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HomeMy WebLinkAbout026-1133-06-000 Wisconsin Department or Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 430468 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: Marek, Darin I Richmond Township 026- 1133 -06 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: �: 06.30.18.919 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing <<.��� �� _ [Lc' Alt. BM /0 7, 9 O Aeration Bldg. Sewer Holding St/Ht Inlet 5 3 X03 T ANK SE C St/Ht Outlet K INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing IWead er an. Aeration Dist. Pipe 4 , V1-, 3 9..c; yr.c'' c - - Holding Bot. System r- +`t ji. Final Grade PUMP /SIPHON INFORMATION 3`i" � > - L.i.IS.f. (� Manufact rer Demand St Cover GPM Model Number I % TDH Lift Friction ys em Head 7 :)H t ForcrlvI Length Dia. wen SOIL ABSORPTION SYSTEM BED/TRENCH Width i Length 7� No. Of Trenche PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS , r -- � _..... I SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: r INFORMATION CHAMBER OR P) Type Of System: // UNIT Model Number: �•�--,^ � h J 2 n • c> ra .,...k" J I DISTRIBUTION SYSTEM f - 3 ch , fx .1 A-tkr%. Header /Manifold s't Distribution / x Hole Size x Hole Spacing Vent to Air Intake Length G Dia L' Length Dia Sp=9/ cing ((( ^ >� SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded 1 xx Mulched Bed/Trench Center � Bed /Trench Edges Topsoil _Yes j „ No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / /Z / y Inspection #2: Location: 916 172nd Avenue New Richmond, WI 54017 (SW 1/4 t SW 1/4 6 T30N R1 8W) Pine Valley Lot 6 Parcel No: 06.30.18.919 1 v P t • °. ! .z c - T � ; , ci.) 3 4 ., -I N� p e.- c; 6. 1.) Alt BM Description= .� ,, 2.) Bldg sewer length= Z u roc - amount of cover = COL71 r� -- i -_ P r Z/� lan vision Required? Yes e No l/ 17T 2 � other side for additional informal' n. _ - - -- - - 0 (R.3/97) Date Insepctors Signature Cert. No. i ` Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7082 CountY��' ✓' Co. Madison, WI 53707 — 7082 Sanitary Permit Number (to be filled by ) ; (608) 2616546 Department of Commerce State Plan LD. Number Sanitary Permit APP won In accord with Comm 83.2 1, Wis. Adm. Code, personal info ation ypopwi ide "" a Project Address (if different rhea mailing address) may be used for secondary purposes Privacy Law, 5.()'1(1)(lrr A;Le- I. Application Information — Please Print Ail Information Parcel IF # Block # Property Name Property Location property Owner's Mailing Address / - G - �C/ K/'1., Section JC/ City, State Zip Code Phone Number ~� N� R 4 J4 W e) l�el O � LSL IL Type of Building (check all that apply) /J Subdivision 1 CSM Num r or 2 Family Dweuing - Number of Bedrooms n l�X � � ❑ publidCommercial- Describe Use villa "Ship o ❑ State Owned - Describe Use ✓t f f 1 ❑City ❑ IIL Type of Permit: (Check only one box on tine A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System List previous Permit Number and Date Issued B. ❑ Peanut Renewal Permit Revision ❑ Change of ❑ Permit Transfer to New l O l t I d 3 Before Expiration Plumber Owner /� IV. of POWTS System: Check all that apply) V ❑ At- Grad n - pressurized [3 zed ln- Ground Mound > 24 in. of suitable soil ❑ mound , 4 24 in. of suitable soil e Single Peas Sand Filter res ❑ Constructed Wetland 11 Pressurized In ound C1 Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculatin �Sand Filter ❑ pe ❑ Other ( ex lain ) 3r Recirculating Synthetic Media Filter ping Ch ber D 'p ine ❑ el -1 Pi V. Dispersal/Treatment Area nformation: � Des* Flow cam Design Soil Application f) Dispersal Area Required (st) Dispersal Area Proposed (sf) System Elevation prefab Site Steel rber