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HomeMy WebLinkAbout020-1395-12-000Wisconsin DepartmenNof Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (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 Alchele, Brian Hudson Townshi CST BM Elev: Insp. BM Elev: BM Descr tion: / ~ oa. a /DO . a ~~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic i2 Dosing _ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to it Intake ROAD Septic 1 1 ~ 20 ~ Dosing Aeration Holding _e PUMP/SIPHON INFORMATION Manufacturer Demand M Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Len Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width ~ ,~ Length DIMENSIONS __ ~ ~_ j „/~ ~ SETBACK SYSTEM TO INFORMATION Typ~Of System ~ ck~b-Q„y yr No. Of Trenches P/L CHAMBER O&~ I °~•~"TU- Depth DISTRIBUTION SYSTEM ' ,J„~,.~~~ ,/„o„ ~ -(;,, Header/Manif~d Distribution ~ L x Hole Size x Hole Spacing it Intake Vent t ~~ Pipe(s) / „~'j ~ ~~T ~ / -_ p ~ ~, Length Dia Length lU / Dia Spacing l SOIL COVER x Pressure Svstems Onlv xx Mound Or At-Grade Svstems Onlv Qom' ~~K-B'1'"'~ Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Ed es g To soil p 0 Yes ~~ No ~ Yes ( No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~/~ Inspection #2: / /_ Location: 785 Kinney Rd Hudson, WI 54016 (NW 1/4 NW 1/4 25 T29N R19W) Scenic Hills Lot 12 ~~ Parcel No: 25.29.19.2406 1.) Alt BM Description = ~~~~-I ~ ~y~~~~C.J~~ 0 2.) Bldg sewer length = ?J~ / -amount of cover = d Plan revision Required? ~ Yes r o 22 Use other side for additional information. ~ ' ~J ~~%~%~ ~~ ~6 SBD-6710 (R.3/97) Date Ins pctor's Signature Cert. No. ELEVATION DAT county: St. Croix Sanitary Permit No: 420638 0 State Plan ID No: Parcel Tax No: 020-1395-12-000 Section/Town/Range/Map No: 25.29.19.2406 STATION BS HI FS ELEV. Benchmark ~~~ 10~s L Gi'U. v AIt.~~~dQ7 o CO Bldg. Sewer ~ ~ , 0 ~' O S t Inlet `+ S~ S t Outlet ~•~ Dtln t i- t Bottom ~ HeaderlMan. -~, ~g U` ~ o Dist. Pipe Z ~ 3 CJG Bot. System 2 $ , S' ~p Final Grade Z~~ p b St Cover ~ Z Safety and Buildings Division 201 County C ~~ ` m m W. Washington Ave., P.O. Box 7082 ,~~®~~~n Madison, WI 53707 - 7082 Sanitary Penn_it Number (to be filled in by Co.) ~ De artment of Commerce (608)261-6546 ~ D p O • Sanitary Permit Application _ State Plan I.D. Number Tn accord with Comm 83.21, Wis. Adm. Code, personal information you provide maybe used for secondary purposes Privacy Law, s15.04(1)(m) Project Address (if different than mailing address) I. Application Information -Please Print All Information --------------"°°"' c;... ,.. ~~ 3~~~a-~-~ ~~~.~ ~/ gs ~i /Vil/t~ ~ Property ame ~ • 2 ~ ~ -~~ ~~~~~~ _ arcel # Lot # Block # zo-13~ B ~~ Z .___ ~,, ~ . . y Property Owner's Mailing Address r roperty Location / S i ~~ ~~ City, State 6 - ~ ~ ( Zip Code ~ T't~~t~ Phon nH t~',,,o__,_,;..~ ect on a ~ " trcl f ~ e o e) T ~ N R~E II. Type of Building (check all that apply) ; or ~• 1 or 2 Family Dwelling -Number of Bedrooms Subdivision Name CSM Number ^Public/Commercial-Describe Use I~GKi~ O Co~1aU/Z w'~ ~~Nf L LL ^ State Owned -Describe Use . 0 ~ , O ~ ~ / C~iG'~rT.