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020-1344-12-000
s Q N M „~J ~' '~ C n O C N O ti a" '~ d •~ N .,,y V •~ O ~' c 7 LL v 3 v ~ Z N ' ~ ~ ! !' ~ rn Z ;,; O O L Z ~"' rn w d a d m v ~ z c U 0 2 d' c ~ r T 7 d y z H ~ ~ °'~ m o . c ~ .a U a~ r N O) 7 = N ~ N ~ O ~ a m ' ~ '' o - Z ~ Z o Q .. O) ~ R C y ~ Q t0 N d w ~ N c o a ~ c~ ~ ' ~3 ~ ~ oo o o a a a a ', ~ ~ o N ~ (q J V O O N N O N I~ N O 7 O r 2 O) '6 m ~ m 00 ~ 'i J M N N N C ~ ~ O ' O ~ ~ O ~~ Y d' ~ ~ ~ C ~ '. _ r d1 , y '' ~ O ~ p N 'O 'I '. t M N 0 ~ 7 2 N N W co 0 ~ ~ ' ~" :: xt n m a ' a ~ O. y _ U y ~ ' 3 ~ v a ~ ' O inv ~o 30 o U ~ O ry N C C ~ O .C~ a0 ~ 7 C O C y .~ _ T E ~ ~ N ~ w U c ~ a o y _N o ~ NL N - -o a~ N V VOi ~ ~O U C N N C C O N C N °~~CNE O) 0. 7 C N C O N N j~ N N p ~ fl_ 7 L C Z ~-o ~" m O C lL 7 L_ (0 N O ~ ~ vi N •3 °_ E ~cao ~ ~ O U 7 `- -O f0 O N O .-. 4 'O N «. E o N c E .~ N N O E N N O ~ ~ £ ~ m a~ .~ ~ ~ } O Z ~' o ~ o Q n O a~i ~ ~ N N m O C ~ ~ N Q ~, ~ w Z N Y ~ c 0 w ~o Z ~o ch O .~ U O Z N O ~o z N 7 m O E ~' va7O°. ~ O O ' -O N N ~ ~ N ~ 7 ~ ~ r ~ S: N /* Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division • INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law,xs.15.04 (1)(m)). ~o ame: ^ City ^ v o ip CST BMElev.:- Insp. BM Elev.: BM Description: /O© / o~ ~,-Q~ ~ G$T TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ lZ(o ~ Dosing Aeration Holding TANK SETBACK INFORMATION TANK TCt P/ L WELL BLDG. vent to Air Intake ROAD Septic ..f.t~ " °(',~ 2„J Z I NA Dosing NA Aerat n NA Hol PUMP /SIPHON INFORMATION Manufacturer errand Model Number GPM TDH Lift Lriction S s TDH Ft Forcemain Dia. oist.Towell SOIL ABSORPTION SYSTEM ELEVATION DATA nita STATION BS HI FS ELEV. B c rk -~',~j'?j ~~'s joc .qd 3 ./o /a3.It> loci St/Ht Inlet * Jf',~ ~~,ZZ,.r St / Ht Outlet '~ (,.p'~- ~ ~, ~?j Dt Inlet Dt Bottom Header /Man. ~?.~ ~~ •$ 3 Dist. Pipe 11.bG 70.E Bot. System ' ~ •/ o ~ 3~3 ~9. ~ ~ BED /TRENCH Width ~ Length ~ No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I N DIMEN I N SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING Manufacturer: r ~~ ~ 1 SETBACK l'Nwk~' ~ r INFORMATION TYpeO ~ CHAMBER Mo a Number: Syste ~i•w ^~'],Qtr,~ OR UNIT Zj DISTRIBUTION SYSTEM Header /Manifold •• ~ Distribution Pipe(s) ~ ~~ ~ 6f~ ~ ~ x Hole Size x Hole Spacing Vent To Air Intake Length ~_ Dia. Spacing Length ~~ Dia. SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Bed /Trench Center Depth Over Bed /Trench Edges xx Depth Of Topsoil InS eCtlO xx Seeded /Sodded xx Mulched # Y ~ InS 4@!7 # N ~ LoCailonTS98~~a`~arcg°eel~udsgn;`1~~' ~4rf~~~s ~e~~41 1/4 14 T29N R19W) - 14 9191848 Grass Range Addn. 1 -Lot 12 , ~~~~ 1.) Alt BM Description = ~~«r ~ yi~7~• •'' ~~~ ~' ~~ ~'~' _ ~•ZS~~~.{~`„~Q, 2.) Bldg sewer length = Zos,.