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HomeMy WebLinkAbout020-1376-68-000department of Commerce PRIVATE SEWAGE SYSTEM ~ Building 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 Griesbach, Scott Hudson Townshi CST BM Elev: ~ Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic w ~ ~~~~ ' 1 l Dosing Aeration Holding V TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ,~ s-~ ' ~ I (D f Dosing Aeration Holding PUMP/SIPHON INFORMATION Manuf turer Demand GPM Model Numb TDH Lift I n Loss System Head DH Ft Forcemain Length Dia. ' t. to w .-.e-~r~r~r1A~1 ~+V~+TC11A 1 1 I t county: St. Croix Sanitary Permit No: 395159 0 State Plan ID No: .__ i-~ Parcel Tax No: 020-1376-68-000 ~ ~- a9,lY~ ~3-~7 STATION BS HI FS ELEV. Benchmark + ~ '~-e ~~ Dt. Alt. BM ~ IOC ~'~J I04- l~- Bldg. Sewer /Ql 11. // - S~ to ,p~ ~I St/Htlnlet // \ C7 J 6~3Z 0 . I,B/ St/HtOutlet //1 r 8~„ L ~. 3r Dt Inletnlet Dt Bottom Header/Man. ' (o D t R `, ~fo Dist. Pipe ~ fp ~' 2O Bot. Syste 10 • ~ S i. X11 Final Grade St Cover 3,~ ~ /2" ~ I ~~,~, . S'Q ~IS} ~ ~,~b. is / vv,~ ,--•vv v ~ R NC .~. ..~.. ... idth . ~.-. \ V Length -~yr,~ No. f Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS t r ~~ Z SETBACK SYSTEM TO /L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufa~tly~r: ~ ~ S~~ { t' bF~r INFORMATION t f S UNIT . em: Type O ys Model Number: nICT~IQ11T1~1A1 CVCTRM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake /~ L~ ~ Pipe( -.. [-y~ J ~ Length 1 Dia Length Dia Spacing ~r~n r•rwco __ ..____.___ ~.._a_~_ ~_~., .... ^A......,1 rir nu~rano SVCiP_mR UfIIV Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center BedlTrench Edges Topsoil Yes ~~1 No jai Yes ~j No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: (y /~/~ Location: 934 Fraser Lane Hudson, WnI 54016 (NW 1/4 SWnn,,1l4 14~,T29N R19W) Sweet Grass Farm L 1.) Alt BM Description = ~up ~,,.~ ~ ~'~"'K~~ 2.) Bldg sewer length = .. 6,0+~ ~ ( ~ f ~ ,, ~ h ~~ ~- ~~e~') -amount of cover () a ~'-° 4~'~ - -- --- Plan revision Required? s c3 ~D3 ~/ ~~~/n~-- .~ ~~s~ Use other side for addi ona formatio ', CJm.Q[r ~C ---s~r S ate Insepctor's SignaSUre /101-•'t SBD-6710 (R.3/97) I~.r~Qf~,~ Inspection #2: _ / Parcel No: 14.29.19.2329 -; s~ p .~ C --I --- ~~ ~~ Cert. No. 3 L~ ~~~/~ ~.~ i ~Q Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code See reverse side for instructions for. completing this applicati 201 W. Washin ton Ave. g PO Box 7302 ISCOnSIn ' Madison WI 53707-7302 Persona- information you provide may be used for secondary pu oses , Department of Commerce [privacy Law, s. 15.04(1)(m)] (Submit completed fotrn to County if not state owned.) Attach comple"te plans (to the county copy only) for the system, on paper not less-than 8-1/2 x 11 inches in size. County State Sanitary Permit Number Check if revision to previous application State Plan I. D. Number 3 ~ Yz ~ I. Application Information -Please Print all Information Location: Property Owner Name ~ Property Loca tiffon /I ~~1/4 ..5~-i'/4, S T ~N, (or Property Owner's Mai li ng Address Lot Number Block umber ~ ~ f ,~ 7 ~ ~` r City, State Zip Code Phon e Number Su division Name or CSM Number ~.