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HomeMy WebLinkAbout020-1395-35-0004 ° ~ 3 0 o '~' 0 "~ m ~ '' a~ 0.. ! '' ~ c I ', ; Q ° o~ N yv a c N m ,r I .o O I ,~a o ~ ?, ~ I a v ~ ,~ o ~ I ~ c N ~ I ~, ~ ti i f0 O Vl a~~ O ~ O I a N N i u, y i oo p j ~ f9 Z ~ C N = L O N c 1 N T C O ? 'O p a U ~ .y Q ~ ~ ~ .d. I ~ ~ I Z y ~ Z " C ~ ~ ` Z ~ N a m ~ - In N f ' i t c O , o z a ~ c ~ 1 `~° ~ ~ v , ~ a w "= ~ a i Z a i rn m ~ z v~ -- •- j C t U ~ 'O .p d' N M N U ~ C 7 N N ~ ~ C ~ 0 3 L C o a m ~ _ ~~ I Z C = Z i c I d N N y ~ ~ I __ 2 ~ _ y C. r .. ~ ` m C U ~ CO N d ~ ' N O ~ 'c c o a ;o aE - cn m ~ ~ ~ ~ ~ ~ ~ ~- ~ o ~ I ~w ~ O O O I Z r'N R ~aaa ~ ~n a I N v ~ N ~ o N ~ ~ v v N t `l ~ fq J U = N N ~ a i Q ~- O ~ ~N ~' N ~ o I N ~~~ m O o _o v ~ ~ a~ m ~ a I ~ ~ ~ v ~ a? I ~ ~ °_' ¢ n in co b _ w 2 N ~ ~ 0 L W I W N C I O `~ O~ ` N .d 3 ~ II U 0. p °' ~~ N N V s, H u~ O .. ... C _ N O \/ C C O C7 ~ N Y O 7 ~ C 7 N ty~, C" 0 N I p ~ O E C N~ •~ L ' l ~ ~ ~„~ O N 2 m~ O N Z c~ g (A O V .a ~ `~. ~ ! r ~ •~ :: a ~ I rw r ~ o m~ ~ 3 :? o I A vat IOv~c~ , Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT G6NEFAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Bast, Kernon Hudson Townshi SST BM Elev: Insp. BM Elev: BM Description: SANK INFORMATION ELEVATION DAT TYPE MANUFACTURER CAPACITY Septic / a. Dosing w ~~Z~~ ~- -llS~ l l7~ Aeration Holding TANK SETBACK INFORMATION TANK TO • P/L IV WELl / ` BLDG. Vent to take ROAD Septic ~S/ ~ I~ ~ / Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss stem Head TDH Ft Forcemain Len Dia. Dist. to County: St. Croix Sanitary Permit No: 453064 0 State Plan ID No: Parcel Tax No: 020-1395-35-000 Section/Town/Range/Map No: 25.29.19.2429 STATION BS HI FS ELEV. Benchmark .~i cps/ ion . d Alt. BM C,`- ~~ j Bldg. Sewer Cad D w o3~ . ~ ~aa (® SbHt I. n St/Ht Outlet ~J r~ n J Dtlnlet Inlet / Dt Bottom ~ Header/MME v'' ~ 6 ~~, Dist. Pipe t Z ~. C( - 7- ~ ~ Bot ystem'o~ ~ - ~. ~ ~ (,. ~ 3 Final Gra e i~~ 5 ~^- 5~ a s / od • l St Cover ~ ~ Z. o f n3 ~ / SOIL ABSORPTION SYSTEM Z2--N 7~3 ys ~ ~ d -, ~'~ /. BED/TRENCH Width Length No. Of Trenches PIT DIME IONS No. O its Inside Dia. Liquid epth DIMENSIONS ~ r ,Y~ Z. "~/ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM EACHING anufact : / L INFORMATION CHAMBER O . ?'"YL~X Q't T Of S tem: yp ~ ` ~ ~~ ~f3 7 (J ~ ` / F.J ~ D -- Model Number: DISTRIBUTION SYSTEM ~ 12D /~~i2,o..~~OiL. (~+ Header/Man' Id ~ Distribution x Hole Size x Hole Spacing Vent it Intake ~i N Length Dia Pipe(s) l/Clr~ v h~,.y,T.~ / Length- Dia Spacing~~ _~- ~--- SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Systems Onlv Depth Over ) Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ • Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~G~ Inspection #Z: / / Location: 818 Highlander Trail H,ud~son, W/I 54016 (SW 1/4 NW 1/4 25 T29N_R19W) Scenic Hills Lot 35 Parcel No: 25.29.19.2429 1.) Alt BM Description = S'n ~v~V` ~~-.t-4_.O~-' lti.