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HomeMy WebLinkAbout014-1021-10-300Wisconsin Department of Ccinmerce PRIVATE SEWAGE SYSTEM Safety and Buildirr~ Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Gale, Jerem Forest Townshi ;ST BM Elev: Insp. BM Elev: BM Description: >~ ~ G5 ~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic t~, Cf~(R~ /~r /1+, + - ~~~1Q Dosing ~ ~ ~a n ~' Holding County: St. CroiX Sanitary Permit No: 463097 0 State Plan ID No: Parcel Tax No: Section(town/Range/Map No: 09.31.15. ELEVATION DATA STATION BS ,~~ HI ~+3 7 FS ELEV. Benchmark ~ , ' ~~ ,7 /~ Alt. BM ~p Bldg. Sewer ,`' ~ ..~ ~ ~ ~~ l ~ ' l SUHt Inlet ~~ .~ c~! r' SUHt Outlet ~ ~~ Dt Inlet ~~ ~ Dt Bottom Header/Man. I ~ Q JO/~ ~l Dist. Pipe `~ ~ ~ ~ C) ~ ~ 9L Bot. System z S ~ ~©~ ~ Z Final Grade t ~S~ /(S 2 -`j St Cover ~ ~ ~ ` o~ ry ~o ~ . 05 °~`l. ~ TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD septic ~ 1~C' ~ ~ ~ ,~~~ _ Dosing ~ ~~r; ~ /~ f~ ~' 1 ~ r ) ~ ~ -~-- Aeration Holding PUMP/SIPHON INFORMATION ~~`' Manufacturer ~ ~ Demand f ~ o~ GPM Model Number 3G~.. Z TDH Lift ~ ~ 3 Friction~LosZ System Hea~ • ~ ~ TDH ~ 3 Ft Forcemain Leng~~ `Dia.Z ~~ Dist. to Well i v~ Snll_ ABSORPTION SYSTEM BEDITRENCH DIMENSIONS Width ~ ~ Length ~ ' ~ No. Of T nches n ~ ~, x.11 PIT DIMENSIONS ~~ No. Of Pits ~ Inside Dia. ~~" •_ Liquid Depth i~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of stem: ,~ /,~~ ~ ~/ „ I ^ ~ UNIT Model Number: 111STRIRIITION SYSTEM HeaderlManifold ~' Distribution C~ ~ /t ~ x Hole Size ~ / x Hole Spacing L ~~ Ve to Air Intake -7 `/ i i S Dia Len th pac n Len th D a ~• 5~ S.r,,G -~1~ C/lll C~1VGR . re____....-. c~....a....... n..~.. .... ~e......a t1. et_l~rnrlc Cvctcmc Anly Depth Over ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulch\ed Bed/Trench Center I (. ~ I ~ V7 Bed/Trench Edges ~ Topsoil ~ ~ ~ es ~~~ No . I Yes [] No _ ~\ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /t1 / ~ ~ ! ~L ~l Inspection #2: / / Location: 2820 Cty. Rd. Q Clear Lake, WI 54005 (SW 1/4 SW 1/4 9 T31N R15W) NA Lot 3 P'''Ot,,J~Q~,~'~( 1`..~ Parcel No: 09.31.15. 1.) Alt BM Description = ~ ~ i L G~1 "`" ~ 1 , 0 ~"J 2.) Bldg sewer length = ~74 ~' ~ ~. ~"~ ~-1~;.~.,Otr\ .~-- fie, ~5~~ -amount of cover = y, ~ ~ ~~,,~. ,.~, ~ Low ~, ~ _ _ ----- Plan revision Required? [ ; Yes o ' ~ ~ 3 ~~ 1 (~. 3 f 7 Use other side for additional information. ~_-_ J _-~ Date Insepc is Sig ature Cert. No. SBD-6710 (R.3/97) Safcty and Buildings Division County i ` ~ ~ 201 W. Washington Avc., P.O. Box 7162 S 7` V ls~O~sln Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co ) a De artment of Commerce (608) 266-3151 Sanitary PeI`IYlit Application __. State Plan I.D. Numbcr ,~S ~~ C I ~~ / S ~ In accord with Comm 83.21, Wis. Adm. Code, personal information you ~rovtde may be used for secondary purposes Privacy Law, s15.04(1)(m) ;' ~ s Project Address (i(differen[ th mailing address ~ I i I. Application Information -Please Print All Information ; ~ "` ~ I i ~ Z ~ Z Q ~ ~~ . I Property Owner's Na me Parcel N t k ~- o-,~-~ ~: ~ 3 ~ ~ life Property Owner's M ailing Ad ess ± Property Location ~ i ~ ~ ~ ! tt ~'~ Section ~ ~ City. State Zip Code Phorx Number ' ~ '~"~-' L ~~ ~ f ~ ©d~ .circle ) ~ R~E r W I T ~~ N ~' II. Type of Building (check all that apply) ? p~ ; 0 /` ~ ~ I ~l or 2 Family Dwelling -Number of Bedrooms ~ Subdivision Name CSM Number I ~ ~ ~ ^ Public/Commercial -Describe Use ~~-L,~i ~/ lJ State Owned -Describe Use ~ X ~S ~ y9.