~l.L~-Q- LLB 7 ( / ~~ ) ~ I ~ b J II. Type of Building: (check one) ^ City 1 or 2 Family Dwelling - No. of Bedrooms :~ ^ Village ^ Public/Commercial (describe use):_ Town of ^ State-Owned Nearest Road ~tiC~- ,. .r ~ P ce T N s _ ~ III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) / , 2 , Z 3 z A) 1. New 2. ement 3. ^ Replacement of 4. 5. 6. ^ Addition to System Only Existing System B) it Number Date Issued itary Permit was previo sly issued ~'' oZ ' D IV. Type of c {Non-pressurized In- .___-_.__ ^ Sand Filter ^ Constructed Wetland ^ Pressurized In-ground --`- ----- olding Tank ^ Single Pass ^ Drip Line ^ At-grade / C~ ^ Aerobic eatment Unit _ ^ Recirculating ^ Other: V. DispersallTreatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals./day/sq. ft.) (Min./inch) ~ Elevation ~/ j VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete strvcted Tanks Tanks r ffJC1 G °°- OO© / L ^ ^ ^ ^ ^ ^ ^ ^ ^ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Nam e (prin t) Plumb 's Signatwe (no stamps): P RS No. Business Phone Number c ~ / ~"'~/ Plumber's Address (Street, City, State, Zip Cod .ri?v~.~ ~ ~ Q~ IX. County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groun ater Date Issued Issuing Agent Signature (No stamps) ~l Approved ^ Owner Given Initial Adverse Swcharge Fee) ~ S ~ ~ { ~ C ~ Determination d Zpp X. Conditions of Approval/Reasons for Disapproval: 1. Well setbacks to be maintained per NR 811 & 812. 2. Effluent filter to be installed and maintained per manufacturer's recommendations. 3. This revision/transfer was submitted to reflect a change in plumbers. SBD-6398 (R 07/00) f _~av z~ ~~ ~ ~ ~ ~ ya Uoo ~ ~r ~j/M-l = /fib ~~`°~h6'""',~~/~yyeJ~ ~i-n_.o-o-a- ~/te _ a = 9~so r~~ ~o~ s~ T-a= 9a a-a ~F~` ~j S , ya ' ~ T- ~~ ~ ! ~~io Nl~- r i /h ('- c2ov 3SU7 i N~: S~ 9y i ~ C.C~~ l~ ll~ax~ ~ ~'~.s "' vYisaar~slr-oepartrnentofComntsrco $OIL EVALUATION REPORT ~ ~-~ pivistitm of ~tety and BuNdmOs _.....~-.-. in acoorrlanoe wilt Conem F5, wis. adrrr; Code Couttr ~~, roi Y' Attach oomptete sire piss an papeC.M-t case Uiar1$ 41,2 x 4 4 incMs in saa. Plan rrutst - lndudrl.but txat timitrd to_ vetfical 8nd hor¢ort~t rafarerxA point (BM), dhacllan and Parcz# t.Q percent s)gpe. scats ordirnensiarts, npnh arrow. end IoC+ation and r b naanast road. ~~ ploaes prMt aH inlinttnsdat. Rerlav~rEd by Parraon.l,lnlonnatlwti two t^o~e mey be uae4 ror eecandary PwP~+ IPA ~, ~, rsa• c~) or»t• . ~,~~ Oyrner Propcrhr i_acation t ~ ~ govt dot ,U ua ~,,.i Ora s( r a N R h e t«f® aroPeny, Owner's N~ling Address ~ ~ tAt M Block ~1 soda. N ~ ~ r T.rp Phone Number ~b ~Nege Town Neerest toad ~ ~ ~, t ~ I c ~ '~~ ~1~ F c (~ New Canstrudlwr Use_ [~ Reel ! Number of bedrowrrs 3 - y Cad dQtfred dRS~ flow rate ~.y~'Cl / t~ 0 ~ GPP ^ Rtiplacemom ©Put:lic nr commercial - Dex~ibe= ,rf Parent material Food Pl~rt elevation K appirable ..