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HomeMy WebLinkAbout004-1052-70-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division ' INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Lamb, Ben'amin Cad ,Town of CST BM Elev: Insp. BM Elev: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PIIMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well Crlll AQCl1DDT1(lAl CVCTFM ELEVATION DATA county: St. Croix Sanitary Permit No: 106 State Plan ID No: Parcel Tax No 004-1052-70-D00 Section/Town/Range/Map No: 22.28.15.351 A10 STATION BS HI FS ELEV. B chmark I. M Bldg. Sewer St/Htlnlet I I SUHt Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: INFORMATION Type Of System: UNIT Model Number: 111CTDIQIIT1/1A1 CVCTGM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing C l1n /~P1VCD _..,____..__ c-._a_...,_ ~_i.. .... nn.......~ nr e-_!_r~~Jc CvcTamc r)nly Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1 Location: 250 310th Street Wilson, WI 54027 (NW 1/4 NE 1i4 22 T28N R15W) NA Lot 1 1.) Alt BM Description = r 2.) Bldg sewer length = - amount of cover = ! ~ / ~ ~ ~ ~ ~irSJ~~ ~ ~ / Plan revision Required? ~ ! Yes ' i No i ~6 IZS ~ O ~ Use other side for additional information. - Date SBD-6710 (R.3/97) / / Inspection #2: / /_ Parcel No: 22.28.15.351A10 __ __ - ~--- 6~~ Cert. No. ty ~ County Sanitary Permit Application sT. cROlx couNTY wiscoNSIN T t~ ps- In accord with Chapert 12 St. Croix County Sanitary Ordinance PLANNING ~ ZONING DEPARTMEN ~i Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER 6~~j~0 ~' ~ [Privacy Law. S. 15.04(1)(m)] 1101 Carmichael Road WI 54016-7710 d H $t• ~ ~ son, u P 715)386-4680 Fax (715)386-4686 Attach com lete tans for the s stem on a er not less than 8-1/2 x 11 inches in size. County Sanitary Permit # ^ Check if revision to previous application o/tS(o I. A lication Information -Please Print all Informa on Location: Property Owner Name NE 1/4 SE 1/4, Sec BEN LAMB (BENJAMIN) AUG 1 4 2006 28 N, R 15 E (or w Property Owner's Mailing Address CROIX COUNTY ST Lot Nu Block Number . 25A 310TH STKEET 1 N A City, State Zip Cod one umer Subdivision Name or CSM Number WILSON, WI 54027 715/772-4876 653804 II Type of Building: (check one) D~ aD ms lli N f E3 d ~] il D 3 amity ^Village Town of : o. o e roo ng - i or 2 Farn y we ^ Public/Commercial (describe use); 5~~..~-e ~J~Q CADY ^ State-owned ~u./~-- Nearest Road licable) k box on line B if a li A Ch l b h k 310TH STKEET pp ox on ne . ec on y one il. Type of Permit: (C ec b T er(s) ~ ax Num Parcel A) 1.^ Repair 2. ~I Reconnection 3.^Non-plumbing 4. ^ Rejuvenation 04-1052-70-U00 cYc ^B - Sahitation Permit Number Date Issued e) ~ State Sanitary Permit was previously issued ~ 9-19-2UU1 ~ IV. Type of POWT System: (Check all that apply) ^ Non-pressurized In-ground ^ Mound t 24 in. suitable soil '1(} Mound 5 24 in. suitable soil ^ Mound A+0 ^ Sand Filter ^ Constructed Wetland ^ Peat Filter ^ Drip Line ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Other ^ At-grade ^ Aerobic Treatment Unit ^ Recirculating V. Dis ersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soi! Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed (Gals./day/sq.ft.) (Min./inch) Elevation 45U ~ 450 450 1 N/A 98.94 100.77 VI. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- l Plastic New Existing Gallons Tanks Concrete structed ass g Tanks Tanks 1000 1000 1 HUFFCUTT 0 ^ ^ ^ ^ 600 600 1 - ^ ^ ^ ^ VII. Responsibility Statement I, the undersigned, assume responsibility for repair/reconnenction/rejuvenation/installation of non-plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the installation of non- lumbin sanitation system. Plumber's Name (print) Plumber's Signature (no stamp~)• MP/MPRS No. Business Phone Number BENNIE HELGESON 220292 715/772-3278 Plumber's Address (Street, City, Stat ,Zip Code) 6J1229 770TH AVENUE, SPKING VALLEY, WI 54767 VIII. Count Use Only Approved pi caner Giv (Hill dverse Sanitary Permit Fee ~ z~~ ~ Da a Issyyed p' fG~/Q~ o Issuin ent Signature sta p ) Dete ion IX. Conditions of A rovallReasons for Disapproval: SYfITf~OWNER: 1. Septic tank, effluent flaer and dispersal cell must all ~g services !maintained as per management plan provided by plumber. 2. AU setback requirements must be maintained ore per applicable code / ordinances. ~~ J ~(3 _~ ~. Q i d ~ / \~ 1 ~ ~- as ~~ ~ ~ ~ ~~~ ~ ~ o 3 ~ ~ -~ ~~J ~~ ~ ~~~ _~~\ of ~ ~ ~~~- pa a ~ ~. Q ~I f - sac- .~\ ~, , ,'' ~ }~,~'~ ~ 3 ~, Gu, six '~ ~- ~,.... V a Q lr1r ~~ ~ ~ ~ ~ ~ d N ? c ® ~ d Q. ~ o 'S -~ x ~. ~ - ~~ `~ N W Q Q/ Y `~ ~ Ct '~ 1 '9 1~ J .,r 4 ~J r ,, a S3. v O M 0 c~ T ' ,1 ~~ ~~ d ~ V;I ~1 ~' b ~ a, \~~ ~ ~ ~~ ~~ ~~ ~- ~Q 3 ~ ~V ~` ;D S J ~ y ~ '~ ~ °~~ V ~ f . S ~ ,~ ~-E- O h ~~ o 9.. J~\ ~ o ~,~ ~I o~ t-.