HomeMy WebLinkAbout032-2174-11-000
wsoonsii Depar,ment dt Comr'er"' PRIVATE SEWAGE SYSTEM "'u'ty St. Croix
Safety and 136dd nq Drv s' ur
INSPECTION REPORT Sancta-y Perrrrd No
;ATTACH TO PERF:IIT) 605075
GENERAL INFORMATION Sta!c Plu- Ict v,.
Pe_rSGnaI mbrmat on yo-, arc, .1e be risen rnr seponcary Durpdsc$' P a v m^/ I a, 5', c4 Ii I;m.)
Fenn t 4olders NamE C,ry 'Village Tcwr'shtp Parcel Tax No
Oevering Homes LLC TOWN OF SOMERSET 032-2174-11-000
CS' 310 Llr:. Illsp BM Elev Bit Dcsuipt m SedtOIVTCbti Rarge'Mi No
S• 27.31.19.1466
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER ~.3 CAPACITY STATION BS HI FS FLFV
SeptC 1 if Benchmark
u V~~ dv
Dos rig - J•6i Alt. BM
(-6K1~a (a30 ot.•I u•~ 10O•;ir)
real - Bldg. Sevier
l 10. Lap 9K• D
Holding S-.- Ht Intel r
I I, b0 4L(. ;Ito
TANK SETBACK INFORMATION SVHt Wile!
TANK IU P:I r Vs'FII BLDG 'oen71cArlnla4.e ROAD Dl ln'et
Septic 1 JU 3dl Dt Bot:o•r. l3• I~ I j.
Dosing HoaceOMan. 7 Jci
4.r~ lol.
Aeration Dist. Pipe
4l0 /a•!o
Hold rg Bo:. System
r~ ti4 a lac. ~
PUMP/SIPHON INFORMATION Final Glnde.
30 bbl , Qp
Man.ta::urer Demand St C:;ver
F~[~T GPPA ~ll .50 IOo'70
Motlel N'irnbe•
01r) ~ P 1/10.10
1011 I_i31r,_ Friction l System Head I DI I r: Y O
3
Fdreemal~ Lc-qu, st to 1.1ki
r D a. L r 5,60 49.70
SOIL ABSORPTION SYSTEM
BEDJRENCH e, J'h + I erq.h Nc. OI Trench,-s PIT QIMENSIONS Nr, :;r Pis 1.1. 7 lha Liquid DupP~
DIMENSIONS 7 C)I~-T~/ \ /,I
SETBACK SYSTEPA TO PiL BLDG V-JF1.L LAKE: ~I REAM LEACHING Ma•ufa:;:c'er.
INFORMATION CHAMBER OR
I:pc O".fysre- ( p t 'e UNIT
lDp ^ t ` rv1l Number
DISTRIBUTION SYSTEM 1-6•
1'Irac c-!t.t.:n Irdr, li¢rit,rm- x Hole Sze a Hole Spauiny Vert ie Air Int• e
to :rk~
I er3'h Q_ Uia_;L Lcngl - D a Staining
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
DC'p IP J' I !cpth Cser Depth of vx Seele.gtk iced - xx Mol.--ud -
6edTc .h Center / -er, Trentr Edges
Q Yes Nn Yes Nn.
