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HomeMy WebLinkAbout028-1002-65-000 r �,r Wisconsin Department of Commerce ' PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Divisicii W r INSPECTION REPORT sanitary Permit No: (ATTACH TO PERMIT) 479458 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: Karne , Tom I Rush River, Town of 028- 1002 -65 -000 CST SM Elev: Insp. BM Elev: BM Descriptio Section/Town /Range /Map No: d 1 /0 C J}„ :fd�yl,.. 01.28.17.11 B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 7 Septic / Benchmark 3 S3 1 7 /a Dosing Alt. BM vim` I scot i�Z �4erativn Bldg. Sewer Holding St/Ht Inlet I t TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Dt Bottom Septic / � �G� 72- 7 Z_1 — 12 -(A 9 Z C Dosing ) �� 7 Header /Man. 770 - 7Z: 7L , tr Aeration Dist. Pipe 4, lob / at � Holding Bot. Sys�em f � X4 1 Final Grade PUMP /SIPHON INFORMATION °� �d� v3 � Manufacturer Demand St Coverer (f � GPM 1- Ct, 3 -T-6 /60. 7 Cjh Model Number 36,T) n I � 0 TDH Lift Friction Loss System Head TDH Ft Forcemain Length . Dia. 2; i Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width , Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS V C y \ SETBACK SYSTEM TO � P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: \ INFORMATION CHAMBER OR Type Of ystem: ' i - % �l /� UNIT Model Number: 5 l i�sS ill 7 I Z- �7 v DISTRIBUTION SYSTEM r (,{ Header /Manifold i J bistribution /` 1 t r I �� x Hole Size j r x Hole Spacing Vera] to Air Intake P e . ( Length_l�Dia Length D Dia r r Spacing 3Z 5 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 1 f ` 1 ` _ eS Fl No es No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: r / 2 _j 5 Inspection #2: Location: 507 200th St. Baldwin, WI 54 (SW 1/4 SW 1/4 1 T28N R17W) NA Lot 1 ® " � ff� Parcel No: 01.28.17.11B 1.) Alt BM Description= ^"JO 2.) Bldg sewer length = ©� - amount of cover = 1 i Plan revision Required? �°� Yes No i66 4 [nsepctoes Use other side for additional information. L__ -1_ L_ - Date ignature Cert. No. SBD -6710 (R.3/97) r Safety and Buildings Division County ` m W. Washington Ave., P.O. Box 7162 ST. CROIX Co ns�n adison, WI 53707 - anitary Permit Number (to be filled in by Co.) Sanitary Permit AP " n 11 S to Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal infori tti on yo rdet+ i �)l 189432 = S It, maybe used for secondary purposes Privacy Law, s15 4(1 xm) Pr4ect Address (if different than mailing address) uN�Y I. Application Information — Please Print All Information Z pFFICE 'Ya Property Owner's Name Parcel # Lot # Block # TOM KARNEY 028 - 1002 -65 -00 1 N/A Property Owner's Mailing Address Property Location 1146 507 200TH STREET SW SW City, State Zip Code Phone Number `fig `�. Section 1 BALDWIN, WI 54002 715/ T N; R I 28 17 (circleone) r II. Type of Building (check all that apply) 3 CSM Number d 1 or 2 Family Dwelling - Number of Bedrooms q —J ❑ Public /Commercial - Describe Use 4361 14 V �� / / ❑State Owned - Describe Use []City []Village []township of RUSH RIV EF III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System y 0 Replacement System ❑ Treatment/Holding Tank Replacement Only 13 Other Modification to Existing System B. ❑Permit Renewal ❑Permit Revision ❑Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that apply) )C 54 - Z S T '7 ❑ Non - Pressurized In -Ground I Mound > 24 in. of suitab soil 13 Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground [3 Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line C1 Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: _ qwA Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) ystem Elevation 450 1'0 450 450 99.50 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units txr� &J kk A _ E f - Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank 1000 1000 1 WIESER CONCRETE X Aerobic Treatment Unit Dosin Chamber 600 600 1 WIESER CONCRETE X VII. Responsibility Statement- I, the undersigned, assume respons'bility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum 's Signature NIPAVRS Number Business Phone Number BENNIE HELGESON - 220292 715/772 -3278 Plumber's Address (Street, City, State, Zip de) W1229 770TH AVENUE, SPRING VALLEY, WI 4767 VIII. County/ e artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Issued Issug gent Signature o Stamps) Surcharge Fee) ❑ 0,�er ivCn Reason for Denial �Date m IX. Conditions o rovaV reel � n _ n SYSTEM OWNER: 3 �5 5 bls�n� 1 Septic tank, effluent filter and o� dispersal cell must all be serviced / 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 less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) 1 O wl', < (r Ccr j I fit ; J 8 i i To 04 0, e- a-, A r , \�\ E L L- i I F4lI� C Safety and Buildings 4003 N KINNEY COULEE RD commercemi.gov LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 isconsin www.commer isco govsb, www.wisconsin.gov Department of Commerce Jim Doyle, Governor Mary P. Burke, Secretary August 30, 2005 CUST ID No. 220292 ATTN.- POWTS Inspector BENNIE W HELGESON ZONING OFFICE HELGESON EXCAVATING ST CROIX COUNTY SPIA W1229 770TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/30/2007 Identification Numbers Transaction ID No. 1189432 SITE: Site ID No. 703711 Tom Karney Please refer to both identification numbers, 507 200TH Street above, in all correspondence with the agency, Town of Rush River St Croix County SWIA, SW1 /4, S1, T28N, R17W FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1036574 Maintenance required; Replacement system; 450 GPD Flow rate; 25 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual, SBD- 10572 -P (R.6/99), Pressure Distribution Component Manual, SBD - 10573 -P (R.6/99); Biofilter 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. Condit No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. APPR The following conditions shall be met during construction or installation and prior to occupancy or use: DER RTMENT OF FTI • 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 SEE CORRE (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10573 -P (R.6/99). • The existing POWTS must be properly abandoned per Comm 83.33 Wisc.Adm. Code. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum. of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. BENNIE W HELGESON Page 2 8/30/2005 • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) A copy of the approved plans specifications and this letter shall be on -site durinp, construction and open to inspection by authorized representatives of the Department which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633' (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday cbratz @commerce. state. wi. us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 INDEX SHEET PROPERTY OWNER: TOM KARNEY 301 TIMBERLINE TRAIL VADNAIS HEIGHTS, MN 55127 PROJECT NAME: TOM KARNEY PROJECT LOCATION: SW 1/4, SW 1/4, S 1, T 28 N, R 17 W MUNICIPALITY: TOWN OF RUSH RIVER AEG 31005 COUNTY: ST. CROIX _ � DESIGN: PRESSURE DISTRIBUTION MANUAL SBD- 10573- P(R/99) MOUND COMPONENT MANUAL SBD- 10572 -P (R 6/99) CONTENTS: Page 1: Plot Plan Page 2: Cross Section and Plan View of Mound Page 3: Distribution Pipe Layout Page 4: Septic Tank & Pump Chamber Cross Section and Specifications Page 5: W 1000/600 -MR ZABLE Tank Specifications Page 6: Pump Specifications 'Onall Page 7: POWTS Owner's Manual & Management Plan - Pg. 1 J 'VED Page 8: POWTS Owner's Manual & Management Plan - Pg. 2 ' F CCIWERCE ' Name: Bennie Helgeson Signe Address: W1229 770th Avenue Spring Valley, WI 54767 Credential Number: 220292 Date: August 22, 2005 F 8 To ter- ore 7 � s r 13. Q3 1 Iw \ ,J I � _ old �OuOe�ic��� a� sir I _ I u . � r � �� -- I`��trcC. � •n(f� -h E r i \ i \ 1 1 i C leo�.o•t -r Perfo/ornn r�lr. Dnroll ncCrs� ` r End VI-11 PVC Yips �` .. 0` Holes Located on Bottom are Equally Spaced R Al .i 5 i / e C.�•�CK�7� !a O11111bullon.•• PIP. Distri bution Pipe Layout R / S ;3 --- x Y Hole Diameter Inch Signed: Inch (es) Lateral " License Number: 1 11 Inches Manifold Date: Force Main " a Inches �0 1, _ CD�'" ® ova M MODEL DVP03 vertical -�, -0 • • Su bmersib le r .Jr r; II Pump Specifications MEFERS FEFT -, '/Z HP MODEL: 3871 Up to 40 GPM Discharge size 1 NPT '° Solids: ' /�" maximum e j ,..._. Motor 7 Single phase: 115V 6 6 20 ` Materials of Construction Brass/thermoplastic :Eoo 2 IS - -- -.. - S Features and Benefits *Top suction eliminates impeller clogging. E ' i -Corrosion resistant construction. ° ° I .. __. _J —t ..__ . _ ... ° t0 �0 40' Zo _ w uJtGrM -Float actuated switch. 0 2 4' 6 0 t Ca AGJIV METERS FEET Pump Specifications Features and Benefits - F 25 i . .. .. ... i MODEL DVP03 lho and 1 /2 HP •EPO4 impeller- semi -open design ° 6 20 i ! ' i Up to 60 GPM with pump out vanes to protect 6 1S 1 I 32' mechanical seal. Maximum head to Discharge size 1' / ='NPT • EP05 impeller - enclosed design o 10 Solids ' /•" maximum for improved performance. • Rugged glass - filled thermoplastic 6 All feature ball casing and base design provides 6 i.._ _.._�. i bearin construction. superior strength and corrosion °° - S 10 1S - 20 2S 20 75 40 U.S.GPM g resistance. Single phase: 115V .Cast iron motor housing for 0 2 4 6 6 10 nt Arc CAPACITY Materials of Construction efficient heat transfer, strength, Cast iron and durability. Thermoplastic • Corrosion resistant threaded Stainless steel stainless steel shaft. • Available for automatic and manual operation. • CSA listed models available. All Models are designed for continuous operation and feature stainless steel hardware. • POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 7 FILE INFORMATION SYSTEM SPECIFICATIONS Owner TOM KARNEY Septic Tank Capacity 1000 ga l 0 NA Permit # Septic Tank Manufacturer WIESER CONCRETE D NA NA Effluent Filter Manufacturer ZABEL `'D DESIGN PARAMETERS Number of Bedrooms 3 ❑ NA Effluent Filter Model A - 100 (12 X 20 1.17 NA Number of Public Facility Units NA Pump Tank Capacity 600 gal " '' D NA Estimated flow (average) 300 gal/day Pump Tank Manufacturer WIESER CONCRETE " '13 NA Design flow (peak), (Estimated x 1.5) 450 gal/day Pump Manufacturer COULD PUMPS . "D NA Soil Application Rate 0.5 al /da /ft z Pump Model 3871 EPO4 DNA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit : I�! NA Fats, Oil & Grease (FOG) 530 rng /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L IX NA ❑Mechanical Aeration ❑Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) t D NA Biochemical Oxygen Demand (BOD,,) 530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L (I NA ❑ At -Grade It Mound Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in die. ❑ NA Other: 'r. NA Other: ❑ NA Other: O NA Other: D NA "values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Event Service Frequency ❑ moms) (Maximum 3 years) O NA Inspect condition of tank(s) At least once every: 2 earls) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume D NA O month (s) (Maximum 3 years) ,.D NA Inspect dispersal cell(s) At least once every: 2 It years) Ckmonth(s) ;D NA Clean effluent filter At least once every: 13 ❑ year(s) limonth(s) O NA Inspect pump, pump controls & alarm At least once every: 13 ❑ year(s) ❑ month(s) D NA Flush laterals and pressure test At least once every: 3 Qtyear(s) ❑ month(s) D NA Other: At least once every: ❑ year(s) Other: D NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifi� Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer, Septage Servicing OperetQ4' Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks Or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any p ond in g of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR _113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4101) OWNER: TOM KARNEY Page 8 of 8 START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to Assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, The area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may unprove the performance and prolong the life Of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; Disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat Scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the System is properly and safely abandoned in compliance with ch. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space Filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code Compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a Vast resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS XK Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect.;d that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name HELGESON EXCAVATION INC Name JOHNSON SANITATION I Phone 715/772 -3278 -Phone 715/273 -581_ 1 SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORIVY Name JOHNSON SANITATION Agency ST. CROIX COUNTY ZONING Phone 715/273 -5811 Phone 715/386 -4680 This document was drs4ed by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sankatlon aDWidp& Tide dOCfIrtMAF M" in* minimum requirements of ch. Comm 83.22(2)(b)(1)(d)3(0 and 83.54(1). (2) 6 (3). wisconskd Admirdsl alhn Cods. U&S Of 966044 "dwarf qusrsnde• the pertormsnee of the POWTS. Q11W�1) 1818 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of S a f e t y and Buildings in accordance with Comm 85, Wis. Ad ode A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan mu's County St. Croon. include, but not limited to: vertical and horizontal reference point (BM), direction a r� percent slope, sale or dimemsions, north arrow, and location and distance to nea t road. Parcel I. D. 028 - 1002 -65 -000 Please printer if Z ewed By Date Personal information you provide may be used for ( Law, S. 1 .04 (1) (m)). Prop erty pe�Y Owner ro Location Shellley O'Bri Monlcken ) l L 3 ( X004 Go vt. Lot SW 114 SW 1/4 S 1 T 28 N R 17 W Property Owner's Mailing Address loot # Block # Subd. Name