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Holding Dist. to well TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic F > , -�- �5 f Forgeffiain Length T ia 1� . Dosing Dist. to well Bldg. Sewer t*A Aeration SYSTEM TO St/Ht Inlet �w IWELL HoLdMg St/Ht Outlet Type Of System: C,. + v. � _s , > 120 � > I Zd PUMP /SIPHON INFORMATION M ufacturer BS Demand GPM Model ber ELEV. TDH Lift ri Zi Loss System Head TDH Ft Forgeffiain Length T ia 1� . CZ Dist. to well SOIL ABSORPTION SYSTEM 7``I_.I'1,a_��.��f -trrwA EVATION DATA County: St. Croix Sanitary Permit No: 405185 0 State Plan ID No: Parcel Tax No: 020 - 1083 -50 -000 STATION BS HI FS ELEV. Benchmark W 1 1 -o 1°'' Liquid Depth qz -qo Alt. BM - 3.�Sr CZ Bldg. Sewer t*A 4 SYSTEM TO St/Ht Inlet �w IWELL LEACHING CHAMBER OR UNIT St/Ht Outlet Type Of System: C,. + v. � _s , > 120 � > I Zd Dt Inlet Model Number: i1 1 Z Ot Bottom Header /Man. Dist. Pipe ►'�.o`I- ts• s� Bot. System 15.3'+ I` -Gn Fina Gra 83 .S BED/TRENCH Width Length No. Of Trenches Vent to Air Intake PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 r 3.�Sr CZ SETBACK INFORMATION SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING CHAMBER OR UNIT Manufacturer - 1 - - 5- = T Type Of System: C,. + v. � _s , > 120 � > I Zd Model Number: i1 1 Z DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake a `j Pipe(s) Topsoil i� Yes ] No 7 (Zb Length Dia Length Dia Spacing SOIL COVER v Praeeura Svetems Oniv rx Mnund Or At -Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed[Trench Center Bed/Trench Edges Topsoil i� Yes ] No — Yes I, j No COMMENTS: (Inc d discrepen ies,� person res nt, et .) f al Inspection � #►11: / / Inspection #2: 6VT Location: r9v`(n dsbn, W 54016 /4�5W 1/4 29 T2�) Walden ooW ds Lof 1� Parcel No: 29.29.19.335A Location: S 1.) Alt BM Description = 2.) Bldg sewer length = p - amount of cover = >.f a 3)Eet� t : :ws Plan revision Required? Y No _ Use other side for addition a ormation. _ - n - In Date sepctor's Signature Cert. No. SBD -6710 (R.3/97) I ^� ty and Buil dings Division ashittgtoa Ave., P.O. Box 7162 County � ZW."W :1 :201 ? D e �I Zsin � � Y s��a, - 7�3� site Aar � f Commerce S ani Parnit r, Sanitary Permit App L- / �') In amord with Cott 8321. Wis. Adm. Code° persoml i you provide ❑ Check if Revision ma F be used for & Law. 915,04(t m InfWmatlon - Please Print AD Information State 1 hrr I. Application Name Paroa Number Property Owner's RECE�V w ��s o� Address 2 4 2002 I G1�70 '/0 Ysr s D jNumber property Owner's Malting MAY 4i •S T�Q N. Code �� Pbo -*lN t Number Block Number City. Stan ZONING FFIGE Subdivision Name CSM fladsa , v U. Type of Building (check all that apply) W1 or 2 Family Dwelling - Number of Bedrooms -- []Village 0 PubUdCommer W - Describe Use o -AJ Nearest Road 0 State Owned III. Type of I'ermtt.. (Check only' one box on fine A (number tS scheme for internal use). Complete Wae B if applicable) A. 1 o New 2 11 RCPI MM System 3 C1 Replacamant of 6 02 Addition to For County use sow Tank Ohti Exis stem Permit Number Date Issued B. 0 Cheep if Sanitary Pernik previously lssuad IV. Type of Pumgb (Check all that apply)(numberh4 scheme is for internal ,' �f 50 ❑ Constructed Wetland 44 %Non - Pm=ired 10-Ground 210 Mound 47 ❑ Sand Filter 22 11 Pressurized In- Ground 410 Holding Tank 48 0 Single Pass 510 Drip Line e � 45 ❑ At -Grade 46 0 Aerobic tmeat Unit 44 0 Recitcula ' 30 ❑Other �` 3 ' V. �, Aran Information: Area e �+ Dispersal Soil Application Percolation Rate System Ele uioa Elevation Required rat 33*h R(Gak./DayslSq.Ft.) . Ilnch) 9G ^ O � / � PmP O 7 7 g L �� T ank Iaito Total Number Manufacturer Prefa b Site Steal COMMIS constructed Fiber Glass *Capac Gallons of Tunics 'h Sq or xo c Tank 1.2 , ° e Y VII. It W Statemeut- L she undec�d, am= res for n of the FOWTB shown on the attached Number Busituesa Phone Number Plumber's Name (Print) r u nmr'a Signature MP GJ! !!i'd `k SChu ovi'd ` plumber's Address (Streat. City. State. zip Code) ® J�V I AA rU1. !LV went use 01d Sanitary Permit Fee ('includes Groundwate ISM' Agent Signs wra (NLftamp-s). Approved ❑ Disapproved Surcharge Fee) ` 0 Owner Given Initial Adverse 2ZS Datetnrinatioa Ix. q of App ty� i asaussURe�al � for Din 21� ` � Cie (w-� AMM COWOM Y� tso the COOMY nab) for the ayrtem on not less Slll :11 lathes in me SBD -6398 (R. 05 /01) � l�J.a.