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HomeMy WebLinkAbout020-1447-12-000Wisconsin Department 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 Bast, Kernon Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: ~ ~~ (c7o - ~ ~ v~o s ~ U over- S~~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ S / Z SCE l ~~ Dosing Aeration Holding TANK SET K INFORMATION en o it n a e ep is ~ >~ ~ I ~ f _ osmg ~~ G~ ~t 2 / ` era Ion o ing P{1~IP/SIPHON INFORMATION A~A ~~ aV1~Hiaavr~rllVlvJiJluvy IC'1~I1.~,.,,.L,~,~1`-~r•ow,rr.l.. ELEVATION DATA County: St. CrOiX Sanitary Permit No: t 488065 ~ t State Plan ID No: Parcel Tax No: 020-1447-12-000 SectionlTown/Range/Map No: 15.29.19.2843 $TATIOI~ \ ,~.o..~,a~o,., B~ / J BS HI FS ELEV. Benchmark ,,, ~M~.JSz~ // ~ ~b '' II ~~ ,t (~ . ~ Alt. BM Bldg. Sewer r ~ . pa ~ - 3g1 J t t nlet In~3d . br t t ut e t ne 0 om ea er an. (~~ ~y t Z / 9•s is . ipe 99• ot. ys em S . ~~- ~. r ma ra e 2.av ~ p2.. over DIMENSIONS t 3 / 0 ~. •~ J INFORMATION CHAMBER OR ~ ~ . > Say ~(~ UNIT <<-- VFJ 1 RIG~J 1 IVIY J I J I GIYI ^ _y W ~rlv Pipe(s) .ength Dia~_ Le Spacing ~ x Pressure Svstems Only xx Mound Or At-Grade Systems Only anu ac urer eman GPM o e um er ~ ~~1~ ~ i nc ion ys em ea orce m e g f ~ ia. tt ~ ~~~ Bed/Trench Center Bed/Trench Edges Topsoil Yes i No Yes No GOM ENTS~'.~(Includ code dis repe~n..cies, person rese t, tc.) Inspection t~uvTt~- `~"f_L.(~~1o mspecuon mac. ~-+- ~ a C~~Location:' 67~2 Pinee T Ladso W016e (NW`1/~S~/4 15 T29N R19W) Coyote Ridge Lot 12 ^ ' Par el No: 15.29.19.2843 T, ~~.~- comer. r~oa.,,eS( J©~~ 1.) Alt BM Description = 1,}-~je S• 2.) Bldg sewer length = I 2 -amount of cover = I u-f-, '' -- nn .~aw~ Ig'~1. ~.T t"~•ti~'~Q ~~ ~S .~. _ Plan revision Required? ,j Yes No ', ~ I - - . o - Use other side for additional information. ~~~- ©~ t "~^~ ~ ~ ~ ~ S [ `' - - - --i ~ __ L. - ~ Bated -- - - re-- SBD-6710 (R.3/97) x:, Safety and Buildm~s Divi~ County ' 201 W. Wasbingt~ P:O. Box 7162 fj ~ 2 ,~~~~,~ Madtsan, 07 162 Sanitary permit Number (to be filled in by Co.) Department of Commerce 1 B Sanitary Perm App 'cation State PIanLD.Nmnber Wis. Adm. m accord with Comm H3.21 ~ , may be used for sceotaiary Pri 1EI `~ Pmjed Addnss (if differatt Chart mailing address) I. ApplicatiooInfornm6on-PkasePrintAU rmatflgnCROIXCOUNTY L T z ~+vFr' Tr~r, Lrr ner's Narrre ~ ^ Property Ow 3 Pared # ieE* ~ / ~/~. ~ .. ... ~~d / 3- Meriting Address Property Owne's ~op°h' 1-OmnOn / ^~ • ~~c%'/y Section ~ Y, City, Sta a Zip Code Phone Number , ~ %~ L /p/ .. ~l~ / 7 S ~4 - 7~S . -f Z.~ N. R /g(~13 ) ~i ~ 1 ~J -~- - l ) ck all Wat a ildi ( T f B II ~ pp y ~ ype o u ng e . p t~ a S o ~. er i n. Subdivision Name CSM Number ^ 1 or 2 Family Dwelling- Number of Bedrooms ~l ib ^ I `' PublicJCommercial - Descr eiUse ^ 5ta[e Owned -Describe Use 7 ~dF"' ~.~`S ~ ( 1 S t ~ 5 ~- /5 ~ e~,~e.~J -~-- ^City ^Village f~Pbwnship of III. Type of Permit: (Check only one 60= on line A. Complete tine B J appliabk) A' (-~New System ^ Replacxrrterrt Sysoen- ^ TreatmemlHotdmg Tack Replacement Only ^ Otlter Modification to Existing System B. ^ Permit Renewal ermi[ Revision ^ Grange of ^ Permit Transfer in New lid Previats Permit Number and Date Issued Before 1"sxpiration ' 1 ' Plumber Owrte~r # ~ p0~ ~ ~. ~ B v e e.~.