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HomeMy WebLinkAbout020-1376-40-000/* Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division • INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Lawa~.15.04 (1)(m)l. ~llle~'~eHO.~e~rey e. ~ city ~'~Ilu~sgn ~"ownship CST BMElev.:- Insp. BM Elev.: ~0- BM Description: /_ ct/~t TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic r ~, ~ ~..r Aeration-~ Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. vent to Air Intake ROAD Septic °~sb ~ >/ G r Zd ~ NA Do ~ NA Aeration NA Holding PUMP /SIPHON INFORMATION ufacturer errand Model Numbe M TDH Li Lri ~ System TDH t F terrain Length Dia. li ELEVATION DATA countJt. Croix Sa n itaLV3~1;1ry~No.: State Plan I~JD44No.: ParcelO~~Nq 76-40-000 STATION BS HI FS ELEV. Benchmark , Z 0 Bldg. Sewer `Z, l q Ht Inlet p', ~p Ht Outlet ~ ,~ ll) ZZ Header /Man. ~. ~ ~ - Dist. Pipe ~~' ~ ~~' ~ ~ Bot. System Final Grade ~, ~Z .~~ 0 -ZC~ SOIL ABSA~RPTION SYSTEM ~ ~ , t ~ _ _ . o BED / EN Width Length No. Of Trenches ~ PIT No. Of Pits Inside Dia. Liquid Depth DIME ~ -~ D MEN I N SYSTEM TO P / L BLDG WELL LAKE /STREAM L ING M nu cturer: SETBACK INFORMATION T pe O + r ± 3 G r ~~Gr1 r ~--~~ CHA OR UNIT o e um er: ` r ~- System: , r11tTRIRl1T1AN SYSTEM Header /Manifold _ ~ ~ Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake / Length ~ Dia. ~ ~ Length Q~~SDia. Spacing ~Gi~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil p Yes No .Yes No /COMMENTS: (Include code discrepancies, persons present, etc.) ~ Z~ 1, Location: 952 Florence, Hudson, WI 54016 (SW 1/4 NW 1/4 14 T29N R19 ) - 429192301 Sweet Grass Farm -Lot 40 1.) Alt BM Description = ~, c~ ~~ 2.) Bldg sewer length = 2 0 ` -amount of cover = 7 JP-~ 3-~ 0 b 5 c r//v,,,,((~i/~ /M ~ (.YJI S i`k ~j-~A~ ~ ~~~ Plan a isit5fi3t i~d?~Yes~~ Use other side for additional information. SBD-6710 (R.3/97) I~ ~- L 0 Da a lnspedor's nature Cert. No. \, ~~ ~~ ,~, ~~ . ~.~L.. 'F~--OR~mr L'f4n1t/ Sanitary Permit Application [n accord with Comm 83.21, Wis. Adm. Code fsC~ ty! Ja+, f~ Sec reverse side for inttructiona for compacting this application De tirtnier>t:oE:~'"`' Personal information R mmeree You P~de ondaty ptnpe ~~~ ~' ~a~ . Safety do t3uildings Division 201 W. Washington Avc. PO Box 7302 Madison, W(5370?-?3,02: (Submit compacted form to county if not . -nr•----...•.-+..=v,,,,a~.un - crease Yrtnt aU iRfO Proper! Owner NBsne f~+Yu~ g O ~ (~ City. State ~ Codo lr.~T ~• o l (o II. Type of Bui2diag:(check otre) ~( I or 2 Family Dwelling - No. of Bedrooms ;~_ [~ PubGcJComme.rc(aI (dcscn3e usc):r © Sfatc-Owned .~ 4 3, " - h~,~~~ 95 ~ o [II. T e'of Permit: gseclc onI one box on tine A A) i. .New 2. Realaoement 3_ ~~~ ~ Pmpaty Location ~ i/4NWt/4 SI T N R~ W' °~r Lot Number B N ~' `~ ~ -- Subdivision Namc or CSM Number i -i e b~ S rasr `~-,.. ^ City ~ Village ---_- B if applicable? i ~! . 