Loading...
HomeMy WebLinkAbout020-1395-04-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and B.iilding Division 1 1, INSPECTION REPORT Sanitary Permit No: 420345 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: PLUMMER,JOE AND MARY Hudson Township 020-1395-04-000 CST BM Elev: Insp.BM Elev: BM Description: I00 / /00' Slrolrilj door • 1( TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic • Benchmark (,l/Jl� /� 5.-_7 Dios-.9y�� 16t Z�� Dosing /) /U (/ Alt.BM CS'T nlytyti'1 0^* c h, . .4..r / d. I Aeration �d - Bldg.Sewer (/_ Holding St/HI Inlet ., &'z 4/4- ' '7 St/Ht Outlet ! TANK SETBACK INFORMATION Z7i z4G t01 TANK TO P L WELL BLDG. Vent to Air Iryake ROAD Dt Inlet wyN pl SEGR-Wn - Giys Septic ! 7 r 4D l y 7 Dl Bottom Dosing Header/Man. Aeration 1 Dist.Pipe �r / ' '� ` Holding �' Bat.System Z 13• 9�-�5Da /`— Y2 .1 -Q At-O PUMP/SIPHON INFORMATION Final Grade Ma facturer Demand St Cover GP1 10.2. 7� Model ber TDH Lift Friction L System Head TDH t Forcemain 'Le Dist.to Well SOIL ABSORPTION SYSTEM Ti_P/)i`� j �,4y1 _ / tf C 4....g •in,.cA DIMENSIONS BED/TRENCH Width 3 l 4. Length / No.Of TrenchQs PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS S v)" SETBACK SYSTEM TO P/L BLDG 4 WELL LAKE/STREAM LEACH G Manufacturer INFORMATION / CHAMBER OR Typr Srl Ve 4 0, 7 D , / UNIT Model Number. DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Q s) „...1Length Q _Dia Li " Length � / Dia �/r Spacing / SOIL COVER x Pressure Systems Only . xx Mound Or At-Grade Systems Only Depth Over L Depth Over xx Depth of xx Seeded/Sodded xx Mdtched Bed/Trench Center 7 Bed/Trench Edges Topsoil ■ Yes • No • Yes ■ No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: /V?/ 0 L Inspection#2: / / Location: 816 Prairie Meadows Dr Hudson,WI 540161 , (NW 1/4 NW 1/425 T29N R19W) Scenic Hills Lot 4 Parcel No: 25.29.19.2398 1.)Alt BM Description=![` v � •4/( . 2 C _ �� / �fi j — A et4C-1 fiG1i� 2.)Bldg sewer length = Tb r sys4e- 't CU, Lq��� ,/p Oa (�. 5,1t4tetairmi -amount of cover= > y I Plan revision Required? in Yes IYNo 2 //11 fet-'724-2-‘ 10CDT-1-,!/Use other side for additional information. v Il fDale Insepctorsre Cert.No. SBD-6710(R.3/97) Safety and Buildings Division t County 201 W.Washington Ave., P.O.Box 7162 5't CR0 t'x N ,t�sCons,'n Madison,WI 53707-7162 Site Address Department of Commerce 4 J6 P/Z4/12/lrs /ttemoe f O/2 Sanitary Permit Application Sanitary Permit Number e���fCJ. *2 2Mc--' In accord with Comm 83.21,Wis.Adm.Code,personal information you provide may be used for secondary purposes Privacy Law,s15.04(12(m) Cheek if Revision I. Application Information-Please Print All Information Ftate Plan I.D.Number 1//4_ RECEIVED N Owner's Name Parcel Number 0 -d6 i AIM,Y Q(, u" ,vlr - /z AUG 21 2002 OZ4 /395- oi< Property Owner's Mailing Address . 'roperty Location AI ST.CROIX COUNTY 11 / 2' p 4 �r7.7 %j 3�%l� S1 7nNtnr_pFF q"WscNWu:SG.sTZf N,R I I #� City,State Zip Code a"im rramtA Mott Number 9 Block Number 6-Et 4 14)J7zf4 w/ J ! / J/' �fjc-Z7 J-3 si�/ Subdivision N matne CSM Number l $CFvic Hit 1-5 II.Type of Building(check all that apply) /Q�1� �A} ❑Cory 141 or 2 Family Dwelling-Number of Bedrooms v/ ` 5//40/d Y ❑Village /, ❑Public/Commercial-Describe Use J ! rovmship /'-f�Qto5o N ❑State Owned a 7-ittit,ti- - 3` ( g 7 ' - l y chal.til4 .d 11s1-c�. Nearest /4t /lIf/f%Jvs Dive DI.Type of Permit: (Check only one box on line A(numbering scheme for internal use). Complete line B if applicable) A. 1 ig.New 2 ❑ Replacement System 3 ❑ Replacement of 6 0 Addition to For County use ' System Tank Only Existing System B Permit N bet Date Issued Check if Sanitary Permit Previously Issued r J is 9 / IV.Type of Permit: (Check all that apply)(numbering sch for internal use) S 444,4,5„ ,T/t. !