Plastic V1. Tank Info Capacity in Total Number W/ Man l6D Concrete Constructed Glass Gallons Gallons of Units / New Existing { Tanks Tanks Septic or Holding Taak 0 Aerobic Treatment Unit Doting Chamber VII. Responsibility Statement- I, the undersigne me responsibility for installation of the POWTS shown on the attached plans MP/Nir" Number Business Phone Number P1um�Name (Print) Plumber's �- Plumber's Address (Street, City, State, Zip e ( J Coin /De artment Use Ont o Sanitary Permit F (includes Groundwater ate Issu Agen 'gna t Approved Disapproved Surcharge Fee) U I /X'7 03 ❑ Owner Given Reason for Denial rI�X. Conditions of ApprovaMeasons for Disapproval A s /� - 6 Lulu h / S /�7n Agac6 c m late pleas (to the County Daly) r the stem ry oa p es sise SB - 98 {$. 08102) L mthladovAao-ao PLOT PLAN PROJECT Darren Marek ADDRESS 1306 210th Ave New Richmond Wi 54 017 SW 1/4 SW 1/4s 6 /T /R 18 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/20/03 BEDROOM 4 CONVENTIONAL XXX IN -G UND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1212 # of chambe 39 BENCHMARK V.R.P. Top of 1/2" Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL -H.R.P. Same as Benchmark SYSTEM ELEVATION 100.0/98.4/96.7' 5 below g rade 172nd Ave Plans Designed Using 50' Conventional Powts Manual Version 2. cafe is 1 = 40 B -3 unless otherwise ` noted (off Vents 200' \.. N . 3 '� -t . JI 50 , S FLT B- 39' , , 15 * B.M. 0 y' awt- u. to ICY \ 2,5� Fro 4 3 -3' X 83' Cells with >3' Spacing Bedroom House Pr operty Line Vent Standard Biodiffuser > 6 Leaching Chamber of Cover �� 31.1 ft2 of Area 6' Long 11 " Grade at System Elevation 4 " PLOT PLAN PROJECT Darren Marek ADDRESS 1306 210th Ave New Richmond Wi 54017 SW 1/4 SW 1/4S 6 /T /R 1 8 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/20/03 BEDROOM 4 CONVENTIONAL IN -G UND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1212 # of chambe s 39 BENCHMARK V.R.P. Top of 1/2" Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark SYSTEM ELEVATION 100.0/98.4/96.7' 5' below qrade 172nd Ave Plans Designed Using 50' Conventional Powts \ Manual Version 2. �c ale is 1" = 40' B -3 Vents unless otherwise noted Ir ". Vents 30' 200' 3 S 50 , B 38' , 15' *B.M. 09 Sto Pro 4 3 -3' X 83' Cells with >3' Spacing Bedroom House Pr operty L ine Vent >6" Standard Biodiffuser of Cover Leaching Chamber with 31.1 ft2 of Area 6' Long 11 " 34" Grade at System Elevation Soil Test Plot Pla r Project Name Darren Marek Sha Address 1306 210th Ave New Richmond Wi 54017 M #226900 Lot 6 Subdivision Pine Dat 10/20/03 S W 1/4 S W 1/4S 6 T 30 N /R W Township Richmond F1 Boring ()Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1 /2" pipe System Elevation 100.0/98.4/96.7 *HRpSame as Benchmark 172nd Ave v 50' Scale is 1" = 40' 106' B -3 unless otherwise 25 noted 1 ' 200 '102' 30' 50' B -1 30' B -2 15 30, ' B.M. 15 � to '` 52 Pro 4 Bedroom House Pr operty Lin • - R D "a k - 1 fir' `- L. Wisconsin bepartment of Commerci SOIL E/ALUATION REPORT Page of Division of Safety and Buildings i ilia% rd`�n v6tQamm 8P, Wis. Adm. Code County Attach complete site plan on pap[ not I titan, 1/ , �c 11, inches in ize. Plan must induct[, but not limited to: vertical nd ho 1��, F iht (B direction and Parcel I.D. percent slope, scale or dimension nce to nearest road. 0 - / / 3 3 'V do 00 d Please print all information. Re ew Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). P er Property Location a'L� Ma' V/ Lot L 114 /4 S Tao N R E( ) Property Owner's ai tng Address n Lot Block # SName or CSNW city to , Zip Code Phone Number ity ❑ Village EMwn Mgarest Road New Construction Us Residential /Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or meraal - Describe: - -- Parent material ett Flood Plain elevation if applicable ��� Y ft. General mmerrts and recommendations: 9�17 kv-Y wring Boring # it Ground surface elev.I ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 r �- �3j _____ �, 2 B Ground surface elev. �ft. Depth to limiting factor in. Soil 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 I 3 r, • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 ' Effluent #2 = BOD 130 mg/L and TSS 130 mg/L CST Name (Please Print) S CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 r 715 - 246 -4516 Property Owner _ Parcel ID # Page of Boring # 3 C] Boring it Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 - �- s, l -s if ❑ 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/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efl#1 'Eff#2 [] Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil ication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 ' Effluent #1 = BOD. > 30 220 mg/L and TSS >30 < 150 mgA_ ' Effluent #2 = BOD 5 30 mg& and TSS 5 30 mg1L 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 (RAM) Soil Test Plot Pla Project Name Darre Marek Sha Address 1306 21 Oth Ave New Rich mond Wi 54017 M #226900 Lot 6 Subdiv sion Pine Dat 10/20/03 S W 1/4 S W 1/4S 6 T 30 N /R W Township Richmond Boring Q Well PL Property Line County ST. CROIX BM or VRP Ass me Elevation 100 ft. Top of 1/2" pipe System Elevation 1 0.0/98.4/96.7 *HRpSame as Benchmark 172nd ve 50' B -3 Scale is 1" = 40' 106' unless otherwise 25 noted -; k402' 1 4' B -1 7 30' 50' 30' B -2 15' * 30' B.M. 15% lope Pro 4 Bedroom House Property Line I Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety afid Buildir,,0 Division INSPECTION REPORT Sanitary Permit No: 430468 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Marek, Darin I Richmond Township 026- 1133 -06 -000 CST BM Elev: Insp. BM lev: BM Description: Sectionrrown /Range /Map No: 06.30.18.919 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATIO Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BEDITRENCH Width Lengt i No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. T uid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER c Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bedlrrench Center 3ed/Trench Edges Topsoil Yes M No [ Yes [ No COMMENTS: (Include code disc r pencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 916 172nd Avenue New R chmond, WI 54017 (SW 1/4 SW 1/4 6 T30N R1 8W) Pine Valley Lot 6 Parcel No: 06.30.18.919 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? _] Yes No - ----- _. Use other side for additional informati n. — ___ SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. i Safety and Buildings Division Counr � 201 W. Washington Ave., P.O. Box 7082 Madison, WI 53707 - 7082 Sanitary Permit Ntt�ber (to be filled is by Co.) Arse�On� n (608) 261 -6546 p Department of Comm ree State Plan LD. Number Sanit ry Permit Application. provide in accord with Comm 3.21, Wis. Aden Code, personal information you p may be used secondary Purposes Privacy Law, s 15.04(1 xm) Project Address (if different than [nailing address) tr K ^ I. Application Information - Please Print All Information a e d ` `_ �? 