~' (J -amount of cover = ($ - Z `"~KV~s ~ ~, PI`a~ revision required? ^ Yes ~ No Use other side for additional information. SBD-6710 (R.3/97) til t~. of '" ( 3 Date Inspector's ignature a o. ~~ r _. O ~4 ~~ g 3 ~~~~ (~,p , V i v vV Safety & Buildings Division `~ Sanitary Permit Application 201 W. Washington Ave. sca-nsin In accord with Comm 83.21, Wis. Adm Code PO Box 7302 Madison WI 53707-7302 Department of Commerce Personal information you provide may be used for secondary purposes , (Submit completed form to county if not (Privacy Law, s. 15.04(1)(m)] state owned. Attach com lete tans to the coun co onl for a not less than 8 -1/2 x 11 inches in size. Counry' ~~ ' ~ ~ State Sanitary Pe ~t Number a vision vja~ plication State Plan 1. D. Number I. A Ifcation Information -Please Print all Informatio `- t'~r '' a Location: Property Owner Name •r . ~ ~ y y ~ Property Location ) ~ ~~ ~ '/ = ~" IV~ IvIAJI 1 /4 /4, S ~ ~ T ~ ,N R~ 9E or W Property Owner's Mailing Addres ST C~~ /`_., ~ ~ n` 12.1 ~4 ~ p ~f ~, ' ~.. ii~r f{r~ ~ Lot Number Block Number ~ ~ N ~ Ci State ty~ ~ ~ t~U~D c-~ ~ I ., Zip Code .~ ~y~~~ o .)none Number ~,~ ''. ~/ s ~~t.. ~'~ Subdivision Name or CSM Numbers ~ ~~ , ~ ~j2PS pN cY~ II Type of Building; (check one) ~s s ^ city fl' 1 or 2 Family Dwelling - No, of Bedroorns: ,. ^ village ^ Public/Commercial (describe use): 9 Town of ^ State-owned ~, J (~ ~ ~ O III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road ~ A) 1. blew System 2. ^ Replacement 3. ^ Replacement of 4._ ^ Addition to p A Parcel Tax Number(s) , 13 Y' r. /~ S tem Tank Onl Existin S stem ~,~- B) Permit Number ^ A Sanit Permit was reviousl issued Date Issued ~ y tit IVe Type of POWT System: (Check all that apply) l~1on-pressurized In-ground ^ Mound ^ Sand Filter ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Constructed Wetland ^ Drip Line ^ At-grade ^ Aerobic Treatment Unit ^ Recirculating ^ Other: tt V Dis ersaUTreatment Area Information: ~g 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate m 'on 7. Final G e Required Proposed Rate (Gals./day/sq. ft.) (Min./inch) a /{:^ j (~ Elevation q •OU . ~.-s. ~ ~- ~.a~~ VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks 5~ °, ~ ( las9 ~ ee ~s ~ ^ ^ ^ a ^ ^ ^ ^ ^ VII Responsibility Statement . I the undersi ned assume tes onsibilit for installation of the POWTS shown on the attached tans. Plumber's Name (print) Plumber's Sigttpttt_nq, a stamps): ~ MP/MPRS No. fi~ Business Phone Number ~ r~, 6ou1~$s ~~ ~ a as 9 ~~ 7 -~ 8 ~r 4vav Plumber's Address (Street, City, State, Zip C ) r 1v~v .~1w' 3~ tJ ~~1vSor~ ~ YU tsc~ VIII County/Department Use Only Approved ^ Disapproved ^ Owner Given Initial Adverse Determination Sanitary Permit Fee (Includes Groundwater Su Fee) ~ 225. Date Issued (~- 'Zua t Issuing Agent, Signature (No stamps) ~~,u'"`^. ~ . IX. Conditions of Approval /Reason for Disapproval:' n~ '~ ~~~ u S~~ .cL~Lr-tn.~r~r.~ t S ~ ~1~a.~A.~, `~~D~n. dry ~qp ~~ be -~.~ ~yo Sc P .{ - ~. X22 , '~ Z,. ~ S~1.Q.; ~e51~-_) -~ 1nS~C St[ ~, ~ tY Tt-~;n. Q i ~-~ ~~i! (ou..c~Jt•;4Lt J S~~S y., D . o ~~z. `,t.~-.~` St~S~• cQA~, .~, (~ ., . , ->~ t ~ ~4-waves ~ ~~ ~~~~ ~ ~. ~a .~--`1~M~,ty ~-- Ul.¢, S.Ppf~. -t-l.~,~_ J~~~'~11~Q-4t~ ,~„1. G~-~ cs 1 ' -~ T~ ~~t.S . .r ,. . ~ rc U , ~"` r F~ /„1 U/1GL _ ._._,1 / C.l. C. /.lJ l I ll.l.c• 1 J ... __~_J m_._ . v u.a.~.1~.~ der..'