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HomeMy WebLinkAbout032-2116-20-000 Wisco�n Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety.and B9ilding Division INSPECTION REPORT Sanitary Permit No: 395208 laEtNERAL 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: Hatch, Douglas I Somerset Township 032- 2116 - 20-000 CST BM Elev: 1 Insp. BM Elev' BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark I C c� Dosing I Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet 6-53 q5-. 2 9 TANK SETBACK INFORMATION St1Ht Outlet l`f1 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic > 1 Dt Bottom Dosing Header /Man. , 2O / 9L 62 Aeration Dist. Pipe ID q� +7_' . 7d W. 6 Z' Holding Bot. System L S.4b ' v �13.3� PUMP /SIPHON INFORMATION Final Grade foo ge. Manufactur Demand St Cover 2. 94. 1 / G Model Number TDH Lift Fri o s System Head TDH Ft Forcemain r gth Dia. Dist. to Wel SOIL SORPTION SYSTEM f ENCH 'dth Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM 3 fp�e�S •� Z SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Ma u qt ft Z- �`` n INFORMATION CHAMBER OR lF°Y i NACU Type Of System: 33 I �� UNIT Model Number: C AF- DISTRIBUTION SYSTEM 114 JA LApW f/4- Header /Manifold a Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipes — 7 -7 r Len th Dia Length Dia Spacing 9 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over IDepth Over xx Depth of xx Seeded /Sodded xx Mulched Bedrrrench Center Bed/Trench Edges Topsoil h, Yes No Yes No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: IZ / 0 s / V 1 Inspection #2: 1 / Location: 593 217th Avenue Somerset, WI 54025 (SE 1/4 NE 1/415 T31N R19w) Shadow Pines Lo Parcel No: 15.31.19.1062 1.) Alt BM Description = 2.) Bldg sewer length= 23. - amount of cover = Plan revision Required? F] Yes >( No I Z� Use other side for additional information. Date Insepctor's Signature Cart. No. SBD -6710 (R.3/97) nt Rf v i le Safety do Buildings Division `Z `� p. 201 W. Washington Ave. Sanitary Permit Application lJ PO Box 7302 NIVIscons In accord with Comm 83.2 1, Wis. Adm. , Cgde Madison, WL 53707 -7302 Department or commerce Personal information you provide may be use c ndary pu fposes [Privacy Law, s. I5. ) t.- (Submit completed form to county if not state owned. Attach complete plans 0 o the county copy on) for 1 on r ggt lesst r' $ -1/2 x I 1 inches in size. County I State amts Perm Number h visielp applies ' n \ State Plan 1. D. Number O �\ I. Application Information - Please Print all Information ocation: Property Owner Name r_., roperly Location I/4 /UG I/4,S „ — T 31 ,N R/9E W Property O er's Mailing Address Lot Number Block Number Z Al z ie pet City, State Zip Code Phone Nu Subdivision Name or CSM Number -st"UJOLL2 tae Type of Building: (check one) ❑ City I or 2 Family Dwelling - No. of Bedrooms:_ ❑ village Public/Commercial (describe use)a_ E21 of U State- owned - -- - -- - — -- - -.... 5 coi e ' e III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road J n A) 1. A New System 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s) System Tank flni Existing System 0 - 3 / - ,ZQ -(00 B) Permit Number � Date Is ued A Sanity Permit was previously issued A IV. Type of POWT System: (Check all that apply) V%Non- pressurized In- ground ❑ Mound 0 Sand filter ❑ Constructed Welland ❑ Pressurized In- ground ❑ liolding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V Disp ersal/Treatment Area Information: 1. Design Flow (gpd) 2. DisperselArea 3. Dispersal Area 4. Soil Application S. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation _ ISU 3 - 1 ,5) 37 1. D 13.50 7 5v VI Tank Capacity in Total It of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks S . ' 10 VII Responsibility Statement 1 the undershtned, assume responsibility for installation of the POWTS shown on the attached plans. _ Plumber's Name (print) Plumber's Signs re stamps)- MP/MPRS No. Dusinesa Phone Number 1 70 90,116 1 731)111, 4 - - - - -- ­... ;r - Plumber's Address (Street, City, State, Zip Cod -- /0 740 244lutJ ZY s' 11 5 1 VIII County/Departmen Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued 1 su' g Agent Signsturo o stamps) IX A Determin ' pproved 13 Owner Given Initial Adverse Surchar ee) 00 C rr /OZ �O IX. Conditions J � A � Q easons for Disapproval: a - ttsti. '�-° ^-� �A"M"' " _ nl.k1 S- r 141 cAg � V rj ....__.___ --_ /JV l �u _ t _.._.__...__. _.._ SAE. a17 +� l�Ve 3 G t,7S Ali RRM04 �o N►��► iN Ch.�2ny TR-R4 � �w 1I 3/u o f 3 NdRour Ne'�1 i N Rea ?,OR asf u�,a 41�v -1uub 1i Iierr. IF s � �o erg, �RQN C S 93. s V a� C N 0 O O O E C �►-, (p C ('7 °°°/ (� C O x V .�__...... a `- O In — — = ^ (d CV cc i.. EEac N r x D) Q ro o 0 0 _o Z - _ mamma �(ti co O N (n O 4 _ >. 0. 1... W .' to N—.' � :3 � ^ i N C ��d. U (l1U W N = i[ U E -. l E•7c x CTJ J 2 t'n N O O .� I I va���Il .. ► (n U) f / awl 5 cl e ai nde. rs nolp- VI 1) 3x h $,I5 Ali RM04 c►�nR Alt �Ievr toy.ls QRp� p 3% v 30 NQ�1 � N Rpa f'WR psra►•V� �I�v- luub /l1 i N Mir- TAN 93.56 1Nh vop-Q T T S O i aj o Ci ° e.JA; (b C N X W) u i LO EE'vC ca X rnM W CO U) �, M i ',>32 C0 (NaO°0 Cp u) a�v a 3� z ! 3 N U ^�,, p O N = F C fA U W C D >.'a 1 a) W N C- Nd - 0 U W -- .1 > E .N c C x LL (no - - -- - -►� v vv aav, J LL O = n N O N A - 1478 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. Sal & Site Evaluations Attach complete site plan on paper not less than 8 %x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference pant (BM), direction and parcel I. D. percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. 032 - 2116- 20 - 000, ID #15.31.19.1062 Please print all information. B Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). O O Property Owner Property Location Douglas D. & Linda L. Hatch Govt. Lot SE 114 1 NE 114 S 15 T 31 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 12 N. Square Lake Trail Crt. 5 Shadow Pines City State Zip Code Phone Number �j j Village )e Town Nearest Road Stillwater MN 1 55082 651 - , Somerset I 217Th Ave. JIM New Construction Use: Residential / N r ` �j 3 _ Code derived design flaw rate 450 GPD Lj Replacement Public or Desc r Parent material Glacial outwash ° + Flood plain elevation, if applicable _ na S _{ General comments and recommendations: Install 2 trenches using 22 h Incapacity in boe System elev. = 93.50'. 