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HomeMy WebLinkAbout016-1039-10-000r Wisconsin 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 Donald & Mar Bonte Trust Glenwood, Town of ST BM Elev: Insp. BM Elev: BM Description: 9i.o 13-Z LS i TANK INFORMATION (l . TYPE MANUFACTURER ~ ~" i CAPACITY Septic ~~ ~ ~~---_ ~ ' ~ OOp Dosing ~ >n ~--~ Holding __ TANK SETBACK INFORMATION TANK TO P/L ~e5~' WELL BLDG. Vent to Air Intake ROAD Septic ~7 - f ^ ~ ~ ~ ~0 1 Dosing ~,7 N t~-' / a / 3v `-° Aeration __~ Holding PUMP/SIPHON INFORMATION ;° Manufacturer ~'` a '~ Demand -.-- _ %. , ~:'~- i ~t, 'GPM .. Model Number , ~ ~} ~..-,~i TDH Lift.. ~~ Friction Loss„ System Hea. TDH Ft _~ .~ Forcemain Length ^ : Dia. t ~ Dist. to Well , E ~. SOIL ABSORPTION SYSTEM County: St. CrOIX Sanitary Permit No: 514970 0 State Plan ID No: Parcel Tax No: 016-1039-10-000 Section/Town/Range/Map No: 18.30.15.284 ELEVATION DATA STATION BS HI FS ELEV. Benchmark ~, L 9>. ~j > 7 q !~ a Alt. BM ~ ~ Bldg. Se er 7 I I _ P ~• A ~y SUHt Inlet I~~ ~ ~~.1~ " SUHt Outle 1 ~ Dtlnlet ~ ~ Dt Bottom ~S, U ~b . ~{ Header/Man. /~ Z ~T T Dist. Pipe Bot. System ~ ~ ~ 9 3 ~ ~ Final Grade `" d . Z ~1 ~y st Coaer ~ L ~ 7 . ~ar~~,uC" Z. 9Z. ', t BED/TRENCH Width j'~ Length ~ No. OfSrenc es PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ t:,, ' ' 7 w t SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: ~ CHAMBER OR INFORMATION ~ Type Of $ ] 1ystem: ~, - % ~" : r( ,`~ UNIT Model Number: \~ ( 1 + r~l[.T~IO11T1A\I CVCTCIIA Header/Manifold s>; Distribution . ~ ~ ~ ~ i x Hole Size ~ j x Hole Spacing ~ ntake Ai r I Veryt o p () ~~ ~ _ `i ' ~j' "1 ~ ~/ f ~' '`/' _ ~ p ^~ v Length=~ Dia Spacing Dia Length s.._ 1 c G~AII nA\/CD __ n__....__ cs_.~a-.y- A..1.. .... 1111.....,.1 Ar~ A4-G r9l1G CVCTPMS C)r11V r 7 { f -- - - Depth Over Depth Over xx Depth of t -~, xx Seeded/Sodded ~ Mulched Bed/Trench Center ~ ` ~+ ,~ Bed/Trench Edges Topsoil ' ~ " , Yes ®No ~ i Yes ~] No - COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~/ / z9 / ~ a Inspection #2: / / Location: 2777 160th Avenue Glenwood City, WI 54013 (NE 1/4 NE 1/4 18 T30N R15W) 40 acres Lot G ~ ~ Pa cel No: 18.30.15.284 1.) Alt BM Description =~'"''~j'' 't •R ,~~'-~..... ~1r~1/.1:,".. ,~- -G-.G~ •fi:_'~ ` cv~~ t,_._ 2.) Bldg sewer length - (o ~j o - amount of cover = « ~ ~' Plan revision Required? Yes ~No Ja~-~ Y,r` r ~(j J Use other side for additional information. °"'~~ Date ~ Insepctor's gnature y Cert. No. SBD-6710 (R.3/97) ~~! ~ D~ ~~ . I _ _ F -_ Tt)~ t~:i0 Flu 3 5 3~,~~'V~D y ~~ if4/22/0a . AUG ~ 6 X008 . T ~d 7it ~~ . L ~ pl y ZO ING W13370~-716 ~~ ~ ~ ~ . d SsalitsrY P ~ppl~aetion Z ~ d~ifYnststMaPO~I~M~""'a"'r w61~ d111°~~ P+~1aet ~ radr4s ~Ib s anti. t~t~b~ Mia ~si~ ~ ~ ~c MrrM+~d refit is rsq~wt Pier o ~>triii s a~iMr!- ~ i~ Y~ PiwiM ark a ~ C ~ }}..,, . ` 1, -~ ~ I V ~W ~ aid A iFM Olpre~M~ D! p .. ;~'" /D ~ ~ ~,rq,b.erlo. 2`d`f' . v a' ~ ~~~- sow ~, s~e ~ ~ ~ ~ CaBs t~>~ ~~~$~ TG~ 2FiodbTDrelii-~'1i~ero[He 0,,,,~ ~~ ~~ fladecow+.a-ti'o'~'v" ~ ~ ~~~ ft~li~ ~ MI~sA. '~!