�` .� � � S�✓y 5.�9 T a 9F'/ L:e7 /� !�/��clP.�lCrJaed.r dr..l f 1 TC/-Gpb.V— /4�d g'�r ale J � v 6j 2,3 �410 � fog 12 ff'4 '% 7 ` 6 w. •rA cab,c �Id -& w� <<,�� AJ�s <oe.r/ ,r/E/ S�✓ y s.�2 q Ta 9191f . e 7 fa A,4� „Sc eL / -C- / `, = ,YU ' d v 12 S-DS�P� , 'G w. - -rA AM li M � I M �a r r /0 _g -o f 1476 Wisconsin Department of Commerce SOIL EVALUATION REPORT p 1 of 4 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. C roix include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D. percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. 020 - 1083- 30 -000, ID #29.29.19.3340 Please print all information. B Date y Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). f 2 Property Owner Property Location Midwest Const. & Development Of Hudson„ IN Govt. Lot NE 1/4 SW 1/4 S 29 T 2 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# P.O. Box 932 12 Plat Of Walden Woods City State Zip Code Phone Number Village eiM Town Nearest Road Hudson WI 54016 715 - 760 - �- n I Glenna Drive JIM New Construction Use: 01 Residential / Number C design flow rate 600 GPD � j Replacement _ I Public or - 6scribe: Parent material Glacial outwash c> ? _ Flood plain e�vation, if applicable na General comments and recommendations: Install 2 trenches using 29 high city infilt four feet below grade at elev. = 90.0'& 89.0' on 94.0'& 93.0' contours. Boring Boring # N1 Pit Ground Surface elev. 94.47 1 ' h to limitinq factor >9211 in. Sal Application Rate ck Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF *Eff#1 *Eff#2 1 0 -10 1Oyr3/2 none sl 2fsbk ds cs 2fmc 0.5 0.9 2 10 -28 1Oyr4/3 none sil 2msbk ds aw 2f,1mc 0.5 0.8 3 28 -39 7.5yr4/6 none gr Is 0 sg dl aw 1fm 0.7 1.2 4 39 -56 1Oyr5/4 none grs Osg dl gs 1 f 0.7 1.2 5 56 -92 1 Oyr6 /4 none grs Osg dl - - 0.7 1.2 0• Horizons #3 & 4 contain approximately 20% gravel & cobbles, #.5 contains 10 °� gravel. F 16 Boring # j Boring Pit Ground Surface elev. 93.80 ft. Depth to limiting factor >93" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD #1 /ft' *Eff#2 1 0-4 1Oyr3/2 none sl 2fs mvfr as 2f 70 0.9 2 4 - 12 1Oyr3/3 none sl 2 mvfr cs 1f 5 0.9 3 0 1 Oyr6 /4 none grs 0 sg ml cs - 0.7 1.2 4 F30493 1Oyr5 /4 none s Osg ml - - 0.7 1.2 o•� approximately 20% cobbles. * Effluent #1 = BOD ? 30 < 220 mg/L and TSS > < 150 mg/L = BOD i mg/L and TSS <30 mg/L CST Name (Please Print) Signal : CST Number James K. T hompson . y . � - � - 3602 Address A.C.E. Sal & Site Evaluations Date "valuation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 5402 9/15/01 715 - 248 -7767 Property owner Midwest Const. & Development Parcel ID # 020 - 1083 -30 -000, ID# Page 2 of 4 F31 Boring # :,j Boring 89.48 h to t Pit Ground Surface elev. ft. Depth limiting factor >91" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft= _ *Eff#1 *Eff#2 1 0-8 1Oyr3/2 none sl 2fsbk ds cs 2fmc 0.5 0.9 2 8 -25 1Oyr4/3 none sil 2msbk ds aw 2f,1mc 0.5 0.8 3 25 -33 7.5yr4/6 none gr Is 0 sg dl aw 1fm 0.7 1.2 4 5 33-44 44 -91 1O 1 Oyr6 /4 none none grs grs Osg Osg dl dl gs - 1 f = 0. 7 0.7 1.2 1.2 5 46 -88 1 Oyr5 /4 none grs Os d l - - 0.7 1.2 Horizons #3 & 4 contain approximately 30% gravel & cobbles. 41 Boring # Boring Pit Ground Surface elev. - ft. Depth to limiting factor >$g in. Soil Application Rate Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots 2 *Eff#1 *Eff#2 1 0 -8 1Oy non sl 2fsbk ds Cs 2fmc 0.5 0.9 2 8 -24 1Oyr4/4 none sil 2msbk ds aw 2f,lmc 0.5 0.8 3 24 -31 5yr4 /6 none gr Is 0 sg dl aw lfm 0.7 1.2 4 31-46 7.5yr4/6 none g rs Osg dl gs 1fm 0.7 1.2 5 46 -88 1 Oyr5 /4 none grs Os d l - - 0.7 1.2 Horizons #3 & 4 contain approximately 30 9 /b gravel & cobbles, #5 contains 20% gravel. Horizons #3 & 4 contain approximately 30% gravel & cobbles, #5 contains 10% gravel. 