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HomeMy WebLinkAbout026-1155-28-000 10/16/08 THU 10:10 FAX 715 386 4686 001 �Bae* ERROR TX REPORT xcxc* ��cxca��cxc�e�c *�xe���c�c� *��c�xxc *m� TX FUNCTION WAS NOT COMPLETED TX /RX NO 2369 DEPT. ACCESS CODE 1245 CONNECTION TEL 91866258602 SUBADDRESS CONNECTION ID ST. TIME 10/16 10:10 USAGE T 00'00 PGS. 0 RESULT NG y 0 #018 ® UMU I %.pU y Planning zoning �1M1:%I:ZG:: Sties' :t +liini'.a,; stlYCt 'YHRii4FeuxWW:U1MMi1fMtYC {MC ai1 N�a 6 E 4 ' tli i!'l S 4 f> Mf 6 YJ'• : ' r N.: MNbYNI H k nt i t flh; Nltti! vNtiTi4di' Yk: RM'. flSR'!E'{Ji?:itxt }i45JCtiHIAY I #AilNfftAM' Are%' Af_ IMYi1Rii1' n' i3iM !!!::ett:t(JImMCW:*IMpibik!h tafVt#.a «::Y• Fax Memo Date: To: Code Administrati 715- 386 -4680 Fax Number: Land Information Planning From: k (�� - - I)W TT c lat� 715- 386 -4674 q Fax Number: 715- 386 -4686 Real Phone Number: 7 Z 715- -4677 �' � /S— ���j � / R ling 386 -4675 Number of pages, including cover sheet: Y3 � DCov��. 8 0 Re: /� .L ST G N COUNTY ..........: Planning & zoning Fax Memo D ate: Code Administratzi To: c1-,5,,l 91 S-- - 13 330 715-386-4680 Fax Number: LandInformation Planning F ro m: C/� 715-386-4 Fax Number: 715-386-4686 Real m° 7 -4677 Phone Number: 34— LIl y-� R ling 386-4675 Number of pages, including cover sheet. F3 W *2o Re: > 2,S- s� eg g, St.Croix County Government Center pz@co.saint-croix.wi.us iiol Carmichael Road, Hudson, Wi 54016 715-386-4686 Fax VVWW.CQ-5a!nt-croix.yv'j.U5 n 7 0 \ ■ - � � § § o ] § a 2 § i _■ = J e F co ? 2 § m f / { a) g CCD: 0 e \ \ \ j :-1 ° \ \ \ \ \ / w _ _ ° § _ ] ; S 2 7 / G ƒ \ / § § _ ° a 7 7 7 ° % � ^ : /c \\ ° / / f G E e' ƒ \ § / _ : \ S - $ \ 2 : .: 0 \ \ : / CD \ CD : g E a CL _ e � 3 0 o k (' z * S E E$ \ 0 ° . . . I E \ o v z < \ / CD N) ` a E ! C L ; E o � ! g §}7 \ / (( CD In \ { \ a «/ § k z $ � { j - ca � j $ w § 0 } $ 7 o E 7 Z \ 00 $ : � 03P2.o \ %E( § °0 :3 cc e�E § ; 7 E § \j / \ \ \ \ ° 0 ( 00, K ' ? $#2\ \ ƒ§0 \ \ v+a° 2 CD � 0.0 a k o > ® � R / % f / a 0 � # W.4T,on3in Departnlent of Cdnmerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and! Building Division INSPECTION REPORT Sanitary Permit No. 499192 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: Davidson, Ron I Richmond, Town of 026 - CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: / to M C5 T 22.30.18.1191 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER :A 5 CAPACITY STATION BS HI FS ELEV. / Septic Aj , / 5� Benchmark 5 w� S 3. lo3•S !Od DQ" 19 Alt. BM Z (0`7 /a0 •�S3 Po 1.5 �1.5Z�J F•I4,• C604.1 Aeration Bldg. Sewer Holding St/Ht Inlet B •33 95.7 TANK SETBACK INFORMATION St/Ht Outlet g.(.7 O f f• $3 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 7 ZS / f�-- 7 ZS / Dt Bottom Dosing Header /Man. Aeration Dist. Pipe `d • 9 �• lo/ All Holding Bot. System 1 c.J PUMP /SIPHON INFORMATION Final Grade ZD `19 ' 3 Manufacturer Demand St Cover • GPM F•t �.�- Co Model Numb 73. 149 TDH Lift Friction Loss System H TDH Ft e1660011s I L /p-Z1 13 . Z.Sr Forcemain Le D' Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width I Length , / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 111 t Z V I �_ � 1 SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer- , / f INFORMATION Type Of System nn CHAMB T Model Number: , , 33 � Y�' Nlfq(' .Q �• • c.