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Home My WebLink About020-1378-04-000w of Conxtterce Safe4y and t3uikfings Ditriskxt GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) Personal infomtation you provice may pe uses for secondary purposes [Privacy Law. s.15.04 (1)(m)]. Permit Holder i Name: ^ City Vi lage ^ own of: ollova, P.C. Hudson Township CST BM E v.: Insp. BM E ev.: BM Description: ~c7C.~l (~.Ot ~ ~ ~ ~ ~ TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P / L WELL BLDG. vent to Air Intake ROAD Septic ~ ~-p' ~ ~ ,d l NA Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION Manufa urer Oeman Mode[ Numb GP TOH Lift ri 'on S tem Ft Forcemain Length Did. Dist. To Well ELEVATION DATA ounty: St. Croix Sanitary Permit No.: 384126 State Plan ID No.: Parcel Tax No.: 020-1378-04-000 STATION HI FS ELEV. Benchmark l l " p,~ , O' Alt. BM ~~~ o ~ ~ `~8 ~/b r Bldg. Sewer ~, ~-(a ~(p r St/Ht Inlet ~_ ~. y,~ `Y2,b~r St / Ht Outlet g ~ ~S `~2. ~~ r Dt Inlet ~~ ~- Ot Bottom --- Header/ Man. Dist. Pipe ~' `F3 ~ Bot.System ~I`„az ~R•~L/ Final Grade St cover SOIL ABSQRPTION SYSTEM ~I C~ ,,Q, ~.,v~,b~ „~ ~f-le,~, e.~, Blfi~' ENCH Width I Lent I No f Trenches PIT _ No.Of Pits Inside Dia. Liquid Depth N 3 ~~S IM I N SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Man a urer• ~ SETBACK L INFORMATION T o t CHAMBER M e Nu r: ~ ~ S em• V~ a ,~ O ~"•(pO OR UNIT fp DISTRIBUTION SYSTEM Header / Mani ~ tt length ~~~ Oia ~ , Distribution Pipe(s) pacing x Hole Size x Hole Spacing Vent To Air Intake i . 7 6~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded I Sodded xx Mulched Bed /Trench Center I Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: ill LZ1 ~ ~ Inspection #2: ~--~"+ Location: 1042 Moonbeam Rd., Hudson, WI 54016 (NW 1/4 SE 1/4 12 T29N R19W) - 1229192243 Moon~~e/~m~Ridge -Lot 1.) Alt BM Description ~~ ~1~f~~ 0'~l 2.) Bldg sewer length = (3. n'~ -amount ~f cover = ~~ r-fD~~ ' I ~ / eat ~ ~ Ga,v~ -~'rP~'t-r~- 3) (~Sc~d~O'k Pi e~ 6+~ 2 d'f.6r'''~ Plan revision require ^ Yes ~~, No t Use other side for additional information. ~ Z 2Do SBD-6710 (R.3/97) ~ ~e (~ _ ~ Inspector's Signature ~JGC. S Cert. No. :, ,~ S2 ; 02 ~1~,~ y ~ ~~ Z ~ /o ooi~6s,~ o . Sanitary Permit Application s ety & Buildings Di tston In accord with Comm 83.21, Wis. Adm. Code 201 W. Washingtort~ve. See reverse side for instructions for completing this application PO Box 7302- isconsin Personal information you provide may be used for secondary purposes Madison, WI 53707-7302 Department of Commerce [Privacy Law, s. 15.04(1)(m)] Submit COm leted form to COUn if not ( p ty state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. County State Sanitary ~ermit Number ^ Check if revision to previous application State Plan I. D. Number ,:y. I. Application Information -Please Print all Information Location: Prope Owner Name Property Location c ~ N LU1/4 5,1/4, S Ja T ~ ,N, 1;1 (or Property Owner's Mailing Address Lot Number Block Number 7oS City, State Zip Code Phone Number Subdivision Name or CSM Number II. Type of Building: (check one) /- asPa-~ 5u, oM5 ^ City 1 or 2 Family Dwelling - No. of Bedrooms :~ • ^ Village Public/Commercial (describe use):_ 'Town of ^ State-Owned f~ Nearest Road ~~J ~/. P ~ l oTax Nw r s) Q _ OOt7 III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) 12.29. 