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HomeMy WebLinkAbout020-1351-17-000i (~ •Tj ~ .ZI to Z o ~ N N d N ~ to ~ ~ c ~ ~ A ~ ~ i ~ o ~ N ~ A c0 to ~ C ~ O fl W . O O i ~ ~ Z 0 O z z A p ,~_._ o =h =" N N Obi ~ ~ O 3 m ~ qr N a c m a W ~ a c 3 ~ IN m c O S N C W W y Q o- a a W ~ CT O7 O ~ ~ O N O ~p f ~ N ~~ ~Q ~ O A p~ ~ ~ ~ ~ N in o N N C1 ~ ? ~ ~ n A W O ~ d C1 n. _~ O fD ffl O ~ o :- G ~ f ~ m ~ ~ ~ r: O ~ f0 ? A ~ ~ ~ fl1 W fll y ~ ~1 ~ f0 ~' (O O O O j ~ ~ co ~ r °o °o ~ r ...~ _ c n ~'v~o ~ ~ ~ N N N v o v ~ ~ ~ m 7 K D ~, o m 'o O (p i y 2 1 ~ N S N na '~O ~ d n Q C n m A N a °o " 3 N Z O G T C 7 a 3 d o ~ n 3 eo v w C O N O ~_ Q 7 W ~ ~ r O ~ ~ b 0 -~.. O N o c 3"'? .. ~ ;-• v ~ m y w G f N D a a o~ 7 ~ ~ ~ A Z n -~ ,Z1 ^~ A Z O •• ~ 7 j N O N Z m ~ A d e~ A~ D. d "! A7 O O a y A t~ a ti ti N O b V i A ti ti O ti a Wi~,,onsin Department of Commerc~2 PRIVATE SEWAGE SYSTEM Safety and Building Division a INSPECTION REPORT ~ (ATTACH TO PERMIT) GENERAL INFORMATION Personal information you orovide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Whitemarsh, Brian Hudson Townshi :ST BM Elev: Insp. BM Elev: BM Description: ~ rnNK INF[)RMATIAN ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic ~~`^ ~ p3"D Dosing ~Z ~ ~S'Z~ b..~'4 ~ Aeration \ Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~~ / ~~ ,~ Dosing Aeration Holding PUMP/SIPHON INFORMATION Manuf cturer Demand GPM Model Num r TDH Lift / riction Loss System Head TDH ~ Ft Force n Length Dist. to well c•~u w Q~nonTrn~r CVCTCIIA r _~ _ ~ 1 / f __ 1 County: S{. CrOiX Sanitary Permit No: 399458 State Plan ID No: ..~-- Parcel Tax No: 020-1351-17-000 STATION BS HI FS ELEV. Benchmark ~~ t f ~ 03. l~ ' b Alt. BM Bldg. Sewer • ~O Q'p , ,S St/Ht Inlet r[ ~ _(, • O / SUHt Outlet ,L ,8~ T qp ~~ / t D Dt Inlet Dt Bottom Header/Man. Dist. Pipe Sot. System Final Grade St Cover a•s3 ~ •cj21 ~ e 'To s t qS• ~ r s 3S B/ s• a3• 9~ 9 iS' BEDITRENCH Width Lengt No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3l Q3•-#,5t 4c,~ SETBACK SYSTEM TO P/L BL G WELL LAKE/STREAM LEACHING CHAMBER OR Manuf ~yr=r. _~ ~' i'' INFORMATION t NIT em: Type Of S y s 1 .,, / _ U Model Number. ~~ bo l~'+'~V ' ~D ~(~" ^ nICT~IQ11T1f11~1 CVCTCIIA •* ~/' HeaderlManifold D'lstribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Lengt Spacing ~~n r+rweo -- ..._----_ n___._~_ ~_~.. .,.. ~~......w r~. nrr-r~nn svemme ~ mw Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bedlfrench Center ' ~ rl _ 3G " Bed/Trench Edges Topsoil ~ Yes ~ No ~ Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: to /~_/~L Inspection #2: '~T-T- Location: 919 Waxon Lane Hudson, WI 54016 (VU1/,~ SjE1/4 16 y29N ~19V,~./1)~ Pleasa+n~t ~e~cre, s L ~ Parcel No: 16.29.19.1894 1 J Alt BM Description = 5~ t.ta~G•c~ ~/(,~..v~. ~++we.. SF• 2.) Bldg sewer length = 3p S - amount of cover = 1S `~, ' z 9 ~ Plan revision Required? Yes [l No 1'Z 1~ ~ 1 ~ ~~~ __. - Use other side for additions ' ation.. 11 l Dat ~ ~ Insepctor's Signature Cert. No. SBD-6710 (R.3/97) ~}'~"P'" -~ P.~,~ cS i ar. i'e cv1r~ , ,...