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HomeMy WebLinkAbout020-1376-09-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Build'w'~g CJivisio~ ~ ~ _ INSPECTION REPORT GENtRAL 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 Bast, K.ernon Hudson Townshi SST BM Elev: ~~ ~ Ins UM ~ ,: ~ BM De„scrjption: ~/~/ JC ~ ~/JtXii.~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ q j Dosing ~ _ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L b WELL T BLDG. Vent to Air Intake ROAD Septic ~ ~ S''j ~ Q ~~-~'"__, s Dosing °"` ~~"" Aeration Holding PUMP/SIPHON INFORMATION GPM System Head Well SOIL ABSORPTION SYSTEM ~ BEDITRENCH Width 1 Length r DIMENSIONS ~ 1h ~ I INFORMATION ypl- ~IT e f S stem: ~~' 13~' ~ .,'~ DISTRIBUTION SYSTEM ELEVATION DATA STATION BS HI FS ELEV. Benchmark •~ lDO. 2slS.[5 Alt. BM cY •3T ~~ q ~ (, [ T Bldg. Sewer St/Ht Inlet ~~ 6< <` SUHt Outlet S• ° 9r y Dt Inlet ~ ~- Dt m ~~ _~ Header/M n ~i Dist. Pipe (o ~ ~ 3 3 Bot. System ~_91v. ~3•Q,Z Final Grade 3~S .y 5t Cover Z ~ ~ ~ , PIT DIMENSIONS ~No, Of Pits (Inside Dia. (Liquid Depth CHAMBER OR UNIT -~r Header/Ma ifold Distribution x Hole Size x Hole Spacing I 6~ h @ Pipe(s) Ij '~ t ~ ~ l // >~ ~.~--''- ~~ Dia Lengt Dia Spacing Length R(~II CnVFR ~re«..re c..~ro.,,~ n.,~.. ,.,. Mn~~nrl nr ~r.Grade Systems Only ~~ .7 U Ve to it Intake ` i Depth Over Depth Over xx Depth of xx Seeded/Sodded BedlTrench Center ~ ( Bed/Trench Edges Topsoil Yes No pa's, Yes '; No COMMENTS: (Include code d[screpencies, persons present, etc.) Inspection #1: /~ /3d ~ /6Z-- Inspection #2: / / Location: 973 Fraser Lane Hudson, WI 54016 (SE 1/4 NW 1/4 14 T29N R19W) Sweet Grass Farm Lot 9 Parcel No: 14.29.19.22710 1.) Alt BM Description = ST. ~~~-- ~~2v"~''~ G~tClis"clotks i:is,.~u,,,,-off %`'~'•'' /~""'`'~ ~"~G~uc~s.~+L.t' 2.) Bldg sewer length = 25 f TiEiK.~- ~ btiu,Qo(M...~ ~OQ,~.ta.24~ a~~ 2! ~ ~~d-u~L~a ~~wec~-Q - amount of cover = (~ - ~~ r~~ I ' J ~^ O~yn ~ -~ 7 /~Q~' i~p~~ ~ Coeur. _ --- ,_ __ __ _ _ __ - -c '~ I ~~-^-7-~ - Use other's de foruadditional in Yes ~' o i //~ ~ ~ ~ ~ _ _ _ _ ~ ° v _ 1 `formation. 1... ! _ __ ~I __ f!~G'L!~. - --1 - Date Insepctor's Signa ure Cert. No. SBD-6710 (R.3/97) xx Mulched ~, Sanitary Permit Application safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code See reverse side for instructions for completing this a lication 201 W. Washington Ave. PO Box 7302 isconsin pp Madison WI 53707-7302 Personal information you provide may be used for secondary purposes , Department of Commerce [Privacy Law, S. 15.04(1)(m)] ~ - (Submit completed form to county if not _~ ~ state owned.) Attach complete plan (to the county copy only) forth system, on paper not less han 8 -1/2 x 11 inches in size. Count State Sanitary Permit Number Check if revision previous aopl~tion State Plan I. D. Number . / ~ C e N I. Application Information -Please Print all Location: Property Owner Name Property Location ~,,,,,1 /f/ Cl~"' ~ ~ 1/4 /4, S/ 'f2 ,N, Ij/ (o Property Owner's Mailing Address ~ ~ u Lot Number Block Number ~- City, State Zip Code ZON~N~' 0 ~ e Numb r mber division Name or C SM Nu Sub L `` ~ / ~ ~ c II. Type of Buil ing: (check one) ^ CitY e' 1 or 2 Family Dwelling - No. of Bedrooms :~ bli ~ ^ P /C i l d i ? / ^ Village Town of ~ u c ommerc a ( escr ~ ~L ~.. /qJ be use):_ . /~ / ^ State-Owned /S/G//,~'pt~ ~ =. f ~ 7. /~j/ S~ ~ • ~f'• ~ t' ~ 7~ 6 at 2 ~' ~~i~a+Ij',~.e~' i~ N azest Roa e d L~ 7 G Lld~ ~ • .