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HomeMy WebLinkAbout020-1365-14-000Q. o o ~' o~ ~' 4 e' r1 N O C t d O 'Ct o"i •~ O N .N v •~ U r'~i r i v °~ Z ~ g z rn "' ~ z c C9 r ~ ~ N H r 0 g m 0 a N J U a 0 RS C~ i7 ICI C ~I w O p O ~ n 3 N ~ ~ ~ O C ~ O of p N 'D 7 O ~ 2 it ~' L •~ a m ;~ c c~a~ A ~ o° i ~ °~ ~ I ~ I I I d c Z ' c L c L l ~ ! 3 ~ I 3 Q 3 v I 3 `~ I Z y Z lp I E E ;; o I _; o •`o ~ v` I m a m a o- c c of N ~ T ~ ~ ~ O U C d ~ N ~ ~ I .~ U N ~ . O N ~ . _ ~ I N = ~ N Lp N I N O a m ~ I a m O ~'- Q O O~ Q Z ~ Z Z ~ Z '~ d o.. m c' o m - ~ o ~ ~ a "' o o a` ~ o ~) 0 0 o a` N H ~ aa aaa ~n . ~ ~ o _ •~ U ~ ° ° N N ~ d >. I v ~ (~ N N y' o l~9 N I ~ ~' ° O M N Z ~ ~ ~ °D ci a ' ~ I o O ° mOO 3O O ~ ~ ~ [0 c ~ ~ ~ M 'C N Q N fn N 'O N ~ H '., 0 3 H H N C ' 0 f N H C . N 7 C C O O O ~ pp = m ~ y rn rn ~ d 00 C O > O ~ O f0 f0 } } G O N Q1 O ~ U > ~. j M d d c c C N~ T () M 2 OV O Z y Q' d' ~~ I d M 0 I ' r . .. C a I ~ a a ~ ~ e a ~ C S C C y C O t~ U O ~ U y °o 3 0 O ~ a~ 0 °a 0 0 N ml 3 z °~ w m c -0 o y '~O X Q W N C N d .~ N N L m m ~~ 3 O) a ~ 0 Z O 5 ~ m Q Z (/~ O ~ ~ ~ .c _~ c C N ~ N N d ~ 4L1 ~ O ~=q O O Z '~ ~ Z Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division f INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Hooverson, Russell Hudson, Town of SST BM Elev: Insp. BM Elev: BM Description: q5 . ~5 E3tM \ c~S~ i TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic `, 3 / Z Aeration Holding ..-~-.. TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic *7 ~ ~ A I~ ZC~ ~ Z Dosing _, .,.,......~_ __.~...__..,_ Aeration .r° Holding ' `°_~-~°- _..__.._._. ..-.- PUMP/SIPHON INFORMATION Manufacturer Demand PM Model er ._...:_.,.._,.._.. f,,f .~. TDH Lift ~ Friction Loss System .Head ~ TDH Ft Forcemain Length "~-•---•-~• Dia:"" Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. CrOIX Sanitary Permit No: 463367 0 State Plan ID No: Parcel Tax No: 020-1365-14-000 Section/Town/Range/Map No: 15.29.19.2174 STATION BS HI FS ELEV. Benchmark Alt. BM r'~' ~C Bldg. Sewer ~ ,9 ~, 9 3 3`l SUHt Inlet ~ ,~ ~ `1 Z SUHt Outlet ~~ ~rl •95 Dt Inlet ~ Dt Bottom Header/Man. ~ ~~ ~ C Dist. Pipe ,~ q. 1~ Bot. System /Z1.7 ~ ~~ , CP Final Grade ~ ,~ ~ ~ ~ r r - `P St Cover ~~~ ~ 1 ~ ~ ~ ~ BED/TRENCH DIMENSIONS Width ; ~ Length/ / c'Z ~ ~ No. Of Trenches ~ ; ~~~ ~ PIT DIMENSIONS \ No. Of Pits \ Inside Dia Liquid~h SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Mariufacturer: ~r ~\ ^ 7 INFORMATION CHAMBER OR w ~,,, ~ V Typ Of System: ~ ' C! 7 / /~ V ~ /~ ~ UNIT Model Number: v DISTRIBUTION SYSTEM L?, ~ ~. L Header/Manifold ~/ Distribution x Hole Size x Hole Spacing Vent to q>jr Intake / ~ ' ~ 3 / ~ ~ Pipe(s) \ ` ` \ ` - C e Length_ Dia Spacing Dia Length j~~ Snll_ COVER v Drnec~~re Sve4eme Anly YY Mnunrl nr At-riranlP Systems Only 'c7 Cl ~~~` Depth Over / Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ Bed/Trench Edges ~ Topsoil \ Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2:_ / ~ i Location: 988 Marcy's Court Hudson, WI 54016 (NW 1/4 NE 1/4 15 T29N R19W) Riverpark Meadows Lot 14 Parcel No: 15.29.19.2174 1.) Alt BM Description = ~~,~~ C..cJ~ ~~~~"' ~O`°`~~ ~~~~'~" ~'~~"`J ~ z ~~~- 2.) Bldg sewer length = 3 ~ ~ 11 -amount of cover = ~ f l '_ PIS ~,~-- ~ ,tl~ i ~~U ~ e.;lR. ~ I~ ~ `~~. __ I ___ _ _ --i ~~~ ~- Plan revision Required . r] Yes No ~ ~ Z~ I ~C ~, ~ ~ Use other side for additional information. ___~___i ________ ___- ._ _ __-- -_~ Date Insepctor's ignatur Cert. No. SBD-6710 (R.3/97) Safety and Btyildiugs Division County ~~ ~, 2 o rx P.O. Bpx 7162 Washingtol~ Ave 201 W ., ~ . iscon~~n Madison, ~I( 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) ? (608) 266-31 j(p ~-- (p 3 Department of Commerce Sanitary Permit Applicat on REC rovide ou 'on form l i S to Plan I.D. Number p y n a In accord with Comm 83.2I, Wis. Adm. Code, persona may be used for secondary purposes Privacy Law, s1S.0 (1)(m) `A ^0 3 Q 2005 'ect Address (if different than mailing address) I. Application Information -Please Print All Information ST • CROIX COF CE '~ S ~ t ' `/~~'G ~''~ C' ~ U, r's Na me ne Property Ow Parcel N Lot N Block N 1 ' ll~ ~ L~ s~ ~ ' ~ ~ _ e Z' ~~~ roperry Location s M ailing Address Property Owner ~ /Y!~ A"~/a ~ t/a'~[.1~~/a,Section e ; = u City, State Zip Code Phone Number ~ - - - d ~ . ' , r l W ( ~^ O 6 J •~- ~ / /1(circle one) ~ N; R_~E or W II. Type of Building (check ali that apply) 1- S t Su ivision Name CSM Nwnber 1 or 2 Family Dwelling -Number of Bedrooms , ( Z ~~ w ^ Public/Connnercial -Describe Use _ ~ ~ f u~f ^ ^ State Owned -Describe Use Cownship o 0 Village ty_ III. Type of Permit: (Check only otte box on line A. mplete line B if applicable) A' ~ New System ^ Replacement System ^ Tream~eht/Holding Tank Replacement Only ^ Otlier 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 IV. T e of POWTS S stem: (Check all that a 1 -) t.tt Z S 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 ^ Holding Tank ^ Pea[ Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain V. Dis ersal/Treatment Area Information: 22 