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HomeMy WebLinkAbout020-1380-35-000Wisconsin ~~artment of Commerce PRIVATE SEWAGE 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 (1)(m)]. 'ermit Holder's Name: City Village X Township Waldon, Curt & Donna Hudson Townshi SST BM Elev: Insp. BM Elev: BM Description: • 0~' Gva,.Q ~'-QVt~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic r Z Dosing 0 Aeration Holding TANK SETBACK INFORMATION TANK TO /L WELL b '^ BLDG. Vent to Air Intake ~ ROAD Septic \ ~ ~ i l / ~ ~ {. ~ Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model N ber TDH Lift 'ction Loss System Head TDH Ft F main Length Di Dist. to Well SOIL ABSORPTION SYSTEM I BED/TRENCH Width / Length DIMENSIONS ~ SETBACK SYSTEM TO INFORMATION TygG Of System: , DISTRIBUTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 405110 0 State Plan ID No: Parcel Tax No: 020-1380-35-000 STATION BS HI FS ELEV. si~~ •s `( l •~~ toy ao . ~ Alt. BM ~. ~~ Bldg. Sewer 2- ~~` St/Ht Inlet . ~ a_ ~ SUHt Outlet ~- Lj2. Z Dt Inlet / Dt Bottom / HeAan. Dist. Pie o~ ~~ ~ ( t g• I q 3 0 Bot. Sys em / ~ ~ -tid ~ q O Fi al Grade ~ sl 1 ~• cr 0 - st coy ~• q • 3 ( INo:OfTrenches I IPIT BLDG W LAKE/STREAM EACHING fi CHA uNET OR 'y ~ ~ ~~ I Depth ~r~U r~/ )'" Header/Manifold Distribution( Pipe(s) / h ~~ li~ ~ ~ x Hole Size x Hole Spacing ~~ ~ Vent to Air Intake r-Q o`"-~ . / Len th Dia Len acin V u th Dia 'S g g g p SOIL COVER x Pressure Systems Onlv xz Mound Or At-Grade Systems Only Depth Over •,r Depth Over xx Depth of xx SeededlSodded xx Mulched BedlTrench Center ~. J / ~ . ~ - Bedlrrench Edges Topsoil ~ Yes [~ No ~_. _ ~ Yes ~~I No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~ U Z Inspection #2: / / Location: 651 Packer Drive Hudson, WI 54016 (NW 1/4 S 1/4 11 T29N R19W) Homestead-1St Additi~onl-Lot 35 Parcel No: 11.29.19.2361 1.) Alt BM Description =L~~~' ~~Y~ ~ -.~.Q~Q~_ ~'~~~~~f vN QC~LQ~- (~ 2.) Bldg sewer length = I ~ ~ '~ I b~ ~ U ~ /}~2~/~~ R.P ~ t~~CG ~/~~0'~'- P !~1-` ~ ~~~U (.• - amount of cover tQ // -tom _-- __ Plan revision Required? Yes I1 No i - T - i Use other side for additional information. ~ _~~__ _ _ -- - ~!~!~!+~ -1 -~ ~-- - SBD-6710 (R.3/97) Date Insepctor's Sig u e Cert. No. o ~~ 3~~ ° d G1 e .. ~ to ~ ~ ~ ° W ~ ^, ~ ~ I '• '~ ~ M O (n $ I ~m ~' Z 3 w o O A C ~d =~ O a~N `~ ~j' t0 O A ~ ~ ~ ~ Q N ~ d r11 . fJ (.~ ~ O ~ N d> 7 o n p G N ~, i'7 n N ~ ~ ~ C ~ ~ c ~ ~ e a o C7 I v ~ ' ~ ~ m Us v D i ~ , , n I c a$ c ~ o o~ 3 ~ ~ t\O N ~ ~ ~~1 L ~ ~ ~ ~ fD O p c, cO~ N N nrm ° ~ ~ ,r ~,- OQ ~ N • ~ II ~ C d (( VV ° OOO~a °~ o tnv ~~~~ v ~ O O ~ m 7 ~ ~ ~ ~ ~ ~ a ' ~ ° •• o ~' m y n N rn 3 .. I o- ~ D I o a ~ o ~ ~; I ~ ~ ~ O ~ ~ a ~ I ' v+ 3 , ~ J .~-~ ~ a m .. v, C ~, N I ~ m o~ ~ w I ~ Z n N N 4 7 ~ ~ -i fn A Z ~ f~ ' < ~ N O C n '~ i0 Le O O ~ O. A ~ 7 O ~ .. ~ ~ ~ N _. Z ~-.~ p~ ~ O "' A ,ZI fn co I ~ c z a ~ p Q t'ii d N a I ~3c~c~~ ~ I a ° o' = m ~' c y z o 3am a I oco J .~ ~ fll y I ~ ~ m m d <, ~ O I N fyD O oar c °w ~ ~O =+' ve I g~~ b ~ ° od ~ fDOm~ ~ I ~>>~ eo-o I a a ~. o a ~, j 7 < y ~ 01 ~ 7 O, ~ ~ N O 'O O W ~ ~ ;o I m oo :A I c ~ ti ~ S~ ti a I ~ ~ Safety and Btrildings Division 201 W. Washington Ave., P.O. Box 7162 County JT ~ ~ Q ~ f1(/ ` in Mad'son, W 1 53707 - 7162 i 'terry Permit Number (to be f ed in by Co.) (608) 26ti-3151 seons ~-~~ Department of Commerce State Plan LD. Number Sanitary Permit Application rovide ou formation l i C d p y n e, persona o In accord with Comm 83.21, Wis. Adm. may be used for secondary purposes Privacy Law, s15.04(lxm) ojed Address (~% ereny~an ing addre~) (/f,. S ~/f/ ~ 1. Application Information -Please Print All Information D ~ 3~~~4-Q Property O is N/ame ' // ~// 4 ~ ~ Parcel # Lot # Block u ~S p~ n A GI/i G~!