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HomeMy WebLinkAbout020-1447-28-000Wisconsin Depanment of Commerce PRIVATE SEWAGE SYSTEM Ss~ity and Building Division INSPECTION REPORT GENERAL INFORMATION ~ (ATTACH TO PERMIT) • Personal information you provide may be used for secondary purposes [Privacy Law, ;15.04 (1)(m)]. Permit Holder's Name: City Village X Township Bast, Kernon Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: 1 ~'~ 1 5'T TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic i /~ ~~ Dosing ~ ~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ` ~ ,~ ~j ~~ r ~ ~ ___,- Dosing Aeration Holding PUMPISIPHON INFORMATION Manufacturer Demand GP Model umber TDH Lift Friction Loss Sys TDH Ft Forcemain a Dist. to Well 501E ABSORPTION SYSTEM ~ BED/TRENCH Width ~ Length~~~t~ No.O~ renches DIMENSIONS ~ L.~ ~ c SETBACK SYS INFORMATION Type ~o~Zb~ I l~ ~ I ~~' DISTRIBUTION SYSTEM ELEVATION DATA County: St. CroiX Sanitary Permit No: 453443 0 State Plan ID No: Parcel Tax No: Section~rown/Range/Map 29.19. STATION BS HI FS ELEV. Benchmark '' ~ L 'al • ~ ~~ Al~o~ ~•LZ5 q7 Bldg. Sewer ~'. 7.b ~Z. yZ St/Ht Inlet ~ r ~ ~0 ~I ~ Q~ 7 St/Ht Outlet Dt Inlet Dt Bottom ` ~ Header/Mangy..,/ TT7 f ~ y7 I ~/. Dist. Pipe /b.Ilp J~ r~~-~ Bot. System lI~ZS 9d~ 37 Final Grade y, ' / ~~ ~ ~ 5t Cover D~[1AENSIONS INo. Of Pits CHAMBER OR UNIT ~~ i~ Inside Dig a. Liquid Manufacture ~` \ ` ~. c Model Number}, v i d, 7 7 ~s l Header/Manifold // ~~ ~~ Distributio ~ ~ x Hole Size x Hole Spacing Ven to Ai Intak i ~ ~ J Len th Di "I L th Di i \ S ` ~ g ^ a eng a ng pac SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Svstems Only ~ ~ Depth Over 1 Bed/Trench Center ~ Depth Over Bed/Trench Edges xx Depth ofC Topsoil xx Seeded/Sodded 1 r ' xx Mulched ~ ' 1 1 \ ; Yes '-I No ' No '*lLLs L-: df ~~ Ti D~ Say bLl COMMENTSG} (Includ o,/d~epdisc~en~cie$, persons present, etc.) inspection #1:~1~~ 6 Inspection #2: / / Location: ~di~g~nkn'ovGn (' T1W 1~4~SE 1/4, 1~4 T29N R19W) Coyote Ridge Lot 28 Parcel No: 14.29.19. 1.) Alt BM Description = ~ ~ ~~~~~ ~~ ~~~ dh ~~, N~ ~` ~.D O dam, l Q ,, n 2.) Bldg sewer length = ~ r_ ~ ~a~_ ~'7~-~-~~~~//Q - amount of cover = ~/ ~(,~ (/-,~, ~~--~.~~0~, J d~~ (~ -r~T"i f-- ----- -- -. ~ i -- Plan revision Required? Y ~ : No ~ ~' ~ 2~ ~ ( j i _~ ,thersideforaddition ormation. ~__ ~ ~ ____._ _,___ ______ ,_____ _____ i ~___,_, (R.3/97) Date ~ In pctor'L nature Cert. No. Safety an Buildings Division 201 W. Washi t .O. Box 7162 County ~ ~ ~, Cr/L.,v-'~c. ` ,~~~~~~~ Madtso , WI ~~S' Sanitary Permit Number (to be filled in y CoJ ~ $) 266-3T5 I V pepartment of Commerce fate Plan I.D. Number Sanitary a tio~~ rr zOQ ersonal i ormation you proiid~ Adm Code Wi 83 21 C , ~ . , p s. . , omm In accord with may be used for secondary purposes Privacy La , s15.0~ s) Project Address (if dit7erent than mailing addres 0/X / lication Information -Please Print All Information OFFjC A 1 U// ~ 7/ h ~ / r~ E . pp Property Owner's Name Parcel # Lot # Block # 7 f7~ Property Owner's Mailing Address .r 7 Property Locatio ~ / 9yg l/ /V~!