-- IV. T of POWTS S Check aD that a B~NOO -Pressurized In-Cnound ^ Mamd > 24 in. of suitable soil ^ Mo>~I < 24 in. of suitable soft ^ At-Grark ^ Side Pass Sid Fittex ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sard Filter ^ Recirwlating tltetic Media Filter ^ I.eachiog Chamber ^ Drip Lice ^ Gravebless ^ Outer ( ~ ) V. D' 1/I'reat~nt Arta Information: t ,.F~tr. m Design Flow ~) Desig~t Soil Application Rate(gpdst) Dispersal Area Required (st) Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total Number Manufatxttrez Prefab Concrete Site ConsWrxed Steel Fiber Glass Plastic Gallons Gallons of Units New Turks T~ 2 B~ LAG s~ or~ielaitlg9'snk o .- 1., f?~ ~ Aerobic Treamnnt Unit Dosmg S~ ..- VII. Responsibility Statement- I, the aadetsgned, assume respo for installation of the POWYS shown on the attached plans Pl Si •l~/MPRS Nttrober Busutess Pttorte ~~ Plumber's Narrte (Print) Plumber's Address (Stroet, City, Zip Code) ,~P.z~F ~ - o ~-- ~lTo- 3 VIII. Conn JDe srtment Use On Sanitary Permit Fee (includes Groundwater Date Issttittg t Signaw ps) Approved sapproved Surctwrge Fce) 75 • OQ 5 / OY, Reasaut J I7t. Conditions Approv !1 SY8TEM OWNER: 3~ 1jJ ti ~~ Wtt)b~" ('a J, ~ ~~~•'~- ~ ~ ~~ y~~,~ t . Septic tank, effluent lifter and dispersal cell must all beservPces /maintained ~0.~ ~,~a./~. ~Q.. ~ °i•v`'' as per management plan provided by plumber. I 2. AU setback requirements must be maintained 1n.t~~^^-e-~ w~2..C--- ~ P~ aPP code / ord'gtartces. r.. r....~.-.. ntrt . t t i.a~6K ie .:>r All>1CLL cB®tgeR pasats Sao u.c a.vaa.a7 °•Y7/ •v..... a>>........-. a.y SBD-6398 (R. 01!03) r Fogerty Piumbing~ /mop ~ #221180 ~~ = ~a~_ ~~~ ~ e~ ~~ stct 28288 t`JlcKenzie Rd. ~ Spooner, WI 54801 _ - to3~~. ~ (715) G35-9609 O ~ T>'v~2~ ~CitG. Cvstdo T/1~icK f~'Gp = ALL Tif~~4ca nctC,S' el0 ~ ,li.+d~ / ~ ' /Ofi4 / x O l ~ 3 ~ t I ~ ~ ~ J I ~ ~ ~ ~,~ f G s~~t , ~ ~ -~ ~ --- ,vW v ' \ i ~ ie \ ~~ 30 _ 1 f~'j2 1!#/ ~/~ w ~ r 1 ~ ~ ~,~ > /cP ~ ~ i~ 6of' ~r L-r c~T ~~~~ /'~-`.v~S `7 d#/ = dam,, 7~S ~~ wrwr~~ suc Fogerty Plumbing /mo.p ~ X221180 ~~~ _ ~`T_ ~~~ r at ~~ ,rrzt 28288 McKenzie Rd. ~ Spooner, WI 54801 to3•~, (71J) X35-9609 jC = ~vkiJL' ~ ~ ~r tom, ~ u' ~tC ~~ ~~~m~ D = G~.Rccr- ua~i~,v /~-w~e /`?~sT y,./~p6 O ~ Ta ~~.tsz rC~tG. lm.~ TifitK /`~GQ = .¢LG TiY,t~a c~tGt ~fv ' lr~v~ rc •r ~ ~ EL,i'/• OF pp 7 ' G~/T 'E~2 • _ rmu~D (,d' Gorrlri^ fG.~LE / ~ = ~ ~ \ / I /OS 0 / \. l x O ~ ~ \ ~ ' ~ 1 1 ~ ~ ~ I x ~ \ \ ~ .~ i ~ _... _ /oyo _ X j° ~ ~ ~ 3f ~ o , ~s.D 1 ~'~~ c~I ~Dr~~ ~~ / ~ 1 r I ~ ~' 1 ~ /oo r 60!' L~~ ~- ~~r ~~'~ f~ , , s,. r ,c ~) ---- ~ ~.~ jtawr~P,~7C L•U. wscor>sin Department of Div~ion of Safety and Bui; ~~c~ivE~ APR 2 8 2006 ST. CROIX COUNT EVALTh~N REPORT Page / of -3 w~ ba~rvdo~ ca, me. ircrr~. ~.vae Attecfi complete site plan an paper not less ~ 81/2 x 11 inches in size Plwr must . indude, but not limited to: ve~ti .rat at-d horimntai reference point (BM). dredion and Paroel I.D. P~Pe. scale or drtrrerrsiorrs. north arrow,and locakiorrand distancelo rrearestroad. -/m,2 •- P/ease print aN lnformailon. by Date F+mrsond iidaRaNon Yau niay 6e used forseeoMtary purposes (Privacy t.aw, s.15.04 (1) (m)). S ~ ~~ P~tyOwrrer - AcS% ProperlyLocaAion Govt Lat W 1/4 114 T ~, N R E (o~ Property Owners 9 Address Lot # Block # Su6d. Flame or CSMIt - v. /a - ~ aly sr~e z~ c«le Phone FiM.riber o (~„ a v~age own Fleetest Reed a o t -~3 -~ G7'NeM- Cdr Use: [l~'Resider~al / Nrrinberaf be~oorrrs ~~,_ code derived design flow rate ~~o GPD ^ Replaoenrent ^ Puh6c or wrrwrrendal - oesaibe: Parent material ~ulG/.~~ food Plain elev~an Tappfirahle ~/.Q g. ecrra ~lJV~.drz~.r~•f L ~ ~~ ^ ~s - ~ - ~• ~ ®Pit Ground surface elev. 2 ~ R Depth m ~9 feClor > /Z ?