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HomeMy WebLinkAbout191-1011-60-000 ?J &Ua) %a W' Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM 6� 1�1 r nt Safety and Buildings Divisiont. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) tar_y83807No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)1. Permit Holder's Name: ❑ City ❑ Villa ❑ lbwn of: State Plan ID No.: Anderson, Botan Village of Wilson S(Z(v ° Ts..!� CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 9 � 13 , �,' 191- 1011 -60 -000 TANK INFORMATION iLEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic K L anti Benchmark L Dosing �! r to Alt. BM a. � 2, Bldg. Sewer 3 H g �/ Ht Inlet TANK SETBACK INFORMATION S / Ht Outle $/ l2 . ? 3Y 93• :�Z TANK TO P/ L WELL BLDG. Ae Intake ROAD Dt Inlet Septic a ' + >� �/ r NA Dt Bottom ` Dosing '.f. 7.3 / 4'1 ' ±_;bo NA Header /Man. Z Aera I NA Dist. Pipe tZ I •93) g S �' Holding Bot. System ( 3 l ` "( b" LIM / SIPHON INFORMATION Final Grade t ;ll L, -" 12 `4- t cover c S ,a < < ' 6 Demand 5 �{� 38) 1�1a -1 Num Po tp `GPM TDH I Lif('-PA Lriction4 c2 System3.� TDH1�.7� �t q (k R� - Forcemain Length D' Dia. 2 " Dist. To well Z q, O �1o2•(A) 3 /a SOIL ABSORPTION SYSTEM, BED/TRENCH width Len h o. f PIT - No. Of Pits Inside Dia. Liquid Depth DIMENSION `_ A IS DIMEN SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEA anu acturer: SETBACK CH ER INFORMATION Type Of r: System: )O t >'�j y�� UNIT DISTRIBUTION SYSTEM Header/Manifold ti Distribution Pipe(s) t r u r x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length 3 pDia. I (Z 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 ❑ Yes ❑ No ❑ Yes ❑ No WS COMMENTS (Include code discrepancies, persons present, etc.) Inspection #1.4 1 Inspection #2• 0�/31 / n Location: 1900 Johnson Street, Wilson, WI 54027 (SE 1/4 NW 1/4 26 T29N R15W) - 26291592A 1.) Alt BM Description = 4„04 does 2.) Bldg sewer length= 3 ` o` - amount of cover= e' 3.) contour = 2.ao 7 Vt Plan revision required? ❑ Yes J�CNO (� (s, Use other side for additional information. SBD -6710 (R.3/97) `� a `S Inspector's signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: - J IL w p , - x r I� x i I I I I 900 `�° So+n� ` • Sattitan, Permit Application Safety & W. W Division 201 W. t�shington Avc , 0 -I (t), ts' In accord ., +an Comm 83 2; uk iY. Adrn. Code PO Sox 7302 See reverse side for instructions for cor- pleung th ;s application Madison. Wl 53707.730 Personal information, you provide ma} be used for secondary purposes Geportmenr of Commerce (Privacy LaW . s. 15.04 1)(m)j ') - ` Subr. 11 c mpleted form to couitty if r state owner Attach c omp fete plans (to the county CODV only ) for the v o er not less than 8. 12 x i I inches in size. co" State Ssuti Permit Numb to )otitappticatlon State Platt 1. D. Number L Applicaslop Information - Please Print a!I I>formation Location, Owner N ame a , � Property Location 1 5114 1 4. S To� N. R�� r' Property et's Mailing Address I-OVU Lot Number alock Number ST CROix 1. .2G'7 Ot: S' C C ty, State Zip Code h nu FICE� Subdivision Name or CSh1 Number U Type of Building: (check one) 0 city O 1 or 2 Funily Dwelling — No. of Bedrooms: p T of 0 Publie/Comnmvial (describe use): Q State-owned lVi III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Rosa g usd A) 1. New System 2. 