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HomeMy WebLinkAbout020-1353-11-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Bukding Division INSPECTION REPORT Sanitary Permit No: 395147 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)]. Permit Holder's Name: City Village X Township Parcel Tax No: Fall, Steve Hudson Township 020- 1353 -11 -000 CST BM Elev: Insp. BM Elev: BM Description: / U /ov kar / /14 /a" • TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark / ti Pi. S /Z-(a Z .51 / 2 "� l U.0 Dosing Alt. BM -- -----____ / . y /% 1/ Aeration __--- Bldg. Sewer z. 65- 9q,,Ft Hold g '8 Ht Inlet 90 /7. 4f St/ t Outlet TANK SETBACK INFORMATION S// 97, /(J TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic , 32 ' /�' . Bottom >2 — Dosing Header /Man. _ ‘,/Z- 4. Aeration Dist. Pipe L i 3 9 Te Holdi Bot. System L / q1/3 _ __ R 9. vs 93 - riG Final Grade PUMP /SIPHON INFORMATION 9 P? '77, j g Mar► er Demand St Cover r` ._.. GPM k Model Number _ TDH (Lift 'ction Loss 'System = • 'TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM /- el,, — .A,.,.. 6� BED/TRENCH Width Length No. Of Trenches I PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 / fi. --75- I Z I SETBACK SYSTEM TO 77 P/L BLDG WELL LAKE /STREAM L NG Manuf ctur INFORMATION FP R .,ice Type Of System: 4- r Ss l S� • l I T Mo el Number: A) �iilww, ;...,21;r DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake I r , pipes) i IS- / Length g S Dia / Length 93. -.f Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes M No [] Yes [_] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /Z / 7.- / 0/ Inspection #2: / / Location: 642 Hillary Farm Road Hudson, WI 54016 (SW 1/4 NW 1/4 36 T29N R19W) Cottonwood Ri Parcel No: 36.29.19.2011 1.) Alt BM Description = M-- 6' k / ..(& 5,4 2.) Bldg sewer length = ; y'} - amount of cover = > Zr (,4.4( a,., also , 4S 3. 0LservA p4.05 I#1.s / ik ge Y c1. .6e.- 4 " , 4P4 Pan revision Required? Yes [ No 1 Use other side for additional information. L L 3 I Z.. & S 7�" / 67 Date Insepctor's Si nature Cert o. SBD -6710 (R.3/97) '4, 1- - 641? 2/ 0 �,... #0-� 1 (2J F tl( R.Q, Safety & Buildings Division 201 W. Washington Ave. Sanitary Permit Application PO Box 7302 ` sconsin In accord with Comm 83.21, Wis. Adm. Code Madison, WI 53707 -7302 Department of Commerce Personal information you provide may be used for secondary purposes (Submit completed form to county if not [Privacy Law, s. 15.04(I)(m)] state owned.) Attach complete plans (to the county copy only) for the system, on paper not Tess than 8 -1/2 x 11 inches in size. County State Sanity Pe t N umber 0 Check if revision to previous application State Plan I. D. Number t5+ CPOIX 31 5 - 1 1- I. Application Information - Please Print all Information Location: Property Owner Name Property Location 7 9 tie rai/ i / fl sllj 1/4 I/4, S A Toi;9,N, 12. (or Property Owner's Mailin Address / ! • �/�- Lot Number Block Number 1 eir/ifaAriffiriro Iri7 1/ City, State Zip Code 1 u Subdivision Name or CSM Number ' II Type of Building: (check one) , t RL�,E tV � �� 0 City q 1 or 2 Family Dwelling - No. of Bedrooms: '7` `/ , ti D village O Public/Commercial (describe use): _ fit Town of 0 State -owned -, IILL2 ?0 01 - Mago4 III Type of Permit: (Check only one box on line A. Check '4..17 line B ' LLab1e) - N est Road ' �8 ! u /- A) I. 