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HomeMy WebLinkAbout020-1356-20-000 % / , ' ` ea , . ) 7 Z. ei vi k § • EZ tu $k{7 o OH c a. 3�7E tii z |k |! u. : IuI . U ' 3. § $| I 3 III ! c/ Bc f \ z 0 •2i § g 12 Ioda. ) � . ) B k § § ! / k / 2a2 � .% t ; 2i2NN a -Ju1 § § § N ' # § § § � © • v � 77 # � J0 i f % . EL , c § ) & � § � j § § 'i k � \&k } 7 _ ■ 3g 2 � ' a , { .. | 7• 1 .1 - §\ l El INNia COk\ � Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM COunty. St. Croix Safety and Buildixg Division INSPECTION REPORT Sanitary Permit No: 420306 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: Johnson, Marie Hudson Township 020-1356-20-000 CST BM Elev. Insp.BM Elev: BM,Descri n ptio ^� / OD,0 /as • 0 • 64 �T' D 4-avt. 1/I.GCI TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Ben ma RC Dosing Alt. BM l b _ sa4-5 Utz-C wA- . 33 /03. / Aeration Bldg.Sewer R• o 9d• y Holding St/Ht Inlet (77. / St/Ht Outlet TANK SETBACK INFORMATION `. S 9 (r, 1 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Siv4 1(or �-�p Septic > I� • ��/,-) r - o r� '� Dt Bottom / L� 70 -7o Dosing Header/Man. C,,,d S CitTuin Ak---- b. - Aeration Dist.Pipe Tbp o-f 2- �S Z 1Y1 I/��—I /r1t /o Glipry./ilnr' lU' /.Z Holding Bot.System / G1 rev Final Grade PUMP/SIPHON INFORMATION g•4.1 e 8. 0 Manufacturer _ Demand St Cover / G 3.3 /03 , Model Number TDH Lift ion Loss System Head Ft For:s.smairr Length 1Dia. 1st.to Well _ SOIL ABSORPTION SYSTEM 22 BED/TRENCH Width J I Length No.Of Trenches PIT DIMENSIONS No Of Pits Inside Dia. Liquid Depth DIMENSIONS /„ ' —L SETBACK SYSTEM TO P/L BLDG WELL Off---/ LAKE/STREA LEACHING' nu rer 6✓ INFORMATION u" CHAMBER OR �• /�'{144 Type Of Syst r / lO r / _.ter- ✓ UNIT I Number DISTRIBUTI214 /`( IrcVISYSTEM^ I Y� / 51e� r+v (� �`a rt c- (--)4.dGothes 4r.4-41 Header/Manifold Distribution x Hole Size x Hole Sing ver...„tgalantake Li// P'pe(s) J) 7 6 / , Length Dia Length C '/ Dia Spacing 147' rL��I�QIL,S�./ky( /�)) SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only t C-4oue.i 4 -K.ia Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil s Yes p No ■ Yes ■ No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: 10/I � /Q-2- Inspection#2: / /_ Location: 703 Paul Burch Drive Hudson,WI 54016 1/4 NW 1/4 14 T29N R19W) Grass Rang Aadn.I Lot 20 Parcel No: 14.29.19.2082 1.)Alt BM Description= 3T• (2T C+'- lr CSTiOP44d - nef-yj -044,.,,¢4if,. 74a.zi+t....* 140;i2t/e.t 2.)Bldg sewer length = 7 a/ gg yr ?pile-o I.r.: 4 foID#-p/Qn. - e"hpc.J sys,l.,n I :&-r -.Ij yt r) -amount of cover= .31 1 Plan revision Required? le Cs is No ��� T & , . io _fUse other side for additional information. .�� Wv S 1� SBD-6710(R 3rB7) Date Insepcto s Signat Cen.No. Usconsin Safety and Buildings Division County !� ^ d , , 201 W.Washington Ave.,P.O.Box 7162 J l� /�Q i y Madison,W1 53707-7162 Permit Number(to be ffdlfd in by Co.) (608>266 3151 j Department of Commerce .uiid - -/ 26 30,6tale State LD.Nuolbel Sanitary Permit Application lI'/A Adm.In accord with Comm t3.21,Wis.Ad Code,personal information you provide may be used for secondary purposes Privacy Law,s 15.04(18m) Project Address f di than mailing address) -70 3 atad► bi-, 1. Appllcatlon Information-Please Print All Information O5 20—/3S-10— ego —66 0 Properly