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Home My WebLink About020-1395-65-000 (3)' n~0~, 3~n d 3 ~ > ~ > 3 ~ * ~1 ~ ~ ~ N ' ~~ ' ,~ ~ ~ C ~ ~ ~ ~ I~ 3 :. ~ ~ ~ ~ ~ v ~-• ^! ~ ~ O ~~ f~D N N O O O H ' C CN11 N ~ ~y r;• ~ ~' ~• ~ ~ ~ y O (A Val ~ Q ~ ~]~l ~ Q N > O `' N = a 3 N Q 7 y j ~' Y' O ? ~ N O N C ; ~ R O ~ N ~ .n-. ° ' ~' 7 O O A~ 3 , ~• ! y o o ~, o ~ I u i t ~ ~ sx ': D m fn -< D a A ~ i I ~ ~ y W a ~ I 3 O .' o~`'co CD ~ A O S L ~ y O O N N j~ ~ O C a ' ~ '* 3 ~ . 000 i . I o ~ c gg gg y y~ c ~ ~ t~l I ~ 3 m °: ~ °• m vvv°- ~ i I o - ~ A N o i II a ~ I m ~ ~ ~ v~ N ( ~ 3 t A I a„ A i ~. o ~I ~` I ~ Z W o ~ `~ Q I v O o D v ~ I o 7 ~ o c N • ~ ~ y ~ y ': C ' !r fD ~ N I w ~• ~ fD ~: _a I ~ ~ Z ~ ~ co D ? 2 cNo I ° v, ~ ~ I ~ ~ o- A Z ~ O .. o (/) ~ N ~ ~ m~~^ I a 3 j A~ O ;. o z ~ ~ N ~ ~ Z ? ~ i A I =m Do ~ fO~o ~ oom $. a o ° o < • a m coaac c c o ~ acn ~ ~ y N S y d ~ y y ~ QfD N ~ d~ D 0~ C C N O ~ ~ CD fD CT ~ ~ N - - 7 N ~ . ~. ~ ~ ~ tll UI ~' ~ O ~ CD 'i1 y ~ ~ O ? ~ y I . . ~Zm 3 <_•°~ 3 0 0 o c CC~ o I a oQ ro~a~~ ° o'fD CD 5 a ~ co . o S 7 ~ N fD ~~ y .~ f~D ~ > ~ ~ ~ 1 •pp ~ y I ~ y~•o~iv' m~~ofJ `e I m c ~ (p y ~ d V1 7 ~ < o Qn•-~ ~ .-r y. ~~ S N 7 O ~ ~ ~ ~ b (A N `t I U7 fD ~. Ny 7 CO ~ ~ . ~ C~ v ~c ~ °' -• v o a !D ~ O ~t p~ ~ [D y U7 O A fD y y~ C ' N O O ~ W ~•~ W ~ a I d ~. ~ N O N ~' d .A.,. ~ 3 ~ ~ .., 0 CD A N 69 ~ ~v V I o ~ o ~ o ~ a I ~ Wisconsin Department of Commerce , PRIVATE SEWAGE SYSTEM Safety and Building Division y , INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Christensen, Mark Sr Ma Hudson Townshi 6S~$kF~Elev:! ~ 1 Insp. BM Elev: ~ BM Description: Q ~ - Z J 4 . T~7 . -~ 63 ..e.,t,orz TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic t~S~ __-_- ~ Dosing - " Aeration Holding ,- i TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~ ~ / , t ~~ L ~ / Dosing Aeration Holding PUMP/S HON INFORMATION Manufacturer Demand GPM Forcemain SOIL AB ORPTION SYSTEM ~GBf R Width I gpgt DIMENSIONS U SETBACK SYSTEM TO INFORMATION Type Of System: C~n,,r. DISTRIBUTION SYSTEM stem Head ~ TDH Ft is . to Well zg ~ No. Of Trenches fir' ~~> P/L BLDG WELL I2. r ~, y ELEVATION DATA county: St. Croix Sanitary Permit No: 405062 0 State Plan ID No: Parcel Tax No: 020-1395-65-000 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer SUHt Inlet St/Ht Outlet ~~ ~t (p.3 )0,13 r ~'~. 3L Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System w 1'~•~S IS. BS 2 ~j(. tio0' Final Grade ~ ~ St Cover (~ .30 )O(. I S Of Depth CHAMBER OR d~odL UNIT Model Numb r: it Header/Manifold Distribution x ize x Hole Spacing Vent to Air Intake Length Dia Pipe( - - Length Dia Spacing ~ ~ r SOIL COVER x Pressure Systems Only 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 MN~N S; ^(Inclu c discrepencies, persons pr ,etc.) Inspection #1:...071' ~/~$ ~ Inspection #2: ~~ V c~ion: /g1g Highlander Trail Hudson, WI 54016 (NW 1 T29N 19W) Scenic H[Ils Lot 65 Parcel No: 25. .19 459 1.) Alt BM Description = 1 ~ e~ ~ r-Pt~rl~ ,~ ~T-~ ~o$~(. 