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HomeMy WebLinkAbout022-1011-60-075 RECEIVED SAFETY AND BUILDINGS DIVISION commerce .wi.gov Integrated Services Bureau ,J i, J N 0 ! 2004 13 East Spruce Street i Chippewa Falls, WI 54729 sconsi NSPECTION REPORT www.commerce.state.wi.us /sb ��I),. JJPh (715) 726 -2544 apartment of Commerce �,r�n„N�.; riFF�CE. Date of Inspection: April 20, 2004 Plumber Name and Address: Project Name: Waskiewicz Kim O'Connell Use: Resdiential 504 3` Ave Legal Description: NW, NW, 5,28,18W Osceola WI 54020 Site Number: 664527 Subdivision: Certified Soil Tester Name and Address: Municipality: Town of Kinnickinnic County: St. Croix Plan Transaction Number: 905298 Sanitary Permit Number: 430351 Owner Name and Address: Jon Waskiewicz Wastewater Flow: Persons Present: This inspection was completed pursuant to s. 145.20 (3) (b) Wis. Stats., as part of the annual audit of the St. Croix County Private Onsite Wastewater Treatment System program. The following code discrepancies were noted at this site and require attention by the installing plumber. 1. The observation pipes must terminate with a water tight cap pursuant to the Mound Component Manual for POWTS (Version 2.0) SBD- 10691 -P (N. 01/01). 2. The mound needs to be seeded and mulched as required in Construction Procedures step 19 of the Mound Component Manual for POWTS (Version 2.0) SBD- 10691 -P (N. 01/01). 3. The manholes on the septic /dose tank are required to be secured by a locking device ( i.e. a padlock) pursuant to Comm 84.25(7)(h), Wis. Adm, Code. Please see that the above discrepancies are corrected by July 9, 2004. All work must be done at the plumber's own expense. The plumber will need to contact either the county inspector or me for an inspection of the corrected installation. If you have any questions regarding this report, please contact me. d ro 2 y � G. �J#nsky, tewate pecia list Liansky@ ommerce.state.wi. s E -mail 715/726 -2544 Voice 715/726 -2549 Fax cc: ZCounty [K Plumber ❑ CST ❑ Owner ❑ Other . Wisconsin Depatrryent of C* mmerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430351 0 GENERAL INFORMATION '(ATTAN TO PERMIT) ate Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. f C = TYp 1�i • /6 #) Permit Holder's Name: City Village X Township arc ax No: Waskiewicz, Jon Kinnickinnic Township CST BM BM Elev: Insp. BM Elev: escription: Section/Town /Range /Map No: Q (0.G /00- o r LkAl � / 05.28.18. TANK INFORMATION ELEVATION DATA • 70 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 66 6 (� -' Septic � G �� _ l a2 (o � Benchmark o � -L I � • � � a� • 2 1 Dosing , 6 Alt. BM O r / 4 I Aeration Bldg. ewer , ? -3 ` 1.90 Holding St/Ht Inlet 3. 1.022 TANK SETBACK INFORMATION St/Ht Outlet 13•`f 90 -92 / TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet / t 13•s� W. 8 Septic > (/ b) Q I C Dt Bottom W -13 ��• ll Dosing / V Header /Man. 3 29 36 / s �, y3 ??- Aeration Dist. Pipe 1 1- 1 13 9 op Bot. Syste uo� � - e t e ✓. 0 Final Grade PUMP /SIPHON INFORMATION t J QS�, DD• 3 Manufacturer Ckv Demand St Cover G d�vy GPM �' Model Number Friction Los System Head TDH Ft f 1 , �y�y -71 Forcemain Len 6th / Dia. /, Dist. to Well / l SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of T enches PIT DIMENSION No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO v P/L BLDG WELL LAKE /STREAM ii Manufacturer: INFORMATION Typ Of System: CH R / i7 / I ( �� / Model Number: DISTRIBUTION SYSTEM Head r /Manifold Distribution x Hole Sizef V I x Hole Spacing Air Intafe Length Dia r Length ! 0 Dia • S Spacing l �j ' ,q' SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Iched Bed/Trench Center s Bed /Trench Edges Topsoil Yes No n Yes Ci No CO M NTS' (Include ode d cr penc es persons pr sent, C. Inspection #1: / 0 / 0,3 Inspection #2: I t / /03 () WeK cs�s rU- ° s�er en e, . -4..ks � a -rte � Location: 1005 King Drive River Falls, WI 5410.2L2 ( 1/4 NW 1/4 5 T28N R18W) NA Lot 2 Parcel No: 05.28-18. 