19 . Z 2 3 A) 1. New 2. ^ Replacement 3. ^ Replacement of 4. 5. 6. ^ Addition to System System Tank Only Existing System $) Permit Number Date Issued ^ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) Non-pressurized In-groun~d' ~ / ^ Mound ^ Sand Filter ^ Constructed Wetland ~ ~~ Pressurized In-ground ~? c t ^ Holding Tank ^ Single Pass ^ Drip Line ^ At-grade ~ ~ ^ ero is Treatment nit ^ Recirculating ^ Other: R - D ~ ~- ~ es ,,~.,.~ - s ~. 3 X 93• V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation ~ 7. Final Grade ~ Required Proposed Rate (Gals./day/sq. ft.) (Min./inch) 9'~n (ps Elevation ~ ~ ~ ~ VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks s - ~ ~ ~~. ^ ^ o ^ ^ ^ ^ ^ ^ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS sho on the attached plans. Plumber's am int) ~ G~~f Plumbe Signatur (nos _ MP PRS No. Business Phone Number - - aa~3 s ~~ ~ - ~ s Plum et's Address (Street, City, State, Zip`9Co ~ ~j ~ ~ ~ tJ ~ 2%'L IX. County/Department Use Only ~ ~ nn>ab~ u; ~ ~Q ~ S .~,-" ^ Disapproved Sanitary Permit Fe ncludes Groundwater Date Issued ,,~" ~ GIs ncng Agen€Sig (No stamps) Approved ^ Owner Given Initial Adverse Surcharge Fee) r,~' ~ Determination ~ ~ s • Q'b 02 - 09-0 /~`~~,."' ~ ~' ~t~ ~' ,,^ ~ `; s " X. C ditiQQns of Approval /Reasons ,fir Disa roval• .. vt~G S v`tiua~ ~2.~~¢dA~e.rQ '~°r ~r.Q.t~tP~~4 ~e~ _~ ~ at.-~->-yS-F.u.~ - ~ ~ ~. ` , 5~~.- r.,^'~, ~ '~'A ~, ', ~ '~-~.~ ~ae .¢, ~.Q ~ w-~.o~E~ (L~cR.Qu.~e_S '~-c ~~ ~ / ~ ~ ~ ( ''"~ s- d,. -~ ~ V1AJA.5`t-b4- ~l~t~t.J1.. "~C s~ ~sl~ v^M, S l i ~ ~i e _. :. ~. ~•~ - t l` tQ > . I ~tA., ~,~,~,~~ nn ~{{~~-~ n r n ~'S~~ ~ V ~- ~1'-_. SLYIU/s~~'''` n,R.¢,d~ ~ ~~~ S~~ -~ °i~,~,l~,y~;OFF1G` ~ - i rl -- ~- l.C .n • n /1 / A ~ n n ~ n A.Z.en~. ~-6398 (R. 07/00) ~ <~ V ~~~i y~p~...~ CJ~2~ 1W~fa.tM tII,a ~:. `~~cS tie-C,e~w~,wl axS . v~° ~p ~ Faso ~ a = ~-~° ~ i' "~i°=goo ' ~I ~~-- q-ioo z,-v~~ ~} JA l ya~~s _.~ z~~ ~ ..~: F _.=. .; r' . aa3s ~ ~~ ~~ y_ ~asD !~-~o~ ~. 1~-,~s ~ ~" n L ,. X a-3 _._-_ ~. ~~ osX'" ~~ ~G. v v a9 ' a C /a //" U ~F' ~l_,,~Q~'S ,~ `np~ ~ ~' ~ ~7 y- v~ C \ _ ~ ~~~ /~ / X ~X ~~ Hain Department of Commerce 9ston of Safety and Buildings SOIL L~ALUATION REPORT Page / of~ in accoroance vatn c;omm s5, urns. rwm. was . - _ t P - County S ~ • ~, ~ lan mus Attach complete site plan on paper not less than 8112 x 11 inches in size. indude, but not limited to: vertical and horizontal reference point (BM), diredion and Par~oel I.p. scab