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Home My WebLink About028-1045-95-000 epartmwnt of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix nd Building Division INSPECTION REPORT sanitary Permit No: 506316 0 ERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: sonal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. rmit Holder's Name: City Village X Township Parcel Tax No: We er, Charles Rush River, Town of 028- 1045 -95 -000 GST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: C t a 0 / 36.28.17.286 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Z • (*7— 02.6 /eb Septic � , ! / Z 50 Benchmark �I 1 /Gala / ab . C) Dosing CAv�v� �✓ 1 3 ' S 76Z Al BM — 0 ""_ y. X 1'8.3 F. o�y to Sz Bldg. Sew r * Holding �l SUHt Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO ! P /� P WELL BLDG. Vent to Air Intake ROAD Dt Inlet I7 ~ Septic I 23 i Z5 ZD 1 / Dt Bottom 13.3 , Dosing /Z5 / Za w / -_ Header /Man. - 3, &5 / 37 Aeration Dist. Pipe 3.215 Holding Bot. System qV. 75 Final Grade PUMP /SIPHON INFORMATION Z -ZS /6 0 1 - 5 -7 cldc Manufacturer t 4 GPM nd St ver / 3Z U. � l-Jd v G t Model Number /� 7 � �Z. (! / .0 9 0. TDH Lift Friction Loss System Head TDH Ft ,r-- 1k 6 Z 9y, 75 I�1 / aCc tv�� %, ZS Ja a� � cr+'� Forcemain Lengt 7 " Dia. t I Dist. to Well 25 3 Z SOIL ABSORPTION SYSTEM BED /TRENCH Width / Length No. Of Trench PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS I� d 'J e \ SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: r A > UNIT Model Number: In 6 .! DISTRIBUTION SYSTEM o� Header /Manifold Distribution or I1 / x Hole Size i/ x Hole Spacing Venter Air In e L I Pipes) q l r Length / Dia /' Length �� Dia / Spacing � O �! C,k..._. _ 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 l' Bed/Trench Edges Topsoil" � 'Yes [] No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: // �� Inspection #2: Location: 46 Hwy 63 Ba win, WI 54002 (NE 1/4 SE 1/4 36 T28N R17W) 40 acres Lot �Q 06W v Parcel No: 36.28.17.286 1.) Alt BM Description = �✓�" a'S� S S 2.) Bldg sewer length = 7Z ' �„ r G ( I► Ga sacl - amount of cover = N�e.6 4 a:.�Q. o� Plan revision Required? ❑Yes Use other side for additional information. / 6-7 SBD -6710 (R.3/97) Date Insepctor's S4ature Cert. No. commerce Safety and Buildings Division County 201 W. Washington AO. Box 7162 St. Croix i sco n s i n Madison, WI 5 ve . - 7 162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce J6. 504 3 /(o Sanitary Permit Application 1433308 action Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to app ate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for to -owned Project Address (if different than mailing address) POWTS are submitted to the Department of Commerce. Personal information you rovide may be d for L1� secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), tats. w 3 I. Application Informati - lea se Print All Information Property Owner's Name Parcel # 0� e Charles W er AUG 3 2007 o • 4 + 9 i Property Owner's Mailing Address Property Location ` 46 Hwy 63 ST. CROIX COUNTY (� Z 9 J Govt. Lot City, State Zip Code Pnone Numl5er NE 'k,SE '' /a, Stion 36 Baldwin, WI 54002 715- 684 -3975 (circle one) T28N; R17 W II. Type of Building (check all that apply) �'� Lot # ®1 or 2 Family Dwelling - Number of Bedroort 4 J Subdivision Name l/ N/A N/A ❑ Zn a ❑ Public /Commercial - Describe Use Block # - 7 - V / N/A of ❑State Owned - Describe Use J f� CSM Number ❑ Village of /o k �td'tJ N/A Town of Rush