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HomeMy WebLinkAbout038-1189-80-000 Wisconsin Dgpartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and 63uilding Division INSPECTION REPORT Sanitary Permit No: 399648 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: Driscoll, Jason I Star Prairie Township 038 - 1189 -80 -000 CST BM Elev: Insp. BM Elev: BM Description: o to v TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �C7 U U Benchmark ` Sc ►r o Dosing Alt. BM Aeration Bldg. Sewer Holding t/ t Inlet , TANK SETBACK INFORMATION t/ t Outlet 3 9� TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet _ ilp- Septic 7 / r Dt Bottom Dosing Header /Man. Aeration Dist. Pip 3 Hol Ing Bot. System I• J� o �=�S L PUMP /SIPHON INFORMATION Final Grade 9- Manufacturer Demand St Cover R PM 5 •3 �d � Model Number TDH Lift Fr' ' n Loss Sys Head TDH Ft Forcemai Length Dia. Dist. to Well SOILL ABSORPTION SYSTEM s BED/TRENCH Width Length No. Of enches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS -3 � SETBACK SYSTEM TO P/L JBLDG IWELL LAKE/STREAM LAG Manufacturer INFORMATION C M R R i Type Of System: I. U T Mod I tuber: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake / n Pipe(s) Length Dia �{ Length �S 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 Bed/Trench Edges Topsoil 12:1 Yes [W No Fnj Yes :[#:N], COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: 1 _6Z, Inspection #2: / / Location: 2141 138th Street Unknown (NW 1/4 SE 1/413 T31 R18,�11 Northgate Lot �21 Parcel No: 13.31.18.970 1.) Alt BM Description = 71 64 C.4 2.) Bldg sewer length = Z (� - amount of cover 3�Oj6e eu a� - , ov` Plan revision Required? i, Yes No Use other side for additional information. L__ / Datel Insepctor's nature Cert. No. N SBD -6710 (R.3197) r Safety and Buildings Division County (� ` 201 W. Washington Ave., P.O. Box 7162 S �-+ I visconsi n N Madison, WI 53707 — 7162 Site Address Department of Commerce l /`' aD gs� 3 l\ Sanitary Permit Application sanitaiy Permit Number 3 (34to 4 K In accord with Comm 83.21, Wis. Adm. Code, personal inf ti n fir V, Vw Check if Revision may be used for secondary ses Privacy�. I. Application Information - Please Print All Informati State Pl I.D. Number Property Owner's Name Parcel Number � . 3 (� . 9 7 e _ Property Owner's Mailing Address '" ? Property Location �h ST CPDX a 7 i v' -Q COUNTY j ca,) Si Sr,' -A; S T 3 N, R E City, State Zip Code Lot Number Block Nur*er Subdivision Name CSM Number II. Type of Building (check all that apply) ❑City 9(1 or 2 Family Dwelling - Number of Bedrooms []village ❑ Public /Commercial - Describe Use rWonsbip < ❑ J Owned Nearest Road l use Com lete hne B if applicable) III. Type o f Permit: ( Y Check only one box online A (numbering scheme for intern ) . p PP A For County use 1 New 2 ❑ Replacement System 3 11 Replacement of 6 ❑ Addition to S stem Tank Only Existing stem B. Check if Sanitary Permit Previously Issued FPe xmit Number Date Issued ) a- -o I IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 KNon - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. DispersaLlTreatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals./Days/Sq.FL) (Min./Inch) Elevation r / /V# 13 TS,91 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel: Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank - tam Q Dosing Chamber VII. Responsibility Statement- I, the