Loading...
HomeMy WebLinkAbout018-1083-13-000ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owne f /~- ~ !'ti /~„v Property Address v ~ ~ ~ City/State ~',,~~ E_ mo ~,,, .~- y~ Legal Description: Lot / 3 Block Subdivision/CSM # ~i~c AS/k-NT' S~ '/4~1 ~'/4, Sec. ~, T~,N-RI~W, Town of SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer G.~~cS~~ Size ST/PC/ooo/ ~-- Setback from: House ~/ ~ Well (~S ~PIL /~~~~ Pump manufacturer - Model '' Alarm location r-- (HOLDING TANKS ONLY) Setbacks: Service road _ Meter location Alarm location SOIL ABSORPTION SYSTEM: ~/L~/'~~+fTp~j ~~pr~W~•v~t~' Type of system: ~~ jycM Width 3 r Length~~• ~f~ ~ Number of Trenches 3 Setback from: House ,~$_ Well ~6~ " p/j, ~ r~ Vent to fresh air intake ~' 9' ELEVATIONS: Description of benchmark / ~~Po.J T i~~" ~? Sc ~c.~, ~a/titJw ~ Description of alternate benchmark Elevation /d ®- oo Elevation Building Sewer /4 -09 ~ST/HT Inlet ~~• $_ ST Outlet _ /o/.S,io PC Inlet PC Bottom ~ Header/Manifold /J/ , .?,? ~ Top of ST/PC Manhole Cover D . 3 ~ • Distribution Lines ( ) Bottom of System (~-) /0©.~ 4~c7 ` (g) Water Line io o. yo " (c) ~ o D . ~a Final Grade ~) / ~ ~ . S~O '' ,(~) / D !~ , ~ v '' (G') ~v~.s~u` Date of installation I!~/o ~ Permit number ~ 8.3~g'~1 State plan number Plumber's signature License number ~~~~ ~'~ Date Inspector Complete plot plan a Vent to fresh air intake NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmazk, if applicable. PLAN VIEW 45 /o~ob G.~ Gr.~se~ S`~ic 'Tr1+t~w' ~ r rK.=.~6~.d A~ ~~oo ~`F'l~'(71~ S i pdGai~Dt~? G~rnbee S ~S l~Gt'fior~. /ri ~m~~~a~~ ATE NORTH ARROW 3 6E0 Qoa~n ~~ I~~`S~gd.UtE ~g' -~- d _ ~ ~ % ~6' y~~ ~z' ~~avcd4/~•t+~K -- >" ~N l'i~E ~t ~.sT ~~Pn~~~ ~t~~- /oo. oo" i ''"in Department of Commerce PRIVATE SEWAGE SYSTEM Safefyand f3ui~dings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information You provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 'ermit Holder's Name: ^ City ^ Village Town of: 'urington, Timothy Hammond Townshi ~ST BM Elev.: Insp. BM Elev.: BM Description: Q SF ~~ ('ANK INFORMATION TYPE RER MANUFA CTU CAPACITY Septic pp p "Et ~ / Il Q U~ i ~Y ~ C~ sing Aeration Holdi g TANK SETBACK INFORMATION TANKTO P/L WELL BLDG. vent to Air Intake ROAD Septic ~ ~~ ~ ~ ' r ;"`~", NA Dosl NA ation A Holding PUMP /SIPHON INFORMATION .. r Demand Model Number G TDH Ift friction stem TDH Ft Forcemain Length Dia. Dis . F1 FveTIC1N DATA Count Sit. Croix Sanitary Permit No.: 383989 State Plan ID No-: Parcel Tax No.: 018-1083-13-000 STATION BS HI FS ELEV. Benchmark 2.. l ~Qv Alt. BM ~ ~ . S Bldg. Sewer ~, ~ ~ ~. ~~ t Ht Inlet Q ~' r6 Z. l~ (~/Ht Outlet Q.y 0~ 9~ Header/Man. ~j, ~~~ ~~ Dist. Pipe ,,,~ °' ~i , `"~' !o~/, ~ ,v(, ~ o Bot. S stem Y ~ I -'z, $e Apo. y~~ y~ Final Gra~e ~ e •y __ ~~" p ~ over SOIL ABSORPTION SYSTEM /p ~, gED / Width ~ Le gth / No.Of Trenches PIT No. Of Pits Inside Oia. Liquid Depth IM Z •~ DI N ING Manua rer SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREA - INFORMATION Type O ~~ ~ ~ r ~ CHAMB N m System: i,~vn, OR UNIT Header / Mani old Distribution Pipe(s) ~ ~ x Hole Size x Hole Spacing Vent To Air Intake t~ Length ~ / Dia. _~ Length ~~ Dia. Spacing ~_ DISTRIBUTION SYSTEM «111 !'f1VFR ,r Praccure SvetPms ~nlv xx Mound Or At-Grade Systems vmy 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, et '. •- -"'"-"" "" ~ ~ ~ - ~ -" Location: 1738 96th Avenue, Hammond, WI 54015 (SE 1/4 NW 1/4 16 T29N R17W) -162917585 Pheasant Hills -Lot 13 1.) Alt BM Description = `~ ®`~ ~~~-- y e~s~rv~~o~- (,~S Gv~rr iwst4l~~// ~%ti 2.) Bldg sewer length = (+~ ~ ~ _ 2..d ~~ ~~, ~~ ~,~ ``~~~ -amount of cover = ' ~,' c ~r row ~ ~ c ~.- ~,~ Plan revision required? ^ Yes ~ No / Use other side for additional infor lion- © [f Dat Inspect ~ ignature Cert No. SBD-6710 (R.3/97) AP: ~~32.Y ~"}-~ °((~ E Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21. Wis. Adm. Code See reverse side for instructions for completing this application 201 W. Washington Ave. PO Box 7302 iseonsin personal information you provide may be used for secondan• purposes Madison. WI 53707-730' Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit Completed form to Cowtty if r state ovine: Attach com lete lans (to the county co • only) for the system. on a er not less than 8-1/2 x 11 inches in size. County Stat Sanitary Pe i Number ^ Check if revision to previous application State Plan 1. D. Number ' ' lication Information -Please Print all Information ''~~ '`~ • ~ - `. / , ' - I. A Location: Property Owner Name ~:C;. ~`' ~ I~ Property Location ~~ ~/ ~~ ~ t r ,r} S,tC 1/4/Yh/1/4, S 6 T ,N, E or Property Owner s Mailing Address ~y Lot Number Block Number R n,q? 03o v /1/. -- °i~~~' City, State Zip Code Ph e~Q tuber 1" i;~ y;., Subdivision Name or CSM Number . ~ n/. ~Sso Ya. ( } ~~ ~ II Type of Building: (check one) .% orc Ps.I sa.h ~ ^ City ® 1 or 2 Family Dwelling - No. of Bedrooms: ~- ~S ~ j~,~ ~ ~~..`t ~~, `~ ~ ^ Village ®T f ~~- ^ Public/Commercial (describe use): ` own o ^ State-owned III Type of Perr.^.it: (Check only one bex on line A. Check box on line B if applicable) Nearest Road ~. _ _ p) 1. Jdl New System 2. ^ Replacement 3. ^ Replacement of 4. ^ Addition to Parcel Tax Number(s) S stem Tank Onl Existin S stem O/ / - 00 B) Permit Number Date Issued Z9 /7 ^ A Sanita Permit was reviousl issued ~o •d . IV. Type of POWT System: (Check all that apply) -t1~ ~-~ . ® Non-pressurized In-ground . ^ Mound ^ Sand Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At-grade ^ Agrobic Treatment Unit ^ Recirculating ^ Other: --~ (~. 