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HomeMy WebLinkAbout022-1011-40-120 +meet of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Division INSPECTION REPORT Sanitary Permit No: 430313 0 ,L INFORMATION (ATTACH TO PERMIT) State Plan ID No: ,nformation you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)J. Holder's Name: City Village X Township Parcel Tax No: .nos e, Jeremy Kinnickinnic Townshi CST BM Elev: Insp. BM Elev: BM Description: gm / SectionfTown /Range /Map No: l 00 - 00 !0 0J 0 CeIj 05.28.18. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic. Benchmark /�' �• �� d� I - "10 1OV7 / eo, a Dosing L Alt. BM t1wou 5e U T �) U, q dj t l - �c y'�'. 5/ 8.1 7 1 lab' Aeration _ B d . Sewer Holding C L74.. _ St/Ht Inlet Zz, TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet I Septic 1 / � Ri k j t, I Dt Bottom S -3 4 83.0 In 4W_ Dosing Header /Man. Aeration _ Dist. Pipe S` ' Z.Z t'' /d /. 7y r Z /or . 7Z— Holding W -------- -- - -.. Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer } Demand d St Cover �— a nt GPM Model Number ^ � � G � 3 // 5au - h 1 _ ` �1 l� it D,-th 9 .3b TDH Li Friction Loss Syste Head TDH t ,'S 75r-- 2.7 z h> 1. 7j / ,�� q--? 2 T_ .27. y f'; r.l E z• Z3*' /o / - - T Forcemain Length c� )e_ Dia. Dist. to Well L s 4 SOIL ABSORPTION SYSTEM T- Wt Pi - -n« BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS — -- . SETBACK SYSTEM TO P /L,tpf BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System SAO3 { ACg ' UNIT Model Number: 11, DISTRIBUTION SYSTEM f Header /Manifold) /� Z Distribution x Hole Size x Hole Spacing Vent to e Pipe(s) ' 1 1/ t Length Dia ' Length Dia Spacing 3 1 11p, �y SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of 1 7Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges 7 / Topsoil El y es [71 No Yes No COMMENTS: (Include code discrep ncies, persons present, etc.) Inspection #1:Oq f7_4 /0 Inspection #2: / / Location: Unknown (SW 1/4 NE 1/4 5 T28N R18 ) NA Lot 1 Ti if 6% t1 Parcel No: 05.2.18. MW I 1.) Alt BM Description = /08y l 2.) Bldg sewer length = 2- 3 - amount of cover I / Plan revision Required? ]Yes l No Use other side for additional informa)n. SBD -6710 (R.3/97) Date Insepctors Signature Cert. No. Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 <4 C �Ql N visconsin ' Madison, WI 53707 - 7162 Sanitary Permit Number (to be f�1ecJ�n�1y Co. Department of Commerce (608) 266 X303 / �fCa�l(/ State Plan I.D. Number Sanitary Permit Application _ - - �f In accord with Comm 83.21, Wis, Adm. Code, ersonal it )rmati¢f r�a �y D `f may be used for secondary purposes Privacy Law s15.04(1r) �,w Project Address (if different than mailing address) log g c o � I. Application Information - Please Print All Information AUG 1 (� 2003 ! / Property Owner's Na me Parcel k Lot # / Block X T /✓4 k'NoS C� i Property Owner's M ailing Address - - °' Property Location (xj J( City, State Zip Code Phone Number t �'! /� =�� Section (�1/[ " ' (circle o te) 1, Type of Building (check all that apply) T N; R /O E o,�V �� Ill 1. L Subdivision Name 7ly3 {/ SM umber 4 or 2 Family Dwelling - Number of Bedrooms 7 ❑ Public /Commercial - Describe Use V __ o L 7 rI — _ -- ❑ State weed - Describe UsN� ;r (! (. �p 7� �_ -� ❑City ❑VillageXTownship of ���,�( O' III. Type of Permit: (Ch o nly one box on line A. Complete line B if applicable) A. New System ,e y ❑Replacement System ❑ TreannentlHolding Tank Replacement Only � iJ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous I'erntit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS Systern: (Check all th apply) — ❑ Non - Pressurized In- Ground 1c Mound > 24 in, of suitable it Mo d < 24 in. of suitable soi ❑ At -Grade 11 Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) ; - V. Dis ersal /Treatment Area Information: Design Fl w (gpd) Design Soil A lir tion 12ate(gp 3 �st) Dispersal Area