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HomeMy WebLinkAbout020-1376-56-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division • INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal infom~ation you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village Township Roschen, Delmar Hudson Townshi SST BM Elev: Insp. BM Elev: BM Description: i~ 6~ .c71 (`D ,c7 ~ `~ ~ 3IY JG CSI-" i31M'~ TANK INFORMATION LEVATION DATA TYPE MANUFACTURER CAPACITY Septic I, Q~ Z / D fo Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~[ ~ 1 Dosing Aeration Holding PUMP/SIPHON INFORMATION tuber SOIL ABSORPTION SYSTEM (~ ~' r,,,,,,,. BED/TRENCH Width Length No. DIMENSIONS --, 1 h-v. ~ County: St. Croix Sanitary Permit No: 395250 State Plan ID N Parcel Tax No: 020-1376-56-000 STATION BS HI FS ELEV. Benchmark ~ ?• [ ol. ' ~ D Alt. BM 3 . y o ~ g. ~'r Bldg. Sewer ~; Z O , ~~-~ SUHt Inlet b . 4r ~s' SUHt Outlet ~ •~2 ~S .c.31 Dt Inlet Dt Bottom Header/Man. Dist. Pipe 2 ~ • g'L- 3•G3 93.13' Bot. System ,p, ~p I q z-mss Final Grade , St Cover Of Pits Ilnside Dia. INFORMATION T e Of S stem: CHAMBER OR t YP Y ~ UNIT Mod I N=mCb~er: ~• ~ DISTRIBUTION SYSTEM ~ ~' Header/Manifold Distribution x Hole x Hol Vent to Air Intake u Q e S Pip s ~ ZD 'I- Length Dia,_ . Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Ontv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes ~ No [] Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ ~ /~/~ Inspection #2: TT Location: 931 Florence~,lLane Hudson, WI 54016 (NW 1l4 SW 1/414 T29N R19W) Sweet Grass Far Parcel No: 14.29.19.2317 1.) Alt BM Description = -f `~re$~. a `~ ~ ~' dasf ~) b~Scnrr.~°"` ~v`,^~' P ~taeJ ti" t;~`^~cr'~ Z.""~c,~,~..~yv~ 2.) Bldg sewer length = ti 30 ~ tip.- ~- ~t,~~ ,~ - amount of cover = ~ t$N ~~ t~'"r 3~~~ ~.-~Qo E~ ~'1-I~, r Plan revision Required? ^ Yes ,No ~ Z ~~/~~" J `,~~,~ r - ~/ Use other side for additional information. f t ` ~~ ~'~" SBD-6710 (R.3/97) ~Dj~ f} n t~ Insepctor's Signature Cert. No. ~ ,q~(C ~~~~~~ ~_~! >~~«a,,. .ten /i~ ~~ ~ % > ~ ~~ ~ ~ Safety and Buildings Division 201 W. Washington Ave., P.O. Eox 7162 W Corry ~ -~^~ C'~~ f ~ ~Srn js'~~ Madison, WI 53707 - 7162 ___ Sao ~ Address + 1 De artment of Commerce _ ~ ~f ~~ ~~.C1~~Ul1Ga~ Sanitary Permit Application m`-` ><' "nb~r Srna.tary Pe~' J In accord with Comm E3.21, Wis. Adra. Code, personal informal ~~~Fo}ide 'j ' ~ ' ~~,b~l~ tf R:~ tna be used far seco ses Privac Law s15 ltt ~. ~ - -----? r _ I. Application Information -Please Print All Information ~,~:~- ~ `^ '~ j Sit: Pl:uz t.D.-h~~~zt,er --- Property Owner's Name ~ ,,,.~ - ~~ rn `~ ~~ reel N.rmbe /~ ~ ~, (~ - Z 3(~ _-- - 1 Za - /~ 7b - 6 ~ coo a Pmperry Owner's Mailing Address ., l:~X J carion ^1' ;lsrrty L a ! ~ J I ~ ^ Ciry, State Zip Code ~ ~ L, .1`i'umber ~ Bloc;ic nlumber ~` ~ ~ ~LLyu~ ~ s~a~~ ; _r t~ ..__~__,..~ Sul:~ivision N CSM Number ~ --~k w, _ II. -Type of Building (check all that apply) Clcay ~,1 or 2 Family Dwelling -Number of Bedrooms ~ ~_ _~ ~- _.._ ^' - +%]lage _ ^ Public/Commercial -Describe Use - -- ~~~ ~~o . y ~h'na'tLS:hi ^ State Owned . p lY __ Ne. Esc Ituad ~, _ _ , ~ZL''NG~~ III. Type of Permit: (Check only one box on line A (numbering scheme for internal usej. Campl~te liaYe B if arplicable) A• ~ 1 New 2 ^ Replacement System 3 ~ Replacement of 6 ^ Addition to For County a>: _.__~ S stem Tank Onl Existin S stem B • ^ Check. if Sanitary Permit Previously Issued Permit Number _ _ _ _ _ __ Datr l ~ s sec lv. Type oP Permit: (Check alI that apply)(numbering scheme is for internal use) 44 ~ Non -Pressurized In-Ground 21^ Mound 47 ^ Sand Filter 50 ~_ ~'onshu:aFJ '~ ;::a:+.u 22 ^ Pressurized In-Ground 41 ^ F.;alding Tank 48 ^ Single Pass 51 ~~ ::;rip Lire 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculatin 30 ^ Omer V. Dis ersaUTreatment Area Information: 3 ~ v -~.t~~.u~ .~ _ Desi n Flow ( d) Dis ersal Area Di rs l A il A S i ti ~ g gp p spe a rea o ppl ca on Yercolucion Rate Systatr r(e~utio~ Fir.'1 Grade R i d P d ~ ~ Q~' equ re ropose ~~~ Rate(Gals./Da s/Sq.Ft.) (Min./] net.) P~. ~ wn,.. Oe~ HE1f;sation ~~ ~ ~/~8 ~ ~~ , 7 / ~ I Z . o ~ ~ Y,~ o _._ ~ VI. Tank Irtfo Ca city in .Total Number Manufacturer _7 _-_. Prefi: F ~% ~ Stem ~ 1"Tiber p]as~;~ Gallons Gallons of Tanks Con~:~cre Cors ,~ .°e;d ~ fslass New Existing Tanks Tanks j Septic or Holding Tank Z `~ .~ ~ f - '1 ~ j` " - '~~ Dosing Chamber -- - ~ ~!