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HomeMy WebLinkAbout010-1024-10-000Wisconsig 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 Berends, Adam Emerald, Town of CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing ~ ~ 6~'~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~ f D i os ng Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 97 State Plan ID No: Parcel Tax No: 010-1024-10-000 Section/Town/Range/Map No: 10.30.16.150 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer dJ'5.~. n1e,,.., ~ ~ 7 9 ~ • Y sUHt IXet X01 ~ ~ 3 s, vSs 9'S .~ s SUHt Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P B G WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center Bed/Trench Edges Topsoil 0 Yes ~.,~ No ~ Yes Q No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Location: 2456 160th Avenue Emerald, WI 54013 (SW 1~ SE 1/4 10 T30N R16W) NA Lot 1 1.) Alt BM Description = aU + ~ j .n, 5k'.~..~2I`. ~p ~ Z `r 2.) Bldg sewer length = / _ ~ ~ `/ -amount of cover = ~G _ Plan revision Required? ~ Yes ~No L~N Use other side for additional information. L ! ~__`_~o~ Date SBD-6710 (R.3/97) Inspection #2: / /_ Parcel No: 10.30.16.150 1° ~3y~- ~---- -- Cert. No. ~ County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN ~~ In accord with Chapert 12 St. Croix County Sanitary Ordinance PLANNING & ZONING DEPARTMENT tO~~ ~ Personal information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER 1101 C i h l R d i ' ''" [Privacy Law. S. 15.04(1)(m)] arm c ae oa $ :~ `' Hudson, WI 54016-7710 ~ 715)386-4680 Fax (715)386-4686 Attach complete tans for the system on paper not less than 8-1/2 x 11 inches in size. County Sanitary Permit # ^ Check if revision to previous application I. A lication Information -Please Print all Information Location: Property Owner Name () 1 /4 ~ ~ ~ 1 /4, Sec ~~•-~ ~ e 3L1 N, ~r7 R E (or W Property Owner's Mailing Address 'y am' ~ Lot Number Block Number V~ - 5 l / G / .^.~ ~, City, to ~i~E7z14ZL~ `~ Zip Code ~~o/v Phone Numer 7lS'o~lS cla~~/ Subdivision Name or CSM Number ~~~ 3~2z ~~~.~(~~~ II Typ Building: (ch ck one) f 1 /~ 1 2 F il D lli N f B d l / ~/ ~ ~~~ ~ [amity ^ Village wn of or am y we ng - o. o e rooms: ~ ~~ ~E ' ^ Public/Commercial (describe use): l~ ~~ } - ~ ^ State-owned T~ Nearest Road / / / ~ .{ ')~ / ( , / 97 / II. Type of Permit: (Check only one box on line A. Check box on e B if licable) U/ `i J / y f Parcel Tax Number(s) A) 1.^ Repair 2. lra' Reconnection .^Non-plumbing 4. ^Rejuvenation ~~G~~ ~~ ~ /vJ~ Sanitation - B) Permit Number / / ~ 7y ~' ~ Dat~ I sued ~ ~ fate Sanitary Permit was previously issued 7 % IV. Typ POWT System: (Check that ~Ppl~y) _ ~~ ~ ` ~~ ~~ `_~ ` ~ C ound 5 24 in. suitable soil ^ Mound A+0 le s Non-pressurized In-grounc '~~~~''~ '" l/ ^ Mound ? 