HomeMy WebLinkAbout032-2114-70-000 � 1
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County -
Safety afld 80dings Division,
INSPECTION REPORT St. Croix
GENERAL INFORMATION (ATTACH TO PERMIT) SanitarK Permit No.:
Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)). 370325
Permit Holder's Name: ❑ City ❑ Village JE] State Plan ID No.:
Somerset Townshi
CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax Nn
1 070 10(-) 1 C ST
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic w Benchmark Z.ZX 1 0221 l
Dosing Alt. BM 3.5- qy-
Aeration Bldg. Sewer I 97,
Holding St / Ht Inlet
ti TANK SETBACK INFORMATION St/ Ht outlet
TANK TO P / L WELL BLDG. Air ir l to ntake ROAD Dt Inlet
A I
Septic 1, Z. $ ✓ NA Dt Bottom i
Dosing NA Header / Man. 0, L c k z, O /
Aeration NA Dist. Pipe 10. 4 1 Zo /
IT 93 e?o Holding Bot. System - 1 I I'9 y jr
PUMP/ SIPHON INFORMATION Final Grade 1 .7 9t/,5
Manufacturer Demand 3.?3
Model Number GPM � I /f� 92.a3
TDH I Lift Friction System TDH Ft /O. jp C j ' / sS 3
Forcemain Length Dia. mead Dist. To Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width ,, Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 �'' �v` DIMENSION
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manu acturer:
SETBACK CHAMBER
INFORMATION Type OA Moe Number:
syste 3� 35�� S '' OR UNIT
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s) x Hole Size x Hoe Spacing Vent To Air Intake
Length Dia. �_ Length Dia. � -
_ Spacing ' �
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 a /Trench Edges Topsoil E] Yes ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
Inspection #1: b/ t P ( Inspection #2: 1/
Location: 2345 53rd Street, Somerset, WI 54025 (NE 1/4 SW 1/4 3 T31N R19W) - 0331191055 Meadowoods -Lot 7
1.) Alt BM Description = - i6 p v � 5� ( I — waj4e -n � - pW Corny yt ' R
2.) Bldg sewer length= 12. S ill1��
- amount of cover =
4n t r W � N lM ii�t L` C .�4�it n fV
' PI n p revlslo a �r es �gJ No
Use other side for additional information. D /
SBD -6710 (R.3/97) Date Inspecto ' Signature ert. No.
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— 1000 �S
C2 • �- � S
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A LP i% ic9� flevue for ='r 7 ^ o o woozu
-1 W-- 2 34 5- 93 S , Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave.
See reverse side for instructions for completing this application PO Box 7302
I Y A "sconsin Personal information you provide may be used for secondary purposes Madison, WI 53707-7302
Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not
state owned.
Attach complete plans to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size.
Count �� t /� V State ,I;tary e it Number Check if revision to previous application State Plan I. D. Number
`51 ---- --
I. Application Information - Please Print all Information _ - - .. Location:
Property Owner Name Property Location
I14 1/4, S 3 T 33,N, R or
Property Owner's Mailing Address ', of Number Block Number
City, State Zip Code Phone Nu]gbgr n Subdivision Name or CSM Number
G( 5 O t ( T E
II. Type of Building: (check one) d City
9 1 or 2 Family Dwelling -No. of Bedrooms : 3 � ZONt+� (Df F-1Gf ❑ Village
❑ Public /Commercial (describe use):_ Z Town of
❑ State -Owned E �T
Nearest Road
7 r K Parcel Tax Number(s)
III. T ype of Permit: Check only one box on line A. Check box on line B if applicable
A) 1. JQ New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to
System System Tank Only Existing System
B) Petruft Number Date Issued
A Sanitary Permit was previously issued ✓ k ✓ 00
IV. Type of POWT System: (Check all that apply) ' ltYO
@)Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
• Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
• At-grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
V. Dispersal/Treatment Area Information:
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade
Elevation
Required Proposed Rate (GalsJday /sq. ft.) (Min ✓inch)
_ Vol s y
SD 377,eja . " 9
VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks I Tanks
p hF
VIII. Responsibility Statement
I, the undersigned, assume responsibility for installation of the POWTS shown on hed plans.