>>t/ rT' Property O~wer's Mailing Address Property Location 3 7 s ~ t` tv~N ~~~ Sot,N4 h ~ ~,,.SuJ ~.. section ~ I City, rate Zip Cade Phone Number ~ t`OU('• (1(x^1 ss01\ So ~\Z - ~Z-SAO , ~ (circle ne) r 9N; R14 Eow 11. Type of But ding (check all that apply) p~ „/ _• ~ '" umber I N SubdivisionNatne CSM LC ~1 or 2 Family Dwelling - Number of Bedrooms 0 ' 1 / / 5~ /1 /,~ !_~N L /dme /^~ ~ir ' '~ ~"' ~ a / I J ^ Public/Cornmereial - l~seribe Use ^Village ownship of~/J ^City ^ State Owned -Describe Use _ Ill. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B. ^ permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New list Previous Permit Number and Date issued Before Expiration Plumber Owner o s/l ~ 7 7i?/ ~?~ 1V. T e of POWTS S stem: Check all that a 1 I Nass Sand Filter ^ l ^ Si d ^ e ng e At-Gra Non -Pressurized hr-Grotmd ^ Mound >_ 24 ur. of suitable soil ^ Mound < 24 ur. of suitable soil Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ ~ Recirculating Synthetic Media Filter Leas ~ Cher 'p ~ ^ Grav les Yi ^ Other lain) V. Dis ersal/1'reatment Area In ormation: Design Flow (gpd) Design Soil Application e(gpdsf) Dispersal Area Required f) ~ Dispersal Area Proposed (sf) System Elevation t ~ [ ~ ~ Z_-v3 _._ ~ gs7 ~ p Vl. Tank Info Capacity in Total Number MauufacUrrer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass Ncw Existing Tanks TacJcs Scp[ic or HolJing Tank ~ I ` 1 ~~(~~ `, R Aerobic Tsatmcnt Unit DusinK Ctwmbcr ~ I Vll. Responslbllity Statement- 1, the ersign a ume res slbllity for installation of the POWTS shown on the attached plans. Plumber's Name (Print) PI t MP/MPRS Number Business Phone Number T~.Si~z /1~~~39y6Z Plumber's Address (Street, City, State, Zip Code v~ S~!''rt"'~ ~ t ~ ~ ~ d9 71~ti mAO ~--aa~v Vll Count /De artment Use Onl Sanitary Permit Fee (includes Groundwater to Is ued suuig Agent 'gn ure S s) Approved ^ Disapproved Surcharge Fee) ~/ ~r / /O (0(J J ^ Owner Given Reason for Denial lJ~~sgr}¢ttror~~'NA~~rovaUReasons for Disapproval ~~s~ ~ ~~I~~-~CX-o /~~ /~QZ / fit; _ „ /~'L_ J~ / d Q / -I '"~ sj L~c- 1 $eptlC tank, effluent filter and dispersal cell must all be serviced /maintained - ~i'~ s~ ~~,~- ~~j 7/~Z~ plumber vided b . y as per management plan pro 2. All setback requirements must be maintained I„ ,, ~ ~~ -~a G~~~ ces ~""' ' di . nan _ ~ ~ /~ as per applicable code/or _~__ ., !~ Attach eotnpretc plans lw me ~:ounry yq.~~u< <uc .y..s~~~ ~.. r,..y...... ~.....-.....,- ....___~ .- ---~ `~~~ J , ' SBD-6398 (R. 01/03) /~/WJt7°fK'iC// ~~ Inc. th Ave. ~'~~ ~ ~h~ ~ ~~~~~~ Phone: (715) 235-2644 PST ~~'`~ Fax: (715) 235-2592 ! „c omonie, WI 54751 ~ T ~ ~ ~ s T- ~~. Tv DL,~'- < www.tlsinzplumbing.com OG ~-><o rat F5 ~~~0 Tc~/~ OF 2-~-JSon STG~o~~t ~° °~ Nth Sw t t Zq I~ W -.~--- - o ~avoy~~ HuJ-~ ~ ~-~~ a8 s~,~is ow _ ~~~ ~ ~ \p T° P ~ V_ ~ (~'P 4 D Rga ~ ~ L \~ ~~G~~~ !Jf 1 ~~ J_ __~ ~ ~ ~ ~'' , ~/D ~ I~ D ~~k PAGE ~ Of~ ~ ~' NAME f'f' /./ ~~~ LOT# .~.~L,EGAT I~ESCR IPTION ~v l Sub ~~S /~ T Z9N R /9 E~;or~ ,_ __....__-_._.I--_ .._ _ ....._-~-----, SCALE:I"= ~D I BM 1 ELEVATION ,~GD ~ ~ ~., j BM 1 DESCRIPTION ~ o~o f~orr ~'~~ ~ f ~ ~ j _ -.-- ~ BM 2 ELEVATION BM 2 DESCRIPTION r _ ~ ~ SYSTEM ELEVATION ~-` T I I j I SYSTEM. TYPE ~o.'