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HomeMy WebLinkAbout020-1357-18-000,~ , ST. CROIX COUNTY ZONING DEPARTMENT ~ ' ~ w AS BUII.,T SANTrARY REPORT Owner ~/f~~/~o?•E ~u5 4T'GI ~r~ Property Address 8y% (.y rt- L 0 2 o f~' ~? ~ ~Q~ City/State ~t,~)S o,~J c,~ , . ~y~ iG Legal Description: Lot /g Block _ Subdivision/CSM # EV~7PG ~t _ '/a ~ '/a, Sec. ~, T~,N-R/~1 W, Town of _ o,J Pnv # ~a ~ -~ 3$~ - ~ g - ~'~ SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer t'•J'iLSE~ Size ST/PC/~"'~ / Setback from: House `7' Well ~o ~ P/I, 35~ Pump manufacturer -- Model Alarm location ~- (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: ~'r ~ T~.t ~ ~~ Type of system:~R~~- ~ Width 3 Length ~~ ~`~ ~~ Number of Trenches ~ Setback from: House 33` Well 73' P2 ~ 7,~ Vent to fresh air intake ~/.? ELEVATIONS: Description of benchmark / ~ ~ !t o ~ P ~~ ''~ ~ ~ ~ ~ rt ~`~'`'~ Elevation / oo •~' Description of alternate benchmark ~,.~, s rl ~ oc? ~ vw e ~ ~~ v ~~ Elevation o ~ • ' Building Sewer / ~ ~ ~3 ~ ST/HT Inlet / y 3 • ~~ ~ ST Outlet ~ y 3 •yS ~ PC Inlet PC Bottom ~- Header/Manifold ~7• ~~ ~ Top of ST/PC Manhole Cover / ~ ~ - ~~ Distribution Lines (p') ~'9. r7a (B) 9~~ ~ ~ ~ ( ) Bottom of System (!~)°~ •'~~ ~ (~) ~ n~ ?$ ~ ( ) Final Grade O 'a3 . Sy Date of installation ! Y /O~ Permit number ~ ~~ ~ 2 ~ State plan number Plumber's signature G 'cense number ~~ ~~ ~~ Date /~~ ~ Inspector ~~~. Co~lete plot plan ~ nl ~STr¢ TF4 R 4 ' 4 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 ~dgrN 04u0~+r~i.c~s ~N~/ LT2 rtraP ' ~' O~W t ~u QC>? I ~-/GN __~ -- s3' X73' lv..x~PL~~i ~/.u/sH Ffe•~ ~ t~v.: l c7 /. ~ 96' X~Et.,1 ~~S~O~ntcE 3 ~AQoo-„s gM , 1 " 1 +P~~- ~i ~~ ~r ~~h/. I0o•Oo // a ~~i'r L,i.~ ~8. {~ /3 ~~ 1~9~~ ~N ~~~ 3Sr~~ ~.,v~ ~`~_ lbo6) w~~ .~b~ ~~« ~~ c p Sc r4'cL~ INDICATE NORTH ARROW ~~ ~,cPnc T~-K !nO-ce46 <7~ ~Pv c 5c+~ac~~,.c ~ _ -- a w1SO0"~" ° °f CO"~`~r`"e PRIVATE SEWAGE SYSTEM Safety and 8tll~algs Uivisktn INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal irNormation you provide maybe used for secondary purposes (Privacy Law. s.15.04 (1)(m)j. PUMP /SIPHON INFORMATION Permit H r s Name: ^ City ^ Vi lage ^Mown o usdigian, Theodore Hudson Township T BM E v.; Insp. BM E ev.: BM Description: r/ (7 ~',, TYPE MANUFACTURER CAPACITY Septic !~Q Q Dosln Aeration Holdi TANK 1NFUKMAIIVN TANK SETBACK INFORMATION TANK TO P / L WELL SLOG. vent to Airlntake ROAD Septic 3 i ~ ~ ~ .- NA Dosing NA Aeration N Ing urer Demand Model Number TDH Friction TDH Ft rcemain Length Dla. Dirt. To We SOIL. Ag.SORPTION SYSTEM i ~ / ~ ELEVATION DATA ounty: St. Croix Sanitary Permit No.: 384120 State Plan 10 No.: Parce Taz No.: 020-1357-18-000 STATION BS HI FS ELEV. Benchmark ~p (~ l~ Alt. BM 2 , Bldg. Sewer ~ , / Ht Inlet St Ht Outlet , j 0 , Header/ Man. ~ Dist. Pipe ~~ !bo , ` 1Dl704 , a eot. System ~~ ~ ~ L ' T Final Grade •/G 103, 5 St cover '~ , 5 Z i BED / ENC Width , Len tfi No. Of Trenches a ryplT No.Of Pits Iraide Dia. Liquid Depth b ~~~ ~- I E I N SYSTEM TO P / L BLDG WELL LAKE /STREAM L IN Man dui r: SETBACK ~ INFORMATION Type ~ / O H ER e Num r: s` System: J Z 3 ~ nISTRIRI ITION SYSTEM Header / Mani old Distribution Pipe(s) x Hole Size x Hole Spacing o Air Intake T Vent ~ length ~ / Oia. ~ I Length ~Dia. ~_ Spacing __~' _ ( ~(.