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HomeMy WebLinkAbout020-1376-30-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Divisiyn INSPECTION REPORT GENERAL IN1=0RMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 'errnit Holder's Name: City Village X Township Blue rint Homes Inc. Hudson Townshi ;ST BM Elev: Insp. BM Elev: BM Description: SANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic ; n r, w ( I D~ Dosing Aeration Holding I TANK SETBACK INFORMATION County: $t. CrOiX Sanitary Permit No: 399469 State Plan ID No: Parcel Tax No: 020-1376-30-000 STATION BS Ht FS ELEV. Benchmark 5~ f01•~ ~ A BM I ~nS ~--1~ r s.' 4 I ./ Bldg. Sewer >~-' ~~ S n s' 3. ~ p - ~~ t/ t Inlet ~- ~ , / • 3 St/ t Outlet ~ ~ ~O . t Dt Inlet ~ ~ Dt Bottom ~ Header/Man. f ~. a 3 • Dist. Pip UP C GLwrb ' ~ ~ r~ Ol 3 , ~ (o Bot ystem a• ~'°i .3 Z - ~-f ~- Final Gra 3 ~~ ~ ~. '7 St Cover ~ I ~ ~ G~, TANK TO P/L WELL BLDG. Vent to Air In~ke ~n S ROAD Septic ~ - / Z2 °Ltil Dosing Aeration Holding " PUMP/SIPHON INFORMATION Manufacturer Demand PM Model Nu er TDH Lift ion L System Head DH Ft /" Forcemain gth Dia. II C(lll ARSf~RPT1C]N SYSTEM BEDITRENCH Width I Length I No. Of Tren s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ ~ ~ ~ ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM ACHIN MBER R Man rerj 1- ~~r , ~ ' C'''C% INFORMATION Type ystem: ~n ~ / ~ ~ / CA UNIT Model Number: /b ~~ / V , oLV n 1'11CT1?IRI ITI(1N CVCTFM /1/_ _ r n . . / / h _ w /"J .. d. ('~llti..l.te'I~l~~n I~~1G~CS Header/Manifold Distribution x Hole Size x Ho e Spacing Vent~~ Pipe(s) ! ~{' k ~„le'N ~T cin S Di ~ / ~ Length Dia g pa a Length Cnll CAVFR ., o.e~~...e c..~~o.,,~ n..i~ YY Mnund nr ot.Grade Systems Only Dep Ove ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched B dtfrench enter ~ Bed french Edges Topsoil ~ Yes ~ No ~] Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ / /~ K> ~"' Inspection #2: / / Location: 8f34 Fraser Lane Hudson, WI 54016 (SW 1/4 SW 1/4 14 T2 N R19W) Sweet Grass Farm L Parcel No: 14.29.19.2291 1 J Alt BM Description = r1/A - 541 ~ ~r61 ~f- ~•-ep o~ ~,n,.,~(„a.~t.Qri t+c,,.,e,.d ~ ~cld..-~Fro~.ra~CST~~~ 2.) Bldg sewer length = 2.L r ~ ~ P - amount of cover = ~ I Q `/ Plan revision Required? [f Yes No ~ ' n ~ „ ~ i GZ~~ _ 4 C~~ ~ ~O Use other side for additional information. v l lU~~-- ~C-2~ Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) 3 4~ 1 ~" ~ s9~ V ~ ~ ~~-02-~ ~ yj{ S ~ ~~ ~~ Safety and Buildings Division C0°IIry S.7 C R D I ~ `~ ~ ' 201 w. Washington Ave., P.O. Box 7162 ~~ ~~nS'l ~ Madison, WI 53707 - 7162 Six Address~2 ~ ~~ ~ De artment of Commerce ~ ~Qg6~L /_.Afl.