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HomeMy WebLinkAbout020-1376-25-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 567242 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Sweet grass Properties LLC, c/o Richard Stout Hudson, Town of 020-1376-25-000 CST BM Elev: Insp. BM. Elev: BM Dqcript~: 664 - Section/Town/Range/Map No: l/7I If a a'~ 14.29.19.2286 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 6 r i Benchmark A3.7 /6/1 ges" Alt. BM - ~ 1 2.1 5 /A b Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO r t~ P/L, WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic t 3e / Dt Bottom Dosing Header/Man. Aeration Dist. Pipe -7, ZF3' ~o • S Holding Bot. System IFIZ5 Final Grade PUMP/SIPHON INFORMATION 3. Z / 00 Manufacturer Demand St Cover GPM F,` t"am. Go Z. /J' V Model Number UQ 4,54 57. TDH Lift Friction Loss System Head TDH Ft ' I Va t 5 9 7 z Forcemain Le st. to Well I Vc. L-t 6 t.) L)t Col 17 . SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMEN.%ONS No. Of Pits Inside Dia Liquid Depth DIMENSIONS 3 SETBACK SYSTEM TO lD P/L BLDG WELL LAKE/STREAM LEACHING Manufactur r: II / INFORMATION Type Of System: /1 .7 F 7- CHA uBER OR ~r l ~'"lo~rP1 r > Z.5 Mode umber: Coati A Y7 DISTRIBUTION SYSTEM Z1 x Header/Manifold It Distribution x Hole Size x Hole Spacing Vent to Air In ke 7+1 -1 Pipe(s) 1 \ SL cJ Length Dia Length Dia Spacing 1-~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Mulched Depth Over Depth Over xx Depth f xx Seeded/Sodded T Bed/Trench Center f7 Bedfrrench Edges Topsoil es No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 891 Fraser Lane Hudson, WI /54016 (SW 1/4 SW 1/4 14 T29N R19W) Sweet Grass Farm Lot 25 n Parcel No: 14.29.19.2286 1.) Alt BM Description= 6j ~Cc JQ s +~-(~,6 ~~+e U 2.) Bldg sewer length = I t - amount of cover = 5 F~ y Plan revision Required? Yes No r 70 Y3 Use other side for additional informati n. No SBD-6710 (R.3/97) Date Insepctor' Si nature Cert. No. County Safety and Buildings Division St. Croix 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison, WI 53707-7162 5 (tO -7Z -4/ Z rt Permit Application State Transaction Number In accordance with *V32 2 is. Adm. Code, submission of this form to the appropriate governmental unit Na is required prior toitary permit. Note: Application forms for state-oWTS are submitted to Project Address (if different than mailing address) the Department of and Professional t Personal information you provtd deed for secondary purposes in accordance with the Priv Law s. 15.04(I m , Slats. (•~jy~S~• 1. Application Information - Please Print All Inform n top* -4zn l Property Owner's Name / Parcel # Sweet Grass Properties, LLC - C/O Dick Stout C ~~9 020-1376-25-000 Property Owner's Mailing Address Property Location 1353 Awatukee Trail Govt. Lot City, State Zip Code Phone Number -SW SW Section 14 (circle one) Hudson, WI 54016 715 781-5250 T 29 N; R199 E or W Ill. TT ype of Building (check all that apply) Lot # ~ 1 or 2 Family Dwelling - Number of Bedrooms 6 25 Subdivision Name Block # Sweet Grass Farm ❑ Public/Commercial - Describe Use 1 Na ❑ City of CSM Number Village El State Own -Describe Use ❑ of 3 :0 ~ (el~ t:.J Z 1 aC?S Na tai' fown of Hudson III. Type of Permit: (Check only one ox on line A. Complete line B if applicable) A. ❑ New System 91eplacemcnt System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. El Permit Renewal El Permit Revision El Change of Plumber E] Permit Transfer