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HomeMy WebLinkAbout020-1130-50-000 -o op I ~° I M ~' , pe°a I ~°~ 0o m eo ~ I m I a a ~ i ~ I n ~ I , o i I N h I I ° d I I ~ I I ~ ~ I l q ! I ~ I I y I •- € c I L ~ I I w ~ I ayi C o ~ Z~ I c o ~ Z °' ~ i c ~- LL ~ 1 _ d _ rn ~ ~ ; I ~ ~ ~ o 4~-. I E ¢ w I i I ~' I M 3 ~ M I °- I ~ d a~ rn Z ~ i w O I ~ o I a € € Z ~ z ~ am I d I am I I ~~ l I o I o z a i ~ I ~ ~ I ~ ~ ~ ~ ~ w ~ z N H S O ~~ ' N ~ I Q v N ~ o l ~ E I c~ ~ ~ I .o ~ ~ U ~ M N ~ ' ,~ N C1 ~ •~ ~ m ~' a o ~ I ~ z o ~ •~ N ~ a m ~ = I ~ a o t I C ' O I ~ O '~ °mz I Z cZ Q z z N C ~ I .. c I c m Vl i .. a ~i R E rn O I .. a i tC ~ E_ ~ I N W 3 i ~- .. to ~ ~ .. to ~ ~ a i a Sg y ` I a '~ ' `' `~ ~ "~ I '>' H m~ m ~ I w d~ ' m y ° O° I . ~ oca EL coa E E mN h,~ `"~ aM rrrnv~vrr> ~ > o a~ I vrr~cnvrri ~ >> a.m ~ N ~3 3 aaa I o3 3 aaa Zol • ~ ~ I ~ v, `~ o. > ~ _ ~~ C N } ~l N J U ~~ ~ ~ ~ fOp O ~ ~ r N O } '.t O O O N N 'O O O ~ M } tG N ~ 0 .-. E '~ = 0 a~ •= 'O o m 0 0 I c - ~~ ~ ~ a N 9 m y I m J 9 ~ m Q _~ d i -~ v m Q Y to I ~e 'o m Q Z lA io I ~ 0 ° l a N C n N C Q ~, ~ o ~o ~ I ~ v ~ r~ I~ 'm E c°fiap I T ~? (NO O E O N ~ ~~ N \ 1 ~ M ~ i N ~ y ~ ~~ ~ ~ O 1/ y,y ~ C ! fA O N O ~ Q1 ~ M ~ N O N C O ad. C N ~p I • o ~_ ~ ~~ cr ~ Z ~ FO- ~ r°0i o 2 ~ Y g Ul Q I I = r~ ~ ~ ~' i z = I V Ea I ~Q :~ ~ ~ •~ ~ a ~ I ~ a ~ `1~l ~ E ` 'c a :: ~ c ;: ~ A vat !Oait~ , Otnci ~ o a ~' m o a Oq w h O O N n O d ti V Y I r v c LL 3 U O M ~ a N rn w ~ y c _ ~ Z r+ O ~ Z ~ °' w ~ n a m H z oz a' ~° . ~ r 7 ~' ~ Z ~ O U M I- ~ ~ a C f0 -o U N L O) 7 2 •~ I ( y N ~ O a m Q Z ~ Z N .-. ! y R E • • ~ w ~' .. A m °' > ~ ~° °' co ` o a ! O O O • ! o N ~ ~aaa a ~ ~ c w fA J V ~ c O N N 'V ~ 'p O O O r f~) _ ~A In y O O C J 'O ` .a d d O ~j ~ O O p d N N I~ N C O ~ O C O N O ~ ~ \ v Sr O H M rn ~ l9 ~ W ~ O ~" O i W N j p) p C O • ~ y,, N ~ 7 0 2 O CMO i s cn o ~ : ~ ~ ~ . ~= € ri U ° ~ € a 'r . 3 ~ o, O m c Ua ON ° ~1 A ~ C ~ a~°i °o ~ O ~ ~ 0 C N N (6 d N L 3 m ~ o n z _ ~o m O O •~ .., o aw c o . U .~. ~ p I Z E ~ ~ r~ N N = i O ~ 0 z N I ~? c ° ~ .o °~ EI - o N ~ ° .~° m 0 0 z } ~ N m ~ C d N Q ~_ ~ Q Z ~ Q a ~ O c a (0 ~ ~ N N O Ur ~ > ~ O C N = ~ ~ . . O N ~ ~ U Z ~ Y ~ to AS BUILT SANITARY SYSTEM. REPORT ~~ OWNER 5 ~ ~ ~ ~ ~ l ~° ^ TOWNSHIP ~~ N d S 6 ~ SEC ,-~T~ ~i-R~" IW ADDRESS T~"' ~ u I ~~'~ ~'~`~~ ~~ ST. CROIX COUNTY, W SCONSIN. ~ ~ C~ 0 .h t/ v t 5' SUBDIVISION u n (~~ ~ ~ r ~ 6-~ 5 ~4 ~~ LOT 3.~ LOT SIZE, 3 PLAN VIEW ' Distances and dimensions to meet requirements of H63 ~~~~ OtnL EVERYTH IN G W IT HIN - 100 r'LE~1~ ur~ SYS~r~M ---- i y ...; ~J ~- -_- -. . .._._ -- - -- I SC di a ~-L~_.. _. e , .__._ o th __ _ Arrow ~' ~_ j __._f _ ~ ~ ~ BI/NCHMARK: (Permanent reference Point) Describe.: ~ ~ t c a r n ~r ~' 1"a k~ Elevation of vertical reference paint: ~ UG ~ Slope at site: 3 ~a- , Liquid Capacity : j G ~ U a manhole cover elevation: '' Tank Outlet Elevation: ° SEPTIC TANK: Manufacturer : ~ r n 5 !' ~` Number of rings on cover Z ~ Ta 'Cank Inlet Elevation: GI 7 ' PUMP CHAMBER Manufacturer: Number of gallons fJumber of gal. pump set or a cyc e gallons; Iota capacity o distribution lines gallon: size ~ pump head; . gallon per minute horsepower ran name of pump and model numbe-r ; 'T'ype of warning evice _ _ HOT_.DZNG TANK: Manufacturer _ Number of gallons L;l.evation of manhole cover typpe of warning device SH,EPAGE PIT SIZE: um er o pits eet iameter feet liquid dept seepage pit in e~ pipe-elevation hr~tt~m ~f seenaee nit e evation feet. _ ~ , ~i C '.