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HomeMy WebLinkAbout020-1409-05-000 ° J m ~ o o 3 ° 00 ~. ! ~ 0 ao I ~ ~ a .. i i o g I ~ I Q ° ~ o c ~ ~ I _ E I o ~ ~ a I ~ ~ ~ m 'o ~ I z o I ,~ j ~€ I ~I a m ~ I I y c ~ i m rn~ I 'C p N c O Z ~ ti i ~ o .o I O N N 3 Q ~ c I ~ I I v z ~ E I o ~ Z ~ ° 'w am I N F- fA ? T LL N d Z ~ ~ C ~~~ ~ ~ I !~ ~ _ I I ~ 3 m i o v~ Y O I az l I ~ i a~ I~ d R ~ I Y ~ ~ a •~ ~ ~_ ~ O y d ~ O G N ~ ~ p I c m o a ~ ~ ~ ~ k ~ 5 ~ a ~ I hw 000 ~"4J a I c a a a I • 1V a ;,; ~ N ~ v ~„~ W J U ~ _ °o Z p ~~~ + N ~~ Y co w o ~ o ~ a i d m ~, I~ v ¢z in I ~ C7 °' = ~ H I 00 L y OD y C ~ ~ rc C~ O M ~ ~ ~ O N O W ~ o ~ O ~ rn ~ ~ O ats ~ Y~ ' ty {' Ci ~ O y ~~ - o y N -gyp = l ~'~ ~ O N= , m~ O 2 S Z O ~ U at ~ I E I ~ ~ ~ °r ~ E d ~ ~ a 1 • ~ o.m.~ ma ~ I r~ r W~ ~ L C a~ ° ~ Y ~ i i A c ~ ;o nc ! ' W`~9..... 0~.~`"(~ wog "Ev ~ ~.~^"^"~ 1 ~~ ~ e Lam, ,~ _~-~~ ~~- ~ 9 Q- ~~t u ~ ~ ~~ ~ ° ~ f ...n. ~-.~ ~ rte. _~~~~~~~ 1 ~ 61 i - w...t~ Adc,~o~aJ~ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFOR11r~gTION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Bast, Kernon Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic lrJ 6t5~2 t Zsfl Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic y ~ / 5 `~ Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Numbe TDH Lift fiction Loss System Head TD Ft Forcem ' Length Dist. to Well SO ABSORPTION SYSTEM county: St. Croix Sanitary Permit No: 430054 0 State Plan ID No: ~ ~~ Parcel Tax No: 020-1409-05-000 Sectionlrown/Range/Map No: 24.29.19.2563 ELEVATION DATA STATION BS HI FS ELEV. Benchmar 3- ~ Alt. BM Bldg. Sewer SUHt Inlet $• ~~ Q ~ /~ 1 SUHtOutlet ~~ ~ Dt Inlet Dt Bottom Header/Man. ~o.t 3.3z' Dist. Pipe +t- ~ ~.~ t w ..~ ~ ,o ..~ ~ q 3, 03 Bot. System ~ I • ~O ((•,S`ti ~ l• ~,Z.oO r Final Grade g~&.er ~~ , f ~S- a 3 St Cover ~' ~•$ ~~ Oi ~ ~ I ~j•~S ~~•~~ i BED/TRENCH Width t Length ~ No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~' ~ •~ 3 SETBACK SYSTEM TO P/L BBLDG WELL LAKE/STREAM LEACHING Man r INFORMATION CHAMBER OR ~! ~~ S I ~' ? • l r Type Of System: t UNIT Model Number: (t t,..o v~J. ~ z S "` SD .0 DISTRIBUTION SYSTEM Header/ anifold tt Distribution Pi s x Hole Size x Hole Spacing Vent to Air Intake ~ - Length Dia Length Dia Spacing . ,. S~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Onty Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil [~~ Yes ~ No ~-, t_<,.~~ Yes No COMZM•EI~TS: /(1I~,c~lude co a dis~nciAs, persons present, etc.) Inspection #1:~~ 7d73 Inspection #2: / Location: 81 Hidden Lake Rd Hudson, W~I/''54pp0._16 (SE 1/4 SE 1/4 24 Tt29~N R/19W) Boundary Ridge Lot 5 ~ Parcel No: 24.(29~1~9~.25~63 1.)Alt BM Description = t.S~• 5•T• `^'~ ~~ °fiM(v~ e ..~•.. Z~ ~~` - ""'^"'r ~~ 2.) Bldg sewer length = C~'r' ~ ~ 'R~'S~ !~°'~ ~S~ Q.r2 Y~"" , - amount of cover = + Lo S.a~ car+.~ • I~-tOfl C'T'r c~) 3) No ~..~.P ~- .~~t.~~, ~,~. Use other's de foruadditional information. No V'r'Q ~ ~~____ __ _ -_ __ _- - _ '-_- - __J ~ ~ _ _ q ~- . Date I sepctor's Signature Cert. No. SBD-6710 (R.3/97) Safety and Buildings Division County s T ~ ~ ` 201 W. Washington Ave., P.O. Box 7162 r ~ it ~S~O~~~~ Madison, Wl 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) i (608) 266-3151 3 ~~, ~ 7 y De artment of Commerce . Sanitary Permit Application State Plan LD. Number ~ personal information you provide Wis. Adm. Code !n accord with Comm 83.21 , , ma be used for s Privac La """"'°"`..