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HomeMy WebLinkAbout020-1376-57-000/* `' r±tiscs:.. Clerparhr-errt of C.onwrlerce PRIVATE SEWAGE SYSTEM ~ . safety and 6u4dings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal intortnation you provice may be used for secondary purposes (Privacy Law. x.15.04 (1)(mjl. ~yT"" ~o x~ anson, Robert CST BM Elev.; Insp. 811 .,3~ TANK INFORMATION S~ Hudson Township '~LEVATION DATA TYPE MANUFACTURER CAPACITY Septic [~O Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. vent to Airlntake ROAD Septic ~ ~' ~ } ~' ~ I - NA Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION .. Model Forcemain I Length I Dia. SOIL ABSORPTION SYSTEM /~i I STATION BS HI FS ELEV. Benchmark ~,S"S ~oS`.a l a -3 •. BM Bldg. Sewer St/ Ht Inlet • IS Q}.~Q St/ Ht Outlet S , , ~ f ~ ~ Ot inlet ~--- ~-. Dt Bottom Header/Man. f D~ 19 ~5•~6 r Oist. Pi T Pe •wl 9 (. p S •s~ 9 .s r Bot. System I ' /'r ~ Final Grade ~(. 9(, . p ~ Cover ~l, g S ~ 1 TDH t rst. To Well n_ L...~ a_ _1,., , •EL'D ENCH Width Length No. f Trenches PIT No.Of Pits Inside Dia. Liquid Depth I 68- Z DIM I N ACK SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING ~Qanu ~ ure : S ` ~,,~-,~ _,~' SETB INFORMATION Type O , I 1 CHAMBER a Num r• System: ~. ~ ~ ~~'6 7~ OR UNIT _ DISTRIBUTION SYSTEM ~~° ~'~ P~L • Header / Mani old k Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake -.. / Length~~ Dia. le `s ~,5~ 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 ~Ip Bed /Trench Center Bed /Trench Edges Topsoil Q Yes Q No Q Yes Q No COMMENTS: (Include code discrepancies, persons presentJlaB~ection#1: °}/b S7°i inspection#2: -f--- / Z~ 23 I~ Location: lorence Lane, Hudson, WI 54016 (SW 1/4 SW 1/414 T29N R19W) -14219 Sweet Grass Farm -Lot, ~~ ~) c~y¢~uv. /~._ P Pc: ~'^ t2~, ~ 2 1.) Alt BM Description = /~~~ ~,~ eAc~ ~„R./ ~,Q, •~-.r,~t,~, 2.) Bldg sewer length = SI ~ ~, -amount of cover = > 42 Plan revision required? ^ Yes ~No ~•( Use other side for additional information. ~ O ~. DI SBOf710 (R.3/97) Oate Ins or s Signature Cert No ~'~3' G(_n R.6JC~ L~hhl~ ""~ Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 iSCOnsin personal information you provide may be used for secondary purposes Madison, WI 53707-7302 Department of Commerce ~ - -- • [Privacy Law, s. 15.514(1){m)] (Submit completed form to county if not state owned.) Attach complete plans {to the county copy only) f es3~stem, on paper;not s than 8 -1/2 x 11 inches in size. Coun State Sanitary Permit Number ~h ' if re 'o q.Qprevious;apph ation State Plan I. D. Number ~ I. Application Information -Please Print all Information, l -.-. - °'~ Location: Property Owner Name ~ ^, - .:., s Property Location ~~ ~~~~ G~ ~ '1 ~ ~(f 1/4 1/4, S T ,N, R (o Property Owner's Mailing Address {~~" GO ~ Lot Number Block Number , f';, p~~C ~/ City, State ip Code Niit>wti7i~t~"~, ubdivision Name or CSM Number S ohs ~' ~ r ~ _ ( ~ ~L~~ 60 ' - E 2 ss II. Type of Building: (check one) ^ city ~' 1 or 2 Family Dwelling - No. of Bedrooms :J~ ^ Village ' ^ Public/Commercial (describe use):_ ~ TOWn of ^ State-Owned Neazest Road Z Parcel Tax Number s III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) / , 07 , , A) 1. New 2. ^ Replacement 3. ^ Replacement of 4. 5. L 3~ ~ fe. ^ Addition to System System Tank Only Existing System $) Permit Number Date Issued ~ A Sanitary Permit was previously issued 3 N. Type of POWT System: (Check all that apply) ~ A - L ~ Non-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At-grade ^ Aerobic Treatment Unit ^ Recirculating ^ Other: V. Dispersal/Treatment Area Information: I. Design Flow (gpd} 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade ir Req u ed 3 7 ,•'~ Proposed 3~.~ t~j Rate (Gals./day/sq. ft.) (Min./inch) ~y /~/~ Elevation ~ ~~ // [ ~ ~ ~ ~ ~ 2 C'Rc?/1r 3 y 5~ . t0 7 p t • . VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks .~' ^ ^ ^ ^ ~ 0 ^ ^ ^ ^ ^ VIII. Responsibility Statement I, the undersigned, assume responsibili or installation of the POWTS shown on the attached plans. Plumber's Name (print) Pl b is Signature (no stamps : PRS No Business Phone Number fl /TT / ~ - - Gs Plumb er s Address Street, City, State , p Code) Zi ` / Q f /~J ` ~U v G ~ ~ (// r~ '- ~f/ ~ IX. County/Departme t Use Only ^ Disapproved Sanitary Pennit Fee (Includes Groundwater Date Issued Iss in Agent Signatu (No stamps) 1} (,Approved ^ Owner Given Initial Adverse Surchaz a Fee} ~ ~ Determination ~f7 • ZS ~ Op( X.{~Conditions of Approval /Reasons for DisapprovaL• /~ ~ ,.~ x1 r p T~'~ S~(Si~ W c 1~ lt9'h t r~ S 8t ~ ~~ CC~Q2~ 1'1ti~ ~ l is 0. b ,. ' ~ . S , s -- -. t~+ d~6 /~t~ -~it.~.5v~ Ar~'.n~t~e~s ~r{ ~f GD at~ 6~4rirs~ tt ~.eKi~ry ~{;>/~'3F'~/~~~y, ~ ~ , ~ . / ,yj ! ~„~~F• . ~ ~ ~ . •. ,~ ~ ~ `~"~ Z~ (JCrw~ ~ QlSo Pik iSS4Ll~ ~~~f/ftn~~ f's~ Grf -~~. 7A~ r1w~ .. `~~~' SBD-6398 (R. 07/00) ~ ~ W'~' ~E Vt<ic~; I i _-t - i ~ { + ~ r f i ~ ~ ~ 4._ _.. _ ______.-~. __.___... .. t ; i i I f I i __ _ /f i~/l/ S//1 it/ ----~----~----*------r---~~,~. ~!/ Ut.~NI~~ ~ ~nrs~ cr'/,nom ~/~[~ .,-.___._ - _ , ._ ' f f ~ ' ? ~.- f___ ~.,_~.~~ _.__ ~~y -~ _ ~- -~- _ i -+-___ ~~ , s i ~ / i ~ i g - - +-- , l ~ 44i ! ~ f ~ ~ t ~ + -...-. _ _ ~ ~ ~.__- _y..., _.S-~__ .__-. I , K ! I ~ I t ~ ~~ ~ i ~ ~ ~ i i ~ ~ { _ ~ , ~ ~ T , , , --r -~----,---. _~ ..