Loading...
HomeMy WebLinkAbout026-1113-10-000 Wisconsin Department;of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 569585 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Gafner, Ronald I Richmond, Town of 026-1113-10-000 CST BM Elev: 11in-W.BM BM Description: Section/Town/Range/Map No: C5 03.30.18.646 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER . CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing J zg O Alt. BM r-' Holding St/Ht Inlet 2-16 (� g -73. 1:% TANK SETBACK INFORMATION St/Ht Outlet7a �� •7. 9z �`� TANK TO �P/LL WELL BLDG. ent Air Intake ROAD Dt Inlet \ '\ Sgptic gq 7 5� f6 `� Dt Bottom UL � Dosing Header/Man. ! 7z. Z Aeration T / Dist.Pipe a 4ZZ Holding �O Bot.System 9? . Z b4r 7.� z . '77• PUMP/SIPHON INFORMATION Final Grade `T Manufacturer Demand St Cover��t Z. � c7$ GPM � v Model Nu rr r TDH Lift Friction Loss Syste DH Ft I Forcemain Length Dia. Dist.to Well I SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No.Of Trenches ' w PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufactureff►l ' ^ INFORMATION CHAMBER OR >f-i' Type Of System: C UNIT !j J A Mod.Numbgr: Co wJ ir0 3� �3 J [yatl•LfG q DISTRIBUTION SYSTEM Z Z 4-ZZ -1p, S Header/Manifol f I Distribution x Hole Size x Hole Spacing Vent to Air Intake [[ Pipe(s) `� iLength__U_Dia 1 T Length Dia Spacing 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 Bed/Trench Center Bed/Trench Edges Topsoil Fa_1 Yes 0 No ❑ Yes ❑ No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 1209 172nd Ave..NNew 1Richmond,WI 54017(NW 1/4 SW 1/4 3 T30 R18W) Green Acres Addition Lot 11 Parcel No: 0 30.18.646 1.)Alt BM Description= ', ^- �J - 6, ,ait� 4-a Gove'le 2.)Bldg sewer length= / / a� �t::5 4-b Le_ Ueej 0 A by 1411 -amount of cover= X� �` /'� Z 4 i` Plan revision Required? ❑ Yes ;No Use other side for additional information. SBD-6710(R.3/97) Date Insepctor's nature Cert.No. J PLOT PLAN PROJECT Ronald Gafner ADDRESS 1209 172nd Ave New Richmond Wi 54017 NE 1/4 NE 1/4S 3 /T 30 N/R 18 W TOWN Richmond COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 6/5/14 BEDROOM 4 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000/280 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 890 # of chambers 44 BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 100° Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 91.5/91.3 6.5' below qrade 172nd Ave L Scale is 1" = 40' >6„ Quick4 Standard unless otherwise of Cover eaching Chamber noted 0, ith 20.0 ft2 of Area .6ft^2/pair of end caps 4' Lon20� B-1 Grade at System Elevation 34 2-3' X 90' cells with>3' spacing All piping shall be SDR 30/34,within 10' 0% Slope of tank,piping shall be Schedule 40. 45' Well 30' B-3 20' 40' 10' X�L B.M.* Existing 4 Bedroom House 45' 25' 40' 20' B-2 "septictank Old drywell is to be pumped and buried Ven z Z 6,1 I y5 ailed Huffcutt 280 DW Property Line o m ° p °en ti W a> C N CD CN o :D N N N ld U� C 4. CO N � L O 3 c � m I a`�i rn v (D O O c O c Z o m Z 7 f0 - LL L N LL c O)_ CO O c+� E Q wm o Q I' v Cl) C MC L m am M O7 O Z a c :q c w o w in H O1 ? aci 4' (D c a E c E v I_ v N U O N .O �l (D • ''',, N O N m N d d Q O O Q O N Q C Z Z Z fn Z N U) ((vQ a .. to a .r C H o G C (L .0 U) v G a a o (D E c l m ° FN- H H a s CL E • Laaa `-' aaa 10 U IL 3 O U) 3 v Z o p N > c0 O M — O M O M O_ O_ O _ O> Q C N (D _ C O .� 'O N O O N N W V m C n' Cl) V 00 N m N O (D LO h ;z N M Q Z 0) Mp 'O d Q Z UJ N O ! O y7 a� � 7 +� N 7 _ _ _ _ OC N C a 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 O y •` y O € O 'O N N N N N N N N N N N N N N N V Q 00 C C l6 N C C m N C K N O In U7 CO 00 O (O C } N N N w 'O M r .