HomeMy WebLinkAbout014-1000-90-000Vv+isctansin Department of Commerce PRIVATE SEWAGE SYSTEM
Safety and Building Division
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township
Cormican, Sandra Forest, Town of
CST BM Elev: Insp. BM Elev: BM Description:
~~ ~-'Vl t C~~
TANK INFORMATION
TYPE MANUFACTURER . ,/~~ CAPACITY
Septic C L~ ~ ~'1 3 ~ I~QO
Dosing 7 ~~,~ P~ $ ~ S~
,1 n ~~
t',/~ C v ~ c1
Holding
TANK SETBACK INFORMATION
TANK TO AAP/
f~~ WELL BLDG. Vent to Air Intake ROAD
Septic ,7 /b0~ 7/~! ~J~
/bC~
~
/60
7
Dosing ~/~~ ~ /Ob, /tOZ.' ~ ~~, /
Aeration
Holding
PUMP/SIPHON INFORMATION / V~
Manufacturer r
it~
~'^ errand
_ (q GPM
Model Number ~ ~ ~ °~~~
TDH Lift Friction Loss System Head TDH Ft
~. S'7 3.z5 /3,7
Forcemain ength ~
/ 3a Dia. ~1 Dist. to well 7 ~~' /
SOIL ABSORPTION SYSTEM
ELEVATION DATA
County:
St. Croix
Sanitary Permit No:
514906 0
State Plan ID No:
Parcel Tax No:
014-1000-90-000
SectionlTown/Range/Map No:
01.31.15.7
STATION BS HI FS ELEV.
Benchmark ' ~ ~ ~/ ` ~ ~~
Alt. BM~ \~ ~ ~ / ~ l
/ ~~ 3. 55
Bldg. Sewer A .~
, C
7 !6L
St/Ht Inlet ~ !~
~ 9~ ~ 7~
7
SUHt Outlet ~~~~} f' 3. 1.~ 98.a~
Dt Inlet ~ ~• I~j ~~,
Dt Bottom #
~Z•~ ~p b7
v
Header/Man.
~~ ~
q5-95
Dist. Pipe ~ ~ ~~ ~~
Bot. System
~•~s
~~•y
Final
G
rade ~,~ ~~ r ~~•
y
g
St Coyg.' 1~.~. Cz,
f
- P ~f~ /~3. S
~- ~ ~
1
A q, Z 9 Z • Z
P. , ~o ~o $ 5. Z, Q6 • Z~
BEDITRENCH
DIMENSIONS Width /
la Length
`~~ No. Of Trenc s
2 e ~ PIT DIMENSIONS
~ No. Of Pits
\ Inside Dia.
\ Liquid Depth
i~
SETBACK
INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING
CHAMBER OR Manufacturer:
T
t
Of
S
yp
m:
,
ys
VL 7 ~~ ~
~ `~ ~
~ ~bo A' A UNIT Model Number: \
DISTRIBUTION SYSTEM
Header/Manifold
° Distribution t r~ a
~~
Pi
e(s)
` x Hole Size /1 x Hole Spacing ~
, V~~q+t to Air Intake
~
Length~_Dia ~~ ~
p
-7
Length 3 / Dia Spacing ~ ~ I ~~
it ~ • 73 IJ
SOIL COVER ""'-"""""~
x Pressure Systems Onlv xx Mound Or At-Grade Svstems Onlv 1
Depth Over
Bed/Trench Center i
•7 fs Depth Over
Bed/Trench Edges
\ xx Depth of
Topsoil t
~ xx SeededlSodded xx Mulcli~
L • ~'t ,, es ~ No Yes ~ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ / //yy~~' / a a ~ Inspection #2: /
Location: 2359 310th Stree C ear Lake, WI 4005 (SW 1/4 NW 1/4 1 T31N R15W) 40 acres Lot /It Ae,~jp j~l`-''`Q1y Par I No: 01.31.15.7
1.) Alt BM Description = ~ ~'~ ~~`~~- ~~F..~~.~ ~ ~~~+~
V~
2.) Bldg sewer length = ~ ~, ~d ~,.~`J r. ~ P' ~~
- amount of cover = /
a~
--- - _ - - --- -- --- t
Plan revision Required? ~ Yes ~No ~ -T i b~'
Use other side for additional information. ~ _ ~ I li I!~
1- - ~' U _--- -
Date Insepctor's ignature
SBD-6710 (R.3/97)
commerce.wi.gOV Safety and Buildings Division County
^
201 W. Washington Ave., P.O. Box 7162
St Croix
i seo n s i n Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.)