_/�'/- ier ZAA- 44 1KNon-Pressurized In-Ground 210 Mound 47❑ Sand Filter 50❑ Constructed Wetland 3 1 1 Ct l✓bu✓ 22❑ Pressurized In-Ground 41 0 Holding Tank 48❑ Single Pass 51 0 Drip Line // 45❑ At-Grade 46❑Aerobic Treatment Unit 49❑Recirculating 30❑Other CZr a(4 V. Dispersal/Treatment Area Information: Design Flow(gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevatio VFinal Grade pp/ Required 8 Proposed Rate(Gals./Days/Sq.Ft.) (Min./Inch) qZ Elevation O A' ____ g N 770 VI.Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank f L-Sd - / Gv/Esera- fC Dosing Chamber .. - . VII.Responsibility Statement- I,the undersigned,assume nsiblity for Installation of the POWTS shown on the attached plans. Plu!O& it is Name(Print) PI 's Signature MP/IdDQ�NumberBusiness Phone Number .1/EGy.n/ 240 �9 7 Z7 3- 545e5 Plumber's Address(Street.City,State,Zip ) 7/. . g 1 `y 4 f f7/1/ C coy W�2•,+-4� W( .5-iiD(i �! 7'`7 7 VIII.)otmty/Department Use Only ppeoved ❑ Disapproved Suniary Permit Fee(includes Groundwater Issued rat S' Stamps) Surcharge Fee) _,,,t[ JD / 0 Owner Given Initial Adverse ` 1 5T• (i/O Determination CJ IX.Conditions of Approval/Reasons for Disappr,val ' 7,74 ,GovZ I) S ILS 1!J MN s`G2 a+oa. " -G a„C- 47'('11 c.�stl ' b21L>� til.r Ce115� - / UJ/6•/ `mil �4.--C 0-0-n- ed OA_ ��d¢.2, r3e,o�ir���a�t.ed ced � 4• `'r ,'�ttlu L4Mt+� silo /tea-bw 0.7 sr c(or O5ss/b�J/y � ~ 4 /oI/ Pi,a4itieitJ ,�CG(2a vt0.d`r1/>te2 ti r v t'!L(! ��y7.Y!-,4rJ /s»,+Q.401111,t..1 64�/ ..JJ .(fLl u.-- t RAY q %c tG�/ �%r2t! SBD-6 98 (R. 05/01) ( �Q�,_ I ea- it R A/ 30E t 4lhtq QG11.44M tot Ld + if sctM: _ 4401 /1\ dp4i owl 4L# A+c64 T��G _ BI -4c) .. `� Covvf3101,(11 IZ s0 f+ cf-te Bum tfoaw • Po-" i)LAAJ 3b o- 4lAlty p1.1t4/1M L 6 + T SL tIWWf LO+ LO'RNere.. /1\ 104. N4 LA- 4+t6a T�Z drat) $IGdah1 LL Q,,-1 �Z-�- 9-r'Y /'h Lt- ^4 lZ s0cpc- S+ 401 610) ffoo& a . o 0 c I Sc Lset(( 4 p • n i gi tri 251-1-" • Ce , lj,t-011%1 r W 2 i CO ..__N 1 c 2 = 4 -12J3ANI—� — C TiE O II X -go 1111 O ` . (V E. r. C „J (2 I v X. cl n r Z Z w "� ' 4 C Y a a 0 0 . c � N ' E Z N > 75 II 3 W •—� 1 = l w `c \ ( Ci-jV• Mill i a . Ci rci III N J i.--h I t 2 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ` of 3 Divirion of Safety and Buildings in accordance with Comm 85,Wis. Adm. Code • County T. CR0\}. Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must include,but not limited to:vertical and horizontal reference Parcel I.D. percent slope,scale or dimensions,north arrow,and location and R[er@ lEI)oad. 0 a)_'3 S- p 111 -DO 0 Please print all informatio a. 1 pprry� Re w by Datep • Personal information you provide may be used for secondary purposes(Pn'/1tj&els_g.O srn)), �(eliyf,),.. 1 G/zq _- Property Owner Property Location�L7 S R f�J�. T/) Q.� j�uh-1 M'l elyz mm--myp _COUNT Y 1/4 1/4 S ZS T zp 7 N R ICI 1 E(orC..J Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# ) ) \vS 3S n4 SI-R. .E.T — Ski\C 1-MU,,S City State Zip Code Phone Number 0 City 0`tillage ®Town Nearest Road L l-\_S 1JO RTI4- 1 w I 1 S'4 o l I I (l tS ) 7 3 . L v D S c.)►J I PIZAr1 R(u 1'1 M„s D>`. El New Construction Use:® Residential/Number of bedrooms Li Code derived design flow rate 1 Q d GPD ❑Replacement ❑ Public or commercial-Describe: Parent material Cn v-P•s•J'f 1`l Flood Plain elevation if applicable . 