~ ~en-~t a ~ a~ ~' .; ~ ~ ~ ~ ; ,. CONTOUR. ELEVATION ~~.Go - 9Z. O4 ~ ! ~ r n~~ ~~ ~ ~~ ~~/n ~~ od q2 °~ ~v SR- f~i~'~- SIGNA Wisconsin Department of Commerce SOIL EVALUATION REPORT Divisionof Safety and Buildings in accordance with Comm 85, Wts. Adm. Coda County Attach complete sib plan on paper not less than 8112 x 11 inches in size. Plan must include, tart not flmitad to: vertical and horizontal reference point (BM), direction and ~ Parcel t.D_ percent slope, scale or dimensions, north arrow. and location and distance W nearest road. Please print all information. Re 'wed Personal intomiatior- you provid® may be used for secondary Parpases (Privacy Law, s,16.o4 (1) (mlA Q1 w SUKn 5~~ rrty Owner's Mailing Address 31S ~'6ra.GtiS r-roperry ~ow~v~ Govt. Lot ~/~ 1/4~W 1l4 S ' ~~ ' T CsM# Page -l °~-~- ~,. ~ ~ ~ Sv ~' ~ 6tt' ~` LGr~~/3~/ 6 ~a N R •I9 E (or)~ Lot # Block # Subd. Name or ~ Number n Citv ^ Village [~ Town Nearest Road ~('~ ~ ~ ~~- I r~ h I SSa/6 I i9SZ~ ~9 Z~ - ~Z~ I~ ~t s~ _ I Aa ~Le / lJr~ I [~ New Construction Use: ~ Residential ! Number of bedrooms Cade derived design flow rate ~S~ OD GPD [j Replacement ^ Public a cotnmertdal - Descxibe: Flood Plain elevation H applicable iL~/2- ft• Parent material D - ti =- / General comments ~ s /C~ ~~~. ~(' z . ?J. ~ t/ ~ ~~,Q and recanmendatians: Y T r/ ~- w~~ ~~n~ ~~ r'-'-, n Borlna tsonng ff ln. ~- pk Ground surface elev. ~ - ft. Depth to limiting factor Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Boundary Roots in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. I a'i- 3/Z ~ ~~ ~ ~ S ~ Soil cx~tion Rate •Eff#i PD ~ r S" 3(v -17p to r `~ m ~ ~ ~ ~~ """'i n Snrino 1 rsonng e d. ~ p•~t Ground surface elev. r ft. Depth to limiting factor 'n~ So9 Appitc:ation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •Ef~ ~ Etf#Z in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. 1"I'W ~ON~ ~I~ `" S~' ~ ~ r ~ ~ ~ i,~ 3 y~-S'1 rsl~ Z ~ / S~ z k ~ ~5 - ~ •G ~ 5 - ~3~ o o~ r -- 1 ._ ~ r /~ Z .rm .._._. un . onf l t QA rr.nfl anri TCC G 3n ritO/L 'Effluent#1 = BODs> 30 G ZZO meyt_ ano r~ ~sv ~ »u irs}p~ -...--....._ ---e... -- _ - - - - ._. _ . .. _ _ sianatvre CST Number q ~/t~.r-t .~ iddfeSS Date Evaluation Conducted Telephone umber ~~13 $~~' ~' , ~,y,a, te,~, ~/~. SyOZS ~_ ~ ~. -6Z 7/,s'-Tye-~'~~~' Property Ortmer ~ t+J ~d h N ~~ Parcel !D # Page _~„~, oi,~_ Boring # ^ Baring "• ~ [y~ Pit Ground surface elev. q~ ~ ft. Depth to Ilmiling factor In. Appiica6an R Soi! Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft' In. Munsell Qu. Sz. Cant' Color ~~ ~~~-, Gr. Sz. Sh. 'Eff#t 'Eff# . l 0 ~ /p I Z. ,~ m.itb r' S , S , q J I ~ ~ _ o _ ~ ~ /. Baring # ^ Baring ^ Pit Ground surface elev: ft. Depth to (Imiting factor in. foil pligtian F Horizon Depth ~ DorntnaM Color Redax Description... Texture _Structure Consistence Boundary Roots GPDlift In. Munsetl Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#i 'Efiti Boring # ^ 8aring . ^ Pit • Ground surface elev. ft. Depth to limiting factor in. Soil Appliptior. R Ho-tron Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fir ln. Munseii (2u. Sz. Coat Color Gr. Sz. Sh. •EffiRt •EftN - 'Effluent #1 = BODs > 30 c 220 mg1L and TSS >30 < 15Q mgA, • Effluent #2 = BODS < 30 mry't~ anc17SS < 30 matt. r The bcpartrnent of Commerce is an egrtal opporhrnity service provider and employer. If ynu need assistance to access services rsr need material in an alternate format, please contact the department at 6Q8-266-3 l S 1 or TTY GQ8-2 ti4-8777. SBr}i330 (R07I00) Sattiry and Builditiga Division 201 w, Washinsrott Avt:., r,a, sox 71b1 C°~ 5T G'r~x ~~~i~,~~`~ ae artment at commerce Madison, WI 53707 ~ ?162 S =Z f-dz 3/ O Sire Addtru ~7 G2 ~i V~ Sza>duifaly Permit A-ppli~ ~ Ep saaitt:ry ~r:o~ Nttmbcr ~~ la accord with QP~aa3.21, Wis, Adm. Coda, porsanai iaFo do ms b d f off' ~' /~~ Q Clseok if R~vition e or set oser vfo Law, a i m z, Application Infocettatian _ pte~ >~ au IaformAtion MAY 2 2 200 ~~ pleas ~~. 