The URL can be used to link to this page

Home My WebLink About020-1376-64-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secrondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Stout, Richard Hudson Townshi :ST BM Elev: Insp. BM Elev: BM Description: Cl[).c~ t ~ `~i SANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~.t' S ~t2. Z$'t~ Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P!L WELL BLDG. Vent to Air Intake ROAD Septic r ~ ~ t ~ ~ t ~ ~, - Dosing Aeration Holding PUMP/SIPHON INFORMATION Ma facturer mand GP Model tuber TDH Lift riction Loss System Head TDH Ft For ain Length Dia. SOIL ABSORPTION SYSTEM X1'01 ~1..re,..,4,arC /..kd..~D,. ELEVATION DATA County: St. CiroiX Sanitary Permit No: 404933 0 State Plan ID No: Parcel Tax No: 020-1376-64-000 STATION BS HI FS ELEV. Benchmark -O ~ QS".o`{ ~ .~ r Alt. BM .2, Q3 l02 •11 r Bldg. Sewer i• , ~.P~ta f 1 ~ • 19 SUHt Inlet .SDI ~ -~t SUHt Outlet S•9~f ~9.r`hf Dt Inlet Dt Bottom Header/Man. a,0 ! q~ .a~ !! ~isE-Fine S Q-e.. Bo . yst ~ Final Grade ~ ~ra q~ oy,t St Cover .vQ (TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth D, 3' t (,2 •Sa ~3 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR B ~OSr~ Type Of Sy tem: i "' / ,,, S~ r ~ ~ UNIT Model N b r: ~. ~ _ A ~ . r ( tn~A DISTRIBUTION SYSTEM (~ ~„ ~ ~., o. w , ) Header/Manifold y (,.~ Length ~'~S Dia 1 Distribution Pipe Length Dia Spacing a Size ole Spacing Vent to Air Intake r ~~ '~ 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 ~ Yes ~ No 0 Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1/ Z~~2_ Inspection #2: Location: 914 Fraser Lane Hudson, WI 54016 (NE 1/4 SW 1/4 14 T29N R19W) Sweet-Gr-rass CQI 1.) Alt BM Description = {~~ ~ S~ ~-u~-Ins-.~') 1 °YS ~ 5 S~'~"'~ 2.) Bldg sewer length = ,., 2[ a S O~ = 9(p ,~' to . 2) = q`F' ~ ~ -amount of cover = ) 2'f ~ ~ ~ rn 9 3 _ qy, r(' [ 2 .o} s Q2.9?• ~ ~ 3 rw,,~!1.a~_~~MS~a.O ~'' "}'' •~' 12 , 38 - 92 • ~e6t t 3.6°i ~ q r. 3s Plan revision Required? ~ Yes No ~ ~/ Use other side for additional information. ~ Z.CTO SBD-6710 (R.3/97) Date Insepctols Signature Cert. No. Wisconsin Department of commerce PRIVATE SEWAGE SYSTEM Safety and~Buil'.iing 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: Stout, Richard City Village X Township Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA County: St. Cit"OiX Sanitary Permit No: 404933 0 State Plan ID No: Parcel Tax No: 020-1376-64-000 STATION BS HI FS ELEV. Benchmark ~ ~ ii Z Alt. BM ~ Z ~~ ~ lq; ' Bldg. Sewer a re SUHt Inlet ~~~ q St/Ht Outlet ~ lal~ Dt Inlet Dt Bottom Header/Man. / Dist. Pipe -~ Bot. System L Final Grade ~ ~• (7 St Cover TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~~ ~ > ~ r ~ ~ `, Dosing Aeration Holding PUMP/SIPHON INFORMATION nand M ITDH ILift~Friction Loss (System Head ~TDH Ft Fnrce n I annth . to Well/ I i SO~fL ABSORPTION SYSTE BED/TRENCH Width length DIMENSIONS f ` b 2 -SP SETBACK SYSTEM TO INFORMATION Type Of System: ~~ I~ISTRIRl1TInN SYSTEM No. Of Trenc es PIT 31 P/L BLDG WELL LAI z. y~ ., ,~~. • ~ ~ ou 1_I,. . ~ t ~ ~_~ 1 CHAMBER OR UNIT Dia. Liquid Depth ~t Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pi s ~ ~ „~, Length Dia Length Dia Spacing SO11 CnVFR v Drncm~ro Avc4nmc flnhi YY Mnunrl nr At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsail I ~ Yes ~~~~~ No ! ,i~j Yes ~~G~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection ..r / 23 / ~v Inspection #2: Location: 914 Fraser Lane Hudson, WI 54016 (NE 1/4 SW 1/414 T29N R19W) Sweet Grass Farm Lo~6~. P reel No: 14.29.19.2 5 s + _ _,( 1.) Alt BM Description = 5 ~~ " ~ L l ~ ~ IC`s Z IZ 1 J I ~ ,'~ 2.) Bldg sewer length = `t 1 ~~ s - amount of cover = ~ ~ -- --- --- ~ ~ I ~ - -- ---- - ------I - t ~ - - 1~ - - -- _ ~ i _ , r-- ~ ~ ~ :~ ~ Plan revision Re uired? Yes ~ ] No i I ~ ~, II 4 ' ~ ' I ~ ~ ~~ ' ~, I I ~ ~ L ' .