undersigned responsibility for installation of the POWTS shown on the attached plans. Plumber's N (Print) Plumber's Sijnature MP/MPRS Number Business Phone Number X05 15 - � 51 Plumber's Address (Street, City, State, Zip Code) VIII. County /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date Issued Issu' Agent Signature (No ps) Approved El Disapproved Surcharge Fee) El Owner Given Initial Adverse J D . CAS Z Determination EK. Conditions of Approval/Reasons for isapproval 6'ti.. Attach complete plans (to the County only) for the system on paper not less than 81a x 11 inches In size SBD -6398 (R. 05101) o L RCL V\ A n10 LOT a] .Scfo17� loor L ��� s o2c-4� s eQ . / - � -oa \1� 14A a �7 -To � u*1k D� 0.fi� �• : 1 ,yss,FS(� N D n 1 �( h d 9 � Alt G', M O� PCL v\, , I A) �'�Ys� � S 13 T3/ N LOT:;val f:Z,c�\m" " S o ! r x 1000 0- s `�; Moo - Lo`l;&�� s �g 02 - ("re v�clw.d� !� Fs ? s Q "a . Ot\ mib ,orb, off` � 4 ' 4 i r �m �c�p 6 fv� � r►�' � 1 1 Ss.�SC� P -.O 1 i ` /} o me— h � 7,3 9 al Al m T ti I of Wisconsin otcantrnerca SOIL EVALUATION REPO RT Page � Division of Safety and &,Ncings in acaadartce vith Comm ti5, V1fw. Adm. code county � Attach corrrpide aft pan an pow not lass am a 112 x 11 inches in size. Plan must trtdude, but not irrdled to: vertical and horizontal reference point (BM). direction and Parcel i.D peraw dope. *cdo ord nwolorts. rel mo arrow. and iorsattort and distance m ar neest mad. . - I 19 9 - O V PION" print an knimm itfoq. by Date wr WAwpolon you peoM l my bo us.a for r»oa+d�rr ProperlYOvirter (� Propertyt melon oovt. trot A) tt.) lmZ4f lm S 13T 3 N R I i�Eo'W ProperlyOwneft Mating Address jag Block a '.,t' A Name A A� a NP A) �r CRY Sate Zip coda Phone Nurrlber ❑ CRY ❑ WrTovvn Nearest Road -QAl k LoT I 5 ot7 1 (S) a 1 New Cartstruction t%: M Redddentiaai / Number of bedrooms _ Code derived design flow rate GIRD ❑ RepMearrot ❑ ar Des: Parentmaterial eq C-I I l ct S -� Flood Plaln elevation a appicaae / - It. Garteral consrre►As f p � and s04� , F/-1 Boeing Gtourtd surface elev. / 01, 3 n Depth to limo factor 7/ 2 0 in soll Ho�iort Depth Docalant Color ftft Description Texture Strtxeure ConsisUnce Boundary Rood in. munsell 4r. Si. Cont. Col m Gr. ft Sh. -S WI T1102 o -i w i r. a � , s ia� m5 D 5 r n S' `�.L (DS. a 6odnp a Pit Ground wrtaoeatev: �c 7 R Depth a sm[ing facfo i Sol Rae Depth .. Redm Deaaiptim Texture Structure Cor tce B oundary Rcoa Gpom h Mansell Qu. SL Cant Color Gr. Sz Sh - m" 'E /o r a — H1 trJ ' S A 7 Vl • EMuartt 01 = BOO > 30 Z20 nV& and M 40 1150 mgt Effiuol 02 - BoD 1 rng& and TW 1 ffQ& Nerve = Nurrd r o t as Address Date EvaNmtlon Tdophone e 1�n c l— - 7- 7 1-oZ -�J 4 2 Property o,anx Sl (3 So _rti Forcer io # � Page Of Baring # Ground surisoe /0D. 3 tt ► w ttrritlrg Ihdo sat Rde Pit Hatt n Depth Oorrrirrort ftadox Deac�ipi: Texture Structure Cotrsi Wws Boundary Roots QPDtIE o in. Munsel OLL SL Cont. coior Gr. SL Sh 'E1t#1 D D Y rat .6 3. Q # ❑ ❑ Pit Ground srrfaoe alev. ti Depth to Batting tarAor in. Sol irate Holt = Depth W dnetrt PixicK Dowdpdm Texture Sduciure Consi�enoe �rrrlarY Roots GPM bAunsel t1u Sz Cont Color Gr. Sa. Sh. i E Borkv# ❑ Boris in ❑ Ph Grarx! atr(aoe sleV. ti Depth to imBnp �� Soil Race Gaon Depth Darirast GOIN FbKlaK Description. TOduaa SYu*n CamtdeniOe Boundary Rook OEM IM in. Mtneel Qu. SL Cont. Color Gr. SL Sh • Eftiu a #1 s WD O. 30 < 220 rng& and TSS >30 :150 frQ& ' Eftwt #2 s SoD, <_ 30 mg& and TSS <_ 30 mgA. The Department of Commerce is an equal opportunity service provider end emoye 60 8-213151 1 o TTY ante to setvlces or need material in an alternate famat. please contact the departmen at Y y fV ©- 6Jl r �a UEt a► <{0 3 7 �-�-s 4 55 •� p a f� J9 MQ� n I R1 2 IDh, 3 a° p� C — '.t t 1)CAUt '0 C C— .c c t 81 1- .Myy M j�j�/� • m 78 _ O X vs t!1 to cn a. < O c`n i { i • Y 8 F i •t e O t "� i f. S v cif �_ s { • a. U E 4 CL O O t Safety and Buildings Division County ` 201 W. Washington Ave., P.O. Box 7162 vviff sconsin Madison, WI 53707 - 7162 Site Address Dep artment of Commerce z2 5 z� Sanitary Permit Application �tar Permit Number 3 q 10e In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision may be used for secondary purposes Privacy Law, s15. 1 m I. Application Information - Please Print All Information State Plan I.D. Number r' Property Owner's Name p ` Parcel Number Z 3 ( �? Q 0 Property Owner's Mailing Address Pe�r rty Location bi I �>�� �... ? � N1 -AS 9-A T 3 1 N, R I K 9� City, State Zip Code Phone Vr N her Block Number QFF bdivision Name CSM Number V J LYE C 0.�. II. Type of Building (check all that aPPIY) \ s'`` ❑City 1 or 2 Family Dwelling - Number of Bedrooms -3 / a3 no n� � 1�t t � ❑village ❑ Public /Commercial - Describe Use r Wownshi, ❑State owned / � C� Barest Road 6 9 t 7S r M. Type of permit: (Check only one box on line A (numbering scheme for internal use). Complete line It if applicable) A For County use 1 New 2 El Replace System 3 ❑Replacement of 6 ❑Addition to stem I ank Only Existing System B. ❑Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44XNon - Pressurized In -Grou> d 2111 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ pressurized In-Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Dispe rsal/TYeatment Area Information: 7-2- 7Z Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals./Days /Sq.Ft-) (Min./Itrch) Elevation 5a 911. 3°T5 377 / , ���;�-1) ►'u R- qs, 4S"✓ 99,7 VI. Tank Info Capacity in Total Number Manufacturer Prefab site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank _ / Dosing Chamber VII. Responsibility Statement- I, the undersign , responsibility for installation of the POWTS shown on the attached plans. Plumber's Nam ) Plumber's gna MP/MPRS Number Business Phone Number 53 SJ . A '01(o CL=L- � ' I'.1 C) Plumber's Address (Street, City, State, Zip Code) 5" l VIII. Count /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) ❑ Owner Given Initial Adverse 2 r i L Determination J I IX. Conditions of Approval/Reasons for Disapproval 1. Effluent filter to be installed and maintained per manufacturer's recommendations. 2. The septic system is sized for a 3 bdrm residence. A violation of the state administrative codes would be created if any modifications are made to the structure that increase the # of bdrms /design wastewater flow. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 05101) �"us pros A)W 5,e s 13 AOIQ- W % SS'o ! Qvo c+--t �ap W Z- A - o© a T (.8 CPA a r j A& E I ice, 55,E I � 0 a ro r � 0 �o I �I r W%; SS`o 17 Nor rk & s /p8O r u�l -/ 00 w Z ,t b(.Q„ l �a, o I r w 1C�wh� $ CPA 0 L A h I � ID � I I as T 0 I 190 cn r C Q .t t I)GAUt td � ,E � rn U it'd ;Y N v, '? C c CL n � c L a dA_ _ 1 O. fA .0 O . Q1 , Q. 3 tq cn l '0 Q = .0 m y t r g :D 0 vs vi in ' o o - - � 't i 1 t 1 i 3 Y + F Fn o Z N cc i s F i 'mm a o o S ! Lki LL { W 4 f I r Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor Art', Human Relations Division of Safety &Buildings in accord with ILHR 83.05, 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 St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 0 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION R VIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION Greenwood Enterpri Inc. GOVT. LOT NW 1i4 SE 1i4,S 13 T 31 ,N,R 18 ft(or) W PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # I SUBD. NAME OR CSM # 1416 Third St. 21 na N rt Gate CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE ®TOWN NEAREST ROAD Hudson, WI. 54016 (715) 386 -3674 Star Prairie I 214th Ave. [ New Construction Use jr, J Residential / Number of bedrooms 4 [ ] Addition to existing building j J Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate _ bed, gpd /11 trench, gpd /ft Absorption area required 858 bed, ft 750 trench, ft Maximum design loading rate .7 bed, gpd /ft .8 trench, gpd /ft Recommended infiltration surface elevation(s) 95.45 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwaGh Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem K7 S ❑ U R7 S El EkS El ®S ❑ U ® S ❑ U ❑ S ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Ktw Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerldi ta& .................. ................. ................. 1 0 -14 10 r 212 none 1 2msbk mfr w if .5 .6 S 2 14 -34 10 r 4/4 none sicl 2msbk mfr gw if .2 .3 Ground 3 34 -84 7.5 r 4/6 none 0SQ ml na na .71 .8 elev. 9 9.1 ft. Depth to limiting factor +24 II " Remarks: Boring # 1 -12 1 2 2 •6 5 2 12 -26 10 r 4/4 none sicl lcsbk mfr qW if .2 .3 L . Ground '.... 3 6 -84 7.5 r 4/6 none o 0SQ ml .7 .8 ,� elev. 9 9.2 ft. � dLU Depth to limiting 1! 1 1q9 factor +84" �s .- ST RD Remarks: emarks: CST Name: -- Please Print Gary L. Steel Phone: 715- 246 -6200 `/ ( L ` Address: 1554 200th. New Richmond, WI 54017 Signature: Date: 10-29-98 CST Number: m02298 PROPERTY OWNER Greenwood Enterprise SOIL DESCRIPTION REPORT Page f 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GP — ................. in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITrench .................. ................. .................. ................. .................. 3 1 0 -11 10 r 2 S ................. 2 11 -2 .Z Ground 3 1 23—a4 ' elev. 9 9.1 ft. 5« dae,.b(ww. Depth to limiting factor �� Qr ys " +84" H3. a Remarks: Boring # 1 0 -14 if 2 14 -34 10yr 4Z4 Z Ground 3 - 4 0/ 6 none ' elev. 99.2 ft. — Depth to - limiting factor y5 „ +84 Remarks: Boring # 1 -10 10 r 2/2 none 1 2 .5 .6 ' 5 5 ' 2 10 -25 10 r 4 4 none sici lcsbk mfr aw if .2 .3 Z Ground 3 5 -84 7.5 r 4/6 none cos os ml na na .7 .8 elev. se e- 9 9.2 ft. Depth to limiting od 95. y factor +84 ti yes Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) u - r STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. Greenw000d Enterprises, Inc. CSTM2298 NW4SE4 S13- T31N -R18W New Richmond, WI 54017 MPRSW -3254 town of Star Prarie (715) 246 -6200 lot #21- NorthGate This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown 113;,.._as permanent lot lines were not established at the time the test was conducted. 'S3d08d BM.= top of 2" pvc pipe @ el. 100' Alt. BM.