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HomeMy WebLinkAbout020-1285-10-000,;oonsin OepauhneAt of Conunerce dety and Bliildirl~s Division GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) St. Croix Sanitary Permit No.: ` 384113 State Plan ID No.: (PI t 6 ~-2 Parcel Tax No.: oao-legs-IO-ooo ~+ ersot>fl iniortnation you provrce may oe usea ror seoonoary P~P~ Irnvacy taw, s.~ 5.ua 1 ~ f fm)1• Permit H er's Name: City Village ^ Toetn o Graf, Thomas Hudson Township T BM E ev.: Insp. BM E ev.: BM Dion: ~`_•_. P~ w TeNK INEC~RMATI~N ELEV TION DAT TYPE MANUFACTURER CAPACITY Septic ,Q,~`~, coo~6ao Dosing Aeration Holding TANK SETBACK INFORMATION TANKTO P/L WELL BLDG. ventto Airlntake ROAD Septic 5D +- i NA Dosing NA Aeration NA Holding PUMP'~SIPHON INFORMATION M fadurer nd Model tuber GPM TDH U `ridion System TDH F For emain Length tf CAII ORGARPTICtN SYSTEM @eD TRENCH Width r ength No Of Trenches PIT No.Of Pits Inside Dia. Liquid Depth I As-~: DIMEN I N SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING Manu acturer: ,,,,~; 4 . - s i ~P~w.rrwcQ~ SETBACK INFORMATION Type O , ~2~ r S6 ~ CHAMBER OR UNIT Mo a Num er: (~ - C a.e,. System: f11CTDIR11T1A1U CVCTGM ~ L`+iGU~f`_'__ L 0 ~ w- _•~: ~_~.~ d C_I._.__ ...e/ Header anifol (~ k 'I0'"°rD ~ h Distribution Pipe(s) Spaang L Dia x Hole Size x Hole Spacing Vent To Aid Intake ~ S v . , Lengt . 4A11 OVER x Pressure Svstems Only 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 Q No /~~ C~IOMI1(1ENTS: (Include code discrepancies, persons present, etc.) ( ~+M^xt) Inspection #1: ~`~ / f 9 /01 Inspection #2: '-y'-'T"" Location: 57s Schommer Drive, Hudson, WI 54016 (NW 1/4 NE 1/4 21 T29N R19W) - 2129191378 St. Croix Industrial Park -Lot 1 j `f y ty,~~ ~;,~ 1.) Alt BM Description = sP ~- ~"` (i""'~r (~ 5~,,..,~,,,,,,,.,~cr. -E• ~..,~..r, 2.) Bldg sewer length = ~f 2 -amount of cover = S.p r ~ S~ ~ ~, ~.~.c,~e~ . 3) fps -~ (-~-- ~,.~„t.~ ~ ~~,'""'`~"' Plan revision required? ^ es ~ No D~ 19 d ( _ ~ ~ Z U~}~o~ther side or additions infor a i S~-6710 (R~3/9~ l~ ~S~ ~ ~~ to Date Inspector sSignature Cert. No; ~ 7" __ STATION BS Hi FS ELEV. Benchmark , ~-~' 2.~$ 9~p. A' Alt. BM G- ~~ `186 - a ~ Bldg. Sewer ((. Qty eO , 5 I St/Ht Inlet (2•~8 $q 17-/ st/ Ht outlet 13, orr $+~9, 6 9' ~t Inlet _ ----~ Dt Bottom ^-"-'"" Header /Man. (3.12 9, ~3 r Dist. Pipe °PS f 3 •'Fo I 99 .'SS Bot. System t~• ae f }8 g`~~-. q~- I Final Grade $ • 8C qD ~ • ~s r St cover 8.9 0 0 3,85' ~pplieation Safety & Buildings Division . bVis. Adm. Code 201 W. Washington Ave. completing this application PO Box 7302 >e used for secondan' purposes Madison, Wl 53707-730^ .04(1)(m)] (Submit completed form to cou:~ty if r __- - -° -~--.._ state owner sv teft~ on a er dot less~t an 8-1/2 x 11 inches in size. rw~i~orS"io previous applicati ` ' State Plan 1. D. Nu her #~ 6 !I b ~2 ,~ ~ ~ •i . Property Owner Name _ ~ roperty Location n qq ,~/ - / i» ~~ ~l ~ ~ ~tt~ l !/4 ,E' 1/4, S T ,N, R E or Property Owner's Mailing Address g7 CRgX ;° ~ of Number Block Number "'~ CpUNTY ~~ ~~ ,~ GOFFICE `~., ~/. / City, State Zip Code Ph a''!J er ' ~ R Subdivision Name or CSl\1 Number II Type of uilding: (check one) ^ City O 1 or 2 Family Dwelling - No. of Bedrooms: ^ Village >39 Public/Commercial (describe use): pi=t~r.