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010-1047-20-000
Wisconsin Department of Commerce P!+tIVATE SEWAGE SYSTEM Safety and Build Division 14+~SPECTION REPORT GENERAL I (FORMATION (ATTACH TO PERMIT) Personal informat~ ;i you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Kenned Trust Emerald Townshi :ST BM Elev: Insp. BM Elev: BM Description: RBI , 3 ~ ate. S{ ~. ~ ~' 1/11~If~ u~rvRmr~l Ivl~ TYPE MANUFACTURER CAPACITY Septic,. / ~ ~ ~ _ I t I,~- ~~ ~;a~II ~I~C~ U Dosing f-U l~/ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic .~~~ ~ ~p~ h~ ~ ~ ~ / 51 Dosing _ Aeration Holding PUMP/SIPHON INFORMATION Manufacturer ( ~ _ ~ n Demand f~-~ 'I ,~ r'~/1 GPM Model Number ~~ -~ ~ TDH Lif ~~( Friction Loss System Head TDH Ft e "1 Forcemain Length Dia. « Dist. to Well SOIL ABSORPTION SYSTEM GLL VHIIVIY VMIF1 county: St. Croix Sanitary Permit. No: 430298 / 0 State Plan ID No: Parcel Tax No: -1047-20-000 Section/Town/Range/Map No: 20.30.16.285 STATION BS HI FS ELEV. Benchmark Alt. BMCt h ~ 5~=~'t~+ Ou. ~G1AYt a~- " 3 ,~ Iu~;7~' Bldg. ewer 5 , lv~ ~ . 3c~ St/Ht Inlet St/Ht Outlet Dt Inlet / Dt Bottom puwi p pad /!•SS ~0 •.~;~ Header/Man. t. Pipe h~ Bot. System z ~ 7• ~ WSJ. 3O 1 Final Grade ~ ~ 0' CI St Cover ~D ~~~~,Nv`%~, ~ 7.3c~ ~~~ ~~~ ~~tlolvl s s-l~~ ~ __ ,~. ~~ ~- 0 ~ /-f:Gld~l.~~~` r~alvfr a. few ~ 4;25 BED/TRENCH Width Length No. Of Trenches 3 PIT DI NSIONS No. Of Pits Inside Dia. Li uid Depth DIMENSIONS ~ ~ `' ~ ~ l _. SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: ' D d Typ Of System:L ~(~ ~' ~~ / 7Sb ~ b ~ 61E I~ UNIT Model Number. I Zl / S T DISTRIBUTION SYSTEM / Header/Manifold / ~[ C/ Length_~ Dia I Distribution Pipe(s) t/ ~ / Length ~r ~`~ Dia ~ Spacing- x Hole Size x Hole Spacing Vent to Air Intake Sb / SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Systems Onlv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center Bed/Trench Ed es Tepseil J Yes ~ No ~ Yes No O~! ~{+ 1 I~f COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /V / a I /~~1,. Location: 2251 County Road G Glenwood City, WI 54013 (NW 1/4 NE 1/4 20 T30N R16W) 40 acres Lot Parcel No: 20.30.16.285 1.) Alt BM Description = ToPj ~ ~ Fc~VIA!(~~DJ~,,' 4 f}f~~~,°~ ~jl..~~ ~1:~~~~ ~ /~/i'(,~/.!.¢~1 /YY--Q~ 2.) Bldg sewer length = ~~ SL p ~ .~ -amount of cover = (p G0~- _ S~C+-~ ~'' q ~ [41 No I ~_- _ __ __ __ _ _ _ Plan revision Re uired . I Yes ~ ~ ~~ ~ ~ ~ ~ i i ~j/ Q p l i Use other side for additional information. ~ I ~ _- __-__ ~~ L ~ --- -~' !~Q ~~9J_~ :-- _ Date fnsepctors Signature Cert. No. SBD-6710 (R.3/97) .... i^ ~n (~ ~ ~~ .~ ~ e ~f1t~ Safety and Buildings Division 201 W County ' ~ ~ . Washington Ave., P.O. Box 7082 / ~ iseonsin Madison, WI 53707 - 7082 Sanitary permit Number (to be fifi l in Co.) De artment of Commerce (608) 261fi546 i 30 Z ` Sanitary Permit Application State P>aA `°~ N~ ` In accord with Comm g3.21, Wis. Adm. Code, personal information you provide , /U tnay be used for secondary purposes Privacy Lew, s 15.04(1 ~~-- .. ..-, - rid (if different than mailing address) I. Application Information -Please Print All Information ~ ~ R~1- L~ Property Owner's Name `' ~ ~ ~ ~~ -- ~~ v i arcel Lot # Block # r Property Owner's Mail/ing Address ~ ~ , . r;r ~ ©,o .~ ~~ ~~ ...-,...~.,. ..