1\D Pi ft. General comments (z8 UN 1-\--s R Q t)) and recommendations: 1 3'- TLL \*IG\A- cs pti-CVr-f SlDFW)Lp( L—q .p Mt3V- 1 O1TOWl of '.tcS M R1`= nc.k o 1- -SS IF SM41 , 1s F:">,,i• ?T P Wi C 4ER ELQ"\-)P)0)O• ( SEE PAGE • cTF 1 Boring# ❑ Boring ® Pit Ground surface elev. G�' ft. Depth to limiting factor 7 5 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz. Cont.Color Gr.Sz. Sh. 'Eff#1 •Eff#2 I 0 -.7 1 vY'12.313 - \_. a l^n v 4s. cS z . 5 - 8 Z y3 1 .SLt23ly - sl \ c.sb\c mV+,- c - •4 3 `r3_105 1.9`icz..q (y _ S G S9 W1 — C-i) \. Z Z Boring# PO ❑ Boring ® Pit Ground surface elev. GS-S ft Depth to limiting factor 7 3 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM' _ in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 1 0 -A5 Uri 9_3 L 1 — L 2 -c l� m Vf,-- c-S z • S - 43 Z. %-'-121sklz) 1v — _ s ( \e3bte. m\ C-1- eS — 'I -6 3 c2-103 .S Liz yl(c — S O s5 vei I — ( —) 1- z 1-1-1- 92.O '- 472 V7gi' - 7d Q GeiL rs , _s164. /a7 de 'a-; •Effluent#1 =BOO,>30<220 mg/L and TSS>30<150 ng/L •Effluent#2=BODs<30 mg/L and TSS<30 ng/L CST Name(Please Print) , �,� n iignatum O Z-I CST Number Arthur L . Wegerer /I+1/►�wvt ` 220254 Add reS5 W e g e r,p r Soil 'Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. Hain St . River Falls , (•II 54022 cb -1 -02. '715-425-0165 Property Owner 'LU 1 R Parcel ID# O ZO - 11 q S _ 04 _0 0 0 Page Z of 3 Boring# ❑ Boring ® pit Ground surface elev. -ID.q ft. Depth to limiting factor 7 1 00 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl' in. Munsell Qu. Sz. Cont.Color Gr. Sz. Sh. •Eff#1 •Eff#2 0-8 1 v'1 lZ 313 - L Z`FS w► C5 z'(z , 5 . .8 • Z B _z3 )s`1RZ Sly - s I 1 sbk mv`fl. - - 6 3 z3_112,U `�s-t2 u�� S 0 SS t11 ) — t. 2 • Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor In. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/R' in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 •Eff#2 • Boring# ❑ Boring • ❑ Pit Ground surface elev. it. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description 'Texture Structure Consistence Boundary Roots GPO/ft 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=BOD,<30 m0/L and TSS<30 mg/L • The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,please contact the department at 608-266-3151 or TTY 608-264-8777. SBD.6330(R.6roo) PLOT PLAN Page 3 of ' ` Scale 1 ' = 9D ' • • s\)\�al.‘ W For e_ ems" Lo's coQ�JPI �e14 3 `X �(9•ZS`LOu6_ � 1� IRDIJ PIPE go • § '_ ao @ / -;I 1\ 097 c 7 1S% (a), sV L'S PBL� FOR eS , ix S v 14MiE v 3'M_1 / 3C) ,ca Ci s %WI I - lst.‘00.0 'Oh) 'ZOOM SILL• . aw1E-2- EL_ko2. 9` 00.koivsy3ki SILL 1-) �_ 11-3 STP ..`.L312 \)Et LF7' teruNes e>-1=02.- ,rvsr M-2DX.. o aR CiA4L±I'V 8,1_ p Z 715-425-0165 220254 CST Signature Date Telephone No . CST No . Job NO . • J 1919P 589 ' - 1 State Bar of Wisconsin Form 2- 1982 DOCUMENT NO' I WARRANTY DEED 6 HHLEEEN1 el H H. AYALSH 020-1J95-04.000 REGISTER OF DEEDSV ST. CROIX CO.,, I Parcel Idemillntiae Number(PIN) D-(OR_ p Carriage Homes XXI, Inc., a Minnesota corporation conveys and C 07-01 2N2 9:30 AN warrants to Joseph R. Plummer and Mary um E Plmatas survivorship ` marital property the following described real state in St. Croix County, EMIR $ State of Wisconsin: REC FEE: 11.00 TRANS FEE: 257.70 4,Scenic Hills,St roix County,Wisconsin COPY FEE: CERT COPY FEE: PAGES: 1 This is homestead WyKtq, THIS SPACE RESERVED FOR RECORDING DATA Exception to warranties: any easements or restrictions of Name and Return Address record,if any. Land Title,Inc. 1900 Silver Lake Rd#200 Dated this 6th day of June,2002 New Brighton,MN 55112 a2o5gq.4 Carriag once XXI,Inc. < " /(/1! � u (SEAL) (SEAL) •Kellei St