24 i C J~" ~ v ^ Sand Filter ^ Constructed Wetland ^ Peat Filter ^ Drip Line ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Other ~~~ ~ ^ At-grade ^ Aerobic Treatment Uni ^ gecircu ling ~ V. Dis ersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal A a 4. Soil Application Rate 5. P colation Rate 6. System Elevation 7. Final Grade /~/ Required Proposed (Gals./day/sq.ft.) (Min./inch) 7 Elce~valtion/~ I. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete strutted glass Tanks Tanks ,r -~ /06 0 / Mtd ~ ^ ^ ^ ^ r 44 ^ ^ ^ ^ ^ VII. Responsibility Statement yj ~-w~ I, the undersigned, assume responsibility for repair/reconnenction/rejuvenate stallation of non-plumbin r the POW shown on the attached plans. A license is not required for terralift repair or the installation of non-plumbing sanitation system. Plumber's Name (print) PI er's Signal re (no st ps): M MPRS No. Business Phone Number Plumber's Address (Street, City, State, Zip Code) ~-so7 /a2 r T.,l~ /'sr /~C f~/N c~P ~/ ! Sf~oo VIII. Count Use Onl Disapproved Sani ry Permit Fee ~ Date Issued Is ai g nt Si iatur o tamps) Approved Owner Given Initial Adverse ~DO, ~ ~/ ~/ D 1S Determination IX. Conditions of Approval/Reasons for Disapproval: ~ ~~ ~tiL~~~~ ~~ ' 2 r~o--~-/4~~:~,~- ,~~..~'~'~ `rte ~ i °~Z~a.S ~~ a~.~ ~ ~ ~il/D~~h~~6-u~~ -~at~~ o~~o r v~ c~ ~~ z~ ~_ m n~ Op zy ~v ~~ ~~ ni z ZZ 2 I"" z r D z m z v 0 O h m n a W 0 z 0 r O D -~ -rv m r C7 N m a b `"1 m ~~ ~~ m a m m~ ~a y a m g~c n~ ~ ~ m ~ ~~~ o ~ ~ m 7~ N ~ ~~~w j ~~ m M O j ~ ~~ 3 z ~ ~ ~ ~ ~~ ~_ yv ° ~ c ~~ X01 ~' o ~~5'i m 3 '~ °~ ~ cow ~ ~,~ mr~~ m ~m tn~ ~c~ N ~ c ~~ ~ N a~ a~ ?~x ~ ~3~ ~ ~? X N ;-. N N m ~ N O ~p n N ~~ (~ `Z ~• d~ < 7 Q vJ ~ ~ c w y ~ ~ j. ~. w of ~' j_ ~ ~ ~ N m ~ ^~' ~ ~ ~ ~ O ~' ~ pNpv n-' ~ ~ ~ to ?~ ~ -~ 5 ,~ - a v m ~ 3 mm mD cg ~ •<~w a c~ q N N ~ f~ 'O ~ N „~ 7 N m ~~ w ~ N 3~ 3 3 0 ~ cv y ~ o ~ ~ a ~ ~ c ~ o ~ ~ m ° °: ~ W m ~ ~m ~ a~ 3 N m ~~ ~ ~_m ° y :y n 0 ti O n b b w N m < z D '~ Z m z~ z ~ ~ ado ~ ~ Z z z D z G) ~ o ^ ~^ Invoice # ~ ~v~ O Cassellius Sanitation Service Joe Berends, Owner/Operator 1414 County Road D Glenwood City WI 54013 715-265-4623 Statement of Acc' ount Date 0 e~. 2 ~ , O cJ Name L.cdl~,,1 ~J~j,,Q,~.y,,.,~iy Address r t,..1/ Telephone ~.(. I Pa able u on recei t TOTAL FINANCE CHARGE of 1 1i2 percent per month, with a minimum charge of $1.00 will be added to all accounts over 30 days past due. $4.00 fee assessed on aA returned checks. ' ~ ~ C~ cn O' n y O 3 w n d 3 ~ ~ o ; 7 ~ ~ c o ~. ~ v1 H~ I ~ ~ ~ I. `~ ~ ~ ~ 'C ik .C. ~ C. 3 I 3 3 ~ g! ~'~, \ 1 '. ~ O A ~ ~D O V O V (D O N 4Ni O ~ O ~~ ~ O O ~ ~• I d d ~ f i O ~ m O I O ~ ^~ ~ C SwD ~ ~ f~D 7 (D W ~ ~ ~"~ 3 I O fG , • ~• O m ~ y ~ O ~ y H N p 7 y '~ ~ o ~- ~ N O n ~ a y ~ a I ~ j ~ ! o i -' C~ pp ~~ (( I O ° °~ tD fD C ~ ~ I y ~ N ~ O Q ~. O ww3 0 3 I a ° 3 i ° ~ ~ I N N A I w C ~~ O O „~, 1 v I ~ ~ ~ I m lei o ~ ? lug a ~ ~ W c, o ~ I °°° s ~' I ~°_ o I N3 .-. 