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HomeMy WebLinkAbout030-2120-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Cr oix Safety and Building`Div'ision' INSPECTION REPORT Sanitary Permit No: 430060 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID Personal information ou provide may be used for seconds purposes [Privacy Law, s.15.04 (1)(m)]. ` } Y P Y secondary P P I Y Permit Holder's Name: City Village X Township Parcel Tax No: Nolan, Eric St. Joseph Township 030 - 2120 -20 -000 CST BM Elev. Insp. BM Elev; BM Description: Section/Town /Range /Map No: 60• (CO-0 1 Q'�I = Cc�; IA 25.30.19.975 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELE . Septic B W e �—+C.S f n Dosing Alt. M Aeration Bldg. Sewer Holding SVHt Inlet / 8.98' ci TANK SETBACK INFORMATION St/Ht Outlet Z TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic , / 1 i —� Dt Bottom Dosing Header /Man. c� Aeration Dist. Pi! / � Holding Bot. Systbm U I O. p 9 1 • S� `� ZU p PUMP /SIPHON INFORMATION Final rade Sp, 1 �•OD� Manuf urer Demand St C er GPM AAA Model Num r TDH Lift Friction Loss System Head TDH Ft Force in Length SOIL ABSORPTION SYSTEM 0125f(R ENC11b Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSI S 3 D��S 2 SETBACK SYSTEM TO D P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of System: , O 1 f q CHAMBER OR t0D — 3 _^ UNIT Model Number: 0 DISTRIBUTION SYSTEM 1 Header/ anifold L4 Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipes) , Length Dia Leng i s Spacin 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 Bed/Trench Edges Topsoil – Yes fl No L 1 Yes j No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1:N(g. L -3 +� - 3 5 Inspection Location: 810 134th Ave Hudson, WI 54016 (NW 1/4 SW 1/4 25 T30IVR19WRidge Pines Lo Parcel No: 25.30.19.975 1.) Alt BM Description = _r`f �"'�+ �► A \) 2.) Bldg sewer length = 2 ? 1 (AW -- amount of cover = f i+ • I _�� �p " .� _ r`� 3) J �yerJ oie+► J2M7C - $ ��. 2 C.`�'bM� `t++` Use other l side for u additional information. ' �J• r ?J !— - -- - -- ---- -. -_ -- L f - In t rt. No. Date sepc or s Signature Ce SBD -6710 (R.3/97) Safety & Buildings Division 201 W. Washington Ave. Sanitary Permit Application PO Box 7302 14scons In accord with Comm 83.2 1, Wis. Adm. Code Madison, Wl 53707 -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 co less than 8 -1/2 x 1 I inches in size. Couny State Sanitary Permit Number r vious pplication State Plan I. D. jJu(n I. Application Information - Please Print 1 Informatio Location: /V Property Owner Name 0 3 Property Location, rl S � ) IVd ' • COUNTY NW1 /4501/4.S T3 N Rl or W Property Owner's Mailing Address ZONING OFFICE Lot Number Block Numbs 10 10 g si -Q a City, State Zip Code Phone Number Subdivision Name or CSM Number II Type of Building: (check one) �/ `� ��� ❑ City O 1 or 2 Family Dwelling - No. of Bedrooms: y ❑village O Public/Commercial (describeu e RTown of l r O State -owned J d st III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road A) 1. @New System 2. 0 Replacement 3. ❑ Replacement of 4.. ❑ Addition to Parcel Tax Number(s) 1 System Tank Only Existing System a $) Permit Number ✓ Date Iss ed A Sanitary Permit was previously issued IV. Type of PONT System: (Check all that apply) l�, tNon- 'ressurized In- ro un_ d ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurtz F ed ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V Dis ersallTreatment Area Information: ti 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolatio to 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. R.) (Min. /inch) Elev