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HomeMy WebLinkAbout028-1013-60-100 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453441 0 GENERAL INFORMATION (ATTACH 4 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 Parcel Tax No: Owen, Ian I Rush River Township 028 - 1013 -60 -100 CST BM Elev: Insp. BM Elev: BM Description 11�� ,I Section/Town /Range /Map No: ToO 6A'f 11.28.17.68a10 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ' C106 Be chmark n Dosing Alt. BM7, �J t 7-1 or Aeration Bldg. Sewer / '3 7 8? Holding St/Ht Inlet TANK SETBACK INFORMATION & 6d t4/ 0 e�) St/Ht Outlet --�° TANK TO P/L WELL BLDG. � r Vent to Air Intake ROAD Dt Inlet Septic 135 , a 3o 36 Dt Bottom fit � t S 2 Dosing �� ea er/ an. it Aeration Dist. Pipe z•S oi,t� Holding Bot. System 'Z v� Final Grade PUMP /SIPHON INFORMATION 1, b Manufacturer Demand St Cover Q . GPM /04 Model Number 1 /0 q,3 , TDH Lift Fri ction Loss System Head 3 �s�� TDH Ft . Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM , BED /TRENCH Width Length No. Of Trenches M PIT DIMENSION No. Of Pits Inside Dia. Liquid Depth DIMENSIONS , U SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHIN Man INFORMATION Type Of System: C OR / / Model Number DISTRIBUTION SYSTEM 5 , (; Header / Distribution r I I x Hole Size / x Hole Spacing Vent to Air Intake '" / 2// Pipes) `� / 0 (o 2- �S / Length Dia Length S Die Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems 9nly Depth Over D Over j xx Depth of xx Seeded /Sodded - Mulched Bed/Trench r Bed/Tren Topsoil 5 f Yes IF No e U No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1:� /� /Q��j>ti Inspection #2: (1 0q Location: 464 200th St Ll��W (SE 1/4 T28N R17W) NA Lot 3 Plo1� ' p IG Parcel No: 11.28.17.68a10 1.) Alt BM Description = $104 LDa/! 4 F &u 2.) Bldg sewer length = , z - amount of cover = It1,{ h,�T1111�/WL 3.) Contour Plan revision Required? ?S inaWr ` a C _ Use other side for additional information. SBD - 6710 (R.3/97) Date Insepctor's Yes No Cert. No. 1 _ Safety and Buildings Division Cnnn 201 W. Washington Ave., P.O. Box 7162 ar Madison, WI 53707x- 7162, Sanitary Permit Number (to be filled in by Co.) I'.SconSit n (608) 266 -3151 4 5-3 44 ( Dep artment of Commerce st Plan, LD. Number Sanitary Permit Application 0 2 5 (0g ess (f differen 3 r �s . , lit scoord with Comm 83.21, Wes. Adm Code, personal information you provide project Addrt than mailing address) may be used for secondary purposes Privacy LAW, sl5.04(lxm) L Application Information — Please Print All Infotwation 4q 2� S4 Parcel # N Block# property gene's N omc-- Property Owner's Mailing Address – property Locaoion 1 1 : ✓� SG, city, state 21p Code Phone Number It 1 N, E r W EL Type of Building (check all that apply) 5 "'" / 3 CSM Numbers -y 2 Family Dwelling – Number of Bcdroo 2 , I V. /� �/ L 6 0(10✓ p Pub rdL:otnrnacw – Dsstxibe use tt'~ City_ V loge owtdP of State owned – Dr=19 Use IIL Type of Permit: (Check only one box on line A. Complete line B if applicable) p : 29— 1015 — bo — / 8 R r O A. System Replacement system TreanaenMolding Tank Replacement Only odor Modification to Eziatiag system B. Permit Renewal Permit Revision Change of Permit Transfer to Kew Lot previous Permit Number and Date Issued Before Expiration Plumber Owner IV. a of pOWTS S l a t"k all that a i) S Non - -Pressurized In-Ground _> 24 in. of suitable soil Mound < 24 in. of suitable soil At-Grade Single Pan Sand Fi Wr Constructed Wedand Pies ti ized In- Ground Holding Teak Peat Filter Aerobic Treatment Unit Recrrtarlating Sand Filter Recirculating Sl Media Filter Leaching Chamber Drip Line Gravel -less Pipe other (explain) v. of U i tment Area Information (tm . 