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HomeMy WebLinkAbout018-1096-25-000Wiscpnsin~eparrmei t's`af Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). - ~ oxxYo Permit Holder's Name: City Village X Township Ulferts Famil Trust Hammond Townshi CST BM Elev: Insp. BM Elev: BM Description I . ~ I a 0~ c~ t3~Y~. ~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic /v n V Dosing a~ Aeration -___ Holding TANK SETBACK INFORMATION TANK TO /L WELL BLDG. Vent to Air Intake ROAD Septic ) ~ ~~ ~ ~ -- Dosing Aeration Holdin PUMP/SIPHON INFORMATION ELEVATION DATA county: St. Croix ~~~.e__..,_. Sanitary Permit No: 420580 0 State Plan ID No: Parcel Tax No: 018-1096-25-000 STATION BS HI FS ELEV. Benchmark 8.0~ /o8.d Boa-~ AI~ 6 Co1.c2n/ !0 . S Bldg. Sewer 5• ~ a D t Inlet 6- 3 D/. 7~ t Outlet ~v-~S . /v Dt Inlet ~- r- Dt Bottom ' Header/Man. " ~ Z ,.O Dist. Plpe b,e,Y1 Bot. ys ~ ' g • Z ~j ~ ~' -~ Final Grade S• b ld Z, y~ st~~ 3 , ~ /0 . SS Manufacturer ,~ Demand GPM Model Number j TDH Lift riction Loss System Hea TDH Ft Forcemaln Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM S( 3o't ~! ) .Vi~.~i~S(iS BED/TRENCH Width I" ~ Length ' No. Of Trenches " PIT DIMEN~ NS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ _ ~ i ~ Q O ~ SETBACK INFORMATION SYSTEM TO P/L BLDG WE L LAKE/STREAM LEAC ING CHAMBER O Manyf~tylrer: ~„ ~ r _ ! / J~'d~. 1Y~o Type Of System: , ~ /1 / ~ Model Number: DISTRIBUTION SYSTEM Header/Manifold / ~ ~+ Length~Dia Distribution / Pipe(s) / Length~~ Dia ~~ Spacing ~ x Hole Size ~.! x Hole Spacing ~ ~,.,„-r+- (i(J~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only r~ ~aa~ Q,K~ Depth Over ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center 3, Bed/Trench Edges Topsoil ~j Yes ~`] No ~- [~] Yes t_f No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ 23 a Inspection #2: / / Location: 1729 109th Avenue Hammond, WI 54015 (NE 1/4 NW 1/4 9 T29N R19W) Pheasant Ridge 25 Parcel No: 09.29.17.800 1.) Alt BM Description = ~T ~V~ 2.) Bldg sewer length = ~ ~ f - amount of cover = ~ ~ i Plan revision Required? [~; Yes __. No ~ ~ ~' Use other side for additional information. ~ _ ~ 23 ~ _I ___- ___ _ J~~~2~~~ J ~ ~ --- SBD-6710 (R.3/97) Date lnsepctor's Sign ture Cert. No. 3-%L cG~. Vent to A Intake N... J L I //' I~ ff~ L - S Sanitary Permit Application safety az t3uttdings liivision In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. PO Box 7302 i `~ See reverse side for instructions for completing this application Madison, WI 53707-7302 n seons Department of Comme-ce personal information you provide may be used for secondary purposes s. 15.04(1)(m)J [Privacy Law (Submit completed form to County if not , / / -a? 7 -v t 9 ~d.~ a state owned.) Attach complete plans (to the county copy only for the system, on paper not less than 8 -1/2 x 11 inches in size. County ~~~ State Sani ennitSN_umber Check if revision to previous application State Plan I .Number I. A placation Information -Please Print all Informatioq Location: 7 Property ner NamQe L CA? ~ /~ ~ ~ ~ ~~~15 /`/i/~~ /1 ~li~Y/ ~N~ i1perty c~~ /on ,~j _/ ~ g-D jn) /~G 1/4/V/VI/4, S ~ TO/'/,N. tl- ~ (or,~,W' G // Property er's Mailing Address Lot Num er Block Number City State Zip o e ~ Phone Number u drv Sion Name or SM Number p /~S~ivT v E II. Type of Building: (check one) ~ -' ~ -P/L ~ 1 or 2 Family Dwelling - No. of Bedrooms : ~ a2 ^ City Village _ / own of /,~f~"~'31'j'L 7N~ ~ ^ Public/Commercial (describe use):_ `) ZG [ ~ ' ~~'~ ~~ ~ : ^ State-Owned ,ix ~,uu l~ l'`~~~ ~' ~~. ,~`~~~r.-~'"" /~Y~[ Nearest Road ~ ~~.