~ •/'~ N ~ t POD I T=X / (~)D -6~!J III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) A) 1. ~IVew 2. ^ Replacement 3. ^ Replacement of 4. 5. 6. ^ Addition to System System Tank Only Existing System B) Permit Number Date Issued QYA Sanitary Permit was previously issued fj ~ 2.t L N. Type of POWT System: (Check all that apply) ~n ' ~. fi-~¢p r ~r' i ~e~~- C+~!'~ ~ [l~'Non-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetland r /S~-/Z ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ~ 3/. D S>~/ ^ At-grade ^ Aerobic Treatment Unit ^ Recirculating ^ Other: a~~, ~ V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade f Required ,/ Proposed ~ Rate (Gals./day/sq. ft.) (Min./i Elevation VII. Tank Capacity in Total # of Manufacturer Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks ^ ^ ^ ^ ^ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the PO S shown on the attached plans. Plumber's Name (print) Plumber's Signature (no stamps . 1PRS No. Business Phone Number um is Address (Street, Ci ,State, Zip Co e) IX. County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Gro~r~lr ~Sr S D Issued umg ent Signature ps) Approved ^ Owner Given Initial Adverse D i ti t Surchazge Fee) .. uj L Ji7 dl !~ (Sf7 ~~ ~ a'~' erm na e on . Q. b X. Conditions of Approval /Reasons for Disapproval: ~ -~zra s.~,~Q~ ylo 1 SyS~e y,, r~ O>^rLn~L f .SCE ~~ ~->p-4~~G, ~~..d C~ ~rn ~L' ~'~' ~.y+ D ~ °J af'~lrC~cr1~. ~g r`!s. ~ro~Pih s .f-{~rn e /ed~ ~ ~.2. S ~ SIt,~~ta.7<" Sim louvers an ~!-~.r,, 6-ers- ~'-e ;h n-t2~l-S-~d.~Gr~,c~.~~n.c~ ~~~ . a h/e(.c~ ,C'~~c~i-~ IrS-~a-d'_P,ca~('~n-d 6'` ~.rs ~-~n ~.~- ~~<t'~~~~ G~oa~-sue s', <~. SBD-6398 (R. 07/00) v ~~ E~ " ~at°i~ ~0° o- o.~ ~~~ ~N~ ~~ ~k c ~ o ~ °o,~ N ~ V ~~ ~ r ~ ~,. ~~ ~` ~~~ 3 o. y ~ h 2 4 ~ ~ ~ °~ ~ ~ ~ ~ ~ s ~ ti o _ k o. ~ ~ , r t. ~ n ~ u .. i, ~: _1 W y~ ~ ~ ~ ~. ~ ~ ~ '` ~ ~ ~ ~l ~ ~ 1 ~ 4 / ~~~ ~` ~ aN ~k ~. f, `~ n~ ~ _ ~T i~•' ~~ ~- cd 1 ,~~~ l ~ ~~~ ~ '~, D h~ O_ A la ~~ ~; '/~ -~-Ary~ ~ I Q t 1 ~ a ~~ ~ ~ ~~ -~~` ~ v A I ~ ~ N 1 ~ J 1 A) A I N ,it A ~~ ~` ~~ ~ ~ v 0 _ ~ mac, I ~~ v ~ ~® ` ~~ y ~~ •~ ~~ ! N A ~~ ~ ~ ~ \~ ~ m ~ N~ i ~ ~ ~ ~ `w ~ ~ p ~ 3 ~ ;i w ~h o~ ~~ _ ~ ~~® ~~ ; ' ~ . ~ I . .. ~ O O (!Z `~ ~ . `~ ~ O ~ W ~ ~ ,~ ~A~ w •~ ~ ~ C '~ .a ii ~ II c~ II ~ -'~+. ~, y. -~ I . b .. ; ~ ~ ~ ~ ~ o ~ U~ e: .• CD ~ . ° •, ~. ,~ ~w, . ~ G . , . .. ... . •~ ~. + 0.. I a. ~. ~ ~ I ~, t I ~O y..I y~_: 4 a • W •p ~ ~, ~~ .a ,~,--••7.. ~b ' ` ~ ~ ~~ ' • . cu. . ~~ a ~. ;~.. .. ; ~ .. _ _. ~._~ ~ ,;~ ' ' ' b a f ~ -~ ~ '~ ~ P ~ n ~ ~ ~ ~ . , ly ~ ~ '• ~ ' N • ' a ~ °. t ~ ~~~ V P ~ ~ ~ i ~. :l ~: . ~ \\ / \~ ~~_~'~~ ~`_; 0 o ~ II A. ~ ~ ~ a c~ I it v ~ . .-~ ~ p h~ ~ ~~'C (~ ~ L ` .. ~ ~ ~ fit' ~ \ \ a• • , - ~ •~ ; ~,,, r ~ ,._- ~. :~ ~ "~ • ' c' ~ ' ` ~ ~J . M .. ceo ~ O .. ~. •II ~, ~ • n ~ ~ ~ ~ ~ ~ ~ • ~ ~ G ~ a ~• ~.. CD II ` ti ~ ~• ' O ~. r~ c/^o~ 4/ I~%1 o' ear 1~b V CD N N V O N ~ ~ A N ~~ SN~ ~ - ~ ~ C ~~N O~ ,p~~. ~ c00~ 3 Y Q ('~ O t~D n ~• -~ ~. ^~^,, 1~ ry~- o ~ • C'~ ~~ ~~ a 0 CD r- p C.1 Y / 3 T ~_- . ~ ~ ~ SOIL EVALUATION REPOR ~ Oirisian dSaiehl and auildires in aooordenoe wih Comm 85. wls. Adm. Cade .` ~- A1~acn aomplate site pion an pepm not less Uren 81R x 11 incAas in sms. Pyan must ;ndude, apt not llmeaa n: gal and ha - ~ ,,~„~ ~ `s'` ._ 3 G pen~~tsbpe,sce~leorec.~ ant De®B ~ ~ ~2 a trocalion - _ ~ N R E /~~O„l ST. CROIX COUNTY Ld s'~ ~K ~ S t T'Z p~ppe~~/Owtter's ~~/ldd~sss tltotk ~ 9iid. Name or tSt~ ..