to New List Permit Number and D Issued Before Expiration Owner S- 0 1 (/O Z 04z IV. Type of POWTS System/Component/Device: (Check all that apply) Non-Pressurized In-Ground El Pressurized In-Ground ❑ At-Grade El Mound > 24 in. of suitable soil El Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Compon ain) atm ce (explain) V. Dis ersal/Treatment Area Informatio • 63 Infiltrator " " Standard Plus chambers & 6 endca s Design Flow (gpd) Design Soil Application R se (s System Elevation 900 Gpd 0.70 Gpd/Sq. Ft. 1,285.72 sq. ft. 1,290.60 Sq. Ft. 95.50 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units New Tanks Existing Tanks w L °v la IG. v cn C7 0. G P L11 Septic or Hokiing Tank 2,000 2,000 1 Wies Conc. X Dosing Chamber VII. Responsibility Statement- 1, the un rsigncd, ass me responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' Signature MP/MPRS Number Business Phone Number James K. Thompson MPRS 30021 715 248-7767 Plumber's Address (Street, City, State, Zip Code 340 Paulson Lake Lane, Osceola, WI 54020 VIII. oun /De artment Use Only Approved isapprov Permit Fee Date Issued Issuing Signature $ 001 iven Reason for Denial LOT. ~ ~6 Z3 IX. Condit~ateasons for Disapproval 1. `I epti lank, effltientfiiterand dispersal c. ell,must all be services / maintained as per management plan provided by plumber. 2 $90Wk requirements must be maintained as per applicable lode Attach to complete plans for the system and submit to the County only on paper not less than 8 to 111 inches in size SBD-6398 (R. I1/11) ~~Q✓Q~tAl.+.trOn~,~ A Er,sb'~ ~rade elZr! cx,'.s riiSA+,celiK%o~GKc ~P ASSK,ned e kA _ 141,74e rae~ 1352 5~ee~ Grass Prop44,e s 4~c i 4 e,/o [~cf'Sf~wf II i 3s3 A~A~Ce ~ ~~u S of Lo~t~s P,lef 6P w e e6 ~s 7wyw5 Y/-119e., i, o~ ~Xis~ir~q ipGJ. 6so-i3gG-1S-coo DupltX a X/ 5 '6 1QWn r-'~e ~ ~ ~ low g tQ ffCS ~~jli SEin1 eSNCon cre.6e Sit( k~75 o/yLo~~L S1se/{I ' I ptopos<,d ~ ~ ya f yal~e J o cn /Qwn t ~a llo w 8► ~ ~ mosses 6 Ski wlzs UrrEQ-" 3 ~ 5'c • v T7EreG (3~ ~i+~nC~.iJ.S G-~ yQ-t("/V/u.s S~i+.rc~a/c~ L~l~l.wb-Y~ Sw ee e%~ ~,be = yssa: 8z I "5.d e uJ; n des "e.],fsn/b~/J//~ S {a ce a l t,/ f-: 3 Conventional POWTS Index & Tilte Sheet Project Name: Sweet Grass Properties. LLC - 6 bedroom Replacement Conventional POWTS Owners Name: Sweet Grass Properties. LLC - Dick Stout Owner's adress: 1353 Awa pkee Trail, Hudson, WI 54016 Site address: 891 Fraser Lane, Hudson, WI 54016 Project Location: Subdivision: Lot 25, Plat of Sweet Grass Farm Legal Description: SWI/4 SWt/4, Sec. 14, T.29N., R. 19W., Tn. of Hudson, St. Croix Co., WI. Parcel ID 020-1376-25-000 Page 1 Index and Title Sheet Page 2 Site Plan Page 3 Dispersal Cell Sizing Calcualtions Page 4 System Cross Section Page 5 System Management Plan Page 6 Parcel map Page 7 Certification for Utilization of existing septic tank Page 8 Waranty Deed Attachments: Soil Evaluaiton Report Mater Plum r Restrict Service: James K. Thompson, Dept, of Comm. Credential #30021 Signature: a--~ " Date: ®ce - -Zelj Page I Of 8 Design pursuant to In-Ground Soil Absorption Component Manual for POWI S, version 2.0 SBD-10705-P (N.01/01) ♦ EX,sb• ~mde elec. Q- c/.%t%oe; GKc n rn Sradl. -~P Ass KMed a Ic✓` 0 ,Pe~'~~3SZ r Su~te~ Grass prop" ,e "Cal - e/o ~J / 353.4wa ~f~cc 7%. O l-ric.dson c.J/. sf~/6 S,Qi Lots p,~~o~'Swt~6~a~ts~r.~l, v~ 7w1'd5 sry!5ec.~4,'T.19~;~P~9~, °a L~Xis~rr~ tae,/. 