Required sf) Dispers 1 Area Pro os 1 S stem Elevation tee. i VI. Tank Info Capacity i 1'0 ta umber Mat ufacturer Prefa Site Steel Fiber Plastic Gallons Gallons of Units --- ',A✓jL DU �L onerete Constructed Glass New Existing ' Tarils Tanks Septic or ltolding'lx k / -- - Aerobic Treauuent Unit ' Dosing Chamber � — VII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown oil the attached plans. APluniber' ber's Na me (Print) lumber' gnature MP/I�'umber Business Phone Number ddre e ss (Street, City, State, Zip Co VIII County/Department Use O Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Dat Iss ed suing Ag it�S S amps) Surcharge Fee) y(7 QO C� 6 3 ❑ Owner Given Reasat for Denial 'lhr t VIE TN 149 is of Approval /Re ons for Disap��va� 1 3eptic tank, effluent filter and isper m cell must all e e i m d i s per management plan provided by plumber. L / n 2. II setback requirements must be ma ntained s per applicable code /ordinances. �dyvt�r� S3 . Y �.� ✓ 0 Attach complete ph s (to tha County only) for the ystent oil paper not less than 81/2 x 11 inches in siz SBD -6398 (R. 01/03) rt,U't rLr1V Scale Page 3 of NV t ZZS of 1 s . - t.1AU:o or-�ZuP o f ' 6 0,F 100. S t , o � 3 -Z x F -- rj Ci ti O - NOTES: 1.- Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observat' ion i es with approved 3. Septic tank to be 1\31g / allon cacit maaufacturedrbquired) . Og P Y y 1.rC1 4j( 1000 �6S`c� - w11, w �9 -L$UO �t -TLSZ_ 4. Bench mark S ; S `POV �. Divert surface water around system to prevent ponding at the uphill side. Safety and Buildings 4003 N KINNEY COULEE RD —� LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 N viscons#n www. commerce.state.wi. us /sb Department of Commerce www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary August 12, 2003 ��� ��� Au g X CUST ID No.267341 ATTN: POWTS Inspector ARTHUR L WEGERER ZONING OFFICE WEGERER SOIL TESTING & DESIGN SERVICE ST CROIX COUNTY SPIA PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL 3 PLAN APPROVAL EXPIRES: 08/12/2005 Identification Numbers Transaction ID No. 896011 SITE• Site ID No. 663111 Jeremy Knospe Please refer to both identification numbers, County Road N above, in all correspondence with the agency. Town of Kinnickinnic St Croix County SWIA, NE 1/4, S5, T28N, RI 8W FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 915026 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes COndih 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. R DEPARTMENT 0 The following conditions shall be met during construction or installation and prior to occupancy or use: OF E General Approval Requirements: SEE CORRES • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10572 -P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10573 -P (R.6/99). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) 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. i ARTHUR L WEGERER Page 2 8/12/03 Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation /operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 G Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II, Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday cbratz@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 J TITLE SHEET Page of -7 FOUND SYSTEM FOR A 3 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 C 2. b/ qq� C R. 6 1 4 9 LOCATED IN THE S-IP 1/4 OF THE E 1/4 OF SECTION S ) T Z t N, R 1 8 W, TOWN OF ': T• COUNTY, WISCONSIN. L.DT 1 OF ( sv't INDEX PAGE 1 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 SECTION PAGE 7 of 7 PUMP PERFORMANCE CURVE PREPARED FOR MMERce DINGS PREPARED BY PC � C ENC WEGEF:;-ER SO S L . TEST S P4 (3 AND . DES X GfV S1 I CE P.O. Box 74 421 N.Main St. River Falls, WI 54022 � Phone 715 - 425 -0165 0 Fax 715-425-6864 .