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030-2124-10-000
7- 31- (5V / oo Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 579010 -8` GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: Oakes Doug & Debra St. Joseph, Town of 030-2124-10-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: -rDPcF UG Fri; 0P-Al/&* aF 25.30.20.1005 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic w'gC/~ Benchmark Dosing !GI ~dO~ Alt. BM ~y~~ IDO.d 0 GF -!o e Aeration Bldg. Sewer#/ AS /oo. 07, v3 ox, y Holding St/Ht Inlet (vo.c7 • TANK SETBACK INFORMATION St/Ht Outlet 7-40 TANK TO P/L WELL ]BLDG. Vent to Air Intake ROAD Dt Inlet Septic 1 N O Dt Bottom r ~Oo Dosing Header/Man. vD Aeration 7! ~ 9la. Dist. Pipe Holding Bot. System pp vp PUMP/SIPHON INFORMATION Final G adeub 8 /0.70 f&.~0 nufacturer BemaQd t Cove GPM n ow !c~6kk /~zj Model bar iL TDH Lift oss System Head TDH Ft For aln Length Dia. en SOIL ABSORPTION SYSTEM BED/TRENCH Width t Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 7 ,l yDw\ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of System: CHAMBER OR ~ /L / 1Z Tt I UNIT Model c t(Number,. 4-r. DISTRIBUTION SYSTEM ?&T PLUw`aCIZ Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake c 1 u Pipe(s) Length j! Dia_ Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over t xx Depth of T Seeded/Sodded I)o(Mulched Bed/Trench Center Bed/Trench Edges Topsoil i I Yes No ®Yes No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 7 1! Inspection #2: Location: 1344 27th Street Hudson, WI 54016 (E 1/2 SW 1/4 25 T30NtR2,0% Birch Park Lot 1 Parcel No, 25.30.20.1005 1.) Alt BM Description = 5If'G/kow~ /hs7~1tll~t of r,/,,I~crsec d~r~dr 1s~"~en/~! ~t 4J 6yAo 2.) Bldg sewer length =R~t•f 0-Z 1~$ 32, -37 (9 ~IP/f 97 - amount of cover ~y OVA-go7N f T rag, Nude i S Gw~~ dulU~~tJG S~ i~S LEU~, T Plan revision Required? FN_1 Yes No Use other side for additional information. 7 lZ rp 9 d SBD-6710 Date Insepctor's Signature Cert. No. (R.3/97) - ~lQ. 1 Ttt a Industry Servi County. P UL 1 1404 E Washington Ave Sr cRoi Sanitary Permit Number (to be filled in by Co.) Madison, WI 53707-7162 JT~ XCaUNY S c~ / 0~V :,OMMVN Permit Application State Transaction umber In accordance with SPS 38321(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to roject Address (if d Lent than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary., u ses in accordance with the Privacy Law, s. 15.040)(m), Stats 1. Application Information - Please Print A-11 Information 7 r~ S r, Property Owner's Name 4 (A- Farce{ 4 ~64% )4Xe5 0,30- ,?/Ay-/o-oe Property Owner's Mailing Address O 7S/ Pam Location ~E f ~C E/f T ~Aw/E City, State Zip Code Phone Number Gott Lot ~ J E y? S' SW Section .?X G~/GG.O's!/AY (circleone II. Type of Building ( eek all that apply) Lot T N; R ,?o e ._JO X I or 2 Family Dwelling - Number of Bedrooms .3 / Subdsion Name ok t~-0 Brock n /f/R ew ARK D PubliclCommercial-Describe Use .fol 91 ` Q-~rEyof State Owned - Describe Use CSM Number 3-e0f 2 A:5}- L4. 