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Home My WebLink About018-1090-48-000 ~ 3~n C ~ c ~ ~ ~ ~ ~ ~ ~~~~ A ~ ~1 ° ~ ~ ~ ~ ~ n I ~ :* ~ ~ p _ .. .. Q N ~ N ?. ?• A w N -p01 A~ ~ ~ ~ p Mi 3 ~ O ? `1 a p O O A ` 1 ~ w c~ ~ c ~ o ~ ~ ~ ~ 7 C p m I ~ co ~ ~_ O r ~ ~ N l I L ~Z O °A N ~ ~ p pp c O o c o N :' ' C ~• ~ C 3 • ~ ~ a a 41" ry~y,,~,,~ ~ 000 • ' vV o ~ ~ A ~ ~ N~ N N y 0 ~ O d p ~ ~ A v (J1 y a ~. ~ w ~~ ~ 2 3 d 3 y I n ~ o_ ~ ~ o a a I =+ y .~ .~ ~ ~ ~ ~ 7 7 rn ~ o ~ ~ 3 ~ jp ~ d y d ~ N w ~. ~ ~ I a t- v ~ ~ I ~ n ~ ~ ~ rn c ~ ~ A Z ~ ~ ~ :~ ~ ~ w Z m I ~ A ~ ~ '' a -' D m n m I v~'aja ' ~ o " I ?v ~ m c I ~ o~ o a ~ N 7 O y ~ d I 03 N 7 ~ y ~ a I . ~(`cn0 ~ ~~ b I y I H ~' y ~ ~o I m -°1• ~ (~ D O N Oat ~ rv ~ ~ ~~ H I ~ W 7 w I a ~ ~ b ,,, N fD ~ v ~ ~ c ~ ~ w n ti . _. s / . ~_ ~ ~ (r~p./l WisconSln Department of Commerce SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERACIA~F~RMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes IPrivacv Law. s.15.04 (1 Nm11. Prmrit Holder's Name: Tala a, La City Village X Township Hammond Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~' . Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufa er Demar PM Model Number DH Lift Friction Lo S stem Hea DH For ain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM f BED/TRENCH Width Length No. Of Trenches DIMENSIONS 3 t ~ z SETBACK SYSTEM TO P/L LDG WELL INFORMATION Type~~Oppf~S~~ystem: lvN. (! • '• S~o ~ ~c DISTRIBUTION SYSTEM ELEVATION DATA Pl.'. Sr tv~ inty: $t. t/rDIX nary Pemut No: 395234 e Plan ID No: ~I Taz No: 018-1090-48-000 c 4, z9 ~ t.~, '? l 3. STATION BS HI FS ELEV. Benchmark o.y-3 r~.~{-3 l ~ • a Alt. BM Bldg. Sewer St/Ht Inlet Ll ~S T ~ ~ f SvHt outlet .s , ID Rs. 3 3 Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover Of Pits Ilnside Dia. LEACHING CHAMBER OR UNIT Header/AAanifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Prassura Svctame Anty rY Mrnrnd Or At-Grade Systems Only Depth Ewer Depth Over xx Oepth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ® Yes ~ No ®Yes ®No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/0~" /~°~ Inspection #2: ~ %- Location: 968 176th Street Hammond, WI 54015 (SW 1/4 NE 1/416 T29N R17W) Pheasant Hills Lot Parcel No: 16.29.17.713 1.) Alt BM Description = ~oQ 'f~~. ~ c.,-a~B~ 2.) Bldg sewer length = 3•~l0 ` - amount of cover = u~ I Plan revision Required? Yes ~ No Use other side for additional information. I I I I I J I I I I i SBD-6710 (R.3/97) ~ "'~'~'`~ Ste'! ~ ate Inset is Sig~at -,,,I; ,9± /41 ~~ ~ Ztr~o~ ~Nsconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings ................,« ~,,...... Q~ ,.,:,. ~.,... ~_a_ Page ~ of Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County ' ~) u 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 S~ ~~~~, ~' i ~ ~~ f ~' ~ l~~!