Loading...
HomeMy WebLinkAbout020-1447-10-000 Wisconsin D County. epartment of Commerce PRIVATE SEWAGE SYSTEM St. Croix SatEfy and Building Division INSPECTION REPORT Sanitary Permit No I 506139 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Bast, Kernon I Hudson, Town of 020 - 1447 -10 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Ma N om ` � 29.19.2841 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER H CAPACITY STATION BS HI FS ELEV. Septic , Z `N Benchmark f,J ys Z•`� `+S •1 Z• Alt. BM Aeration Bldg. Sewer �r Holding St/Ht Inlet 4 M l�S 3. TANK SETBACK INFORMATION St/Ht outlet 3 • `l$ . (oS TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic y � VZ ,, l � _ 7 3 , 7 Dt Bottom Dosing o Header /Man, 6 • � R S • Aeration Dist. Pipe gyp• �O 9 s • s Holding Bot. System '7 • �O 94' • 85 . z 9A/• Z5 Final G ,d� �� �J PUMP /SIPHON INFORMATION M� 'T /3 W • a .7 :• Manufacturer Demand St C 14., -7.0� J �$ • 7 a � �� , (� GPM � O Model Number TDH L' Friction Loss System Head TDH t Forcemain Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width / Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 fag Z SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of System: / CHAMBER OR �•••�• ��'1 (\ ' _` �� ` /� a ) ModelNumber/� G 0 wt1 Q, � pv�X (� � V (� ��' DISTRIBUTION SYSTEM tJe,fh- Z'7 + - 7-7 = Header /Manifold 11 Distribution x Hole Size x Hole Spacing Ve4teAi IntakrN T L' Pipe(s) \ \ ` Length C Dia �f Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /So ded xx Mulch d Bed/Trench Center �• Bed /Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: Location: 676 Pine Timb L ne Hudson, WI 54016 (NW 114 SW 1/4 14 T29N R1 9W) Coyote Ridge Lot 10 Parcel No: 14.29.19.2841 • 7 1.) Alt BM Description 2.) Bldg sewer length = z • 5 I�� - � , �� - amount of cover = Z / �`TD►'�C u 1 `� b `Z Plan revision Required? Yes it No Use other side for additional information. p ! ��-- Date Insepctor's ignature Cert. No. SBD -6710 (R.3/97) eommerce.wi.gov Safe at 'I i ior. County �._. 201 W. Wa ung v ., P.O��C q -�G 1 s nom. Mad rt, l 5 787 -71 1' 'v t�urnbIto t lined in ov Co.) n Nu Sanitary Permit Applicr io accordance with s. Carom. 832!(2), Wis. Adtn. Co+ie, subrnissto7 of this f rot o{1 to Quern, tttttal � unit is required prior to obtaining a sanitary permit. Note: Application fo �s fur state -o 9 ( ;QW (if different t nlsiling address' sublmaed to the Depanmew otCommerce. Personal infornution you piovide m for secondary Pt A;u �msts m accordance with the Prl a w, s t�.Ud(1 rn Stats. / .+/J IIIIII t t, Applicat I nformatio n Please P rint At or n O _ /(. r �.--. - - - -•--� i huperry Ownet's Marne �+ Pa1Ctl N f 'pret>,trty long Property Wca.wo I r �? /t dt.,lJ L Govt. Lot r- City, State Zip Code Yhune Nwrtbnr ( f � i. Section � 1 clnle ortt:) I L Type of Building (check all that apply) Lot l� �I,, r.: Fami {yt)+retting•humhe+ofl3adro.M � SUkrdivlaiWtName PubhuC'onsmtrc {si ilest nix Use I l� Crty / u T t V � ! _ Owned D State oed DCscri{r4 List C5M Number l� Village of f ti i d Town of t ? iV 2 4- Z7 6k..,J.L r ll. Type of Permit: (Clseck only one box on line A. Complete lin B if applicable) -A _T New Systen, Replacement System treatetsnutialdingTonk Replacernr nt G + st y Other Mllt:icattort to k:xtsuny System (exptaiu) List Previous Permit Numlut aruf U Is Issued R- i Q Petmtl Rtnewa f ermit Revision ❑ Chan of Plumber ❑ Y+e Trsnsl'tr to *few 50 f �� Before Explranon 1 _ Owner 8 OZ 11. Type of PowTS a tem/C;ompostent/Device. (Check all that app y) Non- Po In-Ground C Pressurized ln- Ground 0 At -Grade ❑ Mound >_ 24 in, of suitable soil [] Mound < 24 in. of Suitable sv' __. Nold +its Tank C Othrr Dispersal Component (explain ),�,•, � Prttreatment Ucv;ct (ax alit) ____•�_, ... 4 `. Oisjsersalfl reAtntent Area information: Rcsi4n Flow (god) Ueslign Soil Application Ratetgpds 1 Dispersal A s Dispersal Area Propoued (st) System EE W- 4c�on'�"'�� x ZZ t/ Vl. Tank Info Capacity in Total Y of ivlanufacottrcr S Gallons ^ Gallons flans New Tanks — L'xuhnt; Tenita °u a Septic or Nol YY aak'� l !