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HomeMy WebLinkAbout020-1447-27-000 a o N ~ m o ~i w h O O N N i •o b o i 'y Ol c LL v ~ v ~ ~ w Z y ~ rn ~ ~ o ~ v ' Z ,n~Z y m am o Z v' c ~ V ~ ~ O E d Z ~ fA F- N ~ L ~ c i c '6 Y N U 7 N •~ h ~ O a m O Z C Z N ~ N {p ~~ ~ l0 _ ~ ~ ~ ~ m a '~ °: o ° O O a` ~ N W f A U N r rr ~ ~ 3 3 •~ aaa ~ o a N ~ o ~ ~ _ 7~ fn J V c N ~) ~ O N d O O c 9 ~ ~ m A 1 ~y O ~ O ap C ~ ~ ; O C v w ~ o L Y ~"~ ~ ~ p N 'O ~ O N ~ ~ N ~ • ~ L O .~- 2 ~ m d' O O : ~" # ~' - '~ \ v C~ ~ `m ~ € a ~ o ~ a ~` • `IV +~+ , d . ~ c d c +% ~ a~ 3 ia ~ A o c ornc 3 O 0 c v v y ~ T d ~ ~ ~ ~ ~~~o. •Ev,a~ ao~~` oy3•o fq w N ~ i y ~ >. O t C y r L C ~ O ~ ~ O 3 a~ O ~ C y ~ a• ~ o~~ac rn Z C N C Qj ~ ~ o°-cp;: 0~~.~3m i =a ~ .Q ~ > ~ m ay c m Q a m5 m~ i o I U ~ c ~p ~ z E ~ ~ m i ._ ~ I ~ L C O O U I O N m ~ a v . -° ~ j m ~ U a ~ 'o ~ z N I I } ~ I ~ 3 ~ 00 c d rn 4: i Q Z v7 ~ O C O CI ~ V ~ O O C_ t N ~ N n o } U ~ ~ N y~ C C N O Z ~ ~ ~ Cn Safety and Buildings Division County , ' ` m ~ 201 W. Washington Ave., P.O. Box 7162 ~ I SCOT ~SIII ~ ; M WI 53707 - 7162 ~ ~ Sanitary Permit Number (to be filled in by Co.) t (6 _•~~"`'- L"r' ~ Department of Commerce ° -... ` ~- Sanitary Perms 1011 S to Plan LD. Number In accord with Comm 83.21, Wis. Adm. Code, personal info ation you provide ~ ~ x; ~~-• may be used for secondary purposes Privacy Law, sl .04(1 xm) P jest Address (if different than mailing address) [. Application Information- Please Print All Information _ ::; F;+_)ih COUNTY ~ ~ ~~ ~;~, ~ ,M,~ ~n,',~j,`, ~'3FFiCc Property Owner's Name ar I # Lot # Block # ~! Property Owner's Mailing Address Property lion ~ ~ Section 'Sr % ~~ ~' i S Zi d C h N b , ~ ty, tate C p o e er one um P i l / 7 f7 / S!/ rc ~) ~ < ~~ T N; E o W ( ~ II. Type of Building (check all that apply) n ('~ ~ ~ ~ ,,, d ~ , ,.~," ~""" Subdivision Na „C M Number tA•LOr 2 Family Dwelling -Number of Bedrooms 4 ^ Public/Commercial -Describe Use ^ State Owned -Describe Use ^City_ Vil a ,~T wnship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) a ~ - 7 z7 A' New System p y ^ Re lacement S stem ^ Treatment/Holdin Tank Re lacement n g p tier Modification to Existin S stem g Y B• ^ Permit Renewal Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued BeforeExpiratfon ~-'------ Plumber Owner ~~~ LJ(~~ (,~ z^ O / / U J IV. T e of POWTS S stem: Check all that a 1 Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter Leachin Chamber ^ Drip Lin ^ Gravel-less Pipe ^ Othe (expl 'n) V. Dis ersaUTreatmentArea Information: ~- 00 Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal rea Required (sf) Dispersal Area Pro ed (sf) System Elevation G ~ ~ / ,~7 / So~B VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Ta~ilcs Septic or Holding Tank ~ O ~~ O Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersi ned, assume responsibility for i Ilation of the POWTS shown on the atGtched plans. Plu er's Name (Print) Plumb Signat a MP/ PRS Number Business Phone Number aao~s- 7rs --a~ ~ ~~~ P umber's Address (Street, City, State, Zip Cgde) VIII. unt /De artment Use Onl Approved ^ / Sanitary Permit Fee (includes Groundwater Date Issued Issuin gent Sig at (No amps) ^ O eason for enta Surcharge Fee) ~~. ~d 't ~ Z7 ~~ IX. (:onditions of Approval/Reasons for Disapproval , ~„ ~~ . ~ ~~~ ~ O t /~U ~ ~ ~YlTEM OWNER: ~-~ 1. Link, efn, lpnf rjk and ~,(,~, ~ l /b (D~ di,pataat ceu ~ ' b' i ~~ as par manac~ ::~r.. ~y~, 2 AN Mock regw em. r,uSt MmNnYlkrd it pa/ applicable cone , ordirlalwN. Attach complete plans (to the County only) for the system on paper not teas than 8[R x 11 incdes is size w~ ~~~ SBD-6398 (R. 01/03) N . ST ~ ~ w N ~ -~ 1 ~ ~ ~ I~ N °o a ~ ~ ,~ m ~ a X 3 z ~ a ~ ~ n~ m ~, ~ m = ~ c ' ' _ i ` Z { o ' ~ cn N ~ ~ w 3 c a ~ ~_ ~ N .