-~ %., ~Y., Section City, State Code Zi p Phone Number /~ ~ / c , S Q~W '7 /~~- - ~, 9 ~I ,J ~/ / circle gLte) T s~-L N; RLL_E o~y Q. Type of Building (check all that apply) Subdivision Name C M N tber ~l or 2 Family Dwelling - Number of Bedrooms ^ public/Commercial -Describe Use Z 2 Z 3 a ~1 ~' C ~ ~ ity_^ tll ge ~1' wnship of - -- ^ State Owned -Describe Use III. Type of Permit: (Check only one box on line A. Complete line B ifapplicable) /~ ~ Q Cj A' New System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner ~. N. T of POWTS S stem: Check all that a 1 h .Non -Pressurized to-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 SynUtetic Media Filter Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersal/Treatment Area Information: roposed (sf) System Elevation / Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (sf) Dispersal ~~ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or HoldinE Tank ^ U ( l/`~`~"^~~`R., Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume respoasibitity for i Nation of the POWTS shown on the attached plans. P!u ber' me (Print) Plumber's gnatu MP PRS Number Business Phone Number ~- ~ a~635 7 ~/.S- _ Plumber'fs~A}ddress (Street, Ci ,State, Zip ode) / ~'^ ~~C./ ~C~~~_ ~ / ©C~ VIII. un /De artment Use Onl Sanitary Permit Fee (includes Groundwater to I sued 1 ing Agen Signature ( tamps) pproved ^ Disapproved Surcharge Fee) ~ ~ ~ ~ ~ ~~ ~~ 7 ~ LG i% ^ Owner Given Reason for Denial /X. Conditions of Approval/Reasons for Disapproval - G~ s'-~~~Q~~ a'~- ~~~-~~a ~ ba.~-e~d ~n-~ .~=~ ado ~~ ~~ ~ ~ ntncn eompsea psam tco rssc wunq vwst .......~ .~..~....,.. ,.-,._. __. SBD-6398 (R. 01/03) 9 r,~ -~,, Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT in accordance with Comm 85, Wis: Adm. Code 1478 Page t of 3 Steel's Soil Service, Inc. County pl pl paper not less than 8%Y x 11 inches in s¢e. Plan must Attach com etc site anon St. Croix include, but not limited to: vertical and hor¢ontal reference point (BM), direction and Parcel I D percent slope, scale or dimensions, rrorth arrow, and location and distance to nearest road. . . pending Please print all information. Re 'wed Date Personal information you provide be used r set~ndary proposes (Privacy Law, s. 15.04 (1) (m)). ` oZ ~ b Properly Owner Property Location Quality Homes Govt. Lot na NE 1/4 SE 1/4 S 15 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Sutxl. Name or CSM# 575 Schommer Dr. 28 na Coyote Ridge City State Zip Code Phorre Number ~ Ciry J Village ~ Town Nearest Road Hudson ~ WI 54016 715-381-1724 Hudson Pine Timber Ln New Construction Use: ~ Residential /Number of bedrooms 4 Code derived design flow rate 600 GPD _J Replacement ~ Public or commercial - Describe:na Parent material ouiwash Flood plain elevation, if applicable na General comments and recommendations: Conventional system, system elevation 91.25ft. Trenches spaced and depth to code 5.50ft below grade. Boring # J Boring ,~ Pit Ground Surface elev. 96.75 ft. Depth