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Home My WebLink About020-1376-08-000 , Safety&Building Division Sanitary ermit Application 201 W. Washington Ave. Nfeiscionsln In accord with Comm 83.21,Wis.Adm. Code PO Box 7302 Department or Commerce Personal infomwion you provide maybe used for secondary purposes Madison,WI 53707-7302 (Submit completed form to /0-r4.,Oz [Privacy Law,a. 13.04(I gm)) glyclo date county i ow • Attach complete plans(to the county copy only)for Spe syslem,on paper not less than 8-1/2 x I I inches in size. , County,- State$nituyyPermi!►lymber p,Ceck if revision to previous application State Plan I.D.Numbs J/A I.Application Information-Pleas Print all Information Location: G/-7-7 -fitot :gl Property r ""Ae RECEIVED I`Property Location OP Kcccti0 (3(,f VC I/4/0()1/4,SALT,1I ,N,R E(aka • s Mailing Add, 0 C l 1 t 200Z Lot Number Block Number City,Stale Yip Code Phaie Nuntker ' . ff • , •- ,,,-,- CL Subdivision Name or CSM Number �G W • lr,.; S 6 l _ Salee/ Glass II Type of Building: (check one) o Cit Q r tr I or 2 Family Dwelling-No.of Bedrooms: / o Village Public/Commercial(describe use): la Town of O State-owned — — t y SOA) III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest R oed 1 r ,...- Iq o N A) I. Ilif New System 12. 0 Replacement 13. 0 Replacement of 4. 0 Addition to Parcel Tax Number(s) l System Tank Only I Existing System QUO-ia qb p8- OCJ0p B) Permit /Number / D n/ Date Issued Sanitary Permit was: (Chet zeal l issued ap er fR (I (.� ��/ r'v /rQ/ DOvt IV.Type of POWT System: (Check sit that apply) _ L I[t Non-pressurized In-ground ❑Mo 0 Sand Filter '�❑Constructed Wetland ,K 3� I r ❑Pressurized In-ground 0 Holding Tank 0 Single Pass 0 Drip Line S'/d ,d�_Wit- 0 At-grade 0 Aerobic Treatment Unit 0 Recirculating Other: V DbpersaVfrcattneot Area Information: t`�"'�,(TA--/hse{Q�p�eh t � �) I.Design Flow(Wd) 2.DiapersatAra qts({ Dispersal ra L 4. I Application acolstien Rate 6.System Elevation 7.Final Grade (, ✓ used Proposed 1' Rate(Gals/day/sq.II.) (Min./inch) Elevate). �i VI Tank Capacity in Total It of Manufacturer Prefab Site Steel Fiber- Plastic , Information Gallons Gallons Tanks Con- Con- glass New Existing crete strutted Tanks e�CS Tanks.� ❑ ❑ ❑ ❑ l/ U) S�6 t �- I 2; ).ties ---- , — -❑ 0 ___ ❑ 0 0 VII Responsibility Statement I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. trrbers Name tint) Plumber's i sumps)! MP/MPRS No. Business Phone Number /41 ,C�bu.n Eeskl' 290y 74.1....v6 pow Plumber's Address(Street,City,State,Zip Code ! a L ')__{ v, 3S �5s i S. VIII County/Department Ise Only 0 Disapproved Sanitary Permit Fee(Includes Groundwater Date la e• $igppth ) 111,Approved 0 Owner Given initial Adverse Surcharge Fes) le l/U fb ,yto. �% . Determination 7 �c IX.Conditions of Approval/Reasons for Dis pprovah `� S sue► lest r e>." CJ24 � to v Uua t- �„ frur& a/VA- (pit/idu yMaw es T ./did" .1/d.)-a 'D-- • 0 17' /ie:Q/u-11),Aitrva de ,i�Pot, /r,7 /%-.t �,� / C-a nil j 74 ''a.`J ,e0 rnLr r�rll,lb 1-// li r „ /I uI /off° 4,'�� CO. !',1h4 ><GS�r ,e✓ s s . D.6/ Wisconsin Department of Commerce r PRIVATE SEWAGE SYSTEM County. St. Croix Safety and Building Di'ieion ' INSPECTION REPORT Sanitary Permit No' 408294 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 Xm)I. Permit Holder's Name. City Village X Township Parcel Tax No: Bast, Kernon Hudson Township 020-1376-08-000 CST BM Elev Insp.BM Elev: BM Description. /DO ' d / d a . v T p D,C r . We-l//L0143 s/drktt TANK INFORMATION ELEVATION DATA - TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �/ �Q�i�/Y /�t�0 BenI o s� 2 .6, /O 2. (i /00.D f� Dosing 1��) -1d0 i Alt.BM (,tia.1( sT q vec� / Aeration -� Bldg.Sewer l.