HomeMy WebLinkAbout020-1409-01-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No: 4P600 _ 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal infonr;at(on 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:
Bast, Kernon I Hudson Township 020- 1409 -01 -000
CST BM Elev: Insp. BM Elev: BM Description:
q1 n1
TANK INFORMATION V ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic BenchmarkB -7 to
Dosing Alt. BM YJ
4D ojt i ' �f c es, . 7 • ZZ
Aeration Bldg. Sewer
Holding St/Ht Inlet 5
t�
�-/
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L VVELL BLDG. Vent to Air Intake ROAD Dt Inlet
/Z st'-
Septic \ / / Dt Bottom
Dosing / / /� Header /Man.
e 13.3
Aeration Dist. Pipe
S .f 3-
Holding l ailipm
ina ra e
PUMP /SIPHON INFORMATION
Manufacturer Demand Stir
GPM
Model Num rd
TDH Lift ricti oss System Head TD Ft
Forcemain ength IDist. to well
SOIL ABSORPTION SYSTEM 0 2
BED /TRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS /
SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM EACHING anu rer: ff
rl b
INFORMATION CHAMBER OR lj,�
Typ Of System: - / / UNIT
D / Model Number:
DISTRIBUTION SYSTEM ( rd
Header /Manif Id Dtribution x Hole Size x Hole Spacing Vent Air Intake
� �� y / � " - 4- - � Lengt Dia Length Dia "spacing ✓
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
S 112-11 Yes No � Yes ❑ N
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: S / Inspection #2:
Location: 836 Hidden Lake Road Hudson WI 54016 SE 1/4 SE 1/4 2 29N R19W Boundary Rid gib Lot 1 Parcel No: 24.29.19.2559
( ) rY I �
9
1.) Alt BM Description = �"" �" pth �vt�C� G�QIi� /� -�" ��"` / S ` -41 t'j6_ Sa uZ6
2.) Bldg sewer length = / � jD =
- amount of cover = too
_ 4f /
Plan revision Required? Yes ❑ No _ %
Use other side for additional information.
SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No.
Safety & Buildings Division
Washington Ave.
Sanitary Permit Application 201 W. PO Box 7302
Ivis In accord with Comm 83.21, Wis. Adm. Code Madison, W153707 -7302
Department of commerce Personal information you provide may be used for secondary purposes (Submit completed forth to county if not
[Privacy Law, s. 15.04(1)(m))
state owned.
Attach com iete plans to the county copy only for the system on paper not less than 8 -1/2 x 11 inches in size.
County State Sanitary Permit Number CheciCif evision to previous application, State Plan 1. D. Number
I. Application Information - Please Print all Information i Location:
Property Owner Name Property Location
„59 1/4 t; 1/4, S -47 TO,N R I E o W
Pro y Owner's
Mailing Address Lot Number Block Number
City, State Zip Code Phone Number Subdivision Name or CSM Number
&fido r d e
II Type of Building: (check one) ❑ City
I or 2 Family Dwelling — No. of Bedrooms: ' ❑ Village
Public/Commercial (describe use): W7'own of /
O State -owned �� � riot
III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Ro d
A) 1. '0� lew System 1 2. ❑ Replacement 3. ❑ Replacement of 4.. ❑ Addition to Parcel Tax Number(s)
System Tank Onl Existing System 00,20 - /`fU 9 — XV0
B) Permit Number Date Issued
A Sanitary Permit was previously issued &.g
ky-Typi of POWT System: (Check all that apply)
Non- dressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line
❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other:
V Dispersal/Treatment Area Information: `
I. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevatio 7. Final Grade
Required, Proposed Rate (Gall./ ay /sq. ft. (Min. /inch) 9 a 3 Elevation,
8sQ 8�� �' g�,� 9t,3
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
_ _ ❑ ❑ ❑ ❑ ❑
VII Responsibility Statement,
1 the undersigned assume responsibility for installation of the POW7'S shown on the attached plans.