~- . Sbi Rate Horizon Depf}r Dondrrarrt Redder Desaipion Texlue Struchee Ca~erroe Boudary Roofs - GP D/l~ ~. [1Arnsefl Au. Sz. Conk Color tom. Sz Sh. `0~1 'E1iff2 / O- 0 2 c f L - o - ~5 F .3 a - u - -- ~ ,~ _ - 1 - -~ • I L~ ~ ~ ~~ ... ./ I.UJ t_I Plt wour+asurr~ce e~ev. ~ it-.r•i. R r~prn si er.~-~q .,v n. Soi Rate Horizon DepOr Dnmirrarrt IZadorc Desai~on TerAu~e Slnrdire` Corrsisienoe Boundary Roots GP DItIZ irr. i ~ Sz. Cant Cobr Gr. Sz. Sh. '~1 'Et812 ~ B- Q Z - s3 ~ - ~~ .~ s nr' s ct f~ k. ~ ~- ~.. ~rsS oSF ~wG - • EtAuent lf1= BOD > 30 < 27A mdL and TBS > < 1 90 mod. ' Efrluert t-2 = BOD_ <30 nsflE and TSS <_ 3D mM. CST IJarrre PliirQ Sigr>p~' CST Plumber Addre~ Sy~d/ OaAe Evahraion Oond-rcled Telephone Ntrr+ber ~ ,eo tai ~ ~,r~_,~v ~`d _ nr~ r ,~ y i~ ~zt 7>.s = 5'l6 vooo prpperty Owner Di1/ /Si1'~y~ Parcel iD # ay -- ~o~ 7 -r Ya' °~ Pag® Z of .~ Pit Grv~d surface etev. /02.7 tt. Depth to tirrdh~g factor ~- ~ / Soil Rate ~ ^ ~~ GPD/f'f tioriaon ~ ~. Dominant ~Arursed t2edox Desuipdon Qu. Sz Cad. Color Texdxe Sirudure Gtr. Sz Sh. Cow t?ourrdery Raata 'Effixt •E~ ~ ~-- sL z k.S' 2 3 f L s l F /F 3 RSA .yrL - . L j r _ ~ ~~ it Q Pit t~otxrd surface elev. R Oeplh to ~9 factor ~ Soil A Ik:alion Rate a~ °~ Horiux- Dept Dominant laedox Description Texhre S>nx~ure Came BouMary Roads GPOVfE ir-. Mtnsel t]u. S'z Card. Calor Gr. Sz Sh. •E!t#1 'EtT#2 Q Bo~~ a ~ ^ Pit c-aour-a ar.faoe slay. R oepth b ~ facbr in. Sot - Rate Horiz n th De Dorrrina4 Reboot DesaipGon- TexYre Sure Cara~tence Barrdary Roots GP DA! o p in. tlAtsrse~ Qu. Sz Cont. Color Cdr. Sz Sh. •E1(~1 'Eft#2 ~ .. • E18uerd #1= BODs > 30 < 710 mgli. arni TSS >30 <_ 150 rngR ` Effluent J{2 = BODE S 30 mgA. and TSS ~ 30 mglL 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 60&264-8777. seoeawtR.~roo~ Fogerty ptnmbing X221180 28288 l'i'tcKenzie Rd. Spooner, WI 54801 _ , ~ (715) u3a-9609 ris~'F / " = Yo y//~6 .Q. !C'/ = ~/H~ , TJ~I ~ ~ wcwi~mav SILL /rp?.O ~ ~ ~rj c /ALT- /~~. r'~ 6F i~IL s^L'u /o~if . ~ = ,~9 YI /G 6~l' Lf ~~' (lot ~i l 1 ,03.~ g~, ~~~ ~~ . ~ ~«.: r j ~ /e~'•7 ~ /oO ' 3 /,.~.7 c 22> -- ' .~ 6 ° ~' ~ ~~ ,~ ~ ~ ~ c ~ ~ ~c ~' ~ y~ ~1y '~ ~, ~ ~ o .- ~ I . I `I ~~ , _ .. ,.. ~ ~_ I ~{ O~ ~ s ` a .~. _~' --~ - -- ..... ~ ,, i- .~•- _~ - - e- ~ L~ -- .. 1 ,, n . ~ ~ -------__._ __.. ., ~ r. Q -CD •' ~ •~ _ ~, ~ - -:.. ~` . ~ ~ __ ..:. - ~ s ~ - a \ \\ \ f~A ~ ^' f~1 ~; ~ _:.. ___-~__ ~ J ~~, r ~ ~ ~~ ~. ~r .:..: ~ . - ~. to-:'- :..:..r : ^ '~ r~ ~ it ~ ~ ~ }};; -'+ W v. ~~4:---..:. II ~ - -. __ _.. ..T \ .-. ..r ~ .~ eC ~p ~ ~ ~: ~ ~'S N ~ ~ ~ n Wax~~° C~ I cn ~?'-~ ~e to .... a' ~ ~o cn N o 3 C ~' ( ~ O 0~0 ~ ~ 3 II ~" II `~'' ~ ° a °° . b u u~ 1 ~ ~ ~0 w v w ~~~T Fogerty Plumbing ~,r- ~2 -X221180 2132_"`3 P.1cKenzie Rd. S~4..n^~, WI 54802 p1~) X35-9609 Combination Tank Component Cross Section Approved Manhole Covers With Warning Labels and Locking Device / 4" Min. Above Final Grade Weather Proof Junction Box Electric per NEC 300 & CObflvt. 4" Sch. 40 Vent ~ 1b.28 WAC > or = to 12" Above Final Glade Disco ct Alternate Outlet Location W/Approved 4" Sleeve _ Inlet Approved Force Main Diam. _ Effiuent Filter < or = to 1/8° Weep Hole or Anti Siphon.Device Baffl~ Particle Size ~ A ~ - B Pump Off Elev. C Tank Mfr. ~ I D r--~1 Dose Tank Elev. _ Vertical Difference Between Pump Off and Distribution Pipe = lz- . Minimum Required Supply Pressure ...................................... _ ~- jo' FT. of Force Main x 2 ,~~ Friction Factor/I OOFT.... _ . & ~ Total Dynamic Head .................... _ / .