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HomeMy WebLinkAbout020-1378-01-000 ~ ~ ~ o ~ ~ I A ~ fD V=i O O O fD ? 6f. I QI N > a m < > N y ~ W ~ fp cn ~ i o m ~ 6! ~ ° y Q O N O ~ p C N C ~ 3 M S 0 y y J ~ ~ o I ~ 'm ~ ~ ~ ~o~I___~~. I" rnc°ng I ~ .~ N pp O A ` ~ ~ C• y ~ O O ~ _a ~ I a ~ Z I m c 0 0 0 O ~ ~ a y I n C ~ o f/1 fA f/~ ~ °~ I o ~ $ ~$~~ ~ ~ ~ eo ~ w ~ ~ I = .. a o N ~ N d ~ ~. d „~,, 0 3 .. c = 2 I ~ rn o o ~ o x ~ ~ o. ow~ o n ~ I 7 NN ^ ~i C ~ ~ •O fOd T y V lV ~ N I a of m n ~... ,~ N x c ^ m a cfDOV~ 3 ~ g ~ ~'v a I a N $ I ~ ~ ~ a I ~ o I I ~ y: ~ ~ .~ ~ , y y G 3 o~ v 3 c :' v 3 3 a~ y W I a ~ w I o °-' cnvo ~ D m a `a , ~~ 3 m ~ a ~. o a ~ ~ 3 . 7 a n'i c a I ~ m ~ ~ ~ I o ~a~~ ~ ~~~orn y O y ~ .~. y ~ O ~ M 7 N ~ ~ ~ ~ p 3m ~a ~ n S ~ I ~ . i~ ~ d ~ ~ ' 'm o I m N '' ~ ~ W y Q I wo a~q~ I A ~ n I O 7 O °o ~. d o ~•~~ ~ ~ e~~o _ -~ o C N N ~ Q (O v I ~ N b f.J O p ~ O v' (Aj~ O C a .. ~ ~ 8 Z1 d f0 fD A ? N ~ ,Z1 ~O+, A ~Z ~ C T~ N ¢~ N m tO a d m A> A~ MGM Q rO~ R O 0 ~• 4 • vy i ~~ A 0 N A w ~0 Q ~ O ~ Q ~:, b /* vlsconsin Department of Qommerce Safety a~nCl f3uildinys Division GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law 15.04 (1)(m)). P rmit older' Name: ^ ity ^ V a ~ n o~ . Ilfeag~ler, 3oseph ~t,l~sgn°~°~ownship CST BM Elev.: Insp. BM Elev.: BM Descri tion: (a0 .a I d v .c7 ~` ~ ..~~%rru-ate s~`d.~ ~a-~.~-r,. TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ ~~ Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG.. vent to Air Intake ROAD Septic > ~ ~ Z ~ NA Dosing NA Aeration NA Holding PUMP /SIPHON. INFORMATION ELEVATION DATA count~t. Croix Sa nita~y,PRG(o1,j~No.: State P331a2ofnblDyy /No.: Parcel T x N .• 020-1378-01-000 ?• s STATION BS HI FS ELEV. Benchmark D, I O I I D, S 3• t. S `din 03•~ Ilz'I ~ v Bldg. Sewer- (~ / (~ ®~~ . (oD ~~,~'J St / Ht Inlet 5 . ~ ~ ,(~ St/ Ht Outlet ~o•I S Cj'1, ~js Dt Inlet Dt Bottom - - --~ Header /Man. ~ •~ z tt LL ~~t• Dist. Pipe //ON o 8~6~ Bot. System ~ . ~ p 3.'3s ~3 ,too Final Grade ~~ ~ 3 - 6 • [ ° a7, ~ • Zo oZ. 3 i L S IL COVER IVIOdeI UmD ~rw~ T Lift Friction System TDH Forcemain I Length .Dwell I SC11{i~ ABSORPTION SYSTEM~I {~ _ D _ ~ __ ~, _ . O_ .I .~,._ „ L BED /TRENCH Width ~ ~, Len th ~ .r. ~ ...~ N Of Trenches ,,. --.-- p[T No. Of Pits Inside Dia. Liquid Depth 1 N 1 N 3 ~S• 2 DIMEN I N SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Man urer: - S a~e INFORMATION Type O ~ + , 3S J' CHAMBER o e Num er: System: s --- OR UNIT u, . r]ISTRIRl1TInN SYSTEM ~'~' ~+'"~ti` P~1-) u He der /Manifold I r (~ Distribution Pipe(s) x H x Hole Spacing Vent /To Air Intake 3 6 r .Len h Q~- Dia. ng Dia. Spacing x Pressure Systems Only xx Mound Or At-Grade Systems Only ~6i 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.) Location: 1054 Moonbeam Road, Hudson, WI 54016 (NW 1/4 SE 1/4 12 T29N R19W) - 1229192340 Moonbeam Ridge -Lot 1 1.) Alt BM Description =~vC~~ 2.) Bldg sewer length = ?p . p ~~n~u~Z,Qna 3 -aQm~ou S of~e~ ~ g ~' S.; ~ Cm-xi ~t~--- ~ ~5 ~X ~•.c.