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010-1003-20-000
Wisconsin Department of Commerce County: PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 515088 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: Warner, Scott Emerald, Town of 010-1003-20-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 01.30.16.17 TANK INFORMATION ELEVATION DATA TYPE MANUFACTUREPV& ~f CAPACITY STATION BS HI FS ELEV. Septic n. Benchmark /Ob (iJ 1600, Z► Dosing Alt. BM P, A 5 7-600=4 q, jj_ Bldg. Sewer G q2- T1 . , Holding SUHt Inlet 7. bS ~$.7 , TANK SETBACK INFORMATION St/Ht Outlet 7• ZS `ts• S TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet 64 7 y z G Septic r Dt Bottom 0.(,o7 Dosing Header/Man. Aeration S Dist. Pipe A= :9.1 - 2. Holding Bot. System 3.61 1,S~5 9 • . ~ PUMP/SIPHON INFORMATION Final Grade ~1Z-+ Manufacturer Demand St Cover ~J CC 4 GPM l~ 1' I co Model Number if TDH Lift Friction Loss System Head TDH , Forcemain Length, Dia. d t Dist. to Well `r f SOIL ABSORPTION SYSTEM 3, (~Z 3. S4 3, BED/TRENCH Width , Length No. Of Tren hes PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: ` INFORMATION CHAMBER OR Type System: i . I UNIT Model Number: DISTRIBUTION SYSTEM.. Header/Manifold ID istribution ; < # s/ , x Hole Size f r d x Hole Spacing Vent to Air Intake 11 r x ,~s Pipe(s) i`M w a r .i Length Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of TSeeded/Sodded xx Mulched Bed/Trench Center ' Bed/Trench Edges Topsoil y * Yes No Yes No . t..e i COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: / / Location: 2658 170th Ave. Glenwood City, WI 54013 (SW 1/4 SE 1/4 1 T30N R1 6W) 40 acres Lot Parcel No: 01.30.16.17 ~ 1.) Alt BM Description ,P 2.) Bldg sewer length - amount of cover = F - Plan revision Required? Yes No T `Use other side for additional information. L7_.T. _J Date SBD-671 0 (R.3/97) Insep tots Sigture Cert. No. re t comnierce.wi.gov Safety and Buildings Division County 201 W. Washingto Ave., P. O. Box 7162 77-0 ItV- Madison,, 57162 Sanitary Permit Number (to be filled in by Co.) i sconsin Department artment of Commerce J I 4WP Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate mental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information yoube used for secondarw ~sv /`7OT AOc ses in accordance with the Privacy Law, s. 15.04(1)lm), Stats. 1. Application Information - Pleas t All Information Property Owner's Name / JUN 3 0 2009 Parcel # ,5d -VTW q-tJ 64-1-1 O~ - 10b3-Do-Lx--, Property Owner's Mailing Address ST GROIX COUNTY Property Location A j r PLANNING & ZONING OFFICE t/) Govt Lot City, State Zip Code Phone Number , Section -7 L a ~ (circle one U. Type of Building (check all that apply) Gk Lot # T N; R _1t C-- E or A Subdivision Name *-3 or 2 Family Dwelling -Number of Bedrooms V~~ 1% 7vbAt.i ere &JSf_ Block# ❑ Public/Commercial - Describe Use IAL ON- ❑ City of "a CSM Number El village of ❑ State Owned - Describe Use Town of 6 k 75 AJ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' New System Replacement S System El Treatment/Holdi Tank Replacement Only El Other Modification to Existing System Y ng (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that app ) 1 ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treat ent Area Information: Design Flow (gpd) Design Soil Application R e( s Dispersal A~~repp Required Dispersal Area Propos (sf) System Elevation fTT /9 70 ~F3^, -7 VI. ank Info Capacityin Total # of Manufacturer y feA^ Gallons Gallons Units P • o q New Tanks Existing Tanks w o All 4o: U rig m vl is [7 0. Septic or Holding Task Coo Y Dosing Chamber o0 ( e0 AL-- ge-T A- VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Sign tune MP/MPRS Number Business Phone Number &t e.b i 1~ leZeK~.5" Plumber's Address (Street, City, State, Zip Code) / l 5W G! r so 3 ~l 17 l '7dt-qpwc~_ -'''~Aq-t't_. L,A 1..~ C ~f VIII. Coun /De artment Use On , cl _It Yt Z = 2 pproved isapprove Permit Fee D(at~e ssued Issuing nt Signature ❑ tven Reason vial $ OD `a' 07 IX. Conditions of A rov UReasons for Disapproval I t g'M a: 3 660414h o"6 n 15&- 1. Septic tank,.effluent filter aril • dispersal cell must all be services :1 Malrttained IA. ~l Pc r, as per management plan -provided by;plumliv. 2. All setback requirements must be maiMai >8d c comp ete p sus or the system and submit to the County only on paper not less than 81/2 x 11 inches in size I SBD-6398 (R• 02/09) Valid thru 02/11 HARDINA SEPTIC SYSTEMS MFRS/CST 824825 _ ! LJ ELL Tclcopy 140L-1 NZ 9 T- 7 _ : ! f _ ~ -mow u ; A t LEfL l 5 rre, _ (kS c'al)cfcm Tn?3~ c 1 S~ f4~ f 6f7'w- P~ fA ~eL_ HARDINA SEPTIC SYSTEMS MFRS/CST 824825 r L).) - 1 a _ _ 1 ~ l a goo - f ToFiE.Lts~1RS ~ s~us:Je; rrut iC Fj'A 104 Pre, .7WK ~C~L . - P ~/p Ate: TA Safety and Buildings 10541 N RANCH ROAD CommerCe.Wl.gov HAYWARD WI 54843 Contact Through Relay isconsin www.commer n / ' www.wisconsin.gov Department of Commerce Jim Doyle, Governor Richard J. Leinenkugel, Secretary June 23, 2009 CUST ID No. 824825 ATTN.• POWTS Inspector ROBERT J HARDINA ZONING OFFICE HARDINA SEPTIC SYSTEMS ST CROIX COUNTY SPIA I 477 170TH AVE 1101 CARMICHAEL RD TURTLE LAKE WI 54889-9187 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06123/2011 Identification Numbers Transaction ID No. 1673917 SITE: Site ID No. 748749 Please refer to both identification numbers, Scott Warner 2658 170TH Ave above, in all correspondence with the agency. Town of Emerald St Croix County SW1/4, SE1/4, Sl, T30N, R16W FOR: Description: Mound, 3 bedroom residence P,0, Object Type: POWTS Component Manual Regulated Object ID No.: 1229204 Cpntli Maintenance required; 450 GPD Flow rate; 70 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), SSWMP Pub. 9.6 APPI The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance COF with all code requirements. SEE No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Key Item(s) • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. ROBERT J HARDINA Page 2 6/23/2009 • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(i). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions 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. Beginning October 1", 2008, small wastewater holding tanks with estimated flows less than 3,000 gpd that are based completely on approved POWTS component manuals must be submitted to the appropriate governmental unit and will no longer be accepted by the Safety and Buildings Division for review. Please refer to s. Comm 83.22, Wis. Adm. Code for further information. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation lenance of the POWTS. Sincerel Fee Required $ 250.00 Fee Received $ 250.00 (715 I Balance Due $ 0.00 Patrician Sh dorf POW TS Plan Review , Inte rated Services WiSMART code: 7633 (15) 634-7810, Fa (715) 34-5150, M-f 7:45 am - 4:30 pm pat.shandorf@wisco in. v cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: WARNER Owner's Name: SCOTT WARNER Owner's Address: 2728 CO. RD. S EMERALD Wi 54013 Legal Description: SW,SE,S.1,T.30, N-R16W Township: EMERALD County: ST. CROIX Subdivision Name: Lot Number: N/A Block Number: N/A tionally 1OV Parcel I.D. Number: 009-1003-20-000 AT 0f COMM E ~ Plan Transaction No.: Page 1 Index and title RFSPONDEN Page 2 Data entry Page 3 Mound drawings / Page 4 Lateral and dose tank / ~-C' Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan Page 9 Soil Data (a,b,c) Designer: Robert Hardina License Number: 824825 Date: 06/02/09 Phone Number: 715-986-2508 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01181) Version 4.0 (R. 04/03) Page 1 of 9 Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 83-44-3 in-situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150%) conform of - 36 inches. 450.00 Design Flow (gpd) 4.00 Site Slope 95.75 Contour Line Elevation (ft) 30.00 Depth to Limiting Factor (in) 0.60 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 75.00 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (c or e) a Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation ft 2 Number of Laterals of the highest point 0.188 Orifice Diameter (in) (e.g. 0.25) 3.15 Estimated Orifice Spacing (ft) = 11.25 ftz/orifice 2.00 Forcemain Diameter (in) 120.00 Forcemain Length (ft) Does the forcemain drain back? Y 82.50 Pump Tank Elevation (ft) Enter Y or N 3.25 System Head (ft) x 1.3 19.57 Forcemain Drainback (gal) 13.25 Vertical Lift (ft) 67.47 5x Void Volume (gal) 1.81 Friction Loss (ft) 87.04 Minimum Dose Volume (gal) 18.31 Total Dynamic Head (ft) 26.21 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection 7 in. dia. options choice in. dia. options choice ' 0.75 1.25 x 1.00 1.50 x x 1.25 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons/Inch Calculator (optional) Treatment Tank Information 805.00 Total Tank Capacity (gal) 1000.00 Septic Tank Capacity (gal) 37.00 Total Working Liquid Depth (in) WEEKS Manufacturer 21.76 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 805.00 Dose Tank Capacity (gal) Best Filter Manufacturer 21.76 Dose Tank Volume (gal/in) rg-f Filter Model Number WEEKS Manufacturer Project: WARNER Page 2 of 9 Mound Plan View 1110 B J Observation Pipe K: - l T 5 A W - B I L Mound Component Dimensions A 6.00 ft E 8.88 in H 1.00 ft K A17.73 ft B 75.00 ft F 9.50 in 1 6.93 ft L ft D EA in G 0.50 ft J 4.80 ft W ft 450.00 (ft) Dispersal Cell Area 969.46 (fe) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 98.04 (ft) 2 G F Dispersal Celi 96.75 (ft) Lateral 96.25 (ft)---- - Invert Invert Dispersal Cell s.:. 1 Elevation E D s :a.... 95.75 (ft) Contour Elevation 4.0 % Site Slope Geotextile Fabric Cover Shading Key a- Dispersal Cell See lateral details on Q Topsoil Cap o ~ 1.5 ft Page 4 for number, size, © Subsoil Cap; and spacing of laterals. ASTM C33 Sand t F Laterals are equally Titled Layer m 0.5 ft ` Typical Lateral spaced from the Q Aggregate v, 5 distribution cell's -W centerline in the A distribution cell (AxB). Project: WARNER Page 3 of 9 End Connection Lateral Layout Diagram Laterals centered over the A&Bdimension Turn-up w'ball valve orcleanoutplug E P AN laterals at identical IF x ---->I Holes drilled on the bottom of the lateral equally spaced S Force main connection via too or cross to maniFold at any point. Laterals & force main of PVC Sch 40 (per COMM Table 84.30-5) Number of Laterals 2 Orifice Diameter 0.188 in Lateral Diameter 1.50 in Orifice Spacing (X) 3.87 ft Lateral Length (P) 73.53 ft Orifices per Lateral 20 Lateral Spacing (S) 3.00 ft Orifice Density 11.25 ft2/orifice Lateral Flow Rate 13.11 gpm Manifold Length 3.00 ft System Flow Rate 26.21 gpm Manifold Diameter 1. 50 Total Dynamic Head 18.31 ft Forcemain Velocity 1.68, f sec Dose Tank Information Locking cover with warning label and locking device and seated watertight Electrical as per NEC 300 and Comm 16.28 WAC 4 in. min. Disconnect Tank component is properly vented E- Alternate outlet location Forcemain diameter WEEKS Manufacturer 2 in. Capacityl 805.00 Gallons Volume 21.76 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 18.99 413.32 C B 2.00 43.52 Pip off elevation (ft) _t F_ C 4.00 87.04 83.50 D 12.00 261.12 D Total 36.99 805.00 Dose tank elevation (ft) 3" Bedding un er tank. 82.50 Alarm Manuafacturer SJ RHOMBUS Alarm Model Number 101w Pump Manufacturer ZOELLER Pump Model Number [RN 152 Pump Must Deliver 26.21 gpm _ at 18.31 ft TDH Project. WARNER Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name r- ROBERT HARDINA Phone 715-986-2508 POWTS Regulator's Name ST. CROIX CO. Phone 715-386-4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 fe Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once eve 3 ears Effluent Filter Should inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound In ct for ndin and seepage once eve 3 ~71ars Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: WARNER Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals ISBD-10691-P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump 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 a tank or component. 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. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet finer shall be cleaned as necessary to ensure proper operation. The fitter 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 finer 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 sludge and scum 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 a triennial 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. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Departnrent of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verity proper operation. If an effluent fitter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODE, 30 mg/L TSS, 10 mg/L FOG, and 10° cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice dogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: WARNER Page 6 of 9 Page 1 of 1 W W PUMP PERFORMANCE CURVE MODEL 151/152/153 so 14 45 153 12 40 35 10 152 30 8 25 151 J Q g 20 15 4- 10 2- 5 0 10 20 30 40 50 60 70 80 90 100 GALLONS LITERS 0 40 80 120 160 200 240 280 320 360 FLOW PER MINUTE 014508A '7d g http://zoeller.thomasnet.com/imageresizer?image=a0001216 jpg&quality=100&size=100&I... 6/2/2009 SAFETY AND BUILDINGS DIVISION commerce.wl.gov Integrated Services Bureau INSPECTION REPORT 13 East Spruce Street Ste 106 729 isconsin Chippewa Falls, WI 854729 com (715) 726-2544 Department of Commerce Richard J. Leinenkugel, Secretary Date of Inspection: May 27, 2009 Plumber Name and Address: 'Project Name: Warner Robert