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HomeMy WebLinkAbout018-1036-60-200Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT} Plzrsonal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: ^ City ^ Village ^ T n of: Madsen, Scott Hammond Township CST BM Elev.: Insp. BM Elev.: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ ~~~~ P~~, - t~O Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO ~ WELL BLDG. Ae Intake ROAD Septic > D' NA Dosing NA Aeration NA Holding ELEVATION DATA County: St. Croix Sanitary Permit No.: 374913 State Plan ID No.: Parcel Tax No.: 018-1036-60-200 L6~Z9,17, .zS~~3 STATION BS HI FS ELEV. Benchmark ~- • (O ~ ~ • Op Alt. BM Bldg. Sewer '4 I~ •t ~ .8 S St/Ht Inlet ~f.cS 1:.93 Q'}-tZ' St/ Ht Outlet ~. (~ ~. ~~' Dt Inlet - -- ~ --~ Dt Bottom ~~ Header /Man. g • S~ ~ S e ` Dist. Pipe Bot. System •~S 8 ,fir Final Grade ~ t d St cover ~ ~• 35 / SOIL ABSORPTION SYSTEIVI`~ 11,. 0 ~.___.~.~.~ „n~ 1 .5.,~. , ~1_ ~°t3 = (~ • 3S" + . S~ RENO Width 7 Le gth v ~ N .O Trenches PIT No. Of Pits Inside Dia. Liquid DIM N N 3 ~~ DIMEN I N SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manu rer: ~} ' S SETBACK ~ INFORMATION Typeo ~ Yc{o ~ CHAMBER ode Num er: System: C~ . ~ OR UNIT ' _ d,ct. DISTRIBUTION SYSTEM Header Mani old u Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake r .. Length P.:Q-! Dia. Dia. Sparing 7 (~ 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 YI~~ COMMENTS: (Include code discrepancies, persons present, etc-1 Inspection #1• ~1 /Z~ / ~ Inspection #2• ~t Location: 1788 90th Avenue, Hammond, WI 5401 (SE 1/4 SE 1/4 16 T2 N R17W) - 162917256B -Lot 5 1.) Alt BM Description = vse 5 T . ~....~. ~ . ~ ~-~- Sf '~"`~`# I~ 2.) Bldg sewer length = ~ ~ p' (~Q-~,{' 8d' ~~•~"~~us~e_) '~'S -amount of cover = o ~ ~ ° ~ 4 g• ~) ~t.A,.~p cevvec~-. ~e w r? [._ w~ -tbM.i~~ B~j = ~eva ''lb i Plan revlsl¢ o brequi es ~, o Use other side for additional information. o°/ ZG ~ ~S~ SBD-6710 (R.3/97) Date Inspector's Signature Cert. No. L w c.~'' Depth PUMP /SIPHON INFORMATION ADDITIONAL COMMENTS AND SKETCH ,. Sanitary Permit Application Safety & Buildings Division ~~ In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. PO Box 7302 ~ ~~~~~ See reverse side for instructions for completing this application Madison WI 53707-7302 w ~+1~ Dapnrtrtent saf Gariimer~e Personal information you provide may be used for secondary purposes _ [Privacy Law, s. 15.04(1 , (Submit completed form to county if not state owned. Attach com lete lans to the coon co onl fort e o e Ethan 8-1/2 x 11 inches in size. County State Sanitary Permit Number eCk' , 'vision to~vious application ' ' State Plan I. D. Number ~T c~o~rx ~- ~ ~~ I. A lication Information -Please Print all Information ~:°-,' - Location: Property Owner Name `_° ~ . - Property Location C r ~ n 'r tSt~ ---- 1 ~' CQIJ~ D~ ` '1/4 aG 1/4, S~6 Ta~,N, R/~E or t CG Property Owner's Mailing Address ,~ ~-, ,` 1;+ % ~- T ~~` ,Lot Number Block Number Y / COUt~l S~S ~LO.Y ST ~ •'i'' zC>rvINGOFFiCE ~~ S City, State Zip Code hpIDe member , ;~ ~:~ Subdivision Name or CSM Number ~,... s, SIP dol /~ II. Type of Building: (check one) - ~-" ^ City ^ Village 1 or 2 Family Dwelling - No. of Bedrooms :~_ ~I'own of ^ Public/Commercial (describe use):_ ~ a v ^ State-Owned f- +' ~"'+ ' _ 30d Nearest Road f ~-~ /a2 ~.2~ Yt.N G ~f 1 %O~GW~',dG~6YS Cyr 71~C.er~ a 7 tt I Parcel Tax Number(s) III. T e of Permit: Check onl one box on line A. Check box on line B t a tcable A) 1. New 2. ^ Replacement 3. ^ Replacement of 4. 