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Home My WebLink About020-1376-33-000L~vl ~~~-~c ~=I,SJ" ~ I j Safe and Buildings Division County , ~ ., 201 W. Washington Ave., P.O. Box 7162 Sr )C lseons~n Madison, WI 53707 - 7162 . Siteiddress ~ De artment of Commerce ~ ~s~ ~O,P ~lt~ Sanitary Permit Applica ' -- ~ _ , 1 SanitP~ i[ Nu~ber In accord with Comm 83.21, Wis. Adm. Code, personal ' n rovide ; ~ ^ Check if Revision rna be used for seco ses Privac ~ 1 m I. Application Information -Please Print All Informatioffi , ~.' , . ~ State Plan I.D. Number N A Property Owner's ame Parcel Number NJ~ ~~~ 020 ~!3?b-33-o00 Property Owner's Mailing Address , - ~ ~ ~~ .t-~,.- ~. ' ~~ ~ ' ~ Property Location or~-~ !~ S~ ~ N City, State Zip Code Phone Number Lot Number / Block Number ' ;" I .. Subdivision Name 29~Nmrtbet .~T- ~L ~(1`S SS !2`7 j~5"(- 33~{ - Sri ~ S ~ ~ II. Type of Building (check all that apply) n L1~1 or 2 Family Dwelling -Number of Bedrooms ~~~ ~N^ ^Village ^ Public/Commercial -Describe Use . 1 ownship {~,SQjJ ^ State Owned Nearest Road r!o ~.1C.~ III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A' 1 ~ New 2 ^ Replacement System 3 ^ Replacement of 6 ^ Addition to For County use S stem Tank Onl Existin S stem B • ^ Check. if Sanitary Permit Previously Issued Permit Number Date Issued lV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 ~ Non -Pressurized In-Ground 21^ Mound 47 ^ Sand Filter SO ^ Constructed Wetland 22 ^ Pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass S1 ^ Drip Line 4S ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other V. Dis ersal/Treatment Area Informat ion: QO ltr r Design Flow (gpd) Dispersal Area Dispersal Area Soil Application ercolation Ra System Elevation Final Grade Required Proposed Rate( s./Days/Sq.Ft.) (Min./Inch) Elevation /~//~~ l,(I t/V ~b O ~oa e~r-.~-.1.~-" ~ • Z '_"_"` q i ~. b 1170. O ~- - VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallows Gallons of Tanks Concrete Constructed Glass Ncw Existing Tanks Tanks Septic orfieiAixg~'ailc t~ "` ( ' ~ ~,t,- ~p // Dosing Chamber VII. Responsibility Statement- I, the and ed, assum esponcibility for installation of the POWTS shown on the attached plans. Plumbeya~Name (Print) Pl is Signature MP/MPRS Number Business Phone Number ~P l b Z `Zt r ZZ~ ?~'~~ Plumber's Address (Street, Ciry, State, Zip e) , ~ o `~ ~1~ t ~~7s 7 VIII. Coun /De artment se Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) ^ Owner Given Initial Adverse . Surcharge Fee ~ 2 Z.S °a1 ~isb ~- / ~ ~1 (~ ~ ~ l v ~ Determination 17C. Conditions of Approval/Reasons for Disapproval kIa .~.. (~,~~}~,~,,~ per' ,~~~~,~„~,i ,~ ~ y,~y~ ~,~ ~NR_~e~ u Q , ,~ ~ ~/~~ lia e w ( ' f lct~'fij ' ~,(.t/ N"-~S ~s S~o~ ~ 14t~t~.vYN~ i't 5 ~+ ° ~ ~v'ta/l'S l,e='~C.rd 1: ~ - 1 ' j ,, '~ ryb (~^~'-orDl~tln r 'W)1,~T l~J ~'. ~G •I ~~ Attach comp! plans (to the C only) or We eer on per not less x 11 Inches In she '` ~ r' t~e~'d-'-~ ~ ~ ~t.~e ~o~1..ev~t~,lua;~t~- ~~co(- ~ ~ ~b 9-avt¢- f~,. c~• ~k ~~ker-~ H~ ..,SBDy6398 (R. 05!01) :;'• q~rxv~nu., - Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division r INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). 'ermit Holder's Name: City Village 7( Township Huth, Ma Hard Hudson Townshi :ST BM Elev: Insp. BM Elev: BM Description: ~p < 60.E / =CSr"~~'u' ~~NK INFnRMOTh[]N ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic ~ ~ ~ Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ? r S~ ~ g ~I $ r .~_ Dosing Aeration Hol ' PUMP/SIPHON INFORMATION >~ ,j Manufactur and GPM Model Number TDH Lift ri n Loss System Head TDH Ft Forc ain Length Dia. Dist. to Weu Cnll AQCar1DDTlf'1A1 CVCTGM / IC" I _ i< __ _ Il county: St. Croix Sanitary Permit No: 395246 State Plan ID No: o Parcel Tax No: 020-1376-33-000 STATION BS HI FS ELEV. Benchmark 'O O ~1 1~•~ r Alt. BM 3's'Z ~ o3.~E Bldg. Sewer ~ Dy r T• SUHt Inlet 9 ~ ~. 8 -SZ / St/Ht Outlet .