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HomeMy WebLinkAbout018-1083-43-000/* Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety' and Bullclings Division INSPECTION REPORT GENERA•l. INP~RMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law,~.15.04 (1)(m)]. F~j~iol~i'k~lame: ^ City ^ V ®O fOWhsh'~ CST BMElev.- Insp. BM Elev.: BM Des i ion: a ~~ TANK INFOKMAI ION TYPE MANUFACTURER CAPACITY Septic ~. 2 ~ Dosing Aeration Holdin TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Air Intake ROAD Septic ~ ,~' ~~' ~ NA Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION M ufacturer and Mode er GPM Lift Lriction System TDH F Forcemain Length Fi oweu ELtVAl1UN UAIA Count Sanitar State Plan ID No.: ~_~ Parcel o STATION B I FS ELEV. B nc r •Z~ p, ~~ [~ (~ 6 Bldg. Sewer 3• So ~Z,60 r St/ Ht Inlet "3.~0 Z•'{Or St/Ht Outlet 3'g~ 92.LS` Dt Inlet -~ ----~ Dt Bottom .`-, "-'' Header /Man. ao ~° •~0` Dist. Pip (~ S S• `F~' ~o .4s• r Bot. System e~ SOIL ABSORPTION SYSTEM ~I ~) ~f_ _. _ 1-.~ _,._ o _L~ _ .L BED /TRENCH Width r ,L,gngth 1 r N . Of Trenches ~ PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I N 3 ?S(•'L~o+~+•e-~ DIMEN I N SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING Man 1ctur rr:' ~ ~ - S `~ ` ~ SETBACK "` ~''°^"' ` ' '` INFORMATION Type O 1 r CHAMBER o e1 Num er: System: ~.-+~•~/ • "'IS 2S ~ ~ ~S OR UNIT - ~, DISTRIBUTION SYSTEM ~ ~~ E~s~f-P/i ~ V Header / M nifold [f I ~ Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Q-~ Dia. Length 3~ 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 InS eCtlO # Yes / /No In tt@!1 No / ~gM~~NTS' u cl a ode discrep ties pers r t Location: '170 1~t~i Avenue, ~'amrfianc~~ ~~~~5~ ~NW 1/4 NW 1/4 16 T29N R17 -16 ~ 761 Pheasant Hills -Lot 43 1.) Alt BM Description = ~ ~'°-~ 5 ~ ~ 88•`~ • ~~ ~. ~° ` 2.) Bldg sewer length = I$ r ,,~ ~ ~ ~ N ~. ~~ ~ ~~ ~~ ~.~> . 3 o S • ~f s 9 -amount of cover = ~ ~ _ _ - n ~ 3} A' N'/~p~-~te„~k-S ~'(~- w ` u ~~. t~G, w~^~ S ~ ~~' , ID r ~ S . r o Planrevisio required? ^ Yes ~No ~ Z~ a( ~ SZ~ Us~~j•e''))other si for additio al intor ation SBt3c6~0 (R.3i/ ~ ,Da e - spector's ~gnature , ~ n ~ ~oµ 0.~rt No. ~j Q. ~ F ~ ~ sf.Zxtdt ~ 1~3 I~ . hs~-ir~-~lri OsP#rtmrM er t~otrlp-grsa Sanitnr~ Permit Applicstioa !o accord anth Cotstm 83.E 1, Wu. Adm. Code Paraattat informtttian you provide rutty be toad far oeaondty ptu~poaa [Privacy Law, R. i 5.04(1 ~(a+aJ -- - 4. G Additioa. to ~. ~ ~~~ 5` 7'c r~ .' ~ r-' ~, t~llarmtt 101ri~t y ~;~ Prup~ty c~wr t+l.rae ~k~ ~ r/ eve Qe~n~ ,o'~.d -~a ~ iu a T ~ ,~..~~..