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HomeMy WebLinkAbout020-1376-19-000W;sconsin Dz{~artment of commerce PRIVATE SEWAGE S'Y`SYEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT} Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. rmit Holder's Name: City Village X Township )berie, Chad Hudson Tbwnshi .T BM Elev: Insp. BM Elev: BM Description: ~ d l1NK INFORMATION ELEVATION DATA STATION BS HI FS ELEV. Benchmark ~ ~~ ~D~/ lOa Alt. BM Bldg. Sewer ?•~ r a G.o r SUHt Inlet !O.3 p t t• ~ 1 7 St/Ht Outiet Dt Inlet '~ Dt Bottom ~~ ~ ~ Header/Man. ~ ~ ~ Dist. Pipe Bot. System ~ ~• Gt 3 , Final Grade g ~(o •~ St Cover ,~ /O O. / To '~ ~! t',',Ss' Qg' TYPE MANUFACTURER CAPACITY Septic ~" t`i? ,~-~ '4 ~®Ob / L$O Dosing O'++^~~ O ~~~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ^J /~ / 30 ~ ~ ~~ Dosing N ;v r 3 ~ ~ Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand G ~ y GP~ Model Number ~N.=- ~~ TDH Lift Friction Lo$~~,' System Head TDH Ft 563 .~ ~ r~'"~ •~'~ ~. Forcemain Length Dia. Dist. to Well I ~a L" SOIL ABSORPTION SYSTEM BEDITRENCH Width ~ Length No. Of renches DIMENSIONS 3 Q'3•~s 2..~ SETBACK SYSTEM TO P/L LDG INFORMATION T e Of System: ~ DISTRIBUTION SYSTEM 1 PIT DIMENSIONS No. Of Pits ~"'" io L,o Header/Manifold I~ 'f Distribution Pipe(s} ~ it x Hole Size x Hole Spacing Vent to Air Intake rL Q Length ~+ Dia T (p a Length -`3`~Dia 3 ~ Spacing _ cnu rnvGQ .. o____....,, c.,~...».~ n..~., .... Mnnn~l (]r A}~~AfIP SVSiEn7S UflIV Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center Bedlfrench Edges Topsoil Yes No ^ Yes No ^ ~i 4 COMMENTS: (Include code discrepencies, persons present, etc.) Inspeciion #1: r r / r ~ /~_ Inspection #2: / / Location: 919 Fraser Lane Hudson, WI 54016 (SE 1l4 SW 1/4 14 T29N R19W) Sweet Grass Farm Lo Parcel No: 14.29.19.2280 1.) Alt BM Description = I ~ ~\ ~T t! ~~ 2.) Bldg sewer length = 30 S,GG ` - amount of cover = ~,~ ~ ~,~,~~ ~ D~ s~v ~ ~~ f s: ati.c, I~ ~ I',>~~G,t i~ ~ GGurcw,,G~c /' ~ ,~ ~'y -~ Pldfi revision Regwred? Yes L~ No i -=7 ,_ Use other side for additional information. Date Insepctor' ign ure • N SBD-6710 (R.3/97) ~~. XJ h ~~ ~~ tip} 00 ~o to p ~- i /~ vY.- ~~ . ~~ -~r-r°c_oI ~b-`7rS~ 01 aft Buildings Division Av t hi W W • ~ on e. ng as . 201 Sanitary Permit Application PO Box 7302 `~ ~~ 'OII~ eII ~ In accord with Comm 83.21, Wis. Adm. Code Madison, WI 53707-7302 r ,, J Department otieommerce Personal information you provide may be used for secondary purposes (Submit completed form to county if not [Privacy Law, s. 15.04(1)(m)] state owned. Attach com lete Tans (to the count co onl) for the s stem, on a er not less than 8-1/2 x 11 inches in size. County State S it r Permit Number ^ Check if revision to previous application State PIan~L~ Nurr~ber ~ I. A lication Information -Please Print all Information Location: Property Owner Name ~ ~ at io n Property Lo c ~"~ ~ fi^._ + { ~ ~ ) T~1/4/ "lei/4, S T ,N, ~ or W ' Property Owner's Mailing Address ry E~Efd ~~~- - Lot Number Block umber /_ / /~ ~ I ~~FJb~r " ~' LtrC '---. . ~ City, State ( Zip Code ,r '~ N'Qm r ~- , _ i Subdiv'sion Name or CSM Number ~ ID ~0 ~ 1 ~ ~® ~, ~~ Type of Building: (check one) ~ ZONtNt30FFtC~ ,:`.;' , \, ; m f B d : lli N ~ 1 2 F il D ^ City ^ Vil g ~ ~ e roo s we ng - o. o . or am y y ~ of ~° ^ Public/Commercial (describe use): / ~~~ ^ State-owned ~ J l -' III Type of Pern-it: (Check only one box on line A. Check box on line B if applicable) Nearest Road Z ~ C ~~ A) 1. ~1Vew System 2. ^ Replacement 3. ^ Replacement of 4.. ^ Addition to Parcel Tax Number(s) ` r~ z, ~ ~ - - ( '~° ~~ S stem TankOnl Existin S stem ' ] j B) Permit Number Date Issued ^ A Sanitar Permit was reviousl issued IV. Type of POWT. System: (Check all that apply)-)E. f1r`'/~ Non-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At-grade / ~ Aero i Treatment Unit ^ Recirculating ^ Other: a3•~S s V Dis ersal/Treatment Area Information: t . Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Propose~ Rate (Gals./d /sq. ft.) (Min/inch) --~ ~ ~ El vat n ~~ ~! ~ ~ / 2 ~ VI Tank pacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanl<s Con- Con- glass New Existing Z ~~L ~-~ Crete structed Tanks Tanks /~ S'T ~~ ~ /~ WC~S~1L ~ ^ ^ ^ ^ $V v C/8~~f~ ~ ^ ^ ^ ^ VII Responsibility Statement I, the undersi ned, assume res onsibilit for installation of the POWTS shown on the attached lans. Pl bet's Name (print) N~-c,,g~ ~1 Plumb 's Signatur stamps): MP/NEF}~"s No. 2z .~ ~- Business Phone Number 2'73- 4~5~~d 'lumber's Address (Street, City, State, Zip Cod VIII County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued [ssui Agent Signa re o stamps) Approved ^ Owner Given Initial Adverse Surchar a Fee) QD ZZS !~ (t$" w ~ Determination ~ IX. Coi dition~of Approvae~~easo-~ ~ for Disapproval: , ~~~ ~ ~ L • ~ J~~ ~"t ~ c 1^ s -~ ` ~~~ • { ,~ ~, ~~ R v Y C~ ~~ L~ ~ ~~ ~~ '~ ~ 3 ~~ ~ ~~ ~~~ 8'~ Pc 4 lZ~ofc l~oti(,f ~ ~~~~ /`l~ ~~ Zz~,~ ~ SOII EVALUATION REPORT ~ / ~-~- W~nset Department of Cotrtmerce ~' Division of Safety and Bui1d'mgs in accordance with Comm 85, VWs. Adrn. Code co<,nhr 5-~-. C ro Attach complete sibs plan on gaper not less than S 1/2 x 11 inches in s¢e. Plan-must include. but not IvrriM1ed to: v~erttcal arxi hortzortal ret~rtce potrtt (~1, direction and parcel I.D. percent slope, scab ~ dimensions. north arrow. and location and distance to nearest road. ~ Date / Please prirtf aU irrforn-ation. _ !~/OS•/d 1 Porsonai information You Prrmde maY De used f~ seoondaslr PmPmi'm: (eft Larr, s.1b.04 (1) (m)). Property Owner Property Location ~~ F' 1/4,$W 114 S f y T Z °I N R ~ R E (or~N RlchGr~I sfou+ 5 - Prope~tyOwner's MaitingAddress Lot # Slodc # Sulxl. Nen+e ~ CSt~ 1353 ~ ke Tr . 19 S e-I• Crass State Z~ Code Pirate Number ^ City ^ 1~Ilage ©Town Rarest Road ~, Fra cr La..ro. ud on 1 SyOI (~ ~y ~ d Code derived design flow /ate '/Sd /( ~ ~ GPD tvew Construction tie: Q Rceidential / Ntunber of bedrooms 3- y ^ Repfaoement ^ Pubfic or corrirtrercial - Descr~e: ft. ~~4~.~ ~ Flood Plain elevation if appficabfe .