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Home My WebLink About010-1059-50-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Divi* n ~ 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 Cassellius, Brian Emerald Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~~a Dosing lava Aeration W ~,~r~ Holding TANK SETBACK INFORMATION TANK TO ~ WELL BLDG. Vent to Air Intake ROAD Septic S ~~i ~, G f `T ~ ~ ~ Dosing y~' Aeration Holding PUMP/SIPHON INFORMATION Manufacturer _ L Demand ~-/ ~ ~Q~ CTfO~ GPM Model Number 1 ~, ?7 TDH Li 1 ~,~ Frictjgn Loss Sys em Head T ~ ,3~ t _L , Z. Forcemain LengthU t Dia. ~ ~f Dist. to Well ,b~ / SOIL ABSORP~aTION SYSTEM ~ P' BED/TRENCH Width .~ DIMENSIONS SETBACK SYSTEM TO INFORMATION _ _. _ DISTRIBUTION SYSTEM h _,~ No. Of Trend /V'1I~/T P!L BLDG WELL ,3~~ l Of Pits Inside Dia. Liquid Depth _E I G Manufacturer: t OR UNI Model Number: CJ.~z~a/ Header/Manifold Len th Dia 9 ~ ~ Distribution ~ Pip 9s) ' ~l, g~L Len th Dia Spacin x Hole Size~J I b r/ x Hole Spacings ~Ll•', Vent t Air Intake A'L-~ G~~ SOIL COVER r Prascura SvetPmw Anly rY Mound Or At-Grade SvstemS Only COMMENTS: (Include code discrepencies, persons present, etc.) Inspecti~ 1: /~~//y~/OZ Inspection #2: /~/ 0 y Location: 2622 130th Ave Glenwood City, WI 54013 (SW 1l4 SW 114 25 T31 N R16W) L`6t~ N~~ ~ Parcel No: 25.30.16.3~B ~..• ~~ ail ~ ~,~~,,, sys-~,_.~:~~v,,.t. SyS~ ~.~~ 1.) Alt BM Description = 5 t 2.) Bldg sewer length = 3'1 ~ ~ b ~,"~~--- ~~~ ~C!.r~ - amount of cover =~ ~p I 3.) Contour = ~ ~~ i _ _ i i._ Plan revision Required? ! Yes ', _' No Use other side for additional information. `__ __ _- _ - - Date Insepctor's Si nature Cert. No. SBD-6710 (R.3/97) Depth Over ~ q~ ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrenc Center ' !~'- Bed/Trench Edges Topsoil ,Yes !_~ No _ _ Yes I _' No ELEVATION DATA county: St. Croix Sanitary Permit No: 405187 0 State Plan ID No: Parcel Tax No: 010-1059-50-000 STATION BS HI FS ELEV. Benchmark 1~~ ~ ~ S~ ~ DO r l 06 ~ Alt. BM <~ P Bldg. Sewer /S`~ S~ T St/Ht Inlet /s. 7 ~ ~ SUHt Outlet. Dt Inlet Dt Bottgn ' ( J ..1`~ ~I • ~ S~ r /Man H d e ~~ a Sys ~ y s.~ Dist. Pip~~~ ~ - ~^~~ 1~ 7 T Bot. Sys m o" . s3'-F-l l 93- ~ Final rade ,,/~ ~5~6 St over /~, ~ g ~ t5 1 J ~ 2 ~2 . !i 222 13t~~ ~~_ • Sanitary Permit Application ~~ In accord with Comm 83..21, Wis. Adm. Code Sec reverse side for instructions for eompieting this application f SC~1l'~*~~+~ Personal information you provide may bt used for secondary purposes Oepartmant of ~Cammerce ~ _ ~,.r.[P~ti~acy I,aw, s. 15.04(1){m)] S"~~~-~ I. . Please Print atl JUN 1 S 20Q2 r. c~o,x cou;v-r~~ ~„~,,. , City, State ip Code ~ Phone Piumtxx - (/cl ,~ L~ ~ II. Type of Banding: (ch k one) Ks ~ 5~- ~ e~uS. $~ 1 or 2 Family Dwelling - Na. of Bedrooms :~. D Public/Commercial (describe use):_ p S wried z_ 2S ~r ~ / ~ ~ ` x lav `[~t9ea..