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020-1351-16-000
Wisconsin DepartmAnt of Cbmmerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT t GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. ermit Holder's Name: City Village X Township Hicke ,Thomas Hudson Townshi ST BM Elev: Insp. BM Elev: BM Description: SANK INFORMATION TYPE MANUFACTURER CAPACITY Septic / Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO ~ P/L WEB BLOC,. Vent to ROAD Septic / Dosing /n ~ fyy~ Aeration Holding PUMP/SIPHON INFORMATION Number Loss to ELEVATION DATA county: St. Croix Sanitary Permit No: 453475 0 State Plan ID No: Parcel Tax No: 020-1351-16-000 Section(Town/Range/Map No: 16.29.19.1893 STATION BS HI FS ELEV. Benchmark •------ ~. ~ q v~• ~ ~a ~d Alt. ~ ~•oZ /0.3.16 Bldg. Sewe~~~ r / `~ ~ O/, pY 8 0 S Ht Inlet ~ U ~ S~ / - U f~ ! . S Ht Outlet ,,.- / o /- Dt Inlet ~~._ Dt Bottom ~ Header/Man. ~ Dist. Pipe ~9. I Bot. System ,d ~ . V Final Grade " ~~ S ~~ StC r / ~ ~'~ P // SOIL ABSORPTION SYSTEM ~ ~D~1,. C~ .D BEDITRENCH DIMENSIONS Width t //) Length ~ /,~. ~ J No. Of Trends PIT DIMENSIONS ~~ No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L~ BL~ WE L LAKE/STREAM LEACHING CHAMBER OR Manufa r~+ T f S t yp ys em: %f \ )~s/ ~ ~i UNI Model Number. DISTRIBUTION SYSTEM ~'"~-~Pin.Po ~.ti-.~ ~~~ ~O U~-v ~~'~~ Header/Manifold Q CM/ l~ q Distribution / ~ „ `i ~ ( Pipe(s) ~jyy t!u"+ t~"' ~~ f/ g x Hole Size .~"_ x Hole~ciag- Vent t 'Intake Length Dia Length Dia Spacin SOIL COVER .,, ~t aw+O.~it Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over ~ r Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ ~~ Bed/Trench Edges Topsoil ~ Yes i No ~ Yes n No ~~ ,i' ,~ v COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / ~ / ~ Inspection #2: / / Location: 925 Waxon Ln Huds/o~n,W./I_-54016 (SW 1/4 SE 1/4 16 T29N R19W) Pleasant View Acres Lot 1 Parcel No: 16.29.19.1893 1.) Alt BM Description = WtZ4 K(j1/(,( ~~~~ ~~ S~~,v-~-~ ~/ ~S',`~Qjyyt 2.) Bldg sewer length = 1 ~~ G~ ~- ~j,~,{, _ J" -amount of cover = ! ~ ~ ~~~`~ t"""'" "" r--,---~ Plan revision Required? Yes No ~ Use other side for additional information. ~ ~ ~ ~ ~__~ _ ________ (~ ~ ~ l Date Insepctor's Si ature Cert. No. SBD-6710 (R.3/97) 7 . _ ,~~ . -- ............._....._. N~4%!!1 L" ... _ :'n:~.. ~vu.m,~,e,s der..'. .. ~ 1. ---.---__..._----...._.__ . ._ ~ ~/r ~ ~~ ~ T ~~ . ppPox ~~uti~2y pE @~ DS S F ~ev 83'~4~ eh-~~ ~bK1C ~l~d ~ s.~ ~ Np~ , N e n J ~`vnltio'~,n~' (~ hn 79. ~''~ ~ E rev = (vu . ~ ~ ~~ ~ ~ , / ~, ~- ~ 1~1.U~ ~-;~fib~~ 1 ixaN~~s u p~c,o~i1~~ ~~ 4 3x`3,?