-- ~/ .S Stele Cade Phone Number ^ Clly ^ V~aBe Town Nearest Road ~ _~ L code domed design tiorr rats c~D Nawcatshucf"ion tlse:~~Nunberaf6ediooms L7 ReAmoerrrerr ^ Punic a aommeidet - oeaabe: ~ ~ Parent mabrial LLo Flood Plain elenrefon if appica6le . ma~rtmeadetiorrx ~°~GL ~C"~-s~jlc~i~ 93 O~c~ 2~ ~' ~- ~ l-~'-- ~s ~i~J ~- ~e.mP ~~~.~. ~LEV ~ ~" - sue- ~2 ~~ g~ ~ ~~..5 " / ~re~ 0 e«•~ ~.~eela~-.~[,._tt ~b~~~ ~ i ~ i~ell~n Imra Pit ^ ~ Roaes Redox Terdise Slrudtiae t~orrsisierM~e Barndery Hodmn Oepm Daninent '~1 'Et~2 ~ ~Aunsd tiu. Sz. Cont. Color Or. Sz Sh. - ~~ •- Z '~' _ ~ ..~ - 2 3 s_ 3 ~ ., ,, c( r ---~ 2. ~- s;de vr~ o,~ ~ ~ ~,~~ k~j /. Z _ ,a-~ .S~triit~~-d ~ ~/~~o •~ sicl.~ /ovvers , a ~ ~ 4aurrrlsurfacealsv.~~- +~~~_-_~-"~ Floliaon Depth Oarrriierd Redarc Nesaip`an Texture SUu~e Dorrsistetroe - Roots f3PQIR ~, tuM~ t1u. Sz. cant Caior (~Y Sz ~. '~1 'E~12 A- L "'_ L •` ~ G O- ^"'_ L ~/ ~ . t/ fi 2 :~ > < andTSS>3~_<150mg11. `Eliuant~2=BOD <30mglt.erd75S-`~~' Etiuerrt *1 ~ _ ~ ~- CST Nuntier Oats Evek~aion Ca~dudad Telaplaae Number A~ddmss _ _ . Spooner. iNl 5401 ~ / ~.Z /- !~'-~3~ ' ~6~ ~ Proae~ir owner ~~E/O~ a',9~T Paraei io # .2D -",C-37/ T ~ ~ ~e ~ R --~ ~ ~* ~ (~ ~ c~o~nd surface ale+-. 9d? o a oe~ +o ~ ~ *~ s~ t~s Horimn ~ Dominard Radooc oasextption Textrane strew~ae Cora~noe eou~dary Roots t n cam. sz caont. tolor c~ sz sh. ~ 'ice '~ ~ _~ D ... ~ ._-. ,w E ~ 3- r. p- ..-~--- ~ G ~-Y c < < ~ • q2 ~= <~ ~~ ^ ~ ~ c~a.d s~.~faoa eler-. ~. ~ ~ r•~e ~ ~ sail Ra Haixon [leplh Does Redaoc oa~on Texbue stuaure Cansi~enoe Baa'idarY Roots GPDVIE in. far. sz, cant Color Q: Sz sn. "mil Horizon ~i Oo~rMtwrd Redwc Des<aipiion Teocture Stnic4ure tenoe 9ounde~y Boats (3PalE &~. trtunsal Du. Sz Cant Cdor Gr. Sz. Sh. 'Elttfl 'Et~R2 ~'i ~ ~ C~ound sur~aa eta,-. tz t to tttrr~ng fa$+ar ~. Pit y,~ Rate " Etfiuent #1= 80Di > 30 c ~ mg/t, and T8S >30 » 150 fi9n- ' Effluent #Z = 60D~ <_ 30 mgll. aid TSS <_ 30 mgll. The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608$t16t3131 br~f$'Y 60&264-8T77. _ , ., sew3mlR.dw~ 1~it.~'~- L.v. Z i. I J ~ _ o ~` i~' N 1 1 ~a I J4 / b ~ ~~~ • K M 1 ~ ~ ~ v g ~ ~w ~ ~ ~ ~ r ~ ~a ~. h ~ ti ~ ~ ~ _. ~`- ~ ~ ~ O ,'~ VO N ~ ~ A N ~~ ~Y~ wax ~ ~ m p'~ _ •0~1pN ~~ 00 ~ s ~a L . , Sanitary Permit Application Safety & Buildings Division M ~~ ~ ®~ In accord with Comm 83.21, Wis. Adm. Code See reverse side for instructions for completing this application 201 W. Washington Ave. PO Box 7302 SCOB~S~n Madison, WI 53707-7302 Department of Commerce Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x I 1 inches in size. County State Sani P 'Number D Check if revision to previous application State Plan I. D. Number I. App ication Information -Please Print all Information Location: Property Owner Name - RECEIVED Property Location . ' A,f/ ~ ,N, I/a~~(/a, s Property Owner's Mailing Address Lot Number Block umber MAR 1 9 2002 Ct fate Zip Code Phone Number CROIX COUNTY Subdivision Name or CSM Number d ~ GcLt T. ~ ( I. Type of Building: (check one) as ~" .u,~ eMs, ~I 1 or 2 Family Dwelling - No. of Bedrooms :~ / ^ city p ^ Village ~~; Z.q. l I. ZZ~ ` /~ z ~~ I~Town of / ^ Public/Commercial (describe use):_ ^ State-Owned O,~(/ ~0 ' ~ ~•' ` ~ ~d ~~~, ~Ls Nearest Road ~r ~- ~7. .~ ~ .2,) _ . 