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HomeMy WebLinkAbout018-1090-49-000 o ~ 3 m o C7 ~ ~+, ~ ~ ~• ~ ~ vl ~ of ~ .. ~ d , ~ n .~ ~ ~ o I N 7 ~D ~ ? ~ ~ N ~ Fy I°'cm N OWN ~y 3coo ~, d. ~ N N ~ 0 7 a v ^ `1 p O O c ~ ~ p A~ O ~ ~ ~ N ~ O A7 7 UI ~ ~* c m ~ ~ O D ~ v v N v D ~, ~ ~ a o ~ ~ ~ . _ ~ ( ' ~ W ~ o = ? I I o, .Z1 ~ N p=j O ~ c o03 nra- ~ ~' ~ N~~ ~~a ~• a ~ ~ ~ 'v ~ °: O O O I o ~ ~ ~ v N 3 N W N~ cc ~ ~ ~ ~ ~ A ~ N C $ y n ~ ~ ~ N ~~ ~ 2 ' ~ ~ a IY H ~ c a I ~ ~ O ~ m c ~ ~ I a o ' ~ ~ ~ 3 I y ~~ ~_ =~ N w ~ ~ ~pp 0~ d ° o Az~ . I ~ N c ~ ~ .~0 N d A ~ ~ j .. ~ ~ ~ ~ o,3 ~ ~z A _ .Z1 I ;~ 3 m I ~ z I I f w A' m y »`D y D _ _ a a m I y $°-' ~ N V O_ n N y ~ ~ C o N o fD ~ d -. y N ~.c~ov ~'3 w s~ mac ~ o~ ° m ~ I co m x ~' °~ ~ m ° ;e I `• ~,gad b 0 d ~ N A ti ~ ~ ~ a ~.m > > „ i 1 ~o ~ ~ ~, v, ~ m rv I ~. < y o 0 N O , . 3 I ~ o ?+ ~ ~ oro o++ e o ~ m ~ . A ° ~ v' o . V sin Department of Commerce ~_, ety anc~"~~ikling Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERALt VFORMATION (ATTACH TO PERMIT) Personal infomtagwtyou provide may be used for seconrlarv „~ ~,,,.,~~ ro.:...._. ~ _... _ . ~ ,.. ,_.. .. - ------- _.,........, r. nvwy maw, 5. IA.U4 (1~(m)), Permit Hd±fars Name: City Village X Township Robinson Jeffre Hammond Townshi CST BM Elev: / Insp. 8M Elev: BM Description: TANK iNFnRMertnut ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic Dosing /"~' Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air In ke nS . , ROAD Septic t ~ ~ r Dosing 0~' Aeration Holding PUMP/SIPHON INFORMATION Ft SOIL ABSORPTION SYSTEM ~r-rj ~ yC~~ ~ BEO/TRENCH Width / Length o~NSIONS 3 ~ No. Of Trenches ~ .~ ~ SETBACK SYSTEM TO INFORMATION P/L BLDG El Ty System: / )ISTRIBUTION SYSTEM ~ feader/AAaniFold Distribution County: St. CrOiX Sanitary Pem~t No: 399465 State Plan ID No: Parcel Tax No: 018-1090-49-000 east' lo~f-l:.,y STATION BS HI FS ELEV. Benchmark 2.G~ 1a2.~o too.o Alt. BM t er ' ~~ !ZI 3. a ~ Idg. Sewer _ .a s ~J'~. SUHt Inlet .3 Y. St/Ht Outlet -~ _ R ~ ~ `~ Dt Inlet ~~ Dt Bottom _~ Header/Man. - /~- 6 `I Z. as Dist. Pipe ~ ~ r ~ b ~ ~ ~'L -bs Bot System ~ ~ r l.'7 ~lD ~ `l o Final Grade ~/ iS• Q - St C ver 2. c.(. Z /S buv~ Y. L ~ , 3 r ~ / OR -+~Vr~i"~~ i / f {i Pipe(s) l ^ ""~~ ~~ctl ~ x Wore Spacing ~ ~ Vent Air int~ engih Dia.J.,__ Length Dia ei p~c~ing ~ i /~ ~~ f / TOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only l ' '~ Ovet Depth Over xx Depth of xx Seeded/Sodded xx Mulched 'ed/Trench Center Bed/Trench Edges Topsoil ® Yes ® No [~ Yes ® No :OMMENTS: (Include code disa'epencies, persons present, etc.) Inspection #1:~/ ~Z~ Ins ection #2: / P / ovation: 967 176th Hammond, WI 54015 (SW 1/4 NE 1/416 T29N R17W) Pheasant kitis 1st addn. ~ P ~l o: 1 ~ T.714 Ak BM Description = ~~ IOGa.~r.. e ~ d - s;µ,(~„~ ~~~ ~ ` ,~, ,~ ¢-~{~~ 'I ) Bldg sewer length = A ~ ~~ 0~" `" .~ea,. -amount of cover = ~ .~1~,~G/`..,.,~', an revision Required? Yes ®No !I >e other side for additional information. - ~D-6710 {R.3/97) Date Insepctor's Signature Cert. No. '~ M - ~ 8 '~,~ F C> Y r 10 h.,]~ O _ g_ ~~`U'h. ~. ~, ~~ OO 3 '~o ~~ o,. ~' c~~9~ c~~ r d ~ ~. > ~ `si cSa . e y, ... PAGE ~ OF i T a Mp jc~' ~„ h ~„ s U n T OT# y yT EGAL DESCRiDT'rnt~T st,~/ ~ ~GI~ ~ / r~ T Z~~ N R / 7Z E(or~ SCALE:I"= ~~C BM 1 ELEVATION /GYM ~ /n BM 1 DESCRIPTION~..I/'! / ~n !0 ~ ~ ,~.