HomeMy WebLinkAbout020-1395-33-000 Safs;ty and 5ui OiViii' 91
2G I 1h' IN aslangLOn Av p, 0. Box 7162
cousin Madison, W1 53707 - % 162 (to be fU)ed in by COO
(608 2 466-3151
De &rtment of Commerce 1. D. Number
Sanitary Permit Application
In accord with Comm 83,21, Wis. Adm, Code, personal information you provide
my be used for secondary purposes Privacy Law. s15,04(1l(M) Project Address (if different than nailing address)
Pl ease Print All Information
� ,-_Aiilicadw —Information - Pl Lit # Block
I -- — Par el #
r
Foropeity OW Ps No me RECEIVED I Ozo- 131
6; _7�� C_— 1-33 =
/VO —;- Property Location
prop" ow�W's Address s APR 2 1 2`003 ?A,Swthxl
City, State
ZONING OFFICE I (Circle on
E
71I.
T 9 V N R /F W
_ I(V
' Eu - pe of �Iding (Ckn_k all that apply) CS 4 Number
/ Subdivision Name
I or 2 Family Dwelling - Number of Beirooms I -bwr— - 1 .1
, S te rn "o
Public/COMmOrcial - Describe ITSO
getTowaship
❑l State Ownwd - Describe Use
al. Type Of Perjalt; (Check only one box on line A. Complete line B if applicable)
-- i 1 [11 other Mod ification to Exist System
A. [I Replac eat System tatmem/HoldnIg U* Replacement 0111
N qyattrn '
Pe rmit U
List Previous Permit Number and [)ate Issued
B. ❑ permit kenewal ermli Revision I ❑ Change of Perm
Ir
Plumber Ti -Transfer to New i
Owner
Before Expiration 4 12 0 5 - 7
TV. T of _POVVTS System: (.Check all that a
YP
easurized In- Groused ❑ 0 Mound > 24 � n, of suitable 50il Mound < 24 in. OfsuiLab
le soil L_j At-Grade 2 Single Pass Sand filter
Non _Pr
E: peat Filter Di Aerobic Treatment unit ❑ Recirculatirl Sand Filter
❑ Constructed WetlW Pressurized In-G",und 0 Holdinj Tank"
-aching Chamber 0 1X2 Lin: 1 Gravel less Pips 2__�Othr (explain)
PXcirculatina Synthetic Media HXOT__IL�. —
i
V. Dispwal/Treatment Area Infor 'on: System, Elevation
D Flo* (Va) Desigr, Soil Application RaWW$t� D#ersal Area Required (sf- ; Dispersal AM Proposed Of) I I
b Si te Steel j Fiber Plastic
Capacity in Tital j N,:mber Manufa�:turzr Prefa 3
V1. Tan truto -
I e
of Uruts C onc r ete Construed Grass Gallons Gallons
N ew
sting
TO" I Tanks
zzk
r 3v 'ex V
septIc or Holdln& 1
Aerobic S'reatmetu UnIt
Dosing Chamber
for hutallation of the POWTS shown on the attached plans.
8 ResponsibiLty Statement 1, tilt ' Business Phone Number
�P�Jum �s No me (?rino ?lumber's Si gnavure TPRS Number
�i o C;iL r� •i7 /1 � bt•k %,/rI J• " " ^ .��Xi ` a3•+� ' . -- ��""". � J��'.d _ ' l,S�� ' � 3: iRt
Plumber's Addre ss (Street, City, State•�, Zip Code)
V111. 0049tr�Merfttnt Use-RUIX
pnt si;7 Stamps;
App roved ❑ DisaWolled", - T Sanitary Permit F includes GroOdWatOr Date Issued is ng
Surcharge Fee)
Owner Given Reason for Denial
LX. Conditions of ApprovW.'Reasons for Disappral
SCE vkv �j:a ov _ 1 � � `
d# " - 1,11
'7C
C ounty WY) for the System on gap Act INS t han 811 A 11 inch"
Attach complete plans (to the 5 In size
SBD-6398 (R. 01103)
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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page _ of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code County
G oo In
Attach complete site plan on paper not less than 8 1/2 x 11 inches in sae. Plan must
Include, but not limited to: vertical and horizontal reference point (BM), direction and Paroel I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all Intonation. Reviewed by Dace
Personai intormation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
A/I GovL Lot 114 1/4 S T N R E (or) W
Property Owners g Address Lot # Block # Sum. Name or CSSM#
3
City State Zip Code Phone Number ❑City ❑ Village / [0 Town Nearest Road
( ) Hof c
New Construction Use: (iResidential / Number of bedrooms__ Code derived design flow rate � GPD
❑ Replacement Public or commercial - Describe:
Patent material 60- Fl0000ld Plain elevation if applicable — ft.