}~ PrOp6ttY (yVYltatl"y ~ F! Qt~lWgiiQr }~lilOiC tvWY~~6 Sf. ~a City. State n lap Cate # Pawns Nuaiba' &ubdiviax+n Natr~o a CSM Numtca II 'ryrpe a~ S~iii~e ~t~eck tee) ~ ~ ,~; 1 ar 2 Pahtly molting - No. of 8adroaas:..,_,,,,,,~ ~ Cl pu~i,e/Cattt>,eet«iel (dt~cclba ttu):,_,,. - [u TES et' Pt~t~: (Cb~adt, a~iy ~-ne i~x nn li:u A. C~ueek box on I'tAe ~ ii A) t , ~'Nrrv 5yatmro 2, O Rgtttcadaavttt 3. CI ~~ a#' $ Taak B) 1?4:aait a w s PaaYnit ~~~No7ya~e e-t IaWT Ste: tCleetc.U that rpp~Y) ~ Mwu~a _ t~ ~~Prwa~rludtlt D li~ldistg Ttaak ©At~grt~ Trwateat Utut ~ 2 S/i~0/ Sateiy 1~. ~iuzki~~$s iJ~v~s~vr, 201 W, Washsr-~ton Aye. too ~. ~r~a~ Mttduana 1A'i 537U7.73Uz {Subtyit cara~rletod fort» ~ csnunty~ if not 1Satap Rood ~aL Th D 8wd Fitmr D t~asd Wetland O S3og1e Putt Q ~ Llae a ~,~~ a over: "t_s..1Lt`t1~S t , Claii~;p FWw ~ _. 6~9~ ~'~'"dt 3. l7ir~snai Aran t~ 4, tici~i Appdigtiatt wtact7ala.tayhq. ti.~ S. P4xoolatiari ltaos 0-C~.~-) 6. ~~ o ~ / fstnwtkm ~' m~ , 20 ~ • ~ .~~- 89.0 0 9d~ ~ V1 T,u1t atY ~ Tatai a of ©dtans Tanlwit 14~ C,ou. a '~ Can- - Pteata t~ dt~lara~atias New ~ t~ f r ~ ~ © Q ~~ r,- ~ ~ r~~ r ~,~,~~ 5 ,~ , a .., fi..,..~ ---t- !f, vn~ C ~3~G / .o .,N.,,i...,.,~. ~Appraved D tamer tiiraa faiaial Advtese i$ • F22S ~ ~} 2~ 1 ` ~-.r.......,,..._ ~..9,~.. , e,..~.. ~ ~ 5.~,-~..~-. sr,.~. ,~-~ ~- ~,.~~,,,~ SYN. ;..-~., , Cs.e~-'°~ ,~ < <rtii ~ ~ :.c~Qs~ u~ nna55,'~ - s c.-I r~ ~" SG ° 6~,Q.~r-~ °~- ~o,,,,~ ~ S~ / -~ ~S rwxs((-f~l~-- GR,a-~.~e.. f t ~ ve.~'t C~+4~.. c,s-~.t~a~~ Ce-wtc~'" ~ R_,~ ~ ~. f..a,,,~ ~L~-r rs c~w-a~~wutin:~a.~e~ 00 s-ro- o (COQ ,,,~lac..+aa~"s:~.) ~~ f~-G c~ r~~Y _ ~o ~ ~j.~ .F~2 ~G t /`I" 'lry ~ ,0 1~~C ~m iy~ i,-s d .C~l~ '.~,~a ~. ~t ~,i~-e 9c .~ ~f u"' ~f"~""`~ t \~ ~. .. _ ~ ~~ ~~ i ;, i t r ~sconsin Department of Commerce SOIL AND SITE EVALUATION - Division of Safety and Buildings OR~G'I~!'[f:.d with 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 d t -" St. CCOix roa . ~iea,and distance to neares percent slope, scale or dimemsions, north arr ~ nc>~,o I ~~ Parcel LD # , ~.. / .~. ~.~ APPLICANT INFORMATION - Jesse rint arF'ir~~ ~r tion . . p ; Personal information you provide may be ~C for`secondary~pos s (Pr14aDq L w, s. t s.oa (t> (m)). Reviewed By Date Property Owner - -~ ~ ! Property Location Bonte, Ron ° ~ Govt. Lot NW 1/4 NW 1/4 S 16 T 29 N,R 17 W ! Property Owner's Mailing Address '°. ° ~ Lot # Block # Subd. Name or CSM# 1011 170th St. ,' 43 Pheasant Hills City State Zi C ±~~a#Rlth~[ier ~~ ! ~ '~ ~ City nn Village ®Town Nearest Road d 170Th St I~ 715-796-5240 01 Hammond VVf, 5 . ammon ~ Residential / Number of bedrooms 3 ^Addition to existing building New Construction ____. Use: Replacement ~I Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate •3 bed, gpd/ft2 •4 trench, gpolftz Absorption area required 1500 bed, ft2 1125 trench, ft2 Maximum design loading rate •5 bed, gpd/ft2 •6 trench, gpolft' Recommended infiltration surface elevation(s) 20" below contours ft (as referred to site plan benchmar install 2 - 5' x 112.5' shallow trenches on contours for 3 br Additional design I Site Considerations Parent material till Flood lain elevation, if a licable NA ft S=Suitable for system Conventional Mound In-Ground Pressure AT-Grade System infill Holding Tank U=Unsuitable for system ~ ^ U ®S ^ U ®S ^ U ®S ^ U ^ S ®U _ S X U ~- l vorlo ~ ~ ~ Depth Dominant Color Mottles Structure Consisten Bounda Roots GPD/ftZ # Borin Horizon Texture Sh G S ry 1 g in. Munsell Qu. Sz. Cont. Color . r. z. Bed ~ Trench 49 1 0-6 7.SYR 2.5/1 - sl 2 m gr ds cs 1 f .5 .6 2 6-13 7.SYR 2.5/1 - sl 2 m sbk mvfr cs If .5 .6 Ground 3 13-38 lOYR 4/4 - sl 2 m sbk mfr cs 1 f .5 .6 elev 91.9 ft 4 38-72 7.SYR 4/4 - sl 2 m sbk mfr - - .5 .6 depth to limiting factor > 72" ~___ __~- hnriznn 4 has inchisinns Is +snme SYR 7/'t s ,Pt s l w/ snme SS fracrs helow 64 " + occasional er- cob. & st: north nit wall read: lots o f ~~~~~~p~~~. 2 Ground elev 92.0 ft Depth to limiting factor 57" 1 0-3 7.SYR 2.5/1 - sl 2 m gr mvfr cs if .5 .6 2 3-15 7.SYR 2.5/1 - sl 2 fsbk mvfr cs if .5 .6 3 15-33 7.SYR 4/4 - sl 2 m sbk mvfr cw If .5 .6 4 33-38 7.SYR 4/4 - is 0 sg dl cs if .7 .8 5 38-57 2.SY 8/3 - fs 0 sg dl cs - .5 .6 6 57+ SSBR Remarks: ~~litc by resistance to cemented, monolithic sands; honzon 5 has stratified 7.J YK 4/6 is bands Cti 4y-1U ~c 55- s an s CST Name (Please Print) Signature; Telephone No. Henry F. Grote _ 715-665-2681 Address erti to of esting Date CST Number Ref # P.O Box 57, Knapp, WI 54749 4/15/2000 222774 1054 PROPERTY OWNER: Bonte, Ron SOIL DESCRIPTION REPORT 2 `' 3 Page of , PARCEL LD.# Certified Soil e"t sang 3 Ground elev 90.9 ft Depth to limiting factor 60" 4 Ground elev Depth to limiting factor ~'6II'~ 5 Ground elev 90.7 ft Depth to limiting factor > 62" Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots GPD/ftZ $ed Trench 1 0-4 7.SYR 2.5/1 - sl 2 m gr mvfr cs I f .5 .6 2 4-12 7.SYR 2.5/1 - sl 2 f sbk mvfr cs 1 f .5 .6 3 ] 230 7.SYR 4/4 - sl 2 m sbk mvfr cs 1 f .5 .6 4 ~i 30-37 ! 7.SYR 4/4 - is 0 sg dl cs if .7 .8 5 37-60 2.SY 8/3 - fs 0 sg dl cs - ~ .6 6 60+ SSBR g8,~ ~ ~ •p ~ 2G •Y (p 2 . 35( ~"8 i Kemarlc$: ~, ,,,~.~...,,~., .., r... ..~ ................, .,........,... , .,~....,........ ~~. , v..~.wwi"w ~i.wvi~~ ~~."vW w , auauin,u ,.~ i ~. ~+iv-„o i~ 1 0-3 7.SYR 2.5/1 - sl 2 m gr mvfr cs 1 f .5 .6 2 3-12 7.SYR 2.5/1 - sl 2 f sbk mvfr cs 1 f .5 .6 3 12~ 7.SYR 4/4 - sl 2 m sbk mvfr cs 1 f .5 ' .6 4 31-40 7.SYR 4/4 - Is 0 sg dl cs if .7 .8 5 40-58 7.SYR 4/6 - is 0 sg dl cs - ,7 .8 6 58-60 lOYR S/4 - scl 0 m mfr cs - NP .2 7 60+ SSBR ~~~yZ- 2l•6 0 ~•~, ~ 1 0-5 7.SYR 2.5/1 - sl 2 m gr mvfr cs im .5 .6 2 5-13 7.SYR 2.5/1 - sl 2 f sbk mvfr cs if .5 .6 3 13-28 7.SYR 4/4 - sl 2 m sbk mvfr cs if .5 .6 4 28-42 7.SYR 4/4 - is 0 sg dl cw if .7 i .8 5 42-56 2.SY 8/3 - fs 0 sg dl cs - .5 .6 6 56-62 7.SYR 4/6 - scl 0 m mfi - - NP .2 Z'~ 0 68• rcemancs; I Ground elev Depth to limiting factor ' ~ 1` Oh J~ dN~Q. ~ 1 I O ~ ~1JI l~ti . N, . . o sd ~o ~ , ~~ ~Z'~1 2 21'i- ~ 4- `~ o~.N; 1~A.~~.o~Q -z ~~' X3.1 ~~ ~-s5 I 4i~-. ~' ~.~ ~t 2..c~~ ~Z7.58' 3. ~2 ~ ~, R,g~c.o~ ~~ .Z.,,~. 13 M o~G 9.