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HomeMy WebLinkAbout020-1322-50-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENEF~AL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)~. Permit Holder's Name: City Village X Township Delta Construction Hudson Townshi CST BM Elev: ' Insp. BM Elev: l BM Description: ~l `~ i tJ0 bU ~, s;l~ ~vn TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic 2 lob Dosing w ~--16a Aeration ~, Holding , /. TANK SETBACK INFORMATION TANK TO P L ~ V~ WELL BLDG. Vent to Air Intake ROAD Septic ~ , ~dj ~~ 2/ 1 Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Model N to Well SOIL ABSORPTION SYSTEM /L ~ D.,~l,.,,~ /., ~c ./ ,, o~ ELEVATION DATA county: St. Croix Sanitary Permit No: 405099 0 State Plan ID No: Parcel Tax No: 020-1322-50-000 .1- 1~.~~~t 1 C~G LGI-rLQ~ STATION BS HI FS ELEV. Benchmark ttil,~llCru~'~aY' >J y•7 /oL/ ~ ~Z~13 Alt. BM S~t-' ~ r ~~, ~ ~,,? Bldg. Sewer . t~ Q ~/ ~ SUHt Inlet .~ ~. ~ St/Ht Outlet t~ { ~~- ~7~ Dt Inlet ~- ~. Dt Bottom / ~_~ Heaa~r/Man. ~/ 2. r0.8 ~~ .~~ Dist. Pipe f ~t3 , Bot. System ».~s - 3 ~ 'L . 0 q2. 67 Final Grade St Cover W ~~~-. ~ ~~ a :-k ~ „ ~ L. BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ t /2 l / / SETBACK SYSTEM TO P/L ~ BLDG WELL LAKE/STREAM EAC(iING Man turer~ ~~ INFORMATION CHAMBER OR I~ - I? l< Type System: ~~ ~ ' i ~ t ~ I~l ~J / UNIT . Model Number: IJ_ T' l (0 DISTRIBUTION SYSTEM Header/Manifold ) ~ ` N Distribution , ~ Pi e s vn~~ ~ ,I p t x Hole Size l~ x Hole Spacing ~'- Length _ Dia I Length 1 Dia S acing SOIL COVER x Pressure Systems Oniv xx Mound Or At-Grade Systems Onlv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~- L~J Yes ;~~ No ~ ~I Yes ~ No COMMENTS: (include code discrepencies, persons present, etc.) Inspection #1: ~~ / Z / Oz Inspection #2: / /. Location: 659 Todd Lane Hudson, WI 54016 (SW 1/4 SE 1/4 10 T29N R19W) Scott Acres Lot 5 Parcel No: 10.29.19.1665 S.r . ~~~- ~ yt1~ ! t Ld ~/ j-C,I~irs•ec,~ P t Of' ~~ Q 1.) Alt BM Description = ~/J~ ~ a 2.) Bldg sewer length = I'L ~ X.X.(G<1 R-~ ~ ~' ""'" ~~'~ 1~~ ~~~~'~~~~~` - amount of cover = ~ ~ "r Plan revision Required? ~_ ' Yes ~ No ~~q i ~ / L -- -- +___ _ w ~ i -~ - - -s Use other side for additional ~ l~ v vJ information. ~ _ ~~~~~-`' _ l Date Insepctor's ignature Cert. No. SBD-6710 (R.3/97) ~ ~ rl ~ ~. Vent to Air Intake ~ pD tft Sl rntI (fie Sanita ermit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. `~ See reverse side for instructions for completing this application PO Box 7302 SCOf)Sin Personal information you provide may be used for secondary purposes Madison, WI 53707-7302 Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not - 3 ~ ~ 7~ ~ 00 ~ state owned.) Attach complete plans (to the county copy only) for the system, on paper not less t_ an 8-1/2 x 11 inches in size. County State Sanitary Permit Number Check if revision to previous application ,.._.o.,...,~.....,._W~,,_,._ ,., State Plan I. D. Number I. Application Information -Please Print all Informat on ~ ~- ..k Location:. ~ ivy' Property Owner Name w Property Location , ~~ l 1 ~(' ~ .~/ 1/4~~ ,C.1/4> S /OT 2 ,N, ( Property Owner's Mailing Address Lot Number Block umber City, State Zip Code - .._+ Subdivision Name orE9lot~Tier ~ s©,r/ ~ o c .~~/) ~~6 ms's II. Type o Building: (check one) ^ City 0" 1 or 2 Family Dwelling - No. of Bedrooms : ~ / ^ Village f ®'f ,~~ef~,EL ~c ~~ ^ Public/Commercial (describe use):_ own o . s•T ~~~ ^ State-O ned 2 C~-L Jt:' ~ 7• S p f Nearest Road L • ~e~, Q1f~ III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) A) 1. ew 2. ^ Replacement 3. ^ Replacement of 4. 