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Home My WebLink About018-1083-21-000Wis'c3pnsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 {1){m)]. Permit Holder's Name: ^ City ^ Village ^ down of: Hammond Townshi CST BM E ev.: Insp. BM Elev.: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ ZC~ Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Air Intake ROAD Septic ; ,~ ~ 6' - NA Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION Manua r Demand Model Number GPM TDH Lift L ~ Ion Syete TDH Ft Forcemain Length Dia. HH Dist. TOweu ELEVATION DATA County: St. Croix Sanitary Permit No.: 363887 State Plan ID No.: ~~ Parcel Tax No.: d18~ ~v8j z 1 /6~ Z7.t/r~j~ STATION BS HI FS ELEV. Benchmark , f-~ a~,gp ~, ~ r 3~6~ q~.BS'' BI~tS~wer , 5 qS' St/Ht Inlet •p~ ~j6,c(S r St/ Ht Outlet S• 3L q6 ~ t8 ~ Dt Inlet -----^ Dt Bottom -=---'- Header /Man. `~ s ~, 3 ~3,~ r Dist. Pipe ~3~C7 Bot. System oar! ~;fo; Final Grade St cover a ~~ • ~ SOIL ABSORPTION SYSTEM~ii1r.P~~,,,.Iao1S cldrJs~ ~P,u~. BED /TRENCH Width ~ Len th No f renches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I N DIMEN I N SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manuf tur r `" _~~ SETBACK ~ t INFORMATION Type O r CHAMBER Mpdel Number: System: ~ D ~' 32 -I" ~"'~" OR UNIT ~.~..~, ,~ DISTRIBUTION SYSTEM ~ d' Header/fold , ~,~ I L f "_ 5 stributi Pipe(s) x Hole Size x Hole Spacing I Vent To Air Intake ~ Length C.~/ Dia - l - ngth Dia. pacing 1 ~S 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 BedlTrenchCenter Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No :/' COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: oG//'~/~ Ins>7ection #2: "i---~"' Location: (NE 1/4 N`V 1/4 16 T29N R1?W) - Pheasant Hills -Lot 21 1.) Alt BM Description = T°P$ ~+~~*"~ 2.) Bldg sewer length = Z3 M K -amount of cover = ~ ~(o ev~f Plan revision required? ^ Yes (~ No Use other side for additional information. e6 1 c( W SBD-6710 (R.3/97) Date Inspector's Signature Cert. No ~~i38Wf1N llWa3d l~~l`dllN`dS H013~IS aN`d S1N3WW00 lt/NOIlIaaH 4 ''~`~'~ ~ ~ ~~ Safety and Buildings Division `~SCOnS~n sANITARY PERMIT APPLICATION yt; 201 W. Washington Avenue ~7 (''t~ _1' ~/ P O Box 7162 Department of Commerce In accord with Comm 83.05, Wis. Adm. Code ~1 ~~ " ~~ "" Madison, WI 53707-7162 • Attach complete plans (to the county copy only) for the system, on paper not less cJOUnty /l than 8 vz x 11 inches in size.. '~r !. P'O ~ • See reverse side for instructions for completing this application State Sanitary Permit Number 3l~3~p~- Personal information you provide may be used for secondary purposes heck if revision co previous application [Privacy Law, s. 15.04 (1) (m)]. to Plan Review Transaction Number I. APPLI ATI N INFORMATION -PLEASE PRINT ALL INF RMATION Property Owner Name ~~ ~ Property Location /a /a, 5 ~ T ~ , N, R~ E (or W Property Owner's ~ fling Address ~ Lot Numb r~ Z Block Number Ci y, State " LJi ~ G' Zlp de ~'Dyp l 3 Phone Number ( > Subdivision Name o Number ~ a . 