}'a 3b / • Dt Inlet Dt Bottom Header/Man. Dist. Pipe I~•~ ~~ • ~~~ Bot. System ~ , p 3 ~t L • q 'l Final Grade ~ St Cover ENCH idth Length No. Of Trenches /,~ ~ PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 ' ci~,~ rt~G,(+ ~5 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufa }~rer: ` ~e- Ct''-' ~ ~ ~NPr;w/ INFORMATION Type Of System: ~' ~ r ^' 7 -- UNIT Mo el Number. ~ u v. C~ ~ ~w - a . 111CTDIRI IT1~1N CVCTFM v Header/Manifold K Distributio x Hole Size x Hole Spacing Vent to Air Intake ~ ~ ~ Pipe(s) /J ~ ~' 77 ~ Length~~-Dia Length Dia Spacing cnu C(IVFR ., c~..........-., c..~a~...~ n.. ~., ..., IUnnnrl nr ofl:rarlR SvSTP_mS UnIV Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center BedlTrench Edges Topsoil ~ Yes [~ No ~ Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~~ /~/,~( Location: 914 Florence Anne Hudson, WI 5401 SW 1/414 T29N R19W) Sweet Grass Far 1.) Alt BM Description = ~ ~ ~ ~'a'rj+e ~ 2.) Bldg sewer length = 1 U - amount of cover = Z, "-1• Inspection #2: Parcel No: 14.29.19.2294 Plan revision Required? ~~ Yes ~No ~ Use other side for additional informaYon. ~ O ~ ~ O ( _ Date Insepctor's Signature SBD-6710 (R.3/97) 2 2~ 3 3~ Ce~. No. M ~~ l L ~~ ' ~T.L.'Sinz Plumbing Inc. E5609 708th Ave. j c~ Menomonie, WI 54751 o~ M Y~ ~~~ ~~ Q ~~ ~ ~-- Phone: (715) 235-2644 _' Fax: (715) 235-2592 ~ ~v.tlsinzplum~~ing.com if ~ ~ .y ~~ ~~ o ~` ~- i S ~~~ ~ a ~ ~~ ~a ~„ ~ ~"` ~ ~ ~ ~~ ~ `.' ~ C r, ~ ~~ -~ ~ c~ } ~_ ~_ ~ ~. o` w ~ ,~ _~ ~~~~~ , o ;~ ~ ~ ,.~ ~ ~, ,~ ~. ~ . =~ a l~~° ~, N ~} Q ° ~ ~ ~ ~ ~ ~ ~ ~ `~ ~,,. ~ ~~ ~,n ~ ~ ~ 0 ~ ~ ~ ~ Ica N ~.. Q ~_ ~ ~ -- ,_ t . '~ Wisconsin Department of Commerce Division of Safety and Buildings OR-G-~A OIL EVALUATION REPORT in accordance with Comm 85, Wis. Adm. Code ~~~ /:Q f-~" ~~1 ~ ~ j~ . C. 1364 Page I of 3 Certified Soil Testing ounry Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and D Parcel I percent slope, scale or dimemsions, north arrow, and location and distance to nearest road . . . Please print all informat/on. ReXiewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ ~ ropey wner rope oca ion Huth, Maynard Govt. Lot SW 1/4 SW 1/4 S 14 29 N R 19 W Property wner s al Ing dress Lot # Block # Subd. Name or CSM 693 Springhill Road 33 Sweetgrass City State Zip Code Phone Number Cit Village Town Nearest Road Saint Paul ~ MN 55127 651-334-5131 Hudson ~ , ~Flo'rerice /j New Construction Use: Residential /Number of bedrooms 4 Code derived design Aow t3tie~ 600 GPD Replacement Public or commercial -Describe: Parent material till Flood plain elevati , if applicable NA General comments ~ and recommendations : install 2 - 2.T x 93.75' stipulation 1099 cha mber trenches @ system elevt~ti0n of 94:~ ~~ - ~ ~ ;' ~, , . _~ ~~~N ~ ~a r r l~+-! !. Borin ^ Boring # ~ g Pi 100 1 '' ~ r` ;.. ~ 138 `~- i ~~ .° t Ground Surface elev. . ft . Depth to limiting factor n• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roofs " ~ GP O/ft1 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-5 7.5YR 3/1 - sl 2 m gr ds cs 2f1 m .5 .9 2 5-11 7.5YR 3/1 - sl 2 f sbk ds cs 1 m .5 .9 3 11-44 10YR 4/4 ~ - scl 2 m sbk dh cs 1f .4 .6 4 44-139 10YR 5/4 - s 0 sg dl - - .7 1.2 ~.L Boring # Boring Pit Ground Surface elev. 100.1 ft. Depth to limiting factor ~ 144 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Dlftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-5 7.5YR 3/1 - sl 2 m gr ds cs 1f/m .5 .9 2 i 5-11 7.5YR 3/1 - sl 2 f sbk ds cs 1 m .5 .9 3 11-41 10YR 4/4 - scl 2 m sbk dh cs 1f .4 .6 4 41-144 10YR 5/4 - S 0 sg dl - - .7 1.2 `~,ti q~,ti ' Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L ffluent #2 = BODS < 30 mg/L and TSS < 30 mg/L ame ( ease not Igna ur um er Henry F. Grote 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 547 7/25/2001 715-233-0398 Property Owner Huth, Mdyndrd Parcel 10 # Page 2' of 3 ,~ ^ g Boring 3 Borin # J Pit Ground Surface elev. 98.3 ft• Depth to