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Home My WebLink About020-1404-02-000a o M a 0 c N N tl h y •wV O r O � V � w FBI r .� C A v c LL LL C C) of c 0 2 0 z m c 0 Q N N E 0 N N L M � c d E N 7 d z O O O C 'U O w ° CN w N z z o Vl a� 3 � v � � 0 z CO =' o p z °'w 7 a am N 1- z Q T c C7 r9 o Z co c a o � N Z cn F- •- 0 ) o. O C co LO v U (O N L •N � 7 = ° t N C R N O Vf N 0 r � o - Q o z s z a p N z y = c G1 'O.. � _ d 13 m CL N N o ) o a` RR 2 R �aaa a = N N tq J U 0 0 N O N ch = N C O ca O O C o — m ro cn a O 0 O U 2 N N N C O N LO � = 0 O o ry H 0 U d. 0i en N 3 . N Q LO O N = V O y iv a ` a CL U N d = O O U n. g 0 cn U C) of c 0 2 0 z m c 0 Q N N E 0 N N L M � c d E N 7 d z O O O C 'U O w ° CN w N z z o Vl a� m 0 CO D 7 a V1 Q T w Q z co 0 O LO u a ° ql E C R N Vf N 0 r � a p ° z � z a in Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) 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 Renton Homes I Hudson Townshi CST BM Elev: b b . a Insp. BM Elev: 1 0 D: 6 BM Description: 07►-, #/ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic l a� Dosing DS' V er /o� Aeration P/L C Dosing Holding `74 -3 Bldg —leeyd � TANK SETBACK INFORMATION .S ce_ TANK TO P/L �n n WELL BLDG. Vent to Air Intake ROAD Septic DS' V er /o� G' P/L C Dosing WELL `74 -3 Bldg —leeyd � Man fa9tuur: _ ; INFORMATION � ST� Aeration St/Ht Inlet S°d ye-7— 7 .oS V, 3 Holding S 90 42 2 Dt Inlet PUMP /SIPHON INFORMATION Manufagturer Demand PM Model Numb' TDH Li n Loss System Head TDH Ft orcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 405112 0 State Plan ID No: Parcel Tax No: - 0 U 0- 00 STATION BS HI FS ELEV. Benchmark G 3 78. Liquid Depth /o� Alt. B P/L C BLDG WELL `74 -3 Bldg —leeyd � Man fa9tuur: _ ; INFORMATION � ST� - 7 , 7 9 St/Ht Inlet S°d ye-7— 7 .oS V, 3 St/Ht Outlet S 90 42 2 Dt Inlet Dt Bottom Header /Man. 6,e i y /0 Ipd�m e ,a � Bot. System ]� / �• b Final Grade 241E ads s 6. j / • S J St Cover / C4 c / V. / 7 D E Width / Length ( No. Of Trenches it Intake PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO P/L C BLDG WELL LAKE/STREAM CHING Man fa9tuur: _ ; INFORMATION Type f System: R / ` i / �� ye-7— ER O R B IT f Y! ! �►' Model Number: DISTRIBUTIQN SYSTEM Header /Manifo;d istribution r Hole Size x Hole Spacin it Intake / Y i Pipe(s) ►� �(� / '�5pacin� I x J �e r ] Yes j# No [ Length Dia Length Dia SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded ulched Bed/Trench Center � Bedrrrench Edges Topsoil Yes No r ] Yes j# No [ COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1:Y / 7 / 6 Z- - Inspection #2: Location: Glenna Drive Hudson, WI 54016 (NE 1/4 SW 114 29 T29N R19W) Walden Woods Lot 2 Parcel No: 29.29.19.334C 1.) Alt BM Description = / d�/�J - ct d 2.) Bldg sewer length = (� 7 � - - amount of cover revision Plan Use others de or Required? No t information. SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. P�O� �. �E�&j R t� N+oti! 40 o4- Z qo _a FS /T( V *Z� r fl- �� nVtt yl!� - LL) q. y F t iZ u>>K, -� A g- xt- 5 / Cyt PA ok-l� 83 C;CC-OtIA 0wot z SBD -6398 (R. 07/00) Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. 14 See reverse side for instructions for completing this application PO Box 7302 Madison, WI 53707 -7302 Department of Commerce Personal information you rovide may be used for second u oses � p � [Pr i vacy Law, s. 15.04(1)(m)] (Submit completed form to county if not ,5 L `t. / - 9 1 state owned.) Attach complete pl s (td the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. Coun - f — CR-0 I State Sani Permit Number ❑ Check if revision to previous application State Plan I. D. Number I. Application Information - Please Print all Information Location Property Owner Name MID&U&S Property Location, .