~, ~ ur' o t an revision required? ^ Yes No ~Us~~o{t~hle~r side fora di~ nlal information. 3BD-8710 (R.3/97) ,~ Date Inspector's Signature Cert No. ~~ y~~~~- ~ ~~ ~~ o... [~ . J ' o+.. ~,.~..; ~., ~ ~ ~~ ~~ Safety & Buildings Division Sanitary Permit Application 201 W. Washington Ave. 7 isQOns~~n U atx:ord with Comm 83.21, Wis. Adm. Code Po sox 302 Madison, WI 53707-7302 Department of Commarco Personal information you provide may be used far secondary proposes (Submit completod form to catnty if not [Privacy Law, s. 15.04(Ixm)] state owned.) Attach co lete lens to the coo otil for on not less than 8-1/2 x 1 I inches in size. Cotmty ~ ~ /t , l State Sari N i to prevt fiat State Plan I. U. N~nnber ~j ~~" L A iitatioa Infotwna ' n - Pkase Print ali Informatio lion: d Property Ovvrter Name ~ ~ l,ooetiort . Z 3 ~/~ ~, ~ !d e y S W l/a ova, S 1 Ta~JN, R/~ 'or Property ~Wnef y Ma[IIII~L f~rC89 ~ ~ ~ ~~ Rlock Number o G~ ~ City. State Z.ip Cade Phone Ntunber S Name CSM Number tco~s~a.r~ .S~ C6 " i fho o„d 6 a~- ,' s ll Type of Building: (check one) ,/ ~,il.~ ~ , ,;,, ,,. Q ~ ~ - r" ~ '" ^ v ~ O I or 2 Family Dwelling - No. of Bodrootns: / "!'own of O PubliclCommercial (dtsaibe use): O State-owned u d a -v ID Type of Permit: (Check only one box on line A. Check box on line B if applicable) Neecrsst Road p.IJ ,b~.t: ~ A) t • ~Vew System 2. D Replacement 3. D Replacement of 4. D Addition to Parcel Tax Number(s) `` System Tank Onl Exi S tem // / (j--/ 3 - ~Uv B) Permit Nwnber ~ ~ ~~ ~ Date lssuod Sanitary Permit was viousl issued O ~ IV. Type of POWT System: (Check ap that apply) DNon-pressurized In-gourd D Mound D Sand Filter ^ Constructed Wtxlad ,Pressurized 1n-gourd D HoMing Tank D Single Pass D Drip Line D At-grade ^ Aerobic Treatment Unit ^ Recirculating ^ Other: V Dis rsal/rreatment Area Information: t . L>esigrt Flow (gpd) 2. DispersalAt+ea 3.17ispetsal Area 4. Soil Appticstion 5. Percolation Rate 6. Syst 8tevation T. Final Grade Required Proposed Rate (Cisls./day/sq. ft.) (Min.lr>ych) ~3, "3 ~`~ {:'kvaticm VI Tank Capacity in Total # of Mmtufarxrtrer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks ~ I ~r , s „~ Cat- Con- glass N i E ' ~ i `[nX ~6 ew x sting / erete striretod Tan6-s Tanks ~ ^ ^ D D ~ ~, G x o 1 ~ ~ >r ~~p D ^ D D ^ VII Responsibility Statement I the undtasi assume r 'bilit for installation of the POWT$ she the attached stns. Plumber's Name (print) Plumber's Signature (no stamps): S No. Business Phone Number Plumber's Address (Street, Cit y, Sta te, lap Code) ~ ~ y 7 d G Ti i Gt `- +~ VIII Couaty/Depatrtment Use Only ^ Disapproved Sanitary Ferntit Fee (Includes Groundwater F S~ Date Issued Iss ng Agent igmtta+e (N stamps) PProvoti Initial Adverse D i i ee) J~ • /A ~~ Se ~ I y~ ` eterm nat on iX. Conditions of Approval lKeatwas for Disapproval: - 1 s sys~ ~~ ~~ FROM Schumaker Plumbinq FAX N0. 