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HomeMy WebLinkAbout020-1042-90-000Wiscoisin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and $uilding Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Gavic, Paul and Debbie Hudson Townshi CST BM Elev: Insp. BM Elev: BM D~SC ryJ ~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic _-~L,,Q/,~PJ~t/ ~ da D Dosing w f-} v Aeration Holding TANK SETBACK INFORMATION TANK TO /L EL BLDG. Vent to Air Intake ROAD Septic ~ / /- [ rn i a ~,~! Dosing ~ > 5D Aeration Holding PUMP/SIPHON INFORMATION Loss ISvstem Head Dist. to SOIL ABSORPTION SYSTEM BED/TRENCH Width ~ LengtJ DIMENSIONS 3 ~/ INFORMATION D RIBUTION ~O Ft ELEVATION DATA County: St. Ct'O~X Sanitary Permit No: 429943 0 State Plan ID No: Parcel Tax No: 020-1042-90-000 Sectionll'own/Range/Map No: 19.29.19.174A STATION BS HI FS ELEV. Benchmark ~ d ~ DQ. 6 ` I ~('~ ~ Alt. BM ST- eaJt~ Bldg. Sewer sly - ~ ~ ,3~ q` • R St/ t Inlet 13,' t ~ ' ~~ SUHt Outlet I~ 3 q ,7a- Dt Inlet _~ Dt Bottom /i Header/Man. Dist. Pipe Z I ~. Bot. System t I 5 ' 3•s~ Final Grade •62 d.~ St Cover ~o, 32 9'~I• ~ > PIT DIMENSIONS No. Of Pits Inside Dia. WELL ~ LAK REA LEACH NG Manufactui CHAMBER O ~ , ~ f \ 7vt UNIT Model Nun /iS'1..... n ..-1 p~ Head /Manifold Distribution ,r x Hole Size ~ x Hole Spacing Vent to A ' S ~( ~ Pipe(s) ~ `7~ ~: ~ ~ ~~ ~ ~ ~ Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Systems Only 07~ -~-1 Depth Over f ~ 7 Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center r 5 BedlTrench Edges Topsoil [~ Yes ~ No [~ Yes [] No COMMENTS: (Include cod discrepencies, persons present, etc.) Inspection #1: ~ ~S/ fJ~ Inspection #2: ! Location: 344 Audubon Lane Hudson, WI 54016 (NE 1l4 NW 1/419 T29N R19W) NA Lot ~ Parcel No: 19.29,/.19Y1~74A / - ` 1.) Alt BM Description = Ste' CoY~`TZ • ~~ ~a' 4~~ (~t~.t~h ',~201ti,-CI[LG7~ 2.) Bldg sewer length = Zro~ t>~ ~~ ~~ fl1n.- ~ ~, t ( QLt;~C-CX~f ~DC.~~C7~~/ ~'`-` ~6~1~/`h.(/1'~~ -amount of cover = -j-~~ _ - .. i---- - _---- ---~ r __ - ------ - -- ------~ I Plan revision Required Yes ~, ~ No ! ~ I ~~ /~3 ~i ~ ~ / ~ ~' Use other side for additional information. L--~ ._ V---~ ~-- ~ ~ (p ___i Date Insepctor's S nature Cert. No. SBD-6710 (R.3/97) ~ Z~ ~~ .~ .. Safety and Buildings Division CamtY ` ce 201 W. Washington Ave., P.O. Box 7082 S f . CQG 1 , s~~nS`, ~ Madison, WI 53707 - 7082 Sanitary Permit Number (to be 811ed at by Co.) f De artment of Commerce (~) 261~asa6 oZ ~ ~3 Sanitary Permit Application State Phn LD. Nnmber In accord with Comm 83.21, Wis. Adm. Cade peesonal information you provide ~Y be used for secondary purposes Privacy Law, :15.04(1 xm) Project Address (if diffixmt tban rrtedlirtg addraa) I. Application Informati~ -Please Print AU Information RECEIVED 5 tee. Property Owner's Name ~ Parcel N Lot S i4~.([, f ~~$i3/~ ~.4vtc APR 3 0 2003 1 ~~~-~o~~-qd -oo0 1 Property Owner's Mailing Address Property Location 3y./ ~~48~ ~~Ntf ST.CROIX000NTY `!/~ ` a c Y. /V W v. section / City, S Zip Code . , /, 5 oiV LJ t 5~D t ~ ~7/S- 3~G ~ 33 /G (cirrle~e) f ~~ T~a N; R IQ E Type of Building (check aU that apply) I a 2 Family Dwelling -Numbs of Bearoo~ d 3ubdivisioo ,y CSM Nu~m/ber (~ ~f ^ PubGc/Commaeial - Dtsaibe Uses d / ~0 P o I V.