___.___ ~ ___, Use other side for additional information. L_____ Date - --_- ------ - - --- - Insepctor's Signature --- ----- ---- Cert. No. SBD-6710 (R.3/97) ~ ~ Safety and Buildings Division County j~~ ` ~ ! 20l W. Washington Ave., P.O. Box 7162 /a.~~.- jS~O~~,~ Madison, WI 53707 - 7162 Site Address Department of Commerce d ~ ~ z !f`D 2P.EJ e //'~ ~ " ~~ /~~ /'/'Q ~~" ~-Cos?C ~ Sanitary Permit Applicati ~ ~ ~'~ ~"~ ~ry~ SanitaryL7lP~elrmit9Number r v ~ ('3 3 In accorc! with Comm 83.21, Wis. Adm. C<xie, personal infor o rovide '~ Check if evision •.~ , ma be used for seconds ses Privac Law, m) T. Application Information -Please Print All Information ~'(~p•r[ flD ~ = ~~~~I111((JJ % to Plan [. D. Number Property Owner's Name ' ' ~' ~~' 1 Nurrdter / L 9-~ Z LSD _.; Y 3 S ~ ~ Z~ ~~3 ~ ' 6 S~'Y~ Property wner's Mailing Addtess ~ ( ' f 13~ ' ~ P Location ~ c~ ~ fir City, State Zip Ctxle ~mber -s~ _r ~ ~ of Number Block Number ~ // ` ' Sutxl Narne CSM Number TI. Type of Building (Check a!1 that apply.) y~~ ( / // '~ A k S ~ ~, ~J 1 ar 2 Family Dwelling -Number of Bedrooms y .per ,plQ.ti S ltElinil~L p Vitlage_ ^ Public/Commercial -Describe Use,___ ownshi ^ State Owned Nearest )toad ` ITT. Type of Permit; (Check only one box on line A. Numbering is for internal use.) (Compl ete line B, if applicable.) A. 1 ^ New S stem 2 ^ Replacetent System 3 ^ Replacement of fi ^ Addition to Tattle Onl F,xistin S stem Eor County use B' ^Check if Sanitary Permit Previously issued Permit Number Date Issued IV. Type of pOWT System: {Check all that apply. 1~'umbeting is for internal use.) 4+4~ Non -Pressurized In-Ground 21 ^ Mound 47 ^ Sand Filter SD ^ Constructed Wetland 22 ^ Pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass Sl ^ Drip Line 45 ^ At-Grade 46 ^Aerobic Treatment Unit 49 ^ Recitcula ' 3t} ^Other V. Dispersal/Treatment _Area Information: O' _ ~ oe Design Flow (gpd) Dispersa[ Area Dispersal Area Soii Application Percolation Rate System Elevation Final Grade Required ose Prop d Rate(Ga1s.JDays/ .Ft.) (Min./Inch) Cf ,~ ' Elrv stiorr /' ~ ~' ~/J' g VI. Tank Info Capacity in Total Number nufacmrer Prefab Site Steel Fiber Plastic Gallons Galioac of "tanks Gmcrctc Constracted Glass New Tanks Existing Tanks ~-~ ~~~ Septic orHolding'fank ~~ e^ J ! / --- Dotiirtg Chamber - - - VII. Responsibility Statement- I, the tendersigued, assluge responsibility for installation of the POWTS shown ou the attached plans. I Pl tuber's Name (Print) Plumber's Sigtature MP/MFRS Numher Business Phone Number -- 'Plumber's Address (Street, City. State. Zip Code) V T. Count !De artmeat Use Ont Approved Disapproved ^ Owner Given Initial Adverse Sanitary Permit Fee ('includes Groundwater Date Issued I g Agent Signature (Na Stamps} Determination Surcharge Fee) ~z ZSGtJ 3 Z IX. Conditions of ApprovalJReasons for Ihsapproval Effluent filter to be installed and maintained per manufacturer's recommendations. System near boring 1 shall be installed >46 inches below uniform contour line to ensure proper location within soil profile. Chamber louver shall be installed in soils with a soil application rate of .7. Recommend commencing installation on the portion of the system that is closest to boring 1 (greatest depth to .7 conditions). If soils are marginal, installer shall contact the county prior to installation (originally soil test tnutcateu muuuu wnutuuusgtth~~btf(~Nhe pains (W the County otily) ror the system on paper not less titan 3112 x it iacltes in size 1 ' ~l~f~„ ~f , Z D r fo ~~~ ~~o~ G~-~' ~ ~~ ~~~~/ sue./y S /~ T~4 ~(~2/~7 ~/ . .