~, er N w '~ t o M ~ 4 V S 3 ©~3 SOIL EVALUATION REPORT vvs~oa+sin Department of c ` txvision of Safety and Bum in aocordanoe vridh Comm 8`, Wis. Adm. Code . cot~ty s q~qr ails plert.on paper rxrt less il~t 812 x 11 irtdtes ~ di[ection and ~~ ~• indude• but not firriiled to: verUcai and fiord reiferertoe point (BM). peroentsfope. scale ~dirrmnsions, north arroM . ~d loc~ion and dislau~oeb nod- ~ P~Se print ~ ir~o~rnta~+. Pan~onal wonualion you provides mey be used for p (P~l- larr, s. 15.04 (7) (m)). Pam (~ 3 ~. , a ~fri c ,' Dab9 n~,. I ~, ~,eny uvvrrer Govt. Lot /U c,~j 1/4,(J~J 1/4 S / (p T Z C( N R / ~ E (~) 2. O Y1 '~ L~#F Block# S?ubd. Name or CStllll~ opertyo~ner$tar y 3 {,.~a..~a ~ 1-~ •• ~ s ro ~ ` ~v ~ S-~ • Phons Number ^ ca~- ^ ®Town Neared Road iy zip code vh wt W Syv 15 (~4S'~ 7 6 -Sa y0 / „•~a rt d l 70 ~' ~f; ® New Corastruction Use: ® Residen8al / Nunher oi' bedrooms ,.~."' y _. Code derived design Saw ra6e `!.5 Q //00 ~ - , , ur-u p ~t ^ PubNc or camrerciel - ~ Flood Plain elevation if app~Cable ~iCi!!4 ~, ~- ~ • Parent materrai ~' r ~ ~- I i 1 ,: ~ c-•~. ~, '; I General corruriertts C o r1 {cur .e. ~ e_ V ~ 9y •3 C , ~. ~ , ~_ • ` i ~ S`.ZO ~,:.; ~ .... ~ arxf s S-f~Nn eleV• q - ~ ST CFZCaA ~~ Z:ONNUn ncnrC ,,.~ -- ~i ~~9 I ~~ ~ ®Pit Ground surface dev. q 3 . fl0 R aeP~ m Mfg -~-• in: ~ " _- ! ~ S~ Rate I•braat lJeptfi Dominant iRedooc Description Texture Structure Come Bo~I- • in. Murrsell thr. Sz Coat. Color Gr. Sz Sh. 'E~'1 '~ O~IO 10 - S.' I Zvnub IC VK~r' G S i v ~ , S- ~ 2 /O-3(c I ~ ~3 - S.'c ~ Zvn bk wt~r G5 - `'~ . ~ - ~o r- /N Zl= .S Flo SG- z~sbk v-ti~'~ - , S Z ~9 # ®Pit Ground surface elev. 9 • (va R Deptlt ffo rmiUn9 factor 6 in. Sod Ram Horizon Dep(h Dorrtirtant Redax Destxiprron Textile Stnx~rue Cayce Boundary Roots GP01AF 'Eft#1 ~~ in. MtmseQ t1u. Sz Coat Cobr Gr. Sz Sfi. i a- o ~ 3 z - s~'1 b r~ ~ r- c~ l ~ ~ . S .fit Z 8- y /3 - S~•/ ,nab m~~ cs - ,S 9 ~ Z(o -3 /a r z . S ~f L / rn5 Yn. v ~ r -- - . -7 . Z • Et>1~ ~1=BOO > 3t ) <71D mgfL and TSS >30 <_ 1 50 ntgfL • i~,enc ~l2 = eta < 30 mgA. and 1SS _< 3o mg1L csT Name (Please Print) z Nrmr6er ,L A Date Evak~atior- Tel~fione Number `.. - - ~ z ~' 3 Pr~Y Omer ~ 0 ~ .~ e Parcel ro # ~-R SOt"'g ~ a ~ ® ~m ~ ~ ~ . Pi d S Rooms GPOIfP Desotip~ d Teslrse e~ oun Strudus Cara~slenae Y 'Etf82 ' ox tloraon Depth Dorninarrt Fae (1u. Sz. CoM. Color NNx~ in Gr. Sz. Sh. Ef~1 $ . - S ~'l Zrnabk w~.-~,r G ~ ~~ , S I -~ o~ r 3/ ~ ~ L r1 s k m~ .r- c , S ~ 3 d-y8 ion r /~ t,3 7.~ / v~ o.s ^ eoring ~ ^ ~ C surface ~. ~ Deptl, b ~ ~- soa - Ra ^ Pit ftedcor Desoiption 7estum Strtrclrrre Conses~rroe Botar~rp Roots GPDI(p Horizon Depth Dom+rrent Gr. Sz. Sh. •Et~1 'Eff#2 in. tilhrneeY f]~u. Sz. Coat Cobr ~°~ ~ ~ Borxrg Ground surface elev. fk ~ ~ erg factor in. Sod Ra ^ Pit tlorizorr Depth Dominant Redact Desttiptiorr Teidure Structure C.arsisbenoe Soradar9 Roots GPD/lt: in. Murrsell tlu. Sz. Cant. Color Gr. Sz Sh 'C-fflFi 'Eff#2 • a > < and TSS >30 <_ 150 mglL ' EflNrerrt #2 =SODS < 30 mglL and TSS <_ 30 mgt[. EAMmnt#1 SODS 90 _?1A mgll Tfie Dirt of Commerce is an cqual opporhmity servcece P and empioy~. If you