3 X 93. 'i-S-~ -f~.~. cs~Q. V Dis ersaUTreatment Area Information: o. 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./daylsq. ft.) (Min.linch) Elevation %JU ~$'vv ,rT .S%`/ 2 s ,f7' (9ero~~`~" ~DO, rfv SOS. SO VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks ® ^ ^ ^ ^ vo vva / ^ ^ ^ ^ ^ VII Responsibility Statement I the undersi .ed, assume res ensibili fcr installation of the POWTS shown on the attached Tans. Plumber's Name (print) Plumber's Signature (no stamps): h!tP/MPRS No. Business Phone Number 7 7/S ~.1' Plumbe Address (Street, City, State, Zip Code) /S" ..~' S . S l VIII County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued nt Signature (No stamps) Issu ~( Approved ^ Owner Given Initial Adverse Surch a Fee) dp ~ Determination ZS `- () 601 IX. Conditions of Approval /Reasons for Disapproval:. n ~ ~ _ v ~ . `~S ~ t Snn ~' w ~¢~. S"t~s~~~~n' S i/nt~ a. /w/~. ~- /5~ ~ /~ t ~~ ,..~.tn. a.d~ S k t,~, ao adLac¢a I~ed~. ro~S r~ ~- ~ ~. Gt9 ~(j~L~tlC.t .-~. ~.,as~ewe~. ~0 11 - ~~t~ 1 'iE ~a,9+Ma~tartilll is d~2~nw,e ~;I~.Pe ~er .~..~.~u~ro '~.a~' ~.. Se~._-E~ ~~I~~~ia?-K~ ~t-t ~•~r tS C~Q.D~ lac Oyt ~, efl PFD, Uh/.vtM.t~-CJIAM~~ SBD-6398 (R. 07/00) .. 3 /3~ORao-r~5 ys0 -.9=500 - /~7./~,/-~j,/rJ oQ 3aS,ac~.,~..,a~ ' 3 • TjQiE/.uc.lf~5 u ~Tf! /D C/-~firlhi:75 L+vu G . ~ G.t~/Sq ~t/~~y ~u ~3 ~ 3o,n~~L ~s5 '~ 30.~~` _ . Lf G.~~~vFr~~.~"~ ~~r~~Co E6~~ua~,T iyB'To ~.~ N~~rNL„~ ~, ~' - i~ !/ nn ~dSI 7 ~~G/f5/O >"~/L ~iLJZrI ~/.uF / ~~' - ~~ fi ~PrI c Trru,~ w ~ rµ ~ ~hrSc:: A/acs ;l~N-rLcr ~~T~,e 1 g~ Gam~.--A-~~rr ry I~~/~E[ T ~~v~r~~s ~N SPEl7iON/~Ic.`I.!'r5 /'~ . E/t L H t~l/~0 l.oT ~,9PnJG7. FL~V `~7.Oa' Q I?a~Yc•~y 3 d~t~rPoa~..ti ~ESI/Js,M td r--- i ~T f ~ GMtt~~ ~z~~ ~~ .I w,7~ D,o J' '~ roe y '~ ~ ~s ~ 1~iE~,.~ m~ ~rtra•~d~Q ~' 085~2J/krio.y.~, ~F •TiNQE.:~A6A f~3SF.X~'iJ,g2-iv~u ~~' /11,t7{I /YlHM /~+ I7~~~ T/,JiS}'~ ~O~Ik4~ FN,SH ~o.Q,ngE ~~ w~ SAN yp R~~ T `I 16.' d 'c .~ 7S" S, of w „~ acR ~,GH ~,4PAc-r,~ "1~X,MuM 9~P~~ /tib?Vd ~~Nr1fSC~ To ~~N~sH G4.+o~ ~' % W i7o a 0 0 810t~D: uceNSe: PLOT i~ CfiOii i6CTICN PWdi L1F~PA BROi. ExG1VA71N~i1 MIC ~.uMelrw uMT ... PFiO~JECT - PQ~P~~o w~« -' ~~T Tl~o fE?>Ff~ - c...~~ PPi: ~ s,E.1,~~,~r.~ea .. Env: ~ /oo. oo ~ N W ;~~ E. ~O 1 VS `~`~ 8d TEe~iNq 8Y: . .....~227~~ Side View FEE f A'rjo.J T Etc N ,Be rro~.v. ~£Q So, ~ T£.ST End View 15° Env = /oo_ ~o ~~; 34• .I /~nnEL _' ...... , . 3 ~Ea fan-~ s ySo ; .9 = 500 I ~. /S/= ~;. ~'7 ©~ 3~ 5,a~ ~,N • ••P 0 • ~ -'7`jQ~E.~c tl~s c..~,TN /o L/-f-rhrlh~lS L~ vu 6 PLOT It CROOK O~CTION PM11Ni . ~~t~//S~pT fQ,t+/ +8~©3 ~ 3c~m~jt: ~s5 ~ 3ar~Gf = • ~f G.t~~gi`-~D.I-~/ ~F'PA 9ROS. E~((C/1Y/1T1Nti INC T~res~r% SFr- c c~ ~>ur PLUMBIt~IO UMT .. - iyB To ~. d+ ° R 3 \ w 1 Gq ~xm.•v la~ ~ I s / o ' ~e5«J.t.