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HomeMy WebLinkAbout020-1452-13-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Sofety and Building Division INSPECTIdN REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township LaCasse Develo ment Hudson, Town of CST BM Elev: Insp. BM Elev: ~ bt'~ BM Description: _ (~ ~ '~' ( C g S TANK INFORMATION TYPE MANUFACTURER ~ CAPACITY Septic '"• y• S W 5 F•,~. ' 6Z~o Aeration Holding TANK SETBACK INFORMATION TANK TO P/L ~') WELL BLDG. Vent to Air Intake ROAD Septic 7 ~~ ~ 3 ~ ~ 7 S~ ~ ,- Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss Syst ead TDH Ft Fo+cemain Length Dia. Dist. to well _ SAIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 499197 0 State Plan ID No: Parcel Tax No: 020-1452-13-000 Section/Town/Range/Map No: 13.29.19.2901 STATION BS HI FS ELEV. Benchmark s, g 5 /65.9 / O ~ Alt. BM 3•`~g ~6z , y~ Bldg. Sewer ~,~I 5 !J s~, SUHt Inlet X6.7 4'7~ZS SUHt Outlet ~•6 X7(0 -`r5 Dt Inlet ~ ~ Dt Bottom ` ~ Header/Man. 9.yz 9,73 Dist. Pipe y, ~Z ~ S~ Bot. System ~~ , y 5 , (~ S Final Grade 5.15 J /~ St Cover F;t~. 3.~ /dl.~f7 BEDlTRENCH Width Length ~ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ 3 9b ~ ~~ewc.~ ~ ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: /1 /I .~~ CHAMBER OR r3 ' adJ' '~'S't-- INFORMATION Type Of System: ~s ~ 5. ~ / /~ v ~ ~ UNIT Model Number: ~(, ~ 3 r ~ ~ewJG~ o~ / DISTRIBUTION SYSTEM /U,.fll,. C-T Header/Manifold ~ ~ Distribution x Hole Size x Hole Spacing Vent to Aid Intak~ 3 " ~ Pipe(s) \ \ \ Di S i ~ ~ ! ~ ~ ewe( Length Dia a pac ng Length S[111 COVFR ., o.e~~~~.e e.,~+en,~ nni., ,.,, Mnnnrl nr Af_(:ratla Svctamw only Depth Over , Depth Over xx Depth of xx Seeded/ odded xx Mulched Bed/Trench Center ~ ~ ~~ Bed/Trench Edges \ Topsoil \ Yes No Yes No COMMENTS: (In:.lude code discrepencies, persons present, etc.) Inspection #1: / /_ Location: 926 Sadies Lane Hudson, WI 54016 (SW 1/4 NW 1/4 13 T29N R19W) Bluebird Meadolw~s Lot 13 1.) Alt BM Description = ~~ `~ Cov.~,`' ~ Z GoJt~N 2.) Bldg sewer length = `~ L I Inspection #2: / /_ Parcel No: 13.29.19.2901 4 Safety and Buildings Division County ~, = 201 W. Washington Ave., P.O. Box 7162 ' ,~ Madison, WI 53707 - 7162 ,S~On~ ~ Sanitary Permit Num (to be filled in by Co.) (608) 266-3151 I De artment of Commerce ~ cam. ~c^r Sanitar Permit A li ti state P,an I.D. Nu m b e r y pp ca on In accord with Comm 8321, Wis. Adm. Code, personal information you provide ~ Q _ ., ~ J / vT 1 maybe used for secondary purposes Privacy Law, s 15.04 1 m i ~ ) Project Address (if different than mailing address) I. Application Information -Please Print All Inf aY f V Property 'Name arcel # # / Block # s~ ~ - - RECEIVED ~, Property Owner's Mailing Address Property Location ~ ~ J Section ~ ~ ~ ~ ~'/. Ci Stat t , , , e Y, Zip Code Phone Number ~- S CROIX COUNTY (circle <~ Z,.