~ ~ ~ /~ I ~ / 7 Z~ SOIL COVER x Pressure Systems 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 ^ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: Y /~/d/ Inspection #2: / / Location: 849 Waldroff Farm Rd., Hudson, WI 54016 (NW 1/4 SW 1/4 23 T29N R19W) - 2329192092 Evergreen Estates II -Lot 18 ,~- I 1.) Alt BM Description = ~~ DLtI ~S~F Trt+~-0l~ior~ 2.) Bldg sewer length = f Z' -amount of cover = 7 3 '' ~~ ~~-- ~ r`~ Plan ~~'visl~req"tlirBd? ~Q Yes ~ No Use other side for additional information. b ~ Oat Inspect 's Si ature Cert. No. S80-6710 (R.3/9~ ~ 8 .I~~~FF ~, Sanitary Permit Application Safety & Buildings Division ~ In accord with Comm 83.21, N'is. Adm. Code 201 W. Washington Ave. ~ rr `~ See reverse side for instructions for completing this application PO Box 7302 S`~R~~n Personal information you provide may be used for secondan• purposes Madison. W[ 53707-730.^ Department of Commerce [Privacy Law, s. I5.04(])(m)j (Submit completed form to county if r• state ovine: Attach com lete tans (to the county co ~ only) for the svsterrt, on ~a er not less than 8-1/2 x 1 I inches in size. County ~~ / x ~ State Sanit ry Pe~ t Number O Check if revision to previous`application State Plan 1. D. Number ~ I. A lication Information -Please Print all Information t .- Location: Property Owner Name Property Location „. ~r I/ I/4, S T ,N, E or Property Owner's Mailing Address - Lot Number Block Number City, State Zip Code Phone Number- Subdivision Name or CS~4 Number II Type of Building: (check one) ~ CitY ® 1 or 2 Family Dwelling - No. of Bedrooms:~ D Village _ ^ Public/Commercial (describe use): ®Town of ^ State-owned III Type of Perr.^.it: (Check only one bex on line A. Check box on line B if applicable) Nearest Road _ p) I. ®New System 2. ^ Replacement 3. ^ Replacement of 4. ^ Addition to Parcel Tax Number(s) S stem Tank Onl Existin S siem v~p - - $) ^ A Sanita Permit was reviousl issued Permit Number Date Issued ~j . ~~ . l g . oZ D IV. Type of POWT System: (Check all that apply) ® Non-pressurized In-ground . ~ Mound ^ Sand F!Iter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank ^ Single Pass ^ Drip Line ^ At-grade ^ Aerobic Treatment Unit O Recirculating ^ Other: -~ / - Dis ersaUTreatment Area In ormation: 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. stem Elevation \ ~ 7. Final Grade Required Proposed Rate (Gals.ldaylsq. R.) (Min.finch) ~ ~. ~$" ~~owe/) Elevation .~7S,P .F7 3~7 ~ . FT• /•o`Z p / 90a ~s V / ~~.~ S4 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 ~ ^ O ^ ^ ^ ^ ^ ^ D VII Responsibility Statement I, the undersi .ed, assume res onsibili fcr installation of the POWTS shown on the attached !ans. Plumber's Name (print) Plumber's Signature (no stamps): / M PRS No. f~4P r be Business Phone Num /t ~/~ gq e ~ n o[oC. /~ oo ~~ - d0- Plumb s Address (Street, City, State, Zip Code) r - T s' VIII County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued nt Signature (No stamps) Issut Approved ^ Owner Given Initial Adverse Surc~rg ee~ e F .~ ~ Determination a ~ a 2 ,~ 6 / IX. Conditions of Appro~v~a~,l/,/,Reasons for Disapp val: ~ ~~~ ~,~~- ~.. (,d, ~. Q3Z_ o' a,o ~ ~ .~.,,~,~, n ~,-P, .,~,~.~ •~ (~Ie~ I~._ c~atad~ ~µA~w,~a,~,QQ a,, ~,,. ~a+~u.c~.u~s treco+~t ~w~~~~ ~ SBD-6398 (R. 07/00) l ' ~ . ~ SNfTLT/L9T[1R ..Q'.O.EI'~¢NOE2 /~ISG.4 C.Q.~AC.zTr Ci,N.vr»,os~t.s . ~-tiw~ 1 ~(~- OVE/t ?Uti~ T:a HrsY ~-~ t /~ienP2/2TY LINE f ~ OVN/L S'U~Tu ~{!/reL. ~yyyyi, Fnnp/t /lc7E./7Y J.J •1T' /J p /~t` '! /'O/Y~ 1 /3 ' Q CJ f , I -- ys 6~. ~ ~/ .7RUN /Q1'P.E ~~~ SigpN /=Y.E . ~P~.Y d ' ,r Fi+v,~,Firrr Cv~c. ~T .