General comments 5y�r1 2�ev
and recommendations:
Bong # F1 Boring !�
Pit Ground surface elev. R Depth in limiting factor � m• Sol Applicatiori Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. `Etf#1 `Efl#2
Z ro-so - Z
t5 s"
/ Kin
❑ Boring # ❑ Boring l
Pit Ground surface elev.6!_ ft. Depth to limiting factor (ZI _ in. Applica Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2
-ll 6 ` N4� U 5 �r
ZM5&L n4� 2
Effluent #1 = BOD > 30 220 mg/L and TSS >30:5 150 mg/L ` Etiluent #2 = BOD < 30 mg/L and TSS < 30 mglL
CS Name (Please Print) _ ura z E 3
10 - Address
Date Evaluation Conducted Telephone Number
alJ r rSe� JAI 1. S'yozS
Property Owner Parcel ID # Page _ of _
--- --
[-31 ��g # ❑Boring ��, �
❑) 'Pit Ground surface elev. _�___."- ft. Depth to Nmiting factor in• Sol Appl ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfI=
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 'Etf#2
1 o sr Zrngb YK 6.5 v
�
El Boring
F
Boring # ❑ Pit ;Ground surface elev. ft. Depth to limiting factor lo• Sop lion Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'EfW2
Boring # a Boring Ground surface elev. ft. Depth to limiting factor in --
❑ Pit Sod lion Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDI(P
in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
• Effluent #1 = BOD > 30:s 220 mg/L and TSS >30!S 150 mglL ` Effluent #2 = BOD < 30 mg/L and TSS <_ 30 m9k
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- 2648777.
SBD.8330 (R.07/00)
r
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page _ of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code County
Goof
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 point (BM), direction and Parcel ID.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. - j C ('5 - 3 - 3-00 0
Please print all infonnat/on. Review by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 1 ,� j
Property Pro Location l
(911 Govt Lot S V v 1/4 /)(/ji /4 S_ T N R E (or W
Property Owner's Mbiling Address Lot # Block # Subd. Name or CSM#
3 Se-e
City State Zip Code Phone Number El City [I Village , (0 Town N l ea est Road J
( ) crcr' r
(� New Construction Use: [� / Number of bedrooms —_ Code derived design flow rate _— _ ___ —__ GPD
0 Replacement D Public or commercial - Describe: -- —
Parent material - -_ Flood Plain elevation if applicable _� � _- -- ft•
General comments < � fl eV . P r
and recommendations: J l r
F-11 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 GPDfff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 "Eff#2
/o /0Y'--_3/3 u4 S
Z /0 -,5 — , Z 5 S
Boring # Boring �/1 I
L p' Depth t limiting
Pit Ground surface elay. !C _ ft. epo miting factor l r!� -- in. - Sol Applica 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
10-11 6 ,J S fW_ pylp U
Z l- d / L —
x '1'(0 • �-� S s of c(2 . (03 2 . �o
`
Effluent #1 = BOD > i0 220 mg /L and TSS >30 < 150 mg1L " Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CS Name (Please jetfure ,7 CST umber
MA Z Tj-
Adder Date Evaluation Conducted Telephone Number
1. 5 - o Z 71 S-z y - 4)"11
r -
s 4
Property Owner _ _ Parcel ID # __,— _�_ —__ Page --_ of _
E) Boring
Boring #
1 - 31 [2 Pit Ground surface elev. _E- 5 ft. Depth to limiting factor - -�[� in. Son Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD&
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. v�� *Eff#1 *Eff#2
1 l��f'0 r jr Z mqb I ► C� v
❑ Boring # ❑Boring -
❑ Pit ground „surface elev. ft. Depth 10 {uniting factor in. Soft Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/If
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Etfff2
❑ Boring # E] Boring _
El Pit Ground surface elev. `___,_ ft. Depth to limiting factor — in.
Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfff
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2
Effluent #1 = BOD 30 <_ mglL and TSS >30 <_ 150 mglL ' Effluent #2 = BOD < 30 mglL and TSS < 30 mg/-
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.
ssD -8330 (R.07i00)
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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
420567 0
GENERA. 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:
Carriage Homes Inc. I Hudson Township 020 - 1395 - 33-000
CST BM Elev: Insp. SM Elev: BM Description:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTU ER CAPACITY STATION BS HI FS ELEV.
hf"
Septic la � Benchmark
Dosing Alt. BM
ST C�Vg Z 9 !- - 7 S"
Aeration Bldg. Sewer
7
Holdin St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outl 1 k_,, L Jol v ,O
TANK TO P/ WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic
2_51 t t ► Dt o
1'
Dosing He der /Man. , /p�a� � s� �•�, 9
Aeration Dist. Pipe
Holding Bot. System
Final Grade
PUMP /SIPHON INFORMATION
Manufacturer Demand St Cover
GP
Mod Number
TDH U Friction Loss System Head TDH Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width I Len th No. Of Trenches PI 7 DIMEN S No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 7
SETBACK SYSTEM TO P/L BLDG WE LAKE /STREA LEACHIN Man ct /
INFORMATION CHAMBER R _ I -} V V°
TygQ Of System � � � � �� U Model Number:
DISTRIBUTION SYSTEM
Header /Manifo d Di t ib ti n x of in Vent to Air Intake
s n u io x Hole Size Hole pacing ,
I t Pipe(s) q / �Li'
Length Dia Length / 1 Dia Spacing � U
SOIL COVER _ x Pressure Systems Only xx Mound Or At -Grade Systems Only h
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center -1_/ 7 Bed/Trench Edges Topsoil [W Yes ❑ No [] Ye7%�No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1 -2- /ZG / Z__ Inspection #2: / /
CsZ
Location: 830 Highlander Trail Hudson, WI 54016 (SW 1/4 NW 1/4 25 T29N R19W) Scenic Hills Lot 33 Parcel No: 25.29.19.2427
1.) Alt BM Description �r� nn--
2.) Bldg sewer length 4 * GA F v 1`"'Z �D iu.►- a P' rr» �' !��° �tx.!/ 7
- amount of cover = I L lb_1
Grp.
Plan revision Required? es
Use other side for additional information. Z o � _ _ __� C_ Q ._
SBD -6710 (R.3/97) Date �� � n L � �nsepctor's Sign t �
i
Safety and Buildings Division County t
201 W. Washington Ave., P.O. Box 7162 S
1111 fisconsin Madison, W1 53707 - 7162 Site Address }(, L"
De artment of Commerce 1 -ZV - 0`Z-- .3 0 �� / ✓ '
Sanitary Permit Application Sanitary Permit umber
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision
may be used for seco purposes Privacy Law, s 15. 1 m
I. Application Information - Please Print All Information State Plan I.D. Number
Property Owner's Name areeI Number
02.0 — (3 95 3 ^a= C. 242'
Property Owner's MaQijAddress petty Location
1 1772 �
ST. Cr` ( (' ; -A S4• S T N, R f
City, State J f � �� y I L � Zip Code Lot Nu� r Block Number /
Sub ivision Name CSM Number
r ( f
II. Type of Building (check fall that apply) aS s i ❑City
1 or 2 Family Dwelling - Number of Bedrooms 0. A ❑Village
❑ Public/Commercial - Describe Use ❑Township h'&,45 �
❑ State Owned Neatest Road
III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable)
A. j KNew 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to For County use
stem Tank Only Exist stem
B. El Check if Sanitary Permit Previously Issued
Permit Number Date Issued
IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) it (CYD
4j)NrNon - Pressurized In - Ground 2111 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland
22 ❑ Pressurized In -Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line
45 ❑ At -Grade 46 ❑ Aerobic T Unit 49 ❑ Recirculating 30 ❑ Other
V. Dispersairrmtment Area Information: r - IC
Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade
Required Proposed 9 33 Rate(Gals./Days/Sq.Ft.) (Min./Inch) Elevation
�S 7 7 y a-- 9�- , F,-/ lal), 7d
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 Q l
Dosing Chamber v
VII. Responsibility Statement - I, the undersigned, assrmte responsibility r /WRS tion of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Signature Number Business Phone Number
� 1T�e � � s• 3 86 - ��z /
Plumber's Address (Street, City, State, Zip Code)
(;7G C a7 1 � 0—
VIII. County /De artment Use Onl
Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issu Agent Signature (No Stamps)
Surcharge Fee)
❑Owner Given Initial Adverse
--& Z2-5 (I ��j 0
9
Determination �J
IX. Conditions of Approval/Reasons for Disapproval tAL S s+X�
- �- ' �� ►nn.x SE CIA , �iNlLts- rt��:. ^� c �e w 1G 6.4 � ►NSA., u� t� t S
^ n + Attach complete plans ( to the County only f ayrtem on paper not leas than 8112 x 11 Inches In size
SBD- 6398 05/01)��
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NUisconw Department of Commerce SOIL EVALUATION REPORT Page I of
Division of Safety and Buildings
in accordance with Comm 85, Vft Adm. Code qty
Cr0�
Attach complete side plan on paper not less than 8112 x 11 inches in size. Plan must
�
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D.