~ U Lot 3`I ~{, ~''ar~C ~/Ifw ~=St~~^5 Soulh ~. ""; <+. t S * . - Rt.PORT VC iNSPECTit)N -~ IND~IV1pl[AL SrGIAGE SVSTEM • ticrni ('cx~rr[ 1'~~~rrnt t ~~ S r~ tr~ Se~,t~.c ~~~~ NAM rawnah~ ~,`~ /~ st. chat x cr,rrn•rr, l nr'«t~iorr ~ „~r Sec~ti.un Lot: a~~ ~Subd~.v~,~5-i-an~~~~~/'~~-~„~j~~~'~ SEPTIC TANK S~ze~~1 _ga.QQ.an~ Nu.mben. v{~ cvm~an-~;me-nt~~- ~ ---------~ "D.i.~tanee nom: tve_2Y Buti.Pd.i"ny_ 120 ~s~P.ape Htighwafien__--.__- Pt[MPING CHAMBER Sti z e____ -~~ ~ga;~~P a yr HOLDING TANK r S~ ze qaP Pan.!t Pumrvn Ul;~tance (nom: GIeY('~;,r l H.r. ~~ t e, n. ~ At3SORPTIUN SITE lied Tnench i~~(actune~r N befr a{~ am antm A[! arm .' /e m _MadeX Numben_ ,. I,~Q n Pone 3~~ •~~Z ~qt? Di.btanc4'~' (t~iom: (UePF [iu~t.~d.~-ng~_---- i2°s ~~a~e f1~.gG-wa.teh AE~SORPTIUN STTE. DIMENSIONS w~.dt-h o(, #neneh---------- ~~ Requ-~ned ahea (~t LengtG~ c,{~ e•ac.h ('dne ~~ Depth afi hack be~aw t~..Pe ~n Numbvh o(~ 4'~ine~5 Depth a~ naeh avers .t.i.~P ~-, TataX (.evrclth oh k~i.nv!~_~_ ~t Dert6r a~ ttiQe be Paw gnade Sri • ~ -. •..., rn, gnu„ .. ~ 1 ryr' nnnr, r,. ~a.h trtncv by twevn ~~~ wvi, (yt '..,~p'u~ ri ~ Zhe.nch ,~."'~"i"~":""'"~i""~r..1'OU h l To-tRP cc[~hanrrtiovr crfrect {fit Tr{re ah Caveh: Pane n. ah ~tt~eruv ' PIT DIME"NS(ONS Numbv~ c~~ r,i.te G~cavvf' nrror~ncl ~*,tb -rlvti___ it ' Outa~i de cfi amv,tvn ~ (~t Dvrth be4'aw c.n('.et ~~ r Tata.Q ab!tanptticrn anva ~t A ~. e. a n- e- q u ~. re e. H ~ ~ .t INSP€ '~~ TITLE - _ _~ APPROVE-D ,DATE I~Ih R'.L B 6 7 State and County ~y Permit Application ' for Private Domestic Sewage Systems *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # State Permit # /~ ~~" r County Permi # 2~ County A. OWNER OF PRO/P(E~RTY Mailing,,LAddress: _J A B. LOCATION: '/4 '/4, Section ~, T N, R E (or) W Lot# City Subdivision Name, near est road, lake or landmark Blk# Village Township ul ~ (> ~ C. TYPE OF OCCUPANCY: Commercial *Industrial 'Other (specify) Variance Single family ~~ Duplex No. of Bedrooms ~ No. of Persons D• SEPTIC TANK CAPACITY t ~ Total gallons No. of tanks HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Fiberglass Other (specify) New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E, EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New ~/ Replacement Alternate (Specify) Seepage Trench: No. of Linea Ft. dth 9epth Tile de~pth~j(t~op~-No. of Tren hes Seepage Bed:-(~~ Length Width W Depth ~ Tile depth (topJ-.L~_No. of Line Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land_ ~ °~O Distance from critical slope ~' WATER SUPPLY: Private Joint ^ Community ^ Municipal ^ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby certify that the information 1 have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I leave sized the effluent disposal system from the EH-115 prepared by the Ce tified Soil Tes er, NAME ~j ( ~ t ( G / r ~ 4 ~'`' SP r( C.S.T. # ~~- ~ 7'~and other information obtained from t ~ Plumber's Signature (ovvner/buil er . PRSW# ,N(/~^~~?~Phone #Z¢~ 3 Z 3 3 MP/ Plumber's Address 1/ m r G a~ G K G( Lt~~ c PLAN VIEW: Provide sketch below of system. (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. E 115 Rev. 9/78 ~. - ` r REPORT ON SOIL BORINGS AND PERCOLATION TESTS WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES P.O. BOX 309, MADISON, WISCONSIN 53701 ~:'~ ~ ~ RECEIVED ~~ JUL S 1981 ~~r ~/~ ~~' ZONING LOCATIONav~'/a,L.