Owner's Name reel a Lot S Block a 'hive aeArb yt) Properly Location aD 00 Z Properly Owner's MailinngM_dress /77s laws Ae kul v, vi✓ Section /1 City,State ///� y/ Zip Code Phew Phone Number �lr ' .of • V//�f 1/ / _ . as i7'cr oie f N, REo� Il.Type of Building(check all that apply) P.3 Subdivision Name CSM Number Al or 2 Family Dwelling-Number of Bedrooms /�d� �J /�l ❑Public/Commercial-Describe Use n /J J ,,, �,�p�,, �1,� (,� "✓./ A([/jf e ❑State Owned-Describe Use . ej et al I//� C d.e 4 .eL' "` OCiry❑Vil)ageifIbwnslai of II1.Type of Permit: (Check only one boa on line A. Complete line B If applicable) A. New System ❑��Ref System 0 Tr atment/Hnitling Tank Replacement Only 0 Other Modification to Existing System B. 0 Permit Renewal �t Revision 0 Change of 0 Permit Tramfer to New List Previous Permit Number and Dare Issued Before Expiration Plumber Owner 9 0 3 0/ 0 3/0 2j 1 .Type of POWTS System: (Check all that apply) Non-Pressurized In-Ground 0 Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil 0 At-Grade 0 Single Pass Sand Filter 0 Constricted Wetland 0 Pressurized 0 Peat Filter ❑Aerobic Treatment Unit 0 Recirculating Sand Filter 0 Recirculating Synthetic Media Filter ' Chamber ❑ ' Isel i ❑� les� te❑our . V.Dispersal/Treatment Area Informs h [ 2 Design Flow(gpd) Design Soil Application Rate(gpds0 Dispersal Area Required(st) Dispersal Area (st) System Elevation 1 LSD _ 693 68g • - 4y,0 VI.Tank Info Capacity in Total Number U� Manufacturer Prefab Site Steel Fiber Plastic i Gallons Gallons of Units QRTN,66 Concrete Constructed Glass New Existing ei O`�V/�G r L Tanks Tanks Scprrc or Holding Tank X /' : / x I Aerobic Treatmcu Vail 4(/8u a Ita'el fi Drnina Ctrmbcr X ` '♦ Vinnka NC1 VII.Responsibility Statement- 1,the If derslgn ass responsibility for ImuWtlon of the POWTS shown on the attached plans. Plumber's Name(Print) s . MP/MPRS Number Business Phone Number rG r 5/�Z it/ /0,o 12Qe./ Z a.35 . .W Plumber's Address(Street,City,State.Zip r venv • J/ S 7t9 ) /4 414o it VI .County/Department Use Only Sanitary Permit Fee(includes GroundwaterC > Date teed I . ,_ s •, ure(No •',s.ii Approved 0 Disapproved Surcharge Fee) ,� ]J� 620 /?, - 0g / pr C ❑Owner Given Reason for Denial wCX �l/ IX.Conditions of Approval/Reasons for Disapproval / n APA/,A-AC // 4 _a, f 492 „ Qr-6i SYSTEM OWNER: (/�w/J_,-"' 4A 4. (/(/ fii�`iC"� *!//��f'�•` ' 1 5,eptic tank,effluent filter and dispersal cell must all be serviced/maintained ,/j„P „ d,-r�„ 1 vyt•�/�� ,pryt ft%) as pet management plan provided by plumber( /"" `/ rD� � 1/ w// 2—. 2. All setback requirements must be maintained �aw-rc as per applicable code/ordinances. / Attach complete pleas(u the County only)for the system r/"paper MA le, ` rs s locks la We 44/ SBD-6398(R. 01/03) '�� -------„,x \ gyp / , �.r• ------"' 1/,' ROW It'rw w I G.r.5 , E. ' ‘11 0 . to .- Be iNe:C,r,f‘ i 0 6\ * ")% CIA)(6 -3i., ..S '1 O v ��gg r — 9e . �� � -et $: L71r./l�istr SW+e g 9 7 / z 0 3 1n/1A film( 9 3 ' 9 5 , QG. 9 3•3 --- /0 3./ ZI q__ i -ix/, Ncrl{t T//Ehci // Y 95- • . J�dalr. fit coal /z . y � � Q n l 9r�de 8• / ' 9 $ a l\10'r s A‘-4- elW,ciOA, too 2 i 08/12/2002 18:55 FAX 17152352592 TLS I NZ PLUMB I N G 4 02 1 ER Cri i VI I 8 1- K.' t a w L o o 1 r I J 0 , ---1 Qv Q I -- Z. ! od z\ - i 1 -oz. I § -----------4 Z. U) N 'fi N ;II ; m E_ J, -a r 1 rn - v - t>.:,..,,t.