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HomeMy WebLinkAbout020-1407-08-000Wisconsin Department of Commerce Si3fety and Bu Iding Division PRIVATE SEV~AGE SYSTEM INSPECTION REPORT GENERAL INFORMATION ~ (A1-EACH TO PERMIT) Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)1• Permit Holder's Name: City Village X Township Bast, Kernon Hudson Townshi CST BM Elev: insp. BM Elev: BM Description: ~~i/ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing ~ ~~ ~~~ ~ D Aeration ~ Holding TANK SETBACK INFORMATION TANK TO /L q,t ~P ~ ~ W LL BLDG. Vent to Air Intake ROAD Septic ~ j ~ .. ~ ~ ~ Dosing > 2 ~ Q"Y~ .~'J > Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand D GPM Model Number ~~ TDH Lim ~ Friction LosDs System~e TDH Ft / !/ ~ ~ ~ Force in Len th / Di ~ Dist. to well ELEVATION DJ~'TA County: St. Croix Sanitary Permit No: 430332 0 State Plan ID No: Parcel Tax No: 020-1407-08-000 Sectionfrown/RangelMap No'. 10.29.19.2555 ATION ->~L/ BS r HI /0 ~• FS ELEV. ADD - ?1 Benchrr~ark ~ ~n't ~~ X00.7 pD ~d Alt. BM _ lj l , ~ ,.~7 -CF/ Bldg. Sewer zo SGI~~~ 9-g 9D 9z t/ t Inlet (] Zv 0 9~ ,/~ / 7 S t Outlet r Dt Inle~f ~" Dt Bottom ~~~ G~ 0 S, / ~ ea ~ - 3 / ist. Pipe Bot- System ~~ .S Final Grade . 1 t Cover ~ ~ ~ ~ ~ 3-, ~ ~ ~ 9 - 3 K 4'~` SOIL'ABSORPTION SYSTEM :1. ~ BED/TRENCH DIMENSIONS Width ~ ~ Length y ~' 1 No. Of Trenc~}es I PIT DIMJF_D4SIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM EACHING CHAMBER OR an ~r ~'1't"~~~ V u~ -{- f - ~ T O System: ZD/ `~ ~ r~ UNIT odel Number: r~ i. DISTRIBUTION SYSTEM Header/Maa' gld 4 Length ' Dia Distribution 22 / Pipe(s) r Length (J Dia pacing x Hole Size ~- x Hole Spacing -" SOIL COVER x Pressure Svstems Onlv xx Mound Or At-Grade Svstems Oniv Depth Over /,. ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center ~ Bed/Trench Edges Topsoil ~ _~ Yes ~ '' No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/2~ /d ~; ~In,~slpection #2:~/~/ 6 Location: 717 Zephyr Lane Hudson, WI 54016 (NE 1/4 SE 1/4 10 T29N R19W) Shepherd Park Lot 8 ~' ~ ~~I~ XParcel No: 10.29.19.2555 1.) Alt BM Description = 5-r.CQ1/,~~ ~ v i" ~~~~~c~~~c~rue~~ / ~s ` 2.) Bldg sewer length = Z~~ _ l' ~ ~cvvc I"L~=' cL ~ A,' ~~~~Y ~V~ -amount of cover = ~ /„tl ~V~G~~~~ ~"~`- --~.~ _ _ _ ._. _- _.- -- --- ---....._ I ~ I Plan revision Required? ~JI Yes o /~ Use other side for additional information. I!/ (~ ,6~ ~ __ __ _ __ . _ _ _ ' SBD-6710 (R.3/97) Date Insepctor's Signat re ~~-~~ Cert. No. ra' -~•~ Vent to Air Intake d 5 / //l / / ! i~ ~\. k Safety and BlllldtngS tvtston County ve., P.O. Box 7162 ,$' .. d ^ ~0~~~~ Madison, WI 53707 - 7162 Sanitary Permit Number (bo be filled in by CoJ ~ (~) 266-3151 3 3Z Department of Commerce _ ' . Sanitary Pei-mrt Application State Plan I.D. Number perstxral infort~tion you provide Cade Adm m 83 21 Wis ith C I d , . , . . w om n accor may be used for secondary purposes Privacy Law, s15.04(lxm) Project drecs (if different than mailing address) l9' ~SSS ~~_. ~~ , . I. Application Information -Please Print All Information _ __ ~. _- .._. s Property Owtter's Na me Parcel ~ Lot ~ Block ~ . Property Owner's M ailing Address Property Location M G~ ~ 6 ~ .vim ~. s~ 1t,Sec6on ~ City, Stat e __v._ Ode Z ip C `~oiie'liTurri~r"`~_~" - /! f u ~ / ~ - U ~ T ~~N T .Z 9 N. R ~~(cE le _ ck all that a ildi ( h f $ II T ) I n ng c e ype o . Y PP 3 Subdivision Name CSM Number i~r 2 Family Dwelling -Number of Bedrooms . ^ PubliGCommercial -Describe Use ~.