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HomeMy WebLinkAbout040-1225-90-000 0 E; 0 5 ( ' J % (D E 2 e 7e z/ z � /( / j E A \ � _ ® W CD � ¥ 00 w@E03 ƒ� E CO e � E 8 C 2 @ R k: 0 2 e 03 ^3 CL0 f ° - 2 � 0 � § l ƒ CL E CD \ � CD 2 2 § a \ % C) ° _' \ 2 CD CL \ { § § M. ( § § [ n r ■ m f e e 9� 2 J ( 0 0 0 M - 2 c § § § ) §� �® % \ - § @ ■ ■ �_ 0, o- A» C co i [ ; CD / ® 2 # z ® � / o �%\ � / ¢ §/ �- I / C $ ¢. / §. z CD _ w - / E ¥ G ) ƒ ■ / 2 E§ $z ƒ eeemF_> . \CD z k § / \ ƒ \/{ "n %kt\kZ C . ( CD 3 ƒkk t o 22� ■ Ea= CD a co . k � 3 / \\\ / kƒ%/ % ] ■ 0 00 ° § - o § § \ , � Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations Dvision of Safety & Buildngs in accord with ILHR 83.05, Wis. Adm. Code COUNTY a; r'- Attach complete site plan on paper not less than 81/2 x 11 inch st inciude, but not limited to vertical and horizontal reference point (BM), a a f e or PARCEL I.D. # dimensioned, north- arrow, and location and distance to n , 11s APPLICANT INFORMATION- PLEASE PRINT A ORMTI�OA REVIEWED BY DATE C* PROPERTY OWNER: P , RTY L. ON �- �'S ►tib ��►J t'c L Mil , ` �. G81R -1 OT : 1/4 S W 1 /4,S 9 T Z S N,R 9 E ( w PROPERTY OWNER' :S MAILING ADDRESS 3 ' ; # KOC # SUBD. NAME OR CSM # y S D IQ. G l v �Z p1j� j ` �' ,cam' ,' ;.. v Lo v ek \ �l S CITY, STATE ZIP CODE PHONE CITY.' GE ®TOWN NEAREST ROAD 16— ,�VI S (JOL` (7t S)3 p 62lPf1VR Lf�IV� [kj New Construction Use pQ Residential / Number of bedrooms [ ] Additigrt to existing building [ ] Replacement [ ] Public or commercial describe Code derived daily flow tSo gpd/aEblzoo" Recommended design loading rate — bed, gpd/ft2 0.8 trench, gpd4t2 Absorption area required — bed, ft 1 trench, 9 Maximum design loading rate o • bed, gpd$ 0.8 trench, gpd1ft Recommended infiltration surface elevation(s) 5ME! woT>r OQ 'pose 3 . It (as referred to site plan benchmark) Additional design / site considerations c-*ffS Parent material N Flood plain elevation, if applicable N. A It S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem Eo s ❑ U ®S ❑ U CC'S E3 U NI S ❑ U a ❑ U ❑ S Nu SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. I Bed fPench ' 1 0 -111 lb`�R �! S l Z fSb wt's►- �S Z�� o.S 0 - 1 % x '-- Z ) e-I8 1 kN `t 2 31 — sit Z" S M M G -S o- l Ground - 3 1$ -g Lo `1, ti Wl6 — S o s9 elev. \eA ft. Cj 0-10>v TfO A) _S S 'A $ v P_4ve.5 Depth to limiting factor 7 Z Remarks Boring # a -11 1b rnS vn.'Flh &S 2u i 6-S 0, 6 Z Z 1 - LO'1 R-31b Z,mSblt lM�� a lug c .S p -1, 3Z -93 L IN L2 TZ_ Vk S O Sg r1 )i -- e r1 0. Ground elev. f - Depth to limiting factor � R3y Remarks: CST Name: — Please Print Phone: Arthur L. We erer 715- 425 - 0.1.65 ress: - , e,gerer Soil.. Testing & Design_Service -P 0. Box 74 River Fal1s,WI 54022 l PROPERTY OWNER UnS31 L'i2. SOIL DESCRIPTION REPORT 2, Page _ of PARCEL I.D. # i�41 i� i Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft ;a In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Consistence Bour>d�y Roots .: ..:� Bed Tnendt:, ' 3 € <? O — � b`-t R Z — 51 S b 1M U '(- - C S l'i �• S o. � '!'