HomeMy WebLinkAbout020-1400-10-000Wisconsin 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
Bast, Kernon Hudson Townshi
CST BM Elev: Insp BM Elev: BM Description: ypp p ~ -'t0
~ ~ 1.? ~7 D 8a,e.c - .~z e dev• ~- ~~~ ~Ld
TAIU1l IAICADIIAATIl~AI r~ ~~iwr~~u r~wrw
TYPE MANUFACTURER CAPACITY
Septic
u?ia~4.~
l Zsa
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO P(L
V~/ 4MI~e^ WELL BLDG. Vent to Air Intake ROAD
Septic
? ZS'
t ~ ~ c
Dosing
~ n~o~
Aeration
Holding
PUMP/SIPHON INFORMATION
Manufacturer Demand
M
Model -umber
TDH Lift Fri oss System Head TDH Ft
Forcemain Length Dia.
~~~~~+~w~~ v~~~
--"~'' St. Croix
Sanitary Permit No:
420483 0
State Plan ID No:
Parcel Tax No:
020-1400-10-000
r~
STATION BS HI FS ELEV.
enc mark Gti'' ~
AIt~BM
.o
gs
Bldg. Sewer
,S`~
9P• 3
SUHt Inlet
~! 7. ~ ~
SUHt Outlet 4
0- v G, p
/ ~O'a
Dt Inlet
Dt Bottom
Header/Man. ~~ Cf f'1115
V t.l~-+i
1 ~ (e ~ l
Dist. Pipe '
Bot. System
t +~ ~ GrY, y
final Grade ~~ ~
~
~ ~' 3 Lt o , ~,.
St Cover
~
7
SOIL ABSORPTION SYSTEM 1 n ~ vinyl /'iQ.S/1, o ~ ~~i._ I~.E~
BED/TRENCH Width ~
~'" Length , ~
' No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 L S 3
SETBACK
INFORMATION SYSTEM TO PIL BLDG WELL -7- LAKE/STREAM CHING
CHAMBER Manuf~tryrefl --
~~~~""Q ~+'/I
T Of S stem:
y y _ ~ ~
t ~ / ~
!
~(,~ L
Model Number:
J~~ ~ ~
DISTRIBUTION SYSTEM ~+~' (N (~?' fl-~ SvJ~•~%CO="`~ ~/,d.~~oC C~j~•s"
Header Manjfol
trJYC
L
th ~
Di
~ Distribution
Pipe(s) 7I ~
~7
L
Di
th ~J x ole Size
'"''~-_-- x Hole Spacing
`J- V Air Ir~,gke
3D -
eng
a
_ g
en
a
pacing
SOIL COVER
x Pressure Systems Onlv xx Mound Or At-Grade Systems Onlv
Depth Over ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center `y 3 Bed/Trench Edges Topsoil ~ Yes ~ No [] Yes ~ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: t ~ /~/v ~" Inspection #2: / /
Location: 770 Packe-r~D-rive_HLudson, WI~5i4~0~16 (SE 1/4 SE 1/4 11 T29N R19W) Hopkins Estates Lot 1~0~ /~ Parcel No: 11.29.19.2500
1.) Alt BM Description = )~P "1 ~U--(/-•LU2N~~/t~Y 1it"'~ ~QS~ds~ (~. 3 / G~(f7 c~ ~Lt'~~-~-~ /iQ~(.~- /!
2.) Bldg sewer length = ~Q7 ~Lil~rr0~ ~. /3 .S~/S a~iLw V'N• sw L~vY~.2~1r ~T fiG~G~~"
- amount of cover = ~ S~ ~~. ~ . , ~~ /I tY~~~~a~f~"•p,(p (~~,y~ /p"Y.'`~~~ //fit/ ~ f .SOIB'~~3-vc-~' ~ l (0 6 3
Plan revision Required? es ^ No /~ ` ,~-
Use other side for additional information. ~ ~/ (/~, ~~~ `~ ~ ~
SBD-6710 R.3197 ~ ~ Date Inse tor's Signature_ .. / ~ / /~/~Ceft~. Nf~~~
( ) f~~C~C~G lca~ ~ ~~~ S O..uIL- u~c~ 7 r'UX/Ga~'~"
Cir!i,WYV+.bev
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FROM Schumaker Plumbinq FAX N0. 7153863121 Nov. 15 2002 08:36AM P1
601, 1=VALUATION REPORT p'e' -~- °~ ~•~-
WisaeprlR OeDBAlllould GonXMtm
Divtsbn d Gsisl~ Nod 6uidir-y>; M ~~an~ wRh Carmn B3, NAs. Adm. Cello Cwnb
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a1t8eA eee~te she plan on W 0~ not Ises Men e t /Z f ,1 lochs. in aia<4. P19n ~nt~
Mme. pyt not tlmNod to: ~ and 11 ~ahw~ pe{ne (81111. dibEdml and PerCa1 I.D.
pezant rive, scale or~rrol,sbna, north anvw,and lot9tion and vsuncte nearest nssel. [goes
Ravkwsd by
Plet+ase p-'~ ~H /fflb~Non.
