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HomeMy WebLinkAbout032-2142-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 399579 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: P.C. Collova Builders, Inc. I Somerset Township 032- 2142 -50 -000 CST BM Elev: Insp. BM Elev: BM Description: Ion I /&d -/ TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic d o Benchmark S D Alt. BM era i Bldg. Sewer Q/ Z (4; Holdi S Ht Inlet �6 z Q,3 TANK SETBACK INFORMATION ! t Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic i Dt Bottom Header /Man. 9 s7 Aeration Dist. Pipe 'L H mg Bot. System Il , 9a PUMP /SIPHON INFORMATION Final Grade P— k �/ Manufacturer Demand St Cover Model Number TDH Li Friction Loss S m Head TDH F F rcemain Length Dia. Dist. to SOIL ABSORPTION SYSTEM LQ� BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 / SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufact rer INFORMATION MB OR = / Type Of System: Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake A N Pipe(s) Length 9 Dia / Lengths Dia / Spacin — SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded Mulched Bed/rrench Center Bed/Trench Edges Topsoil 0 Yes r No 0 Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1( / /-S 0/"' Inspection #2: Location: 2365 53rd Street Somerset, WI 54025 (SE 1/4 NW 1/4 3 T31 R1 9W) Deer Trail Estates Lot Parcel No: 03.31.19.1245 1.) Alt BM Description = +-T C � k,, wa // y'o-i ( Id l q4 4r„.a 2.) Bldg sewer length = 2 `� - amount of ` cover 3.� g�serJGU %n� p,Pcs %h s> /�� AK lkc V4 Plan revision Required? Yes No r te Use other side for additional information. SBD - 6710 (R.3/97) D Insepctor's S nature Cert. N6. Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 NNW See 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) f o system, on paper not less than 8 -1/2 x 11 inches in size. Count State„Sanitary Permit Number IU -heck if revision to previous application State Plan I. D. Number :: 7_ 1�ro j �4_ 1 3 9s_]' I. Application Information - Please Print all Information Location: Property Owner Name Property Location Q is 561 a4, S3 1l ,N, V E (or) Property Owner's Mailing Address Lot Number Block Number Z City, State Zip Code Phone Number Subdivision Name or CSM Number II. Type of Building: (check one) ❑ City or 2 Family Dwelling - No. of Bedroom ❑Village 110 • Public /Commercial (describe use):_ `' Z. Town of ❑State -Owned —��` I RV , r A.-,- C r 1 Nearest Road fib Pazcel3Ou`�-� -J F° 3. 3 . S' III. Type of P rmit: (Check only one box k line A. Check lto ; on line plicable) / A) 1. ew 2. ❑ Replacement ❑ Replace nY' 4. 5. 6. ❑ Addition to System System ank Only Existing System Pe $) rmit Numberti_, _ Date I sued ❑ A Sanitary Permit was previously issued 3 Z ^ Z L Z IV. ype of POWT System: (Check all that apply) on- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating 0 Other: �XrJ V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. S stem Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) G Elevation 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 ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's ame (print) Plumber's Sign r tamps): MP/MPRS No. Business Phone Number Plumber's Address (Street, City, State, Zip Cod IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) •f!] Approved ❑ Owner Given Initial Adverse Surcharge Fee) n Determination 1 S_o ! /� X. Conditions of Approval /Reasons for Disapproval: 1. Effluent filter to be installed and maintained per manufacturer's recommendations. 2. This revision was submitted to reflect a change in system location. 