~(.J ~G/ Sr~~LL'~-t9~L~ ~i C~~ 2.) Bldg sewer length = ~G.~ / /yt, v -~ ~ 7 ~ - amount of cover = 3 ~G,B Plan revision Required? Yes No ~ 'S Use other side for additional information. ~ I ~~ ~ ~_ ~~(~~/!/i^~ hd'~~ n Date Insepctor's Si nature JJ.../ / ~~~~ Cert. No. SBD-6710 (R.3/97) _{~(p(/ Safety and Buildings Division Count>' t 201 W. Washington Ave., P.O. Box 7162 , I ~~O~~I ~ Madison, WI 53707 - 71,.62 (608) 266-3151 Sanitary 'ennit Number (to be tilled in by Co.) ~ Q Department of Commerce ~ iv Sanitary Permit Application State Plan I.D. Numb er~ Code persona Adm ccord with Comm 83 21 Wis I / . , . , . n a may be used for secondary purposes Privacy w, s15 e~ (Qn ~ ~ E ® ng address) aili dill rent than m Project Address (if / / ~ / ~ ~ ~~ L ~ ` ~ ~` ~ ~~ I. Application Information -Please Print All Information Property Owner's Name ( Parcel # Lot # Block # ~Z~'~n1 ST. ChOIX COtJNhr" Address /1 Property Owner's Mailin//g / J Property Locat~ijony; ~ o Z ^7 / ~G __ L h [ / ~ y., /'~!/~/<, Section City, State Zip Code Phone Number ! ~ ~~ 1/t.~C_- !] G ~~ ~ Z5 (circle one) T ~ N; R~E or W il t l h k h f di y} app ng (c ec a t a Buil II. Type o rCS tuber Subdivision Name ~or 2 Family Dwelling - Number of Bedrooms ~ ~ e; ~J ^ Public/Commercial -Describe Use ' ! ,, ' - /- ^ State Owned -Describe Use ~ ~/ST ~~ t~ ~~ r7 -~/~` i' ^City_^Vill ge ~ ownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ^ Replacement System ^ Trea[ment/Holding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T ~e of PO~VTS S stem: Check all that a 1 Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter Leachin Cha er ^ Dr' Line ^ Gravel-less Pipe Ot er expl 'n) ~ t V. Dis ersal/Treatment Area Information: d / - ` Desi n Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf J stem Elevat VI. Tank Lrfo Capacity in Gallons Total Gallons Nwnber of Units ~ ~ ~Ma~n/uJfacturer ~li~~'C A~QC~ Prefab Concrete Site Constructed New Existing / ~~ /~,~ ~"~~' Tanks Tanks f Septic or Holding Tank ~~ 1~O t'J( Aerobic Treahnrnt Unit Dosing Chamber Vll. Responsibility Statement- I, the undersigned, assume responsibility for' Ilation of the POWTS shown on the attached plans. Plu be 's Nat a (Print) Plumber' ign re P PRS Number Business Phone Number ~ ~ o ~.S ~7 7/} - a~ 8- b y5 Address (Street, City State, Zi de) Plumbe ~ C.~-'~ v V111. 