~t~o ,..81~-G~ ~,~~. ~'j~ O ^City ^Village Township of Q !j D /l/ III. T ype of Permit: (Check only one box on line A. Complete line B if applicable) A' ew S tem ys ^ Repla ent System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B • ^ Permit Renewal errttit Revision ^ Change of ^ Pertnit Transfer to New List Previous Petmit Number and Date Issued Before Expiration Plumber Owner ~GO / ~ ~/ ~?j ~3 ~v o IV. T e of POWTS S stem: Check all that a 1 Non -Pressurized In-cr<,....,+ ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Consttucted Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersal/Treatment Area Information: f . 1 / , Desi Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Requi d (st) Di I Area oposed (st) System Elevation ~ . 7 8~ ~ s~. ,~,, L.~ ~<u s VI. Tank Info Capacity in Total Number Manufactur Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank /z I ~~ f ' ' ~ ~ ~~_ vC/ Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. m s Name (Print) ~ Plumber's Signature MP/N4P&FrNumber Z Business Phone Number a6 ~/t- ~ Z ~, S~ Z > ~ f~~ Plumber's Address (Street, City, State, Zip Code) CL ~ s~-~-~ w( o~~ VII . Coun JDe artment Use Onl Approved ^ Disapproved Sanitary Permit Fee t cludes Groundwater ~ Surcharge Fee) //,, ~ ~ Dat Issued 2 ssuing Ag t Si atu Stamps) ~- ~~ ^ Owner Given Reason for Denial v ~ ~ ~3 ~~• IX. Conditions of ApprovadRea~~Disa proval ~ ~ OYt, ~a ~r-~--~° ~.CG~ ~ ~~ ~ `~ .~' ~- -t~~rd~dn~ Gva,~vt-~c~u~m(~/~los~ ~~l -~ y 2,~~ ffDU-a~ ,ate-~p~~- ,,Q S/a~e ~ ~GLC~o /~~z-~ - ~o Cdr ~~, ~ ~~,~/~~/'2'~/" ~ fy/a~• ~°1b . f ~'4"''u'f /?~"'z°-Gr'~ fie, `~/~ - t~G,rrtp~/t~ i -~ ~'y,-~ `~ _ S~~ ,~. (/ C 3 _/ r Attac complete pl ns o t e County onl for the s stem on paper not IesZhan 81/2 x 11 inches iasize /-~ ~~~ ~~ ~ is /4~~a,a~~ s ->~yr,/~s sa SBD-6398 (R. 08/02) ~ .~ ~ 4~0 , _._....---- -e n^.3 .. Y ""' / ~~~ ~ k ~ ~ .~-~ 2. ~ d~, ~ ~- . ~*~ ~y ~ ~ n 4X 1ti~ a" z cy+ 8 M ( i~ ® e '' ~ ~Mz q S, 3 X ~v ~~ 2~ ° ~' ,'' ~ b CSC ~~~ ~ `.~- 4 Ca~~~\ Wpb CE2L I /afl ~2~,~~~ ccy~~ Z 98 ~~ ~Q t ~ C1`~~u ~~~~EL~ ~~~ ~~~ i T ~GL l c~L~ Z /~ 98 ~~ ~° ~` ~'g ~- ~~~ ca ~,~ 1 tix ~ti~° V ~'~ ~~ /~JPZld~q~ u`~ ~ ~r~ ,. w ~ .° ~.~ . (R 203 v~~„~b 'Q!° D ~` ~~ 3, ~ cy+ ~ B ~'^ ~~ q S, 3 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ~ of ~ Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code _ ~~ Attach complete site plan on paper notless than 81/2 x 11 inches in size. Pian must ~ ~ ~~ ' ~--~ 1~. i inGude, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I D . . percent slope, scale or dimensions, north arrow, and location and distance to nearest road. OZ~ _ ~ 3Q S - ~ Z -C~UO Please print all " viewed b Date Personal information you provide may be used secon~oeeSµ~r~ra~Law, s. 5.04 (1) (m)). D Property Owner P perty Location ~~-~. ,~-:{~ ,~' ~ 7~I,~ N~114 N6v1/4 S SST Z`D( N R 1 E(o~ W Property Owner's Mailing Address L # Block # Subd. Name or CSM# -"15 ~ t3 Lv ~ SP~^-( E ' .