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HomeMy WebLinkAbout018-1099-42-000Wisconsin Department of Commerce Safety and Building Divisic~; ~ PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Ulferts Famil Trust Hammond Townshi SST BM Elev: Insp. BM Elev: BM Description: /vc> av ~ o Vv- ~ ~ ~ l~~{ I( I~O~ SANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic D D~ Dosing ~~ `_~ J / lp Aeration Holding , TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 1 ~ ~ 7 C D/ J "1 ~ ~ l- / Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer _~ __._.pp__~ f Demand b .~ ~ Md:.~7 GPM Model Number ~~ ~ ~ a ~~' TDH Lift , 5 Friction Loss Syst Hea TDH Ft 6.3 0.~ 3,25 ~. Forcemain Leng 77 t ~ / ~J Dia. // o2 Dist, to well /J~ ~ 1 SOIL ABSORPTION SYSTEM County: St. CroiX Sanitary Permit No: 430544 0 State Plan ID No: Parcel Tax No: Ol - D ~ - ~fZ GY~U Section/Town/Range/Map No: 09.29.17. STATION BS HI FS ELEV. Benchmark ~ `} ~I .~ IU , i ° s • ° row.. ~~ Alt. BM L 't Lv U ~/ Bldg. Sewer S •L ~ ~ 3~ ~ SUHt Inlet 8~~ !b©•Z SUHt Outlet Dt Inlet ~+ ~~~ Dt Bottom ; ~ z .brj qt..3 Header/Man. (, Go .7U ~ 0l.' Dist. Pipe ~a~" WcSr (,, ~~ X0.7 ~~ /b~~~ r Bot. System Noa t-+~- - -~ , I lp/ . 3 Final Grade ~ Cc ~b i n.o.~ Q w ~ ~'D St Cover 3 r r w~ ad ~~~ ~I. ~ (pb . ~ BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 5 / , 1 ~) ~, Z. CQ SETBACK SYSTEM TO P!L BLDG WELL LAKE/STREAM LE urer: INFORMATION CHAMBER OR Type Of System: ~ ~ ~ ~ / ~ C ~/ J ~ ~ / UNIT Model Number: ~ bl.W~ DISTRIBUTION SYSTEM Header/Manifold ~ -/ ~ ~ ~ Distribution Pipe(s) p ~ (/' 1 ~g // ~ / 1 b \~ I ~ `~ x Hole Size ~/' ~r ( x Hole Spacing / Vent to Air Intake ..~~ Length Dia Length iDia Spacing f SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Systems Only Depth Over / '~ Depth Over ~ ~ xx Depth of ~ xx Seeded/Sodded xx Mulched Bedlrrench Center Bed/Trench Ed es g I To soil p I ~ Yes ! No '' Yes ~'No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: '-/ / ~E3 1~_ Inspection #2:11 C~ rrw. ~ ~''l~ ~l Location: 1045 174th Street Hammond, WI 54015 (NE 114 SW 1/4 9 T29N R17W) Pheasant Ridge 1st'Lol~2 Parc/e-llNo: 09.29.17. 1.) Alt BM Description = ~ ~ 31 k" ~.r``n-b~~- b It ~ b~"~ l~l 2. B!d sewer len th ='"Fuu`'E ~ ) -amount of cover= "1~1h ~OVQ" ~ ~7~Ir~Wt`i-~ % '~ ~b~ C~~~p6~ Gt5 ~s,/ ~~~''" Plan~reision Required? ~ Yes ~~] No ; _._ f~ r--- - - ----- -~ - - - ___ , Use other side for additional information \ l ~_ _ ~ _ _!_ J ~ __-- -_ _- __- -.___ __.___ - _-~ SBD-6710 (R.3/97) Date Insepctor's ignature ~~~ ~t /c '~ ~ / Cert. No. -ti~ ~ rCCb Via-{ ~ ,~, w ojl.v- w'~-LSd ~K LEGAL ST. CROIX COUNTY, WISCONSIN NEW TXSCR02 REAL ESTATE TOWN OF HAMMOND COMPUTER NUMBER 018-1099-42-000 Parcel Number 09.29.17.852 OWNER NAME: First ERIC Last ROLLAND PROPERTY ADDRESS: Hse # 1/2 PD --Street Name-- Type SD Apartment 1045 174TH ST SECTION 9 TOWN 29N RANGE 17W '/<160 SW '/<40 NE Line Description Line Description TOTAL ACREAGE 1.880 PLAT PHEASANT RIDGE 1ST 33/54 '03 LOT042 BLK 01 SEC 09 T29N R17W PT NE SW 15 02 PHEASANT RIDGE 1ST LOT 42 16 03 (1.880AC) 17 04 18 05 19 06 20 O7 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1-General, F4-Prev. Parcel, F5-Next Parcel, F7-Valuations, F8-History, F10-Exit ~ Safety p~Dl W. Wasb~ iscoinsin Madiso Department of Commerce Sanitary Permit Applic In accord with Comm 83.21, Wis. Adm Code, personal utf may be used for secondary purpoat:s