- N r N N N � O �() • , �' r O C In d O c 'fl I E o y O v C N m y co N Cl) O (O LO I- N V) •r^xll N M U (0 p O W >. O O M O N (C O O U 0 0 C7 (O O Z y Q' Z U v 0 Z y m Z v C� v� a € a • CL 2 !1maw maw t� CAS d c m c A tia � ', oaiv ouiv ^ � may_ V Safety and Buildings Division County fb! anitary Permit Number(to be filled in by Co.) 01� 201 W.Was"3#7W2 Ave veP.O.Box 7162 � J�N O `L i 5 X55 S ov T pxX PMEN State Trtmsaction Number ^oMMV k anitary Permit Application In accordaucj with SPS 38321(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit L. is required prior to obtaining a sanitary permit. Notre:Application forms for state-owned POWTS are submitted to Project Address(if MV than mailing address) De the pwtmed of Safety and Professional Servies. Personal information You provide may be used for secondary /zz-% sw in accordance with the Privacy Law,s.15. 1 m Stets. 5� 1-7 11 L kppfic1tion Information-Please Print All Information O Parcel# Property Owner's N T i- � ��� Property owner's Mailing Address CQ j 7.) �V.Lot City,State Zip Code Phone Number &F=1 1/,, Y4, Section k 1i N: R or W PP J II.Type of Building(check all that a 1 Y) � / Stion,Name 2 Family Dwelling-Number of Blo ❑PublicXommemial-Describe Use PejOLaze..V-NC ❑City of / CSM Number ❑'V'Wage of — J ❑State Owned-Describe Use `� r _ 'P� own of — z t,✓ 2Z�-ZZ- G1� r III. type of Permit: (Chock only due box on line A. Complete line B if applicable) o^-e— A ❑Treatment/Holding Tack Replat ent Only ❑Od cr Modification to S (explain ❑New System lacement System / _ / 2/ List 'o PermitN an Issued B. ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New Before Expiration Owner IV.T of POW I S S atcmJCom nentlDevice: Check all that anplyl on-Pressurizcd In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound 2:24 in.of suitable soil mound<24 in.of suitable soil Prd� Holding Tank Compooem(arplaio) ❑Pretreatment Device(explain) V.Dis rsaUTrea Brit Area Information: `� f Design Flow(gpd) Design Soil Application Dispersal Area Required(sf) Dispersal Area Proposed(si) VL Tank Info capaaty in Total #of Manttfacwrer c Gallons Gallons Units J New Tanks Exiaong TadM rn ii C7 a Septic err Iioldiag Taok 2 / d G--- ( c Dosing Cb=ber VII.Res risibility Statement-1,the undersigned,assume nsibility for installation of the POWTS shown oa the attached Plans. 1 s Name(Print) Plumber s MP/MPRS Number Business Phone Number Plumber's Address 'S '�ZrP ) Coun /De ent Use Only u (✓(u L �for Permit Fee Da Tssu Issuing Sign ature ed C r�e� S `7 75•DL Condih'61 13i* roval � f:- SreptiC tank,effluent filter and . 3) 6�dL !f �'f�•t�- ¢a dispersal cell must all be servtces!maintained t as per management plan provided by plumber. i is must ft*ntaltied I n per applic6file c6dir/W d FlCei. not kas than a lut z ll ioriea in size Attach to eempkbe plans for the system and sabmit m the Coon oalp or paper SBD-6398(R.11/11) Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 6/5/14 Owner: Ronald Gafner Location: NE 1/4 NE 1/4 S3 T30 N,R18W 1209 172nd Ave Richmond System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specifications heet 8-10. Soil Test 9. Existing Septi nk Signature License 4�er#226900 PLOT PLAN PROJECT Ronald Gafner ADDRESS 1209 172nd Ave New Richmond Wi 54017 NE 1/4 NE 1/4S 3 /T 30 N/R 18 W TOWN Richmond COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 6/5/14 BEDROOM 4 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000/280 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 890 # of chambers 44 BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 91.5/91.3 6.5' below qrade AL 172nd Ave j4' Lon ent Scale is 1" = 40' Quick4 Standard unless otherwise Leaching Chamber noted 0' with 20.0 ft2 of Area 5.6ft^2/pair of end caps 20' B-1 34„ Grade at System Elevation IF 2-3' X 90' cells with>3' spacing All piping shall be SDR 30/34,within 10' 45' 0% Slope of tank,piping shall be Schedule 40. Well 30' B-3 20' 409 10' rB.M.