~,rc.C ~~/ ~+.v7~ ~/ y s~~~ o > vc. 5~~~~c~ ~/tip - - - , _ .L, ~ T ~ ~ - CiA"p~4~ ~7 / ~_ ~~ P4vPosc~o Gt7~tL -~ /oocG~r[ G,/,tESEir ~ 3S~ S~PT~c T.~-.uK c,,,r~ --- - ~r ~ ~~pp ~ ~if JGt~ AIa~ ;~lnTLcr ~c~,e \ n {~RapE?~ ___ 1 c,, ~~ ~ ~z~' g~ ~ ~ r ~i11 ~-rG-T (nvf T0~ ' S/~EGI ~ M~OEIZ I'"~/G/-~ ~ • G~,~~~-~ ~ry ~~~E~ ~ReNC~t~5 w,7N ~ ~ 17 e` 1 /jt:hJc Ni~~PK ~~ SPEiTivnl~~~a-?-S /~-~ . ~/tGH ~•UO ' o a ,g L.~ 1'~Pl; ~' S.E. ~~7"~aQ.u~k • ~, Q~ ~ g ~ ~~/i End. = /00, oo' l' 0 ~/Y ~ ~ n g a ~~~ N,ry,.~,~ z~o,~ pow M- s_w. ~ - ~ ~ Vii , ~~ E. 1, 07 [~~QivC~? . ~t.4 V• ~7. ~ D , ~O vs t`.~LH ~i++p~10~,0 D~S~i V~i~iu ~.~-,~ /~/t7(I /YiHM /i~~ ~TO~~~ %'/a1~S¢'~ ~QI~4£ Fti~sH ~v,QA/~E sa TE9jINq aY: • ~~ o .....~~2~'7~ ~ ~ Arc S~ N yo P P~ Nt~x, M4 ~ 9~" Am.,~ . ~~~-,ss~ To ~I N ! 5 H GQhQE T 16.' a~ c' Side View Fig ~lM'~o~J T e~!< N ~s tro,,.~ rbQ So, ~ TE.st End View eio~o: ucetrae: ~:~ v ~i ~ ~ i_____~ DATE: `~` // • c~~' 15° ~t---- 34' ~--i~ ~voEt .• wi,eohsin Department of Commerce IL AND SITE EVALUATION Division of Safety and Buildings OR~~Id~111~th Comm 83.05, Wis. Adm. Code Page 1 of 3 Certified Soil Testing Attach complete site plan on paper not less than 8'/z x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and l ti t d l di i h d l d di t t St. Croix roa ance o neares . percent s ope, sca e or mems ons, nort arrow, an oca on an s _.-.- ° Parcel LD.# ~ APPLICANT INFORMATION - P/e ~e p~'int eN Information y . Personal information you provide may be used >~~e~oridary purQoses (Privacy LaW, s. 15.04 (1) (m)). Reviewed By Date <~ 1 - Property Owner ~ „ ' ; ,Property Location Bonte, Ron a govt. Lot SE 1/4 NW 1/4 S 16 T 29 N,R 17 W Property Owner's Mailing Address i '. f. of # Block # Subd. Name or CSM# 1011 170th St. ~ ,, ~ 13 Pheasant Hills City State,. 2i Code P r H d WI ` 54015 '~~ ~! SI6 ~~44 `~ City n Village ®Town Nearest Road d 170Th St 'A ammon .: . ; •,, ,, . ammon ~ ~~~ I;N~ibe~pf ` rooms 3 ^Addition to existing building ~ ' New Construction U __ se: 'Replacement ~ Public orso~late~eiat"scribe Code Derived daily flow 450 gpd Recommended design loading rate •3 bed, gpolftz •4 trench, gpd/ftz Absorption area required 1500 bed, ftz 1125 trench, ftz Maximum design loading rate •5 bed, gpolftz •6 trench, gpolftz Recommended infiltration surface elevation(s) 24" below contours ft (as referred to site plan benchmar Additional design I site considerations 'nstall 2 - 5' x 112.5' shallow trenches along contours for 3 br Parent material till Flood lain elevation, if a licable N~' ft S=Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U=Unsuitable for system ® ^ U ®S ^ U ®S ^ U ®S ^ U ^ S ®U ^ S ~ U JVIL UC~I+KIt' I IVIV KGI"VK 1 Boring# 9 Ground elev 102.8 ft Depth to limiting factor > 80" Z Ground elev 101.8 ft