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HomeMy WebLinkAbout020-1071-10-000 o~ O A ~i ~ ~ ° 3 m o ~ d ~1 I I A ~ c ... I ~ ~ r° ~1. I ~ ~ I ~ ~o ~ A ~ ~ ~ ~ ~ I ~ ~ ~ ~ ~ m ~ c ~o ~ I ~ " I •'•' ~ `~ ~ ~ ~ ~i :.. '* m O ? y ~ N ~ O O 3 O a ' O. N G F~ CXl a~ p ~ y ~~ z n N ~ ~ NCO o raw, _~~ ~ ° ~ C ~°; ~ ° ~ n N Q 7 7 O ~ O a O V O lo~~ I ~ =moo ~ ~ ~ 7 N 7 H O a ~ O O ~ y y y ~~ d i y y N i y ~ a "'7 ~1 !r 0 v cn Z D m 4 j I v~ ~ D A 4~ I m ~ D ~' a c? N W a a ~ I ° 3 ~ ° rn a N O ' O a A i I ~ ~ V O D. v N W f/1 J !ri , d t a N O O. (O C ~0.. Q 3 lV I C ~ I C I • Z OOOO 7 I OOOo ~ ~ I ~. ~ ~ ~~~~ ~ a~ ~NN~ m ~~yy,,,,~~ `~~i O. < ~ ~ ~ ~voa, ~ ~ p ~ N ~ A w p"j ~p O ~ N 01 ! D eN~ y O ~ G7 'O ~ S~° ~1 I ~_~ ~ I c m r 'D rn v lei ~ ~ Q ~ a ~ 3 M ~ ; . N z I .. ~ Z D~ o O I 0 I D D ~ a I v O ~ I m m v ~ m' w ~• I ~ m I l ~ m ;U ~ m t~ G N a c ~ N N n I W ~ I ~ ~ Z m ~ O m ~ ~ ~ -1 fp ~ p Z <D O N ~ N C ~~ ^O'. I v a I a I A~ j .. j Z ~ N m ^' rn ~ a ~D I 3 a~ ~ ~ B Z +' ~ m N y ~ 'a .Z1 ~ y W W I ~ ~ O. Q N "O"' =t 7 y ~ ~ K _~p N G O`G ~ 01 ~~ N C ~. N N N C ~ ~~ T f Z d ~. O. ~ ~ Z p d -~ N Q O ~ p N I x 3 ~p w I ~°- x y N CT O fyD N N .~. 'O ~ ~ ~ O Ol ~ O N' ,O.,OQ I ~ nm D 'C I v °Of fD Tj f oar I ~d~ a: o ~ ~ - . v ~ a ~ a I -~ I o~ ~ m < N ~ W O ~ N ~' ~. N ~ (D N I ~ -~ O. I d O ~ ~ ~ + y ~ I A I o I o I m I m ~ ~" o I o~ ~" I ~ ( ° c ~ I °o ~- I a o ' ~' I - :,. ~ _ - - • ~ i , ; b ~~. AS BUILT SANITARY SYSTEM P,EPORT i -i. ~ >R$5 ST. CROIX COUNTY WISCONS .. N ::DIVISION LOT LOT SIZE PLAN VIEW Distances b dimensions to meet requirements of H62.20 C1T(1TJ' ~."R lFA VTSIT~~/• i.~T mt7rw~ ~ nn t+n ran. .. ~. ..n,.,..,, .. I ~ --- , ~ ~ ._ ___ I -- r---- 1 --- r f.--- -- ~ }-- --- ~ ---- i ~- ~ ~ . -- ~.___ ,,,,, i _ t ' j _~ I_ -I- ~__..__ r• ~ ~ ..~..i~~. + - i _ ~ .. ~ _.. t--- i ~ ~ ~ i ~ ~ i -..----._ ~ ~~~ {-_ i r ~_ ~ ~ ~~. _ __t__,___~---- ~ ~ ~ ~ -_r~~__ ~ V 1-----~__~___- ~ ~- 19 -- - ~ ~._ ~ G r- ~ ._. i -+-- ; _-~_--~_-~-~ ~ ~ ~ i ' ~ ~~ -~ ~ I j ' ~ ~ ~ 1 ---- ~ i . t _ ~ ~~ - t- ~ -- - ~ , -r L------ _. -- _- -~ ~ ~ i 1K ~ __~- ~ ~ ~.~ _~ __ --1----~-- -- ~-- _,__ :- --}--- - 1 i ~ i i ~ , ~ ~ _, . ~--~ '-- ;~ ____ - ----1 ~ r_- --_~ ~ ~-_ - __. -- --- __ -- ____ _- _ t - - ' ~ ~ ~ ~ ~ ~ ~ - -~- ~ ~ i - , ~ -~ I I i ~- i , i f 1 _. i .~ -,-- ~ _ ` ~ ' . ~ _ ~ ; -~--1~ - ~; I ~ ~ -t ~ _ ~ ~ i ) ~ i ,. ~ i , f i ~ r- ---I---- _ ,___ -_ _... - t.__ _ L ' ~ ~ ~ ~ ~ ~___ - . . ~ _--- -~! _ ~__ ,~ ~,, ~~` Indicate Noz th A row - -rt _i -- ~ -- . __; ___ i ` ; f ` ~ ~ ~ ~ --- ~ SCALE i ~ ~ ~z '`-TIC TAh'K(S)__~~ R. CONCRETE STEEL N0, of rings on cover Bepth DRY WELL ':'ACHES N0. of width length .area a no. of lines~_ width lengthy: area ~-~r® ii depth to top of ig~ ~ ~J o ~ ~f~ I a:.EGATE ~ . I .W~ R4TE A A, REQUIRED ~~` AREA AS BUILT~~l "~?aimer: The inspection of this system by St. Croix County does not imply complete .valiance with State Administrative Codes. There are other areas that it is not possible inspect at this point of construction. St. Croix County assumes no IiaSility for ;gem operation. However, if failure is noted the County will make every effort to .