3 , ~ t azcel ~ x um r(s) DD III, Type of Permit: (Check only one box on line A. Check box on line B if applicable) / / 'J A) 1. New 2. ^ Replacement 3. ^ Replacement of 4. 5. 6. ^ Addition to System System Tank Only Existing System B) Permit Number Date Issued ^ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) .. Non-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Single Pass , ^ Drip Line ^ At-grade ^ Aerobic Treatment Unit ^ Recirculating ^ Other: V. DispersaUTreatment Area Information: ' 1. Design Flow (gpd) 2. Dispers Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required ~~ Proposed Rate (Gals./day/ q. ft. (Min./inch) Elevation .~ . ,~ ~ . cS ~ VII. Tank Capacity in Total # of Manu cturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks ^ ^ ^ ^ ~/ '~ d ^ ^ ^ ^ ^ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the P TS shown on the attached plans. Plumber's Name (print) Plumber's Signature n slam ivll~Iv1PRS No. Business Phone Number w Z.Z ~ ~~ m is A dress Street, City, State, ip Coe ~-~-_ -. -_ _ _ , Cwt G~~- y°~ ~~o ~' ~ o ~ i IX. County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issui Agent Signature o sta,ups) Approved ^ Owner Given Initial Adverse Det rmi tio Surchar Fee' ~ ~ e na n LlA ~ Q ~ itil ons off" Ap r vailv/l~sons fox Djsapproval; ,~ - ~ S~~ ~, _ !1!I ~"'~ I ~ ~ ~ . D ~~ ~~ v` S ~~I +c0~0 t er ~S~l`4o~Ip,~Sr~P~sJ~(~, ~XX~ v~ i S~-'~ c. (R. 07/00) r 7 ~ \ r Ems" -~ I N ~ ~ ~ ~ f~ •~ ~~ 00#A w~ ~~~ I u'~~'re o~N,o3 / ~ lD Q. ~OZ1 ~ O r-+ jy OQ b • ,~ a o"' ~ N 10p R1 1'~ W ~~ 1 ~. ~ o F ~~ • ~ s ~ ~ ~ ~ ~ \~ ~ ~, h ~ ~ ^ o ~ a ~ ~. Z ~ ~ -~ J ~ _ ~ N ^~ N ~O VO ~ •~ ~~ pp~A W~ ~~~' `n~~'rc ~~, o0 ~o~ ~ ~a ~ F^ flOL" 7 i i II 1 ~~ b N d a~ ~ ~ k I l_ . ~N ,a ~w n . ~ "° ,~ ~~ o. ~ o ~~ ,, 1- ,, „ ~ ~ \~ ~ ~ y b ° ~ w -~ ~ ,~ o I I~ ~.~--o ,, v O -~ r ~ ,~~ 11= w 0 ~~ ~~ r v~ 1 o= tMsconstn~vepartment of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Bureau of Ir`.egrated Services ~ in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1!2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and 5~- percent slope, scale or dimensions, north arrow, and locat~n and d'-s ce to nearest road. Parcel LD. # ~ < ~ ;", e''. o APPLICANT INFORMATION -Please tint all info~gatiori' ' - ,''~ Reviewed by Persona{ information you provide may be used for sec dary~iurpose~(~(Ii s 15.04-(1j~(m)). ~ Page l of ~~ ~ ~.. Property Owner Pr Location ` ~ ~ ~"~ ~` ~ ~' ~~~ Ggvt,~ of c, ~ 1/4~jGr! 1/4,S f L~ TZ R ,N,R J4 E (or~ Property Owner's Mailing Address :'s' `; lot# ~ Block# Subd. Name or CSM# ,~~. i 35 3 ~uY>;t't, k-e e ~Y ¢ ~ > r ~ ~- ,.SS City State Zip Code ",Phone Number F City ^ Village [~ Town Nearest Road ~-~tlct~r'Zr~ I t~~t l~`it)ll~ i(~i~ >~`-t9-t~~~~_:.~ Nvc~son _ a Pr New Construction Use: Residential / Number of bedrooms 3~4 Addition to existing building ^ Replacement ^ Public or commercial -Describe: Code derived daily flow ~~ gpd Recommended design Loading rate ' ? bed, gpd/ft2 g trench, gpdJft2 Absorption area required v~_bed, ft2 7~d trench, ft2 Maximum design loading rate ~ ~ bed, gpd/ft' ` ~ trench, gpd/ft2 Recommended infiltration surface elevation(s) ~4 ' ~ ~ ft (as referred to site plan benchmark) Additional design/site considerations /¢G { ' ~ S ~ ~ Parent material ~U~t.