+ Holding _ SUHt Inlet '7•1 R 5 6 TANK SETBACK INFORMATION St/HI Outlet 1 .35 95. 23" TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet I Z ......----_ EatSfr 73 J'f't / Septic / `/ /O, Dt B tt Dosing Header/Man. ' IC" q s Aeration Dist. Pipe I 'O 1 7 0S (,63 �144.�7 Holding —� Bot.System j 1e- I ( -1-re41 1 . ( 13 •S- Final Grade PUMP/SIPHON INFORMATION 5 0 9'Ma Manufacturer GPM nd St Cover S •Q+ 3 2 g ell_ d Model Number TDH Lift __ c' Loss System Head TDH Ft FQlrcemain Length Dia...."----__^Gist.to Well SOIL ABSORPTION SYSTEM /u ddt �� DIMENSIONS Width r Lengt 1 I/ No Of T ches PIT DIMENSIONS No.Of Pits \ Inside Dia. Liquid Depth DIMENSIONS VC 1 SETBACK SYSTEM TO P/LAI BLDG WELL LAKE/STREAM LEACHING sourerr INFORMATION Type OOttSystem �r 1 CHAMBER OR p I D d- y S' `� vatt,h611a.< .7� }- 0 , �1[-/ �— UNIT Model Number: r 1 •. DISTRIBUTION SYSTEM �o!�t,iri I J fV►ll' ceozAAT�la Header/Manifold Distributi r / x Hole Size x Hole Spacing Vent to Air Intake J - y� �J I 4, it Pipe(s) �i..fr[ 'e / / • C.w.M1 Length / Da Length Dia Spacing / SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only --0.4..r Depth Over _. Li0 Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center l�I Bed/Trench Edges Topsoil _I W Yes N No ■ Yes ■ No COMMENTS: (Include code discrepencies,persons present.etc.) Inspection#1: 7i /t7'Z Inspection#2: / / Location: 977 Fraser Lane Hudson,WI 54016(SE 1/4 N��W+ 1/4 14/729N R19W) Sweetet Grass a t 8 Parcel No: 14.29.19.2269 1.)Alt BM Description = 5!" �"kG� Ok /1� Ye W L' 6624:1 '►'lC2 2.)Bldg sewer length= I S / -amount of cover= )3/ Plan revision Required? Yes rNo d / ^_ &� -D Use other side for additional information. �� I i SBD-6710(R.3/97) Date Insepctor's S nature Cert.No. • . . K 'LC . - I f'lvt- /1/ f and S ,•c e &Inclers . _ am. - iuu.m�e,1eJ..-.. .. . LtL a L-in Swe_Q\- r(css . _. _-- License . #- Aye 10 -1 ua f LQT4. 1) . All' &Plata 7-41, of ()kw,* Ptd t lad- /(U .yv A 1-1 bin /t1' I 3i � 8t — a i � �4S IA ,ov ri rt<� 3 < 7 SO 4.)0 o Bo, mo„k fItV - Nr� dw*l1 Z10 ( CC �f TOp 1T Ir6 i.1; ,Ui1 neV= /UU Q z o , a J v . J I E . 1 I i Faps,R /bhp( i 1-ill-- ui tu I 5-)Atil, I{V d . Lrn Wni It R r—FT .. f- ti . 6 / f'I v t /�/u`� u� _S d e &,nc(e rs -� - _ PI .e _._. - ---- — ►zNor. . T_b_J�_-.-..-- ---. ..---- 474 M L . . .. _ ;m. _ ou.me..e ler. ... 46ficZi-in0 Swe-k ltass - --- .L_/cense -4. ._71.2Ay0 . - -- - ---__ --Lo 8 - ._SVeC=. _PLI I0 � 7)oa wf(3Monk Top o4 el,014t Pca I,v- /uU ' vv • lad- I 5.p' nor 1 jN+ Ali nu4,p g� a Inok c s /40• mei wiA /�bl `i.11c 3 .( 97SQ i. Q' I • V41,00 o (3oH(1. ►hotik fIcv ' kifk d)TII „42Fop ,4 Fti4.,brl.,01 1 z 1-leV= /00 Q O 3 v J • E 1 1 i — Faps.R Zo,,t ---- Nc r- W • loll ill 9L', oo Cti I o 1 I i . IL III �1 I1I� ic: m x • Ii- 11 p u CC i --- oh • Iv ' E R. c x a N. i LI H U W, ILI Crl ;14I v Z °' l ' m l'AEc.n g ' m c�I M N • D i W °' IIII \ 41it g I12. 