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HomeMy WebLinkAbout040-1263-60-000 0 12 i � O O O W Z 7 Z 0 3 f _ ao - C> CD 3 o l � m w y < p0 j w N 0 - 3 Q 3 G O_ 7 7 7 A O 3 N C j OD 3 — y - — W 7 A fA Z W � N O � C C J m - � cn Z D a � Z D m Z, m co' D N a m l m co D N a ° N W C W 3 O a 3 O m V ,. 0- N i A L W O f' !''f O 0 i13 R3 C < 0= I O O O ( O C CA •+ oc cn cncn <I 3"a CL ° v N 2 i A o 0 00 �I O OOpc «lvv o � I g- _' O 3 O O o _»' 3 Q O O CD O ° °--' O ° v' ° ��—' e� ° 7 M N O 7 .► �y CD .. om n7 fD .. ? 3 0 CL d .�► Z Z Z D o O = D o° O ° ° -0 m m ? m c m N • N y CD �J c (D c O O. N 7. ? N c A N 0. f , n 3 5 a 3 Z CD N cb Z (D fn tb A Z N o m D r o c D C 9 C6 n A 0 Z a a Z A 0 8 � co Z w D (D a I I o 7 NN 0 5 D am y v s D D o < a o < n> >. o. a 0) 0 my 3om _ Cr 06 —a) O 0 fD M' t0 O CD a 01 C CD j N fD N C < 'CD >• � Z 0. n j S 7c N) Z C. 7 7 fD 7 7 CD Er fV 0 0 0 LD. CD >• O2 N Z O 7 5 x d t0 m CO W = C 0 'O (20. O. fD 0. 01 Q< �0 _ C 0.. , C DZ CD --I y o'3 ° a te° gm y 0 o0 E °s CD �dc�i °cmm 5i(D a Z 0) 0 7 w 0 0 0 M ;C O _ N f ° f C C - N - =r DO N Q V 0 fi C 3 ' < ao fD •• fC O 3 <0 a•` I N 3 w CD Q C O O d f0 ° c m m3< l i, N d ° .CDm3° o p fD 0 O. A. 0 ? b f (D N 40 N 00 00 ." w CD CD o co �° b o : o CL Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 479319 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: Nelson, Michael 7 Tro , Town of 040 - 1263 -60 -000 CST BM Elev: Insp. BM Elev: BM �5piion: Section/Town /Range /Map No: • v 05.28.19.1424 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 'ti./► /, f `2 / Benchmark 4 ulA _ Alt. B_ t / 8 Z 0 1 I Aeration G _ ` _ Bldg. ewer f U Holding St/Ht Inlet 7 .9 3 93. TANK SETBACK INFORMATION S t/Ht outle TANK TO P/L WELL BLDG. Vent to Air Intake ROAD D Inlet �' a Se�j�� ) / i Dt B tt t He Man. Aeration Di t. Pipe Holding Bot. System Final Grade PUMP /SIPHO FORMATION Manufacturer Demand St Cpver GPM RX4 I Pwk Model Number TDH Lift Friction Loss SystemNqZd T FH Ft Forcemain Length Dia. Dist. to Well SOIL AB PTION SYSTEM BEDITRENCH Width Length No. Of Trench 9s I PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION T Of System: CHAMBER OR Y UNIT Model Number. r. DISTRIBUTION SYSTEM Header /Manifold I D istribution x Hole Size x Hole Spacing Vent to Air Intake Pipes) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil E] Yes E] No Yes :[ COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: � / - 1 7 X /05 Inspection #2: Location: 421 New Century Drive Hudson, WI 54016 (NW 114 SW 1/4 5 T28N�R1 " 9�W) Frontier Lot 7 Parcel No: 05.28.19.1424 1.) Alt BM Description =V � Solt aoh//� d-rK.. 0 � � 7'tQ�'�htT OIP-/' 2.) Bldg sewer length = Z � I ] ✓ l���'/- �, u � w aa/a f m Y*../ / - amount of cover = t , /- I a_ /� P 1 � Plan revision Required? _ ] Yes Akl�o I / Jas—v Use other side for additional information. 