16.4-1l I . I l ® Town of sr. ,ToSE/N III. Type of Permit: (Check only a boc on line A. Complete line B if applicable) Nets System D Replacement System D Treatment/Holding Tank Replacement Only ❑ Other Modification to Fa;isting System (explain) B. D Permit Renewal D Permit Revision ❑ Chan a of Plumber Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration g Owner IV. T Me of POtVTS §vstem/Com onent/Device: (Check alt that a iy) IgNon-Pressurized In-Ground D Pressurized In-Ground D At-Grade D Mound > 24 in. of suitable soil D Mound <24 in. afsuitabiesoil4~ ❑ Holding Tank D Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis rsal/T'reat ent Area Information: ~Design Flow (gpd) Design Soil Application Rate(gp Dispersal Area Required (sf) Dispersal Area Proposed f) System Elevation / S~So , 7 y3 VL Tank 11n4'o Capacity in Tatal of ` ct a 9s d / 9.~ d ~ Gallons MIIttUf3Ctulfi Gallons Units L o Nor Tangs Existing Tanim L U N v O a v vi -a z LL. t, Vl m VJ t] Septic or HeldiagTnei; ~OOC Dosing -teaabcr /ooa / 1ESLriC Co.~t lErE v VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS vi-n on the attached plans. Plumber's Name (Print) Plumber's 00, MPS Number Business Phone Number d//A✓ IEL,-e Plumber's Address (Street, City> State Zip Code) /V 6 2 98 r. r, a?S- ,~uas.vo !✓I sS'~7~1 VIII. unfy/De rtment Use On Approved Permit Fee Date Issued Issuing tSigrature ❑ Owner eason for De 'al S 47✓ ' IX. Condi easous for Disapproval ofkw* a tae r, tdaiatatn~d 3~ ~~ac o wwt M' a. ~a ~c°Se ft ' disoemat can Mus as per management plan pFavdc pd fi umbel. 4. All setback requiryt(~entg rrtystbemt~ur)t~itiL~: as per applicable aodip / ordinAlltal. Attach to complete plans for the system and submit to the Coul only on paper not less than 3 in x 11 inches in size SBD-6398 (R. 48/14) 0 ONO I I a Q3 I T I v CQ _ M i ~n a Q J v, W o J. 13 r ~ r Z zoo av~ c~/ ~ P n ~ ll__ 14 i-~ \x 0 v r ~ ~ n t All h V 0 r ~ 10y ^ ~ ~ ~ V rp ~ ~ 0 41 ~ O i. ~ j aQ ,o Pfivate C ite Wastewater Treatment System Index and Vitae Page - P~a3ectName: __K/ONb ORxES- 3.lrof /.eJt~r.s .ao Pew rs ~s ces Names. It- it ~GOG,6aaY /y,/V SS/~ p - a LOW Desadpf3on: E S~.! a?_ S 30~/~~?o A/ Jas~,.N County: Sr L2o1 , diviasonName: 11.1 - GiV I Lot Number: R1ockNumber: Parcel I.D. Number: 030 - a/.?y- to - o000 Page 1 1777le Ir Page ,2 ~~a i' ~R~ ~ ~~.~c ss -~Ec)°la.J ~ ~,L.Q•~ rJ~~ar Page 3 Page 4 Page-5 tt rt tt ee it Pap Y~/E ~E°r1 lePfy ~~-~0 .f✓~o Page 7 Page $ 6-F~Gilgn►T'S ° saltd+gL,G~R"i~is~ /E.porrT Page 9 Name t Desigocer: d EL E i io=e Number: ~lP a 3/ 3 YG Sigaa€zne: ?ter Bate: G• 9-,?o%s' Desigasd PLC m,ant to the Foltowjng POD'S CwPonent Mmmal and SPS 81-$f: lu-&ound Str bst am Common Mmmal far p£3wTs CVer 01 9BD-j-Q705 P (N 01/01) v1 1 Q3 1 T y~ 1 • o ~ '1 e - v a0 M v a ~ J ~ v v T C ~Jllz 14 1 e , o a_ 14 ` It c v a ~a o } V v O k M o 14- Wee ER 5,~ ~v Af raw, 14 O ~k ~i o v o V ~ M ` Zj All h 'h 0 ` n e y N y ~ \ ~1 it ~ ~ ~ v O o h W r ~ Q lv 1~ a y X x 4 ~i M~ sM -ooowl~ III s~~8-5z~-oo8 Oloz NV a3SU138 anon-lsod 31Va oLaz k:7Wf ova o313M "NOON N3alVI4 Ot AMH sn 9tam z \ r n3a ~~~0~ lb'f1NdW OIld3S w o =a3 .o L ...S 3WS nod- Jl8 NMdaa 21W-000IdlM ~ r-- \ J MO ~ Z t4i Z ~p~ ¢ ° z }L"~ i W J z V F-Q: Z5 0 cr 0 C) U) ro °Z o ¢ o v' w 0° a m w Q o a C z t- ° in LL. w ) w O o ~d~ ~°o o= a Q °Z m Q O 0 LL. 0 U) 0 _W LL M ~zw f__ it wcoM l-J zJ= \ aoo z a wp ¢ z ui Q a W to o ow ¢QU Q °O_ to ° imU z F-i w w° m' a 0 0: CE - ° mV] ~WWw o 0 j ZO a O~' V o z w Q 0 U.) UJ O li U? ww>O ° Nwm Q m °cn OR 3~ a y p o z 'o O v _ 0° a UO°*K? W I wN O t17z y V n W W O N i- w I'l a v ww f o z n r- IL °C '00 _J Z> alk ¢ ¢ a a O W N W O N W~ ',i ° F J (to (!J 1- N ¢ t- \(n0a O~Oa .W1¢V W ~Q O= ~O z (n F- ¢ 4 N d Vj°W'-OOZwtO 1-~ ~(n~ F- =U z > J j W Oo C9 Z~ J JNZQ U J O ¢J ¢Q Z_i° =2 :0= UY w pOW ¢ Q Z I ¢ W O I= F= O 2$ WU CAW stn ° J~ >z0 C9~O30 ° U) °wF a ° to ma X° °U Z fn¢o O¢W °wOr_ aSp~ U ODD 0 Y~ ° Z ZW 2x N W3m UL!'