'ounh~/Dc artmcnt Use Onl roved A roved ^ Disa Sanitary Permit Fee (includts Groundwater Date Issued suing Agent Si nature St mps) pp pp Surcharge Fee) ~~ ~ !f Z ^ Owner Given Reason for Denial IX. Conditions of Approv I/IZeasans for Disapproval ~- YSTEM OWNER: ~GL~ ~!U~~" -5~~~` ' ~.O ~ ' , ~ ~ ~ ~ , L ~ 3- effluent Filter and tic tank ~ e , p dispersal cell must all be ~Prviced I maintained _ ~~~ as per management plan provided by plumber. ~y,- d ~3 -1~ ~ ~ i ~ - ~ ~ ne All setback requirements must be mainta ~I ~ / ~ 8~~~3 - C~.~ T 2 ` / J . ~~ ~~~/ ~ . . ; as p r applicable code/ordinances. qo . 2' ~ e~ur.~~ Attach complete plans (to the County only) for the system on paper nor Tess man atic x „ mrnes w srm 7 ITT ;~ n~ SBD-6398 (R. 01/03) ~_ti~R~~~ ;.. ~ ~ 1405 '' SOIL EVALUATION REPORT Wisconsin Department of~Commer'ce ~ Page 1 of 4 Division of Safety and B )dings_ __ _in,accordance with Comm 85, Wis. Adm. Code Steel's Soil Service Inc. County Attach complete sit thf.f~~h~lp.~y=x.11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. pending Please print all information. Re ~ wed By Date Personal information you provide may be used for secondary purposes (Privacy taw, s. 15.04 (t) (m)). ~ Z, 6 Property Owner Property Location McCabe Homes Inc. Govt. Lot na SW 1/4 NW 1/4 S 25 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 935 Osprey Blvd 35 na Scenic Hills City State Zip Code Phone Number ~ City ~ Village {/ Town Nearest Road Bavoort i MN i 55003 i 651-351-1018 Hudson ~ Highlander Trail 1~ New Construction Use: y..J Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement J Public orcommercial -Describe: Parent material Glacial Outwash Flood plain elevation, if applicable na General comments and recommendations: Conventional system, system elevation 96.85 ft. Trenches spaced and depth to code 4.25ft below grade. Boring # ~ Boring If Pit Ground Surtace elev. 101.10 ft . Depth to limiting factor 100 in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description t1u. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GP "`Eff#1 Dlit2 *Eff#2 1 0-16 10yr3/1 none sil 2msbk mfr cs 1 f .6 1.0 2 16-30 10yr4/4 none sicl 2msbk mfr cs na .4 .6 3 30-42 7.5yr4/4 none sl 2msbk mfr cs na .6 1.0 4 42-100 7.5yr4/6 none ms osg ml na na .7 1.6 Boring # ~ Boring Pit Ground Surface elev. 98.40 ft. Depth to limiting factor 100 in. Soil Application Rate Horizon th De Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftz p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 1 0-16 10yr3/1 fill sil none mfr cs 1f .0 .0 2 16-31 10yr3/1 none sil 2msbk mfr cs 1vf .6 1.0 3 31-39 10yr4/4 none sicl 2msbk mfr cs na .4 .6 4 39-48 7.5yr4/4 none sl 2msbk mfr cs na .6 1.0 5 48-100 7.5yr4/6 none ms osg ml na na .7 1.6 'Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L "` Effluent #2 = BODS < 30 mgn_ and i 55 < ~u mgi~ CST Name (Please Print) Signature CST Number David J. Steel ~ ~ - `~ 248956 Address Steel's Soil Se nc. Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 4/4/2004 715-246-ia Page 3 of 3 STEEL'S SOIL SERVICE INC. David J. Steel CST-POWYS Lic. #248956 obi 3~ G CS 3 r a~ ~~ ,~"~~~~ / {~ 6 ~' H •`/~- McCabe Homes Inc. SW 1/4,NW 1/4,S25,T29N,R19W Town of Hudson, St. Croix Co. Scenic Hills Lot, 35 1564 Cty Rd GG New Richmond,WI 54017 Bus.(715) 246-6200 Fax (715) 246-9372 Legend 1"=40' • =Benchmark Ele. 100.00ft Top of 3/4"PVC Pipe • =Alt Benchmark Ele. 99.SSft Top of 3/4" PVC Pipe ^ =Borings Boring Elevations B1 = lO1.lOft B2 = 98.40ft B3 = lO1.O5ft B4 = OO.OOft ~o r~ ~o ~ ~ ,fie v2 ~ ~ ~ ~~~~-y ~- ~~5 ~`~ ~L~l- /d Z~ b~~- a~~' ~ ~~ ~v~~ s ~~~- y_~v ~ ~l ~ ~ C~ ~i 8-0 ( r ~fl43.7 ,,~. ~ ' t 1 ,r' ' ' X50' ~ ~~, } ~ ~ i - ~ ., { ~r"~ 3~ ~ d~Ci.jpf ( '4 t' i r t s ~ ; ~ 1";, t ~~~ + ~ ~~' ~ i i` /j 7r aa~{~~ i t ; / ,, ~ ~. { ~ ~ r ~ - - - 1 , l ~ '`, _~ ~ (~ ~ ! ,' ~ r--' ~~ ~~ `'' ~ t !~ W Vii` ~~~'~-'"~ ~ ~ tf}~ _~. ~ ~ --_ `. f ~ ~ ~ .* a ,~ 1 t 4 ~ ~.~. ._..~ ~ -~ ~ _~~~ ti^~ I ~. . ,~ ~ ~ ,. \\ t ~ f _ j . .___ ~' . c~ r /_ <°~~ r',; ~ H.W 024,0 `~ 1 a 025. f ? H.k f _,\} 1 F ~:,.~ ~~~ -~~ ~ ? 3.9 ~ 1~Q24.$~ I ~ f ~1 { ~ ~ - ~ L z f r f !1 ,!". ~.. ~ F ~ ~?~ ~ ~ _ ~~~ ~~ 1~ -= ~ ,~~ __ ~ rr ! '` ~1 i• 0 ~ / ~J ~ t _ _. 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Nom- ~,~.~. sY.~. y~~8s' N~ ~~ ~,~- ( ~,3 ~~.s' f ~~~~ ~~ s ~~ ~~ I ~','~' I ,a / ,, /~ ~ ~ 7 u f r :~. t ~ ' X50' `t '} ~; ~ ~ ~ ~ ~~.~ er' e ~ T ~ i I ~ ~~ ~ t , ~ ~ ~^ 6 ~ ~' ~,~ x ~ ''' l 2~z' - ;_ ~ ; '~ 1 C ', / ., f e { ~ / ~ ~`~('~ 4 - 1 RBI `~ rr t~ 1 ~t , 1 t~<\~~~`<~. ~ ir~?;? ~ ~ t V ~ I i ~ ~ _~ ,~ ..~ ~._.~.... r r ~ l y ~ _ f ~~ t Ii ~ 1 ' I ~ ~\ ~1 1., ' i ~ ~ _ _. - -- tt ,, ~. 1 1~ ~ l ~~.~~ __1 - ~_-.. ~ -- • i ~ 1 l0t8.o ~ 024.0 ` ~ i --.._- ~ ~ ~- ~~ 1 ~ " ~ ~ 1025. ~ a _. ,:,~,.- H.1~ ~ -r ~' ~~ i{ -. ~ f -~-' ~ `, ~~ s ~ ~ ~~ S _ ~ ~~ / ` ~ x ~ \.r~r j,r i ~ , , ' (~ 1 ~ a c~ 2 ~ s --= 20 FT D t - -i-- -- - -~N-"._,_~,_-~ l: ~_ - - --. . ~~ f. ~ ' ,~ ~ f , ' - -- _...__ - EASE , .. . ~ ~~ ~_ ,, ' .~ - 4 i _ _ -_ ~~pp - r_ ,' r ~ ~ ~ CiD _ - - ~~ ~ ~ I -- _ ___ e __ - -_-_ / /! y - _ -~ ' i - I i / ~~ [ _- ~ - rte. :, __-- ,~~••.,1 ~ -.. ._ _ - ,- _._ Y• - ~' ~ t ~ ._ { _ /- ~ . .- t ~ J ~ jf _ l ~~t ` 1~ f f ' (((( r ~ 4 ~ " {1 '' / ~ y • , : ~~ e - , f ~~ . ; ~ ~ t ~ , ~ ~ ;~ i ~ ~ ~ ~_~11 '!~ R~~_ < -V \ ,~- /~ f 7 ~ .~ + .. 1 ~ ., ,- ,~ ti ., ~ - ~~ ~ ~ ~ _ i - _ ~-- ~--~~ f~ ~~ ' ~ = ADD ~' ~, ~~ _~ ~ q~7 y~ g ,~ ~,~~, T ~~sv ,~ ~~ ~ /~ ~/D l~ ~~ ~~~ ... ~ i s ~ `r ~D ~~ 3~ ~T- ~ ~ yv3-~~ ~ j .~`/ _ ~r 4J~ ~ l ~~ ~~ !.J I'~J'N'~G357 V/ ~~ .~v~, ~ ~l~ - I = 1Ca ~ ~ ~~~ / f ,~ ,.i l > _ v ~~'~ . ~ r l~r'~~ ~~ 3 ti ~~ ~ T ~ = yv.