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HomeMy WebLinkAbout020-1378-05-000 I - Wisconsin Departme;. of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety ana Building Division - I INSPECTION REPORT Sanitary Permit No: 395127 t� 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: P.C. Collova Builders, Inc. I Hudson Township 020 - 1378 -05 -000 CST BM Elev: Insp. BM Ell: BM Description: /0' 100 / TANK INFORMATION IJ ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / / / v Benchmark DM I X11.. 1057 /0 1 Dosing (/mil � t / � �-b Alt. � `' -S � t l• t� Aeration Bldg. Sewer , �� ��• S� Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent Air Intake ROAD Dt Inlet Septic / ] r / Dt Bottony /2, c C2 gs Dosing �, � ,/i .�'l 0_r' / He ^ m4<.+" Aeration iPe Holding Bot. System / /0- S * UMP/SIPHON INFORMATION Final Grade Manufacturer Demand St� GPM gM J 3 g 9� -(�/ Model Number � . ( ( /– TDH Lift, i Friction �oss System Head TDH Ft Forcemain Len / Dia. / Dist. to Well I , SOIL ABSORPTION SYSTEM DIMEN IONS Width / Length ( No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS / IS�J d SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREA LEACHING Manufacturg : 1 � INFORMATION 7 e stem: / 6 CHAMBE yp y 5 Ab' S I -}� (,L Model Number: p - "' DISTRIBUTION SYSTEM Header /ManifoP Distribution x Hole Size x Hole Spacing V to Air Intake r� a Pipe(s) /� �j 0 1 Length 0 Dia Length lU ` ! Dia W � pacing_ SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ELI] Yes ] No Yes FN No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1038 Moonbeam Road Hudson, WI 54016 ( /�4SE 1/4 12 T29N R19W) Moonbe R Parcel No: 12.29.19.2344 1. Alt BM Descri li N � � on C • (.�' `ffl 2.) Bldg sewer length = 3Gl r — 30 � N vv CO r KaAQ- - - amount of cover Plan revision Required? [ Yes No I G Use other side for additional information. Sig Date Insepctor's � � _ nature Cert. No. SBD -6710 (R.3/97) ._�. - y e � . ` ! ` � 1� A y Y o �� I u,r,S �°` -- -� �� �fi °� �� � �` /.� ,� County Safety and Buildings Division 201 VJ. Washington Ave., P.O. Box 7162 j������� Madison, WI 53707 -� 7162 Site Address De artment of Commerce Sa„itary Permit Number Sanitary Permit Application 3q 57 1,�? In ,c=M V t Comm 83.21, Wa Adm. Code, personal information you provide Check if Revision wav be used for see ses privae Law, s15. 1 m State Plan I.D. Number / I. Application Information — Please Print All Information A A Parcel Number Property Owner's Name RECEIVED ciao- 137�F O ad G 5 Xa -e Property Location Property owner's Mailing Address JUN G v /0� �- /-/,& �So.1 1 2 200 �/CNum S�'�: S T a N, R U S � Number Lot Number � Block Number city, State Zi p Code S X COUNTY ONING OFFICE Subdivision Name _w CSM Number G- G� S'Cl �/ G✓ H. Type of Building (check ail that apply) ❑city 1 or 2'Family Dwelling - Number of Bedrooms ❑Vt'llage ❑ PubliclComnrercial - Describe Use Township G� 3 /x (a 1 NaMst Road ❑ Star Owned o? A.Q'h' -� - � M. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete ' e B if applicable) A• i � New 2 ❑ Replacernen[ System 3 ❑ ReplaceroOnc of 6 ❑ Addition to For County use stem Tank Onl F.xis ' S stern Date Issued B. ❑ Check if Sanitary Permit Previously Issued Permit Number IV. Type of Permit: (Check all that apply)(numbering scheme is 7orrintern � Fil e) C wedattd 44 � Non -pressurized III-Ground 21 ❑ Mound 51 Drip Line 22 ❑ Pressurized in -Ground 41 ❑ Holding Tank 48 C1 Single Pass 3 �� 0 46 ❑Aerobic nit 4 Cl Recircuating 30 ❑ Other 45 ❑ At - Grade .e �, / e Y- C a >,,, �S V. D rsaUlreatment Area Information: ga Percolation Rate System Elevation / Final Grade Design Flow ( Dispe rsal Area Dispersal ea Soli Application / E / Regn�� P�r^o-posed�o�,j -�� ,7 ✓ �l/� 7 ac Tonal Number Manufacturer Prefab Site Steel Fiber Plastic vi. Tank Info d ons Gallons of Tanks 7 _ , // /► / //o Concrete Constructed Glass New E-1 tiAg Tasks Tanks l} Septic or Holding Tank - Udv G Dosing Cbamber �j v VII.. Res ibili Statement - 1, the undersigned, Lowne responsibility for Lion of the 1?OW TS shown on thBu �`� one Num ber Plumber's Signature RS Number Plumber's Name (Print) � l S - 3 Plumber's Address (Street. City, State, Zip Code) / el 7 d S C & /0,�-y [ TOE 4, , Sic VIII. Count /De artment Use ON Sanitary Permit Pee (includes Groundwater Dale Issued Is gent Signature (No Stamps ❑ Approved ❑ Disapproved Surcharge Fee) �f ❑ Owner Given Initial Adverse �j 3 0 r Determination 7 � IIf. CQrtditions of Approva for Dis pprova9 � �ilA.tr replete D uo the county only) for the system on PGW oat E111 x 11 t chi SBD -6398 (R. 05101) pD, Q h QQ � i N y V4 09 YM ' ► h 0 v � , CQttnN � � Safety � ildin$s Divi siaa � 162 201 W. Washington Ave., P.Q. B � Madison, WI 537M - 7162 ai f.- A � - Scon NYertment of Commerce Sanitary Permit Number Sanitary Permit Application �" "+ 83.21, VPs Adnt. CO", porsoast mforass'tinra you provfde CheeY if Revision i in accord ` Cotes ses Privao tAW. s1S. it m tm, be used for sec St Plan I.D. Ntus►bcr �I j L ApplicAdOu Information - Piease Print AD Information _ - �� — parcel NwuDcr ! 3 7,? Property owner's Name RECEIVED C� A . G l ; I .A-e Ir• Propetcy i octtion op property owwwo Mailixi A MNSs - JUN 1 2 �QG 'A S .2- R C e / l T7l' �SO✓ Number Stock Number City. 5 u Zip Code S '. - �+X C �NTV Lot Jr' ONi NG OFFICE 5ubdivisiion Name. CSM Number n. Type of Building ( IM that apply) ❑City ILIA -�.J _ av� 1 or 2 Fata4ly Dweliia$ - Number of &dtoorns owttship L4- [J p jdC;n aterdal - Deserlbe Use N - •� ?,1�i� ��G (B aarest Road ❑ State Owned cwt of persaitt (Check only one boat on Me A (aumberin$ Scheme for lnternai use). Coczxpieto BI tf applicable} M. Type For Caus# =4 A. 1 lYew 2 ❑ > SY 3 itepiacctuent of 6 ❑Addition sn _____ ---- -- Tank O axis S Item Date Issued stasn Pettak Naval B. ❑ Cb,,* if SWUM Permit Ptttvioasly Issued ❑ Mound IV. Type of permit: ( Check all that appiy)(numbering sccbeme is for internal use) ` wd wedatld Ia A 4'7 n Sand Fit= - d 44� xQ - Presautized tn•Cri+�tsad 21 ag L3 S'tn$le Pass 51 C.3 AriP line 3 D• iY r � " - � 22 ❑ pressue zed in -Owund 41 O Iioiding Task r , f • 0 y-f 46 ID Aerobic nit E) Rscsrcu:aang 3u t dxr r 45 fl At -Oracle , ° t c✓, , e r V. D tmget Area Ittforglationntt� Soil Applicadon percotacion ilA.e syate Efavadon Final Grade Flaw Dis (gptly pe blevanrn Dew real Area C proposed wf Rate(Crais.lDayslSq.Ft } (!vtin.Jlncl� r7 �/ � lar�ic R / Steel Fibot P I Prefab Sito Glass VI. Tank Info Capacity in Total Number Concrete Coastt+pctc4 t3ailotts Gallons of Tanks Mew Iixiatint 1 �l /T �i)�' �f�'v► . y T Septic or Holding Tank t)osing Costa +eer _ 1 bW far tYon of tt�e POVVT'S shaven on the ttttstclted Mme*• ._.