� � � DISTRIBUTION SYSTEM E Z 1 4' Header /Manifold Distributio x Hole Size x Hole Spacing Vent take / ` 4 Pipe(s) � \ \ Z= � p Length Dia Length Dia Spacing 4 .3 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only L Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center 0-1q Bed /Trench Edges Topsoil es No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 1482 128th / Street U known (NE 1/4 NE 1/4 22 T30N R18W) Pond View Meadows II Lot 28 / Parcel No: 22.30.18.1191 1.) Alt BM Description _ C .1 GovE`- C►. . � � o i � V+Oc `C `J o – F 2.) Bldg sewer length 8 = • „ ` S d' � - amount of cover = S s 1 7 s4 Plan revision Required? Yes No Use other side for additional information. Z3 k ignature Date In epctor' Cert. No. SBD -6710 (R.3/97) r �f3r►, N�� is o�gnSc p,4.�..� .�vo�4 N �� $3 or «..,I- a:- I� of t�S�'�` 5T' �l= /Da•s � or EI _ luo•3 d Q A,- k. hot p; ScN �C l Yee -{ pc> 4, : Na wall A4 4 -c o .00- v C H. D 0 � t 50' 0 Et _• t P C�ri ✓twAY 1 t NHS sj �O o T Sf. �.d ",L Co WZ - _ Safety and Buildings Division County ` 201 W. Washington Ave., P.O. Box 7162 S'f ���i�S�f� Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 -3151 / - / 7? 1 W 111h Sanitary Permit Application Lff tatc Plan I.D.Numbfrr In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide A may be used for secondary purposes Privacy Law, s 15.04(1 xm) Project Address (if difrcmt than mailing address) I. Application Information - Please Print All Information 1,41,R 2 Property Owner's Name arcel # Block # / 2 8 2006 P ' S E � 8 Property Owner's Mailing Address roperty location /0 i �en `G ST. CROIX COUNTY City, State / CC Zip Code T N; R /)C- % a '/ti Section 2 � ' 47 w -, S,�o6J ? Fs �- 3.�y y70o (circle �e ) I l l a o f g E or4➢f) D. Type of Building (check all that apply) ok Q (' Saba..' �F Subdivision Name CSM Number ❑ 1 or 2 Family Dwelling - Number of Bedrooms 1 4 14 / ❑ Public/Commexcial - Describe Use6 ^ f w w ❑ State Owned - Describe Use Z L..) 21 `/" Z2 elS ❑city ❑Village ®'township of UL Type of Permit: (Check only one box on line A. Complete line B if applicable) A 19 New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New Ust Previous Permit Number and Date Issued Before Expiration Plumber Owner r ` 1 ^ IV. IM of POWTS System: Check all that apply) - �12 Q7 ® Non - Pressuri=d lnn- Grrrmiid ❑ Mound > 24 in. of suitable soil ❑ Mound <24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Construct Wed etlnd LJ a Pressurized In- Ground ❑ Holding Tank ❑ Pelt Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter " ❑ Recirculating Synthetic Media Filter hing Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersalffirestruent Area Information: Design Flow (Bpd) Design Soil Application Ra f) Dispersal Area Required (sf) Dispersal Area Proposed (sf) Syst Etevati / goo ✓ b .� ✓ 8s� ✓ �� /�i y, 93 VL Tank Info Capacity in Total Number Manufacture Prefab Site Steel Fiber Plastic y Gallons Gallons of Units Concrete Constructed Glass p New Exist Tanks Tanks P I I 1. 