~.._ __-~ --:_ ty +- -~ - - - _-~-_- -- _ t - -~- - - - - i ? ~ ~ ~ ~ ~ I ~ ~ ~ ~ ~ ~ f ~ ~ a ~ ~~ ~ l p ' -+- ~ - - -r - l -i- ---- , ~ , --r-- -- - --r---+ +---+--r- - -*- ---- ~ ~ • ~ _ -~_ ~ ~ . ,.._ _ .,- i - ~ ~ _ y_ ~ _-_ ___ ~._ _. -__ _____... i f i . r ~ . i ; I ` } i y ~ ~ ~ k -~_ _~ ___>-- I ~-_- -- --t ~-- , 1 - ~ i ~ ! i .. ~b ._ 1 _._. -- - - - -- _-~- - - - - - - ,~ - ---•~- - - - _. ~_ _ -- ~ ~ V _____~.__ ~ _____~__..~r ~ rt_ -- . _.. ~ ~._ ____3_ _ : • ~ ~ , ~ ~ ~ , ~ ~ ~ L ~ ~ _ ~ , r- ~ , ~ _ ,- c ~__ _. ' •, ; Y --1-- -+- - --+_-__-__ ~ __~ -T- -~- -?---t- .. ~._ i I i E , , i i ; I ; i ~ r~ / ~ r ; ~, ~ „~ ~, _.} ._ 3 ! 1 r -~- ~ --~----~-__--r--. i ; i , r----1----- ~- _ . t-- _._ - - - --r---+- -- ~-- _._j---;--- - --r -t-----±-~--; --~-- ---r- --r-- _._._. - _: _ _a.._ __f...,__...Y_._-_r,_....~___ , -+-~ ~ • ~_._ ~._;.~. __ _ _ __ _T- ~ _ 1 ~ ~ ' r --'~ -} J _ f }~,, f ~ , 'S ' ~"~ ~_11~__~ ,~ ~_T1~ ------- --_. ~" S~-~; ~~ y~~425-;-----__-___--___ . ~. ~ ~ 1 * Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT in arr:nrrianr:e with Gnmm A5 Wis. Adm_ Gale ~cP (~ -/9-~n( 1064 Page 1 of 3 Tom Schmitt County Attach complete site plan on paper not less than 8'/= x 1,1. inches rn S¢e. Plan must l i f i n M St. Croix ere inc ude, but not lim ted to: vertical and horizontal re ) fict on and ce point (B Parcel LD percent slope, scale or dimemsions, north arrow and tbc~t~ora-and,distanee'te nearest road. ~ . 020-1376-57-000 Please print ar-1 informan. ~ iewed By ate ~ Personal information you provide may be !1sed~for sewnlh~l~ rivacy Law, s:15.U4 (1) (m)). F Z~- Property Owner .' ' " ;, f'' Property Location Swanson, Robert Govt. Lot NW 1/4 SW 1/4 S 14 T 29 N R 19 W Property Owner's Mailing Address ..,. ~ C.~ G ,N Lo Block # Subd. Name or CSM# 1489 No. Bay Road ~;;~., '~ F~ic~~ 57 Sweet Grass Farm City State Zi ~e Pho er ity ~ Village i~ Town Nearest Road Somerset ~ WI 540 r :'" T15-X47-5605 .- '~ Hudson Florence Lane New Construction Use: ~/j Residential /Number of bedrooms 3 Code derived design flow rate 450 GPD _,j Replacement J( Public or commercial -Describe: Parent material Outwash Plain Flood plain elevation, if applicable na General comments and recommendations: Area suitable for a conventional with a 0.7gpd/sgft rating. Possible system elevation for Area I is 94.45' (high trench) 93.45' (low trench) Based on a 10% slope. Boring # ~ Boring Pit Ground Surface elev. 97.95 ft. Depth to limiting factor >113 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIft~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-23 10yr3/2 none I 2mgr mfr cs 1f .5 .8 2 23-33 10yr4/4 none sil 2fsbk mfr cw ------ .5 .8 3 33-50 10yr4/6 none ms Osg ml gw ------ .7 1.2 4 50-65 10yr4/4 none grcos Osg ml cs ------ .7 1.6 5 65-113 10yr5/6 none ms Osg ml ---- ------ .7 1.2 Boring # ~ Boring Pit Ground Surtace elev. 97.95 ft. Depth to limiting factor >110 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-11 10yr3/2 none I 2mgr mvfr cs 1f .5 .$ 2 11-25 10yr4/4 none sl 2fsbk mvfr gw ------ .5 .9 3 25-49 10yr4/6 none Is Osg ml gw ------ .7 1.2 4 49-110 10yr5/6 none ms Osg ml ---- ----- .7 1.2 `Effluent #1 = BODS> 30 <_ 220 mg/L and TSS >30 < 150 mg/L "Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt ~~~~~ 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 586 Valley View Trail, Somerset, WI 54025 6/18/01 715-549-6651 Property Owner Swanson, Robert Parcel ID # 020-1376-57-000 Page 2 of 3 Boring # --~ Boring ~~ Pit Ground Surface elev. 93.12 ft. Depth to limiting factor > 112 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-37 10yr3/2 none I 2mgr mfr cs 1f .5 .8 2 37-56 10yr4/4 none sl 2fsbk mvfr gw ------ .5 .9 3 56-70 10yr4/6 none Is 1 msbk mvfr gw ------ .7 1.2 4 70-112 10yr5/6 none ms Osg ml ---- ------ .7 1.2 ^ Boring # -~ Boring _~ Pit Ground Surtace elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots D in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring # --~ Boring ;j 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. *Eff#1 *Eff#2 * Effluent #1 = BOD 5> 30 < 220 mglL and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mglL and TSS <30 mg/L. The Department of Commerce is afn equal opportunity service provider and employer. If you need assistance to access services or naaA mataria) in an altPrnata format nlPaca rnntart tha AAnarfrnant at !.!14_7(.(._11 C 1 nr TTV ll1R_7(.A_Q777 ~. ~ . . .~ n~ i ~~ i ~r«~~~ i ~~~ ~~ ~ I t r .~ 9~, o ~i i Q~ ~ /f~f~9 /Ilo• B4 y /e~ ~~~a~~ t ,~- `~ ~~,p ,~~ f~3 /off ~~ ~~ L'S Thy ~~ 7 S/,?'' ~+~.~s--P-~`, LJZ l~d~ S- .e~9~~ ~I r- Wisconsin Department of Commerce SOIL AND SITE EVALUATION ~Divisiort of Safety and Buildings Page I of 3 Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and ~j~ . C ~6 I percent slope, scale or dimensions, north arrow, and location and distance to nearest road. parcel I.D. # APPLICANT INFORMATION -Please print~lfi,~Idrm~tion ~ ~., Reviewed by Date Personal information you provide may be used for secondar~ur~oses (Pnvac~y Law § 15.04'(7) (m)). (Z 2~ Property Owner ~~ ~ ~ ~ ~ r, Prop , Location ~ U' IQrC! JTDI.)~ ~ Govt.. L,ot ~ (,~ 1/4,5(,v 1/4,S ~!. f T z~ ,N,R /~/ E (or) Property Owner's Mailing Address - ,~ Lot # Block# Subd. Name or CSM# 35 3 A ~; ~~..~ kte. ~ ~ - ..: ,~ ~i- SCE e-e->•- ~s- r~.S S City State Zip Code Phone Number . ^ .