~ s y econdary purposes .-.~Y.-sl'~f'~~~_ ~-~ a Pro ect Address tf different than mailin address) J ( b' ~ / g f~ ~ ~ ~ ~ ~ /.~kd I. Application information -Please Print All Info tion ~ MvJ13-, t~~ ~ Yo~G Property Owner's Name '/~''~ ~ y~ ~,~ a ~t ~ .. _ Parcel # L.ot # Block # . ~ ~,} ~~ ~ ~! ~ ~ 1 , r.""_ .... . Property Owner's Mailing Address ti i ' ~ ~ ~ { ~ ~%f= -°- ~ Property location ~ :>:_..-....---.....- v p ~G~ ~.4.. ~~ r Q..f h - C ~ ,,. 5 G t~. Section L ~ ~ City, Sta e Zip C o de e Number Pho n , , _ ~ t ' N l-' la. -S b r~^a. ~ ~ ! / ~7 0 ~lp ~ / ~ O fie' ~ ~ 7 S (cu+cl T~N; R,~ Eo I Type of Building (check all that apply) I _ . . ~1 or 2 Family Dwelling - Number~edrooms Subdivision Name CSM Number 3 1-Ci,un.. a t 3-Tca~ l(c* , ^ PubliclCommercial - Describe Use ~ / ~av ~r :~ ~.~ . . ^ State Owned -Describe Use / ,3 ~/, r~ tx ~ ai.C ~f,! Ctl ~ f tw ~ G.-{~ ~ ^City_^Village ownship of /""`~ u o Ill. Type of Permit: (Check only one boz on line A. Complete line B if applicable) `a" New System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner . IV. T of POWTS S stem: Check all that a 1 '2 a - ~ m ~ ~ ~ -'' Non -Pressurized In-Gramd ^ Mound >_ 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized ln-Cttound ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recir+~ulating Synthetic Media Filter ^ Leachin tlranrber ^ Ihi Line ^ Gravel-less Pi ^ Other (explain) V. Dis rsal/I~-eatment Area Information: Design Flow (gpd) .. . - Design Soil Application Rate(gpds0 S Dispersal Area Required (sf) / ~ Oc3 ~` is Area Proposed (sf) 1213 ~ ystem Elevation . ~~ ~? C: f'` .~ . : . ~ . Vl. Tank Info Capacity is Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallows Gallons of Units Concrete Constructed Glass Ncw Exiaaing Tanks Tattler Septic or Holding Tanlt ; - Aerobic Ttcatment Unit Dosing Cbambcr Vll. ltesponsibIIi Statement- I, the undersigned, assume responsibility for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Si tore ,s~ ^' P al MP/MPRS Number Business Phone Number ` Plumber's Address (Street, City, State, Zip Code) .. ~- pt~ ..q ~ ~ t",.~' /'~t.! ~ 9 ~. r` ~ t~ ~...» ~ ,~ ~t~: t{ ,, ~;. !-, i .~, f !'~ ~ ~f J) ~ ro VIIL Coun /De artment Use I $( Approved ^ Disapproved Sanitary Pemilt Fee (includes Groundwater Date Issued ]ss ' g Agent Si a (No Stamps) ^ 'ven Reason for Denial Surcharge Fee) ~ ~ w,~_ ~„/~ / % ~p .. 1X. Conditions Approv aeons for Disapproval ~ _ i p ~ ~ (`^~`S a~aiLt,pv~ ~~ ~o-r" ~. d e.J t~ i 6-~ `Q~ v1. ~ px~tnn~,t ti't' S I /~- S Jw. ci. vwa.wv~ ~ASSL ~~ f~-~-~ ~ tJ~.l 1 ~- C~~ , Attach complete plans (to the County only) for the system on paper ooc teas ctcaa auc x t t mcnca to size SBD-6398 (R. 01/03) K~rL Non ~~~~ ~~~ ~~~ r ~ .. J ~~ V n~' / ~-' ~ of ~- ~(y /Sti , ._. _ {{ ~. e s~~~ r • ( "' V' .~ ~ ~-" ~ r __ ~ ~ ~ ~ ~ eC '` ? a r~ i,~ ,, ~ ~ ~ '; - ~ '~ ~~;~ ~ ~, ~. ~~ }. i t ,~~ J `vQ ` ~ f i ~ 7" ark K i rs.t/ ~.~ ,_ e ~ 0 k ~- i _ (~ // s a ' \ .!- .f art' i i t ~~ __ . -...~....~~.__.....~.y--.-- r _~. _ _~__~w. . ! 'k ". 1 A J ~' j (( r\ r ~' r ! '~ J/ ) ~'("/~ J'~ / x ~~+ Y{ ~~ r G- 3'~~( Q `~ u ., 3 ~ ~~. ~ . ~ ~ ~ ~ .. ,, ~y ~~ , *r,, - ~ ,' ~ , ~~~ ~ ~~ ~~ ;~`0 v ~y11 1~ ~ ~ ~ +. ~ ~ ~ GrfaK ~Pe-Q/ ~ `~°, ~- ~ ~ ~ ~ ~~ 4 ~w N+y~~~ ~ F,~t ~ t ~..