0 !D= F1oW (gpd) Soil Application Rate(gpdsf) Dis Area Required ( Di Area Proposed (st) System Elevation J- �S� capacity in Total Number aq� Prefab ix Steel Fiber Plastic alc Info o f o� A _� (�F{-l'.tttlrt�" '>) Concrete conat:tr«ed GIM Galion!; Gallows ni Prey FsHog Tacks Tanks Mor Hotdiag Taok AcrobicTaatmeotUnit Dosing c3arabx O bD YII, psibill Statement L the bili for instansdon or the PowlS dwim on the attached mber Plumbers Si Ir1PYMPRS umber Business Phone Nu Flu �ame (Print) Plumbers Address erect, fai fate. Zip VIII. Conn Use Date Issued issuing Signatute (No Stamps) Sanitary Permit Fee (includes Gmundwater ppmvcc] PPr°ved SttrchargeFee) '4 owner GFNii, Reason for . U IX. Conditioas of Approval/Reasons for Disapproval SYSTEM OWNER, 1 Septic tank, effluent filter and dispersal cell must all be serviced I maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable codelordinances. Attach coanpkte plans (to the Conti ty WAY) for the system on Paper not less than 81lE z 11 inches is six II PLOT PLAN PROJECT 4am and Christv Owen ADDRESS 2237 Golfview Drive River Falls Wi 54022 SE 1/4 NE 114S 11 /T 28 N/R 17 W TOWN Rush River COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 7/18/04 BEDROOM 3 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 464 # of chambers none Ilk BENCHMARK V.R.P. Base of fence post ASSUME ELEVATION 100° Filter Zabel A -100 ❑ BOREHOLE O WELL * H. R. P. same as benchmark SYSTEM ELEVATION 101.0' nN 391' Property Line Od I-If.M. #2 is gra e101' @ marked stak 1 Please note: the length of the cell is to be extended @ 99.0' B-1 54e_ 0 1' duet he slight % deflection on the cigM. Grading is to be done to divert run -off away from system Nil is to meet all P cks found in om .83 4% Slope B - 2 Area 15 elow system B.M. V #1 is to re ain b us undistur ed O�� OOt t. B -3 Huffcutt Tank is to be proper Combo tank Pr 3 bedded and provided h Be r om lockdown covers with 1(� Ho approved warning labels 361' Property Line Scale = 1/4" = 10 391' Property Line m ol? *4 Safety and Buildings 4003 N KINNEY COULEE RD commerce LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 scons n www.commerce.state.wi.us /sb Department of Commerce www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary July 26, 2004 CUST ID No.226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 07/26/2006 Transaction ID No. 1025683 SITE: Site ID No. 686929 Ian & Christy Owen Please refer to both identification numbers, 200TH St above, in all correspondence with the agency. Town of Rush River St Croix County SE 1/4, NE 1/4, S11, T2 8N, R17W FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 970796 Maintenance required; 450 GPD Flow rate; 26 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version 2.0, SBD - 10706 -P (N.01 /01); 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. The following conditions shall be met during construction or installation and prior to occupancy or use: DEPARTMENT I FT1 General Approval Requirements: • This system is to be constructed and located in accordance with the enclosed approved plans and with the SEE CORRE; "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). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat SHAUN R BIRD Page 2 7/26104 • 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 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 Cover Page t7 z 41*4 Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 07/18/04 Owner: Ian and Christy Owen Location: SE1 /4NE1/4 S11 T28 N,R17W Lot 3 200th St. Rush River System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section /Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve Y Ct}A)kPe�, r � 7 -8. Maintance and Contigency plan U iyc 9 -11. Soil test ,P ONJEN CE Shaun Bird Signature License number 6900 PLOT PLAN PROJECT lam and Christv Owen ADDRESS 2237 Golfview Drive River Falls Wi 54022 SE 1/4 NE 1 14S 11 /T 28 N/R 17 W TOWN Rush River COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 7/18104 BEDROOM 3 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 464 # of chambers none IL BENCHMARK V.R.P. Base of fence post ASSUME ELEVATION 100 Filter Zabel A -100 ❑ BOREHOLE O WELL * H. R. P same as benchmark SYSTEM ELEVATION 101.0' 391' Property Line B.M. #2 is graded 01' @ marked stak 1 Please note: the length of the cell is to be extended @ 99.0' B 5 �-�- ❑ 1' due he slight % deflection on the 49M. Grading is to be done to divert run -off away from system Well is to meet all setbacks found in Comm. 83 4% Slope B -2 B M Area 15 below system is to remain #1 undisturbed 200th St. B -3 Huffcutt Tank is to be properly AL Combo tank Pro 3 bedded and provided with Bedroom lockdown covers with House approved warning labels 361' Property Line Scale= 1/4" = 10 391' Property Line i 7 - I r Designer No Date Non -Woven Filter Fabric 4" Observation Pipe Perforated ,Distribution_ Pipe Below Filter Fabric : As1M C -33 Sand 4" o ' Topsoil :, _ D_ E - % Slope ���Flowed • t' M•Oin Bed Of Force i / Drain Rock From Pump L cyer {O E J �s f A Mound S stem Us - � Cress Section O -Y F A Bed For The Absorption Area G -;"- A Ft. Fi L; __ Ft. Vt.. 2 — . , 2 Ft. K1 Ft. . L 7�Ft. Z4c L 4:'Observotion Pipe _ K r jqj). - - - -- 1 Force Moin From Pump W 3 � � i� 0 Distribution � :Bed 0f /2 - 2 2 Pipe Drain RocK I 40bservation Pipe ' �C,cx� Permanent Marker w.s P i pe or Rods Pi on Vi 0 M n f and Using A Bed For Th Absorption Area o V PAG E�OF Perforated Pipe Oetait End View __ �Rertororsa �♦ .y+ PVC Pipe Kaes Located Oa t3ortom. Are Egy°Ity Space° .,, n r PvC Forts Main FIRST i4OLi tff. %'1� T6 CanntL }�o� PVC Manifold Pipe j?ke, f3i51riaYf�°ff L- Pipe ?Xf 1)- Distribution Pipe Layout p Ft. n X �- Y Inches Yr Inches Signed: Hole Diameter� Inch Lateral �" �, ' Inch (es) License Humber: Manifold " Z, Inches Date: Force Main " Inches ,# of holes /pipe U Invert Elevation of Lateral r ggECti ICATIONS SEPTIC TASK 5 PIMP C WEal ,t A BOv 7E GRADS jU NCT1014 $flx APPROVED IZ Hi2� W,Tjj C014DUIT W/NPADLOOK 6 CF VENT Fin IYE w1gl0w OR WARKING LABEL -B `ROK DOOR I FRBaii � 'S' I �r c� IS ,�►��• s• INLET - ---- TZGHT , SFe°s �' APPROVE = PIIPE WATER TIGHT 5 EA A RLM it1E B ' N SOLID SOIL ApppOV£D C ` • FF J FT- pOM SID - � '"' �Hp 4FF ELEy .r-- -- D SOIL ER. C R CRETE pAU Y ED gEDDI3EG V ND '�Al+i j �.� 3 AS APPRa SpECZFICA NLI3iBE#t ,DOSES DAY PER SE IC ! DOSE /� cDING 9 °_ GAL - FAC'I�1 E �C�ME ZK 1C: TANK IMAM) gER : 6 G A IL. F LQ x 3 l` , AL SEPTZC� GAL • p , O al' Z3rCHES TA DOSE �(� CRFhCITIES: g Z3►1CHEs = ^' �'� G AL. ALARM MmUTAC AE MpDEL mu34s%R -- "' L /'C L �. Jr - INCMES ---�" SNITCH TYPE / C FRCT{JR£R : 0 = PV KP i�lA �gE�L : MODEL TYPE= � PunP uYR�� �` PER LHR 16`23 WAC � FEET SWITCH aISCHl,RGE RA2'E �✓ GPM ANDS IgUT'L0! PIPE : EET REQu -jRF.D D S'TR. FEET ENC SETWEZ14 pVMP OFF - `�" 'QH FACTOR FEET VERITCAL OIFFER T / SUPPiY R � RE AI, r)Y Uti HETw0jtK FltiQ -F flTAL DYN IC M J MI FEET.FORCE / DIAMETE Y 2 INTERNAL INTERNAL OIMENSI44isF PU M? TANK : LIQU D D A7= r LICENSE NUMBER S ;GATED = _ /So r - TOTAL DYNAMIC HEADICAPACITY HEAD CAPACITY CURVE PER MINUTE EFFLUENT AND DEWATERING MODEL 152/153 U: MODEL 152 153 W � 50 Feet Meters Goi. Liters Gol. Liters 153 5 1.5 69 261 77 291 10 3.1 61 231 70 265 1 2 - 40 152 15 