0 ~~ ~ ~ ° N I ~ ` ~ Z ~ ~ ~ ~ = oom ~ Z ~ ~ fD 7 m' ~ m ~ I o 0 a ~ o , nrtn 0 y~ 0 0 3 ~ °~ 3 ~ a ~v~a1 a ~~'oa' :: lwl. . o Z , A o f0 'v ~ ~ ~ ~ I ~ ~ ~ ~ ~ ~ ' G ~ Z `i ` N ~ ~ ~ N ~ N ~ovv ~ ~ ~ m Q N N to ~vv ~~ ~ D vl ~f O j ~ ~ , IUD iii 1/! ~ I ~ ~ _ !~D w fA ~ i A ~ ~ d ~ d. ~ W ~ d. ~ W ~ !1 ~ 3 m 1 ° 3 m '' ~ w ~ N I a ~- I a ~ .. N o .~ I N c ~ D~ a D u o °: ~ m ~ ~ I o m ~ m v ~ o m • I Vl U1 ~ / ~ ~ / p ~ m I w ~ n a I ~ n a d 3 m -p7o ~ I ~ m v ~ -~ v~ ~ y O n 0 ~ c of ~• O ~ C A? Cam'! ~ ~ n I a O A G> > .. I ~. I I I ~o° oov ao~ i I o. ~ I 3 a ~ '' ~ .~ z i A ~ I I y y m~ Z ~ I m I ~ ~ ~ I w I w ~ I ~I ~mN a I 1 cc~°~.o.oc o a m o N N W r; G ~ Q Q~ ~ p; ° fD c G 7 I my 0 c I c'o ~?o n~a n~i c I ~ i o -+ - ~ o ~ a I v ~ao;~ m - y o y ~ a ~ 0 o T N i m o a~c ~ c O~ y S O O n g O O fD y n~ 7 O v N (3D 4/ ~ 'C c 3 m ~ ~ ~o _u, - ~ _ m O ee ~ 7 fD ~. Q C 'O U1 n. ~ _ C ~ fp O ~ O Q. ,~ .E y A. y. ~ I O ~ N ~ ~ p _ fD ~ O O N ~ ~ `z_ -- o - ~ N ~ O ~ I ~ p aL 0 ~ 7 ti I `nom a~~ oe , ~ ~ d N ~ N O N O b ~ ~ I ~ ~ w E» d ~ O ~ w ° ° ~'' a. o I o ~ L Wisc sin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ^ City ^ Village ^ T n of: Berends, Adam Emerald Township CST BM Elev.: ~ Insp. BM Elev.: BM Description: (~.~ aO.D' ~ ~ TANK INFORMATION ~ ~ f ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic F -~ ~~ Dosing Aeration Holding TAAN(~TBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Air Intake ROAD Septic ~/ppr p' ~ NA Dosing A Aeration NA Holdi PUMP /SIPHON INFORMATION Manufac r Demand Model Number GPM TDH Lift Lriction ~r TDH Ft Fort ain .Length Dia. Dist. To well County: St. Croix Sanitar Permit No.: y374948 State Plan ID No.: Parcel Tax No.: 010-1024-10-000 STATION BS HI FS ELEV. Benchmark d ~sr ~,~ I ~~o Alt. BM Bldg. Sewer , 30 ~~ -`fS- St/Ht Inlet 5.00 ~$-~ St/Ht Outlet 5:22- S •$;3~ • Dt I n I et -~ Dt Bottom ---- Header /Man. 6 • f3 R~ro Zr Dist. Pipe ~ Bot. System `13.20 Grade ~~ St cover 2. Zo $ , S-s r SOIL ABSORPTION SYSTEM (,'~ C~.. h,Q,~s ~~Q_ ~-,r~„~~ ~B ENC Width r length ~ N Of tenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I ~ ~'s ~ DIMEN I N SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING Man f dur r: -~~~~ SETBACK INFORMATION Type O r ~ , CHAMBER Mo el Num er• System: ~(~ '~"~~ y'~`~' OR UNIT ~,r, DISTRIBUTION SYSTEM Header / M ifold 4 ~~ ~ Distributio le Size x e Spacing Vent To Air Intake ~ q ~ Length - Dia. Length Dia. Spacing 0 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only MENTS: Incude code d screpancies, persons present, etc.) Inspection #1: ~q/o~/O"DInspection #2: 't-~ Location: 2456 160th Avenue, Emerald, WI 54012 (SW 1/4 SE 1/4 10 T30N R16W) - 103016150 -Lot 1 1.) Alt BM Description = r~ ~~ N,,a,r,~~ ~ ~ ~"~ ~ ~ ~ZS ~~ 2.) Bldg sewer length =Zf , ar~ . ~/ ~ ,_.~. -amount of cover = 18 -t-. ~ s ~ ~ ~ I S ~ ~ t~ Z - f~ t` ~~e/ ~.