~'/a, Section ,To2~N,R~~(o~r+)~JTo nship or Municipality Lot No.3~, Block No. ~~ ~"T ~s County ` ~ ~_ _ u ivislon ame Owner's/Buyers Name:- ~ ~L~ ~ " .~` A //'~ Mailing Address: ~'^' ~ ~ So s. III. TYPE OF OCCUPANCY:. Residence ~-No. of Bedrooms COMMERCIAL EFFLUENT DISPOSAL SYSTEM: NEW~REPLACEMENT ALTERNATE SYSTEM OTHER DATES OBSERVATIONS MADE: SOIL BORINGS Le ~~'(~PERCOLATI TESTS ~ ~ '1 SOIL MAP SHEET_y~~ NAME OF SOIL MAP UNIT ~- ~ T PERCOLATION TESTS. TEST P!UM DEPTH CHARACTER OF SOIL HOURS SIN H LE WATER IN H AFTE TEST TIME INTERVAL DROP IN WATER LEVEL, INCHE RATE - BER INCHES THICKNESS IN INCHES CE O 1ST WETTED OLE SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN P-~ a e Y 0 ~ 3 3 3`L 3'~ ~ P- P- P- SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, MOTTLING AND DEPTH TO BEDROCK TEXTURE NUMBER INCHES OBSERVED ESTIMATED HIGHEST , ED IN INCHES IF OBSE R V // ~~ ++ B- .Z ~ ~ ~ 2 7 ~ h l~ `~ V k ~' ~~ ~ cf , B- PLAN VIEW (Locate percolation tests, soil bore holes and suitable soil areas.) Indicate on the Ian the loc tion and square feet of suitable areas. Indicate number of square feet of absorption area needed for building type and occupancy a~ dP/ Ifdicate scale or distances Give horizontal and vertical reference points. Indicate slope. - Slci ~ /~ /~/~Gg E ~ ; w r i I ~.~~ e~ ,~, f- Q ~. 3 F r 4 t _.~P r ,. ~~.,.- i ~ ~~ ~ _~~~ ~ _, P~~ '~ P~~~~ ~/-~4~'t-G-r~. ~ ._ ~ s 3~ 3'~ i I . , O ~- n a . _ a. .w . _ ~~ _ e ~_. ~.l` ~~. - /~Q ~ m. ~ _ ~ ~ O ~ - ~ ~ ~ ~- ~ ~ ~ . n_ _ ~..~...~ ~-~.-- _ 3 C~• = /~~' ~ ~ ~ f ._~m A~ __ a~m._~ n~_~.~_~~__ ~ U ~S~' ,'~ ~ ___.~ _, _e tip ~-~-- ~_1• _ E _ ~ _~. ~~. ~ _ _ ~ ~~~~ } I ~ ~ ~ ~__ -- .~ ~n ~~s~~ ~ ~tt'.1,~, ~.c Sy s ~e.~.. _~--ems R .;....._ ._ __~__ '//~~ § ) / j .}' ~^ ;Lr ~ ~ ~ r ~, 's _,,~ {_. 33, ~, _ .~ „r ~ 4 ~-, .~ 3~-~ ,,1 -, r ~, F ti' .4 ~ ~~ ~~ L~f ~G ~ n ~, .. ~. `i v... ''-°.~ ..„. .... `- ,._ 9 Wisconsin Uepartm~ent of indu ry,: Labor &> NomaB Re] ~~' Safety-&- Buildings vision Bureau of Plumb in Plattin & Ffre P~vtec ion ame o rem~s~s ~ 3/r a e rj_ -~~~c~ 1 art " o. Street ~ y ~ oun ani ary erm~ s er. ~ um er ~ rm _ame '.s V ~ l.. ~: ~. Gj .~' ~ i`~-„)'t$"~."aT.~. ~ ~ ~ ess , t • Q~ ,~ ~~ ~ _. t. ~ (\ ' ~ f ~ r ~ J • ~.1 1 ~3 Z r um er ress- t1 ~" Mc ~r, fi` ~.,1. ner ress ~~ ~ I ~-~ l~ ~„ _ -sue--- i_ r, _ ~ -- ~ ~ ~ .~, f i ~- y ~~ ~ ` ~scusse wt gna ur a ~ - v w. ( )See Attached.. `~ DILHR-SBD-b192(N.09/80) igna ure o ~s um ng;- *~_ .~: ~ White-Inspector Yellow-Local Inspector Pink-Plumber: or Responsi e Party 6ret~hrrner ~, ,' /* Wisconsin Department of.Commer~e PRIVATE SEWAGE SYSTEM satety>~ Buildings Division INSPECTION REPORT GENERAL INFORMATION. (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: ^ City ^ Villa a Town of: 'cling, Mark Hudson Township CST BM Elev.: Insp. BM Elev.: BM Description: ~.v ~,,~~~~ ~Iso.~ / - csr 6~ ~. uv uf~~nu ~Tf~u CI C\/ATIlllil r10~ r Mfvf~ ff~rvnfnr+f fvfr TYPE MANUFACTURER CAPACITY Septic ,~ ~ ..~..~~ p-ts>J Dosing Aeration ,--~'~ Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. vent to Air Intake ROAD Septic ? S-a' `~3 `{. z I NA Dosing NA Aeration ~.,~-- NA Holding~% PU~1AP /SIPHON INFORMATION . anufacturer D nd Mo I Number GP TDH Li Friction System TDH Fi F~main Length ell !