HomeMy WebLinkAbout014-1066-20-000Wisconsin 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)].
'ermit Holder's Name: City Village X Township
Karau, Dou las Forest, Town of
:ST BM Elev: Insp. BM Elev: BM Description:
TANK INFORMATION
TYPE MANUFACTURER CAPACITY
Septic ~ ~ b
Dosing
Aeration , . r ~ , ,~
Holding -
~ ~ vS
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD
Septic \ ~1 /
/ ~ I~ I Z n ~
~ ~ C .,,,nh
"
-' 1~
Dosing
posing -
Z It / 'bZ ~ /
Aeration
Holding
PUMP/SIPHON INFORMATION DLL
Manufacturer ~/~ / ` Q
~.G ~J~~ Demand
GPM
Model Number ~~r f
f~
Z, 2
TDH Lift q
tZ•21 Friction Loss
• (o System Head i
~, rS TDH Ft
~?. ~ ~
Forcemain Length ~
zs Dia.
" Dist. to well /
> ~c~
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Leng
DIMENSIONS /„
SETBACK SYSTEM TO
INFORMATION _ __ _ ,
I~ISTRIRLLTInN SYSTEM
ELEVATION DATA
county: St. Croix
Sanitary Permit No:
487977 0
State Plan ID No:
Parcel Tax No:
014-1066-20-000
Section/Town/Range/Map No:
31.31.15.485
STATION BS HI FS ELEV.
Benchmark
z3
/113
/pD•d
Alt. BM
rte' ]_,
~~ 1L Z
~F-
Bldg. Sewer
'lj O Sw
D• f0 c~
6 • ~I
St/Ht Inlet // 3 ~ / • v
SUHt Outlet ~ ~ ~ (, ~
`~~
Dt Inlet
/ ~
Dt Bottom irz g~•l
Heade Man. Z ~ ~ ~~• 3g
Dist. Pipe Z. ~ G~, '~
_!
Bot. System
~. yz i,-~~ 3. ~~ y~. ~s.
Finaf Grade't.~~, - eS~r
st Cover ~ 2 ~..~ ~ /~_ YS ~ .3 ~~
.~ ~j~.7
-1'~'1.~C.~/Yn-Gl~y~ UvU r{~l~-"~v-C1~-/ w~~ `-tip w~ a~S CoY~~~-~t
th ~ No. Of Trenches PIT DI SIONS No. Of Pits Inside Dia. Liquid Depth
an l rzi nr_ ~niFi i i nKF/STREAM LEACHING, Manufacturer.
Olt n o _
Heade anifol
~~
L Distribution ~ ~ ~ n ~
Pi e s `'")
~
~
~ x Hole Size ~
2
~ x Hole Spacing ~~
~ a•~OZ Ven o Air Intak
Length~Dia Dia ~ .
Spacing
Length +
_ 7 '
R('111 C(~VFR
Y o~o~~~~.o c..~•oma n~i" YY Mm~n'1 (lY 0+-~irArtP $VS}P_Il7S Only
/~
i
~~~
e l
~~
Depth Over L _n ~ pti
~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched
l U~/'"-
Bed/Trench Center Bed/Trench Edges Topsoil ~ - i
]Yes ~ ~ No
~ "?; Yes lj No
.,-
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~/~,,, l ~Ionspection #2: ~/ /~~~~W~
Location: 2643 Highway 64 Glenwood City, WI 54013 (NE 1/4 NW 1/4 3 T31N R15W) 40 acres Lot ~~~~~,~0~"-/'-~'7~ y Parcel No: 31.31.15.-485
1.) Alt BM Desc p o Y2~-C"Yt~~ -~ O~T~ ~""~ ~ ~ ~ ~ ~ n' L~~~
2.) Bldg sewer length = Zg /
-amount of cover =~ g ' b~~t?~- ~ ~~ ~~" S ~ ~ ~- 3~'
1 I / ~ - __ _ ~--__ ---,
~ ~ ~
Plan revision Required. ~ ~ Yes , ' No ~ ~ ~ _ ~" ~ ~ ~ ,,
Use other side for additional information. ~ ~-- --~
Date - Insepctor's Signatur Cert. No.
SBD-6710 (R.3/97)
ty and Buildings Division county Saint Croix
~ ~ O1 .Washington Ave., P.O. Box 7162
I,~~On~~n ~ lso Sanitary Permit Number (to be filled in by Co.)
