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020-1376-78-000
Safety and Buildings Division County t 201 W. Washington Ave., P.O. Box 7082 577 C Nvi Madison, WI 53707 — 7082 Sanitary Permit Number (to be filled ' y Co.) S���SI� (608) 261 -6546 Department of Commerce 16 Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s15.04(i)(m) Project Address Vdifferent than mailing address) I. Application Information - Please Print All Information `3I — �'& Property Owner's Name Parcel s#13 t # Blocllk�k # ## f D °J 6 d Propcfty Owner's Mailing Address Property Location , Z ' A re `' �- — 56 /., k"L , Section City, State d 1 Zip C ode Phone Number ircle one) II. Type of Building (check all that apply) T N; RE or W ❑ 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number ❑ Public/Commercial - Describe Use ❑ State Owned - Describe Use ❑City_❑Vil ge ownship of 1 /7 a Its III. Type of Permit: (Check only one box on line A Complete line B if appl A ' [*ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑Permit Renewal Permit Revision ❑Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner (_f 3L 7� IV. Type of POWTS System. Ch all that appl ! (/ 0 ,Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In-Ground ��y❑ Holding Tank El Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Leacl g hf C amber ❑ Drip Line ❑ Gravel -less Pipe Other (explain) V. Dispersal/Treatment Area Information: — 0 0 i Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) I Syste e n f' VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing �� l / Tanks Tanks Septic or Holding Tank s V� Aerobic Treatment Unit Dosing Chamber 192n 9 VII. Responsibility Statement- I, the undersigned, assume responsibility for igAllation of the POWTS shown on the attached plans. Plumber' Name (Print) Plumber's ' atur P ` PRS Number Business Phone Number Plumber's A (Street, City, State, ip Code) VII . oun /De artment Use Onl Approved ❑ Disapproved FS-U.i tary P Fe ermit F�j 4J includes Groundwater Date d Issuing Agent ign (No p haz g e e) , >ri(� (� CA ❑ Owner Given Reason for Denial 7T Q IXof Approval/Reasons for Disapproval P7 4 5 l0 2- 3 , ttacb Complete plans (to the County only) for the system on paper ■ s th 81/2 x 11 inches in size SBD -6398 (R. 08/02) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Di� INSPECTION REPORT Sanitary Permit No: 430410 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: Bast, Kernon I Hudson Township 020- 1376 -78 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: e_� — 51-) L,-, { 14.29.19.2339 TANK INFORMATION ELEVATION DATA 151 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark C-,-;, ri,?� � tZ d C.) �f Ica /ay. y 106 -o Dosing Alt. BM Aeration Bldg. Sewer / r 9 5 Holding St/Ht Inlet 163 a TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic +pl Dt Bottom q 13.$0 i Dosing r Header /Man. 7.5 ys Aeration Di LP. ripe Holding Bot. System S B sn' C 1 1 7- Final Grade PUMP /SIPHON INFORMATION (j — Lt. G% /00. Manufacturer mand St Cover C lC� - GPM �� Model Number G. Po L/ 3 C _> •r° • 0-,?, S 7. Se_ q TDH Li _ Friction Loss System Head T el. DH Ft '�� 8 --S e. -73 Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SiYSTE q ch BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONSZ SETBACK SYSTEM TO P/L BLDG IWE LL LAKE /STREAM LEACHING Manufacturer: _ 11 INFORMATION CHAMBER OR Type Of System: tj c T NIT Model Number: Cis r tvern� ; o,.> c.J� " 3`E 1 31 - ► rp 1 y r-e-- L 1 -L" DISTRIBUTION SYSTEM A -_U V C {tea r �h Header /Manifold Distribution / x Hole Size x Hole Spacing Vent to Air Intake Length Dia Length Dia Spacing �y SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over I. Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center 3 f ed/T ench Edges F_ To soil, _ -. g S p ]Yes No Yes L "l No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1 / f S / 03 Inspection #2: Location: 725 McCutcheon Rgad Hudson, WI 54016 (SE 1/4 NW 1/4 14 T29N R1 9W) Sweet Grass Farm Lot 78 Parcel No: 14.29.19.2339 1.) Alt BM Description = c.