creed assistance to access services or need material in ~ altatr~e format, Please contact die ~ at 608-266-3151 or TTY 608-264-8'177. sm.arioc2oaaot PAGE 3 OF 3 NAME /,3o r1 f~ LOT# y3 LEGAL DESCRIPTION ~W '/<,uw'/4 S / ~ TZ`l ,N,R! ~- E (or~V SCALE: I"= ~~ r '` r BM I ELEVATION /o o . U BM 1 DESCRIPTION no ; - ; r• tGlc pHonsz ~o f e - ~-- BM 2 ELEVATION R S Ca ~ ~ S C G•/~ BM 2 DESCRIPTION {~ P a~ P H o nq, ~ e d~ s~fal SYSTEM ELEVATION 9S, ~ O ALTERNATE ELEVATION ,U /!4~ CONTOUR ELEVATION 9 ~1. 30 /00 ~ , a-Z ^ A Q~ Z C o y r L r' ~ y~ 30 ~ q~l.oa ^ N B-3 B_ ~ i~ SIGNATURE ~,r~~~----- ~J ~ ~~ - DATE 5 ~' ~l° - ~ ~ y ,Private ~nsite Wastewater Treatment System Management Plan Septic Tank And Gravity tn-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS} shelf 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 a# 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- 1056?-P (R.6J99). T_~~_ ~. ease... nn~tisr~ Cnacifications .. {i1Y~Q ~. VraiVns vvv Sanita Permit Number ~~..~~______ - 8'3~ ° Number of Bedrooms Desi n Flow -Peak (gpd) °~ Estimated Flow - Avera e ( pd) ~ Septic Tank Ca achy ai) Soil Abso tion Component Size (ftz} 2 (~- ~-~ ` ` T pe of Wastewater Dom stic Table 2: Soil Absor tion Component -Limits of Reliable O eratlon Septic Tank Component Soil Absorption Comb Desi n Flaw -Peak ( d) ~~ ~ ^ `f Maximum Influent Particle Size (in) 1J8 Maximum GODS (m JL) 220 Maximum TSS (m L) 150 Table 3: Maintenance Schedule Septic Tank Inspect andJor service once eve 3 years Outlet Filter Ins ect once a ear and clean at least once every 3 Soi! Absorption Component Inspect once eve 3 ears Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. 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 these I~d outlet filter shall be assessed at least once every 3 years by inspection. Th outlet fil hall be cleaned as necessary to ensure proper o er .The filter cartridge should not be removed unless provisions are made to re am solids in the tank that may slough off the filter when removed from its enclosure. If the ~O.o~,~ 1 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 ar an impending continuous alarm. The septic tank shale 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 fo 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 conf/ned space. The atmospheroe within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank maybe dI>fgcult 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 Absoration Com- og: Went 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 sail 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 soli 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 r Management Plan for a Septic Tank and Soil Absorption Component plantings of deep-coated trees and shrubs directly over of within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. Contingency Plan In the event of system failure, a new system could be instaliea in an altemate area. With the installation