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020-1447-01-000
' WisFonsin Detnartment of Commerce PRIVATE SEWAGE SYSTEM Safety and 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 Whittaker, Dou Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER ; ~S CAPACITY Septic 4~r1. (,/p,2~>~S 1 Z Cm O g F,•) rat"' / ~ V Aeration Holding TANK SETBACK INFORMATION TANK TO , ( (/~ o ~, WELL BLDG. Vent to Air Intake ROAD Septic ga ,. l~ / ~/ ~!rJ0 ~ -- Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System H TDH Ft Forcemain Length Dia. Dist. to well Still .ABSORPTION SYSTEM /'9,, 7 7~ X07, BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ ~ r C~~, 5 ~ Z wLl ~ ~_ '' ` SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: ~~~ ~ t!'f~' INFORMATION Type Of System: , 5 ~ / w ' ~ / /I ~~ UNIT Model Number: ~~ / ~ p 3 3 p ~ /V q, U~ nICTRIRt ITt~1N CYSTFM Aln/'ll_ (_ Header/Manifold rt Distribution x Hole Size x Hole Spacing Vent to Ai tit r ~ g Pipe(s) ~ ~ ~ i S \ \ //1/ z YS ~ Dia Length pac ng Length Dia c . - Cf111 ~`f1\/iGR .. o..,........., c..~~....,~ n.. i.. .,.. 11An~.nr1 !lr Af_(:r~rln Cvc4ome only Depth Over / Depth Over xx Depth of xx SeededlSodded xx Mulche+d Bed/Trench Center ~ ` ~ ~ Bed/Trench Edges Topsoil \ es ~ ', No Yes i No COMMENTS: (Include code discrepencies, persons present, etc.) Location: 698 Pine Timlbe'r Llane Hudson, WI 54016 (NW 1/4 SW 1/4 15 1.) Alt BM Description = ~` "~ ~~ ~L CoJ{~ 2.) Bldg sewer length = /p' ~ ELEVATION DATA County: St. Croix Sanitary Permit No: 499186 0 State Plan ID No: Parcel Tax No: 020-1447-01-000 Section/Town/Range/Map No: 15.29.19.2832 STATION BS HI l!b .~J FS ELEV. Benchmark ~r /r ~ I Il0 ~~ / / 9 . ~l Alt. BM auk. n Bldg. Sewer 5. /b5./3 St/Ht Inlet (, .at /~y. 52 SbHt Outlet c.• ~6~. ~3 Dt Inlet ` ~ Dt Bottom ~ ~ Header/Man. '7•c6 z. /62 , 7 Dist. Pipe 4.7Z //a.S 7. 4L 445 /62.7 ~ . D Bot. System 4. 45 /a.~{ /o / . !0 8 .D Final Grade ~!, /3 , 3 ~~~ . 5 St Cover , 1~ ~ ~bsd- efv..,_. 3 Kn X93.43 /~ • 3 ~ 7 7. s 3 Inspection #1:__/ / Inspection #2: / ! T2 N R19W) Coyote Ridgne "Lot 1 Parcel No: 15.29.19.2832 S o r 1 f"GS~ Sat'ety and Buildings Division Canty ~ ~ b1 ~ ~ C 201 W. Washingwn Ave.. P.O. Box 7162 - - ~ jscons~n Mdhan. VPI 3370 Ib2 San N Number (te be 81 n by Ce.) De ertment of Commsrae (~) 266-3 r, ~ ' `S~ ~ 9~ ~ ~~ Sanitary Permit Application ~"" I ~°~ N ,e~ . / in accord witlt Comm 83.21, Wis. Adm. Code, persoml information you provide may be used for secerdary purposes Privacy taw, si S.Of(i xm) wa mailing address) tl Address (if di(fersm QQ ~ r ~ T ~ T't N~ 1 1-'~~ ]( ~N 1. Applkation luformation -Please Priat AlI Infortnrttioa Propatyowner'aName NOV 0 S 2006 ~ ~ ~ S 1 ~ ParcdA ~ r Bkek. ~, ~ ~ ) 1.2 ri Ok ~ Property Owner' ailing Addreu ST. CROIX COUNTY . ~ Property location U ZV / i///-,;~1 Y7' ~~ ~~ D Ph~ ~ ~ ~/~ ~ '/., Section ~ S City, State ~ Zip Code U 1 umber --~ 1 (circle one) ( ~ 8 3 2 , S DN ~ ~ ll~ , t N . l p / T ~S ! N; ~~E of W (cheek ail that apply) R T e of Buildin yp g CSM Number i on Name Subdivi ~t ar 2 Family Dwelling - Number of Bedrooms 's ` `~ Cta ° ~ ~~ Q FublicJC cial -De cribe Use " '` omrna s ^City OVNlage ~'I'ownsAip of o }' ^ sate Owned -Describe Use 111. T ttrm Check oulY one box on line A. Compkk line B it applicrtbk) 4 Q ' ~{ ~ - 0 _ OoU - $31 A' ~lew Systan ^ Replatxrnent System ^ Treaunatt/Fiolding Tank Repltuement Only ^ Other Modification to Existing System •d• ^ PemtN Renewill Bd'ero Expiratfbn ~QamN Revision ^ Change of Plumbs ^ Permit Transfer to New Owner List ~~ Penmt Nnmbu i d Q to iss d '~ 0~ ~ ~' ~ ~ 9 ( ° (3 v [Y T of POWTS S em: Chtxk ail that a I -Non-Pressuriad In-Ground ^ Mowd >_ 24 in. of witaMe soil o Mood < 241n. of suNabk soil o At-0rade a Single Pas Sad Filter o Cetafitrcted Wetlad ^ Prtsteurixed ^ Holding Tank ^ Pat Filter ^ Aerobk TnxttneM UnN ^ Recircuhitirtg Sad Fiper ^ Reehwiad Med'a Fihas Line . ^ vel- i ^ Other ') ~- V, tfl'reatu~ttAreaIn[oruwtion: ---- - D~g~t Flow (gpd) Design 1 ration Rate(gpds 0~ ~ ' 1 Dispassl Area Required (s ~5g Disperal Ara Propaed (sq Elevation 'Z Q~ ~/ I~LSO - 100.0~~ ~ 3 p VI. Tauk Info Capacity in Oailoru Total Oalbns umber of Unib Msnufacturer Prefab Concrete Site Constructed ibex- Gtas Plastic New Trice P.xbtiua Tasks Segk er Tank ' ~" ~ ~ ~ ~ 'f -4 TmtmaA Unit Dwirri Clrmbx VII. usibi $dttensent- 1, the aawt>te N!Y for laallatisa of the POWTS shorru on fire attatdW ~~ ¢ ~~`'~~s MP,Maao~ B ~ i+J ~~~ qoa ~ Plumber's Addnesa (,,St11reet, City, State, Zip (l ~1 ~ ~{~JfrIbSUU ~,1.5t- J ~U VIII. oua / D art U:e Oni Approved ^ Disapproved Permit Fa ncludes Groundwster SturlauBe Poe) ~ /J ~ ~% Date issued (~ ( 1 (' tamps) ^ Owner Given Rason for DenLl F / J ~ ~ ~ ~ ~l" ,//y+~ f ~,f/yl ~(r tX. (:onditions of ApprovallReasons for Disapproval - ~ J v~-~S S ~/ S~~ SYSTEM OWNER: a G~ ~~ Gj~,~R, ~Jlij~' ,(Gj~ p~_ / 1 Septic tank, effluent filter and ~J ~, / n dispersal cell must all be serviced /maintained n~~~ , , L ~U/~ ~/~6 ~ 0 l~ ~' `~`',~ ~p " ~i7 ~"` ( as per management plan provided by plumber . _ ,~ , / i i b t d ~` e ma n a ne 2~ 2. All setback requirements must G~~t/ f~~ ~~ . .. Atbeh tewpkM peas (M nary) ter 1Me tyes[A'era .et rae t1w sus : u tacaes r. we ~" `G~ SBD-6398 .01 /03 /~u~~f" /~U7,c.I t,G~ /~iu~~~iJ./ ~ ~0~ ~° ~ (~ ) ~/ i...~~ s ~~.1...~~.... .._.__._ ...-- - ../~/ -----~~ . ~~~~~n.._.. _.._. ~i~%~l1J .~.~ _..... _._..__ _.._.~_ ~o ~ ~ . - . _ :'n:-- uu.m,~e~ der..: .. . / r~~ o~ ~~~~~ SRay ~ - s4~, y~ p, ~ ~ao, ~ ' 1 rc~ ti ~~. S ~(ew . r~~. ~ 8 3k~~.~v ~a ' __._~... ~ ~'~ ~ ... _ u.m~e., hex: .. . . _ __ `c~ ~?~~~7..G1~. ._..__._..__... _~_._e_.~e__._._.________ ...__~__-_--- - . ~: ~, N ! ~ ~, Ql ~. ~~° ~ I` ~ pb r~ Tub, o~ ~~~'~ GRpy n ( --- - s,,1, y ~ ~, W ~a o, ~a 3 k ~8~. s o Wisconsin Department of Comm --~601L EVALUATION REPORT Division of Safety and Buildings ' h Comm 85, Wis. Adm. Code 2010 Page 1 of 3 A.C.E. Soil & Site Evaluations Attach comaete sfte plan on paper not less than 8~ x 11 indaas in size. Plan must i l li d t d i County St. Croix nc u e, art not mite to: veR cel and horizontal refererx:e point (BM), Qirec#ion arxi Parcel I D percent sbpe, scale or dimemsiornt, north arrow, and location and distance to nearest road. . . 0-1 7.01-000 PI®ase print all iniormat'ion. Reviewed By ~ Date Personal irdorrnatia~ you provide may be used for secondary purposes (Privacy Law, s.15.04 (t) (m)). ~~ ~ a Property Owner ECEIVED P operty Location Dou & Shirley Whittiker R ,~ NE 1!4 SE 1/4 S IS T 29 N R 19 W PropeAy Qwner's Mailing Address L # Block # Subd. Name or CStYI# 927 Coyote Lane ~~ 1 g 2006 1 Coyote Ridge City State Zip Code Phone Number City -f Village ~If Town Nearest Road Hudson WI 18 ST. CROIX COUNTY Hudson 698 Pine Timber Lane New Construction tJse: L/] Residential / Number of bedrooms 4 Code derived design flow rate 60U GPp J Replacement J Public or commercial - pescribe: Parent material Glacial Outwash Flood plain elevation, if applicable n8 General comments and recommendations: Site suitable for conventional dispersal cell at 0.7 gpd loading rate. Recommended trench etev.s = 101.50' & 100.00'. 