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HomeMy WebLinkAbout020-1447-24-000~o~ ~ ~~ ~ Nisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division v J 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 Townshi CST BM Elev: Insp. BM Elev: BM Description: ~ ~ I ~~j_D (~-~ ~V~-Pl IHIVr\ IIVr'VI'CIVIAI IVIV TYPE MANUFACTURER CAPACITY Septic Sd Dosing ~~ Aeration ~1D~ Holding TANK SETBACK INFORMATION TANK TO ~P/L/ ~ WELL BLDG. Vent to Air Intake ROAD Septic ~ ~ ~ ~ ~ 1 ~ 1 Dosing b~" (/i2~ Aeration __ Holding ~ ~~ ~~-~ d2 PUMP/SIPHON INFORMATION ~ vi N ~ . Manufacturer Demand GPM Model Number TDH Lift Friction Loss ys ead TDH Ft Forcemain Le Dia. Dist. to Well tLCVAIIVIV UAIA county: St. Croix Sanitary Permit No: 463107 0 State Plan ID No: Parcel Tax No: Sectionfrown/Range/Map o: 15.29.19. STATION BS HI FS ELEV. Benchmar .~z) 3 •~S l~'' ~p0 Alt. BM. ~h-e-e-w~~~ ,~ , 5~:~' 9 . ~ Bldg. Sewer 30~ q r_ .3~ SUHt Inlet 9 G _! , v2 SUHt Outlet ~--- ~ o . ~ 93. s Dt Inlet .-~- Dt Bottom ~-.~ Header/Man. Q, '~ I 1 „~ !-~ Dist. Pi 2 "! , Z. Bot. System ~ I ... / Z Z- Final Gra st Cover / ~ ( ~_~ 7`- ~ 3 C~ r, ` ~ d C~b L SOIL ABSORPTION SYSTEM '7 7. -~ /_ ~ ~ `7'"~ -{~/--~~ - b.Q,tir,5. /itrs-j~.//(/p~(~`~%1~7'• BED/TRENCH DIMENSIONS Width ~ ~ ~ngth ~ .~ No. Of Trenches (D/,r !/ Oil`- PIT DIMENSIONS No. its Inside Dia. squid Depth SETBACK SYSTEM TO P BLDG WELL LAKE/STREA LEACH NG nufact ~` ~ INFORMATION CHAMBER OR d}~T I Typ Of System: ! ~~ ~ / UNIT odel Number: DISTRIBUTION SYSTEM Hea anifol~l Distribution x Hole Size x Hol // Pipe(s) ~ / ~~ ~---~._ Length Dia 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/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil '~~ Yes No ~~ Yes [~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~/~~ Inspection #2: / / Location: 927 Coyote Lane Hudson, WI 54016 (NW 1/4 SW 1/4 15 T29N R19W) Coy to Ridge Lot 4 7// Parcel No: 15.29.19. 1.) AIt BM Description = I I ~~~h ~~ ~~ ~~ ~ ~~ ~ ~/a ~ D ~ `~ ~u ~'~''I I~ 2.) Bldg sewer length = 1 ~ £b~ t k S~~a ~ ~'`- ~jl S+Gyic U 5~+49'~ . -amount of cover = ~ c f r ~ ~ ,/„~G, ~~"~ '-"~ `--~f~(,Cl~u~ 2 r~td ~ i~d'd Plan revision Required? ,Yes ~~ No ' ~ ', Use other side for additional information. ! ~°~ 1 ~~ ~~ J ~~ __ ___ _ _ ~ ~6~ SBD-6710 (R.3/97} Date Insepctor's Signa re Cert. o. I'd. ~{q~IrPJZ 6tit ~rk~ta(L.e~ e Spacing Vent to Air Intake ~.~, ~ y~ , -E7 G 1 .-:. ~' r~~;~~~ VN n it f ~1 safety and Buil on"ty ~~`~ 201 W. Washington A ., ~~~" ' ` in i Madison, WI S 707 - 7162 Sanitary Permit Number (to be filled i by Co.) seons (608) 266-3151 ~l6 De artment of Commerce Sanitary Permit Applica 'o~,E~CEtVE S to PIanLD.Numher, NI ersonal info ion you provide Code Adm Wi 83 21 i h C , p . s. . , t omm In accord w may be used for secondary purposes Privacy Law, sl 04(1 xm~ ;_ f ~ ~ 2~ 0 fl ' P )ect Address (if di Brent than mailing address) t 1. Application Information -Please Print All Information 00NTY AA '' 7 L/C/• 51.CRUI~0 Property Owner's Name ~ ZONING OF P cel # # Block # ~ ~ Property Owner's Mailing Address Property Location ~(' l ' I / v ~ %., ~~^S/., Section ~~ City, Stat de Zip Co Phone Number e I ~l~i~-9~'~^'l ~'L-~ ter / / ~Z CSU~(~j / /~ 7j,~' /m m '!9 ~ ~( T~N. R~ ! cEc1eW II. Type of Building (check all that apply) ~ Subdivision Name CSM Number ~1 or 2 Family Dwelling - Number of Bodrooms ' ^ Public/Commercial -Describe Use Q L S~ ~S ~ ~ ~07 ity_ Vil a ownship of ^ State Owned -Describe Use III. T ype of Permit: (Check only one box on line A. Complete line B if applicable) '~' New System ^ Replacement System ^ Treatmenr/Holding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ge of ^ Chan ^ 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 i Non -Pressurized In-Ground ^ Motmd > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized U-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter beaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain} V. Dis rsaVfreatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevati~n a ` ~ ! ° ~ a~ ~ 7 s £3 7l VI. Tank Info Capacity in Total Number Manufacturer Prefab Site eel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank !^ V ,i V r ~ ~ ~ ~ ~ ~ ~!:~,-Ci'~`L Aerobic Treatment Unit Dosing Cbamber VII. Responsibility Statement- 4 the nadersigned, assume responsibility for Nation of the POWTS shown oo the attached plans. PI 's Name (Print) Plumber' ignat re M /MFRS Number Business Phone Number ~- ~ ~~a 3s ~/S ~ ~ ~' u tier's Ad Tess (Street, City, State, Zip Code) / ~ ~ -~ ~v. ~ ~ T s o~ VIII. un /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date Issued Iss ' g ent S~ign~ature (N ps) proved ^ Disapproved Surcharge Fee) J'D /a- ~ ~ ~V ~~ ~2 ~%X-r~`r- V ~ ~ ^ Owner Give» Reason for Denial IX. Conditions of Approval/Reasons for Disapproval //,~.,, l d ~1 0 - S S-~~ ~5 - ~~ ~ /~~~ G~G~~ ~ ~ ~ ~ ~ wtaca totnptere pwm tro me a.uunry omy~ .or ...~ .~..~....... r-r• °- k SBD-6398 (R. 01/03) ~~ a -i~~, z~-~-F y~=4 y ~aa' ~~s-a ~~. ,~ ~~ -1= ~,13~-a- ~~' y . 0 1bc~ ~ y- fly ` ` v~-- roo T _ ~~ %y----- U ~ _ ~~ h t3-1 ~r o N~ 3 ~ I c :; ~ J d o ~ 3 A 3 o ~ ~ I . .~ I ~ ~ ~. ~ ~ ~ ~ 3 ~" :~ ~ p n '. ~ ~ A'+ n s ~ ~ Z ~ ~ ~ c ~ e~ !~I• O C N O ~ 7 O N j ~ O ~ ~ N O- 7 7 ~~ I O yy R I o ~ m ' , ~ ~ i ~ ~ N S r ~ ~ N _ ~ I m cnZD co Dy ~ a'~ a ~' t~ C I ~ 3 o. W ~ ~ ~ r ~ ~ O o N ~ O ` ~1 L ~ CO W = O Z O pooa A°p ~ nrtn ~ ' Q I , . 3 .^ -~ ~ ~ l~i ~. ~ v ~ ~ °: o C ~0 ~ ~ ~ ' p N ~ o a Q A G O O ~ W m ~ ~ 9 ~ ~ ~ ~o • ~ d ~< 3 d (~D N I ~ a .. I o : ~ ~ O ~i y ~ ~ ~ ~ ~ ~ ~ _ y L S O O ~ ~ ~ ~ ~ 3 ~ ~ ~ ~ A p Q j ~ • ~• I ~' N ~ ~ W •a 0 i a ~ m I S i Z O 'o 41 ~ i ~ a ~ O s -1 N A ? n =f ? N ~ C 1 T 1 j ry ~ i d 7 7 ~ a A~ 7 O ~ p_ -w O ~~ f f D M W ~ Z ~ ~ ~ ~ O a ~ ~ Z A .Z7 f G %~ ~ ~ I ~ ~ ~ Z ~ A A I ,y w°°_ ~ n I m ~' a .. ~ y o. ~ ' ~ I v m e d ~ o a I a o ~ `~ I I ~ f I a ~. I m ~ ~ ~ o < ~ o ~ ~ ~ I ~ ~ ~ ' on . ~ -~ N y O ~ A I ~ A ~ ~ I ~ ! vo }°v can O ~., ~ ° ~ v' - o Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT in accordance with Comm 85, Wis. Adm. Code 1597 Page 1 of 3 Steel's Soil Service, Inc. County Attach complete site plan on paper not less than 8% x 11 inches in s¢e. Plan must St. Croix indude, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I D percent slope, scale w dimemsions, north anow, and kxation and distance to nearest road. . . Pendin _......