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HomeMy WebLinkAbout022-1020-70-050 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: t (ATTACH TO PERMIT) 399578 0 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Powell, William & Julie Kinnickinnic Township 022 - 1020 -70 -050 CST BM Elev: Insp. BM Elev: BM Description: r 1061 o -� TANK INFORMATION ELEVATION DATA TYPE MANUFAC UR R CAPACITY STATION BS HI FS ELEV. Septic /A y S � Ben mark Dosing Alt. BM /JoejrH Aeration Bld g Sewer Holding t/ t Inlet ,i X 3, bj St/Ht Outlet �/ TANK SETBACK INFORMATION 3 d TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet s 3.oP Septic 7 �� ' ��i a �•� Dt ottom Dosing ' �s! / Header an. > T Aeration Dist. Pipe 3•D2. Holding Bot. System 3,3 117 PUMP /SIPHON INFORMATION S Final Grade Manufacturer Demand Cove vat GPM ��l Q1� Z i 3 O ! • 5 Model Number qq, 14 TDH Lift Friction Loss System Head T H Ft 2Z. .i o zz .3 od Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMEN S No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L 18LD WELL LAKE /STREAM 5HA C G ufacturer: INFORMATION C R Type Of System: Model Number: DISTRIBUTION SYSTEM Header /Manifold i stribution x Hole Size x Hole Spacing Vent to Air Intake L � J P D ipe(5) i it 3.33 9 I 3 (, " > Length l, Dia 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 Bed/Trench Center Bed/Trench Edges Topsoil Yes its. " ul No Yes ! No i 1 �! . COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: ­ 7 / 1 1 L /�v Inspection #2: /� IZI 7 Location: Coulee Trail Unknown (SW 1/4 NW 114 8 T28N R1 8W) NA Lot 4 �� �� Parcel No: 08.28.1+8.19A50 1.) Alt BM Description = � S D�,vG- y / ~ . e 5/ � �f�/ 2.) Bldg sewer length = Z�l �^Cr S�✓td /,vG !K lnAA,t' A `'(� l( - amount of cover = y tl > 5�y/'� Q� // td�4 v o r $at► �/n,1+ G�y�. 0►. 3.) Contour = �' 1 8 ` L Z/ �e� Y'►� �+^L� �'� Plan revision Required? Yes mi No Use other side for additional information. � Z D SBD -6710 (R.3/97) at epctorIs Signatu Cert. No' 47 /O O j 0 d 11 1 1510 1 Sanitary Permit Application Safety & Build Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application ISO Box 7302 10 sconsin Personal information ma ou p rovide be used for second p urposes Madison, WI 53707 -7302 Department of Commerce y p y p [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not state owned.) A ttach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. County J v State Sanitary Permit Number ❑ Check if revision to previous application State Plan 1. D.Number I. Application Information - Ple Print all Information Location: Property Owner Name p /- Property Location � C (() l C L 164 1M t✓ 1 O 0 �L Gt) �1 /4 NLJ 1/4, S , ,. e-o ,N, R (or) W Property Owner's Mailing Address Lot Number Block Number City, State Zip Code Phone Number Subdivision Name or SM Numbe II. Type of Building: (check one) / ❑city 1 or 2 Family Dwelling -No. of Bedrooms : Y� Cb ,�' ❑ Village ❑ Public /Commercial (describe use):_ o(C �� Town of / 11 State-Owned j �4 i k JAJtllC,G Neare t Road FJ ou � L� 7`(7414 / Parcel Tax Number(s) 70 III. Type of Permit: (Check only one box on line A. Che on licable �, 1?k. / / 9 - S - 0 0 2 L - /UZD ?�O - A) 1. New 2. ❑ Replacement 3. ❑ Replace �4 5. 6. ❑ Addition to System System Tank Only / ! > ; xr Existing System B) Permit Numbe Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) ❑ Non - pressurized In- ground l emound(/p `h 90 ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: C `l , Z ' S G'2 C 3 3 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation 60✓ ?oU-" 1 700 S o .y5 �) /oo. /6J- / VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks -44 ; c. ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (print) Plumbqrs Signature (no stam ): MP/MPRS No. Business Phone Number W1<< rvt '!!� an1 CJX .: / 3 3 -?U � 7/s - "� 0 - -53J Plumber's Address (Street, City, State, Zip Code IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued I7__.1 Agent Signature (No stamps) Approved ❑ Owner Given Initial Adverse Surcharge Fee) r Determination 3 Z ©O p/ X. Conditions of Ap /Reasons for D / / G / / h e iK Si�V PO 4'a 4 Q 7'4 7'4 e.1 1 4ly A&a k c- fa-tj�c l ✓ S llPGo cv��Lt � d i�v� 5 SBD -6398 (R. 07/00) PLOT PLAN pa e 3 of ^� Scale g t , 3�qq otZ 0,8, D p 1'1 o T eavlP A C)M ar►1a N y?t pvC 3 s N 7' b cn (0 5 V _ t?'t_., "-a Q►J fi tr HlGl � 31 y�1�1 PVC s?� I^1lL�Y`F7I NOTES: - 1. Elevations.shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z requ red). 3. Septic tank to be Z gallon capacity manufactured by(zSo 1 �MEC3 Uv��S�Z. CU�1C'CL �AJA - tZ ZP(:aQU r-iLT R. Y^ -iP`f` )k lU e�� lLSocr� 1 ^jLe - S(2z. 4. Bench marks : SEE sSU \jE 5. Divert surface water around system to prevent ponding at the uphill side. r Safety and Buildings s 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 iscons n www.commerce.state.W.us/sb Department of Commerce www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Acting Secretary September 27, 2001 CUST ID No.691727 A7TN. POW7S 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: 09/27/2003 Identification Numbers Transaction [D No. 675908 SITE: Site ID No. 636171 WILLIAM & JULIE POWELL Please refer to both identification numbers, COULEE TR above, in all correspondence with the agency. TOWN OF KINNICKINNIC ST CROIX COUNTY SWIA, NWl /4, S8, T28N, R18W FOR: DESCRIPTION: SIX BEDROOM MOUND SYSTEM OBJECT TYPE: POWT SYSTEM REGULATED OBJECT ID NO.: 812345 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: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 /O1) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD - 10706 -P (N.01/01). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the Mound manual, and section VI of the pressure distribution component manual are complied with. A copy of this letter including instructions and information relating to proper use and maintenance of the system must be given to the owner and each subsequent owner upon completion of the project. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. • Access to the filter for cleaning must be provided per Comm 84 product approval conditions. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required • 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. • 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. ARTHUR L WEGERER Page 2 9/27/01 • 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). In addition, 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. • Comm 83.52(3) The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • 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. 