= J~m~' ° Zo¢ z Z¢~i¢ U~ mo _ 0 Z ~ u' ~ Q Y ~Y ~Oti _ O Z J = z ¢ O¢ O F- U h- U W C9 z ~X w w >U°oct~ w F_ L ~ Q JWV I l~ m < 1:2 ¢ I - w 2>0 0 < .62 0 U W d 0 O a W Cl- M O a ww N N Sb3 o „b I I Wa „e2 do w CM0 U) J O ¢ ¢ ¢ U U X \ d W 0- J SY3 e ltr do w l w 0 `F N W J Z_ „Zb Q u9g z „l9 ¢ W Q N Y z F PO WT'S OWNER'S MANUAL & MANAGEMENT PLAN Page 'S' of G FILE INFORMATION SYSTEM -SPECIFICATIONS Owner GvG O K Tank Manufacturer: 1-✓1ESER Zon3toct/'£ ❑ NA Permit r Septic 0 Dose 0 Holding Volume. ~oaa (gal) DESIGN PARAMETERS Tank Manufacturer 0 NA Number of Bedrooms- 3 0 NA 0 Septic Q Dose 0 Holding Volume: (gal) Number of Public Facility Units: ® NA Vertical Distance Tank Bottom(s) to Service Pad: B (r,) Estimated (average) Flow : 300 (gaUday) Horizontal Distance Tank(s) to Service Pad: /oo (ft) Design (peak) Flow = (estimated x 1.5): Specific servicing mechanics must be provided if vertical is >15 feet or f-fo (9aVday) if horizontal is >150 feet. Specific instructions to be provided on back, In Situ Soil Application Rate: .7 (gaUday1fe) Effluent Filter Manufacturer: 13 £S r" Standard (Domestic) Influent/Effluent Monthly average Effluent Filter Model: ❑ NA G f -!o Fats, Oil & Grease (FOG) s3o mg/L Pump Manufacturer Biochemical oxygen Demand (BOD5) x220 mg/L 0 NA 1 NA Total Suspended Solids (TSS) X150 mg/L Pump Model: High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L - Manufacturer. ~ (BODs) >220 mg(L 0 NA 19 NA (TSs) >150 mg/I_ 0 Mechanical Aeration 0 Peat Filter Pretreated Effluent ❑ Disinfection 0 Weiland Monthly average 0 Sand/Gravel Filter Other. (BOD5) 5_30 mg/L Soil Absorption System (TSS) 530 mg/L 0 NA Fecal Coliform (geometric mean) <_1o' 9 In-Ground (gravity) 0 In-Ground (pressure) 0 NA Maximum Effluent Particle Size 'fa in dia. 0 NA 0 At-Grade 0 Mound 0 Drip-Line Other Other. 0 NA Other: 0 NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) 5rWhen combined sludge and scum equals one-third of tank volume t7 When the high water alarm is activated Inspect condition of tank(s) At least once every: 0 month(s) 3 19 year(s) (Maximum 3 years) 0 NA Inspect dispersal cell(s) At least once every: 3 0 month(s) (Maximum 3 years) 0 NA year(s) Clean effluent filter , At least once every: 13 19 month(s) 0 NA 0 year(s) Inspect pump, pump controls & alarm At least once-every: G month(s) RNA 0 year(s) Flush laterals and pressure test -At least once every:. 0 month(s) )Rr NA D year(s) Other: At least once every: 0 month(s) 0 year(s) DNA Other: - ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper). Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The soil absorption system shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equals one-third or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 5512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals. or sediment that may impede the treatment process -and/or damage- the soil absorption system. If high concentrations are detected have the contents of the tank(s) removed by a Septage Servidng Operator (pumper) prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended, as the excess wastewater will be discharged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to#he pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System star,, up