~ ~ ~ ~ ~ , ~ ' C• ~ ate Zip Code Phone Number / ~., Section ~/ 1~, ~Jj ,~ /~ io `~°~`~ O ~ ~ II. of Building (check at apply) ~ N; or ~ v ~ 2 Family Dwelling -Number of Bedrooms Subdivision Name CSM Numbs ^ PublicsCotnmercial -Describe Use ^ State Owned -Describe Use ^Ciry ^Village , ' wnship of III. T ype of Permit: (Check only one box on line A. Complete line B ifapplicable) - A. ew Systan ^ Replacement System ^ Tratment/Holding Tank Rephicement Only ^ Other Modification to Existing System B• ^ Permit Renewal Before F.xpimti~ Permit Revision ^ Change of Plumber ^ Permit Transfer to New Owner List Provious Permit Number and Date issued ~ ~ /~/~ _i ~b N. of POWT'S S tem: Check all that a 1 -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized nand ^ Holding Tank ^ Peat Filter ^ Aerobic Troadnent Unit ^ Recirculating Sand Fiher ^ Recirculadng S thetic Media Filter ping Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain ~ 3 V. Dis rsaUTreatment Area ntormation: Design. Flow (gpd) Desi Soil App ication Rate(gpdsf) Dispersal Area Required (s~ Dia~al Area Proposed (sf) System ti ~ ~v i Z S- / L~ ~ s~ t~ VI. Tank Info iry in Gallons Total Gallons Number of Units Man j ~~ /~ Prefab ~Concrte Site Constructed 1 Fi Glass pl tic ' New Facistiag i~ ~f I f 1 Tacks Tanks Septic a Holding Tank Aerobic Tnratroeat Uoa lbws (:bomber VII. Responsibility Statement- I, the wdersigo ume respoasibitlry for tastallatbu of the POWTS showy oo the attached pleas. Plumber's Name (Print) /i Plum gnature ~~, i C_:cU MP/MPRS Nu~ 2 ~, Business Phone Nu ber~~ ~ ; ~ z j~'~ Plumber's Addnss (Street, Ci State, P ) / nun /De artment Use Onl proved ^ Disapproved Sanitary Permit Fce (includes Grour~water Surcharge Fce) ~-/ ~~ ~ Date ed ~ ~ ~ suing t Si~gn~at~ure s) t ^ Owner Given Reason for Denial ~-P 2 0 „Q%t-~-- IX. Conditions of Approval/Reasons for Disapproval Sys; - w~-s->~c,~~Zd l ~~zr~o3 ~w~ ~- ~~~- ~-t~.~- io~z~~a3 ~d~~~ ~~ ~-d ~~ ~~ Ce~~t,~~~-o~ -~~~~ ~~ ada~ ate. ~ ~ lh~~ • ~d'~~;~ G~~~ a.~ ~~..~ 1~U~ rel.` c~.o~- naucw cwap¢re puasNre roe r:wary wry) rer foe tyste~jaa paper not Tess taaa srrz s r l taMaa is qm ~i SBD-6398 (R. 08/02) . ~ s~~ t ~-~-SysP~OT PLAN PROJECT Edward Kennedy Trust ADDRESS 1561 310th St. Glenwood City Wi 54013 NE i/4 NW i/4S 20 /T 30 N/ 6 w TOwN Emerald COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/21 /03 BEDROOM 3 CONVENTIONAL IN-GROUND RESSURE CONVENTIONAL LIFT )44C HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE 630 gallons DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1212 # of chambers 39 ,BENCHMARK V.R.P. Base of Steel Stake ASSUME ELEVATION 99.3° Filter Zabel A-100 ^ BOREHOLE O WELL 'H.R.P. Same as Benchmark SYSTEM ELEVATION 95.0/94.2/93.4 4' below grade Cty Rd G Vent ~ >6„ Standard Biodiffuser of Cover 1-eaching Chamber with 31.1 ft2 of Area 11" 6' Long „ Grade at System Elevation All dimension are assumed from Cty Rd G and West lot line, no east 90' or west reference point was provided, dimensions are a educated guess Well . Vents 40' B-6 B.M. 20'B- 5' 30' 40' 3-3' X 83' Cells with >3' Spacing 35' 8°Io Slope 7' B-3 '~ 35' 15' ~~ Please note: current 10' soil test will be field 30, 1 verified before -5 installation, also further Vents testing will be done g_ 1 to try to locate a more suitable area for system Plans Designed Using Conventional Powts Manual Version 2.0 105' Was removed prior to installation Pro 3 ` Bedroom House 60' Huffcutt Combo Tank . #2 Q a~ 0 $ER CROSS SECTi4N AND SP£CIiFCATIVNS SEPTIC TANK ~ 'f0~1P C€~AM ~£ATHERPROOf 4» £~ VENT PIPE 12" MIN- ABOVE GRADE ~ ~1 4R JUHCTIflt~ $QX AFFROVED MANHOLE C4V ER > fig= FROH D04R. 41INI?0 W I'TH C413DU IT w! PADLOCx £ FRESH AIR ;NTAKE ~ ~ y~pRN;NG LA,$£L gZHISHED GRADE ~~ ~~, MIN. ,~ , ! y C • Z. QHSEiiWT+o~ S. p. : ~ u ~$ Mf M• ~ M . 