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HomeMy WebLinkAbout016-1061-50-000/isconsin Depar~m~nt of Commerce PRIVATE SEWAGE SYSTEM 3afetyand Building'Division INSPECTION REPORT GENERAL INFORMATION , (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Tone, Tom Glenwood Townshi CST BM Elev: Insp. BM Elev: BM Description: ,^~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ ~`l t'G~at.~- ddb Dosing Govw~ c~5~ Aeration ~ ~,~ Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~~~ ~~ t ~ Z7 z~ f _ 9 ~ Aeration Holding PUMP/SIPHON INF ATION ~ ~ Manufacturer n De nd / 9 ~, ~~ ~ GPM 1 r Model Number ~~~ ~, TDH Lift Fr Los m Head ~ TDH t Za, [~ c. ~ t ,~j Z9~Z'~ Forcemain Leng~~ ~ Dia. Dist. to Well ~ 3~ SOIL ABSORPTION SYSTEM county: St. Croix Sanitary Permit No: 453300 0 State Plan ID No: Parcel Tax No: 016-1061-50-000 Section/Town/Range/Map No: 29.30.15.429 ELEVATION DATA STATION BS HI FS ELEV. Benchmark 3. ~~ /e~.w ~a~ Alt. BM ~ Bldg. Sewer )$, Lt; JT ~4 54 SUHt Inlet ~g.9c~ ~y. i~~ SUHt Outlet Dt Inlet Dt Bottom 'LZ ~ 35 ~ ~ • ~ Header/Man. 2 ~Z~ 9tk1 - S(® Dist. Pipe Bot. System 2 ~.~ ~~~ 13 Final Grade I `~ t Coverq ~ ~; ~ -Z~ ~~ , ~' _ 6,~~.. f ~ i . ~ 9 9 . ~o BED/TRENCH DIMENSIONS Width ~ ~ Length~Q ~ No. Of~Tren s (1J PIT DIMENSIONS No. Of Pits Inside Dia. Li uid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: ~~~ Typ System: l~l ~~,.~ ~ ,•,~ r ~ UNIT ModelNumbely~ DISTRIBUTION SYSTEM HeaderlManifold ; r ~ ~- Distribution\~(s Z, r I ~ y L \~ ~i x Hole Size ~ ~ \ ~ ~ x Hole Spacipn~g 7 ~ Z Vent/to Air Intake / 5 Length_ Dia ength Dia Spacing i ` d SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Svstems Only Depth Over t Depth Over xx Depth of xx Seeded/So ded xx Mulched Bed/Trench Center '~ i -~ (~ ~ Bed/Trench Edges Topsoil ~--, Yes ~ No Yes ~ ~ No ~//, Z ~Ci.y COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~/ z-~ / C ~ Inspection #2: / / Location: 1332 290th St~U~nk~nown (SE 1/4 NE 1 29 ON R15W) NA Lot f \Pl'O eca~ d~ Parcel No: 29.30.15.429 1.) Alt BM Description = "~~ ' ~ C-O"~~ ~/ ~ ~-5 ~~~~~ ~ `^~ ~`^' ~pp~'` - Z~ P U~-~l 2.) Bldg sewer length - -amount of cover = ~~ 16 ~-. /" ~ c--fcSt-T' ~U r"~ ~ P~~A~J,~,1,~.. Wt 1 ~. 3.) Contour = 9 ~ Ip Y._ _._ \ _ _._~1? ~~~ ~~ i5~ Plan revision Re uired? Yes No ~ ~ ~~ ' ~ i - --- _ _ ---_J I~ O~ J ~ . Use other side for additional informat' n. I 1_ __ _ __ ~ / SBD-6710 (R.3/97) Date Inse tor's ture Cert. No. Safety and Buildings Division County` ~x ~/ ! '~ ` ~ ~ 201 W. Washington Ave., P.O. Box 7162 C ` iseonsin M,dison, WI 53707 - 7162 Sanitary ermit Number (to be filled in by Co.) De artment of Commerce (608) 266-3151 3 ?,. ~ Sanitary Permit Appli State Plan I.D. Number ~ ° In accord with Cornm 83.21, Wia. Adm. Code, personal ' orma e~~'? l ~ ~Z~ . ~ r?.~ftu s ~ ~ may be used for secondary purposes Privacy La ~ , s15.04(1)(m Project d ess (if differen[ than mailing address) ~~ ~~ I. Application Information -Please Print All Informati ~ ~ ~~~ ~ S 200 ~ ~,~3~ 2 0 ~ . Property Owner's Na me / ':~ I, CnUIX C;U',)N~i`.' ZUNW Parcel fl ~bee#- '9io~k'~Y--' C ® ~ G G OFFICE= ~ ~ ®- ~p-~ . ,2~ Property Owner's M ailing Address r .; _~r~~ i ~~ - -~ / Property Locarion ~ ~..z ~ ~, ~ ~ - 3 ~~ - _S~ Section ~~ ~~ ~'~ Ci ,State Zip Code Phone Number . ~ t, ~~~il~c`~I~ l., I ' fir-` © ~ircle o e) R ~ S E T n N II. Type of Building (check that apply) 5 ; . ~ ~ CSM Number N bdi i ' S 3 1 or 2 Family Dwelling -Number of Bedrooms v on ame u ^ Public/Commercial - Describe U u.