'f 610-/37~-?s-u~ DkplaX EXi sin • v~ ro -~f 14WO (/ow c~ r~ tttS ~ 5 rkbs ~~jr,'s6~q cJ:tsi.corc:rclx 2~ 5KP syoE,cf~►~''~ o/y~~'Pc-s~s`~fYk~ ~ • ~ P-repwd n~E o u t cuf de3%Or» o th /Qw✓1 IV 0 y , Gl rGSS¢.5 w 0 ~ f -rArCG (3) &,e,; clcs c-,& yQ-~r~/~/aS s~~rrC~a/G'~en4.»~W.S Sw~ace e/e% Abe = 9sso.' 6A 70, Joe i&,," e.0-e-3 'X /.g75,w12.t "S,deu~~n~dT.e^s" bn~J~v Skr {4ce elc✓, =95.So - SWEET GRASS PROPERTIES DISPERSAL CELL SIZING CALCULATIONS 1. (6 bedrooms)(100 gallons estimated flowxl.5 design factor) = 900.00 Gpd design flow 2. Infiltrative capacity of native soil = 0.7 g,Rd/sq. ft. 3. Absorption area required: _ 1,285.72 N, & 4. Absorption area as proposed: 1.290.60 M. ft (63 chambers totals / Infiltrator "Quick 4 Plus" = 20.00 sq.ft. EISA per chamber, Infiltrator "Quick 4 Plus" end cap = 5.10 sq.ft. EISA J 1,285.72 sq. ft. - (6 endcaps)(5.10) =1,255.12 sq. ft. 1,255.12 sq.1/20.00 = 62.76 chambers required Number of trenches: 3 a, 21 chambers per trench Trench width: 2.83' Trench length: 86.00' Trench spacing: 9;00' on center Total system area w/ 9' center spacing: 21.00'x 86.00' Pg. 3 of 8 Soil Absorption System Cross Section ft 4" Schedule 40 Final Grade PVC Vent Pipe With Vent Cap 9G,5a ft Leaching Chamber ft System Elevation 3 ft ( ft (0 ft Soil Absorption System Plan View ~(o ft 3 ft G ft Leaching Trench 1 Chambers 4" Dia. Trench 2 Header Vent Or Observation Pipe Trench 3 Leaching Chamber Specifications M a n u factu rer An d Model i014e-s ,c(ord EISA Rating :Zo•O sq ft per chamber Soil Application Rate o. 7 gpd/sq ft 9d4 gpd Design Flow . ©.7 Soil Application Rate + d EISA 63 Chambers 3 rows of chambers each. Page _ of C5 Conventional Septic System Management Plan Pursuant to SPS 38354, Wis. Adm. Code General The conventional septic system shall be operated in accordance with SPS 382-384 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD-10705-P (N.01/01). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Septic Tank Septic tank servicing mechanics comply with SPS 383.54(lxe). Septic tank to be located within 150' of service pad, with bottom of tank to be 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1 /3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to ensure 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 filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank manholes 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 individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface within and above the system and will promote frost penetration during cold weather months. Cold weather installations (October-March) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Effluent flow shall be alternated between dispersal cells on a two-year schedule by use of diversion valve. Effluent to be diverted from new cell to old Drainfield at 4 year anniversary of new system installation. Old drainfield to be utilized for a 1 year period. Effluent dispersal to be alternated between systems on a two year rotating basis thereafter. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715) 248-7767 or the Polk County Zoning Department at (715) 485-9279. Pg.5of11 cm N My - - \ gG (.0 ; z o _ r Oz ti \ Qj \ cr D N \ 71 m 71 m ~ x z m \ C,O C) Oz. u < ` F rri N 00 so u b 0 \ \ T Z \ It C r m 03 q it i ~ ~ • 9ElY tp n \ w V A Q a i 52 . g ~ 00 CD > cn Ci c'G p~ om ~ N 9£'r•39 777 90S W W z m N \ \ \ O S X' r Z u oA ~ t Sc . Z9 \ m; ~ m co \ C o ~ ~ \ N b A U1 \ N \ ,9 O, MCP \ 7,L6:93.