~~ i/.v .~ror,~,cs ~ Town of ^ State-owned ~~ III Type of Perr.:it: (Check only one box on line A. Check box on line B if applicable) Nearest Road .~a'. - p) 1. '® New System 2. ^ Replacement 3. ^ Replacement of 4. ^ Addition to Parcel Tax Number(s) S stem Tank Onl Existin S stem (, o~ d - ~ ~ - ~ d ( $) ^ A Sanit Permit was reviousl issued Permit Number ..~ ~ Date Issued o~~• ~• ~ ~ ~3~ ~ IV. Type of POWT System: (Check all that apply) 5 ~ nw~.OO ~! ~n ~ Non-pressurized In-ground . ^ Mound '" __ I ^ Sand Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At-grade ^ Aerobic Treatment Unit ^ Recirculating ^ Other: /li 2q ~ - - V Dis ersal/Treatment Area Information: 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals./day/sq. fi.) (Min./inch) Elevation ~DU d~~ 6~ 6~s" 6s / ~ dc5aa o0 903.vo 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 T~ ^ ^ ^ ^ .ow 6s / - .,~ - ^ ^ ^ ^ ^ VII Responsibility Statement I, the undersi red, assume res ensibiiit fcr installation of the POWTS shown on the attached laps. Plumber's Name (print) Plumber's Signature (no stamps): -hf~P/MPRS No. Business Phone Number /5 ~ Plumbe Address (Street, City, State, Zip Code) ~ S" '6 VIII County/Department Use Only O Disapproved Sanitary Permit Fee (lncludes Groundwater Date lssued Issuing Agent Signa re (No stamps) IRbApproved ^ Owner Given Initial Adverse Surc?~Be Fee) ~ ~ ~ Determination 4~' ~~S ~ 20~ IX. Conditions of Approval/Reasons for Disapproval: V ~~ 0 ~ -I~s +~F ~- Pte` ~-~- - ~ ~ +~- ~I ~_~ l~•e~ ~u~..~- 6.~. w~:.;~al~.~~J /c.Qe.e~t,~-~ ~ ~ a,~,w~,rS ~~.~+~d ~ ~ SBD-6398 (R. 07/00) ~n,~~i ~~:rswor~7~ ~~-~7 h~.y~d~ye ~~ ~~ = - _ p _ N ~ a c(1 ~ ~ -~ ~ ,~ 1 _. L~ : L.-- ~- ~ ___. __....f~ `. ~ _- 1 a ~ _~ P o ~ _• o • ~_ M ~~~ O ~~ ` .~ `• o t~ V _ a v ~ a I' ~ ~ ~ ~~ ~ - - ~ - ~ p ~~ Y ~ ~ ~o 0 ~ ~ 3 w ~' ~ ~` w Q o ~ ~ ~ M ~ ~ a~ Y ` ` ? ~ ~ ~ 3 ~ ~ ~ ~ ~ t ~ , ~ ~o °~ y ~° ~ z w ~ ~ k a ~ ~ o, ~ 3 z `~ ~ w o ~ v a ~ ~ r --- ~ ~ .. -- o- o -- -- --- ac J ~ o ~ . ~'. -; ~ ~ ~ i ~ ' `, ~ Q D ~ pv ~ o ~i~` W ~ o~ ~ Q„ ~~ O \ ~ ~ O ~y O vo ~ • - •~ t v Q ;~ ~; o. s 1' .. . isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi. us/S B Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary January 24, 2001 CUST ID No.310478 MARK STAHNKE C/O ZAPPA BROTHERS, INC. 659 6TH STREET HUDSON WI. 54016 A7TN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 01/24/2003 SITE: SITE ID: 625771, Graf Concrete Construction Co. St. Croix County, Town of Hudson NW1/4, NE1/4, S21, T29N, R19 Subdivision: St. Croix Industrial Park -lot l Identification Numbers Transaction ID No. 611672 Site ID No. 625771 Please refer to both identification numbers, above, in all corres ondence with the a enc . FOR: Description: Non-pressurized Inground Conventional Soil Absorption System Object Type: POWT System Regulated Object [D No.: 778355 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed. approved plans and with the "Conventional Soil Absorption Component Manual for Private Onsite Wastewater Systems" SBD-10567-P (R.6/99). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VII[ of the conventional soil absorption system component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The leaching chambers must be installed in accordance with the manufacturer's printed instructions, the plan approval and Comm 83, Wis. Adm. Code system sizing criteria. If there is a conflict between the manufacturer's instructions and the plan approval, the plan approval and code requirements will take precedence. MARK STAHNKE Page 2 l/24/Ol • This approval does not include plans for the general plumbing systems or sewer piping leading to the septiclholding tank that may be required for this project. See section Comm 82.20, Wis. Adm. Code, to determine if plan submittal and approval is required. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/instal lation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, • Gerard M. Swim POWTS Plan Reviewer -Integrated Services (608)-789-7892, Mon. to Fri. 7:15 AM to 4:00 PM j swim@commerce. state. w i. us DATE RECEIVED 01/18/2001 FEE REQUIRED $ 175.00 FEE RECEIVED $ 175.00 BALANCE DUE $ 0.00 WiSMART code: 7633 ~~ ,A`~ v i y\ ` d!-. 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Jk'~vE ... ~k'~~ ~~ e' 4 ,0 Div ~ :~l~lN~ ~~ L / ~ /Lq-'r/c9/tJ5 ~/~ / / ~ /ip'f t~ ~N~ UNt'r5 C~~1L/~ir1cTZ~~ L...~~~.co.~f f+~S~>~j~tc~,~J ~lC~r'~ 1.~11'T"N ~~L7~~~ ~~~~u ~~-t~ ~~ ~~~~~ ~~t~Y s 3©x a o ~ / ..~ ~d ~ s~,T , Q , / ~c QLI r ~Q~a ~ IP ~ G . Io ~j S4 ~~- T ~~~t4`~D ®~ -~~D.G~ o~ ~~r~T/j,~t-Tnlc !T-!G~ ~q`~~~'l7"`~ ~-~lfn'I~t?S ~ gam- G' s Sda '(=7 ~lS~~c ~3uT1o•~1 f~0i~c/G ~[,1ET~t/~ ~Ro~ ~E,~T~~ '1'i~J K y,f,,, m~~t~,°~,•~BEQ - ~/F.~.,r F C~85E~P'lrtrJa~l /~,~~ ~PP/y~uyEC, (ENT ~i(~ N~,1~(,.r~.,.,~ 1~7~~ ABoJE I/~I~sN ~oQAoE F~„sJ, G~~~~ ~~ ~~ >~/c sc N y~ ~I~nIT P, PE' M~KI MrrM ~Q. ~CvV~ <<IA.•~RjR To ri.~J r < f1 ~ ~/ pE Side View F~c~(AT,o.J "7'jPFnic,r .~oTr-o,,., {~£Q So,c TtST End View T 1s• _~ - ~ `ter I` :r.•- ' ~ __ _ _ ' - - C ~~ - I C f •~/ ~7S'i __~' ~ I ~~ S^ro~c..,,.~o~k f-~,cf~ L'Ar'r4c~r~ ~'VIvOEi /i9~r ~~ 15° 34• .I ~~ 7 ~D ~ ~T ~ ca ~. ~., b ~~ FROM„ Zappa 'Brothe'rs Inc. FAX N0. 715-386-0323 Jan. 23 2001 04:24PM P1 ZARPA BROTHERS EXCAVATING INC. 715 S1XTFi STRI;~I" NOR7N HllDSON. Wl 54018 PH. 715-386-2850 Gra'~ Concrete Construction Company PO'W'TS Operation, Maintenance and Performance Manus~l Oruner: Crraf Concrete Construction Company 575 Schommer Drive Hudson, WT. 54016 Contact: T'om Graf (715) 386-1752 Designe7: Zappa Brothers, Inc. 71. ~ Sixth Street North Iludson, WI. 54016 Cozttact: Mark Stahnke (7I5) 386-2850 Fax (715} 386-0323 Installer: Zappa Brothers, Irtc. 715 Sixth Street North. Hudson, WI. 54016 Contact: Mark Staluike (715) 386-2854 Fax (7I S) 3860323 Crovc:tnniental Agency: St. Croix County Zvntng Dcpartmc;nt 1101 Carmichael Road Hudson, ~VI. 54016 Contact: Rod Edinger (715} 386-46$0 Kevin Crrabau (7I5) 3$6-4680 Sohn Sonneatag (715) 3815-4680 ('715) 386-4886 in the event of component faiture or maifunclion notify Z.appa Brothers, Inc., or Tri-C•o'ur~ty Sanitation, Hudson, WI. Contact: Ben Mar~-,~n (715) 386-2130. FROC.1.; Zappa brothers Inc. FAX N0. 