* Existing 4 Bedroom House 45' 25' 40' 20' B-2 Old drywell is to be pumped and buried Vents 40' 20' ST 10' Failed Huffcutt 280 gallon septic tank DW Property Line Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber To be >1' above grade 5.6ft^2 pair of end plates g Finish grade elevation Typical Installation 97.8' Vent Al Grade Vent 3' 4„ 3' X30/34 Septic Tank 5' Long 117 5' S' Long 179 Grade at System Elevation 36" Grade at System Elevation Spacing 5' 2-3' X 90 ' Cells Same on other end Observation tubeNent At end of cell A B 22 chambers per cell System elevations: A-91.5' B 91.3' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Tank Manufacturer.4,-j s�lti,_ O NA �n 0 Permit# ptic 0 Dose 0 Holding Volume: (9�) Tank Manufadurer:��(?.c� 0 NA DESIGN PARAMETERS Number of BedroF� 7g tic O Dose 0 Holding Volume: Za? (9N) Number of Public Facility Vertical Distance Tank Bottom(s)to Service Pad: (ft) Estimated(average)Flo : (� Horizontal Distance Tank(s)to Service Pad: (ft) Specdk servicing mechanics must be provided it vertical is>15 feet or Design(peak)Flow-(estimated x 1.5): G (gaVday) If horizontal is>150 feet. Specific Instructions to be provided on back. In Situ Sal Application Rate: (gal/dayR) Effluent Filter Manufacturer: j 9 AQ 0 NA Standard(Domestic)Influent/Effluent Monthly average.. Effluent Filter Model: Fats,Oil&Grease (FOG) sm-mg/l- Pump Manufacturer: Biochemical Oxygen Demand (BOD9) s220 mg1L 0 NA Primp Model: . Total Suspended Solids SS .1150 High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg(L.. Manufacturer. (BODs) >220 mgA. IVA 0 Mechanical Aeration [3 Pee Fifer SS) >150 m 0 disinfection 0 Wetland Pretreated Effluent Monthly average 0 Sand/Gravel Fier 0 Other. (BODs) .130 mg A- /&-NA Soil Absorption System (TSS) s30smg/L �`y,�Ground(gravity) 0 in-Ground(pressure) 0 NA Fecal Coiform sometric mean 510 ' —❑At Grade ❑Mound Maximum Effivant Particle Size 16 in dia. 0 NA 0 Drip-Line 0 otheother.' Other: NA Other: 0 NA MAINTENANCE SCHEDULE service Even $°^dCe FrequericY tank(s) hen combined sludge and scum equals one-third(15)of tank volume Pump out contents of tan ❑When the high water alarm is activated �� L1.months) (Maximum 3 years) O NA Inspect condition of tank(s) -At least once every: ;* r(s) At least once every: '� month(s) (Maxirnurn 3 years) 0 NA Inspect dispersal cell(s) �• '� s(s) NA Clean effluent filter A every: �� EoErth(w) Inspect pump,pump controls&alarm At least once'every: NA m (s) A Flush laterals and pressure test .At least once every:. 0 y ) Other: At least once every: 0 y (s)s) NA. Other: NA MAINTENANCE INSTRUCTIONS one of the following licenses or certifications: Inspections of tanks and soil absorption systems shall be made ;p ct individual carrying Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, any missing Maintainer a Sardwa Servicing Operator (pumper). Tank inspections must include a visual inspection of the tank(s)to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluenot for anry ponding of effluent absorption system shall be visually inspected to check the effluent levels in the observation pipes and on the ground surface. The ponding of effluent on•the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equals one-third(%)or more of the tank volume,the entire contents of the tank shall be removed by a Septage Servicing Operator (pumper)and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code All other services,including but not limited to the servicing of effluent filters,mechanical or pressurized components,pretreatment units. and any servicing at intervals of 512 months,shed be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. GMW-005(02/05) Page Of START UP AND OPERATION at er For new construction, Prior to use of the POWTS check vestment tank(s) for the presence of painting