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HomeMy WebLinkAbout004-1051-40-200 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 538886 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 2-00-0- Permit Holder's Name: City Village X Township Parcel Tax No: Lamb, John R. Cady, Town of 004-1051-40-200 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: / 0 G . l /al. /04)1~ 404 22.28.15.342Al 5-1 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic tM Benchmark 51f f /obS 01610 / Dosing lJ( Alt. BM T I D a C1cl - Aeration Bldg. Sewer a&ndft: Holding St/Ht Inlet St/Ht Outlet TANK SETBA K INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing lJ ead /Man. Aeration ist. Pipe . 1A rf q3.0 Holding Bot. System r / It T Final Grade 11-f T PUMP/SIPHON INFORMATION 0 Manufacturer Demand t Cov GPM Model Number TDH Lift Friction Loss S em Head TDH Ft ~e Forcemain Length ia. Dist. to Well r, ~ km 4d~ IQ / SOIL ABSORPTION SYSTEM `[rl BED/TRENCH Width t Length N pt Tr c h e s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS v 1_ q r / SETBACK SYSTEM TO Y/ P L e BLDG !T WELL LAKE/ST AM LEACHING Manuf r: INFORMATION Typ Of System: f ~ r CHA LINER OR ` Ltatr \ Z~b / Model Number: 2 D TRIBUTION SYSTEM I l 7~ U ea a)nifold Distribution r Y Hole Size x Hole Spacing Vent to Air Intake I V f h Pipe(s) T h 7 f7W qL~engt Dia Length Dia Spacing h SOIL COVER X Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Center 1 Bedtth ov ench Edges xx Depth of T7Sodded xx Mulched 0 Yes EA No Fp~ Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 11I 4 / I I Inspection #2: Location: 274 310th Street Wilson, WI 54027 (SE 1/4 NE 1/4 22 T28N R1 5W) NA Lot 2 Q Parcel No: 22.28.15.342A15 1.) Alt BM Description = -rj WZ(,(, d-o- z'I 3 / d 2.) Bldg sewer length = q- L4 o4_1st - amount of cover = 4~C Plan revision Required? FNI-] Yes No 1 / (D Use other side for additional information. "I 66 j_.11P - J Date Insepctor's Signatu Cert. No. SBD-6710 (R.3/97) a ° 3 0 l\ ` 3 d N 0 0 to o n (D N a' Ili O O O N ry C I d I I I. 0 0 C Z C Z i Li c Li c o - o C o _0 ='o N Q Q C 3 M V Cl) V N N Z 0~ Z O 00 N N> a m a m N H Z i' C C7 O_ Z a j m m r+ ~ ~ 7 N 7 N U N N 4) z fn f•~ r N N C N C N m cu L_ 7 L 7 N N N N N N O O O • N N d •O L 'O L N Ll N 7 Q 7 ~ w l.U-. O Q Z Z Z Z O Z N N C N N C v °v N N °v y E N I m m d CL c CL c > W d N O N y d O ooa a (v ooa` a E rn o Y) (n cn E 6) o mo co N "~J S ~S n I- F- I Z > 7 o 0 0 0 0 0 •N a m m a a m o 05 j ~O (n L 00 00 o N L 0 N N (n J U O O O O O C. N N ap _N N } 1~~ M N Z N O M a) N Z O w •O m 01 CO C a' •p C C 'O y ~ m N C 'C M ~ 01 N Q A (n f6 O 'O d Q h (n N IQ m d co 7 7 Q O O fNC 06 (Np C r:+ O ° Q o E o 0 0 7 0 E o m Lo o C V C ro a~ c c 0 a. i N cl O y -E E: c 0 N N C U) C Q CO C (6 (O C (O m C N C N O o U) L O N -p In CO > a w~0 N C C C N O L C14 E a) (D E a) 0 -6 • O N U III, J Z N a' a' (n J m O z N Z 4j L: a y, U a a t A 0 a 0 N 0 0 0 - I Saf ety and Buildings Division County 1 W. Washington Ave., P.O. Madison, WIC 53707-71C MA Permit Number (to be fille in by Co.) 't!R~Itm of ~7 rc~ ~t S g 99(a ani pplication Sta i< Transaction Number} In accordance with s. Comm. 3.21 Code, submission of this form to the appropriate governmental / unit is required prior to ob 'nfd~ tary permit. Note: Application forms for state-owned POWTS are Project Address (if c fferent than mailing address) submitted to the Department ommerce. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04 I m , Stats. I. Application Information - Please Print All Information Property Owner's Name Parcel # j-Ayk Property Owner's Mailing Address Property Location (f Govt. Lot 7 City, Stag, Zip Code Phone Number 5~F % 1 2 Z I b, Section 7721- circle on T 7R N; R E H. Type of Building (check all that apply) 1 or 2 Family Dwelling - Number of Bedro Lot # Z Subdivision Name !I 5~ Block # 14414 Q ❑ Public/Commercial - Describe Use w El City of CSM Number ❑ Village of ❑ State Owned - Describe Use P. Town of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) J A. ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision El Change of Plumber ❑ Permit Transfer to New List Pre vi Perrrffi Number and Date Issued 41 / Before Expiration Owner V2 49 yS ~d 7 200 IV. Type of POWTS S stem/Com onent(Device: Check all that apply) ,WNon-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade P Mo d > 24 in. of suitable soil ❑ Mound- 24 i of suita le oil / El Holding Tank El Other Dispersal Compone explain) /L7 P7€t f ite ev ex am V. Dispersal/Treatment Area Informatio Desi F ow (gpd) Design'0Soi Application ;F(gpdso Dispersal Arga Re fired (sf) Dispersa , Proposed s Sys%m Elevation ae Tank Info Capacity in Total # of anu acturer Gallons Gallons Units ° d o r. U w y y New Tanks Existing Tanks d °o a U rn vi w C7 fs. Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plum s Name (Print) Plumb is Signature < MP/MP $ Alumber Business Phone Number Plumbe r's] Aiddress (Street, ity,~ySetate, Zip Code) -3, & 62~g--?-xt At~: VIII oun /De artment Use Only Approved ❑ Disapproved Permit Fee Date Is ue~dt Is tng Agent S' afore d ❑ Owner Given Reason for Denial 7 f ( i d IX. Conditions of Approval/Reasons for Disapproval ® , SYSTEM OWNER: ~W A 1 Septic tank, effluent filter and -M dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2- ~ 2 9 ZGO~ as per applicable c6ftN°dit' f n' for the nd submit onty on paper not less than 81n x 11 'aches io ize -7 Asw AAlk Y3 S 8 (R. oa/) e, c~ JOB TIMM EXCAVATING Route 1 Box 192 SHEET NO. Of WILSON, WISCONSIN 54027 CALCULATED BY i DATE 9- z oZ (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE / = Y SCALE y Jv "e e~ a3 a . All ~v 5(t)i~Gh .ream ion << JS F . ~e>- 0 tine km 4v ClCC_.nG..~~ \ i la U e C) 4 i i 1 J I /~~l:ole Lo f c_ /0 ~Y'~ ~K a cgoo+X' 205" %A~S'~c CraoYm O+/+ to Om F40ME Toll FREE 14M225-M CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Owner's Name: Owner's Address: K/ j ~s~Y7 ~j _(f©a~ Legal Description: Township: County: Subdivision Name: Lot Number: *1~ Parcel ID Number: 04ef Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: q {s~^ I"qA IJ l~ License Number: -3Z Date: Phone Number 711,3-- 77,9 Signature Designed pursuant to the In- /11 und Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 JUh_. C JOB TIMM EXCAVATING Route 1 Box 192 SHEET NO. OF WILSON, WISCONSIN 54027 CALCULATED BY DATE y Z U UZ (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE / = Y SCALE U _ a o~ Pre km A ! 1 n <r ~ ~ Z lob . f i 1 (15 L,ole ow, ' fc in0 SJP~`~~Krl ~t Ivry i/~~ II bum-,.. wpOT~py1-AE~H m C-w Wa 01471 T.Oran NONE TOIL FREE 1-000-2?563W I Soil Absorption System Cross Section ft - 4" Schedule 40 Final Grade eti G1WA/ 0 Z PVC Vent Pipe 11/ek With Vent Cap ft I t D IL, Lft System Elevation ft ft II J~~V~ Soil Absorption System Plan View 3 ft . ft Leaching Trench 1 Vent Or Observation Pipe Chambers / I 1111 IIIHI 4" Dia. J,-1 Trench 2 Header 7` D Leaching Chamber Specifications Manufacturer And Model o? 31 EISA Rating 0 sq ft per chamber Soil Application Rate m 7 gpd/sq ft 31 a? l gpd Design Flow + s 7 Soil Application Rate Zo EISA = ~zl_!L` mbers 2 rows of chambers each. Page of St. Croix County Planning and Zoning Tuesday, June 13, 2006 at 12:32:17 PM Detail Sanitary Information Page I of I Computer 004-1051-40-200 Sub/Plat: NA Section: 22 Parcel 22.28.15.342A15 Lot: 2 TN/RNG: T28N R15W Municipality: Cady, Town of CSM: Vol. 20 Pg. 5050 1/4 1/4: SE 1/4 NE 1/4 Owner: Lamb, John 274 310th Street Wilson, WI 54027 State Permit: 420451 Issued: 10/04/2002 POWTS Dispersal: Non-Pressurized In-ground Permit: Replacement County Permit: 0 Installed: 10/31/2002 POWTS Detail: Infiltrator- Standard Bedrooms: 3 WI Fund: yes POWTS Pretreatment: NA Notes Issuer/Inspector As Built Plumber Other Requirements Additional Notes Money Owed Pam Quinn NA Timm, Roger original failing septic system was south of house in $0.00 Pam Quinn Signed Off: Yes mound/at-grade type soils. See Henry's soil report showing loamy sand for this system. New CSM 2005 to split 40 acre parcel Maintenance Scheduled Pump Date Pumped 1st Notification 2nd Notification 3rd Notification 10/31/2005 10/1212004 04/20/2006 10/12/2007 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - fl r-11 " I.S S FORM NO. 985-A i- Ff B n ~er 80438 Si ~7 P...a L..i.a t Stock No. 26273 VOL 20 PAGE 5050 KATHGEEA H. REGISTER OF DEEDS CROIX R GEIVED FOR RfiCORD RTIVIED SURVEY MAP ND. exi7ai~o~wa 02:30P1! VOLUME 20 , PAGE 5050 CERTIFIED SURVEY 11AP REC FEE: 13.00 THE SOUTHEAST QUARTER OF THE NORTHEAST QUAFM. 