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HomeMy WebLinkAbout032-2116-50-000 C CZevf Wisconsin Department of Commerce �� • PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Divisi&', '� Sanitary Permit No: INSPECTION REPORT 399459 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: Mattiacci, Jean I Somerset Township 032 - 2116 -50 -000 CST BM Elev: ! Insp. BM Elev: BM Descri tion: Section/Town /Range /Map No: bD •'0 W •a� rk �k�e s CS VSkAA I ( &�Sr`t&, S 3 o 15.31.19.1065 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark ELK S OD 0 1. Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet _ q 2? Gj�• oZ' TANK SETBACK INFORMATION St /Ht Outlet �$ qb • �S TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet , Septic , 0, 2 5 ! J, Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Z. .35V �j`�f•4S ( s•oS � Holding Bot. System WS 3 •SS • yi. 93. 98 Final Grade PUMP /SIPHON INFORMATION A 0j Manufacturer Demand St Cover M • Model 117 ber TDH Lift F ' ion Loss System Head TDH t Forcemain Lengt Dia. Dist. to Well SOIL ABSORPTION SYST DEB RENCH Width ' Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMEN i 3 I (A-75 r 2 SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufa u j r: nn INFORMATION CHAMBER OR �OtCa�� Type Of System: t UNIT 1 o V J• O � q — Model Numbe�� 1"ht � DISTRIBUTION SYSTEM Header /Manifgl Distribution ole x Hole Spacing Vent to Air Intake /S. it Pi ! Lengt Dia Length Dia Spacing 3� SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of T eded /Sodded xx Mulched Depth Over Center Depth Over Edges Topsoil ,,�11 0 Yes 0 No o Yes H] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: (J4' 2290 Inspection #2: 'T Location: 581 217th Avenue Somerset, WI 54025 (S 1/2 NE 1/4 15 T31 R1 9W) Shadow Pines Lot 8 Parcel No: 15.31.19.1065 1.) Alt BM Description = S•c • wo+� Cam. 2.) Bldg sewer length = 33 t - amount of cover = a� ` � S , n / / 3)(•}�v"�'°'�r�`�' �. � .x.�, � _ cm's) t-cA� -ewe L0 /4�n to -k� -- 4 Plan r v�'ision Required? Y s N Use other side for additional information. ft ( I _ S Date nse tor's Signature Cert. No. SBD -6710 R.3/97 ) L� r p. � Cr roc fe 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 15 Box 7302 onsin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 nt of commerce (Submit completed form to county if not [Privacy Law, s. 15.04(1)(m)] state owned.) Attach complete plans (to the county copy only) for e system, on paper not less than 8 -1/2 x 11 inches in size. State Sanit P i�Number PTheek if revision to previous application State Plan k D. Number / s I. Application Information - Please Print all Infor Location: Property Owner Name Property Location J i � a V etc c— &vm � r– / - r - 1 liC C.-r t..E, 414 A4614, S ST_ ,N, WE (or W Property Owner's Mailing Address Lot Number Bloc Numbe � � ! a t ` City, State Zip Code Phone Number Subdivision Name or CSM Number II. Type of Building: (check one) ��t• - `�, ❑ City 1 or 2 Family Dwelling - No. of Bedrooms _ t ❑Village ❑ Public /Commercial (describe use):_ own of et ❑ State -Owned y Neares Ro ;d, I l L cool ;' �. Parcel Tax Number(s�i3 ll ) I cvce III. Type of Permit: (Check only one box on line A. Check b on rte �[ p icab o � A) 1. w 2. ❑Replacement 3. ❑Replacement t _,._ ..�; %� d > 5. 