�� -e- 4 � � -• - - ' Vil. Res onsibilit Statement- 1, tht undersigned, assunu rexpol »lbtUts fo�ins tatlatlon of tfie POW TS _ IMwn on the at tr►efied plaits• Y-untbcr's Name Pont) Plumber's Signature RP PRS Numlxr B �'itonc Number S� �yz li �_Y t2.27 Plumber's Ackires:: (Street, City, State, Zip Code) C.o.mc /De ar"neat Use ott _ --- � Appro. ad Permit Few L7atC t 6 t,aed I ss uing � Sit;rutttre __ -. sat�rsn C ner Given Reason for Denial_ s ✓'_�� Z� D 7 ___ tX. Condit ~ nsons for Dtaapi,roval 8 i h "lee , JJ�e�roGO 1. Septic tank, of dint fit ee Nrld dispersal cell must all be setvtces !maintained ( / j as per management plan provided by pltttnber. 1 2. AD setback requ irements must be maintained L , — W tNr systtp+ sail sub +nit to nr Ja//, -' untr onl cn v er zeal feu tttie ai 1 i (,I, me 31n s1zC SLID -6396 (R. J1 /07) Valid thru 01109 Parcel #: 020 - 1447 -10 -000 02/22/2008 03:42 PM PAGE 1 OF 1 Alt. Parcel #: 15.29.19.2841 020 - TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 07/27/2004 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - NELSON, DEREK & CHRISTI DEREK & CHRISTI NELSON 676 PINE TIMBER LN HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description 676 PINE TIMBER LN SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 2.030 Plat: 10- 017 - COYOTE RIDGE 020 -04 LOTS 1/29 SEC 15 T29N R19W PT NW SE BEING COYOTE Block/Condo Bldg: LOT 10 RIDGE ('04) LOT 10 (2.03AC) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 15- 29N -19W NW SE Notes: Parcel History: Date Doc # Vol /Page Type 10/29/2007 863235 WD 10/06/2004 776363 2671/82 VRNC 07/27/2004 769938 10/17 PLAT 01/07/2004 750940 2487/120 WD more... 2008 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/2512005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.030 95,600 0 95,600 NO Totals for 2008: General Property 2.030 95,600 0 95,600 Woodland 0.000 0 0 Totals for 2007: General Property 2.030 95,600 0 95,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 i v A\ � A r h R 1 � � o v �p commerce.wi , - Safety and Buildings Division County l 201 W. Washington Ave., P.O. Box 7162 _� �c s CCU n s 1 n Madison, 3707 - 7162 Sanitary Permit Number (to be titled in by CA).) de partment of commerce 4r S 04 S Sanitary Permit Applica • State Transaction Nunn r to accordance with s. Comm. 83.21(2), Wis. Adm. CoJe, subnusswn of this form to the a Ste governmental 1 unit is required prior to obtaining a sanitary permit. Note! Application lbrms for state own WTS are Project Address (ifdLffeient than address) submitted to the Department of Commerce, Personal inforrnation you provide may be used for se ndary t (r`�wA4Jt - pu oses in a ccordance with the Privy Law, s. 15.04(1 (m), Stats. 1 Au tication Infor - P lease Print ifor io J� �, a•1, jProperty Owner's Name Parcel p T � _ � Address sT V 62o - 1 *17- - - -._ Property Owner's Mailing Property Location / I Lf !i_I — ST. CROIX COUNTY Govt, Lot City. State Section Zip Code Phone Number Alm , �— Section f I r (circle one� ,� s�,r� Gr J, 1a� " - 11. Type of Building (check all that apply) ,tFb Lot T N i N; R__ E o /W/ '91 or 2 Family Dwelling - Number of Bedrooms � Subdivision name ❑Public /C,emmercial - Describe Use . - -- _ ❑ city CSM Number ❑ Pillage of ❑State Owned - Ucscr;Fw: Use Z 0�3 ZZ �q�+fs re Town of —_ - - - -- Ill. Type yp or Permit: (Chect only one loex an line A. Complete line 8 if applicable) A. ` New System ❑ Replacement System i [3 Treatment /Holding Tank Replacement Only C Other Modification to Existing System (explain) j B. ❑ Permit Renewal Permit Revision ❑ Chan a of Plumber ❑ Permit Transfer to New List Previous Permit Number d D to Issued f Before Expiration y Owner - _ # 5Q(p a �$ � )y. Type of PO W - TS System /Com_ jsonenVDe (Check all that app Non- Pre In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. ofsuitable soil C1 Mound < 24 in. of suitable soil i Oa k- ' — f ❑Holding Tank 0 Other Dispersal Component (explain) ❑ Pretreatment Device (explain) 3 V. DispersaltTr Are Information. e Design Flow (gpd) Design Soil Application R te(gpdsq Dispersal Area Require (lit Dispersal Area Propose) (sf) System Elevation G 1 1. Tatsk Info Capacity in Total b' of Marmfactu r Gallons Gallons Units o p P ,6 how Tanks Existirt � Tams Septic or Holding Tank Dosing Chamber i V11. Responsibility Statement- t, the undersigned, assume reshons)billty for installation ofthe POWT wn on the attached plans. _ Plumber's Name (Print) Plumber's Signature ,MPfM PRS Numlxr Business Phone Number " fJ rx I" sc 14l� aa27�QD l�s Plumber's Address (Street, City, State. Zip Code) / d�, S C oIr Vill. Count /De arttaent Use Onl X Approved ❑ Disr row I P rmtt wee Dat Iss d Issuing gent Signature l s g 5, _ ❑ _O ive %R . fur Denial --- jjj --- ___ IX. ConditiQj,,_4pneasons for Disapl,roval 1. Septic tank, emttertt fvtw Wid Q J► � u- 1 �6 ('oJ� t �e_R f dispersal cell must all as per management plan provided by pkflnlbar. 