to limiting factor 135 in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D(ft2 in. Mansell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr3/1 none sil 2msbk dfr cs 1c .6 .8 2 10-28 10yr4/4 none sicl 2msbk dfr cs 1c .4 .6 3 28-140 7.5yr4/4 none cos osg ml na na .7 1.6 Boring # _) Boring ~/ PR Ground Surface elev. 96.75 ft. Depth to limiting factor 135 (n. Sod Application Rate Horiaon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GP D/ft= in. Mansell Ou. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10yr3/1 none sil 2msbk dfr cs 2f .6 .8 2 9-37 10yr4/4 none cos osg dl cs 1f .6 .8 3 37-135 7.5yr4/6 none cos osg ml na na .7 1.6 * Effluent #1 = BODS> 30 <_ 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS <_30 mgll. CST Name (Please Print) 'nature: CST Number David J. Steel 248956 Address Steel's Soil Service, I Date Evaluation Conducted Telephone Number 994 200th Si., Baldwin, WI 54002 8/11/2004 715-684-5680 Property Owner QUBlity HOmeS Parcel ID # Pending Page 2 of 3 Boring # Boring . LfJ Pit Ground Surface elev. 92.85 ft. Depth to limiting factor 135 in, Sod gpplication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Murrsell Qu. Sz. Cunt Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-37 10yr3/1 none sil 2msbk dfr cs 1f .6 .8 2 37-57 10yr4/4 none sicl 2msbk dft cs na .4 .6 3 57-135 7.5yr4/6 none cos osg ml na na .7 1.6 ^ Boring # J Boring J Pit Ground Surface elev. fl. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring # Boring ,] Pit Ground Surface elev. ft. Depth to limiting factor in. ~~ ~ Rate Horizon Depth Dominant Color Redox Description Texture Stnucture Consistence Boundary Roots in. Munseil Qu. Sz. CoM. C~or Gr, Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS> 30 < 220 mg/L and 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. Page 3 of 3 STEEL'S SOIL SERVICE INC. David J. Steel 994 200 th St CST POWTS Quality Complete Homes, Inc Baldwin,WI 54002 #2489S6 NEl/4,SWi/4,S15,T29N,R19W Lic Bus.(715) 6$4- 5680 . Town of mason, St Crouc Co. Fax (715) 684-3449 Coyote Itldge Lot, 28 ~e~ , • = Benchmark Ele.100.00ft Top of 3/4" PVC Pipe • = Alt Benchmark Ek. 99.90ft Top of 3/4" PVCPipe ^ =Borings Boring Elevations B1= 96.75ft B2 = 96.75ft B3 = 92.85ft B4 = OO.OOft 3a `~3. tN ~~ ~,,.~ ~2 oY „~~~~' ~ c}~~ ` ~! l C' J _ ? G.- 6 ~, ~ b~-- ~' ~ ~~' ~x~~ A~ ~~ ~ti~'l h ,. ~Y c h,~i 3 08!12/2004 ~~ x x x x 14:11 7157491719 S ~~~ ~ N ~ ~ C g~ j ~ x ' -- S S~~ ~~ Q _ •~~~ ~ ~ _. rn~9x N ~+ _ ~~~'~~ ~~z ~ I ~- ! o x m a f to ~ c7 ~~ x N a ~ ~ z ~ ~ '® ~ ~ ~ ° ~$ ~ =~x ~ ~Q ® C~ p rtt eD ~ ~~ ~~~ ;~x~. ~- ~~ N z t x '~ ~i r ~1 ..NCC s, Z b I~ ~ ~~ N ~ -.~ ~ ~ ~ ~ P ~ al o~~ ~~ hIORTHLAND 5LIRVEYING PAGE 81 ~ ~ ~,~•~ , o •~ ,. ~ ~ a a . ,~ .~ ~ \ 1` i •` ~~ ~ ,r ~~~«~,~ r O N ~ ~. ~• 11 ~ ~ O ~~~~ i ~~,.~, f .~ t f ~~ ~~~ i I .r °" N b 6 I O ~ p k Gff (7 • to ~Q ~ ~ , ~ iy !? i t I ~ V I A 1 I A i ,l0'St63.6E.1~~S `~y~,i i ~~ J. j - ' I n ~ 't .. ~~ . :~ ,~ ~~ ~~ ,~` ~~ •~ 'L ~ ry +~ .. ~, /• .i" ., •~ ,r• ,. ., ~, ~,. ;y~ ., ~' ~ ~ ~~. ,~ ~` ~ . 