(i ~~- PareMmaterial R ~ -~_ ~ General corrirr>errts Sys-l-c.w~. e 1 t y q 3• ~/O ' `\ ~ ;- acrd recommendations: y~.G.,l. tlttl. q 3• yo goring # ^ ^ t3ortng ~ ® Pit Groundsurfaceele+v. ~ ~ . ~L~_ ,, ~ 9 ~P"~ factor /?$ in. Sod • Rat Horzon Depth Dominant Co Redox D~iptiat Texttme Struc~tais Consistence Boundary Roots GPD/fl? 'EtT#1 'Eff#2 in. Mansell Qu. Sz Can. Color Gr. Sz. Sh. y • 5 I .$ 1 0-~ IU 3 3 -' S i J 2rr,abk t c.5 v $ 2 l - $ to ~+ `- 5. I c s ~ • 5 - • 3 ip y/mil C2 ~•5 ~ LS Im my~ ~ S 1 • /•2 p g m ~ -- I.2 l I ~ ~/ (~o ~ i i ~ a Boring# [] goring M Q Pit Ground surface elev. '7'7 • ~ ~ it- Dept ~~ factor, / 3(o in. Soil Rate Horizon Depth Dominarn Cobr Redox Desrx~ion Texture Structttte Consistence Boundary Rcets GPDIfEv 'Eff#9 'Etf#2 in. Mansell Qu. Sz Cart Ctnar Gr. Sz Sh. - f ~ • 5 '~' 1 t a -1 ~ l0 3 ~ SiJ 2msbK r ~5 m v 5 3 3l0 - y8 1U r `~/ 3 -. 5 ~ Zmsb k ~~ c ~,. _ . 5 .9 y yB-~7 /0 ~ r 5h CZP 7.5 ~f ~ S,`c/ 2rnrabk m ~-" ~- . `! ~ - ~ l~7-lab 10 y ~ - 'r'S ~ 5 rn I / . 2 1 .8 06 - ' Effluent #'1 =SOD > 30 < 220 ~- and TSS >30 <_ 150 m9n- ' C-ifluent #2 =GODS < 30 rrgJL and TSS _' 30 mglL CSl. Name ( ~~ Si nature ~ ~ Nlumber t7abe Evaluation Cartd<trted Telephone Number ~~ 2(1~~ ~~ ~f ~rrr~er tiT u ~~ ~~2~ s- ~ -ai ~l~~z~l7-4~ .. +. ~, 2 ~ 3 ~~, ~. ~~U U `~' Parcd ID ~ a ~~ ^ ~ 9 s~ >t_ ® Pit ~~~"~ Depth ~ , ~o - in. Harimr- Depth in. Domirt~t Mansell - Redaoc Description Qu. Sz. Coat Cobr Texture a Gr. Sz. fir. Coma ~~~Y Roots Ivy 1 D-l9 lp 3 Si ~ Z k c.s 2 ~9-~z tD r 3 5, 1 21r,abK ~r ~- 5 3 y2-(v5 Ip r~fl4 C2P`1•5 r ~ ~5 ems m~-~r cs e -- rr's p s ~ c.5 '. y ros -~~v 10 r y 'S ~~a _ /7 lU y/3 - Cc~ s O m l -- - ~3.Z~I~•2- - •Ei5F1 'Ei!#2 •5 ~ . --i I.2 .-7 J.2 .1 I !•2 # U Bonng GrGUnd S11[faC@ slay. tt Depth tD IN1111K18 faCmr In- ~ Rate ^ Pit Horizon Domirrarlt Redaoc Desaip4on Textlare Strrxiure Conroe Boundary Roofs GPD/1t= in. Mansell flu. Sz. Cont Color Gr. Sz. Sh. "Ei~l 'Eff/F2 n _ n B~ ` ' ~ ~a suriaoeeleY. n. ~ m IIIi11WIJ ia~ew ,~~~ ~, ^ Pit Horizon Depth Dorrlirrerlt Redox Description Texb~ae Structure Ca>sist~lae Boundary Roots in. Murlstil Qu. Sz Cunt Color Gr. Sz Sh. Sod GP 'EtflF1 Rate Dl1~ *Eti#2 • EtBuerlt ~ . BOps > 30 < ~0 mglL and T5S >30 <_ 150 mglL * Effluent ~ =GODS <_ 30 m911-and TSS < 30 -n9A- The Department of Commerce is an egoal oppordmity service provider and employer. 1f you need assistance to access services or need matierial in an situate format, please contact the deparhmer-t at 608-266"3151 or TTY 608-264-8777. sao-a~3o cRmroo- ,~ A PAGE 3 OF .3 NAME 5~ov-I- LOT# /9 LEGAL DESCRIPTION SF 'fSW'14,5 I~{ T Zq N,R~~ E (or)~ SCALE: I"= SID BM I ELEVATION /C~ • 0 BM I DESCRIPTION fop Q~ `• prc P~'D~ ~.~~ BM 2 ELEVATION ~q• ~~ BM 2 DESCRIPTION~~ ~ /~d~~• P c w/F/u~ SYSTEM ELEVATION 9.3. y'~ ALTERNATE ELEVATION r 3 • `~~ CONTOUR. ELEVATION h0 Q~e- ~S " Z __ _ • ~0 5/oP ~ ^ t3~3 ^ $_~ moo. • • ~~ gM 2 _,~ ~on^iP Department of Commerce SOIL AND SITE EVALUATION Division of~Safety and Buildings Bureau gf Integrated 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 """'' include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and slist~ace.,to nearest road. Parcel I.D. # aC'~~ ! 