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HomeMy WebLinkAbout008-1079-40-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GE~ERAL INFORMATION (ATTACH TO PERMIT) Pdrsr nal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)J. Permit Holder's Name: City Village X Township Stone, Jeff Eau Galle Townshi CST BM E1ev: Insp. BM,~lev: BM Descriptionnn ~ o e Ca• q ~ ~ytrw..rQ .~C- ~" ~ ~ 1 T4NK INFORM TION EL ATION DATA TYPE MANUFACTURER CAPACITY Septic ~ ~~ C OWN l~ S~ Dosing !~ ~ ~ Aeration Holding TANK SETBACK INFORMATION TANK TO P!L WELL BLDG. vent to Air Intake ROAD Septic y `~ ~ / ~\ (_,, l S ~ ~ ~~ Dosing ~' ~ t u ~ 6' t Aeration Holding SOIL ABSORPTION SYSTEM Ti~Sfi Width t Len~h _ t No. C DIMENSIONS /b SETBACK SYSTEM TO P/L INFORMATION Type Of System: ~~n~A6 > / pb ~ a ~~a/1~1 G~VGaTC\I Z' C~ county: St. Croix Sanitary Permit No: 399455 State Plan ID o t/Q oU" S' • ~~U Parcel Tax No: 008-1079-40-000 STATION BS HI I FS ~ ELEV. ttencnmarK ~ ._---- Alt. BM ---~' Bldg. Sewer C~ ~ Q t /• O SUHtInlet ~~•22 93031 Dt Bottom ~ / 8~ ~ ~, /Zl ~([' Header/Man. ~' • ~ ~ zlc r ~~aS Dist. Pipe 3 p ~, ~c f ~ Ir Bot. System I q6-3Z Final Grade ~,.~ ~t,~z s ~s~ 9q • r~` -e.o$ L Inside Dia. Liquid G DA ufacturer: Mo umber. ~~ A Y~V • [~IVV • •Va~ v • v • HeaderlManifold rr I ~.~• Distribution l { ~ t I , ', t ~ x Hote SizeG~ rt 1~ x Hole Spacing ~ ~ ~ Vent to Air Intake ~- Dia ~ Length 3' ~ -_ I - ~Dia ` l 2 Spacing Length ~ 8 VV•a. vV ~ r.a~ Depth Over w r~caau.c v~.~av..w .....~ Depth Over .... ...___.~ _. _ __ _. xx Depth of _ xx Seeded/Sodded xx Mulched BedlTrench Center Bed(rrench Edges Topsoil ~ Yes ~ No ~] Yes ~ No COMMENTS: (Include. code discrepencies, persons present, etc.) Inspection #1:~~ ! t ~ / " ~ Inspection #Z: ~-` U~a~~ Location: 2385 20th Avenue Glenwood City, WI 54013 (NE 1/4 NE 1/4 28 728N 16W NA Lot 3 n Parcel N~: 28.28.16.417D 1. Alt BM Descri tion = ~ CAKICt^'~"'~'C:btXf) ~ ~ ~ 2.) Bldg sewer length = g0 a~ o] C l - amount of cover ~ ~ ~{'2. ~ :~ 6.~S.r ~ ~ : Ip~ ZS,) Plan- revision Required? No Use. other side for additional i a I , ~ ~~ S Cert. No. SBD-6710 (R.3/97) ~ ` ` /~ PUMP/SIPHON INFORMATION Sanitary Permit Applicat>IOn Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. PO Box 7302 `~seonsin See reverse side for instructions for completing this application WI 53707-730" Madison Department of Commerce Personal information you provide may be used secondan~ purposes . (Submit completed form to county if r [Privacy Law, s. I S ,~ )( ~ I state owner Attach com lete laps (to the county co 'only) tem. n a er I s than 8-1/2 x l 1 inches in size. County ~ State Sanitary P milt Number • if r visi o ~vious li lion ~ State PI 1. D. Number ~ ~ I. A lication Information -Please Print all Information a ~ ~ Location: Property Owner Name n r+T O ~ 2QO~ UL 1 Property Location ~~ ~ $T ,~ :~ ~ o~ Gil/4 1/4,SrZ~T~O,N,R or W ~• Property Owner's Mailing Address ~~~ Lot Number Block Number Ciry, State ~ Zip Code o e p~ Subdivision Name or CSM Number ~~-o, ~ ~d 3 c / ) S' ~ ~3b X70 ~' 2 P. 3Z3 11 Type of Building: (chec one) ~ 5..,4,...