9 t q ~ 3 o i IY. Type. of POWT System: (t~teck a!I that aPP1Y) ~Nort-ptrsn'rizcd I~ g Cl Mound D Pressurizod ~y-gourd ^ Holdin Ta k ^ Sand i:,lter ^ i O Constructed Wetland . g n ^ At- de [] Aerobic Ttcatmc»t Unit S ngle Pass ^ RecirwIatin O Drip Gnc ^ Other ~~ Y. Dts crsa!lTrsntmcnt Arca Information: . t. Design Flow (gpd) : Ro uitnd Aix p Mca A, a ~ ktimr !fate r 6. ystem 7 ~ q Proposed c~ Soap` St-~ Rate (t? 1s Jday/sq, ft.) ~ >U ~ F. icvaGOn 9~ S 9q 9 VII; 'Wank Capacity in Total Information Oattons O lt # of Manufactunx . Prefab ~ , Site Steer Fiber- Plastic ~; [r,,,, a ons '~ Tanks Con- Con- glass ~ Tanks ~ erctc str ucted + s ~-- ~ ~ ~ ~ ~ es e r:s fl - o. o 0 0 0 VIII. ResponsibUity Statement t the undersi ed assarnc bill for instal! of the POWTS shown on the attached laps. f Flumbe~s Naare ( MP/MPRS Alo. Pboae Number IX. County/Depart'ment U:e Oniy 0 ~~PPro~ Sanitary t'ctmit Foe (includes Gtotmdwatcr pate tssucd Arrant ~ ~ (~No starts ~APProv~ D Oamer Given tniNal Adverse Fec eO ~ S~/1~.10""---~ X. ~onditioas of Approval /Rcrrasons for Dtsapprrovai:, p w ~~ ~ ,, ~ /~ ~____ .~. t.( 1M~S-t- .Q.v~b~,lAtC_J~Y`~:t-LYIQ, `~ -uK,I~.I~L D.,i 7 ~i'i'L~ t. 3 C~ ~2~ ~K J~ i r ~ ~o _ Q,. - t 3 S ~ ~ Q ~. 3. ~ r o ~ ~ i '= o ~. -~ ~: I p 1 i w 6 : ~ ,~ ' f i _ ~ 0 I I I = °~ _ ~ ~ -=- - -- i M -- -- _. - J ~ - i , - - ~ -- ~ - ~ ~ ` { ~ ~ __ - ~ ~ i ! ! -- - ! i ~.~ ~~c i ~ ~ - ~ i I E r , ____ __. { ._ i._. i. _~... c i ~ _....- .... i. F"--'- ____ i.. ~ r i ~__ ' __. i k ~5~ r ---- -~._ _ ._ , - j_ -_ _. ~" ;. -- i ~ .~ f-c~,_ .._ ~.t~a „ { ~ ~ i ' - r ; ~ i ~ ~, ~ ~ t i _~ ~ ~, ~ ~ ~ ~{- 1 - - ~~ f~ a~ N y~ __ s_ E._-___ j . ~ _r. _ -- ~ i ~ ~ { ~- _ ~ _ _ -~ -- ~_ t _ -_ --- ~'-' ~ ~ _ ~ ~ ' t r li ---_ h ..__. L d -.l l Uanu~ ---y~ ~~ ~_ ~ ~ ~I:CC[I:fflf.~fl:~•i1.l:l p~ L ~,~ a~ 1~' I •~ ~ r ~• ~ `v U ~~ ~° c 0 `~ aNi c ~ ' + cti C ~ ~ N O ~ ~ _ ~ ev • O <3~•~0 ~~`. C •_ U ~ C TJ C N ~ ' 3 O O -~ Q,O ~ ~ ti vi U~ C • `v~~ai yr o>, u,°'~$. ~ .G E ~ ~` ~= ~_ U O N 1~ ~ ,n 0-~-J~ ~`~N.. O C ~ ~ ~ •O ~. ~ N ~ U ~ •D L ~ ~'' ~ cc N ~ O m~ C • V „ ~ `J V N L r ~-~ c ~ ~ ~ c ono a~~' o ~JOl in a Y~ ~.. ~ p n ~ ~ ` (/j A ' ~ ~ X M ~ J ~ c~ N ~' r o , c ~ ` o N C ~ ~ 0. a~ 2 ! X n ~ . ,- G ~ .c ' O~ ' ; : N O cw i ~ ~ ~ ~: ~t ': ~; . • '` ~ V • I T~ 1 .~ C V) : j ~ ~ 1 u v.~ ~ :. `> i~ .. 