Loading...
HomeMy WebLinkAbout020-1447-08-000 Wisconsin Department of Commerce ~ PRIVATE SEWAGE SYSTEM Safety and B,pilding Div~ion INSPECTION REPORT GENERAL INFGrtMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: City Village X Township Bast, Kernon Hudson Townshi SST BM Elev: ~ Insp. BM Elev: / BM Descriptiony~ .~ TANK INFORMATION ELEVATION D TA TYPE MANUFACTURER CAPACITY Septic ~ 2.(0 Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. i Vent to Air Intake ROAD Septic ' ~ ~ / ~. Dosing Aeration Holding SOIL ABSO county: St. Croix Sanitary Permit No: 453465 0 State Plan ID No: Parcel Tax No: Section/Town/Range/Map No: 14.29.19. STATION BS HI FS ELEV. Benchmark ~O.S3 as3 ~ ~~•~ Alt. BM 3-Z I Z,y Bldg. Sewer SUHt Inlet ~ S • ~ ~ >,S• 33 StIHt Outlet S. 2 ~ 0 ,11 Dt Inlet Dt Bottom Header/Man. 1 o .2~ Dist. Pipe ~o r ~ ~ • ~ ~o 02.9 Bot. System O .S (o2•g3 o .9}r Final Grade .15 ~ O St Cover rd 'J O . 95,' y S E Width ~ Length ~ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIME NS ~ p ~ • ~ O ~9 , G r6ETBACK SYSTEM TO P/L B LDG WELL LAKE/STREAM LEACHING Manu c~urer:~~_/')!~ INFORMATION CHAMBER OR ~~ ~TT~i. Typ Of System: .. ~ t Z ~ / \ .~.~--- ) ~ UNIT r Model Number: O a V / DISTRIBUTION SYSTEM Header/Manifold ,~,.pD y Distribution Pip le Si x Hole cing Vent to Air Intake Length - \"~ Dia Length Dia cing SOIL COVER x Pressure Svstems Only xx Mound Or At-Grade Svstems Oniv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center Bed/Trench Edges Topsoil Yes ~ No Yes ' No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ /2~ ~ Inspection #2: r-t----tom Location: 682 Pine Ti 1 r~La~ son, 154016 (NW 1~ W 1/4 4 T2 N R~9W) C~dgLe ~ot 8 Parcel No: 14.29.19. 1.) Alt BM Description = a~" l Vl... ~.L1 2.) Bldg sewer length = 'p tf '7~J -amount of cover = ~ S qq P an`~vision Required? [j Yes ~No ~.y. ~~ I t ~ ~ u,~ I -t,~ Use other side for additional information. ~_.___ _ 1 ..~~ ___..} _ ___..._.____ _ __ _. __.-_J L_- -i SBD-6710 (R.3/97) Date Insepctors Signature Cert. No. PUMP/SIPHON INFORMATION Safety and Buildings Division County ~ s ~ ~ 201 W. Washington Ave., P.O. Box 7162 ,5~ ~(~Oi )` ~seons~n Madison, WI 53707 - 7162 Sanitar Permit Number (to be filled in by Co.) De artment of Commerce (608) 266-3151 ~S~ /~ Sanitary Perrn~ Appl~ation -- State Plan LD. umber In accord with Comm 83.21, „bode, pera° for ~~ may be used for seco pos Rrivacy OR Project Address (if different than mailing address) I. Application Information -Please Print All Information $~ y ~~,~ ~ uN~~ ~~at / /~f/ /I iV~~.(~,~ Property Owner's Na `me~ GRU\ OFF\ Parcel N Lot X Block X Location City, State Zip Code ~ Phone Number -L1LPdL 'ti..`71f~ ,Section ~ (circle ) T ~ N; R~E t II. Type of Building (check all that apply) ~1 or 2 Family Dwelling -Number of Bedrooms "~~ a' u` ^ Public/Commercial - Descr' the Use ^ State Owned -Describe Useo2 ~' ST. ~~/~~ (.(/ i[/ /~/ „~_ _ ems„ D~ _ i1 Subdivision Name CSM Number O ~t° i~~~ OCity_I. )Village ~QTownship of III. Type of Permit: (Check only one box on line A. Complete line B if appllcahle) A. New System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Malification 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 of POWTS S stem: (Check all that a 1) ~~J ~ ~~ Non -Pressurized in-Ground ^ Mound > 24 in. of suitable soil [.I Mound < 24 in. of suitable soil ~~ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Gr and ^ Holding Tank ^ Peat Filter (_~ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculatin Synthetlc Media Filter Leachin Chamber ^ Drip Line ^ Gravel-less Pi Other (explai V. Dlsner'a91/'1'r~afinent A rae i..t .......s:..... . ~ _ ,_ , ~ ~. Design Flow (gpd) ~v Design Soil A lication Rate(gpdsf) Dispersal Area Required (sf) Dis rea Proposed (sf) ~ System Elevation 8~7. 