3. This revision/transfer was submitted to reflect a change in plumber. SBD -6398 (R. 07/00) PLO PLAN PROJTCT P.C. Collova Builders Inc. DRESS 705 Ctv Rd E Hudson Wi 54016 SE 1/4 NW 1/4s 3 /T 31 N/ 19 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/24/01 BEDROOM 3 CONVENTIONAL )OOC IN -GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 377 # of chambers 22 IL BENCHMARK V.R.P. Top of Nail in Tree ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL +H. R. P. Same as Benchmark SYSTEM ELEVATION 89.4/89.0 345' Property Line Pro 3 Bedroom House J ts 5 25' B - 1 75' Plans Designed Using Conventional Powts Vents Manual Version 2.0 3% B -3 35' Vent Slope > 12" Sidewinder High of Cover Capacity Leaching 2 -3' X 69' Cells Chamber with >3' Spacing 6' Long 16" 3 4" Grade at System Elevation a� r a 1~ w a 0 N ' M Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of-3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. ZRei ed y Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 'r Property Owner Property Location 4 � Govt. Lot S_ 1 /4,t f LAJ 1 /4 S 3> T 3/ N R E (or) IV Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 7O S' c d C - V't Y- City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road ® New Construction Use: ® Residential / Number of bedrooms 3 ' `� Code derived design flow rate 527 ��� D O GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material 1 o PYam e iat if;p icable til ft General comments 5�/S� r✓l GIe- ��, 3 O '� and recommendations: ' � ` �Q 3 d 11 ,I a �C P t- R msS x F-1 I Boring # ❑Boring "C OUly7y g ® Pit Ground surface elev. 9�i! d ft. �, Depth t G mFftkactor 1_ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF in. Munsell Qu. Sz. Cont. Color Gi�: -6h-' 'Eff#1 'Eff#2 I -12 /0 33 s;i 2 f � 2c -5 Z . /o yr 3 Si I 2 r 5 I 5 3 -116 III r3 Lio rn :7 S m l — — - 1• Z 2 Boring # I ❑ Boring p LrF Pit Ground surface elev. ft. Depth to limiting factor �d O 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 I ��2 •I m c 5 Lr ryi c 5 '4 ' mS rn ' Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name (Please Print) ignature CST Number 46�a a - Z.S3 Address Date Evaluation Conducted Telephone Number r— Prop;rty Owner �� �h ��i�– Parcel ID # Page 2- of -2 F] Boring ❑ Boring # ®' Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 6-11 10 3- — S i r cS Z c 5 2 11 l W — )< �' c S E 1a10� 5a 5`f o F-1 Boring # 11 El • ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil A pplication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F -1 El Boring Boring # 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 GPD /fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD -8330 (R.07 /00) i r3 -� a N4aMZ}ps - ,; , p x .r ..•,.:0.n:" 'K' -`', l,CA'"$'f r;°'S'.`.. - "'.['+N `-�,a�'S e #t' 4 w; „�, .,'.`. i PAGE�OF_ y NAME Cd U U q LOT# O LEGAL DESCRIPTION X X ,S T N.R. E(or)W SCALE: I"= 6 0 l BM 1 ELEVATION NO • G BM 1 DESCRIPTION — X BM 2 ELEVATION 100.0 BM 2 DESCRIPTION K a. f +• 4 1\ 2 O SYSTEM ELEVATION C IO. 30 ALTERNATE ELEVATION 4s c{ . 3 O CONTOUR ELEVATION 93. SO 9y Sc� eCk r • a g,3 SIGNATURE /- ,,, DATE 9 -/ 3 - c/ FR:JM : P C COLLOVA BURS, INC PHONE NO. : 715 549 5911 Feb. 01 2001 07:33AM P1 ST CROIX COUN *ry SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �6 OVA (� n 5 - T.N Mailing Address - 706 01:1 !' d . 