2 s.Oe INCLUDING LOT 1 OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 16, PAGE 4352 OF SECTION 22, TOWNSHIP 28 NORTH, RANGE 15 WEST, TOWN OF CADY, ST-CROIX COUNT Y,WISCONSIN Northeast corner OWNER/PREPARED FOR: Section 22-28-15 John & Cheryl Lamb found 1' iron pipe v, 274 310th St UNPLATTED O ; Wilson, WI 54027 LANDS o 1 N c IN 0 centerline tin 1 C-4 r+1 1 NW corner 37.75 SE/NE S89'57'00"E 1308.52' 33' t 1270.77' moped l~ septic. o tahk ip LOT 2 ` drivey oy \ N 863 901 sq.ft. horse Iy z ` 83 acres ~T'I I^ leek°o centerlin e shed o S Cady Creek r-0-w well 1 ° O UNPL►TfED N w o. 8- Ln LANDS c' tO t 839,744 sq. ft. 33~~ N m 4i 01 19.28 acres ~j not incl. r-o-w v ~-:oo' Ao r4 n ;55.39'I to 1274.13' ° m ^ cn S89"S3'47"E 1309.52' u' DRAFTED BY: r =-\--O y' I vp~j R testslj i LA (c.P Joel A. Brandt LOT JB SURVEYING LLt N ~tP SM ; ° can 966 Rustic Rd 3 , 871,20 .ft. I vol. 16, Pg. 1352 o0 Glenwood City, WI 20.00 - orsqes I - - - - - - cn o_w -F---- 848,456 sq. ft. .48 acres - 6-_1.- SW corner Ot_ inc_I_._r-o-w----__ ~i Lot 1, CSM SE/NE setbock line ; Vol. 10, Pg. 2814 _ 392_7._27' 1277.51' - - - - - _ P West 1/4~N89'53'30"W N89'53'30"w 1310.51 33.00' P.O.B. Section 22-28-15 (N89•53.34-w) East 1/4 Computed per ties Lot 1. CSn P 5237.78 UNPL►TTED Section 22-28-I5 Vof. 15_Pg. 4149 - - - - (5237.75") [.ANDS found 1' iron pipe Note: Each parcel on this map is subject to State and County laws, rules and regulations (i.e. wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing ~V ty; any parcel, contact the St. Croix County Zoning Office for advice. LEGEND S"C 0.........Government Corner (as noted) * * V o.......... Set 3/4"08" Iron rebar weighing ` 1.502 tbs./lineal ft. °LE"'"'OoDCMY* ...........Found 1" Iron pipe <,q ( ) recorded data S~+~" , North is referenced to the 1010 east line of the Northeast SCALE: 1" = 300 Quarter of Sec. 22-28-15 which bears S00°40'45"E Page 1 of 2 ' (St. Croix County Grid System) 0' 300' 600' Vol 20 Page 5050 Parcel 004-1051-40-200 06/13/2006 11:40 AM PAGE 1 OF 1 Alt. Parcel M 22.28.15.342A-15 004 - TOWN OF CADY Current LXj ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 01/24/2006 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - LAMB, JOHN R & CHERYL K JOHN R & CHERYL K LAMB 274 310TH ST WILSON WI 54027 Districts: SC = School SP = Special Property Address(es): • = Primary Type Dist # Description SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 19.830 Plat: 5050-CSM 20-5050 SEC 22 T28N R15W 36.77A SE NE CSM Block/Condo Bldg: LOT 2 20-5050 LOT 2 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 22-28N-15W SE NE Notes: Parcel History: Date Doc # Vol/Page Type 08/24/2005 804385 20/5050 CSM 08/05/2002 686056 16/4352 CSM 02/21/2002 671700 1840/330 WD 04/02/1985 400771 708/573 LC 2006 SUMMARY Bill M Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 04/19/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 31,000 194,200 225,200 NO AGRICULTURAL G4 16.830 1,500 0 1,500 NO Totals for 2006: General Property 19.830 32,500 194,200 226,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Aivision INSPECTION REPORT Sanitary Permit No: 420451 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1`)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Lamb, John Cad Township 004-1051-50-000 CST BM Elev: Insp. BM Elev: BM Description: 106. 7 /06~ ~ T-022 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / vOO Benchmark . a -1 Z D a Dosing i Alt. BM Aeration Bldg. Sewer r Holding_ St/Ht Inlet t 2.51 9 .5-1 St/Ht Outlet 7 " 1 n r f i t 12 . (O 7- 35- TANK SETBACK INFORMATION f 11 7 .09 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. I D -y " l Z . o/ , Aeration Dist. Pipe 1 Z. 9 Z c~3.13 Holding Bot. System r Final Grade PUMP/SIPHON INFORMATION 144)/ v Z (o,/ Manufacturer Demand St Cover apm, 33. 