_.[ g Please ~nt ~rif~~'11.34 D t i Personal information you provide m i 15.04 (1) (m)). ~y be used for secondary purposes (Privacy lair s a e ewe y Rev , . ~ / 2"6 Q Property Owner ~~ Q~ Property Location McCabe Homes Inc. Govt. Lot na SE 1/4 SE 1/4 S 15 T 29 N R 19 W Property Owner's Mailing Address , ; ~ ;; Lot # Block # Subd. Name or CSM# 935 Osprey Blvd ~ << ~,1 ~ ~'i=r ~,-- ( 24 na Coyote Ridge City State Zip Code Phone Number J City ~ Village ~ Town Nearest Road Bayport ~ MN 55003 651-351-1018 Hudson Coyotey Rd New Construction Use: ~/ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement ~ Public or commercial - Describe:na Parent material Outwash Flood plain elevation, if applicable na General comments and recommendations: Conventional system, sysetm elevation. Trenches spaced and depth to code 5.50ft below grade. 2.2 ' ~~ ~j_ s Boring # J Boring ' 120 Pit Ground Surface elev. 97.40 ft. Depth to 1/ in• limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *EfF#1 *Eff#2 1 0-30 10yr3/1 none sil 2msbk mfr cs 1f .6 .8 2 30-40 10yr4/4 none sicl 2msbk mft cs na .4 .6 3 40-52 7.5yr4l4 none sc /sl 2 sbk mft gw ~ na .4 4 52-120 7.5yr4/6 none cos osg m na na .7 1.6 2 q- S 2 Zf ~ ~h (~Z ~~ ~3s~ . , Boring # J Boring it Pit Ground Surface elev. 97.40 ft. Depth to limiting factor 120 in. Sod 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 0-11 10yr3/1 none sil 2msbk mfr cs 1f .6 .8 2 11-30 10yr4/4 none sicl 2msbk mfr cs na .4 .6 3 30-46 7.5yr4/4 none sl 2msbk mfr gw na .4 .6 4 46-120 7.5yr4/6 none cos osg ml na na .7 1.6 (~Gi 2 ~ ` fi ~ * Effluent #1 = BOD 5> 30 <_ 220 mg/L and TSS >30 < 150 mglL * Effluent #2 = BODS < 30 mg/L and TSS <30 mg/L CST Name (Please P 'nt) rg ture: ~ CST Number David J. Steel ~ ~--~~ 248956 Date Evaluation Conducted Telephone Number ~ Address Steel's Soil Service, Inc. 11/29/2004 715-684-5680 ~ 994 200th St., Baldwin, WI 54002 Property Owner Mct:abe Homes InC. Parcel ID # Pending Page 2 of 3 Boring # ~ Boring Pit Ground Surface elev. 98.80 ft. Depth to limiting factor 120 in. Sob Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eft#1 *Eft#2 1 0-18 10yr3/1 none sil 2msbk mfr cs 1f .6 .8 2 18-34 10yr4/4 none sicl 2msbk mfr cs na .4 .6 3 34-57 7.5yr4/4 none sl/sict 2msbk mfr gw na .4 .6 4 57-120 7.5yr4/6 none cos osg ml na na .7 1.6 ^ Boring # J Boring J Pit Ground Surface 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 Pit Ground Surface elev. ft. Depth to limiting factor in. Sod 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 =SOD 5> 30 < 220 mg/Land TSS >30 < 150 mg/L * EfFluent #2 = BODS <30 mglL 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 608-264-8777. s Page 3 of 3 STEEL'S SOIL SERVICE INC. David J. Steel CST-POVVTS Lic. #248956 McCabe Homes, Inc. S E 1 /4, SE 1 /4, S 15, T2 9N, R 19 W Town of Hudson, St. Croix Co. Coyote Ridge, Lot 24 994 200th St Baldwin, WI 54002 Bus.