~h~~. i 3 ~ l ~ acct ax um s'-d-~-v III. Type of rmit: (Check only one box on line A. Check box on line B if applicable) A) 1. New 2. Replacement 3. Replacement of 4. S. 6. Addition to Existing System ystem S stem Tank Only B) ermtt um er ate sue ^ A Sanitary Permit was previously issued Type of POWT System: (Check all that apply) ~ _ `t r G`t~ yt 5 Non-pressurized In-ground ^ Mound ^ Sand Filter ^ strutted Wetla~n/Z~ ~"~lcl ~ ~ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line 3/•! ~ C'. i%~m ^ At-grade ^ Aerobic Treatment Unit ^ Recirculating ^ Other: V. DispersaUTreatment Area Information: ash- ~ ~ f" /~ I. Design Flow (gpd) 2. ispers Area . Dispers Area 4. Soil Application 5. Perco scion Rate 6. System Elevation / 7. Final Grade Elevation / Required Proposed Rate (Galslday/sg. R.) (Min./inch) ~ ~ 38' ~ ~~ ~9 a ,. /o~.~ t . / . ~ / 1 VII. Tank Capacity in Total # of Man acturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete strutted Tanks Tanks F~llL LYX~ c~0 1 Tl, ^ ^ ^ ^ ^ ^ ^ ^ ^ VIII. Responsibility Statement I, the undersigned, assume responsibility r in 'on POWTS shown on the attached lens. Plum is Name (print is n ps : MP o. usmess P one Num r ~ lS' Z~ 7-!i ~~ I ~' 9'S~~ J D L NZ Plumber's Address (Street, City, State, Lip e SGo 9 7~8 ~ ~~i~ . G~~' S ~7~~' IX. County/Department Use Only ~~~ [tYApproved Disapproved ^ Owner Given Initial Adverse Sanitary Permit Fee ncludes Groundwater Surcharge Fee) Z S O~ ~ Date ssued ~ i1 ssuing Ag t Signatur tamps) ~ Z Z2 Q /~Z~z ~G~ivr~ Determination X. Conditions of Approval/Reasons for lJisapproval: - ~- ~-~ <~~`~~:4~--~Q~,~ ~- ~ ~ (~,~ ~ ~3' ~ ~/ ~ / 3 /'~~~~,~`~,, s~~~a-cam r/ _ _ 1~o iJ is o ~ i ~~O / ~Lr4-~ . , t'.L. Sinz Plumbing Inc. I..o T ZS p t~ IBC ~ ~"nJT I?~ c.Q C~ E hl E '/~{ tJ v.~ ' l~{ 5 9 TZ9 121 ~ c~J E5609 708th Ave. ~ Phone: (715) 235-2644 Menomonie, WI 54751 ~"`~ ~ ~ F ~~ `~` `~`~` ~' Fax: (715) 235-2592 ~r ~' ! K ~- C ~~ ~- >v -~ ~1 '~ ' o `oo ~o rJ 1`~ o n~ i ~ ~l o % t~L~R-~.~ . ,~ T.L. Sinz Plumbing Inc. ~ .r Zs p~ ~„~ ~^~T ~~~ ~ I.1 E y~ tJ ~ ~ -~ S `~ TZ9 12- ~ ~ ~..~-~ E5609 708th Ave. ~ Phone: (715) 235-2644 Menomonie, WI 54751 T"'~ ~ ~ F ~"v"' "!` `"~`" ~ Fax: (715) 235-2592 ~T ~~ ! K ~_ C ~~ r ~ ,v -----~ ~- i '~ ' o ~~0 / _ 4 ~RIG~I~e4L Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in acrnrrlanr.P with Cnmm R5 Wis Adm Code 1665 Page 1 of 3 Certified Soil Testing Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan mUl~t § ~. , i l d b t t li it d t i l d h i f t l !hd ' ~ ~ ;., St. Croix nc u e, u no m e o: vert ca an or zon a re erence point (BM), d ection a percent slope, scale or dimemsions, north arrow, and location and distan a to nearest road. ` Par I.D. ~~d ~ !~, / Z ~~'d~ tom Please print all information. ; ~ ~ ~ Z ~ Date ,e ed , Personal information you provide may be used for secondary purposes (Privacy , s.15.04 (1) (m)). < ~ ~ '7i Property Owner Bonte, Ron =-- -~--I 1/4 NW 1/4 S 9 T 29 N R 17 W Property Owner's Mailing Addre$ Lot # Block # Subd. Name or CSM# 1011 170th St. 25 Pheasant Ridge City State Zip Code Phone Number City Village ~,~ Town Nearest Road Hammond ~ WI 54015 715-796-5240 Hammond 110Th Ave. / New Construction Use: y; Residential /Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement _. Public or commercial -Describe: Parent material loess over till Flood plain elevation, if applicable NA General comments and recommendations: install 2- 2.83' x 118.18' (St"d-I~~ f,,ilt~rat~or. 38 shells) stipulation ~1099~chamber trenches @ system elevation of 99.2 ~l:~i~~ e.~ al- 3(- ~ ~C;E'~t",f/~P/!i ~ ~ 7j , - 2- a Boring # -- Boring /' Pit Ground Surface elev. 104.1 ft. Depth to limiting factor ~ 80 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Struciure Consistence Boundary Roots GP DIft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 1 0-8 10YR 2/2 - sl 1 c sbk mvfr cs 1 f/m .4 .6 2 8-36 7.5YR 4/6 - sl 2 m sbk mvfr gs 1 m .5 .9 3 36-80 7.5YR 4/6 - sl 1 c abk mvfr - 1 m .4 .6 I ~ ~~ ~~~ 3 has ocr~ sional 1 YR 6~3 fs coats on peds Boring # Boring /'; Pit Ground Surface elev. 101.3 ft. Depth to limiting factor ~ 84 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 1 ~ 0-10 10YR 2/2 - sl 2 f sbk mvfr cs 1f/m .4 .6 2 ! 