24" - 42" sub-cutting ofi system area advised. ^-~ 7 1 Boring # ~ Boring 1 ~ I P 6 ~~ 27~~ r+~ it Ground Surface elev. 10 in. .95 ft. Depth to limiting taaor Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Dltl= in. Mansell Qu. Sz. Cont, Color Gr. Sx. Sh. 'E 1 ff#2 1 0-15 10yr3/2 none sil 2fsbk dsh cs 2fmc 0.6 0.8 2 15-27 10yr4l3 none sil 2fsbk ds gs 2f,1mc 0.6 0.8 3 27-46 10yr5/4 none sit 2fsbk ds cw 1 fm 0.6 0.8 4 46-62 10yr5/4 m2d 7.5yr5/8 sil 1csbk ml gw 1f 0.4 0.6 5 -127 10yr6/4 none s 0 sg dl - - 0.7 1.6 ILH omm. .30( )(a 3 appplied to discount redox eatures reported in ti#4. Boring # J Boring Pit Ground Surface elev. 106.57 ft. Depth to limning factor ~ ~ 30" in. Soil Application Rate Horizon Depth Dominant Cobr Redox Description Texture Stnx:kure Consistence Bourxlary Roofs P in. Mansell Qu. S,z. Cont. Color Gr. Sz. Sh. 'E 1 ~#2 1 0-14 10yr3/2 none sil 2fsbk dsh Cs 2fmC 0.6 0.8 2 14-29 10yr4B none si! 2fsbk ds gs 2f,1mc 0.6 0.8 3 29-53 10yr5/4 none sil 2fsbk ds cw 1fm 0.6 0.8 4 53-68 10yr5/4 ' ~ m2d 7.5yr5/8 _ _ , sil 1csbk ml gw 1f 0.4 Q.6 5 68-130 10yr6/4 none s 0 sg dl - - 0.7 1.6 f R o )(a)3 appplied to discount redox features reported in li#4. 'Effluent #1 = BODS> 30 < 2Z0 mg/L an TSS >30 <_ 1 0 mg/L Effluent #2 = BOD < 30 mg/L and TSS <30 mgJL CST Name (Please Print) Signatu CST Number James K. Thompson / ~---- 3602 Address A.C.E. Son & Site Evaluations Date Evaluation Conducted telephone Number 340 Paulson Lake Lane. Osceola. W1 54020 10/10/2006 715-248-7767 Prope-ty owner Doug & Shirley Whittiker Parcel ID # 020-1447-01-000 Page 2 of 3 a Boring # Boring Pit Ground Surface elev. 113.92 ft. Depth to Ilmiting factor > 138" in. ~ gp~gaon Rate Horizon Depth Dominant Color Redox Description Textwe Structure Consistence Boundary Roots in. Mur~I Qu. Sz, Cont. Cobr Gr. Sz. Sh. `Eff#1 `Eff#2 1 0-14 10yr3/2 none sil 2fsbk dsh cs 2fmc 0.6 0.8 2 14-30 10yr4/3 none sil 2fsbk ds gs 2f,1mc 0.6 0.8 3 30-54 10yr5/4 none sil 2fsbk ds cw 1fm 0.6 0.8 4 54-138 10yr614 none s 0 sg dl - - 0.7 1.6 ^ Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. soii gppi Rate Horizon Depth Dominant Color Redox Description Texture Structure Conststenoe Boundary Roots in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 ^ goring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in, Soii APplicabon Rate Horizon Depth Dominant Cdor Redox Description Texture Stn~cture Consistence Boundary Root irl. Munseit Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 `Effluent #1 = BOD 5> 30 < 220 mgll. and TSS >30 < 150 mg/L * Effluent #2 = BODS ~ 30 mglL and TSS <30 mgll T'he 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 depatlment at 608-266-31 S 1 or TTY 608-264-8777. SBD-8330 (R.o7/00) A.GE. Solt & SiOe Ev81u~lOnS ~ So,/ t da/ua ~'on ~D; 6 • ~oca~ed ~Ororv. Sz~a.~ 0 /a~/ P/atoFCoyv~e~'d~ye, nE~¢SEJ~, Sec . isT. ~9~I,Q /9w; ~. o{'f/udS~ ~~. Croix ~.i ~,J! Pct dog-i~v~-oi-cam i o~ o~ ~~ i 0 0~'~ I ,o ~i QI z ~~z 3e9 yy'- =, ,, _ ,. ,. ,~ ,~' ,-' .-- elec. Cc+~+alu.lE, f}ssa.~,ed e/e~ =icD. ,, ,.' i ~~k/ ~QI`. ' ~, ~' ,' , ~ ~~ 1~. ,cS.~'1. r Toro e~l'z~`8-~'aj. S~• ~fG ^\ . ~ /~w'9 > ~ i 1 ~' , ' ,~ e lei. C'ar-dK%t E/erg ~ ~i9. ~/' ,~ ~ ~ / i / ' ~ '' 0 i , ~, ~i' ~~~' ~ x'/,33 ~ ~ ~/ ~ i ~, , ~ i ~ , ~, 1\y0 • t T'~) 0~9B98ESTG ~seg ~aadg weal dES~EO 90 ZZ ~eW Safety and Buildings Division County S ~ ~ ~ m ~ 201 W. Washington Ave., P.O. Box 7162 ~ , ~(~ ISCOI~SIIf Madison, WI 53707 - 7162 Sanitary Permit Number n be filled in b Co.) Department of Commerce (608) 266-3151 LI C~ 9 /~'~ Sanitary Permit Applicati State Plan I.D. Number ~~^ Itt accord with Comm 