(715) 684- 5680 Fax (715) 684-3449 Legend 1" = 40' • =Benchmark Ele. I OO.OOft Top of 3/4"PVC Pipe ~ =Alt Benchmark Ele. 100.00ft Top of 314" PVCPipe ^ =Borings Boring Elevations B l = 97.40 ft B2 = 97.40 ft B3=98.80ft B4 = OO.OOft Safety and Buildings Division County , ri • ~ 201 W. Washington Ave.. P.O. Box 7162 ~%L-~~~ ~seons~n Mae 608W266-3 I S 1 7162 Sanitary Permh Numbu (to be filled is by Co.) De artment of Commerce ( 3 ~ ~ I.D. Number Sanitary Permit Ap c fZECE(VE In accord with Comm 8321, Wis. Adm. Cade, m) ~ov~ Project dress (ifttitferent then mailing address) may be used for secondary purposes Pri I~, 1. Application Information -Please Print All Information ~pC`~ ~ /~/ arcel, ~ Lo Block M propatyOwns's Name ZONING OFF ti property Owns's Mailing Add 7 ~r ~ y., ~'/., Stction 1~~ City, SGtte Zip Code Phone Number ,~ / / unclep~ i' UY 6 / ~ ~ ~~ T ~N: RorQOV [L Type of Buildiag (check all that apply) I~ S S Subdivision Namc , CSM Numbs 1 or 2 Fatuity Dwelling -Number of Bedrooms ^ PubliclCommerciat -Describe Use ^C' ^Vil ownship of ^ state owned - Describe vse III. Type of Permit: (Check oaly one bo: o 'ae A. Complde line B if applicable) - /D O A' New System ^ Replacsrtent System ^ Trcadnent/Holding Tank Rep t Only ^ Oths Modifiation to Existing Sys List P P r B. ^ Permit Renewal ^ Pamit Revision ge of ^ Pamir T fu to New Before Expiration Plu Ownu ~ ~ Z N. T of POWI'S S cm: Check all that a Non -Prrssuriud In-Ground ^ Mound >_ 24 in. of suitable soil ^ ound < 24 i of suitable soil ^ At-Grade ^ Singie Pass Sand Filtu ^ Wetland ^ Pressurized In-Ground ^ Holding Tank Peat Filter ^ Aerobic Treatment Unit ^ Rocircula6ng Sand Fitter ^ Recirculating Synthetic Media Filter beaching Chambs ^ Dri Li ^ -less Pipe ^ Oths (explain) V. Dis rsaVl'reatment Area Information: Dispesal ~ ~ (s~ Disposal Area Proposal (sf) Syst ~ EI ~ ~ ~ ~ Design Flow (gpd) Design Soil Application Rate(gpdsf) ~ r \ (f~~.C,~ _ _ der ~ Prefab Site St Fibu Plastic YI. Tank Info Capacity in Total Numbu ufacturs Concrete Constructed Grass Gallons Gallons of Units ~~~ `1~~/ New Existing t J Tanks Tanks Septic or Holding Tank .~ ! ~ 1 ~ 'f' i~ Aerobic Trcatmnu Unit tbsi~ CYumber VII. Responsibility Statement- I, the andetsigaed, assarae respoast ty for lastallatioa o[ the WTS shows oa the attached plans. Plu s Name (Print) Plumbs' igna P PRS Numbu Business Phone Numbu f ~ ~ao3s 7~s~ab~-G Pt~~~ddress (Strcet, City, State Zip Cod ~ ~ l~ ~~ \'[II. Count •/De artment Use Onl Sanitary P t Fa (i lodes Groundwat Date Issued lssuin gent Signature o Stamps) ~ApPfO~ ~ Surcharge F ) ` en Rtason for ial ~~ ..._- ~ 13~ i~. Conditions f A rove al 3 S "'""u'~ ~ PP ~ S SYSTEM OWNER: ~ ~~. ~- -Sac . , 1 Septic tank, effluent filter and t II ervic d i ~Q.a~ dispersal cell mus a be ~ ~~ f , as per management plan provided by plu er. f 2. Ali setback requirements