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HomeMy WebLinkAbout022-1011-38-150 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division y INSPECTION REPORT Sanitary Permit N« 515250 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Sabelko, Jason I Kinnickinnic, Town of 022 - 1011 -38 -150 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: /� /• 5 �! e.5 05.28.18.67C E TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic , S� Benchmark o es� Z IF.', /. 1 rz D98iR Alt. BM 1 �-- �; Ac) G•, cl�.. C a I Aeration Bldg. Sewer .. Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet "7.7 MAI . $ TANK TO P/L WEL BLDG. Vent to Air Intake ROAD Dt Inlet Septic �� `, `' Dt Bottom '7 '7 Dosing Header /Man. . A2 Aeration Dist. Pipe q y /62 �« Holding Bot. System re . to /d /- PUMP /SIPHON INFORMATION Final Grade `J C /66 5 Manufacturer Demand St Cover 1 t /$ 3 GPM ,'�.l.t,.., � � /V • / � O Model mber TDH Li Friction Loss S s ad TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width I Length No. Of Trenches PIT DIMENSIONS No. Of P' Inside Dia. Liquid Depth DIMENSIONS 3 ZO Z 1 r SETBACK SYSTEM TO P/L JBLDG IWE LL LAKE /STREAM LEACHING ManufacturerC� I�d INFORMATION ^ CHAMBER OR G Type Of System: (� ko UNIT Model Number: DISTRIBUTION SYSTEM e,° (-s. 17 f--/ Z = Header /Manifold '" � N1__1 Distribution pr � x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) 2 C — (c a Length _ Length Dia \ Spacing J SOIL COVER x Pressure Syste Only xx Mound Or At - Grade Systems Only Ve Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center •'v Bed/Trench Edges \ Topsoil \ es R No Yes No —.— COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1061 Cty Rd N Unknown (SW 1/4 NE 1/4 5 T28N R1 8W) NA Lot 2 ; �� t Parcel No: 05.28.18.67C 1.) Alt BM Description = r, ( G 6.3 e" t�K.� 2.) Bldg sewer length = 2.711� 1 - amount of cover = T !Z. r � a— /'5 J' 30 • WCw ' O 1�$� Plan revision Required? ❑ Yes XN o Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor' Signatur Cert. No. r _ nmerce.wi.gov Safety and Buildings Division Comity 201 W. Washington Ave. P„p. 6 T ST, Z Q I)( t c o n s n Madt� Sanitary it Numbff_& be filled in by Co.) � 5152 50 Sanitary Permit Application State Transaction ber In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to cntal unit is required prior to obtaining a sanitary permit. Note: Application are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you TideWu-sed for secondary purpo in accordance with the Privacy Law, s. 15. 1 m , Stats. I. Application Information — Please Print All Inform 10 6 I cT M N I J 404 Property Owner's Naamee n ' 1 # J / ) Jo' J � f . �o S CR � FIC 0 2— t I —3 8 —1450 Property Owner's Mailing Address ( / PI AN Property Location T /0 % / f / �� / Govt. Lot City, State Zip Code Phone Number � �� N y � Scion % Q - (circle o T 28 N, R IS Eo N U. Type of Building (check all that apply) Ole Lot # or 2 Family Dwelling - Number of Bedrooms Subdivision Name Block # Q,N C 2 T Z PA ❑ Public/Commercial - Describe Use -^ ❑City of ❑ State Owned - Describe Use CSM Number ❑ Village of _ /- Vi C eA_s 1Z 4" /Z VA 4-5 i FYf , J . �,.