2 69 Model Nu ber TDH Lift rictio ss System Head TDH Ft Forcema' ength Dist. to well JA~!~ SOIL ABSORPTION SYSTEM 2,q C (,.~Ny 2 t4,c.4_ - Q a-Ke ,0Ae,* Zty~ BEDITRENCH Width 3 / t Length /f No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth __7 I DIMENSIONS ~j p r~ p SETBACK SYSTEM TO P/L 45- BLDG WELL LAKE/STREA LEAC ING Manufacture INFORMATION CHAMBER Type~Of System: _ ~ ~ UNIT Model Number: / DISTRIBUTION SYSTEM ,N,VtLj, ,_VI. Header/Manifold Distribution x Hole Size x Holeg Ven Air Intak - S Q Pipe(s) L Length O Dia Length~~ . Dia Spacing 7 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 3r r/~ Bed/Trench Edges Topsoil Yes [N No ❑ Yes ~i No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:/0 / 3t /Qd-7-- Inspection #2: Location: 274 310th Street Wilson, WI 54027 (SE 114 NE 1/4 22 T28N R15W) NA Lot f-~ Parcel No:D22.28.15.342B 1.) Alt BM Description = ST`~~ ~ 0'"- " O~ b p 2.) Bldg sewer length •CvAU54 jK~~~t~p A - amount of cover = o /ST'~•t~ G+f ~1 t~.Q, ~ZG✓ V C~,f SDtitT' @ -A~ f oe -3-,Y G~ Plan revision Required? Yes _ No l0 I3/ Use other side for additional information. _ 4C _L 1 SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. Safety and Buildings Division county 201 W. Washington Ave., P.O. Box 7162 S1 CAD J NVisconsin Madison, WI 53707 - 7162 Site Address Department of-Commerce 10-7-02- J 0 Z 3 ST Sanitary Permit Application Sanitary Permit Number C- In accord with Comm 83.21, Wis. Adm. Code, personal information you provide / Q ~J may be used for seco Law, s15. 1 m ❑ Check if Revision I. on Informat on - Please Print All ormdtion -510t& e Plan I.D. N r osW F-vAJJ) - IV ED P Ls Name CST Parcel Number Z Z, S. 3q2 7ne' 002 do - dos/- ~o Property Owner's Mailing Address Property Location 29 R1J CIk -7 41( 3/0 Tf / ST. C~OIXCUUNEY st 'k ~V~'k; S -7 ZT 74,V N, City, State Zip Code Lot Number Block Number I Subdivision Name CSM Number Oi Ism lJ -f-, S o~7 7~S 777- 32q II. Type of Building (check all that apply) / ❑City 1 or 2 Family Dwelling - Number of Bedrooms ~G 1.5 71 A ❑Village ❑ Public/Commercial - Describe Use kownship ❑ State Owned ~'~f C( (~S -2j "X & q l Nearest Road 0 III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. 1 ❑ New 2 Replacement System ❑ Replacement of 6 ❑ Addition to For County use. System Tank Only Existing S stem B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued"' IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use)~~ ~{a r 1~Tbd r 4t;g Non -Pressurized In-Ground 21❑ Mound 47 ❑ Sand Filter 50 ❑ Constru ed Wetland CJS,4 ktU 31 -O - 22 ❑ Pressurized In-Ground 41 ❑ Holding Tank 48 ❑ Single Pass 510 Drip Line QQ,e~ 3/ 45 11 At-Grade 46 El Aerobic Treatment Unit 49 El Recirculating 30 11 Other o V. Dispersal/Treatment Area Information: Design Flow (gpd) Dispersal Area / Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required J Proposed Rate(Gals./Days/Sq.Ft.) (Min./Inch) T ~ 13,7- Elevation 7~ "Z 4~0 q fo~3 . 7 7Z ~z.~ ~(o• z VI. Tank Info Capacity in Total Number ~Mannuffaacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks /GZ~`W Concrete Constructed Glass New Existing Tanks Tanks C161 Septic or Holding Tank 0~ 000 Wlkkk-S pp J `161 Dosing Chamber 1 VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. lum is Name (Print) Plumber's Signature MP/MPRyS Number Business Phone Number o /l~vtrw 22 Z`f ~_-?2-3z 1 Plumber's ddress (Street, City, State, Zip Code) .3118 do 1~ h i• l 55107-7 VIII. go epartment Use Only Approved 11 Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Is ft-Agent Signature o Stamps) Surcharge Fee) (D ❑ Owner Given Initial Adverse . , s-e ~ L/ Determination IR. Conditions of A pro easons for Disapproval C,S `Yt Rjy Gvr->, d a-e~ - o R~&U 71 3 nches in sirs ; Attach complete plans (to the County only) for the system paper a 1 than 1/2 z 111 SBD-6398 (R. 05101) JOB _JUG/ n Gt r.. TIMM EXCAVATING Route 1 Box 192 SHEET NO. / OF WILSON, WISCONSIN 54027 CALCULATED BY DATE Z0-2' (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE SCALE .tr i Fc... ~...L«~ r~. i i641 --I1 l a . . < 1 63 . :r 1 Y~r a ti. : 1 Fit. ,.J i Zr _ . ......