products,concentrations sdv ft Or are chemicals or sediment that may impede the treatment prooess'ar dlor damage-the soil absorption. us�eem. 9 to a Servicing Operator(Pumper)prior a n9 detected have the contents of the tank(s)removed by Sep 9 under these Pump tanks may till above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power conditions is not recommended,as the excess wastewater will b discharged to the soil absorption system in one large dose causing an overload that may result in the backup a surface discharge of for(pumper)damage prior to the system. to the pump or contact a Plumber contents of the pump tank removed by a Septags Servicng Operator(pampa+)prior to restoring power or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the Pump tank. System start up shall not occur when sell conditions are frozen at the infiltrative surface. compact, not drive or park vehicles over tanks or the soil absorption system. Do not.drive or park over,or otherwise disturb or oompa ,the are@ within 15 feet down slope of any mound or at-grade soil absorption airea- the life of the treatment Reduction or elimination of the following from the wastewater strearn m performance may improve the perfoance and prolong tanks and soil absorption system: acids, antibiotics, baby wipes.'dgaretW'butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain(sump pump)Discharge,fruit fled vegetable peelings, gasoline, greases, herbicides, meet scraps,medications,oils,painting products,Pesticides,sanb�y napkins,solvents,tampons,and water softener brine discharge. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shell be taken to Insture that the system is properly and safely abandoned in compliance with s.Comm 83.33,Wisconsin Atlministra�}ve Code: • All piping to tanks,pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. disposed of b a e Servicing Operator(pumper)- t • The contents of all tanks and pits shall be removed and properly epos Y SePtag • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space Oiled with soil, gravel or another inert,solid material. CONTINGENCY PLAN vide a coda compliant If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to pro repla ant system: am A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption sY ut The acement area should be protected from disturbance and compaction and should not be infringed upon y req setbacks from existing and proposed structure,lot lines and wells. Failure to protect the replacement area will result the rules in for a new soil and site evaluation to establish a suitable replacement area. 'Replacement systems must comply effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil•limitations. If the soil absorption system cannot be rehabilitated and baring advances in POWTS technology,a holding tank may be installed as a last resort. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. if no replacement area is available a holding tank may be installed.as a last resort to replace the failed POWTS. ng 11 surface and at-Wade soil ns of such systems must comply with the rules in effect t that i meremoval of the.blomat at the infiltrative WARNING � � TANKS., .PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE ADDITIONAL INSTRUCTIONS: POWTS INSTALLER in POWTS;: MAI NTAINER. •� Name�� - Name Phone Phone 2 W' ° SEPTAGE SERVICING OPERATOR(PUMPER) LOCAL REGULATORY AUTHORITY Name Name <7 �/ Phone Phone /J�' cif"Z�k� � ankles in camPNar+ce witl�sectla�s This document was drafted by the stalls d the Green Lake, Marquette and Waushara County POWTS regulatory agencies Comm B3.22(2xb)(1ud)a(f)and 83.54(1),(2)&(3),Wisconsin Administrative Code. 1L FILTER CARTRIDGE INSTRUCTIONS STEP s Dry It the filter woe ante the gad of tins outlet pipe to enswe it is centered under the acoeea