of a diverter valve, the existing system could also be reused after a period of three to four years. ft is the property owners responsibility to maintain the altemate area free from any planting of trees, shrubs, etc. kn case of failure of the original system, the altemate area will be needed. If any trees, shrubs, etc. have been planted on the altemate area, they will have to be removed at property owners expense. If alternate area is destroyed, there are other alternative systems that can be used, in which, could result in added expense to the property owner. Any tank abandonment shall be done in accordance with Wisc. Code 83.33. Any questions regarding this coda, please contact your local Zoning Office or contact the installing plumber. ~, C,CLO l )C, ~~~~ ~ ~'~ ~ - 3~fo - y~~ aa[ety oL tsuttatngs ueviston Sagits Permit A lic$tiuq r7' PP 201 W V~'ashinBt~n Ave. Pte Box 7302 ~n~n ~ lh aeoord with Comm it3,2i, Wis. Adm. Code Madiaon» Wi 53707-73U2 Department or Cammoraa Peraosal information you provide may be used for secondary purpoeos (5ubtnit comp6etcd form W county if not ' (Privacy I.aw, s. 15.04(!xm)~ state awned., Attach ! de lane to the onl for the stn lase than 8 -i/2 x ! l inehes is alas. Camty Jr~'~YOi 71. State Sanitary Permit Nutabet I"J C.'haek if, lion State Pten !. D. Number L A a lntot~natttios - P 'leatae Frvat ail inforanatloa ~ L loratioa: Property Ckvnar tVsrna ~,, s. ~ ' ,~ i_»~ ~. property I.oatim t~'~ ~ ,~ a ~ _( s'1f':~ - ~ iJ4 S/4 S ! 7'a `1NlRl~(~)~ FTropnrty Auvner's Meiling Addre+w S~~ _- ~ % ,~1'!} l.ot Number Rlook Number City, Sarre !ip Code Id tap-'~it;~ Subdivision a C.;iM Number rya ~ ` Z/G / - 3.Z 4%f ` e mss' ~ l~ I3 'T'ype oi' Building: ( one) ~ D Ci 1 or 2 Family Dwelling ~N . of Bodratmts:~_____ _. ~ PubliclGacial (durcribc ): Tow P v State-oweod cL. iIi Type of Ferauit: (Check only o box on line A. Check box an line B if applicable) Noatdst Roca 0 ?.-!c ,+) l . ~Naw Systatn 2. D Rcpt ant 3. D Raplacenaeat of a. D tiort to Parcel Tax Number(s) Svotcm Teak Qnl ~ S aicra 9) Parmii Number l]atc Issued O A Sanitary Permit was viotrsl issued iV. Type of FOWT Syateaa: (Check all that apply? on-pr+s>rsurixed !n-ground ound D Sand l:iUea D Canatruetod Wetland D Pressurized inn-gt'oeRnd L7 iding Tani: C3 Slagle Pau D skip Lute D At-grade ®A T t Unit Q Rocircttlatiog ^ othcc: V D' IlTretttaaeat Area Iatormatioa: 3 !' u, ter, b e ~ 3 e ,~ '.v B y t. t)e,ign 3'iow (gpd} Z, thelx+tbalArea 3. Disporset Area 'i Application s. Percolation Rate 6. sy:tarn lilevatiua 7. Find Urede Rayuitrd Proposed ltat c)ats.rd-~/••. fi.r.. (Min.lu~l,) ~ ~r ~ 70 ~ ~ ~a~ /' ~ ( ~ VI Trtrlk Capacity in Total iJ of .actwor Pccfiab Site Stce! Fiber- Plastic Infor~aation Galkxte Gallons Tanks Con- Coat- glare New Exerting crate strutted Tanks Tanks C] © ^ D Sc - ~ ~ ~d / ~.,~~-- D D D o D vii Retzpoadbdity Statement the ttttdorai assume ' i!i ~ iasWlation of the POWTS sho the attacbod tans. Pluml+er's Nemr (prQU) pltembix's Signalwe ( damps): S No. Husirraes I'twnc Numb f j' ~_a~C.