or dimensions, north arrow, and location and distance to nearest road. percent slope , Pleaase print all Infons-ation. viewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 75.04 (1) (m)). ~ ,,Z ^ - Property Owner Properly Location ~ ~.. C~ I ~O ~ ~ Govt Lot ,U~,,~ 114 ,S ~ 114 S / ~ T Z N R / r( E (or)~ Property Uwner's Mailing Address Lot # Block # Subd. Name or CSM# i!y State ~ Code Phone Number ^ City ^ Vllage (~ Town Nearest Road 1-I-cr~~,~ wl .S-y0~,(~ (7r5" )~S'y9-.S`tT ~}~ f~u~sa~ rnaQ~.b~`n k~f [~ New Construction tJse: l~ Residential / Number of bedrooms ~_ Code derived design flow rate. y.~d . ~ ~ ` GPD Replacement ^ Public or cornmerdal -Describe: ---e ft ~' / ~ Parent material 0 y ~-c,~a~ ~ Flood Plain elevation if applicable • .~//<-~ ~=~,, ,, - General canments ~ Q . ~ ~ fi * ~ ~', ~, ~ and recommendationss~s~~ eleJ. ~~~f ~,.. ? ~- ~~•~ : , ; YL SR VY~O J.2 1, C,.: I Y o ,.w n. ... l IMf.PI i/ I)-l~. {~Q.P_"U"lX '~7RQ/"~ ~T r•,~X' ~ ~ ~f n,nt,r' -Y2.et7~nv~ ti~ r Boring ~ ~ 1 -~ Boring # g3 .. Pit Ground surface elev. ~ ~ s ft. Depth to limiting factor ~ /~ in. -` Soil ~~ Rate D h i l D t C tion Descri R d Texture Structure Consistence Boundary Roots GP D/fi? Horizon ept in. or om nan o Munsell p ox e Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 * 1 -I ~ 0 3/Z -- G- rns6 fir'' C S ~ v ~ `~ .a Z( a-rlg - vn 5 ~ r - --~ qo, 6 S ~ .~.- 5th- ~o ~Z W N. . ~J 8.7 Z Boring # ~ Boring ~ Pit Ground surface elev. q~ ~ ~ ft Depth to limiting factor / l ~ in. Soil Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/f~ in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. "Eft '~~ 3 / Z-Z~ , ~ ~ - ~S / m/ ~ -~ . Z `f z -l l /~ - m l - ~ , ~ /- z .y' as •~! _._- * Effluent #1 = BODg > 30 < 220 mglL and TSS >30 < 1 50 mglL * Efltuent #2 = BOD < 30 nrg/L and TSS < 30 mg/L CST Name (Please Print] Signa ~ ~ CST Number 25 9 A~~ Date Evaluation Conducted Telephone Number 2 t1 ~ ~T-~ ~~~rv->~r~;-~ (a ~~ ~~02~~ z-~s'-c~ / _ _--~ZS~Z4 7-4CY~ Property Owner (~ G 1 ~O(fcc Parcel ID # Page . Z of ~ . ~# u ^ Pit Ground surface elev. IG- /~ tt //~ Depth to limiting factor 11L_. in. ~ Rate Horizon Depth Dominant Coto 12edox Desc~on Texture Stnx~ure Corrsistanoe Boundary Rooffi GPD/f'~ ~~ in. Murrsell Qu. Sz. GoM. Cobr Gr. Sz. Sh. -~ CS 9 ~ '~ ~ ' 1 I o~~l 3/z - S~ ~ m , ' v - - z ~~-~ ~ - sG/ ~s~ ~~ ~ cs - , y , ~ u~~ 3~G _ LS lrns m( CS -- - l-Z ~~ y/l - vas ~/ - _ - ~ /.Z a ~~ # ^ Ground surface elev. ft. Depth to teniting factor in. ^ Pit Soil licafjon Rate tion ri De R d Texture Structure Consistence Boundary Roots GP D/ff Horizon Depth in. Dominant Cobr Munsell p ox sc a Qu. Sz. Cont Color Gr. Sz. Sh. 'Eft#'I ^ ~9 # ^ Bonng Ground surface elev. ft. Depth to limiting factor in. ^ Pit Soil lir;ation Rate l tion do Descri ~ R Texture Structure Consistence Boundary Roots GP D/fF Horizon Depth in. or Dominant Co Munsell p e x Qu. Sz. Cunt Cobr Gr. Sz Sh. 