPORT Page ~ of 3 in accordance with Comm 85, Wis. Adm. Code Hnacn complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must ~ ~ ! ~..1 LU 1 `~ include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D. ~ ~~b1 tJ~ percent slope, sple or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Dace Personal information you provide may be used for secondary purposes (Privac/ law, s. 15.04 (1) (m)). , Property Owner Property Location ~~ ~~lZr ~ ~~G~ a ti Gav~tet-- ~11~ 114 -~yt)1 J4 S 3 T 2. a' N R ~ S E (or)v Property Owner's Mailing Address Lot ~ Block~t Subd. Name or CSM# City State Zip Code Phone Number ^ City ^ Village [~ Town Nearest Road 1...)ttSO~v L`J) S OZ~ c~lS)Z?Z-~~`~~ C~ i S-r1~ tZv ^ New Construction Use: Q Residential /Number of bedrooms ~ Code derived design flow rate _ >`l S 0 GPD Replacement ^ Public or commercial -Describe: Parent material ~ ~--~-~ ~- 1, l.l.. Flood Plain elevation if applipble N A ~ General comments and recommendations: 'f`'1,UUY•.,r~ t,,~~q rx S 0 r ~lS~1Z~3U`f1,U 7~1 ~~C. , C-t~~vv~ ~-~- a3.S' Boring # ^ Baring - Fit Ground surface elev- ~I.l~. ~ R r,e.,~~ r„ n.,,a;.,., a..~,,. l S Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate GPD/ft2 in• Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eft#1 'Eff~2 ~-~ 10`'l YZ.- 3 !. Z - S ! I 2`~ i- YYl V ~r- (_S Z V ~' • 5 -8 2 ~-)S L'0`~~Z31b - si I Z s~~z m`F}- ~c lv~ • s .g 3 Is 3~ -t•S`1Ry~y c~a~.sk~.s~a L pw, rnv~fi- - .3 .s ~ 7 ~ Boring # ^ Boring t ' ~ Q - `- I ~ Pit Ground surfar~ elpv ~ `t • U N ns.,«. ~„ n...a«.,.. F.,..,,.. 1 Q r-- -- -- , ----- .... - Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate GPO/ft= in. Munsell t1u. Sz Cont Color Gr. Sz Sh. 'Eff#1 'Eff#2 ~ o-q ~Ok23lz - si l Z~9U rnU~ ~S Zvi :S -8 ~ ~-~~ tio~(z316 - 5 ` ~ 3~Fsbk mom- ~S lv~ , s -g 3 1g-31 ~.s~rz_~i c~~.z,s~rzst~ ~ o~-~ mv~ - -3 •s Effluent #1 = BOD. > 30 < 220 mall and TSS >30 < 15r1 mn/I ' Fffluant i!7 . Rf1r1 c ~n .,,,,n ~..a -rcc ~ ~n .....n G5T Name (Please Print) Si nature CST Number ' Arthur. L . tJegerer ~!~,~~y1,.n.. • ~~-?~ ~' 220254 Address ~~l.e g e r e r Soil Testing & .Design S e r v i c e Date Evaluation conducted Telephone Number 421 i~, iiain St. River calls, EdI 54022 l~=Z--~Z .:715-425-0165 :;cousin Department of Commerce SOIL EVALUATION REPORT Page ~ of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inch inGude, but not limited to: vertical and horizontal reference point percent slope, scale or dimensions, north arzow, and location an Please print all information. Personal inforrnaGon you provide may be used for secondary purposes rroperty owner Z~ C3~1ZT' 3~G~a Iy Property Owner's Mailing Address S °1 3 ~'lGtf~v~Ps~-t 1ZR wl ~sov , tiv ~ in si~i ~~l [IIi601 ~ iJ BM), direction and distance to nearest road. pa L~©,e,~,~ ~ 1 Z~~Z 'vary S I .' ~f~~Q~.