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HomeMy WebLinkAbout006-1074-40-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information ~•ou provia`e maybe used for secondary purposes fPrivacv Law, s.15.04 (1)(mll. Permit Holder's Name: City Village X Township L'Allier, Tom & Elizabeth LLC C Ion Townshi CST BM Elev: Insp. BM Elev: BM Description• ~ ~ E>~ ~~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ _ /~~ Dosing ~ c'~ ~ ~~ Aeration ~~~/ Holding TANK SETBACK INFORMATION ~~ ~+- ~a~~ I ~~,~ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ( ~ Z~ r 3(n' "j f ~3 f Dosing r i g ~71D Z ~' 3 ~~ ~ ~'~ 1 Aeration Holding PUMP/SIPHON INFORMATION ~~ Manufacturer Demand GPM Model Number ~~ TDH Life` ~ Friction L~s lO• System He d T ~ ~ Forcemain Lengt~~ Dia 11 Dist. to well ,~ ~ SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 453388 0 State Plan ID No: Parcel Tax No: 006-1074-40-000 SectionlTown/Range/Map No: 33.31.16.5030 STATION BS HI FS ELEV. Benchmark ,+~ q/ ` /~ Alt. BM Bldg. Sewer SUHt Inlet I ~ ~ ~ / + Q~ / SUHt Outlet ~_ ` Dt Inlet Dt Bottom ~ ~ + ~ O Z , Header/Man. Z ~ ~ ~ / Dist. Pipe Z 3 Bot. System ~ ~ ~~ Final Grade ~ ry i ,+ - J ~ q~ , t Cover ~ n ' ~~ ,!' c~ q ~ . ~7 C.~o~O J ~ '~-~- L ~S. BEDITRENCH DIMENSIONS Width _ ~ ~ . Lengt~~ ~ No. Of Tre ~ PIT D ENSIGNS No. Of Pits \` Inside Liq ' Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturet~ - / Type Of S e d~ ~^ ~~ 7 J~~ tDl UNIT Model Nu DISTRIBUTION SYSTEM HeadedManifold ,1 ! ~ f Length "t Dia Distribution i ~ Pipe(s) ~,rl ~' Z ~ i ~ ~- Length 7 Dia Spacing x Hole Size / ~ r ~ ~ l~ x Hole Spacing ~~ Ve/nt to Air In e C~~ ` 8 SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center 0 J I . ~~ Bed/Trench Edges Topsoil ' _ ` ~ ~L Yes ~~ No - Yes ~ No ~.r- COMMENTS: (include code discrepencies, persons present, etc.) Inspection #1: ~ / ZO / b~ Inspection #2: / / P1aw+ cZtt Qi~ Location: 1887 Cty. Road O New Richmon , WI 54017 (NW 1/4 NE 1/4 33 T31N R16W) m\e-tes & b unds Lot t'`` ~ Parcel o: 33.31.16.5030 1.) Alt BM Description = ~.AGc~e~.. ~~ ~ ~^''~ ~1 d"~1 J~ 2.) Bldg sewer length = ~j~C15e4-`~ ~ ~~ , ~ L"~-~ ~ -amount of cover = ~ 7 ~g n --- - ~ Plan revision Required? C~ Yes ~ o Use other side for additional information. L_~_... ~~~~~ SBD-6710 (R.3/97) Date ~~~ ak ~~~si Cert. No. Safety and Buildings Division County ,-~ ~ ~ ~ - 201 W. Washington Ave., P.O. Box 7162 ~~~~~~~~ .Madison, WI 53702 - 7162 Sanitary Permit Numbs' (to be filled in by Co.) (608) 266-3151 S-~ ~8 De artment of Commerce Sanitary Permit Apphcatian pip ou de mation so al inf d W 21 Ad C d i 83 h State Plan I.D. Number o~ ~ ~ .~ p y or e, per n w , u. m o t Comm . In accor may be used for secondary purposes Privacy Law, s 15.04(1 xm) mtiling address) ecc Address (if different ProJ ~ J ~ /~~/ c~ ~1 ~ (~ /Kf L Application Llformation -Please Print AU Informatio ~ ~ ~ ~ ~~ ~ - ~ / j ~S ~ ~1.~n- S s Name _ it~~ 1 2 2004 ~ ~ Parcel # Lot # Block # ~~`°- ~b1~ °~U-~tn7 ~,~~ . I 3 . ,~ 's Mailing Address Propertyjn _ Code Zi one Number City. State ~~~,../ ,, ~ ~ ~J p / ~2 ~ ~ ~). T Eo W t l h W c app e k a IZ Type of Bnildiag (c ~{,1 S~~~G/ y) ~ld) C a ~ Subdivision Name ~ Number . - i 2 Family Dwelling - Nnmbet of Bedrooms T ~'//1F_~_ PublidCommatial - Desaibe Use ~ I ST • C Ll~~ x fr)'1 Gty_ Village owaship S ~ state ovvttod - Destxibe use III. T ype of Permit: (Check ody one boz on line A. Complete line B if applicable) A' New System c System Treatrnent/Holding Tank Replaoeme+rt Only Odter Modi6catioo ~ Existing System List Previous Permit Number attd Date Lssaed B. Permit Renewal Permit Revision Ctuutge of Petntit Transfer to New Before Expiration Plumber Owner IV. a of POWTS S (Check all that a 1 Non -Pressurized In-Ground ound >_ 24 in. of suitable soil Mound < 24 is of suitably