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HomeMy WebLinkAbout018-1083-30-000Wisconsin Department of 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 IPrivacv Law, s.15.04 (1)(m)1• Permit Holder's Name: City Village X Township Corbett, Carol Hammond, Town of CST BM Elev: Insp. BM Elev: BM Description ~ ~ /off G T TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~-- /dd0 Ft` 6 ~ fev`.c,c7 ~-J~~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 7 ~T/ vv , /~ V ~~ / __ Dosing Aeratio Holding ' PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System H TD Ft Forcemain Len Dist. to well S[111 ~RSARPTInN SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 487931 0 State Plan ID No: Parcel Tax No: 018-1083-30-000 Section/Town/RangelMap No: 16.29.17.602 STATION BS HI FS ELEV. Benchmark !.3 101,3 /Ub Alt. BM ~i"i.!-~.~..., Gov ~s ~o ~y. ~s Bldg. Sewer ~,~ ~~ 9 z.. °~ SUHt Inlet g~ `! Z ~-l SUHt Outlet ~.a qZ •3 Dt Inlet ~~ ~ Dt Bottom ~_ -~ Header/Man. o' ' ~ 9' ` Dist. Pipe ~ ~ ~ 4' / Bot. System i'0 .`7 50: (0 Final Grade 9•z qZ • t St Cover ~, 1 ~ `nom ~ . t~~ 9 , ~~ BEDITRENCH DIMENSIONS Width / 3 Length ~ ~~ No. Of Trenche_ 2.. ~ r~~ PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING / Manufacturer. ~~ ~/Qt..~ INFORMATION CHAMBER OR Type Of System: , GOJMI~QVa~'I 'd ~ ~ ~O ~ „f r~ !/V UNIT Model Number. r11CTRIR11TInN SVSTFM S~ Zr ..~~ Header/Manifold i~ / ,f Distributi n Pipe(s) ~ ~ x Hole Size ~ x Hole Spacing ~ Vent to Air Intake r4,5,~-' G~Z. Length ~ ~ Dia '7' Length Dia Spacing S~lll Rf1VPR ., o...~~...e c.,~a....,~ n..r.. .... IIAn..nri nr Af.[:rarla Svc4ams Anly Depth Over Bed/Trench Center / / ~ Depth Over ~ Bed/Trench Edges ~ xx Depth Topsoil ~ xx Seeded/So d No Y xx Mulched ~~ Yes ~:: ~ No ~ es ~~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1726 97th Avenue Hammond, WI 54015 (SE 1/4 NW 1/4 16 T29N R17W) P/heas~an/t Hills L t 30 Parcel No: 16.29.17.602 1.) Alt BM Description = ~' `~ Co~t~' 4 ~ 'YI^'~u ~ ~ ~~ Q.. 2.) Bldg sewer length = ~, / ~~ i ~ // CO d -Q.J`~ -amount of cover = ~ ~a J ~ 1 ~ r I G~ tea.: ~-.'~ G ~_ ~" p `/l' s 'J~ Vim. 1t_ r -- -- ---- Plan revision Required? ~ J Yes No I 1 i Z1 i (~~~ Use other side for additional informa ion. ~ i ~~ ~__- Date Insepctor's ignature SBD-6710 (R.3/97) ~~~~~~~~ ~~ ~~ -I--- J Cert. No. S and Buildings Division County St. Croix 201 W shi on ., P .Box 7162 ~ ~ ~sconsrn 707 62 Sanitary Permit Number (to be filled in by Co.) D f C (608) 266-31 _ ~ 3 epartment o ommerce ~ l Sanitary Permit Applicatio ~``~~~": State P'a„ `.D. N°mber In accord with Comm 83.21, Wis. Adm. Code, personal info ion y~~ct3l~fde '" may be used for secondary purposes Privacy Law, sl 04(1)( ) \'~t1'. p ject Addre (if different than ma~i7li~address) ` ~ -2..10 °I T - J4 t/ 6 .) L Application Information -Please Print All Information E ~~ th 1 C Jti~C Property Owner's Name ~ ` IyiN ' ~ ~ Parcel # Lot # Block # Carol Corbett 1-O "'"- ~ 30 ~- Property Owner's Mailing Address Property Location 10560 N 62nd Street Grt. SE %< NW %< Section 16 City, State Zip Code Phone Number , , T 29 N; R 17 W Stillwater 55083 651-295-4928 II. Type of Building (check all that apply) X 1 or 2 Family Dwelling -Number of Bedrooms 3 ~ Subdivision Name ~~- Pheasant Hills ^ Public/Commercial -Describe lJse ^ State Owned -Describe Use ^City_^Village X Township of HammOrid III. Type of Permit: (Check only one box on line A. Complete line B if applicable) p g_ X3.30 _ pZ A' X New S stem Y ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B• ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T e of POWTS S stem: Check all that a l k ~ mD S O Q1.