= top of pvc pipe C el. 100.30' C3 " Z 'Z y Gary L. Steel 10 -29 -98 I 3 -06 -1995 8:00PM FROM P.2 i, nm►w +max .nr�r ui�nc v� u�wewy, +b'' UI L AMU 011 C C V A L U A 1 1 V ��[^��/�. �� �1 Y 1 1 at .] m • lamer arWHu mn RoNmW �a Division of Safft 4,Widngs in &=ord with ILHR 83.05, W Aftch bompiste site plan on paper not less than 81/2 x 1 t inches in size. PI rot limited io vertical and horizontal reference point (8M), direction and % at : Wme D A dimbnvioned. north arrow, and localion and die tanee to nearest road. _ APPLICANT INFORMATION PLEASE PRINT ALL INFORMATH4N I', �a'.... ,t BY ' DATE PROPEM.OWNER: 1 G ; Lf1. ° : rs ` 13 T 31 .N,R 18 ft(q) w PROPERTY OYYNER' S t�AAN JNG ADt)gE58 5 4 th , Op GSM a 141§ M3ird §t G AT Z IP CODs` N UMBER' i .. OWN NEAREST ROAD , WI. 54016 (715) 386�3674-- $. iZtiie 214th Ave. [ New cons►udon Use is ] Residential / Number of '' �JVJ Addition to eids*q btAding i 1 RaPlaoert►errt Puetie: at mrrunereial dasalea Coda derives flow dad► _ gPd Reoottireridad raw 7 � . 9P _. H — aertGh, 9p AttaorpliW else required 858 bed; fl 750 --to dt; lf Ma ' . n rale. Dt)cf, gpd 18 . trench; gpd* . Rewrnmended inflitradon surface.elevaka(s) 95.45 ` : "w;. •0 er't ptl;<n 138M WK) Additional design •/ site oo sideratiorL, 178 Parent material eutvaah Flood plain 010 VOW, if ao§C*le ft r $ # 51JiG7bl@ for SyStPJrt 72G M VWnW C MOUND bV GAOUNO PRESSURE GRADE SYSTEM FILL NolDttuG TANK uQ Ursuimbi for S Dv US O v [ks ©U ®S Ov. ®S � v QS ®U SOIL DESCRIPTION. REPORT Depth Dominant Color Mottles Structure GPD Boring # Horizon in. Munsell p SZ_ C"tit Color Texture Gr. Sz. Sh :. Corts�inoe Bo rtdsy Roots lid Tierce 1 1 O— 1 .6 2 14 - 34 1 r 4 laaine Biel 2msbk mfr aw if .2 .3 Gmund dev 3 naL n 7 9J. h. how tag GfI S _ Remarks: Boring # 2 2 -2 . . s 1 mfr if .21 .3 Gmund 26 -84 7. Sy-r- sl�nr- 9 9.2 li r 10 ladng factor �r Lj Remarks: Cs! Name: - t?"w Print Gary L. Steel plow: 715- 246 -6200 Address: 1 S5 200th. New RjstM2nj, W154017. 5ignstutc: x Datc:10 ^29 -98 CST Number. m022" Signature: ° ` 10 -30-98 CST Nwaaw. m0229s 1 . ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM ' \ Owner/Buyer Mailing Address _ 1 1 x 5 Property Address (Verification required from Planning Department for new construction) _ City /State Ej !Y`^ L- Parcel Identification Number LEGAL DESCRIPTI n Property Location N w ' /., S 1& ' /., Sec. , T_,ILN -R__ IVW, Town of .5 X �-- Subdivision N Lot # Certified Survey Map # (0 S ©3 Volume 7 Page # _ _ o Warranty Deed # LOS 7 D ( , Volume (o8 Y , Page # 3 Spec house ❑ yes K no Lot lines identifiable K'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 ro er operating condition and/or 2 after inspection i necessa the se tic tank is less than 1/3 full of sludge. and pumping f g P P P g O P P g( necessary), e. P I/we, 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 your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. lit l>l 01 SI ATURE O LICANT 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 Private Onske Wastewater Treatment System lY�rna Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Prlyaft Onw/e Weateweter Treaknent SYslem (POWYS) shall include k*"'"IMOn► and Proosdwes for "w*"ning the syswn wilhin the Pew Of Comm 83 Ord 84. and the condlbom of approval by the deport nwt, agent, or 9ovamrnental unit. The apprOMOd plans and Pemnits for Wyslem we On file at the county aging or health depart"W". This nmuW r wg Plan complies with Comm 83.51, Wis. Adm. Code, and the in- Ground Soo Absorplion Component Manuel