= �i e r"L 1 c c'2, c" °�" cwt* - .�e``�' -°� �• 2.) Bldg sewer length = - Z I T �, w_� ' VAAe � �%vKl�ttil1� - amount of cover = L/ 2 A, ! ',(�,(_ D' s L- •,c S`� V " - -- -- -- - -- -- r Plan revision Required? Yes 0 No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. 7P 7 7�`Y L 3 if Prl--7 L&3 b I a bps PAC 1 GF PUMP CHAMBER CROSS SECTION) AKJ0 SPECIFICATIOUS VENT CAP 4"C.I. VENT PIPE WEATHERPROOF APPROVED LOCKIAIG � 25' FROM OoOR, JUMCTIOKI BOX MAIJHOLE COVER WIIJDOW OR FRESH 12 "MIU. AIR INTAKE GRADE I 4 " MIN. I COQDUIT -- - 11� IAILET PROVIDE I - - - -- AIRTIGHT SEAL ( i / * A I I II I I ALARM I *APPROVED i I one JOINTS WITH I ELEV. FT. APPROVED PIPE _ 3' ONTO PUMP —� ,1 OFF D SOLID SOIL COAICRETE BLOCK RISER EXIT PERMITTED ONLY IF TAMK MAMUFACTURER HAS SUCH APPROVAL SEPTIC E SPECIFICATIOAIS DOSE TAWKS MAU UFACTURER: �iL IJUMBER OF DOSES: PER DA TAWK SIZE: 1 , 90 ? 0 GALLOUS DOSE VOLUME ALARM MAUUFACTURER: INCLUDIMG 6ACKFLOW: • GALLON! MODEL LIUMBER: 4 V CAPACITIES: A= fV( IAICHES OR A LLOWS SWITCH TYPE: B = (�z INCHES OR �' GALLOM! I 1 PUMP MAMUFACTURER: C = 7 93 IMCHES OR I5kS 4LL01J.` I MODEL MUMBEFU C D = INCHES OR — GALLOM! j SWITCH TYPE: — �' IJOTE: PUMP AMD ALARM ARE TO BE I MINIMUM DISCHARGE RATE GPM INSTALLED OW SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEM PUMP OFF ARID OISTRIBUTIOM PIPE.. FEET + MIIMIMUM METWORK SUPPLY PRESSURE /.. , , , . , 'Q` FEET + / /Q FEET OF FORCE MAIN X F loo rtFRICTIOM FACTOR..! ` .Z FEET TOTAL DYNAMIC HEAD = L11-9 FEET X / IIJTEREIAL DIMEWSIOUS of TANK: LEAIGTH ;WIDTH - ;LIQUID DEPTH 91GNED: LICEWSE NUMBER' o557 DATE: �JS 6 eo6lds Submersible Effluent Pump J EPO4 - EP05 APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron stainless steel, grade turbine oil for for efficient heat transfer, Specifically designed for the . Capable of running lubrication and efficient strength, and durability. following uses: dry without damage to heat transfer. ■ Motor Cover: Thermoplas • Effluent systems components. tic cover with integral handle • Homes Motor: Available for automatic and and float switch attachment • Farms manual operation. Automatic • Heavy duty sump • EPO4 Single phase: 0.4 HP, models include Mechanical Points. •Water transfer 115 or 230 V, 60 Hz, 1550 Float Switch assembled and ■Power Cable: Severe duty RPM, built in overload with rated oil and water resistant. • Dewatering preset at the factory. automatic reset. ■Bearings: Upper and lower SPECIFICATIONS • EP05 Single phase: 0.5 HP, FEATURES heavy duty ball bearing 115 V, 60 Hz, 1550 RPM, construction. Pump: EPO4 built in overload with 0 EPO4 Impeller: Thermo- - Solids handling capability: automatic reset. plastic Semi -open design AGENCY LISTING 3 /4 " maximum. • Power cord: 10 foot with pump out vanes for ' • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. pI Canadian Standards Association • Total heads: up to 24 feet. with three prong grounding m EP05 Impeller: Thermo - • Discharge size: 1 1 /2 "NPT. plug. Optional 20 foot (CSA listed model numbers length, SJTW with plastic enclosed design for end in F or AC . ) rotary/ceramic - stationary, three prong grounding plug • Mechanical seal: carbon- 9 improved performance. "" " " BUNA -N elastomers. (standard on EP05). ■ Casing and Base: Rugged • Temperature: thermoplastic design provides 104 °F (40 °C) continuous superior strength and 140 °F (60 °C) intermittent. corrosion resistance. • Fasteners: 300 series METERS FEET stainless steel. 10 • Capable of running dry without damage to s 30 components. 77 ___.-- _-- _; -_ -- Pump: EP05 8 • Solids handling capability: c 25 3 /4" maximum. w .- -__- - - f • Capacities: up to 60 GPM. 6 20 • Total heads: up to 31 feet. • Discharge size: 1 1 /2" NPT. Z 5 • Mechanical seal: carbon- c 15 -- rotary/ceramic- stationary, a 4 BUNA -N elastomers. o • Temperature: 3 10 104 °F (40 °C) continuous"" 140 °F (60 °C) intermittent. 