limiting factor ~ 140 Soil A lication Rate ~ in. Pp• Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-4 7.5YR 3/1 - sl 2 m gr ds cs 1f/m .5 .9 2 4ti10 7.5YR 3/1 - sl 2 f sbk ds cs 1f .5 .9 3 10-38 10YR 4/4 - scl 2 m sbk dh cw 1 m .4 .6 4 38-140 10YR 5/4 - s 0 sg dl - - .7 1.2 'kS'~' Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Appligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 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 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I i - I 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 department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) Certified SOiI Testing 3 d 3 '~ 3 /~ n .n f 3 ~ ~I t d ~ 0 ~ ~~ f~ M o ~-+ S d t d S 6 9 ... L -~ ~ J ~- _ ~~/~/ J Y ! v o ~ ~ ~ 3 ~ ' ~ `~ ~ .' `'~ .A ~ ~ d ~ ~ ~ ~ ..~ ~ ~ ~ d~ 6 °~ s ~i ~ y ~ 1 9 ~ ~..~ ~~~ e v °~ ~ /~ ("ra 2 tT' ~~ ~ a '~ ~ o ~~ ~ I d y ; d S n N • \ `c^ ~~~ Y v ~~ /~ ~ r. ~/ • `~ 1 = 0 ~„ ~ 6 ; v ~'r 6 r^. .~ S N V'. ~ ~ ' ~ s ~• •-~ p ~~ ~ ~ - 1 n f ~ w~ ~ ~ ~ :~ -• y+ • /y; ~ 6 `~ d ~ ~ ~ ;~ ,, ~ d , N r°~ d" td o /~ q~ O I J ,.,3 ~ ,_„~, zi0 v f Z^ ~ ,~: .,~ o ~ ~ J 9 c( K,;r,~;ol~Aepartment of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Bureau Qf rategrated services in accordance with Comm 83.09, Wis. Adm. Code Page + of 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 ~ ~. ~ ~ G I percent slope, scale or dimensions, north arrow, and locati9p.aed-dict~ce to nearest road. Parcel I.D. # I \,--~. APPLICANT INFORMATION -Please ~~ ~~ll ~r~ormation. "' , Reviewed by Date -z, n Personal information you provide may be used for se nt~ry`pu es (f iiVAcy~aw, s. 15.04 {~~ (m)). Property Owner _ 1 Prop ii rty Location jch0. ~ S~~ ~! r-,~ a ~ ~ GoviJLot S (~ 1/4s(~1/4,S /~( T 2G(,N,R ~ ~' E (or)~J Property Owner's Mailing Address ~-"; G i,qt ~ Block# Subd. Name or CSM# l ~°> ~ A ~ ~+u P~ T~. a` ~ f, ~4:.~,j ,L. ~ Su~ee-I Urc~ss City State Zip Code ~ Ptio>le NbNiber ~] City ^ Village [~ Town Nearest Road I 1--~i tC~°~,n I t~.11 I ~Llh- to I~'`'~.i5 )~"19=~(0"7~,1~'" l-~v~P~o n I ,G/o~~e ~ ~ h ~ e ®New Construction Use: Residential /Number of bedrooms ~ _ G/ Addition to existing building ^ Replacement Public or commercial -Describe: ~7 Code derived daily flow ~ ~ gpd Recommended design loading rate ~ / bed, gpd/ft2~trench, gpd/fi2 Absorption area required X5,5 7 bed, ftz ~ ~ d trench, ft2 Maximum design loading rate' 7 bed, gpd/ft~ '~ trench, gpd/ft2 Recommended infiltration surface elevation(s) ~ 3' ~/~ ft (as referred to site plan benchmark) Additional design/site considerations ~ 3• ~l Parent material G U'F1~4 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 ®S ^ U IBS ^ U ~ S ^ U ^ S [~ U ^ S ~ U SAII IIFSCRIPTICIN REPORT Boring # Ground elev. ~-1 • SI ft. Depth to limiting factor r' 2.1 -in. Boring # Z' Ground elev. Depth to limiting factor 1 J 1 in Horizon Depth Dominant Color Mottles Structure i B d R t GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. stence Cons oun ary oo s Bed ,Trench e-~ ID ~~ Z, r------ s~ 1 bk c l v~ , `~ ~ . s ~ l y ~'~ - L `~ YYl ~r ~- 5 . -1 y !~-~ /~ y ~ ~S mI ~S ~ ~ ~ •~ Remarks: Z 11~- y~ `~ `~ L 1 ~ c. S - ~ • ~ l0 L.S s - -~ ~ .$ ~ (C~ r I~ ~ s ~ s _- ~ ' RRmarkc~ ;ST Name (Please Print) Si tune ~~ Telephone No. 4ddress Date CST Number ~~~ CS fy' .S~ o h-~P~ ~ ~ ~ S"y'G 2 ,S! ~"G~-GU Z S 3 - 3G PROPt:RTY OWNER ~~"U ~ SOIL DESCRIPTION REPORT PARCEL I.D.# Boring # Ground C3e~le~v,.` ~LLft. Depth to limiting factor Lin. Boring # ~) Ground elev. /pp.ff ft. F~_ Depth to limiting factor / 2 l in. Boring # 5 Ground elev. . 9/ tt. Depth to limiting factor L! (a in. Boring # Ground elev. ft. 7.~ Page G.. of K Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench ~ i~ ~ ~o ~ yl ~ ~ ~ 2 -~' ~ _ ~ . 3 --II l y~w -~ ~S o cs - ~ , Remarks: f b-lo U ~Z --- ' n~ I c ~ ~ ~ . 3 2 y~ r illy ---_ ~ - 1 ~ -- 3 p--l2f /d ~ ~ -- 1 C S -- . ~7 ~ . g 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 I o-r IO r~ Z ----, s r v~ . Z~. 