8 7p H lv3,© (.-io~,so VI. Tank Info Capacity in Total Number Matrofacturer G ll Prefab Site Steei Fiber Plastic a oro Gallons of Units Nww Ca..1..- Concrete Constructed Glass or nwatng c Treatmem VII. Responslbillty Statement- I, the undersigned, assume rtsportsibiBty for htstallatlon of the POWTS shown on the attached plant. Plumber's Na (Print) PI is nature MP/MPRS Number Business Phorrc Number s ~ 96~ 7is-.~8~ - ~0~0 Plumber's Addre ss (Street, City, State, Zip C e) /d 7D ~uJy 3~iy ~crdsv,~ ~~' ~ ~l'!~ VIII, oust /De a_r~! _ ens ! t~ Onl~ Approved ^ Disapproved Sattitary Permit Fee (includes Groundwater Dat Issued .suing Ag t Signatu o Stumps) Surcharge Fee) S v J ~ `~/ ! ^ Owner Given Reason for Denial IJC. Condltlons o /Reasons for Disapproval ~'~~ /~~,/~~"" ~'~C%~ wtueh complete p1aM (to the County only) for the system on paper rtot less than 81/2 x I1 inches fn size SBD-6398 (R. 01103) ..P B ~. ~~ l~ .~ : _.., 1.. lU t" ~ ~ ~ «ikl S ~~ cl ~. uJ~ nc% r s. lL~ - .. ---- - y ..:...___~.~:d ~;, ,. ~, l ~ ... `~ .. 7 Iv say . ~r ~ i ~P`i Ne ~-~ I~ R ~~ ~ . .~.L..~ . _._ / '7 S `~ - ---....__..._..__ .... _ .-.,_.~ ~ I~ say . _____ .._ ._ ~ ~ ~r ~ t .. .. ae N~~ >~~x Tip ~ ~ 3~y"Pvt, P",~r, ~ ~~ y ., I t~tr. Q ~~ .. I~ 8~~~ KK Npl jN ~" ScoT~~ ~l~ . ~3 ~Isv- 113.UV. ~ 19 ~S ~ ,o e a-T~oN~~ f C3~ 3 x 8? 5U I--30 - dS' ~ ~ ~'~"` ~.P R f ~' ` 1~-~ w c~.. ~~ DP~k ~a' w/A 1<w 2P~, ~ ~or~ F~ l~~rz W~// ., j ~ f . ~ - Wisconsin Department ofQbmmerce SOIL EVALUATION REPORT Division of Safely and Buil~ings in accofdance with Comm 85. Wis. Adm. Code 1841 Page 1 of s A.C.E. Soil & Site Evaluations Attach complete sit~'plan on paper, rfot,l~ss than 8%z x 11 inches in size. Plan must County CfOb( St d fi c ~ . include, but not limite 3"verti tido2optel reference point (BM), direction and al ~d percent slope, scale or dimemsions, noifli arrow, and.location and distance to nearest road. Parcel LD. Pending ~,, Please print all information. ~ ~~~ , Ravi B Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). , ~ ~ (f(ij Property Owner Property Location Kernon Bast Govt. Lot NW 114 SW 1/4 S 14 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 948 LaBarge Road 8 Coyote Ridge City State Zip Code Phone Number City J Village ~ Town Nearest Road Hudson ~ WI 54016 715-386-7775 Hudson 682 Pine Timber Lane New Construction Use: ~ Residential ! Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement ~ Public or commercial -Describe: Parent material Glacial outWash Flood plain elevation, if applicable na General comments and recommendations: Install two trenches, upper trench at 103.00', lower trench at 101.50' using 28 leaching chambers. Boring # ~ Boring Pit Ground Surtace elev. 106.07 ft. Depth to limiting factor >119~~ in• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-5 10yr3/3 none sl 2fsbk ds as 2f,1mc 0.6 1.0 2 5-12 10yr4/4 none sil 2isbk dsh aw 2f,1m 0.6 0.8 3 12-21 7.5yr4/6 none Is Osg dl cs 1f 0.7 1.6 4 21-66 10yr5/4 none s & gr Osg dl gs 1f 0.7 1.6 5 66-115 10 y r6/4 none s Osg dl - - 0.7 1.6 / l / K 70 _ ~ ~ ~ ~~%trll w ~ -~ Horizon #4 co tains approx. 