- ~ _____.._ _.. ._-_..1~! __ _ VII. Res onsibillty Statement- I, the undersigned, assume res nsibWty for installation of the P(3WTS shown on the _at:3::clled plans. Plumber' Name (Print) Plumber's Signature MP/IA'umber ~.- _ Ee:,i: sss Phone Number Pl ' umber s Address (Street, City, Stag, Zip Code) ~~'~~lil/~/L VIII. Coun /De artment 17se Onl --- ---.__~_~__._. _._____~_ _--. Approved ^ Disappmved E Sanitary Permit Fee (includes Groundwater- T+ate Issued Is,u:~,~ Agent Sign;,rsre (No Stamps) `. ~ Surcharge Fee) ^ Owner Given Initial Adverse .. ~ Determination 7f ~C~ , O ~ Z /~'~ ~ a ~~~~ / w. .~. ~-vuuauv u1 appcovaLltceasoJ]s IOr LISa~proVal ~ ~ 1. Effluent ter to D8 mstalledd andU mamtame Peer manufacturer's recommendations. 2. This revision was submitted to reflect a change in system location. 3. Well setbacks to be maintained per NR 811 & 812. 4. Any filling and grading that will affect the capacity of the HWL retention area is prohibited. ~ Attach tom lets >s~ (to the l,oun od )for the - ~" ._ . _'-'~ P P h 7 s7stem on paper' not leas ttunr 81/2 a 11. tnehec 1n eL~: . SBDyb39$ (R. OS/Ol) ~~~- ~~~~ D~~M~R, ~ o~c~iv l''=-3a' ~N L~L 2 ~1LU~p(`~ ~J ~\~ ~ ~ ~ yo 2~~ ~~V ~.~~ q~+ ~~ a~ ~M2 ~~ ~~ ~~ mp aza~l97 ,, ~~ q-~=~/ Wis~orvsin Department of Commerce • Division of Safety and Buildings SOIL EVALUATION REPORT Page ~ of in accordance with Comm 85, Wis. Adm. Code __ ~~ ~~. Attach complete site plan on paper not less than 8 1/2 x 1 t inches in size. Plan must ~ ST • e. lX inGude, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I D percent slope, scale or dimensions, north arrow, and location an ce to nearest road. . . ~ ~ _ l3~ 6 _ S 6 - 0 0 D Please print all inform tv2~, ~ /~, /. Reviewed by Date Personal information you provide may t1e used forsecon ~ ses Priva Law, s. 15.04 Y1) {m)). ~~ Property Owner pc~F\~~ ' Property Location ~~L Zl)gE~~ , SZ- ~ r \'~'. ~ r;ostt^J.ot• Nl.v t/4 Si.U1/4 S 1~ T Z~ N R ~l°~ E(or W Property Owner's Mailing A~~ddress - Lot # Stock # Subd. Name or CSM# MM l City State Zip Code Ph tuber ~ v`Li SI J 0 S ~ o t t Z ` ^ City ~ ^ Village ®Town Nearest Road . .t ; 1 (~ t 27 3 _ 8- kl 1 ~~ S pt~ Ft.~ Z~v G~ ~~E [~ New Construction Use: ® Residential /Number of bedtooms_._,~_ Code derived design flow rate b0 O GPD ^ Replacement ^ Public or commercial -Describe: Parent material ~ A-fJ 1. VT ~.J'f!'S (9 Flood Plain elevation if applicable )V 11 ft. General comments ~,~~'MWl and recommendations:~V~ y (° ~.~ ~ ~~.!{ 3 ' ~ S p' 1.0Y~1 G t~J ~ 8 U N L`I-3 0 F L-~tG~~ e:{~pf~t~ ~tDEwiwp~2 L~e~~} ~H-flr~tt3~ZS ~i~ cez~, 8o`~pr~ o F- ~u.~ ~ ~ ~ ~t~ . az.o ' Boring # ^ Boring Pit Ground surface elev. 1, c~• S ft. Depth to limiting factor `~ ~ ~8 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 f p_~Z 1D`~i.tZ 3LZ - S~~ i Z`Fsbk s ~ ~°_g - . S .S r Z . ~zy 8 1u ~R ~ ~ _ ' - ~,,,, Sb~ cS - . z . 3 Boring # ^ Boring ® pit Ground surface elev. ~ ~tJ • D ft. Depth to limiting factor 2 )- ~ ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0-~~1 ~oKVZ 31 - sZ( Z~E=sbk. gh es - •s •~ ~ Z ~ ' ti~l-6n 1D`i2 ~l - s i 1 wt Sb~ h ~,-g _ . Z . ~ ~ 3 ~ ~ -lop ~0`~2 MI6 - S O S c~.1 - •~ ~- z ~ - tmueni ~i = rs~u, ~ su < uD mg/L and T55 >3D _< 150 mg/L ' Effluent #2 = BODs < 30 mg/L and TSS < 30 mglL CST Name (Please Print) Sign lure O 1 _ ZZ 3 CST Number Arthur L. tdegerer ~. 220254 Address tdegerer Soil Testing & Design S e r v i C e Date Evaluation Conducted Telephone Number 421 ~d. I~iain St. River calls, tdI 54022 ~ 30~0~ 715-4"25-0165 Property Owner ~l~S~. ~ `"N Parcel ID #_ (~ ~~ ~ `~`Z b ~ S6-QQ(1 Panes ~ of Boring # ^ Boring ~ ~ O ^ pit Ground surface elev. ft. Depth to limiting factor ~ ~ 2b in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Si. Cont. Color - Gr. Sz. Sh. `Eff#1 'Eff#2 ' ~ o -Fl I,p~1,IZ 3~Z - Sl'I z `E'S1,1z p cQ s h t=s _ . S / . 8 / Z ~ $ -3~ 10 `ZR y ! - S 1 I 1 Yrt Sbk h e _ Z, . 3 ,~ 3 ~ 36- lZ[, 10`-tIZ 4~1~6 ~ S ~ g~ oQ. I - , ~ L. -2 a,~ a -a ' ~z `r ~e Boring # ®Boring ' ® Pit Ground surface elev. l~~- S it. Depth to limiting factor ~ ~ in. So11 Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eft#2 o-y ~0`~1231z - Sit Z'~~b--c sh a~g ~ .S .8 Z - y -3~ 1p ~G12 ~! Si ~ ~ m s1~-2 1~ e g _ • Z _ 3,, 3 ~ 3~ t y ~o~ ~ y~ _ S U s~ r~. l - . -~ ~- Z ,~ ~ 9~ . o /~ z ~~ ., t~TE = - 2 ~ l..U X11' S LO ~ ~- U 0 ~ -t 2,Y 1,~1 y t,LJ by W L`T~ $U ~ 8o`1Tz1 OF ^ Boring ._ Boring # Ground surface elev. fL Depth to limiting factor in. ^ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsefl 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 fonxtat, please contact the department at 608-266-3151 or TTY 608-264=8777. ` I PLOT PLAi1 ,,.