Loading...
HomeMy WebLinkAbout016-1062-95-000i I I I chi ~ N N N O ~ ~ < <. ~ GO (D p_ ~ 7 7 CD ~ ~ C ~ ~ ~ a I oo °o ~ ~' °~ °' m O ~ = C7 C C C7 I 3 i I a U, V D (D (~" A N 'D j W I ~ ~ o c_ I ~- -, o I y ~ I c I a I m ~ I ~ ~ fD I I I I C (D I 3 m N I I I I C N Q ~ ~ n . d O O d ~ 7 O ~ Z n N O ~ ' N 7 ~ I N O y O ~ ~_ I ~' O a I ~ I N N Q I o ~ I oa c~cno I ~ ~ ~ o d f ~ ~ d o C ~ ~ ~ '~, 3 p hnD ~ ~ ~ A d ~ cD ~ ~ ~ ~ i ~ ~k O O O` it ~ ~ O ~ N it ~ O O O ~ ~ i Q ~ N N i N ! -~ ~ O W 7 N ~ ~ O ~ Ot N O. '. a O N m 0 ' 0 ~ (\ 0 A ~ ~ ~ ~ _ 3 ~ N ~ N o ' O C a , 3 ° .. ~ O O O a n ~ ~ ~ =` ' ~ , ' 3 ul t/J f~ m ~ N N d ~ N Ca O 3 m _ ~ ~ m °. N 3 o ' I D D c ' 3 i a ~~ m N N S 01 7 i A ~ ~ N N p Z ~o C ~ A K a j' ~ ~ ~ .. N ' ~ Z w N 00 ~ ' m o ~ a ~ ~ Z 0 3 ' ~+~ ~ o ~ " ~ ~ ~ ~ ~ ~ ' ? ' 6 . W N N ~ ~ I C ~ I T C 7 Q a r+ A~ `~ 'Z r~ O ~t A7 O ."~ Q ~` l ti Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and wilding 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 Johnson. Kelvin Glenwood Towns CST BM Elev: ~ Ilns i BM Elev: IB 170.a~ ~•t~f TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~~ ~ S~(L, ~~ // Sb Dosing 1 _ ~l `' 1 \,O J , ll Aeration Holding , TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic t f ~ Dosing t i } I~ 1 u -. ~Z Aeration Holding PUMP/SIPHON INFORMATION wa•lho(Q cs~c!'t ELEVATION DATA county: St. Croix Sanitary Permit No: 404999 0 Sta~,Pl~n~~No: /~ ` D~ Parsec Icel Tax No: 016-1062-95-000 ~ ~'°~l STATION BS HI FS ELEV. Benchmark ~ . ~ } ~ aT •~~' 1 cJD •c7 Alt. BM Bldg. Sewer ~ • ~,y ~jj SUHt Inlet ~~cc'• SUHt Outlet Dt Inlet ,ma=y '~'~~~1 Dt Bottom Header/Man. l~ l Dist. Pipe ~Z. • 3 ! ~ Bot. System 13• ~3 •(o Final rade y w ~ l ~ X02 tZ+ a~ St Cover g.ol ~ -~ E IMENSIONS Width •~/ Length 00 ~~ N . O es ~,~~,f J PIT DIMENSIONS No. Of 'ts Inside Dia. Liquid epth SETBACK SYSTEM TO P/L LDG ELL W LAKE/STREAM LEA ING acturer: INFORMATION CHAMBE Type ON^ ystem: ~ ~ ~ ' ~ U el Number: 1'11CTRIRIITI(1N SYSTEM Header/Manifold iY 2 Length 7' O Dia ~ Distribution ~ , 1 Pipe(s) q Length ~ `•~~ is Z Spacing ~~ D x Hole Size I ~ ( ~ x Hole Spacing ~~ ~?`'l~ Vent to Air Intake / C(lll r(1VFR 1 ..'IS.e«...e c..~•e.•,~ n..~.. .nr Mnnnrl Ar Of.(;rarla Svctems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center Bed/Trench Edges Topsoil a2 Yes No Yes No CO M NTS: (Include • repe;cies, persons present, etc.) Inspection #1 / 7i' Inspection #2: ~i-----t--~ ~~ ~ ~~ t ~( +L ', t ~ Parcel No: 29.30.15.4386 Location: 1340 290th St. Glenwood City, W'I 5p4013 (NE 1/4 SE 1/4 29 T30N R15V1) of 1.) Alt BM Description = 1i.fi~- 5'?' `"^~' ~"r • 2.) Bldg sewer length = - amount of cover = 1 3.) Contour = $B•a ~~.i~ l ~.?'}'1 ~ ~' = 102. ~~J Plan revision Required? ',j Yes i o Use other side for additional informat on. SBD-6710 (R.3/97) - q-- ~, ~ -~-_ _ _ _ -_ - - _ - -- ©Gr 1 IL 1 Date Insepctor's Signature Cert. No. Cf111 ~RS[1RPTInN SYSTEM - ~ / - Safery and Buildings Division Counryr. ,r ~ ' 201 W. Washingtott Ave,, P,O. Box 7162 -.~ • ~,S~j~~,s ~~ Madison, WI 53707 - 7162 Site Address Dep;srtment of Commerce ~ ~~ ~ ~~Gl Sanitary Permit Application eta''' Permt ~ ~ In accord with Comm 83.21, Wis. Adm. Code, personal information you provide tna be used for seco oses Privac Law, s15.04 1 m ~ 9 ~ ^ Check if Revtston I. Application Information -Please Print All Information State Plan I.D. Number Property Own'er'sf game /~~ i n) ~rrx~ s-v~ RECEIVE Parcel Number ,'Z ~, 3 • ! S . 