- (Town of /) //l//ll /CK //VnJ1 III. Type of Permit: (Check only one boa on fine A. Complete line B if applicable) A " XNew System ❑ Replacement System y p y ❑ Treatment/Holding Tank Replacement Only 11 Other Modification to Existing System (explai B. ❑Permit Renewal ❑Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous ermit Number and Date Issued Before Expiration Owner 5 IV. j of POWTS System/Component/Device: Check all that a pply) Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mour 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersai/Treatipent Area Information: Design Flow (gpd} Design Soil Application Rabe( Dispersal Area Required (sf) Dispersal Area Pro sf) System Elevation / VI. Tank Info Capacity in Total # of Manufacturer u Gallons Gallons Units New Tanks Existing Tanks u c d v Septic or Holding Tank �/ i Z.SO ( W t 4 sue'✓ ` /� Dosing Chamber /� VII. Responsibility Statement - 1, the undersigned, assippe responsibility for inst Ilation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumbers tre MP/MPRS Number Business Phone Number Plumber's Address (Street—City, State, Z Code) r3 VIII. Coun /De partment Use On proved Permit Fee Date Iss ye Issuing A Signature iven R Denial $ 7.5. Do S 5 I6 IX. Conditions of easons for Disapproval 3 , n� 1. Septic tank eftluent filter and �;61 dispersal celf must all be services / maintained bG r; 4% as per management plan provided by plumber. 2. All seltbaCk fYtq*eutlents must be maintained A to rnarplete plans for the system and submit to the County only on paper not less than 8 in a 11 inches iA size fir �rr� �'e�� GofJL� � t�• rJw SBD 6398 (R. 02/09) Valid thru 02/11 p g �� 1 � ^ Ae� ;i 4 q r 0 lo 40 3 � � Vl °m e � o lilh rDo M cv' 0 �.. 0 o - 4 r w 0 � 0 y -41 11 oil s _ T a i e _ L c `� Q rDo 1 co Private Onsite Wastewater Treatment System Index and Title Page Project Name: Owner's Name: TA50t S A G P t u Owner's Address: t orlo ()N L 4- �A P L k4 A TMA l L L k,AA[[e-iWT7 "022- Phone #: - 7 tS� Legal Description: �� N >' Z Qj $ Municipality: Town,' Village, City of �� N N � c.K : ti➢ i L County: Subdivision Name: C:,/' Lot Number: o� Block Number: ^ Parcel 1. D. Number: (� `Z 2 1 0 l 1 — 3 8 — 1 Page 1 D � 1 A NJ Page t 0,61 oto t A M -k Page 3 EZ P L tit �k Page 4 E F lotz S Page 5 Page 6 �t�tX. Page 7 NAM VnJ V6J Tw ppq a- -S Page 8 h S Page 9 -�n Name of Designer: License Number #: oss Signature: Dat ---- Designed Pursuant to the Following POWTS Component Manual and Comm 81 -85: In- Ground Soil Absorption Component Manual for POWTS (Ver 2 0) SBD- 10705 -P (N 01/01) 6� N �. ! ' LA INI O � Cf) n �1 Q p j� � i �• � � �- p w O D C\ I t _ I EZFIow Distribution Cell Media Layout l 3.00 Cell width (ft) 1.50 Sidewall to Lateral (ft) Distribution Cell Cross - section Arrangements Drag appropriate drawing to space below. ( O ( S ( a 3 ft Wide Component. Legend 6" EZFk)w Bundle - EZ0601A, 5 or 10 Foot Lengths 12" EZFIow Bundle - EZ1203H, 5 or 10 Foot Lengths 12" EZFIow Bundle - EZ1203HP, 5 or 10 Ft Lengths a 4" Distribution Pipe With Pressure Lateral Inside Tumup Enclosure - - - - Lateral Distribution Cell Plan View Layout - Typical 3.00 Cell width - A (ft) F Cell Length - B (ft) Center Connection Lateral Layout Diagram Drag appropriate drawing from left to space below. 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Orenc / 1 C_a_taloy Site M ap FT Series Residential Biotube Effluent Filters Catalog Search FT-Series Residential Biotube° effluent filters are used in new or existing tanks, for both residential and commercial applications. Each filter comes with a Biotube filter cartridge Tanks, Risers, Lids, and (in 4-, 8-, 12- and 15-in. diameters), PVC housing, and Accessories extendable PVC handle. A shortened version of our standard 8- and 12 -in. diameter filters, called a "base inlet filter," is available for low - profile tanks. Optional alarm to Pumping Packages and signal a tank high -level condition which may indicate a Components need to clean the finer. Optional slide rail system, available on larger filters, simplifies