Plumber's Name (print) Pl is Signature (no stamps) RS No. Business Phone Number
T /
Plumber's Address (Srmet, City, State, Zip Code)
58 — ,,- — Z
IX. County /Departm t Use Only
[ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Iss ing Agent Si ature (No stamps)
Approved ❑ Owner Given Initial Adverse Surch a Fee
Determination
X. Conditions of Approval /Reasons for Disapproval:
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1029
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page t of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Tom Schmitt
Attach complete site plan on paper nod lesstfian 8 it ches in size. Plan must County
. St. Croix
include, but not limited to: vertical and horizontal referent e,p, (BM), direction and
percent slope, scale or dimemsions, north arrow, and location istance to nearest road. Parcel I.D.
032- 2114 -70
Please pr/nta/An anon - .' ,.
., s r - viewed B Date
Personal information you provide may be t�¢cbit8ary purposes (PrivacjLaw, s. 15.04 (1) (m)).
Property Owner Property Location
::.
M& G Inc r r r; Govt. �lG Lot NE 1l4 SW 1/4 S 3 T 33 NR 19 W
Property Owner's Mailing A ress 5� t`< Lot # Block # Subd. Name or CSM#
N
�,0�
1359 Awatukee Trail �, s� 7 Meadowoods
City tate Zip a Phone Kumbpr ' City J Village V Town Nearest Road
Hudson j 54016 M-5 b - 5971 Somerset 531Rd St.
bel New Construction Use: VI Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
J Replacement J Public or commercial - Describe:
Parent material Outwash Plain Flood plain elevation, if applicable na
General comments
and recommendations: Site suitable for a conventional system. System elevations based on a 9% slope. Area I (high trench)
90.80' (low trench) 90.00'. Area II (high trench) 88.10' (low) 87.30'.
a Boring # J Boring
e Pit Ground Surface elev. 94.72 ft. Depth to limiting factor >112 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fV
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -12 1Oyr3/1 none sit 2mgr mfr cs 3m .5 .8
2 12 -20 1Oyr3/4 none I 2fsbk mfr gw 2m .5 .8
3 20 -31 1Oyr4/4 none I 2msbk mfr gw 1f .5 .8
4 31 -36 1Oyr4/4 none sl 2msbk mfr gw - - -- .5 .9
a�00 tq� �'t3
a 5 36 -44 7.5yr4/4 none Is 1 msbk mvfr gw - - - - -- .7 1.2
4 +0 ff 6 44 -112 1 14 none ms Osg ml - - -- - - - - -- .7 1.2
Boring # J Boring
✓j Pit Ground Surface elev. 96.37 ft. Depth to limiting factor >117 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 1Oyr3/1 none sil 2mgr mfr cs 3m .5 .8
2 8 -28 1Oyr4/4 none I 2msbk mfr gw 2m .5 .8
3 28 -45 7.5yr4/4 none grsl 2msbk mfr cw 1f .5 .9
4 45 -58 7.5yr4/4 none Is 1 msbk mvfr gw .7 1.2
X0 5 58 -112 1Oyr5/4 none ms Osg ml - - -- - - - - -- .7 1.2
* Effluent #1 = BOD? 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD 130 mg/L and TSS < 30 mg /L
CST Name (Please Print) Signature: _ CST Number
Thomas J. Schmitt 227429
Address Tom Schmitt Date Evaluation Conducted Telephone Number
586 Valley View Trail, Somerset, W1 54025 1/27/01 715- 549 -6651
Property Owner M & G Inc Parcel ID # 032 - 2114 -70 Page 2 of 3
F Boring # Boring Lej Pit Ground Surface elev. 91.94 ft. Depth to limiting factor > 105 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -7 10yr312 none SO 2mgr mfr cs 2m .5 .8
2 7 -28 10yr4 /4 none sil 2msbk mfr cw 2m .5 .8
3 28 -44 10yr4 /6 none I 2msbk mfr cw 1f .5 .8
4 44 -71 7.5yr414 none Is 1msbk mvfr gw - - - - -- .7 1.2
S 71 -105 10yr5 /4 none ms Osg ml - - -- - - - - -- .7 1.2
r Borin
Boring # g
F 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
F-1 Boring # Boring
Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BOD 5> 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 - BOD < 30 mg /L and TSS <30 mg /L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
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Safe & Build Division
Sanitary Permit Applic - -_, �' g
In accord with Comm 83.21, Cidb /"" /' 201 W. Washington Ave.
N181sconsin See reverse side for instructions for o l t is appli�gr�, PO Box 7302
Personal information you provide ma l d for send purl Madison, WI 53707-7302
Department ofrCommerce [privacy Law, 1 (1)( �wf \ � (Submit completed form to county if not
G state owned.
