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HomeMy WebLinkAbout020-1445-06-000Wisconsin Department of Commerce Safety and BLilding Divisior~ ' PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes tPrivacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Bast, Kernon Hudson 7ownshi :ST BM Elev: Insp. BM Elev: BM Description: ~/ l ~ ~ D / o ~ .-~ ,Qyy)~ f T ~' ~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic S Dosing ~ ,{ /~D J-- Aeration -~~ Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic I Dosing / z 1. Aeration Holding PUMP/SIPHON INFORMATION ~~,(.(-~1 / Loss Dia. (Dist. to Ft ELEVATION DATA county: St. Croix Sanitary Permit No: 463125 0 State Plan ID No: Parcel Tax No: Section own/Range/Map No: 11.29.19. STATION BS HI FS ELEV. Benchmark ~~ l O ~ ) / t7a~ a Alt. BM ~ _ / 1, n r-G ~•~" -(,(~ g ~ ~ 6 ~ ~ ~~ Bldg. Sewe /U~sc~ /~ ,~ 9'2 .~ ~ SUHt Inlet ~~• ~7 ~• SbHt Outlet Dt Inlet /- ~ Dt Bottom ~ Header/Man. ~ l Dist. Pipe Z~r>~ ~ 3 !~ ~ ~ Bot. System ~(7 ~ 3 Final Grade ~~Si~ ', ~~ c(Y. 7 St Cover r~ s ~D3 6.~ ~-` SOIL ABSORPTION SYSTEM Z 2 ~~ ~ ~ QO ~-3 -v.iL~ ~~ ~ ~ ~'~S BED/TRENCH DIMENSIONS Width Leng~ ~ (J No. Of Tren es PIT DIME No. Of Pits nside Dia. Liquid Depth ~ b SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREA LEACHING anufaflyrer~ / / _ INFORMATION CHAMBER OR ~ ~ n C 'f~ Ty Of System: UNIT Model Number: DISTRIBUTION SYSTEM .-~r~v~ -~ ~ - wv}J.S~_).Prt•h, Header/ nifpld fi (/ y Length Dia ` Distribution / ~ Pipe(s) ~ 2 ~ Length g~ Y Dia Spacing x Hole Size ~----- x Hole Sp SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over ~~'~ Bed/Trench Center Depth Over BedlTrench Edges xx Depth of To soil xx Seeded/Sodded xx Mulched p [l Yes No [] Yes ~u No COMMENTS:. (IngJude code discrepencies, persons present, etc.) Inspection #1:~/~~ /~ Inspection #2: / / Location: 753 , ' /~~ it H~(u~d~son~,~W}-I 4016 (NW 1/4 SE 1/4 11~~11T29N R19W) Sunset Hills Lot 6 Parcel No:11.29.19. 1.) Alt BM Description ='~~ w _"'~'" ""' ~~ ~~~~ ~~ `~'-5' ~ Yv~.C.~J ~~~~G~~ ~ / 8/ 6y 2.) Bldg sewer length = ~ ~~ ~ ~-s,~`"'``' ~ ~, ~3 - Sl -amount of cover = a ~ ? ~~ ~ „ ~Ij OK ~ j Y ~ i-- 1r~7 r---- / --- Plan revision Required? ~; Yes ~] No ~~ ~ _G~(/1'1/h` Use other side for additional information. ~ a ~~ 6 _ ~ ~ _J SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. Y acing Vent to 'r Intake ~ `h ~- / i ~" "V' ~ r y~ /'~~ /' , ~I ~0~ 2 2 I~ ~__~ v ~f ~ ~^~~ ~ ~~ ~ ,~ c~v~0 3'9 n d c ~ 3 N O ~ n 3 ~ :: ~ ~ ~ ~ ~ :. 3 , '~ ~ m Cs n ~ x O n ~ N N O O W N C ~ ~ • ~ r a O 3 ,-~ fD y w v, N~ a CO y p I _ ~° c o ~ m 0 ~ co 0O N a , ~ 0 3 O ~ 0 .7 3 C ~ o ~ ~ ~ ~ to H w ~° C \r 0 I ~ v D y ~ ~ ~ a m ~ ~ ~ a v I ~ ' ~ ~ Qo~ ~ y ~ oo ,o~, N ~~ o~nj c ~ ~ N ~~ O c ~ ~ n ~ O Q 3 r. ~ I °' a o 'v m ~ ~ r. 2 o C ~ _ ~ ~ ~ ~ rn w ~ ~ ~uJVJO ~ I o -°- m ~ A ~ rn ~ pp ~ ~ 9 = I a ,` d y 3 °-' vi N Q •• 7 •' Z O () ~ 77C =~ 7 ~ p d ~ ~ I N ~ O fD ~ p ~ C (7• N ' ~ a w I m ~ Z I ~ ~ y m ~ ~a ..~ Z eyD ; ~' ~~ N ti o. A Z O ~ 7 O Z ~ ~ ~ ~ ~ ~ o ~z •~ ~ A ~ O w ~ ~ 3 m ~ ~! Z ~ A A N `~ ~' O O G (~D d O ~ CD A C y p_ ~. N G I ~ m.