10-40 7.5YR 4/6 - sl 2 m sbk mvfr gs 1 m .5 .9 3 ~ 40-84 7.5YR 4/6 - sl 1 c abk mvfr - 1 m .4 .6 ~ .. I oriz 3 has occasio_ n~1,10Y~~~ oats on peds; occasional 5YR 4/4 scl inclusions (3" x 6") below 72" tmuent s~ = rj~us > so < zzo mgit_ and T55 > 0 < 150 mg/L ' Effluegt #2 = BODS < 30 mg/L and TSS _< 30 mgr CST Name (Please Print) Sign to e: CST Number Henry F. Grote 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 11/16/2002 715-233-0398 ,. Property Owner BOrtte, ROn Parcel ID # Page 2 of , 3 ,~ ^ Boring # -Boring ~/~ Pit Ground Surface elev. 102.2 ft. Depth to limiting factor > 84 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 1 0-10 10YR 2/2 - sl 1 c sbk mvfr cs 1f/m .4 .6 2 10-32 7.5YR 4/6 - sl 2 m sbk mvfr cs 1 m .5 .9 3 32-84 7.5YR 4/6 - sl 1 c abk mvfr - 1 m .4 .6 3 `~ horizon 3 has occasional 10YR 6/3 fs coats on pads 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 ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 i I i i 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 P ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ---- ~~ I ' Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L "Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) Certified Soil Testing i' ~. ~ '~~ ~ r _~- 3 ~3 0, zg Cl X2.2,5 ~t'%:-~l Q,lON F ~, .. ;~~,,, ~ +~ ~ ~.,q-qti v. ~PJ ' ON'~CI \ f Mwrr N o ~ 3 `sC',~ ~-a~ 1~ ~4~ ut ~~3 '~,-.._ C os.~~ ~'"'l iu~~o) .. ~~~~, l ho.a~ (~~.~~ K t -~1w -~t-'~~t-1'i~W +~ ~ ~o ~+.M.t ~~ww...a.. ~S c ..~. ~. 1° _ S"b' J ~ O ZS Q ~5~10 1 ~1r--~) ~Gc T~-c'ts'L'i Y\ sa~3 ~~~ m _~~~` »g _ EFDy~m ~' Ti' i 9" X'+: ;. _vv.. ~C »» ~ y : t isconsin Department of Commerce INSPECTION REPORT SAFETY AND BUILDINGS DIVISION Field Operations Bureau 13 East Spruce Street Chippewa Falls, WI 54729 www. commerce.state.wi. us Scott McCallurrti Governor Philip Edw. Albert Secretary Date of Inspection: July 18, 2002 Project Name: Pheasant Ridge Use: New -Residential Legal Description: NE, NW, 9,29,17W Lot Number: Lots 25-26 Subdivision: Pheasant Ridge Municipality: Town of Hammond County: St: Croix Plan Transaction Number: Sanitary Permit Number: Wastewater Flow: 450-600 gpd Persons Present: Jon Sonnetag Rod Eslinger Plumber Name and Address: Certified Soil Tester Name and Address: Henry Grote CST 222774 E 4366 353~a Ave Menomonie WI 54751 RECE11/ED Owner Name and Address: Ron Bonte 1011 170« st ~`'a~- ~ 4 2002 Hammond, WI 54015 sr. c,ROlx counrrY ZONING OFFICE This onsite investigation was conducted because of conflicting soil and site evaluation reports by Henry Grote and Adam Schumaker. CST Schumaker felt that the contrasting soil colors of the substratum might be indicative of seasonal soil saturation. Two soil pits were reviewed (one on lot 25 and one on lot 26) and it is my opinion that the bands a streaks of contrasting color are depositional in nature and not pedogenic redoximorphic features. The contrasting colors were likely deposited by water from different sources and thus there are different colors. Convolute bedding often overlies horizontal bedding as was observed in the soil pit on Lot 25. The high chroma streaks noted in the horizontal bedded sands are like due to uneven weathering of minerals in the sand rather than contemporary redox feature formation. Recommendations for these lots include keeping the dispersal areas as shallow as possible and not to load the fine sand over 0.4 gpd/ft^2. Sizing example: 3 bedroom home 1125 ft^2 or about 37 chambers 4 bedroom home 1500 ft^2 or about 49 chambers If there are any questions regarding this report, please feel free to contact me. Le y G. J sky, ast ater Speci ' t Ljansky~ mmerce.state.wi.us E- it 715/726-2549 Fax 715/726-2544 Voice cc: County ^ Plumber ^ CST ^ Owner ^ Other alluvial Fan Deposits CONVOLUTE BEDDING HORIZONTAL REDOING OLDER SEDIMENTS Fig. 429. Sequence of sedimentary structure in a hood plain de- posit, sedimentedduring asingle hood. Ripple bedding is com- pletely absent. (Based on McKee et al. 1967) alluvial fans exist beside each other-coalescing-in a tectonically active area, i. e., actively sinking ba- sms. i~tten iauit plains are ~ICVCiupeii along su.;n 7tountain