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HomeMy WebLinkAbout020-1266-70-000/* Vvisoonsh Oepeutrrlent of Corm~er~oe Sedet~euld Bulldrugs Division • GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT) P6Iaorlal kaorrriation you provice may be used for secondary purposes (Privacy Law. s.15.04 (1)(m)). Permit H er s Name: City Vi lage Town o lson, Joe Hudson Township BM E v : Insp. BM E ev.: 8M Description: ~ • O ~ f ° !~ Laev~rr` ca~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic 12 Dosing Aeration . Holding ~ , TANK SETBACK INFORMATION TANK TO P / L WELL BLDG. vent to Air Intake ROAD Septic ~• SO ` ~ ~ ~ ~-- NA Dosing NA Aeration NA Holding PUMP/ SIPHON INFORMATION rer Model I TDH I Lift/ ~ , I d=am I TOHs~ Ft I F emain Length Dia. Disc. ro well SOIL ABSORPTION SYSTEM ~ 3, x r c • zS ~ ELEVATION DATA ounty: St. Croix Sanitary Permit No.: 384146 State Plan 10 No.: Parce Tax No.: ©20 - 2.Ieb - - Q'0'D STATION BS HI FS ELEV. Benchmark , 2S' 01.25 ' ~ -p r Z.IS ~.Ip' Bldg. Sewer ~" ~ +MS e~ St / Ht Inlet 9.22 ~ . 03 St/ Ht Outlet q.2q { I .9(0 Ot Inlet ---~ Dt Bottom --, .---- Header /Man. 0.6 0 . b ~' t~•~2 ~b . i3` Bot. System It ''~ ~ p' Final Grade .bo g2,lcs ~ ~s ~.ro,, .4. ~~ d 7 = rh r oie TRENCH Width ~ Length T N f Trenches PIT No.Of Pits Mside Dia. Liquid Depth M SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM LEACHING Man aAturet: ~ lNfORMATION ype ~ CHAMBER e Num r: System: v, '~ 10 ~ ~(~ '~-' OR UNIT }~i DISTRt6UTION SYSTEM ~`~ ~ ~~.-,~,,,~,~.,. v n..l~ e Hea a ~S ,~ Distribution Pipes x H le Size x Hole Spacing Vent 7o Air Intake length ~ Dia. ength Dia. Spacing ~ ~5 , 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 I Bed f Trench Center Bed /Trench Edges ~ Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etg~spection #1:03/(r~/ O( InsLection #2: '7-T-" Location: 861 McDiarmid Dri~,nn (N ,W^~ 1~/4~ W 1/4219W) - Sunridg Lot 11 1.) Alt BM Description = -~ d~ ~ ~ ~e+^ '- o~+e_~e~ • Seus¢r , 2.) Bldg sewer length = I~• ~ cJ -amount of cover = > f 8`~Se:~ c~ ~~ ~U.>v` ,~ a ~.~. ~- c -cam ~`~ ~~ Lr, ~,, t~. ~R. ~S `~) O v Br C~~ Plan revision required? ^ Yes ~ No U,-~~ ipt~,~er~deforaddifq Info m~t{gn~.~ 03 O$ O~ ~ ( ~ 2 8~b-67~~r bpl~. 1 ~ ~ .I~~tt 1'4~, Cert. No. 10 (R3l9~j ~ Date Inspector's Signature A .' V 1 `1 ~ ' . ~~o~n t~~~ Q ~ Q ~~'~~ 1 ~~ ~_ ~ ~' v s ~~ g~ i } ~ ~ Cis °~ ~~ iq •-- •- C ~ t~-'"'u ~.. •Sanitary Permit Application Safety & Buildings Di { ~ isconsi In accord with Comm 83.21, Wis. Adm. Code See reverse side for instructions for completing this application 201 W. Washingtor PO Boa n Department of Commerce personal information ou rovide ma be used for secondar y P Y y purposes Madison. Wl 53707 (Privacy Law, s. 15.04(I)(m)] Submit Com le ( p ted form to county state ov Attach com lete lans (to the count co onl )for the s stem, on a er not less than 8-J/2 x 11 inches in size. Count}' lr