3 z ~~- ra ~ ~( s ~ - i -~' ~ ~ ~ s ~ . ~ 3 -i I !~ 0 s m~ ~ S ~- . ~ ; . ~ Remarks: Depth to limiting factor in. Remarks: SBD-8330 (R.9/98) .~ ~., ~• . PAGE~OF NAME rJ ~U-4-- LOT#3 ~ LEGAL DESCRIPTIONSW '/•Sf~1'/4,S 1 ~(T ZQ,N,R )q E (or) J~ _ r SCALE: 1"= ~~d BM I ELEVATION ~ QU. U BM I DESCRIPTION~pol Z''~Odc }7; p~ I o-+~ c,JiF~a~ BM 2 ELEVATION ~ ~ • S(~ BM 2 DESCRIPTION.Fo~ a -~Z ~~vc A TDB locf'~ ~F,b~ J SYSTEM ELEVATION q 3 , 3 I ALTERNATE ELEVATION ~ ~ ~ s l CONTOUR ELEVATION ~~- a _ 1 x 1 C 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 (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 ln-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: System Design Specifications Sanitary Permit Number q,~Z 40 Number of Bedrooms Design Flow -Peak (gpd) o Estimated Flow -Average (gpd) ~ ua•s, S Septic Tank Capacity (gal) p Soil Absorption Component Size (ft2) [a~ S F+'` Type of Wastewater Domestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soif Absorption Component Design Flow -Peak (gpd) Maximum Influent Particle Size (in) NA 1/8 Maximum BODS (mg/L) NA 220 Maximum TSS (mg/L) NA 150 Maximum FOG NA 30 Table 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Outlet Filter Should inspect once a year and clean 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 tank and outlet filter shall be assessed at least once every 3 years by inspection. 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 continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic Management Plan for a Septic Tank and Soil Absorption Component 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 comp{etion 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, Ws. Adm. Code when the tank is no longer used as a POWTS component. Soli 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 firom 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. Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since rootlin rusion into the component may obstruct wastewater flow. n~,,, ~'vl VGIi ~IUN~ ~ ~~Gt ~rrl ~(S - Z3 ~~(o ~~~'~'~ 2 Monday, July 23, 2001 3:22 PM 763-785-4148 UB•'u:rUO FRI 1U;31 F.~.T Tt5 ~K6 iRAtl ST CRT CO ZGYINC 5T CRt3IX C~tfiCTY SEPTIC TANK MAII~i'iBNANCB AC3RB$MHNC AND OWNERSxIIP CBRTIF'ICCATION PURM OWrtstx~/Buyar Mailing Address PropartY Address '~ t 'I o (Vetificatiera mtaireet from Pbtusiag Dtparnnene ittt oep croanautxiaal . GityJState ~~»~~ ~ ~ Yucca Identification Ntt:stber t~'.'~O-!'/3'710~ ~ ~/' ""tea ~,EG4A~D_ILS ~TIQN ~D~Y Loeatien~l _ %., +.,. /., Sec. 1'( T o~$ N. 9 w, Town of ~~S1rf Subdivision ~U,~ ~?'~ ~~ S Lot # ~- Cet~tilted St:rtrey Map Q _ Voituue ~_ +. peBe # ._--,._: W4trtttnty Died # ,~. ,Volume l~ # Spec hgttsc C1 yes ~` no Lot lines identifiable,'yes ~ qo ~l7U1 sYS~~~ ANt~ Improper use sad ma~ntcaano~ot y4vr stptic sys:emeould scsutt in ita ptrm+ttare faituta to h:adte+rastes. P:opermaaoe eoast:ZS ear pyrapma out (he septic teak every three years eer stwnar, if neseled by a licensed pumper. What Yera put into ties system tree met tLe llmctioa of t}» scpdc teak as : tratmenc stage is tlta masts dispont s~tetit. 'The ptoparty ataarr attecs tc ettbmit ro St. Cxoi: Zaatbog Depattmem a eterdScadoA fornL Biped hY the osrper cad by a tssasaeeptta~obeac. ~~Inaabati testKSekad pltmtber ar a ticeoacd Des ~~7r'4g drat (t) ~ ea-stte.~.so~aarntuasal ~y~eaa -s ea pttrp~r opetat4ng t7naditioo smdlar (x} aAcx f~eetioa and pumpia~ (if t(eceasatY), tits sepNe ueaie is ices Sutn ils !oQ of atadge. I/ws, d/e ntsdaaettpsed hsvo twJd the s~bave taq+eirweeata cad agree to ttssiudtin the pt3rsite snw~ga tiityoael t~ s~ the stmderQt set faetb,, hetsia. as sat by flit DePaemaeat wt Coam~etae cod ttte DcpasKzncm of Netaat+l Rejotaces, Ott: of Wi:~ ~~ ~~ 3~ stathog tbsl yewr septio system has bean ras+adined mutt be a0alpteKOd cad rtxlttnod to Cleo St. dare t :otmay clef-~4 a titrae year eapteatiaa date. t X31 B S~(3NA~ ]7[iRE OF LiCANC >)A'i'E b R t~R'YTkZ~.