~d' - Number of Doses ... _ ~_ Per Day Gal. Per Day/ #of Doses = ~ Gal. Volume of Backflow .................................................................... = y. 9 Gal. Total Dose Volume ..................................................................... _ ~~ Gal. Pump Tank Capacity zS"O Gallons Pump Tank Vohme lL.~t Gal/Inch Pump Mfr. G Pump Model Minimum Disc a Rate = -~- GPM Dimensions Inches Gallons A ?0.9 ~~3j B ~ Z•:S~ . C ~_ /5 y' 7.~ D ~_ ~-~ Alarm Mfr. 'f' ,~ l~rXO Alarm Model /m t " Ol f/ Total= C. ~ ,Z~'o C~~m~ ~~ Bed Tank per COMM. 83.45(5) Anchor Tank as necessary to negate buoyaat forces per COMM. 83.43(8)(g~. ;~ Up t0 40 GPM :.-...::~;;, Discharge size 1'/." NPT : ' Solids:'/e" maximum Motor Single phase:115V Materials of Co~~struction Brass/thermopt~lstic Features and Benefits •Top suction eliminates impeller clogging.. • Corrosion resistant construction. • Float actuated switch. METERS FEET i zs MODEL DVP03 c 620 =s ~ w 15 ~ 4 a 3 .~ 2 5 ~' I 0 00 5 10 15 20 25 30 35 I 40 U.S.GPM 0 2 4 6 R~ 10 m~Alr CAPACITY ~~~~ ,~, ~T GAT /L METERS fEEi 70 MODEL: 3871 9 30 8 - 25 7 6 20 ~ 5 4 15 EP05 0 3 10 2 5 0 °G 10 20 30 0o so usGaM 0 2 4 6 6 10 12 xPIN CAPACITY Pump Specifications Features and Benefits •/,6 and'/Z HP • EP04 impeiler- semi-open design Up to 60 GPM with pump out vanes to protect Maximum head to 32' mechanical seal. Discharge size 1'/Z' NPT • EP05 impeller -enclosed design Solids:'/." maximum for improved performance. Motor • Rugged.glass-filled thermoplastic All motors feature ball casing and base design provides bearing construction. superior strength and corrosion Single phase:115V resistance. , Materials of Construction • Cast iron motor housing for efficient heat transfer, strength, Cast iron Thermoplastic and durability. Stainless steel • Corrosion resistant threaded stainless steel shaft. • Available for automatic and manual operation. - • CSA listed models available. All Modets are designed for continuous operation and feature stainless steel hardware. S ioI w. w 4:. X n~ co~.y - "' ~ Madlsan, wI 53707 - ' sammry remit Nrmob~ to be tr~led in by Co.) ~ ~~~~~ IS r ~ g~65 De artment of Commerce Ste" ~r~.'~ . Sanitary Permit App ca - ersoratl Code Ad w armation you provide - , p m. >s. m accer~a wan Comm 83.21, may be ved for aecooduy purports Privacy , a15.Off~ ~ ~, 2006 Project Addre~ cd' di8'aeat than mailing address) L AppGeation Information -Please Print Afl Informatioe ST. CROiX COUNTY ~ ? ~ Property Owner's Name !S'e,2.~ Lot! Block ! Property Owner's Mailing Address Propetty Locatiar City, Slate Zip Code Phone Number IL Type of Bn7d (dr all that apply) P.Br'S ' Subdivision Name CSM Number ~'f or 2 Family Dwelling - N of Bedrooaos S ' '• ~ • , •...- ^ Public/Commeccial - Descnbe '; ~ ~ ~ ^City ^V illage }~'t ownship of~~"~~o~/ ^ State awned -Describe Use IIL Type of Permit: (Cheek only o 6oz oo Gee A. Compllete tine B if appliabk) , `" Q 20 - ~ ~{~- -' C'Z-t7u~ 3 A' mew System ^ Rep ^ Treanmart/Holdrng Tack ReplsCidment Only ^ Olher Modification to Existing System B. ^ Permit Renewal ^ Permit Revision of ^ (~ ^ Pert(iit Transfer to New Lim ~~ Permit Number and Date Issued Before Expiration Phmrber IV. T of POW'I'S S em: Check se that a `r- ^ ' ~NOn --Pressurized )n-Ground ^ Hotrod ? 