~~ j ,~~' ~- ,~ - wlsoonsin Department of Commerce ~ - SOIL EVALUATION REPORT Division of Satiety and Buildings Page I of m acooroanoe wmr wmm ~, rrrm. rwm. ~.we 81/ in Plan must it t l th i h l t l Att ~~ s+. c ro i' - an on paper no an r comp e e s e p ess a inducts, but not Irrnited to: vertical and horizontal , ' and percent slope, scale or dimensions, north arrow 1 anc~ distdnos crest road. Parcel I.D. . G+Zo - 3 9 S= 3~-~~c~ Please nt all *~' ~_~ at~~ j~'~~ ~ ' .. by . ` Date Personal information you provide may be used for dary purposes (Privaey law. s 15.04 1) (m)).. ~,G(/Yl/JL q ~ Z Property Owner :a, ; ~ ~`+ ~ ,, 2~~Q P _ ~~ . - ~ ~ - - '`~ ST Lax SW 1/4tic~f 1l4 S ZS T ~ q' N R ( E (or~ Property Owner's Mai~ng Address ~ ~ ~,..J c~lvirti~.~i~ .~ Bock # Subd. Name or CSMt/ t'o ~ Z O 5-(• i ~ ~ wr~e S e City State Z~ Code ~ .: r,, ~ ~ ^ Ydlage (~ Town Nearest Road ® New Construction Use: ® Residential / Number of bedrooms 3 _ ~{ Code derived design flow rabe ~Sa ~~ O O GPD ^ Repiacx'ment ^ Public or commercial - Destxlbe: Parent material C)U c~J (~ /Fylo .elevation if app6c~ble / oZ `'~ ~ ~ ft. General COmmB„u ~ Y11 e. ~ ta~~ '~ 7 0 2 ~ G~ba SL O ~ U ~ `I~ Q~ 6 ~1n c //{ SYSt'~ ~d and recommendations: ~ ~ ~ E, I ~e.J a ~-,`d r~ --•>~ p~S~ ~ ~ ~o w c ~- ~G a Boring # ~ Boring 1 l b . Pit ~~ surface elev. 9'y Yo ft. Depth to limiting lector in. Solt ic~tion Rate Horizon Depth Dominant Cob Redox Desgiption Texture Stnictrire Consisfienoe Boundary Roots GP D/fP in. Mansell Qu. Sz. Coat. Cobr Gr. Sz. Sh. 'Etf#1 'Eff#2 ~ o-li ~p ~ 313 ~~ l ZmQbk ~-s Iv ~' . ~ 2 I Z- 35 ~- ~ 3 -- S L Zrr~s b k -Fr- c s - ; 5 .9 _ ~ - _ ~ ~ ~,, ®Pit Ground surface elev. 9a• ~ d ft. Depth to limiting factor I l ~ in. ~ ~ ~~ # ^ ~~ _ Horizon Depth Dominant Cobr Redox Description Texture SWdure Consistence Boundary Roots GP DVf~ in. Mansell Qu. Sz. Cont Cobr Gr. Sz Sh. 'EtT#1 'Eti#2 i b- lD 31 ~- ~ k . ~. cS li,~' .5 -~ 2 ~ ~. D y ~ 3 __-.. k -fir- cs -- 5 -~ 3 y-tti ~~, ~ m a .. ~ - - .~ c. Z su--~-~ 1 oat ~ue~ ,Q s s .~ ~ r,~.~ s - mom- ~ Sur. _ ~~' ~, 'Effluent #1 = BOD_ > 30 < 220 ma/L and TSS >30 < 1 50 ' Etfiuent #2 = BOD _ < 30 mdL and TSS < 30 moll CST Name (Please ..Print) S' slurs CST Nurr~er Address Dale Evaluation Conduc6ed Telephone Number 2113 8DT'' ~- S~me--~e-~ ~J~ ~y22 ~-/-U/ 7/5-24 ~-~oo~i' 1 Property Owner l1r k< Parcel ID # Page z of ~_ Boring # ^ Bonng ® Pit Ground surFac:e elev: 4~. ~ y ft. Depth to luniting factor ~ ~ ~ in. Soil lication Rabe th D nt Color i D Redox Description Texture Structure Consistence Boundary Roots GP D/ff Horizon ep in. om na Munseil Qu. Sz. Cont Color Gr. Sz. Sh: "Eff#1 "Eff#2 - Z b-~~ 1 , _~ ~ ----~ ,~--~ S.I 21-,-~.bk rn-~- ~s _. g G - ~ -~ . ~ - g 9 ~ Z4-I lv 4~~0 ~'. m ~ -7 1- 2- -~ D . Z - ~,`' '7~ ~ ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ic~tion Rate H i th De Dominant Cobr Redox Description Texture Struchx~e Consistence