~tyw. -" t'LO i ^ State Owned -Describe Use Jr ~ lid ~°C City 'llage 1~Township of ` D = .D ~, III. Type of Permit: (Check only one box on line A. Coin etc Gne 'f ap ca le) A' ~ New System ^ Replacement System ^ Treatmen olding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner 1V. T of POWTS S stem: (Check all,that a 1) - Q ^ Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ~' 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~~te(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation ~ f~ C 1 ~ ~ ~'""'.' (~ ~-~~ © ~ S VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Corstructed Glass New Existing Tanks Tanks Septic or Holding Tank ~~~ ~ ~ / ~~~'~ Aerobic Treatment Unit ~ ~ ~ / , [f ••' a ~/CJ Dosing Chamber ...~- VII. Responsibility Statement- I, the undersigned, assttme responsibility for ' allation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumbe 's Si cure P/ PRS Number Business Phone Number r ~ ~ s ,~ ~z- ! ~ ~ ~3 ~ -2~ Plum is Addre ss (Street City, Stat ' Code e ~ ~ .5 ~ ~~ / C-s1 '~ [.~ L. C, ~ ~ a"rt" 2 r- VIII. Count /De artment Use Onl Approved ^ Disapp?o Sattitary Permit Fee (includes Groundwater Date Issued I uin Agent Signature No Stamps) ^ O en Reason for ntal Surcharge Fee) ~~~_ f) ~ ~. C SYS o ApprovaU us_fe>F-Bisepprav~" 3~ ~ CSC 1 Septic tank, effluent filter and ~r- ee~ J S-. c~ ~_ ~~ ~_ dispersal cell must all be serviced /maintained t ~ as per management plan provided by plumber. ~ ~ ' ~1 t~' hQ~T" ~Q p`~ , ,, 2. All setback requirements must be maintained ~ ~ i~ ~ . ,, . ~ ~ e~ as per applicable code/ordinances. ~J Attach complete plain (to the County only) for the system on pater not less tha~li 81/2 x 11 inches in size SBD-6398 IR. 01/03) ~ P~~~ ~ ~.~ -:;a+' 1' .+~ r ~, ~ N ~ I 1 i N -n -~, ~ ~~ ~ ~ ~ ~~ ` N Vj -d ~ ~ ~ ~, o .~ l °I~ a / ,` .~ ~~ ~~ ~ N~p(~ ~ ~~ ca ~ Hof- F~' ~ ~ lCr ,q - >~'~ ~ ~ aN; ,„ moo v~ o, °. ~_ n „_ ,\\ ~~ ~~~. ..,` ~ . ~ ~ p ~ eJr°~ N p ~ . N ~ ~~ ~ wG ~i ~ L M ~ m ~ m Z~ ~ o ~; i m° Z ~~ a m I ll 1 I- 1 ~ 1 ~ I p~ ~. ~ ~ _ .sa .~ ~ O` I -t1 ~ ~ .~. e o ~Q~l ~" II~ ~~ ~ nZ I ~~ ~ ~ ~ i l~ ~~ ~\ t" 1 Li ~ y ~~ O ~d commerce.wi.gov isconsin Department of Commerce Safety and Buildings 141 NW BARSTOW ST FL 4TH WAUKESHA Wl 53188-3789 TDD #: (608) 264-8777 www. com m e rce. state. wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary May 17, 2004 CUST ID No.224617 LYLE J MYERS NORTHLAND PLUMBING INC E1556 STATE ROAD 64 BOYCEVILLE WI 54725 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/17/2006 SITE: Tom Tone 290TH St Town of Glenwood, 54013 St Croix County SE1/4, NE1/4, S29, T30N, R15W Identification Numbers Transaction ID No. 997201 Site ID No. 683295 Please refer to both identification numbers, above, in all cones ondence with the a enc . FOR: Description: Mound, 3 Bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 957437 Maintenance required; 450 GPD Flow rate; 29 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1lOl), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.O1/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD- 10706-P (N.O1/O1). In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, th~awn~r must comply with the operation, maintenance and monitoring duties as described in section VIII c~io~d~p~i,et~[ manual. A copy of this information must be given to the owner upon completion of the ~pje~t4'~~%,..