Plumbe Name ) Plu er's p(no stamps): MP/MPRS No. Business Phone Number
Plumber's Address (Street, City, State, Zip Code y,
VIII County/Depart ent Use Only
❑ Disapproved Sanitary Permit Fee (Includes Gro� dwater Date issued cling Ag t M s)
Approved ❑ Owner Given Initial Adverse Surcharge Fee)
. Determination
IX. Conditions of Approval /Reasons for Disapproval:' , S �, 71
& Sy�4rmr Axe, 4 d
'y
u ,
r
P B 167 PIO u/kl SlW e cvi nd e rs:
AM
� ► rcp N ��..� J c�`j � c � �`"
C�
Pay 3xGJ.S d
j 3S�
�Itv= Iv v
w b-)uo F; vf4yk
7 Qpa rlC,0
ze
up
m
oo�
l im (-...... W x t71p
. 1645
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 2
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations
Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D.
0206409-01-000
Please p 4 Dat or
Personal information you provide may used s. 15.04 (1) (m)). nj B 3
Property Owner Property Location
Kernon Bast JU'1 1 Govt. Lot SE 19 SE 19 S 24 T 29 N R 19 W
Property Owner's Mailing Address UU3 Lot # Block # Subd. Name or CSM#
948 LaBarge Road �_ �`� ��i >: 1 Plat Of Boundry Ridge
City State t ber City Village rI Town Nearest Road
Hudson I WI 1 54016 71 - 5 Hudson Hidden Lake Road
Use: Code derived design flow rate 600 GPD
New Construction
Residential / Number of bedrooms 4 9
Replacement I Public or commercial - Describe:
Parent material Glacial outwash Flood plain elevation, if applicable na
General comments
and recommendations: Soil evaluation completed to verify depth of suitable soil below s 23' as
installed, based on B.M. = 100.00' at bottom of siding.
Boring # Boring
Pit Ground Surface elev. 95.85 ft. Depth to limiting factor >109" 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 I "Eff#2
1 0-4 10yr3/2 none sil 2fsbk mvfr as 2f,lmc 0.5 0.8
2 4 -13 10yr4/4 none sl 2msbk mfr cs 2fm,1 c 0.5 0.9
3 13 -20 7.5yr4/4 none scl lfsbk mfi gw 1fm 0.2 0.3
4 20 -3 7.5yr4l6 none sl 2msbk mfr cw 1f 0.5 0.9
5 38 -53 7.5yr4/6 none Is 1 msbk mvfr cw if 0.7 1.2
6 53 -109 10yr516 none strat. s 0 sg ml - - 0.7 1.2
3 `D
MI Boring # q & y ?, �O
// Pit Ground Surface elev. 97.53 ft. Depth to limiting factor >105 in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2
1 0-6 10yr32 none sil 2fsbk mvfr as 2f,1mc 0.5 0.8
2 6 -13 10yr4/4 none sl 2msbk mfr cs 2fm,1 c 0.5 0.9
3 13 -24 7.5yr4/4 none scl 1fsbk mfi gw 1fm 0.2 0.3
4 24-45 4/6 none sl 2msbk mfr cw if 0.5 0.9
5 45-,%, 7.5yr4/6 none Is 1 msbk mvfr cw if 0.7 1.2
6 50 -105 10yr5/6 none strat. s 0 sg ml - - 0.7 1.2
Effluent #1 = BOD 30 < 220 mg /L a d TSS >30 150 mg/L ` Effluent #2 = BOD .S 30 mg/L and TSS < mg/L
CST Name (Please Print) Sign re: CST Number
James K. Thompson 3602
Address A.C.E. Soil & Site Evacuations Date Evaluation Conducted Telephone Number
340 Paulson Lake Lane, Osceola, WI 54020 5292003 715- 248 -7767
prt
♦ arbl elev = 9f 1 59'
9 „ ■ BI
E.ri3 f%�
rl5i oknCQ
lt �'
�,s(rkc6p�
d ri W a y e%le. Lli eoaol
r -
n�0 3 -0 n C col
d 0
• c e��o � �• e��o
T 7! a c
CD
U) Z ° N a C A N !