3H° ~fE :; i s ~ INLET ; ' - wAT£R '~3GHT SEALS ~ TZG$T ~ .f VAPPRQYE~ A gEAL • JOi1iTS WITH ~3LTE.R ~ < ALM D PIPE 3Pp ~ H -- - ON 0IiTO S~Ig SOIL ppPROVfiI ~ PIPE 3' C I + OFF 0~ SD:.ID SAIL pUt+fP flFF ELEY - ____._FT' D 3-t APPRQY~ BEDDZN'G UWDER TANK ONCRETE PAD S ~~ ~ = ~`r~ SP£CYf 2CATZON SEPTIC / DOSE sA13K MAMJFACTURER: SEPTIC ~~~ 6AL. TANK S I Z£S ~ DOSE GAL . S S~ ALARM MODEL Iif31KSER: VAC ~iZTCH TYPE: ~ pf3HP iIAMiFACTURER : ~v Q """"' MODEL NUli$ER = - _ -'-~ SWITCH TYPE: TE ~ D GPtf g DOSES ?£R DAY = _._.._----- t,FUHS£ DflS£ y{}~ME INCLUDING 7' J. S GAL- E LOUBAC K = ~.-e--'------- 2 ~• S INCHES = -~,~,.~-` ~'AL - CAFACITIES= A f;AL. 8 _ 2 INCHES = 5~.._.--- C _ -2-- I~cKES = /~ ~- D I?ER I ~R 15.23 WAC PUtlP ~ ALARM tJIRZNG AS REg13IR£I3 DISCHARGE RA _.._---- FEET PU?'IP OFF ANI3 DZS•i'#~Z8t3'flOtd PIPE- • - _.----FEET VERTICAL BIFFERENCE $ETWEEN _ - '~j -FEET N X ~ ~? FTl1Qfl FT- FRZCYNAMICAIiEAD •= ~~FEET ~ MI IMUM !~£T~+1f3RK S;3ppLY PR $SUR£ ,FATAL D J,,- W~ iH 6 D I AM fiTER ____~- 1.ZQO Y D ~ ~ ----""" - pT£R1~AL DIMENSIONS L3F PtJM? °IANi~: LEKGTN I ~` ;a` S IG~tED: _ LICENSE. ~uMBL'g - i/S8 . ~ NEAD ICAPACIT Y C URVE EFFLUE NT and D EW ATERING . WARNIN G: Model 18514185 should not be s ubje cted to-less than 30 feet TDH. DYNA MIC H EAD/CAPACITY PER MINUTE TOTAL ~ s7-ss !1 177479 1 aDNtae ~ 1611.161 161.167 16fN1aS 16YH 15 1/LHIf 1W/t11 1HN,if to Gd ~Lb - W ~ EittE3 1 31.5! Ztrc G , 2 Ltn I G., Ltn Ga ., WI L)t . GN, 117 WI..LiM1 G.I. L6S.' GII: ~Lhs. Gd. ltz: GII. L1rS.l~ GU. Los .. SIT /S i'1T1 ~ L~ Fl, M f . . 1: CN. itr>l' G.S. L . 352 3 156 N 13f 106 601': f1 271 '' N 77f St 210 ti3 Se7 S .1.51 1t 1 t2 71 10f /7 117 . 12 <1T3 1 : 3 PI o lW1:.: 0 3 ~~1T1 1 1 4 10 7A8 171 SO ': 27 17 :. x 129 N I)1 79 :300 . 1 S 115 1 SO 777 < 10 277: !1 23e? t 42 ,! I f ,s s, ; ,! .! 'tro ~ 1 q x 1 0 s! 217 f0 737: SI 71e' ul lIS: ,/0 570 .S 111 13 2S (Jf': 2f 1 :: 7 n:;. -. 1s `!! 3a tx 7) 2r1 ' : t2 31 769 57 711'. Sf _221 31 2215.111 If/: 1)3 50.1: 4 170 N ZS TAS 1 .70 233 U ) :201 . . SS 1.1 55 MI> SI 1I6 f0 340 SS 110' 171 131 1I7 111 .S 175;: 40 13 m L1C S , tt 30 . .6 tt. /1 .172: !S 761 iS 212 11 510 -. 105 -377:.111! Ut l! : 111 : {e :111! :< 71 s0 77 12s !1 114 SI Ii1: SI 120' N 3tC 100 Af of 170 38 12 w lss2 - 1s sr a ur 31 i~l sl 71e 71 :ze1 i u u s to ' f0 1t1r JO ;1t1. 10 31` SI 1f1.'. !1 ,!) 70 163: U :171 12 ro n.K ~ „ ~', as rn a ,ee s. za ` a al IS '170 Jr 120 ' '' 36 1 9 1 10 xsl , 77 lit I 1 ~ 9o sr.+l n u 2, Ti < ao ut 11 100 x:u r ^f 1 m 70 '<1u G1zoo - i 70 -Ts 34 fro 1 1 uo s/sl 1 i`-- j 10 r• 105 no 3xu '. ~. 7r u• ~ K. Ir sa I rr 1,s n• I 1,: i ur 32 LaS va.: 21.E Ir v1s 100 30 ~ 95 I 28 90 186, 4186 26 85 165. 80 416 5 24 75 0 22 ~ 70 x v 20 ~ 65 60 163. 1 89. 18 4163 4189 J ~ 55 O 16 50 14 45 40 8 12 140, 18 , 4188 4140 35 10 30 185, 8 137,139 4185 25 20 6 15 4 10 . 2 5 43 4 98 161 416 , 1 57 ,59 0 60 70 90 100 80 110 120. 0 140 150 160 S. GALLONS 10 U 20 30 40 50 480 560 640 . LITERS 80 160 240 320 40 0 009911 FLO W PER MINUTE o M0219 H d Ca a ci on Model 11 ty 2, industrial colu . mn•explosion prooof pump, see F Note: Fot ea p Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings m accordance wncn wmm co, vvis. ram. ~.oae r County Plan must er not less than 8 1/2 x 11 inches in size lan on Attach com lete site a " r ~ x . p p p p indude, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Dat Reviewe d Q/ Personal irHorrnation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). /~ /~ / ~ /~j~ ( ~%/~~ ~~/ 7i ! (/ Property Owner Property Location n Govt. Lot 1/4 /4 SO~ T~Q N R E (or) Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# ~ ~ l ~--_ State Zip Code Phone Number ^ City ^ Villa a own Nearest Road SAD ( ) ~' zz.rl ew Construction Use. esidential / Number of bedrooms ~_ Code derived design flow rate ~ ~ GPD ^rReplacement ^ Public r Comm -Describe: ___-____ __- ________.