~ "•~~~„ ;~ f. ljs~E ~~ ~'~•. ~~ .gyp Per scale, the slope appears to be 10 1/2%, not 7% as indicated in the plan submitta . This w~ t~i~itl;d in the field prior to installation of the mound. If the slope is 10 1/2%, some of the mou~ ensio~„a ~~de miscalculated. With a 101/z % slope, the downslope sand fill depth (E) would be 13.3~rIa the ~~ifi required endslope width (K) would be 8 feet, and the minimum required downslope toe width (I) w 10.6~The total mound width would be 20.3 feet, with a total length of 106 feet. FSA, The soil application rate id .6 gal./sq.ft./day, and the minimum required basal area is 750 sq.ft. If the slope is 101/z %, and mound dimensions are adjusted accordingly, the available basal area will be 1404 sq. ft. LYLE J MYERS Page 2 5/17/04 Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. 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 of Sec. 145.20(2)(d), Wis. Stats. 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. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Julia ALewis-Osborne POWTS Reviewer 2 ,Integrated Services (262) 548-8638, Fax: (262) 548-8614 j lewis @ commerce.state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 __ Mound System Cover Page pg 1 of 6 ~~~~~~~ Project Name: TONE-MOUND Owner's Name Tom Tone Owners Address 1386 290th St. Glenwood City, WI 54013 - i-_ ~.._ --- Legal Description ~, se ' %<, ~~ NE ', ~ Y< Sec 29 T 30 N, R 15 i, w ! ~ Township Glenwood County (Saint Croix ~! ~ Subdivision N/A Lot# Parcel I D# RECEIVED Table of Contents pg~ MAY - 7 2004 1 Cover page 2 Mound Sizing Calculations T'YS BLp~. ~~V. 3 Pressure Distribution Layout and Dynamics 4 Dose Tank 5 Management and Contingency Plan 6 Plot Map total # of pages: 6 Designer Name: Lyle J. Myers MP/License #: I.D.# 224617 Date: 5/3/04 Ph. #: 7156432520 Signature: ~..::.< Mound System Design Methods Used `~~~~ per "Mound Component Manual For Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD-10691-P (N.Of/01) , ~U ACS per "Pressure Distribution Component manual for Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD-10706-P (N 01/01) F,~ c~, Spreadsheet provided by: 3bAdvisement N12486 220th St, Boyceville, WI 54725 Ph:715-643-6068 email: 3bar"a)3badvisement.com Mound System Page 2 of 6 Mound Sizing Calculations Project Name: TONE-MOUND Site Conditions 1 _. Project Type: i 1 or 2 Family Dwelling ' ~ Slope: 7 # of Bedrooms: 3 Depth to limiting factor: 29 in. Absorbtion rate of fill material: 1 gal/ft2/day Absorbtion rate of in-situ soil: 0.8 gal/ft2/day Effluent quality Eft#1 I, • ~_-~ Max BOD effluent value: 220 mg/I Max TSS effluent value: 150 mg/I Design of Entire Fill Cell depth at upslope edge (D): Cell depth at downslope edge (E): Distribution cell depth (F): Cover thickness over edge (G): Cover thickness over center (H): End slope width (K): Fill length (L): Upslope width (J): Downslope width (Toe) (I): Fill Width (W): 7.0 in. 11.2 in. 9.5 in. 6 in. 12 in. 7.7 ft. 105.4 ft. 4.7 ft. 8.5 ft. 18.2 ft. Design of the Distribution Cell Basal Area System Design Flow: 450.0 gal/day Basal area required: 562.5 ft2 Distribution cell width (A): 5.00 ft Basal area available: 1215 ft2 Distribution cell length (B): 90.0 ft Area of Distribution Cell: 450.0 ft2 Observation Pipes Contour Elevation of Mound: 99.10 ft Location from end of cell (Z): 15 ft System Elevation of Mound: 99.68 ft Final Grade of Mound: 101.48 ft Mound Plan View J /Qbsenration Pipes ~~ ~ K=- ~'~ E~i~~trib~_ition Cell. ~:~ Es ILK 1 I Tilled Area/Fill Material L Mound Cross Section Final Grade __ ~ ., -__ Observation Pipe Synthetic Fabric :- , ~ -- G Distribution Gell-~=~_., - -- _ 'ti. ` tii f o System Elevation , ~n s ,", ~ '~~ F a.., b ~ a -.,~~ Goner Material; ~'' ~,~.