J. Hardina, MPRS 824825 Use: Residential 477170 Ave Legal Description: SW, SE, 01, 30,16W Turtle Lake, WI 54889 Parcel Number: 010-1003-2 WCEIVEI) Subdivision: na Certified Soil Tester Name and Address: Municipality: Town of Emerald Robert J. Hardina, CST 824825 County: St. Croix JUN 0 5 2009 Plan ID Number: na Gt CROIXwuw; Sanitary Permit Number: naPLoPiNasZ0406 Owner Name and Address: Scott Warner Wastewater Flow: 450 gpd 2728 Cty Rd S Persons Present: R. Yarrington, B. Hardina Emerald, WI 54013 This investigation was requested by the Certified Soil Tester in response to a county investigation that indicated a possible seasonal saturation condition in the upper 12 inches of the sandy loam glacial till substratum. Two soil pits were reviewed to determine their suitability for a subsurface treatment and dispersal system. The most logical place for infiltrating water to perch in this type of soil profile (silt loam over sandy loam) would be in the lower part of the silt cap or the upper part of the horizon below. If saturated for periods of time of more than a week, this would be evidenced by the formation of redoximorphic features. My review of the oil profiles did not reveal any discernible iron concentrations (redox features) and thus it is my opinion that soil conditions would be suitable for a below grade system. However,,as reported by the county, the soil structure is poor to nonexistent below approximately 24-30 inches. I am in agreement with the county observations in this regards. A below grade system would need to be installed very shallow (e.g. 12 inches) to take advantage of more permeable conditions and better soil structure. A system installed at a greater depth would need to be very large (0.2 gpd/ftz) and the cells spaced further apart to take into account the massive, slowly permeable till below. This approach is not recommended but technically would meet standards. In consideration that a shallow below grade system Cover material would likely require a pump tank and cells would need to Distribution lateral be at different elevations, it may be a better idea to in- Distribution cell stall an at-grade or six-inch sand lift mound system to take advantage of the complete depth and volume of soil above the slowly permeable substratum. An above grade _ system would take full advantage of the most permeable Original grade surface ~ and biologically active soil horizons and provide more Mowedarea than adequate vertical distance for wastewater to move y laterally away as it moves downward in the soil. My Water movement away from an recommendation for this site therefore is to use an at-grade at-grade system and eventually or low profile mound system. into substratum soil. 4 Leroy Gv. Jansky, RPSS, astewater Specialist cc: ® County ® Plumber ❑ CST leroy.jansky@wisconsin.gov E-mail ® Owner ❑ Other 715/726-2544 Voice 715/726-2549 Fax ST. CROIX COUNTY 3 WISCONSIN ZONING OFFICE I N N 0 1 N N on rrtsr+r ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 FAX (715) 386-4686 Page / of / COUNTY ON-SITE VERIFICATION FORM Inspector: Q~,. 6 a t1Y , ~e••. Date: Parcel ID Number O/0 - 603 - Za 00n Property Owner Propertyl-ocalion 5ca Meg' Govt. Lot 5IJ 19!!~4 114 S 1 T ✓6 N R / to r= f s t.ot # Block # &W. Name or CSM# Prop rt Ownr's Mailing Add a City State p Code Phone Number ❑ City ❑ Village own Nearest Road E^e --A 5 13 c 7,611 26S- ewConstruction Use:❑ f3esidentialINumber ofbedrooms.... Coda derived design flow rate Replacement ❑ Public or oommercial - Describe: _ Parent material Rood Plain elevation if applicable General comments Q and recommendations: C(~U O~w .W. ~P- 6 Ja ~ S o . \ S 0 / Co ~a~ to aolo° lard: s i-oC16 ❑ Boring # .❑p Boring jj pit Ground surfbce elev. Depth to limiting factor in. Sail Application Rate Horizon Mph Dominant Color Radox Description Texture Structure Consistence Boundary Rods GPDrtp in. Munsel I Gu. Sz. Cont. Color Gr. Sz. Sh. 'Eif#1 "0#3 / o-/,{ /0 5ik 2iws it rnv( 2. Low &N o-(o 0~$ -3o to 2-m5lk IPG M G o(,A , 13o- VZ 7,'5 Z 76T!e $ S L X15 erw - 0.4 9 7 Conditions: /--)Ao.,'~'tiS fac-~rrt. o z,,ci rr Vel L~ Soil Survey description: rf~ea~ ~k- ©.2 9P~1~ 6e-to,-3 Notes: 34+7s FEE: WisconsinDepartment ofCommerce SOIL EVALUATION REPORT Page I of 2 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County ST. CROIX Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 00111003-20-000 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Review by oat Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location SCOTT WARNER Govt. Lot SW 1/4 SE 1/ S I T30 N R 16 E (or) )WW Property Owner's Mailing Address Lot # Block # Subd. Name or CS 2728 Co. Rd S N/A N/A N/A City State Zip Code Phone Number []City Village ■ own Nearest Road EMERALD WI 54013 ( 715-2654442 170th AVE El New Construction UselD Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD 0 Replacement Public or commercial - Describe: Parent material OUTWASH Flood Plain elevation if applicable ft. General comments RECOMMENDED SYSTEM ELEVATION : M UND ON 95.75' CONTOUR and recommendations: / w' I a Boring # ❑ Boring 0 pit Ground surface elev. 95.67 ft. Depth to limiting factor 75 in. Soil Application 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 1 0-15 10YR3/3 -a SIL 1MSBK MVFR GW 2M .4 .6 2 15-32 10YR4/4 -0- SIL 2MSBK MFR CW 2F .6 .8 3 32-75 7.5YR4/6 -0- SL 0M MFR N/A N/A .2 .6 2 Boring # ❑ Boring 95.25 75 El Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-14 10YR3/3 -0- SIL 1MSBK MVFR GW 3M .4 .6 2 14-30 10YR4/4 -0- SIL 2MSBK MFR CW IF •6 .8 3 30-75 7,5YR4/6 -0- SL 0M MFR CW N/A ••2 .2 * Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 rrg/L CST Name (Please Print) SignCST Number ROBERT J HARDINA 824825 Address Telephone Number 477 170th AVE. TURTLE LAKE WI. 54889 5-1-09 715-986-2508 Property Owner WARNER Parcel ID # 010-1003-20-000 Page 2 of 2 F3- Boring # Boring El Pit Ground surface elev. 96.50 ft Depth to limiting factor 75 in. Soil Application 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 1 0-16 l0YR3/3 -0- SIL 1MSBK MVFR GW 3M .4 .6 2 16-34 10YR4/4 -0- SIL 2MSBK MFR CW IF .6 .8 3 34-75 7.5YR4/6 -0- SL 0M MFR CW N/A ..2 .6 F 4 Boring # ❑ Boring 96.5 75 pit Ground surface elev. ft. Depth to limiting factor in. Soil Application 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 1 0-15 10YR3/3 -0- SIL 1MSBK MVFR GW 3M .4 .6 2 15-34 10 4/4 SIL 2MSBK MFR CW IF .6 .8 3 34-75 7.5YR4/6 -0- SL 0M MFR N/A N/A .2 .6 a Boring # Boring 95.25 70 Pit Ground surface elev. ft. Depth to limiting factor in. ■ a Soil Application 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 1 0-16 IOYR3/3 -0- SIL 1MSBK MVFR GW 3M .4 .6 2 16--33 10YR4/4 -0- SIL 2MSBK MFR CW IF .6 .8 3 33-70 7.5YR4/6 -0- SL 0M MFR N/A N/A .2 .6 * Effluent #1 = BOD, > 30 < 220 mg& and TSS >30 < 150 mg/L * Effluent #2 = BOD, < 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. S1313-8330Test (R07/00) HA RDINA SEPTIC SYSTEMS MFRS/C$ST 824825 f -7- r Lj eu-- : f ~ _ _ . f 317 2+-cam=•1 ~ ~ TEA t 1: ~4t~CSS .04 .44 ~0- C ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer S5Cy-T &)A- W E Q Mailing Address 0? C44,e-,,t Z S y a 13 Property Address p?