River III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System ® Replacement ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) System B. ❑ Permit ❑ Permit Revision ❑ Change of ❑ Permit Transfer to List Previous Permit Number and Date Issued Renewal Before Plumber New Owner Expiration IV. Type of POWTS System/Component/Device: (Check all that apply) ❑ Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ® Mound < 24 in. of suitable s oil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) L V. Disper sal/Treatment Area Information: Design Flow (gpd) Design Soi' tion Rate(gpdsf) Dispersal Area Re red (sf) Dispersal Are ropo ed (sf) System Elevation 600 I / CG 600 QGb 600 25'1 98.4P7 VI. Tank Info Capacity in Total * of Manufacturer w Q Gallons Gallons Units ¢ 0 a H g / I�. PL s ZS' a a < New Tanks Ex istin g Tanks C w o w F H w Septic or Holding Tank 1250 1250 1 vNesd Concrete ® ❑ ❑ ❑ ❑ Dosing Chamber 750 750 1 Wieser Concrete ® ❑ ❑ ❑ ❑ VII. Responsibility Statement- I, the undersigned, assume responsibility for instaRatiqn of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Sign MP /MPRS Number Business Phone Number Bennie Hel eson 20292 715/772 - 3278 Plumber's Address (Street, City, State, Zip Code) W1229 770th Avenue, Spring Valley, WI 54767 VIII. County Department Use Only proved _ D' Permit Fee Date Igsuecyo "um gent Signa e _ O ner G' cplt for $ ��! ,114 �L IX. Condit o for Disapproval 1. Septic tank, effluent fitter and ' dispersal cell must all be services / maintained as per management plan provided by plumber. 2. All sdroack requirements must be maintained as per appiictlble code / ordirktc:es. Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD -6398 (R. 01/07) Valid thru 01/09 I O + I �, t a� 8 r ((Rc ` k CIT Al r— � 6r- mod- - rc)WAJ RU64 Rio ER yy" �xCelflr As :5, oco ELL- 132, 3'y 97 S d _ — — 57o Sv �� M� y S' c lo k y f �D Ac res 'ST 6 01k CCUVTY A] Ri7 err- �f� rowm f R Ct A R O CR —_ X y „ J� �xce�o AS J l SP�ke `% P, nk:RUC) -i — I �-- �B EU- _._ a� s � q �e(C We�� S� MIA r �/ b. Safety and Buildings 4003 N KINNEY COULEE RD commerce .Wi.gov LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 i sconsin www.w w ww.coe.wi.gov/s sin.go / Department of Commerce iscosin.gov Jim Doyle, Governor Mary P. Burke, Secretary August 23, 2007 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: 08/23/2009 Identification Numbers Transaction ID No. 1433308 SITE: Site ID No. 729437 Charles Weyer Please refer to both identification numbers, 46 Hwy 63 above, in all correspondence with the agency. Town of Rush River St Croix County NEIA, SETA, S36, T28N, R17W FOR: Description: Four Bedroom Mound System / Replacement construction Object Type: POWTS Component Manual Regulated Object ID No.: 1148488 Maintenance required; 600 GPD Flow rate; 18 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual, SBD- 10572 -P (R.6/99), Pressure Distribution Component Manual, SBD- 10573 -P (R.6/99) 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. 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: • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. • 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. • The area within 15 feet horizontally down slope of the dispersal cell shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • The existing POWTS shall be properly abandoned per Comm 83.33, Wis. Adm. Code. • Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the effluent filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • 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 MU include local inspectors. P.