(fig) 2~ ~~
°
Department of Commerce g~-
~ ~~-
State Plan LD. Number
Sanitary Permit A p c tior~~~ ~ s~ z00~
1
In accord with Comm 83.21, Wis. Adm. Code, pe onal ation you provide 1208189 = ~(1Q~'~ . I D ~)
may be used for secondary purposes Priva La .04(l)(m)
E roject Address (if different than mailing address)
CRO1X COU
'
C
$
f.
I. Application Information -Please Print All Information
-'~ V~" `~
Property Owner's Name arcel iet~ Bt6 cLR"~~
Doug Karau
06 - o~ ~~S)
Property Owner's Mailing Address Property ocation
2643 State Hw 64 NE %<, NW
'/<, Section 31
_
City, State Zip Code Phone Number
T 31 N; R 15 W
Glenwood City WI 54013 715-265-7311
II. Type of Building (check all that apply)
Comet;.
X 1 or 2 Family Dwelling -Number of Bedroom 3
^ Public/Commercial -Describe Use ~ • Q
^ State Owned- Describe Use ^City_^Village X Township of Forest
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. New System X Replacement System ^ TreatmenUHolding Tank Replacement Only ^ Other Modification to Existing System
g,
^ Permit Renewal
^ Permit Revision
^ Change of
^ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
I . T e of POWTS S stem: Check all that a I Ca )( ~S Y1~ = 23.0 /• Z
Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil X Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^
Constructed 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 (explain)
V. Dis ersal/Treatment Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
450 0.6 C~ O$~ \ 450 450 98.6'
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Unit I
~~~ 5-r-~ ' ~D \ Concrete Constructed Glass
N E
i
i ~
(
t
ew x
st
ng ~
,
[1e „ 1
'
Tanks Tanks •
LtT~+ /
-~
Septic or Holding Tank X 1000 1 Skaw Pre-cast X
Aerobic Treatment Unit
Dosing Chamber X 642 1 Skald 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
Tom Gustum 2276]8 715-658-1344
Plumber's Address (Street, City, State, Zip Code)
N13450 937"' Street, New Auburn, WI 54757
VIII. Count /De artment Use Onl
Approved ^ Disappr d Sanitary Permit Fee dudes Groundwater Date Issued Issuing gent Signature (No Stamps)
^ Ow n Re for Denial Surcharge Fee)
~ ~~~ ~D
, ~'~
IX. Conditions o Ap rov al ~) ~K' S~~ ~ A ,, ^ ~
0..yJa,~,p~~(
SYSTEM
OWNER: ~_~
1 Septic tank, effluent filter and ~. ~.~~. ,
dispersal cell must all be serviced /maintained
as per management plan provided by plumber
.
2. All setback requirements must be maintained
as per applicable code/ordinances.
~+ttacn complete plans (to the County only) for the system on paper not less than 81/Z x 11 inches in size
SBD-6398 (R. 01/03)
o ~ ~ 1 m
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commerce.wi.gov
isconsin
Department of Commerce
Safety and Buildings
1340 E GREEN BAY ST STE 300
SHAWANO WI 54166
TDD #: (608) 264-8777
www. commerce.wi. gov/sb/
www.wisconsin.gov
Jim Doyle, Governor
Mary P. Burke, Secretary
October 27, 2005
OUST ID No. 679647
THOMAS GUSTUM
GUSTUM SEPTIC SERVICE
N13450 937TH ST
NEW AUBURN WI 54757
ATTN. POWTS Inspector
ZONING OFFICE
ST CROIX COUNTY SPIA
1101 CARMICHAEL RD
HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 10/27/2007
SITE:
Doug Karau
2643 State Highway 64
Town of Forest
St Croix County
NE1/4, NW1/4, S31, T31N, R15W
Identification Numbers
Transaction ID No. 1208189
Site ID No. 706344
Please refer to both identification numbers,
above, in all corres ondence with the a enc .
FOR:
Description: Mound System for Doug Karau
Object Type: POWTS Component Manual, Regulated Object ID No.: 1046516
Maintenance required; Replacement system; 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.01/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)".