~£Sr<.90S . lid 05 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) 891 Fraser Lane, Hudson, wl 54016 located at: Sw '/4, SW '/4, Section 14 j own 29 N, Range 19 W, Town of Hudson , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service 10/11/13 Did flow back occur from absorption system? Yes x No (if no, skip next line.) Approximate volume or length of time: Unknown gallons unknown minutes Tank Capacity: 2,000 gallons Construction: Prefab Concrete x Steel Other Manufacturer (if known): Wieser Concrete Age of Tank (if known): 12 years, installed 2/01/01 rmit mber (if known) 370345 James K. Thompson ><censed Plumber Signature) (Print Name) Mater Plumber Restricted Service MPRS 30021 (Title) (License Number) MP/MPRS October 18, 2013 (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 P~ 7oL8 i vm.15;3 WE 81 STATE BAR OF WISCONSIN FORM 2 -1999 KRTHLEFM H DS poerweaNastbar WARRANTY DEED RE61STCR 9P DEEDS ST. CROIX CO., WI Tbis Deed. made between O"A ds Sow. alkh DOntilds J. KMYE1 F11 *M Donald J. Spwr vast. "d biw&104 09-31-M ISM P1 a e Dona a er- at YARD Grantor, and Rkbord O. Stoat and Janet P. St" bwbaad and wih. V C1DY• M. 3 r 1 Grantee. Grantor, for a valuable caaide nkm conveys to Grandee the following de aibod real estate in SL Croix County, Swe of Wisconsin (if more space is needed, please mach sddehdumX Rtaoddml Ares All of the Plat of Sweet Crass Farm in dte Tows of Hudson EXCEPT Lot I Nrar ad Retem Addrw of said Plat. fl,AM4 0-'SMPT - Mds Eked is given to verrea the ommissfon of additional lots in the Plat of A4*W-"9 Sweet Gras Few between the above Grants ad Or_s$ a batch in the P490, (U► V-w,& i eeetaiR Dead teeorded in Yolume 1953 T. Pegg ~i aO , as Om No. le8.q C5 g (120 1(21.60, 0111.10211.80. 1021-90. 020.1Q240 a 020.1062.20 Pared Idcodfxuioo NwaW (PIN) This Is _wt- kmawsd lowly Oq Now) Exceptions to wanttlties: Falsenwa. restrictions and rights-of-way of record, if any. Dated this ?l (day of Awgast 1000_. / i • • ~ akJa DaanYS J, a/Wa DsmrW J. • • s0a east ACKNOWLZOGMENT AUTHENTICATION Siaaatan(s) DetaldsSpur. a1WaDom"@J.Speers-aM STATE OF WISCONSIN } J. S t %o snd busbaad. ) sa County ) wthennicated this 'P1 ay of ArtuN Personally came before Inc this day of the show named •-Krhdaa TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the perOWS) vbO eaecated the fb0801011, (Ifnot, iostrumat and acknowledged the swse. smhorized by 1706.0& Wis. S%MS.) THIS INSTRUMENT WAS DRAFTED 9Y Attorney Krhda OAbad Notary Public. State of Wisconsin my Commission is permanent. (If not. Stste expiration date: (Sipatmes my k aodtatkaled a adwowledled. Hots an not tteeasry.) ) • Ihsixs of penswts sipial is aq ape aMIR k typed or priest;! Eepw their r+, I rww.w.r ew.v, ra r r WARRANTY 0[LD STATE 8" OFWISWNSIN FOAM Nw 2 199! I 2352 Wisconsin Department of Commerce SOIL EVALUATION REPORT page I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel L Please print all information. 0202137612"W Rev' By Date Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1) (m)). lOZ3/ Property Owner Property Location Sweet Grass Properties.LLC C/O Dick Stout Govt. Lot SW 1/4 SW 1 S 14 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name CSM# 1353 Awatukee Trail 25 na Sweet Grass Farm City State Zip Code Phone Number JJ City J Village 16 Town Nearest Road Hudson WI 54016 (715) 781-5250 Hudson Fraser Lane & Florence Dr. J New Construction Use: V1 Residential / Number of bedrooms 6 Code derived design flow rate 900 GPD 01 Replacement J Public or commercial - Describe: Parent material Glacial Outwash Flood plain elevation, if applicable na General comments and recommendations: Site suitable for conventional POWTS dispersal cell with 0.7 gal./sq.ft./day loading rate. Recommended infiltrative surface elev. = 95.50'. Eac.dispersal cell elev. = 95.50'. 