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 /instal lation/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. Sincerely, FEE REQUIRED $ 175.00 ' a > FEE RECEIVED $ 1700 BALANCE DUE $ 0..00 Charles L Bratz POWTS Plan reviewer II- Integrated Services WiSMART code: 7633 (608) 789 -7893, Mon. -Fri. 7:45 AM to 4:30 PM cbratz @commerce.state.wi.us cc: WILLIAM POWELL TITLE SHEET Page I of 1 MOUND SYSTEM FOR A BEDROOM RESIDENCE This plan has been prepared in accordance with the Mound Component Manual SBD- 10691 -P and the Pressure Distribution Manual SBD- 10706 -P (N.01 101) (N.01 101) LOCATED IN THE SIAJ 1/4 OF THE NW 1/4 OF SECTION 8 , T Z$ N, R g W, TOWN OF � , S`� COUNTY, WISCONSIN. 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 619 F:4eL_� _ ^_v k�tQ U L - t�. 1U�12 PREPARED BY WE( S0 S L .TESTING AND. DES I GI<V SERVICE P.O. Box 74 421 N. Main St. River Falls, WI 54022 Conditionally Phone 715- 425 -0165 Fax 715- 425 -6864 APPROVED 4-) 8 BUILDI�lG8 ta, i., • ° � �", RECEIVED i SEE CORRESPONDEOtE SEP 12 2001 "- SAFETY & BLDGS DIV. _ JOB NO. Mound System Management Plan page 2 of Pursuant to Comm 83.54, Wis. Adm. Code Seotic 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 113 the liquid volume of the tank, If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic.tank use by the Department of Commerce, Safety and Buildings Division. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October - February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg /L BOD5, 150 mg /L TSS, and 30 mg /L FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manual [ arid local or state rules pertaining to system maintenance and maintenance reporting. S WO - tbb9l. P (�ti o i to 1, 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 I S _ 3$1 , L4 6� ST- C V-0V The system installer at LlZ•S - SS144 STE1 IVt7 The tank manufacturer at cj0 - 17 S- $ q � 1 t_StEk The effluent filter manufacturer at Sou— The pump manufacturer at 4 11114 t�ly Page + OT Z Approved Synthetic Covering _ ASTH C33 - Distribution Pipe Medium Sand fG Topsoil __ �- —F F� ev. 1 p (3, g E 0 b I . % Slope Distribution Cell of Force Main Flowed z" to 2 AagreSate From Pump Layer 0 \', 6 Fi E - �� Ft. CROSS SECTION OF A MOUND SYSTEM F O. Ft. G O -S Ft. A 1D Ft. F. 1 -o Ft. Linear Loading Rate 1O.O GPD /IN FT B L3 Ft. Design Loading Rate= o,45GPD /SQ FT I Ft, J �1 Ft. K _Ft. L 112 Ft. er Ft. L -Observation Pipe E � K b S Main e --� -- - - - - - -- - - - - -- ------------------- - --�-a Farce W - -- — — — — — �c cuss so ;� �Distrib ution h to 2 Pipe Cell of z 2 a0n regate Observation Pipe — (Anchbr sec=e1Y) PLAN VIEW OF A MOUND SYSTEMM PLOT PLAN •Page 3 of Scale 1 "= Sp ' a�l � C, $ � 3n ��� 0 Z 8 i i b 0 h10T QDMP h-er o2 •Z v Ar�1�-Z,J Z6� o� Z Pv e Fz:. N Lp pvc 2t�� nF y" PVC ^� xp � b in Distribution Pipe Layout Pade S of - 7 o 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 Iong turn or 45* fitting to a point within six inches of the final grade. Terminate the ends of the laterals with a valve cap or . threaded plug. Provide access from final grade for the valve, threaded cap or threaded plug. 7-1 F'_ 1 C-9 L C\Zz5 S s Zc- ,j pv C. Fv C �v c Lateral — Manifold Lateral X x x x x!2 x!2 x x x x Lateral Length — Lateral Length — io Distribution Line • P — � � PrcCas sox — —o rm��w�a S Pvc PtzCE yt o -- _ G.q P 3 -SFt. Hole Diameter � Inch S 3 .Z�3 Ft. Lateral Inches) X 3 Inches Manifold Z Inches Force Main " Inches ;i of holes /pipe l S Invert Elevation of Laterals 1 01.3 Ft. �SX6.� �. 