.T� j C 1
m Z' 3 m rn ( o n m O
N C ; p o H G(D O O
N a> > 3 o N o
rn c 0
O
3 th H =r o p
th IA
y c 2
R
m �o Dy `pia( CL
c C c _ r
3 CA o x
O co a) (D
L 0 0 0 01 lY
I O w N C 3'. Q N•
O.
z O O O 0
7
I o � Or o n
CD CL
C y N CO) y
a _ m C) � TT
CD d .. 1 N
3 01 a
CL 3 fD
Z w
C co Z
-i 7 p O
0 =r n N x 7
. O GSM 0 0 '�
O O. 0) O 7 0
_- N3fC; CD 3 C co
S fD CD CD C C
a@ O N N N
CD CD -. C (D
w . N N fD O.
59 (aD) Z 7 n m CD N cb
O p Z n
D c M =
w (D C ° v CL A 3
O. D. v -
� c a
CD
N O O m N A
oov mco
CD : a � Z
cove 0 �
v 0 °
CA CL �_ H m
� O CD
A i
d
a �
0
m' c
o Cl
rn
N
y
� I �
11 �
fi
C'
Qb
W
i p
I t j ti
0
A A
fD ti
Dq
A
69
/ /O°
a a
and .S /'d.e._c)indeer_s_ ..
NO n► P
04 N 12,b 1
(a 1 d
m
0
v� e ' 4 s
Pie ENV,
/60 0 4�s v-xP
v a y(►zoNC�aj 3 �vU
� k
QaoIpN1 J ���n
n,�� '
C
1 / b TI l q c�
1. („! I hQ N C, h / J • ? c a� �
o co
- rn
calm
4 "
r)
j �,
9 � a). x to vi
zo
tu
6A &j I. e. b . Safety & Buildings Division
Sanitary Permit Application 201 W Washington Ave
N*6consln In accord with Comm 83.21, Wis. Adm. Code PO Box 7302
Department of commerce Personal information you provide may be used for secondary purposes Madison, W153707 - 7302
[Privacy Law, s. 15.04 1 m bmit completed form to county if not
[ )� )) �4�0��2 .. 1 D state owned.
Attach comp lete lens to the count co onl for the s tem on a r not less than -1/ x 11 inches in size.
County State Sanitary Permit Number 0 Check if revision to previous application State Pion I n u— k-
2)
I. Application Information - Please Print all Information Location
Property Owner Name
VName l p Property Owners Mailing Addres DEC 0 5 L002 N RI W
�� Block Number
` �,OIX C U City, State ' Zip C e
1 � s o l' ��'�I�
II Type of Building: (check one) / as per S �• tee_ 0 city
VC 1 or 2 Family Dwelling - No. of Bedrooms: l ❑ Village
O Public/Commercial describe use): W Town of u ,
O State -owned 2 K /4D I 3 K (06.2
III Type of Permit: (Check only one box on line A. eck box on line B if applicable) Nearest Road 77 l 1
Vf'NbIPNdS �O�D
A) 1. +1New System 2. 0 Replacement 3. Replacement of 4. ❑ Ad tiory to Parcel Tax Number(s) 2 . 0 - - 0
S tam T k Onl Exist' S stem
B) Pe it Number Date Issued
O A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply) 3r /!- -
oNon- pressurized In- ground O Mound ❑ Sand Filter ❑ Constructed Wetland
E3 Pressurized In- ground 0 Holding k 0 Single Pass O Drip Line
0 At -grade C1 Aerobic Tr tment Unit O Recirculating 0 Other:
V Dispersal/Treatment Area Information:
I. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil A cati 5. Percolation Rate 6. Syst E vation 7. Final Grade
r Required Proposed �d� Rate (Ga s. / . R.) (Min.linch) j(P Elevation N I Ob
I lU i�l
VI Tank Capacity in Total As Prefab Site L S- I-- 71--7 Steel Fiber- Plastic
Information Gallons Gallons TCon- Con- glass
New Existing crate structed
Tanks Tanks
� o 0 0 0
0 0 0
VII Responsibility Statement
1 the undersigned. assume responsibility for installation of the PO 'S shown on the attac
Plumber's Name (print) gCo ar's Si (no siarrgn): MP/MPRS No. Business Phone Number
m kk �da
Plumber's Address (Street, City, State, Z li ft D ��° 3 ov\Dj s
VIII County/Departmed Use Only
0 Disapproved Sanitary emit Fee (Includes Groundwater Date Issued ZA891 gnature
Si o stamps) )
VApproved 13 Owner Given Initial Adverse Su F
Determination ` �,,�'� I � °Ga Z
I ndit i of Approval /Reasons or Disapp' oYalt; .
essuyv. �r tn+ 4+ _ A*A�_ f�Qt:� l �ce oq e� wlyrt r e.