` ~ c :~A1 ~.,--- ~~ 1 ~ ~ ~~ .,; i ,,~ ~~~. k~ ~~{ ~~ ,--. e ,. r Wiscx>nsin Deparhment of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings ,,,,,,,,,~,,,,e ,,,;,,, r,,..,.., n~ tinir~ e.~.,, rrv~o 1649 Page 1 of 3 A.C.E. Soil & Site Evaluations Courrty _ Attach complete site plan on paper not less than 8'/ x 11 inches in size. Plan must St. Cfobc include, txd not limited to: vertical and horizontal reference point (BM}, drection and and location and distance to nearest road. north arrow scale or dimemsions percent slope Parcel I.D. , , , 020-1409-05-000 Pl inforn-atfon. evi gy Date Personal information you 'de may ~fyr~~°ses ( acy law, s. t5.04 (t) (m)). O(P p 3 Property Owner I Property Location Kernon Bast -¢ Govt. Lot SE 114 SE 1/4 S ~ T 29 N R 19 W Property Owner's Mailing Add Lot # Block # Subd. Name or CSM# 948 LaBarge Road S ~, ;~z,;;~ ~,~,;; ~; ~,~ 5 Plat Of Boundry Ridge City tate~L~ ~.:~Ph(fdE Num J City ~ ~Ilage 11' Town N~rest Road Hudson (Wl 54016 715-386-7775 Hudson Hidden Lake Road New Cor~truction Use: t~' Residential /Number of bedrooms 4 Code derived design flow rate 600 J Replacement ~ Public or commercial -Describe: Parent material Glacial outwash Flood plain elevation, if applicable nor General cornments and recommendations: Install 3 trenches at elev. = 92.00' using 39 leaching chambers. Each trench to be 3' x 81.25' using 13 chambers per trench. GPD Bonng # -f Boring iY' Pit Ground Surface elev. 95.79 ft . pepth to limiting factor > 120" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Siructure Consistence Boundary Roots GP D/ftz in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Etf#1 'Eff#2 1 0-6 10yr32 none sil 2fcr mvfr as 2fmc 0.5 0.8 2 6-25 7.5yr4/4 none sicl 1 msbk mfr cs 2fm,1 c 0.2 0.3 3 25-39 10yr4/4 none cos & gr 0 sg ml cw 1fm 0.7 1.6 4 39-56 7.5yr4/6 none s & gr 0 sg ml cvv - 0.7 1.2 5 56-92 10yr5/6 none s 0 sg ml gs - 0.7 1.2 6 92-120 10yr6/4 none s 0 sg ml - - 0.7 1.2 t ~~~ ~r ~a.~p ~,'f`~ ~~ ~~2' a Boring # Boring Y' Pit Ground Surface elev. 98.37 ft. Depth to limiting factor ~12T' in• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots t~ D/fl2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-8 10yr32 none sil 2fcr mvfr as 2fmc 0.5 0.8 2 8-20 10yr4/4 none sil 2fsbk mfr gs 2fm,1c 0.5 0.8 3 20-45 10yr5/4 none sit 2fsbk mfr cw 1fm 0.5 0.8 4 45-56 7.5yr4/6 none Is 0 sg ml Lwv - 0.7 1.2 5 56-88 10yr5/6 none s 0 sg ml gs - 0.7 1.2 6 88-127 10yr6/4 none s 0 sg ml - - 0.5 0.9 H#6 contains 1 /4" - 2" bands of 10yr4/41fs at 4" - 17;iat!ervalr. Loading rate of horizon reduced to reflect restricted permiaf~ility associated with banding. * Effluent #1 = BOD y> 30 < 22p mg/L and TSS < 150 mg/ ' #2 = BOD < 30 mg/L and TSS <~0 mg/L CST Name (Pl~se Print} Sig ure: CST Number James K. Thompson g-- 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane. Osceola. Wt 54020 6/142003 715-248-7767 ~'~~ °/~. ~ prey p,,,,r,ef Kemon Bast Parcel ID # 020-1409-05-000 Page 2 of 3 Boring # .;.~ Boring !