161 G v S u v L Property Address (Verification require d from Planning Deparunent for new construction) j City/Stato Identification Number .EGAL DESCRiMT7 N Property Location 5--F— " y., Sec. Town of Subdivision Lot # Certified Survey Map # Volume Page # --- VVimsty Deed # 'V'olume _6 - L ' Page # - 3 ' 3 q Spec houm ❑ Y,,- / lines id / t6a4 � yes ❑ no cl SYSTEM MA I MWANQ Improper use and mainten acc of your septic system could rrsMit iu its prernatt re•faihue to Dandle wastes. propermaintenance consists of pumping out the septic task every three yeas or sooner, if needed by a licensed pumper. What you put into the system an affect dW 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 Verification form, signed by the owner. and by a " ftstrictod plumber or it licensed pumper verifying that (1) the on -site wastewatardigx=l system is in Fir operating condition and/or (2) alter inspection and Pttmping (if accessary), the septic tank is less than 1/3 full of sludge. Vwa, the ttndcrsigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set fortk heroin, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsia. Certification slating mat Your septic system has been maintained must be completed and returned to the St. Croix County Zoning OtTtce within 30 da y ar 'ire ' date. 'CURE OF APPLICANT DATE UWNLR CER'T2T+`I -,�IflN I.(Me) �y that all statements on this form are true to the best of my (our) knowledge. I (we) ant (are) tlse owners) of the ^ abovc7by virtue of a warranty deed recorded in Register of Deeds Office. 1` A_ TM_ _ OF APPLI T ! ! DATE Any information that is =is- represented may result in tie san ry permit being invoked by @ac Zoning Department. "•'••' as Include with awls Apptteatton; a stamped warranty decd from the Register of Deeds Mee a copy of the eartified survey map if reference is made in the warranty decd I r T Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan 1. If system fails, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715 - 246 -4516 Shaun Bird #226900 (16.1 THU 11:13 FAX 715 386 4687 REGISTER OF DEEDS Q002 WARRANTY DEED l M p3 .W - FO 3. 3T K H. UALM DOCUMBWT 140, Vol_ fgal psll,�397 REKSTER OF DEEDS ST. CROIX CO., W1 OECENS FDA REM is This indenture, mAjo this Ch dAy of --qm • 0•.12-20.ID4 9:30 An WARWY DEED y o(ganlxtd Pod exiolinjit under and by virt of 16 lava of the Stoic o(Weicuriln, located at I C I FT UPY FEE: Aul Wworaun Fing , of the first pm and F EE, lders, ;Ua. st Wlq'lks � 1 _qjr %6 FEE 1151. RE IMIND FEI; D36 PA purl iea of The Went Part.. "WilnesnLh, That JIN Add party of the Best pan, for and in consideration of the gum of in it pf-id by the said par I or o f the scc;d PArl. Inc Mmi whnainf is hereby ;mriatiDed and ackrrowkdVd, has given granted, iatyruted, mid, rtin;nd. raleasked, alisialci, conveyed L-Au; Amo A.TuA4 Aoorigot; and conkrnad, and by thaw prellerils does ova, Vana, bargain. sell, t u 4 I Alrdirm unto EV, said gin leg or the at mcd pan, rhnir helm OAKE & 0XICEY TX'X"-E : and mcou bagmr, the following deKr .1 30K 126, Osceola, W1 5020 St. Croix (Lied ra wake. Mv;aed in lific c6amy teal jr kkitil 61 Wkscarwirl, to-VAL Lots 8, 9, 10, 11, 12, 17, 18, 19. 20, and 21 of Cho Plat of Dater trail Beracas, according to thu recorded . .•..... ... .... Plat ou file and of raeoril In the office of the 032 - 2141.x0 -00 ! R49isteT of Deeds. St. Croix County, Witconsia. We 7VER 'Nut 032-2742-20-00 032=2142-30-00 li 032-2142-40-00 032-2142-SC-00 (17 141CYMRY. CONTiNkit wawnoiii oN Paivitasli slob) TOICtIliCr with an 634 11IM&Ii 96 hiartalk;iviena; and appizatsimm thereunto 11ICLODIMS Of to any wLv apperatining and all iLe es tate. r1s"t, thth, i'ttirreol, claim or 44m;nal whill-Poever. Oldie said party of the Hire; pan. tither in law = equity, ekber in powssion or expectan" if, in And ta the above bupiacd promili and their haxidUameralts and appulTetionets. Tv have and 9% held iiii: said prtmzacii as above dvxdbrA vnih the heredumenit and appurtenances, titur flat sAid ;nrt 4 iv­ of the mcnn4 put. and