percent slope, scale or dimensions, north arrow, and f aOstdnce to nearest road.
Please print all e n: t f 1 `sib R by Data
Personal information you Provide may be used for aY Law .04 (1) (m)).- . � Z.
Property Owner i * _ U Prop" Location
. M i ^ Govt oft 1l4 r (jw 1l4 S Z T Z �/ N R/ E (or)6
Property Owner's Mailing Address 4 ' Lot# I Block # &W. Name or MIS
f,D Z D S I i W 1 `P( Y
City State Zip Code y MMV NW"G OFF +CE. ity ❑ Village W Town Nearest Road
sti I L Wa,.•� -c r YY1 rl , f "S"o �Z ( ��" 4 - � s �, • n ri, �d
® New Construction Use: ® Residential I Number of J �' ` Code derived design flow raise -4�Sd . O O GPD
❑ Replacement Q Public or commercial - Describe:
Parent material OU k.'J" L-- Flood Plain elevation if applicable �� R
General comments S y S k w" e, l e J 0. f b n — qG • t o
and recommendations: I e. � a {-; o r� — QG 60
Boring # r 0 Boring 9
i pi Pit Ground surface elev. q Q a ft Depth to limiting factor 118 in.
Soo Appi station Rate
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDMIF
in. Munsd Qu. Sz. Court. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
n-19 l 3 3 ail 2mc� C-
` l L / - � - 51 it) tl f3 Si c_I gym b k m 4r GS
3 34 rL/
37.2. '� • .
Boring # ❑ Boring
® Pit Ground surface elev. ft Depth to limiting factor > > O in. soy Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDflF
in. Munseli Qu. Sz. Cont Color Gr, Sz. Sh. TOM - Eff#2
mfr C— V �� g
Z 12 -3a j Si�1 Z SDK , r — y Co
2
' Effluent #1 = BOR > 30 _< 220 mg/L. and TSS >30 150 mg/L ` EMwnt #2 = B013 30 mg1L and TSS < 30 mg/L
CST Name (Please Print) S• nature CST Number
Address Date Evaluation Conducted Telephone Number
. Y
Property Owner Parcel ID # Page Z Of
a Boring # ❑ Boring
® Pit Ground surface elev. 00 .7d it Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'EW '01#2
1 o -t2 10 I Si I mab - c
z �2 - I —J Zrf` ]�)
❑ Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in. - Fod — Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/iti
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'EfM "Eff#2
F Boring # E] 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 GPD/fF
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Efr#1 'Eff#2
' Effluent #1 BOD > 30 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS _< 30 mg/t.