Department of Commerce 5~ 9~
Sanitary Permit Application State Transaction Number
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental 1542936
unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS aze Project Address (if different than mailing address)
submitted to the Department of Commerce. Personal information you provide may be used for se dory ~ ~~- ohs 7
u oses in accordance with the Privac Law, s. 15.04 1 m), Stats. 310s' Street
I. A lication Information -Please Print All Information G~~e~,t„ ~i S
Property Owner's Name
~ Sar~arr.~ ~' ~ ~ Parcel #
o~y - ~~ - ~v- coo
Property Owner's Mailing Address •-
3188 205`s Ave. Property Location ~ ~ `
Govt. Lot J\)
City, State Ztp Code Ph ~ Number SW'/4, NW'/., Section 1
Glenwood City WI 54013 715~(~-4974 (circle one)
T31 N
R 15W
II. Type of Building (cheek all that apply) d(c, a0 Lot # ;
-
X 1 or 2 Family Dwelling -Number of Bedrooms 1 ~/+ C'v Ep
V GG Subdivision Name
Sv~e.wt1~ ~~~~
Block #
l
a,~
^ Public/Commercial -Describe Use p
2008
^
~'~ ~~.~- ~ JUN 2 ~ City of
^ State Owned -Describe Use CSM Number
CROIX COUNTY
~ ^ Village of
ST.
~D k" ~ A ~a.~ ZONING OFFICE X Town of Forest
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. X New S stem
~ Y ~
^ Replacement System
^ Treatment/Holding Tank Replacement Only
^ Other Modification to Existing System (explain)
B• ^ Permit Renewal ^ Permit Revision ^ Chan e of Plumber
g
^ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner ~
IV. T e of POWTS S stem/Corn onent/Device: Check all that a I v /
^ Pressurized In-Groun eAt-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 App ' ation Rate(gpdsf) Dispersal Area quired (sf) Dispersal Area oposed (sf) System Elevatio
n #
~95L
450 .6 750 750 p
u
(7 ~S~o
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units ~ o '~ ~
New Tanks E
i
ti
T
k ~ ~
x
s
ng
an
s
/~ ~
o
r~ U
v~ ~
~ ~ ~
w c7
0
I G~LB I ~, ,
Septic or Holding Tank 1000 1000 1 Skaw Pre-cast x
Dosing Chamber 800 800 1 Skaw Pre-cast x
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number
227618
Thomas D Gustum 1-715-658-1344
Plumber's Address (Street, City, State, Zip Code)
N13450 937'" Street New Auburn WI 54757
VIII oun /De artment Use Onl
Approved ^ Permit FeFee
~
$ Date I sued
~~~ Issuing t Signature
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a
IX. Conditions of ApprovaUReasons for Disapproval ' ~J~
SYSTEM OWNER: 3~ iJ-ior-.S /ti v~~. ~.G Q.~, iti-•
~, ~
1. Septic tank, effluent filter and (~., / ~.~
~" kJ
ed'i*r t
'
~
,
~
/ maintained
dispersal cell must all be services
as per management plan provided by plumber.
2. AU setback requirements must. be msitltaiNed
ntcacn to complete plans for tue system and submit to the County only on paper not less than 8 t!2 x 11 inches in size
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commerce.wi.gov
isconsin
Department of Commerce
Safety and Buildings
PO BOX 7162
MADISON WI 53707-7162
TDD #: (608) 264-8777
www. com merce.wi.gov/sb/
www.wisconsin.gov
Jim Doyle, Governor
Jack L. Fischer, A.I.A., Secretary
June 16, 2008
OUST ID No. 227618
THOMAS GUSTUM
GUSTUM SEPTIC SERVICE
N13450 937TH ST
NEW AUBURN WI 54757
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 06/16/2010
ATTN. POWTS Inspector
ZONING OFFICE
ST CROIX COUNTY SPIA
1101 CARMICHAEL RD
HUDSON WI 54016
Identification Numbers
SITE: Transaction ID No. 1542936
Jim Cormican -Dwelling Site ID No. 738289
310 St Please refer to both identification numbers,
Town of Forest, 54012 above, in all corres ondence with the a enc .