91_ 52,5 Septic or Holding Tank 12 1 25 W i �ytJ X Aerobic Treatment Unit Dosing Chamber VIL Responsibility Statement - I, the eadersigned, assume respo bility for histailation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Si ! /MPRS Number Business Phone Number �v a w ►�t; k: i /3�/ 7 Plumber's Address (Street, City, State, p e) P. o. 0 oA_ 13a VIII. Conn artment Use Onl lcr /� ❑ Sanitary Permit Fee (includes Groundwater Date bsu Lssui t Si re o S '�C Surcharge Fx) �f 2-9 a�p rven Reason for ial - 7�(J IX. Conditions of Approvai/Ressous for Disapproval C c SYSTEM OWNEW 3 1. Septic tank, effluent finer and U /I C - / dispersal cell must all be services / maintained aI(o LJ G y4; (E_ S dCQ�I �C ivc4pC as per management plan provided by plumber. n G Z „ /' /U6/ n ' /� f 2. All setback requirements must be maintained' I � ' 4 lam/ -- 1 as per applm;" Code / ordina. 7 L Z' 6Q_ Q ' q �7�' l t, J l Ce� r` be G Attach complete plans (to the county only) for the system on paper not has than Sin x 11 Inches In size SBD -6398 (R. 01/03) l LeSQ•�c � �eoAT.7r� dA�A pf 3 (8 K o d E (c too. o' IR o-. cen�+rl�re Of t?� }+� ST fit= /Oa.S` �cr Y, [t _ too •3 li QAck6 p;4 140 uyS roof Io Scale L k v— $(ode �•3� X13 Qy �� k W 02 o' � t E-- y 9 i 12 � oo' Q2 0 ° �t \"So 0 Et _. ho , 'c s. � � �os cct d ri ✓e.u a.� iu s r t �Y�+ sT 9 �P ='P 026• 146S =AO- coo co GvT I� w rDepwtnmtd SOIL EVALUATION REPORT Pape / ofY iondsale�►ana ,mo Comm fl�,vYls Adn code F sfaPl m cm lees *mS 1l2 x 11 iichm in aim Plan must Cots* 5 t include; but not limited b: vertical and hori axa*reiatenoe point (BK ds A r ic and Pend M poem tabps;w alem ax- mmiotrs .nomamm.andbcatonoWdobasio mmL Da - Deb Pell inlcnnatlpr►yau proYi7,b. Lew. a 1504 (1? GN]- Propert PmperivLoceson D yx SEP 2 8 2006 Go Lot A) f, 114 19 S T 30 N R (S' E(arj�& O is (, ST QIX COUNTY Loth Bbckt Subd Name crCSW and V; gw M d see Code ❑ Qh ❑ VMw ® Town Nearest Road 5 : (j �✓ IC/ SJ ( r ) 3 – 700 ,wv );d' 57 6 NewCmmbucion Use:® Radderdd /Numberdbedrooms Code boo GPD 0 Replacement Q Pubic or corramcial - Desmaw Floso rneleriel T"(( Rood Pfein dwabm i appI e R Gwmmdconvnmds CDn�s �i'on.o/ r and neoommendaikm 1 I 1 g� S ❑g 1 ' 1 ® Pit Grandsurfaoeelev. l eO . o R- Deph b i T0V bcbr /ao jn Sai Reis H oibm Dot Danirwd Cdw Redox Deaa"on TO&" Sbrrctis Canoe Bour dwy Rods GPM in. mural CkL Sz Cant Cdor Gr. Sz Sh. *em I •EW Z / (? - .c — S: c( Z ft sb M r q w C�• C7.c 3 _,�� �' 41-ct co 4 I( A F BmV # ❑ Boritg ® Pit Gmundsurbwdev. 100 • o R Dspih to tsnbv bcbr > /fl in Sol Appicubm itals Horizon 04* Dm*mdcdm Re by DssadpBon Tarim Shuck a (aorisislmm Boundary Rods Gpow in. ftsma Gu- Sz Cant. Color Gr. Sz Sh.. `EM 'EW2 Z ;Z3 Sb !a y.y -- S� c( w — b.y O•!c 3 -o.�y 7s - y �� �.s s -'�( a.�,�b� — w� F� w y - (15 -T " I oS nn ( D • 7 �I Efiumt-S7 _ > 30 S 220 mglL and TSS >30 S 1SD mglL ` EMLm t ll!2 =WD < 3D mglL and TSS _< 3D mglL CST Name (Please Primp CST Nmmber Addim Otis Evakat n Canduded Telephone Number sw/2 `i ,9,2- pG 7/S 6.?7- 5 l.T�n M•M TMII11. PF - 31 perty Owrrer �v.� 1�n,,,'dso . Parcel ID# Ob�b /o6S - /D Ooa Page •2 of c/ ® p Grounda ntmedw. -93.5 1 Depd to knbv factor p Sal Rata Horizon Depth Don*WdCokx RedQK Desorption TeAMS 3buctue Cansistierroa Gaudery Roots GPOW in. MunseN Qu. Sz. Cant Color Gr. Sz Sh. 