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HomeMy WebLinkAbout030-1066-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 399610 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: Thomas, Patrick D. & Susan M. St. Joseph Township 030 - 1066 -20 -000 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS H! I FS ELEV. Septic Benchmark I Dosing Alt. BM Aeration Bidg. Sewer t Holding St/Ht Inlet r TANK SETBACK INFORMATION 5tlHt Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic > 10D I I t Dt Bottom Dosing Header /Man. 9 b % 2 aeration Dist. Pipe $ clb.Zgr olding Bot. System to , 9'f- 8b IMP /SIPHON INFORMATION Final Grade i � ` j $v f Sy wfacturer Demand St chver �[ A GPM Ga�oes el Nu er Lift Friction Loss System Head TDH Ft main Length D' ell ABSORPTION SYSTEM, t Z tENCH Width leh 62 5 ' No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SIONS t 1CK SYSTEM TO P/L IBL=WELL LAKEISTREAM LEACHING Manuf yy�� 4TION Ty Of System: CHAMBER OR ZN �°r — S = Q'J YP Y C UNIT Model Number: 5D BUTTON SYSTEM iifold 10istribution x Hole Size x Hole Spacing Vent to Air Intake Plpe(s) 1 ( r _ Dia I. Length Dia pacing 7 V IVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over xx Depth of eeded/Sodded xx Mulched xx S ''enter Bed/Trench Edges Topsoil * Yes X No 50 es, ® No TS: (Include code discrepancies, persons present, etc.) Inspection #•t Inspection #2: `y - -�-- -- 16 134th Ave Hudson, WI 54916 (NW 114 W 114 25 T30N R19W) Bass Ridge Pines Lot Parcel No: 25.30.19.243A tcription d� length = r Q Q Q) f cover %. —too quiredti [in Yes No Z� ���—►� )r additional information. Date nsepctor's Signature Cart. No. Safety do Buildings Division Sanitary Permit Application a �/ 201 W. Washington Ave. fl 0 PO Box 7302 Nvisc In accord with Comm 83.21, Wis. Adm. Code Madison, W153707 -7302 Department of Commerce Personal information you provide may be used for secondary purposes (Submit completed form to county if not (Privacy Law, s. 15.04(I)(m)J state owned. Attach com late plans to the county copy onI4 for the system on paper. not sass than 8 -1/2 x 11 inches in size. Couny State Sanity P it Number heck if revision tolfreviotls epplicslion State Plan I. D . Number / I. Application Information - Please Print all Information Location: Pr y Owner Na L Prgperf Location 1 s � r 1'14 /01/4, S T N R/ pp 'G or Properly Owner's Mailing Address Lot er Block Number AA J City, St ate Zi Code u � ' � p Phone Nu bar. �aN{Nt3 t Sion Name CSM Number II Type of Building: (check one) []City 'JR' I or 2 Family Dwelling — No. of Bedrooms: ❑village O Public/Commercial (describe use): Jq .l.oVA' of . --r O State -owned --- _ -.__ —. _------ "___.__�_ E St JQs III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road,,/ 7yj14 8 A) 1. kNew System 1 2. O Replacement 3. ❑ Replacement of 4., ❑ Addition to Parcel 7'ex Numbers) S stem Tank Onl Existing System Q ( 1 /6 �W /L) -- B) Permit umber Date Issufd A Sanity Permit was previously issued / LV. Type of POINT System: (Check all that apply) XY\Non-piessurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Welland ❑ Pressurized In- ground ❑ holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V Dis ersaUTreatment Area Information: 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /i c1) Elevation VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons 'Tanks Con- Con- glass New Existing crete structed Tanks Tanks `bc �� ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ VII Responsibility Statement 1 the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's, print) Plumber's Signatum.