i n () v 85'8 87 V • 1j 9S .0 �,b a VI Tank Capacity in Total H of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks , . / Con- Con- glass New Existing W �/ crete structed Tanks Tanks 0 0 L VII Responsibility Statement. I the undersi ned assume responsibility for installation of the POWTS shown on the attached plans. Plumbers Name (print) PI nd stamps): MP/MPRS No. Business Phone Number ,Y, D% Tl* -r s aa:� 7 U Plumber's Address (Street, City, State, Zip Code) 1616 A S N U 4 >41115 o W ' VIII County/Department Use Only ❑ Disapproved Sanitary Petmit Fee (Includes Groundwater Date ssued suing eqR Signatpre s) pproved ❑ Owner Given Initial Adverse Surcharge Fee) p0G / 1� G Determination 6 IX. Conditions of Approval /Reasons for Disapproval: POU-).7� Ae,&C_a,7ti_� Act�z_l AA L/ Septic tank, effluent filter and L/ dispersal cell must all be serviced / intained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable c ode lord finances. Pm - _.. - - .ML " -" _ u.mp.e.3 der'. .. OT AM / I S A 1 'r p :. Ing N L f 'vR� 83 3 sa - V0 3 g, 6 (u 510 s��►c d 1�u [Its = I bl Pvc Alt Ti - OV m En ~ a p '� W I it �_ 1 _ ..�. `'" . / /AII AeI 11 i • f ` y i1 O N , �uu.m.e.e3 der..'. .. . • - .. -_ ._- .- .__..- _ I S , 3k 87 sv l 00, .�. 3 PPP f;NP 6 l a`p 5131 s�� ►c ��PpR0oM u pv U f Alt Q rv1 Flw- /oo. a Tip 3 �y" Pve V-r N o m u� ( U rn to 13 S � C � • CIL OL l _ u `r� v �- Lit o CL A W, LL x 'v L • w _.. - ......... \\ of -- CL.- �. 0 3: tit \ \ \,,�� • • • • V/ T pq�p 1661 Wisconsin Department of Commerce SOIL EVALUATION REPORT P age 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 n on r not less than 8'/ x 11 inches in size. Plan must County p � � St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. 030- Z1120-2000 Please print a/l _., irnlEnatl m 1;q0) B D ilte Personal information you provide may be used sewn S . (m)). L'- Property Owner Projerty Location Eric Nolan F,' [_ j `% ; n .a Gov!. Lot NW 1 /4 SW 1 /4 S 25 T 30 NR 19 W Property Owner's Mailing Address Lot Block # Subd. Name or CSM# 1010 9th Street C -' ?. 2 Plat Of Bass Ridge Pines City State Zip City JJ Village rf Town Nearest Road Hudson WI 54016 715 -381 -2833 St.Joseph I 134Th Ave. AM New Construction Dce: 1I Residential ! Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Install 2 trenches at elev. = 95.00' using 28 leaching chambers. Each trench to be 3' x 87.50' using 14 chambers per trench. © Bi # — j Boring 0 Pit Ground Surface elev. 99.50 ft. Depth to limiting factor >1 11 ° 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 1 0 -8 10yr3/2 none sil 2fcr mvfr as 2fm,1c 0.5 0.8 2 8-27 10yr5 /4 none sil 1msbk mfr as 2fm,1c 0.2 0.3 3 27 -36 1 7.5yr4/6 none Is 0 sg ml a if 0.7 1.2 4 36-60 10yr4/6 none s 0 sg ml gs - 0.7 1.2 5 60 -111 10yr6/4 none s 0 sg dl - - 0.7 1.2 FA Pit Boring # I Boring Ground Surface elev. 99.17 ft. Depth to limiting factor > 108" 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 1 0 -10 10yr32 none sil 2fcr mvfr as 2fm,1c 0.5 0.8 2 10 -36 10yr5/4 none sil 1 msbk mfr as 2fm,1 c 0.2 0.3 3 3642 7.5yr4/6 none gr Is 0 sg ml cs if 0.7 1.2 4 42-69 10yr4/6 none s 0 sg ml gs - 0.7 1.2 5 69 -108 10yr6/4 none s 0 sg dl - - 0.7 1.2 A • Effluent #1 = BOD 30 < 220 mg/L and TSS 30 < 150 mg/9 nt #2 = BOD <30 mg/L and TSS <-0 mg/L CST Name (Please Print) Si ature: CST Number James K. Thompson 3602 Address A.C.E. Sal & Site Evaluations ate Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 7/812003 715 -248 -7767 Property Owner Eric Nolan Parcel IDS 030 - 2120 -2000 Page 2 of 3 3] Boring # Bering %o Pit