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HomeMy WebLinkAbout022-1020-70-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 405016 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 I Parcel Tax No: O'Malley, James I Kinnickinnic Township 022 - 1020 - 70-000 CST BM Ele : Ins BM ev: BM Description: r rv-%` r TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic - -`Up �� /l Benchmark P �Csr . .2S AD Z 11� Dosing je r , AI g 6 , L S�C�d l ' • D J Aeration 0 v V Bldg. Sewer `3; � � Holding St/Ht Inlet i y V St/Ht Outlet TANK SETBACK INFORMATION A 6 TANK TO P/L 1/)IELL BLDG. Vent to Air Intake ROAD Dt Inle Septic / n Dt Bottom t5 [a - �L P ' a�' 3/ .33 �` R 1 713 8 47• Dosing / —� / Header /Man. 0 2.7 Aeration Dist. P' t , Holding Bot. System / , US Co �L �a a Final Grade PUMP /SIPHON INFORMATION ,P Ian Manufacturer Demand St Cover c� GPM C`i1Gt y� J / 7 3 Model Number V q 1 TDH Li Friction L Syste He / \ ��J , {�J j TD Ft V �- J L Fof jpf 1 1 - ength D ia. � Dist. to , G� J '?� SOIL ABSORPTION SYSTEM BEDITRENCH Width Length / No.i f ch s PIT DI IONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS / SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LFkACHIIJG Manufacturer: INFORMATION CHA OR Type Of System: /� j / U Model Num�: / DISTRIBUTION SYSTEM +' l ,S�, o/ l I (' s 0- Header /Manifold Distribution x Hole Size x Hole Spacing Vent Air Intake r� Pipe(s) / ^� Length Dia 2 Length Dia Spacing � SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched i� I l Bed/Trench Center 1 . p Bed/Trench Edges Topsoil � Yes I;,] No Yes No l i v"/4� -7 COMMENTS (include code discrepencies, persons pressnt, etc.) Inspection � Inspection #2:�/ Location: 1012 Coulee Trail Hudson, WI 54016 (SW 114 NW 114 8 T28N R1 8W) NA Lot 3 �I �11`►��.. C,� Parcel No: 08.28.18. 1.) Alt BM Description = T 2.) Bldg sewer length =a ( - amount of cover = >31 3.) Contour - � Plan revision Required? w] Yes , o n Use other side for additional information. % y fkgna�ture Date Insepcto Cart. No. BD -6710 (R.3/97) Safety and Buildings Division City 201 W. Washington Ave., P.O. Box 7162 C9 N viscOns`� Madison, WI 53707 - 7162 Site Address Department of Commerce q - - Z 2 -d Z r// CCU 1,g ' ` OZ41 �- Sanitary Permit Application Sah Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑Check if Revisio � j may be used for secondary purposes Privacy Law, s15.04(1 m I. Application Information - Please Print All Information State Plan I.D. Number 6 2 Property Owne r's Name Atz `�V Parcel Number � 0 F� 0 - tie o Property Owner's Mailing Address ly 1 operty Location �111/V {' S Sr c 2 Z00 5 LJ N 4; S T N, R City, State Zip Code I Lot Number Block Number n GFFjC y — Subdivision Name CSM Number H. Type of Building (check all that apply) ❑City V or 2 Family Dwelling - Number of Bedroo .1 ms ❑Village ❑ Public /Commercial - Describe Use ®Township IC (n/N /C e, n/A.IlG ❑ State Owned , ye,�� �� LZ ,ti/ �Q�' - ' ���� ' v Nearest Road Y, 64` (33 i�'</ Sa��/ CO U,(_&C 'ff Type of Permit: (Check only one box on line A (num ering scheme for internal use). Complete line B if applicable) A. 1 New 2 ❑ Replacement System 3 ❑Replacement of 6 ❑ Addition to For -County use S stem Tank Onl Exis ' S stem B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued N. Type of Permit: (Check all that apply)(numbering. scheme is for intemal use),.