~ i~ ~ ~~' ^ City ^ Village I or 2 Famil Dwellin No. of Bedrooms: Y g - r~ccd~~ ,"Town of ^ Public/Commercial (describe use): ^ State-owned III Type of Perrtii: (Check only one bex on line A. Check box en line 13 if applicable) Nearest Road ~ ~ 020 p) 1. New System 2. ^ Replacement 3. ^ Replacement of 4. ^ Addition to Parcel Tax Number(s) o'S ' /~ ' ~ '~ S stem Tank Onlv Existin S stem O B) Permit Number Date Issued ^ A Sanita Permit was reviousl issued . IV. Type of POWT System: (Check all that apply) -I °p ^ Non-pressurized In-gr and i Mound ^ Sand Filter O Constructed Wetland le Pass ^ Drip Line k O Sin T ~ ~s'~) ^ H ldi / z g an a ng o ed In-groun~ ^ Pressuri ^ At-grade t ^ Aerobic Treatment nit ~ Re irculating O Other: " " `t ~ D . 83 t O.O K ~ yVl cA~- V Dis ersa reatment Area Information: 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals./day/sq. ft.) (Min./inch) Elevation hf~2~ ~~ Aso ..s ~, 3 S ~ /3 VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks ~ ^ ^ ^ ~i° Ti G r'~ D -=, G ~v o 0 0 0 S VII Responsibility Statement 1, the undersi mod, assume res onsibili fir ir+.s*.allation of the POWTS shown n the attached laps. Plumber's Name (print) Plumber's Signature (no stamps): P PRS No. Business Phone Number Plu is Address (Street, C' ~, State, Zip Co ~, ' ~ G d - ~ = a_.s VIII County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued I u' Agent Signatur (No stamps) Approved ^ Owner Given Initial Adverse Surc a Fee) de ~~ ~~ Determination Z.S. ~""~ IX. Conditions of Approval/Reasons or Disapproval: n_ / n ~~ ~ M,l •{•~s ,~t..l~~ ~,~ cry ~ ~~~r~.°~-~C' _G+D~GP.o pi,c1~+~ ' , ` -n C is ` re ee~ y~o p ~wkt ~ = c, ~ A~ ~ ~~ ~ «~.~ ~ wM a-- 3~ t nape.- ~. ~t~. sue, ~~ .M•e~~, SBD-6398 (R. 07/00) ~ ~~ ~~ 11h I_ f a ~ ~ ~~ ~" :~, z ~~. ~ ~~~ ~~ ak C .gyp ~ ° `~ G r ~ ~ ~ ~ r ~ ~~ ~~ ob~ ~ U`~ ~' ~ o ~~ `~ ro~ -----.. t ~~ ~ ~ .r ~' v+ ~~~ g ,~~ r,~.. ry ~` ~v -~--- ~ - !- ~ ~~ ~ z ~` d ,~ ~~ N ~5 ~~ b a -- -~ d N cA b ~. ti n ~. ti '~ lb V~, t~ b ~~ ya ~ V ~ r t',~ ~-` ~ $ ~ ~~ ~ ~ ~ . ~~ ~~ ~~L n ~ A ~ ~ 1 ~ ` ~ ~ '~ ~ ~• L e u~ ~ ~ ~ ~' o~c~~ W ~ ~ V Q ~ F n a~ d ~ ~ , ~ ~scons~n . Department of Commerce September 26, 2001 CUST ID No.224617 LYLE J MYERS NORTHLAND PLUMBING INC E1556 ST RD 64 BOYCEVILLE WI 54725 Safety and Buildings 401 PILOT CT STE C ~~ ~ / WAUKESHA WI 53188-2439 ~C?i TDD #: (608) 264-8777 ,~~ A- `C, www.commercestate.wi.us/sb ..~,~' ~~CE1V~Q `~ ~ www.wisconsin.gov •, .. r o~ 1 " _ Scott McCallum, Governor ~~ 'f ~ ~~~ µ~ Philip Edw. Albert, Acting Secretary x r ~^;-__~,, ~, ~A7TN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/26/2003 SITE: JEFF STONE COUNTY ROAD BB TOWN OF EAU GALLE, 54028 ST CRODC COUNTY NE1/4, NE1/4, 528, T28N, R16W LOT: 3, SUBDIVISION: CSM Identifi n Nu hers Transaction ID o. 676808. Site ID No. 63 83 Please refer to both identification numbers, above, in ali correspondence with the agency. FOR: OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 813958 DISCRIPTION: 450 GPD MOUND SYSTEM. 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 Waste Treatment Systems" SBD- 10691-P (N O1/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD-10706-P (N OI/O1). • 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 mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • 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. ~ LYLE J MYERS Page 2 9/26/01 M ` 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 Deparirnent, 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. Since y, THOMA J~ S POWTS PLAN REVIEWER ,INTEGRATED SERVICES (262)521-5064 , 7:30-4:00 TPERKINS@COMMERCE. STATE. WLUS FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 