~o,ov ~ Z a ' o<sm~ 'y l a c <~ Q O I o °: _ O o o< a~ ~ ~ v W N 7 ~. y C7 ~ rn a A ~ ~ ~ c o ' ~~v a~ ~ ce b ~ ~ y d N Q .+ 3 ] 1 ~ ~ C O N fD ~ cp ~ m ~ tn' O O ? ? 7 ~ » tG ~ O CN fD 7q ~ ~ ~ ~ ° o b o ~- ti ' Safety and Buildi vtstyy,,~~ ((~~ 201 W. Washington Av . Boz~'9162 Dory, ~ , , ~ Madison, WI 53 QT- 162 _ _ , anitary Permit Number (to be filled ' Co.) lscons~n ~g _ 51 ( ) ~ ~ De artment of Commerce Sanitary Permit Applicati n EIV~' Ian I.D. Number j . ~ ~ ersonal informat' you provide C d Wi Ad 1 o e, p m. , s. In accord with Comm 83.2 may be used for secondary purposes Privacy Law, s15. 1 xm)D C~ C Proj •t Address (if diff nt than mailing address) I. Application Information -Please Print All Information ST. CRQiX ,J Property Owner's Name Ci OFFICE Pa I i'1 t ocl # Pro Owner's Mailing Address Property Location ~ y., ~%., Section ~~ City, S e Zip Code Phone Number / ~ ~ ~ F C.t~--rte" ~ ~ ~~s ' ~~ /j ~'~ C~ N: n) '7cEcIe9Deo1 '°-F 'X-~- o~ II. ype of Bui ding (check all that apply) 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Nu t ~i ~ L~y~ _ 'Yl/~ ^ public/Commercial -Describe Use ^ State Owned -Describe Use ^Ciry illage ownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) ~. o Q A' New System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal evision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner N. 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 thing Chamber ^ Drip Lin ^ vel-less Pi _ ^ Other (exp ' V. Dis rsalll'reatment Area Information: / at ion ev Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Req fired (sf) Dispersal Area sf) System E~l / ~ J VI. Tank Info Capacity in Total Number Manufacturer Pre ab Site Steel Fi r Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank ,-~ ~-- Aerobic Treatnxnt Unit Dosing Chaffer VII. Responsibility Statement- I, the undersigned, assume responsibility for in Ilatioa otthe POWTS shown on the attached pleas. Plu N m Print) ~ lumber' gnat PRS Number Business Phone Number { a~3s ~~`=a~ ~- ~ 9ys- lum is Address (Street, City, State, Zip ode) VIII ount /De artment Use Onl Sanitary Permit Fee (includes Groundwater to Issued 1 tog Age Signature ( Stamps) Approved ^ Disapproved Surcharge Fee) ~/ ~ ~ /~ ~ ~ -~P sV ' ^ Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval ~~`' ~ ~ l1~3~~oy~ ~~~ ~ ~~ ~~~~°C `~y/~~. Amen eomptere pum (ro ca a,ounry vnryt .ur .,,c .~..~....... v-~^.• ••-• ^-_ _._ SBD-6398 (R. 01/03) ~ _ 1~~. I aso ~~'- N~' U~ SY ~ 8° ` - 9~f ~o ~3~ ~ -~n~ , r- T a z~-~-~ ~'s~- ~ - ~ -aa l~ ~ ~~L ~~3-3 _k f ~- y~, i ~,,;~ raj r~ ~~ ~~ ~~~~ o h l~~~( ~3 ~ ~ ~~~' rvu~- o~203s ~ 93. S~ ' ~ =a 9.~ ~ o ~ ~ _ 1~~. v` N ~..