% I invert ' u Fill Material,,` r ~ 1 ,~' Tilled Area ~~Slope u ~"`~-Forcemain~`System 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)(g) Distribution Cell to have minimum 6" aggregate below lateral and 2" above. Mound System Pressure Distribution Calculations Project Name: TONE-MOUND Lateral Layout Lateral elevation: 100.2 ft Rows of Laterals: ~2 _ ! ~ Manifold type: Cnter ~ Orifice diameter: ~ 0.125 ~ In. '--- - # of Laterals: 4 Distal Pressure: 5 ft Lateral Length: 44.5 ft Orifice Spacing/Distribution Orifice spacing (X): 28.86 Inches Orifices per lateral: 1 g Avg. ftz/Orifice: l ~) 5.92 ft2 ~I Lateral Plan View Lakeral Length ~ ~ Turn-up wlball valve or cleanout plug Orifices on botkom of lateral equally spaced PVC laterals and forcemain to comply with specifications per Comm 8d.30(2)(e) Forcemain connection via tee o~ cross to manifold at any point Clean Out Detail Clean-out plug Grade ror ball valve Observation Pipes ~Va#er tight cap or plug Long Sweep 90 ortwo ~5's--.t 6" Minimu~ .51ot Note: Closet Collar may be used in place of 3!B" bar X318" Bar Page 3 of 6 Lateral/Manifold Design Lateral diameter: 1'iZ ~ In. Lateral spacing (S): C~ft .Lateral to cell edge: 1 ft Lateral discharge rate: 7.83 gpm System discharge rate: 31.31 gpm Manifold diameter: 2 i . In. ~-' Manifold length: 3 ft Forcemain Friction Loss Forcemain length: 80 ft Forcemain diameter: '~ ~ ~ In. Friction loss in forcemain: 1.678 ft ~ ~ t Z~ ~~~ Lateral Slde Vlew /. Lawn Sprinkler Box Mound System Page 4 of 6 Septic, ,Pump and Dose Tank Project: TONE-MOUND Tank Information Pump tank manufacturer: Wieser Concrete Pump tank size/model: wiooo/seo-r-tR Pump tank gal/inch: 17~,~~~ Actual Pump Tank Volume: 646 gal Tank bottom elevation (inside): 84 ft Septic tank size/model: ! wiooo/65o-MR Pump and Filter Pump Manufacturer: Little Giant Pump Model: 9EH Effluent Filter: Zabel A100 Note: Access opening of sufficient size to be provided to allow removal of filter Opening to terminate at or above grade. Pump Tank Diagram Watertight Locking Cover 4 Inch ~j With Warning Label Finished Minimum r, ,~r,,e,,- Outlet Location Eleet. per Comm 16.28 and am NEC 300 ~ Weep Hole '~ or Anti- Siphon 8 Device c D Pump must be capable of: and head pressure of: Dosage Volume Forcemain drains back to tank? OQ Yes O No Lateral void volume: 18.8 gal Dosage to absorbtion Cell: 90.0 gal Forcemain volume: 13.9 gal Total dosage: 103.9 gal Total Dynamic Head Are laterals highest point? y if not, enter highest elevation: 0 ft System head (distal x 1.3) 6.50 ft Vertical Lift ("D" to lateral) 15.52 ft Friction loss in forcemain: 1.68 ft Pressure loss from filter: ~ft Total dynamic head (TDH): 23.69 ft Dose Tank Levels In. Gal A Reserve 21.9 372.1 B Pump off to Alarm 2.0 34.0 C Total Dosage 6.1 103.9 D Effluent depth for pump 8.0 136.0 Total Capacity: 38.0 646.0 FLOW- LITERS/HOUR 31.3 GPM 23.7 Feet 30 W ~ i'g Q 10 0 to y 7.5 H W I $ ~ A 2 z.s 0 Little Giant FL^W- GALLONS/MINUTE 9EH PUMP PERF^RMANCE CURVE I15V 60HZ Mound System Management Plan pursuant to comm 83.54 W. A. C. page 5 of 6 Owner's Responsibility: The component owner is responsible for the operation and maintenance of the component. The county, department or POWTS service contractor may make periodic inspections of the components, checking for surface discharge, treated effluent levels, etc. The owner or owner's agent is required to submit necessary maintenance reports to the appropriate jurisdiction and/or the department. Septic Tank: Septic tank(s) are to be inspected routinely and maintained by department approved