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HomeMy WebLinkAbout020-1380-36-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety ~ Building Division INSPECTION REPORT GENERAL INFORMA~fION (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 Miller, Sam Hudson Townshi :ST BM EI v: Insp. BM Elev: B Descript~ n: ~ ~ /O v SANK NFORMATION //ELEVATION DATA '~ TYPE MANUFACTURER CAPACITY Septic , ` c 2 Dosing Aeration olding TANK SETBACK INFORMATION r TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic / ~ / ~ ~ Dosing Aerati Holding PUMP/SIPHON INFORMATION 501E A850RI•' I IVIV SYS I CM /_5 (~ ~_. G~~~ DISTRIBUTION SYSTEM County: $t. CirO[X Sanitary Permit No: 384153 0 State Plan ID No: Parcel Tax No: 020-1380-36-000 STATION BS HI FS ELEV. Benchmark ~..~ 02,E 00 Alt. BM Bldg. Sewer ~ 3 / ~ ~ ` Ht Inlet Ht Outlet 93. Y Dt Inlet Dt Bottom Header/Man. ~ ~ ~ n ff ' Dist. Pipe ~ !y- ~ Z /, Z Bot. System L ~ l ~ Z ~ r Final Grade ,~ X .~ 9z. St Cover y 3 9~: Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake ! !/ Di ~ Pipe(s) /~ / / th T ~ rDi f~ S i P'-~a L ~ N' ~~v/ Length a _ a _ pac ng eng - . SOIL COVER r Proeenra Svefome only xx Mnund Or At-Grade Systems Only 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, persons present, etc.) Inspection #1:~/ Z 3 /~ Location: 1048 Viking Drrive Hudson, WI 54016 (NW 1/4 SW 1/411 T29N R19Wj Homestead-1st Ad 1.) Alt BM Description = ST Gove/ 2.) Bldg sewer length = ~ Y~' - amount of cover = sY2 n ~~~tlSt/~~6ar~ Vt~S ~hSTics'~r~ G 'rNk'rt~ rt Ww1l / ~,~ C.t Plari re Iv sion Requ"fired?r Yes No Use other side for additional informati ~ Z l Date Insepctor's Sin ure SBD-6710 (R.3/97) Inspection #2: / / Parcel No: 11.29.19.2362 Cert. No. IX " ~, , cT-rJ ~~ ~' ~ i G tJ ~ S~ SafaY and t~>vildin~ Division C°1°h S-~. C~ D ~ ' + 201 w. WaettioRton Ave., P.O. Box 7162 J Madison, Wl 53707 - 7162 ,• ~ Addroas ' isconsin ~d ~ w , Oe artment of Commerce • Number Sanitary Permit Application ~ ~' _ ~ ~~ 1 s 3 ]a ,eoa~d with carom g3.21. wie. l1dm. code. ptxsoaal ~ r..._r~ Check .r Revision tat be wed tot Pri La 1 ~l 1.D. L Appligtlm Iotoesuatloa -Pleas Prier All Inf s , . ' Parcel Ntmsber Properpt Owoa's Name - ~~ ~ /'V( I L G ~ ~. P~eperty Loation Owaar's Wiliq Atldase ~ I rI R ~ ~ E Fs~aperRy # `•~ ~ ~ ~. k-a•' G(f 1i ~ ~il~yt • $ T D ~ / S ~ ~ coaa~ `" Lot Number ~ ~ slots Number ~. `~ ,. ~ x ~' Stibdivision Name CSM Number ~ S~ y o / ~, 3 ~~' Z 7,6~> I~/orvt E 57rc ~ h ~vp So N ~ ~~, 'Iyp. a (~.u that app4) ,~ ./ ac 2 Fttanily D~Iro{ - Nttraber or Bedrooms Ovid • Nvb.s oN ^ pttbiielCamtnawl- D~ ~ Ntelat Rod 0se~eoaaed ~~ C ~ g/o~~~Fvsd/3 7, 7 ~~`~~'~`/1 /~ /A/~ ~2` Y~ Z % ~~~ achtm-e for interrnal tsss). Canplete line B if applicable) IIi. TPpe of Pettmtt: (Cheek ono ale boat on line A (numbering or Couat7 stae A• 1 ~ New 2 ^)iepLaesneat S~taem 3 ^ Replaaemeat of 6 ^ Additids ro Tanis Onl sam Date lasved asem Permit Number C a. '~cberx it sniarr Pamir Pr~eva"q''~°d 3~ t f I S 3 3 S i N. Type of Poemit: (Chtaclc aU that apply)(numberin~ tlcheme b for internal tine) 3p - t'~/I~1 /~'P3 E/L 'f /.S Fi~~e HT~t ~,(/c~{ Ia{~t~d 210 Mauap 47 ^ Sand Filoer SO ^ Cotuentctod Wetland 44 ~ Non pregstrtaed ~- tz ~kG H 410 Holding