~:E ~iu„~~icTy PLOY it CF10ii iECT10N PLJ1tdi ~G.ev. = 99.70' Cv/i,.ELEV. =/oo.vo" L1PPA 8800. EXG-YATWrf!# INC ~.ulrlelrw uMIT ... /obi ,~ 0~_6 69,ru~,°t ~~ ~- Jo ~--- 68.~s=--~ ~ Q /~posEG ~~N~ R~u~ /'~ o Bo ~_ 3v. ~~ ~~ /A°P°sGO tree ~ I ~~ 60 '~ win ~~o~E~ L>~r Jt~~H,py PFiO~JECT E.ur Po~«rr L7~vE `J~ ~iflYC J'a2 TS E~FLuc-:,rr LzN~ /oou G.Ac ..(`£vr.~G 7NAC hcirv /9/~Do 2iol~cL /rstTE2 i N~ l~/rvtt~?oF'r F.ov~ /zo/ ~tzcirr of b~.Ay W ~~~ E .~l3ELlitown 5'Sc~-G'°'d =/-2 .f~v~ ~ ~v/7G~L L?,SFf'~'= /7/Y = ~/•.~~ o,a a°la~ GvAi-~~(-6,0.c ~~ ~e _'__'/ l}tQf-r111CQ V~Ss..IVJ~IeLy r~i~t~e -i--=-- - F.v,sN fo.ga~E - ~ ~ ~r< s~/N yo PPE M~lKt Mu^1 ~~N . ~ltsova L.~~,,~,sc~t ?c ~i N i 5 H GQhQE d _~ f 4 ~sK !~~ T slDFc-.-l.~/QctQ f-ftGN ~APA[ITti ` ; 8011 TE611t~iq 8Y: ....... v`b2d 9S9 Side View ~ Ft~~(A•Tto.J ~E~l<H ,veTf'on TtQ so,c TEST End View 8101~Q: ,. . ucEtrse• ~~'~ ? DATE: a~/vs/oi , 15° 34. .I MO~E4 r ' 3 SNfSLT/~ATU/Z~ ~O.EbKZNQE2 ~iC1'GN C~.ovcirv CN.vnxa~2S ~~ . ~-i,~wt ~~ D/E~i ?UD~Tu HCST -~ ~ /SituPt/2TY Lz na,E Fv/L /ZcTE.U73 o.J ~ I /~uivA J'J r =/ 7Row BsPL- A /Q/iUFFit`tY Ca/C. .EYE"v. = 99. ~v' /aG~ ~ d 69 JYu~E ~L~- 9 Q " Q' 1 ~ ~--- 68.96=-~. ~ / ys 6~• ~T ,~.~ .°~,°f~Ty Poor ak cAOSS sacr~oN Pwrt C....~n.,E'LcY =/oo.vo' ~A BIi00. EXG1V/1T11~i INc PWMB1Nri uMT ... PIiO~1~CT ~~T //Zv/~ERtY Lxivt 1{~ '/4YG .r.0~1 ~S EFFLTiasvT ~zvE JUO GN L .TFO9.,~C. TNK r..~z9-N /~/~00 ~i~I~GL /~LTE/L Y/~/~l~ .I~[NFL v/U .QL06.fr`hiER I up°Sko/^ ~~~ NG ~~~~ /~ ~V~f1'7 /RUFE/1%Y LLvY pSrU ~~`~ 1 60 , P~~2P~Wpf !~'~~ / ~E-- .dv~ l ', ,~ .. ~ . N/ In//~LD/(OFF FAivn /~ /ZZGNT vF LvAf" w ~~~ E. - ~.CfELYtvo.~, 5'scx-G.~•v=~.2.Oo~_<..7U/'.G/L= ,.~ G~.B Y~F~ ~~ ~~~e --. oas~r~~~~,J~,.P~~~ ~~~E~~~p c~85~i vA~i~v ~~~ /1'tkj(~~rlaivl /.Z~ f~oJF ~~u~sH ~Q14Acr FN,sH ~~~~E 1 ~ ~ ~ ~" ~<~ SAN yo RPM To f/ N ! 5 H ~Qh~JE Side View SIONEQi - : -~~ ._._ ,. uceNSe• ~~~,7 o~Te• a~e~s/o~ ` ,say/TEeTu~gev: .1791 L~L'~Y~. OiYNr~"~.~ ~ ~ - . ....... - ~ 2 ~s9 ~l.E ~A'r/on) T Ei.l < H I-~a 7i'o~.~ rE4 Sc ~ L TEST End View 15° 7s~ _ I ca ~ iUF t,..- i .~l Oc:R N ~G H G., ~}PA [ (T~ 34' - ~ /hv ;QE t. .. Wisconsin Department of Commerce SOIL AND SITE EVALUATION ~ 3 ~ivision of Safety and Buildings Page of Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code ~~..~_ . - Attach complete site plan on paper not less than 8 1/2 x 11 inches in ~dc,'~P~rf must Coun include, but not limited to: vertical and horizontal reference point (; direction ar~,, - \` ~? ~~ ~~ percent slope, scale or dimensions, north arrow, and location and,tiis~~D(ce to ~~ee~~ss t~p~. ~:' Peicel LD. # _. >> ~~L1=~ si C v~ ~ r .f APPLICANT INFORMATION -Please print all inf rpa~t~oh r i ~~:: n~~~ R v'' wed by Date Personal information you provide may be used for secondary purposes (PriNiae~r-' _Law, s. 15.Q~4-I(1~X 2 ~ p (o ~O 1 Prope~j, Owner l ~ r-~ -`"maw lion"~.~'~' Q p !"1 r.. )>``~ /~ 11)~ ~~ nl~ ~ C.3 ~~:~',.?•~. Z ion of ~ ~~'', 1/4 ~1~1/4,S Z~ T Z ! ,N,R ~ / E (or) W Property Owner's Mailing Address ~ ~, •-~~ ~o k Subd. Name or CSM# ~Zw~cu ~ '~~ ~~l~~QG ~~~~ i~ST ~ S City State Zip Code Phone Number ^ City Village ~ Town Nearest Road pp .TrJ~..,vv~.e. I /~?..