••••••••••.,, q ►RTHI L WEGER P615 � ErLLSWQRTM, fS. RECEIVED r, �•�•• J U L 2 8 Z003 r c1 SAFETY & BLDGS DIV. � `z�� SAFE 3 JOB NO. 03 —� Mound System Management Plan , = of / Pursuant to Comm 83.54, Wis. Adm. Code peptic 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 outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids 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. — umTank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps 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 Systern 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 mainteran e) 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 instaUations (October - February) dicta 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 p ovided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated sol ds at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the ;ystem was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distdbudo within the dispersal cell. Observation pipes within the dispersE I cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches consic ered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accc rdance 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 assess ent 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. Continaencv Plan If the septic tank or any of its compon nts 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 control s, alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with 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 about the operation or maintenance of this s stem should be directed to: The County Zoning at - 6 — q u Y . The system installer at 71 ILL Cyv The tank manufacturer at The effluent filter manufacturer at 1) — .ZZI _ The pump manufacturer at Z-�19 j l - - - -L Z . � S - PLOT PLAN Scale 1 " =y0' Page 3 of —] c `o DF 3�GR� J ZZS'0F 3��1� - �- .w�_o'_oN l•uP o f � `'PVC pI P�, __. , �.5 i b tip' qq o FLT C1 iv`zWZAZ%T l uT cvvu i y - SS NOTES: 1.- Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required). 3. Septic tank to be loon / Sp gallon capacity manufactured by W ) �z C C1 w U 1000 6 w r9 -t 0 7A 4. Bench mark 5. Divert surface water around system to prevent ponding at the uphill side. Pace OT , Approved Synthetic Covering ASTM C33 Distribution Pipe Medium. Sand Topsoil l H —_ F Elev. 3 E p I e 6 % Slope Distribution Cell of Force Main Plowed i" to 2- Aggregate From Pump Layer D 1 S Ft. E 1 . 3 e Ft. CROSS SECTION OF A MOUND SYSTEM F p Ft. G 0 S Ft . -- FT �.6v` A Ft. H t - Ft. Linear Loading Rate •3 PD /LN FT B �S Ft. Design L oading Rate = g (��� PD /SQ FT I � Ft. �4 �a. 1 �" ka�_ kK+'V - ,4, J Ft. om . 3 IS'bz� A z h K Ft. L ct - 7 Ft . _ W Z o Ft. ,} - Observation Pipe B ' K 0 --------------- - - - - -- --------- - - - - -- - - - - -- A 0 - -- L ` 1z W — _� -- - - -- - - - -- �_ -- - - - - -- J Force Main Distribution �-- Ce1T of to 2 Z" Pipe aggregate , Observation Pipe (Anchor securely) PLAN VIEW OF -A MOUND SYSTEM ' Distribution Pipe Layout P� o e S of . Place the holes at the bottom of the distribution pipes at*equal spacing. Remove all burrs from the pipe and holes. a Extend the end of each lateral up wirh the use of Iona turn or 45° frdng to a point within six inches of the final grade. Te.•mivate the ends of the laterals with a valve,:threaded cat) or • threaded plug. Provide access from final Bade for the valve, threaded cap or threaded plus. Fu C PV C f RI Lateral— Manifold Lateral X x x ( x xnl xnl z x x x = Lateral Length — P Distribuden Line �Lt?•N V \eve .