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HomeMy WebLinkAbout004-1028-60-000/* Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ^ City ^ Village ^ T n of: Anderson, Ted & Jae I Cady Township TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic _ ~ ~~ ~ ccQ 12~U Dosing G ~D U Ho ~ g TANK SETBACK INFORMATION l ~Q r~~ TANK TO P/L WELL BLDG. vent to Airlntake ROAD Septic ~rsd' ~~5 ~ -~ZD` ±Z3' NA Dosing >~~6 ~ > ~S ~ J Z y' ~ ZGJ NA NA Ing runny / ~~rnurv irvrvrciws~- i wN 1;~ Manufacturer s Demand Model Number ~~ Z7 GPM TDH Lift Lriction System TDH Ft Forcemain length 3 Z Dia. Z " Dist. To Well SOIL ABSORPTION SYSTEM /- ELEVATION DATA County: St. Croix Sanitary Permit,No.: 370326 State Plan ID No.: Parcel Tax No.: 004-1028-60-000 STATION BS HI FS ELEV. Benchmark , ~ ~~ . 06 Alt. BM Bldg. Sewer ~, b ~3 , S' ~ St Ht Inlet ~ ~S Z• ~/ Dt Bottom ve ~ 3.Z3 ~ 3 Header /Man. 3 ~ yZ ~~6. U 5~ Dist. Pipe ~- 3-YZ ~~C' OS'' Bot. System ' / ~~ ` 3 3 Final Grade St cover C~o ~, ~ ~~~ 9S. dr' ~ b oc/< /dU~ ~d .~"~ ~ 2- t~ 3 . / . BED /TRENCH Width ~ Leng##h No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN 1 N / 6d DIMEN SYSTEM TO P / L BLDG WELL LAKE /STREAM LE G acturer: SETBACK CHA N m er: INFORMATION TypeO ~ (s/ >2 t70 ~ l ~15U O NIT u System: 1N- DISTRIBUTION SYSTEM Header / Manilfold / Distribution Pipes ~ x Hole Size x Hole Spacing Vent To Air Intake Length ~ Dia. Z ~ Length ~ Dia. ~ ~r Spacing 3 ~ 1, ~ L ~' SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No r COMMENTS: (Include code discrepancies, persons present, etc.) ys /s Inspection #1 c / o / l P'/o U Inspection #2: 7s / / 9 / o c Location: 405 325th Street, Knapp, WI 54579 (SW 1/4 SE 1/4 12 T28N R15W) - 122815193 1.) Alt BM Description = ~,~ Sa.•~ ~LO~ t,~~~c~.~" 2.) Bldg sewer length = ~d/ d reG 1z -amount of ever = >yz ~~ ~, hr~~ a I;+N, 3.) contour = 3 • oS' ~ !/~/, ~bt ~ ~ u la.l•ow bt~.e s> Y.) 7aticl (pCu~ ihSYa(/~9' Plan revision required? ^ Yes [~'No Use other side for additional inform tion. (o ~ ~~~~ SBD-6710 (R.3/97j Dat Inspector' gnature Cert. No. • Safety & Buildings Division it A 11CatlOn S it P ` ' 201 W. Washington Ave. erm an a I PP 3 PO Box 7302 iseonsin In accord with Comm 83.21, Wis. Adm. Code Madison, WI 53707-7302 Department of commerce Personal infot-mation 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 fete fans to the count co onl )for the s stem, on a er not less than 8-I/2 x 1 1 inches in size. County State Sanitary Permit Number I~LTiec~iTt~evasion to previous application ~ State Plan I. D. Number ite ID 1997 -~ X32(0 ~ ~' ~ I. A lication Information -Please Print all Infor a op~' Location: Property Owner Name ~ `'-, ~~ ~`~: ~~ 114L~~~Vjli1 `~ Property Location ' TED & JAE ANDERSON tea t/~,s T ,N, F r ~a~ Property Owner's Mailing Address -~---{ ~ ,. T ., .t##,~,ry//y~~~~ ~~ ~ s Lot Number [31ock Number .' ~ ^ Ll' i}V 405 325TH STREET ~=`'~ ~"~ N/A N/A City, State Zip Code + ,.