~- 6u ~ s. ~~ ~ ~ w ~ N ~ ® s1,,, 4 ~. i c / / ~ ~. 0 Q~ r 1J v ~+ HELGES N EXCAVATI N, Inc. SEWER AND WATER SPECIALISTS Plumber/CST Cert, #220292 BEN HELGESON Office (715) 772-3278 W. 1229 770th Ave. Home (715) 772-3127 Spring Valley, WI 54767 Fax (715} 772-3387 August 8, 2006 St. Croix County Zoning 1101 Carmichael Drive Hudson, WI 54016 Dear Sirs: I have inspected the mound sytem on the Ben Lamb property and find it to be in working order at this time. Sincerely, ~`fwL.` ~~~~ Bennie Helgeson President BH:cb Floor Plan --HDA0217 $Prtnt VQ Pa#io Cara ~ ~ _ v ~-~ Ki /Qi ~ r. 9 n t 12- x ~~-~ X 23-5 ~ P 7-fix 14-~ . ~- ~; ~:w~~ ~ 4-6 ~, _~ ~fifll~i; ~-- na ^ dam. fir Br ~ . . 17-6 x 14-7 ~ 12-1 x 12-2 x ~a$ ~ s-o 11 ~3 11-3 t~ - - . ~ . CcwBred Parch 23-4 ~ 8-0 The Brightmoone House Page 1 of 1 cr~.® http://www.menards.com/web/pages/components/featuredProjects/homes/floor~lans jsp?c... 8/3/2006 ST. CROIX COUNTY No.sTO- o ~ o ~. SANITARYPERMIT OWNER V~e~ Lct~nn~Ll PLUMBER I~ent~~ ~. ~t~~c~e t~~ LIC. # ZZtSZIZ TOWN OF Cad LOCATED ~~ ~~ SEC ZZ T ~~ N;R l5 AND/OR LOT ~ BLOCK G5~'1 ~ 5/ ~`/~~ THIS PERMIT EXPI TWO YEARS UNLESS RENEWED BEFORE THAT DATE DATE OF ISSUANCE POST I N PLAI N VISIBLE FRDURWG CONBTR ~T ON THE LOT SUBDIVISION REPAIR ^_ RECONNECTION NON-PLUMBING ^ SANITATION REJUVENATION ^ (a) The purpose of the sanitary permit is to allow repair, reconnec reJuvenation, or installation of non-plumbing sanitation as described in application for permit. (b) The approval of the santtary permit is based on regulations in force on the date of Issue. (c) The sanitary permit is valid for 2 years from original date of Issuance a may be renewed for similar periods thereafter. Application for renewal shall made through the county and shall comply with regulations in effect at the tii (d) Changed regulations will not Impair the validity of a sanitary permit until the time of renewal. (e) Renewal of the sanitary permit will be based on regulations In force at 'the time renewal is sought. Changed regulations may Impede renewal. (f) The sanitary permit Is transferable. A sanitary permit transfer shall be obtained from the St. Croix County Zoning Department. AUTHORIZED ISSUING OFFICER -DATE g ~ VIEW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety apd Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Lamb, Ben'amin Cad Townshi CST BM Elev: Insp. BM Elev: BM Description: / , ~/ e TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic 4d Dosing Aeration Holding -_ TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ p u i QQ 77 ~ 3 ~ + / y ~ Dosing ~ ~`~ , v ~ ~(,, ~. 2- ~ , Aeration .g PUMP/SIPHON INFORMATION Manufacturer ~ 6 e~ Model Number TDH Lift r ~ Friction Loss S' ~~ Forcemain Lengt~ U, Dia.Z !I SOIL ABSORPTION SYSTEM GPM ~ ~•/~ )H Ft ~A ~ ELEVATION DATA county: St. Croix Sanitary Permit No: 399402 State Plan ID No: Parcel Tax No: 004-1052-80-000 STATION BS HI FS ELEV. Benchmark ~ %a ~6 Alt. BM 3.z Bldg. Sewer 9spz Ht Inlet ~ Z ~ S.S SUHt Outlet Dt Inlet Dt Bottom / ~ Header/Man. 3 ~ A / / Dist. Pipe ~~; ~ S,L~ Bot. System , q,~ R / Final Grade St Cover M ~ 2 Z-`~ 3 2. ~f> BED/TRENCH DIMENSIONS Width ~ ~ Len / ~ No, Of Trepches Z (/_J G ~- ~ PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO P/L BL D G WELL LAKE/STREAM LEACHI nufacturer. INFORMATION CHAMBE Type Of System: ,~~ ~ t ~ ~ ~ ~S ~ - Model Num DISTRIBUTION SYSTEM Header/Manifold i /i Length ~ Dia Z Distribution Pipe(s) r / ~~ ~ ~ Length3~ Dia Spacing x Hole Size ~ /~ x Hole Spacing ~ :i Vent to Air Intake ~/ SOIL COVER Y Procm~ro Sve4am¢ Anly YY Mnund Ar At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed(rrench Ed es g To soil p ^ Yes j No . Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) ~S `pIn(s~pec~tion #1:~/ Z,~/~ Location: 250 310th Street Spring Valley, WI 54767 (NW 1/4 NE 1/4 22'T28N R15W) NA Lot 1 1.) Alt BM Description = ~ at I,~le ~I 2.) Bldg sewer length = ~8 ~ ~ - amount of cover = y l~'r' ~/ 3.) Contour = y, L ~/ k , 2 d ~ Q ~ (+z 2 Inspection #2:~/ Zl /~~s Parcel No: 22.28.15.252 Plan revision Required? ^ Yes No G~ Use other side for additional informati l Z Date Insepdor's Sig ure SBD-6710 (R.3/97) ~` Cert. No. Q~ ~ ~~s3~~5" Safety and Buildings Division County ~ 201 W. Washington Ave., P.O. Box 7162 ST . CROIX SC~~SI J~ Madison, WI 53707 - 7162 Site A s - De artment of Commerce ~ZSa 31Dr Sanitary Permit Application sari Permit r Z ~ ~~ In accord with Comm 83.21, Wis. Adm. Code, personal informati e ~ j ~''` ! - ^ Check if Reviston tna be used for seco ses Privac Law, s I. Application Information -Please Print All Information ,~ '~ ,,` ~;> ~ State Plan LD. Number Site Id # 531362 ` ~ ' Tr n 651607 ~~, ~~ ,r Property Owner's Name Parcel Number ~ a F` '1' Benjamin LAMB & Brenda Lamb •- '~ - 04-1052-~0-000 ~ 004-1052-80- Property Owner's Mailing Address ,~~ X ~~ ~ ~ Property Location 109 Glen View Drive 6' 5"( W&NE~SE ~,~; S 22 T 28 N R15W /E/ City, State Zip Code Phone Lot Number B 1oc,ANumber Glenwood Cit WI 54013 1 65-7 N !