~ ^ State Owned - Desar3e Uae ~ > 2 ~ ^City ^V;l4Tawaship M' ULY~a ~I IIL T ype of Permit: (Check only one boz oo line A. Complete Gne B if applicable) A' ~.l`lew System ~ Replaxmeot System ^ Treatmmt/Holding Talc Rephxxmmt Only ^ Other ModiSation to Fxiatiog System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfix to New List Previous Permit Numbs and Date Isaued Before F.xpirsdm Phtmber Owner rv. of POWTS S Cbak aU that a -Pressurixod In-Ground ^ Mound >_ 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sarwd Fika ^ Constructed Wetland ^ Presauriz7ed Io1'uaund ^ Holding Tank ^ Peat Filter ^ Aerobic Trcahrtatt Unit ^ Recirwlating Sand Fiker ^ Rxircula6ng Synthetic Media FiUex ^ Leaching Chamber ^ Line ^ Gravel-less Pipe ^ Other (enc lain) V. Drs reattt tent Area Information: Dtaiga Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf j Dispersal Ares Proposed (sf) System F.kva~ ' ~s~ . y ~ y.2. ~~ s4~. 7~s 3 ~.~ . 3 .s~ VI. Tank Info Cttpaciry io Tdal Number Maaufacauer Prefidt Site Sled E'ba Plastic Gallons Galls of Units Cerncrete Coosanected Gkss Nees Esilg Tessler Tama Septic err Holding Talc l:" b /tab ( GJ/ FSF~f X Aerobic Tnwlmeat Unit Dosisg Chamber VII. Res nslbility Statement- i, the eadexsigoed, assume rempoosibHlty for lastaliatloa of the POWTS shover oa ire attached plans. Phw 'a Name (print) Phan Si MP/MPRS Number Busiraa P6oae Number Plumber's Address (Strew, City, State. Zip Cade) // VQ[. Coua rtment Uce On ~ Approved ^ Disapproved Sanitary Permit Fce (inchtdes Grotmdvvatex Date Isaued t Si (No Stamps) ^ Owner Given Reason for Denial Surcharge Fce) ~ 2zS~ 0~ . ia. Conditions of ApprovaUReasoaa for Disapproval .~. n ~t 5~ S yam... ~ ~ ~ ~ ~~,, ~ .,~. wtreer e..ydaere plan (b era Gaaty aqq rer ere sp.w a paper erne tors trap airs s tl sacra h :tae SBD-6398 (R. 08/02) .. ~. . I~LG~ !~'~ ~.dPf ~c~~ ~d/ ~opog~o IJfc~ .~_ +d l~~~~ ~" ~ 'PLOT A CIWSS SECTION PW LIPPA 6HOS. EXCAYA~1ti~ lip 1 ~ PWI+EIW'16 UNNT 1 ~ ~-,~ ~ PNOJECT 1 ' ~ y~ ~ ov L,.~vE 2 ~ , • fPt~lCdNl6~tJ~ '~t/~Jtlt S! }1r r~ ~~ Z~K~~~ ~~'^' ~~ ~ ,.~6~poNME~t Of ~ ~£x~sr~w~ w ~ ~ S I ~~ ~Al~c ?.hwe /WO Der `'~'tL/ B~ ~ pie c~-+.R ~c.s3 .vow ~/`,ac E~K~t.~,E ~ 2 ` l~a~! 2~ ~l g~- ~ ~~N~ ~ . ~~ .Azov W F -~. /VO •' 4 ~ ~ ~ SCAT yS"Qs~.y~T~12-~'~ =-31-,~ ;ao.~7oe.?~E~is~~s~~o '~ P y~ Ew -- DBsE~~f•~rlo,~ P, p~ ~'° .23 ~t~3~s _ ,~ , ., ~ ~.~, ~` 3 ~iss~n~si0~`E w~, ~.~ fip ~ ~~~ . ~ ~_ ~~ ~, ~~ ate'' V~ i8 so ~6s~~/r4~no~J ofZ VEN r 44P SIeNE~•%[ c ~~V ~? OATE• 'y/- ~ • 0.3 rYl~+c-.nrA~n ~i1G'I~do~~' The Stands d in It for Chamber ;,801LTE8~iNQ1lY. 'I ~~~ 3. o ~E~nkN Bo7t'~n ~4EV~~ ~~ Sorc`rK' ~r o ~o o ~ tEv S,oE v,Ew 75' Effective .. '. ~Lkt~ ~~ ~~n p~ ~~~- a~~ ~oposto /~Ew .~-..-_ ~ ~~ R~`'' a~^'`~ fi,~R~ ~'~ ~~~. i` !~ s° ~ ... 'ul b 'PLOT k CROSS SECTION PtAI~ 1 7J1PPA EROS. EXGIYATW$ Ih ~ ~u uNIT ~ ~~, h .. PRaECr ~ s ,Qc~s~E lvav~c 4/cl ~ o~v l.,~E ,~v ~, ~ ~,- I,Q~Ps•~r•ra~-r 'rifrNck ~ ~,4 + ~~'~ ~~ ~ 1~Sd S~K ~ ~ ~~ ~'~ ~iL~ !J ,,~g,~poNa~EaT Of ~ £wsTrw. ~" ~ 5~ol~c ?.e~K M+0 per csu: ~t 6 Bbt Oie G•v-+Nr ~ . s3 NEw s/` p/c Fr~~.c~.