shall not occur when sail conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the treatment tanks and soil absorption system: adds, antibiotics, baby wipes, -cigarette butts, condoms, cotton swabs, degreasers, dental {loss, diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge. - ABANDONMENT When the POWTS falls and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with s. SAf383.33, Wisconsin Adcssinistrative Code. s All piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. o The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator (pumper). © After pumping, all tanks and pits shalt be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A sine replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, tot Ones and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suKable replacement area. -Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. ❑ The site has not been evaluated to identify a suitable replacement area Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable repilacetent area. if no replacement area is available a holding tank maybe installed. as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply oath the rules in effect at that time. WARNING j- TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE DEATH MAY is RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT 13E POSSIBLE. ADDITIONAL INSTRUCTIONS. POINTS INSTALLER POWTS MAINTAINER. Name a,yF.~ 61KE a? l.3y EPhonePhone / f 47.7/,S' 47.7 -5 46 SEPTAGE SERVICING OPERATOR (PUMPER /,&X ,J LOCAL REGULATORY AUTHORITY Name Name ST `Ito/X Lo, 24w,,,jz OfficE Phone Phone /S 384 - Y4 So START UP AND OPERATION Page .SoF_~ For new construclion, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process'and/or damage-the soil absorption system. If high concentrations are detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended, as the excess wastewater will be=discharged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent-and damage td the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to-the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the treatment tanks and soil absorption system: acids, antibiotics, baby wipes, -cigarette butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps, medications, oiis, painting products, pesticides, sanitary napkins, solvents, tampons, -and water softener brine discharge. ABANDONMENT When the POWTS falls and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with s. SPS383.33, Wisconsin Adrrsinistrafive Code.-: All piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. $ The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator (pumper). 3 After pumping, all tanks and pits shalt be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system, The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot Ones and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. 'Replacement systems must comply with the rules in effect at the time of their permit issuance. Q A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. El The site has not been evaluated to identify a suitable replacement area Upon faiidre of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. © Mound and at-grade soil absorption systems,. iay be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE ADDITIONAL INSTRUCTIONS: POVVTS INSTALLER POWTS MAINTAINER. Name /J a'''`"~ tKE -a31.3y6 EN me J a,,w A&X eE Phone 7/S G 7,? - S.7 G ne 7/S G 72 - S~7GG SEPTAGE SERVICING OPERATOR (PUMPER) -itJK.