Attach complete plans to the county copy only) f4kio system, on paper not 1 tha - 112 x 11 inches in size.
County State Sanitary Permit Number ❑ Z if revisiorUo pSe�ius do State Plan I. D. Number
C , ! r- -,
I. Application Information - Please Print all Information S'I ocation:
Property Owner Name � i ° ro Location
114
_SUjII4, S 3 T33,N, R or
Property Owner's Mailing Address T t; Lot Number Block Number
City, State Zip Code Phone Number Subdivision Name or CSM Number
f D S
II. Type of Building: (check one) eu a� r. '^"` p c
il
1 or 2 Family Dwelling -No. of Bedrooms : e _ s g
C1 Public /Commercial (describe use):_ ' f XTown of
❑ State -Owned
Nearest Road
.`� 3 kjO S
!p t CAS a Parcel TaxNumber(s)
III. T ype of Permit: Check only one box on line A. Check box on line B if applicable) _01. 1 7 1 1.
A) 1. E New 2. ❑ Replacement 3. ❑ Replacement of 4, 5. 6. ❑ Addition to
System System Tank Only Existing System
B) Permit Number Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply)
00 Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
• Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
• At-grade ❑ Aerobic Tre4ftnent Unit ❑ Recirculating ❑ Other:
V. Dispersal/Treatment Area Information: • Z
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. 7 Application 5. Percolation Rate 6. System Elevation 7. Final Grade
Required Proposed Rate (Gi(siday /sq. ft.) (Min./inch) Elevation
i
VII. Tank Capacity in Total # of Manufacturer Prefab Site ; Steel Fiber- Plastic
Information Gallons Gallons Tanks Con- Con- glass
New Existing crete structed
Tanks Tanks 11 El 13
� Oov
VIII. Responsibility Statement
1, the undersigned, assume resp onsibilityfar installation of the POWTS shown d Plans.
Plumber's Name (print) Plu Signature (no stamps): Business Phone Number
01 r s -5 Y G6S/
Plumber's Address (Street, City, State, Zip Code)
r .r
L
IX. County /Department Use Only
❑ Disapproved I Sanitary Permit Fee (Includes Groundwater Date Issued i Issuing Agent Signature (No stamps)
)T—Approved ❑ Owner Given Initial Adverse harge Fee) 2 `
Determination a ' Z
X. Conditions of Approval /Reasons for 04approval., l&A&>U1 I
Z L� 4 4- S js�-. -
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vtlisconsin'Department of Commerce SOIL AND SITE EVALUATION
&Rion of 3afetyand Buildings - Page 1 of 3
Bureau o'!?ntegrated Services in accordance with S. ILHR.$3 Q9, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size'yai9 must n
include, but not limited to: vertical and horizontal reference point (BM) 4itrecleon and ,.`4:St . Croix
percent slope, scale or dimensions, north arrow, and location and distrreeo near�stt?� ' Parcel .D. #
E ,
APPLICANT INFORMATION - Please print all information.'' % ' a I.F Reviewed by Date
Personal information you provide may be used for secondary purposes (PrivacAur ,�S. 15.04
Property Owner �f9R; bqq�
Richard Stout ��� `Govt. Lot NE 1/4 SW 1/4,S 3 T 33 ,N 9 E (or:iW
Property Owner's Mailing Address Lot,°# � . Block# ,. „ ubd. Name or CSM#
1353 Awatukee Trail Meadowoods
City State Zip Code Phone Number ❑ City ❑ Village :E] Town Nearest Road
Hudson i 14016 (715 549 -6731 Somerset 232nd Ave
® New Construction Use: ® Residential / Number of bedrooms 4 Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow 600 gpd Recommended design loading rate ' 7 bed, gpd/ft ' _ trench, gpd/ft
Absorption area required egg? bed, ft 750 trench, ft Maximum design loading rate • 7 bed, gpd /ft • 8 trench, gpd/ft
Recommended infiltration surface elevation(s) See plot plan ft (as referred to site plan benchmark)
Additional design /site considerations
Parent material CNC 2 Flood plain elevation, if applicable ft
S = Suitable for system Conventional' Mound In- Ground Pressure AT -Grade System in Fill Holding Tank
U = Unsuitable for system [RS ❑ U 0 S ED 5d S ❑ U] S❑ U ❑ S ® U ❑ S [0 U
SOIL DESCRIPTION REPORT
Boren # Horizon Depth Dominant Color Mottles Structure GPD /ft
9 Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
2 1 10-40 10yr4/6 -- sicl mfi cs -- .4; .5
Ground 3 40-E9 10yr4/4 -- ms osg ml cs -- .7..8
elev.