~t~ T T ~ N; R~E o~ II . ype of Building (check all that apply) ~I or 2 Family Dwelling - Number of Bedrooms ~ k' '~'a /-~ 1S r~ Subdivision Name ~Q N m},er ^ Public/Commercial - Descn'be Use `~~ °i'"` J r~ ,' f ^ StateOwned-DescnbeUse z ~k~5a- Gellb t.._, ~ /$t 1~ G~a,,.w~o t~5 ^City ^Vill (~ownshipof S III. Type of Permit: (Check only one box on line A. Complete.line B if applicable) ~ „ ~ ~ ~ ~ a `~ ew S stem y ^ Replacement System ^ TreatQtent/Holding Tank Replacement Only ^ Other Modification to Existing System -~--~- B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner r G ~ Sai-- IV. T of POWTS S stem: Check all that a 1 r 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 ^ Rxirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersaUTreatment Area Information: Desigm Flow (gp~) Design Soil Appli ~ n Rate(gpdsfJ Dispersal Area Req~ ed (/ Dispersal Area Proposed (s~ System Elevation ~„ / ~ / VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic i Gallons Gallons of Units Concrete Conshucted Glass ~s ~ e ~ P lob- 5 Septic or Holaing Tank -- l S Aerobic Treatment Unit Dosing Chamber VII. Respo sibility Statement- I, the nodersigned, me responsibility for installation of the POWTS shown on the attached pleas. Plumb ame Plumb 's S' MP/MPRS Number Business phone Number ~ /~ _r / s~- P is Address (Street, City, fate, Zip Code - - ~ VIII. Coun /De artment Use On Approved ^ prov Sanitary Permit F includes Groundwater Date ued lssuin ent Si ~ Surcharge Fee) ^ aO d, ^ ~ ~ ~ ~ tJ ~ en Reason for p r5 1X. Conditions of ApprovaUReasons for Disapproval nn //~~ / n SYSTEMOWNEf't: 3~ 10J.~~G~. / V2t~2~cp~ ~ prop; ~ 6t~.1t~a-l_ 1. Septic tank, effluent lifter and {f 1~ , n 1 Lo ~~ I ~~ "" a No dL (~ 1ti a 4.~ .~.~t.Q. C.ft dispersal cell must all tie services ! maintained / as per management plan provided by plumbisr. / 2. All setback r uirements must be mairttained ~ ~ ~-o ~ t ~. ~o,,,, ,.~.. s~ • ' " ° a r S ~ b ~ ,r ._ y / / _ as per appn le code /ordinances. -IC~_• J •....~r~.~ ww tw •••~ ~-~~ on.y/,ior me sysuvt on paper noc teas man alr~ x i - ~nehtt in see SBD-6398 (R. 01/03) i ~f~~ k=- ----- -f ~~~~J ~~ /, ~~~ -~,.-' ~ Ir j ---~ `J ~~ __. _-_ ,_ __ -- _- _~ '~` ~~ _, -~ -- ~: .: .~ ~~ ~~ a ' r r .`~. ~ ,'1 ,~; F~ r~O. ti~ ~~ { ~~ \ ~ ~~ `~ ~ ~ ~ > ~ C, ~ 1 '? ~' \ ~~ v ,~ ,,,- ' \ ~ -v ~tiC V V ~ .: r i . ~,~ `v ~J ~i n-j ~ ~ ~ 0 . ~ ~ v ," ~~ ; ;~ ,, j` `1 e `~ / T ,. j ~:y ._ ~~~ ~. v ~,,, s p~~ ~ ~ ~ ;~ o oa ~ ~~ v a ~ ~ ~~ ~ ~ ~~ ~ ~ o e `~ , ~b ~ a ~'' >~~ 1 ~ ~~ ~ ~ ~ ' ~ ~ ~ ~ ~ ~~ ~~ ~l ~ ~ ~ ~ v ~ ~ ~~ ~7 ~ M `~ M1 ~_' q g I, -. ~~ ~\ v `~ Q `+~ .'