Sta[~ Qit O Pe it Number ^ Check if revision to previous application Stale Plan I. D. Number I. A lication Information -Please Print all Information Location: Propeny Owner Name Property Location ~ " I ~t~' I/4(~~ l/4, S T N R E Propeny Owner's Mailing Address , , Lot Number Block Nun ' ntl (~ Ciry, State Zip Code Phone Number Subdivision Name or CSM Number II Type of Building: (check one) / _.,s ~ s,,,,j,w„~ I or 2 Famil Dwellin - N f B d ~ l D City D Villa y g o. o e rooms: ~ l~_ ~ w,.s. ge O Public/Commercial (describe use): (,(,4~r-- 6~ Town of O Stale-owned ~(,(,~~~ III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Roa A) l . (~ New System 2. O Replacement 3. D Replacement of 4. O Addition to Parcel Tax Number(s) S stem Tank Onl Existin S stem L^' ~ '~~~ -~ ~~ '~~j' a3) Permit Number 11 O A Sanita Permit was reviousl issued ~ / ' ~ ~~ : / ~ Date Issued ~ 3rd IV. Type of POWT System: (Check all that apply) Z 3' X lb6 •2S Non-pressurized In-ground/~~ O M 3 ~~r~,u,P^a ! 3 x aU •O s oun a ^ Sand Filter O Pressurized !n-ground cX~~ ~ D Holding ank ^ Single Pass D Constructed Wetland D Drip Line ^ At-grade ~ l 1C~ ^ Aerobic Treatment Unit D Recirculating O Other: V Dis ersaa/Treatment Area Information: _ ~ I Design Flow (gpd) 2. DispersalArea Required 3. Dispersal Area Proposed 4. Soil Application at (G s /d / 5. Percolation Rate i 6. System Elevation 7. Final Grade . e ay sq ~) ~ ' ~/ nch) Elevation Cam ~5~ ~5~ - o•~) ' 7 JJJ ~~ • ~~ -'- VI Tank Capacity in Totai a of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- lass New Existing Crete structed g Tanks Tanks ~t . lam ~- ,~$~ ~ ~ ^ o a ^ ^ D D ^ VII Responsibility Statement I, the undersi ned, assume res onsibilit for installation of the POWTS show on the attached Tans. Plumber's Name (print) Plumber's Signature (no s[ M MPRS No. Business Phone Number r - alp ~~ ~~ ~- g Plumber's A ress (Stre City, State, Zip Code) N ~~ U~7L ~ ` V I ~'t ~' VIII County/Department Use Only Approved O Disapproved ^ Owner Given Initial Adverse Sanitary Permit Fee (Includes Groundwater Surce Date Issued I s ing Agent Signature (No stamps) Determination ~s• ~ .- Z ~j 1 IX. Conditions of Approval a ons r -sap r val• ~ • t~ n n c + ~-s~- ~ vu~ct .K~a.~h ~ ~4-l,l ~~ V ~ /y rµ y~1~ ~ ~~/J{ -t J /~ (~ ,- . - - ` 'u' ` `~"•~~ _IM~-d/1 ~ tJ~~ T~-C.D'~ r1 111Tr _ 't7) ~V~+P~.~ ~1n C~YDn~C~1_ f SBD-6398 (R. 07/00) ;s .~Q,~s i b-Qe ~ .,zwe~,;,t..~ t~. s-e~ ~-+~n.k .~'a (~- ~s c~eun~~~ aw~Q, cab ~. wtan~ae•~c.cnar~ re fit. s . $~ ~ ~ t~-'"'u ~ . Sanitary Permit Application Safety & Buildings D ` ~~ In accord with Comm 83.21. Wis. Adm. Code See reverse side for instructions fo o l ti hi li 204 W. Washingtc PO Bo SCOfISin r c mp ng t e s app cation t)epartmenr of commerce Personal information you provide may be used for secondary purposes Madison. Wl 5370 [Privacy Law•, s. 15.04(I)(m)] (Submit completed form to