~ /1t/t ..---- ^ State Owtted -Describe Use -- - ~ - - ^Ciry ^Village ®1 ownship ofhl(~L~ III. Type of Permit: (Check only one box on line A. Complete line $ if applicable) A' New System ^ ReplacemeM System ^ TreatmendHolding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal it Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number artd Date Issued Before Expiration Plumber Owner 1 d IV. Ty of POWTS S (Check all that a I ) i~Non -Pressurized In-Ground ^ Mouttd > 24 in. of suitable soil ^ Mourd < ?st in. of stitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treaitnem Uttit ^ R~ircutating Sant! Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chaasher ^ D ' ^ Gravel.-less Pipe ^ Other (explain V. Dis reatment Area Information: ,E /3/• z' S' 1B.~J~ Design Flow (gpd) Design Soit Application Rate(gpdsfj Dispersal Retptired {st) Dispersal Area Proposed (sf) System Elevation v G ~'3 • ~ VI. Tank Info Capacity in Gallons Total Gallons Number of Units Manufac er ~~'-~ Prefab Concrete Site Constructed Steel Fiber Glass Plastic Tatilts Tanlrs '~~d ~ Septic or~HeldingTank ... ~~. Aerobic TreattrterN Uttit Dosing Clamber Gs/ s.~ = VII. Responsibility Statement- I, We'irndersigried, assume " 1Tity for installation of the POWYS shown on the attached plans. Plum4er's Na the (Print) PI tier's Si gtrature -IofE'YMPRS Number Business Phone Number Fogerty Plumbing ~ ~~ ~ T~~ - .~s - 960 Phmtbr~r~e~ t~~tate, 2tp ode) 7/S-~3.5 = S ~2 d=6 F/AX Spooner, WI 5480]. 6si- vt- a 6 VIII. Co se Unl 70 - 7 L Approved ^ D~sa rov ,~~' Surt:har ~ t F~ (includes Groundwater Date Issued IssaittEtt agent Sigtature o Stamps) e / ,F~ r-- ~ g ^ Owtw - en R n for Denial ~(/`~ ..J try- Z 3 ~ Z6~ IX. Conditions of ApprovaUReasons or Disapproval ~q _ SYSTEM OWNER: U 1 Septic tank, effluent Niter and - C~~~~ ~-~~-tl~'' B'`^ a~ ac ) dispersal cell must all ~e serylced / ms~intained 1~Q ~~-~} ~¢ '~ as per management plan provided by plumber. ~~ ~~ 2. All setback requirements must be maintained i . as per applicable code/grdinances ,.,~ 03 Attach complete plans (to the Comty only) for the system eper-rtott es m - -~ ~ ~~HvR- 1~/- / ~ DoT '~~ sca~E / " 3a " Fogerty Plumbing #221180 28288 McKenzie Rd. ~ ~~ < ~~ ~ ~~ ®F ~,~~,~ ~~ Spooner, WI 54801 Sze ~ ~~ o , (715) 635-9609 ~~ yi 4.a~ i. _ .SGT- /~a> , gerrvw, o•° seatv~, 99.76 VV = ,~-,~GFS rrit/~ cum!-L ~/,~~~/sue ~.-~) S clf~Eiw .ELa~I~ : 9/. L / c~Y.C / 3/. 2S ~ L~.d6 l ~ ~ ~ - ~. ~~~~ ~ ~ `~ s, r x ~' ~ ~ V k~ / G-~~~-- 3 /Soie~. ' d ~ / /~foleE /~~ , i d#2 L /~ ~ ~ ~ ~ ~ 'yp ~ ' / ~ ~ ~~ ~~ _ - pLv CYCv L/fN~- ~ lr poi ~~ -r-.~~ N,rI' f6oT''~~ t~~E / ' 3v ~ Fogerty Plumbing /~ ,4 ~/ s /~ s 4 .a~ ~. - x= • = W = s s ysrFiM ~6r. yS~ .t'GL. /Ap~O __ ~ , .r~LT- ~3a~ , ,y~ rrnsrr o~ seat~~ , 99. ~~ /~,c~J frDU~vv G vT' c~~~ as/ ,co/~ ,c~~s rs~/G- w~bd ~jsia~l~' ~~~ ,Er.~d = 9/. z / c~6C / .~/. sS ~ ~Cev6 /~~ L /~ g- 3 W ~ ~~r ~~~~ ~. _ r .