4 t ~ ~. /~ ~ - r,,. Page ~ of S~.C~f~ APPLICANT INFORMATION -Please prinll~rormion. '°, Reviewed by Date Personal information you provide may be used for secondar~p,7i t~"ses (Pr{~C)rtavu~?'sS ~ 5.04 (t) (m))~ Property Owner - Property ipcation ' ~ ~~ ~ P'='~ '? ~ f~ovt. Lot :~~ 1/4~(,~/ 1/4,S ~L~ T ZC~ ,N,R f ~ E (or) p~,)I Property Owner's Mailing Address ~, , Lot # ~lock# Subd. Name or CSM# 135 A- '~~ ~r ~~ ~~' .~. (~ ~~,~ee-~ ram City1 ~ \ State Zip Code PFibne Numbe(r'~ "`~ 2) ^ ~ ^ Village ~] Town Nearest Road I--Yitl'1``~Yl I ~1~~ I~1''~~~~ I ~~~~)~~[~ `JI N IJl~~lfl __ ~ C~~..~ [New Construction Use: ®Residential /Number of bedrooms ~ Addition to existing building ^ Replacement ^ Public or commercial -Describe: Code derived daily flow 9~ y gpd Recommended design loading rate ~_bed, gpd/ft? ..trench, gpd/ft2 Absorption area required Z.SO bed, ft2 / UU trench, ft2 Maximum design loading rate ~ ~ bed, gpd/ft2~trench, gpd/ft2 Recommended infiltration surface elevation(s) l~U' y y ft (as referred to site plan benchmark) Additional design/site considerations C' ~'"L ~ ~ r ~~ y~ Parent material ~~'w ~-.S ~ Flood plain elevation, if applicable i~ ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank u = Unsuitable for system ^ s C~ u ~ s ^ u ^ s C~ u ^ s ~ u ^ s ~ u ^ s C~ u SAII nFSCRIPTI~N REPORT Boring # Ground elev. cleft. Depth to limiting f ctor ~in. Boring # z .Ground elev. ~%`-l`f ft. Depth to limiting factor ,~` in. Remarks: CST Name (Please Print) Signature - Telephone No. Address Date CST Number Z1~ 3 ~0~-`~}- ~rYner;~e~, Ct )1 ~S~IOzS" ~t-~I-oy 253305 Horizon Depth Dominant Color Mottles Structure i B d R ts GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. stence Cons oun ary oo Bed ,Trench 1 -12 L f Z ^' Si I 'Z IL ~' •S' - ~ ~- t2-.~i IQ - S~ sbk. m cs - .y , y 1 SI C2P~.~ ry Sr rnab~ 'rr-~~ c ~ ~5.~ ~~ Remarks: - I (~ ~ ~ ----- ~ ~ I Z ~ tY~ ~ s, - ~- ~2 ~ c~ l~ ~ ---- s~- 2 ~. ~~ - ~- (~ CZ ~. 5 J k, ~~ -- . ~ ~ - ~ ~7C~-c.l~ SOIL DESCRIPTION REPORT PROPERTY OWNER PARCEL I.D.# Boring # Ground elev. ~. ~y ft. Depth to limiting factor ~in. Boring # Ground elev. ft. Depth to limiting factor in. Boring # Ground elev. ft. Depth to limiting factor in. Boring # Ground elev. ft. - ~~ Page ~ 'of Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench a-- z l0 Z s; I 2 ~~- m ~s t,r-~ - iz- ~ ~-' ~.- 2 ~ --~- ~ s -- , ~ 3 - {~ .S ~ S~ ~.. CAS _- • S Remarks: Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/flz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench Remarks: Depth to limiting factor in. Remarks: SBD-8330 (R.9/98) a PAGE~OF 3 NAME `,~-f-~c~-~- LOT# ~ ~ LEGAL DESCRIPTIONS r '/4Sw'/o,S /y TZq ,N,R (y E (or)~ SCALE: 1 "_ ~ C~O~ BM 1 ELEVATION (W • ~ BM I DESCRIPTION -I-o Q o L (i «p~T P ~ ~f'~ ~/"!q9 BM 2 ELEVATION , (~ . ~ BM 2 DESCRIPTION{~p ,~ ~ ~N JG p~•,/p~. ~Af~ F/~ SYSTEM ELEVATION ~~JU •• /~ t ALTERNATE ELEVATION /!