~ ' ~, Sanitary Permit Application ~ ~ ~ ~% Sanitary Permit Number 1 Ia accord with Comm 83 21, Wis. l+fda[.,Cods, personal information you provide , , 3 ~ ~ y~ 5 !G Check if Revision "~ ma be used for seco ses Priva La I. Application Information -Please Print Au Information IVED Star Plan I.D. Number Property Owner's Name MAY 3 4 Parcel Number 2002 I3~U~P~i~T NornFS Inc b2o-1376 3o-ao Property Owner's M at~ing Address ST. CROIX COUNTY Property Lora°oa , ~a g ~77 / ~2~ 7 N .~~t~ ~ ~ ZONING OFFICE Sam/ ,~ S yl/;,i. S f ~'~ T Z9 N, R lg ~ City, Star Zip Code Phone Number Lot Number 7 b Block Number B~ I ~ E /(n ~ ~S f "19 Subdivision Name csnx Number ~ S sn/E£"1' ~ G SASS II. Type of Budding (check all that apply) / ^Ciry ~-1 or 2 Fatm7y Dwelling -Number of Bedrooms ~ ^Vtllage ^ PubliclCotntnercial - Descn'be Use ®Township t UQ~~I/ ^ .State Owned Nearest Road 3 ~ ~ ~" W -~4~~.c~- ~,~A~sElz 1A1.1~ III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) p'' 1 -New 2 ^ Re lacement S sxm P Y 3 ^ Replacement of 6 ^ Addition to For County use S stem Tank Oat S sxm B • ^ Check if Sanitary Permit Previously Issued Permit Number Dax Issued ];V. Type of Permit: (Check all that apply)(numbeting scheme is for internal use)Z'~1R'[, ~!L /, S/AG-1~// .D 44 ^ Non -Pressurized In-Ground 21^ Mound 47 ^ Sand FQxr 50 ^ Consttucxd~and~~ ~i9'7~78t~'~ 22 ^ Pressurized Ia-Ground 41 ^ Holding Task 48 ^ Single Pass Sl ^ Drip Line ~) ~~5~ ~~~ ~ 45 ^ At-Grade 46 ^ Aerobic T: nt Unit 49 ^ Recirculating 30 ^ Other V. Dis ersaUTreatment Area Informat ion: ( KI 1 W!k/1~~iL J 1 FIL7 n'tt~r Design Flow (gpd) Dispersal Area Dispe oil Application Percolation Rax Sysxm Elevation Ftnal Glade Required t ` Proposed i ~ Rax(Gals./Days/Sq.Ft) ~ (Min./Inch) / ~ ~ Elevation 4S D o l3 oY~ ~ g _ 1 ~ /d 7 ._ 9~, 5 ~ 97 5 . ~ ~ VL Tank Info Capacity in T Number r Prefab Six Sxel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New P.ristint Tanis Tank= Septic or Holding Tank 1~ - 1t`~J e? ~ ~~S > ~~ VII. Responsibility Statement- I, the undersigned, a responsibr7l for !°stallatIon of the POWTS shown oa the attached plans. Phanber's Natae (Print) is Si RS umber Busirtess~ Phone Number --~F~ ~~ 2Z32yZ . `7J5-Z9`I-3IN1 Phtmber's Address (Street, City, Stax, Zip Code .gt~~. ZR5 .D)2ESSEIZ , WI 5yD0~ Coua /De eat Use Orel Approved ^ Disapproved Sanitary Permit Fee (includes Groundwaxr Dax Issued gent Signature (No Stamps) ^ Owner Given Initial Adverse . Surcharge ) Dexrmimdon I~. Conditions of A provaUReasoas for Disapproval n < Z) E~,~~d So-c.~ ~%a-~e.~.l- ahlc-~ oCu,~~ ~~rQU~~oc~-t-a-r--G ~ ~'C~r,,~E, ~"1~r~ti_NC~.JI.C,/v~tCl Si-{ovl..