•AU wff~ASBT~AwI ~'V~TLwA ~~1 ~ .. '1 Count SYt. Croix Sanitary Permit No.: 383990 State Plan ID No.: ~_ Parcel Tax No.: 020-1130-50-000 4 {~.iq, ~a, 4zo STATION BS HI FS ELEV. Benchmark [ 02, oS'' ~ tS~ •a Alt. BM Bldg. Sewer St J Ht Inlet --~ St/ Ht Outlet -°(~ 9r{. fS' Dt Inlet ~' Dt Bottom Header /Man. '^^r $ '2o R3 -~ ~ Oist: Pip °Y$ S sa 93. •g = final Grade (n • 8° R~.Zr r over ~~~~ ~~~ ~ ~. 5 9 , o s / I_ __C__... 0_ th id De li TRENCH width / Len,Qth / N Of Trenches PIT M I N 'S'~ ~ ~ No. Of Pits qu p Inside Dia. ME I •~ fn SYSTEM TO P/L BLDG WELL LAKE/STREAM LIEACHING a~`~.~.r;_ ~~,p,v,J/ SETBACK CHAMBER INFORMATION Type O ~~, S 20 f~ r `~~. ~~ --'~ OR UNIT o e Num erQ c.t ~ ystem: f~ff•Tnf of fTlAff CV['TCR^ Vf•~ ~ ~\~YV ~ •V~.. V . .I.. Header/ i old , / It -.-. Distribution Pipe(s) x HoleSize x HoleSpacing Vent/ T2A~take Length Dia. ~ Dia. Space tAll_ CdVER x Pressure Svstems Onlv xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No s ec Ion o Inspection #2: -f-- / COMMENTS: Llnclude coop dpiscrenan~ipS persons present, et . L~oca><wn: 477 NarK Lane, h~MV./fr, vvl o4u~6 (NE 1/4 NE 1/4 17 T29N R19W) -172919620 Parkview Estates Addn. IV -Lot 39 1.) Alt BM Description = CN~}~ 2.) Bldg sewer length = -amount of cover = ~ ~ ~~ o~A 3) c~~„~ .~,~„~,Ra, ~, Plan revision required? ^ Yes ~ No Use other side for additions{ information. O 3o d I ~.,~~~ ~~~ SBD-6710 (R.3/97) Date Inspector's Signature Cert No. . ~ ~- Safety & Buildings Division ~~ Sanitary Permit Application 201 W. Washington Ave. S+riO~S~n In accord with Comm 83.21, Wis. Adm. Code PO Box 7302 Madison WLS3707-7302 Department or commerce Personal information you provide may be used for secondary purposes , . (Submit completed. form to county if not [Privacy Law, s. 15.04(1)(m) ^ . state owned. Attach com lete lens to the coun co onl for the em o . ` " n ess than 8 -1/2 x 11 inches in size. County' State S its Permit Number D C if~ravisi"on to previoifs~spp ' ation ` ~ Stau Plan i. D. Number ( ~~ I. A lication Information -Please Print alt Information ; •P _lt:Er ~~1,~ Location: P tJwner Name ,N," ' Property Location ~ s a O ~ p' a.~ ~ ty ~ ~~ ~ ~ 1 /4 1 /4, S T N RISE W PrLop/erty Owner's Address 1 ~ ~•~• ST (:rs~r?i Lot Number Block Number "T r C.~G11.1~~ _ City, Stall Zip Code Phone um Subdivision Name or CSM Number Type of Building: (check one) •-----~•- D city 1 or 2 Family Dwelling - No. of Bedroorns: ~ ^ village , _ ^ PublidCommercial(describe use): ~ Town pf O State-owned ~~~ III Type of Permit:.(Check only one box on line A. Check box on line B if applicable) Nearest Road~~ /, l .a~ FC . A) t. D New System 2. ,Replacement 3. ^ Replacement of 4. ^ Addition to Paroe1 Tax Number(s) S tem Tank Oni Existin S stem Q- - J~''Q -O ~ ~ B) D A Sani Permit was reviousl issued Permit Number Date ~~ • ~D ~V. Type of PUWT$ystem: (Check all that appl -rte .,+~ uS,-~ , Non-pressurized In-ground ^ Mound D Sand Filter D Constructed Wetland O Pressurized In-ground ^ Holding Tank ^ Single Pass D Drip Line ^ At-grade r I ^ erobic Treatment Un' D Re it la 'ng D Other: V Dis erss-I1Treatment Area Information: O -~ - e r L Design Flow (gpd) 2. DispersalArea 3. Dispersal Area . Soil A hca ion 5. Percolation Rate 6. System Elevation 7. Final Grade S U Required 31 S ~Z Proposed ~1? Rate (Gals./day/sq. ft.) (Min./inch) Elevation ~ ` : ~ ~ 3 . ~ . 