soil At-Grade Single Pass Sand Flter Constructed Wedand Pressurized in-Ground Holding Tank Peat Filter Aerobic Trt~trneat Unit Recirwla6ng Sand Filter Synthetic Media Filter Leachirt (]ratnber Dri Line Gravel-less O~cr ( hrin) // V. Di tment Area Information _ pesign Plow (gpd) Design Soil Appli ' n Rate(gpdsf) Dispersal Area R ~ spetsat Area Pro (st) S Hev~ion ~ ~ ~ „ / T J i~~ -~~ ~ i~ (7: (~ ~~5,3u, ~`~~ 7~b °~~~ ~ 2 1 ~ , VL Tank Info ~P~ty ~ Total Number Manatacdtcer P fab Site Steil Fiber Plastic Gallons Gallons of Units Concrete Construtxed Glass Arew EiiSClag . Tanks Tanks Septic or Holding Tank AaobicTieatmentUnit ~ n ~~(,/ 7~ Dosing Chamber ?,~ T YII. Res Onsibill Statement- I, the audersigned, bility for installation o[ the PO shown on the attached ns. Busittess Phone Nu ~ ~ Plumber's r{aate (Print) Plumber's Si M~~ ~ J i / J / ~ l uric Plumber's Addttss (Strut, ty, State, tip VIII. Coun /De ent Use Onl Sanitary Pernut Fee ( dudes Groundwater Da lssu ing Sigffaptn: )~. Appmy~d ~PPro~ Surcharge Fee) ~ 2 ~~ ~/ it ~lJ / // Owner Gives Reason for Denial J `~ , IIG Conditions of Approval/Keasonsfnr Disapproval 3 ~.~G2~j~ ~ ~ ~ ~ . ~vc ~ti ~G ! YSTEM OWNER: GGk%t-~/ ~ /a/'r!'L~~ Septic tank, effluent filter and / erviced /maintained ll b t ~~~~~~~~„ e s a dispersal cell mus as per management plan provided by plumber. c,G S~~ ~~~ 7`" ~ ~G~~~~~~ ~ 2. All setback requirements must be maintained n „ ~ ~~1~,~,. (~ 3- 3 -3 ' L as per applicable codelordinances. ~ ,~ Attach complete plans (to the County only) [or the ayatera oa paper not less than 81/2 x 11 inches is size PLOT PLAN PROJECT Tom L'Allier ADDRESS 338 S. Arch Ave New Richmond Wi 54017 _NW 1/4 NE 1ldS 33 /T 31 N/R 16 W TOWN Cylon COUNTY ST.CROIX MOUND XXX SEPTIC TANK SIZE 1000 gallons DOSE TANK SIZE 630 BEDROOM 3 LOAD RATE 1.0 ABSORPTION AREA 454 Filter Zabel A-100 BENCHMARK V.R.P. Toq of wood corner post ASSUME ELEVATION 100° BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION g6.6' Line Property Line .~ Scale = 1 /4" = 10' Grading is to be done to divert run-off away from system Area 15' below system is to remain undisturbed Pole Shed J B~~ '~ 9 6 95.6 g,M, *Alt. B. M. is top of steel Fence Post C~ 98.1' 1F~affcutt Combo Tank Existing 3 Bedroom House Tank is to be properly bedded and provided with lockdown covers with approved warning labels O ^ 295, Old Tank is to be ~, ~ pumped and buried ~~ Property Line g~,3~ Fail commerce.wi.gov ^ ^ 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 Jim Doyle, Governor Cory L. Nettles, Secretary July 06, 2004 CUST ID No.226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/06/2006 Identification Numbers Transaction ID No. 1016687 SITE: Site ID No. 685972 Tom L Allier Please refer to both identification numbers, 1887 County Road O above, in all eorres ondence with the a enc . Town of Cylon St Croix County NWl/4, NE1/4, S33, T31N, R16W 'FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 967152 Maintenance required; Replacement system; 450 GPD Flow rate; 26 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual -Version 2.0, SBD-10691-P (N.OI/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1); Biof-lter 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. COttditi No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, ~~~~) stats. The following conditions shall be met during construction or installation and prior to occupancy or use: DERARTNlENT~ OF General Approval Requirements: SEE CORRE: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.OI/01) -- --- -~~ and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.O1/O1). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehiculaz traffic and other similar activities that impact the treatment and dispersal are prohibited. • The welt must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • 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. SHAUN R BIRD Page 2 7/6/04 ` Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83.2217) 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. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/instal lation/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. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, ~~~~ ~~ ~~~~ Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@commerce.state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 06/26/04 Owner: Tom L'Allier Location:NW1/4NE1/4 S33 T31 N,R16W 1887 Cty Rd O Cylon System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01 /31) Pressure Distribution Manual Version 2.0 (01 /31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9-11. Soil Shaun Birc Signature License n~ RE~E~VE ~~N s 3 o Zoa4 ~~ ~ BL DG~ DIV. ona~.y ~~~© COMMERCQ ~D ~IN(y ~PONDEN • PLOT PLAN PI;OJECT Tom L'Allier ADDRESS 338 S. Arch Ave New Richmond Wi 54017 _NW 1/4 NE 1/'4S 33 /T 31 N/R 16 W TOWN Cylon COUNTY ST.CROIX MOUND XXX SEPTIC TANK SIZE 1000 gallons DOSE TANK SIZE 630 BEDROOM 3 LOAD RATE 1.0 ABSORPTION AREA 454 Filter Zabel A-100 BENCHMARK V.R.P. Top of wood corner post ASSUME ELEVATION 100' BOREHOLE ~ WELL * g, R, p, Same as Benchmark SYSTEM ELEVATION 96.6' Line Property Line Scale = 1 /4" = 10' Grading is to be done to divert run-off away from system Area 15' below system is to remain undisturbed Pole Shed i ^ B-3 5% Slope g,M, *Alt. B. M. is top of steel Fence Post @ 98.1' Huffc utt Combo Tank Existing 3 Bedroom House Tank is to be properly bedded and provided with lockdown covers with approved warning labels Well O 9 6' 95.6 9 5' B-2 Old Tank is to be ~, ~ pumped and buried ~~ Faile Property Line g~,33 Rd 0 Designer~~, +Date -,.1-- ~•~'` No r Non-Woven Filter Fabric 4" Observation Pipe Perforated Below Filter Fabric TK C-33 Sand --~ ' Topsoil _ J ~ 5 7. stop l~ t E Bed Ot~j~-2`2 Drain Rock QislriDution Pipe H G Fot ce NOin From Pump ~~~ Cress Section Ot q Mound S steeQUsin A Bed For The Absorption q __-- p ~ Ft. 5.,~ ,~ Ft. _._...-- I ~ Ft.- ~ '~,j Ft. t: Ft. - ~ L~~,.3Ft. F love 0 -- -: _ Layer Q -~I -~- F"~~J G ~' }; ~ ~ L 40bservotion Pipe'~_~-_K _ r -~ -~ ~- ~~ ~.- ~ A ~• ---------- _ ~ Force Main -° ir-----j-------------- --------___~_ ~ From Pump W v' ~° .~ ~.T-..- ~ ~..~....- .~ ... 3 t ~' o Distribution Bed Of ~Z - ~ t ~ Pipe -Drain RocK I 4~~Observation Pipes-~C~ Permonent Morker ~5~~„ ~4~ ~ ~r~~ bv~y~,~1s'~Pe °r Rods Plon Viev+ Ot Mound thin A Bed For Tie Absorption Arto PAGE,,,. ~F_..._ !'%~ tot:atea On 8otto~+. EquaaY Soocea ,RAT 1SpLL NsxT ~e Gannet}nor Ft. F#. Signed: License Number: Oa to X ~ Inches ~'o~_ `~ Inches Hole Diameter ~~Inch Lateral ~" Z- Inchtes) Manifold 2- Inches Force Main inches # of haleSlpip~ Invert Elevation of LateralsG ~~ b Ft, ~, Perforated Pipe Oetoii C TA_. . J 'rte. S?EC~~ ICATIOI~S t ~,N pin Pt3M? Ct~AM$~R CR45S SECT • AEOV E GRAD £ ~ VENT piPE ~Z" SIN 4 ~} ~~N~ow OR } ~II+ ~'ROls D4QRr nc ,~ E ~ r ~~~:: tt~s.ET .. s~A~ .~- Ui-AT~ TI6 HT ~ 3 LT ~R `~ ..~--- H ApP~~ C PIPE SQi,tO - ~~ ~ / FT - D UHF flgF £ S0 w£~~RPR4Df '~`~~c~COhDUOT W ~'TH r. ~ :, _. i 7 ~ ~ ~ •t ~+'-~~ ~ ~ TIGHT, s~i• . ~ , ~ , T pppROV ED MOLE CQ~ER W/ PADLOCK ~+ WARKING iABE.. _ ,~++ HIM ;Su M11F .~ • --- ~pRQ~ll£di 3~yp~SOIL a pRpYED g~DZHG t3ND~ T ~ fs CRETE PAD 3 AP - SP~CIFICA"r~CR' . 5 ?fig DP-Y = ,~..•---~" 2+ILTt'ib£R DOSE / DOS£ ~ D1~~~' GAL- SEPTIC RER= '~'' DOS£ ~tOf~ME pHL,O~$~K' Gl-L- TAH~ I'IAZ+R1FJtiC'I~1 GAL. ..~`' L~ 33~I+CHES = si~ .---_' %~ gZZ£S ~ SEp~ZC ~ 6AL- GZTI~' A ,..... 6AL- T~111i~ DDS C CAPA 8 _ ~+ INCHES = `-~"' ~~ ALJ~ ~~RRIFAC~RER~ .~, ,/' ~;~!~ ;NCHES =~~/ =,-~~L. C - ~~ ~L . .~"'..~ t40DEL ~NSER ~ ~ ~ ~-~'" SNI~H ~'YPE = ~ ~ ;~it£S ~v,~,~ ~/ ~ _ ~s. za wwc ~iFwC1RJRF.