'f ~ . Property Owner's Mailing Address .- Pro rty Locado n ~~ D p~ 5' ~ APR p 8 ^ ~ ~~S 4 ~ 'S~ ' City, State Zip Code one l~mher ~ ; N,R , G Lo umber Block Number o! ZO NING CCU T Y N A OFFlC~ S 'vision Name CSM Number II. Type of Building (check all th t apply) ^Ci 1 or 2 Family Dwelling -Number of Bedrooms ry ^ Public/Commercial - rite Use ^Village Ci~.~- ,p ^State Ow d ownshi ne t Nearest Road III. Type of Permit: (Check only one box on line A (numbering scheme for internal use), Co mplete line B if applicable) A' 1 ^ New 2 Re lacement p System , p 3 ^ Re lacement of 6 ^ Addition to For County u4e S stem _ Tank Onl Existin S stem B • ^ Check, if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numberingssheme is for internal use) ~ 14- -ttp ` 44 ^ Non -Pressurized In-Ground 2]~Mound 4? ^ Sand Filter SO ^ Constructed Wetland . 22 ^ Pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass Sl ^ Drip Line 45 ^ At Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other V. Dis ersaUTreatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Required Pro osed Soil Application Percolation Rate System Elevation Final Grade R l p ate(Ga s./Days/Sq.Ft.) (Min.Mch) Elevation VI. Tank Info Capacity in ,Tonal Number Garcons Gallons of Tanks Manufacturer Prefab Site Steel Fiber Plastic New ExiatinQ Concrete Constructed Glass Tanks Tanks Septic or HoldinY Tank C DosinY Chamber VII. Res onsibility Statement- I, the undersigned, assume reaponsibWty for llation of the POWTS shown on the attached plans. ' Plumber s Name (Print) Plumber's Si cure P MPRS Number Business Phone Number zz / ' ' Z~'~O Plum en s Address (Smet, C ,State, Cod -~ ~ ~ ~^ VIII. Coun /De artment Use Onl Approved ^ Disapproved S~tarY Permit Fee (includes r_- :undwater Date Issued Issuing Agent Si gnature (No Stamps) Surcharge Fee) ~ ^ Owner Given Initial Adverse . S z ` Determination 3 ~ ~ y al C ond Dons ~f APPrQ ns forPPr ~ ~~ ` _ .q - n ~~ Nbu~.~U ~. q!(:~~ csa Sao a~ Ge~Go ~ot,~ p. ~r - t, ~ I_ - p.~., ~ ~ c~ -~ ~ v~.os~ ~ C~J~~iMO~a ~,~,T~-~ ~~j~~~ tt ~N ~~Y y~N~4Aq(t ~ c.c-~'C-°~7,e',lS~ ~----- Attach wmplete plena (to the County only) Por the system on paper not lean than 8112 x 11 lnchea [n size SBD-6398 (R. OS/01) (F1.c~o~ Rh~tly= ~ ~~ isconsin Department of Commerce Safety and Buildings 401 PILOT CT STE C WAUKESIiA WI 53188-2439 ' TDD #: (608) 264-8777 - www,commercestate.wi.ustsb www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary March 11, 2002 CUST ID No.224617 LYLE J MYERS NORTHLAND PLUMBING INC E1556 ST RD 64 BOYCEVILLE WI 54725 ATTN: POWTS Inspector ' ~'ZONING'OFFICE -. ~ ST CROIX COUNTY SPIA 1101 ~ CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/11/2004 SITE: Kevin Johnson 1340 290TH Street Town of Glenwood, 54013 St Croix County N1/2, NW1/4, 529, T30N, R15W FOR: Object Type: POWT System Regulated Object ID No.: 831640 Description: 450 gpd design wastewater flow mound system. 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. 