..., .... , ~~ P °~ ^-~ Su~~ ey S~pk~ ~I~v,IuU~ ~~ U GRVP p u~'s /p~iy f fip~ ~ . i3~ ~\y ~~~ 9 a. 'pPq ~ ~ ~~'. '~ ~°~ ~ ,~ i ~ ~ ~-~ ~ T~~ ~ Ga Sb ~r ~9l Q/ ~I ~Go ~~~ ~. `/~' , ua ~ p4 ~ Q~.Sb a f ~t c ~e~"") ~- 98 0~ ~ T / ~` ~ro~ C}~Q s S ~G~%~ ~~i ~ ~ ~ :~ o .. _: ~ c c ~ j ~ ~ ~ 'D ~ ~ x Cn ch ~~~L U ~~ `~ ~ V/ N ^O O /~ C O Q ~ Q_ ~ r .~ ~0P °~ N~- II SURV Qy S'I A~ ~. ~~eU , ~ ub. U lo~ la anc~ .~ ~~cl e uJinde rs .. ~~~ ~A~~N~ ~~~~ ~o ~$ Q~~ i "' °'~ ~ ,~ / ~ i 3 ~~ ~ Teti ~ ~asb ~r `~ ~-sue. ys ~a~~ yb~ ~ ~ ~f ~e~KU~ ~, p c Tti,~ W ~- o ~,, .~' , /A EGG G 0 w4 ~~ ~'n W 0 wla.~_._ _/'l f e ~~e ~. rte. -~~A~' w _,'~ =~~- ~~~ ~ 3y i i~ ~ < ~. ~ /3~/ / \.V /3; ~~~ p ~p'~ oh. ~/Zp-r C~ N _ ~~,s ~ M- gS,ov ~ , gy.sU F~~ ~1 G~c~nw ~ P9 O~ ~ gg.5b ~ 9g.oo ~~ ~ ° ~ ~ ~ _ro _ ,o `~~ .~ - ro~ w ` ~ ~ •C ~ ~ ~ . C E~O T x X ~ ~ ' N N ~ ~ ~ ~ ro . ~ L (~ ~ ~ +.+ ~ 0 ^~ n u~`P ~P °fS \~'~~ N T Cp ~-- ~.. ~ X ~ ~ L X U ~r ^L W y Cr. Q cif ~_ T N M ,, ~stry, La .~ nivi Inn drvie SOIL AND SITE EVALUATION REPORT w~ ~_~_ Page 1 of 3 -'-~ - III 4VVVIV 1.1111 ILI 111 VJ.V V, •.IJ. /1VII I. VvVv COUNTY but Plan must include er not less than 8 1/ ~-4# ' s in size sit a l t l on Att h St. Croix , . p comp e e e p an p ac not limited to vertical and horizontal reference ~ t (bM), direction d % of slope, scale or PARCEL I.D. #~ 3 y ~ ~pUl~ dimensioned, north arrow, and location and 'trice to nearest d 020 M f~ NT A~i~ ;l APPLICANT INFORMATION-PLEAS REVIEWED BY DATE - °- , I ~ PROPERTY OWNER: - -" ' ~ ~ ~ ~ '~ ~ ROPERTY LOCATION Kernon Bast ' ' ' ~~ I - ~ R OVT. LOT NE 1l4 NW 114 S T 29 ,N,R 19 ~ (or) W PROPERTY OWNER':S MAILING ADDRESS ~= % ~:'?rw;}; ~ LOT # BLOCK# S .NAME OR CSM # 948 LaBar e Rd. ~ - `'~~,w~'y 12 na Grass Range First Addn. CITY, STATE ZIP CO j~H ~' ^CITY ^VILLAGE [~0 Hudson, WI. 54016 ( 1~ 386- Hudson McCutchen Rd. [x] New Construction Use [x] Residential / Numbe ooms 4 [ ] Addition to existing building A~-~ j ]Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loadin rate .4 bed, gpd/ft2.5 trench, gpd/ft2 Absorption area required 500 bed, ft2 500 trench, ft2 Maximum design loading rate •4 bed, gpd/ft2 •5 trench, gpd/ft2 Recommended infiltration surface elevation(s) 105.35 ft (as referred to site plan benchmark) Additional design /site considerations system el based oncontour line of el 104 35' Parent material outwash Flood plain elevation, if applicable na ft S =Suitable for system CONVENTIONAL ^ S Chu MOUND ®S ^ U IN-GROUND PRESSURE ^ S ~7 U AT-GRADE ^ S ~7 U SYSTEM IN FILL ^ S ~U HOLDING TANK ^ S CCU u =Unsuitable for s stem SOIL DESCRIPTION REPORT Boring # 1 Ground elev. 104.6 ft. Depth to limiting factor +84" Boring # 2 Ground 1~~: 3ft5 Depth to limiting factor 39" Depth Dominant Color Mottles r T t Structure Consistence Boundar Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color ex u e Gr. Sz. Sh. y Bed Trench 1 0-15 10 r 4/3 none 1 2mgr mfr gw 2f .5 .6 2 15-45 l0yr 4/4 none sil 2msbk mfr gw if .4 .5 3 45-84 7.5 r 4/6 none ms os ml na na .7 .8 Remarks: 1 0-12 10 r 3/2 none 1 lcsbk mfr ~r 2f .3 .4 2 12-39 10 r 5 4 none sil lmsbk mfr if .2 ' .3 3 