~k~/C'~i i Y Re P n °ty ST - CZU 1 K cel I.D. p N. Bbl NG ieLw i~ by O Ge:~- NIA 1/4 )`l~lJ1/4 S "3 T Z~' N R 1 `j E Lot # Block # Subd. Name or CSM# ^ City ^ Village (~ Town Nearest Road e'P~~ i s~-rr~ tz8 LJ New Construction Use: ~ Residential / Number of bedrooms __~ Code derived design flow rate >`l S O GPD ~ Replacement ^ Public or commercial -Describe: Parent material ~~--~-~ ~- 1, LL Flood Plain elevation if applicable N A General comments and recommendations: ~'lvUY~-ham LJ/ q f~ S 0 r ~D1S112~,BU'T1 U 1`1 ~'Lt_ , c-car., ~ vR ~-~- a 3 .S ~ \ Boring # U Boring t ®pit Ground surface elev. ~.17, 3 ft, flepth to limiting factor 15 ~irr: -T Soil Appliption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 o-a 1~~1 ~._ 3 c z - Sit 2`(~ r- rn v `~- ~5 Z v~ . S . 8 2 ~-) ~~~~Z31.6 - si`1 z`~sh~Z m`Fh ~ 1v~ • s .~ 3 1s 3~ -~.stir`yiv c~a~.S'~~?~s/s L Owe rnV~I- - - 3 •s ^ Boring # ^ Boring Z ®Pit Ground surface elev. ~ ~~ • ~ ft. Depth to IimiGng factor _ 1~ in. - Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfftz in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I o-q ~0~2312 - sit Z~-~~ mv~- ~S Zvi :s -8 Z q-~~ 1o~~z3lb - 5 ` ~ 3~Fsbk m`Fy- ~S 1v~ . s -~ 3 t$-3l ~-syrL ~i Cll. ~s `~R..-S~ $ ~. ~~ Yv-U'~1- - - 3 ~ S - tmuent ~i =Bobs > 30 < 220 mg/L and TSS >30 _< 150 mg/L ' Effluent #2 =GODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) _ Si nature CST Number Arthur. L . tdegerer ~ ~~--~~ g 220254 .Address 4~ e g e r e r S o i l Testing & Design S e r v i c e Date Evaluation Conducted Telephone Number 421 ~~T. %iain St. River calls, E7I 54022 l~-Z.-QZ :715-425-0165 ,~ .~ _~ .~ 7 Property Owner ~ E~t~_S (~tU Parcel ID # Boring # ^ Boring Pit Ground surface elev. ~ ~ - a ft. ~~v~J w G Depth to limitinn fnr•fnr Z~ t.. Page Z of _~ Horizon Depth i Dominant Color Redox Description Texture Structure -~ Consistence Boundary Roots Soil Application Rate GPD/ft~ n. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 o-q to~,~3cz - s~( Z`F9h ~vf-~ ~-S Z.~ -S -S Z q - ~ ~ io~l rZ l - ~ S t• i z~s b lz m ~- ~ 1 ~ • 5 . ~ ~u w ,S ~ ~' _ - ~ ^ Boring # ^ Boring ^ Ptt Ground surface elev. ft. nanth fn r,.,ihn., f".~..~ ~_ Horizon Depth i Dominant Color Redox Description Texture Structure Consistence Boundary Roots -Soil Application Rate GPD/ft= n. Munsell Qu. Sz. Cont. Color Gr. Si. Sh. •Eff#1 •Eff#2 ^ Boring # ^ Boring . ^ Pit Ground surface elev. ft. Depth to limiting factor in_ Horizon Deplh i Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Appliption Rate GPD/ft' n. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 • Effluent #1 =BODE > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 =BODE < 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. SBD-8330 (R.N00) ~~ .~ .~ ..,' _ I i I ~_ r I_ - PLOT PLAP1 Page 3 of Scale 1' _ ~0 ' ~ O `11-F- t°~V E - ~Z ~- - [ Oct .p r aN c~,.~C1Z.L''`~ ~~ ~~ ~. CST Signature a~ D) s~v~Z-lam `T~f-i ~ BIZ-~aA , 5 ~ ~~ ' ~,a~. ~ g ~~ -'`'1 OF c~'L ~- ~\ ~ ~ ~C~S ~ >y ~.\ o~~ s•z 9`''s S ~ri~ ~ 3 g "- B~ sH l-t-owtE 1~-Z _Q 2.715-425-0165 220254 c~Z-Z2~ _ Date Telephone Ito. CST Alo. Job PtO. OwnerBuyer ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND ~ OWNERSHIP CERTIFICATION FORM Mailing Address Property Address ~ ~ ~'`7 ~ (Verification required from Planning Department for new construction) CitylState ~' (-f ~ `~ ~~ Parcel Identification Number oU`I- l~65 ~ 3~-DU~- LEGAL DESCRIPTION ~ ,y, c~ ~ 6 ~ Property Location ~ ~ %., ~ '/s, Sec. ~, T v°l ~N-R , ~W, Town of ~~ ~~ ~~ ~--- ~-- Subdivision , ` .Lot # Certified Survey Map # Y ~ S ~ ~ ~ .Volume °~_, .Page # 2 5 ~ ~ r Warranty Deed # ~ ~ 5~3 ~ Y ,Volume 21 ~ ~ ~ .Page # 2 R 3 Spec house ^ yes e'no Lot lines identifiable Ef yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mastCiPh~~+l~eymanPlumber, restrictedplumber or a liccnsedpumperverifying that (1) the on-site wastewaterdisposal system is is 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 standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. GNATURE OF APP ~~NT r; it bid`s 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. SIGNATURE OF APP CANT ~~l~~G DATE «sst«s ent.:««*«« Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Deparhn '`• Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map ff reference is made in the warranty deed Wisconsin Department of Commerce 'Division of Safety and Buildings SOIL EVALUATION REPORT Page ~ of 3 in accordance with Comm 85, Wis. Adm. Code ~_ _~. Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must `~`~ ~ ~ 1 c-~~ ~. K I inGude, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel I.D. 7 ~D 1 u G ~a-/G-oZ 3 ~/ f07 Please print all infor Personal infom~ation you provide may be used for secondary FF FE ~~~~FEnD urposes~~nv~cy-C Iw s~f 5"04 (1) ( )). Reviewed by Date ! Property Owner ~, Q ~ ~Z ~ ''~Ir J .S ~ (v DEC 1 6 Property Lo ~~~., lion w 1 /4 nJ I~171 /4 S ~ T ZS N R ~ S E (o W Property Owner's Mailing Address L~ ©S SUS; f~lS01V ~U ST. CROIX C ZONINGO ~RS~Y FICE 8 ck # Subd. Name or CSM# City State Zip Code Phone Number wo~~vt~~ ~,~ s~n~ (-~t s) 6g~-~~o ^ City ^ Village ~ Town Nearest Road cPr-p 6 0 ~ ~u~ New Construction Use: ® Residential /Number of bedrooms 3 Code derived design flow rate >_~ S l7 GPD ^ Replacement ^ Public or commercial -Describe: Parent material G 1.