~ .... ~ ~ ~--.,r L ~~ #221180 28288 McKenzie Rd. Spooner, WI 54801 (715) 635-9609 ~l ~j{,r/Bil~ ,~iff~ ~~~`~o~ t `~ wsconsinDepartrnentotCommerce SOIL EVALUATION REPORT ~ Page_,~of~ - Division of Satety and Buildings ' in accordance with Cantu 85, Vlfis. Adm. Code County - Atlach complete site plan on paper not less ttrarr 8 112 x 11 )ncfres ;n side. Plan must include, but not limited to: vertical and tarizantat reference pant (BM), direction and Parcel I.D. c~ percent slope, scale or d~mensKms. norm arrow. arm location and distance to nearest road. 0.20 '- / Yo 7'" 8 Please print all information. by ~ ~ ~~ ,.,,', ' Date Personal irrtom~ation you may be -Lary a 15.04 (~) (mU. -/~,~/`g~ J'~- ~~2 3l0 Property Owner ~:, .._a ~.~ Property Location . . ~0 % `~ Govt Lot ~/€ 1 ~ 1/4 "S /~ T~j Q . ~ N R ~ E (o~ Property Owners Maibr~rg,A~/~dress - ., _ ~ Lot # t~lodc li Subd. Name or CSIWiF ~ts6 . z ~ ~ ? = City shale zip Code ~ Phone; ^ City O Verge Nearest Road ~j'New Constnx~ian Use: Q'Resi~ntiat / ehxnber ~ bedrooms ~_ Code derived design now rate ~''~'~7 GPO ^ Replacement ^ Pub6c a carrar~ai - Desrnbe: _ Parent material fJ~ Flood PIS elevation if app6Cdble T~~ ft. motions: sG~~ `~"~.~ ,ti~~ EL.CI~: A/r ~..~a, ..; L~ - - ~ ~ p-t Ground surface elew. ~ R Depth m artMnn9 ~ i®-v r~• Horizon Depth Dominant Color Resdox Descxiptiar Texhre Siruwue Consistence Baurdary Roots ~. Munseq Du. Sz. Cont. Color Gr. Sz Sh. - Sal Application Rate GPD/R2 •Effli'f •Efl#2 Or3_Z 2 Z -2Y i 3 '~ c / o 3 ~'- .s - s s0 _ - - -~ - ~L ~" 7 . f ~ 1 ~...~... ~ 0 -- ` i [~ Pit G~ stutace elev_ Tb. o tt Depm ro wraon9 mc~r ~ o~ °` ~ App~tion Rate GPD/fN Horizon Depth in. Dorrt~rt Color Munseli Redox Description Qu. Sz. Cont Color Texture Strut~ure Gr. Sz. Sh. Consistence Baraldary Roots ~~ ~~ 1 -- 3 D -3 L --- S ~ O L' -2 ...- Z c S/~ G S /~ - 3 27-39 .~ , F s ~ - . s y 9- 9 - 3 ~-- m ~ ---- S~ .~- mSG --- _- ' EfMrerrt tY1 = 800, > 30 < 220 mgll. acrd rS~ >30 < jau mgrr_ ~«~••• ,•~ - """s........+,- -•- - -- - -- -- ° - ~T ~~ - - CST Nurnfrer • ~ ~^ .2 ~ d Hate Evahratiar Telepf>one Number Address Fogerty Plumbing & Perk T sting ~ /J o /S- 3S-Z~9 28288 McKenzie Rd_ ~""~ j~ ~Q~'T Parcel ID # ~?~~---~~ Page ~ of -~ Property Owner ~- Boring # Q Boring ~~ ;~~ ~-/~ Ground surface elev- _~-,~_-~'~ ft• Depth to 1"smiting factor l03 in. mil icatwn Rate Pit Horizon Depth Dominant Color Redox Oescription Texture St-udure Consistence Boundary Roots GPD/fF Gr. Sz. Sh. 'Eff#1 `Eff#2 in. Mansell Qu. Sz. Copt Color ~-- ,~ c s 2 2 r' L ~, z s - ~ '^ L 3 ~ . ~ - ~-- ~ S,r3 w - , s y - ~~- 3 - ~ ~ _ ' ~ q(. D Boring # pit Ground surface elev ft. r Horizon Depth in. Dominant Color Mansell Redox Description Qu. Sz_ Cont. Color Te; Boring ^ Bonng # t-3( Ground surface elev. _ ft. YJ Pit Depth to tinting fade . +n• :lure Structure Consistence Bounds Oepth to limiting factor ~• e Structure Consistence Bounds Horizon Depth in. Dominant Color Mansell Redox Description Qu. Sz. Cont. Color Texfw Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mglL • Effluent #2 =. BOOS < 30 mg/L 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 60886=3191 or'TTh' 608-264-8777. SDD•833(I (R.rJ00) . , Lo-T `~ ~ sc~ ~ ° = 30 ~ s.FGt fRO-•p t = ~,~~~ ~ Fv~ap ~ oT c oNVV•E ~ w~ /zoD ~y w,~c t ~ T,it1~"Tff tt~0 a-3 ~-- x,30 ' > s' z~ t-z ~-. L//, ~l ~ ~ W 8-I X "- ~(NCt ~'~ L:~~~ --- QG ~ l®uJ L/fN~ - N~ Fogerty Plumbing #221180 28288 McKenzie Rd. Spooner, WI 54802 (715) 635-9~ ~1i~ ~/./off ,~~v: ~ 3 9, f: P6 kirf[~aT ~R ~ , `o fogerty Plumbing #221180 28288 McKenzie Rd. Spooner, Wl 54801 (715? 