2 1 5 ___ - - - -- -- - - - - -- _ . --- _ r.._. -- - 0 00 10 20 30 40 50 GPM L -L 1 1 1 0 2 4 6 8 10 12 m3 /h 1357 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Steel Soil Service Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix 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. Please print all information, evie d D Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). t7 Z d 4 Property Owner RECEIVED Property Locati Stout, Richard Govt. Lot na SE 19 NW19 S 14 T 29 N R 19 W Property Owner's Mailing Address Lot R Block # I Subd. Name or CSM# 1353 Awatukee Trl. is C i 0 3 2003 78 na Sweet Grass City Stati Zip Code Phone Number City j Village 0,1 Town Nearest Road Hudson WI 54b '6731 Hudson McCutcheon Rd New Construction Use: yA Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD _ j Replacement Public or commercial - Describe Parent material outwash Flood plain elevation, if applicable na General comments and recommendations: Conventional System. System elevation 96.35ft, trenches spaced and depth to code 4.00ft below grade. p Boring # _ Boring 01 Pit Ground Surface elev. 100.85 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -16 10yr3/1 none sil 2msbk mfr cs 1f .5 .8 2 16 -39 10yr4/4 none sicl 2msbk mfr cs 1vf .4 .6 3 39 -120 7.5yr4/4 none ms osg ml na na .7 1.2 S° 7& 7& Boring # Boring Pit Ground Surface elev. 100.35 ft. Depth to limiting factor 135 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/jP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -16 10yr3/1 none sil 2msbk mfr cs 1f .5 .8 2 16 -35 10yr4/4 none sicl 2msbk mfr cs 1vf .4 .6 3 35 -72 7.5yr4/4 none ms osg ml gw na .7 1.2 4 72 -135 7.5yr4/6 none cos osg ml na na .7 1.6 LL I * Effluent #1 = BOD? 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS S30 mg /L CST Name (Please Print) Signature' CST Number David J. Steel - 248956 Address Steel Soil Service Date Evaluifi Telephone Number 1564 CR GG, New Richmond, WI 54017 1011/2003 715- 246 -5085 Property Owner Stout, Richard Parcel ID # Page 2 of 3 3 ] F Boring # Boring Y� Pit Ground Surface elev. 99.35 ft. Depth to limiting factor 135 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -12 10yr3/1 none sil 2msbk mfr cs 2f .5 .8 2 12 -36 10yr4/4 none sicl 2msbk mfr cs 1vf .4 .6 3 36 -72 7.5yr4/4 none ms osg ml gw na 4 72 -135 7.5yr4/6 none cos osg ml na na .7 1.6 �l ❑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 GP 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 GP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L *Effluent #2 = BOD < 30 mg /L and TSS <30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. Page 3 of 3 STEEL'S SOIL SERVICE INC. David J. Steel 1564 Cty Rd GG CST - POWTSM Richard Stout New Richmond,WI 54017 Lic. #248956 NWl /4,SE1 /4,S14,T29N,R19W Bus.(715) 246 -6200 Town of Hudson, St. Croix Co. Fax (715) 246 -9372 Lot 78, Sweet Grass Legend 1" = 40' ♦ =Benchmark Ele. 100.00Ft Top of 1" Steel Pipe • = Alt Benchmark Ele. 100.30ft Top of ''h" PVC pipe ❑ = Borings Boring Elevations B 1 = 100.85Ft B2 = 100.35Ft B3 = 99.35ft B4 = 00.00ft �i'l . /o6, 3 5�s4- 4 -7 �4 A�e - 7? s� g�� cIVo J Cin J % k c k f Q! a -gz o�= =�2 O ƒ§ % A 7 i g§ 0 7 ƒ� f ' 3 \ § pi E o § \ § CD § C', f ■ 0 E E U = 8 to Q g 0 2 $ / § £ ¢ " c 3 C g . § \ § ) � ® « m f 0§ k g 0 ° CJ I _ J / J � � � T o - § § § ) / \ \ 1 v o \ CD ca - &i2� G) B CL § § 7 c @ z 7 g / � \ $ E££/ 9 (A %2ƒƒ 7% r kf g qt k_ a / k 2 0 � _ ■ � ( §§ E $ k z m CL § a . 