~! / /~- - 3 c~ertetat aan,rner,fs r~vt.c~ ~y a U Lrwcr {r~~~Gt `~ 2. o v ~y,~, sled recorr-r-lgrtdatlons_ ~'` ~'/• aU Gou.1`i' ~*~t~t-~. ~8, UO - e/~ V. -Rn~ cs Y t 1~ 1 1 .. f ~l BorMla l '~ ~ ~ F ~ , ~+~._ . Horlaa ~„~,u ,. ® Pit Caround SUAdOQ OI®v- 0 tt. OeP[h bo rn.•` , n Dapth Ocmirtant Cobr Redox Qeau~tion Texhxe Suur9ure Consistence Boundary - irt, MurrseN 4u Sz. Cant dolor f3i', 8~ Sh. , . RgolS ~ ` • ®B °~`~ # ~ ~ ~ ^ Pit C'attrtl tid t 6urFaoeetev. ? ® t f ]1~rpt to 9 t>r3ar.1„~1,-. T itr. ~ Rate ~ nt Cobr E~o i tion Redox Desdi Texture StfuCtNre ^.arrelstence Bawtdery Roots NOlli On in. m ne MurrrMN p t]u. 9x. Ca+t Color Gr. Sz. $h. *~ " 6lfluertt #1 = BOt7, > 90 ~ 220 rnglL and TSS }30 < 150 rtrplL " cif lueret d2 = 90D < 30 mg/L and 7SS K 30 mglL CST Nanyyce {Please ~rt0 I / ~ Slgtteltlrer. _ : CSTNtnnber Address ~ tktle C-vak~Nrn Conducted Tdephohe Nurrbar r Od Wd~Z:OT T00Z ZZ 'd~S 'ON ~d W0~ ` ~ _ , ~ i~roperty Onrter LtJrl I~LVeDa+7l rf!yV • Peroet IL1 #_ ~ ~~ of ~ / ~ ® Plt G~rourtd Surface elev. ~,~• ~ ft. in. o4ptA to lirtltlrrp radar ~ ~ Horizon Dominant RetlOU Desdtptlon Texture SkvcRra Corlsi7terx7s t3oundery Roots ~ "EtTl~t ~ "E1fIF2 in. r~AUr~sell Qu. Sz. Cont Color Or. Sz. Sh. -t$ / r ..~, r- ~ ~ -~ R' LJ Pit Gn~rxrdsurfaceeiev.,_,"„•^_R. OePthielimitingtector,,,_,~_in. Soil Ifaationlta Horimn Oeplh Dominant Color Rt+dOZ l)esc~ptbn Texture 9huc~ure Consistence Boundary Roots GPI in. Mun6ell Qu. 5Y. Conk Color - Gr. Ss. Sh. 'E!i#t •Ef(g2 { ~ .. ~ ~ U Pit yTaurro sunsae YAYM. ,~,,.,,,^ rc. ~..., ~. ~~.w y ,w.w. mtngnt G Rednlt Demon texture 8tructtne Carxrrsienoe Boundary f~aols th D H i D 5gi1 licatlon Rate GPDItP zon or ep in. o tiAunsel! Qu. 9z. Cars. Color Gr, S2. Sh. "F_ifi1r1 •Effle2 " Ettkssrd ~1 ~ ROD, a ~0 ~ 220 mgl! and Tti5i ?30 < t 60 mglL ' Etlkrertt 1!2 - BOOS K 3D mgA. And TSS . 3D rnglL 7'he t)epartment afCotrtmerce is an oqual apporturrity service pravidar and employer. tf you need amststanee to access rervicrs or need material in an shernate format, glossa eontacl the dcpurunent at G08-zGG-31St or TTY 608-2Gd-8777. F(IE}A}M {R 07/110) sd wdbz:~i ieez z~ •d=s •orl ~~ woa~ r //.30 ~. YALE ~ OF ~ SCALIi; I"= ~{4 ~ ~ ... ~. i BM 1 F3.T:VATIC)IV' /QCl• C) `'~ I IiM I. DI~SC',1tIP'1'IO'N ~a,g o-~- ~,~'~ $ ~ ~ ~- ~+ ~ 'I I3bI ~ Fd:.EVATICaN ~_~, S o _ ! ~~ ` ~ / BM 2 i~l^SCRIFTIOlI~:~~,,o u -1~!.~ ~ w I ......_ ............... ..._ ................ .. SYSTEM EJ.bV'A"Y"iON dap Q'Y•a3 !.-Gw+r ~ ~~ cs U ~ ~i„,':„. ~ ' i ALTERNAI"E ELFVATIC7'N~e-a °10 ~G01.aw~• FJ $, O ~? ~ II ~ 1--- CON'I'OUIL F.LI•:V11'I'ION ~ I.U° "~' '~~'• do E~ ........