Pnvacy Law, s 1. Application lnformatlon -Please Print All Information property Owner's Name ~1 26¢3151 ion ~ n a on,~```` ~~(COUNTY .t)4(l^'ZONING OFFICE l s~ ~~ y Pemtit Number (to be filled in by Co.) ~f3oS'-f~f 'Ian LD. Num ~~J3~-~5}= In Address (il' t than mailing address) o S ~~• q Lot ~ Blot:k a . ir. ate `~ Property Owtur's Marling Address Property Location O/~ . /.. ., Section ~ e Number ip Code Phon Z City, State / L ~7 ~~f ~7{/( (MyF1/~. II ~ s7 0,5 ~IGO" ~ ~ (~~ T~ N~ R~E o~) 11. Type of Building (check all that apply) CSM Number Subdivision Name Q~l or 2 Family Dwelling - Number of ooms I~ 0 /~ ~L~,~,/. tf r/. ~ l,~ rj~ p, ~ ~( rf7is^+r l`~ • ^ Public/Commeroial -Describe Use Q ~ D = .O 2-- ' 9 2 c~ Ciry_^Village~I'ownah;p of l~.(~ x . . 5 ^ State Owed -Describe Use 111. Type of Permit: (Check only one boz on line A. Complete line B if applicable) A' ~ New System ^ Replacetent System ^ Tmatmmt/Holding Tank Replacement Only r ^ Other ModiScation to Existing System list Previous Permit Number and Date Issued ^ Permit Trangfis to New e of B. ^ Pertrtit R®ewal ^ Permit Revision - ^ Chang Before Expiration Plumber Owner -• 0 2 - IV. T e of POVdTS S stem: Check all that a l lp-tAC ^ > 24 rn. of suitable soil ^ Mound < 24 u~. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Non -Pressurized In-Ground ~ Mound _ ^ Constructed Wetland ^ Pressurizod !n-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Ttratment Unit ^ Reciroulating Sand Filter Rectrculatuig Syn[lutic Media Filter ^ Leaching (Mamba ^ Dtip Line ^ Oravel-less Pipe ^ Other (explain) V. Dis ersalrI'reatment Area Information: Desi Flow (gpd) Design Soil Application Ra sf) Dispersal Area Required (sf) Dispersal Area Pr~~(sf) SYstemD~ vation i V1. Tank info Capacity to Tom Number Manufacturer c Conecrcte Constructed Steel Glas I Plast Gallons Gallons of Units I s~~ae.~mttt~rsm I /w~nl I /~ - ~~ Uwin~ Lnamocr I ~(LOt~ V11. Res onsibili Statement- 4 the Plu s Name (Print) ~p L ~rNZ Plumber's Address (Street, Ciry, State, Zip Approved I ^ Disapproved Surcharge Fee) ^ Owner Given Reason for Detual 1X. Conditions of ApprovaUReasons for DIsapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code(ordinances.. for insWUatlon of the POWTS sbovvn on the attached fans. MP/MPRS Number B/u./si~neCs Phone N 1~1~1~9y~Z ii/- L3~ ~_ Attae6 complete plans (to the County only) ror the rystem oo paper not feu than a1R s I1 Inehn In she /La .~# SBD-6398 (R. 01/03) .:;~'" NAMF /J/F~r~ S r nr~ y~ T'F~f',~Y DlrrrrON •yF 1~~~~ Y,S ~ 'r ~9,~LB ~~ ~~ ~ ~~[~ COPY ~ o~ ~ ~, V' ~. isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce. state.wi. us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary November 06, 2003 CUST ID No.139462 TODD L SINZ T L SINZ PLUMBING INC E5609 708TH AVE MENOMONIE WI 54751-5520 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/06/2005 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: Ulferts Family Trust 100th Street Town of Hammond St Croix County NE1/4, SW1/4, S9, T29N, R17W Subdivision: Pheasant Ridge, 151 Addition -lot 42 FOR: Description: Proposed Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 928637 Identification Numbers Transaction ID No. 937757 Site ID No. 667680 Please refer to both identification numbers, above, in all comes ondence with the a enc . 