4.6 53 201 61 231 W 20 - 6.1 44 167 52 197 T 20 25 7.6 34 129 42 159 Z B 6 1 30 I 9.1 23 87 33 125 r ° 22 85 o 40 12.2 - 11 42 4 Lock Valve: 38.0 Ft. 01.6 4 4.0 Ft. (13 0 0 60 80 100 GALLONS e 1/4 LITERS p 80 .160 240 320 3 27/32- 1- --+�::4 1/8 FLOW PER MINUTE l y 3 27/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Timed dosing panels available. - 3 27/32 • Electrical alternators, for duplex systems, are available and supplied with e an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. ll ! • Sealed Qwik -Box available for outdoor installations. See FM1420. • Over 130 °F. (54 °C.) special quotation required. ! 1521153 'Series 12 1/8 --�- t52t153 MODELS Control Sele 'on Model Vohs -Ph Mode Amps Simplex ^ Duplex i 5 1/8 N152 115 1 Non 8.5 1 2or3 BN152 115 1 Auto 8.5 Included 2 or 3 J_ sK20e4 E152 230 1 Non 4.3 1 2 or 3 BE152 230 1 Auto 4.3 Included 2 or 3 N753 115 1 Non 10.5 1 2 or 3 11113 1t5 t Auto 10.5 Included 2or3 SELECTION GUIDE E153 230 1 1 Non 5.3 1 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float SE153 230 1 I Auto 5.3 Included 2 or 3 switch. Refer to FM0477. o cqurtoN 2. See FM0712 for correct model of Electrical Alternator E -Pak. Alt Installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10 -0225 used as a control activator, specify duplex (3) licensed electrician. All electrical and safety codes should be followed including the most or (4) float system. recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P,O, 10X 16341 Louisvilfe,KY 40256 - 0347 Manufacturersof.. SHIP TO: 3649 Cane Run Road �+ Lv ® Louisville, KY 40211 -1961 Q/1QL /TYPVMP9 INF (502) 778 - 2731.1(800) 928 - PUMP http: / /Www.zoeller.com PUMP M. FAX (502) 774 -3624 © Copyright 2000 Zoeller Co. All rights reserved. AGS _NT PLAN Page ct _ MAN 8, MAN S OYKNER'S MA SPECIFICATdONS WT M t?O gTE SY � _ O NA $eptic Tank NA piL INFORMA-11ON u �turer T{ Owner rept3c Tank Man G Q NA p it Fflter jModelactu rer Effluent ✓ / p NA t Ftter Model Effluent ppRpME� � ' d tVA E o NA DESIGN Ca aaity :3 Number of OedmOrns Pump Tank P NA m i �cial Units p Tank Manufacturer --� ❑ Number of Co at/da EsdtTiated flow ( e) , 5 S aVd . Pump Manufa 0 NA X ) Mode akl n flow (Ps- (e"mated �j aVda � Pump d ant Uni t Fitter Soil App°n Rafe Monthly average' ' SandlGrilvel Fitter p Wetland lnflusntlEffluent Quaiay G _<30 mg/L ❑ Mechanical Aeration ❑ Other Fatsr Od Grease (FOG) Q20 mg/- C3 Disinfection BMoem ch�t OxYg�" Demand (SODS) 5150 m /L Manufacture Total Suspended Solids (T SS e Otspersat t ;ett(s) c3 [n- ground (pressurized} Monthly ave rage (greviry) � plea Effluent Quart �i0 mg1L ❑ l t Othund t300s) Q At -grade p er Biochemical Oxygen Demand ( 30 mg/L 5 ine ' Total Suspended Solids (TSS) St0' c�ul'tppmi O Dri wr OW Fecal Copform � mean) Y aruas typ for domestic (no rrcom�T1e roan �� Y, i diameter septic tan entuenc. ,,,,s�vrater. Maximum Effluent Particle Size values typtcitW Service Frequency MAINTENANCE SCHEDULE ar(s) (Maximum 3 yrs.) Service Event At least once eve equals on rd (1S) p months ry and sc of tank volume um e' i Inspect condition of tank(s) When combined sludge d months ar(s) (Maximum 3 yre•) Pump out contents of tank(s) At least once every r(s) real cells) 13 months . dspe At least once every r(s) NA inspect C3 months Glean smuent filter At least once every O months ear 17 NA Inspect Pump, Pump °Onus 8. alarm At least once every C3 months [3 year(s) p NA Flush laterals and pressur test At least once every � months ❑ YA g) C3 NA K odw- At least once every ocher licenses or �AAI ce iNSTRUCTIONS e of the foltawM Maintainer, SePtage dispe veils shalt be made cu an individual carrying