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HomeMy WebLinkAbout018-1098-25-000Wisconsin Dgpartment of Commerce PRIVATE SWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 C1)(m)]. y Permit Holder's Name: City Village X Township Jackman, Jeff Hammond Townshi CST BM Elev: ~ia~- 3 Z Insp. BM Elev: ~ a~ 3 ~- BM Description: v ~ ~-~, TANK INFORMATION ~ EL"EVATION DATA TYPE MANUFACTURER CAPACITY Septic / ~ / ~ ~ !ryl (/~ Dosing ~~ (/~1 ~. Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. VJ?o Air Intake ROAD Septic ? ~ i / Z ~l Dosing Aeration Holdin g PUMP/SIPHON INFORMATION ~i~~' ~~ Manufacturer Demand GPM Model Number TDH Lift Friction Loss ad TDH Ft Forcemain Length Dia. Dist. to Wel SOIL ABSORPTION SYSTEM ~ -.l County: $t. CI'oiX Sanitary Permit No: 453409 0 State Plan ID No: Parcel Tax No: 018-1098-25-000 Section/Town/Range/Map No: 30.29.17.832 STATION BS HI FS ELEV. Benchmark Z ~`.~ I p ~ ~ I 0 ~D ` ~/ Alt. BM ~ ^ . ^ - , N ww" .- Bldg. sewer S~ , ; L3 93 . D SUHt Inlet /D i ~/ ~,2. I, St/Ht Outlet ~ 3q 1 ~ .~ Dt Inlet Dt Bottom t ., d an. .~ ~ - ~L (d • 76 Dist. Pipe ' Bot. System 2 4 t, ~ „ 6 Fin t Cover ~ 2 ~ : ~ ~ L S ,~,~' ~ 2 ~` /~ ~s~c~ d 1 BEDITRENCH Width / Length No. Of Trenches ~ PIT DIM IONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ d ~ p SETBACK SYSTEM TO P/L 5 BLD WEL LAKE/STREAM LEACHING a ur r./ ~ ~Y INFORMATION CHAMBER OR Typ O~m'ti 1 ~ 7~J / _/ UNI Model Number: `-~' "'- _' l DISTRIBUTION SYSTEM ~) /,~4,~n,..,~0 Header/Ma ' ,~ ~ Distribution ~ / ` x Hole Size x Hole p g ~~ • H h Di ~ ~ ~ ~/ ~ ,{- Pipe(s) ~ ~ L th i S i a Lengt eng pac D a ng SOIL COVER x Pressure Systems Onty xx Mound Or At-Grade Systems Only ilYl 5 ~~Lt Depth Over ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center ~ Bed/Trench Edges Topsoil Yes No ~. ; ~ Yes No COMMENTS: (Include code discrepencies, p sons present, etc.) Inspection #1: /~/ / Inspection #2: / 1 Location: 743 154TH UlIni'ky`now~nA(NE 1/~4..S,W~f1,/4~30.T29N R17W) Emerald Acres Lot 25 ~"~ ,, e Parcel No: 30.29.17.832 1.) Alt BM Description = W ~~~'`'t " "" ` - Sl(,~,J J4~.~O,,G~ tom, 1~E~~~~- r -~(ih.~ ~ _ U 2.) Bldg sewer length = ?i`-~ - amount of cover = ~ 3 / ~- ~^ ~ ~, y~(/~L~ , Plan revision Required? ~° +'' Yes No ~ L Use other side for additional information. _ o ~ J ; , ,~ ~A _ ~_____~ - -G'~-~~Z!2`~'~- -- - - - - SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. .~ .7 t 1.r,- ~ a~.. ~-~ S acin Vent to A' take 1 ~'~ Ib ~. ,~bs~ ti ----~- - ~~ ~~ o~ I ~~ -~ ~~ ~i Safety and Buildings Division County ~ ~ 201 W. Washington qve., P,O. Box 7162 .S~` Gro i ~seons~n Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266-3151 ~ ~c~ Sanitary Permit Application Statc Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s15.04(1)(m) .. _. Project Address (if differe~t than mailing address) ~ ~ ~ ~4 i i li I f Pl P Al ~ 4 ormat I. App cat on n on - ease rint l Information ; ` ~ ~ k ~ Property Owner's. Na me , -~ ~ ~ Parcel k t -Btoek~ a s > m~~l ~~ oc o Property Owner's M ailing Address ! Property Location tw.