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 Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.O1/O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.O1/O1). • Limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • Comm 83 22(71- A coRy of the approved Mans 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. P.C~.'~'~~.7:~. Co~zc~it~®~i?a~~,~ TODD L SINZ Owner Responsibilities: Page 2 11/6/03 • Comm 83.52(1)(a) -The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4} shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Gerard M. Swim POWTS Plan Reviewer -Integrated Services (608)-789-7892, Mon. -Fri. 7:30 am to 4:15 pm j swim@commerce. state.wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Henry F Grote ,Certified Soil Testing Ulferts Family Trust -Mound Transaction # Construction Materials and Techniques All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. Construction methods must comply with the following Component Manuals: Mound, SBD-10691-P (01 /01) Pressure Distribution, SBD-10706-P (O1/O1) Location: Lot 42, Pheasant Ridge, 1st Addition NE 1/4, SW 1/4, Sec. 9, T 29 N, R 17 W Town: Hammond County: St. Croix Date: November 4, 2003 Owner: Ulferts Family Trust Address: 101 170th St. Hartond, Wd~ 54015 Plumber: T Signature: License # MP 13 Attachments: 6748-Plan Approval Application SBD-8330 page 1: cover 2: design criteria & calculations 3: plot plan RECEIVED 4: system cross section 5: plan view, lateral detail p ~ ~" 2 2 2003 6: pump tank exit detail 7: pump curve SAFETY & BLDGS DIV. 8: system management _ .. ~ W ~~~ DEPARTMENT OF COh4P.4ERCE DNiS-ON of SAF TY AND BUILDINGS , page 1 of 8 SEE GORRESPO ENCE ' . Design Criteria Y ~S Residential Wastewater Contaminant Load: 30 mg/L < BODS < 220 mg1L Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L Fecal Coliform > ]0,000 cfu/100 mL Fats, oils, grease < 30 mg/L 3 Bedrooms x 100 gal/bedroom/day x 1.5 4'S~ gallons/day hydraulic load In situ designed loading rate Depth to estimated high ground water Depth to bedrock Cross slope at system Force main length Manifold/header length 2.5~ Drain-back 3• b~ Lateral length Z @ ~t o • ~ Lateral elevation t °~•~ Lateral hole size ~~~ b in. @ ~° °' ° ~ 9 holes/lateral 3 8 Lateral volume ~ b• 5 b Total lateral discharge rate ~• 5 ~ ~ ~ Network pressure compensation losses ~~ ~ 5~ Elevation difference 6•~ Friction loss `~ •Z$ Total dynamic head ~ °' ° 3 Pump/si•~hon ~' a gpm @ ~ 2 - Manufacturer ~~ '~' ° `~w~ Dose volume `~`~•4• Lift/siphon tank (~ ~ ~ 4 ~ ~ ~ ~ ~ - ts~ Co.-C,o Septic tank '' ~' '' Effluent filter oY ~~o F ~ ° ~ez.1_ ~ `~- t3 W . o m. ft. of Z in. gallons ft. of ~~~ Z in. ft. @ bottom of lateral in. ( S' ° ft.) Spacing holes total gallons gallons/minute @ 2' ~~ ft. head ft. ft. ft. @ 2a~ gallons/minute ft. ft. of head Model # S ~ ~ ~ 3 ~' gallons ~ ~ gallons o-a'•~ gallons Measurement pump on and off ~• o in. Height alarm from tank bottom ~ ~'• ~ in. Reserve capacity 3~•~•~' gallons specs.calcs.res Design Calculations o,Zb gallons/sq. ft. per day '~ 7- ~' in. ~ ~"° in. 1 0 % w .. ,. ~~ ft f 2. Page ~ of g ,. _ .. NAME U/F~r`l~ S r arm y~ r.F~ji12ESERIP'i'ioN /t!F_ `~Sw ~ C '~ T .~~ N_R ~~ Flom S" ~c L l w '~/~S~~ e 1 ~., 30~~ - „_. 11 /1 ZI, 3 ~ ~~ 0.ZS~re ..fit (a" 4's\o""~ 1 ~ o.~o o p t ~~.~ s....Q c w aa. ;, / Ct9.~3' ao.a r ~ <.v . ~ o l , o ~ tZtr*1 ~o t o,p t ~ ~ , ~~~ ~ b i~~co•` Sa..~ 3 ~~ ° "~ Q„14.V O.Y a.0.. ~ °) . ~ ~ _ 2..3~~ ~.t~ Slog lo.o' ~L}.,3' OTC-: ~ 06~ vi:~ 0.j ~-•'h V.~ \ X11 ~ ~ . i J, :. - __ .. 