2.) Bldg sewer length = 5 (e-~,t: - amount of cover = ?~ _,j_. n ~ t ~ 1 ~t S ~ ~_ -, r Plan revision Re uired. i No .,~ ~ i ~ . ~Y Use other side for additional i anon. ^~~A•__ __-_ Q~l_ 1 ~ ;I'' _ ~ ___~ wL~__ ___~I ~_ _ I' < <- Date if ~ Insepctor's Sig lure Cert. No. SBD-6710 (R.3/97) , / _ ` .,~ A IUD . ~~ j ~ ~`` ~ ~ ~~`~~D r , Safety and Buildings Division County ` ~~ ~ ~OnS,~ W. h' O. Box 7162 i `. ~ ` anita Pe i N b b f ll d i 2 ~~ ry rm t um er (to e i e n by Co.) Department of Commerce So (o . i, Sanita Pe it A ~ fate Plan I.D. Number rm Y PP . r i ~ ~, In accord with Comm 83.21, Wis. Adm. Code, personal in rmation you provide may be used for secondary purposes Privacy Law, 15.04('~~(n~~Ulx cUUrvr~ Project Address (ifdifferent than mailing address) I. Application Information -Please Print All Information --.,.._ ~ i E Property Owner's Name ~2 Parcel # t # Block # ~J Property Owner's Mailing Address Property Location ~~ Ci rate Zip Code Phone Number ~~%., ~~%., Section ~ S ~ .r / ~j trcle ) T ~ / N; R~E o~ II. Type of Building (check all that apply) `1 or 2 Family Dwelling -Number of Bedrooms Subdivision Name CSM Number ~ __ ^ PublidCommercial -Describe Use ~ ..//~ ~.-C~µ1.L~ ~~.[~,~ ^ State Owned -Describe Use ^City_^Villa e)~T wnship of III. Type of Permit: (Check only one box on line A. Complete line B if applicabl ~ ,~ A. ew S stem y ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B, ^ Permit Renewal ~Petmit Revision ^ Change of ^ Permit Transfer to Ne~v List Previous Permit Number and Date Issued Before Expiration ~"~ • Plumber Owner o s-e~ ~ S -ia - a IV. T e of POWTS 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 Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sfj Dispersal Area Proposed (sf) System ~levation DO aS7 ~G / 7 /~- . VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank /~~b ,- !a st~ Au'obic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undetsi ned, assume responsibility for inst lation of the POWTS shown on the attached plans. Pltlm¢ 's Name (Print) _ ~~~ Plum s Sig ure PRS Number Business Phone Number Plumber's Address (Street, City, State, Zip de) VIII. Coun /De artment Use Onl pproved ^ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued Issuing Agent Signature (N Stamps) ^ O ~al Surcharge Fee). -' IX. (:onditions r /Reasettfr€er-l~isappreyal -- ~Q.v-3- S~s:~.-Q, -- at~Q,A . .+••e~n w.up.cac pu.na pu me a.ounry onry) for me fyS[em on paper not leas man alit x Il Inc6la in fize SBD-6398 (R. 01/03) ~ ~XJI.Rs~ 1 /l~ ( ,_ / ~~ Faso ,~--~ ~~ ~~ ~ -/aQ ~ ~" t< << t~ C~ ~ ~~~"" o~- ~ ~ ~M'~ ~~ ~ t ~~ Z z~z ` g~ D ~'~ 1 ~ ~~ ~ a o3.s7 I~' ' Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Cade 1013 Page 1 of 3 Steel Soil Service County Attach complete site plan on paper not less than $'/: x 11 inches in s¢e. Plan must St. CfODC include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and locatron and distance to nearest road. Parcel I.D. P/ease print