SPe c.� c`6 +its. ( ( )
eM- 0
�.....��..,... � .z......,.._ -J��_. _ ...._...., .:...�./. �.. -.� ___._..Q/.KJL. ...� i (.A....e.. -u / l G.r -�. - --
V wN Ps
9 0 kA N b4b L\, R I J 90
�a, d
m
o�eti�
y (3ed 1Z 0 rh
boo o
QooIP J ��p
►��� Tr►11 (h
ca
0 m n
J V >c
C 'a-) Ci
N OC X W V1
«_. N E h lv N E E O ,c X m M
N N N om. ► ('7
LU
*'
P� T , a� �tPP�oX 35 �4 �es — ��� a,2 P 1 4 -� /Dt-7AJP1
m Msconsirm Department of Commerce SOIL EVALUATION REPORT
3
Iivision of Safety and Buildings Page / of
In accordance will' Comm 85, Wis. Adm. Code
Allach complete sIle plan on p,
per not less Iha1m 8 112 x 11 Inches In size. Plan mustCounty 57. CR OI
hiclude, but riot limited to: verlical and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north allow, and location and distance to nearest road. Parcel I.D. 0 • ��� Cj . �O . ��
Please print all IrffonnaUon. Revt d by bate
Personal Inforrnallon you provide may be used for secondary pvmoses (Prtvacy Lew, s. 15.oA (1) (m)), Z-/C)
Properly Owner Properlation
KE�NoN I� y Loc
Plmup G
Govt. Lot S9 114 $IG 114 S 2 T T Z N R // e
IF (or) W
Properly Owner's Mailing Address Lot M Block M Subd. Name or 66MM
9y8
City Slate Zip Code Pho um r
[] City [] Village gj Town Nearest Road
lfvUSo A) tai. Syo /(� if -cc y 3660 A 1 �f vf�SoN I3AAU1 COs
New Construction Use: Residential l Number of bedrooms Code derived design flow rate
Replacement (j Public or commercial - Describe: GPD
P:mrenl mnlerial 10ESS O ( &R Flood Plain elevation if applicable /V
General cornrnenls ,� [ / n
and recommendations: o �'TV N
•
5i726 7 7-&1, sr.�/�,�e ,p e jA-1 IA3;� Po v�Iv e Ve J 7 A.) 4c.
T5
U Boring 0 L] Boring > ��
pit Ground surface elev. fl. Depth to limiting factor ►n,
Soil Application Bate
Horizon beplh Dominanl Color Redox bescriplion Texture Structure Consistence Boundary Roots GPD101
in. Munsell Qu. Sz. ConL Color Gr. Sz. Sh. ff
0 E M1 1102
z lz•31 7oy�3 /y - siL 2 Shy l w /f . s .8
3 .60 7 SYR SL / 'e /-M 6e cw . y • 4
U L) Boring
Z Boring If Z F
' 19 Pit Ground surface elev. ��• fl. Depth to limiting factor ! In.
l iorizon bench Dominan Redox Description Texture Structure Consistence Boundary Roots Soil Ap� n Rate
In• MunsGlu. Sz. Cont. Color Gr. Sz. Sh. TIM • EffM2
o' $ 16 5G � fsb� �►�+ 09e S 3 f . s . 9
• z /o Y "I" �,� f^w a S • 8
/• yle /o YAP SL sb�
15: 9b
' Eifluenf M1 = BOb > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent M2 = Bon < 30 mg/L and TSS < 30 mg/L
CSI Name (Please Print Signatur - 'ogEk7 � /6 R %GI,T CST Number
Z a243�S
Address
• bale Evaluation Conducted T / phone Number
ht 8 Associate- 7�5 3aco • �l C� 5
Privatri Sewage onsu .