Design Flow (gpd) Design Soil Application Rate(gpdsf) uired (sf) Dispersal Q~r ' Dispersal Area Proposed (sf) Syel~et~-E~3tion D r ~~ ~Qf u /ct~ 6.3S 2 • VI. Tank Info Capacity in Total Number n u fac tu re r Ma Prefab- Site Steel Fiber Plastic Gallons Gallons of Unit 4r ~ ~ ~` ~ ~ Concrete Consti-ucted Glass New Existing ~~~F~~^A 4~ ~~• / ' ~ ~ Tat>}s Tatilcs Septic or Flolding Tank ~ / ^~~ / G- ~~ ~ ,! ,\ Aerobic Treatment Unit Dosing Chamber 8~ ` ~ v VII. Responsibility Statement- I, the uudersigtied, assuute responsibility for installation of the POWTS shown on the attached plans. Plu er's Na me (Print) Plumber' Si gnature MP/ivI~RSNumber Business Phone Number Plumber's Addre ss (Street, City, State, Zip e) L ~ S ~ ~ ~F-l-~ uJ ( ~ Sib l ~ VIII. Count /De artment Use Onl ~Approvzd ^ Disa Sanitary Permit Fee (includes Groundwater Date Issued Issuing A gent Signa re (No Stamps) ^ Owner Given Reason fo enial Surcharge Fee) ~~ - ~ ~ , ~~ ~~~---~~%! .}- _ - n L1. Conditions of pprov 1/ 3~ s .ILX.O.vD~C[.e.~' w0'~ ~hL ~ - SYSTEM OWNER: ,~.~;,, S ~ ~ t~ ~~ C4.~ ,~ 1 Septic tank, effluent filter and I dispersal cell must all be serviced /maintained ~ ~~~ r~.o~ ~~...~~ ~ r~s l as per management p an provided by plumber. _____ 2. All setback requirements must be maintained c~l ~.~~~~~ ~~ i SS ~ (~ ~~ , /I eve! V ~na• as per applicable code/ordinances 1 ~ - `1~ / ce A ...... SBD-6398 (R. Ol/03) ~~•••y.ew N,u•,o „v u,c wuu,r wuJ~ ,u, um armeua vu Nupw uUl Po~J LLIiIROSIL d 11 l1IpAC5 III 5lLG ~~~+ ~~~ ~. c~ ti s ~ooy~ s ® ~ ~ ~ ~` ~ ~b ~~ ZZb~~~ ~~ Lod ti ~~ ~~ C ~~ ~A~ ~~ ~~~ ~ ~ ~ 2 ~s~5 N ,~~~~ ~ ~ , _~ ~2 Q' ~~ ~~ ~~ ~~ ~L ~~ ~a ~ ~ ~ ~-~ 3 -~a h~ G A-~~ ~~ ~ '~ ~~~. , ,; ~-- b~°~''' 2 `~ QvC ~~ ~~ L 1{23 Q~~~~ C~pV T l 2~1 L~ (~ U, 5 5 ~ooV~ s o ~ C ~~ ,fib, ~~ 22~~~7 ~~ ~~~ ~ 2 ~S~S ,~~~~ ~ ~2 ~ ~. ~~ T l s a P P`~- ~{2 3 r Wisconsjn Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Bureau of Integrated SeMces in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # Page j of 3 ~- _ ~rpi X APPLICANT INFORMATION -Please print all information. Re iewed by Date Personal information you provide maybe used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ ~ 2~ Property Owner Property Location CSI j0~ Govt. Lot Sw 1/4~ w 1/4,S /(, T Z ~ ,N,R / `{ E (or~ Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# ~`10~ C Rc~ - C. ~ ~ City S e Zip Code Phone Number Nearest Road ^ City ^ Village Q Town i l~ c1 >5~-14- G~~ r~ c,,,~~~~~s ~ .~ ®-New Construction Use: ~-Residential /Number of bedrooms 3_~ Addition to existiny building ^ Replacement ^ Public or commercial -Describe: Code derived daily flow ~C~ gpd j 2 - ec nded design loading rate -~ bed, gpd/ft2 ~ trench, gpd/ft2 2 Absorption area required _bed, ft ~ J rench, ft V Maximum design loading r ' 1 bed, gpd/fit o trench, gpd/ft~ Recommended infiltration surface elevation(s) U e ~Z, /~ ~au~ ~ r ~, /S ft (as refer ed to site pla benchma ,k ~U ~a Additional design/site considerations ~. e I-e u Per S QJ ow 4 v Parent material ~ Flo ain elevation, if applicable ('~ ft S = Suitable for system Conventional Mound - round Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ~ S ^ U Q S ^ U ®S ^ U [~ S ^ U ^ S ~ U ^ S ~ U SOIL DESCRIPTION REPORT ~~- _ ( -~i t~ Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench Z ff-Z i y - ~5 /rnr f~ ~ z ' -~' Ground l 3 ~-i~~ lD ~r~ 5 U5 CS ~ '~ e ev. ~~1,~.~©ft. , D th to ep limiting ~. ~?~ , 3 S factor /l~ in. p- ~y •p 2,(.b Boring # Ground elev. 9/.oU tt. Depth to limiting factor ~in. Remarks: ~ D- 3~L 5f' f ~ ; ' _... _ 2 (o - Z9 /l) ~ ~ y ~ __.._ 5 5 r 11Xr'~ ~ c ~ ~ ~ -d ~~ ~ ~ ~ ` S~ , v ~~ ~ =~'l , z ~~ ~ it~~ ttf~ , ~ ., ,- ._ _ - ~ ~~ , Remarks: `,~~~~-~~ CST Name (Please Printj Sign Telephone No. ~} ~.- _ 7! - L 7-~fOa Address Date CST Number U rS - -#- ~O 5~0~ l~ 8 `~ z533o5 PROPERTY OWNER t^U I ~ 0 y ~ PARCEL I.D.# Boring # 3 Ground elev. y~~ft. Depth to limiting factor ~/Sin. Boring # Ground elev. ~/~ ~~. Depth to limiting factor l?Qin. Boring # SOIL DESCRIPTION REPORT ~ ~ ~~ ~ ~ ~ c~ '1 Page Z of 3 Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench U-S / 0 i!Z ' ~ l l rnabl~ m-fir ~ ~ v~ • Z'- 3 Z 5 ~ZZ !v ~ y~~ is !m m~~ cS -~ ' - ~ 3 z.-~/ ( ~i~~ ~ m US m t ~ s - .1 ~ . ~ ~ , Wo ~ . rS ~ ~--qo.~ 15 I ~o , a ~, o ~, Remarks: I o- 8 tv 3l L - ~ I I ~ rn-~ ~ l v~ . Z ~- 3 Z $-17 `-~~`~ -" LS I m rYl-~r ~ - -1 3 17-I2.o U ~ b _ ms c 5 ~ . -t , Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench ~ o-•n t' r 31L -- ; l (r>~bJ; r~'r I v -I? . Z ~ . 2 /o-z~ 1 tS ry 1 `l - ~ 5 ~r c-S - -1 ; . ~ 3 zy-~~ t a - y ~ ~ mS oS m t ~ s - . -7 ~ . ~' ~. r 2 a Ground elev. ~/~~ft. Depth to limiting factor I1 (u in. Boring # Ground elev. ft. Depth to t~ limiting factor in. Remarks: SBD-8330 (R.9/98) Remarks: PAGE ~ OF 3 ~w~i s l0 -Z ~-/l/-~ SCALE 1"= '~ BM1 ELEV. S S DESCRIPTION--k,Pe.~z"p,;LP;p~ 10.t'~W/K;bban BM2 ELEV . ~~~ ~/ ,- ~ • - _ - __ 'r, ~ ., ~, ~.