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Home My WebLink About020-1400-05-000~consin Department 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)]. Permit Holder's Name: City Village X Township Girard, Ste han & Mar Louise Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic t,~..~ :z ~ tic =~ _ ] ~ ~. Dosing Aeration Holding ~. ~h....it 1'Z - i C' ~- TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic `o. _~ °~ L. ~ ~ ~ ' ! / 4 -- _ _ Dosing ~ - Aeration s Holding _ PUMP/SIPHON INFORMATION Manufacturer ~-- Demand GPM Model bev " ,, TDH Lift ` Friction Loss System Head TDH Ft Forcemain Length Dia. ~ .elL___.-___-- SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 453368 0 State Plan ID No: Parcel Tax No: 020-1400-05-000 Section/Town/Range/Map No: 11.29.19.2495 STATION BS HI FS ELEV. Benchmark ~,. , / %ocr. ~ ~cx: ~~ =' Alt. BM Bldg. Sewer ~ ~ ~ ~~ St/Htlnlet SUHt Outlet 13 ~~~~ B ~~ Zc.~ Dt Inlet Dt Bottom Header/Mangy t ~c:4, Dist. Pipe ~ ~~ l ~.-7 ~ ~% $ ~ ,~~ 3 Bot. System E- ~-= i4; ~ ~~ - ~ ~ 3 `~ ham. Final Grade 1',2.ty ~,7•`~ St Cover \ ~ ~(~[~ l J-~~r Wr•7Tty~ L~CiY /l 1~7 (IIC~ BED/TRENCH DIMENSIONS Width L gth No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer. [ f ~ ; v c :.~.u-` Type O System: / ~.4 it t) vY`~r aG-.; Y-~ - ! ~7 L`C.~I ~ ~ ;v •'' ITr- ,~ ~!^ ~ t`~ UNIT Model Numb ~~ ~ / ~i D15TRIBUTION SYSTEM ~-- I ~-l ~- 6, / ~-r.~ ~,~~ Header/Manifold Distribution x Hole Size x Hole Spaci g Vent to Air Intak e ~ ~ ~ r Length ~ Dia ~{ Pipe(s) ....___ ._ . _._ _ _._. _ Length Dia Spacing ~-' '-- ~, [ ~ J SOIL COVER x Pressure Systems Only xz Mound Or At-Grade Svstems Onlv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center _ BedlTrench Edges ... Topsoil _ ~ Yes No ~~ Yes ~, No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~~~ / ~`(/ ~'`f Inspection #2: / /, '~L~ , Location: 761 Packer Drive Hudson, WI 54016 (SE 1/4 SE 1/4 11 T29N R19W) Hopkins Estates Lot 5 I , Parcel No: 11.29.19.2495 1.) Alt BM Description = 'Tc ~ e~ ~.~d.. ,-~t ~- t< • ~, -• ~ ~~ ~- ~_ (/r c. ~..~ 7 , L~, ~ l ~ -Lot's ~ S h~' r ~~• Y r, 2.) Bldg sewer length = /(~ ` g„~,,.~ rn_:--Y-- r-~-~; h~ ~`-~~'` ~~~ p -amount of cover = ~~; "~ ~rx,~ D~ ^^^ ' ~°~ " ~ .c' `~~ `i "t r ' l~ Plan revision Required? 'Yes ~ No Use other side for additio al i f ti i ~C, /x~ i ~~~ I ~ i I n n orma i SBD-6710 (R.3/97) Date Insepctors Signature Cert. No. /. C', CcJc S c'i f 5 Depth ~ Safety and Buildings Division County ~ ~ ~ ~ ~ 201 W. Washington Ave., P.O. Box 7162 ~p SCOI ~SIII Madison, WI 53707 - 7162 ` Satutary Permit Number (to be filled in by Co.) Department of Commerce (fig) 266-3151 Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy L 04(1)(m) Project Address (if different than mailing address) I. Application Information -Please Print All Informati :~~ ~ n~C~Q Da~~ •\ C Property Owner's Na me Parcel k ~ z SF9s" t Block ~ e ~ ~'1a~ ~.r,y*, !