St Croix County
SW1/4, NW1/4, S1, T31N, R15W, Lot: 1
FOR:
Description: At-Grade
Object Type: POWTS Component Manual Regulated Object ID No.: 1185258
Maintenance required; 450 GPD Flow rate; 39 in Soil minimum depth to limiting factor from original grade; System(s):
At-grade Component Manual, SBD-10570-P (R.6/99), Pressure Distribution Component Manual, SBD-10573-P (R.6/99)
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 he component manual(s) referenced above.
The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code F?
requirements. C'~l'~
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.
DEP
DIVISI
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 SEE COF
construction/installation/operation.
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence 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.
THOMAS GUSTUM
Sincerel
Peter E Pagel
Private Sewage Plan eviewer ,Integrated Services
(608)266-2889 , M - F, 0630 - 1500 Hrs
pete.pagel@wisconsin. gov
Page 2 6/16/2008
Fee Required $ 175.00
Fee Received $ 175.00
Balance Due $ 0.00
WiSMART code: 7633
cc: Leroy G Jansky, POWTS Wastewater Specialist, (7.15) 726-2544 ,Friday, 7:00 A.M. To 3:30 P.M.
~Y~i ~,Y ~ ~3 l 0
Cover Pag~AFE~~Y ~ ~UI~LDIt~t~S~
Project Name: Jim Cormican 3 Bedroom At Grade
Owner's Name Jim Cormican
Owners Address 3188 205th Ave
Glenwood City, WI 54013
Legal Description sw ~ %4, Nw ~ %< Secr~ T 31 N, R 15 w ~
Township Forest
County Saint Croix ~
Subdivision
Lot#
Parcel I D#
,~ _ Table of Contents
Y~~s Pg•
• 1 Cover page
2 At-Grade Sizing Calculations
j}I~~" 3~ %. 3 Pressure Distribution Layout and Dynamics ~ ,
~F' ~*'~ ~
'
~USTUt~ 4 Dose Tank Calculations/Pump Curve .~
,
~d
101
' 5 Management and Contingency Plan ~,~~~~~~
~~
~
6
Plot Map ~
;
NIE~`:
~
' ~T
~` ~ ~ ~k.,.y-' C ~
:FE~ RCf
// h...
total # of pages: 6
Designer Name: Tom Gustum
License #: D1201
Date: 5/27/2008
Ph. #: 715-658-1344
Signature:
At-Grade Design Methods Used
per "At-Grade Component Manual For Private Onsite Wastewater Treatment Systems" (Version 1.0) SBD-10570-P (R.6/99)
per "Pressure Distribution Component manual for Private Onsite Wastewater Treatment Systems" (Ve~i@~Y1:0) SBD-10573-P(R.6/99)
~:
At-Grade
Sizing Calculations
Project Name: Jim Cormican 3 Bedroom At Grade
Site Conditions
Private Dwelling or Commercial: p (P or C)
Slope: 12.42
# of Bedrooms 3
Depth to limiting factor: 39 in.
Absorbtion rate of in-situ soil: 0.6 gal/ft2/day
Effluent quality Eff#1 •
Max BOD effluent value: 220 mg/I
Max TSS effluent value: 150 mg/I
Design of the Distribution Cell
System Design Flow: 450.0 gal/day
Distribution cell credit width (A): 10.00 ft
Distribution cell length (B): 75.0 ft
Area of Distribution Cell: 750.0 ft2
Contour Elevation: 94.56 ft
Page 2 of 6
Design of Entire Component
Upslope Width added to A (E): 2.0 ft
Total Width of Distribution Cell(C): 12.0 ft.