~Pc~.l W-l,, rl ~.L Flood Plain elevation if applicable iy )~ ft. General comments and recommendations: Y''~DU`M~ W l Z C~1~ ~ ~,gP.c~,~2~~-~ 3' k ~, S r Lp rte'. e or.ihi~,{Z ~2 . ot= unsC..o PE- ~2.L - q.9. S ' Boring # t^~ Boring 1Ct. Pit Ground surface elev. ~ 8 • + ft. .Depth to limiting factor ~- 5 in. Soil Appliption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr . S z. Sh. 'Eff#1 'Eff#2 O ~ l 0 `Z 2.3 C -~ S ~ , ~ C ~ 2`F-S h 1-C m~ ~ CS 7~`~ . S . ~ ~ $--L LU`Z2yl S11 3~'Shh ~`~-- Cc ~ -S -$ 3 is 3 s -a- s ~ ri- ~~ ct -~ .s~2 ¢. s/~ s Z c) L ~ b k. ~`~- - • Z -3 ^ Boring } -Z Boring # W pit Ground surface elev. a a. ~ ft. Depth to limiting factor ~ in. - - Soil P.ppliption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 (~ -$ L0~.423 I,Z -- s~~ ( 2-~s b ~ Yv1fh ~S Z~ - S $ Z ~`-~~ ~o~,rLy~ - s ` ~ ~,~-sbh mfg- es 1~ ~ i -3 3 1~ 3y ~s~tZ~~ ~t~~.s~~sls S-~ ~esbk ~..~- _ •Z -3 Z LX lh 1~ Y'~ ~ ~ Ls`f~'1-z S~l`c.U rlJ 1Z i ~u~uc~n» i = ovvs ~ ou ~ [zu mgiu ana i ~s >3u _< i5o mgit_ - Emuent #Z =GODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) - Si natur CST Number Arthuz• L. Wegerer ~ ~ ~-- Z Z9 220254 Address t~ e g e r e r S o i l T e s t i n g & Design S e r v i c e Date Evaluation Conducted Telephone Number 421 ~1. I~iain St. liver r'alls, tJI 54022 1.x_2-C~Z ..715-425-0165 Property Owner ~ 'T~lti/ G'j-',SON Parcel ID # ^ Boring # f^~ Boring td1 Pit Ground surface elev. ~-~- Z_ ft. ~~vp 1 n~ 6 Depth to limitinn fartnr Z ~ t.. ti Page Z of 3 Horizon Depth i Dorr)jnant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate GPD/ftz n. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 O g 10~ IL 3 L Z - SI I Z s b12 1~ `FIB ~S Z'F - S , ~ Z ~ zo 1O`~tZ vey - sI ~ t 'FS~tz es 1~ , z- - 3 3 ZD 34 7.S~2 ! 7S~VZ5l~ a d~ n~U - , 3 , s O ~ `~vS oMc -ti~. s Zv ~ 2~ ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. nPnth to ttr„it~nn r~..F.,. ~.. Horizon Depth i Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate GPD/ftz n. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#t 'Eff#2 ^ Boring # ^ Boring ` ^ Pit Ground surface elev. ft. Depth to limiting factor tn. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary ' Roots -Soil Application Rate GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#t •Eff#2 • Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 =BODE < 30 mg/L and TSS < 30 mgfL 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 608-2G6-3151 or TTY 608-264-8777. . SBD-8730 (R.W00) PLOT PLAPd Scale 1' =-30' Page 3 of 3 ~L bow- gv~.. J~~ i~^~ -~ ~O ~~I~ ~tiil~ . ~ ~• ~ ~ ,moo j o~ ~ . ~,,~~ ~ I I~~ /g.3 • • B~ ~-1 /~ ~ / ~ `~ ~,, . v~ / / ^/ / i / ~ / d, / / / / // - ~ / B' ~ ~ g. Z ~ // ~~ ~~ ~ oT ~M, P+~~- o'er / ~ ~ s'tv~z.