(no stamps): MP/MPRS No. Business Phone Number Plumber's Address (Street, City, State, Zip Cod VIII County/Departifient Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued IsYng ge nt Signature o stamps) ,Approved ❑ Owner Given Initial Adverse Surcharge F ) Determination AfifilAk IX. Conditions of Approval faeasons for Disap vah , ..r .6 r u �C S , d e- Li i nd e- rs _QL c�l�.__.� �s'� _......__. _.. ,4M_ L -" i f i Q 3 r���., u °� Sr• � o Iwo ) OS. 00 8� z7 05-54r,,�a qtV! : IbU.p IU 1 'Tot c �• ti I Q p V C C ur� -'� - - - - -- - - 0 E c cl , I/lAa�a 5 Em i C N x cA vi E E c C x� Cj ( J. W I � 3 T Q o co z XXXX �a�a 0- v 45 - . vim —''`� a 'LZ �. C O L C x W I cl N� N L X VS C— L \ U L?^NL c U = h —_ -_ _ va O J lL O 2 of in cn ) it _ a . _ f b/ _S ," d e uo l' ncl e rs �c� c�k __- �s� __....__. _.._ A N1'L- Jer...... . ow � a ,� � 0 4�0��� �► � II � Q n � k -f TiCP )oS. oo 3k 87 A ey ----- �N� 13'9+� pug P A) /N ( A; e AIR A5-s4r,,r Iwo In IU Q _ > c 2 N x to u i -- - - -..__ 'AA / ... f-- t� N 1. EEvc t x rn cn to ui O �22o o co o uV l =F� cn c D o �` o. W N Q C N �. - -- _ aD ° in U) s CL . l s 1520 Wisconsin Department of Commerce SOIL EVALUATION REPORT page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8'% x.11 inches is size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM) direction and parcel I.D. percent slope, scale or dimemsions, north arlarr, and location and dista � o nearest road. 0 30 - 1020 _1 - 000, ID #25 Please pilnt,,�[i info " tioq ., ewed g Date Personal information you provide may beiiSed for seoondarY prpgs$s i1 Law i.15,04 (1) (m)). 170 Property Owner r Property Location Patr & Susan Thomas GovL Lot NW 1/4 SW 1/4 S 25 T 30 N R 19 W Property Owner's Mailing Address Lbt Block # Subd. Name or CSM# 347 South P R � ``�' ;' 1 Bass Rid Pines City State Z Oode. Phone u City Village *0 Town Nearest Road Hudson WI 54 T;15 -4 6 +x$97 `' St.Joseph 134Th Ave. Code derived design flow rate 450 GPD Use: �9 f / Number of bedrooms 3 New Construction � Residerlt�al __ - -_ Replacement I Public or commercial - Describe: -- — -- - -- -_ -- _ _ -- Parent material Glacial out Flood plain elevation, if applicable na General cornmerft and recommendations: Install 2 trenches using 22 high capacity infiltrator chambers at system elev. = 95.00'. System will require lift station to reach system elevation. Bo ring 1 Boring # -.) ft. ?93 in. Sal Surface elev. 98.56 or ❑ 01 Pit Ground — __ —_ -- Depth to limiting fad Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' *Eff#1 *Eff#2 1 0 -7 10yr3/3 none sil 2fcr mvfr as 2fm,1c 0.5 0.8 2 7 -12 1Oyr 5/8 none sil 2fs mfr cs 2f,1mc 0.5 0.8 3 12 -21 1Oyr4/6 none Is 1msbk mvfr gs 1 f 0.7 1.2 4 21-52 1Oyr5/4 none s Osg dl_ gw 0.7 1.2 5 52 -93 1Oyr6/4 none strat. s Osg dl - - 0.7 1.2 bl - - -- - - -- -- -- Boring # �j Boring Pit Ground Surface elev. 98.55 ft. Depth to limiting factor _ >96° in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' *Eff#1 *Eff#2 1 0 -9 1Oyr3/3 none sil 2fcr mvfr as 2fm,1c 0.5 0.8 2 9 -26 1 none sil 2 fsbk mfr cs 2f,1mc 0.5 0.8 3 26 -34 10 Y r4/6 none Is 1msbk mvfr gs 1fm 0.7 1.2 4 34-74 1Oyr5/4 none s Osg dl gw - 0.7 1.2 5 74 -96 1Oyr6/4 none strat. s Osg dl - - 0.7 1.2 * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 150 mg/L * Effl #2 = B013 S30 30 mg/L and TSS <30 mg/L CST Name (Please Print) Signatu CST Number Ja K. Thompson 3602 Address A.C.E. Sal & Site Evaluations D e Evaluation Conducted Telephone Number 2 12/19/01 715- 248 -7767 340 Paulson Lake Lane, Osceola, WI 54020 property Owner P atrcik & Susan T homas -_ Parcel ID # 030 - 1020- 10 -00 #25.30.1 Page 2 of 3 F # Bones { Pit Ground Surface elev. 1 ft. Depth to limiting factor > 128 "__ - in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft= *Eff#1 *Eff#2 1 0 -10 1Oy / none sil 2fcr mvfr as 2fm,1c 0.5 0.8 2 10 -23 1Oyr5/8 n one sil 2fsbk mfr cs 2f,1mc 0.5 0.8 3 23 -38 10yr4/6 none Is 1msbk mvfr gs 1fm 0.7 1.2 4 38 -70 1 /4 none_ s Osg dl gw - 0. 