~,d~t:e.Q.Q.) "~ t` = lo,o ~0, 83Z; one box online A. A) IV. Type of POWT System: (Check all that apply) ~~ ~' `lam ~'-t'` 1~' ~Mouad d Sand Filter Q Non-ptcsstuiztd in-ground ^ Holding Tank C Single Pass ~ ~ ~-~~d ^ Aerobic Trcatmtnt Unit O Itecieculatu ^ At- V. Dls ersalfTreatmeat Area information: 4 Soii A hca4on S. Pe,rolasion Roc Safety & buildings Division 20i W. Washington Ave. PO Box 7302 Madison, WI 53707-7302 (Submit compacted form to county if not i.ocaraon: Pmpecty C,ocation 3? >(.l.! 1/4~~4, S2~'f3 t),N, g` or W Lot Plumber Block um r ~ _ ~t1 /~ ~ -- -- Name or CSM Number 5}~bdivision / / OYl°-- FMWvbrttO ~-X~_ _ O City ~ ' b village fir, l C:•~ ~- .~D+r" ss s~r D Constructed Wttland ^ Drip Line 1. Design Flow (gpd) 2. spersal Ares ~~ sa~ Area 3. Drs{x~ Proposed Rate (Gal~sJ ylsq. R•) (MinJiach} ~ ~~ ~i ` ysv ~~~ ~~~ ~~,z I Fiber• S~ Tank VII Capacity in Total # of anufactt:rer Prefab Con- Site Con- e glass . Iniormatlan Gallons Gallons Tanks orttc strtrcted New Feasting Tanks Tanks p D ' ~~ r L.f /Yl f ~.iQ ~~ ~- VIIL Responsibility Statement i_ ehe mdaaianRd aasum- rCspansibilil Elevation to g 5 ~ ~ ~ iX. CoantylDepartment Use Only i in Agent signs (No stamps) D Disapproved Salutary Permit Fee (Includes Groundwater Rate Cssued ` ~Approvtd D Owner tliven Initial Adverst 3uro Fee) ~ ~ 2, ~~.,. Detertttinadon 3 ~' 7C. ~Conditti~af~s, of ~4.pproval t~teasonsifar Dlsa~pi•avat~N~~~~+^"« °° ~,~„ "~T ~t ~.o~~ c.f~o ~'d''~~ ' ~ ~ ~^"s..cr{t_, n~,tnQ~CtA~CS .wu.~7C'"b~. ~~,,~,,~'~` /~ [I,, I t 0 c~t,aM /rM~cf-t~'til .~,c~r~~ --~.~ ~~~u "- - - 7'r l7~ °~ ~ S SPA'" . ~ ,~ . old ~, ®~ t,~ o p k ~ 0 ~ ~ ~ ~ ~ ~ ,~. v ~. 3 ~ ~ (/~ Or v ~} ~ I ~ ~ ~ ~ ~ o ~. e~ "3 ~~~~ ~ _~ ~ ~ _~ ._ tin ~ ~ -+, c~ -~ ~iOtl~ Wrv~ era ~s s ~'~'~- •~,sc ~~~ ~ ~~ ~~~~~ s~x-~`I 1//J!~ f~ ~ ~ ~ e= ~v v '~- o ~ h ~ ~ ~ ` ~ ~- I~~~ ~ ~ ,. ~ t~ ~ S N ~ ~ v ~ ~ ~ ~ ~ ~ ~ ~ ~~`~l ~ a .~ ~4 ,.,~ A r. ~'~~'~ n ~ ~~i ~~~~~ f .-- ~e~ ~S' a~ ~~~~~~ ~~ s ~''a;, ~~S ~, ~° __ , ~.~~ ~ ~ ~~ ~~ ~?. ~4 ~`~ 9 til ~N ~ ~ ~ a ~ ~ iscons~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi. us/sb www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary June 14, 2002 CUST ID No.224617 LYLE J MYERS NORTHLAND PLUMBING INC E1556 ST RD 64 BOYCEVILLE WI 54725 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/14/2004 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: Brian Cassellius 130TH Ave Town of Fi~eu~ucoci ~/-~ C/2 r4 t.. f) St Croix County SW1/4, SWl/4, S25, T30N, R16W FOR: Description: Proposed Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 855267 Identific s Transaction ID o. 756208 Site ID No. 645862 Please refer'to both identification numbers, above,.in all corres ondence with the a enc . 