~T' u~-n.~ X Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ \ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter~0 ~;o~ Tre#tm~nt Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line G v less PipeA L~J OfJher (explain) V. Dis ersal/Trea en Ar Information: Design Flow (gpd) Design oil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 450 0.3 1500 1500 91.0' VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank X 1000 1 Skald Pre-cast X Aerobic Treatment Unit Dosing Chamber VTI. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number Tom Gustum 227618 715-658-1344 Plumber's Address (Street, City, State, Zip Code) N13450 937d' Street, New Auburn, WI 54757 VIII. Coun /De artment Use Onl Approved ^ Disa t roved Sanitary Permit Fee dudes Groundwater ~ Date Issued Issuing gent Signature (No Stamps) Surcharge Fee) ` ' ~~ '- ~ r Given Reaso Denial Tf @ . ( IX. Conditions pproval ; ( -1-! ~ ~ b~e ~ 3) -T~ ~ s s . a SYSTEM OWNER: s~`~~~ ~~nq ~ ~~-=~ ~ 1 Septic tank, effluent filter and ~ ~ 5 ~ 15~ i ~- tnn.a~.r, . ~j dispersal cell must all be serviced /maintained ~ I I as per management plan provided by plumber. ~`~ ..e p.v~ ~ 2. All setback requirements must be maintained ~~ ~ , as per applicable codei'ordinances. ~~~t~- S~ Attach complete plans (to the County only) for the system on aper not1lAelss'th-an~8-1/-2 xL11 inc,.he~s~in~psi~z~e~~ ' SBD-6398 (R. 01/03) (/ ~ (y4`~. c~au--~ carer a-f°Sa~'P{16"` '~~ ~ i U i m i Q i i Za N F ~--- ~~ . ~.~ . ~ ~~~~~~_ m -~_~ ~Z~~~ ~~~~~Ws ~ o~ p a mrn ~~ o o ~ fn O 0 N d O ~~ oa g o __.__,,__ ''--~-- ~ N E ~ U s ~ ~ m ~, ® m O) ^ Yi O ~ _- J ________________ __________________ o llJ ________~ __~ ________ IN ~ GCn ,-- ~ ____ ~ O ~A~ ~ ~ j~ ~,j. ~ o ~ (V ~ ~ rn 1 M m J °' a 2 ~ N ~ y . m N o g2~ roar ~' d' §~ II m~°~ ~ o Z ~ g Q c ~ m° w (V u t~ g ~~ m ~ U r M m ~~ ~~~ / m a~ .~ M ~. ~ m ~ Q ~ } tubers Page 1 of 4 Cover Page Project Name: Owner's Name Owners Address Legal Description Township County Subdivision Lot# Parcel I D# Corbett 450 GPD Conventional Carol Corbett 10560 N 62nd St. Stillwater WI 55083 651-430-0165 ~ -- sE I, ~ %4, I Nw l~ %< Sec 16 T 29 N, R 17 I w ~ Hammond __ __ Saint Croix Pheasant Hills 30 Table of Contents P9~ 1 Cover page 2 Calculations and Drawings 3 Management and Contingency Pfan 4 Plot Map total # of pages: 4 Designer Name: License #: Date: Ph. #: Signature: Thomas Gustum 9/30/2005 715-658-1344 `-i29S3~ Design Methods Used "IN-GROUND SOIL ABSORPTION COMPONENT MANUAL FOR PRIVATE ONSITE WASTEWATER TREATMENT SYSTEMS" (Version 1.0) SBD-10705-P (R.6/99) Chambers Page 2 of 4 Calculations and Drawings Site Conditions Infiltration Elevations Site Type: ~'~Private ~ Cell #1 Cell #2 Cell #3 %Slope 3 % Contour Elev: 92.90 0.00 Ft # of Bedrooms 3 Infiltration Elev: 91.00 0.00 Ft Depth to limiting factor 60 in Limiting Factor Elev: 87.90 N/A N/A Soil Application Rate: 0.3 gal/ft^2/day Treatment and Dispersal Zone: 3.10 N/A N/A Effluent Quality', Erf #>. ~ Cover Material Required: 2 NIA NIA In Design Flow: 450 gal/day Finished Grade Over Cell: 93.07 N/A N/A Max BOD 220 mg/I Max TSS 150 mg/I Distribution Cell Septic Tank _- _ -- Choose chamber type Ez Flow 3 x io ceu __ - --- -- ~ Septic Tank Manufacturer: Skaw -- # of CeIIsO Septic Volume Chosen: 1000 Laying Length: 10.00 Ft Effluent Filter Selected: Biotube FTS0854-36 EISA Determined Area: 50.0 Ft2 Note: Access opening of sufficient size to be provided to allow removal of filter. Opening Open Bottom Area: 35.30 Ft2 to terminate at or above grade. Chamber Height: 12 Inches Required Infiltrative Area: 1500.0 Ft2 Actual Infiltration Area 1500 Ft2 Total # of Chambers: 30 Total Cell Length: 300.0 Ft Cross Section of Septic Tank Cross Section of Cell Vent in a"Min. manhde cover 17' Min. ~ P Barrier Paper 18" Min i VA i i ~~~ ~~ ~ All / ~~ ~A ~ ~~ ~ ~ ~~ ~ ~ jdnts to ~ be water tight pig or Effluent F1pe Flter Flow h noel 3" Beddng Under Tank Plan View of Typical Cell / ~ /I J --.vn~ V~~] lr~~~ ~~ - ~ -v ~ - - _ V - > ~ - - _ ~ ~ ~ ~ - - - _ _ Page 3 of 4 In-Ground System Management Plan pursuant to comm 83.54 W. A. C. Owner's Responsibility: The component owner is responsible for the operation and maintenance of the component. The county, department or POWTS service contractor may make periodic inspections of the components, checking for surface discharge, treated effluent levels, etc. The owner or owner's agent is required to submit necessary maintenance reports to the appropriate jurisdiction and/or the department. Septic Tank: Septic tank(s) are to be inspected routinely and maintained by department approved individuals when necessary in accordance with their approvals. The use of chemical/biological "treatments" is not required or recommended. If such additives are used, make sure they are approved by Department of Commerce, Safety and Buildings Div.. Effluent filters are to be removed & cleaned as necessary, with provisions to keep solids from passing the septic during removal. No more than 1 /3 of the usable tank volume may be occupied by sludge/scum. 3 year inspection: If tank has greater than 1/3 volume sludge, tank contents must be emptied and disposed of in accordance with NR 113 Wisconsin Administrative Code by an approved individual. If the inspector does not recommend pumping of the septic tank, then the owner must be notified of when pumping should be done as to not exceed 1!3 sludge volume. Septic tank should be routinely inspected to be watertight and of good repair. Absorbtion Cell The absorbtion component must remain free of ponded surface water prior to pump operation. If 4 inches or more water level is detected in the observation pipes, the owner must be notified of possible problems/failure. The designed daily flow capabilities of the component should never be exceeded. Trees and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the component. Activities OTHER than mowing/maintenance (i.e. excessive walking, pets, vehicles, etc...) could compress the component and reduce it's absorbtion capabilities and/or possibly cause it to freeze in winter conditions. Performance Monitoring: Performance monitoring must be done at least once every three years following the installation or at the time of a problem, complaint, or failure. Contingency Plan: If the septic tank or other components therein (including floats, alarms, etc) become defective, the defective tank or component must be replaced immediately to ensure that the system can operate as designed. If the absorbtion component cannot accept wastewater