count, state o Attach com lete Ians (to the count co onl )for the s stem, on a er not less than 8-IR x I I inches in size Count} • State Sait O Pe it Number O Check ifrcvision to previous application . State Plan I. D. Number I. A lication Information -Please Print all Information Location: Property Owner Name Property Location Q~ Property Owner's Mailing Address IUW t/4 ~ 1/4, S T ,N, R E ~ nd Lot Number Block Nu i1 Ciry, State Zip Code Phone Number Subdivision Name or CSM Number II Type of Building; (check one) / _`y ~ s,,,,J,~,,,,, D City '~ I or 2 family Dwelling - No. of Bedrooms:~_ ~f,,~ ~(a.~s. D village ^ Public%Commercial (describe use): ],(,~ ®Town of ^ State-owned .j~u~,l[sp,~ [II Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Roa A) I. [~ New System 2. ^ Replacement 3. O Replacement of 4. ^ Addition to Parcel Tax Number(s) S stem Tank Onl Existin S stem B) ~ O A Sanita Permit was reviousl issued Permit Number Date Issued IV. Type of POWT System: (Check all that apply] Z 3' K tQ6 •2S (~ Non-pressurized In-ground /~ ^ M ~3 l 3 /c ao •O y oun ~ O Sand Filter O Pressurized In-ground ~~~~ ^ Holding-~'an ^ Single Pass ^ Constructed Wetland ^ Drip Line O At-grade ~ _ ]v ^ Aerobic Treatment Unit O Recirculating O Other: V Dis ersal/Treatment Area Information: 1. Design Flow (gpd) 2. DispersalArea Re uired 3. Dispersal Area P d 4. Soil Application S. Percolation Rate ~ 6. System Elevation •' 7. -Final Grad C q $ ropose ~ " ate (G s./dayJsq ~) ,/inch) l Elevation EO 5~ J 5 o •~f) ~ ~ ! ~q • ~5 -- VI Tank Capacity in Total ay of Manufacturer Prefab Si[e Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- lass New Existing Crete structed g Tanks Tanks S,t • la~SO _ 1 ~8d ~ - ^ ^ ^ ^ ^ o ^ a ^ VII Responsibility Statement [, the undersi ned, assume res onsibilit for installation of the POWTS sho on the attached Ians. Plumber's Name (print) Plumber's Signature (no st M MFRS No. Business Phone Number r - aao ,y-• c~- g Plumber's A ress (Stre City, State, Zip Code) (I u N k~!~~ Cam.. ) h/ ~ • ~J4C~O ~ VIII County/Department Use Only ^ Disapproved Sanitary Permit Fee (includes Groundwater Date issued 1 s ing Agent Signature (No stamps; Approved O Owner Given Initial Adverse Surce Determination ~~S• ~ Z ~j ] _~-• ~..~~~~~~~u~~~ ur r+ppruvar r e -ons r tsap rpvat• E Sy~~~t,R;,„~ ,:,,. o • ~ o a.~g .~.~ ~~s . A- o . ~ ~ t`s ~~-. ~ ~~a.r~ NoQA, •-'+~ is ,~td.~o,,,~~~-2e. ~ .Q.~ c>~st. s-e~ ~-~•k ,~ (~ is c~u~~€ y,,,a,t~-a.~;vve.~ cad ~ w~ ~ re ~+~. s . SBD-639$ (R. 07100) ~~ // 7 ~~ yea ~~ ~~ ~d ~~ `~ - /OG ~ ~~ ~ ~ ~~ ~-,~'~ ~ ~- ~ ~~~ ..-_---_ - / 7 ~'~~~ ~ob.as a ~ ~~ T- ~ _ ~ 7 - /~~/o T 3 _ /~ rf -/O ~3~ ~ u~~ 0 IJ ~_ X~,~_~r ..~~~~ ~~~`.~' R~ a- y x~~ ~ ,~, ~ ~~~ a~~~~ ~. ~- ~/ ~~ 13~~ 0 o ,~. A ~-S ~" y~ e~ j3. Xis ~ ~~~~~ '~ ~ I®~ ~ ~-~ ~ .~ ~L y - ,~~ '~~ U' ---_ e"."