--~anitar"Applieation Safety & Buildings Division In accord with Comm 83.21, Wis. Adrn. Code 201 W. Washington Ave. ® ' See reverse side for instnactions for completing this application PO Box 7302 ®.S~ +~nS~n Personal information you provide may be used for secondary purposes Madison, WI 53707-7302 Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not state owned.) Attach complete plans (to the county copy only) for he system, on paper not less than 8-1/2 x 11 inches in size. County ~~~ State Sanit~~n~ij~V~q~ber heck if revision to previous application ~``~6 State Plan I. D. Number I. Application Information -Please Print all Information Location: Property Owner Name erty Location Pro p J ~ ~ l K-~ `~~ tr '' 11 c~ 1/~ 1/4, S 6 T ~ ,N, E (or) W Property Owner's ailing Address Lot Number Bloc Number City, State Zip Code Phone Number Subdivision Name or CSM Number Sid 1 ~ (~ > / II. Type of Building: (check one) ^ ~ty 1 or 2 Family Dwelling - No. of Bedrooms : ^ Village ^ Public/Commercial (describe use):_ Town of ^ State-Owned ~`/ Barest oad Pazcel Tax Number(s) III. Type of P rmit: (Check only one box on line A. Check box on line B if applicable) A) I. 2. ^ Replacement 3. ^ Replacement of 4. 5. 6. ^ Addition to System System Tank Only Existing System B) Permit um r Dat Issu d A Sanitary Permit was previously issued ~ ~~ ~~ r'Z 0 IV Type of POWT System: (Check all that apply) n-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At-grade ^ Aerobic Treatment Unit ^ Recirculating ^ Other: V. DispersaUTreatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade / ~/ G Required ~j Proposed Rate (Gals./day/sq. ft.) (Min./inch) GY! /~~ ~ Elevation / / VII. Tank Capacity in Total # of Manufacturer Frefab Site Steel Fiber- lactic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks ~ ~(Jc'J!1 ^ ^ ^ ^ ^ ^ ^ ^ ^ VIII. Responsibility Statement I, the undersigned, assume responsibility for instal lion of the POWTS shown on the attached plans. Plumber's Nanie (print) Plumber' Sig ure (no stamps): MP/MPRS No. Business Phone Number Plumber's Address (Street, City, State, Zip . ~l IX. County/Department Use Only Approved ^ Disapproved ^ Owner Given Initial Adverse Sari Permit Fee (Includes Groundwater Surcge Fe ~ Date Issued Is ing Agent Sig lure (No stamps) I Z ~ ~ Determination /,~ ' X. Conditions of Approval /Reasons for Disap~r val: ''~~jj ~~oo ~ , `~ ~L_ ~.r ~~ sal' ~~`~'~l ~ ~ ~~^` ~~l•MC' • SBD-6398 (R. 07/00) Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT Page of 111 ~VWI4011VG YYILII VVI11111 VV, YYIJ. /14111. VV4G County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Pfan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ~-~ ~-- Please print all information. Personal information rovide ma sed for seconda ur L 04 (1) (m)) o be oses (P ivac 15 Re iewed by Date ~,J ( /('~ p . y u p y u ry p r y aw, s. . p Property O,_,wner ` Property Location ~ ~ t.,,~ Govt. Lots. 1/4~ 1/4 ~ T N R E ( ) W Property Owner's Mailing Address Lot # Block # Sy1~d. Name or CSM# ~ / n _ ~``- '~ ~~ 7`/'J r City State Zip Code Phone Number ^ City ^ Vill e Town Nearest Road ~ ~~{bt (CAL )30 - l.~/ New Construction Use: Residential /Number of bedrooms Code derived design flow rate a GPD ^ Replacement ^ Public or co mercial -Describe: Parent material ~..t~.[.Ci Flood Plain elevation if applicable ~/"//~' ft. General comments ~ , ~ and recommendations ~~. (y~ ~~ ~~ ~~ l Boring # ~ Boring J ~- pit Ground surface elev. , ~ ft. Depth to limiting factor / ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 p -r z d a Z s ~~ .