5. 6. ^ Addition to System System Tank Only ~Q,~' ~(/ Existing System B) Permit Number Date Issued [9~A Sanitary Permit was previously issued ps"© ~f S 7 02 IV. Type of POWT System: (Check all that apply) .. [9'1`lon-pressurized In-ground ^ Mound - ^ Sand Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Single Pass . ^ Drip Line ^ At-grade ^ Aerobic Treatment Unit ^ Recirculating ^ Other: V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate .System Elevation ~ 7. Final Grade Required Proposed .Rate (Gals./day/sq. ft.) '(Min./inch) e'- r 93.o Elevation 6~0 ~s~.i~ ~ s- . > c-z ~2~~~ ~ ~o ' VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic y Information Gallons Gallons Tanks Con- Con- glass ~ New Existing Crete structed /GNT Tanks Tanks J/~!I`r1~ ^ ^ ^ O S~" T-zz ~.~v - /.roa cv~- ^ ^ ^ ^ ^ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the PO TS shown on the attached plans. Plumber's Name (print) Plum S' ature ~-4R/MPRS No. Business Phone Number ~~ 2Z-/ d lv3S- o lumbe s Address (Street, City, State, Zip Co e .~ Z z~ ~. ,~ max- B4/ C~GL 6s r- o~- ~io6 IX. County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Iss ing Agent Signatur (No sGv~ips) ,'Approved ^ Owner Given Initial Adverse Surcharge F e) Determination s~l ~ t70 , 2(0 ~ L X. Conditions of Approval /Reasons for Disapproval: ' nn SBD-6398 (R. 07/00) ~~ L /T F~/~ z ~r r ~ ~ ~--~ ~C - L ~~/ ~ ~ ,n~ ~O CZ Fogerty PlumbMs 28288 McKenzie Rd Spooner, WI 5480 (715) 635-9 ~~ ~j ~~~ ~.r~ p// 7~f l LoT S scorT' ~c~r S'uK.~ / ~ Y, ~ ~~ S~LL~ l,~s~-f fT~f1r~• `~2~ 6 Srgr~~ S ~ ~~-•- ~ - ~i • _ ~ur>D Lam' cc/w~`-'R O . ,ZOO ~L ~~~s ~.,: of s ys/-.~a, ~l~v= c - ~ 93•~ d •7 S ~ 1 m.c~ C- .Z g.=~ 7 ~0 ~ ,f,BT~: /~~uT1.d ~2~-G~ ~.[~iti sLo~E To ~`cYi7J~f, ye Pi¢.h' of StrT~~/1 GLOSEI~ ~//,E~ /pD.e ~ ~M L e~' tr./,F. Fogerty Plumbin` 28288 McKenzie Rd Spooner, WI 5480 (715) 635-960 ~3~`1 ~~~ ~,,s~ p`/ 7~ L Gen s scorn ,fcc~s ~ x_~ y ~ sad-C.~ / ~YB ~ ~ ~# -~~, ~~ o~ o~~o ~so,~ s~LL~ !~~ fT~!lr~. ' ' ~ q~• ~~, ~lotrt~,+~ d r ~ it ~~,~ s.~~,u.~+/G ~ ~~ .-- X ~ ~~~ Z o - ,z~ ~~ ~~~s ~., • Q _ 7 yam' r ~I .~ /fi!/'~ ~jM~T X - Z ~ : ysr.~~, ---" ~~v= c - ~ 93•~ ~ g~ ~tm~ /e ~ C- 1 y~T.~ • ,fir ~~z ~ ~ y7•sGo.~d~ y aa,~M SSE . >a l./ ~2.~Gd ~ic~i1S fLO~tE TD ~`Qfi7jf. % No 9t~~T' aP Sc~rF~- c~vt•~r~ rsr~! ioO.o ' ~iH L eT Lr./~E. f e _. ~ o O N O Uri i ~ ~'h ~ ' r -~ ~ ^ .0 ' ~ ~ a Q .II cu ~ II O ~ ~' ~. ~ . ' a ..~ ° • ~ ~:. ~ ', ~ II ... ~ ~ O . O v ~. ~ , n CD ~ . ~ • •, ~ O ~ ~ a c o 'd ~ .,.. ~ s.. .. s ~ , 11 ~ , . ~ ,. ~ ~ , ~ r' QCr .. ,. .~°,• I, a, . ^ ' ~ ,~ ~J (7 ~ ~ ~ t .. ,,~~ ~. ' ..~'1 O p i .. o ..~• ~ W .,~ ~ ~ ~ ~:e~ . ~ ~ Y• ~ f-+ ~ i ~' , `/ ~~ \ • ~ ~. ., • ~ . ~ .. . . , Y ~: . ors ~ .. :• ~ •C3 . - , b ~' ~s.i ~r~ • e ~ (A b C ., , r e . : ~ '~ . ~ C ! • ~ a ' .. ~ ~ " ~ ,"".. ~ p . ~ ~ •. ~ . , w!. ~ . ~ . ~ ~ (~ a,. . . .4 '' . - r~ . ~ V+ rt 7~ ~ ~ \ ~ ~y\ ~ ~J g .. ~ \ . ~_ ~~ ., ~. ..,. ~ ,Y o o ~ C~ `_ ti ~ II ~ ~ e~-t ~ ~ ~ ~ O ~ ~ (~ -1 ~. '~ ' ' -~ ~.. . .~ ~, a O ~ ' ' II II ~ ~ ~ A C D • - II V d O o' g b C9 V O N ~ ~ ~ ~ ~ ~ ~ v (p N 07 ~ n N W~x~-'~ -~ ~'~ ~~~.~~. l~Opa N n r~+• ~• ry~, o ~ • C~ ~ r~-.• h~ ~~ a O w ~--r ~ ,~ ~ ~ SOIL EVALUATION REPORT Page ~ ~ _ 3 alvision o! Safety and B~dings ~ aaxxda~ vrrithh Comm 85,111fis. Awn. Code - ntmar oompeta see ~ «- P,aP~' ^~ less ~" a ~n x ~ ~ inches ~ size. Plan ~~ irxiude, but ~ ~rrited to: vertical and tiorizoreal refererv~ P~ tom). ' a"d ParoeF i o. pint slope, sole or ~. nom amaw, and location and distance to neatest road. m1 D •-- 2 2 .