655 O'Neil Rd.
Hudson, Wis. 64016
Go7
D. s p��• l3�sr �.� s
Properly Owner parcel ID 0 Page of
boring M U Boring w /,0 0.7 &
pit Ground surface elev. h. Depth to Mrrriling factor a / M
horizon beplh bominant Color Redox bescriplion Texture Structure Consistence Boundary Roots Soh GPD/n, Rate
In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff!!1 'Eff#2
�• & Faye 31 — s ►�� w 3- . y
YK Y16
3 /Y-
- , Y6 7•S /l' SiL /fS�dk nrl�i" cCcl — • �. • 3
92 sy .v, �� y
`fg } .�z
Boring 1 11 Boring
t_I pit Ground surface elev. _ n. Depth to limiling factor In.
I lorizon Ueplh bomtnanl Color Redox Uescripiivn texture Structure Consistence Boundary Roots Soil Ap Ilcallon Rale
orY GPU /pt
In. Munsell OU. 3z. Cont. Color Gr. Sz. Sh. •Ef(!11 •Effll2
r Boring (! Lt] Boring
l_ 1 pit Ground surface elev. fl. Depth to Mmlting factor in.
I lorizon p Soil Application Rate
fh
be Dominant Color Redox Descripllnn Texture Structure Consistence Boundary Roots GPD/flr
In. Munsell tau. Sz. Cont. Color Gr. Sz. Sh. 'Eff!!1 •Effif2
OP
Effluent #I - BOU > 30 < 220 mg/t- and TSS >30 < 150 mg/L • Emuen182 = BOD < 30 mglL and TSS < 30 mglL
[ he Ueparlmenl of Commerce is ar
r equal npporlunity, 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 'ITY 608 - 264 - 8777.
Sph Rlln (R 61M)
1. o
o
Nx
W Q
o �
��
oms
o ow
W
r
w
w
d _
zz�
VIZ3
o�
o ;
o kA
Il z
4
v a �
G
11
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 (POWTS) 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-
10567-P (R.6/99).
Table 1: System Design Specifications
Sanitary Permit Number I f 4601)
Number of Bedrooms
Design Flow - Peak (gpd) dd
Estimated Flow - Average (gpd) t�
Septic Tank Capacity (gal) ( a V 0
Soil Absorption Component Size (ft 150
Type of Wastewater Domestic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Compo ent Soil Absorption Component
Design Flow - Peak (gpd) t 5 .13
Maximum Influent Particle Size (in) 1 1 , 6 1/8
Maximum BOD (mg /L) p 220
Maximum TSS (mg /L) , h 150
Table 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, Slats. 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 filter shall be assessed at least
once every 3 years by inspection. Th outlet filte s hall be cleaned as necessary to ensur
proper o era ' n. The filter cartridge shou not be removed unless provisions are made to
re am 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 with 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 components 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
du g compaction during winter months. The action or removal of snow cover over the component may lead
p
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 which may lead to
more intense, and earlier, organic clogging of the soil.
2
Management Plan for a Septic Tank and Soil Absorption Component
Plantings of deep- rooted trees and shrubs directly over or within ten feet of the
component should be avoided since root intrusion into the component may obstruct wastewater
flow.
When system fails, we will replace with another system
at owner's expense. Alternate area must be left undisturbed.
St Croix County Zoning Office 386 -4680
Boumeester & Sons Excavating 386 -9020
Tri- County Sanitation 386 -2130
3
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE
AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyw /� t°y'�'loy"- & f f
Mailing Address g e- (R , !A
Properly Address / b '
(Verification required from Planning Department for new construction)
City/state �tX.1'Sd�'� t*'A") / Parcel Identification Number O4,0 /042!Z /O /DO
LEGAL DESCRIPTION ,+ &
Property Location 5� %., -� r/., Sec. a • T _ -R ZY_W, Town of ,5
Subdivision ` Lot #.