39-75 7.5 r 5/4 c2p7.5yr 5/8 10 r 5/4 ms/sil Os /M ~~ ml na if .2 .3 Remarks: PROPERTY OWNER Kernon Bast SOIL DESCRIPTION REPORT PARCEL I.D. ~ 020 1020-90 Boring # 3 Ground 1(~~~'5 tt. Depth to limiting facto +~4~~ Depth Dominant Color Mottles Texture Structure Consistence Barxiary Roots GPD/ft Horizon in. Munsell Du. Sz. Cont Color Gr. Sz. Sh. Bed Trerxh 1 0-1$ 10yr3/2 none 1 2msbk mfr cs 2f .5 .6 2 18-39 l0.yr4/4 none sil lcsbk mfr gw if .2 .3 3 39-84 7.5yr4/6 none ms Osg ml na na .7 .8 Remarks: Boring # .................. ................. .................. ................. .................. ................. . .... .... ........ . Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # .................. Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8 .05/92) STEEL'S SOIL SERVICE Gary L. Steel Kernon~ Bast 1554 200th Ave. CSTM2298 NE4NW4 s14-T29N-R19w New Richmond, WI 54017 MPRSW 3254 town of Hudson (715) 246-6200 lot #12-Grass Range First Addn. N 1"=40' BM.= top of SW lot stake ~ el. 100' Alt. Bm.= top of elec. trans. ~ el. 102.40' ~p~'~"5c Gary L. Steel 9-26-97 Wisconsin Department of Industry Labor end Human Relations 1'17..~..i.... of C.~4nhi R Rnil.li..~,c SOIL AND SITE EVALUATION REPORT I~_J_ Page 1 of 3 ~+ - ui a~.w~u v.n~~ ILI 117 UJ.VJ, •.IJ. /14n~. vvVv COUNTY but Plan must include h i i 8 1/2 11 i t l th l i l St. Croix , nc es n s ze. an on paper no ess an x ete s te p Attach comp not limited to vertical and horizontal reference point (B 'nand % of slope, scale or PARCEL I.D. # 6~n~dreis~roa~:`' ~. dimensioned, north arrow, and location and distan 020-1020-90 , ~ ;r ,`,,..,._. _ ~, APPLICANT INFORMATION-PLEASE PF}~LrIT;ALI INRMATI01~~ R EWED BY DATE ~ ,~, ~ PROPERTY OWNER: (,;;~ ~~ ' ~'-''_;;'s f:. '"~ OPERTY LOCATION Kernon Bast ~ ~': "" VT. LOT NE 1/4 ~,~1/4,S 14 T 29 ,N,R 19 ~~°f~ W '"' ` ' ' ~" 1Q .,~, - , ~$ PROPERTY OWNER':S MAILING ADDRESS ~ : " # BLOCK # SUBD. NAME OR CSM # __ ,,, 948 LaBar e Rd. sr ~'~ax , ...~~ na Grass Ran e CITY, STATE ZIP COD ~.-J' PHO fig' ,'' CITY VILLAGE SOWN NEAREST ROAD Hudson, WI. 54016 ``~ : (71 ~'~5 ,~~ r` Hud McCutchen Rd. [xJ New Construction Use ~ ] Residential / Numta@f of ~e~lrcprhs• ~ [ ]Addition to existing building - ___._ (]Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rat~2bed, gpd/ft2-•-8trench, gpd/ft2 Absorption area required 858 bed, ft2 750 trench, ft2 Maximum design loading rate .7 bed, gpd/ft2 .8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 95.00 ft (as referred to site plan benchmark) Additional design /site considerations trenches spaced to code 3/50' below s Urfa 1 Parent material outwash Flood plain elevation, if applicable na ft S =Suitable for system CONVENTIONAL ®S ^ U MOUND ®S ^ U IN-GROUND PRESSURE ®S ^ U AT-GRADE C~ S ^ U SYSTEM IN FILL Cx~ S ^ U HOLDING TANK ^ S ~] U U =Unsuitable for s stem SOIL DESCRIPTION REPORT Boring # .................. ................. .................. ................. .................. ................. .................. 