0 Replacement 3, O Replacement of 4. C 2 Addition to Parcel Tax Number(s) S -Stem Tank Only Existinlat System `t t -- ) fm —66—M B) Penn t Number � j a�.2g, lS.9a issued D A Sans Permit was eviausi issued IV. Type of PUWT System: (Check all that apply) . O Non- preamwized In- ground Mound O Sand Filter ❑ Constructed Wetland O Pressurized In-ground I tH m Cding Tank O Single Peas O Drip Line G < 0 Ac obic Treatment Unit O Recirculatin O Other: V LDkwr saf/Treatttteat Area Information: t. Design (Spd s ispersal Area 4. oil Application . reo alion 6. yteem levation 7. in Required Proposed Rate (Gals. /day /sq. ft.) (Mindinch) Elevation am 1111110� VI Tank Capacity in Total ;<i of Manufacturer Prefab Site steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass Now Existing crew structed Tanks Tanks U E3 i { VII ReSpoosihility statement tha an d mvi IM raponlibility for installation of the POWTS sho n the attached 21ans . Plumbees Now (WW) Plumber's Signature (qp stamps); M /M o. Bus Hess Phone Number umbees Address (Strat, City, St Z ip e) VIII County/Depairtment Use Only Disapproved Sanitary Permit Fee (Includes Groun water to Issued lssuing t Signature o stamps) proved O Owner Givettlnitial Adverse Surcharge Fee) 7):;I Determination s bra LX. Condition of prav i as for Disappr vat: b s y � I n �,� -i f,,'S �� (Js v. ► ne— . v.4ex as � loc�ee�►, o � vLO�t 6"j. wk u - wt.oQ t� c ( l c'_s o.,.... - lea ayvw, l S a v, Le b a C Us i tw ac Md� Sf` tMt� N Ttt m t. S_ . SBD•6398 (R. 07100) Safety and Buildings 10 541N RANCH ROAD HAYW AYWARD WI 54843 TDD #: (608) 264 -8777 Visconsin www•commercestate.wi.us /SB Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary October 25, 2000 CUST ID No.691727 ATTN. POWTS INSPECTOR ARTHUR L WEGERER ZONING OFFICE 421 N MAIN ST ST CROIX COUNTY SPIA PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/25/2002 Identification Numbers Transaction ID No. 445126 Site ID No. 201042 SITE: Pleas rof ' T11704 entification numbers, Site ID: 201042, BOTAN ANDERSON ab a a with the agency. ST CROIX County, Village of WILSON; JOHNSON ST �'' <: SETA, NW1 /4, S26, T29N, R15W FOR: NEW MOUND, 450 GPD Object Type: POWT System Regulated Object ID No.: 768291 .+ 2 The submittal described above has been reviewed for conformance with ap ` le6a} dmirfisir tive Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APP R Eh.. The owner, ..0' a ed in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all �ke&/ r� r1 The following conditions shall be met during construction or installation and prior to occupancy or use: 1. This plan action is subject to designer comments on the plan. 2. The maintenance plan for this system must be given to the owner of the POWTS. 3. The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. 4. Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. 5. Maintain well and waterline set backs per COMM 83.43(8)(i). A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. - Sincerely, DATE RECEIVED 10/12/2000 FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 PATRICIA L SHANDORF , POW'LAN REVIEWER BALANCE DUE $ 0.00 Integrated Services (715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM PSHANDORF @COMMERCE.STATE.WI.US WSMART code: 7633 cc: BOTAN ANDERSON Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264 -8777 N *isconsin www.commerce.state.wi.us /SB Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary October 25, 2000 CUST ID No.691727 ATTN: POWTS INSPECT t. REcEivED `�� -- ARTHUR L WEGERER ZONING OFFICE O CT 0 2000 421 N MAIN ST ST CROIX COUNTY S I� Cy�ptX r" PO BOX 74 1101 CARMICHAEL S �KTY RIVER FALLS WI 54022 HUDSON WI 54016 Z O NIN G , RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/25/2002 Identification s Transaction ID No. 445126 Site ID No. 201042 SITE: Please refer to both identification numbers, Site ID: 201042, BOTAN ANDERSON above, in all correspondence with the agenc ST CROIX County, Village of WILSON; JOHNSON ST SETA, NW1 /4, S26, T29N, R15W FOR: NEW MOUND, 450 GPD Object Type: POWT System Regulated Object ID No.: 768291 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: 1. This plan action is subject to designer comments on the plan. �.