2. -AN stttbeck requ refit" must be mabttaktad (� , ae r to cornpte e p a s he svittem and submit fro he County oaty on paper not 1 ss than 8 In x I I inches in site � ` N d a 6� t ,ti S8D -6398 R- 01/07 Valid thru 01 /0t) `� NE w- { ) 64.1 810 3 • ��. ,t V01. zs . �w� 5 n t M as K l GC11. R Sept �T� Y 1� C �fGJ� �3 a Z/3 M D ell Wisconsin Department of Commerce S IL E I REPORT Pape, of �. Division of Safety and Bulidings in accordance with Comm 85. m. Code Attach complete site plan on paper not less than 6 112 x 1 1 che Vf p parcel I.D. include, but not limited to: vertical and horizontal reference 'nt (6 1i percent slope, scale or dimensions, north arrow, and iocati and distance to nearest road. Reviewed Date Please print all infonnatio - AUG 0 6 2007 Personal information you provide may be used for secondary pur es (Privacy Law, a. 15.04 (1) (m)). Aroow naes Owner r lion 1/4/ t!4 S! 7 T zQ N R r E (or) �//1Un Melling Address Lot # $lock # Subd. Name or M CT Y State Gode ❑City O Village Town Nearest Code derived design flow rate �� GPD R New Construction Use: IgResidentiai /Number of bedrooms [J Replacement C3 'j or commercial - Describe: .. _.__ ft. Parent materia �a _Flood Plain elevation if applicable General le and recommendations: J F Bori Boft ng # R. Depth to 1'rcnititlg factor Z in. Pit Ground surface afev..L.�:.L— S gica lion Rate Textu Structure Boundary Roots GPDiff� Horizon orr Depth Ddnant Col Redox Description ,E"1 'Eff#2 In. Munsell Qu. Sz. Cont. Color 2 /y -3(a /o �/ � �l c 5 - � y # ❑ eoring l ® Ground surface elev. �. :.d.1L.C_ �- Depth W limitlng factor in. ;� Rate Pit Texture Structure Consistence Boundary Roots GPD/fF Horizon Depth Dominant Color Redox Description 'Efrrtl 'Eti#2 in. Munsd Qu. Sz. Cont. Color Gr. Sz. Sh. i n -, Z to /3/3 ' I ms 6 W .r S V . 5 - Z qj b � G ✓vl • Effl #1 ■ SOD > 30 _ 220 nVL and TSS >3011 mgll. 'Effluent #� = SOD _< 30 a*& and TSS 130 ffok CST Number CST Name (Please C7 G r✓l0� J Date fovatuaWn Conducted Telephone Number Address p 76 ep Property Owner 1�` 5 Parcel ID # (� / Cj page of 3 C) Borg F c3 1 Wng # (a pit Ground surface elev. J -� ft. Depth to limiting factor In. Soil Rate Horizon Depth Dominant Colof Redox Description Texture Structure Consistence Boundary Roots GI'DMF In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh, 'Eff#1 `EM 0 - 12 MAO VYA F-1 �, # ❑ Wn U ❑ pit Ground surface eiev. ____ _ ft. Depth to limiting factor In. iratian Rate Horizon Depth Dorninant Color Redox Description Texture Structure Consistence Boundary Roots GPDM! In. Munsell Qu. Sr- Cont. Color Gr. Sz. Sh. `Etf#1 'EM Boring # C] Wng 0 ❑Pit Ground surface eiev. _�_____ ft. Depth to 4mitlng factor In. Soil Application Rate Hod= Depth Dominant Color Ppdox Description. Texk" Structure Consistence Boundary; Roots GpD ff In. Munsell ( = Sz. Cons Color Gr. Sz, Sh. 1 - 0#1 'Etf#2 Effluent #1 BOD > 30 1220 mWL and TSS 40;j 150 ffVk ` EftluaM #2 : BOD, 130 nVt and TSS 130 rng1L 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 fornnaL please contact the department at 608 -266 -3151 or TTY 608 - 264 -8777. Ssoasw MM) i PAGE � 41► NAME "r LOTO C PTI N vV) /4Swih IY TZq N R $CALL'S 1 •i 9M 1 ELEVATION U G• C) i S a ELEVATION SM 2 DttCRIPTION r S YSTEM 91.EVATIO ,���✓� /� y r SYl1'EM T YPE __ l "dJIU�✓�l iav� 0.' 7_ O CJ SIONATURE r commerce.wi,gov Safety and Buildings Division I County -- „ 201 W. Washington Ave., P.O, Box 7162 t �Y � _ _ sco n s n Madison, Wit 53707 7162 Sanitary Permit Number to filled in by Co.) I t i *Partiment of Commaroa I �j Sanitary Permit Application t State Transaction Number In accordance with s. Comm. 83,2 t(2), Wis. Adm. Code, submission of this form to the appropriate governmental A C unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different thanmailit%address) submitted to the Depailment of Commerce. Personal info rmation you provide may be used for secondary put7K in accordance with the Privacy Law s. 15.0 4(I)(m Mats . .