-1~., ~hptfR'Number - '` Subdivision Name or CSM Number KNAPP WI 54749 '~.. ",~.1`~. ZO" N ~ ~f~E ; _1, ~'~-4684 N/A II Type of Building: (check one) mot, ~` ~ ` ~ -; -:~ : ~ ~ ~ ~ ^ C;ty ,c ^ vina =~ .~-'" ~ 1 or 2 Family Dwelling - No. of Bedrooms: l ~=..,~;-_ , [~ -gown or LADY ^ Public/Commercial (describe use): ^ State-owned III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road 325TH SIRE p) 1. ^ New System 2. Replacement 3. ^ Replacement of 4. ^ Addition to Parcel Tax Number(s) S stem Tank Onl Existin S stem 004-1028-60-000 B) Permit Number Bat~iSSlied 12 ~ ~ ~ I Z 3 ^ A Sanita Permit was reviousl issued IV. Type of POWT System: (Check all that apply) v ^ Non-pressurized In-ground ~] Mound ^ Sand Filler ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Sin~~lc Pass ^ Drip Linc ^ At-grade t ^ Aerobic "1'reatm t Unit ^ Recirculating ^ Other: C~~ 11~-10 Qt.~ _ 1,2' - ! •S `` ~ csot e.~.~-k~- a Z I~.~t V Dis ersal/Treatment Area Information: _ 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate G. tiystcm Elevation 7. final Grade Required Proposed Rate (Gals./day/sq. ft.) (Min./inch) Elevation 600 600 600 1.0 N/A 115.3 117.18 VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete stntcted Tanks Tanks ^ ^ ~ ^ ^ _ _ _T ~ _ _ _ - :_ ___ _ ----- -- I [_~ ^ ^ ~ ^ , 800 800 1 MIDWESTERN PREC T VII Responsibility Statement I the undersi ed assume res onsibilit for installation of the POWTS shown on the attached fans. Plumber's Name (print) Plumb •' Signature (no slam P/MPRS No. business Phone Number BENNIE HELGESON 2202 2 715/772-3278 Plumber's Address (Street, City, State, Zip Code) W1229 770TH AVENUE, SPRING VALLEY WI 54767 VIII County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) Approved ^ Owner Given Initial Adverse Surcharge Fee) Determination aZS. W O "' -2~ IX.A C'onditions of Approval /Reasons f r Disapproval: , a-o ~ S ,f'2.c.tr+~~ ~ tin ~ a~ {' ~ . C_ 6-~, 7~un ~- ~. - +hN t -------' 1S , _~ . ~ ~ ~ 4 ~ ~ ~scons~n Department of Commerce September 29, 2000 CUST ID No.268093 BEN HELGESON HELGESON EXCAVATION INC W 1229 770TH AVE SPRING VALLEY WI 54767 RE: CONDITIONAL APPROV PLAN APPROVAL EXPIRES: 0 Safety and Buildings 1340 E GREEN BAY ST STE 300 SHAWANO WI 54166 TDD #: (608) 264-8777 www. commerce. state.wi. us Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary. ATTN: POWTS INSPECTOR ZONING OFFICE S'~CROIX COUNTY SPIA 110 CARMICHAEL RD HT1D1fiON WI 54016 ~i?i ~ ~~ /~•~ •~ ~ ~' ~,.., Y • f.) n lf" ~I. ~ (; f ~ ~l e , r..i ~ ~` i ie Fr LCI ~' t i~002 ~ UV sr cr~oix ~ `" ` ~ ~ ~ CUUr.1w ., c, ~ ZONlNvi;:ivE ~ ~... ~~~ ~- t..~ SITE: ~. % , _ __ ^`~::~ Site ID: 199707, TED &JAE ANDERSO~AI~'~ ' ' ~ ^~.