~ Pit Ground Surface elev. 96.89 ft. Depth to limiting factor >!22" in. Soil Application Rate Horizon De th Dominant Color Redox Description Texture Structure Consistence Boundary Roots p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EtT#1 •Eff#2 1 0-7 10yr3/2 none sil 2fcr mvfr as 2fmc 0.5 0.8 2 7-23 10yr4l4 none sil 2fsbk mfr gs 2fm,1c 0.5 0.8 3 23-48 10yr5l4 none sil 2fsbk mfr cw 1fm 0.5 0.8 4 48-53 7.5yr4/6 none Is 0 sg ml cw - 0.7 1.2 5 53-93 10yr5/6 none s 0 sg ml gs - 0.9 6 93-122 10yr6/4 none s 0 sg ml - - 0.5 0.9 H#5 & 6 contain 1 /4" - 2" bands of 10yr4/4 Ifs at 4" -17' intervals. Loading rate of horizons reduced to reflect restricted permeability associated with banding. ^ Boring # Boring Pit Ground Surface elev. ft. Depth to limfing factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ^ Boring # J Boring J pit Ground Surface ekv. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 =GODS<30 mg/L and TSS <30 mg/L The Deparhnent 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. /G S~9 /" s~o' ' eda~ua~v~-~ ~-Et d~Q~o~ S~a~ aou•~dry,(~, d~ c 8.0 'coy, focc, ~, 3 0~3 Safety and Buildings Division County r~ 2U1 W. Washington Ave., P.O. Box ?162 ~. C(ZD I K, ISCO~Ss~~ Madison, wI 53707 - 7162 Sine A De artment of Commerce '~ ~g f-{.lpp~ [,~{~. ~p Sanitary Permit Application I d i ~~''' Pe t Number ~'3oos~ n accor w th Comm 83.21, Wis. Adm. Code, personal information you provide ^ Check if Revision ma be used for seco ses Privac Law, s15. 1 m I. Application Information -Please Print All Information State Plan I.D. Number Property Owner's Name - Parcel Number D20 - /~f oq~ - 05 =c7at~ . k E le N o ~ t31~5T" Propcrry Owner's Mailing Address ~ ~ ~ L 0 0 3 Property Location tt ~? t! 0.Q~r ~ I~G _ SF- uSE,~•s Z~ TLf N R~~! City, State Zip Code P s ` ' ~. ~.~ .-r FIC= , Lot Number ~ Block Number Subdivision Name CSM Number I~v~SoN WI S~lpi~ 3$~ 7715 Bpi ~, ~2,O~E II. Type of Bur~ding (check all t aPPly) ~ P u~~ ~ . _ ^Ctry LL'' ^ 1 or 2 Famil Dwell' T y nog -Number of ms ^Villa e ^ Public/Cotnmerc' Describe Use ' ~~ ~ g ownship ~ l,J s O_ Cs ^ State Owned .a w~b~" ~ ~ Nearest Road 3'X ~ S' ~o.nc h t S /Zc~,- 1~s atc4 T..~,.I, N-'dd~+~ t ~.k~..:- ~aQ III. Type of Permit: (Check only one box on line (n scheme for internal use). Complete tine B if livable A' 1 ~ New 2 ^ Replacement System 3 lacemeat of ^ Addition to For Courrty use stem 'I' mm B. ^ Check if Sanitary Permit Previously Permit Number Da lv. Type of Permit: (Check all that ap (numbering scheme Ls for internal ns ,(x,/ w /00 ~i~ ~; /t./, 44 ^ Non -Pressurized In-Groin Moues 47 ^ Sand Filar ^ Constructed Wetland 22 ~ Pressrrized In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 Line 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other V. tment Area Infotmat ion• Design Flow (gpd) Dispersal Area Dispersal Soil Application Percolation Rate System Elevation Final Grade Required Propo i X23 9 Ga1s.lDays/Sq.FK.) (Min./Inch) Elevation boo t sac~l~b) i soo ©. Yo `~~.od ~ '~>,s-a' VI. Tank Info Capacity in Total Number Manufacturer .Prefab Site Steei -Fiber piasbc Gall Gallons of Tanks t Concrete Corutructed Glaze New o I ~ O/~St~ 6/~ r • J Tanks Tanks Septic or Holding Tank / / _ / Z SC / ~ a /~ r' $ ~ r Y1G p M1,60 VII. Responsiblllty Statement- I, the undersigrted, assume respoastbility for installation of the POWYS shown on the attached pleas. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number /"Gllk~ Wl` S~oKall ;i/re.~.• r Z ~ S`D ,S'fo G/z -' 86s /~"Z-7 Plumber's Address (Street, city, state, zip Code) 0 o N u ~Ta 12~eQ e.- !~ ~ ~ fa ~ ~J a n !.