~ ~ ~ ~ i j ~ ~ t N ~k ~ n O Z ~ ~ ~ _ C ~_ w ~' a . O o a D ~ °a W ~ o g ;, .•r ~ Vl ...~ ~ J N ~_ (D < ~ d I ~ a~i OZ J ~ a m Z ~ <~ ~ Q N CD (D 7 ~ O UI ~ 7 D ~_. ~ < a a S m c n i 3 y ~ 1 3 ~ 0 ` ~ Q A v ., c n ~ ~, ° m p p c m nv ~ ~ v 'a z v o n ~ o• ~ u D O N. ! ~ ~ ~ ~ ~ _` Cn ~ _ N ~ °" m ~ a. ~ C N O Q ~ Q z~ ~• ^^ 'o m ~ m ~ .~~ ~ m n ' _ ~ C ~ N d N o O (D ~ tD ~ ~ A O. ~ ~ 1V (D ~ W p 0 0 -,, o C> D -~ r d O ..C _ . .. ~ w ~ A N. N iD = rn Z n w ~ a ' ~ ~ ~ j ~ ~ +~ ~ -+ m O ~ A ~ r w m p N U3 n ~ ~ 3 ro a N O o D `° cn ~ m ~ r m ~ C m m o °' ~ o ~ z ~ 3 ~ m ~ D ~ '',~ .n 'D II1 (D _ '. d. . t? Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TJ 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: f-~ l ~~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~~ ~Z~ Dosing ~ /~ (~'- Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ / ~ ~ / ~ / / ~ ~ Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GP Model Num er TDH Lift Friction Loss System TDH Ft Forcemain Le h Dia. . to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length ~ ~ No. Of Trenches DIMENSIONS ~L~~ Z -r ~~_ _ SETBACK SYSTEM TO P/L BLDG WELL v INFORMATION Type Of System: ~ ~ / ~ I / ~~ CO~nll2~' D e. DISTRIBUTION SYSTEM ELEVATION DATA County: St. CroiX Sanitary Permit No: ~ ~ 453442 ,J~~t State Plan ID No: Parcel Tax No: Section/Town/Range/Map No: I 4.29.19. STATION BS HI FS ELEV. Benchmark Z' S~ dZ- / ~ Alt. BM 3 ~ ,,~, r aa ~ i~J 1 ~ ~V Bldg. Sewer '/ `~'•~ /O~ SUHt Inlet ~ ~ y 7 -7 SUHt Outlet / ~, 30 ~ .~ I Z~ Dt Inlet ~ Dt Bottom \ Header/Man. S ~~ ~ ~ :I T Dist. Pipe c~ _System _ ~ q ~, ZC, -/~ . Z Final Grade 3 . z~ 9~ ~ zS St Cover ~ ~, $~ Id ~ ~ ~ DIIIQENSIONS No. f Pits Insidg Dia. Liquid epth i <E/STREAM LEACHING Manufacturer: CHAMBER OR ~ti i ~~~ • [ /~ UNIT Model Numbers ;~ ~ rJ i~r C]r1J, 7 ~ ~n n 7 ~ ~~P ~ ~~ Header/Manifold ~/ Distribution Pipe(s) \ x Hole SKe x Hol Spacing Vent to Air.lnt ~ Length~~ Dia Length Dia Spacing ~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Onlv T.o~ ~ C,.~ f Depth Over / Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ Bedlrrench Edges ~J Topsoil ~ ~,, LJ Yes [, No '' Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / /. Location: pending Unknown (NW 1/4 SE 1/4 14 T29N R19W) Coyote Ridge Lot 27 Parcel No: 14.29.19. 1.) Alt BM Description = ~'~'~~ '~ CoJ~LI- L~,w,',tid ~- u1~5 O 2.) Bldg sewer length = ~g ` s~s~jyy~ 6C ajyL.a~ ~Qi,3.Q~ - amount of cover = v ~ „ ,L ~ ~// ~ Z~ O 3 V ~_~ V _- --- -_ -- ---- Plan revision Required ~ ~ Yes No ~ Z~ b Use other side for additio ation. ~_ ~~ ~ ' ~ _ SBD-6710 (R.3/97) Date Inse tor's S ature ~- ~- -, Cert. No. ~r /v~ Sd ~~ v~ ~e ~;~~o, ~dt a~ y-,~3~1. N~ ~~ ys g y /asp ~,, ~~° ~ 3fy' ~U~ r v Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT 1476 Page 1 of 3 in accordance with Comm 85, Wis. Adm. Code Steel's Soil Service, Inc. County Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan must St. CroiX include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I D percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. " . . P nding Pease nt all information. ate Reviewed B D Personal infomwtion you ide may be Tor aeWndary purposes (Privacy l aw, s. 15.04 (1) (m)). q t` / Q 7 Property Owner '~ Property Location ~ McCabe Homes Inc. ~ Govt Lot na NE 114 SE 1k1 S 15 T 29 N R 19 W Property Owner's Mailing Address Lot # Blodc # Subd. Name or CSM# 935 Osprey Blvd 27 na Coyote Ridge City State Zip Code Phone Number J City ~~ Village ~ Town Nearest Road Bayport ~ MN 55003 651-351=1018 Hudson Pine Timber Ln 1/ New Construction Use: ~ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ~,,,~ Replacement J Public or commercial - Describe:na Parent material outwash Flood plain elevation, if applicable na General comments and recommendations: Conventional system, system elevation 95.85ft. Trenches spaced and depth to code 3.75ft below grade. ~-- Boring # ~ Boring ~J Pit Ground Surtace elev. 103.60 ft. Depth to limiting factor 100 in. Sal Application Rate Horzon Depth Dominant Caor Redox Description Textun; Structure Consistence Boundary Roots GP D/IC= in. Munsell Qu. Sz. Cunt Caor Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-7 10yr3/1 none sil 2msbk dfr cs 2f .6 .8 2 7-22 10yr4/4 none sicl 2msbk dfr cs 1f .4 .6 3 22-100 7.5yr4/4 none cos osg ml na na .7 1.6 7 a Boring # Boring ~ Pit Ground Surtace elev. 99.60 ft. Depth to limiting factor 100 in. Sod Application Rate Horizon Depth Dominant Caor Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-8 10yr3/1 none sil 2msbk dfr a 2f .6 .8 2 8-34 10yr4/4 none sicl 2msbk dfr cs 1f .4 .6 3 34-100 7.5yr4/4 none cos osg ml na na .7 1.6 * Effluent #1 = BODS> 30 <_ 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS <30 mg/Land T55 < 3o mcyt_ CST Name (Please Print) 'gnature: CST Number David J. Steel ~ ~ 248956 Address Steel's Soil Service, Inc. Date Evaluation Conducted Telephone Number 994 200th St., Baldwin, WI 54002 8/10/2004 715-684-5680 Property Owner McCabe Homes Inc. Parcel ID # Pending Page 2 of 3 Boring # Boring ill' Pit Ground Surface elev. 94.30 ft. Depth to limiting factor 100 in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-7 10yr3/1 none sil 2msbk dfr cs 2f .6 .8 2 7-24 10yr4/4 none siG 2msbk dfr cs 1f .4 .6 3 24-100 7.5yr4/4 none cos osg ml na na .7 1.6 ^ Boring # ~ Boring _, J Pk Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rye Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring # ~ Boring Lf Pit Ground Surface elev. ft. Depth to limiting factor in. ~~ Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD 5> 30 < 220 mg/Land TSS >30 < 150 mglL * Effluent #2 = BODS <30 mglL and TSS <30 mg/L 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. Page 3 of 3 STEEL'S SOIL SERVICE INC. David J. Steel CST-POWYS Lic. #248956 ~2 ~~~~ w.~~~ ~~~~~ ~`. ~Q, Ga fry ~? McCabe Homes, Inc NE1/4,SW 1/4,S15,T29N,R19W Town of l~u~sr~,, St Croix Co. Coyote Ridge Lot, 27 994 200 th St Baldwin,WI 54002 Bus.(715) 684- 5680 Fax (715) 684-3449 Legend 1"=40' • =Benchmark Ele. 100.00ft Top of 3/4" PVC Pipe • =Alt Benchmark Ele. 100.00ft Top of 3/4" PVCPipe ^ =Borings Boring Elevations B 1 = 99.60ft B2 = 99.60ft B3 = 94.30ft B4 = OO.OOft ~~ ~ I 7~ ~~ ~~ r ; ,~ -~ ~y ~ ~ ~~ 3~~ 08/12/2004 14:11 7157491719 _ ~ ro -~ Z C1 ~ C ~~ 1 S 8t4~i ~~~ ._._ ~44' r i N ~ ~ 't ~ ~ :. ~ _ m ;~ ~~ s~ ~~,~ !