9 6 _8-0-ft. �—
Depth to
? -70
limiting . Z �3.
factor
--8g_
Remarks:
Boring #
1 0 -1 1 0 r4 3 -- sil 1 YnA*I( mfr cs if .5 .6
2 2 12-- 1 0yr4 /6 -- sicl 2 jn a�K mf i cs -- .4 � . 5
3 39-E2 10yr4/4 -- ms osg ml cs -- .7 -.8
Ground
elev.
9 6 ._0 —ft•
Depth to
limiting
factor
—B-2- Remarks:
CST Name (Please Print) Sign ture Telephone No.
3 —
Address Date CST Number
1U7� Sc�� 4,c �,�
Richard Stout
PROPERTY OWNER SOIL DESCRIPTION REPORT
Page —_ of
PARCEL I.D.# r
Boris # Horizon Depth Dominant Color Mottles Structure 2
Boring Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
3 1 0-10 10yr4/3 -- sil 1PPAbk mfr cs if .5 '.6
2 10-50 10yr4/6 -- sicl 2:h24,6k mfi cs -- .4 ;.5
Ground
elev. 3 50 -95 1 r
— —
95 ft.
Depth to
limiting
factor
9 5 in.
Remarks:
Boring #
4 2 8 -6 -- Nsa6K ,
3 60 -109 10 r4/4 MS os
Ground
elev.
95 ft. o af 42 -�� af�lo.fie�
Depth to
limiting
factor
1 09 in.
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 #
1 0- - - y�►� �jrC
5 2 9 -55 10yr4/6 -- sicl 2:bf mfi
r 3 55 -100 10 r4 4 --
Ground
elev. —
9 6 . — ft.
i
W imp
Depth to a
limiting
factor
1 in. Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
in ' Remarks:
SBD -8330 (R. 07/96)
"•P Richard Stout SOIL DESCRIPTION REPORT Page
PARCEL LDI
Boris # Horizon Depth Dominant Color Mottles Structure 2
Boring in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench
�
S 3 ,= 1 0 -1 10yr4/3 -- sil '_XANl mfr CS 1f .5 '.6
2 1 10-50 10yr4/6 -- sicl 24414,6k mfi CS -- .4 ,.5
Ground 3 50- 5 1 -
elev.
95 .20 ft.
Depth to
limiting
factor
9 5 in.
Remarks:
Boring #
4 2 8- -- " N o'bA
3 60 -109 10 r4/4 Ms os --
Ground
elev.
9 5 .3 0 ft.
Depth to
limiting
1
Q - 9 — in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots PD /4
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring # 1 1 0 - 9 ,
2 9 -55 10yr4/6 Sicl L 2. e�,
6�f mf' --
3 ;
55 -100 10 r4 4 - :7 -
Ground
elev.
9 6 . -Q-- ft.
Depth to
limiting
factor
1 in. Remarks:
Boring #
[3
Ground
elev.
Depth to
limiting
factor
in ' Remarks:
SBD -8330 (R. 07/96)
s moo 7
!� me n, r
s ys re /y�
Zl/ r
i
i
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m
153 • ('�� �-. ; n 2.
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F
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 �O
Number of Bedrooms
Design Flow - Peak (gpd)
Estimated Flow - Average (gpd) oD
Septic Tank Capacity (gal) (cro - V
Soil Absorption Component Size (ft') - - 3_ 42 z I aver
Type of Wastewater Domestic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absorption Component
Design Flow - Peak (gpd) t 0'&0 �� Z
Maximum Influent Particle Size (in) 1/8
Maximum BOD (mg /L) 220
Maximum TSS (mg /L) 150
Table 3: Maintenance Schedule
Septic Tank Inspect and /or service once every 3 years
Outlet Filter Inspect once a year and clean at least once every 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, Stats. 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 sepf d outlet filter shall be assessed at least
once every 3 years by inspection. The utlet fi all be cleaned aG nerc?scary to ensure
pro ion,. 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
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 113 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 POINTS 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
Management Plan for a Septic Tank and Soil Absorption Component
Plantings s of deep-rooted trees and shrubs directly over or within to n feet of the
component should be avoided since root intrusion into the component may obstruct wastewater
flow.