~ ~ Scale 1'=3D' ~c,T- S S Page .3 of 3 LoT ~~~J~. L,oT S~ ----.PPr?C~',L-_ 1~j._1~j~ DZ6-t°3"1-b=: ~=6b:0- _____ ~?tZ~uLwt~{ ~' s ~ Z y a~2~ 1 \ ~~E. 15 ~~> ~.w.~_ ~-S z.~ z.i' p t.PR P'1 ~N . ~T-` 3 t t~ lTl A-~- N CL31..LS C~1.LS ~ ~ ~o / ~ ~~ ~q zoo ' L~ q,~ a~ ~ DpN ~,1 2~, z~,. ~~- - / o cAN ~tz~ Fvo'ne~,G Q.~v. ~yMs~ BM~-i a~,~ ' S°MU., -~ ~M #f- 2 I.OT l1N l,p~- $ ~ _- -- ~z=~-o: oLoN -9-~ Tecc~, -3 r~ "_~ c~. P V e F:r pC` -_w I~r- - - -- -k --' K t ~~ • h K h ~ --~-- _k~~L~-1U ~~: -~-_--L~~3T~_~p-,- ~~-~1 _~~..t.S - p~~-p~j= -LET-----. - -- g-30-0~ 715-425-0165 220254 ~j)_Z,Z3 CST Signature Date ~ Telephone Igo. CST T~1o. Job PIO. Wisconsin Department of Commerce SOIL EVALUATION REPORT Page \ of Diyisi6n of Safety and Buildings ,. ~ in accordance with Comm 85, Wis. Adm. Code County S-t-.. ~ LX Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must i indude, but not limited to: vertigl and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. O ~ _ 13~ 6 _ 5 6 - 0 0 D Please print all information. Reviewed by Date Personal information you prpvide rosy be used for. secondary purposes {Privacy Law, a 15.04 (1) (m)). ~ Property Owner Property Location ~~-- ~)gE~~ , SZ- 6oxLJ,.of- Nltill/4 SiU1/4 S (~, T Zq, N R :.lq, E(or W Property Owners Mailing Address Lot # Blaclc # Subd. Name or CSM# ~3~ w. ~~o~v sT. Sb - Sw~TGt~~ City State Zip Code Phone Number ^ City ^ Village ®Town Nearest Road ~`Li-SLU O1Z tv ~ s ~ 01 t ('1 lS) Z7 3 _ 3 S ~. ~v'fl S p1~ F-L.u1~.kJ G~ 1.1~1F (~ New Construction Use: ® Residential / Number of bedrooms ~_ Code derived design flow rate b4 O GPO ^ Replacement ^ Public or commerdal -Describe: ', Parent material _ ArN ~ VT I~.1'f!'S l4 Flood Plain elevation if applipble lV ~ ~ General comments .R~OWIWI and recommendations: ~~1~ y Ct?a,1.l.s~ ~~~ 3 ~ ~ S l~~ LORI G 1~,I~ 8 U N l`t-3 0 F L-~t G t~ e.I°(p ~ [.`~( S ~ D EW ~ W p~2 L ~el,~t ~ ~.H-Ar~[ i~~s ~ ~ cez. ~_ Boring # ^ 8oring - pit Ground surtace elev. ~ ~. s fL Depth to limiting factor ~ ~ L8 in. Soil Appliption 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 1 ~-tZ 1o`~f,rz3Lz - sal Z`~-sbk s~ ~~ - .5 -8 Z ~z-x-1.8 1u ~R ~! ;. ~ ~,Nt sbk ?~ cg - . z . 3 3 ~~g-(t8 ~0~.~~1b - S o s ~ i .~ ~- z Boring # ^ Boring ® pit Ground surface elev. ~ ~o • D R Depth to limiting factor 2 ~ ~ O in. Soif Appliptlon 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 0-1~{ 1oK~-3L - S~~ Z~sbk s1~ eS - •S •~ Z ~ ti~l-bd 1D`t2 ~! ~- s i - rn Sbti h eg - . i. . ~ 3 ~0-~40 to~~. ~~6 - s O s c~ 1 - ~~ `- Z ' Effluen t #9 = BOD_ > 30 < 220 ma/L and TSS >30 < 1 50 me/L ' Effluent #2 = B~D_ < 30 mnA- and TSS < 3n mnA CST Name (Please Print) Si lure - CST Number Arthur L. Wegerer ~ ~. ~~- ~"Z3 220254 ~~ W e g e r e r S o i l Testing & Design S e r v i c e Date Evaluation Conducted Telephone Number .421 i1. Bain St. River Falls, [dI 54022 ~~ 30~0~ 715-4"25-0165 _. . .z Property Owner ~uS~. ~- -~ N Parcel ID # ~ Z~ . 13~ ~ ~ SO-~6Q a Boring # r^~ Boring IJC 1 Pit Ground surface elev. ~ ~ - ~ ft. f)Pnth }n limifinn f~ntnr ~ ~ ~ ~., i.. Page ~ of 3 Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate GPD/ft2 in. Munsell Qu. Si. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 o-a 1p~1,231z.. - Si~l Z`fs1~k ~Qsh cS _ .S .8 Z 8-3~ lo`~fZ y! - Si I 1 ~sbk h e. - Z • 3 3 36-1Z~ 1O~-1~.4~1b ~ S o s9 oQ, I - ,-~ ~_ ~ , , ~ Boring # ®Boring t-y! J~ ® pj( Ground surface elev. l~O- S ft. Death to limifinn faefnr 1 ~ V U Horizon Depth Dominant Color Redox Description Texture Structure - Consistence `-'-' Boundary Roots Soil Application Rate GPD/ft~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 ~-y ~o~rz31Z - sit Z~s~~ sh ~S - •s .8 Z ~ -3`1 10 `tif2 ~! ~ S 1 ~ ~ H2 S1~2 ~1 e S - • Z - 3 3 3~-t~l lp~t2 y~ S U ~ t~. I - -~ ~- Z 1~C~ = _ 2, " L_U L1.r1- S ~p ~ ~ U ft- 0 1~ -tz,''- Lily' t=,V by 1~11`~. ~U ~ $0'1"1"I) OF Boring # ^Boring ^ Pit Ground surface elev. ft. Depth to limiting factor ;n. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate GPD/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mglL 'Effluent #2 = BODE c 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate fonmat, please contact the department at 608-266-3151 or TTY 608-264-8777.' SBD-BD30 (R.N00) PLOT PLAiT Scale 1'=3D' ~r S S Page 3 of DoT l.