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HomeMy WebLinkAbout014-1050-70-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Swane oei, Joel Forest Townshi CST BM Elev: Insp. BM Elev: BM Description: 03.1 ~© ~ ~ ~ ©~P W~u. TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ Dosing 1 SO Aeration Holding TANK SETBACK INFORMATION ~~°~ 1'~CO© ~ ~~ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~~~~ ~~ ~ ~~ ~ ~ I ~ ,`j ~[ ~ Dosing l7tu' ~ C? Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand L( ~( GPM Model Number ~ , / ~1 '3 (-~ Y TDH Lift Fricti n Loss System Head TDH Ft Forcemain Lengt ~ _ Dia. ~ ~~ Dist. to Well ~~ r i SOIL ABSORPTION SYSTEM county: St. Croix Sanitary Permit No: 453029 0 State Plan ID No: Parcel Tax No: 014-1050-70-000 SectionlTown/Range/Map No: 24.31.15.375 ELEVATION DATA STATION BS HI FS ELEV. Benchmark Z~ 3, ,3 Id 3 1 Alt. BM Bldg. Sewer ,1j D~{ ~ • ss 9.~. o~ St/Ht Inlet •3 z'7 SUHt Outlet r..._ _~ Dtlnlet Dt Bottom o~ JZ•9~ ~8• 7 Header/Ma .-0~ `~ 7 7 ~/ py 0 / Dist. Pipe _~;,,~„r (~ { Bot. System • (~ (• / Final Grade t Coygr y ~ ~ ~~, J I • Z-j ~-{,v ~-- Gt • Z-~ BED/TRENCH Width Length No. Of Trenches PIT DIMENSIO o. Of Pits i Inside Dia. Liquid Depth DIMENSIONS S ~ , ~ LA ( W ~ ~- ,// SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: ~~ ~ >`/vb ~ 138 ~ 15~' UNIT Model Number: DISTRIBUTION SYSTEM ~Tluydt Header/Manifold ~ ~ 'I Length Dia Distributionp q Pipe(s) I I / ~ i ll ~ I Length Dia Z Spacing x Hole Size I i/ x Hole Spacing 2 a /~ Vent to Air~Ilntake ~/ 1 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Svstems Onlv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~ Yes No xYes No ~, I COMMENTS: (Include code discrepencies, persons present etc.) Inspection #1:~(,Z/~/~~L Inspection #2: ~ / ~~ /~~ Location: 2061 310th Street Deer Park, WI 54007 (SW 1/4 NW 1/4 24 T31N R15W) 40 acres Lot Parcel No: 24.31.15.375 1.) Alt BM Description = {~ ~~ -- 2.) Bldg sewer length = (00 _ d~ - amount of cover = ,5' ` C-ti'~`'~t ~~ ~J~'"~ 31 ~ ~ ~~ ~' __ Plan revision Required? Yes No Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. Safety and Buildings Divis' ~D Cout ry ~ ~ 1~ 201 W. Washington ., ~~ ~ r ~ / i~c®ns~n Madison, WI 370 6L Sanita Permit Number (to be filled in by Co.) Department of Commerce (bog) 2b -3151 ~ Z~ 4 S3 D29 Sanitary Permit Application o~ ~~te PI LD. Number ~ ~.,, I accord with Comm 83.21, Wis. Adm. Code, personal information yo provide G~~~6 OFF G~ 93 ~, may be used for secondary purposes Privacy Law, s15.04(1)(m Z~N~N Project Address (if different t h an mailing address) Q I.t-App cation Information -Please Print All Information - 1 ~, Z o6 / 3101 Property Owner's Na me Parcel !/ ~K ~ ~~ s~,~,t~,~a~~ / ~ o~ ~~ ~/~~c 3~s~ Pro Owner's M ailin ert Address P L g p y rope ty ocati n C .. r o ' 2 ~GU t /U UJ t 4 4 S i City, Sta te Zip ode C Phone Number . , , on o , , ect / C.•C~u~(~.D t ' / SY~ .3 7~yLG S~ rJJ~ /~circle~) 3 ' T N; R E o W f ~~ II. Type of Building (check all t at apply) ~ ~ C~ 1 or 2 Family Dwelling -Number of Bedrooms 3 ~K+a•~>t.1t2.. ` ^ Public/Commercial -Describe Use ~ ~ 4y¢pt,,t"o(9•.v. pr.. / J •d ttC.tk~ otlCQ.