// CONTOUR ELEVATION yy K I -(- -- t ~ F ~Z t r -----'-- - ~ - ~ U DATE ' ~. - Combination SEp>r,3•c~'Tank ~.ri~i • -' Pu•M'? CHAMt~ER CROSS SECTIOfJ A.~~P[ C1 1f ~1'~F.~ ,` _. _.._...r.. ; ~_ r ~~ It ~ aox ~~ - wu. ti~C.I. VEAIT PIPC ~ .i _ ~,,., .'.P- ~ E; i,.Gc_r;i?.1G '.111JOOW OR FRESH ~' i•pta(:r.)]T\, u~sP~o~ ~ tpF ~ K INTI~Kf: ~, ~ ~ r __~i....... _.._.. AL_, t • ~ ! r'rtcLT1 s tr7"' e.rrp ~ I ~- ~ ~ ~ ~ r ~ ! 8' /~I I.1. Ib~MIA1. _ ~` ' ._..... .~ ~ ~ INLET _ ~,~, AIRTIGHT SE:.aL. ( '~ '•~ /~ 8 t~FF~~ ~~ ~ ~ APFROYI:C~ JG..J1 APPRDYED JOINT ZPQ3~L. Tt4~k -. ~ ~ ~~' , ~ ~!/C. L. ~l?t''~`t~ w~C.T_ PIPEoR Tank constrtaction ,I ~ r..L~,~ , shall comply with I' ',` , ILH~ t~3 ,15 and 33.20 ~ ; ; ~ .- ~. c_ i i~ ; PUF',P -•-~.,, ~~--~1 ,F 0 I 1 ~So ~ l C01~CR,ETr .Z.~ -R ~ : pt.OC.K-~• I ~, ~ _1 L RISCR EXiT PERMITT ED Out_y IF TAUK MANLFAC?'IJltkk: -`AS 5., .":,I ~t: ,f .1.. ~gsC,pt~aG SEPTIC f SPECIFICATIQf.]S 005E TA1.1rC MAlJUF~+CTURER.: ~1~L~000I~JCC~~T~ fJUr,BERUI~ DOSES:._..~_-.~,> -_PERI~ . TAAJK SIZC:- GAL.I_pk15 D054. VDt..~t4E At-.SRN htA1JUFACTURCR: S,~',~,-L,~~-0 S~1S~?'l.~ ttict_unlu:> 5~cx~~.c>;~ : w4~~:.-._. GA>rl_~~,~; MODEL. 6,.7UM8ER: yOl ~w CAPNLITIESt .1c[~'('~;;.,;C<.1;~ Qf~:. ~gZ GAt.I.:)~,; SWITCH TYPO: 1-~~Z-~~ 13=._ __ +•!C-.:~y0i ..~(,C~' ~r~LL.:I.:; f UMP h~A1JUFACTURCR:. ~•`G~~-S l: s•_~.S,;:L :`•; 0~; L./c%~ -. y'•Lt.JI~: MODEL. IJUMBER: ~(,yl ~~y f)=_.~.._. ~it,''...: on ~ ~.~~~i'.l)1:1b . SWITCH TYPE: ~~--~C~' IJOT__ PIJ..,? A.1J0 ~,i_.;:;: ~, ,'.E ~I"~i t:~i. Mlld;MUM pISCFiA,RGE ~RATE~/._.~GP/'~ INS'"AL'..EG : ~, ~:';:}.Ri,;~~ CIRCUITS ~EIZTICAI_ pIFFER.EIJCF DET!rJCEU PUMP OFF AIJO..I)ISTRIBUTICU PiPE... _~..._ FE:E:~ t rtlti.-lh1UM tuETWORK SUPPI,y PR((E((S~~~S~~URE , ; , . , . , .. , _~ .._ Ffwf~? ~- ,~~ FEET OF FORCE; IMl1J X .L...L~.L_F/Ipp(1,FRICTIO-1 FaG'roR.._~__~ FE:E:T ' .._.... . _.. TOTAL Oy1JAMlC HE:Ap -._ Ff'~' `y _...:.. _ pp ..----..._.. . As per , izanufacturer ~ ,.b •, gal; in. 4 M E4Q Series ` i 4/1U HP Effluent and Dr~~r~ Water Pumps Perfc~rrY~~nce Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 35G 40 35 30 4. H 25 20 J ~ 15 O H 10 5 C 12 10 ~ Ir e z H 6 J 4 0 h 2 G 0 10 20 30 40 50 60 70 8G 50 ;00 CAPACITY GALLONS PER MItdUTE F.E. Myers, A Pentair Company • 1101 Myers Parkway, Ashlsnd, Ohio 44805-923 419/289-1144 FAX 419/289-6658 'Celex 98-7443 K3326 7/91 Prints=~' in U.S.A. A ~ ~ N ~ A Q N N ~ ~ ~o ~D N ~g~• a NO A x W • ~ ~ O a ~ w Qa ~~ ,~ o~ A N O a 5 D 8i I I C ~ m o ~. ~ ~ X =- r n x ~ 2 ' .,.. ~ -~ (D ~' n 3 n _,, ~ ~ +, ~ O ~ O N N ~; ~ CA ~. ~ X 3 V j ~ v 1 W .l GJ i ~ 1 ~ ~ ~ • I ~ ~ ~o • • • • -~ ~~~ ~c~ c ~ ~- (D C ~ ~ ~' CD CS (A ~. CD fu ~ fll ~ CQ '*, ~ ~ ~ ~ a . ~ c ` t5 n' ~ ~ CD -~ ~~ O cn "'~ Ul 6~ ~ ~ fll ~ ~~ ~' N ` ~ ~ _• ~ O ~ ~ ~ mn~,`~ r,. c~ Q. ~ ~t~m~ ~ f2 ~ ~p ~ f2 W * . (D ~ n d ~ ~ n ^, O F~ /O~ W rf ~ f2 Q ~~ ~ ' ^ ~, v ` ~ ~ ( ~, tiy. W ~ ^^ ,, R /^ \I~ ~ f. AS r O. !~, ll~ ~ ~, p~ ~ m ' Q C` C v c ~ ~~~~ I u .n ~. ~; F Y..c` G~61iCi131 'n dJ~ ~~~kSll .. 