7 t Boring # J Boring L t 01 Pit Ground Surface elev. 99.55 ft. Depth to limiting factor >109° in. Soil Appla ton Rate Horizon Depth Dominant Color Red% Description Texture Stricture Consistence Boundary Roots PDflf' In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Ef1#1 -Eff#2 1 0-8 1Oyr32/1 none sil 2fgr dh cs 2f,1mc 0.6 0.8 2 8-14 10yr4/4 none Sid 2msbk dsh gw 2vf,fm 0.4 0.6 3 14-28 1Oyr5/4 none sit 2fsbk mfr Cw 2vf,fm 0.6 0.8 4 28-35 7.5yr4/6 none Ifs Osg cil 9w 1 vf,f 0.5 1.0 5 35-62 10yr5/4 none s Osg dl aw - 0.7 1.6 6 62-88 1Oyr5/4 none Cos Osg dt aw - 0.7 1.6 7 88-109 10yr5/4 none s Os% dl - - 0.7 1.6 E I L I Boring # -I Boring I 1 fe Pit Ground Surface elev. 11,70 Depth to limiting factor >112*1 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/R' in. Munsell Qu. Sz. Cart. Color Gr. Sz. Sh. -Eff#1 -Eff#2 1 0-12 1Oyr32/1 none sil 2fgr dh Cs 2f,1mc 0.6 0.8- 2 12-18 1Oyr4/4 none sicl 2msbk dsh gw 2vf,fm 0.4 0.6 3 18-35 10yr5/4 none sit 2fsbk mfr cw 2vf,fm 0.6 0.8 4 35-43 7.5yr4/6 none Is Ogg dl gw 1vf,f 0.7 1.6 5 43-74 1Oyr5/4 none s Osg dl aw - 0.7 1.6 6 74-91 1Oyr5/4 none cos Osg dl aw - 0.7 1.6 T 91-112 1Oyr5/4 none s Osg dl - - 0.7 1.6 " Effluent #1 = SOD 5> 30 < 220 mg and TSS > < 150 mg/L N *F uent#2 = BOD 1130 mg/L and TSS 130 mg/L CST Name (Please Print) Sig tune: CST Number James K. Thompson 5-- 3602 Address A.C.E. Soil & Site Evaluation Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 10/22/2013 715-248-7767 EX~s6' yade clE~! Assk•»ed e Ww _ /a/.7S1.~ 0 ~a~ .Z Z /-X ss c/ 'c S -r ee~ G a ~o ~ /35.3.9~Af"''~ce 7:. O /~icdson cJ/. sf~/(o sy~ Lo~~ s Pkf a f' Su~e6~c.u ~w,~t, ~ ~ 7wy~5 yy/,~c,/~'TZ9/l;,Pi9~v, o~ ~Xis~ir~ /o~% a` azo-/376-1S-ceao DkplcX f~ri3t~inc9 • v~ra well la~,n .Fa low ~ ~a ifcS ~ 5 rkbs ~ ~~~li S~7ilq W:CSN~onCC't~~C ~ o/y<okPL-szse/F/k~ ' j propos~.d ~ { ~ yam!✓<. J o ~+-i /a wy ~V ' Fallow ' -U , 0 roSSeS w v ~ur ~ d Shrubs . ~ v Pra/O~se-al drsp~..so`1 c~/r. 'T7E~eG (3Wrrc~GS t 3'X 8G' ~ z•/ ~n Fr'/~►' ~0~' ~r"c~. Zn ~/fin~E~'ve Sw~ac~ a%~ ,~,6e = ysso~ 8,z 70, , 6Joe ~ - ' EX~'s~~~:~~~99 d,'s/r~~e./Cc/% Two( - ' - f/'er~cl,ls of X /.37. S' w~ 2.2 ri'~~ /fi"aLLo~ !~%y{ /i ec~Jo C' i ~j'' "S.dec ind."- nbn~s/~-V S~~face e/c%=95.sa - P,~l P ~racKy 6. ~o~z Wisconsim Department of Commerce County: ,Aafety and Buildings Division PRIVATE SEWAGE SYSTEM St. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary,P"~ppixJ o.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 344J Permit Holder's Name: ❑ City ❑ Vi e E] T n of: State Plan ID No.: Stout, Richard ~idson Township CST B lei.:' Ins . BM Elev.: BM Descripl 19 See here S) Parcel T 1 88-1376-25-000 TANK `IINF RMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic -p- Oro Benchmark Dosing t. a ~o OI'} Aeration Bldg. Sewer 9.91F 0 Holding a St/ Ht Inlet . Zo 18 •`'f'{' TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic 30 3 ' NA Dt Bottom Dosing NA Header / Man. Aeration NA 9is.2i~e tk_4W/$7- `~~•$~r Holding Bot. System / S q • zz °ts 1 Z PUMP/ SIPHON INFORMATION Final Grad y 3-0 .5q.