chains; the mountains are being elevat- ed and the alluvial tans are sinking. In such cases, thick deposits of alluvial fans are produced and preserved as marginal facies of the basin of deposi- tion. Alluvial fan deposits maybe found with various environmental associations, depending upon the topographical and climatic conditions. The most common association is the fluvial environment, where the alluvial fan deposits are associated with Braided river deposits of mountainous regions. Al- luvial fan deposits also occur in desert climates, as- sociated with sand dune and playa sediments ; in glacial environments they are associated with gla- cial and fluvio-glacial deposits. Sometimes alluvial fan deposits are associated directly with coastal sediments, e. g., the California coast (Shepard and Dill 1966). An alluvial fan is of the shape of a segment of a cone that radiates downslope from the point where 299 the stream channel emerges from a mountainous area. In the lower part the alluvial fan flattens out, becoming more fan-shaped and ultimately coales- cing with adjoining alluvial fans in the lower part. The angle of dip of alluvial fans rarely exceeds 10° ; generally, it is between 3 and 6° .The radius of alluvial fans varies from a few hundred meters to 100 km or more. The point where the stream emerges from mountains, and the highest point of elevation on the alluvial fan is known as the apex. Bull (1964a) found that the overall radial profiles of alluvial fans are gently concave upward, but that the slopes do not decrease at uniform rates down- slopefrom the apexes. Instead, the radial profile of most of the fans usually consists of three well-de- fined straight-line segments (sometimes there may be more). The surface represented by each of these segments makes a band of approximately uniform slope. _and runs concentric about the fan apes. Blissenbach (1954) distinguishes three zones on the alluvial fans 1. Fanhead (Upper fan segment): the area on the alluvial fan close to the apex. 2. Midfan (middle fan segment): the area between the fanhead and the other lower margins of the fan. MUD '~_AYER CU MBING RIPPLE LAMINATION CONVOLUTE REDOING HORIZONTAL REDOING iLAMINATEO SAND I !ARGE -SCALE CROSS-9EOOING (OE!'A FORESETS 1 MUD LArER CLIMBING RIPPLE LAMINATION HORIZONTAL REDOING (LAMINATED SAND 1 OLDER SEDIMENTS Fig. 430. Sequence of structures in a flood plain deposit of a single flood. (Based on McKee et al. 1967) l y ' Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings ~~~ auww~+a.~w ••.u~ liy~. u.. w, ••u. rw.... waac C,prJrr~/ Attach canplete site plan on paper not less than 812 x 11 inches in size. Plan must ~ v ~ indude, but not limited to: vertkal and horizontal reference point (BM); diredion and Parcel I.D. percent s{ope, scale or dimensions, north a ' Nance to nearest road. Please print a pp ~~ (~ ~ infdr'l~a~! V E D ~ Reviewed by Date Personal in(ortrration you provide maybe used secondary purposes (Privacy Law. 15.04 (1) (m)). Property Owner _. Location (~ -~ ovt. Lot N W 1/4 /U -U1/4 S 9 T Z,q N R ("~ E (o W Property Owner's Mailing Addres - ~ ~ ZONING OFFICE t # 2 Block # Subd. Name or CSM# , PI ~ ~ d . l0~ I 7~ 5 S :~ City State Zip Code Phone Number ^ City _ ^ Vllage ®Town N st Road ~1 (AX 11 ~)7 - I (2~(a ~f tom Pte New Construction l1se:~ Residential / Number of bedrooms ~-~ Code derived design flow rate y5~/!fl O y GPD ^ Replacement ^ Public or commercial -Describe: Parent material ~ ~ Flood Plain elevation if applipble /'~ ff. General comments SyS {~~ ~U• ~~- U G and recommendations: ~; ! /~ f /~v , ! ~ ~, (D/Lla ~ Boring # ~^1 Boring ~_ 1=T pit Ground surface elev. ~ ft Depth to limiting factor ~ in. Soli Appliption Rate Horizon Depth Dominant Color Redox Descxiption Texture Structure Consistence Boundary Roots GPD/ftz in. MunseO Du. Sz Cont Color Gr. Sz Sh. 'Eff#1 'Et'f#2 r ~-- S' ~ s I v-~ . 5 .8' 14 - 5 " c.