-----~. ......_~-.._._ . ....._. .: ~~~~ bd WdpZ:Oi Z~3&'. zz •d~g 'ON Y{tJd WOa.~ / ~ ._. ... _-Y ' ~• O ~d • (~ ~ ~ •~--~ ~ < < -~ ~ v v ~~~ ~a V it 1 r t Department of Commerce ~~ SOIL AND SITE EVALUATION • Division ci~5afety and Buildings ~ Page ~ of Bureau of Igtegrated Services in accordance with Comm 83.09, Wis. Adm. Code r" Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and 5~ C iZj t percent slope, scale or dimensions, north arrow, and location a ~tfl nearest road. parcel I.D. # ` ',-', rs,'~, APPLICANT INFORMATION -Please pri forp~maffon. R d b Date Personal information you provide may be used for seconds p~a~prses (Pn~-~c~r layv, ~s: 16.04 (t) (m)). ~ d Property Owner Property Location "~ ~~~ , , _~vt. Lot 1/4 1/4,S G T N R E (or)~l Property Owner's Mailing Address Lot # f3lock# Subd. Name or CSM# City State Zip Code PholZef3umber ^ pity ^ Village ®Town Nearest Road ~i.)l~ (~ { J'ZIU I In ('-'(I 5>., ~~`l, ~~~ ~ ~ .-~ ~rU 7-e r /~ r• 2 New Construction Use: (~ Residential /Number of bedrooms ~ _ y Addition to existing building ^ Replacement ^ Public or commercial -Describe: Code derived daily flow (P ~ ~ gpd Recommended design loading rate ~_bed, gpd/ft2~_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) rwo/Xf ~z• ~1U ~ ~.,,-•,r' `! ~• 7 6 ft (as referred to site plan benchmark) Additional design/site considerations ~~-~ vi0i1-~r' 9~• S4 GUcrR r ~d • Sd Parent material (~Vf ~tisCQ S ~ Flood plain elevation, if applicable /~/ '~ ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ®S ^ U [~S ^ U ~ S ^ U ~ S ^ U ^ S ~ U ^ S ~ U Boring # Ground elev. 95 ~ ft. Depth to limiting factor '~_in. Boring # .... ~. ~' 2 Ground elev. ~/ ,!~ ft. Depth to limiting factor. 9~ in. SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Structure i t C B d Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Sh . Gr. Sz. ons ence s oun ary ,Trench B e d /d '7 l / ~)1/~ ~ [ ' o SO.Y~ ' Remarks: Remarks: 3ST Name (Please Print) Si nature Telephone No. 4ddress Date CST Number ~ i ~~' .S' ~' ~ a s.~ ~ Sri /, S-yG ~. S.- y- ~/- ~ d zs-~ 3c PROPt:RTY OWNER ~S~y ~ SOIL DESCRIPTION REPORT PARCEL I.D.# Boring # Ground elev. 9~t. w ft. Depth to limiting factor . min. Boring # Ground elev. 9 ./©tt. Depth to limiting factor . ~`~in. Boring # 5 Ground elev. ~.S ~b ft. Depth to limiting factor 9/ in. Boring # Ground elev. tt. ' Page Lam" 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 . zs~ ~O ~~I~ ms s i c~s - . ~ '- g 9 ~0 ~/ ' !~G' Remarks: Z -~ ~ y 3 - ~5 I m m-~r ~-~ _ ~ ; .~' ~ o sz. ~~ Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundar Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. y Bed ,Trench ! ~ 6s r3z S/ ~ ~r c~s ~~~ .S;•~ Z - x-18 i6 w' `- LS ~ m S r L - ~, ~ ~ $ 9. O ,s~_ Remarks: Depth to limiting ' factor in. Remarks: SBD-8330 (R.9/98) PAGE 3 OF 3 NAME ~f~U-~" LOT#~9~ LEGAL DESCRIPTION,Uw '/4sw'/4,SlY TZR ,N,R ~4 E (or) SCALE: 1"= 1~0 BM 1 ELEVATION ~ OG • O BM 1 DESCRIPTIONt+~P o~1 ~i.