(Dq 1.c1 Manufac urer Deman St cover ,Ip it t. Or Model Num r GPM TDH Lift ' Loss tion System TDH Ft Forcemain Length Dia. H Dist.Tow SOIL ABSORPTION SYSTEM Z.2, s 2Qc-~ ~ Iw / R NCH width Len , N Of renches PIT No. Of Pits Inside Dia. Liquid Depth IM N I N 3 ~fi• S DIMENSIONS LEACHING ,panu acturer: It S, SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION Type O CHAMBER Moe Num er• 1 n System: -21 -690, OR UNIT u DISTRIBUTION SYSTEM l.C Distribution Pipe(s) x Hole Size x IS Vent To Air Intake Header / M ''fold Length ~ "ia. aung SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over [Bed h Over xx Depth Of Tx Seeded/ Sodded xx Mulched Bed /Trench Center Trench Edges Topsoil E] Yes El No ❑ Yes No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1:.0 1 /12/01 Inspection #2: -f--f-' Location: 891 Fraser Lane, dso~4016~ SW I/4 SW 1/4 14 T29N R19W) - 1429192286 Sweet Grass Farm -Lot 25 1.) Alt BM Description 6 6 N 2.) Bldg sewer length = 3T -amount of cover= r Id- y2~ dak"e-"^~ " -1,/ ,54 Plan revision requTBd? - ❑ Yes Nwo C FEE Useother side for aadddiitioorma ion. 0 2 I 1 Or2 Q! . ~ `~ns dor' ature~.1 ~ Cert. SBD- 710 ( 3/97) D S ~ s s 54e~ ~J d4J~ ~,L+b7 safety & k3ui~dinss U,v~ssor Sanitary permit Application 2Qt washing:on AvC ?0 Bc,% 130!. 1r. accord ~~:t~ Comm St ?1 U:: AO!Y: Code ica: ar. Sec rr~ersc side for instr.ct~ors for corr.alCang .nes aPt' Madison. ~ Madison. W1 -131f'7-730' In T'et onal inrurrrtetior. yo;. provide m{} be 4sed fe^ stecrcar PurPOSCS ~cutrr,;; compie;ed Earns tostalt u if pwrt►nrr+t of Comm.lce ~ jPr;vac4 Gt~. 5. SOi_(i )c~_)1 loill i, ht{ Attach Coat taro ions to ttta count co Y on ~s r Wm. un er rso! 1e` ~uron 8.1,1 1 umi Stan 3 i i~ utrbo:~~\ ck rev4sian to psar ApP ' cation Slow • n l tty AvalWgUgg t r t' - ittt In :/I ! t o ton $ 4F X. R/ r A y , f f ifs J rya. s!`/ t.. 10ci: Number Lo N- t umber /3 ..y'-.3 !✓e~7~u~l~..e_ Tv' Su +visian Hs<>»e or SM {p ode Number y ~~yy Phone . um t t) 1 t1iM / r , ^i f: !<ae G ~ ~v 0'~ S7lGl to r J City U Tyjae of BnHdic , (ebe" one) O Village e ! or 2 Pwily Dwelling -No, of Bedrooms; Town at 0 Pubuccomsoamill (dwribe use); 11,a d Sa L M rzaal 4st RogU o tts (C ack nly one box on line A, Check box on line 8 1 aplltttbte) A,) New Syatam 2. C Repiactment 3. © Replacement of 4. O Addition to Tax Rut" WO Tmk, 1 xisti S to b 7,0 i 3'16 " a-5-"-0010 I it WHIM 2n . . ZZi em A- lary { Pendt wec vious issuod IV. yps OfX POWT lSY$tMt (Chock all that apply) sand Filter O Cottst:ucted Wetland otap~ !n•gmund CM ouna3 At p~dP. 3 'K r34 c~ O Si !a PM O Drip Line G houritod In-VMd O Holdin` Tank ng~ e g 0 Other. ---41T =M921 D•~' at Ago I f tLM., a1 s yaurn vatiort 7 Fria e vWPWML4M 1sp Area a. W1 AppfiWar Etciruon -Flow W Required Proposed W (OdlJdty/sR R) iMiadittclt) ~Od /aP 12 td 7 9s -3 y 4Q QY TOW o Mutuwuw i Prtfltb Site Stet Fiber- Plutic H Tank Gp~i atA Gallons Tanks Call. Con. glass ; 1lotothatttioe Haw lr:g crate strutted ! T Tanks 9'l,` 6rle'sftY deJ •at VII r== t 1a l,n,. bili tirr in tall n of the P W'T o rt um r e lamps), o. SUMMU f 2R9-7 ~5-'_T Pk 3: 21 : 7 c~ik.rradT.~~ ,e„ jr L My. tan. Zip c4ov) 5~h' D/G /6? VIII Cousi-Owpartment uu Oaly t i eture o sta,rsp{; lowyTerin t Poo i polo AS tau vrattr t Slue } Stains App gn mvod owed O Owner Given lnltiki AdvtM g Fu) 1)0-( 6 - Doem instl n Mge~__L, ZBaD IX. Condom o Apprpvsd ~ i ~tor,B ~ UPI - ~ je~ OAAA- i _'fo `k*e w reccrw.w~a,•,~o tea 4,~ o a V~0 A¢,rJ 4P ti5_- .ter---- 911"M (R 0700) r y 3o~frry~ ~~p~ ~ SGc2 ~C 410 o 6y 3 a y v ~ e ~ U no Q~ c >w~sconsin Department of Commerce SOIL AND SITE EVALUATION 3 Division of Safety and