~-~- s ~ Flood plain elevation, if applicabl ~ ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system `~ S ^ U '®S ^ U ^ S ^ U [~S ^ U ^ Snn ~ U ^ S ~ U SOIL DESCRIPTION REPORT AL.. ~l"~o, ' ~~t t~ 20>~fl Boring # Ground elev. 1C).t5 ft. Depth to limiting factor I l ~ in. Boring # Ground elev. lop. i~_ft. Depth to limiting factor It Cv ~r~_ Remarks: ;ST Name (Please Print) Signa ~ Telephone No. e~' ~~ ~ ~7 I 2~ 7 -`{~ 00 4ddress Date CST Number 21I ~~"- --~. ~oi~2r- ( ~yo2s' _~_ao ZS 3og Horizon Depth Dominant Color Mottles Structure d B R t GPD/tt2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence oun ary oo s Bed ,Trench 1 0-~ ~ Z -- S.~ t wu~b~ ~,G; ~s 1 v~ ~ ~ .3 z ~~-y to ~ _ ~,r z ~, ~s - s ~ . ~ ~-;-- ~~~~~~/ ' s5 • °t (• g Remarks: PROPERTY OWNER 5~' cl PARCEL I.D.# Boring # 3 ~' Ground elev. `1~• 7S ft. Depth to limiting factor 1LLin. Boring # ~~ Ground elev. leo.ystt, Depth to limiting factor ~, i Boring # S Ground elev. cj9 9~ft. Depth to limiting factor Boring # Ground elev. ft. Depth to limiting factor ~ ~ l SOIL DESCRIPTION REPORT Page • ` of .~ , Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Ro ts 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry o Bed ,Trench 6-pct,. l0 3 Z S ~' ~ F i ~. F .Z ~3 ~ .,„ fa ~. ti r 6 - s os ~ - .~- ' .~S r}- , Remarks: z.. ~.-3~ o I y - \ cs - ~ '. 6 3 3~-l~~t y 1 6 `~ c~ - ~ ~ . • Y ~s. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench 1 aez to 31 z 5.~ o'`^-Ab ~ vim? LS ~ i .2 ~ .~ Z r2-~z.- o `11 '~ - I a~.ab C-S - . S ' .6 3 y2- u ~ '11 6 .~. ~5 o w~~ C_5 . ~' ' • ~ Remarks: ~n' Remarks: SBD-8330 (R.9/98) ,... . ~ • ,. PAGE J OF~ NAME S ~'C3 C~--}- LOT# ~ LEGAL DESCRIPTION S E '/aUW /4,S I ~l T Z~(,N,R I R E (or~ SCALE: I"= ~~U BM I ELEVATION ~UC> • O BM I DESCRIPTIONI'oPo~' I~'jvc c `~~/~FI-~ BM 2 ELEVATION ~ ~• S~ BM 2 DESCRIPTION fvp o~ 1 ~Z'Uvc. P; p~ Is++h~r=lay SYSTEM ELEVATION ~ ~ • ~ S ALTERNATE ELEVATION `I S, ('D S CONTOUR ELEVATION /U~(A- ..~., -- x ~~ ~~ 5` ~~ ~~ ~~ z ~. ~~ 3M ~ ~ 62 ,~~~ • ~5 ~ ~,3 ~ ~ ~,,~ ~~ Z~,J - ~~ _ ~ ~~ ~_f - DATE ~~ - y ' ~ Fogerty Plumbing #221180 28288 McKenzie Rd. Spooner, WI 54801 (715) 635-9609 Cross Section of an Inground Component Cell Using Leaching Chambers Finished Grade = .,s! ~~ .~.___ Observation/Vent Pipes ---Finished Grade = f~ Slope % _ _~ __ / - ___- /~ ~ Original Grade = ~G~:d ~' '' ~~ ~J --.___.__~_.-____ ~ y~ Top of Shell = ~T ~ yam' `~ ,~ " ~, --°-C! S stem Ele =gf y Original Grade = ~. y v. - ~:, ~_~_ n n ~a ~° Treatment and Dispersal Zone t~. / ~' ~- u (-~---~~ -.- _.~~_._-~. Limitin F - g actor Observation/Ventpfpes to be constructed and capped with approved materials for the particular use. ~~~ e 5 t Q .'"f. ,~~ a c~ a ~\~/ \ ~\ ~~K/ ~ ~._- , ., ,y `_- b o ~. II a . ~ ~~ a c~ ~~ b I~ ~ ~~ ~ . -r ^ ~. l J ~ ~' ~ ~~ ~ i~ •. ~ t ~ • ~ ~ \ i r ~ ~~ ; ~!, ~. y ~ • ~ -° ,` O "rJ' II ~, A~ N O ~ -, ;j ~ ~ , . `"1 ~ c n • '"t ('D ~ u u ,a ~.. .. ~, d CA `C O ~ ~ co n ~' ~ 0 ~.. ,~ II ~ ~, .. 4~ ~. ... { a :.. ,.. .~v . 1 0 ., O. CD e . •.. ~ ~. .., . c~ ~ r , y. ~ ,. ..,,yam; Q , . ~.. ''' ~ .~~ ~. I t{ ~ i, ti V ~ ~ ~ °W' ~, v~ - `-- .p . ~..~~ ~, .. ~ "V ~ ;.. a. \e CD !~ . • ,. G. _ _ :.~ .. ~. ~: ..~ . ,. ~ ~ ~' a ' q.... _ :. ~ '• '-' . . ~, ~ ; ~ fD r CD'`~ CQ. ~ j ~ C ,~ .. -+. ~ o ~ ~ '~ •- .