Ground Surface elev. 97.84 ft. Depth to limiting factor >115" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -13 10yr3/2 none sil 2fcr mvfr as 2fm,1c 0.5 0.8 2 13 -21 10yr4/4 none sil 1 msbk mfr as 2fm,1 c 0.2 0.3 3 21-45 10yr5/4 none Sid 1msbk mfr cs If 0.2 0.3 4 45-62 7.5yr4/6 none gr Is 0 sg ml gs if 0.7 1.2 5 62 -81 10yr4/6 none s 0 sg dl - - 0.7 1.2 6 81 -115 10yr6/4 none s 0 sg dl - - 0.7 1.2 F-1 Boring # I Boring _J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 ' Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD S < 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. • ■ So // ec� /ua Eio� A E /eva >ca./e . / ' = /0' o � - rrrrr�t o - �2 tea, d �i Li H k¢a��ly c.,ao dad�o:nes I � � "zi a M Pre posed 14 6cdr oor►, re5t' deocc keau;Iy �vod�.d 1°i"es b ssu..»ed a !e v: = roo.0e Q. A L I N TDPo� 0 -� :_ ,4�e 13V . r Safety & Buildings Division N v isconsin Sanitary Permit Application 201 W Washington Ave PO Box 7302 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(1)(m)] state owned. Attach complete plans to the county co only) for the system on paper not less than 8 -1/2 x I I inches in size. County O State San' a Peermit Number ❑ Check if revision to previous application State Plan 1. D. Number n 0o (06 I. Application Inform t n Please Print all Information Location: Property Owner Name Property Location RECEIVED IJO /4 5iJ, 1 /4,S T3V ,N R E or W Property Owner's Mailing Address Lot Number Block Number r/ ' JUN 0 3 20 3 A Ile, <:A City, tate tY. Zip Code Phone umber Subdivision Name or CSM Number I�I`� vUN i Y _ s FICE fd / II Type of Building: (check one �PiL ❑ city Jr 1 or 2 Family Dwelling — No. of Bed m O s: �-C.� / ❑ Village Public/Commercial (describe use): u / own of O State -owned sic / III Type of Permit: (Check only one box o ine A. Check box on line B if app able) Nearest Road y. A) L -k( New System 2. ❑ Replacement 3. ❑ Replacement of ❑ Addition to Parcel Tax Number(s) d30 System Tank Only Existing System B) Permit Number Date Issypd ❑ A Sanitary Permit was previously issued � Type of POWT System: (Check all that apply) .� on pressurized_:.. -gw+ ❑ Moun ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holdin a ❑ Single Pass ❑ Drip Line ❑ At -grade ❑Aerobic e Unit ❑Recirculating ❑Other: V Dis ersaL/Treatment Area Information: h / 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Ap ' ation 5. Percolation ate lion 7. Final Required Proposed Pale (Gals./ sq. (Min. /inch) s Elevati rog 9. VI Tank Capacity in Total j f # of Manufactu Prefab 1 Site Steel Fiber- Plastic Information Gallons Gallo I Tanks Con- Con- glass New Existing crete structed Tanks Tanks O Z __.,1xJeek1_15_i 11 0 6­ ❑ a 1 ❑ VII Responsibility Statement I the undersigned, a ons' lity for installation of the POWTS shown on the attached plans. Plumber's Name (print) ber' t4l* ( no stamps): MP/MPRS No. Business Phone Number Plumber's Address (Street, City, Si , Zip Cod - \ I 1 1J. 6 - J RP6 - ?Ck �Z VIII County/Depa tment se Only ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date ssue Is ng Ag Signature mps) Approved ❑ Owner Given Initial Adverse Surcharge Fee) Determination I . Conditions /Reasons fo Disapp ro al� G �r�v►•�-ea ►�' du, e� -�--n paw _ 1, J �/ I'D 0 Comm- P .5 - 2 - Li m 7 vl o t / �/c u�kl _S cl cc�i nc�e rs IL ly, _.... - -_ - �rl . J . f o to b Q S14A 'FeNce �> id t F ' �....