individuals when necessary in accordance with their approvals. The use of chemical/biological "treatments" is not required or recommended. If such additives are used, make sure they are approved by Department of Commerce, Safety and Buildings Div.. Effluent filters are to be removed & cleaned as necessary, with provisions to keep solids from passing the septic during removal. No more than 1 /3 of the usable tank volume may be occupied by sludge/scum. 3 year inspection: If tank has greater than 1/3 volume sludge, tank contents must be emptied and disposed of in accordance with NR 113 Wisconsin Administrative Code by an approved individual. If the inspector does not recommend pumping of the septic tank, then the owner must be notified of when pumping should be done as to not exceed 1/3 sludge volume. Septic tank should be routinely inspected to be watertight and of good repair. Pump/Dose Tank If an effluent filter has been installed in the pump/dose tank, it must be removed & cleaned as necessary, with provisions to keep solids from passing to the mound component during removal. The pump, float switches and alarms must be inspected at least every three years for proper operation. Pump/dose tank should be routinely inspected to be watertight and of good repair. Mound and Lateral System The mound system component must remain free of ponded surface water prior to pump operation. If 4 inches or more water level is detected in the observation pipes, the owner must be notified of possible problems/failure. The designed daily flow capabilities of the component should never be exceeded. Trees and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the component. Activities OTHER than mowing/maintenance (i.e. excessive walking, pets, vehicles, etc...) could compress the component and reduce it's absorbtion capabilities and/or possibly cause it to freeze in winter conditions. Lateral distribution pipes should be flushed out/tested every 18 months using the cleanout points at each end of the component to remove scum that may clog orifices. Performance Monitoring: Performance monitoring must be done at least once every three years following the installation or at the time of a problem, complaint, or failure. Contingency Plan: If the septic tank, pump tank or any of their components therein (including floats, alarms, pumps, etc) become defective, the defective tank or component must be replaced immediately to ensure that the system can operate as designed. If the mound component cannot accept wastewater or ponds wastewater to the surface, the component must be repaired or replaced in it's current location by either: extending basal toe to provide added absorbtion area; or by removing the clogged bacterial mat,aggregate cell, and distribution piping within the mound and replacing said components in order to return system to proper working order as required. i~ s N ._c) 0 '.~ t_ EQ/Cc~ ~%~E-- -~- --- -- ----- Nd Y ~~~ W Ng • ~ 3~ ~~o x~ ~ ~,,~ ~9~ ~~ ~~ .~ may, l7d ~ N ~- ,, „ '~ o 0 -~ o , ~ ~ ~~ ~_ . 1 n ~~t ~ o ~ ~ o ~ ~ o ,`~ ~. ~ ~ ~ N cJ ~' ~ g ~ L • ~ R+ ~ a ~, o ~ m # p ~ -0 N ~ p c ~ °~ L b m Z ~~ n ~~ N ~ l '`~a~ a '~ ;~ w I ~ I v- • ~ I .~ -~ °. ~ .a, e o ~ ~ n of nZ ~'~ ~ L .~ Q M o ~ ~~ ~ C °~ N C ~ .Q ~ 0 ~ Z Z (, 1 ' ----- i - - -..~ Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT Page ~ of in accoraance wim wmm aa, vvis. Ham. was Attach complete site plan on paper not less than 8 112 x 11 inches in size Plan must . include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensio»s, north arrow, and location and distance to nearest road. Plea a pri~ ~t1~~en. °? evi ed by Date Personal information you provide may be used for secondary purp~es (Pri~acy Law, s. 15.04 (1) (m)). ~ p '~ Properly Owner A F R ~ ~ ~ ~ ~ ~ Property Location ~ /y~ T .