opening. V not,than ether i nsart mete pipe into the hank through the outlet or solvent weld(ohm)additional pipe onto the mullet Pipe. STEP 2 VVMM the Casa iR stir dry fitted an the outlet pipe,measure ow lweg* of'A-inch pipe needed to bran the fllbw to tM tank end well if uterine the optional supplemental We support,if we support methoa is rat utfized, proceed to step faun: S'7 F.Y 3 For koftlatlons utiggaing the Optional supMnrrsuW side support: solvent waW the IA4nch pipe ants the fker am. if side support method is not Udbod,proceed to step four. Solvent weld the filter case onto the outlet pipe. Insert the filer r ti%:: cartridge into the ease,pressing down until the Ater locks into the bottom of the case. If a VRS switch is utilised:insert into the filter and Iodk by turning r dodkwise 9f>•. MaMtemmce 1. The effluent Ater should be seamed every time the septic tank is serviced. 2. open the outlet access opening to inspect the tank and fliet a 3. Pump the septic tank cw"PkM*,making sure to remove the sludge layer on the bottom of tM tank and not jufit the scum and effluent. 4. Once the eftkwnt gavel has been lowered below the invert of the outlet pipe.ftmlY Pull on the Aker handle to didmige the cartridge hum the Case. S. Slide the cartridge up sod out of the case for cleaning. 6. If a VRS switdn cetu+actad to an alarm is present,tie switch t• , should be removed by torlor g cmdardodkwin 9ir and cleaned with water only. 7. While homing the cartridge an Its side(fovea flat surface facing w :. down)over the access opefift rkrse off the cartridge wlW water may.ins suss of suPage matsrlel is rinsed hack Into the tank. '► & If VRS switch is utilized,replace by insar*q into Mter and '"f turning ebdarlse 90-. 9. Insert the Aitet cartridge back into the ease,pressing down urn •:� • "� r. the Aker locks,into the bottom of the case. �,^� •E 10.Replace and sgwre the access opening on the tank. sr ta^•.:Kati"+!c"S:aN'R:in(� -IYE••'1 r..:+irei':.0:r,tJ!►t:v•. .i• •i'•..f t. .. �7x.•.4'.n•'Y If• •Y• www.be it+e con 877-1 LMMRS("3-4583) /Z -/Z-. ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that-1 have inspected the septic tank ,crving the p p presently residence located at: Section If T N, R� 1, Town of Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced: /J? otC)l bid Plow back occur from absorption system? Yes _ No (If .no, skip next line) Approximate volume or length of time: - gallons minutes Construction: Prefab Concrete-4 Steel � Other Pdanufacturer: � i � l �- -- -- (If known) :Q-ran,ge- ✓ Age of T (If known) .:�GYI-C� vl�u�J,,✓ 'v' d (Si ature) (Name) Please rint (Title) (License Number) — K DaIte I ['arm to be completed by licensed plumber Statutes) or Licensed Disposer (NR 113 Wisconsin 5 Administrative Code) Plumber (applying for sanitary permit) Certification: _ in accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR 83, Adm. Code (except for inspection openin over outlet baffle) Name "/ Signatur l MP/MPRSZZK fz---' ST. CROIX COUN '! SEPTIC TANK MAE,4 TENANCE AGREEMENT AND OWNER/SHIP CERTIFICATICN FORM Owner/Buyer 2o -- Mailing Address l2 per_ / 7 -2 Property Address (Verification required from Planning&Zoning Department for new construction.) City/State Parcel Identification Number LEGAL DESCRIPTION Property Location/VE_ r/4 , 1/4 , Sec. , T30 N R W, Town of /2+ Subdivision 1 ee A-,-� ✓ Lot#// Certified Survey Map# `-- , Volume�— ,Page#' -' Warranty Deed# �-� , Volume Page# Spec house yes no Lot lines identifiable no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the wash disposal system Owner maintenance responsibilities are specified in§Comm. 83.52(l)and in Chapter 12-St. Croix County Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&Zoning Department a certification form,signed by the owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site wastewater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is less than 1/3 full of sludge. Uwe,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth,herein,as set by the Department of Commerce and the Department of Natural Resources,State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St.Croix County Planning& Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on form are true to the best of my/our knowledge. I/we airfare the owner(s)of the property described above,by virtue of a wa anty deed recorded in Register of Deeds Office. Number of bedrooms Z�L: J� /__ _ SI ORE T OF APPLICANT(S) DAT ***Any information that is misrepresented may result in the sanitary permit being fovoked by the Planning&Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV.08/05) /@ oo �q f 554154 1 STATE BAR OF WISCONSIN FORM 3- 1982 �I Q IT-t.T AIM DEEM II rr ----DOCUMENT NO. —I� V�� `1. PAC a 0 --- — - it f� / A 1 � H.E,GiSTI: 3 G`:=:;is 11Cnifl id A. r;&A4er '�" �tN�r� � �r/ ��d? ST.CROIX CO.,W1 fwd lot Rego a quit claims to ' ! r JAN T 1997 �) at 9:30 A. 1'di tl 1.-Kt.. '1* ldw.,l, �� @@ F189ISter tit Duuc;. the following described real estate in County; W tl State of Wisconsin: (Z C'7 n 1?a,n AV e­. . - �l �I"del/1 �c✓'eS fa 7/lA1rI � 1�1�'1 eI1VYI� THIS SPACE RE3ERVEC FOR RECORDING DATA — NAME AND RETURN ADDRESS /1 / 0 6 , IfJ i. oxa►d of Ivc :w►u a �'v►�v /v'.aa l?o'ZItrY Gt;U� Ne,,j A"-,nrrwnd� l PARCEL IDENTIFICATION NUMBER } 1 I FEE �. I i �I �I If This f5 homestead property. (is) (is not) Dated this. t�}� day of 4— ZI-1) -(SEAL) (SEAL) I (SEAL) _ (SEAL) AUTHENTICATION ACKNOWLEDGMENT I; Signatures)_ State of Wisconsin, I� Count): ;i authenticated this —day of onaliy came before this _ �`' _ day of �{ tA >a>r / 19_E7-,the above named -- -------_._ ,._.—_ ham^`.i��1^+sa�y a4 t•ep.. �•4r�� .� � ,�2'A-� e+.�_ II TITLE:MEMBER STATE BAR OF WISCONSIN �- (If not, authorized by 5706.06,Wis.Slats.) �M ` t d twvp in to, tte the person _S who executed the foregoing I� .y .eetiiinstrugseh"t�n " -knowledge 0,.e sain j! THIS INSTRUMENT WAS DRAFTED BY er��• � I ii �i�irB,a f sat*!¢� it Norery P[ihlir, County.Wis. (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration�date: li necessary.) -2 !f 'Names of parsxns signing to any capac..y should by typed or pnmed Wow their signatures. I Wisconsin L SIGN Co.,Wine. t STATE BAN o. -WISCONSIN 982 e9zy I; QUIT (:LAiM DEED Form Nn.3-1482 Milwfluke9.tNs ,� i Ex1�tvir► G X1134 g � 1 Q�p1i P9 200.0 0' 180.00 � 200.00 200.00' 176.00' Colemn L. West 1756.00 2.00I.00' 180:,.00 200-00'.. 2.00.00' 176.00 I P3 �fX P, f s2 12 t 2 ,.,.00' 180.00' 2 00.00' 2 00.CK IL 17 6.00' 0 B East 1 North 81 60' East ' 50 corner Sec.3, 0 50 100 200 Soo 400 Soo Unplatted Scale I"= 100' 0 indicates 1'% 30" iron pipe: ( minimum weight 1.13 pds. per lineal foot ) 0 Indicates 2"x 30" ircn pipe ( minimum we,aht 3,65 pds.per lineal foot.) :-:7RTI F ICI ATF Kruse, Surveyor, hereby certify, surveyed,divided and mapped the within lands known as Green Acres Addition to the Town of Richmond, County of St Croix i 'node such survey,land division and plat by the direction of Gary 6 Jeanne Kohl and Wayne 8 Erma Coleman, owners of ornmencing at a point which is 747' North and 60' Eost of the SW corner of Section 3,1".30 N.,R.18 W. and the POINT 0 proceed East 1756. 00, thence propeed North 567, to the north line of the S 11 of the SW 1/4 of said Sec. 3, then Q of SWI/4 a distance of 1756.00 , thenceproceed��South 56700 to the point of begining. Being all contained in the E I., R 18 W. lot is a correct representation of all the exterior boundaries of the land surveyed and the subdivision thereof made, fully complied with the provisions of Chopter 236 of the Wisconsin Statutes,the subdivision regulations of the Town of R Subdivision Ordanance of fhe St Croix County Planning Commission, in surveying, dividing and mapping the some. Date Oct 28. 