1!Itltssber ^/ ~ uVlV ST.GR~G~~F W~~" ~11f~~' ~+lit CEY araalN ¢.DIE j Z9~~~~ ~.~ i ~ Propotry Owuor's Mailir~ Addsta: ~j, r I~,t ~ ~ ~~' Fropar~+L OO Atl oa r"V~ 7s- ~3~J ~0~ ~b vn'~. C , t qp q ~ 5i ~+ yi•S ~~ ric I N g•~ f City, Stau /~ /~ ~ ~ ~ ~ zip Code Phone Plumber ~ ;- l.ot tomes BIOC~C Na~bor • S / ~, ~ 14 ~ `~ i 1/~G ~ Sabdl l f I ~ ~S~ ~ e brz-~3z- sLoa~ ~ ~ r Wne s oa P CSAQ Nt~r ~ 1 s ~o~ r m 1~ru Es ~,o ZT, Type of 73ulld~ (ai~e3c opPZY) ~ / _ ~ ~ ar z 1?smily Dwtu;~ _ K~b~ o Beemouu $El~Gex~K1 Odty -- o ~~rciai - Desoriba v:a ^vm,¢a: !fir NVASOiJ ^ 3tats Cwned Div i cl~~~~ia- Nearest Road Ar.~'t,e I~ietJ~ IYY. Type o[ Y+e><•prlt: (Ct-eck oztly onto box R o A (nmraborigg scheme r Internal usa), Compiote Uue it AppLteabla) A. i ~Ncw Z D RapSiCoapo>lt S~sseAt ^ RtplAOcmant of 6 ^ ,Additioaa to C°~ nsa ~ Exi~tin 8 . Ci Check ii Snaitaq ~eimit Pravtously Issuod 't Nttmt~er ~/ Iswod i N. Type or! ~'ertnit: {Check all that appiy~(,numb aehatna,r~ for incerswl uae) 5 /~7'A~r ~ert ~-- 44 ~N'on -Prauuri. od Tn-Cic~ousd 2I© Mound ,' ~7 ^ 5sad FtLez . Ll SO ~] Coasavctc! Rloctand El.~' .3/• /~7 y 22 ^ Ptoasutiud Ia•4"iTwoKi dl ^ Iioldittg Ttm)e rr 48 0 Sittgie: ~.i 51 ^ Drfp 1.inC o~~/1'wr.- . ' d5 ~ At-(3rada 48 ^ Aarnl~d417' Unit 44 ^ Reciicalating 30 ^ Ofhar N" -S ~~' h+ V. LN8 etsalPheatnlp~tt AYw InformadotL' , Design Flow (gpd) ~o~e+td Area 1}isperssl Aiea~ YeopOaed !,E° / it Applicsdaa R~(Gsta.lDrayslSq.Ft.) Percolation Ytara (Min.M~cb) Sy~em Hlavsrien / Piaal Cicada >~iavadoa • VL Tan3a: Ynfo Capaciq+ isa ~(3alions Total / Gatian~' Nurabu of Ttutks Mutu~fsctsstar Prefab Coaorote Slta Cautxs+aeud Stael ~lriber Gi>ts: Plastic New ~ / ~ ~-/Od/'-~ s~ °~ 1200 --- l ~ o ~ a~e~ Doiir~ unbar VII. Ras bAl Statomwt- I thf anti et butt for itustallu of the FOWT9 shore on the aetaalaea ans. 1'lumbnr's Nano (prigt) P s S ~a© S~Nz f ~ ~ MF1MP unbar 1~~ ~3 z 1;NiiLC9i P110oa Nutaber ~,~ Z3.~ z`~ Pitrarycr's Address (Street, City. ) Sl~9 08 /6U~' F lot~ton~~ Gds 5~7~~ . Y11x nun !De eat Uso O Approved ^ Disapproved Feo (inaluctes Grwadwauu Dtitc IBSUCd Sigaant 3nmps) ^ Owner QiVdA initW AdYlrsa • Smehax Ice} c~ ~ ~ ~ 2 ` I]OttillataAdD71 i Z Q . Cond3~tii4ne of ApyrvvaVRmaona tos btsappzmral ~~~ ~~ ~ ~~/ / I'I1~fits,w S.¢.~'~+~.s ~b GuP~~ ~~ Gto- .r C~rt~-. 83• y3-~ AttacL oamplata Cana a Y (pr the qa as p qet tw iLan 87/2 x 11 loe~ ~ eyye r~SE,~'77L ~K- O~n ~izu~ Mme: ~ . SBD-6398 (12.. a~~oa> TOOiTUOl~j ZIdI5 QQOd. OFF Zid~idC!'I3A3Q A.LAL'100 AiNIi1Q 660 ZCZ STL T XV3 ~~:60 3fLL TOAZ/60/ZT T.L. Sinz Plumbing Inc. E5609 708th Ave. ~'~/ ~ ~'~'~'4 ~~~~ °'~ Phone: (715) 235-2644 Menomonie, WI 54751 ~~~ ~~~ T ~ Fax: (715) 235-2592 J,~,-T- 3~ !~ /ma. Tv Dt~ ~,~,~,,tlsinzplumbing.com o G ~-{-o wt !~5 ~~~4p Tca.~~ OF ~~son srcro~~ ~o, Nw sw i ~ zq i~ w n S ~ q9+3 6'~ STaI-ND ~-D ~i~l Fr ll-r~ ~ ~ ~'~ P,~ C, Q3 ~~FW \L C7 ~ 2~ ~~ Z ~ boo ~~~ 1~--uv \p To P o ~ ~ ~~rry ~J 45 3l~ t% p Rc6~. A gµ, 2 , \' d /~ 'f~P of ~~ ----, ~ _~ /,, , ~/0 ~ ,~bv ~~~~~ 0 ~~ ~~ ~~ ~~ ~o~n~ Y Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT .~..nnrrl~nrc uxFh (`rvnm Rri Wic Arlm r:rY'IP. 1301 page 1 of 3 AC.E. Sal & Site Evatu~ions ---- - - County -- Attach complete site plan on paper not less than 8'/z x 11 inches in size. Plan must St. Cn~x include, but not limited to: vertical and horizontal r ), direction and D Parcel I percent slope, scale or dimemsions, north arr , grQi~ lion and di ce to nearest road. . . 