1i I I t / i i i I i i i t 1 1 1 1 I 7 t 1 I ~^ i' ~ \ . ~ '+ ~A .~ o;,~~ ~, ,~ ' • • ~4 ~~`` •' ~~Q. .,. • '~ ~~ r ~ ro b °' r j ..~ o ~~ N S~ W c i I I I ~' ~ n N ~ m O ~ fD O. 7 tD N ~ N c ~ fD p~ a ~ ~ ~ O O '~ ~ C cG ~ ~ ~ ~ cn Z D ~ m co D '^ I ~ a ~ 3 O ~ - Z I O 1 Z I O ~ -~ ~ A 0I ~ o' a m ~ ~ I N Q. Z 0 y~^= W TT N O ~ 0 y^ = W_ Q ~ a ~ d a~ C . a ~i ~ ~ ~> > o N i y = o °« . o a ~ ~ ~ y ~ d ~ ~ 7 I ~' s I ~ . y Z ~ Z O L G ~ fD M n ~' y N~ O O ~ . ~. CD 7 ~ fD y- 0 3 d ~~'O N Na ~ ~ a am 3 0 ~ °< o m ° I ' ~ O ~ T Q ~ N ~ O ~ ~ 7 O ~ ~ b '~ fD 41 O ~ O ~ ~ ~ ~ KO 7 " m ~ ay < ~ m c m a ~~_`~ ~`° ~~ _ Q O W 7 y N Sp d ~ fD 0. ~ ~ v ~' O N N - d ~ O p O I O 7 ~ N ~ a ~ O ~- nv,p! °c ~ ~ ~ ~ m ~ ~ M O C~J1 ~ W ~ O -~7 b1y'- C a' ~ ~ a .~ ~ ~ m ~ w 3 0 0 ~ A A ~ ~T S {S~ ~ 0 C N ~ ~ 7 'o v O ~ A M .• 7 M ~ ~7 Q Qs J O~ .1.J y C ~. (~ 3 d o 3 ~ 3 ~ ~o d ~ m 2 cn ~ N O ~ 7 ~ "'~ (D y S (gyp O G 3 ~' ~ ~_ N (7 ~ O O m ~I ~ a ~ ~ ~ ~ ~ c ~,I ~ a III fD lD a 3 ., N Z f T C 7 a A Zz_T ro ...1 N ~. A ~Z ~ G ~ ~ ~ ~ m ~ A d m, a~ C7 0 A'+ ~1 O ~• O 0 ~• `fie ~e a fi N V N O A v N Op A A ~ ti W ! O y ~ y Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 County ~ Madison, WI 53707 - 7162 i i Sanitary Permit Num er {to be filled in by Co ) n seons (608)266-3151 3 )? Department of Commerce Sanitary Permit Application State Plan I.D. Numbe ou provide al information rs d 21 Wi Ad C 8 y m. o e, pe on , s. 3. In accord with Comm may be used for secondary purposes Privacy Law, s 15.04(1 xm) Project A Tess (if different than mailing address) 1. Application Information -Please Print All Infor lion ~~ ~ Property Owner's Name arcel # Lo # Brock # ^ yv{ Property Owner's Mailing Address rope ation ~~~ _~~/., _~., Section 1~ City, S to Zip Code Phone Number ~ / ucle one) 7 7 d/ ~~ T~N; R ( EorW II. Type of Building (check all that apply) ~ ~ 5 Subdivision Name S Number or 2 Family Dwelling - Number of Bedrooms O Public/Commercial -Describe Use _ _ .ill e~T ship of ^City _ O State Owned - be ~ ~ ~Jk III. Type of Permit. Check only one boz on line A. Complete line B if ap icabl A' New System ^ Replacement System TreatmendHolding Ta 'Replacement 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 weer IV. T of POWTS S em: Check all that a 1 ^ Non -Pressurized, Tn-Ground ^ Mound > 24 in. of suitable soil d < 24 in. of suitable soil ^ At-Grade Sin Pass Sand Fil: ^ Constntcted Wetland ^ Pressurized In-Ground ^ Holding Tank ^ t Filter ^ Aerobic Treatment Unit culatin Sand ter Recitctrtating Synthetic Media Filter Leaching Chamber ^ Drip Li Gravel-less Pipe ^ Other (explain) V. Dis tsaVTreatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispe Area Req (sf) Dispersal Area Proposed s System Elevation ~ 9 '~' a-a 0 ~ ~o ~ • i~ (•~° VI. Tank Info Capacity in Total Number Manufa rer Prefab Site eel Fiber Plastic Concrete Constructed Glass Gallons Gallons of Units New Existing Tanks Tanks Septic nr Holding Tank a -- (/ Aerobic Treatnrnu Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume ponsibility for i Ifatioa of the PO shown on the attached plans PI tuber's Name (Print) Plum s Si lure P PRS Number Business Phone Number - ~~-6 ~ .