5. 6. ^ Addition to S stem S stem Tank Onl Existin S stem B) Permit Number Date Issued ~ (3 "Z~ ~ ~a A Sanita Permit was reviousl issued 1V. Type of POWT System: (Check all that apply) I~Non-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At- rade ^ Aerobic Treatment Unit ^ Recirculatin ^ Other: V. Dis ersal/Treatment Area Informatio aR.,%~c~s..,..~.. " L,v~ 1. Design Flow (gpd) 2. Dispersal Ada .Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required~Y '' Proposed Rate (Gals./day/sq. ft.) (Min./inch) '~/ 8~. G ~~ati6 yS~ ~ 3 6 .~ ~- ~ GCr T2 d''3~ d . 4 VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks ^ ^ ^ ^ ^ ^ ^ ^ a VIII. Responsibility Statement I, the undersi ed, assume res onsibili for installation of the POWTS shown n the attached Tans. e (no stamps): RS No. Business Phone Number Signatur Plumber's Name (print) Plumber's ~ ~ ;~~ 's~~u~.,~~y .~G~-~~.~N~ ,~a~Q4~ ~s-3~c~.~/mil Plumber's Address (Street, City, State, Zip Code) 14?O .~~ o ~~dL ¢~./ ~ ,, . ~ IX. County/Department Use Only ^ Disapproved Sanitary Pemut Fee (Includes Groundwater Date Issued tamPs) Issuing Agent Si a .Approved ^ Owner Given Initial Adverse Sur~trarge Fee) ~~St~ r ~ K<-- ~ l7 4 _~ _z~ i~~ ~ Determination • X. Conditions of Approval easons ~o_rn~~sapproval: C~'~ a~Q.__ t~ {~ ~ l l,t r to-tuwtQO ~~~ , ~ ~ w~K4 s ~~ ZL.~ ( o "~~" ,~-~L~~1~ 'Ett~s ~2. ~~-r..s u6e~ ~ S C _ j~_, t ro u 1~~ D cv \ r ~ t ~Imlc g,G 03~ ` 1'`e f'o% s,~~ ~ a N'~ ~ ~e ~~ R' o ~ -d o ~' '~ -m 0 e. q o ~~ ~ l~ P `ti U 1 Z b ~ I a u cis W h ~ n ~ ~ .. ~I~ ,p r- _ ___ __ //ii'' ~~Gt- b' Wisconsin r3epartmnnt of Commerce SOIL EVALUATION REPORT Page _~ of 3 Division of Safoty and 8uiidin~s } in accordance ~Nith Comm 65, Wis. Adm. Cade County S"~ ~i }i'O rr ~' ~ Attach complete site plan on paper not lass than S 112 x ~ 1 inches in size. Plan muss include, but not limited to: vetfiCe and Horizontal reference paint (6M), direction and Parosl 1.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print aH !nt-arma 7 , - "' Reviewed by I Date ; Wercona~ inlarmaiion you provide may be used ft~r second p •rptg r t w i.ew; s•,4b.D4 (1? (m}), ~ ~ ~ - 2,(p - 2ed~ I Property Owner ~ ~ ,,/ D '~ i i ~ ~C E ~~ ~ ~~ Properjy~ Lccat'~on ' ~ 4 i ? : ~~. i C cJ ~ ._5 e .~c.l ~ 1 /d,~~ 114 S f Govt: Loti ,S ~ E (0 T ~ ~ N R / I Property OwnePa Malting Address a ,. r ~ # _--~ 1 ot lock # Stud. Name CS M# n 11 ,. 4 rC,~ State Zip Code one {Number ~ T ~ ~~~• ! ~ Viliape Town Nearest Road cc v utv l ~ o .r/Gl i lrJ . ~ SY6/S ( t,~') t ~y, ~ ~ ~ ~f-~2 }$J New Construction Use: ^ Residential / Number of bedroo # ~~ _ . ~ ,Code derived design flow rate T ~~~ ! ' ~ ~/_~Q OPD ..