~/b Govt. Lot S ~ 7/4 /~~1l4 S 2 9 T 30 N R ~5 W Property Owner's Mailing Address Q , ; % : J ~ Lot # Block # Subd. Name or CSM# /~~4 2 90 ,S~r~ir~i`o~~icr. City State Zip Code he u ^ City ^ Village f ~7'own Nearest Road ~7,6aJty~ t~ Gu / .f46 / 3 (~- / S) Zd 5 -¢3 ~ G C-E u./d~w 2 90 fem. -S~ New Construction Use; Residential / Number of bedrooms ~ Code derived design flow rate '¢-~ d GPD ^ Replacement c- _ ^ Public or cemmercial -Describe: Parent material cS~q.uJ D S'TD~~ Flood Plain elevation if appligble ft General comments and recommendations; Boring # ^ Boring C~-~°''r"~ qD y C'E'9 Pit Ground surtaceelev. /a0. O ft. Depth to iimitin~ractor ~~ in. D r ' t Soil A ication Rate Horizon Depth Dominant Color Redox Description Texture Struct Consistence Boundary Roots GP D in. Munseli Qu. Sz. Cont. Color Gr. z Sh. 'Eff#1 'Ef(#2 2 ~-!S /a ye.~ cg/•/ t3S~~ /Jf /~'r cS /~' • S • 8 4 0 3~ /o y2g/~ os n1. / cs - . ~ 5 3 -'~ ~ SYl~ 4~ ~' SY~• ~/g ~l ~ s,. ohs ~S'C / /s.6 ~.~',- C S - . ~. , ~3 Boring # ~ Boring Pit Ground surface elev. JOO.O ft, Depth to limiting factor c..~~~in. Soil A ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/iF in. Munsell Qu. Sz Cont. Cokx Gr. Sz. Sh. 'Eff#1 'EfF#2 l 0-// /o y~e 3/3 Si / 3s~k /n v~r ~ 2~' - 5 •8 Z /l- 2'¢ /o y!2'4/¢ ~S % ~ S~b fi' ~ r ~~S / ~' . S . ~ 3 293•s ~. s y~1/ J'ic/ 2 sbk .n /~r cS - . 4 • lp -¢ ~35 /f I ° ye, ~/~ ~. s ye `/s' ~'l -'spa fs s o nt. r ~s -- . 4 'Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Eftiuent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST ame (Please Pp'nt) Sign ure CST Number Address to Evaluation Concluded Telephone Number 293 /~af~Z. i9Y~, G~~/w~~ry ~/sgoi3 ~-Z-a~ ~/s-2G5-~J~2 l Property Owner ~p I1't O h/~ Parcel ID # Page 2 of Boring # ^ Boring Pit Grourxi surface elev. 9~• ~ ft Depth to limiting factor 2 9 in. Soil icatbn Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rook GP D/f~ in. Munsell Qu. Sz Cont. Cobr Gr. Sz Sh. "Etf#1 `Eti#2 / o-/z /oy2-/3 si/ c3.s6k ~/f'r cS 2 ~' . 5 •8 2 I2 -23 /o y~ ~/ d'~ / ~.3s~6h rr-v~'r c S / . 5 • S t3 23'27 ~ • 5yie'F~ ~i c/ 2s /K /I' ~'~- S - . -`~ • ~ 29•~z is y~ ~ ~• syR `/g ~l ~S ~ Esc ~ ~x l e s - ^ Boring # ^ Boring ^ pit Ground surface elev. ft Depth to limiting factor in. Soil A icatbn Rate Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GP DfIf in. Munsell Qu. Sz. Cont Cobr Gr. Sz. Sh. "Eff#1 'Eff#2 ^ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ^ Pit Soil A icetbn Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/(~ in. Munsell Qu. Sz. Cont Cobr Gr. Sz. Sh. *Eff#1 "Eff#2 * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L " Etfluent #2 = BODS < 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. .Cp .~ SBD-8330 (R07/00) 0 s ~~ n ~~ i~ ~ ~ ~.~ t~e~i(f~py ~` ~' m ~ ~ ~~ L ~ ~ ~ ~ m ~ x °~ ~' ~ ~~ ~ m ~~ c ro L N ~ ~ ~, ~~ W N ~' 0 ~ ~~ ~, ~.~ ~~~ o~ ~ ,~ ~ . ~~ b~ .~ ~~ mo Q z ~~ 1~ 0 0 z n h W I I ' ~- I ~ ~ ~ I I r1 ~~~~ ~ ~ ~m I ` I ~ ~ ~ ~ I ~ I ~ ~ I ~ I ~ ~ i D~ 0 I ' ~~ ~ ~ ~. i °~ ~ ~ I I :~ ~ ~ o ~ 0 0 N` ~ o\ ~ ~ ~ ~wa~ N ~~ '' ~~ ~ 0 ~ ~ ~ I o0 -~ ~~~ \~~ \~~ l m ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerB uyer , ~ /e to ~ ~(E Mailing Address 2,ROf~ S~- Property Address o~ '~ S'f l~.c=->~ o~a°o ~ I - (Verification required from Planning Department for new construction) ~ ~_ City/State Gt.