~.._~~.~~ ~ ~~ Wn ~ ~ Secdon y w t~ ~ t t City, State Zip Code Phone Number ' ' ' ~ ~ L/ 4. ~'1 ['(J f '~ `~0 Z ~i /~ '~ a~ - G3 ~ C1 (circle ne) R~E or~ T ~~ N _Q ~ II. Type of Building (check all that apply) y ; ~ ~ ~~~ a, ('~- ) CSM Number bdi i i N S ~1 or 2 Family Dwelling -Number of Bedrooms ~ v u s on ame ^ Public/Cornmercial -Describe Use / ~ 77-x:-~ ^ State Owned -Describe Use ple-D,a.gQ l,l;t ~c~{~ ~c..Q. c.QQQs ~$ Z. ~ ~ ^Village J~Township of l~y~ y m k~ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. y New S stem ^ Replacement System ^ TreatmendHolding Tank Replacement Only ^ Other Modification to Exis[ing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner N. T of POWTS S stem: (Check all that a I ) ~ivon -Pressurized in-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis rsal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdst) ispersal Area Required (sf) ispersal Area Proposed (sf) ystem Elevation VI. Tank Info Capacity in Total Number Manufac[urer Prefab Site Steel Fiber p astir Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks sePt~~ or ~k -- l~ 5(~ 1 iaJl ~ ~~ '-.~-/ '~ Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the ttrtdersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si gnature MPlMPRS Number Business Phone Number C~r~ ~' tst5~ ..~~ ~aOSSQ `7~S q S .a~7 Plumber's Addre ss (Street, City, State, Zip Code) /o ~fZ S rn~ ~;;~~ ~.ils a6 Zv VIII. Count /De artment Use Onl Approved '' ^ Disapproved Sanitary Permit Fee (' eludes Groundwater Surcharge Fee) Date Issued Is uin Agent Signatu (No Stamps) ( ^ Owner Given Reason for Denial ~~~ ~ Z IX. Conditions of Approval/Reasons for Disapproval 3>~ ~~ ~~ _i„ ;-~,/) ~°"~ SYSTEM OWNER: U _ /~~ 1 Septic tank, efflu®nt fliteF grid ~ y _ ~ ~ ~^~ ~>~-.. dispersal cell must all be serviced !maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. Attach complete plans (to the Counl only) for Ute system on paper not less than 81/l x Il inches iu size t_ , t ~.rt , SBD-6398 (R. 01/03) ~~) c~~k. ~ . ~2 ~ ~~~- ~~ ~w STa ~ ~ C~rkr» ~r,S ~o - 4 9 r ~ ccP ~~~3~ w/zp Sn 5~~ ~ ~ C $' »'F. 1Tr ~rto~ q w~ ~ 4 S7 l q a-rs r~-f end owPs~ ~I °- i49a. °, ~/ ~ yc 5. ~ ~pr 1 ~~ 1 ~Tal 1 ~~3 5` fY Tai .d. 'a''~' ~Z . t bo____v 0_ T~ P -~' ~ ~ ~c r~ ~~a a ~ 2 ~ z, R6.3Z ToP r~ ~~,~ ~ ~s ._._-_ ~ ~-r Z S ~wjeY~~d 1~~-~ ' cam, 00 ~ ~~'s 3~ ~~ ~eS-~hr~ ~ ~7 ~ ~~ ~~oSS~ ~.~~~. ST. CROIX COUNTY WISCONSIN ZON=NG OFF=CB ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 FAX (715) 386-4686 Page _~ of COUNTY ON-SITE VERIFICATION FORM Inspector: EVi-~1 ~c2~3~4-~ Date: ~~u Z ~~ ?.