9 /(o /7 �`1 J6 Parcel # Lot # Block # Property ame •-� Property Location Property Owner's Mailing Address Section Zip Code Phoog Number City, State T N, $/ E iI. Type of Building (check all nt apply) s� S `^^ jS CSM Number 2 Family 1)weniag - Number f Bedrooms ❑ PubGclCommercial - Descnbe U ❑Villa o of ❑ State Owned - Describe Use III. Type of Permit: (Check on y one box on line A. Complete line B if applicable) D 2-6 " 3 - CG - O • A. ew System ❑ R lacement System ❑ Treatment(Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Pei mit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T of POWTS stem: heck all that appl . n - Pressurized In - Ground Mound >_ Z4 in. of suitable soil ❑Mound < 24 in. of suitable soil ❑ At - Grade ❑Single Pass Sand Filter Q Constructed Wetland 11 Pressun ln-G d C1 Holding Tank ❑Peat Filter El Aerobic Treatment Unit ❑ Recirc [i� Sand Filter Chamber -Q 1 -less Pipe ❑ Other (explain Recirculating Synthetic Media Filter Ming Z_ V. Dispersal/Treatment Area I formation: rem Eleva Do �) Design Soil ppli 'on Dispersal Area Required (sf) Dispersal ea oposed (sf) _ Q t , Number Manufacturer Prefab Site tat Plastic VI. Tank Info Capacity in Concrete Constructed lass Gallons Gallons of Units New E4 Tanks T anks Septic or Holding Tank Aerobic Treatment Unit Doss Chamber VII. Responsibility Statement - 1, the undersigne a responsibility for installation of the POWTS shown on the attached plans P] 's Name (Print) Plumber's a MP/MPRS I!1umt�e Business hone Num Plumber's Address (Street, City, Star e Zip e) VIII. Coun /De artment Use Qnl }� Sanitary Permit Fee (includes Groundwater Date Issued 1 ui Agent Signature (No Stamps) P 1 Approved Disapproved Surcharge Fee) 0 (Z do 3 ❑ Owner Given eason for Denial IX. Conditions of Approval/Reasons for Disapproval 3) SYSTEM OWNER: 1 Septic tank, effluen filter and _ - dispersal cell must Il be Serviced / maintained as per managemen plan provided by plumber. 2. All setback requirer ients must be maintained as per applicable c de /ordinances. / ttaeh complete plans (to the County nary) for the system on paper not less an 81/2 s 11 inches In sire SBD -6398 (R. 08/02) tx�t.eS . r P140T PLAN PROJECT Darren Marek ADDR S 1306 210th Ave New Richmond Wi 54017 SW 1 /4 SW 1 /4s 6 /T 30 / 8 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/14/03 BEDROOM 4 CONVENTIONAL XXX IN -GRO PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1212 # of chambers 39 BENCHMARK V.R.P. Top of 1 " Steel Pipe ASSUME ELEVATION ioo Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark 511' Property Line SYSTEM ELEVATION 97.0/96 ' below grade Plans Desi d U ing Conven ' Po is Vents B -3 Man Ve ion .0 Ve t 3 -3' X 83' Cells 30' with >3' Spacing B > S Bi 'ffus 3 o v r Lead iing C ber with 31.1 of - B�- 6 1 ng 11 G at S m E vation 35' O 1/ 1" Steel Pipe 175 @a 104.38' Vents l � B. # � 5 10 Pro 4 10' B -2 a- Bedroom T House 5 30' B.M. #1 45' N OVA 172nd Ave c opy P PLAN PROJECT Darren Marek ADDR s 1306 210th Ave New Richmond Wi 54017 SW 1/4 SW 1/4s 6 /T 1// 8 W TOWN Richmond COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/14/03 BEDROOM 4 CONVENTIONAL X00C IN -GRO PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1212 # of chambers 3 9 BENCHMARK V.R.P. Top of V Steel Pipe ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark 511 Property Line SYSTEM ELEVATION 97.0/96.0/95.0 1 2' below grade Plans Desi d U ing Convert ' n Po is Vents B -3 Man Ve sion .0 3 -3' X 83' Cells 30, Ve t with >3' Spacing 3 B > Standard Bi ffus o v r Lead fing C ber with 31.1 f of Are B 6 L ng 11" G at S m E vation 35' 175' 1 " Steel Pipe @ 104.38' Vents l B.M. # 5 10' Pro 4 10' B -2 � w Bedroom T House 5 30' B.M. #1 1 45' N N O ;,, 172nd Ave Wisconsin Department of Commerce SOIL EVALUATION + - EPORT Page L of 3 Division of Safety and Buildings ` in accordance with Corrim 85, Wis. Adpi Code 1 // ounry si . C(O / A Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. FS t include, but not limited to: vertical and horizontal reference point ($M), direction an cel I.D. Dn percent slope, scale or dimensions, north arrow, and locatio0460 distpwt,to dearest road. / en� t Y) tj 1 ?Q�� r 'ew by Date Please print all informatioiq..