~~{ r~ ~ BM 2 ELEVATION /C~'~- d BM 2 DESCRIPTIONn~, ~~q~ ~ pIC~~ A~~91~ ~-~-~ SYSTEM ELEVATION / J~~' / ~ SYSTEM TYPE ~c'/t (/--~ v1 ~'4~ G(' CONTOUR ELEVATION `IS , S ~ ~ ~ 9 y S ~ 1' '~ SPC ~ ~ I ~- __ -, ~y ~. S NATURE ,~ W`~iscortsin oepartrrient of Cocnmeroe SOIL EVALUATION REPORT Division of Safety and Buildings ~ / ~~ m au~crancx mur wrrnn w. ••u..w..w vwc Plan rrarst aper not less than 812 x 11 irtcl-es in size Nan on lete site Attach m . p p p co include. but not limited >ao: vertic~ and horizontal reference point (BM), direction and percent slope. scale or dimensions. north arrow. and location and distance !b nearest road. Parcel I.D. d ~ /D ~ ~ a ~(~t, Please print all information. Reviewed by ~~ ~ "~ ' ~V Date ~ ~ Personal information you Provide may be used for secondary PmP.~" (PAY Law. s. 15.04 (~) (m)). ,i// ?~ ' t er Property Ow n ~P~Y ~~ ( ~ ~ l~ O ~~ n S O /~ GovL Lot s t,V 1/4 r 1/4 S ~~j T Z~~ N R ~ ~ E (or)~ property Owner's Malting address Lot # Block # Subd. Name or CSM# City State Ztp Code Phone Number ^ City ^ Village ^ Town Nearest Road (~ New Construction Use: ~ Resxiential I Number of bedrooms ~3 - Y Code derived design flow rate ~/.~'o/! ~ G O GPD ^ Replacement ^ Pubflc or corrurteraal -Describe' Parent material ~, ~ ~ Flood Plain elevation if appli ~ tI ft. General conurteMs s S~~m ~/~t,J, ~O- ~/Ca ar,d ~~+~~ y ~ JUL 0 2 2D02 a% ST^CROIX COUNTY D Borin9# ° ~'~ Pit Ground surface elev. ~ ~ ~Q ft Depth to limiting factor ~ ~ in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Stniclure Consistence Boundary Roots GPDfft~ in. Munsefl Qu. Sz Cont. Color Gr. Sz. Sh. 'Eff#'1 'E1f/!Z Boring # ^ ~"N~ , ^ ~ Gramd surface elev. tt Depth to limiting factor in. Sofl Apptiption Rate Horizon Depth Daninant Cola Redox Description Texture Structure ` - Consistence Boundary Roots GPD/ft~ in. Munsefl Qu. Sz. Coot Color Gr. Sz Sh. 'Eff#1 'Etf#2 Z ~ ~ ~o~ / S~ zm ,~ 1'~r ~ s - s . ~ ~ .~- ~°~ ~~~~ ~s G -- m ~ Yn r - - Y: , ~ ~ ,~. ' Effluent #1 = BODS > 30 < 220 mglL and TSS >30 < 150 mg/L ' Effluent #Z =Bobs < 30 mgrs anti T55 < 3tJ rrtgrt. C.,//ST Name (Please Print) ~/Sr'~natore / CST Nut~m~ber~y Address trace tvatuanon c; i/5-15~~-YG~'~ T.L. Sinz Plumbing Inc. ` E5609 708th Ave. Menomonie, WI 54751 ~~~ 2~ W 1~0 (~ ~ r~S rv) ~~E L-~~ W(N SSv~ 3 acv N~ /~ ~ 9 i ~ ~v Lr r ~ 9 /,~:.~,P,~s~i 7 ~//s Phone: (715) 235-2644 Fax: (715) 235-2592 w~u~u.tlsinzplumbing.com i ~ r~~ 4~~v j pyvn ~ ~ ~rh,b. T.L. Sinz Plumbing Inc. E5609 708th Ave. Phone: (715) 235-2644 Menomonie, WI 54751 Fax: (715) 235-2592 ~F FG ~~~ w ~D g l ~Se'» www•tlsinzplumbing.com Lr~-u~o INt N SSv~ 3 Div ~~ /~ ~ 9 i -~ ~v ST ~~v ~ joyu~ ~ ~ ~~~vurh,n. ~o T ~{ 9 ~~~_ log ~---r-----T `o I, ~ ~,., ~~ .; _,,. ~.a Q~, ~rs~~lk~ c'O ~z~ ~ ~ X ~s 2s ~ GGIIS $2 ~~ ~ Q~!h ~ ~~ ~ ~\ -~ ~ ~~ ~~ y" ,Serv,c~ ~ ~~ ~ ~ -~ loo ~ NM L I vl ~ ~~ ~ ~fav~ ~,+~""'~ ~p 3 RED lFvr~tl11T loov ~W~ ~ L S`~• ~p~ St~fir~ 7,g,TlL I.IVH L I v~ ~~~ ~'vt-fva~d u>~o~ z.~it Frlf~~C, ` wsr~nsin Department of Commerce SOIL EVALUATION REPORT Page / of_,~ Division of Safety and Buildings In aGWfOdmGC VYrUI ~rUil O:.l, YYW. r+u~~~. a.wc County S / ~~~ ~~ X Plan must er not less than 8 12 x 11 inches in size a l Att h t ib i T . p an on p canp e s p ac e include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. ~ ~ l " ~\ ~`~Uv percent slope, scale or dimensions, north arrow, and location and distance to nearest road. D ~ a Please print all informat`iap. 04 (1) (m)? 