1 . TYP F B 1 ING: (check one) ^ State Owned ° !ty ° v a Nearest Road Public 1 or 2 Famil Dwellin - No. of bedrooms n OF ~rw ow III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ^ .Apartment /Condo , 2 ^.Assembly Hall 6 ^ Medical Facility/ Nursing Home 10 ^ Outdoor Recreational Facility 3 ^ Campground 7 ^ Merchandise: Sales/ Repairs 11 ^ Restaurant/ Bar/ Dining 4 ^ Church /School 8 ^ Mobile Home Park 12 ^ Service Station /Car Wash 5 ^ Hotel /Motel 9 ^ Office /Factory 13 ^ Other: specify IV. TYPE Of PERMIT: (Check only one box on line A. Check box online B, if applicable) A) 1. ew 2. ^ Replacement 3. ^ Replacement of 4_ ^ Reconnection of S. ^ Repair of an _______yytem ________System _____________ TankOnly______________ Existing System _________ExistingSystem B) A Sanitary Permit was previously issued. Permit Number 3 (~ 3~~ ~' Date Issued ,~ Z Z d V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental ~ Other 11 ^ Seepage Bed 21 ^ Mound 30 ^ Specify Type 41 ^ Holding Tank 1?,,,~Seepage Trench ~ In-G and Pressurg, /~ / 42 ^ Pit Privy Pit 3 ~ 3 x6g~~ 3 3 {~ 1! ~~ta ~-~O 43 ^ Vault Priv 13 ^ S y eepage « 14 ^ System-In-Fill ~.~ //j ~j - VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade equired (sq. ft.) Proposed (sq. ft.) (Gals/d sq. ft.) Min./inch) Ele at'on ~ ~ ~ 3 ~ ' ~ 7 ~~~ Feet •O P e ~c~li U ~ ~ < VII. TANK INFORMATION Ca aclt in altos Total # of r Manufacturer s Name Prefab. Site o e- St Fiber- Plastic Exper. N E i i Gal{ons Tanks concrete u e glass App ew x st n st rted Tanks Tank tiZ o#}efdiTtgTank IZ !~ ^ ^ ^ ^ ^ of ^ ^ ^ ^ ^ ^ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's ame: (Print) Plumber's ure: (N ps) MP/MPR W No.: ~6~ ~ Business Phone Number: ~ ~ ~~ ?~s-~ -ysi Plumber's ddress (Street, Cit State, tip Co ): ~a<S /~ Z ~ ec.c/ /2i LJ ~ Yom/ 7 IX. COUNTY /DEPARTMENT USE ONLY ' ^ Disapproved Sanitary Permit Fee tlncludesGroundwater ate slue Issuin Agent Signature (No Stamps) ~] Approved ^ Owner Given Initial Ad e D i i /~ Surcharge Fee) ~Sv 6 O(J vers eterm nat on 1C._~.VNUI IIVNS OF`ANP/K/U/VAL/ KtASUNSLFVR/DISAPPKUVAL: ~ ` * de.~~l.Sro~ LS u./~vhiP'f~( / ~/ ~'C I~~CG~ L~//'I~~~9C r~rl Sl~~S7~G /~/ ~GQ~<Ov~. C1..~1/,h. /~.~5 SM14/l( !x ~K ~ TQ[ /~ -r- ! 3 ~ " 6Ql w yr /" l ,7,~1/ Y,~ ~, ft. l~Q s adC rc c.o~.. Kf 5 ,` SBD-6398 (R.12199) ~ ~~>~ ~~ Original tb County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS ' 1. A sanitary permit is valid for two (2) years. 2. Your sanitar-y permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained: The septic tank(s) must be pumped by aiicensed pumper whenever necessary, usual ly every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. ' VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank ~raterial. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if -tanks received experimental product approval from DILNR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County /Department Use Only. X. County /Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 1 1 inche~~ must be submitted to the county- The plans must include the following: A) plot plan, drawm to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose vof~me; elevation di fferences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if `required by the county; f) soil test data on a i 15 form; and F) all sizing informationsr GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (#ees) for