® 2. The maintenance plan for this system must be given to the owner of the POWTS. Condt 3. The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. O 4. Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. 5. Maintain well and waterline set backs per COMM 83.43(8)(i). pEpp EN pIVlS SAS A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits SE E GORE required by the state or the local municipality shall be obtained prior to commencement of construction/installation /operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 10/12/2000 FEE REQUIRED $ 175.00 '1 t✓ FEE RECEIVED $ 175.00 PATRICIA L SHANDORF , POW PLAN REVIEWER BALANCE DUE $ 0.00 Integrated Services (715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM PSHANDORF @COMMERCE.STATE.WI.US I WiSMART code: 7633 cc: BOTAN ANDERSON w TITLE SHEET Page of MOUND SYSTEM FOR A BEDROOM RESIDENCE This plan has been prepared in accordance with the Mound Component Manual SBD -1057 P and the Pressure Distribution Manual SBD- 10573 -P Ctz. blgq� Ctz, 61 LOCATED IN THE -S; 1/4 OF THE NW 1/4 OF SECTION Z G ,T, Z4 N,R 1 W, TEK,fN OF WLLS01'1 S'�. C°_�Zq lX COUNTY, WISCONSIN. V 1 LL� C INDEX PAGE l of 7 TITLE SHEET PAGE 2 Of 7 SYSTEM MANAGEMENT PLAN PAGE 3 of 7 PLOT PLAN PAGE 4 of 7 PLAN VIEW -CROSS SECTION PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT PAGE 6 of 7 PUMPING CHAMBER CROSS SCION PAGE 7 of 7 PUMP PERFORMANCE CURVE JonallY PREPARED FOR fCl 2ESPONDE PREPARED BY WEGEF:ZEFZ SO I L TEST 2 NGa AND. DES 31 GFV 1 SCE P.O. Box 74 421 N.Main St. � River Falls, WI 54022 �� Phone 715- 425 -0165 'NS / Fax 715- 425 -6864 �.. AR7Fe1R l ` W WEGERER fl ESWC P t1,JWCRTM, tS. . N•w.n SIGN l0 -10 -00 JOB NO. 00 , Zq7 Mound System Management Plan Page Z of - 7 Pursuant to Comm 83.54, Wis. Adm. Code 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. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The u e ilt s hall be cleaned as necessary t o ensure proper operation. The filter cartridge should not be removed unless provisions are made tretain 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 tank shall have its contents removed when the volume of sludge and scum 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 a triennial 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. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October - February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg /L BOD5, 150 mg /L TSS, and 30 mg /L FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manual [SBD- 10572 -P (R. 6/99)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump 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 a tank or component. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions on the operation or maintenance of this system should be directed to the County Zoning office at 11S-38b- 4680 or to the licensed plumber who installed the system. — 8► =�L too.' a� v:}rPnc. lr:.►1�� r� e r'rLZ�g o 00 i / 1S. i 4 / C y'j (st-1- N CO o 3 Co J 2 �j 2 J t O NOTES: 1. Elevations shown are existing ground 2. Install 4" observation pipes with apl 3. Septic tank to be 1ppO gallon cal Mlsk1t�Ylz� 4. Bench marks STl� �poV . Divert surface water around system tc Pace L4 Of _7 Approved Synthetic Covering AST2 C33 Distribution Pipe Medium. Sand Topsoil - " H G ,• F Elev. 3 E p b �O % Slope Distribution Cell of Force Main Plowed 2" to 2- Aggregate From Pump Layer 0 0,15 Ft. E S Ft. CROSS SECTION OF A MOUND SYSTEM F o- Ft. G o- S Ft. A 6 Ft. H . 