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 Septic Tank Effluent for Private. Orisite Waste Treatment Systems" SBD- 10691-P (N O1/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD-10706-P (N O1/O1). • In the event this soil absorption system or any of its componentparts,maIfunctions so as to create a health hazard, the property owner must follow the contingency plan: as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. r ~: • Maintenance information must be given to the owner of the tank explaining that peri~ic f the filter is required. Access to the ftlter for cleaning must be provided per Comm $4 pro~uct'a~pr,~l ce~di ' • A Sanitary Permit must be obtained from the county where this, project is~iQcated ~y~~¢~rd with the requirements of Sec. 145.135 and 145.19, Wis. Stats. ~'~; s ~~j.I ~ ~~ 'fir n_ 4 • Inspection of the private sewage system installation is required. Arrangements `fr'~'lt~ection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2~~, 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 :, Identific on N Transaction ID o. 711267 Site ID No. 641 2 ;'Please refer to bo i tcation numbers,. above, in all. correspondence with the agency. LYLE 1 MYEItS Page 2 3/11/02 required by the state or the local municipality shall be obtained prior to commencement of construction instal lation/operation. 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, Fed Required $ 175.00 ~ Fee Received $ 175.00 Balance Due $ 0.00 Z~ Thomas J Perkins POWTS Plan Reviewer ,Integrated Services (262)521-5064 , 7:30-4:00 tperkins@commercestate.wi.us Mound Cover Page Agra e RECEivE® MAR 0 6 2002 SAFETY & Bi.DGS. DIV. Project Name: Kelvin Johnson Mound Owner's Name Kelvin Johnson Owners Address 1340 290th Street Glenwood City, Wi. 54013 Legal Description NE ~ %., sE ~' %. Sec 29 T 30 N, R 15 w '! Township Glenwood County saint Croix ~_~ Subdivision CSM Pending Lot# 1 ParcellD# 016-1062-95-000 Table of Contents P9• 1 Cover page 2 Mound Sizing Calculations 3 Pressure Distribution Layout and Dynamics 4 Dose Tank /Pump Curve 5 Management and Contingency Plan 6 Plot Map total # of pages: 6 Designer Name: ale Myers RAG License #: 224617 ,~ Date: 01 /29/2002 ~!~ Ph. #: 715 643 2520 ~,~? 'Q~ ~'c7 lf~! Signature: s'LO~'~ ~Gi~~cF~ Mound System Design Methods Used ~ O,L iy per "Mound Component Marn~al For Private Onsde Wastewater Treatment Systems" (Version 2.0) SBD-10691-P (N.01A01) ~~f` Cry. per "Pressure DistrlbuGon Component manual for Private Onsite Wastewater Treatment Systems" (Version 2.0) S8D-10706-P (N 01!01) ~C~ 6 . Dlu. N12486 220th St, Boyceville, Wi 54725 Ph: 71ra-6436068 email; Y ~ Mound System Slope: # of Bedrooms: Depth to limiting factor: Absorbtion rate of fill material: Absorbtion rate of in-situ soil: Effluent quality Max BOD effluent value: Max TSS effluent value: Mound Sizing Calculations Project Name: Kelvin Johnson Mound Site Conditions Project Type: i or 2 Family Dwelling Mound Plan View ~rDbservatian Pipes ~'` Z--~ o ~k f~~rtic~~ ~- t ~~- . ~ k-K Tilled ArealFil! Material I-~. L Design of Entire Fill Cel! depth at upslope edge (D): Cell depth at downstope 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): Mound Cross Section ed Area ~'"~'"~ Slope ~Forcemain Notes: Fill material to consist of ASTM C33 Sand Distribution cell aggregate to comply with Comm 84.30(6)(1) Synthetic Fabric covering on cell per Comm 84.30(6)(8) Distribution Celi to have minimum 6"aggregate below lateral and 2"above. Contour I 191in. 1 gal/ft2/day 0.5 gat/ft2/day Eff#1 ~ 220 mg/l 150 mg/I ~2ae 17.0 in. 20.8 in. 9.5 in. 6 in. 12 in. 10.1 ft. 120.2 ft. 6.8 ft. 11.5 ft. 22.8 ft. Design of the Distribution Cell Basal Area System Design Flow: 450.0 gal/day Basal area required: 900 ft2 Distribution cell width (A): 4.50 ft Basal area available: 1600 ft2 Distribution cell length (B): 