~ ~~v t • in ~' ~ ~ ~ s~ i( :~ n ! ~~~ _( i~ m !~ ;t ~ ~ s ~d V Z ~~ ~ -. j x ~ r Z m ' ~ a _~ b ~~ ~ ~~W ~ <a~ T ~ mom= ~ ~ ~ v~~ I ~ ~ ~,s z,~ ~ ~ ffi ~ r a- j 0 ~ ~ ~~ ~N h~RTF~AND SURVEYING PAGE 01 1 ~ E s~~ 1 •, ' O a •' \ `~ o ~, ~~ ` ,\ '~ ._ '\ ~ ~' ~,. ~ ~ '~ '.~ ~ ~`. ' '~ ~' ~ •~ % _ ~. ~ ~ ~. , .~ ~~ v, ~' .~ •,~ /• ~ .` ~ ,\ /• ~ ~/ ~' r , s' ,' / ~ ~ ~ •'~ ' ~ ` r ~ ~ N r ~ . ` ~' ~~, ~ `~ ` `, `\' A ~~ ~ ~° w ~ O o ~ ~ ,' . ~` •~ ~ `~ ~.G ~,A 1 ~ r ~ a~,~C~,, •~ ~ ~~~ ;' f / ( by l4a ~ ~ ~. ' / r ~ ~ ~ ~ 3 ~ ; r ' ' ' ~ OD ~ to '" r ~ -.•... ~ '' II O (? ~ 1 i ~~ ~N -~~~ S o~N~ M O ~ • ~a r m ~ ' ~ 1 v, ~ ; v I I ~ r ' _ ~'~ ~` A 1 ~OJ. v a ~ 1 r i ~ ~ 1 ~10'5~63,6~,r5.90S .' i ~ . ~i 1 1 ' ~ 1 • ~1 ~ 1 1 ' + ! • I ~ v ~ r ~•_ ~ f f i ~ to _ ~ .' ~ ,.. •~ r.` ~ ~ '+ -F c 2 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT . AND OWNERSHIP C;~RTIFICATION FORM OwnerBuyer ,~F,Qyv,r/ ~~'~--' Mailing Address ,Q®! v~,i/ Property Address ~j ~ l/1tiSZ, (Verification required from Planning Department for new constructio City/State ~ Pazcel Identification Number LEGAL DESCRIPTION Property Location ~ ~/., ,~~ r/4, Sec, ~ T~N-R~W, Town of Subdivision l' yo ~P~ Lot # ~. Certified Survey Map # Volume ,Page # Warranty Deed # /~J 6 ~f y~ Volume Page # ~~ Spec house ~ yes~o Lot lines identifiable yes D no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result is 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 is the waste disposal system. The PrePoriY-~a+IIer agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber,]oruneymanPlumber, restrictedplumber or a licensedpumpcrverifyingtlrat (1) the on site wastewaterdisposal system is in proper operating condition andlor (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Deparnneat of Natural Resources, Stag 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 a iratioa date. ~i yi oY SI NA OF APPLICANT 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 above, by virtue of a warranty deed recorded in Register of Deeds Office. 718' i aY S GNATURE OF APPLICANT DATE ****** Any information that is mis-r resentedma result in the sari «*«««« eP Y tary permit being revoked by the Zoning Department. ~R 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 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ' of 2 FILE INFORMATION Owner Permit # Z DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units ^ NA Estimated flow (average) L' ~® al/da Design flow (peakl, (Estimated x 1.5) ~ ~Q al/da Soil Application Rate ` al/day/ftZ Standard Influent/Effluent Quality Monthly average * Fats, Oil & Grease (FOG) <_30 mg/L Biochemical Oxygen Demand (RODS) _<220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (RODS) <_30 mg/L Total Suspended Solids (TSS) 530 mglL ^ NA Fecal Coliform (geometric mean) 510° cfu/100m1 Maximum Effluent Particle Size Y8 in dia. ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity a Q al ^ NA Septic Tank Manufacturer ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model ~ - aQ ^ NA Pump Tank Capacity al ^ NA Pump Tank Manufacturer ^ NA Pump Manufacturer ^ NA Pump Model ^ NA Pretreatment Unit ^ SandJGravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ^ NA Dispersal Cell(s) r In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ^ ea~~sj(s) (Maximum 3 years) ^ NA Pump out contents of tankls) When combined sludge and scum equals one-third IY31 of tank volume ^ NA Inspect dispersal cellls) At least once every: ^ yea~~ 'Is) (Maximum 3 years) ^ NA Clean effluent filter At least once every: ^monthls) . earls) ^ NA y Ins ect um ,pump controls & alarm P P p At least once eve ry~ ^monthls) ^yearls) ^ NA Flush laterals and ressure test P At least once eve ry~ ~ ^ month(s) ^yearls) ^ NA Other: At feast once every: ^ month(s) ^ yearls) ^ NA Other: ^ 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; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tankls) 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 cellls) 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. AI{ other services, including but not limited to the servicing of effluent fitters, 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 ~ of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment t~nklsl for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal celllsl. 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 celllsl in one large dose, overloading the celllsl 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 fast resort to replace the failed POWTS. T ~~ alua ' a o ing~ank b e ai a ~RDi-I18 Tf~. ~D/c- /J~ CpNS7Rt1~T1.C~ ^ 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. ADDITIONAL COMMENTS POWTS INSTALLER Name (~~~ Phone l - fo - ~j POWTS MAINTAINER Name `S Phone SEPTAGE SERVICING OPERAT (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name ST. ~ ( d N ~Oll~~l(.f Phone '~ / S- 3 ~ (A- (O (~ This document drafted in compliance with chapter Comm 83.22121(b1111(d-&If) and 83.54111, (2) & 131, Wisconsin Administrative Code. - - yG~g~ ~, IZo STATE BAR OF WISCONSIN FORM 2- 2000 Document Number 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 750940 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIx C0.• MI RECEIVED FOR RECORD 61/07!2004 12:35P?! WARRANTY DEED Elft:llPT li 8M1 REC FEE: 13.00 TRANS FEE: COPY FEE: CC FEE: PAGES: 2 Name and Return Address: Edina Realty Title, Inc. 400 S. 2ie 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 Pazcel ]dentification Number (PIN) This is not homestead property. Dated this 6th day of January, 2004. * ernon J. Bast * AUTHENTICATI~C~NIC~ Signature(s) _GOeC~~ a~,~ C' .M, authenticated this 6th day of Japt>~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 (Signatures may be authenticated or acknowledged. Both are not necessary.) •Names of persons signing in any capacity must be typed or printed below their signature * * ACKNOWLEDGMENT STATE OF WISCONSIN ) ST. 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. ~.,Q._ - ~~~.~- *Cheri Brown Notary Public, State of Wisconsin My coltunission is permanent. (If not, state expiration date: 3/11/2007 ) 17 WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-21100 ~ 2`I87P 121 EXHIBIT A The NE %. of the SE 'h 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 '/, 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 O 1 degrees 07 minutes 26 seconds West 400.07 feet to the monumented south line of Certified Survey Map recorded in Volume 1, page 217 at the St. Croix County Register of Deeds Office; thence North 88 degrees 51 minutes 13 seconds East, along said south line, 570.78 feet to the point of beginning. :, .