25% gravel & cobbles. Boring # ~ Boring // Pit Ground Surtace elev. 107.52 ft. Depth to limiting factor >135" in. `Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots - GP D/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-5 10yr313 none sl 2isbk ds as 2f,1mc 0.6 1.0 2 5-16 10yr514 none sil 2fsbk dsh aw 2f,1m 0.6 0.8 3 16-30 7.5yr4/6 none gr Is Osg dl cs 1f 0.7 1.6 4 30-65 10yr5/4 none cos & gr Osg dl gs 1f 0.7 1.6 5 65-135 10yr6/4 none s Osg dl - - 0.7 1.6 Horizon #3 contains approx. grave bbles. Horizon #4 contains stratified s, cos, & approx. 25% gravel & cobbles. * Effluent #1 = BOD ~ 30 < 220 mg/L an TSS >30 < 150 L uent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number James K. Thompson _ s 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane. Osceola. WI 54020 9232004 715-248-7767 Property Owner Keeton Bast Parcel ID # Pending Page 2 of 3 Boring # J Boring II Pit Ground Surtace elev. 103.70 ft. Depth to limiting factor > 109" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-5 10yr3/3 none sl 2fsbk ds as 2f,1 me 0.6 1.0 2 5-15 10yr4/4 none gr sl 2fsbk dsh aw 2f,1 m 0.6 1.0 3 15-19 7.5yr4/6 none gr Is Osg dl cs 1f 0.7 1.6 4 19-62 10yr5/4 none s Osg dl gs 1f 0.7 1.6 5 62-109 10yr6/4 none s Osg dl - - 0.7 1.6 Horizon #4 contains approx. 10% gravel & cobbles. ^ Boring # J Boring _f Pit Ground Surtace elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ^ Boring # ~ Boring J Pit Ground Surtace elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mglL 'Effluent #2 = BODS<30 mg/L and TSS <30 mgJL 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. • ~ ~ ~ S o i'/ Q ~a lua u'o n pr"E • • Eley4~;o~ • ~o~opcr~y st~~E-~ A ' Ica /e: / - alp , (~ ~P~~ '~ iByr ~Ma®,~! : ~,o of j/S~ ~~ d C. /~ n e. Ele v- = //3. ~' i ~ ~y~' - ~ -,.3 ^ . fi ~ _ -- 3 . 51 ~. ~f~,~ ~i - i~ ~ ~ ~ ~ ~ IO~Ai U ~~ ~ i ~p~•~,C3~~ ~. ~~,o,'o~p~. ,~ d~~ Approx. Lv ca-fi o,-, o f p~o,oostd 3 be. ~lside„ce P,i~eTm6~~ne Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT in accordance with Comm 85, Wis. Adm. Code 1841 Page _ 1 of 3 A.C.E. Soil & Site Evaluations Attach com late site Ian on p p paper not less than 8'/: x 11 inches in size. Plan must County Croix St mclude, but not limited to: vertical and horizontal reference point (BM), direction and ----------- --- ---- . -- ------------------..-- . percent slope, scale or dimemsions, north arrow, and location and distance to nearest road Parcel I.D. Please rint all inf ti . ------- --- Pending - - p orma on. Personal inlarmetan you provide may be used for secondary purposes (Privacy Law, s 15.04 (t) (m)) Reviewed By - -- -------- -- Date Property Owner Property Location Kernon Bast Govt. Lot NW 1/4 SW 1b S 14 T 29 N R 19 W roperty Owner's Mailing Address Lot # --- Block # --------------- - Subd. Name or CSM# 948 LaBarge Road ----- ---------- ---- _------------------ 8 Coyote Ridge City State Zi Code Phone Number P _ ------ -)City ___ ----- _ J Village /J Town Nearest Road Hudson ~ WI 54016 715-386-7775 Hudson i 682 Pine Timber Lane /_ ;New Construction use: yJ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD _ _! Replacement __J Pu