1.) Alt BM Description= - I V 2.) Bldg sewer length = ) 8 r - amount of cover = 4 Plan revision s Required? �'_ de for additional information. No Use other — •�!j L SBD -6710 (R.3/97) Date Insepct s Signature Cert. No. r --------- --- -- Of r I �...,,' �� # �� �R �•.r. T 4 i V- { i r` c z 7 t c� z m 0 y � . Z 0 W U . nJ r - - y Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 N visco,nsi n Madison, `VI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) De artment of Commerce (608) 266 -3151 3o3s- Sanitary Permit Application g tate Plan I.D Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide e415 . may be used for secondary purposes Privacy Law, sl5.04(1)(m) Project Address (if different than mailing address) I. Application Information - Please Print All Informati RECEIVED Property Owner's Na in Lot 1 S E P 0 2003 �! d 2 Z7 / - /_ 7- " �) Property Owner's M ailing Address operty Location S T. CRUIX CUUNTI' & ZONING GFFICE _ tti,!4,Section C' y, State Zip Code Phone Number - _ (circle ) 11. Type of uilding (check all that apply) T � g N; RE on �1 or 2 Family Dwelling - Number edrooms p ZX� Su ' e C M Nnmhe E) Public /Commercial - Describe Us lv = 9 O . �1,) � b ❑ State Owned - Describe Use K 1 r - ❑City_ Vi se PTownship of 111. Type of Permit: (Check only one box on line A. Complete lin B if applicable) A. New System ❑ Replacement System Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System I B. El Permit Renewal El Permit Revision El Change of El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner I. IV. Type of POWTS System: (Check all that appl _ to ❑ Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil ❑ AiGrade ❑ 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. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank ' Aerobic Treamunt Unit Dosing Chamber �� S VII. Responsibility Statement- 1, the undersigned, 49sume responsibility for installation of the POWTS shown on the attached plans. Plumber' a me (Print) Plumbe 's Si jl& / MP /MPRS Number Business Phone Number 1 r l 1 7 lu ber s Addre ss Street, City, State, Z' C 19_�2 ,�2 131� VIII. county/Departnfent Use Onl Approved ❑ Disapproved T SS urcharge Fee anitary Permit Fee (includes Groundwater Date Issued Is ui Agent Signa (No Stamps) El Owner Given Reason for Denial 3 5V J�/ _, a � t . A O r.�IAAA IX. Conditions of Approval /Reasons for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced I maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not Iw than 814 z 11 Inches in sin SBD -6398 (R. 01/03) 1 i f r � I :4 4'-C 1� X . �I �a ;Jes. slarf' a,Gld.w3 ymp I l:rl -slv� �o se�a5�!� /Ire 9V jo � � S" < v •- � tdci �... , +.u :� ; +ask . ,11 ! c (?poa OlZ 'are:$ 'AllJ 'i?a»$) s .gay ;yid a =H�cu��t auoyd s iTsfl aayumH SW aa ► g s.Jaquinid (lulad) aw wtj s, iaqurnld a at{ae�tR c,..r... PR S I MOd aiEa {n uageri> aodsa� atuusse °pau�lsaapun ) ' autaaea .,f; pup W i - #N s )�►a 2I 'IAA : � � l I I I i T -y I I IrT 1 I - ^ i 1 \ � I U I - �__- -- _•! - -- _. -__- -- _ -. �{ -. -t- - -- - y -- 3 4 - I _ 1S .� Safety and Buildings PO BOX 7162 MADISON WI 53707 -7162 TD #: (608) 264 -8777 �sconsin www www.commerc . o nsin. ov Department of Commerce .wiscnsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary September 02, 2003 CUST ID No.224263 ATTIC• POWTS Inspector KIM A O CONNELL ZONING OFFICE K.O. CONSTRUCTION ST CROIX COUNTY SPIA 504 3RD AVE 1101 CARMICHAEL RD OSCEOLA WI 54020 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/02/2005 Identification Numbers Transaction ID No. 905298 SITE: Site ID No. 664527 Jon C Waskiewicz Please refer to both identification numbers, 100TH St above, in all lcorrespondence with the agency. Town of Kinnickinnic St Croix County NW1 /4, NW1 /4, S5, T28N, R18W Lot: 2, FOR: Object Type: POWT System Regulated Object ID No.: 919245 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. 