~ = _ ~ ~ 'Zi PER I LHR p{~TSP ~' K$ER . ~ . A~•~M i~1Z8~ ~ ~ FEE? b~ GPK I B~T.i pM FSP£ ,~ ---FEET REQ13IR£fl DISCHARGE g~,TE •DIS'~ - _ .'; .J-~----" ggET p~ir4P pFF AND •~~Q~'-~'" _FEE't . FRZ FACTOR 2~ vER;IGL. ~;ET~pRKCS~P£XRES~R~'T/1QQ.F,~flgAL DYNA.t~4iC ~~ -i/ .- MIHII"IUPt N IM ~_..------ ~ DIAMETER _..----- +~~ F£~T FORO .i ~~ ~~x~_ I4'~S T3F ~ MP ~~ LI~~ ID T~iT~MAi' DIMEMS LICENSE ~~$R~ -. Y ~T~ if~$ ww ~ ~ 50 153 12 40 152 °a ~ w s 30 ~, z 8 a 20 ~- 0 4 10 HEAD .CAPACITY CURVE MODEL 152/153 - TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE EFFLUENT AND DEWATERING 0 ~ 20 40 60 80 100 GALLONS LITERS 0 80 160 240 320 FLOW PEf2 MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. '° ' • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. • Sealed Qwik-Box available fornutdoor installations. See FM1420. • Over 130°F. (54°C.) special quotation required. 1521153 Series 1521153 MODELS Control Selection Model Volts•Ph Mode Am s Sim lex Du lex N152 115 1 .Non 8.5 1 2 or 3 BN152 115 1 Auto 8.5 Included 2 or 3 E152 230 1 Non 4.3 1 2 or 3 BE152 230 1 Auto 4.3 Included 2 or 3 115 1 No 105 1 2or3 MODEL 152 153 Feet Meters Gol. Liters Gal. Liters 5 1.5 69 261 77 291 10 3.1 61 231 70 265 15 4.6 53 201 61 231 20 6.1 44 167 52 197 25 7.6 34 129 42 159 30 9.t 23 87 33 125 35 10.7 -- - 22 85 40 12.2 -- -- 11 42 Lock Volve: 38.0 Ft. (11.6m) 44.0 Ft. (13.4m) 3 27/ rz i/s 32 32 ~~, i s~oa~ N153 n ~ SELECTION GUIDE BN153 115 1 Auto 10.5 Included 2 or 3 E153 230 1 Non 5.3 1 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float BE153 230 1 Auro 5.3 Included 2 or 3 switch. Refer t0 FM0477. o cnurloN 2. See FM0712 for correct model of Electrical Alternator E-Pak. All inatallatlon of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10-0225 used as a control activator, Specify duplex (3) licensed electrician. All electrical and safely codes should be followed including the most Or (4) float System. recent National Electric Code (NEC- and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL ro: P.o. sox ~s347 Louisville; KY 40256-0347 Manufacturersof. - ~ SNIP T0: 3649 Cane Run Road ~ /7 LL~~ p~JO ® Louisville, KY 40211-1961 QlL4UTY/'Ud7P9 J~NCE ~t7d0 ~a• (502) 778-2731 ~ 1(800) 928-PUMP http;//www.zoeller.com PUMP ~O FAX (502) 774-3624 © Copyright 2000 Zoeller Co. All rights reserved. • ~. Wiswnsin Department,of Commerce SOIL EVALUATION REPORT Page ' of~ Division of Safely and Buildings m accoraance wun wmm oa, vvis. ram. ~.cwe -~ -°-I ~ , County X ~d Attach com lete site lan on a er not less than 8 1/ x 11 i~tG ~ r~st ; ~ ~ ` ~ a - p p p p •~ ~ ¢ indude, but not limited to: vertical and horizontal refer (g ), iredion and ~ nce poinl parcel I.D. / 1 Q - percent slope, scale or dimensions, north arrow, and I lion and distance to nearest road. fa Please print all infor ation.; ~I ~ '~ ~ ~ 0 ~)~- k Reviewed Date Personal information ou vide ma be used for seconds Y Pro Y u D rposes -dracy Law, s. 15.04 (1) (m /,{/f/f/j.>~. ~ ~ ~ Property Owner ~ / , . ~.,~ ~~ ' ~ ~~erty Lo lion ~' ~~ N R J E ~~ V ~,, or) T , ovt. Lot 1 /4 ~1 /4 S ~~ Owner's Mailing Address • Lot # Block # Subd. Name or CSM# S City fate Zip Code Phone Number ~ City Village wn est Road ~Ol~ ~s2~~-~ C ^ New Construction Use' sidential /Number of bedrooms Code derived design flow rate JZ~ GPD eplaoement Public or commerdal -Describe: ________ __ /~ ___________ __- Parent material Flood Plain elevation if applicable /f~/~~f-' ft. General oornrrteMs / / ' and recommendations: j G~~~~/l~ ~~li!/~,~/~Ti(/t'v ~~, ' ~ ~- ~L, Boring # ~ Boring Pit Ground surface elev. ~ ft. Depth to limiting factor~~~ in. Soil icatron Rate Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP D/f~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~/ ~. - 1 '-~` .S,(j mot/ / Boring # Boring •t Ground surface elev. i ft. Depth to limiting factor ~_ in. Soil lication 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 ~ 2 ~'~J/Z~ ~~ ~ ~ ~ .