(S fJ /'7 (2T y En'lceFE L)T_sG l/ v`-y0 13 (Verification required from Planning & Zoning Department for new construction.) City/State gxi6jA,1W ( Parcel Identification Number 01O - 1 Dd 3 - aO --0cex) LEGAL DESCRIPTION Property Location 5 W '/4 , f, 1/a , Sec. T _Lk N R_/4 -W, Town of 6m &C4L ~ //2 4 Se > , Lot # Subdivision Certified Survey Map # , Volume , Page # vukuv,f W-/ `a ty ee # Imo/ Vt~P^ , Volum Page # Spec house yes Jno Lot lines identifiable C es) no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal 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. I/we, 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 that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe 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. Numb of bedrooms - i SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) U 2 7 4 0 P 6 1 9 STATE 13AR OF WISCONSIN FORM 11 - 1982 KATHLEEN H. WALSH LAND CONTRACT REGISTER OF DEEDS ST. CROIK CO., WI Individual and Corporate (TO BE USED FOR ALL TRANSACTIONS WHERE OVER RECEIVED FOR RECORD $25,000 IS FINANCED AND IN OTHER NON-CONSUMER Document Number ACT TRANSACTIONS 02/01/2005 10: 06AK LAND CONTRACT CONTRACT, by and between Allen L. Warner and Ardys Warner, EXEMPT # husband and wife, REC FEE: 13.00 TRANS FEE: 360.00 COPY FEE: CC FEE : ("Vendor", whether one or more) and Scott Warner, a single person, PAGES: 2 Recording ("Purchaser", whether one or more). Vendor sells and agrees to convey to Area Purchaser, upon the prompt and full performance of this contract by Purchaser, James Name N. and Krave Return Address ave the following property, together with the rents, profits, fixtures and other Attorney at I.aw appurtenant interests (all called the "Property"), in St. Croix P.O. Box 304 County, State of Wisconsin: Glenwood City, Wisconsin 54013 010-1003-10-000;010-1003-20-000 (Parcel Identification Number) West Half (W 1/2) of South East Quarter (SE 1/4) of Section t-30-16. This is not homestead property. (is) (is not) Purchaser agrees to purchase the Property and to pay to Vendor at 2728 County Road S, Emerald, WI 54013 the sum of $ 120,000.00 in the following manner: (a) $ _!0,000.00 at the execution of this Contract; and (b) the balance of $ 110,000.00 together with interest from date, hereof on the balance outstanding from time to time at the rate of 5 % percent per annum until paid in full, as follows: Bi-annual payments in the amount of 55255.27 commencing on June 30, 2005 with the next payment due December 31, 2005 and continuing each June 30th and December 31st thereafter. Provided, however, the entire outstanding balance shall be paid in full on or before the 30th - day of June _ _ 2020 _ (the maturity date). - Following any default in payment, interest shall accrue at the rate of 10 % per annual on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance)- Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor amounts sufficient to pay reasonably antici- pated annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor, Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest unless otherwise required by law. Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. An amount may be prepaid without premium or fee upon principal at any time biMf f11kr,#JANi"~Y/Ardh'ra/lY.t7VY~aa~Nrv/aA4'rYitttzllb'di'/11Dhrbau.VM~YrrtA~B'.67arualf/N/dd'dar/rt - - In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated as unpaid principal) is less than the armor that said indebtedness would have been had the monthly payments been made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded here from. Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except: Purchaser has waived his right to title evidence. Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall be retained by Vendor until the full purchase price is paid- Purchaser shall be entitled to take possession of the Property on January 12-_ _ 20115- • Cross out one- LAND CONTRACT - Individual and State Bar of Wisconsin Corporate Form No. 11 - 1982 Information Professionals Company. Fond du Lac, wl aoG-655-2021 U 2 7 4 0 P 6 2 0 Purchaser promises to pay when due all taxes and assessments levied on the Property or upon Vendor's interest in it and to deliver to Vendor on demand receipts showing such payment. Purchaser shall keep the improvements on the Property insured against loss or damage occasioned by fire, ex- tended coverage perils and such other hazards as Vendor may require, without co-insurance, through insurers approved by Vendor, in the sum of $ N/A , but Vendor shall not require coverage in an amount more than the balance owed under this Contract. Purchaser shall pay the insurance premiums when due. 'The policies shall contain the standard clause in favor of the Vendor's interest and, unless Vendor otherwise agrees in writing, the original of all policies covering the Property shall be deposited with Vendor. Purchaser shall promptly give notice of loss to insurance companies and Vendor. Unless Purchaser and Vendor otherwise agree in writing, insurance proceeds shall be applied to restoration or repair of the Property damaged, provided the Vendor deems the restoration or repair to be economically feasible. Purchaser covenants not to commit waste nor allow waste to be committed on the Property, to keep the Property in good tenantable condition and repair, to keep the Property free from liens superior to the lien of this Contract, and to comply with all laws, ordinances and regulations affecting the Property. Vendor agrees that in case the purchase price with interest and other moneys shall be fully paid and all conditions shall be fully performed at the times and in the manner above specified. Vendor will on demand, execute and deliver to the Purchaser, a Warranty need, in fee simple, of the Property, free and clear of all liens and encumbrances, except any liens or encumbrances created by the act or default of Purchaser, and except: any easements and encumbrances of - record. - Purchaser agrees that time is of the essence and (a) in the event of a default in the payment of any principal or interest which continues for a period of 30 days following the specified due date or (b) in the event of a default in performance of any other obligation of Purchaser which continues for a period of 30 days following