Tank 48 ^ Shale Pass Sl ^ Drip Line 22 ^ Presariaed In Gcarad 30 ^ Other Z - 3 ~" ~ 3.7 S ' 43 ^ At-Grade 46 0 Aerobic Treatment Unit 49 0 Rcc' V. Area Informations Soil Application Percolation Rase SyrtOem Elevation Ptnal Grade Ded~ga (~ Dispersal Ara Area gapa~y./Drys/sq.Ft.) (Ivlin./Istch) Elevation ~ ~ ~ `oo S 3 • 7 ~ ~ Pretab site sooel Fiber Plastic ' VL Talc Into Cape bymht ~ ~ Mannfacturer ~ma Comttucted ~ New esieriat Tsars Taub sepu~ a<xaw~ Tam - / z 40 1 ~ l ~ ~/~ -K, z f3E ~DO~ bill Statement- T. the tmderdpied, astmle ~P~~' for inatallatiaa of the POWYS shown oa the attached plane. VII. Irlp/MPItS Number Business Phone Number pktmber'i Name (Print) Plumber's Signature r 3 ~ ~ ~ ~y y Z Plttmbet'a Amtat (~ Cigr. Sass. z4 Cade) ,; t.7 /Sl ~ / ~ ~!~'~~ . cam /De t Uae Issuing Agent Signature (No stamps) sanitary Person Fee (incttides Gmwidwater Date lsstied Approved ^ DifapP~~ ~ syrcharge Pee) ~ ~ ~~ ( [~ Owner Given Initial Adverse ~ S~ ~/o-v Desetminatian I& Caediitioos of AppT~~m°as fa Dbappcoral / 5~~ ~S ~o~w~~ ~ Qo't.GV~cM.A-• ~</ -uia~lu-~r~t ~'a~~ 9/! 9/o D 1lfaei ei~etlta Per to tYc Carat) ad71 tK Ire q~a+ M NPR Yt tan ttrr i1/2 t 11 IreYea Y dse SAn-6398 (R. OS/Ol) 5 N ~ ~ f . ~u !. L L ~ ~ z._ /-I o ~ l ~ 5 7`,~,c~ ~ ~- ~ 7` ~` ~ G. /D yg Y~,~/~v ~ ~~ l ~E ~•y~ few, ./• = ~7 ov' ~<<2 r~ ~~~~": ~~ ~ ,~,~ f/iS~pN ,~a2 ,~E,P~vYir~3~S~f~s3 ~L D J y ~~~ ~., La's ~%1 ,~v ~ ~ ~.+ ~7, ~? ~~" ~ `lrt.~ I~ ~.~~ ~ z Z s~~ ~ ~ yzi, zy- ~~ ~ q-,. ~° F~ - ~ -.~ ~~_ ~ __._ 93,7 S ~ __...~.I i3 - z ~` C i3- ~ f ~ 5` ~ BVK TAP o~ 34s~-~K`~ `+~ tZ `~ '~ `~ ~,~ ~,. i ~"---~ Ho~S~ mo 1 °"~ $ ~)l S 7 ~ r-~ ~ l~V~ Z p i3 E~ ~ I pu ~~."~~146'~ ~ _ w~__~~ ~Q~a~ ' ~, ~/'~37 ----- , A~-._ ~ _ _____ _ t3 • z ~ ~~ >` /~- ill ~'~~ ~ ~~ t A _._. __ -- - __-_ _ _ ____ _ - m _ _ .. Q S' ~/ ~, &.~ ~-~~ 4 Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT in ~rrivrl~nro -Ary'nm Rri IAfist Arlm (:[YJr3 \ 1437 Pape 1 of 3 A.C.E. SoN 8 Site EvaduaRions Attach complete sde plan an pier not loss than 8Y: x 11 ' ~ ~ . 1n size. rgtl$t+ ~ ~'s ~~ ~ County St. CnD'Dr include, but not limited to: vertical horizornal re orld (BM), ' arced I D percent slope, scale cr dimemsions nortii arrair, t `~ distance to road ~ ~1 020-1380-38-000, ID#11.29.19.2382 alI into ~, Please ~ 1, ~ t .- Personal iMoimatfon you provide m ~u~ed for dry ~- lax,, s.~ • ,Lm))• ` $ kj a ProP~Y Owner ~ S ~~ aOUN Miller, Sam ` ' ~:y' Lot _~ NW 1/4 SW i!4 S 11 T 29 N R 19 W Property Owner's Mailing Address ''' Z `x, ' , _,# # Subd. Name or CSMIf P.O. Box 151 ~`'~~_- -'\ y ~---3Gr 1st Addition To Plat Of Homestea8 City State Zip J City J Vllage ~ Town Nearest Road Hudson ~ WI 54016 (715) 388-2789 Hudson Packer Drive New Construction Use: ~ Residential / Number of bedroarls 4 ~ Code derived design fkrw rate 600 ~ GPD ~ Replacement _,;;j Public or corrurrercial -Describe: Parent material Glacial outwash Flood plain elevation, iF applicable na General comments and recamrrrendaticns: Install 2 trenches at 3' x 93.75', 30 HkJh capacity BioDiffuser infiltrator chambers at 87.00 '. Replacement area identified an previous soil eval. rBport ref.