~ n G a ~ P)umber's Address (Street, Ciry, ~a~• Zip Code) _ \'tll. Count ~/De artment Use Onl Sani ry Permit Fee (includes Groundwater Date Issued Issui Agent Signal a (No Stamps) pproved ^ roved Sur rge Fee) r- ~ ' n ial Ia. Conditions of Approval/Reasons for Disapproval ~vQ~~_ , , ,,, _~ ~p ~ j ,~n~y~ `~'"` SYSTEM OWNER: -~~~-- S ,~ 1 Septic tank, effluent filter and dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. _. ~...r.-..:t n . t t r...~r... r...s~~ Ataep compete psm tto tse a:ouaq sorry) ror me ryasm ..~ r~• . SBD-6398 (R. 01/03) . _ _ _ ,a- . ~ ~/~` ` L `^` vO ~\~ ~' V d~ J' 1~ a ` 1 ' ~ ,w\ w C~ ~ ~~ ~ s ~~ r i t V Q © ~ ~~ ~~ (~ v) (~ ~~ l J`~ lr. M~ ~A `~L M. M Q rlS ~~ 1~ r M Q 1 iy c~S i ~-- ~~~ - o~ ~ , ~ ~- G ~. ~~ V O~ j .~ ~00 ~, m C~ ~Z ~~ ~ ~~ ~~ ~~ ~ i \. C~ ~. S ~I ~ ~~ ~°~ Y c~ O d ~ ~~ ~~ ~` ~ ~ ~t ~~ ,tom ~ ~ ~ M Q ~~ ~~ ~ -~ ~~ `' ~ ,~ ~ ~ }- ML ~~~ ~ ~~~ ~, ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer _ '~{~~ (~ ~~ Mailing Address Property Address _ (0 S -~ i n ~ ~~ r ~rv~ ~ (Verification required from Planning Department for new construction)- ~ City/State ~Gu~ ~ Parcel Identification Number LEGAL DESCRIPTION Property Location ~l~ %,, ~ ~,L(y,, Sec. ~ ~ T O~ yN-R~W, Town of Subdivision Lot # ~. Certified Survey Map # ~----- Volume ~- ,Page # ~ .- Warranty Deed # ~],'~C:3 ~/Lld' Volume ~? Page # 7 Spec house ^ yes ~o Lot lines identifiable yes ^ no a SYSTEM MAINTENANCE 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. The property-owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner anti by a masterplumber, journeymanplumber, restrictedplumber or a licensedpumperverifying that (1) the on-site wastewaterdisposal 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. 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 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 expiration date. SIGNATURE OF APPLICANT OWNER CERTIFICATION I (we) certify that all state is on this form are true to the best of my {our) knowledge. the property described ab e, by a of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF A PLICANT / / DATE I (we) am (are) the owners) of lo`~al 6 DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. *****• ** Include with ttris 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 R~c.taVED .~ `•° ~' `~ ~1 2003 vl/rscoar~ Departmer~ of ~ S L EVALUATION REPORT ~~~~ aT. CEdU~~ UC?UNTY ~... , 1 ~ ~ ~ ,.e.awur~ m a~, ms..,om. woes cagy 5 T' cR vt ~ oomptete site plan ~ paper rat less than 812 x 11 trrd~es in sine Plan mgt . incwde. but not r.~ed ~: r and Iwdaontat ~ t~3. won eESC! Paroef I.D. s,~~- ~ !o w percent slaps. scale arda's-ensiar'rs. norttr ,grid location and woe to nearest read Please print all l~matlon. Reviewed ~ t t inrun+eNice~ r~ r> seer b. uses wrrleooewery>~~ t..w. a,sot c,) tom. N w S~ SEGT• l Propertyowner ~C~iE'~tl4,V ~3fFS T Propertyt.