~antJ LOCAL REGULATORY AUTHORITY Name Name Sr litaix Lo, Zari.vt officE Phone Phone -38~ - YG go LLI ,l Q Li. { u m` " V ;i p a-. m Qj a a 17 T.ll ~ v ~ a ~ }r i { i2 O ~I PAW ~ ~ 'Vf ~ u~i R G T ~ ~ } N r j tEe V O O N ~ ~ ~ ~l U °J B 4-1 Y N ui a v °.3 °±Y =o a y v $ v v R c c N % 'o Ln MMr u c dJ Q id Yy ( L a F' O 1 ? CP i~+ N A 3a Q ° y N i t -0 m lag, a v a, a c~ oa N v m ~ a~+ CSC ~ in ~ R = c Q.j o QJ w o 0 72 v u s c v a $ Q aR c E y e ~p E Y v ° E E E e p~!P41 C A O Q ,b,,~/ 0 y O a} R o_ 3 c 3 my o CL (D N/ R CL vi R P R a~ ° a° o v, - c ° K a 2-t -n !S _c 'Li O~~ O N V 1~~y9~ c rn ~n v 3 c m M/ °J `O v L ~ u~i Q1 •1~• m-5nc°-v~ 3mY•~y i O H ? C avn r O O O C > rL p~ ~ R V ~ -O E yRj R pieF aR.. R - G Q1 w a®~.r a3 5 V w c - E O R O Y ' c v a a a, R V E a a x w r L R~ 0~ V Y QI 'n R R 13 ."r ~ z 4 a v - 77' CL r +L.a N Y J R M d a. ~ O v~ v ~ y r u E VJ ~ c ~ v, E t.i m 5~ `a a weA } R ~ O ~ ~ L Y° at e}.+ N •4-b J C &J car p~1~ al CJ 9J d 5; a= I ~ Z O ~O \ O Q Cn Obi 0, O II -j In \ _ ( \ \ 01 Q LL o 3 Lu 21 a 0 o. a f o o = j~ r t0 X = 0. ~ f(l ~ cp _ ~ ~ (K N U ui Lit Zi- (3 z u, Ill Q CO CO Z2~ LIJ \ \ , j a w J i t /m / LU U O a r r z-Zo \ r f / \ i U w o CL C, Q o r- a o i 11 i. ~ I F f i a t II, p ~ s ® sse ~d r 1 70A w s -s log r ~ I ~ I 't'•- - - i I u w. s-inin.uto-, Rr ~ ~ 6ZQ 'D-d ; 01 -70A WED 4 107 'Y - T s / y / I S07d I10 i p~ 9 101 Q I W / ~ 1 SY04Y A,K,Il.00S i 1 69YLt i~dr .~'`-Y~.a•-,~ _ gig MM , ~ ui _j LLY V aeg WS WZ cla 6 t ..7 all, vU JIB all CIA _ E. it 1 -Tj I se a ~A _ y'sa l -g ~ ~ SONV7 0311YF7dNn i' ST. CROIX COUNTY SE PTIC" I i 'K '~IAINTFNTA;\`CF A(.-II EFi\4E.N--r -AA D 0\'kNERS 41P CFRTr ICATIQN, I C)R'\j Owp,er/Buyer "Jo~► Va e-S Maililtg Address (n~S~ g~tre',-r Properly Address e_ri:,cation required from Ptanning c Zo-nin Depa ~rn ~st5u Department for ncy~x c-onstruc ioti } City/State WZ Parcel Idemification Number 030 - 24 ~'-1 - (0 _ o0 o LEGAL DESCRIPTION Property Location E ~~Z Ski M. L5 Subdivision v,cn RAT rc- L0 1z Certified Survey Map # Vol>.IY11e , Page Volume Page Spec house yes Lot lines identifiable yes no SYSTEM MATENA, CE AND ONVNER CERTIMCATION Improper use and n izrtenance of your septic systen, could result in its premature failure to handle wastes. Proper mainte lance consists of pumpin out the se=, s r tic tank every three years or sooner, if needed, by a licensed pumper. What you put into the svstem can affect the function of the septic tank as a treatment stage in the waste disposal system, 0,,N ;er maintenance responsibilities are specified to ~-,C.ornm- 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinanee_ - The property owner a asy ei and by a ri>a ter p ll = grees to submit to, St. Croix County Plarmim-, GC Zoning Department a certification ai. er, journeyrnan plurnber, restricted plumber or a licensed pumper verifying that (1) the oil-site cd by the wastewater disposal system is in proper operating condition. and`or (2) after inspection and pumping (ifnecessan,the septic tanL is less than I ?3 full of sl :dge. J/we the undersigned have read the above requirement; and agree to maintain the private sewage disposal system with the er m, as set by tll~ vcliartment of Commerce and the Department of Certification st~t,ng that your yep Natural Resources, State of Wisconsin, Department v~ithin 30 days of the three