--- .- --•-` vrr Rea bill Statemeant 1, the un , a s RS Humber a usiaest Plxtctc xurz:ber plum W's Name (Print) Plumber's S!gtlature I ` ' . - e a / AV '79fd Plumber's Address (Street, City, Soata, Zip Code) ` c _ /e. -- - `'III, Count Me cut use Od ' Date. Issues is Ageat Signature (Na Staainsj� Sanitary Permit Fee (u eludes Gtrnu+dwate� } Q Approved O DtsapPro" d Surclbarse Fee} D (wIIer t:si Irlitlsl Adverse petc�inado» --- -• � , � i Of App L 4 rovaUlieasons for Dis ppro`�al IX, CCondido � tts W L f o & E 0- " ' n � �G� rYii.•, ,avl- �r,�c.k:�.- '.���.uv�d v,,. �.�rr+,.�r�» - "a-'? Atka, - s in x !t►titea }, =Ptak (to the County od7) for the sy,dem oa Pei � 5BD -6398 (R, 05101) 05/17/2002 13,55 17154256864 WEGERER SOIL TESTING PAGE 07 Goulds`? Submersible Effluent Pump lei ;. EPO4 3871 E P05 APPLICATION • Fasteners: 300 series • Fully submerged in nigh ■ tiger Hawk* Cast iron stainless steel. grade turbine oil for for efficient heat transfer, Specifically designed for the Cagbie of runn ing lnabric�tlt}n and efficient strength, and d umb ;14. fallowing uses: dry without damage to heat transfer. ■ Nkft Cover. Thermoplas- • Effluent Systems Components• tic cmr with integral handle • Homes Motor. Available for aatarm>atlD and and float switch attachment • Farms pera manual o 0. Aotomatie • Heavy duty sump • EPO4 Single phase+ 0.4 NP, models lade Mechanical points. • ■ Power Cable: Severe duty Water transfer 115 or V 60 Hz, 1560 float Swbk mantled and • Dewamning RPM, built in overload with p at tie rated oii and water resisw . automatic reset. t0 gewhV: Upper and lower • EP05 Single phase: 0.5 HP, heavy duty ball bearing SPEGN=ICATNINS 115 V, 60112,1550 I PM, FFA S construction. pump: EPO4 built in overload with ■ EPO4lmpeltet: Thermo- s Solids handling capability: automatic reset. plastic Semiagw design AUNCY L 13TING 114+ maximum, • Power Cord: 10 foot with pump out vanes for —,� • Capacities: up to 55 GPM. starxiard langth,1613 SJTO mechanical seal protection. f esW**AwuW0 • Total heads: up to 24 feet with three prong grounding m EM Ia"W. Thermo • Discharge size: i' /s' NpT, plug. Optional 20 foot plastic �etonred design for (OSA lined model numbers • Mechanical seal: carbon lengtfn, lBl3 SJIW with end in "F" or 'AC ".) rotaryhenamic- stationary, three prong grounding plug imps perform BUNA - OWOrnerS. (standard on EP05). >! C815�1I •ad B us : Hugged • Temperature: superior design provides . 1041(40°C) continuous superior WNW and 140•F (Wq intermittent corrosion resistance. • Fasteners 300 series METERS FEET stainless steel. 10. • Capable of running dry without damage to s i i '` , Pump: EPOS e I r ,•. � !6f • Solids handling il' F rig � nY� i , �i maxirrwm. � •- -�- - -- I I • Capacities: up to 60 GPM. 1 • Total heads: up to 31 feet. s I i -- • Discharge size: IIN NPT. a I • Mechanical sed carbon - 15 rolaryiceramcc- >►fionary, 4 1 I l BONA -N dastomers. I - • 041 40 continuous ~ 3 1 0 I 14(PF (WQ ), intermittent. 