�t�./ .. LAI t. A pplication information Please P All inf 9a tibnR��+ Ce V GLJ V76 4E T/M "� Properl Nanm - •-=- = APR . �YN der Pa � —�(/ 7-/ 2007 D. �C� U � Property Owner's Maifin &Address Property,dL&ation 7 F , �y y -� e ST. CROIX COUNTY GoO. Lot ` .1y, State _ Zip us.�5' • X 1 1 . . <, !sJ A. Section ), i c ircle one 11. Type Building (Cher 11 that apply) Lot p t f � N: R Eo& pr 2 Family Dwelling - Numl • of Bedronn�c _ / �Sutxlivision Name t Block a l7'i �e P I ❑ ubliGCommerci - Describ, Use -- i t CSM Numbe Cl Village of J State z}wrtrd - Dcscrilx Use i "' _. ------ k (Town of' -/ --i Ill. Type of Permit. (Check on one box on ILt 6. Co mplete lin B if p ppi i ca ble) A. Ne +v 5 ❑ Replacement System reatmeyt ltoidiivg Tank Replacement Only ❑ Other Modification to Existing System (explain) 1 R. Q Permit Renewal ❑ Permit Revision j List Previobs Permit Number and Date Issues! ❑ Chang f P'Iun>her ❑Permit Transfer to New 1 T Before Expiration Owner j �e of POWTS Simem /Cam onendDevice: Chec� k haf tI � r — g Non•Pressurized In -Ground ❑ Pressurized In- Ground t-cmde run A in, o[sut ble soil Q Mound < 24 in of suitable soil �) Holding Tank Other Dispersal Component (expiai _ r rc n e vice a plain)_ `'. DispersaIf real tent Area information: _ -' a Design Flow (gpxl) Design Soil Application Rate( pds Dispersal Area Required (Sl Dispersal Area Proposed (sf) System Elevation � �-.- 3 ° � � �` 7 i �- ' e%a .tip VI. Tank lin fu Capacity in t ° Total �9 of Mantafacturer Gallons Gallons I Units e u s u New Trunks L stung Tanks W/ /nt L r f Septic or Holding Tank Uosing Cf,amber e - Vli. Responsibility Statement- 1, flyrundersigne assume responsibility for installation of th e POWTS • own the attache plans. Plumber's Name (Print) Plumber's Signature iv /MPR, ntbei Business Phone Number " / -y �C Plumber's Address (Street, City ate, Zip Code) NA Vi)i. C nt /De artntent Use [)nf Permit Fee U Date I sued Is mg Agent S na e pproved Cl Disapproved 3 U zL ooh Ow Give Reason for Denial y G _ Ix. Conditions of Approval/Reasons for Disapproval I SYSTEM OWNER; y� I I Septic tank, effluent filter and dispersal cell must all be Serviced/ maintained /�- as per management plan provided b lumber ��c5�/ Y P L ` ¢ irvwtrr ra A em a submi to the County enpy on paper not less than a In if inches in size as per applicable code /ordinances �`- /Yl/ Z— a ?& 3, 0 SBD -4398 (R. () 1107) Valid that 01109 JG _Ie4 i L T - �P yM ^ \ 1 Q y � - p , r V 1 sll t Apr 16 2007 9:32RM TERM SPEERHRST 7153868660 p.4 OP i o ' 15 "� 1 x zso.6e x r{S�Oi x-- --- x OP OF3/4'REMR ---x 386.64 x" ---" LOT 11 LOT 10 2.16 ACRES ® 2.03 ACRES 942()5 sa FT. SeW Sa Fr. 3 Ls O Lcff 9, 2.04 ACRES WM So. IFT �. ...... . . ..- ...... . ! / J / LOT 19 S LOT S; ® 2.11 ACRES J . _ 2:28 ACRES 9Q005 aQ• F gg335 S0: ° Ff- ! � 311.63r �ogpie"E87a� �' i LOT; 21 3 . 30 143M LV 17 2.43 ACRES T F �� " �� �,. .... 1 1058' S4. , • .ri- 1 is •y ' '� I C' R _ c� � b -�` i o ltb `e Deparbr RE C E1VEklL ALUA - noN REPORT 3 vulsoonsitr rerrt of Page - d - DMsl n of safety and sins 6 f °" ` mm . Vft. Adm. Code Attach compiefe site plan on pap not less than 81/2 x 11 inches " size. Plan avid txh+de, but not raked to_ vertical h direction and Pat I.D. �e `o w � Pe�rt slope. scale or4irrutsimt .no� Ap rd t etonear�estroad. d Please Prmf all fi mmi nimu on. Pe WXW Inkn oWn You govide MW be MW rorssMWmy awposes (PrivoW taw. a ISA4 (4) (mg). A�£ Property0mar Prcpertylcretiorr ki�i 13A 7 Goat. Lot N611 114s 114 s-f`T T -2 ? N R �9 .i{ur) w Property Owner's MaMW Address Lot 8 1 0ock# Subd. Name or C%W ENV !N q'y `4 • 4tFR G"�- �'•f� ' /O " L'o Yo TE' ID6rE CRY stab ap a& �Up,$'O 41/• 5 y 4 P?holrr5e 3 $j� •7?? ❑ City ❑ Town Nearest Road t 5 ff UDSo.J 13,44AE - v AS - l+iew C.ortatn ian Use. jd / Nundm of bedrooms 3 " code derived design low rate ySo —' O'er GPD ©Repiacernent ❑ Pd*c or conmerciat - Describe Nffent material _ Sr /it� oU7'l,IJA - �Lr Flood Plah elevation ff fit (t c3erterat oon>mer4ts and GO�v79E.vTi v,gG - P.O.W. T. s R p Gratindsmfteelev fL Depth to ikn*V fador im Solt Rate l latmv Depth Darr*wd Cokx Riedott Oesc ipion Texom Struckre Corsid®nce Boundary Roofs GPOW to. M meet Qu. SL Cont. Color far. Si SFr. 