#1302. ---_---. Pit Ground Surface elev. a# --~~~ 94.01 ft. Depth to limiting factor > 125" in. ~ Rate Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GP D *E~ 1 0-12 10yr3/2 none sl 2fsbk mfr as 2fm,1c 0.5 0.9 2 12-19 10yr4/3 none sl 2msbk dsh aw 2im O.S 0.9 3 19-24 10yr5/4 none gr Is 0 sg dl ai 1 f,vf 0.7 1.8 4 24-75 10yr5/4 none s 0 sg dl ai - 0.7 1.2 5 75-125 10yr6/4 none s & gr 0 sg dl - - 0.7 1.2 .~ _ t ° Boring # _._) Boring ~rj Pit Ground Surface elev. 92.15 R Depth to Ihratirp factor >122" in. ~,gpppcation Rate Horizon Depth t>aminarrt Color Redox Description Texture Stnrcture Consistence Boundary Roots GP DIftz ~E~ 1 0-11 10yr3/2 none sl 2fsbk mfr as 2fm,1c 0.5 0.9 2 11-19 10yr4/3 none sl 2msbk dsh aw 2fm 0.5 0.9 3 19-41 10yr5/4 none cos 8~ gr 0 sg dl ai 1f,vf 0.7 1.6 4 41-62 10yr5/4 none s 0 sg dl ai - 0.7 1.2 5 82-122 10yr8/4 none s 8~ gr 0 sg dl - - 0.7 1.2 -- ~\ • '~ 'Effluent #1= BOD 5> 30 <_ 220 rrglL and TSS >30 < 150 mg/L ' E = BOD <30 mglL and TSS <_30 rrrglt. CST Name (Please Print) Signature: CS Number James K. Thompson s 3802 Address AC.E. Soi18~ Site Evaluations ---- -- a Evaluation Conducted T Nurr~er 340 Paulson Lake Lane. Osceola. WI 7/17/01 715-248-7767 o........... n..,.~ Millar . ~ . 3 oF3 yz 8' ^ 50,'/ Obs~w~ ~~"~ ~ Ellda~m-) Q2 IQ~ ~ eda/u~ y'2. ~ 9/~~/00 X3.0' 63 9fe0 ~C'on L~~. ~ E)45~'nq rc5~dence Beni. ~/: To of ~m~ ~,~rs~cd FoDr -- - - - - AsSu,ned elc~: c icy. cam.' ~~ • P~o~Oa~ ~~ CAL-dQ-Sa - ~oad \ D~' ~ G ~~. b3 • SO3. ~s ' •~ g- /off 3G, / ~t~dd,~•on Eo /~/¢,~of'flo.ne.sfeard,T. of . VWsoorts~ OepardneM of Conrneroe Sataiy and 8ulldirlgs Division GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) rersonai rnrorrnatan you prowce may oe usea for seoorWary purposes (Privacy Law. s.15.04 (1xm)). Permit H r s Name: City Vi I ge T n o Miller, Sam udson ownship T M E .. Insp. BM E ev.: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration . Holding ~ , TANK SETBACK INFORMATION TANK TO P/L WELL Blp(,. vent to Air Intake ROAD kp~c NA ~n9 NA Aeration NA Holding PUMP /SIPHON INFORMATION Manufacturer Demand Model Number GPM TDH Lift Friction S tem TOH Ft Forcemain Length Dia. Dist. To well STATION BS HI FS ELEV. eery~~rtgr~ Bldg. Sewer St/Ht Inlet St/ Ht Outlet Ot Inlet Ot Bottom Header/ Man. Dist. Pipe Bot. System Fin ounty~ $t. Croix Sanitar~84153 ~~ State P an 10 No.: Parce Tax No.: oav- 3~0 -.~6-000 ELEVATION DATA SOIL ABSORPTION SYSTEM 8ED /TRENCH I width length No.Of Trenches PIT No.Of Pits Inside Oia. Liquid Depth SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manu adurer: INFORMATION Type CHAMBER M e Num r: System: OR UNIT DISTRIBUTION SYSTEM Hea er / Mani of Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Oia. I Length Oia. Spacing + I I SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.)Inspection #1: / / Inspection #2: / / Location: 1048 Viking Drive, Hudson, WI 54016 (NW 1/4 SW 1/411 T29N R19W) - Homestead-1st Addition -Lot 36 1.) Alt BM Description = 2.) Bldg sewer length = -amount of cover = Plan revision required? ^ Yes ^ No Use other side for additional information. Gate Inspector's Sgnature Cert. No. seo-s~1o (a~s~ . . ~- ~o~$ t~C.l NrT D~- Sanitary Permit Application safety & Bui-dings Division 201 W. Washington Ave. In accord with Comnt 83.21, Wis. Adm. Code PO