__ �✓ 3 G 44 ❑ Non - Pressurized In- Ground 21NMound 47 ❑ Sand Filter 50 Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Dispersal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area oil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals. /Days/Sq.Ft.) (Min./Inch) Elevation 3 6o , 3 1 c;e 3 VI. Tank Info Capacity in Total Number Manufacturer - Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume poponsibility for installation of the POWTS shown on the attached plans. Pl ber's Name (Print) Ptumber' ignatur MP/lotlYlS Number Business Phone Number �_bV, 4J�o1 2� Plumber ddress (Street, City, State, Zip Cod VIRX /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued is ent Signature (No Stamps) Surcharge Fee) ❑ Owner Given Initial Adverse Determination fffYYY 7 IX. Conditions of Approval/Reasons for Disa (l c d rr e ozc/✓ - �E -Qu' 7" f L' Pin; Z �� In r, �r� ✓ ` ° 71 Attach complete plans o e Cotm on y for the #ftbm­mrV1pw1%Rre 814 x 11 inches in the _ SBD -6398 (R. 05101) Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 isconsin www.commerc .wis ons Department of Commerce www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary April 03, 2002 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 PLAN APPROVAL EXPIRES: 04/03/2004 Identifi Nbe1s Transaction ID o. 720860 SITE: �Q /a, � n�,, Site ID No. 6426 James Omalley - Coulee T rail Please refer to both identification numbers, St. Croix County, Town of Kinnickinnic above, in all correspondence with the agenc SWIA, NW1 /4, S8, T28N, R18W FOR: Description: Four Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 834873 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: General Approval Conditions: • 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). • 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. Stats. • 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. Owner Responsibilities: • Comm 83.52(1)(a) - 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. P.O.W.T.S. Conditionally \ APPROVED r ARTHUR L WEGERER Page 2 4/3/02 Owner Responsibilities Continued: • The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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 Fee Received $ 175.00 Balance Due $ 0.00 Gerard M. Swim POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm WiSMART code: 7633 jswhn@commerce.state.wi.us TITLE SHEET Page \ of MOUND SYSTEM FOR A BEDROOM RESIDENCE This plan has been prepared in accordance with the Mound Component Manual SBD -1057 P and the Pressure Distribution Manual SBD- 10573 -P C a - ; l3 /q j C tz. b 14q� LOCATED IN THE SW 1/4 OF THE N UJ 1/4 OF SECTION g , T Z8 N, R Q3 W, TOWN OF 1-c l il.l 1V 10 Vt_l1�jj� 1C S`f'• C_ COUNTY, WISCONSIN. INDEX PAGE 1 of 7 TITLE SHEET PAGE 2 Of 7 SYSTEM MANAGEMENT PLAN ��0 LOT PLAN v PAGE 3 of 7 P 0 PAGE 4 of 7 PLAN VIEW -CROSS SECTION PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT S PAGE 6 of 7 PUMPING CHAMBER CROSS SECTION 1k PAGE 7 of 7 PUMP PERFORMANCE CURVE PREPARED FOR ST rLLS PREPARED BY WECGEE:ZER SO 11_ - TEST 3: NG AND. . DES = GN S�Rt1 � CE P.O. Box 74 421 N.Main St. River Falls, WI 54022 �� 0 �e�+�E�oe� Phone 715- 425- 0165a� Fax 715 - 425 - 6864 °.••� » »M•. ®� API ELLSwpA7.. // I DEPARTMENT Of COMMERCE u I DIVISION AFE A BUILDINGS SEE CORRESP ENCE JOB NO. ' Mound System Management Plan page of Pursuant to Comm 83.54, Wis. Adm. Code Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with 3, Wis. Adm. Code. Theo operating condition of th p g e septic tank and outlet filter shall be assessed at least once every 3 ears b inspection. The outlet filter shall be cleaned Y Y P c e 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 o the tank. The addition of biological g However, if such products are usedthey shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pum — o Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and'pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October - February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg /L 6005, 150 mg /L TSS, and 30 mg /L FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, an it is recommended that each Lateral be hed of accumulated solids at least once e month When a pressure test is performed its ou e compare o e mi flus P uai tes w en a sy €r5i�i�sTit� as a ne ifi orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manual [SBD- 10572 -P (R. 6/99)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Continaencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions about the operation or maintenance of this system should be directed to: The County Zoning - Office at LS- 38 Q 690 S`r• L The system installer at S— Z1 QVVg IFS0Ki The tank manufacturer at l buo Z_ 3_zs - &LLS(o 1_111eme The effluent filter manufacturer at S ZI The pump manufacturer at L 41 0 1- Z &4- I I`[V M LlLZ)Z,S I, PLOT PLAN Page 3 of Scale l"=60 ' Z Tom"t R(" PIPt` >';'i..101.5 ' `js • O 1� 0D II I I.Z II lop L o I uj iz-t aL Page Q) A- pproved n �Sy�thetic Covering __ST I C33 Distribution Pipe edium Sand I Topsoil y - -'"` G To P F E? ev. Lot 50 E D. 3 3 . Ja Slope ;W Vti7e,,t�� s Distribution Cell of Force Main Flowed z" to 2 " Aggreg From Pump Layer i • y��� l�n,��� �.So FL .1. E t Ft. CROSS SECTION OF A MOUND SYSTEM F n• g Ft. /� `1� ° G 0•5 Ft.,�, i A 9 Ft. H 1 - - 0 Ft. Linear Loading • Rate =b?O[5 GPD /LN FT 8 b Ft. Design Loading . Rate = � -S9 G_ D /SQ FT I N H Ft. J Ft. K F L t. V / r Ft. W 3 N Ft. - Observation Pipe - - - -_ ter -- ---- ---- - - - --- . � , � __ _______ _ __ __ Force Main W L-- l -- - -- - - - - - -- _ — - - -- "trcc�s �,-� Pe — - -- s�:� o� PO S LTI. Distribution to 2 % Pipe Cell of z 2 aggregate Observation Pipe (Anchbr securely) - PLAN VIEW OF A MOUND SYSTEM Distribution Pipe Layout Page S of Z Place the holes at the bottom of the distribution pipes at equal spacing. Remove all burrs from the pipe and holes. Extend the end of each lateral up with the use of long turn or 45 fitting to a point within six inches of the final grade. Terminate the ends of the laterals with a valve, :threaded cap or . threaded plug. Provide access from final grade for the valve, threaded cap or threaded plug. PVC Tr�1C PVC Lateral— Manifold Lateral x X x x x/2 x!Z x x x x Literal Length — Lateral Length — p Distribution Line ftC.f" Is soy; S f PVC =oQC� r�� i P 3 3 Ft. Hole Diameter Inch S 3 Ft Lateral I Inches) X z4 Inches Manifold Z Inches Force Main " 2" Inches # of holes /pipe k1 Invert Elevation of- Laterals Ft. Al l �(.SZ Gph� Combination Se' i.c: Tank and PUMP CHAMBER CROSS SECTIOM ARID SPECIFICATIONS ' PAGE OF - 7 NE W T CAP WEATHER PROOF JUUCTIO►J Box . ti C.I. VEMT PIPE APPROVED LOCKING 1 10' FROM 00011, MWHOLE COVER ;-JIV - ilk)DOW OR FRESH u'ARtJ1ti1G LN EL. sp�G10tJ P►PE� A.Rr1JTAKE cor�putr ''1•)IF�'LCLj'161�L`f�Q i Fl N 1 SH© Y m1m. GCE � j L IWAIU. IMLET i " PROVIDE - AIRTIGHT SEAL BAr-:7LS I I \ APProved zi� u�Q °A I I Approved joint ca/ 1 1 -1a0p ��I� I I( i Joint w/ PVC pip ,rye ALARM PVC pipe I r C I CLE .