PNsM11 kiteeeufkn l~ oroeid• n+atr tie used 1rr seoosa~ yepaleo tPiiva~r t.ow. `. ts.a tr) p-yy.
---•-^
f3ov4 Oat ~ 1i4 ~11a S/( T Z N R f E
Lot ti f3isdc8 gum- alern~Cr
/J~ ~ R
Cinr 1/Nlslio Te~a1t NieNeR Rw~ ~
~V C
4 rJ __... GPG
. ~- Gpce derived dsalgn flaw rots
[~ New CenstiuCtlcn Use; ® RseidontleN I Nunrosr of bstlroams ~ ~- _ .,..-~-~
Redeanwnt ^ Pubes ter cOnrae~ • Dsef~Ds~ ~J/4 ~_.^ _ a.
Q ~,~,~~ ~ ~~~~__r FbodPlainebrs6on fiop~P~~ -
Perent nleMrlal ~~_=~mr~ J---
Ganeiel fytrMtlehtt sy~l_Al ~/tV, 1FlP ~• CO ~"~~+sr ~`'~
~ sod raaomrnendationsa 3T~
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p~ Grautd surlevB der. ~ ~e_. R
DpIM es NfIM~t9 a~ ~ In, ~
veaN 9tvuaYra Gardaranss ®prndary Raota
Or. Az. Sk:. ~lel1 'f'.IM2
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t]avfl+ a irlr~s ~• ~~ - en.
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till WdtiZ:f30 Z06~ t'Z 'noN 'd`I ?{M~ WONd
FROM Schumaker Plumbing FAX N0. 7153863121
pkoyMAy Owner _..~,."'r-'-~"'"~'..r...- ..
6orin4 4 II~MInp feeler„ ~~ ~ In.
I~ i~dng ~ [~ Ph 6rvund W~ ~~ -^ R OePtl+
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Nom. 15 2002 O8:36AM P2
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Ta~vn1 BIn~A panok~bnve Yo~neery Root
Mnrtam t)aDIA DereMaHl ralnr Redet a'~°^ gr. flat Sn.
-n. Munsall Qu. Ss. OonR Odor ~
• E'Nluoet N1 • BOf~ti a ~! R X20 ~ aM TSS >30 ~ 1:10 mpf L ' dal' Alleft>>Q . 900, c 30 mAft- and T~! 5-~ ~
the DepaRf+Knt Of pofsut~~e ~' $° °~°i ~~iN fbrviQ provider gild employer. It you nccd eNiateaiso to auaaissf ~~ or
~ mum-rtal ie m ot~rnra fon~+e~, Pla-so ~Dd~ ~ ~~"~`~ u ~~~3~ 51 or TtY 6C~-264^a'i'17
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yYtsoor,elnDeparhnentotConxnercn 601L. EVALUATION REPORT p.go_~ ~..~-
pivisbn ctif 6eidy end Buidings In acraordattoe with Comm 85, IAlls. Adm. Cade
courny ~'. ro `
Attach tampet8 site Plan on paper not kss thou E 112 x 11 Inches in slxe. Plan must
IncltrdE, but not MmNsd to: vertical and harkor+tar nlfMenae point (BNj, diraetian and P~ I.D.
percent slope, sCOle ordimenebrx+, north erlgw, end IoCAdon and du:tanceto nearest mad. Revkvred ~ ~~
pfe+ase p-GtR sN InldmteNon.
Porsen8l hNamwtien 70u prONOe 1nRY be uead }bt secopear~ parpPSaa (FrivOg° taw, c. 16.04 ft f (m)}.
propersyOwn~ Property Locadon
Caavf. Gat ~ 114 'S,~1l4 S / ( T ~ N R f E {
~ Lot # Block # SRJhd- Name ar CSId~ r
Ptoperiy ~ t+s AAefling Address 0.,, ~ /'~l~ e'!n ~ ~t~ ,~,~.
w r4 (, - -
[~ New censtructlon Use: ® Reeidenikll 1 Number of b.drooms _,~ '" `~- Code darivad doeign flaw ntte ~~„~ ~ Q G ~.-.. OPD
~ EiepiecemeM ^ Pub1c a cgnrngrdat . Descrlba; __......- --..•^ ~'"_ ....
.~4------•---,------ Fbod Ptah elevation ~ apl~~ --..-!~~--__.^--- tt.
Pensnt meterlat ,„__--~,. L e4 p
and dorrtmer~as~rrr: S~.~ICr-1 ~ U ~ ~/~ I ~~ ~O 4aw ~r ~ls •S'~
(+- ~ 1 ~~Q # Q~ tlo+tna Ciraund wrface ebv. q ~~_~ R. 1).Pkh to I:ttlting +a+Ctor ~_-.. in.