~ ~ , ' ~ o r F ~~~ ~ -t__ - S e ~v lC Yr~ ~L S City State Zip Code ^ City ^ Village ®Town Nearest Road ~`~ S o~ -~ ~ 5 y d~ ~ ( ) - 1`-~-v ~S`p1v ~-c.! ti -~ L J ~-c~ ~ New Construction Use: [Jt] Residential /Number of bedrooms _~_ Code derived design flow rate ~ ~ GPD ^ Replacement ^ Public or commercia{ -Describe: Parent material C~U~lti~l~-3 ~~# !=!eod Plain elevation if applicable ~ ~ ~ General comments and recommendations: z. ~_~,S ~ `~e~ 3 ' X ~l `J~ `.~ r,,~;; !ti/~ ~ U !V l i S ~~ ~ }(~ EZ ~ V pW ~~ct-!-1~~ ~~t~ ~~z e.;~z~ ~ Ez ~ ~03~}~ o~Z 3'x B~.S't_v~v~ w~ ~ y, U )V l T~g ~~~~ ,~Tfcl,~'f~ t7 1 jv ~ L~~'TUR ett~,3 SRS ~ ~ ~aZL ^ Boring S ~~;, ~ 1~~5 0 N 1~~t31; 3 Boring # o ® pit Ground surface elev. 1 l~ ~ • u ft. Depth to limiting factor ~ ~ LO in, Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~ D - ~ ~ 10`~ it 3 l Z -- S 1 1 ,m S ~c `r• lvl `F'r ~`~ ~-~ - ~j . 6 z tiz-z~ ~o~tiZyl6 - ~ s ~ cSti~~~ ~,1 c~ - . -~ ~ ..Z ~~-- - ~ z~ Z ^ Boring _ Borng ` ® Pit Ground surface elev. ~ ft. Depth to limiting factor ~ L 1 ~- in. 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 1 J- lZ lO`~1Z3lZ - si I Z~s~ y,~ `f }-. r=1,v ~U~ -S - ~, Z 1Z--~ l `f -Z S//3 - s) 1 Z 1~, S~ k wi `~- e- S - 5 . ~ 3 y 6 ~~ 1 ~y -Z y/6 - S 0 5 9 vvr 1 _ .`~ t. Z. .5 /` ~' 3~~ ~ uae_ ©,~ -f~ s s - tmuem ~~ = tsvus ~ su < uu mgrL and I S5 >30 _< ~ 50 mg/L 'Effluent #Z =GODS < 30 mglL and TSS < 30 mglL CST Name (Please Print) ~ S' nature ~ 3 - ~ ~ CST Number Arthur L, tdegerer ~ ~~~ 220254 Address raj e g e r e r S O 11 T e s t i n g & D e S i g n S e r v i c e Date Evaluation Conducted Telephone Number 421 i~T. iiain St. liver r'alls, [~,1I 54022 ~- ~ b-U3 715-425-0165 Property Owner Parcel ID # U ~-~ ~ ~ -J"t.~ - ~ Z -~ Pape Z of Boring # ^ Boring pit Ground surface elev. ~ ~ ~ -~ ft. Depth to limiting factor ~ ~ ~ ln Horizon Depth Dominant Color Redox Description Texture Structure Consistence . Boundary Soil Application Rate Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 1 o-tiZ ~0`1~3)2 - s 1 l~n'-sb1~ ~`~- C-~ ) v~ . ~) .6 Z ~ loy2y/ - s I ~ csb~ rn v~~ c-s - -~ _~ 3 3~-~ -~! O`~i1Z ~!6 - ~ S ~~.. SS ti"l1 - -`t t, i. g~ Boring # ^ Boring l b -Q/~ - ~' ~r-S S J ~l'~t.~Q a h~j .`yam / Pit GfOU nd Surface el@V. ft. Depth fn limitinn facfnr ~.. ~" Horizon Depth Dominant Colo r Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Boring # ^ Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots I;PD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 • Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BODY < 30 mglL 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. S8D-8330 (R.N00) '' '~ ~~- ~W i~ ~~ ,X~ • - PLOT PLAN Page 3 of 3 Scale 1' =V0' ~M~#-I -~ . ~no.~'orv ~~1`'TfYt,~, ~/~~.c~A, ~13~YR w/~~~ _ \~ N ~4 ~~~ „\ ,cam - ~ ~ r -~~ o~ ~U-'n".,G ~~... 103-~ r ~o _o 8 ~~ ;- D S /~ ` a. ~ tv 1T1 rte. c~~S ~~-~-5 ~~ .~ l z ! ~~, ~ ;~ 0 S1T ~ ^ ~ ~-'~1u ~i VvR'T~ Ll~~ ~. ~i ` ~ / / / ---~-_ ~ ~~ ~ L~r~t ~~t,,- _ ~~ C-To= ~ ~ O ~ TN U ~~ T}~~, C ~L ~- S ~ ~t E \, J _1ZE~0_Ut~C. 01= ~ ~ l~ 3 ~ pC= Spl L- ~5 / C'~~,Go~`'1h'iQ!.iD~D 1~~ iU~Z- ~. C~t-~- t;ws~L~Uyv Lo p.~-~c~J 5 ~--~ ~ r~ PC1N~k1 r~1 V~-~ _ ~ s ~1,: s t-r~ o t -- ----- ~~- ;~~ CST Signature ~-~{~-~3 715-425-0165. 