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HomeMy WebLinkAbout020-1044-80-050 r Wisconsin of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix 'Safet;,' and tjuildin Division INSPECTION REPORT Sanitary Permit No: , 515287 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)1. Permit Holder's Name: City Village X Township Parcel Tax No: Johnson, Jason & Dayna Hudson, Town of 020- 1044 -80 -050 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: 100:D I o010`" o g m i Ne.- a J ' ,et/frvi- 19.29.19.177H20 TANK INFORMATION q.cEVATION D TYPE MANUFACTURER r CAPACITY ° '� ' � 3, 131 1 i • zU FS ELEV. ont\ Septic SRS W." . Q T 3 Benchmark , r,'lk.. / 2 Ca 00-8141 ' qq-IS' Ioo. a Dosing p 1 5 It. 1 d k_. . 5z �'r)� 10.7s- 9 .q t Aeration \ Bldg.5 2 S 1L tA. /w / X , / q / . / j Holding Ht Inlet J�vt2v Iv - 8 7/ y / -or TANK SETBACK INFORMATION Ht outlet $ • %ll,h V r el 7 90 • X TANK TO /L WELL. BLDG. Vent to Air Intake ROAD Dt Inlet \ 7 Septic / 01- 1 Dt Bottom Sv (aZ �/ A Dosing Header /Man. S • 5 L I 4 = 7 , 7* D "( - Th Aeration /' Dist. Pipe c , 74 Holding Bot. - /0 7 d < ill' . p PUMP /SIPHON INFORMATION / / Final Grade 300 3.7S 7/. S _1111 Demand St Cover GPM Model Number IllMpPZIMIMIM I► ' ` TDH Lift Friction • y - .ead TDH Ft .3001 /J /mil q s JG� �� �l i Forcemain Lengt Dia. Dist. to Well bath PI J SOIL ABSOR' TION SYSTEM / JQy►.,� ., BED/TRENCH Width 1 Length it- No. Of Trenches 'PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 g$- • �e,A. SETBACK SYSTEM TO P/L BLDG WELL IceDTREAM LEACHING Manufacturer: T / INFORMATION / CHAMBER OR / 11--Act-cr.,, T e Of System: 3r) /z 76 / G 3(X) � / UNIT Model Number: • / t , . G T DISTRIBUTION SYSTEM ZZ 4- Z o�v -- 5 dN.�, Header /Manifold ' V Distribution x Hole Size � / x Hole Spacing C Vent t Air ntalso\ �`'- s) �_ � (' � 4_.;.6 I Length � J Dia `Y' Lengt Dia ' Spacing n SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only ��` tis o rN. Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges 1 Topsoil El Yes No Yes El No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / a / / 2 "/ i y Q Inspection #2: / / Location: 880 Canterbury Ct. Hudson, WI 54016 (SE 1 /4NVV.1/4 1 T29N R19W) NA Lot 2 /� r Parcel No: 19.29.. 1.) Alt BM Description = e cc e j - A'�o - � �' JIL 5 - C j' �� 2.) Bldg sewer length 4 R 3( r� )/ugfL_ th, Q � . 3� amount of cover - , C -/ - 3 £V Z t j�� --- � <`d ^/ / 14 d fri y / , iri-IttiAii4ii_ ►(Q % DUl)�'wi o Plan revision Required? / I' es No 3 s — [6_3. — * Z __5 Use other side for additional information. � � f SBD -6710 (R.3/97) Date Ins/, • nature Cert. No. commerce.wi.