~ ..BE ~t2!)Ylf1V`~ (~/ ~/1TS IUF,rfl >~(_14n~ ~ Jnit<T• 1=111 /h~.~ l/t1r.~vrdG ct, d T7t.n~l~F/ F'r-c. u e~ ~c ~ ~ plde plaa,~to tL5 C tytlie .I em on ~ , u iv • , ., ....- i NSt~ ~i'? / x ly~• ~°n~ II0t les. than sv2 x u lacJtes m size SBD-6398 (R. OS/Ol) ~~~i C3~ v~P,e~ ,v7' jb~vl F S !7 7 ~' /~ 7 ~H tl f/E N~ t~LFlI tit ~ M iv 5'Syy9 JV1 P12S ZZ3Z42 srl~l~~l S c~/ ley S !`~ T 2 9 ~ le ~R' h/ 7Dc~/,(/ or f/J/c2solJ ~~ ~~P~S~~ 7~'tl~s t~vi~~ ~It1 UZ' >/ }~/G~ Cf1P~,C-T~~ sl~wiuoE s'Nj7[?R~r'rrnu ~. ~~('i~ 71~tJK lODO GAL Y~~KS hs ~ iced ZR~E~. ~Lr~'~. ~ 11 I~r~HM A R k ~ .~ ?Df' OF ~ JLL !n/~iLk BUT F.L ' lOb ~ ~3EI~Ci-IACtARIL ~'L SDP 6r S. VIII X67 S7A.k~ ~.. ~/.76 Wisco~5sin Department of Commerce SOIL EVALUATION REPORT Page ~of Division of Safety and Buildings u~ ouwiuanuc vvnii vvinn~ u.', vv~a. r~uni. vuuc County 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 Parcel I.D. , percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. d by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). G~',(~~y~- ~ ~b Q Property Owner Property Location ~ Govt. Lot 1/4 1/4 S T N R ,E'(or~ Property Owner's Mailing Ad~ s Lot # Block # Subd. Name or CSM# ~- " ~~ City State Zip Code Phone Number ^ City Village ~J Town Nearest Road v ~ ( ) 1 New Construction Use:~J Residential /Number of bedrooms -- ^ Replacement ^ Public or commercial -Describe: Parent material ~,~~~J..tsr~ General comments ~~ and recommendations: ~~sy.e.~. ~ 9~?~7 '/ Code derived design flow rate ~~ GPD ~~~J ~? 7 X002 ST. CI~J!X Ci~tii~a Y ZONING OFFICE v / Boring # I^I~~ff Boring IL} Pit Ground surface elev. ,~ ft. Depth to limiting factor ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. ont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 / _ o _ ~ ~ ~f *~ i - ~. _ _ --s _ 7 ~ ,~ ~ ~ .~~i ~~~h ft. Boring # ^ Boring _~ Pit Ground surface elev. ,9~-~7 ft. Depth to limiting factor~'yCL~• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 3 s s s. ` -' ~ - --- - ~ (r~0" ~~ ~ ~ - Ct~R--- * Effluent #1 =GODS > 30 < 220 mg/L and S >30 _ 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L ~~%'-J`"'' CST Na a ease Print) Signature / CST Number ~/ Address ~ Date valuation Conducted Telephone Number ~ 'P~ -J ~' l ~~ arse-assu trcv nvv~ Property Owner y~u.~ .!1 ~ .~`~`~,ES' .,c. rJC~- Parcel ID # (~-~=,/37~ -.~D- rJDd Page ~ of ^ Boring # ^ Boring Pit Ground surface elev. - ft. Depth to limiting factor ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 s~ ~ ~ ~' - -3 .3 --- ~ ~ qZ.~f~- 5 ,~~G ~o.~~° , / ~:.