7 1.2 5 17 0 -128 1Oyr614 none strat. s Osg dl - - 0.7 1.2 H#5 contains many stratified layers of fine, medium & coarse sand and gravel. Total coarse fragernents < 20 %. F # >� 1 Boring -- Pit Ground Surface slap. 103 0__- ft. Depth to limiting factor >90" ---in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' _ *Eff#1 *Eff42 1 0 -8 1Oyr3/3 n one sil 2f mvfr as 2 0.5 0.8 2 8 -20 1Oyr5/8 no ne sil 2fsbk mfr cs 20mc 0.5 0.8 3 20 -28 1Oyr4/6 no Is Imsbk mvfr gs 1fm 0.7 1.2 4 28 -53 1Oyr5 /4 none s Osg dl gw 0.7 1.2 5 53 -90 1 /4 none strat. s Os g d - - 0.7 1.2 H#5 contains many stratified layers of fine, medium & coarse sand and gravel. Total coarse fragements < 15%. Boring # M Boring - Pit Ground Surface slap. --10 Depth to limiting factor >148" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots : *Eff#1 *Eff#2 1 0 -7 1 none s il 2f mvfr as 2fm,lc 0.5 0.8 2 7 -16 1Oyr5 /8 none sil 2fsbk mfr cs 2f,1mc 0.5 0.8 3 16 -23 1Oyr4 /6 none Is 1msbk mvfr gs 1fm 0.7 1.2 4 23-61 1Oy /4 none s Osg d gw - 0.7 1_2 5 61 -148 1Oyr6/4 none strat s Osg dl - - 0.7 1.2 H#5 contains many stratified layers of fine, medium & coarse sand and gravel. Total coarse fragements < 25 %. *Effluent #1 = BOD .., 30 < 220 ,,/I and TSS >30 < 150 mg/L Effluent #2 _ - BOD < 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. • � �,/ 46se� ✓a�o,� � f ♦ E/e✓ai6�0n t S ca/ �aflic l!� Susan umaS pro?. / O'Cvn { - � f . � 1 \ 2 S /ova 98,0' "\ , nail rr+ H tree. Ele!�` = /cs (V' �\ ✓ �� �e . 63 V Qp � V7 Ck 1 e Aye. Safety & Buildings Division 7� 201 W. Washington Ave. Sanitary Permit Application - PO Box 7302 `�seonsin In accord with Comm 83.2 1, Wis. Adm. Code Madison, W153707 -7302 Department of commerce Personal information you provide may be used for secondary purposes (Submit completed form to county if not (Privacy Law, s. 15.04(1)(m)] state owned, Attach com lete plans to the county copy only) for the system on paper not less than 8 -1/2 x I 1 inches in size. CounyState Sanry Permit Number ❑ Check if revision to previous application Slate Pla I . D. Number q I. Application Information - Please Print all Information Location: Prq rt yOwner Name Property Location ` - I i t M 1/4, T.� N E or W Property Owner's Mailing Address Lot Number Block Number Ci , Sole Zip Code � hone 3pber r� Subdivision Name or CSM Num .�' s II Type of Building: (check one) ❑ City I or 2 Family Dwelling - No. of Bedrooms: fat ) 6 2001 ❑village Public/Commercial (describe use): T X D� TOVAI of O State-owned �-�� -- ri rTA III Type of Permit: (Check only one box on line A. Che b'o on tb1ll g c Nearest Road r 3D i,., 97 A) I. )(New System 2. ❑ Replacement 3. 0 e obits c ddition to Parcel Tax Number(s) System Tank Onl xisting System - 00 n B) Permit Number ❑ A Sanitary Permit was previously issued Date Issued IV. Type of POWT System: (Check all that apply) -Y — t 9 Non- pressurized In- ground ❑ Mound D Sand Filter D Constructed Wetland 1'ressurized In- ground ❑ liolding Tank ❑ Single Pass ❑ Drip Line D At -grade 2, 3 r x68 •+s t _ , Q/J� D Aerobic Treatment Unit ❑ Recirculating ❑ Other: V Dia ersaUTreatment Area Information: 1. Design Flow (gpd) 2. DisperselArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate "ystem Elevation 7. Final Grade Required Proposed Rate (Galsy /sq. ft.) (Min /inch) Elevation C0 3 5 '] M 1 ' 7 � V,'] W, VI Tank Capacity in Total N of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons 'Tanks Con- Con- glass New Existing crete structed Tanks Tanks O b id ZOL - -- � -- - ❑ ❑ O ❑ Cl D D ❑ ❑ VII Responsibility Statement I the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na (print) Plumber's Si turo;(Ind stamps). MP/MPRS No. Bualness Phone Number i V Plumber's Address (Street, City, Stale, Zip C )0 Nw� 3S vip-s W Ui SC VIII County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issu' g Agent Signs a (No stamps) Approved ❑ Owner Given Initial Adverse Surcharge Fee) eta Z Determination 22$ D Y 0 i IX. Conditions of Approval /Reasons for Disapproval: / A -�S - Ntia.`A {E•t�J. L. c�n4as/ owcad Iltst -t at1� �k�t . a4 � w�e,�, e-11S. �1 l S A,r6 Safety do Buildings Division Sanitary Permit Application 201 W. Washington Ave. F0 Box 7302 �Vlsconsln In accord with Comm 83.2 1. Wis. Adm. Code Madison, WI 53707 -7302 Department or commerce Personal information you provide may be used for secondary purposes (Submit completed form to county if not [Privacy Law, s. 15.04(1)(m)) stale owned. Attach com late plans to the county copy on) for the system, on paper not less than 8 -1/2 x I 1 inches in size. 'ounty State Sannit Permit Number O Check if revision to previous application State Pla 1 . D. Nu mber q l . Application Information - Please Print all Information Location: z y-Owner Name �� Prr p operty Location /C (/. ., a ) U,5( 1bYY1ft s /Vwl /4 1/4, T�C> N E W toperty Owner's Mailing Address Lot Number Block Number __R1 ir, Stau Zip Code , � Iwn t�u -, Vl Subdivision Name or CSM Nu 'I Type of Building: (check one) 4w _ ❑ City 1 or 2 Family Dwelling — No. of Bedrooms: T�� ) 6 ?QQ� 1. ❑ village PublidCommercial (describe use):X of ] State -owned $3 O III Type of Permit: (Check only one box on line A. Che bo i on }iT"tw tc red Nearest Road' 3a k A) I. New System 2. 11 Replacement 3. 0 Rep cdt f � ddition to Parcel Tax Nun S) System Tank Onl xislin S stem , B) Permit Number Dale Issued O A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) _Y — (a Rr K Non- pressurized In- ground ❑ Mound ❑ Sand filter ❑ Constructed Welland Pressurized In- ground 111 lolding Tank ❑ Single Pass O Drip Line O At -grade 723 YO-Is- / t 11 Aerobic Treatment Unit ❑ Recirculating ❑ Other: ct�s V b1speredlTreatment Area Informat I. Design Flow (gpd) 2. WispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation L i 50 3 317 1., a I • '7 TV 1 98 VI Tank Capacity in Total N of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons 'ranks Con- Con- glass New Existing Crete structed Tanks Tanks 51 I _ -- -! - - -e - -- -- -- - ❑ ❑ ❑ O ❑ VII Responsibility Statement 1 the undersi ed assume responsibility for installation of the POWTS shown on the attached plans. Plurnba"s Na (print) Plumber's Si imm1no atal : MP/MPRS No. Business Phone Number _T � 1 Plumber's Address (Street, City, State, Zip C )o pw 35 j�ubs sC CyU) VIII County/Department Use Only O Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issu' g Agent Signa (No stamps) Approved O Owner Given Initial Adverse Surcharge Fee) eD ' % ) Y/ 0 ( Determination 2�- ' ¢,_,,,; IX. Conditions of Approv /Reasons for Disappr k A_q5 h._,$ S V C 'kl.i &4-.L.c` J4. (.c.1. L . c:n4.ot s / � O�.D ad 1(tl�C � � K>➢W� c� o�n tit. -i h � +o -�^-� °'a ►�c,�,�d� ems. AZA M 0 T P - t (Od t, if I WO a2a,� �,11aN w R - 100 1�t2 is Q It g 3(i a i�N�1�P 3x-$: BS )sb' ai- To of NO iN fin w i f� 0110 �tl, baN At lo►. y /a�' j 13� �4A� in 0 0lh Tao NL4S I 'Flop) - 7 0 .t / V S d e- Li nd e- r,5 AIA V m � of �fieel Ow I0U.0 .i c� (Oft t,j ifl, I �vo y�� � P�► L gV 02AH F-41o1 win 1 �Q I 3 6Pa2aorh /� N Q 3V o r.