must be mainta ed as per applicable code/ordinances. Attach eowpkte plain (lo the County oaty) for the ayetem oa paper dot tas than ittZ : tt ruched is size SBD-6398 (R. Ol/03) _ . ~- - ... L ~~ ~. ~ w 1} ~ ~ Q /> >.. O i ~~ S ~. '~ y ~ .. ~g ~ Q, ~ ~i ~ -~. art ~ r ~l ' ~ } ~~ ~ ~ ~} ~~U ~ i t ~ Q ~ ~ ~i ~ ~ d ~ ~ c ~~ ~ © ~ ~ ~ ~ ~ ,~ ~ ~ ~ ,~ o ~ ~ ~ ~ ~~ ~ ~w 0 -~ i~ ~- o ~6 ~ ~~ 0 '~ v 1 ~ ~ ~ ~ '~ ` ~ 1 ~ I ~ ~~ ~ ~, ~ o -~ ~ ~ d v~ 1 ~ ~ ~ ~ ~~ ~ ~ .~ ~' • '~ ~ ~ ~~ 4 RECEIVEC~ ~ J ~ wsconsin a of - _ SC~iI EVALUATIQN REPORT 3 txvision of s~yend D ~ C~< t~ornm as. vi+ls. Ilctrn. code r«.,ty s T cR Or ~ ~h oar,pteoe ~ ptan ~C„ in~es in etas. Ply mgt ate. >~ not to: rtuai nc~ point (~. direx~ion and Paroel t.o. ~•~- ~C `p w percera slope. scale prim l~na ~ ~ d to r~rsst road. _ - Please print all IMwr>tatfon. RevlaM~a ~' ~e laeaoiW tetom~eNon Y~ P~~ mhr ~ used tsrasoonoeey ou-iwsss (Prtracy caw.: {5.04 t+) t~M- ~y ~,,~ f S£ SE;GT• t ~ Propertytcc~ior- ,i ~'~iP~vo,v 13f~S T corc cac iVq! i~~~ ira ~~T 19 N R /~ ~-(or} w t~„ers ll~ling Address lroc s* ~ sma. ~ o< ts~ E,t' .u ly L • ~r1~R G'~ ~,a ' Z a ~o }~o r~• ~fv~-E ', state Phone Nun6er [] ~ ^ vie ®Town t Road t~UDSo ~ 4>l. s 4ot ly ?t S ~ 3 8!~ •n?S hE vOSo.J !3A'~i~~ ~~ Newconatn,c6on user R~esidenfial l t~unberof bedrooms 3 " cove ae~ea desi~ boar rate y.SG -" ~ GPD ©~ ^ Pubt;c a tiornrr,arrlet - Oe~e: .- ~ - Peretyt mnteriai 5f}N~/ t) U f . ~ifF~ Fiona Plan efeeion if alppi~e /~/ ~ ~ . ,~Q~,i'F T~'S?"it:'D ! 5 Stl1Ti9-~f3 /~ . ~o!c' ~' jli~fy~;r~,v~j .coNv~flo~q-~L ~ ySf%2w~- C It? D, lei. T= S•, -- l3 ~'o v~ F~s~ Q c~ '`~`~° ~' °~ ~ ~ t~anrrd surtaoa ste+-. ~ 7 ' ~ ~. ~ e ' ~ ° t"• - Sd, Zee ~ ~e~e e e ea.rdsr)- Roots irr. llu. sz coca. caor c1r s:. st,. -~, tS o Y ------ S~~ f ~ls crv /f • s iS .3 /o ---- - /L / v c ~ • ~- . D --- 5 D ~ S a~ 2 ~ Ptt tiortzon Depth Oon~ent M. tidurrSeR _ ~ t~OUtrd surface elev. tt. Degh b twg tACtor ~- Reaarc Desaiptlon Te~arxe Stnrdue C,a~ban©e Bounc~ry Qu. sz Cont. Color Gr. Sz Sh. - Sal Raba Roots QPOdI! "E~1 'Eff#2 ~ ~ ~o ---- ~. ~ f~sbk ~ 3 •~ s • z • I ~o ------- r~ z sh w /f- , s ~o Y -- ~~G i S c .--_ s t. t~,ent #1= t3on ~ as _< r~o rriglf. and,5s >30 < i so mgt. • ~uera ~ = t;vo < ao rrgl[. and •rss ~ ao rrrpn. - `~ ~"~. ~ ter- ~ ~b ~~ ct, i " 2 q ..L Oete Evaiu~On Conducted tio~• ~6'• 2~3 7elapt~orie Ntn~er 7~s•~~a•3~~Z Private Sewage Consultants O 2812 10th Ave. ~/N S f-o~2 TOT,q-G of O ~ Spring Valley, WI 54767 Z O • to 2'7 . Z o • Ozra .ZO • /0~.7. 30 • azra 2.0 • io1-~ , yp • aa~ u ~ yi, T~ `, ~;©i~ ~~Rtia~ ~,~~- Hof ~y z 3 y ortmer Parcel ro # ©~ ~ ~ ~~' ~ 3 y Page of y~Y Pit Ground su-tace elev. ~ Depth to frrdl6g tactor i<r. Hori~ott Dotnarant Redox Desaip5on Texture SLtrata+e Cortce Bomar Sol Roots Gp Rye pm, in. tiAunsel f]u. Sz Coat Color Gr. Sz Sh. 't~f'I 'Effli2 • ~ is y ~ ------- ~ z ~ .c cs i~ . s . ~ , ~ •~- ~a y - iL 2fsh ~ ~S - S .~ 6' © SQL ~f alt ~S -- .Z -3 • ~ l0 ~S MO SiL d ~, c{, $ o 0 . sL ~. s yR ~- s y ~ L p „~ a2 l~ a S - ..3 . S' ' - o - nr-tai. S D, S eQ.