3 S P \ 0.h "' ; a.,,,,, b.s' ~~ •O 2S.a~ 114+ '3 ' I~ ~a'' 1~2.b~ . O ~. 4 ~ t~ u L c ~ /( ~e7- O~ L i~w v ~ ~ ~~~. ~.. t ~ l ~ '[~• Q b ~ ~ o ~+. + ~ ~ ~~ p iv o it; `v'4tt..`i ~ +a.~...Sr,~.~ ~_~D~ i•~O~ o.~.~+{ • 1• boc.y~ b~ ~.~ i 112 f v c s ~ 40 Z.,1' ~ / - S I S ~~~ 5,..p' I S°, .o ~'(O • C~ ~ 11 (' ( f1 - ~4r r\ w ~ l1 .-/ •4.`r L~ ~ G{.~.,~M ~O Ci N.,.~ •~•~.~.+o.. a, t~~Q~}~-O~ ~""'/ VR`vt beuulftC O`• u~/Uvv~,~0.w'4 ~~ QVL St o~~t r. a', v` _' ~ ~ c `~ ~ ~- LL/r `` ~/ L ~ G. ~ ~ O r- -LACKING GOVfiR -~ lvA~,'N Luc .~ ABED . avtcK Dt~t;OUVlG7-~ ~ ^-~ r; ~....~ t~' 4" ~~~ ~..~ 4m DIP6 3' no NDISTua6~a SOIL iMU r SK!^T JZJN1^J V PtP'G 4 ~KHEC.TIOKS ~.C~e~ I~ qs• o ar'~~~ 6'~ > •4~ A ~FFLE a `~ ~ r ocK Lp F'~' is '~'E1-14 ~ t1 c~irc~ 2, ~, o ., AIC.R~I 2'. ON - ~~o ocF 9„ 2 to FoR~~ Mnir+ WEATHERPRDJF ~,TLNCTtor+ 8cac ~' TTi i`~~~7rr,/~ \ ~" 4 0 _ V 6 hT .~ "S.S ~ --_ _;, %v 'wG:.D N C>.L ~, .. O ~ _ 5~~1 4c 3' o~c ,I l;+~LL'uc~ ~ ~ ~:..:u+~o 4z'~ i Pu•KP Go~F-r-c bcoCK ~4 ~ - ~ .. t. ~, 14 •~ ', ,' SEPTIC E SPEGIFI~CATIO-JS DO 5 E I ( , ,ti 1-S- c. w ~' ~ .' TAtJ..S MA-JUFAGTURCR: i"i' IJUMBER OF DOSCS: ~~ Z GAL~OIJS PEK C~~ ~ ,DOSC VOLUME _ S'~ ~}~~c..~Ys ALARl1 l1,NJUiACTURCii; ~. IWCLUOIAJG 6AGKFLOW: g~`4 C,At~J~;S Mood ~.IUV~ecR; • ~ ~ ~ ~"E `~ CAPACITIES: A . ~~ `~ IuCHCS OK 3~2'~~ SWITCH TyPC; HUMP MAIJUFACTURCR: ~'~'lr~`y~ ~+- ~ b _ ;~ MODEL 1JUM0[R: SN1.`~ 30 . ~3 4 1 ~'`~ ~/"~ QJv w, v w JWITCH TbPQ; . D" INCHES OR Coy .. ~ ~. IJOTE: PUMP A1J0 At_ARM ARC TJ BC MI-JIMUPI DISCMARCsF RATE 2s'~ GIM INSTAELED ou SEPARATE CiK_ -_ VERTICAL DIfFERCUCC p[TWCCU PUMP OF- A ~•~ UD OIJTRIDUT I ~ OIJ PIPE.. ______~ FEE T + Mi-JIMUM -JETWORK SUPPLY PRftSURE ~ ~ ~ ~ z''~ FEET ~°~~-$ S + ~'O FEET OF FORCC MAID x 1-3--~..F/poFEFRICTIOU FACTOII. Co~2g FEET ~ ZS~ ' _ ~ 1 _-.~ .-. ~~ -' TOTAL. DyUAMIC HEAD ~0~03 FEET (.IIJTERI,IA~. DIMEIJSIOIJC •0/ TAIJK: LEf`lGTH 2 ;WIDTH ; t_Iqulo DEPT H t~a~.~ 6 a Q i .. ~, -~ r i ~~~. r t ~ Pump CharactarisHcs - ~Me1M Dell SY~/Nr~~ Aldettetnfk Rsodeh SNEI~OA) µarepewer .SO Isll Loud Ann t.0 R4Ofa Sllded hb (4 ) R.-JA. 1iS0 -Ibee @ 1 Yek Its Han b0 lornpK.tRO 140'f AiliWoat NEDAA pest'. A r,aaorio+t au A Solids Net~q S/4'' I19Rpn) U>aE Welg1- ~4 6s. hover Cord 16/x, SJTW, 20' std. Pefrfertnferifte Data 1 1! ~ ~ >o I~~lo I I ~ i io to ~ a sa WKhU3,il.IL i __1.... , ~,,..,....~_.._ ..__. .~..,._- ... -t-- uwsrSw~+ e ~ 1 1 iotol N~id hit 4 i 12 1~ ZO 91 a~M cu.s.a ~ s4i ~~ 2s ~ s o Dimensional Data 1. Y e lw i~ Ilwufd ~ hwgimd ~. z c~neeatt M~ ~•r tom: In ~o i Iw kr t~nava4n p~erw ~ ntt~ l ibrdon d niiM e~ IOe ~I~nOM 5. 6n/Off fwd a~waY~ 6. Venrn+Ar~o~ Rte. I... prYua sld tM. tgdNmeoe dlku M>re ~,..,.~. ~{. `.. 1 ., ~ ~K cao~l ~°" I s'y~ s~t ~vpe (U4) ryAw do I~,`~j° HYDROMATICw ~ r ~ i 840 BaneT Rsod AsNm1, dto 41105 iel: 419~1t9~9041 (ix 419-~a1 ~Ipi7 wit Sne: wer,ptMdfOuelR(otri StIES C1fFKE5 IN 4ll IIWOR CRIES ANO COUNTRIES Item ~: Wci4.8350 t20o tSM ti 1499 Hydnomolic' Purnp~, Adtlorni, C~1io, •I! Rg - Ywr Auti+onsed lord DiYriburor - r, iFl: ,i o. ~ O~ '\~ . ~ ~ ~ ro- 7j YI ~ I ~ ~ ,. ... f~.._.._ I .... _ _ ~ ..~... _.. Materials of Constru4aion '~ , ' ~ System Management Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber, T.L. Sinz Plumbing, 715-235-2644, or the St. Croix County Zoning Office, 715-386-4680, should be contacted for assistance. General Proper functioning of an on-site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. ] . If the septic tank is installed prior to sheet-rock and/or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. 