blic or commercial -Describe: __ - _ _ Parent material - Glacial outwash -- --------- -- -- - --- - - --- - - __ _--_ _- Flood lain el.,vation, if a livable P ' ~ PP ---- rla General comments and recommendations: Install two trenches, upper trench at 103 On' to wer trench at 101.50' using 28 leaching chambers. __._---- Boring # _~ Boring Pit Groun d Surface elev. __ 106.07 __- ft. Depth to limiting factor _ ~ 1 19~~ _-_ in. Soil A pplication Rale Horizon ~ Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft' in. Munsell Qu. Sz. Cool. Color Gr. Sz. Sh. •Eff#1 _ •Eff#2 1 j 0-5 10yr3/3 none sl 2fsbk ds as 2f 1mc 0 6 0 1 ---- -t--- -- , . . 2 ~ 5-12 10yr4/4 none sit 2fsbk dsh aw 2f,1m 0.6 0.8 3 i 12-21 7.5yr4/6 none Is Osg dl cs 1f 0.7 ~ 16 4 ~ 1-66 - --- _ r 10yr5/4 ----- none ------- --- --- s & gr - - Osg dl gs 1f 0.7 I 1.6 5 j 66-115 10yr6/4 none - _ s _ -- 9 - Os --- ---- -- dl - - - 0.7 - -- ~ --- - __ . 1 6 --~- - --- I . -- - -__- ~-------- l 3.6 o L 3~ `~ - 1 H rzon #4 contains approx. 25% gravel & cobbles. ~---- ^ Boring # J Boring /J Pit Groun d Surface elev. ' 107.52_ ft. Depth to l imiting factor ? ~ 35"- _.-_ in. 'Soil Ap plication Rate Horizon i Depth i Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP_ tfl' D n. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 _ 'Eff#2 1 I 2 ~ 0-5 5 10yr3l3 none sl 2fsbk ds as 2f,1 me 0.6 1.0 _ -16 10yr5/4 none sit 2fsbk dsh aw 2f,1m 0.6 0.8 3 j 16-30 7.5yr4/6 none gr Is Osg dl cs 1f 0.7 1.6 4 130-65 10yr5/4 none cos & gr Osg dl gs 1f 0.7 i 1.6 5 65-135 10yr6/4 none s Osg dl - - 0.7 6 1 s~' v ~~ i / - I . - Horizon #3 contains appro . grave bbles. Horizon #4 contains stratified s, cos, & ap prox. 25% g ravel & cobbles. J. ~ _ Effluent #1 = BOD 5> 30 < 220 mg/L an TSS >30 < 150 L uent #2 = BOD < 30 mg/L and TSS <30 mglL CST Name (Please Print) Signature: CST Number James K. Thompson _ o :_- 3602 Address A.C.E. Soil 8 Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 9232004 715-248-7767 !roperty owner Kemon Bast Parcel ID iF Pending __ ___ _ Page ._ ~2 _of __ 3__ - Boring # J Boring ~/ Pit Ground Surface elev. _. 103.70 ft. Depth to limiting factor > 109" in. Soil Application Rate Horizon De th Dominant Color Redox Description Texture Structure Consistence Boundary Roots _ p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff/it 'Eff#2 1 0-5 10yr3/3 none sl 2fsbk ---- ds - as --- 2f,1 me 0.6 1.0 ---- - - --- ---- 2 i- 5-15 10yr4/4 none -- grsl 2fsbk_ dsh aw 2f,1m 0.6 1.0_ 3 ' 15-19 7.5 r4/6 Y none r Is 9 Os 9 dl cs 1f 0.7 1.6 4 19-62 10yr5/4 none s Osg dl gs 1f 0.7 1.6 5 62-109 10yr6/4 none s Osg dl - - 0.7 1.6 Horizon #4 contains approx. 1096 gravel 8 cobbles. a Boring # J Boring J Pit Ground Surface elev. _ ft. Depth to limiting factor in. Soil Application Rate Horizon Deplh Dominant Color Redox Description Texture Structure Consistence Boundary Roots ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 j ^ Boring ~ J Boring J Pit Ground Surface elev. ft. Depth to limting factor in. Soil Application Rale Horizon j epth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 • ,o~oP,u~y s~~ AA II 5ca ~~: / . s/o' I ~1 ~Q,r ;~ !o'~ scotcl, ~~ ~ r / ~ i ~ /~ -~ ;63' ^ ~ ~- - ~ ~ ' ~ S _ - -B.Z. w~ ~a- .~o .