~ ~ .~ ` i • Effluent #1 = BOD > 30 < ZZO mg/L and TSS >30 < 150 mg/L - Emuent irZ =taw < su n1g/L ana t ~ < :7U nlg/L CST Nartte (Please Print) Si re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address ~~~uati~Condu d Telephone Number 1008 192nd Ave, New Richmond, WI 54017 -~L'7 715-246-4516 +- .. Property Owner Parcel ID # Page of ® ^ oring ~ ~ l . Boring # Lam, Ground surtace elev. ~ ft. Depth to limiting factor ~n• Soil ication 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 ~~ ~J~z ~l0 ~ .~ z ~ ` --~ f ~ ~ Boring # ^ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring # ^ Boring ^ Pit Ground surtace elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Cdor Redox Description. Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = BODE > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BODS < 30 mg/L 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 (8.6/00) M ' Soil Test Plot Plan Project Name Tom L'Allier Shaun Address338 S. rc Ave ew ichmon i 54017 Lot ----- Subdivision ------- Date g/2 4 CSTM #226900 N W 1/4 NE 1/4S 33 T 31 N/R16 W Township Cylon Borin~WellpL Property Line County ST. Assume Elevation 100 ftBM or VRP Top of Wood Corner Post System Elevation 96'6 *HRPSame as enc mar Line Property Line Scale = 1 /4" = 10' B-1 B\ C Pole Shed ~6 5% 95. Slope B-295 g,M, *Alt. B. M. is top of steel Fence Post @ 98.1' Well O Property Line Rd 0 Failed drainfield FILE tNEO Owner oonnit ~ ENT PLAN OWNERS MANUAL Sc MAHA sP1rCtFtCA'riQl+ls POWt'S SYSTEM _~ ~~~ ~ ~~ms t Units Number of Commerr~ . . Fsdm~ fb~ {~~~ ~msCed x 1.5) p~i9n tbw (P~)~ t . so>f /4pp~tiO" ~~ trtAu~M~ QuatitY FOG) Fats,~Og b Grease Demand (RODS) gioci~teT~ Os~pended 8o-ids (TSS) P went Gluatity 800s) Biachem~al Oxygen Demand Totat Susi~ded Solids ASS) Fecai Cotifom~ eometric mean) Maximum Effluent Partide Size Service Even insptxt oond}tion of tank(s) Pump out contents of tank(s) Insped disf~~ Cefi(s) Ciesn effluent filter S /vim [rasped pun+P~ Pip controls 8. alarm Flush Iabamis and p~u~ ~~ Page~~?~ O H!A SePdc Tank ceP°`'"' NA ~nn //~~ Septic Tank Mane ter Efttuent Fliter Mane a ~Auer~ Flter~Mixiel ! „~, p NA A d NA .~ ~ Pump~Tank CaFa~Y ~ o N . ~ ai(d pump TartK Manufacbuter ~ ~ D 1VA -~ ~ 1 aVd I~ Mantsfgt .Pump ~~,"",~ [] s Pump Model r_~saUda /h Monthly aveBge' pretn~tm®nt Unit _ ram f=liter , ~ D Peat Fitter O Wetland ~~ mg/L x.20 mg1L anicai Aera~on p Mec,l~t ^ pisin~ion D Other. s150 m fL averag " Monthy e Manufaeturgr ntiat Gelf(s) ^ 1 round (prBSSUr¢ed) p I round (gravity) nd S30 mgn. D ptgrade 'gi ou p Outer. 5'f 0' dull t)Omt nor~'~~~ wastew~~ ~ domestic t Y. inchdiameter vawes typt~ ~ntcsAtuont ~~ wsstewsur. ~ for 0~ . ~ s lues tYP v At least once every $eryfce Frs4uencY ads) (Maximum 3 yrs.) At feast once every D months oafs on$-this (~} ~ of ink volume When combined sludg e and scum r(s) (Maximum 3 yiz•) D months . At [east once every D months r(s) At feast once every r(s) months DNA At (east once every D D moms eaKs) D ~ At least once every ~ D months O yeads) DNA At least once every t7 months ~ year(s) DNA other_ ~ licenses or IiAANhITENAH~ INSTRUCTIONS an ind'Nidual cgrrying one of the fO,lowln~gintainer, Sspta9e made by ~-S tns~padon PdvY'fs oc broken of tanks and disperaat Celts shah tie mower. PO to ider~Y am miss~9 t~cic up Inns: Msstef plumber. Master Plumber Resb'1~ on of [fie tank(s) rn and to check ~ any t feveis ns must indude a visual inspec~J a and s ~ ~~ the ~ffuen Sew Operg~r, Tank inspedio ore .the volume of mmbined siudg of effluent on the hardware. ider~l5- am cracks or Peaks. mess The dispersal cell(s) shall be visually ins Th+~ I~~i~ or ponding round s ~ any i~ndin9 of