- S"QO~- Please print all in ~._~,_._.fi - ~ Personal inranwtien you provide ~Y be uses r« v~•~ ~15.w ( (~-))• . 26 ?moo ProP~Y . , • ~ 'g i = ice. w 1l4 f~ 1i4 S T N R E (o-}~ y ,~ ;vr,~rrg~Address ~ lot # BbGc ~ Suhd. Name orb' r 5^ .r-- --- '2 ~T ~.,.~ _._ f~}Eilrr' ^ V~age L~'Town Nearest Road // ~ ? - Code derived design Aaw rate ~ GPD (g'New Corlstniction Use: ~ / Nurribet of bedrooms ~~~- ~ ^ Pubic or corruneraal - Desrxi're: _ ,~~ ft. Parent material '~-- Flood Plain elevation ~ appicableN..{ General oonarlerlts ~ arts reoonurtendatforts: s'yyf~tr~ G'G~v.' C'- l 9 3. ° c- z '2•s a # ~ Pi ~,dsu~ee~v. ~!~• Y ~ s. ~ ~ , in. ~ Ra Hotimn Deptt- in. Ootranant Golor Murls~l Redox Desaiption Qu. Sz. Copt Color -3 5 = Z -j3 p- 3 3- - (o- 5 - 8 ~1 j ~ ~- ~~ _ --- L r ~' to l . s z.._ Texhae S6txau'e Corte Boundary Rom Gr. Sz. Sh. •E1f~1 'Eff~2 ~ ~ 9 S'L S~ ~ _ &' S ~/ ^ ~n9 ~ ~ ~ Pit Ground surFace elev. ~B . ~G ~ Horizon DepUr in. Dorranant MlalseA Redox Description cltl. Sz. Cont. Cobr Textu Z. _ S 3 s -iiz ~, ~ - - 93.Dr 6'f- 3Z 6crA -~`2- ..m_ --~ ... _ nro, . v - ~ 7xt .rv,A aryl T.SS >3D < 1 50 rr1911 ,r S 'K m n~ L S rlr L __ I ------ ~ ~-~-`. re Sbuchae Consi~erlce Bo~d~Y Rom GPDJt[ Gr. Sz. Sh. 'Eif#1 'Eft#2 nos I os~ Gs~~l6 b Peck Testdnnt ~~ address C t3f1Zl@ Spooner. WI 54801 ~~ • E #2 = BOD < Date EvaNratiort Condur~ed .~ / i -, ~. 1 30 mgll and TSS _< 30 mg CST NuM>et .Z.7ll~ 7~~"~63~''- Y6D9 ~ /- ~S`~- ~fp2 ~-.Z/ O6 ~ I, ~ ~ s ~•e' cd-~~ 41 ~i Property Owner U~G~ ~/O S%' Parcel ID # 4~4- ~-~i~ - ~O-GtR~ Page ~ of ~ Boring `3 Boring # ~ pit Ground surface elev. _.QP1.(~_ ft. Depth to IimiGng factor rn• Shc ication Rate ti i D R d Texture Structure Consistence Boundary Roots GP D/fy Horizon Depth Dominant Color on escr p ox e ' ' in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. Eff#1 Eff~t2 - ~ 7 .S- Z Z /2~ d- .~_ K P 3 0- i zcs6 '~ - .8' 2 d0~ a Boring # ~ Boring pit Ground surtace elev. _____. Horizon Depth Dominant Color Redox Description in. Munseli Qu. Sz. Cont. Color ft. Depth to limiting factor - in• Soil ication Ra Texture Structure Consistence Boundary Roots GPO/fF Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring Boring # Ground surface elev. _ __ ft. Depth to limiting factor in. Pit Soil ication Ra Horizon Oepth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 'Eff#GPDIf~Eff#2 in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. ' Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 _< 150 mg/L 'Effluent #2 =~80D5 < 30 mglL 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~~319~1 or'ffiY 608-264-8777. - - . 7 ~ SBD•8330 (R.6I00) . ` I ' ? /09 ~ ~f?~tt~ I _, x_~ r -~~-2 (~- ~~ (''JD ~_ X- ~ 1 ~- / ~~~ Fogerty Piumbins #221180 28288 McKenzie Rd. / Spooner, WI 5~1 (715) 635-9609 ~~~ Loj r~S`- /~*~ SCALL' / ~ _ yB ~ ~,/r f . (Ssh/ /-a, BF f~~~d l~l~ sz'G~~ h',D / f~~k~d a = ~uM/ j~ Ld? Cd~R//~/Z flow, ~ ~~, -ly/>/~ L.~il/c - Sanitary Permit Application Safety & Buildings Division • In accord with Comm 83.21, Wis. Adm. Code 201 W W `~ See reverse side for instructions for completing this application PO Box 7302 sconsin Personal information you provide may be used for secondary purposes Madison, WI 53707-7302 Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not S t J p~ O// S J state owned.) Attach complete plans (o th county copy only) for the system, on paper not less than 8 -1/2 x I 1 inches in size. County State Sanitar~ unit Num r Check if revision to previous application b^^e State Plan I. D. Number ~~ ', r~ ~ V I. Application Information -Please Print all Information Location: Property Owner Name Property Location ~jcz r~ ~ ~/ 1/4 1/4, S T ,N, (o Property Owner's Mailing Address t Number Btock Number ~~ ~ r ~ ST. CROIX COUNTY s.