635-96.09 ~ • Ldl ~~ f~trr®~/ Q~T j Cross Section of an Inground Component Cell Using Leaching Chambers -- Finished Grade = .v ` r Slope % _ ~ / 7 - - ~~_:> / ,~ Original Grade = ~,~~ %~ Top of Shell = 2 •L ~ System Elev. _ . Z^ ~ -- ,~ ~' '° „ ~a Observation/Vent Pipes -~_~Finished Grade = ~~-y ,~-----_,~ f `` ;, Original Grade = 9~`':~ ,. Treatment and Dispersal Zone ~- .__ Limiting Factor Observation/Ventpfpes to be constructed and capped •with approved materials for the particular use. Fogerty Piunlbin~ ' #221180 j 28288 McKenzie Rd. ~ Spooner, WI 54801 (715) 635-9609 'i~C.I. yEUT PIPC ~• ZS• rR0!'1 DOOR 1~ WiNDOW OR FRESIi AIR INTAKE 18~ M I Ai. I•Ar.F c~ --~ PUrf,P CHAMBER CRO55 SEC ~ IoIJ AAIG SPEGFICATIO~!S INLET *~ A 4 c ELEV. FT.. f D ~-VEAIT CAP _ - WEATHERPROOF JUWCTIOAI BOX It"MIU. 1 GRADE i COIJDUIT ~-'- gPFROVEO LOCKIAIG MAUIHOIE COVET •i" MIW. j ID' /~CIU. v ~~ ~\~~ PROVIDE I AIRTIGHT SEAL ~ *APPROVED JOINTS MITN.~ APPROVED PIPE 3' ONTO SOLID SOIL i 1 PUMP -1 C Ou1C RETE DIOCK i~ • ~') • (i (,~ ALARM ~ - • • D oa.. - - - _ ~ OFF • ~ RISER EXIT PERMITTED 01JLy IF TAUK MAIJUFACTURER HAS SUGH APPROVAL SEPTIC E SPECIFI•GATIOILIS '~G~ DOSE ~ - TANKS MAIJUFACTURER~/: ~-,,L~/,+FsS,~'R IJUM9ER OF DOSES: ~-' PER DAJ . TAA1K SIZE : ~ GALLOAIS 0056 VOLUME ZZ ~ ¢~~~~~ -' - IAICLUDIAIG OACKfLOW: GA~i ALARM MAAlUFACTURER: ,C' ~ ~~~r~°-- MODCL IJUM9ER: /m ~ -D/ ff CAPACiT1ES~ A- •~ INCNCS OR Z S's3rt,AL1 SWITCH TyPC: ~Zl~.~000t,Cv1 a= ~ INCHES OR Z~ GALi PUMP MAWUFACTURER: G-o(iG,t~ C=~IIJCHES OR Z •~/GALI MODEL AIUMDER: ~~ p~ D ~ ~ INCHES OR ~ GAL • SWITCH TYPE: /J6(,es,IC,C~iR~ lUOTE: PUMP A1Ja ALARM ARf TO DL M1iJIMUMI O15CHAR6E RATE~G-t''~ INSTALLED OIJ EPI~RATE CIRtU1T5 P MP OFF AWO DISTRIDUTIOU PIPE.. ~ FEET ~ ~ s7 N VERTICAL DIFFEREIJCE DETWCfU U ~-- + MIIUIMUM RIETWORK SUPPLY PRESSUitE .. .. ..... ~- FEET /0•S~ 1 K ~~ • 11~FEET OF FORCE r-AIW X F/oO/LFRiCTIOAJ FACTOR..~s.[~/FEET~• ~• ~•L`~'~- : TOTAL Dy1JAMIC HEAD = ~~-•L FEET t~ IIiT~R\1~1 111M~1It1A\It AF T\-li(• 1 ~\If TN ~/s •IJIf1T4t ~~ .'1 IAIIID f'1fPTH ._ 3~ Discharge size 1Y.' NPT Y-~' ° '~~_ Solids: ~a maximum "- Motor -. Single, phase:.115V r Materials of Construction Brasslthermopl~stic Features and Benefits • Top suction eliminates impeller clogging. • Corrosion resistant construction. • Float actuated switch. METERS FEET 7 ~ MODQ. DVP03 p 0 20 = 5 ca 15 €. Z o s to 2 s uo s to is 20 zs ao 3s eo u.s.6Pr o z a s e mph cAPACmr 1 . 3 ~ a IIIETERS FEET - 10 9 8 0 6 5 Y 4 0 a ' 3 0 us 0.. 2 4 6 B /0 12 m1Ar CAPACITY Pump Specifications Features and Benefits - '/>, and'/: HP • EP04 impeller- semi-open design Up to 60 GPM with pump out vanes to protect Maximum head to 32' mechanical seal. - Discharge size 1'/:'NPT • EP05 impeller -enclosed design Solids:'b" maximum for improved pertormance. Motor • Rugged glass-filled thermoplastic All motors feature ball casing and base design provides bearing construction. superior strength and corrosion Single phase:115V resistance. Materials of Construction 'Cast iron motor housing for Cast iron efficient heat transfer, strength, Thermoplastic and durability. Stainless steel • Corrosion resistant threaded stainless steel shaft. • Available for automatic and manual operation. • CSA fisted models available. 30 MODEL: 3871 zo is EPOS m 5 ~ , o ~ ~ , ~ s o 9~ All Models are designed for continuous operation and feature stainless steel hardware. Safzyr and Bniidio~ Division (~- Z0! W. Washit~oaa Are., P.O. lllauc 71G2 ~~~~~ Vf/i 53?