~~ ~a o.~o-lyoo-o~oou ~ ^' Property Owner's M ailing A ress Property Location ~4~ ~R ~ ~~ ~~ t )ORtt-, u C i S ri ~ S ~ '~ ~ ~ '~ Ci Sta ec on , * ~ ty, te Zip Code - - gr~ _r_ _ UoSUU ~I SC• 5 i Q~ `P ('~ ~ "' ~" `~'~~ n i (circle one) ~ ~ ' II. Type of Builtting (check all that apply) E or W T t N; R 1 ^ 1 or 2 Family Dwelling -Number of Bedrooms ,~ ~} ~ 61 `~. ~ U `~ 1 ~ Subdivision Na m ^ Public/Commercial -Describe Use [ Na INS L~a S ~j ^ State Owned -Describe Use 2.~ 7j x 0 'r'•.~ ~ONI~~,'~ ~ - i~; a ^City_^Village ^Township of q $ p/3 III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ~1ew 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 arxi Date Issued Before Expiration Plumber Owner IV. T of POWTS S stem: (Check all that a 1 ) Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter eaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis rsal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units ~ n ~-/fi0 ~ Concrete Constructed Glass N E ~ ~°~ ew xisting ~ Tanks Tanks Q~ • Septic or Holding Tank ,.. I ~ ~ ~ ' I _ e L S Vv {„ Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's NQa me (Print) -JAM ~NdUM eS~n PI ber' nature MP/MPRS Number ~a~gU~ Business PhoSne Number ~~~~ 3 ~ gU~U Plumber's Addre ss (Street, City, State, Zip e) 01 D ~ ~ ~ N u soy ' sc- ~ y01 VIII. Count /De artm t Use Onl pproved ^ Disa v Sattitary Permit Fee (includes Groundwater Date Issued I uin Agent Signature (No Stamps) ^ O ner n Re for Denial Surcharge Fee) ,- ~ ~'~' ~ IX. Conditions of ApprovaUReasons for Disapproval \ .-~ /1 ' t~tQn,~.r- ~ S t -~'+.. '-`_ ~5 t I-#- a~ ~ ~ " ' „ f ' SYSTEM OWNER: 1 Septic tank, effluent filter and ~` S{~stac~lL Qee-w~'~ '{~{~.t~ w~ ~ C~/lS 4p dispersal cell must all be serviced /maintained ~ _ a ~ S~ ~~_ - 54~Tt~c- rovided by plumber. ~oe~- lan ement p p as per manag r 2. All setback requirements must be maintained S tt ~..~ •~ ~ "~" "" 5-^~ae~~~W~ ~ 5~~+1ce . as per applicable code/ordinances. ~ ~ ~~~~ oG ~. 'r anacn complete plans Ito the County oNy) for the sysper not less th 1% ~ l~e~ ins e t /, ~ SBD-6398 (R. 01/03) -}-a o-~cg.c.~i~ se=e ~ ~eaS~slln' 'L~,`•M•'a~1-l",",`^Lr~~/~' r 5~`e~ hPN ~ h~~~ ow u ~iQpa~n `1 Col PQ~~eR ~xiv~ (r3~, N ~1, ~na~ ~s W~~~ a ------------ -- `----- -- ~1 X0.0 6.mp ~ rn~p~~ ~I~v = I N~,~ Nn~l '~~ $'' Q~~~ 7~' ~~'' '~ o.. . _. .... ,_ ..- r~~ ~'"~ ~ - _ - ~ ' ~-~ tii~, Y I pl ~ ass' ~-- g~ C~pY go~o~ TRaNC,~us ~ 9o.ao L. 89.0 J'i rr ~joul~neeS~{~ aaa~~y ~~a~,~~y ~J s l e~ ~1P~+ ~ rIAK.~ (,opt S~ C ~l ~~ ran ~~ m ~oulmees~}e~- ~~~ ~~~~~ ~~~~~ a a~~~y - ~~a~~~y ~~N c,~ ~~~~5 t-.1 Imo. ~ ~ -_ _._ _ _ __ ~~___. ~1 ~o.o f 6.mp~.K ~a ~I-w-100,0 ~rn,a~.~ ~I~v ~ 1 I ,, N~~1 ~~ u ~ ~i 1v4 i (v h ~ l` ~ w g~. Q'i ~~ 7 v ' - - --------_ -_ ~ ~ o ~ ~; f~~ A « ~~b ~ ~ ` ~~V 1/ 1 0 !