� � S.) Su,�� --cam `�1• r� C W c O e x to f l U t / p lc CA/k/ _S cl ccJ/ ncle r,,5 emu. �. - . - . - - _ AM/ y Q,e 1jur�e a o ,g _ 3x81 SV y � X15.1 t Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Build)ngs in accordance with Comm 85, Wes. Adm. Code Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must C ounty !C )nclude, W not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. � n percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print aH information. R �' _ Date Pemonw irdormetion you pr'ovkle may be used fi nm dwy tA 5.04 (i) (m))• Property owner % 3ud 30 Gt Ludt W t „j 1/4 1/4 S' T t} N R 4 0 E( W 1 1 Property owners Mailing Address 0 i 2003 # Block # 1 A " o pate . Zip Code U Ny 13 vi T west Road ZONING OFFICE i New Construction Use : Residential / Number of bedrooms Code derived design flow rate `�'.lyd GPD ❑ Replacement ❑ Punic or commercial - Describe: L — Parent material oa ikiod elevation if applicable 1� fL General comments 51 5- and reoorrrrrerndations: S y G 1 �� (-aY`� a# �. q M Pit Ground surface elev. l �' fc Depth tD ww" fadar In. Sod Applicellon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G PDW In. Munsed Qu. Sz. Corti. Color Gr. Sz. Sh. 'E111#1 'Eff#2 I -1 Z 0j q a7 ® Borin g # Boring R Pit Ground s urface elmr. ft Depth to limiting factor '� v in. SON � Horizon Depth Dominant Redox Description Texture Structure Consistence Boundary Roots GPDW In. Mu nsed Qu. Sz. Cont. Color Gr. Sz. Sh. *EW1 *E f#2 4i w 3 av I D r y� _ S C� 1 - 4 rn a h u -7 �- z Effluent #1= BM 8 :1 , 30 228 mglL and TSS >30 _< 15r , ' Effluent #2 = BOD <_ 30 mglL and TSS <_ 30 mg1L CST Number Address T Date Evaluation Conducted eleplione /ova �P1td? s O) -7 a sr�• Property Owner Parcel ID # Page 2, of ng # ❑ Boring 3 0-pit Ground surface elev. ft. Depth to limiting factor I� Sop Application Rate Horizon Depth Dantnard Color Redox Description Texture Structure Consistence Boundary Rook GPDff In. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. 'E01 'Eff#2 0"1'L Colo- 3 �Z r 5L 2rn r 01 F r CS Zri'l r5 z A s LL w if . 13 O v y — S O, ► a n a � /.2 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor n. Sol Application Rate Horizon Depth Dondnard Color Redox Description Texture Structure Consistence Boundary Roots GPDW In. Munsell Qu. Sz. Court. Color Gr. Sz Sh. 'Eff#'I •0102 Boring F # ng D Pit Ground surface elev. ft. Depth to knifing factor n. Sap Rate Horizon Depth Dominant Color Redox DescripbOn- Texture Structure Consistence Boundary Roots GPD1fF In. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Effluent #1 = BOD, > 30 < 220 rng& and TSS >30 1150 mg& • Effluent #2 = BOD, _< 30 mgA. and TSS < 30 nVL 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. seo -U300t W) Soil Test Plot Plan Projedt Name David Railsback Sha ird Address 845 133rd Ave New Richmond Wi 54017 M #226900 Lot 2 Subdivision Date X'1 2/12/02 SW/NW 1 /4SW /N W 1 /4S 30/31 T 30 N/R 18 W Township Richmond ❑ Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 95.1/90.0 *HRpSame as Benchmark Alt. BM Top of Steel Fence Post @ 104.0' 179' Property Line a ote: Tested area may not suitable for desired building area. Check system location before excavating. Soil test was done to satis Zoning Requirement. 