~ - - ~ ~C1 s5 , ~ 06 U~S~o~ . ' ~ ~. ~ Combination Sep~>r,:i.c~ Tank and - PL]MP CHAM6ER CROSS SECTION ANQ SPECIFICATIONS . . -- VEiJT C^P ~ W(:A7HER PKOOF . Ju1JCTI0-.1 BOX tirC.LVEhIT PIPC ~ APPROVED LOCKihlG ~ Q' FROM DOOR, ~MA}JNOLE~u QYLA. ~1~ u~sP~no~ ~ IPA I IS'Mlti.i. Ii\JLET APPROYEO JOIIJT W~C.I- PIPEdR ~Z •,jlNppW OR FRCSH qLK I-JTAK~ "-'~ _.~ .. 6.. i~ i CONDUIT i I • I ~ -- r \^ ; " 1 PROVIDE ~ AIRTIGHT SEAL ~ I . `~ i- ,~~, _ ' ;h ,1 ~ ~~~~ Tank constructzon shall comply with 1LFT~. 13.15 and -33.20 6 ~6 c 0 I •i I PUMP --~,,, ,[,==,J ~ ~ ,., l `(~ FitA.l. ,1~ ~,=- ~'~ ~I~ ~~I I~ I ~' ALARM I~. i I ~, o N I OFf COAICRETE ~~ocx--- APPROVED JOI-J w/C.T. PIPF~F ~ ~ 3" ~a~ RISER EXIT PERMITTED OIJLy IF TANK r'1~luUFACTl1RlGR HAS SUCH A1'pRDVAL~g£apIHE SEPTIC F SPEClF1CATIQf~.IS POSE INI~~t. Cf~~J~C~~ 1JUhtf~ER OF DOSES: PER DAy TnN~ MAl.1UFACTURER: • TAA1K :,IZ[:, --GAI.LOk1S DOSE VOLUME AL,IAM MANUFACTURER: SAS ~~l.,~T17-~ S~tS~~'I-~ ItiCI.uDItaG bACKF~OW: ~ ~ ~- GAl~otis P1ODE.L -JUMf~ER: ~Q~ N~ OPACITIES: A-,,,~4(JIUCHCSOR J'_:_-CALLOUS SWITCH T7PC: Y"~~~-~-1~~ 8 = Z IUCHES'OR ~l~~ C~~Ll0U5 PUMP MAIJUFACTURGR: ~~~Z--S Cx~IULHES OR 1-.~-_~L~•QUS MODEL. NUMOE.R: ,_,_~!~ 7r ~ 0=J~_~nirHES OR f Z ALLOIJS SW(TC.H TYPE: Y`'1~~~~ NOTE: PUMP Ati0 ALARr~ ARE '1"U ~L MllllMl1P'1 Q15CMARGE ~RATE~.LS.! GPh~ INSTA~~L--LEO 0~1 SEPARI~TE CIRCU175 VERTICAL. pIFFEKE,VCF ~ETWEER! PUMP OFF AUQ..DISTR!&UTION PIPE,. ~~7`~hEET t /`tl-JIMUM NET~lORK SUPPLE PgRE~S~SURE~, ; .. , , b FCET • ~- ~ FEET OF FORCE f1,~lN X .! ~r FllppF[FRICTIO-J FtiCTOR..~ FEET ' TOTAL Q~iJAMIC. ME:Ap -- _r{ ~ ` ~ FEET - ..... . As per.r>anufac~urer L,v~~-,---- gal./in. r~ . ~~ss ~~~soti ME4O Series i~~ 4/10 HP Effluent and Drain Water Pumps Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 35 ~j 30 W W H 25 Q I~ 20 J ~ 15 t~ to 5 0 ~ 0 -._..~.. 12 10 to 8 Z M 6 J Q 4 N- 0 ~- 2 f0 20 30 40 50 60 70 80 90 100 0 CAPACITY GALLONS PER Cr(~NUTE F.E. Myers, A Pentair Company • 11 U1 Myers Parkway, Ashland, Ohio 44805-1923 419/2$9-1144 FAX 419/289-6658 Telex 98-7443 ~w ~iyi Printed in U,$.A. _1 ~~,~~ ~aU~~a~/ CONVENTIONAL SY TEM CROSS SECTION NO SCALE ~~• (sou/crz ~ ,J~l~--~ l ~~-~2 . _. ` 'I ~ 12" COVER 12" COVER " VE ~>~'~ ~:i~v` >:i:~zj :;G ''iii , :•, s ~. ?t. ~{F ~' ... ,J ;:l:i I.iil~ ~.: ....... .:v~~. '.r::......: :. ,.# {{; <1..6jiihi•i•;•: ::;y.ni,;.. !!i!ii'h• i'ii' 'r' ` .; : 4:;. ~ b .,f 111. .a. 1 ..y„ i.. ~a ii7j(' „#.: .U~~i~; ~;{ , lu` .~,,IIs`.•%i4iti : al:'1:: ~ili~ i;E ;i~ii_i fis: :; ` ,1.,.. :4': aq" Siiii -:r~l''. iRe 1 .~~'G~i'i: : p~ : J t ' ;'4ii i i::..r: :<1:rf •` ,i " : L' •.1 . . . ... ., : ,•. .. :, . , ; `. s ;, .. ., ~lili~~. w.{. ..J. t ~•..~ Jl.. ::O:i i!.i:' iil'I'. :;Ii :'~ {I~~ rf =~i~' I ....a .,;. 'I' i ' i' r ' i `'i ~ ~ : c ~ 1 " ' ~ ? ' . ,.. : 5:; '! ` ' ~ :' b 1 ~ ` . ,~); d, ;.r: :ra" t b i :i I i i : :...: , ili riy 'i. 1~i~i ',~ii.:~ai iti irt :,.b.1..I a.li.li,. ,lr`,~:;i:>;:;;".,t. ,.1.. ..'~r ~ :: : lJ, :.• 1 E .~.;•:~:~r Wis , "' Via' ' ' ., ~. s. . . 1 °~7. ; ..,:; .,,~~! . ~' '`> „ y . r •,: c . : ~, ,.;; . r,e .; : ~;,:,... : ; : : , > .l 1 :; 1 ...: Y ~ .: . :.:.: ,; ':' ...s...>: ~ ..... :.. :: •1~:1 t!" ;iCi~~ ,:: ~~;~ 's : ' .s~,:-i: iii . ~.; : ~ / g~~ ~ ~ ~~ ~ ~~ ~ ~ ~~ l ELEVATION Tl ~ 7; 3 S T2 ~.. ~, 3 ~ .~ - IN SITU SOIL QUICK 4 STANDARD INFILTRATOR DIMENSIONS: HEIQId'I' 12" LAYING LENGTH 4D" WIDTH 34" ~' r FILE INFORMATION Owner ~ S ~ ~l/6ritf o ~ Permit # L.~./_ 2,?/ ~ I, DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units A Estimated flow (average) ~~'~ al/da Design flow Ipeak), (Estimated x 1.5) ~j~ al/da Soil Application Rate ~ al/da /ft2 Standard Influent/Effluent Quality Monthly average" Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODE) 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODE) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ^ NA Fecal Coliform (geometric mean) 5104 cfu/100m1 Maximum Effluent Particle Size Ys in dia. ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE POWTS OWNER'S MANUAL & MANAGEMENT PLAN SYSTEM SPECIFICATIONS Page L of Septic Tank Capacity '~~ al ^ NA Septic Tank Manufacturer ~/t, ^ NA Effluent Filter Manufacturer 'Z ~ ^ NA Effluent Filter Model ~ ^ NA Pump Tank Capacity ~--~ al ^ NA Pump Tank Manufacturer l ^ NA Pump Manufacturer ^ NA Pump Model G ~Cd ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: "I~VA !( Dispersal Cell(s) f~„In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA Service Event Service Frequency Inspect condition of tankls) At least once eve ~'~ '? ^ month(s) (Maximum 3 ears) earls) y ^ NA Pump out contents of tank(s1 When combined sludge and scum equals one-third (Y3) of tank volume ^ NA Inspect dis ersal cell(s) p At least once eve ry~ ^ month(s) (Maximum 3 ears) year(s1 y ^ NA Clean effluent filter At least once every: ^ month(s) - ~ year(s) ^ NA Inspect pump, pump controls & alarm At least once every: ^ month(s) ^ year(s) ^ NA Flush laterals and pressure test At least once every: ^ month(s) ^ year(s) ^ NA Other: At least once every: p yea~ls)(s1 ^ NA 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, measure the volume of combined sludge and scum and to check for any back up 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 IY,1 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. GMW (4/01) ~'- ~ ^r Page ~ of 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 celllsl. 