/ y tp Subdivision Name CSM Number L ° N/A II. Type of Building (check all that apply) ~ ~ ~ ~ 3 ^Ciry 1 or 2 Family Dwelling -Number of Bedrooms .~vw.,.r. nler ^VIllage ^ Public/Commercial ~ sc ' Use f ~1'ownship Cad ^ State Owned t « r ~~ Barest Road t X ~ ~ ~`p ~ ~. 3~ 'b, ~ S 310th Street III. Type of Permtt: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A' 1 ~ New 2 ^ Replacement System 3 ^ Replacement of 6 ^ Addition to For County use S stem Tank Onl Existin S stem B. ^ Check if Sanitary Permit Previously Issued Permit Number Date Issued ]V. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 ^ Non -Pressurized In-Ground 21® Mound 4? ^ Sand Filter SO ^ Constructed Wetland 22 ^ Pressurized 1n-Ground 41 ^ Holding Taiilc 48 ^ Single Fass 51 ^ Drip Line 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other V. Dis ersaUTreatment Area Informat ion: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevadon Final Grade Required Proposed Rate(Gals./Days/Sq.Ft.) (Min./Inch) Elevadon 450 450 450 1 NIA 98.94 100.77 VI. Tank Info Capacity in .Total Number Manufacturer Prefab Site Steel Fiber plastic Gallons Gallons of Tanks Concrete Constructed Glass New ExisCuig Tanks Tanks Septic or Holding Tank 1000 - 1000 1 HUFFCUTT CONCRETE X °osing ~"'~" 600 600 1 HUFFCUTT CONCRETE X VII. R onsibility Statement- I, the undersigned, assume respo 'bility for Installation~of the POWTS shown on the attached plans. Plumber's Name (Print) PI is Signature MP/MPRS Number Business Phono Number Bennie Helgeson 20292 715/772-3278 Plumber's Address (Street, Ciry, Spate, Zip Code) W1229 770TH Avenue, Spring Valley, WI 54767 VIII. Coun /De artment Use Onl Approved ^ Disapproved ~~5' Petmit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) - ^ Owner Given Initial Adverse . Surcharge Fee) ~ ~ Determination 32s. IX. Conditions of ApprovaUReasons for Disapproval t tt~ c~.~ t~~, ' ~-~- ~ ~ ~~ ~ Pte' ;M ~..,~,~e,,~.t~~s . C M. ,tm,e. ~ tom... . A 2.n~ 1 . Attacalp~mplets plans (to the County Dolt) for the system on papa not less than 8111 Y Il inches In size 8D-6398 (R. 05!01) ;~. c,. ~~ Q --~-- a 4 ~~ ~~ ~~ i ~ ^~ _.{ LJ ~ ~ -+- v `J i ~ . ~ ~. ~ ~ ' ~ r- ~ ~ j j 4 1 L I L Z ~ ;, ~ M ~~ t_ s / ~ B ~ ~ ,C ~\ / ~ I Y b °' 4 I 1 i ~ i ~ ~ ~ ~ ~ ,~ ~ `a ~1 J s ; 4 ~ ~ / ~~ J% ~ / .L I ~ r i ^; ~ o ~ ~~~ v ~' ~ L Q ~U W k ~ ~~ ~J~ ~ 0 --t, ~o y ~ u '~ q ~~ ~~ ~.+U ~:1 q ~ ~` ~ Q1 ~ Q 0 ~~ ~~ ~ ~ ~ i ~'a o ~~~ rI ~ ~ ~_ L `; ~~ ~ ~/? ~~~ I i i f ~3 ~~~ ~~ ~' ~ ~ ~ i~' ~ i i / J ~l, ~~ w~ i ~~ / L E- r ` 3 o ~~ ,, _ ~. ` n~ ,~I V 1 "~J s - ~ ~ ~scons~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD lA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi.us/sb www.wisconsin.gov Scott McCallum, Governor Brenda J. Blanchard, Secretary June 22, 2001 CUST ID No.220292 BENNIE W HELGESON W 1229 770TH AVE SPRING VALLEY WI 54767 `.`'' CONDITIONAL APPROV PLr,N APPROVAL EXPIZ2 SITE: `~/ BEN LAMB ~`' 310TH ST ~., TOWN OF CADY ST CROIX COUNTY NE1/4, SE1/4, S22, T28N, R15W F. "~~, ~ • ~ ~~ fi,. ~~~-~~ i~'~l ~`'~'?.~ a: ~~~~ ST CROiX i zor~~'o~ICE ; C' s~ `1 A7TN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD `~. HUDSON WI 54016 " ~! Identification Numbers 4L+1 Transaction ID No. 651607 <~`~'! Site ID No. 631362 ;~ ~ Please refer to both identification numbers, above, in all comes ondence with the a enc . FOR: DESCRIPTION: THREE BEDROOM MOUND SYSTEM OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 797345 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "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). In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the Mound manual, and section VI of the pressure distribution component manual are complied with. A copy of this letter including instructions and information relating to proper use and maintenance of the system must be given to the owner and each subsequent owner upon completion of the project. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stars. • 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). In addition, 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. BENNIE W HEI.GESON Page 2 6/22/01 • 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 83.52(3) The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. A copy of the approved plans, specifications and this letter shall be on-site durjRg construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence maybe made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, ~~12 Charles L Bratz POWTS Plan reviewer II- Integrated Services (608) 789-7893, Mon.-Fri. 7:45 AM to 4:30 PM cbratz@commerce. state.wi.us FEE REQUIItED $ 175.00 FEE RECEIVED $ 175.00 BALANCE DUE $ 0.00 WiSMART code: 7633 cc: BEN LAMB 4 - ~ ~r iscans~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi.us/sb www.wisconsin.gov Scott McCallum, Governor Brenda J. Blanchard, Secretary June 22, 2001 CUST ID No.220292 ATTN. POWTS Inspector ZONING OFFICE BENNIE W HELGESON ST CROIX COUNTY SPIA W 1229 770TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/22/2003 Identification Numbers. Transaction ID No. 651607 SITE• Site ID No. 631362 BEN LAMB Please refer to both identification numbers, 310TH ST above, in all corres ondence with the a enc . TOWN OF CADY ST CROIX COUNTY NE1/4, SE1/4, S22, T28N, R15W FOR: DESCRIPTION: THREE BEDROOM MOUND SYSTEM OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 797345 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "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). In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the Mound manual, and section VI of the pressure distribution component manual are complied with. A copy of this letter including instructions and information relating to proper use and maintenance of the system must be given to the owner and each subsequent owner upon completion of the project. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • 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). In addition, 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. BENNIE W HELGESON Page 2 6/22/01 • 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 83.52(3) The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. A copy of the approved plans, specifications and this letter shall be on-site duri~Ig construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, ~ ~~ Charles L Bratz POWTS Plan reviewer II- Integrated Services (608) 789-7893, Mon.-Fri. 7:45 AM to 4:30 PM cbratz@commerce. state. wi.us FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 BALANCE DUE $ 0.00 WSMART code: 7633 cc: BEN LAMB R j > INpEX SHEET PROPERTY OWNER: BEN LAMB 109 GLENVIEW DRIVE GLENWOOD CITY, WI 54013 PROJECT NAME: BEN LAMJ3 PROJECT LOCATION: NW 8c NE 1/4, SEl/4, S 22, T28 N, R, 15 W MLTNICII'ALITY: TOWNSHIP OF CADY COUNTY: ST CROI~ DESIGN: CONTENTS PRESSURE DISTRIBUTION MANUAL: SBD-10573-P (86/99) MOUND COMPONENT MANUAL: SBD-10572-P (86/99) Page 1; Plot Plan Page 2: Page 3: Page 4: Page S: Page 6; Page 7: Page 8: Page 9: Name: Bennie Helgeson Address: W 1229 770Th Avenue Spring Valley, WI 54767 Credential number: 220292 Cross Section & Plan View of Mound Distribution Pipe Layout ~~4 s9,~ ~Gti 4 F/~ ~ . FO ~;~ ~G ~~i ~~ `°~s Septic Tanlc & Pump Chamber Cross Section & Specs. Hufl'cutt Tanlc: Tanlc Specifications 870650 Pg. 1 Tank Specifications 870650 I'g. 2 Pump Specifications POWTS Owner`s Manual & Management Plan POWTS Owner's Manual pg. 2 Signed ~?~ ~-,~ z~=~~ Cvn~tionally Date: June 5, 2001 APPROVED p~W1R1Ml~fT OF f.~IERCE rM~i~L~~~~ .0{ ~ .~..... ~ ~6C r / i r fTI ~~ ~> ! c ~:; ~ ~ ~~ ~r ri '" I b p -i ~ _ g N ~ .~ v ~ ~~ i o ~ ~ ~ Q ~ ~ ~ 0 _ ~ ~ ,6 A S ~ • ~ F' mn r cn ~ F~ T o ,~ ~ - ~ ~ r~ ~ ~ ~ ty ^ ~ ~ O` ' r~ r orf t~~OCII /P~ 5 ~ ~I ~7s= ~ °~ Rt c~\ o° ~ ~ ~' s ~ h cr- ~~ ~ ~. ~ '~ ~~ r r i r 'f ~ I I T. ~. r i } 0 rt ...b ~; *'~l ~ ~ ~~ ~~ ~~ i ~ ~ P I ~ , A I c R ~ ;~ ~ r ~ ! ~ ~~ ~ e ~ ( s ~ c ;T ,~ r ~c ~~ ~:; ~. t F; ', ~I 4 I G T ~~ ~T, ~. ~ Q~ ~~ .G ~~ / ~ ~ Synthetic Covering ;~-tS7"M C 33 Medium Sand -~ Topsoil - __._J ~ 3 Slope c«.kof 2"- 2 Aggregate -' Cross Section Of A Mound Page ~- Of 9 Distribution Pipe K- ~ io~.77 G F -,tom, yg-~1 D / ~ :u. q).~ Force Main From Pump A ~v Ft. Signed: B 7s Ft. License Number : K /C, ~e3 Ft . L 9sy~ Ft. Date: ~ ~_ Ft. T /~.5' Ft. W ~y, y Ft . L --` w L ~ -. Plowed Layer D ~ Ft. E /~8~ Ft. F a$3 Ft. G ,S Ft. H / Ft. Observation Pipe d ~ K ~ a A ~ - ~ ------------------------------------- I - -j ~ .~ ,,, Distribution ~~l.L Of 2 - 2 2 Pipe Aggregate I Observation Pipe Plan View Of Mound End Vlew Perlorole0 n ~ol~ Pvc Pipe , E ~ Mar, Q~~ ~ ~ Holes Located on Bottom are Equally Spaced L I'~rC 1 ~ Ln A/~ r~/------ •!-rI'ST {~l~~e /V~xT ~"o /'(tlvt,io{~ OlctrlDullon..