'New System 12. ❑ Replacement 13. ❑ Rep :cement of� O 'trAdditio ` o Parcel Tax Number(s) J ti Tank On Existin: stem ryy B) Permit Nu ef'� � Date Issued ❑ A Sanitary Permit was previously issued ' .3, ' ..-''' 0?6 13 513 - 11 - 01) 34.29, /g. ao!( IV. Type of POWT System: (Check all that apply) - 1 e4aC A- - /oa E Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland • Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade r ► ❑Aerobic Treatment Unit 0 Recirculating ❑Other: x ct3. V Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal,Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed i`t Rate (Gals. /day /sq. ft.) (Min. /inch) Elevation C0 0 0 S00 50 O 9 (va� 9 5 VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks A5 o ❑ ❑ ❑ ❑ VII Responsibility Statement 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na i. (print) Plumber's Si : tu!'0(, a' ' ) :' MP/MPRS No. Business Phone Number • 11 tt . c .w1/ , 0?07o2_ 9O 7/5-386 - ?elezo Plumber's Address (Street, City, State, Zip Cod ) — 0 - e • . - ♦lam VIII County/Depa tment Use Only 0 Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuin gent Signature (No stamps) X Approved ❑ Owner Given Initial Adverse Sure rge Fee) .. Determination V y � 2 2S I/ A.'` • IX. Conditions of Approval /Reasons for Disapproval: L �� �- -er is C /1.(cuwitzt\iek Al. p,2 ,rte c 9 w M (91.4.S . k - i r " • • • .. „ . K ti • , 6/ hot. . Pl p and _5 / cl e ub ncle.r.5 _ mjEc—i 2/ um._ .............__________ AM / E SY .ro J l ,---- . 4..M1-.. JI M__ . . ___Lo_e_AliDn_edsciiixaked_44e_. ..d.ense...4t:._. ,A..QA Yo LI 'PC - Or - • • A • - • • • . .. . .. V ‘C <5 el Nc. toN 5, 51 0.• ( 2) . 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E a ... •• . al cp > _J (Ti 8 ( IL'' ; - . - . ---- i' -- ----- - . 7. 7 1 CD ''''' .0 • c 0 IL (I) 0 0 4'' X — c - 0 0) .0 wasswe ,.. ..0 t z >, a c • 2) a z CO 0 E 14 • -,.(e -------ol \i„,„..4 , ,..„ . - = 0) a.9) ED_ m , E .o. .0) -0 DU_Otiii N 0 6 4, il 4„ 2 0 0 a_ • • • • K 6/ tin _ / r /p and � .� � to -- . ,. _ � tic-Jars rs _ t" mje.e_i- /V 1 M/1 F Ste _E 1 ____ _ 4..1. —"... _ _.Tin__ . L70ana , der .—.L- e fan e_ nr.� __ �� die_ - �.d.ense._ . _ 4.21.11 ..OY — -- - --- .... . I1 I ? f �c, on. ti° p ! S. Q I $' r r,. D .N. Pal 1 13 u 1\ � / � � -a � � Ali 6���, mp& ` -5 f ` No'd 'IN 3 Ste Y-1,- 1 ,r on )1-21.Q foo' tv. � 7- s b '• 35 35 ' ��11 Npll 'IN id' c) ( .2S' y '`' ,f,kk' i i 1 J - 11.- , 0 t.Rr<• —• • ( - -,--m 1 r c r J'- ! i mil ( v • -- •' ., r 1 1 I Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page I of 3 Bureau'of Integrated Services in accordance with s. ILHR 88:Q9, Wis. Adm. Code ''''./.. County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Af'let ` Cl include,but not limited to: vertical and horizontal reference ppi'nt(BM),dire tiop;r pr�,n \,.-- , )1- C COI 1( percent slope,scale or dimensions,north arrow,and location and dist nce to neares`tt{{..6bad. f arcel I.D.