Depth to limiting factor > 64" Horizon Depth Dominant Color Mottles T t Structure Consisten Bounda Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color ex ure Gr. Sz. Sh. ry Bed ~ Trench 1 0-11 7.SYR 3/2 - sl 2 f-m sbk dsh cs if .5 .6 2 11-43 lOYR 4/4 - sl 2 m sbk mfr cs lm .5 .6 3 43-68 l OYR 4/4 - s 0 sg dl cs - .7 .8 4 - 68-80 SYR 4/4 - sl 2 m sbk mfr - - .5 .6 Remarks: gr at; occasronat coo m nonzon s 1 0-4 7.SYR 3/1 - sl 2 m gr mvfr cs if .5 .6 2 4-9 7.SYR 3/1 - sl 2 f sbk mvfr cs lm .5 .6 3 9-27 7.SYR 4/4 - sl 2 m sbk mvfr cs lm .5 .6 4 27-48 7.SYR 4/6 - is 0 sg dl cs if .7 .8 5 48-52 7.SYR 3/2 - Imcos 0 sg dl cs - .7 .8 6 52-64 l OYR 4/4 - mcos 0 sg dl - - .7 .8 Remarks: °unwn v nas gr a coo CST Name (Please Print) Signature: "telephone No. Henry F. Grote ,~ - 15-665-2681 ertt re o~ eshn pa Address P O Box 57, Knapp, WI 54749 3/2/2000 222774 mbar Re 025 PROPERTY OWNER: t3onte, xon SOIL DESCRIPTION REPORT ~ Page 2 ' ~ 3 . PARCEL LD.# Certified So-I eT-ss;~ng 3 Ground elev 102.3 ft Depth to limiting factor > 60" -~ Ground elev 102.8 ft Horizon Depth in. Dominant Color Munsell Motties Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots GPD/ft2 - Be- a-~T - 1 0-4 7.SYR 3/1 - sl 2 m gr mvfr cs lm .5 .6 2 4-12 7.SYR 3/1 - sl 2 f sbk mvfr cs lm .5 .6 3 12-41 7.SYR 4/4 - sl 2 m sbk mvfr cw im .5 .6 4 41-48 7.SYR4/6 - is Osg dl cw if .7 .8 5 48-60 l OYR 4/6 - s 0 sg dl - - .7 .g rcemancs: 1 0-3 7.SYR 3/1 - sl 2 m gr mvfr cs lm .5 .6 2 3-9 7.SYR 3/1 - sl 2 f sbk mvfr cs lm .5 .6 3 9-46 7.SYR4/4 - sl 2 m sbk mvfr cs lm .5 .6 4 46-60 lOYR 4/4 - mcos 0 sg dl - - .7 .g n_~_~__. nri~nn ac rnnm ara v o Depth to limiting factor > 60" SCI I IGI R5. ~ 1 0-4 7.SYR 3/1 - sl 2 m gr mvfr cs Im .5 .6 2 4-13 7.SYR 3/1 - sl 2 f sbk mvfr cs lm .5 .6 Ground elev 3 13-50 7.SYR 4/4 - sl 2 m sbk mvfr cs Im .S .6 101.7 ft 4 50-64 7.SYR 4/6 - s 0 s dl g - - ,7 ,g Depth to limiting factor > 64" Remarks: .onzon as some gr co ; eep r p ss y sma et y e ms a e is are a ~ oermea a sol s c an a veri ie v Ground elev Depth to limiting factor \~-Ow S~ Oh TG- - ~ \O~ ~10.N L~~- .3 ~~~.~SaN-~ 1~:llS SL'---Nw_ 1b-zq-lbw O w ~n', '~ w w w o `+ N T S C_o~ I " L ~ b, ^ O S o Ls c~ ~~ a14h t,i1'~~1 1~ 13 t-l ~~ e.v n ~. ; ~ o h ~ S E c.e~..,. ~. ~ l cro . 01 ~ z a K ~.~., o., :~ o N ~ "4' Q ba.a\c~~~ J ~- ~~1 ~.~:~~.aQ~. r I 23? ' 31.6.'1 ' 13•x. 3W..i3' / ~ 4: r,~` [~ e~.E~ ~ni C ~oz.T) a ~~9 \(~oa.8) i ~ a-s~ z ,~3K C - °-.