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HomeMy WebLinkAbout042-1086-90-210 Nisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 563862 0 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Carpenter, James & Amy I Warren, Town of 042-1086-90-210 CST BM Elev: Insp. BM Elev: BM Description: Section/Town!Range/Map No: 31.29.18.485A21 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic n e fj_j__ / I Benchmark Dosing ~ Alt. Aeration Bldg. Sewer 0 .Z /0 / 3 Holding St/Ht Inlet C Id Y2~ TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. jVentto Intake ROAD Dt Inlet Septic a Dt Bottom -70 Dosing Gydh~~ seder/ an~.~~l. ~U ~ • ~ / D - ~ o Aeration Dist. Pipe G Holding Bot. System g , o T ly~Zg, '7 Final Grade PUMP/SIPHON INFORMATION 2 /0 S, Manufacturer Demand St Cover /U y ' GPM C ro C VX d 9 3 a5 - Model Number C tA, TDH Lift Friction Loss System H dad 7UH Ft (_i7 1 1 Forcemain Length Dia. Dist. to Well Z~ H,t~~G~ ~ 13 SOIL ABSORPTION SYSTEM 2~' C!~_9w" L I- g = `f BEDITRENCH Width Length No. Of Trenches P IMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 7 SETBACK SYSTEM TO rP/L BLDIG/ WELL LAKE/STREAM (CHAMBER LEACHIN OR Manufactyfeq INFORMATION 1 T e Of System UNIT Model Number: IBUTION SYSTEM ova n cri Heads anifgld Distribution Syr / x Hole Size x Hole Spacing Vent to it Intake Length Dia Length Dia Spacing SOIL COVER V x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bedrrrench Center Bed/Trench Edges Topsoil Yes 0 No Yes FN_j No 19 COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:J / / C Inspection #2: / / Location: 635 91st Street Roberts, WI 5/4023 (NW 1/4 SW 1/4 31 T29N R18W) NA Lo 12 / Parcel No: 31.29.18.485A21 - F,9 1.) Alt BM Description =f d 1( I ✓ yam, ~1~ QC Wt b" C S~S vl Vt~ ~C- I A'~-~ c~e~~ 2.) Bldg sewer length Zr'~36 3 y~ / 8 Cain amount of cover ~Otq = 11 a~ ►~~s ~ '2 / n /-f" ilk,-0rV. Plan revision Required? 0 Yes W/No Use other side for additional information. ~ I ~ ~ G~'~'✓l/~~ SBD-6710 (R.3/97) Date Insepctor s Si ature Cert. N . PLOT PLAN PROJECT James Carpenter ADDRESS 7260 Guidar Dr. #101 Woodburv Mn 55125 NW 1/4 SW 1/4S 31 /T 29 N/R 18 W TOWN Warren COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 7/31 /13 BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambers 46 BENCHMARK V.R.P. Top of iron pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 1037.0/1036.0 5'below qrade All piping shall be SDR 30/34$10/iithin 10' of tank, piping shall be Schedule -IM Well is to meet all setbacks required by Vent WDNR >6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area S~f " air of end caps 1 Scale is 1" = 40' 12" U 4' Long Unless Othei Wise at Syst m le It o 3419 rioted Spy J ro 3 ; f ed~;tiom 10, L s-g PA. 10' ~a ~1 Yv" 12% Slope 307' Property Line B- i SG , I o Q 2-3 X 94 cells with >3' spacing B.M.* '~o 8 ' U 7 0 I"~D U 282' to 91st. St. B- 2A 40 1040' 1042' 329' Property Line Property Owner Harvey Hielkema Parcel ID # 042-1086-90-200 Page 3 of 3 BENCH MARK. SITE PLAN - _ TOP OF I" o.d. IRON PIPE ELEVATION=1046.65 LU) AQ, I ~ O OI J W JUJI PROPOSED LOT 12, C.S.M. _ 1040 Oa Q I o O I c 1040_ a 7042 , ,1042 _ 1044 - - 104¢ _ - _ 0¢E A4) j 1046 p S12B 1048 0 - ' S SCALE IN FEET 1050 0 25 50 100 " 3 / CONTOUR INTERVAL=2' 282• 9% STRF fi Fr Lj. BENCH MARK: TOP OF 1" o. d. IRON PIPE ELEVATION=1054.31 i OGDEN ENGINEERING CO. DANIEL . KUGEL CST #250693 Civil Engineering & Land Surveying 1234 S. Wasson Lane, River Falls, WI 54022 (ff DATE: (715) 425-7631 ~A Z ~ ~ County t f '':►k Industry Services Division is 1400 E Washington Ave Sanitary permit Number (to be filled in by