5 Boring # Boring 1 Pit Ground Surface elev. 88 .1 5 ft. Depth to limiting factor >85" in. Soil Application Rate Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 1 0 -14 1Oyr3/2 no sl 2fsbk ds cs Vine 0.5 0.9 2 14-42 1Oyr4/4 none sil 2msbk ds aw 2f,1mc 0.5 0.8 3 42 -50 7.5yr4/6 none gr Is 0 sg dl aw lfm 0.7 1.2 4 50-69 1Oyr5/4 none grs Osg dl gs 1 0.7 1.2 5 69 -85 1 Oyr6 /4 none grs Osg dl - - 0.7 1.2 Horizons #3 & 4 contain approximately 30 9 /b gravel & cobbles, #5 contains 20% gravel. * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD -i.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. r t 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 Des i n Specifications Sanitary Permit Number 7 Number of Bedrooms Design Flow - Peak ( pd) Design Flow - Peak ( pd) 9 Estimated Flow - Average ( pd) tso Septic Tank Capacity (gal) 290 r Soil Abso Lion Component Size (ft) 220 Type of Wastewater Domestic 150 Tahla 2- Sail Abserntinn Comnonent - Limits of Reliable Operation Table 3: Maintenance Schedule Septic Tank Outlet Filter Soil Absorption Component Septic Tank Component Soil Abso tion Component Design Flow - Peak ( pd) ( 9 Maximum Influent Particle Size (in) 1 $ Maximum BOD (m /L) 220 Maximum TSS (m /L) 150 Table 3: Maintenance Schedule Septic Tank Outlet Filter Soil Absorption Component Inspect and /or service once every 3 years Inspect once a year and clean at least once every 3 years Inspect once every 3 years 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 se tic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet fiite shall be cleaned as necessary to ensure pro2er d ra io n. 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 Manage Plan for a Septic Tank and Soi! Aosorption Component filter Is equipped with an alarm, the filter shall be serviced if the alarm is activated contlnucusly. Intermittent filter alarms may Indicate surge flows or umending c sludge ala t � tank septic tank shalt have its contents removed when the exceeds 113 the liquid volume of the tank. If the contents of the tank ar of when the removed next service time of an assessment, maintenance personnel stall advise the owns needy to be performed to maintain less then maximum scum and sludge accumulation In the tank. Manhole Myers, access risers and covers should be inspected for water tightness and soundness. A,coess openings used for service and assessment shall be sealed wStGttght upon the completion of service. Any opening deemed unsound, defective, or subject to fslturs must be replaced. ,Exposed access openings greater 84nahas in diameter shall by an effective locking device to prevent acciden No on+s should enter a septic or other tna&wt or holding tank fW any reason without befny i full compliance with OSHA stondw for r nq a owflned grace. Tito atmosphere within th• aepd trwttn»nt of Wdiny took nmy awtitin lethal gas" and rucue of a penton from the interior of the teak may be dINIO t or impoasibie. Tank abandonment shalt be in accordance with Comm 83.33, Ws. Adm. Code when the tank Is no longer used as a PQWTS 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 cocupents and the installation o component conserving plumbing fixtures are key factors in extending the use life of 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 o f surface seepage or discharge from the oomponont. On steeply sloping sites, areas of erosion should be Identified and reported to the owner for repair. The surface discharge of dorraestic 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 ntthe coi and dispersal ee11, Which may lead to more intense, and earlier, organic clogg 2 Y Management Plan for a Septic Tank and $oil Absorption Component Plantings of deep - rooted trees and shrubs directly over of within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. Contingency Plan In the event of system failure, a new system could be Installed in an alternate area. With the Installation of a diverter valve, the existing system could also be reused after a period of three to four years. It Is the