6lC;tCl.:~ ~:. ~_ '._ Y b EBB ~i ~~~r,. ~,~r ~~~ ~---- Invert 11"-- . . ~~ . G¢~-Pr~0 ~ 06~'iZ~e P~vate t~ns~t+~ 11V~ti~w~t#~ Tr~sE~lint 5y~~rr~ l~gs~sr~~~'r~~n~ ~~a~ Sepfi~+c Tank Anse Girwtty 1~-t3src~~st^i~d' ~®IE A~;~s~~rp~1:8c ~~:-~_~~~~~~~ Pursuant to Comm 33.54 Wits. Adm.. Code each F'ril~ate ~JrtsitF~ `~1la:~te~, ~;~~r Treatment System (Pfl~JVTS) snail incluc~ formation and procedures for m~ntaiE~ing the system within the parameters of Gornrn 83 and 84, anti the conditions cif ;~ppro~+ai ~'~' the de~~ rtment, agent, car gar+ern~rrientai unit. The apprc;d pians and permits ftx syst~rri aa•<~ cart file at the county zoning cx health departrr~nt. This management pian tx~mplies with Comrn 83.54, Wis. F,dm. ~ ode, s~r« the ln-Ground Soii Al~orpt~n Comprnt Manual for Private O~ite Wastewater Tr::;,3tment ~~~stems SPn- 10567-P (R6199). Table 1: S :aim laea S eciflca~lhns Sanita Pifi Numiaer `Nurrtber of Bedresc~ms ~ ~_ lies n ~io~t ~ Paek d as ~._ ~. Es#ima+i~d ids - Aver d ~., Se tic Tank ! Soil Ab~rption ponent 'ze; Z ~~~.r ____...~ ` of teuvater _ Uomes c Tsl~le 2: ~Oi~ Altssorc~tion ~fi3nent ~ l.lrt~t>$ O~° R~1i~!~~le C)p~!~`':;tatDn ~~ - -- --- - l?esi Flov+r - P~.~iK d Se tic Tank Corr, -___,- Sr~~l_A~;~s-o~;~t~n Component ~. 5_LZ, ~~. - Maximum influent. Pa~icle~Siz® in t %8 _ Max4rnum B0 m /L X20 AAax~~ TS5 rx~ ..__._._..~.._..... ` 5C Xa~~ -~ Table 3s AAatnlaaCe $s~l-e~ e - ---- 3 'c Tani!c - - I and/ar tie c3ver~» S years _ _ _ _,,...,...,k f>utlet Fiit~r In once a ar end dean at Ityaat or-ce every 3 years Sod Absor Lion Corn Went Ins once eve ~ ~e ._~,_, 3eg~#ic Tank ,,* The septic tank shall be maintained by an indviduai certified to service -eptic tGrzlt~ under s. 284.48, Stets. The contents +~# the septic tank sheli be c)isposed of Pn :~ ;cor~;a~ce with NR 113, V1lis. Adm. Gode (Servicing Septic or Molding Tanks, f~urnpi~~g Ghar!~;~rs, Grease Interceptors, Seepage fads, Seepage Pits, Seepage Trenches, l'riv~t~s, cr F~;-~t~sb~e Restrooms). The operating condition of the ~ and outlr::t fi#ter shah be ass ~e~ ~-t I~~., once every 3 years by inspection. The shall be c~eanod ~ y nece<~ ~r tc ~n ~ ,-e proper olssration. The filter cartridge should not i~ removes unless ;;>rovis~oE~v ire ~~;ac~e ~.~~ re m so ~ s rn a tank that may slough off the Bier when rem~rved f~nm its e:~~los~re. If the Manageme~7t Plan for a Septic Tank and Sail Absc~rp_ ~a~i C;or~il:c~~~ent filter is equipped with an alarm, the filter shall be serviced if the lar ~- is act +i~{ieci ccntir7r.rously. Intermittent filter alarms may indicate surge flows or an irnperdi ~g c:r ~nti~uo: :1idr r~. ; r,;, septic tank shall have its contents removed when the vohrme of scupr and siu~_~,~e~ i€~ the iank exceeds 1/3 the liquid volume of the tank. If the contents of the tangy, are net r~:~no~.