~ Pe-~e l~rhW ~ F~QO~ BM 2 ELEVATION ~(xj. ~ BM 2 DESCRIPTIONTQ ~ z~ v~ : ut ~ Y~~ SYSTEM ELEVATIONu~a<~92.Ro ~owcr R l.~y ALTERNATE ELEVATIONTp,~c~T q/$p ~ ow~r `I U. ~ CONTOUR ELEVATION /~ / ~~ ' .. -, 's .. ,~ ~N ~ f - -f- - ~2 r' n{ 1 `~ ~i~ -~~ ST CR(~T~' COUNTY SEPTIC TANK MAITT'1'ENANCT: AGREEI\~NT A1~ID OV~'NERSHIP CTPTTI'ICATION FORM OwnerBuyer Mailing Address Property Address City/State ~~'~C(~~1LT~ Farcel Identification Number t~o~U -~,3~(~-(Og-UOI~ LEGAL DESCRIPTION Property Location f ~ '/., e '/4, Sec. ~, T~N-R~W, Town of C i ~ U Subdivision Certified Survey I11ap # Warrant} Deed # Lot # _~y c ~ . Page # Vo 1 ume Volume ,Page # Spec house ^ yes ~] no Lot lines identifiable ~ yes ^ no SI'STEi~s MAINTENANCE Improper use and maintenance of your septic system could result in 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 fotm, signed by the owner and by a master plumber, journeyman phunber, restricted plumber or a licensed pumper verifying that (I) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than I/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards sct forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certificatior_, stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiratiuririate. ~~~ S!~/ SIGNATURE APP CANT DATE O~'4'NER CERTIFICATION I (we} certify that on this form are riue to the best of my (our) lrnowledge. I (we) am (are) the owner(s) of the properi~y describe above, by virtue., a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE ****** Any inforniation 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 refercnee is made in the warranty deed (Verification required from Planning Department for new construction)_ (tom Private Onsite Wastewater Treatment System Management Plan Septic Tank and Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wisconsin Administrative 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 systems are on file at the County zoning or health department. This management plan complies with Comm 83.54, Wisconsin Administrative Code, and the In- Ground Soil Absorption Component manual for Private Onsite Wastewater Treatment Systems SBD-10567-P (8.6/99). Table lavstem desien specifications Sanitary Perniit Number 3 ~ ~ ~Z ~- Number of Bedrooms 3 Design Flow -Peak (gpd) 450 Estimated Flow -Average (gpd) 450 Septic Tank Capacity (gallons) 1000 Soil Absorption Component Size (ft2) 3 ~Q-effective area - 2 - 3' x 'high capacity infiltrator runs Type of Wastewater Domestic Table 2. Soil Absorption Component -Limits of reliable Operation Septic Tank Component Soil Absorption Component Design Flow -Peak (gpd) 450 450 Maximum Influent Panicle Size (in) NA 1/8 Maximum BODS (mg/L) NA 