~Set)lee~ ~e~ ~g , ~~~~~ pty ©ppncl~Aa~ , Q,~ flaiC ~. ~a Q~ Mq$Ri0a10MtIMMd _ fib l~l~~~iow Q~yMeatlile~ee Oweee Zyr~N4iwr R ^ pwsitFw~ ~ ~s . ~y et s~ti-dwirDlssei atiiieed<~is.afwiebieavi /! M.tieeard Q~rrieedtrdertil O ~tawe pp~eerssiaDseioe ©~Tdc ~ DiepoeiCtinPee~t . Afea V ~~~. Dei1~ ~~~ ~ ~ 011oMet~~ 1 v ~^ 1 / J~ ~ 11,w1 to[ VL?scffe~ ~ ~'a ~ ~ ~~ ~ .~ w . _ ,, .~ >~~ ~ ~ w:+ s b • S Zt'o d~ ~- ~ 1 c- 1. Septic tank, effluent fitter and ~+G ~ cu[. '~ ^- dispersal ceq must all be servkes I maintain ~ , ~~ as per management plan provided by plumber. rM 2. Aq'sa~aakcequirements must be maintained eeNie~WfussnltletLele ~elMeeieiM~e r~a~N~~ ~~ ~~Y• 7 ~~ ~ 031 . . 7 iC, .. ~ PLOT PLAN PROJECT Donald and Marv Bonte Trust ADDRESS 337 220th St. Baldwin Wi 54004 NE 1 /4 NE 1 /4S 18 /T 30 N/R 15 W TOWN Glenwood COUNTY ST. CROIX SYSTEM ELEVATION 93.9 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 BEDROOM HOLDING TANK DOSE TANK SIZE # of chambers none BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100° Filter BEST GF10-8 ^ BOREHOLE O WELL * H. R. P . Same as Benchmark 160th Ave __ ~'®A C, Pro 3 Bedroom Trailer 350' Grading is to be done to divert run- off away from system 93' 92.9 B.M.* Huffcutt Combo Tank Tank is to be properly bedded g 1 ~ and provided with lockdown B covers with approved warning ~, labels 10% Slope Area 15' below system is to remain undisturbed /~ Well is to meet all setbacks found in - 2 ~ Comm. 83 13 0' roperty Line ~1 CQF'Y PLOT PLAN PROJECT Donald and Marv Borate Trust ADDRESS 337 220th St. Baldwin Wi 54004 NE i/a NE 1/4S 18 /T 30 N/R 15 w TOwN Glenwood COUNTY ST.CROIX SYSTEM ELEVATION 93.9 BEDROOM CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter' BEST GF10-8 ^ BOREHOLE ~ WELL *H.R.P. Same as Benchmark 160th Ave ~~ ~C, Pro 3 Bedroom Trailer 350' Grading is to be done to divert run- off away from system 93' 92.9 B.M.* B-3 Huffcutt Combo Tank Tank is to be properly bedded g 1 ~ and provided with lockdown covers with approved warning B- 1 labels 10% Slope Area 15' below system is to remain undisturbed // Well is to meet all setbacks found in B - 2 Comm. 83 1320' roperty Line r commerce.wi.gov isconsin Department of Commerce Safety and Buildings 3824 N CREEKSIDE LA HOLMEN WI 54636 TDD #: (608) 264-8777 www. commerce.wi. gov/sb/ www.wisconsin.gov Jim Doyle, Governor Jack L. Fischer, A.I.A., Secretary August 21, 2008 CUST ID No. 226900 SHAUN R BIRD BIRD PLUMBING INC 1008 192 ND AVE NEW RICHMOND WI 54017 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/21/2010 SITE: Donald & Mary Bonte Trust 160TH Avenue Town of Glenwood St Croix County NE1/4, NEI/4, S18, T30N, R15W >_ _ Identification Numbers Transaction ID No. 1582613 Site ID No. 741553 Please refer to both identification numbers, above, in all corres ondence with the a enc FOR: Description: Three Bedroom Mound System /New construction / 10% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1197088 Maintenance required; 450 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 installationand prior to occupancy or use: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • 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 ofSec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally down slope of the dispersal cell shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • Maintenance information must be given to the owner of the tank explaining that periodiccleaning of the effluent filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • A copy of the approved plans, specifications and this letter shall be on-site durine construction and open to inspection by authorized representatives of the Department, which may include local injectors. f-a. ~?. ~"J. T. S. C~F~~itioncc~'~~, SHAUN R BIRD Owner Responsibilities: Page 2 8/21/2008 • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • 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). • 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. • The owner is responsible for submitting a maintenance verification report acceptabh 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 madeto 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, Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon -Fri, 7:15 am - 4:00 pm j erry. swim@wisconsin. gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART' code: 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ,Friday, 7:00 A.M. To 3:30 P.M. Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 5/ 20/08 Owner: Donald and Mary Bonte Trust Location:NEi/4 NE1/4 S 18 T30 N,R15 W 160th Ave Glenwood System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01 /31) Pressure Distribution Manual Version 2.0 (01 /31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9-12. So Shaun B Signatui License ~F~~~~ q~G 1 ~ FO SqF~ 2008 ~r eU~~i ~~s D'c~~'~~R7MFNT OF COMMERCE Dlv1~+UN ~F SaFE~ Y AND BUILDINGS SEE C;Gk =SPONDENCE ~; ..~--- . '~. ~.. . 1?~tte k" Observation Pipe Perforated Below Piiter Fabric . .. ~ C-33 ~ant3 ° Topsail J: (~ ~ $ta~t • ~ . Drain Rock r Dtoa-T,1'avea Fi~.tar Pabtid • ~D~stribviion. Pape s - ! °'~ `'~ ~ ~O'r C! ~EOi:+ ,Flans Pump 'c = a `~`i~w! d • l...4Yes .. fQ / .!~ i~~ '• ~. ~ Gfes~ ~t:on t7t A IKo~und - sierrs Us - ~ `- ':.f -% $ J • A Std For T~se ,ADsot tsars Area ~.~b • b`~ Ft_ ~ ' ~• K ] ~_ Fib - .. ._.. _~ rt ~- .. ,f - ` fe rn ~ ~,ot . ... _ - ~,*' ~ - Wit: . ______.._-' L • - ~ 4 Observos iar- ?ipe~-.~ ~ K • ~ ~ Q - ~ G' _ ~ir FOf~C! ~YlOsti M.~---- •----- From• Pump ~~~ ~~ _~~w~~ ~ 3 _.~.._ - ° Qistributiar~ Bed G~ +~~~ ~ #Z . a Ripe - Di-aur FtocK ~ ~ - • 4 t3bsaJr`v~'#'sosi Pipe ~~C~~ permoneni I~otice~' ~S~i'-' 1t~/ ~ ~a~ 6r~~po or' 12ods ~ . ~+; ~,. ..~~'~~~~ ~~ Pbn Yiex Qf~Moun~ ~3s~n~ A Bed •For T~~ ~~sorpt~on Arso ~ . • _ P~-6~~ ..,.~ ~. . ; l R~¢peattd piDS ~stOti .~_~ ,e~s4 Ca ia~ive~ oAr Slpsst4~ ~a 'yes siat! ss Garti+ec}~ r /) !/~ S#g~tedt: ~ta3e ~i~eter ~~inch t~tterst .« ,~...~. - inch{~s~ ~z~et'st roanifo3d '_~ dies . Date , Force l~ltin . " '~-.:. ~et~e5 . ~ of motes/f~~ ~ ~ L/ • tnrer~ Etevatfa~ o!' to#~e~alsL _:,,_ fit; .~~' ~ •. . ;i~ ~ ~, • .. ~' i ~ . ,~ ~fA~iBER ~'it~)SS ; g~pT2~ ~At~ ~ a43lf~ £. . EEC ~~ ~ ~,, .ff ~~ ~~~ ""' ~~ x~~ .... ' ..: ~ ~~ ~w~ s~ . ... ?F3LZ£R ' '~---"- ~TL ~' $~~~ u' - 3 • ~gCeY' R~ '~ ~R ~~~~ ;T • • s • ~ .~ _ ~.. c„~s- ~ • ~ fit. ~ . ~ : ~: _ . C t D ~ ~ .~ ~~.~ -~-- ~~~~~DiiEii LE ~~ ~;~ ~~ ~~ ~• . t ~~ stT£ PJ~ . ~~ ~• !