®. "N.T.S. Conditionally A bw ii" E� DEPARTMENT OF COMMERCE VISION OF SAFETY AND BUILDINGS BENNIE W HELGESON Page 2 8/23/2007 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • 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 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.' The owner is responsible for submitting a maintenance verification report acceptable tIn granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerry.swim@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. r ' INDEX SHEET RFcF,� 406 2 FD SgF 120 PROPERTY OWNER: CHARLES WEYER NHS 46 HWY 63 BALDWIN, WI 54002 PROJECT NAME: CHARLES WEYER PROJECT LOCATION: NE 1/4 SE 1/4, S 36, T 28N, 17 W MUNICIPALITY: TOWNSHIP OF RUSH RIVER 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: W1250/750-MR ZABLE Tank Specifications Page 6: Pump Specifications Page 7: POWTS Owner's Manual & Management Plan - Pg. 1 Page 8: POWTS Owner's Manual & Management Plan - Pg. 2 Name: Bennie Helgeson Signed Address: W1229 770th Avenue Spring Valley, WI 54767 Credential Number: 220292 Date: August 20, 2007 &I* Cf�RRESP �DEE Z, I e- LO 2 M e e CUFF Synthelic Covering Distribution Pipe S TNI C 33 / 0 0, 9 Medium Sand - -- Topsoll „ o s E b C cn ta.� v 97 0 3 % Slope Plowed Force Main Aggregate From Pump Lcyer D 67 Ft. E Ft. Cross Secti ,n Of A Mound F Ft. 6 s5 Ft. F Ft. H Ft. Signed: p O Ft. K // Ft. License Number: — L g Ft. Date: -- j �, a Ft. I l2. l Ft. W y Ft. Observation Pipe d — K I r-------------- ,-- - - - - -- - - -- -- O A �r- - - -- --- --- ...-- - - - - -- --- - - - - -- - -- j Distribution l-t- 0 If 2— 2 Pipe Aggregate I !7 f Observation Pipe A c /aCl Plan View Of Mound Perforated Pipe Detail Cleanout Access Threaded End V 14 Cleanout I U! G I( V J PVC Pip( . 1 End Manifold _ -� J� Holes Located on Bottom Are Equally S q Y aced P Force Main From Pump First Hole Next to Manifold P Cleanouts Distribution Pipe Layout P � R � S �— X Y Hole Diameter Inch Lateral " Inch (es) Manifold " Inches Signed: Force Main " Inches License Number: Invert Elevation ,/ 7 Date: Holes Per Lateral J_ Number of Laterals Total Holes l D� LoAC4 '• \ A(ktke S \r� / _ Page�Of 8 SEPTIC TANK E PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4" PUy_VENT PIPE 12" MIN. ABOVE GRADE E WEATHERPROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W1 PADLOCK E WARNING LABEL MIN. 18 _ 4 " 2y' " � �l 18 MIN• INLET fj WATER TIGHT SEALS GAS- r VEO TIGHTi FILTER A SEAL S KITH APPROVED pc! y f °_k --I VED PIPE PIPE 3' SAS -- TO ONTO SOLID ' SOIL C SOIL PUMP OFF ELEV . g2,Jr FT. -#-- D 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFI r SEPTIC / DOSE TANK MANUFACTURER: (. le ej — x-� TANK SIZES: SEPTIC /DS GAL. DOSE VOLUME INCLUDING DOSE S GAL. <-� D.. C, f, FLOWBACK: /_S� GAL. ALARM MANUFACTURER: 40 CAPACITIES: A = S INCHES = -q0'3 GAL. MODEL NUMBER: !o/ N om— B = 2 INCHES = Z a.ay GAL. SWITCH TYPE: locd PUMP MANUFACTURER: T - ✓ C = INCHES = /�/S-D� MODEL NUMBER: SWITCH TYPE: _ /t/p / crr�� D = �_ INCHES = l Z 3� C'AI" REQUIRED DISCHARGE RATE GPM PUMP E ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . FEET + FEET FORCEMAIN X 3,� _ FT /100 FT. FRICTION FACTOR FEET TOTAL DYNAMIC HEAD = 3 ?_a, FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH DIAMETER LIQUID 6I.'IS'Y`Fr L '' 1 6, 10 &P.1, //�65,n_ :S-e 74,4 S� e c . SIGNED: LICENSE NUMBER: DATE: 1/88 0 a c 1 0 o N V z ( n d n X -j U LLJ (n D EB cn a Z �Li o �� No w 00 IT` ai. O 1 0 Fd N � mCU� DO 0� Nd o �a I a\ �i.l a N �WC) U m � .