23 65' ' ( (O ,T Date Ins SBD -6710 (R.3/97) epctor's Si nature rt. N J,� Safety and Buildings Division County � N V 201 W. Washington Ave., P.O. Box 7162 �� R O X SC��SI Madison, WI 53707 — 7162 Sanitary Permit Number (to be filled in by Co.) Q (608)266 -3151 1 1 11 7 1,3 1 J.. Department of Commerce State Plan I.D. Nur In Sanitary Per i P 1i In accord with Comm 83.21, Wis. A pe 1 information you provide may be used for seconda u Privac Law, s15.04 xm) Q ?_ Project Address (if rfferent than mailing address) 1. Application Information —Please P ' 1 Informatio RW ;�013NT ° Property Owner's Name _ Parcel # I Lot #' Block # MI1 I� Property Owner's Mailing Address Property Location AI �A ) �., � Y., section City, State �r Zip Code Pt 14 J l?t I�(circleone) (J )� S nl l V 1Q T N; R E or W II. Type of Building (check all that apply) Subdivision Name CSM Number [3 1 or 2 Family Dwelling — Number of Bedrooms A.t/ Nrl ❑ Public/Commercial — Describe Use [I State Owned — Describe Use ❑City ❑Village�Township o III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only <d 01 f r Modificat'n te�xisting System l N b1, JL List Previous Permit Number and Date Issued B. ❑Permit Renewal ❑Permit Revision ❑ Change of ❑Permit Transfer to New � !, � �� Before Expiration Plumber Owner O IV. Tyjwof POWTS System: Check all that appl on — Pressurized In- Ground ❑ Mound >24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In-Gro ❑ Holding Tank ❑ Peat Filter 11 Aerobic Treatment Unit ❑ RepiScyl Slpcd F(Iter ❑ Recirculating Synthetic Media Fitter Ching Cham ❑ Drip Line ❑ Gravel -less Pipe �ther (explain) hhWW as fI V. Dispersal/Treatment Area Information: L n I I ) Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (st) Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks I_I Septic or Holding Tank as� t 3 Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POW1`S shown on the attached plans. Plumber's Name (Print) ature MP/MPRS Number Business Phone Number -/-S 0b L Plumber's Address (Street, City, State, Zip C 167 VIII-Countv/Departincrit Use Onl Sanitary Permit Fee (includes Groundwater Date Issued Is g Agen Signature( t mps) Approved ❑ Disapproved Surcharge Fee) ❑ Owner Given Reason for Denial IR. Conditions of Approval /Reasons for Disapproval dj� Atta complete p the County o for the tem on r not laa than SI ► R�z 1l�inches in size SBD -6398 (R. Oft) .. Pei 8 6 V . o y «ik� r � /u t. � /.► " ov O o . � : , New ►aLo ��`�� __... ���►�`� W � ps wu ?21 ffIE: tc now i .` �YM 4, �� K b � _ -� O < zrn0r 1� 0 C - z (As 53 O m O z� rn ❑ ,' M m X m �p —� Cf) - O rn N m "' o ol x i� -v -q z 55 CO) _ C m n m X 0 C/) c OD m z '� a v �1 z O 4 X o p z M r Z m 0 �,_ Z z z - 7C 0 G) m � C r ..... CO a _ Z m M G) C om m O m O m „ Z 0 0 —d m< II I, m m a '`' ;u < m s a ? E CO) Z O �o � ��I����gleM z l e t ^ m rn m g �d m 0 Tc HERE H Q Q x3 x w g 0 0 Z > I ■ 5p i � Q�4?1' ✓ p. t /- 5 Q lei Ile" & - & /(, /, or ScG4 : s�o 573.7,E r �'� }Y ='! 6Cr (.C. -5. C. S, e %d ionS� /c� «c+►cL�✓fn q u �. lof corrte� g ( 8 i ' /,, 6 / �-o Vjr /oL S e = 87577' 82 8 yy 37 L33 8 y/• 88' a� 83 7. 