BALANCE DUE $ 0.00 WiSMART code: 763 j ~ ~~ . isconsin ' Department of Commerce Safety and Buildings 401 PILOT CT STE C WAUKESHA WI 53188-2439 TDD #: (608) 264-8777 www.commerce.state.wi. us/sb www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Acting Secretary September 26, 2001 CUST ID No.224617 LYLE J MYERS NORTHLAND PLUMBING INC E15S6 ST RD 64 BOYCEVILLE WI S472S ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIItES: 09/26/2003 SITE: JEFF STONE " COUNTY ROAD BB TOWN OF EAU GALLE, 54028 ST CROIX COUNTY NE1/4, NE1/4, 528, T28N, R16W LOT: 3, SUBDIVISION: CSM FOR: `Identif cation Numbers Transaction ID No. 676808 Site ID No. 636683 Please refer to both identification numbers, above, in all correspondence with the agency. OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 813958 DISCRIPTION: 450 GPD MOUND SYSTEM. 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 Waste Treatment Systems" SBD- 10691-P (N O1/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD-10706-P (N O1/O1). • 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 mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. ~"~ A ~~•o • Maintenance information must be given to the owner of the tank explainin that p~ ~ ~ig~ftsr is required. Access to the filter for cleaning must be provided per Comm 84 pro ct ap~ on~i~ns. • A Sanitary Permit must be obtained from the county where this project is locate~~ corda~ith the requirements of Sec. 145.135 and 145.19, Wis. Stats. ~,p ~~ • 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. LYLE J MYERS Page 2 9126/01 ' A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions azise 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. Since y, QQ ~ ~~1~~ THOMAS J PERKINS POWTS PLAN REVIEWER, INTEGRATED SERVICES (262)521-5064 , 7:30-4:00 TPERKINS@COMMERCE. STATE. WLUS FEE REQUIRED $ 175.OC FEE RECEIVED $ 175.00 BALANCE DUE $ 0.00 WiSMAR`F code:-7633 r. r e ~'~ Mound pp1d 8 Cover Page Project Name: Jeff Stone Mound Owner's Name Jeff Stone Owners Address 1443 300th Street Glenwood City, Wi 54013 Legal Description NE ~ %+, NE ~ %. Sec 28 T 28 N, R 16 w ~ Township Eau Galle County saint Crobt Subdivision Lot# 3 Parcel ID# Table of Contents P9~ 1 Cover page 2 Mound Sizing Calculations 3 Pressure Distribution Layout and Dynamics 4 Dose Tank /Pump Curve 5 Management and Contingency Plan 6 Plot Map total # of pages: 6 Designer Name: License #: Date: Ph. #: Signature: Lyle Myers 77dFi17 O53/'1'l17OU9 RE~Ew~' SEP ~ 7 Dili SAFETY ~ gLpGS, ~1 t~•' ~~¢f~ (75 f~4~ 151U O yyoeG`oc~O F i Mound System Design Methods Used ~~F,j, per "Mound Component Manual Fa Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD-10651-P (N.01/t71) CSC` per " Pressure Distribution Component manual fa Private Oneite Wa~ew~ Treatment Systems" (Version 2.0) SBD-10706-P (N 01101) 3bAdvisemerN N12486 220th St, Boyceville, WI 54725 Ph: 715-643-6068 email: Mound System Mound Sizing Calculations Project Name: Jeff Stone Mound Site Conditions PI.Oject Type: 1 or 2 Family Dwelling °Io Slope: # of Bedrooms: Depth to limiting factor: Absorbtion rate of fill material: Absarbtion rate of in-situ soil: Effluent quality Max BOD effluent value: Max TSS effluent value: o~ l zel m. 1 gal/ft2/day 0.5 gal/ft2/day Eff#1 ~ 220 mg/t 150 mg/1 ~e2as 10.0 in. 15.1 in. 9.5 in. 6 in. 12 in. 8.6 ft. 92.2 ft. 5.3 ft. 9.7 ft. 21.0 ft. Design of the Distribution