~ '~ WG ~l -~~~ ~ I ~ ~Cf ~~ m ~~h-~v ~~ a v~ '1 ~~r ~ ~~ ~ ~- a.~ ~ ~, 1 --~ ~ - -~ ~ - ~ - ---~ , ---~ --1--- , - -- ~ - -- _ _ _-~ _-- ~ ~-- ._ ~. ~ - ~ _._1 _... i __ ~ ,; .-- ( ~ --~- i -- -, ~ -- _ -- - -- _ i _ ~ - .._.._ . _ ____ _ __, .. -- - - - -- i ` _ .~ ~ __ ~ ~ -.1 ~ .__ ----- . _-.. --_l__.. _._. 1 .~ i -1 s t _1 ~ .... -_ ~ I - i ~ -- -- ` - - . _ j ~ _ _. __--- i . ~_. ~ ~- ~ ~ ~ . _ - _ _ --- !_..1. ~ _ ---t __ _~_ - ---~-- - __.._ ._ ___ ~___ _. _._.~, - -- --- ~ --- ---~- __ ' ~ ~ `/ C./ ~~~ I ~. _ ~ ~ ~ --f-- ~ --F -- ---_ _. ~ _.- - ~ - - ~ -1----- --r--- ~ -- - i -r- _ _ ~ 1 _. . .. -- - - - ~ _; ~ ---~ { i I i i i - - ._.__~_._ t-- -* - - .~Y ~_ -- i t ~ ~ _~ ~ ~_ - }} ~ _ T II i ~-_ --~--_ ~ _-~-- _._._.t_.-L.~,. _ i f d ~~/~q d ~, ~ __1~ _ I -t~l--t- ~_, - ---i-. r-- - -- .: '....... ^ "'i-_ _.......~+ V I _. ..._ .. _ ~~.._ ._. ~ rte--.~ I i ~ __ }__:..._. i i ' : __ .L_- ---- ~ ~ ~ .- - --_ ~ . --- i i -.._ fr' _._.._ ~ ~ c/ I ~ i ~ ' O i _ --i----~ _.. j I W i ~ ..-~ . ~ a ~ ~ ,_ _--~ __.__ ' f~__._ ( ~ _ ~ j- I -L---1---1 1- ~ r--- -- ~ ~_' ~ Y ~ , ~I l ! ~ ~ - I ~ --- i -'- - ~ - ~ __ t -L-_--1-- ---~--~ ~ t . .- - -.--'....1 ---.. ._.. ~ -+ - _._ - ---'- '-''! ~ I ; - i -- '-- - ~-~ -- - ' -'-~- T i ~( I ___ i ~ L ~ _.._._._ t ~ 1 1 ~._ _ -~- i , . .~. _ __--~_ - - _ ~ - __ I --- -- _ _, - I i--_ - ~- i ~ __ _ ~ 1 ~ ~ ---t__ ~ ~_. - --- f - ~ _ ~. ~.. __ ~____ i - ~ i - - 1 w consin department of Cor»merGe SOIL EVALUI4TION REPORT ~ Page I of ~ • Division of Safety and' Buildings - fn aCCprUdrfCe Wlrr'I WmrT1 ~. vrls. txni~. vwc ~~~ Attech complete site plan on paper riot less than 8 112 x i 1 inches in Size_ Plan must ~~ ('~ t X include, but not limited to= vertical and horiiontal refererux point (BM), direction 8tid Parce3 t.0_ percent slope. scale or d'smsnsion5, north arrow. and location and tGSl2nce in nearest coed. Please prinf all fnformatian. R sate Persnnai inrOrrrlBtlon you Provide may De used fbr secondary P~~~ <P+'I~Y l.avr, s. 15.04 (~) (m)). ~~, Ovvrter Property Location ~ ~c:~Gtrc~ ~ .~cJ-~ .... Gaut. Lot Nr ~t4 c.~ w714 s / T Z q N lz j ~ E Property C>wmers iiAailinq Address Lot # Btodc # Sutxi. Name or CrSM# ,Q.~ _ .'o~...-~J ~ ~..._ ~ ~Q SGti e- ~-T ~-- YurS 5.. I~t ~ rYl City. r `~`S-'fate Zip Code . Phone N .... (] City. ^ V'dlags (~ Town Nearest Road . C~ SO (7. ~ G ( 0~5 ~ ~t r La r~ New Construction tJSS: [~ Residential / Number of b8droorrrs '} '" Code derived design Bow rate ~!S`lJ/,~ {3'CJ GPD (~ Replacement [~ PubGC ar cpmmera8t - rieSGrlbe: Parent rriateria! r~~~ ~ ~ ~ Flood Plain elevation if appY~cable ~/f f~ ~- General conrnenis sYS~em. e{ tv ?~~ ql• 5 ° Ga w ~,- T'G, S`o and reoomtrsendations: ~ ly ~- . a ~-~, r- 3~ 7-- ~ Z . ~s 0 r~ ~ ~ `,~.~ ~ ~~ _ .~ Boring # ~ ~ _ ~~ ~ i - ~ f ~ Pit . Ground y Surface elev. ~ spy, ~ limiting factor . _ n_ Snit iicatlon Rate }{ori~Dn Depth Dominant Color esciip5on Redox D Texture Structure Consistence . Boundary Roots GPDtitZ in. Mansell __ Qu- Si. Cont. Color Gr. Sz S'h. 'Et3#'! "Eff#2 .