~07 - n~ Saai~y ' 1~6a~ (ta be filed io by Co.) De artment of Commerce ~~ ~r'3~1 3 ~ 3~'~ Sanitary Permit Application s~ ~°'~. ~, ~ teed for y l~n~ Pri,-ag- ~,. .fMell(mmI ~~~.~ P~ojxt ndata~ aifFereat than - >~, L AgpOn Infort~tion -Please Prior Afl 1<n6ormarti'ion °~ _.: t~ ~ ° ~ g k .~ ~~ /~~ A I E Pa+opeaty~Owoer'a Name 3 ., . .-s ~ b~ ~ 2 ~. . 0C3 ~ -_„__ orvnx's Address ; . 1 Praperry Laeaoon a ~~' ~~, S~ ~~ d S m R~E~ ~ 9 T o1 ; II. Type of ( >~ appij) ~ e i ~ 2 r~- n~ - rr~ber 3 e~M o Pablic/Commercial- ~ O stare ooraod -Desixa'be use L-;Z..l~ w ld -- ~- - _ - ~~~~ m. Type of Pess~ ( ~ ~ are >~ ~ A. a >~ s if a A. ®''Flear System Repiaoemmt System ^ Tretimeat/13oldiag Taat Replaoaoest ^ Odr;r Madifieation ro System B. ^ Permit ltetawal 13efore Expiration ^ Perarai[ Revision (~ta~e of ^ Perm to Nerr Owner Lis[ Previas Permit Numbar and Dane leaned IV. of POVPIS (Chad[ all. fhat f . ~. ~" ~Nao -Prmsuriaed IrrGround ^ Mauod > 24 0. of stile ^ Mamd ®. of anid6k sod ^ AK;tade ^ ^ Caastruaed Wetland ^ Presatar®ed ln-Groamd ^ Hoidmd ^ ^ Aanbie 1}atmt~t tl~ Sand Rleer ^ Rociraalatiaag Sydhaic Modia Filter Leaching ( ^ C~avd-Mss 15pe der V. ~ Ares Inf n 1 Desgn Flow (gpd) >~ Sad - Dapasal Di~rsal ( System ~°°~ ~ ~ ©~~ G,~', a hs3 VI. ark Info ' in Total IJuatber St~ Plastic Galtorm Galhs - of Units Tk+r 'CaeYs Tads a'~ ' ,~.. VII. R StatemasN b t6e'aapaed, fbr of the sbnwa sa tLe affaehed plsn9. Pluaolar's Na me (Print) S Si ~/MPRS i!ImnDer Ifa4faaess P6ooe ~ ZZIt d ?t~ - ~9 Plumber's Add ~A (sty, Setae, 28288 McKenzIe Rcf. .. r ^Z ~ VIII. ,a,~o„~ o ' Saoituy Panrit Fee arr~de G mamriwaler s Dared ^ owner Giren far David ~ -- 7 ~' ~02 ~2 v ~' 9 ~ a ~Yao°°w ~ ~° ~ nis~p~a~ 3 ~~ ~~o;.r~~~ n 1 Septic tank, effluent filter and l~-d PlJli(1?`S ~~~. di l spersa cell must all be serviced /maintained wC~,~~- ~-6-~.~dl-- s~ Pi~ ~~ ~1~~ as per management plan rovided b l b p y p um er. / 2. All setback requirements must be maintained -~o tae. ~ ~yw~- as per applicable code/ordinances. M~ ee~ i~ w me uoaany r41 asr aaae s~ r paler aaew<aess uaa sus x u aacors as sne F ~ + R ~~ /cD _ .._. I ~ , Fogerty Pf bieK #221 $0 I 28288 Mc enzie Rd. Spooner, 15480 ~ r (715) 35-9 ~'° II ~,GW~r/ ~;ihT / ` ,~~~~ 3 f 3 Br-X p^ ~rr,~ det ~p ~s~ /d ~ ~, ~~ e~ ~y rnE~ o ~a~' 2„Q '° ,SGT. ,8A"~~ ~ ~ << ~ S ~ z QQ'~x'.d~ . = t~iodl~ tor' ~e~~ w~R49 «"1[S; e _ ~ ~ 6 ~ 7S ~ X3.8 ~ ~'. '~ 3 ww~x• S ~, • .~ • /l C - ~. = 6.z.5 ~. yam, y ~ ,wrd- /~ ~ C" Q-a Ps 3 ~ .max , ~ Cj ~ ~ ~_d ~ 6-~~ lER ~, ~' I ,x ~~ i 8-3 1~ 1 t~ 1 r ~~ « ca rn O rn a Q+ n a. 0 a 0 ~+ cu ~+. CA CD 0 0 ~ ~ • ~ ^ l 1 t IA~ _~--~ I~ C (~ ~ ~ ~) I~ ~ ~~ ~ ~ • ~ .a` ~ •' ; ~, .- .~ .... - ~• •.:o•- - 4. ~ ' .r.~.. ` . :~,°~~~ ~i ,4 ~7~.~y{. 1 ~Y• • F+ ~, •. ~ _... ` - !P \~ ~ 1 Jr • • ~ -~._ ~~ a i ~a. ~• °~ -. • .-, • . :~ - a . •:r ~~ - -' . _.. , ' •a-•~'• 1 ~ ~~ i r ~ ~~„ ~, ~. ~ {~~_, .. o 'p~` ~ II ~, o0 0 ~ ~ a CD ~~' Q ~ '' ~ 3 o 1 , ~ , "` •,+,~ ~~ a or p. c~ ~`~ a , ; ' 1 ` ~ ~ ~ ~~ ~. c~ Q+ Q+ (D V p CD O ^~ r ~• ^~^,, t'~'~ t"' y n ~~ ~ r~-+ ~~ V O N O ~ ~ ~ ~ ~ # ~ N ~~ ~N`G W~~~-'~ ~-~ ~C OpAOfD o°~ t4 ~ C ~ .. , ,.