~~ Parcel ID Number o) g -- I o ~$ - ZS= ~D . g32) arty wner on ropertyLocati _~ Spq~~/1n~-~} r Govt. Lat yv ~ 11ds~1 !4 3 30 T z ~T N R PropertyrOwner'S M~linp Address Lot # Block# Subd. Name ar CSlut# ~ 0 2 Q Tt9w~J f~-+- R.D ~ ~ - ~ S State ZpCode PhoneNum er ^Cdy ^Yllage ~faHn Nearest,F~oad ~~1e~gt ( ~0 2Z { ~lS"} ?Jp. 0 3olA O~v ~ S j ~• NewConstruction Use: ResidantialtNumberofbedrooms.._._..._........_,._ Codededveddasignfbwrate__._-_. O_D _._.__..___-_GPD ^Replaoement ^ Publicorcammerrdal-Describe : ............................................................................._...._........_.._._.........._.._......._........._...._...__........_.__-_...__--.-- Parerrtmaterial __._ ...._...,,_W-_-_ .__ __._ _.___ _ ._.. _ _ Rood Plain elevation if applicable _._ _-_._ _...,-___ _--`~ ft. General comments and recommendations: ~ Q ~^^~ . ~ y '~ l~:Q-rte. -S ~" . I~ Badny rl ~ u Boring # ~~~~IILL~~~~ ~ ,Pit Ground surface elev. _-_.._-_ ft. Depth to limiting fa _,D~! :Rail Mnlitrfitrt t2afr3 Horimn Depth Dominant Color RedoxDescripticn Texture Structure Cmsisfience Boundary Rods GP D~K in. Munsel I Qu. Sz. Cant. Color Gr. 5z. 5h. `Etf#1 "Eff#2 Conditions: Soil Survey description: Notes: C~ ~_ °~ ~ P~- ~ ~ ~~S B~ ~, ~ .---dQo ~~ ~ 4~ ,re Sr Cxo~x Cssu~.Ti ~ ~ nA U Sf~c i a ~ tsT Kc~'~e~l ~~-cagB+~~t , -~ ,~a~ ( S,~e~ ~b 5T- C12.mf~00019~N~ w (Sc_ortJS~n~ 5~ `~~5 o,An~ -~o -~isw2 ~o•~D `C~ -~'°~~ icQOU w i~'L. C~.~nn.iQ 5.~-r.t.~c- ~~ 3S `` loe-~r-FEE: ~~ . ~°~' ~ Cam- ~-~ ~-f- ~ ~ ~.~~~ • ~ ~°'`~ ~ree~ to ~`N, I~.; s -~p~ ~°~ ~ ~o-~s, ~ ~ ~ 2 , o i . t~ S;d~o.~-~ . ~ s ~dZ s ~Q,~~dZ ~ .,.~.r~ ~ 2 ~~ J'e 5 ~ ~--aa.c~ -~ ~.2~s,^ ~ t.~i J o~ ~. ~ ~- ~-~ . 'tom S a.~aQD ~«~ ~ ~n~~~ C.~~ --~~ i S t~ rte,. S'e¢,~.~ -}~o ~- w~eo-Q~ e.~~,M.e,n.C2~ ~~ ~-~.c2,~ ~~ b~ ~ ~ ed~ . `tom .,~..a~~ .~ ~ ~ e®a.~c,a.e,.~ ,~ a,,,c~ u..r~ a, w~~C, y u~5 J ~ a.~ d~ ~' c,~~,Q~ @,tS~.~ ~ ass ; 0 / ~.p Cam. t~~-e- ~~ ~ u ~Q aC ~ °~ ~~''^ 4 s ~`~'~^"- ~ Qa-e o'C ~ ` D • ~'~/~4"i5` I 5 `~~ w-~~- ~' ~2 -~J-E~J tom- /~. .~ c~S rl'm^'~ `~ ~-re~n,~ ~~'~'~J ~ ~ ~ S~ Imo- S((--~ ~ a--- I ~,, 'n~'~-<<-~c Vle SS /~ h ~:2~~-C /~ 1, u.r« .~ rye~eKs Ol CA~S.~ 7~S ~''~ S~+^C~s ~ ~..~~'~'L e~/`alrtSC~ ~K~ 2 a T"'~~. ~---' U //'' ~R~.~-M-- ..._ ~ Z~i,~,.~ COQ, ~~~ s~-1.1.0 ~ C ~ ~3, ~ ~ ` Wisconsin Departrnent of Commerce SOIL EVALUATION REPORT ~ Page ~ of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code _ Attach complete efts plan on paper not less than 81R x 11 Inches~in'~Ize. Plan must County ~ ' { o ti ~' 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. ~ I rl `l 2 S ` d ~ 0 Please print all ~ ~"._~.n.~. ~ ~~~ ~ Reviewed by Date ~.. V~ Personal IMomutbn you provldr rrwy b~ used for s~oond~ -Iv~cy'1aw. s. 1ti.~4 (7) (m)). Property Owner Pro Ry Location e,.f .