(/ / S5/0 /6 VIII. Cozen /De artment Use Onl Approved ^ Disapproved ~~' Permit Fee (includes Groundwater Date Issued irrg ent Signature tNo Stamps) Surcharge Fee) ^ Owner Given Initial Adverse ~ Determination ~ 2 2~ ~ l~' ~ . IX. Conditions of ApprovaUReasoas for Difsapprloval ~ ~ ~ a.o ~' v~-vta oa^ ~~.~ SBD-6398 (R. OS/Ol) Attach complete plans fhe Count? od7) far a~atem on paper oot na than s Il Inches !a atu 'S6" ~~ '~_~fsr ~ ~~~,v~ w~ ~--~.. ~ --- o , 4 ~o. .} m f -t \_ ~ c ~c •. q n L ~ n o o - ~~ ~. ~ ~~~V 'b ~ 0 r _ ~ # n O 0 ~ N ~ ~+ ~ N p x o ~ ~ 1 [~ ~ ` ~_ P ~~ f M ~} `f 1 Y ~- w ~, 1 ,---. ~+ N ~ ~ 1 ~ ~ m N Q ~ ~? ~~ _y 6 ~ r) " ~G b -d . (_- 0 ~~ ,~~ N/ ~ ~~J ~;. ~, t 2~ a'~''~ 1" _..,_...~.,r~~..~__.._ _ _ ~ ...._. .32D, Sv ~ ~/1~ Sra/cJ . 1yEST L ~ C/~t/,E 00 ~__...~--P ti m ~' f t ~~ ~. o ~ ~ -~ ~ d c -C i. tJt ~t N~ w ~ o * e ~ N ~- ~ cr h ~ ~e°\ ~w~v ~bZO ~,$~~ ,~ .. ~. 0 ,~ N -_ ~+ n w O ~ ^J V'1 ~ ~ a ~ s r ~ f ~' ~~ wl 6` -n 0 ~, v Z, m N~ ~ `~_ i~ ~-1 ~ i~'~ 6 ^b i o `O '~/ •~ W ~~ ,~ ca d2 N J N \ ~ ~ I 111 ~ 1 ~ ~ _ : ~ d •..,~~ ~~ T . of ~1P/'~o~ . 'Msconsin bepartmenl of Commerce 1lyjsicsr of 5ately and 8ulldirigs - 3 5 Armes ~ MA-~ d i2 ~i,4-~ /~~,v~i'~G- SOIL EVALUATION REPORT In accordance whir Comm 85, Wfs. Adm. Code nllach cornplele site plan on paper not less Ilan 5 1/2 x 1 t Inches In site. Plan must hulude, but not Iindled to: ver)lcal and hodtorrfal reference point (BMI, direction and percent slope, scale or dimensions, north arrow, and locaifon and distance to nearest road. Please print All infonnatlon. personal Inrormopon yo~.r provide may be used for secondary purposes (r'rivary lew, s. 15.01 (1) (m)). Properly Uwner ~ Properly l.ocalil Page ~ or 3 County ~'; r!R Ol Parcel I.b. 020 ' /O(o 9 • /Q • /~ R ed by nn bale KEI~NoN ~fFST / D/NA~t~~4 oNOot ~~ 1/d 5~ I/4 S 2T T ~ I N R // ~ cort W property Owner's Malting Address of M Block p Subd. Name or•G6Mq ~~ 9`/ 8 6~ /3rrR<r~ ~!~ • 5 M ~3oaN~,4-RY ~P~f~i~~ City State Zip Coe Phone um er ~ ~ City ^ Village ~ town Nearest Road - Ifv~So~ Gvl. Syo/~ ~ ~~.~S~cA~r~ ~f vf>SoN ~ l I3AA/•~~Ds ~~ - New Construction Use: ~ Residenilal / Nornber of bedrooms Code derived design Iiow rate y5'!J' "" ~lJ~O GPb [_] Replacement [] Pubtlc or commercial - bescribe: h:,rent material ___ ~~~ p (~~~~?"j/~~ Flood F~latn elevaflon H appllcabte /V /t, General comments +t~ d,p and recommendations: .~J! r ~L~~ sV~•~7~J/~ /~/( /Ny/~OU.uv ~Q,~j~~j~,~~d,~~L s y sr~ - w,r~-~.. ~a w ~D~,~~,~G-- ,~~-~-~-s ~ . y ~P~~~,~. ~ ~ ' / 'Boring $ ~ Boring ¢~ Cv > ' III "' 111 ~ PII Ground surface elev J tl b ll I li iti f t ~2 I . . r ep o m ng ac or n. Solt Appllcatlon Rale horizon bepih Uominanl Color Redox bescrlption texture Slruclure Consistence Boundary Roots GPD/ttt . in. Munsell qu. Sz. Cont. Color Gr. Sz. Sh. 'EttMt 'Ettp2 ~ a • r a ~ ~ y~ 3~3 - G / ~shK .aM~r~ ~ 3 f . G y ll • ~y a~R y<~ ----- Sim / fsh~ ~~f' cc~ . ;- , 3 r t3•~ ' S`f a (~ ^f I Boring !f ~ Boring ~~ ~~ ~ ~n LL ~ hn C;rrnlnd surfars+ atnv • n n....~ti ~,, n...u~.... r~_.__ lJ ._ Norhon beplh bomhlanl Color -tedox Descripllon texture Slruclure Consistence Boundary Roots A011 nppnc 6P aaon trace U/ti' in. Munseq qu. Sz. Cont. Color Gr. Sz. Sh. 'Effflt 'Etfi1Z / o• i io e ~, /~s~ ~~R w 3 f z /o S/[.~ Zfsbre % w ~ r~ . s _ --...