allinfonrration. D~C~ /3~t5" los~DOO Reviewed By Date Personal information you provide may ~ used s_ 15.04 1} (m)}. Property Owner Pr rty Location Arkell, John Govt Lot NW 1/4 SW 1/4 S 25 T 29 N R 19 W Property Owner's Mailing Address ~ ~~ ~~ 0 5 2002 Lot Block # Subd. Name or CSM# 6720 Stillwater Blvd 5 na Scenic Hills City State Zip e ~~T~_CF,~OI~OUNTY City ~I Vill a Tam Nearest Road ~jj~ FICE ~ Stillwater MN 55 - Hudson Kinney Rd /.,~ New Construction Use: /` Residential /Number of bedrooms 4 Code derived design flaw rate 600 GPD Replacement Public or canmercial -Describe: Parent material Glacial Outwash Flood plain elevation, if applicable na General comments and recommendations: system elevation 94.17, trenches spaced and depth to code 4.83ft below grade Boring # _ :Boring 110 Pit G round Surtace elev. 99.20 fl. Depth to in. limiting factor Sod Application Rate Hoiizbn Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= *Eff#1 *Eff#2 1 0-9 10yr3/3 none sil 2msbk mvfr cs 1f .5 .8 2 9-13 10yr5/4 none sicl 2msbk mfr cs na .4 .6 3 13-21 10yr4/4 none scl 2msbk mfr gw na .4 .6 4 21-38 7.5yr4/4 none scl 2msbk mft gw na .4 .6 5 38-110 7.5yr4/4 none ¢ ml ~ osg ml na na .7 1.2 ~~( ~ ~ ~ -~ ~~ 1 i `~ Boring # . __ Boring ~` Pit Ground Surtace elev. 98.70 ft. Depth to limiting factor 110 in. Soil application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 *Eff#1 *Eff#2 1 0-12 10yr3/3 none sil 2msbk mvfr cs 1f .5 .9 2 12-28 10yr4/4 none scl 2msbk mfr cs na .4 .6 3 28-110 7.5yr4/4 none ms osg ml na na .7 1.2 tmuent ~1 a t3UU ~ 3U t ZZO mg/L antl TSS a:i0 ~ 154 mg/L `Effluent #2 a BUDS _3l) mg/L and TSS < 30 mg/L CST Name {Please Print) ~ Signature CST Number David J. Steel ~k/~~"""" ~~~ 248956 Address Steel Soi! Service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 017 6/4/2002 175-246-5085 PropertK Owner Arkell, John Boring # _' Boring /' Pit Horizon Depth Dominant Co 1 0-22 10yr3/3 2 22-32 10yr5/4 3 32-46 7.5yr4/4 4 46-110 7.5yr4/4 Rnrinn # Boring Parcel ID # Ground Surtace elev. 99.00 ft. Depth to limiting factor 110 in. Page 2 of 3 Soil Application Rate Redox Description Texture Structure Consistence Boundary Roots GPDIft' 'Eff#1 *Eff#2 none sil 2msbk mvfr cs 1f .5 .8 none scl 2msbk mfr gw na .4 .6 none scl 2msbk mfr gw na .4 .6 none ms osg ml na na .7 12 Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BODS <30 mg/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 Boring # ..:Boring _ .. _.. _ STEED'S SOID SEIZ~'ICE Page 3 of 3 David J. Steel 1564 Cty Rd GG CST-POWTSM .-/vin ~-r,~e // New Richmond, WI 54017 ~ j Lic. # 248956 ~~ ~~.~~ ~~S' ~ s'T~~Ji?~`iW (715) 246-6200 !"~ % o w~ a f ` tf~dso+~ / ~'C~o %}~ G v • (715) 246-5085 Cot 6'-~~ Sc,eniG ~i ~~ 170' ~~ c~1n / /„ `roe d ~ g.» ~'/e,~.,yor~G, /QZ~ ' jo,t~ o ~ / ~~~~ ~~+ee /~~~~ ~ 1 op ~ F / /`f "' S~~~e / ~:/ate. Q ='~or'~'r~5s ~ /.3e~,•.