~N t~s1~- tsv~~S '°~`'~' Plan revision required? ^ Yes ~ No ~ 1 UsP ntl~r side for additional information. i3 Z o SBD-6710 tn.3/97) Date Inspector's Signature Cert. No Depth Over ~ ~ ~ ~ Z~ Depth Over xx Depth Of xx Seeded /Sodded xx Mulched N Y Bed / rent enter B /Trench Edges Topsoil ^ Yes ^ No es ^ o ^ ~ yS~ I ~ ~~ ~, rP Sanitary Permit Application Safety & Buildings Division ~ In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. ~ ~ `~seonsin See reverse side for instructions for completing this application PO Box 7302 Madison WI 53707-7302 Department of Commerce personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04(1)(m)] , (Submit completed form to countytf not state owned. Attach com lete tans (to the count co onl )for the s m er ss than 8-1/2 x 11 inches in size. County~-{ _ State Sanitary Permit Number ^ Chec ~ i o pr ap ligation State Plan 3. D. Number cam . ~ (O l K ~ . , . I. A lication Information -Please Print all Information ~' Location: Property Owner Name v t ~ Property Location ~~i ~~ ~ ~ /~p : j ~^i F l ~? ~ 1 ~l /4 S~ /4, S Q ",N, W Property Owner's Mailing Address Q~ i s, SF CROIX j•' . Lot Number Block Number J~ ~y ~ ` City, State ~ Zip Code ~ umber r CSM Number ~~/~ ~Ld C~ ~ ~/2. •r 3 ~ ~~ ( II Type of Building: (check one) 'a A~ (~ ! _ / 1 or 2 Family Dwelling - No. of Bedrooms: ,3 " V"/~' S~ u7"~~f ~~~~ ^ City ^ Village ^ Public/Commercial (describe use): ,;Town of ~ ~ ~ ^ State-owned ~ ~ III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road / A) 1. New System 2. ^ Replacement 3. ^ Replacement of 4. ^ Addition to Parcel Tax Number(s) S stem Tank Onl Existin S stem ` ©~ff -~ D~ ~' `O~- ~ 00 $) Perm' Bats~ssHe~ ant ermtt was revtous issued (~ ISo V. Type of POWT System: (Check all that apply) (Non-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At-grade ^ Aero ' ^ Recirculating ^ Other: V Dis ersal/Treatment Area Information: 0 ~~. ~ 1. Design Flow (gpd) 2. DispersatArea 3. Dispersal Area of .Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals./day/sq. ft.) (Min./inch) lev E ation ~1 ~ ~C ~ Q Q ~/ - / ~ ~~ /~~ / t7 g / d . - ~_ /._ a , / 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 ^ ^ ^ ^ ^ VII Responsibility Statement I, the undersi ned, assume res onsibilit for installation of the POWTS shown on the attached lans. Plumber's Name (print) Plumber's Signature (no slam ): MIJo. Business Phone Number Plumber's Address (Street, City, State, Zip Code) ~~ ~ Lv / ~ -Cr~~iV ~~av ~ G~i ~ `vim ~ o/ VIII County/Department Use Only ^ Disapproved Sanitary Petmit Fee (Includes Groundwater Date Issued ]suing Agent Signature (No stamps) pproved ^ Owner Given Initial Adverse Surchazge Fee) S d~ Determination O ! IX. Conditions of Approval/Reasons for Disapproval: 1~ R9 • >Qes. ~taoc~>~a`r -~`~ 7~,~-C- ~~~ 9 ~ ~° l S~.f,~~,ti,,~,t~ der ~ Svv ~ ~~, r~ ~ Rio c~AC,,~s . man (~-~ 3 x q~.7s~ SBD-6398 (R. 07/00) O ~ ' O _ 0 a P t ~ ~ , ~~ _ D i ,- - 1-~ ~ J __ _ s- - - _ ~ I ! _ _ ~ - --~ --i-- - - --- __ ', _ ~ --- -- -- - - -- ~- -~ --- - - - - ---, - -~ ~ - -- 3 -- ~- -- - i --- --- -- I--- I - ' --- - I I P - --- - --- ~ . ~ ~ ~ - -- ._ - -- --- - - - - - - - ~- ~ - ~ ~ ~ i I _ i ; .