~~--- ~~ ao, ~-->~ ~' ~~ (~ li IaLuScp~';~ o W~plau ~; ~~'''.. ( S ,~ ~ ~~ ~ ~ol~ I ~1 ls~, r ~N~ goTioi~ Tr~NC~s +~ 9p` ~: ~9 0~ -c Wisconsin Department of Commerce Division ou6afely and Buildings SOIL EVALUATION REPORT Page ~ of .,, o.........o....` .................... , ....,. ,,.......,....` . County s ~ Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must r 0 indude, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale w dimensions, north arrow, and location and distance ib nearest road. Parcel l.D. Q Z D - ~ /l !~U - n s-~dc.,~ Please print all information. Re ' y ~ Date R Personal information you provide may be used for secondary law, s. 15.04 (1) (m)). ~ ~ '~~ ~ ~ y 03 Property Owner Property Location L P r ~ D ,~ ~3 ~ S 1 Govt. Lot ~ ~ 1 r4 ~~^ 1r4 S' ~ T ZG N R ~ ~ E (w Property Owner's Mailing Address APR 2 2 2002 lot # Block # Subd. Name w CSM# ~ ~l G r e ,~ ~ ~ ~ ~ K I ~ s C s ~-c. -~-~ S City State Zp Code Plzpn~BOUNTY ^ City ^ vtlage [~ Town Nearest Road o ~ ~"NG r ~ 4 ~ ~ ~ r r ~ I-~ s vc ~ ~ , ,c P ~ New Construction Use: 0 Residential /Number of bedrooms ,~~~ Code derived design flow rate y S O ~~ O O GPD ^ Replacement // ^ I Public or commercial -Describe: Parent material ~C9 r W C~~h Flood Plain elevation if applica,Gl fe t~ fL General comments s Y.S~cN'~ e/~ V. ~ .,~ liAw~-r- ~'~_ SCJ IV 0 ~ • M• S S~~h.t.~--~~ ~~, and recommendations: ~ ~,~, c/ G U • ~L~ 8S $'a L, p w-c. / 8~,. S, ~-C_- rQ.Q.G~vt ~~ ~k.c,(c~ Y ~o~QiYk -~ ~D~ -~vr' I'YISi~ Boring # ^ Boring ~' ~ ~~ t;xSV`~ ~ J -~.6 ~ l~ol'J~ __J ~ Yli vw~u~a auna~.c c~cv. . ~v -- - L.cNu~ av nnnw.y ~o~.w. , . i o~. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 ,o r 3 - ~ r ~ Z,~av ~~r CS ~~ ~ c~S Z ~ Z r' L ~i - r I -vt Fr ~ ~ S ~ ~ Z ~-~' ro 5 ~ - r Z s )~~'r ~ -' ~ ~ ' £s _ I - to ~ -- wi Os r~l ~ --- - , 7 ~ , Z ~Q~c> 0• rri-~ _'-~ Boring # ^ Boring ~y " /~ " U X ~_ TU p I1~~.L ~~ ..~J:~~ LJ..~ I ~ / ~J ir[J F'Ir v~w~ti au~ ~rn.c c.cr. V •~' .L L•cMu~ av ~u~xu~~y rowan ~~~• Sa1 Applrcation Rate Horizon Depth Dominant Cotw Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~ i~ r 3 Z -- SiI ~~ C5 v ~~ ~~ ~ -Z a ~~ - Sri ~ r ~ ,S~ : ~ -o a sal _ r( ~ ~~ ~ .S •~ o-1Zo o r y~ - ~ G s• V''l - _ ~ ~ l~ Z ~/ ~ f ~ 'Effluent #1 = BODS > 30 < 220 mglL and TSS >30 < 150 mgrL ' Effluent #2 =GODS < 30 mgrl and TSS _< 30 rnglL CST Name (Please Print) Signature , CST Number Address - Date Evaluation Conducted Telephone Number 21t3 g-o ~'~ S~. Sommers of r`,,~ ( S~-[O ~s' lis' 24? yoafs Property owner I~G S~ Parcel ID # . ~ . }" ~ " , Page _;~ of Boring # U Boring ~,~,~r -~~~~ 3 [~ pit Ground surface elev. ~~ ~- Depth ~ titrnting fay ~ _ in. soa Application Rate Horizon Depth Daninant Color Redox pescxiption Texture Strucdue Consistence Boundary Roots GPDIffZ ' ~. Mansell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eit#1 Eff#2 Sr 1 ~~b~ -nnF~ C I ~ ~ S - --~ ~~ z ~- Z ~o e - 11 Gbk ~ ,S r _ ~- - ~l 2~~k ~ ~ -- ,s ~ 3,_~~~ ~ ~ - w,S s ~1 - ~-- .7 i~Z 2~i ~ vy,; Qv7 r ~~ # U ~s .. pit Ground surface elev. ff. Depth to limiting factor in. Soil q~p~ Rate scri tion D d Texture Struchue Consistence Boundary Roots GPDIft~ Horizon Depth in. Dominant Color Mansell p ox e Re Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 a Bonng # ~ ~~ Ground surface elev. ff. Depth to kmiting factor in. ^ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsefl t2u. Sz. Cont Cobr Gr. Sz Sh. 'Eff#1 'Eff#2 'Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mglL and TSS < 30 mg1L 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. ssu-ss3o cR.mroo> ~ ~. •~ . r PAGE~OF .3 NAME ~~~5 T TOT#~S LEGAT, DESCRIPTIOI~LS_/`- ~~~ 14 ,S / J T Z 9,N,B, /~( E( ~--~ SCALE: 1"= `-~(~~ % BM 1 ELEVATIO /00 • ~ BM 1 DESCRIPT ON a ; ~ ~ ~' nsZ BM 2 ELEVATIO l 0 • ~ BM 2 DESCRIPTIO tt ~ ~ ~~ '~~L SYSTEM ELEVATION Lot~++~ ~ ~• S ALTERNATE ELEVATION ~p ~- S~ !vw ~ r SS 3 Sa CONTOUR ELEVATION 9y Sa f+~ ~•~. S~ C. J ~lJ~ SIGNATURE /~~ -~~~ __ DATE ~ ~~ ~ ~ ~~ n iti u _ n n v~• .. v i_ ~ r ~ ~ - -- --- - x _, -_ -=~e~ ~y ,.. " !` , ~ • ,, . - - . ~ ~ ~~ _ _ .- "- i . .. . - / / ~, ~I ~ _ .O ~. I, ;~ /MIN. BUILDING ~ - ~ ~ _ ~ . ELEV. - -882.50 ~ 2.~ ~~~ ~ - ' ~,p ~ MIW. Il.Q1~6 :~ •( ~, - _ f ~ ELfid. ~~ +88'2; ~ >> / ' '~ ~STORA AREA \21' ~ `~~ _ J , " ~ , ~ i ,, " _ ~ ~ ~ VOL =2.69 AQ-~ ~ ' l - -- ~- `, ~ . \. ~, _ i ~~ ~~ 9 3 'X ~ ~,/ ~ a SILT FENCF,. '~ ~' x ~ l ! 1 ] ~ ` ' '~ 1 ~ ~ a~ ~ " ~ ~ ~ ~ , - ~r S'I~T~ FEN ~ ~ ~ ~ ~ ~~~~ '-~" 2.84 AC i ~ ~ it ! ~`~ / ~ 1~11N ~ ~11fil,DlN~ ,, '~ ~~ { ~LEV~g=~8~4180; ~ ~ `~' MELEV.~I89J.50~ ~~ ~ ~ ~ T ~~ ~~I~V AC ~o~,~ ~~~ ~., _ .l ~ ! ` ~ I ~I 14 ,. ~ \ 11VL = 0r '; MIN. BUILDING: -. ~ ,~ - ~ _ ' -- " f ,// /i l i ~, ~~ `~ ~ - ,_.\ ~ .'` ~- ~. __ ~LEV. _. 887. 0' ~• •\ a ~ ~ ' '~ ~~ .1°` At~A 6 ~ -1 ~.'1 ~ I~Cr ~ ~. i ^ ~ ~ - . ~~~ ~MhV.'~.B,UII.DiNG - ~ y ~~ ~ l ~ ~ ~ VOL = ~. 72 AC-F~ 1 ELEY ~ ~ 88~'l.5~ . ~ ~ ( ~1 ~ ' ~ ~ ~ , ~. , A l 7 ~' 1 `t ~ ~ ~I ~ " ' ~ ' ~ ,' ~ 1 1 \ ~ ` ELIF~V. ~~ $85.50 J - ~ \ ~ ~~ ' -, ., 1 ~ ~ -; .. _ ~ _ i ~ ~ ~ Sf AGE` AREA ~9 ~, ~~~. 1 I ~ - ~ ~ . f ~ ~ ~ I ~~~WES W x . ~ ~" ;~,~ - ,-,RIP RAPS ~ ~_ " ~~ ~r~.~ -~ - :~ ~ BERMS ' n o e Y ~H. W.L. = 885.50 ~ 1 ~ -,p ~ ~; ~, E SOIL REPORT SUMMARY - 3/21/2003 Adam - thought a summary with copies of the soil reports would prevent any "lost or misplaced" originals! ! 1. Lot 33 Scenic Hills -Your dad gave me the report at the time of inspection last fall, which needs a revised application, etc. Never received $10.00 & date stamp for official acceptance. I have listed this on the database for the permit record. Talk to Bill about submitting $60 at time of revision submittal. 