220254 Date Telephone I•lo. CST i~1o. 03 -off Job "d0. v Attach complete plans (to the County o y) for the system on paper not less than 8112 x 11 i hes In size SBD~~5i0~,~2r1~ ~ r~.ek~.. ~A~•~- f~u~a ~G~, ~ ) . ~ Safety and Buildings Division County ~ ~ 201 W. Washington Ave., P.O. Box 7162 ~~'" ~, p ( ~ ~~cons~n Madison, WI 53707 - 7162 Site Address Department of Commerce 7~ S ~'Ct~rtl~ ~.D Sanitary Permit Application Sanitary Permit Number ' c rn accord with Comm 83.21, Wis. Adm. Code, personal inf 1~t~LD ^ Check if Revision~aa ~3~ ma be used for second u ses Privac La s15. I. Application Information -Please Print All Information 003 State Ptan LD. Number Pr erty Owner's Name .. GOUN~Y z R ~ fl 1 ~c ~ ~ ~R~,X FIDE Parcel Number ~ ~- ~3~s -ia - ~~ Z dress Property Owner's M a ' mg A d Property Location l ~ ( ~ f / /~ / QL U-E ~~el C-/~ ,/U(,t~ lk NbV~k; S ~T Z~ N, R ~ City, State Zip Code Phone Number Lot Number / ~ Block Number ~m~~~ ~ ~l //_ / ~ 7`-rJ Subdivision Name CSM Number ~G il/jG 1 LLS II. Type of Building (check all that apply) ~ `P~ ~~ ^Ciry ~1 or 2 Family Dwelling -Number of Bedrooms ^Village D scribe Use ^ Public/Commercial - e / / 1 ./(~ ~wnship f~ 'O ~ - _ v / ~~ ,, , ( ~ ^ State Owned 7 w i~ ~`~ ~/ ui'{~t~ .3~~C O Nearest Road N~ III. Ty er it: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A' 1 ~A1ew 2 ^ Replacenent System 3 ^ Replacement of 6 ^ Addition to For County use S stem Tank Onl Existin S stem B . Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) ~, Zn~i /~~i' S~ Y 44 ~ Non -Pressurized In-Ground 21^ Mound 47 ^ Sand Filter 50 ^ Constructed Wetland 3/ r ¢//~ . T 22 Pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line/~j ~ " ~ ~ ~ a~ - _ ~ ~~ 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recirculating 30 ^ Other ~ V. Dis ersal/Treatment Area Informat ion: Design Flow (gpd) Dispersal Area d R i Dispersal Area P d Soil Application Rate(G ls /D s/S Percolation Rate /Inch) (Min System Elevation ~~ S Final Grade Elev o n re equ r7po~ ~~~ . q~ a ay . © , ~ ~ ~ ~ ' ASS ~ ,~~iu., Bh/ . `~j ----~ C~ 9g.~ ~ 9S VI. Tank Info Capacity in Total Number M anu f to r /~ Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks ~ `~~~" _ ~-~U / ~ Concrete Constructed Glass New Existing ~ " ~ Tanks Tanks p 0 r ~ /" Septic or Holding Tank Z~ _ ..r w ~li9't1 Dosing Chamber ~-- ~ t ~ ~ VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plum is Name (Print) Plumber's Signature MP/D3J~15 Number Business Phone Number ~ rv~ ~(,fo~ Z~ ~o ~9 7 z~3 ~~ Code ip Plumber's Address (Street, Ciry, State, Z / ~ L~~~Gt ~~ ~~~~ VIII ount /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued gent Signatu No Stamps) Surcharge Fee) ,// Z~ ~ ` ~ ^ Owner Given Initial Adverse 2 `~ 3 ~0 G~~~ Determination v . /Conditions of ApprovaUReasons for Disapproval ~ `~w~~ /~i ~ ~~~ u f~ ~~ ~ 83-~3-/ ~ ~ ,~~ ~4/c~~~~ / ,~ / ~~ i ~J `C ~~ ~~,.., ~~ ~ ~~ ~~c~~L~ I , ~ / ~~ i N ;' ~f~ ..., ~~, 6i ,~ ~~~ ,~ , ~t 800 , pc as ~~ 9~ ~~~~ ~z~ ~" s~ >~'~ ~ ~~~ ~ ax. ~~r ti~ ~ ~ ~~ ~L ~~ b'2(AnJ ME40 Series 4/10 HP Effluent and Drain Water Pumps Performance Curve 4 3 3 W W Z 2 H J Q I o ~ ~- I M~'~° MODEL. ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE ~ 50 100 150 200 250 300 350 0 5 0 5 f a ~ IU 20 30 40 50 60 70 80 90 IOC CAPACITY GALLONS PER MINUTE F.E. Myers, A Pentair Company • 1101 Myers Parkway, Ashland, Ohio 44805-1923 419/289-1144 FAX 419/289-6658 Telex 98-7443 K3326 7/91 12 10 N B Z F-i 6 a ~ ~- 0 ~- 2 0 Printed in U.,~.A. • ~ Combination Sep.t;ic~ Tank and • PUMP CHAMBER CROSS SECTIotJ AND SPLCIFICATIOti1S ' R~~~ ~ rG~~" ~ •VE-J7 CAP WEATHE ~: PRO~~Ir ti~C.I. VCtJ7 PIPC ~,~PPROVE.: LC?:.Klt~i ~`~1~ ~.L 'FROM DOOR. l"1AlJF{OLE COYc: ~~~=~~~ J" ~ ~+rirJDOW OR FRESH ~ u~ARr.~~, e 1.~--.2~`~~ ,p y~~ A1k IUTAKE ~ co,~D~~r ~,,J~~p _ c _ ~~~f o .1`_ `~ I ~ ~ " " ~5~~~~x. ~ i ~ i 6~~r,iN.~GR.1DC I ~ I N.11.<. ~~ ,.~...--- ~ I ~ ' ~...~ 1--~ y~~l>JS?~cT~on~ Pik ~ I/JLET APPROVED JOINT w/c.~. PIP~orc~ ~ AFFI.:rS Tank construction shall comply with ~ 83.15 and~83.20 eo>~ ~ ~ W ~ w ~(~ ~ ~ ~~ 2 Q~ :'~ ~ ~,~. `~~ _ ~ PROVIDE I 'j'~AIRTIGMT SEAS Ir I A I ~ I G I .. I PUMP --~ ~" J D ' COAJCRETE BLOCK ~_ 7 i I '~rj.I. "IPwuftF"~C A L ~'~k h1 . 0 i.. O F ~ I ~' .3:~ 1t(Jr-'kor~~~~ RISER EXIT PE.RMI'Tl-ED OIJEy IF TA-Jw MAIJUFAGTURE.K HAS SUCH AP~RO~,'ti:_ I. ~,~z~~,D,~,H }_ SCPTIG F SPECIFICATIOt~1S DOSE TAr.IKS MAIJUF^CTUR~R:~~~`~~~' I::~~J~I~~.IC_ IJUMHER OF poSES:____~__ .P _. ;.:ti,; TAfJK `Jt,'_E : ___~IL~ ~ GALLO-.15 DOSG: VULUME A~xRh1 MAIJUFACTUR~R: S' ~~ ~Zl~D S~l~`i~`~'13 IA.ICLUDIIJG 6ACIC~'.OW: ~__~_L_!. ~_~AI.~..O!.1:. I`10DCL uuMBER: 1~ ~ ~rw _ CnPAITIES: A= Z3~$,~C!-.C` OR _L~~ G~~I_Wo~_~ SWITCH -rJPC: I`'~L'1ZLU~~! f'uMP MA}JUFAGTURfft:: ._ _ C= 7 IA1Ch_50ft ~~'~~.r~~L.'~JL.; MDDEL 1.1UMBER: ~~~• ~~ D '~ ~ 1110 H E S O R ~~~ __ ~'=. G ~~, t. L D k:~ 5 SWITCH T`,JPE: h'1L~1Z.C'.USZ~j ~ IJ07E: PUMP AUD ALARr~ -~,.~~ Ti. 5C MIA71MUf''~ DISCttARGE RATE (,pM INSTALLED ptJ SE;':'.RATE C4fZC.:'~7~ VERTIChL pIFFEKErUCE DETWCEU PUMP OFf AuD.Dl5TR40UT101J p1PE.. ~Z r•EEr ~Pr~'..Yt7~a.u.r~YCjlp.Y2~ •t- M1f.11h1UM ~E1-~lORK SUPPLY PRE,~/~SSURE _~ FCET -~ ~~ FCEl OF FORCE f'1AIN X ~ Y,3~/iUOFi.FRICTiot•.J FACTOR_.~_[__~ rEE~{" "' TOTAL OyuA,MIC HE:AO= 1~~Z FEET ~' ~a~ "'~J ~G~-~h~~y DIAMETER - ~-f ara,l.,a~~ Puv-rrcuAG~. Pump chamber ~_ 1AlTERA1AL DIME. 1.1St01J~ OF T,~IJK: LE~.10TH ~____~WIDTN .~.- ,;LIQUID pEPTI-l ....,,.,,.....,,..._..~ BOTTOM AREA - 231= '"~' GAL/:I?~;:'FI A x D ~. i .~ ~~ ~~~~ o C ro ~ ~ -~' N N+ a 0 Q _ ~ _ W O V W X Q ~ O ~ N C1~ V ~ X `~ Q ~ a .: = - rn ~. ~~ a tV ~ ~+ N ~_ r~ \v m m to Z v n ~~ 'T7 O 2 m ~v _~ Z ~INVERT~ 7' tfiAsconsin Departrnent of Commerce - SOIL EVALUATION REPORT Page 1 of avisbn of Safeiy and Butldings ~,';~,~ p y ~~ . m accoroarwe wmr ~:onnn a~, rns. rwm. ~,oae ' Plan must 8112 x 11 i in ¢e ir i t l th h l l 5 c ro l . an rx es s an on paper no ess Attac comp ete s te p inducts, but not 16nited to: vertical arxt horizontal and percentslope, scale ordimensbns, north arrow, a -'dim crest road. -1 Parcel LD. ~ Zo-- / 3 `~ ~ ~ /a 'DUD ,, ~- , Please print aU f n. ~. ~; { ->y Date \ ~~~ Personal infomtation you provide may be used for ry purs~~~~aw, s.'16:04 1) (m)), ~ ~ ( Q Property Owner "`•` ~ P y lion ~. ~ ~ ~ ~~E~ ~ ~ ~~ ~ ~ 1/4 W1/4 SZSTZy N R ~ E(~)~ Property Owners Maifing Address ; ... S LoZ,e, . Block # Subd. Name or CSM!