�Cj.1.5'f'C PUMP—,, _ OFF D COUCRETE BLOCK 5 , - RISER EXIT PERMITTED OQLy 'IF TAU MAUUFACTURI`R HAS SucH APPROVAL 3APPRo+FD .BEDO t �� SEPTIC F SPECIFICATIOt\1S DOSE T AWI ( MAQUFACTURER: wLESC)Z cak1L° IJUMBEA OF DOSES: PER DAB TAMK :,IZC : _ GALLOUS DOSE VOLUME r ALARM MAMUFACTURGR: MICLUDI 6AGKFLOW: 1 Sy S CA LLOMS MODEL ►.!UMBER: 1 () 1 14I,,j CAPACITIES: A- `ot I IZZ •IUCHES OR GALLOAI S SWITCH TYPE : R - Y $= Z IWCNES'OR ��' ��LLOA15 PUMP MAUUFACTURCR: `- 1ST• kL-RS -C = �) Z IUCHES OR - CALLOUS MODEL NUMBER: y"tE SO p, INCHES OR ` ".. GALLO►JS SWITCH TYPE: M OTE: PU n P AUD ALARM RE TO )E-L- 8 MINIMUM DISCKARGE 'RAT �LL'8Z m INSTALLED ON 5EPARATE CIRCUITS VERTICAL DIFFERENCE DETWECIJ P M P OF F AIJO..DISTRIBUTIOU PIPE [T K•- MI&JIMUM METWORK SUPPLY PRESSURE , / IS O • - c • � + Z6 FEET OF FORCE MAI X 3 .59 F FE.ET OFCFRICTIOU FACTOR.._ ' FEET TOTAL Dy1JAMIC HEAD = C_ET ✓ As per manufacturer Z 0 gal /in. Liquid depth 3 8 " ' SAGE 1 of - 7 ME Series M"M 1/3 through 1 -1/2 HP Effluent Pumps p Performance Curve CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 400 450 100 90 28 80 tij�. 24 70 $� Lu W MF W W /CC 20 2 Z 60 Z w 50 MFG$ 16 LLI = J J MF a 40 O 12 O O i- 30 41.82 g 20 M E33 10 4 0 Fl 0 0 10 20 30 40 50 60 70 80 90 100 110 120 130 CAPACITY GALLONS PER MINUTE MWIV • 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. Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County S 1 Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must C include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. �avDlti G percent slope, scale or dimensions, north arrow, and location and distance to nearest road. U2- _ —16 -- _ (J Please print all information R ewe by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). L uYt/Y� / 7 �1 Property Owner Property Location ��T Z Gaut. l S 113 1/4 M U) 1/4 S _ T a N R L ?j E (or nW Property Owner's Mailing Address t# Block # Subd. Name CSM P• o -Box Z� Z 3 — � zo os r ll A 4 City State Zip Code Phone Number City E] Village F] Town Nearest Road 11 7 - - �i'ry L )-i. N i SSoZ S ( 6 L Z) - 7 Z3 - $ "7 `r- l mm 1 C yr-1 Q.j lC C0U U � I I_ ®. New Construction Use: ® Residential / Number of bedrooms 1 4 Code derived design flow rate O r GPD ❑ Replacement ❑ Public or commercial - Describe: t Parent material L t LL Flood Plain elevation if Applicable 1�1 ft. General comments Se-!? { � �/rrcirwg -et ma and recommendations: f ✓ L �� . WtoU�7 W /a x �l DI.SII��L 3 U n � V CohJllivG� �t ! 0 . D I Boring # ❑ Boring / - ®pit Ground surface elev. 1 \) (3 , 9 ft. Depth to limiting factor 18 in. (9 ication 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 - 2 Boring # ❑ Boring ® pit Ground surface elev. 6 ft. Depth to limiting factor Z 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 J a -� lo�(Z31Z Si 1 Z Psb►� �`�t 1� 5 ,� Zs -z� �•s�1���3 - L l cshk m � JL S L) Z 3-7 '?.S'72 3�3 'FL`F �•SLlrL SlS 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) Si ature CST Number Arthur L. Wegerer. 01 -59 - C 3 220254 Ad dress Wegerer Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. Hain St. River Falls, UI 54022 y_z 6 -01 715 -425 -0165 Property Owner Parcel ID # �JD 1►u G Page 2 - of 3 Boring # ❑ Boring - �S ® pit Ground surface elev. 1 O O - f o ft. Depth to limiting factor 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#1 •Eff#2 0 -e 1o�tR -BIZ — st1 Z,�sbk'F'>r CS s 3 ZA -4,2 �.SY2 3L3 `� � 1.S `'L{LS �S l_ mow• 1'n 'Fi- — • � . S 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 /ft' In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 I ' I 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 I GPD /ft= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 -Eff#2 ........ . . . . I • Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < ISO mg1L • 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 -6330 (X6100) i PLOT PLAIT Pane 3 of 3 F Scale 1' B� LZbKJ I > IPF 'Zgyp.Z.7- cc !) 