15 ` P~ ~ Re/v~iewed by ~ ~"„ '~ Date (~'~ ~ ~ ~~~ ' . . s. • Personal information you Provide may be used for secondary pun t cy l property Owner Property Location .~~ Q ~~ /l S c} /~ Govt. Lot ~ W 1/4 }- 1/4 S ~FJ T Z~~ N R ~ ~ E {or)~l Property Owner's Mailing Address Lot # Biodc # Subd. Name or CSM# City State Zip Code Phone Number ^ City ^ vilage [~ Town Nearest Road 1iu~-~~GAO~ l !_~? ~ ~y~'`7l t > ~b,~~~td~ aC (~, New construction tJse: ~ Residential ! Number of bedrooms 3 - Y Code derived design iiow rate O O GPD ^ Rephacement 7 ^ Public or commercial -Describe: aa Parent material / ~ r' ~ Flood Plain elevation if applicab D ~ ft. General comments ~ S~PM PAC', v, ~~ l G~ and recemmendations: y ~ JUL ~ 2 2002 sys~ ~~ ~ ~a ~~- ~~~~ JT c~o~x ,- C.OUNTy 7.ONIN' Q Boring # ^ Boring C [~ pit Ground surface elev. ~ ~Q ft. Depth to limiting factor 0 ~ in. Soil Appligtion Rate Horizon Depth Dominant Color Redox Desription Texture Structure Consistence .Boundary Roots GPDfft2 in. Munseli Qu. Sz. Cont. Color h. Gr. Sz. S 'Eff#1 'Eff#2 ~ o 7 (~' . ,., a ^ Pit Ground surface elev. ft. Depth to limiting factor in. ~~# ° ~~ Sofl Application Rate Horizon Depth Dominant Color Redox Description Texture Structure `• Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Z ~ ~ ~o~. / - S~ zm .~ ~r ~ s - s ~ .~- log /cat ~s ~ -- ~s U ~ Vn l - , ~ ,.~ 'Effluent #1 = BODS > 30 < 220 mglL and TSS >30 < 1 ~ mg/L 'Effluent rig = t3UU5 < 3U mg1~ ana ~ 5~ < 3u mcy~ CST Name (Please Print) Si lure ~~._ ~~ CST Number Address Date Evaluation Conducted Telephone Number Property Owner F~~ i'~ SG h Parcel ID # Page ~ of BOMB # ^ BOfing _ I J ~ ®Pit Ground surface elev. S..%~~ ft. Depth to limiting factor ~C~~ in. Soil AppGp6on Rate Horizon Depth Dominant Color Redox Destxiptan Texture Structure Consistence Boundary Roots GPDfftz in. Mansell (2u. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Ett#2 - ~ Z 10 3/ z ~ ~, ~ ~~~~ ~ r c ,S 1 ~ ~ s - f Z -Z- o /~ - .SL. z~b~ ~S l v ~ S ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Mansell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#'I 'Eff#2 ^ Borng # ^ Bonrrg ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. MunseG lZu. Sz. Cont Color Gr. Sz. Sh. 'Etf#1 'Eff#2 'Effluent #1 = BODS > 30 < 220 mglL and TSS >30 < 150 mgiL 'Effluent #2 = BODS < 30 mglL and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the departrnent at 608-266-3151 or TTY 608-264-8777. sso-saw tRmroo) PAGE ~ OF TAT A MF 5~~~' ~ h ~ „ s ~ n T OT# 7 y LEGAL DESCRIPTION ~ ~ tiC ~ ,~,1(n T Z~I N R ~ ~ E(or)~ 1. .. _ SCALE:I"= ~~U BM 1 ELEVATION /C~'7 ~ ~~ BM 1 DESCRIPTION//'! >'ri /Q ` ~ &~(~ ~-r-e ~ ~ fi BM 2 ELEVATION /CaC~ - d ~ BM 2 DESCRIPTIONn~, `~g~ ° n pf C~ ° °~~~~~ ~~ --- CPC ` ~ SYSTEM ELEVATION /~~ ° / ~ SYSTEM TYPE ~c~~t ~~ y1 Tz COI Gil CONTOUR ELEVATION IS . ~ ~~~ ~ ~/ y S ci - -- - -~ CSC ' ~/ ~` I L r", ACA Z \ /, 1 ~ ~~~ 3 ~~,ti x TUBE DATE _, / k tsin Department of Commerce PRIVATE SEWAGE SYSTEM ety and Building Division ~ INSPECTION REPORT GENERAL NFORMATION (ATTACH TO PERMIT) Personal informatiun you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village x Township Robinson, Jeffre Hammond Townshi CST BM Elev: Insp. BM Elev: BM Description: ~ ~d ~ -r; ~~' vta.J1 ,,,,,,' .~-~,.«_, 30'x"/- o County: St. Croix Sanitary Permit No: 399465 State Plan ID No: Parcel Tax No: 018-1090-49-000 ~-I' lo~la.