~ Znn k r~ ~ 5 - . ~I . ~o Boring # ^ Boring ® pit Ground surface elev. ~~p. ~ R Depth to limiting factor ~_ in. Soil Appliption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlftiz in. Munsell Qu. Sz. Cont. ~Cdor Gr. Sz. Sh. 'Eff#1 'Eff#2 ~ ~ ~~ .~~ Z - S; ( 2 m ~r c I v ~ - ~ - 8 'Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 =GODS < 30 mg/l and TSS _< 30 mg/L CST Name (Please Print) ~i lure CST Number Address Date Evaluation Conducted Telephone Number 1 s Property Owner 4JU~ Parcel ID # < ~ ~ ~~ Page ~ Z ~ 3 Boring # ~ Boring . Pit Ground surface elev. 1O(). y~ ft. Depth to limiting factor ~ ~ in. Soil Appliption Rate horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Mansell Qu. Sz Cont. Color Gr. Sz Sh. 'Eff#1 'Eff#Z 1 (~-l2 (~ Z Sr l 2-rrC.L ~r ~ I v-~' , S ~~ 2 (2_yp L O --~ S i d 2 g~IL r c S -' _~ yO 57 .5 LS 1mS m~ c s - . ~ (• 2 51-~~ - ~ Z `?.5 mS OS t -- - . ~ ~ . 2 Boring # ~ Boring ^ Pit Ground surface elev. ft. Depth in limiting factor in. Soil Application Rate Horizon Depth . Dominant Cofer Redox Description Texture -Structure Consistence Boundary Roots GPDfft2 in. Mansell Qu. Sz Cont. Color Gr. Sz Sh. 'Eff#1 'Eff#2 ^ Boring # ^ Bonng ^ Pit Ground surface elev.. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Caor Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Mansell Qu. Sz. Cont. Caor Gr. Sz. Sh. 'Eff#1 'Eff#2 - 'Effluent #1 = BODS > 30 < 220 mgA_ and TSS >30 < 150 mglL 'Effluent #2 =GODS < 30 mglL and TSS < 30 mg/t. 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 (R07/00) e ~ j 4. Y PAGE~OF~ NAMF L.)r ~ ~~ TOT#~~ LEGAi DESCRIPTION NW ~ iflW `4 ,S `~ T Z~ ,~,R, / ~- E(or)~ SCALE:1"= yG BM 1 ELEVATION l DU - O BM 1 DESCRIPTION ~ao o-~ ~ ~~©/c p,~A-e BM 2 ELEVATION 9q Z y BM 2 DESCRIPTION ~~ Q -~ ~ ~ P yc 1~" P-~ SYSTEM ELEVATION /GO. U SYSTEM TYPE 14- f - 6-(taco Q CONTOUR ELEVATION `T 9 Sa N .- ~ - ~ C, ~,~ ~~,od ~.~~ Pa,~{o~r Qlev, Z ~, , „~ ~ 99 s~ ~ p. .~ y,~o .~q Z SIGNATURE i~ _~~~--~ DATE G - 9 ~~. , ~ ~ `<°POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page L of FILE INFORMATION Owner Permit # oZ~ DESIGN PARAMETERS Number of Bedrooms 3 O NA Number of Public Facility Units ~'NA Estimated flow (average) al/da Design flow Ipeakl, (Estimated x 1.5) ~~ al/da Soil Application Rate • ~!g al/da /ftZ Standard Influent/Effluent Quality Monthly average• Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BOD5) 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly ave rage Biochemical Oxygen Demand (BODE) Total Suspended Solids (TSSI 530 mg/L 530 mg/L ~A Fecal Coliform (geometric mean) 1 ` cfu/100m1 Maximum Effluent Particle Size Ys in ia. ^ NA Other: ^ NA "Values typical for domestic wastewater and septic tank effluent. ~~AI\ITC\IA\If~C PAtJCI1111G SYSTEM SPECIFICATIONS Septic Tank Capacity ~9Q al ^ NA Septic Tank Manufacturer ~ ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model ~~jZ ~ ^ NA Pump Tank Capacity a~'fiTA Pump Tank Manufacturer ~$f~A Pump Manufacturer .rB'IQA Pump Model ~ ~8'IOA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection - ^ Peat Filter ^ Wetland ^ Other: NA Dispersal Cell(s) n-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA IYIMII\ 1 GI ~IV~VL vV11LVVVV Service Event Service Frequency inspect condition of tank(s) At Least once every: 3 ^ month(s) (Maximum 3 years) earls) ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third IY31 of tank volume ^ NA Inspect dispersal cell(s) At least once every: ^ month(s) (Maximum 3 years) ear(51 ^ NA Clean effluent filter At least once every: ^monthls year(s) ^ NA ^monthls) ~'(~A Inspect pump, pump controls & alarm At least once every: ^ year(s) ~ ^ month(s) ,~NA Flush laterals and pressure test At least once every: ^ year(s) Other: At least once eve ry: ^monthls) ^ year(s) dNA !" Other: ~NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals ode-third IY,1 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and' disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. . ~' ~ y ti Page 2 of ~~ a START UP AND OPERATION '~ For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s!. If high concentrations are detected have the contents of the tankls) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cetl(s1 in one large dose, overloading the ce{{(sl and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain {sump pump- water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replacement system: {~SS id L~ _ ~~ ~ aid ~ ~~.c.Q ~ 6~4,v. [.tom ^ A suitable replacement area has been evaluated and may be utilized for theYocatio of a replacement soil absorption O system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ^ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area: If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name ~ 71/t~ ~~i~'' II/L Phone 7~~~ ~.- nnuire ^AA~IUTAINFR rv~~.v mr+ Name u., , L. %~ ~/L Phone .. ~~~~- SEPTAGE SERVICING OPERATOR (PUMPER) OCAL REGULATORY AUTHORITY Name Phone L Name ~ ~~/ ~~ /V Phone f This document was drafted in compliance with chapter Comm 83.221211b1(111d1&(f) and 83.54111, (2) & 131, V~sconsin Administrative Code. , - • ST CROIX COUNTY SEPTIC TANK MAINTENANCE ~-GRB'BMENT AND OVcTNERSHIP CERTIFICATION FORM OwnerBuyer K r~r 1 ~ { ~ ~ ~ - r v Mailing Address ~•. ~ q IO 9"~`` A v e Property Aaaress , ~ ~ . (Verification required from Planning Department for new coastructioa) . otg - i©9b - ~ ' State N ~ M ^~ ~ ~ ~ ~^' + s y ~ t ~ Parcel Identification Number ~ v CttY~ 2 ~ ~,EGAL DESCRIPTION ~ T Zq N-R » Town of ~ w M~~ ri d pro-party Location N W /4, N W /., Sec. ~,.~ Lot # ~ s Subdivision ~' t (~$t~l ~`1 Volume Page # ~'~ Certified Survey Map # , Volume _~ Page # Warranty Deed # Spec house ^ yes no Lot lines identifiable yes ^ ao ~ST~+ 1~'I 11'iA-INTENANCE rzmature failure to handle wastes. Proper maintenance Improper use and mamtenanceof your septic system could result in its P a licxnsed pumper. What you put into the system ooasisis of p~PinB out the septic tank every three years or sooner. ~ n~ by can affect rho function of the septic tank as a treatment stage is the waste disposal ~°m• ent a certification form, signed by the owner and by a to submit to St. Croix Zoning DeI~ve~~ that (1) the on-site wastewaterdisposal system The property owner agrees mastaplumber,]outneY~Pl+ ~trictadplumbcror a licensedpumpa the tic tank is less than 1/3 full of sludge. is in proper operating condition and/or (2) after inspection and primping (~ nTY~• ~ the vate sewage disposal system with the standards ~, the undersigned have read the above requirements and agree to marntam Pri State of Wisconsin- Certification cnt of Natural Resources, Office ~~ 30 ent of Commerce and the Departm set forth, herein, as set by the Depattm ed must be completed and returned to the St Cmix County Zoning stating that your septic system has been maintain day{~s of then thhree year expiration date. I~1 Vrlas~X~ ~~ ~~~~ DA'TE,o / 0 Z SIGNATCJRE OF APPLICANT OWNER CERTIFICATION our knowledge. I (we) am (arc) the owneds) of I (we) certify that all statements on this form are true to the best of my ( ) the pmpctty described above, by virtue of a warianty deed recorded in Register of Dads Office. t(l ~~l oz ~. DATE S GNATURE OF APPL CANT . ««««~ Any information that is mis-represented may result in the sanitary permit being rovoked by the Zoning Department. •sasss warranty deed from the Register of Deeds office •• Include vrith this application: a staained rf reference ins made in the warranty deed a copy of the certified sruvey map . /~ ~~.. . ~~ arc iw4 ~ 5~ .. ,~ ~ ~ ~ ~~" ~ ~~ ~` tiP ~ ~ ~ ' , ~, i~ 0 ,~ ~ t ,0 •, ~ ~ ~ ,~ . '~ ~~~ LOT 29 ;~' mo. .. ~° 62 1.6T ACRES .' ~,, ~ ~6 68, 524 S0. FT. i~ i9i ~S~o LFE 1064' -~2 / ,' ~ ~. PIPE 1061.30- ~ ~ .,' OQ`P 1~ Oj~~ ,, o~. a~~ ~ 6 ~ ~z3 q 28 '~9s .` ti .~4~ ;RES ~ ~ ' ~s, ~~' ~~Px~ISTER'S OFFICB .' ~~ ,~~ fa thu~ea ~ ~ ~'~ `~~ ~'~ , ~ o'c~occ M::Reooraoa in / ~P J~Q. '' Vow z ~ ~ of ~ ~~ ~: /~ g°~ .rte ~~ .. °o. R,eg}lEetafDoe~is ~o ..