on ed Sewer ppWTS i�pector, pOW any missing or broken inspec tions of tanks and dispe Plumber Reslri to identify for any back UP �r scions: Master Plumber: Master on of the tank s and and to chec>K ns must include a visual inspedi a a nd sc um � �� � effluen t levels tor. Tank inspedio of effluent on the Servicing Opp or leaks, rrteasure the valume ceiM(�s) shall be visual Ins pondMng hardware, Identify any Crate The dispe round surface- M nding of effluent an e ground surface auModly or ponding of effluent on the g for any Po e local reg fication of thulates' lame, the in the observation pipes and to check nand r equires the irnmediste noti or more of the tank volume, m indicate a failing condibo ua {s one -ttiir� {�) ac co rdance with ch- ground surface May and scurn in any tank equals Sect of in acce acc u mul ation of o su by a Septage Servicing Operator and d ispo sed When the combined aocu and any entire contents of the tank shall be re t ment cernporients, onents, p re" t Maintainer. 113, yylsconsin Administrative Code. 1 or ressurized POWTS c�mP ��� by a certified POWrS mqn of effluent filters me , ctianica P - service event. The se 9 at intervals 12 months or less shall be f Of completion of any er maintenance or monitoring regulatory authority vyitfirn 10 days provided to the loca A seryige report sha ll pnovM l reg resence of painting products or ofl1er N tment tank(s for the P concentrations are START UP AND OPERATIO S check trea ersal cell(s). if high For new Construction, for to use of the ant rotor prior to use- e the treatr'rrent process and/or damage the lisp chemicals that may imPed removed by a septage servicing ape dett;Cted have the contents of the tanks) Page ot�_ - - conditions are frozen at the infiltrative surfaoe- en $ al V oen P0*W is testored the excess S up shaft not occur volt above normal highwater !costs. an d may result in the a d'in the oeH(s) S Ill e rSos 9 s ystem ov outa99S pump tanks , cetl(s) in one large dose k removed by a Dur3n9 Pe sd to the To id this situation have the Contents �� umber pOwrS Maintalner to tvfii be dtschar9 wa d hasge of ettl test er to the effluent PUMP ar contact backup or surface Opere� p�.6- ttng P unt '. e Servicing trr�ls to restore normal levels within the P . P Sig manually o perating the Pump loon . Do not drive ar pack over or othentilse disturb or compact, a and dispersai ce(1s over tanks Do not drive or park �� o f a � mo und or at�rade sail absorption area- ���� grid Prolong the life area within 15 feet down slaps wastewater stream may improve the Pe rte butts; condoms; cotton swabs; de9��; dental floss; diapers; ReQudion o r .elimination of the fottor+ring fT a the asotine; gam; herbicides; meat of the POWTS: antibiotics; baby' VAI water fruit and vegetable peertth9s; g duwnfect� , fat; foundation drain (sumP P =P �des; sanitary napkins: tampons: and water softener brine. wraps: medications; Olt; Qafnting products: P� AgAIdOONMMF -� taken out of servtce the following steps shalt he taken to insure that the When the POWTS faits and/oabandoned in compliance with ch. Comm 83.33. W Ad pen e res -edli d. tive Code system is property and safety Wings seale disposed of by a Septage Servicing Operator. • All Piping to tanks and pits shah �� disconnected and the abandoned Pipe Pits shat! be removed and properly �,� the voi6 space The contents of a n tanks and p After Pumping. all tanks and pits shall be excavated and removed or weir Covers r0 filled with soli, gravel or another inert solid material CONTINGENCY PLAN lied the fo(low g in measures have been, or must be taken, to p a code If the POWTS fatly and