'Etlfi ' /o yR '73 Si C. /fs irr �iC' CS 3 - f- 2- /4 he Y 6 r - Z 3 /d YA 51 ----- Si G fs 1*4 • s �o 42 e- - S Z, in uA' c Z- • 3 / GS /wit cs .'1 /o,�. " kw kAn r2-11 # p 0 .�� p > 10l Pit Ground surface eiev. ft _ Depth 10 �g factor ! js in. Morixon Dep4h oon*urrt Ookx PJXSOK + ;axe stnraffe Consisience Boundary boots G nm Im Lummell OtL sz. Cont. Color Gr. Sz. Sh. -mot 1 0-6 /d ye 3 ( Zfsh� - Fie c s .3 • s 2- 6. JU CS �. Z o 9 44 - D,S t•Z muent #1= WO > 3 _ < mgk and lu S *#W 150 WQ& ' tsbom 02 = BCP 1 mgll. and M :S W nv& CST f� �- T • ' (� �: (C ( 2 Z. (.O Address Dete E-tiorr Conducted Telephone Number i3 - 6 715.77a•3g4 Private Sewage Consultants 2812 10th Ave. 7 ,, +L F p Spring Valley, Wl 54767 ��N S / TO 4a O O ff riit Z p . !o 17 . Z o • oar 2.0 • / 017 • 30 - O• o ao • 1 ©a. 7, yd • ozrO yo T� R06-z� �Eie1v,o v T3 /q-5 7 Paroei iD # 40 f /O pap Z d 3 3 Borft # 0 Bo Ground surface dev. `" ft. Depth m rrnai<►g factor >" Sol Application Rate Horizon Depth Dominant Cokx Redox Demon Texture Structure ConsMence Boundary Roots GPD1ff In. Munsel Qu. Sz. CorIL Color Gr. Sz. Sh. 'Eff#1 'E}y2 o -/X ye (3 G /fps ite Jd 4) 3 f 511- / F-I Boring # Berns ❑ pit Groun surface elev. ft. Depth b WnftV fader in Sal Application Rate Horizon Depth Do *wt Cokx Redox Description Texture Structure Consistence Boundary Roots GPDfff In. Mu nsel Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ef 1 'Ef #2 # D cl Pit Ground surface elev. tt Der to frniVng factor in. Sol Rate Dff Hortaon Depth Dominant exa Redox Description. re Structue Cornsistenoe Boundary Roots G in. Munsel CkL Sz. Court. Color Gr. Sz. Sh. 'EW1 'Eff#2 EMuent #1 = 800 > 30 <_ 220 nv& and TSS >30 < 150 mgL ' Effluent #2 = BCC < 30 nV& and TSS 130 nvt The Department of Commence is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, plem contact the depst went at 608 -266 -3151 or TTY 608 - 2648777. t�t»ocre6root l y� y � � a t `• d r CA Ms w G aF T'TIC TA;tK E PUM CHAMBER CA0'5 51�CT ON AND SPECIF , -- A TION 'S 4" Cl VENT PIPE 12" MIN. ABO GRAI)Z WEATHERPROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE .- -WITH CONDUIT MANHOLE COVER W! PADLOCK F FINISHED GRADE WARNING LABEL 4" ", RISER k" 1l = td, IN. 6" MAX. S EALS 1 WATER TIGHT DEALS '."IGHT + ', APPROVED A SEAL ` JOINTS WITH 1 , ,PPROVED — -- ; ALM APPROVED PIPE 'IPE 3' k1 1 0 14 3' ONTO ,INTO SOLID ' ` SOLID SOIL ;flll PUMP OFF ELEV . FT . -- -- OFF RISER yX IT D PERMITTED ONLY IF TANK s MANUFACTURER HAS APPROVAL 3" APPROVED BEADING UNDER TANK CONCRETE PAD aI"'�CIF'ICATTQNS SEPTIC DOSE / WANK MANUFACTURER : �,� ��:� �.�., NUMBER DOSES PER DAY: �! TANK SIZES SEPTIC 1`a. CAL. DOSE V QLI.7ME INCLUDyNG i DOSE `t.... GAL. FLOWBACK: GAT.. ALA RM MANUFACTURER: 1►tL�►& CAPACITIES: A = ;�k INCHES = `� �a GAL. MODEL NUMBER: Q L - r/ SWITCH TYPE: Cn & &( B = 2 INCHES = GAL, P UMP MANUFACTURER: Gro C = INCHES = b$ GAL. MODEL NUMBER: bp d S'WI'TCH TYPE: mr D INCHES = (p GAL. REQUIRED DISCHARGE RATE '4 0 GPM PUMP & ALARM WIRING AS PER I LHR 16.23 WAC f RTICAL DIFFERENCE BETWEEN PUMP OFF AND DIS'T'RIBUTION PIPE . FEET f MINIMUM NETWORK SUPPLY PRESSURE , . . . . s 2.5 FEET FEET F ORCEMAIN X .Z,16bFTi1UO F�', FR:C'�ION FACTOR ' FEET T,PTAL DYNAMIC HEAD = FEET hTERNAL DIMENSIONS OF PUMP TALK: LENGTH ; WIDTH •�--�' DIAMETER LIC} 63 &4L Pee STG1tiED: C �, ,�►'' .___ LICENSE NUMBER: Q Q(; !) DATE: _ -- -�-- -_ x /88 [qG0ULDS PUMPS Submersible Effluent Pump EPO4 3871 EP05 { APPLICATIONS • fully submerged in high ■ EPOS Impeller. Thermoplas- ■ Bearings: Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing followi uses: lubrication and efficient improved performance. construction. heat transfer. ■ Casing and Base: Rugged • • Effluent systems thermoplastic design provides AGENCY LISTING Homes Available for automatic and superior strength and corrosion • Farms manual operation. Auto- 41• Canadian StandardsAssodanon • Heavy duty sump magic models include resistance. • Water transfer Mechanical float Switch ■ Motor Housing: Cast Iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in "V or "C ".) { strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic Goulds Panix is ISO 9001 Registered. F EATURES cover with integral handle and • Solids handling capability: - float switch attachment points. t/e" maximum. ■ EPO4 Impeller: Therm°plas- 8 Power Cable: Severe duty • Capacities: up to 60 GPM. tic Semi open design with rated oil and water resistant. • Total heads. up to 31 feet. pump out vanes for mechanical • Discharge size: 1 NPT. seat protection. • Mechanical seal: carbon - rotary/ceramic- stationary, BUNA -N elastomers. • Temperature: 104°F (40`C) continuous METERS FEET 140°F 60°C} intermittent • Fasteners: 300 series 10 Stainless Steel. ---- -, 5 GPM I......_. • Capable of running dry without damage to $ zs components. 25 :.... 7 Motor x • EPO4 Single phase: 0.4 HP, s 20 _.... . 115 or 230 V, 60 Hz, 1550 RPM, built in overload with 5 automatic reset. 0 • EP05 Single phase: 0.5 HP, o a Epos Single 115 V, 60 Hz, 1550 RPM, +- 3 10 . .__ built in overload with EPO4 automatic reset, z • Power cord: 10 foot s; ...__ . standard length, 16/3 1 SITOW with three prong grounding plug. Optional 20 0, °o _ .._ za 30 40 5o GPM foot length, 16/3 S1TW with three prong grounding plug (standard on EP05). o z a G s 10 1z m , / r, CAPACITY Goulds Pumps ® 2O00 Goulds Pumps ITT Industries Effective february, 2000 83871 .RPr 16 2007 10:12AM TERM SPEERBRST 7153868660 p•1 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer N tsr Mailing Address Pro perty Address , Lo i /O t &wm Jro6£ op (verif9talion required from phoning DepanmeM for new conntructtan) City /State NvO / 6o2 Parcel Identification Number t - AW7 -9 /0 — � i EZA EFFACR[1inTYON Property Location N , ' /., _ /..Sec. 3�� T _N =it W, Town of J _. Subdivision COs 000" . Lot V �d Certified Survey Map ale i Volume , page # Warranty Deed N - 7 � y , Voluttnc - u-- = • Page # Spec house 0 yes D no Lot lines identifiable 56 yes 0 no symm MASNTF�NANCGF Impeoperuse and trtaintenariever your guitar syataro cauid resuit in in prcauuum rmium so handle wastes. P roper maintenance consists or pump ag out the septic tank every three yeas or sooner. A needed by a Irrensed pmnper Wheat you put into the systefn can &,Fleet the ltrncrioo of the septic tank as a uraunetu stage In the waste disposal syltatt. The propeM owner agteas to submit to St, Crou. Zoaiag Depaim.ein a cetofication f4m. signed by die owner and b- a :nitro plumber, joorncyntan pltmibt t, testcicicdplmnba w a liceatsed pumperverii'ying that (i) the oss-sge.vitxtewaterdisposai syste rrt it in propt s operaiial condolion antbor (2) ahcr rnspccnotn wil purrryitlC (if wecess ary). thtr septic gal* is 1455 eban V3 full of sludge. yNtoL lInkf-t tstgrted have read the above retlartrttents and agttee to maintain the private sewage disposal system with the s mda uL by the Vcpanteent or Cutnmsrce and the Dent of Natural Resources, state of Wisconsin C"tricauon septt y m has teem maint ain m anuat be completed std returned to the St. Croix Gotutty Zonintt Office within ]4 ee cot is trop dare, %1GN A APPLICANT DATE w fMFIVAIM 1 ) IR t a ri scatanents on this Gain are rnic to the best of my (our) knowledge 1 (we) am (are) the Ownar(s) of the prop rive . trnic of a - Arran+y deed raeorded in Remoter of Data Orrice. S Ant wrPucwrlT oars •• "•• Any infortnation that is trots - represented may reautt in the sanitary permit being revoked by the Zoning Deparrmcnt. •'•••• •• Include +viih this application: a stauTcd warronty deed from the Register of Deeds Office a COPY of the cenAkil survey "Op it reference is anadt in the warrenty deed ,d Z66L88ESIG Uosuyar UOS4r dr t xjp Cc '6.2.aaQ POWTS OWNER'$ MANUAL & MANAGEMENT PLAN Pane / of Z FILE INFORMATION t ` L— \ p SYSTEM SPECIFICATIONS Owner Permit # Septic Tank Capacity /• ls al ❑ NA ` J�O Septic Tank Manufacturer W t e~.S� ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Q ,b ❑ NA Number of el Bedrooms 17 NA E Filter Mod _ _ 10 O 0 NA Number of Pu Facility Units 0 NA Pump Tank Capacity g 0 al 0 NA Estimated flaw (average) Pump Tank Manufact Vi c ❑ NA Design flow (peak), (Estimated )K 1.5) �j al /iia purnp Manufacturer G v.� �!