-~ ~ u ~.1 ~. I~ l ~ ~ Govt L 1/4 S 1~ 1/4 S 3d T v"2 ~' N R 1 '~ E( W Property Owners Mailing Address L~o1t # 'Block # Subd Nartw or /CSM1/ jI.L ~ i K. 1.,~~ ear ~%I C (f ~1f GfY~ T o U,~ n a 1 17tr . ,~ ~ ~~ ~, ~ ~ ~~~_ City State p Code ^ Village Town Nearest Road n So'" s T I~tvcr ~ ~ ~~ S bZti !S - v3o lFh~ oH~ New Construdlon Use:~• Residential / Number of bedrooms ~_ Code derived design flow refs ~ ~ V GPD ^ Replacement ~; /~ ^ Public or commerdal - Desaibe: Paront material Flood Plain elevation if appUcable ~ '4 8- ,~ and reoomm Dons: / h ~7~ /~ > S o 0 ~ ~ i •,'{~.~T r ~~ p ^ , G ~ ~ •.- ~ " ,S: ~ ? v ~~ ~ 1hS~~ 4 CC~~~ '" Boring Boring # I~ Pit GI _ ~G~ . of "!-SS `' ~ • C~~ Horizon Depth in. Dominant Colt MunseU ~ o- .c~~Q3Z ~ g-> ~Y 4 3 3 i~'Z ~ 9 4 ~1-9Z 4 $-~Q, ~1 5 ~Q 7 N~~ w 50 ~~. ~- ~ ~.,~F ~ 'ASS ~'N ~'` P'~ 2 ~ ~° ~ /~-'M, t~ ® ~~ #. ~ Boring. . Pit Ground sw Horizon Depth in. Dominant Color MunseA (] (~- ! UY~f ~ ~ °a o 3 ~ a,3 ~ ~ s~37 Y 4 ~O - f1 9 • Effluent #1 = CST Name Please Print ~4.1 I ~ > so < zzo rngll. F J a ~ Z- S. 57 ` L61~_ ~ l~ o S ~"' Roots 'v~ ~f Soil lion Rate •Eff#1 •Ef(#2 o..~ D, ~' o. ~ o. .S a. ~ b<S 0. Q Q.s o.q o, a. •Eff#1 'Eff#2 o • S ~+ . o. s' 0. ~ 3 s - ~~ ~ ~,, rte- ~. ~ ~~ ~ t ~~~1~~. a ~a~ s~ - av- uate Evaluati~+Condudad Telephone Number 'caw ~~ils iw~ s46 ~ ( o ~%s das-a(~S Property Owner . ~L° ~ S4 clLvr ~H Parcel ID # U ~ 8 ' 1 D 4 8 " 2 ,~ ' 4 Et C! Pape ~.,- of ~~ # - _^ ~~ ® ®Pit Ground surface elev: ~~. ~ ~. Depth to Umitlnp•Tada, ~ , . ~ ~ in. • .,,.. . _ ^ . ' SoU lion Rats Horizon Depth .Domiruuif Color Rsdox Desdiptlon .. Texture Stnxxuro - ,Consistence Boundary ,. Roots. GPD/ft' in: ~ - MunseA • Qu. Sz Cont. Color Gr. Sz Sh. 'Eff#1 'Etf#Z Q•-1~ • `1 0~ rvl~r a J~ a la~ a rR 4 - s; m l nz r s i~ f ,~ o, ~ aa•33 /U i 2 -' I ~ ~ ~ 5 _ S ~( ~ Boring Pit Ground surface elev. ft. Depth to limiting factor ~ ~~ Rats th D minant Color D Redox Desaiptlon Texture Stnx~ure Conslstsnca Boundary Roots GP D/ft? Horizon ep In. o Munsefl Qu. Sz Cont. Color Gr. Sz Sh. 'E!f#1 'Etf#2 1 D~ IU2 I - 6 rz~r s ,• GS o~ ~ 1~'~Z :10 .~ rn ~ ~ ~ ~ ~i ~ • ~-- S 0. Q' ~~~3 .,or~~ .. ~m : ~.f .. s ..~ o 5' - ~:S ~ ~ .~- .~ ,,,,5 ~ - v,4 G~ /• 1 ~~ ~ ~ ~~ / II~L ~ _N~ a Boring # ° Boring ^ Pit Ground surface elev. ~~3. ~ a ft' Depth to limiting factor ~ 4 in• ~ ~~ ~ tlon i D d R Texture Structure Consistence Boundary Roots Horizon Depth in. Dominant Color Munsefl p esa ox e Qu. Sz Cont. Color Gr. Sz Sh. ~~~ ~~ 5 ~ y4 ~.sy2 --_ -F s ! m s - - 0.4 G . Effluent #1 = BODE > 30 _< 220 mplL and TSS >30 _< 150 mglL 'Effluent #2 = BODE < 30 mglL and TSS _< 30 mpll. '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 608-266-31 S 1 or TTY 608.264-8777. seo-a~w ere.eroo) ©wrvcr ' 102 Tows ~I.I~'Vr~ ~ 4cZZ parcol~otg- X046-25-000 Lc,T2S~ L r~n~r aid IT~iVlS , 01.2 S.ao ~~~5 ,oz.a Qr~ }l orn e ~ 00.32 Q rn~ i Tn p -'~ p ~~ (~, ,~ IG ~~ G~bc~< ~ r dE Q~ ~ 4~ -3'- 9 7• ~ --' ae oP, ,- ~o,. ,# 1"ef f ~So-~K Mph ~~) c~~ ~ = ~2 I~,~-- G ~~~3i ~n Soli ~ ~ C7 $~ S n'~ . ITy a`~d -' q ~. ~ ~~ 9 5? ~~ ~Bx t4.1~= 148a~g °, ~ l ~ 5. B jP r ~ ~---- 1 vTa~ ti 5~3 5! fy Tv~ ~_ ~® a ~- 2 ~ Z, 46.32 Tod t~ ~ ~' psi ___-_ PL~~t '~i ~-~ ~~7 z s GmeY~~~ '1~~, S, oo ~ ~~'s g3~ ~a.oSS~ e W CL !