or ponds wastewater to the surface, the component must be repaired or replaced in it's current location by removing the clogged bacterial mat, aggregate/leaching chamber cell, and distribution piping within the cell and replacing failing components in order to return system to proper working order as required. If repair is not feasible, a new system is to be constructed in a designated replacement area • F Y U 4 ! Z ~ ' ~' OZ1 W O c ~ f0 - ~ E ,~ : N ~ 0 ~ \ i a Q 7 c`~~7n~ ~w S a V N : ~ U ~a (~ ~ ,~ m ~ M o> ^mrn t //~~ p ~ _ __ ---_'--_--- ---------- - ~ ii l1J _ ` N - - __ - - ,.,. . . o er _ ~ N a ~ ~ O ~ o~ ~ ~ n ~o ~ ~ ~ ~rn ^ . o- , " ~ ~ /= - ~ ' , ~ ~n i __ ~ N /~~~ ~ C/ =/ \ % •r~ .mom '~ ,m~ ~ m m / ~ o O o ~ ~ fA ~' a ~,> ` ~ a o v N ~ ~~ ~ ~ ~ . m ~, ~ m rn /J ~, ~- v i a o a ,_ ~ _.. ~ O ~~ tour o v~ ~ • ~ a ~ ~ _-Q i- _ ~ o u~ a ~ O m ~ e- ~°W ~ ~gJ ~ m U .o ~ w mW~ ~~ ~ ~~ m ~ ~~ ^~ Q U m Q i Department of Commerce rliviainn of Safraty and Ruilriinns `~~SO~IL~ EVALI in accordance with I 11 r (S((~~~ O ~~ ~1~23 0 ~ C~ ` ~ Pan 11~ Soil Testing, LLC Attach complete site plan on paper not less than 8Y: x 11 inches in size.' Plan rt-~31st St. Croix include, but not limited to: vertical and horizontal reference point (BM), d ection and d d l d di t di i h i t (i~Jf~~1.D• o n~~reLs~a,~ arrow, an on an s an percent slope, scale or mens ons, nort ocat , Please print all inform n. ~ ZOP~INf we ,~y Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ L-F- ~2 Property Owner Property Location Bonte, Ron Govt. Lot SE1/4, NW1/4, S16, T29N, R17W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1011 170th St. 30 Pheasant Hills City State Zip Code Phone Number ~ City [] Village ®Town Nearest Road Hammond WI 54015 715-796-5240 Hammond 172Nd St/97Th Ave. !x' New Construction Use: ®Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement ^ Public or commercial -Describe: Parent material loess over pitted till Flood plain elevation, if applicable NA ft. General comments install shallow "conventional" in-ground trench system @ system elevations 24" below surface contours w/ and recommendations: 0.3 gpd/sq ft loading 2] Boring # ^ Boring pit Ground surface elev. 92.4 ft. Depth to limiting factor > 76 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistenc Boundary: Roots GP D/ftz ih. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-6 7.5YR 2.5/1 - sl 2 m gr ds cs if/m .6 1.0 2 6-30 7.5YR 3/2 - sl 2 f sbk dsh cs 1f .6 1.0 3 30-36 7.5YR 2.5/1 - sl 2 m sbk mvfr cs im .6 1.0 4 36-76 7.5YR 2.5/1 - sl 2 m abk mvfr - - .6 1.0 pit located by depression w/ poor grass growth near south lot line of lot 29; small closed drainage area w/ erosional deposition Boring # ^ Boring Pit Ground surface elev. 92.9 ft. Depth to limiting factor > 60 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Textura Structure Consistenc Boundary Roots GPD/ft' in. Munsell Ou: Sz. Cont. Color Gr. Sz. Sh. •EffM1 •Etf#2 1 0-5 7.5YR 3/2 - sl 2 m gr mvfr cs 1f .6 1.0 2 5-18 7.5YR 4/4 - Is 0 sg ml cs if .7 1.6 3 18-52 .