-' 1 ` '~i , ST CROIX County, Town of CADY; 504 325T S'f~^~ SW1/4, SE1/4, S12, T28N, R15W FOR: Description: MOUND SYSTEM FOR TED &JAE ANDERSON Object Type: POWT System Regulated Object ID No.: 764269 Identification Numbers Transaction ID No. 438364 Site ID No. 199707 Please refer to both identification 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 installation: • The piping used for the force main and manifold shall comply with Comm 84.30 (2)(e). • The distribution piping shall comply with Comm 84.30 (2)(d). • The aggregate used in the distribution cell shall comply with Comm 84.30 (6)(i). • The synthetic fabric used to cover the aggregate cell shall comply with Comm 84.30 (6)(g). • The observation pipes in the distribution cell shall be located pursuant to Table 3 of the mound component manual. • Documentation shall be provided to the County to show that the effluent filter is aState-approved product and to show that it is capable of filtering out all particulate matter that is greater than 1/8 inch in size. • An access opening of sufficient size to allow removal of the filter must be provided over the outlet "tee" baffle of which this product is installed. This access opening must terminate at or above grade. 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. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. BEN HELGESON Page 2 9/29/00 Sincerely, `. KEITH A WILKINSON , POWTS PLAN REVIEWER Integrated Services (715) 524-3630, FAX: (71S} 524-3633 , M-F 7 AM - 3:45 PM K W ILKINSON@COMMERCE. STATE. WI.US DATE RECEIVED 09/21/2000 FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 BALANCE DUE $ 0.00 WiSMART code: 7633 cc: TED & JAE ANDERSON . ~ 3~ <, ~`~~O S~~ ~~~~,s ~'~' INDEX SHEET ~~~~ ~ PROPERTY OWNER: TED & JAE ANDERSON 405 325TH STREET KNAPP WI 54749 PROJECT NAME: TED & JAE ANDERSON PROJECT LOCATION: SW 1/4, SE 1/4, S 12, T28 N, R, 15 W MUNICIPALITY: TOWNSHIl' OF CADY COUNTY: ST CROIX CONTENTS: Page 1: Plot Plan Page 2: Cross Section & Plan View of Mound Page 3: Distribution Pipe Detail Page 4: Cross Section & Specifications of Septic Tank & Pump Chamber Page 5: Pump Specification Page: Mound System Management Plan Name: Bennie Helgeson Signed ~ Address: W 1229 770Th Avenue Spring Valley, WI 54767 Credential number: 220292 ~. Date: September 1$, 2000 F'.~.~b~. ~.~. ~~xr~~~~~m~~r~y ~ ~~. pF.PARTMEt~T OF COh1h9ERCE ~~JIS~ON OF SAFETY AND BUhDiNGS ~ ~RRESPONDENCE ~6 ,~ a ~~~ No~,.~ Gam ~---- ~ rto p o 4 Cov.cv~e.~ S I ~b -~- 1 _ -- ----- --- s~o~ ~~, 3~ ~~ f .. tt} ;f~ ~ %L~'r ~F ~ 1 e _ .~ _~Q~.. u~ ~~ rS Ova l~~-~-~--mac '~Con~aw- ~~. I Iy, I --~ ___-^ .-a~--~-~ ~ _ _ _ ~--- ~e„c.e d /iJPav-~s~ • ~ p ~~ f ro-~os~~C (ado%a Gam./. Seo,1, ~ ~~. 7~~.k J T g. a _~ a / ~ K~y~M __ _. 1 `` ~ JJ••..JJ ~~•JJJ 1 ~ l7 ~cj ~ \, ~ / ~o~'^ 610 ~ ~ ~ '. i \' , ~ ~~ ~ f .~ ~ i3.M. t ~~. o ~~ f `.vn ~.;~', l eat ~ ~CtaE /~toC,~rS v n Synthetic Covering 9~T'~ c33~ Medium Sand 1 Topsoil 3 E ~' % Slope ~l -~B~e-d 0 f 2r- 2 'i Aggregate Page _ Of _ Distribution Pipe 0 G • 115.3 Force Main From Pump Cross Section Of A Mound Signed: License Number: Date: N ,°'o ~. A ~o -Ft. \g ~'Ft. a K, q_ 7 'Ft . ~Lyr'~~" ~Ft. ~ ~~ t. T ~' Ft . W\~'Ft. Plowed Layer D~. , Ft E / sj ~Ft . F ,g -Ft. G . 