7 41.7 5 ~.S ,~ S VI Tank Capacity in- Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing Crete structed Tanks Tanks St ~' ~- _ ~ t' b0U ~~flS~e~ ~ D D ^ ^ D O ^ ^ VII Responsibility Statement I the undersi ed assume res nsibili for instaliaNon of the POWTS shown on the attached Tans. Pls N (print) Plumber's Si pv etatnpe)•x " MP/MPRS No. Business Phone Nurr~er' 4 aa~.go~ 7 ,~ Plumber's Ad rasa (Street, City, State, Zip C e 3 VIII County/Depart eat Use Only . ~ Disapproved Sanitary Permit Fee (Ine{udes Groundwater Date Issued Issuing AgeA4Sigrtature (No statnpa) 1~Approved ~ Owntr Given Initial Adverse Su 1~-Fee) ~ Determination `$,`~. '~ ~ Q "~ IX. Conditions of Anaroval /Reasons" for DisapprovaL• l~ raus,'t" .~.:wSw~`l'~.ot~ -~. , ~r, . (~ (.t+~ . S CX,Q.p~~-MOtt ; .ova K.. ~" V~Miua- S 1~C~.tnn?~•~~c ... l 1 U ~...../ 'l f~ a/~c~ ~ ~ cc C. w ~ , ,~. ~ , ., ___.__._ _~..1_u.z~ ~ ._ _.._..~_ _ __. __.___ . .f ~~~ __. _ ~1 N_ ll _.-._---.1 ~e,,~ f~ f .._ _..._ .__...__ ... n Q ~. ~'~~ ~~ rnpM1k - ~.~~ ~~, s2~~k M oN i ~W~r~ I~ev cl W ~u~o~-- ~ lev. ~ ~o.~ 00~ cool St~~'~ ~ / (3osK~~' W-~'l, ~'IU~ ~i li'oR a~,11 R~N Vn\~~ ,~ U ~- -. , r. ~~l 1~Jic~.t _/'/aria an~C~.S~~cl~e ~,c~~nct~rs _. ~~~ _ _ . ~~~ 'j(L1M ON ~oWe~ ~~eutl WIIJnOW ~)~.Vr ~00•c~ ~ooo go) stn~'~ ~ / ~ ~3osK~fi w~-fil,` ~-lug f ~ Ifi{r~ - ~ ~1 R) „1 ~Ml! ~4N ~n l~~ ~~ . . ~~~ i ~,~ • '~~ ~~~ `J 1367 f~ SOIL EVALUATION REP '~;r` ~ti~ ~w~'~ ~ 1 cf 3 Wisconsin De rtment of Commerce Q~, f pa 1 ~-~.~.; <. Division of Safety and Buildings ;,, ar:c~rciance with Comm 85. Wis. Adm. Code ' "'°"{ ~ ~ E. Site Evaluations ~ ~ ~ ' Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan must i g'S Ga Croix ~ include, but not limited to: vertical and horizontal reference point (BM), direction and and location and distance to nearest road. north arrow scale or dimemsions percent slope ~~`I'p 620 19 ~ 9 ~~OtG r , , , . . I 0-1~A~ 9 Please print all information. . , .-t ~~ %' pie t .._-._ ~• Personal informatbn you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). , .J t~ ~ S X.` - := ~ Property Owner Properly Location Mark & Janet Polin Govt. Lot NE 1/4 NE 1/4 S 17 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 477 Park Lane 39 Parkv~ew Estates First Addition City State Zip Code Phone Number :`j City ~ Village ~ Town Nearest Road Hudson ~ Wl 54016 715-386-1378 Hudson Park Lane New Construction Use: yJ Residential / Number of bedrooms 3 Code derived design flaw rate 45 U c~ru Replacement ~ Public or commercial -Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Recommend installing 2 trenches at 3' x 68.75', using 22 high capacity sidewinder infiltrator chambers at system elev. = 91.75'. ^ Borng # --j ~~ >99" i t !~ Pit Ground Surface elev. _ 96.71 ft. Depth to n. limiting factor e Sal Applicatia- Ra Horizon Depth Dominant Caor Redox Description Texture Sbucture Consistence Boundary Roots GP *Eff#1 OIR' *Eff#2 1 0-10 10yr4/2 none sl fill na na na 2f na na 2 10-22 10yr3/2 none sl 2fsbk mfr cs 1f 0.5 0.9 3 22-40 10yr4/4 none sl 2msbk mfr cw - 0.5 0.9 4 40-48 10yr4/6 none Is 1msbk mvfr cw - 0.7 1.2 5 48-99 10yr6/4 none s Osg ml - - 0.7 1.2 9(•~Sr Boring # -~ Boring Pit Ground Surface elev. 96.37 ft. Depth to limiting factor >97" in. Sal Application Rate h D i t Ca dox Descri tion R Texture Stricture Consistence Boundary Roots GP Dlit2 Horizon Dept nan om or p e *Eff#1 *Eff#2 1 0-12 10yr4/2 none sl fill na na na 2f na na 2 12-20 10yr3/2 none sl 2fsbk mfr cs 1f 0.5 0.9 3 20-42 10yr4/4 none sl 2msbk