. Ir.N 95 Ground ri elev. 9LY ft. Depth to limiting fact a Remarks: Boring # 0 -8 1b`1R ZLZ ) �r 4 t Z g -2y 1, 112- 31 — s i I Z ►.,., S ,, zv -90 w`1fL 4/ _ s Ground 3 6 S O 5 w, 1 — 0.7 °. i t r; ° 17 0 ft. C.° � w S' S ° v 6 R-� VeL S Depth to limiting i factor t Remarks: Boring # SL I' R 2'g w1 1 e Z�� S ° h iI� 2•:s:: o. S Z to Z6 tv �t 6z 31 — s t'1 Zrvr s bh `F� eS 1 v �` o. S b w�s"wss S s7 wt 1 — "0, la. �s Ground g 6eVS ft. © c NS S 0 1p t Ga yW s _ s Depth to li z limiting i factor Remarks: Boring # Ground elev, ft Depth to limiting factor Remarks: PLOT PLAN Pa 3 of 3 ~ SCALE 1 "= SO ' �vSE ?� $� R'I �:- L`IcST Z,S' l�'ze►y 1�t@v - �2 So r►N et ge, q M N 8.3 / sQ 1K-1 th I,L lr)ra ow l l ti116lf \ 8,1 3 p►h A . vC a1PC o CL-1 - ty Z4Z.00� - lV- 1t'[10►U.S r'S� �t 1 OF C�1V S�1ZVc�d�v. - �ls -1S -q -7 --ZL - 9.5 (715 ) 42A-01 1400576 CST Sigj ett&e Date Signe . - Telephone Fla." Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wi Adm. Code COUNTY Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: G E1 S S ! Aj G tsT2 PROPERTY LOCATION ) Kit. ��ti �.O M. FORD G6VP.-6QT NE 1/4 SW 1/4,S 9 T Z8 N,R 19 E( W PROPERTY OWNER':S MAILING ADDRESS LO # BLOCK # SUBD. NAME OR CSM # t4 S p M. G �p v� RAi� p `� - 6 L_o V 1il u- S CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE ®TOWN NEAREST ROAD `c �vps b1v, w S (( b L ()t S) 38 6- l3 1'7 � 821 PtYJI� LPN@ [kj New Construction Use N Residential / Number of bedrooms Addition to existing building [) Replacement [ I Public or commercial describe Code derived daily flow \ gpd ebizwa Recommended design loading rate — bed, gpd/9 ° • 8 trench, gpd/ft Absorption area required -- bed, ft - trench, ft Maximum design loading rate 0 - 7 7) bed, gpd$ O. 8 trench, gpd/ft Recommended infiltration surface elevations) 5°F ► OQ PfcC-E 3 , ft (as referred to site plan benchmark) Additional design / site considerations T -` CV_ S T-L-- �)-t�'►' Parent material c v71-ikg N Flood plain elevation, if applicable N_ P\. It S = Suitable for system cONVEM!ONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem EOS ❑U ®S ❑U ®S ❑U ®S ❑U IR S ❑U EIS M U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon Texture Consistence Barxfary Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ranch O - �D`tR �! S Z � S b1z mTi, C- S z uq o.S o - Z 1b -18 1u� 31 - S l) ZwtSbk vKfy. �S \v� us•S o.l Ground (_s `'L 1Z X116 - S o S9 m 1 - a - 0.8 elev. Depth to limiting f�actOr Z " - Remarks: Boring # Z "_S zui o.s 0.6 h 4.ry _ Z Z 17 -3Z l � ZmSb1r vr1'�1- ag u .S u.l, 3Z -9_1 LO R - S � Sg 0" 1 0. Ground elev. lt�l'j ft _ Depth to limiting factor � 934 Remarks: T Name: - Please Print Phone: Arthur L. We erer 715- 425 - 0.1.65 egerer So,ll Testing & Design Service -P 0. Box 74 _Fall_s WI 54022 .� -If — w, i I PROPERTY OWNER GknS9)"LM — �pR-D SOIL DESCRIPTION REPORT page ?of . PARCEL I.D. #�;, 4 1 Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft y j; in. Munse11 Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Bo�mcicity Roots 3[2 S Z,Sb YHU Bed Trerxi i' s ��^ CS 0. Ground �i elev� ft. Depth to ;; limiting factQr Remarks: Boring # z L z s �� l Z s cS ' a. t �� >4...