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HomeMy WebLinkAbout020-1353-14-000 Wiscon in Department of Commerce 1 S'fety4 PRIVATE SEWAGE SYSTEM d Buildings Division County: INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 363991 Permit Holder's Name: City ❑ Village ❑ Town of: State Plan ID No.: Miller, Greg I El Townsh CST BM Elev.:- Insp. BM Elev.: BM Description: .. ( �j Parcel Tax No.: 1 VD, D (ao.D/ CS-r AAA. lH 020- 1353 -14 -000 TANK INFORMATION ELEVATION DATA 34 • Z.Q. CU z.oi4 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV- Septic WA I 7.-5 Benchmark 4f-343' lam' , r Dosing t� D Alt. BM 3 . e o ' , t 1cto• Aeration Bldg. Sewer 13• so' 9(• 24 Holding St /Ht Inlet (3.1S' i o .; z 1 TANK SETBACK INFORMATION St/ Ht Outlet I Li -3-o 90. 34' TANK TO P/L WELL BLDG. vent to ROAD Dt Inlet Air Intake 90 -34 Septic >5 ( / 2.-(• NA Dt Bottom 11_ 7-b S6. r Dosing , 5 --y ' \ 35 ' NA Header / Man. k4( °f [`f4 `�& 3' 100 -40' Aeration J NA Dist. Pi e `�' lea L$' �� p `f-•95 oo. Holding B.t. System 4,.o o � mison 5.72 qS.943' PUMP / SIPHON INFORMATION , r , ' inal Grade 0 �" Manufacturer .1.. Demand St cover ( ,6 4 • S t /I \ Model Number u .-- . H Lift -5.cs Friction 1 M m T rpyt ' Forcemain Length t n Dia. 2 Dist. To Well W'— SOIL ABSORPTION S YSTEM00 c,g,vs 4) Jam" - 0,0 + 7•3G) arsi) R Width, , Len _ Ng f Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIME J Length 3 • l DIMENSIONS Manuf rer: SETBACK SYSTEM TO P / L BLDG WELL LAKE / STREAM' LEACHING � J _, /_ S INFORMATION Type Of LEACHING Model Number: n _ System: l 5 f "coo , j & R UNIT { DISTRIBUTI ' SYSTEM Header / u Distribution Pipe(s) x Hole Size x Hole Spacing I Vent To Air Intake Length CL Dia. 4 -. • . ia. pacin. 1 40 r 4 SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over j xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) `^ /, sst. ivtsfse c ei.t . • Inspection #1: o`( /Zo /crDInspection #2: -1--1 L"ocation: 648 Hillary Farm Road, Hudson,`WI 54016 (SW 1/4 NE 1/4 36 T29N R19W) - 3629192014 Cottonwood Ridge - Lot 14 5 r � e �. o c 1.) Alt BM Description =1 eK. . a , n. � . , 4. _ 2.) Bldg sewer length = 3 `f' V 04,...a i� 4,a,,.- , 5 - amount f cover = > 4 2, E 6. ,,, � [�•xl s` C�I.�l A-0 S Pladrevisi�r0 ❑ eY l � Use Cher ide for ad itional information. O 1 Zo 00 A P.a..... As - S y ) g Date tns ctor' Signature Cp � p SB 7 1 0 R.3/9 r Z Date lu r.e 0 _ P� .A.0 Q Ge+X_S- l t« ADDITIONAL COMMENTS AND SKETCH 1- : ,' SANITARY PERMIT NUMBER: -- f - T - T - T - T - TT - T - T - 1 - r - i F" T rl " - I T armr—r- 1 111 -1 '---4-1------1-1--- -+-4-1-4 i-d, -4 -[-H- e _� �..__.i._ 4_ _ '- ____.