7 \] C G$ � ƒ 2� 0 / ■ T m 2 « E� g9 m � \� k \ \d � # \@(± g\gk § !Ek§ �x, , 8£I A $aIE / \� 7 � (D a $ 10 A IAA 2 0 � �/) � /A \ ' 0 N � ` t NO 69 � ` Safety and Buildings Division Coup JOB 01 W t 2. Washington Ave., P.O. Box 7082 3� isconsin Madison, WI 53707 - 7082 Sanitary Permit Number (to be filled in by Co.) Department Of Commerce (608) 261 -6546 /0 Sanitary Permit Applicati n iR State Plan I.D. N r Code, personal informati you provide In accord with Comm 83.21, Wis. Adm. Cod ���� may be used for secondary purposes Privacy Law, s15.04 Ixm) Proj t Address ( different than mailing address) I. Application Information - Please Print All Information Property Owner's Name` ` 0 (_)1 \ t, Par&rk Lot # Block # 76 020 — 137 7�-, Pro Owner' Mailing Address Property Location Z , 3 City, State ip Code Phone Number V`' ection s- circle one) TN; EorW I. Type of Building (c k all that apply) / 1 or 2 Family Dwelling - ber of Bedrooms G ✓ Subdivisi sane CSM Num 4 09 ❑ Public/Commercial - Descn se ❑State Owued - Describe Use / orty ❑Vil ge wnship of III. Type of Permit: (Check only a box 6n-line A. Complete line B if applicable) A New Sy ys ❑Replace t System ❑ Treatment/Holding Tank Replacement O ❑Other Modification to Ex��Z B, List P viou i to Issued ❑ Permit Renewal ❑Permit Revisio 11 Change of ❑Permit Trap to New Before Expiration Plumber Owner IV. Type of POWTS System: Check all that 1 - Q 0 A c 41� Ale on - Pressurized In -Ground ❑ Mound > 24 in. of s bie soil ❑ Mound ,< of suitable soil El At-Grade a Pass Sand Filter 11 Constrvcted Wetland ❑Pressurized In Ground ❑ Hof Tank ❑ Peat F r ❑ Aerobic Treatment Unit ecirculating Sand Filter ❑ Recirculating Synthetic Media Filter hing Chamber rip Line Gravel-1 s ipe ❑ Othe plain) V. Dis ersaUTreatment Area I ormation: h f Design Flow O ) Desi n Rate(gpdsf) Dis ea Requited (sfj Dis Proposed (� ysl Elevati VI. Tank Info -city m Total Number Manufac ter Prefab Steel F' Plastic Gallons Gallons of Uni /! Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank -b Aerobic Treatment Unit Dosing Chamber Jer VII. Responsibility Statement- 1, the unde ed, assume responsibility for i Nation the POWTS shown on the attached p lans. Plumber's Name (Print) P u s S atur M PRS N ak ber Business Phone Number �y Plumber's Address (Street, City, Sta , Z' ) b II oun /De artment Use nl Approved ❑ Disapproved Sanitary Permit Fee (includes Ground ter DJNLlssued I Iss ' g Ageyt I gna re 96$ unps) � (d O3 /�/ El Fee) n,......- Owner Given Reason for Denial `t`1 . , L of A.m_ - --- '" sapprov SY P lQ Noe 1 Septic tank, effluent filter and 0 L L' Wlp, �� dispersal cell must all b serviced / maintain d as per management plan provided by plum r. 2. All setback requirements must be maintains Q, 'r7 ` , as per applicable code /or 'nances. Attach complete p s (to the ona my tar the system ea paper not less than 8112 x 11 lath In size SBD -6398 (R. 08/02) 64�A, �tJ 1a�o ti� 0 1 � IC I D � � INa r Vic{" N� 13- 0 I Z I q�yo ' PAGE_2) _OF_ NAME yc LOT# LEGAL DESCRIPTIONSt ' /.,S 1't Tza ,N,R iq E (or)® SCALE: I BM 1 ELEVATION _ q R 3 S i BM I DESCRIPTION i jwt-k j/ �' �� � - +x BM 2 ELEVATION 100 O L/ BM 2 DESCRIPTION l cones 1G 4 w/ r- ( o SYSTEM ELEVATION CP ' v ALTERNATE ELEVATION gG.ov ��,�,- GN: CONTOUR ELEVATION Zf f[i) ea • aMt a� va 1 1 SIGNATURE i DATE - V epariment of commerce SOIL AND SITE EVALUATION 1 of Safety, and Buildings Page — Integrated Services in accordance with Comm 83.09, Wis. Adm. Code complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County e, but not limited to: vertical and horizontal reference point (BM), direction and cent slope, scale or dimensions, north arrow, and 1poat -and distance to nearest road. Parcel LD. # v 26 & _ 7� -g&) APPLICANT INFORMATION - Ple .i print all Wormation. Re ' ed by Date Personal information you provide maybe used f s6�ondary pmrpose5 (Pnvaby Law, s. 15.04 (1) (m)). / Property Owner , 1 Property Location p Z 3 3 Li Icl�ar u Govt. Lot E 1 /4,OW 1/4,S / T Z_ C( ,N,R E (oroo Property Owner's Mailing Address dot # Block# Subd. Name or CSM# City State Zip Cod Phone Number ❑ City ❑ Village [T Town Nearest Road ® New Construction Use: Wesidential / Number of bedrooms 3� y Addition to existing building ❑ Replacement /��` �) Public or commercial - Describe: Code derived daily flow y v gpd Recommended design