020-1012-40 ID# 11.29.19.546 I,~ ~attion. ~, Please print gy _ Date ~ Personal information >~ provide maybe sed for secon~ p~r);wses (Privacy Law, s. 1.04 (t) (m)). Gnu,,,, ~ ~i Q ,- Property Owner ! Pr Location ~ Miller, Sam ~' ~. _ ,~ ~~} Go .Lot NW 1/4 SW 1/4 S 11 T 29 N R 19 W ~ Property Owner's Mailing Address `~- L• # Block # Subd. Name or CSM# . ~T ~~`'~" P.O. Box 151 ~, ~1.', " Tv ~ 135 1st Addition To Plat Of Homestead City State ih, a P~ ~. ~ City . 'j Village # Town Nearest Road Hudson ~ WI X4,0 t 715) 386.-27 9 ~ ~ Hudson Packer Drive ~. r ; y i+'' New Construction D~~ ResidentiaTJ~ifla~Ft e~drooms Replacement ,.:j Public or commercial -Describe: Parent material Glacial Outwash General canmerrts and recommendations: 4 Code derived design flow rate Flood plain elevation, if applicable 6UU na ~ru _ ^ ~ `] Boring Borng # ~ Pit Ground Surface elm. 104.52 ft. Depth to limiting factor > 133" in. Soil Application Rate i C ri ti n D R d texture Structure Consistence Boundary Roots GP D/ft= Horizon Depth Do m nant olor p esc o e ox 1 0-8 10yr3/3 none sl I 2msbk ds as 2f,lmc 0.5 0.9 2 8-18 10yr4/4 none sl 2msbk ds cs 2fm 0.7 1.2 3 18-23 10yr4/4 none gr.ls Osg dl cs if 0.7 1.2 4 23-8 10yr5/6 none s & gr. Osg dl gs - 0.7 1.2 5 81-133 10yr6/4 none s Osg dl - - 0.7 1.2 3- ~'(o ~ Boring # -~ Boring > 132" in. Soil A ti' Pit Ground Surface elev. 104.33 ft Depth to limiting factor pplication Rate i th D r D i l t C Redox Descri tion Texture Structure Consistence Boundary Roots GP D/fN Hor zon ep om nan o o p 1 0-12 10yr3/2 none sl 2fsbk ds as 2fm,ic 0.5 0.9 2 12-23 10yr4/4 none si 2fsbk dsh cs 2f,lmc 0.5 D-q 3 23-36 10yr5/4 none sil 2msbk dsh aw ifm 0.5 0.8 4 36-50 10yr5/4 none s & gr. Osg dl gs - 0.7 1.2 5 50-13 10yr6/4 none s Osg dl - - 0.7 r.~ 3 ~~ * Effluent #1 = BOD 5> 30 < 220 mg/L and TS >30 < 150 `Effluent #2 = BODS < 30 mg/L and TSS <~0 mg/L .CST Narne (Please Print) S ature: CST Number James K. Thompson ~~ 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number Osceola, WI 54020 9/19/00 715-248-7767 prey O„~ Miller, Sam p~ Ip # 020-1012-40 ID# 11.29.19.546 Page 2 of 3 ^ $ ~ Boring Boring # Pit Ground Surface elev. 104.35 ft. Depth to limiting factor > 135" in. Sal pppl Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 1 0-21 10yr3/2 none sl 2msbk ds as 2f,im 0.5 0.9 2 21-50 10yr5/4 none sil 2fsbk dsh ai 2f 0.5 0.8 3 50-76 10yr4/4 none Is lmsbk ds cs - 0.7 1.2 4 76-135 10yr6/4 none s Osg dl - - 0.7 1.2 3~- ti y~.~% _ Deptl~ of horiizn #2 ranges from 26" - 50" below grade. a Boring # Boring - Pit Ground Surface elev. 98.45 ft. Depth to limiting factor > 121" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 1 0-13 10yr3/2 none sl 2fsbk ds as 2fm,ic 0.5 0.9 2 13-24 10yr4/4 none 2fsbk dsh cs 2f,1mc 0.5 0.9 3 24-40 10yr5/4 none sil 2msbk dsh aw ifm 0.5 0.8 4 40-50 10yr5/4 f2d7.5yr5/8 sil lcsbk dt gs - 0.2 0.3 5 50-121 10yr6/4 none s & gr. Osg dl - - 0.7 1.2 Redox. features described in H#4 are indicative of the greater matric potential of file sil soils lying immediatiey above the coarser s & gr. This condition is not indicative of seasonally saturated soils and is dismissed as allowed by Comm. 85.30(3)2. 5 Boring Boring # 99,14 ft, Depth to limitin factor > 119" in. ;~ Pit Ground Surface elev. _ g Sal Application Rate Horizon Depth Dominant Caor Redox Description Texture Structure Consistence Boundary Roots GPDIft= _ *Eff#1 *Eff#2 1 0-20 10yr3/2 none sl 2msbk ds as 2f,lm 0.5 0.9 2 20-52 10yr5/4 f2d7.5yr5/8 sil 2fsbk dsh ai 2f 0.5 0.8 3 52-94 10yr4/4 none is imsbk ds cs - 0.7 1.2 4 94-119 10yr6/4 none s Osg dl - - 0.7 1.2 Depth of horizn #2 ranges from 29" - 52" below grade. Redox. features described in H#2 are not indicative of seasonally saturated soils and are dismissed as allowed by Comm. 85.30(3)2. * Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS <30 mg/L and TSS <30 mglL 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. , ~. 