~,TION I (vim) exttiry tbas stl tntrxncnts oa this fotrse are trice: eo the bets of my (our)1-ae>,xtedge. t twe) sue tom) ~e awaer(s) of the p=apetty des ed above, vinut of s vrattaury decd rGeemkd io Register of Deeds Office. `. ~7 ~ a ICt23A E OF N'PL ANT DA'Tg rovoksd b ttte •••~•~ •••••• Aar iz4fcrsett+ti9a that is atiis-~aCSe~dtedtnty tetult is the aaaitirypt~a-it btWg Y ~~S DsP~~- •s Tectsidt# vrit6 tots applitatioa: a ttan~yped watraaty dead from the ICe~;atcr t!t >)eod~ olCcs sa caapy ot't5e ta;rttltrd sun-ay ~ K rskteaae is made ate 4ee wanttttP dead p.02 ,~ aOQj 9NIflN[I'idZNIS7.L t8SS96ZStLT XYrI ZT ~ bi I00=/£ZlLQ ._.. __.. WISCONSIN -' DEPT. OF NATURAL RESOURC ES September 12, 2000 vo!_ 1~~x?Par,~ 490 State of Wisconsin 1 DEPARTMENT OF NATURAL RESOURCES Tommy G. Thompson, Governor George E. Meyer, Secretary Scott A. Humriekhouse, Regional Director West Central Region Headquarters 1300 W. Clairemont Avenue PO Box 4001 Eau Claire, Wisconsin 54702001 Telephone 715.839-3700 FAX 715.839-6076 TDD 715-839-2786 Keman Bast, Donalda Speer-Bast, Richard O. Stout and Janet P. Stout 948 Labarge Road Hudson, W[ 54016 SUBJECT: Request for Variance to Deep Casing Requirement Dear Mr. Bast, Ms. Speer-Bast, Mr. and Ms. Stout: Your potable well variance application from the Wisconsin Well Construction and Pump Installation Code (NR 812) has been reviewed. The location of this proposed well is in Section 14, T29N, Rl9W Town of Hudson, St. Croix County. The legal description is Lot 33, Sweet Grass Farm Subdivision, in the SW '/a of the SW '/o of Section 14, T29N, R19W, Town of Hudson, St. Croix County. As mandated under sections NR 812.10(5), NR 812.12(3) and NR 812.12(15), Wisconsin Administrative Code, greater casing depths are required for new wells drilled in Section 14, in the Town of Hudson. This is due to the presence of volatile organic compounds in the upper water bearing formations or aquifers. Special well casing requirements for this area specify a 10-inch diameter outer drillhole extending a minimum of 50 feet into Cambrian sandstone. A 6-inch well casing is installed within and below the 10-inch drillhole. The annular space between the k0-inch drillhole and 6-inch well casing is then filled with neat cement grout to prevent contaminated upper aquifer water from using the annular space between the well casing and outer drill hole as an entrance into Cambrian sandstone. You have indicated that your existing land investment combined with the deep well casing protection costs would result in a personal financial hardship. For this reason,. you. wish to terminate this well in a more shallow aquifer than required. VARIANCE GRANTED Your variance to the requirements of ss. NR 812.10(5), NR 812.12(3) and NR 812.12(15) is granted, However, because this well will be subject to a greater risk of contamination than a well specifically constructed to protect your water supply from known contamination, this variance is granted subject to the following conditions: 1. Prior to construction of the weU, a copy of this variance must be recorded at the 5t. Croix County Register of Deeds Office and written verification of recording must be forwarded to the Department of Natural Resources, Drinking and Groundwater Program, 1300 West Clairemont Avenue, P.O. Boz 4001, Eau Claire, WI 54702-4001. After proof of recording is received by the West Central Region Drinking and Groundwater Program, you will be contacted with a ftnal written approval to proceed with your well. You may not proceed to construct your well ttntil after this fmal written approval is given. Quality Natural Resources Management Through Excellent` Customer Service °^^~°°^ RxytleO Prom col. iG42PA~F 491 Kernan Bast, Donalda Speer-Bast, Richard O. Stout, Janet P. Stout -September L2, 2000 2. The well must be sampled for volatile