~rl..~E . ~ ~~lkpt~~''' ~~N~ V~ E 3 ~i ~*.' • Flo ~- ~ ~~ i~ S, 8CAL ySo; .'7 ~T ~/2-~'~ :- 31.,E , ao.4~7oe a?t~~~ies ~~edo ~~ 1 /~ Ew -- D4sE~e~•~aw P~ P~ eo, .z3 ~r~~s ^ ~~~ ©fS'S~Q'1/14TlOwI OfZ SIAI~D: VAN c ~ /4p ucel~• ~~ i2` A~ ~'~,,s,~ Gtr • I~IkRrnnaw~ ~1G~/~6oJE c.~~e y Are ~M ~/o PEE ,sos.TESTa~a! sr: The Stands d In It for Chatrbet ''' r overt a~ ~accn~ .. ~~tZ'L.~.~ -~--~ - ~ o TF~lcH 8o'R'a~n ~~V,M7e~rt1 ~tq Scrc~K1 ~r -- o o Ed. ~ ~ s~o£ ViEw 75' Ei(ecuve length ~ ~°g 5~ ~~b~ f ~f Wisconsin Department of Commertire Division of Safety and Buildings SOIL EVALUATION REPORT ... ~r...nrrl~n..n ...iFh !`nmm RS \A/ice Arl m (`n~o 1619 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 percent slope, scale or dimemsions, rwrth arrow, and location and distance to nearest road. Parcel l.D. 020-1042-90-000 Please print all information. ev' By Date Personal information you provide may ba used for seconde~Y Pub t~v~Y ~, s. 15.04 {1) (mi). ~ Property Owner Property Location Paul D. & Debra F. Gavic Govt. Lot NW 1/4 NE 1kt• S 19 T 29 N R 19 W Property Owners Mailing Address Lot # Block # Subd. Name w CSM# 344 Audubon Lane Mallacove City State Zip Code Phone umbe _f ~Ilage il/ Town Nearest Road Hudson ~ WI 54016 Hu son Audubon Lane B r. r, n rl '/ 1111 i P __ J New Construction tJse: i~ Residential / Num r of rooms 3 C~e derived design flow rate 450 GPD M_,{ Replacement ~ Pubfic or commerc" I - De~ril~ ~UUN i ~~ Zp1VING OFFIG~ Parent material Glacial outwash Flood plain ele vation, if ap plicable na General comments and recommendations: Install three trenches at elev. - 1.5 'using leaching cha mbers. 7 Boring # -I Boring ' ~ 42" i Pit Ground Surtace elev. 1/ 99.44 ft . Depth to limiting factor n. Soil lication Rate APp Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft~ ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 Eff#2 1 0-6 10yr3/2 none sl 2fsbk mvfr rs 2fm,1c 0.5 0.9 2 6-22 7.5yr4/4 none Is 1 msbk mvfr gs 2fm,1 c 0.7 1.2 3 22-48 7.5yr4/6 none Is 1 msbk mvfr aw 2fm 0.7 1.2 4 48-66 7.5yr4/4 none gr Is 0 sg ml aw 1fm 0.7 1.2 5 66-142 10yr5/6 none stmt. s 0 sg ml - - 0.7 1.2 93sor ~.(.2g fo ~ Boring # 1 Boring Pit Ground Surface elev. 98.39 ft. > 127° in. Soil lication Rate Depth to Limiting factor App Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 1 0-12 10yr3/2 none sit 2fsbk mvfr ce 1fmc 0.5 0.8 2 12-19 10yr414 none sl 2msbk mfr cs 2fm,1 c 0.5 0.9 3 19-36 7.5yr4/4 none gr Is 0 sg ml gs 1fm 0.5 0.9 4 36-53 10yr5l6 none gr s 0 sg ml cw - 0.7 1.2 5 53-63 7.5yr4/6 none gr s 0 sg ml aw - 0.7 1.2 6 63-27 10yr6/4 none stmt. s 0 sg ml - - 0.7 1.2 'Effluent #1 = BOD 5> 30 <_ 220 mg/L and T >30 < 1 mg/L 'Effluent #2 = BOD < 30 mg/L and TSS <30 mg/L CST Name (Please Print) 'nature CST Number James K. Thompson ~---- 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane Osceola 154020 4/2/2003 715-248-7767 . s Property Owner Paut D. & Debra F. Gavic Parcel ID # 020-1042-90-000 Page 2 of 3 Boring # ~ Boring Y_f Pit Ground Surtace elev. 97.84 ft. Depth to limiting factor > 128" in. Soil