Martin,Vice President • (SEAL) (SEAL) • AUTHENTICATION • ACKNOWLEDGMENT Signature(s) STATE OF MINNESOTA }SS. WASHINGTON COUNTY. authenticated this 6th day of June,2002 Personally came before me this Sth day of June,2002,the above named Kellci St Martin, Vice President of Carriage Homes XXI,Inc.,a Minnesota corporation to me known to be • the person(s) who executed the foregoing instrument and acknowledge the tame. TITLE:MEMBER STATE BAR OF WISCONSIN (If not, authorized by§706.06,Wis.State.) THIS INSTRUMENT WAS DRAFTED BY Gregory A.Booth,Any, 1900 Silver Lake Rd 4200,New ` fi��M�` p 1 U�✓ Brighton,MN 55112 a Notary Public,Washington County,Minnesota My Commission Expires: (Signatures may be authenticated or acknowledged. Both are not necessary.) awaw..aw-�...:...........vww..w *Nona aperient signing la any any Mould br typed or pined below Nee tineawes ; , ;A : E.1 E.), HEI S VM/Va + ((o PLA-(a-IE wADews -.tlP_ . Sanitary Permit Application Safety&Buildings Division In accord with Comm 83.21,Wis.Adm. Code 201 W.Washington Ave. See reverse side for instructions for completing this application PO Box 7302 `t sconsin Personal information you provide may be used for secondary purposes Madison,WI 53707-7302 Department of Commerce (Submit completed form to county if not [Privacy Law,s. 15.04(1)(m)J O`/S ) state owned. Attach complete plans(to the county copy only)for the system,on paper not less than 8-1/2 x 11 inches in size. County State Sani�r Permit Number 0 Check if revision to previous application State Plan I.D.Number � C E o i — 'Tos-og`I _ I.Application Information-Please Print all Information RtC:EJ v E Location: Property Owner Name n � Property I nr ation > /�/ ���++,, D 41 N 4 CZ is C L VC/W-4MGI e 4,K46S MAY , q 2 kNWt/4 N(�t/4,Sc S T l'N•PRE-torOj Property Owner's Mailing Address Lot Number Block Number h-7 Zo 5 I LA, J A+1<-�. 1)L v o ST Ck,,, . . , . f (�[ 7fNINt.�,c� { City,State Zip Code Ph ,�j Subdivision Name or 6tr'Att/ORlber jLLWWIt M/"J ) Sc FAvcc //fcc.s II Type of Building: (check one) It/K efecat.., ( .s • ❑City 1 or 2 Family Dwelling-No.of Bedrooms: r 7 0 Village Public/Commercial(describe use):_ tv-Town of ❑State-Owned /kV5o l J N t Road 9 I '�nAa / `/ 1 - r_ n 1al(Rc6 /1ME'40,64, ' D�rvE z) 3 X Pa•7 1 4-vehAL, fJWRS=( i T l C.6O 42,- /-YW c1( Parcel Tax Z n r(s/ J 9 5J cp,e—0!� III.Type of Permit: (Check only one box on line A. Check box on ne B if applicable) A) I. jitNew 2. 0 Replacement 3. 0 Replacement of 4. 5. 6. 0 Addition to System System Tank Only Existing System B) Permit Number Date Issued ❑A Sanitary Permit was previously issued IV.Type of POWT System:(Check all that apply) $Non-pressurized In-ground 0 Mound 0 Sand Filter 0 Constructed Wetland ❑Pressurized In-ground 0 Holding Tank 0 Single Pass 0 Drip Line ❑At-grade 0 Aerobic Treatment Unit 0 Recirculating 0 Other: V. Dispersal/freatment Area Information: CZ $� 61/ C,¢p in/F/L-f � ! I.Design Flow(gpd) 2.Dispe Are 3.Dispers a \ 4. oil Application 5.Percolation Rate " 6.System Elevation 7.Final Grade Require(8c1' ) Proposed 8 f` Rate(Galslday/sq.Il.) (Minlineh) (9 9 9 ionl0 G 67) 560 54—eD 6)1) / 2 .------. 11 Cf°'6- 98 /03 VII.Tank Capacity in Total #of Manufacturer Prefab Site Steel Fiber- antic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks C ❑ ' 0 0 0 0 VIII.Responsibility Statement I,the undersigned,assume responsibility for installation of POWTS shown on the attached plans. Plum rs Name(print) Plumber' Signature -or ps): MP/MP'ICS No. Business Phone Number _IN Plumber's Address(Street,City,State,Zip Code 6 (.