Box 7302 jr See reverse side for instructions for completing this application Madison, WI 53707-7302 ~i i~S +~~~s Department of Commerce Personal information you provide may be used for secondary purposes s. l 5.04(I)(m)] [Privacy Law (Submit completed form to county if not , state owned. Attach tom fete fans to the coun co onl to a er not less than 8-1/2 x l t inches in size. ~~~ State i Pem»t Number ~ ~ rr si n oJp ~o~ applica6on C,R~ ~ 153 State Plan L D. Number A lication Information -Please Print all Informa n I Location: . Property Owner Name .~ / , 't `~ , ., ~~ 7 Property I-ocatro ~-'~ R~t E ~~ ~ ~ 5 ~ Wl ~ L ~..- ~ _ ` ~ or N, I/4, S T l /4 Lot Number Block Number ~ t ~ _ property Owner's Mailing Address ~ . fi~ii~ ~~ ~~i / i J Q ~ / ~ / -~ ~ Ci State Zip Code /'~ p ,' ~ tY. ~ \ U ~v ~r ~~/ / ~ l ~ S~u1bdivision`Name or CSM Number ' MB STS 5 T /7 eJ / ' .-._ ~ ~ ~~.s~ ~r ~~~f // O , ._., ... II. Type of Building: (check one) G i `l I ms :~ f B d L N i ^ City ^ village ~ roo _ ~ D R ' ~ e US ~ o. o ~ ~ ^ 1 or 2 Family Dwelling - JJ 1 p Town of l` ^ Public/Commercial (describe use):_ U ~ O ~ ^ State-Owned ~ N est Road '~ ~ ~ "~ / "'~( ( a I 0 U ~FFtJ [Y y ~ ~7 ~ ~ ~~ Parse Tax Number(s) III. T e of Permit: Check onl one box on line A. Check box on line B if a licable 5 6. ^ Addition to A) 1. ~ New 2. ^ Replacement 3. ^ Replacement of 4. Existin S stem stem S stem Tank Onl Permit Number Dale Issued B) ^ A Sanita Permit was reviousl issued X ~ p tn. IV. Type of POWT System: (Check al] that apply) 30 . ~ ~~~ ~lL 3 Z 3 swcted Wetland ^ C Non-pressurized In-ground ~-~AL}~ ^ Mound ^ Sand Filter ^ liolding Tank ^ Single Pass on ^ Drip Line Pressurized Ir--ground ^ At- de ^ Aerobic Trcatmcnt Unit ^ Recirculatin ^ Other: V. Dis ersal/Treatment Arca information: 1 Design flow (gpd) 2. Dispersal Arcs 3. Dispersal Area 4. Soil Application 5. Percolation Rats (IvtinJinch) tt / d 6. System Elev'ion Elevationradc / .) sq. a Req~ritrd Proposed Rate (GalsJ - ~ ---- S oaoo 9y ~ -~ z ~o~ s anFi s - VII. Tank Capacity in Total # of Manufacturer Pre! ~b Con- ' Site Steel Fiber Plastic Con- g looks Gallons Gallons Iuforn-ation crate strutted New L^'xisting Tanks Tanks ^ ^ ^ ^ SE2 T ~ ~. li4v I ~C / s ~i~.- ^ ^ ^ ^ ^ i Z tt g~ L ~ to o~ t' ~ L"T rL Vi1I. Responsibility Statement the undersigned, assume res onsibili ~ for installation of the POWTS shown on the attached tans. 1 Business Phone Number , Plumtxr's Namc Unint) 1'lumhcr's Si6nature (no stamps): MP/h1PRS No. ~~! Z Plumber's Address (Strrxt, City, State, 7.ip Code) l0 70 F~v u~2 l~ i Ac~E- ~o~ D N ~Dso ~ u3 S~{~ l IX. Courtly/Department Use Only Sanity Permit fee Includes Groundwater Date {ssued ^ Disapproved ry ( Is ing Agent ure (No stamps) ~Approvcd ^ OwncrGiven Initial Adverse Sur• -rge Pet) ~a~ ~ t Dctcnnination ' al /Rca on f r isapprov, l• r ~~ n„ _ _ . ; ~ ~ Crj~~ ~.,,,,~,,,~, #~ 3 X. Conditions o[ Appr~ov emu, a(5~ •'"- _`J _ ~ 5~~^ ~~. t s s~ ~6J.' z a . i L~ 1 ~` ~~N J o ~ ~ ~ b v.- ~ 1'`, ~, ~ z ~ . !~ `^ ,~ ~; ~ ~'~ ~ o N ~~' ~ a ~~: ° `~ y ~ ~ U ~ '';w ~ ~ ti R\ \ \ ~ ~ ~., ~ Z >. ~[ ~~ a ~. ~ _ ,.~ .~- ~ ~'- ~ ~ _ _.---'' 1 ~' - ~ .~.-'"~~ ,,-r v U~ Y' Ot c ~: ~; _, ~. D y,. ^. ~,, m t~ ~``i , c --~ N ~ Z ? ~` ~- ~~ ---r -~- r ~ ~~~ z ~ ~ ~,l ~: 0 \ ~ .