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 (R07Po0)
s �
PAGE 3 OF�_
NAME 14 r K e-! L LOT# 33 LEGAL DESCRIPTIONSw `14AtJ14,SZS'T 24 N,R /` E (or) 4k
SCALE: 1 "= 4 y 1
I
BM 1 ELEVATION /DO . 0
BM 1 DESCRIPTION {o n 1 c,*L $ " 14 "!A — t
BM 2 ELEVATION /00 - Q6 ,
5eC -Z S
BM 2 DESCRIPTION a r
SYSTEM ELEVATION 6 76 • y 0
ALTERNATE ELEVATION QCv F o
�—1
CONTOUR ELEVATION Zoo.o �Io/ o
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SIGNATURE DATE - -O
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 department, system within
conditions of approval by agent,
the parameters of Comm 83 and 84, and the p
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 Z-
Number of Bedrooms
Design Flow - Peak ( pd) a
Estimated Flow - Average pd)
Septic Tank Capacity al)
Soil Absorption Component Size ( ) porn tic
Type of Wastewater
Table 2: Soil Abso tion Com onent - Limits of Reliable Operation
Septic Tank Component Soil Abso tion Component
Des! n Flow -Peak d Z$O `l33 s4
lie
Maximum Influent Particle Size (in) 220
Maximum BOD (m /L 150
Maximum TSS (mgil -)
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 sep 'c tank and outlet filter shall be assessed at least
once every 3 years by inspection. Th outl t filter all be cleaned as necessa4LJa ensure
proper o eration. The filter cartridge shou no a removed un ess provisions are made to
that may slough off the filter when removed from its enclosure. If the
solids in the tank 9
retain soli Y
Management pian for a Septic Tank srd Sal; Absorption Comt�rtenl
s
filter
i e quip ped with an shirr, the filter shall b serviced if the alarm Is mu cus ai ntInu u&l
In filter alums may lndt* surge Mows
o
!ze voiu nd .um and slu i n the tank
septic tank shall have its contents removed whe
exopeds 413 the liquid volume of the tank. if the oantar�ts of the rank erg when tha Heats $ervioe
time of an agassmont, maintenance � than max� � � � a �urnuiatlon in the
nauula to be peiforrned to rnalnteln es
tok.
Manhole risers, access risers and oovers should be Inspected fo
waled ; t open
soundnsoss. Access OFIVInga used for service and auls+NSa d saws' or subject to falluns fr'►ust
the taompletlon of aerviae. Any opening deemed unsoundt
be re lewd. , eed &001166 openings greater than 940hes to eia for shall gcured by
an effective iookiny device to prevent aaddentai or unauthoAzsd mtY
t or ho ding a se fen # far
No one should enbr pf 1! other o �
any reason w1ti Gut briny Nl n the ear other
� s �tlnid �„ .� eah
intRln it attd A110" of s
trrgbl�nt of "Mine
person from the intw►lor of the tank may be aftuN or IMp"Ai*
Tank abandonment shall be in s000rdarwe with Corn 83.33, WIG, Adm. Code when the
tank is no longer used as a powy$ component.
The Boll absorption component serving this s+tntbturo lof�� � �+,��ars :hown�r�
wastewater from a midentlat facility. The #unit: of hparatlon
Table 3.
The ipngevity of a loll absorption om
component depends greatly on proper and tlmelY
maintaneno9f and system use within or below the limits of reliableO �nseNl G plumbing
floneervation pnotices by elf oocupa a oomp�onsnt.
fixtures are key factors in extending the use li fe a
The soil absorption OW operatton must be asaessad by inspsotion at least
in
levels of ponding, If any,
once every three yearn. The Inspection $ hail include Oi of swap` seepage or discharge
the observation plpisa, said a vl�usi Inspection far any
from the oamponent. On steeply sloping site areas of of domesti was owatsr or sew ga
rs►ported to the owner for
repair. d ca naldered a health hazard
from tip sy�ttem to proh ibited
Traffic around or over the Bali absorption comp
onent Cov er , Over the COMP"rit May
should be avoided patticularly I$ad
during winter months, Tit• compaction or ramaval of u�sll tempo rY. but Is dl cult Of
to hydraulic failure by freezing. This type of failure s
impossible to repair until weather canditlons improve. In dig ei, al sell,, which "Y ead to
r WN41nent will reduce diffusbn G O* g n the e0il en A
m om intense, and earlier, arils tto Clo
Management Plan for a Septic Tank and Soil Absorption Component
Plantings of deep-rooted trees and shrub$ directly over of within ten feet of the component
should be avoided since root intrusion into the component may obstruct wmtewater flow.
Contingency Plan
In the event of system failure, a new system could be Installed in an alternate area. With the
Installation of a diverter vales, the existing system could also be reused after a period of three to
four years.