(~ ^ State Owned -Describe Use = °1~ •2.0 lhtax.. c>~ CZ~ Ciry_^Villag ~ownship of ~• S' 00 ` Wt w ecarcl ~ T" III. Type of Permit: (Check only one box on line A. omplete line B if applicable) A' New S stem y ^ Re lacement S stem p y ^ Treatment/Hold;ng Tank Replacement Orily ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T e of POWTS System: (Check all that a I !Z " (. ~ ^ Non -Pressurized In-Ground Mound > 24 in. of suitable soil ~(ia~fsuifi~bJp~s~C it ^ At-Grade ^ Single Pass Sand Filter ^ Conswcted Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber Drip Line ^ Gravel-less Pipe ^ Other x lai V. Dis ersal/Treatment Area Information: ~-Jt7o Design Flow (gpd) esir- " pli a 'on Rate( t) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in T 1 N tuber Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank ~.- ~ i Aerobic Treatment Unit c Dosing Chamber /~ VII. Responsibility Statement- I, the Undersigned, assume responsibility for ' tallation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si gnature P PRS Number Business Phone Number ~ d ~ -2 S Z 2 / ~-S•-ZO Plum is Addre ss (Street, ity, State, od VIII. Count /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued I ui Agent Signatur (No Stamps) ^ Owner Given Reason for Denial Surcharge Fee) ~ ~~ ~_ '~ IX. Conditions of ApprovaUReasons for Disapproval ~,`~ ~Q_ SYSTEM OWNER: 3~ ~,( l~t~~~-CretM Vv~~- ~ ~tn'~2 1 Septic tank, effluent filter and ~~. dispersal cell must all be serviced /maintained a as per management plan provided by plumber. a 2. All setback requirements must be maintained as per applicable code/ordinances.. Attach complete plans (W the County only) for the system on paper not less than 81/2 x 11 inches in size SBD-6398 (R. 01/03) J~ ,.; ~:r ~' bd v~ N ~ ii. ° ~ ~ ~- ~ ,~ ~ w -~ ~ 1 :- L o ~ O Z vMM ~ 0 d ~ -~ L 0 n ~~ d ~o ~. sr. s ~. ~ ~ NC N~ ,(~~ ~~ ~. ~® W ~, ~~ o ~^ N ~' ~ a w N (~ t u, ~ o g'. G ~ ~ ^~ I o I ~ ~.~.., I d I ~ u ~. I o ~ "s I~ ~ N trl p ®~ O '_ COPY o ~ ~ L m N ~ r ~ x Z ° , °, ~ ~ ~ ~ ~ ~ .~' r b Z A ~` ~ ~scons~n Department of Commerce Safety and Buildings 141 NW BARSTOW ST FL 4TH WAUKESHA WI 53188-3789 TDD #: (608) 264-8777 www.commerce.state.wi. us/sb www.wisconsin.gov Jim Ooyle, Governor Cory L. Nettles, Secretary February 24,2004 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: 02/24/2006 SITE: Joe Swanepoel 610TH St Town of Forest St Croix County SW 1/4, NW 1/4, S24, T31N, R15W FOR: Identification Numbers Transaction ID No. 972939 Site ID No. 670939 Please refer to both identification numbers, above, in all corres ondence with the a enc . Description: Mound, 4 Bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 943376 Maintenance required; 600 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-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, the "Mound Component Manual for Private Onsite Wastewater Systems Version 2" SBD-10691-P(N.O1/O1). 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)". 