Application Rate Horizon De th Dominant Color Redox Description Texture Structure Consistence Boundary Roots p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 1 0-8 10yr3/2 none s1 2fsbk mvfr cs 2fm,1c 0.5 0.9 2 8-19 5yr4/4 none grls 1msbk mvfr gs 2fm,1c 0.7 1.2 3 19-48 10yr4/6 none gr s 0 sg ml aw 2fm 0.7 1.2 4 48-82 10yr5/6 none gr Is 0 sg ml aw 1fm 0.7 1.2 5 82-128 10yr6/6 none stmt. s 0 sg ml - - 0.7 1.2 ,oQj t7 Boring # ~ Boring ,~ PR Ground Surtace elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots *Eff#1 *Eff#2 ~~ # _] Boring Pit Ground Surtace elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots *Eff#1 *Efi#2 * Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mg/L `Effluent #2 = BODS < 30 mg/L 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. . ~~ ~ ' 1E, 4.~1.: %op of /o E 5traiS'e. E/e ~ = 9I Bo' ~; ,: 6.0 ~cA,~,4i Ex~'5~~~ 1~rywtll /`j 83 . X20' ~.Od E • ~n ~J ~X~St~~ c.J¢/ ~ Tp bC 4 Dr4~dcilf<l E~iSf.'n5 Scpb'c ~ ~nK-to be ~ ~e p /a "e' $ ~ s/opt !a /; e cc ~occnd,~~„. ASS~~ud eltv`= /UD.CO' ? zS `6 iS /opC w ~p a m N Q :~ p~p~ r~ 8 ~` fl .~oo.o' ~~~. o- °f! o . Sf o(' Slop~- ~ProPos~l u~el! w -iF Ef~'IaenE elegy i~ ~XISL` ~/ ~ ° ~~"`- fz,,,~ ~ 93/9., 0 r~ 3' v ~ <: P -.L \~ ,Sc4/C. /~= f~0~ ~ Soy"/ er/~~ua~"c " P' ~ • Elc da cvOn • /oca~cd P~~ S~~''e p~ 3 0~ 3 .~ . ' ~ POIAITS OWNER'S MANUAL ~ MANAGE,NIENT PLAN ~• ~. ~ ~ l~nber d ~dnoonia 3 o NA Nunbe- of PueNc - unit. ~- 6dnaad Clow ~Os1 300 Gsetpn Aow lpsakl, ~atknatad x 1.51 450 soll,~oolkadon Ras .7 sw~d.d UAu«~HEMArwt Dulllir ~,aaor.... ~ ~ O~cgpsn psnprd IoW Total iuepsndsd SaMds 11"851 MapAh- ararao sao~ ~ spit. 5150 nqA. s' O NA Prstrated EMMwt Ourty 6iooheenioal O~t~sn Osnian0 IOOOrI Tool Sapendad S~olida ~ ~ oai~oan ~aotnaMa mwd MonMNf/ swra0s fi0 ~ s~o ~ tea' oArtooml O w- Ma~nvtn etnu.nt t~ardcla ~. >i, iA dis. o tw- • ' sl~- •vdu~e t~pk+t tx e.~lle wset~wsar and s~pde tMt etllvNt. s11Z>I>>ll ~~ ~laptlo Tsnk Capaolty 1000 O ~ ~ Tam ~ Nie3eer O ql1 e~Auent lNter ~ Zable O ~ E~lklelK ~r ~1 11-1800 O NA ~ TaMc ca•ah- n tw- tAw~p Tank I~Aanufaolura r m NA ~p ~ ~ n w- ~~ aw- ~ nN,- o ~awrawl ~1Ner o ttic war o Irl.etw~ieel /-are~i~a o watw~e O WNnhotton O ~~ ~~ Carhl O MI- O Imd~amd IOra~ltf-1 O Mt~ound ~nawslaedl O At~Orads o ~AoWUI O OdrrLins O Other: . o w- ~~ oa~n o w- MANii1ENANCE ~Cl~l~,a ~a1r10a lllallt ~a1Nea aa~raway tiepeoc oondldon d taMda nt ktaat ono. awq: a aMadawa ! ~ O w- ~p out oonlwib d tsekial When oon~Nd atudoa and ~ o0wlo o~ Iljl d sank vok~e~s O NA Mapsot dlepael oslllal ~ kiset ana swa~~l: Z s,r...+ o w- Clan NIMMrK iifbr At ktrt one awry: 1.~ O NA O NA MaOsct pump, pump aoimole ~ akin" At NMt one awry: a w- Awh aterale and vroawr cat we Nrt anos.M«y: O • l1t ktwt onoe awry: ~ ~ oar ~ ~ tdAwtlNANlss w511N1C'tIONi aw o f ~ p ~~ a p~ntli Mapsctions d tanb and eNparw aaNa alail df nada by sn iiisl orMnO 1Aaater PUMnbet: llAaae~r lM~ndfet ll~Iar10 Swwr; POw1's lMpaate~: r0'wT'8 McM~tainar: sratw ~~' Tank ~ aiwt ku8ids s vi~Ni in~psetiea d the tankNl is ~dN ~!- ~aMO at brolw hrdwsrh. id~ndh- ~!- !