CoJ BOX 7162 s~ Madison, WI 53707-7162 -2, f ~~'J r State Trar;svctionNutr,ber a ry Permit Application fn accordance a83 , Wis. Adm. Code, submission of this form to the appropria mental unit _ lu! is required pri bt g a sanitary permit. Note: Application forms for state-owned POWTS a ~I d to Project Address (ifdinbrent than iTailing address) the Department o Safety and Professional Servies. Personal information you provide may be used fo sectlF or ses in accordance with the Privacy Law, s. f 5.04(1)(m) Stats. rlU f T`~_ 1. A Aication inforlnatiion - Please Print All Information / Property Owner's Name _ C Parcel T R O p / o oZ~~L$ Property Owner's Mailing Address ~ t--~1 /r~ a ~ - Property Location t~ 1 _ Govt Lot T~S~ Z1/ City, State Zip 'ode Phone Number SSl Z e~_ ~;;,.~J Section 31 de f rcle o - fI. Type of Buildin lecli all that apply) Lot # N; R -r E U W 2 Family Dwelli Number of Bedrool s / 2 Subdivision Name ❑ Public/Commercial Drscnbe Use _ r--- ❑ City of ❑ State Owned - Describe Use _ CSM Number ri t' L ❑ Village of lownof_W_LC/r_~,,~/ Y PL f Permit: (Check only one box on line A. Complete line B•tpplica-b3 New System' ❑ Replacement System ❑ Treaunent/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) - ❑ 6• ❑ Pegnit Renewal ❑ Pennit Revision - Change of Plumber El Permit Transfer o New List Previous Permit Number and Date fssued Beforc Expiration Owner IV. T e of POWTS S stern/Component/Device: (Check all that apply) - Non-Pressurized In-Gro[t-id ❑ Pressurized fn-Ground 17 At-Grade ❑ Mound > 24 in, of su ible soil ❑ Mourld < 24 in. of suitable soil ❑ Holding Tank ❑ Othe -Dispersal Component (explain) > G ~ r ~t❑rPF tN!Eitr en evice expla its= 4l '773y V. Dis ersaU Treatment Alea Information: - Design Flow (gpd) Des n Soil iica[ion Rate( st) Dispersal Area Required (sf)Dis Persal Area Proposed sf ~ ~G) in eve io k: LIZ ~ _35, VI. Tank Info . Capacity in Total b o(of Manufacturer Gallons Gallons Units New Ttutks Existing Tanks U Septic or Holding T;u~k l , - - _ U rn U. C7 a. VII. Responsibility Stateu_ient- 1, the undersigned, assume unsibility f'or installation ofthe POWTSshown on the attached plans. Plumb Name (Print) Plumber's ture MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) 1 -2 VIII Count /De artment [)se Only Approved ❑ Disa roeed Permit Fee Date issue - PP $ Ci issui ig Ag SiSignature ❑ Owner&ven Reason for Denial IX. Conditions of Approvttl/Reasons for Disapproval SYSTEM OWNER: lI} ,lZ LC7t77iL'Z L 1. Septic tank, effluent filter and dispersal cell must be serviced !maintained( as per management plan provided by plumber. ff~ 9 All etb8rk r- a_ firiramantc m ti 4 I ) h~ It G ~j~xJ ~l tG~ s~tEr, as per applicable Gi~ a/Vl ~~~tr na 101• the system an submit to the Cour ty only oil (japer not toss than 8 in x I I in e SBD-6398(R0313) L '2`Z GCS'.. 1 (t :7 Z:. L2(t4 l 2 Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 7/31/13 Owner:James Carpenter Location: NW1A SW1A S31 T29 N,R18W Lot 12 91st. St. Warren System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan Sheet 7. Filter Specificatior r Signature License num er #226900 PLOT PLAN PROJECT James Carpenter ADDRESS 7260 Guidar Dr. #101 Woodburv Mn 55125 NW 1/4 SW 1/4S 31 /T 29 N/R 18 W TOWN Warren COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 7/31 /13 BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambers 46 BENCHMARK V.R.P. Top of iron pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 1037.0/1036.0 5'below qrade All piping shall be SDR 30/34,p ithin 10' of tank, piping shall be Schedule ~-r-M Well is to meet all setbacks required by Vent WDNR >6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 12" 5.6ft^2/pair of end caps Scale is 1 99 = 40' 4' Long unless otherwise Grade at System Elevation 3499 noted Pro 3 Bedroom House 10' 10' ST 10' B-12C 12% Slope 307' Property Line B-12B 2-3' X 94' cells with >3' spacing B.M.