~iJL y J s g•Z ~ y 3DCZ`M LDO\ l~lr'lE \ & ~/ ~1 •W •L. ~S 15'+'»x. Z 1 2.1 P ~R Z~'tp Rfl ~j So ' p I.tfi- 1" l LN . ~T., 3 ~ t~ lTt A-L 'o C~t...LS Ci1-L9 ~ 1.00 / N ~ / ~~ ~q s c ~ q,~ a~~~-~' DOn7 B.\ ~ X3.3 ~i ~ z-~~ ~ zip. ~ CON CZGTZ~ ~0•T~A,r" 8M~-) obi' S'r~u.,.~ t3M#~-2 l.oT 1.1N.~ C.~- S -~ --_ -~-~-~-~-~Lo~ _9-~-,c,-3-r~~_~« _PVe-ter-~~ _-w-r_ _- K _ - - h - ---h--~ ~` L~~~-$~- ~-- L-~~A~T ~Q ~-~iZU~ _C-X2..1.3 - f~`l~iy7 p~= Z~SZ'_-- g- 30-0 C.ST Signature Date ~.oT S~ 3 715-425-0165 220254 ~j~_Z,Z3 Telephone Ido . CST A1o . Job PTO . Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Puilding Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Roschen, Delmar Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: ELEVAT IUN UA I A TANK TO P/L LL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMPISIPHON INFORMATION Friction SOIL ABSORPTION SYSTEM BEDITRENCH Width Lengt DIMENSIONS SETBACK SYSTEM TO INFORMATION Type Of System: nlcT~lollTlnAl CVCTCIIA to of County: St. CPOIX Sanitary Permit No: 395250 State Plan ID No: Parcel Tax No: 020-1376-56-000 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer St/Ht Inlet St/Ht Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. Syst t Final rade ~ • t Cover , ` PIT DIM NSIONS . Of Pits Inside Dia. • Liquid Depth CHAMBER OR ~ - UNIT Model Number. Header/Manifold . Distribution x Hole Size x vole Spacing Vent to Air Intake Pipe(s) ~ Length Dia Length Dia Spacing cnu rrwoo i __ ^_----.__ c..._._.Y_ ~.-~.. ..., u.......~ ri. nr~~r~ne weromc unrv ~.. Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center Bed/Trench Edges Topsoil ^ Yes No ^ Yes ^ No COMMENTS: (Inclt~e code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 931 Florence Lane Hudson, WI 54016 (NW 1/4 SW 1/414 T29N R19W) Sweet Grass Far Parcel No: 14.29.19.2317 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ^ Yes ^ No Use other side for additional information. Date Insepctor's Signatun; Cert. No. SBD-6710 (R.3/97) TANK INFORMATION ~~ /mss Aso ~ ~ Safety and Buildings Divisi~~n 201 W. Washington Ave., P.O.1:'~0~ 7 162 Cc~a ~ ty ~ ~~ ~ n ~ V _..._~.___._. _______._ _.._ _.___ ~scons~n Madison, WI 53707 - 7162 S'i~. Addrtss3 De artment of Commerce ~ __ .___ <<_~'_~ ~Lo 2'~~'~ _ Sanitary Permit Application S 3t3~sZ :s~:bj` In accord with Comm E3.21, Wis. Adm. Code, personal informatio a 'eie ~~ Cbeck if R ,:; on ma be used fir secondary purposes Privac Law s1S L'r ~ I. Application Information -Please Print All Information 1 S.i:. Pl.m :.I ~ ~ ~t< r~ ~_________._ .__ Property 0 ner's Name ~ RI~E, P:ii i ~:1 Nii~bl-: 2 9. ~~, 2 3/ -~, - ~ ~ ~ Property Owner's Ma' Address ` A~1(', •~ P :~i:~;~t3' L,cca;_ .~r~ ~ / / SS C ~`~ ~lJ S F ,tom /V ~!~y4 ~_Tiv'- 1~5~ TZ.~, R~~._ City, State Zip Code `Y Phon~ ~, L~ "bltnber BIoL{ ~`~Iu bed r -•--~- C ~ ~ ( ~fv ~< ~~ ~ L~~ ~.~~~ ~~t t~ ~~t GR ~s s II. Type oP $rtildiag (check all the ply) / •~ Qe:r P(cs.r.,s C' tY or 2 Family Dwelling - Number of Be ems f ^ Public/Cotnmercial -Describe Use _ ~ a•ns'~tp / (u ~ S~ ~~ f~ ^ State Owned Ne,~7st Road ~ "- ~~ Q ~ III. a of Permit: (Check onl one box on lin Typ y (ntunbering scheme for ante al ase). Camp >:e hne B i' ,~ ~li~•<tiJle~ -. ~ _ _ A. For County i >_ - .----___.__~ _.__ 1 ~ew 2 ^ Replacement System 3 '^ Re ement of 6 ^ Additio 0 S stem Tanis Onl Existin S em B. ^ Check if Sanitary Permit Previously Issued Permit Nu r :~s r) _ e ' ` -~ ~ IV. Type of Permit: (Check ali that apply)(numbering schem fo ternal use) ~ ~~ -• 44 n -Pressurized In-Ground 21^ Mound ^ Sand Filter SO C ~'onsouaed `~-; ~:iand 22 ^ Pressurized In-Ground 41 ^ I:olding Tank 48 Ingle Pass S1 C_ :.:rip Lire 45 ^ At-Grade 46 ^ Aerobic Treatment nit 49 ^ R 'rculating 30 L Over V. Dis ersaUTreatment Area Informat ion: 3 ' r ~; ,~~,.•_ ~~~ ~ •^ Design Flow (gpd) Dispersal Area Dispersal Area Soil AppIicadon 1'ercoltaion Race . _ _ Syst;~r ,l r Fr 1 G-a je _ Required Proposed ~ Rate(Gals./Days/Sq.F . (Min./hicl } © q ~ ~~ ~ i , aticn 9~ / ~ / ~ VI. Tank Info C acity in To Number Manufacturer Pre'i~ ~te~ ~ ~ 7=-ibex P1as_:~ Gallons Gallo of Tanks ~ Con. ~,~,e Cors n : d ilas New Existing Tanks Tanks ' Septic or Holding Tank 2 _ ._. l~fZ~~ _. ~_ ..._ __~.. ~ + "-" Dosing Chamber $ ~ Cd'hf B0 ~ _-~..._ _. a ~.- - ~ -•-- VII. R onsibility Statement- I, a undersigned, assume r nsibtUty for installation of the Pl)W TS s6: t cat tht :,;~e~: ~.an,;;. Pium`~s Name (Print) Pittm is Signatur MP/ltd~it'tut~ber .rr_.