~ , [] Replacemont [~ Public orcommercial - L?escritia: - ~---~~"~ Parent material ~e.~ ; ti,~ ~e~~ s, ° ~ Ptoad Ptain elevation if applicable ^_.,__ ~• General t~nments ~ and -eaammerxtations~ ' / I Barino# i~ Boring ,.n i . / l , 1 't...l P!t t3raund surface elev. 1f a • rv tt veptn to nmrnng rector / y ~ _ ~r'• Soil A licati0n Rate n De th H ri nant Gotor Dom tion Redox Descri Texture Structure Consistence boundary f Roots P /if p o zo in. i Munaell p Qu. Sz. Cont. Color Cr. Sz. Sh. "Efft#1 'Eff#2 6- is ! 7.s si'3 -- S'<'/ ~t~ i ~-r,``•i 3 c s ~ F ~ ~ • ~ - ~ ;!a -sat rs --~ S / 6 ~frr e ~ ~ F ~ ~ `/ ~ ~ i S ! (S$ i /77~ ~ i ~ ~ ~ r- j i i ~ i i i ~ ~~ 6 i i ~ f aarina # ~ goring ~ LJ Pit around surface elev. c 7 ~ / R Depth to lif?ltting rector ________._.,, in. Solt lication Rate ~ HoriYon 1 Depth Dominant Color Redox Description Texture ~ Structure Conststence Bpurttiary Roots GP Dfft= ! in. Munsedl Qu. Sz. Gont. Golcr Gr. Sz. Sh. "Effk1 "Eff#2 ,+ // G i S!- /O ?, Jr~ S ~' I t S d S e S ~ ! • d~ ; i i I i • Effluent #1 = BRD s 30 < 2Zt) mg/L and TSS >3t} < 15C mg~L ° >±ffruent t~z = iirlu ^ av m6vi. ana + as ~ su mg~i CS7 Name iPtease Print) Signature CST Numt~er ~, ~ , as !~- G' /7 Gc 1YC e ..-- ?~ 7 ~ O Address Dato Evatuetian Conducted Telephone Number I I /d~?D ~~-s'zr D~c~ ~~d s~~ GJ r` SS~a~G' ~/i~'/6A ~~ s - 3~6 - ~3~a/ _ property Cv~mer !1~~S~~ Parcel iD # ~~ 3cring # ~ Boring ^ Pit Ground surface elev. g ~ S ft. Depth to limi!ing factor 9~ in. Page =~ or .~ S~If I Aonticatian Rita Harltdn Depth in. Dominant Color Munseil Relax Desaiptfan tau. Sz. Cont. Color Texture Structure I Consistence Gr. Sz, Sh, t Boundary ! Roots GPd/fP~~ •Eff;l+1 + 'Effi#'? 2 ~ Q-YO' l~ y~ ~' Sl ~ ~S' if ~~' '~ -I i i ~ t .+.+_. ._..__ .._sw_ ~ ~ ~ ~ l _ .~ j -! ~ eon+ng goring # ^ pit Ground surface elev. ft. Depth to l;miting f8:tcr :n, Soli Auciirat;4n Rate f Horizon, Depth Dominant Coiori Redox Deseriptfon Texture Structure ~ Consistences Boundary Roots G#~D1i€ in, Munse!' ' Qu. Sz, Cont. Color ~ Gr, Sz. Sh. ~ 'EPf#t ! 'Eff#2 i ~ I ~_~ ~ i ~ ~ I i i ~ 4 ' i ! ~ i ~ ~ ! t ' ' I i j~'~ ^ Boring g= i (Borin6 # Ground 3!.Zrf2~ Elev. `t r3et7rn to lin'ltin actor in. pit ~ moil Anoliraficn Rats f•ior zar DeFtn {?orr„nar;t Color iZadox Gescrtpt~on Texture f Structure Consistence aoundary~ ~ Ror~ts P /~ in. }Aunsall Qu. 6z. Coat Cafor ___._ C;r. S2. Sh. I "Eff#1 `Eff#2 : ... _ ~ i i i ~~ , f ~ i ' I ~ i I t f t 1 ~ i ~ I I -y ~ "Effluent Mkt = 60t.,s > 30 < 22t3 mg/Lend T3S =30 < t 60 rng/L 'Effluent #2 = BODa c 3a mg1L and TSS < 39 mgfL ?'he f7epartment of ~amrnerce is a*7 etyuai opportunity service provider end employer. if you need assistance to access services yr need materiaf in an alternate format, please contact: tJte department at 608-266-3151 or TTY 608.264-$777. SHA•h73G IF. G7P7N us h` ~~ a -r. 0 a,~ • °,~ ~ ~.. ~'~~ ~~ .