+2 SI It i . pip � a -1 �T. � 3x4 %.T5 BS Isb' Rj. Al D ►tk T op J Nn� iN r►�c w;1;� onpw� A lo►- 4 13 � Nd ��F In 9 y. 7v C � ro 2 p ° - rI G � •� p � ` � rn - -_ - 4 S r i v 9 . O C j c E_ M i — (n I A /ddddeA E (d 0 N x t N ee C _ - '- ��� ?, .•_ U In � 0 — -- i_ E E -C x rn M W- -._ w � L co I N N _ a c O C O Z O N ►—� n (n V Y � � Q. v i � � �.n W E a x cl � \ � LL �U � - - -- ;D - - - - - -- - ►� �a�v rn j IJ m _ _ ���o _J LL 0 = n Ni O 'N Do- Wiscontz�n Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of ;3ureau of Integrated Services in accordance with s. ILHR 83.09, Wis. A3rn. Coil Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must Cou include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. p el I.D. # APPLICANT INFORMATION - Please print all Information, A eviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Y GU 6 Govt. Lot � 1/4 < � 1/4,S d, T 3o ,N,R f q E (o0 Property Owne s Mailing Address lot # Block# I Subd.NameorCSM# City to Zip Code Phone Number ❑ City ❑ Village ®, Town Nearest Road J7 3 rJ 5� 1 New Construction Use: 54 Residential /Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow gp d Recommended design loading rate . 7 bed, gpd/ft gpd/ft Absorption area required bed, ft ft Maximum design loading rate bed, gpd/ft trench, gpd/ft Recommended infiltration surface elevation(s) � ft (as referred to site plan benchmark) Additional design /site considerations /� Parent material 'L f -& 2d- 4.�'�. Flood plain elevation, if applicable S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill I Holding Tank U = Unsuitable for system I X S ❑ U I ,0 S❑ U 91 S❑ U 1 0S ❑ U I ❑ S U ❑ S 'Pt SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 00"s in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench I 4 a Ground / I t\ Mum ; Depth to limiting * I-- , ILt - r `�' 199 Remarks: Boring # 44 iv/ v� Lnd v , Depth to limiting fin. Remarks: dim CST Name (Please Print) S' n re Teleph No. Address Date CST Number C IL DESCRIPTION REPORT Page of PROI'ci; i ti' G,: i:LR - - 4�,I PAF{CcL ;..... ► Structure 2 Boring !: .crizon Depth Dominant Color Mottles Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Grounu v.. { -� -- limitiny - -- fc - ---- GU;. t Bor r� elf — i / eniarks: on Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft� i Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 1 i _ _ --- } - =,�.rnarks: i i I , t aarKS: C ID IL DESCRIPTION REPORT PROPERTY OWNER _ Page of PARCEL i.ri.# Boren # Horizon Depth Dominant Color Mottles Structure 2 Boring in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed . Trench V3 a C s - -3 Ground �L ` ft. Depth to — limiting ?fin. 5 , Remarks: Boring # 0�g e 4V Z tii ( Ground Depth to limiting ell"' Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # 7e Y l Ground Depth to limiting 2 Remarks: Boring # Ground elev. ft. ' Depth to limiting factor - -in. Remarks: SBD -8330 (R. 07/96) J Soil Test Plot Plan Project Name Dave and Arla Railsback Sha i Address 845 133rd Ave .10 New Richmond Wi 54017 C M #226900 Lot 1 Subdivision Date 6 /4/99 NW 1 /4SW 1/4S25 T 3 0 N/R 19 W TownshipSt. Joseph ❑ Boring ()Well PL Property Line County S T. C ROIX �Br VRP Assume Elevation 100 ft. Top of Steel Fence Post with Orange Ribbon System Elevation 94.7 * H R P Sa as Benchmark Alt. Top of Nail in Tree with Orange Ribbon @ 101.4 334' Property Line V B -4 j13 2 45' lope o, o B -3 ` 0 , 60' Rep A Pri A tr 0' % S lope 150' 15' 15' B -5 B -1 20' 1. 