\ 1 i i -- S ----1 o - 1` s S. CZ-. )2 7I W r `7 \PA- U c '� I K C: f 7---------- \24.... > \\\sN•\ t NE9-- fro -7--- ,kt -t) wk- ‘ \G". \ -‘tc: . li. 1 , -... )---- =, -,,:‘ cck \\ \ "$7.. t, C . —\t-i-, -)._ wisconsln Department of Commerce SOIL EVALUATION REPORT Page/of 3 Division of Safety and Buildings in accordance with Comm 85,Wis. Adm. Code County Attach complete site plan on paper not less than 8 12 x 11 inches in size.Plan must S I y T y include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. —� �� 020 percent slope,scale or dimensions,north arrow,and location and distance to nearest road. O.-�O - I 3 6 Please print all information. eview by Date Personal information you provide may be used for secondary purposes(Pnracy Law.s.15.04(1)(m)). tlit'/n/yr 1 /bh 7/d,"'----- Property Owner Property Location,/I lI 1 l ` Alf t -0 11 t1 Ste,,.1 Govt.Lot �(/' 1/4�V"1/4 S I 416T 211 N R (1' E(o) Property Owner's Mailing Address L # Block# Subd.Name or CSM�#r Z n City State Zip Code Phone Number ❑ W ❑Village Q.Town Ne ` st Road ILA ,\ I LA/t 1S Lie/ (.; I ( o' ) .se -s- 2813 14,„i 1 66 ,I !3. - rh Ur,, ® New Construction Use:[ Residential!Number of bedrooms 3 `I Code derived design flow rate °f5Z'/Z' c'C GPD 0 Replacement ❑ Public or commercial-Describe: Parent material c 1 1-u-' .(A Flood Plain elevation if applicable ti/14 ft. Generalcomments s: SyS1' 1rh e l4 v 1 lc P 9s Cc) i cw ergy.ci(2, I El TBoring# n Boring TI I I 51+ pit Ground surface elev. 7 9,C c.I fL Depth to limiting factor )./.5_ in. Soil Application Rate I Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 I 0 'i5 Ic/i 317- S, I i1114..19` m4r cs hi-I ,5 SJ Z I5 30 itle 'ill — . .c l lr i.k 1'1` l ' C — , d-I . (, 3 >c 11$ icyr L!/L — m c 0 i- m 1 — - , 7- /. 2 I Boring# Boring ❑ pit Ground surface elev. ,./y.Cc l fL Depth to limiting factor 1,70 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont.Color Gr.Sz.Sh. r 'Eff#1 'Eff#2 i I 0 l'" ICi/31L 5' I -2mU 4.ht YYf ( S Iv 1 .`5 r r ZI`I -y11 /c-)r /Pi - 3."/ Z:w,sbic vr.-( / c s — , LI I (-' 3 Ny-(zC• y( /( - ms "'� IM( — I z •Effluent#1 =BOD5>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 Number7 ri[a G Mtn [JG I•a..r^n. f ' 6 ' r2 S 3 )c'Q Address Dale Evaluation Conducted Telephone Number 31/3 '3`'6 31. 5c, ra-1 , w(• syc‘.: s— i(,' I( -' L-- 7,s Zy7- - 4/<r Property Owner 14.r' Si.h :1 Parcel ID# Page Z of 3 Boring# ❑ Boring Q ' • ❑ Pit Ground surface elev. -I fl. Depth to limiting factor 12 1 in. Soil Application Ralu I orizon Depth Dominant Color Redox Desaiptlon Texture Structure Consistence Boundary Roots GPD/117 In. Munsell Qu.Sz. Cont.Color _ Gr.Sz_Sh. 'Elf#1 'EII#2 0 -1Z /CI( 3/z - £, 0-14_r CS I ✓1 ,s" • lS Z 12,-3c wig 4qN - Zrrl.s.bj' Jr\� r s I , , 3 ;0 -z� Y►'� .� r � S � , S � y • Boring# ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture _Structure Consistence Boundary Roots GPD/I12 In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'E##I 'Efl#2 • • Boring# ❑ Boring ❑ PII• Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Struchue Consistence Boundary Roots GPD/l.r In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Elf#1 'Eff#2 - 'Effluent#1 =BOO;>30<220 mg/L and TSS>30< 150 mg/L •Effl(renl/t2=BOD,<30 mg/l.and TSS<30 mg/I. 