_....:(r 5 C Cpl h . l~.......... , .........i........... .j... ...a...........>.. ..........r 'L . . r.... r a 3 ; Pei t lydr+v . p" (1 . . . m 1 goo . e~ a . b" PRODUCT 206d~1nt.. Gwlm. Mm 0147t To Order PHONE TOLL FREE,4OU-725M JOB 6 ,TIMM EXCAVATING SHEET NO. OF Route 1 Box 192 c~z WILSON, WISCONSIN 54027 CALCULATED BY DATE (715) 772-3214 (715) 386-5443 MPRS #3224 WI MPCA #696 MN CHECKED BY DATE Yo 8CALE Itit 4.-....; ..............................................:...................................>..../V.... 63 i A ...;,.....`1;..11' ~ i i i . . ` i 3 ;a. ! s i 5 k .1 > F 1.> Ft l F fi-Q ..G y7, v fL 96 •ti- ~ 1 l ..y...: 5... ~c Lha . 35 3,z-.... N~2- m f f 3 B Clydrv 3 vlt c?v SS irtikk O Ivry-~ ~e i~ 33 ate'" b PRODUCT 205-1 ~ Inc., Groton, Mess. 01471. To Order PHONE TOLL FREE 1-800-22544 r GRIGINAI: SOIL EVALUATION REPOT RECER 1603 Wisconsin Department of Commerce Pa~e 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Allf, 2'/ Certified Soil Testing Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must C unty St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. P rcel LD~Cr.li •-1~4z'l _ Please print all information. revue By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Lamb, John & Cheryl Govt. Lot SE 1/4 NE 1/4 S 22 T 28 N R 15 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 274 310th St. City State Zip Code Phone Number _j City Village 16 Town Nearest Road Wilson WI 54027 715-772-3294 Cady 274 310Th St. New Construction Use: yj Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD ✓ Replacement Public or commercial - Describe: Parent material till Flood plain elevation, if applicable NA General comments ✓ and recommendations: install 2 - 2.7'x 68.42' (St'd - Infiltrator, 22 shells) stipulation 1099 chamber trenches @ system elevations 4.0' below nominal contours as trench center lines FT] Boring # Boring yJ Pit Ground Surface elev. -95 ft. Depth to limiting factor 18 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 1 0-12 1OYR 3/2 - sil 2 12-18 1 OYR 4/4 - sil 3 18-30 10YR 5/4 c2d 7.5YR 4/6 sil 1 OYR 6/2 i Category 1 failure of existing system by WI Fund criteria Fil Boring # Boring Pit Ground Surface elev. 97.2 ft. Depth to limiting factor 86 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 1 0-6 10YR 3/3 - sl 2 m gr ds gs 1f/m .5 .9 2 6-15 10YR 3/3 - sl 2 f-m sbk dsh cw 1 m .5 .9 3 15-38 1 OYR 4/4 - Is 0 sg df cw 1 nn .7 1.2 41, 38-86 10YR 4/6 - Is 0 sg ml - - 7 1.2 I occasional gr & cob in horizon 3 ' Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mgr CST Name (Please Print) Signat re CST Number Henry F. Grote 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 7/28/2002 715-233-0398 Property Owner Lamb, John & Cheryl Parcel ID # 004-1051-50 Page 2 of 3 F3 I Boring # Boring t/ Pit Ground Surface elev. 97.2 ft. Depth to limiting factor > 88 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 ! 0-6 10YR 3/3 - sl 2 m gr ds gs 1f/m .5 .9 2 6-10 10YR 3/3 - sl 2 f sbk dsh cs 1f .5 9 3 10-36 10YR 4/3 - sl 2 m sbk mfr cs 1M .5 .9 4 6-49 10YR 4/6 _ Is 1 m sbk mvfr CS - /.7 1.2 5 49-88 10YR 8/3 - s 0 sg ml - - L.7 1.2 occasional gy si oats on peds in horizon 3; 10YR 4/4 Is bands, irregular & discontinuous: 50-51, 58-59, & 65-66" F4 Boring # Boring Pit Ground Surface elev. 96.4 ft. Depth to limiting factor > 88 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots = in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-6 10YR 3/3 _ sl 2 m gr ds gs 1f/m .5 9 2 6-13 10YR 3/3 - sl 2 f sbk dsh cs if .5 9 3 13-22 10YR 4/4 _ sl 2 m pl ds cs Inn 0 .2 4 22-36 7.5YR 4/4 _ sl 1 m sbk mvfr cs - 4 6 5 36-45 7.5YR 4/4 _ Is 0 sg ml cs - 7; 1.2 45-88 10YR 4/6 - Is 0 sg ml - - .7~ 1.2 6 horizon 6 has occasional stratified 