~~.t wow ~T7,~W ~ Parcel Identification Number U - - r~ ) ~/ LEGAL DESCRIPTION Property Location ~~ `/., l~ ~ `/., Sec. 2 9 , T 3o N-RAW, Town of 6 e.E•~fu~a~c~ Subdivision ~~ Certified Survey Map # '~ Lot # Volume ~ ,Page # Warranty Deed # (~ ~ ~~~ 7` ,Volume o~ ~ 30 ,Page # ~ ~ ~ Spec house ^ yes ~ no Lot lines identifiable .yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days f the three year expiration date. ''nn~~ C/ SIGNATURE OF APP ICANT DATE OWNER CERTIFICATION I (we) 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. ~/ SI NATURE OF APPLICANT DATE ****** Any information that is aus-represented may result in the sanitary permit being revoked by the Zoning Department. ****** «* Include with this application: a stamped warranty decd from the Register of Deeds office a copy of the certified survey map if reference is made is the warranty deed -T,n TAE air, ~b~ o ~~ ~~~ .~. :, ~J/^ an.T ~- ~ _ i ~ressx-~ ~r~ rs ,r as .~ air x asszr _ 58' Y -I 18 15B 9 BDRJ/ .8 BATB U 2030P 222 I STATE BAR OF WISCONSIN FORM 2 - 2000 Documentlvumber WARRANTY DEED This Deed, made between Rose C. Mundt, a single person Grantor, and Thomas M. Tone and Laurie J. Tone, husband and wife as survivorship marital property Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum:) East Hali of East Halt of Northeast Quarter (E'/: of E%a of NE'/.); South 100 rods of West Half of East Half of Northeast Quarter (W'/a of E'/: of NE'/,) and East Half of Southeast Quarter (E'/: of 5E'/.) EXCEPT South 400 feet of the North 697 feet of East 533 feet of Northeast Quarter of Southeast Quarter (NE'/. of SEY.); And EXCEPT Certified Survey Map in Vol. 15, Page 4177 located in the Southeast Quarter of Southeast Quarter (SE'/. of SE'/.); All in Section Twenty-nine (29), Township Thirty (30) North, Range Fifteen (15) West. Area Es96~~4 KATHLEENI H. IiALSH REGISTER OF DEEDS sT. CROIx co. , 1fI RECEIVED FOR RECORD 10-31-2002 8:30 AM WARRANTY DEED EJ(17~7 # 17 REC FEE- 11.00 TRANS FEE: COPY FEE: CERT COPY Ffifi PAGES: 1 Name and Return Address Thomas A. McCormack PO Box 2120 Baldwin, wI 54002 016-1061-10 Parcel Identification Number (PIN) This is oat homestead property. (is not) This deed is given In full satisfaction of that certain Land Contract between the parties dated November 3, 1999, and recorded io the office of the Register of Deeds for St. Croix County, Wisconsin. on November 8, 1999, in Volume 1469 of Records, at Page 54, as Document No. 613428. Exceptions to warranties: Easements and restrictions of record, and except arty liens or encumbrances created or suffered to be created by the acts and defaults of the grantees, their heirs, successors or assigns. Dated this ~ ~ ?O~ day of October , 2002 * * Rose C. Mundt r • AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSiN ) ss. St. Croix County ) authenticated this day of Personally came before me this °~~ n~ day of October 2002 the above named Rose C. Mundt _ * ..t. ,,..,~1~ , 11,,/I TITLE: MEMBER STATE BAR OF WISCONSIN '• ~~ (If not, to me known to be tha~jtff3b~j(s~ yv'jsoS~C~CUted the foregoing authorized by § 706.06, Wis. Stats.) ins nt d ackasiylclei tl~e sat`t>~Lt` ~=: _ _ r - TIiIS INSTRUMENT WAS DRAFTED BY * a'~o ~'+ ' a ~' ><'~Z Thomas A. McCormack Notary Public, Stafp ~ ;W l~ Baldwin, WI54002 My Commission is ~iet~allent. •~t`~expiration date: (Signatures may be authenticated or aclmowledged. Both are not necessary.) ~~~^- ~ ±r...~..