It Is the property owners responsibility to maintain the aiternts area free from any planting of
tress, shrub$, etc. In teas of fair Original ltve atte 1, sr�► , they
have to be removed t If
any trees, shrub$, etc. have bee n planted on
property owners expense.
If alternate area is destroyed, there are other alternative systems that can be used, in which,
could result in added expanse to the property owner.
Any tank abandonment shall be done in accordance with Wise. Code $3.33, Any queettons
regarding this code, please contact your bail Zoning Office or contact" installing plumber.
2.t9N1N q �Ge. �� 1 J� J• �p `"' 4� (p� 0
o
5t��� aka
SEPTIC TANK MAINTENANCE AGREEMENT '
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer t%` r' l7`a', . { 'fit' L
Mailing Address l'
Property Address _ �• `'- ��''
(Verification required m Planning Department for new construction)
city/State Identification Number
I,GAL nESCRIPT ION
Property Location 6 ' 41 AL 1 A.. Sec. 23" . T_ZLN -RAW, Town of
. Lot # _
Subdivision
Certified Survey Map # , Volume . Page # _—
Warr=ty Deed # a A R�10 1 1� . Volume 4GZ , Page It 28q
Spec house O yeSA no Jot lines ideutsfiablAye s 0 no
SYSTTM MAINTENANCE
. ImFoper use sad =&hdcmamec of year septic system could malt is its prcmt=faffure to handle wastes. Pieper maiatcaance
consitu of pumping out the septic Unk every th= yeas or sooner, if needed by a licensed ptnsper. What you put into die rysum .
can affoct the function of die septic tank as a tiieatnteat cup is ilia waste disposal System.
7be property owner ac= to mbmit to St. Oram Zoning Department t oatificatioa form. Signed by the owner and by a
inasta plumb=, joumeymiuz plmnber, resmcwdpiumber oralic a nsedpumpervrsifying that (1)theon-site wastewaterdisposalsystem
is is propex operating condition and/or (2) after inspection cad pumpiag.(if aeccssary), the tcpdc tank is less than 1/3 . fid! of sludge.
Vwe, the undersigned have read the above roquirements and agree to maintain the private sewage disposal system with the standards
sect forth, herein, as Set by dw Department of Commerce and the Degattmeat of Natural Resources; State of Wisconsin. C O- catioa
stating that your septic rya= has boom maintained must be completed and rdnaicd to the St Croix County Zoning Office within 30
days of the throe year expiration date.
SIGIZAIIM OF APPLICANT DATE
OWNER. CERTIN CATXON
I (we) certify statements on this form erne true to the best of my (our) knowledge. I (we) am (are) the o wner(s) of
dye , by virtue of a warranty deed recorded in Register of Dee& Office.
SAVCTUkE APpUCANT DATE
s.s.aa Any information that is lair tedsuy result in the sanitary permit being revoked by the Zoning Department. `• ""
•• Include with this application: a tt&MPJ warranty deed from the Register of Deeds office
a copy of the certified survey nap if reference is made in the warranty deed
1662PAG(289
' 648604
KATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
06-18 -2001 12:45 PM
WARRANTY DEED
EXEMPT 1
CERT COPY FEE:
COPY FEE:
TRANSFER FEE: 9900.00
RECORDING FEE: 14.00
PAGES: 3
kfemdiat Am
Name amd Retina A".
L.4,i
Ne,.a 13r "' lkbn , MN /IZ
(7Zo 1 Obq - ?o
meal *' Nmo6er wm
t�ZO - 1C� 6 Y -DSO= vci
( - c/o
1070 - 00 - �p
02 1070 - 10 ... 0
01
- THIS PAGE IS PART OB THIS LEGAL DOCUMMT - DO NOT REMOVE -
7Lls ie<ama6os ewa 3e eemplmed 6j �;,�; rGle
m & d1e P-1119 d--. ktaf 4a tpafe,y as -V k p(oed aw dtr nsam adds err •d P1N f✓rrq�dnedj. W6er(�erwadoa ryd
ft4i (kr d A oewr prate addr arae pmtt ro ywr docomme and S1�w to Ae K be piaesd en adawfaiet pater of iRe
11 cenam.&& WWO-6n Ammer. SAM. 14RD4 2,W
1,
DOCUMENT NO. 11
WARRANT! F D6RD
/� STATE O WISCONSIN —FORM S
vel..1�i62 f TNIf "FACE MMCFtVLD FOR 09eOADIN0 NATA
TM MDENTURE Made b RICHARD N. PEARSON and JEAN M.
t..... .. and (.ife
PEARSON hus » ......................»..... ....._.........._.._....__.....