715-386-0323 Jan. 23 2001 04:26PM Pl Yagc __v~ of o~ Lv1ANACEMEN`I PLAN This Prlvatr. Unsite Wastewater "1 reattnent System (POWYS) has been designed, and is to be installed and . maintained-its aciroidi-15 to Lamm 83, Wis, Adr~iiu. Code, the !n-ground Soli Absorption Carriponent Manual for Private nxuite wastewater Treatment Systems (SBD-lUSG~-P; Junc 11, 1y99), and the MaratJton County Privates Sewage $Ystem Urdintttice, This PUW1'S has been designed to accotxuiiodate a maximum daily flow of ~ov gallons of domestic wastewater- per day. The quality of influent discharged into the POWYS treatment or dispersal component shall be equal to or less than all of the following: ~ •3o~»a/~a monthly average of 30 mg/L Fats, oil and grease. { • st~o,.w~c, a monthly average of 220 mg/L GODS. ~ •~-s-o~~/L a monthly average of 150 mg/L TSS. Wastewater shall uorbe discbargecl to the POWYS in quantities or qualities that exceed these limits or that result ut exceeding the enforceuicnt standards and preventative action limits specified in eh. NR 140 Tables 1 & 2 at a point of standards application, 'except as provided in Comm 83.03(4), ~?V,is.'Admin. Code. 2. The owner of this POWYS is responsible for system operation and maintenance. The following taintenance shall occur within three (3) years oi'the date of installation and at least once every three.years thereafter: 1. The septic tank shall be pamped by a certified septage Servicing_operator, licC113ed under s•281.48, Wis• Stats, unless inspection by a licensed master plumber or other person authorized~to make such inspection, finds less than one-third (1/3} of tha tank volume occupied by sludge and scum. More frequent pumping maybe . necessary to prevent solids frotn exceeding one-third (1i3) of the volume of the tank. . Wastes shall be disposed of by the pumper iii accordance with ch. NR 113, Wis. Admin. Code. At each pumping the pumper talust visually inspect the condition of the tank, baffles, risers anal manhole cover and verify that any required locks are present. 2. The soil absorption co.tt~.ponent(s) shall be visually inspected by a licensed master plumber, certified septage servicing operator or POWYS inspector. Inspection shall chock for evidence of discharge of sewage to the ground surface and for parading of effluent in the distribution cell. 3. The tank filter{s) shall be 's.nspected and cleaned to remove any accumulated solids according to manufacturer's specifications. The filter cartridge shall not bo , FROM,,,;. Zap+pa Brothers Inc. FAX N0. 715-386-0323 Jan. 23 2001 04:26PM P2 . ~ removed tuiless provisions are rliade to retain solids in the tanlc_ C'lea~iix~g of the filter at more frequent intervals may be necessary. 4. Any pump, alarm or related electrical coiuiections shall b~ visually checked for defects and tested to confirm that they axe operating properly- 5. Reports for alt system n1aintenance shall be submitted to Marathon County in accordance with Comm 83.5, Wis. Admin. Code and the Marathon County private Sewage Systems Ordinance. f 3. Defects or malfunctions identified during maintenance described in item #2 above shall b~ repaired in conformance with Comm S3, Wis. Admin. Code, and the Marathon Coutlty Private Sewage Systems Ordinance. The User's Manual, provided to the owner of the POWTS includes khe names and telephone numbers of the properly licensed individual(s) to contact for such repairs. :t. Anytime a failure or malfunction occurs, it shall be reported to the person(s) identified in the User's Manual for this POWT$. Repair or correction of such failure or malfunction shall comply with Cornxn 83, Wis: Admin. Code, and the Marathon County Private Sewage Systerrt Ordinance. 