~-~ ,~ Z- S s wi • ~- w(- ~' •J/ 3 / (o Boring # Boring _ .Pit Ground surface elev~~~ J ft. Depth to limiting factor _7~~~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 / Z ~ ~ ,r- i~ d\ D * Effluent #1 =GODS > 30 < 220 mg/L and TSS >3 _< 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST (Please Print) re C~S~~r ~~.- Address Date Evaluation Conducted Telephone Number JtSL-B~JV (1(V //VV) Property Owner Parcel ID # Page of Boring # Boring 3 it Ground surface elev. ~ O ft. Depth to limiting factor~~~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ~ G-~ ~ ~- ~r ,.~- 2 , , ~ ~ ~/sy ^ Boring Boring # ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ^ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS > 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. SBD-8330 (R.07/00) LOT PLAN / PROJECT ~r j .,~. w ADDRESS G Z ~ Gtr-Q,~ /' -SyOI.(~ S~ 1 / 4 ~ ~ 1 / 4 S ~ /T 2 N/R~ W TOWN COUNTY ~ MPRS Shaun Bird 226900 DATE ` ~~ dL BEDROOM CONVENTIONAL~~IN-G UND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE ~( p~j ~o~~LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE f , ABSORPTION AREA '7 ~7 / # of chambers ~ ~ BENCHMARK V.R.P. ~"~ °~rQ,,,«,Q, ~° / !~ L.._ SSUME ELEVATION 100 Filter Zabel A-100 ^ BOREHOLE O WELL * ,R,p, Same as Benchmark SYSTEM ELEVATION /3. ~, ~r~, ~j ~~ Vent > 12" Sidewinder High of Cover Capacity Leaching Plans Designed Using Chamber Conventional Powts 16 " Manual Version 2.0 6' Long „ , „ Grade at System Elevation a ~~ Safety and Bt»ldin ivision County 201 W. Washi 't162 ~ ~~~~~~~ Math ' ~ ~ S s De artment of Commerce '~~ .~- ` Sanitary Permit Ap ati ~~i ~~ Sanitary Permit Number Ia aoeord vvhh Comm 83.21, wb. Adm. code, oemation you provide ^ Check if lteviaion be tlSed for it I. App>te~ttton Llformation - Flares Print All ST UFi0lx ~ , r State Phm t.D. Nwnber~ ~ A ! V G c- Pcttpetty Qwcer'a Name r~~ ~i ~h C~OE 1 Nntnber ~ ~ q' . l L 4 itydWVC~ ~~ `~ ~ c'e~,Cua~ -~i • s N R Ciey, Sate Zip Code Phone Number Lot N bar `/ Block G~ L _ 3 a ~ _ t~ r ~ ~' ivis Name CSM Number l 5~ ~~ ~' arl ~ r l D. Type of $n!ltling (check sU apply), QChy i ~t y Dwepias Number of ~ ~ C~VIllage ~r' ^ PubliclComaterciai -17esorlbe nee ovvnshi ~ DN ~ ^ State Owned Neatest &osd \ / /~.. . III. Type of Per>ntt: (Check only one box line (mmsbering scheme for internal tale). Complete line B V apptlcabte A' New 2 ^ Rephuement Syuem 3 of 6 ~ Addition to For Cotdtty ttse ~ roam A S B. ^ Check lE S>toitary Permit Previously Issued /' Numbo ` Date Issued .~ 1V. Type of Peratitt (Ch~x sit that ply){aambering scheme isit~r interns[ Use) j -Preewrfzed In Orow-d r/ 21^ Mouna a7 l~saaa Piloey, ' so 0 Constructed watlana n ^ ratae~lti:ed In-0iotntd 4i ^ lioitllag Tank 48 ^ Side mss' S1 ^ Drip LiiKS as ^ At-Grade 46 ^ 1}eamnent Un1t 49 ^ 30 ^ Odur l n ~ l~• S ~ V. ant Area Iuiornast Mn ' ~ Deslga Plow (Spd) Dlaperssl Area Dispersal Area Soil A on Percolation Rate System Sievatio Flaal Grads X00 Requirod ` Proposed Rate(Gals~ J~~ •~) ~' ~{Mia./lrrch) 3' BC /orvf /' Blevatlon 7s 0 7 ? z ~ ~ ~yo ,o i 0 , U YI. Tank Info ~hY ~ . '~ Nnmber Matmfacwro: ~ Prefab ~~ Site Steel Fiber Plastic dellvm Gallons . of Tailts ,' ~onra'de Cot>neuc~d Glee New lbtistla= i Saptia or Holdia8'feak - ZOOO Doslnj Chstnbee Q wpb 100 VII. btattemmit- the , far in:ta>mtion of fire POWTS shows as the attached Phtatber's Name (Friar) ~ Phunber's MPiMPRS Nturtbor ' Bu:inea Phone Number - S .