'E~ ~ ' Effluent #1 =BODE > 30 < 220 mglt. and TSS >30 _< 150 mg/L ' Effluent #~ = t3ODs _< 30 mg1L and TSS _< 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an ahernate format, please contact the department at 608-266-3151 or TTY 60&264-87'77. SBD-8330 (8.07/00) PAGE ~ OF~_ _NAME Cd ~ ~Oc1c~ LOT# "L LEGAL DESCRiPTiON~ity `/s/=% S!Z TZA N RIRE (or)~ SCALE: 1 "_ ~D ELEVATION ~~O• U BM 1 DESCRIPTION 7~.p a-~' ~ ~5~~_,,o,~a e M 2 ELEVATION /6G ~ q c~ BM 2 DESCRIPTION ~p 0'~ P~••-~-r.~ ~k I SYSTEM ELEVATION 9C~ •(o.~ `r - + -- ALTERNATE ELEVATION T5e~ ~ f-I~~ so ~ l~P-5'~" RO~ wtay ZpOd CONTOUR ELEVATION ~~ _ o~Q° ,(• ( ~ a / "` r • B3 ` (~ ~°~ . ~ , ~ ~ ~~ ~ ,. ~~' •, ~~ ~ of ~ . ~~ ,~`~. ~~ ~' / ~~ ~• ( r~ a- / /_ .~ s ~ / ~ -r ? ~µi~ 5 ys~c rlrl a ~~ // // i ~e~^' /7~US.Q i (~„~ ~ --~ v `~ i ~ ~ •~ ~ `t `' - ~- ~}7 v~_ A.~`~~ 1 r ,8i~ DATE 'U18R-( U.r nt~-t-- " '~sconsin Department of Commerce SOIL AND SITE EVALUATION Divisiop of Safety and Buildings 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 County include, but not limited to: vertical and horizontal reference point (BM), direction and ~- percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # Page ( of ~ APPLICANT INFORMATION -Please if~llVr>ifdrrt~>f~s~. Reviewed by Date Personal information you provide may be used fors o~ ~ purposes nvacy'Law ~:~f5.04 (1) (m)). ~ ~. ~.0 Property Owner i 1' '" ~ra~ C ~ ~'~ ~v ~-a •'. "[?roperty Location Govt. Lot ,u~ c1 1/4S ~ 1/4,S ~ Z T~ t ,N,R ~ ~ E (or)~l Property Owner's Mailing Address ~ ~ =e' , it Lpt # Block# Subd. Name or CSM# a C7 v ~ .x ~ - ~ ~ ~~C>N ~1~ ~~ E ty Sta a Zip Co et. . Phone~fllorriber Ci r LJ City ^ V illage ~ Town Nearest Road , 1 ~tV~1si^ni I i~~ I S~I01 ~ I ~'~l ~~jr~yY~S~~~ ~~t ~sBf~ ao n c~ o-a. New Construction Use: ~ Residential / Nu edrooms ~? 1.- Addition to existing building Replacement ~~ /~ ~} ^ Public or commercial -Describe: Code derived daily flow ~ gpd Recommended design loading rate =bed, gpri/ft2_~trench, gpd/ft2 Absorption area required bed, ft2~trench,'ft2 Maximum design loading rate _~bed, gpd/fi2 ~ trench, gpd/ft~ Recommended infiltration surface elevation(s) ~ ~' ~ % ft (as referred to site plan benchmark) Additional design/site conside'ra`ti1ons L"~'- ~ a ' ~ L Parent material ~„1'y' - W ~- 5 ~ Flood plain elevation, if applicable /lam ~}' ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade tem in Fill Holding Tank u = unsuitable for system ®S ^ u ~ s ^ u ~ s ^ u ms's ^ s [~' u ^ s ~ u CAII 1'11FSCRIPTIAN REPORT ~ '~ Boring # Ground elev. (a.ZNft. Depth to limiting factor ~,in. Boring # ~~- Horizon Depth Dominant Color Mottles Structur d B t R GPD/fit in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. C nce oun ary oo s Bed ,Trench its l 3 _ r~ ~ s ~ r ~ ' z. - ~~ ~i 13 - ~ ,~~ ~~ ~s - .