220 Maximum TSS (mg/L) NA 180 Maximum FOG NA 30 Table 3: Maintenance Schedule Septic tank Inspect and/or service once every 3 years Outlet filter Should inspect once a year and clean once every 3 years Soil Absorption Component Inspect once every 3 years Seatic tank The septic tank shall be maintained by in 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, Wisconsin administrative code (servicing septic or holding tanks, pumping chambers, Grease interceptors, seepage pits, seepage beds, seepage trenches, privies, or portable restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every tluee years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. lithe 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 one-Hurd the liquid volume of the tank. ff 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 water tight upon the completion of service. Any opening deemed unsound, defective, or subject of failure must be replaced. Exposed access openings > 8 inches in diameter shalt be secured by an effective locking device to prevent accidental or unauthorized entry into the tank No one should enter a septic tank or other treatment or holding tanl~ for :rny reason without being in full compliance witb OSHA standards for entering a confined space. The atmosphere within the septic or other treatment or holding tank may contain legal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83,33, Wisconsin administrative code, when the tank is no longer used as a POWTS component. Soit Absomtion Com on Went The soil absorption component serving this structure is designed to accept domestic wastewater from 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 rr4~intenance, and system use within or below the limits of reliable operation. Good water conservation pr;tctices by all occupants and the installation of water can serving 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 bonding, 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 shall be avoided particular during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. Tlris type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. Plantings of deep rooted trees and sluubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. Contingency Plan In Case of Soil Absorption System Failure Should the current system fail ("failure"as defined by s. 145.245 (4) Stats), the SAS will be repaired or replaced immediately. Repair may involve fluslung the distribution lines, reconstructing part of the system, or resting the system. Replacement may involve construction of another code-compliant SAS. Rectification of the problem in a timely manner is essential so as not to generate a healtl- hazard or a hazard to the environment. J-,~ - ~ ~ lac ~_ ~x,_1. ~-l LIVING AREA 470 sq ft ~W rl Jn-S f/ N /G LIVING AREA 918 aq ft STATE BAR OF WISCONSIN FORM 2 - 1998 - WARRANTY DEED Document Number !'