-~ ~I C~.w..lvx~ ~. n~nTtmuc~, ,~~ ~ ~ t ~° y ~ ~ ~~ ~, 1 . ~~ J~~ ~ '°~'~ p I~F pub P ~ ~ 1 ~, -- -- ~~ R~ ~_ ~O' ~Ak~ N rA~ ~~ Tu ~ ~ ~' ~~ ~, h- R l _ ' I~~~V~ ~~~L~J - ~ ~heN v~~) p C g ~~ S ~ Safety and IIuildittgs Division County } ~ c 201 W. Washington Ave., P.O. Box 71G2 ~~ ons~n Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) De artment of Commerce (fig) 266-3151 ~(S-3 ~s- _ Sanitary Permit Application State Plan I.D. Number in accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Address (if different than mailing addrt'ss) I. Application Information -Please Print All Wormation ~'~ ~ {~° ~" ~ ~ T a'? . ° ° ~ _ .` 9~5 lc)a.xon La.~e u.~ so nJ GlJ.l Proper Owner's Na me Parcel X Lot K Block / .'?)U~ c Property Owner's M ailing Address 12 o f Property Location ._ ~.... ' Cj,' // ' S~ ' City State Zi C d .Section /+. , ~ ~ ` ' ~ p o e ~ ~~ U Phone Number ~ • _~~ IY ~ Q 0 j J J (circle one) II. T of Buiidin ype g (check all that apply) ~, ~¢r c~ T ~_ N; R~~E or (~ 1 or 2 Family Dwelling -Number of Bedrooms V Subdivision Name CSM Number .^ Public/Commercial -Describe Use ___ _ ~ ^ State Owned -Describe Use _ _` I.1Ciry_I_~Village (Township of p III. Type of Permit: (Check only one box on line A. Complete line B if applicable) ~ p ~ / s _ ~ ~p 3 A. I~New System ^ Replacement System ^ Treatment/Holding Tank Replacement Oniy ^ 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 IV. T 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 ^ Rxircula S nthetic Media Filter aching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. D restment Area Information: Design Flow (gpd) Design Soil Application Rate(gpds~ Dispersal Area Required (sf) Dispersal Area Proposed (sB System Elevation S 8'?u . U 9ss(~ g1 S VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber pl~ic Gallons Gallons of Units Concrete Conatntcted Glass New Existing - l Tanks Tanks Septk or Holding Tank r ~ ~ ~ l/~ Aerobic Trcatmera Unit Dosing Chamber VII. ResponsibiUty Statement- I, the undersigaed, ttsstwe rbpottsibWly for htstallatlon of the POWTS shown on the attached pltuu. Plumber's Na the Print) Plu 's Si grta MP/MPRS Number Business Phone Number ~. ~a~, ~..,~ ~~ 9 ~ ~1 ~s '3 ~ - a L ~~ Plumber's Addre ss (Street, City. State, Zip Code ~~ ~ ~ ~s ~- , so~>., ~~1 ~ ~ b1 VIII. Count /De artment se Onl Approved ^ Disapproved Sanitary Permit Fee (i lodes Groundwater S h Date Issued I. uin Agent Signatur No 5tatrgrs) ^ Owner Given Reason for Denial urc arge Fee) ~~ ~ . Z ~ ~ IX. Conditions o p rev 3 \ ~~.{.---- ~- ~ J SYSTEM OWNER: / ~lQ'~"'~ 1 Septic tank, effluent filter and ~~ aARQ t t - i / i d ~ ~ a ~ ~~ ma nta ne - - dispersal cell must all be serviced as per management plan provided by plumber. ~ :~^~ueve~hl~.~:.-. ~'~. ~~ ' All setback requirements must be maintained ~A ~ ~ ~ o ~~ ~ J~ ~ _ n ~ t 2. 'C ' P as per applicable code/ordinances. ~ ~ ~ -_ ~ ~ S~Q ~ ,vv.. ~ N~ f~t,l SBD-6398 {R. O1/03) •••• ...~ ..v....y vaq, .m me nrs.wn vn paper rnrr Irs3 UInO errs E 11 InCnla In alt! /u t~ ~~ ~., «~k~ _S,~ ~l ~. cvi ncl~ rs~ ._,4L~ _. ._._._. _..._.