~ ..`\ .~ .,\> ,~ ~~ ~~ /, >°~ . ~ ,. ~ ~,• ~T 26 ACRES 3 SQ. FT. -'~---- -- - -- •-- -~~w.y. 131 2T `• 571-~`J.-- ® `` ....................... ......... ................................................. .. . DRAINAi . .. .... ............................. ti • ~ ~.' ~\ •. . ~ •~''•~.• LOT 28 ~ ~~. ....• ~ 2.01 ACRES w LOT 2! ~°,°~ 4 87708 SQ. FT. 50 =894 O L B 0 2.11 ACRE m . . . . 91713 SQ. ~ L.B.O. = 87 ® BENCHMARK TOP OF 3/4" R ~ 279,58' 281.E 160.96, 240.44' ELEV. = 913.27' - SOUTH LINE OF THE NORTH 1/2 OF THE SE1/4 OF SECTION 15 x-_ x_~x _x x x x x x x x M _n[Y]. p___~_ ~__C~D----~~___~_llD_~~___O~Mn CAD _ ~ ~--_O__4C~C~G°3~ ~ ~ c~,.. J „Q,~ z ~/ ~' `~ DATA TABLE ^~ CHORD LENGTH C LENGTH TANGENT IN TANGENT OUT RAt~IUS CENTRAL ANuLC JG ..~ IORC BEAR!! 233.00' 13°14'04" S14°29'29'1N 53.70' 53.82 $07°52'2TW 233.00' 21°56'53" S10°08'04.5"W 88.71' 89.25' ,. 821°06'31 "W 367.00' 05°00'34" S89°53'18"W 32.08' 32.09' S87°23'01'1N 167.00' 47°32'59" N83°49'55.5"W 134.65' 138.59' N87°36'25"W 80.00' 245°38'17" N72°52'34'W 134.45 342.97' N49°56'34"E 80.00' 35°32'40" N32°10'14`E 48.84' 49.63' N49°56'34"E 80.00' 56°09'11" N13°40'41.5"W 75.30 78.40' N14°23'54"E 80.00' 25°34'33" N54°32'33.5"W 35.41' 35.71' N41°45'1TW 80.00' 54°02'41" 885°38'49.5'1111 72.89' 75.45 N67°19'50'1N 80.00' 74°19'12' S21°27'53'W 96.65' 103.77' S58°37'29'W 80.00' 65°38'17" S17°07'25.5"W 86.72 91.65' S15°41'43"E 233.00' 40°47'20" N80°27'06'W 182.39' 165.87 N40°03'25W 233.00' 08°18'36" N44°12'44`W 33.75 33.79' N40°03'28"W 233.00' 32°28'44" N64°36'24'W 130.32' 132.08' N48°22'02"W 233.00' 47°52'38" S75°12'55'1N 189.08' 194.70' N80°50'46"W 233.00' 34°35'18" S81°51'35'VJ 138.53' 140.66 N80°50'45W 233.00' ~ 13°17'20" S57°55'15'W 53.92 54.04' ~°~" ~' +~-. m~ ~a•ern~e~~ R7(1°3A'18"W 110.73' 112.87 ` S51°16'35W / QQ• ~a~ .~ ~\ ~'\ ~~-_:^ --.Aa %; --•-~ --~--•-- ----- - 284-~ ----- ----- -- -- ~~~~ ~\ 87°36'25" 74.74' `~ . 3~, _ - --PNVB; -T-AMBER-~kId~------- ` ~._ •( ~ .... LOT 27 rrm 89313 SQ. Ff. ~ L.B.O. =894.50 S21°OB'31'W - S00°50'22MV N87°36'25'1fV N40°03'26"W S15°41'43"E N14°23'54"E N41 °45'17"W N67°19'S01fV S58°37'29"W S15°41'43"E S49°56'34'W N80°50'45'W N48°22'021N N80°50'4511V S51°16'36'1h/ S64°33'S5' S51°i 6'35'W N90°00'00'1N I ~~ I I .. gI ~ g '~I ' ; g) J"~--___~~ t d~ I ~~ I ~ t '~. ~` I ~~a- ~------'-----~-------L-----------------I------------ Ls_ -.a._._._._.___._._._ O~ ~ '? gq 'mS ~~~q"j `u~ 12I i$ ~ ..~~m ' ~ ~ i as Lai ~ ~ O ~~J 3 ~8 m 8 o _~ ~8 C~ m O°p•1 J°^ O bl J d ~~ d m _._..__ ____i_______________i___ ~ I N - ~ ~ 1 i 0 I J V ~ 1 t I ~ Fp- ~ I ' ~ I ~ 1 g d I ~ d I I 1 I , I I I I o ~ I d ~~Tgc ~ ~ I , I I I ~ P aa I ff ' ' d •~ .BO'L8t 3.EE~LY.00SI Er CaLI 1~ ~_ . .~ ~ °O~LBt ~ azu~.oos W;& ~~~ I t~ ki m N ~~i n ~ pp F., ~ a3 a a °~p~ j ~.~~~~ ~:~ N ~ ffi ~ ~ ~ I 7 a Ogdd I J~aJ q - ® I > . o ~ i $W'306~4 T+& I ~ ~ • $ N 07C ~yy ' I ~ ~ F y 9 _ 0 " • p DO J ~ J ~O I • y ~a ~ T1C1145Q3.q 3 ~ I WN I ~ O r Jg ~ ~' ~ w~ I U ~~ 5,x,4 ~ , gH ~ gEE I LL O N W 7S .'7I ' ffi k ~ 8R$~al~ R q'd. A$ ''k 3 8 A ?