&- , Z' T N,R/I(o Property Owners Mailing Address Lot Number Block Number PO R 0 � to `L , City Stat�e Zip Code one Numbe�� oF Sub Name or CSM Number II Type of Building: (check one) 1 or 2 Family Dwelling - No. of Bedrooms :� �� ❑ City ❑ Village Public /Commercial (describe use):_ 9" town of ®f ❑ State - Owned fl ,} v�� e � '; X c i C ,�? `, ! _ �� . , aC j 7 ` �l Nearest Road 69em r r 6� G c,:�)"J"J A Ae/ ve Parcel Troc Numb s) _ a O a O L III. Type of Permit: (Check only one box on line A. Check box o line B if applicable) A) 1. New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing Sys tem $) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: `)? 0 < �i4 i V. Dispersal/Treatment Area Information: Z EF AN E'1514 - D 3 /.O - 37 1. Design Flow (gpd) 2. Dispersal Area Requir d 13. Dispersal Ar Proposed 4. Soil Application Rate (Gals. /day /sq. j) 5. Percolation Rate (Min. /inch) I 6. ystem Elevation S � C) " 7. F' al Grade Ft tion 9 1 , 6 p 5 0 V1 Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Z"67L Con- Con- glass New Existing Crete structed Tanks Tanks '- z k 2 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, assume respo nsibility for installation of the POWTS shown on the attached plans. Plumbe s Name (print) f Plumber' Signature (no s): MP No. Business Phone Number 7 z7 3 Plum is Address Street, City, State, Zip Code) IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued gent Sign a (No stamps) Approved 0 Owner Given Initial Adverse Surcharge Fee) / Determination X. Conditions of Approval /Reasons for Disapproval: -/9.7 =r ACS � - A ;;( , �'�,5 mss. f3. Lf SBD -6398 (R. 07/00) P�64-- � LPJ Mru+t/�-f m6 s /-o k Z &JAL, J > E 5 p PA ok-7-7 City State Zip Code Phone Number City : j Village �j Town Nearest Road Hudson I WI 1 54016 1 715- 760 -1149 Hudson I Glenna Drive RECEIVED 1467 Wisconsin Department of Commerce SOIL EVALUATION REPO T age of 5 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. oil & Site Evaluations Attach complete site plan on paper not less than 8 %x 11 inches in size. Plan must ou St. root include, but not limited to: vertical and horizontal reference point (BM), direction and 61IC)CROIX CO N Y percent slope, scale or dimensions, ce sions north arrow, and location and distance to nearest road. ff"DO �f� , ID #2 .29.19.334C Please print all information. R y Date, —� Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Z7 1 yj O Zu Property Owner Property Location Midwest Const. & Developm Of Hudson,, INC. Gov Lot NE 19 SW 114 S 29 T 29 N R 19 W Property Owner's Mailing Address Lot # Bloc Subd. Name or CSM# P.O. Box 932 2 k # Plat Of Walden Woods New Construction Use: jo Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement -I Public or commercial - Describe: Parent material Gl acial outwash Flood plain elevation, if applicable na General comments and recommendations: Install 2 trenches using 29 high capacity infiltrator chambers. Upper trench elev. = 87.0' on 91.0' contour, lower trench = 85.0' on 89.0' contour. M id Boring # Boring Pit Ground Surface elev. 95.41 ft. Depth to limiting factor > 106" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft *Eff#1 *E 1 0 -15 1Oyr3/2 none fsl 2fsbk ds as 2fmc 0.5 0.9 2 15 -35 1 Oyr3 /3 none Ifs 1 msbk ds cs 2f,1 me 0.4 0.6 3 35 1Oyr5/4 none s 0 sg dl cs if 0.7 1.2 4 63 - 106 1Oyr6/4 none s Osg dl - - 0.7 1.2 E l Boring # Boring Pit Ground Surface elev. 95.65 ft. Depth to limiting factor >10 8" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G *Eff#1 *Eff#2 1 0 -23 1Oyr3/2 none fsl 2fsbk ds as 2fmc 0.5 0.9 2 23-48 1 Oyr3 /3 none fsl 1 msbk ds cs 2f,1 me 0.4 0.6 3 48 - 59 1 Oyr5 /4 none Ifs 1 msbk ds cs 1 f 0.4 0.6 4 59 -108 1Oyr6/4 none s Osg dl - - 0.7 1.2 * Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS > 4 D - < 150 mg/L ent – BOD 30 mg/L and TSS <-,30 mg/L CST Name (Please Print) Sign re: CST Number James K. Thompson �'° 3602 Address AC.E. Sal & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane. Osceola. WI 54020 40 0 10/14/02 715- 248 -7767 property owner Midwest Const. & Development Parcel ID # _ 020- 1083 -30 -000, ID# Page 2 of 5 ]Boring # Boring Pit Ground Surface elev. 91.82 ft. Depth to limiting factor >97" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots z *Eff#1 *Eff#2 1 0 -15 1Oyr3/2 none gr. %I 2fsbk ds as 2fmc 0 0.9 2 15 -28 1Oyr3 /3 none ifs & gr. 2msbk dl cs 2f,1mc 0.5 0.9 3 28 -55 1 Oyr5 /4 none s 0 sg dl cs if 0.7 1,.2 4 55 -97 1Oyr6/4 none s Osg dl - - 0.7 1.2 �k S0 = S�f- Ct34q�' Horizon #2 contains approximately 20% gravel & cobbles. Horizon #2 contains approximately 40% gravel ,cobbles & stories. 4] Boring # Boring #d Pit Ground Surface elev. 89.55 ft. Depth to limiting factor >96" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfV *Eff#1 *Eff#2 1 0 -18 1 Oyr3 /2 none gr. fsl 2fsbk ds as 2fmc 0.5 0.9 2 18-42 1Oyr3 /3 none Ifs & gr. 1msbk ds cs 2f,1mc 0.4 0.6 3 42-64 IOyr5/6 none s 0 sg dl cs if 0.7 1.2 4 64-96 1Oyr6 /6 none s Osg dl - - 0.7 1.2 �k S0 = S�f- ` qQ, � & Horizon #2 contains approximately 20% gravel & cobbles. orizon #2 c ontains approximately 20% gravel ,cobbles & stones. F ng # A Boring Pit Ground Surface elev. 88.44 ft. Depth to limiting factor >98" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 1 0 -14 1Oyr3 /2 none fsl 2fsbk ds as 2fmc 0.5 0.9 2 14 -31 1 Oyr3/3 none Ifs & gr. 1 msbk ds cs 2f,1 me 0.4 0.6 3 31 -55 1Oyr5 /6 none s 0 sg dl cs if 0.7 1.2 4 55 -98 1Oyr6 / none s Osg dl - - 0.7 1.2 Horizon #2 contains approximately 20% gravel & cobbles. 0 * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 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 need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777. property Owner Midwest Const. & Development Parcel ID # __020 -1083 30 -000, ID# _ Page _ 3 .of - _ 5_ _ FIS ] O # Boring Pit Ground Surface elev. 88.81 ft. Depth to limiting factor >9 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ' *Eff#1 *Eff#2 1 0 - 7 1Oyr3/2 none gr. fsl 2fsbk ds as 2fmc 0.5 0.9 2 7 -13 1Oyr3/3 none gr. Is 1msbk dl cs 2f,lmc 0.7 1.2 3 13 -21 1Oyr4/4 none gr. Is 0 sg dl cs if 0.7 1.2 4 21 -94 10yr6 /4 none s 0� dl - - 0.7 1.2 - '- -7 a' A�-I - L . Horizons #2 & 3 contain approximately 20% gravel, cobbles & stones. Horizons #2 & 3 contain approximately 15% gravel & cobbles. 7] Boring # Boring JA Pit Ground Surface elev. 85.34 ft. Depth to limiting factor >87" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP *Eff#1 *Effrrrl 1 0 - 17 1Oyr3/2 none gr. fsl 2fsbk ds as 2frrc 0.5 0.9 2 17 -25 1Oyr3/3 none gr.Is 1msbk dl cs 2f,1mc 0.7 1.2 3 2541.. 