Buildings Page of Bureau of 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 County include, but not limited to: vertical and horizontal reference point (BM), direction and C percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION -Please rirltall reformation. Re "awed by Date Personal information you provide maybe used for sec ry purpo 51cy ww, s. 15.04(1) (m)). awtM o Property Owner Property Location Govt. Lot z 1/4 _5~1/4,S ls// T 2 ~',N,R lq E (or)C) lCl~ Property Owner's Mailing Address i Lot ~ Block# Subd. Name or CSM# City State Zip Code Pho City Village Town Nearest Road S~In W - LA, Y a r Z -h . ® New Construction Use: Residential / Number of bedrooms 16 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow C/OC) gpd Recommended design loading rate bed, gpd/ft2 ~ trench, gpd/ft2 Absorption area required /Z $5 bed, ft2 112- ,5 trench, ft2 Maximum design loading rate ' -bed, gpd/ft2_trench, gpd/n2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/site considerations Parent material U 4-c-uc, 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 5~ S ❑ U 0 S ❑ U ®S ❑ U ❑ S (a U ❑ S B U SOIL DESCRIPTION REPORT ;;~o Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Z ll~ 'J(Z~ S Z L 1 v~ S' Z rZ-ya D I - s. Znrc~b~ ~ cs .s; . Ground 3 y i f C 5 - -g elev. q9 9 ft. ' Depth to r limiting f 'S • 3y factor min. S75%2- 9 Z_ Remarks: Boring # 6- l0 L S;1 L v 1- ; AMM ~t tYl p CS . Ground elev. Depth to limiting factor I f Ic in. Remarks: - CST Name (Please Print) Signatur Telephone No. Ac S i e l' C7/~~z47-Yd0 Address Date CST Number ZI13 ( 5 Z ZS3~3o PROPERTY OWNER -G~7t L~~ SOIL DESCRIPTION REPORT Page _1 ,of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots Gep/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench NIALI fly1whL n4 11 Ground 3 ~-!l l 5 CS ' 1 q elev. O Depth to limiting, 13. ` factor I I (C in. Remarks: Boring # I b-i z ~ p 2 ~ -fir I v.~ . ~ , Mau 3 46-4(3 IN 96 Ground elev. loo.oy n. ' Depth to limiting Min. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/4 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # ' 6tb _T 3 2 c QbIL ,nor 5 011~1 C_ ' , to 3 -J t0 c Ground ; elev. Depth to 6 . `f . limiting ; factor 117 in. Remarks: Boring # i Ground elev. i n. Depth to limiting factor in. Remarks: SBD-8330 (R.9/98) PAGEaOF 3 NAME y LOT# A.5 LEGAL DESCRIPTIONSc+1 `/4SO/4,S T2-4I ,N,R 19 E (or) SCALE: Iloo, BM I ELEVATION /00.0 (IM DESCRIPTION 4op of II ,,A& ~/OT_ BM 2 ELEVATION 1 I E~DESCRIPTION-f~,,C14,M,, n:OC. la-rti wlF( SYSTEM ELEVATION (9 3"1 ALTERNATE ELEVATION (y• 3 Ll I X CONTOUR ELEVATION f_ cw p3 SIGNATURE • • ATE -D U i 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 3~ 3 q S Number of Bedrooms Design Flow - Peak (gpd) Estimated Flow - Average (gpd) csu Septic Tank Capacity (gal) 2eytS0 Soil Absorption Component Size (W) Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) CXD z Maximum Influent Particle Size (in) 1/8 Maximum BODS (mg/L) 220 Maximum TSS (mg/L) 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 tWh se f tank and outlet filter shall be assessed at least once every 3 years by inspection. outlet filter shall be cleaned as necessary to ensure ` be remove un ess provisions are made to proper operation. The filter cartridge shou not 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 FROM : Schumaker Plumbinq F-iX 1,10. : 715388,3121 Sap. 18 2000 07:20R l F1 ST CROIX COUNTY SEPTIC TANK MktN"I RWANCS ACR 9MENT AM WNBRSHIP CBR'TIFICATION FORM Owuear/Buyec V,~ La S Maling Ad+dra*rs e. ~ b Praputy Ati&= (va meotiaa tlmft ant for or camel oo) s"/s Cfty t Pates ld4mUud= Number oz©- 13 - aS- S . r`f .e.