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 ` ~scor~srn De artment of Comm Madison, WI 53707 Ib2 ~ ~ ~ Sani ermit Number to be filled in Co. ~' ( ~' > p erce , ~ ~~ ~ Q Sanitary Permit Application `~-~ `'+ - e Transacts°n; ~ n'ber ,1 , In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this fo t propriate governmental i N un t is required prior to obtaining a sanitary permit. Note: Application f s for ed POWTS are submitted to the Department of Commerce. Personal information you p vide secondary Project Address (if different than mailing address) ur oses in accordance with the Privac Law, s. 15.04 1 m , Stats. r / ~ ~~~ L A lication Information -'Please Print nformation C4}~/`~7LJ Prope~er's Name ~ / ~ 1~~ P az cel # / ~ Property Owner's Mails g Address / ' . Property Location Govt. Lot City, Stat Zip Code Phone Numbe /~,+ F , , C ,~-_,~ /,, ~f/irJ /<, Section ~~ ~. ~- ~ ~ trcle one T ~ ~ ~ II. Type of Building (check all that apply) ~ Lot # ~ _ N; R E o V ^ I F Subdivision Na or 2 amily Dwelling - Number of Bedrooms ~ me O~ Od ^ ~ Block# ~ .,~,-, PubliclCommercial -Describe Use ~ ^ City of ^ State Owned -Describe Use CSM Numbey /Jp / -'?~ /' S"~7I ^ Village of z ~:~~- w 3o t-3z~ c~ ~ ~ ~ Town of p III. T ype of Permit: (Check onl one box on line A. Complete line B if applicable) - A New System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System (explain) B• ^ Permit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner ~! ~ ~ IV. T e of POWTS S stem/Com onent/Device: Check all that a 1 ~ Non-Pressurized In-Ground ^ Pressurized In-Ground ^ At-Grade ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ~ ~ ^ Holding Tank ^ Other Dispersal Component (explain) ^ Pretreatment Device (explain) V. Dis ersal/TreatmentRrea Information: Design Flow (gpd) / Design Soil Application I~te(gpdsf) Dispersal Area Required Dispersal Area Proposed System Elevation i ~ ,J~' ~-- VI. Tank Info Capacity in Tota] # of Manufacturer Gallons N T k Gallons Units L, o 'g o ew an s Existing Tanks (~' w c ~ y 'n y ~ 7 a w U h yr C . Septic or Holding Tank , Dosing Chamber VII. Respo sibility Statement- I, the undersigned, assume responsibil' r installation of the POWTS shown on the attached plans. Plumb r' am (Print Plumber's sgnatu r Kr. ;- MP/MPRS Number Business Phone Number Plumber's Address (Street, City, S e, Zip Code) , ~ ~ • ~ ~ 1Q VIII Coun /De artme a Onl pproved isapproved Per~m (it`F~ee ~ $ ~ -Daate sued) Issuin ent Signatu caner Given Reason for Denial , (/ • / ~ /~ IX. Conditi~~~~~asons for Disapproval 1. Septic tank, effluent fli tmr and +dispersal cell must all be senrk;es 7 maintained ~ i. 8s per management plan provided by plumber. 2., AN~ttt~>ffisck fet~emer~ts must. be maintained .,..a..., ,~ w,up~cac p,uos rur .ne system ana sunm~t [o me t.~ounty Doty on paper not less than g Ui x 11 inches in size SBD-6398 (R. 02/09) Valid thru 02/11 ~~~o~ /. . ~.~.v~G.~i` ~~~%»~~ ~ /6~ 6 T ~~9~t ~.f~.n.C.E /o f - ./~G /OiOJ~ ~ , ~ /~ f _ __-__- ._.._ __ _~ ~~~ ,, ~-- ~~ ~~=~~'~'J ,\ ~ ,~ ,- . ~~~ i ~, ~~d,s.