~ m n ~ I~ y ~. .a <<° ~, b~ 4~ pl. I ~ l e l :. k ,'~ t ~ ~_~ Sanitary Permit Applicatio , L- ;~-- ~ Ad ~ V1/is d I ith C 83 21 -, Safety & Buildings Division / 201 W. Washington Ave. ~'~-,~ ~ `~ . n accor w omm . . g See reverse side for instructions for completi i appl' idYf" ~ - PO Box 7302 iseonsin artment of Commerce De ~ personal information you provide may be used r3'racondan~j~ ~~ ' Madison. WI 53707-730'' r p (1)( )L (Privacy Law 04 s I S (S~btA+ completed form to County If r• , . . _ ;,,.. state owner Attach com lete tans (to the county co ~ for hp i;•r+ a e les th n - x 1 I ' c es in size. County r K T C State Sanita Pemut Nu r ^ Check if rewsi o revious al$Ti our~n ~~'` ~ State P l- .Number YO . R ~ 3 r - c 3 I. A lication Information -Please Print all Inf ton L ~ti Name ~ ~ ~ ~> _~ Property Ow ner pe Location ~ c .SCJ!/ cQ e ~ ~l/" !` ~ qq / ~l/4.JC1/4,S ~T29,N,1~`E or~ Property Owner's Mailing Address Lot Number Block Number City, State Zip Code tfdf.Ltlumb6l~. Subdivision Name o CSl\ Number ~ s~ / ct ~j p~/ /~ Q `// / ,Q q II Type of Building: (check one) --.__..._~'' ^ City ^ I or 2 Family Dwelling-No. of Bedrooms: ^ Village ______ ^ Public/Commercial (describe use): 1~Town of ^ State-owned ~ ,ud 111 Type of Pert*.tit: Check only one bex on line A. Check box on line B if applicable) Nearest Road 5 ~ p) I. New System 2. ^ Replacement 3. ^ Replacement of 4. ^ Addition to Parc~ axNu er(s S stem Tank Onlv Existin S stem ~ ~ ~~~ / -~ B) ^ A Sanita Permit was reviousl issued Permit Number Date Issued ~~. a g. ~ IV. Type of POWT System: (Check all that apply) ` 1 ~` ~'~ ~ Jr~ C ~ Non-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At-grade t f ^ Aerobic Treatment Unit ^ Recirculating ^ Other: a 5 ~r3 V Dis ersal/Treatment Area Information: 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals./day/sq. ft.) (Min./inch) ~~ Elevation ~ Q~ y5~ o?S ~ r 3 v "~ ~/G~ /o3-G . cos: VI Tank Capacity in Total # of Manufacturer Prefab eel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks % ~~JJ • ^ ^ D ^ ^ VII Responsibility Statement I, the undersi red, assume res onsibili fir installation of the POWTS shown the attached Tans. Plumber's Name (print) Plumber's Signature (no stamp s): ' P PRS No. Business Phone Number C~J,`l /;ant Selia~.~Gfer / A GJ - ' c~••-~~ c~a7Q l.S - 3~G -3 0? l Plumber's Address (Street, City, State, Zip Code) o~~ ~~u~ .° col VIII County/Department Use Only ^ Disapproved Sanitary Petmit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) ~l. Approved ^ Owner Given Initial Adverse Surcharge Fee) Determination S• ~ g `Z[ `Z,~D IX. Conditions of Approval/Reasons for Disap royal: ~~ SBD-6398 (R. 07/00) 5+'L: O ~ rn~ e~ SE~ S~~/f S%~~~ 9'/~/TI J Tj,~J.d d t~ 1~0 /a.~no.sc~ Wisconsin Depardnent of Industry, SOIL AND SITE EVALUATION R E P O R T Labor~snd Human Relations fl:..:e J.....f Cofnf.. R RI ri Winnc n _ ~_ Page \ of ,~ -- - 111 Ql.VV1V •Yllll ILI 11 ~ V.J.VJ, ••IJ. r~.J~~~. vv~a. COUNTY S T C (~ (~ ~ x but i tan must include 81/ t i ~ t l th i l l " , an ; nF( an on paper no ess ete s te p S Attach comp PARCEL LD # not limited to vertical and horizontal reference poi ~I); directiamanff ~o pe, scale or . dimensioned, north arrow, and location and dis ~ nearest road ~~ ~.r '~ ~ p APPLICANT INFORMATION-PLEASE P ~fl ALL I;ORb4l~l,T, N R IEWED BY DATE ~~Z(r PROPERTY OWNER: - F ~ ~~` / '~ ~ ~Z /a ~1 ~ a C•'%c~N.