6 _ 36.9 G pr..j PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS ' PAGE ( OF VEIJT CAP _T `i'C.Z VENT PIPE ' WEATHER PROOF APPROVED LOCKING MANHOLE 1 10 ' FROM ODOR. JuIJCTION 80X COVER WITH WARNING LABEL • 12�MIiJ. WINDOW OR FRESH I AIR INTAKE I GRADE Lw- 8 0, =L I 4 Maj. WAIN. v �,; - - --- -- -- INLET PROVIDE I -- . — 7"' AIRTIGHT SEAL 1 APPROVED JOILIT A I I i APPROVED JO0J I I I I i I ALARM • e �I II . I I I ON c •I I -- 50, I CLEV. F7. PUMP --� OFF r D I COLICRETE DLOCX Y 3" APPRoYED RISER EXIT P£RMITtED OUILy IF TANK MAUIUFACTUREIt HAS SUCH APPROVAL gEpp SPECIFICATICIMS DOSE TANKS MANUFACTURER: 1",,LR1Q1 e IJUM9ER OF DOSES: S Z PER DAB TANK SIZE: � GALLONS DOSE VOLUME z ALARYI __PJW FACTUKF , S-- �TRD S INCLUDWro 5ACKfLOW: " 5 � GALLONS MODI`L NUNIBCR: CAPACITIES: A= Z 111CHE5 OA GALLOtIS - 3WITCH TYPE: — B= 2 INCHES OR 5 "� G�LLOL15 PUMP MANUFACTURER: L S C■ p g IWCHE5 OR Z I k - GALLONS MODEL NUMBER: M� SQ D =- ► 4 1? CHES OR 31 S- 3 GALLOU -6 SWITCH TUPE: MOTE: PUMP AMD ALA A L TO DC 0" p M I IJIMUM DISCKARGE RATE 3b.GPM INSTALLED OW SEQARATE CIRCUITS VERTICAL DIFFERENCE DETWEEIJ PUMP OFF AIJD.OISTRIBUTIOUI PIPE. I ' I . FEET + EI•M ' NETWORK SUPPLY PRESSURE .. .. ..... 6 ' � FEET + �' b D FEET OF FORCE MAIN X - 2 . 56 F p ptFRICT104I FACTOR. ._ —Li FEET TOTAL DyIJAMIC HEAD 3 FEET ~� As per:manufacturer . Z6 -g) gal /in. Liquid depth �l`I� 0r-7 ME Series M 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 24 � cc 70 /SO H W A1F w � X00 20 2 60 Z Z — 0 W M� 16 2 so = J Fa- 40 O 12 O O .04 30 8 20 MF 3 10 4 36 -q 0 L11 0 0 10 20 30 40 50 60 70 80 90 100 110 120 130 CAPACITY GALLONS PER MINUTE M"rs • 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. Division of Safety and Buildings vrtLUr11 JUN mr -r I Page of in accordance with Comm 85, Wis. Adm. Code _ Attach i complete site plan on paper not less than 8 1/2 x 11 inches in ' County S L include, but not limited to: vertical and'horizcntai reference point (SM),diirection and t C� `x Parcell.D.1iVD11116 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. . Please print all information Reviewed by Date Personal information you provide may be used for second Law, s. 15.04 (1) (m)). Property Owner F E 1 Property Location WG LL C-04 - LOL SI.J 114 NW 1/4 S T Z-$ N R IFZ E or W Property Owner's Mailing Address Lot : Block # Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ Village 0 Town Nearest Road .9r.�L Mry sso�s ( 08"7. )cu�� - MZPrt, L ®, New Construction Use: ® Residential / Number of bedrooms Y_ Code derived design flow ra b GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material _ L LL � L.l. Flood Plain elevation if app \` �C Genersf comments '� ' and recommendations: 'N1 V Y�1 tsvt k - 9 �D F M I Boring ;. ❑ Boring ® pit Ground surface elev. ° L q 1 ft Depth to limiting factor in. oil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary ^ Roots GPD /ft in. - Munsell . -� Cu. Sz- Cont. Color Gr. Sz- Sh. •Eff;itl •Eff#2 o -`?- Lt TL I LZ _ g 1 Z '6 z q - �oK cz31b - s t 1 Z�Fsbk -( •cs • s - 3 Zo _y,� �•S`11z.�13 �l� - 1.S�2518 -L � o� In �t- _ _� _ Boring # ❑ g - ® pit ' Ground surface elev. OI.Q . ini ft. Depth to limiting factor Z1 in. Soil Application Rate Horizon Depth Dominant Color Redcx Description Texture Structure Consistence Boundary Roots GPD/ft In. Munsell Cu. Sz. Cont Color Gr. Sz Sh. •EfM - •Eff;i<2 3 1� 34 z S �23� 'Flr� �.S `2 tii5�8 L o�, mkt- — •� : 5 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) Signatgre CST Number Arthur L', :Wegerer ��` C� 220254 Address W e g e r e r Soil Testing. '& Design Service Date Evaluation Conducted Telephone Number. 