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 T(Y 608-264-8777. 5Bl i O(IC07g01 PAGE 3 OF 3 • NAME Sr^h DSc?✓\ LOT# LEGAL DESCRIPTION .S T N.R., , Ftor)W SCALE: I"= NU BM I ELEVATION /Lv. BM I DESCRIPTION BM 2 ELEVATION — BM 2 DESCRIPTION SYSTEM ELEVATION4or qSov r fef c ) 1 7J 4 • SYSTEM TYPE rcnueh4,..nG( CONTOUR ELEVATION 15•o r 4 . c( I- . « - -- ta a k• Dr, 11'6 z I +�cl� s G"Z 99 " • — - • b i7 . a111 Pvb7-er4 y 11h.e s013 or eas-r57 So scat is an Pie ,n1--1'tu.a s Itzir.4 SIGNATURE DATE io-/G — oZ 3 Pam- g,..ert& D R..w6 Sanitary Permit Application Safety&Buildings Division In accord with Comm 83.21,Wis.Adm. Code 201 W. Washington Ave. `�seonsin See reverse side for instructions for completing this application Po Box 7302 Personal information you provide may be used for secondary purposes Madison,WI 53707-7302 Department of Commerce f,{ d'L [Privacy Law,s. 15.04(1Xm)j (Submit completed form to county if not C state owned.) Attach complete plus o the county copy only)for the system,on paper not less than 8-1/2 x II inches in size. County A�D/,/ State Vary Pcr�i4umber 0 Check if revision to previous application State Plan I.D.Number sr- I. Application Information-Please Print all Information Rhet1VEB Location: ©old—l35—6'07 D--Mr/ Property Owner Name �(� ���/� .PropertyLocation Q � L ' )i7/U-S / I JUL 2 2 IO2 /'r)1/4A't /4.S/''Tp97,N,R(ore Property Owners MailingM Address Lot Number Block Number I I'l s 7 /{,) � b(, ST CROIX' UNTY ,��jzj / 6rl/ ti �N NC; ' FFICE 0910 City,State Zip Code ...• • •, Subdivision Name or CSM Number Sr- Plot At,J 55/04 (1 , 96— D a^Q,r° II.Type of Building: (check o•e) K p� ❑ 1 or 2 Family Dwelling-No.o :edrooms: 3 0 Village am ❑ Public/Commercial(describe use):_ JirTown of ❑State-Owned Ale 10Te4 eH Ie0 Nearest Road (2) I X /Gr l r 1 S ( 4;4Q Parcel Tax Number(s) III.Type oermit: (Check only one box on e A. Check box ' line B if applicable) A) I. g New 2. 0 Replacement 3. 0 Replacement .f 4. ❑ rhon to System System k Only fisting System B) Permit umber atc ed 0 A Sanitary Permit was previously issued ,�1 IV.Type of POWT System: (Check all that apply) .� , n R'-' •f t 1i on-pressurized In-ground 0 Mou . 0 Sand Filter ❑ o cted Wetland ((, Pressurized In-ground 0 Hol. Tank 0 Single Pass 0 p Line �" ❑ At-grade 0 Ae,•bic eatment Unit 0 Recirculating Other: V. DispersallTreatment Area Information: I.Design Flow(gpd) 2.Dispersal Area 3.Dispersal Are. 4.Soil • •.lication ' 5.Percolation Rate 6.Syste.. 7.Final Grade Required Proposed Rate(Gal .ay/sq.ft.) (Min./inch) Elevation 45-0 643 th & gzi cP /7 'I. ..5" 941, s fi — VII.Tank Capacity in Total N of Manuf rer Prefab Site eel Fiber- Plastic Information Gallons Gallo • Tanks Con- Con- glass New Existing crete structed Tanks Tanks 9�1L boo — 1' D : I > &Or ye ❑ ❑ ❑ ❑ 0 0 0 0 0 VIII. Responsibility Statement / / I,the undersigned,assume responsibility fo • stallat'• o 1 e POWTS shown on the attached plc. . Plumber's (print) Plum.• Si: a �(n• stamps): MP/MPRS No. Business Phone Number t� /S7N z -41 il A-lP /39/b . 7/5:O —ZZW/ce Plumber's Address(Street,City,State,Zip CNit t.