~ ❑ NA Soil Application Bate gal/day/ft, Pummp Model ❑ NA Standard Influent/Effluent Quality Monthly averse Pretreatment Unit NA Fats, Oil & Grease (FOCI) X30 mg /L M Sand /Gravel Filter Q Peat Filter Biochemical Oxygen Demand (600 4220 mglL 0 NA 0 Mechanical Aeration D Wetland Total Suspended Soli (TSS) x150 mg /L 0 Disinfects 0 Oth Pretreated Effluent Quality Monthly average i isper Celifa) /� A Biochemical Oxygen Demand (f30D } S80 mg /L - Ground (gravity) 0 In -Grol ipressu ztr ed) Total Suspended Solids (TSS) 530 mg /L NA 0 At -Grade 0 Mound Fecal Co liform (geom etric mean) " etuti1 ooml � 0 Drip-Line 0 Other: Maximu E P a r t i cle S i Y8 i d ia. ._. 0 NA gmdr _ O NA Other C} NA p4h ®r;� ❑ NA "'Values typical for domestic wastewater and septic tank effluent, Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency (aspect condition of tank(sl At least once ever mnnth(s) Y (Maximum 3 years) 0 NA Pump out contents of tank(s) When combined sludge and scum equals one -third (;3! of tank volume ❑ NA Inspect dispersal celi(sl At least once eve 0 month(s) -- _ _X year(s) (Maximum 3 years) O NA Clean effluent filter At least once every: / N Q month(s) _ /' A year(a) i ] NA f _ -- __ d month(s) Inspect pump, pump controls & alarm At least o nce every: �-.. _ R C1 NA ❑ year(al Flush laterals and pressure test At least once every: G month(s) O NA ___- .____. ❑ year(s) other. `� motwtthia} - At least once every -- ❑ 0 y ith [I NA ❑ 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; POINTS 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 celi(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 imrr+ediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of :he 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 beat not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment un'ts, and any servicing at intervals of sl2 months, shall be performed by a certified POWTS Maintainer. A. service report shall be provided to the local regulatory authority within 10 days of completion of any service event. I STAi{T UP AND OPERATION For new constrvctiort Page - °t Prior to use of the djor d painti that may impede the tr6atment tsgs S proc es s icing m4es the dle"i'64l c*llfa da check treatment tank(s) far the presence of , if high concentrations are detected have The cont cf the tankl&i remavad by a septage servicing operator P g product; or other chemicals System Start up shall not occur when soil conditions are 10 M Ot the Infiltrative surface. During powet outages pump tanks may fill discharged to the dispersa above normal fill ISVe1R, When power is eeifiei in one large dose, pVerlq�; rtQ the 014 r estated the excess wastewater uvill i;� effluent. To avoid this situation have the contents of the pump tipnk rpmgyed b a Setrtage Servicing Operator pr,ar to restcrir 111 i and M&Y result in the backup or surface discharge of Dower to the effluent Rump or contact a Plumber or PO1' TS Mtlntelnsr to assist in manua operating the pump controls t.a restore normal levels within the pump tank, g Ga not drive or park vehicles over tanks and dispersal Calls. Do not drive or park over, or otherwise disturb or compact, the area within: 15 feet down $1000 of any mound or at -grade soil absorption area. Rsducti0n or elimination of the following from the waste wrpter We4tti may improve the performance and rolon POW*, S: antibiotics; baby wipes; Cigarette butts; Condom$; 00tt00 SWabs; dog p 1? the fife of the foundation drain, (sump pump) water; fruit and vegetable pslllin til `� dental floss; diapers; disinfectants; fat: uainting products* pesticides; sanitary napkins; tampons; anif yvst a n �ol�i0; grSase, herbicides; meet scraps; medications• c,i; ABANDONMENT ftfsnor brine. When the POWTS fail& and;or is permanently taken out of service the following steps shall be taken to inaure that ti)e system is F'operly and safely abandoned in compliance with chapter Comm 83 ,33, Wisconsin Administrative Code; e All piping to tanks and pits sfiBN be disconnected 4nd the ebMndoned pips opening& sealed. e The contents of all tanks and pits shall be remavod and prgperly disposed of by a Septage Servicing Operator. e After pumping, aft tanks and pits shall be excavated 4nd removed or their covers removed and the void space filled with soil, gravel or another inart solid material. CONTINGENCY PLAN ,f the POWTS fails