~ J x s ~O. ~ ~" . s .. i l,~ "L, s, ~ n,. _ .e O p ~ ~ O.I° / AO /1 ^ Borin # ^ Boring ~, , ,,., ~~ ,; ,~l _~ ~~G~Y~cf~~° vyi. lY~~ 9 u/ uc-- ^ Pit Ground surface elev. ft. Depth to lim ing factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 'Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the deparhnent at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) ~ 7 ~ 9 ~~7'~ ~J.~ ~~ IS G i' ,3 /o r/,~k5 '`~ \ ~.°~, ~ , ~~\ i T ~ t~X T_ ~ ~ 3 _~ h~ /,r_se ~~ u nsp~J P' b \ ~~k 3~ ~/~~ ,~~,/ \ ' ~ \ ~~ ,~ ~~~ s ~j ~5~~ r~ ,- ~ 3a~_3 i" .~ ,!s,~,~~ /l/ .~~~ - ~~ m ~ / t ~ ~~c.~ (sue) r~ 9i 7~ a ~,-/ ,a~,~,~~ps ~ Safety and Buildings Division 201 GV. Washington Ave., P.O. Box 7162 County ~''~~ $T C.~GI)C, ]r~eons~n Madison, WI 53707 - 7162 Si Address De artment of Commerce ~ 88~ (.~~ Sanitary Permit Application r i ' Sarutazy Pernut umber 399~bR n accord w th comet 83.21, Wis..tfdm..Code, personal in~ ormadon you provide ^ Chxk if Revision ma be used for seco ses Priv L.aw, s15. 1 m) , I. Application Information -Please Print All Information State Plan I.D. Number Property Owner's Name Parcel Number i31UE('RII~?~ ~1QIJ`~ES 11 ~~ ~2C~- ~37~ ~ 3~ -CL~ Property Owner's Mailing Address Property Location ~ %lq /L7 7tl ll~`E IU': ~= ~S~r ~ Srt~'~; S J4 T 29 N. R l9 vJ City, Stan Zip Code Pho~ Number T ~u~ber Block Number ~L-~11~ ~ , l~l'11~ ~ J ~~ ~ ~ /^7 1 ~3 ~ 7~7 - X422 Subdivision Name CSM Number 1. I SWEET /rL3 A$,~ Ff~J11 S II. Type of Bta'ltiing (check all that apply) ~ ~ s ~~,,,. ^City ~-1 or 2 Family Dwelling -Number of Bedtnoms ~ ^ Publtc/Commercial - Descn'be Use ^Vtllage ~o /~(.i~~'~ ^ State Owned Nearest Road III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if app ' _ , ~ ' A. 1 New 2 ^ Re lacement p System 3 ^ Replacement of 6 ^ Addirion to For Coun e ~ ' ,~'\ S sttm Tank Onl S stem . as ~ ~ ~~ ~ 9• B• ^ Check if Sanitary Permit Previously Issued Permit Number Da Is d 0 Iv. Type of Permit: (Check all that apply)(numbering scheme is for internal use 44 ~ Noa -Pressurized In-Ground 21^ Mound 47 ^ Sand Filter 50 ^ Consttncu`'-'_(~,0,,~cYX + - 22 ^ Press<uized Ia-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line ~ x( c,> 45 ^ At-Grade 46 ^ Aerob' Treattnetu Unit 49 ^ Recirculating 30 ^ Other ~ V. Dts al/Treatment Area Informat ion: 2Z H ! L- If CAt'. S 1bEYL' K% ffZ J Design Flow (gpd) Dispersal Area Dispe ~ Soil Application Percolation Rate System Elevatio rode 37~ SQ ~`T ~~~~ Ra s./DayslSq.Ft.) (Min./Inch) Elevation VI. Tank Info Capacity in .Total Number Manufacturer Prefab Site Steel -Fiber plastic Gallons Gatlorts of Tanks Concrete Constructed Glass New Ezistin` Tanks Tanks Septie or Holdint Tank /fJCX.1 ~~ ~ ~ vs /~ Dosiak Chamber VII. R nsibilIty Statement- I, the undersigned, assume responsibr'L'ty for installation of the POWTS shown on the attached plans. Plumber's Name (Print) is ture RS umber Business Phorx Number ~ T~FF~ ~~ 2Z32`-1L . ~715-Z9y-31N1 Plumber's Address (Street. City, State, Zip Cade .l~o~. 