~Q,. . `7 /. Z, , Q ~ # O Dir GrrxeM Stufaoe eiev_ $ rle.dL. s• G...i1:.... h.r.... ~ - -____~ Fioriwn Dorrunant Redox Description Texture • -.. --- _.. Strucdxa Come Bormdary Roots ~ Rate GPD/fP in. Mutrsell (lu. Sz. Cont. Color Gr. Sz Sh. 'Hd~1 'EtTli:1 r! ~ 5 ,~ ^ ~;~ Grormdsurtaoeele,-. Denthto~Srrirtirrotacmr ~, eoi`'g # ~ _~~ >•iarizon Depth Dominant Redooc Tmchrre Shudrre Cake 8orard~y Roots sol GP Rate Odif in. Hansel Qu. Sz Carty. Gr. Sz. t5h. `Etf#1 'Etf#2 Etlluerrt sikl = t30Ds > 30 S 220 mgll-and TSS >3t? _< 150 mglt. • Etluent #2 = gpDf < 9l) mgli, and TSS < 9l) mgl!- The Department of Commer+x is as equal opportunity service provider and employer. If you need assistance to access services or aced material in as alternate fomrat. picase cxnttact the department at 608-266-3 t S t or TIY 60~Z64-8777. sum-isro(r~roo~ .. s ~ ~~ -~ -b .. ~ ° ~ ~_ ~ ~ - • _ '~ I ..--w~ a ~, -, \~ , ` ~ \w ~_ ~ r ~ ~- ., ~'' ~~ ~_ "~ v~ V^ ~~ C J 7'~iv . ~~ Q G ~'~, b s ~~ ~ ~~ ~~ ~ 6r `a ~ ~ ~ o t~ -~ Z ~~ ~ ~~ n a ~, O 'O }~ Q `©~ r ~1 T -.1 Cn ~ ~ ~ O N ~= ~ ~ 6 m t,~ -D _ .P~ ~ C n ¢o N cr ~ y ~. ~l ~ No N J (~D C~ . ~ ~ Q- t~l~ cdD G1 N O ~ a :_ .~ ~~ ~ ~ a POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of 2 FILE INFORMATION Owner ~{ Permit # uL~t ~fG DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units ^ NA Estimated flow (average) ~ al/da Design flow Ipeakl, (Estimated x 1.5) QQ gal/da Soil Application Rate gal/day/ft2 Standard Influent/Effluent Quality Monthly average" Fats, Oit & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODE) 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODE) 530 mg/L Total Suspended Solids (TSS) <_30 mg/L ^ NA Fecal Coliform (geometric mean) 5104 cfu1100m1 Maximum Effluent Particle Size Ya in dia. ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity f (~ al ^ NA Septic Tank Manufacturer ~ ^ NA Effluent Filter Manufacturer ~ ^ NA Effluent Filter Model - 6C(~ ^ NA Pump Tank Capacity al ^ NA Pump Tank Manufacturer ^ NA Pump Manufacturer ^ NA Pump Model ~ ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ^ NA Dispersal Cellls) ^ In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA ewnu~rcw~nw~re cr+uenru C Service Event Service Frequency Inspect condition of tankls) At least once every: ^ month(s) (Maximum 3 years) ear(s) ^ NA Pump out contents of tankls- When combined sludge and scum equals one-third (Y31 of tank volume ^ NA Inspect dispersal cell(s) At least once every: ~ ^ monthls- (Maximum 3 years) year(s) ^ NA Clean effluent filter At least once every: ^monthls- year(s) ^ NA Inspect pump, pump controls & alarm At least once every: monthls) ^yearlsl ^ NA Flush laterals and ressure test P At least once ever y~ ~ ^monthls) ^yearlsl ^ NA other: At least once eve ry~ ^ month(s- ^ yearls) ^ NA Other: ^ NA j MAINTENANCE INSTRUC71ONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third 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. Page 2 of Z' START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tanklsl