~tY ^ Village ~ Town Nearest Road I-luclson wt 5tiotto c ~~5 ltq~~`~ ~ ~~~so ,-. ~~r~,~~-- Ic~-~- ®New Construction Use: ®Residential /Number of hs~roa~s~ ~ 3 _y Addition to existing building ^ Replacement ^ Public or commercial -Describe: Code derived daily flow ~U gpd Recommended design loading rate ~_bed, gpd/fi2 ~ trench, gpd/ft2 Absorption area required ~_bed, ft2~trench, ft2 Maximum design loading rate ~-bed, gpd/ft2 ' ~ trench, gpd/ft2 Recommended infiltration surface elevation(s) ~L<o • G CO ft (as referred to site plan benchmark) Additional design/site considerations ~~~-~ ~ S• O (p ~~// Parent material ~)C 5 -{~~3 cc.5 ~ Flood plain elevation, if applicable -/l/ ~ 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 I~ S ^ u ®S ^ u ^ S ®u ^ S ® u RAiI r~FSCRIPTIAN REPORT ~" Boring # Ground elev. q•/(n ft. Depth to limiting factor 9~in. Boring # ~ ~.... Ground elev. 9•t ft. Depth to limiting factor 9~ in. Horizon Depth Dominant Color Mottles Structure B d R t GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence ary oun oo s Bed ,Trench I ~-la 1Q r 3I z ~ t 1 ~ L j l v~ .2 ~- 3 2 !0- 1b ~(} ~ ylto i C im ! c s . ~ • S 1 ~-qb, o e , '~~, y X3.2 ' Remarks: l-~r~za,~ Z-- %s Sd,~w!<~--F C~1b-e-~~ I o-tb i 0 r l Z ~ 5i I k. ~ L v~ . 2'. 3 2 Ip- Z~ t r `~ I y `- Sr ! Zmcabk m~ ~ ~ - ' ~ ; ~ ~ -9`1 1 ~ `i ~ to 'r Yr~ S OS h~ ( ~` • ~ ' • ~ Remarks: :ST Name (Please Print) ignature ~ Telephone No. ~c.Qct rv~ S c~.u vim. - Z/S-~ ~/ 7-~/~O ~' 4ddress Date CST Number z ~ /3 Fs-o .~ ~~ ~ ~ ~ -f- w ~~'oZ .S- ~'- y oo z s3 3a q PROPERTY OWNER - S~ ~~ SOIL DESCRIPTION REPORT PARCEL I.D.# Boring # 3~ Ground elev. `~9• ~tv ft. Depth to limiting factor ~9 _in. Boring # ~r~ Ground elev. 9~tt. Depth to limiting faclpr ~in. Boring # Ground elev. 9 .~~tt. Depth to limiting factor ~_in. Boring # Ground elev. ft. Depth to limiting factor ,f Page ~ o~ ~' 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- ~ ~ lO r 3/~ `'- S; f k ~n~r c-5 I v ~ . Z. ~ ; ~a ' Remarks: 1 0--2 1Oyr I Z S~ ~ k ~~~ G I . Z' 2 IZ-fib r ~ I~ -" S, l Zn-~nk YY~, c 5 - . ~ ~ . (p .~- 3.2 .L -S 5(~- , ~~"_ 4 ~ ~.YKQ~( Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundar Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. y Bed ,Trench 1 0-Ib I r 3) Z ~i I ~ rnabk ~r c.5 I u~ . 2~• 3 2 r0-yz. I~ --- 5; J 2 ab m~; c S - . 5 ; ~ ~ Remarks: m. Remarks: SBD-8330 (R.9198) f ~ PAGE~OF~ NAME ~-~C~~-f ' LOT# ~j 7 LEGAL DESCRIPTION/)W `/4Sw'/4,S /W TZ4 ,N,R Iq E (orYW~ BM 1 ELEVATION (OC R. U ~ ~~ 1 DESCRIPTION o.( ~"~s I>; Qe lu-F~I. T~b~ti BM 2 ELEVATION ~ ~. 3 DESCRIPTION dap o ~ f "~=~r Q: ~ Ir t~ ~.utQ.'b1~. SYSTEM ELEVATION ~(p. U w T E E TIO c `S` Q6 ALTERNA E L VA N l CONTOUR ELEVATION ~~ fU Co~S~sfrn.t-51oGG l~~ \ wit ~ .~ a3- UZ (i pr"ha ~y t e~~ •' ~~ ~- DATE `~`~ ~Q ST CROIX COUNTY i SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~1 rl i3 E /2 % ~ S,L.L~A/IISQ/t,~ Mailing Address Properly Address ~~..7 ~LG /t wive ~ [. ~ iy' ~- (Verification required from Planning Department for new construction)- City/State Trui~sow /.LJi`- sYo~~ Parcel Identification Number ~2n -/3 7G •-S7-GC~D LEGAL DESCRIPTION Property Location .d[L11_-'/<, -SuJ '/<, Sec. ~, T,~~N-R~_W, Town of /~t~o_s~ n~ _ Subdivision ,,S ~U ~ ~ T lr2 ~ s S ~A 2 h~j - .Lot # ~. Certified Survey Map # ,Volume ,Page # Warranty Deed. # /0 3 G ~ /' ~ ,Volume / S_9 7 ,Page # S~i!J Spec house ~f yes ^ no Lot lines identifiable [~' yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result is its 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mast~rplumber, journeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on site wastewaterdisposal system is is proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin, Certification stating that your septic rem has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the piration date. AX /h' i~ l U.-lV O DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the prope desc ' abo by virtue of a warranty deed recorded in Register of Deeds Office. ~~ ~~'~ OF APPLICANT DATE ««««*« ««s««« Any Formation that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. •* Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty decd r - . 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 In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: System Design Specifications Sanitary Permit Number 3 3 Number of Bedrooms Design Flow -Peak (gpd) SZ~ Estimated Flow -Average (gpd) lJD Septic Tank Capacity (gal) OZSO Soil Absorption Component Size (ftz) ~S Type of Wastewater D mestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absor tion Component Design Flow -Peak {gpd) ~- - ab ~tS Maximum Influent Particle Size (in) 1/8 Maximum BOD5 (mg/L) 220 Maximum TSS (mg/L) 150 Tab le 3: Maintenance Scheau~e 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 septic tank and outlet filter shall be assessed at least once every 3 years by inspection. Th outle i ter shall be cleaned as necessary to ensure proper operation. The. filter cartridge shou no a removed unless provisions are ma a to retain solids in the tank that may slough off the filter when removed from its enclosure. If the ~P,~+ ' ~ Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere wifhin the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank maybe difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation.. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. .Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 ~~~ ~~~ PAGE ~~~ STATE S ONStN FOR 2 - 1982 WARRANTY DLED DOCUMENT NO. Richard 0. Stout and Janet P. Stout conveys and warrants to Robert W. SWanSOn the following described real estate in _ St . CroiX County, State of Wisconsin: of 5 Plat of Sweet Grass Farm, Town of Hudson, St. Croix County, Wisconsin. Fs;~9'96 S KATHLEEN H. WALSH kEGbSTEk OF DEEDS ST. CkOIX CO., WI RECEIVED FOR RECORD 43-07-2001 iZ:30 PM WARRANTY DEED EXEMPT # CERJ COY FEE: COPY FEE: x.04 TRANSFER FEE: 157.24 RECORDING FEE: 14.00 PAGFS~a~ 1 3 THIS SPACE RESERVED FOR RECORDING DATA NAME AND RETURN ADDRESS Robert W. Swanson 1489 North Bay Road Somerset, Wi 54025 020-1376-57-000 PARCEL IDENTIFICATION NUMBER This _ l S Tlnt _. hnmPCfPA(i nrnnorrv ~ ~qL ~iJ~~PAGE JIJ~ STATE BAR OF WISCONSIN FORM 6-S - 1982 MORTGAGE (To be used for: loans over 525,000: loans 525.000 DOCUMENT NO. or less and first lien: or other non•cortsumer act transactions} ROBERT W SWANSnN ('Mortgagor", whether one or more) mortgages to orrunnn n em {7~ 3~ 774FTI3T E~STAI9T {'Mortgagee", whether one or more) to secure payment of Dollars ( evidenced by a note or notes beating an even date executed by to Mortgagee, and any extensions, renewals and modiltcatlons of the note(s) and re0nancings of any such {ndeb[edness on any terms whatsoever (including Increases in interest) and the payment of all o[hef sums, with Interest, advanced to protect [he security of this Mortgage, the following property, together with the rents, profits, flxtu res and other appurtenant Interests (all called "Property"), in ~~~~~ _ County, State of Wtxonsin: of Plat of Sweet Grass Farm, Town of H St. Croix County, Wisconsin. This homestead property. This i c a purchase money mortgage. (' not (u) (u na) Mortgagor warrants Utle to the Property, except resvrctloru and easements and easements of record, ro Et.5O297' KATHLEEN H. WALSH FfEGISTEFt OF DEEDS k;T. CkOIX CO., WI RECEIVED FOR kECORD 47-05-2001 x:44 PM MORTGAGE EXEMPT M CERT COPY FEE: COPY FEE: TRAFESFER FEE: RECORDING FEE: 10.00 PAGE: 1 `~!S i 1 (eS~-R "l,r 'i E.t U it NCi DArF .... ... NAME AND RETURN ADDRESS Dick Stout 1353 Awatukee Tr. Hudson, WI 5401fi r! any and except Mortgagor promises to pay when due all taxes and assessments levied on the Property or upon !~~ Mortgagor's interest In it and to deliver to Mortgagee on demand receipts showing such payment. Q 2 Q _ 1 3 7 (_ 5 7 - f) Q Q Mortgagor shall keep the improvements on the Property insured against any loss or damage pgRCEI iDENnciCgnON NUMBER occasioned by fire, extended coverage perils and wch other hazards az Mortgagee may require. through Insurers approved by Mortgagee in wch amounts as Mortgagee shall require, but Mortgagee shall not require coverage In an amount more than the balance of the debt without co-insurance, and Mortgagor shall pay the premium when due. The policies shall contain the standard mortgage clause in favor of Mortgagee and, unless Mortgagee otherwise agrees in writing, the original of all policies covering the property shall be deposited with Mortgagee. Mortgagor shall promptly give notice of loss to insurance companies and Mortgagee. Unless Mortgagor and Mortgagee otherwise agree in writing. insurance proceeds shall be applied to restoration or repair of the Property damaged, provided the Mortgagee deems the restoration or repair to be economically feasible. Mortgagor covenants not to commit waste nor suffer waste to be committed on the Property, to keep [he Properly in good condition and repair, to keep the Property free from liens superior to the lien of this Mortgage, and to comply with all laws, ordinanrg and. regulations affecting the Property. Mortgagor shall pay when due all Sndebtedness which may he or become severed at any time by a mortgage or other lien on the Properly superior to this Mortgage and any failure to do so shall constitute a default under this Mortgage. Mortgagor agrees that time is of the essence with respect to payment of principal and intemst when due and m the performance of any of the covenants and '. promises of the Mortgagor contained herein or in the note(s) secured hereby In the even[ of default, Mortgagee may, et his option and subject to the notice provisions '. of this Mortgage, declare the whole amount of the unpaid principal and accrued Interest due and payable and collect It 1n a suit at law or by foreclosure of this Mortgage by action or adveriisemenl ar by exercise of any other remedy available at law or equity, and Mortgagee may sell the Property at public sale and give deeds ' of conveyance to the purchasers pursuant to the statutes. Unless otherwise provided in the note(s) secured by this Mortgage, prior to any acceleration (other than under the last paragraph of this Mortgage) Mortgagee shall mail notice io Mortgagor specifying: (a) the default, (b) the action required to cure the default; (c) a date, not less than 15 days from the date the notice Is mailed to Mortgagor by which date the default must be aired; and (d) that failure to cure the default on or before the date specified in the notice rosy result in acceleration. [n case of default, whether abated or ont.all oosls and expenses including reasonable attorneys' fees and expenses of title evidence to the extent not prohibited by law shall be added to the principal, become due as Incurred, and in [he event of Foreclosure. be Included in the Judgment. Mortgagor agrees to the provisions of Section 896.101 and 846.103(2) of the Wixonsin Statutes, as may apply to [he Property and as may be amended, permttting Mortgagee in the event of foreclosure to waive the right to Judgment for deficiency and to hold the foreclosure sale within the time provided in such applicable Section. Unless a Mortgagor is obligated on the note or notes secured by this Mortgage, [he Mortgagor shall not be (fable for any breach of covenants contained in this Mortgage. Upon default or during the pendency of any action to foreclose this Mortgage. Mortgagor consents to the appointment of a receiver of the Property, including ' homestead locates[. to collect the rents, issues, and profits of the Property, during lice pendency of such an action, and such rents, issues, and profits when so collected, shall be held and applied as the court shall direct. - Mortgagee may waive any defauk without watvtrtg any other subsequent or prior default by Mortgagor. In [he event of any default by Mortgagor of any kind render this Mortgage or any note(s) secured by this Mortgage, Mortgagee may cure the default and all sums I paid by Mortgagee for such purpose shall immediately be repaid by Mortgagor with interest at the rate then In effect under the note secured by this Mortgage and shall corutitu[e a lien upon the Property ' Mortgagor shall not transfer, sell or convey any legs! or equtta6le interest in the Property (by deed, land contract. option, long-term lease or in any other way) without the prior wriuen consent of Mortgagee, unless either the indebtedness secured by this Mortgage is first paid In full or the interest conveyed is a mortgage or other security interest in the Property, subordinate to the lien of this Mortgage. The entire indebtedness under the note(s) secured by this Mortgage shaft become due and payable in full. at the option of Mortgagee without notice. upon any transfer, sale or conveyance made in violation of this paragraph. Mortgagor hereby transfers and assigns absolutely to Mortgagee. as additional security, all rents, issues and pro0ts which become or remain due (under any form of agreement for use or occupancy of the Property or any portion cite roof). or which were previously collected and remain subject to Mortgagor's control. following arty default antler this Mortgage of the note(s) secured hereby and delivery of notice of exercise of ibis assignment by Mortgagee to the tenant or other user(s) of the Property. This assignment shall be enforceable with or withwd appointment of a receiver and regardless of Mortgagee's lack o! possession of the Property. Dated this _ __..____ day of April . 20Q.~--__. ~~ (SEAL) (SEAL) (Mortgagor) (Mortgagor) Roharr w Swa~snn ,. AUTHENTICATION Signature(s) authenticated this day of . 20 TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorl2ed by §706.06, Wts. Stars.) THIS INSTRUMENT WAS DRAFTED BY Janet P. Stout 1353 Awatukee Tr. ~igrratu~sntttay~ aut4t~`~t~t~ or acknowledged. Both are not necessary.) ACKNOWLEDGMENT State of Wisconsin, ~ I ss. St. CroiX County. Personally came before me this day of '. Apr i 1 20 Q 1 ,the above named 12nhtarY Ct St anenn NQTAR~pI IRI I(~ rnMef ~ to me k o b}~e~~Tttecuted the foregoing I m nt acknowle~ig~ey~Fte same. a NOfa Public, ~ County, Wls. My commisslo~i r~p~ rmanent, (If not, state expiration date: ~Y , 20 G9~, ) Names of persom signing In any capacity should be typed or printed Ixlow their signatures. STATE 8AR OF WISCONSIN Wisconsin Legal Blank Co.. inc. MORTGAGE Form Nu. 6-5 - 1992 Mawauk96, vets. / ,.,~ ? s ~ f i f .6 (tjl, ~ ~ l ~` xa< r~ ~ ~ ~~ ~ ' ~ ` . ''~ °~ ' ` ~ 1 ~, + d f I r [ 1 ~ ~ ,,~ ~ ~ ~ ~ -~ ~~,,,.. `,~ ~ ..- t r ~ ~ ~ c~ ~' i ~ ft 1 d t ~ f ,. a ~ `wV 1 ~. I f ~ t ' ; j ~°' ~ "'M 'a, r S l~ ¢ ~ ) ~ ~, a ~,... f ,f t ~ ~ t ~~ .~ i ,I ~, ~y -~ _ ~ _. ~..._._ ~ _.- - ~ ~ - _ ~~r, if ~ ' w xr 1, ~_ __ . ,~~ f,f,; -' r ,,. S ~"" F __ ~ ~ _-- r ~ ~ ~ ~~ -- ' . ~~ -a ,~r~ g ~ _ _.. - ,,r- 1 ? ~ ~ ...1/ ` ~ CSl s ~' ', ~ ~ ' ! .,~ ~~ ~ r ~ --_ ~ ,~ '~ .~.n '~ ~~ ~ ~ ~ ' ~ .~ I ~~ ~ `~~ 1 `~_-~qpp~~~/~ j ~~... ~ _t ~~ _s t he ~~ ai ~~~'~ ~ ~ =. r r , _~._ ~ ~ ~` ~ _r- _.~ .._ 1 ~ ~~ ~ ~ ~ .. -,-T -c ... r j Sj ~ u ~ r-. ~} ( ~ U" <„ a, ~~ ~ ~ ~~ ~ ~~ r a; - '~s m .~i ~ f 1 ti ~ ~. .~~ _}.. .__ a~ ~, ~ -- ,.._. __. i __... .~ __ _t~ ____ _~. _~. '~' ~ ~ ~..ti ~ _ _~ ° r ) r~_. ~ ,_ ~ ~~ i ;.~ t .. }., 1 ~ d I El ~~. _~~ .. , , - J f! l ' 1• /~ + '~ ~. ~ti ~~ e ~~++ '/ ., r .,- ~ ~. ,.. ~. f ~j ~ -~~ ,. _.~ .~. FF ,' _./ ~~ -. ~ / a~ u~ ~ / /F f f ~`~J ~M tit ~. ` /// ` ~ ~;~ co X ~` '~A ,* ~ g~ ~ /'~ u~ p ~~, ` ~~^.,~ .. ~ ~ ~ `~,sx ..+ ,rte 1 ~ .. ~~ . O ~ ~ ~_ _.. ~ '~ r C~?-..._....~ it ~ ~ ..._.! ~' ~ ~ _, ~ ~ c1~ ~ -~' ~° ~ x ` . °' ~ ~ ~ ~ ~ I F 20t1~' ~ ~~ ~ ~ "~ CJU W tLl ~ ,. ~ ~~, ~`-~ ~ L~ t~ ~ rr ~---- ~„~ ~, ~~\ AAh~~~ ~a. kk i 7 c0 r' ~, ~~>-_. C. t .~, ~ ~ E ~ ~ ~ ~~ 1, ` l k` ~ k fr i ~~ Y `_' i ~~' l . , r ,;_ ~,, ~~ ~ ~~ ' f f ~i ~ ~..._, ' ,~~ 1 ,. ~~ i' ~ ~ ~ ~~ "~ -~-..~~ _--~, iK ~. \~ l ~ ~~'_ ,'~ as ~ ,\ ~ '•. , \\ X cs> ~ ! }) ,~ rn `~ ~ 4 /: ~ . ,, ,~ , ,, , ~ ~~ ~' ~ '~ 1'~` ~rj,/ ~- ; i ~~~ ~' ~~ '~ ~ .d0 ;/~ ~~S ~ 195.03' 195.U3' .35' 20Q.35' 6 ~' `~ Q h ,~:. w w a L \ ~' ~ 00 ~ ~ N b O . c t. ~~ ~ } o ~ ~~ ~~ ~ ~ ~ ~~ z ~ ~' ~~ ~ ~ r~ ~ ~~ ~ ~ ~ u~ ~~ a (3 ~ ~ ~ ~ ~~ ... ~ ~ .~ - _. _ ... ~ ~, y": ~ I ~ - .. y J~Y . ~ `^- ... p 86.63' 7.89' - ~.._ ..,~ l~,~a ~ !'"`~~ ~..IA~E NOtJ'13'i0"VY846.74' a ,,,. ~----~. ----_. .,~~~ _~ SOa'18'i[YE 846.74' `' 438.£~m' ~46.DT -- ...__ ..._ _._. ~ _ _. i _ . T ~ _ _ . ~ _ ~j- _ _ 245.x' • d ! 