* 05 8 ' 70' 20' 50' 282' to 91st. St. B- 2A 40 1040' 1042' 329' Property Line q--e. Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber To be >1' above grade 5.6ft 2 pair of end plates Finish grade elevation Typical Installation 1042.0' Vent A91 Grade Vent 3' 4" 3' X30/34 Septic Tank 5' Long 1 91 5' S' Long 1 19 36" Grade at System Elevation Grade at System Elevation Spacing 5' 2-3' X 94' Cells Same on other end Observation tubeNent At end of cell A 23 chambers per cell B System elevations: A__1 038' B -1037' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 4 of FILE INFORMATION SYSTEM SPECIFICATIONS Septic Tank Capacity gal ❑ NA 11051, ner Permit # Septic Tank Manufacturer-L~c'~ ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer- ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public- Facility Units - NA Pump Tank Capacity _ JE-01 Estimated flow (average) 0Z~ al/da Pump Tank Manufacturer Design flow (peak), (Estimated x 1.5) Pump Manufacturer Soil Application Rate /da /ft2 Pump Model Standard Influent/Effluent Quality Monthly average` Pretreatment UnitFats, Oil & Grease (FOG) _<30 mg/L. ❑ Sand/Gravel Filter G Peat Filter Biochemical Oxygen Demand (BOD,) s220 mg/t_ Q NA © Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 6150 mg/I_ ❑ Disinfection_ ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) - ❑ NA Biochemical Oxygen Demand (BODs) 530 mg/L n-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/1, -ANA ❑ At-Grade ❑ Mound Fecal Collform (geometric mean) x104 Gfu/1001rr1 ✓ ❑ Drip-Line Cl Other: Maximum Effluent Particle Size - X in dia. ❑ NA Other ❑ NA NA ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: - ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) months} At least once every: ar s~ (Maximum 3 years) ❑ NA Pump out contents of tank -------s.._.~ - (s) When combined sludge and scum equals one-third (A) of tank volume ❑ NA Inspect dispersal cell(s) At least once eve monthis) ry: (Maximum 3 years) 0 NA year 6 Clean effluent filter At least once every: monthis} ❑ NA ars; Inspect pump, pump controls & alarm- At least once every:- ❑ monthis) -A ❑ year(s NA Flush laterals and pressure test - At least once every: - ❑ monthis) - NA - El year(s) I[I NA Other: i-- _ At least once every: ❑ month( s) O#her: - - ❑ year(s) 141 NA - - NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POV'/TS Inspector; POWTS Maintainer; Septage Servit:ing Operator, Tank inspections must include a visual inspection of the tank(s) to identi,y any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for anu back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents of the tank shall he removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code, All other services, including but not limited to the Servicing of effluent filters, mechanical or pressurzed components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regu atory authority within 10 days of completion of an!, service event. Page of START UP AND OPERATION For new construction, prior to use of the POWTS" check treatment tank(s) for tho presence of panting products or other chemicals tha may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. "'hen power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and way result in the