- ,- , ,o-,•-,ei~, ~, D,' ~ dlc~ A,oprax. Lv ca-~E: or, o f' flrepostd ~ 6~, ,~,`~tSidenCe Safety and Buildings Division County ~ ~ ~• ~ 201 W. Washington Ave., P.O. Box 7162 o iseons~n Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) De artment of Commerce (608) 266-3151 L~ls-3 ~~~ Sanitary Permit Application s to Plan I.D. Nu bar In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Addre (tf different than mailing address) I. Application Information -Please Print All Information ~. y, . f ~ 8~ ~~~ lo,w6er ~e Property Owner'MMsIlN__a me Q Parcel /! ~ Block X Property Owner's M a~i{ling Address I ~~ t ~ ~ Property Location ~ ~ C 1...~ AYI 1 s , z ~< lJ .1 ~~ ~ W , S ~ ~ City State Zi C d Ph N b y , 54 ,Section _ ~ p o e ) i ~ um one er lA pS tl ii ~ 1 ~ () f ~ ~ ' : ~j~ ~ ~ ~ (circle one) ~ ~ II. T of Buildin Ype g (c eck all that apply) ~ - ~._. T . N; R E or W ~ 1 or 2 Famil Dwelli N b f B d / ~ ~S ~ Subdivision Name CSM umber y ng - um er o e rooms p1 ... C~c~' vN /l ,~ „_ ^ Public/Commercial -Describe Use ~ ~~_ ~ ~-~~'~~"'~~ C O v ~~ ~`/~ ^ State Owned -Describe Use ~ C ~.S vU~ ~!~ ~j~li/+~/ ~Q(~ 1 _ ^City_( Village owns ip of spy III. Type of Permit: (Check only one box on line A. Complete li B ' applicable) '~' '~ New System ^ Replacement System ^ Treatment/lioldin ank Replacement Only ^ Oth odiCication to Ex' g y m B. ^ Permit Renewal ^ Permit Revision ^ Change of _ ermit Transfer to New List P vi s m u Date Issued Before Expiration Plumber Ow r N. T of POWTS S stem: (Check all that a 1 ) I~Non -Pressurized In-Ground ^ Mound > 24 in, of suitable soil Mound < 4 in. of suitable soil At-Grade ^ Single Pass Sand Filter ^ Coacttvcted Wetland ^ Pressurized in-Ground ^ Holding Tank ^ Peat Filt ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter aching Chamber ^ D p Line ^ Gr el-less Pipe Other expla') V. Dis rsal/Treatment Area Inform tion: ) O i~ I 1 ~ = S ~ i<_ Design Flow (gpd) ~~~ Design Soil A plication Rate(gpdsF) Dispers Area Required (sf) ispersal Area Proposed (st) System Elevation ~ S 87b ~~~~o ~ ~g.~ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank alp ~ I ~ Aerobic Treatmem Unit ~ ~d Dosing Chamber VII. Responsibility Statement- I, the undersigAed, assume ponsibility for installation of the POWT'5 own on the attached plans. Plumber' Na me Print) P is azure MP/MPRS Number Business Phone Number r /~~` rlrn i101~ri,,~ ~ ~~~~V ?'J ~~~ -9V~~ Plumber's Addre ss (Street, City, State, Zip C e) ~~ U ~~: ~~ ~ f~)y~ pJ-~ N l~')J~~ VIII. nt /De artment Us nl Approved ^ Disapproved Satti Permit Fee (includes Grourt~water Dat issu Issuin A t Si to Stamps) ^ Owner Given Reason for Denial Sure rge Fee) ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~~~ ~ l ~~!/(~ ' °~ IX. Cpn ions of Approv /Reasp for isap royal ~ ~ ._~ ~~~ ~~(/ y~•OZ~G1 ~~`,(~/ yZQ~ ~{.~~~(/~,~ 1 ~ ~ ~I ~ ~1 /.Gt~i-r ~YI Amt ~ -U~ ~ ~ ~.Oirl ~ ; ~' -~YSIE11tLOWNER' - ~," ~J /~>o /J~it~~ f~~-~ Septic tank, effluent filter~n'ti -~' ~3 . S2 ~ s~S ~ i~'i~/,Q,~ ~2 ~~~az~-e-~ CX~ ~ / dispersal cell must all be serviced /maintained (~~~.-.~b f ..P~~~~~~ t~'~~3'~- ~ ~~ !~ ~~' `~ ~'~ L er mana ement plan provided by plumber. ~~~~ ~~~ ~, `, ~~f ~~ ~,c~., 2 ~~~~~~ 2. All setback requirements m t us a mam aln ~ ~~ ~ C''' . _ " ~~C~Fs. O,~Cf ,,r~~ as per applicable code/ordinances. ~ ~!n ~ ~Z- A1.--L ____ _ _ _ _ __ _ _ _ _ _ / SBD-6398 (R. 01/03) .~•...., con,p.ece puns tw me eounq omy) for me system on paper not less than al/l x 11 Inches ha'aht! ~"'~ " " `71/ ~~` ~e K No rv ~ VSQS" ~yofi.