_........._....._.......,
_ - - --._.---_-__._----------------------_..----••-•-------........_-..--••-•-------------••-•--•---
grantor_S» of.. �St. ... » _ Count ,Wisconsin,
_... y
hpreb conveys
and warrants to_.._RRIAGE HOMES XXI, INC., a
M>,nn�sota corporation, _.._. .___............__.... ».._.....
_.........._......» -----...._ .............................................. _ .................................................
'
........................................ _. .................... _............_.._.._._._....
_.. .»......»_.....»»....... _...._.........._....._........n���p C raatee »._... of
asfiing�on -' Count F
» �.:. »... ».... »........_- _._ . ............................... c the sum of;:
Qr)QQ�ar_ » and - .no /100 - •• (1 : OOZ » and - other good _and - valuable ±RETURN ., e A T;{ !Y F!
OSN1& lSll'.Lc11r12� .......... .................................................... . t L c. ti
.._.. ..
1S[i'3 /el3 S'r Iv Ltll(e i?�.
»._... _ ........
S f 1 v c
the following tract of land in ..... $t
.... .. _ ............ Coun
Wisconsin: . 11 XI. 9 f._ kh .. N_ o• ir•• Quar <er.,_LNW;a�d,.,j1Qr���lalf (Nh) of the Southwest
Quarter (SV%N) of Section Twenty -Five (25), Township Twenty -Nine (29) North, Range
Nineteen (19) West, St. Croix County, Wisconsin, except Lot One of Certified Survey
Map filed June 29, 1994, recorded in volume 10, Page 2782, St. Croix County Register
of Deeds, as Document No. 518444.
See Attached Exhibit A
Parcel Identification Number
r
F
!
7
This is not homestead property
In Witness Whereof the said grantors.. haVe..... hereunto set ....... » ...._...
1S. hands... and seals.... this
_._..._ ................. day of ....... ..........._ ................... A. D., 4(_2001
BIONRD AND 3ZALBD IN PRZBRNOE Or ....................... ..... . .............. ... .......................... .........(SEAL)
.._». ... _._ ...................... . _. ..........................................................
� csEAt)
.._ ... _ ............... _ ................ ..... ..................
....... _ .............................................................. ...• - -- ................... (SEAL)
S ttaaff of
to
WasbLnQton
___.._...____.. County. L6 , gonally me before me, this.?` i' . day of. A. D., iW...2 -QO1
the above named._$ICH N. JEAN M. PEARSON husband and wife,
---...--••----...
._..»_ ....... ..................................................... .......... .
... ...............................
to me known to be the persons-_ who executed the foregoing instrument and acknowledged the same.
.................... ..... .� ......_- ..__. .
......................
THIS INSMUMINT ww A* Ml
E v 64 NOTAR asnRSsa- av1 0UNTAIN
R>chaYd J. Gabr> # 9'6
Y Notar Publi f l � .- 4 RY PUBLIC MItO(ESOTA
880 Sibley Memorial Hwy. , #114 SEAL Y G KQIA .. ............ ".................. County w is.
My Comm. Expires Jan. 31. 21305
1736 M commission
tlw X39 31 (1) of the W"WOMin Statute ptovldes that all anRry 39 l"ents to be worded shall have plaloly d t printed a typerrittea thereon ,
pantar; g arReaa. ritooaea aad notary. Sartion .31) Wlvkaly " hat tM " I he pawn roe, en "over"•
aV afarq .hick. dotted tech iaNrvrvent. shall be printed. ty p— rotes, a rritlen thereon In a lefibk manna.)
wssaswTr DSBD STATE OF W[SCONS wboeeM" Le"AI Rtan" QomDaDy
rORaI Np f Mliwaoafa, Wta, (Job aJ611 )
F
vn!.1662PAGt 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
i
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2.389 ACRES �•
454.58'
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