tQckup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Ooerator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells, Do not drive or pars: over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scrap: ; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83,33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. S The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or thEJr covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replac ment system: ble replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil lir1itations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following rtrmoval of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in off act at that time. <<WARNING>> SEPTIC, PUMP AND OT14ER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DPiiATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY SE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER ^POWT5 MAINTAINER - - Name' i.w ~j=--- Name Phone : a Phone) 2L SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AU-"HORITY -_N=hone P_ Name /~U/ _Z~7/ J - 2l Phone / C7 This document was drafted in compliance with chapter SPS 383-22(2)(b)(1)(d)&(0 and 383.54(1), (2) & (3), Wisconsin Administrative Code. F"ILTER CARTRIDGE ~rllli;'t~~lil~Etrln STOP a Ury lit the elr it C-6621 arfttt the teed at 1:1111 u(04 pipe to errsura it is relvtutad ,►rvderr the ;:cdui:s up"IffRg. Yf° yvfrr, ttrylr rltlltlY lhl;frl C triUre 111pd itrtu tlevv tank Iirr►,ugh the, uutibt ver ■ulvvl.t wdld (Vlbb) addffiahal l+ipit efetu Cho uutfdt Mile- +t.p a Whav tin canoe is atih dry Mod Oil ttnf audet Yee, tnvta&urv tivm fervgtt, of ►16-b.ct► plies rwpder tm brace fleet 111tar to tfte tank +xtid Wall if utlt illeg the aptiuaul vupplom+rttt'at xlde SUPPart•, If r."ida supyaurt rrt►othud. is riot utlfutd, proceed to stop tutu'. a 'k.V For imytallatrtttt:tl tltdiafng ttltl uptienail euplllr fYr~rrtz~! side suNpurt molveevt wrle) live W-itrci► pipe autto tiro fllW case. If side support triwidd ir; lout' utlihe", proeeed •tu step rout: solvent woid the Met case otito tha uutiet 01,-. 10msrt the hite+ cartritdga into the case, Iyrelks1011 down ulitil this titter loetkki IFItu the huttv►va vY thu case. if a VN5 +swJtch fx ut'&A d: fnstreit htto thrs filter' throe lock try turnim3 clockwise 9(r, w..m`Y'.y i ,k,►~,x+;.•l:~r, maintemmilic s t. Am of luvrvt Ifltrsr uhwteld be eirsr,lved uvv ry tlrrltl rite uapt{C Gitnlc to service►1. 2. opekt thu oUtime actas,o epar~irru to inspaut the t'kuik atld HQter 4 f J" pump tf.n 5epuc tack r wnpN lfeely, fr►irkirig :fors to rarnuiiy the 51utho lmydr tore the 6etiu.vg ni' the Ur+kL dad tout juut Cho sr.:►itre rind v ftiaimtrt. :n 4. once tow vrlkxent le,vr'll ivas tiwrn fowxtred t►alety tht: ir►v+ert ref tine uut6t pipe, tirtrefy pull up oto tlna filter hmadte t'u dhOudge the t:bvkthlgu "to the cus'e. S. 5f1de the cartridw up ad utu of tile cats fife deaninfl. G. lP is vA6 switch wmntn:ted to aft L1140 11 is pi`0tltlltt, the sv ULP, stouuld he ru.nuv e,d by turwnff a uutittlrdoclewlslf ti" wird lituUdd n• wlkh water only" r ' p u 61u11^, i. Wltife 11giding the t:rlrtridde C+kl its, fdd11 (large fiat surfil.;u kre:tnv doweet) wrier the atwustr uponirlor riltse UN Oils valtrid"a With WAve d,. c,nly, t mkit+y aura an svv.ptalla ovaderial Is rihsod back Into the tur+k. d" if VRG switch Is utiliraur, repk.4' +:0 by lifsnrttflg into rotor urlti t' . turuilvp 0aekwie a 90 , 9. luscit tiro filter cartridge bilck here the ditto, lirea;binil d1yYVrt 140 t4 t, tiller luck,; lkrrvr tfr+a baKoo lv trf Chile calliu. !tl"itaglace arid secure the 4eixema 1106111110 Oil tho t8"k- Hr lr.._rds.o ^15 "fir: 4V1;'irC:TtYd •!