120' o0 w con Pro Town Road Soil Test done to satisfy zoning requirements, may not be suitable for buyers desired building site. i POWTS OWNER MANUAL 8L PIAN +vLr Ictfl r"t" ,'NFORMATION SYSTEM SPECIFICATIONS Owner , P�q,•T(� IC, i-}- ti qn1 Tiber �5 Septic Tank Capacity UtsD al ❑ NA Permit # �q b Septic Tank Manufacturer W ❑ NA Effluent Filter Manufacturer ❑ NA DESIGN PARAMETERS 13 NA Number of Bedrooms 3 DNA. Effluent Filter Model �_-1 vb Number of Commercial Units NA Pump Tank Capacity gal NA Estimated flow (average) I/ ay Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) -D gal /day Pump Manufacturer IEZNA Soil Application Rate 0 . + gaUday /ft' Pump Model G(NA Monthly average* Pretreatment Unit NA Influent/Effluent Quality ❑ Sand /Grave ' ter Peat Filter Fats, Oil ez Grease (FOG) s30 mg/L ❑ Mechanical Aera ❑ Wetland Biochemical Oxygen Demand (BODs) :5220 mg /L ❑Disinfection 103 her: Total Suspended Solids ( TSS) 15150 mg /L Manufacturer Pretreated Effluent Quality ' ❑ NA Monthly average* * Dispersal Cell(s) Biochemical Oxygen Demand (BODs) :530 mg/L ';In- ground (gravity) ❑ In- ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ At -grade ❑ Mound Fecal Coliform (geometric mean) :510 cfu /100m1 1 ❑ Drip -line ❑ Other: Maximum Effluent Particle Size A inch diameter * Values typical for domestic (non - commercial) wastewater and septic tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency inspect condition of tank(s) At least once every 3 ❑months ❑ year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one -third (Ys) of tank volume inspect dispersal cell(s) At least once every 3 ❑months 13 year(s) (Maximum 3 yrs.) months ❑ year(s) Clean effluent filter At least once every — �j ❑ e Inspect pump, pump controls ex. At least once e ry ❑months ❑ year(s) ANA Flush laterals and pressure test At least once every ❑ months ❑ year(s) KNA Other: At least once every ❑ months ❑ year(s) CKINA Other: At least once every ❑ months ❑ year(s) tg NA MAINTENANCE INSTRUCTIONS Mas inspections of tanks and dispersal cells shall be made by an Inspector; lndi poa as aintainer Septage Servicing licenses g Operator. Tank inspecd'o Plumber; Master Plumber Restricted Sewer; POWTS cracks or leaks, measure t must include a visual inspection of the tank(s) to identify an any back ti o r broke hardware, g of identify any the ground surface. The dispersal volume of combined sludge and scum and to chec Y effluent o cell(s) shall be visually Inspected to check the effluent levels observat! ndi ate aefailingt�onditlonoand requires immediate the ground surface. The ponding of effluent on the ground surface may notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Ys) or mo ordan e th with h volume, NR 1 1 W scon e Servicin b removed b a Septag g Operator and disposed of in ac contents o f the tank shall e Y Administrative Code. ems, pretreatement components and The servicing of effluent fitters, mechanical or pressu POWTIi be performed by a certified POWTS Ma nrtainer.ny other maintenance or monitoring at intervals of 12 months e A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the prese tions are detected have o the conte con that may impede the treatment process and /or damage the dispers al cell(s). If high centra ce ( ) e or p rier to use. At rho ranlr(s'! rarnovad MY z SenU>xe servicing •p rat r Pate —of.