— P i ` ;rCl:s six --0 r rrs,a � F%u • S FORCc r+�rN P Ft. Hole Diameter 1 Inch S 3 Ft. Lateral " Inch(es) X 'Z Inches Manifold " 1 / ZInches Force Main " Z Inches # of holes /pipe l9 Invert Elevation of.Laterals 101 =aft. _ Combination Sept3,c;Tank and PUMP CHAMBER CROS SECT AMD SP E CI FICATIONS ' PAGE � OF VEUT CAP - WEATHER PROOF JuuCTIOU BOX . ti C.Z. VENT PIPC APPROVED LOCKING 1 10' FROM DOOR. MANHOLE COVER k. V :WINDOW OR FRESH wAptJItJG LA6>;L.. L u � 3 P1otJ tPE R IIJT/lKE cCV.3plllr /RtcLTi s p�- p AL_ c F1 N ISM `i' Mimi. G�s'oE INLET PROVIDE AIRTIGHT SEAL I I I : ^ �At -rat ' I I Approved zt�8�. F1� I i�I Approved joint w/ I I I joint w/ PVC pip ALARM PVC pipe a I I • C ow CLEY 1 ` $ FT. _� PUMP — OFF D COAICRETE DLOCK t: RISER EXIT PERMITi ED ONLY IF TAWK MAWUFACTUREIZ HAS SUC APPROVA APPR 3 "ADP12ti.1<p . �BsDO t iv 4 5EPTIC F SPEC, IFICATIOKJS DOSE TAUK MALI UFACTU;LER. V OtZS �Z OZ 1JUM5ER OF DOSES: - S PER DA. TA SIZC: 10L�OAQ - I'"1R GALLOWS DOSE VOLUME z f ALAR NIAUUFACTUFZC:R: S - O S I &J IAICLUDING /ACKFLAW: l �b GAttOt�tS MODEL WUMBER: 1 ' 0 l "w CAPACITIES: A= � y 3U� �1Z�v�� -y IUCHES OR GALLOij5 SWITCH TyPC: g = Z IUCHES,0R G�LLOUS PUMP tkA.NUFACTURCR: L1ZS s� 11 MODEL 1JUMbER: �� S� WCH ES OR 1 � GALLOLIS Dw INCHES OR GALLOmS 3Wt7CH TYPE: / AJOTE: PUMP AIJO A ARM ARE TO C 3 b MINIMUM DISCKARGE RATE t• �1 GPI INSTALLED bM SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWCEIJ PUMP OFF AUO..DISTRIBUTIoM PIPE.. 1q -1 -7 — FEET + MWIMUM METWORK SUPPL & .30 Y PRESSURE . .} �� S FEET OF FORCE MAIN X Ft �l ` � u FE.E. T C no FEFRtCTIOLI FACTOR.. FEET TOTAL Dy1JAMIC. HEAD = - - ----. - f EET As per manufacturer ti`1.0 gal /in. Liquid depth 3 g " • 1�PsG E o F 7 ME Series MyM 1/3 through 1 -1/2 HP Effluent Pumps Performance Curve CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 400 450 100 90 28 80 tiJF 24 � 70 / ` S Q W W MFG w W QQ 20 M Z 60 Z W 50 M ��$ 16 w 2 _ J H 40 0 M F$Q 0 12 O H 30 310 8 20 F33 10 4 0 0 10 20 30 40 50 60 70 80 90 100 110 120 130 0 CAPACITY GALLONS PER MINUTE mvem • 1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289 -1144 FAX 419/289 -6658 Telex 98 -7443 K3327 8/92 Printed in U.S.A. 06/17/2003 09:11 7153814232 NIELSEN PAGE 02 ` b . t ��, SOIL EVALUATION REPORT Page of n ision of Safety and Buildings in accordance with Comte 85, WM Adm. Code County *ach complete site plan on paper not less than 8 1/2 x 11 inches in Size. Plan must Zclude. but not limited to: Vertical and horizontal reference point (BM), direction and Parcel I.D. mroent slope, scale or dimensions, north arrow. and location and distance to nearest road Reviewed by Date Please plInt all h7forlmati0n. Personal inromration You P -vw may to used lot second Y Wrposes (PdvM La*' s. 15.04 (1) Owner (mi)- ,, y Property Location (or) ) US P c , Govt. Lot _<6V 114 E 114 S $' 7 Z N R E l Lot # F Block # Subd. Name Or CSM# ,perty owner's Mailing Address / r�it. VGlage ® Town Nea=j Road y State P Cod Phone umber Q City [{ r% G Iss 07 ( ) New r Corlsftcdm Use: (a Residential / Number of bedrooms Y Code defined design flow rate 4 0 GPD Replacement 0 Public or comrneraal - Describe: R ,rent material Flood Plain elevation if appq� able _ aneral comments C S /C/vA $ /'CV rf idrecomnendationss: y i 1 Boring # 0 Z- Z In. r ( - �{ Ground surface alai. . /0 ft Depth to Gtr�ltin9 _ gpil Oon Rate Roots GPOW lorizorr Depth Dominant Color Redax Description Texture structure Consistence Boundary �## 1 *01102 in. Munsell Qu. Sz. Cont- Color Gr. SZ Sh. r .�.� �ntb !n � G s � ✓�' � � fJ — Z .50 Boring # Boring p Ground surface elev_ T& Zd el Depth to Gna6ng fact in. Sot AppNcation Rate GPOW Mnzron Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots -0112 in. Munsetl tau. Sz. Cont. Color tar. Sz. Sh. Effluent #1 = Boo, > 30 720 rnWL and TSS >30 _� 150 mg/L ' Etlluent #2 = 80D < 30 mglL and TSS < 30 n+BfL CST Name (Please Print) alure CST Number Address o� Date Evaluation Conducted Telephone Number rFa i Cto S) r CO r n t 1 i A w rparh*rent of Commerce SOIL EVALUATION REPORT Page of 3 Dh oafety and Buildings in accordance with Comm 85, Wis. Adm. Code County 1 Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must `, \ include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel LD. c✓ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Q Please print all information. eviewed b Date 2 Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.14 (1) (m)). 