66' d 837.72 ' L�. ,�.� Q•/ i/J S S c E/e ✓` = i .off Area 6; h l -9 ek �0,0,e Bi 8S 84 3kncj M, Tp of' w en Vi nce �asf 7 4 t /6 ,4ssu,n e Jed =i�? cD' ,( E iS ekr -- PIE � . sb FROM PHONE N0. Aug. 09 2000 01:15PM P1 o . ♦ ♦\ 3 ON NET bU .54 A r CRES '`•�_ - c3 FT 212,48 FY �2 027 `� 8.38 FT �231-70 Fr (� 1 ;J / REST Y- S r - 7 a L T r l r l 3.71 ♦ `CRt"S �, r L, 161 3 s u N BUILD. �. . 0 a�RE� � r // 1 I / �V FT � N � �� / / l fi r/ 1 f � ! w / / 00 LL. CN CK) LLI ro FT 209.55 FT {= ! r 2 4`.- r wotel Le L (c�G Wisconsin Depa rtment of commerce PRIVATE SEWM y: � Sat�t� and BVIdings,Oivision AGE SYSTEM Count INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary PermitNo.: Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (i)(m)). Permit Holders Name: ❑ City ❑ Village ❑X own of: Statel0lan ID NO.: �— Insp. BM Elev.: BM Description: Parcel Tax No.: � •p tZfl . t� f � or u.+oe� t � CST es^'t�1 0 4 0 12 6 -1 6 Q_ :0- Q:_Q TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark (S. �S IIS"•IS bp.o r Dosing Alt RM Aeration Bldg. Sewer Q Yt Holdin St/Ht Inlet C� 12b• q Z 2� TANK SETBACK INFORMATION St/ Ht Outlet I �6 �b �.� 1 z t -�S I Ve TANK TO P/ L WELL BLDG. Air l to ntake ROAD Dt Inlet ---� Air I Septic ? iaO NA Dt Bottom —� .I t Dosing NA Header /Man. 08,9" 9 •!0 I0.Zz ld Aeration NA Dist. Pipe '7-Z2 Holding Bot. System H o PUMP/ SIPHON INFORMATION Final Grade p$ . 2.O' Man facturer d Cd r p -} �ZS• � Model er GP TDH L on System TDH Ft p H ead Forcemain Length I Dia. SOIL PTION SYSTEM 13 �.a�� ' "C'L RENCH Width r Le pgth p � No. Of Trenches PIT No. Of Pits side Dia. Liquid Depth DIME 3 81 257 DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING fulanu� r: S CHAMB �� INFORMATION Type O Moe System: >/'D Iwo � OR UNIT DISTRIBUTION SYSTEM �,,. f` �,(1e��.:�,�. C -aaf L • C •, +° +"- Header/Manifold Distribution Pipe(s) I x Hole Size I x Hole Spacing Vent To it Intake Length7 tl �5 Dia. � Dia. Spau 7 �6a 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 ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc. 7 N � Inspection #1: 05 4016 /01 Inspection #2: -4- Location: 421 New Century Drive, Hudson, WI 54016 �N� 1/ SW 1/4 5 T28N R19W) - 0528191424 Frontier -Lot 16 {r+ee CSr e'L 1.) Alt BM Description - Y � 1 2.) Bldg sewer length = 2 a1} C ••� 5 �'(u -� ' 1 D;- - T - amount of cover - ► a S - Plan revision required? ❑ Yes No - U e ther side for Ladditi o nal infrr�tion. tr a ��- � DI (,• Z Date I spect is S�gnatur i� Cert. . o- � R. a,. .e ac� 1�k� v v t S P ` , , �l • 42-1 NEt„> Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. PO Box 7302 `4.