-�D 9 708 1, E ,GyPfrtIiV/y//C .St/`?'44-7 IX.County/Department Use Only 0 Disapproved Sanitary Permit Fee(Includes Groundwater Date Issued Issuing Agent Signat (No stamps) Si,Approved 0 Owner Given Initial Adverse Surch Fee) 41.41..,... Determination X. Conditions —o/ q f Approval/Reasons for Disapproval: A-- sfw+.. Sciiumak aNt . 04241,4apc 3.s r cl ct L jA te' ai. -6 i d c 14--- c aisswi.er t • Cki /bai l .tad Sa l s, 4- KMMPau uotlr�M7�wp�uS-�" C D�^� ~kw"- knA1 c 4!M nr� c�no ufS.. c 08/12/2002 18:55 FAX 17152352592 TLSINZPLUIBING Q 01 I T.L. Sinz Plumbing Inc. E5609 708th Avenue Phone: (715) 235-2644 Menomonie, WI 54751 Fax: (715) 235-2592 FAX TRANSMIjTAL f Date: V Q f V07 - No. of Pages: (including cover) • To: Sr- Vl )/X f -DI Y( Ri 20MU Attn: V60 kki - ! From:• Subject: 11 LIke e af J.$dti'1 Lb( Z0 Message: NeLL) kO T 4E1 ). ie oe`'`i_ CR,e„„ • Signature: d • < )0 .4. i- -LI 4-- I c ""46,\\\:t. ii, cz,-- ---,, ,A ilk I r� 1 (..1 _ p !• • 3 J S - i `1 if r ti ,, I Jk.,, C LI �liJ! ^� 1_. z- ( E , I ,...1 , , L...'' ts,1 ,._ r 1 �[ &\ (NN Ufa 2 `yam 41 1 — I m \; Qo -, �� -- 3 k i. .� a r, . . . —. 1— d ,� o T .A. 1 .... ca tz.1 'to, m._ ZOM 9NIfix11dZNIS'LL ZBSZSCZSTLT YVd 22:9T ZoOZ/ZT/90 Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations Division of Safety&Buildings in accord with ILHR 83.05,Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include,but St. Croix not limited to vertical and horizontal reference point( , ,direction&bet,*of slope,scale or PARCEL I.D.I dimensioned, north arrow, and location and dista tq h}iarest road. \ 020-1021-00 APPLICANT INFORMATION-PLEASE P 'VALL NF4R ',MATION.\ REVIEWED BY DATE PROPERTY OWNER P ERN LOCATION 11)---(Kernon Bast '� 4fir: 2 7 /998 GOV7.LOT NW 1/4 NW 1/4,S14 T 29 ,N,R 19*(or)W PROPERTY OWNER':S MAILING ADDRESS LOT BLOCK* SUBO.NAME OR GSM./ ST CROIX 948 LaBarge Rd. rr]IINTY =` 0 na Grass Ra a Sec. Addn CITY,STATE ZIP CODE NP1b1YM961iti 1 FFicE \ . ITY OVILLAGE S N OWN REST ROAD Hudson, WI . 54016 ,51,/ 386-7 Hudson McCutchen Rd. [4 New Construction Use Ix I Residential/Numbe 4 I I Addition to existing building ( I Replacement [ I Public or commercial describe Code derived daily flow 600gpd Recommended design loading rate •7 bed,gpd/ft2 .8 trench.gpd/ft2 Absorption area required 858 bed,ft2 750 trench,ft2 Maximum design loading rate .7 bed,gpd/ft2 .8 trench,gpolft2 Recommended infiltration surface elevation(s) 95.60 ft (as referred to site plan benchmark) Additional design I site considerations trenches 4.o' below surface level spaced to code Parent material outwash Flood plain elevation,if applicable na ft S=Suitable for system CONVENTIONAL MOUND IN GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable for system MS 0 U 0 S ®U EIS 0 U 0 S ®U as ❑U ❑S E U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles StructureConsistence Bounday GPD/ftzoots I Texture P Mansell Ou.Sz.Cont.Color Gr. Sz. Sh. R Bed mien i 1 :, 1 0-12 10yr 3/3 none 1 2msbk mfr gw 2f .5I .6 2 12-36 10yr 5/4 none sil lcsbk mfr gw if .2 .3 Ground 3 36-84 5yr 4/6 none MS osg ml na na .7 .8 elev. 99.6ft. Depth to limiting fact+r84„ ,t .kt Remarks: Boring # >x v;;a 1 0-12 10yr 4/4 none 1 2msbk mfr gw 2f .5 .6 2 2 12-33 10yr 4/4 none Si]. lmsbk mfr qw if .2 .3 Ground 3 33-53 5yr 4/4 none cos osq mvfr qw if .7 .8 v. 99.4ft. 4 53-84 7.5yr 4/6 none