~ _~ ~~ ~ \~' }_ ~ } v"~ ~`~ ~ ~~ a 4 ~~ °~ e ,~ ,y T~ ~~ ~~ 2 Wisconsin Department of Commerce Division of Safety and Buildings J h~ ~~ SOIL EVALUATION REPORT in accordance with Comm 85, Wis. Adm. Code ~~~~ /~~ . /~ ~zco~ V C p,o c~ 7~ 1493 0 Page 1 of 3 Steel's Soil Service, Inc. County Attach complete site plan on paper not less than 8'/2 x 11 inches in size. Plan must St. Croix indude, tx-t not limited to: vertical and horizontal reference point (BM), direction and scale or diria~,.aad laration anfl distance to nearest road. percent slope Parcel I.D. , . _,., ' pendin 9 ase p-~AL ~1111bif~rrifi~ation. PI¢ ~ ~y Date Personal information you p(ovxle maybe used for secondary purposes (Ptivacy Law, s. 15.04 (1) (mp. ~ •' Property Owner ! ~ ' %` k,1 ii ~ Property Location LaCasse Development , lInc. Govt. Lot na SW 1/4 NW 1f4 S 13 T 29 N R 19 W Property Owners Mailing Ad ress ; Lot # Block # Subd. Name or CSM# 573 Cty Rd "A" ..m.M~_.':.:_.,n.,......: ~_..__..`~..,._._..~ 13 na Bluebird Meadow City State Zip Code Phone Number ~ City ~ Village ~ Town Nearest Road Hudson ~ WI 54016 715-381-5405 Hudson McCutcheon Rd New Construction Use: ~ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD J Replacement ~ Public or commercial - Describe:na Parent material Stream terraces and pitted outwash plains Flood plain elevation, if applicable na General comments and recommendations: Conventional system, system elevation 98.55ft. Trenches spaced and depth to code 3.75ft below grade. ~ (~ o'IL et~ .- Boring # ~ Boring 102 30 120 i R . Pit Ground Surface elev. ft. Depth to n. limiting factor Soil Application ate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-18 10yr3/1 none sil 2msbk dft cs 1f .6 .8 2 18-36 10yr4/4 none sicl 2msbk dfr cs na .4 .6 3 36-75 7.5yr4/4 none ms osg ml cs na .7 1.6 4 75-120 7.5yr4/6 none cos osg ml na na .7 1.6 «~ 98~. -~ S Boring # ~ Boring Pit Ground Surface elev. 102.30 ft. Depth to limiting factor 120 in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr3/1 none sil 2msbk dfr cs 1f .6 .8 2 10-18 10yr4/4 none sicl 2msbk dfr cs na .4 .6 3 18-29 7.5yr4/4 none cos osg dl cs na .7 1.6 4 29-67 7.5yr4/4 none ms osg ml cs na .7 1.6 5 67-120 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 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number David J. Steel 248956 Address Steel's Soil Service, Inc. Date Evaluation Conducted Telephone Number 994 200th St., Baldwin, WI 54002 8/20/2004 715-684-5680 Property Owner LdCasse Development , Inc. Parcel ID # Pending Page 2 of 3 Boring # ~ Boring 4~ Pit Ground Surface elev. 100.60 ft. Depth to limiting factor 120 in. Sal Application Rate i H De th Dominant Caor Redox Descri tion Texture Stricture Consistence Boundary Roots or zon p in. Munsell p Qu. Sz. CoM. Caor Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10yr3/1 none sil 2msbk dfr cs 1f .6 .8 2 9-19 10yr4/4 none sicl 2msbk dfr cs na .4 .6 3 19-35 7.5yr4/4 none cos osg dl cs na .7 1.6 4 35-72 7.5yr4/4 none ms osg ml gw na .7 1.6 5 72-120 7.5yr4/6 none I osg ml na