yea- e~ rnatao edate, be completed and returned to the S*. Croix County Planiuirg ' v,,e certify that all statements on this form ye trite to the best r , U,,ve anr~are the owner(s) of the property described above, by virtue _ a warranty d -ed recorded in Register rtster ter of De ~eds o Office, wlfficeice, . beer off be roes SIG ~`I 1 ruF of APPLICANT(S) (s 2 Zo1~ L) DATF ***An, information. that is misrepresented may result in the sanitary perm t being revoked by the Plaruisng R Zoning Department. Include 'with this application a recorded warranty deed from the PegistGr of Deeds Office and a copy of the certified survey referee e is naad< in the warranty deed. map it' (REV. 08105) w g Y f ~ i J I 2 ro Address LOi Block... 3500 Willow Lake Boulevard - suite 100 Salesperson PRATT Addition Vaanais is Heights, MN 55110 Buyers Name Pie 651-429-802 Plan MN Builder license gBC000001 www.pratt taw pratthwm eaeom w ~ •~t<~ , 'C1 ~ - t►~wt ,ors , { ~ a x I~ t- f t j°iAt{~ 9 ~ N` +uu i + ! a t 1 t 1 ~ r .Si:'' s4 f ° Cam' F 1 ~ i i t O V J( ro _ ' Address Lot Nock 3500 Willow LakeBoulevard. PRATT Suite 100 S"esper'son Addition vadnais Heights, MN ssizo fi phone: 651-429-W32 . $tNJCCg Nan9C s.. ` &1. MN Builderlicense*Bcaoml fare 651-429.0255 www.pratthomes.cam a N m 3 3 D F 7F 4. - 1 >x 1w- I Is ji Ims is E u, s ; 1 Y i f r ~ im CO, 701 r rn CO. Address o}Block PRATT 3~"Ow Lake Boulevard Suite 100 Salesperson Addltlon V-W-- Heights, MN M10 TI &Wrs Name phone: 6%-m-sm Plan _ MN Builder 8cense 86t1oooooi fax 01-429 om W Praako nee-corn S k m 0 - ITV LI 1 I t h N I ~I 73_ f ?I h ro Address Lot 81ock 35M Willow Lake Boulevard suite 100 Salesperson Addftion PRATT vadnais HOW&, MN55110 t ?til phone: 651-429.OD32 $IJyerS Name 194 "5- MN Builder license gB fax 651-429.0255 X00001 www-Pratdwmes.com Wisconsin Department of commerce SOIL EV L!416 -REPORT Division of Safety and Buildings Page of in accordance with Comm 85, Wis. Adm. G "ode 11 Attach complete site plan-on- paper not less than 8 1/2 x 11 inches in size. Plan must County ~T t c~ i 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. d L~ r2 h& il-7 ) j WOO Please print all information. Revie by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). / S Property Owner Property Location z Govt. Lot 1 W4-SLd 1 /4 S X-T ~ N R E (24, o Property Owner's Mailing A dress Lot # Block # Subd. CSM# f~ Cfly State p Code Phone Number ❑ City ❑ Village Town Nearest Road Construction UseResidential / Number of bedrooms Code derived design flow rate C/' 0 G GPD ❑ Replacement ❑ Public commercial - Describe: Parent material ~ccc/~'~2 Flood Plain elevation if applicable General comments and recommendations: System Type System Elevation Boring F 7 I ] # t❑~~ Boring ~J q 1L1 Pit Ground surface elev. 0 ft. Depth to limiting factor o in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 0-/0 01", 1417- - k 0-3 , 6 L 67 i ~r Boring # ❑ Boring 9 pit Ground surface elev?. 0 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAf in. pMunsell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 FjM a Z 3 -illy l f • Effluent #1 = BOD. > 30 < 220 mg/L and TSS >30 < 150 • Effluent #2 = BOD. < 30 mg/L and TSS < 30 nxyL CST Name (Please Print) turn a CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 5401 - _l 715-246-4516 Property Owner _ Parcel ID # Page of aBoring # ❑ Boring rnl pit Ground surface elev. ft. Depth to