1 '~ ~' ~ . ~, a ~~ z~ ' a~ ~ ff9 ~ ~ O C ~ ~~/ ~./' N ti O ~~ ii it ~~ 1 ,~ , ~3 ~i.Ot~~~ E Sanitary Permit Application Safety & Buildings Division ~ ' ~ In accord with Comm 83.21. VJis. Adm. Code See reverse side for instructions for completing this application 20l W. Washington Ave. PO Box 7302 iseons~n personal information you provide may be used for secondan• purposes Madison. WI 53707-730" Department of Commerce [Privacy Law, s. 15.04(1)(m)) (Submit completed form to County if r state ownee Attach com lete Tans (to the county co ~ only) for the system. on a er not less than 8-1/2 x 1 I inches in size. Count~__ Stag S Mary 3 it Number ct11:~i r t i~q revious application State Plan 1. D. Number G~! I. A lication Information -Please Print all Informati Location: Property Owner Name ~` ~ Property Location ~~ ~ ZL~~rt~~ `~ C ~ C,(J.4%/~ f '~~ < ~ 114. 14. S f T ,l` o Property Owner's Mailing Address '"" ~ ~~ ~ ` Lot Number Blr~r~ umb°r _ City, State Zip Code ber ~ Subdivision Name or CSM Number II Type of Building: (check one) y }-~~" ~ 1 ~%' O Ciry ~ 1 or 2 Family Dwelling - No. of Bedrooms:~ ~`''~---..i ~ -=-~''~ ^ Village _ ^ Public/Commercial (describe use): ~[TOWn of ^ State-owned G/OSO III Type of Perrztit: Check only one bex on line A. Check box on line 13 if applicable) Nearest Road ~ ~ _ L/1~. A) 1. J8f New System 2. ^ Replacement 3. ^ Replacement of 4. O Addition to Parcel Tax Number(s) S stem Tank Only Existin S stem - -p40 g) Permit Number Date Issued ^ A Sanit Permit was reviousl issued IV. Type of POWT System: (Check ali at apply) 9E- ~ J}-te~D ~ ?~-~ Non-pressurized In-ground ^ Mound and Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank Single Pass ^ Drip Line O At-grade ^ Aerobic Treatment Unit ^ Recirculating ^ Other: V Dis ersal/Treatment Area Information: %1. /N~!` T /} '- /L.S 1. Design Flow (gpd) 2. DispersgJArea R i d '~ ~ 3. Dispers~ ~' L P d ~ 4. Soil Applic /d R G l ft 5. Percolation Rate Mi /i h 6. System Elevation 7. Final Grade El ti equ re S ropose j ate ( a sq. .) s. n. nc ) ( y,3 ~ j eva on ,d.Pp~o ~s~ Co ~ ~(~ ~~• 2 ~ v'Z . 7 (~ S VI Tank Capacity in Total # of anufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks ~ DO D ^ a o ^ ^ VII Responsibility Statement I, the undersi .ed, assume res onsibilit fer installation of e POWTS shown on th ed laps. Plumber's Name (print) Plu is Signature (no ps): PRS No. Business Phone Number r -- / Plumber's Address (Sveet, City, State, Zip Code) L VIII County/Departm nt Use Only -'c a so -r ~} sit-~ s ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) Approved ^ Owner Given Initial Adverse i S ttr~~e~ ~ , ~! l C %~ n J~^-+" nation Determ ooCC IO - IX. Conditions of Approval 1Re sons for Disa proval: ~ 5: &e,~ oa~W}++e1A~ ksx (, ~, ~~ ~ w r`l; Qw. ~`e- ~ t~ (~~ -d.~.Qs y O • ~8Pd1, ~ Op-I~t~•-~~. ~i~ -~-p,~.~C..e.~Q~' t~ ~~ I Bt ~ ei-(t(~~ ~X~++`~-1 ~`~'°~.. ~- ~ ~ ''~-1j1M~ t'om` `40 44 IA^~` ~- 1~8 dto,we~- et>w-- ~o -Fo ~-~'e.Qd) ~~ ~ ps ~ u~O,L~ d'Qtow~wtert~~S. SBD-6398 (R. 07/00) *-'L[A. A2~it1~rt-btik- ~+'~~ ~ t'~ f s C~~~IWIU.T i ~ r `~ 1 Iy E .~_ i ' ~ i ~ ~ i ~ I ..._~ 1 i } ~ ~ ; i S -- - - .._ -. ~ __ ~. __l.. _._1-- -s---+ ---~-- - t-- - + _ ~ t _ t- t i ~ -- 7 I [ i I i ~ `~ Z i ~ ! ~ ~ ~ I 1 I ~ ~ , I tt 1 f j j _ ~___ - . ! I - a-- - >_ ~ T __ - , . ~ i ~ y j - --_ ___ } ~ --.4 I ~ ! ~ ~ r ~ ~ - - -- _ ~ ~ i ( _- - - -'---- --- I - ~---t---- --~--i-. i ___- -- -- - -__ ~ ' - -.-- -~ -~ ~ ~ -~ _ __.__ ~- -, , ~ --- ~ ~ i ~ ~ ~. __ ~ ~ nG 4 ,- ,_ ~ ~ I ` i'~iN r _ ~ ~ , i w { ~ t I ) 1 '. ~ ~ ~ i _.'~~_T_ `` i i I ' I ~ i i i ~ 1 1 ~ _ i~ i 4 r ~~ I i # ~ ~ ~ r / ^ , i _ p P j _ y ~ i ( ~ i ~ I ~ ~ { i ~. i ~~ 4 _._ ~ ~t i ~~ ~~~~ ~D~L~~S " ~ ~ s ~ f __ ± _~~..__. ~~ . ' -'--T-- f -i` S ~`; _.~ _~ _~~.. j_ _~___ -~. ___,..._ r__ ~ _. _~~ _ _ .~ ~-- ~-t ~ 't ~ ~ ~---. .~ ~ r ~~ ~ ~ 4 t 1 i ..~. ~. t I ___1 ~ ____+__ ~.~_~__._ ~~ _ r _ _ 4 ; ' _.._ ~~ i V ' 1 i ~ ~ ~_i. i ~ ' ~ ~ t } ~ i E ~. ~ __~ r ~____ i i ' I i !~ ~ - ~ i ~ 8 - ~;~. _____~____ - _ ___ _ ~ I ~_ ;_ ~._ ~ s ~~_~_ _ ..~.~~~-~ --~-~ _ ~'`~~-~ --~- ' _ __~~/~~-~--~.~--- pro 5 ___~_ _~ i ~ ~ ~ r~~' •, • ' ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~Dl3~2 i ~ ~.[J/a-b^~•S~~/' - Mailing Address Properly Address "! I ~ .~ L~R ~~yc~ ~~ (Verification reQuired from Planning Department for new City/State ~~a~~ t ~ ~ /,Ui` . Parcel Identification Number ~ ~l~ - / 3 7 ~ -- ~ D- DGp LEGAL DESCRIPTION property Location Subdivision _y r/4, ,~~'/., Sec. ~, TAN-R~.~W~ Town of r~u,a c-~n/- Certified Survey Map # Warranty Deed # Lot # ~Q.. .: .Volume _ ,Page # Volume ~.S 0 ,Page # / d 3 Spec house ~ yes ^ no Lot lines identifiable (~" yes ^ no SYSTEM MAINTENANCE f Improper use and maintenance of your septic syste uld re,~lt in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years ors r' if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage ' e waste disposal system. ~~,< The property owner agrees to submit to St. Croix, ~oning ~ ent a certification form, signed by the owner and by a mast~rplumber, journeymanplumber, restrictedplumber `a licensedp r verifying that (1) the on site wastewaterdisposal system is is proper operating condition and/or (2) after inspection and pumping (~ ssary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigacd have read the above require nts and agree to maintain th - 'vate sewage disposal system with the standards set forth, herein, as set by the Department of Co erce and the Department of Na Resources, State of Wisconsin. Certification stating that your septic system has been main ed must be completed and returned to' St. Croix County Zoning Office wrthm 30 days of thythrefiy~xpiration date. /'" ;~ TORE OF APPLICANT / / DATE V YY 1`1 tilt t.lrin a, ar ice.