~~~~~ Ci ~ ~ / - Personal information ou rovide ma tre used for seconds ( cy O i )) y p y ry purposes Priva Law, s. 15.04 1 m ~~ ~ / / Property Owner ~ Property Location ~j Govt. Lot ~,~ 1/4~ ~ 1/4 S T z q N R ~ ~ E (or I~V Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# ~ ~ ~' `-~ ' 1 ~' ~ ~dl--ion City State Zip Code Phone Number ^ City ^ Village ~ Town Nearest Road ~] New Construction Use: ® Residential / Number of bedrooms C ~ rived .de~i ow rate y~~ O' GPD ^ Replacement ~ ~/ ^ Public or commercial -Describe: ~ ~ ~ ~~ Parent material ~ lain el~eti cif app ~// ft, General comments sys~m ~~tV, ~p g~oa > REL~.1~l~- ~, and recommendations: Ti ~ 8 ~ (~ ~ Qu N sS ^ Boring \, Zd~~" ,.' o; Boring # •~ ~ .` . Ground surface elev. 9`~ 3o ft. De toy '~ " -i ~` in. Pit ~m1~ng F f ;' 1 'c~ . Soii Appliption Rate Horizon Depth Dominant Color Redox Description Texture Structuf~- onsistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Z r,2 3~ I U ~ ~tl ~-- ~.I ~f`fl5 ~ - 3 ~-SZ I r~l~ 5~..1 ~~b rn c . ~{ ~ -72 11~ $ Z C~?. ~ 5 ~ c.5 5 2-1Y1 t `il coS ~ -- ~ .~ ~-Z 2 ^ Boring Boring # 9~- ® Pit Ground surface elev. ~ ft. Depth to IimiGng factor ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 t - ~ 2 Irk r Z 5 i I Zv-%bk nn~r c s t v-~ . 5 . Z IZ -39 10 ~ I~ ~I 2 fit- ~5 -- . ~ 3 -84 ~~ rgl3 s lms mJ ~s - .5 - 9 gy-,y ~ ~ ~ c~ -- co s l - _ ~ 1. 2 ~... ~ • - ~+5 - vv ~ cw ~uyi~ anu ~ ao ~JV _~ IDV mg/L _ CTTIUeni iFL = CVUS ~ 3U mg/L an0 155 < 3U mg/L CST Name (Please Print) Signatur CST Number c~ .~ ~- ~ _ Z.s33d c/ Address Date Evaluation Conducted Telephone Number z~~ ~~~s ~ s~ ~~- w. -yo s- /i ~ -oi ~7is aye-y~o~ SRD-R330 (R07/001 ;~ PAGE .3 OF 3 1 NAMF. ~n ~~ LOT# Y~ LEGAL DESCRIPTION Sw ~,vE t4 ,S // T Z 4 ,L~I~R, ~ ~ E(o~ SCALE: 1 ° = Ya BM 1 ELEVATION (pd. U BM 1 DESCRIPTION }a p ~.~ Q~ {-: a doc r S : ( I BM 2 ELEVATION QG . Sv BM 2 DESCRIPTION_~ P a~ Z ~' ~ u c ~; P e SYSTEM ELEVATION~„p ~'4.oyL^~g7.GO ~P~. ~ ~~oo ALTERNATE ELEVATION F ~ 0~:9 ~ ~. ~ So ; «e5-~- Matt lD o CONTOUR ELEVATION 9`/ Go r ~'S; o a 1 - -}- - k ScL. ~~ ~ ^ ~~, ^ ^ ~, Z ~S~d ti's ~ •p~\ .00 ~V ~J SIGNATURE __~/~ , ~~~ ~ DATE j~( ~o - ~ T.L. Sinz Plumbing Inc. E5609 708th Ave. Phone: (715) 235-2644 Menomonie, WI 54'751 ~~( + U~ ~~ ~/~'~PA' Fax: ('715) 235-2592 g ~ pp T~,Y4-~~ ~ ~ /~ ~ www.tlsinzplumbing.com 5T ~p~~ S ~-4-~-K ItiIIJ. ~,~, '~~ ~ E '/~ ~ ~ ~ Tag ~ ~7 c,~ , P~~-5,,~ ~ tit ~s ~~~ ~ ~v - ~-~~ . c~ ~ ~~~ o~ ~n~~ S~ ~o1x l ~ Z o ~° o ~ U.- r ~ J ~ x ~ °q i~ s ~ ~\ ~~! ~ ~ / -- ~~ L~, W ~ ~ ~~ ,, ~M L i~ /ip 130 i~l~~ ~ Quc~ =~~'•q3 ;- 7Iz ~ond~~~ 7o p o I ~= ~~~ y ~v ~,~, ~~~ ~ ~gF ~~ ~~~ ~~,~ ~, ~~ c ,~ 'z c b ~~ ~ ~~ „~ ~v ,~n ~ ~~ l~ ::~.,. ~~ Wisconsin~Department of Commerce SEWAGE SYSTEM "Safety and Building Division INSPECTION REPORT GENERAL INFt~RMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: Tala a, Lar City Village X Township Hammond Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~ ( , Dosing Aeration Holding AI 1^~r1/l~Ir11JA\I 1\Ir'A~\/ ATIA\I rvmrr~rrnvi~ u~rvR~r~r~iw~~ Manufact er Demand PM Model Number TDH Lift Friction Los S stem Hea TDH Ft Forc ain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM t,.p.s BED/TRENCH Width Length . No. Of Trenches DIMENSIONS 3 t ¢. J- z SETBACK SYSTEM TO P/L LDG WELL INFORMATION Type Of System: DISTRIBUTION SYSTEM ELEVATION DATA P . ~ „~. county: St. Croix Sanitary Permit No: 395234 State Plan ID No: Parcel Tax No: 018-1090-48-000 STATION BS HI FS ELEV. Benchmark o .