� Q 2 p') n fn F OJ J 2 ZZ c_ I OUW O W W Q U J J Q ,..,�^ T 04 Q. �U °- m �oN JO(n o u rn �+(NO > w _° r 7 Of (n Q W (D N LJ O a = O O F QWW � O ^�� J a LLJ YY �, V' ""= NO U) r- Q mfnQ N ^ rte- I ,^ O Z 7 Z ,..�r.OI -_ F- DOW DOW 0 � ZJO >z5ZF-o50 Omcnn O N d W Q O L — �i.11 0: Q Z —O Q o N�mommJ mJ3 ZQ�O Q U 0 O W W O Q z z O J 0 r- „£9 W J = z N I \ I I I ( "r 1 , � I I I _ `o S I , w O J w I— U I (n U j N I I N i V) I I F- „9 z J i .,L9 r' f- W 0 „98 „OS „99 COMPOSITE CURVES STA -RITE' EFFLUENT/SPECIALTY PUMPS PERFORMAJUCE CURVES CAPACITY LITRES PER MINUTE 0 50 100 150 200 250 300 350 400 450 500 550 90 1 �O 26 80 24 22 9 FC�� , � y 20 gyp 60' 18 16 W 50 A r. eoe 14 zo ud V Ul x c 40 — 12 A y to 30 c 8 20 r. s 6 F a 10 2 0 0 25 50 75 100 125 150 CAPACITY GALLONS PER MINUTE 1 NOTE: Please see page 11 for ST.E.P. Plus' Series performance curves. 20 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 7 of 8 FILE INFORMATION SYSTEM SPECIFICATIONS Owner Charles We er Septic Tank Ca 1250 al ❑ NA Permit # Septic Tank Manufacturer ❑ NA Wieser Concrete DESIGN PARAMETERS Effluent Filter Manufacturer Pol lok ❑ NA Number of Bedrooms 4 ❑ NA Effluent Filter Model PL-525 ❑ NA Number of Public Facility Units Ej NA Pump Tank Capacity 750 gal ❑ NA Estimated flow (average) 400 gal /day Pump Tank.-Manufacturer Wieser Concrete ❑ NA Design flow (peak), (Estimated x 1.5) 600 gal /day Pump Manufacturer Sta —Kite ❑ NA Soil Application Rate 0.6U gal/day/ft' Pump Model EC750 ❑ NA Standard Influent /Effluent Quality Mow#hly average* Pretreatment Unit 1$1 NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L IN NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODO 530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) _ <30 mg /L IN NA ❑ At -Grade K7 Mound Fecal Coliform (geometric mean) _ <10" cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tanks) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 2 10 year(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 2 10 year(s) Clean effluent filter At least once every: 13 10 month(s) ❑ NA ❑ year(s) Inspect pump, pump controls &alarm At least once every: 13 ® month(s) ❑ year(s) ❑ NA Flush laterals and pressure test At least once every: 3 ❑ month(s) ❑ NA 10 year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. 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 ponding 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 <_12 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. OWNER: Charles Weyer Page 8 of 6 '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 improve 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 chapter 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. • r heir covers removed and the void space filled wit h After pumping, ,all tanks and its shall be excavated and removed o t p P P 9 P 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. in POWTS A suitable replacement area is not available due to setback and /or soil limitations. Barring i El u 9 advances P technology a holding tank may be installed as a last 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. ® Mound and at -grade soil absorption systems may be reconstructed iri place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at 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 Phone 715/772 -3278 Phone 715/273 -5811 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name JOHNSON SANITATION Name ST. CROIX COUNTY ZONING Phone 715/273 -5811 Phone 715/386 -4680 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. 