[-~ i av i I (we) certify that all st ments on this form are true to the best of my (our) knowledge. I (vve) am (are) the owner(s) of the pro d above, by virtue of a warranty deed recorded in Register of Deeds Office. / / SIGNATURE OF APPLICANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** •~ Include with this application: a stamped warranty dud from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed r ~ ~ . ~,,~.1594PAGE103 `~ STATE BAR OF WISCONSIN FORM 2 - 1998 L' `' WARRANTY DEED ; ; ~; Document Number ~, This Deed, made between RTCHARD O_ STOiiT and ~TANET p_ STOiiT, husband and wife, Grantor, and Grantee. Gra or, for a valuable consideration, conveys and warrants to Grantee the following ~,~' described rea state in St _ Croix County, State of Wisconsin: s' 6~~$991 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 02-~~-2001 9:45 AM IiARRANTY DEED EXEl4PT N CERT COPY FEE: CORY FEE: 2.04 TRANSFER FEE: 163.50 RECORDING FEE: 10.00 PAGE&,,.y ~ 1 Rt~cording Area p ,., L t 60, lat of Sweet Grass Farm, Town of ~~~ ~-`^~~... Name and Return Address Hudson, t. Croix County, Wisconsin. t`~ ,~ ;, Swa ~ rJ~ ~~- ~~~ ~y~y ~ cur r~ ,. ~! - __ - 020-1376-60-000 Parcel Identification Number (PIN) This iS riOt homestead property. (is) (ts not) Exceptions to warranties: eas~tinentS, restrictions rights-of-way and covenants of record. ~~~" oN ~" - .,„,,. Dated this 21 S t _.. ~~ ~+' F'°t"'" ^ °"' ~. ~i ~~ ~ - I • ~ ,a' i ter: _.r .~ lEI.lV. ~ 883.0 y. I ~.~Aip~eb `~; ~.~ . r LOT 35 2.00 ACRE8 37184 80 ~ OT 34 '.oo ACRES 71 dS 8Q fT 48~'E 344.41' OT 33 b ACRES 31 SQ FT ~1'4S'E~ ~T 32 ~sa~r ~o 0 ~ 4', i ~ ~ ~` ~. ~ ~: z~~~ . p ~ y ~~ ,~ ~ ~~~ ~ . 4 -.. ti ~~ ~> ' . I ~` \ M~ ,~ S7~ _~. ~j' - ~' ~ ` f 1 ; ~' . ~ ~ w 7 ~ 4 E ~ ` ) ~ ,g'' = ~ ~ ' f ~~ ~ ~ ~ I ~° ~ ~ ; ! • I A '~ MW B41Lp1~IQ ' a EI.EV E ~ 888.0 i ~~' Neo-ss'do"E des. ' I f~ . ~, ~ . :~ ~~, -- - . ~ a 11~ 8~ . , , ~ f25r . j ~~ ~~ H.W.L : 8820 LOT 58 3.44 ~s 140474 8!O ~ MIN sIJILDINO CI.H1/. s d~_0 . &1 '~ N88'48'40'E 488.44' g l` - _ _._. ~ i- ~ ~ ~ -~ i~ - -:~ , T 60 . ~ 4 - - ~ 1134 ~ ~ ~ ~ ~~ -. ~- 1 ~~ '. .,~ ~~ . t N88"4A'd0`E ~, 248.38' .. ` ~ ~ . . \ • a_ ~ . • ~\ \ Z ~ LOT 61 a '. ~. ' z.1eACRES 31 Z.82' LOT 62 2.01 Aug a7s4>- so Fr A,` O O (~ _.. ~ ~ , ~ ~ ~ ~: ~ ~1 ,~ , ~ OOO m ~' ~ . r " ° ~ ~\ \ _~ ~ ~ (~ (~ • ~ w ~ \ ~ ~ ~ s ~' „~ ~ l , .~~ ~ O x Q ~ ~ J 1 ~ / J t• i / ; `" /'~` ~ ` ~ / / Y /~ ~. ~ ,. ..y f ~,` :; n ~~ a ~ - X j • , x ~ ,~~ _ t f, /i / / N ,:~ a fir. ~' / ~ _ Y R ~ ~ ~ ~~ ~~ 1 ~ ~ j/ .~ \ .r ~ i ~._ ~ ' r N ~ ~\ v ~ ~- E ~ / i ~ / ~ ~ ..~ ~ '~ ~ ~ W ~ K ..L X ~ ~_~ ~~ ~~' i ~ ~ ~ ~~~ ~ 1 ~ II C rn ~ ~;~. f ~ i f ; ~ ~ 1 'C 1~., ~ N ~ ~~ i _ t N - , ~' ~ N = O .N. ~ ~ ~; ~ v \ ~,,y ~ a ~ 1 4 `, v t ~ ~ ._ r 9 Z ~ Fcoa-~c..E NE Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21 Y~is: Adni. Cade 201 W. Washington Ave. ~~, ~ See reverse side for instruction~,fOF completing this appkcation PO Box 7302 ~~ Personal infotrnation you provt ,ruay be used for secondary jlurposes Madison, WI 53707-7302 []ept~rtment aE commerce Privac s i 5.04 1 (Submit completed form to county if not ,. , state owned. Attach com lete lans to the coon co or the s '," er not less t an 8 -1/2 x 11 inches in size. Coon --- State 't Number Check if revision to previous applicatipn State Plan I. D. Number ^~^ ~ _ I. A lication Information -Please Print all Informati ` Location: ., ~-• Property Owner Name G}U~ 1. ~ : Property Location a , ~~(~~l1r:L ~ .-- (i(J ?~~. 1 /4 $~ 4, S T ,N, or Property Owner's Mailing Ad ss =: ',~ ;: Lot Numb Block umber y8 a• ~ i City, State Zip Code Phone Number ~ Su ision Name or CSM Number E S~ .5- D .~ ( - (00 CULeT lr2/~s'S r4' /7 II. Type of Building: (check on ^ City I or 2 Family Dwelling - No. of ooms : .~ ^ Village ;Town of ^ Public/Commercial (describe use):_ ^ State-Owned u/JSO/'~ Nearest Road 1 _ ~ /i/G !r 2 ` 3' x/ ~.~15 T 10 Parcel Tax Number(s) Ck onl one box on 'n aline B if a [cable Che III. T e of Permit: / 3 A) 1. New 2. ^ Replacement 3, acemet~, 4. 5. 6. ^ Addition to S stem S stem Onl -. Existin S stem B) t umber Date Issued ^ A Sanita Permit was r io IV. Type of POWT System: ( alt pl ' l~Non-pressurized In-gro d ^ M' nd ^ Sand Filter ^ Constructed Wetland ^ Pressurized In-ground Hole ' g Tan ^ Single Pass ^ Drip Line ^ At- ade ^ Aerob T tment Unit ^ Recirculatin ^ Other: V. Dis ersal/Treatm~f Ar on: 1. Design Flow (gpd) 2. Di 3. Dispersal Area oil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rat Galslday/sq. ft.) (Min./inch) Elevation s ~ ~~,~~~~ ~~ .p 99r G VII. Tank Capacity in Total # of ufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing ~ Crete structed Tanks Tanks ^ ^ ^ ^ ~ ~ / 0 D ^ ^ ^ ^ ^ VIII. Responsibility Statement I, the undersi ed, assume res onsib' for installation of the POWTS shown on t d lans. Plumber's Name (print) Signature (no stamps : ness Phone Number Bus i ` ` 7 ~ ~ Plumber's Address (Street, City, Stat ip Code) - S IX. County/Departmen se Only Y6 / 0 w. a 5 r ^ Dis roved Sanitary Permit Fee (Includes Groundwater Date Issued ss ing Agent Si tore (No stamps) ~pproved ^ O er Given Initial Adverse Surchar ee) _ _S ~ ~~ Det ination • X. Conditions o pproval /Reas~s~fo_; Di(approv^ : ~ , r ~ _ ~ n - 5~ ' ~ C'~ .~a d1CJCit~4 r~,.~-t`+v. -~. ~-"weav "( "" k o ~~ie dl s 5 Q i . s • P . ,~ , ~~ ~ . ,dss ~- ~~Qa~ w c~R.o,~-i~e~ ~. c 1S b0 ~~y~,pltY~,rtecY GtS ~.e.~. IM ` /'e ~w~-e,,~~~s ~ ; y .__. . _-- t ~. _.