cannot be tgpa compliant re pl a cement system rep lacement sod and should not re lacement'area has been evaluated and m rot �alro� d sturbance and co mpa ction p A suitable P ent area shou P sed structure lot tines and wells- Failure to absorption system. The replacer from existing and propo be infringed upon by required setbacks the lacement area will result in the need for a new soil and site' evalu at that time es tablish a suitable protect p ms must comply with the rules in effect replacement area_ Replacement Syste re (acement area is not available due to setback rep ri li Barri advances in PO S tiNT Cl A suitable . p be installed as a last reso ethnology a holding tarrkmay a suitable replacement area Upon failure of the POWTS a soil and The site has not been evaluated to rdenfify replacement area is available a to locate a' suitable replacement area. If no rep b it e evaluation must be perWmed removal of the biomat at olding tank may be installed as a last resort to replace the failed POWfac Mound and at�rade soil absoryn systems may be reconstructed if pt [t�gn effedatthat6me_ e infiltrative surface- Reoatstruchons of such systems must comp y <-WARNI TMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIEN OXYGEN. SEPTIC, PUMP AND OTHER TFtFJ� CIRCUMSTANCES. DEATH MAY EP FROM THE INTERIOR OF A TANK MAY BE TIC, PUMP OR OTHER TREATMENT TANK UPIDER ANY RESULT. ,RESCUE a' A PERSON DIFFICULT OR IMPOSSIBLE DO NOT ENTER A 8 ADoMONAL COMMENTS POWTS MAINTAINER POWTS INSTALLER Name Name Phone r-- Z� Phone SERYtC(NG OPERATOR PUMPER LOCAL REGULATORY AUTHORITY SEPTAGE Agency x '� Name %v..� / - Phone Phone / �'� s Gam' This daarment meets and Sanitation agenclw- TNs document w as dialled by VW stabs of the Gram Lake. Marquette and Waushara County Zoning and Code Use of this damment does not the minimum requirements of ch. Comm 83.ZZM(bXj) M &(t) and 83.54(1). (2) & (3). Wisconsin Rdrrtints GMW MOi) guarantee the performance of the POWTS. MIGINlAL 1568 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Certified Soil Testing Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. 1l• I � CSM Pending P �3� P/ h7f ormatica— I iewed By Date Personal information you ovide mi)y be used for econdarposes ( rivacy Law, s. 15.04 (1) (m)). � Property Owner Property Location VanKeuren, Mike ' 3 20OZ Govt. Lot SE 1/4 NE 1/4 S 11 T 28 NR 17 W Property Owner's Mailing ]:Saoiq ss Lot # Block # Subd. Name or CSM# 472 200th St. r 3.9 A. CSM Pending City Zip Code. P ol. r g City Village Town Nearest Road Baldwin WI 54002 715 - 684 - 3778 Rush River 200Th St. 1/i New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe Parent material till Flood plain elevation, if applicable NA General comments and recommendations: install 4'x 112.5' rock bed mound on 100.0 contour as upslope edge of rock w/ 0.9' sand fill for 3 br residence F] Boring # -: Boring Pit Ground Surface elev. 101.5 ft. Depth to limiting factor 28 — in. - Application Rate , Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -4 10YR 3/3 - sl 2 m gr mvfr cs 1Urn .5 .9 ,( 2 4 -9 10YR 3/3 - s( 1 m sbk mvfr cs 1M .4 .6 `T 3 9 -28 7.5YR 4/6 - sl 1 m sbk mvfr cs 1 m .4 .6 t, f 4 28 -55 10YR 6/4 m2p 10YR 6/2 sl 0 m mfr - - .3 .5 considerable gr, cob, & st in horizon 4 Boring # j Boring Pit Ground Surface elev. 100.0 ft. Depth to limiting factor — 26 - —in Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft� in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -6 10YR 3/3 - sl 2 m gr mvfr cs 1f /m .5 .9 40 2 6 -10 10YR 3/3 - $l 1 m sbk mvfr cs 1 m .4 .6 . 