~ ~ ~ k ~ ~ 8 B F! ~ R i 3 ~ ~ ~t 8 ~ 7f ~ B ~ ~ ~ ~ d ~ ~ $ ~¢ ~ 9i ~n ~ 3 ~ 3 3 ~~~ 3 3~~ w w w w ~~ s R a~~e46 a~3151~a" 4 8 8$ 8 g g g g g 8 8 8 8 8$ 8 8$ 8 8 $ 8$ 8 $ 8 8 8 8 8 ~ ~ g "~ ~~ ~~ ~ o u ~y5y W b~ L~ ~ b ~ ~ ~ 3 I ~ O • • ~ I ~ 1 Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 County nsin Madison, WI 53707 - 7162 i Sanity Permit Number (to be filled in by Co ) seo '(600)266-3'x51 TS3l.r Z Department of Commerce State Plan I.D. Number Sanitary Permit Application nal information you provide C d Ad Wi e, perso s. m. o In accord with Comm 83.21, may be used for secondary purposes Privacy Law, s15.04(lxm) ,.. Project Address (if different than mailing address) ~ =i 1. Application Informalion -Please Print All Information - - , Property Owner's e ar e! # t # Block # ' ~ ~. ~~- Property Owner's Mailing ddress Pro #w ~tS~io~ 1 J i %, ~'/., Section ~~ City, State Zip Code Phone Number ~` circle ) ^ _ ' I .Type of Building (check all tha ply) s ~ t c'~ Subdivision Name CS Number yl~ 1 or 2 Family Dwelling - Number of B ms rtM.S + ^ public/Commereial -Describe Use ~ „%~~ ~~ ^City_ i I g wnship of ^ State Owned -Describe Use III. Type of Permit: (Check only o e boz on It A. Complete line B if appl'exble) '+' New System ^ Replacement System Treatment/Holding Tai)li~lteplacement Only ^ Other Modification to Existing System ~ ~ , ~. List Previous Permit Number and Date Issued B. ^ Permit Renewal ^ Permit Revision ^ nge of ;;^ Permit Transfer to New Before Expiration Plum Owner ti. N. T of POWTS S stem: Check all that a I ^ In-Ground ^ Mound > 24 in. of suitable soil otmd < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Non -Pressurized ~ , ^ t Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Constnicted WUland ^ Pressurized In-Ground ^ Holding Tank~~ Recirculating Synthetic Media Filter Leaching Chamber S7rip Lin Gra el-l Pipe ^ (explain) V. Dis ersal/TreatmentArey Information: - Design Flow (gpd) Design Soil A plication Rate(gpdsf) / ispersal A R fired sf) y Dis Area Proposed (s t EI / '- ~~® ~ ~ Q~ ~ Jr _ _ r Q ' lactic Man cturer Prefab Site Steel Fiber [ VI. Tank Info Capacity in Total tuber Concrete Coast ted Glass ~ f Units Gallons Gallons New Existing ! Tanks Tanks Septic or HoWin~ Tank --- ~ ~~~ Aerobic Treatment Unit ~ _ losing Chaffer VII. Responsibility Statement- I, the un rsign ,assume responsibility for i Ilation of th OWTS shown on the attached plans. Business Phone Number pl~¢'/` ~ (Pri t) ~ 1 ber' ignatu PRS Number K , b ~ 7 7/S - . ~ Plumber's Address (Str t ity, Sta Z' Cod ! l ~. /~ ~ ~ ~~ ~ ~~ o 0 \'[[I. Coun '/De artment Use 1 Sanitary Permit Fee (includes Groundwater Date Is d Issuing Agent Signatur ( Stamps) Approved ^ Di roved Surcharge Fce) ~ ~~ ~ D ^ O for Denial I~. C.onditians of Approval easons for isapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced /maintained 8s per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. ... ~...1.-.. of h . 11 i.,el,ee in siu Ar[aen eompleR pram (iu coc a..auwaJ °a~7/ ~'^ •"c •7•••••• -•• r-~r-. SBD-6398 (R. 01103) .,~ - y- ~' N~ w- ys q `~~~ ~ laSO ~ err - / _ ~ ~-~~ ~/ r~~~. r ~~ ~~ ~ ' - a ~~~,~ l N~ ~ ~ /o z~ ldSO i,,..-: /~~ _ / .boo ~ ,. 7"°70 ~/a i8~2- =~oi,3ti .. ~ y~ a ~~ ~s ~ RECEIVED -~ ~~ - Wieoonsin oepartmaa of cake ' DEG , 2 9St~i~.