~-yr. `1ItJ f lt+Ft'(J.1 W;4hel:uf" wwwIeacwur>nlrAte-IMIM ~E~7 - ll . it ail" l ~kr~i Cti 4 ~ ak+ ; : ST. CROIX COTJ1~lT" i~ S.EI'' TC TANK MAMI°E+;NANC".I: J/ -(JIWEIw]ENT AND OWNERSHIP CE1ZTIFI(;A'.aGN }CORM Owner/Buyer J i ~w 4- :Mailing Address / Y- Property Address (Veri ration retlrtired frorn planning & Zoning Deparivitnt k. new Construction-) City/State V v V Marcel Identification lNtiniber 0 Yd'108~~- - LEGAL DESCR11"140N Property Location /4 , r 14 , a5f C. , 127 1 .t~ _..1 , fJwlf E)1 W .z (Wi'n'' Subdivision Certiified S"arve;y Map ~/c~ l xtnte _Z 1'a e Warranty Deed Vo lul13u - Page, # Spec house yes 60) Lot litres; .dentifiable yes rro SYSTEM MA1NTE;NM4C' AND OWNER CERTIFICA110N Improper use and maintenance of your' septic system coultt result in its pre tiature,, failure to handle wastes. Proper nrainterraat►ce wonsists of pumping out the septic tarrlc every three years ur sooner, ii'ueeded, by a licensed lunrper. What yotr put into the system can affect the i[buction of thv septic tatnk as it treatment stage in the waste disposal systeru. Owner rrutintenance responsibilities are speciii.ed in §(,ornm. 83.520) and in Chapter 12- St. Croix Cou uty Sanitary Ordinance. The property owner algees to submit to St. Croix County, Planning & Cori; Lg Department a cortification tor.-in, signed by the owner and by.a master plcmbe:r, journeyman plomber, restricted pluinbe.r or it licerr. -d pumper verifying that (1) the ou-site wastewater- disposal systc:rn is in proper operating condition and/or (2:) after inspech m and pumping (if necessary), the septic tank is less than 1/3 firli of sludge. I/we, the rrrlderstigned have read the above requirernrents and agree to rnaiwELirr the private senvagt, disposal system with the standards set north, hcreirt, as set by the Department of c'orrrrnerce and the Departmout of Natural Itebources, State ofw4sco.nsi.rr. Certification stating that your septic system has been maintained must be cornpleted anti returned to tine tit. Croix County Planning & Zoning Derpartrmrtt within 30 days of the tlne0 year expiration date. I/we certify that sill statement, on this torrrr are true to the best of my/otu' k;wwledge, liwe alidl 1r'e the Owner(s) of'ttte property described above, by virtue of a warranty deed recorded in )register of Detx,t Office. Number F nisr - - APPLYCANT(S} DA']'I ***An . is rnisreprOsented may result in the sanitarY permit being rn,oked by tire, Planning & Zoning .Department. Include with this applical-ion a recordcd warranty deed from the Register of.' Deeds Office and a copy of the certified survey reap if reference is made in the warranty deed. (REV. 08/05) Y , t Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St. Croix 4- Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan mus include, but not limited to: vertical and horizontal reference point (B dir9'con(3n Parce l 1. D. 042-1086-90-260"-,.) . ` ) percent slope, scale or dimensions, north arrow, and location and d tancetoAea - Please print all information. ► Reviewed Date Personal information you provide may be used or sec y Law 15.04 (1) (m)). /l~i.