1 Ground elev. 99.0 ft. Depth to limiting fa+84 Boring # 2 Ground elev. 99.R Depth to limiting factor +84" Depth Dominant Color Mottles T t Structure Consistence Baxxia Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color ure ex Gr. Sz. Sh. ry Bed Trench 1 lcsbk mfr cs 2f .4 .5 2 14-40 10 r 4/4 none sil lcsbk mfr if .2 .3 3 40-84 7.5 r 4 6 none ms os ml na na .7 .8 Remarks: 1 0-13 10 r 3 3 none 1 lcsbk mfr 2f .4~ .5 2 13-30 10 r 4 4 none sil lcsbk mfr w if .2 .3 3 30-48 10 r 5 4 none sil lcsbk mfr w if .2 .3 4 48-84 7.5 r 4 6 none ms os ml na na .7 .8 Remarks: PROPERTY OWNER Kernon Bast SOIL DESCRIPTION REPORT Page 2 of 3 PARCEL I.D. # 020-1020-90 ~~ -' Boring # 3 Ground elev. 97.1 h. Depth to limiting factor f80~~ Boring # :<~? 4 .. Ground elev. 94.8 ft. Depth to limiting factor +80" Boring # .€; 5 .. Ground elev. 94.8 ft. Depth to limiting factor +$0" Boring # .................. Ground elev. ft. Depth to limiting factor i H Depth Dominant Color Mottles Texture Structure Consistence Bour>dary Roots GPD/ft zon or in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 1 0-8 10 r 2 2 none sl 2m r mfr 2f .5 .6 2 8-20 10 r 4 4 none sl 2m r mvfr if .5 .6 3 20-80 7.5yr 4/6 none ms osg ml na na .7 .8 ~ `~~- 3y~ Remarks: 1 0-12 10 r 3 3 none sl 2m r mvfr 2f .5 .6 2 12-80 7.5 r 4 4 none ms os ml na na .7 .8 Remarks: 1 0-10 10 r 2 2 none 1 2m r mfr w 2f .5 .6 2 10-18 l0yr 4/4 none sl 2mgr mvfr yw if .5 .6 3 18-80 7.5 r 4/6 none ms os ml na na .7 .8 Remarks: Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel CSTM2298 xernon Bast MPRSW-3254 ~4~4 S14-T29N-R19W town of Hudson 4 lot #12-Grass Range First Addn. N 1"=40' BM.= top of NE lot survey stake C el. 100' Alt. BM.= top of SE survey stake C el. 97.60' 1554 200th Ave. New Richmond, WI 54017 (715 246-6200 ~ b~ ~~®~ ~~ ~x S Gary L. Steel 8-25-98 ` , ~/ ~ 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 Number of Bedrooms Design Flow -Peak (gpd) U U Estimated Flow -Average (gpd) ~ U Septic Tank Capacity (gal) ) a Co Q Soil Absorption Component Size (ftZ) S Type of Wastewater Domestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow -Peak (gpd) Maximum Influent Particle Size (in) 1/8 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 and outlet filter shall be assessed at least once every 3 years by inspection. The tlet shall be cleaned as necessary to ensure rop per operation. The filter cartridge should not be removed unless provisions are made to retain solids- in tie tank that may slough off the filter when removed from its enclosure. If 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 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 ofher freatment or holding tank for any reason wifhout being in full compliance wifh OSHA standards for entering a conbned space. The atmosphere within the septic or other freatment of holding tank may confain lethal gases, and rescue of a person from the inferior of the fank 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 ` Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. ~- ~ Sy S~~f r. spa ~ S W -~ W ~ 1, ~ ~~ P c-~ pN ofi~r n ~K~~NS~ Sfi,Ciz c'j~ ~~N~ by o~~~c.