421 N.'. Main - S t . River Falls, F7I 54022 Lf 6 = 01 715 -425 -0165 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings ` t _ in accordance with Comm 85, Wis. Adm. Code S l • C-1 !x -; Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. Vk v 6 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). / 3 Property Owner L2 Property Location Z Gaut -LQL SI, 1/4 NW 1/4 S a T ZS N R E (or W Property Owners Mailing Address Lot # Block # Subd. Name or CSM# F Cc) - $QS X 2 Z L; Eb City State Zip Code Phone Number ❑ City ❑ Village Z Town Nearest Road 11cu I Mti i ss0-1 3 )1-c.1 m1J 1CIz- !)J )V1C ®, New Construction Use: ® Residential / Number of bedrooms Y_ Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: i' Parent material L L Pr l . TL LL Flood Plain elevation if appli �: yr ft. Generar comments t and recommendations: Y OQKAZ�. 1 n wt i tvIk -tUPA o7- sf'r 'uD F� LL. 44.3' 5 GPD 1 Boring # , ❑ Boring ' " / Gr ° l q . ❑ Pit nd surface elev. ft. Depth to limiting factor Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bounda GPD 1ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 0 -4 LuL(R ��z` - S t Z`Fs�,�`�t� �°S L`F - S ✓, Z -Z 1 q 0 �0`2iZ3 b — se I Z'Fsbk h2'f�- 'CS S - 5 ✓ 3 . zo -�.� � -F t.� - �s�2 sus � o� m ��- _ - � _ s✓ Boring # ❑ Boring ® pit Ground surface elev. O I.OI . - 0 fL Depth to limiting factor 11 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 -9 10112. - St Z`�sbk w1� CS 1� • S -43 ✓ t0 s,`i Z 4�sblr v►2'�t- eS _ . S ✓ -S v n-3 �lr� �. '� �Z s ✓s L o >M fit- _ • 3 ✓ • S ✓ Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = B013 : < 30 mg/L and TSS < 30 mg/L CST Name (Please print) Sig re CST Number Arthur L: Wegerer OI`S9 C 220254 " Address W e g e r e r Soil T e s t i ng. & Design S e r v i c e Date Evaluation Conducted Telephone Number 421 N. 1 St. River Falls, WI 54022 715 -425 -0165 Property Owner AZT Z. Parcel ID # page Z of 3 a Boring # ❑ Boring ® pit Ground surface eiev. 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. Si. Sh. •Eff#1 •Eff#2 I 0 -9 bLjfz 31z - si�I mf-r- S t-(� , s r .� Z 4 - tp frz 3l6 '" Sl 1 Z'T�Sb�L Wt1Ft^ Cg — .5 ✓ . $,✓ 3 2Z 39 1. S t1 f2 3 I l 7. S Lt ❑ 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 Boring # ❑ Boring ❑ Pit Ground surface elev. fL 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 I •Eff#2 -1 F • • 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. SBP8330 (86/00) PLOT PLAN Page 3 of ''• Scale 1 ' =SO 0 o1 16a, S� j���' o�sTv�Z.`3 T1fLS ►��. i aq i ri �( l U LUO.O' C)Nj 1" L7jpr. l2�yV 1�[PE. L UT y Q CUU L (2rE T TL-Al L. — .12- -0 715- 425 -0165 220254 CST Signature Date Telephone No. CST No. Job NO. ST CROIX COUNTY SEPTIC "I'A.NK MAINTENANCE AGREI;MIN I AND OWNERSHIP CERTIFICATION FORM OwnerBuycr 7� f�� y� JLL /c 150_11`;`e_ L �o� OULc E TR>�1� MaIIMA Address l/ 4 f=i eic:l /v ✓��e / �,e' J CCU �S z - y -,q), Property Address �.. L i ,..al C',,� ,� /�1�✓ y S -- (Verification required from Planning Department for new construction)___ -__ City /State zivYX /'?, GCS �—r Parcel Identification Number DzZ -iozo - � � - os o I,ECAL D KSCRIM _QN Property Location V W ' /,, l V W ' /., Sec. _ , T dg. -N -R_ [9— W, Town Of' K j n n GH I' n Subdivision Lot q . Certified Survey Map ft l Vol Page N -- Volume --gip - - -- Warranty 1)"d tf (-DS( g Volume _�7.t - .