Perimeter Beyond Aggregate (D): 5.0 ft
Overall Width of Component(W): 22.0 ft.
Overall Length of Component(L): 85.0 ft.
Elevation of Lateral in Cell: 95.06 in.
Height of Component Over Lateral: 15.5 in.
Height Over Rest of Cell: 13.5 in.
Final Grade of Component: 96.35 ft
Observation Pipes
Location from end of cell: 12.5 ft
At-Grade Plan View
h-°~
i
Slope
I~
At-Grade Cross Section
Final Grade
Lateral Invert- _ __~__, S~rnthetic Fabric
Coverl~laterial~_~~ ~ _~ Distribution Cell
System Contour ~~~`` r~. ~~ x,46.\ ~~~~~ observation Pipe
~ a Q , ~ e ~ ~
-~___
Tilled area , ~ L ~ b L oar ds~` ~6ee ;ah. @ ~ '-+~k~~.
C A
~` awl f~
Shape
Notes:
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.
~~ .
At-Grade
Pressure Distribution Calculations
Page 3 of 6
Project Name: Jim Cormican 3 Bedroom At Grade
Lateral Layout Lateral/Manifold Design
Lateral elevation: 95.1 ft Lateral diameter: 1'iZ • In.
Rows of Laterals: 1 Lateral to upper cell edge: 2 ft
Manifold type: center • Lateral discharge rate: 15.15 gpm
Orifice diameter: o.1s8 • In. System discharge rate: 30.31 gpm
# of Laterals: 2
Distal Pressure: 2.5 ft
Lateral Length: 37 ft
Orifice Spacing/Distribution Forcemain Friction Loss
Orifice spacing (X): 19.73 Inches Forcemain length: 100 ft
Orifices per lateral: 23 Forcemain diameter: z • In.
Avg. ft2/Orifice: 16.30 ft2 Friction loss in forcemain: 1.976 ft
Avg. Lin ft/Orifice: 1.63
Lateral Side View
Forcemain
Lateral Lateral
t_ateral t_engm I_aterat ~engtn
Lateral Plan View
Lateral length
Orifices on bottom Of PVC Manifold
lateral equally spaced
PVC laterals and forcemain to comply with
spedfications per Comm 84.3012)
Clean Out Detail
nal Grade
clean-out plug
ar f,all +~al~e
Lawn
Sprinkler
box
Lang Sweep 90
artwo 45's-~_
Observation Pipes
Jdater tight cap
or plug
6" Minimurm
L
wlball valve or cleanout
Mote: Closet (Collar
may be used in
glare of 3J8" bar
'`3f6" t3ar
At-Grade
Septic, Pump and Dose Tank
Project: Jim Cormican 3 Bedroom At Grade
Tank Information
Pump tank manufacturer:
Pump tank size/model:
Pump tank gal/inch:
Tank bottom elevation (inside):
Septic tank manufacturer:
Septic tank size/model:
Skaw Precast
800
19.18
84
Skaw Precast
1000
Dosage Volume
Does forcemain drain
back to tank?
Lateral void volume: 7.8 gal
ft Dosage to absorbtion Cell: 39.1 gal
Forcemain volume: 17.4 gal
Total dosage: 56.5 gal
Pump and Filter
Pump Manufacturer: Little Giant
Pump Model: 9EH
Effluent Filter: orenco biotube 8"
Note: Access opening of sufficient size to be provided to allow
removal of filter. Opening to terminate at or above grade.