5- No one should enter~a septic or other treatment tank for any reason without being in full eonapliance with OSpiA°standarxls for entering a confined space. ;Theatmosphere within these tanks may contain. lethal gases, and rescue of a person from the interior of the tank maybe difficult or impossible. 6. Igo product for chemical qr physical restoration or chemical or physical procedures for POWTS may be used unless approved.by the Department of Commerce in accordance with Comm 8a, Wis. Admin. Code. 7. Ln the event that this 1?OW"fS or a component of this POWTS fails and cannot be repaired, the following contingency plan is proposed: . ~:>~. //~ ~rz ~ ~~ u~ o~ .~~QZ ~ /~,C~,CSa~~T ~ r t~~ .T.~.spat.i` /YEh/ _~„ f ,17r- iAr~iv,Eiyl lip/ /~LrE/LyAi E i9/'Z~t`/J 4vN~'..~ -~u2 L ~~.o a ct~v rzon/ t..~A~ /~r.~ci=oivn t ~o iR,r- .ot/Z ~~2 GZi/iv ~. ~ow7~' !,.),E.J'z'6.v /~~is+n/.. Fit l/tG l3l/,1~=2_ f~j,~~,,!~rr rZiz /~7i+~F~r.,.G~z~_ocS~ /I :O.are O~/~~/t.~n,,,T ia7,<~J' !1~?~G~J~ 7iy i4GGWL/JfJNG~• 1i+.!lT/,+ CP/r/I~'1 . ~..r ~.f'~ I~/~TiJ' • /V.(rL'~?IN~ 4~OE if this POWTS is replaced, or its use discontinued, it shall be abandoned in accordance with Comm $3.33, 'Wis. Admin. Code, ~ , `t •Ir' Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT Page ~ of m accoroance wnm Comm oa, wis. Nam. ~.we ~~~/'' County ~~ 1 X Plan must it er not l s than 8 1/2 x 11 inches in size h l t l Att J I ` •~ ~ . comp e s e p an on pap es ac e inGude, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please prfnt all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location C ~ ~~~ ~ ~~ [~ Govt. Lot ~ W 1/4 J~ ~ 1/4 S 2, ~ T Z i N R Jg E (or) W Property Owner's Mailing Address Lot # Biodc # Subd. Name or M# City State Zip Code Phone Number ~ City ^ Vllage Town Nearest Road (~ ~N ~-~ ~ ) o ~ ~~ New Construction Replacement Parent material ~Ld General comments and recommendations: Use: ^ Residential /Number of bedrooms (~ Public or commeraal -Describe: ~, / ~ L~~T/ l L Code derived design flow rate ~~ c~ GPD ,f />.~:~~/L.~n~,=.vyss_r~ _•~~___ __.~_._ Flood Plain elevation if ~li~a~le A/ ft. r ~~ : ~~ ,~, rt n ~-`` ~' f +4-'~` (~iC~;1 ...i ,. _ ; a ® Boring 5, Boring# '7~ ^ Pit Ground surface elev. ft. --''t. CQiJN'Y ` ", `~ZONINGdFFIC~ Depth to limiting factor 1 in. Soil lication Rate Horizon .Depth Dominant Color Redox Description Texture Structure Consiste .1,~oundary.~ ~`; ~~ ` GP D/f~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "-~•-• --= '"'~ 'Eff#1 'Eff#2 p 0.I Z y ~'' ~-. ! ~ k" rz•~~ ~ ~ / Q . 4 ~ r; ® Boring # ®Boring ~u,~~ ~ r, ^ Pit Ground surface elev. ft. Depth to limiting fador>~ in. Soil lication Rate 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 _~ - y 3 -- ~ t ms~~ n~ r ~~ / 0.4 Dy ~g i~.~ .