�j`i(�nsin See reverse side for provi for completing this application Madison, WI 53707 -7302 Department of Commerce Personal information you provide may be used for secondary purposes (Submit completed form to county if not [Privacy Law, s. 15.04(l)(m)) state owned. Attach complete lans to the county co only) for the stem, on a er not less than 8 -1r2 x l 1 inches in size. State Sani 1,,w tjt Number ❑ Check if rm� iigrl to p vio pliltion State Plan 1. D. Number Co ��/ L� I. Application Information - Please Print all Information �_ Location: Property Location Pro Name Owner , �tty 4� S /a,s T i& N. R49 o w Property Owner's Mailing Address t Number Block Number City, State Zip Code Phone Number Subdivision Name or CSM Number / al) H LO 1 55 4 Z. T► ❑City II. Type of Building: (check one) �[ ❑ Village 6' 1 or 2 Family Dwelling - No. of Bedrooms: (_— "KTown of -tee Public/Commercial (describe use):_ ❑ State -Owned Nearest � R qqad LCOVE / f' Parcel Tax Number(s) (e '( 0 0C III. T e of Permit: Check only one box on line A. Check box on line B if appli cable `i • 1 `4 _�_ L_4 A) 1. New 2. ❑Replacement 3. ❑ Replacement of 4. 5. 6. El Addition to S stem S stem Tank Only Existing System B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) ro ❑Sand Filter ❑Constructed Wetland Non - pressurized In- ground LE AC# t � ( Mound Pressurized In-ground r <3aF ��� ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At- de �, V (�Z it NCH S ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Di.s ersal/Treatment Area In formation: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation E F on v G rade Required Proposed Rate (Gals"day /sq. 1t.) , (Min inch (O y i )e � Q ( O b 1 (P7 VII. Tank Capacity in Total r of Manufacturer Prefab Site Steel F l s Plastic Information Gallons Gallons Tanks Con- Con- g New Existing Crete structed Tanks Tanks ❑ ❑ ❑ ❑ S FPT El 1 W �� T 7 � VIII. Responsibility Statement I, the undersigned, assume responsibili for install of the POWTS shown on the attached tans. Bu Phone Number Plumbers Name (print) Plumber' Signature (no stamps MP/A4PRS No. Plumber's Address (Strce City, State, Zip Code) (670 Ha S (Z X�bro IX. County/Department Use Only Sanitary Pemril Fee (Includes Groundwater Date Issued Iss ing Agent Signa (No stamps) ❑ Disapproved �Y ` $a Approved ❑ Owner Given Initial Adverse Surck4e Fee) Determination S• X. Conditions of A. proval /Reasons for Dis p�pr�oval: Ail S.t �� T We- s.A o�i S+t`bc -Q %t ~ S �X�' O^G -o.. i.1�•� -�' COG - - A DR) VIC F, l ee 97 1E tE 7 /6,, AS IV f' vL, 4 ' i :, I Cl 4. (e S.Cala- I // - /ZC t, JAS r2 - 47 L I 1 7 I? Nc Pi F s S 7 r,#c ne C- t4 c H Lf t14 • IV* E I eakt 7 I li- �BMD-- elf cvop 0 I)e,.7 DEC -1.4 -2000 12:18 PM A.C.E. Soil & Site E�al. 715 248 7764 P.01 ,y . 04. Soo * & " v'C d uwt&v w .Tam !G a 'rAhNX16&V'rX&jPevftr hbvnw a0E#4MAP CW4#W Bail ?Te &r &ww #3003 Fax Transmission To: Fax #: 1 15"' .3 -A From - Am Thom pson, A.C.E. Soil & Site Evaluations Fax #: (715.248 — 7764 # pages includine cover sheet: Z If this report is incomplete or illegible, please contact Jim Thompson at telephone #(715) 248 —7767. d i e . ' 0 r dw cam( DEC -1.4 -2000 12:19 PM A.C.E. Soil & Size Eual. 715 248 7764 P.02 r ■ moo; I umr V46'C- P.