~., ~i oo 2~- ~ l.~ ~-~ ~ ~~- ~~ Phtaobar's Address (3oroet, Ctty, State, Zip ~db8 ~ ` ~ ~~~`' , vml. me t v~ ~pproved ^ Disapproved s ~ Fee (htchuiee Groundwater Dtue Iaetud Issuing Agent slgaawre {No Stamps) tttitfat Adve»e. ~a,~ 4~I 1 ~'~Z~~ (~ t] ~" ~ .went' fif~ r~toorbe m~s a ~ar~>~~er manufacturer's recommendations. 2. All setbacks to system and residential structure must meet applicable code requirements. 3. This system was designed in accordance with the in-ground soil absorption component manual (version 2.0). 4. Well setbacks to be maintained per NR 811 & 812. 5. Floodplain mapping =Zone "C" Attach oomPMte t~ do the Cedb' coy) toe the s>na+a an paper sot lee mss am s u weea to et:e SBD-6398 (R, OS/41) PROJECT `BMW Residential LLC SW i/4 SE i/4s 16 /T 29 PLAN DRESS 424 Park Lane Hudson Wi 54016 9 W TOWN Hudson COUNTY ST. CROfX MPRS Shaun Bird 226900 DATE 10/3/01 BEDROOM 6 CONVENTIONAL XXX IN-GROU ESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 2000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 771 # of chambers 45 BENCHMARK V.R.P. TOp Of 1.25" Pvc ASSUME ELEVATION 100° Filter Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark 190' 3' below grade, 99.0/100.0/101. ~erty Line a~ a 0 78' To be installed 3' Below Grade ~ ~-5 i ~50' By2 35' Vents B-4 lo~'~ Vents l ~i•u~ B-3 Huffcutt 2000 gallon combo tank 0 10' Vent ~~ B-1 > 12" Sidewinder High of Cover Capacity Leaching Chamber 6' Long 16" 4„ Grade at System Elevation Plans Designed Using Conventional Powts 7%~~ Manual Version 2.0 Slo e ~,~~ ~b w S ~ ~~r S~ ~J~~6~ _\~~ . Pro U1 ~~~ duplex, ~' each side 3 bedrooms 0 of wl ~ ~~ ~,~ ~ ~ti ~ `~~r,,,,c~V~ 104' 3-3' X 94' Cells with >3' Spacing PROJECT" BMW Residential LLC SW 1/4 SE 1/4S 16 /T 29 ' 10/3/01 6 MPRS Shaun Bird 226900 DATE BEDROOM CONVENTIONAL XXX IN-GROU ESSURE CONVENTIONAL LIFT HOLDING TANK SEPTIC TANK SIZE 2000 gallons LIFT TANK SIZE DOSE TANK SIZE MOUND HOLDING TANK SIZE LOAD RATE 1.2 ABSORPTION AREA 771 # of chambers 45 BENCHMARK V.R.P. Top of 1.25" PVC ASSUME ELEVATION 100' Filter Zabel A-100 ^ BOREHOLE O WELL *H.R.P. Same as Benchmark 190' .M. Vent B-1 > 12" Sidewinder High of Cover Capacity Leaching Chamber 6' Long 16" 3 Grade at System Elevation Plans Designed Using Conventional Powts ~%~~ Manual Version 2.0 Slo e a~ 0 3-3' X 94' Cells with >3' Spacing 04' B-2 3' below grade, 99.0/100.0/101. ~erty Line 7 8' Vents B-4 l ~`~'~ To be installed 3' Below Grade ~os.o'S ~50 5' '~ Huffcutt 2000 gallon combo tank o 10' ~,~~ ~ ~- ~J~~6~ _\~~ . Vents •^ 104~r~ B-3 Pro Ul ~!°.~~bOYn' duplex, ._~ each side 3 bedrooms ~~ ~~~~ O PLAN DDRESS 424 Park Lane Hudson Wi 54016 / 9 w TowN Hudson COUNTY ST. CROIX Wisconsin Department of Industry, SOIL AND SITE EVALUATION / ,~j Labor And Numan R9lations Page of Division of Safety end Buildings in accordance with s. ILHR 83.09, Wis. ANach complete Site plan on paper riot less than 8 t/2 x t 1 Inches in size. Plan must County Include, but not limited to: vertical and horizontal reference point (BM), direction and ~~• C~t~~ percen4 sbpe, scale or dimensions, north arrow, end location and distance to nearest road. parcel I.D. # O 2 D - ! p • /Q dof ~ 020•/30•% ozo•~3o~.so AP LI AN P C T INFORMATION -Please print a l Personal inlorm~tbn you provide maybe used for secondary s~s cy Le s`.:19.fhF 1) (m)). R viewed by Date ~~,~,,, ~j Property ffOwnsr n \i p C ' VE/~'jVON ~/'}1(~N ~`~J !