~ .,: ~~ ~~. . C y-^,~'_ TltN~ SIZES: ~ s ~p 8..' ~- ~ a g~2REt! DI p~[t!'iP ~€ A~ _ - ~ FACTS FED . SURE - - - ~;C~`T £ D =/S / z 3• _ ~~~s • HP LassrJet 3100; ~ 71 ~ ~'t ~~ r Sent' 8y. • • IBS SUMP/~~'F~..~ENT PUMP' g E 1~-! S ~R N ~ ~ ~ ~ Mz.W 11/~li ~ , ~ ~ t1S ~~ •.89lM eR~ Y•C ~ ~.aae spas ~ ~° m rte- ttTtRSi~ ,o 4t ~ ~~ _ ~ ~ ~ ~ ~ ~ S 8E '~ 8 Power Cad ~~ ~ ~ Shafl Seat s ~ ~Fasteoumcs Z3~ sc -----'., a• ~ ~ 1a~ ~ ~ ~ ~ Asa +a+a ~ ~ ~ ~~ 2~ x,77 z41.81:59~ ?7 iii z1~E/:t8t a srt :r[~~ od Cast Iron A8S .~ _. ~irrW,A .. Nye with carbon snd ~~~~- Upper g6aerrs end l..a~~ Badt B~Ss ~~tC4. ears t7/N•o1d~.oRt~ds~~ ~r.saaacsrtastt-~ ~~° ss~ dt3 roan v-Qr~ ~icw- t~wtrisnawrE ~, ~p p~RVE ~~ .. _ putts Qw'~tER'S NSANU~ 8~ MAIrtRGF~~T Pmt ~ sYS-r~ sp~~~o~cs o~ cTs~ic ~' pef~~- C-~ftje~ F2[~er N~ ~~ ~ ~ pip Tank C ~~~ UJ~ 2 ,,-sr-1 .,~u~v Pump T~mk ~t~ar ~r~+-±~l .~ ~ d x i~ f~ 11PJ~°n f~ t ~~ p~,~e~i Demand (~ ~ t~$f ~ Oer:rsrsd t~~ f~ c~a ~~ s~rn She - ttaspect mn~e a~ tank(s3 ~P out oa~afar~ts of farfJQs) . tr-~pea ceri~s) C~e~'1 t~T 1ns~ PAP. tx~P aon~ at ;sf8+m Flits 1a anal 1~ p''~~ of_ .. ~=-_=-- Pump ~ r 7 ~ . Pues+3~ (~ .. g+~V'da~risti y '~esR ~ Frlrsr f3 Pait FJ~x fl wand s~ mgn. D M~ A~ g OSier. St2Q rrL9~ a ~ a~ fl biA O HA D 6 ~ !Ul' . ss0 mom. ssa:~- o e o S'fi3` ~~SOOtr11 ~ ~sL~wwranQ 9tuttdlamet~ - Vadtles~~~ ~ rrv~ 11x ae•m+sars wad Sarvrrs J=reQe:~ © raosrt~ S1 t~ 3 Y's'•} At fezsc once aver'' '-~ ~e-~rictf (K~ ~~ Y~rae S1V7ter~ COtTrbirtOd sludge' and Srctitn e4ti~ ;) (Mi7dtntrr~~ 3 Yom-) ' AL least onoe ev~sry © . At feast arras ~/ ~ f3 :eso~tss yw~L~s ver ~ ~ s) D J1tA y ,~ least oezce e ver ~ ~ ~) O t~tA y At Je~saot ocsos e -- O resoaB~ 13 tea) O tlfif, At west onos every Q nsors~ II Y~{s~ f3 NA At Jest atsc:a avert eelltliT@i/~NCE 1NSTRVC!'IO~iS oe~ tier ns~c3e 5Y :ut J:sdJvtdlrai ofd arse cd !!~e fia~o+~ 6oer~ ar ~ d~ and Res~3cbed Ssvwr. POEM'S tetsp~: fPC~1l1t'['S . T ~ n'nst tc'cJud° a v~uai ksspsdlocf of the bcekCa} fay tdee~->~_~ ~_~` ~y ~~-' cradrs cr iea~os, +~'O itee ~raduma a! oorrsbtned studso ar+~ ~~ ~ ct:er~c rhfa et~t tsv~ ar porf~ of ort ~ Ttses ~f:) stta~ bet ~"~ c# on ~ fn tfrs o~vrv~ pJpea and fp crfecx ifar' ~ ~ e!lJuerrt a~f ttls a ffsa lOCaliiegv~- ~1Ortb- grocxld :~- u:d~case s ~~ n arm ~ tha innn::efira6s nom ~ ~}VtbJi ~lte oombk~ed ~ da ~ sc~sm Yrf ~ ~ add ~s iC sxilf ~' NR e~Jrt~s of B~ t~1ic ~ bt, r+ ~` $ S ~43~ ~ Aim ~'~- ' ~ uri~ed POWi"S compote. ~~a~' atld any °~ ~ , pj i 1r~t1'ttiS OT ieS$ St13It bB ~ ~ S ~Sfied P ~' ,~ sfJf rf~poe;tshaAbe prclr3tifd ~o ffie jocat r~f1a~Y $'~Y w~;n '(Q ~ of ~ ~~Y . sa~rup~n oP~aano~t ~ ~ ~tcdt#s orb' nor tuw ~. P•~' ~ ~ s ~s a ~tr~- ~ ca'°e~'tra~na ate ~~~ hams Bra o0rlbls>'>~ at me't~c fs~ ,r+emcv+ed t~' a sa~9e'csr"tc~g ope~a~or pry na ~ ~ .. -~ i n ,~ ,_ ~..