~ 'Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mg/L ` Effluent ir'1 = taw < :w mg/L ano i 5ti < ;w mg/L CST me (Please ' t} 'g CST Number Y W ~ti /~ L2Z7 7 Address Y Date E aluation Conducted Telephone Number ~, S~+ ~; / ice' v ~ .• , ~ Property Owner `~ ^ ~ T ~-~~ 1 Parcel ID # Page ~ of ® BOring ~ vv Boring # ~,~ ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication 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 ~-i 3 il~~i~ 3 --- P.. ~ ~~ Ih ~r c.5 ! ~ ~ d . _s~ ~~ ~>~e 4 4 - r~ ~ S~, ~, ~, - ~ I ~ ~ ~- ~',~. ~ zf.2 (~-Z ® Boring # ®Boring ~~ •~ / ^ Pit Ground surface elev. ~v ft. Depth to limiting factor~~c~~ in. Soil lication 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 3 -/ /6~ 12 4 -~ n'IS SCE -- 1Q.7 , Z Boring Bonng # Ground surface elev. ft. Depth to limiting factor in. ^ Pit - Soil ication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GP D/fl: in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 =BODE > 30 < 220 ntglL and TSS >30 < 150 mglL 'Effluent f)'2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. .. SBD-6330(8.6/00) P~~~ 3 of 3 ~ ~~ ~~ I` iiP ~~~ ~~ ,. ~, C, ~ ~ , I~' ~~ hS S CIEv'~~c,9 E~6J- ,, ~ , I 9ns 9 ~.1 ti H 1 HI•Pl.~wr ~ ~ ~o-~ LANE ~ ~`~ ~~~~° ' \~'I ~~a I' I ' , ~, ` Ems' 9 & ~ qs ~L~Y~' -904.4 ~. .,~~ ~ i ~! ~4 'S/ ~) ., ~ ~ ~i i ~ I n ~ ~i~tJ~-NlhdR 1: - S?~k~'~ N 1"~w~ - - M>, g~ ~s 9~" j Z~,Is:~1M-~Rk- ~ ~1Qa~ ~1~ AT LaT i ~ j ~ I ~i~~ . ~' ~~o~-c~ ~~~ 1= ~' y V ~ ~, ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer /~ ~? Mailing Address ~~ ! l G~.O~~~ C~~c l Property Address ~ ~JS .('cyo.» ~.~ 2 l`-h- ~F (Verification required from Planning Departrnent for new construction) City/State ,/-~u.nc~~. Parcel Identification Number Oo20 -/~~S- /O LEGAL DESCRIPTION Property Location ~vl /l / '/4, ~ '/4, Sec. ~_, T~~N-R~W, Town of , ~u.ru-~,/ Subdivision ~~ ~~z~x 1, „rrr SAL ~~~< ,Lot # _~. Certified Survey Map # ,Volume ,Page # Warranty Deed # ~ l ~ Y d.9cP , Voltune ~1 ~ ,Page # `/ ~7 Spec house ^yes ^ no Lot lines identifiable ®yes ^ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expirati n date. ~, ~ , ; ~ ~^ ~ / / ~ SIGNATURE OF APPLIC DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above, by v' a of a warranty deed recorded in Register of Deeds Office. ~~/„ ; : 1,~ 1 / ~/Ol SIGNATURE 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 DOCUMENT N0. 9TATD NAB. OF WI800N92N FORM 1-19>xt ~~~ ~~~TM~ 4~7 d 6242~dE3 /~ KATHLEEN H. 'WRLSH REGISTER OF DEEDS ST. CROIX CO., WI made betwean`SI)I '"'A`.NLNtt~ This Daed is , RECEIVED FOR RECORD GILL..EAR72Tl;RRSAIY ............................•..................................,.... •..... ................... ......... .................................................................................... 06-46-2000 10:15 RM ....................... Grantor, . ....... . ....................... . and.....T~CikSAS.i'[....G ...T . ............ .........•........................................... YARRAHTY DEED EXEMPT N ..,............ ................................................................................................. CERT COPY FEE: ..................................................... . . CDPY FEE: ... ... ............ • ....................................... Grantee, TRANSFER FEE: 5b5.00 ........................... ................. ..................................................... RECORDING FEE: 10.00 Witnesseth, That the acid Grantor, for a valuable cansideratlon...... pA~S; ! ...........................•.......••...•............•.~....•.....•............•••••..•.............•....•.. •.•.. eonveys Lo drantea the follawin¢ describod resl estate in rte. ~ C~F.Q7,~ ............... RiTV RN TC County, State of Wieeenatn+ ~~~~~/~•, ~~ If0 4, St. Croix Industrial Park Tat Parcel Nos >~~.:.f~:~~.... ~~ ~~_~D in the Town of Hudson, St. Croix County, Wisc onsin. ThU ,,,,is•.not homestead property. ............ (la) (1e not) Together with aU Gad ^in¢ular the heredltamente and appurtenances thereunto belon¢in¢; And... Grantor ........................................................................................................................................ warrants that the title !s =ood, lndafuslbla In fee simple and free and clear of encumbranees except Encumbrances of record and will warrant and def..enld~the same. Datcd this ................'o-~..!.:..`.-:.................... day of .... .................................................................... (SEAL) ....................................... (SEAL) .......... .................... AVT)381N"TIOATION iE ...................................................... ale... 2000 SAINT CSOI%, VFNTQBES ............................(SEAL) "G~" ~ A1tT1+ ........... ......................... .. ......•... ....... ............ (SEAL) ..... "G~ "CSgIG SlEENSFII•s" AOBNOWLIDDOMI4NT Signatuze(a) .......................................... STATE OF MINNESOTA .................. es. .....................................»......................................... ~~~1... ...... .County. ....... ..... authenticated this ........day of ........................... 19...... Panonally cams before me this ..........day of ..........:..:.......JuAg.............. 204.. the above named ................................................................................ ......CiXg&4.~FY..Xn.. ~T~1eY. and;...... ................... , ...... .......ri.~.. G;~#8..4'~?~Fiatensenr....Partners ............. TJTLE: MEMBER: STATE BAR OF WIS~O I of $sint; Croix, Ventures,,,,,,,,,,,,,,,,,,,,,,,,,,, i`WR" ~'~' ' z.~.......... (If not . ........................ .... ................ ......... ...... ................. . . authorized by § 708.08, Wis. State.)' ~~E,~.~ me known to be the person ..........who executed the ` ~'='~'8ie¢otn¢ i~~m~ent~as~cknowledge the lama. ; /J~11C~TRl~MaN:~Y.. / ..... ... ~/C/ ..................... ...,............. .l • n .. ....... .......Co Ss. yam; ~3^7~ .. Notary Public .. .u . ...... . ~~~~'~ ~ My Co on 1a a anent. if no state exp (Signatures may ba authenticated or acknowled d. Both / . arc not nocessarY•) dateilk~~~~f~. ..................~•.••...., ..•..• •Nemee et o.reoee daalaa In enr e+peeltr elwuld M typed er printed Detor their daeu,tuw. arAn DAR OF wraCONe:x Wleeoneln iwsd $Lnk Ca IDs WARRANTY DRLD FORM Na r-3Ne Mliwevkw. W4. I ~~ ~~a r ~~o ~~~ ~° ~._.:J ~.~._. 1 I ~ ~ ~~ ~ ~a ~,~ 1 1 1 1 1 ~ A ~I I ,.__.