~ed ai the time of an assessment, maintenance personnel shall adv e tl-~e ownf~r of w- f~ 7 the next service needs to be performed to maintain less than maximum scrum _rnd sl . dge acc;r-: r ui~ tior7 ir, the tank. Manhole risers, access risers and covers should re inspect.,ri for war ;:.:ic,~htness and soundness. Access openings used for service and assessment sh~l' bE se_~'~_: ~~ v,~~t_~rtigt,t upon the completion of service. Any opening deemed unsounc, de~:~ectiv:,~, or subject to tailurE: r-nust be replaced. Exposed access openings greater than 8-inches it di meter sh~,_ii be secured by an effective locking device to prevent accidental or una~athorizec' entr~~ in':o ti;~_: tanks. No one shouh~l enter a septic or other trEc~finerat or ~~o/dine frtllr far any reason without being in full complianc~r with OSE'~~~, star3o'crs~~als :nor entering a confined space. The atmosph~~r~~ witl~i~~ tlrra sE~r~ti~; ,t. otrrer treat-nent of holding tank may contain letFial g~~ses ,~nc- rep: s. ~ ~, of a person from the interior of the tank maybe ~IiffiLult or~ ~~rnoos~ei~1e. Tank abandonment shall be in accordance with Comm 8.3.3 Wis. ~ryrr?. Code when the tank is no longer used as a POWTS component. Soil Absorption Com~men~t The soil absorption component serving this structure is d~~sic~ned to accept domestic wastewater from a residential facility. The limits of operation of this c ompor,c,r;t are shown in Table 2. The longevity of a soil absorption component depEnds greail., on orc~:~ and tirne`y maintenance, and system use within or below the limits of reliable of~:ration +: ;~o~~? water conservation practices by all occupants and the installation of w~rter :anser~ ~ ~i;.;~rlbing fixtures are key factors in extending the useful life of this c:omponen}:. The soil absorption component's operation must be as~esse~ by insi~ :action crt lei st once every three years. 1'he inspection shall include recording tiie i.:°,~els of i,r::~~dnC, it anu, in the observation pipes, and a visual inspection for any evidencE; cf s~ii~~ce sE.~°~:age or discharge from the component. On steeply sloping sites, areas of erosion .~har~ld be id}ntitied and reported to the owner for repair. The surface discharge o.` dor~restic ~,~asteu4:a; or ~;ev',r~ic c' from the system is prohibiied and considered a human he lth rrazard. Traffic around or over the soil absorption compa~~ent shouid lc; avoiciecl t~articulariy during winter months. ThE: compaction or removal of snow core ~ ova: r the r.~:: rr,:~or~F:~,t may lead to hydraulic failure by freezing. This type of failure is usually tern por :,iy, but _:.~fticuit oi~ impossible to repair until weather conditions improve. In general, sr: cor~~~a ;+,iccin lever tl~~is component will reduce diffusion of oxygen into the soil and dispersal ::ell:., vrt~!;: ~r.~:i lead to more intense, arrd earlier, organic clogging of the soil. 2 f Management Plan for a Septic Yank and Sc>il Absr.+rE~tiar :;or~~pc '. rat Plantings afleep-rooted trees and shrubs directl~~ c;ver ~:~r witr~ i~°i tE;n fE: f ,' ~t component should be avoided since root intrusion into th~~ 4;omE~onen~ niay ~~! + ; L~: , a ~~ r7iatet flow. ,_~ , ~ . C ~. , ---.1- . C° ~..J rte' ~ .~., ~, . •l, ~ z_, :!