__ ~ f ---- - _ I - __ -- . - - - -_ -- -- 1 _ , ~ - -- _.1___ ~ _- - - -- - - -- -- - - - - _ - ~ 1 , - . . -- __~ -I - --~ - --- ~- ; _ _. ---~- _ - - -_i _._ - - ; - ~ _ I -,- -- - -- --- ---_ - ._ _ I ~ . - _ - --~ - ~ ---i - -- --- - - _ ~- ~ ~ _ ~ _. - - -+ . -__ - - b_ -- - ~ _ _._ _, .,p ~ - - - - - --~-, ~ -- -- - -- ~~ --~-- ;- ,-- - ~ ; --- --_ _ -- - --- - - --- --,- a - - r -~ I -_- _ -. ~ --- -.--5.. __ ~ 1 _ - ~ ~- -- r `~- ~ --- --- --- _ _ _ . - . _ - I I i - - - - -- - - - --- ~ I ~ - ~ -- -- -- - - - --- --- -- -- - + ^) r M i` rf ~ ~II ~ a ~ • "~ ~ ~ ~ ~ ~~ ~ ~ ~ ~ i ~ ~~ j~~ j Tp~ i~ 77 tt ~¢ K C'1 f'7 ~ TT ~ v 1,1 ~ ~~DD~, p • n 3 M ~ ~ f~~ • • C1 _ V fs N ~ ~~ ~ ~~ s ~ ~ ~ ~ A W I ~~ - i ~ ,_ „ ~~ 3 ~ tt v ~~ ~~ = z • ~ ~, ~ ~ ~ ~ ~ - m ~ ~~ : , ~ ~ ~o Y~ g r ~ ~Y_ ~ ~ O r ~ N ~O ~~ ( iI fif } t iG I } ~:r 3^ t ~ I f 1 ~ y W S ~ ~ ~ ~ ~ I II ~` 2 f~ ~ ~ ~• ~ ~? m to ~ ~'1 r ~ m ~~p a c .: ~'~ - ~ M = c_p ~ /~ i; ~ m ; ~ ~~a ~ ~ ~ I ~:i n•~ ~ ~3 ~ ~ ~~ ~~~ ~ ;I a ~ `~ ~ < ~ m ~ . i A ~ ? ~ ~ N I l!. !I N i x ~ 3 ~ a 3~ ~ ~ ~~ ~~ `~ N ~ ~ x m '` _ ~ ~ ~ ~ a ~ ,~ ,~~ _.._ • ~ ~: ~ 5 ;~ ~• ~• ~,I, ~ . f 1 - ~ ~ ~, ~m=~ ~ ~ ~ ~ Invert 11 '-->>~ ~ ~ d ~ .. ~ N ~: M A ~ ~. ~} D _~ S ''~!E" in Department of commerce SOIL AND SITE EVALUATION Di6rs~,,n of Safety and Buildings Page ~ of Bureau of Integrated Services in acco~dance~with s. IU-~R83a~;'tly~is; Adm. Code ~ `.~~a Attach complete site plan on paper not less than 8 1/2 x 11 inches in include, but not limited to: vertical and horizontal reference point (Bh percent slope, scale or dimensions, north arrow, and location and dis APPLICANT INFORMATION -Please print all inform, Personal information you provide may be used for secondary purposes (Privacy Property Owner ~, ~~ ~ n _~`:.; ,~ ~4~ `" ~"~ Revie~ r~txZication ~,~~ Lot ~"~ `~ S, C9y~~r~ Date ~1/4,S /Q Tao ,N,R 10 ~W ne or CSM# City ` State Zip Code Phone Numbe~r~ ^ 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 -f'-z- r gpd Recommended design loading rate .~ ~ bed, gpd/ft2~a trench, gpd/ft2 Absorption area required ~ ~ bed, ft2 7~D trench, ft2 Maximum design loading rate ,.~ .bed, gpd/ft2~trench, gpd/ft2 Recommended infiltration surface elevation(s) 9~i ,~ ~ ft (as referred to site plan benchmark) Additional design/site considerations Parent material G ~ /~' ~ / ~ ~ T / ~ ~ _ 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 Boring # Ground p elev. ~~ft. Depth to limiting fact r .