~•3 (~,..{,3 ~ ~ • ~ Alt. BM Bldg. Sewer SUHt Inlet `J ~r • A~ 68 / St/Ht outlet ,$,, ID Rs. 3 3 Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System Final Grade St Cover Of Pits CHAMBER OR UNIT Model Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER Y Prassurp Svetpms Only YY Mound Or At-Grade Systems Only ~yl ~~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection#1:~/~* /2~'~ Location: 968 176th Street Ham/~mo/n'~'d, WI X54`01'5-(SW 1/4 NE 1/416 T29N R17W) Pheasant Hills Lot 1.) Alt BM Description = ~ Q ~* -~~ouan6Lo~t6+.t, ~,~" ~~ 2.) Bldg sewer length = 3a~,p ` - amount of cover = u;(l Inspection #2: -t---~--~. Parcel No: 16.29.17.713 Plan revision Required? Yes ^ No Use other side for additional information. SBD-6710 (R.3/97) Iy~, °1a'~`~ Ste' i ~ e _ ~^ta ~~ ~ ~ se I is Sign`atyfe ~~ _A..,_ (~ ~ (e~~rt• No. Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center Bed/Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No ~. ~ t s Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings Page ~ of Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County Q J ~) u 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 D e ~ Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~- ~/ ' Property Owner ., ) Property Location b ({ Govt. Lot ~S 1/4~ ~1J4 S T Z g N R I ~E (or~N Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# ~ ~ ~' `-~ 'll ~" + didl~-ian City State Zip Code Phone Number ^ City ^ Village ~ Town Nearest Road ~J New Construction ^ Replacement Use: ® Residential /Number of bedrooms ^ Public or commercial -Describe: ' ` C erivedTde~i ow rate ~~~ O' GPD ~. Parent material ~ )t// Qo~! lain el~eti f app i'(// ft. General comments and recommendations: Sys~~l ~ ~ -~ V , 1'pP ~ ~ 06 n .Z 8 ~ , l9 O ~ ~"a ~ ~i .-.. ~ ^~C~,~,~ ~ R ,~ ~~`a `~ ~ aQ1 ,, Boring # ^ Boring ~/ ~ . Z~~~ ~ ~~ «, '` ® Pit Ground surface elev. 4 /• 30 ft. Der tb Jint~ti -#~c~oF " U in. ~, . ~ v ,~- Soil Application Rate Horizon Depth Dominant Color ~ Redox Description Texture Strucfuf8`-° onsistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I ~--I -a r31Z - 5;~ 2 ~'~ ~s I ~ . 5 . ~' Z ~2 3~ IU r~tl ~-- ~-~ 2~ r 3 $-Sz l r~l~ ~_ 5~1 ~b< rn c .~f . ~ -~2 Ifl 8 z C3p~.~ I s ~ ~s -- ~5 -7Z- /~ 1 ( `fib --- co S ( ----- . -7 / • Z- Boring # ^ Boring 9y~.- / ® 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/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ~ -(2 ID r ~Z ~ s. I Zw,~k rn~r c.5 I v.~ . 5 Z ~Z-39 -D r l~ - ~1 2 ~r ~5 - . ~ . 3 -S~ I~ r81~ - -~s lfns my ~ 5 - . 5 - 9 'Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signatur ~~ CST Number cr .~ ~ Z.s3~ ~1 Address Date Evaluation Conducted Telephone Number z// ~ ~~S • Sa ts~--~- w . s`s'a s /~ G -o/ ~7~5 zY~-yU0 Fl SBD-8330 (R07/00) Property Owner ~n / ~' Parcel ID # Page ~ of Boring # ^ Boring ~ / Pit Ground surface elev. Q.3~ ft. Depth to limiting factor f ~ ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 I a- ~f z s~ ~ ~.s (~ .5 .8 -~f6 r ~t G r m r ~ 5 - 3 b- ~ 3 --' -~ 5 I ms G 5 - .,5 - 9 -/y~ is y C6S l - .