7153863121 Jun. 13 2001 01:00PM P1 > , Sahantaker P/anrrb)r~S 1070 SCOTT RD HUDSON WI 54016 phone ~ Fax (715) 386.129 DATA ; ~'~l~l ~ l YO' ~~Yd~~X ~O~le%+® ~I=: Sp~C1At INSTRUCTIONS: FROM: ~1~ FAX # No. DF PaG~S: ~~ d~ i~ FROM ScP,umaker Plumbinq FAX~jNO. 7153863121 Jun. 13 2001 01:00PM P2 ~ ~ Co ~~r1,', ~4- ~ls r~l ~ ~ Y,s' ~ y~ ~ J/lQl1R1 ~G4 pF ~ ~O ,t T ~~ 4~ /~L Ur'.S ~'O~/ ~7gw.s Td ,da lv ~E : ~ T " ~ T ,r/ff x .a.,~ 1 ~ 1;,1~~ j ~ ~Ta~_ r`i a S'a m G ~. S d v `~ r ~ sa! ~ P~~ .(/e 41 S ~ S f'~ gyn. ~~ c G/ ~` S ~s a ~ N ~,if,Z l p y~ ~„~ ~i// d' ~3 ~ • M ~o v a h ~l ! `~- ~~ S ~~` G „~.h~`b`e N~f° /~p4$ 6 b2 S%f~ 14ir'11 pr, t1e /sly 4 . 1~ .. ~ / ..® /' irr !®• ~.1., mil .r / ~/J >.s / • ,-C , ~~~ i ! ?~ Wisconsin Department of Commerce ~~,•• ` ="'` ~, ~`UATION REPORT Page ~_ of 3 '~,. ,~ , Division of Safety and Buildings •~,~~ ~ ~,, ~' `mgccorean ~mm rsa~\v~~.i Ham. t,oue Coun ~ t~ l it l P n must ize .~~~ th 1/2 1 ' • y n S C... l an on paper n Attach comp ete s e p i in s an x . , ~ C~ include, but not limited to: vertical an z onta nce point (BM), die. i n and parcel I.D. percent slope, scale or dimensions, ottp{a n-ow, an ocbti~Sh d distan ' Barest road. Please p ~ II Inf Soo, l~c,., ~ viewed by ~ Date Personal information you provide may be d f se ses (Privacy~w, .15.04 (1) (m)). ~~a r Property Owner .~.1, Property Location ~~ -}- ~ v f~ / j ~ Govt. Lot ~(JLtJ 1 /4 5 E 1/4 S ('Z T Z ~l N R (~ E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#• ~ ~ 7v S c ~ Od a. , City State Zip Code Phone Number City ~~Ilage Town . Nearest Road ~+u c(Sc~ r~ W SYo/ (v (7/$-) Sys! -S"97 ~v c~.So co ~w New Construction Use Residential / Number of bedrooms 3 - `"~ Code derived design flow rate `750 / (y G Q GPD I^ Replacement ^ Public or commeraal -Describe: Parent material D v'(wa S ~ Flood Plain elevation if applicable ~tJ ~ ~' ft. General comments S'/ $ ~ e wt t l t V • Q S• ~ ° and recommenid~ations: ~ eft:.. GI t V• 43 •o ~ F.Y3ri2~ # ~ 'fOQSni ( Wa,s ~GWLOUeC~ ~_~ Boring Boring # pit Ground surface elev. ~• ~ ~ ft. Depth to limiting factor ~= in. Soil lication Rate i H th D Dominant Color tion Redox Descri Texture Structure Consistence Boundary Roots GPD/ff zon or ep in. Munsell p Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I o-ll !o r3/3 - S; ~ Zvna YYt~r' GS 1 J~ .s z I I- o ry - ~•s 1 ms U~~ ~ ~ - . Z Z-~, d - s c - _ i. z S 3• -Z Z Boring # ~ Boring ^ Pit Ground surface elev. ~• $~ ft. Depth to limiting factor 9 ~ in. Soil ligtion Rate i H D th nt Color D i Redox Description Texture Structure Consistence Boundary Roots GPDIfP or zon ep in. om na Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 l o - ~a r (Co - rn d s v~ l - - /. ~!'9S .a ~ .4 * Effluent #1 = BOD > 30 < 220 mglL antl I55 >3U < 15U mg/L - tmuern *c = ovu _ ov ~~ny~ a,~. ~ _ ~~~~~ CST Name (Please Print) n re CST Number a rv. ~C ~'W rvta "' ~ Address Dat valuation Conducted Telephone Numb r Zl 13 ~~ So~,~t.~.•I- w~ s-L/yzs- G ~- ! -ot 7~S- ay} -yam s Property Owner C ~ ~ ~O u ~- _ Parcel ID # Page ~ of 3 ..-. - ?' Boring # U Boring Pit Ground surface elev. ~Z~ ft. Depth to limiting factor /O ~ in. Soil lication 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 Z /~-20 / - 5 ,c~ Zma /Yl r' G - 3 Z~ -~ ~ - L s s G - ,~ . Z ~( -/o -- 5 l - ~ Z 2a.