~ .. r ~ ' p~ i :~•: ''~ i• ~. co a a IG 1 o~ CD b CD O CD n ~~+ UQ • ~' r ~ ~- o ;~ //~~~• n Vrf ^^ F~- l l1 ~ a 0 ,~pN A ~ v, ~ ~ # v~D ~N~ ~ 'd W~ X ~~c~ ~G cti cn ~ o ~ .a `D ~ ~o o ~ ~ 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 fepartment, 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 0 Number of Bedrooms Design Flow -Peak (gpd) Estimated Flow -Average (gpd) ov Septic Tank Capacity (gal) ~. Soil Absorption Component Size (ft2) SdO Type of Wastewater Do stic ~ Table 2: Soil Absorption Comppnent -Limits of Reliable Operation Septic Tank Component Soil•Absorption Component Design Flow =Peak (gpd) `Z.CoA 3 . - ~ Maximum Influent Particle Size (in) 1/8 Maximum GODS (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 septic and outlet filter shall be assessed at least once every 3 years by inspection. T ou et filte shall be cleaned as necessary to ensure pro er o eration. The filter cartridge be removed unless provisions are made to r tain solids in the tank that may slough off the filter when removed from its enclosure. If the i~ ` ~ ~ ~ - 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 113 the liquid volume of the tank. If the contents of the tanlr 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 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 Absorp~ion'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 thi's 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. 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. Mound System Management Plan Se tic Talk The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents o t e septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least onr_e every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridrle 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 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 sludge and scum in the tank exceeds 1/3 the litauid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personhel 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. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pumo Tank ~ The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mglL 8005, 150 mg/L TSS, and 30 mg/l FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 mo~iths. When a pressure test is performed it sFtould~tid' compared to the initial test wt~n the system was installed to determine if orifice clogging has•occurred and if orifice 'cleaning is required to maintain equal distribution within the dispersal cell. ~ ' Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall a e SI3D 10572-P (R f 6109)j and to art or state4rules pertaining to systemalmaintetnance land mairitenanceh its component mane [ repoRing. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shalt be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump 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 en-ry into a tank or component. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep t e system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shalt;be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wassen aba al a ea f toe leakage occurs ortby remov9ng biolog catty clogged adso Ipt'on or replaced in its' present location by increa g and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. ' '~ Questions on the operation or maintenance of this system should be directed to your county zoning or health inspector. L ~ i. Fogerty Plumbing ~~ ~.. ,. ~,,,. #221180 ~' ~_ 28288 McKenzie Rd. Maintenance Spooner, WI 54801 (715) 635-9609 ~ , ~• The interval for servicing septic tanks is s Nal shou d be, b t most reguhatory agenc es sulggest two to five years. wide difference of opinion on what this ante The Zabel'" filter, which does not i ncre usn ed f Howeve~, our filter) sv irtually