__ _ ..._.. _ ..l ~ ...... _.._..__ _.__.~_ ~~ ~ _____ ... ._ ~ ~ ~r ~ ~Ak~~ ~..b~, ~li . W p PP'X ~~u-~~2y pip uSGS ~ w $3'~4~ e1~c~ ~"~1,b~k E-~,~ os ~1~d fi~ ~ N,~- ~ N °'~ ~yb ~ ~ lub~,o~ Qn~ 49.57 ~ E~ev = l~U 1 I~GU S~~k oN \ ~ I'1cvNc~s s ,~~ ~ u~p~~o~;1~-~ ~ 3x~3.7~~, 'y C 1~~..lex,~ P~ n ~ja,N c ~, f. -j_~ -~ ~ ~ /o' i3 ~II) S~ S, ~ ~"~~ L V _f, flu pfd p~caP ~ l ~ `. _~ , 1` ~-. ~~. .~-~-- ~ ~ ~ ~ ~ ~ ~ rnS~bN Tu v ~' _~`, N fi ~, r. __-. a or, ~ ~ N c,~J a - ~ ~he u u~4 1 ~ ~~ ~ U a ~ T~~~--~.~ 9~. s ~~ '~ ~ <- /~ ~~ Wisconsin~Department of Commerce Division of Safely and Buildings SOIL EVALUATION REPORT in arr•nni~nrn wi4h (:nmm RS Wiz ~rlm r:nr~a 1800 Page 1 of 3 A.C.E. Soil & Site Evaluations 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 t d -~ Parcel I D roa is nce to neares percent slope, scale or dimemsion ~~ ~, . . . 020-1351-16-000 Pleas ~ e ewed.By e Personal information you provi m secondary purposes (Privacy Law s. 15.04 (1) (m)). .~,~ Property Owner ~ Property Location Elizabeth Woolley _ ~ Govt. Lot SW 114 SE 1kt S 16 T 29 N R 19 W Property Owner's Mailing Address ~70NINGOF~IC~ Lot# Block# Subd.NameorCSM# P.O. Box 724 '"` "- 16 Plat Of Pleasant View, 1St Addition City State Zip Code Phone Number ~ City _j Village ~J Town Nearest Road Hudson ~ WI 54016 Hudson 925 Waxon Lane New Construction ~~~ ~ Residential / Number of bedrooms 4 Code derived design flow rate -- 600 - GPD Replacement ~ Public or commercial -Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Install four trenches at 95.5', 95.5', 97.5', & 97.5' using 28 leaching chambers. Lift station may be needed to reach system elevation. Boring # ~ Boring > 108~~ /~ Pit Ground Surface elev. 100.16 ft . Depth to limiting factor in. Sal A lication Rate pp Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/tt' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 1 0-17 10yr'2/2 none I 2fsbk mvfr gs 2fm,1c 0.6 0.8 2 17-24 10yr312 none sil 2fsbk mvfr cs 2fm,1c 0.6 0.8 3 24-30 10yr5/4 none sil 2fsbk mvfr cw 2f,1m 0.6 0.8 4 30-36 7.5yr4l6 none cost 2msbk mvfr cw 1f 0.6 1.0 5 36-41 7.5yr4/6 none Is 0 sg dl cw 1f 0.7 1.6 6 41-108 10yr5/6 none s & gr 0 sg dl - - 0.7 1.6 Z a Boring # ~ Boring N Pit Ground Surface elev. 106.40 ft. Depth to limiting factor '118 in• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-9 10yr32 none sl 2fsbk mvfr a 2fm,1c 0.6 1.0 2 9-15 10yr/12 none sil 2fsbk mvfr cs 2fm,1c 0.6 0.8 3 15-25 10yr3/3 none sil 2fsbk mvfr gs 2fm,1c 0.6 0.8 4 25-38 10yr5/4 none sil 2fsbk mvfr cw 2f,1m 0.6 0.8 5 38-42 7.5yr4/6 none Is 0 sg dl cw 1f 0.7 1.6 6 42-118 10yr5/6 s & gr 0 sg dl - 1vf 0.7 1.6 'Effluent #1 = BOD ~ 30 < 220 mg/L and SS >30 < 150 g!L uent #2 = BOD <_30 mg/L and TSS < 30 mg/L CST Name (Please Print) ignature: CST Number James K. Thompson 5--- 