~ UT I L ItTY ~ E~A$EMENTS , NO POLE `OR BURIED CABLES ' ARE:.TO . BE PLACED'. SUCH THAT THE INSTALLATION, WOULD DISTURB: ANY: SURVEY STAKE,. OR OBSTRUCT VISION, ALONG ANY LOT L INE OR STREET L 1NE. THE' D 1 STURBANCE OF' A:SURVEY STAKE` BY ANYONE:. iS ~ A VIOLATION.OF SECTION.,,236.32~OF:.WISCONSfN.. STATUTES. UTILITY EASEMENTS AS; HERE, I N;; SET .FORTH ARE FOR ..THE USE OF PUBL ! C BOD 1 ES AND PRIVATE 'UTILITIES ' HAV 1 NG THE R 1 GHT TO SERVE THE AREA. ..,~L~. ~GEND o SET 2.376' O. D. X 30'' IRON PIPE` WEIGHING 3.65 LBS. PER LINEAR FOOT. NOTE: SET 1' O. D. ~ X 24' •IRON; P~IPE~ WE IGH fNG ;I. '13 LBS. PER LINEAR FOOT A T AL l OTHER LOT CORNERS. ~_ • UT 1 L 1 TY EASEMENT (TYP ' ) S li4 CORNER OF - SECT I ON 9, T29N, R 1 TW. (FOUND AL UM I NL " MbNUMENT). _ .. :; ••••••••••••••- ROADWAY SETBACK ,,r.~T 'Y ~' PROPOSED DRIVEWAY LOCATIONS ~ JAMES M. ~ ® I ...WEBER --------- • DRA 1 NAGE AREA ~' • S • ~~ ""-" "SPRING V ALLEY B GOVERNMENT CORNER AS NOTED <'9 ~\q_JO' t~', HWE H i GH WATER ELEVATION ~~~ LFE LOWEST. FLOOR ELEVATION ~~ht~eeONo~~,~ ' THE PARCELS SHOWN ON TH 1 S MAP. ARE." SUBJECT._, TO ', COUNTY AND TOWN LAWS, ;RULES .AND REGUL AT, I ONS WETLANDS, MINIMUM LOT SIZE, ACCESS::.TO,pARCEL, ~, BEFORE PURCHASING OR DEVELOPING ANY_:PARCEL, ICT THE ST. CR01 X COUNTY ZONING OFF 1 CE AND' THE Nov 21 02 11:57a Honte Excavating .' [715]796-2519 p.2 ST CROIX COUNTY SEPTIC TANK NIAIN'TENANCB AGRSBNIENT AND OWl.1BRSHIP CBRT'IFICATION FORM QwnerBuyer ~) S s•~ . is ~ ~ ~.t c; n d w ~ S `~ Address J y Z u ~J c v i s Mailing Iny-~ti Aut Property Address ~ 7 L , - (Verification required from Planning Deps~~t for aew coast Q1 City/State N ~ •• ., ~ ~ ~ w - 5 y ~ ~ S Parcel Identification Number -- i O ~t Irr -( ~Z fv - U O LEGAL DESCRIPTION ~ T Zq N- ~~ Town of N a .~..«~ n d property Location N `''i '/•, N W /,, Sec. ~~ Lot # Z s Subdivision P r (o ~9 . Volume _~_---~ Page # z-~ Certified Survey NIaP # Warranty Deed # Spec house ^ yes no Volume .Page # Lot lines identifiable ~ Y~ ^ no SYS'CEM iyLaiN'I'ENANCE Improper use and ~ntenanceof your sepCe system could resole is its b m ~~~ p t~T ~Wbai you put into thetsystem out the septic tank every three ycass or sooner, if needed Y m. consists of pumping tic tank ~ a treatment stage in the waste dispo~ ~e ua ~~ the function of the sep eat a eettificadoa form, signed by the owner and by a The pmp~ty owner egrets to submit to St. Qroiz Zoning DeP~ that (1) the on-sift wastewater disposal system tf tyooessaty), the septic tank is less than Ira full of sludge. mast,cx plumb, j~Y~ PI~'~r' restarted plumber or s licensed pumpu vorifym8 condition and/or (2) after iatipection and pampm$ (~ is in proper opecatsng em with the standards od have rod the above mquiramwts sad agree to maintain the private se9vage d'sT'O~of W nsin. Certification ~, ~° ~~~ nt of Commerce sad the Departa-~ of Natvaal Resources, Of6~ within 30 set forth, heroin. as set by the Depsrtrue leted and returned to the St Croix Cotmty Zoninv stating that your septic rystem has been maiata,ined must be ~:~ dayQns of then three year cxpuation data !l ~ ru / ~ Z ~!^l ~~ c~X e ~1~~rt~ DAZE SIGNATURE OF APPLICANT - OWNER CERTIFICATION our knowledge. i (we) am (arc) the owact(s) oC 1 (we) certify that all statements on this formda~trru~~~ ~ Register of Deeds Office. the property descnbed above, by virtue of a wattaary IS / ]V/ oC DATE S t3T1ATURE OF APPL CANT .... •, t bring revoked by the Zoning Dep~cnt. ...... qny infonnatioa that is mis-represented taay result in the sanitary pew ctaa,pcd warranty deed from the Register of Deeds office •• Include vrith this appllcatlon: i SPY of the eercifiod survey map if rcfcrtnee is made in the warrznty decd fVov 21 02 11:57a Bonte Excavating M ~ '~, (715)796-2519 p.3 DOCUMENT NO. ODIT CLAIM DZBD ~~n1. ~ ~ i J ~~ u Karl M. VlFerta and Katherina O. PlLerea, a/k/a Ka[haeiaa O. ulLarts. ^/k/a Katherina V1[erta, a/k/a Rate II1Ferta, •/k/a Rathasina U1Leree, hua'~•nd and •riEe :tioldin9 as aur~•ivorahip marital property, quic•claia:r to Rarl M. VlLer[a sad Katharine G. DlLerta lamily Trust, Dina M. Bence, Trustee. Ronald C. Bonte. 