self-cleaningb The continued action septic tank is normally inspected a d p p of the anaerobic organisms on tSmartbeleflt ala m you w 9be not field by ani alarm when the filte~needs setic g. the tank. If your filter contains a To service the filter: 'Servicing any zabel filter should only be done by a certified septic tank pumper or installer. Locate the outlet of the septic tank. 0 Remove the tank cover and pump the tank if necessary to prevent any solids from escaping to the field when the filter is removed: ~; While holding the cartridge over the access opening rinse off the cartridge with fresh water, being careful to rtnse all septage material 'Note: It is not nece. 'spotless'. The biom, aides in the pretreatn be left on the fitter. (11 maybe disa: ~~~ Insert the filter cartridge back in the case making sure the tilter.cartridge is properly aligned,.and completely ir}se~t .ii7'- J e Replace N WDE IN U The product(s) shown are covered by one or more of the /ollowing patents: U.S. 5,762,793, 5,580,453, 5,591,331, 5,759.393, 5,683.577, 5,582,716, 5,779,89fj, 5,593,584,5,795,472,5,736,035, 4,710,295, 5,382,357, 5,482,621 U.S. Des. 386,241, 349067, 4605501,5098568, Des. 309007, Australia: 134440; Canada: 2,135,937; Israel: 111574; New Zealandr264824; . 7 ~ Other Patents Pending Call for a free ZABEL ZONE An Onsite Wastewater Magazine 1-800-221-5742 • Website httpJlwww~abel~. bo' ;. -~~ Firmly pull the fitter handle and slide the cartridge out of the case. 'Note: A fee handle may have to be used it the litter is too tai. below ground )eve! to reach. Contaot'Zabel (or into on tee, handles ` ~''~. /~ ~, i INSTALLF.,R'S NOTES: RECYCLE GREASE! Do not pour grease down the drain. Your septic tank and filter will not handle it. NO BLEACHES! Do not introduce bleaches into your system. The bacteria in your septic tank is what makes your system work. Bleach kills the bacteria. When that happens, your septic tank will no longer function correctly. This will cause premature failure of your system. WATER SOFTENER! Do not run the brine solution into your septic tank. This solution "' has a high concentration of lime (that's what makes your water hard). The lime tends not to settle out in the septic tank but goes directly to the drain field. Lime is an excellent sealing agent, and yes, it does the same thing in your drain field. Think of your sewer system as you would your car. Treat the attached information as you wAUld your car manual. Remember, also, that your car requires regular maintenance. 'hare must be exercised as to what you put into it. And like your car, your system eventually will wear out. The question is -how quickly. If you have any questions, please call: Dave Fogerty - 715-749-3656 -Roberts 715-635-9609 -Spooner If you have an emergency, and you only get voice mail at these two numbers, call Keith Knutson at 715-796-5436 -Hammond I have read the attached information regarding the construction and maintenance of my sewer system. Owner's Name Date ST CROIX COUNTY SEPTIC TANK MAIIVTENANCE AGREEMBNT AND OWNERSHIP CERTIFICATION FORM OwnerfB~yer ~~` ~~/,Gt/ ~~ Mailing Address property Address `7 /J 7 /l,G.b..~h. Cam- ~~~/UlG (Verification required from Planning Department for new City/State ~iDs~-~ ~~ ~YD/l0 Parcel Identification Number ®.ZO --- ~ 3 7 G - e 9 - vOd LEGAL DESCRIPTION property Location ~ `/4, ~ `/a, Sec. '~ TAN-Rf~_W, Town of /~~f/~SO~ Subdivision ~-~.