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HomeMy WebLinkAbout018-2009-27-000 0 CO) 0 0 tv .00 110 oi c OR H . CD M 3 m CD ^ � \ 1 a CA "'y - 0 z to Z p a Z 2 Z v f ? y v O G O N N O d c O co co N O iv ao i--i x Q A p 0 CD y m a m y c o CD s c_ m 3 w m CO w c°o 0 CD y g y 0 1 m y o N CL 0 7 7' a =r CD CD cn CD 3 CL O CL co OD 0 co y C) y A n o p v cn v D a tJ> z D CD C. Q �p .p fn (O o y CL CO a m OD a CL CL CD ' Z O CL CD cn C p p 0 O O-D O N 0 0 (� N N> d 3 Q c CL 9 �+ o 000 000 Y � C) z r - 3 y N �� .i C7 O a' M G G CD m » v m n _ CD e�D = eo m CL N z , D o 0 D a o O O 0 O CD c m CD y (n y tN y . fn 7. m (OO M. C CD C CD CL m w v a n 3 3 CD CD Z fA N 0 a a I d A G Z +� OD T W A m OD m tl! m I y m A W W `y o CL c 0 a n n < cr a c G a N d a G U) 0 0 N C y' 3 0 N C �m Z a •'mom z a Co o a o TI In N 0 ti 3 CD 3 t y 0 3 �CD o O s3 t7 0 C y CL > n N w y 4 co O -I O CD 7 j 7 7 7 (D a m a fi n 7 0 �0 m 0 C m CD o mO ap p o _ a Lo 0 A O O N O Q I I � O� W S9 O ti q CD ti Z REPORT OF INSPECTION INDIVIDUAL SEWAGE SYSTEM San.itatcy Permit - r / State Septic l�lj 1 NAM€ ✓.'�� -a �% Townshi p- St. Cnai x Coun Laca .ian % o %, Secti TjN, R�tv SEPTIC TANK Size gattonz. Numbers 96 CompantmentA Distance Fnam: W ett it. 12% an greaten ztope it Bu.itd.ing it. Wettand H.ighwaten - it. DISPOSAL SYSTEM Distance From: Wett it. 12% an greater ztope it. / Bu.itd.ing jt. Wet.2ands F t. H.ighwaten it. FIELD DIMENSIONS: W idth o6 trench it. Depth ob tack. below Cite .in. Length of each tine it. Depth aj rock oven t.ite .i n. Number, ab tines Depth a6 t.i.2e betow grade .in. Totat .length o j tines it. Sto pe o j trench in pen 100 it. Dis tance b etween tines i t. Depth to bedro Totat abbonbt.ion anew jt2 Depth to groundwater ix. Requ.i.ned area it PIT DIMENSIONS: Number o6 pits GAavet around p.itd yes no Outside d.iameten it. Depth below .intet it. Totat abz anbt.ion area t2 , z AAea required Jt2 m INSPECTED BY TITLE APPROVED ,DATE 197 REJECTED ;DATE 197 �EH 115 WISCONSIN DEPARTMENT OF HEALTH AND SOCI !CES t DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 MADISON, WISCONSIN 53701 REPORT ON SOIL BORINGS AND PERCOLATION TESTS C,/ LOCATION: , Section —#— TA-94, RL1� (or) W, Township or Municipality— ✓h `� Lot No. ,Block No. County Subdivision Name Owner's Name: tv o Mailing Address: TYPE OF OCCUPANCY: Residence X No. of Bedrooms 3 Other EFFLUENT DISPOSAL SYSTEM: NEW *X ADDITION REPLACEMENT , DATES OBSERVATIONS MADE: SOIL BORINGS 7-3 PERCOLATION TESTS 7 - 5 / — 7tF SOIL MAP SHEET SOIL TYPE Cd Ewl �l L �' 4OAr» PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN TEST TIME DROP IN WATER LEVEL, INCHES RATE NUM- INCHES THICKNESS IN INCHES SINCE HOLE HOLE AFTER INTERVAL MIN /IN BER rA 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 P P_ /V0 5 gly 5 SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) B _ �fJ J `` r o c. r 019 �i /� O B _a�� If If � PLAN VIEW (Locate percolation tests,soil bore holes and suitable soil areas.) Indicate on the plan the location and square feetoof suitallLoreas. Indicate umber of square feet of absorption area needed for building type and occupancy. 6. .