written notice thereof by Vendor (delivered personally or mailed by certified mail), then the entire outstanding balance under this contract shall become immediately due and payable in full, at Vendors option and without notice (which Purchaser hereby waives), and Vendor shall also have the following rights and remedies (subject to any limitations provided by law) in addition to those provided by law or in equity: (i) Vendor may, at his option, terminate this contract and Purchaser's rights, title and interest in the Property and recover the Property back through strict foreclosure with any equity of redemption to be conditioned upon Purchaser's full payment of the entire outstanding balance, with interest thereon from the date of default at the rate in effect on such date and other amounts due hereunder (in which event all amounts previously paid by Purchaser shall be forfeited as liquidated damages for failure to fulfill this Contract and as recital for the Property if purchaser fails to redeem); or (ii) Vendor may sue for specific performance of this Contract to compel immediate and full payment of the entire outstanding balance, with interest thereon at the rate in effect on the date of default and other amounts due hereunder, in which event the Property shall be auctioned at judicial sale and Purchaser shall be liable for any deficiency; or (iii) Vendor may sue at law for the entire unpaid purchase price or any portion thereof; or (iv) Vendor may declare this Contract at an end and remove this Contract as a cloud on title in a quiet-title action if the equitable interest of Purchaser is insignificant; and (v) Vendor may have Purchaser ejected from possession of the Property and have a receiver appointed to collect any rents, issues or profits during the pendency of any action under (i), (ii) or (iv) above- Notwithstanding any oral or written statements or actions of Vendor, an election of any of the foregoing remedies shall only be binding upon Vendor if and when pursued in litigation and all costs and expenses including reasonable attorneys fees of Vendor incurred to enforce any remedy hereunder (whether abated or not) to the extent not prohibited by law and expenses of title evidence shall be added to principal and paid by Purchaser, as in- curred, and shall be included in any judgment. Upon the commencement or during the pendency of any action of foreclosure of this Contract, Purchaser consents to the appointment of a receiver of the Property, including homestead interest, to collect the rents, issues, and profits of the Property during the pendency of such action, and such rents, issues and profits when so collected shall be held and applied as the court shall direct. Purchaser shall not transfer, sell or convey any legal or equitable interest in the Property (by assignment of any of Purchasers rights under this Contract or by option, long-term lease or in any other way) without the prior written consent of Vendor unless either the outstanding balance payable under this Contract is first paid in full or the interest conveyed is a pledge or assignment of Purchaser's interest under this Contract solely as security for an indebtedness of Purchaser. In the event of any such transfer, sale or conveyance without Vendors written consent, the entire outstanding balance payable under this Contract shall become immediately due and payable in full, at Vendor's option without notice. Vendor shall make all payments when due under any mortgage outstanding against the Property on the date of this Contract (except for any mortgage granted by Purchaser) or under any note secured thereby, provided Purchaser makes timely payment of the amounts then due under this Contract- Purchaser may make any such payments directly to the Mortgagee if Vendor fails to do so and all payments so made by Purchaser shall be considered payments made on this Contract. Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. All terms of this Contract shall be binding upon and inure to the benefits of the heirs, legal representatives, successors and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable consideration joins herein to release homestead rights in the subject Property and agrees to join in the execution of the deed to be made in fulfillment hereof.) Dated this yday of January - 2005 _ D -<~-~/Ji i~~ opt (SEAL) (SEAL) + Allen L. Warm -Vendor ' Scott Warner -Purchaser _ Y/iJLa✓l1-__-- (SEAL) - - - - - - (SEAL) + Ardys Warner Vendor ` ----------~.__Purchaser AUTHENTICATION ACKNOWLEDGMENT Signature(s) Allen L. Warner, Ardys Warner and Scott STATE OF WISCONSIN ) Warner COUNTY) henticated this /~a of January 2005 Personally came before me this - day of - the above named ~ o + Ames H. Krave Atto ey at Law - - T LE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (1 f not, instrument and acknowledge the same- authorized by § 706.06, Wis. Slats.) THIS INSTRUMENT WAS DRAFTED BY + James H. Krave, Attorney at Law - J Notary Public County, Wisconsin Glenwood City, Wisconsin 54013 My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not ) necessary.) • Names of persons signing in any capacity should be typed or printed below their signatures. LAND CONTRACT - Individual and Corporate - State Bar of wi-sin Form No_ 11 - 1992 Information PMfaasionals Company, Fond du Lac. WI 800-655-2021 s 1 p3 ----1 I----' i O T el O I 1 w a U i o 0 Wi 2W Z _v al Z zOC m W a c „-W De ~ I Z 1 U Ii W -O 0 LL IV'J v L l7 32 l___~I I~w e ~ ~ J L.I.. Z~ tu- 3 v p W ~ O ~ o Z d a a~ V W Y v O XY9 H9lH C: E I- O `J v a~ V O a a ~c z T- °C x a O V Ul) o o w ~ o z 3 v ~ p w I ~ ~ ' ° rp x w 1 rll 3~ gro ~m i E °c o 0 W 3 W IQ top W c N V W V J n m v "O v a \L E W N ai .-14 N E 75 ' ~ v V O O I I~i3 X31 I O e V C rya a O I -1 1 I I W Vj 1 . I ~U. L ~ 1 elk I~ ~ I a xk I M N O O w ~ 3 m . J_ o v v 5 'CO X X 3 Y ne m a x Q a_. O 1 W W Lu 1 a" - I m 1Y1 I C ~ °1 I I W ~ ~ v v ~a c rw ® O O ® O 10 a+ G _ p v ~a O_ < ° c O ° o k ELL Fw- K -Q yy- Ell LU wI n=57, U) Q, v V o o W o ° m C j N C c V E O us m. ? O a C 53A73H5 > LV - T ~ W ~L e~ - Y i Fm a N E o I W X ~ d v be j, G` F M TL,7- _ m c -°c' X/ ad o~ Q i p 3 Ev E a L o l i d U` m I p N m T QI a X0tp0 !00 ® 0 3 o°o AYMH)MV - C_ C Q LL LJ1 ~ a commerceml.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 j 1' tric sc o n s n Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) e partment of Commerce Sanitary Permit Application ~State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form late unit is required prior to obtaining a sanitary permit. Note: Application form 0 state- TS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may used for secondary 2668 ) `16714 A V 6 purposes in accordance with the Privacy Law, s. 15.04 1 m , Stats. 