A copy of the approved plans, specifications and this letter shall be on-site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction/installation/operation.
t GUSTUM SEPTIC SERVICE Page 2 10/27/2005
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,
~^'\-~
YtS-~
Keith Wilkinson
POWTS Plan Reviewer ,Integrated Services
(715) 524-3630, Fax: (715) 524-3633 , M-f 7:45 am - 4:30 pm
kwilkinson@commerce. state.wi.us
Fee Required $ 175.00
Fee Received $ 175.00
Balance Due $ 0.00
WiSMART code: 7633
cc: Leroy G Jansky, Wastewater Specialist (715) 726-2544
r
1
f~ECENED
0 C T 1 '~ 2005
__
nd System pg 1 of 6
SUETY ~ ~~®GS,. DIV. Cover Page
Project Name: Doug Karau 450 GPD Mound
Owner's Name Doug Karau
Owners Address 2643 State Hwy 64
Glenwood City, WI. 54013
715-265-7311
Legal Description i NE !i • ~4, I~ Nw I, ~ %4 Sec 31 T 31 N, R 15 w j ~
Township Forest
County i Saint Croix 'i ~
Subdivision
Lot#
Parcel I D#
r~ ~
I ~.';, ~. ,. G;. _,CCE
t:~:::.o~y a~ s,:~~~t~r ~;l:u ~;,;~,~;tics
pr ~/I~ ~ Table of Contents ~ n•
~Q ~~ Cover page ~ ~~.~ J.l.:!.~,.~f
' ~, ;rE;;PUND~+`~CE
~Q ~ Mound Sizing Calculations
. Pressure Distribution La out and D namics
y y ~~ ~~
Dose Tank /Pump Curve
Management and Contingency Plan
~~~+~~`~ 6 Plot Map
total # of pages: 6
Designer Name: Tom Gustum
License #: D1201
Date: 10/13/2005
Ph. #: 715-658-1344
Signature: .~d~'r/
a
Mound System Design Methods Used
per "Mound Component Manual For Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD-10691-P (N.01/01)
per" Pressure Distribution Component manual for Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD-10706-P (N 01/01)
3bAdvisement N12486 220th St, Boyceville, WI 54725 Ph: 715-643-6068 email:
Mound System ,
Mound Sizing Calculations
Project Name: Doug Karau 450 GPD Mound
Site Conditions
Project Type: ~1 or 2 Famil y Dwelling ~
Slope: 3
# of Bedrooms: 3
Depth to limiting factor: 13 in.
Absorbtion rate of fill material: 1 gal/ftz/day
Absorbtion rate of in-situ soil: 0.6 gal/ftZ/day
Effluent quality ~ Eff#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
23.0 in.
25.2 in.
9.5 in.
6 in.
12 in.
11.4 ft.
97.8 ft.
8.9 ft.
11.2 ft.
26.1 ft.
Design of the Distribution Cell Basal Area
System Design Flow: 450.0 gal/day Basal area required: 750 ft~
Distribution cell width (A): 6.00 ft Basal area available: 1290 ftZ
Distribution cell length (B): 75.0 ft
Area of Distribution Cell: 450.0 ft2 Observation Pipes
Contour Elevation of Mound: 96.70 ft Location from end of cell (Z): 12.5 ft
System Elevation of Mound: 98.62 ft
Final Grade of Mound: 100.41 ft
Mound Plan View
/Observation Pipes z~
_- ~ _ -~
vv K r~'" Distribution Cell ~~~ q
B k
Tilled Area/Fill Material
L-
Mound Cross Section
Final Grade
Synthetic Fabric
Distribution Celle,
System Elevation~~-~
Craver teelateri
Fill hJlateria.l?
=~-~Qbs~tian Pipe
G
~ a ~ ~ ~ ~~
6n' , , F
Late`re.l d 3
Invert ~.
Iled Area
~~~--~Slape u Forcemain`'~"'S~'S#em
Contour
Notes:
Fill material to consist of ASTM C33 Sand
Distribution cell aggregate to comply with Comm 84.30(6)(1)
Synthetic Fabric covering on cell per Comm 84.30(6)(8)
Distribution Cell to have minimum 6" aggregate below lateral and 2" above.
Mound System• •
Pressure Distribution Calculations
Project Name: Doug Karau 450 GPD Mound
Lateral Layout
Lateral elevation: 99.1tft
Rows of Laterals: ~ 2 --_ ~
Manifold type: 'Center ~ ~
Orifice diameter: iLO. 51 6 ~ In.