6. ❑Addition to yytem System Tank Only E Existing System B) Permit Number Date Is ued A Sanitary Permit was previously issued /" I i 0/ IV. Type of POWT System: (Check all that apply) Ton 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 Required Proposed Rate (Gals. /daZ sq. ft.) (Min. /inch) ,115j Elevation VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete strutted Tanks Tanks ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, ass responsibility for installa of the POWTS shown on the attached plans. Plumber's Name (print) Plumber's nature (no stamps): MP/MPRS N o . Business Phone Number �-• 7)l � s 'off '" I� Plumber's Address (Street, City, State, Zip e) IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued ss ng Agent Signa (No stamps) Approved ❑ Owner Given Initial Adverse Surcharge Fee) Determination I S - V3 X. Conditions of Approval /Reasons for Disapproval: Cr SBD -6398 (R. 07/00) � PLOT PLAN PROJECT J e�N � Z ;� ADDRESS 8,�4 / -/ 4 1 /4S /T N/R WTOWN COUNTY �� e��� MPRS Shaun Bird 226900 DATE 4 _ZZ -51 BEDROOM 3 CONVENTIONAL/ IN PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATF/, 2 ABSORPTION AREA # of chambers IL BENCHMARK V.R.P.: �N� ,4,4__ o,_4 � j�SSUME ELEVATION 100 Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION Vent \ \ ALong Sidewinder High Capacity Leaching Plans Designed Using Chamber Conventional Powts 6" Manual Versi on 2.0 34" Grade at System Elevation Pro kA N I C � o C> , - 3 x (s 1�3 Wisconsin Department of Commerce l SOIL EVALUATION REPORT Page of Division of Safety and Buildings In accordance with Comm 85, Was. Adm. Code Attach complete site plan on paper not less than S 112 x 11 Inches in size. Plan must County Fro Z Include, but not limited to: verticaf 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 Reviewed by Date (� Personal information you provide may be used for secondary purposes (Privacy Low, s. 15.04 (1) (m)). Property Own Property Location C C y� t r Govt. Lot SL J 1/4 , c —' 1/4 S/S T3( N R/ E ( r) W Property Owner's Mallln � Address Lot # Block # Subd. Name or CSM# 0 _2 !f -C:� City Wis Zip Code Phone Number [1 City [] Village 25Town Nearest Road 71 ( 1 --S New Construction Use. esidentlal / Number of bedrooms = Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material © f.{ Q Flood Plain elevation if applicabl ft. General comments ^ � vt o � and recommendations: J F-, tt O A 7 � DEr�E C �.; F-il Boring # Poring ❑� — l} O r p0� Jet l pit Ground surface elev. ft. Depth to limiting factor I licatlon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bo afy is GPD/ftz In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 s d' ,-S - 3 a z -7 o Boring Boring # ❑ y� 02 p 6 Ground surface elev. � ft. Depth to limiting �- Pit p g factor fn. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftl in. Munseli Qu. Sz. Cont. Color Gr, Sz. Sh. *Eff#1 'Eff#2 31- ,-s f' F .3 S'f o " Effluent #1 = BOD > 30 220 mg /L and TS >30 50 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L CST Na ,, Z (Please Print) CST Number f 000 Address Date Evaluation Conducted Telephone Number gM1.911h riM1171M Property Owner Parcel ID # Page of [ji Boring # ❑ Boring . pit Ground surface elev[ , " ft. Depth to limiting factor —2��-n• 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- . �Z Og 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 GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 1-- 4 F -1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Horizon 1 Depth Dominant Color Redox Description Texture Structure Consistence Bounda Roots Soil Application Rate in. Munsell Qu. Sz. Cont. Color Boundary Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 m /L – _ 9 'Effluent #2 = BOD < 30 mgiL and TSS < 30 mglL 