0 Ft. Linear Loading Rate= 6.o GPD /LN FT B S Ft. Design Loading Rate= 0. /SQ FT I 1 Z Ft. J S Ft. K Q Ft. ete Position L 0. Ft. of Force Main W 7 - 3 Ft. I I k - Observation Pipe a i + Access A 6 8 _ O - w -__ - -- --- - - - = -- ---- - - - - -- _ --- - - - - -- �Oistribution \-- Cell of %" t z o 2 Pipe aggregate Observation Pipe (anchbr securely) PLAN VIEW OF A MOUND SYSTEM Distribution Pipe Layout P -Ag S of Place the holes at the bottom of the distribution pipes at equal spacing. Remove all burrs from the pipe and holes. Extend the end of each lateral up with the use of long turn or 45 fitting to a point within six inches of the final grade. Terminate the ends of the laterals with a valve,: threaded cap or • threaded plug. Provide access from final grade for the valve; threaded dap or threaded plus. Z`iP.1C1� L t,�ZOSS. 5`c PV C F�JC PV C Lateral Manifold Lateral x x x x xQ x!1 x x x x Lateral Lenath — Lateral Length — P Distribution Line P `- &cci}s six 0 7 - .. ---C rrru -0 S P 3� Ft. Hole Diameter 3�l6 Inch - ' S 3 Ft. Lateral ) <<Y Inches) X ?�_ Inches Manifold ZP- Inches Force Main " Z Inches #of holes /pipe �9 Invert Elevation of. Lateral s Sq -7- SFt. PUMP CHAMBER CROSS SECTION ARID SPECIFICATIOUS PAGE OF 7 YEIJT CAP '1 "C. Z. VENT PIPE WEATHER PROOF APPROVED LOCKING MANHOLE lO' FROM DOOR, JUUCTIOU box • COVER WITH WARNING LABEL � 12�MIU. WINDOW OR FRCSH I AIR INTAKE I GRADE • I .� i o'MIU. CONDUIT - Is'J'IIAI. IIULET PROVIDE — T AIRTIGHT SEAL I I APPROVED JOIAIT A Tank construction shall comply I I I APPROVED .JOINTS with COMM 83.15 and COMM 83.20 I II I I I ALARM Is I I II 1 C O N LLEY. FT. PUMP __j v —� OFF D L(- 5 Q CONCRETE BLOCK 3" AvPRweD • RISER EXIT PERMIII'ED OWLy IF TANK MAIJUFACTURI~R HAS SUCH APPROVAL a 00ING 5PECIFICAT10US DOSE rA LI KS MAM UFACTURE R: w1LDW � A) � 1' MUMBER OF DOSES: �' _ PER DAy TANK SIZE: -IS GALLOWS DOSE VOLUME r ALARM _- P.AJyUFACTURi`R' S S S ST�1 IMCLUOING 5ACKFLOW: �� • GALLONS MOOCL NUMBER: L4 L L�lv CAPACITIES: A= - jjCHES09 3 $ 0 'ZGALLOWS SWITCH TUPE: 5 = Z INCHES OR 3 G�LLOf.15 PUMP MAmu C GOy� 1S S �.S FA TURER: i S °L C IIJCHES OR GALLOIJS MODEL NUMBER: D s N L INCHES OR O GALLOAIS SWITCH TYPE: tMC -Y JJOTE: PUMP AMD ALARM ARE TO OE MINIMUM DISCHARGE RATE 50- l 6 GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE OETWEEAi PUMP OFF AA10_DISTRIBUTI61,1 PIPE.. FEET t MINIMUM • NETWORK SUPPLY PRESSURE .... ..... .. 3 - FEET - 10 FEET OF FORCE M AIM X S UH F 0 FACTOR. C) FEET TOTAL DYNAMIC. HEAD = z ' Sd FEET As per manufacturer • gal /in. Liquid depth 38 � Z 0 i= 7 ' Goulds Submersible Effluent Pump 3871 EPO4 EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer, following Capable of running lubrication and efficient strength, and durability. g uses: dry without damage to heat transfer. ■ Motor Cover: Thermo las- • Effluent systems components. p • Homes p Available for automatic and tic cover with integral handle • Farms Motor: manual operation. Automatic and float switch attachment •Heavy duty sump g p , models include Mechanical • EPO4 Single phase: 0.4 HP 1550 points. • Water transfer 115 or 230 V, 60 Hz, Float Switch assembled and ■ Power Cable: Severe duty • Dewatering RPM, built in overload with preset at the factory. rated oil and water resistant. automatic reset. ■Bearings: Upper and lower RP 115 V, 60 Hz, 1550 RPM, , SPECIFICATIONS • EP05 Single phase: FEATURES heavy duty ball bearing Pump: EPO4 built in overload with ■ EPO4 Impeller: Thermo- construction. • Solids handling capability: automatic reset. plastic Semi -open design AGENCY LISTING 3 /a' maximum. • Power cord: 10 foot with pump out vanes for : o Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. 