1Oyr4/4 none gr. Is 0 sg dl cs if 0.7 1.2 4 31-87 1Oyr6 /4 none s Osg dl - - 0.7 1.2 L . Horizons #2 & 3 contain approximately 20% gravel, cobbles & stones. 81 1d Pit Boring # Boring Ground Surface elev. 85.89 ft. Depth to limiting factor >91" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD& — *Eff#1 *Eff#2 1 0 -14 1Oyr3/2 none gr. fs 2f ds as 2fmc 0.5 0.9 2 14 -21 1Oyr3/3 none gr.Is 1msbk dl cs 2f,1mc 0.7 1.2 3 21 -34 1Oyr4/4 none gr. Is 0 sg dl cs If 0.7 1.2 4 ' 34 -91 1 Oyr6 /4 none s Osg dl - - 0.7 1.2 Horizons #1 & 2 contain approximately 10% gravel, cobbles & stones. lLC�i�li'l � * Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD , L30 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 need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 264 -8777. SOIL AND SITE EVALUATION 1467 Page -( of 5 PROPERTY OWNER: Midwest Const. & Developme Of Hudson„ INC. PARCEL I .D. # 020 -1083- 30-000, ID #29. 29.19334C A.C.E. Soil & Site Evaluations REPORT MEMO Proposed house ill , area. Evaluation of soil borings #779, & 9 completed to provide additional area for sytem installation while complying with setbacks as required by code. 8encl, mdr /la;/ :? A'd A-^<. A ss u meal c e% = 100,60' 8.2 /6;9 .Z e) MIL C (. A t LE . 8. K4 ,\ ?„ ,�r-c _ E I -- 86.77,' ■ 5o,� I DbSeril �o-o Are N Sca /e: �a -6,z, P/Q �w "� ��ds See.29 T. oIc A�45m Sf Oz "x C'o y LL Elm = p9. s 8r R.1 r 97.o Can 9so' Glenna ■ b ri ve. B7o' 8� /*, :5-w6— 9c ` 1467 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Sal & Site Evaluations Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must County St. Croix include, txrt not limited to: vertical and horizontal reference pant (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 020 - 1083- 30 -000, ID #29. 29.19.334C Please print all information. By h Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). �� a Property Owner Property Location Midwest Const. & Development Of Hudson„ INC. Govt. Lot NE 1/4 SW 114 S 29 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# P.O. Box 932 2 1 1 Plat Of Walden Woods City State Zip Code Phone Number City „j Village t t Road Hudson WI 1 54016 1 715 - 760 -1149 Hudson �/ lenna Drive 19 New Constriction Use Residential / Number of bedrooms 4 C des [AC &O Y 00 GPD Replacement , ] Public or coryurleraal - Describe: _ Parent material Glacial outwash _ _ F ptaMr (f app(jsable -- na General comments M 4T � , and recommendations: Install 2 trenches using 29 High capacity BioDiffuser infiftrato bets. rich ele>i: •� 0.0' on 95.0' contour, lower trench = 88.0' on 93.0' contour. �GOt�� ,� ?1 Boring # A Bores id Pit Ground Surface elev. 95.41 ft. Depth to limiting facts —. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/(P *Eff#1 *Eff#2 1 0 -15 1Oyr3/2 none fst 2fsbk ds as 2fmc 0.5 0.9 2 15 -35 1Oyr3 /3 none Ifs 1msbk ds cs 2f,lmc 0.4 0.6 3 35-63 1Oyr5/4 none s 0 sg dl cs If 0.7 1.2 4 63 -106 1Oyr6 /4 none s Osg dl - - 0.7 1.2 M jg Boring # Lj Boring Pit Ground Surface elev. 95.65 ft. Depth to limiting factor — 108" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF *Eff#1 *Eff#2 1 0 -23 1Oyr3/2 none fsl 2fsbk ds as 2fmc 0.5 0.9 2 23 -48 1Oyr3/3 none fsl 1msbk ds cs 20mc 0.4 0.6 3 48 -59 1Oyr5/4 none Ifs lmsbk ds cs 1f 0.4 0.6 4 59 -108 1Oyr6/4 none s Osg dl - - 0.7 1.2 * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS > < 150 mg/L #2 = BOD < 30 mg/L and TSS < X mg/L CST Name (Please Print) Sign ure: CST Number James K. Th 7r -- 3602 Address A.C.E. Sal & Site Evaluations D e Evaluation Conducted Telephone Number 340 Paulson Lake Lane. Osceda, WI 540 9/15/01 715 - 248 -7767 property owner Midwest Const. & Development p 1D # 020 - 1083 -000, ID# Page 2 of 3 Q Boring # Boring -- Pit Ground Surface elev. 9 1.82 ft. Depth to limiting factor > 97" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots SPD/$2_ - *Eff#1 *Eff#2 1 0 -15 1Oyr3 /2 none gr. fsl 2fsbk ds as 2f 0.5 0.9 2 15 -28 1 Oy►3 /3 none Ifs & gr. 2msbk dl cs 72f,1mc 0.5 0.9 3 28 -55 1Oyr5/4 non s 0 sg dl cs If 0.7 1.2 4 55 -97 / 1O /4 none s Osg dl - - 0.7 1.2 Horizon #2 contains approximately 40% gravel ,cobbles & stones. 4] Boring # Lj Boring id Pit Ground Surface elev. 89.55 ft. Depth to limiting factor >96" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD *Eff#1 *Eff#2 1 0 -18 1 Oy /2 none gr. fsl 2 ds as 2f 0.5 0.9 2 18 1Oyr3/3 none Ifs &gr. Imsbk ds cs 2f,1mc 0.4 0.6 3 42-64 1Oyr5 /6 none s 0 sg dl cs If 0.7 1.2 4 64 -96 1Oyr6 /6 n one s Osg dl - - 0.7 1.2 Horizon #2 contains approximately 20% gravel ,cobbles & stones. F- 5 Boring # Boring Pit Ground Surface elev. 88.44 ft. Depth to Limiting factor >98" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots SG.P_DL$=_ -- *Eff#1 *Eff#2 1 0 - 14 1Oyr3/2 none fsl 2fsbk ds as 2fmc 0.5 0.9 2 14 -31 1Oyr3 /3 none Ifs &gr. 1msbk ds cs 2f,lmc 0.4 0.6 3 31 -55 1Oyr5/6 none s 0 sg dl cs if 0.7 1.2 4 55 -98 1Oyr6 /6 none s Osg dl - - 0.7 1.2 Horizon #2 contains approximately 20 gravel & cobbles. * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD S 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 - 2644777. 8en&i 1►'tsi 1Ia;/io (D,c( - A - n e . A ssit r p.d 82 ■ T O ■ � rrt Area, 59 1 "' /y ■ :5 I Obr)(Zrvc - ) � HE t I � i L- .Z , ) la � a Lc�lc /,&n cicoc Se oz. 1_9 T, oFA�,dsol LAD,. �- ■ .e m AreR 93. o' yi o' r" �� G den na 97 4 . voFS ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP Owner/Buyer FORM Mailing Address / e !> Property Address rLCl✓ WA beyv (Verification required from Planning Department for new I ---" G��D /a JD City/Stato ��a Parcel Identification Number P T° J fl U LEGAL DESCRIPTION P roper t y Location ` /., SO ' /•. Sec. 2L T - RW, Town of Subdivision Lot # . Certified Survey Map # r ' - P Volume . ,Page # IL)o0 s 7 / Warranty Deed # _ r � i . Volume Page # Spec house ❑ ycs�t no Lot lines identifiableo yes ❑ no ly, 6TEM MAINTENANCE Improper use and maintenanecof your septic system could result in its premature failure to beadle wastes. Proper maint0mce consists of pumping out the septic teak every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic teak as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a Ocrtificstion form, a' pod by the owner and by a masterplumber, journeymanplumber, restricted plumber or a liceWd pumper verifying that (1) the on -aitc waatowaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tack is less than 1/3 full of sludge. I/we, the undersigned have toad the above requirement; and agree to maintain the private sewage disposal system with the standards sct forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Cerdfrcatiou stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 da year ejTpition date. _ J` ld ?