6 Property Owner Property Locati / •C Zen el'o_ z Govt. Lot Sw 1/4 NE 114 S s T z N R E (or) d Property Owner's Mailing Address Lot # F Block # I Subd. Name or CSM# o 0 71 3/ / - P City State Zip Cod Phone Number ❑ City ❑ Village [ Town Nearest Road (( C y ' T• � X07 ( ) L W New Construction Use: Residential / Number of bedrooms 3 — y Code derived design flow rate _-Y O O GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material / e' // Flood Plain elevation if applicable /l/ //`� ft• General comments S ys> el-ev �'I- so -/Lo — and recommendations: d _ �on�� � el c u• �'ff. Boring ©Boring # ❑ ® Pit Ground surface elev. 7q. /D ft. Depth to limiting factor Z Z- in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#2 ),no Z� / 31f CZ-P ' Boring # ❑ Boring ® pit Ground surface elev. . ZC) ft. Depth to limiting factor 26 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff1Q 2 r -Z 6) / 0 , /" /G / a C Ze LE ry/ C � — , `Y 6 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 _< 150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L CST Name (Please Print) ignature CST Number �'s 3 o Address O Date Evaluation Conducted Telephone Number 9i/3 �Q �-� ��,..��, wi• .s zs � y - r _ � t Property Owner Z G h 4ir �" Z Parcel ID . # Page o Boring # ❑ Boring Pit Ground surface elev. , y6 ft. Depth to limiting factor Z_ In. Soil Application Ralu Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIiI= In. Munsell Qu. Sz. Cont Color Gr. Sr- Sh. - Ef 1 - 'Eff #2 7-Lx 1,sAk A Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Ralu Horizon Depth . Dominant Color Redox Description _ .. Texture - Structure Consistence Boundary Roots GPD /ftr In. Munsell Qu. Sz Cont Color Gr. Sz. Sh. •Eff #1 'E11#2 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftr in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. •Eff #1 'E14#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 m _ g/l. and TS5 < 30 mg /t_ The Department of Commerce is an ecpral 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. SB"330 (807100) PAGE�OF__� NAME Pr1 -ef - - LOT# LEGAL DESCRIPTION S U X AJE Y ,,S 5 T Z9 ,N,R, y$�(Qr� SCALE: 1 BM 1 ELEVATION /00 • y BM 1 DESCRIPTION L164 &C - BM 2 ELEVATION BM 2 DESCRIPTION r l H DyL /l•D -L – SYSTEM ELEVATION 9J 5 SYSTEM TYPE /!I ov hd CONTOUR ELEVATION Y9. 40 W ME _ 1- 11,4 O G aZ a o 0 ya° SIGNATURE \ DATE --,— O 2 UC /ii /UU rhi iJ:iz CAA tia Joo 9000 al k1rA VV LV1v11vV wjvv� ST CROIX CUUNTX SEPTIC TANK MAINTENANCE AGREEM AND O)M�ERSIW CERTIFICATION FORM OwnerBuyer Mailing Addr ess Property Address c.�. 1 JC (Verification required from Planning Department for new construction) Q n Number City/State P arce l ;1 t �J «��? Idenhficatto W4&� A EGAI� DESCRIPTION Pro erty Location SLR %•, � � '/4, Sec. � T �Ga N -R L Ww , Ton of 1 �! � P Lot # Subdivision Certied Survey Map # „ I`1 3 Volume Page # fi Warranty Deed # _? _ L `� Volume Page It Spec house 0 yes P no Lot lines identifiable [ yes O no SYSTEM failure to ENANCE Improper use and inaintapance of your se pti c system could result in its Pm=t= h ssyteou P roper ut into t systcon consists of pumping out the septic tank every three Yom or sooner, if needed by a licensed pumpe What can affect the function of the septic tank as a treatment stage in the waste disposal tysteai. t a eertifi cation form, signed by the owner and by a The property owner agrees to submit to St: t�roix Zoning pepazimen mi that (1) the oa -site wastewaterdisposal system asterplumber, journeymauplumbar, restrictedplumbet or a liceasodpumpervcrifying the septic tank is less than 1!3 full of sledge. is in proper opasting condition and/or (2) after inspection and pumping (if necessary). cd have dead the above mgdremcnts dad agree to maintain the private sewage disposal system with the standards set