0 Canadian Standards Association ! .otal heads: up to 24 feet. with three prong grounding a size: 1 1 /2" NPT. plug. Optional 20 foot ■ EP05 Impeller. Thermo - Discharge plastic enclosed design for (CSA listed model numbers • Mechanical seal: carbon- length, 16/3 SJTW with end in "F" or "AC ".) rotary/ceramic- stationary, three prong grounding plug improved performance. BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 °C) continuous superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. to- Capable of running+�;� 4 �, dry without damage to s 30 ► components. Pump: EP05 s i I :,his • Solids handling capability: c 7 25 maximum. L a, i • Capacities: up to 60 GPM. = j 6 • Total heads: up to 31 feet. 20 • Discharge size: 1 NPT. z 5 • Mechanical seal: carbon- >. I-t "s rota /ceramic stationa ry, ° i5 — - ry BUNA -N elastomers. 16 4 tz.S o ; • Temperature: � P 3 10 104 °F (40 °C) continuous 140 °F (60 °C) intermittent. 2 I °POa 5 1 I i S .11p ° ° 0 10 20 30 40 50 GPM L 0 2 4 6 S 10 12 ml /h CAPACITY ©1995 Goulds Pumps. Inc. _ Effective May. 1995 Wiscon 'w Department of Commerce �� AND SITE EVALUATION Page __ — of _3 . Division of Safety and Buildings ORIGa ith Comm 83.05, Wis. Adm. Code Certified Soil Testing Attach complete site plan on paper not less than 8'/: in size. Plan must County include, but not limited to: vertical and horizont ekef" oint- (15141, direction and St. Croix percent slope, scale or dimensions, north ai ,\a n and�dis ce to nearest road. - - - -- — , Parcel I. D.# CSM Pending APPLICANT INFORMATION e �,yg o prl H 1fF�rma w' u -- -- - - - P ndary � � Law , C '��.oa (t) (m))• R W �� Dal, Personal information you provide may be 1 °ems Property Owner "' party Location -- Anderson, Botan T p a `�9 Lot SE 1/4 NW 1/4 S 26 T 29 N,R IS W Pro ert Owner's Mailing Address C 3720 2 6th Av .�t3Ni1dG t # Block # Subd. Name or CSM# yy E 1/2 Of 191 - 1011 -60 S. . < , C3f`t=ar� • •, _ City State ZI Code ; P,honeNumber . r ❑ City �Q Village ]Town Nearest Road Minneapolis MN 5 '612 .M -7948 Wilson Johnson St. ❑ New Construction Use: Z Residential / Number of bedrooms 3 L- ]Addition to existing building ❑ Replacement ❑ Public or commercial describe Code Derived daily flow 450 g pd Recommended design loading rate -5 bed, gpd /ft� 6 trench, gpolft' Absorption area required 900 bed, ft 750 trench, ft" Maximum design loading rate • bed, gpd /ft' - t rench, gpolft' Recommended infiltration surface elevation(s) 84. _ _ __ ft (as referred to site plan benchmar Additional design /site considerations install 4' x 95' rock bed mound on 83.1 contour as upslope edge of rock w/ F sand till Parent material loess over till Flood lain elevation, if applicable NA ft S= Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system ❑ M U ® S❑ U ❑ S NU I S X U S X U Depth Dominant Color Mottles Structure GPD /ft' Boring# Horizon in. Munsell Clu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistency Boundary Roots Bed Trench 1 1 0 -5 l OYR 3/3 - sil 2 m gr ds cs 1 f/m .5 .6 w 2 5 -12 l OYR 3/3 - sil 2 f sbk dsh 1 gs 1 f 5 j 6 Ground 3 12 -19 l OYR 4/4 - sil 2 m sbk dh I cs i if .5 i .6 elev - -- -- - -- - - -- - 93.5 ft 4 19 -26 1OYR 4/4 cld 7.5YR 4/6 sit 2 m sbk dh T aw If .5 .6 Depth to 5 26 -30 5YR 4/4 c2d IOYR 6/2 SO 0 m dvh - - NP .2 limiting factor 1 1 Remarks: lacks A 4 "; horizon 2 and 3 part to 2 m pl 2 1 0 -4 l OYR 3/3 - sit 2 m gr ds cs 1 f/m S 6 2 4 -11 e 10YR 3/3 - sil 2 f sbk 1 dsh 1 gs if 5 6 Ground 3 11 -20 l OYR 4/4 - sit 2 m sbk dh cs If .5 .6 elev - -- — — - - -- -- - _ ------ --- -- --- - - - - -- ] ; 92.2 ft 4 20 -25 5YR 4/4 c2d tOYR 6/2 scl 0 m dvh - - NP .2 ff ! — - - -- — - - - — f - limiting —__ - - -- - Depth to 9 1 factor 20 Remarks: lacks A+ 4" CST Name (Please Print) Signature: Telephone No. Henry F. Grote 715- 665 -2681 Date CST Number Ref # Certified SoifTestin - - - - -- --- - - - - -- - - -- _ _ g Address P.O. Box 57, Knapp, WI, 54749 9/3/1999 222774 1225 qj 1 PROPERTY OWNER: Anderson sotw SOIL DESCRIPTION REPORT page. 2 of 3 PARCEL I.D.