5 ,Ft . H 1 0 ~Ft. i ~ L ~ / / ~ Observation Pype /~ g A ~.5:~6 0~ I w ----- -- -~~ N q Distribution '~~'Of i - 2'2 Pipe A99re9ate I ~6 a0 ~ .Observation Pipe Qasa~ ~r~~ ~ K ~• ~R T-a r~ ~s ~~,~,~s i~ ' ~c. Plan View Of Mound ~r Pw~ Z ~ 4 C )ea~.o~ 1" ~~.ccs~ ~- IeaNo~~ End Vl~w P~rlorolad r PvC Pipc Er,:d M,..,~ Told Holes Located on Bottom are Equally Spaced ~or •~ /~ ~ e ~' - ~r~ {-~e~ /UQxT '~'o /'(av~~ioldl' d~~~s ~ c.Psl•~~ ~ ~7•Sr ~ IF~~ Signed: Perforoled Plp• ovioll Distribution Pike Layout License Number: Dare: P ~ ~ ~~ `~ s 3 X ar b ~ ~ ~a Y Hole Diameter: Inch Lateral ~ ~Incn (es) Manifold " '`°~~ Inches ~-- , torte Main " a Inches i,~~VE~~" ~I~e~. ~ is". 8 o°~'~~' ~a~ws~, ~o,~ • ~~~'~ w .-- •l Pr~ ~I- .SUE' ~ _.J1,~fCrm Page__ ~f_ • COMBINATION SEPTIC TANK/PUMP CHAMBER 4" CI Vent Pipe with A roved Cap, +25' (No Scale) Manhole Cover From buildings •Approved Locking With Warning Label Attached ~~ Weatherproof Approved _----~ Junction Box Vent Cap .Warning Labei 12" Minimum ~- 6" Minimum ~ 4" Minimum Final Grade-~ i 6" Maximum Quick 4" C.I. Disconnect I n s _ P_? P~ `' _ - ~ ;8" Minimum I M~x~ko%~ , 1 /4~~ Weep n , Hole Baffles ~ ~ L~ ' i r •~ i A Approved Joint i w/C.I, Pipe Alarm 6~ B Approved Joint _xtendi ng 3' ~~.pj~~ On 6; w/C.I. Pipe Onto Solid Soil I C Extending 3' /(v ~7, s ~ Onto Solid Soi Off ~,-r..~ ~ ~ ,,, ~;~ ~ Conc. Block /~ ~~^^ , , 3" of Bedding Under Tank Per Day Gallons Noce: Pump and Alarm Are On Separate Circuits Number of Doses:- o DOSes: Gallons Per Day/~~ Backflow:.••••••+~~Gallons Volume of ~/7^Gallons r ~~ Total Dose Volume:..••••••s Tank Manufacturer: ~ ~ a ons ,~ ~-~• per ~'^`~ Tank Si ze-Septic/Pump: ~ ~ c, c~~r~S 2D~~ fig' ~ O~.O~allons Alarm Manufacturer: C - ~ Capacities: flinches orGallons Model Number: - + B~ inches or ,allons Switch Type: r + C~~inches or~$_~'allons Pump Manufacturer: + D inches o ~llons Model Number: - © Total..... s~~;nches or. Minimum Discharge ate: Feet Vertical Difference between Pump Off and Distribution Pipe+~g~Feet Minimum Required Supply Pre~s~ rFriction•Factor/100~Feet: +~ eet !I•o ;3~_Feet of Force Main x ~N 3 Inch Diameter Force Main Total Dynamic Head:...= ,~ Feet ;y ~~ ,i ~ ~~, Li uid De th 3gt~ Internal Tank Dimensions: Length; Widthd ~ q p ~ "'~ ~ License Number~_Date Signature r ~~~ ~~-~~~~ Performance Curves ~~~~ METERS FEET 80 25 ~ 70 = 20 H ~ O F- 15 ~ 40 10 ~ 20 5 10 0 0 ,~ ~,., .,_ --- p 10 20 30 40 ~ ov 10 20 0 CAPACITY GPM J 301n'/h ~GOULDS~. PU~M~PS~IN~C. t METERS FEET 120 35 110 100 30 90 25• ~ ~ 70 = 20 60 O H ~ 15 40 10 ~ 20 5 10 0 0 3 0 4 0 5 V ° ~ ~ ~ ° " ° " " "" ' •- 0 10 20 i e 1Cil5 (:nn1Af PumOE. InC. L 0 10 ~ ~(~,l CAPACITY ~`- ^/~~ Ellactlw July,108S R: TED & JAE ANDERSON Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code Septic 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. T rating condition of the septic tank and outlet filter shad be assessed at least once every 3 years by inspection. The outlet alter hall be cleaned as necessa ensure ro er o eration. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may s ough off the filter when 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. Pump 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 System 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. Cold 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 BODS, 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 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 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall 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)] 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 with 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. 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 on the operation or maintenance of this system should be directed to your county zoning or health inspector. . ~ ~ ~ r~RIG11V~~ IL EVALUATION REPORT ~• Wisconsin Department of Commerce Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code 1164 Page 1 of 3 Certified Soil Testing ounty Attach complete site plan on paper not less th es in size. Plan must Croix St inGude but not limited to: vertical and ho ' I f r ~ i di ti d . , o e 1 ), rec on an parcel I D percent slope, scale or dimemsions, i nce to nearest road. . . 004-1028-60-000 Ple i f ase n or on. ~ .~. ~ ~ ` ~ Reviewed By Date ,; r Personal information you provide a sed for ss (Privac~ L~w, ~ i5.04 (1) (m)). ~ ~ 1 p ~4~ 7~~ rope ner t_ S ~ Z~~4 A d T d & J '~ A~f~ ropey oca ion n erson, e ae • ovt. Lot SW 1/4 SE 1/4 S 12 28 N R 15 W roperty ne s ai ing re ~ ST C ' Lot # Block # Subd. Name or CSM ^/ 405 325th St. ~;s. ~ C:OUN City to ne Num ~ ~ Cit ®Village Town Nearest Road Knapp ~ WI , IDj 4 Cady 325Th St. New Construction Use: Residential /Number of bedrooms 4 Code derived design flow rate Replacement ~ Public or commercial -Describe: Parent material loess over till Flood plain elevation, if applicable General comments and recommendations: install 6' x 100' rock bed mound on 114.1 contour as upslope edge of rock w/ 1.2' sand fill GPD NA ^ Boring # ~ Boring Pit Ground Surface elev. 113.3 ft. Depth to limiting factor ~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. 1 0-3 10YR 3/2 - sil 2 m gr ds cs 1f/m .5 .8 2 3-9 10YR 3/2 - sil 2 f sbk ds cs 1f .5 .8 3 9-14 10YR 4/4 - sil 2 m sbk dsh cs 1f .5 .8 4 14-29 7.5YR 4/4 - sl 2 m sbk mfr cs 1f .5 .9 5 29-38 10YR 5/6 c2p 10YR 6/2 scl 0 m mfr - - 0 0 ^ Boring # ~ Boring Pit Ground Surface elev. 114.1 ft. Depth to limiting factor min. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft' in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 1 0-3 10YR 3/2 - sil 2 m gr ds cs 1f/m .5 .8 2 3-10 10YR 3/2 - sil 2 f sbk ds cs 1f .5 .8 3 10-15 10YR 4/4 - sil 2 m sbk dsh cs 1f .5 .8 4 15-22 7.5YR 4/4 - sl 2 m sbk mfr cs 1f .5 .9 5 2 -30 10YR 5/6 c2p 10YR 6/2 scl 0 m mfr - - 0 0 CIIIUCIIL $ I = DVUS ~ su _< <zu mgrs ana i ss >so < 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L ame ease not igna ure: um er Henry F. Grote 222774 Address Certified Soil Testing ate valuation onducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 8/11/2000 715-233-0398 ~, - Property Owner Anderson, Ted & Jae Parcel ID # 004-1028-60-000 Page 2 of 3 ^ g Boring Borin # ;Pit Ground Surface elev. 114.1 ft. Depth to limiting factor 26~~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont Cobr Gr. Sz. Sh. 1 0-3 10YR 3/2 _ sil 2 m gr ds cs 1f/m .5 .8 . 