~ `nhs p~Z~ .~ ~~i/ j ~~-~L.LOO:o' off, '~ w ~- l `'~i=~. 3~y ~~a PVC_pGt'~._N_S~t ~eL I~c~T. 1 -....__._~_ -_ .. ... .. -. ~ r K N ~~, ~~-Z-UZ 715-425-0165 220254 v- OZ-Z-Z' r-.,~,~ 1-~li~t~ CST Signature Date Telephone Pdo. CST T~1o. Job PdO. Wisconsin Department of Commerce SOIL- EVALUATION REPORT Page ~ of 3 Division of Safety and Buildings. in accordance with Comm 85, Wis. Adm. Code ~_ Attach complete site plan on paper not Less than 8 1/2 x 11 inches in size. Plan must ~ ~ ~ C--t~ L K I inGude, but not limited to: vertical and horizontal reference point (BM), direction and 7 ~~) ~ G Parcel I D percent slope, scale or dimensions, north arrow, and location and distance to nearest road. . . Please print all information. Reviewed by Date Personal information you provide may t>e used for secondary purposes (Privacy Law, s. 15.04 (t) (m)). Property Owner Property Location tom, ~ ~' ~~ ~~ `L~~ ~ 'S ~ N Govt-tot• N w 1 /4 nJ ~V 1 /4 S~ T ZS N R 1 S E Property Owners Mailing Address • ~ Lot # Block # Subd. Name or CSM# (o W Ll O S ~ N lu S O~v CUV~~- CitY State Zip Code Phone Number ^ City ^ Village ~ Town Nearest Road woo~vlL~. w~ S~o~ (-~~ s) 6q~-~~o cP>-p 6 0 `~- ~-u~~. ®New Construction Use: ® Residential / Number of bedrooms 3 Code derived design flow rate L ~~ O GPD ^ Replacement ^ Public or commercial -Describe: Parent material _ G I~P~EL V~ 1, ~ ~..~ Flood Plain elevation if applipble 1V ~ g, General comments and recommendations: Y~'~DVY~~ w l Z C'~Z.t~ ~ ~,~ 3' k -Z S f Lp r,~. ~`'1lNL~u~ zt k OFS'~'th~ I=iLL, e-UNTU~.i~ tZ.. ot= uns~.epE ~ZL- °19.5, Boring # ^ Boring •' Pit -Ground surface elev. ~ 8 • ~ ft Ilonfh fn IimiHnn f~Mnr L Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ~ Soii Appliption Rate GPD/fR in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 O ~ l0`Z23 L -, S ~) 2~Shk ~~r GS Z`~ . S _ ~ Z ~-t LU`~2Y1 S11 3`~s)~~r f~'1`~1-- CS L -S -$ 3 lS 3S ~-s~fz~~ ci ~ s~~S~B sLc1 L~ b k h2`~- - -Z- -3 Boring # ^ Boring _ ~~~,,,. ~_ •~ Pit Ground surface eIPV C1Q. ~ ~ ne.,~r, ~„ r.,,,fi.,,, F.,...,.. 1 S'h Soil Appligtion Rate Horizon Depth Dominant dolor Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 C~ -$ Lod Gz3 ~Z - s~L ( 2~s b k m.~ ~S Z~ • S $ 3 1~ 3y ->, s~~~~ -~L~ ~ •S ~~ s1 s s '~ ~ eSb~ v+~l.~l- _ ~ Z- -3 ~~..~a~ ~. n ~ - ovus ~ ~u ~ ttu mgrs ana ~ s~ >su < 15o mgt - emuent or1= 80D5 < 30 mglL and TSS < 30 mg/L CST Name (Please Print) Signatu CST Number • ' Arthuz• L. [Jeerer • ~ ~- Z Zq 220254 address W e g e r e r Soil Testing & Design S e rvi c e Date Evaluation conducted Telephone Number 421 L~. I~iain St. River calls, tJI 54022 l~_2-d Z, ,.715-425-0165 Property Owner g~-/GT.SO N Parcel ID # Boring # ^ Boring 3 [~ pit Ground surface elev. ~ ~- Z ft. 1~~vp ! rv 6 Depth to limiting factor ~- u in Page Z- of 3 Horizon Depth i Dorrunant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate GPD/ft' n. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 o g ~0~~3 ~Z - s,' ~ Z sb~ ~ ~~ ~s Z~ . s T~ Z °i Zo ~DyR y~y - s, I ~ ~Fs~h yyl, es l~ • z - 3 3 ZD 34 7 . S'~2 ! ~ S ~1 vZ S l ~ a d~ yrt U _ , ~ . s ~ ~'4'c1M/s a M L vV~TPt~z. S c 2 ^ Boring # ^ Boring n Pit Ground surface elev. ft no.,-h +„ ::.,,:~:..,. ~..,,.,.. Horizon Depth i Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate GPD/ft= n• Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to Iimltinr3 factor In_ Horizon Depth i Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate GPD/ft' n. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 ~. • Effluent #1 = BODS > 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. . SBD-6330 (R.6/00) • ~ PLOT PLAid Scale 1' =30' ~. b o `~ AU ~. . ~ JV Yn i ~ ~~ .,~ V ~~~~ ~ . ~,. ~~ ~ ~,,o ti o~ ~, . J~ ~~~ ~~~ i g• 3 eI ~ ~ ~ / ~ \~ Q,, ~~ i ,o ~ / // e' k3Y"1 1~2 . ~~ / / ^i / % ~' / ~ ` / d,, / / ~ // B.Z ~/ ~ ~~~/// / / ~ l S'1~~Z-~ `~1S ~1Z-eA ~~`~ ~~ i o. ~~`L.-.~2:. C~o~o' oti: ~''_"1`(n=~-,_~ty°DiR--~?vC+~~~1?~1y.-S'~LL ~C~ I~a~T. - -- - -- _.._ •- 7.._ ~ Y _.__ _ ___ __._ __. _._ r K N ~,'t~ 1U-Z--UZ 715-425-0165 220254 Page 3 of 3 r"~3'1'1.J~~ ~~~ Lu ri~'}"IUU~ oZ-ZZ9 CST Signature Date Telephone ido. CST A1o. Job PZO. J 2189P 293 7 1 5325 I STATE BAR OF WISCONSIN FORM 3 - 1999 Document Number QUIT CLAIM DEED This Deed, made between Roger A. Bengtson, a single person, Grantor, and Robert M. Bengtson, a single person, and Sharon M. Bengtson. a single uerson. _ Grantee. Grantor quit claims to Gla~ee the following described real estate in SL Croix County, State of Wisconsin (if more space is needed, please attach addendum): N 1/2 of 4 of Section 3, Township 28 North, Range 15 West~x \ there&o Lol as set out in Certitled Survey Map filed in the Regrster of Deeds ) Office on u y 15, 1992 under Document Number 485887. / Recordir-g Area KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO. , MI RECEIVED FOR RECORD 03/31/2003 04:00P![ QUIT CLAIK DEED EXEItPT ~ REC FEE: 11.00 TRANS FEE: 96.00 COPY FEE: CC FEE: PAGES: 1 Name and Retum Address Kenneth N. Sortedahl II Gavic Law Offices P.O. Boa 400 Spring Valley, WI 54767 004-1005-50 and 1005-60 Parcel Identification Number (PIN) This is homestead property. (is) (is not) Together with all appurtenant rights, title and interests. Dated this o? / day of m~,,,~ , 2003 * * AUTHENTICATION Signature(s) Roger A. Bengtson au enticated this day of a ch ~ 2003 * Kenneth N. 5ortedahl II TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Kenneth