a riumber of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. PLOT PLAN PROJECT Chad Behrendt ADDRESS 1443 300th St. Glenwood Citv Wi 54013 NE i / 4 NW i / 4 S 16 /T 29 / 17 TowN Hammond COUNTY ST. CROIX 5/25/00 4 MPRS Shaun Bird 226900 ~~ DATE BEDROOM CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1200 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .6 ABSORPTION AREA # of chambers ,BENCHMARK V.R.P. Top of nail in tree ASSUME ELEVATION 100' ^ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 92.3/92.0/91.7 Alt. BM Top of Steel Fence Post @ 96.7' 487' property Line - 444' Property Line ~~ 8%rP 3-3' X 72' Trenches with 6' Spacing ~ ~ _~~ ~~ Vents 20' ~~. ~ z . v ~ 5' ~ e2• ~ 45' 45' B-3 ,B.M. 100' B-1 System elevation is '10' below basement grade Pro 4 5 Bedroom House 592' Property Line ~ Area is original test for plat 170th St.? 60' G f~~ l~e+~r~( /vim y ~~~1 Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County ~._. include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel I.D. # Page ~~ of APPLICANT INFORMATION -Please print all information. ed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). wti Property Owner Property Location Govt. Lot~f~ 1/4 (~I/4,S /~j T~ ,N,R 1 E (o W Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# y 3 ~ ,~Pt- `~ z I _ 1, ems. ~- ~' City State , Zip Code Phone Number Nearest Road ^ City ^ Village Toyyn New Construction Use: residential / Number of bedrooms ~ Addition to existing building Replacement ~ []"Public or commercial -Describe: Code derived daily floK~1! /lL~(,.~_ 9Pd Recommended design loading rate ~ bed, 9Pd/ft~ o trench, 9Pd/fib Absorption area required /~~ bed, ft2 ~~p^rd~trench, ftc2 Maxigmum design loading rate • S bed, gpd/ft2~trench, gpd/ft~ Recommended infiltration surface elevation(s) / . /o~.~% ~ /•?•oT^t / ~ ~ ft (as referred to site plan benchmark) ~-"~'~ / Additional design/site ponsiderations C r So ,/~P f ~O/LL ~r /~ • Parent material Flood plain elevation, if applicable .~l/) 1~ ft S = Suitable for system Conventional Mou d In-Gr nd Pressure AT- rade System i Fill Holding Ta U = Unsuitable for system ^ U ^ U ^ U ^ U ^ S ^ S SOIL DESCRIPTION REPORT Boring # 1 Ground ele ~S-1 ft. Depth to limiting fa~~tpp~~r,, ~,~~U~n. Boring # Ground gel 9 ~ft. Depth to limiting ~~~in. U Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/ft~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench I ~~ 3/Z s ~ r ,~- ~s~, S rn ~ '~~ - ~ `1l N ~ rl `/ M f ~ . '' ~ 1` ~ Remarks: S~r`Q ~~ `~ S{ruGl~ccr~ Lolamn ih1¢~( o~'Gk`Y~ s ~ 7 . br y2 ~A~~ , Remarks: CST Na a (Please Print) 'gnature Telephone o. -~~~ / ,~~ ~ .r V ~ `.a Address ,, Date CST Number ~ ~,~ ~ i s~o e 7 ~ s~--o d dad d~ PROPERTY OWNER PARCEL f.D.# Boring # Ground V. ~ft. Depth to limiting fa for ~~in.' Boring # SOIL DESCRIPTION REPORT Page of Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ary Bed ,Trench ld /D X3/2 ~~y~- ~' L',,r' , s ,, r , L C ~ ,OA's ,?;~ '' ~.