~_ -• Et t s "~ a urr..~r _-- ---. _. ~, ~ ~ Plumber's Address (Street, Ci tat:, Zip e) _____.__v. ----..__._.___.____.___.. _. _.__ VIII. Coun 1De ent ZTse Only _ _ _ ~ Approved ^ approved S~~Y Permit Fee (includes Groundwater Late Isaed ' I: r,t:_Lt S w a:e ;ldc, Stampsl- • • Surcharge Fee) ^ Owner Given Initial Adverse . i Determination i it'v ~,~p(~ ~ d^ Z ~Q~ ~~ ~~~,.h~d.~ a1a. wuwei~us vc ap r/o/vauxeasons ror ytsapprJOVaI / ( f ' ~ t,./ '1'~ ~'+Tftl.t~ i ~~t,r ~ ~ t~hiTR~~~cd' aCti.Oc SGPCfuteCy pC'r tu~Qhlti~C~,rets fCC.-Oin~r.vh_QtthL-~,5„ ~'` p~u,.r.~iCr lurfl Gksar~ ~< BK~'s ~~ve l~M SeeVit de5~~py~~ ~n ;cr ~ req kpsf. ir3 .~a ~ i9// S,S-N G~kv! 3 rw k-S~ ~e ouf5<c(e D~// N// G/L arrq , l~'//~.~ s~ yra~~ '~ist7`- j,,i,!/ e .~,necf t(~ ~ C~+joa Attach complete (to the County only) for the system on paper not less t6r~n 81/2 x :I 1 buhet to ;, _. >~ SBD-6398 (R. 05/01) ~i v~ ~~ ~~c,.ir,A-lL fZOs~~~~v te' ~~ ~ ~~ ~. ~'' ~~ J Y J O a CC0 G ~ ~ J~ Q W LL cCS ~ ~- - U ~,~lGlaa~u~ --I C O ~ + . cU cn ._ N ~_ C ~ ~ C cCf ~ ~ '~ ~ ~ ~ ~ ~ o c ~= ~ ~H L •~ Q ~ O O ^~ ~j ~ ~W ~--~ ~ ~ ~ ~ ~ f ~ O C~ ~ ~ Q ~ ~ ~. ~ ~ f >, ~ ~ ~ U O J Q j, ~ ~ . :~' O ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ro ~~c~~c~ LL ~ ~ U ~ ~ N ~ ~ U ~ ~ ~ ~ ~ C ~ ~ Q ~ ~ O JJO= c'Jn ~ ~ ~ ~.. • • • • W~ Q ~_ T~ V W i~ ~~ T i (~ W ~v ~ ~ ii MTM X i ~ l'J U ~Nl r L. .~-~ CrJ ~+_- U C :,= ', U Q ~ (!~ d ='~ '~ U X' J I _~ X ' ~ ~ ~' J ~ Z , ~ i N ', ~ ~ ~~ N ', O ~ v ~ ~ ~! : ~J ~~ ~~ w~ - ~' n r- ~~ ~ O v ~ V u ~'. Y. ~ i ~ ~ ~i ~ ~ To ~ ~ " .. p ~ ® Z _ /' - tJ ~ N ( • ~ ~ J ~ V U) )C d' T3 ~ , W ~~ N ri ~ ~~ ~o .~ ~ h Ll U JI W v ~ ` , ~ ~ r t ~ cD / f ~y s ~ UJI A ~i1 cC co ~ ~ c!~ ,o ~, s~ ;» ~; m J • ~. Combinatio.n Sep•t,~.c~ Tank and PUMP CHAih6ER CROSS SECTIOIJ AA]Q SPECiFiCATI0IJS . . -• VEUT CAP. ~,, WCATHEK PROOF . ' JUIJCTIO-J BOX . ti~C.I. VElJT PIPC ~ APPROVED LOCKING ~ jQ' FROM OOOR, MAIJNOLC COYER 1N1~ ~ wARr..)IUG L.A6EL. :/IAJDOW OR FRESH O~DUiT u~ sP ~1oaJ ~ IP E A!_R I1.I T/~ K E ~ ~ w ~ H'LlZ'j7 6 t!'1- 'C.f TP ~ ~ I ~~ ~ I ~t' xlu. 6~..~w. ~ lp0 T ~ j I ' ~~- _. -- ~ 11~ -~ PROVIDE I I - r'-- . ilJLET _ „~~' '"`AIRTIGHT SEAL I I I ~ f ~~, 1 I ~ (I `.i ~`~~`-~ .. A . I (~ ( APPROYED JOIiJT: APPROVI-D JofuT zt~8,~. ~~~C I II( w/C.T. PIPF~P~~ W~C.T- PIPE~IZ Tank construction _ ( i I ALARM shall comply with ( Il ZLH~ 1,3.15 and 33.20 a f I i I o-J ~ .I I I PUhIP-1 __1 Off ~ ~ ~` ~ ~ C0IJCRETE QIOCK L 3" APP~~: F(15EFL .EXIT PERr'11TI ED O-JL~ IF TAUK MA1JUFACTURER HAS SUCH APPROVAL. gFflpINO SEPTIC F SPECIFICATIQtJS POSE ~ W ~~~ CC~1~JC~.'j->~ 1JUMf3CR OF DOSES: PER DAB TA~.1K MArJUFACTURCR.: © . TAk.IK :,1ZE : ~ Z ~~ : O~ GAI.LOk15 DOSE VOLUME AL,IRM MAUUFACTURCR: S~S~~-1--~~-0 S~~~~ INCLUDIiJG 6ACKfi.oW: ~ G~ILONS MODEL I.IUMgER: L ~~ Nw CAPACITIES: A=_._~IIJCHCS OR ~/' "O/ALLOI~s SWITCH TYPL: ~~~'~~ 8= Z I{JCHES~OR _J.1.i=G~LL0U5 wt.k ~'z-S C = ~~ INCHES OR ~ lrAl.L0U5 HUMP MAfJUFACTUREA:. ~ ~ ~.lF1.-.- / MODEL 1JUhlBER: ,, !~ ~ D = ~Q.-.INCHES OR Z~' _ OALLOUS . SWITCH TYPE: ~1~~~~ 1JOTE: PUMP AA10 ALARf~ ARE TO dL f'''11A1lMUM DISCHARGE ~RATE_~GPM INSTALLED OIJ SEPARATE CIRCUITS YERTfCAL OIFFElZEA1CF DETWCEU PUMP OfF AUO..DISTR18UT10-J PIPE.. hEET + KI1JIh1UM AIETWORK SUPPLY PRESSURE , ; , . .... .. ~ FCILT + ~ FEET OF FORCE !"IAItJ X F~pFC,FRICTIOU FACTOR.. FEET ' ...... . TOTAL OyIJAMIG NE~AD = --- FEET As per manufacturer Li~ I ~ gal/in. a D ~~~~ ~ R v s~~~~v Ni E~0 Series 4l'10 HP Effluent and ~-rain Vllater Pumps Performance Curve 40 ~ ~5 20 ~'~„ t 5 O F- 10 MooE~ ME40 E~.uENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 z50 300 350 35 30 5 (~ 4 O 10 20 30 40 50 50 70 80 90 100 CAPACITY C~AL..LONS PER MINUTE F.E. Myers, A Pentair Company • 1101 Myers Parkway, Ashland, Ohio 44805-1923 alsiaes-lyaa ~Ax a1s<2es-ss5e reiex sa-~aa3 12 10 N e Z ~. 6 J Q 4 F- O H 2 0 n~3[~ ~~~ Printed in U.S.A. ~i. Wisconsin bepartment of Commerce SOIL AND SITE EVALUATION ~ Division of Safety and Buildings of Page Bureau of Integrated Services in accordance with Comm 83.09, uVs. 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 S ~. ~ Y"O ~ ~ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel I.D. # .-r - APPLICANT INFORMATION -Please t~all~i~fcrt»atott~. Rev' ed y Date Personal information you provide may be used for se nH~ry.pUrposes (privacy Law, s. 19:04 (1) (m)). 