100.0 ft Area of Distribution Cell: 450.0 ft2 Observation Pipes Contour Elevation of Mound: 88.00 ft Location from end of cell (Z): 16.67 ft System Elevation of Mound: 89.42 ft Final Grade of Mound: 91.21 ft ~' Mound System ~ s ~ s Pressure Distribution Calculations Project Name: Kelvin Johnson Mound Lateral Layout Lateral/Manifold Design Lateral elevation: 89.9 ft Lateral diameter: 1~ ~ In, Rows of Laterals: 2 ~ Lateral spacing (S): I,_Jft Manifold type: center ~ Lateral to cell edge: 0.75 ft Orifice diameter: o.i2s ~ In. Lateral discharge rate: 7.83 gpm # of Laterals: 4 System discharge rate: 31.31 gpm Distal Pressure: 5 ft Manifold diameter: Z ~ In. Lateral Length: 49.5 ft Manifold length: 3 ft Orifice Spacing/Distribution Fortaemain Friction Loss Orifice spacing (X): 32.11 Inches Forcemain length: 60 ft Orifices per lateral: 19 Forcemain diameter: 2 ~ In. Avg. ft~/Orifice: 5.92 ft2 Friction loss in forcemain: 1.259 ft Lateral Side View Manifold Lateral ~ Lateral x x x x x x x x x x x x 2 2 stare engt Lateral Length Lateral Plan View Lateral Length `-' Turn-up wlball valve or cleanout plug 0 0 ~- a o Orifices on bottom of f"VC lakerals and forcemain ko comply with lakeral equaNy spaced specifications per Gomm $4.30(2](eJ Forcemain connection via tee or cross to manifold ak any point Clean Out Detail Observation Pipes Glean-out plug Final Grade or ball valve Water tight cap or plug Lawn Sprinkler Box Slot Note: Cbset Collar Lon Savee 90 6" Minimum pla~ro ~ 318" bar 9 p oriwo 45's ~~~ Bar. Lateral Mound System Septic, Pump and Dose Tank Project: Kelvin Johnson Mound Tank Information Pump tank manufacturer: Pump tank size/model: Pump tank gal/inch: Tank bottom elevation (inside): Septic tank manufacturer: Septic tank size/model: Wieser Concrete 650 15.94 84 f1 Wieser Concrete 1000 rage a or s Dosage Volume Does forcemain drain back to tank? Lateral void volume: 20.9 gal Dosage to absorbtion Cell: 90.0 gal Forcemain volume: 10.5 gal Total dosage: 100.5 gal Pump and Filter Total Dynamic Head Pump Manufacturer: Little Giant Are laterals highest point? Pump Model: 9EH if not, enter highest elevation: 0 ft Effluent Filter: ,/ Zabel A100 System head (distal x 1.3) 6.50 ft Vertical L'Ift ("D" to lateral) 5.08 ft Note: Access opening of sufficient size to be provided to allow removal of filter. Qpening to terminate at or above grade. Faction TOSS In fofcemain: 1.26 ft Pressure loss from filter: ~'Jft Total dynamic head (TDH): 12,84 ft Pump Tank Diagram Watertight Locking Cover 41nch With Warning Lafael Minimum -Finished Alternate Outlet Location y~ Weep Hole or Anti- Siphon Device Elect. per Comm 16.28 and NEC 300 A 8 C 0 Dose Tank Levels In. A Reserve 22.5 B Pump off to Alarm 2.0 C Total Dosage 6.3 D Effluent depth for pump 10.0 Total Capacity: 40.8 Pum Curve: 9EH FLO LITERS/FIOUR 0 1000 2000 3000 30 Pump must be capable of: and head pressure of: W ~ 2U I Io )2l0(` -~o• ~ o ,~', o N Little Giant FLON- ~~• 9EH PUMP PE Gal 358.3 31.9 100.5 159.4 650.0 10 V1 7.3 ~W Z s ' A 2.s 0 40 60 ~ 31.3 GPM 12.9 Feet' i ~ Mound System Management Plan pursuant to Comm 83.54 W. A. C. page 5 of 6 C>wner'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 sludgelscum. 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 Gog orifices. Performance Monitoring: Pertormance 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 cun'ent 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. ~ ~. •~ ~~ L ,~ ~*'~ V ' "'V r~ S ~~ ~ --~ ~; °'~J 'y ~. ~ ~. t ~, q ~ ~~ '~ ~ -~ t~~- ~ ~ ~1 -~ .