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: General Approval Conditions: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.O1/01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.O1/O1). • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • Comm 83.22(7) - A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • Comm 83.52(1)(a) -The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. P•~•w TS Conditionally _ LYLE J MYERS Page 2 6/14/02 Owner Responsibilities Continued: • The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence maybe made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Gerard M. Swim POWTS Plan Reviewer -Integrated Services (608)-789-7892, Mon. -Fri. 7:30 am to 4:15 pm j swim@commerce. state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code; 7633 cc: Leroy G Jansky ,Wastewater Specialist, (715) 726-2544 R r Mound System COV@P Page ~, d e PQ~iAETE Project Name: Owner's Name Owners Address Legal Description Township County Subdivision Lot# Parcel I D# BRIAN CASSELIUS MOUND BRIAN CASSELIUS 118 Tiffany Creek Road Glenwood City, Wi. 54013 sw ~ y4, sw ~ 'l4 Sec 25 T 30 N, R 16 w ~AteNWAAd' ~E4~ Saint Croix --~~~ N/A NIA 010-1059-50 ~~~IE~ Table of Contents P& 1 2 3 4 5 6 Cover page Mound Sizing Calculations Pressure Distribution Layout and Dynamics Dose Tank Management and Contingency Plan Plot Map total # of pages: 6 DEPARTMENT OF COMMERCE Designer Name: L le J. M ers ~V~SION OF SAFETY AND BUILDINGS MP/License #: I.D.# 224617 Date: 5/30/02 SEE CORRES NDENCE Ph. #: 7156432520 Signature: ¢~ Mound System Design Methods Used per "Mound Component Manual For Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD-10691-P (N.01/01) per" Pressure Distribution Component manual for Private Onsite Wastewater Treatment Systems' (Version 2.0)SBD-10706-P (N 01/09) ~ Spn;adsheet provided by: 3bAdvisement N12486 220th St, 8oyceville, WI 54725 Ph: 715-643-6066 email: 3ba~3badvisement.com I Mound System Mound Sizing Calculations Project Name: BRIAN CASSELIUS MOUND ~~z~ s Site Conditions Design of Entire Fill Project Type: ~i or 2 Fatuity Dwelling ~ Cell depth at upsiope edge (D): 10.0 in. °~ Slope: 4 % Cell depth at downslope edge (E): 12.2 in. # of Bedrooms: 3 Distribution cell depth (F): 9.5 in. Depth to limiting factor: 26 in. Cover thickness over edge (G): 6 in. Absorbtion rate of fill material: 1 gal/ft2/day Cover thickness over center (H): 12 in. Absorbtion rate of in-situ soil: 0.2 gal/ft2/day End slope width (K): 8.2 ft. Effluent quality Eft#i ~ Fill length (L): 116.4 ft. Max BOD effluent value: 220 mg/I Upslope width (J): 5.7 ft. Max TSS effluent value: 150 mg/l Downslope width (Toe) (I): 18.0 ft. Fill Width (W): 28.2 ft. Design of the Distribution Cell Basal Area System Design Flow: 450.0 gal/day Basal area required: 2250 ftZ Distribution cell width (A): 4.50 ft Basal area available: 2250 ft2 Distribution cell length (B): 100.0 ft Area of Distribution Cell: 450.0 ft2 Observation Pipes Contour Elevation of Mound: 92.25 ft Location from end of cell (Z): 16.67 ft System Elevation of Mound: 93.08 ft Final Grade of Mound: 94.8$ ft Mound Plan View Mound Cross Section Final Grade __~ Synthetic Fabric Distribution Cell System Elevation 6n,°'; ,- ~` p Cover Material ~ Lateral Fill Material Invert Slope I L ~~ bselvation Pipe Ju~~`~°1~~ 1 ~ D ,~^~lli d Area ~Forcemain~ `System Contour Notes: Fill material to consist of ASTM C33 Sand Distribution cell aggregate to comply