10YR 8/3 s bands Boring # -i Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 2 I I ' Effluent #1 = BOD5> 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) Certified Soil Testing Cif-h~1Z' -z2~2g• w 6..4. n z ~ N y Ic C a R•L~ ff w~ O Lo ~ :x 2z2'~-fit 3~0~ S~. O rS 1 r+u~a cQw.m m ~a = lt 1: 7 7 l v-o .O 11:1.. U r ~K • n ~NC 1C KOQ ( : J .Q aAj ' v a E6 m U ( t~ mmx xi,~ rr.mmi^O.r System Management I ~V ,Management of this system is critical. As a condition of approval of these plans this system management section must be rep revved with the owner, and the owner 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, Timm Excavating, 715-772-3214, 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 svstem and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the berter 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. I If the septic tank is installed prior to sheet-rock and/or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. Install water-saving appliances whenever and wherever possible. Repair even small water leaks as soon as possible. Lever pour grease or oil down any drain or stool. Garbage disposals are not recommended; if you must have one, use it sparingly. 6 \o paper products other than tissue should go into the system. \o chemicals should go into the system A u[c suree flows of water, try to spread laundry throughout the week. C'(X ~y Maintenance /~/f 3 The septic tank must be inspected every three/ftars by a properly licensed person. PAX. K=mfid"a~?, 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. EMMy 3 y9y. 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. 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; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. 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 the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows resern e aoacin to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or dais should pass before any necessary repairs can be made. ~~oid compaction such as vehicle traffic within 15' down-slope of the adsorption system. 8 A ~ otd disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. y Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10 Surface drainage must be diverted around the system; avoid landscape changes which might send surface run-off into the system area. Contingency Plan astewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitorinc ma,, become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 t?) 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 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ~O h `I, za~'m b Mailing Address a 7--/ S~ Property Address (Verification required from Planning Department for new construction) City/State _ CcJG i5 ovi L(1~ Parcel Identification Number DC l0 ~G --l~U~ LEGAL DESCRIPTION Property Location S 1/4, AV 1/4, Sec. 2 Z, T 28 N-RAW, Town of Subdivision , Lot # Certified Survey Map # Volume , Page # Warranty Deed # 3 1 Volume Page # 3Z) Spec house ❑ yes ~C no Lot lines identifiable [Y 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, 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 expiratiion date. D~ L,4 Zy/ eX SIGNATURE OF APPLICANT 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. /ZO/vZ SIGN TURE 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 DOCUMENT NO. STATE BAR OF WISCONSIN-FORM 1 - WA&VATT DEED 9 8 4 4 8 >)09K 503 PACE 30 THIS SPACE RESERVED FOR IMCORDINO OAT REGISTERS OFFICE ii THIS DEED, made between Marvin Timm end Beverly Timm ST. CROIX CO.. WIS.' husband and wife and each in their own ri ht ROC'd for Ro=d this.4t - Grantor day of-Aff&L.....A.Q 19 ' and John Lamb - - --••p • - - Grantee, • Witnesseth, That the said Grantor for a valuable consideration-.