~ f f /,~ J t ;~ ~i= 9S.ze' ~ /~z ; ~'~. ,o' ~3- ~l9.ov~ N a w j ~ ~ tv ~ A ~~ ~ ~~ 0 .'1 ~,~0 ' ~av~'cl~-1 ~ cS~e ~e ~- ~-~-°~ r~ ~~ ~. Safety and Buildings Division Cooney ~ - ~ 201 W. Washington Ave., P.O. Box 7162 cJ -~ti ` ~~~~SI ~ Madison, WI 53707 - 7162 Sit dress e De ~ tment of Commerce / O Z /J1(~ Sanitary Permit Numbe Sanitary Permit Application Ep In accord wilt Comm 83.21, Wis. Adm. Code, personal inf ^ Check if Revision ~D~O~ ~-~ aoa be used for ses Privac Law. 15. I. Application Information -Please Print All Information O 3 2002 State Plan I.D. Number Pro rty Owner' Name 1 COON-iY 1 Number _. C FICA (~ - 3 .S - - ~ ~Q Property Owner's Mailing Address Property Location City, State Zip Code Phone Number Lot Number ack Number S ~.~-• f Subdivision Name CSM Number .Type of Building eck all that apply) ~.~~~~ S,fu ^city or 2 Family Dwelling - r of Bedrooms 7 ^Villag ^ public/Commercial - Descri se ~'o hip ^ Stars _ ~ 7 ~ N st toad - IDC3 ~ - 7 III. Type of Permit: (Check only one x on line A use . C plete e B if applicable) A For uuty use I,~New 2 ^ Replacement System 3 ^ Replacemem of 6 ^ Addition to stem Onl Eris ~ stem ernrit Ntunber Date Issued B. ^ Check if Sanitary Permit Previously Issued 1V. Type of Permit: (Check all that apply)(numbe scheme is for internal us /p bl~i` ~ - / ~ ^ C [rutted W ~ 44 ion -Pressurized hr-Ground 21^ Mound 47 ^ Sand Fil ~ SA- /' 22 ^ pressurized ~~,round 41 ^ Holding Tank 48 ^ Singl ass 1 Drip Lirt~ /'/1 i cGI~ ~~' 45 ^ At-Grade 46 ^ Aerobic U ' ^ R , ulatin ^ O er V. D' rsal/'I~eatment Area Information: Design Flow (gpd) Dispersal Area ispe oil Appli on n Rate Sy m Elevation Grade Requued~~~ ~ Pmpo 0/• ~ /y Rate(G Sq. T / Elevation 0C~ s-- Z' -T ~ ~ 7 lrJ~ ~a3s ~. Tank jnfp Capacity in .Total Number Manufacturer ab Site Steel Fiber Plastic Gallows Gallons of Tanks rete Cons ted Glass New Existing Tanks Tsnks __~ .. n ~ 1 [1 n ~ --.--- -- -------~ - ,a , ~ ~ ~ ~ ~,,.,,..~ -.. Doa;ug chamber VII. Responsibl7ity Statement- I, the andersigned res ility for tion of the POWTS sho a the attached plans. ' RS Number Business Phone Number PI r' ame (Print) Plumber ~ ~ fi~ 3 ~ - a~~- des Plumber's Address (Street, Ci ,State, Cod ~~~ t~ Cotmt a artment Use Onl Sanitary Permit Fee (includes Groundwater Date Issued u-g Si (No Stamps) roved d ^ Disa pp Approve Surcharge Fee) _.. ^ Owner Given 1 Adverse ~~~~ ~j / Q Q ~,t~~i~~ Determination ~ t~ - v ~ IX. Condition_st of Appro easons for Disa proval ~'~"" _ @G~ -L'o~ • G112.~ ~:s . ,, y~ ~ ~ , t~ n......s ~ ~, / ~QOSS /` ~G'~e,~Gl~-~`~ _ L l 1~-~-~ ..., ~nGth-~' awtl 8112x11 DI" ~~~'1'~ ~W~~- ~„SQ~t~ ~itr+ /-V/c-' 7) for th~a7s<e~m_op w~T'(/~~K ~ ' SBD-6398 (R. OS/Ol) ~~P'LV~~T~~~~ ~/~~~~~/ ~~~ P~ 6 W-" - ld 8 o c`t'~^, ~ ~~- i = ~ ~~,-a " ~ .,~- N r ~-; yo ~~ ~ ~~- ~P,~~ /ZS3o~ s~. ~~ tQ€soonsin~Department of Commerce - SOIL EVALUATION REPORT Division of Safety and Buildings Page f of _ ~ in aoooroanoe wmi ~;ornrn oo, r,ns. r,am. woe st Pl 81/2 7 ' ~~ 5f. croi' an mu x • . Attach complete site plan on paper not less than indude, but not lanited to: verlirr~l and horizontal C~, lion and Parcel I.D.. percent slope, scale or dimensions, north arrow, ' n and d~arias crest road. ,,O `~ ' ~, ~ Please print ad adolD . ~. ~ by Date ' (1) (m))• . Personal information you provide may be used for P~+~Po~ ~Y. s.1ft:0 ~ Property Owner __.j lr~ ~ ? P Location . ~~ a ; T c~e?