2 Install water-saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly. 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic or pump tanks are no longer used, they must be properly abandoned. 1 ] . If construction timing and weather could create a frozen infiltration system, weather-proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start-up. Maintenance 1. The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required ifthe combined scum and solids volume equals one third of the tank volume. 3. When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back-washed into the septic tank to remove accumulated material. 4. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in-situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. 5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Avoid compaction such as vehicle traffic within 15' down-slope of the adsorption system. 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run-off into the system area. 1 1. Warning: Do not enter septic, pump or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.4 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and/or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 a Wi.".`.onsin Department of Commeroe Division of Safety and Buildings SOIL EVALUATION REPORT Page _ ~ _ of _ J m accoroance wim Comm po, vvis. rum. ~,wn County ~( C Plan must lan on er not less than 8 1/2 x 11 inches in size Attach com lete site a _ J' . p p p p include, but not limited to: vertical and horizontal reference point (BM), direction and Paroel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. eview d Date Personal information you provide maybe used for agc~u~oses.(~duecKLa~v. s.,t5(04 (1) (m)). ~/y11 ~• a a o 3 Property Owner ~ .. • .- _. Pro rty Location ~ ~ r ~ Gov. Lot N ~ ~ 1/4ShJ 1/4 S ~ T 2~ N R /? E (or~ Property Owners Mailing A dress Ot ~^1 .~ S-I. °~ ~ ~ ~ ~ - Lot ~~. Block # Subd. Name or CSM# Pn~n+ ~Id ~ sr~-~-d State Zip Code City Phon8lVumkeT ^MCity ^ Village-Town Ne rest Road `,~ [~ New Construction Use: ~ Residential I Number of bedrooms ~ = L Code derived design flow rate ___~_~ ~~ ~ ~ ___ GPD ^ Replacement ^ Public or commercial -Describe: ______`__ ___ Parent material __Si _~ ~_,^____~ __ _ _ ___ _ Fbod Plan elevation if applicable ___!~/_/~ _ _____.__ ft. General comments S ~ S~ f r/~ -e /t' /, ~ G / • O U ~.0 ~ ~~ s~d~// and recommendations: ~d ~~ U ~ { 1 C v ~ /pU• `~ :l JGCS~ ~s2jOLv Q3 s.~ic -~a~ a. lrt /~f~'1~ su•-f~-cx. O•s~~~-l~ ~' p,c,~ ,t.~-~~~ ii `' /~~-„f ~,-~la/a.~ J D ^ Boring # ~ Boring QQ t ~. Pit Ground surface elev. _! U_~ _ ft. Depth to limiting fador ~ -I _ in. Sod A lication Rate Horizon Depth Dominant Color Redox Description Texture Strudure Consistence Boundary Roots GP Dlftz in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Etf#1 •Eff#2 ~ ~g l 3 - mfr cs (~~ .8 3 Z4- !~ S C ?. 5 ro S L 2m5bK - Boring # ~ Boring Qp ~ ® pit Ground surface elev. ~~_ ft. Depth to limiting factor ~~ _ in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fl= in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 •Eff#2 ~ lU r s; i bk c ~ ,, 5 2 ~~-~ ~ ~I Z ~~ ~ - • ~ . ~ 3 ! - rs ~ s~ 2 b ~ t~~ r ~ - . 