30'3 ~yyz?' ^ poi l Q65a~da-~'or 1d; ~ • Elercz-,~!'on 1 ~i Scalc: ~ '_ ~/o' b `~ ^ ion 3so~/ p~opos.ear ~~t,~ ~ p~4 ~ O{~ eYOmL.SLQRd, Tn, od' az ^ ,,~ o, ~ P 83 p,-~d ^ GEC-cle-Sac . RenckWlarK~ Topof ~'i'~'. ~c~cd f1 ssum~.al elegy = /oo.1x~; AssK.-ru1 elt~' . io7.~' ^ br ~- ~ ~~ ST CROIX COUNTY ' SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM ~ ~ar ro. ~~ ~-o r~ OwnerBuyer ~ ~'~' ~_ ~ e -ro ve ~ ~~ Mailing Address ~ ~ ~ ~ ~~U r ~ e~~^ ~ y~ ~ ~~' S `'~ ~ ~ t ~° Property Address ~ J ~ ~~L-key ~ ~ ~ ~1 ... i (Verification required from Planning Department for new construction) City/State ! ~ ~`~~'~ ~ ~~ Parcel Identification Number OoZO ` ~.3~~_ 35--'~~ LEGAL DESCRIPTION property Location ,~ '/., ~ '/~, Sec. 1 ~ , Subdivision ~©YY`~-S ~ ~ ~ __/ T~N-R ~ l W, Town of ~"'~' S~ ~ ~ lJ ~C Lot # ~~ / Certified Survey Map # ,Volume .Page # Warranty Deed # 1° 5 ~ ~ y~ ,Volume ~ ~' ~ ~ .Page # Spec house ^ yes ~ no Lot lines identifiable ~ yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. 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 mastCr plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office v~nthin 30 days/~ year expiration date. e ~ i )1 iOa SIGNATURE OF APPLICANT DATE 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 owners) of the pro described above, by virtue of a warranty deed recorded in Register of Deeds Office. ~~ ______ ~ ,1I , ~a SIGNATURE OF APPLICANT DATE Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** **s«** ** 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 sF1LE INFORMATION Owner ~,J,~,T' -~- Aa~,,r~.,a 1'.t~~oor~1 Permit # ~ ~" DESIGN PARAMETERS Number of Bedrooms ^ NA. Number of Commercial Units ~ ^ NA Estimated flow (average) 9 ~+~ s gal/day Design flow (peak), (Estimated x l.) ~~ gal/day Soil Application Rate ~ -7 gal/day/ft2 Influent/Effluent Quality Monthly average* Fau, Oii ~ Grease (FOG) s30 mg/L Biochemical Oxygen Demand (BODs) <_220 mg/L Total Suspended Solids (TSS) s 150 mg/L Pretreated Effluent Quality ' O NA Monthly average * * Biochemical Oxygen Demand (BODs) _<30 mg/L Total Suspended Solids (TSS) s30 mg/L Fecal Coliform (geometric mean) <_l0' cfu/100m1 Maximum Effluent Particle Size ~ inch diameter POWTS OWNER'S MANl1AL ~ MANAGEMEf~7 PLAN __ __._ rage _ of Septic Tank Capacity (Zpp al ^ N.A Septic Tank Manufacturer ~ ~~ ~j' ^ ~, Effluent Filter Manufacturer ^ NA Effluent Filter Model ~~~ ^ NA Pump Tank Capacity gal ^ NA Pump Tank Manufacturer ^ NA Pump Manufacturer `-"' ^ NA Pump Model ^ NA Pretreatment Unit ^ NA ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Manufacturer Dispersal Cell(s) dd'In-ground (gravity) - ^ In-ground (pressurize d) ^ At-grade ^ Mound ^ Drip-line ^ Other: SYSTEM SPECIFICATIONS * Values typical for domestic (non-commercial) wastewater and septic tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ~ ^ months 'year(s) (Maximum 3 yrs.) Pump out contenu of tank(s) When combined sludge and scum equals one-third (Y~) of tank volume Inspect dispersal cell(s) At least once every 3 ^ months ~ year(s) (Maximam 3 yrs.) Clean effluent filter At least once every ^ months )fa'year(s) Inspect pump, pump controls :alarm At least once every ~ O months ^ year(s) ANA Flush laterals and pressure test At least once every ^ months ^ year(s) ,18( NA Other: At least once every ^ months O year(s) ~[ NA other: At least once every ^ months ^ year(s) ANA MAINTENANCE INSTR[ICTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Mast Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servidng Operator. Tank inspectior