organic compounds (VOCs) within 30 days after the well is completed. The well owner must send a copy of the sample results to the Department of Natural Resources, Drinking and Groundwater Program, 1300 West Clairemont Avenue, P.O. Box 4001, Eau Claire, WI 54702-4001 within 30 days of receipt and keep a copy of the sample results for their file. The well owner must either: A. Allow the Junker Landfill PRPs who signed a consent decree with the State of Wisconsin in May of 1996 continuing access to the well owner's home to install and maintain a whole house point-of-entry activated carbon filter treatment unit at no cost tv the well owner; or B. Comply with the following sampling, and treatment or well replacement requirements, at the well owner's expense (1) If the sample results referenced in paragraph 2. above indicate that the well is presently free of VOCs, or has detectable amounts of VOCs below Wisconsin drinking water standards, the well must be sampled once every six months following completion of the well until further notice by the Department. These samples must be sent to a lab certified to perform VOC testing and are the responsibility of the well owner. The expense of the lab testing and associated costs are the well owner's responsibility. A copy of all sample results must be sent to the Department of Natural Resources West Central Region Drinking and Groundwater Program (at the address indicated in paragraphs 1 and 2) within 30 days of receipt and a copy of each sample result must be kept on file by the well owner. (2) If the sample results referenced in paragraph 2. above indicate that the well contains VOCs at or above Wisconsin drinking water standards: (a) The well owner must either drill a new well, reconstruct the present well to 50 feet into Cambrian sandstone, if possible, or install a whole house water treatment device. This device must be approved by the Depaztment of Industry, Labor, and Hutrtan Resources as capable of removing or reducing the specific VOCs identified in the well. All maintenance of the treatment device, sampling and testing costs are the responsibility of the well owner. Because the water contamination problem in the Town of Hudson is complex, any whole house treatment device requires receipt of written approval from DNR before installation begins. (b) If future VOC levels increase above the capability of the treatment device in use, a new well must be constructed with casing terminating 50 feet into Cambrian sandstone. However, it ~ be possible to reconstruct the existing well 50 feet into Cambrian sandstone, although the cost of reconstructing, operating, and maintaining the existing well may not be practical. ~a~ 1642PA~,~ 49? Kernan Bast, Donalda Speer-Bast, Richard O. Stout, Janet P, Stout -September 12, 2000 (c) Anew well, reconsuvcted well or whole house water treatment device must be connected [o the home plumbing no later than six months after receipt by the well owner of VOC laboratory results. 4. At the time the well is constructed, the wel! owner shalt notify the Department of Natural Resources, West Central Region Drinking Water and Groundwater Program in wrhin whether the well owner will allow responsible patties or entities who have volunteered to do the sampling, filter installation and maintenance at no expense to the well owner access or whether the well owner will do the sampling and, as needed, filter installation and maintenance at the well owner's expense. 5. The well owner is ultimately responsible foc complying with al] of the conditions of this variance. 6. A copy of this variance must be given to the well driller. 