# of Laterals: 4
Distal Pressure: 3.5 ft
Lateral Length: 37 ft
Orifice Spacing/Distribution
Orifice spacing (X): 30.62 Inches
Orifices per lateral: 15
Avg. ftz/Orifice: .7!atTftZ
7.GS y
Page 3 of 6
Lateral/Manifold Design
Lateral diameter. Wiz '; ~ In.
Lateral spacing (S): ~ft
Lateral to cell edge: 1.5 ft
Lateral discharge rate: 8.05 gpm
System discharge rate: 32.21 gpm
Manifold diameter. ~ 2 ~ In.
Manifold length: 3 ft
Forcemain Friction Loss
Forcemain length: 45 ft ZS
Forcemain diameter: ~ 2_ ! • In.
Friction loss in forcemain: 0.995 ft
Lateral Side View
M anifeld
Late ral ~, ~ Late ral
n
Turn-up w/ball valve or daanout plug
~ PVC Manifold
O rificea on bottom of
lateral equally spaced PVC laterals, forcemain and manifold to comply with
specifications per Comm 84.30[2]
Fort t NtR ~ nI
Forcemain connection via tee or cross to manifold at any point
Clean Out Detail
Clean-ou# plug
nal Grade ~-ar ball ~+alve
Observation Pipes
Wvlate r ti g ht cap
ar plug
Long Sweep 90
ariwo 45's--~
6" Mlinimur-n
Nate: Closet Collar
may 6e used in
place of 31'8" bar
`~-318" Bar
Lateral Plan View
Lawn
Sprinkler
Bax
Mound System
Septic, Pump and Dose Tank
Project: Doug Karau 450 GPD Mound
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
642
16.47
85
Skaw Precast
1000
Page 4 of 6
Dosage Volume
Does forcemain drain
back to tank?
Lateral void volume: 15.6 gal
ft Dosage to absorbtion Cell: 78.2 gal
Forcemain volume: 7.8 gal
Total dosage: 86.1 gal
Pump and Filter Total Dynamic Head
Pump Manufacturer: Little Giant Are laterals highest point?
Pump Model: 9EH if not, enter highest elevation: 0 ft
Effluent Filter: simtec STF 110 System head (distal x 1.3) 4.55 ft
Vertical Lift ("D" to lateral) 13.12 ft
Note: Access opening of ; ufficient size to be provided to allow
FrfCtlon IoSS In forcemain:
1
00 ft ~
removal of filter. Opening to terminate at or above grade. Pressure loss from filter: .
~p ft
Total dynamic head (TDH): 18.66 ft
Pump Tank Diagram
NktertightLocking Cover Dose Tank Levels
4ind7 ~VufthUUamingLaUel Finished
Minimum _ Grade In. Gal
A Reserve 19.8 325.4
Alternate B Pump off to Alarm 2.0 32.9
Outlet
Location C Total Dosage 5.2 86.1
E lect. per Comm D Effluent depth for pump 12.0 197.6
1 6.28 and
roemain N EC 300 Total Capacity: 39.0 642.0
A
Nkep Hole
orMti- B
Siphon
oevice c Pump Curve: 9EH
FLOW- LITERS/HOUR
~ 0 7000 2000 3000
3
W
~ Z
Pump must be capable of: 32.2 GPM A
and head pressure of: 18.7 Feet =1
10
N
7.S W
W
Z
s
A
z,s
0
Little Giant FLOW- GALL(1NS/MINUTE
9EH PUMP PERF^RMANCE CURVE
tlsv 6aHz
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
problemslfailure. The designed daily flow capabilities of the component should never be exceeded. Trees
and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the
component. Activities OTHER than mowing/maintenance (i.e. excessive walking, pets, vehicles, etc...) could
compress the component and reduce it's absorbtion capabilities and/or possibly cause it to freeze in winter
conditions. Lateral distribution pipes should be flushed out/tested every 18 months using the cleanout points
at each end of the component to remove scum that may clog orifices.