3
III
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer N\
Mailing Address 13`�`� �w'��r. -�� 'C V,os��
Property Address S�
(Verification required from Planning Department for new construction)
City /State SOxv'g-j 5LT Parcel Identification Number (?3� " SL 11`�� • "?c?
LEGAL DESCRIPTION
Property Location J-4-_ ` / <, 5�Q Y<, Sec. T_3aN -R —[�L-W, Town of SQ M1 Y SQT
Subdivision 'M A OO W 0 0 D � , Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # C93v6 , Volume Page # a
Spec house R yes ❑ no . Lot lines identifiable yes ❑ no
SYSTEM AlA.INTENANCE
Improper` use and maintenanccof your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of- pumping out the septic tank every three years or sooner, if needed.by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber 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 113 full of sludge.
Uwe, thti undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days o he ee yea expiration date.
1 0 1
SI ATURE 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 pro rty d scri be above, by virtue of a warranty deed recorded in Register of Deeds Office.
SI ATURE F 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
10/11/00 WED 07:28 FAX 715 386 4687 .4EGISTER OF DEEDS ljpp'1
VOL 1549P.AGt 562
a STATE BAR or. WJSCONSIN FORM 2 - 1998 ; 6_ 3L M 14
WARRANTY D EED ,i KATHLEEIq H. WALSH
( REGISTER OF DEEDS
Dooumerri Number ST.. CROI:X CO-, UI
This Deed, made between RECEIVED FOR RECORD .._.: _.. II
_. .
li i
RICHARD O STOUT and _' > ,NET P _ S OUT{ 14 -34 2444 14:44 Rte
husband and wife, WARRANTY DEED
i - - - - -- raptor,
EX EM P T C O PY G CE PT 4 FEE:
! and —�
TRANSFER 12420
1 RECORDING fEEII 10.04
Gr
.... ee, a . PAGES: 1
�' ----- - - - - -- -- 'r
Grantor, for a valuable consideration, c ;nveys and warrants to rrwtee the following
j� described real estate in 5t . C ro ix Gounty, �wte of'IVisconsin: it
Recoidino Araa
Lot 7, Plat of Meadowc'ods, Town of Somerset,
:Name and Return Aod,ess
St. Cr oix County, W].$ "C7RSiri.
l
i �- It�p�dN wt S.�ottc
432- 211_4 -70 - 000
Parcel Identificatio> Numper (PIN)
This_.. 5.._not_.homestead peoporty.
(is) (is not)
!
�I
I
(
I�
I! i
1' i!
I
it
!r
I� iI
Exceptions to warranti ease meltt restrictions,, rights -of -tray and covenants
'I
of record. j
�I Dated this Sth day of Octc ,;-- _-2_00 .0__... j
C �
i
_ . .... (SEAL) (SEAL)
i!
Richa O. Stou Janet P. Stout
i (5E ,L) (SEAL,) i
if ,!
AUTHENTICATION ACKNOWLEDGMENT
Signatures) — --- State of Wisconsin.
xs. �
St. Croix -
— County. �•
at this — day of _ . Personally came before me this 5th day of !
2 0 0 0 , the above named �
— _ Richard 0 ,Strut a ja—
,P..�:._S tnu t h
TITLE: MEMBER STATE BAR OF Vl'1SCONSIN ` ... to
(If not, me known to be the person 9 _ who executed the foregoing
authorized by §706.06, EVis. Stars.) ECKiRYL ,..,,,. insuument and acknowledge the same.
I: C08 —eN
Natal, Fu1JiIC
THIS IN WAS RAFTED i3Y t@ of
Janet P.To ............:«a,..,�....
1353 AWatukee Tr.
9 P� co ^sin
f .. -,. _..__....._.. it
�Ut380n, Notary Public, arc of s
M• commissio a c,•srra:sent• I. Clot state expiration date.
(Signatures may be authenticated or acknowledged, 3, th are not
i necessary,)
Names or persons sipn!ng in any eapaciry roust be rypr.-d or printed wio, thctr slpawm i
STATE DAR OF WISCONOIN Wisconsin LWA1 Blank co- Inc. �I
WARRANTY DEED FORM No. 2 - 1998 Milw fukcr, Wi::.
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