~,~in. SOIL 1']ESCRIPTIDN REPORT Horizon Depth Dominant Color Mottles Structure t C i B d R t GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. s ence ons ary oun oo s Bed ,Trench ~z• `~~ ' Remarks: Boring # Ground elev. 96~tt~ Depth to limiting ~ - o .~- e ~. 6 ~s ~~ ~ r ' .~' r .s----- ~ • i .~6 factor ~in. Remarks: CST Name (Please Print) Signature Telephone No. ~~L~ Lis ~'~ 17i"~ 7~5=~ dam'- Lj~.~~ Address Date CST Number PROPERTY owNER ~~eNIY 1S' l~~~~~dSSOIL DESCRIPTION REPORT PARCEL LD.# G~Gf ._~~,~~1 "'~~ "" ~~O , T Boring # Ground elev. gd.~ft: . Depth to limiting actor in. Boring # l~ Ground elev ft. Depth to limiting factor $„~in. Boring # Ground efev 9~ft. Depth to limiting factor ~in. Boring # Ground elev. tt. Depth to limiting factor in. Page ~ of ' Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ~ Trench / v- o --- s '.~ rd r, G S 3 - ~ ' d ~-- - a~ o -~ eL i,w6 ~ ~ ~ I v ~ ~. o- S ~ .~ ~. 3`~`~ ' Remarks: / v- o a ---- S G d M~ ~} S 3 Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/fit in. Munsell Qu. Sz, Cont. Color Gr. Sz. Sh. ry Bed ,Trench l o. o /v 3 .~ ~ S L ~ 6 /~ ~' ~ ~ , ~ ~ `~ G 6k ~ ~~ ~ ' ' `6 C .I ~ ~ i 4 Remarks: Remarks: SBD-8330 (R. 07/96) - - y_ _ - - - - - o P f L N ~ __ --- - --~ ' ~ -- _v -_ ~ ~ ~ _- _- ---' -- ~ -- _ - - - - - ~ ! ~ I - -- - - t --- - --- ~ __ _-- -I --I - ~ ---- - --- -- _ -- __ - -- ___ -- __ -- ' ---i - - ___ - - - , ~-_f _ - ' -___ I - - - - ~--, ~ -- I-- ---_ _- ___-~ --- --- -- I - -- -- -- --.~ - .-_ I --- ---~ - -- --- - ~ -- _ - __ - -- ---{ - - - --- - -- - - ~ ~ ~- ~ --__ - i ~ i -- ~ i -___ - -- - ~ --- --_ ~ __ - - --- -- I - ~ - -- --- -- - - - ~-~ - - - -- ---j -- --- -~ -- - --- - -- - . - ---- -- --- - - - -- --- j~ - - i ~ -- - - -- - I - - -- 1 -- --- -- ' -- -- - --- ~ - ~ - ` _ ~ -- -- - - - i . - - - - - - ~ _ -- - - - - - - - -~ ~ __ - _- --- ~ _ ~ - I _ _ - I_` i ___ - - ~ - _ - ~ '~ -- _ - _ I-- -- --- -- - ~ -- 3° ~ L e I I ~ __ - ~ ~ --- - -- - --- i -- --_ - - - ___ ~ __ ~ ~ j - -- - , _ __ -- - - -- --- ,--- ~ I--- - _ I - ~ - _- -- ----- ;__- --- -- - - - - - , - -- - - - - - --- ~ -- © -_ _ -- ---- ~ I - - - --- __ - ' - ---- - - - '--_ l _ _ ~ - - -- ~ ~ ~ ' ~ ~ I i i i f I '. ___ -~ -_ -- - -- -- - ---- - _ --- ~ - i -- - -_ -_ ___ ___ ~ _ ' i -_ - ~ ~__ --- ' _- __ - __ _ -- ~ - ~- -- ~, Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: System Design Specifications Sanitary Permit Number ~ °~ Number of Bedrooms Design Flow -Peak (gpd) S~Sa Estimated Flow -Average (gpd) Septic Tank Capacity (gal) Soil Absorption Component Size (ft2) ,S"/~ Type of Wastewater Domestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absorp ' n Component Design Flow -Peak (gpd) ~ S-/ Maximum Influent Particle Size (in) 1/8 Maximum BODS (mg/L) 220 Maximum TSS (mg/L) 150 Tab le 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the r Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank maybe difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 s . f Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. 