~ (. Z ^ 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/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ^ 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/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 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.07/00) . u PAGE ,3 OF 3 TT~AMF ~n ~G TOT# `~~ LFGAL DESCRIPTION SW ~~t1E la ,S // TAR .N.R.~ ~ E(o~ SYSTEM ELEVATION~p Sf~.OUZ`~~7~0 ~8~. ~ ~ ~ boo ALTERNATE ELEVATION SFr' or."9 r na. ~ So ; ~}~S~- c~a~t. lD CONTOUR ELEVATION 1 `~ ~° ~' ~'S. "° 1 +- - x SGG• ~~ i ^ QF'~ ~~, ~ • ~Z ~ _C~ ZI ~Svd ~ ~ •p~~ ~~ .00 GV J e SIGNATURE___~C?~ =-~~~~ ~ DATE - ~O - a ~,_E 1 ~ 1 •.-~- .~~~ f Safety and Buildings Division County _ ` ~ ~ ~ ~ r ~ ~ 201 W. Washington Ave., P.O. Box 7162 )C ( (.~ ~ ~.~cons~n Madison, WI 53707 - 7162 Site Apddress ,~ De artment of Commerce 6l/08 ~~rv s ~ Sanitary Permit Applicat'a. ~_` -~--'-~..~, ~~~' \, Sanitary Permit Number[ 3~'s Z3 ~~ ` ~ o ' [ ti In accord with Comm 83.21, Wis. Adm. Code, personal inf u rovi ttoa y ^ Check if Revision ma be used for secon ses Privac Law s•f~: ' 1 m I. Application Information -Please Print All Information ~~~,.~' rate Plan I.D. Number Property Owner's Name { C, ~ ~+, `~ l cel Number 1 wner's Mailing Address Z: y,` C~G ~ Propert~yjO f ~ ~ roperty Location ~ > ~~ 7 ~ ~~r ~C:- 3` UI ~~ /)~ 7 ,~~ ~i /Vt~~,y, S GIP T~~ N, R City, State Zip Code b~r Lot N r Block Number v Subdivision Name ~ CSM Number II. Type of Building (check all that apply) ^Ci ry ~ or 2 Family Dwelling -Number of Bedrooms `7 ~-~'~L'('~f~ ^Villa e g ^ PubliclCommercial -Describe Use ~ownship Q/'jt7 ^ State Owned Nearest Road III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A' New 2 ^ Replacement System 3 ^ Replacement of 6 ^ Addition to For County use S stem Tank Onl Existin S stem B. ^ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(ntlmbering scheme is for internal use) l ~ ~ , 44 Non -Pressurized In-Ground 21^ Motmd 47 ^ Sand Filter 50 ^ Constructed Wetland 22 ^ Pressurized In=Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other V. Dis ersal/Treatment Area Informat ion: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals./Days/Sq.Ft.) (Min./Inch) Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Cotutructed Glass New Existing Tanks Tanks Septic e~iie~g-a:artlr - „~ ( t ~~~,~.~- Dosing Chamber VII. Responsibility Statement- I, the un 'geed, possibility for Installation of the POWTS shown oa the attached plans. Plumbeys-Name (Print) r Pl r Si MP/MPRS Number Business Phone Number ~/~ ~ ~ i~ ~ ~ IJZ~- ~ ~ J~~'~!'~ ~~~' ~~" ~C~ Plumber's Address (Street, City, State, Zi Cod LL/ J t' VIII. Coun /De artment Use Onl ~. Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) ^ Owner Given Initial Adverse . Surcharge Fee) ~ Z Z ~ ~ Z Detetminadon . . IX. Conditions of pproval/Reasons for Disapp oval. n 1AMJl~~ -_ ~~ t^x-' 'TO 1 ll r--_ Attach complete plena (to the County only) for the system on paper not less than 81/Z x 11 inches in size ~~,~. SBD~6398 (R OS/Ol) I'.L. ~'inz Plumbing Inc. E5609 708th Ave. Phone: (715) 235-2644 Menomonie, WI 54751 l-~'~ + U~c~~ r~'~a-P~ Fax: (715) 235-2592 g J p p ~~Q~„y4-~~ ~ ~ /~ ~ www.tlsinzplumbing.com ~'~~ ~~% ~ ~~ raw ~~7w , P~~,b-ter r ~~ f s ~ae.s j ~~ ~ t-,~'` ~ ~~,,~ o~ l~"~ ~v~~ ST ~1X ~:E. ~o~~ / a ~ ~- =~~ ~ NM L ~rJ /lv~ 130 i~~~~ ~R8'•R3 ~ Zl ~ Qo ~ r ~Iz ion n~~~ t TP ~~ o D c lu~ 1 1 ~` ~ ~=~~ ~ ~ J ~ x ~ °4 N ,n ~1- - y ~ ft i ~~ II ~ Gsr~~~~~ ~ ~$~,0~ - ~~° ~ ~ ti~ .