• ' Plp~ Distribution Pipe Layout P 7y` Signed: License Number: Daee: R 3~ s X ~y rr .. ~ ~ '. Y r Hole Diameter 8 Inch Lateral " ~ i Inca (es) Manifold " ~ Inches Force Main " Inches iA,~VER`~ ~I~e~. 99 yy Ro ~ •e 5 ~P r F- 0.~ e rG I k 2 ~a~-e -- w~ S `1 ~ ~o~~S ~~ ¢~I C )ea~.o~--~ PerlorolnA rlp• Deloll ~cl~'5c (!~Yl f .r ~ ~~1 ~ Y'7 COMBINATION SEPTIC TANK/PUMP CHAMBER (No Scale) ,Approved Locking Manhole Cover With Warning Label Attache d ~~~s~~ ~ ~~o.. ~'l~-S y~~m~~ Weatherproof Junction Box hti~~ Page_~ Of ~'_ Approved Yent Cap 4" CI Vent Pipe with Approved Cap, +25' From Buildings J 12-' Mi n~mum 4"Minimum Quick Disconnect 18" Minimum 1/4" Weep Hole Baffler Approved Joint 2ARl.E. w/C.I. Pipe F~I.t'~c~ Extending 3' ~nt0 SOlld $C)11 ~a''x/~ri i I i ---~ ~ Alarm ~ On 6 A B I C Off D Approved Joint w/C.I. Pipe Extending 3' Onto Solid Soi Conc. Block 3" of Bedding Under Tank--J 7oTal Gad. 1=h L.cil-erals ("3,~~ G~IIonS Note: Pump and Alarm Are On Separate Circuits Tank Manufacturer: k S' a-Se tic/Pu Gallons Dose. volurn~ ~.,., ...... •••~ ~. 3 Volume of Backflow:.......+ Gallons Total Dose Yolume:........~~ /,~' Gallons pan iz p -~ Alarm Manufacturer: ~' r C f~~>` ~ c', ~~~ Capacities: ADO, inches or 30 Gallons Model Number: + B inches or o.,LGallons Switch Type: ~ ~ + C'~_ inches or~~allons Pump Manufacturer: + p ~ inches or ~/~,~Gallons Model Number: i,t_? o ~ '~ _yinches or. Sallons Minimum Discharge ate: 31 i~~ - 7ota1.....° -~ 9 Feet Vertical Difference Between Pump~Off and Distribution Pipe+ Feet Minimum Required Supply Pressure; :.................. . jp0 Feet of Force Main x 2..~ Friction Factor/100 Feet: +~~ eet ~_Inch Diameter Force Main ,1 Total Dynamic Head:...=/ ,b2Feet ?nternal Tank Dimensions: Length__; Width L//iquid Depth/ ~~~~ ~ /S. ~ G~~ T`'h~~`t l D a t e_______ Signature ~ ~~/~ _License Number~~°s' TOP vlEw OF COVER I 29' DIA. I 1.5' 26' DIA. 1.5' ----------J LIFTING HOOK N \. (TANK BASE) _ 5' DIA. ro 27' DIA. a,5' 1.5' 2 a• DIA. 1.5' ^~Q ~- ~ 3.5' I, ~.~, ~, W~ ' O s Z `~ y N i ~o~ `y ,~ OUTLET T d a ~~ ~~ gs ~~ ai W W ~r ~ K Z u ~+ ~~ N N Qa u" W ~ ad N 2 ~u i ii ~- m W ru w~ a~ ~ N In f- i N {{ ~ fL fW-0 a Q` ai 4 W (~ A v c~ g 1~ u W n U v, z~ X U F- 'O c ~ ~ U ~ LL ~ L~ „ 0 D 0 ~- O J n J 4 ~ Q s{ c O Y ~ a' Z o u i Q o .- ~ .-. W H WARNING LABEL EMBEDDED INTO CONCRETE COVER READS AS FOLLOwS~ I CAUTION DO NDT ENTER WITHOUT PROPER VENTILATION. COULD CAUSE DEATH...DANGEROUS GAS. TANK SECTf0~' "HRU HASE, TOP, AND COVER 29' DIAMETER CONCRETE\ COVER ~ SEE 'ACCESSORIES' FOR OTHER CD\/6~ OPTIONSI y)O 0:~ ') . ~~ '~ O Z J G SHEET 2~2 SQRTANK3 TANK IS LABELED 'HUFFCUTT - 1000 600' USING 2' HIGH LETTERS FORMED INTO CONCRETE -~ •I r 0 O A r D Z 1 D x a+ D N t1 r 0 C d f'T D V D i 0 tU ~O D r r 0 z D 0 z V7 I I 200007 81 ~~~ElVED MAY 2 4 2000 SAFETY & BLDGS. OIV. v r D Z C O TI D 2 x 1 C7 ~ o~q `~ H U F~ C U T T C D N C R E T E 737 HERBERT STREET MEMBERS ^F; r--~ VI TANK s7obso CHIPPEVA FALLS, vl Sa729 A = NATIONAL PRECAST CONCRETE ASSOCIAT: ~•• D ~ m 1000/600 GALLON (715) 723-7aao ^ FAx (715) 723-7111 (g00> 924-1516 VISCONSIN PRECAST CONCRETE ASSOCIATIC~• W ~ ~ SEPTIC AND PUMP TANK THIS DRAVING SHALL NOT BE COPIED DR SUBMITTED TQ QTHERS vITHQU7 CONSENT OF THIS COMPANv v 30' 12' 30' BAFFLE m N W d W ~ A l11 l11 J c11 a V C1~ b7• I 72' I I I I 7$• I I I 78' -_ u~n~i fluent Performance Curves ~~~ METERS FEET 25 ~ 70 I 20 60 O H ~ 15 40 10 ~ 20 5 10 0 0 MODEL 3$85 SIZE 3/a" Soli - I I I I I I I I I 1M 11/1 1X1 0 10 20 30 40 5U bu /V w ~., ,.... ~- 1 20 0 10 caPac~Tv GPM J 30 m'/h ~GOULDS PUMPS.INC. SEA ~ -~,~ ~e `_. MODEL 3885 SIZE 3/a" Soli 0 10 20 30 40 50 60 70 90 yU wV 1 IV IN aarm 1 1 1 0 10 40 30 m'/h caPaciTv •1985 Goulds Pumps, Inc. EHacfivsJuly,1985 METERS FEET 120 110 100 30 90 25 ~ 70 x 20 so 0 1s 50 ao 10 ~ 20 5 10 0 0 POWTS OWNER'S MANUAL & MANAGEMENT PLAN page ~ ot~ . ~u _E INFORMATION .Owner BEN LAMB Permit # nlcs>IrN PARAMETERS Number of Bedrooms 3 ~ ^ NA Number of Commercial Units ~ ~ NA Estimated flow (average) 300. aUda Design flow (peak), (Estimated x 1.5) 450 aVda Soil Application Rate aUda /ftz Influent/EffluentQuelity Monthly average' Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODb) 5220 mg/L Total Suspended Solids (TSS) 5150 m /L Pretreated Effluent Quality ^ NA Monthly average"" Biochemical Oxygen Demand (BODb) 530 mg/L Total Suspended Solids (TSS) 530 mg/L Fecal Coliform (geometric mean) 510' cfu/100m1 Maximum Effluent Particle Size Y inch diameter SYSTEM SPECIFICATIONS Septic Tank Capacity 1000 ai ^ NA Septic Tank Manufacturer HUFFCUTT CONC. ^ NA Effluent Filter Manufacturer ZABEL ^ NA Effluent Filter Model A-100 12" X 16 "^ NA Pump Tank Capacity al ^ NA Pump Tank Manufacturer HUFFCUTT CONC. ~ NA ,Pump Manufacturer GOULDS PUMPS Ili NA Pump Model WE03L MODEL 3885 ^ NA Pretreatment Unit ®NA ^ Sand/Cravel Filter ^ Peat Filter O Mechanical Aeration O Wetland O Disinfection ^ Other. Manufacturer Dispersal Cell(s) O In-ground (gravity) ^ in~round (pressurized) ^ At-grade ®Mound ^ Dri -line ^ Other: • Values typical for domestic (norrcommerclaQ wastewater and septic tank effluent. *+ ~ Values typical for pretreated wastewater. ^.wurresrw~~r+c er~ucn~n G ~nnu~ ~ c~sr~~............