~s- SANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing /-~' _ ' /~ Aeration Holding T4NK SETBACK INFORMATION TANK TO P/L WELL BLDG. ~ Vent to Air In ke ns , ROAD Septic f f , ~ Dosing G~ Aeration Holding PUMP/SIPHON INFORMATION Manufacturer and GP Model umber TDH Lift Friction ss System Head TD Ft Fo cem ' ngth Dist. to Well SOIL ABSORPTION SYSTEM ~ ~ ~ -~~,,,,_ k _ .~. ~ BEDITRENCH Width ~ / L~ DIMENSIONS SETBACK SYSTEM TO INFORMATION Typ Of System: Pik, DISTRIBUTION SYSTEM Header/Manifold Distribu 1 /I ttir Pipe(s) Cnll ~ iJ No. Of Trenches ~ ~'~ P/L BLDG WEL 8. ~ 5, r ~~ ~ _ l¢.~- '-4-- Dia ~' paang_ . e~-.......-., c..~a....,... n..r., tLtVAIIVn uwlA STATION BS HI FS ELEV. Benchmark ~.GS 1r72.(a too. o Alt. BM I cy' f~( q Idg. Sewer .a s ~~g. SUHt Inlet .'~ Y..3 SUHt Outlet -~ R~-9s Dt Inlet ~ Dt Bottom ~ Header/Man. _ X0.6 G) ~ ~ Dist. Pipe ~ 0 r /o-,(~ ~.L .~ Bot System ~ L / I~.~ `~D~~ a Final Grade _ _ ~/ S . St CSt C ver 2.~2 ~ba~ ~ lib .3 PIT Pits LAKE/5 I KEAM r-r~cninu ~ - ~ylgc_w ~~ ~ ~ ` - HAMBER OR .GL ,}7 ~ / tuber. 2-,-~ Cam, ~ x Hole Size x Hole Spacing Vent Air Int ~ e I /- ~ ~ /, .... 11An~~nr1 nr A4.r:rarln Cvc}Rmw Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bedlfrench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:_(~1~V `~ Inspection #2: / / Location: 967 176th Hammond, WI 54015 (SW 1/4 NE 1l4 16 T29N R17W) Pheasant Hills 1st addn. ~ Par~l o: 1 ~~7.T74 ~ v~ 1.) Alt BM Description = 2.) Bldg sewer length = _ ~ - amount of cover = s y" ~ ~ ~ ~s~c.c_c/fz-~-~ Plan revision Required? Yes ^ No (~ `~ n-y~ ~ ~ - V ~ < Use other side for additional information. Date Insepctor's Sig ture Cert. No. SBD-6710 (R.3/97) kg~ a V a. y~ ~ ~ ~o ~' '~ ~~ .... F~~ ~ . ~. ~~~ _ ~~ ~ ~~ ~ ~ • T.L. Sinz Plumbing Inc. E5609 708th Ave. Phone: (715) 235-2644 Menomonie, WI 54751 Fax: (715) 235-2592 ~~~ ~~ !~ ~D gl~JSs`1/1 www.tlsinzplumbing.com ~.,art1,E L~ wt N SSo~ 3 ~LV ~~ /~ ~ 9 / -~ u~ ~ r err r y g ~~,e~s~i r ~/s ~' ,~~ ~o T ~ 9 ~ ~r, ~ ~ `o ~~ ~ ~~ ~ ~~ ~~ '~ a ~ ~-' ~~ ~ ~ g`~ f~ ~g.~ ,~ y~ST~-Gf Z - Z•-7X ~~ l -~ ~ ~t e COs I ~, L ~ l 4-~r1%-~~-- ~ l ~ n~ . 1 t ~^~ 63 ~ ~~ ~ ~ - ~ loop ~' 0 lfv~~~clr lover / ~ r-~ ~ T.t-,± r~ S c / '~ L l~ - S`~ ~ of ~ ~~ ~ ~ k-f oa IJ Vq'I L I v1 ~ r Co (~ ~ W ~ o d~ Z ~ ~ ~ ~ r 1 ~?•C . R~~-~ ~ ,d-~- n.w,~, r ~ ~~~a~9 . Safety and Buildings lrtivision~ CountYc . y ~~ ~ ~ ~ ~ 201 W. Washington Ave., P.O. Box 7162 ,> ~ ~ ~seons~n Madison, WI 53707 - 7162 Site Address n7 I ~~ ~ ~( De artment of Commerce o ~ g Sanitary Permit Application sanitary Permit Number r/ ~ ~ In accord with Comm 83.21, Wis. Adm. Code, personal information you provide p ^ Check if Revision ~ ma be used for seco ses Privac Law, s15. 1 m I. Application Information -Please Print All Information State Plan I.D. Number / ~ /~ Property Owner's Name ~ ~ ~ Parcel Number ,ov c~ ~D / 8'- 190 ~ ~r 1 in95u`/t ~.1 ~~i ~ Property Owner's Ma' ' Address Properly Location ~ (o , q . ~ ~ ~ '~ / ~, l / C. d jQ~I /T ~ "- , S6 ~~~~.6 • S l ~O T /~ 9 N, R City, State Zip Code ' Phone Nutribar " " . Lot ber Block Number l ~ ~ ._,~+ ` ~~ „ ~ r ~ , p- ~ ~ ; r ~ Subdivision Name CSM Number S ~ o ~~., , ~ T l~ II. Type of Building (check all that apply) ~ t ; ~, ~ u ;i ~ ~ ~; i ~ .City ~1 or 2 Family Dwelling -Number of Bedrooms ~ ~ ` Village ^ Public/Commercial -Describe Use ^Township ^ State Owned `'~, cY~ ~ ,~ ~' Nearest Ro III. Type of Permit: (Check only one box on line A (numbering scheme I use). Complete line B if applicable) A' 1 ~ New ^ Replacement System 3 ^ Replacement of 6 ^ Addition to For County use stem Tank Onl Exis ' S stem B • ^ Check. if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 ~' Non -Pressurized In-Ground / 21 ^ Mound 47 ^ Sand Filter SO ^ Constructed Wetland 22 ^ Pressurized In-Ground 41 ^ Holding Tank 48 ^ .Single Pass 1 51 ^ Drip Line ~.e~, l~y,~ir~ -~ 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recitcula ' 30 ^ Other ~~' V. D' ersal/Treatment Area Informat ion: ~' !C Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed_ Rate(Gals./Days/ S Ftl (Min./Inch) El e vation (/ ~ ~ ~ Aw pG G ~ VI. Tank Info Capacity in .Total Number Manufacturer Prefab Site Sleet Fiber plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks s (J --- ~~ Dosing Chamber ~1 a'b VII. Responsibility Statement- I, the tin , A~+~++• nsibility for installation of the POWTS shown on the attached plans. Plumbeys Nam e (Print) Pl is Signature MP/MPRS Num ber Busicess Phone Nu mb er // U~~ L~ L ? // ~ `~ iA ~i ~ ~ / ` / ~'~J' !~ ~7`" Plumber's Address (Street, City, State, Zi e) . /~, ~ ~p~ ~A .y--~ ~~~ p ~ ~ ~ /4 r/~ Z/l LS/r"~ ~f' ~ ~'~ ~./ / . Coun /De artment Use Onl pproved ^ Disapproved Sanitary Permit Fee tnclttdes Groundwater Date Issued suing A nt Signature (No Stamps) ^ Owner Given Initial Adverse . Surcharge Fee) ~ s °b/~ ~ ~~ ~ t Z~ 0 ` { ~ _ .~ Determination 1 [mod IX. Conditions of ApprovaUReasons for Disapproval 1. Effluent filter to be installed and maintained per manufacturer's recommendations. 2. Floodplain mapping =Zone "C" 3. All setbacks to, system and residential structure must meet applicable code requirements. 4. Well setbacks to be maintained per NR 811 & 812. h5, : , ..Attach complete phvn (to the Connh only) for the system on pawp /a ~1, lest than 81/2 a 11 Inches ht alas S, ~`~^'sq-~ ~~~~~r'~~'~t CJ't'bh~ ti)~ i i'1 `~tA IM.tti~~Gt Gi,IFki/lLcGt2 Q,f~Cfit SBD~398 (R~05~6ii) ~:. ~, ti.... < ~~ e w:; ~~~: ~ 4 ~-a~,~ r , I Y t Y i T.L. Sinz Plumbing Inc. E5609 708th Ave. Phone: ('715) 235-2644 Menomonie, WI 54751 Fax: (715) 235-2592 ,~~~~~.(~ W e~0~1/JS/'/! www.tlsinzplumbin~.com l.~,E L-~ Vu N SSo~-.~ 3 ~LV N~ /~ ~ 9 f ~ ~v Lo r y 9 ~~,e.~s~ r ~~~/s i s T ~l~ ~~{l~ %oyun ~aG ~~!~~urn,n. ~oT ~9 oY . 1 ~~ ~ a~ ~ ~~ ~ ~b d 1' 6g•~ ~~ ~~n.sTi~-Gt Z - Z.~ X .~-~~ l r~ ~I e N-~0 S Z ~l G ~ I ~ rr1-; -sil.., ~~"~ ~ tS~ ~ i~ ~_ Toil-I~ SLr-'~S ~ ~ f l (~ 1 y" ,Serv,~ ~ ~ ~ -. loop ~ LG 12 p z N~ 1- I ~ g rI ~ ~~ ~""'~ ~D 3 (3>r-0 ,fv/r'rFWTI lovv/~ ~ L g~ (~o~ / Sr.~1".~ T~rc / ~ do .QD;L ~{~ " ~U~ i,~.l..~ /l--loo 1.~ Vq'(L I vl ~ , ~ CO l-f v ~d' ~.J ~ O d~ Z ,~-t~ 1 ~ ~ ~ !t°~C -yt1u,J ~1,~ .~ G~ ~~~ rna-~2.2- .a(.ul~ ~~~ p~,~, ~ a~ '~~~ i l~~A ~~ S . `~ ~ ~ ~ `~ ~ ~~ ~ ~' ~ ~ ~ NORTH QUARTER CORNER ~ SECTION !6 -FOUND AL UM l NUM M~QlYUAENT ; . i ti~ ~, 8, A U s m 12 ~ ~~\,. r ~ ~. i . ~ ~ ~ ,. ~ ;~ ~ ~ ~~ RF~vED n`d f ~ ~ > X; '` ~ ~ L o~ , ~ (/~ ~ ~,,~ ,, . , .. ~l, ~j - _ ~~~ ~ ~ ~\~` x: <~ ~ ~- _z ~ oT f 8_ :~ :~~ ~~__ \~~ lo~~~. --_. ` ~~ x _ __- 243. G8' ~~ _ , ~ _ x ~ ~~ ' wreoor~in Department of Commerce ,' SOIL EVALUATION REPORT Division of Safely and Buildings P~~ct~ m aoaoroance wrm ~.ornm aa, vv~. r,am. ~.aae Plan must i 8 i/2 11 i h f h l Couniy -- ~ C ze. x nc es n s an ess t Attach complete site plan on paper not inducts, but not I'lmi~d to: vertical and horizontal reference point (BM), dRedion and Parcel I.D. percent slope, scale or dm~ensions, north arrow, and location and distance to nearest road. Please print all iriforma8on. ~~ Personal information Y~+ Proves ~y be used for ~.