installation and provides tank access for servicing. Slide rails are required when there is Effluent Filters only one access to the tank. - Overview - FT Series Residential Biotube Covered by U.S. Patents #4,439,323 and 5,492,635 Effluent Filters FT Series Base Inlet Model Product Nomenclature - Float Elbows Effluent Filter Overflow Plate = Kit - Biotube Junior Effluent Filters - - Biotube Effluent Filter insert- - FT Series Commercial Biotube Effluent Filters - External Effluent Filter Basins Control Panels, Alarms, and Floats Treatment Systems and Drainfield Supplies Additional Onsite Products t Options: ' Blank = no options 1 M = low modulation nlatc insttall.od R = float bracket anacheu Cattridac height: 28" and 36" arc standard i i Housing height; 6' and 44" are standard F'ilrcr diantewr (inches) W jts TVpc 3034 cutler a l}e S = fits Schedule 40 outlet pipe i I i Blank = !r' & " filtration 1 i p - IJtS" f51:- ra:San I i J Biotube efFsucnt filter scrics i Product Example { Model Code j FTSO444 -36M Description Biotube Effluent Filter, Schedule 40 outlet, 4-in. diameter, 44 -in. height, 36-in. tall cartridge with { flow modulating plate E Related Products External Effluent Filter B Biotube Effluent Filter Insert Biotube Junior Effluent Filters Home I Distributor Locator I vde_.os I Product Cataiog I Document Library New Products l Fiberglass Tanks I Effluent Pumping_Systems Advanced Treatment Systems I Community Collection Slrstems AA—. ...i.... —A f`--1 n..,a...... I 1..0........1:.... T...:..:nn 1 Al.....a (1......... http: / /www.orenco.com/catalog /product detail .cfm ?FarailyID= 3 &ProductID =33 4/1/2010 START UP AND OPERATION Page of For nevi construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and /or damage the soil absorption system. If high concentrations are detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended, as the excess wastewater will be discharged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. 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 treatment tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and .vegetable peelings, gasoline, greases, herbicides, meat scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge. 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 s. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks, pits and other soil absorption systems 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 (pumper). • 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 replacement 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 the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ 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 TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. ADDITIONAL INSTRUCTIONS: �� e yvx POWTS INSTALLER � s B ork ,TAINER Name Ve <� Phone Full Service Plumbing SEPTAGE SERVICING OPERATOR 715- 231 -7375 ORY AUTHORITY Name C ay Phone o� ew e m This document was drafted by the staffs of the Green Plumbing and 6 1 4 County POWTS regulatory agencies in compliance with sections Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Aonnt,.