`. ~ ~ ~ = i '7 /{~~~ 1 = ~ ~ /~ ~f -/o ,w ~ ~ _ ~ ~ ~+ -. Wisconsin Department of Industry, SOIL AND SITE E V A ~{~ J4~'I~U N F~ E R`(~:l=i`T ' Labor and Human Relations Division of Safety 8 Buildirx,~s "' fF in accord with ILHR &t9b~; W~~at~,~Code BOUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in~iae Plan mu§t imctt~de;,but not limited to vertical and horizontal reference point (BM), direction a~-d-~ of stripe;scale or ;PARCEL LD. # dimensioned, north arrow, and location and distance to nearest road.`: - °;'; APPLICANT INFORMATION-PLEASE PRINT ALL INFORMAT~(ON".. R~VIEWEDBY n Page f of .~ PROPERTY OWNER: PROP TION ,/ DOE •; l''lE Ii SS,et' O~ SOa G~m~.. fl4!uwlra,S=-7 T 2-I ,N,R ! 4 E(or~~W,~ PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # 330/ c•o.4cl~.H A N t2fl. ,~4p1-. aZ I ~/ sv,~,e~•vG-~ ~' ~(rh~i J`1i.N.y . S s1a..1 (4111Co~-~359 ttv Se,-~ ~!c D.%4'rP.tiO [~'Wew Construction Use [ Residential / Number of bedrooms `~ [ J Addition to existing building j) Replacement [ ] Public or commeraal desaibe Code derived daily flow ~°d gpd Recommended design loading rate ~V/J' bed, gpdm2 • y trench, gpolft2 Absor ption area r€ ;wired bel, its trench, its i+wia~umum design loading rate N~' bed, gpd/tt2 . /~ trench, 9Pdlft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) l Additional design /site considerations ~ ~ SE ~~ a 4' N~'''~ ~ w fi'R E'er ~t S - ~o t"" ~ ~ £~ Parent material SCS 59 " Sl~a~.a s 45 5~4TTRE' Si [ . Flood plain elevation, if applicable ~~- ft I S =Suitable for system I LJS ~ { ~ou~ ~ IN-GROUND PRESSURE I A~T•GR~ I SYSTI.M IN, FlLy I Q S1NG~~ t1=Unsuitable for system L75 I CC'S ^ U [~S' ^ U L~ ^ U ^ S L~t7 p(~ CA11 1'1CC~+DIDTIAIJ QCDART ~W ,«7 Boring # i~::~{ s:. .:.x t ~~~ ~.:t `;;~~: Ground elev. `i3, l o ft Depth to limiting factor a 7 Q Boring # Yti~~ •::v:'J:ii:~ ~...~: ~~~'i Vii;. a2 i.~>~h>t:~;: Ground elev. °IZ~Bft. Depth to limiting •.---- factor ~~ 7~ Depth Dominant Color ~~eS Te ture Structure Consistence ~~.~, Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont Color x Gr. Sz. Sh. Bed tench o-,o ~o yie ~z - ~~ z.f stir ~w-u~R ~ s z . 5 • ~ rat D •~~{ ~o ~,~ ~ ~~ 5~'/• 21 ~, .~ .w.~' R. ~s t'F' ,~ a (3,_ y !o die y __.-- ~•/ z ~.. bk ,w,f R cs if . s . G ----~ gq. }S ~'"7 ~o•Z Remarks: fft~~i?o.~ C ca_c,fil~~;ws ~^+ ~ c.u r• o.., s of 7• s y/~ G/8 ~~' • S . ~/o-v5 p~ ,~. b .:y /o y~e ~z ..~--_ sr~ I 2 ,~ s!-,~ ,-~-F,e ~ 5 3 f . s • ~ ~ y 38 !O y~Q Y~ ~- Si / 3 ~• bk r,,,,-F Q C S l ~ . 5 . G ~ g.. ~.sy~ y ----, s~ I,f, sbk ~fR ~ ~ .~{ .S $`l- ~ • 36~~'Z- 3.c Remarks: CST Name: Please Print R D b ~ Q 7. ~ L ~ (~ 1• C ~T- Phone: ~t S , 3 ~~ _ ~ ~ ~ fC Address: ~o S S ~~ N k ~ L ~' D• I'~'19 D$ O a 49 l• S Y O/ ~ [ ~.' t 5` `~ 3 c 5TH Z.k ~Z. Signature: _ Oate: CST Number: • ~~i~- Z%~.P.~ ~~ w ! ~ TI~ !e TEST ~o ~ D r'T~o.~ S o r~ ~rz• car s c~ a -~ ~ t ° f ~. ~~. PROPERTY OWNER SOIL DESCRIPTION REPORT PARCEL I.D. # ~ f ~ ~ ~ Boring # ;;..tr:;>.:~r v 3 r'. '•v <f~..