far Private Onsite Wastewater Treatment Systwns SBD- 10567 -P (8.6M). TOM 1: ism Permit Number Nesrbar of Sedroanrrs Design Flaw - Peak ( ) ESbRtataed tNgA► - A � T�r1it SON Stave � -- Type of wasteweler I DomestiC Table Z: Soil Aboot ption .1�111BS of Tank Sol AbwMftn Flow - M la= 377 eodrne m ln8uent Partin* 25050 1 Maxkar = 220 Maadrr>KSn T3S ) 150 Table 3; Meinftnence SdWddle SOPUC Tarn InsPed ardor service once 3 vow Sod Pillar nce o a yew and dam at least once every 3 yeem Vem once 3 Sead TIM The septic teak shall be meintorwd by an kxlividuai rid to service septic tenlm under s. 281.48. Stems. The cantanls Of #re septic tank shall be disposed of in accordance with NR 113, Wis. AdrrL Code (Servicing Septic or Holding Ter". Pwnpirtg Chambers, QnMM In tom, Seepage Sods. Seepage Pits, Seepage Trenches. Privies. or Portable Restroom s). The operating condition of the septic tank aril outlet filler shall be asseewW at least once every 3 Years by Wwpocbort. The outlet fitter shalt be cleaned as necesew to ensure Proper OPwa*m. The filler cwftlge should not be removed w*= prawsivns are made to retain Solids in the tank that may slough aff the abler wtM removed from its endoswe, ff rice Management Plan for a Septic Tank aid Soil AbBM*ln Component mw is equipped with an alarm, the filler shall be Serviced if the 00 is actvated con lY• tntecnrrittee+t filler alarms merit indicat sutra I1� ex an Impending co alarm. The Septic tank shah have Its cwtents removed when the WROM Of sctMn and shrdge in the tank exceeds 113 the liquid vokwo of the tw*. If the consents of the taint are root removed at the time of an assenmim t. mairaeraance personnel shatl advise the abater of when " next service needs to be performed to meirtloin less titan nWdmurn scum and sludge acowmilgtion in the tank. Manhole risers. aeons risers and covers should be irspecled for waler "WON and soundness. Access openings used tar service and assessmot shall be sealed wad UPW the won of service. Any Mertang deemed unsound, dAfective, or subbed to failure must be replaced. Exposed access cperdrW 9 tlren &*Idm M ftm*W shad be secured by an effective loddng device b prevent accidental or unmAhorkeed et*Y 11110 the tank. No +care shoedd enter a septic ear etNtar with CO" fbr say anon heft iA "� her erlftr*rg a aor ~ space. The abwoep"V r tike > *r oti»r hsM+nant of hoildi a W* M' corm low $11" and awe of a pardon A+om do N WIW of** &" sway he dMM W or er+P Tank abandMMOM shall be in ewe with Gomm 133.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. snit Al�nrntlen Gomoofle The scull adsorption component serving thh structure is designed to ac cW domestic wast.W from a residential facility. The limile of operation of this component are shown in Table 2. The kmgevlty at a sod absorption componend depends greally on proper and tti"Y �nco, and sYalem use within or below the lirri is of r olobie operation. Good vwatsr oonaefvabon p ractIoas by all ooaupants and #e inslsillibm at vaW cordwvlog pkxnbbV are trey factors in exleriduV the USOM 19e of this cernpWWO- Tire sod sbsorptw contportertt's operation must be assessed by inspection at feast once every three years. The ink shall Include reeordinp the tevets of PWK%9• if any. in the obaervaftn pipes, and a visual inspection for anY evidence of surbee Seepage or discharge from the component. On steeply doping tulles, w of erosion