__ __- Parent material ~ a~ v` ~~-r Flood Plain elevation if applicable ~ / ~ ft. andrecomndations: T `s' ~~9 ~ 2//~3 !~ ~~ ~~ ~ ~~J ~~~ d /, / J S o- ar-~ ~ Ong # '~ Bonng~ U L~ Pit Ground surface elev. ~ ft. Depth to limidng factor p 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 ~i 2 ~ r-~-.~~ r /r' /~ i s Z 2-a _ 6 ~ ----, , ~ ,~s,~~ - a ~ ~ / J ~~ # O Boring Pit Ground surface elev~/' ~ ft. Depth to limiting factor ~~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~- ~j3 ------- r s ,~ .~ - ~. ~ , J ,---- r ~~ • Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mglL 'Effluent tr2 = BOD < :io mg/L and I ~ < su nlg/L CST 1Vafrle (Please Print) _ - Signa CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ~~~~~ i7y 715-246-4516 ' Safety and Buildings lllvlslon P.O. Box 7162 Washington Ave. 201 W ~,uunty ~I~ , ~ . iscons~n ~ Madson, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) (608) 266-3151 ~30 Z Department of Commerce State Plan I.D. Number r Sanitary Permit Application ou provide rmation f l i y n o In accord with Comm 83.21, Wis. Adm. Code, persona be used for secondary purposes Privacy Law, s15.04(1)(m) ro ect Address (if different than mailing address) J may 4 Application Information -Please Print Infor ation ~ I /r , ~ ZZS ~ Co . . arcel # Lot # Block # Property Owner's Na me n ..~ --- Property Owner's M ailing Address Property ocatiQn F +~' ~/ N ~~ _ l J ~j / i T~ J~ k,Section ~ ~/ [ ~ Ci ~ to Zip Code C ~ ~ ~ Phone Number ~ ~s r ' / crrcle~9~j~ T~ N; ~E or ~Wr~,/ II. Type of Building (check all that a ) ~ Oo S N^'~ J ivision Name CSM Number _, 5 , or 2 Family Dwelling -Number of Bedrooms Use ib e I ^ PubliGCornmercial -Descr p 3 X ~ Z 3 [ ~ U i~ ^Vi11a~Township of ity j se !.-! State Owned -Describe _ a-/ ` ~ "a C-; ~ . • , .~ ~ III. Type of Permit: (Check only one box on line A. Co lete line B if applicable) ~~ l'~~ ~ i~ ~f i -~ ~ ; ~' ~ ~`-' A" System ^ Replacement System ^ Treatm t/Holding Tank Replaceme Only ^ Other Modification to Exis ' g Pre us erm ~ t . ued B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Tr sfer to New Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that apply) n -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ and 24 in. of suitable soil At-Grade Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Fiher ^ Recircularing Synthetic Media Filter eaching Chamb ^ Dri L' ^ Gravel-less ipe ^ O er xplain) ~ 1 ~ ,e V. Dispersal/Treatment Area Info ation: ~ Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Ar Require (st) Dispersal Area Propo ed (sf) System Elevation ~ , ~~ ~~ ~ 212- ~ 7 ~ VZ. Tank'nfo Capacity m Total Number Manufactu r Prefab Sice Seel Fi er Plasti Concrete Constructed Glas Gallons Gallons of Units New Exis[ing Tanks Tanis Septic or Holding Tank :aerobic Treatment Uni[ ~ Dosing Chamber ~ VII. Responsibility Statement- I, the undersigne ume responsibility for installation of the P S shown on the attached plans. Plum 's, Na me (Print) ~~ Plumber's - MP/ PRS Nymber ~~ ~ ~ ' Business Phone Number l~ l~ l . c~ ~ J /~ ~l Plumber's Addre ss (Street, City, State, Z' ode) ~~fl ~ ~ i r~~ ~~~ -. VIII. County/De artment Use Only .Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued ~ I su' Agent Signatur No Stamps) ^ Owner Given Reason r Denial p3 Surcharge Fee) 2S O - ~ Q2.t IX. Conditions of Approval/Reasons for Disapproval 3 , ~ 'S l3' ~ ~.p i~[A+~1.~,~ 6~v~ SYSTEM OWNER: 1 Septic tank, effluent Tilt®r and ~ `tr1 ~ ~S ~, dispersal cell must all be serviced /maintained ~~ /~tg as per management plan provided by plumber. 5-\ ~,~~ ~ M i d ll ~ha ne ~ ~ ~ 2. All setback requirements must be mainta es - ~ di / d ~ Q nanc or . ~ \ s ~ ~, ~` ,i e as per applicable co J ~w~w~.. 2 Attach complete plans (to the County SBD-6398 (R. 01/03) for the syste o paper not less x m PROJECT Steve Dale ~~ /~-!JJ`~G 1/4 ~ 1/4S 20 /T 30 --~ `` ,~ COUNTY ST. CROIX W ~~ Y~' 8/6/03 BEDROOM 3 M S Shaun Bird 226900 DATE CONVENTIONAL X)4C IN-GROUND ESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1212 # of chambers 39 ,BENCHMARK V.R.P. Base of Steel Stake ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL *g,R,p, Same as Benchmark S 1561 310th St. Glenwood City Wi 54013 w TowN Emerald SYSTEM ELEVATION 97.6/97.0/96.4 1.5' below grade Rd G , Vent ~ > 6•~ Standard Biodiffuser of Cover Leaching Chamber with 31.1 ft2 of Area 11" 6' Long „ , „ Grade at System Elevation ~i~f ~L'-~ ~ ~;~ Y CL~+ ~~~ s~ ~~~ ~o AIS ~1 ~ ~ ~~ r-- ~ ~~' ~ B.M. ~" N~' ~ Ven ~~ ~ ~, ~ ~' ~'`~ ` ~~ ~~ 7' Please note: current soil test will be field verified before ~'? installation, also further testing will be done to try to locate a more suitable area for system 90 Well i fin' 40 c ° ' f Plans Designed Using Conventional Powts Manual Version 2.0 105' Pro 3 Bedroom House ~~~ - ~~ ~ / ~~ 3-3' X 83', s with >3' acing All dimension are assumed from f' Cty Rd G and West lot line, no east .d or west reference point was '` 'provided, dimensions area educated guess nts 0 -1 B.M. #~ ~ B~ PROJECT Steve Dale / ~~ / /~1J~, ss 1561 310th St. Glenwood Citv Wi 54013 1/4 ~~ 1/4S 20 /T 30 N ~b W TOWN Emerald COUNTY ST.CROIX ~~ `-`+j Y~' 8/6/03 BEDROOM 3 M S Shaun Bird 226900 DATE CONVENTIONAL XXX IN-GROUND ESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1212 # of chambers 39 ,BENCHMARK V.R.P. Base of Steel Stake ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 97.6/97.0/96.4 1.5' below grade n~., n a r_ Vent >6„ Standard Biodiffuser ~-~~C~~'~t '~ of Cover Leaching Chamber with 31.1 ft2 of Area Plans Designed Using 6' Long 11 " Conventional Powts Grade at System Elevation Manual Version 2.0 34" 90' Well , 105' 40' Pro 3 B.M. 20' Bedroom 5' 30' House T Ven s 40' 65 Please note: current soil test will be field verified before installation, also further testing will be done to try to locate a more suitable area for system 7' 45 Q~ ~~~ - ~~ in~ ~ i 3-3' X 83' Cells with >3' Spacing All dimension are assumed from Cty Rd G and West lot line, no east or west reference point was provided, dimensions are a educated guess Vents !~ B.M. #2 Q a~ 0 Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in ~r•enrrinnr•e wihh Rnmm RF 1Arie Grim Cnrle 1776 Page 1 of _ 3 Certified Soit Testing County Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan must St. Croix - include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I D percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. _ ~ _ ' . . CSM Pending Please prin ~ all i n~ ~ ti V ~~ i viewed By Date Personal information you provide may be sed for secondary purposes (Privacy Law, s. 5.fM (i) (m)). ~ * ~Z Property Owner ~ ~ ~~ ®~ 20~~ roperty Location Dale, Steve ovt. Lot NE 1/4 NW 1/4 S 20 T 30 N R 16 W Property Owner's Mailing Address ST C'10~X. c~Uliv i ', of # Block # Subd. Name or CSM# 1561 310th St. ZOP.IN ~ OFF!CE