� z g- 2y 1 u `-t ►Z 3 L S 1) Z� S blrt M `Fh c S � u� 6, S: c_ ���,; ' Ground 0. Bleu, w S S° o G t�t�ueL s ft. �. Depth to t• . limiting factor 't Remarks: "r j• Boring # , n -lu �o� cz z-CZ SL� 2 � 3 b� rv� `F1 C - S 2u o.S io bar. U. k�;�i s L 1 Zv►� s bh � `Fh e.S 1 v o� ; vv,l - b,1 i c►,r Ground 3 .4 Bleu 0/p ° f 6v ft• i. Depth to ` : I limiting f Remarks: "i� Boring 2' j 9 r ro I Ground R elev. ft. II Depth to ri a limitin .� factor ,r r Remarks: I PLOT PLAN Pa 3 of 3 SCALE 1 �pv SE 'CD l � �� �- LStcST Z. S ' ►=�ze � �v et1�S �2 ;' ��owAlry G \ !1 1 L uT o� So +,%VP . tt,R6 s 31y AvC P1PC o eL ty Uri Vry � &J&JT Z4Z.00� lJUS�tl'l C -�)✓ ' � 1 4 0 t� Sz 4 b CA S (7 1400576 - CST SIgn Stu re - F�ae signed TelepFiorieN�a5T # - I- f " S " O of rce PRIVATE SEWAGE SYSTEM Safety and Still tgs Divis ount INSPECTION REPORT S i . t Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary PermitNO.: Personal iMtxmation you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)). 384134 Permit Holder's Name: ❑ City 0 Village own of: State Plan ID No.: lade, Dana/Rebecca Troy Township T BM Elev.;- Insp. 8M Elev.: SM Description: Parcel Tax No.: Cn. }p 99. -0 A.((- - i3 1I11 ,, &,A : 040 - 1225 -90 -000 TANK INFORMATION ELE ATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark �p,S 9g +-p Dosing Alt. BM ZS I o 3. o 1 Aeration Bldg. Sewer $ -3` [ r O 1. 91 Holdin St /Ht Inlet g{�`f 1 E)I- b I TANK SETBACK INFORMATION St/ Ht Outlet S - D(, -f o TANKTO P/L WELL BLDG. ventto ROAD Ot Inlet Air Intake Septic y I �I NA Dt Bottom Dosing NA Header /Man. .bS g.(v0 Aeration NA 19isin -Ripe s t ,'4- Holding Bot. System 0 ;o Z PUMP/ SIPHON INFORMATION Final Grade S AIL Manufa d St cover Model Number _ GPM TDH Friction t - Vorcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM No. Of Pits Inside Dia. Liquid Depth DI /TRENCH width 3I Lengt S- 2 ( Trenches P IME 1 ! ` 11 7 .. j� ����e�r�� SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Ma u! c�tu� �R`r*v' St SETBACK CHAMBER M Nu r: INFORMATION Type O System: Co" , 'S t OR UNIT DISTRIBUTION SYSTEM Header / Min' I Distribution Pipe Length s) x Hole Size x Hole Spacing Vent To Air Intake I t Dia. ia. Spacing �® SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over t�u pth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center l /Trench Edges Topsoil ❑Yes ❑ No ❑yes [] No COMMENTS: (Include code discrepancies, persons present, etc.) ,L Inspection #1: 0 T/OZ /D/ Inspection #2: Location: 549 Briana Lane, Hudson, WI 54016 (NE 1/4 SW 1/4 9 T28N R19W) -0928191105 Glover Hills - Lot 9 �n � �"� 1.) Alt BM Description = "� 2.) Bldg sewer length = 10'" Z alnount of cover = 18 l:,a•e� Plan revision required? [I Y� No 1 Use other side for additional information. O o O 1 S80 -6710 (RAW) Date Inspectors Signature Cert. No. { S''E q BR tr4rv�E Sanitary Permit Application Safety & Building In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washir `Wisconsin See reverse side for instructions for completing this application PO Department of Commerce Personal information you provide may be used for secondary purposes Madison. WI 5: [Privacy Law, s. 15.04(I)(m)j (Submit completed form to co