1 1 -1 \ \ lL s u c 0 .,, ( i ) -co u L T y L C _ 1 o (75 os p 7 it . • • • , 1579 Wisconsin Department of Commerce SOIL EVALUATION REPORT page 1 of 3 Division of Safely and Buildings infZco 7 m Com 85 Wis.AdmmCoode_° z ACE.Soil&Site Evaluations County Attach complete site plan on paper not less than 834 x 11 inches in size. Plan must St.Croix include,but not limited to:vertical and horizontal reference point(BM),d'ecfion and percent slope,scale or dimensions,north arrow,and location and distance to nearest road. Parcel I.D. 020-1376-08-000 Please print all Information. II'' Personal Information poste YMe may be used nor l L Y- t—v.M(1)( 11. R G ,14z* Q//v, Li Property Owner P Location Kemon Bast �} -La SE 1/4 NW 1/4 S 14 T 29 N R 19 W Properly Owner's Meiling Address P 1 6 2'�1.0t N • Block* subd.Name or CSMM 948 LaBarge Road 8 Sweet Grass City State Zip Code Phone Number J J Village d Town Nearest Road Hudson WI 54016 6-36b-77f5 Hudson McCutchen Rd.&Fraser Ln. 116 New Construction Use tb Residential/Number of bedrooms 4 Code derived design flow rate 600 GPD J Replacement _f Public or cormiercial-Describe: Parent material Glacial outwash Flood plain elevation,if applicable Lr na COhrire General rrcl mmen ants a%a,7 //k/. t! d�- and recommendations: Install two trenches at 94.00'using 28 leaching chambers. — 5-ent • 1 Baring* J Boring rJ Pit Ground Surface Oev. 98.19 ft. Depth to limiting factor >95" in. sal APpn Rafe Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots GPDfft' 'Eff*1 1 'ENO 1 0-9 10yr3/2 none sil 2fsbk mvfr cs 2f,1m 0.5 0.8 2 9-33 10yr5/4 none sit 2msbk mvfr cw 1f,vf 0.5 0.8 3 33-40 10yr4/6 none Is lmsbk mvfr cw 1f 0.7 1.2 4 40�8 10yr5/6 none cos&gr 0 sg ml aw - 0.7 1.2 5 -95 10yr5/8 none s 0 sg ml - 0.7 1.2 . 5o .2//gzr . 2 Boring* J Boring VI Pit Ground Surface elev. 97.98 ft. Depth to limiting factor >100" in. Sal Application Rale Horizon Depth Dominant Color Redox Description Texture SUudure Consistence Boundary Rods GPDAN 'Eft*1 1 'EfT*2 1 0-12 10yr3/2 none sit 2fsbk mvfr cs 2f,lm 0.5 0.8 2 12-31 10yr5/4 none sit 2msbk mvfr cw 1f,vf 0.5 0.8 3 31-42 10yr4/6 none Is lmsbk mvfr cw 1vf 0.7 1.2 4 42-54 /0yr5/6 none cos&gr 0 sg ml aw - 0.7 1.2 5 54-100 10yr5/8 none s 0 sg ml - - 0.7 1.2 . . & 46 c.P•tt d 'l4-• . 'Effluent cent*1 =BOD >30<220 mg/L and T >30<1 *2=BOD <30 mg(1_and TSS< mg& $ CST Name(Please Print) ' nature: - CST Number James K.Thompson ,, / <`/�s- 3602 Address AC.E.Sal&Site Evaluations /Date Evaluation Conducted Telephone Number 340 Paulson Lake Lame,Osceola,Wl 54020 8/27/02 715-248-7767 property owner Kemn Bast ParoelID# 020-1376-08-000 Page 2 of 3 3ng* Jg 98.23 ft. Depth to limiting factor >94" in. Sal d Pit Ground Surface step Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDHt' 'VW 'Effx2 1 0-11 10yr3/2 none sil 2fsbk mvfr cs 21,1m 0.5 0.8 2 11-24 10yr5/4 none sil 2msbk mvfr cw 1f,vf 0.5 0.8 3 24-42 10yr4/6 none Is lmsbk mvfr cw 1f 0.7 1.2 4 42-48 10yr5/6 none Cos&gr 0 sg ml aw - 0.7 1.2 • 5 410. 10yr5/8 none s 0 sg ml - - 0.7 1.2 j citf.01. 5-0.7(04 . ii/,6-7&/, Boring# J Boring _J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Ufa Redox Description Texture Structure Consistence Boundary Roots GPD/fP 'Effk1 'EffN2 • • • • Boring A J Boring J Pit Ground Surface step. ft. Depth to limiting factor in. Sq1 Applicabon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots . GPO/ft' 'EMI •Eff#2 • • • •Effluent#1 =BOD 5>30<220 ng/L and TSS>30<150 mg/L 'Effluent 82=BOD,<30 mg/L and TSS<_30 ng/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 crontact the department at 608-266-3151 or'ITV 608-264-8777. A91.