~. ~! gy~bem s~ ,~ ~t rtflt cur vut~ sor~~condfions are frozen at the int~trative stst'Eace- 1s tee the e>a~ss tanks r~31 ~ $bonrei normal ttighvsraier ieYets. When ttte mss} and tlratY result in me • Dureng power PAP pett(s} in cne large dose. ov+etioadurg . mtte v~ be ~ To avosd this situar~rr have the contectts of tries pucr~ f~ilrfk removed lty a S g Opacacb~ pcbr~ fttisaotfc~4 P~ ~' the elltcrecrt PAP ~ a Plurnbec oc Pt,YVTS M m ;3t~>n tnantraQy , ~ ~P ~~ #~ rpstpne tlorrrtat fevers wr~hfn t~,e p~mP taflk. ~ d cis. Da lwt drnre or petit overt ~~ dlsb~ub oteomp~ po not dri+Ae oIr pa~3c v+ehides t f~ mo~rld or at-grade sa'[ at»cp~ott at~ea- ~ alra v~ 15 feet down sbpe ~anY from the Kra~sir~eam may impc~nne the perfiomsance and Q~ the ftf~ Redeem or-~Grtltnaficn of the ~ btttt5; condoms; cotton swabs; daS% t ~: of thePOWT~ ~~Y• • dam; ~ f~tidaftort dia~t {s>~t;p p~P} : titdt and vt~gefabte g S ~~' ~ ~ sctaps~ mew olt; ~s3tl~ 3~"cts~ ~ wry tsapkrns: tampons: ,acrd vratet sctten~ brine. . ABANDd[~dENT tatoE•n ovt of service ttra foQav+rtng snaps strati ba taker: ~ ~e ttrai the Vttlten the PL')WT5 t~s ed in eon~Prrance w~ ch_ Cotrtttt 83.33, Vlrsscortsirt Adm~trt~ Codes sysLern is Pr+oP~~ rarefy AII ptptrtg b~ tania acrd Pits shah •be drscanrtect~ad and the abartdorsed Pipe oPen~ The oontanls of at{ tanks and P~ sh2d1 be rierrto'v'ed and property dssposed ~` >~Y $ '~ Op~~ p{p~ ~npi<tg, ati taNcs "attd P~ shaft be exesva2ed arts removed or ptetr c~avers r+ernovrd~ ltus ~ sp®t+e Sited tnrSh sot[, grav+ef or arsotf~' inert sand ctsateriat. . . COPFi'IHtGENCY PLAt~1 the fottowtng measures have teen, of must be iscKen, tq prrn+ida a coda tf the POWtS tam and c~a'utot ba tep~ oarnpGant t+eptaotxr+ent ~~' O A suitable reCac+aa ttas besrt evaluated and may be cfi72ed for the tocsmort of a rrt~tt saB absorption ~ The nrp~errent area should fie protected from disturbance attd ~ anQ should rtad setbacks front exisdng and proposed srttrt~rte, Eot Imes and volts. FaScme >b tae infringed upon by ~~ ~~ the ~ aces ~1 result in the need for a new soil anti sits =gvatu2~iart m ~~~ a sui'~bfe ~~ $~ RaptaoectYent systems must aompty with the rules in effect at 8yat ~_ D A sv~tbie r~eptaoerrtent at+ea is not available 6rre ro sett:acx artdlor sot[ tunitatiorts_ Sart-rl9 a~dvattcPS ~ PODS txhnotogy a ttotding t~tk. r~Y be ~ a fast resort to replace the laded POINTS. bD identity a su"rtable reptaverner+t area. Upon farluna Of Sze PC3tNTS a s0it.arid site tress not been. area is aivailabte a, / si6e evatua~on must be pes'~m~ fio ktcate a suitable rep~ement area. if rro repLacerrtettt holding tank may ba lnslaSed as a last resort Lo repiaae the faired POVYTS. of ttze biaanat at and at-flrade saS a6sorP~ ~s ~Y be reconsiruc~ed itt piece fciiot~ving the tn~sre surface. Re~trttdtons of such systems must comply vv"tift Ste roles in et5ed St fiat tune. <NtFAftNIN©> . gEp7iC, Ptlti![P AND OTHER TRFATME~~ TANKS MAY GONTAtt~t LETHA{.. C~ASSE$ AND,fDR WSt11"FICfE]1iT O%Y!'aF1d. DO 1titOT H~'ItR A $Ep?It;,, F!t;T1KP t;?R OTllER Z'RF.~i7Mt3+IT TANK U1~IDER Al1[Y CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSOi~t FROM THE INT'EWOR OF A TAtHK iViAY SE DtFFICUL-T OR IiIEPOSStB~~ ADDR?OIVAL COb[MENTS _ POm'S lNSTAt.LER POWTS MAINTAINER tYarrle q~,~/ Name S~~'k .c~/ ,~' ~; ~ ~~ ; Phone ~/ 1 = -' Phone 5EPTAGE SER~CINCs QPERATOR LOCAL REGULATURY A~TNORI7Y . ~' C. Hartle ~ /j ~~~ Phone ~ t J -C.~ ~~ f' i~ ~ Phone ~ ~-. rros accrs+a:at wvs drat6ed ~!