1 Wisconsin Department of commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County �/ Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Par I I.D percent slope, scale or dimensions, north arrow, and location and distance to neare ad. Please print all f Date Personal information you provide may be used for y a w, s. 15. 7 27 1) `7 Property Owner Prop Location C h �r eS �e ` JUL 2 3 200, Govt. of /V' E 1/4 SF1 /4 S T N R i' 7 E (o W Property Owner's Mailing Address I +ot # Block # Subd. Name or CSM# Y4 6 3 ST. CROIX COUN City Ste Zip Code P one Nu City ❑ Village own Nearest Road ri Sy3;) I (7�S" 397 �- 63 ❑ New Construction Use: E31 - esidential / Number of bedrooms Code derived design flow rate GPD eplaceme ❑ Public or commercial - / Describe: are material L o �� S o U et � / / Flood Plain elevation if applicable ft. General comments (/dv7) and recommendations: S E ' a� `� � �� C« C4 -11 6W-11 ,��q a �4E �( 6� ColooE� 7- VV blA 5, j%p 4--- / ❑ Boring L Boring # Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I *Eff#2 Q— 1 r) a u I LD — �o �D 7S`18 L (� L') t tvf . 4 A 10 112 C O 6 Fa-1 Boring # Bo ' ✓ [ L d� pit Ground surface elev. 'F71 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 /o bk s C �o 1c - 8 _ V t2 -- - s6 w t uF t F 3 -- L LJ t C in, O Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name (Please Print) Si ture CST Number Ad r ss valuation Conducted Telephone Number f' y Property Owner Gh ar I e5 `L4_)e_`t e i — Parcel ID # Page '_ of F3_1 Boring # � Bo 'ng Ground §ilrfaoeelev. - _" ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color , Rsdoxi]oscc49km Texture Structure Consistence Boundary Roots GPD /fh in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 J // s 1 sd i i IJf eq o `I � Cab 7 !�y X 10 < 6 D ❑ 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 # Ground surface elev. ft. Depth to limiting factor in. El Pit =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 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) R e vy VL ( 2 3 �> Ora- _ 97Q v C— �40' a�10 `tom oX Sc�ecti� N U3 �� F F.'. Me K S. r. i5o` 1 �x�'rpt As 5howtt G- pct ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer ��, � L to ) e P I °r" 7& A Mailing Address Property Address 46 (Verification req fired from Planning & Zoning Department for new construction.) City /State - aja Lot, Parcel Identification Number d F - /o 46. LEGAL DESCRIPTION Property Location U6 `/ , SE `/ , Sec. 3 , T ES N R _L7 W, Town of ue Subdivision /y /A , Lot # Certified Survey Map # /V 2A , Volume , Page # Warranty Deed # `� i� a - ,Volume (a S , Page # to 3� Spec house ❑ yes A no Lot lines identifiable ❑ yes ❑ no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I /we certify that all statements on this form are true to the best of my /our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms SIGNATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) • • DOCUM NO. STATE 13AR OF WISCONSIN FORM 1 - 1982 11: TNI6 SPACE R¢6 ER VEO FOR RECORDING DATA i WARRANTY LFEED io Martin T. Sabby Family Trust " �- �- Th Deed, mrid� betw -:ei- - - - - ------- --- - - - - - - -- -- a /k /a Martin, T.