< a Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. / S d D 6 9 , Id 0 v d r C_ / State and County State Permit PLB67 Permit Application County Permit #� for Private Domestic Sewage Systems County Si ! X *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: J I-I �,�� fa / L1 r4Mr" a.jd &); B. LOCATION: / '/4 " '/4, Section , TcX7 N, R P, (or) W Lot# City Subdivision Name, nearest road, lake or landmark Blk# Village Township N44 C. TYPE OF OCCUPANCY: Commercial * Industrial *Other (specify) * Variance Single family X Duplex No. of Bedrooms No. of Persons d D. TYPE OF APPLIANCES: Dishwasher YES X NO Food Waste Grinder YES X NO # of Bathrooms—&N Automatic Washer ( YES NO Other (specify) E. SEPTIC TANK CAPACITY f0 0b Total gallons No. of tanks _ 6N �.• *Holding tank capacity Total gallons No. of tanks New Installation X Addition Replacement _ Prefab Concrete X *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) 2) 3) _Total Absorb Area q. ft. New Addition Replacement *Fill System Seepage Trench: No. Lin. Feet Width Depth Tile Depth No. of Trenches _ Seepage Bed: Length�Width Depth Tile Dept No. of Lines �[.y 0 Seepage Pit: Inside diameter Liquid Dept Tile Size Percent slope of land L or Distance from critical slope I, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH -115 prepared by the Certified S it Tester, NAME C.S.T. # , S'S'-5'S -Y- and other information obtained from (owner /builder ). [� phone # 74 7 Plumber's Signatur MP /MPRSW# L�2 -� 3 Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20, including well). / Ow 0 ° ` Z Parcel #: 018- 1006 -90 -000 08/04/2006 04:50 PM • PAG 1 O F 1 Alt. Parcel #: 04.29.17.49A 018 - TOWN OF HAMMOND Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 09/28/2004 00 4 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner RETIRED CUTTING EDGE FOUR LLC O - CUTTING EDGE FOUR LLC, RETIRED Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 36.745 Plat: N/A -NOT AVAILABLE SEC 04 T29N R17W PT NE NE EXC NSP R/W & Block/Condo Bldg: EXC CSM VOL 12 PG 3414 NKA PT HILLSIDE HEIGHTS ('04) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 04- 29N -17W NE NE Notes: Parcel History: Date Doc # Vol /Page Type 05/20/2004 763197 2576/397 WD 133482 161/312 QC 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 03123/2005 Description Class Acres Land Improve Total State Reason Totals for 2006: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2005: General Property 0.000 0 0 0 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 HAMMOND T 29 N- • R.1 7 W 31 SEE PAGE 45 AM-NA A/ONO LINERa �E c A an✓i _ .K s V �r S a.SYOJ .sfbva� E N 1hc5Ya+t s • wer � . fNNt „ � • j A rs7 ca i s !TJorothy tl. h u " C C Thor f diiCe d < < 3 Q pehiEe wu m ,\�y reri �% h e�`< Ma/ s r /a ^, c C Ub CO�� une C� b vo a'7 Lris uisl- T a H4rveyy 4 /1/e /s /arm C cSu 71nn¢ /98, s John 9rra!e soli Pa / NerCSan U pV; 1 9 Ro �a /d `.0 d tl0 1 j AL /sB.Lj 18. s g Pau/ • o ' 44 aRO USHNEL' _ r o sBOSO ao 6 �, �" • �W y CT � p L / %en � n/e /s • Bo ,ton° /d Fra nrE '• 9.p Kar/ �, 4 ,(3in ham { q do son 40 � ti Thomas yJ1C tl � Kafher•,nc n BO Powe s Up�p �`Y 0 Ufe t ` � f 9z `9 (Smith • Bo Q ss /zo �� ib p 3 °� .Dona /d E 26o k'ona/d 4 • �Ta lees ry B Rose /yn Wallace /s7 tl4 tl �tl /bo Nanc y n e,- Q/rLine E Ka S'chu /t t 1_ E /hor We i s er ,Be—i 6J I � `l 1• � Bo Hank Bo BO V YrrB3e �ausmu L°u /se MT Marie /� Ij W`l • Fa ms, Sric t,3y McrVe// s ,fie ne th � Llferfs, Johnson • e .y � '` " J I B a * ' � � ' • 7E 4 .QObe �•C efa/ d,° Qo ber C A CO � e _ %U p 0 �D'00 ac C /arerrce Thor ass .P. •FrancRS 6 � Glen E ,Qo o dG/ U tl b l l C tl 0'Ob � G- P we s orofh 4.o C 0 J • FIr'ene 28 Bo OTN cSathe'y ST �c /9O 0 v� • ��� �} tSandfor/'• Bo 3t � E /oo R T s e • a/d rs • Tean ry � a/ . ` V Fern H gh £ E/i abeth k'o9e Evan 0 aa � � ie3e t eon ca _ �Tohn E. 