(s ~~'e;~+^"' ~ S /f~/ /lam/~ !I~ ~ S ,~ 2. ~ ~i ~ 9 ,, ~ r Remarks: Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Boring # Ground elev. ft. Horizon Depth Dominant Color Mottles T t Structure Consistence B nd Roots GPD/ft~ in. Munsell Qu. Sz. Cont. Color ex ure Gr. Sz. Sh. ou ary Bed ,Trench Remarks: IDmtingo I I I I I I I I I I factor 'n' Remarks: SBD-8330 (R.9/98) . ~ ~ Soil Test Plot Plan Project Name Chad Behrendt Shaun Address 1443 300th St. Glenwood City Wi 54013 Lot Subdivision Pheasant Hills Date 5/25/00 NE ~ /4 N W 1 /4S 16 T 29 NiR 17 W Township Hammond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Nail in Tree System Elevation 92.3/92.0/91.7 *HRp Same as Benchmark Alt. BM Top of Steel Fence Post @ 96.7' ~~ ~~~ `~sconsin SANITARY PERMIT APPLICATION Department of Commerce In accord with Comm 83.05, Wls. Adm. Code • Attach complete plans (to the county copy only) for the system, on paper not less than 81n x 11 inches in size. • See reverse side for instructions foccompleting this application Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04 (1) (m)). Safety and Buildings Division 201 W. Washington Avenue POBox7162 Madison, WI 53707-7162 County State Sanitary Permi umbgr 3G 3~~- ^Check if revision to previ nation State Plan Review Trans Number I. APPLI ATION INF RMATI N -PLEA E PRINT ALL INF RMATION P perty Owner Name ( ' Property Location is Zia S ~~ N R ~ (o W ~ ~ ~, , , , Property Owne Mailing Addr ~- ~G 0~ ` Lot Number Block Number -- 5 . 3 l C~yyState Zip Code hone Number Subdivision Name Number G"/ ~n. / ~ ~ ~y 'r !~v ~y I1. TYPE B ILD (check one) ~t$ , v_j~nQd, ~: ,; ~ !t~ ~ Il e Nearest Road~/~ Public r 2 Famil Dwellin - ed om3~ ~ wn ~ ~ $~; III. BUILDI ~7 USE: (If building type is p li eck ~~j~'r) arce x Number(s) UU 1 ^ Apartment/Condo `~l r n ~ ~ ~ 2 ^ Assembly Hall 6 dic~J'~~(cill~ty~ ~ e 10 ^ Outdoor Recreational Facility sl r 3 ^ Campground 7 chandi~: / R ~"~ 11 ^ Restaurant/ Bar/ Dining 4 ^ Church /School 8 ^ 'le Ho ,~"~ 12 ^ Service Station /Car Wash 5 ^ Hotel /Motel 9 ^ I F23 y /.~G3 ~ 13 ^ Other: specify IV. TYPE OF PERMIT: (Check only one b o ~ C ox on line B, if applicable) A) 1 2. ^ Replacement 3. placement of 4. ^ Reconnection of S. ^ Repair of an ____System____-___System--___-___ __TankOnly______________ Existing System ________ Existin~SYstem B) ^ A Sanitary Permit was previously is d. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pr urized Distribution Experimental Other 11 ^ Seepage Bed ^ Mound 30 ^ Specify Type 41 ^ Holding Tank ~~.~Seepage Trench 2 ^ In-Ground Pressure 42 ^ Pit Privy 43 Vault Privy 3 ^ Seepage Pit ~ 14 ^Sgstem-In-Fill- ij~ VI. ABSORPTION SYSTEM I ORMATION: 1. Gallons Per Day 2. Abs .Area 3. Absorp. Area 4. Loading Rate 5. Pert. Rate 6. System Elev. 7. Final Grade Re ui d (sq. ft.) Proposed (sq. ft.) (Gals/da /sq. ft.) (Min./inch) Elevatio ~DU ~ ~ ~ Q ~~ ~ ~ ~' Feet - Feet Ca aat VII. TANK in allo s INFORMATION g Total Gallons # of Tanks Manufacturer s Name Prefab. concrete Site con- steel Fiber- glass Plastic Ex er. App New Existin strutted Tanks Tanks Septic Tank or Holding Tank ~/ ^ ^ ^ ^ ^ Lift Pump Tank/Siphon Cha er ^ ^ ^ ^ ^ ^ VIII. RESPONSIBI Y STATEMENT I, the undersign ,assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Na : (Prin Plumber's e: No p) MP/MP SW o.