COMMENTS: ;Irlude code discrepenaes. persons present, etc. Inspection #1 Inspection #2
Location: •.9865lTHST way +'toti S ol V~'
' ) AI: BM Description - t
2.. Bldg levier length =
- amount of cover =
Plan revision ra le Yes No
Use other side e for ad di: onal information
Dafe InSeDetur s Sgrare" CGl NC
ti;W e-10 tR
te r, P. ~f~,~~ - - _s:mty
'I ~ l,-J Safety and Buildings Division
1 $ 201 W. Washington Ave., P O Box 7162 SaniLut occmi:'ameba ;a he fi.kd is by Co.j _
P 1~., ! IJ:adison. \h7 5370?-7162
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ti i. i uril 'Lan
R~ Slme T.'aatai7p lba - _ _
ermrt Applicat
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or rzwt 3 11• a'ts Ant u.,c, an-n . i : l ill.- uetml Unit
i. cgyi: u' pr:m to CAW n a w'tuc? p .cut. N,te .Appb a- m or.. r !vi 'LLc ow,ad vaTS me sut tied Pro ea Address id dllfaeat lion mailing aeNacsr
tlw LYparFneut of Sate'v an! NOIl ,Inn 1 sa,, PasnoJ I g2"D )M pr. vI*- ma• ne used
Irn xtet in ~:::urdanu alrt Ih. Prvml L:w !r11 FwJ S.: ta. ,,llV/./
L Application Information- Please Print All Information
Yr+x:y' N11 $Name Puca
J s ^
'41"Io
R , Pr<gierty'Laea[im "1n, 3 io , )y 6 b
00vt Lot
City, Sale '1 n 7.ja - e Prone Nwubw
Seetim n
Eilding (cha all that appl T N, R W chccallth ppi Subd::^stoo game acial-Ihsribe I!se
U C." of
SWU Oh M - Desaibc else CSM Nurlbc, village of
CrA
DI. Type of Permit (Cheek. only one boa on line A. Complete Inc lB if applicable)
A '.t Systnn I Replm,en nc ':.rtrv ! reltmrn d.np Tank Rcplaraneot ONy ~i C1n:a SlrslifUxinc to -
tnstL
in i:s7 Pres Unut
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F=1:1 Rnrwa' Pram' RfYI mG Permit Number and Date luued~
(i o-u:ge P i.rbu ❑ i'cci: 1'rarsla New'
I Be : Lxp.nnw i~woe %/JJ77 siG J/i
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I -W-1 'ypr of I ON n',ys[eou'f-omponent.Tyrvice (('beck all (fiat apply 1
r ijC-.•:~or.-P~r v v-..-I Ire.-in u_ cd i_ Rc:: n rd L -L'r. ou d i i A:ouud _ 26 m. of suitable soil L) b(oUnd - 23 in. of .n;a c soil -
o cu l-i I 'Irok ! J Vtbcr lu-pca21' ¢ ~cm a I:nrl-
V P,,,,+!!!!•vcannrn[(kv:..c lcxp .uai
` Uis pens Ppd) a rot Aria Iokirmanoo - I rr< r
Ysig F{. w.,aplj i Ccsi~nS/ ippll. ,,n Igod,fl ~Jupcrs Area i.~ul lsf~ Dspusal A:ra l'r s ncC.a Svstcm ElnQ - I~
17Tank Info
isacrt• rl-~Lat a ofiacur~. '
63
NM iWts
- n
SeV:n.:x N 11-a Tani -
A71. Responcibi ity SUtem 1- 4 the undrrsigoed aau . pouvbrhn liar installation of The POW IS ahow-n oa the atnched plans
Iluaba's Nam P;umb -anue N:sit:ess PWnc N• her
1
Y: 's fey (Soak Utz. Slacq .,l C'vAC;
Ill. atv/lle artmcot L sc Only _
App:rna! _ :sa rI'ermrt Fee Pale's N ai
S i<pumg tSigUature
~~~-p~ yts a' ~r,5
LX. Condit s-viapproasoni. (nr Ua~approv al 1 O✓a
1. :6epiM lark e(IC. 1 etn 3/ -
titaper. o, cell awt ell bg: tsl r!- tk
r
ss per lacayemen! plan P' L ocie... by rluinoe.. f~ r M,w1~'IOVI
N "1M* rvqUMAlnll Mwt W rma-.L it.f I
as per appkW9 co& t mCwoaf.