3� Boring # A Boring td Pit Ground Surface elm 9 8.21 ft Depth to limiting factor >1 17" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure 1 Consistence Boundary Roots GPD/ft' "Eff#1 *Eff#2 1 0 -5 10yr3/2 non Is 1msbk mvfr cs 7fTmn, c 0.7 1.2 2 5 -22 7.5yr4/6 none Is 1msbk ml cs c 0.7 1.2 3 22 -54 7.5yr5/6 none s 0 sg dl gs 0.7 1.2 4 54 -86 10yr5/4 none s 0 sg dl gs - 0.7 1.2 5 86 -117 10yr6/4 none s 0 sg dl - - 0.7 1.2 `13 •S"n � .52 R 2 Fil Boring # � Boring jo Pit Ground Surface elev. 99.94 ft. Depth to limiting factor >120" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' `Eff#1 *Eff#2 1 0 -7 10yt3/3 non Is 1 msbk mvfr cs 2fm,1 c 0.7 1.2 2 7 -19 10yr4/4 none Is 1msbk ml cs 2fm,1c 0.7 1.2 3 19 -53 7.5yr5/6 none s 0 sg dl gs 1fmc 0.7 1.2 4 53 -83 10yr5/4 none s 0 sg dl gs - 0.7 1.2 5 83 -120 10yr6/4 none s 0 sg dl - - 0.7 1.2 .L8 It 3, — " Effluent #1 = BOD ? 30 < 220 mg/L and TSS >4 < 150 " #2 = BOD < 30 mg/L and TSS < mg/L CST Name (Please Print) Signat CST Number James K. Thompson 3602 Address A.C.E. Sal & Site Evaluations Pate Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 9/20/01 715- 248 -7767 property Owner Douglas D. & Linda L. Hatch Parcel ID # 032- 2116 -20 -000, ID# Page __ 2 - of 3 a � # 16 Boring Pit Ground Surface elev. 99.15 ft- Depth to limiting factor >118" in. Sal Application Rate Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 F 3 1 0 10yr3/2 non is 1msbk mvfr cs 2fm,1c 0.7 1.2 2 6 -25 7.5yr4/6 n one Is 1 msbk ml cs 2fm,1 c 0.7 1_2 25-49 7.5yr5/6 none s 0 Sg dl gs 1fmc 0.7 1.2 [� :4 49 -91 10yr5/4 none s 0 Sg dl gs - 0.7 1.2 5 91 -118 10yr6 /4 none s 0 Sg dl - - 0.7 1_2 o 4 Boring # F Ong Pit Ground Surface elev. 98.01 ft. Depth to limiting factor > 107" in. Soil Application Rate Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 1 0 -5 10yr3 /2 non Is 1 msbk mvfr CS 2fm,1 c 0.7 1.2 2 5 -28 7.5yr4/6 none Is 1msbk ml CS 2fm,1c 0.7 1.2 3 28 -58 7.5yr5 /6 none s 0 Sg di gs 1fmc 0.7 1.2 4 58 -88 10yr5 /4 none s 0 Sg dl gs - 0.7 1.2 5 88 -107 10yr6/4 none s 0 Sg dl - - 0.7 1.2 o Boring# Boring !d Pit Ground Surface elev. 97.83 ft. Depth to limiting factor > 106" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots f2PDtft2 __- *Eff#1 *Eff#2 1 0 -5 10yr3 /2 non Is 1msbk mvfr CS 2fm,1c 0.7 1.2 2 5 -20 7.5yr4/6 none Is 1msbk ml CS 2fm,1c 0.7 1.2 3 20 -37 7.5yr5/6 none s 0 Sg dl gs 1fmc 0.7 1.2 4 37 - 79 10yr5 /4 none s 0 Sg dl gs - 0.7 1.2 5 79 -106 10yr6/4 none s 0 Sg dl - - 0.7 1.2 * Effluent #1 = BOD ? 30 < 220 mg/L 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 alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777. iy78 01 1 ♦ E/e c/a �i o.� 0 4re e- d 7 ■ � ProPoS�d ■ P,ie &ee-- ,ass uIM e�/ e lei = ida. CU S-4 Wi� K` Sdi Lo&% �• �5 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix -Safety and Buiiding Division INSPECTION REPORT sanitary Permit No: 395208 GENEfAL 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: Hatch, Douglas I Somerset Township 032 - 2116 -20 -000 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number M! Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution TH ole Size x Hole Spacing Vent to Air Intake Pipe(s) I — 7 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 T hd Mulce Bed/Trench Center Bed/Trench Edges Topsoil Yes [1 No �] Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 593 217th Avenue Somerset, WI 54025 (SE 114 NE 11415 T31N R19W) Shadow Plnes Lo Parcel No: 15.31.19.1062 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? [] Yes ❑ No Use other side for additional information. Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) l Safety & Buildings Division W Ave. Wa Sanitary Permit Application 201 W. PO Box 7302 In accord with Comm 83.21 Wis. WI O 7302 Box /s�onsin Madison, Department of commerce Personal information you provide may b 04 17 oses (Submit com leted form to coun if not [Privacy Law, s. 1,\/ p state owned. Attach com lete plans to the county copy only) fo to o of 1 8 -1/2 x 1 I inches in size. County State Sanity Permit Number ❑ if revis s appli to State Plan !. D. Number 0 I. Application Information - Please Print all Information - r Location: Property Owner Name �w x ST Cox Property Location - SC 114 A)6 S T ,N R/9E or W Property er s Mailing-Address f ` i Lot Number Block Number L City, State Zip Code Phone Nu S� Subdivision Name or CSM Number 5 `,1 II Type of Building: (check one) ❑ City 1 or 2 Family Dwelling— No, of Bedrooms: ,3 ❑ village ❑ Public/Commercial (describe use): .kTown of O State -owned �v . �• III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road �ry A) 1. )'New System 1 2. O Replacement 3. ❑ Replacement of 4.. ❑ Addition to Parcel Tax Number(s) System Tank Onl Existing System — B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: eck all that apply) '1Von pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland p❑'Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V Dispersal/Treatment Area Information: 4 r d x 3' le 6$ a — 14 ( j t. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application S. Percolation Rate 6. Sy em Ele ion 7. Final Grade Required Proposed eq Rate Gals da /s . ft. Min. /inch po Ele ( Y alto n �v 3 37� 'I a � ( , '1 .a 4a Sa %'r3 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 O ❑ ❑ ❑ ❑ VII Responsibility Statement I the undersigned assume responsibility for installation of the POWTS shown on the attached plans. I, Plumber's Name (print) Plumber's Si MP/MPRS No. Business Phone Number J ' I n & / — !v Plu�mber's Address (Street, City, State, Zip C 1 o v VIII County/Depar4ment Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent,,Signature (No stamps) 5 ' Approved O Owner Given Initial Adverse Surcharge Fee) Determination b f I p X. Conditions of Approval /Reasons for Disapproval. `� �G�.bQI..�o..$� �QGM p'"t"� -'f' G`' 1�.�°u'�c�t.".a"� �tt. ►'"''�ptlty�.r.s:#t''�"�t�t ' r / anal -S I'd e- a)/ n cl e rs M/:77 alki am P- e 1�er, 4 i QS v OA e A It ARe 03 r la 3 (j rn q�t pe Noh., 55 � - IrZQtic�.2f �OooyA) Wfoni Department of Commerce SOIL AND SITE EVALUATION Divksiop of,Safety and Buildings Page 1 of 3 Bureau of Integfated Services in accordance with s. [LHR-834 , Wis. Adm. Code Attach complete site plan on paper not less than 8 112 x 11 inche4ini Akan m use IRounty include, but not limited to: vertical and horizontal reference point frectior+ and - St . Croix percent slope, scale or dimensions, north arrow, and location and ce to rrearel r 41 Par 1 I.D. # APPLICANT INFORMATION - Please print all info md tio Revi wed by Date Personal information y ou p rovide may be used for second n y p y ry purposes (Priv cyLaw, s. 15.O�1' br u Property Owner Z tE tioln ;' Richard Stout - * govt. Lot .