~ . ~ 3 2 -yq `1 ~ r ~ ~ ~ ~ ~ - ~ ~ -t~ ~. ~.sf , Remarks: I o-~ ~o ~ 3 13 - Ls l ,~. w~ ~2 ~ ^ , ,~ Z ~2~ t~ ~ `t 3 - L.5 1 , ` -~ 3 - bbl 6 `" i~ Ire ~ 5 _ ~' 32•`f •`'~ '~ , Ground elev. ~~~. Depth to limiting factor ~~ ( in. Remarks: ---- ------------ CST Nnnam^e^(Please Print) ignature _ _- -~' Telephone No. Address Date CST Number . . PROPERTY OWNER SOIL DESCRIPTION REPORT Page _~. of-~ PARCEL LD.# ' Boring # 3 Ground elev. ~~tt. Depth to limiting factor ~in. Boring # `-I Ground elev. /~`~ tt. Depth to limiting factor LO~.in. Boring # 5 Ground elev. ~0l•3~1t. Depth to limiting factor a(,~_in. Boring # Ground elev. tt. Depth to limiting factor Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench 2 S-Z~- t o t! 3 L ~ ~~.s ~~ ~ ~- ' ~ Z l 0 1 6 --- ins L ~- ~' ~ ~-- '.~~ 't{ ~•'~ Remarks: Z 11 3c ~ ~ 3 - L~ ~ - cs -- ' ~ v-lo (, ~ ~ ~ _ ~ 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 ~ -IZ I ~ 3 - L.S ~ r~5 ~ v t- ~ ~- ~ . g Remarks: m. Remarks: SBD-8330 (R.9/98) ~ ~ .. ^\ i PAGE ~ OF~ NAME C o ~w Va. LOT# ~ LEGAL DESCRIPTIOlyc,~„i '/~ '/<,S /2 T2~(,N,R (q E (or~_ t SCALE: i"= (~O BM 1 ELEVATION ~QG • C3 BM 1 DESCRIPTION./Q~ao.,~ ~lt Arc ~Pe„ ~a-1~,~3~~/gc~ BM 2 ELEVATION -! BM 2 DESCRIPTION fob ~ ~ la ,Ov C P; fie. la-~h~Flay SYSTEM ELEVATION__ q$ . $ H _ ALTERNATE ELEVATION ~~ ,F/S• ~~ CONTOUR ELEVATION ,N( +Z x ~ .- -~ - ~- o c~ Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: System Design Specifications Sanitary Permit Number $~IZ Number of Bedrooms Design Flow -Peak (gpd) o~ Estimated Flow -Average (gpd) d'O Septic Tank Capacity (gal) (Z~ , Soil Absorption Component Size (ftZ) c7D '' ~ - .s' ~ Type of Wastewater omestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow -Peak (gpd) 1 SI - ~ Maximum Influent Particle Size (in) 1/ Maximum BODS (mg/L) 220 Maximum TSS (mg/L) 150 Tab le 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the se tic tank and outlet filter shall be assessed at least once every 3 years by inspection. Th outlet filter hall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the ~o~,,~.~ ,~ $ '~ _ Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access. risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank maybe difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND ~ ~ OWNERSHIP CERTIFICATION FORM Owner/Buyer ~. ~ . ~ ~ ~ oV'A g ~ ~ ~ s ~N t... Mailing Address -70~ ~u . ~t d : ~' /~vQsu-v i,vL .S ~-v 1(t, Property Address (Verification required from Planning Department for new City/State fw~ S 0 N ~~ Parcel Identification Number *+~ ~ 0 20 - 13 }`$ - D ~{ - cn1'~ LEGAL DESCRIPTION I Z - 2a • t ~i • ZZ~ 3 Property Location lVI/V %,, SE %,, Sec. ~ ~, T~N-R~W, Town of ~ dd SQL Subdivision ~c~uN ~'J ~ln~ /P~ ~ ~ Lot ~~ .