Anack tc cumplne li:aas ear Wesramm aM svbmia m the (.own only ea VaWr aoaeu dua R v: a 11 imhaa m rw - - -
SBU-6398 fR- )1:'I l)
Svsicm PLOT PLAN
PR<)jvrl 'i~w2-ina riomrs ADDRESS 1433 Cernohoas Ave Suite A New Richmond Wi 540' 7
NE I; 4 NE 1 r4s 27 rf 3' N`It ' 9 Ni T0w'N Somerset COONTy ST. CROIX
SYSTEM ELEVATION see inspection report '.6' beiO'•a grade 8!28"$ BEDROOM 3
_ i A'f E
C'ONVENTIONAI. AT'-GRAVE CON'\ ENTIONAL LIFT XXX HOLDING TANK
1,000 gallons LIF'1 'IANK SI'ZE630 DOSE TANK SIZE
i\t (Il!NU SEPTIC TANK St%E
HOLDING 'L'ANK SIZE LOAD RATE .4 ,-,B ORPTION AREA 112:3 # of F.Z F'lows22.5
BENCHMARK N.R.P. 10p of SE 1-01 Come- ASSUME ELEVATION 100' Filter LlTefinlc FIhC:r
benc`lma!'F;
❑ BOREHOLL (D \SEI.I. s 11. R. P. same as
Fro
Bec oom
Ilousc
57th St.
Hut fcutt Combo Tani:
System installed along the contour
B-2
t`.%r Slope
Vents
90'
B-I
,S.
i3-: s • 5
3' X 55' cells with >3' spacing.
1-3' X 00' cell
Proper Line
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 5/23/18
Owner: Oevering Homes
Location: NE 1/4 NE 1/4 S 27 T31 N,R19W 1986 57th St. Somerset
System type: In-ground absorbtion system(conventional)
Manuals Used: In-ground absorbtion system (version 2.0)
Pressure Distribution Manual (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4-6. Maintanance and Contingency Plan
7. Filter Specifications Sheet
8. Dose Tank Cii``,os Section
9. Pump Curvel► 1
Signature4/
License nurrib~r 4226900
lay]XNS u+l""4711'~c;ryl+i NVId 1f)03NV1S JS'i0il
j0018 NMVH N{AIN %1 IOl
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System PLOT PLAN
PROJECT Oeverine Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017
NE 114 NE 1/4s 27 /T 31 N/R 19 1A' TOWN Somerset COUNTY ST. CROIX
SYSTEM ELEVATION 100.0.199.7,199.4 1.6' below grade 5123/18 3
DA•rE BEDROOM
CONVENTIONAL A'I'-GRADE. CONVENTIONAL LIFT XXX IIOLDING 'L'ANK
MOUND SEI''1'IC TANK SIZE 1000 (gallons LIFT LANK SIZ6:630 HOSE 'T'ANK SIZE
HOLDING TANK SIZE LOAD RATE .4 ABSORPTION AREA 1125 # of EZ Elows22.5
BENCHMARK V.R.r. Top of SE Lot corner ASSUME ELEVA'11ON 11111' Filter i.ifelime Filter
❑ BOREHOLE 0 WELL -11. R. v. same as benchmark
Pro 3
Bedroom
House
II uftcutt Combo Tank
1% Slope 101.5' 57th St.
40'~
101'
13-2
60' B-1
10,
78'
Vents
B-3 75'
to be >5'
-3' X 75' cells with >3' spacing
537' Property Line
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _of_
=1LE INFORMATION SYSTEM SPECIFICATIONS
. Owner
Permit# Septic'IankCapacity CNA
Septic Tank Manufacturer
.DESIGN PARAMETERS ---5. • O NA
Effluent Finer Manufacturer O NA
Number of Bedrooms - _ ' NA Effluent Filter Model ❑ NA
Number of Public Facility Units ~ "-Zi A Pump Tank Capacity -
G NA
Estimated flow (average) - al
(~aVda Pump Tank Manufacturer ~ ❑ NA
i Design flow - - . _ f_-
(peak), (Estimated x 1 5) J J awa Pump Manufacturer
~s- - y- A fir 10 NA
Soil Application Rate <
- -9aVda~ Pump Model ❑ NA
Standard Influent/Effluent Quality Monthly average- Pretreatment Unit
Fats, Oil & Grease (FOG) s3C m L / - A
9/ ❑ Sand/Grave: Filter O Peat Filter
Biochemical Oxygen Demand (BOOS) <_220 mg/L ❑ NA O Mechanical Aeration C Wetland
_ Total Suspended Solids (TSS) -150 mg/I. 0 Disinfection ❑ Other
!Pretreated Effluent Quality Monthly average Dispersal Cell(s)
Biochemical O ❑ NA
xygen Demand (BODs) X30 mg/L Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) _:30 mg/L ❑ At-Grade CJ Mound
Fecal Coliform (geometric mean) <_10" cfu/100m1 / L'i Drip-Line 171 Other:
Maximum Effluent Particie Size in dia. ❑ A Other -
~Other - - C NA
A Other.------- -
_ JNA
'Values typical for domestic wastewater and septic tank effluent Other - -
C NA
MAINTENANCE SCHEDULE
Y Service Event
Service Frequency
Ilnspect condition of tacks month(s)
At least once every: S ears (Maximtmr 3 years) ❑ NA
Pump out contents of tanks--o -
- O When combined sludge and scum equals one-third i of tank volume ❑ NA
Inspect dispersal coli At least once
_every_' -J month(s) -
`year( s) (Maximum 3 years) ❑ NA
Clean effluent filter At least once every: l ❑ month(s)
inspect pump, pump controls & alarm At least once every: ❑ month(s) - -
'lush laterals and - - - ~_1'ear(s) - - O NA
pressure test At least once every: ❑ month(s)
7tn: - ❑ year(s) ❑ NA
er At least once every: Q month(s) - " -
~xher - - - year(s) n NA