$ ,x'1/4 NE 1 /4 15 T 31 XR 1 9 E (or) l Property Owner's Mailing Address Lot,# + I Subd. Name or CSM# 1353 Awatukee Trail 5 Shadow Pines City State Zip Code Phone Number ❑ City ❑ Village g )E] Town Nearest Road Hodson I WI 154016 1(7 15 )549 -6731 Somer New Construction Use: Residential / Number of bedrooms _4 Addition to existing building ❑ Replacement H Public or commercial - Describe: Code derived daily flow 6 0 gpd Recommended design loading rate _ bed, gpd /f1 gpd /f1 Absorption area required 85 bed, ft trench, ft 2 Maximum design loading rate 7 _ bed, gpd /ft gpd/ft Recommended infiltration surface elevation(s) St-t- P1 nt P1 an ft (as referred to site plan benchmark) Additional design /site considerations Parent material COC 2 Flood plain elevation, if applicable ft S = Suitable for system Conventional I I MMound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ® s ❑ U S ❑ U Os ❑ U I OS ❑ U ❑ S U ❑ S U SOIL DESCRIPTION REPORT Boris # Horizon Depth Dominant Color Mottles Structure GPD /ft Boring Texture Consistence Boundary Roots in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 1 1 0 -1 10 r2 1 none 2 10- 8 10yr3/6 none sil 2mabk mfr c Ground 3 38-134 10 r4 6 none ms elev. -- -- 94 Depth to limiting factor 8 in. Remarks: Boring # 1 0 -6 10 r2 1 none 2 6-24 10 r3/6 none $mIota 12,ihabk mfr 3 24-84 10yr4/6 none ---�? ms oscr M 1 -- -- Z Ground elev. o 95 - 9 n ft.' b a ; Depth to limiting factor 8 in. Remarks: CST Name (Please Print) Si nature Telephone No. Address Date CST Number i l _ PROPERTY OWNER Richard Stout SOIL DESCRIPTION REPORT _ .Page ofT PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -6 10 r2/1 none sil 2mabk mfr cs 2m .5'.6 2 1 6-24 10yr3/6 none sil 2mabk mfr cs if .5;.6 Ground 3 124-84 10yr4/6 none ms osg ml -- -- .7 (. 95 . 5v. ft Depth to limiting factor 8- in. Remarks: Boring # 1 -6 10 r2/1 none Bil 2mabk mfr cs 2m 4 2 -24 10yr3/6 none 3il 2mabk mfr cs ftC .5 .6 3 k 4-81 10yr4/6 none ins osg ml -- -- .7 � Ground elev. 95. ft. Depth to limiting factor 84 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 -6 10yr2/1 none E3il 2mabk mfr cs 2m .5 '.6 5 2 24 10yr3/6 none it 2mabk mfr cs if .5 ;.6 3 24-84 10yr4/6 none ins losq ml -- -- .7 .8 Ground elev. 94. ft. Depth to limiting factor 8 in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in " Remarks: SBD -8330 (R. 07/96) ogj-e- _ LY ne,l�.Yr�rk I Pt�y. IOd ly '�Pir2 -�rzt rcb.v r ka el�V to ' Jaf' , 4re op 133 4,A 7 r •� M 1 f r 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 3�SLo Number of Bedrooms Design Flow - Peak (gpd) Estimated Flow - Average (gpd) 300 V Septic Tank Capacity (gal) Soil Absorption Component Size (ft 3`75 Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) 3 Maximum Influent Particle Size (in) 1/8 Maximum BOD (mg /L) a U 220 Maximum TSS (mg /L) I U 1 150 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 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 residential f i it i it of operation of this component astewater from a ac I y. The limits s are shown in p p 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 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 Tri- County Sanitation 386 -2130 3 .OV13 81 16; 21 71539 COPY GAT PAGE -81 ST CROIX COUNW SEPTIC TANK MAINi'EMANCE AC3MEMENT AND OWNERRUP CBRTin TION FORM wmdbay zf .* (VMfiN" ftwirod ban Pfd vvwumw aw ww aa,ah+wim) rOVA 14MUfical NwnW A.. Y•. lJL . Y., Sec. /_,17— T V R W, Tom of wwromy ~� Deed 9 vow= Per if � ......