L `J set
Horizon bepth Domtcmnt Color Rr+dat Desrolptlon Texturo Structure Coneiatsnce 9axidary Roots
ki. Munaetl qu. Sz. Cant. Cabr 3r. 9z. St+• _ 'Eltarl
Q • ~ ~. ~ 4 1 11~F •~
--
,a .,. ..~. ~ trio < Iles 'tN\
~ ~~
9orkto * ~ pE Grou
>•pr4zpn Depth t)orniriant Color
M. A+lunedl
j 4- 3/Z
Z. 4 1!~ ~ewr y/~Y
td surllace elev. ~~~Q„,. tt. Oeptlt to Ik1~9 hacEar ~~ - ~+• gpp
Redox Desor~rtbn Textur0 Strudwe Conaietertce Boundary 14oots GPOJlt`
qu. SY. Cent Cobr Or. Sz. $h. "t<tt1~1 `E1l<1F2
E1Auetn 01 = 90D y 311: ZZO rnplL and TSS a30 ` 1 SD m91L ' EAluent IC2 ~ BOD ~ 90 mgA. end T133 .s, 3D moll
Slgnshre t~T ~~
CST Name (plow Print) f,'" .._ ; . ~,,,='' ..~-, ~~~7
~'~Cwc1-:~~In1~c~.Y~: '".-°`~!:`- ~•^ pate v~aluatipri'Conducted 7cbp-~oneNumbm
Addraw _ _ _
.
s- ~t~ /~~' tJ C' '7/S'- ~y'7~ '' 0
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tid Wdl:Z:l30 ~00z bZ '^~N 'ON i{dd W0~
^ Boring pQ~~,~~,.~
~°"g # [~ Pit Grotxrd wrfaoa Nev,1alsfcyG..- 5'
tlodng * ~ ~np ,.. T
^ Pft Around Burtaoe elev. ft•
Depth b lirrr~ing facl0r',„ ~/'?~ -r ~T•
Clepth m Ilmtln0 faG6Dr ..~~_..- in-
t7elAh b wrfitlnp taclor _,... m.
7'hc Do{7eetmcttt of Comtnetnc is an egtrel of-potitlstity yervicc ptovidcr 8ttme~m~1~tY~'~6(+-3151 orb TCY t4gR-264 ~t~4 or
need ror-tcxiat in un altern+tn format, P~ ~:ontact the dcpart
4~u~.k»ote.rnini
~d Wd~~:8O ~OOZ ~S '^~N 'Ohl Xdd : W0~
PotcW tp N .._~_ .- ~~.r~ P~ ~ ~ _ Of
~~ ~- W BCIa, > ao ~ A30 nrga•. and T8S >30 ~ 150 mgfl ~ 6fAuent ~ = gpp, c 3o mprL and 1'59 5 ~ ~
Boang
~~ ~ ^ Pit Groun4 surface elev. ---.•r---~.
.~
PAGE„~U~,~.
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SYSTEM FJ.EVATIUN~a ~-~ J~-•++r ~i•St~ I ~ ~ ~
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S'XSTEA~[ 'I'YI'J: A ~ II '~
C:UNTnT1R F,LEV,t#TIcaN ~~ ~ l ) ~
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~~"~ Safety and Buildings i~ivis'sust
' 2Ai W. Washin;ton Ave., P.O. Box 71b2
~~~~~~~ Madison, Wl S37Q7 - 7162
' pa ertment of Commerce ~ v-. 7 - ° '~` ~ ~~ ~ ~ ~
~ Sanitary Permit Appiicatian
Ia aooord wllh Cootm x4,21. Wis. Adm. Code, petsotsil iaWtaattica you provide
prir Isw s1S. 1 m
I. Appiin#fom Imform~a - P1aue Prior AU Information __ _ ,....-- .. , r- .~
.jT Cfrpr~1L
ttss
O Da.a ~ Er2 Q (2 .
^ Check ii Revision
bate Plan I.D. Nun:bsr
Property t7wner'a t-sus~ nacu.e.