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. 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 f the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Robert Kanter POWTS Plan Reviewer, Integrated Services WiSMART code: 7633 (608)261-7735, Monday -friday 8:OOAM - 4:45PM rkanter@conmerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 f , MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: JON C WASKIEWICZ Owner's Name: JON C WASKIEWICZ Owner's Address: 4411 QUEEN AVE NORTH MINNEAPOLIS MN 55412 Legal Description: NW -NW SEC 5-- T28N- --R18W Township: KINNICKINNIC County: ST. CROIX Subdivision Name: CSM Lot Number: 2 Block Number: Parcel I.D. Number: Plan Transaction No.: RECEIVED Page 1 Index and title AUG 2 2 2003 Page 2 Data entry SAFETY & BLDGS. DIV. Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 PLOT PLAN Designer: KIM A OCONN License Number: 224263 Date: 08/1 4/03 Phone Number: 715 - 755 -3145 Signature: Designed Pursuant to the T `' Mound Component Manual for POWTS Version 2.0 SDB-10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) 7 Version 3.0 (03/01/01) Page 1 of 8 4 'L Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 83 -44-3 in-situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150%) coliform of <- 36 inches. 600.00 Design Flow (gpd) 6.00 Site Slope ( %) 98.00 Contour Line Elevation (ft) 23.00 Depth to Limiting Factor (in) 0.50 In -situ Soil Application Rate (gpd/ft Distribution Cell Information 100.00 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (c or e) E Center or End Manifold 3.00 g( ft Spacing Lateral S P If N above enter the elevation ft ) 2 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 3.00 Estimated Orifice Spacing (ft) = 9.09 ft /orifice 2.00 Forcemain Diameter (in) 145.00 Forcemain Length (ft) Does the forcemain drain back? Y 88.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 23.65 Forcemain Drainback (gal) 10.92 Vertical Lift (ft) 90.43 5x Void Volume (gal) 2 �(, 2.34 Friction Loss (ft) 114.08 Minimum Dose Volume (gal) 19.76 Total Dynamic Head ft stem Demand m �'I Y ( ) 27.19 System (9P ) al Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x X 1.25 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons /Inch Calculator (optional) Treatment Tank Information 800.00 Total Tank Capacity (gal) 1260.001 Septic Tank Capacity (gal) 1 37.00 Total Working Liquid Depth (in) WEEKS iManufacturer 21.62 gal /in (enter result in cell B49) Dose Tank Information Effluent F ilter Info rmation 800.00 Dose Tank Capacity al Zabel Filter Manufacturer P Y (9 ) 21.761 Dose Tank Volume (gal /in) JAII 00 Filter Model Number WEEKS IManufacturer Project: JON C WASKIEWICZ Page 2 of 8 Mound Plan View t 1/10B :::::: :::::: ::::::::::: :: :::::::::::: :: ::'' :: :::::::: :::::' J FK Observation Pipe — � W I _ :......:......'......:.. B .. .... .. ..... .'......'....... .............. ........ ........... . . . ...... .. . ...................... ................................ ......... .. ........... . ....... .......................... ............................... 1. ........... ........ .. ......... . ..... ................. ... ........... ........ . .......... . ....................... . .. ..................... L Mound- Component., Dimensions. A 6.00 ft E 17.32 in H 1.00 ft K 9.17 ft B 100.00 ft F 9.50 in I 10.01 ft L 118.33 ft D 13.00 in G 0.50 ft J 6.04 ft W E 22.04 ft 600.00 (ft Dispersal Cell Area 1600.61 (ft) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 10.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 100.88 (ft) --► H ; I I F isp ersal ' Ce . 0 " 99.58 (ft) Lateral atera 99.08 (ft)- - ► — Invert Dispersal Cell '.�- .;.� .:............. ........ � Elevation :.: 98.00 (ft) Contour Elevation 6:0. % "Site. Slope. Geotextile Fabric Cover Shading Key v T Dispersal Cell See lateral details on 1Q Topsoil Cap 1.5 ft Page 4 for number, Subsoil Cap size, and spacing of , " , 'T ASTM C33 Sand F laterals. Laterals are Q Tilled Layer 0.5 ft Typical Lateral equally spaced from [0 0 Aggregate o the distribution cell's --- A - -40 centerline in the distribution-cell (AxB Project: JON C WASKIEWICZ Page 3 of 8 r End Connection Lateral ram Layout Diagram 9 to 1 La ra s centered over the A & 8 dimension i = Turn -up wl bell uslve or aleartvtrtplug P -� AN laterals are identical Holes drilled on the bottom of the lateral equally spaced S Force main connection via tee or cross to manifold at any point. Laterals & Force main of PYC sch 40 (per COMM Table 84.30 - Number of Laterals 2 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 3.08 ft Lateral Length (P) 98.56 ft Orifices-per Lateral 33 Lateral Spacing (S) 3.00 ft Orifice Density 9.09 ft /orifice Lateral Flow Rate 13.59 gpm Manifold Length 3.00 ft System Flow Rate 27.19 gpm Manifold Diameter 1.50 in ✓ Total Dynamic Head 19.76 ft Forcemain Velocity 2.78 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Disconnect Electrical as per NEC 300 and — ;: Comm 1628 WAC 4 in. min. Tank component is properly vented :'•: �— Altemate outlet location Forcemain diameter WEEKS Manufacturer 2 in. Cap acityl 800.00 Gallons Volume 21.76 gal/inch A _ Weep hole or anti- Dimension Inches Gallons B siphon device A 21.03 457.67 C B 2.00 43.52 Pum off e levation (ft) C 5.73 124.73 — t I 88.67 D 8.00 174.08 D Total 36.76 800.00 J [ Dose tank elevation (ft) 3" Bedding un 3r tank. 88.00 Alarm Manuafacturer 1SJ ELECTRO Alarm Model Number 1HW 100 Pump Manufacturer IGOU Pump Model Number IWE031 1 L Pump Must Deliver I 27.19 gpm at 19.76 ft TDH Project: JON C WASKIEWICZ Page 4 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name �— KIM A OCONNELL I Phone 715 - 755 -3145 POWTS Regulator's Name ST. CROIX COUNTY ZONING I Phone 715- 3864680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1260 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 ft Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 ears Mound Inspect for ndin and seepage once eve 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Tura -up Detail Finished ..��••,........� *000 *00 *00000 *0 Grade 6 -8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral — Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: JON C WASKiEWICZ Page 5 of 8 Mound System Management Plan Pursuant to Comm 83.84, Wis. Adm. Code Goneral This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01/01) and SSWMP Publication 9.6 (01/81)] 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 84nehes in- diameter shall be secured by an effective - locking device-to prevent accidental or unauthorized entry into a tank or component. 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 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 wherr -the volumeof sludgeandscum inthe tank exceeds -1 13 tlw liquid- vokune 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. 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 DWributiorr 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 then 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 as protection from freezing. Influent quality into the mound system may not- exceed -220 mg/L BOD5, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BON.. 30 mg/L TSS, 10 mg/L FOG, and 10" cfu/100 mL for highly, treated effluent. 