— System start up shall not occur when soli 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(:) in one large dose, ovedoading the cell(:) and may result in Ow backup or surface discharge of eftent. To avoid power to the effluent or contact Plu ber POWTS Malntalner to assist In manually pe acing the pump one ob rtnti to restore ncrmal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise dLswrb or compact, the area within 15 feet down slope of any mound or at-trade soil absorption area. Reduction or elimination of the following from the wastewater Mam may Improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; (at; foundation drain (sump pump) water; fruit and vegetabit peelings) gasoline, grease; herbicides; meat scraps; medications; oil; painting croducu: oesocides: sanitary naokins: tampons; and water softener brine. ASAN DON EM ENT When the POWTS fails and /or is permanently taken out of sery ice the following steps slid) be taken to Insure that the system is property and safely abandoned In compliance with ch. Comm 83.33, Wisconsin Administxadve Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings scaled. • The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another Inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be liken, W 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 linen and wells. Failure to protect the replacement area will result In the need for a new soil and site evaluation to establish a sultabie replacement area. Replacement systems must comply with the rules In effect at that time. O A suitable replacement area b not available due to setback and /or soil limitations. Barring advances In POWTS 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 replacewnt area. If no replacement area is available a holding tank may be installed as a last resort w replace the failed POW75. • Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the Infiltrative surface. Reconsuvctions of such systems mwst.comply with the rules in effect at that time. < <WARNING> > S EPT IC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TRIEATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM TKE INTERIOR OF A TANK MAY RE DIFFICULT OR IMPMURI F. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name a ,, Na me Phone o 20 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Agency Ceo(,K Cb -?W/ Phon• h n I S'1' CKOIX COUN'T'Y SEPTIC 'TANK MAIN'rENANCR AG1ZR MENT AND �} y OWNERSHIP CERTIFICA'T'ION FORM Owner/Buyer f h i c-1- SUSAN u /'1 Mailing Address _ 3� Sykl Rh, Pj3 )� j Lr d (s111 -1 Property Address L i'I W% (Verification required from Planning Department for new construction) / Cit State y �kD oN Ui Parcel Identification Number C LEGAL DESCRIPTION Property Location /,, (AJ N -Ik W, 'Town of jU S -Q Subdivision �i) SS > d ( r i N S ,Lot It CertiOed Survey Map # Volume , Page # :1 Warranty Deed # (•t S 15 '"] Volume , Page # (o Spec douse 0 yes K no Lot lines identifiable M yes O no lmpropec use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper maintenance conatsts 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 Hmcdon of the septic tank as a treatment stage in the waste disp system. I� y The prop" owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a is In matt plumber, jovroeY=UpIu mbar, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewater; disposal eys/em proper openthrg condition and/or (2), httt ection and pumping (if necessary), the septic tank is lea than 113,itA of AWS& g se have read the above w and agree to maintain the private sewage disposal standards set Pocdr. herein, u set by the ®epertment and the Department of Natural Resources, State of Wisconsin. Uwe, the undersigned OertiTicat3oo stating that yew "PtIC system has been ma mot be com and returned to the St. Croix County Office wig 30 days of: year xP a date. `: ; •;t ; . SIGNATURE OF APPLICANT DATE I (we) oertit�1Mt all statements on*fioup are true to the best of my (our) knowledge. I (we) am (are) the owners) of Thep described vo, by virtue of aNsmaty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT ",.. DATE Any information that is mis f ga y result in the sanitary permit being revoked by the Zoning ,000 Include with this application: a slamped,VGrgtq deed from the Register of Deeds office e 2 copy of dw certified survey map if reference is made in 1he warranty deed i 1704PAGL 461 �s5i?