~(~'riva~.aw s. 15.04 (1) (m)). ~ ~ ~~ /a-'"O Property Owner ~ ,~: y, ? r ~;~ .Property t_ocation .. r ,, ~ Lot (,~J 1l4 ~ f: i/4 S T N R E (or) . Property owners Mailing Ad ~~ , `. # Block # Subd. or nAl/ . ~_~ ~ ~ ~ - , ,~ . F ~ N State Zp ChY - T ~gp1X ~ ~Y ^Villa9e G~ITown Nearest.Road 6' New Construction Use: L~Residential J bedrooms Code derived design flow rate GPD (] Replavement ^ Public or oorrun _ Parent material ~ i l ~ Flood Plain elevation if applicable tt. G~,eraloanmenis SrS~fCrr1 tIGV• ~ 7 • ~~ and reoommendatrons: ( e, ~t J • 7 , ~ ~ "' ~- ~ _~ 13 ~ naeda ~ ~.- ~!~~,.~-G,~- v~ , ~ sates ~ ~~ e~ ~~ / ` ~~ # o ~ Pit Ground surface elev. .~ tt Depth fa limiting factor // Z.~ in. Soli Ram Horizon Depth Dominant Redox Description Texture Structure Consistence Bourxfary Roots 0~ . in. MunseU Qu. Sz. Cont Cobr Gr. Sz. Sh. 'EtT#1 •Eff1J2 ~! ~---- s .~ - 1. ~.. ~• g$ ~, Z ~"~~ o Pit Ground surface elev. ~ 7d ft. Depth t~ lanitirg factor ~ in. ~ ~qn Rate Horizon Depth Dominant Cobr Redox Description Textrxe Stnucture Consistence Boundary Roots GP D/t~ in. Mansell (2u. Sz. Cont Color- Gr. Sz. Sh. 'EflB'I 'Eff#2 1 ~ ~ 5'/ ~ c v~ . 5 Z• 1 - --, 2 < - . 9 ~~' * Etfluerrt #1 = BOD_ > 30 < 220 mall and TSS >30 < 1 50 moll ' Effluent fK2 = BOD. < 30 mglL and TSS < 30 mglL CST M/ame (Please~Prtnt)~ Sign ~.,-. CST Nurnber Address Date Evakiation Conducted Telephone Number `Z1~..~1~ ~' ~~ ~m~ c~ /,~ l/ 5~-ld ZS (U /D - d U 7/s - L ~ 7- S/ UO~' 'y Property Owner ~O /1 K Parcel ID # Page 2 of 3 3 Boring # U ~i"91 ~ Pit Ground surface elev. ~ ~r • tigZ. ft. D~th to limiting factor _ j j_~__ in. Soil ' tbn Rate n ' t G b i D Redox Description Texture Structure Consistence Boundary Roots GP D/ff? Horizo Depth in. o r nan om Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EH#1 *Etf#2 ~ Z ~' s' , . ~ ~ 5 1 3 .2 ~~ b ^ ~' # ~ ^ Pit Ground surface elev. ft. Depth to Ihnniting factor in. Soil ication Rate Horizon Depth Dominant Cobr Redox Description Texture Structure Cenoe Boundary Roots GPDIf~ in. Mansell Qu. Sz. Cont Cobr Gr. Sz. Sh. 'Etf#1 'Efl#2 a Bonng # ^ ~9 Ground surface elev.. th Depth tb limiftrig factor in. ^ Pit Soil Ncation Rath Horizon Depth Dominant Cob ~ Redox Descx~tion ..Texture Structure Consi~noe Boundary Roofs GPD/f~ in. Mansell Qu. Sz. Cont Cobr Gr. Sz. Sh. 'Eff#1 'Eii#2 Effluent #1 = BODS > 30 <_ 220 mglL and TSS >30 ` 150 mgll " Effluent #2 = GODS < 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. sso-eaao ~e.m~oo~ _ r, PAGE ~ OF NAME ~ ~ T-e LOT# y~ LEGAL DESCRIPTIONSW '/4~11J4,s 1 ~PT2q,N,R 1 ~'E (or) -~ SCALE: I"= ~~~ BM I ELEVATION /~ • y BM 1 DESCRIPTION ~ a ; I ~ n ~a f'~on c.1oc~ c~ BM 2 ELEVATION /CU• C' BM 2 DESCRIPTION /lct iQ ~~ti $ " Coo{-~an~a~ocQ SYSTEM ELEVATION D I ALTERNATE ELEVATION ~ ~• ~O d CONTOUR ELEVATION ,/y /f'f X t b Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: System Design Specifications Sanitary Permit Number Number of Bedrooms ~ Design Flow -Peak (gpd) ~U Estimated Flow -Average (gpd) y'CI ,~i ,~ Septic Tank Capacity (gal) ~7 Soil Absorption Component Size (ft2) ~7S f Type of Wastewater Domestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow -Peak (gpd) Of~7 ? Maximum Influent Particle Size (in) NA 1/8 Maximum BODS (mg/L) NA 220 Maximum TSS (mg/L) NA 150 Maximum FOG NA 30 Table 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Outlet Filter Should inspect once a year and clean once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic Management Plan for a Septic Tank and Soil Absorption Component tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank maybe difficult or impossible, Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. 