'BYM 'EW2 0• D•6 3 d' 70 7,� c �� s - y : c aMSb�f .H� r/ — D 0.6 — 0-7 46 rl o Bodm# ❑ ❑ Pit G(ourdeurface else R Depir tD tirrri6 tador ir. Horizon Depth Do kwt tu Raft Desm"on Ta e Shuckm Cae�tanoe R r~ Bourdery Ro SON rr fats in L*Mwl Qu. Sz. Cant Color Gr. Sz Sh 'EM 'EM ❑ �� � ❑ 8orirg ❑ Fit Grourd surface elev. R Depth to bma factor ir. Sal Rye Hormon Depth Domirerd Cokm Rsdox ne or. ip6on Ted<re Struckm Cormaierroe Bmmdm Roots GPOW im m used Qu. Sz. Cart Color Gr. Sz Sh. 1 'EM ' Eitksnt #1=130D.>30 < 220 9o& and TSS >3D < 15D mg1L ' Eftmm t #2 = BM. <_ 30 mglL and TSS < 30 nVE The Dgmtment. of Commerce is an equal oppor miity service provider and employer. If yon need assistance to wxm services or need material in an alternate fonzrat, please contet the dgmtncmt at 608 - 266 -3151 or TTY 608- 264.9777. sso4m %m m ftw y t mw ea, Parcel iD# OS6 - /obS - /0 . WZ) Page of F B.b ❑ �g ® Pit GmurW surface efev d • 5 L Depth to li n&V factor 7 /AO in. Sal App6m6w Ram Etommn Depth Domuwrt cokx DedGK Desa"m Texkire Situdtae 8ardary Rails GPOW in. Wma Qu. Sz Cord. Cator Gr. Sz Sh. "EAC1 'EBW2 f O 02 3 /0" y_ ?�.s1rF rvr`�- GS 1 d• b' 0.6 3 a''7O 7�J�� V. C�4 �S y iC. aMSG M� O• q O•h Y 70 till F-I ,g ❑ &MV 11 Pit QMwsuriaoeeler R t biri6ngtenor Soil Rate Fiaizon h Dorrirrarrt Redox DesaiPtiao Text" Stratus Ca istenoe Boundary Roots r~ in. Manses Qu Sz ON& color Gr. Sz Sh. •EW " EW ❑ pit Qun-A surface eilev. }t, Depth a Wi kL lO&M Depth Da ,, ; ,, Sal Retie Des,"m Textile Sbucbre Carrsis6enoe Ikundary Roofs WON in. Murr4seC Qu. Sz Cast Color Gr. Sz Sh 1E1fif1 TIM Efiluent I" = BOD 30 220 ffQ& and TSS >30 < 150 n jo- ' EiwrdIQ = MV. : S 30 M& and M < 30 4& The DeMftent of Commcrm is an equal opportamity service provider and employer. If y need assistance to access services or need matwW m an alternate fom2a" Ply contsd the depaztmeut at 608- 266 -3151 or TTY 608- 264.5777. sao-s=(RMI" L¢Sa.n� N CIeuA��a� �i p4,4 Joao A4- W (L C-(= 100. o _ a a. o (e>e, N1) i a o a p 4- ,.,,vo� g ` Its o•. ccn a i� }ti ST S= /0�•S or �� /uo•3 1-4 Fir. o CH, - - - o a �- �a ' 1 4"° Q2 30, y ` rG �oStc� sT G1T aw, 7dy / P,, D�v��SS AS P rQI 02(x• P� 70— 5t. C.a ;x Co GaT I C!1 e R t a t ) - ), aYe��a�5$Cy� °ta $ h1g s c" ti d i HP 2 9 3 flibb It 5 e 10 I ! B filp9 @_ 6 iH`� �9� �R � 81i�� ■��L+��H����tQIA ? @�G6d � � � �� a �D � b D � <� O - - -- - - \\ �- a . . d --_ - - - coo - asa ce a6 c - -- - 3 0 - -- � - --------------- I i 1 � t 1 --- •. I a g - � p p •••, I I 3 F .■ ff - _ 1 I 1 ICI i � �_ /� •• 1 � � I - -- I� ■ I \\� /� — s' a � — te a oil 1 ■, \ , - - -- 3f� . / -- VIE • D$ gq • \ 1 .......... gig $n r �ig sib r R 5 avow It WBM alp - - -- g■ !QIIyj��_�a.a�ti S � k�8 ?4�8 Y � � pS8 �� g� g „3L¢ f ��., ! w ® 91 �I ■ l a4 B - u. Aaa wn m mi.■s• se I . r Wisconsin Dep of Commerce SOIL EVALUATION REPORT Page -' of _S Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach Pa on complete site plan per not less than 81/2 x 11 inches in size. Plan must P P I and horizontal reference point BM , include but not limited to: vertical Po direction and Parcel I.D. ( ) percent slope, scale or dimensions, north rrow,�q nearest road. Please print 11 inf on. elire�ved Date used or seconds u Privacy Law, 15.04 (1) (m)). / Z V Personal information you provide maybe secondary purposes Property Owner P F E E B 2 8 2 0 0 