3 10 -26 10YR 3/4 - st 1 m sbk mvfr cs 1 m 4 .6 t 4 26 -34 10YR 6/4 m2p 10YR 6/2 sl 0 m mfr cs - 3 5 5 34 -54 7.5YR 4/5 - sl 1 m sbk mfr - - .3 .5 _ inclusions cl & scl below 34" w/ gr, cob, & st ' Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mgL CST Name (Please Print) Sign to : CST Number Henry F. Grote 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 5/6/2002 715 233 - 0398 ij f w Property Owner VanKeuren, Mike Parcel ID # CSM Pending Page 2 of 3 3� F Boring # .� Boring 1 Pit Ground Surface elev. 99.2 ft. Depth to limiting factor 31 in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 - 10YR 3/3 - sl 2 m gr mvfr cs 1f /m .5 .9 .� 2 5 -8 10YR 3/3 - sl 1 m sbk mvfr cs 1M .4 .6 3 8 -31 10YR 3/4 - S1 1 m sbk mvfr cs 1M .4 .6 , 4 31 -51 10YR 6/4 m2p 10YR 6/2 sl 0 m mfr - - .3 .5 -- F-1 Boring # _j 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 F -1 I Borin 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 GP 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 altemate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) Certified Soil Testing f 3 v 4 r4 4 C M M1 jA 9 j cr r a Y a 4 s V d a v S S ,� i J IN d v 7 � C� Ar °• w 3 "�iaa o ST CROIX COUNT h INTENAI`TCE AGREEMENT` SEPTIC ETA AND . 0,gg,SHIP CERTIFICATION FORM i Owner/Buyer Mailing Address Property Address Plann Depart ment for new construc (Ycarioa required i _ 0 -/� 68 0 ) Parcel Identification Number 4 City /State t FGAL DFSCR� T N � / 1 /. Sec. T- �- p l� w pro ' To wn of erty Location t 1 /• p Lot # , Subdivision �.� page # Volume Certified Survey Map # , Page # 3 2 2- Volume witrranty Deed # p yes p no Lot lines identifiab Spec house 0 Y no S SY remature failure �� w TN'I"FNA -NCE t l the M 1 `' of your B T system could resin asts P to handle wastes- proper maintenance in by a liCense nee pumper• Wba t Yo u put into LUproper use and main every t� Yews or soot, disp osal system of p out the septi tic tank as a treatment stage in the waste disp . consists P s i g ned by the owner and by a can affect the function. of the septic a mo rtification fozza, i>� W astewater disposal system to St. Croix Z Depar� eat 1 the on -site waste The pro perty owner a grees to ted lumber or a licensedp� Uper venfy>ag s ptic tank is less than 1/3 fv11 of sludge. the o plumber, res P i necessary) masterplutriber, journeyman on and/or (Z) inspection and Rump em with the standards is in proper operatiz maintain the private sewage disposal sYrt eats and agree to main Resources, State of Wisconsin. Cernfication d have read the abo 1eq� Department of Natural Office within Uwe, the undersig ne of Commerce and the Dep ed to the St. Croix County Zoning 30 set forth. herein, as set by the D �ia�ed must be completed and reru=n stating that Your septic system has - 2� days of a year expiration da DATE SI4Ntl: nVRE OF APPLI ' knowledge. I (we) am (are) the owner(s) of pVVNE E XC to the best of my (our, I ( certify tha all statCMIMIS on this form are true te of Dee the described a ds Office. prop ove, by virtue of a warranty deed recorded in Reg in DATE SI OF APPLICANT ertriit being r evoked by the Zoning Departmcat. s «• ` GNATUR j A information that is mis represeuted=Y result in the sanitatY P sped warranty deed from the Register of Deeds office deed ss Include with this application: s if reference is made in the warranty a copy of the certified surveY MP U 2 6 19 P 2 2 Z -CD C STATE BAR OF WISCONSIN FORM 2 - 2060 KATHLEEN H. WALSH REGISTER OF DEEDS Document Number WARRANTY DEED ST. CROI X CO., WI This Deed, made between Michael E. Van Kenron sind Connie S. RECEIVED FOR RECORD V eu en h s a d nd wife Grantor, an R. Owen and Christi °e 07/20/20164 0$ 00A1f Ow usband and wif as survivors hi marl roe