~~kj/-- e'I V,4 T_aj.9N-R,.V.LW, TOWR Of s+n~tvi Gva- ss wit ~ Po p# Spm bma D P<m TA t anualb w no VLffAV%PVqM ~'~i{6~~80~~RSiC~7tiG~m~~R~ CfefO'IYII~R.Y~~ce of F=Fbg now if pqp" owr lon atlb sdmk,t* SL C Z644 t andlado tM014 oipad by owaat atd* ss Ia upoaodim~ac~ 1C w% to u bas reseed tie s►twre totdou** ad sgm to =bola the d wsi& to +stro U16 '+l Mt by &@ of ommmad to Dwaml*otNxtmml ~traaaossaai; ad''t bomi& cae as►'w .vWiWgdwywi q*=bra bm ed st'W mad tadnt to &e tL C mix.C=i$y Zw* a 3O dryst oL wo "Pow you ► due. t r flat sfl ~ om ~ ~ ua tsvc to ~ aEuty fc~ ~,owlaet~a. I (wa1 ~ C•~) ~ too pmgmvy dmadltedl abort, by vhu of t wmsjw dad maW fs Anbw of Daft Cif, m omim OF a mTr-.m kTE An IabWWM dM to t,*.rWmwWd,tn y m* In dw a Wtuyr.puwkt besiad mroicad by ft Zt aW$ D$partas mt NuWyN with t rPuessuan. a moped ► dead team 60 &Gjl*r of beo& *moo it copy of tM axtOod mvay map if mf o is mt& in dA wrafmaty dead ' YOL 1539 PAGE 81 629124 STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH DocumentNamber WARRANTY DEED REGISTER OF DEEDS 5T. CROIX CO., WI This Deed, made between Donalda Speer, a/k/a Donalda J. RECEIVED FOR RECORD S peers, a/Wa Donald J. Speer and Kernon Bast, wife and husband, 09-31-2000 1:30 PM aka Donalda J. Speer-Bast - WARRANTY DEED EXEMPT N 3 Grantor, and Richard O. Stout and Janet P. Stout, husband and wife, CERT COPY FEE: COPY FEE: TRANSFER FEE: RECORDING FEE: 10.00 PAGES: I Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area All of the Plat of Sweet Grass Farm in the Town of Hudson, EXCEPT Lot 1 Name an"d~ Return Address of said Plat. ekl4f 4 0 - SST This Dud is given to correct the ommission of additional lots in the Plat of /35--4 AW rdt&E7 L-- Sweet Grass Farm between the above Grantor and Grantee hereto in that gj4soo, wr S? I& certain Deed recorded in Volume 1453, Page 1;aO , as Doc. No. f~ q O 020.1021-60, 01,{1-1021-80, 020-1021-90, 020.1022-00 & 020-1062-20 Parcel Identification Number (PIN) This is not homestead property. OE) (is not) Exceptions to warranties: Easements, restrictions and rights-of-way of record, ifany. Dated this I;etday of August 2000 n ~ 7*Feer, a Donalda J. rs, a/a J. Speer AUTHENTICATION ACKNOWLEDGMENT Signature(s) Donalda Speer, a/k/a Donalda J. Speers, a/k/a STATE OF WISCONSIN ) Dopalj J. Speer and ernon Bast, wife and husband, ) ss. 025dI~g-T-g . - -.1 - county ) authenticated thisl7 ay of August _ 2000 Personally came before me this _ day of the above named r Kristina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, instrument and acknowledged the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Notary Public, State of Wisconsin udson, WI My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both arc not necessary.) ) • Names ofPersons signing in any capacity mu st be tYPed orPrinsed below their signature. bf afl on P o1as all COMPSny. raw au "C' v" r+ooassaosr WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 - 1999 i I MUM" N(MaWO d(r~W m i se sea )l +v3NNW avc NasN3ix3 Noon 03HSUU a N01103s d0 t4mN 3Fu j0 3Nn 1S3M I Z 38 QL~N3W 1OdW31 3Sy30VS-3CSnOpt I ~ZV*OSQ M„69,60.ooN x" A 4 . , LY•► ► N _ c► w► 0 ` 9 •LY'L6► r, r z 0 'Oft TM'H I Z r ~ ~coof 3N r of ISO \ \ •sa•o►o a.►>tor• of 0 \ \ of ~ ~ \ \ \ bs r " r ~0~~6 \ ° verso o.►&9roos \ ~ ~ ~ ~ \ 0060 ON \