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O' onne // � � /sb.6 Tui iser C C p 40 • Hesse /m.E, rs n Webb ,� NEfi �a� /¢B Bo • Ey�� Bo etux /bo 40 /zo ro w 0 h vrOr'i Do% cs S E/ F� �' v - EhU eeme•� C cTose f C e y y ` 21Q y C /yde Turner tl Cl U V �N 7o tl U Deborah 0 h d Y Pau / e � Ui c � c Ford Hanson .,_o-.: ?•- M. ett Do /ores 3 E46 h /a7 2 /so.a4 !vy o ::: - 3 "Q6 V 1 W. C (/os.Eui/ tl �°` �4Q O� 4 /SS e3 Cc %/ Ford 0 W 4 �Id c. ................. ................ ................ ................ ................ ................ ................ ................ ............... .. r _ /•s4 o4 F r. I . :: • V . TT Wm. L .Be ver /y tta ran . "s n C p z Her c °W •.0 C .h Gr //s - .F c 40 l ^ CB/y.• Up Ei a y+, d6 .0 IJo n -ttof q /r7 ° e// a .2usse// .0 V N N ......... _... ...:. Tu rser 6o r :' : y wl .P.Cha �9 .................. _.................: .. i €€ 5 v �iThn �W'9 wyn✓een p OC� .j. .Fob's. s/e tl 41�, `� /sb Hecb . ✓erss rob 3 J�! - :::.:::::::::::::::..::. O Ceefe as { C ne f ;ii 7ss BRr� // Ken -Prch �f s. , w /so.es N y Fa e C y 9 J ft dre i Ho /man Fars,, r c. .� t 40 U erode �,0 o y Haw,Eins �� i one U tl \� 4o . ....... ..... BO '.'E (Toe�Harason j 1•Ne /en Foarsta� 4o a son ........ - Lest ude sr eta o saes • b b "' ii: ,N $ . 4 °. • • :::._ . ... .............24.4.....i.S' 79.83 B° : �.. , . y @ � :: .............._.._. ........... . ....... ............................... roc y/r . • .? chord f • � %� o ..• � � ✓ .. Ih ke / .N.0 Bo CTCO ge Gardner/ • w Q�i@ Kenneh5 O c '� ' '� _ s setfy BO Tohn o Bo h' + Peterson UTA 13 S `� O fit; < rrran Ga °er � hn .Qonnii�,gn �tl 0 ely v� /ea orn - Hoi 9z 8i __ ��pp .Inc. �o +.DcFarrs tTames ob "If v �' .Ber and ✓ H7 Lo y Euyene iPuth " Ho% y � Law 's f � ne KersTen Ly /B Naw.Eins Neuendor /zo Tr¢o N /rar/ y, J C �Je�ris f uer.Ein•,E • //4 ete son oin �' 0 q Peterson a. i.�b. z ao 7' C � � 0 4476 C� q \ � � COiT•.reance /ss � t /S9.r3 • Ken -Kroh /zO Howard 3°04 h C l�n c.c. io • Fa rm�Z c. /sb SJahm U ry V C QO rPob f. Heeb rGf 77 NE KNOLL i/49 ¢. • R Eq �lav � ��. � /s.o = 40 �'He /an Karnes • f /io ©/96B .Po ord Ma Pub /s, Ir/c�,Pe% /979 SEE PAGE L"M gI�ECT ,F . S I EBO LID REF LTY �C*A - - FARMS — BUSINESSES MOLL'S ELECTRIC RESORTS — HOMES Harold Moll Hammond, Wisconsin SHELDON O. SIEBOLD - Broker FARM - HOUSE - COMMERCIAL - INDUSTRIAL PHONE: 796 -2397 — Hammond, Wisconsin PHONE: 796 -2698 05 08:04 AM Parcel #: 01 $- 2009 -27 -000 10/31/20 1 OF 1 Alt. Parcel #: 04.29.17.1011 018 - TOWN OF HAMMOND Current -1 ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 09/28/2004 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner JOHN J & CAROLYN G DALTON O - DALTON, JOHN J & CAROLYN G 1188 CTY RD T HAMMOND WI 54015 Districts: SC = School SP = Special, Property Address(es): * = Primary Type Dist # Description * 1188 CTY RD T SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 2.290 Plat: 10/31- HILLSIDE HEIGHTS 018/04 LOTS 1166 SEC 04 T29N R17W PT NE NE BEING HILLSIDE Block/Condo Bldg: LOT 27 HEIGHTS ('04) LOT 27 (2.290AC) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 04- 29N -17W NE NE Notes: Parcel History: Date Doc # Vol /Page Type 12/22/2004 783276 2720/498 QC 02/28/2004 775409 10/31 PLAT 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.290 26,900 122,900 149,800 NO Totals for 2005: General Property 2.290 26,900 122,900 149,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 