. '~( ~,~8,1,PAGEJos __ I! This Deed, made between ~~ u Z1 u~~~-~'~' r r`~'w-.~~~~.--~T ~~^T~'~' 1?~--P'~QrPT7 ' ]~~ahanr~ anr~ wi fa Grantor, ~~ and SCOTT J GRIESBACH. A SINGLE PERSON () Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St _ Croix County, State of Wisconsin: Lot 68, Plat of Sweet Grass Farm, Town of Hudson, St. Croix County, Wisconsin. 651351 KATHLEEN H. WALSH kEGISTEk OF DEEDS ST. CkOIX CO., WI RECEIVED FDR RECORD O7-i1-2001 9:30 AM iNiRRANTY DEED EXEMPT # CERT COPY FEE: CDpY FEE: TRANSFER FEE: 150.90 RECORDING FEE: 10.00 PAGES: 1 ~ Recording Area ~ Name and Return Address SCOTT J GRIESBACH N4904 572ND ST II NIENCMONIE WI 54751 __ . __ 020-1376-68-000 Parcel Identification Number (PIN) This ~ G not homestead property. (ls) (ls not) -1, - ii i~ li ~1 ,I 26 ~ ', \ ~ ~j~~ g~ W / N ~ N ,~,~~ v / F- Q~ ~ Z~ a~ I I I !- Q a ~ _ on ~ ~ \~~s~ ~\ ~~^ ~d g ICI I ~ ~~ 53 ~~a T~~ \ ~ \ o ,1~1 I v~ m (~ ~ ~ ~~e \~p ~'as \ ~ a I I h S Z ~j J N N ~~~ ~ N j I ~I II m ~ d .~.~\ ~'~ti \\ ~ 3 I I I• ... z i ~ ti\\ ,z.. r .I. I~........ gi i . ~ • ' ' ~ -I- I -I- -- -- -- -- ~ ~ ~ ~ \ 241.85' o • I. . .. ~ , -- ' ~ 66.06' .. ~ r 2~,0 ~ _ . .J•~~ _ NE ~ _ - .~~ .- ~ _- N N~g40'~ ' ?92~ - -- -- - -- --ft-- ,- ~ I ~3 . ~c to ..••!" .. ~ ~b z~ 0 Z~ ~W ~ n ~ ~ ~~ O Q~ ~ ~ ~ co ~ a ~- ~' O ~ ~ ~ --~ ;~ ~i ~!,, n 0 1 CEO W ~ ~'- Q o O~" 1 N O .J Q Q 9~ m" Z ~W _~ 2"W ~ I ~ ~ z ~ ~ I~ 9~ ~ m" I z~ ~d ~ (~ w ri ¢~ U ..!!~~ O N O J -- ~~~~ ~S Y f1 C I n • Safety and Buildings Division / V (!~ County ` 201 W. Washington Ave., P.O. Box 7162 '~~®~g `~ Madison, WI 53707 - 7162 Site Address ~~ 9 3 y F~~ x~ ,~ M Department of Commerce ~' Le-f- 6 8 1Cr s ~+- 1,a -+G Sanitary Permit A licati salutary Permit Number pp on In accord with Comm 83.21, Wis. Adm. Code, personal info ` e 3 ~~( ~ / ma be used for second oses Privac La 1 :[Q[i 1 ^ Check if Revision I. Applicati Information -Please Print All Informatio J State Plan I.D Number ~ ` . Property Owner's e ~ GC'~YE -.,; YL ~J Parcel Number b2o-IT ~i- ~~-Oo6 Scm yes ~ ~ ' ly z y. 9. z~Ly Property Owner's Mai! Address ~ 200 Property Location sr ~'Aax w , `~.> '~ SGv ik` 5 v-1' Tot N R ~9 E City, State Zip Code " ..>~ti z ~ , Lot Number Block Number i ~ ~Pfioa~mai e' ~ y7s- ~ ~ ~ Subdivisi Name CSM Number ~~ II. Type oP Building (check all t apply) a or 2 Family Dwelling - Number o edrooms ~ ~ ~ tty • ^ Public/Commercial -Describe Use Village ^ S t O ~{,,, J~40Wnsh1 ~ ,~_. ta e wned Nearest Road fi'r' A 5.