3602 Address A.C.E. Sal & Site Evaluations Date Evaluation Conducted Telephone Number san Paulson I aka I ana r~sranla t saran 5!20!2004 715-248-7767 Property Owner Elizabeth Woolley Parcel ID # 020-1351-16-000 Page 2 of 3 Boring # J Boring f/ Pit Ground Surface elev. 104.18 ft. Depth to limiting factor > 114" 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 1 0-6 10yr'2/2 none sil 2fsbk mvfr gs 2fm 0.6 1.0 2 6-9 10yr3/2 none sil lthinpl mvfr cs 2fm 0.4 0.6 3 9-17 10yr5/4 none sil 2fsbk mvfr cw 2f,1m 0.6 0.8 4 17-21 7.5yr4/6 none cost 2msbk mvfr cw 1fm 0.6 1.0 5 21-31 7.5yr4/6 none gr Icos 0 sg ml cw 1f 0.7 1.6 6 31-82 10yr5/6 none s & gr 0 sg dl gs - 0.7 1.6 7 82-114 10yr6/6 none s & gr 0 sg dl - - 0.7 1.6 ^ Boring # ~ Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Appliption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roois in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#1 'Eff#2 ^ Boring # ~ Boring pit Ground Surface elev. ft. Depth to limiting factor tn. Sal 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 ~ 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 = BODS < 30 mg/L 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. ^ 5o,/e~i/ua~fim-~~0,~ • Elm /a~a~ E~~~a~" ~arKl /,nt ~ ;ie/ ~e,f br ~Ciob GCIb~'iJr ~` 1 /zz/98 A' S cafe : / "=loo' a i ~ v, ~~ h~ r ~ ¢~ Stw'.n ,.1a~La~ r~t~y~. ti, ~ ,~ a~eq, Ge.S. 6. ~ e l e~ r g37, fib .1~ 1~, E~~vas ~tia~~d~ sai ~ Z/a.lKa~GTu~ ~Qil1. =94.57' ~~ ~~~ a~ ~~ ~ l3enc-k K: ail ~n fence S~~ SSu-nld el¢v~ =/ ~ ~ ~ ~ ~ t~Q A ~• s tol.29 ~~ ., ~''- %/3~`~ 99.5!' ''~u.iwE ~~> trr. 8.cc'~S ' ~~ M ~~o_ y (yes ~du~t2 ~.' /o3.FS \ ~ +~ L[ ~~p~ ~' i//oG' 8 K ~3 ~ , ^ a ~~ ::ob ' - -032 B 2 o`'~ Q~~~ ~in25 A16. ~6.~t. ~ Tc~ o~ /of .S~rf'e. E~ev. = /ion .~ tvaron /-one ~~. ~aF3 !Nisconsin Department of Industry, labor And Human Relations Division of Safety and Buildings SOIL AND SITE EVALUATION in accordance with s. ILHR 83.09, Wis. Page ~ of Aitach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County Include, but not limited to: vertical and horizontal reference point (BM), direction and S~• C~~~ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # ~~ ' / (, ' -~, ;- ~. r, .~ f ~ \ pf ..-.~ ~ d O l72O -! ~l, S vT zo• /3 f~•yo ~• APPLICANT INFORMATION -Please pr ai~~»formatipr~,, ;~, Reviewed by Date Personal Inlormatbn you provide mey be used for secon r¢~~rposes (Pdvp~(,Lew, s. 15.0~t'1 (m)). ~~ , Property Owner ; ; P_• ~ Property Location ,~~ V~~/VON ~uf}X Ditl ~ `', Govt. Lot $W 1 /4 5b' 1/4,S /~ T 29 ,N,R /9 E (orl"J Properly Owner's Mailing Address ' ~ -. ~ ` '? Lot # Block# Subd. Name or CSM# S~f y' c~Y ~'~. ff sT ~;ac~+k ll~i SCI ~~Di,,'I(~- CHy State Zip Code n r ~,,,., ' „ j Nearest Road ffUf~.SoN I ~U/ 155~0/~ I ~r.a F~ •7 ~~S/~iD_ ~ ti ge Town I ~v/t'lC~~v ~~V• ~~ New Construction Use: Residential / Number of bedrooms .3 ! Addition to existing building ^ Replacement ^ Public or commercial -Describe: ySo - Code derived daily Clow ~O6D gpd Recommended design loading rate . ~ bed, gpd/fl2 trench, gpd/ft2 Absorption area required ~_bed, ft2 7s~ trench, ft2 Maximum design loading rate ~ 7 bed, gpd/tl2 ~ ~ trench, gpd/ft2 Recommended Infiltration surface elevation(s) ~4~ 3 ft (as referred to site plan benchmark) Additional design/site considerations Parent material ~OESS 0~7Ef2 S~,t~~}/ ~~~~¢~~ Food plain elevation, if applicable ti~1S~" ft S = Su table or system u= unsuitable for system s^ u ^ s U s^ u s^ u ^ u ^ S SAII r1FSCRIPTION REPORT Boring # Ground ~y-el~n. Depth b limiting factor 7 Q/n In. Boring # 2 Ground elev. 95~n. Depth to Ilmitlng Horizon Depth Dominant Color Mottles Structure i d B R t GPD/ft2 in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Cons stence ary oun oo s Bed ,Trench ~ o •~ i~ yR ~Z s« ~fsh~ ~f~e s i ..z ; . 3 3 s's ioy,~ ~~ S~iL z s ~ ~s _ . s ' . 6 Remarks: ~ • 3 ~s yR y ---- .S D s d c . ~ ~ ..g s ~ • y ioyR sr~ ---- S D s ,e ~ ~ • ~ ~ . 8 acavr In. Remarks: CST Name (Please Print) ~ Signature ~ Telephone No. ~oB~T 77L.8~eicffT ~~' Z~ j 7~S• 38G • BIBS Address A/ // y~Dfy~at+eR C~jS~T~jN~uJmber ' I III..GI.~ O_ Awww..l..~w.. '/ O/ ' ~~ r ~/ f (/ ZZ s .7 / Private Sewage Consultants 665 O'Neil Rd. Hudson, Wis. 54018 . ,~,~ PROPERTY OWNER y • ~~~~~ SOIL DESCRIPTION REPORT PARCEL I.D.# Cy'7 '' ~~ LD ~ /~ Boring # ~3 Ground elev. /o~~f<. Depth to limiting fa~ct~ 7 ~C~ __in. Boring # around elev ~o~•~rt. Depth to limiting factor } ~in. Boring # 3~ Page' Z of Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots 2 in. Munsell Du. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench 2' ~•3 ioy/~ y SOS O,s ~ cS - . ~ ~ .S o . ,a s, ____ s ,e _ _ ~ ; g Remarks: 2 • ~~ io yR y`~ ~--- QS ©, S ale c S ? ; . 8 3 io S`~ s D, ~ - -- ? ~ 8 ,~. , Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots D in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ,Trench y •~ ion Y/ SL / s ~ ~ 2S ~ - y; • S 3 ~. ioy yl~ ~.-- Cos ~ ~ ~s _ . ~ , . Ground elev. /off :~ft. Depth to limfting factor 7 _~In. Boring # In Ground eiev 9~,~ft. Depth to limitfng factor /_~in. Remarks: ~~6~~ ~~~ ~~ / ~ SBDW-8330 (R. 08/95) ../~ G~ / ~j'Yc5' ~ LL(~j[. ~iJn KJ~I~' ~~~iV ~~ .~' /iU~y Remarks: / /o ~ zl ~ SQL l~S,d ~ f~P S' / . ~ '• 3 Z , r y ~J/ft~Qil/ SOIL DESCRIPTION REPORT P~10PERTlr OWNER r ,I / PARCEL I.D.t>E ~ C~''7 '' ~ GD ~ ~G/ Page Z of 3 Horizon Oepth Dominant Color Mottles e T t Structure Consiste e Bo nda Roots 2 in. Munsell Du. Sz. Cont. Color ex ur Qr. Sz. Sh. nc u ry Bed Trencfi ~2 ~ ~ • ioyR y ~oS o, s -C cs - . ~ ~ . 8 o • ~o ~ ---- s - ~ :. 8 Remarks: 3 io S`~ s ~ - -- 8 ,,,, Remarks: Boring # Ground elev. ~ pa2 :fin. Depth to Ilmttlng factor 7 ~-2.,,_In. Boring # (around elev 9~.