~ ~ -~. ~ ~ % ~, ~~$~ `~~~ ~~ °a '~ c ~' !~ ~~~ ~ ~ ~ ~ ~~ l~~ J ,~~`~~ ~~P ~ wfisconsin Department of Commerce SOIL EVALUATION REPORT Page _ j„_ of - Division of Sateiv and Bindings m accordance wmr c:omm ~, vves. rwrn. t.oae i t Pl 11 i h i County C ' an mus n s ze. nc es Attach complete site plan on paper not less than 8112 x inducts, but not limited td: vertical and horizontal referenda point (BM), duedion and Parcel 1.D. , percent slope, scale or dimensions, north arra~v, and location and distance to nearest road. Please print ill i ? `'``,. R by Date Personal information you provide may be used s~pr~Gjl p ~~~~ . s. 15.04 (1) (m)). ~ Z~ Property ° ~ ~ ~~ CM ~ r+operty toc8tron N'" ~~ % Lot S (,J 1/4/(/ ~ 1/4 S ~p T Z N R ~ E (or Property ONmer'S Malhng Address { ~ r ,~ '~ t , - ~ Bbdc # Subd. Name or CSM~ • _ . ivy - City State Zip ~~ ; ?SPhone N T`l ^ Ydlage .Town Nearest Road . 'CE / ~ ~ Z. ~ 7 [~ew Carstruc~ion Use: ~esidentiai / Nur~r of~ Code derived design flow rate ( d GPD ^ Replacement ^ PubNc or corrrrrlercial - Demme: Parent material : // t=bod Plain elevation if amble ,tom/./9f~ n General onrrrrrrents $ ySf e M ~ I G t! • q'O. 7 and recomrrlendatrons; ~ . p~ I G V . ~/ Sd ^I Borxig Bonng # QI Pit Ground surface elev. ~l. 3y it Depth to limiting factor ~` in. 4~r Sol? ' n Rate Horizon Depth Dominant Redox Description Texture Structure Consisbenoe Boundary Roots D/F~ in. MunseU thl. Sz. Cont. Color Gr. Sz. Sh. 'Eff#'i 'Eff#2 2 iiy- / --- Z ~ ~. 3 ~ "- c.s - "~ g0• ~ 3• ~. z Z ~,~# ^ ,~Q ~ Pit Ground surface elev. 3. ~O ft. Depth m lerrlliting factor ~ in. Sod Rate Horizon Depth Domanant Cob Redox Description Texture Structure Consistence Boundary Roots GP Difi in. Munsell t2u. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#'1 'Eff#2 Sil e i • 8 2 ~ ~-- - ~ c -•- r. Z 36 Z/r * EfBuent #1 = BODS > 30 _< 220 mg/L and TSS >30 < 150 mglL * Etfllaent #2 = BODs <_ 30 mgA. and TSS < 3O mgll CST Name (Please Prat) /~%%~ Signature CST NuMaer Address ~ '-°--~~ Date Evaluation Conducted TefeplrOr>e Nrxnber 2.// ~ ~ ~- S-~ J6rr~er5e~, LiJ 1 .~zfy ~- /y to ~UU ~7ij - Z S< ~- yoo4 Property Owner ,~o/~t ~~ Parcel ID # Page Z ~ of Bonrg # ~ ~~ '® Pit Ground surface elev. 9~=~R Depht- ~ Inviting factor l/~' in• Soil rcation Rate Horizon Depth Dominant Color Redox Description Texture Stnx~ure Consisbenoe Boundary Roots GPD/t~ in. Mansell Qu. Sz. Cont Color Gr. Sz. Sh. 