«s~on cont. tot Nov Ira ire s /~ r 19 N e ~9 ~i{ar1 w Ptr3perty Owrret's Address ~l ~ L~J • ~r4-l e G'~ ~'-~ ' Lot # ~-g Black # Subd. Name ar CSMH E•v N " co ~+o rE' ~ fDFrE " _ e~fUDSo~ w/. s ~ ?IS 38 •7?7 N , 5 ~~ o ®r~ /fvoso~ >3~xc~~ ~~ - New OonseucGon tx+e•.~ Residerrtiai r riurrb~ of betlroan~ 3 - Code de-fiied desi~ >faw rase DSO - ~ c~ ©~ ^ PubSc cr oomt - Desawe: Parent mated S~iy,Q Y /9 r~T !~/~}-~ . Food t~ eletration it ale /~/ ft. General cocnrrrerrls ~' ~ ,4~c'~~f- T~s r~ surr~R~- ~~° ~,~ %fi!g~ovvp a B~l~ ~ ~©~. y ~ ~ 'yy'~ tr. Depthtofaotar In. cror,nds~at7sele~-. ~ sw Rate I'lorizcxt Oeptlr Dorerinarrt Rsdoot Oesoription 7exlure 8trudue t~ar~enoe 8ourtdary Roots in. MemseN tlu. Sz Cant Cobr C,r. Sz. ~. 'EtNr9 `Ef~2 / o • s /o yR 3/3 L z sbK s Lv 3 . S ~ z s •1 ~o ye ~--- ~G 2-~shK s cs ~ . s r ~-t _ _ n ,~,n ~(o ~ ~ ars es ~7l ~ tn[ Pit +c~dsurtaoee~~v. tt. .. Depdi>otac~or ~- Hottaon Depth DonrMesrt t'tedoac Des~riptlon T+~ndCxe St~ae Ca>os t3aundary boots sw Rate aPIXtF in. t Qu. Sz. Cont. Color Cr. Sz Sh. '~1 '~ i o • i~ ~l7 y~ 3/3 --- ~ a shK ~, fjz w 3 s • ~ is •30 0 i2 s~~ s rG • ~.. . 3 . 7.5t ~2 5L. ~fS ~S -.- •5 s -, ~• • went #9 = BOD > 30 _< 220 rrrfla. and rss ~o <, 50 mgil. - prruanc ~ =son _< 3o mglL and rss _< 3o tngn. - `~ ~~ Rr- zt ~b ~~ c~.~ .. ~, c~ 3 s Addiese D~ Eamon relepttone Nklrrlirer - ,pia v • ~ y - ~ 0 3 7ls • ~?a •3 ~t~•Fz. Private Sewage Consultants O 2812 10th Ave. ~iN S f--o~2 ToT,~yG o~ O o ~ Spring Valley, W154767 Z p . eo ~,-7 . Z o . Ora _ o • loa.7 . 30 • ~ Z.o • io17 • S/p • aa~ ~~~ ~'~Rtia,v x,9-5 r- w# ~ O 3 ~ Pit Grid sum elev. ~ ~ • `' ii ie .i Go f ~ z r~eardt. to rs.tilin.. rs,•En. ~ 98 ~. ~ Z~ 3 Horiaon Oeptfi - Donunant Redox Description Texture - Structure Coos - Boundary Roots Soil - , Rate l3t'DIR fi. Muriself Qu. Sz CoM. Color Gr. Sz Sh. •E1~1 •Elf#2 • t5 ~ SG ~ s s ~ S f . S S• . S ~---- L S Z © s a, Z ~ Z Z. '~L Boring # a ~9 ^ Pit GrourM surf~e elev. R- rto..t; to rn,ai..,. Efl..t.,. . HoritAn Depth Dominant Redax Dasaiption Texture . Strucka~e . ----- "' Corrsistenoe Bourrda-y Roots Sol Rate GPD/ll: ~. MunseA G1u. Sz. Cord. Color Gr. Sz. Sh. •C~#1 'Ef8f2 U ~°'~ # n Ground srafaoe elev. ~. ~ Dedh !o l'rrrtiria factor ~, Pit Horizon Depth Dorninarit Radar Oesaipdon_ Texhxe Struchae Corrs~tenoe Botatdary Rents sera Rye GPDJfr= in. Mutse/ Qu. Sz Carle. Color Ge Sz. Sh. •Eft#1 •Etf#2 I Etlluent !E'1 = BODa > 30: 220 mgA. grid T5S >30 _< 150 mglL • EA7uerd ~ . Bpps < 30 ntg/i. and TSS _ 30 rtrglL The Departmeett of Commerce is an equal opportunity servicx provider sad employee If yon Hoed assistance to access services or nca! material is an alternate fomnat, please cnataat dte department at 608_266-3151 or TTY 608-264-8T'». .~. ,~ . ~- .~ w ~ .. -~ d ~. -~ ~ ~' Q a --. ~i~ ~~ -ar '~...~ a ~ ~ Z. ~o .. ~ "~,,~ ~ ~~• a w ---• • O` N Z s ~ ~ Q t i; i J y' / { i `V 3 ~~ ur Rf ~ ~ _. . , Q W N ~~ _~, ~, c~~ ~~~ ~ ~ ~- ~ . ~~ °~ ~- `~. t G~ L ~ ~ r Z Q `~ `fiM \J -JCJ~N~~ O_ ~ ~ ~ N ~~ t CD ~ G P~ IV G D ~p G ~ W ~ ~ Q- ~ ~ .