Pending City State Zip Code Phone Number City ~ Village ) Town Nearest Road Glenwood City ~ WI 54013 715-265-4582 Emerald 2251 CTHW G /, New Construction DSe• / Residential /Number of bedrooms 2 Code derived design flow rate 300 GPD !Replacement _ i Public or commercial -Describe: Parent material loess over outwash Flood plain elevation, if app licable NA General comments and recommendations ~ : install 2 cha ber tre~nc~hes w/ EISA at leas 750 sq ft @ syste elevation of 97.0 k ~ CA'w2/ ~~- S 9-li Nl~ W ~ 1,~ ~ r~lk. ~O W~tJI,~.,u~ ~ Boring # -- Boring ' Pit G l 1 99 ,~ / round Surface e ev. . ft. Depth to limiting factor in • Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' ~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 I 0-11 10YR 2/2 - sil 2 f sbk mvfr cs 1f/m i .5 8 I + -~ I 2 11-17 10YR 2/2 - sil 2 m sbk mvfr cs 1m 5 8 3 17-33 1 OYR 3/3 - sil 2 m sbk mvfr cs 1 m .5 .8 4 33-43 7.5YR 3/3 - sl 1 m sbk mvfr cs 1 m .4 .6 5 '~ ~ 43-57 -- 7.5YR 4/4 - s 0 sg ml cs - .7 ~ 1.2 6 57-65 5YR 4/4 - scl 0 m mfr cs - 0 0 7 ; 65-78 5YR 4/4 f2f 7.5YR 5/3 scl 0 m mfr - - 0 ~ 0 a Boring # Boring / Pit Ground Surface elev. 99.4 ft. Depth to limiting factor 65 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 i 0-13 10YR 2/2 - sil 2 f sbk mvfr cs 1m .5 8 2 13-24 10YR 5/4 - sil 2 m sbk mvfr cs 1 m .5 8 3 i 24-40 7.5YR 4/4 - sl 1 m abk mvfr gs 1 m .4 ~' .6 4 ~ 40-65 7.5YR 4/4 - sl 0 m mvfr cs 1 m .3 .5 5 65-70 7.5YR 4/4 f2f 7.5YR 5/3 sl 0 m mfr - - ,3 j 5 -__ i i ' Effluent #1 = BODS> 30 < 220 mg/L and TSS > < 150 mg/L i * Effluent #2 =GODS < 30 mg/L and TSS < 30 mgr CST Name (Please Print) Signa re CST Number Henry F. Grote 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 4/21/2003 715-233-0398 ~3 r ~r~ i Property Owner Dale, Steve Parcei ID # CSM Pending' Page 2 of 3 Boring # ~; Boring t/f Pit Ground Surface elev. 97.7 ft. Depth to limiting factor 66 in. Soil Application Rate Horizon Depth Dominant Color Redox Descdption Texture Structure Consistence Boundary Roots ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-13 10YR 2/2 - sil 2 f sbk mvfr cs 1 m .5 .8 2 ' 13-23 10YR 5/4 - sil 2 m sbk mvfr cs 1 m .5 .8 3 ~ 23-40 7.5YR 4/4 - sl 1 m abk mvfr gs 1 m .4 6 4 ~ 40-66 7.5YR 4/4 - sl 0 m mvfr cs 1 m .3 I 5 5 ~ 66-70 7.5YR 4/4 f2d 7.5YR 5/3 scl 0 m mvfr - - 0 i 0 ~~ ~~ Boring # -~ Boring y1 Pit Ground Surface elev. 98.0 ft. Depth to Nmiting factor > 72 in. Soif Application Rate Horizon De th Dominant Color Redox Description Texture Structure Consistence Boundary Roots i p in. . Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 1 0-12 10YR 2/2 - sil 2 f sbk mvfr cs 1 m .5 .8 2 ~ 12-20 10YR 4/3 - sil 2 f-m sbk mvfr cs 1 m .5 ~ .8 _- --- 3 ~i 20-26 7.5YR 2.5/1 - sil 2 f sbk mvfr cs 1 m i .5 8 4 126-43 10YR 5/4 - sil 3 m sbk mvfr cs 1 m .5 .8 5 '~ 43-50 7.5YR 4/4 - sl 1 m sbk mvfr gs 1 m .4 ~ 6 6 ~ 50-60 7.5YR 4/4 - Is 0 sg ml cs - 7 ' 1 2 7 i 60-72 5YR 4/4 - scl 1 f pl mvfr - - .2 3 Boring # ~ Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~- ~ i I I --- i~ -- -- - i ~ * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8130 (R.07/00) CertiFled Soil Testing .• 2.2~" t L i -~w Cam. ~ w~M?,~~ ~~+s~~~ ~ p~ (~''~~ ~ ~.1. b..~.t~ ((l!~ (mow` C~a~~ ~~q~~ ~~ a,-~ \ ,z.~ ~- L~q ~-). c-r'Ir+w G ~w ~~ q-+ ~ ~K~1r~,o~ ~. cxM n~.9.:~ S•,~ h14 ~Mw _ ~~ ~~.~- 1~.W s,so~^~' S~. ~ . ~ ~~~(~~ ~~ 5: 1{e, 5 ~a. Lc.~ ~. _SL~ 5; Fns '` ~•3 t c ; ', _/ YS ~ `, 2`~~ ~- ~3-ti a{ (4 a •~~ t~~'~~ Z~~ rz Nc C ~t4.-SS ~~,a ? o ate. N ~ ,y t`~ IS' 3C] l~ ~t.~t C ~ ~ ~ 1 r. .,.,W.,,,,.