stai Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x I I inches in size. Coun a Slate Peermi Number ❑ Check if revision to previous application State Plan I. D. Number Jnp � C, 3. I. Application Information - Please Print all Information Location: Property Owner Name � Property Location b G IDd '' N E 1/4 SW 1/4, S q T QS R Property Owner's Mailing Address Lot Number Block (9 , 5a 4 N 01 Cary, State Zip Code Phone Number Subdivision Name or CSM Number 4ud5 ©n , W1 11 1 )1U ( .3) ) _ GLoitr N I1S II Type of Building: (check one) – O City 4 1 or 2 Family Dwelling – No. of Bedrooms: 4 O Village O Public /Commercial (describe use): LjtTown of O State -owned q rro III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road vi - L A) 1. I New System 2. ❑ Replacement 3. ❑ Replacement of 4. O Addition to arcel Tax Numbers) System Tank Only Existing System t�4o cr96 B) Permit Number Date Issued O A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) tom. , d �r , Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland Pressurized In- ground g O Holding Tank O At-grade g O Single Pass O Drip Line g r t ❑ Aerobic Treatment ni ORe' ct cutating Other: 93 S V Dispersal/Treatment Area Information: QC1 1 Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. Syste levation / 7. Final Required Proposed r Rate (Gals. /day /sq. ft.) (Min. /inch) , Elevauor - bo 5- y / VI Tank Capacity in Total 4 of Manufacturer Prefab Site Steel Fiber- PI Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks — O ❑ ❑ o ❑ a o VII Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (print) Plumber ignat re (no st p MP /MPRS No, Business Phone Number L Plumber's Address (Street, City, State, Zip Code) VIII County/Department Use Only O Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No sta Approved O Owner Given Initial Adverse Surrge Fee) Zp ?.Btu 1 Determination S IX. Conditions of Approval /Reas for Disapproval; d. (M n ^/ VN V t �f / /� / Q �y��p� S - �'/,(I S. O pv. © �F\ ... S 1 Vuc�4.�+�.-VaL �.,1�(.�- V/- `.�v... 7 � .'(D WG �& Q - 4, " V�j,/�� -.CL— (//�� I �� A )� �4 Z " \ SBD-6398 R 0 0 7/ -`� , J Ll A/ /acs' -� vC_- ' VIVA- �s �. Vk X357 0 PAR x /47ve 460 �yy F7 / N S " x357 Wiseinsin Department of Commerce SOIL E a � I A PORT Page 1 of 3 Division of Safety and Buildings �\ in accordance with Co is. Adm�Code" f _ 4 �t' Attach complete site plan on paper not less than 8 1/2 x 11 in qg size. 1� Include, but not limited to: vertical and horizontal reference p M), direction an I I.D. percent slope, scale or dimensions, north arrow, and location a ista n crst d. 7�6i° � e � �f►n Please print all information �� avi wed by Date , �5� - ST CROix rm Personal infoation you provide maybe used for secondary purpose (Pn: cY Law, sCIC.9DI MY(m)). 