~( 2. ~ ~ 3 S'~ ~~ •2~~ ^ Boring # ~ Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 [~~ Boring Boring # Ground surface elev. _ ft. ~ Depth to limiting factor in. Pit Soil lication Rate Horizon De th Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 ` Effluent #1 =GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 =GODS < 30 mg/L 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-8330Ta~ (R.07/UO) ,~ • • PAGE 3 OF ~ NAME o LOT# LEGAL DESCRIPTION kJ '/, ~/e S I Z T 2 N R I g E or SCALE: 1"= "/d r BM I ELEVATION lid • O BM I DESCRIPTION {a a ~ ~ /~dc~'r" ~~d v~ BM 2 ELEVATION __ q 3• `~ BM 2 DESCRIPTION -f~P d ~- l ~ ~ P~~ P ~•~e SYSTEM ELEVATION ~I ~ • ~ O ALTERNATE ELEVATION q3 . o ~ CONTOUR ELEVATION 40 •ao - • o ~ 5~.. ! Z X 1 - .~- -- z $~, ~ .\4~0 `G Dr~~.. w~Y 1 1 t SIGNATURE 1 ~~/1~----~~~ ~ ~ DATE ~ S -p ~ ~ O ~ V~Jlt~on] ~~ . Safety & Buildings Division ~ 1 ~ Sanitary Permit Application 201 w. w ~ ~ 73oi .-{SC~h~A In accord with Comm 83.21, Wis. Adm. Code Madison, W[ 53707-7302 Department 4f Commorca Persona! information you provide may be used far Secondary purposes (Submit complettxl form W cowry if not [Privacy Law, s. 15.04(Ixm)] state .) Attach f ete tans to the otil for dtc on not kss than 8-I/2 x 11 inches in size. County ~~~ ~ State . 't N~ ©Check if rt:visian to previous app{icatioa State Plan I. D. Number ~~~ L A it:>atioa Information - P kase Print a!1 Information Location: Property (>vvner Name Property I.ocatinn Ja ~ Gr-~V .~ i a- ~° s- 2 Y ..(/ ., g d 1/4 rJG I14. S o2 T~q.N, /H or Property Owners Mailir-g Address I.ot N~anber Block Number `~~Ol' ~~ Fc Y ~ C « e ~,~ ,:~e City, State Zap C Phone Number 1 ~ :? ; q~ 4 1 a !. Subdivision Narrre or CSM Number ~ ll T of BuiWi , `,~ ~ ,.~ YPe ng: (check one) "„ . ' ~ O City e ~ Villa ~. t ` • O 1 or 2 Family Dwelling - No. of Bairooms:~` ~-,~ _., ~ g J2~Town of O Public/Commercial (describe use): O Stan-owned `'' '~ ~ m r* ~ ..t'~ iD Type of i'ermit: (Check only one box on line A. Check box online t .,applicable} ,';yt, `. NearestRoad p) t. ,New System 2. ^ l~~lacement 3. ~ lacement of ~,. .4. ~A`~ '~ ~s Tax Number(s ~ ~~ !O 0 3 ~ ~) D A Satlitarv Permit was vi # issued Permit Number , ~.:' Dale tssucd , a ~ a IV. Type of POWT System: (Chock al apply) -~ -I . Non-~essuriud !n-ground ,~ t3 Mound C] Sand Fiber ^ Coastrtx~ed Wettmtd Pressurized ltt-ground `,, D Holding Tank D Single Pass O Drip Line D At-grade / ~ ~ ~ D Aerobic Trcaunent Unit ^ Recirculating D Other: ,~ \ 3 ~ X ~g,' V Die rsaVTreatment Area Information: `. 5~ # 1. iksigrr Flow (gpd} Z. DispersatArea 3. Dispersal ~ 4. Snit Application 5. Percolation Rau 6. System levati ~ . Final Grade ' Required t~roposed ~ Rate ((3els.ldaylsq. ft.) ~ (Min.lmclt) S ~ ~ ~ levation ~ ~'~ ~' ~'~ ~ 3 ,~ , 7 ' ~ oDr ~.5 VI Tank Capacity in Total # of Monufacturer Prefab Site Steel Fiber- Plastic Information Gallons Galktns Tanks Cat- Con- glass New Existing crate strttctod Tanks Tanks ~ , `, ,' D ^ ^ D c' T~' L' ' ~ D ^ D ^ VU Responsibility Statement ' ~ ` the undersi assume r bi6t for installation of attached lens. POWT$ she Plumbers Namr (print) Plumber's Signature (no ): t+1o. Business {'hone Numb~x dJ.