~-~~-r' ~ ~. ?' 0 r ~~ r ~ O ~4 ~~; ~ . v_ r r~~ _~ ~__ ~ w ~ F- o -~- _ ~, ~ .~ N ti 00 _~ ~ O c ~ fi _ ~ ~ ~ t.~ ~ ', ~ . s ~ ° A. ~ ~ ~,,.. ~,~"~„•„f 001 ...~ ~~~~~~ i ~~ ;,'~ ~ '_~ ~., ~ ~~ N ~~ N ~! -~ ~ -3 ~j h `~. 0 Q 3 n Q h a ~. ~..... JI w~` 3 ~I h ~J ~~ \. 3 V .~ _' ~ ~ I r p ~ ~\ Z ~' ~~ ~ ~ ,~ a ~ w ` ~~~ ~,- °_ ~ ,^ r ow ~, J q,,. Q ,_, M _r''~? ~ ~ Q ~ O , ~~ .~ ~ ~~ _~ a ~l ~ b ~ w~ ~~ M 11-~ Q-. Q ~ 0 N ["~ , O ~'1 ~~ Q ~~ ~ ~ 1'N _ ~ ~~ ~ k ~ •~ ~~ a* r~ v 1 ]/~ f~ 1 t ~ r~ r M r~ i .r,~ rY~ $V ~'~ ~_. t~ A O d y r f1 A . ~ ~ :1'9j . ~ ' 1302 Wisconsin Department of Commerce SOIL EVALUATION REPORT p~ 1 ~ 3 Division of Safety and Buildings ,,,,.,,",,~,,,.e,.„+r, r,,.,,.., ar; wry nor.., rnrp AGE. Sal & Site Evaluations County Attach complete site plan on paper not less than ' w-.size. Plan must ' St. Croix trection and include, but not limited to: vertical and horiz ~~ a ce pant (BMf,'d Parcel I D percent slope, scale or dimemsions, no tion and distartee to nearest road. " . . 020-1012-40 ID# 11.29.19.546 Please prinf a71, jilforma$sn.. ~ R gy Date Personal information you provide may ge-used for secoridaty purposes (Privacy Law, s. 15.(14 (1J (m)). Property Owner ~ .. ~ LUl1~` Pr~perty Location ? Miller, Sam c'-' Govt. Lot NW 1/4 SW i/4 S 11 T 29 N R 19 W Property Owner's Mailing Address '~ ~t ~ ~ TY L # Block # Subd. Name or CSM# P.O. Box 151 \`',-' ~at~ v~F1GE ; ~._ 7 36 1st Addition To Plat Of Homestead City State C,e~ie Number , ~~,`'~' ~ City 'J village ~ Town Nearest Road Hudson WI 54 .~ r Hudson Packer Drive 1+ New Construction Use: Residential / Number of bedrooms 4 _ ~ Replacement ~ Public or commercial -Describe: Parent material Glacial outwash General comm~tts and recommendations: Install primary system between borings #3, 4, & 5. Code derived design flaw rate Flood plain elevation, if applicable 600 GPD na ^ ~ Boring ~ Bonng # /~ Pit Ground Surface elev. 101.90 ft. Depth to limiting factor > 136" in. Sal Applicat)on Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DItt2 1 0-12 10yr3/3 none sl 2msbk ds as 2f,1mc 0.5 0.9 2 12-19 10yr3/4 none Is lmsbk ds cs 2fm,lc 0.7 1.2 3 19-30 10yr4/4 none Is Osg dl cs ifm 0.7 1.2 4 30-84 10yr5J4 none s & gr. i Osg dl gs if 0.7 1.2 5 84-136 10yr6/4 none s Osg dl - - 0.7 1.2 Boring # ---~ Boring { Pit Ground Surface elev. 102.61 fl. Depth to limiting factor > 133" in. Sal Application Rate Horizon Depth Dominant Caor Redox Description Texture Structure Consistence Boundary Roots GP DIftZ 1 0-15 10yr3/2 none sl 2msbk ds as 2f,lmc 0.5 0.9 2 15-27 10yr5/4 none sil 2fsbk dsh cs 2fm 0.5 O.L~i J 3 27-32 10yr5/4 none Is imsbk dl cs lfm 0.7 1.2 4 32-91 10yr5/6 none s &gr. Osg dl gs - 0.7 1.2 5 91-133 10yr6/4 none s Osg dl - - 0.7 ~ i a.~"`I`{-S s ~ is ~ s * Effluent #1 = BOD ~ 30 < 220 mglL and TSS > < 150 * Effluent #2 = BODS <30 mg/L and TSS <.,30 mg/L CST Name (Please Print) Sign ure: CST Number James K. Thom son ~y,o s-r- 3602 Address q.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number Osceola, WI 54020 9/19/00 715-248-7767 '~ property Owner Miller, Sam i ~/ ~Z.