Cell Basal Area System Design Flow: 450.0 gat/day Basal area required: 900 ftz Distribution cell width (A): 6.00 ft Basal area available: 1178 ftz Distribution cell length (B): 75.0 ft Area of Distribution Cell: 450.0 ft2 Observation Pipes Contour Elevation of Mound: 95.50 ft location from end of cell (Z): 12.5 ft System Elevation of Mound: 96.33 ft Final Grade of Mound: 98.13 ft Mound Plan View ~ Observation Pipes ,~ ~ Z--l B ~-K I Tilled Areaa+Fill Material { L ' Design of Entire Fill Cell depth at upslope edge (D): Cell depth at downslope edge (E): Distribution cell depth (F): Cover thickness over edge (G): Cover thickness over center (H): End slope width (K}: Fill length (L): Upslope width (J): Downslope width (Toe) (I): Fill Width (W): Mound Cross Section Final Grade Synthetic Fabric Distribution Cell-~ S stem Elevation ¢~ '~ b ~ ~ ~ Cover Materia! :~~~ Fill Material ~ '~~' .. ' `. t ...,: . ~„.r.--Slope ervation Pipe -~,_ ~G ~Forcemain filled Ftirea Contour Notes: Fill material to consist of ASTM C33 Sand Distribution cell aggregate to comply with Comm 84.30(6x4) Synthetic Fabric covering on cell per Comm 84.30(6)(8) D'~stribution Cell to have minimum 6"aggregate below lateral and 2" above. Mound System Pressure Distribution Calculations Project Name: Jeff Stone Mound Lateral Layout Lateral elevation: 96.8 ft Rows of Laterals: 2 ~ Manifold type: Cen6er • Orifice diameter: o.a.25 ~ In. # of Laterals: 4 Distal Pressure: 5 ft Lateral Length: 37 ft Orifice Spacing/Distribution Orifice spacing (X): 24.00 Inches Orifices per lateral: 19 Avg. ft2/Or~ce: 5.92 ft2 Pape 3 of B Lateral/Manifold Design Lateral diameter. 1'/~ ~ In. Lateral spacing (S): Lift Lateral to cell edge: 1.5 ft Lateral discharge rate: 7.83 gpm System discharge rate: 31.31 gpm Manifold diameter. g . In. Manifold length: 3 ft Forcemain Friction Loss Forcemain length: 20 ft Forcemain diameter: 2 ~ In. Friction loss in forcemain: 0.420 ft Lateral Side View r- Lateral M anifald x 2 Lateral Lateral Plan View -- Lateral Length - ~ Turn-up w1baN value or deanout plug Orifices on boktom of lateral equagy spaced f"VC laterals and Forcemain to comply with specifications per Comm t34.301:2KeJ Forcemain connection via tee o- crass to manifold at an,~ pont Clean Out Detail Bean-out plug Grade f--or ball valve Observation Pipes water ngnt crap or plug Sprinkler Box Long Sweep 90 ortwo 45's-.~. 6" Minimu~ Note: Cbset Colar maybe used in place of 318" bar `~-318" Bar Mound System Septic, Pump and Dose Tank Project: Jeff Stone Mound Tank Information Pump tank manufacturer: Pump tank size/model: Pump tank gal/inch: Tank bottom elevation (inside): Septic tank manufacturer. Septic tank size/model: 1 I Wieser Concrete) 1 i~ye a a g Dosage Volume Does forcemain drain bads to tank? L_~ Lateral void volume: 15.6 gal Dosage to absorbtion Cell: 78.2 gal Forcemain volume: 3.5 gal Total dosage: 81.7 gal Pump and F ilter Total Dynamic Head Pump Manufacturer. Little Giant Are laterals highest point? Pump Modef: 9EH if not, enter highest elevation: 0 ft Effluent Filter. Zabel A100 System head (distal x 1.3) 6.50 ft Vertical Lift ("D" to lateral) 10.83 ft Note: Access opening of sufClcient size to be provided to allow removal of filter. Opening to terminate at or above grade. FflCtlon IOSS In forCemaln: 0.42 ft Pressure loss from filter. Uft Total dynamic head (TDH): 17.75 ft Pump