must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure tt volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually irupected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Ys) or more of the tank volume, the entire contenu of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR ] 13, Wiscons Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatement componenu, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START VP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemic that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the confer nf• rha ran{r(s'D ramovad ~y ~ tPn(~ze ServiCinR operator prior to use, , " "`~ Fijt ~0~.~_ System start up shall not occur when Boll conditions are (rosin ac ttw InflltratJve surfKe. During power ouUges pump tanks may fill above nomul hlghwater levels. When power ft nator+td the excess wastewater will be d'ucharged eo the dispersal cell(s) in one large dose, overloading the ceI((s) and may result fn the backup or surfxe discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servidn>i Operaior.prior to restorlnti power to the effluent pump or contact a Plumber or POWTS Maintainer to assist In manually operagrtg the pump controls cu restore ncrrnal levels w~lthln the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not dries or park over, oc otherwise dlswrb or compact, the area within 15 feet down slope of any mound or at-grade soG absorption area. Reduction or ellminacton of the following from the wastewater stream may Improve the performance and prolong the lift of the POWTS: antlblotlcs; baby wipes; cigarette butts; condoms; cotxotm swabs; degreasers; dental Ross; diapers; dlslnfectanu; fat; foundation drain (sump pump) water; frttlt and vegetable peetln¢s; gasoline; grease; herbiddes; meat straps; medications; oil; valntlns: t:roducts: aesricldes: sanitary napkins: tampons; end water sofuner brine. A13ANDONEMENT When the POWTS fails and/or Is permanently taken out of service the following steps shall be taken to Insure that the system is properly and safely abandoned In compliance with ch. Comm 83.33, Wlscoruin Adminisuatlve Code: • All piping to sinks and plu shall be disconnected and the abandoned pipe optnlrmgs sealed. • The contenu of all tanks and plu shall be removed and propery disposed of by a Septaate Servicing Operator. Aher pumping, all tanks and plu shall be excavaced and removed or their covers removed and the void space filled with soil, g~~avel or another Inert solid material. CONTINGENCY PLAN !f the POWTS falls anti cannot be repaired the IollowlnQ measures have been, or must be uken, W proVl4e a code Compliant replacement system: D A suitable replacement area has been evaluated and may be uti(lted for the location of a replxement soil absorption system. The replacement area should be protected from dlswrbance and compaction and should not be Infringed upon by required setbacks from existing and proposed swctu+'~, lot tints and wells. Failure to protect the replacement area will result In the need for a new soil and site evaluation to esubllsh a soluble replacement area. Replacement systems rnust comply with the rules In effect at that time. O A suitable replacement area is not available due W setback and/or soli lfmlptlons. 