*/s79 A&9 Swekf�rY�Ss • 50,IObser✓ufibn c A E/e Sta/t: / .=9J N /t1 t Al (3.nt.• -r op(' tekto hme kot-al P . EIt .. _ ,00.y0,' $3'" Q � as✓r Emit 4i Proposed residence /o& /ot 4 j. 3of3 It lieell•41/914,11e'Fb4- c .77 /-r,-se r La",____ Safety& Buildings Division Sanitary Permit Application PO Box 7302 �� 201 W. Washington Ave. sconsin In accord with Comm 83.21,Wis.Adm. Code Madison,WI 33707-7302 Oapartmant br Comrnaro. Personal infornrtion you provide may be used for secondary puts ses (Submit compleled form to county if not d'�'r--tiZ- (Privacy Laws. 13.04(IMu)) �y'Q( 1 state owned.) • Attach complete plans(to the county copy oniyLfor the system,on paper not lets than 8-1/2 x I I inches in size. County -- - State Sankary P�rmjt Number 0 Check If revision to previous application State Plan I. D.Number -f L G9 i ie LJJ/'y�'a�f I.Application Information- Please Print all Information __,ram Location: Property Owner Name _ - p C ErS Gv Properly Location • � la NO , ep )t --- - RE a_ r SE v4 N+I Il4,s( 1 ra 164._ I LUc)W � Property Owner's Mailing Addy s JUL 1 a 2002-- -- Lot Number Block Number l l b\D�P � 9UNlY (8 City,Stye Phon6NiGillrig'x C i ZONING rFiCE Subdivision Name or CSM torsions Ubo� IN S `I0) ( / Sw<A{' GICPSi mien I1 Type of Buil (cheek one) °1 ✓ ys fit, S .; S ❑city V I or 2 Family Dwelling-No.of Bedrooms I O Village O Public/Commercial(describe use):- q Town or 11 O State-owned U D J O N III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Roadf S-t A bNi A) I. kl New System 12. 0 Replacement 3. 0 Replacement of 4. 0 Addition to Parcel Ti Nurtber(s) S em 'Tank Only I Existing System - .1O 37 4 -0 b ' O U v B) I Permit Number - - -I Date lamed O A Sanitary Permit was previously issued IV.Type of POWT System: (Check all that apply) B.Non-pressurized In-ground ❑ Mound ❑Sand Filter Cl Constructed Wetland • O Pressurized In-ground 0 Golding O Single Pass 0 Drip line O AI-grade (28\ O Aerobic'Treatment link ❑ ecircy tsi.n O Other: J -T.---"ay ( ) 3' k /14.0 r �eXJtS g1I,t 1. V DlspersaVfreatmeol Area Inferthatlon: I.Design Plow(gpd) 2.OispersalArea 3.Dispersal Area 4.Soil Application S.Percolation Rate 6.System F,kvatlon 7.Final Grade Required Proposed Rate(Gals/Jay/sq.R) (Min/inch) a Ekvation (10° SS '1 8 4 B - ''� _ iAf-10 %' , 1b VI Tank Capacity in Total N of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons 'Tanks Con- Con- glass New Existing cane sit octet' Tanks Tanks n - --a-- o o ❑ VII Responsibility Statement I.the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. _ (Roo - O(I?) Plumber's Name(pint) Plu s S no sesnnpa►:• MP/MPRS No — Bwlneu Pha to Number Plumber's Address(Street,City,Stale,Zip Code) la7l; uL 5" ti )..kciuti 1� , - ry61 t� VIII County/Departmedt Use Only 0 Disapproved Sanitary Permit Fee(Includes Groundwater Date Issued Issulg{Agent Sigaat rs(No shays) *pproved ❑Owner Given Initial Adverse Surelsrge ) �[/ - Determination u� 12, -ace 2- '\-Qj-AA.n„ IX.Conditions of Appr val!Reasons for Disapproval:itAa sA4D- . s. Si S( -- S L.16 ,QrQ I,� ,h�Fr-1X.Op..4..--.,. ,i ' e',n,. p..4- 0;( /eedeeSC asa4fd rQ • hYA � ) ->� QA,W"W- y x„s4 ,/ .. 4-s•,f Lutw�.t Cs ls-3 �,er Dew J .. , . . f-J is J .. - / not t /'h,.