~p / ~ ^Village Township of , ^City _ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A New System I I ^ P,eplacement System g p y ^ TreatmendHoldin Tank Re lacement Onl ^ Other Modification to Exisnn S stem B Y B. ~' Permit Renewal ~~ ^ Permit Revision ^ Change of ^ Permit Trarufer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T of POWTS S stem: (Check all,that a 1 ) Non -Pressurized In-Ground 1J Mound > 24 in. of suitable soilMound < 24 in. o[~uitable 59i1 ~i At-Grade L~~ Single Pass Sand Filter Conswcted N/etland J Pressurized In-Ground .J Holding Tank ^ Peat Filter ,~ Aerobic Treatment Unit ~ Rec;rculanng Sand Filter I j u Rearculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line QjGravel-less Pipe ^ Other (explain) ~ ~, k~ V. Disnersal/Treatment Area Information: ia1J Osi ~ ~~ Design Flow (gpd) Design Soil Application Rate(gpds0 Disposal Area Req 'red (sf) Dispersal Area Pro sed (sO System Elevation 'I V1. Tank Info Capacity in ! Total Number Manufacturer P efab Site ~ Steel Fiber Plastic i Gallons ~ Gallons ' of Units Concrete Corurructed ! Glass Ncw Ezisung ' ~ Tanks Tanks I __ __ Septic or Holding Tank ,~,~- i L~ ~ i ' An~d~nit ~ ~ ~ ~ / i ' Dosing Chamber ~v .,~•- ~ /1 i VII. ResoonsibiLity Statement- I, the undersit>ned, assume responsibility for installation of the POWTS shown on the attached plaru. Plumber's Na me (Print) Plumber's Si gnanire Number MP/MP RS ess Phone Number usin B ~r I y ~7 G- G- ~ ~ ,~ 4/ g / ~J~ ~ ~ ~~ Plu is Addre ss (Street, iry. State, p C .~/~ S~ 5 ~ ~ " c ~ Z5 V[II. unto/De artment Use Onl Sanitary Permit Fee (includes Groundwater Dat I ssued I mg Age t Signature (: ps) ~` S PProved '.~ Disapproved ' Surcharge Fee) ~/J ~~ ~ ~Q ~ f O ~v!y~ G~7C J ^ Owmer Given Rcason for Denial `~`( / ~~""""-~~" [X. Conditions of Approval/Reasons for Disapproval ~ ~ V~/~~~~ ~ ~y.~ SYSTE M O ~'~_ g 3 ~ , lilt. S- C.~Y~- f 3. ~. '~ eptic tank, effluent filter and UU~{/n ~~' ~~ D ispersal cell must ail be serviced /maintained ~ ~~ ~L~ ~~ yn , , y I as er mana em nt lap b lumber. ~~ -~ ~- ~J Ali setback requirements must be maintained as,,per applicable code/ordinances. ~j; 3 ,G~~~ CitWt... ~ -! Attach complete plans (to the Counq only) for the t7item on paper not less than 81/2 z 1 inches in size SBD-6398 (R. 01/03) >So• ~5° C-I ~~~~~~ ~-~2`~"` ~6~ ~~~ o~ ~4 n ~ ~ ~~ ,~~,, JEREnLY G~~~ c~~t ~ ao%Z,,y~K S w `/4 Sw `!.} S 8 ?3ll~l R isw FoR~S'T Toc,u~(st}rA 5'(. C~o~x Cou~STY I 2 ~~~ I~ ~ 1 100' a ~~ ~ ~ ~ ~~ I I ~ I I .~ I I 1 I g nt~ 1 . loo. o' A ~sRau~/~ EtEU~Y/ati.l I $ G~ u z6-a t'~Pe N ~ar ~l'f6D a Rkn[ 6 E I 8~3 ~3 4 loo _ 8l = lgc5.29/ I ~ I 1 62. g8,a3 ~ 83 = `t`t~`t5 ~ ~ ~ I aq- : 99.x' ~ ~ \ ~ t ~o.u' ~ 99.G~ ~ gg,2o' 98.95' \ 99.0' i ~r~ J l~Y~dzS ~ ~z ~ v~ d 224l0/~ ~' ~ ~' >~so' ~~ C-T N C~ e commerce.wi.gov i ^ ~scons~n Department of Commerce Safety and Buildings PO BOX 7162 MADISON WI 53707-7162 TDD #: (608) 264-8777 www.com merce.state.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary July 14, 2004 CUST ID No.224617 LYLE J MYERS NORTHLAND PLUMBING INC E1556 STATE ROAD 64 BOYCEVILLE WI 54725 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/14/2006 Identification Numbers ' Transaction ID No. 1017764 SITE: Site ID No. 643080 Lynn Gale Please refer to both identification numbers, Town of Forest, 54012 above, in all cones ondence with the a enc . St Croix County SW1/4, SW1/4, S9, T31N, R15W FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 967972 Maintenance required; 450 GPD Flow rate; System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. 