1. , : I O C ~, ~ 1 ~ z~ ~~~ :; -_ ~~ ~, ~ , M is ~ ~ v~ ~~~ rf T6 u R I U ~, ~ • ac, i ':t ~ ~~n Yr ' '`ti 4 7 ~ ~ • ~ s;w ~~ i {. ~' ~: a ;. , Wisconsin pEpattrnent of Commerce SOIL EVALUATION REPORT Page ___~._ of ~, Division of Safety and Butidtngs in aooordanoe v+Rft Comm 85. Wis. Adm. Code County s ~ ' x Arach ~rtp',cte site planon paper not less than B 1R x 111nches ~ atze. Plan must h}dude. but not Limited to: vertical and hartzontat reference point (BM), direction and Parcel. I.O. ~ (3 - parreMslope. scale a dimensions. r>«ih arrc~v, and location and distance to nearest road. pate Please prfRt all intormatlon. Revievred by ~~ Perse!+et rnforrnatlon Ya+ QrOMfdf ~Y Os used ~ secondary purposes {t?dvraeY lew. s. 15.04 (1) (m))• P OvmeC ~ propertylocatton ,~ `,~ Govt. t ct S UJ 1i4 ~ UU 4!4 S / T o1l N R L $~3 W Proparty Ovrner's Mani Address Lot q Btodc !1 Stbd. Name or CSM# S ~r Ci1r ~ ~ r7.~ Code gone Number City ^ Yltage ~~ Nearest Road ~l ~J:~ ~ O s 1 9 I to v~o v. New Corutrudion Use: ~ Residential / Number of bedroom ~ Code derived design flow rate 1 ~ O f~PD Replacement ^ Put>~c a oommerdat - Descrii~ A Parent material O W~ W ~. S Flood Plain elevation if appAcab~ . General a.~rncnts and recorrtrtxtndatlans: /, ~ j ~'' S s- ~ q6.$ y 5 u~~uc.-' t3ortng # p ~9 ~ J ! ~ ~ ~n~ ~~ _ i"` Ground surface elev. Ptt R. ~- ~-- Soli Rate }. peps Dardnant Redox 0escriptlon Texture Stnrcttne Consistence Bounda ry ! G `Eff#1 'E1f~2 hti. MtlnseR Qu. Sz Cont. Color Gr. Sz Sft. l ~ q ~ p-1 ~., l0 r 3 / ~ o~a_ lr C vJ 5 / n, Shk >n~ h] r r 1 a ~~-'~•Z ~~ r ? S 5 ~ C~ ~ I~ , (o ~ RatE ~~ ~ ,~~ p~ Ground surface elev. ~~~' ~ R Oept}t b lknitlng factor 1_~ ~• d Roots GP Dlflz Horizart ~ 3 Depth. in. 0-$ -aa ao a~ Dominartt Mansell /d 3Z /~ ~ s ~ 7.5 ~6 Redox t~saiption Qu. Sz ConL Cdor room 0 Nom Texture !I 5 S l Stnxdtxe Gr. Sz Sh. rn 5 51~ Cortsistence FnU r Mfr M~~~ say Bourt C~ c~ w ~rn i § 1 .~ . 5 ~ ~ 7 `ER#2 •~ ~ £~ ~~ Z 7- 53 ~a r ~ tJo~na- S •~.1 w - , _._.~ i ~.Q4~~ i~ I' yu.. l~to9 - _ t1S~T~ > 30 < 220 mg/L and TSS >30 _< 150 #Z = BOD < 30 mgA. and TSS ~ 30 mglL CST Pltartser x- Telephona~ Nam w t~ - Pro~ereyowner ~2.l~lrQ~ lAa~e~~ Parcel 101x QoZO -1 X7(0 - ~-(~ l~epe ~a.~ a l~ Pit cr~~ /D /t 7 ~ o~, a n ~«,>,!~~ ~- sat , ~ ~ / MaAton Deptlt Dorr~irrark Redox Desalpfion TexEurs SYuctue Coralabenoe 8aundary Rods t3P Drff ln. ~Aunsell t]u. Sz Cork. Cobs i?r. Sz. Sh. 'ElG11 'Etf#2 p -13 ~~!- ~. ~ n~ / m 5b~ err e ~ a rn .~ r 'e r~ ~ ,3 0~ 5~~ m S k r ~ i~ S -~ --~ ~-..~. s-r ~, s ~ ~ t~ a s - ~. s ~• S >r -- ~- ~ ~ ~- ,~ D B«ire ^ Pit Ground surface elev. R Depth b factor ~ SoA Rske Hadaorr Oeplh [)otrrinsrk Redox E~esaiption Texture Strucare C,or~tenoe Boundary Rods GP DAl~ lrr. MurreeM Qu. Sz. Cord. Color Gr. Sz, Sh. 