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 comply with the operation, maintenance and monitoring duties as described in section VIII of mound comp~nt manual. A copy of this information must be given to the owner upon completion of the project. ~~ • o jl~• Maintenance information must be given to the owner of the tank explaining that periodic cl~ni l r is required. Access to the filter for cleaning must be provided per Comm 84 product ap royal cc'~1" N~~ r~F A Sanitary Permit must be obtained from the county where this project is located in acc a with~ie requirements of Sec. 145.135 and 145.19, Wis. Stats. C~ Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. LYLE J MYERS Page 2 2/24/04 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 construe tion/i nstallation/operatio n. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence 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. Sincerely, Julia ALewis-Osborne POWTS Reviewer 2 ,Integrated Services (262)548-8638, Fax: (262)548-8614 j Lewis @ commerce.state. wi. us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Mound System Cover Page pg 1 of 6 w: ~ i RECEIVED ~~ s~ ,~ a . ~,;, ~ < ~v~ ~ ~.. ~ tw~ # ;:~ ~D~~~~TE F E B 2 3 2004 Project Name: SWANEPOEL, JOEL MOUND SAFETY & BLDGS. D1V. Owner's Name Joel Swanepoel Owners Address 1977 County Road P Glenwood City Wi. Legal Description ~Sw ', ~ %4 'r Nw !~'/4 Sec 24 T 31 N, R 15 ~ w Township Forest County ~SaintCroix ''~ ~ Subdivision N/A Lot# N/A ParcellD# Pending Table of Contents P9~ 1 Cover page 2 Mound Sizing Calculations 3 Pressure Distribution Layout and Dynamics 4 Dose Tank 5 Management and Contingency Plan 6 Plot Map total # of pages: 6 Designer Name: Lyle J. Myers MP/License #: I.D.# 224617 Date: 2/16/04 Ph. #: 7156432520 Signature: ~ ~ ~~,~u ~~ Mound System Design Methods Used ~ ~ ~j~1-~ per "Mound Component Manual For Private Onsite Wastewater Treatment Systems" {Version 2.0) SBD-10691-P (N.01/01) ~lyFGC~ +~ per" Pressure Distribution Gomponent manual for Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD-10706-P (N 01101) '`~y0~`'tij~~ Spreadsheet provided bv: 3bAdvisement N12486 220th St, Boyceville, WI 54725 Ph: 715-643-6068 email: 3ba@3b t.com yC,,r Mound System Mound Sizing Calculations Project Name: SWANEPOEL, JOEL MOUND Site Conditions ~~ --- Pro~ect T e: ~' 1 or 2 Family Dwelling ~ 1 Yp ~------_ - Slope: 10 # of Bedrooms: 3 Depth to limiting factor: 24 in. Absorbtion rate of fill material: 1 gal/ftz/day Absorbtion rate of in-situ soil: 0.5 gal/ft2/day Effluent quality (Eff#1 I • -- _~ Max BOD effluent value: 220 mg/I Max TSS effluent value: 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 12.0 in. 17.4 in. 9.5 in. 6 in. 12 in. 9.1 ft. 118.2 ft. 5.3 ft. 11.8 ft. 21.6 ft. Design of the Distribution Cell Basal Area System Design Flow: 450.0 gal/day Basal area required: 900 ft2 Distribution cell width (A): 4.50 ft Basal area available: 1630 ft2 Distribution cell length (B): 100.0 ft Area of Distribution Cell: 450.0 ft2 Observation Pipes Contour Elevation of Mound: 90.20 ft Location from end of cell (Z): 16.67 ft System Elevation of Mound: 91.20 ft Final Grade of Mound: 92.99 ft Mound Plan View J ~Ctbservatian Pipes ~ f<=- ~~~ C~istrit_;~_ition ~:_;e~ll `'~ B ILK t I Tilled ArealFill Material L Final Grade Synthetic Fabric-- Distribution Cell ,~ System Elevation ,-~~--- Mound Cross Section Observe#ion Pipe ¢ ~ i .