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 60$_264 -8777. SBD -8330 (R.07/00) l / 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 NViscons Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce p (Submit completed form to county if not [Privacy Law, s. 15.0�4(1)(m)] state owned.) Attach complete plans (to the county copy only) for the J than 8 -1/2 x 11 inches in size. County State Sam ermit Number ❑ Che ion toorrevious ap n State PI I Number I. Application Information - P ase Print all Information Location. Property Owner Name Property Location v -/"► C C'..e. a 5 /4 N 1/4, S) ST N, P (o W Property Owner's Mailing Address SY Lot Number Block Number City, State Zip Code P er r Subdivision Name or CSM Number J II. Type of Building: eck one r ❑ City — or 2 Family Dwelling of Bedrooms �� (der P� aN—S `'(t �lw� ❑Village ❑ Public /Commercial describe own o ❑ State -Owned N st Ro .3�•l�f -lob jjF arc ­ e I T Nu -ill b - d> III. Type of Permit: (Check only one box on line Check box o B le) A) 1. ew 2. ❑ Replacement 3. L1 lacement o 4. 5. 6. ❑ A ition to System System TariMply jkleng System $) it Num Date Iss ❑ A Sanitary Permit was previously issued IV Type of POWT System: (Check all that apply) ;eNon-pressurized In- ground ❑ Mound ❑ Construct d ❑ Pressurized In- ground ❑ Holdin\TreaUnit S P ❑ Drip Li ❑ At -grade ❑ Aerobi ❑ Rec ing ❑ Othe 1174 V. Dispersal/Treatment Area Information: c 1 5 1. Design Flow (gpd) 2. Dispersal Area 3. Disp sal Area 4. Soil Applicatio 5. Percolation Rate 6. System Elev on 7. Final Grade Required Proposed Rate (Gals. /day/ Q4m./inch) CW, 3 J Elevation VII. Tank Capacity in Total # of M facturer N efab Site Steel Fiber- Plastic Information Gallons Gallons Tanks - Con- glass New Existing cre structed Tanks Tanks ❑ ❑ ❑ icir co VIII. Responsibility Statement 1, the undersigned, assume responsibility for installation of /e POWTS shown on the attached plans. Plumber's Name (print) Plumb 's gnature (no Mm ps): MP/MPRS No. Business Phone Number r Plumber's Address (Street , State, Zip o ) bb IX. County/ Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) Approved ❑ Owner Given Initial Adve Surcharge Fee) C)b Determination iO r X. Conditions of Approval /Reasons ffr Disapproval: 1. Effluent filter to be installed and maintained per manufacturer's recommendations. 2. All setbacks to system and residential structure must meet applicable code requirements. 3. This system was designed in accordance with the in- ground soil absorption component manual (version 2.0). 4. Well setbacks to be maintained per NR 811 & 812. 5. System shall be installed 48- inches below uniform contour line to ensure proper location within soil profile. SBD -6398 (R. 07/00) 1 R x . c �, .� .e :K �; .t�; ,. },� �% �� �� n. , 3 �� � •, � �~ �; `� }� ,, I PLOT PLAN PROJECT Jean Mattiacci ADDRESS 852 Hiahview Unit A New Richmond Wi 54017 SW 1/4 NE 1/4S 15 /T 1 N/R 19 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/4/01 BEDROOM 3 CONVENTIONAL ) IN -GRO D 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 Cedar Tree ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL •H.R.P. Same as Benchmark SYSTEM ELEVATION 89.3/88.0 Pro Town Road. l Vent > 12" Sidewinder H�h Plans Designed Using of Cover Capacity Leaching Conventional Powts Chamber ` Manu Vers , V nZi.0 pf 6' Long 3 4" G at System Elevation pro 3 Prop l P y Bedroom Line House B.M. 0' B.M. T 10 10' 10' 30' B -1 "'N 'lo ,. lop 4 2 -3' 9' Cells w >3' S cing �0 I � y�y�r • KFie^° xt � vlr PLOT PLAN PROJECT Jean