~rV+1 1/ Property Owner roperty Location Harvey Hielke a - ovt. Lot NW 1/4 SW 1/4 S 31 T 29 N R 18 E(r® JAN 0 9nin Property Owner's Mailing Address of # Block # Subd. Name or CSM# 540 Summit Ci le ST, CROIX COUNTY 12 NA +repo"d CSM C~ City State Zip Code - ity E]Vllage ■ Town Nearest Road Lj- Baldwin WI 54002 ( 715) 684-2850 Warren 93rd Street New Construction Use Residential / Number of bedrooms Unknown Code derived design flow rate Unknown GPD Replacement L % - Public or commercial - Describe: Parent material ~-'y > Glacial outwash Flood Plain elevation if applicable NA ft. General comments 1y--~ 9 and recommendations K„' Vli V~/J ; (AV / n c B12A Boring # Boring Pit Ground surface elev. 1041.2 ft. Depth to limiting factor >96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10YR 3/4 sil 2mgr mvfr cs 3vf 0.6 0.8 2 9-18 10YR 4/6 sic lmabk mfi gs 2vf 0.0 0.0 3 18-24 7.5YR 5/6 sc 2mabk mfi gs lvf 0.2 0.3 4 24-48 7.5YR 4/6 cos Os ml 0.7 1.6 5 48-81 I OYR 4/6 cos Osg ml dw 0.7 1.6 6 8 -961 l OYR 4/6 L---- Cos Osg ml 0.7 1.6 Horizon 6 has few 5YR 6/8 fine sand concretions. [;12B] Boring # Boring 1047.0 >96 Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-6 10YR 3/3 sil 2mgr mvfr gs 3vf-co 0.6 0.8 2 6-11 10YR 3/3 sil 2msbk mvfr cs 2f 0.6 0.8 3 11-24 7.5YR 4/6 scl 2mabk mfr gs 2f 0.4 0.6 4 24 g. 10YR 5/8 fs Osg ml if 0.5 1.0 Horizon 4 has pockets of 5YR 4/4 me sand. / * Effluent #1 = BOD > 30:S 220 mg/L and TSS >30:< 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signatur CST Number Daniel P. Kugel 250693 Address Date Evaluation Conducted Telephone Number Ogden Engineering Company (715) 425-7631 1234 S. Wasson Lane, River Falls, WI 54022 May 9, 2007 Property Owner_ Harvey Hielkema Parcel ID # 042-1086-90-200 Page 2 of 3 [;F2C] Boring # Boring 1042.3 >96 Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-11 10YR 3/2 sil 2mgr mvfr cs 3vf-f 0.6 0.8 2 11-20 1OYR 4/6 sic 2mabk mfi gs 2vf-f 0.2 0.3 3 20-29 5YR 4/6 grscl lmabk mfi gs if 0.2 0.3 4 29-96 7.5YR 516 s Osg ml 0.7 1.6 Horizon 4 has pockets of 5YR 4/4 fine sand. F-1 Boring # 13 Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. Pit Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 < 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. SBD-8330Tmt (R.07/00) e Property Owner Harvey Hielkema Parcel ID # 042-1086-90-200 Page 3 of 3 BENCH MARK. SITE PLAN TOP OF 1" o.d. IRON PIPE'S ELEVATION=1046.65 4 ( ~ ~ E cv t ~ O I w U~ PROPOSED LOT 12, C.S.M. X040 °a ¢I o I 1040 ® B12A - d a l 1042 ` ` -1042 BIZC~- - - _ - 1044- 1044 - - - I----1046,` 1046 ® 2B _ - ~ ® B1 ~ -1048 1048 - - - \ - 1050 SCALE IN FEET 1050 0 25 50 100 CONTOUR INTERVAL=2' O 91st ST RFFT BENCH MARK: TOP OF 1 " o.d. IRON PIPE ELEVATION=1054.31 OGDEN ENGINEERING CO. DANIEL . KUGEL CST #250693 Civil Engineering & Land Surveying 1234 S. Wasson Lane, River Falls, WI 54022 DATE: / y aG QL 000-7 (715) 425-7631 -'r" 1- ~ " ~ 1111111 111ii'- "'il IIIiIllill 1111 111111 III IIII V V Y 4 p V L T 8642$2 ,:A'LEEN H. IIALSH REGISTER OF DEEDO ST. CPOIX Co. , WI RECEIVED FOR RECORD 11/1Gi20011 04:30N CERTIFIED SURVEY MAP `JCL: 23 PAVE: 54'1 REC FEE: 15.00 CERTIFIED SURVEY MAP COPY FEE: a.°0 PAGES: J Harvey Hielkema Located in the Northwest t/4 of the Southwest t/4 of Section 31, T 29 N, R 18 W, Town of Warren, St. Croix County, Wisconsin, being Lot 9 of that Certified Survey Map recorded in Volume 15 of St. Croix County Certified Survey Maps, Page 4169 CFRUFHQ SURVEY MAP yauw PA0E 15$0- LQT_1 i LOT 2 LQT PRNATE ROAD o - - - S 149'00'03" E ;724. 7 - :R I ; - - 450.66' 25 40 $ c APMOXE14ATE214 00 273.08' Water Elevation) - see N 8 _ _ 33' 33 BUILDING SEIB CK LIMB ~o T o LOT 12 ~ ~ 1 3.585ACRtS tti~ M Lors3 100' , E-,f OR t .~S w 2. 