- -'1 s Cc�+x / p Personal information you provide may be used for secondary purposed (Prkacy Law, "WY) (m)). Property Owner �! ro p La k�S ��1 �� �-^r1� ,� 1 / 1/4 S T 30 N R ) E( W Pro Owner's Mailing Address Cnn Ac \ ock # Subd. Name or CSM# o , & )( a Rtc�ckra l ion ! All A!e Qeve1q r4 City State Zip Code Phone Number ❑ City ❑ Village [g Town Nearest Road w *A aftrLc &f ii+ 55110 ( 65 ) -04q% ic�►�ar�c 122 ^d Ave IX New Construction Use: Residential / Number of bedrooms Code derived design flow rate 1 / 50 GPD ❑ Replacement ❑ Public r commercial - Describe: Parent material J ! l r� Flood Plain elevation if applicable ft. General comments J r � ?? / X 1 m T I ( X b1 and recommendations: m 41 = S 5 3 cs-# - 5 7 5 - t Rf-Nof- Fd r S 1 ° tom , J T.4 tg a 7.1y-) a: — -,-Je C9g•5y') FOt' T3 (9s.i67') rC t0.(,G C 1 Boring # [] Boring IR Pit Ground surface elev. ) da Y ft. Depth to limiting factor Jav— in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Strurture Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color / 0- g ro R 3 1 a L- a 9- ►3 110413 s q - ---- ---- -� L 3 13 -3a ►04R y y C L y 3o -gi `►,54R y 1 S L SL The soil test report for lot 3 was discovered to be inaccurate during the septic inspection on Nov 2, 5 b 5- s� R y L S 2001. The soil horizon reported as single grain loamyy sand was actually massive loamy sand with occasional pockets of sandy loam. Therefore the ® Boring # ❑ Boring loading rate must be .5/.7 and not .7/1.2. If this Pit Ground surface elev. /OLD, s ft. error is discovered on any other lot, additional Horizon Depth Dominant Color Redox Description Texture borings /soil investigations will need to be performed for the rest of the subdivision. The plumber should in. Munsell Q u. sz. Cont. color make note of the potential for error and prepare for O- 6 1 6 48 3 a SL the possibility of increasing the size of the drainfield. a 6 - 3d -? ,SYR 4 Iy S L 3 30414 - 7 ,54 b SL 9s 0 3 /13 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L CST Name (Please Print) Signa ur Address alb a oo�' !S+ S+or w► e 7 Property Owner bt kes t hi ThG Parcel ID # Page � of M Boring # I1❑ Boring 9g' 7 11� 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 /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I I Eff#1 I *Eff#2 l 0-9 )0Vo L aF &R MrR a,S aF a 9 -aq{ 10 2 51q - L 3F&R M FR F '!5 .8 .3 aq -33 164 - >vy O M58K ,r1Fg Cut 1 vF 1!5 .9 33 -50 - 7,54 R y b Se- L o ?ms13 MFR e 5 50 - )M . - 7,54R qlq S L j g rS8 In F — , 9 S:b FT] Boring # ❑ Boring ® Pit Ground surface elev. ft. Depth to limiting factor q 9% 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 t o -19 )04R 3 1A L dE R m e 25 a F -5 — .2 a It -30 4� a s a F Sak MiF iZ C W 1 r . 5 .$ 3 -4a - 7,540 6 "SL am SIR V- MFk CW W F , 5 ,9 SL - Z wa,-vr See * in A+ ❑ Boring # F1 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 * 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) ✓�". �- = -tea L.ak "t r .Ysw 1/y S & Jy sal. t, ' T �N 8111 •fir_ L n y ©' a , bb 0...e � , �d I � � � ,.� .•� "�' L �c. V sG a) e. . C s -t wi 0� k 1 4 o w 3 y5 x �.. b a.c.►L h o -t : -' t , i re. f4 81 a9 ' maintenance and Contingency Plan for a Septic System Maintenance Plan once every 3 years. 1. Septic Tank is to be pumped larger filter is being installed in 2. Effluent filter is to be cleaned once a year. Please note: a order to extend the maintenance interval of the filter' 3. Once every 3 years, cells are to be inspected v ia the inspections pipes at the ends of the cells. to limit greases, garbage, and water conditioner discharge into the system. 