____ I ~._ . '1 - ~ 1 I I I 1 ~ I i ~ O ~. ~ I~ ~ i I 1 i 1 ~ o ~ I ~~ 1 J I I . 1 I I tI~ I > ~ 1 I ~ I ~ I, 1 p 1N 1 , . 1 1 t.____--~ ~ --_ _.il 1 ___ a ii~ ~~~ I _ ~ Saar ~~ ' a• .._„~~ __.. ~ - - .~1.4~~_ 1J6:J I ~ ~~ I ___, r naz~~~, _ ( I I ~ 1 ~ 1 i i ~' I •, I 1 ~ , ~ ~{. :1 I ! I i i ' ~ :; I I aI I I I I 11 ,, I ~ I$~ p~ i N i 1 9 ~~ „1~ ~O 1 I~ 1 ~n 1 ~~ 1 O 1, 1 I I I ') 1 '. I i ~ ~ ~ l i i l i ~% I I I --------------~` ~-___--__--~ ~- __---1 ~• 1 I 1 ~ ^ ~ ~' ~ 2e' ~ i I . I ~; Sit v •k H,.~... ~ I ~ -___________ ~ y ,~. „01-- _ 410. . _ _ ~ , --~-~ , . I ~ O ~ ; t I 1,, ` I I ~ I i 1 l- 1 I I ~Qi j~ i ~O i ~I !~ ~ ~ j~-~~ P I 1 \ ~`fOt; 1 1 ~ x i t ~ I q,~ 11 , I I i i Q ... _io~...... I. 1 _..._.. 274' ._..._ -=?4'Lt=~ I, 1 s r 2~cr 1 :'~da' _-- -' I __.. --__.__ r ._-------- ~ - . ~-- --- 1 I ii ~ r -i ~ I r_ f ~ - -- N__ _, 1 i t i l! i g ~, i ~ I I 1 ~k 1 I I 1 ~I >O l y I I o to X a "' 1 a l I A ~ _ , I~ i " N ~ I ~ .._~02~ . ^ . ~ l i n I 1 1 ~ ~ O 1-,. .._._ I 1 i I ,s I ,. , ~ _____-_N_-____, I i I -_-____..~ I 1 I SO ~ ~ I I ~ -~- I I. II N J g~0 i ~1 i ~ _: , I 1 I II~~ $ I ~ , , _ , N ;., a ~ , I ~ 1 -------a ~ i~ ... _.... ?~_es ..._ . _.. I 1 r I- I' I. 1 ~ 1 I- ~ azr . --~ 1 1._________J I I 1 , 1 . _.... -~-1I ~ ' I r-______ i I-~ .21i9r..~ I F 1 I 1 I N ' 1 I I. ~~ vNt.' I 1 I 1 8 I - I I~ w 1 I~f~Q~~ ~ ~~ N I ~ 1 1 ~ 1. N~ ~ I~ I II I I I J G~ r NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW G~GLC crtT/and Cgs 2~ u~~~ ~ '~ ~N~ ~o~ ~ '~ ~ ~ y ~4 = Soy. nom' i ~. ~o, z' !7 sw ~ ~ d~~ •~ i ~1.~ , . 900. s '~~- x.25' I I // ll RflT • V /v ~~ ~2~- y'~~~ l.~ ~lv 5~.~~ ~ ,L,,µ~ ~ - ~~i~iD ,.~jhL,. Wt6SG~P ~t~T~C ~irtNL~ i-~r~~t L.~-PhcrrY c~~f~~S ~ INDICATE NORTH ARROW /~I o ~c ~ c~ ~ Sow-rz~ P2~ p~r~r L..~B t~ Q 0 V' ~ksT P~o~~T+' ~.I ~ E ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner ~R~1E' ~o~ ~2~T~ Gt~i~r~5 i • G c . Address 73 `~ /-~u,.i-r-~75 ~i ?. /y'' City/State SOS a.V w ~ ,j'~ uol,G Legal Description: Lot ~ f Block -" Subdivision/CSM # ~~" ~~» ~~.Oa TR~f~ ~AQ k '/4 JV w '/4 /V ~ Sec. a ~ , Ta g N-R /q W, Town of ~ PIN # SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer G~i~ Ste? Size ST/PC/ S/ Setback from: House ~~ Well ~ P/L / 3' s Pump manufacturer - Model Alarm location -- (HOLDING TANKS ONLY) Setbacks: Service road _ Meter location Alarm location Vent to fresh air intake Water Line SOIL ABSORPTION SYSTEM: ~~i~T2~~ X3.75 ~s'~• ?S Type of system: ~ c~tx !~ Width 3 Length Number of Trenches ~~ Setback from: House SS, Well ~?~o' P/L ~1S~Vent to fresh air intake Gam' ELEVATIONS: Description of benchmark ~N ~ Description of alternate benchmark . ~~w Elevation v G .oa Elevation o , ~~' Building Sewer h'do •`jo ST/HT Inlet ~7c1- ~ ~ ST Outlet g ~ .~$' PC Inlet PC Bottom - ' Header/Manifold ~~t' /~. /~ ( Top of ST/PC Manhole Cover ~~ ~f O C~ o Distribution Lines ( ) ASS • /3 • () ( ) Bottom of System ( ) ~~ ~, ~ ~ ( ) ( ) Final Grade O %'a3. SAD ~~~~, O ( ) Date of installation //g/4/ Permit number .~ ~~ ~~ 3 State plan number lP ! l G 7 a Plumber's signature w~ License number ~ 2 4? ~~ Date /! / o 1/ ~ ~ ~ Complete plot plan ~ I c~ 3 m co < < m c. G O~ m ... 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