~......,..~ Service Event Service Frequency Inspect condition of tank(s) At least once every 2 ^ months ®year(s) (Maximum 3 yrs.) Pump out contents of tank(s) ~ When combined sludge and scum equals one-third (Y) of tank volume (nspect dispersal cell(s) At least once every 2 ^ months ~ year(s) (Maximum 3 yrs.) Clean effluent filter At least once every 1 ^ months . ~ year(s) Inspect pump, pump controls & alarm At least once every 1 ^ months ~ year(s) ^ NA Flush laterals and pressure test ~ At least once every 3 ^ months ~ year(s) ^ NA other, At least once every ^ months ^ year(s) ^ NA over. At least once every ^ months ^ year(s) O NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual canying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer, Septage Servidng Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y,) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatment components; and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION. For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the Veatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank{s) removed by a septage servicing operator prior to use. Page ~ of _~___ 9y'stem start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess ' wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. , . Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss;'diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMlVIENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with ch. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space Titled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ^ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction.and should not be infringed upon by required setbacks from existing aid proposed stivcture, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ^ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and . site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a ' holding tank may be installed as a last resort to replace the failed POWTS. ~ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAYBE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name HELGESON EXCAVATION INC Phone 715/772-3278 SEPTAGE SERVICING OPERATOR (PUMPER) Name JOHNSON SANITATION Phone c~15/273- 5811 ,. POWTS MAINTAINER Name JOHNSON SANITATION Phone 715/273-5811 LOCAL REGULATORY AUTHORITY ' Agency ST CROIX COUNTY ZONING OFFICE Phone 715/386-4680 `~`'~ This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agendas. This document meets the minimum requirements of ch. Comm 83.22(2)(b)(1)(d)8~(f) and 83.54(1), (2) & (3), Wisconsin Adm(nistrative Code. Use of this document does not guarantee the performance of the POWTS. GMW (Z/01) ^' • .rR wisoonsinDepartrnentofCommerce SOIL EVALUATION REPORT Page / of 3 Divisien of Safety and Buildings - in accordance with Comm i~5, wis. Ram. was County t Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan mus include, but not limited to: vertical and horizontal reference point (BM), direction and north arrow, and location and distance to nearest road. scale or dimensions ercent slope Parcel I.D. ~ -- / 6 ~ - v , , p Please print all lnformaBon. m)) 1) 04 R awed by Date 9~ >~° . ( ( u provide may be used for secondary purposes (Privacy t.sw, s. 15. yo Personal information L ~ Property Owner L / tGt r >'~S ~ Gzw~ b P~t'tY motion ~ ~ 1/4 5~ 1/4 S ,~~ T ~g N R 1 S E ( W ~, lot ~ ~ A Propernnty //wner'sM7ailing lA1ddres<s~ L ocy ~P J ~C~ `I'~1 J~-r-GCI i.o~t #//AI B/Al1o/c~(k # Subd.~JN/arne or' CSM# /VK I ~fj / Cgy State 7~p Code Phone Number ^ City ^ village own Nearest Road ^ New Construction Use: Residential / Number of bedrooms ~_ Code derived design flow rate ~~~ GPD . ^ Replacement ^ Public or oommerdal -Describe: ' ~~ R y flood Plain elevation ii applicable Parent material c / • r General comments /Vj~u,~ ~" ~ ,s fCvrt and recommendations: C orri~ou~ ~/e~, `~7. ~ '! '~ d ~ ~ C ' ~ e r ~ 75 ~ 1 u5~ ~~'' ~jQn~ u~~c>'er- UdOfJP~- ~cp~ o~ C e ~l , _--~ ._ - ~~ <~e~ r-i~~. 9~.qy z.;gax °'A~ i r.-,, . U Boring? ""w! y Boring # ~NlHG Q p Ground surface elev. ~~ 5 S ft. Depth to limiting factor ad .,~ .