limiting factor ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 in '2/' 0 31 z- , 01 3 ~r T ❑ 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 GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Ef1#2 Boring a Boring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon ' )epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDtlf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 '042 ' Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD5 < 30 mg& 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. SBD.8330 (8.6/00) Pmperty Owner Parcel 1D 0 Page --"of BMW 0 6!2 wound rift= elev. 10. 5 a. Depth to Wring factor .-JLOL tn. Pit _ Sop tY9lton Ralo Hwirnn Depth Dominant r, a Raft Deso llptIon Texture &n came C-,Wmwm 8oundwy Roma (3Ntl in. Munsall Qu. Sz. Cont- Odor tar. at. Sh. _ SEW "#2 0-12 /0, 1`7_ ILE 6ormg # ❑ 13ortng ❑ pft Ground exact elev. R. oepar to pm& g Ndw (n. ~ Hwl=n Depth Oondnant ' Redox Desaipffon Texas 9truaure CAterlete++e~ ftwWwy Roots GPDIM In. Mnuuseil Qu, Sy- Cont. Cola Gr. 8z. Sty. 'Etf#1 'EM # Bolt ❑ Ptl t3rpuntlauriace etev, tt. Depth to 0ndting factor N. SoA Llaft Rafe lidriQOn + Dominant Radox Gasarlptoon. Texture 6tnkaara Canoe 6orr,dmy ` Roofs GPON m.-- ; Munsell Ou 8z Conn Color Gr. 8s. 5h. •C-"l B%wM #1 SOD, > 30;S W RV& pnd TSS 401180 FIV& • Eli wd #2 C BOD S 30 waL w4 TSS; 30 maL The Deparenzat of Commerce is an equal opportunity service provider and employer. If YOU Geed assieh= to aooose swices or need material in an aiterrige fomult, plesee contact the department st 608-266-3131 or TTY 608-2648777. wuaaloptlpoy Soil Test Plot Plan Project Name Nick Henton Shau ird Address 3440 Cherry Lane Unit E Woodbury Mn 55129 C~TM #226900 Lot 1 Subdivision Birch Park Date /12/6/14 E 1 /2 S W 1/4S 25 T 30 N/R20 W Township St. Joseph Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1.5" pipe System Elevation TBD *HRPSame as Benchmark 27th ST. Scale is 1" = 40' unless otherwise noted 260' B.M.* B-2 300' 45' 10' 99' 40' B-1 35' 97' 95' B-3 93' 19% Slope ~ Property Line Z \ NORTHERLY LINE OF LOT 1, BIRCH PARK S89 4 'E 56.00 \ r t ` I 1 t I, ~ f 1 Fle Iff f I i 1 1 r'' / I / , I j ~ ~ 1 r i. l 1 F~ ~ } I I~)i'ii 1/1 r / 5F Ij} I i I /r j 11 J~ rr 1 2 "61 1 SF ! I ~ f I f / ~ ~ I I q18 / I r ~ ~ I ( I I I ~ I 1 ~ 1 / 16 11 1 I ( I \ r t q10 l I I / ` x 16. 0,06 1 1, 904 - - R 1 1 P I i } \ \ \ ~QA ~ ~ 05. ~ I O O.S. 9 3.5 90 qo 61 / -I qo .06 \ 1 q O \ \ q 21 ,x \ lx 4031 l5 ~ 1 \ \ \ \ Ids Q.S. 1 \ \ ~s 1 f O } i 1 1 i i\ ~ 1\ I i 846.2p • t 1 i I 1. I ' 1 1 V ' I t j i I i \ t 4 ~ d~7 ' SOUTHERLY LINE OF LOT 1, BIRCP4 PARK tll Flo " olo LOT I, BIRCH PARK, ST GROIX GOUNTY. WISCONS °z~ SUBJECT TO EASEMENTS AS SHOWN ON THE PLAT I THIS 15 A REPRESENTATION OF LOT I, BIRCH PARK AS DERIVED FRON PLAT AT THE COUNTY RECORDERS OFFICE, ST CROIX COUNTY, WISC DATED THIS 20TH DAY OF MARCH, 2015 --10.00.00 5U LDING LOCATION and 1, 4 896. 0 !l 0.00 FD IP -x- - fl i~ROFEFRT~' D~AT~A ! FD IP 0.00 4 10 F02: DOUG OAKS 0" R I x 00. D VE Y ~ ``~aaaa I 99.s c 5q x 901.02 cyl, 1 132.5 f t ' I SCALE: I"= 50' Ix- (803.5) DENOTES PROPOSED GRADE 1 I I Q) - SF - DENOTES SILT FENCE l ` ; III : ; of PROPOSED SLAB ELEVATION = 805.00 / ;I' l~ _ = m TOWN OF ST JOSEPH, MINNESOTA 1.5 820 ' I 1 i I i 11~ I I \ O.oQ FD IP I _ 1.5 45 \ JI°- I o \ \ I N 66 3.0 0 ~ I uIW I 4.5 3.0 m I N i 2.0 2.5 THE RECORDED NSIN. HOUSE DETAIL (NOT TO SCALE) I