2. Lot 12 Walden Woods -Glenna Drive installation on 10/10/02 was not in the original tested area. Did you do a new soil evaluation for Bill - I couldn't find one in the 2002/2003 Hudson soil reports. The soil report can be submitted when Bill sends in the revised application and plot nlan/as-built. Lots 5 & 8 of Hopkins Estates -need BM locations marked on the reports. The originals are in the "red file" in the filing cabinet. 0 ormerly Lot 14) in Rolling Oaks -did you end up having to do another soil test after the lot lines changed? They moved the frontage around to expand Lot 25 and reduce Lot 26, which might leave your borings partly on Lot 25. Please check with Dick Stout or let me know if you alrea y di amore recent set of borings farther back on lot. '~~ ~ ,~ 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 p{an 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 (o Number of Bedrooms Design Flow -Peak (gpd) U ~ Estimated Flow -Average (gpd) va Septic Tank Capacity (gal) 1 a ~ ~ Soil Absorption Component Size (ft2) S r Type of Wastewater Domestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow -Peak (gpd) 2.~9E~ 870 Maximum Influent Particle Size (in) f ~ 1/8 Maximum GODS (mg/L) ~av 220 Maximum TSS (mg/L) ~ ~ 150 ~i~ 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 sept' and outlet filter shall be assessed at least once every 3 years by inspection. Th outlet felt shall be cleaned as necessary t~ a~~~ ~~~ prop_oneration. The filter cartridge sh 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 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 Management Plan fora Septic Tank and Soil Absorption Component Plantings ofdeep-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. When system fails, we will replace with another system at owner's expense. Alternate area must be left undisturbed. St Croix County Zoning Office 386-4680 Boumeester & Sons Excavating 386-9020 Tri-County Sanitation 386-2130 3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT ~~ OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address Property Address ~~ ~o ~~~~ ~~~~ r~~, (Verification required from Planning Department for new City/State ~JGfsbn (.t/ ~ Parcel Identification Number Dv~C~ '/~~'DSr~C~ EGAL DESCRIPTION ~ Z ~~ s Property Location Subdivision ,n~ ~S?~Gt~i Lot # ~. Certified Survey Map # ,Volume ,Page # Warranty Deed # ~~j ~~d ,Volume ~~~ Page # Spec house ^ yes~no Lot lines identifiable j~yes ^ no SYSTEM 1~'IAAINTENANCE 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, restricted plumber or a licensed pumper verifying that (1) the on site wastewaterdisposalsystcm is is 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 that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of a three year expiration date. / // / ~y 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 owner(s) of the p erty described above, by virtue of a warranty deed recorded in Register of Deeds Office. ~~/ ~ /fit/ SIGNATURE OF APPLICANT DATE ==--FF «««««« ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. F '/., ~ '/., Sec. l ~ . T~N-R,~W, Town of [J d72_ . ** 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 it J 2i5~;' 585 7 1 1 4 5 0 II STATE BAR OF WISCONSIN FORM 2 - 1982 WARRANTY DEED DOCUMENT NO. conveys and warrants KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIII CO. a MI RECEIVED FOR RECORD 02/27/2003 11:05At1 EXEF~t # REC FEE: 11.00 TRANS FEE: ,1.'70 COPY FEE: CERT COPY FEE: PAGES: 1 THIS SPACE RESERVED FOR RECORDING DATA ' NAME ANO RETVRN ADDRESS the following described real estate in St . Cr01X County, P4ic ^-~-;p4~'s ^z.'- - ------ State o[ Wisconsin: ~~'~i'Iia~e~~E-~ ~-z ar~+..-~°~- Lot 5, Plat of Hopkins Estates, in the of Hudson, St. Croix ZToun'ty, Wisconsin. L Sua k 1l5 '~41.~i fo 020-1400-05-000 PARCEL IDENTIFICATION NUMBER This homestead property. Exception to warranties: Easements, restrictions and rights-of-way of record, if any. Dated this 25th day of ~~~ - ~^ (SEAL) •~c~nalda Sneer-Bast (SEAL) AUTHENTICATION Signature(s) authenticated this d •^---• State of ~' _ :~nsin TITLE: MENDER STATL• BAR DY`-WISCONS[N (lC not, author[zed by 8706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Kernon J. Bast (Signatures may be authenticated or acknowledged. Both are nu[ necessary.) A.D.,~$ 2 0 0 3 ~' ~ CSEAL) Kernon Bast (SEAL) ACKNOWLEDGMENT State of Wisconsin, ss. Rt _ ~ Crni x County. Personally came before me this 25th day aE __February ~Y8 200,3he above named _ Kern~_J__ Bast and Donalda J. Sneer-Bast to me known to be [he persons whu executed the foregoing instrume nd knowledge the same. ~ Notary P ic, County, Wis. My commission is permanent. (If not, state expiration date: ~-SY(n .19 .) • Names of persons signing in any capacity should by typed or prinlcd below Their signatures. y~ ~- /~ ~ ~ - . ~~ ~\ ~~:; `~' \ ~ ~.., ~ 5 ~v ~~ MIN. BUILDING ~~~ ELEV. =882.50 i i ~ ~ ~ ~ C~ \ \~ ~ / 1g \ \ ~ / ~ _ _ - i ® , ~ ~ ~. H.W.L. _ ~~ - ~ ~ ~~~- _._._ ._ ~~ 882.80 ~ ~ ~~~ ~~\ /, / ~•~ ~~ '~- --- f ,~'~ m N. r r fh M M O Z MIN. ILDING .•~ ~ ~~` _ _ ,~-~~ •'~ ~ ELEV -887.50 ~ ` ~\ ~ ...,......~ 3 `~ ~° MIN. BUILDING 3.55 ACRES ~'" '~ E~y _ 154,716 sca. F r. ~+.w.~ _ ~' ~ 4 ,'~ 5 , ~ 2.41 ACRES :, ~ 105176 SQ. FT. 2.1 CRES MIN. BUILDING 93,850 SG1. FT. ELEV. =885.50 -- FENCE 0.8'+/-SOUTH OF LOT CORNER 3' +/- 235.88' 270.39' 406.1 T S89°81'32"W 912.23' NORTH UNE OF THE SOUTH 198 FEET OF THE SW1/4 OF THE S ~ ~ [~ _°--~ C~C~L~_~ `! ~!Io_9_L`~_,_~_99__°PC~_~_o_0`IlC~3 T SOUTH UNE OF THE SE1/4 OF SECTION 11 S1/4 CORNER SECTION 11 UTILITY EASEMENTS NO POLE OR BURIED CABLES ARE TO BE PLACED SUCFI THAT THE IN; OBSTRUCT VISION ALONG ANY LOT LINE OR STREET U~IE. THE DISIUI VIOLATION OF SECTION 238,32 bF WISCONSIN STAMGS. UTIUTY EAE PUBLIC BODIES AND PRNeTr vrlRl Ir I ml rnFC ue~n,,,r+, Tur.,~..~ ..~..