` l' 1x ~c~ia7"z,eKea- ~ ~- 0~0~7 ~ -3~'G-3/al Plumber's Address (Street. City, State. 7.ip Code) c ~ ~-~s~,r/ ~` ~/ VIII County/Department tJse Only ^ Disapproved sanlary Peravt Fee (Includes Growxtwater Date I I - Agent Si (No stamps) ~Approvod ^ Owner Given Initial Adverse S e Fce) Qfl S Determination IX. Conditions of Ap~'ro~al !Reasons for Disapproval: ,, ,,~, nn ~r ` (' A ~ ~ D . ~ ~ /_(~Qz ~ P T~ tu2~r~ -}'e i~ St+~ 1 'i~ -fya~Fors Qcue ~C'1 6•v. rw.t5~ ~ (~ le ~ <r $~ Q , . ~ I , S s P ~ ~e.ln.. .0 ~ Go~- ~.s s~k~- ~s ~~ ~- -~ 3. ~ s~_~ 9 ~ _____ v 11-. ."7~ ~n.fltttAd_ ~D (. 11pJA (:~'~^~ / VIMt,t`r'\.~X ~ ~- lMd~bt143t~111~(~~~ ~-GU'K~t. W~' `v'KS . d v a1 e WICCQ'rwl Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page r' of _~ Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must """'' include, but not limited to: vertical and horizontal reference point (BM), direction and ~ C ,-; 1G percent slope, scale or dimensions, north arrow, and Ipee~tCS1f'¢Ttd~ } nce to nearest road. parcel f.D. # APPLICANT INFORMATION - P/e~e prir-t all ir~lcrmativn.-'`; Reviewed by Date !1 ~ 1 Personal information you provide may be used for eoondary pugSb~~~(I~~ Law, s: 15.04 (1) (m)). Property Owner i '- Property Location ~~ ~ ~~ J fir i - f ~ ~ ° :.:U Govt. Lot NW 1/4 S E 1/4,S (~, T ZGj ,N,R ~ q E (or)~11 Property Owner's Mailing Address `~ '~ "' ~' Lot # Block# Subd. Name or CSM# .i7'u N i iCify Sta Zip Code Phone Number ,,~ ^ City ^ Village ®Town Nearest Road f'1 V ~~N ~ Jr C71 I ~) ~. ~,~ • ~~'(~° N v ~SU1v t~!?OO o New Construction Use: ,®Residential /Number of bedrooms 3 - y Addition to existing building ^ Replacement ^ Public or commercial -Describe: c~ Code derived daily flow ~ gpd Recommended design loading rate ~ ~ bed, gpd/ft2 a trench, gpd/ft2 Absorption area required ~_bed, ft2 ft Maximum desi n loading rate ~ bed, gpd/ft2~trench, gpd/ft2 Recommended infiltration surface elevation(s) Q ~ ~ "~ ~ 3 ft (as referred to site plan benchmark) Additional design/site considerations A"L ~,~• Z' •r Parent material aC.3k-c~ct.S ~ Flood plain elevation, if applicable i~ ~` ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank u = Unsuitable for system C~ s ^ u ®s ^ u ®S ^ u ~ S ^//11u ^ s ®u^. //sC~ ® u enu n~eroi~Tinu O~DnRT A ~,,. i (x..11., a ~ - 7/31111 °_ Boring # ~: Ground elev. (po• S ft. Depth to limiting factor ~_in. Boring # Ground elev. 9g.1 s'n. Depth to limiting for in. Remarks: CST Name (Please Print) Signat ~ , Telephone No. t~~ er _ , , . ~j -) Z y~- yap Address Date CST Number 1~!~ ~ ~(~~- S-~ ,~c~~rse~ l.J ( 5`-fOZS ,~-7-~ Z..~331~~- Horizon Depth Dominant Color Mottles Structure B d t R GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence oun ary oo s Bed ,Trench ~- '3S~ d , Remarks: ~ ~0 ' 3/~ "' $L lV`~S~;tom 'W~rdt-, lS ~JI" y S 3 ~-1 I v ~ -- /`~5 1 ~ ~ c s ~ ' SOIL DESCRIPTION REPORT PROPERTY OWNER Coo ~~C3 cJcc PARCEL I.D.