~1,lc.z'' ~~ GJ,~l~~ ~. 4 y'p ~s- ~ 8G .. ~~a 1 Plumber's Addrnes (Street, City, s .zap Cade) d d ~ •~ d ~ ~ old l VIII CotutyfDepa t Ube only D ~ ed Sanitary Perini! Fee (lnoludes arcataxtwatcr Deto tesu.d seRting Agent Signad,re (Nu stamps) D Approved D Ow~t• Given lttitial Adverse lkdartunation Su:obarge Fa+e} ~ `~t~5 alr or Approv~so~ps for Drwpproval: w • ~ ~ • 9 ~ ~ ~~ ~ a ~ ~ ~5 ~ - -- ~~~ w~ S P ~ ~ ~J ~~-t~ ~ f ~-G S b~.e, S ~-c ~ ~'~ d~ w (~l ~ t ~ . ~sf .~- S~ 6~ ~ '`= Go` ^~~ ~~~ m tro ST CROIX COUNTY • SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTI/FI /C~AJ~TIrO'N FORM OwnerBuyer V1 [~ 1'~ C9-'~ ~ 1t.~b n~ ~- ( / ' ~ 1~ e' ~~ I ~e'~ Mailing Address ~ ~ I ~ ~ 7C~ ~ S~ Properly Address (Verification required from Planning Department for new City/State ~m 1mf7 ~ ~+ -- Parcel Identification Number ~ ~ ~®~- 7 3-~~ ~ ~, a9, i~.~iS EEGAL DESCRIPTION / U_ property Location,N ~ '/<, ~ '/., Sec. i(o , T o~`~ N-R ~ 7 W, Town of J Cam Subdivision Y ~'~-~~~ ~` ~ ~' S .Lot # Certified Survey Map # ~ ~ a 'S~ `/ ,Volume .Page # 2 ©°Ib ,~ ,Volume )'~ ( .Page # 3~Z Warranty Deed # Spec house ^ yes l~l 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. Pmper 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, joumeymanplumber, restrictedplumber or a licensedpumper 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, 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 SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) laiowledge. I (we) am (are) the owner(s) of the roperty descn'bed above, by virtue of a warranty deed recorded in Register of Deeds Office. C' . ~~ ° SIGNATURE OF APPLICANT DATE «****s 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 is the warranty deed Vr~f.15Q1f~E 37~ Dine M. Sonte, as Trustee and Ranaid C. Borate, first altematrve Trustee of the hart M. Ulfarts and iCa#tarina G. Ulferts Family Trust, far a valuable consideration e~riuieys without warranty to Ronald C. E3ante and Dine M. Borate, ltd and wrfe, Grantee, the faHawing described real estate in fit: Croix County, State of Wisconsin: 6201963 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CkOIX CO., WI ttECEIIIEp f~R REC@R8 04-10-:'000 10:30 Afl ~~ 1EEb GERT I~P1r Ff~: CUP1' FEE: TttpllSf'ER FEE: 240.00 ltEI~RDIN6 FEE: 10.00 frA6ES: i Thomas A. MaCorrnack W 1020 t0F'Ave. eaw~,, wr seooz ota-~aaa-so, ao (Parcel tdenfification Numtler) The Nwdt Half of the Northwest Quarter (N ~ of NW '/.) of Section Sixteen (16), Township Tv~enty-rmne (29) North, Range Seventeen (17} Wt~t. Dated this 24thday of March AUTHENTiCATiUN Signatures} aWhentic~ed this ,_ stay of ~ or Wit rtwroe T1T1E: lNEMBER STATE t3AR OF WtSCONSlN (ff ,wt, aulhori¢ed by § 708.Oti. Wis. Slats.) THiS MSTRt}f~Nr WAS t}R~'. .~ `i TfK)ma5 A. McCa i ~ "~ t3aidwin, WI SaoQ,~,' ~ !t ~ ~; W~ ,a.,: - .~ ~ •~ ~~'•r4~w .r r.+; 2000. 