~~ ar iN1a, saws the vok~n» d aom6Miad tbNlps sod awn and m oi~aolc lac a~ btok oP « 0~0 d ~ ~ ~t TM dhpMaN oeMsl eMN bo vtwaMfl inspated m ahsok tM dlk~wa Inrsls ~ ~~ ~ and of MfAnnt an the paind auAaoo. The paidhp d sMwnt on the s>~ , netltkatlon d tIM kcal Y awAoAty. VMisn the oombinad sooumutation of aktdOs and count in aitll ~c ~* an•'ti~Nd IK! ~ moti of tits teak vokana ~~ so"le"s o! tM tank s1aN bs ramo~wd b1/ s SeptsOs BsrMoinO Opsraar and dlepossd d b aoaAt~ w11h ahsp~K Wleoonain AdMNaaadw Coda. /1N other swiss. inoli~p but act itdad ahaM baba paAionaad'MI « ~ 0 unit;. and aM- twrioifp at iAervale d St2 A senbe "port aheN d! pvvldad eo >M haul tp~otl- avtha~ltr wld~ t0 ~ d oon~plruen e1 a~- arwoa awtt. oar ~t D~II ~a1t~~E1liat START UP AND O~ERATgM far reeve caostruction. pnor to use of the POW'fS aheok treebrrsnt tanWel ~ the peeerree Of paiatlrrB products of oMst dwniceis that may iMpede the t-eabrrMK prooees ardler damage the ~• K hqA oaroerraatbra an dMectad haw the oonanp of the tankid ranoved by a septa0e servioip opertrta< l~ to use. sort up shah snot ocar when coil aonditiora are fiozan ~ the intitradw eurfaos. Oaring Pow t~P tanks ~ /!N above nortrral hiphwater ovals. When power b rw~eoned,tha srooea wasawater vrM be discharSsd >DO Urs d'apsral oealfal in ores bane doses overlosdiq tM oeNtsl and may tewrit in the baotcup or surface disdraroa of eNhrsnt. To swig this sipiadon hew the oonbnb of the pump tank ranro ed b11 s 8eptpe Ssrvioin0 Operator pros m ratorinp power to the effluent pump ar oontaat a Plumber ar POMITS Maintainer to assist N nwwsly operaMna the pump controls m restore normN levels wkirin the pump tank. Oo not drive or park vehicNs over tanks and d'apereel oeNs. Oo not drive or park over, or ogwvWsa disaxb ar compact, the area within t S het down sops of arry mound ar at•Nrade sort absorptbn area. . Reduction of edmination of 1M fobwiro from the waetewaser stream may improve Uia prforrnsrloe and prolong iM lifi of tM P01NTS: arKibiotia; tiaby wipsR aiaarates butts: aadonra; Dolton swabs dsOnrwn; derrnl 11oar• diapers; disirrfectantr fa>r forrrdstion drain Isump pumpl water fnrft and vepetabls peeEnpe; oseoWwa: Srease; hsrbioidse; mat scraps; medicstionr Dab painting products: pesticide; sanipry MP~:'~Paa and waver eofeerrer brine. ABANDONMENT vYlwn the POWTS fails and/or is permanently talon out of servos the fobwtrq saps shah abe taken m berme that the sysam is progeny and safely abandoned b conrpNanos wish duper Carrwn SS.3.9.1f11isooneNr Adrninielratlw Coda • AM piping to tanks end pia ehtN bs dMoonrecad and the abandoned pipe opanirDs sealed. • The aorKents of dt taMrs and pies shah be arnoved end properly disposed M by s SsptaBe Bervbiq Operator. • Aker purrrpirq, all tanks and pits ahaN be aoxa+ratsid and nnrovad or their covers nrnove0 and the void space fNled wbh soil. ErsvN ar anddNr inert soYd matsxial. CON7'NI10611CY PLAN ff the PONITS fells and cannot be repaired the foNowirp nrsawre: haw been. ar anwat be taken. to provide a code oomplwrc nplscanent sysam: 7~ A wiabls repleoernsnt ores has bier waluseed and may be utilised far the loeadon of • replseernent soil absorption