1968 ___ Dn..:..e..E Oka:.. 7th tins of MM 1=14 LAn... M 0'- Wire*. I V­. Property Owner_ Parcel ID# Page of M ja Boring# 11 Boring Q pit Ground surface elev. 10 ft. Depth to limiting factor in• soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. )Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. /� 'Eff#1 'Effff#2 –23 V r/ �i —� �i C J , C V P17f 1-7 F-1 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/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 F-1 Boring# E]E] Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 •Eff#2 Effluent#1 =BODS>30 1220 mg/L and TSS>30<150 mgA. •Effluent#2=BOD5<30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SOD-9330(R.Nao) " r Wisconsin Departm Comb OQ� SOIL EVAtUATIO"EPORT Page of Division of Safety a Bull is��l�G`' in accordance with Comm 85,Wis. Adm. Code �.�, �(Z County +\ Attach complete sltexil'an on paper not less than 8 1/2 x 11 inches in size.Plan must re mss` include,but not to:vertical and horizontal reference point(BM),direction and Parcel I.D. / _ percent slope,Scale or dimensions,north arrow,and location and distance to nearest road. ®a 6" Please print all information. Re ed by Date Personal information you provide may be used for secondary purposes(Privacy law,s.15.04(1)(m)). Property�� �Q-� Properly location Govt.Lot f 11 114 S T 30 N R E(o W Property Owner's Mailing Address Lot# I Block# I Subd. Namep CSM# /oZ O — /�- City late. Zip Code Phone Number ❑City ❑Villa a �To Nearest Road Guff, 1 O� (7/s 6- s i / 702 ❑ New Construction Use Residential/Number of bedrooms Code derived design flow rate 1 1 GPD eplacement ❑ Publijcf�r commercial-Describe: __.---_- __ ----;___--- --- Parent material/411 tXAZ 4 f'�—� Flood Plain elevation if applicable .//// ft. General comments 'a j and reconvrlendations: System Type A VL114Z System Elevation . - Boring# E] Boring a s I Pit Ground surface elev. 71 L ft. Depth to limiting factor in. [Eil:Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 -Eff#2 I 0_2D 111i 1 -j- J 1 S 1t ® Boling# 1El Boring Ii=l. Pit Ground surface elev. , Z ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 0- Z 51- �S sw iS ` iI'I i G I 1 ar i Effluent#1 =BOD >30<220 mg&and TSS>30 1150 mg/L uent#2=BOD <30 mg/L and TSS<30 mg/L CST Name(Please Print) Signature CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 715-246-4516 Property Owner Parcel ID# Page of © Boring# ❑ Boring Q� Pit Ground surface elev. y ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. �)Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. / /1 'Eff#1 'Eff#2 –2 G j . C [IAI-51W a Y-/Js-4,-4L 171 4!11� ph� 4e_Z Ll I ( ,., F-1 Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. So plication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAf in. Munsell Qu.Sz. Cont Color Gr.Sz.Sh. 'Eff#1 •Eff#2 F-1 Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate. Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Roots GPDM in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 Effluent#1 =BOD5>30<220 mg1L and TSS>30<150 mglL 'Effluent#2=BODS<30 mglL and TSS<30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD4330(8.6/00) Soil Test Plot Plan Project Name Ronald Gafner Sh Bird Address 1209 172nd Ave New Richmond Wi 54017 STM #226900 Lot 11 Subdivision Green Acres DgVe 6/5/14 NE 1/4 NE 1/4S 3 T 30 N/R18 W Township Richmond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Bottom of siding System Elevation 91.5/91.3 *HRPSame as Benchmark 172nd Ave Scale is F = 40' unless otherwise 09 noted IF 20' B-1 745' 0% Slope Well 30' B-3 20' 40' 10' B.M.* Existing 4 Bedroom House 45' 25' 40' 20' B-2 T 10' Failed DW Property Line