_. Spec bare D yas1 ao (\ Lot lows - id"iiebk+ yes a too s7 o�W iewiN is i�r p.enw�e 1ti4tms m . aolt Qr task a+� or wooer an , if w by a >ie+rwt fix. 1NL�t 8 e gw�se so rams= *f w � tic s,'* V"b" rt � is ii; Ws 44Pd �r�b�,� *pieu�KOC s iioaio�d * ie i�*t eoeiNloe aewiRot (� . � ,� >�� {t)16s� -.la r�rww�rAi�oMt��lwr F� mmd40 6* p li - mail ` D QMM *r • ♦ 7 OW4 an me %W ** tvu Nir *v (aw km w ia, I [�r4 . + t l aww% vy vmw Oir o is ' of yX iM. �f. l�yY i I�IIt �/ i� 116 gw'O�iDOd by A* ZvwWS Dopow" I *� b ows VIM ab > d"; s deed Beata do ItaWMW of Dgmb SMoo &@m Elie eMRd tssir K ana�M 1u �wa�mtY STATE BAR OF WISCONSIN FORM 2 - 1998 645869 WARRANTY DEED KATHLEEN H. WALSH 141 1�� REGISTER OF DEEDS Document Number 101_ . 6 U PAGE S.T. CROIX CO., WI RECEIVED FOR RECORD This Deed made between _ _ _ 05-18-2001 11:00 AN RTCHARD n RTnrrT and JANET P,—_S huchand and _ _ _ __ WARRANTY DEED Grantor, EXEMPT N and DOUGLAS D HATCH and T.TNDA CERT COPY FEE: - - -- COPY FEE: husband and wife, _ TRANSFER FEE: 164.70 RECORDING FEE: 10.00 -- -.— PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in Rt ('rni w , County, State of Wisconsin: Lot 5, Plat of Shadow Pines, Town of Somerset, St. Croix County, Wisco Name and Return Address, 032 - 2116 -20 -000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptionstowarranties: easements, restrictions, rights -of -way and covenants of record..� Dated this lPk_ day of May 2001 41" ©r (SEAL) �l� C C P (SEAL) Richard 0. Stout Janet p Stout __... (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, lI } ss. St. Croix ounty. JJJ authenticated this day of Personally came before me this IA I day of May 2001 , the above named Richard O Stout and Janet P. Stout TITLE: MEMBER STATE BAR OF WISCONSIN - -- t o (If not, me known to be thNQ�TAfRY_PL�&jGecuted the foregoing authorized by §706.06. Wis. Scats.) Instrument and STAT&OF- MCONSIN KERN ON J. BAST THIS INSTRUMENT WAS DRAFTED BY - — Janet P. Stout ^, 1353 Awatukee Tr. Hudson, WI 54016 Notary P blic. State of Wise sirs My co mission is permanent. (If not, state expiration date (Signatures may be authenticated or acknowledged. Both are not necessary.) ' Names of persons signing m any capacuy mdse be typed or printed below their signauire. STATE BAR OF WISCONSIN Wtscons,n Legal Blank Co., Inc WARRANTY DEED FORM No. 2 - 1998 Milwaukee, Wis. UNPLATTED LANDS OF OWNER — --------- S89'26'46 "E 1271.82' — --------- 1238.82'----- - - - - -- DEDICATED 7HE P U B U C T O W N R _ - -_ -- t7.to' - - - - -- - ---- - - - - -- - 232.01' - �' -_- / -� - - N89'26'46 "W 1239.60'- ' —► - - -- � - - - - -- ;— 33 ; i �( 239.27 — — — — — — — — — — 498.73' 12' UTIL/TY I 5po y bg 2 ' o o \ N EASEMENT e ..1..........� ....` J / y ti ................ �..... : .�R� ................ M in /( 6 N 4 \ Q 13 3.01 ACRES !" 131,940 SQ. FT. 8 3.03 ACRES � 131,150 SQ. FT. 3.01 ACRES S89.26'46 "E Q� _91_17_ � �P 517.00 , N89'2646 "W R= N89'38'; 3 r POND � M 2 H .W., �M M LOT_1 PSI , Ip M 3 CERTIFIED SURV! DOC_ NO._ 427 P�\ ° VOLUME 7_PAGE �• 78.42 91.17' - O N89'26'46 "W �� 169.59' Z � O � C! (n g R= S89'38'5 8.00' 211.57' N89'26 - 46 "W 20 t---- N89'26'46 "W 2115.60' - - -- R= N89'38'55 "E ----- - --(TO WEST 1/4 CORNER) N89'26'46"W 5331.35'--------- SOUTH LINE OF THE SE 114 OF R= N89'38'55 "E THE NE 114 (EAST -WEST 114 LINE) UNPLATTED LANDS