-lc and ..S de to ncle rs> _ . _Jim. cguu. E l er.. ._ SW..4._ Q.'�h3s_ � pKh, p �7 ) I.. ti) I / / o \ \o p rj 1"c•..,1 w;- r Will ill' \ 4) Fi`1 -Iev=1W U . yr{,eR„b�,, 40 )en,a .2 {_ -.2 iga° Iy{l 14 FIP, fl i- 9930 6t ' 0f,.. ,s I rpm I �(,(� (� 3k 87- 5o vc Ali Atia i • Q' .AV TO _ ui r- l� co �o In lIcN t Le S a)i 1i Dli Ii I cCra2 inr I) il E v e L x rn co LU Lian 1 . . I_ ( (1) 13 -92 iD " U to a� 0 o _ ' co o �, • m _ co o O p o .• t0 4. Q. 4J y .n c� ( w j tE g � n �a. 'o Nu) _ U �{ fl U� CI al 0 (�.��? ': II T U- CD O U w .tom. x ♦��t \ \ u L T N C ch N Ol 3 boa L 01 ,''`1,•c,, in V n. • • • • Y Wisconsin Department of Commerce SOIL AND SITE EVALUATION Divisron of Safety and Buildings Page 1 of 3 igureau of Integrated Services in accordance with Comm 83.09, Ws. 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 - ( rO i y percent slope,scale or dimensions,north arrow,and location and distance-to nearest road. Parcel I.D.# A.- APPLICANT INFORMATION- Pleasd print alllfitormo ion. Re ' wed by Date Personal information you provide may be used for selondary purposes(Privacy Law.s. 15.04(1)(m)). a[ - .i►1 A f, _k-02t-1e02_ Property Owner + Cr'" 1 ' � ProprtyLocation vl1Rarw� `�-� - 4Y D /� 1I1l w . LhGrC1. StoL],F- :;, - , :,. Govt Lot SF 1/4.G4/1/4,S /c.r T e't,N,R /( E(or)W Property Owner's Mailingin Address \ - COUNT'r Lot Block# Subd.Name or CSM# I 35D -- '1NGOFF GE Awo ku e� I� _Wce-i- LA ra 5 City State Zip Code - one Number Town Nearest Road i-\ Ucvc,ty Ilvl I 'S`1olvo I (7i� ' • - '�54 ❑ City ❑ Village ( I--htiI<\0)1 I �IC.f",8( ln - [ New Construction Use: [}Residential/Number of bedrooms 1 __ Addition to existing building ❑ Replacement ❑Public or commercial-Describe: Code derived daily flow 1000 gpd Recommended design loading rate' 7 bed,gpd/ft2 T trench,gpd/ft2 Absorption area required q S 7 bed,ft2 -7_S t) trench,ft2 Maximum design loading rate ' ? bed,gpd/ft2 - Y trench,gpd/ft2 Recommended infiltration surface elevation(s) cf y''' ft(as referred to site plan benchmark) Additional design/site considerations / f' 4 3 -7 r) Parent material O v ' rr4 .S s? Flood plain elevation,if applicable /// ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system 'S ❑ U Wt S ❑ U 2 S ❑ U ❑ U ❑ S 0 U ❑ S opU,l SOIL DESCRIPTION REPORT "*� Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 Texture Consistence Boundary Roots in. Munsell1 Ou. Sz.Cont.Color Gr. Sz. Sh. Bed Trench r 1 1 O-12 l0 yr 312 5; I irylahk mC'r c s Iv+- - 2 : . "S •2 z 12 `+I )DyryI4 5;1 2r abk m-F, C5 — • S : .(o .r Ground 3 41-1210 IOyr 11(f m5 DSc rill c 5 — .1 . R .} elev. i1 lo ft. • Depth to • limiting factor - f 2l,in. ' Remarks: Boring # I .o-t lOyr3l2 Si , Ilr><Lbk mctr . c5 IvC - Z : • 3 • Z a ., 2 .b-'16 a)yr4Iq , I/ . 2f ►bk rn-c c5 — .s_ .' . 3 frq /Dyry tp m5 - 05i ml . cS — .-7 - 8 •7 Ground elev. C4 So ff. A.t- 14ror : Depth to fir, �/ limiting (pi•`�/ f�• l factor //9 in. Remarks: CST Name (Please Print) fgnature Telephone No. A Sctl)OYL r- �� - C-7/5-1 z47- too g Address Date CST Number 7-US &Q% S--4. Sumer -4-. lot 5`tvz5 `I-(-4-00 Z❑333ei 4 {� v r SOIL DESCRIPTION REPORT PROPERTY OWNER s � Page C, of IS. PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ftZ in. Munsell Qu.Sz.Cont.Color Gr. Sz.Sh. Bed .Trench 3 I 6-13 16yr3/2 SiJ Imalak . r r c.S Ivy' . 