~ ~,d~e L~ 8 ~M~a ~~ ~~ ~~~ s~~{ ~ ~~~ ~ ~~e`' ; ~ ,~3 O i~t,u y 13~e~,c,oh, T~~ o~ ~I a vn~v~~ s~ ~„ Sfie,l ~' yam, ~ ~ i ~ }ev-- ) 0 O~U 1 ~ S R ~ a 4 ~ - ~~ ~ +- ~U , / ~ 'T hew ~ ~~ jr~ ~kU~~ s a3 ~ ~ ~~ l p,- f i Nt -- -- r i ,~. ~ ~ ~_- J i M 16 ou ~e~.s~e.~c aaa9 ~Y ,L~ ~; ~- ~uv.p ~ 49.5 ~ }J ~ ~. ~Q R N01U ~ ~S L~ S QM~1 ,, T~~ ~~'Ia Llw= ~oo~U ~~~ a Y ~! lat~v.~~';~ ` S~s~ -~ , i~~ ~ ) ~ , ~ d,; '~4 • Q3 ~ .J ~ M !6 ou rwe.~.s~e.~c a~aa9 ~y ,~~ ~ - ~uv. ~ ~ 49.5 ~~ ~ ~ ~ti ,,.~;F. ~M~a -~~ ~~ ,1a s~P{J ~~~ p, ,- { iwc 1~, ~~ ~~}~.~ Ke ~ ~vo rv ~yofi-~ L~~ ~ T~~ ~ ' a ~. ~, Step; ~"~~ ~l~v= -uo~U a 4 ~! ~~ '+D~S ~,a~ ~M~a } a, ~~~ ~~ ~~a s~P,t ~ 4~, ~ ~~~ ; ~S ~ ",\ o ~_. y ~~G~^~ lal~u ,~~' ~ lJu~,~ 1 _,,,. ~~ ~ a~ * o a, _ ~-, r,~~ c ,~ ~ k ~ ~~ S. '~ U ~ rL, d ~~ 0 ~~; ~J~~~ ~~u i3 a ~ih~e ~~r~~ - J 1 nn ~ au YM,Q{~,S~Q,(~ a~aa~ ~Y ,~! ~~ d r, ~f1P !~ C. f^e 1 - (uo. p L X9.5 ~ ~ h,' ~.~~ . • ,. ~ ~RECEIVED ,~, ~~ DEG ~ 2 ~~y UATtON REPORT Otvislon of shy and 8v~gs Sr_co~, _fl ~ / ~ 3 ZONING ~ caxy 5 T' cR v/ JL ~aaa~, oomptece see plan on Asper na less ~ in st . Plat muse ~,de, but not Ilnated to: and tiocizor~fat ne(erenoe point ~ ction and Pence slope, sc~e or ~. norm Boa , and loc~o~- a~dnos to n road. Paroel I.D. ~~-. ~ `~ ~ Please print all Inforrnafion. Itertewed by Dana Perao~aM tntoma~ion f~ P~Mde ~ es urea torsscagerr vuryoces (R(~r taw. c. 75.ot (1) (x~} N W S£ SEGT• ~P~Y~ /~C~/P/VG.V ~~$ ~ Pn~pertyLocaUort Gat Lot /VW 1M~~ 114 S ~7 T ''~ / N R ~~ 4{ar} w ProI~Y O~er's Aaddress lY LA • ~tl'le G"~ ~D ' tat # $ Biodc # Subd. IVane a CSMA' EN N a co yo TE" ~ fD6rE' .. State Code Ptwne Ntxnber hFUOSo~ 4>/• Sya~ ~?IS} 38tn•~7,5 ^ cry ^ ®T~ Ne~si Road I'fvOso.J t3ltxi~'E~ ~~ - ~ t~1gl ResldenEist r rxsnaer of bednoo~te 3 ' Cow der~,ed dest~ Claw rase . ~1..~0 - ~ o-a BPD Q ~ ^ Public a ooRr - Oesatbe: Parorrt metu~t ~~f iV ~ o V rGt~ /4- ~i Flovd Pfein ete~ion d ate I~/ tE. and ' ~~'~-i}- T~Sr~ iS SvrTfJ-,G/~" ~D/~' ~i~v /.v~.Pvvvf~ Pn Gtotnd strtaos ele,-. ~ ft. oepd, a factor In. ~,. f ~1 ~~ ^ ~ py 7 f .~ > ya L ~ 1 ~ fit ground autt~oe a{~r. ~, flep~ b rangy ~r in. - ~,, ~ - ~,,,, csr t2t3E RT-- ~ t b ~~ GG ~ '" 2 ~. ~ 3 z s No~• /~~ ci'~d03 7ts•?~a•3~r~2.. t'nvate Sewage Consultants 2812 10th Ave. ~i~tJ 'S /~,2 Td~-,~,G of gD ~¢~ Spring Valley, WI 54767 ZO . l017. Zo • 07T"n 2.c7 • l0~.'7 • 30 • o'rra z.o • /017. yD ~ aa-~ . ,,, . u ,~ ~yo TE ~~~~ ,C ER~vo,v T3~-s r' Paroel ~ # ~, z-~ 3 ~;„~~ ^ ,~ Pit Gro~u~d sutiaCee~v. lol ~ ~~. ~ti, ~ tamer' 9® ~. Sod Rate Fioriaort ~ Dominant Redooc Description Textue Structure Cora-ce Bota~dary Roots l3P WIP in. Munsep Qu. Sz Cont. Odor tar. Sz Sh. 'Eft#1 'Ef[#2 / a • ~ p y 3/ ~---- L - / f S/i~ s S c f ~3 . Y O ! ~~~_ / 'ice ~~ ~ //~' yr ! 1 I ~ • ~ • /Je /\1 S a to s ~ , ~ n2w., Horiaon Dept - ... Dominant - - - - _-,.... _ ._.__„ .,..,.,,. ~. Redox Descxiption Texture Structure Consist~ce Botmdary Roots soI Rate GPDVFf in. Murts~ Qu. Sz CoM. Color Cyr. Sz. Sh. 'f~1 'E1f~2 ^ Pit Ground surface elev. Depth tD l'a~ng factor in. ^# ° Soil Rate I'lorinon Depth Dorrrnara Redox Dasaiption. Texture Stntctrae Cor~stenoe Bourtd~y Roots GP WIF in. Mtrtsef Qu. Sz Copt tar. Sz Sh. 