/ Co ~ Z O S~. l I ware` o F-c.~ ~` S e .' City State Tp Code ~ - ~ ^ lfdlage (~ Town Nearest Road . a ,. - ~Sti' I l wa-~r -~ r\, . fS'o ~z ( ~~y ~q ~~' ~ ,Q-/J s ~ n ® New Construction flee: ® Residential / Number of be~+ooms 3 _ `{ Code derfired design flow rate ~Sd ~le O O GPD ^ Repiaca3ment ^ Public or commeraal - Desa>be: Parent material DU fc~la.s (~ Flood Plain elevation if apprrcable ~( 7• U ft General comments ~ ~ S ~ rri L l ~ t10.~.b /~ - ~ S 30 . ~ Yl'l ~" Z y~.~, ~2 C~4J -~v ~ 3 - and recommendations: ~ ~~ e. I .e.~ a ~-~ d ri - ~~/ o U u~~~ ~lvrn.e. .~~. ~ BZ s (Al Pit Ground surface elev. q~•~ O R Depth b limiting ta~• I~ $ in. Sort Rate Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Mansell Qu. Sz. Coat Cobr Gr. Sz Sh. •Eff#1 •EtT#2 I o -Ib (O L I -~s n-~-Er- ~ 1,r-~ - -t ~- 2 Z- i0-1 `11 - mS rfl t - . ~ 1. Z Z `~ 2 `' EOnng # ®PiB t ng Ground surface elev. O ft. i~epth to laniting factor ~ 2.O in. Sod Rate Horizon Depth Dominant Cob Redox Description Texture SWcture Consistence Boundary Roots GP D/f!z in. MunseU 4u. Sz. Cont t;•obr Gr. Sz Sh. - 'Eff#1 •Etf#2 I v-1 Z --= L l m m-Fr ~ I ~-~ L, 2 ~~- * Effluent = BOD_ > 30 < 220 nw/L and TSS >30 < 1 50 moll. ' Effluent #2 = BOD . < 30 m9IL and TSS _< 30 mg/L CST Name (Please Print) Signature CST Number e.r1 .~~~ ~-_ 25 ~ 309 Addmss Date Evaluation Condur~ed Telephone Number 2lt ~ -~ . I Z ~ - l ~ ~ 15 ~ Zy ~-~-I(~O $ C Property Owner /~.r k~ ~ I Parcel ID # Page z of _ , 3 Boring # ^ Boring 3 ®Pit Ground surface elev. 9 ~ 8'~ fk Depth to limiting I Q`~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDItt'- in. Munsell Qu. Sz. Cont Color Gr• ~- ~. *~ 'Eff#2 ~ b- t 0 f 3 2 -~ I_S~~ I rns TY~f' G _. I v y -~ I. Z ~ S_ o _ u ~ ~~ 33. ~ _ _ _ 3 ~~ # ^ Boring ^ Pit Ground surface elev. ft. Depth bo limiting factor in. ~~ ication Rate Horizon Depth Dominant Color Redox Description Texture Struchme Consistence Boundary Roots GPDflf in. Munsetl ~ Qu. Sz. Cont Cobr Gr. Sz Sh. 'Ef~1 'Eff#2 Bonng # ^ Bonng ^ Pit Ground surface elev. ft. .Depth to limiting factor in. Soli ication Rate Horizon De th Dominant Cobr Redox Description Texture Strucfime Consistence Boundary Roots GP D/ft? p in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Efi#1 'Eif#2 " Effluenrt #1 =' GODS ~ 30 ~ 220 mglt_ and TSS >30 <_ 150 mg/L ' Effluent #2 - 8005 < 30 mgll. and. TSS _< ~ 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-8330 (R.07Po0) .w.~,G 0 N N PAGE ~ OF~_ NAME Y` -~ LOT# LEGAL DESCRIPTION,Uu1'/a Nc.}/a S zsTZ R N R ( E or SCALE: 1"= ya , BM 1 ELEVATION /Qd - O I x BM 1 DESCRIPTION o -~ l z ~ ~vL ~•'~~ -- +' - -" BM 2 ELEVATION C~- ~ y S h'~ 6L-"' =~ ~' ~ I .$ ems. z S BM 2 DESCRIPTION -/a ~ 1 ~~ .' ~G~"" SYSTEM ELEVATION 9S. 3d ALTERNATE ELEVATION ~~' O ~ CONTOUR ELEVATION 9G •so, 9 ~ so, q ~ s~ ~ i ~-. 0 t R<.~ Q i Zo ~ `rfr Shot ,_.~- ~ izd Fi w.