` ~S ~cc~ SR`f'I ~~ P ~ TY LOCATION T ~E- t/4 S~ 1/4,S 16 T Z9 ,N,R l'2 E(or)~ . . . Y PROPERTY OWNER':S MAILING ADDRESS y ~: ~, %` ~ ~ ` ' ' - ~ ~ BLOCK # SUBD. NAME OR CSM # ~ " (~-f ~ ~ ~ ~ i~Z~{ C..ov,v ti+ -- RoP o S ~D e 3 f I CITY, STATE ZIP CODE U ER ^VILLAGE [fi]t TOWN NEAREST ROAD lfil~~ d~t ~~ zv l s o t s ()~ 1 P~~-t ~ o~v~ ~ s ~4 ~ Z [~ New Construction Use. Q(J Residential / Number of bedrooms y [ J Addition to existing building (]Replacement [ J Public or commeraal describe Code derived daily flow byo gpd Recommended design loading rate ~ bed, gpd/ft2 °' y trench, gpolft2 Absorption area required ~o o bed, ft2 1 Sao trench, ft2 Maximum design baling rate a • 3 bed, gpd/ft2 0 , y trench, gpd/ft2 Recommended infiltration surface elevation(s) S~ -~w~ or.> >Rsc= 3 ft (as referred to site plan benchmark) Additions! design /site considerations - Parent material s ~L`-`t S t?~t-"t ts.~T' nu~Z S 4hva~-l Tt L~ Flood plain elevation, if applicable N • R• ft S =Suitable for System CONVENTIONAL LSdS ^U MOUND ®S ^U IN-GROUND PRESSURE ®S ^U AT-GRADE ®S ^U SYSTEM IN FILL ^S ®U BOLDING TANK ^S [$IU U=Unsuitablefors stem SOIL DESCRIPTION REPORT Boring # .~r~:..:F~<:: Ground elev. t pZ_Zft. Depth to limiting factor ~ 73'' Boring # n~•: ~3 ~~ Z >:>_t 25± Ground elev. 106-~ ft. Depth to limiting factor ~ ~ o~, Depth Dominant Color Motties T t Structure Consistence Banda Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color ex ure Gr. Sz. Sh. ry Bed rertctt o-LO l ~`'t~ 'Ll t '-' S l ~ Z~ S~~t `~ ~M.T~-. cs - O-$ o.~ Z ~b-33 lO`'!2 ~!(. ~ S! ~ Z.'~S~tik. tM~~ cS O_S o_` ~ s ~ ~S~k ti,~ ~- ~•S n' 3 33-~i 3 t v Y 2 ~!!L ~ t o w~ w- ~ ~. 3 n. Remarks: ~ o_tZ tb`1fZ Z[Z - St1 Z.rvtgbYt tit.'`-~ Cg - o.S a.b Z t-z._Z9 - o `t ti 3! t, ~ s 1 f 2 `FS bk vn ~„ cs - o. s o. b s o S wt ~ _ o~~; o• 3 Zq-6Z tuYti Y~L ~ sl ~.~sbk v r cS o-Yo-S 6Z 1p 7.S'7tZ3/y ~ S~ ~~ m'F4• 0•3~o.y at O'{. t O~ 31.L 4.~-- Z Remarks: ST Name:-Please Print Arthur L Wegener Phone. 715-425-0165 ~egerer Soil Testing & Design Service-P.O. Box 74 River FaI1s,WI 54022 Signature: n J ~J~~ %~ ~ ~ _ 3 ~ u Date: ~ CST Number: o f 1 Z---~i - `t MO 0 5 7 6 • S" .~ .~ Y V .~ ~:•-- .~ PROPERTY OWNER PARCEL LD. tt Boring # ~:>z ~>: ri ~:> 3> Ground elev. lo6.3ft. Depth to limiting factor ~ -2 (~` Boring # ~~,< >~; s.:>. Ground elev. 1 u~ ft. Depth to limiting factor ~~~~~ Boring # .... »~` k-~-~Z.~1~1 SOIL DESCRIPTION REPORT Page ~ of 3 riz n H Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft o o in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerxh I o-~Z ~u~tti z(z Si.l Zwr sUk ~ ~~ cs - a:S o- b Z ~i ZS I.O~IL 3!6 - St ~ Z`(~SdyC -M~i- c~.s o.S o.~ 3 Z -3 ~b ~tZ 3!L - S ~ l -+1 s bk Vn,v `Fy. L°-S o- ~! o•S 33_S3 to `tR- Y!6 - 1 S O s 9 yn ~ Cg - o .~; o,$ 5 S3-S8 t0`?IZ ~/y - v~'-SI 6-M vK`('~ ~S ~ ©•3o.y 6 sg-1~ lv`ttZ 31` - sal ~~Sbk rn~-• ~ D•Zo.3 Remarks: I o~~Z ~O ~-t\Z ZLZ s ~ I Zw~ 5bk Yvl,'F-- C''~ o. S o. 6 Z ~z-zy 1.L1`~IZ ~/c -- si I Z'~sbh m'F>" ~S - o. s o. ~ 3 zy_c~ ~•S~Q qty _ s 1 ~ csbk v-nv~F-t- cs _ o.