10/13/2005 Batch #: 05 -32 Specials: User Special Code Category Amount l ip Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 I Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. CI'OIX Safety and Building Division INSPECTION REPORT Sanitary Permit No: 420464 0 GENERAL INFORMATION (ATTACl,TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Dalton, John __ Hammond Township 018- 1006 -90 -000 CST BM Elev: Insp. BM Elev: BM. Descri tion: /00 � o c i7" TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic - / Benchmark ��l 3. � /03• � ��o � a Dosing Alt. t 3 o c f �o• V Aeration Bldg. Sewer & .0Z , q7 Holding _ SUHt Inlet 3( '7G. TANK SETBACK INFORMATION St/Ht Outlet •�5 9s: TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 3 Y' Dt om .i ✓/ Dosing Hader /Man. T . •$"3 e� y • O C y Aeration Dist. Pipe T L U-0 1 Holding _ Bot. System y2. b I PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover PM I v 7i Model Number rf TDH Lift riction Loss System Head T H Ft Forcemain Length 1. Di SOIL ABSORPTION SYSTEM j BED /TRENCH Width Len th No. Of Trenches PIT DIMENS S No. Of Pits Inside Dia. Liquid Depth DIMENSIONS "7� SETBACK SYSTEM TO P/L BLDG WEL r LAKE /STREA LEACHIN lvlgnroactur e INFORMATION Typ f System: CHAMBER n f' D Model Number: DISTRIBUTION SYSTEM U „A•C / �! - Header /Manifgld x Hole Size x Hole Spacing Vent to Air Inta e Pe s q /� ` r L Dia Length - f / Dia h Spacing / ✓ J �� SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over / Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil S Yes �J No 1 Yes COMMENTS: rnclude code discrepencies persons present, etc.) Inspection #1: /210 z Inspection #2: Cvg Location: 1188 Coun H wy E //T Hammond, WI 54015 (NE 1/4 NE 114 4 T28N R17W) NA Lot —' Parcel N : 01.29.17.49A 1. Alt BM Description = � b P of --�� �j 2.) Bldg sewer length =3lb - amount of cover => 4f Plan revision Required Yes No T Vture Use other side for additional Information. SBD -6710 (R.3/97) Date Insepctor's Cert. No. r Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 - O N is�consin Madison, WI 53707 - 7162 Site Address Department of Commerce g v o( 15& C 6 Sanitary Permit Application Sa"tu Permit Nut r In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary mi=ses Privacy Law, s15.Nl (m ) ❑ Check if Revision I. Application Information - Please Print All Information _ State Plan I.D. Number N A Property Owner's Name Pima Number Property Owner's Mailing Address " ' Pro try Location 'AN L - , S T N. R Y 7 Id City, State Zip Code Ph =' `' Lot umber oak N bar Subdivision Name CSM Number Type of Building (che& all that apply) S S� bws — ❑City X 1 or 2 Family Dwelling -Number of Bedrooms cr..rtn ❑Viltage­' r ❑ Public/Commercial - Describe Use � Township t ❑ Sate Owned ,'^ V ' f�^ a tt b Nearest Road z X 7(4-C M. Type of Permit: (Chick only one box on line A (numbering scheme for internal use). Complete line B if applicable) I A ' 1 A New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to For County use S S sum Tank Oniv Existin System B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued y IV. Type of Permit: (Check all that apply) (numbering scheme is for internal rise /� ^o 44 q1 Non - Pressurized In -Ground 210 Mound 47 ❑ Sand Filter 50 ❑'Con wcte e and 22 ❑ Pressurized In -Ground 41 ❑ Holding Tank 48 ❑ Single Pus 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Dispersal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System