4. Owner agrees 9 5. The owner agrees to save this plan. 6. Do not plant trees nor parK nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan fails, determine cause of failure, use alternate area and install new system or 1. if system install system at a lower elevation. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715- 246 -4516 St. Croix County Zoning 715 - 386 -4680 Pumper Tom Mondor 715- 246 -5148 Shaun Bird #226900 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address /, Property Address (Verification required from Planning Department for new construction) City /State Parcel Identification Number LEGAL DESCRIPTION r Property Location ` /•,. '/4, Sec. . T VN W, Town of d" . Subdivision i i Lot # Certified Survey Map # �- , Volume , Page # Warranty Deed # 43 T SV Volume �`�� , Page # Spec hous�yes �'no Lot lines identifiable ; g -yes 0 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 the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeyman plumber, restrictedplumber 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. Uwe, 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 WisconsOffiCertifica 30 stating that yours system has been maintained must be completed and returned to the St. Croix County Zoning ys the expiration date. OF APPLICANT OWNER CERTIFICATION I (we) ce 'fy that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the Owner(s) of e p perry d above, by virtue of a warranty deed recorded in Register of Deeds Office. /DA) IGNATURE OF APPLICANT * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** *• Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed STATE BAR OF WIS FORM 2 - 2000 -7 4 Z-3 7 5 1Z DEEDS WARRANTY DEED KATHLEEN H. WALSH Document Number REGISTER OF DEEDS ST. CROIX CO.. WI This Deed, made between Daniel A. Campeau RECEIVED FOR RECORD Grantor, 10/1512003 09:30A1i and Darin Marek Grantee. WARRANTY DEED Grantor, for a valuable consideration, conveys and warrants to Grantee EXEMPT # the following described real estate in St. Croix County, State of Wisconsin (if REC FEE: 11.00 ,more space is needed, please attach addendum): TRANS FEE: 111.00 Lot 6 ine Valley Addition, Town of Richmond, St. Croix County, COPY FEE: CC FEE: '-W isconsin. PAGES: 1 Recording Area Name and RI 'TINA OGLAND ATTORNEY AT LAW P.O. COX 359 HUDSXC�A, VA 54013 026 - 1133 -06 -000 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 I day of October ' 2003 - -- -1/ _. * — * Daniel A. Campeau V AUTHENTICATION ACKNOWLEDGMENT Signature(s) Daniel A. C ampeau _ STATE OF .._. .... ... ._.__ ..— .... —.. — —..— - -- County ) authenticated this (3 day of Octo ber i _ _ , 20 — Personally came before me this day of the above named * Kristina Ogland TITLE: MEMBER MEMBER STATE BAR OF WISCONSIN _ (If not, _ _ to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) i instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Kristina Ogland, Attorney at Law ' _ _3_ L Street, Hudson, WI 54016 Notary Public, State of My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ) • Names of persons signing in any capacity must be typed or P rinted below their signature INFO -PRO (800)655'2021 www.infoproforms.com STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 2 - 2000 a' 3 .F LLI ry 0 ^o . / az o o V) � 00 Z J � W Z I / t! -H a o a 0 108 �' o Q Y 00 I 5 $ I, ��Q / p N a n OD CO N IO -N J Q 1+� U J CO W � v ° I �UOm c0 'I .k4 I _ZOO =Q b+ �� • 2�i 12 U a a <; O6��ti�� 12 p0 vi .sF 8L� l� I 1 •, �t rZro 3.zs s�.so� n _ h m UI 1 _n I Yom'_ NOS'09 05 y , ao 1 I^ J 79' 0 79• , i I Go N05 13' co 10 7 i f �� o OA • >\ � S. o rte, .. �) . \ Vo k \ co °D \ N 11\( W M � \ �y \ o d \ \ n I ' v W 111 i 79' ' • \ \ U CO Q I 7 9• co I I t �' �% \ o �j O g 1 -1 cn . c \ 1 J I 00 N a ` \ A O Y \ a� \ (n I ..J