~ ~~ zee ~ - Page ~ of /// aVYV/VGU /VG f./u• VV//u/I VJ, ~~1J. IIYI 1. WVG County -~ C a Attach complete site plan on paper not less than S 1/2 x 11 inches in size. Plan must . r inGude, 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)). Property Owner Property Location R1C~i1'~ "~ Govt. Lot ~~ 1/4~ 1/4 S 36 T Z q N R (~- E (or~tl Property Owner's Mafiing Address Lot # Block # Subd. Name or CSM# I S3 ~ee ~~ ~~ ~me~lcl es City State Zip Code Phone Number 73~ ~ 1~ 01 9 ^ City ^ Village ®Town Nearest Road ~ I 0 15) 5~ -Co .s~• /So [~ New Construction Use: ® Residential / Number of bedrooms 3 - Code derived design flow rate ySo / Q d GPD ^ Replacement ^ Public or commercial -Describe: Parent material ~L/ _~ Flood Plain elevation if applicable y,°7~'~ ft. General comments $Y S ~ ~ t;(-e. V . / ~ Ud ~ .- _ . ,© and recommendations: ~,o ^ ~ u ~ C f t J • . C~~~ ,$?3 f ~, Boring Boring # ~,~ ~~ ,~~ ~~•A ®pit Ground surface elev. 9~~ ~. ~ . Depth to limiting factor ~ m. <~~,;d ; ~ ~ ,_ $6' liation Rate Horizon Depth Dominant Color Redax Description Texture Structure Consisten $p~ da Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. (; Eff#1 *Eff#2 ~ o la /D /1 -- s i/ ZmctblC m ~ 5 ^ Boring Boring # Pit Ground surface elev. ~ ft. Depth to limiting factor 2 ° 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 3 2 r0 4 ~P ~-~ s r - - ~, - tmuenr rc~ = tsuu5 > su < zzu mgn_ ano rss >30 _< 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print ig ature CST Number da>7, mcE.ke~ ~ ~_ 2 s33o9 Address ' Date Evaluation Conducted Telephone Number 2113 gds ~_ ~merse-E-} l.Jr ~~to 2 5 i 2-~ ~-o i ~7~s)zv~-yda~ 4 C15~- s~~ ~- ~-~~ Pte) Wiacon~in Department of Commerce " -- ~OTL EVALUATION REPORT Division of Safety and Buildings ~ . Property Owner .S~v v-~ Parcel ID # Page Z of a Boring # ^ Boring - p ©. pit Ground surface elev.~~~ , ft. Depth to limiting factor ~ a in. Soil Appliption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. h. *Eff#1 'Eff#2 o-I2 /0 ~ ____ 5L r e I Z 12-l~ I ~ ~ _ 5L ~5 a Boring # ^ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil Appliption 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/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 =GODS > 30 < 220 mg/Land 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) PAGE~OF~ ~T s CIE ~~ V ~ LOT# ~S LEGAL DESCRIPTION 1V C ~Sw14 ,~~3 a T Zq',N.R. ~ ~E(orX~ SCALE: l"= y~J 1 - ~' BM 1 