property owners responsibility to maintain the aitemate area free from any planting of trees, shrubs, etc. in case of failure of the original system, the alternate area will be needed. If any trees, shrubs, etc. have been planted on ft alternate area, they will have to be removed at property owners expense. If sitemate area is destroyed, there are other alternative systems that can be used, in which, could result in *Wed expanse to the property owner, Any tank abandonment shall be done in accordance with Wise. Code 83.33, Any questions regarding this code, please contact your local Zoning Office or contact the Installing plumber. Zz, t % ; m % V> SAS %c e.. (-' t S) 3 g ; — q n, ?� u, e,r,10 � rj �� . . Mailing Address Property Address ST CROIX COUNTY SEPTIC 'TANK MAINTENANCE AGREEMENT . AND OWNERSHIP CERTIFICATION FORM /1 P City /State Parcel Identification Number LE GAL DESCRIPTION Property Location ;VC '/,, 'A, Sec. 2 `( , T al N -RIfW, Town of Subdivision _o /_ a A T t , Lot # - ra Certified Survey Map # , Volume ,Page # Warranty Deed # �� T t w , Volume f O tto , Page # 11 Spec house 0 yes 9 no Lot lines identifiable I[ yes O no • SYSTEM MAINTENANCE Improper use and maintenanccof your septic system could result in its premature failure to handle wastes. Proper maintenanc consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the systen 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposa I systerr 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 standard, set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certificatior stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are tntc to the best of my (our) knowledge.. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office, 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 (lie certified survey map if reference is made in the warranty deed (Verification required from Planning Department for new construction) � i1 1910P 1 0 STATE BAR OF WISCONSIN FORM 2 - 1999 Document Number I WARRANTY DEED This Deed, made between Renton, In c., a Wisconsin Corporation Grantor, and Dewain L. Wasson and Lisa M. Wasson, husband-and— wife Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Cot 12, at of Walden Woods i n the Town of Hudson, St. Croix County, Renton �/�'t ---- -- me 020 - 1083 - 10,020 - 1083 -50 Parcel Identification Number (PIN) This is not homestead property. CK) (is not) Exceptions to warranties: Easements, restrictions and rights - of - way of record, if any. Dated this ,/'Z day of June * * AUTHENTICATION Signature(s) authenticated this day of TITLE: MEMBER STATE I (If not, authorized by § 706.06, 2002 N THIS INSTRUMENT WAS DRATTED BY Attorney Kristina Ogland Hudson, WI 54016 (Signatures may be authenticated or acknowledged. Both are not necessary.) 681716 KATHLEEN H. VALSH REGISTER OF DEEDS ST. CROIX Co., MI RECEIVED FOR RECORD 06 -14 -2002 11:30 AN mo EXE ## Recording Area REC FEE: 11.00 TRANS FEE: 378.00 COPY FEE: CERT COPY FEE: PAGES: 1 Name and Return Address ACKNOWLEDGMENT STATE OF WISCONSIN ) County ) Personally came before me this _Z4- 4day of June , 2002 the above named Renton, I ., a W' consin Corporation by it's to me kno to bet on(s) who executed the foregoing instru d e ed h� same. * Notary Public, State of Wisconsin My ' s�n i perman_ er3t. (If not, state expiration da ,) Names of persons signing in any capacity must be typed or printed below their signaWfe. information Professionals c ompan y, Fond d, Lac, wa STATE BAR OF WISCONSIN eoo$ss-2o21 WARRANTY DEED FORM No. 2 - 1999 m. m T3 iZ +ORES Yri Z I . SO. FT.) o Z . $ LINE. v I • SM32UWW 222.62' ........ I i 0.65' °D DRIVE-' 0.41' I ...... ...... � ' I I 1 I & � LOT 12 OR i Q:l 2.633 ACRES 33' 33' I (114,713 SO. FT.) ® WELL SEPTIC . VENTS ' NA O 66 302.86' - - - -- --------- - - - - -- )� BENCH MARK: TOP OF I 33 33, I 1 -1 /4' IRON REROD, ELEVATION 850.16 / 1 �i ------ - - - - -- ' - -- / N i�li y 161 �i1 lol I�IC! I I I > I I 1 Ivl I4i� 101 Z I p 1 A m d04 0 SCALE IN FE 1 00 0 \ �oc�JoUUUo\ V OL�o c�J9 IY�o U � � 104 2 \\ SHEE