EI ation Final Grade Required Proposed Rate( Gals. / Days /Sq.Ft.) (Min./Inch) Elevation 4 15 0 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site teal Fiber Plastic Gallons Gallons of Tanks Concrete aced Glass New Existing Tanks Tanks Septic or Hetditq-Zaak_ Dosing Chamber - - -- - -- - -- VII. Res onsibility Statement- I, the and coed, a responsibility for Installation of the POVVTS shown on the attached plans. P bar's Name (Print) P 's Signara tvtP/MPRS Number Business Phone Number Cpl - - -,SS Plumber's Address (Street, City, Ste ode) S 1 l ' ,(� .� 5 VIII. County /De artment U iv Approved C3 Dlupprov.L11 Sanitary Permit Fee (includes Groundwater Dace Issued :r WA.. Agent Signature (No Stamps) Surc Fee) ❑ Owner i Initial Adverse � i� - 00 DeDetermina on on IX. Conditions of Approval/Reasons for D' pproval r S 04 apfte X q2 -,¢ ,Qa,,t,�t� -S (zie� 4 t� tn,� die 40 S c` e �c` & 5 at...a Attac p�Ml OU[If] 0p1` (pr the stem per rt t 1/2 x 11 Incba In size l Cdr � ( J SBbF-�'.O5100 "` ` ... .. . ........................ ...... ......... ....... . ................ . ..... T ................ PLM ... . ... ............. . .... ........................ ........ . ............. ...................................... .......................... .................. . ............. .................... .. ...... . . . ...... ........... . ....... ........... ........... ............. ............ . ................ . ................ . ... ............ .... . ...... ............. . .... ... . . ..... ............ ... ........ .... ........... . .... ...... ............. ............ .......... . .... .... ..... .. ........... . ............... . . ....................... . ............ ................ ............ . ............ ........... . .............. ................... ..... ........ ............. ............ . ............ ............. ........ ... . ......... .......... . .......... .. ......... ....... .. . ............ ..... ............ ........... ... ...... ..... ............... .......... ............. ..... .............. ...... ............ ... ....... . ......... . ...... ............ .. . ....... ...... ........... ....... . .................... ... .................. .... ............ ............ ..... . ............ .............. . .......... . ......... ........... ......... ...... ........... . ........... - - — ------- ..... ............ ............. .......... ........... .......... ..._ .... ....... .......... ...... ............ ....... ... ............ ... ...... .. . . . . . . . . . . . . . . . . . . . . . - . . . . . . . . . . .. . . .. .. . .. . . ... . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ................. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... ....... . . . . . . . ..... ..... . .. ...... .......... ............ ............ 4--4 2a ....... ............ .......... ... ..... . ........ ............ ....... --? .... . ... ....... ...... ... . .� ...... .... ( ' k. . ......... L4-4— --J . ........ — .............. . .... .... .... ........... ........ ......... — 7 ..... ........ .. . . ....... . ...... . ------ 77 ..... ...... ....... . ... .... .......... ............... -------- L-- -- ------ .... . ............ ........ . ......... .. . ...... ................... .. ........ Clarence Glotfelty Enviro-Tech Systems & Services N4955 Sunny Hill Road Weyerhaeuser, WI 54895 .... ........ 3 56 q 2-2D-72a . ................ .......... ........... . ................... .............. .... .. ..... .. .. . .... .. .... ...... ..... ............. .... . .. .................... .......................... ... . ......................... ............................ -- T ............ P­­ q ........ .. W�­ . . .... 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I . . . . . . . . . . ............ ... . . . . . . . . . . . ................. . . . .......... ..... .. . . . . . . ................ . . . . . . ............ .............. ... ..... ..... ........... ..... ..... ........... ... ........ . ..... ........... . .... ... . .... .. .. . . ....... . ......... ...... ..... ........... ..................... ........... ......... . ...... .... ..... ....... ............ .... ....... .......... ............. ............ .... . ......... ........... ... ...... . . ....... .......... ­­­ .. .... ...... .... .......... ............ . . ........... .. ....... .......... ........... ....... .................... .... .......... . ....... ............ ............. .......... . ...... . .... ... ............ ........... ......... ... . . . . . . .......... ... .......... ............ Clarence Glotfelty ... Enviro-Tech Systems & Services ......... N4953 Sunny Hill Road Weyerhaeuser, WI 54895 1 A�4 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. eede - Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan ust RE E9VED include, but not limited to: vertical and horizontal reference point (BM), directio and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to n arest T�P 9.o no Please print all information Reviewe - by Date Personal information you provide maybe used for secondary purposes (Privacy Law, s. 1 .04 (1)� CR IX COUNT v 641 QB Property Owner Prop - - Gevt-�st-. N� 1/4 NE 114 S H T � N R _] E (o w Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village 2 Town Nearest Road /v j New Construction Use: ® Residential / Number of bedrooms 3 Code derived design flow rate U SC) GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material (S L-fNcI fi'L 0 j Ljrys H Flood Plain elevation if applicable General comments and recommendations:1� 6 Z Zg' Lv� w f I Q L'� OF t > C i`i �J s t D L w tcv P �Z l.�« e N�P` - f✓13 � 1��''tZ. °�ZL, (�o - U s �o��� �r�� Ct'1.13 S� tw y,2, ' C�Air 3 t�c�ii' S`ASt Boring # ❑ Boring ' ® pit Ground surface elev. C .8 7 ft. Depth to limiting factor 7 ( O in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 z g .�,� -�.5� 23�� - � l s o s� m e - • s •4 3 21 -elf. - 1 �C/ b � S o s `1Z.o Boring # Boring F 7 1 Pit Ground surface elev. � �- 3 ft. Depth to limiting 2 8 3 ® P 9 factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ttz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 Eff#2 1 0 -8 l Di `z 31 — s i Z�s h yyl` C=S v- • S • 8 c _Sb `A\0 cw — - L Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 _< 150 mg/L • Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) ignature CST Number Arthur.. L. Wegerer C)Z.-Z�8 220254 Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. Bain St. - River Falls, WI 54022 - - LI -02 =715- 425 -0165 r Property Owner b L`� N Parcel ID # Page 2 of Fal Boring # ❑ Boring ® Pit Ground surface elev. 3 - O ft. Depth to limiting factor ®S In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 •Eff#2 1 -6 to -1 pz3lz - s �`Fsb1 -� '�1- c 1� •5 -� Z - 1 22t y % El Boring # Boring rM Pit Ground surface elev. Q 7 ft. Depth to limiting factor ' � � in. Soil Application Rate Horizon Depth iDominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 - Eff#2 O �8 10`1 kZ3 l a sw s 0-Is -�- •s - 8 _33 113 wn3 1 C — sl Z hq sbi� Ct 5 Crti _ _S 8 f IT F-1 Boring # ❑ Boring , ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#f I 'Eff#2 Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 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 -8330 (R.6/00) PLOT PLAN Page - of 3 Scale 1' ' I I Oki 121. 