~ r- l T- a '~s~- ~ - ~ ~--a 3 ~ ~,,e~ r~-~ ~-aa 3 ~ ~ (/C_ ~ i~l~- ~l = ~bo ' T~ ~ ~y ~° k~3-3 ;- ~~, ~~~ 9~ ~ o ~ /~ l/~ ~~ a~O3s ~ - '7i Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT in accordance with Comm 85 Wis. Adm. Code 1583 Page 1 of 3 Steel's Soil Service, Inc. Attach complete site plan on paper not less than 8'/: x 11 inches in size. County St. Croix include, but not limited to: vertical and horizo ntal reference int BM , di on percent slope, scale or dimensions, north , an m o n 'O Parcel I.D. pending Please print al Personal information you provide may be used info secondary purposes (Privacy Law, s. 75.04 1) ( R ew Date 1 Property Owner McCabe Homes Inc. - - Pro Govt erty Loca n Lot na SE 1/4 NE 1/4 g 11 T 29 N R 19 W Property Owner's Mailing Address ZONING OFFICE Lot Block # Subd. Name or CSM# 935 Osprey Blvd 6 na Sunset Hills City State Zip Code Phone Number Bayport ~ MN 55003 651-351-1018 ~ City j Village ~I Town Nearest Road Hudson Wild Turkey Trail { New Construction Use: Residential /Number of bedrooms 4 Code derived design flow rate 600 __J Replacement J Public or commercial - Describe:na Parent material outWash Flood plain elevation, if applicable na General comments and recommendations: Conventional system, system elevation 93.85ft .Trenches spsaced and depth to code 3.50ft below grade. ~ ~Gf_P~.2 GCG ~/ `~ ~ ~~'+~ cv-1 ~/Gl GPD b Boring # ~ Boring ~rj Pit Ground Surface elev. 97.35 ft . Depth to limiting factor 96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft2 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-4 10yr3/1 none sil 2msbk mfr cs 1f .6 .8 2 4-32 10yr5/6 none sicl 2msbk mfr cs 1f .4 .6 3 32-96 7.5yr4/4 none ms osg ml ns na .7 1.6 Boring # ~ Boring Pit Ground Surface elev. 97.35 ft. Depth to limiting factor 96 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Dlft2 in. Munsell Qu. Sz: Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-5 10yr3/1 none sil 2msbk mfr cs 1f .6 .8 2 5-12 10yr4/4 none sicl 2msbk mfr gw 1f .4 .6 3 12-20 10yr5/6 none sicl 2msbk mfr gw na .4 .6 4 20-32 7.5yr4/4 none ms osg ml rrs na .7 1.6 5 32-96 7.5yr4/6 none cos osg ml na na .7 1.6 * Effluent #1 = BODS> 30 <_ 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mglL and T55 < 30 mg/L CST Name (Please Print) \ ignature: ~ /,c _ , CST Number David J. Steel ~ 248956 Address Steel's Soil Service, Inc. Date Evaluation Conducted Telephone Number 994 200th St., Baldwin, WI 54002 11/8/2004 715-684-5680 ' Property Owner MCCabe Homes Inc. Parcel ID # Pending Page 2 of 3 a Boring # _:~ Boring ,1~" Pit Ground Surface elev. 95.05 ft. Depth to limiting factor 9( in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr3/1 none sil 2msbk mfr cs 1f .6 .8 2 10-22 10yr4/4 none sicl 2msbk mfr gw na .4 .6 3 22-36 7.5yr4/4 none ms osg ml gw na ..7 1.6 4 36-96 7.5yr4/6 none cos osg ml na na .7 1.6 0 ~~' 3~ / j /p t ^ Boring # J Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ goring # ~ Boring +_J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS> 30 < 220 mg/Land TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employee 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. r ' STEEL'S SOIL SERVICE INC. 3 of 3 David J. Steel McCabe Homes Inc. 994 200' St. CST-POWTSM sE1/4,nE1/4,S11,T29N,R19W Baldwin, WI 54002 Lic. #248956 Town of Hudson, St. Croix Co. Bus.(715) 684-5680 Sunset Hills, Lot 6 Fax.