with Comm 84.30(6)(1) Synthetic Fabric covering on cell per Comm 84.30(6)(8) Distribution Cell to have minimum 6"aggregate below lateral and 2" above. Mound System ~~ s ~ s Pressure Distribution Calculations Project Name: BRIAN CASSELIUS MOUND Lateral Layout Lateral elevation: 93.6 ft Rows of Laterals: 2 ~ Manifold type: center ~ Orifice diameter: o.izs ~ In. # of Laterals: 4 Distal Pressure: 5 ft Lateral Length: 49.5 ft Orifice Spacing/Distribution Orifice spacing (X): 32 1 Inches Orifices per lateral: 1 g Avg. ft2/Orifice: 5.92 ft2 Lateral/Manifold Design Lateral diameter: i~h ~ In, Lateral spacing (S): 3 ft Lateral to cell edge: 0.75 ft Lateral discharge rate: 7.83 gpm System discharge rate: 31.31 gpm Manifold diameter: z ~ In. Manifold length: 3 ft Forcemain Friction Loss Forcemain length: 70 ft Farcemain diameter. 2 • In. Friction loss in forcemain: 1.469 ft Lateral Side View Lateral Plan View Lateral Length ~- ~ T um-rap wlball valve or cleanout plug Orifices an bottom of lateral equany spaced PVC lakerals and forcemain ka comply with specifications Rer Comm 84.31J(~J[eJ Farcemain connection via kee ar cross to manifold at any paint Clean Out Detail Clean-out plug Grade ,-or ball valve Observation Pipes d+later tight cap or plug Sprinkler Box Long Sweep 90 ariwo 45's-~,_ 6" Minimum Note: Closet CoNar may be used in place of 3J8" bar ~--318" Bar .,Mound System Septic tank size/model: wLpiooo/boo-MR ~ n Septic, Pump and Dose Tank Project: BRIAN CASSELIUS MOUND Tank Information Pump tank manufacturer: Wieser Concrete Pump tank size/model: wLPiooo/boo-r~R n Pump tank gal/inch: 16.76 Actual Pump Tank Volume: 603 gal Tank bottom elevation (inside): ~ 81 ft Pump and Filter Pump Manufacturer: Little Giant Pump Model: 9EH Effluent Filter: Zabel A100 Note: Access opening of sufficient size to be provided to allow removal of filter. Opening to terminate at or above grade. Pegs 4 of 8 Dosage Volume Forcemain drains back to tank? (i Ye, O No Lateral void volume: 20.9 gal Dosage to absorbtion Cell: 90.0 gal Forcemain volume: 12.2 gal Total dosage: 102.2 gal Total Dynamic Head Are laterals highest point? y if not, enter highest elevation: 0 ft System head (distal x 1.3) 6.50 ft Vertical Lift ("D" to lateral) 11.92 ft Friction loss in forcemain: t~~ 1.47 ft ~~ Pressure loss from filter: Li ft Total dynamic head (TDH): 19.89 ft Pump Tank Diagram Dose Tank Levels Watertight Locking Cover In. Gal 4 Inch ~~nh blaming Labet Finished A ReSeIVB 19.9 333.2 Minimum Grade g pump off to Alarm 2.0 33.5 Altemate~ C Total Dosage 6.1 102.2 Outlet Location Elect. per Comm D Effluent depth for pump 8.0 134.1 rc n 1 &-28 and Total Capacity: 36.0 603.0 NEC 300 Weep Hole '°` or Anti- Siphan B Device FLgMI- LITERS/FOUR C D W ~~ A a Pump must be capable of: 31.3 GPM ~ to ti 7.S W f- 5 ~ A 2.5 0 and head pressure of: 19.9 Feet 0 PO 40 60 t30 Little Giant FLOW- GALLONS/MINUTE 9EH PUMP PERFORMANCE CURVE Itsv enFlz Mound System Management Plan pursuant to comm 83.54 