- ~-.~jo~ City, State Zip Code Phon Subdivision Name oar.~Sl~?iamber II. hype of uil~Iing: (check one) ~ ~p~ r _ _ ~ ~ pity ^ Vill p 1 or 2 Family Dwelling - No. of Bedrooms : ' '~~~ age ~ Town of ^ Public/Commercial (describe use):_ - pp ZIn ~G ~ ^ State-Owned G! D y ~7 ~ . ~ = / ~ / . ~y ~ • ~ : ~ 3~. 0 17.6 ~ Old Z ~ (' /~'1~€i~ Barest Road 6 J ,~, /~E3 3 / t ~ / ~ P Tax s) _ rJ III. Type o it: (Check only one box on line A. Ch k box on line B if ap cable) A) 1. New 2. ^ Replacement 3. ^ Repla ent of 4. 5 ^ Addition to to System Tank Only Existing System I3) Perms umber ate Issued ^ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) $~r/~Q,,p ~/i'/C, OK.- 5~4 3/•/ ~' = 3/~d ~ l~'1`Ion-pressurized In- rod and ^ Mound ^ Sand Ft ter ^ Const cted Wetland ^ Pressurize n-ground ^ Holding Tank ^ Single Pass , ^ Drip Line ^ At-grade ^ Aerobic Treatm t U ^ Recirculating ^ Other: V. Dispersal/Treatment Area Information: ' 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Appl' n 5. Percolation Rate 6. System Elevation 7. Final Grade Requi red Proposed Rate (Gals./ ay! . ft.) '(Min./inch) / Elevation ~B~ ~ p 3'~ S 7 / ~~ V 7 ,SiQ ' ~ © ~ VII. Tank Capacity in Total # of ufactu refab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete strutted Tanks Tanks ^ ^ ^ ^ ^ ^ ^ ^ ^ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the PO T sown on the attached ans. Plumber's Name (print) Plumber's Signature (no stamps): i ~ ~-4PA1dPRS No. Business Phone Number ~J' / y~. r~~r~- ~ ~j •~ Plumber's Address (Street, City, State, ip Code z ~ s~ yv~ - ~~v~ IX. County/Department Use Only ^ Disapproved Sanitary Permit ee (Includes Groundwater Date Issued sum gent Signature (No star~ips) Approved ^ Owner Given Initial Adverse Surcharge Fee) ~~~ ~~ ~~ ~ /~ Q ~~~ Determination G . X. Conditions of Approval /Reasons for Disapproval: ' r~ ~Dwv'~h ~n 5-~auP~~~ , hiu~~ > 5',0~"6~- P~i< ~ ~iu:~ ~/~ cLoaR. _6-cc~-o~. SBD-6398 (R. 07/00) 7 80 ~ i~ Fogerty PlcnnbM~ #221180 28288 McKenzie Rd. Spooner, Wl 54802 (715) 635-9609 j/i~~Oz ~~ /~~~~~ ~,dsi ~8 /-i~6~ N p~ a#! O CLaT~d~ r ~z L~T''~ ~' .rcorT ~i~'S SALE = /" ~+ Yp i ~DOL~E ~ ~¢~'pwrE' l6Y~.~ ~ !1 ~i X t /SpC.r,~ • s FsIA~D Liz fo~eve/~ /2ol~S. O ~ Sri w~K y19LE o ~ SysT~'.n /, ~o l~ . s.T ~co/ ~ra'R zso _ m • ~~ ~~ a?~yS e~' c,9rq.,.r - usrct ~EiiT,LF~/ Rr~w+r~1~ # 2 /k~~K /yw~sr. Cs~~ N O U ~ ~ -~-~+ U ~ ~ V O v E...., ~ r~ T O .~ fir" ~ 'U V 'O mo II a~ rn c Eo N~~ ~~ ~-~, -, ~~m d ~ . #~ ~ ~ " ~ ~ w ~. ~ a" N N '. N a a a 0 .~ O I~ .~ --•~ ~ , . ' ~;~,~~: -~~ . ,.. •~; ,U o ~~ a " ~ ((1 /~ --~\ ~. \k~~1\ N r~ V .~ fs. '~ II 0 a~ O .~ II a~ , ~; i, ~' ~~ A' an .~ O ~3 ..~ c~ II .. ~ .~ ~ ~ .~ O ~ V ~ Uc~i ~+ O II ~'' cc 0 ~~ ~ h .~ ~.+ cd W ~ .'" H ~ -Z .~ ~ y .b .`~ ~ ; ; ~n ' ' a~ .. .:~ ., . , . -~ ~, c • ~ :. . , ,~ ~~ a ~ .., ~ p 0 ~ ~• .. 3 ~ ~ b •:. ai ~ a~ o Q a ., : ~ Qr _, . ~ `~,~ .. I U ... . y .; ~!