to _.1hLLr_ heirs and assigns ?0"vEa. And the said gQwrkl Varrin, fnr,- piny A the firia, pan, for 4%rj r and its z=fssiois, does coven i ni . grata, bar;ai n an agree to tM with die raid ear, =n or Lha second pan, it theiv Mile and asstgnte. Lhit at the time o the enseahiii; and delivery Ur Lhmsa presents it is oea kitizKa or the premimo abow cicscroed. U eta jtxd. gum, perlitol, aimolafe. and !ndickasible eiwu orlakeritan:ir in the Iniv, in lec mmolki, arid (hat the wme are free Paid Ovirr,um all in= in 6 ilm the - ,k , " 6 rilrained premises in t he qv IN I nd ptieu LIiIii: "L "ic n a nti LhM Said, pan. ,&%_ of the secis e.d part, their hit i - s, and milfiis. agai not c a nd tvitry NT6 Oe PtiAMI IZW(%JIY VWA1 aflA t WhOk Or any part kite Mlor, it wil forever WARRANT And DI: F END. In Wilrm Whereof, iht sold 1 1(cyck!1 Farmc- Ire. pity at the lira Inct, has I*Lstd ilneikeprisianiztzinammudby are KLkowski its i ged ciouatet9iiind by Nrroan Kufrmikki' 4 . 1grmlor. at VAlwonant, and Its Corporate seal IQ be hcrcLnio ati);W this I Art-, day or Ma 0 A.D,.kk ?n 1, is SIGNeD AND STALED IN PUS•NU 00 XoWfiki Farms, I if®rmwo. Its t"I'MIR �.A Rogdar goikowarki COUNTEMONED: A/ ZY Normnn Kialcomas-i- Scale of Wisconsin. 66. wolk IRtSttltDllyrxnr . lcCurc fife, his ..._.J 6th R29*r , Vinsident. and NOMIlin KL14owakl of the 3baka inarnO Cerpornt]"In. to TU YrOV41 W lo;'Ild p-Nora, who executed cric foregoing instrument, pod lb Lau liza Tl W bit wash Pmsi4cnl 1111011. AS koc*ffirielk tt'd I he of said CorTi.rallon, by nA wilionty, % I. 21 Lill ThL$lNr,TRIjN T%VA3CP.,7TE0&v ... t� r Q-nald L. NOTARY SILER, S4. ik& Box I � County, Ws. Post Office N Public, — , 17 MY COMM IIS,M kft pilc;) 031 �4 V _1 . ........ 441woll pftu"I�Iril't . .0 a Lm -Aleolkerli ri iii DMI) -11y CArPAMW, lh&QALi' LOW sane co.. M C p 5TAIE BAR OF WISCONSIN : OR,H 1 - saa, �-�/► 557389 � WA " RRR AAA N y� TY DD �c , Tot DOCUMENT NO. OL 1r..' 0 M E31 — _ . 1 1-7.i:,773 CFF :,G Gerald Shanahan. Patricia MorTia, ST CFO :' < : -r.,V1 Tfii pt'ed, trada ru n.: Dwayne Scl+tefe r b 'ehia Q1bQM and Gary 5chie ieT6etn APR. I l j; ' Kowski Farms, Inc_ a W Co 11:30 !t ',1 __ �,Niinesseth, frtt he ate Gr�t:ur, fur: .aixahle ccn,kle,u,on of one dol lar a oth er good •=Ind valueLb cons de inns ;NI; Sp4CF A SEaVEC "� Nr'= '�'in.r:!1 n,•° S t. Croix , t: \Y)'i Iri IiRL:CY li,t IJIIJ \ \'iP.!; t:ckaikd CCAi r, ylart iR _•_ ' NaMt .w0 +1rTU•14 +.00i f `.i Cattr,ty, �utr . \vihansim The East One -half of the Northwest thtart2r (Ei of MW the Southwast Quarter of the Northwest Quarter (Swa of NW, and the Northwest Quarter of the Southwest t�Jt,. -wr•h' � Quarter OU", of SWO , all Lu Section 3, I31N, R1914; 3 .11.1 9. 3-/3.3 1.T 9. µ0 /. c..�t",F;. OkN Af .,AON IrWFiF 7.31.19.39 & 7R :ER SJ p ( E '- fhm iS not —_ hctncsrcad protxrt; u,l A nc, t':t.;ahrt A'IIh ali ,trtd vt%g -aim tits hereditament.. _nd appuncra:tces therru,uu odwrigi a - A,id — eraIILDL.., _ -- 1 \dttllt!: ihdt dw utle IS p+wd, indarn in fee silY- and free �r.a - tear �d cncambrar.x•. xetpt easements, restrictions and reservations of record; there is a boundary line dispute and there is no warranty of title as to the portion of land shown by the survey stakes that are placed on the prapeet and 'A dl a titan! ind defor.d tilt Ume. '.larch iti 97 ... ._ _ - (SEAL) t7 G erald Shana D%a yne .. Sthief b'dir _ Pa tricia Norris dla 1 ein 7 (SEAL) AUTHENTICAtION A h }' DGM IYT:'t State of W* ,) ASHINGTCN) Benton - + q Personally rarer bclbrc me thol •dzk of un}>l ukatcd ;hs du i +f l c March 97 .. i.. — .._, thS���••t Schfefe — ARV- PUBLIG - -. 