83.21, Wis. Adm. Code, personal informatio e may be used for secondary purposes Privacy Law, sI5.f14(1 xm) roject Address f different than mailing address) 9 ~ ~ ~ b ~ ~ L A li i I f P e t m, ~ 0 e pp cat on n ormation -Please rint All Infor Property Owner's Name `` ~~~, ~h)~b~:~Z Parcel # Lot # Block Property Owner's Mailing d ess Property cation ~~~ ~ ~D 1v -Q ROIX COUNTY r ~ y Sll Y. Section ? City, State ~ ~^ Zip C e Phone Number , . ' t Q(circleone) ~ f~, ~~,f~1.i U T ~ T N; R E or W - 5 ,,,,.,i II. Type of Building (check sll that apply) ~ ~ ~ S bdi i i N F~l - e3i b ~A.~_, ~ ^ I or 2 Family Dwelling -Number of Bedrooms u v on a me v er s vm ^ PublidCommercial -Describe Use {~ ~~ d '`~ ^ State Owned -Describe Use ^City_^Village township of unSi)t.1 III. Type of Permit: (Check only one box on line A. Com ete line B if applies e) v 20 - -~ -cTC7>7 ~ 2 A. I~I~lew System ^ Replacement System ^ Treatme Holding Tank R lacement Only ^ Other M dilicat n to Existin s n B• ^ Permit Renewal ^ Permit Revision ^ Change of ^, ennit Transfer to New List Previo nit r ssued Before Expiration Phnnber ter IV. T e of POWTS S stem: Check all that a l 'P 2 S ~NOn -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ ' pound 4 in. of suitable soil ^ At-Grade ^ ogle Pass Sand Filter ^ i Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ~ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter Leaching Chamber ^ Dr' ~ Line ^ Grave ess Pipe ^ Other (explain) V. Dis etsal/Treatment Area Informs loo: Design Flow (gpd) Design Soil Ap licaiion Rate(gpdsf) ~ persal Area Required (st) Dispersal Area Proposed (sf) - System Elevation ` ~~ o~ . B~~ ~ . ~ 8 ~ 9 .o~ V1. Tank Info Capacity in Gallons Total Gallons N ' ber q nits Manufacturer (.uf-~~ ~.-~ r fab Crete Site Constructed Steel Fiber Glass Plastic New Existing ~ Tanks Tardcs Septic or Holding Tnnk ' 1 1 . d• ~F' Aerobic Treatnxnt Unit Dosing Chamber VII. Responsibility Statement- I, the un signed, assume responsibility for installation of the POWTS sho on the attached plans. Plumber's Name (Print) PI 's Si re MP/MPRS Number Business Phone Number -~'~~, ~3au~, ,~ ti ~aa9Dy ~~. `~~~-3~c~~poa Plum ber's Address (Street, City, State, Code ~~~~ ~1,~ ~.~ ~% ~yb5()~ \\rr ~SC. S~r~~~ VIII. 'ount /De artment U Onl Approved ^ Disap Sanitary Permit Fee ncludes Groundwater Date Issued Issuit g A t Signature No tam s) ^ rven Reason or 'al Surcharge fee) ~ ~ ,~ Z~ I IX. ('onditions f p ova / val n 3~ Z`~ ~~'t S~ S a-~.~ 't SYSTEM O NER: 1 Septic tank, effluent filter and ~ ~ ~ ~h$ 6,~1 / ~ dispersal cell must all be serviced /maintained t ^ n ` ~ as per management plan provided by plumber. I~K.~1'~C~ ~ ~ I '~ 2. All setback requirements must be maintained S~ w 1 ~,Q, ; ~ • ~~~/~ Z Sv as per applicable code/ordinances. ~`"`^-`~ ~S U~ Attach complete plsw (to the County only) for the system on Asper not less than 81/Z x I I inches in aiu SBD-6398 (R. 01/03) ~p~/ T/ ZS~ ~ ~..~ s~-~ ~l~,yl^'`~._= ..~r. ~ ~, i ~`~~I .~? ~a~ ~a~V ~~E s~~fi; lug ~~l ~', ~-.~ h V G b' T~ °p ;~ ' Ste ~ ~~ ~q 1~3, (~ ~~ O •~ ~N ~ fi d ~--`-~~e o ltee5 O~Y ~'"" 1 ~l~ ~~~~ • Q3 a ~_ oQ~ ~a I ~' ~ ~~.~5 ~. 9 ~ ~S a" 1~~~~s 3x~7Sp ~~ ct,~j r,~<< ~~G~ iM!d f_~ Q~ ~ ~ 0 ion o~ , ~a,~ S~~Pi ~, ~ 1 oa. p ~ . _~..~ ..._.....-.- ~~Nl~-~ ... - ~ -.... _.._. __ ---_.