1st Alternative Trustee, having E~11 power to sell and encumber, the Following described real estate in St. Croix and Pepin Ceuncy, Slate oL I+isconaini See actached'Bxhibic •a^ for real estate deseriptian. The purpose a[ this Ou`_t Claim Deed is ^o terminate that occupancy r_gl:c as originally reserved by the Grantors by deed as originally dated September 1, 1995, rec~cded in St, Croiz County Register of Deeds on Noverrbec 1, 1995, at 10:00 a.m. in Volume 11.17 0! Records, Pagas 22- :~, ds L•ocu:rene NuMer 5)5679 and recorded ,.n Pepin County Register of Deeds on !!~~•ember 1), 1995, at 9:OG a.,,. in Volume 106 n[ Records, F.•ges 29{•295, as Document Number 09{1{5. EXD:4PT PER WISCONSIN STATUTE 77.21(1) This is hcmescead~roperty. Dated thin '' day oL AugusC, 1998. AUTRRNTICATIDN Signatures of Karl M. IIlLerta and at erln^ G. VlLarta authentic a da oL August, 1996. Lao A. Seakar TITLE: MEMBER STATE BAR OP NLSCONSIN (IE no[, authorize by 5706.06, N1s. State. TH29 SNSTAUfOTNT MA9 DRA/THD H7~ Leo A. 8eekar, Attocney RChLI. BESK1-R, BOLES i KRUlSCER, 9. C. 219 North Main Street, P. O. Box !38 River Palls, wI S{022 'K'EG T51'r'rr'S""~ ~' F i CE'..._ # ST. CRC.:( CO., w~ t`t• AUG 1 ~ 1998 3:30 Re Liar e1 @eeJt` NAk6 A_VD RETURN ADDRG^S Leo A. Beskar, Attorney P.ODLI, BESKAR, BOLES 6 KRUEGER, S.C. 1219 North Main Street, P. O. Box 138 ii River Falls, idI 54022 Pepin County 010-484-0000; 010-510-0000; 010-507-0000 St. Croix County 002-1026-80; 002-1(x25-40; 018-1018-20; 018-1018-30; 018-1018-4U; 018-1018-50; 016-1018-60; 018-1018-70; 018-1018-8U; Parce identsfi^•at>.on Nu es PINT 018-1018-90; 018-1015-i,^= 018-1015-70; -~ 018-1015-80; Ola-1015-90; 018-1019-UO (SEAL) ~-~'" L ,!/ .~' L ~2 1 ~ :!_ ~; r,. 1./~ t cL4L? xa LT N, p( erta pp ~sPUI RatEarlna G. Ullerte ACKNOYR.1LtXiOIMC STATB OP HISCONSIN 1 1 sa. COUNTY 1 Personally came before me this day of . 19 CFe aabove name[. to me known t~ be the person(s) who executed the Foregoing instrument and acknowledge the same. Notary public County. sai+. My commission ~ipermanenc. I nos, axparation dais. 1 y5,, !~~ ,~ ~ ~ •/:..~ ;~:fr?':Y':", LTA :11t-•~:.Yr`~P n!'Jry''y'~7~'•t~vr~'•'Srtill'Z,: '.'+1.!!'' ~!1}ti r'~lL ;i is ~R i,. .'L,... •,!~~ :~Ya'ti,:.4 ,i l.:R ~vi's'::'wY~.i •y~~ ~ '~ 1 .. ~ • .. IYov 21..02 11:57a Honte Excavating (715]796-2519 p.4 ~ .~ ~XH1~1 w~ Real Estate (St. Croix County, Wisconsin) Northeast Quarter (:~E 1/4) of Sectiaa Eight (~), Township Twenty vine (29) Borth, Range Seventeen (17) West. AND: I West Half (W 1/2) of Section Nine (9), Townsh~p Twenty Nine (29) North, Range Seventeen (17) West, EXCEPT Commencing at the Southeast corner of said West Half of Section°3; thence North on quad ter section line 341.8 o eet; thence N82°W 340. 0 feet; thence X52 W 170.0 feet: thence S39 W 170.0 feet; thence 556°W 263.7 feet to section line; thence East on section line 798.78 feet to Place of Beginning. j i AND: South Half of South rest Quarter of Southwest Ql~arter (S 1/2 of 5W 1/4 of SW 1/4) of Section Twelve (12); ~ And Northwest Quarter of Northwest Qusrtez (NWl/4 of NW 1/4) of Section Thirteen (13); All in Township Twenty Nine (29) North, Range Sixteen (16) West. •! Real Estate (Pepin County, Wisconsin) ~ Lot Five (5), Block 'Ivlo (2), Klampe Subdivision to Town of Pepin, Pepin County, Wisconsin. AND; , Lot 4, Block 4 of the Klampe Subdivision in~the Town of Pepin, Pepin County, Wisconsin; ~ ' ~1 Part !of Lot 1, Block 5, First Addition to~Klampe Subdivision, described as .follows: I commencing at the Southwest oorner of said Lot' which is the Point of Be inning: thence North 46 8' East, 135 feet thence South 43°52' East,J91.40 feet; thence South SO°1~' West, ;163.03 feet to the Point of Beginning. 1 Located in Government Lot 2 of Section T'r+enty,-One (21), Township Twenty-three (23) North, Range Fifteen (15) West, all in TCWN OF PEPIN, Pepin County, Wisconsin.