# Boring # .~~ Ground elev. ~~~. Depth to limiting factor \G in. Boring # ~..1 Ground elev. ~tt. Depth to limiting factor . //~ in. Boring # ~~ Ground elev. /u/ aSft. Depth to limiting factor t~Z. in. Boring # Ground elev. ft. Depth to limiting factor in 4' . Page 2-of ~J Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench `I 66- ~c ~,~ - ~ 1 w~v (tZ cs - ~- ~ ~ 9s'•3S r qS. 0 ~ 6`t•45 .S Gq gas Remarks: i ~?-6 t 0 ~ 3 3 - S ~- ~ v~s1Dk 4°`'~ ~ CS ~ v t- `/ ; S 2 6 - 2 ~ a ~ - LS c~- -~ ~2 ~~ - ~ ; Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench ~ n-~ ao ~t ~ 3 ~ ~~ sbl~ h/~~cL L5 v = ~ S ~ 3Y-I, ; ~ 6 - ~5 0S - tM. ~ LS ~ ; ~ $. `~ off. `~' Remarks: Remarks: SBD-8330 (R.9/98) PAGE~OF~ NAME C U ~ ~ U U q LOT# ~ LEGAL DESCRIPTION~Uw '/~ C•~/4,S 1 T Z qN,R ~ ~lE (or)(GV] scALE: 1"= / UCH ~LEVATION ~~ i• BM I DESCRIPTION~bp~p-~ ~Z Qac. ~c ~(F/a.~1 BM LEVATION 7 ~• BM 2 DESCRIPTION.ti,,~,~ ~ ~, ~,p; pc ~uth~.~+/F/~~ SYSTEM ELEVATION ~ S' 3 ALTERNATE ELEVATION ~ ~' Z S CONTOUR ELEVATION ~fj~G9 z. K ~ • r~as~ ~ YYIa 1C• C c va-( o n l4 ~- f • S ~ Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity in-Ground Soit 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 Camm 83 and $4, and the conditions of approval by the department, agent, or govemmentai unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 105fi7-P (R.6l99). Table 1 • S stem Design S ecifications Y Sanita Permit Number Number of Bedrooms Desi n Flow -Peak (gpd} SO Estimated Flow • Avera a (pd) Septic Tank Ca acity ( al} Soil Absorption Component Size (ftZ) T e of Wastewater ~' z "~ Do estic T_~~_ n. ~+~u wa~.,.siwr. fTn.,,nnnenf . ~ units cif Reliable t~peration n DUt 1 ilY1C L• VV~1 nvw~Ma^v n vw...l.....~..- -------- SepticTank Component So'sl Abso tion Component Desi n Flow -Peak ( pd) ~p 3~'~-' z " ~ h Maximum Influent Particle Size (in) 1!8 Maximum BtJD$ (m /L) 224 Maximum TSS (m L} 150 Table 3: Maintenance Schedule Inspect andlar service once eve 3 ears Inspect once a year and clean at least once eve 3 t 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, Sta#s. The contents of the septic tank sha[I be disposed of in accordance with NR 913, 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 n nd outlet filter shall be assessed at least once every 3 years by inspection. Th outlet filte shall be cleaned as necessa to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain soli a tank that may slough off the filter when removed from its enclosure. ff 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 flaws or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1l3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advsse 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 comp)®tion of service. Any opening deemed unsound, defective, or subject to fai{ure 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. Ho 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 