mfr cw - 0.5 0.9 4 42-45 10yr4/6 none Is 1 msbk mvfr cw - 0.7 1.2 5 45-97 10yr6/4 none s Osg ml - - 0.7 1.2 K * Effluent #1 = BOD 5> 30 <_ 220 mg/L TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS <30 mglL CST Name (Please Print) Sign CST Number James K. Thompson ~~ 3602 Address A.C.E. Sal 8~ Site Evaluations Date Evaluation Conducted Telephone Number' 340 Paulson Lake Lane, Osceola, WI 54020 3/20/01 715-248-7767 Property Owner Mark & Janet Polin Parcel ID # 020-1130-50-000, ID#27.29.19.620 Page 2 of 3 $ ~n9 Boring # 95.73 ft. Depth to limiting factor >94" in. ~ Pit Ground Surface elev. __ Sal Application Rate Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 1 0-4 10yr4/2 none sl fill na na na 2f na na 2 4-16 10yr3/2 none sl 2fsbk mfr cs 1f 0.5 0.9 3 16-30 10yr4/4 none sl 2msbk mfr cw - 0.5 0.9 4 30-35 10yr4/6 none Is 1 msbk mvfr cw - 0.7 1.2 5 35-94 10yr6/4 none s Osg ml - - 0.7 1.2 r ^ Boring # -,-f 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 : *Eff#1 *Eff#2 Borrng # J ~~ - pit Ground Surface elev. ft. Depth to limiting factor in. gat Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS <30 mgJt. 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. - • Elcda-ton 1 .= o /off 39 /~°~dd.f~ ~~oF ~~~~i t~ ES~s T. o f ~cc.dsort, ~~-C.ro,~cC'o,~Jl. p~• ~ z9. /9 /?. bz ~ r~. s ~- ~ '~- Fir ~ ~n ne ., ST. CROTX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TAIJY. This is to certify that I have inspected the septic tank presently serving tie ~1p2K-P ~pn~~' Po~ jlv~ residence located at: N~ ~ ~ -~_~ . Sec . 1~ T a 9 N, R l g W, Town of _ u~;bS ~~ , St. Croix County, Wisconsin. upon inspection, I certify that I leave found the tank and baffles to be in good condi,io and it appears to be functioning properly. Last time serviced $ ~ Did flow back occur from absorption system? Yes_` No V (if no, ski next line. P Capacitmate ~l~me or length of time: gallons minutes P Y• I Construction: Prefab Concrete ~/ Steel Other Manufacturer ( if known) : Ir.) e~ yc Age of Tank (if known):. ~ RS .,. (Si ature) ~ _ (~1 p s~'-{r pl ~- ~.~ r Qe s fin ~ z~"-• ~. ~~ ~ (Title) ~ v (Date) (Name) Please Print ~ ~_a 9 ~y (License Number) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes] or licensed disposer (NR 113 Wiacansin Administrative Code) Plumber (applying for sanitary. permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name ~~ ~ ~b l~ Y~-I-P~~l n S ignature '`~~1f~ -~ MP/MPRS l ~~ b t. , 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: System Design Specifications Sanitary Permit Number ~ Number of Bedrooms _ Design Flow -Peak (gpd) S V Estimated Flow -Average (gpd) -'--~., 3vp ~~, Septic Tank Capacity (gal) Uu a ~ Soil rption Component Size (ftz) 37 S -- K Type of Wastewater Domestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absor tion Component Design Flow -Peak (gpd) C:L90 ~~- z -- as ~ Maximum Influent Particle Size (in) 118 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 se tic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessa to ensure proper operatinn. The filter cartridge should not be remove unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Al, ~~~ 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 enter a septic or other treatment or holding tank for any reason wifhout 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 fhe 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 Management Plan for a 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 into the component may obstruct wastewater flow. WAN S~,~fi-~~, ~~~lf ~ ~~1~ ~plp~ pN~~~~ ~~e Sfi• C12o~~~ z~N;w~ G~-~~\~P ~D~n~`{~j~l d' ~~1J.J ~~ L Y~~v ~~~-9a~~ 3 ST CROIX COUNTY . SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM owner/Buyer ~A~- ~ ~T~Ip ~' ~/~,~/a Mailing Address Property Address ~h_ (Verification required from Planning Department for new construction) Ctty/State 1rr.