~'ZI Parcel ID # 020-1012-40 ID# 11.29.19.548 Page 2 of _ 3 ^ J Boring $ Boring # Pit Ground Surface elev. 100.56 ft. Depth to limiting factor > 130" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 1 0-18 10yr3/2 none sl 2fsbk ds as 2fm,lc 0.5 0.9 2 18-24 10yr4/4 none sl 2fsbk dsh cs 2f,1mc 0.5 0.9 3 24-50 10yr5/4 none sil 2msbk dsh aw 1fm 0.5 0.8 4 50-57 10yr5/4 f2d7.5yr5/8 sil icsbk dl gs - 0.2 0.3 57-130 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 tiie sil soils lying immediatiey above tt~e coarser- s & gr. This condition is not indicative of seasonally saturated soils and is dismissed ~ allowed by Comm. 85.30(3)2. Boring # ~ Boring ~ Pit Ground Surtace elev. 99.21 ft. Depth to limiting factor > 122" in. Sal Application Rate Horizon Depth Dominant Caor Redox Description Texture Structure Consistence Boundary Roots GPDIft' *Eff#1 *Eff#2 1 0-10 10yr4/2 none sl 2msbk ds as 2f,lmc 0.5 0.9 2 10-15 10yr3/4 none ~S imsbk ds cs 2fm,ic 0.7 1.2 3 15-21 10yr4/4 none is Osg dl ~ cs lfm 0.7 1.2 4 21-80 10yr5/4 none s & gr. Osg dl gs if 0.7 1.2 5 -, 80-122 10yr6/4 none s Osg dl - - 0.7 1.2 'f-So 57o.SL~a2•`~ a Boring # ~ Boring Pit Ground Surface elev. 99.25 ft. Depth to limiting factor > 116" in. $al Application Rate Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots : *Eff#1 *Eff#2 1 0-11 10yr3/2 none sl 2msbk ds as 2f,lmc 0.5 0.9 2 i1-33 10yr5/4 none sil 2fsbk dsh cs 2fm,1c 0.5 0.8 3 33-38 10yr5J4 none Is imsbk dl cs ifm 0.7 1.2 4 38-92 10yr5/6 none s &gr. Osg dl gs - 0.7 1.2 5 92-116 10yr6/4 none s Osg dl - - 0.7 1.2 * Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mglL * 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. . ~ P . 3 aF3 ~; E /~ ,ale:/='~o;i t3~n ~': T , 3 j~cbar: P~oPo~r C:c.cL-de -Sac load \ b~' ^ G °~ i~ ~' ~'~ `re 6 /o c.a~cc ^ 7'Eosf {'road ~P. o. c.1. /off ~Sa+y1t a 5 /0 3 ~ ~ N ^ 6S g~ /off 3l~~o~o~rosed / SE~¢dd. ~ l~lQ~ o{' f/o.~+estert~,T. of ,yK.dsa--~, sf. CrotX Cm., ~~ ,~~ ~ ~3oZ S 1'4 ~frt /N ~ L L ~ 2 f'•FO Y11 ~ S TEf~ O 45 ~'~ 3~ ~ • flit f~iytie~Gf' ' Dif fuser S ~f~cat~onS , ~~~ B10 ~~'~ Z t ~~ 3 6 ; --~ ~s• I T T 4` Knockout ~ Universal End Cap ~W~ a • ~ ~ Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: System Design Specifications Sanitary Permit Number $ ~ 3 Number of Bedrooms Design Flow -Peak (gpd) c~ Estimated Flow -Average (gpd) Septic Tank Capacity (gal) Soil Absorption Component Size (ftz) z Type of Wastewater D mestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow -Peak (gpd) ~Z(a0 l . Maximum Influent Particle Size (in) 1/8 Maximum BODS (mg/L) 220 Maximum TSS (mg/L) 150 Tab le 3: Maintenance Schedule Septic 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 se tic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outl t filte shall be cleaned as necessary to ensure proper o eration. The filter cartridge should not be removed unless provisions are made to ain solids in he tank that may slough off the filter when removed from its enclosure. If the `~, ~~s ' '~ 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 scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to.failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the 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 Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer S ~J~'i l~1 - ~ [, f /t._ Mailing Address ~©X #~-~ I Property Address I oy ~ U ~ k / N ` ~ ~ s V .