(715) 684-3449 Legend N 1" = 40' I • =Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe • =Alt Benchmark Ele. 99.55 ft Top of 3/4" pvc pipe ^ =Borings Boring Elevations B1 = 97.35 ft B2 = 97.35 ft B3 = 95.05 ft B4 = 0.00 ft ~~~ -ys' ~// ~ +~i g3r l`f~~ ~~` ' ~ ~~ ~ ~~ 70 ~~~ 1~~ - _ - ,~-,_-_ . ~~` ~-- ~~ I ~ n ~ m v=i o I ~ a m w e ~ p o y N a 7 7 O {~ ~ O C A I 3 I I 0 ~ a y m co ~ ~ a o W ~ ~ O o ~ ~ m Za O 5 fD I a a o C ~ i o~ a v I ~, ~ ~ N ~ a I _Z 0 I ~?~ O y ~ m ~ ~ m d O ~ c I w ~ = c'o z ~? o ~ ~ ~ 7 ~ y ~ O_ ~ ~ N > ~ (D ~ ~ O y N v~ I ~ 3 I ~' s I I ~ 0 0 0 = ~ D ~~Qm a I w ~'.~ 3 m a I c m~ a a m 'ao~' z N p O ~ O ~ ~m~~~ m O< p p p y ~ ~ ~ N a~~yCD 7 O (mod ~ ~ N C a O ~ -o a~ ~ ~ C O 3 (O N ~ ? ~ Ul C N Q ~ v ~ fD fD ,C. I ~~~.o C O y fD ~ y N < ~ O cD O N• ~ ~' 7 ~ 7 O N ~ ~ O L c~ ~ 0 °c °: ~ 3 O ~p ~ ~ ~ it ~ ~ o ~ ~ ~~ ~ ~ 7A ~ H H ~ ~ c ~o A a a o o cc N pN A A = c a ~ ~ ~ ~ O O O ' ~~~~ ~vv,o ~ ~ ~.~~ ~ d y 3 °-' O .. .. ~ ~ o ~c - ~ o m o ~ p y c c n N ~ a a~i ~ 3 f° Q O fD C d W ~ a 3 °o :' ~~^, z a c 3 a 3 d o 3 ~ 3 ~ a d ~ m 2 c ~- N o `O ~ ~ N s v' y :'! ~ 3 ;.. ~~ ~ ~ N A Z lD A ~Z ~ CZ -1 < ~ ~ ~ m ~ d ... as FBI C O O~ C ~• 0 ~y,~ • `~ tii fi y A O Q' i w O O v A 7q Opp ~ O ti ,q ti Safety and Buildings Division county t 201 W. 162 s «~''~ ` ~S~r~S1,~ taon. Sanitary ptxmn Number (to be filled in by CoJ (608) 266-3 I S I 3 (2 De artment of Commerce Sean Plan I.D. Number Sanitary Permit App caticu~ ~ 2 to accord with Comm 83.21, Wis. Adm. Code, personal formation you p XvCOUN-~Y may be used fa socordary purposes Privacy La . sl S.OU4{I.Xt~() Project Address (if different than tnailingfd- / 1NG OFFICE `p~, ~c,, (3G~ (~ ~1 1. Aaalication Information -Please Print All Infotmation _ n n ('1 ~ ~ ,~a 1 / / ~-.--- City, State ~~--ss Zip Code Phone Number l Grole One) II. ype of Building (check all that apply) ~' S '^'r` S bdivision Namc , CStIt Number ~f- ~ Q ~l or 2 Family Dwelling - Numbs of Bedrooms (, •~~. -~ ~` '~ +~ Describe Use l i ~ ~C ^ a - c pub(icf ommer ^CnY ^V• loge wnship of ^ State Owned -Describe Use lii. Type of PetYttit: (Check only Otte boz oa liae A. Co line B if applicabl - DO A• New System t S ^ Raplaoanen Ystan ^ T t/Holding Tani: Rep t Only ^ Other Modifiation to Existing System List Permit Number and Issued B. ^ Petmit Renewal ^ Permit Revision ^ Change of ^ P Transfer to New Before Expiration Plumber Own IV. T of POWTS S em: Check all that a ^ d ~It of suitable soil nd 24 in ^ M er ^ At-Grade ^ Single Pass San Non -Pr~essuriaed In-(',,round ^ Mound > 24 in. of suitable soil ~~ . ou t l ^ Aerobic Treatment Unit ^ Rxir~arlating Sand Filter ^ ^ P Wetland ^ Pressurized In-Ground ^ Holding Tank ea Recitr:trlating Synthetic Mtdia Filar Leaching Drip Line Gra - ^ Other ( lain) nq t n . ~~ Y. Dis tSaUI'tYatmtnt Arta 1nlormauon: rs Rate{ ds li ti il A ' - ! Requittd (s Dispersal Area Proposed (s S qS 3 / / Design Flow (gpd) gp ca on pp Design So S ~ ~ ~ `~- b C~ YI. Tank Info Capacity in Total Number ~ Manufacture ~ dv Prefab ite Steel Fiber Glass oncrete Constructed Gallons Gallons of Uri ,p.,Q ~ -1 New Existing Tanks Tanks Seatie a Holding Tank / ~ .•~ ~- /~Cn / ~ L~L.L~.