'L~1 'gtil1 a ~~ ~ ~ ~ ~ Ground surface elev. ft Depth b irribr~ factor in. SoH Rate tforiaon Oeplh Donclrrarrt Redoes Oeeaipforr. TexOure Slructrrre Boundeuy Rode in. MunseA t1u. Sz Cunt Color Gr. Bz. Sh '~1 ' • Efikrent #i = BODE > 90 _< 220 mgll and TSS >3ti S 150 mgA. • Edrhrent #2 s BODE ~ 30 mglL and T8S _< 90 mg~l Tlu Department of Commerce is an equal opportunity service provider sad employer. If you need assistance to access mnricas or need material in an alternate format, Please contact the dcpactment at 6Q8-266-31 S i or TTY 608-264-87?7. asrss~wc~r t a i r~ ~ '~' "- ~ ~, i t I~ 1 i E ! ! ~ t ! -- _' ~- ~` I , I .. i , ~ ~ w `_ ~{ :. 1 1 i ~..~..- p I I ~ ___ _ _._ _ ~ _ - ~ ! 1 , _ 1 , _- ~_ - -- - , - -- - -- I 1 a . .. 1... _7__.. _~___. ..___..~_~_ ... _i-_ _. e __ { -_ _ . - - --- - f - -- - 1 ~~ ~ E ~ t ~ ~ -~ j j I ' , ~ t V i i I I ~ . ` a 1 I ~"~ i l i V f { i t ' ! ~ I { I ~ ~. . j t~ I ~ 1 ~ ! ~ I 1 r I 1 r ~ k 1 I I ff I 1 ( I ~ ~ I I r 1 ' ~ I t ~ , ~ 1 ~ ! , I I ~ ~ , ! t j i k j 1 i 's I I ~ I I I ~ _~ ~ _.- I{I{ I I... I I 3 i t ! I ~_... I ` k ~~ i c i ~ f 1 _ _.{-._~ ~.-_- .... __.{..._._.I.___._~_ ~.. ~...-_ ~... .. .~__ ..-___. _....1. _ __ J.____ f .__.I. __._ . ___ _ _ _ -_~_..t.. __~__._ _....t_ I j- ~ ,. ~ ' ~ R ( ~ ~ I I ~ ~ I I I cr ( ~ I F ' ~ I I I i . I I _._ -_- _._! j I I ~ I ! I I ~+ I ~~ A ~ I ~ t ~. e I _~ }}~ ~~ \4 ~ ~ i ~ I I I I~ ~ I i f I f ~ k i r I I t ( , i i t ~I 1 _ _ -i. _. . ; _. __._;. _._.-F_~..-~ _~ .____.I_ __._. .__.. _ _.i .i_. _ _._ f ___ __ tr _ _ .._ _ _ __-__ .. _._._ .__- _ ~. } I I I ~ i ~ f I J ~ ~ ~ ~ I I ! f E i ~ k - i ~ I i I~~ i I + ; ~ I i~{ J I~~ I t_~ ~I i~ ~ I i ,_ ~ ~ ` j I i ` 1 I r i I 4 f k I ! I i , ' , I ~ _ ~ I 1~ I i 1 ~ I_ _ _ _i _._- I 1 i l I 1 ~ i ~ i I {I ~ .I ~_ ~. { j I f ~ ~ S j ~ ~ ! ( I , G i I kk 1 " _ I ~ ' 1 1 i I I ~ ; ~ i I ~ r ~ f ~ I I.- -~--- -- ~ r ~ f I!~ ~~ 1 1 I ~ I ~ I I ~ ~ ( ~~ I I ~ I ~ - C ' 1__ ~ ~ ~_ . _ 1 1 ; i ~ I ( , ( 4 ~ { I ~_ i ~ f ~ E -t~ ~ _ I ~ ! I ( ' ~ ) I ~ i i I 't i r I f~ ~ _ 1 _._ f ~~ _ _ ___. _ I ~ - i --- -- - ~ __- I _ ' .I r 1 ~ t t ~- i ~ - i t - - I ~ ;- } - ~ ~ I j I s t ~ ~ ! i f k 11 `' ~ I ~ ~ I i ! ! i I I I i i ~ ~ ~ ~ I ~ I t ~ i i f ' ~~ T i f i j ~ I w E } '. ~ l ~ I; i 11,~( `~ ___. ,__ ___._ i.. I I ~ _ - - -- i l i I j f I ~ l I ~ ~__ ~ ~ , t i ~ ! ! ~ E I I I ! I --- ~ ~ ~--_--- I -- -- ~ ~ - i - '- - _ -~- ~ t 7 --- t- - ~ ~ , 1 1 ~~ t ! j ' ~ i r j i ~~ 1 ~ ; ~ ~ ~.. ___. I I ~ ~ i f i i ; ! 1 i ! I I r ~ I- ; -- ~---'- _1. i 1 r I f i I I ' i 1 I I I , __ .._.. _ _._ ! _. _ _ _ __ ! ~ i _ t_ L - - - -, _. I I I 1 ~ I 1 t 1 .. ~ i I ~_ _I ~ ~- ' i w E ~ i _ _ _. ~ E ~ ~ ~ i ! ~ ~ ~ ~ ~; i i I ~ I I i ~ i r i 1 v r- 1 ~ - t ~__. .i !-.. . _. _ 1 _ 1 + ~ ' i ~ I i ~ f ~ c I Z ~ ~ I f 4f i I i , ` 1 1 ~ ~ '. ( I I ~ .. I ~.. I .. i I ' I f I, ~ A I I I E I ~ ~ I ~ I ~ I ~ I f I f V i f ~ ~ I I I , f I 1 - _ _.- _-_- ___ . _. f -- -- _ - - i _._ ~ _- ~ _ I ~ _ - - i -- - _ t_. _T__ _ _ (t;}. _ -` _ _ _~ _~ -- -1 _ -~-__ I ~ s -x --I i ~- ~_ _j-.