__._ . __ _ _ 1 ..._ .4__ E ._ _____� s La E ms_ _ � I Viµ.. __�-_ [ 1 ion= ' miming ' • mom H i t .. J i imam _ : Ai -: now I , IN nom" 1 : m mum : ,,,_ , _L , imirsi mil iii mimmiii i - I . ! , 1 NE ism _4_ . isimis • L: :LH__ : I • mon _ : 1 ...._ • iiii mini 4 .. ',____Ai a s it 1_ : Impu . _: al Ile al ; 1 admiiiiii . Bo ,Norinman it, -.., : _ _ am il. _Hun mammons l : i ii - L - um au Ram isimommi gni : : .1 lir . _ El onariminu : , . :I.:. R..... .....,... ., . in '.. , 1 NM . Ill INN . MEMIIIMINNI plIMMINIMINM IMINIR 11 • i . : mmomonom Elm i.... ...................... ...,....................,„...... : .b. , : ••• ! : , � d 1, 3 f E ripi-pwirtin „a.m.. , .......... .._. , , : N . _f_i : ' .._H 11111111. , !wain : NM= kf '' • _i HT . fill • . :_ : : -(--- i --- i --- • • am Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. \sc,ns,n See reverse side for instructions for completing this application PO Box 7302 sonal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not state owned.) Attach complete plans (to the county copy only) fo to , er not less than 8 -1/2 x 11 inches in size. County State Sanitary Permit Number k �n to ,pre' us application State Plan I. D. Number S1 c-w Ix 363 99 / .,,�,, - ,..,, , > I. Application Information - Please Print all Informati n- y 111. ` , % Location: �. r ' frt Property Owner Nam --%-f1.44./ Property Location Name" / c/ � ' Property Owner's Mailing Address i _ `i �� 7 Lot Number /1 Block Number • -' G ' //G 1 � del `= -3 �' x � © / / � T = City, to Zip Code \, ?'(I pke rtr er Subdivision a or CSM Num � lei � AN ,`E Y x,17 ,'64 /6(-/.,"7 \ f City II. Type of Building: (check one) �� illage • 1 or 2 Family Dwelling - No. of Bedrooms : y44\fr o wn of ��� ❑ Pu blic/Commercial (describe use):_ �n,,/n� CI l9 State-Owned ) ' . Q3 ;Ts- ,/ ejxxS //mi Nearest R ' n 4 00Perc /Zee/ /1( //7 GC r ` �/`� Parcel Tax rpeer(s f 7 4 I III. Type of er ( Check only one ox on line Check box on line B if applicable) . & • 7 fig• o 0/ A) 1. ,New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System B) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) on- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑'Pressurized In -ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Revired Proposed Rate (Gals./day/sq. ft.) (Min /inch) Elevation VII. Tank Capacity in Total 4 o Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con - Con- glass New Existing crete structed Tanks Tanks 9 , 7 4 .- - �< /, 0 / ZeJG `� ❑ ❑ ❑ ❑ _ --> ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Business Phone Number Pl j es Name (print) Plum. - gnature (nos ): MP RS No glber's Address (Street, City, State, Zip Cod,' • / _ 'b .1 � — / 1 7e �t � IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) gQ Approved ❑ Owner Given Initial Adverse Icharge Fee) 6 �0 ?d90� 1 / c Determination oZQ�.S. _ 0 (V. iiW X. Conditions L tions of Appro_al /Reasons for Disapproval b DisaprS: /] 1 ` i `^' w.sp oii bn t�lt ti t k CtW L- . . 62f-P___ _.. soft -7- --7 Suv -2 ' _ 2 . (3- 3 c. ``"�Oets I. /p Z 11.1t( /Alvtjaawc n ir yam, PLOT PLAN f G PROJECT or 7 / //'�� /r ADDRESS �9 X a;( //?7<c /4 Wfydc it, 1/4 / e t) 1 /4S "6" /T 627 N/R W TOWN /-4I /O!� COUNTY IX GrU ,,,c. MPRS Byron Bird Jr. 220527 DATE7,1 10 y BEDROOM CONVENTIONAL XXX IN -GROU PRESSURE CONVENTIONAL LIFT / HOLDING TANK MOUND SEPTIC TANK SIZE 40v490 LIFT TANK SIZE -.