loading rate � 7bed, gpd/ff gpd/ft Absorption area required _ bed, ft trench, ft Maximum design loading rate e' bed, gpd/f1 trench, gpd /ft Recommended infiltration surface elevation(s) 7 0 0 ft (as referred to site. plan benchmark) Additional design /site considerations 9 c / Parent material c) U4 (, 0 Flood plain elevation, if applicable 1 ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank I U = Unsuitable for system [ S ❑ U ® S ❑ U 0S 1 1 ®S ❑ U ❑ S ®U [Is ® U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD /ft g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed ,Trench 01 3 ! 31 2 - S i rYYA M r G 5 1 V -9 z 3 13 - 36 10 4N S• I 2 I C 5 Ground –� t 1' �� MS G5 elev. r/ UO ft Depth to limiting factor 12 0 in. Remarks:. Boring # (I to / - Z- :51] �s �� 2 , -I c5 , Ground elev. Depth to limiting "ITIr in. Remarks: CST Name (Please Print) Signature Telephone No. au C, I Sc, t a k Address Date CST Number (/3 0th S� ;–a 4 wr oz �/ - 47'- -c C) zs 330 f PROPERTY OWNER r SOIL DESCRIPTION REPORT Page PARCEL I.D.# L Boren # Horizon Depth Dominant Color Mottles Structure Boring in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Tre 3 1 6 I 16 3 12- I I e- Z 1/ OLIN S 1 Z �'t � Ground lf_ ZJ 5 CS elev. 9 �Iq t. Depth to limiting , factor Remarks: ---- Boring # -ii r c& r C- z 16vr 4 Ground elev. 9 sry ft. , Depth to limiting factor 11(v in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Z. 'Z �� r GS I V . Z LU Ground elev. F 3d ft. i Depth to limiting factor Ij - Remarks: Boring # ,:...... Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) PAGE _ OF_ NAME LOT# � LEGAL DESCRIPTIONSt ' /4Pw ` /4,S I't Tz°( ,N,R 19 E (or) C SCALE: 1 "= t BM 1 ELEVATION I BM 1 DESCRIPTION +opak BM 2 ELEVATION 100 U (L/ BM 2 DESCRIPTION bP o.C. ( " con � , -(-- IA iek w / 1%� I SYSTEM ELEVATION ' ( f ' cl v ALTERNATE ELEVATION _ v CONTOUR ELEVATION � VYI L C m 4Z B3 �. v� vP 1 SIGNATURE DATE �/ -� C)C) II POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity f Q a l ❑ NA Permit # 4 1 3 0 /-fl Septic Tank Manufacturer ` ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms L, ❑ NA Effluent Filter Model a a ❑ NA Number of Public Facility Units NA Pump Tank Capacity a l NA Estimated flow (average) a al/dav Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) ©Q g al/day Pump Manufacturer A Soil Application Rate gal/day/ft 2 r Pump Model A St andard Influent /Efflu ua lity Monthly average* Pretreatment Unit Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 6150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD <_ 30 mg /L In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L XNA ❑ At -Grade ❑ Mound Fecal Coliform (geom me an) 510 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ ear( )(s) (Maximum 3 years) ❑ NA Pum p out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ y ant h(s) (Maximum 3 years) E3 NA Clean effluent fitter At least once every: ❑ month(s) ❑ NA year(s) month(s) Inspect pump, pump controls & alarm At least once every: ❑ year(s) ❑ NA ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: ❑ year(s) Other: At least once every: 0 ear(!(s) ❑ NA Y Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, u measure the volume of combined sludge and scum and to check fo r any back p or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. I Page 2 of 2 START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or. must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. W / 91 T he -its • laermTrT rep! he- RG a o ing tank aluat' be a ai e . ?91)44115 rrEl'-, fbR- A16\ 40N STRRUC - ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone 8 , Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name �5t. Ckb Phone Phone I (S— This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.5401, (2) & (3), Wisconsin Administrative Code. • i "o4 Vat 1539PAG 81 STATE BAR OF WISCONSIN FORM 2 . 