system. The nplaoerrrsnt era should Oe pro~sotad from dist<rrbarrw and oompaotion and should not be iMrirgsd upon by roquired setbacks from srdetiq end papoaed structure. bt NrNS end weNa. faYure to propat the rspiaoanent area wi result rt tM need for s new soil and sass evaluation to espbdlr a citable repiacerrwnt area. Replaesrnent systsreu must comply wish tM rrrlet b efhat at that tiirne. p A suitable ropisoertunt one M not avaifabM dw >DO setback and/or soi irri<atlons. Barrbp sdvsnoes b POWTS technology a holdrq tank may be NstaNsd' as a lest aeon m npleoe the failed POVVTB. O The site ha not been ~ evalusieed m id.ntlfy a auleabb nplscanrent ans. t~port fsNun df fife POYVTS a soil and ales walustion must be performed to bas a sWpibM,roplaoanrant ans. M rro rspaament ins r svailabb a hokhq tank may be bstased as a Yet ieeoR to repleios the hiNd PONRS. O Mound and at-Ends eoM absorpdon systems ma1- bs noorohuatad in pba~oe forowirq sensual of the biomst ae tM infilaseivs surface. Rsoautruotlens of ouch systw+rs rnwt comply wMh fire nrles in ethct at that tine. < <WARI~M~ifi> > SEr'TIC. PUMP AND OT1l@t TAEATMEf1T TANKB MAY CONTAIN LETHAL 8ABB6B AllplliON NitNYlC~IT OXYSiEN. 00 NOT ENTER A SEPTIC. PlNi~ OR O1FER TRreATtAlNT TANK UNOHI ANY CMICUMSTANCa1B. OEATN MAY REBIN.T. R~CIJE Of A PERSON ~ T!E WTlEp110R OF A TANK MAY BE OB~ICULT OR POWT'S WS7'ALLER POMITi MAMRAM~I Name ) Name a Phoru 715-386-2850 f~rorre 715-386-2130 SEPTAffE SERVif:MtQ OPEftAT't>rI LOCAL fi~SfitlL/1?OIr1l AlyT110QITY Name Tri County (Ben Morgan) Phone 715-386-2130. Name St. Croix County Zoning Offs e Phone 715-386-4680 Ttiit docurntrrt wit drafttd in cornpbelroe wish dMONr Csrrrrn S.1.Zf1?JIbiIllfdNlN and S.1.laiNtl, ill • p1.11YboorasN AdrrrYrietrsdw f;'aM• ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address Property Address APPLICANT (Verification required from Planning Department for new construction) Duo-ld~~•~~-ooo City/State ~~ Parcel Identification, Number o~ o ~ i ~y~ -- 7~ - c~oa LEGAL DESCRIPTION Property Location /~~ `/4, /~iv '/4, Sec. tq , T-?`~ N-R /g W, Town of ~u asonl Subdivision ~~ ,Lot # Certified Survey Map # ad7~ `y~ ~ 7~~ ,Volume ,Page # d ~ 5f ~S) Warranty Deed # ~~~.28d ,Volume /~'~~ ,Page # i 39 Spec house ^ yes ^ no _ ~~~ ~. J KJ ~'(~p 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 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 113 full of sludge. e, the unde igned have read the above requirements and agree to maintain the private sewage disposal system with the standards set rth, here' rds set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification sta ' g that eptic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 c~ of th ee ear expiration date. SIGNATURE I( 131 DATE that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of above, by virtue of a warranty deed recorded in Register of Deeds Office. OF APPLICANT ~ ~ ~~ DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerlBuyer Mailing Address Property Address J KJ~~p (Verification required from Planning Dcparimcnt for new construction) O 20 - l o~2-gO -ooo~ City/State ~~^'~ Parcel