~~ Stnuture Consistence Bound Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz Cont Color Texture Gr. Sz Sh. ' ~Etf#2 a ~ © ~- w. b r ~ t ~ , S t v 4 f~~ (o ~ N~~ S w. sb v ~ ~ ~ o ~1 . 6 ...- L-- ® Boring # 1--) Boring Pit Ground surface elev. 9s` y ft. Depth to limitng factor ~_. in• ~I IcaUon Rate i xture T Structure Consistence Boundary Roots GP D/fP Horizon Depth Dominant Cdor on Redox Descript e 'Eff#1 'Eff#2 in. Munsell Qu. Sz Cont Color Gr. Sz. Sh. i I ~-~ ICS R ~" - S (L ~ ~SS~ ~ c~ r~~ ,S $ 1 a -i ~~y~ ~ - s t y ~sb~ h ~ ~ s ~ ~ ~~ C3fi p si vas (, r t~F ~(o ._ • Eflluent #1 = BOD > 30 _< 220 mgll. and TSS >30 _< 150 rng/L ' Eflluent #2 = BOD _< 30 mgll and TSS _< 30 mglL CST (Please Print) Signature CST Nurrrber fl ~aoa 9~ ~ vt ~ r ~e -~ 1 CAS O c-~ Telephone Number Date Evaluation Conducted _ Address f f ' 1 ~1~~ coq ~ /~ rr ~~-~,~G lla ll-e~ l~tJo . ~_3 _ D~ (7~s~ 7~d -3a~~ S y~67 ~C/~~ C/l///~///////~ A., Property Owner C ~Qr' ~es ~vvt.~ Paroel ID #.. .. _...... Page... ~ of ~_ .. U Boring- ri # B _ .._.__ _ .. _ .. _ _ . ~ ._.. . . _.._ _ o ng ~--~ 3 L~ Pit ~ ,Ground. surface elev _ 9k. s5 tt. DeP~ ~ limiflng in. ~~ Soil ication Rate Horizon Depth Dominant Color in. Munseil a - i ~ ~ o~~~ ~3 ', . Redox Description Qu. Sz Cont. Color - a~ Io ~ Texture ~ Structure G?: Sz: Sh. L Sb ~~ Consistence :Boundary ~ ~,,~ Roots i`' ~~~ . GPD/ff _..... s ~ ~ . ~~ , b ~- - a "o Y % -~a ~ (o ~ ~-~~ S ~ r ^ Boring # U Boring pit Ground surface elev. ft. Depth to limiting factor In• Soil Icadon Rate re T t Stn3cture Consistence Boundary Roots GP D/ft? Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color ex u Gr. Sz Sh. •E~ E~ ... U Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ^ Pit Soil ication Rate cture Str Consistence Boundary Roots GP D/fE Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz Cont. Color Texture u Gr. Sz Sh. •E~ Eff#2 • Effluent #1 =BODE > 30 _< 220 tngll. and TSS >30 _< 150 mgA. 'Effluent #2 = BODa <_ 30 mglL and TSS _< 30 mgll. 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,6g0) '.. st o ~~. ~~3 ~~ -+~ 8 ~~ r Q- ~ m $-- u; C U ~~ i ~ ~ / i lA ~~ ~ I p ~ ~ G / N ~ ~~~ ~~ ~ F -' ~ ~ ~ ~ ~ '~ ' m~~ / ` ~~ ~ i ~rh ~ ~ ~ I ~ -- --------_ _--1- - -~1----- -t- -p -~- ~e, / ~ o ~° -e / -~• _. ~ o ~ ~ ~ ~~ ~ ~. ti -n ~ o '` P ~ I s /_ ~ _~ ~ W ~ ~ ~ o ro ~ r,~ 0 ~ n~ 00 ~~ ~ ~ o ~ o- ~ ~t- ~ ~ ~ ~ a ~ ~ 1 q A 0 -f- ~ P x r ~, --~- ~ ~ ~, ~~ ~ G ~-I . o i 5 ~~\ _~_ .~__ __._ ___ U 1.,~ ---. _ _ - -~ - G ~ -~ rts QJ ~l ~1 ~.rl ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~e~ ~aw~ Mailing Address I U ~ ~ !e_.v~ 1/'i e~~ ~,e~v~~ ~ lei-, u~vo~l ~ : ~., Lc~~ ~t~ 13 Property Address ~'e~.-~ . ~ ~. ~ (Verification required from Planning Department for new construction)-, City/State - Parcel Identification Number ~~ S~ -/d S~ ~ SU as o LEGAL DESCRIPTION ~~ Property Location ~~ '/,, SE ''/4, Sec. ~~, TAN-R 15 W, Town of ~~ 4 Subdivision Lot # ~ Certified Survey Map # ~ 5 3 ~d~ ,Volume ~~ ,Page # ',~~`~ 5 Warranty Deed # '~ 55 ~ S9 ,Volume /7~~ ,Page # S ~ QI Spec house D yes [~J 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, journeymanplumber, restrictedplumber or a licensedpumperverifyingthat (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the 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 expirat' .ate. `, U!o lo~Sl ~ / A O PLICANT DATE OWNER CERTIFICATION I (we) certify that a tatements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property descr' ed y virtue of a warranty deed recorded in Register of Deeds Office. SIGNAT 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 ~a~ 1711PAf,E519 Document Number WARRANTY DEED Document Title This Deed, made between Charles D. Lamb and Barbara J. Lamb, husband and wife as survivorship marital property, Gr an Ben'amin C. Lamb and Brenda C. Lam ,husband and wife as Survivorship arital Property, Grantees, Witnesseth, That the said Grantor, for a valuable consideration of one dollar and other good and valuable consideration conveys to Grantees the following described real estate in St. Croix County, State of Wisconsin: 655499 I~,ATHLEEN H. WALSH i=;EGI5TE~ OF DEEDS 5T. CFOIX CO., WI RECEIVED FOR RECDRD 48-31-2001 3:15 PM IdARRANTY DEED EXEMPT N 8 CERT CDPY FEE: COPY FEE: TRAN5FER FEE: RECORDING FEE: 10.00 PAGE5: 1 RETURN TO: Bank of Spring Valley P.O. Box 159 Spring Valley, WI. 54767 P.I.N.: 004-1052-70-000 and 004-1052-80-000 LEGAL DESCRIPTION: Lot One (1) f Certified Survey Map in Volume Fifteen (15) of Certified Survey Maps, Pa e'{149, s ocument Number 653804, Filed in St. Croix County Register of Deeds Office on August 14, 