~~~ ~ ST. Ci~'~0!X COUNTY
,,,... a... Z'>F Coda
~ sa.~/ ~ ~ S`t'(J~G ~G~-777
II. Type of BuUttt~ (duck au that sppiy} ~~~5`~ ~,,,, •
~,1 or 2 Fatdly DweUias -Number at Bedtootns ``
^ PubJWCotnmerctal " ~SCribe Use
0 state owned LZ~ tx93 ~,-~~•~. c~s --~'3a~"s ~t~X
III. ~ of P'aratk: (Chacic only oms box on iins A (aumbaiuF schaoe for latstsaai use).
A. Foo C
1~New 2 C Replacement syaasm , 3 ^ R~placemsm. of 5 0 Addition m
Tsalt Oni
B. ^ Checlt if remelt ~~ Praviauly Laud Pecmit Ntttatttr
IV. Type ~' Permit: {Chccic atu that appiy)(ntuulberime fcheme f; for imterttai use)
44 ton -Preeatriaed la-i3round 210 Mound 47 ^ Sand Filter
22 0 t'manuized m~ro~ at CI Holding ?salt 48 Q Siagle Prat
d4 n .t.~ 48 0 Aerobic Tratmeru vdt 49 O Recis~ul
Pio~r t>~ Dispatsal Asa
~'iLed Diepsrsal Area
~'0~ q33 ~ sou App~v
la
,
Rate(ch
/
)
VI. Tad[ Info Cape' ~ Ttual Number
t3a11caa Gattoae of Taaka
~v,~1. ~s ~s ~
Ocity
OVillage
~numahin ~G~-d ,50~/
Q
trro
SO ^ Constructed Wetland
51 ~ Drip Line
(Min.tJttcb) f~evattoa
9~` ° yy ~o
~Qi
pmt $itp Steel Fiber ~
Caocnte Consttuc~ Glue
Sepde a lioWieg'rint~ - ~ GJ~` z° ~s^ ''-
faaia t~embr ____
YQ• 1'di[ Statetneut- I, tlu , satim~e-ra >~' fee or the POWTS shown oq tlss attad>ed
Phunbsr's Name fPelatl piumbet's 8ignatSSee Number 8usimp Pb~one Number
. •„. _ „_. ~ Vii/ ~lf..~ a~~~94 ~~1s.3~'G--~~,~?~
TIII. /Ds t Use Od at S lure (No Sounps;
Saarary Permit Fee (includes Groundwater Date issued Issuing Age ~+
~,ApPr°"ed 0 Disapproved Surtiharge ~>
^ aw~cier siren initial Adverse ~~r-- . IS ?.oo \
Deosrmitwion
~, Conditioat of AirprowaVAeaeoma for Diaagprovet _ ~. ~,~ J ~- ~'~ w : Cl ~
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` Wisconsin Department of commerce SOIL EVALUATION REPORT
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County
Attach canplete site plan on paper not less titan 8 1i2 x 11 inches in size. Plan must
include, tort not limited to: vertipt acrd fraizontal reference point (BM), direction and parcel l.D.
percent slope, scale a' dimensions, north arrow, and location and distance to nearest mad.
Please print all information. Reviewed by
Page ~ of „~
Date
Personal information you provide may be u ftX P ' t.aw , s. 15.04 (1) (m)).
Property Owner Property Loption
(~/1C ~CL ~~- Govt. Lot Sf: 1/4S~ 1/4 S (( T Zq N R ~ ~ E ( W
Property Owner's Mailing Address APR 2 2 2 0 ~ 2 Lot # Block # Subd. Name or CSM#
9 ~I ~ ~ ~ r e d . ~ ~ - I-~~ I~, n S ~' ~a-~P S
City
State Zip Code P3t~n@ft!Qtl'ltt~OU NTY [ j City ^ ~Ilage Town Nearest Road
~( eNl I r
~
k
R
VG G _ , (,J t SyQ ~ V C n (
1c
~
~ New Construction Use: ^' Residential / Number of bedrooms Code derived design flow rate C/ ~~ ' ~ O ~ GPD
Public or commercial -Describe:
^ Replacement
^
!
L.
Parent material r) V i (.J 0. S "'1
Flood Plain elevation if applicable ~ i A
T ft.
General comments SYS~:pvY) e~ e ~ ° y Z~ G ~
and recommendations: p~ e tJ , Q l~ ~ ~
/~ l~~ •
'~
^ Boring
Borin #
g r~ ~~ Z 9/1 _ ~ I (1
..1 l,al F'II vwuuu auna~.c c~cv. , i iii u. ~cNu~ av nnnwy ~a~..v~ ~,, - n..
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
in. Munsell Qu. Sz. Cont Color Gr. Sz. S
h. `Eff#'1 *Eff#2
~' ~ ~~ VV
/vl ~l\ ff
r ~ S ii
I
Z -Zo ~I - f r7 (~Z
z~ o
zz -'F-
^ Boring
Boring # r~ _ g ~ sr~r ~ ~ n
=J ~ rrc .~~~,~n, ~W ~~ ~,,. - ,.. ~,w,u..~ ~..~x~.~ ~a....,~ ~ ... ~,~. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft~
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 *Eff#2
i o-io S~ ~~l~~k 1<'~ cS v ~ ~ ~ 5
a-~s ~ - S s ~ c 5 - ~ 7
~ ~ ~ ~rJ Ip - Vt'l S G - - ~ ~ Z
z , s8.9
` Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 _< 150 mglL ` Effluent #2 = BODS < 30 mg/L and TSS < 30 mglL
CST Name (Please Print) i ature CST Number
Address Date Evaluation Conducted Telephone Number
2113 csd ~~' S~ So ~ e r'Se f w t ,~to z S- I - I S= 0 2. ~ i s Zy 7 yo 08
Properly Owner ~ C~ 5~ Parcel ID # Page 'z of ?
Boring # ~ Boring o
Pit Ground Surface elev. 9 ~ o ~ ft Depth ~ Hmiting factor ~ ~ in. Sod Appdcation Rate
l Redox Description Texture Structure Consistence Boundary Roots GPD/ft~
tforizon Depth
in. or
Dominant Co
Mansell Qu. Sz Cont Color Gr. Sz Sh. 'Eff#t 'Eff#2
o ~a , ~ ~.~ b1< Fr cs , ~
-Z _. ~ ~ ~ --, 1 ~Fr c - , 7 ,. z
-l ~ y - ~ - z
B~ # p Boring
^ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Florizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlfl2
in. Munsep Qu. Sz Coat Color Gr. Sz Sh. 'Eff#1 'Eff#2
~n9 # ~ Boring
Ground surface elev. ft Depth to limiting factor in.