~ s ~/~~SS .Lot # ~_.. Certified Survey Map # ~--~ ,Volume ---~ .Page # Warranty Deed # 6 ~7 333 ,Volume ~J~`~_• Page # / } ~ Spec house ^ yes ~ no Lot lines identifiable ~ yes ^ no STEM 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 masterplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards sot 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~of the three year e~,piration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (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 the property descn'bed above, by virtue of a warranty deed recorded in Register of Deeds Office. ! .. ~7 / / SI ATURE OF 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 decd ., Y~(.1724-AGE 198 ' STATE BAR OF WISCONSiN FORM 2 - 1998 WARRANTY DEED Document Number ' This Deed, made between _ RT!`HAR1] O STOfi'~anrt ,Jprl$`1' P RT(1fIT~__ _.hllShand and wi few _ __ __ __ Grantor, and KERNON ,T_ SPF.F.R_SAGT_ ___ h s n wi e,_ __ __ ,Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate to St CT'OiX County, State of Wtsconsln: Lots 8,~ 10 and 11, Plat of Sweet Grass Farm, Town of Hudson, St. Croix County, Wisconsin. 6S?333 2; i~;_~M N. WFILSH R"r'C,'i5TEk QF DEEDS RECEIVED FOR RECBRD :is~~~flhiY ••reEP. - - +} CG"r'! :~Et: in6NSFCi~fEE: E27.30 ~:QF<Di~l6 EE: 11.00 r h1:~~: i Name andrrReturn Address ~t ~- C ,~ ~: 020-1376-08-000 020-1376-09-000 ~~~i~3~~'~r ~~~0 This i c not hotnestcad property (is) (is not) Exceptions to warranties: easements, restrictions, rights-of-way and covenants of record. Dated~th~is~ Q(21 st ccday of September 2001 ~Q ~J-~ ~VKA~ttJ~ ~• c~ (SEAL) /_-_~G""t-° r"" _.... (SEAL) _R; r-h~rA O. Stout Janet P Stout __ (SEAL) AUTHENTICATION Signature(s) authenticated this day of TITLE: MEMBER STATE BAR OF WISCONSIN (~~ ~w CF (If rwt, ~~ • ~.. au[hortzed by §706.06, Wis. StatsJ ¢ •• v nP.~ J THIS INSTRUMENT WAS DRAFTED BY ~ vnGE~ Janet P. Stout =*,iu'~ , Hudson, WI 54016 _ {SEAL) ACKNOWLEDGMENT State of Wisconsin. ss. St. Croix County. Personally came before me this 21St day of _ Septamhar ,2~-, the above named Rir~h~rd O Stout and .Tanpt P_.._ _ _ to me known to be [he person S who executed the foregoing e and ackn~ the same. - ~7 ~ ©~L4. E_.._ _.. _ Notary Public, State of Wisconsin My commission i permanent. (It not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not "' 3 ~_.. .. ~-F•) necessary) Names of persons signing In any capacity must be typed tx primed below their slgnamre_ STATE BAR OF WISCONSIN WISCOn51n Legal Blank Co.. Inc. WARRANTY DEED FORM No. 2 - 1998 Miiwaukae, wis. /- NORTH UNE OF THE S1/2 OF THE NW1/4 SECTION 14 ~ - N89°x4'61 "E 2! ~ N89~'48'80'E 821.1ar M~ ad 4oe_1o --- f ~ 3a' R~wlus rn~tcAL ~ i I H.W.L =828.7 ~ .1. $ I :.................. LOT 8...... ~ ........ . i 2.23 ACRES ~ a I 97088 eo I=r ± • $ - ~ - • - MIN BUILDING N89'48'80'E 871.20' 488.08' ELEV. =830.0 438.80' 33' 133' I LOT 9 $ I A I 2.04 ACRES III ~ I MIN BUILDING ELEY. =830.0 88888 SO FT I a! ~~ I . 25' ~ 436.84' {~ ~ ~ . ~ ~ ~ LOT 10 I 2.08 AL:REB I 60687 eo FT Im ' • . ~ I • ~ ~ - ~ • ,6 C, / ~ • LOT 11 ~ • ~ 97441 8ta FT a""~ „ ~ . / ~ .' .~ • • • LOT 12 ~ ~`~a • ~-•-•- ,~f / . • 12200a~8 80 FT ee~~'' / LOT 6 2.04 ACRES saw so ~{ $ MIN BUILDING ELEV. = 818.0 N89.48'80'E 871.20' MiN BttILDiNG ELIN. = 918.0 ~ LOT 5 $ ' ~ , i J R A N89'48'60'E 871.89' ~ ~ LOT 4 ~ 2.08 ACRE 90088 8Q F Nd0"48'80'E _ 956.90' LOT 3 2.08 ACRES 90848 8Q iT