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 cellls) in one large dose, overloading the ceI11s) 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 tie 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 r - 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. ^ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ^ 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 Name (o~_ /1~faAI Phone 2 ~~~ POWTS MAINTAINER Name ~-C.~ Phone SEPTAGE SERV LING OPERATOR (P PER) LOCAL REGULA AUTHORITY Name Phone Name S~' C~/2p/K Z°~.1t~ Phone ~.7' ~ ~b ~b This document as drafted in compliance with chapter Comm 83.2212)Ib11111d1&If- and 83.54(11, (2) & 13), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTEI~IANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address Property Address ~ ~- q S 8 (Verification required from Planning Deparhnent for new construction City/State sre~. ~ Parcel Identification Number ~ ~ 4 Z o -~ 36s f ~. 21~~ LEGAL DESCRIPTION Property Location '/4, ~ '/, Sec. ~, T~N-R~W, Town of H ud S'a ~/ Subdivision ,Lot # -,~-~. Certified Survey Map # ,Volume ,Page # Warranty Deed # 7 br7 ~l~ ~~ ,Volume ~,~, Page # Z l _ Spec house O yes~no Lot lines identifiable'~yes O no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper tnaintenar. consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the syste 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 masterplumber, journeyman plumber, restrictedplumber or a licensedpumperverifying that (1) the on-site wastewaterdisposal syste is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludg Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with ttie standai set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certificati stating that your septic system has been maintained must be completed and retunted to the St. Croix County Zoning Office within ; day~efjthe three~ar expj~ion date. APPLICANT ~~ DATE I (we) certify that all statements on this form are true to the best of m}~ (our) knowledge. I (we) am (are) the owner(s) :rty described above, by virtue of a warranty deed recorded in Register of Deeds Office. ~_ . ~, OF APPLICANT 3 ~~ 61 DATE ~ `~ ****** Any information that is mis-represented may result in the sanitary petzrtif being revoked by the Zoning Department. ****~ ** Include with,tliis 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 U. 2534 P 218 Document Number STATE BAR OF WLSCONSIN FORM 1- 2000 WARRANTY DEED Thi3 Deed, made between Grantor, and I A SS211 n yP,~~-'1~ [~ S j n a o .i1~2 rSn_n _ Granter. Grantor, for a valuable consideration, conveys to Grantee the following iescribed real estate in ~`~~ . C co i Y County, State of Wisconsin (the `Property" ore space is needed, please attach addendttm): Lo-~ 1 , ~la~ trF ~iiVtXpark Meadotos -down ~ I-~.tdson , s~-. erax Cat~.rrhj , ~ i Seorls~ n Together with all appurtenant rights, title and interests. 757645 KATHLEfi}I H. YALSH REGIS7'fiR OF DEEDS ST. CROIJI CO. , MI RECEIVED FOR RECORD 03/25/200 11:30AM MARRAi1TY DEED E1lElQT # REC FEE: 11.00 TRA![S FEE: 198.00 GOPY FEE: CC FEE; PAGES: 1 ~~g Area Name and Retum Address ;~ Fc 13 ~~- o-F' ~21(~-131ns -1le Paroel ldentiScatiast N~ber (P11V) This IS Y1U'}" homesteadpzoperiy. ~f (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except ~as~men.~S, r~es-EricfionS and rlsh~-s - cif=t,~a~ off' record , ~~' any Date tltis day of l ~ ~~~ ~`~'y~ . ~i /~~~ ~ •~ AUTHENTICATION Signature(s) authenticated this day of TITLE: MEMBER STATE BAR OF W. (If not, authorized by § 706.06, Wis. Stt THLS INSTRUMENT WAS Q~~t~__ ~ N ~c.--~ Signatures may be authenticated or acla-owiedged. ACKNOWLEDGMENT STATE OF WISCONSIN ) /~++ ) ss. . ~X - County ) ~? `~~...~~~ ~r Perso ly came before me this day of •`P R Y P (~ t ~kri the~}bovo named ;~ .• B.~~i. Arm. L• N,'t~ols a..d l~,.ts_,S. . . ~ '~, N : aJ.o I S . 1~ ~.s a,,..el a.,.. e1. w~ ~ fiIN JAE E. y w - ~Tjt1°F ~W, 5 C 01= are not necessary.) to me known to be the person ,~ who executed the foregoing instrument and acknowledged the same. «~` ~ t~ n/ Notary lie, State of Wisconsin My Co 'ssion is peamanent. (If noj, staff expiratia~n date: ~$ - ,~ *Names of persons signing in any capacity must be typed or printed below their signatrme. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. l -2000 ~-- H 1 GH WATER ELEVAT f ON"- 913. 2' :• _~ .~ ~ a s ~~ .~ ~' ~' L07 23 ~ ~• ~~ 3.41 ACRES LOT 22 2.71 ACRES 0 1 f 8, 044 S0. FT. O m w m of 3 0 0 0 v~ .~' ~ ~ f 48, 744 S0. F T. ~/ ~ ~ ~ o .~ 5 /' o_ ~ / ~ ,1 ~. , ; ~~ ~ . - - ,: ~ 3 ~• '~ ~ H 1 GH WATER ~6 ~ 3 ~ 0 56 \ \ ~' :• ~•. ~ ELEVATION= 9f3.2' 33~ ~g''~ 5~1 ,\6a' i .' /- 6 ~''•. ~ ~ • ~ _._.... ~g o --- , DRAINAGE ' .. ......... `.. ' ~ . ~• ~ ~ / o ~J6 ~'' ~ 2 i\, pv : ~' D ~, o -' O _ _ AREA ~~ _0' ~ ~ 5~j~ \ ~2 ~~c ~ p ~~'~. ~ ~ ''-----------''" ~ ~~\tj Our. /A\ ~ ~~, ~o. ~~ M ii O `' ~. 