—o,,„c Lode. P -� POWTS OWNER'S MANUAL $ MANAGEMENT PLAN Pa of FILE INFORMATION SYSTEM SPECIFICATIONS Owner 1 (iJ 0t�j SA a r Tan Manufacturer: Permit# � (� ❑ NA Septic ❑ Dose ❑ Holding Volume: /Zj (gal) DESIGN PARAMETERS Tank Manufacturer: NA Number of Bedrooms: Ll ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: ( Number of Public Facility Units: 9NA Vertical Distance Tank Bottoms) to Service Pad (ft} Estimated (average) Flow: L100 (gal/day) Horizontal Distance Tank(s) to Service Pad: (ft} Design (peak) Flow = (estimated x 1.5 ): Specific servicing mechanics must be provided if vertical is >15 feet or (gauday) if horizontal is > 150 feet. Specific instructions to be provided on back. In Situ Soil Application Rate: (gal /day/f) Effluent Filter Manufacturer: n r�.,pj cQ Standard (Domestic) Influent/Effluent onthly aver a Effluent Filter Model: FT S ❑ NA Fats, oil & Grease (FOG) s30 mg/L Pump Manufacturer: Biochemical Oxygen Demand (BODs) 420 mg/L ❑ NA NA Total Suspended Solids (TSS) <150 mg/L Pump Model: High Strength Influent/Effluent VS7tth average Pretreatment Unit (FOG) >30 mg/L Manufacturer. (BOD >220 mg/L NA (T SS) >150 mall- ❑Mechanical Aeration Peat Filter Pretreated Effluent Monthly average ❑ Disinfection ❑ Wetland ❑ Sand /Gravel Filter ❑ Other. (BOD5) s30 mg/L (TSS) s30 m NA Soil A 71rn-Ground rption System Fecal Coliform (geometric mean) _ (gravity) ❑ In- Ground (pressure) ❑ NA Maximum Effluent Particle Size in dia. ❑ NA ❑ At - Grade ❑ Mound El Drip - Line ❑ Other. Other. ❑ NA Other. ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) When combined sludge and scum equals one - third (X) of tank volume ❑ When the high water alarm is activated (to t Inspect condition of tank(s) At least once every: ❑ ponth)s) (Maximum 3 years) ❑ NA _ Inspect dispersal cell(s) At least once every: I ❑�ntS(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: � ❑ ' n onth(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) A ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) f , ❑ A year(s) LV Other: At least- once every: ❑ _month(s) ❑ year(s) X NA Other: NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper). Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The soil absorption system shall be visually inspected to check the effluent levels in the observation pipes and to check for any pondttq 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 treatment tank equals one -third (73) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. GMW -005 (02/05) p,� w to ® c < � � -� �O O PT U t� Lv p. 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Adm. Code County ST.CROIX Attach complete site plan on paper not less than 812 x 11 inches JF t j include, but not limited to: vertical and horizontal reference point ( ctio percent slope, Parcel I.D. 22 - 1011 - p pe, scale or dimensions, north arrow, and location and distance'lr:ww� road. Please print all information. RWI by Date Personal information you provide may be used for secon Law . 15.04 (1) (m)). 5 5 1 16 Property Owner roperty Location JASON SABE O Lot SW 1/4 NE 1/4 S T 28 N R 18 E Property Owners Mailing Address L t # Block # Subd. Name or 191 UNIT H PIKA IL y � GpUNN E C - (1061 CTH N) 17/4525 LENERTZ PARCEL C City State Zip Code Pho pN ity ®vdlage own Nearest Road RIVER FALLS WI 54022 p1ANN1 - CTH N New Construction UselD Residential / Number of bedroom 4 Code derived design flow rate 600 GPD ® Replacement ❑ Public or commercial - Describe: NA Parent material TILL Flood Plain elevation if applicable NA ft. General cone Installer /designer must verify and maintain set backs from CTH N and the western property line. Surface water has and recommendations: been directed down the westem side of the property installer /designer must verify that there is not a drainage easement in place. There is a thick scl cap over a dark 5yr hue sand textured soil. With overlying scl , 5% slope and the dark redish hue if any surface water made it to this sand redox would been very difficult to see. oft 111 0% a o vC B A I Boring r 3 C] Pit Ground surface elev. 106 ft. Depth to limiting