Boundary Roots GP Dlif= zon or p in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. "Eff#1 "EfF#2 Boring # ^ Bonng ^ Pit Ground surface elev. ft. .Depth to limiting factor in. Sal ication Rate Horizon De th Dominant Cob Redox Description Texture Structure Consistence Boundary Roots GP D/ft° p in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. "Etfi#1 "Eff#2 • Effluent #1 = GODS > 30 < 220 mg/L and TSS >30 < i50 mglL * Effluent #2 = BODs < 30 r7~gIL 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 departmerrt at 608-266-3151 or TTY 608-264-877?. SBD-8330 (807/00) ~ r PAGE 3 OF 3 NAME ~. r k••e. ~ ~ LOT#3S LEGAL DESCRIPTION Sw '/,~uw'/a,S 7,~TZq ,N,R! R E (or)© SCALE: I"= ~/~, BM I ELEVATION ~~O • O ~ BM I DESCRIPTION % ~ o ~ /ufh 8 " N.'4 h _ "r BM 2 ELEVATION 47• `1 S ~ 5 eC. Z ~ BM 2 DESCRIPTION fob v ~- f u ¢ h b •` /fr a t. - - -~ ~, c a -rr-( (. -~ SYSTEM ELEVATION•FoQ~O•Z.o Gow« k9•Zo ALTERNATE ELEVATION~~ $$•(50 i ~.,~s!'~(i•7~ CONTOUR ELEVATION Qo • ~ ~ qZ, a a , 4yOQ n ~ ,y,~ v~ U ~17~ ~''~~`y~ i ~~~~) ~ A ~~~. •o z ,~J ~•4 B-3 ~g~ ~~ nno~ r ~{ 6~n Z ~Z~ ~w~( ~~e Qp.oo ~ y.va B-c a ~~?'- ~. I "~ I ~I ~i ic~g' TU C~°~.-~~w S~ Ce -'m~¢ r ST CROIX COUNTY SEPTIC TANK MAINTEI~iANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer .~~~ ~~%~ Mailing Address Property Address City/State ,!/G~~d~ ~..z' Parcel Identification Number D 20-- /~~ ~ 3 5 ~ d~v LEGAL DESCRIPTION B 2y2~ Property Location :S ~'/~, ~~%4, Sec. ~~T~N R~W, Town of Subdivision .~5~ c ~/~~-~S .Lot # 3 S' Certified Survey Map # ,Volume ..Page # Warranty Deed # ~ .5 7~ o ~ Volume ~ ~~© .Page # Spec house 'yes ^ no Lot lines identifiable~''yes ^ no S_ YSTEM MAIINTENANCE improper use cad maintenaaceof your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pamping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system, The property owner agrees to submit to St. Crouc Zoning Department a certification form, signed by the owner and by a masterplumber, journeymanplumber, restrictedplumber or a licensedpumperverifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and Pumping (if necessary), the septic tank is less than IC3 full of sludge. I/we, the undezsigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin, Certification seating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expira ', u date. 3 ~ZY o ~ SI F AP LICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property descra hove, b virtue of a warranty deed recorded in Register of Deeds Office. 