or CSM# 507 200th Street ' ``A ` _ '' 1 CSM Vol. 7, Pg. 1953 City State J City _j Village 101 Town Nearest Road Baldwin I WI I 54002 715 -684 -3516 Rush River 200Th St. & 50Th Ave. New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate 450 GIRD _I Replacement f Public or commercial - Describe: Parent material Glacial Till Flood plain elevation, if applicable na General comments and recommendations: Install mound system at elev. 99.50' at 11" above 98.58' contour. Boring # Boring 1I Pit Ground Surface elev. 99.18 ft. Depth to limiting factor 26 � in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -8 10yr3/2 none sil 2fsbk ds cs 2fmc 0.6 0.8 2 8 -18 10yr5/4 none sil 2%bk mvfr gs 2fm,1c 0.6 0.8 3 18 -26 7.5yr4/6 none sl 2msbk mfr cw 1fm 0.6 1.0 4 26 -32 7.5yr4/6 f2f 7.5yr5/8 sl 2msbk mfr gw 1fm 0.6 1.0 5 32 -50 7.5yr4/6 m2d 7.5yr5/8 scl 2csbk mfi - 1vf,f 0.4 0.6 Heavy silt coats observed on cleavage planes of soil peds in horizons #3, 4 & 5. Boring # Boring Pit Ground Surface elev. 97.27 ft. 25i in. Soil Depth to limiting factor � 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 0 -9 10yr3/2 none sil 2%bk ds cs 2fmc 0.6 0.8 2 9 -20 10yr5/4 none sil 2fsbk mvfr gs 2fm,1c 0.6 0.8 3 20 -25 7.5yr4/6 none sl 2msbk mfr cw 1fm 0.6 1.0 4 25 -35 7.5yr4/6 f 7� sl 2msbk mfr gw 1fm 0.6 1.0 5 35-46 7.5yr4/6 m2d 7.5yr5/8 scl 1csbk mfi gw 1vf,f 0.2 0.3 6 46 -54 7.5yr4/6 m2p 7.5yr5/8 scl Om mfi - 0.0 0.0 T Heavy sift obs on cleavage planes of soil peds in horizons #3, 4 & 5. * Effluent #1 = BOD ? 30 < 220 mg/L an 6S >30 < 150 g/L " E ent #2 = BOO <30 mg/L and TSS <30 mg/L CST Name (Please Print) Signature CST Number James K. Thompson = 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceo , WI 54020 6/302004 715 - 248 -7767 L Property Owner SWiley O'Brien - Monicken Parcel ID # 028- 1002 -65 -000 Page 2 of 3 a Boring # _j Boring IA' Pit Ground Surface elev. 98.58 ft. Depth to limiting factor 33" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -8 10yr3/2 none I 2fsbk ds cs 2fmc 0.6 0.8 2 8 -17 10yr3/4 none sl 2fsbk ds gs 2fm,1 c 0.6 0.8 3 17 -33 10yr4/6 none sl 2msbk ds gw 2fm 0.6 1.0 4 _�3-48 7.5yr4/6 f2f 7.5 r5/8 sl 2msbk ds cw 1vf,f 0.6 1.0 5 48 -56 7.5yr4/6 f2d 5yr5/8 s 0 sg dl - - 0.4 0.6 Heavy silt coats observed on cleavage planes of soil � peds in horizons #3, 4 & 5. F—I Boring # J 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 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F—I Boring # I Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * 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. 0 LA) CIVQI lint -.0 o �. 0 0 � ®,Sa�l edu�kao = -� a w I � � I r � 0 Eye ✓u�:��, i 19d�S8' , Y 4 y om /Qa =1as 94' c r, de ¢leer_ 162.20" Wee eel p Inc r ✓lu K' 7�,� ('�' %SEi�+q Efi S in dryWelO oFCVr c/t. 3 bed� QSCpEt'c�A: �16o^°�a`i Assu.rrd e�. z X;L.cYJ ` Pts rdt.+cC a s P,cr code . ° y i I y dGex �araye 3I Shea �" pPLn v -1J� °� yard SD Ale . .� . 