~.I I~6s/ >f%.76-69/6 ~U~~ IWAc.I~Qo~~~~t-11~ New Construction Use: Residential /Number of bedrooms ~ Addition to existiny building ^ Replacement Public or commercial -Describe: Code derived daily flow Xs. O gpd Recommended design loading rate ~ ~~ bed, gpd/ft2~trench, gpd/ft2 Absorption area required bed, ft2 3~ trench, ft2 Maximum design loading rate ~.~ bed, gpolft2~trench, gpdfft2 Recommended infiltration surface elevation(s)li~ ~ ~~ ~ ft (as referred to site plan benchmark) Additional design/site considerations Parent material ~ ~-bC~AL OU7L•~AS-1' Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ~ S ^ U ~ S ^ U ~ S ^ U ~ S ^ U ^ S ~ U ^ S ~ U SOIL DESCRIPTION REPORT ~ 5w Boring # Ground I v. ~~ft. Depth to limiting factor } 12 in. Boring # 7 Ground 10~~9 ft. Depth to limiting factor ~ //~ in. Horizon Depth Dominant Color Mottles T t Structure istence C n Bounda Roots GPD/ft2 in. Muns ell Qu. Sz. Cont. Color ure ex Gr. Sz. Sh. o s ry Bed ,Trench ) J b 4 - S,~ ~ sbK ~ ~' GS - .~~~ .3 S ~~ ~' Q ___. ~ ~ i?~1'1 ~ C ~ ,7 '~ -~ y 4 ~ ~- ,~~ 1 -- .~ ; Remarks: 6, t3-3d Y~ 4 3 -- S ~ ~ n~ Sbk rr, r c.~-.~ 1 ~ 7 d- - S 4 ~vi5 rn c. ~•-~ 0- / Y~24 3 ~--~ SG !~5 ,m ,~ b, --- - -1- 98~ x.-3.0 loa~ $ , Remarks: :STN me (Please P int) n ure Telephone No. ~A~~~v JOUNSb~ ~s~ 40~b 4 ess D e CST Number d $~ ! u~a> ~~a~ 3 Z Z~ Z2Z7S 7 PROPERTY OWNER A~~`A,vn~.~ ~~~ SOIL DESCRIPTION REPORT PARCEL I.D.# Boring # Ground elev ia~.~ ft. Depth to limiting fac~or Ill in. Boring # 9 Ground elev. /~~ ft. Depth to limiting fact r 7~~ in. Boring # /~i Ground ~~ft. ~+r ~ i ' Page. of Horizon Depth Dominant Color Mottles Textur Structure Consist nce Bounda Roots 2 in. Munsell Qu. Sz. Cont. Color e Gr. Sz. Sh. e ry Bed ,Trench /~ f-1 -I Z /by~ 3 ~ ~ L f M Sb~: n, r' ~ w N'1 0,~ 5~ JL.(~ ~ t/~~ 4 -' SAC. 1 ,~r~sb~ i-., r Gw I ,Z ; ,3 1q-~ 7,SY~2 4 4 - SG rh ~ rn ~ ~^' -- ~ o.~S ~ ~-~ >dv2 4 -- ~ rns -~ - ~ o ~6 `~°'(o Remarks: a 12 ~ - ~- ~ b~ r ~w ,4 ' ,~ ~av~2 4- 4 - s~L ,~, sb~ r}, r L~ 1 ,z ~0.3 (~ -~ x-124 4 _ 5- s~ ' mSbK ,'', r Cw ~' ,Z 'd .3 8s (Z ~ S~ S ~ .. Q.7 ;®.Ts ,~- 9ip• iS S 2.2 ~ . L. Remarks: Horizon Depth Dominant Color Mottles T t Structure n C i t B d R t GPD/tt2 in. Munsell Qu. Sz. Cont. Color ex ure Gr. Sz. Sh. o ence s s oun ary oo s Bed ~ Trench -t( /bye .--- L 1 ~ s K yr, r Cw I ~ SJ -3~ dYi2 -' ~' L /n-SbK )'I~ r Gw -' 0.2 ~0.3 C 1 ,Sx,Q 4 ~ SC rn5 im I eS _ D~7 'a Depth to limiting factor ~ !2~ in. Boring # Ground elev. ft. Depth to 1~ limiting factor Remarks: -'n' Remarks: SBD-8330 (R.9/98) _.-- = M1 W r g ?1 , L ~~- _, ^~ ; o ,-T{ j o~ ~' ~ (T 1 L' .~ ~" ~~ ,.r ~ '1 r-q ~ \j ~ V~ ~ I' IN ~ ~.-- ~ 1~ ~ J i r L ~~~~ I ~ A ' ~~., ,'n ICJ .~, `~ R ~~ ~' v~ i ~ ~'" `- --{ r~ Syr ~ `/ ~` c: . ~I ~ ~ ~ - O'er ~ _~ l; ,:~~. ~ ~ O Vin, I i ~.~ ' ~ ~ {; ,. ~ ( ' ~-. -L /~(~ -` i ~rl. -r 4 4; ~ ~ ~ , n._ ----- ~ orj I ~~ /~h ~ ,~~ ~ ; r ~ -~v,1_ --- __ Irv _ _ __ O _\ ~ V ~. Y ~ ~ I R. ,. ., , ~ fTl ~ r L m _ ~.I ` ~ ~ f - V l ~` ' ~~ ~ ' ~ti~ ~- ~ i ' 'w 6 ~ gt ~ ~ ~ ~ \ , x , .~ ~ ~ _ --- z= ~ ~' -I 'r~ ~ ~ I L ~ ~ r o `Q ~ ' ` ~ i ~ ;r r~ ' I ~ i 1 I ~ r ~ ti 1 ~ ~ / 1 aq -G (~ { f~l ~ i iy, I ~ / 1 0 J ,, ~ "~ ~ .- C - - -' ti~ ----- zl ~~ ~ ~ ~ ~ i` , ~. ~ ~ . - t _ ~ ~~ r- err _ ~~• a r ti r ~ ~ o'o ~ ~. ` a -° . ..... .T~ ~-- ~ ~_ . -~ .. 