3 _ _ sue, s __ _- -- _ ••. t.. LOT { 4 p ~ • - Z • •, . ~ • ~, , ,~ ..............: w ~ 88, 095 S0. FTp io ~ ~ , ' ~ i ~ ~ i ~ ` \ ~ ~ o ~ ~ \ ~ • i N '~ ~ ` 1 , •. ~ ~ \ • ' • L OT { 3 ~. N ~ X23• a8 gO~ 33' 33' ~® 3. 10 ACRES •. ~ ~' " `N' •' • o ~ '• ~~ ~ . ~ , ~8 N03 04 15 W n l35, 198 S0. FT. •.•~,~;, ~ '• S6?°05 52. 94~ i ~ 0 iO ~ O, ~ i TT i I N i ORAlNAGE '•' O ~ ~ ~C • ~ '.~, LOT I5 ,~ ' ~~ 2.03 ACRES ~ ,' 88, 641 S0. FT. ` • ~ ~ 'i AREA •~ 25 ~ - i I \••'••. ~ ''~•_ ~ ~9 i ~ '2`' `qtr i i L0T {2 2.99 ACRES 130, 229 S0. FT. r •~ i `HIGH WATER 3~g6 T3 N ~ i 2 w ` O N ~ ` w w ' ° ., A i rn ~: ~• ~ ~ . w ~ ~: '.a !w ;~ r: 1 ca :.~ ` ~ ~~/ N '~ _ 12. 5' TYP. .....385 00, ~~~ 680 39 „5 LOT {6 z.2T ACRES 98, 688 S0. FT. i D ~` o' ~. :: ~o. a~ . o°' ~~ L0T 1 2. 10 ACR 91, 461 S0. ~~ ~\1 ~ J~ ,'~~ O IN Q (D n ~ (D O i ~. a c7 f~ O '. o d ~ ~ ~ ~ ~ ~ m ~ -~ o w oo W O A N 3 obi o ~ ~ 3 m v m ~ o o ~ v' o p- fJ ~ y O j O W ~ O ~ i O ~ ~ A p p O O C ~ .' ;n Z D ~ ~ Q- I «a D ~' a ~ I ~ 07 n ~ A D ~ ^ D O ~ ~ ' ', ~ ~ ''j Z N N O I ~ ', ', ~ a ' n ~~ v ~ ~ ~ C i i e~irt ', 0 0 0 7 '. .. N N N N. '' li A ~ ~ ~ p ~ W ro <° v ~ '' m i _ ~ ~ ~ m o 3 ~; a II ~i N Z ~--~ Z D m p O ~ ~ ~ ~ ~ m m ~ w ' i ~ m c c o a ~ c m, p ' '~ A 3 , a ~ W ~ ' i ~ ~ ~ a 3 ~ z ~ p ~•' A ~7 Z ~p ~ m ~ !~! Z ~ 0 ? D O. a ' ~ o ~ T N C z a o •• m m , 0 m rs~ O o ~ o m o p. /* 'Vl/isconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division - INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, X15.04 (i)(m)j. Peri~iY"~flb I~,'e: ^ aty ^ ~11~sr1riaP~r9wfnship CSTrBtM+ Elev.: Insp. BM Elev.: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORINI~TION TANK TO P/ L WELL LDG. Vent to Air Intake ROAD Septic NA Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION Manufacturer Model Number TDH Lift Lriction System TD Forcemain Length Dia. ti Dist.T SOIL ABSORPTION SYSTEM ELEVATION DATA STATION BS HI FS ELEV. Benchmark Bldg. Sewer St/ Ht Inlet ~ St/ Ht Outlet Dt Inlet Dt Botto Head /Man. D~ .Pipe of ystem Fi a! Grade v BED /TRENCH Width Length No. Of Trenches pl No. Of Pits Inside Dia. Liquid Depth DIMEN ! N DIM I N SYSTEM TO / L BLDG WELL LAKE / REAM LEACHING Manufacturer: SETBACK INFORMATION Type O CHAMBER Mo el Number: System: OR UNIT DISTRIBUTION SYSTEM Header /Manifold D ribution Pipe(s) x Hole e x Hole Spacing Vent To Air Intake Length Dia- Length Dia. Spacing SOIL COVER , x Pressure Systems Only xx Mound Or At-Grad stems Only Depth Over Depth Over xx Depth Of xx Se d /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENT (Include code discrepancies, persons present, etc.)Ins ection #1: / Inspection #2: / / Lo Ion: 988 Marcy's Court, Hudson, WI 54016 (NW 114 NE 1/4 15 T29N W) -1529192174 Riv ark Meadows -Lot 14 1.) It BM Description = 2.) Bldg sewer length = -amount of cover = Plan revision required? ^ Yes ^ No Use other side for additional information. SBD-6710 (R.3/97) Date Inspector's Signature Cert. No. ~ ~88 euvc-~ S -Sanitary Permit Application Safety & Buildini `~ In accord with Comm 83.21, Wis. Adm. Code 201 W Wash seonsin See reverse side for instructions f ring this application PC Department or Commerce Personal information you prov' Fartay?b¢ used 0 condary purposes Madison. WI 5 (Priva a~;_s:'-I~S".Oq(h)(>aa~~,;~~ ~ (Submit comp d form to cc . `~ '' Attach com lete tans (to the count c )for m, on `'~ r of less than 8 C'oun ita .1/2 x I 1 inc m size. ~ / ~ ~ _ ~ S3t~~it~aryOPc it Nu 'he~r.,~ C evision to prcv'tqu application State Plan Numbcr 1. A lication Information -Please Print all lnfor `a-ti n `1 ~ , Propcn Owner Nam Lo ion: e ..-1 4s~:' ~ ,` .~ 5~ ~-ct , `s P ecty Logr~wn W l t ~ ~ 1 ~ Propene Owncr's Mailing Address U ~~~ /4~/4, S T ~N,~ ~ 7~S c,7-f~ ,C Lol Number Blue ~ C~ rate Zip Code •-Phonc_Numbtr Subdiviswn Name Or CSM mbcr ' 11 Type of Iding, (check one) ,,s Po..s t~~++ I or 2 Fami welling - No of Bedrooms: ~ ^ ~~+~•~ ~t^"`S ~ O City . O Public/Comme 'al (describe use): ~'~" O Vill e 0 0 O State-owned II! Type of Permit: ( ck only one box on line A. Check box on line B applicable) care ad A) I New System O Re lac ~~ p ement 3. O Replacement 4. O Additi t Parc mbcr(s B ~ S stem Tank Onl Existin ste aZ ~ ~ ~ a?/'7 ~., O A Sanita Permit was revi I issued Permit Num ~36 /~ Dat~ssued -OD d /) • ~ ~r~ ~r rvvr, system: ((;heck a at apply) Q~Non•pressurized In-ground O Mound ^ Pressurized !n•ground D Holdi D At-grade O er is _~~ V Dis ersat/Treatme nt Area Information; 1 Design Flow (gpd) 2 DispersalArea 3. Dispersal a q yip Required Proposed F 37S 3 V( Tank Capacity in oral Hof Information Gallons allons Tanks New Existin Tanks Tank c5 ~ ~4D0 //fin / Sand Fil` Single Pass circulasmg `" ~ J /bo ~ S. Percolation e (Min./inch) r ufacturer VII Responsibility Stateme I, the undersi ned, assume onsibilit for installation of the POWTS shown on the atta Plumber's Namc (print) Plumb ignatu (no stamp MP/MPRS No. - ~ ao3 Plumber's Address (Scree icy, State, Zip Code) usmess Phone Number ~ ~ - ~8 - ~~ ~ ~~ 2 ~ ~ o VI11 County partment Use Only O Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued ssuing Agent Signature (No stagy Approv O Owner Given Initial Adverse Surc rge Fce) Determination Z2S. ~ ~p ( IX. ditio s of Approval /Reaso(~ns forrDisapproval1; -~' 0 r c CS~S (~t,~,tn+o~.s yw.v.S-~- ~ ~ D~' (~,r`~. {v i t/S~~^ 1.145 0.... wtUr CoM.