effluent on the ground surface. utatory authorftY- of effluent on the 9 lion of the local reg in tha observation P~ and to checK~ndition and requires the imm®diate nctyfica or more Of the Panic volume. ~ NR grotmd t~urface ~' indcaDe a faTng min any tank equals one-tl'-ird (~ ~ Df in a~anOB'"~' ~• e and scu a cenridng OPeroDOr and dispos y~~ ine combined accumulation of stud ~ a Septa9 . entire eontertts of the tank shall be remov ~ ~~tfrtent comPonents~, and any 113, Wisconsin Administrative Code. ~ onents. p a eettified POINTS Maintainer. m~anicat or pressurized POWTS comF ~rtned by Semce event. The sgfvttyng of effluent Fli tars. at intervals of 12 months or.iess shall be Pe of comPietiAn of any . other matrttenance or monitoring 1 ulatory auttlority within 10 days dad to the iota ~9 roduds or other A setvtge report shaQ.be P~ resence of painting P treatment tank{s) for the P If hi h ~~trabons are START tJP ANO OPERA o0~ u~ of the PODS cheer. cell s). ~ FOr hCYY ~ngaud;lOn, p~ s andlore ~ ae sew rag ~ for pnor to use. chemicals that may ' pede the treatment pry ~ removed by a s P 9 dCtecced ham the contents of the tank(s) • ~ - . ~^` ` -I•oonditions are frozen at the infiits'ative suffdce- V~hen pourer is r tt-e e>s7vess • rt u snail not occur v+fi-en so- h hwater levels. the oe~Cs) and may result in the system sta OptitS9es p~ t;3nlcs ritiaY ~ gbov~ ~~~ ne large dose, ovetloadin9 ntents of the pump fank removed. by a Doting p~vrN tae d;scfiat+ged do tl~e d~P,eiocs~avotd this sd~uation have the co 1iYTS Maintafier m wraste a of efl{ , L m or contact a Piumtaer a PO bac9wP or sum ~~~ rior.to~r+e~~ ~~ to the effluent Puts within the pump '. age ~rvidng OPere~ pd,te pt~P ~~Is to restore normal teve ~ over, ar ot€ielvirise disturb or corttpacx. assist in tnarluaflY op~ng and dispersal ~. Oo not drive or pa ~ - ovec taltiics lion area. po not drive or Park vei>~ mound or at-grade soil absar'P a rfcxrmanc8 and Prolong the Gfe the aces vrtthirt 15 feet dawn slope of arN ter stream may imps of the fpliawln$ from the vvastewa dam; dental Sloss; d'ineat Reduction ot~et'uninatton ~~ butts; condoms: cotton swabs; ~~; 9~e~ ~ of the POVti(T'S= antibiotics; ~babY ~P~~ y~r fruit and vegetable pe g ~ .Mine. . f~artts: tat toutidatlon drtaln (sump Pump} des: sanitary napkins; tampon : acrd water dsln ~~~ di: fainting products:: Pe~~ .: ~~ shah i~ taken to lnsune that the pgAN00NMM~T ~ $nd/or is permanerdiY.taken out of service the following steps sin ~rnintstrative Code: When the PAS abandoned in oomplianoe with ch. Comm 83.33. ~~nin s sealed. system is properly and_safeb l t,~e d'tsoonnecced and the abandoned Pipe f ~ Sept~9e Servicing Operator. A([ PIPi"9 to tanks and pits ~ sha0 be removed and prot~fi' disposed and ~B void space • The oonbents of aft tanks and p • It$ :half be ext~vated and removed or Vteir covers rem After pumping all tanks and P fitted wictttt soil, gravel or another inert solid mated- CYPLAN a fo![awing measures have been, or must be taken. m Pie a code CONTINGEN th if the POWTS faits and cannot be repaired location! of a reptaoement soil cement system: been evaluated and may be utilized for the c>yon and should not cempGant repla from disturbance and comps p A suitable reptaoement-~ has should be protected sect structure, tot tines and 1Nells_ Failure to absorption system- '~ ~piacement area u n by required setba~ from existing and prom be infringed Po ~U result in the need for a new seina1e n effect at that tsme~b~ a su'itaPO~S protect the replacement area terns must comply wrath th advances rn Repra~ent sys bons. Barring fplacement area- ~ Aet available due to setback andlor soil limits O A suitable replacement area be insEatled as a fast resort to replace the failed fPaO ~ ~ the P .and t ology a holding tank may ~ ide - a suitable