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 andlor 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 chemical/biological "treatments" is not required or recommended. If such additives are used, make sure they are approved by Department of Commerce, Safety and Buildings Div.. Effluent filters are to be removed & Leaned as necessary, with provisions to keep solids from passing the septic during removal. No more than 1/3 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 & cleaned 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 least 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 problemslfailure. 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 freeze in winter conditions. Lateral distribution pipes should be flushed out/tested every 18 months using the cleanout points at each end of the component to remove scum that may clog orifices. Pertarmance Monitoring: Pertormance 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 clogged 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. L®cA4 N~At-TN AyTsao~etrY: ST GR~tX Govt/ ZoN-N~ oFFI~E =715-386-4680 Y T ~ `~ l~4 ~~ J ~~ ~~ l,~ p k ~, ~ ~ ~ ~~" 'v ~. V1 l a ~9' ~- ~ 1 ~ ~ ~ ~ ` ~ tiJ 3 ~ 0 C'/ ~a ~9 J v ~ m J ~-.~ eQ. ~9 ~ ~ _-~ ~ ~ ~ ~ 5~,~ ~u~ '~ w~v~ s ~e~' Cyr Lu c?S ~ `a° n ~'s~?~(~~ I ~L ~y U ~ ~~ ~ ~ ~ ~ ~- ~ ~ ~ h ~ ~ ~ ~r~, ~ ` T~ ~ ~ ~ ~ ~ ~~ ~ ~ ~~. ~,_ ~~~~~ ~ ~~ :~ ~ ~ _, ti. AA 'M ;~ A r '~" 2,~z",~c~•~~/ vrun~c,N ,,.~... _c ,.r. 7~ --~ ~3 9' .~- ~--. _. .~ ~ ~~ ~s.... a~ ~~~~~~ ~~ s ~`'i O.- ~ ` c ~~ c.S b C ~~ 4 v~ ~~ aq J .~ Wi~+sin~iepartment of Industry, SOIL AND SITE EVALUATION Labor and Humari Relations _ Page ~ of Division of Safety and Buildings /fn aC~CC~rde with s. ILHR 83.09, Wis. ;, l ~" ~.. `' County Attach complete site plan on paper not less t m$ 1/2 x 1 inks in size~Pla must include, but not limited to: vertical and horiz n `~eferen~i{ ) dir~tion nd f percent slope, scale or dimensions, north a-~roY~ land location an~~tance tc'~ est road. Parcel LD. # APPLICANT INFORMATION -Plea , rint a~i-~i~-at~on. j} ~ viewed by Date Personal information you provide may be used for S~Cbn ry purpol;~~ll~y Law, s. 5: (1) (m)). ~ ~ ' 25' ~7 Property Owner `. ~,` • ~ roperty Location 2 LtJ / -...~___,<--~~` Govt. Lot ~"~ 1/4 (,~1/4,S~~ T,~D 'N'R ~b ~W Property Owner's Mailing Address Lot # Btock# Subd. Name or CSM# City r State Zip Code Phone Number Nearest Road G~eN wo od '~t o (7I~') a.~ 76 ^ City ~~^ Village Town ~ V ~ New Construction Use: Residential / Number of bedrooms ~Z_ Addition to existing building ^ Replacement ^ Public or commercial -Describe: 2 Code derived daily flow ~/_ Sa gpd Recommended design loading rate ~ ~ bed, gpd/ft2 ~ J trench, gpd/ftz .r ! Absorption area required bed, ft2 ~ 7.S"~ trench, ft 2 Maximum design loading rate _~bed, gpd/ft2_~_trench, gpd/ft2 Recommended infiltration surface elevation(s) nn~T. ~i ~ ~ ft (as referred to site plan benchmark) Additional design/site considerations t'Yd f~D /~ D'~ ,SYSJ~$ ~ ~..2~ ~ Parent material G L ~ C / A L ~/ ~ L Flood plain elevation, if applicable /U~ ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank u = unsuitable for system ^ s ®u f~ s ^ u ^ s ~ u ^ s ®u ^ s ~I u ^ s ® u cnu nr~nnrn~rrn~r oeonor 1 4_ r` !1_ ~ i ~G _( `, . T.O. I -~.,.,n ~ L"T~' Boring # (7 Ground elev. 9~.