^ 7.5YR 2.5/1 - sl 2 m sbk mvfr cs - .6 1.0 4 52-60 lOYR 4/4 - scl 0 m mvfr - - 0 0 ~- 9l. o 22,g ~ ~ pit located by depression ' Effluent #1 = BODS> 30 < 220 mg/L and TSS 30 < 150 * Efflu t ~ =GODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sign ur CST Number Henry F. Grote ~ 222774 Address Certified Soil Testing, LLC Date Evaluation Conducted Telephone Number E. 4366 353rd Ave. Menomonie, WI 54751 4/13/2000 715-233-0398 SBD-8330 (R.07/001 )~ ~b ~-~. I ~`~•~J S'S'. Property Owner BOnte, Ron Parcel ID # Page 2 of ~ 3 3 ^ Boring Boring # pit Ground surface elev. 92.4 ft. Depth to limiting factor > 70 in. ® Soil Application Rat Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munselt Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Efl`#2 1 0-5 7.5YR 3/2 - sl 2 m gr mvfr cs if .6 1.0 2 5-15 7.5YR 3/2 - sl 2 m sbk`- - • -•mvfr cw if .6 1.0 3 15-47 7.5YR 4/4 - sl 2 m"5tiK"`"~ `~°' mvfr cs - .6 1.0 4 47-50 7.5YR 4/4 - sl 1 c abk mfr cs - .4 .7 5 50-56 7.SYR 4/4 - s 0 sg mi cs - .7 1.6 6 56-65 10YR 4/6 s 0 sg dl cs - .7 1.6 7 65-70 7.SYR 4/6 sl 0 m mfr - - .2 .6 4 ; =j Boring Boring # ~ Pit Ground surface elev. 92.6 ft. Depth to limiting factor > 65 in. Soil Application Rat Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= irt. Munselt: Qu. Sz. Cont. Cola Gr: Sz. $h. •Eff#1 •Eff#2 1 0-5 7.SYR 3/2 - sl 2 m gr mvfr cs if .6 1.0 2 5-9 7.5YR 4/4 - sl 2 f sbk mfr cs if .6 1.0 3 9~ 7.5YR 4/4 - Is 0 sg ml cs - .7 1.6 4 22-38 lOYR 4/6 - s 0 sg ml cs - .7 1.6 5 38-65 lOYR 5/4 - s 0 sg dl - - .7 1.6 pit located by depression 5 ~J Boring Boring # ~ pit Ground surface elev. 91.9 ft. Depth to limiting factor > 62 in. Soil Application Rat Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munselt Qu. Sz. Cont. Colt' Gr. Sz. Sh: •Eff#1 •Eff#2 1 0-8 7.5YR 3/2 - sl 2 m gr mvfr cs if .6 1.0 2 8-21 7.5YR 4/4 - sl 2 f sbk mfr cs 1f .6 1.0 3 21-47 7.5YR 2.5/1 - sl 2 m sbk mvfr cs - .6 1.0 4 47-62 lOYR 4/4 - scl 0 m mvfr - - 0 0 pit located by depression; Note poor soils for loading at depth in B-5, B-2 & B-3 suggest conservative loading rate of 0.3 gpd/sq ft for better system life * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L ,K The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) Certified Soil Testing, LlC .~, - . ,~ w~ y J -.~ _,,~ . ~ s -'t ~'. ,..~.° ~ l'~ ~ ~ tl a ~ to ~ ~qg , S ~ ~ C~ ~ -~O ~ ;... ~ { ~ . 3 i (t ~ ~ '~ r.~ ~ ~ ~-~' _ ~ i !!) G.. J s `~ .. `;.: _~ ~l~ N'~ ~...}- ~i ___i v ~---r 0 ~~ ___. s 9 ~, c 9 s l~ ` ~' ~ 1 "~. y~ d / ~J S Q ; J` ~ r.../~ ~~ d ~ ~ ,~ ~pp ~d- `~- o ~~ ____~•~ . r.._ ~~ s Q J~ ~...1 ` F s \ v N t ..~~!1 I ~ ~ L'i ~' a ~ `_$~ f U Q, ~k s / n+ ~...~ ~ ~` ~ ~ ~ "' \ d_ ~, ~ ~ , , ~/ J' S} /; ~~ 1 ~,. ~, ,~ i ~ '~~ ,~ ~~ s , 3 ~" ST' cr 1h`i5consin Department, of Commerce SOIL AND SITE EVALUATION Page 1 of 3 ' Division of Safety and Buildings ORIGII~A~.rd with Comm 83.05, Wis. Adm. Code Certified Soil Testing Attach complete site plan on paper not less than 8Yz x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and t d di d l ti e di l l i rth w, n t t St. CrO1X o neares roa . s ance percent s ope, sca e or mems ons, no arro an oca on a t Parcel I.D.# APPLICANT INFORMATION - p/ease prir ~ all nformafF n , Y ~ g . Personal information you provide may be usQd for sewn cy,{~rp~e~, (Privacy )_a~nr; ~. 