4 inch
Minirnupl;
Alternate
outlet'
Location
Pump Tank Diagram
Watertight Locking Cover
Wth blaming Label Finish
Grade
Elect. per Comm
16.28 and
NEC 300
V1kep Hole A
or Anti- B
Siphon
Device C
D
Pump must be capable of:
and head pressure of:
30.3 GPM
15.8 ft
Page 4 of 6
Total Dynamic Head
Are laterals highest point?
if not, enter highest elevation: 0 ft
System head (distal x 1.3) 3.25 ft
Vertical Lift ("D" to lateral) 10.56 ft
Friction loss in forcemain: 1.98 ft
Total dynamic head (TDH): 15.79 ft
w Dose Tank Levels
In. Gal
A Reserve 30.8 590.0
B Pump off to Alarm 2.0 38.4
C Total Dosage 2.9 56.5
D Effluent depth for pump 6.0 115.1
Total Capacity: 41.7 800.0
Pump Curve: Little Giant 9EH
FLOW- LITERS/HOUR
0 1000 2000 3000
F-
w
w.
w~
a
x
l0
H
7.5 W
w
E
5 ca
W
2.s
0
0 20 40 60 80
Little Giant FLOW- GALLONS/MINUTE
9EH PUMP PERF^RMANCE CURVE
115V 60HZ
j. i'~~~JG 1.~~+-~
FtE,,'16;'.~E=1~t,_ kt~~:5^ 11565~1~44
TUl•~1 [al_ISTLII+•1
F'r~:aE ~t1
Mound Syst~lm Managemen# Plan p~rs„ar>x to ~~ ss.sa w. a. c_
page 5 of ~
Owner's F2esponsitai~i#y:
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 far
surface discharge, treated effluent levels, etc. The owner ar owner's agent is required to submit necessary
maintenance reports to the appropriate jurisdiction and/or the department.
Septic Tank:
Septic tank(s) are to be inspected routinely and maintained by department approv®d 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 8uildings Div._ Effluent filters are to be removed & cleaned as necessary, with provisions to
ksep solids from passing the septic during removal. iUo more than 1/3 of the usable tank volume may be
occupied by sludg+slscum. 3 year inspectian~ If #ank has greater than 9/3 volume sludge, tank contents
must be emptied end disposed of in accordance with NR 9 f 3 Wisconsin Administrative Code by an
approved individual, If the inspector dogs not recommend pumping of the sep#io tank, then the owner must
be notified of when pumping should be done as to not exceed 913 sludge volume. Septic tank should be
routinely inspected to be watertight and of good repair.
Pump/Dose Tank
An access road to the pump tank mus# be provided to allow for servicing of the tank . The
pump, float switches and alarms must be inspected at least every three years for proper
operation. rump/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 surtaCe water prior to pump operation. If 4
inches or mare water level is detected in the observation pipes, the owner must be notified of possible
problemsffailure, The designed daily flow capabilities of the component should never be exceeded. Trees
and any other deep rooted vegetation should never be planted, cr allowed td 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 #o freeze in
winter conditions, Lateral distribution pipes should be flushed out/tested every 98 months using the
cieanout points at each end of the component to remove scum that may clog orifices.
Performance Monitoring:
Performance monitoring must be done at least once every three years following the ins#allation 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 componan# 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 i#'s current location by either; extending basal tae to
provide added absorb#ion area; or by removing the clogged bacterial mat,aggregate cell, and distribution
piping within the mound and replacing said components in orderta return system to properwarking order as
required,
~'~'~~
Department of Commerce
Division of Safety and Buildings
SOIL EVALUATION REPORT
m accoroance cairn Comm s5, vvis. Ham. code
#2366
^ayz ~ ~; 3
Gustum Septic Service
Attach complete site plan on paper not less than 8'/z x 11 inches in size. Plan must r County
I St
Croix
include
but not limited to: vertical and horizontal reference point (BM)
direction .
,
,
percent slope, scale or oimenswns, north arrow, and locate d di nce ne
Pl
i
ll i
f ~
road.
~ ai cei I•~•
o~y ~
q
/ o " ood
ease pr
nt a
n
ormation.
Review By Date
Personal information you provide may be u m)).
G zy o
Property Owner Property Location
Cormican. Jim And Deanna Govt. Lot n/a 1l4, 1/4, S1, T31N, R15W
Property Owner's Mailing Address JUN 2 4 2008 Lot # Block # Subd. Name or CSM#
3188 205th Ave. n/a n/a N/A
City State ip Cie CRP1)SZ~LCt1lJF~r ~ City ~ Village !~' Town Nearest Road
Glenwood City WI NI - - Forest 310Th St
t
ree
/~ New Construction Use: y~ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
__~f Replacement -~ Public or commercial -Describe:
Parent material outwaSh Flood plain elevation, if applicable Na ft.