~ ~ - ~(v 'y 4 I ~ --' 5 i ~~ Z mSab ~ yY~- ~ r C. ~ ~ / . Co . / y~ . . / .. . ~~[~- .S ,~ ~.3_~ Z~ ~~ # ^ ~~ ~ /a r 1 u Pit ~~ R surface elev. ~ '~ ,~.. in. Depth to IimiUrtg factor ~I Applirdtign Rate Horizon Depth pominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIftz in_ MunaeA Qu_ Sz ConL Color ~ ~• Sb• •E~1 •Eff#2 I ' o ~ zs D r3/Z st' 2i~tali r- G ~ . ~ S '' 45 ~.3CS D '~ -~,' rYJR m-~ ~ C-S -~ _ , S , l~ ~~ ~v. y .. ~ ... l~~ P " EHlueni #1 = t3bQy ? 30 ~ 220 mglL and TSS >30 < 150 mgiL ~/Na/me (Please P(rint) / ~ ~~+ Signature Effluent #2 = 8p155.`. 30 rr=glt-and TSS c 30 mglL CST Number 2-5-3.~~ valuation Conducted Telephone Number id wdzs:ei zaez zz •aa~ •oN xd~ 4 ,/ •EYf#1 E 'Eff1l L~ .-r ~ _ ^ Pit tsrOUrid SYrrdae BrBY. ^ __-- fa -. i+cyw~ w ••••w....a •~•. ~~ tlOr- Texture Stnrchrre... Consistence .Boundary R00lS SCri R d D b $Oif ttOt1 I' GPAIftZ hb~zon Depth in. r Dominant CO Mansell e ax e p Qu. Sz. Cprft Cctor Gr. S2. Sh_ ~Eff#1 'Eft • Effluent #1 = GODS ~ 30 < 220 mg/t, and TSS >30 < 050 mg/l. ' EPAuent #2 = BODS < 30 mgll and TSS < 3U rng1L 'The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services o need material in arx alternate >Eol7nat, please contact the deparhn~Cnt at 608-26f3-3151 or "1~TY 608-264-8777. ..• . SBAk33o (RO'n00) PropenY owner ~cr -~- Parcel 1>5 ~ Q Page ~ of ._,._.~ ao~ ~ ^ Boring ® Ptt Ground satfaUO elev. ~~ ft. Depth to Fn3iting t~or / / In• Sal AppGcatxxr R< Horitols Depth Dominant Color RedOx UesaipUOn Texture Structure Consistence Boundary Roots GPp/ttz in. Muc>.seil Qu. si. Cont. Colar Gr. Sz. Sh. "Etf#1 'Etfrr, 4f'~~ / Z N . ^y 1 ~I Boring # Q Boring ^ Pit Ground suriaoe dev_ k. Horizon bepth Domurani Cdor Redox Desatpilon tn. Mansell Qu. SZ Cont Color Depth to linlit~g factor in. Structure Consistence Bourafary Ft( Gr. Sz. Sh. . j'~ ^ Boring €d wd~s:0i z00z zz •aa~ •ori xd~ ~ PACF~or 3 NAME S~G c1-~'' T U'J'#-._ CA'y L.. ' T, DFS~$.IIYI'IC7I~i '~ r ~.~! la5 / `'~ T' Z `1.1~I,.$, j ~ E(orY~ BM I ELi:VATION JdD • y °`~ ' ~'~.. . . b BM 1. I3FSCRll~TION -}Ci~I G~ f ~~ C ands ~' ~' _ ,, . BM 2 II,EVATIUN "^ Sf BM 2 DFSCRIPTIUN _ -.----.__- _- SY51'E].VI EI,EVATIUN ~ 9/~,S?a ~.or~ e ~-- ~a• 5b x` ' ALTERNATE EJ,E V,~'~ ION .sec c9r ~ ~ ~'+~ ~ ~ •~~ '~- .-.` `~"- - CON'I'QUR, .T~.r V ATIUN 9h! ~ ~ qG • szs, f g~ -S~ Y~ ~g. S~ ~~M i ~H ~I SIGNATURE - ~=:+~:-._ - DATE, G _,j,'~' -off zd wd~s:ai z0ez zz ~aad •oN xdd g,~o ~~ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT A1~iD OWNERSHIP CERTIFICATION FORM OwnerlBuyer -, Mailing Address ~ 3 S~ ~~_ t~rerL ~ ~'~~~ «~ Property Address ~ l ~- /` ~S L°.,~" ~„_.c( V~~ ~, (Verifscatiaa required from Planning Deparirnent for new cocutructioa) J~4i~ ~~ 6Zo ~I ~ ~~ City/State Ca Parcel Identification Number 3 7 ~Q 6 x.EGAL DESCR.IPTTON Property Location ~ Y,, ~~ '/., Sec. ~,, T~I~I-R~W, Town of ~`1`~~~ Subdivision 5~~~~s'r ~~-~ .Lot # _~ Cetrl3fied Survey Map # .Volume .Page # Warrantq Deed # .Volume .Page # Spec house l~'yes ^ no Lot lines identifiable ~ yes ^ no SYSIEM MAINTENANCE Imgmperase tadmai~enanceofyourseptictys6~~couldraaltmiispfaelametohaadleanst+es.Propec aaa~sists of pampiag out the septio taalc every three years or soane~ ifnoodod by a Iioeased pamper. _w'6at you pot iota the tYstRm can affect the fimcxi~on of the septic tank as a trestaunt sage is 8ie waste di pasalsysbem. T4+e property owner agrtes to sabmit 04 St. Gtoit Zoning Department a oaRiSoatioai foam. signed by t>se owau ttrd by a mesberpl~ jouameymaaPla~ber. to~ctodptumber or a liAeasodpvmpervecLfYiag fat (I) lgte oa~ite arsste~vaflcrdisposal