~:~rctine cause of failure. ;:.USES AI3D OILS SHOULD NOT BE DISPOSED THROUGH THIS SYSTEM. ~ - DATED ~~' 'INSPECTOR ~~ ~c_.;-'" PI.U;iBER ON 30B ~ _. LICENSE NU*ffiER °~' c.- TN, R~~W _~. i w• RFPOP,T Or ITlSPECTIO'.?--I:dDIJIDIJAL SE~~JAGE llTSPOSAI, SYSTEI~i Sntiitary Pernit Jl- ° • ~~'' ~ State Septic ~. ~ - ~; '~ TOt•TI~SHIP Ccr- / ,. t. Croi,; Count • ~/` ~ /,' ~j ti° I ,Size _ gallons • 'umber of- Coapart:nents .. --~--~---~- j . Distance Front: r~ell ~ ft, ~ 12% or greater slope ft. . • ~ Building ` f~t. Wetlands ~ ft t~ • Iii.g2iwate ft, ~~ DISPOSAT, SYSTE:Z r____Tile Field or Seepage Pit(s) Distance From: Laeli ~~~~~ ~ ft, 12%.or greater s~.one~~-~ft Building; ` f~ ~ ft. Wetlands "' ~_ f FIILn ~•~iF'-iwater _..__. ft. ..~ . Total length of Lines ~ft, i~iuraber o£ lines 3 Length of each line ft, Distance between lip .s ~~ ft. Width of tiie trenchft, Total absorption area ~ ~ sq, ft. Dept: of rock belo~,= file ~ Z___. in. Depth of rock over the L in. Cover .. ~nver . xock,,~`_, Depth of tide bel w grade --~ ~.n. S1oPe of . trench in +~er 1~1~1 ft. Depth t•o Bedr ck ft. Depth to • Provnd water -- _ _ft. . . ~ '. PITS ~ - ~ ~ ~ ~ ~ . ..` ~3umber of nits f0u side diar.:eter ft. Depth below inlet ft. Gravel a~u pit: es no. .Total absorption area ~• sq, ft. -.Square feet of seepage trench bottom area equired . Y •~ :square feet of seepage nit area`required ~. Inspected bX. ~ ~ ~ j~",' ,~~. Title :. ~ ~~~ ~ ` _ ._ _ _ ~. ° Approved` ~C.,_',~• - ,,. Date ~ 2 ~ 197 I. Rejected bate 197___•. EH -115 • LOCATION Lot No. - + WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH ~ P.O. BOX 309 MADISON, WISCONSIN 53701 ~~~y~ p~f ^`R_EPORT ON SOIL BORINGS-AND PERCOLATION TESTS ~~Q~ (fyw'/4,1`'/4, Section des[, T~N, R ~ E (or) W, Township or Municipality T RL,r.4 ni., Cnunty ~' ~ Owner's Name: Mailing Address TYPE OF OCCUPANCY: Residence y~ No. of Bedrooms ~ Other EFFLUENT DISPOSAL SYSTEM: NEW ADDITION x, REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS----~~~ d~ PERCOLATION TESTS ~ON~-- ~~~-~IZ~,D SOIL MAP SHEET (~ SOILTYPE ~~~k11T PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS WATER IN AFTER TEST TIME INTERVAL DROP IN WATER LEVEL, INCHES RATE NUM- BER INCHES THICKNESS IN INCHES SINCE HOLE 1ST WETTED HOLE SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN P ~ ~X ~V„ ~~ ~ V I P ~ ~ ~ /~ ~ l/,f~ J~ P-~ ~~ // SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST ROCK IF OBSERVED) T O B E D ~ (DEPTH ~/ ~~ ~] / j ~ ~ b ~ PLAN VIEW (Locate percolationtestssoil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of suit le are s. In irate number of square feet of absorption area needed for building type and occupancy. Indicate scale or distances. Give horizontal and vertical reference poin Indicate slope. r State and County State Permit # ~D~`°' P L ~ ~ ~ - p County Pe 't ermit A lication PP ~ for Private Domestic Sewage Systems Count, ~~ *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # A. OWNER OF PROPERTY Mailing Address: B. LOCATION: ~'/4 ~ ~/4, Section T~N, '~i~ E~ (or) W Lot# City ~ ~ Subdivision Name, nearest roa lake or landmark Blk# Village Township C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) Variance