Tank Diagram Watertight Locking Cover 4 Inch ~ blaming Label irn; Minimum ,-,__ Altemate~' Outlet Location Eled. per Comm 7 6.28 and m i ~ NEC 300 Weep Hole p' orAnti- Siphon B Device C D Dose Tank Levels In. A Reserve 21.7 B Pump off to Alarm 2.0 C Totai Dosage 5.1 D Effluent depth for pump 12.0 Total Capacity: 40.8 Pump Curve: 9EH FLOV- LITERS/FOUR 0 ]000 2000 3000 Gal 345.1 31.9 81.7 191.3 650.0 10 Pump must be capable of: 31.3 GPM and head pressure af: 17.8 Feet W W W a N 7.5 ~j W I s ' a zs 0 20 40 60 Little Giant FLOV- GALLONS/M[NUTE 9EH PUMP PERFORMANCE CURVE l13V 60H2 •~ 'Mound System Management Plan pursuant to Comm ss.54 w. a c. page 5 of 6 Owner's Responsibility: The component owner is responsible for the operation and maintenance of the component. The county, department or POWTS service contractor may make periodic inspections of the components, checking for surface discharge, treated effluent levels, etc. The owner or owner's agent is required to submit necessary maintenance reports to the appropriate jurisdiction and/or the department. Septic Tank: Septic tank(s) are to be inspected routinely and maintained by department approved individuals when necessary in accordance with their approvals. The use of chemicaUbiological "treatments" is not required or recommended. If such additives are used, make suns they are approved by Department of Commerce, Safety and Buildings Div.. Effluent filters are to be removed &deaned as necessary, with provisions to keep solids from passing the septic during removal. No more than 113 of the usable tank volume may be occupied by sludge/scum. 3 year inspection: If tank has greater than 1/3 volume sludge, tank contents must be emptied and disposed of in accordance with NR 113 Wisconsin Administrative Code by an approved individual. If the inspector does not recommend pumping of the septic tank, then the owner must be notified of when pumping should be done as to not exceed 1/3 sludge volume. Septic tank should be routinely inspected to be watertight and of good repair. Pump/Dose Tank If an effluent filter has been installed in the pump/dose tank, it must be removed &deaned as necessary, with provisions to keep solids from passing to the mound component during removal. The pump, float switches and alarms must be inspected at feast every three years for proper operation. Pump/dose tank should be routinely inspected to be watertight and of good repair. Mound and Lateral System The mound system component must remain free of ponded surface water prior to pump operation. If 4 inches or more water level is detected in the observation pipes, the owner must be notified of possible problems/faiiure. The designed daily flow capabilities of the component should never be exceeded. Trees and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the component. Activities OTHER than mowing/maintenance (i.e. excessive walking, pets, vehicles, etc...