factor >78 in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ffz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eft#1 "Eff#2 Al 0-4 7.5YR2.5/1 - SL 2FSBK MVFR GS 2F .6 1.0 A2 4-13 7 5YR3 /2 SCL 2FSBK MVFR CS IF .4 .6 B3 13 -30 7.5YR4/6 - SCL 1FSBK MVFR AS - .2 • C4 30 -78 5YR3/4 GRMFS OSG ML - - .5 1.0 a Boring # El Boring 105 >79 ❑ Pit Ground surface elev. ft. Depth to liming factor in. Sal Appficabon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/1F in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh_ 'EM 1 'ENO2 Al 0-5 7.5YR2.5/1 - SL 2FSBK MVFR GS 2F .6 1.0 A2 5 -14 7 5YR3/2 SCL 2FSBK MVFR CS IF .4 .6 B3 14 -22 7.5YR4/6 - SCL 2FSBK MVFR GS _ .4 .6 B4 22 -31 7.5YR4/6 FIF5YR5/8 GRSCL 1FSBK MFI AS - .2 .3 C4 31 -79 5YR3/4 - �D GRMFS OSG ML - - .5 1.0 NO 10YR6/2 REDUCING i i IN HORIZION 4 1 1 A i I I I ' Effluent #1 = BOD > 30 220 ng/L and TSS >30 < 150 = BOD < 30 mg/L and TSS < 30 rmyL CST Name (Please Print) _ _ CST Number LEWIS C WORK 253976 Address Date Evaluation Conducted Telephone Number E7818 COUNTY ROAD E MENOMONIE, WI 54751 4-19 -2010 715- 231 -7375 Property Owner JASON SABELKO Parcel ID # 022 - 1011 -38 -1 Page 2 of 3 B3 Boring # Borin 104 >78 F T ® Pit Ground surface elev. ft. Depth to limiting factor in. Soil Amlication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDJfft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh_ *Eif#1 *Eff#2 Al 0-4 7.5YR2.5/1 - SL 2FSBK MVFR GS 2F .6 1.0 A2 4-11 7 5YR3 /2 - SCL 2FSBK MVFR CS IF .4 .6 B3 11 -30 7.5YR4/6 - SCL 1FSBK MVFR CS _ .2 .3 C4 30-78 5YR3/4 - GRMFS OSG ML - - .5 1.0 Boring i 1 r P4 goring # 130 28 Pit Ground surface elev. ft. Depth to limiting factor in. Sod Appkation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu_ Sz. Cont. Color Gr. Sz. Sh. i *Eff#1 'Eff#2 Al 0-9 7.5YR2.5/1 - SL 2FSBK MVFR CS 2F .6 1.0 B2 1 9 -22 7.5YR4/ GRSCL 2FSBK MVFR I GS - .4 .6 BT3 22 -28 7.5YR4/6 F1F5YR5 /8 GRSCL 1FSBK MVFR AS _ .2 3 R4 28+ - - SSBR - - - - _ - Boring © Boring # Pit Ground surface elev. 10 L /15 1 ft. Depth to limiting facto? in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff in. Munsell Qu. Sz. Cont. Color Gr. Sz_ Sh_ i *EMI I "Eff#2 S - 7-s - 4/ 0- /K i Z Ma-F& Gs zF 6, Lo -2,%,k -) 14 7 -F-IOV uSVL r- * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD, < 30 mg/L and TSS < 30 rng/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- 2648777. SBD- 8330Test (R.07 /00) ei Ft J j � 4 _,< .• � 1 If - N kn +� r to J O o TJ k T ° f ko 0 4 4 fq V9 _ S 86e IL- o LLA = Z z N in �-� -0[ d g W 7L7 `_ 0 win N z z _ cc dz o. ._ ._._._• CV y �NPA NS �n M M �O O N7i'. 7 �/� I I� \\ O c�S� Sn Q Q Q r�!! N N cn N t all } m I �!� Z IU6 C W W . 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Z °w in laas� =zT eemziaziss ® o NN �d+� En 0800321 80,3 a3AI3038 " .gy IM '00 XI080 'IS SU330 30 831SI03H --E - Y1A 'N N333HIV37 SZS11 3'JVd LL - IOA Z� ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer C4�Or1 'S"bC � L' C-) Mailing Address c l 0 H - FCC-; �)L Z Property Address [ 06 A C-T Y 1`0 [ E 3 (Verification required from Planning & Zoning Department for new construction.) City /State r L'_) _E_ Parcel Identification Number L))') _A )j / ?k� - LEGAL DESCRIPTION Property Location '/4 , '/4 ,Sec. T L 24N RV, Town of Subdivision Plat: ✓ TZ ��[� o ( , Lot # Certified Survey Map # � �ZC; ro , Volume /_7 , Page # Warranty Deed # 91V 777 (before 2007)Volume , Page # Spec house I yes no Lot lines identifiable ! - -' yes i no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that ( I ) the on -site wastewater disposal system is in proper operating