~~nA~ f.(~ Parcel Identification Number ~© -//3p -S~_ Property vocation ~ %,, ~ %,, Sec. ~ T~N-R..,[~,W, Tovsrn of .,_,, Subdivision Certitled Survey Map # Lot # ~_. Volume ,Page # rr WttrrAnty Deed # :S/ SS~9 ~ Voltune D 7 Page # ~~ _ Spec house D yes ~ no Lot lines identifiable D yes D no use and maitttenanceof your septic:ystcm could result in its premature failure to handle wastes. Proper mainteoapoe consist. of PAS out tl~ septic tank every three years or sooner, if needed b a licensed r. What y pumpe u ut into t#~e am affect the Amictlion of tha septic tank as a treatment stage iu the, waste disposal system. ~ p sys~ The pt~ttY owner agt+ees to submit to St. Croix Zoning Deparmrent a certification fora!! signed by tbo owrret and by a i mastecplumber, jotunaymanphu~, ratrictedplumber or a licensedpumper vedfyiug that (!) the on-site wastewaterdispapl syalem ~ is pt+opar aperating condltlon and/or (2) .+u~acto~pection and P~~6 (~ Y)- the septic teak is >ea dam-1/3: pwa, the mdaiaided Lave read d~a r' ~ sat ~ Yt'aia. as sat by tM , , ~ t0 dre private aewase ~poM1 i___-__ ........~_ ....._...,..,. ~_ of Nabaal Rte, b'hta d 4 ,1 ~ ~ ~/WMii i1i{~ tMrYtBe{l W ~ ~. ~u LD~y (~{'i0 .~ three year eacplcatioa die. ~ Yr: ~~ ATiJRB t)F APFLI DATB" ';, . , I (we) oestity that all sbttements ~thu form are trua to the best of m our knowl y ( ) edge. i (we) am (are) the owner(:) of the. pmP~Y ~ alhuva, by virtue of a;wrucrao~ty deed recorded in Register of Deeds Office. ~' X AT[JRB OF APFI: ~ r / ~~ 1 I DATE '''•'*' Any infom~stion that !s mis-re ~ y result in the unitary pemut being revoked by the Zoning Depactrnaat.'`+a"' , ~ ;~ ;, "' Iaclnde Mtlr t4b Applfcadon: a stamped,~tarrsaq- deed from the Register of Deeds office a copy of dla Cestitied survey map if reference is made in the warranty deed= i .,, .,, 5~5~9 ~F.: -,.. ss.a~...-r », ~ iQ74-~cc 3t.'~ w~scx~x8I1~T e..a,. isss. ~. ~., tr.s.a TStB II~iDE»'1'iJ1is, ]tads this 18th dy a! April . A. D. if 94 , benveRa ~e Ad~niniserator of Veterans Affairs, as Officer of die United Saes of America, wl+ose address is Veterans Admiaisiration, Washington, D.C., 20420, parer of the tint part, and MARK A. POLING AND JANET C. POLING, HUSBAND AND WIFE, AS SURVIVORSHIP MARITAL PROPERTY ,part ies of the aeooad part Rl'TNEBAB"PEt, That the said Dotty a1 the ifrat Pte. toe and in eaasirderation ~ the stun os ten dollars (110.00) sad other valuable ooasideratlou :.,:. to Hier is leaad Da{d b~ the said parties of the second part, the receipt whereof is hereby c~s- faased and aclonowlsdzed, hes gives, wanted, bartaiued, sold. rem;aed, released, aliened, oer-veyed and con3frtned, sad by these peeaen's does gave, Prank bargain, Seri. remise. release, alien, cunvay and a~nArm emto the said part ies of the second part„ their heirs sad aadsns forever, the foriowia~-descn'bed propertt, dtnated is the County os St . Croix , State of Wiaeonain, to wit: Lot 