207' B -1 * Alt. 12% B.M. B.M. SLope 45' 60' -3 3 ' 394' Property 423' Property Line Line 45' B -2 95' 97' 99' � J Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number Number of B edrooms Design Flow - Peak (gpd) ( Estimated Flow - Average (gpd) 3 S Septic Tank Capacity (gal) I 4 Soil Absorption Component Size (ft U Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) boo 97b Maximum Influent Particle Size (in) f 1/8 Maximum BOD (m /L) 7;a o 220 Maximum TSS (mg /L) I SO 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once eve 3 ye Outlet Filter Inspect once a year and dean at least onq 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the l Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or Impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 y Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep- rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. When system fails, we will replace with another system at owner's expense. Alternate area must be left undisturbed. St Croix County Zoning Office 386 -4680 Boumeester & Sons Excavating 386 -9020 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND C OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address _ f 6 fh Property Address d /. � � (V � e � rification required from Planning Department for new construction) City/State -A cXs?AILI� _T Parcel Identification Number LEGAL DESCRIPTION Property Location A/ %,, sw '/.,Sec. 0 , T *> N -R i`� W, Town of_: Ee_ Subdivision c S n Lo Lot # _C2 Certified Survey Map # _ , Volume , Page # Warranty Deed # !_YJ f Volume 191R , Page # Spec house ❑ yes )V� no Lot lines identifiable N yes ❑ no SYSTEM hAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of in out the septic tank eve three ears or sooner, if needed a licensed um P�►P g eP every b pumper. What you put into the Y � Y P P Y P 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 master plumber, journeyman plumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal 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 req n ments 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 Zoning Office within 30 . days of the three year expiration date. 157 e 3 SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION 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. SIGNATURE OF APPLICANT DATE * * * * ** 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 J 1913 511 i1 t�82976 STATE BAR OF WISCONSIN FORM 2 -1999 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX Co., MI This Deed, made between David H_.__R_ ailsback, 11, and Arlo J. RE RD Rail sback, hus ban d and wife, 06 -28 72002 10 :30 AM __ -- - -_ - WARRANTY DEED ------ -. -._— ___. EXDPT # Grantor, and Eric S. Nola and Samantha R. M illigan . as REC FEE: 11.00 joint tenants _. TRANS FEE: 201.00 COPY FEE: — " -- — - - -- CERT COPY FEE: _T PAGES: AGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix _ County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area of 2, Bass DPin.s, n of S t. Joseph, St. Croix County, Wisconsin. Name and Return Address Edina Realty Title 400 S. 2nd St., #116 �a Hudson, WI 54016 Q t Parcel Identification Number (PIN) This is not _ homestead property. pi) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this 4" day of June 2002 —�yi -- - - -- + Davi H. Railsback, II : - -- + Arla J. Rail ck AUTHENTICATION ACKNOWLEDGMENT Signature(s) David H. Rai 11, and A J. Railsback, STATE OF WISCONSIN ) husba and wife, - ) ss. - -- — - County ) authenticat d this, day of June 2002 � - 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 0 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland_ Notary Public, State of Wisconsin Hudso WI 54016 _ 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 printed below their signature. No m.tion P,a...roda. company. Fond W L... Wi STATE BAR OF WISCONSIN WO-665 WARRANTY DEED FORM No.2 - 1999 1 V l OZ0 0 I � 1 fn OD CA J I 0) �_ I I CJ� ' CA co n w W 1 rn CA G � tJf O CA n O to m N v 4 W Cn to (A �o � Cy 'C i 1 �r 1� S •� • •� •••'•.