24 io. of sot mgie Pass Sand Filter ^ ound <24 in. of sortable sort ^ -Grade ^ S Consuucoed Wetland ^ Pressurized )n-Grand ^ tio>dmg i ~` Peat Filter ^ Aerobic Treatment Unit ^ Ratiruilating Sand Fester ^ Recitwhrting Synthetic Media Fiber ^ Leachurg Chamber ^ T` Line ^ Gravd-lcss Pipe ^ Otba (explain) V. D' rroatmeetAtra Information: Design Fbw (gpd) tlestgn Sot? Application Rate(gpds~ - / - ~ Dispersal Area Proposed ( System Elevation ~ ' ~ , S ~ ' VL Tank Info Capacity in Total umber Gallons Cmlloas ` ofUnits Mamrfa~ ~~ ll„~-~'. c Prefab Site S Fiber Concrete Corrstruded Glass New ~6 ~~!t Tacks Tacks ~ r. L - p0 Acobic T~numeat Un@ DoanBL7umbc _ - _ VII. Responsibility Statement- I,. a nadersigaed, assure r+etpoasib for iestallatlon of the Wls showy oe the attached plans. -ess Phone Number i B Plumber's Name (Print) P. •1-~'/1~RS Number r us o TiS- 6-- moat/ ~D e ~ ddnss (Stttet, City, Zip Code) Plumber's A r ~C. Q /G.O ! ~F O ~1 'lT~'~ VIII, Conn /D a USE Ue Sanitary Permit Fee (' odes Groin ' Date ISSUed mg Agent Slgna (NO $tafnps) _ ~( )°IAPPmved ^ roved S . J Fes) ~' . ~ ?7 ~"'~!J ` Reason far Denial ^ IX. Conditions Apprnv 3\ p(„_„~ ~-(- .[}~'t`~ 5 d."~ ~ ~ t X "'_ SY TE "a.'~" u'~~~` Qr p 1 1 0. -~4.ur•'~ S'~.t-Q ~Q. °y M OWNER: S 1 Septic tank, effluent filter and ~ . Q,.~ ~,~, ~ [~- ~~ ~- S Y~ et.~QA ~r~ ` ~"` dispersal cell must all be serviced /maintained ~ ! as per management plan provided by plumber. ..~ s a~.iv~ cu.~ a ~ ~(,,~ ~~. ~ h"Q'~ ~ t~.r- 2. All setback requirements must be maintained / °"" / °~~~~ ~ ~e nor .nnnlin~hln nnilnlnrrlin~nnoo - n ,,2 CE~' '~ _._ r_. _.r r..__'_._ ____. _. _...-..___. . / Amy, k plan (to ma co.o<r eob) ~r ~ ~ 0° Paper not ku ma. alts : it ia~he is azc ~/ SBD-6398 (R.O1/03) r ~ ~~~-~ ~~ Jys7~~ -~'~ 7 /1ti9~~X~L• ~o(,t`c.u ~ Z~- i~ bra ,~~-~ ~T s~~/o d . ~~ ~~~ Sc,}L~ / `_ ~/o / LoT '°~/2 r-- Sr.+,r~~ loop --, _" YQ'~"L = A1T•/3»-~ p. pF~1" ST~e/ st~4K~, yy, XS, .----- ~~ = /Sa.e.r~~ ~ c tv,E LL ~ = /r2B0 ~iL. S. l . \. = /~DaaD mil' to/~,vER sysTE~ ° c s'• 9 `~4 ~~~ ~~ .j .~ ~ SS , s~ +; ,~•. t D ~~ .. ` " c ~~a \ c~3 /_~ ~~, D 1 c~"~ ~° ~~~ .' ~ ~~= /~ ~` , ~Ya i i / ~ f~rB~+c K 1° ~~~ry v~,a ~ • ~ j~i~~~ ,~rc,v,~ ~T' s~=~o G ~~-,r ~~ ~_, dry/ =,~,r~ rv ~F~ " ,rt St~'~~ ~ ov.~ ..--- Q ~Z = A1T. ~3 wt p.y cf ~i " S r~~ / rr.¢,~, y~, XS r------ IJ = /ScK.oJ~ ~ w,~ LL O = /,ieo ~~. S.T. c-~ //~~ q`.o c z ii ~` _~ ~ 9~.a 11~a c - 3 / t~. i t ~~ /' ~r ,_ R~CEI EV ~__.._. ~ ~ of ~ SOiL ALUATIQN REPORT Division ais~-and Bui(dirt~ R E C 2. ,9 ~ M: ~ 3 psee ~ f Attach site ply on not9l~ d[~~ Nf md~es tee. Plan mud . ac na ii~,ited ~_ and point . d~tion arxi tsiope.scste~d'inensions, tonean~stroad. F'aoa to. ~'~'" ~C `0 ~!/ Please prrat a~ lnfornial~ot>. ~ t~ ~0 ~ •~+r~vn,.r~~aro~~ow~.ro~vo~t~r~.~.,so4c+~cpa~. ~vw of s£ sec~- /~'~'lC'NOA1 ~~45 ~ ~,,L Gaut Ld>. t/4sw 414 S~'J T ~9 N R /9 ~IG{o~} w ~ Owner's Address ~y LA • ~~R G'~-- ~''~ ' t,,ot ~ ~ z 8iodc # subs. Ntane a CSM~ Ew N " Goo }~o Tom' ~ jpf-E' ., ffUOSo~ w . s4ail~ ?I S 38 •")'~7,~ ~ ~v ®To,~ , ~.~ ,~'~ ~+~ ~- Residerr'f~ 1 Wterrber of be<l-oona ~ Code derived dew tiow rai3e . yS0 -• o-a coo Q ~ ~ a ocwrrvrreraai - oescdbe: - -Si~,t~~T s'T~~ ~t ate, ,;f ~y a. General oomrr~er*s ~ ~ • ~Eif" T~.STc~ .S'vi'Tip;~/~. ~a/c~ ~,v %vyi2ovul7. ~aNvt,wrri~ w~,~Q_ t`~. O • t.~ . T •-s * ~ ~ ~ ~ t~tsur~eeler. `~l• ~;f. ~, ~, • ~9 ~. soil lie Maimon Oeplh Oarerinant Riedox Desalptlon TeoAue 8trudrs~e C.a>aistenoe 8andary fioets t ~ Qu.13Z. Cori. Color Gr. S'z. Sh. 'E>l~i 'Et'f~2 / ~- /r ! 6 yi2 3 G. ~~~ fs~j~. ~ ~ ccv .3 . s . ~Q z- ll• Zo ioY~ s/ --- Si ~- /fs~~ GP ~ l7 c's 2 • z. • o • o s ~ ~---~ ~ s~ ~ f 2 ~s ~s ! •F • Y •So 7•s s -- ~ S A. cs -- • 7 <~ S o• o ~o ---- S D- .? l~ 2 4~ .~ ~~.~ y .6 ~• ~ •~ 2 # o y-,, 9a .~ ~ ~ ~ ~ C~roundsurfaoeelev. n. . ~,,~t~' ~..