Single family Cif Duplex No. of Bedrooms No. of Persons D• SEPTIC TANK CAPACITY Total gallons No. of tanks / ~ HOLDING TANK CAPACITY Total gallons No. of tanks Prefab concrete Poured-in-Place Steel Fiberglass Other (specify New Installation Replacement Lift Pump Tank or Siphon Chamber Total gallons Prefab concrete Poured-in-Place Other (Specify) E. EFFLUENT DISPOSAL SYSTEM: Percolation Rate Total Absorb Area sq. ft. New Replacement ~~ Alternate (Specify) Seepage Trenc-~No. of I Ft.~IJVidth Depth Tile depth (top) No. of Tr~hes .t Seepage Bed: Length ~ Width Depth ~~Tile depth (top~No. of Lines -Seepage Pit: Inside diameter Liquid Depth No. of Seepage Pits Percent slope of land ~~ ~l,~a Distance from critical slope "'- WATER SUPPLY: Private Joint ^ Community ^ Municipal ^ Owners name as listed on EH 115 if other than present owner: I, the undersigned, do hereby .certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I Have sized the effluent disposal system from the EH-115 prepared by the Certified it T s ~. NAME C.S.T. # ~ d and other information obtained from caner/builder-. L, Plumber's Signatur ~ - /MPRSW# ~~L~~ Phone '~~~~~ ~~ Plumber's Address PLAN VIEW: Provide sketch below of system (include direction of slope and all distances in accord with H62.20. Well loca- tion shall be included on the sketch. Indicate or dimension location of all wells on the property or neighbors property. If well has not been drilled please indicate. ~~~ Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENBRAL 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 Grosshrentz, Gerald Hudson Townshi CST BM Ele v : Ins p. B M Elev: BM D es ripfon: ~~ // ~~ (JlJ ~ / ~ / ` til.J ~ / ~ ~ V ~ ~ . ~ 1 TANK INFORMATION TYPE MANUFACTURER A P A C CITY Septic ~~ S ~ /t ~~ // 11 ~ 1 ~ ! WV ° G ,~a Aeration Holding TANK SETBACK INFORMATION TANK TO P/L ]NELL SQQ, BLDG. Vent t it Intake ROAD Sepf ,, (~ / I ~ ~ U~ r ~I s~1/ mg ~ / j'y~S~' I Aera on Holding PUMP/SIPHON INFORMATION Manufacturer Demand M Model tuber TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. SOIL ABSORPTION SYSTEM " ELEVPCfION DATA county: St. Croix Sanitary Permit No: 430119 0 State Plan ID No: Parcel Tax No: 020-1071-10-000 Section/Town/Range/Map No: 26.29.19.2780 ~~ S~ATJON xFyV ~- BS ~ HI~ FS E~ V. a Benchm k t/ ,• ~ 0~ Bldg. Sewe~/~ .s 97• S Ht I_ Ile /`J ? 5. ~ ~I SUHt Outlet z. y~•~~ Dt Inlet Dt Bottom / -- ead Man. ~~_ ~ , t r Dist. Pie ~ _ .~ ~ ,,, 2 ~/. 3 Bot. ys em ' 7/ 'li F~ I~ lame ~ p v ro ~ 5 g~ 3 .~ n ~ - 5.2 gnu g~ 9 ~.~ C '-' v~ ~ ~ V'~l C/ 1~ - ~ ~ BED/TRENCH DIMENSIONS Width ~ L T Len the ~ S No. Of Trenc s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth ~ I SETBACK SYSTEM TO L BLDG WEL LAKE/STREAM LEACHING anufacturer: ~ INFORMATION CHAMBER OR ~ 6 Ty Of System: ~ ~ ~~t ~ ~_ 7 \ ~~ _- UNIT Model Number: c , ~ f :l2 DISTRIBUTION SYSTEM X-o~J , ~ Y`~T ~~A,~.a-!u'd Header/ nifol ~ I Length Dia Distributio ~/ 7 Pipe(s) ~~,. ~ /~ ~ Length Dia Spacing x Hole Size / x Hole Spacing --~ Vent to Air IntakseJ / ~ / O SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only «~ ~~ ~ -Q,ke~ Depth Over ~ Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Cen er~ f' 2. Bed/Trench Edges Topsoil ~ Yes [~ No Yes ~ No LI , u v - b~rtu~-- COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/~n/~ Inspection #2: / / Location: 781 Badlands Rdr-Hu/d+s~on, WI 54016 (NE 114 NE 1/4 26 T 9N R19W) 'U_nkn-olwn Lot ~l:( Parcel No: 26.29.19.2780 1.) Alt BM Description = ~ I ' liV ~~ ~d e~ ?