sysEan is is PcvPer operating condition and/or (2) after iaspoction mad pumpiaig. (if necessary), the septi~tadcis less than 1/3 full of sludge. Uwa, the nadersignod have read the above requirements sad agnx to maimtsia the private seavage disposal system with the sdndards set forth, her+eia, as set by the Department of Coaniucce and the Departsneni of Natural Resources; State of Wisconsin.. C.esti~eation stating that has bees maintained must be compleLod sad retumod to the SL t~roix County Zoning Office within 30 d e three 'oa date. ~- /a'I /dal SI OF PI,ICANT DATE all statements ~ this form are true to the best of axy (our) lamwledge. L (we) am (are) the owner(s) of re, by virtue of a warranty deed rocoidtd inRegister of Deeds Office. OF APPI;Lt.,ANI' O.? / /G? DATE ssssss ~ iafonaatioa that is tars-rrtodmay result in the sanitary pexmit being tevolced by the Zoning Department. sRSSS« '• Iadude w~tth this application: a stamped warranty decd from rho Register of Deeds otLice a copy of ffie certified survey map if rofereaee is made in the wsstanty deed r Private Onsite Wastewater Treatment System Management Pian .Septic Tank And Gravity In-Ground Soll 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-C3round Soli Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Takla 1 ~ Svstem Design SDBCificBtiOnS -~ --- Sanita Permit Number Number of Bedrooms Desi n Flow -Peak ( pd) Estimated Flaw -Average { pd) ~ dm Septic Tank Capacl { al) / ;2 Soil Absorption Component Size (ftz) ,S"o. ~! Type of Wastewater Domestic Table 2: Soli Absorntlon Component -Limits of Reliable Operation Se c Tank Component Soil Abso tion Com ent Des' n Flow -Peak 2 ~ Maximum Influent Particle Size (in ~ 1/8 Maximum BODs {mg/L) 220 Maximum TSS m L 150 Tahla 3~ Maintenance Schedule Septic Tank Ins ct and/or service once eve 3 ears Outlet Filter Ins ct once a year and clean at least once every 3 ears Soil Absor tion Com onent Inspect once eve 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 acoorclance with NR 113, Wis. Adm. Code (Servicing Septic nr Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of'the septic tank and oufiet filter shall be assessed at least once every 3 years by inspection. The outlet filter shallrbe deaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan fora. Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shah be serviced if the alarm is activated continuously. Intermittent filter alarms may Indicate surge flows or an impending continuous alarm. The septic tank shat! have its con#ents removed when the volume of scum and stodge in the tank exceeds 1I3 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 shah be sealed watertight upon file completion of service. Any opening deemed unsound, defecctive, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be seared by an effective locking device to prevent accidents! or unauthorized entry into the #ank. Lilo one should enter a septic or other trrsatment or holding tank for any reason without being In full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank maybe dHIFIcWt or impossible. Tank abandonment shall be in acxordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. 