~~..... • - ~~,~s - ~~ = ccv rrryrl ano r a~ eau ~ r5u mg~~ ' Eflluenl i!2 = BObs < 30 mgl~ and TSS < 30 rr1gJL CST Name (Please Print Signature CST Number Address Dale Evaluation Conducted Telephone Number ht 8 Associates l2. '' ~ ~ Z_ ~/,S • ~~ ' $~ ~ S Prlvata Sewage onsu 655 O'Nsfl Rd. Hudson, Wis. 54018 florhrg ff t._1 gyring y ~f t/Y hit Ground surface ctev. _~" 7 ~ (l, beplh to Iimllina fartnr , ~ ~" to ~• .: ~~ 2 3 page of tlorh_on Ueplh Uorninanf C l Soli Appitcatlon Rate In o or Muns h Redox Description Texture Shuclvre Consistence 8ounda rY Roots GP U/ry: l • o •~ e ~oYrP (]v. Sz. Cont. Color L Gr. Sz. Sh. ~ fshe .~~~ w ~ ~ 'Effl11 . f` 'ER!!2 . G 6 • a .y ~ SG / ~-7`,P Qom` - . y •~ ° ,Si ash ~' ~" a - s r-~ _ . ~ f)o-ing !! U ronng Pit Ground surface elev. fl. beplh to Iimlling factor In. t Norizon bepfh Dominant Cotor Redox Description Texture Siruclure Conslslence 8ounda Roots Soll Applicallon Re In. Munseh rY Gf Dllt' Qu. Sz. Cont. Color Gr. Sz. Sh. _ 'Etfif f ~ 'Effsr2 I I ' Emuenl fit = BOUT > 30 < 220 mg/t. and TSS >30 < 150 mgl~ • EOluenl ff2 _ 9Obs < 30 mQl~ and TSS < 30 mgll. '1 he beparlmenf of ("on-merce is an equal npporlunity service provider end employer. If you need assistance to access services or need material in an alternate format, please contact the department at G08-2GG-31 S I or 7TY G08-2G4-8777. enn.a~nrR Rmrq LoT-#~S . D, sP~~. ~3~sr ~~,,~ s 3~ K /3~sT ago . io~~ •io ~ /~ hrorierfy Owner _ parcel Ib p poring p U Boring i -' ~(~, hit Ground surface elev. ~~ b tl. beplh to Ilmllinq factor' ~~ In_ r . ., .~ • , ~Go l `~t N) ,vo . ~o T 4 N~-- 5~ t,~~°~ G ~~'~ :' ~; 3µ a~ Yy Tb~ h~ ~, ~ ~' a URI~E~d ~~s ~° ~ Co~N~, N~ ~ ~ ~ 5~ bd ` l ~ ~.~ i~ i~ i • - ~~, ~----~ . ~ ~ ~- 0 ~/ 0~ a 9[,~0 ga 22 , ~-- li 'lj /D ~_ O sir i ~'P °~ yy .ems ~~ ~ ~, ~~ ~~ v 9~•S cr 91~.s z- TOTAL DYNAMIC NERD/CAPACITY PER MINUTE EFFI II FII T' d11n neW aTe e,.,n h'. It W G{ lln' )x ~a77 ' ' 107.170 G{, ld"i ~ 101 ,1W 101 O{ :Ltr7 100 ~,101~ 10.7 Gal L91 91 a71 If6 G{. lh. 61 t11 1% G{ lh. Ia! 0{ lh. a -~ IY G{ VI. 156 N1 IW Ga v.. 156 X7~ )1 al 2ai :' 79 700 loo '7n~~ el ~:'z71~ e1 mi'~ w ?27 14 660 Isl 1771 ai a7 u •i70 L5 % a+ au Jd n 7u: 1 ao 2a7' ' ao m sa 220 lax fJ7 Iw sa.-1 170 ! JO~~, It 0 0 7f ~?a~ 66 ;211. do a27. a7 211.:. 66 a06'~ eo .?2) 6i -m 4 ?1D. 10 ;'110 dt ?20 W x20 51 ,7~ 176 bll 12• W 121 f66 la0 6~]V 17,7 9.:7 ~ y 1 '~. .. b 17f~ xl -10~ - 16 ,172: ]J ~.1>S' I L ~ A 66 aoa al ~..19t. U '..161, 78 '2aJ N .~ 21 a 70 ~ 1>e ,~ x20 61 21V M x20 IC6 197 SO 711 71 x60 11+ a]I 100 l.y ' 1,5 )Z ' JO I I 1 10 " '>• u 197 61 I % 70 766 ~. 11 67 18 170 b IC6 f+ Yr 73 Ix1 2 1 77 I N I1 I6 11 )5 ..... __. 7 ZO 1 ]7~ .~ __ IIS- 91' 117' EFFLUENT &DEWATERING Warning: Model 185 should not be subjected to less than 30 feet TDH. Note: For Nead Capacity on Model 112, industrial column-explosion proof pump, see FM 219. GgllC TER, ,, ?1 _ BO IS i2 _ 70 10 _ 85 It __ 80 S: It 50 11 15 1 i __ /0 )S 10 . 70 2 .__. 11 8 -- ?0 t5 / t0 7 -- S 7 ~ Ggt107:5 \ F--'_~- :, \ '. iTERS 0 80 180 210 020 ....... .~~. w~.+-v.. SEWAGE~& DEWATERING WARNING: P~1odel 293 should not be subjected - to less than 15 feet TDH. -1-~ TOTAL OYNAMt~ MEAD/CAPACITY PER MINUTE I SEW7(OE AND pEWATERING ~ ~ _~- SERIES 217 299 717 191 211 -~~ 7H 191 297 i FT. M Gal. 11r7 G11 LIl1. G11. llrs. G11. Llrs,' G11. lll3, Gil. llr1 GII Llr i I G l 2W 191 _ ± 5 1.57 90 N1 txa /a1 110 /a1 110 1a/ 170 191 . . . , I lr1. 