na .7 1.6 ^ Boring # J Boring uj 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. Caor Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring # ~ Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stn~cture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Caor Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/Land 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. Page 3 of 3 STEEL'S SOIL SERVICE INC. David J. Steel 994 200' St. CST-POWTSM LaCasse Development, Inc. Baldwin, WI 54002 Lic. #248956 SWl/4,NW1/4,S13,T29N,R19W Bus.(715) 684-5680 Town of Hudson, St. Croix Co. Fax.(715) 684-3449 Bluebird Meadow, Lot 13 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of this test may or may not be as shown, as permanent lot lines were not established at the time the soil test was conducted. Legend 1" = 40' • Benchmark Ele. 100.00Ft op of 3/4" pvc pipe • Alt Benchmark Ele. 99.90Ft op of 3/4" pvc pipe ^ =Borings ~ (;J~S~ ~` Boring Elevations / o ~ B 1 = 102.30Ft `~ ~ ~ B2 = 102.30Ft B3 = 100.60Ft ~~ ~ B4 = OO.OOFt .1 _ ~'` ~/ 1 ~~ (fir ~~ l 7.~- ~ i i ~~ <. ~. ~~~ ~'~ ~1~101.h~r ~o~r 1 y~ ~~~'' ~`~ ~= -~~ '~./oZ~3~~~ ~~`p~Gl~hr- \3y-G, ------------ ----- q - ~ --- ~ ~ ~: ~ ~~ w ~~ r~ ~ ~ ~ ~ V. u ,~ ~ ~ x ill x "-~ ( T~ . i~ © ~ ^ Z ~ w i x -~ w ~ ~ x X .~ ~ ~ ~ N N ~~ X ! ~ `' ~ .~. N 1.._._ _ ~G ~~. 1N7N° N U ' ~ ~ V if ~ ~~. W V ~ ~ r ~..~ R R 1 ~ q ~ ~ ~ ~ N w °° ~ I •~ x ~ / a e `° ~ ! ./ .. ..~ •x- c ~ ~. ,- . ~_ • ;~ -- ~ ~, ~ ,. ~ ~•. ~ . . ~ G P •r i ~ .. r ~ ~~ \ ~ CI~. o r~ N ~ ~ . N o , ~ ---~ ~ i ~1 ~ ~ X ~d -ao LOCATION SKETCN ralrx or xuusox SECTION 131 T29N1 H79W ~' R i i i ~ i - -r 1 -_- i eN ru Eo E ,' 1 11~:, ~~ j I I .ca 9 w ~ SADIE_e " LANE 'sl 1'~? Ig I 1~,:`j Y I ~~ ~ •i ~ Ici .______-99c.u 1 I,a I I '~ I ~ °~ I ,r ,. I ~~ I I N Y ! C L3 ~:~ ~ ^ OF W19L. ~ O 'd '~~ y`Ii '* BNi E6+ '* C s ~ WIB x~ ~~i 9 24 o`f BLUEBIRD MEADOW LOCATED IN THE SWii4 OF THE NWi/4 OF SECT110 SCONSIN.~ R19W, TOWN OF HUDSON, ST. CROIX COUNTY, _-__ 77G ~' `f SURVEYOR: ~~/ \~~ xecDrreESGT,tce DOUGLAS ZAHLER ~ SI'. CRGyIXE ~~y~JI. SkN lANO SURVEYING L _- 73' 33_ _._, OGisO~ ID~ I 2920 ENLOE STREET ( ~ 1 '~-'jy.yy ; HUDSON, N 51016 1 1 I R1 p 1 ~~ 193 I I I OWNER: ' i pp m c O pp I W.r ~ e LACASSE DEVELOPMENT, INC. I 1 q ; IR .~ 14 / y~ 571 COUNTY ROAD A I ~ ~ HUDSON. N1 51016 I I ~ I 1\Y 1 ~ ~ ~ I '~ I ~. .....6.. 6...... I ;P{~ I ~~_ _-~~ a.~'rr~ee~~;as.n~hcn„a.ss;'~c~m~~~, I ~~;. -- ------- ~ ~c'alia. ^,, n ~Y:J"•'_ ~ MCCUteheon Hoad °:.'~ ' - _y~ tl . `~~ LINE TABLE DRAINAD[lASEMENT C NUN9[w DI 01STBxCf CI SOB JB'30'[ 59•]16 LINE TABLE DRAINAGE EASEMENT D WIMBCR DIRCCLION OSSixxLE pl 2]'39'E 6 .SB' p2 x55.52'l5'E ]0.2J' SCALE IN FEET °]~ x° AOI PNiCEL SxO9N M 1X5 YM ,6 s 0EL MI~O YI~W LOi°v E. CCN16C1 mE•S1u. yCRtlr )~Nn EOxNG•6f1aE •xoE MtE~li0xNµ0( MWSM. „~ w,1E.