~ /~J Business Phone N7umb r• (~l Plumber's Address ( t, City, av~,~p Cod , t~ r y / L. J IX. COUNTY DEPARTMENT USE ONLY ^ Disapproved nitary Permit Fee nnclude:Groundwater ate ssue Issuing Agent Signature (No Stamps) ~4pproved ^ Owner Given Initial Surcharge Fee) aas~ ~ ~ -ZZ"~ ~~^' Adverse Determination j ~ X. CONDITIONS OF APPROVAL /REASONS FOR DISAP~PRO~: tt--dl~c,~,, r r ` ~,~r ~~ SBD-639H (R.12/99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit maybe renewed before the expiration date, and at a time of renewal any new criteria in the Wiscor~jn Administrative Code will be applicable. 3. All revisiorii to this permit must be approved by the permit issuing authority. 4. Changes irti ownership or plumber requires a.Sanitary Permit Transfer /Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3151. To be complete and accurate this sanitary~permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to oe installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one online A. Complete line 6 if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every newlor existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for a!1 septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (egg. MP, etc.), address and phone number. Plumber must sign application form. IX. County /Department Use Only. X. County /Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement sys~iem areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------=------------ GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices whit ` _can effect groundwater. - The monies collected through these surcharges are used for monitoring groundwater contamination investi Boni and establishment of standards. , PLOT PLAN PROJECT Chad Behrendt ADDRESS 1443 300th St. Glenwood City Wi 54013 NE i/4 NW i/4S 16 /T 2 N/R 17 W TOWN Hammond COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE5/17/00 BEDROOM 4 CONVENTIONAL XXX IN- UND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1200 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE •6 ABSORPTION AREA/D/7 # of chambers 3'~ ,BENCHMARK V.R.P. Top of iron ASSUME ELEVATION 100° ^ BOREHOLE O WELL *H.R.P. Same as Benchmark 487' Property Line SYSTEM ELEVATION 98.6 444' Property Line Pro 4 Bedroom House 20' B-35 105' 25' 15' -3 3015 \ \ 45' 35' B-5 592' 4 Vents Property Line 10' B-2 _~ 2-3' X 98' B-4 Trenches with 6' Spacing 170th St.? 60' Vent > 12" Sidewinder High of Cover Capacit}' Leaching Chamber with 31.8 ft^2 per chamber 16" 6' Long „ , „ Grade at System Elevation (,.Wisconsin De artment of Commerce I AND SITE EVALUATION Pa e 1 of 3 Division of Safety and Buildings OR~G~~ with Comm 83.05, Wis. Adm. Code g Certified Soil Testing Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan must include, but not limited to: vertical and hori3or~t2'f"teferenc~,paint (BM), direction and County St. Croix d a t a ' h . txl distance to nearest roa nd loca ion arrov percent slope, scale or dimemsions, nost#f , ,~ ~. ti. Parcel I.D.