=go DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE j, 7 ABSORPTION AREAS >y # of chambers .� ■ BENCHMARK V.R.P. ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.p, "QM `O10,0 .e' 0 el ,.. GOrff , C/' OJ% SYSTEM ELEVATION Cottonwood Lane //------- ara e g g 4 bed house driv way 20' . 20' 20' ins atedPi p 100' 50' B 1 10' n : 4 i ) ob / c so 93 5 39E' •A 50' r-I Pond 4' Rep. A 50' PL • ob 5' 0 ' r- B2 30' B5 wood Ln. r PAGE of PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS r�_.--- VENT CAP 1 y VENT PIPE I r" APPROVED LGC KING WEATNERPRooF JUNCTION BOX \ WAP 4 4ING ANItOL6 GDVER WI TH 2. ES FROM 000R. LABEL WLJDOW OR FRESK I2 "MIU. T AIR IWTAKE I GRADE --\ I — 7 J " MI ,k M N. . CONDUIT — / \*\\, I8 "MIN. V \ I. p 1 [ i==3 T I LE PROVIDE - - -- N • " 7. AIRTIGHT SEAL I I V II APPROVED JOINT A I! I I APPROVED JOINTS W /C.I. PIPE I I w /C.I. PIPE EXTENDING 3' II ALARM EXTENDING 3' ONTO SOLID SOIL II ONTO SOLID SOIL I ON C I ELEV. FT. PUMP -� - -�� OFF D i CONCRETE BLOCK 1 W 4. 3" ftPPftovE.t. PEDDc NG UI.NAER- TffNt. RISER EXIT PERMITTED OIJLJ IF TAIJK MANUFACTURER HAS SUCH APPROVAL STATE APPROKED SEPT1c - rank e° -)- `1c SEPTIC E / SPECIFIGATIOAIS 1111 DOSE 4 �� �i TANS MANUFACTURER: Q^ v r'� HUMBER OF DOSES: 1 PER DAy TANK SIZE : /��7;t- 2 --�-- 4-,94 GGAALLO S DOSE VOLUME ALARM MAAJUFACTURE.R: /cam — -�`r INCLUDING 6ACKFLOW: /a GALLONS MODEL NUMBER: CAPACITIES: A =� INCHES OR 4 GALLONS SWITCH TYPE: sr /4. /' 7 ' erG4 7 - g= F; / INCHES OR S GALLONS PUMP MANUFACTURER: /.,p. j /i� / c= /9 INCHES OR . GALLONS MODEL NUMBER: 5t-C) /5--- D= i l INCHES OR g GALLONS SWITCH TYPE: �/ 117 cL MOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE. ./a- "FEET + MINIMUM NETWORK SUPPLY PRESSURE / l FEET + �DQ FEET OF FORCE MAIN X 1 IAlF/OO rT.FRICTION FACTOR.. it/ FEET = TOTAL D►JAMIC HEAD = 13./6° FEET INTERNAL DIMEJJSIONL OF TANK: LE! 7 ;WIDTH 7 .;LIQUID DEPTH 1?4,0 SIGLJE L. ICEPJ S E NUMBER: m' S ° DATE: , %P 2 ' O ___#;g:r . . . ( ENGINEERING DETAILS - SW25/33 i i aduatiuill Performance Data 32 - Pump Characteristics Pump /Motor Unit Submersible --rr te �__ Manual Models SW25M1 SW33M1 2 a •■••■„„..`■ �........, Automatic Models SW25A1 SW33A1 g "•-4.„,„., 1�3 HP x Horsepower 1/4 1/3 2 18 ----, Full load Amps 8.0 10.0 - 1.444400.i. Motor Type Shaded Pole (4 pole) 0 J a R.P.M. 1550 0 8 Phase 0 1 Voltage 115 0 Hertz 60 0 10 20 30 40 50 60 CAPACITY -U.S. G.P.M. Operation Intermittent Temperature 120 °F Ambient Total Head (feet) 4 6 8 10 12 14 16 18 20 22 24 NEMA Design A 1/4 HP 44 41 36 33 29 26 23 18 12 6 0 Insulation Class A GPM 1/3 HP 47 45 43 40 37 34 30 26 22 16 101 Discharge Size 1 -1 /2" NPT Solids Handling 1/2 - Dimensional Data Unit Weight 30 lbs. 3 -1/2 5 -7/8 1. All dimensions in ■nrhe Power Cord 18/3, SJTW, 10' std. 4 -1/2 2. Component dimension (20' optional) vary ±l /8 inch / 1 - 1/2 NPT 3. Not for construction pruposr 3 -1/2 DISCHARGE unless certified Materials of Construction , 2 4. Dimensions and weights ore s'.', - approximate 5. On/Off level adjustable