111 �1EN13 iAIE TSAR Ur ��ISC01 IN STATE OF WASHINGS. - iti nvl. __ pAV1 GOIAI s who cAC:: tlad the I\ rcbt+inS ,Itldlttra:cd hg $706.JN, \t•u Sro,a) My Appoin�rn �""a JULY V Ow %t to belhe rerson — uut ent and oeknowlcdglr tha same. 1 HIS IhbuiuMfNT WAS pRAFTiFO BY �"-+• _ _ . _- -- LII DVI_G SON & G at :.au • II? w Q1l � — - _ O Wisdon 5+02 N,aan, Pubiw Bent —. __iatnt�:' Wash. AI cornmiwl.tta is oernLntrx llf nut. hate rxpirataat dare: lSt t:anire, 1 111v ba anttwntwned or •cknuwledged. snit afc not Y Y' .. , —..., i .,,. ..,..,,... .n a, ��ad. • +.„it 5: nxu a o„tv =h'aw ,nercjy ... _. ,._ ._. AIL ESTATES artier of the Northwest Ouorter orrd port of the Southeast Ouorter of the Northwest Ouorter hwest Ouorter and port of the Northwest Ouorter of the Southwest Ouorter all in Section I merset, St. Croix County, Wisconsin. i t . 'I11 �W 5081.98'- - --- ` S02 I '30'0 1 1 �� 5 W 2�3J.43' `�J\ 'i UNPLATIED LANDS III 3ea.le 3 &4 321.47 W 2e2K_W " I 1 J M Q I ' I fl i t ......... � ° in I 66 , � � 0� I j I n 1 I 9CZ70 0.3'W 444,47 - Seale'•- — — — — — 34.1 j � v � � k S0290'O8'W 414 S 724.7G' _334.04'— _ — — - - — T': — —+•��, \ \ Z �- 3W. k O 1 j —7e' —_ _ -- _ \` \� W Z �11 1 / `\ / O Te. I 1 l� k •' \ t W 1 j J � 9 � � � � � p, � � ,� '; "nrs,�.rw is n• _\ 't$\ •a� i ... W 1 I \ W ,� a s°2 lib — 1 d r +a 4, A , b N•L 343.93' 1 3917 E 98 E7.E3 i NO2 ,1 �•z3' � y r yz UNPLATTED — LANDS OF OWNER Y� " " " """_ < iG400 -- i - = W < — ___ —_- - -• < O (n J W BE10f N4C( 04TUM - Sf. CRC -.. _-- ....u.. p5 `"4' If�•! ; } I S1'eIEM FFF 3 '�•t.i� fco,'?•... 90-CH MNOf3f N olevetlona pt •Aiys . om Q 1 1 < z OF IRON RvE fan.. M awaa , Vh 0 W IL W EMw9enp of Top of yen Pipe A05 - Cm f Q� � J M I t I 11 j r I NO27e'IY 1 9X f 2ee.P7 1 I JI Win Pill :3 S 881.57 - _ • • o I I I W �� �9 A l l 7§ SHEET 1 OF 3 SHEETS Sanitary Permit Application Safety & Buildings Divi! In accord with Comm 83.2 1. Wis. Adm. Code" 201 W. Washington f k_ onsin See reverse side for instructions for completing this application PO Box 7 Dep or commerce Personal information you provide may be used for secondary purposes adison. WI 53707 -7 (Privacy Law. s. 15.04(I)(m)) (Submit c pleted form to county i1 state own Attach com lete plans to the count co only) for the System, on paper not less than 8 -1/2 x I 1 i s in size. Count), Attach S ' Je rsmit Number O Check if revision to previous application State PI I. D. Number 1. Application Info ation - Please Print all Information L ation: Property Owner Name operty WCJ111o r Property Owner 5 1/4 S T R o* s Mail Lot Number Block UM& 7os d City, State Code Phone Number Subdivision Name or CSM Number 11 Type of Building: (check n g ( k e) D City I or 2 Family Dwelling - No. of B oo 3 — AD D D Village O Public/Commercial (describe use) °s S — .1Q 5 Mown of ❑ State -owned ar. / -- . rL, AAJ�L� III Type of Permit: (Check only one box on li A. Check box on li/�B applica ble) Nearest oado I A) t. New System 2. 0 Replacement O Replacemen4. O Addition to Parcel Tax N System Tank OnIv Existing System B) ermit Numb O A Sanitary Permit was previously Date Issued issued ,3 u a t o? � -OOd' j p � ron ! pressurizcd Tye of POWT System: (Check all that apply ✓ 3 !n- ground Mound 0 Sand Filter O Constructed Wetland essurized In-ground O Holdin O Single Pass O Drip Line O At -grade t I 3 Aero Treat nt' U' O Rec' culating 0 Other: • T , iLa-� V Dis ersaVTreatment Area Information: 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Are 4. Soil Applica n S. Percolation Rate 6. System Elevation 7. Final Grade Required Pro osed P Rate Gal ./ s da /s ( Y R•) (Min. /inch) 73 - 7 , 5 -- 7 ` Elevation /3o yy So VI Tank Capacity in Tqj9I N of Manufacturer