~ / , ,.. , ~ d ~/ 'c~ - _ ~~ ' ~ ,~~ ~ ~~ ~ ~ ~ ~ ~ % ~ ~ i ~ ~° -.' i ~, ~ ~ / i ~~ ~ y(~ ~.. V~11 ~n~ I ~ ~~' ~ (~cr~r I f ~ ~ ~A~ ~g~ i -~ _ , ~a~ ~ + ' art of mer~~~ ~~ ~ ZO~~ SO t_ EVALUATION REPORT Division of Sa BIN s Page 1 of 3 rn auunanae wan u cso, vms. rwm. t,oas T COY ST. CR©IX . i~9~Y 1 t ' Attach pars I in size Ptah mr~ include, t>~ not . (Blot), drrec~on and. Paro~ I.Q. ©~ (~-~~~ D pescerN slope, scale or . north arrow, nd distance to nearest road. Please print a/l infom-ation. R by Date aersor,~ s~ ra+ ~rng ~ ~ ~~ ~ ~, p~ car ~. $. , s.o4 t, ~ lm». /Z ZD a Property Owner Property Location ~ ~ G F T ' a 4 }k1Up VIVIAN KAMARTH ~, ~ ---- SW t/4 NE 1/4 19 T ~ N R 19 E (or) W Property Owners ~ Address Lot it Block ~ Subd. Name or CSNgI~ 342. C.T.H. A 2 -- ~U Jt-/~ Zrp Cade Phone Number Village ~ own ` Nearest Road Hudson, WI 54016 ( 612) 203 -8641 Baer Road P 2 ^ Boring #~ ~ 97.35 105 ~ Pit Ground surface elev. ft. Depth to factor n. 5oN Rate Horizon Depth Dormant Redrnc Description Texttre Stnrdrxe Cor~istenoe Boundary Roots GPDIft: th. Mrmsefi (hr. Sz. Coot. Cdor Gr. 'Efflil 'Etfik2 1 0-4 7.SYR2.5/2 - Ifs 3 ds cb 3vf-co 0.5 1.0 2 4-13 7.SYR2.5/2 - 1 ds ab 2vf-co 0.5 1.0 3 13-37 7SYR3i3 - fs sg ml cs Zvf~o 0.5 1.0 4 31-105 7.SYR4/4 - fs Osg ml -- lvf-m 0.5 1.0 C I I Lf~ ~ ~~~~~- ~ Js~' I I I I I l Ettkrer>t ;rF1 = BOD > ~ < 220 nrglL arx! TSS >~ _< 15U mgR " F_f9u~t 41"2 = BOD < ~ mgfl anti TSS < 30 mglL CST Name (Please Prirrl) Signatrx+e / CST Number M Jo Hollister ~I 224832 Addriess Date Evaluation Corrducled Teieptwne Nurrther W9$75 690th Avenue, River Falls, WI 54022 10 - 27 - 05 (715) 426 -1775 Q Nerr Con~luctbn us ~ Ratgdsr>t~ r Nixnber of b~dro~ 4 lode derlwd now 1'1~ ~ Replaoemer~ Pu eF-8esa.~: Parerrt material outwash ~ Flood Plat elevation itappGeatrte ~:~ Ger>erai ~ ~' g3s~, 6 onven • In-ground trenches -- 0.5 loading rate and _ ~~ ~ y%~'~~~~Q`~ ~y,~~ ~ Oh~~~~ To be deli ed by installer. 33 ~ - OPD ft. 1 Boring 4~ ~ Pit Ground surface elev. 98.85 ft. /f Depth ~ hador I ~ in. "~~"~'`-~ Sod Rath Horizon Depth Dorrrkrant Coker Redar Desc»pbon Texture Stnrcitxe Gonsisterroe t3oundary Roots ~. Mru~e# Qu. Sz Corn. Color Gr. 'Eff~1 *Etl4x't l 0-3 7.SYR2.5l2 - Ifs 2fsbk ds cb 3vf-co 0.5 1.0 Z 3-12 7.SYR2.5/ ifs lfsbk ~ cb 2vf-co 0.5 1.0 3 12-100 7.51'R3/4 _ ml - 2vf-m 0.5 1.0 (Some gr.) ,: ._. _ Propert}r Owner Kamartl-, Vivian (L.ot 2) t'arcef ID # (fending) Page 2 ~ 3 3 Bodn } # F ~ 97.85 f G f f ct l ~ D th round. sur ace elev. Pit t. or a ep to Sal Ra HaKizo n Depth Dante Cobr Redox Dgsaipban Textufe Stnx~sue Gorme B oundanr Roots GP ONf` in. Munsefl Qu Sz. Cone Color Gr. Sz Sh. *Efdk1 "Etf#2 1 0-4 7.SYR2.Sl2 -- Ifs 2fsbk ds cb 3vf-co 0.5 1.0 ~ 410 ----- ~ ifs l fsbk ds cs 2vf-co 0.5 1.0 3 10-42 ?.SYR3/3 -- fs Osg dl ~ 2vf-co 0.5 1.0 4 42-106 7.SYR4l6 s (kg ml -- lvf-m 0.7 1.6 ~+ ~ Groa,d s~face~-. tt~ De~h ~ lln ~. ~~°~~ Soi .Race Fbrizori Depth DanmarN Redox Desaipflon Texhxe Stnx~ue Ganoe Boundary Roots GPD/fl? kt_ Muta;efl ~. Sz Cont. Cobr Gr. Sz Sh. *EiF#1 *Eff#2 ~8 # ~~ Ground surface elev. ff. Depth hi S facts' in. Pif ~ A~~ratim Rate1 * Effluent #1 =BODE > 30 < 220 mgll, and TSS >30 < 150 mg1L * Effluent #2 =GODS <_ 30 mgll. and TSS _< 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or 'TTY 608-264-8777. S$D-8330Tast (8.07/00) . . • y -~ ,.. (J~ i ~! i 1 ~ s.a i s ~ ~~ ~ ~~ Zoo ALR~ ~ `~ ~~ 2 J ~i ~ . ___ ~ ~•~ Ei ____ ;34' `v~°°~5 n `~f c ~ ~.