~-/~- Aerobic Treumeu Unit - Dosiag C'lumber , ViI. Responsibility Stattmcnt-1, the undersigned, assn nsl6ttity for i llatioa of the POWTS s owe on the attached plate. Plumber's Name (Print) Plumbs' i M P1LS Number Business Phone Number r3 ur~ yea aa~ ~s~ ''s ^ °~. Plumber's Address (Street, City, State, Zip Code) ~~ ~ ~~~ ~ aQ /~ ~ ~. YII/I. Count ~/De artment Use Onl Sanitary permit Fee ncludes Groundwater Date Issued suin gent Signs n ]~APproved ^ Disapproved SurchargeFce) ~ ~~ ~. O ~q ^ Owner Given Reason for Denial t la. Conditions of Approval/Iteasons for Di provtil SYSTEM OWNER: 9 Septic tank, eff)uent filter and dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances Atbch eempkte plam (to the Ceunty Daly) for the syskat ea paper sot lea due al/2 :ll iaeha is size SBD-6398 (R. Ol/03) _ .,,. s~ N ~~ ~s y ~ ~ 30 o ~~~ ~-~a z~ /~ so ~ y~~ 3~ T~ ~ ~ T-a' _9~~.ys ~3- 3 X ._g~-a ~-a n~~~ ~~~ -i oQ~ G /l /I ~- J~,~ / ~l ~ ~s. ~ 1 = 30 ~~ 14-100 ~~ /~ so ~ r V 5S~ 3~ ~~ ~ , ~ 13- 3 ~/ X ~~v ~~- a 1 ~ ,~ ~ _/ R ~ - . RECEIVED ~~ .JAN U 9 200 S ~ EVALUATION REPORT- Di~ion of s ~a /~ 3 Attad~ oomPlefe site Ptah ST. ~i~V~1~ I.UU NTH wa ~.~•nu OJ. ~1q. J1UI~~. ~r{R7K paper o~61~Cfl~FBItJg x t 1 in~es in size. Plan must CasXy ST• L/PD l ~ axk+de, bcrt mart. to: hhRt (BMj. dkection and t~nt~pe.s~ele«~.~, a~dloc~one~aoew~restn~ea. P>eo~ l.n. 020 • ial3. 70 • e~ PJease prfnt a/! tr~aaaatt'on. Pa/fOfq! ~OInIWpp Yai Pi'avida maY ba iMaO braeo'opduY Pv~P~ t~Y Law. a.15.Ot {1) (eat. ~ Dare i ~ .~ r vw ! /~/q-L E!J ~ W Govk t:oti t/4 5£ t/4 S ,~ T Z/ N R ~~ ~ c~ Property0eRexs trAad~ Address ~ /D 3 D Tf~'NwG G.t! • ~t # Co t~iodc ~ subs. Mane «CSI~ piu(,r SVNS~T ff-~!!S . /yvD.Sa~ ~vl. 5 yo%G 7jf • yQOs c ~ ~ `~ ~' ~-TO""n t~esf ao~d U ~o.v T.9wN~y !-~ . I] ~ U~: ~ Reaid / PtL+mber of bedmorrts Code deriaed desigr- flow rate d "' O'a {gyp ^ Pubflc «oormiera~ - Deaoribe: P~ n,a~,tal ° y at~?1~14.4,~ t'iood Pleb e>ev~ian it app~abte /V ft, ,~ at oomme~xs /~iC'~~f - T~5 r^~p ~ S S' v~~~'~/.3G~ ~i~2 ~N ~iL~,pov,vp C'd v v~°~ ~'~-~ ~ a• 41 • T s . ~'~ ^y~ ~po.o . ylls. etc fa"roex~d s<afaoe alai,. _ ni. Oeplf, b r • > ~d ~. soy ~l«imn o~ D~k Dasaipflon TeoAtie Boucday, Hoofs t irrt. l n~1 sz. cent. Color f~ s~. sn. ~t ~ ~' ~ /~Y~ ~l3 ~~t s ~ vfi2 rv 3 f . ~ Z 8.17 75 S ~ S/L / f S !C GS / Z- • 3 3 7.38 7•sY/1 Si ~- ~Q. s D, s d.~ cs - •? r•Z ~• /D S / Z RS .35. S~e•~Oy °IZ.~, a g°'`'~ # ~. P'it Watrtnd stay ~ ~ ~ 3 ~n Depot ~ fac4or y ` ~ in. . , sd ,- ~ l~ / a ern io 3 /L Sh w 3 • ~- .'3 Z S ~ s ~SiG S Z o- ~o ~ s D~. . ~ /• Sa .4 gg.g Z ~ = SOC > so <r~o ntgll.and Tss >30 < 15 0 mgll. - ~,entuz = BOD <30 mgA. and Tss < eo mga. . csr tveR,e c ~ Ro ~' 'Z1L13Ri cG~T ~' z Z. G. 3't S~ Addre~ Date n Telephone Wunber " ll/O!1.30 • ~-OD 3 7!S• 7?..7t • 3 yy~ ~runcnt & Associates Private Sewage Consultants 2812 10th Ave, Spring Valley, W! 54767 Measurements noted on CST's plot ,_ ._ r ~--~ ~ i ~2 (~1 ~. ~3R~A-iv RR~e~ ~~ ,Svvs.~ f ~il~s ,~ • Y ozo-l6~3. 70 • ~ . ~~ Go t -~ ~ ~ Z ~ ~ ~ ~ ~ ttcxiboet ~ Recto~c ~ Tie ~ructtue i:oruistenoe ROWS ta'P t)~ int. i~ Ems. Sz. ~.. t~lor ~ Sz Sh. -f3t#1 'EltiR2 F~ o,, ~ goy 3 --- s~~ 2-f s ~Qs~ . w ~ . s . ~ Z io r S --- iG / s!