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: • This system is to be constructed and located in accordance with the approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD-10691-P(N.O1/Ol). • The pressure network is to be constructed in accordance with publications SBD-10706-P(NO1/O1) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems -Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81)". /J C°jr o j,~~ A copy of the approved plans, specifications and this letter shall be on-site during f on ~u to inspection by authorized representatives of the Department, which may include loc~ 11 ermits required by the state or the local municipality shall be obtained prior to comme!r~f~gIt N MF '~ construction/installation/operation. flFSAF T ~, In granting this approval the Division of Safety & Buildings reserves the righ~e ire cha ~~s or additions should conditions arise making them necessary for code compliance. As per state stats li~ thing in this review shall relieve the designer of the responsibility for designing a safe building, structure, o mponent. 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 or maintenance of the POWTS. LYLE J MYERS Sincerely, ~~ Allen C Wendorf Wastewater Specialists ,Integrated Services (608)235-0595, awendorf@commerce. state. wi.us Page 2 7/14/04 Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Northland Plumbing Inc Mound System Cover Page pg 1 of 6 ~~~~~~ conc~~E Project Name: Gale-Mound Owner's Name Jeremy Gale Owners Address 2818 Cty Rd Q Clear Lake, WI 54005 ~- - Legal Description ~ sw i, ~ y,, I sw'~, ~ ~/, Sec~~ T 31 N, R 15 ~ w ' ~ Township Forest County Subdivision N/A Lot# Parcel ID# ~~t,ot C~ , ~~nt'.~G ~/'" S~k Table of Contents P9~ 1 2 3 4 5 6 Cover page Mound Sizing Calculations Pressure Distribution Layout and Dynamics Dose Tank Management and Contingency Plan Plot Map total # of pages: 6 Designer Name: Lyle J. Myers MP/License #: I.D.# 224617 Date: 6/28/04 ~~.e Ph. #: 7156432520 R • Signature: M x,004 U~~D Farr $ ~~s. oiu. Mound System Design Methods Used p~ per "Mound Component Manual For Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD-10691-P (N.01/01) NQ~ per "Pressure Distribution Component manual for Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD-10706-P (N 01/01)NCF 3bAdvisement N12486 220th St, Boyceville, WI 54725 Ph: 715-643-6068 email: ~ Sarnt Croix Mound System Mound Sizing Calculations Project Name: Gale-Mound Site Conditions Project Type: 1 or 2 Family Dwelling ~ Slope: # of Bedrooms: Depth to limiting factor Absorbtion rate of fill material: Absorbtion rate of in-situ soil: Effluent quality Max BOD effluent value: Max TSS effluent value: 1 gal/ft2/day 0.5 gal/ft2/day Eff# 1 ~ - 220 mg/I 150 mg/I Design of Entire Fill Cell depth at upslope edge (D): Cell depth at downslope edge (E): Distribution cell depth (F): Cover thickness over edge (G): Cover thickness over center (H): End slope width (K): Fill length (L): Upslope width (J): Downslope width (Toe) (I): Fill Width (W): Page 2 of 6 19.0 in. 20.5 in. 9.5 in. 6 in. 12 in. 10.4 ft. 95.8 ft. 8.2 ft. 9.6 ft. 23.8 ft. Design of the Distribution Cell Basal Area System Design Flow: 450.0 gal/day Basal area required: 900 ft2 Distribution cell width (A): 6.00 ft Basal area available: 1170 ft2 Distribution cell length (B): 75.0 ft Area of Distribution Cell: 450.0 ft2 Observation Pipes Contour Elevation of Mound: 99.67 ft~ Location from end of cell (Z): 12.5 ft System Elevation of Mound: 