~ df ~ Cover Materiel Fill Ma#erial-~=~ Lete re.l in+,rE rt „,,, u Slope ~~~Forcemain Notes: Fill material to consist of ASTM C33 Sand Distribution cell aggregate to comply with Comm 84.30(6)(f) Synthetic Fabric covering on cell per Comm 84.30(6)(8) Distribution Cell to have minimum 6" aggregate below lateral and 2" above. led Area system Contour Mound System Pressure Distribution Calculations Project Name: SWANEPOEL, JOEL MOUND Page 3 of 6 Lateral Layout Lateral/Manifold Design Lateral elevation: 91.7 ft Lateral diameter: ~ ivZ ' ~ In. Rows of Laterals: 2 _ ~ Lateral spacing (S): C~ft Manifold type: End ~ Lateral to cell edge: 0.75 ft Orifice diameter: o.1z5 ~ In. Lateral discharge rate: 15.65 gpm # of Laterals: 2 System discharge rate: 31.31 gpm Distal Pressure: 5 ft Manifold diameter: ii Z '~, ~ In. Lateral Length: gg ft Manifold length: 3 ft Orifice Spacing/Distribution Orifice spacing (X): 32.11 Inches Orifices per lateral: 38 Avg. ft2/Orifice: ~ 5.92 ft2 Forcemain Friction Loss Forcemain length: 100 ft Forcemain diameter: z ' ~ In. ~- Friction loss in forcemain: 2.098 ft Lateral Side View Lateral Length ~ Turn-up wlball valve or cleanout plug ~ Orifices on bokkom of lateral equally spaced PVC laterals and forcemain to comply with specifications per Comm $4.30[2][eJ Forcemain connection via tee or cross ko manifold ak any point Manifold Lateral x x x x x La#eral Length Clean Out Detail Glean-out plug Grade ror bal(valve Observation Pipes Sprinkler Box Long Sweep 90 oriwo 45's-1. 6" Minimum Watertight cap or plug Note: Closet Collar may be used in place of 318" bar -318" Bar Mound System Septic, Pump and Dose Tank Project: SWANEPOEL, JOEL MOUND Tank Information Pump tank manufacturer: Wieser Concrete -- -- Pumptank size/model: ; wiooo/5so-MR _ ' ~ Pump tank gal/inch: 17 Actual Pump Tank Volume: 646 gal Tank bottom elevation (inside): ~ 82 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. 2,~ U Pump Tank Diagram 4lnch Minimum Alternate Outlet Location Watertight Locking Cover With Warning Label Finished A Grade ~ S C Elect. per Comm 16.28 and NEG 300 Weep Hole P' or Anti- Siphon B DeWice O D Page 4 of 6 Dosage Volume Forcemain drains back to tank? ~ Yes O No Lateral void volume: 20.9 gal Dosage to absorbtion Cell: 90.0 gal Forcemain volume: 17.4 gal Total dosage: 107.4 gal Total Dynamic Head Are laterals highest point? y if not, enter highest elevation: 0 ft System head (distal x 1J3) 6.50 ft ~,S Vertical Lift ("D" to lateral) 9.03 ft 3 . 'Z Friction loss in forcemain: _ C L2.10 / ~a Pressure loss from filter: 0 ft , Total dynamic head (TDH): 17.63 ft ., ._ ..--;~~ / X~ + . D D Dose Tank Levels In. Gal Reserve 21.7 368.6 Pump off to Alarm 2.0 34.0 Total Dosage 6.3 107.4 D Effluent depth for pump Total Capacity: FLOW- LITERS/HOUR 3i W ~ 2i Pump must be capable of: and head pressure of: a a w 31.3 GPM =1 17.7 Feet 10 H 7.5 w r i 5 ' a a w z.s 0 136.0 38.0 646.0 0 20 40 60 tlo 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. 