ins osq lana na .7 .8 Depth to limiting fac+84" l Remarks: CST Name:--Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200th. Av , New Richm. i WI 54017 Signature: Y� 4 tr . Date: 8_20-98 CST Number: m02298 PROPERTY OWNER Kernon Bast, SOIL DESCRIPTION REPORT Page 2 of 3 . PARCEL I.D.f 020-1021-00 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boutdary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Trerdl 3 1 1 0-8 10yr 3/3 . none 1 2msbk mfr gw 2f .5 .6 : .. :!': 2 8-27 10yr 5/4 none sil lcsbk mfr gw if .2 .3 Ground 3 ,27-36 2.5yr 4/4 none cos osq mvfr gw 2f .7 .8 elev. 97.0 tt. 4 )36-84 _5yr 4/6 , none ms osg ml na na .7 .8 Depth to limiting factor a q I-S'OI +84" • 6-7.; i c-- .. j Remarks: Boring # 1 ,3-10 10yr 3/1 nonP 1 • 2meh1_ mfr or 2f .5 .6 2 10-27 10yr 4/4 none sil lcsbk mfr qw if .2 .3 Ground 3 27-65 5yr 4/6 none ms osq ml qw if .7 .8 elev. 4 55-84 7.5yr 4/6 none cos osq ml na na .7 .8 94.6 ft. Depth to • limiting -;I..Z/73,2 factor • +84" Remarks: Boring # :;: 1 D-10 10yr 3/3 none 1 2msbk mfr gw 2f .5 .6 5 ,< :.,.`; 2 10-31 10yr 5/4 none sil lcsbk mfr gw 1f .2 .3 Ground 3 31-45 2.5yr 4/4 none __ cos_ osg_ mvfr qw , na .7 .8 elev.5 ft. 4 45-84 7.5yr 4/6 none ,_ ms osg ml na na .7 .8 Depth to limiting 1( i factor - f +84" • Remarks: Boring # . . ... . ............. .... ....... Ground • • • elev. ft. Depth to limiting factor 1 Remarks: SBD-e330(R 05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Kernon Bast New Richmond, WI 54017 MPRSW-3254 Nw4Nwa S14-T29N-R19W (715) 246-6200 town of Hudson lot #20-Grass Range Second Addn. This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. tN 1"=40' BM.= top of 2" pvc pipe C el. 100' Alt. BM.= nail in Elm tree C el. 103.80' N N b0 0,610 N N 3k' ;k 3 , is o z, • iN3, '75 S`l�, c 2` . r. a I ipi 0 f5 O ill k 36 L...>8a----e `V 41111wa° Gary L. Steel 8-20-98 POWTS OWNER'S MANUAL a MHntautVIt(vt r►,rAn -•• 'FILE INFORMATION SYSTEM SPECIFICATIONS Owner il(jtii Wit1501 Septic Tank Capacity i000 gal 0 NA Permit# 417p 3O(0 Septic Tank Manufacturer ,j v7 0 NA DESIGN PARAMETERS Effluent Filter Manufacturer 7-fle j,L 0 NA Number of Bedrooms 3 0 NA, Effluent Filter Model _/00 0 NA Number of Commercial Units .— 0 NA Pump Tank Capacity -�— gal 0 NA Estimated flow (average) Sa qloimeis "Co i 04/ gal/day Pump Tank Manufacturer 0 NA Design flow (peak), (Estimated x l.'S) /�U gal/day Pump Manufacturer — ❑ NA Soil Application Rate f 7 gal/day/ftz Pump Model ❑ NA ` Pretreatment Unit ❑ NA Monthly average Influent/Effluent Quality ❑ Sand/Gravel Filter ❑ Peat Filter Fats, Oil 8t Grease (FOG) 530 mg/L 0 Mechanical Aeration 0 Wetland Biochemical Oxygen Demand (BODs) s220 mg/L 0 Disinfection 0 Other: Total Suspended Solids (TSS) s 1 50 mg/L Manufacturer Pretreated Effluent Quality 0 NA Monthly average"• Dispersal Cell(s) Biochemical Oxygen Demand (BODs) <_30 mg/L fin-ground (gravity) 0 In-ground (pressurized) Total Suspended Solids (TSS) 530 mg/L 0 At-grade 0 Mound Fecal Conform (geometric mean) 5.104 cfu/100m1 0 Drip-line 0 Other: Maximum Effluent Particle Size 'A inch diameter • Values typical for domestic (non-commercial)wastewater and septic unk effluent. •• Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event I Service Frequency Inspect condition of