~ ..... ~ O. • ~ n\ ~ r 1 d'. .. ~. Q i ~•~~~ •. ~ + a~ ., •. ~ a a~ 1 v ' ' i ~ 0 ! '. ` , '~ ~. II II .i ~ p ~ W U c, o ~ i t% s H ~ r - in Department of Industry, stator ar~i Human Relations Division of Safety & Buildings SOIL AND SITE EVALUATION REPORT PageLot 3 in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but ~~ not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. ~.~' / -' ~ --Q`Z~ APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION RE E EDB DATE PROPERTY OWNER: PROPERTY LOCATION / 6C B/f, GOVT. LOTS 1/4 ~cT t/4,S ~ T z 9 ,N,R E (~ PROPERTY OWNER':~ILiNG ADDRESS LOT # BLOCK # SUED. NAME OR CSM # ~oG .~ r- s'' - scorn ,mss CITY, STATE ZIP CODE PHONE NUMBER (]CIIY ^NILLAGE TOWN NEAREST ROAD l /~c~ys'oiV. ~.,~ s~!©/6 13~/) ~~ 6,~ I isz~/D~NJ I ScoTT ~y . I (~ New Construction Use [/] Residential / Number of bedrooms ~ (]Addition to existing building j J Replacement [ ) Public or commercial describe Code derived daily flow DU gpd Recommended design loading rate • ~ bed, gpd/ft2 .9 trench, gpolft2 Absorption area required P~ ~ bed, ft2 _7SD trench, ft2 Maximum design loading rate _Zbed, gpolft~ . ~ trench, gpd/ft2 Recommended infiltration surface elevation(s) ~ 2..? - 9s ~' ~ ys 9J:7 ft (as referred to site plan benchmark) Additional design /site considerations N D.f/I= Parent material ------- Flood plain elevation, if applicable - ft S =Suitable for system CONVENTIONAL. MOUND IN•GROUND PRESSURE AT-GRADE SYSTEM W FlLL HOLDING TANK U=Unsuitable fors stem ~ S ^ U ^ S ~ U ~ S ^ U D S ~ U ^ S 8 U O S el U SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Texture I Structure Consistence Botarla Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. y Bed Trerx~ ~. /7~ 2s ~o - 6 y -- S ©s NIL S . ~' 3 3 .S .7 ~ - ~ ~ GR ~ d SC L s ,7 . ~' y' 7Y ~v - ~ S r~ •~ M L - - 1 ~ ~ ,sue, ~5'. ~ _ ~, << l Remarks: ~~ C'o - N©Tf' D ~~3g!/~' - 6 ~ l~l Zr~~X~ ~°a~2 l r ~.y o -'3 - sss~ ~~ ~S l s- , 6 z -~ Im-6 ~/ 5 o G L Cs ~ ,~ .8 3 -~ z /'o R - 6 _ ~ co ©sG ML rt1 ~ .B' z- .~ 7. ~ - ~ - G,e o SG ML ~ . a' ~ fj ~ ,. ~ `; ~`~. ~, ~~rt}} Remarks: - , CST Name:-Please Print v~r ,~. ~~.,~,~ I 3/ Phone: 7 ~ N{} J'~~t„~ ,,~ ~ r Address: ~ ~ ~~ r ~ ~ .Pm f3i3,e ~ u~t SY~-Z3 7/~ ~ /t'L ~ ~' e: ,VEH_ ~)~LTi¢' SOIL DESCRIPTION REPORT Page ~- of~_ # DoT ~ ~ Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouxl~y Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trer~h / e - srL ~ L !~S F , p Z- 7-/3 v -- ~ S=L ~ L cs F , D / - . S- -- 5- -- S S L f~ S -' 9 3- -s '- S ~ S6 L r ,S' ~ so -a ~~~ `.s Remarks: ~ ~ - 307 ~'~~ Cols o-~ o-~ -rG L i~ ~ /F 2- 7 ~ - S ~ S.~L /N ~'L G S F y 3 - o .- S s s~ ~- ~ -- - ,~ Remarks: -~ 3 ~ yo 7 ~r,~, Co I3 ~ 6 /a /o - ~- SSrL L FS S //- . a Z o-/7 ~ ~- ~ s~fo t SG /1/IL - ,1~ ~-~' ro-s y - S D S~ L - - , ~ Remarks: ~ Z '- ~ S7o G.e~ cOB ., .~/~ T to -- Ted GLC',E 0 ,N~} F L ~r /'~' Remarks: +. J • f'1 j~iYl Fof Lo73' # 7, ~I r~s, pvF~- Ff~/~~ ~7o WE/C LSl'JC ~ ~ i~o ~zovr oti~y 1sr~~c~' ~ ~NW LoT ~o,~NG'(L) i I i ~y9' 13a`E-E _\ a~ ~ ~i s2 / Y .2~2 ~ _ - ~# Z 81' yC6' <~ ~'~~,~- /fEi+~ ~~OU ~F/( Lric-~b' ~~. fV~~~ a ~V~~~V P~Te Plumber ROBEf~t'S,-Wi~ '54023 Phone 749-363b ~~• ~~~ /~~~ /~c l~ ~oaSJ.` LOT ~°' S , ~. ~' s~cc~s sc.~ /~ / " ~ yo . ~ / .d ~ II N1 Tpp or^ /v~L ,3itsE o,G Pd w.E2 , LTi~F- v~L.E r i~S"HKI E /OIJ.G t{ z d _ = w LoT c o,[ N~ rZ S'c.R vE ~ ciZ "s /La U ~ _ ~rv~' ~ = fOCU,~%D nor ~eRtDER fE'~ SvY w~/zcG~ N +~% w/T ,c ov , p = ~~%~'rR j-c=Es 1, 2, 3 ELFV ' ~S ~ ~ ~~y~SF[EU- 9t.7' .~ ~5-' .~ y x :J - -- -- _ _ --- _ _ _ _ - ~sn--- ---- - _ vo --> ,~ (.~/sTrl ~ o D Cf w LoT c o~ryF,c) G d1 90 ° E ~~?, (S~ ~~~`T l ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Ownetf$uyer I.