~RE .TM w oN RES "" mEµ. ao~ catl1tlw6], wnuo6sha+T Is av°FEinasaN wx raw uu rto r°oE euu•wc waN. °BSmucnxc,~iuERwc. nwxc ow nlc~ES° w 9cw nuxw:"rs, w.~ Fiyi°ETnis Bwui' w w•s~jNSEin~iNCS. CURVE DATA WABLE 1.6L 19xR' Nun C' EN ,6>~00 89•220J• 2 2J]00 J6'0]'08' C9 00.AN 91008'020 EaT 11 BO.A00 ~ 16'12' 06.5]'25' LOT 9 00.00 92'50'20' OT 0 00.00 60321''1]' BD Ca 10• [5 0000 95.01'10• L6 2]3A0 ]]'00.28 BT ] 2J]AO 9T5) EOT 6 23].00 22 12.71' 1143 NBINNNENf DONfiFa OT 6W SCHF3TTT0 JOB .•N NaTm 3'OJ'v5'E 1,9.0] IB'0]10.V . 0 •39'E 61.3E N11'2B'06'V IIJ'OD ]6 2]'30'E xIS~4]'0A3•E IIO.OJ SB'9TV 3093 S06'12']0.5'V 62.26 S3J']B'19'V N.9J S23.59'99'V 61.32 N)t'19.29'V 19].09 N60'OB'1].5'V 60.02 x B'30'2].Yy 8975 e. 6001-09 OAIE 0.]/]0/31 ~~~~ 260.98 62.9J 3]).10 509'1 ~J'E w 504.22']6'C x00.22'J6'V N36.23'99'v x9B']1'S1'f 206.2J'%'E 506.2J'36'E SO]'2)'99•v ' E 506'Y]'S6'E H39'19'S2 '32'[ N2]'J3.3]'v . 121.J2 19 X59 N2]'3J']J'V N)0•E]'SJN •9 '39•v 6].9] B x]0.2J'3J'V L6] S6]'1959'V 5032]•11N 862) 650 9 S32 ~993'V S10']15J V ' ' 60.10 90.J1 12 V H52.11'IS'V N6T]2 N6]']2'12'V N09.19'93'V REYDSFh. a9/29/3001 ' `u i.:] yin ---~- I I LEGEND mmrcn.a.uwx~nxc,xw • axnll. aNi6c~,.c~6sT~Dxn ~ ~M, _ _ _ .. _ uwxlx.c6uswENr ................. NpWNAr SE~B6CN ILK I.V.,+T.~'ul g03EYNT IOLA>E0N36rcxt[0 µEn~i~.pa_o.nMa,o.u lE OTN00 LOT 008NW N.MM1.19. uwu.rom 'NO'nR9.. na1 SHEET 1 OF 2 SHEETS ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ~. ,a C,a s s.~. p a~ ~, L Q Fm~ ~- ~..-~ Mailing Address j' 73 ~ tit ~~ 74 l~u~ 5~ ~ u~ C s ~o ~ t Property Address Z ~ 5~t ~ ~ .er 1,,,.~. (Verification required from Planning & Zoning Department for new construction.) City/State ~y~~~~~i.-! Parcel Identification Number 0 ZO - / `~5 Z ' /,3 - OOD LEGAL DESCRIPTION Property Location _,~t,~ '/4 , ~/,~ I/a ,Sec.. ~ 3 , T a~ N R~_W, Town of Subdivision ~~,~„`,,, ~-~ ~, ~r~ ,~~ y ,Lot # ~ 3 Certified Survey Map # Warranty Deed # Spec house es no Volume ,Page # Volume ,Page # Lot lines identifiable es no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & 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 wastewater disposal 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. I/we, 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 Planning & Zoning Department within 30 days of the three year expiration date. Uwe 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, by virtue of a warranty deed recorded in Register of Deeds Office. 'Number of bedrooms ~_ ,fir;~ `--~~~ ~^ SIGNATURE OF APPLICANT(S) ,~,~/~ DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) I ~ ~' a~ ~•'~ 25'--s; g , m~e~viwa~ vaNg[a ~' d a L.D.®. as x-25' i ~~ ~ S~ N89~3~Z~~E OG~ i ~' f ~~~ >~' • ~lA~ f .r ... .f ...... .... ~ . ~ e'!. '~ ~ __. .N89°~9r4'43°iM ;9rD8.61' - - 11~. e • ~ ~ ~~ ~~~ A ~~ ~ . '~ • r~s'. rr sr.oz' sass' i's.os' 1 .