101.25 ft Final Grade of Mound: 103.05 ft Mound Plan View ~ ~,-Gbservation Pipes Z~ K-- ~"(~ C~istribution r~ell ~' k-K I Ti11ed Areal Fill Material L Mound Cross Section Notes: Fill material to consist of ASTM C33 Sand Distribution cell aggregate to comply with Comm 84.30(6)(1) Synthetic Fabric covering on cell per Comm 84.30(6)(8) Distribution Cell to have minimum 6" aggregate below lateral and 2" above. Mound System Page a °r s Pressure Distribution Calculations Project Name: Gale-Mound Lateral Layout Lateral elevation: 101.8 ft Rows of Laterals: l 2 Manifold type: End i ~ ~ Orifice diameter: -- o.i2s _ ~~ • In. # of Laterals: 2 Distal Pressure: 5 ft Lateral Length: 74 ft Orifice Spacing/Distribution Orifice spacing (X): 20.65 Inches Orifices per lateral: 44 Avg. ftz/Orifice: 5.11 ft2 Lateral Side View M anifald Lateral x x x x x Lateral Length Lateral Plan View Lateral Length Turn-up wlball value or cleanout plug -A Orifices an bottom of lateral equally spaced Forcemain connection via tee ar cross to manifold ak any paint Clean Out Detail Glean-out plug Grade J-or ball salve Hater tight cap or plug Lawn Sprinkler Box Long Sweep 90 oriwo 45's-.~ Lateral/Manifold Design Lateral diameter: ivz '': ~ In. Lateral spacing (S): ~ft Lateral to cell edge: 1.5 ft Lateral discharge rate: 18.12 gpm System discharge rate: 36.25 gpm Manifold diameter: I~ '; ~ In. Manifold length: 3 ft Forcemain Friction Loss Forcemain length: 100 ft Forcemain diameter: _2 ~ In. Friction loss in forcemain: 2.751 ft P'VC laterals and forcemain to comply with specifications per Camm 84.30[2J[e] Observation Pipes 6" Minimu~ Note: Closet Collar may be used in place of 3/8" bar X318" Bar Mound System Septic, Pump and Dose Tank Project: Gale-Mound Tank Information Pump tank manufacturer: Wieser Concrete_ -- Pumptank size/model: I wiooo/65o-MR '~ Pump tank gal/inch: 17 Actual Pump Tank Volume: 646 gal Tank bottom elevation (inside): ~ gg ft ---- -- Septic tank size/model:; wiooo/6so-MR Pump and Filter Pump Manufacturer: Little Giant Pump Model: 9EH Effluent Filter: Zabel A100 Note: Access opening of sufficient size to be provided to allow removal of filter. Opening to terminate at or above grade. Pump Tank Diagram Watertight Locking Caver 4 inch With Warning Label Finished Minimum ,/-~__~_ Alternate ~ Outlet Location Elect. per Comm 16.28 and r e i NEC 300 Weep Hole A o r Anti- Siphon 8 Device C D Pump must be capable of: and head pressure of: ti~'~ i~ ~ ~ `~ 36.2 GPM 22.4 Feet Page 4 of 6 Dosage Volume Forcemain drains back to tank? .O Yes O No Lateral void volume: 15.6 gal Dosage to absorbtion Cell: 78.2 gal Forcemain volume: 17.4 gal Total dosage: 95.6 gal Total Dynamic Head Are laterals highest point? y if not, enter highest elevation: 0 ft System head (distal x 1.3) 6.50 ft Vertical Lift ("D" to lateral) 13.09 ft Friction loss in forcemain: 2.75 ft Pressure loss from filter: ~p ft Total dynamic head (TDH): 22.34 ft Dose Tank Levels In. Gal A Reserve 22.4 380.4 B Pump off to Alarm 2.0 34.0 C Total Dosage 5.6 95.6 D Effluent depth for pump 8.0 136.0 Total Capacity: 38.0 646.0 FLOW- L[TERS/HOUR W W W Q it h ~,s W H W Y S A 2 z.s 0 0 20 40 60 80 Little Giant FLOW- GALLONS/MINUTE 9EH PUMP PERFORMANCE CURVE I15v 60HZ Mound System Management Plan pursuant to comm 83.54 W. A. C. page 5 of 6 Owner's Responsibility: The component owner is responsible for the operation and maintenance of the component. The county, department or POWTS service contractor may make periodic inspections of the