5 , q ~ C2 ~, y s ~~ 2rr~5b r~tr - ,-- ~ 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) Signature CST Number dam ~c~~>~ker ~~~~--- ZS3 309 Address ~ Date Evaluation Conducted Telephone Number 2<<3 ~OTM ~ . SiGmerSe-~, (.U I S~aZ ~- / z-.S--G' ~ ~7/~~2~{?-~oo`~ Property Owner~~~~~~~1~~~'~U~ ParcellD# Page _ ~ of _ ^ Boring u Boring # c~ / >~Pit Ground surface elev. ~~-?~ ft. Depth to limiting factor _ ~CD _ in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fl? in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 I d-~ 2 10 313 s i l 2-Y,A.~k (^ c S ~ ~-~' ~ 5 .$ Z f2-2~} ( r (o - 5 c I z L S - - ~ ~v ,3 zy- rs ~ - S~ Zl'Ylsbk r ~ ~ - ~ S - 9 ~ 4~-7U (~ 2 C31P7.5 y C k ~ -- 2 . Boring # ^ Boring ^ Pit Ground surface elev. _________ ft. Depth to limiting. factor ______ in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. "Eff#1 `Eff#2 ^ Boring Boring # Ground surface elev. _________ ft. Depth to limiting factor _____ in. ^ Pit Soil A ication Rate Horizon Depth Dominant Color Redox Descxiptbn Texture Structure Consistence Boundary Roots GP DIfI? in. Munsell Qu. Sz. Cont Cobr Gr. Sz. Sh. "Eff#1 "Eff#2 `Effluent #1 = BODS > 30 < 220 mglL and TSS >30 < 150 mglL "Effluent #2 = BODS < 30 mglL and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD•8330 (R.07I00) ~. PAGE,~OF~ ~~AM UfF~~~ 5 LOT# y~- LE TAL DESCRIPTION ~1/F ~.Sw i4 ,S ~ T ~9 ,N,R, /3 E(orY~ SCALE:1"= ~G BM 1 ELEVATION /(,~O ~ ~ BM 1 DESCRIPTION~,~ c+-~ %y S~~'~/ pecX~f BM 2 ELEVATION , U U BM 2 DESCRIPTION ~~ c~ iy .S~-~~( ~o o~ SYSTEM ELEVATION l4/~ ~1 ~' SYSTEM TYPE /~'l o ~ ~ ~~ CONTOUR ELEVATION %~' ~~ ~ d N S«•. y I ~ ~- + ~(~ .Z ~- ~~~~6~ DATE ~ ~~-~~ f ~ ~>» ~ \ ' ~~ N/8o ti ~ s ~ 5 . _ . - o ~ 80 , x 35 • ' o ~ w x~ x A/~ 36 •n q ~ 35, .~, - x o A .s • ,~ _ 9 N '(~ ~ 0 4j0 ,~ ,` ~ x ~ "f w '~ ~ ~-- '~ _ _ 1 ~ ~ ,'` ' ~~ J . ? . ~ ~ ~~r i~' to x ~ r~ yS r ~ _ ~- ~ ` //yy~~ i•. ' " ~ _ m ~ _ ~ \ Qom } ~_. _ • , ~~ _ ~ a ry p ~ ~ ~< r.. ~ ~ ,~ ` ~,• . o t . ~ . ®• ~ _ ~: ~ • I l . ~~ • ~~ X ` • •~~ ,` ` ` `` ~~ / ~ ~ ~ ~ ~ ~ ~' ~ ~ ~~ ~ ' N 1 ' ~ ~ ~ ~~ ~ • b W ~ /" i- , 2 ~ ~ v ~ i• ~ a '~ N2 o 'V ~ ~ 1 • ~ l r ,,~__ _~ ,. ~ 2 MF $ 1 p O ~ x i ~ ~ g39 ® ~ , ~ 1 v A - ...... G, ~ ~, a ~ ~ ` ~ ~ • , W r cr w ~ ~ ~ x ° n ~ / ~ i ~ i • ~ ~ i ^ ~~~ ' ' ~ tN ~ n / .Z I ~ / ~ ~ '~. a i N i ~ w ~ 6 _ ` ~ ' 1 • ~ 1 b ~ ~ x ~~ Q ~ ~- C A / . t0 X I 1 e ~ 7p N , N - C ~ ~ i ~ T i ~ :; ~ D ST CROTX COUNTY SEPTIC TANK MAINTENANCE AGRE$N~NT AND OWNERSHIP CERTIFICATION FORM Owner/$uyer ~,~ ~-'~er~t~ Mailing Address t~ ~ ~ - ~o`t'~ S--t ~i(` V` ~ 4~ Property Address `~1 CS'~' W S ~~~ ~ ~ (Verification required from Planning Department for new City/State „ 'O•,1~Y~~ ~ W ~ Parcel Identification Number LEGAL DESCRIPTION 1 l - ~ ~ , T°~ N-R~,~ W, Town of 1~+~Y~ 1~0 property Location ~ '/4, 5 '/,, Sec. _ . Subdivision ~~Z'~-~`-~~ ~<~ Lot # ~._• ~- ,Page # ~'- Certified Survey Map # -'~_ .Volume _______- Volume ~ • Page # ~~ warranty Deed # ~~ 3 ~ ~ tifiable •~. Yes ^ no Spec house ~ yes ^ no Lot lines idea ~v~TEM r~A.l7yTE_N_fANCE Improper use and maratenance of your septic system could result in its premature failure to handle wastes. Proper maintenance out the septic tank every three years or sooner, tf needed by a licensed pumper. What You put into the system consists of pumping can affcd the function of the septic tank as a treatment stage in the waste disposal system. eat a certification form, signed by the owner and by a The property owner agrees to submit to St. Croix