~.. Depth to limiting factor a~in. s Boring # Ground elev. ~ ~/.~~ n. Depth to limiting factor 3Q~in. Horizon Depth Dominant Color Mottles Structure d B t R GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence oun ary oo s Bed ,Trench o- ~ 2 s t L' S M . 6 2 - lL -- C ~- sb 1 S , 6w --~ .2~6Ke Z G vF ~.3 S SbK My ~ - Remarks: O-l0 D - S G S,G fit' C ~.•~"' ,. ~ /a /o G t C .S ~..s' ~.~o - -- SG' /F6K M ~t ~S vF ~ ~ '..~ Remarks: L. •s .~ .Z .s . ~f ,z CST Name (Please Print) Signature ,. Telephone No/. p 6 ^~' ~~S ~~S- O Address Date CST Number 22 ~ M rtioot~ C ' br/% -~~97 /~~~ PROPERTYOWNERH/4Q~~ l~if~p~°- 4~/C~ SOIL DESCRIPTION REPORT PARCEL I.D.# 0% "~OJ~7 ~~O Boring # t 3 Ground ~/ ev. ~ ,~Qn. Depth to limiting fact r ~in. Boring # t ill. Page ~ of t Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench l~- ~' S ~~dk~ ~.~ GS Ivy •2 ;..~ 2~A ~ M v R --- ~ ~ ~ •~ Remarks: Ground elev. tt. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Boring # Ground elev. ft. Horizon Depth Dominant Color Mottles xt r T Structure Consistence Bounda Root GPD/ft2 in. Munsell Qu. Sz. Cont. Color e u e Gr. Sz. Sh. ry s Bed ,Trench Remarks: Depth to limiting factor in. Remarks: ~r .~ .2 SBDW-8330 (R. 08195) ~____ ~` ` ' ~ o__ r. L~~ L _- ~ ____ __ __ _, - - -- ~ ~ t_ ~ - ~ ~ i ~ ~ , - -- ~ ._ _ _ --- - ---- o t --- - - - -- - --- _ ~ _ - -- - . ~ ~ ~ Q I ~ ~ __ ~ _ I - p . - i -- -- _, ---, _ i I I 1 ~ _ - - ---- -- ~ -- -- -._ _. .__ _-- -. ~ -- -- - -- - -- ~l ' ' ~, _- _~ _ - - ~ ~__ ~ __ -_ - __ -- - ---I - - i ! - --- -- --1 I - _ ~ i __ __ _ I __ I _ -_ _ - - I ~--- ~ -, ~~ -~ - -- __ -- _- -- ---T I - - - - ~ --- -- ~ -- ~ --- -- - --- ~ --- -- 1 -- - f ~ -~ __ -- I t ~ -- - - ~ - - ~ ~ -- ~ -_ - -- -! --~ - --- - --- I- -- - --- - --- -- - - -- - - - - - - - ~ - J _ __ ~ ! I____ - ~ ~ ~ _ ___ - e / ~ - - - --- f ~ ' ~ I - __ i -- - - -- ---- ~ ~ - _ _ ~ ._ - - ~ - . ---- _.. -- -- ---- -- - -- ___ -- - ---- --- ~~ - - - _ ~_. - ' ~ - ~ ~ ~ ~ ~ - - - -- r-- - -- - -- -~ - - -- - ~ ~ I I - 1 ~ , ~ ~ - }----1 ---- - -- i , ~ ~ i - - -- - r ~ -- - - --- _ _ _ ~- ___ _ __ . _ ___ _ ___ _ __ __ __. ~ __ -- a ___ ~_ _ _ _ _ __ ~ ~ 0. ~ __ - ~ - __ ~ - f- r- ~ , i ~ i ~ ~ ~ br a ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND CERTIFICATION FORM OwnerBuyer y[JX'~ t9-~tJ (,~ S Ez.< t u .S Mailing Address ~ '-^ ~ ~ ~ ~ w ~ ./ Property Address ~ ~ ~~'' ~~ (Verification requireed from Planning Department for new construction) City/State ,~ /ti'2 c,~a-z..