components, checking for surface discharge, treated effluent levels, etc. The owner or owner's agent is required to submit necessary maintenance reports to the appropriate jurisdiction and/or the department. Septic Tank: Septic tank(s) are to be inspected routinely and maintained by department approved individuals when necessary in accordance with their approvals. The use of chemical/biological "treatments" is not required or recommended. If such additives are used, make sure they are approved by Department of Commerce, Safety and Buildings Div.. Effluent filters are to be removed & cleaned as necessary, with provisions to keep solids from passing the septic during removal. No more than 1 /3 of the usable tank volume may be occupied by sludge/scum. 3 year inspection: If tank has greater than 1/3 volume sludge, tank contents must be emptied and disposed of in accordance with NR 113 Wisconsin Administrative Code by an approved individual. If the inspector does not recommend pumping of the septic tank, then the owner must be notified of when pumping should be done as to not exceed 1/3 sludge volume. Septic tank should be routinely inspected to be watertight and of good repair. Pump/Dose Tank If an effluent filter has been installed in the pump/dose tank, it must be removed & cleaned as necessary, with provisions to keep solids from passing to the mound component during removal. The pump, float switches and alarms must be inspected at least every three years for proper operation. Pump/dose tank should be routinely inspected to be watertight and of good repair. Mound and Lateral System The mound system component must remain free of ponded surface water prior to pump operation. If 4 inches or more water level is detected in the observation pipes, the owner must be notified of possible problems/failure. The designed daily flow capabilities of the component should never be exceeded. Trees and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the component. Activities OTHER than mowing/maintenance (i.e. excessive walking, pets, vehicles, etc...) could compress the component and reduce it's absorbtion capabilities and/or possibly cause it to freeze in winter conditions. Lateral distribution pipes should be flushed out/tested every 18 months using the cleanout points at each end of the component to remove scum that may clog orifices. Performance Monitoring: Performance monitoring must be done at least once every three years following the installation or at the time of a problem, complaint, or failure. Contingency Plan: If the septic tank, pump tank or any of their components therein (including floats, alarms, pumps, etc) become defective, the defective tank or component must be replaced immediately to ensure that the system can operate as designed. If the mound component cannot accept wastewater or ponds wastewater to the surface, the component must be repaired or replaced in it's current location by either: extending basal toe to provide added absorbtion area; or by removing the clogged bacterial mat,aggregate cell, and distribution piping within the mound and replacing said components in order to return system to proper working order as required. ~l ll ~~ ~O $Yl~t.