~o-S y u~-~8 1~`t R ~!6 s ~ 1 1 csbk m ~ _ o• Z ~ a. 3 Remarks: ~ 0_~3 lu`'t~- zL.Z _. sl1 2rns1,~ wt`Fh eS - 0.5 v. 6 Z t 3 -33 W ~t R 316 _ s t. i Z~ S~ lrr m ~'l.- c,,v u. S u. L 3 338 ~o`~tR4rl6 _ ~sI 1cs~k wt h - ,,~~~~. - ` o,yo,5 ~- ioz rte' Ground elev. ~u~ft. Depth to limiting factor ~~ ~ 1Q~ Boring # ~~.,;. Ground elev. ft. Depth to limiting factor Remarks: Remarks: SBD-8330(R.OS/92) i PLOT PLAN Page 3 of 3 SCALE 1"= 30 l ~' S ~-~- 3 ~-~ ~-tf-~s , ~~N S ~ w L1~ ~ ~3y l UU' ~.Or.~ G , z ~.1. '` ~ ~~ ~C `R1~ 1>. o wrJS~ u~ ~ ~ h ~ wi vv~ w, uM 6 ` 'Pri'~z-T ~ ~..t ~`n~ t r ~ Sv t~~~ h~'-~'R s trtvw~ • 1=c~ Z 3 3 LSD ~.o o~ s`2 s~ , ugE 3 ~'~~~1~5~ N~~3 S'tc "1 S' LGt~vb. --- ti~vs`t~cLl.~?t2. `ro ~"~~i ~w ~ 'n~c~F ~t ~~w.~S j°rT 7' ~ wr ~ oF' CO~v 9`rn,u e~ tYJ . ~°tu 3.3 - •--- O J ~. 4- ~t ~ uZ `! B~ ~z_ ~uu.uo~ P i P L UaT' CUi'L1V Q.s ~"~U`Iy ~tlu6~' _~?~ S u i~ ~3L`, 1°(YZ-C~} ICU R l~~Y~rst_. Htii~ - s. i _ 2 fiUl~S E lU E3 ~ R-T tE11 ST ? a " ~ZUr~-i ~1Z~v ct{ ~S_ 9~{_3t0 ~~~~~ _, LZ- 8-`~ ~_ (7 5 ) 42.5-ni h5 _ T~00576 CST Signature Date Signed Telephone No. CST # 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 (POWYS) 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- Table 1: System Design Specifications Sanitary Permit Number Number of Bedrooms Design Flow -Peak (gpd) Estimated Flow -Average (gpd) Septic Tank Capacity (gal) Soil Absorption Component Size (ftZ) aS '- ~ 3 p z Type of Wastewater mestic Table 2: Soil Absorption Component -Limits of Reliable Operation iog~> Septic Tank Component Soil Absorption Component Design Flow -Peak (gpd) ~p I X30 z Maximum Influent Particle Size (in) 1/8 Maximum BODS (mg/L) 220 Maximum TSS (mg/L) 150 Tab le 3: Maintenance Scnedu~e Septic Tank Inspect and/or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the 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 ofher treatment of holding tank may contain lethal gases, and rescue of a person from the interior of fhe tank maybe 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 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OWnerBuyer SCOTT ~ WANDA MADSEN Mailing Address 525 CLARK STREET, IIAMMOND, wi 54015 Property Address (Verification required from Planning Department for new City/State l~IOrm. wi Pazcel Identification Number 018-1036-60-200 LEGAL DESCRIPTION Property Location .s~ '/., ~ '' '/., Sec. 16 , T 29 N-R 17 W, Town of Hal~ioxn Subdivision Lot # .~ Certified Survey Map # 526518 .Volume 10 .Page # 2887 Warranty Deed # 528197 ,Volume 1119 .Page # t ~n Spec house ^ yes C~ no Lot lines identifiable ®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 statin that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 da f the three yeaz expiratio date. SIGNATURE O 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 roperty described above, by virtue of a warranty deed recorded in Register of Deeds Office. 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 OOCU1dtt r:0. i~,~~~ BA.~ ak' WI13-~'~°~I# ~:3 E--Sim,, ....~d~tl~~..~..axf ..~_..,.,.......... ...... ~.~~.~.~...~.,~ ................r.._....._.....,...... ._...~...... ..............'