^ .Pit Soil App6catron Rate
Redox Description Texture Structure Consistence Boundary Roots GPD/ft~
tiortzon Depth
~. Dominant Color
Munsefl Qu. Sz Cont Color Gr. Sz Sh. 'Eff#1 'Eif#2
'Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BODS < 30 mgR. and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SBD-8330 (807/00)
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` ,.
PAGE 3 OF 3
NAME 13 G-S ~ TOT# ~ O LEGAL DESCRIPTION ~E %5 t ~ ,S /1 T zY ,N,R. ~ `I E(or)~
SCALE: 1"= ~(j ~
BM I ELEVATION /C~v . o
BM 1 DESCRIPTION n ~ t ~ i ~ ~ • ~ ~ ~ ~
BM 2 ELEVATION IG-U~ c.>
BM 2 DESCRIPTION (1 ~~ + ~ ~~ n ~ ~ ` P ~ ~
SYSTEM ELEVATION tjZ~ G
ALTERNATE ELEVATION q l~ ~' d
CONTOUR ELEVATION ~~~~ r `7 ~• G`'_ ___
~'. / /
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L7
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(3- Z 4~y, acs
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SIGNATURE ~~~.~ ~ ~ DATE ~~,~ - Q~
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 Desi n S ecifications
5anita Permit Number o 3
Number of Bedrooms
Desi n Flow -Peak ( pd} u~
Estimated Flow - Avera e ( pd)
Se tic Tank Ca acity { al) I Z~
Soli Absorption Com onent Size (ftz
Ty a of Wastewater Domestic
Table 2: Soil Absor Lion Com onent -Limits of Reliable Operation
Se tic Tank Component Soil Absorption Com onent
Desi n Fiow -Peak d 3 3 °~ ~
Maximum Influent Particle Size {in) 1/8
Maximum BODS (m !L) 22Q
Maximum TSS {m !L) 154
~t
Table 3: Maintenance Schedule
Septic Tank Inspect and>or service once eve 3 ears
Outlet Filter Inspect once a near and clean at least once every 3 years ,
Soil Absorption Component I inspect once every 3 years __ i
eptic Tank
The septic tank shall be maintained by an individual certified to service septic tanks
under s. 281.48, Sta#s. 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. Th outlet filte shall be cleaned as necessary to ensure
proper operation. The filter cartridges ould not be removed unless provisions are made to
retain so i sin the tank that may slough off the filter when removed from its enclosure. If the
. Management Piat~ fr~• a Septic Ta^ k and So=; p.csorption Com,~a~ent
f(iter le equipped wltn art alarm, the filter shall be asrYlCed 1f the alarm !s activated ~~ontinuousty•
lntetmlttant toter a1a-ms may lndlCate surge 1101Ne or an in'tpendlrty contEnuous alarm, The
eeptlc tank shall Nava l~ oonama romovsd when tl~s vplume of scwr end sludge lr~ the tantc
axcaeds t/3 the iiqutd volume of the tank, !t the oontar+ts of tha tank en not removed at the
time of an aeeesement, t7talntenance penonnel shall advise the oavrter of when tote next service
needs to ba perionned to rrtaintaln lass than maximum tourR end sludge aoa~mu}atlan to the
t~rtk.
Manhole deers, access rlaero and oovara should be frwpeated br water tl~htnsas and
aoundReaa. ACCeui opertlrt~3 used for tervEt~e artd aesesement fhtl{ be ,salad wate~rtlpht upon
the Compfetlvn of sarvk>!. Any opening drtemed ansound, dsfettlve, or sub,{ect to iallvre must
be repiaoed.. Exposed aoCeste openinss teeter than &-IAChde !n dfanleter ahalj be secured ~y,
an a!!riotlvs loo#clnq davlcs to p»var:t ecektantal or unauthorlsad arttry into the tank.
I1I0 area ahstuid any' a as~INC Oi' otf-ar b~etblleA=~~~~`~ ~
any r+raaon wkhoat tbolr~ 1a ~u1f aanpllance o or other
•tt~ltt'lt>~ a t~on~rad~. T!t! llraojpl~- twt~iNn t!» +wpN
trtltb~l! of ho~dln~ tank Syr !n and nrcua vs* e
pawn t~r+orn a» 1n~rlar ~ ~ t1~c nuy~• din a~ Impoalbl~
Tank aband~mant shall be to ac~rdanw with Comm a3,a3,1Ms. Adm. Code wh®n the
tank la no tapper weed n a POwrB component,
The soil absorption campanent eervlna this structure is deslpned t4 accept domestic
wastewater tram a rasldanual iacliSty. The limits of opsratton of thls oamponerzt are shover i~
'Tabls ~~
TIC !or-gevity of a sot! absorption component depends pready an proper and timely
maintenartce~ and system ua within or behave the Ilmits of rollable operation, flood water
troru~rvatlan pcaotioes by elf o~panttt and the lnstalfa~an Of wst*r conswe:,rlAfl plumbing
fixtures are fcey factors fn eadsndlrtp the useful site of thh oompot»nt,
The soil absorption oompar~erit`s cparatlon moat be asssaad by lnspectton at least
once every three years. The InspsCtton ,hail Include »~rding ~ Irrals of pondlrtg, if ehY, in
tkf6 observation pipes, artd a visuati InspeCtlon fot' any evldenc~ of surface seapapet or d~scharpa
from the oomponant Cn steeply sloplrMp sites areas o1 erwlon ehauid be ldent}~ad #nd
reported to the owner for repair. The surlsoe discharge of darnastiC wastewater or sawape
ft~t tine system to prohibitsd anti consi0erad a humsn health hazard
Tr~c araur~d ar aver the soli absorption corrtponent eh~laver the Ecomponsnt Im Y lead
during winter months, The compaction or removal of snow Dauer
to hydraulic hilun by frseZlrts. This type of fallurs }s uswliy tamporary~ but ~ dliNcuit or
lmpveNaibla td repair un#}t vrreather con¢~tans improve, In gansret, ski compaction over this
oornponent will r~aduce dlffusbn of oxygen into the soft and dtspersat oats, whtaf~ may 10a-d to
t'rt~"e Iri~ttutt, artd earlier, ot~snic clogpfrip of the call,
x
Management Pism for a Septic Tank and Boil Absorption Campnnent
Plantings of deep-rontsd trees and shrubs diroctly over of within ten feet of the component
should be avoided since root intrusion into the component may obstruct wastewater #iow.