~ seidFs ofnl» i~a gate, ~ irtd tNZUShm lo~ntY Z.ottTtrg and Sar?~`atirxt ^ ~'lii: ~~ ms mirunusn ~ accts. Caenra XiXdM{r? and 83. as(1). Q1 ~ f31. w~s~~~ ~ Code. th"s of flits doaurxnt does rtot gvarardee tfte ~ of the POW'tS. 6~C~tj . y REC~i`J~D tiVisconsin Department of Com erce L 12008 SOI Division of Safety and Building AU G EVAL A R in accordance with Co m 85, Wis. A C e Attach complete site plan on aper~ibt ~~~ T~1 inc s in size. Plan m t indude, but not limited to: ve 'cal and'-J6bRl~ (BM), direction an percent slope, scale or dimensions, north arrow, and location and distance to neares oad. Please print all information. Personal iMormation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). PORT Page ~ of County ~ T C ~ c . arcel LD. l/ / (o ~`D ~ / ~~~ ewe /~ Date ,~ c 1- --~ Govt. Lot N~ 1 /4 ir's Mailing Address Lot # Block # Subd. State Zip Code Phone Number ^ City ^ Village 1 ~ o (71~ )~ o-TC _ ~ rv /~.L,~.r.- I d /a ~/ 1S S~~ T ,3in N R f ,~~ E (or~ or CSM# r .e.Q wn Nearest Road New Construction Use Residential / Number of bedrooms J Code derived design flow rate y GPD ^ Replacement Pub' or merdal -Describe: __ ____ __-_-________.__ ___ Parent material ~~- ~ ~ -.~-e-~ Flood /P/lain elevation if/applicable ~~J ft. General oommerrts GI-~~ ~ ~ ~,rr . f e ~ zTtlYt ~il.GQh . ~ ~ ~ ~ G~~`- and reoorrurrerxiations: o _(f System Type~'~ !1 ~ System Elevation ~~ ~~ # O ~n~ -~-Z--- oC pit Ground surface elev. ft. Depth to limiting factor ~ in. Soil icatron Rate Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP D/ff' in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. 'Eff#1 •Efft12 ~ 2c '~ pia .syc:~ Bortng # EOring pit Ground surface elev. ~ + ~ ft. Depth to limiting factor JG~- in. Soil licatron Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 1 4-~ ~i/z -~i` ~r ~ /~l' -~ ~ - ~ ~' ~,~° .~ - > 'Effluent #1 = BOD > 30 < ~0 mglL and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 30 mgll CST f~larne (Please PrinU Signa ~^ CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ~-~ ~® ~ ~ ~ 715-246-4516 r Property Owner Parcel ID # Page 2 of~_ ^ Boring Boring # I~qj pit Ground surface elev. ft. Depth to limiting factor ~L ~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 d ~~ ! ~ a mG ~~ ,~- ~ ^ Boring # ^ Boring ^ Pit Ground surface elev. _ ft. Depth to limiting factor in. Soil lica6on Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DlfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Boring # ^ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon 'Depth Dominant Color Redox Description- Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg1L '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. SBD-8730 (8.6/00) Property Owner _ Parcel ID # Page ~ of~ Boring Boring # pit Ground surface elev.~~d ~ft. Depth to limiting factor _ in. Soil liption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~ a 7i~ - r am~ e.; ~- - ^ Boring # ^ Boring ^ Pit Ground surface elev. _ ft. Depth to limiting factor in. Soil licafion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Etf#1 •Eff#2 ^ Boring Bonng # Ground surface elev. ft. Depth to limiting factor in. ^ Pit - Sal ication Rate Horizon 7epth Dominant Caor Redox Description. Texture Stnacture Consistence Boundary Roots GP D/ft` in. Munsell Qu. Sz. Cont. Caor Gr. Sz. Sh. 