~ ~, , 3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer __ ~ hac0 ~~ ~ ~e r) ~ Mailing Address ~ 5 O ~ ~-{ ~ g a P h i 1--~- U c0„~ o r- ~ W =' ~4~7/ (~ Property Address (Verification required from Planning Department for new c City/State f-tUdson , ~-Z Parcel Identification Number 6Zo -l3~'6 -Iq'- ~O L +,GAL DESCRIPTION Property Location 5 ~ '/4, 5 V~/ '/4, Sec. ~, T~N-R~W, Town of flu c>'SOr/ Subdivision S W eel lTr~ SS /CGt /' i'»5 ,Lot # ~ q Certified Survey Map # ~' ,Volume ,Page # Warrality Deed # ~s~ ~ ~D ,Volume ~~Z ,Page # 1P .~ Spec House ^ yes ~ no Lot lines idetitiFable ~ yes ^ 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 Deparhnent a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plun-ber or a licensed pumper verifying that (1) the on-site wastewaterdisposalsystern is in proper operating condition ancUor (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 slating that your septic system has been maintained must he completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration 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 thepro~perty described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE ****** Any information that is nris-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** In~ttrde 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 STATE BAR OF WISCONSIN FORM 2 - 1998 WARRANTY DEED ' ~ 1752 63 Document Number y(~~• ~ ~A~~ This Deed, made between RTGHARD O TO 1T and ~TANFT P S_TOUT~ husband and wife, Grantor, and CHAD W CIBERT.E anti RF.R~'C_A A_~~.$ERLE-, husband and wife, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate In St. CroiX County, State of Wisconsin: Lot 19, Plat of Sweet Grass Farm, Town of Hudson, St. Croix County, Wisconsin. * 020-1376-19-000 Parcel Identification Number (PIN) This 1S nOt homestead property. (is) (is not) Exceptions to warranties: easements, restrictions, rights-of-way and covenants of record. Dated this 31 G day of Octo r a _?OOl , ~ I'~`~'~""~ ~' ~=~" " ~ (SEAL) ~ (SEAL) * Richard O. Stout ,7anet P_ Stout (SEAL) (SEAL) * AUTHENTICATION Signature(s) authenticated this day of 8~1 .. * " ~kholm TITLE: MEMBER STATE BAR OF WISCONSIN 6608 1 6 KATHLEEN H. WALSH fiEGISTER OF DEEDS ST. CFtOIX G0. , WI RECEIVED FOR RECDRD 11-01-041 10:45 AM WARRANTY DEED E?!EMRT # CERT CORY FEE: GOGY FEE: TRANSFER FEE: 158.70 RECDRDING FEE: 11.00 F~AGES: 1 Pe~t;ordin~7 ArF~a Name and Return Address ~N~l~ va ~~~ ~dG~,~ 301 t...vu IC G ~. ~c~Jo~t t-`~l S~~ai4 ACKNOWLEDGMENT State of Wisconsin, ss. St. Croix County. Personally came before me this r . !fir _ day of _ October ?~~ ,the above named Richard O. Stout and Janet P. Stout to ~~ ~ o ~ \ ,~s~ozt 3~ • ' ~ ~ ,. ~/ ` . ; ~ .' ./, ~~ ~ ~op O~ ~~ N 3„4 $ Q n ~~ N O ~bo~ ~ Is ~~ .8Z'04Z -'`` `"`- "' _._,~._._._.- I--- -~--~-- -~ . . . . . . . . . . . . . .1. . . 1 . . . . . I I.B I r I ~~ 0 1 I i~ ~ I I ~~ ~ I ~I I wl I ~~I fTi I Rll I ~I °__°- I gi I ~I l~ I I~ I ~( 1 1 1 I IIr ! I / ,L9'bf:£ I I I ~l0 f .Zf:' l6 ~Z6'6ti8 ~ 3..L ~,b L~ ~i`~ lOp l(~I~; SiPi~ I~IdI~ ~i~i[~ Iwi °O I 11~1~ iov ~ I i ^i i~ IS~I~I 1~1~1 a p I~I I~ • I~le(olj~ /l l tlt~ l O I~I~ I ©I