2W( Property Owner rop G LPVN't_ �/1/4 SW1 /4 S T N R E(or W Property Owner's Mailing Address ck # Subd. Name or CSM# Sr . tQ , G l) V LR 1`x-1 LL City State Zip Code Phone Number ❑ City ❑ Village 5Q Town Nearest Road Spy I '-,) I I S`lW ( 1S ) 386 -%.SQ) - l 1Zl LPOJ L a New Construction Use: ® Residential / Number of bedrooms L4 Code derived design flow rate 60 GPD ❑ Replacement . ❑ Public or commercial - Describe: Parent material G l..t°rQ TIVL OVY'Wf\SH Flood Plain elevation if applicable rQ Pa ft. Genera) comments 3 `!12& elr a x 6Z -S' Ui iv l 1 uxirr-s of H7 o N and recommendations: oLA eL St.pllJtnZ L �yta P TZ0-JC1}, l UWCfS L4 1 Boring # ❑ Boring ® Pit Ground surface elev. 1 u 2 ft. Depth to limiting factor l Z in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 o - o-t - 313 - s l - L �-sb12. 4 \ K\ a> S 1 • S . �•s`�iz -31 Y o S9 V. 2 0 3g �•S R- VA - S o 3$ -121 �Z Li y+') a Boring # t❑ Boring L'Y Pit Ground surface elev. 1 Q • S ft. Depth to limiting factor > Z- in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I o -1 O l 0`� �.. 3 l3 � s 1 -- Z`�sbk ,n� �- cs 1 � • s • � rn g .5 •� •v1 -9,- •20 3R. '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) Si nature CST Number Arthur L. Wegerer all `7 �� Uv - ZO 220254 Address W e g e r e r Soil Testing & Design Service Date valuation Conducted Telephone Number 421 N. Iiain St. River Falls, WI 54022 `B- � I -UC`j 715 -425 -0165 1 r Property Owner G `—�, Parcel ID # _ y - 1 Z $ - 9 0 Page of 3 Boring # ❑ Boring ® Pit Ground surface elev. ft. Depth to limiting factor l 3 3 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 0- N(o L 313 Z )0 - 3 3 1 `i L Z� sbk Yrl`�1�- �`J lU'� • S • �3 3 33- 13 3 10 It R VA S D S9 iM [ -- q] Boflng # • ❑ Boring ® Pit Ground surface elev. 1 k3 b • r3 ft. Depth to limiting factor > 1 3 5 In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 0 –ilk YtH Z 3L3 St 1 z�-nVq ` b Z to - 3 g 3 3� 13S lu`1,R y/L — S p Sy y►� ] .7 `,Z a 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 •Eff#2 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg /L • Effluent #2 = BOD, < 30 mg /L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD•8330 (R.6(00) PLOT PLAN Pale 3 of 3 'Scale 1'= So' ?� ip 7vo, o4o- �Z2s_g vNj G so lZ L4-t6t}, 3114 b I A, W /L" � � �. - lu 1 � ►�-C. Ra.,D J,�3 �fiE X06 t'LlU $ 5 rs' U`n�et`I Lo T L1n1e __ l�ouSC T� �� R•7 L�3T 1l�' Rz�Y -j �R- (�'�r�.I-= i.�1.D�Z�S'11, .50 �I '�'1;t "� 715- 425 -0165 220254 C7Q_Zp CST Signature Date Telephone No. CST No. Job PTO. 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 Number of Bedrooms Design Flow - Peak (gpd) Estimated Flow - Average (gpd) Septic Tank Capacity (gal) Soil Absorption Component Size (ft') Z t C,D►D� Type of Wastewater Obmestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) Maximum Influent Particle Size (in) 0 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 is and outlet filter shall be assessed at least once every 3 years by inspection. The utlet filter hall be cleaned as necessary to ensur proper operatio The filter cartridge shou 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 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP C':"RTIFICATION FORM Owner/Buyer Kmro. �(5- I Mailing Address , y t N " �. SYD/ Property Address �'y� O kLA (Verification required from Planning Department for new construction) City /State N "W n Wi Parcel Identification Number y 40 — 12.x°5`0 LEGAL DESCRIPTION Property Location k/C '/4, Sh( ' /., Sec. q , T ZO N -R 19 W, Town of Truk Subdivision Gr � 1 OYP,� � Lot # Certified Survey Map # / v ' Volume , Page # Warranty Deed # 1 • ;a L O / r Volume 51 ,, Page # Spec house ❑ yes �§ Lot lines identifiable Wyes ❑ 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. 