2q5 .Dr2~SSEl2... , Yi!/ 5y DD 9' VIII. Coon /De artment Use OnI Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agem Signature (No Stamps) ' Own r Gen lnitiai Adverse . Surcharge Fee) ~ ~ e ~, ~ ~. © l~ ~ IZ ~ ~ Q.lllM, IR. Conditions Qf ApprovaUReaLSOns for Disapprovalp ~J ~ _ ~ a~l~2A~ l ~ d~ ~ ~` ~~ `~AVe~t~le~J-5 yv,,ua~~ o~'dttL ~9K ~,~ ~ W L . . o,u.. ~- -~o-a1Z ~{o Ic.~ ~ r n _ ,~ - f n ~1-. t~J . L . ~ ~ 4 -~p tN~Ati, S~c-. ~c.. T'`' ''""` a'°~ `_ f et..C,c.~ts•J~ U ic~!.t ~0"~~f-S ~ c P1A4n~ (to the Coant~ odd) for the system on paprs not less than Ei/2 z Il faefiei 1n dze SBD-6398 (R. OS/Ol) C`~ 3 n ~Cn3 ~ ~ a ~ ~ ~ _ D Nm ~ ~ c ~ _:y b y,\ ti ~ ` _^~` _a ^V V 1Y ~ . .~ 1' ~ ^~ ~' W \ 0 N ~8 ~~ r ~ m s~ ~ b ~ ~v NN W ~ ~ ~ b N ~ N~ .~ m~ ~ ~ ~~ (11 ~ ~ o s ~ ~ ~ ~ ~^ '~ N S '~ ~ r R ~. S _ _ ~ ~~ __ ~ 3 O ~~ `r ° ~ ~ ~' ' ~~' ~ _~ `~ ~ N ~ ~~~ ~ ~~ ~ ~~ ~ ~ ~ ~ ~ ~ 3 _fir~ ~~ hZ=~~ ,~ , , Y ~ ~ . . ^ ~ L~h:,6 /' ~ G~~N a a ~ ~ ~ ~ ~ ~ ~ ~ N~ 1~ 1 X1 ~ ~ ~ ~ ~ N N RZi n r ~ ~ U1 p N ~8 p ~ ~ ~' \~ r 1 cn 1 ~W ~` ~~ `N ~~~~ ~~n~ ~ ~ rn(~` ~~ ~ ~ T~~~ c 3 ~ ~ Q s~ \~~ Rp ~~ ~~ r c ~~ ~~ ~~ ~~ ~ ~ i ~, ~ ~ ~ ~m ~ N N ~ ~~ m~ ~ ~~ c~ ~ s O ~ ~ Z S N S Lt`N~ .+~ . 'Wisconsi Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings 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.~1Y1), direction and G~ I percent slope, scale or dimensions, north arrow, and loca' "end dis~ance to-nearest road. Parcel LD. # Page ~ of .~ ~, '~ , ~,, y APPLICANT INFORMATION - Please p ,alll in~a~ioq. vi ed by Date Personal information you provide may be used for secon ary,pLrposes (privacy Law, s. 15.04 (1) (m)). '~ Property Owner ~ ~- ~~ , .. Cr tG~ ~~U - , , .Property Location Govt. Lot ~~ 1/~(~J 1/4,S (~( TZ f~ ,N,R ~ ~( E (or)(~l Property Owner's Mailing Address ~ ' ~~ 13~ ~,ke~ i~- _ ,~..,~...~_ Lot # , ~~ Block# Subd. Name or CSM# ~.,~e-~ C-t,~ City State Zip Code Ptix#he Number ~]~ City g ®Town Nearest Road ^ Villa e [~ New Construction Use: ~ Residential /Number of bedrooms ~_ Addition to existing building ^ Replacement ^ Public or commercial -Describe: Code derived daily flow ~y y gpd Recommended design loading rate JZbed, gpd/ft2 ~ ~ trench, gpd/ft2 Absorption area required ~~bed, ft2~trench, ft2 Maximum design loading rate ~ ~ bed, gpd/ft2~trench, gpd/ft2 Recommended infiltration surface elevation(s) ~/ 3• y ~ ft (as referred to site plan benchmark) Additional design/site considerations ~~f' ~3• yd Parent material ~'y"fc.