8oi1 Absprptian Component The soil absorption component serving this structure is designed #o 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 operators must be assessed by inspection at least once every three years. The inspection shall indude recording the levels of ponding, if any, in the observafion 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 soli 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 aver this component wilt reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic dogging of the soil. 2 Management Plan for a septic Tank and soil Absorption Component Plantings of deep-rooted trees and shrubs directly over or wi#hin ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. 3 CQN'EINGENCY PLAN !i'the POWTS fa-ls and cannot be reralred the lollowlne meawres have been, Or must be taken, to provide a COde comDllant repixement system: sulubk repluemert area has been evaluated ar-d may be utilized lot the location of s replacement soH absorption system. The replxement area should be protkcTed horn dlsasrbante and compaction an8 sbot>iid rtx bt 1n{rimed upon Dy required setbacks from exlscinS and proposed itructun, bt fines and weEis. Failure to protect tM replacement aria will result In the need for a new soil and site evaluation to estibllsh a suitable replacement ani. Replacement systems rnwt comply with the rules In etTea at that time. Q i1 suitable replacement area is not available due to sltbatk and/or soli Nmltatiotts. 6art'tnE a~vutoes Ir< POWTS technoio~ a holdt~S tank may bt installed :s a last resort w reph+cx ti'te failed POWTS• D The site has not been evaluated to Identity a suitable replacement area. liposs failure of tt-e POWTS a soil and site evaluation must be periormeCS to locau a sulubte rlplacernenE aifea. i(n0 rrplat~nt area is available s hOldinS tink may be Instilled as a last resort W replaKe the faile4 POWTS. D Mound and at•Srade sots absorptbn sysums maybe reconstructed In place tapowlnS removal of the biomat at the lnfliuaeive wrtace. Recoruwcctons of such rystems nwst comp6y with tFie rules Mt sffea at that time. ~ ~ WARNING> > SEPTIC, Pt]MP AND OTKER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT O)(YCEN. DO NOT ENTER A SIrPTIC, PUMP OR OTi1~ TREATMENT TANK CINDER AHY CIRCUMSTANCES. DEATH MAY RESULT. RESGIiE OF A PERSON FROM THE INTiRIVR OF A 7ANK MAY EL DIFFICULT OR lMpAttlRl i. AODITIONAt COMMENTS POWTS INSTALLER Narnt o ,, Phone his-- ~~- ~ y SI:PTAGE iERVICIt+tG OP6RAYOR (PUMPER Name POtKTS MAIMAINER Name Pfione WCAL RE4ULATORY AUTHORITY A~~y S~ Cro' ~O ~/s- - ~v,:n~~r:u~ a. M1 M1 M1 N ~~ N ~ O '~ cri W a) cp ~ cp ~ ~ N c> % m ~ r r C ) Q r N w r_r_r_NNCV ~ .Q V trl 00 tl0 Cp CU C71 r Lh N C') ~ ~ 10 r r r- c') a v c ~ ~ ~ m W Z v . ' . . O v;4~~n~r,4~u: M1NNNr- ~ ~ ~. 'd ~ M~ C M '. v) Q .~ r CV m ti ` m H ~ :fi O Q: 47 ~ G` ~ O r r N M C ~ O _ G1 ~ m ~ ~ ~ ~~~,~v a, ~ V V c- r N M V fi C ~ . . U ' °1 c ~ V O ~ m b ~ u7OOtn:no - .V N N M Cft ~ b VN ~ c~MMr-O~! ~'' ~ C7 M M l7 C7 t- ~'~ ;~ ri ri ~ ci r N ~ J7 M C•) N 0 )!) d ;V M M d~ cp a) L ~. ~ U N O ~ T~ v) ri ~ r O O O O ~~ Q! ~ m aNi Lr C^1 ~ 4 ~ ~ 0 ~ ~ ~ r;eDNV-r~N ,, a 00 OOOC'1 ~ m O ~ ~ ~.~ N CV [`J n- N C1 ~ ~~~ O ~ a) a) M " ~ ~;~ ~ ) ~i N : Q ~ ~ )n .n ~ ui ~~ vi ' 41 y, ~ i+ ~ N r._ N N Cam: f ) ~ M r- CC CD o E ~ •-~a nM?' J ~ a m v C ° r rn '~ ~ L L.t `-- ~ .n ~ ~ n 47 v: FO ~ , _ f_ r. ~~ rv r. ~ .'7 a) 00 :h r OC) G '- r - N C) Cp ~3 M ~~ d v N N Cl O~ r- r C`7 ~ ~ NNNM~n ^~ ~ O ~ _ m H ~ w W ~ u ~ ~ ~ cv rn o> r- .- r) U N f~ N M tl') r-. ~ O L U y °' c t W ...r O ~ ^ W -0 ~ G ~ N O d a0 M v:I c~MMMv~r ~ ~ "C3 N ~ ~ ~~OC4aUh ~ ~.J O G Ol7 O ~~ ~.') O U N O ~' H y i7 ~ ° cL) U f1 L Y_ i J V (V V~ 41 M1 u: QS .