~' ~. ~,'"' ' _ / _.. _'~`_ ~~ ~- ' $88'~b~b'43'E 508.61 `~i ~" • ,~ ~ ~ `. .'~,. DEAINA~E EASE11#ENT C DRAINAGE EASENI~EN1' D • • • , ~ D $ I#.9Td.&. ai g31.1 q.IM.L. a 9CII1.'~ • ~~ ' ~ ~ • \ 9~ ~ ~ . ~ r~. ~ ~ , ~ i' 1 ~ LOT 7 2 ~~~+ i~. ' ~ - ~ Z.02 AC. ~ ~ - ® A A I _~' ~ . ~ ~\ ~ ~ ~ ~ . ~a ~- i ~- r 67T.48' 35.28' 68.00' 353.510' 1~ ~--EASrT-WItEST i /4 LINE ------ ~4 ~ ~~ ~____ e® e ®~ IDISTAIVCE E 5.71` E a48.11;' a ®~ I7ISTANCia d04 a ~a~ ~ ~~a 9~~~ SQ. F~'e ~ 8 ~ 33' ~ ~ ~~ Z''~ ~m ~~ f~ i ~~.~~ c~C~DC~G3 _do~ ~ N®4Et EACH. PARCEL MOWN ON THIS MAA IS SUBJECT TO STATE. COUNTY AND TOWNSHIP LAWS, RULES ANO REGULATIONS (I.E. MA:TLAND, MINIMUM lOT 51ZE, ACCESS TO PARCEL, ECT.) BE~OR PURCHASING OR DEl/fLOPING ANY LOT, CONTACT THE ST. CROIX COUNTY ZONING OFFlCE AND THE TOWN ~ HUDSON. NO OWNER OR RESIDENT SHALL DO ANYTHWG WHICH Mr0I11.D INTERFERE MATH OR CHANGE 1NE OPERATION OF 1HE APROVED COMPREHENSIVE WATER- DRAINAGE AND SOIL ERO~ON PLAN FOR THIS PLAT. 74xc iar+ a once or ~,- ,.- • •! 26y1 i 399 ?72236 t~ STATE BAR OF WISCONSIN FORM 1 - 2000 KATHLEEN H. NALSH WARRANTY DEED REGISTER Of DEEDS Document Number ST. CROIX CD. ~ III This Deed, made between Roaald G. Raymond, Loretta B. RECEIVED FOR RECORD Raymond, husband and wife @8/2@/2@@4 11:SSAK Grantor, 11ARRANTY DEED and LaCasae Develovmeat, Inc , a Wisconsin ~><~r# corporation -- REC FEfi: 11. @@ 7RAAS FEE: 2250.08 Grantee. C,UPY Ffifi: Grantor, for a valuable consideration, conveys to Grantee the following CC FfiE: PAGfiS : 1 described real estate in St . Croix County, State of Wisconsin (the "Property") (if more space is needed, please attach addendum): Southwest 1/4 of Northwest 1/4 of Section 13, Township 29 North, Range 19 West, St. Croix County, WI Recording Area Name and Retu Tess 016 r 020-1017-30-000 Parcel Identification Number (PIN) Together with all appurtenant rights, title and interests. This not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except encumbrances of record Dated this da of Au s t 2 t) 04 . *Ronald G. Ra AUTHENTICATION Tracy ~-• Turner Signature(s) Notary authenticated this day of 0~5~ t TTi'LE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Redmon Law Chartered (Richard Lau) 2217 Vine 3t., Suite 204, Hudson, WI -e.ft~ ~ r -~. /C~- m ~xd *Loretta B. Ra nd ACKNOWLEDGMENT STA F WISCONSIN ) c ) ss ~' County. Personally came before me this day of August 2004 the above named Roaald G. Raymond and Loretta B. Raymond h n a w to wn to be e n who executed th o ' s wledged the same. Cis df4~7 Notary Public, State of Wisconsin My Coaunission i„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 FORM No.1-2000 Redmon Law 2217 Vine St Ste 204, Hudson W154016-5864 Phone: (715) 386-0100 Fax: (715) 386-0700 Redmon Law Chartered T4926305.ZFX Produced with 21pFOrmTM by RE FonnsNet, LLC 16025 RReen Mile Road, Clinton Township, Michigan 