3 o� 3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer '* Te un Mailing Address es .06>01 Property Address M SCI-1 (Verification required from Planning Department for new construction) City /State Parcel Identification Number 0 - 29, .113 LEGAL DESCRIPTION SW /. t , Sec. I , T��N -R _W, Town of Property Location , '' /, Subdivision �j A . Lot # ___�___ 1 Certified Survey Map # Volume - 7 , Page # /y 5 Warranty Deed # Volume Page # Spec house O yes [�g no Lot lines identifiable 50 yes O 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 dw 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 licensed pumper verifying lumber or a licen p fY g that (1) the on -site wastewaterdisposd system master plumber, journeyman plumber, restricted p P 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with rho standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. CettilicStlon stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning office within; 30 days of ee y xpiration date. GNATU OF ICANT DATE RE OWNER CERTIFICATION I (we) certi that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner($) Of the pron desc ' above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNA OF 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 0$124:2005 12:53 FAX 715 386 6560 ESTREEN & OGLAND Q002 U 2 8 6 9 P 114 812�Z3 -101,a10 State Bar of Wiscoasin Form 2-2003 R�Ci38 OF i)EEDS WARRANW ]'TIED s T. CROIX C'0 , MI >5ow+avmNumbtr at Name RECEIVED FOR REGARD OW17 /2M 02:tt P)l VAkRANTY n= TIM >t M, n aac bets m Shelley F_ _ L4g&km _Lag 8Aj jkd1w E. Momicken and w EKEV 4 gheQer E. O"Rt!ien g� FEE- 11 0t) ("Greater" wheths: one or xxlore), 7`R1US FE£; $71. and Vit:We L Ksrney and Tom KarneY, wlfe and husband COPY FEE: CC FEE PAGES: 1 Maw," whether one or nwr4 kccwdims Area Grantor, for a vattrable consideration, conveys and waaram to Grantee the folltrwing des itbed real ashilk together wilh tAe rents„ profits, fixtures and other appurtenant Nan,. Red VAWM tiltdrfts lmreas, in $t Croix County, State of Wisconsin ( "Property') (if more space DaWd , Est M is fre &-4 please actaeh eddaaduat): Xw Lown SM That part of Sw r /+ $w '/, See. 1- T28N.R17W ttlts:ribed as Follows iqsis�.st' f sold Cm rtifasd Surrey Mop meorded in Val. 7 o1 milted Survey Maps, Pap � � k �+ 78� Croix County, WEeeoas►D. I°I S3 ` 1 Prred ldcolifirdtien Numb w 7'6is i��.,r.,_ pom�d proparY, 00 (is rm) Exceptions to wanazdiias: Easements, restrictious and right"r -way orreeord, lrany. Dated o e / (SEAT.) Cary E, ar (SEAL) (SEAL.) V � AUTMNVWATTprr A M0WLEDGMENT Si,gamae(s) SbegU_ M dna fllr/r Sb eller E. MoDlciraD and as SM&T L. O'Brien STATE OF ) eutheaticated QP sa. CC)(JN7'Y ) %mma imid- PerTOWly iMMO trefore MO OR _ TITLE; MEMBER STATE BAR OF WISCONSIN the 46ovt~4aare (if not, td me known to be *a pemon(s) who executed the foregoing authorized by WiL Stat § 706.06) b+a*r++ eat and acmowledged the same. THIS rNSTRUMENT DRAFTED 13Y; Attnroev Krimbo O»rlaad _ _ Notary Publio, Sm of ff 4.410A, W1 54016. f _ _ My Cvmmimian (is permanent) (expiras; NOTE: TBIS LS A FrANDAAM IFOrtM b ANY MEODMCATIO O�`iM FORMSHOULD e$ CL ACtLV tDErMFM. WARRANTY DFJW 02M STATE BAR OF V4$CQKWN FORM NO. 1.2m • Type nAmm belwv alpowes, IMPa -PRO"- Level Pemr rW -W% wew.lnfoplotalmr•Cem eOW bL5'ON Ud dMdO JSd3_11d3 NW 60MI SW2 /rz /Be ` Market Trend A (a' als SURVEY MAP A90ETiDUM Fiie r&. 5Kamey Case No. Borrower Vle_k L Karrwy Properly Address S07 20M Street nh 62ldwin ''aIr1AJ St Crote 5tia WI ZioCado 54002 lemernvsnt 3Jnion River Moiwagg _— _ Adaress 2AG1 Lowry Aye NE. 200. Minneapolis M1�IN 55418 O€; O c�vx': sulaYE� �p 1A or leg w; 4 ibmroP�p Z4 N r i7 gee!•, �'atian ar AuJrr, �k1v4r, 3ab ac„s� eo�r,Ia•, �r:a =omatr.. ;tyre aye a9drs.�a ut' aCaxRra!atroGs* ct' ar�s�= yk Gap ?�omt J•zrt raS� @C Vlr. airi6t. 1.,YkI y.l Jfr "s'a'. 7J /r ^ trt.t rai J'Raae! . 31,lE.uin, b' ;r4L1'J2 . J,�r.br rJr °ea'o' �r e w ` �, ti � Le r _ �' 9i ' e . �. �] . ,r .IL �° • ' `� fi iY'arWY fM' w, 0 4L{ V 4 I t I yV mg, yto, r.