Zoning DoParcmverifyingthet (1) the on-site wastewaterdisposal system mast~rplumber, journcymanPlumber. restrictedplumberor alicensed ~), ~ septic tank is less than 1!3 full of sludge. is is proper operating condition and/or (Z) aRer inspoctioa and pumping (• meets and agree to maintain the private sewage disposal system with the standards Ilwe, the undersigned have head the above require set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certi.ficaaon tic tem has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 stating that your scp s~ da of the three year expiration dot . ~~ / i3 /O3 c _ DATE SIGNA'IZJRB OF APPLICANT OWNER CER'I'ffICATION our lmowled e I (wc) certify that all statements on this form arc true to the best of my ( ) g the property descn'bed above, b virtue of a warranty deed recorded in Register of Deeds Office. ~- SIGNATUR.E OF APPLICANT I (we) am (are) the owner(s) of t0 ~13~03 DATE Any information that is mis-represented may result in the sanitary permit ~~g evoked by the Zoning Department. •««««« «a jnclude with this application: a stamped warranty decd from the Register of Deeds office a copy of the certifiod survey map if refereucx is made in the warranty decd .«..., ____-___.._..,__ lv2 oL I DOCUMENT N0. QUIT CLAZN DYtD sa:a~o.} ,~~ 1:~d~s~l;c:1f1~. I x~rl N. Ulterts and xatherina 0. Rllerts, a/k/a xathariaa 4. Ulferif, a/k/a xatherina Ullerta, a/k/a Rata Ulterts, a/k/a xatharina Ulforts, hus:,~nd and wife Solding as survivorship marital property, quit-claims to xarl N. Ullerta and xathariaa G. Ulterts Pam11y Trust, Dine M. eonte, Trustee, Ronald C. Bonte, lit Alternative Trustee, having full power to sell and encumber, the following deocribed real estate in St. Croix and Pepin County, State of Wisconsin: See attached Exhibit "A^ for real estate description. The purpose o[ this Quit CLaim Deed is •o terminate that occupancy ri3lit as originall/ reserved by the Grantors by deed as originally dated September 1, 1995, recorded in St. Croix County Register. of Deeds on November 1, 1995, at 10:00 a.m. in Volume 1147 of Records, Pages 22- ee, ae C°c+cument Number 535679 and recorded in Pepin County Register of Deeds on ttu~•ember 13, 1995, at 9:00 a. m. in Volume 106 of Records, Frges 294-295, as Document Number 094145. EXD~IPT PER WISCONS.N STATUTE 77.21(1) This is homestea~roperty. Dated this ~„!!~ day of August, 1998. AUT$ENTICATION Signatures of xarl N. Ulterts and at arina C. Ulterts authentic 's da of August, 1998. • Leo A. Des ar TITLE: MEMBER STATE BAR OP WISCONSIN lIf not, authorized by §706.06, Wis. State. T$I9 INBTAUNYNT WAS DRAT?=D fY~ Lao A. eeskar, Attorney RODLI, BESKAR, BOLES 4 KRUEGER, S.C. 219 North Main Street, P. O. Box 138 River Palls, WI 54022 ST. CRGi;( CO., WI Rasa ,'u~ Roao~d AUG 1 ~ 1998 .j ~ 3:30 P~yi ~RJ Wi~~.~~~ ~1~~4 ~-1 ~~ R4Al+irr al Qvedf . . . . . . . . . . . . . . . . . . . . . . HAkE A."ID RETURN ADDRESS Leo A. Beskar, Attorney R.ODLI, BESKAR, BOLES & iCRUEGER, S.C. 219 North Main Street, P. O. Bux 138 River Falls, i~1I 54022 Pepin county 010-484-0000; 010-510-0000; 010-507-0000 St. Croix County 002-1026-80; 002-125-40; 018-1018-20; 018-1018-30; 018-1018-40; 018-1018-50; O1E-1018-60; 018-1018-70; 018-1018-80; Farce I ent fi^ation Nu er PIN 018-1018-90; 018-1015-f.C; 018-1015-70; 018-1015-80; 013-1015-90; 018-1019-00 ' ' i .y L~ j s (SEAL) ~ ~ L•( i~~ ~ ~?