~~-5 ~ Flood plain elevation, if applicable,/~ ~7~- _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 ^ S ®U ^ S ® U Boring # -~.. Ground elev. g7.GO ft. Depth to limiting factor ~_in. Boring # ;: 2 Ground elev. 9 ~• 3o ft. Depth to limiting factor 1(~in. Remarks: CST Name (Please Print) 'gnature Telephone No. n~ l v.~-~~ ~ ~ ~%,~% zy7- yGOfS Address Date CST Number iii ~ ~'a~-sF ~.n.~~.s-e..fi w/. s'yozS~ y 5'-DU zs33r~1 C[111 IIFCCRIPTIAN REP~RT..t.D,r . ~,.~.. ~ . Zd27t"~ ~ ~ ~~ ~ Horizon Depth Dominant Color Mottles Structure i B d Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Cons stence oun ary Bed ,Trench I o-1 / r ~ ~ ~r I l ~ r~-~~- CS 1 -~ . 2 ~ - 3 3 ~-~io !0 5 b ~ cs -- ~ ~ ~ . ~ 6. ~( Remarks: 0-(5 -~ 312 ~I ~rY ~r ~5 ~ •2' •3 PROPERTY OWNER ~~c.>t SOIL DESCRIPTION REPORT PARCEL I.D.# Boring # 3/. Ground elev. 9' 7. oyft. Depth to limiting factor ~~in. Boring # `~ Ground elev. y ,o . Depth to limiting fa ~r ~in. Boring # 5~ Ground elev. y~•~ott. Depth to limiting factor 101 in. Boring # Ground elev. tt. '~" ' ~-, Page Z of Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench ~ 6-Ib Z. `-^ Si ~ LS ~ V 2 b- 1 yl~r - sil 2 cs - '.~ X3.2 .t ; Remarks: o-i !~ r 3 ~ --~ s. ( -~ Y~ . z ; - 3 Z i -20 / y 5r I 2 m - ' 3 - to m S d c ~ Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Sed ,Trench ~ a -~ ~ 3 v -~ ~; I 1 c~ I v~ . 2~. 3 2 ~~-24 lC~ ~-- 3~ ~ q ~ ~~ - •5 ; (~ ~ 2~-aa lv I m5 vnl cs . ~ ; . ~ 3''' Iv/foq,S~ , Remarks: Depth to limiting factor in. Remarks: SBD-8330 (R.9/98) ~, PAGE~OF~ NAME ~ 7~y~~ LOT# ~ LEGAL DESCRIPTIO1~ISc~ 1/,x'/4 S 1'{ TZ~ N R la E (or~ SCALE: 1°~= f Uv~ BM I ELEVATION (CX~'~ BM 1 DESCRIPTION--IooTS7''~~: DT~cc.~-h uy~~aoj BM 2 ELEVATION CIS ~ Z U BM 2 DESCRIPTION -1~ p-_ Z_T~=~(~~~}(~1u c~ SYSTEM ELEVATION ~ 3" ~ 6 ALTERNATE ELEVATION 3' ~~ U CONTOUR ELEVATION _ ,.._ I t --`. DATE C/ ~ %~d R 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 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- Table 1: Svstem Desictn Specifications Sanitary Permit Number Number of Bedrooms ;3 Design Flow -Peak (gpd) ~3UU Estimated Flow -Average (gpd) 'y- y, Septic Tank Capacity (gal) 6 Soil Absorption Component Size (ft2) X75 ZZ NAG Cfll? s~~1EvVIN0Es~2 / NF/ Type of Wastewater Domestic ~p TORS Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow -Peak (gpd) duO '' 3 Z Maximum Influent Particle Size (in) 1/8 Maximum BODS (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 se f and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be clea_ned_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 ' ~ 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 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 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 ;EF'-E~--~~_n_i1 1~=t: =4i=i FF'LiP'1: BLUEFF:IhdT HGP'lE'=: Tr,.' ir,T ~-t~LL TCi: 1T1cL~"~^IJ~-~ _ _ _ _ _ .. ,-.., ~ .. ,,,;~,,,,, ~,~~,u ! r L D=? 