~~ LQ ~:o ~ ~'-vs.33 '~ i3rt ~-- 95.x} , 3 0~3 Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT Page / of in accoroance vnm L:omm tsa, wis. Nam. was _ /~ County S I ( must i Pl l 8 1 1 i h i V an n s ze. ess than /2 x 1 nc es Attach complete site plan on paper not include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~'~ Ztb` Properly Owner Property Location / l n ~7 W T Z'7 N R ~ / E ~ ~ J N --' ~y- ~~, ~ i _ ~ (or) J 1/4 S / O 1/4 Govt. Lot l. Property Owners Mailing Address Lot # Block # Su Name or CSM# 3v o e/ - ~ ~ 13 5~100)7~ t~l i r~ City State Zip Code Phone Number ~~`" ~~°~ ^ City ^ Vllage Town Nearest Road ~ ~ ~r Sa =~ ( si) .36 , d-mm ti~ .. 17bTu l [~ New Construction Use: (~ Residential / Number of bedrooms ~ N K Code derived design flow rate GPD '~, ^ Replacement ~ ^ Public or commeraal - Describe: -___-___ _--- Parent material / ~ ~ L Flood Plain elevation if applicable ~~ yi ft• General comments and recommendations: ~~ImJ+h ~ ~l~ ~-,,~T ~ ~ c~ c o r~,~ E,~~s ~0~4 ~ir~-G ~A~~- O~ ~ ,~' (~ ,~ LXC..iaUsc [5~ ~/A ~, t A ~ ~d r1.5 / / Boring # ~ Boring ~ pit Ground surface elev. ~~ ~ ~ ft. Depth to limiting factor ~_ in. Soil ication Rate Horizon th De Dominant Color Redox Descxiption Texture Structure Consistence Boundary Roots GP DIfP p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 A - ~ ~ ~ -- L I ~- Sbx rit ~w 1 0 . . ~ S 3d 4 ~ -j Sri I ~ sbk r~ r ~ ~ d.Z O,- >~ -~D av 3 J MS s ~ S f :7 ~. nng # ~ Bonng Pit Ground surface elev. _ ft. Depth to limiting factor ~_ in. Soil lication Rate orizon Depth Dominant Color Redox Desrxiption Texture Structure Consistence Boundary Roots GPD/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 - D by 3 ~ ~ ~.. b~ r L~ ~ 0.6 iD~3~ jaY24 3 _ ,L sbK- rti, -~ w -- .2 0 , g 3/ ~ s7 / Y ~ 3 ~- ~ ~S ~ ~ -' .5 .4 IO ~ 3 ..^. S~ ~ S m ~S ~ r 2 ae~ . ~ 'Effluent #1 = BOD > 30 _< 220 mg/L and T55 >30 < 1t50 ' tmueni st = avu ~ s~ rrxy-. arw i ~ = av nyr~ CST me (Please t) Si atu CST Number ~a u s~ ~z2757 (A,~~ Date Ev luation uded Telep Number 1 d ~~ 1~ ~U ~~L1 i~ W 1 ~4~ 1 2~ I f Property Owner Parcel ID # Page ~ of ring # ~ Boring / Pit Ground surface elev. ~~3. b ft. Depth to limiting factor ~_ in. Soil lication Rate Horiion Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/FF , in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 d-r2. >by~23 - L m ~b~ >~ ~- ~ 1 ®.4 0.6 J -~~ ~ 3 _ S I~- J~ rn r -- C1, 2 O .~ ~S~ flvt24 3 -- RS ~C, 1 - .S O.9 - `~ ~ D Yr2 `-- in7S 5 ~ rvt . GS •-' 7 I . Z. ~IOb 7.Sv -~ CL ~~tSb `- A A 3~•c./fig • 4 Boring # ~ Boring ...~ . Qt's 1 - U dd~J Pit urounasuraceeiev. ~ ~-~ r n. uvNoi w w~uwiy ~auw ~•-- ~~~• Soil lication Rate Horizon Depth Dominant Color Redox Desaiption Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~ -g / DYt23 ~- -- 1... I rh sb ~. m r Cw 0 ~ 4 ~ ~ Z~ 3 -- 5, bK, ~- 5 - Z O, ~a y~ ~--- S 1 c.s - 1, z 0- 8 Y S ~ s, ~ rr ~ r S - NA /~ 118- / Y 7 4 GAS ~ ~, r ~.. ~ IL~J~J ~ _ nng # ~ Boring Q~ l~ ~ Pit Ground surface elev. / ~ ~ 1 ft. Depth to limiting factor U ~ in. ' Soil ication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GP DIff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 -5~ --- r~s n11 Ls -- .