0 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: POVtTS Maintainer, Septage Servicing Operator. 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 to check for any back uo or pending of effluent on the ground surface. The dispersal cell(s) shall be
visually inspected to cheek the effluent levels in the observation pipes and to checA for arry pending 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
-egulailory authority.
✓Vhen the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents of
he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113. Wisconsin
Administrative Code.
Ikil other services. including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units,
and any servicing at intervals of <12 months, shall be performed by a certified POWTS Maintainer.
lk service report shall be provided to the local regulatory authcrity within 10 days of completion of any service event.
Page _ of
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 cell(s). 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 will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discerge 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 POWT$:
antibiotics; baby wipes: cigarette bulls; condoms: cotton swabs; degreasers; dental floss; diapers; disinfectants: fat; foundation drain
(sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; neat scraps: medications; oil; painting produc4s;
pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails andfor is permanently taken out of service the following steps shall be taken to Insure that the system is propelty
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 property 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 fined with soil,
gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replaLCr;nterrt system:
-.1 -A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systelm.
The replacement area should be protected from disturbance and compaction and should not be irrfninged upon by requtled
setbacks from existing and proposed structure, la lines and wells. Failure to protect the replacement area will result in the rieled
for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rulet 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.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a Sal 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.
❑ Mound and at-grade soil absorption systems may be reconstructed in plots following removal of the biomat at the infiltrathe
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 POWTS MAINTAINER
Name
Name
Phone Phone
SEPTAGE SERVICING OPERATOR P MPER LOCAL REGULATORY AUTHORITY
n
Lc~-
Phone Phone ~ i. l f, c ~L y
This document was droned in compliance with chapter SPS 383.22(2Kb)(j)(d)&(t) and 38354(11, (2) & (3), Wisconsin Administrative Code.
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Septic-Dose `Wank Cross Section And Pump Performance Specifications
- - C ~ YumpManufacturer
Tank Manufacturer
I ank Model Number 0 UQ Pump Model Number cl<_
Total Tank C.a.pacity
Ma-x_. Bury Depth Alarm Manufacturer %-G
I Alarm Model Number
Switch'Typu
- _
j f ilter Manuftieturer Total Dynamic Head (TDH) -Feet
Filter Model Number
- - -_-J Elevation Head
Distal P_ressure__
Network Loss
-
Minimttm F'ump )?erformaaex Required I Force Main Foss S
(4;',4 T.-) 7. FtTDH~ Total L7, s
Outlet iVManhole Min. 4" Above Grade With
Locking Device. Inlet Manhole Manhole Min. 4" Above Grade
< ti" Below Grade Sealed Watertight I Securely Mounted _ With Locking Lkvice `
- ~ Weather-proof /\l
Junction Box
- - Finished Grade - - - - - _
t- -
Vent Min. 12" Disconnect
Alx)ve Grade Means
With Vent Cap
Outlet Filter
Inlet L► Wet Baffle
Switch Settjngs and Reserve Capaci y A
-__Tank Volume GPI Weep
Dimension Inches Volume Gal. B Hole
(reserve) AS
t~!r')1 2. p Off Elevation C
(dose) C - < _ Ft
{Bottom
(dead) D D Elevation
Total , Y F 3 1`t
'•1'' 'i.a :fa i {J'{J; i J•.. a a.a....a.ra llu~ •'~i
ELL
GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the
manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not
be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock)
installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and
laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank
excavation and the sleeve is scaled watertight. Electrical service complies with NEC 300 and Comm 16.28.