3 ,08'/11/2000 08:09 715-778-5598 HIAWATHA NAT BANK .. _. ~~~ 1532P~~£ 34fi STi~r~[3AR OF WISCONSIN FORM 1 - 1998 ~"~ WARRANTY DEED C)ocumcnt Number This Deed, made between Dennis D.13ercnds and Doris D. Berends, husband and wife, ~'~ Grantor, and Adam J. Berends, a single person, Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (Tne "Property"): PAGE 01/03 027'691 KATHLEEN N. WALSN aEGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 08'04-i?000 3:45 PM IIARRAHTY DEED EXEMPT N CERT COPY FEE: COPY FfE: x.00 TRAWSFER FEE: 6.30 RECORDING FEE: 10.00 PAGE5: 1 Name and Return Address Pan of South West Quarter of the South East Quarter of Section 10, Township lames H. Knave Attorney at Law 30N, Range 16W, Town of Emerald, St. Croix County, Wisconsin described as p0 Box 304 follows: Lot 1 of Certified Survey Map filed August 4- , 2000, Glenwood City, Wl 54013-0304 Volume 1 tl ,Page 3q ~ ti, Doc No. tey7 62.6 otatoaa-to-ooo Parcel Identification Number (PIN) This iS NOT homestead property. (iS) (iS not) Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements and encumbtartces of record. Dated this T~~ day of August ~ 20p0 r AUTHENTICATION Signaturc(s} w De/n~nis D. Bere~n~ds f~ 1/~^c ~TXJI_ t ~L7e~B.4ii./~1~/~ s Doris D. Berends ACK]VOWI.EDGMENT STATE OF WISCONSIN } ss. St. CPOiX Counly_ ) IU "~ I authenticated this -- - -- ~.uuu~y-! Personally came before me this ~_ day of day of s August, 2000 the above named Dennis D. 8erends and Doris D. Serends TFTLE: MEMBER STATE BAR OF W1SCpNS1N (1 f not, authorized by § 706.1Xi, Wis. Stars.) THIS INSTRUMENT WAS DRAFTED BY dames H. Krsve, Attorney at Law Glenwood City, Wi 54013-0304 (Signatures may be authenticated or acknowledged- Both are not necessary.) to me known to be the person(s) who eMecuted the foregoing instrument and acknowledge the samo. Notary Public, State of Wisconsin My Commission is ~txsr3st (!f not, state expiration date: 'Names of persons signing in any ca~paciry should 6e rypcd or printed below their signatures WARRANTY DCCD $TATIt BAR Op W IbCblv5lly FORM Na. t • 19lA ~NFQRMATIpN PRpFE'j$IONAL$ COMPANY FpND DU LAC, Wi 800-655.2tY21 ~.. "~I~ FILED nuc o a 2000 - - KpiHIEEN H. WALSH 2 Ac~~~r~r a Deed: S. CrolxCo.,WI .p, ~ ~7~TP CERTIFIED SUR I~EY MAP Located in the SW '/. of the SE'/. of Section I U, T30N, R 1 GW, Town of Emerald, St. Croix County, Wisconsin. c~v N1/4 CORNER, SECTION 10, ~v- (ALUM. CAP FOUND.) 0 0 ~ -.. 0 12' +- O~ 21 wl a~ ~I OWNERS / SUBDIVIDERS UENNI.S & U(lRl.S BERENU.S 24G81G0 AVENUE EMERALD, WI. 54012 LEGEND -~- SECTION CORNER MONUMENT ( AS NOTED ) • t" X 24"IRON PIPE WEIGHING 1.13 LBS. / LIN. FT. SET. »- FENCE ~ UNPLATTEQ. LANDS z N 88° -12' 12" W 470.26' THIS INSTRUMENT DRAFTED BY: JOSEPH GRANBERG w z J Z O ~ N .- 0 0 Z LOT 1 324,322 SQUARE FEET (7.445 ACRES ) INCLUDING R.