~. -~l.YrtN ~~~ S~'N~~ ~°`~-/,, ~ , 2.) Bldg sewer length = ~ i/ t'S.~ -;' ~ ~ ~ ~~ ~7il.QlL ~~UZti~/L ~Gt-a~ ~ ~~ ~/ e -amount of cover = ~ ~ ^ r_ ] _I ~~ I ~ ~~ ~~~ ~V~,~r.~i0 ~Qs~ ,.~Q,CJ~ Plan revision Required? ', 'Yes ,, No ~ //__~~~ ____ _ _ _ - _- ( -~-- -~ __- Use other side for additional information. ~___1____l _ __ SBD-6710 (R.3/97) Date Insepctor's Sig ature Cert. No. " Safety and Buildings Division County ~ ~ 201 W. Washington Ave., P.O. Box ~. C,Q.,O /X `S"CO~~,~ Madison, WI 53707 - 7162 Site Address ~~ De artmen~ of Commerce Sanitary Permit Applica ' n ~E~~~V~~ ~'' e ~F3~ Ilc~ In accord with Comm 83.21, Wis. Adm. Code, personal info 'on you provide ^ Check if Revision tna be used for seco ses Privac Law, s15. 1 m I. Application Information -Please Print All Information ~ i [ S Plan I.D. Number Property Owner's Name S 1 C 2.0I k C G u ~~ti i"'~ P I Number ZON!fVG OFFICE - jp ... O O ~ a,~. p,20 - ~D ~ ~- Pr rty Owner's Mailing Add s Q ('~ ' Property Location ~ 8 ~ ~ 018--~ ~ ~. 54 /V E i.4; So~ T a~ N. R / 4 ~ City, State Zip Code Phone Number Lot Ntunbet Block Number l ~ /~~ . /I ~~ (~ [ ~ y G ~ ~ ~ `s' ~ ~~ - 3 Y -~ ~ Subdivision Name CSM Number /V /f}• II. Type of Building (check all that apply) ^Ciry 3 ~ 1 or 2 Family Dwelling -Number of Bedrooms ^Village ^ Public/Commercial -Describe Use ~ " 0 fownshiP ~ ~t~..C~,Y.-crr~.+ ^ State Owned t t ~~ Cam) 3 h ~. 5~ -~+ ~s Np~arest Road f1 !Ir/~ a.~.~o.-v~-+.. ~c~o-~ . III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. 1 ^ New 2 Replacement System 3 ^ Replacement of 6 ^ Addition to For Cotmty 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) _ ___ _ 44 Ion -Pressurized In-Ground 21^ 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 Treatm Unit 49 ^ Recirculating 30 ^ Other V. Dis ersaUTreatment Area Information: - (7fl ~+- Z(o~ ~ Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required ~ ~ Proposed ~ Rate(Gals./Days/Sq.FEJ (Min./Inch) Elevation N qb.b ~ >~ ~s.L . VI. Tank Info Capacity in Total Ntunber Manufacturer Prefab Site Steel Fiber Plas[ic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tatilts Septic or Holding Tank ~` ~ / ppP / ~` ~ n ~ pp~ ~ ~ ~ ~utJa.a~ , ~~ Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number ca 0. t~ e -- nler.~~-r~ i I ~e ~~,.--~ aa-~ -z e ® ~~ s- z v 4 - 3 ~S a ~. Plumber's Address (Street, Ciry, State, Zip Code) VIII. Coun /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater h S D ate Issued Issuing gent Signature (No Stamps) ^ Owner Given Initial Adverse. urc arge Fee) '7'7S ,~ ~7~ Determination L•~' ~'~)'~ 1X. Conditions of Approval/Reasons for Disapproval nn~ rr ~nn nn ~ $.~S~w- ww~ ~ quo `t'~n'^ S"b t ~'^. (,,.aQQ j ~r d~o~~dJ Tretit.cXi. Wle./ S #~' ~' ~o1C ~ „~oa,l ,~ ~o be.. (r~ ~o Ms~ s~c~(a 1e~M~JC.o~ Z ~ js ---'R . ~ o ~ • - c,) .