-• . ~~ Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT Page ~ of,~ in accordance with r`nmm R5 VVic nrtm r.,rln Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County c f JT include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I D percent slope, scale or dimensions, north arrow, and location and distance to nearest road. . . p2O _ ( p~. _p g- C~17 (. Z$~S Please print all information. Reviewed by Date • Personal information you provide may lie used for Law, s. 15.04 (1) (m)). ~- ` I I ~ 3 Property Owner Pro erty Location -~ Go t. Lot 1/4 1/4 S T N R E (or) W Property Owner's Mailing Address 2 2 20Q2 Lo # Block # Subd. Name or CSM# ~ City State Zip Code hon NTY NING OFFI City ^ village o^c. own N ea re st Road ~ " ~ ~ [dj-New Construction Use: ~ Residential / Number of bedrooms 3'y Code derived design flow rate y5U- ~obCj GPD ^ Replacement ^ Public or commercial -Describe: Parent material ~V I I.L~CtiS~f'~ Flood Plain elevation if applipble /~.) ft, General comments sYs~~~- -2/~U~ ~~ c~~$d ~wer yyDd and recommendations: J~~- -e~Q~~ ~P J3 so Ga~,~,- Yz. ~~ ^ Boring a Boring # © Pit Ground surtace elev. . ~ d ft. Depth to limiting factor (~ i..p in. Soil 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 •Effif2 ~ o'~ (p Z ~ 5i ~ m GS )v~ . 5 8 Z ~-~ c' `~- I ( 2 GS 3. 2~ `' qy. ~' ~D °! ^ Boring ^ Boring # ® pi( Grou nd surface elev. 9~,~s-d ft. Depth to limiting factor ~ ~ 2- in. Soil Appliption 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 'Eff#2 ~ o-lo ( ,r 2 - S r' 1 ZmoLbk r tS ~~~-~ . S . 8' Z ~~- ( ~ S.I 2 m ~r c - - 8 `~s-l,z ~p y.~~, -- S 1 -- - ~ 1.Z ~-9Y•v/ 3. :- r. z S~ ~o _..._........ - .,....5 _ _ „ ...y, ~ o,.,, , „„ •.+v _~ . vv niyi~ uuuen- r-c = tSVUS ~ SU mg/L ana I SS _< 3U mg/L CST Name (Please Print) ~gnature ~.- / CST Number . ~/' ~ _ --, ~ ~- --.~- Z~ 3309 Address Date Evaluation Conducted Telephone Number ~ I ~SU~= . - ~b e-~ r ~5 oZ /- /s oZ ~7i5) 24 7- yUV 8~ SRn-R~'tn rRn-rmn~ . ~, -~._~~: .. ,~ Property Owner Parcel ID # ~'~ o..~.,.. ~ ~ Boring ~ A Page ~ of { 1'3, ...7 . -Pit Ground surface elev. ~ - ep o ~ ~ Soil Appliption Rate tion Descri d R Texture Structure Consistence Boundary Roots GP D/ftz Horizon Depth in. Dominant Color Munsell p ox e Qu. Sz. Cont Color Gr. Sz. Sh. i 'Eff#1 'Eff#2 ~ $ (~ ._ JI ~ Z ~ Y ~ c.S ~V • 5 2 ~-iy- ~~ `-' S i I oJok r im c `- " .. 3 t ~ l3 ~-- S 5 wn t - 1 . 1- Z 92 .~7~ • S`e•Y~~r'6. U Boring Boring # pit Ground surface elev. ft. Depth to limiting factor in• Soil Appliption Rate scri tion D d R Texture Structure Consistence Boundary Roots GPD/ftz Horizon Depth in. Dominant Color Munsell p e ox e Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 U Boring Boring # Ground surface elev. ft. Depth to limiting factor in. , pit Soil Application Rate tion scri D d R Texture Structure Consistence Boundary Roots GPD/ftz Horizon Depth in. Dominant Color Munsell p e ox e Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BODS < 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. SBD-8330 (8.07100) • ,~t .. PAGE J OF~ NAME ~ ~ TOT# ~ LE AL DESCRIPTION ~ ~ ~ .S~ ,S ~~ T Z `~ ,N,R, ~Y E(or)~y SCALE: 1"= %~ / BM 1 ELEVATION /C~O° a BM 1 DESCRIPTIONT ~ ~~ ~ , (I-~~e / ~o c~ BM 2 ELEVATION ~~ S~ '' le BM 2 DESCRIPTION ~ p ~ !~ 5~"~ e~ ~~ SYSTEM ELEVATION -~~' ~ W ~ ~'~ Law ~r 9 y a v ALTERNATE ELEVATION ~ ~ q ~, SZ~ 1.aw ter' ~Z ~ ~ ~ CONTOUR ELEVATION ~~ ~ Q~> GU N ~pC~ d i fi' ~i 1 i x e aE Il-~¢ w4"4 sue- r ~ (~~'`^}'~ (~~ SIGNATURE ~~` ~2 c ~ 6o a~ ~q. 2 ~~ B C ~, ,9 DATE ~-~ ~ . Q ~ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~~iK,~/D~/ /.