2 3-11 10YR 3/2 - sil 2 f sbk ds cs 1f .5 .8 3 11-17 10YR 4/4 - sil 2 m sbk dsh cs 1f .5 .8 4 17-26 7.5YR 4/4 _ sl 2 m sbk mfr cs 1f .5 .9 5 ~-34 10YR 7/3 f2p 7.5YR 4/6 fs 0 sg ml aw - .5 .9 6 34-48 10YR 8/2 c2p 7.5YR 5/8,4/6 scl 0 m mfi - - 0 0 ^ Boring # ~ Boring Pit Ground Surface elev. ft. Depth to limiting factor in• Soil Application Rate Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots ' in. Munsell Qu. Sz Cont Color Gr. Sz Sh. ^ Boring # ,Boring ~ Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Cobr Redox Description Texture Stnx~ure Consistence Boundary Roots in. Munsell Qu. Sz Cont Cobr Gr. Sz Sh. * 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-8330 (R.07/00) ceraned Shc Testlng 2r~ ~ h ~ SO w . \~ ~ c T J~ \ bin 4oS~ 3Z~~' S~, 4 ~.,, ~ -~1f~+•... w 13 M ~1 ao. ~Z~ ~ S~-, ~~ _ ~ ~_ o ~W .,. O. b ,,.s \ e Sro C.T4rw lV ~~ ws,~ ~+ ~e,,.~. ~~ ~'i'M L2L~ ~Q ~ ( `- y~K v /~ f~ ~"( ((~~@~..rtu p v. utwcJ~.~K ~ 2 lea`.{ ~ L. ~ ~" S ~~ CI l(,,o ~ n ~ ~ ~ ~'Ji s ~ l .}.~ `~ ~ O a. mow. s: ~ ~-I113.1) ~~ I4.3~n l~•'~ ~~ ,~--- / '~ °\`\ ` 2~'' ~3h ( 111.~~~ 3 0~ 3 bC~ ~ - ~o2g -(~c~ .cxr~ ` \ C7 ~hN ~~ ~OVw S O.y .. , .~ ~o „~. ~ .Qw ~.. qT.)" .~.r.¢- ~ N/ J ~ ~ p 20 (kj ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer 12oQ, ~ ~q-~- 1 ~ /i G'2~'~' S G !~ Mailing Address ~-{~ ~ ~~ ~ 5f ~ ~-r ~,~. ~- Property Address ~5 ~ o~~~` ~~--re~ (Verification required from Planning Department. for.new construction) ~~ City/State ~ ,~ ~ ~ ~~' Parcel Identification Number Oo'~ - /aid` -~y -Ooo LEGAL DESCRIPTION ~ ° ~ t-' Property Location S~.t~ '/<, ~~ %4, Sec. (~ . T o°Z8 N-R l 5 W, Town of Subdivision N~ /~ ,Lot # ~. Certified Survey Map # /U/A ,Volume .Page # Warranty Deed # '~ o Sle L/ ?~ .Volume 7a a ~ .Page # ~~ l Spec house O yes ©no Lot lines identifiable ®yes O 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 master plumber, journeyman plumber, restrictedplumber or alicensed pumper verifying that (1) the on-site wastewaterdisposalsystern 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 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 y ar expiration date. - ---- 4 / 3d /a_~p OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) laiowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. s Cl /3J/ Z~ZdR~ SIGNATURE OF APPLICANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed - _._~ _~m-. _.._ -,~ F DcJ~'uMEN7 NO, -- ~ 5TATT BAR OF i:'I3CON$iN I'f38IlI I-~lliii'r iii aPwc3 RcttRYto roa Rc=ctaolxs ewTA ~ '', WAAfiAN'TY Dl~D .,,~ pGt . I PAGE ~0~. REGISTERS OfFlG! L!, ~5~3 --- :_.. This Deed, made betTreen ..H~r;+~.d..!(i~....tiT~hn,~.atlr .............. ST. ~R01X CAM WIC ' and-..Lilly--l.ahnson,:...:~uaka.nd..and...Ki.