02/0) F) Page of
250-SERIES
113 hp Sump/Effluent Pumps for Professionals!
ALL MODELS FEATURE: MOTOR SPECIFICATIONS:
• Rugged 1 /3 lip motor, oil filled with 1 /3 hp 115V 5.2 amps 60Hz
thermal overload protection. Thermally Protected & Permanently Lubricated
1 /2" solids handling. (PSC) Permanent Split Capacitor
•
g• Maximum Fluid Temperature: 140oF
• 1-1/2" discharge.
• Hermetically sealed motor and switch cavities, DIMENSIONAL DATA:
and penTlanently lubricated bearings. Weight: Model 257:20 lbs.
• Liberty's UN [-BODY casting - a solid, one- Height: 10.5"
piece housing that eliminates the lower motor
seal ring found on other pumps. Major Width: 9.6" (manual model 250)
• Epoxy powder coat finish PERFORMANCE CURVE
• Vortex style impeller for superior PERFORMANCE CURVE
solids-handling. Made of high temperature 25
engineering polymer.
• Fasteners - all non-corrosive stainless steel. 20 s
• 416 stainless steel rotor shaft.
its s=
250-series Cord Lengths
S 10 - 3
Model 10' 251(-2) 35'(-3) 50'(-5) ry
250 _Standard Optional Optional Optional s _ 2
251 Standard Optional Optional Optional
253__ _ Standard Optional _Optional WA 0 e
257 Standard Optional N/A N/A o 10 20 30 40 so
U.S. Gallons Per Minute
10' cord length standard on all models. For optional lengths,
add"-2,-3 or -5" suffix to model number. sx 78 na u6 t92
Example: for model 250 with 35' cord, order 250-3 Liters Per Minute
EFFLUENTMODELS
R
L
Model 250 Model 251 Model 253 Model 257 VMF
Manual, no switch. Quick-disconnect Wide-angle float with VMF switch, magnetically
wide-angle float, series (piggy-back) operated vertical float -
mercury-free. plug, allows manual operates in a 10" -
operation of pump. diameter sump.
P ®R:" Dual v_ h ty corbi c: lion to,
r:pnrr-r Certified the United Statas and Cnn.ut:a.
siw.msm: aa -unircro ::n:un.x,exn nnce.
Liberty Pumps • 7000 Apple Tree Avenue • Bergen, New York 14416 • Phone 800-543-2550 Fax (585) 4941839
www.libertypumps.com cupynxhtaubertyPumpS,lnc.2017
NingMorcssxrved_ LUT2WOR5r17
ST. CROIX (MUNI'Y
SEPTIC TANK MAINTENANC , AGRBEMI?N'1'
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address
Pro erg Addrt ?
(Vcrificatimt rer(tured from Planning ~ /r~rnnq pepartrneiN t'or stew constnlchon.) -
City/State Parcel identification Number j~ -
LEGAL DESCRIPTION
Property Location J_ I/t
f._-. i Set.. f 7 T 5l i !L 4N,1bwn of
Subdiviston.---~'
- - - - - Lot At CertMed Survey Map # - L~
- _ ,Volume --,Page #
-
Warranty Deed #
- Volume_ -.-,page fi
Spcr, boost yes no Llit lines identifiab ye • no
SVSTEMMAINTENANCE AND OWNER CERTIITCAIION
Improper
consists rise and maintenance l of your septic system could result in its preurature failure to
the systemean aconsillect sts the imel ing out sa. septic tank every three yc:us ur sooner, et'ueeded, by a the system c:e 16ncuon ofthe septic tank as a treatrnent stage in the
wade disposal syatem.~ U~vnel~- Proper
What you put into
y ' tem. Owner net maintenance
responsibilities arc specified in §Cmtmr. 63.52(!) and in Chapter 12 St. (;Ioix fountYS
amtary (-lniiuance.