~A~S i Mailing Address Property Address (Verification required Planning Department for new City/State ~C/OsorJ w~ parcel Identification Number D20 -/Sro7-Od'.-A~~ LEGAL DESCRIPTION •~SSr Property Location t,~/,~' '/., ,~~ y,, Ste, tl~ . T ,~q N-R~Vi~, Town of _ k,a~,t~ . Subdivision ~~~ ~ ,,~~~~ -- - Lot # -T"` ~_. Certified Survey Map # Volume ~ ,Page # '1 Warranty Deed # 3'7 2 ~/ Volume /7Z.S ,Page # Spec house ^ yes fi~'no Lot lines identifiable Cayes ^ no SYSTEM MAINTENANCE 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 waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeyman plumber,resrricted plumber or a licensedpumper verifying that (1) the on-site wastewaterdisposal 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 Zoning Office within 30 days f `the three year expiration date. SIGNATURE OF ICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. `" ~ /j /03 SIGNATURE OF AP ICANT DATE- ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ,~ ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed M ~ M ~ ,. I~~v~~ / ~ ~ ~ .'~ ~ / ,~~d} / j ~,". ~ .%~ ~ ~ O , ~ ; ' ~ ~' ~i ~~• ~ .% i'' ,• ,- ~v- ~1~ ~~~ . LOT J 2.OZ ACgE$ _ X03 LOT 4 ~~ ~rR~$ ~s~ so. Fr, `~ ~ ~ 1` • `ELEV. +; 92t.5Q ~ '~ .~ , ` ;' ~ ` 1 ~1 ~ 1 ®~ ~ i h -~ i ~a~ 1 ~ ~, ~ ~ , fir i i f/ i ~d • '1 F.F.E ~91Q0 - LOT 10 l.07' /YCA88 7 i~,~ So. FT. _I ~~ i ,N '~I i ~ ,` ` • •`a r ~:~ ~'~ ~ 1 \~'•1 ~~ \ t~ RAaUS PUINTQF ~ pJRVE i - -.~ ~ ~ i~ E ~s r+~ 3 h M R a a ~y 0 ~ ~. ~ ~ in 3 ~ N ~ o~ °o- Z ~' , ~S • ~ o OF IS 7+~ 61St r -._.._.._.- ...._... a ~ ~ .. .................... ~ ~E7 LOT s ~' ~" +ea~,8s,~ so, Fr, .~~ LOT e ~~ ~.e74 SQ, tR. 8S •~-~,~aes.ea~ '~ a ~~ aoooe~ yeses ~:rr ~~ - ~~ ~~ 2.81 ~ T F 61St E+aoow~ sECnoN ~o ----x------_- .d_ 04' ~ 4' 0 A POWTS OWNER'S' MANi.IAL & MANAGEMENT PLAN Page f of Z FILE INFORMATION Owner ~ ~ 6 Permit # L12/, ~ ~~ DESIQN PARAMETERS Number of Bedrooms 3 ^ NA Number of Public Facility Units ~ NA Estimated flow (average) ~jpo al/day Design flow (peak), (Estimated x 1.51 al/da Soil Application Rate Q . ~ al/day/ft2 Standard Influent/Effluent Quality Monthly average* a s, i rease 530 mg/L Biochemical Oxygen Demand (BODE) 5220 mg/L ^ NA Total Suspended Solids (TSS) <_150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand IBOD51 530 mg/L Total Suspended Solids (TSS) 530 mg/L NA Fecal Coliform (geometric mean) 51 ° u/100 Maximum Effluent Particle Size Ye in dia. ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity f~(~Q al ^ NA Septic Tank Manufacturer ~ ^ NA Effluent Filter Manufacturer ~ ^ NA Effluent Filter Model ~ ^ NA Pump Tank Capacity al NA Pump Tank Manufacturer NA Pump Manufacturer NA Pump Model ~ A Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: NA Dispersal Cell(s) In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA iueia-r~Netir•_F cr_NFn~n t` Service Event Service Frequency Inspect condition of tankls) At least once every: Z ~ ^ earl -(s) (Maximum 3 years) ^ NA Pump out contents of tankls) When combined sludge and scum equals one-third IY3) of tank volume ^ NA Inspect dispersal celllsl At least once every: 2 -- 3 ^ year(s11s1 (Maximum 3 years) ^ NA Clean effluent filter r is ~~ At least once every: ' month(s) yearls- ^ NA Inspect pump, pump