f the undersign , State of Wisconsin. C rtMcatiou set forth, herein, as set by the Departracnt of Commerce dad the Department of Natural Res to the St. ources Croix County Zoning Office within 30 stating that your septic system has been maintained must be completed and returned days of the three year expiration date. ,��)) s DATE A OF 1 OWNER CEk2'I'II?'ICA7,TION knowledge. I we am (arc) tho owaet(s) of I (wc) certify that all statements on this form are true to the best of my (our) ( ) the property described above, y virtue of a warranty deed recorded in Register of Deeds Office. - - Ie� �✓`' AATE NATUB F APYLI eat • «s «••. • • *•* * Any information that is mis- represented max result in the sanitary permit being revoked by the Zoning Departm . •• Include with this application: a stamped warranty deed, from the �� boa � � o �e wa rranty decd a copy of the certified survey map 1 2327P 985 731645 It STATE BAR OF WISCONSIN FORM 1 - 1998 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD Document Number This Deed, made between Frederick G. Lenertz, single , Grantor, 07/23/2003 09:30AN and Jeremy Knosoe and Jennifer L. Knosoe, husband and wife WARRANTY DEED , Grantee. EXEMPT t Grantor, for a valuable consideration conveys to Grantee the following REC FEE: 11.00 described real estate in St. Croix County State of TRANS FEE: 134.70 Wisconsin (the "Property "): COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Return Address David J. Estreen 304 Locust Street Hudson, WI 54016 sE V NE Y1 1 � y Parcel Identi Number (PIN) am �, Vjtq �"x�ia,+ ` i D f1 victim, t� 022 loll- 4o Is not homestead property. ;"� C �,A ,paps. This 4 q Q I ao (Is) (is not) ' 1 ` d" Na • 'lIV 311 Together with all appurtenant rights, title and interests. none Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except Dated this 18th day of Jam, 2003. (SEAL) (SEAL) Fre erick . enertz (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, WENDY SWATZINA ) ss St. Croix County authenticatedthi WISrQN IN _ Personally came before me this 18�h day of July(, 2003 the above named Fredrick G Lenertz. a single man to me known to be the person who executed the foregoing instrument TITLE: MEMBER STATE BAR OF WISCONSIN nd ac l owledge the same. (If not, Uyviu 4 ; authorized by §706.06, Wis. Stats) THIS INSTRUMENT WAS DRAFTED BY Notary Public, State o isconsin Coldwell Banker Burnet 1301 Coulee Road My commission i pe a_n�nt. (If not, state expiration date: Hudson, WI 54016 11 3 -46288 � — ) (Signatures may be authenticated or acknowledged. Both are not necessary.) Names of persons signing in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc. WARRANTY DEED FORM No. 1 –1998 Milwaukee, Wis. EROSION CONTROL PLAN For 1088 C.T.H. N (Kinnickinnic) — owner(s) Jeremy Knospe Under St. Croix County Zoning Code 17.70(3)(b)5: "The (Zoning) Administrator may attach reasonable erosion prevention conditions to a permit approved for issuance." Comm. 21.125 also requires the building permit applicant and/or landowner to follow erosion control procedures and maintain them until the site has been stabilized. The owner is responsible for notifying all contractors performing construction on this site that an Erosion Control Plan is in effect and the following activities will be required in order to maintain compliance with the plan: 1. The primary source for construction site runoff will be the house foundation excavation, driveway, and any soil stockpiled until final grading and stabilization is complete. Septic system excavation/installation adds to temporary disturbance, but establishing cover on exposed soils will prevent erosion. Plan to apply seed and mulch as recommended in #5. Maintain existing vegetation wherever possible to minimize sediment movement. Drainage is to the northeast, with >500 to nearest concentrated waterway. 