d/fgcult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a PANTS component. Soil Absorption Com on nt 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 sail. 2 Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep-rooted trees and shrubs directly aver of within ten feet of the component shautd be avoided since root intrusion into the component may obstruct wastewater flow. Contingency Plan In the event of system failure, a new system could be installed in an altemate area. With the installation of a diverter valve, the existing system could also be reused aft®r a period of three to four years. It is the property owners responsibility to maintain the altemate area free from any planting of trees, shrubs, etc. in case of failure of the original system, the altemate area will be needed. if arty trees, shrubs, etc. have been planted on the altemate area, they wilt have to be removed at property owners expense. I# altemate 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 abandonment shall be done in accordance with Wisc. Code 83.33. Any questions regarding this code, please contact your ivcal Zoning Office or contact the installing plumber. 5~~~~ : ~s~ - 3 ~2 i P~~~ e ~ ~1~~~. ~~_~~ " ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~~~ Mailing Address S.~o/(o Property Address /~ ~' ~ ~~~ /1 ~,~ /~~` ~/ L~S o v~ (,~.-~ S y0/~ (Verification required from Planning Department for new constructioa)_~ ,,n City/State Parcel Identification Number o z o ' ~ 3 ~ $ ~ o I - ~ LEGAL DESCRIPTION Property Location NW %,, S~ %,, Sec. ~°~ . T~N-R ~ / W, Town of ~t~~0~ Subdivision ~~^~~ ~~'- / ~ 1 ~~~ ~ Lot # ~ Certified Survey Map # .Volume .Page # Warranty Deed # Co 3 9 ~o ~ S .Volume /~ 9 ~ .Page # ~~ Spec house ^ yes~no Lot lines identifiable yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result is 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 is the waste disposal system. The properly owner agrees to submit to St. Croix Zoning Department a cert~icatioa form, signed by the owner. and by a masterplumber, joumeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic teak is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirtiments and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by rho Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be co leted and r+cturned the St. Croix County Zoning Office within 30 days the three year expiratio date. `~ ~~~~ ~" ~ ,19',0/ 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 property described above, y v' a of warran de corded ' Regist of Deeds Office. :~, ~ ~~ SIGNATURE OF APPI:I ~~ ~ ,% DATE ««sss« Any information that is mis-represented may result in the sanitary pcmut 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 referFnce is made in the warranty deed ~~~~~~.1~9~PA~E1~.9 • STATE BAR OF WISCONSIN FORM 2 - 1999 Document Number WARRANTY DEED This Deed, made between P. C. Collova guilders, Inc., a Minnesota Corporation, Grantor, and Joseph J. Meagher and Patricia L. Meagher, husband and wife, 639645 KATHLEEN H. WALSH kEGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 03-42-2001 c':44 PM YRRRAN'IY DEED EXEMPT N CERT COPY FEE: COPY FEE: TftFViSFER FEE: 195.00 RECORDING FEE: 10.40 PAGES:.. 