'Q ~~ w i 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 $ IZc~ Number of Bedrooms 3 Design Flow -Peak (gpd) S"~ Estimated Flow -Average (gpd) tJ~ Septic Tank Capacity (gal) tsut~ Soil Absorption Component Size (ft2} $- z ~ Type of Wastewater D mestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component .Soil Absor tion Component Design Flow -Peak (gpd) t5t.70 Z - as r~s Maximum Influent Particle Size (in) 118 Maximum BODS (mg/L) 220 Maximum TSS (mg/L) 150 ~~ 1 ~2y 0 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 t' and outlet filter shall be assessed at least once every 3 years by inspection. Th outlet f r shall be cleaned as necessary to ensure proper operation. The filter cartridge shou d not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the :~ Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance wifh 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 the tank may be 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 feast 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 . ST CRQIX CUUN'x'Y SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Ow:- ~er/Buy ty tom: i~ Aa.,~: s 129v ~/~r~ l/ ~ic ~, S~•f~ f /wad ; ~I~I,N .S`s-o BZ (Verifecation required from Planuia:g lhpartrrtent for new construcuon)~ - Cit}~ State :~~DV~ I.t// Parcel Identification Number .DaD --/3S7-f moo LEA: -AY. Dlr:;~~c~ 1T0:~ • Prat: qty I.~:xrc;..~on /VW s/,, Sot/ s/,, Sec. 23 . T~N-Yt~W, Town a£ a Sub c !~i~yisio i E~/~ r Yc eta ~s';-u~-~ s ~ Lot # ~_- . ~~ Cer:;ltled ~,;us~~~.ey Map #,~ . Vohune .Page # War~t~tty~l?ksl::d # ~.,~(, U~,9 .Volume /S,/ .Page # 7/ Spo: ~ house C wl ,yes ~nc Lot Tines identifiable ~1 yes ^ no ~krEM ,~1t~:~~I~ivAt°dCE lmpi~a>~ ~i ~ r,~se sad maxateaaace of yom septic system could t~esnlt in its prematsue failure to handle wastes. Proper m~SncC consi:~ of p~~stiFi;:,sg out the septic tatilc every three yeas or soon, if needed by s licensed pumper. What'you. put:inoo: t'rre`:trystetn ean:i~cet the ;f tn:~:tina of the septic tank as a treatment stage in the waste disposal systeas. 3~e ~ Pi ~7: eaty ovv~r. sgiees to submit to St. Croix ?.oniug Deparimeat a cettf' tcatioa fawn„ signed by the .o'.~ea.° 'an,d by. a magic rplumb~:r .j~ tmoeymaug;mnber restrietedplumber or a licensedpumpervaifying that (1) the on-site ~vastewat'erdispo:~t;system is in'.~rogp[ O`?e Ca ;ing COnd1t1C'•Q andlOT (x) after iasperfion and pumping (if IICCe65ary), the septa tank is less than L!3 £oll ~r~`~sl~ge. IJwe : ~~e un~~ .i;~~iouedhave ra=.d the above tegaicea~ents and agtx to maintain the private sewage disposal sysban v~ritjL tbr~.::;~aadards set fS;tti, herE:u+,; o~s set by the :Dtpartihent of Commerce and~thC Department of Natural Resources, State of Wlscodsin. GFrt.~iCatioa statist ;that yrab • t:;;ptie system 'bas been maintained must be compieeed and ieturmsd to the St_ Croix County 7•onia~ Qffitc~?i4Yt6in 30 days. ef.the t~rec: ;dear expitati:om date. ~7 SIGN ,AT[JRl~ ~ (~f~ .APPi,ICAP DATE I {wl~), c:~:~.:tify that aU statements on this foam are true to the best of my (our) knowledge. I (we) am (are) ffie a~zz_:es(s) of the k~ operty tle::~.l ibed above, byyirdss of a warranty deed recorded in Register of Deeds Office. ~ oL l / ~ I(3I~'!4TUR~ (bl? .APPI:IC DATE ' *""' `_~'; Aay; it} Ec~ :rrtation that is mis-represented may result in the sanitary permit being revoked by the Zoning Depacirnej~i. «ss.:: •' I>> .Inds w~itip i.Gls appiica'!:ion: 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 -; 60 39~d tid9t' LS LS ~St 666L/9Z/L0 • + " ' STATE BAR OF-WISCONSIN PQRM 2 - 1998 WnRI~AN"1'Y UIiGU urxn~~~enlydun~uFl~ Y0L 1571P~~~ ~~ 'Phis I.)cecE, rr,adebctwern --Kennon J. Bast and Donalda _~ _ .S{zeer-Bast_ ---._ .. _ - .....