___. iri. uu./rl~~, ~eI'' W~0 ~c~~oU c~la~ s~~fi; ~Uu ~ ~ ~lLq N Lry Q' ~~ 0 Top o-F ~ ~a S~}QP4 ~, ~ 10'J. p T s ,,.,. . I ~, 9 ~ ~S . RECEIVED ,_.. I ~~~ DEC 2 9 200~ai~p EVALUATt4N REPORT ''// ////-7 ~ / ~~-,,3l/ OhrisiarofSatetyendt3rr ST (~RCIIX c~n~ ~~~, .. n~ ~ ~ 7-`~~-~ ~ " c9t~~oZ2S Sy ~ P~ rt~st er notrat ~ iess tf~ a iTf x M S in see ~ on pi . t ~rrde. ix,c not tisr~ed ~_ vertical and ret a~+t can. won ~ P~ t.o. SEA ~ to ~t'1 ~ percentstopa. scafeardrrrenslons, rwt9r amoMr.arid tor~Uoreand d~rroeto nr~d. . Please pmt alt Inlo~rmatYon- ~` 2~r Zc~ ~ouv~e~rw~aror~oo~rrw.n~c~r~w.~.,ao.c+~c~~. ivw s£ sEGr• l Prgrerlyowner kE/~,3VO,V ~~'/' ~ Propertytocal'an Govt. t:at /1/lt! 1/4`SW 414 S ~ N R ~~ 4L(or} w p+oPe~Y Owner's i ~f'tr ,~/- • ~~t'/e ~'~ ~~ ' Lot # l ~ ~odc # Subd. Name a 6w N p Ca y~o TE ~ 1D6rL~ " State Code Phone Number h~UDSo~ w/. syt~tlP ~?IS 381~'~?5 ^ (icy ^ YrNaye C2~Tovm Nr¢mest Road hfUpSo~ 13~~CiC~E~ ~'~ - _ _--- NewCansUUdan use:$[ ~ Ntmber of bednoorra 3' cone derived flsow rate ~'SO -- O'D GPo O Repiacetnent ^ Pu6Gc a ao+rmeraai - t~xibe: Parrsnt rrreteriN _1ffLSl~ y O vTf'.~lR ~~. ~ PINn ele~on ~ ~v,~T~ ~. .General oorrr<r,er~s ~ • ~£fi r~s7-~ svi•~-,}~Lt. ~v~2 rtv ivy~Po~-moo ~oti~c~-ro~v~~- s ysr~ l,~ o w. ~-s.~ - ~~®~:s~•- ~, elev. R oar to factor in. soli Ram Hor~on Deph Dominant iisdcoc Desaipfion Tiaxttxe 8trucwe Corrardenoe Borsrcfary finds i~. Harvest t1u• SZ Cont. Color Gr. Sz. Sh. 'fi't ' s • o ~ s p ~• ~-- • D ~ pmt ~ ~ 3• ~~ p t - I ~ pt f~"nt (~+ound aurfaoe et~r. a R. _ DepR- a rrm~p factor 7 a 5 in. ~ y~ fide t~torfzon oeaar oomhmrrt Redwc Deaaipllon Texbtx~e i~nuaure C.oroe aourrdery ~ ciPDAF in. ciu. sz. conc. cover c,~ sz sfti. "~+ ' o- 9 io 2/3 Ls Z,-,,r.6 5 ~tv 3 f /~~ Z i q• ~. g t-- s o. s ~ - ~• Z 3 s ~~ • i Itf = l ~ ~ 3 0 <2~ ~d ~ >30 <, 50 m~tl. • ENuant ~2 = BOD ~ 30 m~L arrd'~ = ~ ~- . cST Na~ ~ ~T' u t b ~t ct~-, f z G ,~„~, Dele Evai~'iar corxirxieri Teleptrone Nrarrber Private Sewage Consultants p 2812 10th Ave. ~/N S !`~~2 TOT,yG o~ o ~ /4r/+-~ Spring Valley, WI 54767 Z p . to ~'7 . Z o • Ozra 20 • /oa.7. 30 - oaa Z.o • io17 . yp . oa-n it N ~ERti~~ ~,~ r- Forcer ~ # /.~ f ~ ~ ~ Z ~, 3 3 ~;~~ ^ Zo ~ Fit Ground surhaoe elev. l 3 . ft. Dew to raru6inu ft ~ ~~ n liori~on Oeplh in Dominant M Redaa Desa~tion Texdrre Shure Cons -- Y Roofs ~ ~ Rem OPQIf! . ussel Qu. Sz Cont Color Gr. Sz Sh. 'Eff#1 'Eff#2 l Z o• ZS S• y ~oY~ S -- 5~ S ~- i ,f' /yc SGT CS c 3-F f .~. • • ~e ~~ !~ /b ~R s o G ZfS ~ a - N ?s /o _ S p GS / Z U~~ U ^ Pit Ground Stirfaoe elev.. R 1]pt,tt, en Grnil:v, ~.,. . HOf1ZOn in Dorrdnarrt H Redauc Desa~tion Texture - Structure - Cor~sistenoe - • eourdary Roots SoR GP Rate WfF - ansel t1u. SL Cant Color Gr. Sz Sh 'Ei~1 'Efll{2 gpirg # ^ n an Ground surface elev. ft. sfl Gnitir~ Fsufnr s. - --- Sod Rate Horizon Deptlt Darrt~rtt Redax Oesaiption- T Structure Come 8o1Ald~r Roots GPON'f in. MurtseN Qu. Sz. Corrt. Cobr Gr. Sz. Sh. 'Etf#1 'Eff#2 ' EdAuet4 #1 = BADa > 30 <_ 22A mgt and TSS >30 _< 150 mglt • Eft~rent ~ . gpp5 c 30 rrrgfL and TSS < 30 rrglL f ~/ The Department of Commerce is an equal opportunity service pt+avider and employer. If you need assistance to access services or aced rrrattriai in an alternate format, please c~rttact the departrnent at 608-266-31 S i or TT1' 608-264-8777. r ~ 1 ~ ~ ~ ~ ~ ~ ~~ ~.`~? ~ s ~. ~ ~ ~ o O ~ ~ o ~` ~ ~ ~ ~ -~ o o- - ,~, ~~~. ~~ ~ ((~~ ~~.. V \ E ~/ O ~ Q `2 ~ ;~~ a ~ ~., •• ,. ~ ~l 4 o~z ~ ~ ~- ~ ~ ~ -, ~ ~ _~, ~ ~ .~ ~a ~ = , r N ~ . fi ~~ °1 0~ a, .. 0 ° ~© ~, ~ ~~ ~~ ~ ~~ ~ 3 ~ ~~,~ ~ ~ ,~ .,~ ~ o ~- ~ M , M~ ~ M a ~ ~ f ~ F. -~ ~ ~ ~_ -~ o ~ `~ U ~ ~' ~ 'vl v .:. cis POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of ~ FILE INFORMATION Owner ~ GV, G ~ ~ ~~ Permit # ' DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units -~~A Estimated flow (average) ~ ~`~'_ al/da Design flow Ipeak), (Estimated x 1.5- Q ~ al/da Soil Application Rate - al/day/ft2 Standard Influent/Effluent Quality Monthly average" Fats, Oil & Grease (FOG) 530 mglL 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) 510° cfu/100m1 Maximum Effluent Particle Size Ys in dia. ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity a tQ ~ al ^ NA Septic Tank Manufacturer W ~ ~ ~s ^ NA Effluent Filter Manufacturer Z p~ ~ ^ NA Effluent Filter Model Q~ (U ~ ^ NA Pump Tank Capacity al ~9,NA Pump Tank Manufacturer {~ NA Pump Manufacturer Q NA Pump Model `l~lA Pretreatment Unit -B-NA ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Dispersal Cell(s) ^ NA ~ In-Ground (gravity) ^ In-Ground (pressurized) ^ At-Grade ^ Mound ^ Drip-Line ^ Other: Other: NA other: NA Other: NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once ever y' ^ month(s) (Maximum 3 ears) 8 earls) y ^ NA Pump out contents of tank(s) When combined sludge a nd scum equals one-third IY,1 of tank volume ^ NA Inspect dispersal cell(s) At least once eve ry' ~ ^monthls) (Maximum 3 ears) -year(s) y ^ NA Clean effluent filter 5~ eS At least once every: ~ monthls) ^ year(s) ^ NA Inspect pump, pump controls & alarm At least once every: ^monthls) ^ year(s- - NA Flush laterals and pressure test At least once every: ^ month(s) ^ year(s1 NA Other: At least once every: ^ month(s) ^ year(s) ^ NA Other: NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shalt 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 tanklsl 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 (Y31 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 shaft be provided to the local regulatory authority within 10 days of completion of any service event GMW (4/011 Page 7i of Z START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cellls-. If high concentrations are detected have the contents of the tankls) 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 cellls) 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 soli 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. O 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 ANDIOR 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 \ w. ~ u\,, ~ s ~ (t Phone ~ 1 J ' ~ - 4 () ~, >1 SEPTAGE SERVICING OPERATOR (PUMPER) Name ~ ~ S Phone ~ (p ~, POWTS MAINTAINER Na Phone LOCAL REGULATORY AUTHORITY Name ~~'. (,~(~ ZUy~ -~., Phone ~ ~ S ~ ' y This document was drafted in compliance with chapter Comm 83.221211b-111(d1&If1 and 83.64111, (21 & 131, Wisconsin Administrative Cods. ouurirtrt l F..rt f Xl.: 7168779820 Oarnthr/Buyu ll~ailiztg Address Ptnperty Address City/State ~c ?~ ~,~-g~r ~G~ OZo tc Y ><.oc~txo~V~ ~ , ~~ i, ,sec. T~?~N R~W, Tow,u of Subdivision ~ - - ~ - '~- '~ ~---' ceral~ed s~rr~- ~r~p # _ , voiUxx~~ sT. c~.o~x c~a>vt+rTx SEP'T`IC TANK I-'tATNTL~TANCE AGR.FEMENT AN.~ OWNERSHIP CERT.~FICATION' FOIt1bI Warrrnrtty iDeed # Spec house y~ owe. >~ c r~~~. ort x see a~qd >~nance of ~inbeau~uioe y°~' could x~.asuk fn its piemataxc thilure to °0'~ of pam~ityg out the a handle qr~~, ~ ~4oa of the aept~ic tse,k as a heatrne~gi ~~ c s sooner, ~nF, ~, a ~ pmt,. What apeciixed ,in . Se ~ the waetb y'e'a put ittto ~t-~'ar~. 93.5?.(1) and he t 12 - Se. (~+o~ disposal ' t~orTeer ~aintenauce t.vunty Sanitary Ordfranacc. T~ i'~oPeri9 awinor agrees to aub~ to Sk Croix County Pla at~iag & ,Z,o ' Dropsy ~ hY ° n~er plums' ' ~ ~t a cexAifcatioro foamy afgued by the ~.Ioutx~eytnan pluoc~•, resbnicted lylun:ber set a Ifect~aed pumper v ~ a'a~ dial ie is proper °p01'a0ng condltia~n aunt!