`5 ?4 KATHLEEN H. WALSH >TATE BAR OF WISCONSIN FORM 2. 1999 REGISTER OF DEEDS ST. . CROIX CO., WI Document Number WARRANTY DEED RECEIVED FOR RECORD This Deed, made betwee _ H. Railsback, 11, a n d Aria J. 08 -23 -2001 12:20 PM Ra ilsback, husband a nd wife WARRANTY DEED EXEMPT # _ CERT COPY FEE: COPY FEE: Grantor, and Patrick D. T} otnas and S usan M. Thomas, husband and TRANSFER FEE: 166.50 wife, RECORDING FEE: 10.00 PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St Croix County, State of Wisconsin (if mor- ^^ p ) (� space is needed, lease attach addendum Recording Area Lot 1, Bass Ridge Pines, Town,of St. Joseph, St. Croix County, Wisconsin. Name and Return Address r4 i A �? Rbx� LTk Trrt,� �tlDt 0 n, t�►L 5`lo I M 030 - 1066 - 20.000 Parcel Identification Number (PM) This is not homestead property. 0i) (is not) Exceptious to warranties:. Emorrients, restrictions and rights -of -way of record, if any. Dated this �or- day of M 2001 ° * David H. Railsback If < Aria J. Railsback AUTHENT CAIrION ACKNOWLEDGMENT Signaturc(s) David H. Railsback, 11, a nd Aria J. Railsback, STATE OF WISCONSIN ) -- - ) husband and wife, County ) authenticated this day of Ma 2001 N M. BARRON Personally came before me this day of jA the named Vary l i ��S • Kristina Ogla Wisconsin — i I( TITLE: MEMBER STATE B�R OF W ISCONSIN to ma k to be the person(s) who Cxccutcd the foregoing (If not, _ instrument and r7 wlcdged the same. authorized by § 706.06, Wis. Sluts.) THIS INSTRUMENT �AS DRAFTED BY < Attorney Kristina O gland —._— Notary Public, Vi tats of Wisconsin Hudson, w1 54016 _- _ My Commission is permanent. (If not, state expiration date: (Signatures may he authenticated or a knowlcdged. Both are not necessary.) ' Names orpersons signing in any capacity must be typed or printed below their signature. Warmenonaro(osslonaie Company, Fond duLae, vin WARRANTV nFFn I STATE BAR OFWISCONS)N 800.655.2021 r ►SS RIE)C31E PINES REGISTERS OFFICE +rt of the Northwest Quarter of the Southwest Quarter of Section 25, ST. CROIX CO.WIS. North, Range 19 West, Town of St. Joseph, St. Croix County, Wisconsin. R edforRecordthis1 of A.D. at clock- P M. R r1r G I I I 1 I 1 7ON 25 1 i -- ------------ S89'S0'S5 "W 5274.77'-------- I I I BM #2 I I I 'o TOP BOLT ELEVATION= 923.92 33' 33' ------- - - - - -- - -- I t - - -- - ---- 316.91' - - -- -- --- 203.81' --- — i W1 1 i i3• �rrs� *^• � y � Q j I , 00 N 131,145 SQ. FT. ( x N83 'S� ?g 3.01 ACRES MIN. F.F.E. =931.5 1 SEMEN + `��4 97 f ,•�� po.a 1 0 9� F \\ � 1 NO y 6 s PONDIN t � T o, G AREA �. I 25 YEAR H.W.E :..�/ • o , —_ — = 927.50 c .; : ,• o I �" Imo, 2.89'- • 1 00 1 0 ) 4 —O� ao 42.89' O ^� E •\ t°n_00 a o 1 1 00 1 33.41'— ©�,� \ r Q ;'• ; I 13 . W.L. �+ R 9• 0 !y \ 0 1 d �� \ `�S72. •>>? \ '� \��? 9 \ N89'59'59 "E,, \ I + Lv + 325 32', R \ •� 58.54' `.\ Z i I to F � DRAINAGE �� .��' i, ® o p 1 i EASEMENT— 6y�1b�� N • \ cD I \ D •1 __ . .� i n J I 6 •�` 1 S89'59'59 "W'�. 1 °o O I + • 131,045 SQ. FT. ? 57.80' +n 1 Q , 3.01 ACRES + + O I J i - r -� - _ = x - - - - 1 _— -Y _ — — 1 - BM #2 = - - PONDING ARE TOP BOLT _ ; g -25 YEAR HIGF�" 1 o ELEVATION = _ -' x 931.2 _ -- - - -- - -- 317 LO T ET � 1 - - - - - - -- 131 -._ 45 01 ACRES. ..... _ 931 - - - - - 4 ,+ Z11 I l El - �- Ba � /Q IC4 +. El - P4NDING AREA WATER tc r l Q • I 6 c � X K Z r _ 9.34 % -° a B -2 O r ' 4 f 1 -2, I Y r I m Im El B�3 _- Q 3.01 ACRES '- X �,, 9 z co - f - _ _ •. \ �` .� --i l _- x 1 f ±�T - " ,��