Mattiacci ADDRESS 852 Hiahview Unit A New Richmond Wi 54017 SW 1/4 NE 1/4S 15 /T 1 N/R 19 W TOWN Somerset COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/4/01 BEDROOM 3 CONVENTIONAL IN -GRO D PRESSURE CO�IVVENTIONAL 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 BENCHMARK V.R.P. Top of nail in Cedar Tree ASSUME ELEVATION 100 Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 89.3/88.0 Pro Town Road 2L— Sidewinder H� h Plans Designed Using Capacity Leaching Conventional Powts Chamber Manu Vern 2.0 0�' � � � 3 4 Grade at System Elevation Pro 3 Property Bedroom Line } House * B.M. 0' B.M. T 10' 10' 10' 30' B -1 \ B -25 Slop 4 • 3 ` 2 -3' 69' Cells ith >3' pacing r ~ ° «AA.. ¥/ • « NO SITE PLAN Lot 8, Plat of Shadow Pines w 67.Q'' ! 23.57' e4.V 01 1 C IA I � W \ � \4Ja9 tea. " ,t N89'26'46"W 2a4.53 Note: Construction of this site is to start about Cc, ober 15, 2001. 1. Driveway is to be a gravel surface. Ditc'n lines mill be seeded and mulched in spring of 2002. 2. Temporary soil stock piles will be c,.-)vered with tar.) until used. 3. A silt fence will be installed on the downslope of " disturbed area until revegetation has taken hold. 4. The disturbed creas will be muichec and seeded :r May of 2002. 5. The seed mix ure is to 15% Kentuc >cy Bluegrass -- '0% Fine Fescue — 15% Perennial ryegrass at a seeding rate of 4 -5 ibs /100C s: , ft. 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 i Shaun Bird #226900 / Wisconsin DepartmentofCommerce SOIL EVALUATION REPORT Page ( of 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 — t include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and localkw4aUistance to nearest road. Please print all in _ ._ ,l 2� Reyipwed by Date `+ fv tol Personal information you provide may be used for s n pu sea rivacy tom` NF!s, 5.04 0) (m)). Property Owner ,^ �' p C f! rty Location J - (AoGt. of (,�/ 1 /4 / (j 1 /4 S /5- T 3 � N R � � E (or j Property Owner's Mailing Address , t I� L Block # S Name or CSM# AEY Cl� City State Zip Code ne Number ity ❑ Village ® Town Nearest Road ( m,0, 9G ® New Construction Use: ® Residential / Number of• o" Code derived design flow rate JIS0 �� Od GPD ❑ Replacement I' -❑ Public or commercial - Describe: Parent material U U7`wa -S y,, Flood Plain elevation if applicable ft. General comments 54W\ f v and recommendations: aBoring# ❑ Boring pit Ground surface elev. 9 3 • 3 0 ft. Depth to limiting factor � (Q 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 Z' SL c s v Z $. 16 = L r 5 3 a16 in, ❑ 2 Boring # ❑ Boring ® pit Ground surface elev. :t6 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 I d ICS 3 2 S I a C- s [V 4 Z - Zo b ( 1 — 5 L ZMA s 5 q 3 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) Signature J CST Number s330 y Address Date Evaluation Conducted Telephone Number Property Owner Parcel 1D # Page Z of IN Boring # ❑Boring ^ Pit Ground surface elev. ft. Depth to limiting factor I 1 l� _ 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 J 'Eff#2 -3� o 44 I — Z rn r - 5 3_ m S - - - 1 1.2 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 GPD /fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 F - 1 F1 Boring Boring # Ground surface elev. ft. Depth to limiting factor in. El Pit 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 (1107/00) PAGE 3 OF NA ME ME J h M a �4 , 'ctc- G 8 LEGAL DESCRIPTION Sw kv& l a ,S 15 T N,R, I q E(or)W SCALE: 1 "= QO 1 I BM 1 ELEVATION (00 •U BM 1 DESCRIPTION rb,'l n pr o Q k - — BM 2 ELEVATION (DG d BM 2 