2 _ 1 ~' OL 00 10 20 30 ID 50 GPM lo 1 nolh 0 2 4 6 8 CAPACITY 0 1e95 Goulds Pumps. Inc. t=.irema /day, Im Safety turd $uildirgs L'��ssicn [ ��241 W. W &SW aton Ave, . P.0, sox 71 � _„__ - _,� 'T Via-Dons, MadiM. WI 337171- 7162 Site Address Ds ant t C mm r I ` �` /LI /tae d ed nr iPd „� ttaxy Permit Application Z weber in a000ed w* Ctmina 041. Wk. Aft. Coda. permmi boa you provib � ❑ Clteeit it kevWen L App 8 " PhW Pft AD MIMIUM b a LDS Numter ~” ---� f Properq+ Ciwgr'a wz , i Aaooa I Number E e Ell �f ems �,' / Z. Zf- /q, �3yy .� Property Oww t 1 Proytrty Lau i S a ray /9 �! City, Stall Zip trt btr Block NOW - lu M bdiviftaNum M Number 1 l�✓a d rarJ C,J � 5 `�4l � ��' , `, .' yh��..�/6 ea m� d�� f a, Typo oiC Edtaek aJ! that typiy) X of Z PAa* l ian fts - ltmilbut of Zitdt+eome • k�acr ,,, /�� < _ c., 6,H ,a �vivaEt j f Pnb WCouotDmw - vw be use State Oamid Name Read UL Tyy# of left (C tab► oa e b=an A (atmbwW acHt m for fatarani we), Comp Has 8 iP appUable) A. i New S Q + '! CI Ragltcero+tat at 6 Addition ar Catty wo i only Sw B, n ClNait it i�aaitnry Ptaads Prwious)y )tantd Nmaber Dart Issued �� i . Typo of Fwaft ( W apply) echsma i; for internal wa) + 'Nan •Praetuiwd 14-OMUW LID Monad t7 M Sand I-Ow Soo Conurusunt wetland j 32 G Pt saou*W ft4mmW 4 1 13 lbmw Twk 46 D Sks Pats s 1 Cl Drip Liao I 45 i: At 46 © AMiS 1ltamant Unit 0 C3 RealroulsWu 30 G7 Other ! V. t Peelp Plow ee Arta NU Appliaa on I ,POMIAtton Ras &yam Btrvatloa i Ftnti otad� dt So ✓ /`�2 ✓ RLWO&IWDwyslSq.Pt.) (Mitt,/tach} 1 % �'$' ✓ ElevatYOn is N=btr Mattufa wsr F"M 9iae suset ; ' bec Pflt J t3alioas of TWM COMM CaaetruMOd � aim N ow sa al � w ,'e s� r oC- .__....r. .,.....•....j i V;Lt. 8sflbtt� llsr , atanrme far i+tdaliatlon aid the P4WT8 abe�rp ea the atiaahrti PbxabW NUN MM 'r But" Pttm Number tJ�'ltrav,� Sa�arnal/em 1 o?a ? td i . . ) © DWpprovb t UM Citovwwwr Do 11rad imbs 44M 11twture (No tamgaj i D Owarr Gives UM Adverse Z LS Off} YX, �lp�trt�tlAettaantt L i� Dirq+�avai eK4;r /o vcr 6 �a Ze 64 l/eyl so,A wiAk a vale ©-C �` Ptt �ke�� - �'ll�r i�. �� ih5r Qnt{ sPTU,c�al ��r w�aKH �ac'�Gcr��s rc�ce�+w,CtiC�'a,7�:6�xs I r • �+teta as i�+ea a � V4B 308 (L 031011) 3 Q i � V �u b � 'pl �n � v h U wilco ' n Department of commerce SOIL AND SITE EVALUATION Di. ' ' _jf Shfety and Buildings Page of Bur f 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 V cvd i percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please priat,� Q n. Re ' ed b Date s/ Personal information you provide may be used for second pu{ so&- (`Piivacy La W6, 04 (1) (m)). Z Property Owner Noperty Location TA �\ iT Qovt. Lot 1/45 G 1/4,S 1 Z T 2 N,R E (or)� Property Owners Mailing Address Lot # Block# Subd. Name or CSM# Odv p(� �91'� 1 city Stat6 Zip Codes . °`, Phone Numb2t ❑ City ❑ _Village Town Nearest Road I] New Construction use: Residential ber obtto,dto " Addition to existing building ❑ Replacement n Public or commeraa es - � tribe: Code derived daily flow gpd Recommended design loading rate - bed, gpd/ft gpd/ft Absorption area required bed, n _ trench, n Maximum design loading rate - -'-? bed, gpd /ft gpd/n Recommended infiltration surface elevation(s) c't & • ft (as referred to site plan benchmark) Additional design /site considerations L '1 Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank fk u= unsuitable for system S❑ u $a s ❑ u s u LP s El u I ❑ s 5 u ❑ s SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD/ft2 h 9 Texture Consistence Boundary Roots Y ; in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench to '0 11 W L Z _ c5 Ground _r 1d — S Wes\ CS — elev. 9.3?��• .ft. ' Depth to limiting (ac or tin. Remarks: Boring # _ s , C>-lo tb V P 5L ,ks L k CS Z 1, _ IU 6 Z Sr S CIS , Z� tt It? ©5t C- —' Ground elev. Depth to limiting Z � factor 3 in. Remarks: CST Name (Please Print) ', Aignature Telephone No. Address Date CST Number 211 L01 b�OZSS d - - 7 - W Z533o9 PROPERTY OWNER SOIL DESCRIPTION REPORT Page 'Z PARCEL I.D.# 4t Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench ..k - ° Z S L b VA IF Z - &D vv L-(/ L5 — S Ground elev. Q ft . Depth to limiting + ' factor in. Remarks: Boring # 1 v Z Z t Va .. w• LS — S 6 v� C50 — Ground elev. 4 — 5, q - ft. Depth to limiting factor la in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /fie in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # 04 r Z 6 r L — b o L-1 16 C.5 — s Ground elev. lo �3Yft . At 9 g Depth to 4 3 ' limiting factor W1 in. Remarks: Boring_# k �Ku Ground elev. ft. Depth to limiting factor ' Remarks: SBD -8330 (R.9/98) PAGE_3_OF,, NAME C It 0 0 cc LOT# !!�- LEGAL DESCRIPTION,ya/ '46'/4,S I 'LT 7-I N,R I I (or) (10 SCALE: F'= ) • d BM 1 ELEVATION [ 00 ' O BM 1 DESCRIPTION 4 -- 1 i puc, P; PG k 1t,J / BM 2 ELEVATION [ b (O q / Z BM 2 DESCRIPTION I i Do P, De. (ct+4- ! ct3 // 3 Cl I SYSTEM ELEVATION � CD ' ALTERNATE ELEVATIO 5 - 3 t f CONTOUR ELEVATION �/ -d S�oW no dcc�r,�c 40 K� �' t o 43 Pr �fil P �� / •0 / L, / � SIGNATURE DATE �' �� Ga ' N 5 � .i? � :_• � RS x G1 c�7 JIDAUI .0 9 75 k j I �fI N� a U r u?� :ii _f CL 'o ( 1. T At y �w✓ 9 N ,Y C 4 CL CL b l ! ! � S rz _ I I {{ cc . uj Wo rVr, I v �•x p Private ansite Wastewater Treatment System Management Plan Saptic flank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsits Wastewater Treatment System (POWT9) 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 permfts for system are on file at the county zoning or haailth 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 6113D- 10587 -P (R.8199). Table 1: s stem Deal n 6 illcations Sanitary Permit Number Number of f►drooms Us Flow - Peak - -{ Estimated low - Averag Septa Ton-k el (gal)z Soli Abso tbori ant size of 1Naartewiater Domestic Table 3: loil AbsoMW n Com vent - Limits of Re liabl e Opi mon Sep tic Tank Component Soil Absorption Cora nent� t n Flaw -Peak d ` Maximum Influerrt Particle Ses n 1/8 t Maximum 50 (mW 220 Maxwnum 150 ......