~ s~`~ ~ ,~ ~ '~° --~ ~T PI~u~ u t~ ex C~~i ~~~ ,l33 ~ 1 5' sours-/ o,=Q1. P~'~ .rR _ ,~ ,~ Karnarth, Vivian (Lot 2} p~ ID # (Pending} Page 2 of 3 ~ Property Ovmer Borg 85 ' ~ 106 ~ ~ ~ ~~ 7. ~ st~ceelev. 4 ~ ft. p~h to ~mtling factor' "~• S~ A ~ li catiori Rs ' B ourrd~y Roots Depth ' ~ Caiar Redox Day Textixe Strtxiurr3 iee Gor `Et~t1 in. tu~se~ Qtr. Sz. Cam. Cdor Gr. Sz Sh. lfs 2fsbk ds cb 3vf-co 0.5 1.0 1 ~ 7.SYR2 ~~ -- d cs 2vf-co 0.5 1.0 2 410 -- lfs lfsbk s 0 1 g 10-42 7.SYIt3/3 - fs Usg dl es 2vf-co 0.5 . Osg rnl _ ivf-m 0.? 1.6 4 42-106 7.SYK4l6 ~' s Brumg Boring # q7 ~ R. Depth to lirn8ir~ factor ~~ _ in. ~ _ ~ Ra Grated srs'Eace elev. ice Boundary GPDHf yorizon De{rth ~ Cokx Redox ~ Texture Struchire *E~F4 `Ef~1 Qu. Sz Color Gr. Sz Sh. ",~ Ground surface. elev. ft. - ~ G ~~ ~' SFIi Ra Fiortzon ' QePfih Redox ~ Texttu+e Stnrcture ~~ ~ '' Rooms "Et'~1 "'Et~2 in. tAt Qu. Sz. Grru~. Cok>r Gr. 3Z. Sh. > < and TSS >30 < 150 mglL " Effluent #2 =BOOS < 30 rrglL and TSS < 30 rt>gIL Effluent #1 =BODE 30 _220 mglL 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=3I51 or TTY 608-264-8777. SBD-8330Tast (R,07l00) ~ JJ I CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Owner's Name: Owner's Address: Legal Description: ,~„~'/~%_ ,(/~,1 /y _ _ ~`~ /~> _ 7-~qt/- Township: County: ,~~,1 ~,~,; Subdivision Name: ~~i~? ,~.~r'~.,~lG} - L~~~~,c~ S%7/ Lot Number: ,~ Parcel ID Number: Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing Page 4 System Cross-Section Page 5 Filter Specs Page 6_7 Maintenance & Management Plan Page~$ Septic Tank Maintenance Form Page'' Warranty Deed Page 9 CSM or Plat s Designer/Plumber: ~~~%~ ~ ~~)~ // License Number ~7-~l ~; s--~ Date: l ,~~~= /~ Phone Number 7j5'-,~? C- /y~7 ~ ,. ;~ Signature ~~`~ ~' Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 1 ~,~-o~ ~ ~/~ i = ~ ~a~ ~~~~ ~- .~X/~~ ~»- ~~~ ~®~ .~ ~~~T. ~ ~~~ ~~ ~ ~~~/ - ~G X :moo = %~~~ ~ ~ 1' ~ •~ Sail Absorption Svstem Cross Section ~~'_.~ ~ '~~~ Final Grade 4' Schedule 40 Wdh Vent Ca 88 .~~ ft P Leaching ~~ 11 •- Chamber U ~3 ~5~ ft _ ,v ~ System Elevation ,~ ft ~ft Soil Absorption Svstem Plan View ft 1 ~.ft 4' Dia. Header Leachin4 Chamber Specificati®ns Manufacturer And Model ~ ~~,1~.,~ _~~ ~ ~,~.~,~,~ EISA Rating sq ft per chamber Soil Application Rate '"~ gpd/sq ft /~ f~ gpd Design Flow ~ '~ Soil Application Rate ~~ EISA = ~ Chambers 2 rows of ~~_ chambers each. Page _~ of /~7~ ft ~~ /wn V ,._0/ {.1.. U ,~- Z CO N ~ Q ~ O O z~C7C!3U U ~ cn ~ ~ O Z ~ ~ H Q' m ~ ~ ~~~ ~~~ ~~~ LL 1 L W aD d h a r- ~ U J ~y ~~ ao ~_ O N fV O! Z 0 N r IS.~-I LL ~ LL ~~ ~A rn 4 ~~ aLL mg'm d FEW LL ~ J N r Q n F- ¢W LL J ~ a• ~~~ LL ~ m r a+7 O~ N W f- a 0 U ~ N O ~ n Y POWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE INFORMA' Owner Permit DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units ^ NA Estimated flow (average) .