•f cr�nGr •� l . Loc j d Prom. P4 L � �-nC r0 W.Avj gj4, C . S T..1�if IP �9c cr Tray, 573.7.1 So, / br; ZOM(p 4. S. C.S. e%�irmr, rcl rc�iee c(& /J. f&;. /o come. 8 ( 8 /o'E /B� rqv of /a a E+. = 875 77' 82 8yv.37� a3 ay/. a" B 837.68' 8S 8 3 7.7,E ' Arta e! f , ,6. / a '/ : �1 �' c�.� �.e_ 8 � ■ Pr�..� a,,y srsfe B3'M. -7 Skye B3 7.s 8S B!� Lc snes�M,,r 'Ta n rence posh. r7 4oC /6 ,fssujKecIL*kt�-1Orb' (a.s,r,A ek ,-= x2 . so 1 0 1 1sconsin DepaitmentofCommerce SOIL AND SITE EVALUATION Page t of 3 ,`'Division of Safety and Buildings in accord with Comm 83.05, W is. Adm. Code A.C.E. Soil &Site Evaluations Attach complete site plan on paper not less than 8'/ x 11 inches in size. Plan must County include, but not limited to: vertical arid honzartal reference point (BM), direction and St. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D.# Prt of 040 - 1022 -10 APPLICANT INFORMATION - Plea wIntt all information. � � B y Date Personal information you provide may be used for ndary pu es (Privacy Law,,s. 15.04 (1) (m)). Property Owner '�roperty Location Miller Sam Govt. Lot NW 1/4 SW 1/4 S 5 T 28 N,R 19 W Property Owner's Mailing Address i , L ++ t # Block # Surd. Name or CSM# P.O. Box 151 ` ` i 16 Plat Of Frontier cit State Code Pti r City ❑Village ®Town Nearest Road Hudson W1 140 16 z ka769 Troy Tower Road. ® New Construction Use: ❑ R ' ential f Number of bedrooms 4 ❑Addition to existing building ❑ Replacement ❑ Public2fr�somm�r aal dE:.sa be Code Derived daily flow 600 gpd Recommended design loading rate •5 bed, gpd/ftz 6 trench, gpolftz lion area required 1200 bed, ft 1000 trench f? Maximum design loading rate •5 bed, gpdr .6 trench, gpd/fF Recommended infiltration surface elevation(s) 104.0',103.( - / °� to site plan benchmark) Install 3 trenches using high capac 8 l g ( 1n-ground prey or'At grade Additional design / site considerations o, Parent material Glacial outwash �� S � St _ m 1 elevation, if a licable NA ft S for system Conventional Mound Ir (oG r.� �� i System in Fill Holding Tank U= Unsuitable for system ®S ❑ U ® S El U ,� G. V A' c6 ❑ S ®U El ® U SOIL DESCI �ev qe �, t I �j Depth Dominant Color Mottles L- C'— P if VVq Boundary Roots GPD/fl? Boring# Horizon in. Munsell Qu. Sz. Cont. Color Bed Trench 1 1 0 - 15 10yr3/2 None sl 2msbk mvfr as 2f 0.5 0.6 2 15 - 25 10yr4/3 None gr.ls Osg ml gw if 0.7 0.8 Ground 3 25 -48 1Oyr4 /4 None gr.ls Osg dl gw - 0.7 0.8 elev 109.51 ft 4 48 -127 10yr6/4 None s Osg dl - - 0.7 0.8 Depth to o . o' limiting factor 44 . I Z o z. f �- >127" Remarks: 2 1 0 -19 10yr3/2 None A 2msbk mvfr as 2f 0.5 0.6 2 19 -32 10yr4 /3 None gr.ls Osg ml gw 1f 0.7 0.8 Ground 3 32 -56 1Oyr4/4 None 9r.1s Osg dl gw - 0.7 0.8 elev 108.02 ft 4 56 -62 10yr5 /4 None grAs Osg dl gw - 0.7 0.8 Depth to 5 62 -117 1Oyr6/4 None s Osg dl - - 0.7 0.8 limiting , factor /0 Remarks: CST Name (Please Print) Signature: - Telephone No. James K Thompson . Q 715- 248 -7767 Address A.C.E. Soil & Site Evaluations l Date CST Number