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 sta ' t your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 dal s of a three ear piration date. Z /�� /Ut 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 jpriy desc; ;r' by virtue of a warranty deed recorded in Register of Deeds Office. J- � o/ SIGNATURE OF APPLICANT 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 1 /0 � 62461 1 STATE BAR OF WISCONSIN FORM 1 - 1998 KATHLEEN H. WALSH ��Q REGISTER OF DEEDS WA ST. CROIX CO., WI Document Number Vpl PAGE189 RECEIVED FOR RECORD 06 -12 -2000 10:00 AM This Deed, made between Ronald W. Haaland and WARRAN DEED Jan E. Haaland, husband and wife EXEMPT N CERT COPY FEE: Grantor, COPY FEE: and Dana and Rebecca C. Glade, husband TRANSFER FEE: 123.90 RECORDING FEE: 10.00 and wife as survivorship marital property PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (the "Property"): Lot 9 of the Plat of GLOVER Hil in the Town of Recording Arta Name and Return Address 040 -12259 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements, roadways and restrictions of record. Dated this day of .P.vs oev . s * Ronald W. Haaland s * Zrifn E. Haaland AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ) ss. St. Croix County. Personally came before me this Y7` day of authenticated this day of . rw-vf- em0 the above named �on/iae-0 Lt). NRAC.a.ya e7.un s TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person who executed (If not, the f egoing ins ent d acb lowledged the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY t s l ' e4— Michael Forecki Attorney Notary Public, State of Wisconsi Eau Claire Wisconsin My Commission is permanent. (I ex irA0oq -date: (Signatures may be authenticated or acknowledged. Both are '•'�.,� ;;) not necessary.) 'Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. I -1993 "loduced wah LPFam^' b/ V«a.aa kc. 7 SMS Falaan Mils Road CWdon Township, M oh.9 n 68= (apo) 397.9905 Avomry hachW HF Ia7011 Aw, a.. Cld. w1547o 14627 P)— :(715)835 -7629 F.: (715)135-,112 • y GLOVER V ­T­ , xErcH ' ER HILLS LOCATED IN THE NE-SW, THE NW -SE. THE SE -NW. THE SW -NE. THE NW -SW AND THE SW -NW, ALL IN SECTION 9, T28N. R19W. TOWN OF «.e.wtwnn pROY, ST.CROIX CO„ WI. (BEING LOT I OF THE CERTIFIED SURVEY MAP VOLUTE 10, PAGE 27361. 'i°3'ir;', ae¢u: ,.xaw. .. wuaiNwx .xP w.ne a rote �- :nw i • ,r.x.,ax,d »n.t »r� ,».,,.,,., sw Ira sE La ..,. . I ,,.w... w . • ...., .RNP.LA.TTEO..LANRS. IT • . \\ .. .ate,.,. / w wr .° - \ x • I t .i . I b ._._ _ ..fit .....:,f -�. .+�'� \i� `� r� I I m. t J i �u u n 9 I .r 1 aaff i�„ � � \.� \� \ ` j \ � \S. \ \ Wr j emu' . —: �� \ +, =1 ` ..`I ..\ •\, r ' , - -9P . ,r• c. s. w: vauNE s \ • \'o \. ' � .. ..,,.. — — • UNPLATTED LANDS, ' •O d • . -' \ t CGIVEW.T f1,EKNT OVER l°T , 1ESISTOES OFFICf. 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