'Efl#1 'Etf#2 ' F_tMrerN t~1 = 60Ds > < 220 n'g~. and.. TSS >~ S 150 mglL ' C-~ent tl2 = BODE < 30 rngll, and TSS ~ 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or rood material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. tagaas~ope.6~oo~ -• For issuance of permits antl designing Contact: Ulbrichfi & Associates Registered private wastewater consultant and plumbers 28i 2 10th Ave. Spring Valley, WI 54767 715-772-3442 ~a ~ S SCA1-~ : / " ~ D ~Lo~ 9 Sa ' SST ~~ 5~,~ ~~~9~,0% P, "~ .___ z~ -... o ~~ a loyp ~~~ -~ 5~ To ~, °~ -_ ~~ Yy P; ~"~ ., ,--- ~v ,moo 03f 13/2001 16; 21 71`53968473 _.... COPY CAT PAGE Ol ~QxA' ~l .~ (valiileNooa abgatced f~otil Fieluafgd etUliglAbi tv1 ae~ u~11e1[uvtt `~ 'Wi'n ~ ~ Fame1 )c)a+at~l"iofttinit Aioim ~f'qp~/ At1~~ :Jd..~ ~~- ~~Ld~C pl~a~ -~'CiC. ~~ 'I°j~T'~;`1V~ ~"~DWi1 Q~ Lvt # .,,,,~,_. ~, caf~l~tMd ivy ~~P +~ iroRufrfe . ~ , Fags R ~- _.....,.~.,.,,,, vvlfff~fo ..G~y , p ~ _.,C~,.,,,,, ~~~ Loi Iiciae ideziififiable~yca ®IiO hngpeeper epee eon et' ya~ar -.ysroln cmfa t in t1. ~nv« f~ture:o >~~ ~reetoe. i'IVpar ~ '~w- e~Lct'11ia Illaol~a~a of ~ ~~- ~4'eo yaw~e ar . g' by # 1ioe~~t wr. WLat you pat ~iib ~ ty~1~ talc ~ a f~ ef~ede is th4 araeta etie~+fa1 Tom' plvpe3ty awwler a~ ~ aaberw~ b 8t. a c~tiCioatioa lb~y trod lyr ~ t~!0 ~ ~ ft ~l~pfi~aau~ IaaaidbeA or a ilaeasedpernpK veclfj-iaR-flat (l) the as-elan rvpi4+vaterAl~ed s~gMt~a~i M ~ '+~ ~ aeWlot (~j , lq+aa aad (if nocufwaly~ tba fuaptk auek is isea tiiwU3,y~rt! ptahe~ yeAt~ ~ ~ have wed ~ + • • ~ apgq tO aaal~ifq fht pNYafe MOIY • . sY;P~,~ ~~_, ~ ~ ~ ~ Ilrtd tbs 1a4p1M~111RQR a~f Nr1ua1 ~,'1~at~R at' ~~~ ~~ 7~ ~6~p-1r~ 6~e0fi , ,p~N (~u ~ armed 1k0 tlso ~, f,;lr~ri[ CAam~ Z i 1rtWR 30 °~ 4Pi~tattpR flats. ,~ s. ~.,," ; i' _ :, to , '"""_ "''r~"':: • ~ ~`., ~~r~f` ~.. DA's '; ~ uti;. r .~, ~ aa~g: ant rwe~ fa flwe rant of my {uw) ~+• 1 {rrej aaa (eatM) t11e oiaa~r~ of vltiao atF s T~ load receded in Ra~htar of Deeds O~icc. ~ ~- ~ 1r aa~. aaai~t is the ~q1y Pmt ~iqg ea+ra~ut by the Zvfiipg ~, . ?,` zw' +~.` ~~111M~e fNe atprlies: • "~''`•;i ~:x. '~"''"'t""'~=!~M9tD- deed tka+n~ the- &e~Miar >wt' Deeds otifloa • aq'-Y as' MMIi e~ltlt~d aarwr t~ #~' Ief~iee b made h1 tke wamiMy ~) 8~'T +P~lUiX ~UtVT'~P ~~3FT~C '1C'AN~ 1MA.)iV'x'~W~tG~ AQ1t~B~M~iVT A,ND C'lWI,IRi1Ri-IIA 6"12~'1'Ii~FIf''A'l"if"1lV P./'1RM 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 within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: System Design Specifications Sanitary Permit Number 3 Number of Bedrooms Design Flow -Peak (gpd) 4 0 U Estimated Flow -Average (gpd) Septic Tank Capacity (gal) ~ ~, l1 p Soil Absorption Component Size (ftZ) $ S 1 Type of Wastewater Domestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow -Peak (gpd) 4 0 ~ '] o Maximum Influent Particle Size (in) ' ~ 1 /8 Maximum BODS (mg/L) ~~ O 220 Maximum TSS (mg/L} j SU 150 Tab le 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Outlet Fi{ter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management 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 tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from fhe interior of the tank maybe difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 ' -" Management Plan fora Septic Tank and Soil Absorption Component Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component shou{d be avoided since root intrusion into the component may obstruct wastewater flow. When system