3/ ~`~O~ tJNATURE APPL CANT DATE ****** Any information that is rots-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Indude with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made iII the warranty deed (Verification required from Planning Department for new construction) " POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of 2 cu c uucno~uerrnw Owner G ` Permit ~ ~~ DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units - ^ NA Estimated flow (average) t~ al/da Design flow (peak), (Estimated x 1.5) ~~ gal/da Soil Application Rate ~ al/day/ft2 Standard Influent/Effluent Quality Monthly average• Fats, Oil & Grease (FOG) <_30 mg/L Biochemical Oxygen Demand (BOOS) 5220 mg/L ^ NA Total Suspended Solids (TSS) <_150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (SODS) <_30 mg/L Total Suspended Solids (TSS) 530 mg/L NA Fecal Coliform (geometric mean) _<10° cfu/100m1 Maximum Effluent Particle Size Ye in dia. ^ NA Other: ^ NA Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity ~'~ al ^ NA Septic Tank Manufacturer ^ NA Effluent Filter Manufacturer ~ ^ NA Effluent Filter Model - ~~ ^ NA Pump Tank Capacity al ^ NA Pump Tank Manufacturer ^ NA Pump Manufacturer ^ NA Pump Model ~ ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ~NA ~ _ Dispersal Cellls) In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA u w ~wrrcw~ w une cruen~ u e w,r~u..c.~ra.v~ vv,.wv~a. Service Event Service Frequency Inspect condition of tank(s) At least once every: ~ month(s) (Maximum 3 years) ear(s) ^ NA Pump out contents of tanklsl When combined sludge and scum equals one-third IY3) of tank volume ^ NA Inspect dispersal cell(s) At least once every: ^monthls) (Maximum 3 years) ~d yearls) ^ NA Clean effluent filter At least once every: ^monthls) ~PJ yearls) ^ NA Ins ect um pum controls & alarm P P P, P At least once eve ry' ^ month(s) ~ Yearlsl ^ NA ' ^monthls) ^ NA Flush laterals and pressure test At least once every: ^yearls) Other: At least once every: ^ monthls) ^yearls) ^ NA Other: ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third IY31 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page ~ of y START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s- for the presence of painting products or other chemicals that may impede the treatment process and/or damage tine dispersal celllsl. If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cellls) in one large dose, overloading the cellls) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oii; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails andJor is permanent{y taken out of service the foNowing steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or: must be taken, to provide a code compliant replacement system: [}~ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption sys em. p acemen areas ou isturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. T a o mg tank ~~ aluat' be ' e a~ a ~12p~.j18 Tt~ ~(L Alm CaNS`T72t1G~tDt.1 ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name Phone ~ - .. ~ ~~f POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name s^r', ~ l GU 201J1~t1 Phone '~ j S- 3 0 (p- (0 (7 This document was drafted in compliance with chapter Comm 83.221211b-1111d1&Ifl and 83.5411), 121 & 13), Wisconsin Administrative Code. U 2530P 109 STATE BAR OF WISCONSIN FORM 2- 2000 WARRANTY DEED THIS DEED, made between Carnage Homes XXI, Inc., Grantor, and Kernon J. Bast and Donalda J. Speer-Bast, husband and wife, as Survivorship Marital Property, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following ~bed.ceaL~=J~n St. Croix County, State of Wisconsin: Lot 34 d Lot 35, Scenic Hills, S Croix County, Wisconsin. Retarding Area 7~7t?16~ KATHLEEN H. NALSH REGISTER OF DEEDS ST. CROI X CO. , M I RECEIVED FOR RECORD 03/19/2004 10:35Ah[ WARRANTY DEED EJ!El~? # REC FEE: 11.00 TRANS FEE: 392.90 COPY FEE: CC FEE: PAGES: 1 Name and Retum Address: Fdina Realty Title, Inc. ~/~ 400 S. 2nd St. -Suite 115 ~`~ )%) Exceptions to warranties: Hudson, WI 54016 Easements, restrictions and rights-of--way of record, if any. 423403 020-1395-34-000 t ~20' 195- 3~ o00 Parcel Identification Number (PIN) This is not homestead property. Dated this 10th day of March, 2004. Carriage How XXI, Inc. B "~ /~ * e11ei St. Martin, Vice President of Carriage Homes Development AUTHENTICATION Signature(s) authenticated this 10th ay o ~IbIIC State of Wisconsin * .. . . TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Peterson, Fram & Bergman -Steven H. Bruns 50 East Fifth Street, St. Paul, MN 55101 ACKNOWLEDGMENT STATE OF WISCONSIN ) ST. CROIX COUNTY. ) ss. Personally came before me this March Z0, 2004 the above named Kellei St. Martin, Vice President of Carriage Homes Development to me lrnown to be the person(s) who executed the f going instrume~nt/and aclrnowledged the same. / t/l. DJ:ane M. Barron Notary Public, State of Wisconsin My comtnission is permanent. (If not, state expiration date: -;~_~-aoo~ > ----r- (Signatures maybe authenticated or aclatowledged. Both are not necessary.) 'Names of persons signing in any capacity must be typed or printed below their signature WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000 u- W "' 1 ~ ~ ~ N ~ U !' 0 ~ ~a ~ ; ~ N~ Z ( ^ ~ ~ ACV ~ ~ ~ ~ ~~ 3 ~ ~ _ ~ - _- -- '~~'~ ,,~'9'4LL 3.8S~9l.lOS \ SZ~ _ ~ \ \ - ---- - e Sg'bLL M.8991.1PN _ _ _, _. _ ~~ i ~ ..~~ ~. ....... ~ ...~ ~•w •Z ........... - ~ 1 c~~~. ~aO ~ 1 - T'~.t N 1 ~~ LL ~ W `'~`' ~W i ~ 1 ~~ C1V "3 ~INU g , ,~ ~ -~ yy,,,, pp ~O Wb~~ 1 (V Z ~ .N-O ~N ~~1 ~ 1 OnpCV oWwl ~ ~4L'ZZti ``\~~~ ,~~~~' ,98'L6Z ,9S' LLZ ,6L't~OE ~6l'bOG 3.55 S I ~I ~I a l ~i I g~ ~ ~~ ~~ ~~ I a ~~ Q, ~; a. I I ~ ~ al ~i ~i ~ . '~ `~I ~ ~i MJ . ~ gl o , I a~ 1 O ~ 0 1 c~ 1 - 0 ~ ~ I ~~ ~i 9~ ~ ~ VI ~ _.-_ - - -- _ ,6£'Z54 3.90~40.OOS ___ ---- o - - - _'