` yrrr, grN'ti' >. 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Garsdt Poo a, k0 i $t AM AS 'tih °ost4lr'a �6ts,L� of pi *sc-0 'Iwvrlla V, °24F Vlf. ArRis',a =mod lar $'zvvmr dd ,tiI�asU`ltNlti�� tlaJ^s8Y cewidt"Y vA'ot �l' 01�°e05,eu o: tht AaYmrxt 8, :1son ,�.�1� S'd,�' �,._.. `ttaie, 1 leer aurr6yad °rld at,rfked Sri& =04aa gpenaR nsradl;+ dS b".A74684a vilvr of) LDW rea ds, umptee 2"X 7u of thi k".'mCC+4iN�er S.taAtba am 'tS4 P�tS'irAWem ' -f at. Cso'u C " + I W R y uvX i:?n;,6 Imp ena GrpaCS"LW'btr?� ahc!,tz nArNCh MY4 a M.Hie ; � •' / 713 � to j a:1? :arraoi �r�"aeerta�aE i.�sreo#. � � � : • .YrtCd A,u't Cnrs1 : : »ea S :ayJ?b N*5 L suresav* N. Ml PY 9t, Cro£x Cma�,tp. WSS�QIc9l4Xa� � \ ttpgL °tared Viand ,sr;rTw,wa>! i IMIE t 1 I i I M� 011cWORMS Appfalsel Software 800422-8727 t'sge 8 of W 14 L0061 Tti9'ON L82LeLL91LL6 �- ad dnoau .,Sdd NW eE:r L 5002 /9z /B0 43611 CUiTIFIF.D SURVEY MAP RAYMOND R. OLSON ESTATE Part of the Southwest 1/4 of the Southwest 1/4 of Section 1, Township 28 Nor , 17 West, Town of Rush River, St. Croix County, Wisconsin. Name and Address of Administrator of Estate: Douglas S. Wynveen UNPLA rrED LANDS SO C/0 First Nat. Bank of BalC �R'i� 990 Main St. ,J Y ' '" - W 1.-4 ING SEC. / , T R /7W Baldwin, WI 54002 / J/I IRON BAR fOVN D.) I JAM awd 305. S/' 4 � O 0 �J� 3.0. It ' 2 /-O / e �► a `. 40T A.qs Q I t I � . 1.000 AcRes 1 I,-. Do, So. -r. �I I „ 1rI Q I n OWELL /NO �I W NET = I. JO! A CRES fu y I 3 �� RVINS ~ J{I 2 O I IT. 63! S0. /r. ( ��•CII� OW£LLINO 3 O V O �� O f•� O M RUINS W LINE SWIM p C O le O �I = Y h I2 GARAGE ^ SW COP. SEC. /. TYI N, R 17W, � I O N / 3/I" IRON OAR fOVN O+ BARN O v = N J3 3� h . t N !O. 00' 00 "W J•OA/ S III CON. SEC. I. T YIN. R/TW. Olndicates I" x 24" — G — h — iron pipe wei ghing -- N !o - oo•oo E J IR 1.13 lbs. /lin. ft. se S t" — I —"— sews£ / "= zoo' L INC SW I/♦ e o JO' /OO' zoo 300' Vo 1 S!O' 1 I UN T TED L AND S � 1 Description: That certain parcel of land located in the Southwest 1/4 of the Southwest 1/4 of Section 1, Township 28 North, Range 17 West, Town of Rush River, St- C County, Wisconsin, more fully described as follows; Commencing at the Southwest corner of said Section 1, the POINT OF BEGINNING, of the parcel to be herein described; thence N 90 ° 00'00 "E (assumed bearing on the gouth line of the Southwest 144 of said Section 1) a distanr of 393.51'; thence N 00 18'05 "W 553.49 thence N 90 00 11 W 393.5 thence S 00 18'05 "F 553. on the West line of the Southwest 1/4 of said Section 1, to the POINT OF BEGINNING, containing 5.000 acres, being subject to easement over the Westerly and Southerly 33.00' thereof for town road purposes and also being subject to easements of record. Dated: Feb. 22, 1988 State of Wisconsin) County of Pierce) I, Laurence W. Murphy, Registered Land Surveyor do 010%tagffffff� hereby certify that by direction of the Raymond R. Olson -.� \ 90 N. 'sq Estate, I have surveyed and divided the lands shown hereon ���� . .............. in accordance with official records, Chapter 236.34 of the LAURE Wisconsin Statutes and the Ordinances of St. Croix County; m ! Vy Y and that this map and description shown hereon are a true CP i 1713 and correct representation thereof. 'i!N FAL ��'•., . LAND Vol. 7 Page 1953 Y Certified Survey Maps Laurence W. Murphy St. Croix County, Wisconsin \ R gistered Land Surveyor AN 11 W I =MMYWMQ