~ft. Depth to Iimlting factor ~~In. Remarks: ,~~a~Q ~~~ ~~ ~ ~ • SBDW-8330 (R. 08/95) /~ ~~ 5' (~~' ~ ~~j LG~ GL~ W~..~( ~/~// -~/fJ ~~ ,~iVDy. ~`'' G~~ Horizon Depth Dominant Color Mottles T t Structure i C t B d Ro ts in. Munsell Ou. Sz. Cont. Color ex ure Qr. Sz. Sh. ons s ence oun ary o Bed ,Trench 3 ~• ioy yl~ ^--- Cos ~ os -- . ~ .. 8 Remarks: /o /Z ~ --. ~ ~ SQL. l~S,6 nit f S' / . z '• 3 Z ' r ~ ~~ -d i N, w, ~ b o .. o ~ r boo • ~~ ~ ~_ ~ -.j hl ~ •. i~ ii o GU~~'1,U f~iP~ ~~ -7 0 v a ~ m-~ ~ c -$ ~~ . _ ~ ~. ~~m ~~ -o O ~~ ~~ ,r• O I~ ~ d ~ '~ ~~ ~ ~ ~ ~ ~ ~ °~~ ~ ~. ~ ~ ~- ~ o ~ ~ ~. ~~~N~~ ~ ~ , ~~ ~~ ~' ~1 ~ o •. ~ ~~ ,1~ ~ ~ ~ ~ .e 1 ~, Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment .. System (POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: Svstem Design Specifications Sanita Permit Number ~, 3 S Number of Bedrooms Desi n Flow -Peak (gpd U Estimated Flow - Avera e ( d) Se tic Tank Capacity ( al y Soii Abso tlon Com onent Size ft2 $ (~ T e of Wastewater Domestic Table 2: Soil Absorption Component -Limits of Reliable Oneratien Se tic Tank Component Soil Absorption Com onent Desi n Flow -Peak ( d) /Z~o Maximum Influent Particle Size (in) - S 1 /g Maximum BODE (m /L ZZt7 220 Maximum TSS (m !L) 150 Table 3: Maintenance Schedule Se tic Tank Ins ect and/or service once eve 3 years Outlet Filter Ins ect once a year and clean at least once eve 3 ears Soil Absorption Component Ins ect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. Th outlet filter shall be cleaned as necessary to ensure groper operation. The filter cartridges ou no a removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soit Absorption Component filter is equipped with an alarm, the filter shat! be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1I3 the liquid volume of the tank. If the contents of the tank are not removed at the tJrne of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight uppn the completion of service. Any opening deemed unsound. defective, or subJect to failure must be replaced. Exposed access openings greater than S-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or halding tank for any reason without being In full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding Tank may contain lethal gases, and rescue of a person from the interior of the tank maybe dltflcult or impossible. Tank abandonment shall be in accordance with Comm 83.33. Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorution Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors In extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. in general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soli. 7_ y Management Plan fora Septic Tank and Soil Absorption Component Plantings of deep-rooted trees and shrubs directly over or within ten feet of the . component should be avoided since root intrusion inlo the component may obstruct wastewater flow. When system fails, we will replace with another system at owner's expense. Alternate area must be left undisturbed. St Croix County Zoning Office 386-4680 Boumeester & Sons Excavating 386-9020 BOUMEESTER EXC 7153779620 07127104 08:41am P. 002 S'1' CItU1X CU[1N'1'X SI?1'"1'IC; 'T'ANK MAiN'TL~NAN(..n A(;Itl?I~MIsN'1' AND OWNI?ltSllli' C131tTIfICA'1'Il1N I~OItM Owncr/Buyer oYV~ Iq-3 _-~ (L(~- Mailing Address _ /~ ~.a~ ~r'~.t~~_~f- --_ ~$ Property Address 2-G7 ~/v`~ tit ..~ (Veriitcation required from !'lanning UeparUnont k>r new conahuction) ~ ~('J Clly/Stale O 1~ ~ ~ _ pArcel IclenliTewtic~n Nuhdrer ~a?-0 " (3 ~~ ~1~ - O00 Property I:.vealion JVy %.. s ~. y+. Sec. (~~ '1' Zq N-R L~W, "1'ow,r of ti' JDS a~ Subdivision i ~14~pcNT vl ~~ _._~.----~.. _.. ..---- --. [,c-t fl !~ CertlAed Survey Map # Voluntc Page # r: Warrttuty Deed # - '~9n ,Volume - .,~~_ ^, page # 00 3 Spec house ^ yt;s ®no Lot lines idenlifinble ~ yes U tw ~P'oPm tree said maiateruaeeof your septic system cauid result 1+r its r ernature cotrtish of punspia~ out the septic tank every three years or sooner p failure to handle wastes. Proper uraiotenaaos can aRact firs ~ 8 , if necdedr yy a ticeoscd punnper. Wlwat you pat iota the sprtem Maedon of the Ne tank s. a treatmeat sla a [n the waste d1s sal syaterrr. toaster 'the Y owner agrees to subrttil to St. Croix Zon[ng Department a certification form, eisned by the owner asld br • ~~~fow'~Y~pluua6er, tasMatedplamber or a licerued pumper verif In Ihal A the o V ~° Pty °ibn~t eottdltloo and/or 2 Y 6 () rr-site rvastewsterdLpop{ ~ralseo . ()~ ~ , ~ Hon and pumping {If necessary), the septic tank ii lose tltalo-1J3,}1'1111 Mihtdge, :,j ': Yae, lha uudorsigned bare tsad We abov " wand agree to msinlatn the private sewage dlspoaal . ~~ ' ""~ ~.~ atandtyda ~ ~' ~°ln' a sal by the D~artraeat trod the Department of Natural Resources, Sbte of MooasLt ~~ ~'t ~ mph a»~m has bean uralny~ped nv`uai bo complatcd and returned tv the SI. Croix Cvun ~ days o the sr explntlon Bela. ~ + :' <;' ~ , . b 7.onins Oti>oe wlWln ~H ,~1. • , (, fT ;. ~ DATE 1(~) ~~-lhat all statemonts on,tlljt. ~ arc Icua to the best of rn y (our) knowledge. ; (we) am (are) the owner(s) of Ilre PAY .bed abovo, by virtue of a,w,ariauty deed recorded in Regialcr of Deeds Office. ' ;~. ;,} ' .