} could compress the component and reduce it's absorbtion capabilities and/or possibly cause it to frBeze in winter conditions. Lateral distribution pipes should be flushed out/tested every 18 months using the deanout points at each end of the component to remove scum that may clog orifices. Performance Monitoring: Performance monitoring must be done at least once every three years following the installation or at the time of a problem, complaint, or failure. Contingency Plan: If the septic tank, pump tank or any of their components therein (including floats, alarms, pumps, etc) become defective, the defective tank or component must be replaced immediately to ensure that the system can operate as designed. If the mound component cannot accept wastewater or ponds wastewater to the surface, the component must be repaired or replaced in it's current location by either. extending basal toe to provide added absorbtion area; or by removing the dogged bacterial mat,aggregate cell, and distribution piping within the mound and replacing said components in order to return system to proper working order as required. ~ ~ •. ~ : , . ~ ~~ ~~ ~., ~~~~ -- --3 a N b '~i d n ~ ~~ ~ ~ .,p o ~ o ~ &. ~ ~ b ~ ~ - `~ `~ Y'' can "~ ~ ~ ~ ~ ~ ~~ ~ Rti {A ~,. ~~ ...r-~ ,.rte ~~~ ~~Y G ~' ~ ~. 0 ^~1 ~ „~ b 4 ~ ~ ~ ~ ~ ~ d a ~~ ~' .r ~~ G ~Y r ~- ~~~ y N ~D ij1 ~. 4 ,; ~~ N ~5 ~~ b ~Fl ~ m~ ~ , ~~ ~ ~~ C~ ~ b A ~ ~ ~~ ~' a ~ ~ ~ ~. ~ ~ ~ ~ E ~~V .~ L ~ ~ ~ ~~ °~~°~ ~ ~ 4 ~ Q ~ Q ,~ r ~ ~ ^~ •~isconsin Department of Industry, °-abtlr antd Human Relations Division of Safety~and Buildings SOIL AND SITE EVALUATION in accordance with s. ILHR 83.09, Wis. Adm. Code Page _~ of 3 Attach complete site plan on paper not less than 8 1/2 x 1,1 inches in size. Plan must County include, but not limited to: vertical and horizontal,~,eft~ence point (BM,), direction and ~ ~C Yo ~ percent slope, scale or dimensions, north arroyv;'and location and distaitee to nearest road. parcel LD. # ,; ~~,~(~ ~!~ APPLICANT INFORMATION - P//e~ase prl~l~s~Xrmation: ~''; a wed by Date Personal information you provide may be used o~secondary purposes (Priv law, s. 75.©4 (1) (m)). Property Owner y ~;1 ~~ X jProperty Location ~,. ~ '` ~~ SZ t1~` 'Govt. Lot N~ 1/4~ti 1/4,Sa~' Tz~ ,N,R /6 E (or 1 p, Property Owner's Mailing Address ~, ~' ~~,, ~G, r,'`"-.- % Lo~ Block# Subd. Name or CSM# City State Zip Code N art g ,/ ~~ ~ ^ City ^ Village [~] Town Nearest Road ® New Construction Use: ®Residential /Number of bedrooms _~ Addition to existing building ^ Replacement ^ Public or commercial -Describe: Code derived daily flow ysd gpd Recommended design loading rate y bed, gpd/ft2 r _~ trench, gpd/ft2 Absorption area required 3 7S bed, ft2 tre4nch, ft2 Maximum design loading rate _~_bed, gpd/ft~~~trench, gpdfft2 Recommended infiltration surface elevation(s) __ !G • S ft (as referred to site plan benchmark) Additional design/site considerations ~G.U P6 tC.Y ~5 S Parent material ,~if-a~i`a< pLGTlrJaS~- _ Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ^ S ©U ®S ^ U ^ S ®U ^ S ®U ^ S ©U ^ S ~, U C(lll rICC~`DIDTI/lw1OCDr1~T I_r-a ~.X~. ~.'7~`s~ ~~ ~~G•t! Boring # r Ground elev. +~ft. Depth to limiting factor "in. Boring # Ground elev. ~j?. ~~ft. Depth to limiting y ` factor 02~" in. Remarks: -------- -------- CST Name (P)ease Print) ~lq^aii~+ Telephone No. i licl , ~~(,'a~ tyt Sc u ~u KC r _ ..~--- ~.~-!-- 7l ~ - 3 ~'G ~ 3 /z ~ ~---- - __ _ -- _ w ~ ----- ---~ Address Date CST Number Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPDltt2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ged , Trench -~ /D 3 3 _1vo .v ~ ____ S z m u6 C S 2 m S~~ 6 a. -1.6 10 /' y~y - - - .~-o.v-'G -- 5_c I a_h1 ac~b/g Ftr C / S 3 ac-y6 Y _ - t:2~ ~°sRy/ - s•c ~ ab Fi ~S - -~ -- -- i Remarks: i /} - lD 1~ rP 3/,3 -- ---~~s,v-e - -- S i a/na~ik c 21x1 : ~' .2 0~a ~__Y/Y - ---~c~'vG-_--- - _ _$'~[_ ,2 h?a6/{ ~ ~S l F ~4~ - - - Y -- --- --- -a .