The property owner agrers to submit to St. t ro
owiter and by a toaster plumber journeyman pltunber,resu County f'larttring &Lonbtg llepatvnent a cur (ifcztion folio, signed by the
, mher nt a licensed )"wafer nt tying fiat l
wastewater disposal system is in proper operating conditionicte
uandd; orpllr(2) eftct inspection and
less than 1/3 full of sludge. ()the on-site
pumping (if necessary), the septic tank ic.
Uwe. the, beret, set read the above requrcrrtcnls and a(;ree to maintain turn private sewage. disposal system with the
SLarldardS SCI tOlth lrerCt, lrt, as set by the Deparhneat of-( ;ormrrercc and the Department of Natural Rcsoarccs, Slate of Wisconsin.
Certification stating that your septic system has been roantained most be completed and returned to the St. Croix County Planting &
Lotting Department within 30 days of the three year expiration date
Uwe certify that all stareflients out 1}} town arc Into Who bust of uty/our knowledge. 11wt: atn/ate fire ownsry s1 of the
property described above, by virtue of' a w/(rr~auty deed reccatk;d is gegisster of Deer's Office.
J
Number of bedrooms-` -
i .'1GNATU OF AI7PId(:AN1(S) CJ
DATE.
""'Any rnibmration that is misrepresented may result in the sanitary late-mit being revoked by the. Planning b2 'Lotting Department
Include with this application a recorded warranty deed from the Register of Deeds office avid a copy of the certified survey map if
reference is made in thr. waitanty deed.
(REV. ne/05)
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Parcel#: 032-2174-11-000 P
PAGE 1 OF 1
Alt. Parcel 2731 19 1466 032 - TO':-1N OI SOMI-RSFT
Current X ST CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
0V28i2004 00 0
Tax Address: Owner(s): C = Current Owner, C = Current Co-Owner
ALAN J & PATRICIA H VANASSE O VANASSE. ALAN J & PATRICIA H
534 ROUND t AKF LN
OSCEOLA WI 514020
Property Address(es): Primary
- - - 1986 571 H ST
Districts: SC = School SP = Special
Type Dist # Description
SC,' 5432 Sr'l I DIST OF SOMERSET
SF' 1+100 VA IC Notes:
Legal Description: Acres: 3.000
SEC 27 T31 N R19A PT NV,,' NE 6EIN- RIVER -
HPP;:'K R10U 3; ('04) LOI 11 t3 OOOAr'') Parcel History:
Date Doc # VolfPage Type
12iO5~2001 865182 OC
01;2812004 )52812 09198 PLAT
Plat: ' - P ;nary Tract c, ` a aura lb-'. cr, Block/Condo Bldg:
09-098-RIVER HA'-;','K RIDGE COUNTY PLAT 0 27-31N-19,N NW NF LOf 11
2018 SUMMARY Bill Fair Market Value: Assessed with:
Use Value Assessment
Valuations: Last Changed: 10/12/2010
Description Class Acres Land Improve Total State Reason
AGRICULTURAL G4 3-000 500 0 500 NO
Totals for 2018:
General Property 3.000 500 0 500
Woodland 0000 0 0
Totals for 2017:
General Property 3.000 500 0 500
Woodland 0.000 (1 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0 00 0.00 0.00
I RFCFii,/F;)
I
.