~-~ = (00.0' Csrtou~Jb Et~u~Tlatil I~~~TGD arZ~wt6E Ill = (00,24' B2. g8,a3' 83 = 4~~95' a4 - 99.0' ~(,~~ .f ~YE~S d 2.24'!vl ~ ~rcRE~-y G~~~ S w `/4 -Sr-'-' `~~f S 8 ?3/ n! ~ 15~ FvR1=S'T To~u~f st~r~ 5'(. Crr:o~x Cou~STY 1 10 0' ;' _. ,, Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ~ of .3 DivisioA of Safety and Buildings ui eczwaanrx w~u~ ~.omrn oo, vns. rwrn. t,vue County ~s'T C,ZoYac 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. L~~~ Z~ "~ percent slope, scale or dimensions, north arrow, and location arrd distance to nearest read. Please print all information. R sewed J Date Personal information you provide y be ~s,~d for secondary oruopses (Privacy law, s. 15.Q4 (1) (m)). G~ '~(/i/Ir/~-- / ~ ~~ 6 T Property Owner ~ ~ 1 Property Location G~ '~' `1~l~tJ f. ~A~.E' Govt. Lot Sw 1/4St.C.)1/4 S T 3/ N R 1 5 J Property Owner's Mailing Address ` 4 '° A~~ ~ ~ 2~n~. ,L-t5f~# Block # Subd. N or CSM# za~d ~Ty R~ ~ ' ~ 5 ~ ~5~ ~ City State ip Codr C:~ ,)' h4r~i~~ sty ^ ~Ilage Town Nearest Road Cc~~~ L~+r,,E w l ~ ~ :. 6 FotiESr Cry Rd New Construction Use: (~-Residential ! Number of bedrooms ~ Code derived design flow rate 'l~SU ^ Replacement ^ Public or commercial -Describe: Parent material ~ (.I~ ~/ /~'L T~ GL Flood Plain elevation ff""ap////plicable~p~ / ~°~~ General comments ~~~ ~ ~/.~"`'"" ' ~ ~~,~~~ ""` and recommendations: Q GPD ft. a Boring # ~1^~11 Boring L~+- pit Ground surface elev. oU. 2 ft. Depth to limiting factor ~8 in. Soil A igtion Rate Horizon Depth Dominant Coior Redox Description Texture Structure Consistence Boundary Roots GP D/f>~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efi#1 'Efi#2 / a-~ lo`IK3/3 si/ 3s,bk rnV~r cs 3sr .5 .8' 2 !0-/5 ~o ylz4/ •s'%/ 3s.SK rnV~'r c.S 2~ - 5 8' l8- ~.59R3/ 5y s CxPs Sc. ,X6 ~V~i CS -- O. U d, v I~`t pit Ground surface elev. 98' 2 3 ft. Depth to limiting factor ~ ~ in. Soil A ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/f~ in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. 'EtT#1 'Eff#2 2 5-/0 o`tle~` s%% 3sbk mV~r CS l~ .S 8 3 t~-!~ 3~¢- sc/ Zs/k rh es -' -'¢ -Co /~ 38 ~5yRa/ SYRS/g c2Ps f S~ /s.6k ~tV ~' CS - U• ~ ~. O Effluent #1 = BODS > 30 < 220 mglL and TSS >30 < 150 mglL "Effluent #2 =GODS < 30 mg/L and TSS < 30 mgtt. CST Name (Please Print) l Signature y CST Number ~i1.t..c_lv~.-~ J, l?~ ~-er.,S ~ V~-`~'Q I ~`.~`~' ~G~'9~5 Address Date Eva{uation Conducted Telephone Number 29¢3 /3of~i.. ~,K , GG~..~/cve,~ C/i~y~ w / s.¢.1,~3 '¢ '-~ - a'¢' ~/5 - 2~os - •¢/G 2 4 ,r Properly Owner ~Yi/~(/ (~-AL.t4 Parcel ID # Page ~ of 3 Boring # ^ Boring ~C pit Ground surface elev. ~!~ ft. Depth to Limiting factor ~ / in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eif#1 *Eff#2 2 5-/l~ /oyr~4 Si/ 3s~k ~/ r cS 2f 3 /G-/7 ~.5y~'yt Sc/ 2S6K /y-~~r cS /3' .'`~ , '¢ /9-35 ~~SyR~ SyRS~ C2 SC Usbk ~v~i CS - U. O c~, a Boring # ^ Boring p Q pit Ground surhaceelev. / / . ~ ft. Depth to limiting fade ~ ~ in. Soil A ication Rate Horizon Depth Dominant Color Redox Description Texture S6ucture Consistence Boundary Roots GPDJfP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EtT#1 *Eff#2 / o-X /oy~3~3 si / ~s6ff ~ ~ cs 3~' .5 .~ Z 8- /~ -~ si / 3s1ls ir, r c 5 2.~ . S 3 ~~-2~ ~.sy~s/ 5yR5~8 ~r~ ~ sc,l 2sb ~~: ~s ~ .~ . ~ -~- 2/--¢O ~.Sy2'~f SYK.S/ ~~~5 SL U k r»V~i eS - o.o O, o ^ Boring Boring # Ground surface elev. fk Depth to limiting factor in. ^ Pit Soil A igtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/f~ in. Munsell 4u. 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 mglL and TSS < 30 mglL Th~ Department of Commerce is an equal opportunity service provider and employer. !f 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. ssn-esao ~x ovoo~ •~i J ~ r ~'~ ~ ,L y~r,~ ~~~.~ 9 Sw'/~{ Sw'/~ S$`>•31 NR/5 i.J sY. C2o~u. Co~~y M~ ~ ' Fvrt.EST "7-aw~sN,P ~ ~ ~ ~~ e 3Yvl.