~,~- L,~~ III. Type of Permit: (Chec my o x (number' g scheme for intern use). Complete line B if applicable) ~'' 1 ~ New 2 ^ Re cement Sy 3 Replacement of 6 ^ Add' ' t , ` For County use S stem T Onl E ' s B. ^ Check, if Sanitary Pe eviously Iss d P 't Number Date Issued IV. Type of Permit; {Check al ) um erin a for ' ernai use) 44~Non -Pressurized In-Gro 21 Mo 47 Sand Filter 50 ^ Constructed Wetland 22 ^ Pressurized In-Ground ^ Hol Tank 8 ^ Single Pass Sl ^ Drip Line 45 ^ At-Grade 6 ^ Aerobic Treatment U ' 49 ^ Reci>•culating 30 ^ Other V. Dis ersal/Treat ment Area Inform ' on: S ~ / Design Flow (gpd) Dispersal Area Re uired Dispersal Area P d Soil Ap 'cation Percolation Rate System Ele lion Final Grade q ro os ~~ Y Rate(Gals. ays/Sq.Ft.) (Min./Inch) ~ Elevation ~ ~f';~-o / ~ 7 ~ ~ 3 7 ~ 7 ~ , ~ ~ %/ 7 ~/. $ VI. Tank Info Capacity in Total umber Manuf er Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Gl Hew F.xistin~ ass Tanks Tanka ep[ c r HoldinE Tank _ ©~ I Dosing Chamber VII. Responsibility Statement- I, a undersigned, assume responsibilit for installation oP the P S shown on the attached plans. Plumber's Name (Print) Plumber's Signatur P/b4PRS Number Business Phone Number [ s ----_ _ ~~ d ~ ~ 3S- // 3 Z Plumber's Addre Street, City , Z ip ode) , ~/f N ~~.5~ 3 fT /~ /Ct9o /E- ~i ~S y$- ~ VIII. Count /De ar ent Use Onl Q' Approved ^ isapproved S~tarY Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) /'" Surcharge Fee Owtur Given Initial Adverse Deterntinadon Z Z S. O a Z (~ '~- IX. Con 'ions of Approval/Reasons for Disapproval ~.' sys>`~~ ~/~a ~-~`o~ ~[~y ~f ex~~ w~ > ~~'' d~~ow o.-~y.'~~i ~~IP ~~N.. ~~ 6~ S / ,/ /'t S ~a l ~.C6' dt,~ar1,9 ;K. ~k, b ~ov 1.~. ~T(~a ~'r P y . v l e , ~~ ~ ~ ~ ~ ~ ` y~ ,e+ ~ r ~ ~h ~e ~ ~.a~w~ Qa u~~re S lttach complete plans (to the County only) for the system on paper not less then 1/2 x Il Inches in size ~.C~(KW~ C u~5 SBD-6398 (R. OS/Ol) FRDM : 'PAGERS PLUMBING FAX ND. 715 235 0867 Aug. 02 2001 08:30AM P2 ~a~y~-s O~r~,~.~6 ~~+m~~,~.~ ~~ /S ~-35-// 32 ~p aaso ~ y ~~.~, -~.r,4.: sa, ~ ,~ Tt,r~/t f~~l G~ m Z~s~ -~-~ ~g l ~ s~~ ~d ~"O 1 /t'~~®rO1ra lam' ~ sr S ~- s'~ ~- ~~P 9~I, /L~~j'A~~un G ~i4bl~ ~~/oo ~ FROM ~ROGERS PLUMBING •. ~~r~o~~l~,~x ~v,~s~-. ScP FRX N0. 715 235 0867 Aug. 01 2001 01:50PM P3 ~~'~~~ i ~~~,-s 7 : ~-e a C~aI; ~ ~. r~~ ~ ~ 3 ~~- 5~~0~ - 37Y.s ~ 9, ~'" )u, 9y z -j~ l " _r. k: ~ ~~~ ~.~~ .~. _--y-~--°~°~-- ~~~ ~~ ~~fu~~~~ ~M ~ K ~ ~v y' c .~. < /V ys°b 3 3t ,~ ~Cr~MoN~E ~ ~.,~ ~ aas 1y,~ ®~ S~: ~l, fti ~+a p ~ rs~ Fr Phu, _ ~ ~ T~~.*~ ~' A6fer~+~ A*~t llx /~,/y c I~+~upi'f~ S E' O ~~~ . ~ w ~ er-- ,$c a~ tl r` BPS 4i4G d ~o t~ JO s/p~D lOp 1 ~a~G ~„_ Soy . +~ / /Ga. ~. 9!. 7~ :.~~er~- 7ati,, i _ _t lJI~;~C`..;r'~eJ~l1 14:1E~, 7.53812904 SANDY GEHRKE ~ ~% ~~.oth~r Fax From ~'he Off~c~ of • To; ,~~o-r'7^ dumber of pages ~tetnar~;s; ~~;~~~ ; y ~~~; ~'rease ca11 ~~ you have Sandy ~sehrke RLA.L~'©R./Braker Associate ABR, CRS, GRI WI & T~fN L,ice~see ~7~5~ .3$"~-2.904 O ice ~(7YS) 38~i-0205 ~~ect (888) 355-0278 0~~ F Lynda Ande~-snn: Of~Fice Manager (715) 386-QZt.3 Roger Gelhrk : Buyer Consultant ('115) 38b-O~p8 Carin ~Kera: ~u er Consultant 7~.5 6$4-5127 y ( ) emHi~. sRndy(aahou~~foryou.com ':'H~"~ D1