Certified Survey Map # �- . Volume . .Page #
Warranty Deed # K l , Volume 1 F9 Page # /b
Spec house Pf 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
mastorplumber. 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 sys in has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the three year ; e ti date.
d oP-
SIG"" " OF APPLICANT DATE
C RTIFICATION
OWNER E
wners) of
I (we) certify all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the o
th describe bo , by virtue of a warranty deed recorded in Register of Deeds Office.
e .
// /O e
SI TURL 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
reference is
made in the warranty ma if re deed
a copy of the certified survey p
u l 8 y p (� (� ,r
ST�CTE BAAOF ACONSIN FORM'1 -3000
' WARRANTY DEED KATHLEEN H. WALSH
Document Number REGISTER OF DEEDS
This Deed, made between David A. Larson and ST. CROIX CO., WI
Lee Ann Larson husband and wife RECEIVED FOR RECORD
Grantor, 05-03 -2002 8:25 AM
andKer J. Bast andDonalda J. S - Bast, husband aAR+RM "i, OED
and wife EitEm - e
Grantee, REC FEE: 11.00
TRANS FEE: 1312.50
Grantor, for a valuable consideration, conveys to Grantee the following COPY FEE:
CERT described real estate in St. Croix County, State of PAGES: FEE:
P 1
Wisconsin (the "Property ") (if more space is needed, please attach addendum):
That Part V'.E4 Sec/ 24- T29N -19W described As
follows: of Certified Survey Map recorded in
Vol. 1 o frd Survey Maps, page 31 51 as Doc. Recording Area
No . 5487 N e and Return Addre ss
eF:g �O zo
020- 1069 -10 -100
Parcel Identification Number (PIN)
Together with all appurtenant rights, title and interests. This is homestead property.
(is) (is not)
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except
Roadways, Easements, and Restrictions of Record.
Dated this let day of May 2002 J
*David A. Larson
+ * ee Larson
AUTHENTICATION p � P RY Is ACKNOWLEDGMENT
STATE OF WISCONSIN )
Signanlre(s) ? _ P ) ss.
St. Croix County. )
authenticated this day of G_ Personally came before me this 1st day of
MAY 2002 the above named
hJ S David A. Larson and
Lake Ann Larson
TITLE: MEMBER STATE BAR OF WISCON 1ty;p�
(If not, to me known to be the person s who executed
authorized by §706.06, Wis. Slats,) the fore o' inst�nt knowledged the same.
THIS INSTRUMENT WAS DRAFTED BY
#�Y a -
Michael H. Eoreaki, Attorney Nota Public, State of Wisconsin
Eau Clair® Wisconsin My Commission is permanent. (If not, state expiration date:
(Sl lauu•es ma be authenticated or acknnwled ed. Both are not neccss 09 cembgr 12
*Names orpersons signing in any capacity must be typed or printed below their signature.
WARRANTY DEED STATE IIAR OF WISCONSIN FORM No. 1 -2000
Homey Michael H Forecki 1830 Brackett Ave, Eau Claire WE 54701 -4627
Phone (715) 835 -3029 Fax•, (715) 935 -4112 Michael H. Forccki T6046612.ZFx
Prooucne wild ZipFerrnTM by RE FormoNel, LLC 18025 Fifteen Mte Road, Clinton Township, Michigan 46035, (8001983.91105
1
I
•
•• • LOOT 5 r -
' •� CSful IN
VOL. 13. FG. 3632 r p R
I
• \ Q \ ✓'r�' • � .