Ref # 340 Paulson Lake Lane, Osceola, WI 54020 12/31/1999 3602 1165 PW)PERT1r0'W,NER: M iller .Sam • SOIL DESCRIPTION REPORT Page 2 of 3 VAR M k Prt of040- 1022 -10 A.C.E. Soil & Site Evaluations D�th Dominant Color Mottles Texture Structure sistenoe Boundary Roots c '� Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed � Trench 3 1 0 -18 10yr2/1 None sl 2fsbk mvfr as 2%nn 0.5 0.6 2 18 -22 10yr3/3 None sl 2msbk mfr gw 2f 0.5 0.6 Ground elev 3 22 -60 10yr4/3 None sl 2msbk mfi aw if 0.5 0.6 105.53 ft 4 60 -121 10yr5/4 None Is Osg ml - - 0.5 0.6 Depth to limiting factor >121' � 0_7. Remarks: H #4 contains a mixture of s1, Is, & s, with Is predominate. Loading rate adjusted to reflect least permiable component of horizon. 4 1 0 -29 1Oyr2 /1 None 1 2fcr mvfr as 2f &m 0.5 0.6 2 29 -53 10yr3/3 None sl 2msbk mfr gw 2f 0.5 0.6 Ground elev 3 6 10yr4/4 f2f1.5yr5/8 heavy A 2msbk dh aw if 0.5 0.6 101.33 it 4 76 -120 10yr5/4 f2d7.5yr5/8 is Osg ml - - 0.7 0.8 Depth to limiting 53' Remarks: H #4 very wet, approaching saturation near bottom of horizon. 5 1 0 -20 1Oyr2 /1 None 1 2fcr mvfr cs 2f &m 0.5 0.6 2 20 -31 10yr3/3 None is Osg mfr gw 2f 0.5 0.6 Ground elev 3 31 -50 10yr4/4 None Is Osg dl aw if 0.5 0.6 101.37 ft 4 50 -66 10yr4/4 f2f7 heavy A 2msbk dsh cw - 0.4 0.5 Depth to 5 66 -105 10yr5 /4 ,f d7�yr5/8 is Osg ml - - 0.5 0.6 limiting factor 50 Remark . #5 contains 1/4" -1/2" discontinuous bands of 10yr3 /3 Ifs at 8 " -14' intervals. Loading rate adjusted to reflect permiability restriction assocafted with e. Ground elev Depth to limiting factor Remarks: 3 of3 ■ 5v; ( aszrV"'4 P, t ©inner c� : �c�.��Pr'°i'°• L l � / 5�a•�f'e Q en I;fi Ile e �a� jQr 0/0. J� /a L 07 / /Dn Cj er ✓ 573.%2 a;/ i o Ueda nee. B � ■ �� j 53 as' a� Lot ,cr+c� wla+ To p o f two an 4eme zi . sty �I 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 I Number of Bedrooms Design Flow - Peak (gpd) Estimated Flow - Average (gpd) Ott Septic Tank Capacity (gal) Soil Absorption Component Size (ft') t o c� Type of Wastewater Dom stic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) 12(P .8 - q Maximum Influent Particle Size (in) V 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the se nd outlet filter shall be assessed at least once every 3 years by inspection. outlet filter hall be cleaned as necessary to ensure proper o e ion. The filter cartridge show 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 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 wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 Management Plan for a Septic Tank and Soil Absorption Component Plantings 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. 