____- M Four Thousand Five Hundred and no. 100 Dollars conveys to Grantee the following described real estate in Croix -County, RETURN TO State of Wisconsin: i Commencing at the northeast corner of Southeast Quarter Tax Key N of Northeast Quarter, Section 22, Township 28 North, This is homestead property. Range 15 West, thence South 447 feet; thence West 315 feet; thence North 447 feet; thence East 315 feet to the point of beginning. $ ~jVSF 7 FEE Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining; And Marvin Timm and Beverly Timm warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except and will warrant and defend the same, t Executed at Spring Valley, Wisconsin this day of_ September- 19 73. SIGNED AND SEALED IN PRESENCE OF „ 44.4 ' Z ~ - (SEAL) Marvin Timm (SEAL) Bever -Timm - - - ( (SEAL) (SEAL) i Signatures of Marvin Timm and Beverly Timm authenticated this day of September 1 i Rober . Richardson - Title: Member State Bar of Wisconsin or Other Party I Author ed under Sec. 706.06 viz. I STATE OF WISCONSIN } I1 ss. County. Persnn-*lly_came before me, this. day of _ 19_- , j n the above named - I to me known to be the person who executed the foregoing instrument and acknowledged the same. II I This instrument was drafted by Gavic, Richardson and Skow Notary Public County, Wis. The use of witnesses is optional. My Commission (Expires) (Is) I' Names of persons signing in any capacity should be typed or printed below their signatures. I NQaMMr WARRANTY DEED-STATE BAR OF WISCONSIN, FORM No. I - 1971 ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 • Fax (715) 386-4686 January 17, 2003 John Lamb 274 310th Street Wilson, WI 54027 RE: Wisconsin Fund Grant Application Dear Mr. Lamb: The St. Croix County Zoning Office received a Wisconsin Fund grant application in your name on October 11, 2002. After reviewing this application it was determined that your income did not meet application requirements. We have withdrawn this application and are refunding your fee of $100. This is issued on St. Croix County check #00549521. If you have any questions or concems please feel free to call. Sincerely, ly~ Jane Hansen Zoning Secretary Enc. THIS DOCUMENT CONTAINS MICRO-PRINTING AND A TRUE WATERMARK, HOLD AT AN ANGLE TO VIEW. VOUN l OF S 1 . CROIX I" ' FlRST NATI01M BANK OF M XMft HUDSON: WI STATE OF WISCONSIN VOID AFTER SIX MONTHS (:hock Date perk lh~o. A pount 0l.;W/03 00549521 $100.00 PAY ONE 'HUNDRED DOLLARS AND 00 CENTS ' ny _ TO THE JOHN° L. AMB ORDER OF 274 370TH STREET W1L50i> WI 54027 • 40 9160 2.5 It 71: 52©88 2n' COUNTY OF ST. CROIX y STATE OF WISCONSIN DA VENDOR: JOHN LAMB 101/10/03 00549521 999999 INVOICE DESCRIPTION YOkJOHER:NO:`' Ail(J1+1T:PpriD 01-03-2003 WI FD APPLICATION FEES G0024360 100.00 I 1 Ie I State of Wisconsin WISCONSIN FUND - PRIVATE SEWAGE SYSTEM Safety and Department ot REPLACEMENT OR REHABILITATION PROGRAM Buildings Commerce Division OWNER'S APPLICATION Instructions For Property Owners: TO BE COMPLETED BY COMMERCE You may apply for a grant award for up to three years after you have received Application Number Date Received a determination of failure and after you have obtained a sanitary permit. Complete Part A of this form, attach evidence of your annual income explained in section #7, and send those items to the governmental unit listed below. PART A. TO BE COMPLETED BY THE PROPERTY OWNER Owner Name" Social Security No."" Additional Owner Social Security No."" To k k Vl. m b 3 93 - 56 - f'.Sbs-- -7a V- 57-Address Attach d mentation of additional own 7- ?7y-31otA CEiVED City, State Zip Code Telephone Number (include area code) u)'IsorJ t,~ ' 0 7l5 -77a -3d? T 1 1 2oD2 "Note: Your Social Security Number ay b6RsWtQ1"fXLXWy "Grant awards will be issued in the name and address of this owner. income and status of child support or intenad1Mpt1lCE 1: Was the failing private sewage system serving the principal residence or small commercial establishment constructed prior to July 1, 1978. K Yes ❑ No 2. This application is for (complete both if applicable): Principal Residence Do you occupy this residence at least 51% of the year: _9Yes ❑ No ❑ Small Commercial Establishment Do you occupy this small commercial establishment at least 51% of the year. ❑ Yes ❑ No Small Commercial Establishment Name: Description of Small Commercial