~ z t, ;~ ---, ~~~ d r Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4.Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan 1. If system fails, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715-246-4516 St. Croix County Zoning 715-386-4680 Pumper Tom Mondor 715-246-5148 Shaun Bird #226900 OwnerBuyer i ST` CROII~ COUNTY SEPTIC TANK NiAINTEIVANCE AGREEMENT AND RSHIP CERTIFICATION FORM Mailing Address Property Address city/State Parcel Identification Number I~ o ~. ~c ~~~° ~ ice: -~ ~ ~ r LEGAL DESCRIPTION ~ ,~ / ~}/~ Property Location ~-%/, / ~° '/4, Sec. o~ lJ. T ~~- W, Town of n Subdivision ~- Lot # ~- Certified Survey Map # Volume .Page # Warranty Deed ## C~ ~ 2 ~ o I ,Volume ~ ~ ~ .Page # ~o ~" Spec house ^ yes Lot lines identifiabl es ^ no ~~~ ~__ ~.~'^~~ L~'' ~~ ~.. 4_ SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure. to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeymanplumber, restrictedplumber or a licensedpumperverifyingthat (1) the on-site wastewaterdisposal system is in proper operating conditionand/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating tha ur se 'c system has en fined must be completed and returned to the St. Croix County Zoning Office within 30 days of thre ar expirati te. r ~ / /~ NA:''URE OF LICANT ^~,, DATE OWNE CERTIFICATION ~~rv~~/f we) certify that all s tements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pro de ribed abo , by e o w ty deed recorded in Register of Deeds Office. ~ ~ U / _/ ~ NATURE OF PPLICANT DATE ****** Any information that is mis-represented may es m the sur~ai~ry perrnr being revoked by the Zoning Department. ****** /s 6 / 3 /D~ s~. //~. (Verification required from Planning Department for new ~~~~ ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed io V~'I. 14~ JPArt 307 61.2601 KRTHLEEH H. WALSH kEGISTEk GF DEEDS Document Number TRUSTEE'S DEED sT. CROIX co., wI RECEIVED FOR RECORD Marjorie R. Kennedy, as Co-Trustee of the Edward J. to-zs-t995 9:30 Rh Kennedy and Marjorie R. Kennedy Revocable Trust,. for a TRUSTEES DEED valuable consideration conveys without warranty to E. Peter ~60PY FEE: Dale, Trustee of the Edward J. Kennedy Irrevocable Trust, ~ CDDY FEE: under the Edward J. Kennedy and Marjorie R. Kennedy eEC~i~c~FEE: to.oo Revocable Trust, Grantee, the following described real ppcES: 1 estate in St. Croix County, State of Wisconsin: The SW'/. of the SE'/, of Section 17, Township 30N, Range 16~ Recordin nrea ~' Name and Return Address ~~ West, EXCEPT hat portion described ' P262 Parc I No~.1 O NO- 1042-50-000. ~ ~ ;..~,~,.vs l~, ~~~T ~ C. L. Gaylord 11 __ __ Attorney at Law The NE'/. of the NE'/. of Section 20y Townshi~pl 30N, Range 16 p, O. Box 46 ~~~ West. Parcel No. 010-1047!10-000. L N ._ • T ~ River Falls, WI 54022 The W'/. of the NE'/. of Section 20, To nship 30N, Range 16 ~ ~•~ West. Parcel No, 010-1047-20-000. C ~ 14G b~S. The NW'/. of the SW'/. of Section 21, Townshi 30N, R~afnge 16 p, West. Parcel No. 010-1050-40-000. C N =' , ~• T The SW'/. of the SW'/. of Section 21, wnship 30N Range 16 ~On ~ West. Parcel No. 010-1050-50-000. N~~- • ~• ` (` _ G c l( ~~ / ` ~- Dated this 14th day of October , 1999. AUTHENTICATION Signature(s) authenticated this!. day of .1999 TITLE: MEMBER STATE BAR OF WISCONSIN (If not, (authorized by 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY C. L. Gaylord, Attorney P. O. Box 46 River Falls, WI 54022 ~` 5~` a ~~ ~~ ~2 Edward J. and Marjorie R. Kennedy Revocable Trust ~Cn~,s{~_ *Marjo ' R. Kennedy, ~%o-Trustee ACKNOWLEDGMENT STATE OF WISCONSIN PIERCE COUNTY Personally came before me this 14th day of October, 1999, the above named Marjorie R. Kennedy, to me known to be the person who executed the foregoing instrument and acknowledge the same. C. L. G Ord, N to ~UbIIC, State of Wisconsin My pdMmiy jigf; i~.pe anent ;.