•• �w p i 1= a' I I r I F ` I I IC 35 02• J 1 N IF Z 00 IC U1 -- v J 1 C) 0 4' O O / x. z w � � p C�7� in ;6 A 0 • - - -- I - - -- • ` r '� O p N N Fri UI rn \ 1 to V1 D 1 W a ha z rn S'8 48 0 . 6 6 I N IJI y : m I W �S gS. ! Rl`� I I 5 44 io : 6 S 'l,• I ti, m I i 1 ' 50 = I -� J ~ N F I I 7 . m p \ t�D I I I N Z 4 Co I I D m i - 8 1.03 ; I' ?? 3p 3 "' o r W m Z : j 9 _\ \ 8\ 3 y �+ ? O mD v �' 48 ` �• O O i I I I I N O r'AN f �/ 33' ! / v m p r: ` Aj s , / A ic in O - -- `� 1�•� ?W` : £� ?`���'� ,`v '�/ ��? O / - -102. ;r' � S03'22 "W 286.23' � I 6 3$, u _ 46.69 �/ 0�' , • l —, ..: W / ��• / �o y I S00'11 28 W 4$7 �$, \` 84.11' w 1 • I >� Y � �.� >A N �v 1 •W N A � 1 Co v , , O �.••' D rn � ! / �.�• m z rn ,s' / z Z > �C � S14 38'48 " ` to OD m Z . ao l o Wisconsin Department of Commerce SOIL AND SITE EVALUATION Divisiogof Safety and Buildings Page of Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must Cou n 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. Parcel I.D. # APPLICANT INFORMATION - Please print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ` Z -- 2 o Property Owner Property Location Ar( Gam► ` 6 Govt. Lot � 1/4 <� 1/4,S a�T 3 ,N,R q E (or& Property Own s Mailing Address 7 Lot # I BI xk# I Sufxi. Name or M# i City to , Zip Code Phone Number ❑ Ci ty Village & Town Nearest Rod( ❑ + . 83 r-J 13 � �cQ X New Construction Use: Residential /Number of bedrooms — Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow gpd Recommended design loading rate 7 bed, gpd/it gpd/fl Absorption area required ,• bed, ft2�trench, I t p q ��3 Maxi , g um design loading rate bed, gpd/f1 trench n > � r Recommended infiltration surface elevations) /'y f7` /i ft as referred to site plan benchmark �.,- Additional design /site considerations Aftie Parent material Flood plain elevation, if applicable ti //¢ ft S = Suitable for system Conventional t Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system S❑ U S❑ U S U 1 0S ❑ U I [:]S, U [I ( v SOIL DESCRIPTION REPORT Boris # Horizon Depth Dominant Color Mottles Structure GPD /ft Boring Texture Consistence Boundary Roots ;. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 13 L Ground elev. - 4 Depth to ti'F limiting r'3 _,(, actor Remarks: Boring # 7 Ground Gr ft. fCl•Z q I Depth to limiting ? 7� fctr � n. Remarks: CST Name (Please Print) lure Telephone No. _ _S �t.. �� . 7/�S X d o2 i/ � Address Date CST Number � 2 s 6- Y- 61 IV SOIL DESCRIPTION REPORT PRGf'EfY JWNE Page of PARCEL I.D. Borin # Horizon Depth Dominant Color Mottles Structure 2 � Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 6 Ground L r i � ele Depth to -- limiting factor — "- Remarks: Boring # e � 3 — ✓ ,� /f /ff i O Ground Depth to limiting Y� Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 j in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring ; l t 4 Ground v� Depth to limiting facto � 5 Remarks: Boring # .......................... Ground elev. ft. ' Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) w r Soil Test Plot Pla Project Name Dave and Arla Railsback Sha ird Address 845 133rd Ave 4�21 N Richmond Wi 54017 CSTM #226900 Lot c> Subdivision Date 6/4/99 NW 1 /4 1/4S T 3 0 N/R 1 9 W TownshipSt. Joseph ❑ Boring ()Well PL Property Line County S T. C R O IX BM or VRP Assume Elevation 100 ft of Steel Fence Post with Orange Ribbon System Elevation 9 /, b l * H R P Same as Be n c hm a rk Alt. BM T op of Nail in Tree with Orange Ribbon @ 100.7 Soil Test done to satisfy zoning requirements, may not be suitable for buyers desired building site. 8=4. 30' r R , p A I A 60' $.3. 0' 2% Slope ' Alt. N " B-5 30' B -1 r 354' 130' Property Line 350' Pro Town Road