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): ~loonbe,~ Ridge in the Town of Hudson, St. Croix County, Wisconsin. Recording Area Name and Return Address KRISTINA r`^LAND ATTORr~ ~w,r ; ~~~ L.Aw P.O ~ -C 359 HUDS~.~v, WI 54016 020-1378-O1-000 Parcel [dentificationhumber (PIN) This is not homestead property. Qfi) (is not) Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Dated this D 2 day of ~~ar++ar3~ 2001 P. .Collova ' ders, I * P. C. Collova, President ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. County ) Personally came before me this day of the above named to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. * Notary Public, State of Wisconsin My Commission is permanent. (If not, state expiration date: •) AUTHENTICATION Builders, Inc., a Minnesota a. President aa~il3ent~Gatetel thlsb~s okay of F~rasr~~~ 2001 :N; r ; __ //~~ ~~. t'-"Kr,4'i9fiRatiQgla nd ti... . TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stets.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristine Ogland Hudson, WI 54016 (Signatures may be authenticated or acknowledged. Both are not necessary.) *-Names of persons signing in any capacity must be typed or printed below their signature. ~nlorma~ion Protassana~s company, Pond au Lac, vyl STATE RAR OF WISCONSIN eoo~sss-zo2~ WARRANTY DEED FORM No. 2 - 1999 ~ ~ ~ w i ~ ~ i ao4 ~~ ~ $ ~ ~ z W1/4 CORNER ~ SEC. 12 S89°5T29"E ~ ~ .- ~ -•-- -• -_X-~ X,, 2670.03' d04 ~ J j ~~ ~~ ~~ ~~ ~~ ~3 ~ ~~ I I I ~ ~ 7 ~ ~ I 1 ~ I ~ I ~ I I I I 3 ~~ ~i I ~ ~ I d04 ~~ ~~ ~~ ~~ ~~ . _ ~ ~ ~~ ~~ d04 ~U ,- _~ ~ . ~~ ~0~ ~~ i i i i i N C6 .' N S 89°5729" E • . ~~=, 431.75' ' , _._.~. • ~~ 2 / N 2.49 ACRES 108,456 SD FT ~ / / ~ ~ MIN BUILDING / .~~/ I FFE ELEV. = 910.0 /~^~~ / / ~ I ~ / /~` / ~ / ~ / N 89°57'29" W / 187 541.24' / ~ / ~ MIN BUILDING / /`~ / FFE ELEV = 910 0 / i ~ / . . ~ / ~~Gi ~ 3 ~ ~ '~ ' ,,s1 i / 2.50 ACRES ui ~ ,~y / ~ j / / 108,688 SO F irk / ~~ / ~40' DRAINAGE .i / c}j/ / EASEMEPtTS ~ ?' ~ `~''/ N 89°5729" W 535.7 ' \ ~\ ~. _ MIN BUILDING fig,, FFE ELEV. = 910.0 ~\\ (~ ~\ "F~~~ . \~~ ~\ 1095166 SQ FT \ \~\ • • \~ ` \ ~L N1/4 CORNER SEC. 12 MOONS LOCATED IN PART OF T OiF THE SW1 /4 OF THE TOWN OF HUDSON, ST 12.a+/- MG]pdG\`u~C~D ~GvJD~ O~~nICD -------------------------------- EAST -WEST 1/4 LINE 1 N89°57'29~W 763.1 Q X X~ X------ E 384.94' 12' ~~' ~ I EASEMENT / $ ~ •/ :) i 80' RADIUS TEMPORARY CUL-DE-SAC r EASEMENT TO BE AUTOMATICALLY !, REMOVED UPON ROAD EXTENSION ~~fi` ~ ~ _._._. , 2.47 ACRES 1 C7 107,685 SO FT •, ` , . , • .\ \ ~~ i, A ~ ~ ~ ~ c :: I ~; ~~~ I 3 '•' ~ ~ m ~ ;.. ~ 0 3 y ° ° '.' ~ '~ ° ~ • ~ ~ D) ~' ^ < 7 N ~ 0 1 y IV Q <O ~ F~1 ~' ~ Q „0 ~_~ y ~~ V ? ~~ O ~~( ~ ~~ ~ ~ p N ( r~r ~ n ~~ n ~ O ~ ~ -+ ~ R ' O ~ N ~ ~ C y o i A I ~ y 7 ~ c ~ ". 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