31S('''A. PV_(° 1?l:P._� :..!.l_L)`'�`- i I i I - ru , - � S - N a � a i 6 a. q- Z.`�OZ 715- 425 -0165 220254 CST Signature Date Telephone I•To. CST No. Job NO. ' �y > bt R d V Ste- (Y -- - -- . 4:, 0 14 4:1 r �� 1 Conventional System Owner's Manual Sanitary Permit # II Issued Designed wastewater flow (gpd) 70 Owner Name_ Parcel ID # This septic system is designed and approveu ., meet specific requirements outline in Comm 83 and 84 WI. Adm. Code so that it will provide safe treatment of wastewater, thereby reducing human health hazards caused by improperly treated wastewater. The longevity of this system depends greatly on proper and timely maintenance and system use within the limits it was designed to handle. The owner of the system is responsible for the operation and maintenance of all components. Following is information that will assist you in increasing the life of your systems. Septic Tank Inspect and or service once every three years Outlet filter Should inspect once a year and clean once every three years Drainfield Inspect once every three years Septic Tank(s) The operating condition of the septic tank and outlet filter shall be assessed at least once every three years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may sloughs off the filter when removed from its enclosure. If the filter equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and or sludge in the tank exceeds 1/3 of the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to perform to maintain less than the maximum scum and or accumulation. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access opening used for service and assessment shall be sealed watertight upon completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. An effective locking device to prevent accidental qr unauthorized entry to tank shall secure exposed access openings greater than eight inches in diameter. No one should enter a septic or other treatment or holding tank(s) for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment or holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, WI Adm. Code when tank is no longer used as a POWTS component. Soil absorption component ( Drainfield The soil absorption component serving this structure to accept domestic wastewater from a residential facility. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption components operation must be assessed by inspection at least once every three years. The inspection shall include recording the level of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, area of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system id prohibited and considered a human health hazard c e mil Contingency Plan: In the event that this POWTS or a component of this POWTS fails and cannot be repaired the following is proposed. Replacement area for absorption cell ( per Soil evaluation ), or add an ATU to recover a failing drain field, or other repair or replacement to code. If dosing tank is used — dosing tank, pump, pump