~ W ~ Parcel Identification Number O ~ D --~lJ Ste- SO LEGAL DESCRIPTION E~tiu~ Properly Location,~L~ %a, ~ '/., Sec. ~ ,fir T~~ N-R~W, Town of ~~ Subdivision ~~/4 .Lot # ~. Certified Survey Map # ~ ~~- ,Volume N ~ Page # _~ 5~ ,Volume Pa e # _ f Warranty Deed # ~~ g .:~~~---. Spec house ^ yes ~ no Lot lines identifiable (~ yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, joumeymanplumber, restrictedplumber or a licensedpumperverifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standazds set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three yeaz expiration date. ~~~~~ , ~~~ ~ ~/ /~Z- SIGNATURE OF APPLICANT ,~ ~~~~~~, DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT / / DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed • von ~ ?79PacE 545 NUMBER WARRANTY DEED Michael T. wink and Jeaneen N. Nick, husband and wife, Grantor, conveys and warrants to Brian D. Cassellius, Grantee, the following described real estate in St. Croix County, State of Wiaeonein: The South Half of the Southwest Quarter of the 6outhwest Quarter (S 1/2 of sw 1/3) of SW 1/3) of Section Twenty Five (25), Township Thirty (30? North, Range Sixteen (16) Weat, Town of Emerald, St. Croix County. 663965 KA?HLrEN ti. WALSH REGIS?ER OF DEEDS S1', CROIX CO., WI RECEiUED FOR RECORD 1?-05-2041 8:30 AM WARRANTY DEED ER£MDT M CERT COPY FEE: COPY ~E°: ?RAHSFER FEE: 124.04 YECORDIMG iEE: 11.40 PAGES: 1 Hiawatha National Bank 204 E. Oak St. Glenwood City. WI 54013 010-1059-50-000 Parcel Identification Number This is not homestead property. Exception to waYYdIlt ie9: All easements, restrictions and rights-of-way of record, if any. Dated this ~~ day of November, 2001. (SEAL) AVTRENTICATION Signature(s) (SEAL) authenticated this day oL 20^ {signature) ~^ ( a me Printed o: ad l \ T1TL£: MEMBER STATE BAR OF WLS ONSIN (If not, authorized by §706.06, Wie. State.) `~puunu~p THIS INSTRUMENT WA8 DRAFTED BYs `, `~~ y,.{ ~~I ~ Lao A. Baskar, Attorney `` . I ~ `~ _` . ~~~ _ RODLI, BESKAR, BOLES &ERUEGER, 9.C. r ; `i~-+ j A • 219 North Main Street, P.O. Box 138 ` 9y • ~ ~ Q River Falls, WI 53022 _ ~ y "~ 7 ` . ~G •~y; ~ pU g ~r ' • r ~ . "~W li"~.!`µ+'.'1 \ W N•`~ l (SEAL) Michael T. Wink ~~ lis,~ ~r (~/~ (SEAL) Hess M. Wiak ' Ac:aroWLSawemrr (STATE OF WISCONSIN ) "-jl . e~ a r x ) sa. covNTx ) Personally came before me this ~ day of November, 2001, the above named Michael T. Wink aadJeanaen x. ink to me the peregna who executed the oregoing inet m~knowledge thesame. Notary Public County, Wis. My Commission is permanent. ,(Qf not, expiration date:) f a .• t~ ~' J /~ ~+ r ~„ 1 Y, .: s ,.... ,..pR<:, . I .. ..... ° ®/999 Cload Cartogmphlcs, fnc. St. CIrw4 MN 5630! .. ~ ,.. ~. S~ P cle 70 S~ PAS 68 s ' ~ ta.e ohn Patricia 1 ~ h ~ G wtl m C Peter & Ila . O y !N & RJ Henderson • _ o McConville " 23z • ~ & ~ ~ ~ ~ e sa Will , , s ~ „ D 3 I & SC Erickson ~ ,,,,,, loa t2l ..a r q,n 6: Lortairre Galen .: 128.7 : Roukema O ,n e ~ ~ ~ ow Courtney 5 ~chae ~ y 6 323 ~ s . . • ~ x 6 7 orraine h k [ ~ Wi11i=m '~ 6 ,b N7 x & Donna ~ ~' y zse ° ,,.x _ - 6 7 1 RR 111 g ~ • ' I De ~ nucci ~ ~ ~ LN & . 