7. The well must be completed within one year of the date of [his approval or this approval becomes void. 8. A copy of this variance shall be provided to future owners of the well prior to property transfer. An approved variance does not guarantee water of acceptable water quality or quantity. Failure to comply with the terms of this approval voids the approval and may result in the abandonment of your well. NOTICE OF APPEAL RIGHTS [f you desire to challenge this decision, you should know that Wisconsin statutes and administrative rules establish a time period within which requests to review Department decisions must be filed. For judicial review of a decision pursuant to sections 227.52 and 227,53, Slats., you have 30 days after the decision is mailed, or otherwise served by the Department, to file your petition with the appropriate circuit court and serve the petition on the Department. Such a petition for judicial review shall name the Department of Natural Resources as the respondent. To request a contested case hearing pursuant to section 227.42, Slats., you have 30 days after the decision is mailed, or otherwise served by the Department, to serve a petition for hearing on the Secretary of the Department of Natural Resources. The filing of a request for a contested case hearing is not a prerequisite for judicial review and does not extend the 30 day period for filing a petition for judicial review. All hearing requests must be made in accordance with s. NR 2.05(5), Wis. Adm. Code, and must identify the grounds for the petition and the desired modification or change to the order or variance and include the following: ~o~ 1642pAt;1493 Kernan Bast, Donalda Speer-Bast, Richard 0. S[out, Janet P. Stout -September 12, 2000 i. The substantial interest of the petitioner which is injured in fact or threatened with injury by the Department action or inaction: 2. That there is no evidence of legislative intent that this interest is not to be protected; 3. That the injury to the petitioner is different in kind or degree from injury from the general public caused by the Department action or inaction; and 4. That there is a dispute of material fact. (You must specify the disputed facts.) This notice is provided pursuant to section 227.48(2), Sta[s. Si erely, C Q es E. Boettcher Hydrogeologist c: Well Driller Jim Boettcher -WCR Tim Hanson -WCR Larry Schaefer -WCR Pat Collins -Baldwin DG/2 -Private Water Supply DuWayne Bakke -Nor-Lake, Inc., P.O. Box 248, Hudson, WI 54016 James Dunker, P.O. Box 1340, Long Key, FL 33001 Lori Rosemore -Ayres Associates, 3433 Oakwood Hills Parkway, P.O. Box 1590, Eau Claire, WI 54702-1590 Brian Wert - 980 Cty. Rd. A, Hudson, WI 54016 David Jenkin -All Phase Companies, Inc., 404-A St. Croix Trai] North, Lakeland, MN 55043 This document was drafted by the Department of Natural Resources. Subscribed and sworn to me this t,day of , 2000 p~,. , J;. .T> •. • ~ G- ~ ,~ :,. ~, A '~ ' ~lic, State of Wisconsin My Commission expires ~-~(~ Wednesday, August 22, 2001 12:32 PM 763-785-4148 p.01 c~~/ ,~ Q~ ~ ~l - ~ra i X ~~u r~~ ry 20 i't ~° n jD ~ ~~~a~ ~~~ y ~~~~~~ ~~,~~~ Wednesday, August 22, 2001 12:32 PM 763-785-4148 p.03 Sent by: EDINA REALTY NU060N WISCONSIN 715 388 1502; YCi.1 guur+tr:':veJ ' STATE BAR OP ISCONSIN FURM 2 - 199 WARRANTY DEEfl o.,.,..mt M,ntev oer22io+ ++:a3; ~_xeol;Pege xrz This OEed, made betw~n - --- _ Grantor. ..~vu~ww o [tLTA a~ DRAT2[`I'A M,. /~ADTt:~ Y- artd _ . , single to _ Grantee. G»ntor, Iw a.,aWaAk wnrtdentWti wrnrys end warrants b Grantee the 1o11owing descrthetl real elute in ct ,s~A~ x Coumy. Stau of Wfacotnln: Lot 33, plat of Sweet Grass Farrar Town of Hudson, 6t. Croix County, Nisconsin. n~ __ (SEAIa ~$ne~ p _ Ct A1Y*' _ 020-1376-33-000 ,^.._ Po.tal InNNficaFan -aenEa WM Thb i_S not_ hd[nestwd Pn+perry• (b] (b not) E~eptbro to warrantlse: eaeemante, r•stri.ctione, rights-oE-way and covenants of record_ Dated thle i ~ daY Of ~. _ 1007 uL ~~H ~ ~_-_~ -15EA1J (SEAL) AUTHENTICATION Slgruture(~) authentitatad fhb _.~ day of TITIE: MEMBER STATE BAR OF WISCOMSW prriw. authoritad 6y 5706.08, Wla Suu.) THIS IN9TRU-tENT wA3 DRAFTED OV Janet P. Stout 1353 Awatukee Tr Hudson, WI 54016 (Signetum Wray pe euthmureted or aclutowledRrd. Bub ale not necessary) • N.... d p.,w.wW ~• .