......... .._. .._~_~r_....... ~.....M. ._......._.r~. br a raiaahla _ ~io wstrsa~lr. ~s .__....,_....._._._...._._.... _F1~.V.8~.~.~Y _ .. ......................._.. .. ............., 9eax+~. w ~ raa~ ..s.a. ~ ....,...~.1~..~~s3,~......._...._..a~. saaet t w): fif9i it3GH `R• tOAO IilC•9#$sA6 pAEA SpI,~CRQfX CJ . 4~i1 APR 2 6 1995 R£Q~3f@r ~1 ~nA!+r3 . Ilif VwM h ~~! ° - _ fNBi hkudsa~l Part of the SE} of SEC of Section 16, Township 24 North, Hange 17 West, St. 'tat Pared Ws . .............. Croix County, Visconsin described as follows: Lot 5 of Certified Survey Kap filed !larch 7, 1445 in Vol. "f3", Page 2887, Doc. Ko. 526518. Fhr ~L l~rM~sd >i~nsaala~o ~? tl~ iced does a0a~q 1e Gaaamst al! of w arL-Le and iatat.st Ea w Yzopest,7 a~iek tM Daa~ss lad ~ ~ D.e.iant's dw~. a:d aH ad w .wa .ad Lend ~ w Proya~ ..~Leti w las.anal ~ 1...less aeaairad- • IiaAda llad8eA _ •...._.J$mg'.$..~~~sZ~~1.__._._ .................._. Co~l+wOOt~pMMM~Ya• CD- MaW avsss~rssos:io~r aypaata~sta) ....... ~ ~_._._ .M ~«.... •cssio~LSDOSiwx: armors o~ wisaoxsur as. .....S.L.....~.rs~ix..w~..._a.ati. tia'~'• aN ~ ..~ s~.~:~iia~aa sr~-~rs sage of ~visoo~ssi:~ .._.._.. atad tii- ~ w~. s~i..i ....__..__..__..... nua ~MSneuwctrr wwa aurtzo w ,C._ L,..,Gaxlo~da. AttorneX.___---------------- ..Si.v~._F.al1s....J~tZ...~L`...--------------------- +($i~rw4asra~ ~ M as ae Sed. 1~ are aoi aezesaaxg.) ~~,~ s snd o, r 4= ,_'~ r~,. Ar ZLotaz~ Fubiie ... __d?!.?C_.._.....co~ wt.. Yy ....is per~e ~ (lf net, atat~a aa~ fez .----•-----. . ~.~~..Q~ . .............. .. 1! _~ .._.. :,. ...<.....,~........ ....r:.;r......c... rcuw....~va.u~s ...,n..r..r.,fw ,r.: ~:+,w.... ,araW"- EsT~"YIR PL'ka~lfi'~Y:FkidtM: h%t :"S~1`1A~.~'il~#1~'~~ DClGUMENT NO. BTATS Yt1-$ OF' iI18CON$IN j-OBIt i- lfra ii rNU •-.es es•awra roe eaeeesr«e wrw /f~R>;00e;•'.1. R~R~~IIABTA'CIV@`i D~+ 1? i _.. ~tan~~..liaslaau..~nsL..Iam~,s._l~+cixan-------._ ................._...».» » .._~.., v Psesoaal =eyrsw,trttw9~t tiw .slats of »..H ~ ~.~ ~ ~.t _ ~Cx~.~ a~.t......_._.....».»........._ ........................._...._.---~... for • raluah!• aonslderi:.oc ~wys, without w~arrannty. to ...... .t~e~)• . .. .. ......... .....Scot.i:. Ate. M~d;leil.._~-nd..f~~:~t~~. _~~._MA~I~~n .............__._...... .....h~!s5and.. ~n~..x-.~,~~...a s..~.uz_Y.~.Y.stz~h.~.p..ms.zi.!.al...._....... ....pro.Eer~y ........................................................ ---.., a:ant«, the lailowi~ ieserihad twl wtats la ...._... S L.~__~.ru~.n ................coo><ty. Btata of ~Yis4oasia (2+e~daattee es»~i the "Proprrty') REGIS; EF ~ ,~~F~CL~ ST. CRQi1 C;~.. V~~I } Re:'~~ ter ^'•--"~ 1 APR 2 6 1995 lity 11s30 A.~,~ fNBi ~udsoyl Part of the SEA of SEA of Section 16, Township 29 North, Range 17 West, St. TasPaealxe:....,»......... .... Croix County, Wisconsin described as follows: Lot :, of Certified purvey Map filed March 7, 1995 in Yol. "10", Page 2887, Doc. No. 526518. ~ r 1~A, FED P•r9oac? ryre~p•ntatiw by this d•.+d deri• oouwy to Grainb•e all of the artab aad iat•ryst fa the Prvp•ity which the I)sbad•at h•d stwly yrior Lu 1?eealm-t"a d+eatL, aad sil ut t3ia e•i.t. a~.'