`" I gt"1•o U f ""~~- K ~(,~---- ~2~ 8~~ Ii5 ~ l I ,~~- SIGNATURE ~ ~_,_ ~-~ - ~~-' ~o r g z ~o ~_. ~~ ~~'f ~\~ D a ~ ~ ~ d. O.I 1 _~, LK I x -3 S ~i-~ " ~ ~ Q ~+ , -, ~~ i ~~ATE (~ - G - --- ___ i zv~ +~ +-~~~~~ ~I-~,o -}~ ~tJ L . )~ ' 7 2089? 262 703427 y STATE BAR OF WISCONSIN FORM l - 1998 KATHLEEN H. NALSN Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., NI RECEIVED FOR RECORD Parcelldentitication?JUmher(PIN) 12/23/2002 03:15PM THIS DEED, made between Carriage Homes XXI, Inc., Grantor, and EXEMGT q Brian Aichele Grantee. REC FEE: 11.00 Grantor, for a valuable consideration, conveys to Grantee the following TRANS FEE: 267. 90 described real estate in S[. Croix County, State of Wisconsin (the COPY FEE: "Property"): PAGESCOPi FEE: Lot l2, Scenic Hills, St. Croix County, Wisconsin. This is no[ homestead property. Recording Area _ ~ Name and Return Address ~. Together wnh all appurtenant rights, title and interests. Land Title Inc Grantor warrants that ttte title to the Property is good, indefeasible in 1900 Silver Lake Road fee simple and free and clear of encumbrances except New Brighton, MN 551 l2 Dated this. t"~ ~ &~~ Carnage II es )i?CI, Inc. ,p ~I N '~ ~ ~ ~ - l q ~ / '" bd a ~ ~- ~~l',// _~~~~~ILG~ ~/ ~ (SEAL) (SEAL) * KeUei St. Martin Vice President (SEAL) (SEAL) AL`THENTICA'PION ACKNOWLEDGMENT Signature(s) STATE OF MINNESOTA }SS. COUNTY WASHINGTON authenticated [his 1l"iLE: MEMBER S7 ATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stars.) THtS INSTRUMENT WAS DRAFTED BY Gregory Booth Attorney 1900 Silver Lake Road New Brighton, MN 551 12 Signatures may be authenticated or acknowledged. Both are not necessary.) Names of persons signing in any capacity must he typed or printed below then >umaWre. KeUei St. Martin, the vice president of Carriage Homes }C?{I, Inc. a corporation under the laws of Minnesota on behalf of the corporation, personally came before me this 26 day of July, 2002. * Notary Public, State of Minnesota My commission is permanent. (If not, state expiration date: ~ nnnrs~`^^^~'^~`vw~nMVw.M~ gZgZ NANCY J. LENTZ ~ NOTAPY PUBLIPMINNESOTA , My Comm. Expires Jan. 31.2005 ~l~r~ ~~~~~~~ Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: System Design Specifications Sanitary Permit Number Number of Bedrooms Desi, n Flow -Peak (gpd} /,S ~' Estimated Flow -Average (gpd) Septic Tank Capacity (gal) Soil Absorption Component Size (ft2) Type of Wastewater Domes is Table 2: Soil Absorption Component -Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow -Peak (gpd) ~ Maximum Influent Particle Size (in) 1/8 Maximum BODS (mg/L) 220 Maximum TSS (mg/L) 150 Table 3: Maintenance Schedule ~--?-~ . „ Septic Tank Inspect and/or service once eve 3 years Outlet Filter Inspect once a year and clean at lea once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the ' % "' . I , • . Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shah 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 enfer a septic or other treafinent or holding tank for any reason without being in full compliance with OSHA sfandards for enfering a confined space. The atmosphere within the septic or other freatmenf of holding tank may confain /efhal 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 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. Traffiic 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 wil{ reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 ,, ' s 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. ~~.