ran e . WARRANTY DEED Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (if REC. FEE: 11.00 ded, please attach addendum): TRANS FEE: 141.00 OF CERTIFIED SURVEY MAP IN VOL MIF COPY FEE: SIXTEEN I16) OF CERTIFIED SURVEY MAPS, PAGE 4374, AS CC FEE: DOCUMENT NU HER 690656, FILED IN ST. CROI CX OUNTY PAGES: 1 REGSITER OF DEEDS OFFIC ON SEPTEMBER 17, 2002, BEING LOCATED IN THE SOUTHEAST QUARTER OF THE NORTHEAST QUARTER (SE 1/4 OF NE 1/4) OF SECTION ELEVEN (11), TOWNSHIP TWENTY EIGHT (28) NORTH, RANGE SEVENTEEN (17) WEST, TOWN OF RUSH RIVER Subject to 200` Street right of way. Recording area Name and Return Address Joseph D. Boles G Rodli, Beskar, Boles & Krueger, S.C. C� P. O. Box 138 River Falls, WI 54022 -0138 028 - 1013 -60 -100 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: easements, restrictions and rights of way of record, if any. Dated this � 16 day of July, 2004 * * is e e * * nnie S an "ren AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. PIERCE County. ) authenticated this day of Personally came before me this _day of— July , 2004 ' tiie abgye nam Michael E. Van Keuren and Connie S. Van' . "reu TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the p n(s) who tV trefoin� authorized by &706.06, Wis. Stats.) in nt d ackno deed sa& Q THIS INSTRUMENT WAS DRAFTED BY Joseph D. Boles - Attorney at Law Debra A. Cernobous River Falls, WI 54022 Notary Public. State of Wisconsin ' My Commission is permanent. (If not state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) November 13 , 2005 ) * Names of persons signing in any capacity must be typed or printed below their signature. WO-PRO (800)653 -2021 www.infoprofomis.com STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 2 - 20M 07/20/2004 09:49 6515520414 TODD ALLEN HOMES INC PAGE 08/09 VOL 16 _PAUE R37� REGIRR pAL 9 APPRDV ST. C A R L co. m BT. RECEIVED FOR R 7.on ECORD SEP 1 7 Z00Z 99 -17 -2992 ll:ae A CERT Fi if nol racW atii o w o s ag CERTIFIED SURVEY MAP ` "l 3. 90 �prpval ne�1 yodl shah bo P�aES: x LOCATED IN THE SEI /4 OF THE NE1 /4 OF SECTION 11 T28N,R17W, TOWN OF RUSH RIVER, ST. CROIX COUNTY, WISCONSIN. 4 I f N r VAN BEARINGS REFERENCED �TQQ HE CAST -WEST 1/4 SECTION 472 200TH STREET LI OF SECTION f1, PREVIOUSLY RECORDED As ANO OALOIRN, NI. 54002 ASSLKO TO BEAR Sb9' LEGEND NE CORNR SECTION it - fai g TE 6 SECt•ION C wFA (i` R AID ISM Y W • - INDICATES 3/ STM Fit-BAR ,g' 01 _ FWW (oUT31DE AMgTERS W INDICATES OI 1" X IB" IRON PIPE LOT 3 CONTAI , 1 NEIGHING 1.13 LOS. / LINEAR 157,058 SQUARE FEET ( 3.514 AGES J H FOOT SET, (OUTSIDE DIAMETER) t INCLUDING pR ^-� a3.1�6 SQUARE FEET T ( ( 3 ACRES) w alb (R) PREVIOUSLY RlCDRDQO EXCLUDING plpl'R- OF -YIAy INFORMATION. ' h UNPLAYTED LANDS 1 I NB9 ^os iOl 131 1.26' d i3,00 NOPITH LINE OF THE SE I/4 OF TW NE 1 1 GARAGE + SHED �, LOT 4 BUIt 0I1tG ` FiiDN RIB c -WA 1 �i- 1 S59 °06'56'11 4a4.O3' 11by 0 390 -j L,030 SQUAW FEET ( 31929 ACRES) 391 A3' 33A0' 1Ci a1 t INCLUDING RIGHT -OF -WAY , a 1373293 SQUARE PST ( 33.526 ACRES 1 ; w 1 1 1 LL v{ EXQ.LOING p;MT- OF-WAV �{ • - 1 $ LOT .3 $; 1 1 ~w 424. 1 1 w to n.od) T 2 .I S 1 C -- DI q � r k" i v al I YQ q r a I 589�06'96'•W iK�-. V�• �r 1 x.11 393393' EA$T -WEST 1/4 SECTION LINE k 1 11 1- _ _ a�AO' 7 SOVOSIN"W 885.28' 389 "W ( - 11/4 CORNER, SECTION 11 UNPLA DS 1- 1 ' 1 t ALUND4LN CAP FOUND ). Ef/4 CORNER, SECTION 11 1 I , gC O �/� l i' ROUND FTEEt SURVEY , r••' O1IUNJDD SF YM. I CALF N FEET 1 "= 250' 1 0 + WI ti PAEPAREO BY: 125 250 800' `4 �y "•••". � wKtr ( L* SVA� NEW AICIiI(ONq W1. 54017 T1416 INSTR M9 DRAFTED Y' PHONE t 705) 246 -7529 9 .X15�TH W, GRAtdl1EAG ,JDO N0. 02_O 0 S►£ET 1 OF 2 O .TS 89e 4374