~ Sl ATURB OA LI ANI' . ~ ~ ` ~` ' ~ 7 ~ o ~~ ~~ ~ ~ ` UATB •••••• An info ~~'~`' y tination that bthis-rePr fnay result in Iho sanitary permit being revoked b the Zon +~~*+• . °,. is r;.,t~ y itrg Deptrttmenl. '* lndrtda Mlh Ibis trppllcallon; a stn MIx`~' ~~~~~~~ rnped,~.r:rwty deed from the Regialcr of Deeds omen a copy of Iho cerilfied survey snap if refetencc is made !n the warranty doal u. ZsooP o03 Elizabeth M Woolley a divorced unremarried woman conveys and warrants to Thomas J. Hicke and Jennifer R. Hicke husband and wife as survivorship marital property the following described real estate in St. Croix County; State of Wisconsin: Lot 1 Plat of Pleasant~Ciew First Addison in the Town of Hudson, St. Croix County, Wisconsin. TOGETHER WITH an easement for ingress and egress described as follows: Beginning at the Northwest corner of Lot 17, Plat of Pleasant View First Addition; thence North 82° 10' 23" East, along the north line of said Lot 17, 98.00 feet; thence South 20° 37' 54" West, 75.07 feet; thence South 82° 10' 23" West, 62.50 feet to the west line of said Lot 17; thence North 07° 35' 22" West, along said west line, 66.00 feet to the point of beginning. 766490 KATHLEEN H. YALSH REGISTER OF DEEDS ST. CROIX CO. , NI RECEIVED FOR RECORD 06/21/2004 10:00AN NARRANTY DEED EXElM~T # REC FEE: 11.00 TRANS FEE: 237.00 COPY FEE: GC FEE: PAGES: 1 THIS SPACE RESERVED FOR RECORDING DATA ••..... •..n °CTt I°N 4PflRFCC' Estreen & Ogiand 304 Locust Street Hudson, WI 54015 I~j3(l~ 020-1351-16-000 PARCEL I.D. NUMBER OR G.I.S. This is not homestead property. (is) (is not) Excepson to warranties: TOGETHER WITH AND SUBJECT TO any other easements, covenants, reservations or restrictions of record, if any, but this shall not be deemed to extend any such other recorded encumbrances beyond the term established by law therefor. 1 s~ Dated this day of June , A.D., 2004. YYl (Seal) (Seal) * Elizabeth M. Woolley (Seal) (Seal) AUTHENTICATION Signature(syElizabeth M. Woolle authen ' ted is `J ~ ay of June, 2004. Z rL>~' * h H. Gwin T[TLE M MBER STATE BAR OF WISCONSIN (If not, authorized by X706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY: Attu. Hugh H. Gwin, GWIN LAW FIRM. S.C. ACKNOWLEDGMENT STATE OF WISCONSIN COUNTY Personally came before me this day of , 20 ,the above- named to me known to be the person who executed the foregoing instrument and acknowledge the same. 430 Second Street. Hudson. WI, 54016 * (Signatures may be authenticated or acknowledged. Both are not necessary.) Notary Public, County, WI. My commission is permanent (if not, state, expiration date: , 20 SC '~? ~ ~ 91 N01103S ~O bi 1 _ ~ W ~~ ~~` ,I ,00 'OBb _ x '++ ~ W W , b i 'Ol b to ~' ~' ~= t~ Q~ f. ~ N I N a ~ ~ ~ O I I W i (~~ ~ N~ 3 21 tan Q~ 2 0ir11 N ~ ~ ~ ~ Sao ~ ~,~~~3 ~ ~ ,°~ tO ~ I ~ ~ ~ 2 o'L1 w ^~Q~j ~` Z y i 2~ /~%k3 ai ~ ~~ ~, ._~ ___ 00'082 -------- W ~~ M ~..~ ~ /~ ~ I1 lea. !~ 7 /v~ ~ ~ ~. MrLY ~J40WN ~ 111 I ~ M A O N ~ O ,6b "912 3„£Z ,9Bo ION ~ _ ° v~ ~ ~ ~ °p ~ 4~ 3N I '1 ~~ i -r"~ I ~O t~~ ~ ~~ -- ..: I `` ): ~ ( / ~ ~ - ' ~ `~y _ _.~ _ t82 Z6b _ / ~ : ~ - _-- - r' /'' i ''' .~Vr I / ''. ~ I' ,~'-- "~ , ••. 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