~ .~. -g ~ ~--- 56 r+~ S rn Cs - ~. ~. Z 8 - Ib ~, y 4 ~s ~- `- .~ o. ' Ild'l21 y 4 5~1' ~Q~S ~ ~ A d 3g. ~s ~ 'Effluent #1 = BODa > 30 < 220 mglL and TSS >30 < 150 mglL ' Etfluent #2 = BODS < 30 mgA. 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. sen-e3w (re.woo) w ~~T -3 ' Lo.~ ~ ~ ~~~i ~ ~Ca4 L ~ ~ ~ Sd ~ ~ 1~~1'~Dtil A`r LD'j' I,OCNIL~ E~v= 9b.33, 1 1 I I i37 I 1 I i~A .4~ BZ ,~ „' P~ q~ UZ' ~ ~iD3.1~ ~ ~- l , & S '~ ` ~~ i 6-4 ~~03. i~ I ^ ~, ~/ v ~„ ~crlMa2~- I ~~o~ Lo-~ Cd~vEe Et~v = ILI~•UD 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) SAD Estimated Flow -Average (gpd) a~o Septic Tank Capacity (gal) ~ ~~ Soil Absorption Component Size (ftZ) z _ ~ Type of Wastewater Dom stic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow -Peak (gpd) 01'sp S z- a M Maximum Influent Particle Size (in) 1/8 Maximum BODS (mg/L) 220 Maximum TSS (mg/L) 150 Y ~~ , tan ~~ l Tab le 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 tic tank and outlet filter shall be assessed at least once every 3 years by inspection. Th outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not a removed unless provisions are made to retain los ids 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 freatment or holding tank for any reason withouf being in full compliance with OSHA standards for entering a confined space. The atmosphere wifhin the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the 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 OwnerBuyer SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Mailing Address 3i'3o ~~-ty ~.re. /1~ ^} La~,~Ce. ~~w~8 rb~/ SSD~'Z Property Address ~13~ ~to r ~~9e. ~:r,~la~, W ~. ~y~s~ (Verification required from Planning Department for new construction) '~P City/State ~ar~ r"-o~. w~- Pazcel Identification. Number ~ l ~~ ~ ~ ~ 3 ~ ~ 3 " O BO LEGAL DESCRIPTION Property Location ~ ~ '/,, N W %,, Sec. ~, T~_N-R~_W, Town of }~,~iwt~odl.C~i Subdivision i h~~ig`~^k Ni~~s ,Lot # 13 Certified Survey Map # .Volume ,Page # Warranty Deed # coZZS~ ~ .Volume 7 ~ ,Page # ~ _ Spec house ^ yes ~o 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 masterplumber, journeyman plumber, restrictedplumber or alicensed 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. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, here' t by the D artment of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that septic stem h been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days o e thre year piratio te. ~lt~101 SIGNATURE OF APPLICAN DATE I ( ) em that I statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pro de cribed boV;, by virtue of a warranty deed recorded in Register of Deeds Office. c t' /~ /d SIGNATURE OF APPLI ANT 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 STATE BAR OF WISCONSIN FORM 1 - 1998 ~~ WARRANTY DEED Document Number ~~1 ()~/'S P~~~ ~n a rer ""R i~k.