~i = loo,o' Gr~~r~d ~var~r .~T 3~4 ~~G ~LV ~ ~r ~ ]~i1)~17Tsd DR.A~I GE Z _ q8, a3' 3 = 99.95' ~ 3, ~~~`~ ~ ~ ~ ~ 0` ~ i ~ ~- 8' ~ i ~ ~ i , ~ i~ , I~ ~ I ~ ~ II J ~~ .~ , ~ I i ~ i I I .J I I I I ~ ~ B3 t ~~~~ ~ ~~ ~ ~~ ~~ 20~ i ~ -2.-- q'95 9 ~~, ~~ ~ `~ 99,gr ~3 ~~ ~-st' .~-z G~ 985 ~1, ,~ 450, 10/01/2044 FRI 07:40 FAX 715 265 210E OXBO FRC~1 NzSRTNLFriID PLUMB 1 NG, INC. FAX N0. 715-543-250 ®ct. 61 21dia4 09: 50AM ~2 ST C~OT~ C,[~UN'Y'Y SE1*T1C 'TANK M~-~N'I`~N~Nc:~ AC3REi3~iENT AND QWN~7.dLSi~3TF C~'.TIFICATt~~N FORM t7artYCrlRuyCr _,._,,,,.-+r.~~~~?s~ L:2'" - ..--- . Malting Address property gd+dross .~~ c.• ~ ~- CV ~ ued from I'iamioit ~Pt for Parcel Tdantf ~icaticn ~wt~bet' Ciiy/Staka ,~.'~~1 L~~ES~PT~Qrii ,,' r~ Proptx#y Lor,~tian ~., y~ ~~ 'f..ax.~.~_~•~•w, Tawrt of ~.~s ~ . Subdivieton .Lot # -3 ... C.~rt~e+d S~rey MAp # 7 7 ~ ~~ ~~ Volw~uc ~ -, Pests # Q ~ ~ y/ l ~ `' ,y~~ 2 ~ ~ ~ page # ~~ 3 ~ ~ ~ J ~ I~I~~r~r r~~~ Y ~~WM ~~ Spec hour C7 y lino Lat lines idaat3ffab o p~" y~ slo Ympwpet u9e gad maiatananceof gore septic systoas ooc>Zd m~ulc ut lta prcmastura ~tua to batsdlo~w ~ ~ rho sy6tam tanfists oF~ttfRp~ we tip aepne tae4c mvezYthaeo yeah er ii aaadadby s ]fc+eosadpnmpe taw rl'Ga:t ct~ tuu~atian of ~e aeptle: teak ao a f~satmeat ~ir~a is t4ra ,KOSCO dmpeoal a~vbsu. The grape![y o+ft~et ag~a to ttsltmii m st, Crai:c zQafag pepurtmaat a cttioa Fortst, aigaed by the o~aar asid tsy a tit P jousney~~P~~ resaictsd plumber to a iidawad pun~por ehdz (1) dte on-pits ar~waserdispafxl sy~am rs is Pry' oprsat3aS mnditioa twd/or (x) aEtec iin~oc#iaa aad {it eeoees,:uyj, flee ~egtfc tsdt i81~ tbart il3 tint of sludge. U~r-, tbs vadeuigae4 Live aced t1~a tars roquiromaats aad t~grso to au~it-~a t!~ pefvate pie ~~ ~y40em with tba otsa-dardt sat ~tTeia. oe that tiY 1?~r D~apsrtmetu Of t,..omiuerea iGii the DO~saot of Nadtira3 Reseut+ase, State of Wraaeoain. C~rfiifi~don tip 7~ septic system. bas bona asatataiaed must ix oampietad as~d tc~tetraad fio tT=e St. t~vix tom' Zetsiug OED •vitbia 3C ~"q ief tLc tt~OG Y~ o ti date. /v ~~ d SIdNA~7JRB OF A$pY.SCANT DA1"J~ (~ r.'R~ C1ART'lFt~ TION i (we) aattifY tlsat all asatea~t, oa this fncpn are tn.Ud Go the befit of iay (ouc) kaowledga, I (wa) am (era) die ovruor(s) of the ptiopesty desr~td above, b virtue of a tinarsaCy deed recorded is Itrgis6sr of ILseds Otrao, ~~~~~ ~If3NATCtR~ dP APpI.ICANT DA's ..••.. rwn~ic b zvrek~.i t+y ~~ T.v~ 17•Fa~""nr t,~tir• Aay taltuusstlun ilast to uiie•+oErean~autw! tsuyr tw-utl W 11W ra+eLku J ! ~6 •• iac[uda vrith tbFs aPpticxtiau: a etstaped warranty deed tLa Resistor of Deeds orrice r. copy of tine certftted tnttvey rasp it re~isrextao is madm is t5e wsasiaty dam ~~ L ~ ~~ ~ 10/01/2004 FRI 07:41 FAX 715 283 2102 OXB4 INTL PIXALL 10.1-2iy04_grl;7~31_C:1JtrsnrylHoutre\Howe ROO+F1Leq Hows.PpT CGNFIbENTLIl. OX80 INTERNATIOI'~iA4 CORP 0 4 I 0' - D' - m I N OI .~ +N 1 iti d O h 5' - 7 D' - f 9' - 7 3/4 • ~~ 27' ' 2• 35' - C' -- 41'- ID" -~ 0 .~REMY GaLE 2@18 CTY RD ~ CLEAR LAKE. WI 540 W 800-6c'8.61136 H 715-491-8051 H jgaleero[ketnail W jgal~saxGocap,c s o ~ I 1 R~ 1004/005 b m ~~~- O" 5' - tD' 17'- 2 l2' zl' - o• 27'- 4 t/4" ~--- 30' - IO` 36' - 6' 41'- lC' 14lp1/244~ FRI 47:1 FAIL 715 289 214E OXBp INTL PII~ALL X443/445 1G-1-20~ 8:08:3a 6; We+~tsrrtyWa~ae~Fiouaa 2004~g Nouss.PRT CONF'IO~NTIA6 OX9G INTF1iNA"tzONAL COAP l 6' - -. .7758 1 5 ' STATE BAR OF WISCONSIN FORM 3 - 1998 KATHLEEN H. MALSH ~• Z 6 s s P y 9 3 QUIT CLAIM DEED ~ REGISTER OF DEEDS • ST. CROIX CO. , MI Document Number RECEIVED FOR RECORD 10/01/2004 09:40AM This Deed, made between ~ V Nn/ ~ ~~~. MORTGAGE EXElPT i 8 Grantor, REC FEE: 11.00 and N C, ' l'~,;.,P ~° COPYSFEEE * CC FEE PAGES: 1 Grantee. Grrantor quit claims to Grantee the following described real estate in • .