# APPLICANT INFORMATION: 'p~eas rn~all mfonriatfon . ~.R Personal information you provide may b used for seCOndery purpo3~s (Pnvacgt~yv, s. 15.04 (1) (m)). I e By D t Property Owner i * _ . r, Borate, Ron ~.i~;~~ ~ Property Location Govt. Lot NE 1/4 NW 1/4 S 16 T 29 N,R 17 W Property Owner's Mailing Address `, "' ' Lot # Block # Subd, Name or CSM# 1011 170th St. _~~ .,~,, 21 Pheasant Hills City State Zip Code PhoneNumber 5 0 ^ City (~ Village ®Town Nearest Road ~ d 170Th St I~ Hammond WI ..54015 715-796- 2 a . mmon ~ Residenti~/Number of bedrooms 3 New Construction ^Addition to existing building Use: Replacement ^ Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate •3 bed, gpd/ft2 •4 trench, gpolft2 Absorption area required 1500 bed, ft2 1125 rate •5 bed, gpolft2 •6 trench, gpd/ft2 Recommended infiltration surface elevation 24" below contours ft as referred to site plan benchmar install 2 - 5' x 12.5' shallow trenc es on contours for 3 br ~../a ~+.~ u sy sae.+..~ ,~.1Q.~/ Additional design /site considerations Parent material tilt Flood lain elevation, if a licable NA ft S=Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U=Unsuitable for system ® ^ U ®S ^ U ®S ^ U ®S ^ U ^ S ®U ^ S ~ U w~~ v~wn~r ~ w~~ r~~rvr~ ~ Boring# 35 Ground elev 100.5 ft Depth to limiting factor > 86' Ground elev 100.6 ft Depth to limiting factor > s2' H i Depth Dominant Color Mottles T t Structure Consisten Bounda Roots GPD/ft2 or zon in. Munsell Qu. Sz. Cont. Color ure ex Gr. Sz. Sh. ry Bed ~ Trench 1 0-6 7.SYR 2.5/1 - sl 2 m gr ds cs if .5 .6 2 6-20 7.SYR 2.5/1 - sl 2 m sbk mvfr cs if .5 .6 3 20-23 7.SYR 3/2 - sl 2 m sbk mvfr gs if .5 .6 4 23-71 l OYR 4/4 - sl 2 m sbk mfr cs - .5 .6 5 71-86 lOYR 6/4 - mcos 0 sg dl - - .7 .8 Remarks: occas~onat gy s~ coats on peas m nonzon 4 + occas~onai pocxetsrmcrus~ons is; nonzon ~ nas mcrosrons i.o r x sip si, some i.o r n s consi era a gr 2'' 1 0-6 7.SYR 3/1 - sl 2 m gr mvfr cs if .5 .6 2 6-12 7.SYR 3/1 - sl 2 m sbk mvfr gs if .5 .6 3 12-20 7.SYR 4/3 - sl 2 m sbk mvfr gs if .5 .6 4 20-36 f~ 7.SYR 4/4 - sl 2 m sbk mvfr cs - .5 .6 5 36-62 SYR 4/4 - sl 0 m dh - - .3 .4 tvF' `t 8 . ~ Zy '~ _?~ Remarks: SST Name (Please Print) Signature: Telephone No. Henry F. Grote _ 715-665-2681 4ddress ertt to o~ esttng Dato CST Number Ref # P.O Box 57, Knapp, WI 54749 4/16/2000 222774 1066 PROPERTY OWNER: Bonte, Ron PARCEL I.D.# 3 Ground elev 100.6 ft Depth to limiting factor > 70' 4 Ground elev ,~~ou Depth to limiting factor 63" 5,. Ground elev 100.7 ft Depth to limiting factor > 70" Ground elev SOIL DESCRIPTION REPORT ~ Page 2 'c~~ 3 Certified Soil 'L'estin~ Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots GPD/ft2 Bed Trench 1 0-5 7.SYR 3/1 - sl 2 m gr mvfr cs if .5 .6 2 5-10 7.SYR 3/1 - sl 2 m sbk mvfr cs if .5 .6 3 10-16 7.SYR 4/3 - sl 2 m sbk mvfr gs if .5 .6 4 16-46 7.SYR 4/4 - sl 2 m sbk mvfr cs - .5 .6 5 46-53 lOYR 6/4 - s 0 sg dl cs - .7 .8 6 53-58 lOYR 7/3 - s 0 sg dl cs - .7 .8 7 58-70 1OYR 6/4 ~yg ~- s 0 sg ml - - .7 .8 1 0-4 7.SYR 3/1 - sl 2 m gr mvfr cs if .5 .6 2 4-11 7.SYR 3/1 - sl 2 m sbk mvfr cs if .5 .6 3 11-31 7.SYR 4/4 - sl 2 m sbk mvfr cs if .5 .6 4 31-38 lOYR 4/3 - is 1 m sbk mvfr cs - .7 .8 5 38-63 lOYR 8/2 - fs 0 sg dl cs - .5 .6 6 63-66 lOYR 8/2 flp 7.SYR 5/8 fs 0 sg dl - - .5 .6 K8rT18rK5: b. ...... ....................... ... T,T ..~ v T~-~, ,......,.