for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cellls-. If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cellls) in one large dose, overloading the cellls) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or-must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ~~ T aluat' a o ing ank be ' e ai a ~RDI-Il8 Tf~ ~o~ A/1~ ~NS77Zfl~'l D~ ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. AnnITIANOI Cr]MMFNTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone f _ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name ~T, ~ l dVll~ Z0~(!~(l Phone '~/S- 38'(0_ (p (~ This document was drafted in compliance with chapter Comm 83.2212)Ib11111d1&(f) and 83.54111, l21 & 131, Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP C,:RTIFICATION FORM OwnerBuyer ,~~?rsrm,,~ nom' ~ ~---- Mailing Address 9f~ ~~B,P~',~°Q ,y~.s~/ ~-- ~~~ ga .~ Property Address ~,~~(' ~%o~rrr~ ~__~ ~ / required fmm Planning Department far new construction) ~~ City/State ~ ~ Parcel Identification Number LEGAL DESCRIPTION Property Location ~~ r/,~, ~ y4, Sec, ~ T~N-R~W, Town of /~i1 Subdivision __ C~"~~ Q~~- Lot # ~. Certified Survey Map # `- Voltune .Page # ---- Warranty Deed # _ ~.~~ ~ y ~ Volume ~ Page # ~D~~ Spec house ~es ^ no Lot lines identifiab~^ no SYSTEM M[A.INTENANCE Improper use and maintenance of your septic system could result in its premature ~tailure 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 is the waste disposal system. The PmPonY-oar agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restrictedplumber or a licensedpumper vcrifyingthat (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessazy), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the about requirements and agree to maintain the grivate sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year exp' tioa date. 9'i~ ~Y A ~O PLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described a , by virtue of a warranty deed recorded in Register of Deeds Office. 9~z8ri o5~ S NA OF APPLICANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** "`s Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed V.Z~}8~ P. izo STATE BAR OF WISCONSIN FORM 2- 2000 Number ~ WARRANTY DEED THiS DEED, made between Keeton J. Bast, a married person, Grantor, and lCernon J. Bast and Donalda J. Speer-Bast, husband and wife, as Survivorship Marital Property, Grantee. Grantor, far 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 KATHLEEA H. 1t1ALSH REGISTER OF DEEDS ST. CRQIX CO., wI RECEIVED FOR RECORD 01./07!2084 12:35PM MARRANTY DEED EXET4P? # 8M REC FEE: 13.0® TRANS FEE: COPY f EE: CC FEE: PAGES: 2 Name and Return Address: Edina Realty Title, Inc. 400 S. 2'~ St. -Suite 1 i 5 Exceptions to warranties: Hudson, WI 54016 Easements, restrictions and rights-of--way ofrecord, if any, 4t2S40 20-1027-40-000 & 30-000 &20-00 Pazcel Identification Number (YIN) This is not homestead property. Dated this 6th day of January, 2004. '~ ernon J. Bast AUTHrENTICATIQN~,(Q~jt1C~ Signatures} C