~,. - ~i liot~on Depth DorNner>t 1Zedooc Desaiptlan T SQuaure Cow Bouncy tZoots Gt r kr. Qu. Sz Cart. Cobr Gr. Sz 5h. 'F.f~1 'Eif#2 z _--_ ~ J cs / ~ ~-. 3 ~L /1'~ cis ~S ~ 5` • G S p S 4 , ~• ~ 96•~~ a~-9s z e:sr 2 ,~ • ~t = soo ~ 3a < 22a mdl. and Tss >30 < 1 so maA. • t' it2 =Bo o <_ 3o mM. and Tss <_ ao maa. . csr i .o ~ ~.'[-' ~ ~ b ~ i C f,~. ~ ._ sip 2 ~ - Address Oete Evakretiar Conducted Telephone t+lucnber rnvate Sewage Consultants 2812 10th Ave. SIN S ~~2 ToT,q-,G of g0 J¢Gu Spring VaNey, WI 54767 20 • /oa.-7. 30 • o-aa 2.0 . io~-~ . yo . oao y r. ~t ~i rya T~ ~,~~ ~'~Rtia~v T3~-s r' Parcel ID # Page of © ~~ ~ ^ 8orin9 ~/ ~j / Pit Ground surface elev ~ / • d ~ ft Deptli 1o Cm~ng fac3or >~`p in ~ ~ Ftorizon Depth Darranent Redaa Oesaq~tion Texture Structtse Consister-ce Boundary Roots GPDJfF in. Munsep l]u. Sz Cont. Cdor Gr. Sz. Sh. •Eff#1 'Eff#2 ~ '2 L /7c .S s' ~• Z o D , eoru~g ~ ^ Pitt ~ Ground suface elev. R D~th b ~rNting factor • in. Soi Rate horizon Depth Dorrwtiant Redox Description Texture SUudtAe C~ Botmd~y Roots GP D/tF kr. MunseA Qu. Sz. Cont. Color Gr. Sz. ~. 'E~f1 'EtN{2 Bori<g # ^ ~9 ^ Pit Ground surface elev. R Depth to • in. Sati bate Fioriaon Depth Dorrw~ant Redox Description_ Texture Cansistenoe Botmdary Ram GP DIfF in. ~AurueN Qu. Sz Copt Cobr Gr. Sh. 'Effifl 'E1f#2 • Eflk~ent #1 = Bt7Ds > 30 < 220 Rgrl, ar~d .~ > < 150 ~ • Eflfuerx #2 = BODs < 30 tngtl. and TSS < 30 mglL The Department of Coaunerce is as equal oppo ity service provider and employer. If you creed assistance to access services or need material in an aiberaate forma please cxnttact the department at 608-2fif-3151 or TIY 60&264-8777. saa-tnoR~> ~ .. - ~-- . .~"`- ~~ ,~~ 'f ' ~ ,~ For issuance of permits and designing Contact: Uibricht & Associates Registered pmate wastewater co 2812 10th Ave. Spring Valley, Wi 54767 ~ 715-772-3442 ~~~-~ ~~ ~~s S ~ ~~_ ,~~~~ S' / ~j - `,, ~` f, ,•` ~~~ ~/~ . • L~0 D ~~,~ ~~ ~ ~ s r ~M `' ~' ~ f p lbo.t? ~~ ~' ~~ ~~ 5 ;~ , ~ ~,~ ~~i 0 tb ~ ~ ~ rt y ~i e z ~i . ` /` ~~ ~ba ~ ~o~ ~~~ o~~D , 4 -E ~~~ 5oR ~~~ , ,,~, i?a ~ ~~~~ D r yo ---~'.. ~3b / r n / n ~ / !~ "' '7 w ~ Q~ a l ~ ~ ~ ii ~. . 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YLJW 1 ~ V1IVIVCIS J IVtA1VVNL Oc IYIHIVNVa.nn~.~~ ^ ~ ~-~'-~~ rayn~w FILE INFORMATION owner (~ !y0/~ ~~~ " _ Permit ~ -Q / ~' nFCCrtu aeRetut~as Number of Bedrooms ^ NA Number of Public Facility Units ~~- Estimated flow (average) 0 aUday Design flow Ipeakl, IEstunated x 1.51 ~"~ aUday Soil Application Rate V ; al/day/ftZ Standard lnfluent/Effluent Cluality Monthly average Fats, Oil & Grease iFOG1 40 mg/L Biochemical Oxygen Demand (GODS) 5220 mg/L ~ NA Total Suspended Solids tTSS1 <_150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand tBODS) 530 mg/L • Total Suspended Solids (TSS- 530 mg/L ^ NA Fecal Colifomn (geometric mean) 51 O' cfu/100m1 Maximum Effluent Particle S¢e Y$ in dia. O NA Other: ~ NA "Values typical for domestic wastewater and septic tank effluent. cvctrY caFr~lareTlANS vSeptic Tank Capacity ,Z ~'v al O NA Septic Tank Manufacturer .. ^ NA Effluent Filter Manufacturer ,~ ,E[ ^ NA Effluent Filter Model _ p~ ^ NA Pump Tank Capacity s-d ~ ~1 NA Pump Tank Manufacturer ~ '~~ ~ NA Pump Manufacturer CJ ~ Pump Model ~ ® tJ .IVA Pretreatment Unit [J Sand/Gravel Filter p Mechanical Aeration ^ D'~sinfection ^ Peat Filter O Wetland D ~= ~ NA - Dispersal CeNtsl ~( tn-Ground (gravrtyl ^ At-Grade O Drip-Line ~ NA ^ In-Ground (pressurized) ~ Mound 0 ~~= Other: ^ NA Other: ~ NA Ocher: ^ NA MAIN-II:NANCt sOrtt_uucx