190 99t 110 570 GII llrl G11 tlrt 10 ].OS 90 72) IS 1 57 17 5 B9 JJ7 99 7J) 09 771 95 760 159 59a 111 1a9 I% 717 lal 695 1?5 357 NS i7/ I . . 05 50 199 50 199 50 199 6J i7a 175 511 106 101 I]0 197 70 9.10 t0 79 10 79 10 ]a 77 I11 109 10 195 915 195 700 i 15 7.9? 1 99 477 n9 i50' 150 16a 16a 6]6 70 9 11 7a 19a 9a 157 100 101 179 Sr5 IS7 Sfn I 10 17.19 -' --- y 197 17 t)0 90 710 111 ISa ___ 110 S]0 __ 50 1511 __ S 19 50 199 ~~ 91 759_ ~ _ n7 U1 - T- 60 19 ?9 -- 19 710 99 ]]7 .I ' 70 71.71 _ t7 19 _ ___~ SS 2?7 r' Lo01 V/lv! 19' 11.5 21 5" 11 5' ' ' 75 95 ~ . . 28 75 1?' S0' a? 77' ~ .. I I _ 29 I I - I ~ i J -- ~ ~-r ~ - 282 - __ 292 I 282 286, 287, 28B 281 291 _... 295 t0 20 70 10 ----'-`--~ - 50 80 )0 80 90 100 110 120 17 J I 0 110 150 180 170 180 190 200 210 220 270 HEAD/CAPACITY CURVE 100 18u 58~ I _ 8-qp _ I )2~ I ~--- eoo < -.._...1 eeo __ ~ l 1• / f • ~ ~ o ~ ~° ~ I ° Z u - - ~ \ n nnn , iA I~-~ O '~//~~ V/ W Q ~ ~ N Z W~ ~ ~ ~~ ~' NO w O ~~. I O _ ~^ a ~ OK~ ~U~ z l ~ _ ~ Y ~ ~ ~ o _- ~ ''' to I ~ cn Q 0 0 r. o f-- w~ v a ~ Q a N od\ ~ ~n W U ~ OU ~~ O _ ~Q zz ~ ~ o o_ I ~~a O ~ o /~ ~ ~ Q Q U J J Q F- (n ~ ~ ~ r --~ d m ~ ~ ~ 31nO ~W o o oh oQ ~°N coN ~ ~j ~ ~/1 ~/~ m ~ m N 1- Q CO N Q ~ ~ n ~ Y J V/ F: J f~ N in N ~ ~ a Q (V .- \~~ .. (O~ CO -Jw~ J~U JZ~ ~ ~ ~ N ~ r O Z O~O~F- 3p= S2 pmY pO2 Q ~ o3mo~=w3m~~ °z~~ °z 3~ ~ ~ Q z z ~ J J o ~ Z Z (J J O „~S F- W J r Z_ ~~ N i I ~ / ~ I I ~ l 1 I ~_~ ~ I'' I I I I I I I I I I _ 3 •I{ i w . 3 ~I ~ 5\ ~ w_ ~ ~ I 5~ ~ ~ , a O J ~ W ~" v a I i ~ I (~ U I I I I ~ (n I I ~ „9 „~ I I I I ~ I ..LS ~ ~ -- , '~ ~ ~ I i • ' i I 1 ~~ ~ 0 ~ ~ / I I ~ I I F- w J f- O „98 „OS „99 ~~2~oN Bgs7- r30.c/iJ.~,~~' ~~/~~€ Lo~'~S. ,~/u-~'~Q~6~.~sT~~~-l _~ ~o 00 00 ~o 00 00 00 ~o 00 00 00 ~~ coo coo 00 ~o coo c~c~ coo ~© coo 00 00 ~a ©O OO n© U ~~ i BioDiffuser Specifications Private t~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 Desian Specifications Sanitary Permit Number ~ ~~ Number of Bedrooms Design Flow -Peak (gpd) c7o Estimated Flow -Average (gpd) OfD Septic Tank Capacity (gal) /ZSo Soil Absorption Component Size (ft2) Type of Wastewater omestic Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow -Peak (gpd) 2 Z ~ ao ~7~-S Maximum Influent Particle Size (in) 1/ Maximum BODS (mg/L) 220 Maximum TSS (mg/L) 150 ~u~Br1. Tab le 3: Maintenance Scneduie 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 tic tank and outlet filter shall be assessed at least once every 3 years by inspection. Th outlet filte shall be cleaned as necessary to ensure proper o ration. The filter cartridge shou d not be removed unless provisions are ma a to re ain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Sceptic 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 enfering a confined space. The atmosphere wifhin the septic or other freatment 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. 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 least once every three years. The inspection shalt 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 Management Plan for a peptic Tank and Soil Absorption Component ST CROIX COUNTY SEPTIC TANK MAIN'T'ENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Bu er v J~ ~~~ _ Y Mailing Address ~~ '/ '~ Property Address (Vcrification required from Planning Department for new lakes R~. City/State ~~~.