6arrtnti advances In POWTS technology a holding tank may be Installed u a last resoK to replace- the failed POWTS. D The site has not been evaluated to identify a suitable replxement area. Upon failure of the POWTS a soli and site evaluation must be performe4 to locate a svltable rcplacernent area. If n0 roplacemant xea Is available a holding tank mad bt Installed as a last resort w replace the failed POWTS. D Mound and at•gradr self absorption sysums may bt reconstmvcted In place following removal of the biomat at the Inflluagve surface. Re<onstructloru of such rystems rmwsL.comply with the rules In effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY COMAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TRJEATMENT TANK UNDER ANY CIRCUMSTANCES. t)EATH MAY RESULT. RESCUE OF A PERSON FROM TIr<E INTERIOR OF A TANK MAY 6E DIFFICULT OR IMpr1C~IRl i. . ADDITIONAL COMMENTS POWTS INSTALLER Name 'T.L• $/IJZ ~LZ3Fr A1[.r Phone s'- S~ ?~v SEPTAGE TERVICING OPERATOR (PUMPER Name PhnnP PtJWTS MAINTAINER Name . L. 5/rJZ, ,pt_86' NG Phone (5' - ~- ?.,f• ~ tACAI REGULATORY AUTHORITY AzencY ST D~~ till N hen S- a' d ~ /0 2 -' 1998 STATE BAR OF WISCONSIN FORM 651249 RANTY DEED WAR KA1'NLEEN H. WALSH p 0~ YOL~U811!~ REGISTER OF DEEDS ST. CkOIX CO., WI Document Number ~ - ~• ~ - kECEIVED FDR RECORD This Deed, made be[ween Sam E. Miller': a 07-I7-2001 8:25 AM single person - ----- YARkANTY DEED - - - -- _ ___ ,Grantor. EXEMPT M CERT COPY FEE: __ __ Curtis A. Waldon and and Donna J. Waldon' __ COPY FEE: - husband and wife - - as surivorshio marital TRAN5FER FEE: 195.00 kECDRDFNG FEE: 10.00 -Property, .- - -- PAGES: 1 _, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the fallowing described rral estate in St . CrO1X County. State of Wisconsin: ...,.: f.-..a ~.,.. Name and Return Address Curtis and Donna Waldon 7315 Jorgensen Avenue South Cottage Grove, MN 55016 020-1380-35-000 Parcel Identificatbn Number (PIN) This iS not homestead property. (is) (is not) ' Lot 35, Homestead 1st Addition in the Town of Hudson, St. Croix County, Wisconsin. Exceptions to warranties: Subject to easements, reservations and restrictions of record. Dated this -~ day of Ju y 2 C ._ Signature(s) _ authenticated this day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wls. Stats.) THIS INSTRUMENT WAS DRAFTED BY STEPHEN J. DUNLAP _ Hudson Wisconsin (Signatures may be authenticated or acknowledged. Both are not necessary.) AUTHENTICATION (SEAL) (SEAL) v n,J ~~ ~ (sEAL) SAM E. MILLER •~- ~ ACKNOWLEDCM `11.2 Q J~ :4~.' ; . O t, State of Wisconsin, ss. S t_ r o u x County. / Personally came before me th[s / 6 day of T t ~ , ~ n 01 ,the above named Sam E Millar -_ -~-----~ - to me known to be the person -- who executed the foregoing insttvrt7p t and acknowle~e same. - - (l ~ / - • .~ RU ~ l7 ~-~ Lys2~-rZ s o "~ Notary Public, Slate of Wisconsin My commission is permanent. (If not, state expiration date: C~c~"~_. ~Q1a tJan[es of pei sons signing in any capacity muu be typed or priced below [heir signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. WARRANTY DEED FORM No. 2 - 1998 Milwaukee, Wis. m nu)--n 0 > � rr- o o � � Z z Z-+ cZn o m � m ± )' m O � z -a o zo -1 cn z n N � L..) . m �m 7 z x . , -1 ' z Orn -1 f�a co ' p -D p = � "D cn O cn m�l0 P1 X7° � Z M� _. r _ �' rri r� -< SCOTT ROADX o z o M- * (f)CItn m _� � ocn m - c�z = 414, �O z - Horn =o =_ -+ Ccn -I ir\-- r- g"3 -- tn � �1 ) __Iz o- o� Nz � � (n ±s + f�'-HO > 111 \ Zo > L....) .71 73 o �� cn cn rn z oT _ p I- �j D co o M) m v 0 _ O II 0 0 O N 0 0 \ I- r : m \ O 't 0 I > co i M D -< \ f n - \ rw mA ? _1> _, r \ CK� O O r,, �tV co , ZZ _,• N' \ UNPLATTED LANDS K o 74\ C) N.)PO OcoZ CArri 709.79' N00'25'50"E WEST LII NW1/4 - SW1/4 Z ? .-, ` ib � 295.63' -- 165.22' 245.94' w -- 342.40' , I o °' I ry in I CWI�•c,r r v III ►.)CA --I v 0 N rTl 0to t•V r > NO2'p�'34"E -0 0 c D o CD CA N r o �-I -� • 65.97'� _•, N� v J O� I w CA _0 n J > w rn v co i co I \R�. h Cii P rn v ft a NJ �N s Cn T rn �A 0 II- 's• z N Lma U! 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