__ _.l ._-.__~.___.._.. _.. { _+_~ _ ~ _ . I ' f -_._~ ~ -_ i .~ ~ f I ~..__._ _-1 .'_ .. I ~ . __! _; _ _, wiscvnsi Department of Commerce SOIL AND SITE EVALUATION • Division of Safety and Buildings Bureau tit Litegrated services in accordance with Comm 83.09, Wis. Adm. Code ^r Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ~~'~~U~~ Page ~ of APPLICANT INFORMATION -Please pr%I}Ya~l ~111fdI7rT~>?~Qh:'ti\ Re awed by ate Personal information you provide may be used for second ;iiyrposes {Privacy Law s~ 16.~.~t} (m)). ~ 'Z'~ 'j,~ Property Owner (~ •~_, ' i"~ ~`: ro~erty Location }~ I ~ ~'( }7JU -}°`~ Govt: Lot ~~ 1/4 ,f/t~/ 1/4,S /U T Z ~( ,N,R / R E (or) Property Owner's Mailing Address ' , - - a ,,~) LoY# Block# Subd. Name or CSM# City State Zip Code Phone Number ` °,: ~ ,~, g ® Town Nearest Road ^ Villa e 1~ G ~'uc~ ~~ W l S~'-lc~l la (`1l5 ~~y~ (v ~ 1 . .,a ° 1~~..5a .-~ F/ ~~ h c ~ L.a n e t ~;~ ~. (~ New Construction Use: ®Residential ! Numb"8ref-§~d ms _~ - y Addition to existing building ^ Replacement ~" may- ~ ^ Public or commercial -Describe: Q Code derived daily flow s,p ~! gpd Recommended design loading rate ~ bed, gpd/fi2 ~ c0/ trench, gpd/ft2 Absorption area required ~? bed, ft2 ?52~ trench, ft2 Maximum design loading rate ~_bed, gpd/ftz_ ~ D trench, gpd/ft2 Recommended infiltration surface elevation(s) ~ ~' ~ ft (as referred to site plan benchmark) Additional designlsite considerations ~ / ' ~ a Parent material 0 U~w~51.~ 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 Q s ^ U ®s ^ u ®s ^ U ~ s ^ u ^ s ®u ^ s ® u CAII I'fFSCRIPTIAN REPORT Boring # Ground elev. Q(-P ~ `zYJft, Depth to limiting factor I!Z in. Boring # Z Ground elev. 9~ft. Depth to limiting factor 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 d-9 I~ r Z S.! ~ ~ ~, lv~ .2 ~ -3 Z °f -3~a i 0 r `ll ~l _' S1' i 2r k mF-~ c ~ - - 5 ~ ~ ~ Remarks: ~ ~-lo ~a ~z s~~ ~~ ~ err ~ u~ . z ; 2 -o-z9 is r/ t-tly -- s, l 2 ~. ~; .- -~ ; - ~ 3 29-I !3 `t to `i CdS ~ ,m l C -- . ~ ~ . ~ i~',Lin. nernarKS: ,ST Name (Please Print) 'nature ~ Telephone No. G s~ ~ ~~~`=ay ~-~x~ ~ Address _ Date CST Number Z // 3 ~~'~' ~~ sG V~ ~-Se- ~ G/~ 1 ,S-Yaz .~ y- ~/_ G ~ z S 3 3 cs SOIL DESCRIPTION REPORT PROPERTY OWNER PARCEL I.D.# Boring # Ground elev. 95.K~ ft. Depth to limiting factor 1119 in. Boring # ~~ Ground elev. 9y -cx~. Depth to limiting factor II in. Boring # 5 Ground elev. yy-~~ft. Depth to limiting factor 1 a~ in. Boring # Ground elev. ft. ~,' Page ~ of ~~ " ~~ * ', ~ . Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench Z 9- ~ ~ r y~y Si ~ k ~~ ~. s - ~, 3 - rite ~ o r yI ~o Cos p m 1 c s - . "1 ' . ~ Remarks: a-g I~ 31z ~~ 1 k -~ CS I ~` . z. ; . 