WiscortsnDepartment of Com"Ierce SOIL EVALUATION REPORT Page _of
Division of Safety and Buildings „F
Im 85 Wis. Adm Code
County
Attach complete site plan on paper no less than 8 1!2 x i t inches in size Plan must
include, but not limited to. vertical and honnrmtal reference point (BM). direction and Parcel I D 3-2-
Please percent slope. scale or dimensions. north arrow, and location and distance to nearest road. Q
print all information. Re Date
Personal information you orovme maybe used for secondary pvreoses (Privacy law, a 15.04 (1) (m)). ~ 2e7oY
Property Owner Property Location
Govt. Lot - 114 / - 114 S E- T N R a ~
Property Owner's Mailing Address Lot # oc;~,# Subd. Name or
CSM#
i
City State I Zip Code Phone Numbor 0 City _ Cl Village 8 Town Nearest Road
[I~ New ConstnxSion Use Residential! Number of bodroorns~ Coda derived design flaw rate GPO
D Replacement ❑ Public or commercial - Describe.
Parent material Flood Plain elevation if applicable s' ft.
General comments
and recanrrwndations. .S . 7r--/' r? t
Boring# Boring
® pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots GPD#P
in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
i' -S 7 i
_ Boring # ❑ Boring \I
a ❑ Pit Ground surface elev ft. Depth to limiting factor- in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rails GPD/fl`
in. Munsell Ou. Sz. Cont. Cola Gr. Sz. Sh. 'Eff#1 'Eft#2
:1C 1/
ll
As L
• Effluent #1 = BOD > 30 < 220 ng2 and TSS >30 < 150 mg/l- • Effluent - BO < 30 n1g/L and TSS < 30 mgt
CST Name (Please Ring - - fS)gna4mre CST Number
Address Date Evaluation Conductod Telephone Number
Property Owner Z_ Parcel ID H Page of
a Boring IV ❑ Boring
pit Ground surface olev. sit i -h Depth to linuling fads in
Soil icetion Rate
fionzon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/N"
in. Munsell Qo Sr. Cont. Color Gr. Sz Sh. •Eff41 'EN#2
11 /7'
1
t{
1
❑ Bonn g# ❑ Boring
❑ pit Ground surface elev. N. Depth to limi factor in,
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft
in. Munsell Qu. Sz. Cent Color Gr. Sz. Sh 'Eff#1 -EfN12
❑ Boring
Bon a ng # Pit Ground surface elov. N. Depth to limiting factor - in.
❑
Soil -Application Rate
Horizon Depth Dominant Color Redox Descriptor. Texture Structure Consistence Boundary Roots GPDJW
in. Munsell Qu. Sz. Cont. Cola Gr- Sz. Sh. •Eff#1 -Eff#2
Effluent #1 = BOO, > 30 < 220 mg1L and TSS >30 < 150 mg4 ' Effluent #2 = BOD, < 30 mgrL and TSS < 30 rxy1L
The Department ol'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 TIY 008-264-8777.
seDWOMIS 01
Property Owner _ IGi /s/1J... _ ✓/nl /~/Parcel ID P _ Page y_ of
Boring It f❑f~~II Boring
A=Y Pit Ground surface elov. t. Depth to hiniting'actor rn.
Suit rlration Rate
Horizon Depth Dominant Cwor Reoox Desorption Texture Stmrchrre Consistence Boundary I Roots GPDmf
in. Munsell Ou. Sz. Conl. Color Gr. Sz. Sh. , 'Ef1#1 I 'Etf#2
~ l
I 1 I 1 ~ ~ I
r
Boring i
# ❑ Boring
❑ Pit Ground surface elev. E Depth to Irm g factor in
Soil Application Rate
Horizon Depth Dominant Color) Reoox Description Texture Structure Consistence Boundary Roots GPDlff
in, Munsef Qu Sz. Cord. Color Gr. Sz Sir 'Ett#1 'Eff#2
1 i
I '
i I
I
I I
❑ Bonng# ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor nt.
! Soil Application Rate
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary; Roots GPD/ff
in. Munsell Qo.. Sz Cont Odor Gr. Sz. Sri ! 'Eff#1 'Eff#2
i
A
I
i
Effluent #1 = BODE > 30 < 220 moll. and TSS >30 < 150 mg1L ' Effluent #2 = BOO < 30 mxA 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 ahematc format, please contact the department at 608-266-3151 or TTY 608-264-8777.
5a605DfR.6W
CST 2.3 1 4
Date
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