~. N a ~ 4 ~ Q C7 a~ o c_ ~~ M1 t0 ~ Kr rh N ~ J ~ 0 0 0 0 0 0 ~ Ib O ~ M N ~.:ticvNty ~ - M M rp `! [D O_ 7 tp CJ N U _" f ( + C ~"' ~.. V 47 ~n N N N ~ ~ ~ M M cp ~ cD ~ ~ ~ ~.tC N N M ~ i° a ~a v ~ ~ r a~ a ~t -.. W ~- ro . n~nv;47~nN C .- .• ~ M d •3 N N a -a d ' a3 CO 0 a) r- ' ~ ~ o: M ~f c0 cT. ( 'O o ~ m ~ a ~ ~ v m ~ ao a) C~ a0 r-- U ~ V N M M V CD A) ~. ~ b ~ U Q1 w w. O ~ w W ~ ro C O Ch G7 O O ~ r) M M In (~- r .p v r~r_,torn ~ Ll C_ CU ~ r O CV ' C Q a ~ c. iD ~ in n r~ VI y cD :p a) ~_ O C ^^ T Y V rI {~i J (~ 1 N! m Q~ r- :n ri ~ 1000OC, Cf :~ 'y l4 ~ Q Q 4 , C7 rn r ~ c 1 r} cD ~ ~ M N ~ ~ yb m - o ~. CV V CJ ~V ~v N G7 N M M O ~ 00 cr~7 ~ m ~ M tT. ~ L ' ~ .n oov)u)4~ ~ CV CV N O' N ~ ~ c ) d +I ~ ty to M ~ r` ~ m C v ° ~ . J c s W ~- ~ + + O ~ ii~tin-n~o~n NNN M1'L7N F ~ r(p(~M~''1r ~ :'') U U Q) a) •3 :v M M M f~ a ai H ~ ao~~nN CJ Q r) d tp ap ~ O V m - Z ~ ~ ~' OS ~ v ro U ° n~ v ° cn u c d r r i O ~ V ~ t7- w ~. ~ ' ^ W ^ V ~ ~ 3 M1 ~ p1 f`7 ~ N cp ~ - Z r: r ~ '17 T3 O M ~,,~ M o co ~ ~ c7M (•? `7OO -3 47 M M M1 O ~ ~ N 0 O OC O r N f. .^ N Cl O) r~ ~ r^; J V ~ r 0 0 0 O U O ,.~. N ayi Q.' 4 ~ a ~ _ a w A N ep 1A ~ M N O J~ p p 0 0 0 0 'O ~ ~O N r Wisconsin,Department of Commerce SOIL AND SITE EVALUATION Divigt6n ofSafety and~Buildings Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less ttlan 8 1/2 x 11 inches in size. Plan must County 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. parcel I.D. # ~~ , e Page ~ of APPLICANT INFORMATION -Pleas l'(/ilt ill inforinatiori; Reviewed by Date Personal information you provide may be used fors on~tlan/ pufposeivac Law, s. 15:04 (1) (m)). Property Owner ~~;'' - ° °- doperty Location c, ~Y~ G vt. LotS~J 1/4 ~(~./ 1/4,S ~L T 2 c,N°R ~ q E (°r)~IU Property Owner's Mailing Address 1 # Block# Subd. Name or CSM# 1353 o~w u-~,~..Q -e ~.~ - CP ~j .S r~.~..e -~-4-(~- rte. SS City State Zip Cody Phorie•Num~r ~ ~- •- t^ City ^ Village [`~ Town Nearest Road ~-t v oQ ~ 4i s"Ua/ lr ~ 7~S ~ -~J~`G, ~, ~ ~,+<~ v ~ SG ~ ~ cr 2-e r ~ ~ v~ -2 [~' New Construction Use: [~Residentiai /Number of bedrooms 3 ` y Addition to existing building ^ Replacement ^ Public or commercial -Describe: Code derived daily flow ~Uy gpd Recommended design loading rate ~ y bed, gpd/flz ~ ~ trench, gpd/ft2 Absorption area required ~ Sc' U bed, ft2 / 2 O U trench, ft2 Maximum design loading rate L/ bed, gpd/flz r -~ trench, gpd/tt2 Recommended infiltration surface elevation(s) ~ u~ 7 S ft (as referred to site plan benchmark) Additional design/site conside//rations a n v^ 2(.c v • ~ 7' .~ Parent material (5 ~ T (,.~ G 5 ~ __ Flood plain elevation, if applicable ~ ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = unsuitable for system ^ S [`~ U ®S ^ U ^ S ®U ^ S ®U ^ S ~ U ^ S ® U SOII DESCRIPTION REPORT Boring # Ground elev. 9~• l Sft. Depth to limiting factor ~~in. Boring # Z Ground elev. 98.Is'ft. Depth to limiting factor 3 ~ in. Horizon Depth Dominant Color Mottles Structure B d R t GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence oun ary oo s Bed ,Trench CJ '2 4 ~. '^ S L- mA b JC t^ C.. S ~ y ' s Z G ~ S c~ Z vv~f ~ ~ +, ~ ~ .. ~ ~ y o z1/ 1=1 C A S H/ ',` I 1rt~u 6 r C S Z Remarks: 1 0 -z Io 'Z -- 5~. ~ w.ab w.~- LS I ~ &- 4 ' ~ Z. Zti -36 f O y tz j l - ~ w.c~b~ r~ F t LS - ~ , 6 3 ~ ~s ~ o. y h r s ~ ~ ~ b~, il-~..~ ~s ~" z ~ 3 Remarks: :ST Name (Please Print) Signature Telephone No. ~ S c.a - ~C cif- z y~-~/o~b= 4ddress Date CST Number PROPERTY OWNER S~y~ SOIL DESCRIPTION REPORT PARCEL I.D.