General comments Part of 40 acres. Recommend abrade system alo ng 94.56 contour.
and recommendations:
1
Jf Boring
Boring #
Pit Ground surface elev. 42.2 ft. Depth to limiting factor 41 in. Soil Application Rate
Horizon Depth Dominant. Color Redox Description Texture Structure Consisten .Boundary Roots GPD/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EfF#1 "Eff#2
1 0-7 10yr2/2 none sil 2mgr mvfr as 2f,im 0.6 0.8
2 7-13 10yr4/3 none gr. sil 2msbk mvfr cw lm 0.6 0.8
3 13-20 10yr4/4 none gr. sl 2msbk mvfr cw - 0.6 1.0
4 20-36 7.5yr4/6 none gr. sl 2msbk mvfr cw - 0.6 1.0
5 36-41 10yr4/6 ~ none gr. Is 0 sg ml cw - 0.7 1.6
6 41-65 10yr5/6,4/6 c2-3d 10yr7/2
7.5 r5 8 fs 0 sg ml - - 0.5 1.0
2 _I Boring
Boring # ,~
Pit Ground surface elev. 92.2 ft. Depth to limiting factor 40 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consisten :Boundary Roots GPD/ftZ
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Efr#1 *Eff#2
1 0-7 10yr2/2 none sil 2mgr mvfr as 3f,im 0.6 0.8
2 7-il 10yr4/3 none sil 2msbk mvfr cw lm 0.6 0.8
3 i1-18 10yr4/4 none sil 2msbk mvfr cw if 0.6 0.8
4 18-24 7.5yr4/6 none gr. sil 2msbk mvfr cw - 0.6 0.8
5 24-40 10yr4/6 none gr. sl 2msbk mvfr cw - 0.6 1.0
6 40-48 7.5yr4/6 c2-3d 10yr7/2
7.5 r5 8 gr. sl 2msbk mvfr - - 0.6 1.0
Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 m "Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Sign CST Number
Tom Gustum 227618
Address Gustum Septic Service Date Evaluation Conducted Telephone Number
N13450 937th St. New Auburn, WI 54757 5/27/2008 715-658-1344
cxn_RZZa ix mmni
i~
Property Owner Cormican, Jim And Deanna Parcel ID #
Page 2 of 3
3 ~ Boring ~
Boring # ~j pit Ground surface elev. 95.8 ft. Depth to limiting factor 39 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 *Eff#2
1 0-9 SOyr2/2 none sil 2mgr mvfr as 3f,lm 0.6 0.8
2
9-14
10yr4/3
none
sil . _,
2msbk
.mvfr
cw
lm
0.6
0.8
3 14-20 10yr4/5 none sil 2msbk mvfr cw if 0.6 0.8
4 20-25 10yr4/6 none gr. sil 2msbk mvfr cw - 0.6 0.8
5 25-39 7.5yr4/6 none gr. sl 2msbk mvfr cw - 0.6 1.0
6
39-47
7.5yr4/6 c2-3d 10yr7/2
~ s„~/R r sl
9 2msbk mvfr - - 0.6 1.0
Boring
Boring # fl. Depth to limiting factor in.
J Pit Ground surface elev. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
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/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 ~ *Eff#2
* Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 <150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS <30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services c
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-877 i
Gustum Seatic Service
cnnxztn rx mmni
Property owner Cormican, Jim And Deanna __ parcel ID #
Page 2 of 3
3 ~! Boring
Boring # ~ Pit Ground surface elev. 95.8 ft. Depth to limiting factor 39 in.