�, Page h O Spcc house yes f_! no Lot lines identifiable 0 yes E ne SYST MAINTE NANCE Improper ttsc and rnaintenarrceof your septic system could result in its premanrre failure to handle \, astcs k'; lrcr rnautter,ancr consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper what vier, I,u' rte, the s ,stcni can affec r w sal s , � ct the function of tlrc septic tank as a treatment stage u the w dispo stem y Tare property owner agrees to submit to St. Croix Zoning Department a eemficapon form, signed by the o-net and by a master plumber, journeyman plumber, restricted plumber or a licensedpumper 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 l / ± fat! of sludge I /we, the tundcnigned have read the above requirem and agree to maintain the private sc A disposal S stern ­!h tt, atanda . +. set forth, her as set by the Deparuncnt of Commerce And the Department of Natural Resources, Staic of Wisconsin (_ crttficanun stating that rota septic system has been mauitained must be completed and returned to the St. Croix County Zoning Ulttee with"' lU days of the three yeat expiration da tea_ Sl(;NAI_kJRF O) APPl.1CAN "h DA"IF. O WNER CE t�T I (we) certify that all statements on this form arc true to the best of my (out) knowlcdKc I f an, i.rreI the ownr-ris �J the pro cIty Iescribed ahovc, h >y v. t of a «vatranty dcrd recorded in Register of Dcrd% (Mi, r SIGNATURE OF APPLICANT DA E """ Any information that is mis- represented may result in the sanitary permit hcing revoked by the I_ontng 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 wan decd l 4a STATE BAR OF WISCONSIN FORM I - 1998 6 56 92 WALSH WARRANTY DEED KLC,;_; OF DEEDS W! Document Number VOL172ing 28 RL-CEIVED FOR RECORD This Deed, made between Lenert z Farms, Inc., a 3:30 AN Wisconsin Corporation wARRMI Y DEED EY'61T 4 Grantor, H COPY FEE: FEE: and William A. Powell and Julie A. Powell, husband and TR ANSFER FEE: 125.70 `" FE: 11.00 wife I 'AGES: I Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (the "Property"): Recordine Area RETURN TO: cz Name and Return Address Burnet Title ii 1 L 11 It\ Acp 1 e t 1 e A 6D X, 0 7550 France Ave. S. _00 Co 0 First Floor 4 Edina, MN 5 5 4 3 5 Z- 1 11 , 1 1 54 54 22 ATTN: Post Clos(a&C M 022 1020 70 090 Parcel Identification Number (PIN) This is not.— homestead property I 1 o Lot 4 in Certified Survey Map filed as Document No.( 1A M& n part of the SW 1/4 of the NW 1/4 of Section 8, Township 28 N, Range 18 W, Town of Kinnickinnic, St. Croix County, Wisconsin. Together will all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasable in simple fee and free and clear of encumbrances except Dated this loth day of August 2001 (SEAL) (SEAL) Fmjat�k 6. Lenertz Fa tW Inc., a Wisconsin Cor-poratinn (SEAL) _(SEAL) Steven B. Goff, as Power of Attorney AUTHENTICATION ACKNOWLEDGEMENT Signature(s) State Of Wisconsin, I ss. County. authenticated this day of Personally came before me this loth day of August 2001 the above named Lenertz Farms, Inc., a Wisconsin — Corporation, Steven B. Goff as POA TITLE: MEMBER _STATE BAR OF WISCONSIN to (If not, — me known to be the person _ who executed the foregoing authorized by §706.06, Wis. Scats.) instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Coldwell Banker Burnet 01-24490 ... 1301 Coulee Road Notary Public, State of Wisconsin Hudson,,WI 54016 My !o=aiicm- (If not, state expiration date: Signatures may be authenticated or ackq.Dxftcaoal 'Vbtli are not necessary.) 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