a meat are n area is available a, n ne _ a - ~ s _ . on $~ed fast resort to replace the failed POVYTS. .removal of the biomat at rag be reconstructed in place following ~ that time. n systems may ttte rotes In cried nd and at~9rede sob absorPtio~ns of such systems must camp[ writh the infittratlve surface- Reoonst}'u ~ ~~ ~l~(/j/ SUFFICIENT OXYGEN. «WARN ~ir/n "^"' ~' ~ CIRCUifiISTANCES. DEATH MAY SEPTlC, PUMP AND OTHER TR>=.ArMENT DO NOT ENTER A SEPTIC, PUMP OR O'pirtER T(Zt;~,TMENT TANK UNDER ~cON FROM THE tNTEWOR o~ a TANK MAY BE DtFFICU[.T OR tMPOSSIre F RESULT.. RESCUE OF A P ADDITIONAL COMMENTS -- POVYTS MAIfJTAt1~ER ! ~ POWi'S INSTALLER Name ~, ;~--1 ~~ I_ Name v' ..~ ~ ~ ~ Phone "~/ -~"'~~~ ~~`S`'~ x~ .~'~ -~ Phone ..- ~-~ R PUMPER LOCAL REGULATORY AUTHOR,fiY . SEPTAGE SERVICING OPERATD ~en~, ,~ ~ Name °',~j ~V ~ Phone ~ ., ~~ Phone J - e ~~~ j ~ Thls doarment nteeis uotte and Waushara County Zoning and San~atia- agencies. ment does nor s~ of tM (men Lake. Marq Cock. Use of this dow Gtr t?!ot) This coaxrterrt was dtstted by the ti3.22(~(bl(i)(d)a{t) and 83.56(1). Cl)1£ {3), w~oonsin Admtnt~1° the mL+imw*+ roqu'uen7MtS Of Ch_ Comm guarantee the perfortnattce of tha ppNYCS. ST CROIX COUNTY _ - - PTIC'I'ANK N~TEN~CE AGREEMENT SE ANA . ~ Oy~ERSHIP CERTIFICATION FORM ~i ~~ OwnerBuyer ~ ~ ~, ,~,~ ~7~ v~ Mailing Address --~' - ~~. _ .. - Property Address D arrtnent for new construction) (Verification r ed from Planning eP r ~-- ~ ~ ~~~-~ ~c~~-lz~ parcel Identification Number City/State 'C LEGAI. DESCRIPjfT~I'ON/ ~ { Locatior~,/~~G '~4j ~~~•~ Sec. Property Subdivision T `~ N-R V51, 3 ~ ~~ Town of r- Lot # ~~ . ed ey Map #~ , ~ ~/ ~C 'w~ -~7 /a g ~ Warranty Deed # Spec house ~ y~~no Volume .Page # ~ ~ y a ~9 ~ v b' Volume 21 ~ .Page # Lot lines identifiable~~yeS ~ no ,.,s ~ TNTF.NANCE remature failure. to .handle wastes. Proper maintenance SYSTEM 1~~ -=-~----- of your septic system could result in lzs p a licensed pumPer• What y°u put into the system improper use and mainteaau~ eve three years oz sooner, if needed by stem. consists of pumPiaS out the septic tank ~' at stage in the waste disposal sy trc tank as a treatme ~ owner and by a can affect the function.of the sep • at a certification form, signed by r verifying that (1) the oa-site wastewaterdisPosal system The property owner agrees to submit to St. Croix Z°173~ Departrne trc tank is less than 1/3 full of sludge. o~ey~plumber, restrictedplumber or a licensedpumpc the sep ' masterplumber, j 2 aRer i~Pe in rf necessary), condition and/or () coon and pump g C is in proper operating rivate sewage disposal system with the standards rsi ed have read the above requirements and agree to maintain the p Uwe, the undo ga arttnent of Natural Resources, State of ~nuag Office ~ 1~ 30 set forth, herein, as set by the ~ep~trnent of Commerce and tho DCP ed to the St. Croix County tic system has been matnta~.ed must be completed and return stating that your sep ~, ~ ~ days of three Year expiration date- / ~ ~~ ,/~ / DATE SIC~NA"1'[JRE OF APPLICANT J OWNER CERT~ICATION our) knowledge. I (we) certify that all statements on this f °~deed rerecorded in Register ° Deeds Office. the property described above, by virtue of a warraah' 0 I (we) am (are) the owner(s) of ~~ ~ DATE SIGNATURE OF APPLICANT De aitment. ' that is mis-represented may result is the sanitary Permit being revoked by the Zoning P **•*«*. Any information location: a stamped warranty deed from the Register of Deeds office deed ** Include with this app ~ a Dopy of the certified survey map if reference is made in the warranty *i***k 1 2 1 6 9 f' 0 8 3 I ~~z9~9 ~~ STATE BAR OF WISCONSIN FORM 2 - 1998 This Deed, made between Warren E. DeBoer and Lori K. DeBoer, F/K/A Lori Kay Blanch, husband and wife, Grantor, and Thomas C. L'Allier and Elizabeth