'Effl~'l .,_._ '~~~ ~ Y ~ 2 t - ~ ~ - •$ -Jil . Z, .2 ^ Pit Ground surface elev. ft. Depth to {nrriting factor in. Sod ication Rate Horizon Depth Dominant Color Redox Desaiptbn Texture Strucdne Consistence Boundary Roots GPD/fF in. Mansell Qu. Sz. Cont. Cobr Gr. Sz Sh. `Eff#1 'Effll2 .. w r ^ Pit Ground surface elev.. ft. Depth to limiting facia' in. ^# ° ~ Soil ication Rate Horizon Depth Dominant Cob Redox Description Texture Structure Consistence Boundary Roots GPDfIF in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. *EffAH 'Etflf2 * Etfluent #'i = GODS > 30 _< 220 nrg<l. and TSS >30 <_ 150 mgA. * EfllueM #2 =GODS < 30 mglL and TSS _< 30 (i1gIL 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 60&266-31 S 1 or TTY 608-264-8'777. sec-e~~o cR.mroo~ r ' PAGE ~ OF NAME ~n T,,"~e--\\ LOT# y~S LEGAL DESCRIPTIONSw '/4NE'/,,S ~~y T~Q,N,RI Z E (orKWJ SCALE: 1"= Gw ~ BM 1 ELEVATION ~Q~'• U I BM I DESCRIPTION Y( Gad, ~ ~ /~q ~ (j i3o x e ~GQ -e-r BM 2 ELEVATION f ~ ' r ~ ( 1 BM 2 DESCRIPTION f'U Q~JO ~ z ~ Co ~tc~ J ~ '~ SYSTEM ELEVATION !D•(7~ ALTERNATE ELEVATION ~ 1 '~~ CONTOUR ELEVATION ,v~i4 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 S23 Number of Bedrooms Design Flow -Peak (gpd) ~? Estimated Flow -Average (gpd) f~ ,~'<rts ~~, ~. -eed't~h Septic Tank Capacity (gal) Soif Absorption Component Size (ft2) ~~~7 ~- t=-T Type of Wastewater Domestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soif Absorption Component Design Flow -Peak (gpd) ia{1b ~ i=T Maximum Influent Particle Size (in) NA 1/8 Maximum BODS (mg/L) NA 220 Maximum TSS (mg/L) NA 150 Maximum FOG NA 30 Table 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Outlet Filter Should inspect once a year and clean 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 th tank and outlet filter shall be assessed at least once every 3 years by inspection. Th ou let filte shall be cleaned as necessa to ensure pro er ope~tion. The filter cartridge shou o e remove un ess provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the 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 Management Plan for a Septic Tank and Soil Absorption Component 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 sepfic or other treatment of holding tank may contain lethal gases, and rescue of a person from the inferior of the tank maybe difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Ws. 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. 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. 2 ST CROiX COUNTY SEPTIC TANK MAIN"~'ENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM 4 ~ --- OwnerBuyer =~-C`x ~? ~ W ~ c (~ ~ I ' a~~~ Mailing Address Property Address - I ~ ~ `71(~+h S~- (Verification required from Planning Department far new construction) City/State ~,Yh {~Y10 Y1~ ~~~ ~ Q(~parcel Identification Number ~~ ~ i~- y Z) O LEGAL DESCRIPTION Properly Location ~i^( '/., ~~ %4, Sec. ~, T_ a~'~' :: 17_ ~f~ '^- ~vn of ~G~h1 r'YIOn . Subdivision p -1 ~' A Lot # y'g Certified Survey Map # ~,_____ ,Volume _ ,Page # Warranty Deed # _ b~ ~ °~ ~- ® ,Volume 1 ~'~ ~~ ., , Pa e # '`~'~~ ~ . g Spec house D yes D no Lot lines identifiable p yep O no SYSTEM MAL1y'i'F:NANCP; 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 ar#'ect the Panc~on of the s*,pEr• tanlr. Hs a t*~:ataaea stage in the wash drsposai system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mr~s:e~ pl:unber, journeyman plumber, resirictedpIumber or alicensed pumper verifying that (1) the on-site wastewaterdisposal system is st pr+ape:; operating condtioiH; and/or (2} after iu;~~r-~~on *~d pumping (if necessary), the septic tank is less than II3 fwl of sludge. l/w°. *~9'.i."