~ ~~ ~a~u~.. `W JV cx. JV T uuiu~cu, a~aui~cu 1 0-5 7.SYR 3/1 - sl 2 m gr mvfr cs if .5 .6 2 5-20 7.SYR 3/1 - sl 2 m sbk mvfr cs if .5 .6 3 20~ 7.SYR 4/3 - sl 2 m sbk mvfr gs if .5 .6 4 26-40 7.SYR 4/4 - sl 2 m sbk mvfr cw - .5 .6 5 40-64 7.SYR 4/4 - is 0 sg dl cw - .7 .8 6 64-70 SYR 4/4 - , sl 0 m dh - - .3 .4 s•z 6(. z _...~ u ~ ---- ----- - --- ------------ ~ ~- - -- ... _. ~ ~--w-~---- - ~ - -... ~ ~ ,~, ~g, ~., ...~.~~.~.., Depth to limiting factor 44s•~~' v~lo~ ~~ tik $` `~ --. ~ ,-r $~" S.i1 ~yU°~ ~1 a-' ~~ t~''"'~ 1.e,ss ~w (l ero . I. ~ i , •3 oc,,s~~ 'y" ~ 1?0 ~~~~ 400.}~ n G~g~ ~y..` Lai u, C'1tie.~-,.,.5 15.;1~~5 ,~ (, o l.o N-cfc -r.zz ~~, 1~ ~'~K Q~,Q.v oy. w.q~ iran~J t.J~c1La.S~~~lt}CA~ [` 3 0~ 3 ~., \ ` ~ " J SYSTEM ELEVATION AND SIZING CALCULATIONS Below Grade Aggregate Soil Absorption Systems x ^x ^ only 1 3 ft 6 in 4 in 450 gpd 0.40 gpd/ft2 1125.0 ftZ Oft Permit Number Gravity Distribution Pressure Distribution Suitable Sail , Aggregate Depth z Nominal Pipe Diameter Estimated Daily Peak Flow Wastewater Infiltration Rate Minimum SAS Size Proposed SAS Elevation ######## Date Soil Surface Acceptable Finished Grade EL , (ft) Boring Grade Limitation SAS Elevation (ft) System Minimum Maximum Number Elevation (ft) Depth (in) Lowest Highest Elevation? 1 100.50 86 96.33 99.00 No F[II require 2 100.60 62 98.43 99.10 No Fill required 3 100.60 70 97.77 99.10 Nv F[II required 9g•~ 4 100.80 63 98.55 99.30 No Fill requiredL~ ~~ 5 100.70 70 97.87 99.20 No Fill require R8 ~w~~ 1. Depth of suitable soil required below the infiltrative surface for treatment. 2. Depth of aggregate below distribution pipe. 3. Based on chosen system elevation, and aggregate depth. The addition of fill for cover or the reduction of finished grade may be required to meet minimum or maximum code standards. Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Qr i ..w ~ Qi•.t« ~r-J-- SBD-10553-E (R.05/98) Rod Eslinger From: Shawna Moe Sent: Thursday, May 18, 2000 10:16 AM To: Kevin Grabau; Jon Sonnetag; Rod Eslinger Cc: Mary Jenkins Subject: Soil Report -Pheasant Hills -Lot 21 I have received a few phone calls from Shaun Bird and one from Chad Behrendt, contractor, on the soil report for Pheasant Hills Lot 21. Apparently Shaun will be coming in tomorrow to bring in a sanitary permit for this lot and believes there are a few problems with the soil report and would like it if someone would review it before he comes in tomorrow. The contrators are lined up to begin construction early next week and need to know whether or not the permit will get held up because of the soil report. Do any of you think you'd have time to review this soil report today? Chad asked if we'd get back to him today to iet r~~rr~ know if there are any problems with this or not. His number is 612-625-7022. I will call him back to let him know. Thanks! Shawna Owua~/Buyer-~~/~ Mailing Address Pmparty Addt~ess City/Stttte /3 plana~g Depsruaant for new cot~stn:ctiaa) J / / Parcel Identification Number ,~f ~//~J l ~~~ ~~ U Pt~operty Location f~'t~, ~~1~ Sec.