2 ~- 2~ r y l y -~ S C I Z o.bk ~,-~-~i L c - . s;. (~ ~ 21-~/z 10 ~ `I~la ~ CvS c7S n~ I cs - _ ~ ~ . g Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench I b-~ I ~ 2 - S. ( ( ab r f ~ Z ~ . 2 -28 td r `-I Iy ____ 5. t 'Zmabl~ LS - . 5 ' - 3 -ia ~~s o mf cs -' .~ ; . ~ Depth to limiting factor 'n' Remarks: Remarks: SBD-8330 (R.9/98) ~, . ~~, PAGE~OF~ NAME hr's ~3'f" LOT#KD LEGAL DESCRIPTIONSw'/4pW'/4,S/~{ T2~ ,N,R19 E (or) ~,.~ ,SCALE: 1"= (OCS ~ BM I ELEVATION I U y. ~ BM I DESCRIPTION qq: ( ~ r. 20~~ ~oxelc(R ~ 1~~~ BM 2 ELEVATION IUU .~ BM 2 DESCRIPTION ra; jqn po~b(e ~3oxe~d~rh+c SYSTEM ELEVATION / ~. $U ALTERNATE ELEVATION °I (~ O~~//O}} CONTOUR ELEVATION ~ /I`1 SIGNATURE DATE Apr ' 09 D 1 D 1 : 4t3p OwnerBuyer Mailing Address Property Address City/State ~~o~,/ ~~ Parcel Identification Number _ (~Z~ "" ~37G ~ ~O LEGAL DESCRIPTION Property Location 5 w %,, l `~ ~ %, Sec. ~, T Zg N-R~W, Town of up ~~ Subdivision " WE~`'T ,C'4SS / M" ~, „ -_, Lot # y0 CertiCed Survey Map # ,Volume ,Page # Warranty Deed # ~.~ ~.~ ~ . Volume ~~~ ~ ,Page # .3~ Spec house D yes ~ no CALVIn POWERS 715-246-5135 ST CROIX COUNTY SEPTIC TA.NK.IUTAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM ~' S~ANNo~r ~EGLE p.i Lot lines identifiable ~ yes D no ~~1~ <O/ ~ SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in ifs premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner. if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Tlrc property owner agrees to submit to St. Croix Zoning Department a ccrtiGeation form, signed by the owner and by a master plumber, journeyman plumber, restricted plutnber or a licensed pumper verifying that (I) the on-site wastewaterdisposal systeta is in proper operating condition andlar (2) after inspection and pumping (if necessary), the septic wnk is less than I/3 full of sludge. I/wc, d~c undcrsigacd have rwd the above requirements and agree to maintain tltc private sewage disposal system with the s[andards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning OfFrce within 30 days o tcc year expiration date. ~, ~~ ~ ,~a, a~ SI OF APPLICANT DATE OWNI;It CERTII~'ICATION I (wt) certify that all statements on this form arc true to the best of my (our) knowledge. I (wc) am (arej the owner(s) of the p described hove, b virtue of a warranty deed recorded in Register of Deeds Office. ~,' ~~'~~'~- '- ~ ~/ it ~ S NATURE OF APPLICANT DATE '••**• Any information that is rnis-represented may result in the sanitary pcmrit being revoked by the Zoning Depamnent. ***"' ** Include Frith this application: a stamped warranty decd from the Register of Dccds office a copy of the certified survey map if reference is made in the warranty decd (Verification required from