2 .3 .L Z 13-1y /6 yr`t I4 . .3 1 2.rr-cbk enCt c-S — . S : . (p -5-- Ground 3 y+ii IDyr`i I4 - -- rr,. 055 - ml CS .1 : . g •4- elev. -- - --- `19.0 ft. Depth to limiting Gael/1� factor lain. Remarks: Boring# I e-)3 10 yr 3)ZII s;1 I'm� mar cs I r . Z ; . 3 .2 `-) Z /3-53 /Q yr 9I `f - 5,f 2m6ibIC rrif c.5 — .5 : . (o 4' 3 ss►z4- 10 7 `)Ja n15 asS MI c5 — . 1 .3 .} Ground elev. 4g 8o ft. / Depth to SIr. 42 ,c1 limiting factor rL in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed .Trench Boring # I o-2.3 IOyr312- — i ! jpaabk m-Cr CS !vC ,2. .3 .L 5 2z3StS1Dyr11`f �f I Zmabk inc: cs — .s :. (P .T 3 izi IOyryA, rr,S (1". Yell cs — . -d .1- Ground elev. 9B. )ft. _ Depth to • limiting facor Mn.' Remarks: Boring # • • Ground : elev. • ft. _ Depth to limiting • factor in. Remarks: SBD-8330(R.9/98) . ; • % •. • . • PAGEOF 3 NAME S•i0(} 4" LOT#8 LEGAL DESCRIPTIONS '/.a0.,1/4,Si4 T2' .N,R A (or& ''''SCALE: 1"= IO6 /BM 1 ELEVATION I CX)•0 1 ABM I DESCRIPTION+Qp t I':•a t,'f I.rI,,,.,ro-Le.v� _ \__ — 1 I ./ q$M 2 ELEVATION c l• q 0 itl BM 2 DESCRIPTION fc 2oL I land„,1- Greek W/ 1-10� SYSTEM ELEVATION 4 7./0 ALTERNATE ELEVATION q 3.7 0 CONTOUR ELEVATION 'ti/14 C- C 4k- Le . 'A v• V '6.1 ` 5 raN , n ,U (/ IPr Z i - - - - - , e3 ..• g° ,_ 35 4,1-4'3"_ 8, SIGNATURE i„�� —�"-- DATE N—y_Qd • 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 (POWTS) 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- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number 1082.11 Number of Bedrooms Design Flow - Peak (gpd) (SC) Estimated Flow-Average (gpd) Cek_ Septic Tank Capacity (gal) ( a<<(, Soil Absorption Component Size (ft2) Type of Wastewater Domestic Table 2: Solt Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow- Peak (gpd) (, w gcg di Maximum Influent Particle Size (in) 1/8 Maximum BODE (mg/L) ) 220 Maximum TSS (mg/L) I VOJ 150 Table 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 I ' to i . and outlet filter shall be assessed at least once every 3 years by inspection. The Or Illft shall be cleaned as necessary to ensur% 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 Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. " Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank 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 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. When system fails, we will replace with another system at owner' s expense . Alternate area must be left undisturbed. St Croix County Zoning Office 386-4680 Boumeester & Sons Excavating 386-9020 Tri-County Sanitation 386-2130 3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT . AND OWNERSHIP CERTIFICATION FORM f) Owner/Buyer �6 4''4 OiA /2 -1<---/ Mailing Address Y '/D pl4"M /? • —kli SD/0. i c Sr--4_0 C�O Property Address / (Verification required from Planning Department for new construction City/State F,-.t C( 5 01 Parcel Identification Number b -( 3 76 _6 -co 0 LEGAL DESCRIPTION I/ q Property Location 7 r '/., /V 6)'/,, Sec. 1 L . T (1 N-R ( I W, Town of �i1d5-04'\_ . Subdivision c t )ee'f cam ; Ss /-C+ i :�V1 , Lot # Y. . Certified Survey Map # — /l/ - ' 1 , Volume . Page # . Warranty Deed # (0I / .33 , Volume , ? 