N. 5ortedahl II pring Valley, I 54767 (Signatures may be authenticated or acknowledged. Both aze not necessary.) U S~-d-~sn. * er A. Bengtson _ - - - s ACKNOWLEDGMENT STATE OF ) Ss. County ) Personally came before me this day of the above named to me own to e e person s w o execute a foregomg instrument and acknowledged the same. * Notary Public, State of My Commission is permanent. not, state expu~ahon e: .) * Names of persons signing in any capacity must be typed or printed below thei QUIT CLAIM DEED STATE BAR OF WISCONSIN FORM No. 3 -1999 Information Professionals Company, Fond du Lx. WI 8006552021 ~ FORM N0. 985-A IlC11iINrCarprry ~~ .. 48588'7 CERTIFIED SURVEY MAP LOCATED IN THE NWl/4 OF THE NW1/4 DF SECTION 3, T28N, R15W, TOWN DF CADY, ST CROIX ~ COUNTY, WISCONSIN, ~ OWNER: Evelyn A. Bengtson N ~ NW CORNER Rt. 1, Box 30 W ~ 0 o SECTION 3 Wilson, Wi. 54027 ~ 3 000 0 t 3$' 33' T28N,Ri5W <FOUND NAIL) UNPLATTED LANDS i S 89° S6'25`E 467,00' ~I ~' f A~ I z J Z I $ o ~ r W = ~' ~ t- ~- Q ~ ~ ~ W J ~ ~ N N Zzf~~ ~ I _J O A O p ~ ~ z, z w 3r 1 i _, •' / ,. ~ 33' 33' w ~_ N M :-e N ~ ~ °~ dw ~~ LEGEND m tiOVERNMENT CORNER Cp cMDNUMENT SHI]WN) o :t`x24' ROUND IRON PIPE WEIGriING 1.68 #/FT, SET -x-~c-~ EXISTING FENCELINE THIS INSTRUMENT DRAFTED BY JAMES E. RUSCH 33.00' 1 ~--- 100' W Z .. J Stock No. 26273 LOT 1 v ~ 218068 SQ.FT, C5.006 ACRES) INCLUDING RIGHT-OF-WAY 202,657 SQ,FT. {4.652 ACRES) N ~ EXCLUDING RIGHT-O~'-WAY 1 ~- ~ RIGHT-QF-WAY LINE 33.00' 1 N 89° 56'~5'W 467A0' 0 0 d 3 N 0 0 0 y ~RI~~D '~ JUL 151992- JAMES O'CONNELL ~~ a9.ae~co.,+M oz H _ „_ W W ~ N Z L a. ~ W W J a z ~~z'' ~ y a0 ~ a3M A9 ~ 0o ~ R Z 1- 41 LaJ U > > y V1 Z D ~ z ~ /kPPROV~ Q I A W ST. CROIX t~OtJIJ~'Y I ompgA~iv~°plsnnir~9 J Z~~ ~ »~~~~. H' no ; rtitcaet~ w+~ar: 30'Ityrs at ~: oii41~~ •~ib+-ai~~+Ir~- -~r~s v L SUUTH LINE OF THE NW 1/4 GRAPHIC SCALE t3' OF THE NW 1/4 0' S0' 1:90' ~ nt mre) Wi/4 CORNER ~ ~ -100' ~t. SECTION 3 UNPLATTED LANDS ' ~T28N,Ri5W <2'IRON PIPE fQUND> VOLUME 9 PAGE 2511 St. Croix County Zoning Detail Sanitary Information ~~5~ (~~r I Tuesday, May ll, 2004 at 1:36:43 PM Page I of 1 Computer #: 004-1005-60-000 Sub/Plat: 40 acres Section: 3 Parcel #: 03.28.15.38 Lot: TN/RNG: T28N R15W Municipality: Cady Township CSM: 114 1/4: NW 1/4 NW 1/4 Owner: Bengtson, Robert 593 ST. Hwy 128 Wilson, WI 54027 State Permit: 453125 Issued: 04/23/2004 POWTS Dispersal: Mound less than 24" suitable s Permit: Replacement County Permit: 0 Installed: POWTS Detail: Bed Bedrooms: 3 WI Fund: POWTS Pretreatment: Unknown Notes Inspector As Built Plumber Other Requirements Additional Notes Money Owed Not determined NA Stang, Joe $0.00 Signed Off: No 11 ~Do ~ I~.ce~r~1_" 4--~~ ~~'na ~