3 F roperty Location ovL Lot IV r 1/4 A C 1/4 S Z 2 T N R( E (or W Property Owner's Mailing Address ZONING OF F I C F of # Block # Subd. N me or CSM# /St City n State zip Code Phone Number El City El Village ® Town Nearest Road ;,) �ir�avr 6z46/? q5 y ® New Construction Use: C$ Residential / Number of bedrooms Code derived design flow rate �� Q d GPD ❑ Replacement ❑ Public or commercial - Describe: - Parent material __Z ( _ ^_ —_ - -_— -- Flood Plain elev7tio N appl' ble LiLCL.L_ -- ft• General comments Sy.� G fGJ . Z, $� — � iQ� , q 2. ✓, `l 2 and recommendations: /no -' W� � lZ (�w>l�f�Za�lN�Ss- �J+^v• 0 51 Boring Boring # j pit Ground surface elev. _ M-6 ft. Depth to limiting factor __— in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff #1 'Eff#2 I _ io 5 a C 2 _ I. _7.5 '-1 C` _7. /1 - L �� n . mS vnl - - "1 f- Z qzl ql S F2-] Boring # Boring © pit Ground surface elev. _ ft. Depth to limiting factor __ - -- in. Sod Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 I 0- I / 6 ^' 1 Z mci ry� C T .V 5 8 I - 1 ter c 2 Z 1 � / c — FI /(0 SL Zr �r S 2 - l � r� U 4 � m.S I ' Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CS Name (Please Print) gnature CST Number r - Z53 30 Address Date Evaluation Conducted Telephone Number �' -I C_ W1 S-16 zS a z (I 15 Property Owner __ -1� e L r C V Parcel ID # ----------- - - - - -- Page of F31 Boring # Boring ❑ n Pit Ground surface elev. � � `� f t. Depth to limiting factor IZb in. Sol App lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDrffz in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. - Eff#1 - Eff#2 -i Lt i0 "I 2 04 r C5 (� 5 5L 2-t'n5 rri 5 -12Q l a � I Z hum , : qa q r I �i ii El Boring # ❑ Boring — ❑ Pit =Ground,surfa-ce elev. ft. Depth to limiting factor _— in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlflz in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Efl#1 I 'Eff#2 Boring Boring # Ground surface elev. ___ —__ —_ ft. Depth to limiting factor — — in. F R Pit Sol imation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff#2 Effluent #1 = BOD > 30:S 220 mg1L and TSS >30< 150 mgiL ` Effluent #2 = BOD < 30 mglL and TSS < 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- 2648777. SBD -8330 (R.07l00) < Property Owner 1 J e r r ` C IL Parcel ID # _ —____ Page _ Z of 3 F31 Boring # E] Boring Pit Ground surface elev. ft. Depth to limiting factor I ZO in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 'Eff#2 2 - 1 6 I ILPF 3 - 2 7. Set Z Sb� � C- 5 72W 4 I2—'� ❑ Boring # ❑ Big ❑ - Pit =Ground.surface elev. ft. Depth to limiting factor in. Sofl 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 'Etf#2 Boring F Boring # Ground surface elev. ______ ft. Depth to limiting factor _ in- ❑ Pit Soft Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/lf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 * _ - < < m _ > < *Effluent #2 - BOO 30 m Land TSS 30 Effluent #1 BOD 30 <220 mg1L and TSS 30 _ 150 mg1L 5 _ 9/ _ 9fL v' and em ployer. 1f The Department of Commerce is an equal opportunity service pro vider y ou need assistance to access services or y need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608 - 2648777. SBD -8330 (R.07l00) i r PAGEaOF_"�, � r NAME rir TOT# Z$ LEGAL DESCRIPTION tiF �,yr= 1 4,SZZ T 3a ,N,R, / E(or SCALE: I "= Z d BM I ELEVATION /0O • d nn r BM I DESCRIPTION BM 2 ELEVATION 9 Q. Q d BM 2 DESCRIPTION -F �� , �,Sf•c� (�oc cc 2 Z SYSTEM ELEVATION % Z, Sd SYSTEM TYPE Co AL [1 e h :�JQ A.