15.04 (7) (m)). ! Reviewed By ate Property Owner ' ~ ~ ~ ~~ Ron ~ ~ Bonte Property Location SE ]/4 NW 114 16 29 t S ~ t L 17 W N R _ , ov . o , Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1011 170th St. ~;~ " ' ., :~ 30 P Sant Hills , r. City State `Zip.Code Pftt)iie umber '•. "s' ~' ^ City n Village ®Town Nea Road d 170Th St `FI Hammond WI 5.4015 715-796-524p unmon . ~ Resideritfat-/-Number of bedrooms 3 ^Addition to exi g building '^ New Construction Use: _ _ Replacement ^ Public or commercial describe Code Derived daily fl 450 gpd Recommended design loading rate •3 bed, gpd/ftz •4 trench, gpd/ftZ Absorption area require 1500 bed, ftZ 1125 trench, ftZ Maximum design loading rat •3 bed, gpd/ftZ trench, gpd/ftZ Recommended infiltration su a elevation(s) 24" below contours ft (as referred to si pl b mar install 2 - 5' x 1 12.5' shallow trenches on contours for 3 Additional design /site considera s Parent material tilt Flood lain elevatio I ble N`~ ft S=Suitable for system Conventio Mound In-Ground Pressure AT-Grade Syste Fi Holding Tank U=Unsuitable for system ® ^ U ®S ^ U ®S ^ U ®S U ^ S X U ~ w~rr vr=~~.r~rr r rvr~ ~rrrv~! V / / V ~ Boring# 2 ~ ,' Ground elev 101.7 ft Depth to Ilmiting factor 2 Ground elev 101.2 ft Depth to limiting factor > 60" H i Depth Dominant Color Mottles T t Struct sistenc Roots a GPDIft' or zon in. Munsell Qu. Cont. Color ure ex Gr. Sz. h. ry B d ~ Trench 1 0-6 7.SYR 2.5/i - s 2 m gr cs If .5 .6 2 6-30 7.SYR 3/2 - sl 2 f sbk ds cs f .6 3 30-36 7.SYR 2.5/1 - sl 2 m sbk mvfr s lm .5 .6 4 36-76 7.SYr 2.5/1 - s 2 m abk mvfr - - Remarks: some mtx tuYr 4i4 st to nortz 4; tuts ptl near bottom of ctosea aramage ar stgnmcant erostonat aepostt n er the years 1 0-5 7.SYR 3/2 - sl 2 m gr my cs 1 .5 .6 2 5-18 7.SYR4/ - is Osg ml cs if .7 .8 3 18-52 7.SYR 5/1 - sl 2 m sbk mvfr - .5 .6 4 52-60 10 4/4 - scl 0 m mvfr - - NP .2 f `~1.~ ~ST Name (Please Print) Signature: - Telephone No. Henry F. Grote 715-665-2681 4ddress ertt to of esttng D to CST Number Ref # P.O Box 57, Kttapp, WI 54749 413/2000 222774 1045 Remarks: PROPERTY OWNER: Bonte,Ron SOIL DESCRIPTION REPORT ~ Page 2 of•~ 3 PARCEL I.D.# Certified Soil eT stinger , 3 Ground elev 101.1 ft Depth to limiting factor > 70' Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structu"re Gr. Sz. Sh. ~ onsistence Boundary Roots GPD/ftZ Bed Trench 1 0-5 7.SYR 3/2 - sl 2 m gr mvfr cs if .5 .6 2 5-15 7.SYR 3/2 - sl 2 m sbk mvfr cw if .5 .6 3 IS-47 7.SYR 4/4 - sl 2 m sbk mvfr cs - .5 .6 4 47-50 7.SYR 4/4 - sl 1 c abk mfr cs - .4 .5 5 50-56 7.SYR 4/4 - s 0 sg ml cs - .7 .8 6 56-65 l OYR 4/6 - s 0 sg dl cs .7 .8 7 65-70 7.SYR4/4 - sl 0 m mfr - -* .3 .4 i Remarks. VG/~' VIa:GJI VIIdI Illla UJI VIlJ !V 1! Y/V J ~V, JS, lJl, 111 IIVUGVII J 4 Ground elev ~, ~ ~. Depth to limiting factor > 65" .. 5 Ground elev 100.3 ft Depth to limiting factor a~• Ground elev 1 ,' 0-5 7.SYR 3/2 - sl 2 m gr mvfr cs if .5 .6 ~t - 7.SYR 4/4 - sl 2 f sbk mfr cs I f .5 .6 3 ~;~2 7.SYR 4/4 - is 0 sg ml cs - .7 .8 4 22-3.~r ~ l OYR 4/6'~ ' - s 0 sg ml cs - .7 .8 5 38-65 x. YR 5/4~ - s 0 sg dl - - .7 .8 r ~. ~ +' ! Y KemarKS: ~~~~~~~°~ l V 11\ J/Y l~ V0.1lVJ. llT `W LV, LV, J /, JV, Vf. /J S T-~ e 1" Or$~ ` 7.SYR 3/2 - sl 2 m gr mvfr cs if .5 .6 2 ~. 8-21 7.SYR 4/4 - sl 2 f sbk mfr cs if .5 .6 3 21-47 7.SYR 2.5/1 - sl 2 m sbk mvfr cs - .5 .6 4 47-62 l OYR 4/4 - scl 0 m mfr - - NP .2 Kemancs:...,..L.,.. ~ ...~ ,.,..... , ....._ T,., , ........~..,..~ ,.,, ~b, ..., Depth to limiting factor l f 3 ~ Q ~- rt ~ ~a ~' .. ~, s - ~ ~ ~ o ~ ~_ ~~ ~ ~ 0 d ...~ 0 c,. f S ~JENNINGS STATE BANK STILLWATER 1150 S7~LWATER BOULEVARD NQRTH, STILLWATER, MN 550 PHONE: (651) 351-1 p0.0 Fqx: (651) 35181009 ECE[VED ~ i) ~ ~~~ ~ ~~ 2005 S1". CROIX COUNTY s - NING OFFICE ~. t.~;....:: „.-..,:. '..r.-t1iUO• •- .w - -_ _ ..STS.-A:-, - -- ..,; Ifs; ,... n4 ~:•.r - :,V. '~i'r'~'N... :... ~C y ~:.