-__ -. -..._ -..--.-__- ~~e~.---r.a.~a~.~.. i s.-. .__._ ' i I .s •f •S .~ 1'ftU1~Ll't"lY bWN1R ,~C f" K.~G~~ PARCEL LD.q ';1)11 t,l ':CI{11'I11)N Itl l'(lltl I ~~,u„ 2 .,t 3 Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench I ~-ro o ~.v~ --- ------ _s ~ - ~ rn ~ s ~ ~ 3 8 c ~ Z, Cab ~ F,` c -- ; .- Remarks: Born # lg Ground elev.. ft. Depth to limiting factor in. Remarks: Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPDJft2 in. Munsell Qu. Sz. Cont- Color Gr. Sz. Sh. Bed ,Trench Remarks: s' ,~ factor ~ 'n' Remarks: SBDW-8330 (R. 08/95) e r K,S'e 7 ., I Sc ~~ ~- l ` ~ 5'O ` uv~.ess Shoc~~ ,~~i1 l .9/y Coddea~ P,jpa se T~~er~ /~d. D _~~ ~ y: ~Sa a~ ,r /1/~d/~dS4 [J`' 1 I 1 1 ~D H+ t I 1 $.~T~ ~ ~` _~ of .~_ ~ ~ ` ~~ ~ ~- - ~ • 7, T ~ o _ T ~°~-~r Qs,.~a -- - ~__ ~ 2 ~~ .• v ~~+ a ~ ~~ ST CROIX COT~YV`I'Y SEPTIC TANK MAiNTENANt~E AGREEMENT' AND QWNERSHIP CERTIFICATI~JN FORM Owner/Buyer ~~~~~ ~ ~~ ~.---~-~_- Maitin Address / y `I'-~ yea, s ~ G, g i ` ~i i o5 g - _ -~ ., ~ 2325 property Address ~.-__ -- (Verification required from Planning Department for CitylState Parcel Identification Num>~r T rG .~ C~~ON Property Location C ~/,,'~ ~r l/•, Sec. a 8 . T-2~ N•R_~2W, Town of ~ ~-~G~' Subdivision _,.~., e s I.ot # 3 Certified Survey Map # ~ 7y __. Volttme _ ._________--~ ,Page # 3~ Warranty Deed # ~ ~~~:~ Volumes _~...~~-' PagB # .,._. 1 ~ Spec house ^ yes ^ no Lot lines identifiable ^ yes ^ no i3 a o~ cvcTR,M M<A ENANCE Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Pmper maintenance c~onsfsts of pumPiaag out the septic tank every thraa years or aooncr, if needrd by a licensed Pumper. What you put into the system can affect the function of the septic tank as a treatment stage fn the waste disposal system, The property owner agrees to submit to St. Croix Zoning Depatttrunt a certification form, signed by the owner and by a masterplumbar, Journeyman Plumber, restricted plumber or a licensed pumper verifying that (1} the on-site wastewaterdisposal system is is proper operating condition andlor (Z) after inspection and pumping (if necessary), the septic tank is less than 1J3 lull of sludge. s tem arith the standards Uwe, the nadarsigned have road ~-a above r+cquixamants and agree to maintain the private sewage disposal ys set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconso c~e~th~intt30 stating that your septic system bas been maintained must be completed and returned to the St. Croix County Zonwg days of the three year expiration date. ..._.~-~ SIGNATURE OF APPLICANT DATE nWNER CER'TIFYCATION I (we) certify that ali statements on this form are true to the best cif my (our) knowledge. I (we} am (are) the owner(s) of the p p described a ve, irtue of a warranty deed regarded izt Re£;ister of Deeds Office. ~ ~ ~a ~ GNA OF APPLICANT DATE **•**« Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Departm "'~ Iacfude with this :pgtfcatfon: a stamped warranty decd from ~ ~fa~ference ids m~atk in the warranty deed a copy of the certified survey map . ~ Document Number ~~~ .i"114PAGE 1~ STATE BAR OF WISCONSIN FORM 1 - 1999 WARRANTY DEED This Deed, made between BERKSETH, INC. Grantor, and JEFFERY D. STONE AND CHERYL M. HILDEN Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in ST. CROIX COUNTY County, State of W isconsin (if more space is needed, please attach addendum) A PART OF THE NORTHEAST QUARTER OF NORTHEAST QUARTER OF SECTION 28, TOWN 28 NOR ,RANGE 16 WEST, MORE FULLY DESCRIBED AS FOLLOWS: OT RE 3) OF CERTIFIED SURVEY MAP RECORDED IN VOL. 2 P 323, DOCUM NT O. 366 0, REGISTER OF DEE S~OFFICE, ST. CROIX , WISC SI 2001 008-1079-40-000 Parcel Identification Number (PIN) Together with alt appurtenant rights, title and interests. This is not homestead property. Oii) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and cleaz of encumbrances except Dated this ~C~' day of JULY /rlrL~~ ~ ~ nr ~ ~iC1d~/7cf".rtk4y.~k~ ~~ . _ ~BIERKSETH, INC. BY DON LD BERKSETH, PRESIDENT LLB r1 _ 'SHELBY BERKSETH, SECRETARY AUTHENTICATION Signature(s) au a,ted Fthis ~~ day f JULY 2001 • ROBERT R CAVIC TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Slats.) THIS INSTRUMENT WAS DRAFTED BY ROBERT R GAVIC SPRING VALLEY, WISCONSIN (Signatures may be authenticated or acknowledged. Both are not necessary) Names of persons signing in any capacity must be typed or printed below thei to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. Notary Public, Slate of My Commission is permanent. not, state exprratton ate: nature. Inf«mali0n Proleasionals Company, FonC tlu ta0. yVl STATE BAR OF WISCONSIN eao~ss2o2~ WARRANTY DEED STATE OF 655922 KATHLEEN H. WALSN REGISTER OF DEEDS ST. CROIK CO., WI RECEIVED FOR RECORD 09-04-2001 2:35 PM NARR<aHTY DEED EXEMPT Y CEkT COPY FEE: COPY FEE: TRANSFER FEE: 111.00 RECORDING FEE: 10.00 PAGES: 1 Recording Area Name and Return Address ROBERT R. GAV[C P.O. ROX 400 SPRING VALLEY, WI 54767 ACKNOWLEDGMENT ss. County Personalty came before me this day of the above named FORM No. 1 - L999 ~ ' ~r~3 3~~3 6 b'1 ~., Ft~ED ~ °D 1r0Y 1819 CERTIFI ED SURVEY MAP 76 ~~~~ NE I/4 - NE I/4- SEC. 2 8, T-28-N, R-16-W ~ ~.y , a ~i E ~ ~, ,o ~ , ~~~.~~ ~ zzy mm..l :omz ?~n~ o ~=,miz~D ~ ~ r ~ D I ,v,~.~ to x ~ I •-•-N 00~ 2i'- 27" W 1359.36'--•- I ~ m _ - ,~ -~ - z ~ I ' = _ o ~ ° 33.07 ~ •~ 'A ~ N 00°-21`-27" W 33.07 -~ c ~,'o m ~ , N ~ F..y '' - 291.93`-- ~0 I ~ ~ m ~ "r m O ~ ,, ~ z Z~-° I ~ ~ ~1 Z ~ ~ ~ fN W I ~ Oo ~ ~ cn ~ ~ ro ~' ~ ~I ~' v w 0 ~ ~ 1 ~ °D ti ® ~ g wL ~ ro ~ :° ~ .° \ ~ ~ ti I ~ ~ n CIO = 334 36' ~ 0 D ~'-~~ ~ NORTH LINE a . ~ m I SEC. 28 m w y ~ m I w~ ~ O ~~'C ~Z ~ y W I I r Q ~miD ~o c m o ~W ~ i ' ~ N oo° 2t`-27" w ~'~ -~I ' Z o = ~ ~ m i ;° , - -' "- 291.93'-' " ~ N ro ..o ~b~~ I ro ~ 33.0TI ZI m ~ m No D O 33111WSV0~ ~ktr,oz dNV QQ ~ '~ D 1 ~ m io ~'' I ~ D-1 ,off cnr c ~ 9M?•?NV1d SY.~lb'd ?P .T\aH3:'dYr~} i a11V! ~~ ~ I. ~ ~ c NZ , ~ c ~ D W IA 3m • °° w IW ~ =~ vim ~ 91s~ g Y 110 "'! cmn I ~ m m ~ 0 ' ~ can _ o n D ~ ~ I e s'I ro = A 43/1,0?1dd~ ° w i n m ~~ _~ 'UN'A -- - n---- i_ '---- .__~ L. . ~ ~ rn o - ~ 324.9 0 C.T. H. „ g8~~ ~ S 00°- 19'-31" E rn ~ ~m~ - _ ------ O ~-------- ~r^ -- ~) ~~ ~F ~;D .~ . ~ ~~i 3-7/8" 6-5/8" (168.27) (98.42) 5" (127) 3-718" (98.42) .._ ~`~~'° 3-7/8" (98.42) 31. ~ DISCHARGE 1-iJ2" NPT FLOAT SWITCH 10-3J16" (258.76) 3-5l8" (92.07) 1 ~"" .All d' ensions in inches. (Metric for international use). 2. Component dimensions may vary ± 1/8 inch. 3. Not for construction purpose unless certified. 4. Dimensions and weights are approximate. S.We reserve the right to make revisions to our product and their specifications without notice. ', ~~ HYDROMATIC .~ 7 ,,, Shef40 Performance & Dimensional Dntd