Service Event Serwce ~ Inspect condition of tank(s) At least once every: ^ month(s) tMaxucacm 3 years) ~yeartsl C] NA Pump o_ut contents of tank(si When combined sludge and scum equals one-third (X31 of tank volume ^ NA Inspect dispersal celltsl At least once every: ~ monthtsl tMaxinwm 3 years) ~ yeartsl ^ NA ^ monthtsi ^ NA Clean effluent fiher At least once every: ' , yeartsl ~ nwnthlsl •~Nq Inspect pump, pump controls & alarm At least once every: p yeartsl ' ^ month(s1 Q NA Flush- laterals and pressure test At least once every: ^ year(s) Other- At least once every: ^ month(s) ^ yearlsl _ r1 NA Other. Q IVA MAINTENANCE INSTRUCTIONS Inspectwns of tanks and dispersal cells shall be made by an individual canying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer; POWTS Inspector POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observatwn 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 IY31 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. =' 2 3 .,vtiT UP AND OPERATION ' For new constructieur, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operatcx prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overbading the ceU(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a septage Servicing Operator pear to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist ~n 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 perfomnance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental foss; 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 acode-compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the locafan 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- Falure to protect the replacement area will result in the need for a new soil and site evaluation io establish a suitable replacement area. Replacerne~rt systems must comply with the rules in effect at that time. ^_ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. f], The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN.-DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFlCULT OR IMPOSSIBLE. e nJn o i #22118 _ - c en e Spooner wt Ra>aAt. _ {715) 635-609 ~ POWTS INSTALLER POWTS MAINTAINER ~ - Name 1 (~~~ ~ Phone °~~~~ ~3 - ~v9 Name Phone ~~_ SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY - ~.._. Name Name ~ 1 ~ f x ~~ ~ Phone ~(S-' Phone This document was drafted in compliance with chapter Comm 83.22121(b)l111d1&(fl and 83.54111, 121 & 131, Wisconsin Administrative Code. ~,,.°• ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSIiIP CERTIFICATION FORM OwnerBuyer _ __~Fi2e~oi/ ,SST Mailing Address q ~' ,1,~ /~.iz ,r /~ f/ ~,C~~B,r/ u,~. s- yp~~ ~ Property Address (7L ,r~,~~. T~~sr/v~ ~i, (Verification required from Planning & Zoning Department for new construction.) CitylState /,~y ,(/ _ Uu,,,~~ Parcel Identification Number _ LEGAL DESCRIPTION Property Location /Y,cJ '/a ,Sr,~J '/4 ,Sec. /.> , T ~,~N R~_W, Town of /~Gipsor/ _ _ - _ ___ . Subdivision ~OyB ~~ y r ,Lot # ~. ?---- Certified Survey Map # '~ ,Volume '~- ,Page # Warranty Deed # 7 5o y Ya ,Volume ~y~ "7 ,Page # /emu Spec house yes ~ Lot lines identifiable ye no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner mai~enance responsibilities aze specified in §Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Depazto~ent a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standazds set forth, herein, as set by the Department of Cormnerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be cornpleted and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/aur knowledge. Uwe