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 flashed 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 ceil checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels .above .6 - inches - considered -as. an- impending - hydrauUc- faiure - requiring - additional, . more-frequent monitoring. C Playa 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(s) 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 dogged absorption and dispersal media, and related piping and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS'regulato and service provider. -Project: ;SON C 1f1FASK]EW]CZ Page-6-of -8 w A .. .. • = won� �■ ■rr■ ■■■■■r■ NoR r■m� ■■■■r ■mow '"Noommmmmmm am ablom WINE iris' :.' �'! -- ..._ '� ■ ►.1 ■ ■ ►y ► \ ■ ■ ■ ■■ ■t■ moo■ ■mow ■ ■w■ MODEL 3885 SIZE 3 /4" .. .. ■ �i�ii �i�■�iiiw�i■ ■ � �oiw�iow�iii ■■ rr■r■i■ mom NEm omom■■■■■ ■ w■■r ■E■■ worm■■■ .. M ■o ■■■■■■■■ ■■■mom mall io mom womommono _ 1 T I - 1 I I I i I i i t y ` I I I •V I Is i I — i { y a 1 N +- y 1 � Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code ' County 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 I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. evi ed by Date Personal information ou p rovide may be used for seconds u (Privacy () ( / y p y secondar p urposes Priva law, s. 15.04 1 )) m. Property Owner Property Location � i✓ Z- Govt. Lot Wk) 1/4 ,,44</1/4 S :5; T Z &- N R E (or) Y�} Property Owner's Mailing Address Lo Block # Subd. Name or CSM# J�C � lY L city State State Zip Code Phone N ber ❑ City [D Village Town Nearest Road New Construction Use: R Residential / Number of bedrooms _ 3 Code derived design flow rate 4 5X) Z ty GPD ❑ Replacement t E] Public or commercial - Describe: Parent material z:, L1 Flood Plain elevation if applicable A- j.9 ft. General comments s�s f� elev 9Gj / Q and recommendations: e1 e v . 9g. 6a F 1 Borin g Boring # �nn LTA Pit Ground surface elev. ?/ ft. Depth to limiting factor 2_��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#1 'Eff#2 D - -13 l© v - . 5 3 Z k- r- CS Ij 5 . Z 1 5-Zq Ifs S1 S �< -fir Cg ' (0 3 Z9 -39 lb CZP15 r 4 ko 1 2-►ngb n4l _ - 1 -4 F-21 Boring # ❑ Boring © pit Ground surface elev. 9 K 10 ft. Depth to limiting factor 2- 3 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 l c� -(Z ltd Z r C- IV Z i Z -23 ci `1 ;c_f S •" Vr C1 - .4 3 Z,3 y �C� C "i " 5 r t S� I Z►r� _ Lo 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) nature CST Number r _ r 330 Address Date Evaluation Conducted Telephone Number ll3 S� rl. oz 7 - /O 71S - -Lys- YO 0 SBD -811x 11. 07/001 I _ 1 Property Owner LeYl2��7 Parcel ID # Page 2 of 3_ [a] Boring # ❑ Boring 0 pit Ground surface elev. • 7() ft. Depth to limiting factor ��_ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 •Eff#2 I C)-H A 24Y 'r c 5 1 v 5 Z Z (q l 41 c �] Li ❑ Boring # Boring Depth to limitin g factor in. E] pit Ground surface elev. ft. P Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 ❑ Boring # Boring Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots .EGPD /ft:Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07100) �I PAGE-.-3OF 3 NAME Gen e r�c- TOT# Z LEGAL DESCRIPTION �V( ',1/tJ t4 ,S 6" T z� ,N, /� E(060 ,,—SCALE: I"= BM 1 ELEVATION BM 1 DESCRIPTIO d L vc- D, ^p C �f — BM 2 ELEVATION O BM 2 DESCRIPTION V n o -f f / DUG - ----- S PC _ S SYSTEM ELEVATION SYSTEM TYPE lb pU ,2 ct CONTOUR ELEVATION 95.0 1 co✓I �Jr 2 �f.11, o fl $'3 9:7, D d 1 SIGNATURE �— DATE ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address ( d© j (Verification required from Planning Department for new construction) City /State Parcel Identification Number LE GAL DESCRIPTION Property Location '/a e f , S ^�, T�LN - R_Z&_W, Town of Subdivision _ �y , Lot # . Certified Survey Map # , Volume ,J7 , Page # 7 Warranty Deed # `7 /V /' , Volume ?/'7� , Page # Spec house ❑ yes 1 no Lot lines identifiable ❑ no SYSTEM MAINTENANCE /< Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) 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. I /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 Zoning Office within 30 days of the three year expiration date. * APPLI NT DATE OWNER CERTIFICATION 1 (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. S NATURE OF APPLICA ATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * *• ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed J 2179P 365 714145 STATE BAR OF WISCONSIN FORM 1 — 1998 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI Document