# Boring # 3 Ground elev. 9'I.7Stt. Depth to limiting factor 3~ in. Boring # Page 4• of Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench 3 ~-ti ri y 3 1=1 ~ . ~ S ~ ~ 1 ~~b' w. ~- LS - 2 ' ~ Remarks: Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Boring # Ground elev. ft. Depth to limiting factor Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench Remarks: m. Remarks: SBD-8330 (R.9/98) ,~ ~ ; PAGE ~ OF~ NAME s' I U c>'~- LOT# ~ y LEGAL DESCRIPTION.S4J '/SW'/4,S ~ y T7 ~' ,N,R I q E (orb w J _ SCALE: 1"= ~~ G BM 1 ELEVATION I ~ • I BM I DESCRIPTION -ftS(~D_ 2`_T P;~~ luitic,~~ ~~~J BM 2 ELEVATION ~ (~U • ~ ~ (~ BM 2 DESCRIPTION Ivp o ~' 2 •' pvc.~: o~- lu-r~. r.,)/ ~(~J SYSTEM ELEVATION ~ ~ • ~ ~ ~ ~, ,// - ->- - ALTERNATE ELEVATION p -7/~ ~ ~ ~ ("lIATT(li TR FT RV A TT(lAT / / • ~~ •»~ r+~,nt, MIN BUILDIN<3 ~ ~ ~ =- ~,',~ ~" 105388 SQ FT ELEV.. A86.0 ~ ~ ~ .`''1, ~ 1 -- :~ "-~_ 1- c • ~ m L` ~ ~- ~• N N89°46'S0"E 529.72' - • ~ . ••- ( ~ 231.as' .1. _ 2s7.e3' ~ Y ~ S89°43'25"E 449.E ~ ~f ~ E~ Bs ILDING / ~/ / 886.0 ~ ~ • _ ~ ~ ~~` / ~ MIN BUILDINt# I ( • ElEif..r gg~ Q I • io LOT 64 i ~ ~ i : '~ ~~ - LOT 19 (~ (W ? (^~ ~W ~ 2.32 ACRES ~ ( ~ 2 99 ~3E ~N ~Q LOT `+~ N 100831 SQ FT _ _ ro ( 2.70 ACRES ~"' I 117781 SQ FT ~ . ~ ~ ~i ~ ~\ >. ~ ~ \~ \ ,~ / N k ' I T~= i / u? s i , k ~~ ~ i ~- ~~~ ~ q7 .-72 3a ~ ,- . r '// 2~a23 ~' -~ 1 era o ~ t , 2~~ 23 ~ '~ -' m ~' D~~` -11NA v A -- ,~ H.w.~. ~ s~a.a ~D~a ~ LE?T 22 +a2a.a ~' 3.00 ACRES MIN BUILDING A m ~ 130680 SO ~ w-, ELER = gZa a' w J m LOT Q (~ LOT 2 4 23 3.00 ACRES aoo AcR~s ~ +~osee sQ ~ ~, 13o6so sca Flr ~ 130241 SQ LOT ~ ~ 3.01 ACRES 131285 SOFT 455. ~ ~, A Rl <O IN a1' Q d~ ,d ~ STATE BAR OF WISCONSIN FORM 2 - 1998 ' WARRANTY DEED Document Number This Deed, made between -Ii~G1i11I1B 8 S'f'9~!~_ a -r,~-~:°IIr-rte: 6'ft9H'it, -- ---#~us~and-anew}€e, -- - Grantor. and -- -- - Crantee. Grantor. !or a valuable conslderadon, conveys and wartartts to Grantee the following _i described real estate in Gt _ Croi ?r County, State of Wisconsin: Lot 64, Plat of Sweet Grass Farm, Town of Hudson, St. Croix County, Wisconsin. 6'72363 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIR CO., YI RECEIVED FOR RECORD 02-28-2002 4:30 PN WARRANTY DEED EXEMPT # REC FEE: 11.00 TRANS FEE: 273.70 COPY FEE: CERT COPY FEE: PAGES: 1 . Name .erW Return Ad/or~ess~ / - V. ~ h l~t~esca~J, tv; ~~ 020-f 376-64-000 Parcel Idenlificalion Number (PINT ' This i a not homestead property (is) (is not) Excepuonscowarranuest easements, restrictions, rights-of-way and covenants of record. D^ated~th~is~ 28th _ day of 1~N23;E~a-r~ 200 iGv"'~~-°~ ~ .S~x~ (SEAL) f Yf~t"'e.t' ~ .C! L ~..t- (SEAL) Richard n Strut ' Jdilet P Stout (SEAL) W AUTHENTICATION Signature(s) authenticated this day of , ult.t: MCMtlCtt S1A[C tSAK Ul• WISCONSIN (If not, authorized by §706.06, Wis. Sta[s.) THIS INSTRUMENT WAS DRAFTED BV Janet P. Stout 1353 AwatLkPa Tr _ Hudson, WI 54016 (SEAL) ACKNOWLEDGMENT State of Wisconsin, ss. $~ . Cr0 i X County. Personally wme before me this ~Rth day of Fchr,tdrl~r , .2Q..QZ-, the shove named Richard A StnL} and TanF+t ~`_ St~+nt ...-- _ _ tU me known to be the person g- who executed dte foregoing Instrument and acknowledge the same. ,~ Notary Public, State f Wisconsin My commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not ~~~~~__. _. ,. -.) necessary) ~1IOt8n/ PUt?ViC 'Narks Of person. signing in anycapeclty must 6e typed or primed below ~elr tlgnaWrc. ~tw, of Wisconsin WARRANTY DEED STATE BAR OF WISCONSIN '~Cri Sara J. BUI'I~"ii!P"s'" Legal Blank Co.. tnc. FORM No. 2 - 1998 Milweukoe. Wis. ~~/