condition and /or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. If we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I /we certify that all statements on this form are true to the best of my /our knowledge. I /we arn/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms S SI ATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) ll11111111111111111111111111111111111111111111111 State Bar of Wisconsin Form 1 -2003 * 9 1 4 7 7 7 1 WARRANTY DEED 9 BETH PABST Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD THIS DEED, made between WESTconsin Credit Union a Wisconsin banking 04/19/2010 11 :40AM corporation WARRANTY DEED EXE"l I ( "Grantor," whether one or more), and Jason D. Sabelko and Nicole M. Sabelko, REC FEE: 11.00 husband and wife as survivorship marital proper TRANS FEE: 88.50 PAGES: 1 ( "Grantee," whether one or more). Grantor for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in Name and Return Address St. Croix County, State of Wisconsin ( "Property") (if more space is -r m �, ) needed, please attach addendum): K-b 1 LOT TWO (2) OF CERTIFIED SURVEY MAP IN VOLUME SEVENTEEN (17) 1 4 1 (,QN.i+- F / t14,,Tn ( X OF CERTIFIED SURVEY MAPS, PAGE 4525, AS DOCUMENT NUMBER — Ri Ver F6 5 Lot 723166, FILED IN ST. CROIX COUNTY REGISTER OF DEEDS OFFICE ON MAY 28, 2003, BEING LOCATED IN THE SOUTHWEST QUARTER OF THE NORTHEAST QUARTER (SW 1/4 OF NE 1/4) OF SECTION FIVE (5), 022 - 1011 -30 -150 TOWNSHIP TWENTY EIGHT (28) NORTH, RANGE EIGHTEEN (18) WEST, Parcel Identification Number (PIN) TOWN OF KINNICKINNIC. Subject to C.T.H. 'IN" right of way. This is not homestead property. 00 (is not) Grantor warrants that the title to the Property is good, indefeasible, in fee simple and free and clear of encumbrances except: easements, restrictions, and rights of way of record, if any. Dated / U/d WESTconsin Credjt Union (SEAL) �' r (SEAL) * * By: Leo Schindler, Vice President of Lending (SEAL) (SEAL) AUTHENTICATION ACI�TOW) ENT, Signature(s) STATE OF (� }" �,p -* =$ ), rns authenticated on +� CO Y ) Personally came before me orb �' , ' • ` * the above -named Leo Schindlerr Ike Lendin TITLE: MEMBER STATE BAR OF WISCONSIN 0o (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. r THIS INSTRUMENT DRAFTED BY: * , Joseph D. Boles - Attorney at Law Notary Publl , tate of River Falls, WI 54022 -0138 My commission (is permanent) (expires: a 1 i i a2 p (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED 02003 STATE BAR OF WISCONSIN FORM NO. 1-2003 *Type name below signatures. INFO -PROTM Legal Forms • (800 )655.2021 • infoproforms.com Q , o 0 � i � e Fn 8 a o� z o o � e El 0 El 8 1E. O OGO _ w m Q cr+ o .r_ o � v e ec , m i z c� �- 0 cn co m 6 O O S ezo o <.z cox -�- -- o� .. � a '� i— I _ e ° o - - -� q h — — — saasl e dR .:..:. .. .: : ;..:..� :1 - --------------- L T - 2" -- -- -- - -� -- --------------- 3 6 r — / 2609 o 2 1,0000; VOLT LINE — — — — — — — — — — — — — — — I E:2 DOWN 8 RISERS UP 8 RISERS CEILING LINE _4 cz:l 9— =1 STEPS � 3216 o 99 w a.> O �o a � m s R � � o 5 O — �� I I C- D - I I I I I 1 I I 1 I i I I I - -- I 1 � I I I I I I I I I I I I I I t I _ I I O O I I I I L - - - - - - - - - - - - - -I o ° m 6 CJ cr z car ..c� 0 1 v - z J 1 U F O r_, o� 7 ZAIJ soa rc] rtrr�ent of Comme�oe SOIL EVALUAMON REPORT /off Wy 1 e Division`ofsrdAtyars! legs. it.J Wis. r�dnx oore Attach oomplsbe siee plan on paper- not kwa than 8 11 ktohes ki of7A Pfau UWM mom, but teat l mftd lcr +wecsi 80 h xtwn al Mk fm" point (M), dinactim � $ m r ro rl 36 —1 pano tsWe. scaiaor ci m ions, nail, am m, andimatbon and distance to nauest road DEC plww