Prefab Site Fiber. Plastic Information Gallons G ons Tanks Con- Con- glass New Existing crete strutted Tanks Tanks c O O ❑ O O O O O V11 Responsibility Statement I, the undersigned assume res o ibilit for installation of the P WTS show on the attached Ians. Plumber's Name (print) Plumber's ' nat re nos /MPRS No. Business Phone Number U �-5 - �y s Plumber's Address (Streel, city, State, Zip Code 1/0- r VIII County/Department Use Only N - O Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Approved O Owner Given Initial Adverse Surcharge Fee) S' re (No stamps) Determination l- IX. Conditio s of Approve /Rea ns f Disapproval: � k r a t 4 s / WG 2. tt� o. - t 4.0 - cw l ag e l- BD -6398 (R. 07/004 5 9�� 30 1 100 N w ,�,,, 30 l l Wisc�A . Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County � , C roi Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and_1oca"bon and distance to nearest road. Please print all itiftrmation. sewed by Date Personal information you provide maybe used f s�cpndary purpo*(Privacy Law, s:, 15.04 (1) (m)). Property Owner �; 1. Property Location kick t ' Govt. Lot 1/4 lAtA A S T N R 1 E (0060 Property Owner's Ma' " g Address 4 Lot I Block # Subd. Nam or CSM# _ sr CNoix 2,D Deer lro: 4S Z S " city State Zip Code �. --P on r UFFICc M City ❑ Village Q Town Nearest Road [�[ New Construction Use: Eg Residential / Number ofbedroc S' Code derived design flow rate & 0 b GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material d U-- W'a-S K Flood Plain elevation if applicable ✓� //� ft. General comments V,S} W\ �, /• 0 and recomme ndatio n s: 4 L4 e1-elt q/-.30 i Boring # F I F1 Boring ©• Pit Ground Surface elev. 96.3 ft. Depth to limiting factor 161,_ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fI? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 1 6 - 1 4 /b 2- ; c I C Z- .3 z lD y rli E /Z a(. o F21 Boring # II Boring Q Pit Ground surface elev. ft. Depth to limiting factor //.3 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 I o -z /0 2 — S; I s m k /n-F • Z 2 - /a -d4 2 majok m lc ' • 5 3� `f vim,,.. z * Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) ature CST Number glc;!.r Schu c /ter 25330 Address Date Evaluation Conducted Telephone Number 211- l J/ 9 - / (71zi Z 7 - Y60S Property Owner Ktj rLdc...f5 , Parcel ID# Page Z of 3 F Boring # ❑ Boring ® pit Ground surface elev. ft. Depth to limiting factor 17,1 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I O— a il �msb r r-5 C •2 .3 2 I SI( k LS .7 1.2 z $ ❑ Boring # ❑ Boring ❑ pit Ground surface elev. fit. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Ef1#1 *Eff#2 F-1 Boring # ❑ Boring F1 Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 150 mg /L * Effluent #2 = BOD, < 30 mg /L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) l I PAGE_OF_S_ NAME I�tl�kow_�, LOT# Z� LEGAL DESCRIPTION SF- ' /4#al4,S ?� T31,N,M E (or) ff SCALE: F'= /00 BM 1 ELEVATION 100- G I BM 1 DESCRIPTION hu ' ( ; A 3C" p pr . .}- — BM 2 ELEVATION 10 0. l � BM 2 DESCRIPTION ncii l i' SYSTEM ELEVATION '71. ALTERNATE ELEVATION Q/• 36 CONTOUR ELEVATION A4d 9 Ply. 1 / b 0 SIGNATURE DATE I r 4 Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code ea /ah Onsite astewater Treatment Sys m (POWTS) shall include information and proc main fining the system within the p meters of Comm 83 and 84, and the conditiorov y the department, agent, or gove mental unit. The approved plans and permte are on file at the county zoning or alth department. This agement plan complies with Comm . Adm. Code, and the In- Ground Soil Absorption mponent Manual for Private Onsitater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design