ELEVATION /QU . C~ BM 1 DESCRIPTION +p ~ ~ ~ / ~~~ u G. BM 2 ELEVATIOl\t q ~. ~U BM 2 DESCRIPTION~~ a_~ l ~ ~uG .S PG. 3 4 I SYSTEM ELEVATION 9~ O y SYSTEM TYPE ~ a u n c~ S y ~~ r r~ _ ~ CONTE?UR ELEVATION ~~. SC3 1 ~~! $'~~ 0 SIGNATURE f :.,/,`~ ~ ~ DATE ~ ';~S ~~ '~ 71523215b~ ~ ~ r ~., . ,. ~/ b '1fW STOUT PURCHASING sykeata T+lauagsment • revel of thette plans this syst~t~ . a condition of apP Tovided wrih a gem ~•letc M~gstt,snt of this system is critical. As mint bt tav;Cwcd with the hotntnwnar, turd the homeowner must P m~tgement ement. section set of plans including this rrtxllag Geaerel zdcnt ~m t}e tic cystem," -s significantly depe. propx t~tttctionirig of an on•site disposal syatem~ "scp ~ stem ~ the level of contamiu lcs tzrtthc systt mawi~furct:C`n,.e voiuTtte of water which flows late sY Wattle, the titter tsrtd n8 lain rre •` ar.~_ volur.~e of whet ar+d t}tc lower the level of c~t~ artrne~t to srttle out solids and con 6 ~,,, ~ talk em cotr-p is tank or comp as water. a p' Typical ryst onsets intlwde a sept tcles of the saute dcrsity tank to retait+ small part pill, i fitter on the outlet of the t rccu:stutsted, a Pump and cot-trols. and fatal!,' ublic }tet-lth. ~` os compartnut+t to allow a dose cr to prptcet grourtcl water quality as~d p .dsorpt~ort uU to recycle the water. to • tnar'uz ~,,,,~+,. ria to sheet-rock artdJor pstnttri8. pump the septic tank before t'.o~ t. If the'. st~ptir tttunk is installed p _ restderttlal tuc begins to ensuzti adket~eevar utd ~lEfeveropo siblen criteria. Z ln>;tall wt-tat•savirsa appliarscee wlvene ssiblc• 3. Repair evtt+ srrtalt water leaks u soon as po 4. NeYer pour ijs'sax of vi I down ally drt-in of stool. S• dpr~a djspOSal; are not reeotsvnertdrd; if you must have enc. use :t sparing y. 6. No paper products oth+ar than ti~tte should go into the system. ?. Nv chstrtieals should Eo into the system E. Avold songs flows of water; try to sptetsd laundry throughout the week Msetrtcntattcc i . The septic tank must be tnspected tvery three years by a prolxrly licensed pt~soh . Z. li nscessary, the septic tank must be p+~ptlhftd of the e~idolumesevtm; pumping is ceeuire~': :i i:' cohabitttd scum and solids volume equals on j. When the optic ttutic i3 pumped. nny solids in the bet-tom of the pump tank must be purrtpco. 2..~:'.-s: filar must ba ~ack•vvsslte4 into the septic trnk to remove accumulated matt:nt,i. a. Periodic obxtn+ation pi}+e inspeotions should bt madr by the homeowner to exatt'tine the state o; t?'~` .•~~• situ ao~I adsorption tc'l. Qt-attarly irtapections aro rocomrnrodsd, aril a licensed plumber should ~: ~~ _' ~ f,a? if efilutstt is cottsistt~ntly pondcd in the adsotptlvn ul'. S. if this rystem ctmtains specific treatment components other than those ment:c~ned here, mafnier.:t!°: requirement= wilt aca+ornparty thtxir afleciflcatioaa. 