~::<::> Ground elev. `1ZZ'~ ft. Depth to limiting factor ,~ ~~` Boring # '`ate ... ,:;•: ~~ {4 '~ \ `~+~'Y GfOUnd elev. 2•~ ft. Depth to limiting facer Boring # <..v:.KV::,., ~::: .r.:..~:.: ~< S ... .:::t { {< ~: :. jy . \;.vSv~~i:;: .rk}TCi• 3%:i~~ii:.i'~~ Ground elev. °I~'~ft. Depth to limiting factor Boring # ~~~;r ~~~'~~ xa x '< ;~:::;i6~?:~: ...~..3;:r:+S.:. Ground elev. ft. Depih to limiting factor Page ~ of 3 Horizon Depth Dominant Color Mottles Texture Structure Consistence 8otxxiary Roots GPD/ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rerxft - Zo ~o R 3/3 - S. •% Z ,f, s bk ~w--vf~ S ~. . S . G (3 •3P io y,e ti/z.. ~ S~ / 2. ~ , S~ ~-+~,-die ~ s t `f' . S . G ~ Z ~• s ~o yR y 5r/ 2 . f; sbk ~- f ~ ' c s I f . 5 , G C y-~ /~ ~. s ~! IC ~' s~ 1r-F, sb~ ~ ` /~'N T h _ ~• . y . S Remarks: ~ d-~I l o yi2 ~Z. - S.% L.f, s bk ~-~+ vf-~e ~.. s .Z-F- . s . G (3 ~/_ L3 !o yR y _----- S•/ 2 ,w, sb~ nM~ ~ c s ~ `F • s . ~ C~ 3-y~ 7 s yR y S/ ~ f s,b~ ,w,f.e. s /~ . Y• 5 Remarks: .33 /o yIQ y ---- Sr/ z ~., sbk ~fc es /-f. . S ~ . G 3~ 7s y~ y --- S/ Z,f , sbk M, ~~i~e c s ,. . s . ~ y a ~a rR y y ~--. sr ~, ~, Sb~ ~,-~,~ - - . ~ . s r crt Sa • ~f Remarks: i .. i Remarks: con onnnio nc •no~ 1 Nw ~~~ toRNt2 StEfl f~~ ro5f o. ___ X39 - ~, 4 2 ~° , Na ~ LoT L y?3•o ti~ 1 8y ..----- - -- ------ /oo ~ ~-- ~r I ~ ~ i . I i I ~ i. ~s.. I j. ~'S---.~ ~ 1 f j ~ ~ I I ~ I I ~ ` ~ I i t ~ ~ I I I ~ ~ ID~D ~ I ~' I 'r ~ b0 i ~ 1 i I lU ~, I ; I ~ 1 I j ~ ~ ~ i t ~ I ~~ i i l i ~ i ~ ~ i ~ I~ ,I i t ~ ( ~ ~ I I ~ 1 1 I I ~ y - ~ r Su5SE5TtL7 ~ /?LNGG. i i~~~1 ECM JI~CjI~b'~ P~- ~ 3 T12 4 +~ cl,. ~ s t~ c.L. ar ~ s'X gp ' S!,/ /0 7` Ca,Pyt 2 i ._. 2t 5 E 2 OiPo~ /3 o r~- ~ So ~ LoT L '~ 1 o __.Y ,~~ ~, _----_ __ _, --_._-_- _ --_-____ ___ _ _ _-- - __ ___ _ ____ _ . ~ ~ y~z•~' ~ ~ /3M ' 7'oP of ~' /E~T~P~c rt°~.~5 foR M ~ 2 B o x Z i4T tJ , l.t~ • T l p. E I ~E. U~ T i v~ ~ /!~O.O I i l I E LE V hT1 OrJs ~ y q 3, ip .: 01 p O , ~ z 52' ~6 ! 4 (3 3 y'z.~s , (3 ~ s~.~o .~ ~ ~ 3~ ~ - _ 1 _ Private ~nsite 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: Svstem Design Specifications Sanitary Permit Number Number of Bedrooms Design Flow -Peak (gpd) Estimated Flow -Average (gpd) B O Septic Tank Capacity (gal) ~ Soil Absorption Component Size (ft2) z _ ~ ~ Type of Wastewater D estic Table 2: Soil Absorption Component -Limits of Reliable Operation C ~~ Septic Tank Component Soil Absorption Component Design Flow -Peak (gpd) 5 z Maximum Influent Particle Size (in) 1/8 Maximum BODS (mg/L) 220 Maximum TSS (mg/L) 150 Tab le 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filte shall be assessed at le once eve 3 years by inspection. The ut et filter shal e c e ngd s necessary to ensure proper operation. a filter cartridge sh u d not a 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 shat{ be sea{ed 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 with OSHA standards for entering a confined space. The atmosphere within the sepfic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank maybe difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soii Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 ST CROIX COUNTY SEPTIC 'L'ANK MAINTENANCE AGItLL~MLNT AND OWNBItSHIP CERTIFICATION FORIvI d Owner/Buyer ~~~ ~~- i-~.