3 5294313$ ST CROUC CC3UIV1`Y SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSIiIP CERTIFICATION FORM ~wner/Buyer ~j [dl~ ~~` .s11 C, Mailir:g Andress f ~' 7 `~ ~1J/~ Property ,address _ _ b ~ '~ ~ /L ~.~~~ (vcri6catiom required from Planning ri~rttttaat fnr new GSity/Stag 1r.EG FSCRIPTLOriT F':c' P . (3 2 Parcel Idcnti~tca6on Number _ ~ a~ 0 --~ ~~7 ~ ;3~ -'~ (~ Property T.ocatian ~ y,, SW /> $~- , + ~ T~N-Yt~W, Toum of /n.~ sllba~vi~~II ~) ~..2-F- ~ s , rot ~ 3 c7 c~rnr:ea st~-ey IViap # 'voltune _ . Paga # Warranty heed # ~~ 3 ~ Q Volume Page # ~O Spec house D yes no Lot lines ideutifiable~lyes ~ no SYSTF~IVY Iti3AINT~IyTANt;E Xmpro~per use and mairttenaaeeof ycerr septic system could rr~it is its pt~tnlaturc failunc to baaais~rastcs_ Doper asaiarP••~,..•. consists of pmmping oui ta5e septic samlc every three years or sooner, #f needed by a lit3snsed pttmpes. What you put into the systeru can affari the fitaction of t5t septic tank as a t~t~eut stage in th,c rvasta dihposal systram. T~ Pml'~Y oWnGr agtees to submit to st. Ctanc zonutg Depatmteat a certification farm, sigced by x~ owner and by a m~asterpltwnbar,~vu:aeymarl pl~uber; resaYMedPLunber or a licensed p~cr verifying drat (l) the orrsite vvasteavatcrdrsposal systeut is in psvper operating evadititm and/or (2) after inspection and patnpit?g (if necessary), the septic tank is less than 1/3 full of sludge. !lwc, the tmdGtsigped have Dead the above ngttiremcnCS and agrrc to taaitetaia the private sewage disposal system wit~i the standards set forth, hen-a~, as set by nc~ Dcpartztxac pf Gor~+c:c and the Deparmttat of Natural Resources, So-te of Wiscarrs~ ~:ertificAtioa stating that yous sepoia systems }~ bola inaintaiucd must bo t:ompleted and rahrmtd to the St. Croix C.eunty Zoning Qfficc within 30 da of tl~e three xpitation dace. ~,~ , 1 ®' A,TURE A.PPl:.i DATE OWNER CP:RTIFICAI'ION I (we} certify that all statenopets oa this form a~ Iran to the best of my (our) Imawiedge. I (we) am (are} the owner(s) of the Ala above, by vimie of a ~'w~ ~arranty dee-d,~recorded in Rtgistcr of Deeds O~ce_ J SI of AP LI bA'l'E srsrrs Az<y itjfioimatian that iS tnis-tlCpreSCritCd may res:ilt in the sanitary permit being revoked by the Zoning Depatamenr. ••'••• «` Include with tltl3 mpplicatitla: a stampeed vvarrar-ry deed from the Register of Deeds office a copy of ffic ct~tifird siavey map ii reference is rrtadt in the