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C5 • 65. • Merle 772 Timothy&Valerie W .n G wpre s , w. ms u9 •77.7 v 3 Multhauf Bodte • Z ~ IalonA ~Y Richard a&WO; M •EdWerd Qr ~ ~ kDE9.1 • 40 E 1d 3 G • j Ranee xmssrana, & Robert ~. st xenaeona '0 i k Marjorie z Kenney Tr ~; Delwin Bradley t .; i"°` iir ay • Thomas . . l i h & L 6~1 ~ w Derr c . samve+ Ma sam g , , 7 150 • p^^ & R 236 9 avonne Bur e g ~ . ~k,a„ 7ss T1 n L•Wnstce& w k~M Dorwin a . . Rertee Larson A•d D~ 155.7 ram. Mania Moore • 159.5 110 w Morsel IJau,is 72 ~ • 6 Mari ra~hy vemoa taz5 omana • Icar~ ~~ °nu"' Earley neEoran - Heinisch llarvey sr snzanna ~ • ,~ • ~I & 316. 2 $ ~' Gary Anita = +~ so +• xo Hielkema • so Bamara De1°^g Michael & Roger & Deborah ~ & Mark 391.5 G ` Dean ea 3 wr•20 ~ < xaa«a Daniel& 101.7 wdliam R i ~ SC11U g Nadea u ~ s y;,,~ eao ~ • n Mary & plane Raebel n Kay Dorw s 40 >sa ~ >~ ' c~ I s xts ^ s 3 ~,. 40 ~ 80 rjp $peel paeth 240 ~ ~~ : •IKaren ea luxes ~ I a a ~• ~ ' I~tm& • ~ 3.z • - Gruel w r ~;~o- - Kayleen Dennis • lames & n.s • • ~ ~ ~ ~ k . ~ ahi '" • a9;d raada s Omann & Mari Vickie = weeny 240 ~. Mikla Tr ~ , 80 LE ~ ~ N Richard & srn"it:te: x.ea«a Obe.muelkr I xo..~.re w ~ loo Omann Treutel N r Dean & c 2a.a ~ ~ v 243 Patricia q6 w „ y 160 N n as a r ~~'a"'a,~ Shelley Wink ~ @ a 232 y ~ ~ ~ 160 120 7 9 p ~~ a c ~ 1 5. 177 Spo'o . ~~ ~ and ~ dith • Helen EE ~ O so-so e • °~ w a • 5 rt la e cooly Ju 76.9 Davis a er • 120 ~ ~ € r id D V ~t._. David : 792 Henry ]ernes ? • s ~ n Ra o Klinkhammer & ss.a t« • John & Albert d g +~ 1 9 a s av & Julie o x ~ & Julie Hurtgen Rushfeldt ,I e e ° Gustaveson ~ !«^ 1°i era ~ i susaz. Me er Y Daniel - A x " .. r8 a 3 Waldroff Wdldroff ~•7 134.9 D9naN • "" Paraiaia "' - o ~ ~ 74.9 u° n.5 ; 3a.2 Cotxs • 40 Mrller ~ - ~ ~ $ ~ • LN • M6:1 HogluM •~ 2_ (~ AV • •Te[ry . • ~0 Alkn ti, • ~ rc e Timoth • r S .~ WuJ:2D ~ w r«s y . I 9 $$ ~Melvrrn ~ Ckaagh b: Dewax p • a G ~udy & Pinny y & Rlta • • ~ • ~ t 5 Christine i wp Randy ~p ~.E P Moulton ,b ~ f0 e r$ k W~ ~ Engel Sletten Th0 James ~ 11Q ~ ~ m ~~ & Doris rc Doruld as eoueen Douglas ~,y~ ~ Mary •~;~ ~ ~ ~ Br C lis ` loo Gene & & dy tnB Me eI Y .. E _ .' 393 140.6 Thompson • Melia xane ,,,,o„ x w9 • loAarre w ao irtle 119 Gary & Anita Aaron & Phyllis 63 40 40 ` 40 ` 119.6 zs w:i smith Nadeau 200 Palewicz 110 _ . ' A i ~ ~ ~ ,Douglas rl ta & R ~k Steven . 198.6 • w&o ~ .a.. o n Henderson Lundee a 1 • era sa • zo Janet ~ ~+e e h aul P Mark s IdOL~ ~' 'S & ~ ~ ," ° o tzo Edward _ ~ "'~ aa,v, Gerald ~, ~ • w.w a 7 • 132 • t'°'° Holle ery &ra '' cnaaea Nelson TYler . ?; q "' & Donna .B ,• g & Arissa D p • . , ea; as ;• 140 •Mp6~ • J)J d Elaf h ss " ~erir w r ~ Rox m Erika Kn 77 N • " Gerald&Dorierte •Malehaski Woflack g y 8 Frederick 152 2 I N DD 3.5 SM SA 3J ~Nw . w 147.9 ~ ~ : • m • . • 2100 ~; 2200 2300 2400 Se,~ PAS 38 2500 2600m DD 2700 . ~ I ~ i I SEPTIC TANK PUMPING • 5000 Gallon Capacity I • Computerized Recall • Drainfield Restoration • Electronic Tank Location [ • Over 200 Feet of Hose WE DON'T BACK ON LAWNS! t ~• :. .. Member Wisconsin Liquid Waste Carriers Association I 'I '' ,. D~ Cf icr, fem. Sr. Cord M~u~ r~_-,:~.