~~~ ~~~J Mailing Address r~~ 7 ~ ~--''~~' ,.~ira -rte/ ~/~ ~ ~ y~/~ ~.. ~ _ • w Property Address L (Verification required front Planning Department for new constcuction)__T1,Q p "~ .~ CitylState -~-~~~~.~---7=-e f ,. Parcel Identification Number LEGAL DESCRIPTION ~~~ // ~~~~~ j~~ Properly Location~~~'/,, ~'/,, Sec. ~, 'I',~~N-R~W, Town of Subdivision Certified Survey Map t# Warranty Deed # ~1 ~ ~ ~ < Spec douse ^ yes Rio Volume Page # Lot ## ~' Volume ~ Q ~~ ,Page ## 6 ~~. Lot lines identifiable ,yes ^ no rSYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out We septic tank every Uuee years or sooner, if needed by a licensed pumper. What you put into We 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 Deparirnent a certification form, signed by We owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying Qtat (1) We on-site wastewaterdisposal 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, We undersigned have read the about requirements and agree to maintain t(te private sewage disposal system with the standards set forth, herein, as set by the Department of Cotrunerce and tlrc 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 Offtee within 30 days of the three year expiration date. SI NAT OF APPLICANT DATE OWNER CERTIIi'ICATION I (we) certify Wat all statements ou this form are true to the best of my (our) knowledge. I (we) am (are) We owner(s) of Qte property described above, by virtue of a warranty deed recorded itr Register of Deeds Of[ice. ~~.~8-~_ ~I2 /22/2CX~/ SI NA URE OF APPLICANT DATE ***«** Any inforntation that is mis-represented may result in the sanitary permit being revoked by We Zoning Department. ****** ** Include wltlr th(s application: a atampcd warranty deed from t(re Register of Deeds office a copy of life certified survey map if reference is made in the warranty deed ~ ~.-_ '. . ~ '; - ~ i TNi6 SI~r:[ R[SCRV[D i<TR RC CnROr N~. O~i• DOCUMENTiJO. ,WARRANTY DEED STATE BAR OF WISCONSIN FORM 2-1985! ` 5.1437 '° _ _ ~- w" 1 = - REGIST•ER'S Ofr' E ST. CR41X CO., WI ..P..... GreenWOOd-.Enterprises.,. Inc.,, a Wisconsiq Cor oration,...- Re~'dlhfReteM - - ---- _-------- ----=- ---... JAN 5 1994 . __ .. ........... -------- .......... ~ 1zs30 r. M conveys and Warr i>.ts to ...jglse>?h P Olson end. Mejisse- )1.,. Q.lso~. ,I (~. ~„Q~ as survivorship marita p-^perty-.. .. .--_- .. _ .. ............... ' _ ................... ~isa-aixees ~ i~ ..-- --.. . ........ ........ ...... ...... .......... .......... RCI URN TO ..._... ... .. ........... HeyWOOd ~ Carr S. _--,. _ - ,. .. ....... P.O. Box 229, Hudson, WI ... ... ........ St.- Croix --~ .. ~~ the following described real e.,tate in . - -. --- - •••--•---- - - --- ---~•~-•-County, State of ti4isconsin: ' Taz Parcel No :.............................. Lot 1 of the Plat of_SunRidQe famed in the ;I ice of the Register of Deeds for St. Croix County, Wisconsin on September 22, 1989 in Volume 5 of Plats at Page 71 as Document Number 451750. . ':1 r**; , JV W S( y~ ~~r~ ~. This .. is. not-- --------- homestead property. (.is.) (is not) Exception to warranties: Dated this ~-3 ~.-.. _. .. - day of ....... December..- . _. _ ._......_ _..._. 19_93.. _ SEAL) (SEAL) James..E.._,Busch,-.President-------------- • ---Mar .~.-. --h,_-.Sec;etar --Treasurer •------- --- - -(SEAL) .- . _....._ ..... - - -- - _ ......(SEAL) s - '- --- ~------------------ AUTHgNTICA?ION ACBNOWLSDQML+NT 3ignatare(a) _ James-•E._ Rusch~__President STATE OF WISCONSIN as. ------------------------•---------•-----------••-----•--------•-----•-•---•----- ST. CROIX County. anthent~cated this ~"~~-day of.__ December •-••-.~ lg-- 93 Personally came before me this . .............dsy of ~e~jAA ~~.. ---. December .....--•----•-••----~ 19.93.-- the above named .. R -------------•-------••-----•-- •-----•--.-.-...._....---- Mary ~tusch, Secretary Treasurer TITLE: MEMBER STATE BAR OF WIS _ONSIN ••••••-----•--------•-••--••-- (If not. •-------------------•------- --•-•- - --- • ..... a,athorized by ~ 706.08, Wis. Stats.) to a kn to be the person -.......... who executed the f~egoi i trument and no the s e. , -THIS INSTRUMENT WAS DRAFTED BY ----_-. ----Heys+ood ~ Carr, S.C., By Walter Hodynsky --•- -- - - P,O. Box 229 Hudson WI 54016 ---L-R/.»t4~A....-'-- - ~ _.- - --•---------• - •--- - --•-••-•---•-°---°..-...--°'-----•------° ' ...............•--•----•--•---•-• Notary Public ..... St. Croix- - •--•--......County, Wis. t C;onalnrta may be authenticated or acknowledged. Both M!' Commission is penman ~nt. (If not, state expiration ~~.7 O~ SUNRIDGE E SW 1/4 OF THE NW I/4, IN THE NW V4 OF THE NW I/4, IN THE NE I/4 OF THE NW V4, ANO II . C~ttTIFICA3'~ d!' TOFN T~ OOU[VTY TREASZJRI sTA~ a~ w.~saa s`rATE o~ wssooNSat ) I ~' ST. C1~DIX QOIRd ST. cROIX aotnrrsr 1 I, Beweriy A. Johnson. being the duly elected, qualified and acting 7bwn Treasurer I, Matt' J, of the ~b~ct of [iudsaz, hex+eby certify that in accordance with the in my office, of St. Croix 0 there are no unpaid taxes or special assessments as of o~ tax ~~ '~ on any of the 7.and included in the Plat of SunRidge. affecting the ~~~~~f~ :ed ~ ~ Dat '-- Orate ly 0~~, v' ~~ ~~ ~~ O~ ~. i m~ O ,~ ~' O~~ ~ ~~ h~ ~// a~• V / 3 ~\ ~~ s N 2 ~2~'33« 90 • DO W ih M . ~, SOUTH LINE D o EAST l O ~ N Z 76.50 ' 244 . 14 { .49~ ~~ ~ N w q~r ;,~ 92,992 Sq.CFt ~~N ~ ~r~ ~o~ ~rn 10 ~ . A 2.IJ~T AC. • m ~ 92,20'9 Sq. Ft. ~ m Of ~ m Z d' ~1 ~ tp ~ ` ~' SCALE 0 I~ 2.t 88, 2