6rt~e W1 1. Application Information - Please Print All Information KEECEIVED Sqo 1 Property Owner's Name Parcel # iievE 14)A R_ MAY 13 7009 vl d -10o3- ao -oood Property Owner's Mailing Address Property Location OQ - ~ 7 S3 G & ZONING OfFICE C • ~ Govt. Lot City, State Zip Code Phone Number S W Y., ~E Section Ewt E2 L 5~0 5 aC Y e T _36 N; R circleE orec) H. Type of Building (check all that apply) 6K Lot # 1 or 2 Family Dwelling - Number of Bedroo s Subdivision Name ,5 Y OF'e- Block # ❑ Public/Commercial - Describe Use cz I,- A El city of . 4 1% O ❑ State Owned - Describe Use CSM Number ❑ Village of R Town of Eh&Q-A LJ III. Type of Permit: (Check only one box on line A. Complete line B ' plicable) A. ® New System ❑ Replacement System ❑ Treatment/Holdt T Re a nt On] ❑ er M difi tion to 'sting System (explain) B. ❑ Permit Renewal El Permit Revision El Change of Plum ❑ P t Tran r N w L evious Perm t Number Date Issued Before Expiration Own IV. Type of POWTS System/Component/Device: Check all that a 1 aNon-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersaUTreatment Area Information: Design Flow (gpd) Design Soil i A plication Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 7,o -7 t v c) 75 VI. Tank Info Capacity in Total 4 of Manufacturer Gallons Gallons Units o n New Tanks Existing Tanks c w w wU inV ~n w a. Septic or Holding Tank L o o b I A Dosing Chamber O ( T -Ar VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Si nature MP/MPRS Number Business Phone Number ~o a Plumber's Address (Street, City, State, Zip Code) ~7 17 " k- -u rrLk LA f s VIII. Coun epartment Use Only El Approved El Disapproved Permit Fee Date Issued Issuing Agent Signature El Owner Given Reason for Denial IX, Conditions of Approval/Reasons for Disapproval Attach to complete plans for th yste d submit to the Co ty only per not less than 81n x 11 inches' size SBD-6398 (R 02/09) Valid thru 02/11 Wisconsin Department of Commerce SOIL EVALUATION REPORT ~ Page 1 of 2 Division of Safety and Buildings AL- in accordance with Comm 85, Wis. Adm. Code Coun _'CROIX Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. '1-1003-20-000 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. I Please print all information. Reviewed Date Personal information you provide may be used for secondary pur acy Law, s. 15.04 (1) (m)). 5 Property Owner V&r Properly Location SCOTT WARNER Govt. Lot SW 1/4 SE 1/4 S I T 30 N R 16 E(or)W ❑ )W Property Owner's Mailing Address "Xf 13 Lot # Block # Subd. Name or CSM# 2728 Co. Rd S ..Jug'4 ` E N/A N/A N/A City State Zip Code Ph ity ❑ Village Town Nearest Road 9~ WIN EMERALD WI 54013 ( 71 5-265 4442 170th AVE El New Construction UseE] Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD 11 Replacement Public or commercial - Describe: Parent material OUTWASH Flood Plain elevation if applicable hI~A ft. General comments RECOMMENDED SYSTEM ELEVATION 91.75 and recommendations: Boring # D Boring 0 pit Ground surface elev. 95.67 ft. Depth to limiting factor >96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Ef1#1 *Eff#2 1 0-15 10YR3/3 -o- SIL 1MSBK MVFR GW 2M .4 .6 2 15-23 10YR4/4 -a- SIL 2MSBK MFR CW 2F .6 .8 3 23-96 7.5YR4/6 -o- SL 2MSBK MFR N/A N/A .6 1.0 F2 Boring # ❑ Boring >100 E] Pit Ground surface elev. 95.25 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-14 10YR3/3 -0- SIL 1MSBK MVFR GW 3M .4 .6 2 14-30 10YR4/4 -o- SIL 2MSBK MFR CW IF .6 .8 3 30-100 7.5YR4/6 -o- SL 2MSBK MFR CW N/A .6 1.0 * Effluent #1 = BOD > 30:E 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) S' CST Number ROBERT J HARDINA 824825 Address ate Evaluation Conducted Telephone Number 477 170th AVE. TURTLE LAKE W1. 54889 5-1-09 715-986-2508 lTT n'.'.n Tn.s% n\ qA o ~ V Property Owner WARNER Parcel ID # 010-1003-20-000 page 2 of 2 3 Boring # 13 Boring El Pit Ground surface elev. 96.50 ft. Depth to limiting factor >108 in. Soil Application 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 1 0-16 10YR3/3 -0- SIL 1MSBK MVFR GW 3M .4 .6 2 16-34 10YR4/4 -0- SIL 2MSBK MFR CW IF .6 .8 3 34-108 7.5YR4/6 -0- SL 2MSBK MFR CW N/A ..6 1.0 ❑ 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 GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 S Boring F-1 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 GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 < 30 rrKA 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. M-8330Test (R07/00) 9~ o~ q HARDINA SEPTIC SYSTEMS MFRS/CST 824825 L4) eLL P/c = peg e.-T7 L, A! - ~ s r e 07 Yd o j / I d 9 O ro ~ 'P 4 c~aS&.J Ta A tE2 ( S rm 33Q J94 Q - d 9~ os ~ IN-GROUND SOIL ABSORPTION DESIGN INDEX AND TITLE PAGE - - Project Name: 1A) A Owner's Name` cSC Qi: i L.J A etch Ownees Address: o?-7 ol Y C0 2d 9 04 f 2AL1 t~,J I -qO r 3 Legal Description: ~1-. 30, /J - J to LJ Township: E"m E (-i4 Lt , County: .g1 9-0 ik Subdivision Name: Lot Number: Block Number: Parcel I.D. Number: 06) - 1 Oy,3 - of O -04o Plan Transaction No.: Page 1 Index and title Page 2 -?LCr r LA d Page 3 Seal nvs, Cmb 5<t_ Page4 Aou5$LA,0 Page 5 TAq k~ 01Wt 3 5,Lc- Page 6 ,05r _r A j V A~Ze L Page 7 u r. C LA. IZ~ rc fA4E, f M AdA &4kMe.tr 1 ?qg q SewL ~ATA A~'b Designer: R40Z697 ItAQIi.) A License Number: Date- 05/21107 Phone Number- I = - R4'0 Signature: Designed Pursuant to thin in-ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01), Page f of Soil Absorption System Cross Section 9 ft 4" Schedule 40 Final Grade PVC Vent Pipe With Vent Cap 9a?. 75'ft Leaching Chamber 9 t 7.rft System Elevation 3 ft ft Soil Absorption System Plan View ft ft { ` _ft Leaching Trench 1 Vent Or Observation Pipe Chambers 4° Dia. Trench 2 Header Leachinq Chamber Specifications Manufacturer And Model I~lfi/ L i ~t A i DQ. (DA, Iz q EISA Rating dQ sq ft per chamber Soil Application Rate _ gpd/sq ft gpd Design Flow _ Soil Application Rate : o?t) EISA = 3~ Chambers 2 rows of chambers each. Page of 3 Or 9 SEPTIC TANK AND PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS Locking cover"ft warning label. Access Weather Proof Junction Box. Vent Pipe opening, not top of cover. Electrical as per NEC 300 and must extend at least 4" Comm 16.28 WAC > IT above grade above finished grade. Access opening, not top of cover, must extend to Maximum Cover over Tank a point no greater than 6" below finished grade. D 23" Min. Opening Disconnect E-- Alternate 18" min outlet 1 I location 23" Min.. Force Main Diameter Opening Approved Building effluent filter orce Main Length !a 0 Sewer 5 to 118" particle size A Weep hole or anti siphon device: e C D Pump Off Elev. 3 3, i Dose TTar* Elev. d d -5 Bed and backfill tank according to manufacturers specifications Anchor tank as necessary to negate buoyant forces. Note: All pipe and vent