Soif Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff=
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Etf#1 ~ •Eff#2
1 0-9 10yr2/2 none sil 2mgr mvfr as 3f,lm 0.6 0.8
2 9-14 10yr4/3 none sil 2msbk ,mvfr cw im 0.6 0.8
3 14-20 10yr4/5 none sil 2msbk mvfr cw if 0.6 0.8
4 20-25 10yr4/6 none gr. sil 2msbk mvfr cw - 0.6 0.8
5 25-39 7.5yr4/6 none gr. sl 2msbk mvfr cw - 0.6 1.0
6
39-47
7.5yr4/6 c2-3d 10yr7/2
~ s.,~s,u
gr. sl
2msbk
mvfr
-
-
0.6
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/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
Boring
Boring #
Pit Ground surtace elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont: Color Gr. Sz. Sh. *Efr#1 *Eft#2
* Effuent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS a 30 mglL
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services ~
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-877 i
cRn_RZ3n rR mioni Gustum Seotk Service
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address
Property Address
(Verification required from Planning & Zoning Department
CitylState
LEGAL DESCRIPTION
Parcel Identification Number a 1 ~ " ~~ ~ c70 ' C~OP.~
Property Location~~ '/a , N y(~ '/4 ,Sec. ~, T ~N R~W, Town of ~ Y~~
Subdivision Plat:
Certified Survey Map #
Warranty Deed #
Spec house ~ yes _ 1 no
Lot #
Volume ,Page #
(before 2007)Volume ,Page #
Lot lines identifiable ~ 'yes 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 I!3 full of sludge.
liwe, 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.
Number of bedrooms ~_
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)
: c...... n,.~ ..r ur:, ... c;:.•;;; ~ )o>a~ . ,....:. .,-,:..,.:,;.tea-...:.,.~-~-:3.
A .o ~-+ ~n - ;
~`~#_9.A~i~.~ Q'C,iT t L_itM1i itLD :• e
rocurnenl- rvo (t1~. t.o ~°~`l
rw F^: c
V~~ 1-.LU9VA~=
Jt ae 4 iS1SIFs
Priscilla F_ Olson II.OO Ap~~
quit-darms to Gerald Carmican and E Sandra Cormican, r, i ~tCl,~~.`~w' ~~°t~~r~i
husband and wife, as surva.vorship marital pro ~rt
__. __..-._ _ _.-_ __ __. __.._- __ _ __ P°_ . Xr
.r. .. r.n ...._.. u._.. _.a_, 1 ... .....:.. St. CL'01X ~-...... ~. .7JIS SPAC[ R[£[n~dF rl ron icECOn DING oacn
._..
5t~(C Of WI~C()n~l t1' NAe.+[ AtJ7 nc TlinN AOPr+E tiS -!~~ ~ ~ t. ; }
~~ r
- (parcel klentificatiun Nu)nbarf -
The.West Half of Northeast<Qtaarter (W'~ NFQ} the Northeast Quarter of
Southwest_Qi1arter. (NEµ SWa};.the West'4 rods of the Northwest Quarter_ _
of Southeavt 5,2uarter (1+1tn7%. SE;) and al of trio Nortnwest'S~uarter (Nwa)
all in Sect~an 1, Township 3l North, Range 15 WesC,-EXCEPT part of Northwr.~t
Quarter of Northeast Quarter (NW; NE ,) and part of Northeast-4uarter
of Northwest Quarter:(NE N~14) of Section',, Township-31 North, Range..