-... _.r. _' ' ~ ~ t ~ t ;, ~ r i ~ ~ - ~ ~ _. ~~ ~. _--_ __ I ~ 1 ~ j ~__ _ _ __ -- __1 L___ _ .. ~ _ _ ~ ~ -- . - I ~ 11 ~ t t ~ ~ t ! ! ~ ! f ;. ~ 1 i _ ~ 4 _ ~ ~ Ir i~ t ~ i~ • - ~ ~: u y ~ s s i ~IV~I~% 6 ~/~ i ~ ! s 1 / 1V'~/Lfr~~RfbFt ! I y'~ ~ ~ ~ _ t _ _ _~ f ~ i i ( ~ ~ I F ? ' ~ ~_ _. _ -~- ~ ~ ~ ~ ~ ~ F III i ~ ~ ~ ~ ! i _ ~ - I 1 ~ ~ ~ ~ ~~------ - i ~ F k i E i ~' t w._______.~ i I i i ! ~ p ~ t t 1n T I_ d ~ ~ ~ i ' f ~ ~ j ~ r~ ~. ? j r ~ ~~ i ! t TTT ~ ` ~ I i _ ~ ~~ ! ? S t 1 -r ~_ ~` `i~" rt" ~ ~ ~ I ~ ~ ~ p,~tv~uJ~~r r T --s-- _ _ -- _ I ' ~ .mot---' l~~ ~' S ~~ ~~1DQ ~-L ~ . 7; l~j~ -! ~i ~r E/~ ~2~`p~.~tx.~.._.__~_~ L ,~.(,/L /~.~~f'..3.~~,~_~.'~v.:-t T'.___.},..~.Z-_ _.._y._. ~~-`~ ©1-i--_~._~...~ ~1- /~{/ /1 _-~F-'~"'T' C~-'-H."~~~f.._~.....__.~_ ____~.__T__.-.~.__~-.~_ ~.i - ~- ~ ,w/ ,~ ~ ~ ' 7 D/ S~ ~ ~ ~ -+-G.t:v~~;t~LF--. _ ' l ' = -- -F~~~ Z~ . .~__~---.~._._.L ~~.~~S_iE-,~a.--- -"--- -* -- ~ "a • ~ I J 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 Absorpti n Component Manual for Private Onsite Wastewater Treatment Systems SBD- ~" ~~„" . Table 1: System Design Specificatniiins Sanita ermit Number g~ Number edrooms Design Flow - eak (gpd) Estimated Flow - A age (gpd) ~~ Septic Tank Capac (gal) ,~~' ~i5"U Soil Absorption Compone ize (ftz) 3,~-~" 2 Type of Wastewater ~" Dom stic ~, -- - ,," Table 2: Soil Absorption C! " ~onent -Limits of Retiabie Operation Se 'c Tank Component Soil Absorption Component Design Flow -Peak (gpd) ,~ 'z- r aS ~ xs Maximum Influent Particle Size (in) 1/8 Maximum BODS (mg/L) ;~ 220 Maximum TSS (mg/L) ~~' 150 ~;, ~; :~~able 3: Maintenance 3~edule Septic Tank ;~~' Inspect and/or service Dance every 3 years Outlet Filter ~"~ Inspect once a year and`Clean at least once every 3 years Soil Absorption Compc~'hent Inspect once every 3 years~,~.. „Y,,. A. ~r ~. ..y~.~. Septic Tank The septic nk shall be maintained by an individual certified to servseptic tanks under s. 281.48, ats. 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). - ~ ,, / `1 ~l1~PCW L ~~ The operating condition of the se tic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filte shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to re am so ~ s m the tank that may slough off the filter when removed from its enclosure. If the . ~; ~~; ~ .. ~ . ' ~ Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be pertormed 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 soundne .Access openings used for service and assessment shall be sealed watertight upon the comple ' n of service. Any opening deemed unsound,: defective, or subject to failure must be replaced. xposed access openings greater than 8-inches in diameter shall be secured by an effective to 'ng device to prevent accidental or unauthorized entry into the tank. No one ould enter a septic or other tre~,finent or holding tank for any reaso ithout being in full compliance with OSHA standards for entering a c fined space. The atmosphere within the septic or other treatment of h ding tank may contain ~etha/ gases, and rescue of a person from the interior of the tank m~y~ be difficult or impossible. Tank abandonment shall^ ,e in accordan~~ with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POW componep4. The soil absorption component serving' this structure is designed to accept domestic wastewater from a residential facility. ~>The limit f operation of this component are shown in Table 2. r~, I r~. The longevity of a soil absorption component pends greatly on proper and timely maintenance, and system use within or below the limits""~f reliable operation. Good water conservation practices by all occupants and the installatid~a,,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 thFe, levels of ponding, if any, in the observation pipes, a~r~d a visual inspection for any evidence of surface seepage or discharge from the component. C?h steeply sloping sites, areas of erosion shoul~,be identified and reported to the owner: or repair. The surface discharge of domestic wastewater or sewage from the system is pr hibited and considered a human health hazard. ''' ,~. ':~ Traffic aro d or over the soil absorption component should be avoidearticularly during winter months. The compaction or removal of snow cover over the compbnent may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is diffit*ult 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 ,o~ Y ~. , '"~ ST. CR~IX COtlI~'~`~` . _ `~ `• •• ` 1~ * s ~ r ~ ~ N ~ rr.:+wi. ST. CR4IX C4tJNTY CrwERN~ CEN'fEt{: '';~ 1 t01 Carmichael Road . ,,,,_,,:~.-•-.-.:---' Hudson,. Wl 54016-7710 ,.,~-"- ~~ (71:5) 386-468F~ p'AX (7i 5) 385-4686 . 4ctaber26, 2001 Robert Swanson -1489 N.` Bay Rd. Somerset, WI 54025 RE: Permit fees for Lot 5'7 Sweet Gras,B Farms - refuidd Dear Mr. Swanson: ~ While reviewing the existing paperwork in out office, we discovered that the ~tvning office re~axi two (2) separate;permitfees for Lot S?. Therefore we are refunding one of the'checks (receipt # 2835). i A c1~ck for 5225 (receipt # 28250) was received for the original Qermit(#38143): Tfiis pert was ~r#~r revised to reflect a change in system location and ~a chang+e in lot information (changed fmm lot 60 ~i lnt S7). However, for reasons unknown, another per~it (#384167) vas issued"fak Lot 57 and tl~ $2~5 (receipt # 28315) fee was paid for a second `time. This permit has been voided. Tf you have any questions please contact our offiicje. Sincerciy, J n Sonnentag Zoning. Technician ,i Cc: .:.:.file ~ 'I Lenclasures -copies of the permits issued or'revised ,~~