� Table 3: Maintenance schedule Se Tank Inspect &FWor service o nce eve 3 year Outl Inspect once a y ear and clean at least once eve7y 3 yea rs Soil Abom Oon 60- jngW once every 3 years Seotla Tank The septic tank shall be maintained by an Individual certified to service $eptic tanks under s. 281.48, State. The contents of the septic tank shall be disposed of In accordance with NR 113, Wis. Adm. Code (Servlcing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet Titer shelf 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 Management Man 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- inures 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 conflned space. The ar tmosphere within the septic or other &u msnt of holding tank may contain lethal gases, and rescue of a person from the Interior of the tank may be 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 Absom lon Contilon2tit 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, 9 any, In the observation pipes, and a visual Inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system Is prohibited and considered a human health hazard, Traffic around or over the soil absorption component should be avoided particularly during winter months, The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or Impossible to repair until weather conditions Improve. In general, soil compaction over this component will reduce diffusion of oxygen Into the soil and dispersal cell, which may lead to more Intense, and earlier, organic clogging of the soil. 2 Management Plan for a Septic Tank and Soli Absorption Component Plantings of deep - rooted trees and shrubs directly over of within ten feet of the component should 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 alternate area, With the Installation of a diverter valve, the existing system could also be reused after a period of three to four years. It is the property owners responsibility to maintain the alternate area free from any planting of trees, shrubs, eta In case of failure of the original system, the alternate area will be needed. If any trees, shrubs, etc. have been planted on the alternate area, they will have to be removed at property owners expense. if aiternete 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 acco rda n ce 3 s talling plumber. i que stions regarding this code, please contact y000s '' ur l Z onin g office or contact the ,tea, N ry taS 'Q �c+4 l'1 i S } 3 t -- L4 to % O i ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND nn OWNERSIiIP CERTIFICATION FORM Owner /Buyer �, (b I I oV Q W n S __�_ ,v <_ Mailing Address — 70 , 0o. lC d . E /kv `4su -v I,U Property Address J � �(\�p� -� � (Verification required from Planning Department for new construction) City /State " Parcel Identification Number LEGAL DESCRIPTION Property Location W 'V %,, Sec. T a_q N - R1W, Town of \1U&6o Subdivision 1 J_ Lot I t Certified Survey Map # Volume , Page # Warranty Deed # _(01 Volume � Page # Spec liouse yes O no Lot lines identifiable yes O no SYSTEM MAINTENANCE Improper use and maintenanceof your septic systcm 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. P Ys The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site 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 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 d year p' n date. F APPL I ANT DATE OWNER CERTIFICATION certify that all statements on this form are true to the best of my (our) knowledgd. I (we) am (are) the owncr(s) of the perty dcsc 'be abo e, b irtue of a warranty decd recorded in Register of Deeds Office. NATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.