>"~ .............................. Reed. for Rec*xd this_ ~th ` ........ ............................ ..-----------•-•--• Sept. 85 ' ................................................................................................ Grantor, :na....- -.TQd .W.....Ande-ra.o.n_~...a~nd. Ja.~..A~-d~tr.~o~.r ................ .. huaband. and..~if~ as 3.a~i.nt..Ce~anLa.r..~/kl.?l..JaR..M,.. Anderaun.__.._ ... ...............__. ...............__ ................................. ............................ .. ................ . ............................................... Grl-atee, Witnel3seth, That the t:id Grantor, for s valuable ¢ollsideralion...... One--dollar._aad -,ether valuable...aan.:~~dsz'.ati.a>~--.-... conveys to Grantee the following described real estate in .-S.t....Cr.QiX.......... County, State of Wisconsin: day of________,A.O~ 19 2: ~ P M. ___.__~ .t -i 1. ; RtTURN~yTO ~/~~ /t /~~ J//j']T/Y'J//'/~J~~ ~~,eNy, GUi's syoc~ The South one-half (S 1/2) of the Southeast Quarter (SE 1/4) of Section Twelve (12) , Ta: Parcel No :................................... Township Twenty-eight (28) North, Ranga Fifteen (15) West. ,,. ,~ , J~y•~~ k~~+ This 18. . - -. _ .. - -- homestead property. (is) (is not) Together with all and i!ingular the hereditaments and appurtenances thereunto belonging; and.. Granto.r__...._ .... __ . .... _ _ _._ .. _ _. _ _ ...._..... warrant3 that the title is good, indefeasible in fee simple and free and clear of encumbrances except L i 11 hnso:t and will warrant and defend the same. Dated this .. _ ~0.. _.. _..-.- .. _ _ day of ._ ...September ..................._.._ ......, 19.85 .. _.. .-- _. ._ _.- _._ _ .-...(SEAL) ~ - _ _..- AL) Harold W. Jo on __ _ _ - _. .-. (SEAL) _ _- _.. - ....._(SEAL) ~~ AUTHENTICATION Sigltatnre (s) ................. authenticated this _...._._day of ........................... 19...... TITLE : 'JIE tBElt STATE BAR OF WISCONSIN ([' not, • --- - - ---- - - ----------..._......_._.-... author;zed by ~ 706.06, Wis. StatsJ ACHNOWLSDOMSNT STATE OF WISCONSIN sa. St-'--- Cro x_--•-------------county. Personally came before me thin ._____.!'~..._..day of -_-----_--Setember-------------- 19___85 the above named -_Harold..-W-,_-Johnson--and --L i 11-y-__.__-_- Johnson--- -- ------- -- ---- -- - ..,~.. to me knswr-Lo~he the e. son a~idr - _ THI$ iNSTRUM4NT WAS OR.4FTED BY - w ~.° -' ~ ~ --.. _.. ..._ .-.. ... ..._...~. .c.~~._ .... Robert-G. Walter _ _ <-_ ~ 'i Attorney at Law - •-...- Le.-.o - tort ey---=-~-` ~,r-_ _ --.~i --- - - --------- ----•• ----------•--•--- --•--- -- --------•--....- -- Notary Public . _i -:...^' Coa`-i (Signatures may be authenticated or acknowledged. Both 1Kp Commission is permanent. ~t~~~'''t;,~k>Rte iQu; are not necessary.) date: Jul;/ _,;1,-_-_--. tii b _ •~ •Namea or persons sitnint in any capscitp should be typed or printed below their siR natures. •~~'Y -tChMNrCdrpsrry® BTAT6 BAR OF WISCONSIN Foa>r N.. t - tss: :: Stock No. 13001 s