! inkews;! is Lbe Propsriy wbkh the Pa +ond 3•prtstiw hys aince sey~~lrad. I1wW Shu -----------------_----•----.~,?ts--~-----. aay ot ._._..-•--~--~-~-=-1---------•--...------...._.._._._...._......, lY~~---• ..- ........... ... ..(8ffi.-L) C\\~~~~ot~.,.~yr-•- -• ..p..(8~2eAL) Wanda Madsen James Kra;zap.._ ........................... Co- r.~ a..~+.a.. ......... ......r.~.~ C o - a.n....~e.ar. a-osxxM'rsaA~rtcarl 8!~x.s~srs (s) aaLl+sfit~c.wl.+i•1 thir ........day ot ....................A---~ 19._-•-- waxxoz~Lxr,aaRxxa 8^aAT;tC OP WIgC~3NSiN ~ .....5 t..... C.Z; O.l.X_....._.....Cauniy. p -azlly w har3or• nw th4 ! ww ~~ ..i~da - otof ~ .F-~1 :~ ............. lY.~.~.. tb• sboi~~~~c~ ` fi t-~~., u..:., _.. r:. : ~ . •~`'"~ ,. FIL~® ~ MAR 0 7 1995 - ~a~r~~l:>r H. wus~ ~~` R~aisl~ot Deeds ~26~18 ~ Z Sl.CroixCo.,WI v s.. ~I. ~I a 4 Z ~. to „: 0 ~, v W 3 b z ~,~ Wj, /9~ •'••.......••'SJO ; ~` 7. 844 ACRES I ti ;~ , ~~ LAND ',8 W 34/, 892 SO.F7j. R R W p N ~ 1 ,,,+/~1~~~~1~~,, ~ ~ IM 8.888 ACRESfXIC. ~ m 2 ~ "~ ROAD R.O.W. I a ~ ? °~ ~ N m Laurence W. Murphy ~ ~, 299,933 SO.fT,I MMI .i a ., ~ = Registered Land Surveyor V N I o °' . SCALE I"=200' ` p I tym ~ O 30' /00' l30' 200' 300' 400' 300' 600' O ~ 2 I I l N ~` O „ N I 0 I n a J I I ( '~ ~ LOT /. C. S. M_, VOL. @. 1 ° I ° l/NPLgTTEO LANDS I PAGE 2/ 77 I I _ ~ 8' S B9. 38'00"E 1930,82' !l`3~.~JB' ~ 4/8.48' 23' ~ /00' 1 I 4S• W I . - ~ I I This instrument drafted by L rence W. Murphy : o I I ' a Owner's Address: ~ N I 924 C.T.H. "T'+ s e8•so'l7"w382.3/~ 0 3/7.29' ~ 43 02' Hammond, WI 54015 0 CERTIFIED SURVEY MAP HARRIET KRIZAN ESTATE °art of the Northeast 1/4 of the Southeast 1/4 and the Southeast 1/4 of the Southeast 1/4 of Section 16, Township 29 North, Range 17 West, Town of Hammond, St. Croix Count , Wisconsin. c O Indicates 1" x 24" iron pipe weighing q L-OT_L,_~•S•M••VOL• B, Pq ~' .~ 2 / 77 „ ~ i 2 o 1.13 lbs./lin. ft. set. _ 587'23'4/"E 3ss.83'O w ~ • Indicates 1" iron pipe found. `,~~N~~t~r ~ '''''+/+ej8, ~ t\ 320. ez' I 4 ' ~ I ~ ~e•-~-Indicates fence . ,``~ SSG ~~~~ Q NS ~ / ~ I ~ 1 3.03 I b ~ p ~ ~~ V' .. •• . ~ j1, ~ . •Y •• N I ~ I ~W W > x " W ~ '~ ~q ~ EN c~ I I I ~ " " 0 0 ~ 2 m t W Y oC ~ 4 ~ I Io ~. ~ ; a N :' • ~ i3 : ~ I ~ w a ~. RI ER w: FALLS r ~ ~ ~ LOT 3 ~ 30' ° h N 3 i ~~ ~'•• WI ~• SC ,~ J ( ° I I I W it O N ~ n N ... M ~ ~ ~~ a W r~~ , Y1 b F p 10.239 ACRES W 6 b 448, 002 S0. FT. ~' ~ • 9. 738 ACRES EXC. ROAD R. O. W. M 0 424, 099 SO. FT. n O p, 2 ° O _ { ROAD SETBACK LINE 2 '~-- -- - h S 8 7• 2/' 3 8 "E 3 8 4.73 I,,,~ --- / 4 3 4 3 ' ~~_d _. ~__.__... .; uNPCa rreq- - f 0 n ni ~N I~ ,~ I 2I ip q I J M e p N W 3 ~ n RI n v b I2 ~ ~,~ ~ I I b ~ ~ I ~ I I r O 1 bl h t LOT 4 ~ b N oo W I~ 30'I• N l3. 878 ACRES q O n 393, 833 SOFT. .~„ „ I 48'I /2. 44/ ACRES EXC. ROAD R.O.W. 4 M ) I 54/,9/7 SO.F7. i i SHEDS I Q a DWELLING b ~ 7 --_ DRIVEWAY ._.~~ri~,~ I r I/ WELL ®~ ~ I - - - - - - _ . _ BARN _ -~ - I W ~ _ _ _~/00'~ N Si I ?I' S B8 • 27.43 "E 888.33' /~ /~ SEPTIC ~+ v O TN d /E. 782.39 ' "~ ~-' ~- O 48' ~_ ~ b N 87.02'46"W /~•'/3/0.38'~- ~ M ~ •.282/. /2' ~ ,- M __