# APPLICANT INFORMATION - Please print all informatio► T CROgy 99 ev ed bJSy Date /� Personal information you provide may be used for secondary purposes(Privacy LANA J i�(11)(m)). /a DD �,. c Property Owner ." Prope`7ty�•6eti C‹:i y�i' ,-, `:,/ 9Qvt;Lyt� 1/4 Ait,j1/4,S>6 T z9 ,N,R /et E(or)6 Property Owner's Mailing Address =-Eet-#"' Block# Sub�d. Name or CSM# I '5. i a -fiAu\\C-Au 1r . I ( l/ n \ (c ,1 ) ( )d 1),:l t`' City State Zip Code Phone Number City ❑ Village V- Town Nearest Road . ❑`\IIC )1^, I ) 1 (--1Litt I ( 11`S ), �-I�t-�, .3) nl lr1`-,0:1 Kalif uweea 4r. ' -Flew Construction Use: [Z�'Residential/Number of bedrooms 3 Li Addition to existing building ❑ Replacement ❑Public or commercial-Describe: Code derived daily flow_Le:,L (1 gpd Recommended design loading rate ,-7 bed,gpd/ft2 • 0 trench,gpd/ft2 Absorption area required_'. ) 7 bed,ft2 1J0 trench,ft2 Maximum design loading rate • 7 bed,gpd/ft2 i trench,gpd/ft2 Recommended infiltration surface elevation(s) UeP2r-3fr.34 t i.jer_$7.3O ft(as referred to site plan benchmark) Additional design/site considerations COINOv-' eJ.ea `1 ff 1 66 ',Vonc hn-I,'/+rci* n .Su or e. •, 60 I<-U. qs' 0 Parent material L T)kkc 1-cti .t 1-4 LK../k lG\ Flood plain elevation,if applicable .'t//4 ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ® S [i U ® S ® U © S ® U ® S IA U ❑ S © U ❑ S W U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. Bed Trench o--4 le,Y r 312 L> t al><: rYl l L t 7 4-1-. I.C. tr LI kr rnS C'`)(�) m i c _) — .1 - Ground elev. 9l.10 ft. Depth to limiting factor `:'S`1 in. ��s 1ti�� ' Remarks: Boring # I bs -7 tb p 2))2 ---- L_'S t 14-) Ci m I LS l C . - 8 2_ Z 7-3c) lc, ir411. L 5 1tyl (. m I C S k 1 . . rr `t lip m 5 U_I-i ►r) c — .- ' S Ground `I lct�-6�{ Ili-ir 31 � C1.p -0-yr �-116 LC�S cr,,, me.(; C`-) N� fv�a elev. ----�--- qft. . Depth to limiting factor L':C in. Remarks: CST Name (Please Print) Signature Telephone No. �dras�, .2h r C1/6-)2y7-yoor Address Date CST Number 40O3 Ceder- S. *`" Somerse+ t kit 5(402.S q-IS-99 2 33o 1 - t SOIL DESCRIPTION REPORT PROPERTY OWNER )1L)�J Page '- of '' PARCEL I.D.# Boring # H Depth Dominant Color Mottles Structure 2 g Texture Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench 1 6 - S 16 yr3) L3 , t v c y m1 c i;. 2 S -2 1 ID yr ` L S 1 rr\S ffx( Ground 2V-8`i k.) •r c- 1/0 a) 5 O.S3 i r, ( C — elev. q3.30 ft. L.1 Sq-92 / U si i . C Lt) 1.5 yr 9/40 L S � rn v' rn e -1 , c — f v„ p ; 1\4} Depth to limiting factor ag in. Remarks: Boring # _ (Y lb\s/( - L5 ti rnl c 5 (f 2 - (0 10'ir L eib L 1 11 . 1 5 9 1 n1( CS Ground 4 (E'S-91 IOvr 3 I (2P 7.5yr� L 3mv met; c5 elev. 9 ft. Depth to limiting factor Cos in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # �_ . 16 .1r. rn (3 1 • `1 ; ' Z (c I 10 yr `11(4 )r5 rjS r E C Ground elev. g4 Depth to limiting 'i° \o fa for B i n. Remarks: Boring # 1 (r I ley r ,51Z-- �S I <r-t S / `t . Z �y 16 m5 o iYt,i c S — I . Ground elev. g2ft. Depth to 4 ,4.k 40 .-k limiting factor C1`Lin. Remarks: SBD -8330 (R. 07/96) Vol c30 3 se /o-{- 1 cri-f- icn,_ ► co. , ��. I l o, ha; ,. l$' . L3v\( el�.V• 100.0 I _ ru;l;..lid "Oal. X Ova, 2 I•e V laces. J 111 , uPWr qtr CP Sys cle V. 48.3 R.3 f (bn e , e!