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
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Hwy. 64 _____________
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Gustum Septic Service
~ County
Attach complete site plan o not less than g'f~ x 11 inches in ze. Pleh_ St. Crooc
include, but not limited to: v ical aggftcf~4lA~t~int ( direction and
percent slope, scale or dim sites, n~N~g >3ABFd~n and tance to nearest road. Parcel I.D. ®// / /~~ ~ _ ~~~~~
Please print all information. R leveed `"~ Date
Personal information you provide may be used for secondary purposes {Privacy l.aw, s. 15.04 (1) (m)). ` ~ a~
Property Owner Property Location
Karau, Doug Govt. Lot n/a NE 1/4 NW 1/4 S 3t T 3t N R 15 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
2643 State Hwy 64 n/a n/a NIA
City State Zip Code Phone Number J City J Village ~ Town Nearest Road
Glenwood City ~ WI 54013 715-265-7311 Forest State Hwy 64
mslon fety a I mgs A U ~ ~ ~ ~, Adm. Code
RECEIV~~{1 EVALUATION REPORT
Wisconsin Department of Comm
6
~j New Co Use: /~ Residential /Number of bedrooms 3 Code derived design flow rate
Replacement _.~ Public or commercial -Describe:
Pare lal loess Flood plain elevation, if applicable
General comments
and recommendati Part of 40 acre Recommend mound system along 96.7' contour. 450 GPD
n/a
Boring # _ _? Boring
/' Pit Ground Surface elev. 97.0 ft. Depth to limiting factor 13 in•
Sal Application Rate
Horizon Depth Dominant Color Redox Descr~tion Texture Structure Consistence Boundary Roots GP D/ftz
'Eff#1 'Eff#2
1 0-6 10yr3/2 none sil 2mcr mvfr as 3f,1m 0.6 0.8
2 6-13 10yr3/4 none sil 2msbk mfr cw 2m 0.6 0.8
3 13-17 7.5yr4/6 c2-3d lOcr7 2
7.~~-r~ 8 r. sil
g 2msbk mfr cw - 0.6 0.8
4 17-40 7.5yr4/6 o2jp~r~`g 2 gr.scl 2msbk mfr - - 0.4 0.6
Boring # _ Boring
/( Pft Ground Surface elev. 96.0 ft. Depth to limiting factor 14 in. Sal Application Rate
Horizon Depth Dominant Color Redox Descr~tion Texture Structure Consistence Boundary Roots GP D/ft~
'Eff#1 'Eff#2
1 0-5 10yr3/2 none sil 2mcr mvFr as 3f,1m 0.6 0.8
2 5-12 10yr3/4 none sil 2msbk mfr cw 2m 0.6 0.8
3 12-14 7.5yr4/6 none sil 2msbk mfr ever - 0.6 0.8
4 14-35 7.5yr4/6 ~2 j d ` ~-` g 2 gr. sil 1 msbk mfr - - 0.4 O.fi
Effluent #1 = BOD ~ 30 < 220 mgJL and TSS >30 < 150 mg/L 'Effluent #2 = BODS<30 mg/L and TSS <30 mg/L
CST Name (Please Print) Signature: CST Number
Tom Gustum 227618
Address Gustum Septic Service Date Evaluation Conducted Telephone Number
N13450 937th St., New Aubum, W 154757 5111 /2005 715-658-1344
Property Ovrner Karau, DOU9 Parcel ID #
Page 2 of 3
Boring # __i Boring
~ Pit Ground Surface elev. 97.0 ft. Depth to limiting factor 16 in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
*Eff#1 *Eff#2
1 0-7 10yr3/2 none sil 2mcr mvfr as 3f,1m 0.6 0.8
2 7-13 10yr3/4 none sil 2msbk mfr cw 1f 0.6 0.8
3 13-16 7.5yr4/6 none sil 2msbk mfr cw - 0.6 0.8
4
16-21
7.5yr4/6 c2-3d 10}-r7 2
~ 5~-r5 g
gr. sil
2msbk
mfr
cw
-
0.6
0.8
5 21-50 7.5yr4/6 c2 ~d` °`g 2 gr. scl 2msbk mfr - - 0.4 0.6
^ Boring # _ ~~
!Pit Ground Surface elev. ft. Depth to Irmrtrng factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
° *Eff#1 *Eff#2
^ Boring # _.._. ~~
'. Pit Ground Surface elev. ft. Depth to liming factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 2
*Eff#1 *Eff#2
Parcel #: 014-1066-20-000 os/o7/loos 08:37 AM
PAGE 1 OF 1
Alt. Parcel #: 31.31.15.48 014 -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 - KARAU, DOUGLAS & MONA
DOUGLAS & MONA KARAU
2643 HWY 64
GLENWOOD CITY WI 54013
Districts: SC =School SP =Special Property Address(es): * =Primary
Type Dist # Description * 2643 HWY 64
SC 2198 GLENWOOD CITY
SP 1700 WITC
Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE
SEC 31 T31N R15W NE NW Block/Condo Bidg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
31-31 N-15W
Notes: Parcel History:
Date Doc # Vol/Page Type
02/02/2005 786518 2742/179 OC
07/23/1997 951 /634
07/23/1997 619/148
9f1A~ CI IMMARY Bill #: Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 04/17/2003
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 37.000 3,900 0 3,900 NO
UNDEVELOPED G5 1.000 100 0 100 NO
OTHER G7 2.000 4,500 68,800 73,300 NO
Totals for 2005:
General Property 40.000 8,500 68,800 77,300
Woodland 0.000 0 0
Totals for 2004:
General Property 40.000 8,500 68,800 77,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch #: 110
Specials:
User Special Code
Category
Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
OwnerBuyer '1~J
Mailing Address ,,~ ~L{ .~ ~~ ~y ~.e ~'~ ~c~
Property Address ~o,.rv~e ~, s orb ~~: ~..