&L -1 CONTOUR ELEVATION Qf O c + l a d " q ?f o 2 7d SIGNATURE DA Soil Profile Sheet Owner •1 .D d c • _ Soil Tester. 6, c h • f "^ - System Elevation: Load Rate: o• System Range: 91. 3? to 5'3•J ,o< yr too o /Do /oo o too /JO q5.6 95 �/ b 45 4S c}8.5 4 �' 48 � ,,•n t' 8 97•-'I q-1 97 47 es 9S 9s 9 j 93, o� 93 93 i9 n 5 T a z SA d 9.2 SZ 3 3' °11.33 sef�� it 91 4( SA d ga. 3► 8f•8� �o V8 �0 9� 8y ss fig. 3 3 8d Index Sheet Project Name: Owner's Name: K11 0m, d sd Owner's Address: t o c/.2- a (c( -5 f - 7 Legal Description: 5 as - T 3 0 19 w Township: V%1,o VV County: S f, c, a; x Subdivision Name: W ,,. wmw ,t J� Lot Number: '2 Parcel I.D. Number: bah - log 5 - lo- oo o Page 1. Page 2. c e-a,s s Page 3. ele4- P1 A,% Page 4. Page 5. Page 6. Page 7. Designer: Plumber: (x, g/d tia�:.•sE•' License Number: License Number: Phone Number: Phone Number: 716' vro Signature: Signature: ` Ll� SYSTEM SPECIFICATIONS In- ground Soil Absorption Component Component Manual # /0 70 S f o t l Project Name: l!!a,,, O ".'dso, Distribution Cell Type Septic Tank Aggregate ❑ Non - Aggregate® Min. Septic Tank Vol. Req. 14s o gal. Type of Non - Aggregate Component Septic Tank Volume ,LS gal - Manufacturer w to : -e Manufacturer t4 kzl � Model &A-ec.4 w Effluent Filter Manufacturer AD to 4- k Number of Bedrooms _ 4 Model P I- Sas Soil Application Rate (DLR) O - 7 gpd /f? (Designed L-di-g Pate) Pump Tank Wastewater Quality Manufacturer N Treated ❑ Untreated © Volume Model Combined wastewater: Number of bedrooms Distribution Component gal /day /bedroom x 150 Distribution Box ❑ Daily Wastewater Flow (DWF) = boo Hydro sputter ❑ Other Clear and graywater only: Manufacturer Number of bedrooms gal /day /bedroom x 90 Daily Wastewater Flow (DWF) Cross section of distribution cell(s) Blackwater y A Number of bedrooms gal /day /bedroom x6( Daily Wastewater Flow (DWF) _ .2 go Dispersal Area (Aggregate) c,. — - 7 SSA! ft (DWF) PLR) Dispersal Area (Non- Aggregate) EISA Rating _ ?� o fe System sizing = DWF + DLR = EISA f • �� oo — o.7 — .?d = _ q3 _ chambers (DWF) PLR) (EISA) Diverter valve Dyes ®no Manufacture lT o 4 -r- a u 11 � - rn +-► a II w w ♦ `yam -'�♦ ♦` � ++ } O R. ..: O (u ' "•,,, Cd cis ct'i � �. • ..... to ! • • ° _ ♦ � 1 NJr • • • '• U U ' C40!) O W i.r .• v� tic V1 .gi a>i 0 2 W 0 ca o H a CONVENTIONAL SYSTEM OWNER'S MANUAL to reef spec ft mgmaremer� o m Comm 83 and 84 Wis. Adrn. Code. so that septic system designed and of wastewater caused by improperly treated that � Will provide safe of • thereby � humeri, health t>ezands� system use within the firms � The y of this arm depends greatly on proper and timely all was designed to hmxlle. The owner of the system is responsible for the operation Following Is llormation that will assist you In urging the We of you' system- Septic Tank The The opens" condition of the septic tank tw ensure proper operation- The f � le once every 3 yews by km4 cwr should Flat be unless removed OM filter o be dinned as neY If the ill is provision are made to