UNPLATTECt • L11�.\� \ \������� �� \ �����. ' ,�' I.. • t
` �� \�C�:� / '� • \ \� \� \ \\ � i�
\\ \ \ \\ \\ \�\ • fir: I
\ \ \ \ \ \ \ \ \\
to OrAW
E
��� \ \VAAVVA \VAAAAV ' ����V
. vvvwvvvvv \VA \ \VA V \�
1
I • I
ka
\j I I •
-- -- — 61 AT r"ECORDED IN VOLUME N WD IN Pt
_ _ . ST. CRpDC — �s CpV�. WIS
— 17 , �'AQE 3'f CONJ
THE ST. CROI3
I E1 /4 CORNER
- 1 � �a 1 Z. VA SECTION z4
--O---- -- --- O I ��. n �... i A.'i !1 `�.otl �.fi ii:.�r
Cl I
I f
D
T
pTE O
LOT
9;e;2
�NOTE `QqS
SEE NOTE A ;
SPECIAL DEEP CASING
WELL RE QUIREMENT. -
LO'r 2 0� MINIMUM WILD 10 9.40 /
'�` ELEVAT WILDING
ION - \
2.03 ACRE3 1051.40 � a \
89'205 SQ. Fr: • ' / y \
SEE NOTE A ' � .
SPECIAL P CASING N ib 1�
RE QUIR EMENT
-
LOT 3
2.
�.
88'
LOT 1
s�c II1L � .
y�ELL AEQUIREIyNC' ! ( / 2.02ACREs
87,827 SO. der
SEE
t NOTE
7"W A
984.71 L 1
I
' / ti • � IAL DEEP QASINp
LOT 4
2.01 ACA6S i, j S88°7s
ant
IWO
` I
BOUNDARY- RIDGE
THE A AND IN pART LOCATED IN PART OF THE E1 /4 Or COUNTY, COU 1 NTY, W SCONS NOB NG LOT 3 OF
' R19W, TOWN OF HUD
RECORDED IN VOLUME 11, PAGE 3151 AT THE ST. CROIX COUNTY REGISTER I
— _ — LOCATIa
L - - - - - - E1 /4 CORNER
\ C - - - - -- I SECTION 24
\ I
----------- \ C MINI
O N I L@v 2 W
°
------- - a !LLL
�o � I @ @m oa
\ dog � ° °
D
I �
\ \ I I SEC. 24,
\ ZONING - AG -RESI
\ \ C t lk ' I LENGTH OF ROAE
n
06 E
�3 TO TH AREA OF PARCEL
pV "•F I 12 LOTS 1 3131 A(
LOT1 • —•• —,
2.18 ACRES SEE NOTE C: - " " - - - --
SS
• / 90,812 SD. Ff. . , I , BENCHMARK DQ
SEE NOTE A: H.W.L. s - \• \
SPECIAL DEEP CASING 1049.40 \
• WELL REQUIREMENT. 1 \ • \ \
FM BUILDING
LOT 2 ELEVAnoN - 1D51.ao , • • �
2.03 ACRES
88.265 SQ. Fr- , ���.•� /
SEENOTEA: � /• •' 11
SPECIAL DEEP CASING i • I
WELL REOUBIEMENi.
/• /
----- - - - - --
OD UIaGD wy 04i an@ /
--------- -- %
/ m
LOT 3 � � i �/ :,_ � LOT 12
/ 8B:127 SO.. r. i 1 / 2.02 ACRES
/ 87,927 SO. Fr.
/ SEENOTEA: I I / SEE NOT%
/ SPECVILDEEPCASING 1 I I I SPEC CASING
I
/ WELL REQUIREMENT. 1 1 / WELL REQUIREMENT.
I I
•,. � c��� as
I LOT 4
62.01 so Fr. 1 y 1
I O 1
I SEE NOTEA: \ � Z
I SPECIAL DEEP CASING
WELL REQUIREMENT. _
I _ LOT 11
I � SOl7rH LINE OF THE SPECIAL DEEP \ � 2.01 ACRES A
I CASING WELL REQURWENT \ O
1 87,420 S0. Ff.
I 4T 'N
4 ` [ SEE
1 • ` \ `;
I ` ` - ......... BENCF9dARK
I •••••, \ U . , ELEVATION
LOT
�I 5
I i �O I - -SW39'39'W 19728' -.- --
I
121.03 5 Q. Fr. N I B
CIRCLE
g I gE 198.78 •- -
ol
pG^QG3@Id ON I ! W
WOO d ° - P @° 9 I o LOT 10 •
}y �
I $ r I N I 2.01 ACR64 b
I i 87.587 sa Fr. r
I I S
�I
O �I