# CSM Pending Certified Soil Testing Depth Dominant Color Mottles Structure GPD/ft' Horizon in Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh, onsistence Boundary ! Roots Bed Trench 3 1 0 -4 IOYR 3/3 - sil 2 m gr ds cs 2flm 5 6 a. T •i 2 4 -12 10YR 3/3 - sil 2 f sbk dsh cs If 5 6 Ground 3 12 -21 10YR 4/4 - sil 2 m sbk dh cs i if 5 6 elev _ 83.1 ft 4 21 -27 7.5YR 4/4 - s1 2 m sbk dh cs if .5 6 - -- - - -- - - -- -- - - - -- - . t - D 5 27 -44 _ - 7.5YR 4/4 c2d 7.5YR 5/3,5/8 _scl 0 m dvh 4 NP .2 miting factor i 27' - 1 - - - - -- -- - -- - _. - - - -- - - 1 - Remarks: c ommon . - o tuna gr c 1 — 0 -4 10YR 3/3 sill 2 m gr ds cs 2flm .5 .6 2 4 -12 10YR 3/3 - sil 2 f sbk dsh cs 1 If 5 6 sill 2 m sbk dh - elev Grou 3 - 12 -17 — - l OYR 4/4 - -- r _ gs 1 m 5 - 6 79.8 ft _ 4 17 -29 l OYR 4/4 - sl 2 m sbk dsh cs if .5 1 .6 Depth to 5 29 -34 2.5Y 7/4 - fs 0 sg dl cw - .5 .6 limiting - -- - -- — - - -- - - - - -- - _ - factor 6 34 -40 7.5YR 4/4 c2d 7.5YR 5/3,5/8 scl 0 m dvh - j - NP 2 34` - - -- -- t -- Remarks: occasional gr & co 5 1 0 -4 10YR 3/3 - sill -. - _2 m g`--- - - - -ds cs 2f1m 1- .5 .6 2 4 -9 1 OYR 3/3 - sil 2 If sbk dsh cs If 5 .6 Ground 3 9 -24 10YR 4/4 - sl 2 m sbk dh gs lm .5 .6 elev _83.1 ft 24 -27 7.5YR 4/4 - lmcos 0 sg dl cw If ! .7 .8 Depth to 5 27 - 35 7.5YR 4/4 c2d 7.5YR 5/8,5/3 scl 0 m dvh - - NP 2 limiting -- - - -- - iactcr 27' - - -- - - - - - -- - -- - - - -- - -- — - - _ .. Remarks: occasions gr co { I ground Jev � I Depth to limiting factor Remarks: r d G4 �` 3 =3 � o �^ ✓� -� t ri • 0 .9 r ,. o � 0 N i } ol v d S � n i iA O 0' i ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT --AND OWNERSH P CERTIFICATION FORM wner/B er �ah ort A 3 72 .. �e s � W /© / Z � s ray ddress �/ ° h n s 6 r2 S/• S (Verification required from Planning Department for new constmca ) a Number lq 1, Ml f Sty/State Parcel Identification AG CRII'TION n hwerty 'onS Y<, � Y,, Sec. T -R�w, Town of �,C- 3" ' on IC c Lot # ° Certifi Surrey Map # e l �� - ' Volume Vtrarran Deed # 11 ,, Volume ! t/,5 j . Page # S pec h W [I yes )l no Lot lines identifiable P1 yes 1:1 no 1ViA1NTEN CE r maintenance use and atd*nanceOf your septic system could result in its premature failure to h wastes. � o the system out the septic teak every three years or sooner, if needed by a licxnsed pumper. pump earn the m the waste disposal system function of the septic tank as a treatment stage . ent a certification form, signed by the owner and by a proper owner agrees to submit to St. C Zoning DGpartm that (1) the on -sits wastewa� �posal system masttxpl journeymanplumber, restrictedplumbGr or a licensedpumPer vanfYmg c tank is less than full sa sludge- is operating condition and/or (2) after inspection and pumping (if nom), the septi of to maintain the private sewage disposal system with the standards 11aro, the undersigned have read the above requirements and agree of Natural Resources, State of Wisconsin. Certifioateon set herein, as set by the Department of Commerce and the to the St Croix County Zoning Office within 30 stat t your septic system has been maintained must be completed and returned Of he �CXpir date. � �...