Cantinsency Pian
in the event of system failure, a new system could be irntaliod in an alternate area. With the
installat}an of a diverter valve, the existing system could also bs reused aft' s period of three to
four years.
k is the property owners responsibility to maintain the sitemate area free from any pisntirrg of
trees, shr.~bs, etc. In Casa of failure of the original system, the aiternata area wi}l be needed. if
any trees, shrubs, etc. have twen planted on the e-ternste area, they will have to be mm~ved at
property owners expense.
If sitemate area is destroyed, there are other alternative systems that can be used, in which,
could result In added expense to the property owner.
Any tank aisandonment shell be done in sccnrdance with Wisc. Cade 83.33. Any questions
regarding this cads, pl~~asGe contact your local Zoning Offiw or lcontact the instaNing plumber.
5 c.~ ~..n, v.1~.~.n„ ~ l v~ eY, b ~ r.>
' ~ C~,s~ 3$ ~ 3 ~ ~ i
FROM ,: Schumaker Plumbing FAX NO. 7153121 Sep. 26 2002 11:36AM P1
ST CROIX COUr'TY
SEPTIC T'AN1C MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
owl~erlBuyer ~e ~.~~~ ~ ~~ ~. ~'.'
Mailing Address ~l~' ,1 rx ~ -~ ~ ~ d,~J <
Ptop~ty Address -1 ~ a
(vmifioadosi rege:itad from psr:miog Daputamsit for stew
City~State
Parcel Id~tification Number - i u~ - io - ~ C• 2S
d ~ ~ ...
Property iACatyan 5~ '/., ~ '/,, Sec.1,~, T a9 N-R,,,~~.VV, Tciwn of . ,~~~so •/
Subdivision d ~~ ~o,,E? a ,~~s' , ~~-~ -- ---. Let # .~...l _.
~ $nrvey limp # - ~ . Valutns ,Page #
Warranty Deed # !~ ~~ ~° ~" „ .Volume I S`f~ _. Page # 16 q
Spec hawse ~ yes ^ nn
I.ot lines identifiable ~ yes ^ as
SYBT 1V~AA~iTENAN
improper usz and main~aacoof your amptie system could result in its pramanae fa#lure to handle wastes. Proper waiatenaace
tois~ists of pumping nut the septic tank every three years ar s if Headed by s liteusad pumper. Whst you put into thm system
~ afI'eat thm 8mctioa of the optic trnik as a treatment stags in Cbe waste dispaaal system•
The pnaperty owitiet agtnms to sabmit to St. Cm# 8 Daparm~t a cmrtiScation 5oem, signed by the asm~ srid by e
masterpkunber, joaarpeymaaphitaber, restrtatmdphmaber or a licensed Pumper vsrifyiisg that (1) the oo-site ~veetmwnta~rdiaposal apeteln
is in propmr opeaating eoitdit~iaa atid/ar (2) aRer i pmaP~ (~ ~~ ~ ~Phk tank is loss than l/3 full of sludge.
Uwe, the uiidarsigned havo read the above rmquireuiGnta aa,d agree to maiiitaist thm private smwage disposal xymteoa with the stmadards
~ herein. as set by tlu ~t of C~o~icrpe end the pmparttneat of Natural Reaatrces, State of Wisconsin.. C.ertifieation
atatmg tb¢t }roar amptic syateuti bas been maintained mast bm completed a~ rctunvod to the St. Ca~oix County Zoning Office within 30
days of y a~Cpiratiou date.
~° ~ ~
-~-,,. ~ CJ i /~,~
SIC4NA'RJRE C-F ~ DAT]3
OWNER GERT'~'~~N,
I ( ) eert~+ that aljsMtauei-ts pa this i'orm, arm true to the best of any (anr) kaowlodge. I (we) am (art) the owuei{a) of
the deacxi by virtue of a warntnty demd raeoxded im xegiates' of Doads Ot~ice.