� SIG! OF AffLICANt DATE QWNTR CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) tbn owners) Of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE so "" ermit being revoked by the Zonis Department. •"•' "' Any information that is mis- represented may result in the sanitary p $ $ ep •o 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 pe"),ey,t) A� God � Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Desiqn Specifications Sanitary Permit Number Septic Tank Component Number of Bedrooms Design Flow - Peak (gpd) Design Flow - Peak (gpd) b� Estimated Flow - Average (gpd) '19 ? C Septic Tank Capacity (gal) Maximum BOD (mg /L) Soil Absorption Component Size (ft 220 Type of Wastewater Domestic 150 Table 2: Soil Absorption Component - Limits of Reliable Operation Table 3: Maintenance Schedule Septic Tank Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) -� D Inspect once every 3 years Maximum Influent Particle Size (in) '19 ? C 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once a ery 3 years Outlet Filter Inspect once a year and clean a east once every 3 years Soil Absorption Component Inspect once every 3 years '19 ? C Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the I Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep - rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. S ��f co ry c2 �� 3 1� STATE B4 "; 1 , WI W r a - 1998 Document Number I WARRANTY - DEED This Deed, made between JoAnn E Neuharth and Betty M. Evjen, Grantor, and Midwest Construction and Development of Hudson, Inc., a Wisconsin Corporation, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (the "Property"): 654704 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 08-24 -2001 12:30 Ph WARRANTY DEED EXEpPT M CERT COPY FEE: COPY FEE: TRANSFER FEE: 1800.00 RECORDING FEE: 10.00 PAGES: i Recording Area NE 1/4 of SW 1/4 and the North 66 feet of South 495 feet of the NW 1/4 of SW 1/4, ALL in Section 29, Township 29 North, Range 19 West, St. Croix County, Wisconsin, EXCEPT the South 429 feet of West 203 feet of said NE 114 of SW 1/4 and EXCEPT part described in Vol. 461, Page 421, Doc. No. 300625 and EXCEPT part described in Vol. 477, Page 588, Doc. No. 307501. N e and Return Address dw t Construction and Development of H on, Inc. 17 Industrial Blvd 7 n. WI 54016 020.1083. 10.000 and 020 -1083- 50-000 Parcel Identification Number (PIN) This is not homestead property. (irk (is not) SUBJECT TO the rights of Ingress and egress for an access roadway as described in Vol. 461, Page 421, Doc. No. 300625 and in Vol. 477, Page 588, Doc. No. 307501. Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easement and restrictions of record. Dated this 23rd day of August 2001. Signature(s) AUTHENTICATION authenticated this _ day of 1 A TITLE: MEMBER STATE BAR OF :e (If not, authorized by §706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY William J Radosevich Attorney at Law 502 Second Street Hudson, WI 54016 (Signatures may be authenticated or acknowlWged. Both are not necessary.) JoAnn Neubarth rz{ — * Betty, .Evjen ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. St. Croix County ) Personally came before me this 23`d day of August , 2001 the above named JoAnn Neuharth and Betty M. Evjen to me known to be the person(s) who executed the foregoing instrumen nd edged the same. * WW Notary Public, State of Wisconsin My otnnD ton is pe anent. (If not, state a rati date: + Names of persons signing in any capacity must be typed or printed below their eignAre. 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