— I O O /✓c 5, �o n s o f cz �'l��G N s o f Z DATE SIt3NA OF APPLI U R �i R CATION knowled e I (we) am (are) the owners) of I (we) certify that all statements on this form are true to the best o ffer o our f of Office. . the d 'bed above, by virtue of a warranty deed recorded in Reg DATE SI OF APPLICANT Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department- W ode with tlils application: a stamped warranty deed from the Register of Deeds the warranty deed a copy of the certified survey map if referentx M 1 r O O� v ei..1459PAG E 472 61 1 15E� KATHLEEN H. WALSH msntNumtw WARRANTY DEED S CROI OF DEEDS Docu ST. CkOIX CO., WI RECEIVED FOR RECORD This Deed, made between Claude E. McGee and Louella J. 09 -29 -1999 9:00 AN M ee, husba and wife and each In their own right, Grantor, and ai R Anderson nd Patricia M. Gmeiner- Anderson, husband and WARRANTY DEED wife as survivors ip marital property, Grantee. EXEMPT M Witnesseth, That the said Grantor, for a valuable consideration CERT COPY FEE: COPY FEE: conveys to Grantee the following described real estate in St. Croix County, TRANSFER FEE: 136.50 State of Wisconsin: RECORDING FEE: 10.00 PAGES: 1 The East Half of the Southeast Quarter of the Northwest Quarter (E% of SE% of NW /) of Section Twenty -six (26), Township Twenty -nine (29) Ram North, Range Fifteen (15) West. a r Nam nd Retum Address FIRST WATIOWAL BANK OF BALDWii 1 330 Baia Street Part of 191.1011-80 r (Parcel Identification Number) 2— (. 2`I.1S 1 92A- t 4� C qqb N �1 This is not homestead property. 5 12- G Nw 4 Together with all and singular hereditaments and appurtenances thereunto belonging; ,U( And Grantor warrants that the title is good, indefeasible in fee simple and free and Gear of encumbrances except all easements, restrictions and rights of way of record and will warrant and defend the same. Dated this -7 day of September, 1999. • *Claude E. McGee • •Louella J. McGee AUTHENTICATION ACKNOWLEDGMENT Signature(s STATE OF WISCONSIN ST COUNTY Personally came before me this 2 ` "ay of September,. 1999, the above named 5 authenticated this _day of & - atuva e s 4,ww-X w c to me known to be the person(s) who execut foregoing inst me and acknowled same.. sipr>stun • :: type or print name swwura type or print name Z ¢ S`SL F r TITLE: MEMBER STATE BAR OF WISCONSIN (If not, Notary Public 3�'C {Ct� hl Cour t C authorized by § 706.06, Wis. Stats.) My commission is permanent. (If not, state Io t THIS INSTRUMENT WAS DRAFTED BY Notary Public -Slate of Wisconsin JENNIFER A. O'NEILL My Carnrnisoon Expires March 17, 2002 Attorney at law 'Names of persons signing in any capacity should be typed or Spring Valley, WI 54767 printed below their signatures. (Signatures may be au0mdkaled or acknowledged. Both are not r- es—Y.) UROrrn -eoa PioNsd i. CompnnY Ford du Lm. Whco"n B 04422021 f FROM d)i11a,�e of Wilson PHONE NO. : 715 772 4402 Nov. 08 2000 03:08PM P1 f, VILLAGE OF WILSON 4 �. - - -_' St. Croix County 440 Main Street Wilson, Wisconsin 54027 Phone R Fax: 715/772 -4402 November 8, 2000 St. Croix County Zoning Office Hudson, Wisconsin 54016 FAX: 715/386 -4686 This letter is prepared to advise your office of the fact that Buton Anderson has purchased a 20 acre parcel of land from Claude McGee of Wilson, Wisconsin located on the West side of Johnson Street on the extreme North end of.this roadway. Mr. Anderson has contracted with Larry Wellums of D &S Builders Baldwin, Wisconsin for the development and construction of a new home on this property and his sub-contractors- The Village has determined the address of said home shall be 1900 Johnson Street and also said property is located approximately one mile North of the Wilson Sewer Utility service. Sincerely, VILLAGE OF WILSON: Cam/ r mes E. Winoske Village Clerk