~ Govt. t./it /f/'w 1l4 Sc/ 1l4 S 2 S T Z Q N R f E (or)1~ Property OMmer's Mailing Address , . ~ ~0~~ v,~, z Lot_ Bbdc # Subd. Name or CSMIf VI_!'auC:ZF~I`~ CO ~' Z O S~ i I I WG-~~~` ..: lJ~ ~ S G ~ i City Stake Zp Code ;1!Ct~her --- - _ ..- ~ ` ~ ,. ~ City ^ Ytlage (,~ Tawn Nearest Road ~S7i'Ilw«.~r 111.. ~So~Z ( ~'~)~ 4 ~ ~ ~,',~.-~ '~ ®New Constriction Use: ® Residential / Number of bedrooms 3 _ `1~ Code derived design tlaw rate ~Sd l (o O O GPD ^ Replacement ^ Public or oommerGial - Describe: Parent material DU fc,Ja.S (.~ Fbod Plain elevation if applicable /G/I~ R General comments S ~ S ~..~ f11 t4. (G J 0. f. b ^ - ~~ ~ ~ and recommendations: ~ ~ ~ ~ l .~ J 0. ~-.`o ri - . 9' ~ ~ ~ I Boring # t~~1 Bonng i:pi Pit Ground surfaoselev. /G-~ 0 R Depth to limiting factor I ((~ in. Sod icstrtion Rate Horizon Depth Dominant Cobr Redox Description Texture Stridure Consistence Boundary Roots GP D/f~ in. Mansell Qu. Sz. Corrt. Color Gr. Sz. Sh. 'Eff;l~'1 'EtT#2 o-IZ ~d r 12 5~ 1 2 l~ i~r- G5 I v~ . 5 .8 Z IZ-~ l r ~`i SI ~ b -fir ~5 -- 3 ZO- to lp~ r 4 ~~ -- ran S ~ _ .7 l . Z 1_ ~ ~ ~- `' Z Boring # ~ BO"~ ®Pit Groundsurfaceelev. ~G~ a ft Depth to limiting factor (1 ~ in. sod Rai Horizon Depth Dominant Cob Redox Descxiptbn Texture Stnrcture Consistence Boundary Roots GP DIf~ in. Mansell Otr. Sz. Cont. Cobr Gr. Sz. Sh. - 'Eff#f 'Etf#2 ~ a -I, 10 3 2 - ~ si ~ Z~a.bk m-~~ ~ l ~ ~ • 5 ,. 8 f • / D' = 3 ~ ~ a.'' * Effluent #1 = BOn > 30 < 220 ma/L and TSS >30 < 1 50 mo/L ' Effluent #2 = BOD. < 30 mglL and TSS < 30 rriglL CST Name (Please Print) atufe CSTNun~er e.r- 25 3309 Address Date Evaluation Conduced Telephone Number Zt~ 3 86 ~ .5~. e 1 Zs ~ -/-~ ~~ 5 - z 7-~oa Property Owner Q. r ~~ l ~ Parcel ID # . t V Page z of _~ • 3 Boring # ~ Barmg ^ Pit Ground surface elev. ~ ~• ~ ft. Depth to limiting facbr 1 ~ ~ in. Soil ication Rafie th D nt Color i D Redox Description Textun: Structure Consistence Boundary Raots GP D/fP Horizon ep in. om na Munsell Qu. Sz. Coat Color Gr. Sz. Sh: "Eff#1 'Eff#2 I e-i 3 ~ 2 --- s~ ~ rn-~r c.5 . ~ v ~ ~~ • 8 z -~5 ~ 4/ ~^ ~~ ~~ : g / ~ ^ Boring # ~ Boring ^ Pit Ground surface ekv. ft. Depth to limiting factor in. ~~ ~~ ~~ on H i th De Dominant Cobr Redox Description Texture Structure Consistence Boundary Roofs GP D/ff or z p in. Munsell Qu. Sz. Coat Color Gr. Sz. Sh. 