-e✓. ? 4. / .67 ° 01w/to( s elev. gS760 .lk)1 -44-. 1.....l.... ,,p 6Q-low 66. 15 uer`( -- 7 , 1. 44 . — _ (21 1 . - s t )..., , 4-.0,4,5 • IN ♦ 61° 4° \\131 4 \ • Qy r,' ;cwl Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference .: 1 BM), direction and St. Croix percent slope, scale or dirnemsions, north arrow, . " a?d i to nearest road. Parcel I.D.# 020 - 1352 -02 -999 ID#36.29.19. APPLICANT INFORMATION - PI: �! ' all i' I • viewed B 1 B .te Personal information you provide may be used fo t s � ary pu b " e�rivacy LBO/ .o4 (1) (m)). • .. 1 A W . 2 20O • 1 Property Owner o` Of.. -rty Location Steve Fall 1Ga Lot SW 1/4 NW 1/4 S 36 T 29 N,R 19 W t_ Property Owner's Mailing Address y 11 J _ ? 1 L� I tot Block # Subd. Name or CSM# 313 11th Street South \ :,, ' c%�o -� 11 Cottonwood Ridge City City State Z�i �I ty Village ZTown Nearest Road Hudson WI 541, ; 7166' (. ^ Hudson 1 Cottonwood Trail X New Construction Use: X ResidefNa o' : " • • ms 4 1 lAddition to existing building L Replacement Public or commercial describe Code Derived daily flow 600 gpd Recommended design loading rate 0 bed, gpd/ft . trench, gpdlft Absorption area required bed, ft 857 trench, ft Maximum design loading rate 0 bed, gpd/ft .7 trench, gpolft Recommended infiltration surface elevation(s) 92.75'. ft (as referred to site plan benchmark) Additional design / site considerations Install trenches using high capacity infiltrators. Parent material Glacial outwash Flood plain elevation, if applicable na _ ft S= Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system S U ❑ S❑ U ® S❑ U O S❑ U ❑ S El U ❑ S ®U cJI SOIL DESCRIPTION REPORT K , Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots - -GPD �— Boring# Horizon in. Munsell C;u. Sz. Cont. Color Gr. Sz. Sh. Bed ; Trench 1 1 0 -3 10yr4/2 None sl lfsbk mvfr as 3f - ; 0.4 2 3 -12 10yr5/6 None s Osg ml as 2f,1m - 0.7 Ground 3 12 -23 10yr3/3 None sl lmsbk mvfr cs 2f,1mc - 0.4 elev 97.53ft 4 23 -36 7.5yr3/4 None Is lmsbk mvfr cs l fm,2c - I 0.7 Depth to 5 36 -84 7.5yr4/6 None s Osg ml gs lfm - 1 0.7 limiting _ - - 0.7 factor 6 84 -105 10yr6/4 None s Osg ml >105" , ' , Remarks: _.__ SI. Ye/ R3.3b — __ - - -- __ - - -- — 2 1 0 -4 10yr3/2 None sl lfsbk mvfr as 3f - : 0.4 2 4 -16 10yr3/4 None Is Osg ml cs 2f,1m - 0.7 Ground 3 16 -26 10yr4/4 None is lmsbk mvfr cs 2fmc - 0.7 elev 97.50 ft 4 26 -33 10yr4/4 None s Osg ml aw 1 fmc - 0.7 Depth to 5 33 -43 7.5yr4/4 None gr sl lmsbk _ mfr cw lfm - 0.4 limiting factor 6 43 -75 7.5yr4/6 None s Osg ml gs if - 0.7 >108" 7 75 -108 10yr6/4 None s Osg ml - - - 0.7 Remarks: 9 3 i CST Name (Please Print) Signature: Telephone No. ��i ' 715- 248 -7767 James K. Thompson Address A.C.E. Soil & Site Evaluations Date CST Number Ref # 340 Paulson Lake Lane, Osceola, WI 54020 7/22/00 3602 1270 S is z` se-11 4 —, s ,2.e ( 44.4,4,,,„„h) PROPERTY OWNER: Steve Fall SOIL DESCRIPTION REPORT 1270 Page 2 of 3 - PARCEL I.D.