2 CONTINGENCY PLAN If the POWTS falls anti cannot be repatred the tollowtng meuures have been, or must be liken, tv proVlde a cods compliant replacement ryscem: ~A suitable replacement area has been evaluated and may be utilized for the location of a replxement soil absorption l system. The replacement 2rea should be protected from disturbance and compaction and should not be intrir>¢ed upon by required setbacks from exl:ling and proposed strucWrr, lot tines and wells. Failure to protect the replacement area will result In the Head for a new soli and s(te evaluation to esabllsh a suitable replacement ana. Replacement systems rnusc comply with the rules In effect at that tlrne. D A suitable replacement area is not available due to setback and/or soli ilmltatloru. 8arrtng advances in POWTS technology a holding tank may be Installed u a lut resoK to reptatx the faileQ POWTS. D The site has not been evaluated to Identity a suitable replacement area. Upon failure of the POWTS a soli and site evaluadon must be per!ormed to locate a sulubte replaceia~lent arta. If no replacsment area is available a holding tank may be tnsalled as a last resort w replace the failed POWTS. O Mound and at•gradr soil absorption sysums may be reconstructed in place following removal of the biomat at the InQitradve surface. Re<onswalons of such rystems rrwsL.comply with the ruks in effect at that dme. < <WARNING> > SEPTIC, PUMP ANO OTKER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESUtT~ RESGU6 OF A PERSON FROM TKE INTERIOR OF A TANK MAY RE DIFFICULT OR IMpc1t~IR1 i. ADD171dNAL COMMENTS POW'TS INSTALLER Name ~ Phone ., SEPTAGE SERVICING OPERATOR (PUMPER Name Phnn• POWTS MAINTAINER Name Phone LOCAL REGULATORY AUTHORITY A~~Y ~T: G ro ~ ~ on n ~iS- - ST CROIX COUNTY SEPTIC TANK MAII1'TENANCB AGRBEMBI`IT •~AND OWNERSHIP CgRTIFICATION FORM I` La..nG Nor d M ~ 55 t~~ bgD C~a.I~~ --_ J 1,01' ~~ g1~7 176'" ~Qhnmond Wt 5~0~~ (Yerificatian required from Planning Department fm new eonstructioa) ' Ida rn nn o n d Parcel Identification Number Ol ~ ' -~ ~v ~ ~ ~o ri'iaE.a~an . ~.~.. VJ ~ N E '/~ Sec. ~ ~o T a~ N-R~`N. Town of , ~1'al_tM M X1'_41 ~'r~-~- ~' II s _, I,ot # ~._. ~n Survey Map # , Volume _ .-,.Page # X 2 5 0 0'1 Volume l 52v Page # 9 3 Deed # Spec hose ^ yes C~no Lot tines identifiable ^ yes ^ no ~.~ -~~-'~-~~1(:~ turn failuze to handle wastes. Proper maintenance use and maintenanccaf your septic system could result in its prema ansod per Wlrat you put into the system consists g airt the septic tank every three years or sooner, if needed y pln the furnction of the septic tank as a treatment stage is the. waste. disposal system' cnt a ccstification form. signed by the owner and by a ~,pperxy owrxx agmes to submit to St, t~ronc Zoning v~y~g that (I) ~ a~ita wasbc~vatexdisposal system ts>at~ jaurneymanplum~bet; restrictedplumber m a licensedpumpa tank is Iess than i/3 full of sludge. ~ ~ tipCratiag condit%n and/or (2} after inspection and pumping (if ~},the septic cuts and agree to maintain the Private sewage disposal system with the standards I/wc, ~ have read the above requirem cation set forth. as set by the lr~at of Commerce and the Department of Natural Resources, State of Wisconsin- Certifi t c em has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 ~ S~ ~ date. days of three yam' ~ 0 1 DATE APPLICANT CTRTIl~CATION arc the owneds} of that all statements on this form era true to the best of my (our} lanowlalge. I (we) am ( ) (we) certify ty d a e, c of a warranty deed recorded in Register of Deeds Office. / ~ ' DATB 5IC#~IA ?