~~ ~~N Subdivision W, Tawas of ~n~7~ . LQt # ~~,~. Certtiled 5atvey IMIxp # ~ volume '- .Page ~- ~valTttnty Dead ~ ~~ ~ 3 ~ ~ ~, volume -S~/ r PaBa #~.....Lr._~• spot hour-pea t7 no Lot Iiacs ida>3tifi ao Itaptoper ose sad Hof your optic system could result is its pren»tare fa~ur+e to hudla wsatas. Proper mama coonsbts of pua~ag aft the tept~iie resit ~Y dtt+ee yeas a sooner, if aerded by a ticeased w6st Yon past i~o the system can a~eot die dmction of du septic teak as a treatmReat ctsge in ffie wsste disposal :ysbem. The property owner agmes to sabmii oo b`t. t:coac ?.anius~ Depa:moent a cara5c~ttioa ~ dgr~od by the owner sad by a aa~tarpiua~ber, jotttaeymaa pltuaber, restricted plumber ar a licensed pampa verifyisig dnt (I) the oa-ed0e wrastevvatardlsj~oat ttys0em is in props opatst~gg condition sad/or (2j suer iaspectioa sad pumpi:cg (if nccessary)~ the septic tao3c is less than 1/3 Hull of sludge. 1lwe, ttx wed have tnsd the shove its snd sgrea ao m:iataia the private sewage disposal sy:tam with the s4ndsrds set faath, ss sat by fire Department of C~amace and the Departrneai of Natural Reecurces. State of Wit~coasia. Cettiflcstion statia$ that yoar atptic bas bees asambfaed be cwmpleted aad r+eturaed to tho St. Cra6r Cotmxy Zottiag Office within 30 days of dma year d C=-~'L~.'^-~ SI~NATUR,E OF DATE OwN~R CERTIFI~A.~N_ T (u+) vertify th#t all t oa form arc truo to the best of my (our) knowledge. I (we) :m (are) the owner(s) of the bo virtue of ty deed mcorde~! in Registar of Deeds OlS.cc. SIGMA LICANT DATE ...:s* t be revoked by the Zoning ~~• *e•s.• Any i3ntbrnsation that is mis,reproseatad any r~esutt is the aani~ry peimi rag ST CR.OIX COUNTY' SEPTIC TANK M.AIN'T~1~KNCE A~RE13N1EN'i' AND OWNE&SHIP CERTIFICATION FORM i _ ~ /l _ , _~, '** Inclvsle with this appticattoo: a sturiped wanaaty decd from tlu Register of Deeds Of'fiCe s copy of the ctrtifi~d survey map if ceferonce is made in the warranty tked STATE BAR OF WISCONSIN FORM 1 - 1998 WARRANTY DEED Document Number voi.151~~ac~ 192 This Deed, made between Ronald C. Bonte and Dine M. Bonte, husband and wife Grantor, and Chad J Behrendt and Katrina M. Behrendt. husband and wife By: Dine M. Bonte Grantee. Grantor, for a valuable consideration, conveys to Grantee [he following described real estate In St. Croix County, State of Wisconsin (the "Property"): Recording Area Name and Return Address Lot 21 of Pheasant Hills Subdivision Document ~~622544, Volume 7, Page 86 Chad J. Behrendt (Township of Hammond) 1443 300th Street Glenwood City, WI 54013 018-1034-60-000 Parcel Identification Number (PIN) This is riot homestead property. (is) (is not) Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except highways, easements, and restrictions of record. Dated this 16th day of May 2000 - (SEAL) __i~2~,QQ__1~`~ ~~ J (SEAL) By: Ronald C. Bonte AUTHENTICATION .~. Signature (s) (SEAL) authenticated this day of .~`~` P~ENE /(~ ~/~~~ .. 623339 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED F~ RECORD 05-19-2000 10:30 AM WARRANTY DEED EXEMPT N CERT COPY FEE: COPY FEE: TRANSFER FEE: 116.10 RECORDING FEE: 10.00 PAGES: 1 ACKNOWLEDGMENT (SEAL) State of Wisconsin, ss. St. Croix County. Personally came before me this 16th day of May .2000 ,the above named Ronald C. Bonte and Dine M. Bonte TTTi.F• MRMRFR STATE RAR nF WTSCt'~191:~i" VB1rw_' ~~ ~U S ,.`, LOT 20 4.28 ACRES 186, 516 S0. FT. MAT~N LOT 0 y N ... ~ ~ ` ~/ /~ / ~~ 23 \ \ \ ~ ~ ~ O/ \ G _ ~ . ~ ~ ~ _ / ` ~ ~ \ ~ ~~/ LOT 17 ~ ~ ~ LOT 18