~ gat/day Design flow (peak), (Estimated x 4.5) ~ ~ ~, ~ gal/day Solt Application Rate ~ ~ gat/day/ft2 Standard )nfluent/Effluent Quality Monthly average* Fats, OiI & Grease (FOG) <30 mg/L Biochemica) Oxygen Demand (RODS) <220 mg/L ^. NA Total Suspended Solids (TSS) <150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (RODS) <30 mg/L Total Suspended Solids (TSS) <_30 mg/L I~NA Fecal Coliform (geometric mean) 510¢ cfu/400m1 Maximum Eff)uent Particle Size '/$ in dia. ^ NA Other: ~ ^ NA "Values typical for domestic wastewater and septic tank effluent. 7AINTENANGE SCHEDULE Service Event ?nspect condition of tank(s) ~ At )east once every: SYSTEM _SPFClFiC~T1AMS Page ~ of Septic Tank Capacity gal ^ NA Septic Tank Manufacturer - s' ^ NA Effluent Fitter Manufacturer ~ ^ NA Effluent Fitter Model ~-- ^ NA Pump Tank Capacrty al ,~ NA Pump Tank Manufacturer ~ NA Pump Manufacturer ~ NA Pump Mode) ~3"NA Pretreatment Unit ^ Sand/Gravel Flier ^ Mechanical Aeration ^ Disinfection ^ Peat Finer ^ Wetland ^ Other: .®'NA Dispersal Cellts} ~` In-Ground (gravity} ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized} ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA Service Frequency ~ ,O month(s) (Maximum 3 years) ^ NA Pump out contents of tank(s) When combined sludge and scum equals ane-third (Y3) of tank volume ^ NA -sped dispersal cell(s) At feast once every- ^ month(s) (Maximum 3 years) k~' year(s) ^ NA Clean effluent filter At feast once every: .--7 ^ month(s) J~'year(s) ^ NA !nsc~sc; pump, pump controls & alarm At least once every: ^ month(s) ^ year(s) ~'NA i=i~aF )=tarais and pressure test At )east once every: ^ month(s) ^ year(s) ~ NA ~~~~ At feast once every: ^ month(s) ^ year(s) ®NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal ce}Is shall be made by an individual carrying one of the following licenses or cen:if"ications: 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) shalt 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 (Y3) 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 w)th chapter NR 143, Wisconsin Administrative Code. Att ot~rer services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of <_42 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 40 days of completion of any service event. Page ~ oT 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 the dispersal cell(s). 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 wilt be discharged to the dispersal celi(s} in one large dose, overloading the cell(s) 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 aver, 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; sani<ary 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: • Ai! piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shat! 6e 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 CONTtNGENGY 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 