~ ~a \~ ~~ a d ~t ~ ~ ~ a/' ~~ o ~'.~ ~~ ~ Q ~' ~~J ~ ~ v ~ ~ ~ ~ ~ ~3. ~ ~ ~, ~. ~~ vN Cy~ ~ ~ J \ ~ ~. 1`' ~~ A o-~ ~ ~ ~~ ~~ ~~ . .,-~ p ~ Sr ~: ~~ ~~ ~ t~, ~- v ti ~~ . ~ ~..: ~ ~~ ~~~~~~ ~ ,~ ~~ ~ ~~ '` ~ i ii,~ l ~ M ~ _~ ~ ,~ ~ ~~ ~~ 'y ~`-~ :~ ...... , ~ ~ o ~ ~ `2 ~., ~ ~ ``"2 .~ q C~ L Iv !. ~ v.1 ~ ~4'i ~ ~ ,` \J ~~ \ 3 ~ ~ s ~ ~ ~4~ p .~ ~^ ~ ~ ~' ~ ~. __._ ;~ ~~ ~~ s~ ~: ~ ~ ~ ~~l ~ ~ ~ ~ ~ ~,, ~ ~o ~~ ~ ~ -~ ~ - ~ - ~' ~. /~ _ ~~~~ ~~ ti Q ~ q ,~`' C.. ~~ ~ 0 ~ ~ ~ ~~ ... ~ ~~ ca ~ ~~ t?-~ ~ ~ ~ ~~ ~~`~~ ~ ~~ ' ,~ ~ ~ ~~ ,~ .~ ,, J r ~ \ ~`~ ~Y \ ~.l 1. ~.~ i l~ ,. M ~ _~ ~ ~ ~~ ~ ~ ~- IS ~- Q ..~ ~l Q1 ~~ U C" G S c \~' J ~~~ ~~ q rr O ~~ ~ ~ ~~ ~~ \~ ~~ ~ ~~ a ~ P `n ~ ~ ~} o L7 ~' W^ -~ _~ ~, ~ ~`~ J a ~_ ~ ~, v .9 ~ `~ ~ -- ~ ~ ~ ~ ~~~ .~. ~, ~ ~ ~ 1 ~' ~. .~ - ,~ .n ~ ~~ ~. Q ~- ~~ ~ ~ N ~~ ~~~ q~, ,~ ~, ~ e? ~ fi ~ ~~ ~ ~- d c~ ~ ~ ~~ .~ `~ ~J -~ l~ 1 M ~ c (~ -~: n ~~ Q~ U ~; ~; B~ /o -~-9~0/ Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and BuiMings in ~rmrrianrs~ win, C:nmm AF Win Aclm r:ruia 1490 Page 1 of 3 Gustum Septic Service County Attach complete site plan on paper not less than Sh x 11 inches in size. Plan must ~ Croix indude, but not limited to: vertical and horizontal reference point (BM), direction and Parcel L D percent sbpe, scale or dimemsions, north anow, and location and distance to nearest road. . 016-1062-95-000 Please print all Informat/on. iewed By ate Personal intpmatan you Provide may be used tOr SeCOadify PurP~ {PriVeCy Law, s. 15.04 (1) (m)). Property Owner Properly Location Johnson, Kelvin Govt. Lot n/a NE 1/4 SE 1/4 S 29 T 30 N R 15 W Property Owner's Mailing Address Lot # Block # Subd. Name or CStuq! 1340 290th Street n/a n/a N/A City State Zip Code Phone Number .J City ~ j ~Ilage ~ Town Nearest Road Glenwood City WI 54013 715-265-7591 Glenwo - 290Th Street New Construction Use: ~ Residential / Number of bedrooms 3 ~ ved design floN/ 450 GPD Replacement ,,,,;~ Public or commercial -Describe: ~ ~ Parent material loess ~`~ Flhiti' fion,rf anti ble n/a General wmments '~~J "_ and recommendations: Part of 4.9 acres. Recommend mound system I `~ 88.O~caitolr~. (~ 2~~~ f D ~~ ~~ S CI~X / lip .; ~ Boring# Boring ll~~ z tNppFFICE ~~ ^ ~ Pit Ground Surface elev. 88.4 ft DepUtto'`rg factor ___~2~ Soil Applicelion Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Cobr Texture SWdure Gr. Sz. Sh. s ~ Roots 'Eff#1 ' 1 0-9 10yr3/2 none sil 2msbk mvfr as 2f,2m 0.5 0.8 2 9-15 10yr5/3 none sil 2msbk mfr cw 1f,1m 0.5 0.8 3 15-21 10yr4/4 none sil 2msbk mfr cw 1f 0.5 0.8 4 225 10yr4/6 c2 ~ S 10yr7/1 Y ~ ~ ~ sil 2msbk mfr cw - 0.5 0.8 5 25-37 7.5yr4l6 c27P5 yr 5 / 8~/1 9r•scl lmsbk mfi - - 0.2 0.3 Boring # Borng Pit Ground Surface elev. 88.4 ft Depth to limiting factor 19 Gin• Soil Application Rate Horizon Depth Dominant Color Redox Descdption Texture Structure Consistence Boundary Roots in. Munselt Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-8 10yr3l2 none sil 2msbk mvfr as 2f,2m 0.5 0.8 2 8-13 10yr5/3 none sil 2msbk mfr cw 1f,1m 0.5 0.8 3 13-19 10yr4/4 none sil 2msbk mfr cw 1f 0,5 0.8 4 19-32 10yr4/6 c2 ~ S~Oxr7/1 ~ ~~ sil 2msbk mfr cvtr - 0.5 0.8 5 32-40 7.5yr4/6 02 ~ 5~ ~ 711 gr. sct 1msbk mfi - - 0.2 0.3 ` Effluent #1 = BODS> 30 <_ 220 mgA. and TSS >30 < 150 mg/L 'Effluent #2 =GODS < 30 mg/L and TSS <_30 mg/L CST Name (Please Print) Signature: CST Number Tom Gustum 227618 Address Gustum Septic Service ' Date Evaluation Conducted Telephone Number N13450 937th SL, New Aubum, WI 54757 10/4/01 715-658-1344 Property Owner Johnson, Kelvin Parcel ID # 016-1062-95-000 page 2 of 3 Boring # ~ Boring Pit Ground Surface elev. 86.7 ft. Depth to limiting factor 23 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Ou. St. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr2/2 none sil 2msbk mvfr as 3f,1 m 0.5 0.8 2 10-17 10yr313 none sil 2msbk mvfr Lwv 1 t,1 m 0.5 0.8 3 17-23 10yr4/4 none sil 2msbk mfr cw 1f 0.5 0.8 4 23-35 10yr5/4 c2-3d 10yr7/1 7.5 5/8 stoney si 2msbk mfr - - 0.5 0.8 ^ Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots x in. Munsell Du. Sz. Cont. Cobr Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring # -j 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 in. Munsell G!u. Sz. Cont. Cobr Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS> 30 < 220 mglL and TSS >30 < 150 mg/L * Effluent#2 = BODs <30 mglL 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. r W ~~ ti ~ ~ VI ~~ ~I ~I w~ Q 'A (V~ j(~~" ('~ 8 7 7 gg ~ ~ ~~W 7~i~ Q°, y ~ ~ N ~ a~^ „ ~, m m to Z ~ _~ 14 ~ v I: $~ ~ $~ ~: o ~ m ~ c s ~ w ~ ~ ~ ~rt ~ ~ ~ ci ~ -° ~ N ~"` r ~ ° z~~ ~ ~ ~~_~~~ m~ ~ ' ~~~~~ v_ ~~.~ w ~ m w ~ Q o _l $ w ~ ____________________________ s _ _________2~h ~ _______ ____ _ ~i ~ [11 `< x. ~ V C<s ~ rt W W_ ~ ~ ~ C O W N s ~ N ^~ 2 = w ~ i gW ~g ~, ~ '. 3 -~ N ~ A~w A m R 1~ T Cl n ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHII' CERTIFICATION FORM OwnerBuyer ,~~ L-t Mailing Address Property Address (Verification required from Planning Departmen~or new construction) City/State ~ r t.tl U~'~Pazcel Identification Number O ~ ~ ' ~0~ 2 ~- p 3~ ~6'`~ LEGAL DESCRIPTION /~ /~ Properly Location ~ %a, ~ '/4, Sec~~~ T~l~ N-R~_W, Town of C~ (.citS~r~rtl~ Subdivision ~ ,Lot # Certified Survey Map # ~- ,Volume - .Page # -- Warranty Deed # ~ ? / / ~ `f ,Volume 1.Z ~ ~, Page # Spec house ^ yes (6~1 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 masterplumber, journeymanplumber, restrictedplumber or a licensedpumperverifyingthat (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 standazds 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 of the three year expiration date. / /0 SIGNA OF APPLICANT 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. ~/ / ~ 2 SIGNATURE F APP CANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed /D, DOCUh[ENT NO. WARRANTY DEED 571164 ~o~ ~.~87PaGE4~7 THIS DEED, made between Thomas M. Tone and John G. Tone, as joint tenants, Grantor, and Kelvin ht. Joluson and Kathryn L. Johnsoq husb::nd and wife„ Grantee, WITNESSETH, That the said Grantor. for a valuable consideration of one dollar and other valuable consideration .;onveys to Grantee the fo?lowing described real e+tate in St. Croix County, State of Wisconsin: REGIST 'S OFFICE ST, CRb;X CO.t WI # liac'A !er ROGQrd JAN 12 1998 lo:I~ A M 's~~l~.,.~~ cJ.sJ-. Register-ef Deada A parcel of land located is the Northeast 1/4 of the Southeast 1/4 (NE 1J4 of SE 1J4), Section 29, Township 30 North, Range 15 West, described as fn!!ows: Cot:.m;xtcing st a point 3!-7 feet Sot,t,~ of the Nortl:.:.ut cor:~r oS Section 29; thence West 533 feet; thetace South 400 feet; thence East 533 feet; thence North to the place of beginning. ~~~~ l .~d ~ TRA~SFER hj ~~~ ~' ~ 1~ This is not homestead property. RECORDING INFORMATION NAME AND RETURN ADDRESS B e Orman, S.t^_. 