Establishment (farm, restaurant, etc.): 3. Was the private sewage system replaced as part of a real estate transaction or change of ownership? ❑ Yes ® No If es, explain: 4. As.the_owner, are you a licensed plumber or contractor engaged In the business of installing private sewage systems? ❑ Yes No 5. Will a portion of this system be funded by another source? ❑ Yes 1A No if es, explain: 6. How did you hear about the Wisconsin Fund-Private Sewage System Replacement or Rehabilitation Program? _'t4 fn 7. Evidence of in me. Attach a copy o your federal i co e. tax return for the year of or prior to the enforcement order or determination of failure if you are applying as a principal residence. If you are applying as a small commercial establishment, submit a copy of your federal profit and loss forms for the year of or prior to the order or determination of failure. If you were married and filed separate forms, you must also include your spouse's return for the same year. You must include evidence of income for each owner (and for each owner's spouse) listed above. Evidence of income will be kept on file at the governmental unit and is subject to verification by the Department of Revenue and by the Department of Commerce. If you or any owner listed above were a part ear resident or did not file an income tax return, contact our governmental unit for further instructions. 8. Property Owner's Certification. I certify that, tD the best of my knowledge and belief, the information I have provided on this form and all attachments are true and correct. Owner's Signature Date Signed Co-Owner's Signature Date Signed OCf • /'O - 200 Z 4= _h Oc f la 2oa Z P nal information you provide may be used for secondary purposes [Privacy Law, s. 15.04(1)( SBD-9163 (R. 1/2000) / 4t_ l o - - v Z y~/r~-o 8 too! ~ p' PART B. TO BE COMPLETED BY THE GOVERNMENTAL UNIT 1. VERIFICATION OF OWNERSHIP Does the owner(s) name(s) as listed on the document used to verify ownership agree with the name(s) of the applicant(sj on Part A of this application? ❑ Yes ❑ No What document was used Document or to verify ownership? Page Number If the applicant answered yes to question 3 on Part A of this application, did the applicant own the property when the order/verification of failure was issued or the system installed and incur the cost of replacement? ❑ Yes ❑ No 2. Is this application for a replacement structure? ❑ Yes ❑ No If es, have all requirements outlined in Comm 87.20 4), Wis. Adm. Code, been met? ❑ Yes ❑ No 3. Is a public sewer available to this property? ❑ Yes ❑ No 4. Hasa previous grant been awarded for this property under this program? C Yes ❑ No 5. Principal Residence evidence of income. Please indicate applicable annual income: $ Federal income tax form Line , Year Affidavit of Year Other form used Line Year Small Commercial Establishment evidence of income. Please indicate applicable annual gross income: $ Profit & loss form used: Line , Year 6. Date of Order or Age of the Determination of Failure: existing failed system: Separating Distance from the bottom of the existing failed system to a limiting factor: 7. Private sewage system failure caused by discharge of sewage to (check all that apply): Surface water or groundwater ❑ Category 1 A zone of saturation . El A drain tile or zone of bedrock ❑ Category 2 The surface of the ground ❑ Category 3 Back-up of sewage into the structure served ❑ 8. Replacement System Type: ❑ Conventional ❑ In-ground Pressure ❑ At-grade ❑ Mound ❑ Holding Tank ❑ Experimental System 0 Monitoring 0 Other, explain Uniform Sanitary Permit Number Date Issued Plan Approval Number Date Approved Experiment Approval Number Date Approved 9. Eligible ❑ or Ineligible 0 Reason ineligible: 10. Governmental Unit Representative's Certification. I certify that I have reviewed and verified all information provided on this form and attachments and that the are true and correct to the best of m knowledge and belief. Signature of Authorized Governmental Unit Representative Title Date Signed