~'~$ ~~n~.. , -. n'^ Att~ph homplete pleas (to the Counnt~ odd) [or a a~stem on ne[ rest wWr a[!c z 11 tnchea m stze ~ . a' ,yQU~, e4.. Soy, ~? ~ ~d~ 0 ~~ o (`"~ , ~ ~~ g-~- q~, ~ ~ . gb,bs' • II 1 ~ 1 , So ~r ., ~~. - Y 1' ~~ •• 5 ~~- gB.4l „ ~ pSA- ~~ ~~ ~ - ~'~ N 7B/ T~ ~ x e 6. S ~- ~~ c.D~...,M-~-m T k9~~ .~ 7 ~~ ~ f II i~..~~..i3 ~VIAcw'~i./~%~iY i 1 ;~ s q3 --na-.~ Eve ~~-..- v!~°'• o ~ a ~~"s~` ~~~ so~~ ~ ~~ A~ ~~'- • '~ ~ ~ I~ !. -~ ~~, ! -r- , ~ F ,~ l (, '' 'p I -~b-o'i~.~ i ~, r a'd5'' f ~ n ~~•- _ ~ ~^ ~~..~st~7" ~:. ~:~'~-`t'om _ .~ °1 t~ ~~ ~5-.r r, E .Y, :1 ~r~t Imo-^.• /t'• ~ A $ c~2e, I _ 1..0 ~~~ ~~! l3 R V /~ , 1°1 .~., 7 6 / ~---- ~ , . ~~:~.s., ~~ 'x 8~•S~ o T~ ~~' ~~ q~, ~ 1. 96,bs° > ~o 71 ~ ~~ „., s ~~.,~- 9en~ „ psi-~~ ~, , ~9 ,~ , '~~'-~, r~J,~~-°~ • S~ ~ -~', ~~/, tai ~o,~, ~ ~.°'~ ---~ i >~ r Y ~:~ ' '~. ~ '.i ^ n /~ ` :.yam ,t ~°""' / ~ +r "" /,. ,;+~~/ rr. I~w~.+-c~•'."'' ~ sar/ b • 1- .v ~~ °~ S rode, (~ ~ . s.o ~ q' ~~~ 0 ~, ~ ~ t rb R V Wiscensin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT in accordance with Comm 85, Wis. Adm. Code 1638 Page 1 of 3 A.C.E. Soit & Ske Evaluations Attach complete site plan on paper not less than 8'/ x 11 inch "'~'-" ~~ ~ ~ i l d b li i d l f County St. Croix nc u e, ut not re erence poi {BM), m te to: vertical and horizonta percent slope, scale or dimemsions, north arrow, and location a d dista ce o nearest road. ~ Parcel L D. 020-1071-10-000 Please print ail information. ~~ pp ~ ~> ~ 2~~ ? Personal irdamation conda ou rovid b d f ur ose L tt4b ~ ~15 0~ 1 R v' By D ` ~ ~ ~ y ry P p e may e use or se p s acy . , s . ( ) (m)). p 2-(O j Property Owner ST i~d doh Gerald & Mary Grosskreutr z ~~ ~Fl~'~_ E 1/4 NE 1/4 S 26 T 29 N R 19 W Property Owners Mailing Address Lot # Block # Subd. Name or CSM# 781 Badlands Rd. na na Na City State Zip Code Phone Number J City ~ Vllage t~ Town Nearest Road Hudson ~ WI 54016 715-386-3479 Hudson Badlands Road ~~.`~~ i toss J New Construction Use: ~ Residential ! Number of bedrooms 3 Code derived des~n flow rate 450 GPD i~ Replacement J Public or commercial -Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Install two trenches at elev. = 91.81' using leaching chambers. Recommend Installing as many chambers as sytsem area allows. a Boring # ~ Boring 1~ Pit Ground Surtace elev. 94.81 ft. Depth to limiting factor ' 124° in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fl2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-14 10yr3/3 none sl fill 1 msbk mvfr as 2f 0.0 0.0 2 14-27 10yr5/4 none sil 1fsbk mvfr gs 1f '0~5. '&d3- 3 27-34 10yr4/4 none sil 2fsbk mfr aw - 0.5 0.8 4 34-62 10yr4/6 none s&gr 0 sg ml gw - 0.7 1.2 62-124 10yr6/4 none s&gr 0 sg ml - - 0.7 1.2 91 4'I ~ ~ ~ b ' Z ' ~ Z .Cog ` AG A't_ e~ Lev. o ~ S S ~,~.o..q I H#4 & 5 cRMain pp8rox. 15% g Z ~~ / a Boring # J Boring 1/ Pit Ground Surtace elev. 97.60 ft. Depth to limiting factor >119° in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-10 10yr3/3 none sl 2fsbk mvfr as 2f 0.5 0.9 2 10-19 10yr4/4 none sl 1fsbk mfr gs 1f '~6ti 9.2, 3 19-32 10yr6/4 none gr sl 2fsbk mfr aw - 0.5 0.9 4 32-38 7.5yr4/6 none Is 1 msbk mvfr cw - 0.7 1.2 5 38-52 10yr5/8 none s 0 sg ml gw - 0.7 1.2 6 52-119 10yr6/4 none s&gr 0 sg ml - - 0.7 1.2 O , ~I G ~ ~ / ~~ ~ 2 ` ~ ~~ ntains approx. 