161,~R ES wl~ M OI o 156,170 SQ. FT J pq\ i~i A 94,123 FT. BENCHMARK ~ f 2.001AC70E5 I ~W~.ylG+7I Top V Iron Pipe >~~I Elevation =1054.31• LOT 9 $ 8715N~ w^ I ~i 'z t~ Lq Q Q. 587.30' 72.94 ",I f '0 1 ~A5' o S I y~ 270.39' V. I2.o0 vi ~.a ---S89 54" 602.39'--- CO g g a~C~ `~a9~~ry eon R~G~ - ~A LOT_ 5 $ e v~~• 4'' c4 g7ya \ 2141 -ACRES A LOT 14 5tI 93,1505 FT $ o o '52' li 2.079ALRES 2001 ACRES OR OR ~a ry / 910,546 SQ• 87164 SQ. FT BUILDING SE7BACKLINE ~Exa. R/W) ~iuo' STRUT 2 ' ~`~60 z z 6 EAS'TLINE JA ? WEST 1/2 - SW 1/4 1 ~P ~68m 6a 22 - 535.49 0 331-99' 66.oo' Wide a Joint Driveway r 9ENCH"RK S 89°2 W 557-74' v3 Easement % Top 1•' Iron Pipe , $t (Lots 12 & 14) / LQT 12 Elevation -1036.57' CERTIF~ED SURVEY DAP YQUWE 10., PAGE ~92~ 3 Ea B8 NOTE - (R =1349.6x) $ cc (R ° 13I;599 1SEGTION31 The 100 Year high water elevation SOUTHWEST T 29 CORNRER 18 W 13~3 38 as Ogden Engineering , , N, 135 47' z" Proposed by Co: - (Found 2" Iron Pipe) is 1037.73. The Lowest Building g . 1/4 :Elevation for theses lots is 1039.73. N 88 SOUTH LINE SW°42'04" E 2664.85' (R=N88°5452"E x661.21 N SOUTH QUARTER CORNER SECTION 31, T 29 BerrntsenAluminum Monument) LEGEND (Found O Indicates 1"O.D. x 18" Iron Pipe Set E (Min. Wt. - 1.13 lbs./lin. ft.) f • Found 1" Iron Pipe st y ~rCE Section Corner Monument • RVI-rv W4 5 0 (as noted) 13 : Scale in Feet (R= ) Recorded AS ELDEN~7ILLE 150 75 0 150 Proposed Driveway Location•••. irzgs are referenced to f the a rfl Bear SW 1/4 of Section 31, assumed b the bearing South th tine line ' o oq"E. Dated - Indicates Soil Boring Location October 19, 2oo6 This Instrument Drafted by Mark W. Peavey Sepp ember 4.2007 SHEET 1 Off` '1 of3 Vol. 23 Page 5481 Jul 31 1311:10a P•1 l ul:anrurlrl:ra........... :1 11 III. ~ I .I - X~ m 0®®F11 r: - _ o00 DOR ® - m- Z-1 O®® - j I 1 ~ I%I I I .EAU '1 f l l I I V I fI a ' .11'41. Ilfl.fli ~ 4 i' I 1= l O , ~ 1 I((II ICCII~'sI _ A 80I -I f1A.~ 1Ii d,n Will El rn I~ I m C I' it I I' z a a I 'I 1 z I I I L' I I 1! «-L!J' 1 - 1 ~ I I II is I Ali. 1 .I I r-T~ -.r~ f1: i 1 TIT F~ n t / Z S 6 vn s. 0 ye qhq 4C~ e F :S ou.NN icri CONSOLIL[TED':JM6_ROW'VS.:LLRIGIiT$ ARROWS 1-04G CENTER ~Rl 11 ...I g RAF DELTACONST.-CARPENTER AND OOWROWSOF rwsoRnwNOsw D-II.1'ridN.Kbieivo-w»y RRE.AIwpY0.'dG::11DSn0 ~ ou?Lranous er nu$D~rwwc LS iuco.i ~ era ~ur/Rau ) MRY RE1$IONY OrE: 'I aPbli sL,Lt: ELEVATIONS EL 111DE-D OvOv. E ESFGRGA EB 4n4: H.II. --W +D~L«1MF.R OINENSKiN3~ND SRE~3. LCLL.LLMJ M/S ONn Wit: Jul 31 1311:10a p.2 laa• n.e• _ . m X R G . • _ _ _ +t =~s II 17~ sxr ~Plmeie•nn. ~1 F 11 ri; 6 ~?p d e~ZI 9 is-r a-Y G ~ n.•B. c o ° S ° I° I W' LP-0 FW5H : x °o ^^ti1%:.vt~~L~S; Ss~`!•s_a~a .L x 44 Roza pjI f f ~i of ry71~55E- - r~+-~i~ ~I n , _ fZ K u i • • J 0. • i LA S WSN ._'yM SIOr +1103 § • ~~Z= z4 Ili sR r- z.DdcouT wAU ~ p O - x agC k 0 iga~ s 6 v o z ' 9R D p S N 6 rCR s"o a 2 DRAm+roR: am oLBMT_DLI1MBEn OV,'NS:LLLRGHTS ARROW BUf1DM6 CEPJTER cRAwn BT: Rtm7_ ~R g DELTA CONST.-CARPENTER COTTUWA9CFT NSORAVANO. ANY Dw.q xt°vewmaw r. :°oe"r PRE BJMH OATS OSIr.zSIB OLFLIZATIp1S0F SORAMISILLEGAL /W~I n5wumno.u VMS N y'ISCUE, FOUNDATION MEAilpn _CE B RRAND OBEAM VEN NG . RAVES. J NFGE: ~S9N nn 6FA1 11}} 54. R=V SON DATE o'.0-2 •.•P AND ALL OTHER OWN51D-6 SPECS. WW.'1.VFRG-ocl+ RE`AAONn OATE. Jul 31 1311:10a p.3 c•v ca LcL s FRI- ti! -Y~ I - i I ny ~ Px A~ I I 7= H¢ r z = I „ c f m s 5( a Y A i cJ 0 I i I I xa•n• r. Ea' ,9-Y / I Y I.~ yk I RANGE - n C a I I~ Yx f } _ I £ L YY.T 1, ,//ii is 1 1 4 Y f Y Cj v b I - - As' YA• k, f r•r I b Y.A', i3 f_ I I.~ ~Z m _ ._•SSE -fir. 2 I Y I rl ' ¢ j u>LM - lWl YL.tiH RP.s.o , ~U' H 1b2 I E.A. I E,. .A. Y I D 4 _ I Ss - ~ GJ gg no A JLN I n 1: I f O 4 A, C f I~ I I RNf-frIG:NFFNEP9~ =Ttf~49r". rn 2f'O f.