Should be War~ and reported to the owner for repair. The stMbos dhicharge of domestic w1181ew8lar or sewage from tits system is prohibited and considered a human hmO hazard. Tirsft around or over the MA absorption componeM should be avoided parda►IarlY during winter rrtWft. The compeclfon or removal of snow cover corer the c M may bad to hyd wAr. faihxe by frassing. This type of liaipue is usually W"Pormy, but is diltretd or irnpo is 10 rap& until wee dw cortdtiions improve. In on". sad compoollon aver this component will reduce diffusion of wqW Into the sell and dispersal Call. which may lead to more intense, and earlier. + rWiC cl VOV of the SO- 2 M SW AbSOMW C anagor ,OM Plan j a Sepw Tw* and p %nVrV o f dgeprooied WOO Wd shrubs tVfOCW OVSf Or V Aq n Wn *W of SW 00"Warant WAould be avokbd linos 1W "Maian W40 gw Wr4 mmi rmy ob9VW ws"V" fk)w- 3T. ChujA ziNIN,; = 586-4680 plumber = Calvin Powers - 246-5135 Replacement site will be that soil tested area by 03T Qj" 64et( (# 6 22 qq Replacement site must be left undis or management/ contingency plan must be modified and filed with the zoning office, outlining the steps to be taken in event of septic system, failure. 3 STATE BAR OF WISCONSIN FORM 1 - 1982 6!Ei 1 - ZU6 WARRANT DEED KATHLEEN H. WALSH �UC7� REGISTER OF DEEDS DOCUMENT NO. yi PAGE ST. f: CO. WI {_ RECEIVED FOR RECORD This Deed made between (keenwood enterprises, Inc., 07 -20 -2001 9:30 AN a Wi Ciornnratinn ANTY DEED EXEMPT ll Grantor, CERT COPY FEE: COPY FEE: and ja-r T T)ri arnl l and Ni ml P M Mt Marti n TRANSFER FEE: 91.50 RECOIRDING FEE: 10.00 PAGES: 1 Grantee, Witnesseth That the said Grantor, for a valuable riM, Conveys to Grantee the following described ml estate in THIS SPACE RESERVED FOR RECORDING DATA County, State of Wisconsin: NAME AND RETURN ADDRESS Lot 21 of the Plat of NorthGate, recorded in the p B em 89 _ Office of the Register of Deeds for St. Croix County, Title Wisccnsin, t5n May 20, 1999, in Volume 7 of Plats; at 400 S. 2nd St., #115 Page 46, as Document Number 603503. 77J� Hudson, WI 54016 038- 1189 -80 PARCEL IDENTIFICATION NUMBER This is not homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And qra_ n# -nr warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions, - - •'.. V1 o«u Flame, at. Lroix count Wisconsin. Y, UNPLATTED LANDS EAST - WEST 114 SECTION LINE -7 300.00' 120.00' 455.86' S89 °07 875.86' S 19 3,190 sq. ft. e ms' ? 0 2 1 451 ac. "� L o 105,056 sq. ft. N .4. 55,440 sq. ft. 3 m 2.412 ac. m 1.273 ac. oo N 0i o o O _ S89 °07'26'E 457.62' ° ` D S89 N Ln o 201.62 66 0' T I 1 190.00' ,o 192.41' L 3 m i o o I 24 � 23 o4 o I ' 611 �50' M co S0'� 2 0 P p 58 sq. ft.. d' '3� �• 1.404 ac. a 62,870 sq. ft. w W I N 0 1.443 ac. + I (n CO I I 58,898 sq. ft. o 0 LO 1.352 ac. L_ \ 1 � T I o o �� ► o 0 o Z z I 37.39' 6 6.86' 17 6 0 0 ° 33,133' 1 / I 14 ° V) - 187.20' _ _ _ _ 204.00' - - 6' 31 - 145.75'- 32 ° o CV) S89 ° 07'26'E 391.20' Se *07'26'E 190.00: n ' 213 TH A vE. ° o M N ° 07'26"W 64 7 ' _ — _ 0 73' 34 33 Z M % N 89 °07'26 "W 494.59' 145.75' I 15 ro THIS 80' RADIUS TEMPORARY (;UL-DE-SAC UTLOT 1 y � WILL BE AUTOMATICALLY VACATED WITH / ROAD EXTENSION TO THE EAST. 7.39' ° ° N 89 0 07'26 "W 16 a� N 89°07'26W 66.00' O O �p UNPLATTED LANDS LEGEND C SECTION CORNER MONUMENT FOUND LL ALUMINUM CAP z w ' O. 2" X 36" ROUND IRON PIPE WEIGHING 3.65 LBS/FT. SET J FFF T 0 1.25" IRON PIPE F nT n,,r, z