rebaum solids in the tank that may �oughm cif the flier when removed alarms may indicate with an alarm. the filler she ! be serviced id the atanrm IS actWH ed c=dkxmou*' WjW flows or an impending eontilw0t s 8113111111- The septic tank shall have as corder" removed when the f nd sludge in the WA em oeeds 113 the ft Ad volume of the lark. If the contents of the to k are not cu:roeved at the orris o assessment maintenance personnel shall advise the owner of when the nest service needs to be performed to maintain less item maximum scum and sludge aommfietion in the terdC. for water and soundness. Access openrigs used for Manhole ne are access nears and cams should be k service and assessment shall be sealed welisitight upon the completion of service. Any operuirmg deemed unsound. detective. Of replaced. An bdang device to P aociderld oY unauttuor¢ed entry the tardc shot stMod to failure must be secmae exposed access openings. greater than 84nnches m diameter: No ono should enter a septic or offier trvabnerit or holding tank hlor any reason without being in full oorrlumoe vdh 08M statakirds for entering a confkwd space. The abnosph"s within the septic or . other trealrnent or hohtirg tank may aontain 1 1 md gums, and rescue of a person from the interior of the tank may be difficult or impossible. Tm* abandonment shall be in accordance with Comm 83 -33, Wis. Adm. Code when the ta* is no longer used as a POWTS component Soil Absorption Component (Drainfieid): The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facxTty Good water conservation practices by all occupants and the urstaflation of order conserving plumes failures are key factors in extending the useful lye of this component The so# absorption comports operation mast be assesses by inspection at M&A once every UWW years. The iron shall irnlude recording the levels of pondrig. if any. m the abseroa dDn pipes. and a vuuei inspection for any eve of surface seepage or discharge from the eomponerd. On deeply eloped sites. areas of erosion should be identified and neported to the owner fur repek The surface discharge of domeslfe wastsmrabr or savage *cm the system is prohlIfted and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particuiady during wirAer months. The compaction or removal of snow ever over the component may Wad to freezing_ This type of faitme is usuraiy temporary. but is difficult or impossible to repair until weather conditions improve. Planting of deep - rooted trees and shrubs dlectiy aver or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. Performance Monitoring: Performance monitoring must be done at least once every three years following the installation or at the time of a problem, cornpiakut. or failure. Contingency Plan: If the septic tank or other components therein (including fioets. alarms, etc) become defective • the defective tank or component must be replaced immediately to ensue that the sydem can operate as designed. ff the absorption component canruot accept wastewater or ponds wad to the surface, the component roust be repaired or replaced in k •s current bastion by removing the cogged bacterial mat cling clamber pelf. and distribution piping wpm the oeU and replacing failing componerds m order to return system to proper working order as required. If repair is not fable. a new sydenm is to be constnicted in a designated replacement area �J 2592P 052 76.