•de='"signs3'~.;.E red rb,, above :~qu:rcxi:~r-is bnd agrCa io 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 steal: g f~lst your ~~ei~nir system has been maintai:ied must be co~rplcted and rEturncd to the St. Croix County Zoning Office within 30 days of the three year expiration data. ~- X/~/al SIGNATURE OF APP NT DATB O ER_ CERTIFIC.~i.TION I (wen cextify that a'1 statrtx;.ents ore than f;,rr are trtF to thG Kest of my (Ot~",, W,r.awlyd,~P. I ('su'e) ani (;s;~') tl,,r L~vmer(S) of the property described above, by virtue of a warranty deed recorded in Register of heeds Office. ~~ '~' ~l I ~ L 1 SIGNATURE OF APPL;I 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 /~ °= S'IA'I'C BAH OF WISCONSIN I~OItM ! - 1998 (-„e~$7~p WARItAN'1'Y ULEll KtiTHLEEN H. WALSH ,.- Document Number ~o~ 1663PAGE 174 kEGISTEk OF DEEDS ST. CkOIX CO., WI kECEIVED FOR RECORD This Deed, ,Wade between .. Ronald C. Bonte an d - - __ _ _ Glenn A, Knudtson ~- 06-19-2001 10:50 AM - --------- -- -- ---...------- - --- -_ __ _. WARkAHTY DEED _ ___ ___ _-- -- __ ._ __. ------------- EXEMPT k ----_-.-..__._--~---------- ----- --_., Grantor. and __Lawrenc Tala a and Vicki A CEk7 COPY FEE: . _ ___ ___ __ _ Dresang-Talapa us an an wi a a s COPY FEE: TkAHSFER FEE: 137 74 _ _ _ survivorship marital ro ert ---- - - - _ _ __ __- - -. - --.- P P Y . kECOkDIHG fEE: 10.00 . - _ ._ -- - GAGES: 1 -_ -_-- --_-- _ , Grantcc. Grantor, for a valuable consideration, conveys to Grantee the Rrllowing described real estate in _.-...~_~.r<. ~TO1.x__.,.-.,..__...__. County. Stale of Wisconsin ' (tile Property'): i hs::,rla~ , .r Part of the SW # of the NE ~ of Section 16 Name and Heurm Address ~~'` , Township 29 North, Range 17 West, St. Croix County, Wisconsin described as follows: Q~~..''~/ Lot 48 of Pheasant Hills Addition filed ay th, 2001 in Volume 8, Page 48, Document N644952 _018-1090-48-000 Parcel ldenlification Number (PIN) This __ 15 rtt>t homestead prupeny. (Is) (is not) "fogcdrer with all appurtenant rights, title and Interests. Grantor warrants that the title [o the Property is good, indefeasible in fee simple and free and clear of encumbrances except Easements, licenses, zoning ordinances, and restrictions of record Date~dCthis 1 8th day of June -__, _ 2001 ~/ C) ~ - ~,--..- (SEAL) _.~--ij~~, ~ - , --- _- (SEAL) Ronald C. Bonte Glenn A. Knudtson (SEAL) - (SEAL) AUTHENTICATION Signature(s) `_ anihenP'.A~dt~r" Coat~~.~nutson ---~- -~- Notary Public --- --~ -- TITLE: MEMBER STATE BAR OF WISCONSIN (If not, ___ authorized by §7U6.U6. WIS. Slats.) ACKNOWLEDGMENT State of Wisconsin, lI } ss. -- St_Croix - couruy. J Personally came before me this -._ 1 8th _ -_ day of --.-_aTune_,- ---._. ..2001-- -, Ure above Warned _ _ Ronald_C._ Bonte ___ --- _.--_ Glenn_A_Knudtson - _ to nle known to be the person .,_- wlio executed the foregoing instrument and acknowledge the carne. THIS INSTRUMENT WqS GRAFTED RY Ronald C. Bonte 1011 170th St ~ ' Hammond, WI 5401 5 (71 5) -796-5240 Notary Public. State of Wisconsin -------~__-._.._..