DESCRIPTION klct SYSTEM ELEVATION t '6 , 3O 6ow, r ov .10 ALTERNATE ELEVATION 9 7J d CONTOUR ELEVATION 9l o j q3, od A ll te ' Z yowvt Qd •� La � ■ ■ oa o Pdn� SIGNATURE - DATE r Wisconsin Dtbpartment of Commerce SOIL AND SITE EVALUATION Dl vision of Safety and Buildings. S ou� Page of 3 Bureau of.lntegrated Services in accordance with sjLFtR;8 .0%.,Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in a,� an mus * u / include, but not limited to: vertical and horizontal reference point (B ectio ar j t St . Cr oix percent slope, scale or dimensions, north arrow, and location and e to n P ltId* � Parc I. D. # APP APPLICANT INFORMATION - Please print all in fo r on Reviel' ed by Date 5; CROIX Personal information you provide may be used for secondary purposes (Priva s. 15.04 (6�p}Ty Property Owner Richard Stout �� ' , l 1_ , y //4 NE 1/4,s 15 T 31 N,R 19 E (or))A► Property Owner's Mailing Address Subd. Name or CSM# 1353 Awatukee Trail 8 Shadow Pines City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road Hudson Wi 54016 (715 )549 -6731 1 Somerset 160th Street ® New Construction Use: ® Residential / Number of bedrooms 4 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 6 0 0 gpd Recommended design loading rate . 7 bed, gpd 1ft . 8 trench, gpd /ft Absorption area required 858 bed, ft 7 5 0 trench, ft 2 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 COC2 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 ®S ❑ U 1Z S ❑ U Z] S U JO S ❑ U ❑ S R] U ❑ S q U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -6 10yr2/1 -- sil 2tn m 2 1 6-42 10yr3/6 -- sil 2 a (;&t mf Ground 3 42-88 1 0yr4 /6 -- ms osg ml cs -- .7 ' .8 elev. 96 _?n ft. Depth to limiting factor 88 in. Remarks: Boring # 1 -6 10yr2/1 s m 2 2 6 -42 10yr3/6 -- sil 2.mt�) mfr cs -- .5 .6 3 42 -88 10yr4/6 ms osg ml cs -- .7'.8 Ground elev. 9 Depth to limiting factor 8 8 in. Remarks: CST Name (Please Print) Si ature Telephone No. Address Date CST Number t 7 � _S3 -30 i Richard Stout SOIL DESCRIPTION REPORT PROPERTY OWNER — Page 2 of 3 PARCEL I.D.# r Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GepIft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 1 0 -6 10yr2/1 -- sil 2rn -9>15 mfr cs if .5 :.6 2 . 6-42 10yr3/6 -- sil 2 m4W, mfr cs -- .5 !.6 Ground 3 42-88 10yr4/6 Ms osg ml cs -- .7 � . 8 elev. 9 5 O tt. Depth to limiting factor 8 in. Remarks: Boring # 1 4 10yr2/1 -- it 2mabk mfr cs if .5 .6 2 -46 10yr3/4 Ls 2mabk mvfr cs -- .7 ►8 3 6 -9 10yr4/6 -- ms osg ml cs -- .7 .8 Ground elev. 9 6 -2D- ft. Depth to limiting factor 9_ in. Remarks: Horizon Depth Dominant Color Mottles Structure GPD /ft in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench Boring# 1 -6 10yr2/1 -- 3 ij 2A bK mfr cs if 5 2 -42 10yr3/6 -- bil 2ma mfr cs -- .5 ;.6 3 2 -8 10yr4/6 ins osg ml cs -- .7 :.8 Ground elev. 96. ft. Depth to limiting fa�tor tS in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in ' Remarks: SBD -8330 (R. 07/96) P3 _C3e neV�mcxrk e /f 0 /00 ` "qv �re� 5 S T ti bm `�- • � 0 a 4� G� J jW V a� ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND (� OWNERSHIP CERTIFICATION FORM Owner/Buyer e_o_ � O_ ' L k n d o� 40- -+ Mailing Address l c�.8 1 �� �� A UK. � V C krV)c)0 d -S Property Address $ a r - 7 tk 6"-e.