1999 KATHLEEN H. WRLSH Document Number WARRANTY DEED REGISTER OF DEEDS 5T. CROIX CO., WI This Deed, made between Donalda Speer, a /k/a Donalda J. RECEIVED FOR RECORD Speers, a/k/a Donald J. Speer and Kernon Bast, wife and husband, 08 -31 -2000 1:30 PM a k a Donalda J. Speer -Bast - WARRANTY DEED Grantor, and Richard O. Sto and Janet P. Stout, husband and w ife, EXEMPT N 3 CERT COPY FEE: COPY FEE: TRANSFER FEE: -- RECORDING FEE: 10.00 PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area All of the Plat of Sweet Grass Farm in the Town of Hudson, EXCEPT Lot I Name and Return Address of said Plat. �,d-Qa Q ` S'ttk'' -. This Deed is given to correct the ommission of additional lots in the Plat of 13 AWA -rd Sweet Grass Farm between the above Grantor and Grantee hereto in that g tut certain Deed recorded in Volume 15 3 '3 Page Sao , as Doc. No. (09 0 1 0 S 020- 102( - 60,019.1021. 80,020.1021- 90,020- 1022 -00 At 020- 1062 -20 Parcel Identification Number (PIN) This is not _ homestead property. Ot) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this ( day of August 2000 �t— « + S eer, e/k/a Donalda J. Sp rs, a /k/a Donald J. Speer « + )ernon Bast AUTHENTICATION ACKNOWLEDGMENT Signature(s) Donalda Speer, a /k/a Donalda J. Speers, a/k/a STATE OF WISCONSIN ) popald J. Speer and l�ernon Base wif and husband, ) ss. - i V a0 C County ) authenticated this y of August 2000 personally came before me this _ day of the above named « Kris Ogland TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, instrument and acknowledged the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Attorne Kristine Ogland Notary Public, State of Wisconsin Hudson, 154016 My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) _. ) « Names of persons signing in any capacity must be typed or printed below their signature. wftnation Proresswaia cwany, Fond do I .M. wa 800 WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 -1999 • ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address 1,-0� AV. , 1- 14 1-✓ -� 0/4 Property Address - (Verification required from Planning Department for new construction) City/Stated Gam Parcel Identification Number ©20 /`37 LEGAL DESCRIPTION > 2 3 3 g Properly Location ' /s, N %., Sec. , TN -RW, Town of Subdivision Lot # 79 Certified Survey Map # , Volume , Page # Warranty Deed # 6,2 / /L Volume Page # Spec house.0 O no Lot lines identifiable,'yes C1 no SYSTEM 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 form, signed by the owner and by a masw plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set fo rein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification our septic system has bee intained must be completed and returned to the St. Croix County Zoning Office within 30 days o e three year n dat /� A01 SI ATURE O PLICANT DATE WNER CERTIFICATION ( ) certify that all statemefl n this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of described a warranty deed recorded in Register of Deeds Office. � o Z3 / D3 SI TURF OF LICANT DATE s* r*** A information 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 deed 4N ' ■ • � 11 � '� ► � �1r � 1 , 1� . ,• �� 1��� f�� bP MN z rr a t <, I 1 f• r , 1 4 " �• 6 r .1; •,� � JA, - <. F G a is � • - � +� � i •� 1 p� f f' t f � �7 ; J Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430410 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: Bast, Kernon Hudson Township 020- 1376 -78 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 14.29.19.2339 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding SUHt Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing 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 0 No Yes �] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 725 McCutcheon Road Hudson, WI 54016 (SE 1/4 NW 1/4 14 T29N R1 9W) Sweet Grass Farm Lot 78 Parcel No: 14.29.19.2339 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? [�, Yes F No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctoes Signature Cert. No.