12 eritage Drive N Richmond, WI 54017 Gam'-'Gf ~ /~'~~~~-~ (Pu:c;el Identification Number) Together with all and singular the hereditatneats and appurtenances theretmto belonging: and Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances accept: Easements, highways, utility rights and r+eserwaGotts of record, and will warrant and defend the same. Dated this ~ day of Dace ber , 19 97 __~~~~-/JYLfw~ ~ (SEAL) 'r rY~ (SEAL) ~L_-L~ . . • Thomas M Tone (SEAI.1 AVTIiF.N17CAT10N Signature(s) of _ Thomas M. Tone authenticated thin~4 Way of Dec mbe , 19 97 • Ti hr 1 Soon - TTT1.E MEMBF3t STATE SAR OF WISCONSIN (If not, auttwrized by ~ 706.06, Wis. StauJ ' THIS INSTRUMENT WAS DRAFTED BY: Timothy 1. Scow BAKKE NORMAN, S.C. 'v'E1y "R rL'2'1M07id ; '"lli'1'SC'U71 s i n STATE OF ~Dr>f1t[.~~ N c;,J couNTY 7 J ~~ ~~e>, JON : j3, ~f~ct~tr''".< Personally came beforo me this ~S~ day of Daember . 19 91 ~ tfie above named John O. Tone W me haven a be the person vho execuad the frngoing in ,vtned std actnawkdyad tha wtne. . _ ~AX~( ~i/ tl/r ~C, NfuJ ue.t~,. wtll`7 r ~.L._~. ^..,L1\J~dtP) M~/ Camiss/ion F~e,l„m ~Fk:'r€S {''Ft~'I 14'i1A _ _ _ ® ~ ice. ~ ' ~ -; - `• - 01999 Cloud Carrogrnphica. loc. Sr. Cfoud. MN 56301 3EE PA4E 70 Dulm ~~ $ z , z g 1 ~. • Melvin ~'8 273.5 z ed ~ aar• Pawt',a 1 Nil nssou n . • 1 x 1 ~~ D & (aura a 4s c 3 g 61.1 151 151 JOhn J acke panda I Simonson rame~r k~ ° s8ush ` ~ 6~ ~ a s 6 ; a c 6• d a c ~ g 3 a s e Thomas Jackelert . J y • M.rilyn Maje.,n Lawrence Lake c Michael & .y ~ 12 Emma NitcheY y , effre & ~^° ~ Schug .t+ Sarah Cassellius ` x & Herman Pitt Dale & Maler~ 135.5 1008 3 Enid Bahnub 111 4 % 7 III • 9 117 7 ~ 111 9 % ~~ r~ • 11 9 JAM % 7 Ifl 9 •7 10 4 % 7 207.9 116 . ~ 234 i/ s ~ Berends 212 I~ePh 257.510 436.2 'f . 3 Jackelen ~ 'ls 146 LiHle n• R • Steven W~ Kevin& Bushy IW.2 a`a .CENTRAL 217 ~Hatold& ~ 1732 & Patricia Rodney & Roxanne Croes Lake eo 92 pJune Stack ~ David ~ ~ Warner Marrietta • Clarencek John •~ ,g fi+ C/ 107.5 Marcella )oseph)r Joseph Richard • Genevieve EmeSt Sweene 5e3 ~ GabOWer ~ • ~ Gordon& °0 126.4 ~ 14g +_ • Prinsen Heim to t e ~ a & Patricia Jackelen SevetSOri q9 y ~b `~ 158 r~'. m Carol Adams Bacon Tr ebl Q Frank & Frank • Wayne wninram m= Michael Donna ~ Thomas & 6 c ~ Keny ~ o ~Geral ~M Stch Standaert 152 ~rO 80 ~ ~ Roger & Peter & Ile yyamer Wamer Lynette Schug „ ~ ~ 0 80 T-Ielen ~ Courtney • ~ Ronald & ti ^ Da r a to Robert 3 ° ~ • Stansbury kJKaren 160 ~ ° Y & Melodee 151 3 ~ ~~ stoner 160 200 65 Dine Bonte KennetMh &n 226 0" Forrest • 160 203.3 Donald eemab tr °~°D w ~Maes _ ~ 76 ~ Stephen • cy°wa James & 0 10 ra O 1 ~r8 & Mary Olson Vie" clad aorta o °.~' a '° • Peter & Sheila 160 ~kr. n x ~ n, L Anderson lab Wa e & Newcombe Robert Bonte • w z o7J ~ ,c yn Tmst• Jeffre & 6%.9 8 e A" = ` Torleta etal Fritz Asplund Y 35 ~ a ~ /-~ "~ f>» Earl & Joyce David & Theresa Christopher ~ • Wesley 0 160 Shefla Wagner 40 - p • rn~ Nieman Yoder Hoffman mta;e )etuen Y 0 159 0 71.2 ~ F~.r K 5 . ~ '~ 77.z ~ Pn u" m sram • ~ - • z ~ NichoLc ~ k P V Delmar & w y st Cmi~ Peter & ax..m Marlene Goosseru 40 ~ Richard • °~ ^ Herbert & G o • sr~`i z BnTda w`ak," a~ 1OB`Pi..ti Paul & al ~ 38 re8 r5' s9s • • nun c F w•c so 159 & Grace 'd ~' Rose Luks ~ ~ R°w' a mnk ~w 9$ !~, Susan " " Obermueller Robert & Theresa mat $ Desmith m.