# 020 - 1352 -02 -999 ID#36.29.19. A.C.E. Soil & Site Evaluations Depth Dominant Color Mottles Structure GPDIfP Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Consistence Boundary Roots Bed : Trench 3 1 0 -4 10yr4/2 None sl 1 fsbk mvfr as 3f - 0.4 2 4 -19 10yr3/4 None is lmsbk mvfr as 2f,lm - 0.7 Ground 7.5 r414 None is Os elev 3 19-32 y g ml cs 2f,lmc - 0.7 97.78 ft 4 32 -64 7.5yr4/6 r4/6 None s Osg ml cs lfm,2c - 0.7 - Depth to 5 64 -91 10yr5 /4 None s Osg ml gs lfm - 0.7 limiting factor >102" 6 91 -102 10yr6/4 None s Osg ml - - - ; 0.7 4.0. 96 .S1. Remarks: 4 1 0 -3 10yr4/2 None sl lfsbk mvfr as 3f - 0.4 2 3 -17 10yr3 /4 None is lmsbk mvfr as 2f,lm - 0.7 Ground elev 3 17 -28 7.5yr4/4 None s Osg ml cs 2f,lmc - 0.7 92.95 ft 4 28 -51 7.5yr4/6 None s Osg ml cs 1 fin,2c - 0.7 Depth to 5 51 -90 10yr5 /4 None s Osg ml gs lfin - 0.7 limiting factor >105" 6 90 -105 10yr6/4 None s Osg ml - - - 0.7 Remarks: 5 1 0 - 10yr4/2 None sl lfsbk mvfr as 3f - 0.4 2 4 -19 10yr3/4 None is lmsbk mvfr as 2f,lm - 0.7 Ground - elev 3 19 -40 7.5yr4/4 None s Osg ml cs 2f,lmc - 0.7 93.92ft 4 40 -72 7.5yr4/6 None s Osg ml cs lfin,2c - , 0.7 Depth to 5 72 -93 10yr5/6 None s Osg ml gs lfm - 0.7 limiting factor >100" 6 93 -100 10yr6 /4 None s Osg ml - - - 0.7 Remarks: _ Ground elev Depth to limiting factor Remarks: 3 o-F3 Cam'' • .547 o5s'a or. JJ w P -E • /0calt_.d SF.e� F" a l �ro i °• sh /ot ,,• N Q; d T o -e(son 232 BSI c SZ ' r er 0 4 i\ a PPr dy •Iota - b yr" of 8 - M I N re.Por d by A da ' "*+ \a �,�' : • B2 sc, �k +.� o�(c r' Sr //s/99. • Ate . 8. M. I ►'(a, crr-k /n 3 5-1 c hi E/e tk 97so. 40 ro+ /O " int 5sec Q2 Q od a 70 Z . • S 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 Design Specifications Sanitary Permit Number 3 / Number of Bedrooms Design Flow - Peak (gpd) 0 0 Estimated Flow - Average (gpd) 45:22i 0 Septic Tank Capacity (gal) 1 a (Q 0 Soil Absorption Component Size (ft') 50u Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) f �O () l- Maximum Influent Particle Size (in) 1/8 Maximum BO0 (mg /L) A L 220 Maximum TSS (mg /L) f S'L` 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component 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 septic t. nk and outlet filter shall be assessed at least once every 3 years by inspection. T - out et filte shall be cleaned as necessary to ensure proper operation. The filter cartridge s • I • 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 • _ 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. 2 • 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. When system fails, we will replace with another system P Y at owner's expense. Alternate area must be left undisturbed. St Croix County Zoning Office - y g e 386 4680 Boumeester & Sons Excavating 386 -9020 Tri- County Sanitation 386 -2130 3 • ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer -th Mailing Address Property Address' = (Verification required from Planning Department for new construction) City /State Ihr7i,co / JI' Parcel Identification Number QED- /3501- OA- 999 LEGAL DESCRIPTION Property Location Ski %, AJlJ 1 /4, Sec. , T aq N-R. /? W, Town of /uctsnA/ Subdivision . ��A/u.).0pr� Lot # /7 Certified Survey Map # , Volume , Page # • n .