~C Ti¢ C~i~S'T Mailing Address S.9~ 2 ~ S"T . h~tr.d lO.e~ et/~ J'~~dl~ Property Address % v !,~ ~~ (Verification required from Planning Department for new City/State ~G/ so ~ ~ yo/G Parcel Identification Number D1o - /~ 2 Z - So - off' ~/ LEGAL DESCRIPTION Property Location SW '/,, ~~= '/., Sec. l~ . TAN-R~V~~, Town of /~i<G,',1~f0~ Subdivision __SCoT7- ~CRtE:S ,Lot # ~_. Certified Survey Map # Volume ,Page # Warranty Deed # `" J S'~ ~ Volume I j 77 ,Page # ,~'~d Spec house D yes E~J~no Lot lines identifiable L~7'yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restrictedplumber or alicensed pumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition andlor (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 f the thr ye r expiration /d~atAe. ~~ SIGNA OF APPLICANT OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the p perty describe above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNA OF APPLICANT DATE *.**«« Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified sttrvey map if reference is made in the warranty deed r 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 ¢epartment, 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- Sanitary Permit Number ,S' Number of Bedrooms Design Flow -Peak (gpd) Estimated Flow -Average (gpd) Septic Tank Capacity (gal) ~ Soil Absorption Component Size (ft2) ~ . / Type of Wastewater ~ , -!~ ( Domestic Table 1: System Design Specifications Table 2: Soil Absorption Comppnent -Limits of Reliable Operation ~~ Septic Tank Component Soil•Absorption Component Design Flow =Peak (gpd) Maximum Influent Particle Size (in) 1/8 ' Maximum BODS (mg/L) ~ ® ~ 220 220 Maximum TSS (mg/L) ~ L (~ 150 Table 3: Maintenance Schedule ~ ,t ~,~ S ptic Tank Inspect and/or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years , Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable , Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the !' ~ . Management Plan'for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scurp and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank-are not removed at•the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. ~ ~ Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or 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-6omponent - ~ - •- 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 thi's 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. ;r Mound System Management Plan Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under. s. 281.48, Slats. The contents o the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least onr_e every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The tiller cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. I( the filter is equipped with an alarm, the filter shall be serviced if ontinuousl .Intermittent filter alarms may indicate surge flows or an impending continudu davolume of the alarm is activated c Y nk exceeds 113 the I q septic tank shall have its contents removed when the volume of sludge and scum in the to the tank. If the contents of the tank arc not removed at the time o(a triennial assessment, maintenance personhel 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. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pump Tank witches alarms, and pumps shall be tested to ~- The pump (dosing) tank shall be inspected at least once every 3 years. All s , verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution S stem No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg1L GODS, 150 mg/L TSS, and 30 mglL FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 1ti mo~iths. When a pressure test is performedit sttould'trd' compared to the initial test whin the system was installed to determine if orifice cloggitlg' has•occurred and if orifice t;lt~ning is required to maintain equal distribution within the dispersal cell. ' Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequenT monitoring. General This system shall be operated in accordance with Comm 82-ti4 Wis. Adm. Code, and shall maintained in accordance with its component manual (SBD-10572-P (R. 6/99) and local or state rules pertaining to system maintenance and maintenance reporting. No one should evenment shat Pbe nraccordan eswith Comme 83 33 aW s. Adm. Code when the tanks are nolongeSuseld asd pump tank abando POWTS components. Septic or pump 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 -han 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep t e system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shallbe immediately repaired or replaced with a component of the same or equal performance. ; If the mound component fails to accept waasin dbasal area f toe leakage occurs or by remov9rg biologically clogged adsorption or replaced in its' present location by Inc, e g and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. •- „' Questions on the operation or maintenance of this system should be directed to your county zoning or health inspector. r L i 'i Fogerty Plumbing `~ ~,, #221180 ~~ '_ 28288 McKenzie Rd. Maintenance Spooner, WI 54801 (715) 635-9609 J , The interval for servicing septic tanks is set by state be b ct most regulatory agenc es suggest two tohfive years. wide difference of opinion on what this Interval show d , The Zabel"" filter, which does not increase the f Howeve , our filter) sv irtually self-cleaningb The con~nued act on septic tank is normally inspected and pumped. of the anaerobic organisms on the Zabel filter causeos I wllgl be not ied by and allarm when the flte~ needsoservic ng. the tank. If your filter contains a SmartFilter" alarm, y Remove the tank cover and pump the tank if necessary to prevent any solids from escaping to the field when the filter is removed: ~. While holding the cartridge over the access opening rinse off the cartridge with fresh water, being careful to rinse all septage material back into the tank.: 'Note: It is not nece "spotless". The biom aides in the pretreatn be left on the biter. (ll may be disa: ,: `-'" / . ~; :~ t. Firmly pull the filter handle and slide the cartridge out of the case. 'Note: A tee handle may have to be used it the tiller is too far. below ground level to reach. Contact'Zabel for into on tee. handles ` ;-~..: Insert the filter cartridge back in the case making sure the filter.cartridge,is completely Replace N WDEWU The product(s) shown are covered by one or more of the following patents: U.S. 5,762,793, 5,580,453, 5,591,331, 5,759,393, 5,683.577, 5,582,716, 5,779,896.5,593,584,5,795,472,5,736,035, 4,710,295, 5,382,357, 5,482,621 U.S. Des. 386,241, 3a9067, 4605501,5098568, Des. 309007, Australia: 134440; Canada: 2,135,937; Israel: 111574; New Zealand:-264824; z ~ Other Patents Pending Call for a free ZABEL ZONE An Onsite Wastewater Magazine 1-800-221-5742 • Website httpJ/www.