39, Parkview Estates First Addition in the Town of Hudson, St. Croix County, Wisconsin. Tax Key Number: 020-1130-50 Exempt from Real Estate Trans~a~ Tax, Sec. 7725(2 Vbs. Statutes. d mil G. StTiERS,~AI~!'tOi~Y 1~OG>RTHER with ~ ~ siapdar the hes~adtlatoeati tad aDpltttenaaOM titet~bo ~OO~II j OT is !a~ 1IiN appaetataias; std a>i the eatatar risht, title, interest, eLias oe demand whatsoever, os tier said pr-t~ of the first pat„ either is law a equit,~, either bs poraeaaion ere eotpeetaae~ ot: in sad to tba ~~ed pramiaea„ sad t~ hereditameab and appurtenances. 'iDQ 8AY»Z I,ND TO HOt11 tlu said peopetty as shover described wills the heceditaaneata and appurtenaaoas, Mato the said Daft ie8 or;.ri>ia seooad part, ~d tt- their heirs std aasipos FOBE'~Ea. And the said party of the first part and the suaessors in such office, as such, covenant, grant, bargain, and agree to and with the said part..i?S of the sa:~d pare, their ti.;n ~ , that the above-Dar~ained p~asisae in the artist and peaceable possesdaes o! tLe acid part ieS _ .,... d tM second ~ iQ7`4~365 M 1Pti~iF.~ 1PHE1tF.C1F, pseq of tlwe 6rac Baer, on tGe day.nd year 6stt above weitttn, Gat cawed dive. 14l~e • ` signed and sealed ~ Gis/Get aunt sad on GatGer beGalf br the uader>a~ed employee b~ p g q+and acerai purwaet oo tide 3i, Uoioed States Code, stainers 212 sad Ii20, asd tide 3i. of RR , sections 3b:41+12 and 36:4520, pne~nt t6ereco, as ama~ded, and wbo is aurbo:ised eo eseuas elms pesmtee. l~ ~ ~iit.Ba Ilt ~!!A Oi TGe Adminir+r~ll6or.~ Vsoaraw Af~an VA Reponal Of6oe, Milwaukee. Wl TdepGooe: (414) 291-1179. (>eurwapt to add~los $'!A3= 01 W'tgQ0ttQ1t of autboricy ooncained in VA Reptl~ioas, 3i C.>:.R. Miluaukea ~~ } a-t 3b:4342 and 36:4320.) p~ q~ mph ~ ~ 18th ~~ ~ April !~ A, a ~4 „y,; ~ ~pqr THOMAS M. MALTA .+ an employee of else Veterans Administration, as agency of tGe United Scats Coveramenc, kao~rn to m~e to be the peram wboae name u aabsuibed oo cde foegoiai t s: raid mnployee for the Administrator of Yeceram Affaies, aoad adtao~wlocised tGac beJsbe acecvoed tGe tame. s: tGe act of (~/Gtr principal for du proposer therein contained. 000![tilit{OR 7ij~i~ jg -„Q~$nent . /j~ !~ s ~ i fi0M G. BITTERS ~ '~y '• e r NNs!~y r.~w to «s /~....r~ car.w e~"t .~~ •N07'E.-ItW, R1Mnere. x ~~ inr~ d dw ~ ~wc~d~ di, i~ra~ aiw ~~e d err trisenr a0 ~oorrr ^iae ~iwde trYw ~ 1j1e~R. ~ ~~ **Except municipal and zoning ordinances, recorded easements for public utilities, recorded building and use restrictions and covenants, if any. o~ Is ~~ F 'PHB 4I~LS "9EC8ETART 0! 9BTERAaB ~!1-lIR9» SHALL BS 3IIB3TITUTgD leOR 28A4 01 "tDEIDTIB?Rli`08 ~JF Y~T~RgNS AFFAI}13" B6C8 ?1,E !Sl! I! jPF'SAl38 IN 'THIS DOCII3dBNT POR30~'! TO '!83 p130Y28I0NS Ot SECTION ~, PQB. L. f0. 100-827s 'BB3i B~~ls' H VET~AN3 AHFAI$S AC'!. ` ~ ~ i~ ~ ~ ~ ~ 8 Qo ~ a{ A ~ ~ ~. M i 1 ~~ ~ i ~ v ,,;~ br ~ Z ~ 01 ~ N ~ ~ ~, ~ ~ ~g ~ _~ ~ m p ~ W ~ Z~ ~ .v o rn ~ ~ v ~ A ~1 _ - .i _ ~ z z z z n r' v A W ~ ~ o ° ~ a n _ - , o ° I'Tt N - ~ ~ ~ ~ y~ ~ m D ~ ~ ~ ~ ~ ~ ~ t7 'p ui O -~ ~ ~ rn w ~ A ~ ~ N r a v z c~ r m ti ~ m z ~o m w z o `O ~ - m ~ n z . OO ~ n ~ ~ O ~ ~ ~ m ~ ~ _ ~ 4 ~ W ~~ ~~ ~ ~ y~, 7s.oo` _ QD Q `' L~ O 235.65 ~ . `~\6 6 cn Z N -J ~ N o O p NO~ C - cA ~ ~W cr u± Z N A W ~ ! ~ ~~ ~ w n ~~ m z ~ D ;~ ~ n ~ --1 0~ m m ~ u' 66 .p 3. v ~ ~. r ~,, y~,esozt~ oy w ~D o ~ p ~Z ~ i n ~y4. 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