fails, we will replace with another system at owner's expense. Alternate area must be left undisturbed. St Croix County Zoning Office 386-4680 Boumeester & Sons Excavating 386-9020 3 t. U 2`l87P STATE BAR OF WISCONSIN FORM 2- 2000 WARRANTY DEED 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 ATTACHEll EXHIBIT A 1.1 g -~sra9~~ KATHLEEN H. WALSH REGISTER OF DEEDS 5T. CROIX CO. , WI RECEIVED FOR RECORD 0 L /07 / 2fd04 12 : 3SPI! WARRANTY DEED EXERT II 17 REC FEE : 13. @fd TIIAHS FEE: COPY FEE: CC FEE: PAGES: 2 Recording Area E~cceptions 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 dacurnent number 687523 Dated this 6th day of January, 2004. B * Steven L. Bakken AUTHENTICATION Signature(s) OW" authenticated this 6th day of Janua 04 ~7 U1ptiC Na ary . S~onsin * ~ta~-e~+---- TITLE: MEM$ER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED EiY Edina Realty Title -Doug Berg 400 South Second Street # 115, Hudson, W 154016 (signatures may be authenticated or ackrawledged. Both are not necessary.} •Names of persons signing in any capacity must be typed or printed below their signature Name and Return Address: Edina Realty Title, Inc. 400 S. 2'd St. -Suite 115 Hudson, WI 54016 4[2540 20-1027-40-000 & 30-000 &20-00 Parcel Identification Number (PIN) This is not homestead property, B ! ~ * Ca a L. B en ACKNOWLEDGMENT STATE OF WISCONSIN ~ ) ST. CROCX 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' nstrtunent and ackn~~ d the same. ~.1 *Chert Brown Notary Public, State of Wisconsin My commission is permanent. (If not, state expiration date: 3/11/2007 ) ~ i~3 ~yAp~ANry'y DEED STATE QAR OF W ISCONSIN RORM No.2-2000 __ ,. , ., 2~87P 119 E7~HTBIT A The NE'/. of the SE'/. and the NW %. of the SE'/., aII 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 15; 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 93.31 feet to a point on a 80.00 radius curve, concave southwesterly, whose central angle measures ZS 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, 35.71 feet; thence North l4 degrees 10 minutes 34 seconds East 76.12 feet; thence North O 1 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 the St.-Croix County Register of Deeds Office; thence North 88 degrees 5 i minutes I3 seconds East, along said south line, 570.78 feet to the point of beginning. ~~ V ~i 0 l 'd ~9S1 'ON NOSQ(iN ~ilb'3~ NNId3 Wd00;ti ti00i 'l 'lllr~ ,any? L M Q __ ~.i~~ j ~ ~j ~ cv ~ u CV's :.J ~ Ed.t ~ ~ , U L.tJ N z tl~ ~~ o = ~ ------------. LL M~ O W x O O a~ ~~~ ~~w W ~Z3N W Woo ~~ j~ 0~~~ ~~ZLL Zoo W°~~ H~~~ ~a O W~°z rAap; O ~ ~ _ W ~LLWZ ~ o J 3 ~~~ a~z ~ ~~ w0'~ ~ Z N J N Za ' JO W~~ °r' ~ 53 iLL U o ~~N ~ z O N ~ ~ ~ a ~ ~ ~~~so a ~~~~~~w a~o Wg¢~"8< O Z U ~~c~ ~ o~~Q~ rwrr~m ~ O¢OOWfLLr~ W a O raJ~LLFOOj EQ.Z~ ~Q~°no~~i~~° V ~Q ~ ~f~N a1 O W JQN ® '` '' I o~~~ -' ~ ~ F~w~ I O ~ ~ m t N ~ •~ `, ® ~ ~ •, r ~ O 4 F < w "l .~' O o ~ \ J M tp~ a N~~ O~~ ~ g {' ~~ ~,~ I W u~ ~' ~ 6 O f'6 ~ O m J ~ ~Q~~~ ~~~~~ ~ O ~~m~m a ° Z N ll'A9L ~ Oa 3 EE -~1_ ~ ~ ~ i ~ ~ ~ Mz~~SC.SON '~`~ ~ £ ~ ~ ~ W NN qq55 QQ oOa B ~' ~y8 1 ~ ~ ~ ~O~ eQ KJ .r ~ ~~~~8 ~8~ O ~., 4 '~ Sp0`28'28'E. ~. ~ s~~~ J~°-o '~ N I ~1 .l1'~ '~%l.{I ~iy. '( ~Y ~1 ~I mho o ~ i °~ a~' ~ .~,~~..~ - I ~ ~ a~ ~~ oh ® ~~ ~, o J m ~eo~ °~ I F .~ :::~. Y~ ~y ti s W N @ ~ g Z G .... Q ~ ~ O +. .~ J .V. 'X'1'~ SL NOIL'H6 ~7 3Nf1 HL Nlf%