tank(s) At least once every 3 0 months ,¢'frear(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (y) of tank volume Inspect dispersal cell(s) At least once every 3 0 months years) (Maximum 3 yrs.) Clean effluent filter At least once every / 0 months 'year(s) Inspect pump, pump controls &alarm At least once every 0 months 0 year(s) A Flush laterals and pressure test At least once every 0 months 0 year(s) A Other: At least once every 0 months 0 year(s) 2^NA Other: At least once every 0 months 0 year(s) .® NA MAINTENANCE INSTRUCTIONS inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Mast Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspectiot must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure tt 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 ined mulation of m In any tank , the entire contents of the btank shall sludge s tank ume be removedby a Septage uServicing Operatorl and disposedr of in accordance the with ch.INR 113, Wiscom Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatement components, and any other maintenance or monitoring at intervals of 12 months or less 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. 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 chunk that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the confer At rh.' rar+t'fsl ramovac! `yy •1 centAge 5ervidng operator prior to use. • • Pate _of 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 dir scharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Striking Operator orInt 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 unk. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, of 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 Susan+ may Improve the performance and prolong the life of the POWTS: antIblotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; dupers; disinfeetnu; fat; foundation drain (sump pump) water; fruit and vegetable peelings; guollne; grease; herbicides; meat scraps; medications; oil; painting t roducts: pesticides: sanitary napkins' tampons, and water softener brine. APANDONEMENT When the POWTS tails 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 ch. Comm 83.33, Wlscoruin 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. • Aher 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 falls .nil cannot be repaired the following measures have been, or must be liken, W provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soli absorption system. The replacement area should be protected from disturbance and compaction and should not be Infringed upon Dr required setDacks from exisung and proposed structure, lot lines and wells. Failure to protect the replacement u.a wits result In the need for new soli and site evaluation to establish a suitable replacement area. Replacement systems must comply will the rules In effect at that time. O A sultatle replacement area is not available due to setback and/or soli limitations. earrtng advances In POWTS technology a holding tank may be Installed as a last resort to replace the failed POWTS. o 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• rade soil absorption systems may be reconstructed In placelat follo rules winge re effect moval a of that tithe biomat at the Infiltrative surface. Reconstrucllons of such systems must comply with me. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO DEATH MAY RESOULT. RESCUE OF A PERSON FROM THE IT ENTER A SEPTIC, PUMP OR OTHEit NTERIOR OFENT AA TANK MAY 6E DIFFICULT OR CIRCUMSTANCES.NK UNDER ANY IMPrICCIRI ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name TG S wZ Pei', /NL Name ` Ave- Phone 7f5— Z c— Z6W Phone 7/S ZjS= Z61"e SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Agency ST elPAe2m'/aV Jam, Phone Phone I Z/.T� 38b zj4bd'D ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM • Owner/Buyer 13.-i "C .--7S.OR V\S0 n Mailing Address / I - S The rno-S /3\u e 5-, ill.L,3 N SSIdci Property Address ( O 3 6)4 `V u,,t_o, D, ,-t (Verification required from Planning Department for new construction) City/State H SD r W 7_ Parcel Identification N er s( —DO'(1),04 LEGAL DESCRIPTION �I AUG l 2 200 Property Location /r L4A, ` "� `/., Sec. I T / N�-R W ,Town of ��y� Subdivision r0.SS Po-Y`cse 3 ` �t-c( , Lot # `� . Certified Survey Map/ # , Volume , , Page # . 6 Warranty Deed # O Oc 9-) , Volume ( (T�0) , Page # / Spec house 0 yes ICI no Lot lines identifiable yes 0 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 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 Zoning Office within 30 days sssoof the three year expiration date. SIGNA OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. 1 (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. tAINel\-i SIGNAOF APPLICANT DATE Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. '••••• •• Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed kfr- • STATE BAR OF WISCONSIN FORM 2-1982 I WARRANTY DEED 608973 VOL 1450PAGE 384 I REGISTER O. DEEDS DOCUMENT NO. REGISTER OF DEEDS ST. CROIX CO., YI This Deed, made between Kernon J. Bast andNMEIVEIFORBUDIM Donalda. J. Speer-tasi, husband and wife, 01-20-1999 11100 M a/k/a Kernon Baat and Donalda Sneer-Bast, Grantor, WANT;MI convevx and v,,,nm,to ..Marie K._.Johnson, sin le erson, COMM' p CIRRI: Grantee TER : 116.70 11B FEEL 10.00 PA6ESt 1 Witnesseth, That the said Grantor, for a valuable consideration, conveys Tam{SPACE RESERVED FOR RECOROMD DATA the folbwnng Jescnbcd real estateIn S t. Croix NAAR ARO RETURN ADDRES! —_- - C0 ntY Marie K. Johnson Slate of Wisconsin: Lot I Grass Range Second Addition in the 1175 Thomas Ave. Town of I►udson, St. Croix County, Wisconsin + St.Paul, MN 55104 __ - 020-1356-20-000 PARCEL IDENTIFICATION MN6ER I' -I Ins i c nest p, Pe y homestead o n Exccptmntowammks: Easements, restrictions and rights-of-way of record, if any. Dated • 19th day of August 99 ,A.D.,19 . (SEAL) A 4Q.tw. , Ze _(SEAL) Kernon . Bast Donalda J. Speer-Bast • (SFfw (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) - Slate of Wisconsin, as St.Croix I noteau ntentic ated this day of .ID_ County. Personalty came before me this 9r h day of August 99 -..-- ,19 ,the above named -Kennon" ---Bact-and Donalda-J. TITLE MEMBER STATE BAR OF WISCONSIN — Spa n ~ T •7 v a T (If not. BTt:Ody POu11T1 authonsed by 1706.06,WIs.Suns.) ".c cv Public �� COnSYo 5Ea(C O( Vi i� to be the pe as__who executed the foregoing THIS INSTRUMENT WAS DRAFTED BY Insane and KIOn ge a Alm. Nov NI../-` Kernon J. 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