(-- 4, wo<2+,<{ W( 5-Sidi/ IX.County/Department Use Only 0 Disapproved Sanitary Permit Fee(Includes Groundwater Date Issued Issuing Agent Signature(No stamps) ',Approved 0 Owner Given Initial Adverse Surch ge Fee) pep Determination 2ZS 1,A4�.�, I (s,...., t,riL ,J:71,..y3-�- RCoil dit- iron of Approval/Reasons for Disapprah: d 4,.utsw�r 0,44.�7r alle•t�w.4aa_,_ Seejit< t 0,1.P0'Va.Ai` H L a.7 yk, rkny.u.- I ;OCu liecar* lU I SBD-6398(R.07/00) . A KELL / " zizo , r l°D .3 „ PAL 1.8° g* L ;ix e'vl" C® )3 1C-4 A.416_A gz 01 Wfecortsin Department of Commerce • SOIL EVALUATION REPORT page I of 3 Division of Safety end Buidings in accordance with Comm 85,We. Adm. Code Attach complete site plan on paper not less than 812 x 11inches in sae.Plan must COLintY S-f. C.- ,- t'Attach include,but not limited to:vertical end horizontal point(EMI,direction and Parcel LD. percent slope,scale or dimensions,north and diatribe tD nearest road. Please print �A • R by Date _ Personal Information you provide may be used �!4�-, . �y Last,y •.04(1)(m)). Ql�.� ( 242- Property Owner n ►((1W' •,, - Location q CJ (� r . 4 f JUN 2 2001 I ill Lot �L�f 1/4,Jtt/1/4 S 2.ST 2.4 N R / I E(or)© Property Owner's MaiGg Address S r UMW .. Bbdc# Sibd Nacre ar CSMI1 (o Z o S+, 1 I e« Tr / Sc��;c l ; f I s City State Tip Code 1j • , ill City 0 Vitage Iia Town Nearest Road ,STii a `tff llj �--tr 1mA.. 1a-01(z( ( o- •. -00 140dso' I k ..„v RCl 0 New Construdion Use:® Residential/Number of bedrooms 3 -‘ti Code derived design flow rate 4/.S0 1600 GPD ❑Replacement ❑ Pubic or commercial-Describe: Parent material OU 4-L.10.6 le. Flood Plain elevation if appbcable (.1// R General comments S)(S t'-C wl G I G U 0.f.3/N - /6/C • 0 and recommendations: 4 L 4, e.I LU&--,`o r` — (00 -O f ❑ Boring Boring IF (4 Pit Ground surface elev. /03,?0 ft Depth to limiting factor l 10 in. ApplicationRob L!y Sol Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDI}F in. Munsell Qu.Sz Cont.Color Gr.Sz Sh. •Etf#1 •Eft12 p-lo IOy(- 13 —1 sit Zmc,bk m-Cr c `,, Iv c • . S . 2 lb-Z4 IQy( yI`I . — 51 1 2 rrl c,bk. rrl-cr c S — 5 . 8 3 3 -((o lr 4-q6D — rYNS O rr I - - 1 - Z 1 / at- 77.0 a� 98 o Z Boring# 0 Boring ® Pit Ground surface elev. /U E•G 0 ft. Depth to limiting factor I I l l in. 1 Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/IP in. Munsell Qu.Sz. Cont.Color Gr.Sz Sh. 'Etf#1 •Eff#2 I C-12 IQy(3l3 , 41j 2-11-Yl _ mVr CS 1 vf. • 5 . 8 Z 12 11(1 I0y(`l1(ip m5 cj m t - - .1 1. 2 •Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 ng/L 'Effluent t2=BODr<30 rrg&L and TSS<30 mg& - CST Name (Please Pam) CST tenter 14dGvla .S, 1,,.4) ke-r ,,,L able____-/(.. 2533o9 Address Dab EvaMrMbn Conducted Telephone Number Z//3 St 3 51. Snmrr 4,(c 11 . 2./L Z3 G -/- c'/ 7/5-2y)-`t00$' _ Property Owner Q.r c. 11 Parcel ID# Page Z- of 3 - Boring# . LA pit Ground surface elev. /°`71.2 0 ft Depth to limiting factor I I t o in. Sad Appfication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfft in. Mansell Qu.Sz. Cont Color Gr.Sz.Sh. 'Eff#1 'Eff#2 I 6-1/ 10vr313 S ' 2mabk mar C_ IV . 5 . g Z rnS _ rr'1 - - I • Z c,z.Yi98.y � �u� # ❑ Boring Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAP in. Munsell Qu.Sz. Cont Color Gr.Sz.Sh. 'EfT#1 'Eff#2 Boring Boring# ❑ ❑ Pit Ground surface elev. ft Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color • Redox Desaiption Texture Structure Consistence Boundary Roots GPDRf in. Munsell Qu.Sz. Cont Color Gr.Sz.Sh. 'Eff#1 'Eff#r2 •Effluent#1 =BOD,>30<220 mg/and TSS>30<150 rngll. 