~,~'"~.1oc-m~¢c~ ~ CST w~u.S~ roc-es~~l~p~~~,t~l ~,~a,~,~,s l stn C,~. c(-~, Ss~ '~'~s`~, C~-~..~ tMa.t`~,~`~ ao P-:Q-~- Uv~ J4.7G~t.11.¢~r_`s J~ecc~.,~.C . u.~.w~.~a~-tUt9us . -~ ~1•(,~ ~`~,~t~1vt?.tnn ''~~t" - -~ •~R.~ ~-S r as 0 O Li etland 6. stem Ele - n )Final _ /. Elcvauor 7.5 ~ ~ Prefab Steel Fiber- PI Con- Con• glass ~ Crete structed I .3 ,~ h-~~~ ~ ~~ ~,~ e D s~. r- ~oc~ ~- -BM /(( Ih/1 90 ~ ~ ~ sv ~3 _~~ a -~~ r,~.---~ h-god ~ ~ ~ ~ /~U r,~ ~`=~vo S~ IG 90 ~ ~~s~ r ~' V1f~sconsin Department of commerce SOIL AND SITE EVALUATION e Diviston of Safety and Buildings Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and ' percent slope, scale or dimensions, north arrow, and location and distance to nearest road. c,,,.o, , n « Page j of ~r - CYZ~i X APPLICANT INFORMATION -Please print all informafion. Re iewed by Date Personal information u rovide ma be used for seconda ` ~ Z~ 1 yo p y ry purposes (Privacy Law, s. 75.04 (1) (m)). ` Property Owner Property Location ~Q~ Govt. Lot Sw 1/45 t,~ 1/4,S ((~ T Z c~ ,N,R ~ c.~ E (or~V Property Owner's Maili/n~g Address Lot # Block# Subd. Name or CSM# City S e Zip Code Phone Number Nearest Road ^ City ^ Village Q Town ®-New Construction Use: .Residential / Number of bedrooms 3-y Addition to existiny building ^ Replacement ^ Public or commercial -Describe: Code derived daily flow ~,Q~ gpd a nded desi n loading rate -~ bed, gpd/ft2 ~ trench, gpd/ft2 Absorption area required _bed, ft2 ~ rench, ft2 v Maximum design loading r '1 bed, gpolfiz o trench, gpd/ft2 Recommended infiltration surface elevation(s) U e ~Z, ~~ /vud ~r , /$~ ft (as refer ed to site pla benchm r ~ e~ Additional design/site considerations . e le u e r S ow < Parent material Fto ain elevation, if applicable R ft S = Suitable for system Conventional Mound - round Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system (~ S ^ U ~ S ^ U ~ S ^ U [~(S ^ U ^ S ~C U ^ S ~] U SOIL DESCRIPTION REPORT ~~, _ -mot i~ Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound a Roots GPD/ft2 in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench Ground l 3 2(o-u~ ~D yr`f --- 5 vs ~S - ~ ~ '~ ev. e ~~~~ft. . Depth to ~~ . limiting ~ W factor l/~ in 03 Q . O Remarks: ~ Boring # i Z i Ground elev. 9~ft. Depth to limiting ~ d- r 3/L - 5r' ~ rota ~ : - 3 z ~-z9 ~v r~l --- S 5 ,': ~: ' -~ 3 Z9-~~3 /U r `fly - frns U ~ % ~` - ~ ~ _ ~' 199 g~ ~ ..~~ S~ G X ti . :, , factor ./~in. Remarks: "~._.1~~ CST Name (Please Print) Sign Telephone No. ~ ~ ?! - Z 7-`f00 Address Date CST Number U r S _ ~- 3`tOz.>5"' `~ 8 `1 ZS 309 PROPERTY OWNER ~~ ~ ~ C y ~ PARCEL LD.# ___ Boring # Ground elev. 9~~tt. Depth to limiting factor l/Sin. Boring # Ground elev. ~/~~~. Depth to limiting factor min. SOIL DESCRIPTION REPORT I l ~D`~ ~ !~ ' , Page Z- of ~ ~~ Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench 2 5 .,Z,z t ty , y ~~l ~s t r» rn~r c.5 •'1 ' - ~ r--- , rw ' , -'S ~ a~--qo.a ; Remarks: 3 17-IZO U~ b r ms c5 _ ..~ ' Remarks: Horizon Depth Dominant Color Mottles xture T Structure Consistence Bounda Roots PD/ft2 in. Munsell Qu. Sz. Cont. Color e Gr. Sz. Sh. ry Bed ,Trench ~- o-Z~f I t5 ry 1`I -' ~ 5 ~'r cs - .1 3 zy-~c t 0 ~ y /a ~ YY15 OS m i c s J : ~ ~ . ~ ' ' ,Z Boring # 5 Ground elev. Depth to limiting factor 1110 in. Baring # Ground elev. ft. Depth to limiting factor 'n' Remarks: SBD-8330 (R.9/98) Remarks: T-- ..., -- - _ -- .. NAME ~ cc`~" ~U 4 O U ~ < ..LOT # I SCALE 1 "= ~~ BMI ELEV . 9S 8; BM2 ELEV . ~~~ PAGE ~. OF ; j LEGAL DESCRIPTION. _S w-~SW~ s/p~Zq-/~/-C<- ____- ~, . k Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS) shall include information and procedures for maintaining the system wit ' the parameters of Comm 83 and 84, and the conditions of approval by the department, ent, or governmental unit. The approved plans and permits for system are on file at the ty zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, a the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatmen ystems SBD- Table 1: Svstem Design Specifications Sanitary Permit Number 0 Number of Bedrooms sign Flow -Peak (gpd) Estim d Flow -Average (gpd) Septic nk Capacity (gal) Soil Absorptio omponent Size (ft2) -~" L , - ~ Type of stewater Dourest Table 2: Soil Abs tion Compone -Limits of Reliable Operation Septic T k Component Soil Absorpfon Component Design. Flow -Peak (gpd) ~- Z- `~ Maximum Influent Particle Size (in) 1/8 Maximum BODS (mg/L) 220 Maximum TSS (mg/L) 150 ~pM..b,P.r; `eve Talmo 3: Maintenarlle Schedule Septic Tank Inspect and/or se 'ce once every 3 years Outlet Filter Inspect once a year d clean at least once every 3 years Soil Absorption Compon t Inspect once every 3 y rs Septic Tank The sept' ank shall be maintained by an individual certified to se 'ce septic tanks under s. 281.4 , Stats. The contents of