6. The pturipina companznta ft:r thin system include an slarcrt which must be :t:staited s»d trma~rr c°:' separate circuit from the pttmp~ If the aaturn is activated, mtnitnite water ux artd nv:i>'y a l~Ge~15r,~ r.,~:,?;er for service as soon as possible. 'Ihr aytttein allows reaarve capacity to acctunulste some ncctssarr, ~'..., ,.:,:~ norms! ss:viu Cats ba rrstoredt this volua-e is minin~ai, and no more thar+ ono ~~r two days should pays `-• :•:e ar,y aticessary repai:s cast b+ tttult: 7 Wastewa,tcr t>zonitoring of volume and quality is not o normal requinmes+t for residential syst,r.s, :,~~:•` monitoring may become aeCesaary if problems develop An>• necessa:ti rr~on~tc3ring steal! br done ~::',•"~•~ -<- with the rsquirements of Cumrn 53.54 (2). pumping ttr.d hxuGng ofiwRStewater racy be aeccsa~ry ~~ '" analysis sad repairs are implettnt:r+ted. Adtfittonel testing, designing; and/or installation of adci:ion•~ treatment components or conYdrs;or to a holding tank may be necessary. C~wC571c~hs ~• ~ ~~,.bi NrnS Let) YY 3 `~ ry - Q.1~8 0 C~-~t ~Ie~St ~~c, q~S- a~7~~ '~?' CROIX COUNTY ` SEPTIC ~TA2C MAIIVTENANCE AGRSEMEN'T - AND 4 CERTIFICATION FORM OwnerBuyer ~p~ JAc~itil~l Mailing Address ~_ T wN ~I ~ ~~ Prapt~cy Address ~Y3 lv y~ ; ~AM~fl~c~ w.~ (Verification required &om'Piug Department for new construction) ' City/State ~-~4N1 ~D~ d~ ~~..1 Peel Identification Number O I $~ la~;-ZSf'OG~ LEGAL UESCFtIP1'~aN C~ ~32/ Property Location ~ %, ~ './., Sit:. 3~ . 7' 29 N-R 1 '~' VIT, Town of l ONd Subdivision Q(~' 8•t' ~a~, ry`C:~~ Lot # 2~ ~ y ' v Certified Survey Map # ~j v t y 5~ ~ ,Volume ~^ .Page #; '. '--" Warranty Deed # T ~Y ~ 2~/ Volume 2~ ~ Page # ~ ' 2 3 3 Spec house ^ yes ~( $o Lot tines identinable ~ yes ^ no SXSTEb~ t1~tAIlVTENANCE r use andmaintenanceof our Imp open y septi~;systeui could result in its premature faihuc to handle wastes. Proper maiute~rz consists of pumping out the septic tank every tbFet~ra or sooner,. if needed by a licensed pumper. What you put into the system ran a$ezt fhe function of the septic tank sa a rreai stage in the waste disposal systest The property baVnCf flbRees to stibtait t8 >G~oI7_ ZonitlR i~Cnartrru~et H certification fnim. sitaed by ttte own~cr and by $ masterplumber, journeyman plumber, scstriccadp or a licensedpumper verifying that (i) st-e oa-side wastewaterdisposal~ystem is n pmoct oneratinp condition aadlor (2) afiei itesttiou and pumping (if necessary). the septic taQlc ia`Iess than ll3 fuII of sludge. ?lwe, the uadenaigaaed have seed the above ~i and agtce to maintain the private sewage dispvsa[ system with the standards set forth, horrin, as set by the Dtparaneat of:C~cte and the Department of Nauuat Resources, ~rateaoi w isconsiu_ i ertii~caiion stating that your sepdc system has. been