- Warranty Deed # 4/ 71493 Volume , Page # `7 `l • Spec house 0 yes El no Lot lines identifiable yes 0 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 time years or sooner, if needed by a licensed pumper. What you put into the system can affect the fimation of the septic tank as a treatment stage in the waste disposal system. The property master owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a plumber, jotuneYman plumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdispoeal systems is in proper operating condition and/or (2) + *portion and pumping (if necessary), the septic tank is lea than 1/3slhil of'd adge. Uwe, the undersigned have read the abov . r �!+ l j set the harem. as stet the d and agree to maintain the private sewage disposal standards Department w • and the Department of Natural Resources, State of Wledonif Certification stating that your app system has been maln4,hned must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. '. _ ,. 7 SIONA OF APPLICANT ��O att.) DATE OWNER CERTIFICATION r _ •,r +,• t.c I (we) certify that all statements ow, ! are true to the best of my (our) knowledge. I (we) am (are) the owner(e) of + the , � , .. , . � , ", above, by v e of a Y warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT • ! 12e) ri ',..'.: DATE Any information that is mis in the sanitary permit being revoked by the Zoning popaxtment, * ** *** Include with this appifcatlon: a ata „• mPed,�►�nt#tW► deed from die Register of Deeds office a copy of die certified survey map if reference is made in the warranty deed 07/10/2001 TUE 14:33 FAX Q001/001 STATE BAR Ott WISCONSIN CORM 2 - 1998 CI, I. 414113•0 WARRANTY DEED K A g THL B E E N O F w DEED S Document J 1474Pm, 594 ST. CROIX CO., WI RECEDED flit RCM This Deed. made boswarn _. .RjCH 432,d. -- L141 9:O M _.SET -12.,.-ST -- ---- 11RNeMr?Y DEED and -ragil.F.14. w..- -FALL. — —. —. c !' - FEEI FEE: 171.70 - . -__ — _ . _ ._ _ — . ES 10.00 FE _ Grantee, x s 3 Grantor, rot a valuable consideration, conveys and warrants to Crania, die following do:cribad real agate I att�C1 O X.. County. State of Wisconsin: Plat of Cottonwood Ridge, Town of . None anld Reoln Address St. Croix County, Wisconsin. : A rr�r,,,., P 1 59 -11 -Oren ion Number WIN) Thla- Ps nut homestead property. (11) Ps not) Exceptions w warranne*: easements, restrictions, rights -of -pay and covenants of record. • Dated this 30tti — day of • .4989--- —RicliatiL.0---ELcuit--_ (SEA!) aloof- P / _Skala_ __, EAU • .2.116.11.ta--Q-L-CiZA±.--_ . Ckiaart (BEAU ... !SEAL) • • AUTHENTICATION ACKNOWLEDGMENT Signature(*) ___ — State of Wisconsin. St. Croix _ County‘ , amrtentlea this day of -. - -- Personally tame afore me this 9 30th t named n t .. st• -Qt,— . — TcC1 G: MEMBER STATE BAR OF WISCONSIN Of not. JCIL me known to be the r - • t j ibeu� the fornpping th auorized by 5706.06. Wm. Si) ate. instrument and , . • : 4 • ; V f, cONSIN KERNON L 9A TIS ersinuMLNT WAS DRAFTED 5Y Janot F. Stout _ 9,353 Awaltukee Tr. -. _:.- _ . Rudman, 14i . 54016 N bt Stan or 1.1y a n la ( 0,1 not. atnte exptratton te. (Signet nni rnni ru ,ay inn auetet;Iatsd Or adKnowtsdged. Both ate tax "te d9 „ ) neermery.) • N.A. of oenont opal in any rap.ety must e. tyre re Minot rm. s1.er arm.. wawow*. tte.l stint co . V•p StA FO R RM M No. pp 2 - laid* Llnw Ae.. wa wttRRANYY DUD