15 West, described as fellows; Commencing at the Northeast corner of
Northwest Quarter_ of n7ortheast C~uarter (NW4_PdE;) of said'Secton 1;
thence west along the `North. line of laid Section 1800 feat; thence South
along a line'parallel'`to the East line of, the N4rthwes*_ Quarter of Northeast
Quarter (h~VP~ NE;).0534-feet'; thence East.-1800:-:feet to a point on the
East.'line of said Northwest.;QUarter of Northeast Quarter (NW; NE;) which
is a distance of 653..4 feet South of the Northeast ~ornt?r of the Northwest
Quarter of NOrtheast,Quarter (NWQ NE4) as measured along the East line
of said Northwest Qtsar*_er o{ Northeast Quarter (f7W NE 4), then North
along said; East' line :'653.4 'feet o the paint= of t~ginni:ng. `
.This-deed°is being given in lieu o~ foreclosure of a Land Contract dated :September:i8,
1989, recorded Cletob~r 4, 1989 in Volume 853 Records, page 44 Document No.°952112
in-the Office af: the Kegister of Deeds for St. Croix County,,. Wisconsin. By Signing
this Quit G1aim..Deed, Grarstor_ is-giving up .any and al.l::right that she might have to ''
is not ~ the property. Grantor further affirnis'that she
Thw - ~._-__.~_ homestcgd property. `is doing .this of her aw*~ fre2 will and without
---
$~~ (IS not) duress or co ci Grantor .further affirms
Dattd this -. --_ ._ _~~.~_.___ __ . -:.-._____._~.~_.__ day of ____ -__: ~ .:._ ~_.- _ _ .... 19 :96r
~/~' .- -
that si-,` has itac~ Lne I~ereiit of thz bargain and
the opportpni~y to consult with legal counsel
.before signing this.dabument.°-
,~ _ Priscilla F. Olson ,
AUTHL• NTIGATION A(KMO'1VLEDLMENT
Signature(s) ........ - STAI'c UFlF'}St=La?k1ip1 f'fNTAC ~~ 7 t j7 J'~-~
authenticated this .:. day of ~... _ .: - i9 P~r~m~lly c~li)~ t~fore me this __ __ . 96_Z ~' ~ day of
_.~i-- _ _ ._._ 19 the ahoae named
- - - --- - ---:_. _ _ . _- ---- =-- -- ._ _ _ Priscilla F. Olson
TITLE: IaIEi~INER ~f.\TF BAN Ci= WibC(~NSilt' - ... :. _... _ __.
(If nut: __. _. _ .._ __ _ - - _ _ __ _ ___ _. ._ _ - _~'. _
authorized by § if'6.06. Wr. Slat~.l - to me 6nnii n an he thi p )af,n r c- FxecuicJ thr_
f agamg]rtvtunanl a~ r.c rinwl~yyt~r~ ,= ~ .
1'H!S INSFAI}MChT bVAS f)R,LF TED BY - ` J '~~1/ ~ G, ~~ !1-~
G^_`~LN J! ~' ~ yz
John E. Schneider, F\NDERSON & SCHNEIL'BR ~~
Balsam Cake, Wl 54810 ~~' NGTARY RU9lfC • WtR7F
. _ N ,tan i'uhtl~ (j, 4NOKAG6lJ~lTY~tr~uu . \, i:.
i Signaturr5 m /y he ~utt.enticattd or ackno as ledeed. iluth are n.,( Aiy cc,mmiti, u)n ic ,i~~rFYC13~mH!.ti=FS~pBA£da3.V-?lF:~ Uatr-
•\,~.:, t ,,.': .... ,.;:::^. •rn .-:r,r„ ,..~,, l..i h,~ .f,'.!,. ~I+r ,,,t .~..-.~~~. h _.~:ti.r~r„i.
(!I 11 fl al li l11~1~1) ~f aft:n\It f)1~ La lr('r)•~l'•. ,. . F~-:a.-.,, t-~:
Parcel #: 014-1000-90-000 06/24/2008 09:44 AM
PAGE 1 OF 1
Alt. Parcel #: 01.31.15.7 014 -TOWN OF FOREST
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 - CORMICAN, SANDRA
SANDRA CORMICAN
3146 205TH AVE
GLENWOOD CITY WI 54013
Districts: SC =School SP =Special Property Address(es): ` =Primary
Type Dist # Description " 3146 205TH AVE
SC 1127 CLEAR LAKE
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 1 T31 N R15W SW NW Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
01-31 N-15W
Notes: Parcel History:
Date Doc # Vol/Page Type
12/28/2005 815200 2950/230 TI
07/23/1997 1169/524 QC
07/23/1997 853/44
07/23/1997 826/569
2(1(18 Sl IMM~RY Bill #: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/17/2005
Description Class Acres Land Improve Total State Reason
COMMERCIAL G2 2.000 5,000 37,600 42,600 NO
PRODUCTIVE FORST LANDS G6 38.000 76,000 0 76,000 NO
Totals for 2008:
General Property 40.000 81,000 37,600 118,600
Woodland 0.000 0 0
Totals for 2007:
General Property 40.000 81,000 37,600 118,600
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
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