the septic tank shall be disposed o accordance with NR 113, Wis dm. Code (Servicing Septic or Holding Tanks, Pumping Cham s, Grease Intercepto ,Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Porta Restroo ,The operating condition of the se tic t and outlet filter shall be assessed at st once every 3 years by inspection. Th outlet filter hall be cleaned as necessa to proper og ion. The filter cartridge should not be removed unless provisions are made t retain solids in the tank that may slough off the filter when removed from its enclosure. If the y~ jVlanagement Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. if the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightn and soundness. Access openings used for service and assessment shall be sealed wa fight upon the completion of service. Any opening deemed unsound, defective, or subject t allure must replaced. Exposed access openings greater than 8-inches in diameter sh a secured by an ective locking device to prevent accidental or unauthorized entry into t tank. 0 one should enter a septic or other treatment or ho/ g tank for a reason without being in full compliance with OSH tandards for en "ng a confined space. The atmosphere within t septic or other treat t of holding tank may contain Lethal gas ,and rescue of a bl person m the mtenor of the tank maybe d~ffic or ~mposs~ e. Tank abandonm t shall be in accordance with Co 83.33, Wis. Adm. Code when the tank is no longer used as ~OWTS component. The soil absorption componer wastewater from a residential facility. Table 2. The longevity of a soil absorp maintenance, and system use within conservation practices by all occupai fixtures are key factors in extending The soil absorption cc once every three years. The the observation pipes, and from the component. On reported to the owner fo ep from the system is pro ited structure is designed to accept domestic of operation of this component are shown in I,~m Went depends greatly on proper and timely elow t limits of reliable operation. Good water and the i allation of water conserving plumbing useful life o his component. m nent's operation mus a assessed by inspection at least ' pection shall include reco ing the levels of ponding, if any, in risual inspection for any evide of surface seepage or discharge :ply sloping sites, areas of erosi should be identified and iir. The surface discharge of dom tic wastewater or sewage and considered a human health ha d. Traffic arou or over the soil absorption component should b~ during winter mo s. The compaction or removal of snow cover over to hydraulic fail a by freezing. This type of failure is usually temporary, I impossible to pair until weather conditions improve. In general, soil cor component II reduce diffusion of oxygen into the soil and dispersal cell, more inte ,and earlier, organic clogging of the soil. sided particularly component may lead t is difficult or p tion over this uhi may lead to 2 • Drlanagement Plan for a Septic Tank and Soil Absorption Component Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. 3 S'1' C1tOIX COUN"1'Y S[?['TIC 'TANK MAII~I'I'G+NANC~ AGItL1?M[?NT AND OWN~RSIIIP CLRTIrICATION rORM Owltcr/buyer ~, ~ . l ~ I IoVA Q I~-, s ~.,~~ N~_~ka~ Mailing Address `7c~~ ~u . ~ ~ . ~ /~v'su.v l,v :~. .5 ~-v > (~, Properly Address ~ ~~ /~J~~ cy'r (Verification requirod from Planning Dcpartmenl for new construction) Clly/SlalC _ ~dc~soiy ~/l/~ Parcel IdcnliCcalion Number D~-O -/365' /4 -0OQ T.,rGAi, T)1~SCRIPTTON Property Location ~~ '/,, ~~ '/,, Sea ~~ T~N-It ~~ W, 'Gown of ~ ~ ~ S o N Q Subdivision ~l ~ y~'(Z~~1-t ~. ~ ~ oot~,l_.f' . Lot # ~~" . ct:~'~Irctl sut-vcy MAT, ~~ Volume Page ~I `~AI'I'Ailly D CC(I i'~ (,p n (n ~- (a "~ Volume ~~, Page if~ ~'~ ~ Spec house D yes~to Lol lines idcntifiable~ycs D no SYS`I'I+~M MAINTrNANCT<; Iulpropcr use and nra[ntcrrance of your scplic systcrn could ccsult [u its prcnrature failure to handle wades. Proper ma[ntcnana consists of pmnping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into tlrc systclr can affect the function of the septic tank as a treatment stage in llrc waste disposal systcrn. "I71c property owner agrees to submit to St. Croix Zoning Dcparlnlcnl a cetlificalion form, signed by the owner and by ; ulaslcrplunrbcr, jounrcyulan pluulbcr, restriclcdplumbcr or a licensed pumpcrverifying that (1) the on-rile wastcwalcrdisposal systcn is iu proper operating condition and/or (2) after inspection and pungling (if necessary), the scplic lank is less than I/3 full of sludge. Uwe, the undersigned have read tl-e above rcquircmcuts and agree !o maintain the private sewage disposal system with the standard. set focth, herein, as set by t11e Department of Commerce and the Department of Natural Resources, Slate of Wisconsin. Certificalioi stating that your scplic system leas been ulaintaiacd must be completed and returned to the St. Croix County Zoning O[ficc within 3l da r ee year expiry 'on data 3 /~/ ~~ IGNA'T[JRl? Or APPLICANT' DA1'C ~WNrR rrRTrrrcA~rT~N I (we) certify that all slatcnlents