__- __ __._ .. _. Grantor. -., +nnl TheOdpze O., OUSdig7.di1. , a married person _ ~ _ --._._. ......_... ...._ - _ Grantee. Crai don, lul a ~~alunble cunslderallun, conveys and warrants to Gr:ndr:c the (bllowiug described rt~af esi,tr In ._ ~__CT'O1X __-„__. County, State of Wisconsin: Lot 1 tat of Evergreen Estates II, Town Hudson, St. Croix County, Wisconsin 66029 Y~RTNLEEM H. WRLSH kEGISTER OF DEEDS ST. CkDIX CD., WI RECEIVED F(Dt RECORD 12-23-2000 10:00 AM NARRANTY DEED E%EMPT N CERT CDPY FEE: COPY FEE: TRANSFER FEE: 179.70 RECORDING FEE: 10.00 PAGES: 1 '. F{„~.r.-..~di~.lll lu e~ Name and HBIUrn Atldress Fay /~ Va,1(~,:..` 13a..µ_ k i.. 020-1357-iR-000 ;i Parcel Idenal¢alton Number (PIN( This 15 nOt homestead property. ((s) (is not) ,, ~~ Dated ur;< _-.-.22th-_ day ~f ~~cemhe~_ -- ) ___ _ -- -- ,- - ----- (SEAL ? QQD-_.. i; i(l r9 ,c-...c e4.r_ ', ,, ~;~•=L,--~Q~r ._._ (srAL) $.ern~c n.-J._-,Bast_____- --- • Donalda J. Speer-Bast I' - ii (SEAL) AU7'IIEN'-'ICATION Slgnalwr(s) . _ --- ~-~ ~ ---- . authentiurlc<7 this __,,. -___ clay u(-__....~-, __ ACKNOWLEDGMENT (SEAL) State of Wlsconsitt, l ss. ~__ Saint C'roi x County JJ11 Personally came before me this 2 7th day of _, DecEamttc r .___, 2000 ,the above named _ _.Kernon~__B~ and Donalda J. ' .peer- ast Tll'LE: AILiMBER .i I'A'I li BAR OP WISCONSIN ___. __ -__ to ({( not, .-.--___...-_________._. the known to be the person S who executed the foregoing authul ized by §iUfi.OG, Wis. Slats.) Instrument and acknowledge Lire same. fH1S INSTRUMLNI' WnS DRAFTEll BY _ ;~: __.. _ Kernon_ J....~ast~---------.. --- -~-- i Notary Public. State o~'Jisconsin My commission is permanent. (E( not. state expiration dale ~ (SiHnahuc. m.ry Im urUtcnticated or acknowledged. Both arc not _______ G~J ° i IQ~`-• _^) nccessnr.y) iiVotary Pubtic •N.r~„•..m p~~ „~~. nr;~a~y; t. .~~~~•rap~u~uv uov r,r iyp•.r..r p,en«I tH~io.. m~rr rlF O+~~n c. Stag OE WI$con$i17 tt'n1IRAFlI'Y i~l!1!U Sl'A'tE EiAH UP Nl~ol~7iJara J. Burk® Wiscauin Legal Bl;vik Co.. loc. FORM Nn. 2 -9~79'A~'~ ~;~,,.,.,ro.. w» Exuoplions Ir, warranties: /D .7.s 7 3i ..3? ~r.~-'~i.3i 3~ ~~ ~i '~ .~ t3 .~ 1., A,~.+ 3 .i , ~3. / /~ // .~•/. IN PA}iT ?~~' TSB 1N~f//4 OF T~IB S~f/4 AND i1V P.L~T OF T:Y_3 S7f/4 ~F TNT N71/~ Q ON 23, TxB,~T, JRf~^~, ?`03'~N OF ~UDSfle$, ST. CRflI~ COUNTY, rFISCfl~K~'IN; SSINC L13T 2 // ~Z"'" ,` ~I:~J SU:tI~'Y 1~P Ra~'COt4D~'D IN YDLU~YE f3, P.~GF 353 AT T~~' S?: CRflIX COU'~TY / ~/ / OF DBR3S' OF4PICF. PREPARED FOR: // ~./, // Lt)CATION SIfETCN KERNCN J. BAST / ~' // DONALDA J. SPEE,R-BAST SECTION 23 / ~.' 948 LABARGE RD. HUDSON, SN 54016 :ARLES ARE i0 dE ?UCED SUCH tHAT n+E iNSTAiLA nON w0UL0 STAwE, OR C;.~'.`n:CT syON u_CNG ANY lOT VNE OR STREET UNE. A SURvEY SisKE tlY ANYONE .S A 'AOIA nON Oi' SEC npa 2]6.34 E5. UIIU TY EASEVEN TS AS -'ERE'N SE7 :CF TN AaE FOR 177E USE CF R'VAiE PU%JC UT~:+ DES HANNG THE aIGNi TO SER~.E rNE AREA. vN TIIS LAP (PLA T1 I$ A,8.EC1 TO STATE, COUN ~Y, ANO TONNSNIP 01lAilONS (~.E., AE ILANOS, VRaNI'V LOT SZE. ACCESS TO PARCEL, ETC. j, M OF4ELW~NG ANY PARCEL Of UANO CONTACT *HE ST. CAgX CCUN TY ]PRC]aiA~ TOW4 90ARp c~ AONCE. EVERGREEN ESTATES i LOT i6 I -------- I <589~48'34'E) 589'461'06"E 890.' 