/or (2'~ a Rey ~ ~ ~~mg~r~e~ efts 113 Full ofsl .) areptfc tunic is Uwe, the nndereigned have read the above re ~xiat+de set forth, hcct~, ~ set b the Dq-,art~onit of~te and alyee to a~imtaitt the pxlvate sewage motion stela that Y ant'- the De tin R-ith the ~B Depettaaeat wfthfn 30 day$ of the three Zo °$ Y~ syetelra hns~ °~do t date, be completes anclo ren~rnod ~R ~ c~~°°C~o~iocteC,,o~-~y ~~ dt Y,~fY~ t 6 statemeteta ass this form sure trot to the best c f my/owr Iop~o ~ Y vhrtue of a warranty decd recorded in Re~ia~ter of i)oeds 0~ , l/we mare the Qv~(a~ o£~e Nu~aaber a>f ~edxoo~nas ~,. s~ A - ~/ OF APPLtC.ANT(Sj ~ ~~l.Q~ ''"'*AuY inta~xlnetfon that DATE ~ ~~ ~3're~att in the sarujtarY i~em~it bed rova~ed ~, the Plac-niag dk 7.,ort,h~g ,~,~~, ttecludo with thfe applicatiiion a recorded ~ '~ ~ meads in the wartauretty ,did. ~anty'd~ t the Regis°er of Daeda OtSce and a copy of the cent ~,~, ~ ~. (>REV. Q8l0~ 09/14/05 07~@Fam P. 001 ~# I. ~. Page # Vohnme .~2~~Z,., Page # I:.ot lints fdentifiabl~ Bp `3 Z~87p ~~8 754939 KATHLEEN H. MALSN • REGISTER OF DEEDS ST. CRI]IX CO., t!I STATE BAR OF WISCONSIN FORM 2- 2000 RECEIVED FOR RECORD Document Number WARRANTY DEED 01/07/2004 12:35P![ THIS DEED, made between Steven L. Bakken and Caye L. Bakken, husband and wife, Grantor, and Kernon J. Bast, married, Grantee.. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: SEE ATTACHED EXHIBIT A MARRANi'Y DEED EXERT M it REG FEE: 13.00 TRANS FEE: COPY F:£E CC FEE: PAGES: 2 Recording Area Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. This deed is in fulfillment of land contract dated August 16, 2002, recorded August 20,2002 in book 1952, page 549, as document number 687523 Name and Return Address: Edina Realty Title, Inc. 400 5.2nd St, -Suite 11 S Hudson, WI 54016 412540 20-1027-4C-000 & 30-000 &20-00 Parcel Identifics6on Number (PIN; This is not homestead property. Dated this 6th day of January, 2004. B * Steven L. Bakken o ,~ B % ~" * Ca a L, B 1 cen AUTHENTICATION Signature(s) OW' authenticated this 6th da of Jams SIC y ~yota Y pvb - S~onsin * _ sta TITLE: MEMBER STATE 8AR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY _Edina Realty Title -Doug Berg 400 South Second Street #115, Hudson, WI 54016 (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 ACKNOWLEDGMENT STATE OF WISCONSIN ) ST. CRO[X COUNTY. ) ss. Personally came before me this January 6, 2004 the above named Steven L. Bakken and Caye L, Bakken, husband and wife to me known to be .the person(s) who executed the forego' nsttzunent andrac~kn~ow/le^dg-ed the same. 1 pig V '~ *Cherl Brown Notary Public, State of Wisconsin My commission is permanent. (If not, state expiration date: 3/11/2007 _ ) WARRANTY DEED STATE BAR OF WISCONSIN FORi'd 1Mo.Z-20pp ~ 2~i87P 1.18 EXHIBIT A The NE'/+ of the SE %+ and the NW'/, of the SE'/,, all in Section 15, Township 29 North, Range 13 West, St. Croix County, Wisconsin, EXCEPT a parcel described as: Beginning at the E'/, corner of said Section I5; thence South 00 degrees 47 minutes 33 seconds East, along the east line of the SE %, of said Section, 407.27 feet; thence South 89 degrees 08 minutes 15 seconds West 535.46 feet; thence South 14 degrees 10 minutes 34 seconds West 43.31 feet to a point on a 80.00 radius curve, concave southwesterly, whose central angle measures 25 degrees 34 minutes 33 seconds, whose chord bears North 54 degrees 32 minutes 33.5 seconds West and measures 35.41 feet; thence northwesterly along the arc of said curve, 35.7] feet; thence North 14 degrees 111 minutes 34 seconds East 76.12 feet; thence North 01 degrees 07 minutes 26 seconds West 400.07 feet