3 NT� �Q"r l F go eP BioD iffuser 1catlons J 76" pp Chamber p° ©© OO V --- �° ° DO C=J C_� 0° Height ao 0 0 ©© pO Chamber Height End %ew 34' 4" Knockout Universal End Cap ,Available Sizes ti y,1 r _ • ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer S A / f ( /l i I LL-E (iL - Mailing Address R f)( 3t: S / Property Address 1 '/ Z / N E L4/ 4� t NT J 0L (Verification required from Planning Department for new construction) City /State �Y V Q .SD N U.) I Parcel Identification Number (0 3 LEGAL DESCRIPTION Properly Location N V V, � V4, Sec. . T N -R ,Town of r . Subdivision T-9-0 Lot # I G Certified Survey Map # Volume , Page # Warranty Deed # ( 0 ( &q , Volume ( y , Page # yz- Spec house 0 yes ❑ no Lot lines identifiable 10 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 mastorplumber, journeymanplumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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. o z / ®_7, 00 SIGNA 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 operty described above, by virtue of a warranty deed recorded in Register of Deeds Office. .o f Z /07/00 SIGNATURE F AP CANT 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 soli 1.442oAGE 42 '. S[AI E BAH UM WISCONSIN FOtUN I - 1998 606841 - . W ARRANTY DEFD KATHLEEN H. WALSH REGISTER OF DEEDS This Deed, rustic between Kathryn R, Tuleren and Ferris -- ST. CROIX Co., WI R_ nil g rn a wife wQd h.-, -i—od RECEIVED FOR RECORD Grantor, conveys and lv=;us to 07 -14 -1999 11:00 8M Sate E. Miller. a sinstle person. WRRAMTI Ofd EXE PI Grantee. CERi COPT FEE: Grantor, for a valuable consideration, conveys and warrants to Grantee Curl FEE: the following described real FEE: 2228.10 al estate in St. Croix County, Slate of RECORDIM6 FEES 12.00 Wisconsin ('111e "Property'): PAGES: 2 Recordird Area Name and Return Address 1 040- I M2 -10: 001022.70: 010 - 1021.90: 010- 1029.30: 010.102/-70 Parcel Idcniflurion Number (P1N) This is not homestead property. (See Attached Exhibit "A ") Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any Dated this 13th day of July, 1999. • ° K athryn B. ulgrcn "Ferris R. Tulgren AUTHENTICATION ACKNOWLEDGMENT Signaturc(s) STATE OF WISCONSIN ) ss. authenticated this day of St. Croix County ) Personally came before me this 13 day • of July, 1999, the above turned Kathryn B. Tularen, and Ferris R �lAgren, wffe - and -- TITLE: MEMBER STATE BAR OF WISCONSIN to (If rot, _ _ me sown to the per s) wtso excLutcd dtc foregoing authorized by ¢ 706.06, I". Stars) — — iruvu and acl I � tie sane. THIS INSTRUMENT WAS URAKIED BY Attorney Krlsdua Oglaod • —' Hudson, Will 5406 N blic, State of Wiseonain (Slgnautiel nuy be authenticated or acknowlWiled. Both ate not My Commissio is ntm If not, Slane expiration date: / f r � rcua d aary'J i, $reads Poultn �—' Notary Public State of Wisconsin -Names of person signing In any capacity should be typed or printed below drelr signa0uts wnaaAxry oasts rrAn tuna or wracoww ►ow rr. t . to•a MG Dnt.N nON PAU a 114104A 9 COW"" FOWDVUC.W1 41ME reds • 1442 43 EXHIBIT "A„ r el of land located in the NE' /• of SE ' T� Township 28 North) Range 9 ,/, That certain pa o St: Croix County, Wisconsin more fully described as follows: of SW '/• and the /• of SW '/� of Section 5, A .thence N87 °51'0 "E West, Town of T y, c orner of said Section 5, nce of om isle rter c 5 a d West qua said Section ) , ginning at the quarter line of s " feet to a Be 9 .West q ° 288.00 g e East 108 E, (recorded bearing on the SW ' /.; thence along said East line, 2342.2 feet; thence S00 °13'24 "E;854,00 feet, thence N87 the nce along the point on the East line of said NE 1/4; + 4 f W ' /�, S00 °13'24 "E, 466•o8 feet to the SE come so()- t d une of said N / g� °54'5a "W, South line of sa id NE' /• of SW /� an 170.48 feet; thence S said S87 °54'54 "W, 2372.41 feet; thence N00°30'28'E, 273.91 feet to the monumented West line of said N 941 26 feet /thencae along , 458.40 feet to the North Ima of said NE /. West line, N00 °30'28�E as N6 (recorded 54 50 "W) ( recorded as ,1,32'36"E), ° 0,13 "E N64 0 57'4 7 "W ( recor said North line, N88 2 25 (ods) to the Point of of SE of Section 6; thence , 6 sg feet (recorded as S88-401 and N89-24-4 ) Beginning. i 1 s � 3 "419a1�s'� 3. , ./' 333 � — «'`"i"'"'��'"� -� ' — -s � - -- — — — —, .•-; �.:; U — _" • 1 *A SS r .- � .r.ere ti vw. nc :... ----- -- -- --- - Lots ( s? a t N� 109191st¢ f 20' Draina UliGly Casement j v, - � LGtt13 d14 40' 11 ?d�8s�/R 1'M s4R' ° L /� 1 � 4 / 150, S4 p z M I o-` d b 1w twllbllw 'l • 1 �• ®v / �ar+ DW-Y fASEME 21 1 IN 140 J Ir9 M < 2 ` 09.04' �' M. 33 ' Si \ , S 87 w 34 M 988' 1 ��Md b o tlM bia S 8 E 31 .sr °� 1sipism � �d 9 �� rarer -i • ns. � -. • -•- - -2a:2 �s,� �� 1� E• r i1t97.�Sst�R �'� •� ••� / 1618ao�s n 75 Sol l 119U?9sq /t 7 \re:1 r �17 LGI!~16 & C\+ —. � N! pond", dOri 3�7dIA'L4� .�i11 .-.,,� ® 4 1`91 6 .' 588'49'1 ' Or• 16I. 6sp R r iv 1,�pg 135-W sq t ' Ld 1S `�.,, jx r z81Sao�s 14 , , o 1& 13 I Lfat l4 0 ..... _. 3. la IL ff +D a X20' Drainage ' 264181a�e °�- 78-q r r Easement i 8"WL 11ws4F lt 8411 � �' ,• •• " u d bi,. Temporary Cut de oulomalicolly vam'er S41'50'7S I1'� har T �� r i se , future wad eztens r,: .� S 03'08'39" E / ! 4 N7,5' 4 41 00 1052 ' 45. 4 500.9u 35.10" 5oulh me 4 -SWi 4 c. _ � �; _ ouch hne 4 - t - -- 1051.24 -- S 87 W 2372.41' — — 1321.n -,- ylp L QleLW ly QW94 LEGEND p� I�rre • k*Oles I" Iron Pipe Found Indicates 2" Iron Pipe Found C.T.H. "F" I NW -NW i NE -NW NW -NE i NE -NE i ♦ Indicates I -1/4" Iron Hor Found I � i - -- • - - -' " _ _ Indicates Government Seclion Corner, J�N� �RI r -) 0 as noted i � SW -NW I SE-NW SW -NC I SE -NE 6 I Indicates 2" x 30" Iron Pipe Set r 0 Nin. WI. - 3.65 Ibs. /tin, 11.) ,�. NOTE -All other loi corners - ' ..'` • ( NW - I NE - SE' I menumented with I" i iron Pipes weighing 1.13 Ibs. per lineal fool. "F ! 1 i ±..► Proposed Driveway Location 1 SE -SW 1 SW -SE I SE -SE` I I 1 j —�-`- Fence t .. —._ . —i`MA ^CiH.. i�...._._i.— .....� Roadway Setback line t. JyIA' j, 11' Wide Wily Eosement I pM of `R� ) Recorded as - Slam Water retention area to Nigh Water EkNelion I lobe CNWAI*O in * va ho w M wftr �ThaOt3 � h1�iphh Wv�llorarown. arwNwwnr l td 00 tw bmwalopbm Otto Imb of