3.8c' _-_ 824.77' 18 2.532 ACRES 110,293 SQ, FT. rt~i T29N, Rf91I LoT _f_4 ~! M'!a t CO / Q' ' / / 'c .' / T ,~ ., DOUGLIS J. d / / / / ~ , * ~ r4s 7t / ~ ' / '' / !' NUS // ~.: / / Q : / / / / ~/: / P ~ / ~ / ~'/t/qY / ~ / 8..4..L s/shy / / 400.95' ~ ~~ NORTH LINE OF THE NVI/4 pi THE SVt/4 ~ 3' U'1( 17 ~ "'' of ~( 2504 ACRES 109,079 ACRES I, 3 ~ /~'1 ~, , -. 1 a ~ 1 ~ jSO ~ ~ ~, i ~• ~ , r ' ' ~~ ~ / , ~, .., .. ... , ~ , so. I ... ........ ~ ..... /-~ / ~\`/'~~,Tj' . •\,, 143.x2 / / Q // / - TIT' -`87-o-6'Z,;_E__ __ _- ~ SO' 1 ' f r m• ~i1„: 66 ~: ~I `~ ~. ~ ~ `~ / ~ 143,42' ~ / / ' / / ~~ /' ..i .. .............. . ... / ~ ~ / O ~ ~ / / .~' ( / ~ 1 ~ / ~~ /' ~ z~Z ~~ SA' PO.~'3.vTS '~ ~~ .. ~ .- 2.500 ACRES , ( ~ ' ~ ~° z 1 ~ 108,906 SD. Fr, \ ~ •:~` ` (~L o ~' ~~ oa• ~ ~ 2.504 ACRES w :Q~ \ o 7`~ ~ ~t ~ o 109,054 SQ. FT. NL _ ~ ~ : 0 ~1 ° C t o ~ a, 6 'w 13?7.53' PLATTE) LANDS ~ ~ ~ RADIUS } ?PINT I /~ l R` 80' I l TEMPpRARY CUI.-DE-SAC EASEMENT ~ n is N / Tp HE REMpvED UPON u'N ~' m / / EXTENSIpN pF ROAD i° ~~ 609.20' 387.82' 221.38' t<yLRVE CATA NUMBER LUT NUMBER RADIUS CENTRAL ANGLE CHGRD BEARING CNL8t0 LENGTH Q 167.00' 92.39'43" 546.33'43.3"V ~ 211.68' ® 233.80' 92.54.28" 546.25'23"v 337.77 t7 273.00' 21V9'?6" 582'18'34"V 83.33' 18 233.00' 379d'48" S32'44'47"V 17464' 19 23300' 33.46'14" 516'57'16"V 13').33' / / ~ ~ ~ / r I i I ( I I 1 ~S 1 j S 6• T~9 ~ I ~9. ~ i . SS6~ j& F 6600' 40)16-. s?1 -+- ~ ---- ~ --~J---- ( QI~ 33' ~ 33' o _ ^i"' 12 4' +/- ' . ~ ZI I ~ , ~ i ~3 r` W cU ftl o (U o o t,~ °o `~ 5 fA ~ a b l u 4~ ~~ O~ j' 8. a' +/- ARC LENGTN TANGENTS 270.08' 500.1]'34^v N87.06.23'w 37782' N87.06'23"V S00'JO'SP'E 86.04' N8TC623"V S7l'4+'ll"V 134.43' S71'44•it'•v $33'43'23'•v 177.73' 533'45'23"V 500.00^.i"E ~ x,~clsr~n~s ozTrtca JI', CAOLY ~Q 9/q 7''t !i~ e~i~a! fa R.wd d '- t V~S ~o~C 3l 'L~~~g10 ~~jj NW CORNER SECTION 2J • .. . ® ALUNINUw CCUN 1~ iEOnON C(MNER wO.vuwENr :ounD IIO C.ITB'n ~ I' IRON PIPE FOUND p Or ,S yj~C'~ O 7' :( 30' IRON PIPE SET {i(',HING 0,~ CB'RT 1.85 LHS. PEP uNE AR FCOi n y~G, j~~~,. NOTE: ALL OTHER lOt rCpNE~7S wONUwEN TED WM I' z 2A' IRON P'PE NEIGHING I.IJ U35. PER uNEM FOOT ' ~ ~ ~ ~ ~ RDAOWAT SETH 4Ct( LINE (A$ SMOwN) t2. ,NOE UnUTY EASENENi UTILITY EASENEM 7$ NO POLE CR BURIEC ~ ^ DISTUKH ANY SURh ~+ ~ . THE OI~n;RHANCE ~ -'"""` ~'~ PROPOSED ORI~£ CF 'MSCCN54 STA fI ~ ~! ~ - vUHUC BODIES ANO ~ _ ~ ~ "' K~ '~ ~ STORw WA IER 4ETEN90N AREA EACH PARCEL SHOW lA wS RULES AND P '~ ~ • ~ ~ NIGH wA 1ER LINE ELfvA nDN , 9EFCRE PURCHAyN( ~ W ~ ~ ZONING OFFICE ANO I ~.+ W NO1E A GRADING 'HAT wWLO AI TER THE CAPAG TT ;iT -+~ W CF ME STDRw wA TER RETEN n(IN AAEA ~ IS PRg1181TED ~ A $z I r< '. ~ ~ ~ NOTE B ~ BUI(DINGS ARE PROHIBITED WITHIN n1E STORM wA TER AETENnaN nREA z y °~ ~ ~ PRE~AOUSLY AEG~DED OATH 1 a ~ ~ Ex15nNC FENCEUNE 1 L0~' 9 ~ • l C._S .M_.__ IN 1 1 I o $ ' N _ V: PG. 1fL _ 3234 1 ., _ _ 1 589'A8'O6"E 397_85_ I /~ 4i ( ° - I c.s. o LOT 1 CERTIFIED _SURVEY_ MAP VOL. >3, FIG. 3536 ----------------------- N85'20'00'^E 390,16' H I ~ V ~ ~ M.W.I. ~ 42x.30 w q ~ W ~I ' .q I L-- -------~ ------- 33.00' 3 LOT 1 I C. S_A!_. IN I iv C0 z cu, rno.~co 20 2.910 ACRES 126,776 SQ. FT. SCAtE w FEET T' 60' ~~ 1.9- 2.389 ACRES t0a,tl66 SQ. FT. VMtisconsin Department of Industry, • labor and Human Relations ~ Division of Safetv & Buildings SOIL AND SITE EVALUATION REPORT _..~ ...:ate ii i in nn nc ~11I:.. A..I r.. n....l.. Page 1 of 3 ~„ ~.,.,,,,....,.,, ," „ . ~.,.., .,... , ..........,..., COUNTY but Plan must include lan on a er not less than 8 1/2 x 11 inches in size Attach com lete site St. Croix , p p . p p not limited to vertical and horizontal reference point Ire~tirna.