to the monumented south line of Certified Survey Map recorded in Volume 1, page 217 at dte St. Croix County Register of Deeds Office; thence North 88 degrees `~ 1 minutes 13 seamds East, along said south line, 570.78 feet to the point of beginning. Wi~coris:~'r~partment of Commerce SOIL AND SITE EVALUATION Division o; Safety and Buildings Page ~ of bureau ot+integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than S 1/2 x 11 inches in size. Plan must County , include, but not limited to: vertical and horizontal reference point (BM), direction and S { . C d'G i f percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel 1. ,/ '.~- ~'' APPLICANT INFORMATION -Please pre itiali-information. Reviewe y ~ at~ Personal information you provide may be used for secon rx°~Vrposes (Pf~vacy4~v, s. 15. 04 (1) (m)). Property Owner _ . Property Location 1/4 S T C N R c E (°r)~ _ {e C:h4~"I Govt. Lot , /!( ~j~ 1/4~J ~ ( , , 1 j Properly Owner's Mailing Address j Lot #r Block# Subd. Name or CSM# t35 -~u ee ~~ ~~ ~ J ~ ~i.~J~~-~` L-~ras City State Zip Code phohe NutlZyt~~-?" [] City ^ Village [~ Town Nearest Road l~-, .~~.., i I t11 i ~'i~-1tv1„ I ~l'~ )~l~Q-Ln7~il ~' /--~r~of Svc I ~~arc/t r'~ `G ~i-e ® New Construction Use: Residential !Number of bedrooms 3-'~ Addition to existing building ^ Replacement ^ Public or commercial -Describe: Code derived daily flow ~ gpd Recommended design loading rate ~ 7 bed, gpd/ft2~trench, gpd/ft2 Absorption area required bed, ft2 7~ trench, ft2 Maximum design loading rate bed, gpd/flz trench, gpd/ft2 Recommended infiltration surtace elevation~~(s)/ /y~p-er ~~~13 • YU Gv~'~/- ~~• LAG ft (as referred to site plan benchmark) Additional designlsite considerations Jr~`G~ ! U ' yU Parent material (~ U -F~ L~ 4 S ~n Flood plain elevation, if applicable /f/ ~ 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 SAII r]FSCRIPTI~N REPORT Boring # .~ ~:~ Ground elev. 9,z~~lt. Depth to limiting fact r ~in. Boring # ~> . 2 Ground elev. ~1~2 ,ft. Deptfi to limiting f ctor ~:5~ ir, Horizon Depth Dominant Color Mottles Structure i B d Root GPD/fit in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Cons stence oun ary s Bed ,Trench o--13 10 r I Z s ~ I I'~n~r ~ v~ ~ `~ ~~ S 2 -3~1 !U ~ =113 m s « . ~ - 8 Remarks: d- Z I~ ~ ~~ •--- S ~~ I r~bk r•n~r ~ 5 v~ • Z ; • 3 2 fZ-~1~5 10 Si~ Zry,c,.bk ~~ CS - J,---,`Co Remarks: n'IGT~"U-~ S_~ (T /~~1~ S / n l~~ Z.°v~ Z SST Name (Please Print) Si nature Telephone No. G S~ ~~ ~ 7rS 'zy7-f/Oo8 4 dress Date CST Number 2~~ 3 ~~ ~ ~~ Sa ,~,.e~-~- ~ ~ .S- yo mss- ~-~' - ~- o o z~ 3 3 ~ ~t S~ V 7L SOIL DESCRIPTION REPORT PROPERTY OWNER PARCEL I.D.# Boring # Ground 9elev. ~~ 7Qft. Depth to limiting fa to n in. Boring # `-!- Ground elev. 9~ 9o n. Depth to limiting factor ~`~in. Boring # Ground elev. g5.cx~ft. Depth to limiting factor ~~ in. Boring # Ground elev. ft. Depth to limiting factor a - Page ~ 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 1 o-fo ICS r 3 i s; ~ t ~. ~ f V.~ ~ z~. 3 3 zz-~ l c~l~ ins 5 ~ ~~ .-~ Remarks: ~ ©-r rd r3lZ - - S~1 I ~ cS Ivy ~Z ; .3 Z /B- ~o r yl3 ~ s m t'r~t- c s -- -~'~ g 3 r r`+Ic~ ms mI ~s `- ~~ ~ ~B Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench a -lo I() r Z s~ I ~ mab~- r~r C l U~ . Z~. 3 3 zy - ~f ~ m 5 Os ~ C ~ `~ . ~ ; Remarks: 'n' Remarks: SBD-8330 (R.9/98) '~~ .'f PAGE~OF~ NAME ~'fcs c.r-j- LOT# ~ Co LEGAL DESCRIPTIONSw `/4uur'/4,S (y T~ q ,N,R 1 R E (orXw SCALE: 1"= (UU BM 1 ELEVATION ((,}C~ . d BM 1 DESCRIPTIONtoPoL' J'poc ~ Iwy~ti W/F(a~ BM 2 ELEVATION ~(~. 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