'Effluent#2=BQO,<30 mgll,and TSS<30 mglt The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. seo-u70(L07 ) • • PAGE 3 OF 3 NAME Ark.e-H LOT# `f LEGAL DESCRIPTION.j i%A/,y.,S aST2i,N,R 19 E(or)0 ----SCALE: I'L y o XI "---13M I ELEVATION /OU• d BM I DESCRIPTION P o+ a" P•'P - -4- ---13M 2 ELEVATION 99• ° S e c L 5- BM 2 DESCRIPTION Z "pug M e' SYSTEM ELEVATION /00• d ALTERNATE ELEVATION /OG • 0 CONTOUR ELEVATION /oy,p, /o 3.0, /02.o Ska P f (kg,S j° .o • 103• .0 c � n a .L f+- 6eo. r o � 41110.. ro4_,4 a N GNA • --: - - --- - DATE 6 • `Y. N �c4 Ai tC6 L (_ 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 ` 05-0g1 Number of Bedrooms Design Flow- Peak (gpd) _h Op Estimated Flow-Average (gpd) 44 i.rD Septic Tank Capacity (gal) Soil Absorption Component Size (ft2) ( ec .-i r•- c , Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow- Peak (gpd) -egg tz r) 8�0•$ - �,, h+y u e a Maximum Influent Particle Size (in) 1/8 Maximum BOD5 (mg/L) 220 Maximum TSS (mglL) 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, 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• ' k and outlet filter shall be assessed at least once every 3 years by inspection. Th: outlet felt:r shall be cleaned as necessary to ensure proper o n. The filter cartridge shou • of be removed unless provisions ar o 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 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 • 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. lV66 yo PCv& 7/5-- 2 73 -Y V Sf cQoi, ?ebAHi✓6 r , - 30 :, • 416so 3 • • ST CROIX COUNTY • SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM , "u,, Owner/Buyer \\ 4 S e.��- st% h ca,� t _ - J D G A /`t"► l/ -i I Mailing Address ( Z C) 5-Ft f hi/_ &UJ, Property Address O-/ y firtr"{• (Verification required from Planning Department for new construction) City/State WV Ck !/i/r( Parcel Identification Number O zb 131 S' 0 ! LEGAL DESCRIPTION Property Location Nst/ %, ") 1/4 , //Sec. Z S , T 2'J N-R /7 W, Town of �U�LSct� . . Subdivision e�r/ C I`f�Y/S , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # , Volume , Page # Spec house yes ❑ no Lot lines identifiable Byes ❑ no SYSTE MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle s,astes !'roper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. R !.at yot. out i::to 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, sir :,d by '!te oxner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(l)the on-site wastes-.ater disposal system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is :css than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal syste;t. H itit the standards set forth, herein,as set by the Department of Commerce and the Department of Natural Resources,State Wis::onsin Certification stating that septic system has been maintained must be completed and returned to the St. Croix Counny Zoning of lice within 30 days of year expiration date. SIG TURE F APPLICANT I)ATIF OWNER CERTIFICATION we) certify that all statements on this form are true to the best of my (our) knowledge. I (v.-: am (are) the owner(s) of the pro ribe bove, b virtue of a warranty deed recorded in Register of Deeds Office. S'10 SIG OF APPLICANT DATE Any information that is mis-represented may result in the sanitary permit being revoked by the /oiling I)el art:.ient •• 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 warra deed IN • a . . 