~ -s - . z ~ ~S ~' S D S ,Q c ---- • 7 ~• Z .~ • /0 7 .,,r.~P s D , ~.~ l . ^ Pjt Grntmd st~rfaoe eiev. tt. t3e{~ ~ ~ tack' in. ~ ~ Sd Rate Etorizex~ t D'orrarsaW Redox Dssc~i~cc TexEFire SUu~re Cocoe 8ourcdacy #toots C tct, # Cbw S`t. tint. Color Gr. SL Sh. - 't 'Ei~2 i t~.._._..3 tJ Pit ,.. .a,.~. ~ _-•.,. ° _. .. ~ RBEB t ~ Redaoc i)as~ption- Tr~cttB+e Care (toots ' a1. ~ Qu. Sz. Oont. CoO~r Sh. f ...: A F tirVYf Ri SiRL~W ~PGM~ tL tUflaLiNJ~ ~~ ,~i Y u~w~ L.~ ,may p~.~ T~{~~~ ~j~~..~j~~ }~ male f T#I. KFw! L U4111R 10fN [~O~AM - i@~L v' ~{iB WiNR~J T1F/lll0 '•+~ "•~~ , ` ~ Mcros~! tit. Sz. C,e~ior tai Sz. Sfi. 'E~i " F_N~IAPJTlt ~ = ~a > '.~ < ~} ~ ~ ~ >.~ ~ ~ Ili. ~ ~ _ ~~ ~ ~Q ~, ~4fKt ~ ~ ~ {~' r N ~ ~ c. .~ 4. ~a ~ •- 53 i y4 II ~D For issuance of permiis and designing Contact: Ulbricht & Associates Registered private wastewater consultant and ~It 2812 10th Ave. Spring Valley, WI 54767 715-772-3442 ~ r , ~iJ ~ (7/~ S J ©~ ~ y. ~a- ,a ._______--- .~, -___ ~~° ~3 _~~_~ /00 0 ~~ r `~b.~ b Sa ( ~ ~ ~ s~~' Td~ a~ d ~~ s~ ~_ BG /d~ L• Sa ~ GvT _~.-.-- POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of 2 FILE INFORMATION Owner Permit # (~ 3 ~ 2 S' DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units ^ NA Estimated flow (average( d~ al/day Design flow (peak(, (Estimated x 1.5) ~Q al/day Soil Application Rate , al/day/ft2 Standard Influent/Effluent Quality Monthly average * Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand IBOD51 5220 mg/L ^ NA Total Suspended Solids (TSSI 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODE) 530 mg/L Total Suspended Solids (TSS) S30 mg/L ^ NA Fecal Coliform (geometric mean) 5104 cfu/100m1 Maximum Effluent Particle Size Ya in dia. ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity b al ^ NA Septic Tank Manufacturer ^ NA Effluent Filter Manufacturer ~ ^ NA Effluent Filter Model ~ Ov ^ NA Pump Tank Capacity al ^ NA Pump Tank Manufacturer ^ NA Pump Manufacturer ^ NA Pump Model ~ ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ^ NA Dispersal Cell(s) ~In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s- At least once every: ^ month(s) (Maximum 3 years) earls) ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third IY31 of tank volume ^ NA Inspect dispersal ce(lls) At least once every: ^ month(s) (Maximum 3 years) year(s) ^ NA Clean effluent filter At least once every: ^ monthls) ~ year(s) ^ NA Inspect ump, pump controls & alarm P At least once ever Y' ^monthls) ^ year(s) ^ NA Flush laterals and ressure test P At least once ever Y~ ~ ^ month(s) ^ year(s) ^ NA Other: At least once every: ^ month(s) ^ year(s) ^ NA Other: ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the 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 inspected 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 IY31 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of <_12 months, 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. Page 2 of y START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tankls) removed by a Septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may .improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain Isump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT 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 chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or: must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. a o in an alua ' g~ 1"~ T ' be ' e ai e ~fZD4-~1817~ ~D~ A/~b/ (~IVS771'zl1~=TtD ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone ~ - L Phone SEPTAGE SERVICING OPERATOR ( MPER) LOCAL REGULATORY AUTHORITY Name `~ -LQ~ Phone Name s-T-, C l (~ ~ ZD~I ~tJ Phone ~/S- 30 (p- (O (~ This document wa rafted in compliance with chapter Comm 83.22(211b11111d)&If1 and 83.54111, (2) & 131, Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP C;~RTIFICATION FORM OwnerBuyer _ '~~/Ln/ ~~ Mailing Address _ 1°~^ L~~Si9,~~ ,~~ _ ,c,/,/yl, Sr3!/~ G,f! Property Address !~ S3 (Verification required from Planning ~a/, City/State __ ~f/l~Se~~ ~,/,.~ Parcel identification Number LEGAL DESCRIPTION Property Location ~U~ %4, ~ y., Sec. ~, T~N-R~W, Town of Subdivision .5~/~~T y//LAS' Lot # Certified Survey Map # Volume .Page # Warranty Deed # 7~ y, ~ ~ Volume Page # a~~- Spec house ^ no Lot lines identifiable~es ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could r+esrrIt in its premature failure to Handle wastes. Proper maintenance consists of pcmnping out the septic tank every three years m 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 is the waste disposal system. The PrePony-4~' agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber,}ournaymanplwmber, restrictedplumber or a licensedpumpervezifying that (1) the on-site wastewaterdisposal system is in proper operating conditionand/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 the three year expirati a date. /~/S ~~ S NATURE O 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 property described above, b virtue of a warranty deed recorded in Register of Deeds Office. /oJ' ~ DY SIGNATURE O APP ICANT DATE ****** Any information that is mis-represented tpay result in the sanitary penait being revoked by the Zoning Department. *****" *~ Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed 2586 f~ 2~6 764514 1~J STATE BAR OF WISCONSIN FORM 1 - 2000 Document Number WARRANTY DEED This Deed, made between Brian H. Raleigh and Michelle L. Raleigh, husband and wife, Grantor, and Kernon J. Bast and Donalda J. Speer-Bast, husband and wife, as survivorship marital property, Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (the "Property") (if more space is needed, please attach addendum): See attached Addendum A. ' a ~ ~~~ * Michetle L. Raleigh 020-1013-70-000;020-1013-60-000;020-1013-50-000 Pazcei Identification Number (PIN) This _ ~ not homestead property. Together with all appurtenant rights, title and interests. 