ogCl , >~j rQ ~ , ~~ authenticated this 6th day of Jag ' TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS 1NS'1'RUMENT WAS DRAFTED BY Edina Realty Title -Doug Berg 400 South Second Street #115, Hudson, WI 54016 (Signatures may be authenticated or acknowledged. Both are not necessary.) •Names of persons signing in any capacity must be typed or printed below their signature ACKNQWLEDGMENT STATE OF WISCONSIN ) ST. CRQIX 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. ~ ~, ~ __~,_ i(~~U~ *Cheri Brawn Notary Public, State of Wisconsin My commission is permanent. (If not, state expiration date: 3/11/2007 ) ill WAItRAN7'Y DEED STATE BAR OF 1~'ISCONSIN FURiV1 No.2-2000 ~ 2y87P ~Z~ EXHIBIT A The NE %. of the SE % and the NW '/, of the SE '/+, ai! in Section i 5, 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 OS minutes 15 seconds West S3S.46 feet; thence South i4 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 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 21? 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. ~" ~~ ~ L2o ~~ ~ ~ i ~~ 2.04 ACRES `~ ~ LOT 21 ~ ~ ~ ~ ~ • ss~ss sa. Fr. ,•,> . ~ . 3.30 ACRES J ~' ~ ~ ~ ~ ~ L.B.O. -901.60 ~ / ~ 143828 Sa. FT. Liz •- -•-•- - - -._._.J r EASEMENT ~y ,~ ~~v i ~ /, ~ ~ ® ter.. . X37 _._.~ ~ p~~ ; ~,; • /. i I !~ ~ ! ,'~ /~ , ....._ _ ~ / .....• a ~• .....I. ~• i ... :.., .. _ ..... ..... 1 1 i ' "~ ' ' ~ 1 L14 4 310.54 ,~ j i _ -~.. • ' ~~ ' " ' ~~ ` ,• / N8 E 310.54 8°OB 14 ~ /~ /' - .- ,~ ~ i - , ~ ~' i ~ ~' ~ Z - i % .. ........ ... .. ........................... . ..................... ........ _........ i / ~ . ,- .... 1, , i ~ ~•:.. ` LOT 26 ` ;~ / / ~ ,f ,:`~ " % ~ ; ~ ~ ~ LOT 25 m ~ ~' ,. ~ ~ 2.03 ACRES o ~_ ~ ~,., ~ LOT 24 m sls2~s sa. Fr. ~ ~ . \ • •.~ • 2.03 AC ~ ~ ~ ~ ZZ ~ '-•.~ • 88486 S(~. FT. g N ~ i A A w ~ RAQTEMP~ ~ ~ ~UL-DE-SAC ~ ; ~ ~ ~ ~ ; I ! _ ~O oz ` I \ I 66 00~. ~ ' '•~ ~ 282.03' 310.10' SOUTH LINE O 160.96' E NORTH 112 OFTHE SE1/4 OF SECTION 15 F T 88°S6'~ 1 "~/ x 267 g°82, X x x x- _x x x [~JGIp[~G1 u~4GD ~]] D~ O~G]L~D ~ 1~ OO 4~1C~G3~ DRAINAGE EASEMENT UNETABLE NUMBER DIRECTION DISTANCE NUMBER ~ DIRECTION DISTANCE L1 N44°08'25"W 239.21' L31 N86°29'45"E 65.85' L2 S45°51'35"W 360.65' 1.32 S01 °51'46"E 136.83' L3 S45°51'35"W 20.00' L33 S86°29'45"W 167.88' L4 S45°51'35"W 228.36' L34 S86°29'45"W 123.09' L5 S45°51'35"W 112.29' L35 S86°29'45'W 44.77' l6 S89°21'18"W 93.57 L36 NOt°51'46"W 47.79' L7 S00°17'3T'E 232.63' L37 S88°08'14"W 89.34' L8 S59°38'S0"W 48.43' L38 S01 °55'56"E 106.3T L9 N00°38'42"W 228.80' L39 N55°0203"E 10.02 L10 N45°51'35°E 309.53' L40 N62'12'S3"E 10.OZ L11 N45°51'35"E 83.45' L41 N31'22'32'1IV 92.61' L72 N45°51'35"E 226.08' L42 N84°28'48"W 63.18 L13 S44°08'25"E 217.31' L43 N84°28'49"W 12.50' L14 S88°08'14"W 10.74' L44 N84'28'49"W 50.89 L15 S86°59'54"W 9.26 L~ ~~'1~ ~•~ L16 N01°55'56"W 126.56' L46 N65°49'02'W 150.50' L17 - N88°08'14"E 109.38' L47 N85°48'02"W ..-_.,..,....~.... 120.50' an m N p O y fn Z D D W n. 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