2. Route contaminated runoff into vegetated buffer areas by creating temporary diversions graded ALONG CONTOUR between excavation areas and any drainage ditches or waterways. Make sure no concentrated drainages or ditches transport runoff that may create erosion problems in neighboring fields. 3. If builder /excavator grades the site to create temporary diversions (see #2) to contain sediment and leaves adequate vegetative cover to protect areas of concern, installation of silt fence MAY not be necessary. Silt fence or other approved sediment control products will be required if sediment cannot be contained on owner's property with the diversions and vegetative buffers. The POWTS inspector will evaluate ESC plan effectiveness and make recommendations to owner and building inspector for any action required to comply with applicable regulations. 4. Construction equipment and vehicles must utilize a stabilized driveway access off public road for heavy equipment; this includes cement trucks, well drillers, and other contractor's vehicles that access the property during construction. This helps avoid muddy, rutted conditions that may allow contaminated runoff to reach waterways and/or drainage ditches. Property owner must repair damage to ditches resulting from multiple Y g p rtY p g g p access points and sediment tracked on public roadways must be removed at the end of each workday. 5. Stabilize new topsoil cover over septic system with seed and mulch immediately after installation — do not wait for final stabilization and/or landscaping of entire site to cover exposed soils on the system. If weather will not permit seed germination, a heavy straw mulch cover will prevent erosion until grass /vegetation can get established. Erosion control matting can be applied any time of year and, if installed properly, will provide protection even if seed germination is delayed. The owner of record during site construction will be responsible for compliance with the ESC Plan. Attached is a detail for temporary diversions. Please feel fre ac a wit uestions or ask for assistance with erosion & sediment control installation. Pre ared by: Pamela Quinn, Soil Erosion Inspector #6650; Owner acknowledgement of ESC Plan requirements: '—/—/2003 _- - 996 O asrav o 057 _ M ° . 1/ 78�� 087 - �� 1059_ - -, A C ravel J, J� cc 1 - R /oa -- — - -\ — 5 II 054 11 II 0 i 00 t� - �, 088 1083 —� $ ///4 - r o� n RD 094 ❑ //34 11 I I 0 i7 �' r ❑ ��I �• II o 990 ... _ ... ... � �_— � � � •. �, 92 109 I� tO25 1 - 10 8 _ -_ i lilol \1 M Ile ct r � 4�7 r `�► ��� �- vea1 "ow, v REM AkkrOT ,� �8 714311 VOL 97 PAGE 4489 V I P REGI H. DEEDS — REGISTER OF DEEDS _. - - -- -- - -- - - - -- - - -- -- ... - -- -- - - -- ._�. — - — -- _. -. ST. CROIX CO. NI RECEIVED FOR RECORD W (A ( 03/24/2003 01 :00PM Z2 N O ® ® CERTIFIED SURVEY MAP REC FEE: 13.00 o COPY FEE: ° o m v vv 0m -0 to Corm om0 0 r. PAGES: 2 1 z X X ;o 0) m o — m a)om 000 0 - - - - -- ��C)- --4 00 z - z ZU)o m z ° D D� �`5 r= m — 8 mho m -U °c C) ;u G7 c) Dm ZZ55 NOZ �n mZ M ° n � - c - y_ z c o Z 0 � � r- r_ v ° Z BEARINGS ARE REFERENCED TO THE � rj m 0 m o � CD --I - n m o o z ° a ^ s co EAST LINE OF THE NE1 4 OF SECTION f?1 D - n D � -< 0 N� ° v m m -Z + D m m n a � m 5, ASSUMED TO BEAR N01'09'48 "E (0;f m m BCD : OCR zr r1* 1-1 0 g -z+ cn ° z � - NE m� o' 0)cn�WN; rrrrrrrrr �j] r 00000000 ° 0 °O / C7 A APF" V V z ? 41 W W N N - -i a"I 0 ST. CRO X COUNTY Z Z 0 cn o cn o X11 7C Oo O N a 'o D / pp iilnn 7nnlnn anr{an�h CiPlRlml�k� OD N — OD — — — — m z I 3b Sm ����((11 �j a ry 0(D W N (D N nnnnnnQ0 (D m !YIFiI� 2 Y 00.3 W N A 0D (o O r m : m C m m C m m G � �. a •• I m ffl m m Z m < < < G 1 .4 -P If �� O„ y � Within 30 days of a 0 oval shall be m o N O O W ° I (D �\�� � W {� 1 cn W CO v O OD (0 o (p cn '• 4 O �� Q� J - i _ w _ ca . ca _ to \ \�0 0 \ (o W W O V OD O D . 