~ ~ w 1 Parcel Identification Number ~ Z e - 10 ~ q - / O - / ° LEGAL DESCRIPTION Property Location S ~ %4, S ~ %., Sec. Z ~ . T 2g N-R / 9 W, own of N~~Sa'^ Subdivision Lot # S Certified Survey Map # S4 A?Sl ,Volume 1 ~ ,Page # 3 I S 1 Warranty Deed # to7 80~/ ,Volume ~ $ ~ Page # a 16 Spec house ~ yes ^ no Lot lines identifiable [~( yes ^ no SYSTEM MAIlV'I'ENANCE 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 standazds set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification t our septic system has been ma' fined must be completed and returned to the St. Croix County Zoning Office within 30 ys a three yeaz exp' e ~ /i-3 SI NATURE OF LICANT DATE e certify that all statemen on this rm are true to the best of my (our) laiowledge. I (we) am (are) the owner(s) of rop escribed a ve, y v of ed recorded in Register of Deeds Office. - / TURF OF AP I ANT 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 Number + I STATE BAR OF ~SCONSIN FOAA1"1 WARRANTY DEED This Deed, made between asvid A. Larson and Lea Ann Larson husband and wife Grantor, and Karnon s. sast,andDonalda J. ~pger-Bast, husband ..a :ro Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (the "Property") (if more space is needed, please attach addendum): That Part of E;SSE~t Sec/ 24-T29N-19W described as follows: Lot 3 of Certified Survey Map recorded in Vol. 11 of Certified 3urvay Maps, page 3151 as Doc. No. 548751. Together with all appurtenant rights, title and interests. 6 7 6 0 0 1 KATHLEEN H. MALSH REGISTER OF UEEUS ST. CRUIX CU. , ttI RECEIVED FUR RECORD 05-03-2002 8:25 Ali haaeavrr r,Ecc 'eX6'4~'r v REC FEE: 11.00 TRANS FEE: 1312.50 DOPY FEE: CERT CUPY FEE: PAGES: 1 Recording Area Name and Relum Address ~F~ 020-1069-10-100 Parcel Identification Number (P1N) Thig 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 1st day of MaY 2002 AUTHENTICATION Signature(s) TITLE: MEMBER STATE BAR OF WISCONS~ (If not, authorized by §706.06, Wis. 5tats.) THIS INSTRUMENT WAS DRAFTED BY Michael H Eorecki Attorney to me known to be the person s who executed the fore o' inst~nt t cnowledged the same. ,c.,~-. f + a Not Public, State of Wisconsin My Commission is permanent. (If not, state expiration date: Si natures ma be authenticated or acknowled ed. Bom are not necess -- 'Names of persons signing in any capacity must be typed or printed below thew signature. WARRANTY DEED STATE BAA OF WISCONSfN FORM No. t-2000 omey Michael H Forecki 1830 Bracken Ave, Eau Claire Wl 54701.4627 T6046612.ZFX me: (715) 835-3029 Fast: (715) 835.4112 Michael H. Forccki Pn)d+CaC rrilh ZlpFam^' br RE FormWM, LLC 18025 FanNn MN Roa4 Clinan TamrMp, Mfrhpan 19035, (800) 393-9805 j~Cl N ' Ol0.c./a~i . +David A. Larson ~~ r + ee Ann Larson ACKNOWLEDGMENT STATE OF WISCONS)N ) ss. St Croix County. ) ~ Personally came before me this 1st day of ~,V 2002 the above named Dav'd A Larson end Lae Ann Ls~son /~ -~/ i ~aa i r ~ I 1 ~~ ~9i •- ' ~ ~ W ~ 0 s ~ ~ " ~~ 0 0~ ~~oc , : ~~ -- _ sls L._._._,4s•ounn,z~,LVe~oN-'- - . . ,. __ ~~'~ _~_ ,~ O~m ~_... _._. ._. . ~~~ _.:..... ...-=-- O ~ ,, ,lZ'L9l ~• .~ .~ zd~ ' I ~. . ,~ ~~ O N~~p ~ V- -~ ~G•~~ m ~ `~`~ ~ ~~ ~. o ~ g -- ,L9'LBZ • N~ W ~~6'066 L AA. LE~b9o00N ----------------------------------------- g 6l0't9813.90,0O.OON) ~~o 'S~~O ~ ° Q~~~~ ~~ --~~~_------------ ~---- ------ t ~ ~~~ ~! ~ i ~~~ ~ ~p i ~ ~o ~~~ °~ ~ ~ ~ ~ ~;~ I ~ ~' ~' ~ ~ I .a.~! ~ \ .~~. ~ ~ ~