1v~ Z ~ Property Owner ~ ~ ~~ Property Location ~ tC~~ ~ z ~ ~ 'Govt. Lot ~~ 1/4~ W 1/4,S ~ ~( T Z j ,N,R ~ E (or) ~ Property Owner's Mailing Address ~.__ ~' (" f . „ ., Lot # Block# Subd. Name or CSM# l 3 3 F~~~-Eukee~~fir~~. - ~~, , , ~ ee-~ C~r0,55 City State Zip Cod .Phone ~r ~ ,_ ~~~: ~ _. ~] Ci ^ V ty illa e Town Nearest Road 9 ~~ ~ t I~ t,UlSbn I G1) I Jt-!O) lob _I~~~~1~5 ~ ~`~ ~7~~1 .~~~ , '~ l-~c~cP Sa ~^ I Ffoir!'tGe-_~q n -2 New Construction Use: ®Residential / N~Br~bf~edrooms ~ - y Addition to existing building ^ Replacement ^ Public or commercial -Describe: Code derived daily flow G UO gpd Recommended design loading rate ~-7 bed, gpd/ft2 ~ ~ trench, gpd/ft2 Absorption area required ~ s~ bed, ft2 75~ trench, ft2 Maximum design loading rate ~_bed, gpd/it2 ~ ~ trench, gpd/ft2 Recommended infiltration surface elevation(s) U~.O~' q`~ 99 Goc~er 9~ ~r/~ ft (as referred to site plan benchmark) Additional design/site considerations /-~ ~iJr': v~/De r'' T Z ~~ Gowtir" 9~ ~ y Parent material ~U-~w °i 5 6-. Flood plain elevation, if applicable ,/li C~ 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 SOIL DESCRIPTION REPORT Boring # Ground elev. 9~.oq ft. Depth to limiting factor '.1~in. Boring # Z. Ground elev. q1~n. Depth to limiting Remarks: Horizon Depth Dominant Color Mottles Structure i t C B d R t GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. ons s ence oun ary oo s Bed ,Trench Z ~ I-~s i©~ ,- ~t l~ - ~~ ~ ,~ ~,~,~ ~ ~- s - - s ; - ~ I ~ o-/a i'0 ,- 3J2 Sri' L mu bk mfr C ~ v-~ • 2 ' - 3 2 . ~o_ 1p ~ y~3 CS IrnS 11 c5 - .~1 ~ •8 3 • ~-99 ~OYr ylCo ms O I CS _ . ~ ~ ~ 8 ~ a~ 4 ~. factor ~in. Remarks: CST Name (Please Print) ignature ~ Telephone No. Address Date CST Number z ~ ~ ~ sm .i s ~. so~.+- ~.~ s-y~zs-- y- ~/- ~v z r3 3 a 9 ~~,~,~-~- SOIL DESCRIPTION REPORT PROPERTY OWNER PARCEL I.D.# Boring # 3 Ground elev. 9~ft. Depth to limiting factor ' 9i in. Boring # Ground elev. 95.H4ft. Depth to limiting factor •~~in. Boring # Ground elev. q$.C) ft. Depth to limiting fac r • `~~ in. Boring # Ground elev. ft. y~ , ~ ~ Page Z of 3 Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench J • 0-9 /0 r3/Z 5' ! ~m4bk.. rn~r ~ S I -~ -Z ' . 3 y. 29, g `~ Remarks: I o- ~ r31Z -- s~/ k ~ c Ivy' ,2 ' -3 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 ~ ~ a-8 10 r 312 - 5' J }~ ~S I v . Z ~ . 3 3 l~-`r9 ~0 r yl rrLS 7s m 1 cs - .~ :. $ .O ~ ' 3 ~ . / ~, Remarks: Depth to limiting ' factor 'n' Remarks: SBD-8330 (R.9/98) a '~ `. PAGE~OF~ NAME S~n~ ~~ LOT# <S(o LEGAL DESCRIPTIONNW '~4~.~,V<,S 1 y TZQ,N,R ! ~f E (or)C~, SCALE: 1"= /OC) ~ BM 1 ELEVATION ~~ • C) BM 1 DESCRIPTION ~o(Za~ (~`QV'G ~~ p~- BM 2 ELEVATION ~ 9 3 BM 2 DESCRIPTION iap a~- ~ "~J~ ('J; P~ SYSTEM ELEVATION~"1~3•gq `'q y, y g ALTERNATE ELEVATION ooa~~92• `1 R Ga„~.~ 90. qy CONTOUR ELEVATION ~J~/~ 1~ -t- _ ~ c~U ,.. p~`m~ Ros~~+~~ Pr~vata 4n~~t~a Wasrata~ Tiraalt ~~-s#~m 14~;~ir~ag~~sint P~ar~ Septic 7an~C cwrty ~n-+G~~d ~ol# AbEsp~~~ C~p~ns~t Pursuant to Cornrn 83.54 Wis. Adm. Cade each F~rivate Ottste ~VVaste~~Fa~~r ?reatment System (POWYS) s include information and pt~ac~dures for maintaining the :system within the ~rarraet®rs cif Gon;83 arxi BA,, and #h+e c~ndns of appr~~vai b~ the det~~rtrr~ent, agent, or governmerttai unit.. The apprclmed plans arw~! permits for sys'a=rrtr arti~ c~ file ~:t tine county toning or health dement. This manag+sment plan complies with Comm $3.54, Wis. ~,dm. uode, ar.~ the fn-ground Soli Absc~rp~tion Comment ~Aartuai-for Primate Or~ifie Wastewater Tr~~:,~tmen W~~sterr~s Si~~- Tal~It~ 1 ~ Svtrr ['~s1an SCI®Cifi+r<~ns Sanity I'~rmit Number ____._~ -- __..._.._ ~.,.__ Number cif' Bedroflms Es#ma~d lour -Ave iri Se tic TeniC a ai / 2- ~~~ So~1 A~cx' tifln ~ M ~-iZe; SCrD N Fic +~-+c..4-Fo 0 ~~8w61#~r L7C31~stIC Table 2: 8r`o~l Absor tion ant • Llrt~ts vt? l~~1i~3it:+1_ n~~ra*ion S tic Tanis Com Went Sc7y Adsor~sicn Compr.,nent .