M. L'Allier, husband and wife, as survivorship marital property, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (The "Property"): THE NORTH 237 FEET OF SOUTH 610 FEET OF WEST 350 FEET OF NW 1/4 OF NE 1/4 OF SECTION 33, TOWNSHIP 31 NORTH, RANGE 16 WEST, TOWN OF CYLON, ST. CROIX COUNTY, WISCONSIN. Exceptions to warranties: Subject to all easements, restrictions and covenants of record. Dated this 26 th day of February, 2003. "War en E. DeBoer ~~ ~~~ "Lori 1{. DeBoer AUTHENTICATION Signature(s) authenticated this day of February, 2003. TITLE: MEMBER STATE BAR OF WISCONSIN (I f no[, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Ronald L. Siler VAN DYK, O'BOYLE 8t SILER, S.C. Post Office Box 118, New Richmond, WI 54017 (Signatures may be authenticated or acknowledged. Both are not necessary.) Name and Return Address First National Bank 1?O Box 89 New Rickutlond, WI 54017 006-1074-000 Parcel Identification Number (PIN) This is homestead property. ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. ST. CROIX County ) Petsortally came before me this 28tY1day of Febtuary, 2003, the above named Warren E. DeBOer and Lori K. DeBoer to me known to be the person(s) who executed the foregoing instrument d acknowledge the saFr{j .~ (lf not, state expiration date: KATHLEEN H. WALSH REGISTER OF DEEDS sT. cROIx co., MI RECEIVED FOR RECORD 03/12/20@3 08:30AM EXEMPT # REC FEE: 11.0@ TRANS FEE: 48@. 0@ COPY FEE: CERT COPY FEE: PAGES: 1 Sion i~erfl •- -a/lF.irYt _.~.. 'Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 - 1998 INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 81W-8552021 u ZsssP yes STATE BAR OF WISCONSIN FORM 3 - 1998 Thomas C. L'Allier and Elizabeth M. L'Allier, husband and wife, quit-claims to Thomas C. L'Allier Elizabeth M. L'Allier Partnership LLC, a Wisconsin Limited Liability Company, the following described real estate in St. Croix County, State of Wisconsin: The West 74 feet of Outlot "135" of the Outlot Map of the City of New The North 237 feet of South 610 feet of West 350 feet of NW 1/4 of NE 1/4 of Section 33, Township 31 North, Range 16 West, Town of Cylon, St. Croix 2004. County, Wiscotsin. Recordin Area Name and Return Addcess N at of the City of New Richmond. Ronald L. Sher Outlot "29" of Outlot Map of City of New Richmond, vAN DYK, O'BOYLE &SILER, S.C. Post Office Box l18 New Richmond, WI 54017 The South 12 feet 4 inches of the East 200 feet of Lot 10 and the North 49 feet 7 inches of the East 200 feet of Lot 9, all in the Original Plat of the City of New Richmond, St. Croix County, Wisconsin. 261-1148-95-000: 006-1074-40-000: 261-1165-30-000: 261-1133-90 and 261-1083-SO Parcel Identification Number (PIN) This is not homestead property. .~ `' Dated this ~~ day of "G `"- *Thom C. L'Allier *EI ab M. L'Allier AUTHENTICATION Si nature(s) ~ ~o^~r+s C. L ~it'•°r ~„1 authenticated this G ~9 ~ day of ~ ~-- , 2004. Q7~~ ~ ~ TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Ronald L. Siler VAN DYK, O'BOYLE 8c SILER, S.C. Post Office Box 118, New Richmond, WI 54017 (Signatures may be authenticated or acknowledge. Hoth are not necessary.) * * 7 6 6 2 6 4 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX GO. , YI RECEIVED FOR RECORD 06/18/2004 10:00A1! OUIT CLAI?1 DEED EXEMPT i 15S REC FEE: 11.00 TRANS FEE: COPY FEE: CC FEE: PAGES: 1 ACKNOWLEDGMENT STATE OF WISCONSIN ) )ss. County ) Personally came before me this day of _ 2004 the above named to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. Notary Public ,State of Wisconsin My Commission is permanent. (If not, state expiration date: 20_J 'Names of persons signing in any capacity should be typed or printed below their signatures QUIT CLAIM DEFD STATE BAR OF WISCONSIN FORM No. 3 - 1998 INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 800-BSS2021 \~