warranty deed 09-20-00 09:31 RECEIVED FROM:763 767 0422 P.02 f STATE BAR OF WISCONSIN FORM 2 - 1998 ~ 656330 WARRANTY DEED ;;,i;ILE=F.rd N. WALSH F EG1:, r F; OF DEEDS A 1 +~ Document Number V ~7~1~f f~(1 l ~ t ` , l _ - `. .r J~'~/! i,U. , WY o . Y ~(r V RECE.VED fOk kECOkD This Deed, made between ___g1~ARD__gr__ST11UT and JADdET P STOLI•T~ --- httchanrl anti ta' faT ..._ ioflkitr'Uiil' DEED _ Grantor, Ei;E~F'T N _ _ __ _ and ~.LUI' PRTfVT HOMESr~~ - ------ CERT COF9` FEE: ,;Qpy F,E• TRRNSFER FEE: 147.94 i•;EC~kDI^I~ FEE: 11.00 _ . ___ _ _ _ Grantee. rA~ES: 1 Grantor. for a valuable consideration, conveys and warrants to Grantee the following described real estate in St _ Croix County, State of Wisconsin: Lot 30, Plat of Sweet Grass Farm, Town of `" "" `""" ~ Hudson, St. Croix County, Wisconsin. Name and Return Address I , ~ ~a ~ ~ ~ ~Y~ ~^ ~~ l 020-1376-30-000 Parcel Identitiration Number (PIN) This iS IlOt homestead property. (is) (is not) Excepttonstowarranties: easements, restrictions, rights-of-way and covenants of record. DateQQd this 7th day of~ ~Se--p~te~mber , Z 0~. i`^~ ~} ~~~ (SEAL) iv""`~'' /'. ~~ (SEAL) + Richard 0. Stout anet P_ Stott _._ (SEAL) AUTHENTICATION Signature(s) authenticated this day of , TITLE: MEMBER STATE BAR OF WISCONSIN (It not. authorized by §706.06, W(s. Stats.) THIS INSTRUMENT WAS GRAFTED BV Janet P. Stout X53 Awatukee Tr_ Hudson, WI 54016 (SEAL) ACKNOWLEDGMENT ' // State of Wisconsin, ss. St. Croix County. Personally came before me this 7th ..._...- day of September 204L. the above named Richard O. Stout and Janet_~__ _ to me known to be the ~~__~~LeKCCUted the foregoing Instrument and a~~FS`iONSIN KERNON J. BAS Nota Public, State ofg i onsin My commisstgq is p r~. (If not, state expij tion ate. (Signatures may be authenticated or acknowledged. Both are not _. __ D _ .) necessary) ' Names of persons signing fn any capacity muu lx typed or printed below tlxlr slgren,re. STATE BAR OF WISCONSIN Wsconsln tegai Blank Co., mc. WARRANTY DEED FORM No. 2 - 7998 MBwaukee. Wls. '=:EF-1'=a-E~i~=t1 11: t=i r a FF?=~P'1: BU_IEFRINT HQP1ES 763 75T `ALL ~or ',i~r' cuui ,r'v~nxi flLi ~n~ vni t ins 1 . ~ ®. • { ~ A . - ~ - ~ ~ - --} ~ €+ 1 - ti ~ \ ." ` , `t ,~:~ • ~ - i 1 - ,erg y+~'~r~ r-~ 1 - ~ 41R i$ , ~~ t ~ ', ~..~ ~w y~/ l ' f /I~ tl V' V V V (. I L V ~Gl ppp~ ~~ t ~~ ~~ ~d g 8~ ~ ~_ f , r .- '~ _ ~ ~ ~ - ~. ~ i~, .'.~ ~ .. 1 ~ a ,. ~ . _j ~ r ~;. - ~~. ~ i, ~~ ~ ~ ~` ~ mss ~. ~ ~ ~ ~~'•~_ ~~ ~~ ~ e ~~- ::- ~• - ~. .g 1 - M.w.t. - e®a.a Z { R ~ m Z ~~ 1& _ ~ ~~ g ~. ~ ~' x~"x-IC~ ~a3Vpp~N ~~- Z Z ~ D~ ~~ ~3 Z~ ~ ~~ f"' ~ o ~ $~ w 09-19-00 -"i~0.:04°'~. RECEIVED FROM:763 767 0422 P.03