~ V.;......... ((. •pe~ie§.li! nlnp t;~,y capecHy.noeld be tYPed a printed helav _ A'' InlormeUon ProleesloneM Company Fond du Lac, Wiswnein 806855201 C ~ ' ~ . ~~ / u~ N~~~ ,~~~~ / CERTIFIED SURVEYMAP. VOLUME ,PAGE LOCATED IN PART OF THE NW 114 OF THE NE 1/4 SECTION 20 T. 30 N. - R. 16 W. TOWN OF EMERALD, ST. CROIX COUNTY, WISCONSIN. EACH PARCEL SHOWN ON THIS MAP IS SUBJECT TO STATE, 4 COUNTY, AND TOWNSHIP LAWS, RULES, AND REGULATIONS ( i.e. WETLAND, MINIMUM LOT SIZE, ACCESS TO PARCEL, ect.) BEFORE PURCHASING OR DEVELOPING ANY LOT, CONTACT N THE ST. CROIX COUNTY ZONING OFFICE AND THE TOWN OF BEARINGS REFERENCED TO THE NORTH LINE EMERALD OF THE NE 1/4 SECTION 20, T. 30 N.- R. 16 W. NORTH LINE NE 114 SEC. 20 ASSUMED BEARING S 90° 00' 00^ E , 2661.9T S 90° 00' 00" E, 2661:97 ft.~ N1/4CORNERSEC.20 COUNT TRUNK HIGHWAY °G~~ ~ ~ FOUND CO. MONU. ~, NORTHEAST CORNER SEC. 20 due West FOUND CO. MONU. /1 !I W 33.11' -- - - - -- ~.~ ~ / ~ ~ West 289.91 ft. ~~'~~ ~ 1 ~ ~ C/L C.T.H. "G.' -S 90° 00' 00" E C!L EXISTING DRIVEWAY ~ N 90° 00' 00" W 2171.38 ft. 196.41 ft. I I ~~ \~ WELL n ~ ` ~~ V PERK TEST AREA v ~ ~ Q I e I N PERK TESTS ~ +~ W N W r ~ O .? !n n ~ m H D LOT 1 N S E Z 3.01 ACRES (131,208 SO. FT.) INCLD RAN ~ ~ 2.79 ACRES w (121,57150. FT.) EXCLD RNV ~~p ~ NOTE: J~P~ ~~P ~ ~_ THERE ARE NO IMPROVEMENTS ~ O 1 ON THIS PARCEL AT THIS TIME 0 I EXCEPT FOR AN EXISTING WELL AS LOCATED LEGEND O SET 1.25' O.D. X 24 IRON PIPE O WEIGHING 1.13 LBS.lL.F. SILO ~ SECTION CORNER (FOUND) J (COUNTY ALUM. MONU.) S84°3+5'55^E 1 Ep 230.58 ft, ~~ Scale: 1 in. = 100.0 ft. 0 1 ~ 200 NOTE: THIS PARCEL IS THE EXISTING BUILDING SITE OF THE r i ~ -. CERTIFIED SURVEY MAP NO. VOLUME ,PAGE LOCATED IN THE NW'/4 OF THE NE'/4 OF SECTION 20, T 30 N. - R 16 W., TOWN OF EMERALD, ST. CROIX COUNTY, WISCONSIN. DESCRIPTION A parcel of land located in the northwest '/4 of the northeast '/4 of said Section 20, Township 30 North, Range 16 West, Town of Emerald, St. Croix County, Wisconsin. More particularly described as follows: Commencing at the North 1/4 Corner of said Section 20, Thence, South 90° 00' 00" East, along the North line of the Northeast '/a of said Section 20, 196.41 feet; to the Point of Beginning Thence, South 04° 34' S0" East, 492.08 feet; Thence, South 84° 36' S5" East, 230.58 feet; Thence, North 02° 49' S 1" East, 5 i 2.77 feet; Thence, North 90° 00' 00" West, 294.18 feet; Along the north line of the northeast'/a of said Section 20, to the Point of Beginning. y Containing 131,208 square feet or 3.01 acres. Sub right of way for C.T.H. "G" as shown. Also subject to any and all additional easemen~s,~ t of ways or conveyances of record. Q° Q SURVEYOR'S CERTIFICATE I, Daniel J. Fedderly P.E., Registered Land Surveyor, hereby certify: That I have Surveyed, Divided, and Mapped the above described parcel of land in full compliance with the provisions of Chapter 23b.34 of the Wisconsin Statutes along with the provisions of the St. Croix County Comprehensive Zoning Ordinance (Chapter SUBDIVISION REGULATIONS). And that Said Survey was done under the direction of Steve Dale with this map being a correct representation thereof. Dated this day of 2003. Daniel J. Fedderly P.E.; R.L.S. 5-2360 D.J. Fedderly Management Consultant Approved by the St. Croix County Zoning Office this day of 2003.