sail absorption system. The replacement area should be protected from disturbance and compactian 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 fior a new soft and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rotes 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 tailed POWTS. ^ The site has not been evacuated 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 ~OWTS INSTALL Name ,~ ~~ Phone ~ ~ _ ~ ~EPTAGE SERVICING OPERATOR (PUMPER) Name Phone I POWTS MAlNTAtNER Name Phone LOCAL REGULATORY AUTHORITY Name ./ ~ Phone / - _ ~ _ -his document was c-a`ts~ - ~=-c :ante with chapter Comm 83.22(2)(bi(1)(d)&(f) and 83.54(1), (2) & (3}, Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT A.ND OWNER~IP CERTIFICATION FORM Owneli'Bttyer ~~ ~~~h~~us~o-J iYlailin~ Address ~ S6 ~/ ~ ~ Property :lcidre ~ ~/~Z~~ (Vrriflcation rc;quircJ from 1'lannir-g b`; ~~o~ Department for new consu~uction.) City/State Parcel Identification Number LEGAL DESCRIP'T'ION Property Location ~~ ~~ , ~ ;.,~ ,Sec. ~: '1' ~N R~W, Town of S -- Subdivision t~'S'N1 U~Oo'1/ ~ ^; Lot #~. Certified Survey Map # Volume ~ /7 ,Page # ~ _ 1Vai•r~tttty I)eecl # Voltan~~e Pal;c # ____ Spec house yes no Lot lines identifiabl ye uo SYSTEM MA-INTENANCE AND OWNER CERTIFICATION ltxtproper 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 tlu•uu years or sooner, if needed, by A licensed pumper. What you put iuw the systerr< can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumbez, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operatuig condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than i/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 the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained mnsE be completed and returned to tltt3 St. Crouc.Cotunty Planning & Zoning Uepartn~ent within 3U days of the tltrec year expiration date. ti~~~c certify that all statements at Ibis lurnt arc trt,c to Iht• best ol'my/uurknowtcdge. 1/wc attt/are the owners} of the property described above, by virtue of a warranty deed r~wrtl4d in Register of Deeds Office. Number of bedrooms ~~ N RE OF APPLICANT(S) (~ /2~l~z~(o DATE **Any information that is ?misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Departrntent. *** u.clude with this application a recorded warranty deed from the Register of Deeds. Qfl?iCe and a copy of the cert~f"ied survey map if reference is made in the warranty deed. lt~v. as~as> State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document Number II Document Name THIS DEED ,made between Viv}~~amrath a single y~erson and Jason R. Johnson ("Grantor" whether one or more), ("Grantee" whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests in ~ mix County, Wisconsin ("Property"} (if mote space is needed, please attach addendum): Lot 2, Certified Survey Map recorded March 8, 2006 in Volume 20, page 5171 as Document No. 820219. VIII Illli VIII IIII! VIII VIII IIII 111111 1111 IIII $ 9 1 7 2 6 8 1 ~~~~~~ BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 06/09/2010 01:30PM WARRANTY DEED E%E11Pi ! REC FEE: 11.00 TRANS FEE: 324.00 PaGES: 1 Recordmg Area Atl American Title 1610 Maxwell Dr #120 Hudson, yW 154{016 020-1044-80-050 Parcel Ideniilication Number (PIN) This f5 homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Restrictions, declarations, covenants, reservations and easements of record, if any. Dated ~ , (SEAL) (SEAL) (SEAL) (SEAL) AUTHENTICATION ~ Signature(s) ,lucre ,f,~_, . Oyu ~_~~'(~ authenticated on _ ~r,~d _ ~t~7 ~~GV~ ~e °~ TITLE: MEMBER STATE BAR OF WISCONSIN ACKNOWLEDGEMENT STATE OF WISCONSIN ) ) ss. ST. CROIX COUNTY ) Personally came before me on 05/28/10 the above named Vivian Kamrath, a single person , (If not, m wn to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) t d ac e. THIS INSTRUMENT DRAFTED BY: All American Title Co., Inc. ~AJi ~la~ * L 1610 Maxwell Drive, Suite 120, Hudson, WI 54015 Notary Public State of Wisconsin My Commission {is permanent) (expires: - ) (Signatures may be authenticated or acknowledged. Both are not necessary) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLX IDENTIFIED. WARRANTY DEED ®2003 STATE BAR OF WISCONSIN Form No.1-2003 • Type name below signatures ~~' 1 of 1 8~~21~ CERTIFIED SURVEY MAP VOLUME 205»~ PAG e VOL 20 PAGE 5177 REC*ZS OF DEEDS RECEIVED F°R-SEC°RD 03/08/2006 08:00AM NO. CERT2FIED SURVEY 1lAP E COPY FEE: BEING A PART OF THE SOUTHEAST 1/4 OF THE NORTHWEST 1_ /4, qND PART OF THE SOUTHWEST 1/4 OF THE NORTHEAST 1/4 OF SECTION 19, T29 N., R.19 W., TOWN OF HUDSON, ST_ CROIX COUNTY, WISCONSIN. N.1/4 cor. 19-29-19 ALUMINUM CAP MONUMENT ` i r._______________ __ LOT 2, VOL. B P.245 F ----___i~___ _ ___ ound 1' iron pip e ~, -------- ~ ----- ~ ~ $' i ~ ; ~ ~ UNPLATTED LANDS ~; ~ - - Y, ~, o ; PREPARED FOR: VIVIAN L. KAMRATH 342 BAER DRIVE HUDSON WISCONSIN 54016 OUTLOT 1_ Vol. 11 P_3164 Found 1" iron pipe -----s ' 33'' 1 G ' i 25 `•~~'O \\ ~ n i3 M „ CV ,m n ~ ~ ~ _ tr '$ '= e i ~ i ~ `fp ~~ O 'o M ~ o 0 s, ~~ Z ~~ ~ ~ i i ' ~+ N ' G 43 ' ..7 I E,. ; ~ 111 I 1 1 1 I i i i i 33' i i :___~ ~` ~. _'~-,~. Found 1" iron pipe ~ Fs. ~ -~' SCALE= 1" = 100~~, ound 2" iron pipe ~N °zt ' ~! Q M ~1 a~. jf W CV CV (V G N ,N i ! / 0 v o= ~L C ~L L 3 W ~ c Z 3 t oz d d Z i/1 a - v ~ V- io ° y0' 3 6 I ~ $~,~~, ~ W ' D ; z2 E ~ 11~ 0 N~•37'S3~ N~OO 9g~~d _\Z ~ 6.B8' ~~ © , ~ / $ / 2 G. p ~a~ N~ R N~N~~\"~ 1 I ® O ~ ~ O~ P~ 1 i / :7 f' O ~ 'N / \ ~ j Y -Nl 4' O ~ ® N p •4~~i ~7~ ~ y / / Z I N ZjiO O / / ~ 19'E 3NAGE T ~ ~ ~ ~ ({~ - ~ / / / ms's / ' / ~ iEMEN / L / Y 1 1 / ~ / / M ' ~~ / 4~-l~j~ / lc / / ~ _ _ . - / ~~~ %//~ - 3; ~' -'~ LEGEND N~ ~.~ ..... Government Corner las noted} rf $ ° ~ - Set 3/4" x 24" rebar weighing z' ; 1.5021bs./lineal ft. • ......... . Found iron monument (as noted} S 1/4 -.. _. - ~ Building setback line as shown typical 19-29 ~19 0 100 200 D ._.... •... Soii Borings COUNTY SURVEY NAIL L B.O.......... Lowest building opening SHEET I or s This instrument wos drofted by F.J.G. Shaded areas are 20% slopes or greater. 