~! ~` ~ ~"CO I ~_.County, State of Wisconsin: Recording Area Name and Return Address / L. c~ ~' ~ ~le~'N .~ al,~cm l~ a ~ ~ g Shoos' ~ 9' ~q ~ ,~,t~-~,, ply-/DZl-/D-ooa Parcel Identification Number (PIN) n ~ ~ Ct {^~ Q ~ ~~ ~ ~ This ~f //A ~ homestead property. ~ o C a.~edG i N (is) (is not) - ~ r~~ a~ ~~es~ D I .4 Together with all appurtenant rights, title and interests. -• Dated this f o!'~ day of ~f'~* ~ o ~ y /~ // (SEAL) * ~ 1/ At A) ~ ~~.G~ (SEAL) AUTHENTICATION Signature(s) , authenticated this day of _, TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stats.)', THIS INSTRUMENT WAS DRAFTED BY L, y ~ ,c1 ~ ~~e necessary.) * Names of persons signing in any capacity must be typed or printed below their signature. QUIT CLAIM DEED STATE BAR OF WISCONSIN FORM No. 3 - 1998 Z Vf ACKNOWLE •' (SEAL). ~~ • • ~ N3 31~'~ ~~r ~~ State of Wisconsin, ~.../ ss. ~ / - rGf~ x County. • Personally came before me this ~ Sf- day of O~'1'o b ar r O L ,the above named to me known to be the person who executed the foregoing instrument and acknowledge the s~am/e~. ~ ~_~ Notary Public, State of VVIsconsin My commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not ~ ~ l3 I D to .) Wisconsin Legal Blsnk CA., Inc. MAweukea, Wis. ~---~ ~'+ ? 7 5 7 9 7 VOL 19 ppC,E 4849 KATALEEA H. MJ REGISTER OF DEEDS ST. CR~IX CO. IiI RECEIVED FOR ~tECORD 09/30/2004 02e00PM CERTIFIED SURVEY MAP THIS INSTRUMENT DRAFTED BY: JOSEPH W. GRANBERG S-2295 BEARINGS REFERENCED TO THE SOUTH ~~ LINE OF THE SWi/4 OF SECTION 9, ASSUMED TO BEAR S87°47'!3"W. ~~ ( PREVIOUSLY RECORDED AS S87°47'12"W ) ( SALUMINUM CAPC FIOUND ) ----- -- 402.82' 1 s~• cn I "'~ A ~ ~OJ'. 0 .~ I •~ ~ ~ ~ 1 ,~Y, r r I ~ ~ ~ ~ ~ N02° 12'4B`VY ~o I 50.00' ~ 17.00' 133 3 ~ 33.00' N~ N al ~ , ... 2 ~mv ~ m~~~ m r~+A D Qp M r Z a~~m ~~~ ~?T - WEST LINE OF THE SWi/4 - - - N00°12'47"W 923.46 ~ - - v/NTVTDI/NYI"IY~IWAV'Q• w r N00° 12'47"W 924.45'- - J p ~ ~ S ....................................... ..................N .. n ~~~ ~~ cnmA~g ~z~~iz~ nom ~°.i°~~ 4f g i g N p~ G ~~ I ~ IAA ~ ~~ ~~ I 1 33.00' ' S02° 12'48"E 736.00' I m 703.00' 11f 434.00' ,~~ a67.oo' o ~I~ 1 ~_ ~ rn ~ n~; ~ I ~,~° ~ ~cP~ ~~ < A O V 'n~~~l~ `I~I® C $1 ~~~N ~~~~ ~I~ ~~ - _ .® ~i _ \ N02 12'48"W 417.00 ~~~ 50' m ~ X I i~ O OJO <H 1 ~~N ~`' m~ "< i,w 6o H I I~N ~~ ~~ 150' _ 686.00' N r NOd' 30'03 "W ~ A N 50.02' ~m ~~ mn J Of . ~'~ N ~ H ~ ~ mm [~ „~ d'~•,..,......,,•, ~ ~ .- Q_~ ~_ fA V~ ~ s O~ GY' ~~ ~ ~ ` d m a' ~ ~ OR'•••....•••* ~-~_~ ~~~m~~ ~~_ ~ ~ N V V) 269.00' N m mN N ~'' O ~o ~~ y ~~ cn ~~ o ~O EAST LINE OF THE SWi/4 OF THE SWi/4 ~~ s~~ ~ ~ D~o =~a ~`~m ~ ~ z~ c.~. o 0 oy~ A O ~~a ~ ~ ~~~ o~m i --m 1 ~ ~~~~~€~~I~S r3~~m~z~~ ~ D ~~ m O Z r~r-~Qmm{oCZ~QCO~ OH~~D~--~Z ~~ z ~ ~~ H ~ =m~mo n~~~~~ mm{rH mp °~~ cnl~ma~ H D ~ j H ZZ-~~~~ m ~3 ~ 583.75' S00°30'03"E 1269.75' ~~~~ ~® ~~ ~~0 • `4r ~~ ~~ T1~+H 71OHr.E OHH~H $$~H~3~mi~~HN~ mD ~mD~H~AD D ~~ N D ~~~ D N ~~ ~ a m {~~ HC~fnHmr Z Q~ ~~ `~o~ ~~ ~ N I~ p G1 ~j a N o H ~, ~ Q ~ V ~ ~ N A n a o r m ~ A O m O£~- A 1~ )i ro o ~ n rn ~ m roZc m~z •`~Ym [J1 `o_ ~,: ~~j QI Kj m A v ~c I~ I~ I® ~~ o ~~ m CEO Z A ~ m rn c~ooo o ~ ~ ~ Z ~l UJ Z ~rn~= R1 cn -~ rn '~ H~Z~ ~ V' O-I~~ C H C7 (/,) ~ zoZ~ X ~ Vol 19 Pa~e 4849