materials comply with Comm 84. Tank Manufacturer: W MGR'S C; Doses Per Day: _ Tank Sizes: Septic 160D Gallons GPD/ # of Doses: gallons Pump dd Gallons Backfiow: gallons Gallons Per Inch: 'ar Total Dose Volume: gallons Liquid Level: _ Required GPM: Pump Manufacturer: _Z 0 5&6a Dimensions MInches Gallons Pump Model: A Q Alarm Manufacturer: 671 CC o Alarm Model: I b D Y• 0 Total ga a Vertical Difference between pump off and distribution pipe Minimum Required Supply `Pressure (0 for dosed conventional) =L Feet of force main x friction factor/ 100 Total Dynamic Head = % i' P j SAFETY AND BUILDINGS DIVISION Plumbing Product Review P.O. Box 2658 commerce.wi.gov Madison, Wisconsin 53701-2658 sconsin Dr tment of Commerce Jim Doyle, Governor Mary P. Burke, Secretary January 10, 2007 WEEKS CONCRETE PRODUCTS RAY WEEKS 1832 215TH STREET NEW RICHMOND WI 54017 Re: Description: SEWAGE TANKS, CONCRETE Manufacturer: WEEKS CONCRETE PRODUCTS Product Name: SEPTIC, HOLDING OR PUMP Model Number(s): 800 LOW PROFILE; (37.0" L.L., 21.76 GAUIN., 84" MAX. DEPTH OF BURY, 386 G.P.D. WHEN USED AS A SEPTIC TANK BASED ON A 3 YR. SERVICE INTERVAL FOR RESIDENTIAL WASTEWATER) Product File No: 20070005 The specifications and/or plans for this plumbing product have been reviewed and determined to be in compliance with chapters Comm 82 through 84, Wisconsin Administrative Code, and Chapters 145 and 160, Wisconsin Statutes. The Department hereby issues an approval based on the Wisconsin Statutes and the Wisconsin Administrative Code. This approval Is valid until the end of January 2012. This approval is contingent upon compliance with the following stipulation(s): • This tank must be designed to withstand the pressures to which it will be subjected. • The manufacturer must keep at the manufacturing plant a set of plans and specifications bearing the department's stamp of approval. The plans and specifications must be open to inspection by an authorized representative of the department. • When this product receives wastewater from dwellings and is used as a septic tank, it will produce an effluent quality with a maximum monthly average value for BOD5 of greater than 30 mg/L and less than or equal to 220 mg/L TSS, or greater than 30 mg/L or less than or equal to 150 mg/L TSS, and F.O.G. of less than 30 mg/L. • This product is approved to use the following: - Two inch schedule 40 PVC cast in riser for electrical wiring. - Pipe materials constructed in conformance with Table 84.30-2 or 84.30-11, Wis. Admin. Code poured into tank cover or access cover. - Department approved effluent filter designed to be installed in a four inch diameter tee with extension and installed in accordance with the product approval for the filter including a properly sized and located access opening for service and maintenance. - Department approved EZ Set and Polylok Inc., 24" riser cast into the tank cover. This approval supersedes the approval issued on 06/02/2004 under product file number 20040269. his approval letter shall be incorporated with your previously approved plans and/or specifications approved under product file number 20040269. The department is in no way endorsing this product or any advertising, and is not responsible for any situation which may result from its use. Sincerely, Jean M. MacCubbin, CST; Engineering Consultant--Plumbing Product Reviewer Commerce; Safety & Buildings Div. PO Box 2658; W Washington Ave. Madison W1 53703-2658 Phone: 608-266-0955; Fax: 608-283-7456; mail: Jean.MacCubbin@wisconsin.gov SBD-10564-E (N.10/97) File Ref: 07000502.DOC a T 5' W I-- W LU Uj PUMP PERFORMANCE CURVE MODEL 151/152/153 50 14 45 153 12 40 0 10 35 152 30 Q 0 8 25 151 J Q F- 6 20 15 4 10 2 5 0 10 20 30 40 50 60 70 80 90 100 GALLONS LITERS 0 40 80 120 160 200 240 280 320 360 FLOW PER MINUTE 014508A http://zoeller.thomasnet.com/imageresizer?image=a0001216 jpg&quality=100&size=100&... 5/12/2009 INGROUND SOIL ABSORPTION MANAGEMENT PLAN PURSUANT TO COMM. 83.54, WIS. ADM. CODE General This system shall be operated in accordance with Comm.82-84 Wis Adm. Code and shall be maintained in accordance with its component manual [In-ground Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (n.01/01) and SSWMP publication 9.6 (01/81) and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic tank or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm. 83.33, Wis Adm. Code when the tanks are no longer used as POWTS components. Septic or pump 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 and 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 a tank or component. 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. 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 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 sludge and scum 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 the triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maxium scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Dept. of Commerce. Pump Tank The pump tank shall be inspected at once every 3 years. All switches, alarms and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Soil Absorption System No trees or shrubs should be planted on the absorption area. Plantings may be made away from the cell's perimeter, and the area shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than foot or for vegetative maintenance) on the area is not recommended since soil compaction may hinder aeration of the infiltrative surface within the system and snow compaction in the winter will promote frost penetration. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired of replaced with a component of the same or equal performance. If the dispersal area fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Replacement in a suitable area nearby is also an option at which point a diversion valve will be installed between the old and new systems to allow dispersal cell rotation at a schedule to be determined at the time of cell replacement. ` vtie~onsi2! bpartment91Industry, SOIL AND SITE EVALUATION REPORT P LaWr and Human Relations Division of Safety & sodding in accord with ILHR 83.05, WIS. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches i)l 7n a t iri lude,,lwt t r not limited to vertical and horizontal reference point (BM), direction a % of slope, scale or „ PARCEL I.D. 8 dimensioned, north arrow, and location and distance to nearest road. D1D -loo -3 -oZ C~ o/ I / APPLICANT INFORMATION-PLEASE PRI TALL INFOf3MAT1.OfN REVIE DATE vw l Cd' 4~ PROPERTY OWNER CA' PROP~ITY LOCATION / V AT( n 0 ~ le Vt 11.E O ~ ~ 'GbVT: LOT 5~ 114 1/4,S T ~ Q IN./ (Q r(6r PROPERTY OWNI ~':S MAILING ADORE LOT # BLOCK a SUBD. NAME OR M # O C • 14 Fire 111 ° a (o A- GAff A ~U~ ~ CITY, STATE ZIP CODE PHONE NUMBER []CITY ILLAGE NI`OWN NEARESTOAD A 5 4/ O 3 ( W) aW Lid-I I 70 'tv Are, )OO [ ] New ConsUucGon Use [ Residential I Number of bedrooms .3 [ ] Addilion to exisling buil ft (cement ( I Public or commercial describe Code derived daily flow'SQ gpd Recommended design loading rate O - S bed, gpd/0 d- L trench, gpoltt2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate D- S bed, gpdNt2 U• ( trerx h, gpdgI2 Recommended infiltration surface elevation(s) 8e4een 9T-,J+_ q?, 9 ccm ~ar It (as referred to site plan bench ark) Additional design / site considerations rI?Ou ra ScLsktn - -mod m d~~ c(~_ ~ -e S Flood plain elevation, if applicable AV 4 ft Parent material umc( M( S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL MOLDING TAW U=Unsuitable fors stem 11 S CKU S❑ U 0 S W ❑ S au ❑ S W ❑ S ARJ U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Basiby Roots GPD/ft Boring # Horizon in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed ranch a zC` 011 6 l~ 3 d'Kt / Sbk l n V a 4 .S - tv S d. 11-1(v 2 q A) s i t m 6 v Ci✓ ~rn Ground - 7&3 j Yre s~ elev. Depth to +5~ [ limiting factor , r Remarks: Boring # 6-111 0 It 3/3 /1/c W Si U S M 0 5 0• ep oZ Iq- .Sr2 drt i 1 a rn bk ~,cv M (-35- ? S f Uv k c2 rn Sb k rr ll1 P Nr Ground _Qlev Depth to limiting factor H a Remarks: _ ST Name:-Please Print Phone: 4/. you a vYt " / Address: p / S- Ma ccJ A (Vrlr Atr "5 - D e: CST Number: S' nature: ~-Z -a21- 93 m • -7,0 l PROPERTYOWNER r) 161 WOOJSO1L DESCRIPTION REPORT " Page:" . t PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rerh ~ 7r- 0 !v /vY,c 3 3 rn,5 in J a S 0-S- lv Ground 3 A)e N~ ,el~ev.5 y - it. Depth to limiting factor Remarks: Boring # Ground ' elev. ft. Depth to Wiling factor Remarks: Boring # Ground elev. Depth to limiting factor Remarks: Boring # Ground elev. fl. Depth to limiting factor Remarks: SBD-8330(R.05/92) 3 PROPERTY Ot.NNERr VAn IS O C /f/1 WOOJSOIL DESCRIPTION REPORT Pap - of , . , # PARCEL IA Depth Dominant Color Mottles Texture Structure Consistence Bo rd3y Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed rends 6°14) /VYX 31-3 a m5~ mt! QS rn d,S' to ID-1 ~:SY ~ erne S~ I a m sbk r ~rrt D•.s' (o M Ground 3 .S ,e y awe l-{• S/ an,b _njV - A) e NIP Ito - 30 1 Al ev5 ~ Depth to limitlng t~1&,r Remarks: Boring # Ground elev. IL Depth to limiting factor Remarks: Boring # f [31 Ground elev. fG Depth to limiting factor Remarks: Boring # 131 Ground elev. IL Depth to knifing facto Remarks: SBD4330(R.05/02) ' lt4j scorjin DeparbneM of Industry, SOIL AND SITE E V A L U AST 10'0-- `V'P T, Pt~ -Lo Labor and Muman F/elatlons Division of Safety & Buildings in accord with ILHR 83 6.'Wis. Adm. Code Attach complete site plan on paper not less than 81/2 x 11 inches in sif8:-Plan must include, but not limited to vertical and horizontal reference point (BM), direction and -1tof slopA; scale or P 'CEL LD. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMAT6W, T i DATE PROPERTY OWNER: " TY LOCATION "w / j N A-~r r► d CO ~e w o G9~ ; .1600' i/4,S T 30 N,Ft PROPERTY OWNE„Q:S MAILING ADDRE%Ss LOT # - BLOCK`S SUED. NAME OR9sM # O t• r4k S-free+ ire N° oZ (o A G!/i4 NA CITY, STATE ZIP CODE PHONE NUMBER []CITY VILLAGE TOWN INEARE D I Z, O 3 (715) arRs = La I I / [ J New ConsVucdon Use I >t Residential I Number of bedrooms Addition to existing Wilding Replacement ( I Public or commercial describe Code derived daily flow qSZ) gpd Recommended design loading rate D • S bed, gpolft2 d" ( trench, gpolft2 Absorption area required bed, R2 french, ft2 Maximum design loading rate D• S bed, gpd/I12 U• (o trench, gpdM2 Recommended infiltration surface elevalion(s en It. `a 99.9 con Lur It (as referred to site plan benchmark) Additional design/ site considerations Inn a nq 5wk& Parent material •e S Flood plain elevation, if applicable Al A ft S - Suitable for system CONVENTIONAL MOUND FIN-GROUND PRESSURE AT-GRADE SYSTEM IN FLL HOLDING TANK U- Unsuitable fors stem O S IdU I$ S❑ U O S W IDS lau ❑ S B31 O S .RU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence gamey Roots GPD/ft in. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. Bed michh n,3 13 AJ entf Si SA 011 10 re 0 1 11- iDYttql1k A) 0q S i t m 6 lrn UPS' d 4r., Ground s ICJ - ~P N elev. ga.IL Depth to limiting laclor `r Remarks: Boring # / 4•/ / 3 /1/aW 3i U S i, 0.5 .40 El 114-al , YIL ~o, o x j a i n' k ow » S 04 - 3S S urn e Q m .5b k r` IV P A )P elev. nje7j1L Depth 10 limiting faclof _.LI Remarks: T Name:-Please Print Phone: 6u All rrN Address: p)., . 60- X L AA0 6cJ ffzf &4rn Idr $-17.57 Sgnaturs: Date: CSTN mbar: t-T - - p - I ' - i I ~ I I - i I ~ li I ! I i I I I ! I I ~ I I , I ~ I` I ! I ~ ii I x, o i I I , I i i I I i ~ ~ 1 I _ j c dsi ~ I _ I ~ Ic I a I i i I l t c , 1 Parcel 010-1003-10-000 01/18/2005 09:29 AM PAGE 1 OF 1 Alt. Parcel 1.30.16.16 010 - TOWN OF EMERALD Current * ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): Current Owner * WARNER, ALLEN L & ARDYS --4=rN-rZ-A'RDYS WARNER 2728 CTY RD S EMERALD WI 54013 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 2198 GLENWOOD CITY SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 1 T30N R16W 40A NW SE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 01-30N-16W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 1077/438 QC 07/23/1997 907/198 2004 SUMMARY Bill Fair Market Value: Assessed with: 24210 Use Value Assessment Valuations: Last Changed: 10119/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 20.000 3,000 0 3,000 NO PRODUCTIVE FORST LANC G6 20.000 36,000 0 36,000 NO Totals for 2004: General Property 40.000 39,000 0 39,000 Woodland 0.000 0 0 Totals for 2003: General Property 40.000 5,700 0 5,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel 010-1003-20-000 02/11/2008 09:06 AM PAGE 10F1 Alt. Parcel 01.30.16.17 010 - TOWN OF EMERALD Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - WARNER, SCOTT SCOTT WARNER 2728 CTY RD S GLENWOOD CITY WI 54013 SJ~ Districts: SC = School SP = Special P(77 Address( s): Primary Type Dist # Description 2 7 D S SC 2198 GLENWOOD CITY V-V 2~ SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 1 T30N R1 6W 40A SW SE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 01-30N-16W Notes: Parcel History: Date Doc # Vol/Page Type 02/01/2005 786356 2740/619 LC 07/23/1997 1077/438 QC 07/23/1997 907/198 2008 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: last Changed: 10/19/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 37.500 6,200 0 6,200 NO UNDEVELOPED G5 0.500 50 0 50 NO OTHER G7 2.000 10,000 2,000 12,000 NO Totals for 2008: General Property 40.000 16,250 2,000 18,250 Woodland 0.000 0 0 Totals for 2007: General Property 40.000 16,250 2,000 18,250 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00