~-- Certified Survey Map ~~ Volume ,Page # Warranty Deed # t~ / ~ ~~~ volume /~qa ~ .Page # D~ Spec house ^ yes~no Lot lines identifiable yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature.failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certi/ication form, signed by the owner. and by a masterplumber, journeyman plumber, 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 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 standazds set forth, herein, as set by the Department of Commerce and the Departrnent of Natural Resources, State of Wisconsin. Certifcation stating that your septic system. has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of yeaz expiration date. ~/%/~) SIGNATURE OF APPLICANT DATE OVYNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) Qre owner(s) of the prope cribed above, y virtue of a warranty deed recorded in Register of Deeds O(Iice. 2/ /O SI NATURE OF APPLICANT DATE ****** Any information that is mis-rcpresentedmay result in the sanitary permit being revoked by the Zoning Department. ****** ** Include wily tl-is application: a stamped warranty decd from the Register of Deeds office a copy of lire certified survey map if reference is made in lire warranty decd VOL ..L`~.J~rPAGE Ur~U • STATE BAR OF WISCONSIN FORM 2.1999 DocumentNumbcr R'ARRANTY DEED 'Thls Deed, made between Campbell, UWa Rosemary F, P dames A. Fisher and Rosemary It', 618998 KATHLEEN lI. Wpt,gy kEpISTEi2 OF I3EE1?S ST. CROIX CO., WI RECEIVED FOR RECORD OP-c~9-$000 ~: i?0 PN Grantor, and P. C, Collova Builders, Inc., a Minnesota C~oratlon, Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in _ St. Croix State of Wisconsin (if more space Is needed, please attach addendum)•o~ty~ Part of West 1/2 of SE1/4 of Section IZ-T29N-RI9W described as fotlo~vs: Commencing at the NW corner of said SE1/4; thence E 763.1 feet; thence S 1980 feet; thence W 103.1 feet; thence S Wiy to a point 165 feet E of the S W corner ofsaid SE1;4; thence W 1G5 feet; thence NZ640,0 feet to Place of Beginning EJiCEPT Lot S ofCertiEed Survey Map recorded in Vol. 14 of Certified Survey Maps, page 3788 a:f Doc. No. 61G755, St. Croix County, Wisconsin. !lNRR~,1i1f DEED CCORY FEEe COPY FEEL TR1~IFER FEE: 851.70 R~BDIHii FEE: 10.00 o Zo - 13 ~-8 - ~ ~{ - iTd1~ !z . zq . I9 . -zz `f3 Recordin ~ --> Name and Returr, Address DAVID J. ESTREEN 304 LOCUST ST. ;- o~ HUDSON, W154016 020-1025-70.000 & 020-1015.40-000 Parcel ldentifleation Number (PIN) This is not ----~~`__ homestead property. Exceptions to wamtnties: Easements, restrictions and rights-of--way of record, if any. QI1 {'s not) Dated this _ ~~day of February 2000 AUTHENTICATION Signature(s) James A. Fisher and Rosemary F. Cam hail, f/Wa Roe . Fisher, both single braoas, .i`. ~, ~ °~a$y of February 2000 w . _._. • / ~' ~l.-L.