controls, alarms or related wiring becomes defective the defective component shall be immediately repaired or replaced with a component that is better or equal too performance. Questions on the operation or maintenance of this POWTS shoydd directed to County Zoning or Health Inspector. Gebmey Zen in r ' 47.5k11e,: ffl C V\ 0 • 1 � ± I / U t 1 (b rte '1 c-, 5 t, / , �..I fc)3 9 M i , LL-1 a = CZ Lli > _ 'O I r� I o !IW -� t 3 ' ¢ r. LJ LL m a e • ¢� L,U � w sr IJ CO lo n c 0 v L ,� J L w to Lt_ n� Sx-1 SPECIFICA3'IONS In- ground Soil Absorption Component Component Manual # 1 L� v' D/ L D/ ) Pro)ect Name: ' kzrh n'l.) Distribution Cell Type " Tank Aggregate F1 Leaching chamber Min. Septic Tank Vol. Req. gal- Septic Tank V ume 221• Number of Bedrooms - Manufactur i Soil Application Rate (DLR) gpd /ft' (Designed Loading Rate) Effluent Filter Wastewater Quality Manufacturer Treated ❑ Untreated Model Combined wastewater: Pump Tank Number of bedrooms ol ufac V gal /day /bedroom x 150 Volume Model - Daily Wastewater Flow (DWF) .:) Y Clear and graywater only: Distribution om onent Number of bedrooms Distributio ox ❑ gal /day /bedroom Hydro - spli ❑ � .� Other Daily Wastewater Flow (DWF) = Manufacturer Blackwater - Number of bedrooms gal /day /bedroom Daily Wastewater Flow (DWF) Dispersal.Area . Agate) — fiz Dispersal Area (leaching ch ) ) Leaching Chamber y� e'"t� t.� j Chamber size, EISA Ratingft System sizing = DWF _ DLR _ EISA _chambers (DWF) (DLR) (OSA) \ Diverter valve ❑yes ❑no Manufacture ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address 17q I o o '�- Property Address (Verification required from Planning Department for new construction) City/State Parcel Identification Number O/8 ty � 36 LEGAL DESCRIPTION i Town of /r! a'{ W !� T N -R 1�ir�m ' I �4 �4 Sec. Property Location v , L(� , � � �Z . — II � _ —�� I t o Subdivision amiL LOt # � � Certified Survey Map # , Volume f Page # Warranty Deed # Volume �3 . Page # Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ no STEM 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. to submit to St. Croix Zoning Department a certification form, signed by the owner and by a The owner a sub mng Departm P��Y i;re� master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system sludge- is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of Uwe, the undersigned dersi ed 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 of the three year expiration date. A A '7 l o � TURE 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 owners) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. /0/7/a J IGNA OF APPLICANT DATE ss * * *s An y 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 Q U� >o�J �'` s b� t,, �/ �� -� cT�, o 0 o � � n 1 k� F_ __ - WARRANTY DEED DOCUMENT NO. ST VIA. 0I , S, "(10"', - OR %I THIS SPACE RESERVED FOR RECORDING DATA Fills INDIF", ► ]V►ZL, V-1, fill, 7th March 1) , 10 ') 7 1 , 1 , Adelaide Traiser, formerly Mary Adelaide Keating, and William Keatiiiq, also known I ur as William F. Ke, and Sylvia Pl. Keating, his it .!-, wife, i I T C - -- ,7o? - ,n J. Dalton and Carolyn G. I) jiusl)and and wife as joi nt tenant Imilles RETURN T 111cs.o 11, 1 1, C 0110 dolla a nd of k('r :'II con: ;iderat io-i '!_, l�� I'll li% id Tid (2 if )11,1 L7 I o f t 11( , 3O North or li'llf of tip If N \fill ill, N i r c i JlZ - % JUDI"FIT P RS 0 N 0I. ST CROIX - 7 th Mar Aide la ide 111raiser formeriy , I,iry a William 1". KQatif"'Ji ':U Li t