15% gravel & cobbles. ~/ D io ' Effluent #1 = BOD ~ 30 < 220 mg/L a TSS >30 < 1 g/L 'Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signatur ~ CST Number James K. Thompson ~-~-- 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane. Osceol . WI 54020 5/152003 715-248-7767 Property Ovmer Gerald & Mary Grosskreuiz Parcel ID # 020-1071-10-000 Page 2 of 3 Boring # ~ Boring i/ Pit Ground Surtace elev. 95.90 ft. Depth to limiting factor > 114" in. Soil Application Rate h t C l D i Descri tion R d Texture Structure Consistence Boundary Roots Horizon Dept in. nan o or om Munsell p e ox Qu. Sz. Cont. Cobr Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-8 10yr3/3 none sl fill 1 msbk mvfr as 2f 0.0 0.0 2 8-17 7.5yr4/6 none sfill Osg ml gs 1f 0.0 0.0 3 17-48 10yr5/4 none s&gr 0 sg ml aw - 0.5 0.8 4 48-114 10yrfi/4 none d 0 sg ml gw - 0.7 1.2 `'tct•p gS . H#3 contains approx. 20% gravel & cobbles. ^ Boring # ~ Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate D h i t C l D Redox Descr ton Texture Structure Consistence Boundary Roots P ! Horizon ept in. om nan o or Munsell p Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 ^ Boring # ~ Boring Pit Ground Surtace elev. ft. Depth to limiting factor in. Soil Application Rate H ri D th i t C l D Redox Descri tion Texture Structure Consistence Boundary Roots o zon ep in. om nan o or Munsell p Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 *Eff#2 Effluent #1 = BOD S> 30 < 220 mg/L and TSS >30 < 150 mg/L `Effluent #2 = GODS< 30 mg/L and TSS <~0 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. 9. ^ ~o~ / e /a / c~Qb'on 9~0 • E/e.vftf.'erl (+tppr~. /ocu t~irm n oP b cc~i ed ~ c~S cn e; 1. ~~ life ~~ands l~vcc~ f~ ' ~ / S . y~-o, BI ~~ ~ 83 ~ 5tG•~s --- -- --^ ~ .o ,_- - -_ ~ '' - - _._ .__ _ -_ ~ o, EXi3w'n~/8 jr.~fo a drspcrs C~.//'fo_a ayd,:97.&3' ' C be ! cr~nnac~c~ y~ use bkll rk,n ~ ~~ e , syS'teM d~ 1u e t e v,~ = 9,~ G3 weal ~X%5-v'~ 3 bed/oo.n /'CS. </c/lre EX/s7i~ /, db ~a.0 S.T. ~fv be eon.,eGf{ol. ~3aba~i¢-iGO e+~F/u~~+f .,~-/E~r ~ ~eP/acid - ;n se~Q~4-fie cam.-i~dar.~e. ~u,~n S-{yea,., of S,T_ ol.~-~"iaZ~. 5. T o u ~ ~~ 'E ~ /e v~ az~' ~P 4 a-^a~rc o: ~ 8 of caned e /2r/.' ivo._~ " r-- ~~ : ~/o o { S. T. /y/(sn D~C eOIJQI P~.3o~3 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of FILE INFORMATION Owner Permit ~' DESIGN PARAMETERS Number of Bedrooms ~ ^ NA Number of Public Facility Units p ^ NA Estimated flow (average) ~' gal/day Design flow (peakl, (Estimated x 1.5) i/ ~"p al/da Soil Application Rate •' al/day/ft2 Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (RODS) _<220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (RODS) 530 mg/L Total Suspended Solids (TSS) 530 mg/L ANA 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. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity / poo ~ al ^ NA Septic Tank Manufacturer ~ ^ NA Effluent Filter Manufacturer o,~ ^ NA Effluent Filter Model ~ / 00 ^ NA Pump Tank Capacity al ~) NA Pump Tank Manufacturer ip NA Pump Manufacturer ®NA Pump Model ®NA Pretreatment Unit ^ SandlGravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: la-NA Dispersal Cellls) ~In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 ($ ear(s1(sl (Maximum 3 years) ^ NA Pump out contents of tank(s- When combined sludge and scum equals one-third IY31 of tank volume ^ NA Inspect dispersal cellls) At least once every: monthlsl (Maximum 3 years) .3 yearls) ^ NA Clean effluent filter At least once every: 3 ^monthlsl yearls) ^ NA Inspect pump, pump controls & alarm At least once every: ^ monthlsl ^ yearls) l~ NA Flush laterals and pressure test At least once every: ^monthlsl ^ year(s) jq NA Other: At least once every: ^ month(s1 ^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 tanklsl 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 11.3, 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. GMW (4/01) Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that•may impede the treatment process and/or damage the dispersal celllsl. If high concentrations are detected have the contents of the tankls) 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 celllsl in one large dose, overloading the celllsl 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; 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 tie 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 (~ Phone "7f g _ ~ y q _ 33 ~~ SEPTAGE SERVICING OPERATOR (PUMPER) Name Ro,y..,p ~,st,~,.Wz~ S9-W~-cO Phone -~ c! ps- 3 ~ POWTS MAINTAINER Name /,.~ Phone 7!~ -"~yal• ~~.t1. LOCAL REGULATORY AUTHORITY Name 5~-_ ~ f,~,;.~. ~ Phone ~8(~ t.~ 6 $ o This document was drafted in compliance with chapter Comm 83.221211b11111d1&Ifl and 83.54111, 121 & 13), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAIl~TBNANCB AGREBMBNT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~rer.t~~ ~ ~v asI/~r E c,~~- Mailing Address ~1S'/ a~ ~G ,~~5 /l Properly Address ~ ~ °~ °-' °~~'"'"' (Verification required from Planning Department for new construction) - ~~~~ / ono -- !0`7! -1© ~ooo C•Z~~i City/State /7~~ dst ('o'A~ Pazcel Identification Number LEGAL DESCRIPTION property Location l ~ C '~4, N ~ `/., Sec. o~ ~ . T~_N-R~W, Town of 1-~ v . Subdivision ~- _ .Lot # '-'~ Certified Survey Map # r`l~ ~ - ,Volume ,Page # Warranty Deed # y ~~ ~`j ,Volume Tg Page # ~ o Spec house O yes ~ no Lot lines identifiable ~ yes D no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in 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 fom~, signed by the owner and by a mastorplumber, journeymanplumber, restrictedplumber or a licensedpumper verifying 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 1/3 full of sludge. I/we, 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 the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office withm 30 da of the three year expiration date. l l /1~3 SIGNATURE OF APPLICANT 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 th roperty described above, by virtue of a warranty deed recorded in Register of Deeds Office. /~/ / ~D®~ SIGNATURE OF APPLICANT DATE *««««« ****** Any information that is mis-represented 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 a copy of the certified survey map if reference is made in the warranty deed DOCUMENT