~ EV~,LUATION REPORT / 3 DivisionofsafelyandBu~dkga ~ ~ in ~~c~~i~ as. vV~. Adnr. cane Cou~y S T: c~f2 Ot ~. ZONING OFFICE Attach aornplete site plan on paper x rn sme. Plmt must include. but not t6tdbeci to. rertrcel and fwritorrtai refereru~e point (BMj, dreciion and Pano~ tD. ~~. ~ ~Q perrentatope, scafeardimensions, tror~ ama~ ,arid bcatbnandnoeto broad. Please pni/it aH Jntvrmation. ~" , p}~ Per:onM rabnmWon r«i provide may a aaa~ toneoondtfryr o t~+~r caw. a i5s04 tt) (na). ~ NW o S£ SE PropectYOwr~er Propert)rtacatior+ /~ Cj /C~iC'Nd~t! l3f}S ~' covt. trot NW s-a ra S ~7 T Z / N az 19 ~or~ w Property aNners Address t.,ot ~ Black # Name a tS~ Ew N ~y L • ,BAR ~'~ ~''~ ' Z "' ~o ~`o rE' ~ ,~f©~~' •. cafe Number p c~- ^ vitae ~ Tawn Nearest iZOaa f~UD•So~ 4>l. syol4 ?IS 38h'~75 fifuDso••.- 13A~~~'~ ~~ - ~-~ use:~i Residerifi~ ~ Nurrib~ of becimorr>s 3 ~ Code derived d tbw rate yS4 - ~ c~ ©~ p Pcrd~c ar aorrurieraal - Desaibe: Parent maEermt -SA'JVt~ y B~ ~~-frl.~ Rood Pion eler~on if appr~abte IV~~.i...._ it, ~'Efi 7~ST~.~ -s'UrT'~Q1~' dip ~}.d %v~/'ouc~~ .v~.~ ~.v. ~ .T's . ~ ~ Pit . R Daplh m in. ~e Moeiaon oapa~ Dormant iiedoot oeaaiplion Texture iihuarse aonsiatanae 9ourdary goals in. oe. s~. c«u. actor cx sz. ~,. -~ "Et>~2 i o- y t o YR 3 SL 2fsb,~ ~ rr- •~i2 w 3 s • /v R SiL / f 6h cwt fi' c i • 3 ~- 3 7 5 ---~- ~S /~, S c . ~ l• Z Deptl~ b factor n- KY Pit Guard surFaoe rev. tt. .. 9oi t2sle t~iori7An DepBs Dorttinarrt ttadarc Desaiplion Textru+e C,aarwe Bora>dacy Roots CIP DAF bt. Qu. Si. Cori. taolar Gar 3z. Sh. 'F~1 'E>0!2 o - ~ ~o YR 3! SG zfs bK ~ ~ cs 3 f . s : !' Z l~ • ZD i© !~ ~ ---- Syr z s ,w-~Fj~ c S ~ f • s • ~ 3 -~ 7•s R ~S ~~ s cs • -7 ~• Z /o s , s ~• a,,!- R .o o l #1= BOD > 30 < 220 mdL and TSS X30 t ! 50 mall. ' E1Nuerit #2 ~ BOD < 30 maA. and TSS <_ 30 moil ~" ~ ~r 2t ~b ~~ cG ~ ~~~ 2 ~ 3 s Address Dale [vatuafion Cordirded Tebpltone Number t tlh~s#~ ~ ~ _- ~- ~ay- ly - x.8-03 7r5• ~?a •3~(~~- t~norate Sewage Consultants 2812 ~ 0th Ave. ~~N 's ~,~ TO]"~L. o~ ~~ 1¢Gu Spring Valley, WI 54767 Z D . !017. Z o • D•~a Zr~ • loa.7 . 3 p • o~ z.o . ~©17 , yp - oar ~l +/ ~ yo Tom-- ~,~~ k'ERtia,v T3A-s T' y owner Parcel m # G o ~- ~ z7 •z 3 f~aee ~ ~ O _~ 3 ~ Fit ~,,. /n0•y~ > Deptl~r b CRrdUng tacbr ~~ :~. s~ Rye Horizon Deptf- Dominant Redox OescripGon Texdae Strtrbrre Car~slenoe Boundary Root (3PDfIP ~. Mur>SeQ Du. Sz. Cord. Color Gr. Sz Sh. 'Eft#t `EtI#2 o - $ /o yi2 ~/ sL z s ,~ /114 ct~ ~ . 5 .9 ~ /6~ --' s6L lf~~ ~i CS - L • 3 6.-I rIl -.~~..~ ~.......~..... ...+r.r. w •u•wy wa.nw au Refe fiortaan Depth Dort Redox Description TexGxe Struc~re Consistence Botx>dery Roots GP D/if? ln. Mansell Qu. Sz. Cord. Color ~ St air. ~ 'EtFi~1 'Etf;~2 p ~ crw,rrd st,rrace elev. tz fn >a~or rr. ^ # ~ soa Rabe Horizon Depfn oominant Redoz Texhxie sauca,re cor~terroa 6orridary Roofs f3P (1rIF in. Np,rtseil flu. sz Gr. sz sn. 'Et~1 'EiF#2 ~ = eoo, > 30: 22() mgll. and TSS >ao < tso mglt. • EiBuerd #2 = BOD~_ 3o mgll. and TSS_ 30 mgiL .~ . ~, .~ . ~, . ~. The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access seniices or creed matcrial in an alternate fmrnat, please coact tbe department at 608-266-3 ! S 1 or TTY 60&264-8777. Ln ~ ~ z7 Sc~ G~ : ~ ~~ "" 3p • _ 1j.~9G ,.mss ____,_ 1s 3 c6.v ~vi2S D ._-- ~~ ~ ~ ~ ~ ~ `~ sf~ ~ /- ~ , o / /bl- 3 Z ~ -~ --r- ~0 ~ 't , Q , ~' /off . o ~ J y~ ---_ . O r zS , ______-- d ~ o o. S ° -3 3 1" ~ • ~M #, r~ For issuance of permits and designing p O f ~~ L' _ ~ Contact: Ulbricht ~ Associates 5f~ ~~ r'~ Registered private wastewater consultant and plumbers 2812 10th Ave. ~p4~ _ SpringValley, W! 54757 --'-"' 715-772-3442 ~~3 ~,~ S, w . ~~y