1 (p m r N \ \ O L O /1 OIAVi/ C)1 N �I N W N OD N Iq O 0 O 0o O N O O O (o -I A m D O \ \\ \° I N N N N N N N N D "\.61 o U 133 66, °' _ °o�°OCn°O�m �C7 33' _ —�`— � z ;i:�, I D m I �90'L6� 3 „85�g 1�o50S .0 LV696 D m Z m � � 0 I U) I N v, �+ Q 1 Ln mo 0 A �I �I i W i � �`� �' z � O N Zm . 4S01 °09'48 "W i C C/) M I r E l W I 396.26' (n J Q II 152 i r_� C � �i � _ RECEIVED 3 20_T■ I COUNTY ISCONSIN six cuuN7Y ZONING OFFICE n ■.r G F - UNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 EROSION CONTROL PLAN (715) 386 -4680 • Fax (715) 386 -4686 For 1088 C.T.H. N (Kinnickinnic) — owner(s) Jeremy Knospe Under St. Croix County Zoning Code 17.70(3)(b)5: "The (Zoning) Administrator may attach reasonable erosion prevention conditions to a permit approved for issuance." Comm. 21.125 also requires the building permit applicant and/or landowner to follow erosion control procedures and maintain them until the site has been stabilized. The owner is responsible for notifying all contractors performing construction on this site that an Erosion Control Plan is in effect and the following activities will be required in order to maintain compliance with the plan: 1. The primary source for construction site runoff will be the house foundation excavation, driveway, and any soil stockpiled until final grading and stabilization is complete. Septic system excavation/installation adds to temporary disturbance, but establishing cover on exposed soils will prevent erosion. Plan to apply seed and mulch as recommended in #5. Maintain existing vegetation wherever possible to minimize sediment movement. Drainage is to the northeast, with >500 to nearest concentrated waterway. 2. Route contaminated runoff into vegetated buffer areas by creating temporary diversions graded ALONG CONTOUR between excavation areas and any drainage ditches or waterways. Make sure no concentrated drainages or ditches transport runoff that may create erosion problems in neighboring fields. 3. If builder /excavator grades the site to create temporary diversions (see #2) to contain sediment and leaves adequate vegetative cover to protect areas of concern, installation of silt fence MAY not be necessary. Silt fence or other approved sediment control products will be required if sediment cannot be contained on owner's property with the diversions and vegetative buffers. The POWTS inspector will evaluate ESC plan effectiveness and make recommendations to owner and building inspector for any action required to comply with applicable regulations. 4. Construction equipment and vehicles must utilize a stabilized driveway access off public road for heavy equipment; this includes cement trucks, well drillers, and other contractor's vehicles that access the property during construction. This helps avoid muddy, rutted conditions that may allow contaminated runoff to reach waterways and/or drainage ditches. Property owner must repair damage to ditches resulting from multiple access points and sediment tracked on public roadways must be removed at the end of each workday. 5. Stabilize new topsoil cover over septic system with seed and mulch immediately after installation — do not wait for final stabilization and/or landscaping of entire site to cover exposed soils on the system. If weather will not permit seed germination, a heavy straw mulch cover will prevent erosion until grass /vegetation can get established. Erosion control matting can be applied any time of year and, if installed properly, will provide protection even if seed germination is delayed. The owner of record during site construction will be responsible for compliance with the ESC Plan. Attached is a detail for temporary diversions. Please feel free to c t me w' questions or ask for assistance with erosion & sediment control installation. Prepared by: Pamela Quinn, Soil Erosion Inspector #66505 Owner acknowledizement of ESC Plan requirements: / /2003