\L~~~~r/CD .Prop rty Location B QoYt. of ~~(f 1/45~~ 1/4,S ~~O T Z9 ,N,R /J E(or W~ Property Owner's Meiling Address rte <j t^,cy ~'f>• f~ ~ ~~ ;' rn ~- ~ ~ ~~~ Lot #' !`~ Block# Subd. Name or CSM# SCI ~F~D%~U(~' , ~_ City State Zip Code fpone Nurr~br~ROiX ~{(Jf~.SO// I ~~ IS~O~Co .(.~~s ~~~~ -_ Neargst Road ~ C.b/>~'.~w Rage Town I W~XL7/V LA/. ,., ~.~,,~ y, r .. _. ,,, L'am' New Construction Use: RestdenHal / Nu er~of`t~djro m =~ ~ Addition to existing building ^ (replacement ^ Public or commercial - escr be: YSo - Code de-lvdd dally Bow ~0~0?c~ ~ gpd 2 73,0 Recommended design loading rate bed, gpd/flZ~trench, gpd/fl~ Absorption Brea required bed, H trench, it 2 Maximum design loading rate bed, gpd/tt2 (J trench, gpd/tt2 Recommended Infiltration surface elevation(s) S,ee. ~ G ~ tt (as referred to site plan benchmark) Additional design/site considerations 111 Parent maferlel ~oE~' S ~ ~~ S/~yJQ J/ D (J 7'tyj9-~f~ Fbod plain elevation, it applicable ~~i~""' it S = Suitable for system Conventional ~M,ou/nd In-Around Pressure SAT,-Grade System in Fill Holding Tank u Unsuitable ror system Q S^ U l~ S ~J U [~'S` ^ U L'~ 5^ U (~-s~^ U ^ S SOIL DESCRIPTION REPORT Boring # ,~ Around elev. /OS.~n. Depth to limiting factor ~ ~In. gotittg # z Around elev. r ~~h. bepth to limiting factor /D/ . ~/D In. CST Nat Address Horizon Depth Dominant Color Mottles T Structure C i t d B R ts QPD/tt2 in. Munsetl Qu. Sz. Cont. Color exture Qr. Sz. Sh. ons s ence oun ary oo Bed ,Trench I o.ry /ov~e ~z - sc /fsbk •-~~,~ cs 2~ •'y ~ . s Remarks: ~ o• ~ /oY2 2rZ -- S~ /fade ~ ~~ />~ • Y ' s Remarks: (Please Print) ~ Signature Telephone No. ~oB~T' 77L,S,~i~`fT _~ ~/S• 38~ •8185 ~D+~at^e CST Number lllhrlrhr A Agenrintea ~~~• ~~ r /7I ~ 1.2' ~Q 3 T S Private Sewage Consultants 665 O'Neil Rd. Hudson, Wis. 64018 PROPERTY OWNEp pARCl:I I.D.Ir j/. 6{/~{-)(Q~V SOIL DESCRIPTION REPORT Go f' /~~ Page ~ of Horizon Depth Dominant Color Mottles Stnicture i te C B d Roots 2 In. Munsell Qu. Sz. Cont. Color Texture Qr. Sz. Sh. ons nce s oun ary Bed , Tre ch o • // /o yR 3 / z- - ~s //err ,~ . ~~ v~~Q CS ~ . 7 : . .3 6 ~ 9 ~o y~ s/~ s D, s d ~- -- 7 Remarks: n 0 • /0 /0 y~P 3/Z. -- SG /7~ShK ~ v~R ~S / f . y ~ . ~ ./p , S y,~ y 4 ._ .s o s ~ ~s ~ . ~ 8.y ~o ye y`~ s o s ~ ~ ~. ti~ Remarks: Horizon Depth Dominant Color Mottles Structure i t3 d t R in. Munsell Ou. Sz. Conl. Color Texture Qr. Sz. Sh. stence Cons oun ary oo s Bed , Tr ~ o io ~ y2 3 ~ 3 ~-- Sc ~fShK vie cs /~ • y : . Z o •3 ~.s y,~ yy s o, s ~. s ~. . ~ ~ . s ~ 9 /o y,~ sip --- s ~, s ~~ - -- ' ? . ~ ; Depth to limiting laclor In' Remarks: SBDW-8330 (R. OB/95) Remarks: ~hYw ~, ~.nvND oT. ~~~~/ ~N~ ~ -- ~._ 1. 3! ~ ~i5 T~~cr~-- f~.c ,cue z /yp ~ - o '~, ~ q ~~, .. .- fig' - . ~ ~ ~~ ~M~I S~-r~ L_©~ r°P °~ ~ ~`~~~ Pic ~ 7 ~- Y ~~- _---= ~' 3 (3 z `~~ o ~3~t ~ 2 sir Top a~ l ~'' P~~ p- ~.- ~~Q~~ = /05. ~o, v 0 ~~ ~~yy~sr~ ~.~u~ ,~ .-~ Pi~~'S --------- it/G ~ L~ T G, T 5c~-~~ = / ~' = 30 • _ ~3i4C~~~o.e ~ i' TS Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4.Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan 1. If system fails, determine cause of failure, use alternate area and install new system or install system at a lower elevation. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715-246-4516 Shaun Bird #226 f Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soi! 