NO. STATE BAR OF WISCONSIN FORM 1-1982 ~,,,aA/A~R~4MTY DE~D 495289 von r~6C ~ This Deed made between Bernard E. Ki~ney~_ Margaret G. Kinney as Jc~.nt Tenants , Grantor, and Gerald E. Grosskreutz and ,~ L• Grosskreutz as Join Tenants _ Grantee, W `nesseth, That tho said Grantor, for a valuable xnsidsratlon conveys to Grantee the following described real estate fn St. CrO1X County, State of Wisconsin: A parcel of land located in part of the NEjC of the NEB of Section 26, T29N, R19W, Town of Hudson, St. Croix Canty, Wisconsin; further described as follows: Cotttmencing at the NE corner of said Section 26; thence 589°47'41"W, alortR the North line of the NE's of said section, 1107.55; thence S00°12'19"E, alon>~ the west line of that parcel of land described in Volume 536, • Bernard E. Kinney ' (SEAL) rgaret G. Kinney Page 463 at the St. Croix County Ref;ister of Deeds office, 38.11 feet to the point of beginning; thence I ~_~~ continuing 500°12'19"E, alonr; said west lline, 266.52 ~~~-~--jy- feet; thence N89°44'01"W, 163.67 feet; thence N00°12'19" W IIGG ~y 265.40 feet to the southerly right-of-way of the town road(9adlartcis Road); thence S89°59'16"E, along said `w SEE rikht-of-way, 163.66 feet to the point of beginning. This conveyanct: does not create a new parcel. The above described parcel hereby adjoins the property described in Warranty Deed to the above mentioned Grantee in Volume 536 Page 463. This. transfer does not need a GSM under St. Croix G~tmty Ordinace 18.05 (A) (3). Th;~ is not homestead property. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And- NONE warrants that the title is good, I~ defeasible in tee simple and freo and clear of encumbrances except and wilt warrant and defend the same. Gated this 9 ~ ~ day °f ~ © ~ t9 ~~. (SEAL) r F • ~ (SEAL) (SEAL) AUTHENTICATION Signature(s) authentkated this day of , 19 TITLE: MEMBER STATE BAR OF WISCONSIN (If not. authorized by § 708.08, Wis. Stets.) THIS INSTRUMENT WAS DRAFTED BY (Signatures may be authenticated or acknowledged. Both are not necbssary. ) THtB SPAC: RESERVED FOR RECOROtNO DATA REGISTER`S OFFI E st cROa cc., wi RQc'd fcr Rerord F E B 1 9 1993 ~ 4:10 P.~ Register d Deedt Tax Parcel No' ACKNOWLEDGMENT STATE OF WISCONSIN ss. St. Croix -county. Personally came before me this 9 ~- day of ~ t/. 19~Lthe above named ernar E. Kinney slid Margaret G. Kinney ' ~- - -, --- to me known to t1e the persons ~ • _wt~' exe4il~.l~ foregoing Instrument and ackrawldd>oa the ~S(fte~ ~ j f : , ; s ~ (J 1 @'! ' 'a -Y P.L. Y st •'•. =.~ Notary Public $ t. CtOiX ry:r. • ~:~+o~inllX: W-3. My Commission is permanent. (If not;~.1~(~ a ~ex~rat(ort date• March 26, , t9~_.) ,. ,;* 'Name! of person aiyniny in any gpaity should De typed W printed t»bw tnNr NpnaturN. NF X377 ,y6C1£ ,oic yc ~uuw.+ ~r N (0 M ' N _ m N ~ ~ ~ p ~ N _M ~a ~ a 3 ~ k ,~ a ~ ~ ill o ~ ~ ~ =~ O N N ~ ~~ m r ~ N ~ ~ ~ K t0 ~ V_ Q g N ~ oo ~ N ~ N N el£ ,zzi ,£I.81z 'IFz ,,,; ~ c~ , ~ I a I , 8 . ~ ' q t01' c°v ` I ~ ~ w~ ~ 3 ~~ h 1U , ~ o/isri/ ,` ... ~~ N ~ Iq ~ N ~' O UI M ~ N' • ~ ~ ~ ~ V ~bZ'Oq ~ ,L 190£ - Dc ~ ~ OZ '9£5 ~ ~ ~ 8b'B8b ~. ~ ti~ ,o ~ m 01 M ~ ~ ~~ - --- - --- - --- - I ---- ___.. I ~ ~