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G salao 9Z't L31 'bs 6£ 'b5 ~.: i ~` I o r N ~' ~ ~ ^~'" z log ~~R~"~" ~} :. o~ i ~ ~ / " ' I ' ,9£'961 ,99'0 <, s .lu ~"~:i I ,ZO'L9b 3,.0£,85.88S I ~~ ' _ ' ~ adld uai „ uno , t P ~ adid uo,u „Z puno~ ~ o h/£ P ~ ~'"`` adid uo,i „ uno ~~ I _ ~ SQNV'I Q3,L,LV'Idt~IA i i~9i6 'd ii 't~A I, , I M I ' N ~ t ioz,tno ~3 ' ~8. ' ==------------------------------------_-----~------- 91075 NISNO)SIM NOSOf1H `~ ~ add uoai „ puno ~"~` ~ 3nlao a3da z7~ t ~ Sfiz'd 9 '70A Z ,LO'I ~~ ~•--------------------. ~- -•---------------~ > NdlAln ~ 1N3WnM~' ~' SITE PLAN LOCATED IN PART OF THE SE7/4 OF THE NW1/4 OF SECTION 19, T29N, R79W, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN; BEING LOT 2 OF CERTIFIED SURVEY MAP RECORDED IN DOCUMENT NUMBER 820219 AT THE ST. CROIX COUNTY REGISTER OF DEEDS OFFICE. OWNER DREAM STRUCTURE, INC. JASON JOHNSON P.O. BOX 105 HUDSON, WI 54016 SURVEYOR EDWIN C FLANUM NORTHLAND SURVEYING, INC. P.O. BOX 152 AMERY, WI 54001 1 5/16' O.D. IRON PIPE FOUND N68°47'38"W 0.64' FROM COMPUTED LOT CORNER. ri ro ~ N m o p O O Z LEGEND ~ 15/16' O.D. IRON PIPE FOUND ® 3o%sLOPE p 3/4' IRON REBAR FOUND ~ 2596 sLOPE ! 3/4' X 18"IRON REBAR SET WEIGHING ~ 1.50 LBS. PER LINEAR FOOT zo96 SLOPE © LATH SET 1296 SLOPE - - - BUILDING SETBACK LINE (WIDTH AS SHOWN) ( ) PREVIOUSLY RECORDED DATA -S-S- PROPOSED SILT FENCE ELEVATION OF LAKE MALLALIEU ON MAY 17TH, 2010 = 688.6 FEET. -' -' - 300' SETBACK FROM LAKE MALLAUEU (S86°56'30'E) S89°38'14'E 270.68' q~ ' 1N LOT2-C.S_M. rj _. --=_-'r'ir$'. , r,' % DOC. NO. 820219 / ?fi~~g - - . ~ 1.26 ACRES / ~ b~ / ~ ?~~ ' ' ~ ~ s PROPO \ 54,839 SO. FT. / w p ~ ~ n RI D / ~: POeO SE I I / w O I~ ,~ ~~ ww =r ~~ O~ r Ow wQ U z wo w0 ~- O wU w~ ¢Z Q~ ~O ZU ~O w~ mU i; '~ e ~p~ I ~ c LOT 3=C.S_M. XTS3 3 I I / ~~ DOC. IVO. 820219 \' ~s3.z `• ~ ~' I I ~ ,•"I l `• \ i I I \ / ~~~ I I TOP OF REBAR I ) ~ ~-ELEVATION = 763.45' I // ~ I ~ I ~ ~ I // ~ \ ~ I / ~, _,~ I / ~`` C_ _A_NTERBU_R_Y_ 1 ~, i COURT ~ L-~J ------ ' S89°09'35'W i 08.28' \ /ses°4s~1 svry LO_T 1 - C.S.M_. ~ DOC. NO. 820219 ~ ---- ~ DESCRIPTION ' LOCATED IN PART OF THE SE1/4 OF THE NWt/4 OF SECTION 19, T29N, R19W, TOWN OF HUDSON. Sl. CROix COUNTY, WISCONSIN; BEING LOT 2 OF CERTIFIED SURVEY MAP RECORDED IN DOCUMENT NUMBER 820219 AT THE ST. CROIX COUNTY REGISTER OF DEEDS OFFICE. I, EDWIN C. FIANUM, REGISTERED WISCONSIN LAND SURVEYOR, HEREBY CERTIFY THAT THE ABOVE DESCRIBED AND MAPPED PROPERTY WAS SURVEYED BV ME OR UNDER MV DIRECT SUPERVISION AND THAT THIS MAP IS A CORRECT REPRESENTATION TO SCALE OF THE BOUNDARIES TO THE BEST OF MY KNOWLEDGE AND BELIEF. Edvrin C. Flamm, R.LS. 2487 THIS INSTRUMENT DRAFTED 8Y MICHAEL ERICKSON JOB N0.10.34 DATE SS-10 CURVE DATA TABLE NUMBER 1 RADIUS BO.OD' CENTRAL ANGLE 116'18'52' CHORD BEARING N41'OS'26'E CHORD LENGTH 135.92' ARC LENGTH 162.41' SCALE IN FEET 1' = 4S0' 40 0 40