controls & alarm At least once every: ~ yea~'S'Is1 A Flush laterals and pressure test At least once every: ~ ^ month(s) ^ yearls) NA Other: At least once every: ^ month(s) ^ yearlsl NA Other: NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tankls- to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent 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 tank equals one-third IY31 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator 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, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page ~`'of ~'~y START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal celllsl. If high concentrations are detected have the contents of the tank(s) removed by a Septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater wit! be discharged to the dispersal ceNls) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or, must be taken, to provide a code compliant replac ant system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. T alua ' g ~~ ~ 1Tio..1- ~~- N/~ L'ONS`T7eU~'1.pr~lank be ' e ai a f~D+~118 ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER 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 RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name ~ ~ ~, (~ ( f Phone ~ ~ ~~ POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name S'r. ~, l ~ Z0~l~(J ' Phone '7/S- .3~(~- (O This document was drafted in compliance with chapter Comm 83.221211b11111d)&If1 and 83.54111, 121 & (31, Wisconsin Administrative Code. r• ~ r STATE BAR OF WISCONSIN FORM 1 - 1998 1 l'~25~6~~ ~- Document Number ~~~ This Deed. made between Weldon E. Richert and Lee Anne Richert husband and wife Grantor, and Kennon J. Hast and ibnalda J. Sneer-Bast GrantoG for a valuable consideration, catvcys to Grantee the following,_ described real estate iu St . Croix County. State of Wisa the "Property"}: 49~~935I- ~- Jplp-'.~7 -t t'arccl Ia~tiPwtion Number (fl\) This ~ 3 ho ~ homestead property. lis} lis uot) See attached Exhibit A Together will atl appuncnant tights. title artd interests. F~3-7S24 !:Ail-iLttN ti. tIRLSN ~= diSiE~Z AF DEEDS $T. Gk+JiX CG. ~ MI +~L'I:1+~.D Ff~t ~.rt)RD 09-86-2001 12:30 PII JA~ANTY DEED f%E!k'i tl ra'i .04'Y FEE: ~vY FEE: i ~ I'EG: 122.00 fiEi~itDlll6 FEE: 13.00 i3s:xS: 2 1~ IL~3 ~ _g} \ams and Rntura Aduiess ~ `acv Edna Reaay Tide . r ~zn~'t.v. 400 S. 21x! St, 0115 Grantor warrants that the title to the Progeny is good, indefeasible a- situple feernd fret and clear of encumbrances except Dated this ~6 diy of ~gg~F.mr,P 2001 (SEAL) (SERI-) Weldon E. Richert ee Anne R her (SEAL) ~SB~-) ACKNOWLEDGEMENT AUTHENTICATION SiKnaturets} autltcrnicatcd this day of TITLE: MEMBER STATE BAR OF WISCONSIN t [f not, ruthorirodby §706.Oti, Wis. Swts.) THIS LNSTRUMENT WAS DRAFTED BY Coldwell Banker Burnet O1-2935') 130 Coulee Road Hudson WI 54016 i Signatures may be authptticatedor acknowledged. Both are not necessary.) State Ot V~i't~csaet~'n. ~~J } ss. \, pa~~ Coaaty. 5~J Personally came before me this ~ day of September .2001 ,the abovcnamcd Weldon E. Richert and Lee Anne Richert. Y,usband and wife me known l0 6e the person S who executod the foregoing iostrurnctn and ackrtow) the carne. Notary Public. State ~~y~,,n, .a. pu6:r .:~o+,eso:~ My conuuission is t~~i`v'!`••'~~~re, e: .) 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