~ ~t This Deed, made between Ronald C~, ` Bonte and Dine M. Bonte Grantor, and Timothy D. Purington and Amy E. ~~' Purington, husband and wife, as' ''" survivorship marital property ' Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate In St . CrolX County, State of Wisconsin (the "Property"): °. Part of the SE '-~ of the NW 4 of .,Section 1;; Township 29 North, Range 17 West, in the Township of Hammond, St. Croix County, '~ Wisconsin, described as follows: of 1 of Pheasant u;ii~ filed May 5th, 2000 in Volume 7°, Page 86, Document ,~~ #622544 ~ 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, licenses, zoning ordinances, and restrictions of record. Dated this 2nd day of April 2001 ' ~ ~ ~ '(~~~~~ (SEAL) ~ 1`(~ -c:~~1L %' /~~, /~Gj~'`2~% (SEAL) Ronald C. Bonte ,« Dine M. Bonte (SEAL) AUTHENTICATION Signature (s) authenticaledKhlScla Coa tes-Knutson o ary'~G~~ ' }.,}~.~~ Wisconsin TITLE: MEMBER STATE BAR OF WISCONSIN 641.864 KFi'TMi..f:F:h! H, bJALSH REGISTEfi OF DEEDS RECEIt1ED FOR RECORD 0~-~!3-?~O1 8:30 AI9 ldARkA~1TY DEED Ci<RT CQAY FEE: Crr:•:i cEr. T~~~s~-Ek"FEE: ~s.so F:EC~RL*?Fi6 FEE: 10.00 F~AGES: 1 Recording Area Name and Return Address / ~, D ~~ t* 018-1083-13-000 Parcel Identification Number (PIN) This 1 S nOthomestead property. (is) (is not) ACKNOWLEDGMENT (SEAL) State of Wisconsin, ss. St. Croix County. Personally came before me this 2ri~ day of Apr i 1 2 0 01 ,the above named Ronald C. Bonte Dine M. Bonte y rCly 52 EE ~ N O~ rnN ron O ~ om . ~ y )8" W 1 ~rn m ~-a 550, 28' 0 y do 520. 35' ON O~ ~ n '~ o m CO ~N y M"BI ,bis°OON N N w ~ 1 ~ ^~ O ~" n -1 O n p~ ' cmr> O y ~ I I I ~ I ~ I 1 -m V ' ~ 1 1 1 L / NE w~ ~ .1 ,~ 1 I~ ro i ~ ~ • nl . cb ~ ce °' 1' y; m ; O = 50 ~ O I I ~ 1 cb 1 ~ . ~: ~ ~ ~ 50,: 0 1 ~ ®1 ti 1 ~ 1 /V 1 ~ ' 1 1 iV 1 .Q 1 = 1 ~ ~ = i 1 1 1 ~ 1 1 1 1 1 1 ®. 1 ~ ~ i ~ 1 ~ 1 ~ O o Q ' 'A . , p O W 1 , 1 1 I I I 1 1 ~ 1 1 1 I 1 ~ cn I o, ~ ,- 1~ ©1 N ~ v v- w ;r : _ LV ® •~ i R1 1 ~ :T m 1 1 1 ~I 1 1 1 1 ~ 1 1 ®' 1 ' 1 1 1 © 1 , ~ 0 , 9 9 I rn ~ ~ i ~ 1 Z Cn ~ i ©~: ~qTc ti ;~ ,~ ~, F : a 34s, ss, co O !V 00 n ~~ om SOS 5 02"W (~ y ~ U w 349. ~ ~ ao v N • ~ ~ r, y ~n ~~ N ~ y SOT°37' 22"W 366. 4T' ~) • ~„ N Q y ,~,~ yO~ • ~ W ~1 M "91 -,titi o00N i O Oo O Oo ' SOI °20' 43" W 366. 13' ~ 1 i i ~ ~ 1 _ I ~ ... i N N i rnN ~Arn ~ ~ ~ ~ ® W ~ ~'~ ~ ~ I v N O ap c0 I o ~ ~ U co N r On Q y --XiZ,~ o w w o\ O n ~ a Om ~ -c ano o :~ ®~ p v co ~ ~ O ~ o -- n ' ~ _ ~ O Z "''' 1 '~ ~ _ rn ~ ~ I: .n m to N ;~ • omm ~,1 ~ c,vi \ 0 ~ ~ , / ;~ I ~dy ~ V~ ~ i ~O ~ ~ ro w v 0 ~w U w ~ ~° w O ~ ,~ ~A 0 W O a w ,~ p2