1 ~ ad Od ~ ~~ ~~ ,~ N ~- O -- -N ° W N ~ ~ 'j Q 0 d m F ~~ d ~. ~ ~ NC N~ ,(~~ "N Cx1 ~~ o c c L o v ~ m t~ ~~ w ~® W N a A N s ~! ~~ 0 N~ n t 0 N L !o ®~. a o -~ o ~ ~ L m ~ Z "' X o .~ `r ~ y ,~ ~. N -{a A H v'~ /iv3 ~ . RECEIVED ,549 wisconsinDepartmerttofComrr~rce SOIL EVALUATION REPO T ApR 2 5 2002 P 1 of 3 Division of Safety and Buildings ....,,....,.,,.,..,.e ...,.~, r.,....., Q~ rN~~ n~R, r.~,.ia Gu um Septic Service ' ount~6T. CROIX C Yy I' /: x 11 inches in size. Plan must Attach complete site plan on paper not less than 8 Oix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and locatbn and distance to nearest road. parce . Please pri-tt all information. R iewed By Date Persons iMamation you provide may be used tar secondary Purposes (Privacy Law, s. 15.04 (t) (m)1~ ~ Properly Owner Property Location Swane oel, Jce Govt. Lot Na SW 1/4 NW1k1 S 24 T 31 N R 15 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1977 County Road P n/a n/a N/A City State Zip Code Phone Number J City ~ Village ~ Town Nearest Road Glenwood City ~ WI 54013 715-265-7505 Forest 310Th Street o~ New Construction Use: MJ Residentrat /Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement _f Public or commeraal -Describe: Parent material loess over glacial 61 Flood plain elevation, if appligble Na General cemments and recommendations: Part of 40 acres. Recommend mound system along 90.2' contour. BM #2= 103.1'. Boring # -~ Boring """° ~ ~ ~ Zr~ ^ ~' Ptt Ground Surface elev. 91.7 ft. Depth to limiting factor ~in• Sal Ap 'anon Rate ~~., Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots 'Eff#1 1RT •Eff#2 1 0-12 10yr3/2 none sil 2mcr mvrf as 2f,1m 0.5 0.8 2 12-19 7.5yr4/4 none gr. sil 2msbk mvfr cw 1f 0.5 0.8 3 19-28 7.5yr4/6 none gr. sil 2msbk mfr cw - 0.5 0.8 4 28-40 7.5yr4/6 c2 ~ 5~~7/2 gr. scl 2msbk mfr - - 0.4 0.6 ~---• ~-1 ~p .~ Boring # J Boring JJJ M'I Pit Ground Surface elev. 89.1 ft. Depth to limiting factor 24 .c+n- Sal Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GP 'Eff#1 D/ft= •Eff#2 1 0-12 10yr3/2 none sil 2mcr mvrf as 2f,1m 0.5 0.8 2 12-18 7.5yr4/4 none gr. sil 2msbk mvfr cw 1f 0.5 0.8 3 18-24 7.5yr4/6 none gr. sil 2msbk mfr cw - 0.5 0.8 4 24-35 7.5yr4/6 02 ~ 5 ly~jg7/2 gr. scl 2msbk mfr - - 0.4 0.6 __~--~ Effluent #1 = BOD 5> 30 <_ 220 mglL and TSS >30 <_ 150 mglL `Effluent #2 = BODS < 30 mglL and T55 < 3u mgrL CST Name (Please Print) Si na CST Number Tom Gustum 227618 Address Gustum Septic Service Date Evaluation Conducted Telephone Number N13450 937th St., New Aubum, W154757 4/5/02 715-658-1344 . LP . 4, .~ Property Owner Swanepoel, Jce Parcel ID # Page 2 of 3 a Boring # ~ Boring /J Pit Ground Surface elev. 90.2 ft Depth td limiting factor 24, in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. `Eff#1 'Eff#2 1 0-11 10yr3/2 none sil 2mcr mvrf as 2f,1 m 0.5 0.8 2 11-16 7.5yr4/4 none gr. sil 2msbk mvfr cw 1f 0.5 0.8 3 16-24 7.5yr4/6 none gr. sil 2msbk mfr cw - 0.5 0.8 4 24-40 7.5yr4/6 c2-3p IOyr7/2 7.5 !8 r. scl g 2msbk mfr - 0.4 0.6 ~'" ^ Boring # J Boring ~J Pit Ground Surface elev. ft. Depth to limiting factor in. Sod ~~~ Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots : in. Munsell Cv. Sz Cont. Cobr Gr. Sz. Sh. 