~ tai n ~'iow - Pik R~taxirru,lm Influent Ps~tlcie"Size in 118 IViatrt !l X20 AA~xximiim 95 1.) E ~G Tahle 3 AA~Ir~ Sehle 3 'c Yat~c i and/err senric~ ever, 3 fires; s Outlet Fitter Irr~ ~ once a ar end tin at least once every 3 years Soli Abp' lion Ccm neat ins c~t once 3 ~t~rs ~, _ ~e~ic Tank The septic tank shall be maintained by an individual cer~ifed to service septic tanks under s. 281.48, Stats. The confients of t~ sepfi~ctarttc shall be disposed of n ~^ccr~'a-~~:~ with NR 113, Wis. Adm. Cow (Sermicing Septic or Holding Tanks, p'umpirg Char; ~:~rs, ~. ~ ~ ~ ~; interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, i~riv`es, or pF..;t~:ahl6 Restrooms). The operating condition of the septic tank and outlet fliter shai be ass~~;seci at least once every 3 years by ir~pectron. the outlet flier mall be damned ati necess~r~~ to ensure proper operation. The fliter cartridge should not be remov~i unless ~:rovisior~s are made xo retain solids in the tank that may slough off the Eater when n~nrn+ed from its en~'osure. If the Manageme7t Plan for a Septic Tank and Sail Akrsc~rp~:-:~~ Corr~i~: eft filter is equipped with an alarm, the filter shall be services if the ~lar r is a~~t~; ~7,`:ed corrinuously. Intermittent filter alarms may indicate surge flows or an irnperdi ~g c:untinuo~:~ ~~larrY~. T'~f~ septic tank shall have its contents removed when the vol~.rme of scr.+~n a~~c slr_r~~~ae in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tan < are nct r-na~!ed at the time of an assessment, maintenance personnel shall adv se tl-~e owr:~r of w ~;en the next service needs to be performed to maintain less than maximum scrum _rnd sl . dge acr;u r:uiation in the tank. Manhole risers, access risers and covers should he insp~:ct~d for war:`:, lightness and soundness. Access openings used for service and assessment shall bE se~~l~_ ~ vratertigl-a upon the completion of service. Any opening deemed unsounc, de`~ec;tiv~, or subj...=c~ to t`ailrare must be replaced. Exposed access openings greater than 8-in;:he" ire di~aneter SI~~i be secured by an effective locking device to prevent accidental or unaathorizec err~r~{ in'.:o t(;e tank. No one shoubal enter a septic or other treatment or I;roldincr (::~~F: Efor any reason without being in full compliance with OSr`t~4 srfanry~.rds for entering a confined space. The atmospherE~ withi~~ tl~~.b septic ~Y other treatment of holding Tank may contain lethal gases,..~na( rescr~e of a person from fhe inferior of the tank maybe ~liffi~::ult ar .rm~ros:=;,~~le. Tank abandonment shall be in accordance with Comm 8.3.3:; Wis. A;Ir::~ Gode vrhen the tank is no longer used as a POWTS component. Soil Absorption Com cmer~t The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this _omf~onert are shown in Table 2. The longevity of a soil absorption component depends greatl.;~ nn arc;~~ rr and tir~7e(y maintenance, and system use within or below the limits of reliable cF7~~~ation. Good water conservation practices by all occupants and the installation of water :;onser~•ir,;~~ plumbing fixtures are key factors in extending the useful life of this componera. The soil absorption component's operation must bF: assec~se~:a by insi~~ ;:iar~ at le~~st once every threE; years. The inspection shall include recording the !::;eels of ~:,: dn, ifi ~~r~r, in the observation pipes, and a visual inspection for any evidence cf s:,riace sf~~ ~;:; ~:,g~ or discharge from the component. On steeply sloping sites, areas of erosion shor~id be io-anti*ied and reported to the owner for repair. The surface discharge of domestic ~,~astew~~ter ar sewa~~e from the system is prohibited and considered a human health ~razarcL Traffic around or over the soil absorption component should I;E~ avoid,~.d }~articuiarly during winter manths. ThE: compaction or removal of sno~,v cove.- ova: r the c~::rr ~jo~?er~;t may lead to hydraulic failure by freezing. This type of failure is usuc,lly te;rr por: iy, but ~: ~ifii~trlt or impossible to repair until weather conditions improve. In cene~al, sc co~~pa~;ti~~n over this component will reduce diffusion of oxygen into the soil and dispersal yell whi;~; may lead to more intense, and earlier, organic c{ogging of the soil. 2 ~. ~ Man<~gement Plan for a Septic lank and Sail Abs+:~rE~tior :;ornp+:: , , t Plantings of deep-rooted trees and shrubs directly cver r;~r witt~iri tE:n fc::` ~,f the component should be avoided since root intrusion into this ~ ;omponerir may ok~ =~i ! + ,ct dvaste~{;rater flow. ~ ~ ~ ~_ ;~~ ~L s a ~ P~ ~ ~ ~, dos- ,-- ~ . ~ ~,~ :~~~ '~ ~~ ~~ . ,,~ ..,~. ~ ~~ ~ ~~ ~~ ~ ~ Z ~'i1 ~ 3 ST CROIX COUI\Tl~' tiEt' f.C `I"ANI; MAINTE??JA,'YCE .4GR6FRIEN'f AND OWNERSHIP CERTIFICATION FORM ~.}'a'ner!8uy'EC '•':ati:rg .4dtir~ r'rcfert•y A~dt ..ty-'State ~ ~~ ~~ ~ ~ ~ ~'~4 ~ ~_..~- tVerifica;ion required f rn Pla;t~ir~ Depittmct,; f r new onsttuetion)_ i~'~ sew !