tnsintaine~"~iist be completed-and Yztutned to rho St. Goix County Zoning Office within 30 days of - year iration data. i ~ ie SI aF APPLICANT DATE OWI~FER CERTII~'ICATION I (~^; orr±+f; th?t all statetnents`on the pmpcRV deserihP~~llt^ -~ E N E D I C T g gSj~CIA?ES t.LC rue ~ta tLe best of my (our) knowledge_ i recorded in Register of Deeds Offce. I ti~vve) am (are} ~e owner(s) of ~- , ©~1 'LATE in the sanitary permit being revoked by the~Zoniag Deparisaent ed from the Rcgitter of Deeds office sun^cY map if i+e5ereace is made is the wat~aty deed s!!=s• ` U 2 6 1 S P 2 3 3 STATE BAR OF WISCONSIN FORNf Z - 1998 WARRANTY DEED Document Number This Deed, made between - ht~;v~~ Q ..i€e~- -- - 1--~ Grantor, ~':~ and ~ -slA6~.--- __ Qy a c i n ~.e-~-~-r a np~-- Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate In $t C,L'111X County. State of Wisconsin: Lot Plat of Emerald Acres, Town of Hammond, St. Croix County, Wisconsin, 7'68628 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO. , WI RECEIVED FOR RECORD 07/13/2004 11:15AM WARRANTY DEED EXEMPT ii REC FEE: 11.00 TRANS FEE: 227.70 COPY FEE: CC FEE: PAGES: 1 fier,rd lnq F ..., Name and Return Address 1~~0 SDU.fh 2nd ST~I~S ~ud~avr , w~ moo! b _ _ ~l ~ 3 ~f'~7 ois_~oes_~s_oon Parcel Identification Number (PIN) Thts~ g not homestead property. (is) (is not) Exceptions to warranties: easements, restrictions, rights-of-way and covenants of record. Dated this 3 O t1(i(~ day of .Tune 2 O fl 4 \~ ~ y1 ~ C~~ (SEAL) /~~~ _ (SEAL) * Richard O. Stout *_ Janet P Stout (SEAL) ~___.~_ (SEAL) * AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. St. Croix County. authenticated this day of Personally came before me this - 3 0th day of .Ttii1>e _, _2(lOd ,the above named R i r}-+a rR r'1 -Sta11't 8T1G1.-fit.-. ~._~_--- S'1' C)l7 t- ` TITLE: MEMBER STATE BAR OF WISCONSIN - to (If not. me kno,vn to be the persons who executed the foregoing authorized by §706.06, Wls. Stats.) ins/,try/u/i~t/fir nt annd acknowledge the* same.. THIS 1 STRUMENT WAS RAFTED BY rT_{/~-`-~i11 L.(_ w V.Q~ ~Mns~..._ ' Jane P . stoup Pamela A. Wilima 1 3 5 3 Awatukee Tr . Notary Public ~ ,,,~ ~ ~a~ ~. (~j°r~ 1 w.a,~ _ H11 Son, WI Stat@ O ISCOiISIfNotary Public, State of Wisconsin My commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not ~ ~ T' 01 _ ____, _____.) necessary.) __ __ _.. :Names of persons signing In any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN w~sconsin Le9ai Biank Co., Inc. VARRANTY DEED FORM No. 2 - 1998 Milwaukee, Wis. C T V T~ T~ y~ 1 ~~ N I n ' puTOFI EMERALD ACRES ~ towTeo w pwnr of rHC ewtla oP TNC NwtN,TNE eetls of iXE NW 7N. THE NW 1N OP TNE EWtN, ANO 7XE N61N OF TH! eW1N OF 6eCT10N 30, T2eN, RITW, TOWN OF NNAMONO, BT. CROIX COUNTY, WIBCON8IN. N COBWEB .tCnON iO N LIHf O. 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