~abel~. boi To service the filter: 'Servicing any zabe! filter should only be done by a certified septic tank pumper or installer. Locate the outlet of the septic tank. r J ' INSTALLER'S NOTES: WATER SOFTENER! Do not run the brine solution into your septic tank. This solution "' has a high concentration of lime (that's what makes your water hard). The lime tends not to settle out in the septic tank but goes directly to the drain field. Lime is an excellent sealing agent, and yes, it does the same thing in your drain field. Dave Fogerty • " 715-749-3656 -Roberts 715-635-9609 -Spooner RECYCLE GREASE! Do not pour grease down the drain. Your septic tank and filter will not handle it. NO BLEACHES! Do not introduce bleaches into your system. The bacteria in.-your septic tank is what makes your system work. Bleach kills the bacteria. When that happens, your " septic tank will no longer function correctly. This will cause premature failure of your system. Think of your sewer system as you would your car. Treat the attached information as you would your car manual. Remember, also, that your car requires regular maintenance. dare must be exercised as to what you put into it. And like your car, your system eventually will wear out. The question is -how quickly. If you have any questions, please call: If you have an emergency, and you only get voice mail at these two numbers, call Keith Knutson at 715-796-5436 -Hammond I have read the attached information regarding the construction and maintenance of my sewer system. " ~( .. r P ~ ~"~ Owner's Name Date Y - . J'~a.3J~cJ U:~cument N~imber Return Address Parcel l.D. Number: 020-IOi i-00 WARRANTY DEED i17 ~ PA;r DSO ~ i i, ~ ~ ~i ..~ i i~ u^ ary ~ ~. i MAY, 10 "t s3,'i 11:00 ~ A. r.a • ~ r'. r ^.+ '+~' ,. .~ ., ;c' ~ffa Joseph A. IClewicki, a single person, con~~r~ and warrants to Delta Construction, Inc., a rsconsin Corporation, the following described real estate in St. Croix County, State of Wisconsin: Part of SWl/4 of SE'_/4 of Section 10, Township 29 North. Range 19 Wept, St. Croix County, i described as follows: Lot t of Certified Surrey Map filed April 24, 199b, in Vol. ll, page 3083, I 542664. T rss ~ This is not homestead property. Exception to w,zrranties: Easements, restrictions and rights-of--way of record, if any. Dated this ~ ~ day of May, 1996. ~L (SEAL) _ _(S seph A. Klewicki ACfC.tiOWLEDGMENT STATE] OF WISCONSIN ) COUNTY ) Personally came before me this ~ day of ~ ~ 1996, the above named Klewicki, a sisgte person, to me known to be the pe n who executed the foregoing inst acknowledge +he same. s Notary Public _ County, WI My commission expires ~~ Cogs THIS INSTRUMENT WAS DRAFTED BY: ~ Waco in Attorney Krishna Ogland ~~ Hudson, WI 54016 cons~n, oc. No. AL} A. and ~' ~,...; S0. FT. M v - ~p4, 725 3.06 ACRES ,y ' 1 S7 AC. £XC. ESMT. M 2.36 ACRES 133,167 S0. FT. ,68,321 SO. FL 102, 628 S0. FT. - N 2,98 AC. EXC. ESMT. W ~ 129,671 S0. FT. C1 ~ M \O ~ 8 W Z ~ NWL = 924.0 ''~ 1 '~ N i OO SIC 2 .~~ - ~ } _ ~, - e ~--; ~-- - f 263.77' 70 ~ ~ `~ S 89°3426"E ~ ~ ~ ~ `90 _ ~ `~~ ~ ~ ~ „~~ ~ ~ O DEDICATED © ` ~ `,h"~, ` ~9~ ~~ 1 263.77' ~ ` X89°34 26 1N ~~ ® ~n~ ~ ~. ____ --- ~ `0 / ~~ ~ ~~ T °9°~• ° TODD ~~ ~b•~s\ 6 1 ~_ __~ 4.04 ACRES ~ _ _ ~ . ~ 175,779 S0. FT. 3,92 AC. EXC. ESMT _ `~ 5 170, 652 S0. FT. m ,~ 2.5E i 2. 2 ACRE 111,5 D 122, 61 . FT. W ti g M i!1 ' N 0 8 W Z ~ M iA N 0 S Z 1.26 AC. 54, 942 ' in N 0- M N / °O Z ~~ h ~~'' i ~ / ~ II ~'h, _ o~~~~ - --~`- - ~h. / i ~'' ACRES. S0. FT. 1275.17 250.00 S89°45 ~ 21 ° E S i /4 CORNER SECTION 10 ~1~ ~J~JF~Ai i~~ ac3g' 4~1"~ ~ Gfj1,~"'p.~~ r,^Py'n}-~~ ~{ P'1 ••• ;~,; 1318.21 _a~ ON CORNER MONUMENT FOUND RAS 1v N20~~3'38'e