'Eff#1 'Etf#2 • Effluent #1 =BODE > 30 < 220 mglL and TSS >30 < 150 mglL 'Effluent #2 =BODE < 30 mglL and TSS _< 30 mglL 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-8330 (8.6/00) Soil Test Plot Plan Pr®ject Name Donald and Mary Bonte Trust Shaun Address 337 220th St. B ld W' 3~3 a wm i 54004 Lot ------ Subdivision NE 1/4 NE 1/4S ~ 8 T 30 C #226900 -°---° Date 8/20/08 N/R15 W Township Glenwood Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top o Steel Fence Post Yellow Ribbon System Elevation 93.9' *HRPSameasBenchmark 160th Ave =~~ a NndHS --,,,,~•~S~ ...... , ,, ~~~~~ouNTY SEPTIC T`A~ ~A+I~4Il~ENANCE AGIZE~ AND OWNERSHIP' CERTIFICATION FORM OwnerBuyer Mailing Address J ~ ~ ~ ~/ ~ ~~~~ • ~_ ~~~, ~ u) ~ ~ f Property Address a~~~ 1bo (Verification required from Planning 8c Zoning Department for new construction.) _a ~ ~ - o gq~°l c~ City/State = Parcel Identification Number ~ ~ 7 LEGAL DESCRIPTION Property Location N~ 1/4 , ~y,E '/4 ,Sec. ~?~ , T ~~N R ~,~~W, Town of G/it~GV~ Subdivision ~~~7 '.s~ ail ~ ,Lot # -_..._ - Certified Survey Map # "-` ,Volume ,Page # Warranty Deed # ~ -~~ ~ -~ ~ ,Volume ~~_ ~ ~ ,Page # V ~~ 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 Query three years or sooner, if needed, by a licensed pumper. What you pnt into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner mai~enance 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 phunber, journeyman plumber, restricted plumber or a licensed ptunper verifying that (i) 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 foil of sludge. Uwe, the undersigned Dave 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 bear maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration daft. Uwe certify that all statenvcnts on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property descrtbed above, by virtue of a warranty deed recorded in Register of Deeds Office. tuber o bedrooms ...~ SIGNAT[TRE OF APPLICANT(S) b?o l 01~ DATE ***Aay 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. 0$!0~ :~., _. ~a~ 1:?1 ?~~~Ffi~~ THE GIiANTURJ Dauald ~V. mnnte~ an~+ Mary C. >3aate, hls ~ fe Whose tax nsailing address is: 1828 280th 3t., Glenwood City, Wfsconsin 54018, for the cor~ideration of No/1U0 Dollars, and other considet~tions fn bend {raid, CONVEY and QUIT CLA1M to Donald W. lgonte and Mary C. ante, Trustees of The Borate Fau:tly Truer, Dated October 7,1998, at 1628 280th St, Glenwood City, Wisconsin 5.40] 8 All interest isi the foDlowing described Real Eaters situated in the ~~5:^.t~ ~FQr. l:Fei ~ in the Rtatg ~f V{Ii~onein; to wit: S~V1/4 of SEl/4; El/2 of SEl/4 and NWl/4 of SEI/4 of Section 7; N~NI/4 of SW1/4 of Seetion 8; NW1/4 of NWV4 of Section 17 EXCEPT East 4.58 chains of West 8.12 chains of North 3.82 chains thereof; NEi/4 of NEl/4 of Section 18; ALL in 30.15 IVo money changed hands, so real estate trans~ier tax is not req:ai~d Si~net~ _ doh . Stambul'is, J.D. Date: hereby releasing and waiving all rights and by virtue of the . Homestead Exemption haws of the State of Wisconsin. Address(es) of Real. Estate: 1828 280th Street, Glenwood City, WI DATED this _,,-,~ day of _~ 19,~. signed: ,~,~ ~~',.