amaze the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number o ed ooms i _/_/ I AT'IJRE OF PLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) V ~~ 8~ ~P. I Z o ~sm9~~ ~3 STATE BAR OF WISCONSIN FORM 2- 2000 Document WARRANTY DEED THIS DEED, made between Kernon J. Bast, a married person, Grantor, and Kernon J. Bast and Donalda J. Speer-Bast, husband and wife, as Survivorship Marital Property, 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 Recording Area KATHLEEN H. IiALSH REGISTER OF DEEDS 5T. CROIX CO.. WI RECEIVED FOR RECORD 01/07!2004 12:35PI! WARRANTY DEED EXEMPT lk 8M REC FEE: 13.08 TRANS FEE: COPY FEE: CC FEE: PAGES: 2 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 8c20-00 Pazcel Identification Ntunber (PIN) This is not homestead property. Dated this 6th day of January, 2004. * ernon J. Bast AUTHENTICATI~C0~1n Signature(s) _ G oeC~_P~C ~ authenticated this 6th day of Ja;~g TITLE: MEMBER STATE BAR 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 (Signawres may be authenticated or acknowledged. Both are not necessary.) •Names of persons signing in any capacity must be typed oc printed below their signature ACKNOWLEDGMENT STATE OF WISCONSIN ) ST. CROIX COUNTY. ) ss. Personally came before me this January 6, 2004 the above named Kernon J. Bast, a married person to me known to be the person(s) who executed .the foregoing instrument and acknowled the same. _J/~" *Cheri Brown ~c Notary Public, State of Wisconsin My commission is permanent. (If not, state expiration date: 3/11/2007 ) WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000 ~ 2487P 121 EXHIBIT A The NE '/, of the SE '/. and the NW '/, of the SE '/,, all in Section 1 S, Township 29 North, Range 13 West, St. Croix County, Wisconsin, EXCEPT a parcel described as: Beginning at the E '/. comer 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 2S 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 O I 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. OWNER BLUFF CREEK BUILDERS ATTN: TOM MEYER 1211 COUNTY ROAD "P' HUDSON, WI 54016 NOTE: SURVEYOR EDWIN C FLANUM NORTHLAND SURVEYING, fNC. P.O. BOX 14 ROBERTS, WI 54023 THE PURPOSE OF THIS SURVEY IS TO SHOW THE PROPOSED BUILDING SITE AS DETERMINED BY THE BUILDER AND LOT OWNER. SHOWN FOUND LATH WERE LOCATED ON JANUARY 31 th, 2006. NOTE: SEE THE PLAT OF COYOTE RIDGE FOR EASEMENTS, SETBACKS, AND ANY OTHER INFORMATION WHICH MAY BE PROVIDED ON THE PLAT. LEGEND ~ 3/4" IRON REBAR FOUND , , .. , , . , , . 50' ROADWAY SETBACK LINE ® FOUND LATHE _ _ . , 12' UTILITY EASEMENT '~ , EDWIN C. . ~' ~: = FLANUM S-2487 AMERY = W IS/ ,.~; 4 _• ,' .~~ ~~i~ p~rp ~!rnt~ln+ua'~«~~ ~J THIS INSTRUMENT DRAFTED BY KEVIN REED JOB NO.06-08 DATE 01-30-06 1~ N o ow U ~ .... ~ ~ W ~ d04 ~ 00 ¢ o ~O "_ ~ ~p ~~,^~ ~ a I w= `~ m r Q - _.~_-i_ _ ~ - aNc, i~ ~ ~ k ,~~ ~° ~ ~ I ~ ~~ ~ ~ I , ~ - - ~,~- ` / ~ ~~~ ~ _--- ~° ~ --- ~~ ~V I ' / / ~~ ~ s o ~~ / L t~ X04 ~ s ~~~" ~ ~ - - \ ~ ~~ ~ ~a \~~~~ ~,~ ~~~,~ 4l SCALE IN FEET 1" = 80' 80 0 80 1 TsvN. R1 ~YV ~~ wu, oo~ . sEGtioN 1b ~..~ 1~ _- _ -~- e~sr • west w us: aF ~.TOn a W? 4 4 ~,pT t0 7l.tA 11CAE8 ~ ~ 4.tl0 M~8 l~OS 8d. FT. ~ !d'JY'7 SQ. FT. ~ 1,8.0.. al6.s0 •+ 4 r ~aT 4 ® .. r~ ~r 1ssl4T~ . ® ® -' - . . a.u~ _ - --•--•~.. 1~ ao. ~t. ~'\ J , ;• ....: :~~%`~~ ~ `.. ;~ ... ~ ~` %` .r. ~ ® •, ,,~ ~, r ~ / ~f ~ ~ ' ~ / DoT to 0 '~,~ ~, !g„CaA,W( J ~ ®~, ~ toroF~ ~oa~e ~ 2.zsMCnEB ~; ~,A air. - Nue / ; , ~, 9ec~ SQ. Fr. ,' ,% ~ ~ ~ i 8 ~~ i ~ ,i- at t ;tRO. ~ ilt, - i jam/ /• ~ ~ /~ e } x .. . ~ LOT ! ~