~ ~ D -~ ~_ N'< < .C n ~ ~ ~ ~-. m ~N a, ~~~ ~~~ Q N Q ~- o ~ ~- h -g ~o- POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of Z FILE INFORMAT{ON Owner ~. _ •9L~ ' Permit #~'~ t~° (l~ DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units ^ NA Estimated flow (average) Q ~ al/day Design flow (peak), (Estimated x 1.5- ()Q gal/day Soil Application Rate ~ al/day/ftZ Standard Influent/Effluent Quality Monthly average* Fats, Oil & 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 IT5S- 530 mg/L ^ NA Fecal Coliform (geometric mean) 510° cfu/100m1 Maximum Effluent Particle Size Ye in dia. ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. enerNrcNenir_c cr_WFnru c SYSTEM SPECIFICATIONS Septic Tank Capacity a~ j Q al ^ NA Septic Tank Manufacturer ~ ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model - ld~ ^ NA Pump Tank Capacity al A Pump Tank Manufacturer A Pump Manufacturer ~A Pump Model ~ ~A Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ~A Dispersal Cellls) In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ Nq Service Event Service Frequency Inspect condition of tank(s) At least once every: ^ yea~(s!(s) (Maximum 3 years) ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y31 of tank volume ^ NA Inspect dispersal cellls) At least once every: ^ ear( -(s) (Maximum 3 years) ^ NA Clean effluent filter At least once every: month(s) , yearls) ^ NA ^ monthls) A Inspect pump, pump controls & alarm At least once every: ^ year(s) ' ^monthls) p~A Flush laterals and pressure test At least once every: ^ year(s) ~ Other: At least once every: ^monthls) ^yearls- NA Other: ~A 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 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 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 (Y31 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 _<12 months, shall be pertormed by a certified POWTS Maintainer. service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page Z of _ v START UP AND OPERATION , For new construction, prior to use of the POWTS check treatment t,anklsl 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 tankls) 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 surtace 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, al! 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 alua ' a o ing tank be ' e ai e ~fZD1dl8 TI;~ tiFoi2 A/~/ CoNS77e~~ p ^ 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 POWTS MAIN AINE Name Name Phone _ _ ~~~- Phone SEPTAGE SE ICING OPERATOR IP PER) LOCAL REGULATORY AUTHORITY Name ~ ~ Phone Name s^r'. ~ l d ~' Phone '~(S_' 3F~C0- (O ('~ This docum t was drafted in compliance with chapter Comm 83.221211b11111d)&Ifl and 83.54111, 121 & 13-, Wisconsin Administrative , ~~s ~ V~`~8~ ~~• ~Zo STATE BAR OF WISCONSIN FORM 2- 2000 Document Number WARRANTY DEED TH15 DEED, made between Kemon 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. itALSH REGISTER OF DEEDS ST. CROIX CO., MI RECEIVED FOR RECORD 01/07/2004 22:35P1! liARRAHTY