'I)u aq ►I 1 i s I I 09' 1S'V \2 7 1 'sfi�:pi I 3 0 0 q9 wo 06 Ir to LvT 3 L�rZ 3 � r-o>v 1> ligs.46' cL or- C.T.ti- 715 -425 -0165 220254 e3 CST Signature Date Telephone No. CST No. Job NO. I ST CROIX COUNTY SEPTIC TANK MAINTBNANCE AGREEMENT RECEIVED AND r ---___ OWNERSHIP CERTIFICATION FORM APR 1 2 2002 Owner/Buyer S �/ , ST. CRO O OONTy FICE Mailing Address 1 Ct Property Addres c` tpao- r F e;Fctation required from Planning Department for new constractr n)_ City/State Parcel Identification Number �� Z " I � ' �� " � ° CSI LEGAL DESCRIPTION Property Location r/., 1 /4, Sec. , T N -R W, Town of �-� ►'1 . Subdivisio . Lot #. , ,,Ce rtified Survey Map # 6 7 / d (c , Volume _ / , .Page # i Warranty Deed # - 7 2 ' Volume / `�� Page # e Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ no S SVSTEM 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 maskrplumber, journeymanplumber , restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal 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 sys a has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 of the three year e n date. y SIGMA OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of =43 cribed abo , by virtue of a warranty deed recorded in Register of Deeds Office. 2 MC)� y ,�� PLI ANT DATE * * * * ** 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 STATE BAR OF WISCONSIN FORM 1 - 1998 WARRANTY DEED A i E HSMAALSH ` REGISTER OF DEEDS D c Mjnt Num r. Si l P,rr ST. CROIX CO,, VI This Deed, made between RECEIVED FOR RECORD Lenertz Farms Inc . 02 - 28 -2002 1:30 PM - -. - - -- - WARRANTY DEED — -- - Grantor, EXEMPT i an James T. O'Malley and Laurie J O'Malley, husband REC FEE: 11.00 an wife TRANS FEE: 119.70 COPY FEE: CERT COPY Grantee PAGES: FEES Grantor, for a valuable consideration conveys to Grantee the following 1 described real estate in St. Croix County, State of Wiscons' (the "Property' R ordin a Name and Retum Address G es T O'Malley !/ Lau , J. 'Malley ��JJ11 x Co y R d SS & Coulee \ �� Rive 1 I 54D�,2!C,Q f(A 22 -1020 70 000 Parcel Identification Number (PIN) This not ( homestead property. Lot in Certified Survey Map f ed in Vol. 15, Page 41 WIOctrmeV No. 647126, located in part of the SW 1/4 of t 4 of S Town of Kinnickinnic, St. Croix County, Wisconsin. To 28 N, Range 18 W, Together will all appurtenant rights, title and interests. None Grantor wan that the title to the Property is good, indefeasable in simple fee and free and clear of encumbrances except Dated this 25th day of _FC12KIlary 2002 (SEAL) (SEAL) s s Lenertz Farms, Inc. (SEAL) (SEAL) s \ s AUTHEN \ r wETZINiII 5 KNOWLEDGEMENT Signature(s) %0TARY PUSUG eY � o. 5 FATE l State Of Wisconsin, ) ss. St. Croix County, authenticated this day of Personally came before me this 25th day of February 2002 the above named Lenertz Farms — inc s TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the rson wh ecuted the foregoing authorized by §706.06, Wis. Stats) . ` I ttumen d kno edge same. THIS INSTRUMENT WAS DRAFTED BY J Coldwell Banker Burnet 02 -00918 301 oule Road s li o onst Hudson. WI 54016 commiss on is rm a not, state expiratio4date ( Signatures may be authenticated or acknowledged. Both are b not necessary.) Names of ersons si wan ca i must be or rinted below their si store. WARRANTY DEED FORM No. ] - !9911 S rsconZi gal Mi 03119!02 111E 09:24 FA% 715 4258503 Pat O'Malley X003 1 I� ALA° TM "jjwjkwu oftW O Off WaaW KANE JO8 NQ. l00PC8 UAMOMMMM FLED EAg74NW iN f NE OF SGCn0N JUN 6 1 20M i � W C.T.N. WES► UNEOF0 — — - smi4 OF 1ME NW /4 � $ 31M �. 27L .107 low 1 8g0'40'13W p -r ft 4 y n b ° awl n Q Sur4a�rE�e.or T 14 �- t ,. vi i n 1 1'40'f4'E6RT.70' G o\ � i M f► •' +� 1` 000 n \ Nwx&Tm &Moe , m ®rl ----- y - v01.15 paq. O1O2