___-..- ___.____ __- - - My conunisslon is rennan tt. (If not. stale expiration date: (Signatures may be authenticated or ackrwwledgr•d. Butte are nut Ja- ,~ necessary) - ._.. .._ __.. -3 ' Names of pr sons signing i. uiy ,:apariry nmei Ix• iyp,~d nr pi iutr•d b~4ow thrii s ignx WARRANTY DEED SIATE BAR Up WISCONSIN FI)HAf No I - 19yR Wrsconsin Layal Bunk Co.. inc. Mllwa~kee. Wis ~__ ~ , ._. ~ j' ~ ~ ~! C` aI 1 ~ ~ !~ ~ } n ..i•.. a. ~ ~ :~ .~~ I ~ o+ Y~> ~ ~ '~ p M ~ p ..~ M ~ s N .I ' ", 1b ~a \ V '. p~ ~~ ~.. ~ ~ ~ ~~ ~ ~ ~ ~ H M ~ ~ ~. ~. ~, ~ ' ~ 1 V r ~ at r, O} ~. ~ 5~ j7] •' l •( ~f ~ I .t '~ ~1Ua `~~' ~ ws x ~ . ~ . NQi~° 44 5 9I~ 2' '' F ~{ + 33' 73' ,.. .... T A R + ~ F„ 1 \ , ~ ~ . +. NOR fH-SOU M OV RTE t NE . p ~ ~ Q ~ RES ! DE T 1 At use O ° -~:I ~ _ ~ : .~ : ~ m: ~ `• AGR ICUL 7U g-RES IDENT IAt ~~' ~ i °`:! i ~ r ~ i.~,y~R ' ~ NgTTN tJUARTER COMRiR ,~ ALIMIIRW /RMAMETVT N~, ~~ ~~ } ELI I~ ~ '~- vNPLATTED LANDs ' ~~_ ORAIRilef .A,Q.T....1.8_ - __ -- ----LOT 4E1 -- t.4a AdtEs loe, -so as Fr. ` ~ ~ q ~V ~ LOT 4B - Dv t.4s AcREs IOa, ell a0. FT. E'n ;m .... • .. l8 n L0T ~ , __ • ~~~ ~ 38!'26'21'E PtJ.60.~ ~ , „0 / ~ ` \ , ,~ PHE ""°°' ~" LOCATED 1 N THE NV ~~~ ND 1 N THE SE 1 i .;,~ TOWN F ~ ~~ ~ % : i-- - :_ ~..~ ~ ~ ; LOT JO 3. 14 ACRE8 136, ee! as FT. ~~ ~d _~. . ur~~.AZrn S88•PB'OP'E oRARwfE LOT 'S I r. a / AcREs Itt, a31 Sa FT. ' , 't , 1•E 4 ~ S ` ~' , Sq `om '.. N ~~1t 8 a ~ LOT 47 \ ~~ `'~ ~• \ ' .~ ORAIMABE MEA~ ..G.Q.T....l~. ~ ~ . , ~ , ~ , t ~ ;_ + ~ ~' ~ LOT 'SP x ~ :' 0lTEMiI0N PC110 ,,.~ t .:r~ ,~• ~ ~ ~ ; ~ : r. 34 ACRES iol,oaa as F ~~~ ~. L rNf - •• ' ~~ ~ ~ y~ .. ..............._........--•--~•--....._.... _ __ , ,~.. ------------,tea------ -----, '" , ~ ~---- ----- _ ------ p - ~ _ ae8•ta't4'E I/a.JJ'PUO1 1 f_ 1 I ----- !N'ta't4•E dar.Ta•-- • - - - - - ~ iera~~ x rr - ...L_-_ ~~. t4' M 834. N• __---_.__° 66. as ~~ ~ __ ~~'--- _ ~ oo ------- fM.ar--------- tea ar --------• --°---- #/ ~ Z~10 f /E1EfTIfMI POAp ......... ~. ~ ......... .....SFTIApt_................»........ Z '4 f" i iy ~ ~ ~ _ x ~ ''•~ !~ ~ ~ ' LOT 68 ^r ~ ~ 3 17 ACRES ` # LOT 67 ` t aT ACREB aa LOT 66 aT ACREB t , ~ . '+ 138 i Ir S0 FT . f / l 1 8r7 Sa f7 . FT e so . , . ~ Y~ ~ t.46 AC. Ek1C. EASf. a - . . g . . 1 / 1, e a ~ ? I0T.r0.! 30. £T. ME9T CVARTER CpMER sfcTlaN le - £oiRO Q (i e0' ~ Y IApY PIPE ,~ ~ ~ ~ •r ' ~ ptA1MA0E AREA -' ~M rE ~ i t9s.06' • ~ ~ t3a 00' 4p wtrvR 38 Y ' 1'D \ CENTER OF Dfcrrcw B ~~ UNPLATTE'D LANDS i ......................................._ UNPLATTED ~. ............._._......- e __L ANDS t i NwF: TNra PLAr rE L«ATEO rN AN ApTICVLRRAt AREA. NOIEpINERJ SII0yL0 E7~ECT MICAL fARM RELATED ACTIVITY! (~tOUTN OVARTER CCRAER SECTfCN li - FpMID CpMTI' iWtKY NAIL TINT 1MCLY0E HELL. NOISE. EXTEIDED NONRS OF OPERArlOM FTC. toooaror TNrs rwtrRlNENr cRA£TEO w .rlw rEEER LOT S3 laa le a LOT i. Ti At i, Too ~! '-- ® ® ~ LINE __....«-.. ORAINAEE AREA LOT E3S t. 43 ACRES ios,ooe sa 1 LOT 64 IOa a I a~Q. FT. leer. 3e• t n Is aasEn tza ~~ fAST~lfsr gIARTER L S1t~ET 1 O!