'Eff#1 "Eff#2 Boring # J Boring _J Pit Ground Surface elev. ft Depth to limiting factor in. Soil Appl~ation Rate Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. 5h. *Eff#1 •Eff#2 (p .~ • (e Eftiuent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODs <30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~~~2 ~i~,~~d~r Mailing Address Property Address L ,-~ u ,! k s~ (Verification required from Planning Department for new City/State ~L c,~~ l ~ ° Parcel Identification Number DI'~ ~ f 0 ~ ' ~ "" ~ LEGAL DESCRIPTION Property Location S ~ '/<, ~~ `/., Sec. ~ ~, T3 ~N-RAW, Subdivision Certified Survey Map # Town of f'o/~c~ST Lot # /L-`G~____ Volume ,Page # Warranty Deed # ~~~~ ~ S ,Volume '~ Page # D Spec house ^ yes ~ no Lot lines identifiable ^ yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 ys f the'"' year expiration :... ~ 3 /I~/y~l ,SIGNATURE OF APPLIC DATE OWNER CERTIFICATION (we certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the pro 'bed above, by vi e of a warranty deed recorded in Register of Deeds Office. X ~ 3 /Ic~/c~-1. SIGNATURE OF APPLIC DATE «*«*** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed u. 2sz3~ s2o ' I STATE BAR OF WISCONSIN FORM 2 - 1999 Document Number WARRANTY DEED This Deed, made between Roger E. Swaneaoel and Mary Ann Swanepcel, husband and wife Grantor, and Joseah E Swanepoel and Trisha J SwaneaoelLhusband and wife Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix Cotmty, State of Wisconsin (if more space is needed, please attach addendum): SW 1/4 NW 1/4, Sec. 24-T31N-R15W. * '#oger E. 4141050-70-000 Parcel Identification Number (P1N) This Is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this °?~ ~- day of March , 2004 AUTHENTICATION Signature(s) Recording Area 756235 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO. , NI RECEIVED FOR RECORD 03/10/2004 10:15A11 MARRANTY GEED EXEIW~T ~ REC FEE: 11.00 TRANS FEE: 120.00 COPY FEE: CC FEE: PAGES: 1 Name and Return Address JOSEPH SWANEPOEL 1977 CTY ROAD P GLE]VWOOD CITY WI 54013 C~ z,~ * Mary nn Swanepcel STATE OF - -- ---- ````~~t~*uuur~ authenticated this day of `~~°' , . • N ~ O a 1~r~ c TITLE: MEMBER STATE BAR OF WISCONSIN ~'~ .,p~ .• (If not, ~~~i S/N 7{[0 >~t authorized by § 706.06, Wis. Stats.) -~~~trrttttit~ristrt ~~ .,l ` L_ __--~.2~--~/ . __ CKNOWLEDGMENT -• t.Q-Grp) ss. „~ ~ County ) rsonally came before me this _~ n~ _ day of _ , 2004 the above named Swanepcel and Mary Ana Swanepcel, _ _ _ ind wife ___. -_.__----.-_-._-- -- 1to be the person(s) who executed the foregoing P acknowledged the sate. THIS INSTRUMENT WAS DRAFTED BY ~_ ~ ~ _ ~ .dam ^__ _ Attorney Kristine Opzland * ~ ~ ;, / E S _ _ __ __ Hudson, WI 54016_ Notary Public, State of i S ~r S % rl -__ _ _ 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 must be typed or printed below their signature. Information Professionals Co., Fond du Lac, Wt STATE BAR OF WISCONSIN 800-655-2021 WARRANTY DEED FORM No. 2 - 1999 ~~ . -- - -__ _ _,- _ , _... _ - -- .. ~~•- -a~ T-31-N • R-15-W x... FOREST DIRECTORY ' ~ See Pages 135-140 For Addidoaal Names. ST, CROtX COLRV7'y, WLSCOf~S7N F' POLK CO. (Residents -Owner or Renter) - ~, ' -~~ Sh ane Pndtt ^ ^ ^ POW ST R I ^Mryl O ^ Reed ,~' c~ii Phillip o u r Rogers ~ I a ~ Gary ^ Grendahl ^ Craig Paulson Darin Anderso f ... m \ o ~ ^ ~ 't 9'F \ I a ^ It i N ~ BEEN REEK S ~ ~ Warne ^ 5 "P'°~ . 