- _- -
3IGNA'I"t3RE OF !CANT DATIa
''+`«+"+ Any iafarmation that is this-repre~tcd may rmsult is tlu sanitary permit ?ping revokod by the Zoning Department.'•«*s,
*« ~clude wit4 tt-is sppUeatl~: a stampe8 warranty deed &dna the Yteg~ter or Deeds o~
a copy of the eertifed Bey map if refertee is tirade in the warranty deed
2007P 431
St. Croix County
Occupancy A>~davi~
N~ am (Owner) Typed or printed
being duly sworn ,states, under oath, that:
1. He/she is the owner/pact owner of the following parcel of land located in St.
Croix Countv. Wisconsin, recorded in Volume Page Document
Number ~ _ St. Croix County Register of Deeds Office:
A parce! of land located in the ~ '/. of the ~ '/. of Section ~ I ,
T__ 2~ N - R ~_ W, Town of ~ SOIJ , St. Croix
County, Wisconsin, being duly described as follows (include tot no. and
subdivision/CSM or detailed legal description):
Lot ~ 10 ~ i~oelc.,Ns Esrl~`~s
693693
KATHLEEN H. MALSH
REGISTER OF DEEDS
ST. CROIX CO. , YfI
RECEIVED FOR RECORD
10-10-2002 9:20 Pt1
r7FFiURVI?
EXEMPT
REC FEE: 11.00
TRANS FEE:
COPY FEE: 2.00
CERT COPY FEE:
PAGES: 1
Name and Return~~--aadross
~h~rg~L ,e~irrurssw
9d 1v 0,~ ~t ~
Mkt ~ G.JI' ~y01(~
n2D- I`}W ~ 10 -O'O~D I
owner of the above described property, I acknowledge that the septic system serving this residence is sized for a
bedroom home, or a design flow of ~~, gpd. The design flow is calculated by uming 150 gpd for 2
individuals per bedroom. There are currently ~P occupants living in this residence; occupants are permitted
based on the design flow. Therefore the septic system serving this residence Is code compliant. However, I
understand that if there are intentions to exceed the number of permitted occupants, the system will need to be
modified to accomodate any increased wastewater flows and/or contaminant loads. 1 also acknowledge that 1 will make
this information available to any future parties interested in purchasing this property.
Dated this /D ~~" day of ~=a ~ I . ~°J~
'n ~/
• C Pr QS~'
r
AUTHENTICATION
Signature(s)
authenticated this day of
w
ACKNOWLEDGMENT
STATE OF WISCONSIN )
~s.
S . C County. ) ~ 6~
Personaly came before me this ~ C day of _~~
the above named
Ch es-,r ~ A . ~asm asses.
TITLE: MEMBER STATE BAR OF WISCONSIN
(If rat,
authorized by § 706.06, Wis. Stets.)
THIS eJSTRUMENT WAS DRAFTED BY
~, ~~
L L
(SignaWres may be authenticated Or ackrawledged. Both are not
necessary)
'THIS PAGE IS PART OF THIS LEGAL
to me known b be the peracn(s) who executed the foregoing
instrument and ackrawledge the same.
Notary Public, State or W sco Ir
My Commission Is permanent. If
Data: t - d - aoo3
CUMENT - DO NOT REMOVE"
This hrormatan must be completed by submllter. e^d ~ fyreQr~Hed)' ~~ ' ~ ~
ganrrg eleuses, >~al descdpron, etc. maybe paced on this rBi page ar the docrxnent a may be placed on addrr~ , ,~`
document. ~; use d this cover page adds one pass ro your document and;z 00 ro rile rocorditl4 fas. Ut?aconsh+ IR
.u 2oos~ y~i
6938 i S
KATHLEEN H. MALSH
REGISTER OF DEEDS
ST. CROIX CO., tfI
Document Number Document Tlue RECEIVED FOR RECORD
St. Croix County - 10-11-2002 12:00 PH
Occupancy Alf suit ~ AfFIflAVIT
EREMFT ~
~~
~~ J ~ ~~ ~ ~~-~~ REC FEE: 11.00
TRAIiS FEE:
CE
Name - (Owner) Typed or prints ~ RT COPY FEE:
PAGES: 1
being duly sworn ,states, under oath, hat: ~SV,
1. He/she is the owner/part owner of the followin I of 1 d located in St.
Croix County, Wisconsin, recorded in Volume / Page t
Number~~7 St. Croix County Register of 1Jeeds Office: Race fn Area.
A parcel of land located in theSE '/. of theses '/, of Section ((
N - R / Q W
T~
Town of t~QSpt7 St
C
i Name and Return Address
~~~ ~; ~fjA-s'Z'
_
,
.
ro
x (}.~~ ~~qR~E /C[I.
County, Wisconsin, being duly described as follows (include lot no. and 3e++~, tt9t S'ut0(~P
subdivision/CSM or detailed legal description):
,Cr,T ~ io ~opKlus E3Ti~•'T83 a~-i~cce-io-mlo~
Parcel Idenl~cation Number (PIN)
As owner of the above described property I acknowledge that the septic system serving this residence is sized for a
bedroom home
or a desi
n flow of ~ The d
i
i
l
i
150
2
fl
l
t
d b
d f
,
g
es
gn
ow
s ca
cu y assum
ng
or
a
e
gp
indlvlduals per bedroom. There are currently occupants living in this residence; ~ occupants are permitted
based on the design flow. Therefore the septic system serving this residence is code compliant. However, l
understand that if there are intentions to exceed the number of permitted occupants, the system will need to be
modified to atxomodate any increased wastewater flows and/or contaminant loads. I also acknowledge that I will make
this information available to any future parties interested in purchasing this property.