�..,�s16 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. HALSH REGISTER OF DEEDS WARRANTY DEED ST. CROIX GO., t11 Document Number RECEIVED FOR RECORD This Deed, made between Loren D Derrick Rose H. Derrick. 06/09/2 09: F --' em ard L. Dck Joan L. Derrick and Robert J. Derrick Grantor, "' RR` "TY DEED E 4PT # Ronald F . Davidson Grantee. REC FEE: 11.00 Grantor, for a valuable consideration, conveys and warrants to Grantee TRANS FF E , 129. OP the following described real estate in St. Croix County, State of Wisconsin CC FEE: (if more space is needed, please attach addendum): PAGES: 1 Lot 28, Pond View Meadows U. St. Croix County, Wisconsin. Recording Area Name and Return Address Kl- IS INA ®GLAND /_,1709F MEY AT LAW r � r- , 20X 359 „ %-V1 54016 026 - 1065- 10-000 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. day of June • 20 — Dated this Y R ert D ick — — * Richard L. Derrick — * Loren D. Derricl * oan L. Derrick * e H. Derrick I _ ACKNOWLEDGMENT — AUTHENTICATION STATE OF Signature(s) Lor D . D erri c k, Ros Derri _ } ss. Richard L. Derr J oan L. Der and Robert J. Derrick County ) dti ---- - - - - -- authenticated this y of June _ _,20 04 — Personally came before me this day of the above named * Kristina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, instrument and acknowledged the same. authorized by § 706.06, Wis. Stats.) -- --- - - - - -- THIS INSTRUMENT WAS DRAFTED BY * - -- -- — — Attorney 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 _ -- - -- - -- ' Information Professionals Co., Fond du L. W l r Names of persons signing in any capacity must be typed or printed below their signature. 800-6M 2021 STATE BAR OF WISCONSIN I Sep,28 08 03:04p Gary Christman 17156375971 p Ug /ZU/dai '1U 13:56 FAA 715 3 4b#5 GUU ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM be 1 Mailing Address � o �2 ` � i e / �� r /U i /eiy,�` s'✓` �t �Sd Property Address l� ��" �� te (Ve / JO required from Planning & Zoning Depa nt for new construction.) City /State w n Q J A L hm crl Parcel Identification Number O� 6- /SS" 2 L 4`0' LEGAL DESCRIPTION A n Property Location Or! . `/. , I Y � %< , Sec. �, T 30 N R�_W, Town of A'' c rn s Subdivision P® 12 d ��✓ e w���v 5 , I.ot # �F Certified Survey Map # , Volume , Page # _ Warranty Deed # 7 a_-513 6 , Volume S 92 , Page # SL Spec house 6) no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and nuintenanee of your septic system could result in its premature faihne 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 113 full of sludge. Uwc, 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 trust be completed and returned to the St. Croix County planning & Zoning Department within 30 days of the three year expiration date. t /we certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorder in Register of Deeds Office. ooms PLIC ANT(S) DATE 77 STGNATLJREOF " 'Any information that is misrepresented may result in the sanitary permit being revolted by the Planning & Zoning Department_ * • inchtde 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. 09105) l