6i~ (is not) Grantor warrants that the title to the iroperty is good, indefeasible in fee simple and free and clear of encumbrances except Dated this -~ day of May 2004 Signature(s) AUTHENTICATION authenticated this day of ~_ ~heC_ ~-~~vv is ~~aNota~ ~ons~n TITLE: MEMBER STATE BAR OE'wI~C ONSIN {If not, authorizedby ~ 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Brent R Johnson Lommen Nelson Law Firm, Hudson, Wisconsin (Signatures may be authenticated or acknowledged. Both are not necessary.) _. /~ * Brian H. Raleitrh Area BATHLEEti K. YALSH REGISTER OF DEEDS 5T. CROIX CO.. N!I RECEIVED FOR RECQRD 06l02/200~ 09:LSA1! WARRANTY DEED EXEl~T # 8 REC FEE : 13. ~ TRAlIS FEE : 2 260.00 CaPY FEE: CC FEE: PAGES: 2 Name and Return Address Edina Realty Title, Inc. 400 South Second Street Hudson, WI 54016 ACKNOWLEDGR~NT STATE OF WISCONSIN ) ss. 5T. CROIX County ) Personally came before me this ~ ~ day of May 2004 the above named Brian H. Raleigh and Michelle L. Raleigh, husband and wife, to me Irnown to be the person(s) who executed the foregoing instrumen d acknow edged the same. * Notary Public, State of WISCONSIN My Commission is permanent. (If not, state expiration date: * Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN INFO-PRO (80055-2021 www.infoprotorms.com FORi14 ro.1- 2000 U 2586P 217 ADDENDUM A TO WARRANTY DEED PIN: 020-1013-70-000; 020-1013-60-000; 020-1013-50-000 GRANTORS: BRIAN H. RALEIGH AND MICHELLE L. RALEIGH GRANTEES: KERNON J. BAST AND DONALDA J. SPEER BAST Legal Description Located in part of the NW %a of the SE 1/a of Section 11, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin; including part of Lot 5 of Joshua Hills recorded at the St. Croix County Register of Deeds Office; described as follows: Commencing at the S '/. comer of said Section 11; thence North 00 degrees 33 minutes 37 seconds East, along the west line of the SE'/4 of said Section 1325.63 feet to the south line of the NW %a of the SE'/4; thence South 89 degrees 55 minutes 50 seconds East, along said south line, 13.67 feet to the point of beginning; thence continuing South 89 degrees 55 minutes 50 seconds East, along said south line, 876.02 feet to the west line of Lot 1 of the proposed Plat of Sunset .Hills; thence North 00 degrees 18 minutes 45 seconds East, along said west line, 347.77 feet to the north line of said Lot 1; thence South 89 degrees 27 minutes 39 seconds East, along said north line, 377.45 feet to the west line of a Town Road (Tanney Lane); thence North 00 degrees 18 minutes 45 seconds East, along said west line, 33.00 feet; thence South 89 degrees 27 minutes 39 seconds East, along said west line, 19.14 feet; thence North 00 degrees 35 minutes 36 seconds East, along said west line, 33.00 feet to the south line of Lot 10 of said proposed plat; thence North 89 degrees 27 minutes 39 seconds West, along said south line and the south line of Lot 9 of said proposed plat; 434.50 feet to the west line of said Lot 9; thence North 00 degrees 36 minutes 12 seconds East, along said west line, 511.98 feet, thence North O1 degrees 19 minutes 09 seconds East 74.93 feet; thence North 89 degrees 44 minutes 56 seconds West $31.70 feet; thence South 00 degrees 54 minutes 40 seconds West 1003.69 feet to the point of beginning. 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