~- (Verification required from Planning Department for new construction), City/State N' t~ tJ 5 o f.L W 1 Parcel Identification Number LFGAL DESCRIPTION Property Location L~ '/., ~ ~ '/•, Sec. ~ ~ , T Z~ N-R~C~N; Town of ,~ yDS~ ~abdivision ~ ~ IM,~- ST~t~I~ 1ST H t~ 1.7 ,Lot # ~_• Cerrified Survey Map # ~° ~ 7 Z_ -S y , Volume ~ ,Page # 3 Warranty Deed # ~ Z-z ~ Z 3 , Volume ~ ~~ ~° .Page # ~ ~ ~ Spec house yes ^ no Lot lines identifiable ~ yes ^ no S~S'rEM MATiy'I'ENAN~E_ r 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 thrce 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, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system is in propcr 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 W isconsin. Certification stating that yotu septic system has been maintained must be completed and returned to~the St. Croix County Zoning Office within 30 the three ycar 'ra ' te. OZ-/~/ ~~ A F L DATE '. •-:vOWN~R CERTIFICATION i; i'(we) certify that ail statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) o the propblRy.described above y virtue of a warranty deed recorded in Register of Deeds Office. • ~ o / zol SIGNATURE Ol: ' PL'ICANT DATE Aay infottnation that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ***** s****s ** Include with tlris 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 /O~ STATE BAR OF WIS(:ONS1N FORM 2 - 1998 WY R~J~JUPAGE~S~ Documartt Nurtbar Mark D. Rosencranz and This I]eed, made between --. -. - -- -- Christina Rosencranz, husband and wife, _ - _ -^ _ - - Grantor. and -Sam E. Mi11eY, a single person, _ _ _ _ _ _ -___-____ --- ___ Grantee. Grantor. fot a valuable consideration. conveys and warranu to Cramre the following described real estate In St. Croix ~ County. State of Wisconsin: 622 1 23 KATHLEEN.H. WALSH REGISTER OF DEEDS ST. CRDIX CD., WI RECEIVED FOR RECORD 05-D1-2000 10:00 RM WIRRANTY DEED EXEMPT D CERT COPY FEE: COPY FEE: TRRNSFER FEE: 900.00 RECORDING fEE: 10.00 DRGES: 1 P,. y.;...,q ~ ..., Name &t0 Relurn Address First Federal Savings Bank LaCrosse-Madison 201 South Second Street Hudson, Wisconsin 54016 020-1010-60r 020-1012-40; and 020-1012-10 ___ Parcel bentilicatbn Number (PINT This is -homestead properly. (is) (is not) Part of the NE 1/9 of SE 1/4 of Section 10 and Part of the N 1/2 of SiW 1/4 of Section 11, ALL in Township 29 North, 1 tnge 19 West, St. Croix County, Wisconsin described as follows: Cotnmenciny at the SE corner of the NW 1/4 of SE 1/4 of said Section 10; thence East 2739 feet; thence North 610.5 feet; thence West 1419 feet; thence South 549.5 feet; thence west 1320 feet; thence South 66 feet to the point of beginning. Exceptions to warranties: Subject to easements, reservations and restrictions of record. Dated this a ~ 'day of April 2000 (SEAL) _~C~~ (SEAL) RK D. ROSENCRAC (SEAL- I, ~ (SEAL) CHRISTINA ROSENCRANZ AUTHENTICATION ACKNOWLEDGMENT Signature(s) f authenticated this day of TITLE: MEMBER STATE BAR OF W]SC~ (If not, authtxized by §706.06, Wis. Stats.) THIS INSTRUMENT WAS DPAFTEO STEPHEN J. DUNLAP • ti ~~~ ' ~'~,~N oP..l .