Planning Department for new construction) 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 Design Specifications Sanitary Permit Number Number of Bedrooms Design Flow -Peak (gpd) Estimated Flow -Average (gpd) (~ Septic Tank Capacity (gal) Z.S~ if Soil Absorption Component Size (ftz) "fSD Z- Type of Wastewater Do estic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow -Peak (gpd) 2S~ ~/ 2 - as Maximum Influent Particle Size (in) 1/8 Maximum BODS (mg/L) 220 Maximum TSS (mg/L) 150 ~~ ~9l c~ ~~ 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 is t n nd outlet filter shall be assessed at least once every 3 years by inspection. The utlet filter shall be cleaned as necessary to ensure proper o e{Z ration. 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 t ` 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 enfering a conbned 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 fhe 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 +• Document Number vo-_ 1548P~E 385 STATE BAR OF W[SCONS]N FORM 2 - 1998 WARRANTY DEED This Deed, made between RICHARD O. STOUT and JANET P._STOUT, husband and wife, - _, Grantor, and _.IEFE-Rl9y M w~yl~~nd SHgNNnN M W~_Fr i F'_r__ husband and wife, _ -- ------ --.__ _, Grantee. Granmr, for a valuable consideration, conveys and warrants m Grantee the I'ullowbtg desu~ibed real estate in ! St. CroiX _,~_ County, State of Wisconsin: Lot 40, Plat of Sweet Grass Farm, Town of Hudson, St. Croix County, Wisconsin. 1 631. 183 Y.ATHLEEN H. WALSH kEGISTEk OF DEEDS ST. CkOIX GO., WI RECEIVED FOR RECGRD 10-45-2000 10:20 AM YARRRHTY DEED EXEMPT K CERT COPY FEE: COPY FEE; TRAN5FER FEE: 155,70 RECORDING FEE: 10.00 PAGES: 1 Rcti:oroin;i Area Name arW Return AtldreSs ~FLC__. Parcel Identification Number (PIN) This 1S riOt homestead property. .` (Is) (is not) Exceptions to warranties: easements, restrictions, rights-of-way and covenants of record. r Dated thls _ 3'-_.___ day of ~~ ~1C- 2000 ~"1 C.1~,_ta _~r , ~ (SEAL) -yip:=- ~ ~i4'~ (SEAL) R~icha`r~d O S out _ Janet P, Stout (SEAL) (SEAL} Y AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. St. Croix Count. authenticated this day of , __ Pe`s~n~ c me before me this ra day of 2 0 0 0 ,the above named Richard O. Stout and Janet 'TITLE: MEMBER STATE BAR OF WISCONSIN (I( nat. ___._ authorized by §706.06, Wis. Staa.) THIS INSTRUMENT WAS DRAFTED BY Janet P, Stout ___13.53 Awatukee Tr, Hudson, WI 54016 (Signatures may oe authenticated or acknowledged. Both are not necessary) - m me known to be th~l~rT6~R`bt PD~~(Ge'ecuted the foregoing instrument and ~ITiAZFi(~~ie~~~tpCiONSIN KEflNON J. B S7 No y Public. Slate of ~sconsin ` My commission is/ pe}frtanent. 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