'Ome M. 8onte Tnrstee 'Ronald C. t3orde Trustee ACK-tOylfLEOGMENT STATE OF WISCONSfN ST. CROtX COUNTY Ptxsona~ came before me this 29tttlay of Mard1 2000 the above tserned tine M. florae. Trustee aril Ronak! C. edtte, as frst akemative Trustee of tCart M. 1111eris and Katherina G. t}f6eris Family Trust. to me known to be the Person{s} who executed tlra roFegdng Msgtatsent and carne. ro ~~ Di31e ,- .7ertsert Notary Pubfic St: Croix County, Wisconsin. MyOcsxnERisgion rs permanent. (N rwt, state expiration date: 7 1t ~3 .) Names of persons sigrtirg in any capadty shourd de typed or panted 6ekw their signatures. Inlerm~lan ~ianNS Caroury FaW tlu lC. V Q06855- H ~ ~ ~ _. N H ~ i ., 1.. QCAwT EQ l N tl" i THE t NE # 1 /4 1... L. OF THE NW 1 J4, S E # ~~ ~ ~?F THE NW t i4 ANQ PART ~F THE S~'V i~4 ~F THE NW l i4, ANfl PART QF THE N~ef ! ~'~ C?F THE N~ 1 i4. ALL J N SE ~ T 1 ~i"d 29N. , T R. J ?W. , TOWN OF HAMNr'C1Nfl, . S T. CRa 1 X ~4UNTY, ~Y1 SC4NS 1 N f ~ roof+o AertrwE SET LQ~' 23 ~~ ~ ~~ s ~,f' ,~ s r°~ *~ f ' ~~ mi ~p r w ~ ~~~ e., ,. m ra ^r ~ ~~`` L C? T ! ~ e v SHEET ~ - - - -- -~ ~ i rM/s .r.t ~ .e +t f _.._.._.._.L--------- f. t AL AT i.-+rt ~ e~.e --------- ~ ----•--- i ~. ~ ~ t i ~ ~ t rrlx ' tl-~ ~ A R y ~ ~ i *-~ ~_ ~_i_ _~_~, - .~ - _.. _._..~.~~ r~ t@CiTtp~ StttfC+r st r t v w +M. r. rrw.. .. + nr. , rar+ ar +.wsar (Ipr f0 XCKit UTJL tTY EaSErIE'MT5 THE 10, Ira YALE 'R 9UR'Gt~ CA9tFS ARE r0 SF PtktE~ 36~Ch ?NAT °~+[ r>ySTAttA7+Ow A+CutA A+YTURB I.JrY SURVEY STAKE, CN .79ST~I>.t+:r rt3rclY .C: p4G AIRY t o r L P erE oee S TRf E 7 L 1 neE. Tl+E L1ISTieRdAMCf Qi' A St1RtfY STAKE dY AAIYkE rS A yi(A.Ai:...' ~f' SEL1to~YI 2J6.~F ~ •tSG7AtStN srArtTF3. urPa.f;Y EAsf+eEMt: A~ Mfg= .y Sf T F OR TN ARf ' JR ?haE USE df P~'Bi C 8!)0 . FS A1VD av t VJ -F J7 ~ t 1 T' f S NAY.'kri TN£ R1GNT Tp SFRVE TO ,RRFA. tEGEkeJ f . fc~:r«o I' more PIPE O SfT 2'X3O' 1rft7N PtPF +eF+GnrrG .7.63 LdS. PEre l ilvfaR 6~T kL1TF: Sf7 I'K2A' IAQN P)PE +lifti+t+M~+ 1. t3 tBS. °ER i tNEaR fp(IT AT At.'. y_ orr~F++ coT cc~~~s - uTtt trr EA5£-Et+T z FrP. 1 ___f__ q '- ,. SEE f" Ca ~ ~ .~ g . SE TBa~K~ . JRrk'FYAY IOCAiiCNS ~ ~!~ ~ ~~ ~ ^,~ U Qc.3~~- x,~..5y~ *jpMls~ kK RAiOGI'i~ 111a3~~~ A t7.'~'.g` O 1'~ ? f __~ ,~` ~.-H , .. tl "t. a~ ~ J ; • . { ?~ .... - hif '. ~~~ M i--~'~_ A~ J 11 1\.I\~~ L QCATED 1 N THE NE 1 SW 1 i4 OF THE N SECT ION 16~ T. 29N. - - -~ RNER - FOUND UMENT i UNPLATTED LAND 1 '~ ~ ~~ S89° 36' O 1 " E 2644. 72' t TO NE COR. PLAT; DEDICATED TO THE PUBLIC o ' --------- m O ------ 248. 34'--------- ~- ~ -• 28 J. 3a ----------- -------- ~ - „ 877.88 •JN89°55 16 E -- n ; ° ~ 1 o e 0 D ' i ~ O ~ SETBACK .......... o .c ; .. L JN .• ~ ... LOT 43 : ~: LOT 42 ~. o c ~ 2.26 ACRES 2.57 ACRES ~ ° w 98, 449 SO. F T. 1 12, 138 S0. F T. w c~ ~ ~ ~ - `.. ~: :-.,. }:~' ~~ 1 1 e I 13.' c 6! ~' 33' ;' ;~ ;~ ;~ ~® ,~ ,~ ;- ~~ ~i ;i ;• ~1 1 i 1 1 1 w• co ~: ~: ~" m m n x N w. ~ ~ m 249. 06' 282. 07' ~: S89°36' 01 "E 531. 13' • HIGH WATER /