and cannat be repaired the following measures have been, or mu &t be taken, to provide a code compliant repiecament system; 13 A auitable replacement area has bean evaluated and may be ;.mixed for the location of a replacement sot! absorption system. The replacement area should be protected from disturber** and compaction and should not be infring upon b y required setbacks from existing and proposed structure lot lln*o and wells. Failure to protect the replacement area will result in the n for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must Comply with the rules in effect at that tiny, C] A suitable reptaaement area is not evaiiaWs due -0 setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed ea 4 last resort to ►episce the failed POWTS. The site & not en evaluated to identify a suitable r4placetnopt area. Upon failure of the POWTS a soil ef slte evaluation qWbe performed to locate a suitable replaf omorit area. if no raplacement area is available a holding tank may b ' tact s a last resort to replace the failed PO"', © Mound er!d at -grade soil absorption systems may be reconstructed i n place tafbwing removal of the biarnat at the infiltrative surface. Recanatrua tiara& of such avatSrns Must Cot1'tply with the rules in effect at that time: <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT' TANKS MAY CONTAIN WTHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY 4IRCUMSTANCE8. DEATH MAY RESULT. RESCUE OF A PERSON FROM TiiE INTERIOR OF A TANK MAY BE DIFFICULT ON MAPMISLE. ADDITIONAL COMMENTS i�OWTS INSTAL I.ER M ! TAiNER f Name 1 ft A�®r - 7 3 19 Phone SEPTAQE SERVICING OPERATOR (PUMPER) LOC L. QUt.AT� 0RY AUT HORITY Name Phone I Phone f',is arcurnent was dratted in cnrnp . with chapter Comm 83.2�i 9611111 040) aa4 83.64;11, IZ1 8 i3l, 'Wisconwn Acfwnistravve cues^. 750940 17 Y 1 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO.. WI STATE BAR OF WISCONSIN FORM 2.2000 RECEIVED FOR RECORD Document Number WARRANTY DEED 01/07/2004 12:35PH WARRANTY DEED THIS DEED, made between Kernon J. Bast, a married person, EXEMPT # 8M Grantor, and Kernon J. Bast and Donalda J. Speer -Bast, husband and wife, REC FEE: 13.00 as Survivorship Marital Property, Grantee. TRANS FEE: Grantor, for a valuable consideration, conveys and warrants to Grantee COPY FEE: the following described real estate in St. Croix County, State of Wisconsin: CC FEE: PAGES: 2 SEE ATTACHED EXHIBIT A Recording Area Name and Return Address: Edina Realty Title, Inc. 400 S. 2 St. — Suite 115 Exceptions to warranties: Hudson, WI 54016 Easements, restrictions and rights -of -way of record, if any. 412540 20- 1027 -40 -000 & 30 -000 &20 -00 Parcel Identification Number (PIN) This is not homestead property. Dated this 6th day of January, 2004. * emon J. Bast * * AUTHENTICATIO VONNO ACKNOWLEDGMENT Signature(s) G� I IP byk STATE OF WISCONSIN ) WIT, A ' . Cl'5`� ST. CROIX COUNTY. )Ss. authenticated this 6th day of J pp"�g a ��"" Personally came before me this January 6, 2004 the above named Kemon J. Bast, a married person to me known to be the * person(s) who executed the foregoing instrument and TITLE: MEMBER STATE BAR OF WISCONSIN acknowled the same., , authorized n ot, J/ U" authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY * Cheri Brown Notary Public, State of Wisconsin Edina Realty Title — Doug Berg My commission is permanent. (If not, state expiration date: 400 South Second Street #115, Hudson, WI 54016 3/11/2007 ) (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 WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2 -2000 U 2 7P 12� 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 15; thence South 00 degrees 47 minutes 33 seconds East, along the east line of the SE '/4 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 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, 35.71 feet; thence North 14 degrees 10 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 the St. Croix County Register of Deeds Office; thence North 88 degrees 51 minutes 13 seconds East, along said south line, 570.78 feet to the point of beginning. .� y / 1 � iY l rr yy L'v L V A �SFti : .� � ' � ` :LJ� `T' T` �...�1.�iii '' ��(if ���. `�. ,. \� \ \ \ \ \'�� ' C��, .1.:•:. ..._ .�l ;�' . J f gL -