~
TAt~ecr; , ~.
O
~
this 1 ~
day or
_p
.
~
t ~ u a- +taT' •
ADTHENTICATION
Signature(s)
auttrcnitcated this day of
•;.*:::.
* ~C
i
TITLE: MEMBER STATE BAR OF WISCONSIN' .; ; '. ~
(If not. : O ••
authorizes by § 7116.06, was. stacs.l ~I .. x
~I THIS INSTRUMENT WAS DRAFrE~84 ~ '~` ~• ~`'~ -
/1~~1 ~ Bps?' ,r . G r
;;
(SlgnaWres may be authenticated or acknowledged. Both are not
necessary.)
ACKNOWLEDGMENT
STATE OF WISCONSIN )
)ss.
St Croix County. ) /~ J ~,
Personally came barwe me this ~ f day oty C7'0
~(0 ~ the above named (. ~r 5 f
~~t'no-r. d (~a
tome known w be the person(s) who executed the foregoing
instrument and adcratMedge the same.
Q~ ~~
~ui7=T-r~ oe
Notary Public, State of Wisconsin
My Commission Is pemurnent. If rat, state expiration date:
Date:
"THIS PAGE IS PART OF THIS LEGAL r7000MENT - DO NOT REMOVE"
,~
Th7s Mlorrnntlon must be completed 6y sutwrYMer. Qpcrrrnent tkle. name d return address. and j?((( (bregtrlred). Ofherlnlorrnetion such as lire
granthg clauses, /saga! descdptlon, etc. maybe pJsced on fhls lust page oI the document a may be placed on additbnal pages of the
document. Note: Use of this cover page adds one page to your docwnent and x.00 to dre recordno lee. 4tKsconsin Statutes, 59.517.
' ~ r ~Ij~: ~.546PAGE169
6361707
STATE BAR OF WISCONSIN FORM 2 - 1999 Y,RTHLEEN H. WRLSH
Document Number WARRANTY DEED kEGISTEk OF DEEDS
57
WI
CkOIX CO
,
.,
This Deed, made between Wallace L. Billy, a/Wa Wallace Lee RECEIVE- FOR RECORD
Billy, a/Wa Wallace Billy, and Katharine M. Billy, a/Wa Katharine Billy, 0?-28-2000 9:15 AM
a/k/a Katherine Bi11y~, hLSband and-wife, ___
__ NRRRAHTY DEED
_ __
Grantor, and Kernon J. Bast and Donalda J. Speer-Bast, husband and
_ EY,EMPT A
CEP.T COPY fEE:
wife,
.
-- --------
_
- COPY FEE: p
oo
-
-
-- --_- -- -
---
--- -
--------- ,
TRANSFER FEE: (3S
ORDING FEE
00
10
----- -- ------
---- :
.
REC
PRGES: 1
________ -
Grantee.
Grantor, for a valuable consideration, conveys to Grantee the
following described real estate in St. Croix County,
State of W isconsin (if more space is needed, please attach addendum):
S W I /4 of SE 1 /4 of 1 I-29-19, EXCEPT South 198 feet thereof, St. Croix
County, Wisconsin.
Recording Area
Name and Return Address
I/~ ~ L/
~n_t m a_>an_nnn
Parcel Identification Number (PIN)
This is homestead properly.
Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any.
Dated this __~~7 day of ,August 2000
AUTHENTICATION
Signature(s) Wallace L. Billy, a/Wa Wallace Lee Billy, a/Wa -
Wallace Billy, and Katharine M. Billy, a/Wa Katharine Billy,
a k a Katherine Billy, husband and wife,
authenticated this ~ ~a//y of _--~jq~/~" 7Q,4TZ>
V~
. Kristina Oland
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, _
authorized by ~ 706.06, Wis. Stats.)
Wallace L. Bill, a/k!a Wallace Lee Bill , a~ a Billy _
• Katharine M. Billy, a/Wa Katharine Bill , a/k/a
Katherine Billy
ACKNOWLEDGMENT
STATE OF WISCONSIN )
ss.
County )
Personally came before me this _ day of
the above named
to me known to be [he person(s) who executed the foregoing
instrument and acknowledged the same.
THIS INSTRUMENT WAS DRAFTED BY . - _^
Attorney Kristina Ogland Notary Public, Slate of Wisconsin
Hudson, WI 54016 My Commission is permanent. (If not, state expiration date:
S' b th t' ated or ack o led ed Both are not necessar ) •)
to
(tgnatures may eau en tc n w g y. __. -
+Names ofpersons signing in any capacity must be typed or printed below their signature. tdorrnalbn vroreuarui. Comteny, tuna au tae, wl
eoobse-sort
WARRANTY DEED STATEHAROFWISCONSIN
FORM No. 2 - 1999