^~ c.r.rhr ~+ ew VPed d Pp"Mr eetew lTATt aAMe t)F W ISCONSIN tweerun l.eoa tww Lo . R. wAARANTT DEfA FORM Nom. 2 - IIMR INrw6~q Wa. tEs544~~' IrpTF(LEEH H. WRISH STGI1L'ROYXOCODEEWI . RECE[1k~ FOR RELORD Dd_Z~2ps1 At15 M INIRRDMir DEED EXEKPS ~ GERi CODY FEE: yr FE¢: z.oD RE[DRII~IfiFiEE: 1000 POfiFSe ~ t 4a:rn@ny Mm Mama antl Rw,m Adhere ~~e(1pe. Q~a. Ey.,Llsow . tr+~ a'eJotV 3 ~o ~8~' ACKNOWLEDCMEN7 (sEAW State oI Wiseoostn, SY. St. Croix County. _}._ Prnorully ...ro before erle fhb i W c ay a! _. ~ ~~ znn~~.Omabwerituned R' c•}tard ~ otr~ anA .T~near D ___ Stout _ .._to me known [o bce;r~Ttc,l~ ~ILtieeuted the ftuagoh>L Lstn+mentandS~DFMWJ~CONSIN KEX~10N J. BAST ry Publk. State o In k commue n !s rrunmt. (If not. Yatr reptntw[t date: rc~ 1703n~ 4$9 STATE 6AR OF Y~15CONSIN FORM 2 -1998 Eas4407 WARRANTY DEED KArMIEE:N H. ua1.55 Deaurorr 1dNnlal~ ' This Deed. made lletwaen _~ _. . Tcsantee n ~ nor A Tsars o a.w..~_ _ Cen[ar. MAYNARD R --~ °°arrw u nn~anCr Ind " Ti_- ~ Grantee. ' Cn+naor, for^ wrWebk cons:decatlon, conveys and warnnta to Gnruar the folbwrng ~~arcfltaad real estate to St. C=oix Counh. 5q:e of Wiscorein: I.ot 33, Plat o! Sweet Grasc Farm, Town o! Hudson, 9t. Croix County, 1ViscoASin. REGISTER OF OEEO ST_ CRDIX CO_, WI tEL4tuE1 FOR AECORO OE-22-2001 5:15 M BcwrrwrT oom EAk11DT t CERi COF'I FEE: COPT FEEL 2.00 TppFaFEA FEE: 167.70 REIDR}ll6 FEE: 10.00 PAGES: 1 nvcda.yl a.w wa..ranaa.~+Addeu +~a~ ~ ~ a. e1 r1.tL~ ~,.,osoN. w~ ~Int4 3 ?0~8~ 020-1376-33-000 Pearl IaenaT~calion twmear flra ThY is not hamrstNd p+openy. (Is) (Is noQ Euc.plw+u to vyraniks; ea8em®nts, restrictions, rights-of-way and covenants of record, `'M~ _~ day of .~- 9 nn 1 lys•lad this - - _ .. ~• • '~l+_ 1..- . ~ !'~'~ ~Tet ~~ 15EAL) ~ n~ .-. . (SHAD *.~ - T~a.t P ea•....ti ~- 6EA1-) AUTH~NT~CATION Sigr+rtwc(>) i ulhemicated this day ~ ' '.'fTLE~ MEMtER STATE gatR ~ NASCONSIN pf not. au+hortred 6y §705.06. VYIa. S:w.) ' Tnis awsrwuaatr+n wws o:sAFrso sv Janet P. Stout 1353 Awatukea Tr Hudson, HI 54016 ~51tY+au:res may be emhen[tuted ar acknowledged. Both a+e no: nea~Earyt) ISEAU ACKNOWLEDGMENT State of Wisconsin. ar. gt. Crt71X County Petmttaty came bafo[e me this 1 ~ day of _ ? n rLl. llrc above rnrned _ Richa~~r~ anA 7anot P Stout --- me knrn+n to bs rl~-`~-ad the rayEw"8 icrwmcnt and 1~~iQ~(N J. BAST No Publk. 5ple o scoroin rnmml$ n is t. (I( nod r:ak cKplntlon date: 'ti ~~ .. .) • Nanan N R~ +k~a ~^ rnY +w+•kY ""'a to ypd .. pdnua 6dw gwa+M.~e~+~ +rKaaar.. tagr cur tb., ar:. 3TA Oe R pi= 1 ;~S1K ova-... Ms 'NAIRAN'R DLED Z/Z a9ad100Bk~1=l `•2b:tt ID/ZZ/BO ~ZOSi BBB StL NISN079IM ND90fIH A1ltl3H tlNId3 :~G luaS Zp'd 8bLV-S8L'£9L Wd Z£~ZL 4002 'ZZ;sn6ny '~epsaupaM VO!_ ~,s4~PAGE 4~J~7 Pis•~T otc s~T ~ae,+ss f~, T~ o ~ f 4JO5oNr S t = ~'Ro/x CO• ~ f•C~~ S • 646dOS Y,ATHLEEN H. WQLSH kEGISTEk Of DEEDS ST. CkOIX CO., WI kECEIUED FGk RECOkD OS-21-2001 10:00 RM, UAkIANCE E%EMPT q CERT COPY FEE: CGPY fEE: TRANSFER FEE: RECURDIHG FEE: 18.00 PAGES: 5 x4m~ l4ea rt,m..oa Item~n Address ~~~~~ ao. _. ~~ ,~o~, w ~' ~/~ `n0.: Puod IdmtiGntim Namber R>Nl "THIS PAGE IS PART OF THIS LEGAL DOCOHENT - DO NOT REltOVE° 'Ibi. ieformatiou muYbe oomplemd 6y abmitlet: dxanny Hde. mm~c ~ rcnuft c~Jrvt. awf fjC! ~/ngidredJ. Orher/~ornadas nrcA ar dt sraKdnt dmrru, kia[ drsufpdon, ua ~ be plaeul on thkl4+r P~i~ 4f du docrr~+v or ~7 be rlucsd on odBdanal PQi° ~~ - 1o,vnenL ~£i Vis of rMr cmrrpaia addr awe pare w yo.r Jaciana~t and 37 00 m der neonCnr /er. RZon..te Swuer, 59.51 ~ WRDA 715'6 05f04f2001 0:16° 715855855 4,~ALTER BUILDINGS PAGE 03 :~v ~v~.u:;j~~~.x3 ~lc:~-~~-~ ~~ ~ ~, ~`~~~b~~ „ VV ~ { J /~ ~ ~ G t J ~ w.~.nw.,nwwwwn~.n~y S l t ~ , Yi r' , V a s ~ ~~ ~~ ~~ _ . . .,, N ~i '~" ~a ~ ~ ~ _ ° ~~ °' 1 Z'7 ~ ~. ',~ a ~?' ~ r \ .;,~~ .~ ~ ~. 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