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: System Design Specifications Sanitary Permit Number Number of Bedrooms <v Design Flow -Peak (gpd) 9 Estimated Flow -Average (gpd) ~ Septic Tank Capacity (gal) Soil Absorption Component Size (ft~) ~'~-I Type of Wastewater Domestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absorption omponent Design Flow -Peak (gpd) lo(cS "~ ~ Maximum Influent Particle Size (in) 1/8 Maximum BODS (mg/L) 220 Maximum TSS (mg/L) 150 Tab le 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect 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. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be 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 Soil Absorption Component filter is equipped with an alarm, the filter shall 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 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time 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 upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enfer a septic or other treatment or holding tank for any reason without being in full compliance wifh OSHA sfandards for enfering a confined space. The atmosphere within fhe sepfic or other treatment of holding tank may contain lethal gases, and rescue of a person from fhe interior of the tank maybe difficult 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 Absorption 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 soil. 2 CONTINGENCY PLAN If the POWTS falls anti cannot be repaired the tollowing measures have been, or must be uken, to provide a code compliant rep ce ent system; ~~A suitable replacement area has been evaluated and may be utllited 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 extsdnY and proposed swcwr+, lot tines and welk. Failure to protect the replacement area wilt result In the need for a new soil and site evaluagon to establish a suitable replacement area. Replacement systems rnust comply with the rules In effect at that time. A A suitable replacement area is not available due tv setback and/or soft lfmlptioru. 6an~ilsE advances in P01NT5 technology a holding tank may be Installed as a last resoK to replatx the failed POYVTS. A The site fus not been evaluated to Identify a sultabk tYplxement area. Upon failure of the POWTS a loll and site evaluation must be performed to Locate a sulubk replaceta~ent area. If no replacsmsnt area Is ava7abie a holding tank may be Installed as ~ last resort to replace the failed POWTS. D Mound and at•gradr soft absorption sysums may be reconstructed In place following removal of the biomat at the inflltradve surface. Reco~swalons of such rystems rrwst.compty with the ruks in effect at that dme. < <WARNING> > SEPTIC, PUMP AND OTKER 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 Tiff INTERIOR OF A TANK MAY 6E DIFFICULT OR IMVC1Ct1R1 i. ADDITIONAL COMMENTS POWTS INSTALLER Name ~~, Phone -7 5--~s.F ` _ ctS/ SEPTAGE SERVICING OPERATOR (PUMPER Name Phan• POWTS MAINTAINER Name Phone LOCAL REGLtLATORY AUTHORITY A~nry S~: ~: ro ' ~ On ` n his- - • ST CROIX COUNTY ' SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM ` ~ ,. OwnerBuyer 1~~.,c-cs...._. Mailing Address ~L~ ~~~ L~ K P .Property Address 9 I ~ C~t~t-l~~- (Verification required from Planning Department for new construcrion)~j° City/State 