'Eff#1 "Eff#2 a Boring # ^ Bonng ^ Pit Ground surface elev. eft. Depth ~ limiting fador in. Soil 'icatbn Rate Horizon De th Dominant Cob Redox Description Texture Structure Consistence Boundary Roots GP D/fF p in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'Eff#'t *Eff#2 'Effluent #'! = BODE > 30 < 220 mglL and TSS >30 _< 150 mgll_ ' Effluent #2 = BODS < 30 mgl1. and TSS _< ~ mgll. The Department of Commerce is an equal opportunity service provider and employer. If you need as§istance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SHD-8330 (It07l00) PAGE ~ OF~_ NAME 14 Y` IG-e-~ ~ LOT# ~s LEGAL DESCRIPTION pw `/s~Y<,SZSTZq,N,R -qE (or~ SCALE: 1"= yO BM 1 ELEVATION /Od • ~ BM 1 DESCRIPTION ~p o ~ 2 "py~ ~ic- BM 2 ELEVATION 100 • d ~~ • Z ~C BM 2 DESCRIPTION faP a-~' ~ "~vc. A,•D e ~~ SYSTEM ELEVATION /00. O o _ .f-. ALTERNATE ELEVATION 9 ~ ~ y ~ CONTOUR ELEVATION /O/• Z o~ /0 3. v w. Q r1 L ~a, i ~ ov ~ ~ ~o3.v g-~ g-z. I ~ SIGNATURE ~~ ~~ ~ DATE l -G - of ST. CROIX COUNTY SEPTIC TANK MAINTAINANCE AGREEMENT AND OWNERSHIP CERTIFICATE FORM OwnerBuyer_ i~~Gl(K.5 M~U C.hrl~~en~ Mailing Address ~3'L ~yad Br- ~udSo-~ wt ~~016 Property Address gl q ~ iq h land er' TIZU I (Verification Planning Department for new City/State t-rl/ ~~Y1 Hf l Parcel Identification Number OZf~ ~- L?7q S ~o S` -~ U (~ C~ LEGAL DESCRIPTION Property LocationN 1^~ '/.,'' 1JV~ '/. Sec. ZJr T~N-R~W, Town of ~ ~U~V~ Subdivision SG~1'llL H 1 ~~5 Lot# ~S Certified Survey Map# ,Volume Fage Warranty Deed# ~j 7 7 7 ! ~ ,Volume ~ ~ Page / Spec house yes ~no Lot lines identifiable des no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on- site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by th Department of Commerce and use the Department ofNatural Resources, State of Wisconsin Certification stating that your septic system has been maintained must be completed and returned to the St. Cmi_ County ni O within I~ days of the three year expiration date. S G T l RE F APP (CANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge [ (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds O ce. k r _ _.. ~,~? ~G~ IG ATU E OF APPL CANT DATE •••••• Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Department''''' •• Include with this application a stamped warranty deed from the Register of Deeds office >t copy of the certified wrvey map if reference is made in the warranty deed. ' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of FILE INFORMATION Owner Permit # ~ ~ DESIGN PARAMETERS Number of Bedrooms ~- ^ NA Number of Public Facility Units ^ NA Estimated flow (average) ~Q gal/day Design flow (peak-, (Estimated x 1.5- IJO gal/day Soil Application Rate ~ gal/day/ft2 Standard Influent/Effluent Quality Monthly average" Fats, Oil & Grease (FOG) <_30 mg/L Biochemical Oxygen Demand IBODS) 5220 mg/L ^ NA Total Suspended Solids ITSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand IBODS) 530 mg/L Total Suspended Solids (TSS) 530 mglL ^ NA Fecal Coliform (geometric mean) <_104 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 Q al ^ NA Septic Tank Manufacturer '' ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model ~ -l ~ O ^ 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 MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tankls) At least once every: a ^monthls) (Maximum 3 ears) earls) y ^ NA Pump out contents of tankls) When