1662PAL:289 648604 REGISTER OF KAT EN H. DEEDS \„Ja r rwn�r c� ST. CROIX CO.. NI RECEIVED FOR RECORD 06-10-2001 12:45 MI WARRANTY DEED EXEMPT 0 CERT COPY FEE: COPT FEE: TRANSFER FEE: 9900.00 RECORDING FEE: 14.00 PAGES: 3 4swdie 1 An. N.e..se' d Il.h,r.Ar1deW Ls".l r re, 1900 S .r (Ak• /l/cW ar'i514." a M SS/IZ OZo - I069- 70 -o0 Panel Ie4.pfod..Number OIIN) (97 0 - ( 06/ - gp 000 020 - I vcy _c10 _ OOV 02o - 1o7O - Oo -(p0 020 - 1070 - 'c) -000 020 - 10 -76 -zo -act) • 13`31 -c) "THIS PACE IS PART OP THIS LEGAL DOCUMENT - DO NOT REMOVE" Tb4 l.lmard.•nrabm megw by.ebmi.r:lm.."n gar.Nene 4 roam dd,t„ mad f N^Nratl.ow..}/"..4..s► a,ar gnawing limo...keel 4wfpal.+.me m y►,/I.,ee«elkJ Y Amok. «mq M plated a.- -.mot flagee...aa. yyy u,.Jelkark lv[,lib earl�t�r year famww m.f 2740 se A, anaMne•Jrr Ruca+.ein S..ri,93/7. 1I10:14 196 DOCUMENT NO. WARRANTY DEED —' r, •TAT[DI Wt•CON•TN—IONM • • vet 1062PAt;r 290 TMI. .,I L. saga M[Y FOR •COO.OI MO W.A • THIS IND Made hv RICHARD N. PEARS(N1 and JEAN M. PEARSON, hus and Ulte, .......... s St. Croix •- grantor...._ oE..._..__........_.._...._.._....»..............».._...._.._......_..Count , Wis consin, Mconsiq innr conveys c and warrsnb to...CJIRRIAGE HCMPS XXI, INC., a Minnesota to corporation, •. ...»...._.._............. .._ Washington _.__.....__......._...._.._._..._........._...17I rfrantee..._... of ......._.:.._._....._.........•-..- County, or the sum of;: one_pollar...ard..no/120_111...QQj and other good and.valuable I.•.D... ro 1nA it Tit It IR atide'LA l.S2!1 Rto1913 5/LlLCS,I✓rl lrll(e 1�. the following tract of land in....St.r.,,,C,Kq),i{...............................................Coon ' CT//i Wisconsin: .All...9f...the...a2K.kh!tRS.k..(2<7t7.F.Ce.I.,.i( L„0,pd-_.E1gKth_lia ,f (N1) of the Southwest Quarter (SA) of Section Twenty-Five (25), Township Twenty-Nine (29) North, Range Nineteen (19) west, St. Croix County, Wisconsin, except Lot One of Certified Survey Map filed June 29. 1994, recorded in Voltune 10, Page 2782, St. Croix County Register of Deeds, as Document No. 518444. See Attached Exhibit A Parcel Identification Number I ) This is not homestead property In Witness Whereof. the said grantor_ _ hie..... hereunto set _their hands and seal$».. this des of........ `✓.y _ IRONED AND SEALED IN PRESENCE or , ........__.__._._.....__........_......,. _._.(SEAL)WPAAIMINEIMIP' • • .._..._(SEAL) • (SEAL) • Se,e. �ta • Washington County. Personally came before me Ihia7`." .day of.. .`..�._.._._...,A.D., ISi1..;QO1 of the above named ..RISHIARD N. and JEAN M. 13EARSONL husband and wife to me known to be the person` who executed the foregoing instrument and acknowledged the same. Try IR 1.....MEET WA/1 DRAFT-MM. RUNTAIN Richard J. Gabriel, i132o64 NOTARY NotaryPublic,. !SOT Mew-MIPNESOIA 880 Sibley Memorial Hwy., t114 "AL My Mycomm Es$••aJMw SI20E6 Wu. —1736 Try commission (e _..._. • • (1N noon )SiWiNMWA Semen q.rides Ibl.IIWindom". M be recorded shall►MO M.i•b Mimed w r,.+.. .rhrrem ehe 1 pontoon.WERE. NmMa sod mewl. mn,,4 19.111,n..s.m reaches that the Yore s the pawn he.N amnia pm,which.drafted sob iwru.Nm• dull 1<Mmed. plreroNn• N,m d w r,men Mom:*le, Nook mmneel WARRANTY DEED STATE OF WISCONSIN wl.e.nd• I.r.J nr..e coma... mast N.. r Mlla•ek... WI.. {lob dden 1 1G62►AG 291 • EXHIBIT A Parcel Identification Numbers 020-1069-70-000 020-1069-80-000 020-1069-90-000 020-1070-00-000 020-1070-10-000 020.1070-20-000 Safety and Buildings Division Lounty 2tM W.Washington Ave.,P.O.Box 7162 5--F Cre0(� \\Vis..consin Madison,WI 53707-7162 She,Wd�s Department of Commerce ' 16 //�112/c 4160 '# Diu •Sanitary Permit Application SanitaryPezmit accordaccordN��0 3 In� d with Comm 83.21,Wis.Aden Code,personal information you provide t axa if Revision , .. ✓ tJ O r may be used for secondary purposes Privacy Law,al5.04(12(m) L Application Information-Please Print Ail Information RECEIVED -cna Plan L.D.Number /�' • Owner's Name 'arcel Number J © _ e # mirky A 4" ,i.,�-jz AU G 2 1 2nn7 0 '7 a /3 9 s 0 5€ [tarot p Property /' /a Mailingo T / 35t!4 !