77 C~~ Parcel Identification Number ~~ ~ 13~~ ~ ( ~ LEGAL DESCRIPTION Property Location ~ '/a, ~_ `/., Sec. ~, T~-R~W, Town of ~~-~~ . Subdivision ( ~ ~ Lot # ~. Certified Survey Map # ~ .Volume '" .Page # Warranty Deed # ~P ~O~! ~~ ,Volume _ ~S~ ~ ,Page # q ~ Spec house ^ yes ~ no Lot lines identifiable ~ yes ^ no 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 and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as t by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your se c s stem has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of y az iration date. ~ /2z , ~ ~ SIGNATURE OF APPLICANT DATE OWNER CERTIF C ION I (we) ce a 11 statements on this form are true to the best of my (our) knowledge. I (we) am (aze) the owner(s) of the prope a cri a e, by virtue of a warranty deed recorded in Register of Deeds Oflice. SIGNATURE OF APPLICANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** I$cEude 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 Document Number STATE BAR OF WISCONSIN FORM 2 - 1999 WARRANTY DEED This Deed, made between Vernon Waxon, a/k/a Vernon E. Waxon, and Irene Waxon, a/k/a Irene S. Waxon, husband and wife, Grantor, and Brian Whitemarsh and Mary Whitemarsh, husband and wife. Grantee. Grantor, for a valuable consideration, conveys to Grantee the fo{lowing described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Lot 17, Plat of Pleasant View First Addition in the Town of Hudson, St. Croix County, Wisconsin. 630933 KATHLEEN H. WALSH kF.GISTEk GF DEEDS ST. CkDIX CD., WI RECEIVED FOR RECORD 10-02-2400 10:00 AM WARRANTY DEED EXEMPT Y CERT COPY FEE: COPY FEE: TRANSFEk FEE: 186.00 kECORDING FEE: 10.00 f'RGES: 1 Recording Area Name and Retum Address SUBJECT TO an easement for ingress and egress for the benefit KRISTINA OC3LANU of Lot 16, Plat of Pleasant View First Addition, ATTORNEY AT I.AW described as .follows: P.O. BOX 359 Beginning at the Northwat Cor4er of said Lot 17; HUDSON, Vlf l 54016 thence, North !<2'LO'23" East, alonE the north Gne of said Lot 17, 98,00 feet, thence, South 20°37'54" West, 75.07 feet; 020.135 i-17 thence, South EZ'10'23"Wert, 62.50 text to the wtstllae otsaid Lot 17; parcel Identification Number (PINj thence, North 07'35'22" Wat, along said west line, 66.00 [eat to the polar of This is not homestead o beginoiag pr party. Ot) (is not) Exceptions to warranties: Easements, restrictons and rights-of--way of record, if any. Dated this ~ day of September , 2000 AUTHENTICATION Signature(s) Vernon Waxon,a/k/a Vernon E. Waxon, and lrene Waxon, a/k/a Irene S. Waxon, husbaad and wife, attt"yy~ili~~1~/PM~~ay of September 2000 ~~~(a~ • Vernon E. W~~ axon / - 4-~--, • IrensS.Waxon ACKNOWLEDGMENT STATE OF WISCONSIN ) ) S5. County ) Personally came before me this day of 7~-~ the above named ~-`_n ~ d Ratir~'. Ma~lB>;iR STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing '.,(L7pot;"'. " instrument and acknowledged the same:---- authorized by § 706.06, Wis. Slats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Kristine Ogland Notary Public, State of Wisconsin Hudson, 54016 My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both arc not necessary.) •) • Names of persons signing in any capacity must be typed or printed below their signature. ~nbrmauon wohr:ionais com0err. 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