~ APPLICANT «*s*sr ssssss Any information that is mis-represcntai may result in the sanitary permit being revoked by the Zoning Departa-ent. ss fnetirde with this Application: a stamped. warranty decd from the Register of Deeds of5ce II a copy of the certifed survey map if refcrcrboe is mach in the warranty decd STATE BAR OF WISCONSIN FOR~vi 1 - 1998 • WARRANTY DEED 6553E~` VOL 1711 36 KATHLEEN H. WAt_. t)octwnenl Number PAGE hEGISTER OF DEEDb ST. CF~OIX CO., WI Ronald C. Bonte and kECEIVED FOR RECORD Titis Deed, made between enn A. Knu tson 08-31-2001 5:30 AM WARkANTY DEED Grantor, EXEMPT b and Jeffrey W. Robinson and Beverly A. CERT CORY FEE: Robinson, Husband and Wife as COPY FEE: TkANSFER FEE: 133.20 survivorship marital propertk kECOkDING FEE: 10.44 Grantee. PAGES: 1 Grantor. for a valuable consideration, conveys to Grantee the following described real estate in St _ _rai x County. State of Wisconsin (the ~Property~): Fleco~ding Nea Name and Return Address Part of the SW ~ of the NE ~ of Section 16, Township 29 North, Range 17 West, St. Croix County, Wisconsin described as follows: Lot 49 of Pheasant Hills First Addition, filed May 8th, 2001 in Volume 8, Page 48, Document #644952 Together with all appurtenant rights, title and Interests. KRI:~~'~',1 OGLAND ATT~; . ~Y AT LAW ~' ~ .~~;C 359 HUGS~,w, WI 54016 018-1090-47-000 Parcel Identlacalfon rkxnbar (~M This 1 S not homestead property. (Is) (Is not) Grantor warrants that the title to the Property Is good, Indefeasible In fee simple and free and clear of encumbrances except Easements, licenses, zoning ordinances, and restrictions of record. Dated this 29th day of August 2001 ~~~~'" " `- (SEAL) ~ (SEAL) • Ronald C. Bonte ~ Glenn A. Knudtson (SEAL) (SEAL) AI~THENTT(,;,~1TTQN ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. St. Croix 'M authenticated this day of Personally came before me th `'• 'r ~ day of Au ust b+ov~fiamed ~~ u ona on +~- -- • enn nu s , .Z. ~~, .. . TITLE: MEMBER STATE BAR OF WISCONSIN ~ ~ to flf nOt. m~ 4nnwn en {.. el.. .......... S ...~... ~..~.....-.~ .L_ ,-----'-- ~QG NCaR TH WAR TER CORNER SECTION !6 -FOUND i g ALUMINUM MONUA~ENT (~ ~_ U m NOTE : ALL BU f L 0 f NGS !N PROXIMITY WITH DF HAVE A F ! N I SHED FL Ot ELEVATION NOT LESS ' ABOVE THE H 1 GH WATEf -' UNPL ATTED LANDS ~ f N I A ......................................... ' .'` A 1 ~ ~ N DRAINAGE AREA Jp18Q~ ~ rj' 45" E 65D. DOS ! 20. 00' 440.00' DRAINAGE AREA 90. C FALLS ON NORTHiSOUTH FENCE L 1 NE MNE~ t0,t.t ~ 100-YR ~ LOT t9 -- _ __ ~, LOT 49 - - NN~ 2.48 ACRES v; 108, 160 SO. FT. ~~O ~'. ~, ~ ~" a M ~ LOT 50 `'' ~ LOT 48 w tiry 3. 14 ACRE: ~- ~ 136, 692 SO. 2.43 ACRES ! 05, 8T 1 SO. FT. D ..®.. ~.'L~ Z a '~~' `,~`. "i o ®,' ~ ~ ~ S88'23' 24`E 243. 68'. ~ ~ i G ~~ 1~ 12 ~ , ~,` ~ s ~~ ~~ z ®-, rn yp .p ~ ~a+ ~? F `~ NT2 y ~ .A ~ tt11~ ~` ~ _ N .LOT 47 ~ ~ ~ o g ~ 3.62 ACRES ©~~,~~ '~ 1 `, . n .F • r R 7 A ~I~ I. I'1 rT 1~ h