Identification. Ntunber D2~~~d~o-rl0-oo0 LEGAL DESCRIPTION Property Location 1~1G %,, 1~1U) %., Sec. 1~_, T Z~( N-R l~.W, Town of ~~5~ Subdivision ~~ __ , Lot # Certified Survey Map # ~ ~- :.Volume ,Page # Warranty Deed # s~ ~ti~-$ $ .Volume 10~~ ,Page # ~~°l Spec house ^ yes ^ no Lot lines identifiable LR~ yes ^ no SYSTEM MANTENANCE a 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 tnastcr plumber, joucneymaaplumber, testrictedplumber or alicensed pumpcrverifying that (1) the on-site wastcwaterdisposal 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. e, the untie igned have read the above requirements and agree to maintain the private sewage disposal system with the standards set rth, hen' as set.by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stn ' g tha optic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 of th ee car expiration date. i 3 /a SIGNATURE O APPLICANT DATE that all statements on this form are true to the best of my (our) knowledge: I (we) am (arc) the owner(s) of above, by virtue of a warranty deed recorded in Register of Deeds Office. OF APPLICANT ~ /~ DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed t noc.uMr, SIT NlJ 11115 3PA'..E RLSCRY EO FAII NU:Cf HOI Nfi OAI'A WARRANTY DEED S'PA'CE [),1lt OfF,~WISCONSIN FOIt1~( Z-1882 516~~$ YOl 1.11 1 SAGE 1J9 ~ __ •- . ~. ;~~_ Robert C. Mitchell and Jean L. Mitchell husband L i• ~- • ~ - ~~~ ~• ~'•. ~-""+I . ... s... ........ !tsc'd ft~r i?evxq and wife, _. ... :... __ ....... .. ~~ MAY 4 1994 conva v ~uul wnrrnntM to PaUI D.. GayiC, and. Debra F... Gavic, ..... ~ 2:15 r P ~~ husband and. wife, ................ ...... ........ ........................ e'""`~'"~ ~ ................................ ............ ......... i4ajaoararOwca ............. .................... _. _ .. ... ..... ... .. ...... ...... .. ... ... .. .. .. ........ ... .... ~ RETUfIN TO tho folluwint; described real estate in .......S..t...~rO~.X. .... ....:..........County, ~` State of Winconsin: Tax Farcel No :.............................. (See Attached Legal Dascripti.on) ...,~, ~. .~;~ •~5~1 ~~~a~ 3~~~~ It is understood and acimowledged between the parties hereto that the property conveyed and described on the attached legal description is the balance of all property owned by the Grantors hereto. The Grantors previo\;sly conveyed a portion of their property to an adjoining landowner in conformity with Chapter 18 of the St. Croix County Land Regulations. This ,~~............ homestead property. ()s) (i.: not) t:xreption to warranties: Easements, restrictions and rights-of-way of record, if any. [Dated ehis . J..~?-ems.. ..... . .... day of .....-~10.~' 0 ............ .. .... ... , ;s. 94. ....... (SEAL) 11 .......... .... . . .._., Robert.C. Mitchell , ........ _......... ......................... .... .(SEAL) /~~lf/ll ~ ~ ... .ISEAL) Jean L. Mitchell AUTIiENTICATION Signature(s) ........................................................... auti,enticated Chia ........day of .................. ....... 19...... ................................................................................ TITLE: bIEyIBER STATE BAR OF NtSCONSIN 1t nat ............................................................. authorized by Q 706.06, Wia. Stag.) THIS INSTRIiMlNT WAS ORAf r[D BV ........---•Kristina Ogland......--•-• .......................... ...........:Attorney.. at.. ~w ..................................... ACKNOWLEDGMENT STATE OF WISCONSIN ss. C. CrolX .County. ..................................... ~Pe~o I i ccame before me Chia .... ...day of '-"ft'obert~-~ ~': -'~ii£chell and4,Jean ~ve named ....hti[cheTT...hiisliarid~-arid wife; -------• ............. to me known to be the person 5.......... who e!cecuted the f oink instrument and ack wledge the same. .~~~-~--~-A~ ..... .. .. ~dj:'~itnors...... C\ Noc Public ....................... .. p ..,..... a!T ....._..._... Notary Public ......`~..T..•'-......Of.N!I+~~r~tZF,Bwis. ~~~ ~, ~~ ~. ~~ y ~ vo 1U77r~cE i4Q . PARCEL DESCRIPTION A parcel of land located in part of the NEl/4 of the NW1/4 of Section 19, T29N, R19W, Town of Hudson, St. Croix Gounty, Wisconsin: being part of L'ot 1 of Certified Survey Map recorded in Volume 6, Paqe 1604 at the St. roix oun -A€€3ee; ur er escri a as follows: Commencing at the SI/4 corner of said Section 19, thence N00~15'33"W, along the North-south one-quarter li-ie of said section, 4208.48 fRet Y< to the NE corner of Lot 2 of said Certified Survey Map being the oin ' " ~`~ ~~< W, along said line North- 33 of beain»inv; thence continuing N00~15 ~+ south.une-quarter line, 223.00 feet to the .NE corner of Lot 1 of said Certified Survey Map; thence N89~44'30"W, along the north line of said Lot 1, 421.48 feet to a point 30 feet more or less from the water's edge of Lake M~llalieu being the beginning of a meander li:-e; thence S02~49'22"E, 119.64 feet; thence S00~09'16"W, 97.95 feet to a point 30 ~ feet more or less from said water's edge being the end of said meander `5 line;~thence S88~58'30"E, along the north tine of a parcel of land ~' recorded and described in Volume 763, Page 08 at said office and along the north line of Lot 2 of said Certified Survey Map, 416.92 feet to '. ~ the point of beyinnin4. Including all lands lying between the above ~ described meander line and the water's edge of Lake Mallallieu between the extension of a line bearing N89~44'30"W from said b~ginninq of y .;~eander line and the extension of a line bearing NSSa58'30"W from aid end of meander line. above described parcel contains 2.11 Acres (91,990 Sq. Ft.) and is tified~~ C er sub}ect to an easement for a future town road as shown on z. S-:~vey Map Volume 6, Paqe 1604 and all easements of record. ;~, :, .~: ,. ~0~77$ J 2 _ ~ ~ O vii ~ m z o cn ~ m z -i :t7 ~ ""~ x m r F r 0 rn z ~~ m '~a 1 = m -~ cn Cni> fU7 m m .-: 3 ---1 C m -. p z O r -a z c to a 3 r m ~~ .~ .~ n~ •- v z a Cn c~ ,J N r r cn a -•~ r.. c~ ni ~ I H Iw 'r I ~ Iw in IN y OD C tr au w 0 m w to cn r 6~s.os' SCC°21'16"E /i ~ ~' ~ ~,, ~~ 1 t ,. iy '- o z r •C -~ -r O ~ r ~ T. ~ Z N '~ r Z ~ ~ N ~ m x m n D (-1 T t) 3 -~ L ti --i '+ D ~ m m i '~OC"21' 16"W 666.56' ~ 0 Z O V- C .gym Q CJl `O/ `/III rn cn C7 ~. 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