7 V , Page # / U . Spec house yes 0 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 . .. • 0:t your septic system has been maintained must be completed and returned to the St.Croix County Zoning Office within 30 ys of Gear expitati��,:te. i 4L1 / 07 /!.g/ OoZ- SI TURF OF fir I DATE O ':/ R CERTIFICATION (we)certify that all statements on this form are true to the best of my(our) knowledge. I(we)am(are)the owner(s)of described above,b ' e a warranty deed recorded in Register of Deeds Office. SI ATURE OF ICANT 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 VOL i724•AGE 198• STATE BAR OF WISCONSIN FORM 2-1D98 z E. 7S33 . WARRANTY DEED M. WALSH FEb2STER OF DEEDS o«urnwv Menem, CR:/IX CO., WI REIIIYED FDA-RECORD This Deed.made between i:-25-2J91 5:2) AR _RTCHARE l]_ STOUT_o_nrl JLNRT P ATAIIT, —hllghand and w fe•, tikvitihTY DEED . Grantor. and and MN J. SPEER—BAST��,. -. :• ::.� - TikrocE1 FEE: 627.30 E.:060116 FEE: 11.00 —_— _ . Grantee. Grantor.fora valuable conlderation.conveys and warrants to Grantee the following described real estate in St Croix County.State of Wisconsin: Lots 9, 10 and 11, Plat of Sweet Grass ; .,,..r..,. Farm, Town of Hudson, St. Croix ou�Le None end Worn Maass Wisconsin. FT L C 020-1376-08-000 020-113766--00p9-000 lit 676=137b=1T=�t � Thls_P homestead property (is) (Is not) Exceptions to warranties: easements, restrictions, rights-of-way and covenants of record. Darted this (�21 st etay of September 2001 � R•k•tk JlA7� •41,dr ISEAU ( P /"/�ems a -- (SEAL) • Richard O_ Stout • Janet P.. Stout ._ (SEAL) - _(SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) .- State of Wisconsin, >, St. Croix County authenticated this_ day of ,_ Personally came before me this 21 st day of September .2.O.QL_.the above named Richard A Strntt anti .7anot P„_ Stout • TITLE:MEMBER STATE BAR OF WISCONSIN , l Fos • _to 0f nob, • +. me known to be the person 0—who executed the foregoing authorized by B706.06.Wts.Slats.) and uknow edge the PAM,,. THIS lEM WAS GRAFTED BY dnG Janetet P. Stout + • ekvn 5 1353 Awatukee Tr. _ Hudson, WI 54016 Notary Public.State of Wisconsin My commission A permanent. (It not, state expiratitionn date (Signatures may be authenticated or acknowledged. Both are not ""3 0 ..arse-/) necessary.) •',ewes at peewee sway w wee eepetey ter be typed or peeved blow tare paw,✓e STATE BAR OF WISCONSIN Wuooenn Lebo Bare Co.rc WARRANTY DEED FORM No.2-1991 .... a .We imimiimiumunimimmummimi SWEET GRASS FARM SE1/4 OF THE NW1/4, IN THE NW1/4 OF THE SW1/4, PART OF THE NE SW1/4 OF SECTION 14 AND PART OF THE NW1/4 OF THE NW1/4 ANC ►WN OF HUDSON, ST. CROIX COUNTY, WISCONSIN. , / / OsJ�� / \o \ o / ` %\ / \ ° GRASS RAN@IE \o ��0P,�� (GRASS* e D DD OTOOO nM / / ``‘O‘ 100 91 / LOT 209 / I I l NORTH UNE OF THE S1/2 OF THE NW1/4 SECTION 14 2 N89°54'51"I P Ne96416e0-E e21.1 W GyA — — — — — 40e.10 — — (( 'I _ 3e' RADIUS TIP/CAL I°j I H.W.L. a 92e.7 C • I a, - 3 / .78 r,J: W . .. IL -t- _ — 871.2 MIN MINELE = e30.0 Neo'4e'eo'E 0' 4ee.0e 43e.ea BUILDING 33' I33 I : I I : LOT 9 LOT 2.04 AC d+ + 1 q ese00 E 4 q MIN BUILDING 2.04 ACRES Q Illliiii I R 1 ELEV. = 030.0 �8e SQ FT O - — - MIN BUILDING 1 ELEV. = 91e.0 m I . Nee'416e0'E 871.217 25'1 4se.e4' MIN BUILDIN IN I : ELEV. - o1e 5a • I r r 4r 1579 Wisconsin Department of Commerce SOIL EVALUATION REPORT p 1 of ; Division of Safety and Buildings in accordance with Comm 85,Wis.Adm.Cade A.C.E.Soil&Site Evaluations Attach complete site plan on paper not less than 8''/x 11 inches in