ou this form arc true to the best of my (our) lalowlcdgc. the openly scribed above, by virtue of a warranty decd recorded in ltegistcr of Dccds Ollice, ~/~ IGNA1Ult Or Ai'PLICAN'I' I (1YC) alll (aCC) IIIC Ow11Cl(S) 0 .3 /~/O~ DAT'fs ****** Any information that is nlis-represented may result in the sanitary permit being revoked by the Zoning Dcpartmenl. **••* ** Grclude with thls applicallon: a stomped warTanly decd from the Ttcgistcr oC Dccds o(Yice a copy of the certified survey snap if reference is made in II-e warranty decd ,1 I1,., l .. N~ ~.l~.t,1 _s STATE QAR OF tVISC.Ol7s11! FORl,1 2 - 1981 tja~2,~7v 1tian RAK TY DL•ED K11711LEE11 N. uf11 S11 I ((~~ s I~ P ~ j~ 1' . STG1CkDT OC U,EU[ COCU1n6r1TN0. (1. . a6i~ (J X G 1 Q n3 ~ P.fCE[VED FOk A[CDkD lior jOTiC lfalernea, Frances August and Paul Ketner ns tanant~n summon a k/a Erancia 07-06-1939 9:10 AA __ Au u s t g Y~IkFPo1TY DEED -- E~tE1F/C N c~nvr;a>tr..lwnnmslc ~'•C-Cn'wa Huliceru, Inc., a CEkT COPT FEEL COPYFIEE llls'ronsin Cnrporatlcn •"- TR6NSFEA FEf: 1310.10 • -------- kEC(MIDIIG FEE: 12.00 • - _ PsiOE9: 2 ' ...______.____._ .~ __„_ lnllS•ACE n[SEarED rnn nrCOgID-IIfrG-DAT~ d c 6711ouin8 descril>rd :ual cuale- n ~t ' fro;K _ Cuulny, ~AVIs J. ~Sc~f 1- L~~'~ Sla:e of tt•Ceensin: -- ~O~ 1..)~.i`~$.r ) . SE 1/4 S(d 1/4 Sec. !0-'f,9H-R19:! excepting Lhere[rusD Lut 1 )~11pu0N, W) 5~0•i"` of CertlEied Suivay ftaF rucordad lu Vo117 of Curcified Survey llupo, page 2089 ns Uoc, llo. 44730], also excepting 02U-1010-20 the rnllrcad right of ula~, 020-1024-911• • 02U-10?5-9(1 UE 1/'I tTW l/4 Sec. 15-'f24tI-R19W excepting tha ref r. rm Lot 1HA1'CEE Uknl111C41if.1V ErUA1dEH --- ef l:ertlfied Survey Flep recorded In Vol. lU of L'ertifiud Survey 1•tapc. page 2701 ac Uoe. '10. SCii28. 1H: 1/4 l1E 1/4 Sac. 15-T29t1-R19W Thio is no[ humc;mrJ PropErly. -•Ik1-- !'s nit) E:c:cluion to a•unnnel: /) }~ /~ V DuW rh11-...- dsy of Juna ~ . ~~ , )9 99 . ll..,....,., ~-~ ~~t u~, A Srpng •VF:cC1GJ.•.~1L. ---..(S[,H.) • Frunaus Aukuut ugust_ •+ ~,•,t~~ Paul Earner ~,t~_.~ i_L1Yle .. 711n~~ Al1TllENT1CATlON Y yyll>> ACKNOCYLL'DGRICNT ;:.- (SEAL) .~ on SEE n'CTICNL'D; Si~ucaa;a)-.-_ __ State of \~{~~ ~~~, L`Rl1IULT "A" ': I s. --- - - ----°-- _ King .- __ Couruy raduuuoaJ Ihls d~yol , :9___ Icao»I'y cane briurc Inc sbu 26th dry ul I' _ Junc •--° Iq_-99.-• d+E above nan:nl I f171_: \1k1•tOER SinTC UA11 OF WISC~NSIPI irancuu August - r 1)f nut, --- --- ~- --- audiollttd by 1 i05 06,'.9is. Skill.) l0 n'c 4nu.yi; to c '>thc ptrs[•n ___ aUo cscas:cd Iht fi•rl;larg fuel t~r/{lu ann1r n wlydge1llrital :.i1S 1'v>TFULIGIII 1'/4S DnA:TEr; D~ _~~(~y ~(.~ / Nevuood 6 Car_, 9.C, b Walecr lodynalry 1{1.'UiJ`./..33--// t .~h" -_-_Y-___._ __ 'i04 LxueC St.l P.O. 8cx 725 HaJsua, ill 54U1S -•---- -- -- Noary Public, Kltl{t ----Ca,uuy,_ttlic.- ti:E. (.~ibea;laa may bl :wa¢rdicxeJ uI ad<now:algrJ. lt,,lh an nut Lly caauuixiou Is prnnanenl. ;II ncr, elalc capuailur .isle: ' ncca:aly) --_ Septcnber 1, 2001T KKi--_-,) lhRe: ul pn •nm I.gmny u. ny nla $s•J•nlN 6p IrE.d er pnnpd 611.:r Ineu n~nu.ler. ... .. l5,\dRA~ll' DGEU SLAT: O.Et OF s617CGr.Slr7 wlfcl•rnte[n ¢av. l4. re. Inrm:k. l - 19d1 \q+Iw.a, rY,. I><I ll ll 1 RI VERPARK M~ %` ~ ~ LOCATED 1 N THE SE 1 i4 OF THE SW ! " ,/ ;' __- .- ~~~ NE 1 i4 OF THE NW 1 i4 AND 1 N THE NW ;" ' ~P?~ _ '~ ~/ ALL ! N T. 29N. , R. 19W. , TOWN OF HUD. ' ;' I ~~ ,~ ~ ; - ~ , i ~ ,~' .__ '' ., i LOT 23~ ~ _ I ~ - ~~ ' ~ warn awwrcR caa+t;R warn trwE or nre rrE r.v G eFCrlpr 16 - fe1MW ; ~ J i ALIwIr/Rwf IORwEwr rweM10'tl'e7 'OI S N89.49'37'E 1318.Y1' eecrraw ro ; I- ~ •-r--------------1-------: -: ":. • eeerrow re , . ' e 1 .............. ............................................ ......_......_.........._ .rear. a~ ......».....___......_.. ........... ;.. . .. , : -, :: ~ ~ •, s 1 •---------------------~ q ````v - r LOT Y4 ; LOT YY __ %~%\~•, ( s. as narEa ' , ~ t. tr ears _ ~`` ... ~ •; i i ~ ••''••. ree nr• aasr. ~ ra.oa ao.fr. .._.._....._... ~l~.... ~~ '\, '~• ~ ~~';, ~. ~••'~ • LOT Y3 = ~ = o Lore ,~-~' ~. ~3,~~ ~' '~. - .. , _ ..•°'••r ~. =~ y `. i0` t >, • ... ~ .. a•ee~e aee.se-• I m , O i ~ : t 1~ S W ~' i ... ~ ~1 ~ .0ee a0.fr. :ti ® rj]~ `. $ . g:`• ~ ~' d '~ •'' LOT 13 -~M~:: ", /~,.••~~•.._......••~ 1 ®' se'Iar LOT !0 , ® ~.~® ''•. '. s. ro •, ~ ,...••^' ~ o' wba'a' ra' (~ o € ~ -a., s eo AaE1 ' ~~ rae. rtr. .: ~ .---•'"•.. s° Ot. i4' mi ' D ~'•. ba~=~` `~ --"' ' \ t ~ f~ ~ ~, LOT 15 "m1 }~-' ;g i ' ' ~ J '. t.40 Ap1Ed ; 1 ' ~ - ~ i ~wrex r~reR . ~ ''~+'...~ ~ `2 1 a.ar sasr. r• ®; I .~ - • ` ' ' °"~,,: `.., ~ . j,. " a..»• -tea, ~ ~~~ • ,• }~•~ Lor-1 r ~ `t„~ ra0.tea eaF'r. :~~ Lor rs : ~.. ,~ ' '' _ogniw~ -- ' rae.ar sat•r. ~ E ° : $ ee.eae aar=r. ~ ~ L ,: - :: '8 t. s • .w g " i ~ ~~~ ' $ i I ' ' • acwrvra m,anratr k'---- •~_,_- ; ~~~~ seNbr ~r reN. ae• $~~ we. vat. ®o, ra. w _ b ' ~ .,, ae.•a' ctordreo To irE MMLIC~~ ssa 4r 3Y w 348. »' . .~><:l!T.fd.!€al a sae•4r oe w 131Y. Y r ~~Ib~ spurn t rwr ar: rrrE wr r.• ar• r~ wr rn, a varste ~~~ ~ •UNPLATTED LANDS eourw gNIRTER Oa1w;R auMirrrwwrtaaRwFE°irr SKEET ! QF 3