~J.1: ~ ~ : _'. .rye. : f' ~i.'p • ~w:• 4 ~~ :.'~';`~f, "~?~ . I r )~ .r]ai ~,,.. ~i Iv . ...is' ~!~.'h..1.:.: ~~ ~~:y C?:, Y~Y^?; mot, . J'.• ~ . A ~ ~ ~ ,j 4 : ~ ',~5~:_~~i '~~1.:~•. '•~~~>.,`pl .. ~~Ay, fI.' fv.~• ''~1rv-~~.~ : Y.,..:,4~.~7b Y _':::~•'.~.~ ~ )4.: {.~.1 ~.L,,;A U~tGE~NT CONFIDENTIAL TO : j~ L~ PHONE : FAX : ' ~/~~ 3 $~ --~1'{ ~~ FROM :G~~~ , / V~~~ BANK PHONE : QIRECT DIAL : (651) 351-1000 • Extension BANK FAX : (651) 351-1009 RE : ... FAX DATE AND TIME : , ~'_•' TOTAL PACES (INCLUpING COVER PAGE) COMMENT'S AND IRISTRUCTIONS ilMessage a ii ~ ~i~,L ~~~ _ See alttached dated You will receive attached fax copy only. Original to follow via U. S. Mail , public courier or private courier. 'please cal( immediately If fad transmission is not complete. Thank You. EsrAeusHec 1890 FULL SERVICE BaNKING LQCALLI( OWNER ,AND MANAGED MEMBER FDIC CONFIDENTIALR1( NOl"tCE: This fax cover sheet end all document(s) accompanying this fax may contain information which is confidentlel, information which is fegalty privileged, information which is legally protected under state and federal banking laws end regulations, or information exempt from disclosure pursuant to said laws. The receipt end use of said information is n3stricted solely to the intended recipient named above. If•you are not the intended recipient, then you are hereby notified that any review, disclosure, copying, distribution or the taking of ahy action in reliance on the contents of this telecopied Information, except its direct delivery to the intended recipient named above, is strictly prohibited. If you are not the intended recipient and if you have received this fax in error, then please notify°us immediately by telephone at (651) 351-1000 to arrange for•retum Of the original documents to us l 'd 061ti'°N Wd6E~E 6002 'OE'daS SEP.30.2005 3~46PM IND. HSNS. TCHNLGY. N0.764 P.1 ST. CRQIX COUNT'' SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/IIuyer ~1 Q /p 0 Mailing Address ~G S ~ ~~ .~~- a ~~ = ~ 9a~> s Property Address / ~/ ~ ~ n S' ~ (~id~ ~'e (verification required from Planning & Zoning Departtnen for new .~s~ ~2 City/State ~R 171 rJ7 U h~/ ~/~/.~' pazcel Identification Number - V ~ a -I a ~3~ ~ ~ ~ Q LEGAL D~SCItIPTION ((~oZ.) W N~ Property Location r/a , r/a ,Sec. - T N ~^~V, Town of _ ~~ ~'i7'1 m~?1 jf I , Subdivision ~h e a s a rrI' /~/'l~ , S~, ~'/~ e ~ x G'y (~.~ ,Lot # J.? Certif ed Srutwey Map # ,Volume ,, Page # , W~rr~anty Deed # ~% ~ ~,.~Q '~ G~ 7s~ p~ ~ a> Volums Pa e # S . Spec house yps no Lot lines identifiable yes no SYSTEM MAINTENANCE AND O'VV1yER CERTIFICATION Improper use and maintenance of your septic system could result in ite premature failure to handle wester, Proper maintenance consists of pumping out the septic tank every threo years or sooner, iPaeeded, by s licensed pumper. vVhat you put into the system can affect the function of rho reptic tank as a treatment stage in the Waste disposal syetorrr, Owner rnaintena4ee responsibilities are specified in §Comm. 83.52(1) and in Chapter l2 - St, Croix County Sanitary Ordinance, The property owner agrees to submit to St. Croix County Planning & 2,oning Department a certification form, signed by the owner and by a master pltlruber, journeyman plumber, testriotod plumber or $ licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operatitrg condition arfd/or (2) after inspection and pumping (if necessary), the septic [auk it less than 1/3 full of slUdgc. I/We, the yndersigned have read tpe above requirements and agree to maintain the private sewage disposal system a-fth the standards set forth, herein, es set by the Department of Commerce and the Department of Nature] Resources, State of Wisconsin. Certification stating that your septic system has been maintained nsust be corupleted and returnod to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration darn. Uwe certify that all statements on this form are true to the best of tqy/our Itnowledge. Lwe am/are the ovmer(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. 0W~ N>Xmber of bedrooms ~ '~" '~ Y1 ` ~ ~t - h L f GAG ~ C ~ l h ~ ~, cc~,,~-~ o ~.- SIGNATURE OF APPLICANT(S) ~ ~3 ~ DATE **'"Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department, "'"* !nc]ude with this application a recorded warranty deed from the Rogister of peede Office and a copy o' reference is made in the warranty deed. (x~v. os/o~ trra certwea ~~CElVE~ OCR. ~~! :~ 2005 ST. CROIX COUNTY ZONING OFFICE 9/15/2005 10:47 St_ Cfo1X County Slleroh FU11er~Jennings Bk-Maria y, . ,, .U. 2 7 5 6 P 6 3 2 ~e~~ca7' State Hart ~t Wistausin Form Z-2003 vV'AYtRA~1TY~ DEED Dbcumcnt Number ~ Docmnmt Nsma +~ THIS DEED, nnade between ~3!~ A,,~ryns and Marv Evans. husband and wlfe a /~ ja -~~ ~,>7a ("Grantor," whether one or more), and Carol L, Corbett ("Grantee," whether one or more). Qrantor, for a valuable aotlsideration, conveys attd warrants m Grantee the following described real eaters, tiogech©r with the rants, profits, fixtures and other appur<engnt interests, in Bt: Croix County, Stars of Wisconsin ("Property") (if mere apace is noo ]case ouch mddondum): Lo 30, peasant Hilt st. crvi~C caanty, w>r~~~;itr. ~~;~ 44 ~ 7.00 ~. ry~ 3 ST. CROIX COUNTY ZONING 0_ F_ FILE KATHLEEN N. MAf,S1t REGIST1rR OF t?EEbS 4T, CttOF1[ Cll].. 1fI REC<zIYEp k'Cit[t li!TrC'DBD A3 / 8112t11A5 10 : 0®A![ wARRAI[TY DEEM EiEMD'T R It6C FEB : 1 >< . 0~ TRANS 1:IB$t 135. N GOPY FilsE t u F]EE PAG16S c 1 ' Recording Aron z/z N~ "~a i~t"~.INA QQLAND Es-rRE~N ~ o~u-w~ 3U4 Locust Hudson, Wi 54018 Q18-1083-30-000 Parcel ldenliticsiion Nrcnbtr (PIN) This h sot homasceaa pnap~nY• (is) (ie nol} Exceptions to warranties: Ess+itncnts, rsstri~tion:and rights-oi way of record, Many'. Dated 'Dale A. Evans Slgnatlae(s) authenticated on ,~ - - ACtCNOWLEDGMENT STATE OF F,~ o~ Ilt'A ) • ) ss. BAI.) ,~~a~.~o SSA- COUNTY ) r TITLE: MEMBER STATE BAR OF WISCONSIN Fersanally came before me an D , (lf sot, the above-namerd Dale A. Evans and 11Aaty T~yaast husband authorized by Wis. Stale. $ 706.06) and wife _ - to me known to be the pc~son(s) who oxecuted the foregoing TN15 lN5TRUMENT D1tAFTED BY: instrument and acknowledged the cam . orney KNstlpa Qg~Fd Notary Public, State of /CI My Commission (is penman ) (e pi ($iga~tvrTS r^sy be auti<enttc•ted or acL~wo~ledged. Moth are ^ neces~nry.) NdtB: TI~I31s A t3TANDAAD'~'ORlr1_ ANY MQbIFICATCON6 TO Ti#i5 ~'OttM 9N0[fLD BE CLEARLY IIDftN'T'!t'IED. 1+rAt~RANTY DEkD ~ 2903 bTATt: BA]fl OF WI3COIV5DV F'URM Nt3. b1003 • Tyree name below st[>•r8tnreS. BARBAitAk SQl~.IAINFO- O•" Lspal iCORns 80d-855-2oZt MhWV.gt~fp-C~tprtlas.mRl 5 A1`! CDMNIS81tlH ~ t1t1 f~1t1AQ El(P1F~; ice, 2J, tape mesa lwr ~Y M1ttt*sNasn AUT1:lENTICwTXO~i Z 'd 061~'~N Wd60~0 ~OOZ '00'daS r. 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