+ ~, 6' emerald Obermueller •~ 0 6o rold sron4 Gre o ~E zo Sween ~ 160 233.7 a ~ 110 ltnoaes 7o S Robert r the • s°'y' & Ig ry M wi - ~ Palewicz saam.nn Ynn 426 • • 39 w Barrio er 74 15 "'r ~. ~~ 80 Lewis James Jr & wiwam A ~ • 97.2 +s Schoenwetter DWOOd JOhri Dona Weyer 39.5 x sonita a ,. m • wrule Wayne ~ Emerald Land Trust C'~O° Jyloe 80 • MRT'reke >"per °' ~ ~ _ ° ~ ~ Peterson 217.4 COr~r~oration Timoth Anderson 80• 160 s"^ad Mi1ie1 a •t! `~ Y ° -r Y k D°nm & Jody 114 i ~ ~ .b ~ Davld & Freda Izo wi.es cra•se , € Theresa 79 1192 Fred & Barbara ~^ _ g $ • • a ao ~ a 9,5 •D C5 Hoffman • • Drinkmari • ~ N Mam'etta~Schug Kris O~trrr&ian • • Frank, Krai & ~ D•*1a`e • ~1SO° ~ - ~ • Sharon .°~ `" . Donna, g a+'1 µea Susan Anderson ~ 40 Joseph & " ~ 69.4 ~ Ella 1 69.5 '"^ •a ° • I-lesS • Ldvem & Charlerce Drexler .% ~ ~ W Ohman Allen, Maureen 47 v ro ^ p Ardys Konder a. Clifford & Jolene 78 8 Oho Mce = 5 ~ • I Laberee K"bl' 6 Lo m ` J 200 ~ Wamer ,y d Jean Anderson g i5 142.5 rsx am,nie ~ 167.6 1 2 40 6 , lz Acres & °~ ~ 198.1 ~ ~ ~ 121 ~ m y z 132.7 - ~ ; • Inc 212 183 ~. Wayne & Cynthia S o Steven Thomas & 71.5 David " • 70.1 G Robert Mrch~a 1 7/ Tultle g &f~Y Linda Weber cnaa~ K`ay` X David & • Gram a 53 w.o ©dna~ Smith 9v Hlrene & EVeI c lames Katrina o "' ~ °~ t Ortonm ~• P~ ]zo ~ ."'.~. %a,ena Bo . Haman 124 • sehmeat 53 •Ames Shirley • ~ • G - j°`R 37s ~ Q Schroeder o Q •+ secs CD O 312 +~ 46 • • ry • %+Y°~u~d /` 255 ~ = v Teigen 30 G~ ,•~ Joseph B [` ' 8 Frands & Charles a ~ ~ ~ Keith v ~ Be • ~ 8 otaame David Schroeder D M&P JOhn & ROSe 65.9 ~'rke 78 ,y E ~ _ : & Joan ~ ~ ~ °'`01 Luann 'x"'.+ ^ BUChit $ µ- Monson z a a Oberm~ Desmith f] '~ ~^" Badour 218.5 a4 7 z ~ McCutchin 17 F ~~ne Evel ~ ~ ueller 70 ~ 75.3 g u ~ ~ _ atwv ~ ~ • m ~ ~ 80 ~ ~ 140 ~ 26 ~ ~ a ~a Hop~ann x ~ ~ ~i h. +.9 ~ ~ ~ I~ePh & ames k Patricia z = ~ Z ~ t Melvin, Duane & w Blue •G ~ .~ Gloria Walz J ' D u i Eileen Schreiber W+~oO° Rose Mundt w cl,ristensen G L E N W O O D m E ° d `x ~ ^B Kevin Sdueiber w'%i'"' Walter 120 218 nmer«an - David ,<= - ~ e.kaa.e ITY 119.3 Tn ~ $D ~ 8 ~ P. ~wendt 40 CwkM „ Albrer2n '°• ~o ' _ ~ City of ffm ~ ~~ ~ 40 • 4o Glenwood City %le~ee Bruce ~ msz u91o - • ~ • 8 are & Bonni~ 1. ' +S 4 Kare nder ~ Paul & ~' £ Donald & ' :'" David & G D ,,,, Rand & 31.8 s r rthouse Theresa Hoffman 1e.r •t4~ ' 66.e y `+4v '^' Debra s Julie Frieburg • Y 120 <• = `- ~~^ M.ac Bonnie Doris Bence Dean IxMay & Wagner Andrew )81"~ 6 ~ • -g r 61.9 ~ Gunderson ~ 215 "'"1°r;e _~' ~ T °~y Dean • ~ `D ~" ` ~-. Scotty & Kristi T110mJ)SOn o Konder Sherrie Solberg Dahl ci a a<Mary G* -= 65.5 aw;ela 72 ~ 80 . 40 ao • - '3 = cletm s9 Teigen • ; Teigen 190 0 0 ~ 180 Beverly drew& ~U ~ Hagen 1]4.7 y +.>~ - • Roberi& Donald I Terly Br ~ ,~, .tl o ~ Rehwaldt 1~°" °~ ~ `o Brearle z ~O _ Velma Crosby ~~ 6`)"a"'v I S A Y TC ~thia D Deanna McGee '? a ~ as.s o'k•90 € z 4o Yn ,9., • < ~ ~~ 78.5 281.5 )'"'g 0 0 $ Da 1 & • 5 Ma 2 ~ • Dn"id • Kusilek 128 HESS 80 Steven lames • • W `~ ~ Kathe ~ 7uttle~ ~ 9~.z S Imnikr Ess Tel en •Robert Crosb 264.8 ~ ~ . • lames Dean • • 1 40 $ Y ~ Mona Baron zo ~ zl N • V ~ ~~ '~' Te Tl Orr ^t JkB 8l1 lames R6M 19 - )arc DD "+' ~`° r'`°'"' Moron 162.7 w .kmy.e Drexler 2700 2800 2 0 1 SEE PnaE ~0 3000 3 00 3200 3300 ~n , ` ;: C~Stc3M BURT "~"~OME3 iA a" REMODELING APARTMENT BUILDIN G ) >". ~~} ~r DICK CASSEWUS i - ~{ .• _ ;, p; = ;715) 265-4419 ,<~ eE ~. ~ ~ _ .~ ~ ~)~~ ~~ ~ 7597 S~avIC Row 1 >.~ ~~A C1iY .1N1 54013 lie 54 - q