Number RECEIVED FOR RECORD This Deed, made between Frederick G. Lenertz AKA Frederick G. 03/24/2003 08:00AN Lenertz Sr. Grantor, and Jon C. Waskiewicz and Judith" WARRANTY DEED Husband and Wife , Grantee. EXEMPT # Grantor, for a valuable consideration conveys to Grantee the following described real estate in St. Croix County State of TRANS FEE: 11.00 Wisconsin (the "Property'): COPYFEE: 128.70 * %skie&2 CC FEE: PAGES: 1 Recording Area Name and Realm Address The First National Bank PO Box 89 New Richmond, WI 54017 l 022 1011 60 000 Parcel IdenUflcation Number (PIN) This is not homestead property. (is) (Is not) Lot Certified Survey Map filed In lume 1767 as oc ment No. 710988. Located in part of the NW /4 e NW /+ ' of Section 5, T 28 N, R 18 W, Town o Kinnickinnic, . ro o y, sconsin. Together with all appurtenant rights, title and interests. pone Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except Dated this 28th day of February 2003 (SEAL) (SEAL) F i c rtz (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) Wp1q svvATZ State of Wisconsin, •IATARX Pi1SLIC ) as. �� = WIS CONSIN St. Croix County authenticated this J�f ' Personally came before me this 28th day of February, 2203 the above med // Frederick G. Lenertz , / ra to me known to be * the person wh exectilod the foregoing instrument TITLE: MEMBER STATE BAR OF WISCONSIN and cknov ledge the Sam . (If not, authorized by §706.06, Wis. Slats) THIS INSTRUMENT WAS DRAFTED BY Notary Public, StaJA of Wisd6nsin Coldwell Banker Burnet 1301 Coulee Road My commission is permanent. (If not, state expiration date: WI 54016 3 -21715 (Signatures may be authenticated or acknowledged. Both are not necessary.) -1 1 5- Names of ersons sign in any ca pacity 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. APPROVED cl<ox x:vrY 710966 VOL 17 PAGE 4467 r F B 2 4 2003 KATRLM H. WWCSW REGISTER OF DEEDS -- ST. CROIX CO., WI It nct recv ;— - r. -f Bays of RECEIVED FOR RECORD approva:dateappro,uOt SURVEY MAP 02 ' 13.00 ro "'I! i COPY FEE: 6.00 LOCATED IN PART OF THE NW1 14 OF THE NW1 14 PAGES 2 OF SECTION 5, T28N, R18W, TOWN OF KINNICKINNIC, ST. CROIX COUNTY, WISCONSIN. SCALE IN FEET 1" = 200' MHP' L/ %uVF,DD MMM ----------------------- oOvkv1m1 CD) HMI - 610 200 0 200 L1 NORTH LINE - - PREPARED FOR: OF THE NW1 14 FREDERICK LENERTZ NW COR. 89 °43'54 "E 340.66' 220 LIVESTOCK SEC.5� .32.84' EXCHANGE BUILDING i 1 °o ST. PAUL, MN �s Z = LOT 1 ^' 55075 Q o f OD 03 U) SURVEYOR: IS { I(o�l m v ° 1 fl1 THOMAS M. HEALY L - - - - -- N S do N LAND r� SURVEYING, INC. I33' 33' 1 8 90 ACCESS EASEMENT RECORDED IN 2820 ENLOE STREET 33.55' 307.86' {`II ♦ W VOL.. 2149, PG. 272, HUDSON, WI 54016 S00'1 215 rn S88 °30'02 "W 34l .41 � NO. 710648 66.02' N88 °30'02 "E 448.20' i� Q i (p. O �3 71' 414.49' O �, i C j 4 m O U O 1 II� �D N 0 Q N I 11 >zz LO a W i LOT 2 ;° �� ��> ! v6 16 34.23' 414.49' i nnrl m m I(0 N ?8 °30'02 "E 448.72 i �° ° z rnn I C m N Op N 100' -1 N O I j� > Z I I c� B - op LOTS �o I, V) 0 0 I�l N I �� m l Ole. N A _ 1 JO l0 0 m O 33 33 �34.�4' (o C5 c- I� " m m m f I 414.49' o m i��) n° N88 °30'02 "E 449.23' i i r*i z m 6Z 2 N 100' —; 1 41 o " -0 (D LOT 4 \ I A -4 `` I Ca CA) Ln fo N I cg' ; °\4052 T �o Ca c" LEGEND `2 i o 7 FOUND ALUMINUM ST. 'V 0 3\� CROIX COUNTY SECTION CORNER MONUMENT 06- SET 1* OUTSIDE DIAMETER BY 18" U i° Z 0 LONG IRON PIPE, / �jo�,, WEIGHING 1.13 LBS. PER LINEAR FOOT PROPOSED DRIVEWAY LOCATION 66' WIDE JOINT DRIVEWAY EASEMENT W1/4 COR` BUILDING SEC. 5 I LOT AREA TABLE • • • • • • S ETBACK LINE Lot # Description SO. FT. ACRES LOT 1 INC RW 96.691 2.22 60N LOT 1 EXC RW 87,122 2.00 LOT 2 INC RW 94,263 2.16 �el LOT 2 EXC RW 87,123 2.00 Y LOT 3 INC RW 94,372 2.17 LOT 3 EXC RW 87,123 2.00 2 LOT 4 INC RW 138,449 3.18 UDSON, LOT 4 EXC RW 115,889 2.66 VI/I O� THIS INSTRUMENT DRAFTED BY: WILLIAM KANE ` 44 JOB NO. 6000 -16 DATE: 09/06/2002 REVISED: 02/,24/2003 SHEET 1 OF 2 SHEETS Vol. 17 Page 4467