~ James A. Fisher "` C + aemar F. Cam be11,`f/Wa Roeemar F. Fisher ACKNOWLEDGMENT STATE OF WISCONSIN ~ ss. County Personally came before me this ._~1 day of _______ the above named STATE BAR OF WISCONSIN authorized by § 706.OG, Wis. Stets.) to me known to be the p- arson(s) ~yho executed the foreg lno g instrument and acknowledged the same, THIS INSTRUMENT' WAS DRAFTED $Y Attorney Krirtina Ugland ~' -~"-"--- ~son, 4 a" - Notary public, State of Wisconsin {Signatures may be authenticated or acknowledged. posh are not necessary.) My Commission is permanent, (tf not, state expiration dote; of persons signing in any capacity must bl; typed or printed below their signature, WARRANTY DEED STATE BAROF WISCONSIN FORItiI No. 2 -1999. Mrormallon prof~~aMnaL Company, Fora du l.f+q W! 800.655-2021 I, ~ N 89°5T29" W ,' ~ ,' 1e~.15 ;`._:_._._._ ~• \ MW BUILDING 541.24' i' i i 1$•48' ; \ FFE ELEV. =931 i i ~ ~, • M!N BUILDING ~ ' ' _." -• . •-•- . _ FFE ELEV. = 910.0 i' ~ ~ ~ / ~, ~ ' ~ I I !I ~ I i N ~,~ti' ~' 2.50 ACRES ~i C8 I ~ `~ , ~~i ~~ 108,688 SQ FT I`! ! ~~ ii • ~ 40' DRAINAGE $ I 1 ~ i ~ ~ ~' ~' ~~ r EASEMENTS ~ ~ ~ •. ~ / ~ S ~ / I . h i ~ ~~ •-- -1.-- ~ .' ~ i~ •. i hip ~ N 89°5T29" W 535.74 ~` / i ~ ! i ~~~ 12T+/- 219.9T i i ~ / ~ 1 MIN BUILDING I ~~` \\~ \ ~,a % /33' / .' ~ ~/ a? FFE ELEV. = 910.0 ~ \\ ~s$~, \\ ~ y j / / /~ 2.51 ACRES \~ \\~ \\ .' ~ ~ ~~_ :' ~'sQrr 109,166 SQ FT \ \ \ • ~ c;,° ~s, ~ \ ~~ - :~ N ~ S~S~~ f ~ ~ 1j' / ~ ~ o • .. ys, as, y ~ • ~ ~ ~` ~ .: i N °~ ~ r • ~ ~ Q ~ ~~ ~~ . • N 89°57'29" W ~ 5 '• ~ ~Q = , 281.59' ~ 2.59 ACRES ~ i Q i • ~ ~ 112,924 SQ FT '- ~ ~Q~' ~~ • ¢ M : ~ C~ KI i / . O ~' ~ ' z M!N BUILDING .' ,~ ~ M!N 8lJltDING . FFE ELEV. =930.5 / OQ c+~ FFE ELEV =931.5 • 11 •.• ~ ~ / ~ 2.506 ACRES ~ ~ 109,150 SQ FT i , 1 / • N 89°5T29" W i ~ ~i .~ ~ H.W.L =926.0 316.86' ; I ~ ~ ~i ~ ; I _ H.W.L. =931.5 ~. N as°sT29° w _-~- - MIN BunnING '. ~ 373.33' FFE ELEV. =930.0 ~ , i ~ . C ~ 1 ~ '. ~ ~ 1 6 ~ ' ' ? ' ~. N 2.51 ACRES ~ cA w~ 1 Q g " 109,476 SQ FT ~ a ~ ro 2.55 ACRES co~''.~ -'L- ~ 110,894 SQ FT • ~ ~ m , ~ I MIN BUILDING -.-.- - -•~ 1 ~ ~ ~ FFE ELEV. =931.5 t ~ , , -- J J t • 1 , '. 1 616 ~ ~~ ' ~ '. z ~, ,. aJ j O ~ 0 1 ~ a ; d04~ ~~ o~ D. o, ~' GQ ' o~ O' ~' ~' (~04 ~~ ,- .- ,,, d04 d04 ~~ F Cf ,,~ LEGEND /\ el ~ IMINI t~1 rho MIT/ cCrTlnAl rnanico f ~~ ~ ONNNIINNM/~'- M~~~r .\ ~.~. s,: ~: _ ~ . _s T, ' _ ' _'= ';.._ Thursday, April 25, 2002 P.C. Collova Builders, Inc. 1042 Moonbeam Rd. Hudson., WI 54016 Regarding septic inspection for P.C. Collova Builders, Inc.. Location of Property in St. Croix County: Municipality: Subdivision or Plat: Dear Applicant: Hudson Township Moonbeam Ridge Certified Survey Map: Lot: 4 Address: 1042 Moonbeam Rd. ST. CROIX COUNTY WISCONSIN ZONING OFFICE ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 FAX (715) 386-4686 A septic inspection of the above reference property was conducted on February 22,2001. This property is located in the NW 1/4 SE 1/4 of Section 12, T29N R19W, Moonbeam Ridge (Lot 4 ), Hudson Township, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant fora 4 bedroom home. If you have any questions regarding this, please contact our office at 715.386.4680. Sincerely, e m raba Zoning Staff ~~a~. cc: file