� ST CROIX COUNTY �� SaST2` N,R If �l i v J (7 7 7nriinir nFcicc �: City,State Zip Code -pnoR'.,mttber Number li Block Number 61.14 -L t4 wozf44 t J /kit � d I 7j5 z7f`- 3 V8/ Subdivision Name CSM Number 7 1 5CEv/G f//Llj II.Type of Building(check all that apply) �!�. ❑City �1 or 2 Family Dwelling-Number of Bedrooms Y��41411, 1p?--- ovulate ��J/ ❑Public/Commercial-Descrbe Use � ,4 fownship taSo N ❑State Owned oZ rAidt /1 3 f)( 1-7/ - 1 y / / Nearest Road t'ihKl G{IfLys Xst r,"`� 624/gieg /0e.t-t✓ae5 0,e/a III.Type of Permit: (Check only one box on line A(numbering scheme for internal use). Complete line B if applicable) A. 1 IL New 2 0 Replacement System 3 0 Replacement of 6 ❑ Addition to For County use ' System Tank Only Existing System B. .M Check if Sanitary Permit Previously Issued Permit N r Date Issued .7 0 99 / v5'-i6-o 7. IV.Type of Permit: (Check all that apply)(numbering scheme is for internal use) _.S}7t"42..,a. /1 J} z,161y— 44 11..Non-Pressurized In-Ground 210 Mound 47❑ Sand Filter 50❑ Constructed Wedatd a t 1 6424,4(roan 22❑ Pressurized In- Ground 41 0 Holding Tank 48❑ Single Pass 51❑Drip Line 45❑ At-Grade 46 0 Aerobic Treatment Unit 49❑Recirculating 30❑Other V.DispersallTreatntent Area Information: Design Flow(gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate SysteamE�E1eevatio Final Grade / Required 851 Proposed Rate(Gals./Days/Sq.Ft.) (Min./Inch) •q-f • Elevation 9(a.0 6 ift Yk. vd, , 47 b X _. 'i:7, a _______._ VI.Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank /25-0 _ / - �/`t ffry't_ fe- Dosing Chamber .. VII.Responsibility Statement- I,the undersigned,assum7Wty for Instllation of the POWYS shown on the attached plats. s Name(Print) Pl s Signore MP/MERLNumberBusiness �� hone 3 N T�/r KOcit A' .i1 2 - Z 24 s�9 7 T Plumber's Address(Street,City,State,Zip ) 6( 4&Q '2-r-R- W( 5Y,o l l 6Lez !Department Use Only 0 Disapproved Sanitary Permit Fee(includes Groundwater DZ) / Issued Sumps) • Surcharge Fee)❑ Owner Given Initial Adverse. 5721• O Determination ✓(J _ III.Conditions of ApprovaUReasons for Disappr9val / Ce09t iS I) Se il,S ,Al -i.h - 1""' ,6 eF+�J rites CQYtsi t -f bcJ s'/� dk.-A4..a.. i oa Se awl -Ay e.d4 Jiiiist,c �lt -74 ,E"'t' eimorant) !thine+, �'Sia t /o7. La�cm; 0.7 a Pets ib/ �- �ftf'' . PhPm-144J -le�Y-Le�ri&1M d c� bd L°iWrT Afar? / jarrte ri.-na4/ cc.f../Aaa -Mptas r -a(to only)for so pow:set Ysi anC�/ "y_ -//_ ajjc_i 4_6 SBD-6 98 (R. 05/01) Gw p1,0 - iLPAJ 30E d- 4 ,t if QG.u.MM&?t La + if 5cfA/ic III Lc 5 /1\ P I Tre.tto N./ 4 L+ Rx 6a 6t $I -Aaft ) .1a /s. � R �:• ld+vF�w as p2 g f.JF;•rank-ones 44 't°itts-44-2,42'• vie (�L ki,so s+ 1{-olsa, • • ._ • • 041 • ,� o g Cr 1. .." Z L9SHS . 3 a II II € ii .q .. . • � • E.wz r° h 400 1 9 \�• I n •• y 4 r il;•..61 i i NI ..-. atl�:. —I i • V,• , . U ! :/ " . � / • tp ixNMI 1,4 a � t , / / / I , a4 W M a i V �44 F T I/ ' / ^ a tea`' ( ' / " R3 '�' cnI` 11; .'a 1 s.a,.,pc,oa ' kihr 1 arta O14A \ a -- -- -uw-- o a - - - ¢iF -- -- ---- t_ __L- - ?m N H h w�o.esa •l/4 : It-- - q Af70ii L1M00.0011 \ ,y1T . P 1 .1.••.�M.{M-I • � � 1 �` 1 smite A®enema \-0\; \ ..v_. __Y . __ nn u ® ge Man 6'Eh.1V dfai • r n v i q Y v . j A i4 7Z q yggpyiyy�01.G3W to F Z �: t'1 J" NOLL�iO MMN)LLD�flllYt �� �' �' t -�• NM - VI