size. Plan must Canty St.Croix include.out not knifed to.vertical and horizontal reference point(BM),direction and Parcel I.D. percent slope,scale or dimensions,north arrow.and location and distance to nearest road. 020-1376-08-000 Please print all information. Reviewed By Date n'ersonai nrormabon you provide may be used iO secondary purposes(Privacy Law.s 15 04(1)(m)i Property Owner ,Property Location Kernn Bast 'Govt.Lot SE 1/4 NW 1/4 S 14 T 29 N R 19 W Property Owners Mailing Address Lot# Block# Subd.Name or CSM# 948 LaBarge Road _ 8 Sweet Grass City State Zip Code Phone Number _J City J Village d Town Nearest Road Hudson WI 54016 715-386-7775 Hudson McCutchen Rd. & Fraser L.n d New Construction Use: d Residential I Number of bedrooms 4 Code derived design flow rate 600 GPD ! Replacement J Public or commercial-Descnbe: Parent matenal Glacial outwash Flood plain elevation,if applicable na General comments and recommendations Install three trenches at 94.00'using 28 leaching chambers. Bonng# J B°nn9 lei Pit Ground Surface rsaev 98.19 ft Depth to limiting factor >95" in. Soil Application Rate • Homan Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' 'Eff#1 i 'Eff#2 1 0-9 10yr3/2 none sit 2fsbk mvfr cs 2f,1m 0.5 0.8 2 9-33 10yr514 none Si 2msbk rnvfr cw tf,vf 0 5 0.8 3 33-40 10yr4/6 none Is imsbk mvfr cw 1f 0,7 1.2 4 40.48 10yr5/6 none cos&gr. 0 sg ml aw - 0.7 1 2 • 5 48-95 10yr5/8 none S 0 sg ml - - 0.7 1 2 Bonng# --I Bon'n9 d Pit Ground Surface elev. 97.98 ft. Depth to limiting factor >100" in. Soil Application Rate i nonzon Depm Dominant Cola Redox Descnption Taegu Structure Consistence Bwndary Roots GPD,:ft' *Effort I 'Eff#2 1 0.12 10yr3/2 none sil 2fsbk mvfr cs 2f,lm 0.5 0.8 2 12-31 10yr514 none sil 2msbk mvfr cw 1f,vf 0.5 0.8 3 31-42 10yr4/6 none Is imsbk mvfr cw 1vf 0 7 1 2 4 42-54 10yr5/6 none cos&gr 0 sg ml aw - 0 7 1 2 5 54-100 10yr5/8 none s 0 sg ml - - 0.7 1.2 • • • 'Effluent#1 =BOD 5>30<220 mg/L and TSS 30<150 mg/L • t#2=BOD5<30 mg/L and TSS<_,30 mg/ CST Name(Please Print) S. are: ./ CST Number James K.Thompson 4 7 .—-) 3602 Address A.C.E Soil&Site Evaluations date Evaluation Conducted Telephone Number 340 Paulson Lake Lane,Osceola,WI 54020 8/27/02 715-248-7767 • Property Owner Kemn Bast Parcel ID# 020-1376-08-000 Page 2 of 3 3 Bonng# J Boring el Pit Ground Surface elev. 98.23 ft. Depth to limiting factor >94 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fta •Eff#1 •Eff#2 1 0-11 10yr3/2 none sil 2fsbk mvfr cs 2f,1m 0.5 0.8 2 11-24 10yr5/4 none sil 2msbk mvfr cw 1f,vt 0.5 08 3 24-42 10yr4/6 none Is lmsbk mvfr cw 1f 07 12 • 4 42-48 10yr5/6 none cos 8 gr 0 sg ml aw - 0.7 1 2 • 5 48-94 10yr5/8 none s 0 sg ml - - 0.7 1.2 TTBoring# —1 Bonng I_J J PR Ground Surface ecev f•, Depth to liming factor ;r Soli Applicabor Rate Honzon Depth Dominant Color Redox Descnption Texture Structure Consistence Boundary Roots GPO/ft' 'Eff#1 'Eff#2 Boring# I Boring _J Prt Ground Surface elev ft Depth to limiting factor in. Soil Application Rate 1 Horizon Depth Dominant Color Redox Descnption Texture Structure Consistence Boundary Roots , GPD/fta •Eff#1 •Eff#2 •Effluent#1=BOO 5>30<220 mg/L and TSS>30<150 mg/L •Effluent#2=BOD5<30 rrg/L and TSS< O mg/L The Department of Commerce is an equal opportunity service provider and employer. 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