Pont aA ftim r�moom ' t�csterei Youtxavaamaybowao a• oo�'l rt�l +aaatPKragrl�•.s- isnetYf�to. ss.ca plopmv GovL Ld SW 114 NE 114 s 2 T fl# ambl c# arm oEx6hw 2 5 No- zip Go% ptwe bkaohor EPNY [3vmw W ow i Slt. Pail W 1 53075 1 { 614517320 lcmN w New ConalrucOm Usula Rmidentlel / Mm9 araFbeftow Oo* did design *waft 450 t�+o PAVtaomaM4 13 Pra�carao - Parmt noel of _ _ YMMMMIM Rood Pled dwdan if "01mble - NA tt G ca�rs+erda by An An or site has beer► aat dig alts SL C roix Coanty Zamit on 12rISG2 7 �l Lit- 1E1+ � fYhWf+� e sratt;aAa aim 9621 iL Dep3t to &Mft for g in Se! Aaftabn fierce "Mb Dopm Do &MA Redmc Dsua%* rc tmdM - ttm Ommialafte ftmfty tools im AAansel UL Sr- cant. Color tL &- SA. 'fd1f�1 "Eftl� x 1 0-12 10yi312 to 2mabk Mk cs 2f S .B- 2 1214 1 - ad 2mm& na£r cS 1f .4 .6 3 19-26 i 4 aid it, 4 26.48 7.,$YW6 c2d5yi5B sat imsbk mfi - .Z .3 F21 ft" Q a wng Ground stn�aoe alev. 96.63 m 32 � Ft T WM Dor►tirWW ftffGe: Damopum TOO" smxw a conshft cs Bwrjd Raf mow im ll Qu. Sz. cwt color ► `E2 1 t2 10yr3l3 - A lfpl xu& cas 2f .2 2 -17 1 3/2 sicl i mfr cs if .2 .3 3 32 114 2bi mfr cs - .4 -6 4 -48 I0yr5/6 g imtiblc mifi - - 2 3 Bfliuerrt41= B00 > 30 :5M mgvt ad m >30:S Mk - ' EAAm*42= 80©:S 30 nigh snd M:5 30 mglL . CSt IV8c18 � °a � Thoms C Nelson ! Address Dab EvAsdion Ctarducted Telephou d mr 143 2120th Sttr, Ncw Ridmwm4 W1 IZIt?Gf((}Z 7i5 b -1434 Arw- i s - - Owl 14 t V -Iff t. 11_ 1'ii�tli o-1 r. - - q ^� I .l t • nl; .-e f 1 {:: i�.. tt ff�111 t ail = 1'1�.�.v ♦ .l. i Vq Frd Le-n#-PA-l-, M i1v i 13e m Za v 5 Ike- 9f I 9e at :i 0 r 1 i Z. ?$ • �,a,.r�vrr; ce:r�C['rt; -�-�' .. ..._ _.. weer rtt, Ft�f Category: Minor con" T f nnidkinnic Tomship Engineer. Unknown 35 T 28 R 18 Company. Do not enter infatuation Tat$R P=s: AO.75 a5r� 003 Tom Healy Jar? srx rrentag Tom it is my understanding that LeM Jansky would esrra 11Y supper that there are surtabte areas for a sepfic system au bftlse_prQpased lams. Howrraec, l have art erna� into Mc ,risky Lot 2 of CSM 'C. I :seeded AID dartfY whether as lnie revlaw Is neededforthat / can f - L atiow tha normal i guidrfes for designing a moursi' c►Y wotdd agree that a system go in there, but he mot be a . As dSWW sdx"0sc0n that tee pe=nS#Y rev"% for ttw d esign tar as gattM on the March 13th agenda, that meets is W intended to be for Z issues and staff vAl not be man sift two separate a gendas each month. lam, 9 Stm has the "•. �,�_ opportunity to speak with the Chaimran 1 wV1 ask that #W discuss Oft 13BUS. Steve is at a se mw this week and will not be back until ThutsdW- In regards to cSM D & F, l wild aCeept that the sot test issues have at feast been iderffled and ftbd for ok for the app roval of the CSNI- just be owtai to c ornpl b � Of I w,.wme that you will be sunm � You . the required Letter of Credit. Have a great attemoon. Talk `1on 90nrWWftg Jars smwtag O5O&ZO Leroy Jansky Leroy Wow are you this atle t rnoo ? t just warted � Y some n for Our free. on tat 2 for the p CSM •C- (atads Cty Rd N Tom Nets with an A +3 coon. Was K de maied at an orwas his report conservow we can A+4 oondii ore- Please Ist me know when you rim a cnance. ISM a" I Jar Jon Swnerft We verified >A+4. iMtM I write my report M try t o cave that are so WW a mound plan is F applied for it won't be held up. Swnerft 05*2/2 03 Adam SchuraW r Jan He will Idok fat' the actrrat &A test. it 4"M that we never had tree ctrr+sc� of tot 1 CSM C Q7/ pa3 Adam Schumsrker Jere Som+eretag I left a rre once requ that he produce a sod test for tot T, because tt>�+e is na one an record even though he did visit the site with Leroy at one point. I '