`_,j'`,~ f„r,/L-s IRE4L) x' ~al N. outs p (SEAL) L(a xathariaa G. Ulterts ACxNOWLEDGNYNT STATE OP WISCONSIN ) sa. COUNTY ) Personally came before me this day of 19 ~e above namef. to me known tv be the person(s) who executed the foregoing instrument and acknowledge the same. Notary Public County, Wi3. My commission ~s permanent. I not, expiration date: 1 %~ ' t '•`~+` $ +t}`~.`lf~ y,~,^:I~ F4t%' ~r~:* ~ '~tt~!?~ r W: i'~SF"i* Y`~!~,*wss~ iF:'''•'W~TA+~'.'~.r." ~y- ~`iM ~' {~'. c.,`• . + t ~~. '~"•. +•4 "~ , 9 ~ ~ ° +~{`~~~~ 7 ~ t~ + ~. ~ - rt .~t nyl fit, i f.'t .- . ~, ~, :. . ~ ;a~ 1`~4 ~ ~~rF ~ ~~~ EXHIBIT "A' j ; - Real Estate (St. Croix County, Wisconsin) I~ Northeast Quarter (i~(E 1/4) of Section Eight (8), Township Twenty Nine (29) t7orth, Range Seventeen (17) West. ~ AND; r 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 Sect.ion'9; thence North on quaoter section line 341.8 feet; thence N82°W 340.0 °feet; thence 552 W 170.0 feet; thence S39°W 170.0 feet; thence S56 W 263.7 feet to section line; thence East on section line 798.78 feet to Piace of Beginning. ~ AND; South Half of Southwest Quarter of Southwest Ql~arter (S 1/2 of SW 1/4 of SW 1/4) of Section Twelve (12): i And Northwest Quarter of Northwest Quarter (NW~1/4 of NW 1/4) of Section Thirteen (13); j All in Township Twenty vine (29) North, Range (Sixteen (id) West. Real Estate (Pepin County, Wisconsin) Lot Five (5), Block Two (2), Klampe Subdivision to Town of Pepin, Pepin County, Wisconsin. AND; Lot 4, B'Lock 4 of the Klampe Subdivision in ithe Town of Pepin, Pepin County, Wisconsin; AND Partlof Lot 1, Block 5, First Addition to,~Klampe Subdivision, described as follows: Commencing at the southwest corner of said Loth which is the Point of Beginning; thence North 46°8' East, 135 feet thence South 43 52' East, 91.40 feet; thence South 80°1~' West, 163.03 feet to the Point of Beginning. Located in Government Iot 2 of Section Twenty~'-One (21), Township Twenty-three (23) North, Range Fifteen (15) Wiest, all in TCWN OF PEPIN, Pepin County, Wisconsin. :~ ~ Y_' ~ .r,x kpy:+y1 'Ai,i"J?~ Z s~ k , s :- •, ..a-.~...... -y.. «~~-r.----- \ 2.09 ac~Es N $ \` 91, 199 Sn. FT. ~~ ®~ 1 ~ M ~\ P- \ ( ~'~ .±i \ 1 _ I ~~ \\ ( 303.6, ~ \\ ~ 3 ~ E ~ N66• \ I i0 \ NW I /4 - SW 1 /4 N 4 1 SW 1 /4 - - _ _ _ -~._I_ _ _ _ SW 1 /4 ~.. Z \\ ~ LOT 3~ \I 1. 72 ACRES ~\ 74,.96 7 S0. F 1 I1 ww a~ 1 \ 1 ~`SvO~s'~ N ' \ JAMES IiA. I \ ' E ~ WEBER ~ - i ~?a o4 -6 s~eoa~ \ ; ~II/101AAy.EY. Q : •~ ~ ,{• p cn \ .. a • \ ~ 1 ~ 1, RE~~s~J 3 -2Z-~'~ ~ 1 ~~~ z: .:mow ~~ $ ~ ~• :Q ~~ ~ ~ -. ._ ._. ~~ Q 1 ~IOriMed,~~'~OOI+I~~ : :; 0~ ~w I N6 ~ ~~ • G) O ..t.. . w ~ v. ~ _- •~ ~1~ -1- 3 h H i 1 ( ,_,: i1 N 1~~1~, GRAPHIC SCALE yI y 1 O 50 100 250. r LEGEND ' NO SCALE ~p ~gTTFO ~ , .~ ,qy~s 'F 80 ~• 3S, 366. 35 ` FAS~~NT / \` 4oQ ~~~ LOT 39''~~, I. 79 ACRES `.~ 77,891 SO. Ft. 0~ ~~~~ ' HWE 1078' ~~ ~' s L F E 108 0' ^~ \ NCO - \ ~~,~_ .~ LOT 4 0 ~ ~ ~ N. , ! ~~' f . 81 ACRES ~ ° a 78, 902 S0. FT. ~\ \00 Zc3~ c9 ~~ ~ i ~ ~ \ Q', ....... AZ ~ C?~ ~ „E ~ ~ ~ ~ ---- O .o SZO° 0a1 OZ \~ ~ ~~ ~~ , L O7 4 ~~ ` -~ ~ E ~ ~ wEr~ANO 2. 43 ACRES ~~ -~ 105, 9'93 S0. F T. ~' :a E ~,. -- ~ ~ :~ .~ p Sp3o ~ 0 4 ,~ • ... .. g39 ~ ~ ... ~~ ~ ~ ~ OT 42 s~, N ~ 0 ~ G 1. BT ACRES ~, N 81, 664 S0. FT. / ~ ~ 5E~0 QT 43 ~; , .75 ACRES ~ ~ ~ i 43 S0. FT. ~ W ~ ~ ~ i JOSE , ~~ Cp 83 W i G~~, / ~Or~. ~ O ~ O, ~ OD ~ ~~~ ~ \ . ~' ~/ ~ `` oo `` ~ \`vG• i _ ~~°' ~ 33 ~P. I .~ ,~ O. 0 \~~