48035, (800)383-9805 ~ww.ziofonn.com POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of FILE INFORMATION t~~ ;e- „P~, iilS Owner SS - Permit # DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units C,~NA Estimated flow (average) gal/day Design flow (peak), (Estimated x 1.5) al/day Soil Application Rate 7 gal/day/ftZ Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODS) <_220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand IBODS) S30 mg/L Total Suspended Solids (TSS) 530 mg/L ~NA Fecal Coliform (geometric mean) <_104 cfu/100m1 Maximum Effluent Particle Size Y8 in dia. ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity gal ^ NA Septic Tank Manufacturer ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model ^ 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) Jd'1 In-Ground (gravity) ^ At-Grade ^ Drip-Line f~ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA Service Event Service Frequency Inspect condition of tank(s) At least once eve ry' ~ ^ month(s) (Maximum 3 ears) ear(s1 y ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ^ NA Inspect dispersal cell(s) At least once every: ^ month(s) (Maximum 3 years) year(s) ^ NA Clean effluent filter At least once every: ^ month(s1 ,~ 1~yearls) ^ NA Inspect pump, pump controls & alarm At least once every: ^ month(s) ^ year(s) ANA ~!ush 'aterals and pressure test At least once every: ^ month(s) ^ year(s) ANA `` cr_ At least once every: ^ month(s) ^ yearlsl ^ 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 ~ of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s1. If high concentrations are detected have the contents of the tank(s) 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 (sump 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. ^ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ^ 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 INSTAL~E~ ~ ~~ Name ' h' Phone ~, - S-5 ~ J SEPTAGE SERVICING OPERATOR (PUMPER) Name Phone POWTS MAINTAINER Name Phone LOCAL REGULATORY AUTHORITY Name ~ , " U r, Phone -~ ~ This document was drafted i^ compliance with chapter Comm 83.22(2)(bi111(d)&If- and 83.54(11, 121 & (3), Wisconsin Administrative Code. ,~ START UP AND OPERATION Page ~ of For new construction, prior to use of the POWTS check treatment tank(s) 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 tank(s) 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 (sump 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. ^ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ^ 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 INSTALLED '~i Name ' 1~ Phone , _ S-5-,~~ POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name , " u Phone -> ~ This document was draf*,ed - c~mpiiance with chapter Comm 83.22(2)(b111)(dl&(f) and 83.54(11, 12) & (3-, Wisconsin Administrative Code.