~1 RGZ- SLLV i4G jµ{ Y{ dR cfi' 6 ~p R-1' 2YA' M.n' a p S"c~ F 3 Ge•n i o 0 Sn > 8 _D 6 $ 0 H. RD :m i mr o P m$ z A a 0 Fro _ o y q x o M' ILJ DR1pxp=CX CCVS0L10.4TtJ LLMBER. O/A.S ALL WGX-S AR.I'iO WBUILD;NG CENTER DRi RY. RXETE ECR.,ER DELTA CON-ST. -CARPENTER TT-2-"v'-'L Xrs FTHIS DRA'A'M owamdwG aE w.G LRVM C .,G W D'JR IGIIDNS OF TH9 -TAW V3i51LLEGPL IUD Pr EL-RYDA'P=d5.1-1D SCRLI:: CG CCJNtt i0. U VCRIfYKKEF Apofi[fW s` G4A]E5. IUD9PN.:A •Jt,GiGaS IIEYI9 JI.1 DATL• DGA3GD MAIN FLOOR 'UvATDXE. RGUG40P&v HGS PG S2fi R. C ce: illJpl-TATf I1S {b A9W AND kp JT ICR C1rfEN`rICxS A,p AYCG+. VM'WARG•c[~.cala REVS ]N YZ CAIE Jul 31 1311:10a p.4 r.u• e•.,~ a-ice fi ~2~ 10•r.' b ~Fyt ~j - 3 ~ f ~ G91 c~ b~ u r - ffRZZ mN 1 ' ~o~ l~~QQta3i. ~ zm (,.ogmz~~ ~YG i 7 S c9~9~~'d •~1 ~w -a• a-I x• "vT v 1'/r' 10I. Ham- r 4 N."AP1 b Z ;lit ~IrtI > V 4 O rC l m v i ~u f 4 rn B r / N~ ~'~1 i mo r#~ b r .'a i 4 . 4 W m 0 Yp ~aQ O N Z SRO'. A A ~ °~o ! I I ~ r o en• 4 - O l* " $ zD• ~ O Rig s 3 I s r z b O 3. . rz D - 21 z D•iOVM F~.R coVSIXFV.iEJ IIMREk 1-'/e15 A_L WCN"9 I. DELTA CONST. -CARPENTER ONO IC YIGW$'.F TNI$ ORM4M, ANY D:D e fROW BUM ONG CENR oRw.H BVRHETT'a~l,,ER DOiOt UPPER FLOOR & SECTION OU6 pO: Tlj F°B'uu:yam Rcvls ]N.: [O1p 01 ]°q ANO NL 6TCRCIUE. ~OlIS A+O S)[CS. .VABG4L CAM REVIS'SJYtGR (11111 iliii'*'Il VIII VIII IIII 111111 IIII IIII U V 864282 KATHLEEN H. 14ALSH REGISTER OF DEEDS ST, CROin Co., WT RECEIVED FOR RECORD 55/5u/2QQ7 04:3QPM CERTIFIED SURVEY MAP VOL: 23 PAGE: 5485 REC FEE: 55.'0 CERTIFIED SURVEY MAP r.OPY FEE: 4.00 PAGES: 3 Harvey Hielkema Located in the Northwest t/4 of the Southwest t/a of Section 31, T 29 N, R 18 W, Town of Warren, St. Croix County, Wisconsin, being Lot 9 of that Certified Survey Map recorded in Volume 15 of St. Croix County Certified Survey Maps, Page 4169 CF,BUFjFP SURVEY A'fAt) ?'QL_UW_61 PEE _1W_ LQ~L I LOT 2 LQT-3 I PRIVATE ROAD - - - - - S 89'00 03 . E 7-4- .66 95025J 40' APP1104 trrATE 1037.73' 273.08' Z _8 CONTOUR Goo YR. High Water Elevation) - See No $ 'tio'• 1 33, 33, ° BUILDING SETBAJK LINE 9-- LOT 12 l l o ' I 3.585ACRE5 ~til LOT113 1O°~-i YdC E-.I OR t 111111 h w 0 OI o 156,170 SQ. FT.l 0S s7 2.161~sti ES n ~I .-7i I (+ti'a\ 0 94,123. FT. BENCHMARK 2.0014 S EI i V Top 1" {ron Pipe OR I ~Eievatbn • tosr.3r LOT 9 581.30' 72.94 ^ en tip y1 270.39' V. 10.91 hC o$p 3 y~ N69°o?~~ a e3 ' pg`G, - - - 5 89 :54" 602~.39' - - - LO 32.00 - 8 . 8 a jgi ory t~`~oM RYA T 5 $ $ y c.~ o° cP g, ,,a 2.14r LOT 14 gj 93,250 SQ. FT. w x c $ yo 3 2~~. E 2.0 2.001 ACRE'S a N ..50 .00 90,546 jg.i OR .)BUILDING i 871645 . iYFT ° o ~IXCL R/) /c~~prtrT3 SETBACKLINE / :oo' EAST LINE s7 3`5elyd rim' 1 / - - 535.49' - 331 99 ? WEST 112 - SW 114 66.oo' Wide `p'er v ly i 225.75 o . Joint Driveway BENCHMARK S 89'2'9'54" W 557.74' ^ Easement Top 1" Iron Pipe I (Lots 12 & 14) LQT A Eie"ati°"' 1036"' CERTff D SURVEY MP I YQL~E 1Q, PEE X22.4 3 Sm, _ NOTE SOUTHWEST CORNER " (R =1311.59) The 100 Year high water elevation SECTION 31, T 29 N, R 18~ W Z 9"62) 05 1313.38' as proposed by Ogden Engineering Co. (Found 2" Iron Pipe) 135 47 z I is 1037.73'. The Lowest Building O?e,,' 'Elevation for theses lots is 1039.73 - I SOUTH LINE SW 1/4 N88°42'04"E 2664.85, (R = N 88°54'52"E 2661.21) N LEGEND SOUTH QUARTER CORNER SECTION 31, T 29 N, R 18 W (FoundBerntsenAluminum Monument) O Indicates 1"O.D. x 18" Iron Pipe Set C (Min. Wt. - 1.13 lbs./lin. G 0 Found 1" Iron Pipe Section Corner Monument ~zzD vCIE O 5 (as noted) ttsr Seale in Feet 1 " = 1 .50, (R = ) Recorded As -7-3 a ELDENVILLE,~ WI. r•• . 150 75 0 150 Bit Proposed Driveway Location - Bearings are referenced to the South line of the SW 1/4 of Section 31, assumed bearing N 88°42'x4"E• Dated -D Indicates Soil Boring Location October 19, 2oo6 This Instrument Drafted by Mark W. Peavey Revised- SHEET 1 OV t of 3 September 4, 2007 Vol. 23 Page 5481