~- Names Donald W.13onte Signed: r; ~~: Mary , .~:~k,,,,,~y~ • •. ~~a •.• ., ., qr •~~ ~ r, r '••~..,.,.••' y~• Given under rr>,y hand Notary ~~',ignature: /~°°~- {For Recrxders Use} ,- -----..-_--------- r H~G!ST!^A'~ G. + .C c RtCd is Reoad ~ EC 1 a 1996 `: ~t 2:30 P.M ~.~ t.l.F... '~F ~Jsk - Rog~stat of DseGi f Name and R.oturn Address: Donald W. Borate and Mary C. Borate, 1828 280t1~ St. Qlenwood City, Wisconsin 64018 ~arael Iclanxlflcatlart riTum}ssr: 01.8-1O1G-5t), 018-1015-80, 010-1015.70, 018- 1015-F~0, OI6•t415.90, 018.1018.96, O1H•1087.70 and 010-1089.10 ~' .~ .w State of Wisconsin, County of St. Croix ss. I, the undersigned, a Notary }?ublio in and for said County, iri the State aforesaid, DO HEREBY" CER'1'l~",'that Donald W. Borate and Mary C. Borate, his wife, personally lmown tome to be the same persons whose names are subscribed to the foregoing instrument, appeared before me this daty in person, and ac}rnowledged that they signed, sealed and delivered the said lest; ument as theut free and voluntary act, for the uses and purposes therein set forth, ' eluding the release end waiver of the right of homestead. day of `_~U'~yYl ~/^ _ 19. /~~,~ Commission expires: ~~~~,~~ This instrument prepared by: Attdfner John C. Stambulis, 11D22 Sarctl:west Highway, Palos Hills, IL 6D4GG SEND SUBSEQUENT TAX BILLS TO: Donald W. Borate and Mary C. Borate, 1828 280th St., Glonwood City, Wisconsin 540iG Parcel #: 016-1039-10-000 osi2s/loos 03:52 PM PAGE 1 OF 1 Alt. Parcel #: 18.30.15.284 016 -TOWN OF GLENWOOD 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 %MARY C BONTE O - BONTE TRUST BONTE TRUST 1628 280TH ST GLENWOOD CITY WI 54013 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description SC 2198 GLENWOOD CITY SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 18 T30N R15W NE NE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 18-30N-15W Notes: Parcel History: Date Doc # Vol/Page Type 11/13/2007 864048 TD 03/15/2004 756611 2526/422 TD 12/10/1996 553156 1212/630 OC 435/336 ~nnQ ci innnnet~v Bill #: Fair Market Value: Assessed with: ____ __......... _ . Use Value Assessment Valuations: Last Changed: 04/29/2008 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 35.000 6,300 0 6,300 NO 00 UNDEVELOPED G5 4.000 3,900 0 3,900 NO AGRICULTURAL FOREST G5M 1.000 1,500 0 1,500 NO Totals for 2008: General Property 40.000 11,700 0 11,700 Woodland 0.000 0 0 Totals for 2007: General Property 40.000 12,100 0 12,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ,,, ' ~_r- ---~ ~. ~.~ .~ /~ ~M .. - {.~ _ '~ ~~. _ F A~fam3i~ ufi~tau~C~~rsip:~+i~s tit~_~~+'Faa~ai~zMs. ~hane~ Rv~f Vin~I ~~. ~~~ ~~erg~~ss Tubs Bullet: Lights above ~`ireplace ~e%g Fes: I~i~iu~ ~+r~m i~utch. ~4"x3~" ~kylg€~t ~ra~ ~~r~~ Lights '+~ad-hu~~ ~~rep~~~e ~3ay ~~vw ~e7mc~~e ~s Bc~~~e Panel feel ~?€ra~r E~terivr ~ ~~ Paget 4285. Ss~. Prase llev~ R~.d +~ ~f~t~~~: F~~~sx 1~{# ~2~=$kf ~~ + ~1~~ ~~~-~~~J • ~~.#~~rnandca~r.tryhc~~;n~-cant ~