(Verification required from Planning & Zoning Department for new construction.)
City/State ~~.r~,,~~ ~ ~ ~ Parcel Identification Number p l'~ - /06 6 - 20 --ow ~• ~{~S
s"5~~ / 3
LEGAL DESCRIPTION
Property Location Ivy' '/4 , ~'1.~~"/a ,Sec. ~ ~ , T ~_N R ~ S W, Town of ~ r c S~
~~
f'
Subdivision
Lot # ~'-
.-----
Certified Survey Map # II ,Volume ,Page #
Warranty Deed # ~ O ~ ~~ t ~ ,Volume ,Page #
Spec house yes no
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 1!3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
Uwe certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
m er f bedrooms
SIGNAT ~ F 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)
~'i ` f3 ~ =s _L E~
,~j (;, ~ ~ 2 P 1 1 9 I STATF, BAR+JF WISCONSIN FORM 3 - 1998
Document Number I{ QUIT CLAIM DEED
Diamond K Farms, Inc., quit-claims to Douglas Karau and Mona Karau,
husband and wife, as survivorship marital propet•ty, the following described
real estate in St. Croix County, State of Wisconsin:
The Northeast Quarter of the Northwest Quarter (NE 1/4 of NW 1/4), in Section
31, Township 31 North, Range 15 West.
KATHLEEN N. -vAL~H
REGISTER CtF UEEUS
ST. CRCIIR CCl„ WI
RECEIVED fiGR RECDRU
02/0/2005 0I :1@PM
QUIT CLAIM UEEU
ERET9~'T # 1
REC FEE: 11.0@
TRANS FEE:
CDPY FEE:
CC FEE:
PAGES: 1
Area
Name and Return Address - 1? t~"~ -
~~~' 3t~Ct f~~LL&~1.~
Rona L.SiI ~ ,~-c.~~
VAN D 'BOYLE &SILER, S.C. ~%'[€"~~
Post Of a Box 118
New ch ond, WI 54017
014-1066-20-000 `- ~ ~gS
This is not homestead property.
Dated this2Uf?'t day of , 200
*
*
AUTHENTICATION
Signature(s)
authenticated this _ day of , 200_
*
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by § 706.06, Wis. Stats.)
THIS lNST$UMENT WAS DRAFTED BY
Ronald L. Siler
VAN 1)YK, O'BOYLE &SILER, S.C.
P.O. Box i18, New Richmond, WI 54017
(Signatures may, be authenticated or acknowledge. Both are no[
necessary.)
Diamond K Farms, Inc.
* Douglas Kar u, President
BX: ~ G--
* Mona Karau, ey •etary/Treasurer
ACKNOWLEDGMENT
STATE OF WISCONSIN )
)ss.
St. Croix County )
Personally came before me this ~ day of
200 the above named Doueias
Karau and Moe Karau known to me to be the President and
Secretary/Treasurer, respectively, of Diamond K Farms, Inc.
and to
me known to be [he person(s) who executed the foregoing
instrument and acknowledge the same.
.~
* D edge
Notary Public ,State of Wisconsin
My Commission is permanent. (If not, state expiration date:
~ r
JODI FEDIE
NOTARY PUBLIC
STATE OF WISCONSIN
*Names of persons signing in any capacity should be typed or printed below their signatures
QUIT CLAIM DEED STATE aAR OF WISCONSIN
FORM No. 3 - 1998
INFORMATION PROFESSIONALS COMPANY FOND DU LAC, W I 800-655-2027
\~
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