2001, being locate in the o west Quarter of the Southeast Quarter (NW'/. of SE'/4) and in the Northeast Quarter of the Southeast Quarter (NE'/a of SE`/4) of Section Twenty Two (22), Township Twenty-Eight (28) North, Range Fifteen (15) West, Town of Cady, St. Croix County, Wisconsin. Together with Easement for ingress and egress purposes as described in Volume 1680, page 842 As document number 651216. This is homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging; And grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements of record, if any and will warrant and defend the same. Dated this 25th day of August, 2001 ~~~~ ~ ~ tSEAL) SEAL) * Charles D. Lamb * rbara J. b tSEAL) AUTHENTICATION Signatures of: authenticated this day of 2001 * Diane L. Gavic Title: MEMBER STATE BAR OF WISCONSIN THIS INSTRUMENT DRAFTED BY: Diane L. Gavic Attorney P.O. Box 344 Spring Valley, WI. 54767 (SEAL) ACKNOWLEDGMENT STATE OF WISCONSIN ss. County of Pierce ) Personally came before me this 25th day of August, 2001 the above named Charles D. Lamb and Barbara J. Lamb . osia ~~ to me Imo be the per 1 J Y ~ ~ the foregoing instrume d ckno e e ~ v . ~ G.F. n erson lY1 ~~ ~ ~ Notary Public of Pierce ~1 My commission expires: 10 CERTIFIED SURVEY MAP L OCATED 1 N THE NW 1 i4 OF THE SE 1 i4 AND 1 N THE NE 1 i4 OF THE SE 1 i4, ALL 1 N SECTION 22, T. 28N. , R. 15W. , TOWN OF CADY, ST. CROIX COUNTY, WISCONSIN. 1~, m a lI y "m ~i ~ UNPL ATTED LANDS ~ I w ~ $ ~ ro ncnc~mQ- 2 ~ ...................................ql~. aroA g ~~ncnnn v '"' ran 1 ~ Z °-1-i~_ n I COQ v ~W` I Z ~ ' 2076 n n~~~~ ~ N O5°04' 46'W 2T6. 13 r=c~ v° ~mN~~ 70 r Ay~yht m y~yn~2 m~ ~~~ c~~l*,I-v y062~1 3ku'mo ~ ~~ A~- ~`fr~r 2 ' :~ w - . I ~ p n w ro~ ~ w~~ :a r " ~ y ~ cn (~ 'A r O ~ _ ~ _m D °;~ " m ~ ~ v ' ,~ i,,,'+ : t- m y tq ~ ~ ~- i o ~ wx :p ~ ~ ~ :v cr n a ~' ~ o _ ^~ r- Z ~'- 22 v - -- NW-SE - -- -- -- ^~ NE-SE y ~~ O ^m • W ~' 8 0 ~ ~_ 2 ~ n ~" 0 209. 00' 6. 00' ~ o"'. S 00° 06' 26' W 2 . 00' n~i I : o- n n cry I : o- I z ~cnc~ m~~~*, Q,I la, --u,m Ong vgc~'n z Cpl ~ m •~y !. nOA ~jvnN, y. wi_:n Iw ZO~ a ~ nom. „~`\~<.~U:t:,;:i::tt~JgJJ! J!,''!~i ~ N n ~ ~ z ~ m n~~~y ~ ~~o N T r~ ~ _S Ozcn ..'~`~v ~' -~I I ~ :~ ~~N~mO _ m Ion .':;~ 0 I ~,: ~'^rl2 :~ IGHWAY ~F .s ~O~ P m ~ - C Y, ~ ~ "' O 2 ~ : Z Ht SETBACK . ~ I . ~ I .p L 1 NE. C ~ m , ~ ~ o :~ NI :~• o. v m r7°m(,~s~ ~~ N ~"~ n1 ;~ g 'I<,ww;-1QwI ~ .,,,; :~ U v I :~1,,, -., .:~ (~Cm ma`r' '~- `\;,' ~ ~N 00°41'25'W 2583_80' , _w- rn L ~_-- (J~~ ,~~~~~.~;;;:~;~~~~, ~--- 310TH -- -~-.sl' ST. w °- - m ..._ _ ,_. - - '2 EAS T L 1 NE OF THE SE 1 i4 ~S 00° 41 ' 25' E SHEET 1 OF 2 ss. of DESCRIPTION A parse! of land located in the Northwest'/~ of the Sautt~east'/z ar~+ ir. the Northeast'/ of the Southeast'/4, all in Section 22, Township 28 North, Range 15 West, Town of Cady, St. Croix County, Wisconsin, more fully described as follows: Commencing at the East Quarter Corner of said Section 22; Thence North 89°53'34" West, along the east -west quarter line of said Section 22, 1118.40 feet to the POINT OF BEGINNING; Thence South 00°06'26" West, 275.00 feet; Thence North 89°53'34" West, 804.69 feet; Thence North OS°04'46" West, 276.13 feet to the east -west quarter line of said Section 22; Thence South 89°53'34" East, along said quarter line, 829.65 feet to the point of beginning. Together with a 66' wide access easement recorded in Volume ,Page of the St. Croix County records. Containing 224,722 square feet or 5.16 acres. Subject to any and all easements, right-of- ways or conveyances of record. SURVEVOR'S CERTIFICATE 1, James M. Weber, Registered Land Surveyor, hereby certify: That in full compliance with the provisions of Chapter 236.34 of the Wisconsin Statutes, and the provisions of the St. Croix County Subdivision Ordinance and under the direction of Ben and Brenda Lamb, I have surveyed, divided, and mapped the above described parcel of land and that this map is a correct representation. thereof. _ 2UU 1. ~~`~W~ n 1 Dated this 3~~day of A~~~ , ~ JA~uM~ES~~ppM. . •~GB~R r. James M. Weber, 5-1804 t' z• SpRWG Vi1L.LEY, ,_ ,~.',, NELSEN-WEBER LAND SURVEYING, INC. ~:~:< w~ ` ~,9,~0 ,~ U ..~~~`''~ \ ,,,~;;.• NOTE: w4~~`~'"' S.. ~v~ The parcel shown on this map is subject to State, County, and Town laws, rules and ^~a± e..~ ~i a ::~..+-..,..~.. .~.~.~ •~ ... .,.: ~,- ~ ... .~ .j. Bci~rr puriliasiiig or rrn~4. i ,:., ~ . >a,^^......., ..n...:.^i..:k2 .ail ~ii.i;, a~:%c :~ lv jiiYii,l;~ i;ii developing any parcel, contact the St. Croix County Zoning Office and the appropriate Town Board for advice. 2001071A This instrument drafted by Jim Weber SHEET 2 OF 2