~ 3 ~ L' yc~~b 3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ~ ~ l K.2 (~.i~1 C{ Mailing Address 5 (~C~ ~ (~Q~,~!-' Property Address ~ ~~ .h (Verification required from 1 City/State + ~ t Parcel Identification Number Properly Location (~1~ '/,, N W %,, Sec.) ~ , T ~ T N-R~W, Town of Subdivision Q_„ ~ 5~ ' l Certliied Survey Map # Volume Page # W~trrtui toed c~ / ~~hl~, ~ Voltune 1~~-, Pa e # ~~ ~a~~~S = ~ o0 9 ~- Spec house O yes ~no Lot lines identifiable ~ yes ~ no ___-. .~ improper use and maintenanceof your septic system could cr~ult in its prematuro failure to handle wastes. Proper mainteoanca consists of pumping out the septic tonic every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tonic as a treatment stage in We waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a nwterplumber, journeyrnsnplumber, reatrictedplumberora licewed ~ ~ prop opom~g condltlon ~~~ 2 pumper verifying War (I) the on-site wastervaterdieposal system () ~ io~,~ection and pumping (if necessary), We septic tank is lea than U3~ril o[ shdga ewe, the undersigned have read the abov '~ ,. ,sand agroe to mawtaw the private sewage disposal ' ~~ ~ staatlatds fotih, herein, a set by the Department. and the Deptuhnent of Natural Resources, State of W~bootrin~(~Ificatlat stating that your septic system has been nuinta±,iu~ moat be completed and returned to We St. Croix County Zoning Office within 30 days of the three year expiration data ' ' ~.-'' ; ; , „s , `>~~ SIaNA OF APPLICANT' DATB ,. ~ ~ ~ , Q$ ~ ~,~~` .' I (we) certify that aU statements on~th~ foap are true to Wo best of my (our) knowledge, i (we) am (an) the owner(s) of the described above b virtue of si" ~. ~, ,. , . Y w. ,t~tranty daed recorded in Register of Deeds Oiiice. ., ; , 1?°' S~ 9 0 SIGiNA OF APPLICANT' Y`... , ~ `~ ~y'• ~ ~' DATB ,5 ';. +++'+` Any information that is mis-rep ~ ~nty,.;nsult in the sanitary permit being revoked by the Zoaing Department. *+++++ •+ Inclade with this i~pplicatton: a sta 1`t~~;''~i' { ml~:~-~tr4gty deed from the Register of Deeds office a copy of dre certified survey map if reference is made in the warranty deed ~ 6--~ u~ sC~'1, W t Sao I (o Department for new construction)~~ Lot # ~_. ~J 604956 • STATE BAR OF WISCONSIN FORM 2 - 1982 KATHLEEN H. WALSH WARRANTY DEED kEGISTEk OF DEEDS ST. CRDIX CO., WI DOCUMENT NO. trni 1~J4pAGE2~~„ RECEIVED FOR RECORD 06-1<-1999 1:20 PH Rnnal rla .T Crs p~ and Kernon J Bast YARRAMITY DEED EXEMPT A CERT COPY FEE: COPY FEE: _ conveys and warrants to i ha 1 TRANSFER FEE: 119.70 RECORDING FEE: 10.00 Zehm. husband an wi PRGES: 1 THIS SPACE RESERVED FOR RECORDING DATA ' NAME AND RETURN ADDRESS the following described real estate in St Croix County, Mich 1 nd Arigelena Zehm StateoEWisconsin: 500 P le Lane, Unit B Hudso , isconsin, 54016 Lot Twelve (12), Grass Range First Addition C RT in e Town Hudson, St. Croix County, F ~;$•5'S~ Wisconsin. vad-1020-90-000 PARCEL IDENTIFICATION NUMBER T This 1 s n0 t homestead property (is) (is not) Exeeptiontowarranties: easements, restrictions, and rights-of-way of record, if any. Dated this __ 2ndQ,,~ _~d{ay~of~Mareh , A.D., 19.x_. Lr,.C.l~C ,1"t~,d/~^"- 'w"`-~ (SEAL) (SEAL) • ~nnal rla J ~.geer-Bast (SEAL) (SEAL) AUTHENTLCATION Signature(s) authenticated this day of , 19_ TITLE: MEMBER STATE BAR OF WISCONSIN (lE no[, authorized by §706.06, Wis. StaaJ THIS INSTRUMENT WAS DRAFTED BY ACKNOWLEDGMENT State of Wisconsin, ss. r~ L'_'-/~~iX .County. Personally came before me this ~_ _ -day of ~ y~r~,~j_ 19 ~ , [he above named . S - 9t f~erno~ ? -s~- ~ L~ to me known to be the person who M~ instr men[ and acknowledge th S~yM~~R. ~/u.Wf~'ti:~- Notary Public, (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (lf not, necessary) /~ 'Names of perwns signing In any capacity should by typed or panted below their signawres. STATE BAR OF WISCONSIN WARRANTY DEED Furm No.2-1982 the foregoing J „~rx~. Cou ,Wis. pi tion date: 19Q~_J ~egai ~a~k Co.. Inc. Miwa~ctla. WK. gat ~41..7_p~cf.1_.~~~. /aZ• 60897 KATHLEEN H. WALSH REGISTER ©F DEEDS 5T. CROIX CO., WI RECEIIiED FOR RECORD 04-07-1499 2:15 Pi! EASEl~NT EXERT 1 CERT COPY FEE: COPY FEE: TRANSFER FEE: RECORDIiiG FEE: 12.04 PAGES: 2 ~~~ iv : _ ~~~~ A~,~~~,tc~c~o GRANT F EASEMENT Lot 8 Pazcel ID # 020-1337-80 Lot 12 Parcel ID # 020-1344-12-000 Cindy K. Cameron, owner of Lot 8, Plat of Grass Range Addition, grants and conveys to Michael E. Zehm and Angelena M. Zehm, husband and wife, an easement for a septic system and access to and servicing of a septic system for the benefit of Lot 12, Plat of Grass Range First Ad i#~on, on t e o owing descn parce s: The easement for the septic system is on a part of the NEl/, of the NW'/, of Section l4, T29N, Rl9W, Town of Hudson, Grass Range Addition described as follows: Commencing at the SW corner of Lot 8 of the Plat of Grass Range; thence N40°Ol'37"W,_along-the-southwesterl3~ line of said-lot; 316:09-feet to the-poiirt-of beginning; thence continuing N40°01'37"W, along said southwesterly line, 94.00 feet; thence N49°S£~'23"E,_63.00-feet; thence S40°O1-'37"E; 94.00-fcet; thence S49°S8'23"W, 63.00 feet to the point of beginning. The easement for access to and servicing of the above septic system easement is a ten foot wide easement on a part of the NE'/4 of the NW'/, of Section 14, T29N, R14W, Town of Hudson, Grass Range Addition, being part of Lot $ of the Plat of Grass Range Addition, described as follows: Beginning at the SW corner of Lot 8 of the Plat of Brass Range Addition; thence N40°01'37"W, along the southwesterly line of said lot, 316.09 feet; thence N49°58'23"E, 10.00 feet; thence S40°01'37"E, 311.91 feet to the northerly :~ght-cif-~va~~ c;f LrQVCr~Trail-being-a~pviirt-c~n-curve-ofa 2s"s:00~ioot~raciius curve, concave southeasterly, whose central angle measures 02°39'S8", whose chord bears S27° 1 S'02"W and measures 10.84 feet; thence 10.84 feet to the point of beginning. ~~t Dated this- Z day of , 1'999: r~ Cindy K, ameron ACKNOWLEDGMENT ON PAGE 2 ACKNOWLEDGMENT it Sent by: EDINA REALTY HUDSON WISCONSIN 715 3B6 1502; 04/25/01 9:27; J~tFax #16; Page 2/2 ~. 9 ,~ ,\ 1 j r~ ~, J ~ ~ . -'D- ~ ~' ;v •' ~ . 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