-O.-W. 309,631 SQUARE FEET (7.108 ACRES ) EXCLUDING R.O.W. SCALE IN FEET I" = 120 0~ 60~ 120' 240 z o, c IZ o ~ Irk ~~ D 'o m I~ o, ~4 o ~z ~ l'OA 100' BUILDING SETBACK LINE FROM R.O.W; LINE c ~~ * .~~J APIRW~~.~k t 295 i NEW RICHMOND wr J BEARWCrS REFERENCED TO Tl~ SOUTH LINE OF THE SF.'/. OF SEC110N 10, ASSUMED 588°12' 12"E. /N\ 10' +- 29.50' S 88° 37' 48_E 470.16' _ 3 i01 Scale 1 ~~ = ~ Z0~ ~~,y' CERTIFIED SUR VEY MAP ~~ Located in the SW '/, of the SE'/. of Section 10, T30N, R16W, Town of Emerald, St. Croix County, Wisconsin. DESCRIPTION: A parcel of land located in the SW '/, of the SE'/, of Section 10, T30N, R16W, Town of Emerald, St. Croix County, Wisconsin, further described as follows: Beginning at the S'/, Corner of said Section ]0; thence S88°12'12"E 470.26' along the South line of the SE'/, of said Section 10 (bearings referenced to the South line of Section 10, assumed S88 12' 12"E ); thence N00°00'00"E 690.01'; thence N88°12' 12"W 470.26' to the North-South'/, Section line of said Section 10; thence S00°00'00"E 690.00' along said North-South '/. Section line to the point of beginning, containing 324,322 square feet (7.445 acres) more or less and being subject to any easements, restrictions and covenants of record. SURVEYOR'S CERTIFICATE I, Joseph W. Granberg, Registered Wisconsin Land Surveyor, hereby certify that by the direction of Dennis & Doris Berends, owners, I have surveyed and divided the lands shown hereon in accordance with official records, Chapter 236.34 of the Wisconsin Statutes, the Town of Emerald Subdivision Ordinance and the St. Croix County Subdivision Ordinance and that this map and description are a true and correct representation thereof. This instrument drafted by: Joseph W. Granberg. Dated this 14`~ day of June, 2000. GENERAL NOTICE STATEMENT The parcel shown on this map is subject to State, County and Township laws, rules and regulations (i.e. wetlands, minimum lot size, access to parcel, etc. ) Before purchasing or developing any parcel, contact the St. Croix County Zoning Office and the appropriate Town Board for advice. ~ APPROVED ST. CROIX COUNTY Planning Zonlna and Parks Committee AUG 0 4 ZOQO 1! nol recordsa w~rnin 30 days of approval date approval Bhall be null and void ~~ O NS y __ "'..,~.~ti JOSEPH W ~' ~ GRANBE~ ~ S•2295 NEW MOND WI i Q' ~iyO •....... •I y~ SUH . . ., IvU ~ b I ii , ~ ~ A ~ I ~ ~ ~ _ y 1 ~ ' 1 - ~ 1 i i I ~ , - ~ ' ~ I I ~ ' I - - , T ~ i ~ ~ ~ ~ ~ ~ - ~~ ~ i i ~ ~ t ~ - 7 0 ~ I ~ ~ i , ~ 6 R hQ ~ tt k -~ t ~ i r-1 i ~ J~ - - _ _ i 1 . I _ Po a ~ ~y '~ ` ~ _ ~ t ~ o ~ l I " P f - _ i ~ l r ! - ~ _~ I 1 - I I _ ~ i ~ I - ~ I I 1 i I{ ~ ~ I I ~ ~ a ' ~ ~ ~ - - i - ~ i ~ i T l i 1 ~ 1 ~ I _ 7 I ~ ~ ~ ~ J ~ I ~ ~ I ~ ~ ~ ' , I I ~ ~ i I_ i ~ ~ I 1 ~ 1 ~ ~ ' ~ ~ ~ ~ ~ '- ~, ' - 1 a L ~ . i_ ~ ~ ,- , ~ i i ~ l ~ L ~1 l , ~ , , r ~ t o ~ ~ - ~ r .