•v ~~ I r-1 u re.,~t c~ ~ -~~. -- ._ ~ _._ Parcel Identification Number Ott ~ ~3 -..S(e -~UC~10 Prcpct:y Lora ion ,~ !i., S~ !i. Sec. ~ T~N-R,~[;~;,,,~, Town of __~,~R/~S Q~1_.-_- ~urdivfsian _ _,~-,~~5~ (~ntSS S'~ L~,t # C', rtitied Su aT Map # ` , ~'olu:ne .Page # ti1'~r'ra[tfy De d # ~~_~~~~ ~. volume _~// ~ ~_. Page ~ S~~ 'j i)r~: I.UUS~ ~~yt:s ~ nO Lrt linc9 tden;rfiable~ yes t7 nc~ ~:~'~ N„~ hnprope use and maiaten~nceof yow septic trysrem could rcttult in its prertature failure to hardie wastes, Prohrr muutenancr ^~sts of pump gout the a tir tank et~e. 'threw yearn or soouar, if needed b a li:ettsed urn er tivhat +t affect tse hL-t rioa of the septic tank as a treatment sage in the waste dlsp gal system P p yu'~ pt:c tn:a the system 'I'!;~ Pro ny owner area to submit to St. Croix ZouinII Ucpartmert a eerriticat:oo fetm, s,g~ted Fy tae ~w•~cr anA Dv a ~"'' "t~ *,l~:ntber, l trsey~nanplumber, reatnctedplumbero: a licenst:dpumnarveritying thar; I} LLe n0-s~~~ ~~steu•aterda,pc,sat sys:~~, :~ .^.r^?~ r ~~,,eri '~ ~utadit~on and/or (;}after tr~pection auQ purr:put~ f if ue~assary), dte se;tttc t~fJ::s le;~ Ilta~+ l/3 iwi: of siu tic ''•n r ,hc t~r,:.4crsi~ cd have real the above tegwnmeau:nd agree to rna-nuizr thr private sewage di:p~sa1 SV;tCgt „~t17 :he s::,1~:,,~d; ''' `^"h• hercua, a se*. by the Del>artment of Corrurterce tad the Ueputr.,ent of Natwal Resources, State of V~ isccus,a t:'erN.:ic~;;t,o ~' "1 i; ~- o t p:itt~ystam hay txen maintained must br com t ~. ~° ~ : ~ t :.;c a eat expir t~ ~ dasa` p.eted and returne4 to the St. Cruix ._ au~:R- T..oniifg Uftice v:,C•:~: 3u r 't.~ P . (CANT . ~ LA Tfi i ''~~ t:a i u alt shtements on this form ere true to the best of my (vur) lutowledge. ? i,~.c) an, faref t,;- ov::e[+i1 v: ~'~ 7~'~?°~''r escr c ebove, y vinCC of a warragty deed recorded in Rertster of Deeds Of"ce. .~~:,.'',ti7'.,R~ OF PPI,tGA T •~ ©~ .~ '. ~.A T[ •YiY~• Any info^t~atiott that is min-represented may result in the sanitary permit being revoked by tl:r Zn,,;n Ike:. :Trl,enr ~ •~~~~• " t.~°fude +~ith th appllcatto~t: a stamped wacttnty deed from the Register Of Deeds ofCtce ~ cupy of the eortit-ed aurvry map if reference is made in the watrrnty dec~J ~ STATE BAR OF WISCONSIN FORM 2 - 1998 ' iI WARRANTY -DEED Document Number _ __._ I I -- `I (' . ~ ~ ~ 1 Pa~E ~ ~ O _ _ _ --. _, This Deed, made between 1~~C-IIA1~-8-o-.--UT$E33' mid--aT-11~1E'I' P . S'I'~lU'I'-, Grantor, and DELMAR W - ROS-~HFN-e ~L ar~d~IZf HELLS L• RC).St'HFN hi~ahanr7 anr3 ~~i ~p~ . Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in R1' C_rni x County, State of Wisconsin: Lot 56, Plat of Sweet Grass Farm, Town of Hudson, St. Croix County, Wisconsin. Exceptlonstowarrancies: easements, restrictions, rights-of-way and covenants of record. Dated this ~ ~ day of Ju 1 v 2 0 01 ~~ r ~ (SEAL) * Richard O. Stout (SEAL) * Janet P. Stout (SEAL) * AUTHENTICATION Signature(s) authenticated this day of , * TITLE: MEMBER STATE BAR OF WISCONSIN (If not_ * 651756 KATHLEEN H. WALSH ~; REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 07-23-2041 8:30 AM EXEMPT R DEED CERT COPY FEE: '~ COPY FEE: TRANSFER FEE: 144.64 RECORDING FEE: 10.00 PAGE5: 1 i' Recording Area _.___ .. Name and Return Address p~ ~o~~ X37 W - ,VF.~s~o,J bt'. II ~5``~~ ~~ ~ ~oct 020-1376-56-000 Parcel Identification Number (PIN) Thts i ~ no -homestead property. (is) (!s not) ACKNOWLEDGMENT (SEAL) State of Wisconsin, ss. St. Croix County. Personally came before me this OZd~ day of ~l ~ 2 0 01 ,the above named Ri _ha d O_ ~ o ~ and Tane P Gtnut to me known to ~i spgr-~, ~j~,~,y~,~~,t~d the foregoing ,~ I 466.20' \• / x / f / / / • ._._._ LOT 55 `y~'i~ //~,'~ -'""~' '"""' 2.13 ACRES / a% / • 92661 SQ FT / / a~/'~,y / ~ i • ~ ~ / / /~ _ . _......... / 0~~~~ 7 / ~ di ' ,~~ ~~,' MIN BUILDINQ • • ~ ` ~....~ El.lV.. 890.8 • ~ d ~ N89°46'S0"E 974.52' ,a c~a ~~ S01.1d ' / ,~ ^n \ .._ ..... H.W.L. =889.80 C ~ ~, MiN BU D1N0 ~ ~ ~ • f~ rte- OT 56 • ~ (~V ' ' i~ 1 8~_ 90.8 2.38 ACRES • s{ !J ll 10363TSQ FT ~ ~ ~ _ %~' . 54L2fi' it N89°4550"E ( I ~ X40' DRAINAGE 542.89' ~ I c trASEMENT I ~ rte.,. I ~ ~ LE?T 5~ I MIN BUILDING ,o i I Z $ I cos so so Fr ELt:V. = eee.o ~ D- m ..~._._ ~~ I: ' I I N69°46'50°E ~ f11 ~ s~a.rr y p~~~ I ~ ~3 I H.W.L. ~ 882.0 `~~ I 3~ M 40.0 14 E. I g ~ ~ any ~`~FM"~F, , ~ LOT 58 ~ ~+' ~ 345ACAES ~ ~ ~ '~ ~ ' . rn ~ I ~ .,~ 150474 SC FT MIN 9UILDINQ ELEV. = 888.0 p v I rn I ro A I N89°46'50"E 566.54' ~ w r ' r ~' D O D I I ~~