combined sludge and scum equals one-third IY31 of tank volume ^ NA Inspect dispersal cellls) At least once every: ^monthls) (Maximum 3 ears) yearls) y ^ NA Clean effluent filter At least once every: J ` ^monthls) yearls) ^ NA Inspect pump, pump controls & alarm At least once every: ^ month(s) ^yearls) ^ NA Flush laterals and pressure test At least once every: ^ month(s) ^yearls- ^ NA 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 tankls- 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 cellls) 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 <_12 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. GMW (4/01) '~-' START UP AMID OPERATION Page ~ of ~ For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemical that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the content 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 bi discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge o' effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restorinf power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls tc 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; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following 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 system. The replacement area should be protected from disturbance 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. ^ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ^ 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 u~' ~L ~1 Phone ~~.5 - ~~ ~j - .!~~s-- POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORI Name Name S7` CJ~-!3"~~'C. Phone Phone _ ~ _ O This document was drafted in compliance with chapter Comm 83.22(21(b1111(d1&(f) and 83.54(1-, 121 & 13-, Wisconsin Administrative Code. u 1s81~ yss State Bar of Wisconsin Form 2 -1982 WARRANTY DEED DOCUMENT NO parcel Identification Number (PIN) Carriage Homes XXI, Inc., a Minnesota corporation conveys and warrants to Mark A. Christensen and Mary A. Christensen,as joint tenants, s artial property the following described real esbte itt St. Croix oun , State o Wisconsin: Lot 65, Scenic ills, St. Croix County, Wisconsin This isXhomestead property. Exception to warranties: any easements or restrictions of record, if any. Dated this 24th day of January, 2002 Carriage,Homes XXI, Inc. , /, -i'L~~~L-.y~/L,~IIGLu'' ,~ V, / • (SEAL) • Kellei St Martin, Vice President (SEAL) t AUTHENTICATION Signature(s) authenticated this 24th day of January, 2002 s ACKNOWLEDGMENT STATE OF MINNESOTA }SS. (SEAL) (SEAL) r, WASHINGTON COUNTY. Personally came before me this 24th day of January, 2002, the above ttamed Kellei St Martin, Vice President of Carriage Homes X7Q, Inc., a Minnesota corporation to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis, Stats.) THIS INSTRUMENT WAS DRAFTED BY Land Title, Inc. Gregory A. Booth, Atty 'Annette D.Thers • , n MN Notary Public, Washington County, Minnesota (Signatures may be authenticated or acknowledged. Bo are 55112 My Conunission Expires: not necessary.) +Names of pawns signing in any capac8y should be type8 or printed below then signawes. _ ". ~.