****** ** Include with tills applicallon; a stamped warranty deed front the Register of Deeds office 2 copy of tine certified survey map if reference is made in the warranty decd V0L 1` dj� o PAGE Ui~d STATE BAR OF WrSCONSIN FORM 2. 1999 Document Number, WARRANT DEED KATHLEEN H. WALSH REGISTER OF DEEDS Thls D, made between James A. Fisher and Rosemary F. ST. CROIX CO. s Wr eed Campbell, f/Wa Rosemary F. Fisher, oth single persons, RECEIVED FOR RECORD 02-eq-2000 2:20 Pn Grantor, and P. C, t,'o11oVe Buliders, lime., a Minnesota C oration, El(E?lRTI� DEED -- � F�EEPi FEEe TRANSFER 851.70 Grantee. —"� ` RCORDIIS FEE: 10.00 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): County, Part of West 1/2 of SE 1,4 of Section I2- T29N -R I9W described as follows: Recording Area Commencing at the NW comer of said SEI /4; thence E 763.1 feet; thence S 1980 feet; thence W 103.1 feet; thence SWIy to a point 165 feet E of the SW Name and Return Address comer of said SEIII thence W 165 feet; thence N2640.0 feet to Place of DAVI J. ESTREEN Beginning EXCEPT Lot 5 of Certified Survey Map recorded in Vol. 14 of Certified Survey Maps, page 3788 as Doc. No. 616755, St. Croix County 304 LOCUST ST. Wisconsin. 5jol HIUDSON, WJ 54016 020 - 1015 - 70-000 & 020- 1015.9a000 Parcel Identification Number (PIN) This is not _ homejpope"y, property. ames A. Fisher Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. 0() (is not Dated this _ �� day of Fe 2000 ------ • serna F. Cam bell, f/k/a Roaema F. Fisher AUTIIENTICATION �"— Signature ACKNOWLEDGMENT Signature(s) Ja mes A. Fisher and Rose F. Campbell, f/Wa STATE OF WISCONSIN Ro Fisher, both sin le pbrsoos, ti ) ss. County ay of Febru 20 0 _ p 4 Personally came before me this day of is 0 ad the above named r ER STATE BAR OF WISCONSIN - ----__ _� to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristin& Ogiend " u son, Notary Public, State of Wisconsin (Signatures may be authenticated or acknowledged. Both are not necessary.) My Commission is permanent. (If not, state expiration date: Names of persons signing in any capacity must be typed or printed below their signature. ) P WARRANTY DEED STATE BAR OF WISCONSM 80 o�ss Mt °rmatbn roh.e6mals Company F° du lac, 21 FORM No. 2 -1999 � LOT -54 , x xr '`d X� t•'. dt Al 1- 7 AREA XLA )/�7 `.►� fit,, , `� �:. _� w4.,5: . Y•. i,� /• �� 1 / ,mow "�.: � � �� ��rt� �„�. Y t i ,l / v jam'. -�. s. //mow' �.�^ T / �• • , a / / f 4 / 2.51 ACRES 109,166 SO FT _ ,g ^ / ii LU 4R8.9 404 J X 2.59 ACRES / t 112,924 SO F f _� / i 0 MIN BUILDING �Z FFE . FF5 ELEV. 930.5 0 ----- - - - - -- --7 � A IOU g _ 6 N 89 W C9 I C4 aj H.W.L. = 926.0 316.86' I 1 a ' N 8W5 MIN BUILDING ` 37: --- ---- -.X -- FFE ELEV. - 930.5 1 •. � Z 1 c O c 6 1 f •• p N 2.51 ACRES I N I ' 1 w N cr) 109,476 SO FT w w 12 10 1 MIN 1 WE ;ECTION CORNER N 89 0 5729" W 373.12' 32,51' t r WEIGHING Cto C3 i FOOT )T CORNERS It_, • I 24' rl 1 MIN BUILDING H.W.L. = I °� DOT NG 1.13 LBS. Qo FFE ELEV. = 936.5 939.0 EASEMEI a 2.50 ACRES 109,099 SO FT 'K LINE i I cn Z T ALONG ROADWAY � C11 C2 1 N 89 1 , I 389.21' 2 - - -- -- nM I ni 'dl