4 .., 3 ~ 2 t . coraticaa nR ~ ^ I ^ ~' 1 r I Todd Lard Bert ° ~ Darren ~ ~~~ , ~ ~~ I ~ e ,'~ Arcand ^ W yne ~ I Iaursrn ~ ~ ~ ~ Patrick Scepu ^ ^ 1. ~ ^ ~ R ^ ^ ~ ^~ ^ T ^ HoeCfe e ^ o ^ ~ ~ ~+ Gary - ^ N l • 230th AVE ^ Robert ^ R Suva I e ~ u qq yga son ^ Jamie Alan Nestrud GlueBe '~ ~ ~ W ~ i3 MI I ^ Nelso Fuller Alver- moon Phihp ^ Sp 1 n U $ He ^ I Anderson finger Patzidt ~ 9 Ro bert Zimmer Neil lRrich Bradl ^ Harold Lawrence Brooks R ^ ^ J~aai~ Stein :get ^ BDIi n`ds el ex Kb < A ~ 1 O ^ I Cressy 11 ~d Ko y osrn 12 ~ F ^E88M Fra ^Micheal ~ Thomas f : g m v~ o ^ DmNs 6ger't I ^ Lynn Ri d N Or 5r a e: ~+U ~U u ~ " '~` o CR o E E u Vtr50n K ..U Melvin c c s am W 2201h AVE ueben Glue e ^ ~ ^H~s°n-a ! __ , ^ Heibel ^ ~r~ ^~ ^ H ~ ^ Bernick • ^~+ '2~ Sartfhte^ ^t jl Ketu eth ^E Ibert eY _- I~crson T ^ D ^ ^ Wien. ~so yu°. I Sunday Nt s Richard ^ W Heibel Cress 8 lonatha `a"~ q • ^ D I ~ n id ~° c 17 ~ ~• 16 avid 1 5 Schmi Johns I ^ av ^ erson ~~ ~ F ^ ttl Thomas Johnss •n ~ Goodrich 13 feCry Lun \ ~ < N r osx Todd ~ e~ ~~ p w o Uuo. ~ a I ~I Alan Randall Edgar t - / eld ^ d I Denix \ SNOW=081LETRL Cahn ,..~ a' Z ^ ^ ^t^ "' ~ ^ ~~ ? Jacques Graex ^ ^ De ar Ro g G ^ Robert Mark I C q M a G ^ Ronald ^ °' a ^ n d 1x A o O F ^Hazd ^ Goodrich P~ Edw ds CG Riniker ~~ Roxn r lurisch > < 0th AV • ^J avid Graex Tumm ^ ^ ^ David Swane I Robert Scott - Joel S - Z _ Zz - I D~ ell ^ ^ Y ~ ~~ m Salseg ^ Buhr 90~EN ~ an B g F- ng' I 0 ^ErIc 19 Moll / m ~r 20 ~ ^Roxn n t- 211 c gi Oi / 22 David S M 23 ~ ~~ ~ I ~ Wienke ^ ~azk I ll °~ t Janssen w rd ^ 20 I ,~ U e ijohn ^ m m Blom erg v a ~ 5th AV I ^ ~ ^ Edwin ^Robert ~ D e ^ Denn;e ~Wlohn I N ^ C Iton Y O Cy ~ o ~ ~ ^ one t ^ Richard c 3 N n I J Hall Duval ^ ^Roxn ess 200th AVE n7~ U3 ^ ^ ~~ N(n Tiberg a~ • ames o ~ oval ^Duane ^Roger J F ~~.. ~ ^ Ullom ltzer Bees I Robert t~^ ^ ~/ Rus ^ ^ A V M ,~Jy Voeltz N - - - I ^JWilson ^Larson cer ^ Kritrt J ^ AlEred DeBoer ~ ~ foe ^ Swanepoel `30 m RIVER ~ 29 th Krig Rick ^ ^ Lawrence McNamara ~~(~ ,e e = Bartz ^ / o 20 O 27 E'~ Berger 26 25 I ~~ Sco ~ ~1(celtz +~ ~ °~ ^ Fronds [1 ~~ ^ 7odd Gpistrant ~~ R •n ^ ^ Derrick Doyle A^ I ~ 3 ~ ~ ^ Kuhn e ^ ^ ' )f 1Nyron Lawrence ~ ^ odtz Mitl~eT ^ ~~ Cress Bormet ^ Ro ^ M uert J P Ted u• ~ MRton Be. ell :~, Riba Laverne I ^ HD~ ne Hoitomt I ^ ^ ^Allrn ^ _ ^ ^ A aderson '~ ~ ~ $~ ~ g j ltd ^ ^ O EST Hostvet Scott oelne G! ^ a ^ Hembuch o:~ James Chris- ^ ^ Roger ~ m Miller ~ ^ V I p ~, 3 tianson ^ `~u r ~' 31 32 j E ~ u.9 ~ Hill N Paul 33 Webster I Norman Strande ^ 34 Riba 35 36 I ~ v e I Sheldon 8 ' Allen $ ~ Stmonsoa ~gp ~~~; ~ ~ ^ Kenneth 728 S ^ H '' omt Clarrnce Jackelrn ^ ~rti s °~ ^ G7 ag^ ^ ^ Warner ))ee ^ j~ j " Schmidt C d ~ a c ^Knops ra: or ^ RYA ^ 9F Gerard F ^ g _ Ludemann 'I' Grufel EMERALD PAGE 55 GLENWOOD PAGE 57 ~., ' ms ~^. ^^d swd ~. 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