~ ~, ' ~~ !s:i ~::RY ~•LS~ C - •."Iti~ESCTA y7t My ~:.:,rr~. L-r.q'rd> .,an. 3t, 'LlYJS Y [ y,,~/VWYJVV.~VJVNNV`/JV`/'JYVV•'~`J»>~ 6 7' 7 7 1 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO.. YI RECEIVED FOR RECORD 05-01-2002 12:30 Ph WRRAANTI' DEED E%EMPT ~ REC FEE: 11.00 TRANS FEE: 242.70 CpPY FEE: CERT COPY FEE: PAGES: 1 TH[S SPACE RESERVED FOR RECORDING DATA Name and Retum Address: !ff Lend Tide, Inc. 1900 Silver Lake Rd #200 New Brighton, MN 55112 ~ (70 cj3y t~7=i7 0 2 Q - 3`35 - 5 -ova s ~ ~ ~~~ ~~ ~~ _~ \~ N ~ q, 0 dL ~ ~~ ~ ~Q /"^'~' J ~ '' N N c ~2 ~, ~ N ~~ ~~°~' `~ ~ ~~ ~ ~ ~ `tn ~ U ~ ~~ ~ ~ ~ Q ~~ ~ ~N % 4 _T\ z °~ 'n ~ ~ ~ ~ CV U ~ ~ $ \~ / c W ~ ~~6-~ti~, U I `. ~ 2ado~'~. t1)~ ~~ i _.._ .L _. .- _.-_. s s ' . . -AO~siz M99~91e LON ~ ~ ~ / ~ /~ v ~~ ~~ ~ / 3 ) ~ / b O N i NWW ~w ~ , ~o a~ ~ ~ W ~ ~v' Y~ ~Q ~ ~cn \ \ ~~'7f N LLJ 1 cV Q . \ ~ . ~ r 8 ~ , C^0 (V ~ ~~ ~ ~. ~ ~~ ~ ~ ~ ~~ ~ -'~~~ ~ ,GCUr ' . ,se~[sz ,95~ eta ' . \ ~ a Z~~~ ~r~ \ . ~. ~ ~ ~ s ~ ~,ssoooos \ ~~ •. ~'`~ ~ ,ry o ~ ' ~ °o I M ~ ~ ~ m I V~ ... a c ~I tl h w o N ' ~ ~ w ~ I ~ 0 ~ 0 ~ o ~ J d ~ v0 ~ ~ ~ w ( ~ ~ ' O C ~ 'I D1 N ~ c ' I' O O a ~ U ~ -T ~ E I ayi a~i o ~ I ' m a z o o I ~ 7 U C (0 N N O LL C O ,O n cfq ~ N v oU d Q zC9 am ~r y I ~ z iii I ~ m ~ z ~ , °o _o .. I ~ d m I am ~ ~~~ ~ ° I , c n c o ~ o c C7 o z 'a -o c c -o o a~ m ,~ I ~ ~ o w ~~ a~ Z a c~ o Z ~ "O C N ' Q C7 I N ~ O 'fl N ~ ~ O Q m ~ O Z Z Z ~ N : I z . I •' ~ N ~ i d ~ ~ _ G •~ w '~Nd~ o L m ~~ c ~ I ~ o a ~ l d lL M v ~ ~ y a p ~ > > ~ 0 0 Z a o ~ v I ~ ~ c ~ ' ~ ~ ~ ` !/) J U ~' = O O~ o ~ Z ,~ ~aa ~~ ~ ~,o I , '~~ J ~ ~ N ~~ O O X 0 0 ~~~~ ~~ ~ ~ ~ d N , ~ .. N d' C77 I U. .. i ~ b ~ y y l v Al ~ o o o i _ ~n c ~ ~ ~ O Q r c M o ~ ~ I ~ v d Oo Oo I r\ i o N f- I O ~ A N N v .i C,~ ~ ~ C~ I C ~{ U y 7 ~ N ~" M O N N M y U N C N OD h •~ ~„' 0 ~ 2 ! U d' O Z c Z ~ In ~+ ~ ~ ~ ~I, ~ = ~ I V i E I v~ m ~ a • ~ a ~ .~ ~ c `i~l ~+ E ` ~ c :: ~ ~ U a V 0 _1 A ~ m ~ ~~~ C' Gr- -1 1- ~s ~ ~ ~ P~a"°~ a ~ ~9 ~4 .•.c1~."'~ ter ~ ~,~.~ ~~a~s s%M~ f9 ~'~'~ ~~~ ~~,~ ~2~ Judi Olson Subject: Christensen/U r 405062 Location: Scenic Hills l0 65 -- Start: Fri 6/21 /0 AM f „ ~1~"'" End: Fri 6/21 1:30 AM n , ~j'° ~~~i Recurrence: (none) (/,J~t_N" ~t/Y ^~ ~" Pam ~ v ~• Hudson, NW SW, s25.29.19.2459 ~, j 819 Highlander Trail " ~~ O t=p O ~ O N CD O a (n Z D D ~ O z 0 c ~ cQ ~ N a ~ N ~. f=/1 N ~ 3 ~ ~ 7 fl- ~ N Q C 3 C ~ ~ N ~ d O y v z 0 0 m D a n o' m z 0 m y ncnO o m ~ ~ co m ~ v ~ 3 3 r: o ~ ~ d7 N N ~ N N 7 o~ y fNll x pf ~ Sp !D fl' a ~ o ~ co 0 2 o ~ o m N ~ Q. N v ~~~-i N f~A N c ~vv~- d o ._ C ~ N < U1 w O .. ~ D D o fD N N N N a (O O C 7 a ao v m ~ a ~ °o ~^' ~! z f A C c a 3 d o ~ ~ 3 ~ ~ m ~ ~ ~ `~' c ~. N O ~ ~ 7 GJ ~~ O A ~ ~ ~ O 0 0 0 ~ o c ~ !~. p' .. ~ d .. y A ? ~ ~ ~ A ~Z 3 m n~i cNn z a ~ ~ ~ ~ V '. ~. h~l O ^! 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