ations Sanitary Pe it Number 2 5 - '3> Number of B rooms 3 Design Flow - Pe (gpd) q S-u Estimated Flow - Ave (gpd) 30 Septic Tank Capacity I) I Cvr0 Soil Absorption Component Si (ft Type of Wastewater Domestic Table 2: Soil Absorptio Com nent - Limits of Reliable Operation Septic Xnk Component Soil Abso tion Component Design Flow - Peak (gpd) 315_ 3�� s Maximum Influent Particle Size ) 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Sche le Septic Tank inspect and /or service on very 3 years Outlet Filter Inspect once a year and cleaXat least once every 3 years Soil Absorption Co ponent Inspect once every 3 years Septic Tank The septi tank shall be maintained by an individual certified to service eptic tanks under s. 281.48, tats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. A m. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, S epage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The o erating condition of the septic tank and outlet filter shall be assessed at least once every years by inspection. The outlet filter shall be cleaned as necessary to ensure proper oper 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 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 hen the next service needs to be performed to maintain less than maximum scum and slud accumulation in the tank. Ma le risers, access risers and covers should be insp ed for water tightness and soundness. ss openings used for service and assessme shall be sealed watertight upon the completion o rvice. Any opening deemed unsound, di ctive, or subject to failure must be replaced. Expos access openings greater than 8 -inc s in diameter shall be secured by an effective locking de ' to prevent accidental or uncut rized entry into the tank. No one should e r a septic or other atment or holding tank for any reason without ing in full compl' nce with OSHA standards for entering a confined sp The atmo here within the septic or other treatment of holding tan ay con in lethal gases, and rescue of a person from the interior of tan ay be difficult or impossible. Tank abandonment shall be in actor ce with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS comp ent. Soil sor tion Co onent The soil absorption compon t serving this structur ' designed to accept domestic wastewater from a residential facil' . The limits of operation this component are shown in Table 2. The longevity of a soil sorption component depends great on proper and timely maintenance, and system u within or below the limits of reliable op tion. Good water conservation practices by occupants and the installation of water co rving plumbing fixtures are key factors in xtending the useful life of this component. The soil absotp on component's operation must be assessed by insp tion at least once every three yea : The inspection shall include recording the levels of po ing, if any, in the observation pip , and a visual inspection for any evidence of surface seepa or discharge from the compone On steeply sloping sites, areas of erosion should be identifie and reported to the o er for repair. The surface discharge of domestic wastewater or wage from the systems prohibited and considered a human health hazard. Traffic round or over the soil absorption component should be avoided particularly during winte onths. The compaction or removal of snow cover over the component may lead to hydrauli ailure by freezing. This type of failure is usually temporary, but is difficult or impossibl o 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 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. N 67 1 5) sit �7 i5� 3g