~~ T ,~~~~s~~ P~~ ~ ~~.~-~7~ ~~~~ ~~-,Jk ~-- (~5~~ c©~cczc~~E 7~.5 b4~`7 23 I/ c~ ~ ~~~` ~6~0 //~-~'~ S-f- c d~ o l K ~ o tilN'~ ~ ~S ~,r~ 3 ST CRQIX COUNTY SEPTIC TANK MAII~ITBNANCB AGRBEMBNT AND OWNBRSHIP CERTIFICATION FORM Owner/Buyer Pmgtuty Address (Verification required v~ planning Department for new 0 Ol GytylState Parcel Identification Number ~~ Zr~ ~ 3 "~' ~ ~ Z ~ ~ ~ i FrpY, DESCRIPTION r ~' ~ y,,/V l~ y., Scc. ~at-S. T~ R 1 g W, Town of ' Property Location ,__ - Lot ~ ~ ~-- v Subdivision . Certiftd Survey Map # _,^ ,Volume ~ ,Page Warranty Deed # ~~ ~ ~ Z- ~ . Yolutne Zd U ~ .Page # Z r° ^Z. , ~/ Spot house O ycs~ no Lot lines identifiable ~} yes O no cvc~M MAINTENAI~~. xmpropa use and maintenaneeof your septic ryttem could recall in il~ prcrnaturc failure to handle wastes. Proper maintoosnce o.~psitts of pumping out the scpdc talc every throe years or sooner, if needed by a licensed pumper. What you put into tlu system can affect the function of the septic talc as a taeatmeat state is ~e waste disposal systew- Tbe property owner t~g~ees to submit to St Qroix Zoning Department a ccrtt!"icatiora form, signed by the owner and by a matOprplumber, journeyman plumbe!x, restricted plumber or a licensed pumper verifying that (!) the on-tibc wastewsterdisposal system it is proper opetttiag coalition and/or (2) after inspection and puwpir~g (if necessary), the septic tsllc is less than I/3 fuIl of sludge. I/we, the undorsiened have read the above requirements sad agree tv aoaiatain the private sewage disposal systesu with the standa~s set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Cudttcation stating that your septic system has bees maintained must ba compktcd and returned to the St. Croix County Zo»8 Office ~~ 30 three yea expiation date. ~a~ ~ DATE RTIFICATION OWNER CE t (we) certify flat all etatemeats on taus form arc true to the best of my (our} knowledge. I (we) am (arc) tha owner(s) of perty deacnbcd above. b v' a of a warranty deed recorded in Regisur of Deeds Office. 1~i2~b2- DATB +••++• Any information that is mil-represented may result in the sanitary permit being revoked by the Zoning Department. ••••«. •• include with this: applicstion: a stamped warranty deed From the ILegister of Deeds ofRce a copy of the ccrtificd turvey t;tap if cctereace is made in the warranty deed S{]Nb~ p311'dlc~N(1 "`~•• _~*R. • w ~ • • i i T~-~+Aial~ ~ ~ .~.-. ~ ~ ~ ...~~ .~ _~ ~~ ~.. ., f'. ., .., .. ~ j .. I ~~ilyQ `•.~ ~ : b~ ~ + AAw ..~ . • ~.. ~ _ ^y ~ / `~ 1 .:. ~ ,• t ~ J)~, ~~` I , ~ ~ i1 R • ~ , . ./ ~„ . •. v y ` 4 ~ \ / ~~1 M I~ ~ ~ • ` MM ~ 1 `, `~ ~ S W ~' ~~ r~ r' _.,~ .., . ..:.,:. ,. _ ( _,,. 1 Y N ( ~, ,` r~r~ rte.+~ it1 • ~_~ ' -~ i r = - .~~ ~ oQ ~~ IV i i 1 --~~} . ~, ~ , t i ~ zd wdsz : i® z0az~ ~z •a=a •aN xdd "'~"""' . wow