~ ~ ~~ , oZU U S •) * Names of persons signing in any capacity must be typed ar printed below their signature. ~ ""~~~~""•t ! WARRANTY DEED STATE BAR OF WISCONSIN INFO-PRO (800)655-2021 www.infoprofonns.com FORM No. 2 - 2000 ~t :'~ 76394.6 CERTIFIES AP LOCATED IN TH NE1 /4 OF THE OF SECTION 29, T3 W, TOWN OF GLENWOOD, ST. CROIX COUNTY, WISCONSIN. N89°50'34"E ~ V 1979.98' N1/4 CORNER ~ SECTION 29 "' VOU.8 PAGE 4756 KATAL~EC H. MAGSR T--` REGISTER OF DEEDS ST. GROIX CO. , MI RECEIYED FOR RECORD 05/26/2004 03:30P![ CERTIFIED SURYEY lIAP REC FEE: 13.00 COPY FEE: 3.00 PAGES: 2 LEGEND ALUMINUM COUNTY SECTION CORNER MONUMENT FOUND OWNER ~ 3/4" X 18" IRON REBAR SET, WEIGHING TOM TONE 1.50 LBS. PER LINEAR FOOT 1386 290TH STREET • 2 3/8" O.D. IRON PIPE FOUND GLENW000 CITY, Wf 54013 suRVEYOR ® MASONRY NAIL FOUND • • • 100' BUILDING SETBACK EDWIN C FLANUM NORTHLAND SURVEYING, INC. 856 A HWY "65" / P.O. BOX 1 ~~ SLOPES OF 20%> ~ I ROBERTS, WI 54023 -~--x-.--x-EXISTING FENCELINE ~r apdp'~~~ ~,pa~~~ C.T.H._"t~" ~ N89°50'34"E 659.99' i sr. c~oa couriT p~n~aq Zp'Nq snd Psis C miU~ MAY 2 6 2D0 It not reoordeo vwthin 3u ~ of approval date approval Ifbe nu11 and void ~~ Z ~~ O ~~° N ,~ ° :o W 0 ~w Y ~ N ~ ~ ~ 2~ 3 i ~ 1 AA O ` c UZ w ~~ `Q ~ ;~ o w ~ ~~ ~ w o : ~ c ¢ 4 U Z o _ ~ U ~+ m ~ ~ " m -a m Z m A O OT T ~ x~m m~ z m ,~ T+/- ' A O NORTH LINE OF THE NE1/4 N89°50'34"E 626.56' r ~ Ci"~,~'l~i ..........l..:y~~~. ............................................ N f f ~~ IID LOT 1 I ;~ 15.00 ACRES INC_ RNV fN 653,399 SQ. FT. ~~ 13.44 ACRES EXC. RNV I~ ; 585,416 SQ. Ff. I ~_ u FEB ~ 8 (1 FOLN~q /ON SILO h L/~ w ~~~ ~I ~ ~~~ o ~~ r I SEPTIC VENT SHED Q HOUSE WO ~~ ~~ ~ TING SILO ~ DRIVE 33'I ~~~ ~ 618.48' ~ 1 ~ I1 ., 1A4 ao' ~ ~e~ nom' i .-L.'' 1 659.48' MG!]G?LlQ_`t3_u__GD_[~LaM©~ _OD_~f~1C~D C3Z7_pdL_G_11`I~_u_'GG3 - - - - ----------- - SCALE IN FEET 1" = 180' O 150 30o SHEET 1 OF 2 SHEETS VoZ 18 Page 4756 .~ .O/]`~~vo QO~ ~qGo ''~ I `` ' `~ ~~ _ ~ _ ~NE CORNER ~ SECTION 29 ~'i~. ~/off /-~o ~~~SC 6' I ._ I ~~ ,~ I~~ I ~~ ,o .o f'~ ,~ ~~~ ~ n^ i I l • Ei/4 CORNER SECTION 29 O m~ ~~ g~ "' m o~ m~ ~° Z D T ~ 0 mD 0 .~'~ a Z p ~ ~i-n~z~s r~]~rr~ ~ m r C)5~0~'O ~'~' y„m~ N v c7p~~Om O ~ ~ m Z ~ c~-~NCm Z O ~ ~ m w O n m~ O D C ~ ~ T v -r ~ _ O m m 2 ~ D ~~~~~~ c°~^'Z~ ~~~m ~~ l :'~ .. .. CERTIFIED S V RVEY MA1'~ LOCATED IN THE NE1/4 OF THE NE'1/4 OF SECTION 29, T30N, R7 SW, TOWN OF GLENWOOD, ST. CROIX COUNTY, WISCONSIN. ~ s 3 ~ 4 s Y0118 PAGE 4756 KATf~EN H. MlCC.~"`-` REGISTER OF DEEDS ST. CROIK CO. , NI RECEIVED FOR RECORD 05/26/2004 03:30PM CERTIFIED SURVEY MAP REC FEE: 13.00 COPY FEE: 3.00 PAGES: 2 LEGEND ALUMINUM COUNTY SECTION l ~ CORNER MONUMENT FOUND ~ Q OWNER '' ~ 3/4" X 78" IRON REBAR SET, WEIGHING TOM TONE e ~' 7.50 LBS. PER LINEAR FOOT 7386 290TH STREET a ' /~ 2 3/8" O.D. IRON PIPE FOUND GLENWOOD CITY, WI 54073 ~ ~~~/ ~ I ® MASONRY NAIL FOUND 700'B I DINGSET CK SURVEYOR ~ Q ••••••••• • ~ U L BA 856 A HWY 65`I! P O BOX 74C ^~~,~" ~ ~ SIOPES OF 20%> ROBERTS, WI 54023 I - - - - E?C STIN FENCEI N ° e ~[~]Dr EX STIN FENCEI N ~ e L~°,GV]DO rCS yx--K 1 G I E MG~]C~L~,Q44C~D ~ C.T.H._"Ci" ~ ~N89~°50'34"E N89°$0'34"E 659.99' V 7979.98' ~ ,~, NORTH LINE OF THE NE7/4 N1/4 CORNER ~ N89°50'34"E 626.56' SECTION 29 APPROVE I sr. cROlx .................................................................................... e Plannkq zo^I"4 >Md Ps~ks C ~~ ~mg MAY 2 6 200 LOT 7 I3 K not recorded wiu7kt 30 ~ of 15.00 ACRES INC. R/W , a~eldaseaPproval Ifbe 653,399 SQ. FT. ~ ~~~; ~ I'~ nuu ants void ,m s+! 1 44 ACRES EXC. R ~J ~ i~ 1~ ~ 85,416 SQ. 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