DEED EXEMPT # 9M REC FEE : 13.00 TRANS FEE: COPY FEE: CC FEE: PAGES: 2 Name and Return Address: Edina Realty Title, Inc. 400 S. 2'd St. -Suite 115 Exceptions to warranties: Hudson, WI 54016 Easements, restrictions and rights-of--way of record, if any. 412540 20-1027-40-000 & 30-000 &20-00 Parcel Identification Number (PIN) This is not homestead property. Dated this 6th day of January, 2004. * ernon J. Bast * AUTHENTICATIQN~C0~1~ 1 Signature(s) Gh6 Pua1~C o ~ r 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 Realtv Title - Doue Bere 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. t ~, *Cheri Brown ,( Notary Public, State of Wisconsin My commission is permanent. (If not, state expiration date: 3/I 1/2007 ) t~ WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000 ~ 2487P 1z1 EXHIBIT A The NE %. of the SE'/. and the NW %. of the SE'/4, 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 I5; 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. \ ~ `\> `. .\ ~~\ .\ ~ \> i' i i '~ ~di / ~~ /, ~~ ~ b ~ ~. . ~ ~ /~ ~ T 28 ACRES i SCI. Ff'. ~ / ° /~~J .~i A' V ~`O \ ~»„` '~\ ~\ \ ~~~_ `~~ ~'' - , -__ , LOT 27 R, 2.05 ACRES p 89313 SCI. FT. ~' ~ L.B.O. =894.50 ~ ~. ~4 ~ ~ _~-- --- ----- -~.w-4, -~---- . ,.~~~.' ,,...~''~ LOT 28 2.01 A RES 8770s so. Fr. L.B.O. =894.50 __.__ __. .__._F:___._~. _.__ ® , \ DRAINA~ ~~ 100YR. H.Yb .~ ~ ~ . , ~~ ~~£s ~ ~ ~~. W j LOT 2! 2.11 ACRE 91713 SCI. L.B.O. = 87 BENCHMARK TOP OF 3/4" R ~ 279 58' 281.1 240.44' ELEV. = 913.27' 160.96, . F THE NORTH 1/2 OF THE SE1/a OF SECTION i5 x SOUTH LINE O x x x x X MG~]pdGJ`~GD ---------------------- x x x -x L~LI~nID~ OO~In~C~D_~~--_~O`___G~C~G°~~ DATA TABLE RADIUS CENTRAL ANGLE CHUHiJ t3EtWIr7G CHORG LE~vGTH ARC LENGTH TANGENT IN TANGENT OUT 233.00' 13°14'04" S14°29'29'W 53.70' 53.82 507°52'27'W S21°OB'31'1N 233.00' 21°56'53" S10°08'04.5"W 88.71' 89.25' ,; $21°Q6'31'W S00°50'22'W 367.00' 05°00'34" S89°53'18'1N 32.08' 32.09' S87°23'01'11V N87°36'25"W 167.00' 47°32'59" N63°49'55.5"W 134.65' 138.59' N87°36'25'VV N40°03'26"W 80.00 245°38'17" N72°52'34"W 134.46' 342.97 N49°56'34"E S15°41'43"E 80.00 35°32'40" N32°10'14"E 48.84' 49.63' N49°5fi'34"E N14°23'S4"E 80.00 56°09'11" N13°40'41.5"W ?5.30 78.40 N14°23'54"E N41°45'17"W 80.00 25°34'33" N54°32'33.5"W 35.41' 35.71' N41°45'1T'W N67°19'50VJ 80.00 54°02'41" 585°38'49.5"W 72.69' 75.45 N67°19'S01N S58°37'29'1fV 80.00 74°19'17' S21°27'53'W 96.65' 103.77' S58°37'29'11V S15°41'43"E 80.00 65°38'1T' S1T'07'25.5"W 86.72' 91.65' S15°41'43"E S49°56'34'MV 233.00 40°47'20" N60°27'O6"W 162.39' 165.8T N40°03'25W N80°50'46'1N 233.00 OS°18'36" N44°12'44"W 33.75 33.79' N40°03'25W N48°22'02'W 233.00' 32°28'44" N64°36'24"W 130.32 132.08' N48°22'02'W N80°50'451fV 233.00 47°52'38" S75°12'55'1N 189.08' 194.70 N80°50'45W S51°16'3511V 233.00 34°35'18" S81°51'35"W 138.53' 140.68' N80°50'45'W S64°33'56" 233.00` 13°17'20' S57°55'16'W 53.92' 54.04' 564°33'55' S51°1B'3G'W _-- -- ..,,.~...,~,...,., 11/17Z' 112.87 S51°16'36"W N90°00'00'1IV -------TI\~~-fM.gER..-k.~kN.E-_------ -----