__ Sehby _Ruch !inn Brenna, Trustee - nocY t " - rnarrled. &_ktluwn._ t� l2uCii_ - Ann. TePpen _.._ ____ - - -- --- , - - - -- E FEB 2 3 1994 ...... ...... . ............. Grantor, and Charles L Weyer_ & Barbara A. Weyer .. -. _ 1 (�, 0:00 A husband and i wfe 1 <1 - -_- .. ..... - - ---- ... - -- - • -- Bla(a7OTi7�Lti72 ........... . --- .. - -- . _ Grantee, 1 s js a WitneGSOUI. That the said Grantor, for a valuable conaidoration..._. n_.., doll 63nd h and good - var... aalu - valu a ble a:.V Il414C1al l.lULl - -- - -_- TO conveys to Grantee the following described real estate in St. Croix... ...... County, St4tr of Wisconsin: i N 1 /2 of SE 1/4 of Section 36 -28 -17 Tax Parcel No: -- {' 1.) This deed to given in full satisfaction of that certain Land Contract dated July 2, 1979 in the name of Martin T. Sabby a /k /a Martin T. Sebby and Cora O. Sabby in Volume 596 of Records at page 337 as Document x,357953 AND 2) The assignment of the Land Contract dated January 6, 1986 iu Volume 732, Page 333, Document #409294 AND 3) The assignment of this Land Contract assigned to the t;artin T. Sabby Family >, in ` o 732 of Records, Page Trust, Ruth An- Ja.: Bre nna, Trustee, on uar ' 6, 1986 334, Document #409295. This satisfaction also is given pertaining r_o any X, all recorded & non record ' extensions of Land Contract. (` l i ,j n This is_ not homestead property. (is) (is not) l Together with all and singular the hereditanients and appurtenances thereunto belonging; N And.. ...... ad leaof encumbrances excep I i( warrants that the title is good. indefeasible in See simple and free r_ cr t j, i j� and will warrant and defend the same. Dated this 9th day of February 19_. 94... -- -- ------- _.. ........... - i� ...... ............. 'AL) . f3artiii . "'Sattiy ly .. r . &t .... .(SEAL) ( I i Ruth Ann Bream n /k /a Ruth Ann Teppen, i 'firusCee 1 !i . .. ... ... ........... ................... --....(SEAL) (SEAL) j is i - --- .......... s �1 l; AUTHENTICATION ACKNOWLEDGMENT '! :i 1 !j Signature(s) ------------------------------------------------------------ STATE OF WISCONSIN j a S is. ji - __Pierce ) --- -- - --- -- ------- •-- --• -- -- --._ County. nu this _.......day of __ ______ ______ _ ____ i5 - -. - _ - Personally came before me this _ %'th___.____day of f! ---------- -- --- ------- - > 19 y v� . r amed ........... _____________________ ------ .2222__._.2222_._. ...... R.. t_h Ara.> Are...+u n e epp`en �•' -- ------°•----• --- ---- -------- ----- ----------._ l• ------ - - - -- ----------- •••---•- --- -- ....----- °--..- - ........................ --------------------- '----------------- _....... r. TITLE: ,JEMBER. STATE BAR OF WISCONSIN (If not. --------••--- ---- ---------- ---------- ----•- ---------- ------ .................................. ..................................... authorized by § 706.06. Wis. Str.ts.) to me known to be the person . -- vho executed the foregoing in ment and acknowledge the sane. TI4IS ItJSI'RUMEN? WAS E RAF - TED OY - if •• • '•• Ruth Ann Teppell '16 OQ T.7e David A. Gzl.les _ •'� i `' 'SI o X15 -0 4 .. ............. Ciri.0 may he alithenticaLed or acknowledged Pierce r' 1I:.,:aret T:r: I ( v p er ... - - r( SS l - Sin ; - _crc.; . a�P f �` Gommi�sicn is mancnt. t at � �Ln ` e fiLr \ i �>olt v: :Ire I >ni: .�..c.,: gar }•.) � ;0 a�"wO. G `� °;j t a _ l • T' "IR �D •�;nn,z. ..t n..rao n., A °anima ,n nn rn1• -.t>- .h..n ld 6� t>�r•... .. L ,,nr;d Lit.. �>�.J-n!fxnol�.o. ��`'�� '� J • \`` - . . % DSFD SiTATF nAR OF W Rl'ONo1N \'i- r..:..in l..-.`nr utinl: FORM tie. 1 — 1942 Mil --k— Wu.