~nd % of slope, scale or PARCEL I.D. # n ~sti rbald,\ dimensioned, north arrow, and location and dist ~s~ 020-1020-90 r APPLICANT INFORMATION-PLEASE ~ AL IN~RMAT14, REVIEWED BY DATE PROPERTY OWNER: ~~.,/ • OPERTY LOCATION 'i Kernon J. Bast '-1` ,/~(f GbVT. LoT ~ v4 ~ va,S 23 T 2g ,N,R lg F (or) W PROPERTY OWNER':S MAILING ADDRESS c 7~' ST - ~09 ': ~ L T # BLOCK # SUBD. NAME OR CSM # 948 LaBAr e Rd. ~'X 8 na Ever reen Estates II HEI~i '. CITY, STATE ZIP COD ~ CITY ^VtLLAGE 1fcJfOWN NEAREST ROAD ~ Hudson, WI. 54016 S' •~1$ X75-''~•.., •' Hudson Waldroff i:~tt. Rd ,,., ~ ] New Construction Use [x] Residential / Nu o tl<ob 4 [ ]Addition to existing building j ]Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd/ft2 •8 trench, gpd/ft2 Absorption area required 858 bed, ft2 750 trench, ft2 Maximum design loading rate . 7 bed, gpd/ft2 •8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 99.00 ft (as referred to site plan benchmark) Additional design /site considerations trenches spaced to code 3.50' below grade Parent material pitted outwash plain Flood plain elevation, if applicable na ft S =Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U =Unsuitable for s stem ®S ^ U ®S ^ U ~E7 S ^ U ^ S ®U [~ S ^ U ^ S ~l U SOIL DESCRIPTION REPORT Boring # :::. Ground elev. lOn _ ~ ft. Depth to limiting factor + '~ Boring # ... .::..........::: 2 Ground elev. 100.2 ft. Depth to limiting factor +84" Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed Treridt 1 -12 10yr3/3 none 1 2msbk mfr gw 2f .5 ( .6 2 12-33 lOry4/4 none sil 2msbk mfr gw 2f .5 .6 3 33-84 7.5yr4/4 none cos Osg ml na na .7 .8 Remarks: 1 0-15 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 2 15-38 10yr4/4 none sil 2msbk mfr gw if .5 .6 3 38-84 7.5yr4/4 none cos Osg ml na na .7 .8 1 Remarks: CST Name:--Please Print G L. Steel Phone: 715-246-6200 Address: 1554 200 ve. New Ric and WI 54017 Signature: ~ ^~/ ~ Date: 6-17-99 CST Number: m02298 PROPERTY OWNER Kernon Bast SOIL DESCRIPTION REPORT ~ Page? of3 ~ PARCEL I.D. # 020-1020-90 Boring # ~€ 3 Ground elev. 101.7 ft. Depth to limiting factor +84" Boring # 4 Ground elev. 102.8 ft. Depth to limiting factor ~~ Boring # 5 Ground elev. 102.5ft. Depth to limiting factor +84" Boring # .................. 4ii Ground elev. ft. Depth to limiting factor Horizon Depth Dominant Color Mottles Texture Structure Consistence Bax>dary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-14 10yr3/3 none 1 2msbk mfr gw 2c .5 .6 2 14-29 10yr4/4 none sil 2msbk mfr gw 2m .5 .6 3 29-39 7.5yr4/4 c2d 7.5yr5/6 sil 2msbk mfr gw 2f .5 .6 4 39-84 7.5yr4/4 none cos Osg ml na na .7 ; .8 Remarks: 1 0-10 10yr3/3 none 1 2msbk mfr cs 2c .5 .6 2 10-23 10yr5/4 none sil 2msbk mfr gw 2m .5 .6 3 23-30 10yr5/4 2d 7.5yr5/6 sil 2msbk mfr gw 2f .5 .6 4 30-84 7.5yr4/6 none cos sOg mvfr na na .7 .8 Remarks: 1 0-16 10yr3/3 none 1 2msbk mfr cs 2c .5 i.6 2 16-36 10yr4/4 none sil 2msbk mfr gw 2f .5 ~.6 3 36-84 7.5yr4/4 none co Osg mvfr na na .7 `.8 Remarks: Remarks: STEEL'S SOIL SERVICE Gary L. Steel Kernon J. Bast CSTM2298 NW4SW4 S23-T29N-R19W MPRSW-3254 town of Hudsen lot #18-Evergreen Estates II N 1"=40' BM.= top of 1" steel pipe C el. 100.00' Alt. BM.= nail in pine tree ~ el. 99.30' 1554 200th Ave. New Richmond, WI 54017 (715) 246-6200 "1 C1~ Iv Gary L. Steel 6-17-99