~. ~~~ F _ Hudson, Wisconsin (Signatures may be authenticated or acknowledged. Both are not necessary) State of Wisconsin, ss. St. Croix Cou Personally came before me this ~~ ~Y of April 2000 ,the above named Mark D. Rosencranz and Christina Rosencranz to me kn wn to be the person s ho executed the foregoing Inst nt nd acknowledge the t ~ ~ ~~~ Notary Public, State of Wisconsin My commission Is permanent. (If not, state expiration date: _~ to/zo/oz . ---J • Nanvt or pawn a~nlna in any up.cay must W typed « printed below then stRnaturt_ yy,grp,r,~ ~y &aril, Co.. Inc. - STATE BAR OF WISCONSIN 1.uwakaa wis WARRANTY DEED FORM No. 2 - 199a HbME STEAD ~ Sf ADDiTInN DOC~'L372S9 Vot.B ~~~E 3~ Y4:Si 1/4 CORNER '`~ ' 41!!?~l!LLE4.J.1!NJ2$ SEC1gN Il T.79N.-R.191L jUIINMMlIIi COIR1iY EAST-WEST 1/4 LINE OF SECTION 11 S89'43'OS•E 1315.40' .- _. _ I 1 ' aaa.7T Y Z i I _- 77Q d20.r2' -- ~ 1 - ;~~ LOT 35 \ ~ ~ { P 2.16 Ae. •~ 3 93947 sq. 11 \ Il ~\~ ~® 90J ~ 9gc~11 „ LOT 21 3 u i ~ ~ . \ \ ~ I ~ t f~ . ~` Zp ~\ ~ r' f \ ryn . 139935 t ~ ~ qg ~ ~- - rr r ~~ ~, \ ~ 7 ~, ti ~~ •~ s ~ 1 ®_ ~ s ~ L-~--- ~ a ~ ` 1 ~` f099Y70' ~ _ 4C • \ `~ Keq ~ 1 p9a7Y 9Y ORi a /' / ' ~ / ~ \ ~ `/ w LOT 37 / ~ / -. \ N ~ J ~Sq // /'.'i 1 ~ ~ / 0 ~// ~ ~ I ~/ 1 i ~ B9 ~*l.•' ~ / 317.13• ~ ~ 37~'s3• ~ ~~ LOT ~ _ , ~ ~• . n~ A / 2.51 ~ 7 S" n ~ I 1 ']44 11 i . ~ 3' ~ W 7 ay ~,~ q h 1 ~ ~~ /1 r m (o ,° ~ ~. lOT 7, ,~i ~v o LOT 38 ~ 1 = ~ ,$~ I / Ab LOT 31 ^ LOT 32 01 Ae. 2 i _ r ~ 10 152 9a 11 ,11'a/, I 71 = ~'f 1 tio~ 93602 9Q. rl . 1 87460 9Q. 1 SB9'35'43'E ~ r/ / 1 1 ~ ~~. ~ 6.22 _ _ .F. L - - ~ I9 ' ~ ' ~J93..9 a3.70 ~~ ____ _~i -__-J ~I \ LOT 79 . _ /,; :.~. u N9977'14Y 700.69 ^ NN90't7't i79 ~ \ 1 ; ••$r ~.s?i ~OLO HOPKINS P.~ACE ~ \\\ ~ :1' ~'-~ ' °~~~ i12 520 >a-.'7Il ~ ~ a,~dl ~+, ,7~ t3t.9o ~ ~ 5'0 N9n!'raY ta.u' ~ l°l~ N69']7'14T: 109.OY r'1 ` \ L,'- - _" ,~,6~ G> / ~ ' \ 1, \} may; I YJ.SI T \ \~ '4~ 1T urY.IrY pRAWACE EASEMENT E{- ~ \ a, ~ \ ti. [ASENENl NWE >< 901 00 ~. \ . N ~ n AT ~ . \ 99,01'UY 7ri4Y ~ \ \ '\Ir ~ 2 ~ \~ ~~KfR r,2 ~~ \ ASEYENY a ~ .OT 6 1 : ~ h - ~ oRAwAOE [ ~y. _ DRAINAGE ~'ASEMENF ~ p _ ~ HWE ~ 901.00 341.3 „ ''M ' \ ~ . . ~ Y92j3. \ ES y.Sf' I~ aT 4 3030.Y EASY 1/4 CdINER SEC. 11, i7N1. RH01 3' ALUWNUN E'OYNYY YONINIENi 509'a3'OS-E 39]0.10' 34 ~ . Ac. « ;o !Q. Il ry r ~~ TsyYO9'E LOT 33 ~ 2.06 Ac. 379 sq~ 11 $ !o ~I S ~ 1 BENCN auRN TOP OY 1' MION PPE b[' EECVA110N ~ 093.03' 3 ~~>~ 1977 uscs pAYUY z ._ - m 2 z '' 3 0 .- ~. "n 589'JS'4J'E <I a R 7~ 99.00' 197.73' LoT 2e r 128i2~ sa. It R ~P g ~ ~ ~ t~- ~'M'SY9 3100Y \ ~ ` SIP \\ ,\ ~ r ~ ~ ~ (aY7 3 \ \ O \ f. \~ ~ ~~ , .~ ~ "Y fo $ R LOT 41 \ ~ \ \a A LOT 39 r LOT 40 ~ \ ~ \ 1 \ T 27 LO 2.62 Ac. Il 14244 n „ 2.27 Ac. +~ 11 ~ 99956 9 2.11 Ac. 11 91973 9 \ \3 1 \ 33 . 4 20 Ac 9Q. ~, 1 _ q. 3 5 q. 1 ~ \ 1 . . 11 946 aQ 182 = d I r 2 A I ~ ! l/O _J O \ 'O I . , / I '" ' In bbbSiii BENM YMK 70Y Of 3/a' MON -w ttE 1AYi00 6A1Y11 I ~ I ~ I I ® 1 0 3 h a 0 197 I I ~ I~ I I I ~~ 749.41' - ~I 1 ^^ 397.a7' r H0. Y' 33a.90' 0 00' 1'3f•w fiOUTH .`W 1/4 ~ fW 1 4 0/ ftCTION 11 Ne9'354]~W 1117,e3 \ 33133 / Tolrrro YONUYENI AS NOt[0 \ \ I ~ I rAl!~SIErR.MW.?IS#.N / l(, 91 caRNER 9w eo9NtR Nrr 1/1 a THE NAkf,SIEAQ.(IR4LLIQN li Lor g. / ~ 179N. R19w 9w 1/a 9uY ~. I \ \ LOT 7 ~' IO101YEN1 \ I ull I / LOT_l~