• (Verification required from Planning Department for new constructio City /State � e_ e-t- W r Parcel Identification Number 03a - Q - s - D -- � LEGAL DESCRIPTION Property Location SL '/4, I C '/4, Sec. ls� , T�_N -R 1 Q I W, Town of J' 0rn e rS2_ Subdivision �ho� © c.v f' �` rl P�S , Lot # _ Certified Survey Map # , Volume , Page # Warranty Deed # , Volume Z , Page # 2 2 Spec house ❑ yes 2 no Lot lines identifiable [l yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of 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 wastewater disposal 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 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 y ,, ow sep 'c system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days f th e ' y xpiration ISIG A AP ICANT DATE OWNER CERTIFICATION I (w ce 'fy that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the prope s d above, by virtue of a warrant deed recorded in Register of Deeds Office. A PLICANT 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 • - t r STATE BAR OF WISCONSIN FORM 2 -1998 646587 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS — W01. .. CROIY CO., 41T Document Number .164 122 ST RECEIVED FOR RECORD This Deed, made between 05-29 -2001 3:30 AM __� Tnrnun n cmnttm a rnnTt m �� em��n r_ — WARRANTY DEED _ huc;hand and _ Wife -- - - -- - - -..— EXEMPT p Grantor. CERT COPY FEE: and Jean A Mattiacci and Linda Hoff _ _- P E: YSFE T FEE: 167.70 —� -- - --- - RECORDING FEE: 10.00 PAGES: I -- —_ -- ------- - - - - -- Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St CrQiX County. State of Wisconsin: LOT #8, PLAT OF SHADOW PINES IN THE TOWN OF Name and Return Address SOMERSET, SAINT CROIX COUNTY, WISCONSIN, WESTCONSIN CREDIT UNION P.O. BOX 269 NEW RICHMOND, WI. 54017 032 - 2116 -50- 000 ___. Parcel Identification Number (PIN) This is IIOt homestead property. (is) (is not) Exceptions to warranties: Rights — Way , easements,covenants, of record Dated this _ 2 4th `�� day of _ Maill __— -_ -_ —_.. 9001 (SEAL) - ^'i — (SEAL) Richard O Stout T - -_ net P Stout (SEAL) _ (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, Sr Croix --County ss authenticated this day of Personally came before me this ___2At_h__ -- day of May . 2001 the above named Richard - 0 - Stout and Janet P.____ - - - -- to TITLE: MEMBER STATE BAR OF WISCONSIN — me known ro cuted the foregoing al CONSIN authorized by §706.06, Wis. Slats.) I nstrument and e oN J. BAST THIS INSTRUMENT WAS DRAFTED BY — Janet P. Stout _1 - i 5'1 Awat ukPe_T� � -- - - -- -- Hudson, WI 5401 6 Ndtar Public, State �tppperanent, sin My commission is (If riot, state expiration date'. Si natures may be authenticated or acknowledged. Both are not Apr i 1 1S ( g ___ _... . 2 0 0 2 - -•) necessary.) Names of persons signing In any capacity must be typed or primed below their s,gnamre. STATE BAR OF WISCONSIN wrsconsm -.gal Blank Co Inc. WARRANTY DEED FORM No. 2 - 1999 W. -lee, ws v w m I 0 0 UNPLATTED_LANDSIOF OWNER V) - - - - -- -------- - - - - -- rn ' I I I I S89'2646 "E 1271.82'- 15 T OW N R ' :570 14 _ — - { — — — 6 � 6 +o4 "E ' " "� ' f _---- N89'26'46 "W 1239.60' -- — 246.02' i " -.tA'7 %c `' 30 I 23.57�� 12' UT /L /TY ' 1E0 �Q 1N% 04 5-78.04 ' 1 -- 13 I EASEMENT "-NH 4' 2 9 1 I / ` .�. ......... .. .............................. 80' 1 I 1N I o � 1 7 � w � 131.150 SQ. FT. 3.01 ACRES 131,028 SO. FT. c 1 131.284 SO. FT. r� 1 0 �' N 3.01 ACRES �, 3.(1 ACRES 13 SO. FT. �^ 1 M ACRES I 0') N •I• i 1 70 . • � ,,ice, �\ � M, � c i, 331.20' 248.84' 204.58' i • .194.00' - -------- N89'26'46 "W R= N89'38'55 " E _ I SOUTH L INE - - WETLAND THE NE 1/ �V li 5331.35' (TO EAST 1/4 CORNER)--- - - - -�- 25 YR H.W.L. R= N89'38'55 "E 1 i , 918.37 UNPLATTED LANDS ( -'+"ax COunfY step f __ -G oe'dQ i w , Ole 2 g 4 r S z i AI