Handle Steel 3 -1/2 6. We reserve the right to Lubricating Oil Dielectric Oil 1 -- -0 make revisions to our \ products and their ■ Motor Housing Cast Iron \ specifitations without notice Pump Casing Cast Iron Shaft Steel Mechanical Seal Faces: Carbon /Ceramic , 1 Shaft Seal Seal Body: Anodized Steel Spring: Stainless Steel Bellows: Buna -N . PoNP 11 -1/8 Impeller Thermoplastic 70 1/8 9-1/2 Upper Bearing Bronze Sleeve Bearing i - DISCHARGE HEIGHT Lower Bearing Single Row Ball Bearing l —1 Strainer /Base Plastic I I I 11 I L' 3 PUMP 3-1/2 Fasteners Stainless Steel ) oFF ! r J AURORA /HYDROMATIC Pumps, Inc. 1840 Baney Road, Ashland, Ohio 44805 (419) 289 -3042 ,^„t,5 `3 L- - ✓( .7 ie S T d'°l L. (fit lY c) . 6""\- ,n/ A- er2f:- yVisconsi: Department of Commerce SOIL AND SITE EVALUATION �� ‘----i7_ Divisioh of Safety and Buildings Page of Bureau of Integrated Services in accordance al Comrh 83 -Wis. Adm. Code / - .bounty Attach complete site plan on paper not less than 8 1/2 x 11 inch 0:402e. PI fnus include, but not limited to: vertical and horizontal reference poir�sM), directi& acid • ' ` - Sit �, /,K percent slope, scale or dimensions, north arrow, and location afrddistance to nearest road. parcel I.D. # , APPLICANT INFORMATION - Please print all intOrniation - +k ' R iewed by Date ilC ry Y ° t - /°'v Personal information you provide may be used for secondary purposes (Pn� ; 1��- Cacy Law, 8a '. M I p _C6_ 7V e6100 � Property Owner �'- Property Loc; tioit. UU a e 112 //�°1^ Govt- Iro; . � 1/44411/4,S1� J T02q ,N,R ` 9' E C�.%-s"' ( Property Owner's Mailing Addfess ,, � L Ulf - Block# Su Name or CSM# " M(C / a rni(Cfn^. / , 4 7 ,2i. , ..7 4./4 e City S tate Zip Code Phone Number r� `` ❑City Village To Nearest oad Neares � ! Ll So vl i /0( 1 S�f�'i6 i (7iy )3�"s ?3G% . eij, ""3 1 Z :o c . . 1T.. ❑ New Construction Use: r esidential / Number of bedrooms g Addition to existing building 9 Replacement U Public or commercial - Describe: Code derived daily flow 4 e9v gpd Recommended design loading rate . 7 bed, gpd/ft – ' trench, gpd/ft Absorption area required 4 bed, ft 7.�c2 trench, ft 2 Maximum design loading rate . 7 bed, gpd /ft trench, gpd/ft Recommended infiltration surface elevation(s) - �;r,:. y,�>> ft referred to site plan benchmark) Additional design /site considerations ( 1-r . ,./ .J e. A. /e<Or...-n Parent material _ - ` _ / /_ Flood plain elevation, if applicable 4/ ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system OS ❑ u OS ❑ U '' I s ❑ u s ❑ u ❑ S Lu ❑ s E1 u SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft in. Munsell Qu. Sz. Cont. Color Texture Consistence Boundary Roots ` U Gr. Sz. Sh. Bed ,Trench 1,4-1 4 / a / r !/ , 2 7 n G . , / ,s-4. ,- _ ,, > .t S / �... 5 ../&"' f-- /- .�6' . , ; s Ground % /i O I ��� %/� ./� P''a� �i•>♦ . R 74, - Depth to limiting ' • f2in. 3 t) p? S Remarks: Boring # . f Z – moo o 4 %7 >7 /` _ 5 , .� 46,/ r 11 - �. 7 s' ,C' - s 6 %l e7,1. _ 2 ' Z .. 7;23.- . q-- Ground , 9 ris t. Depth to limiting ftor "A"- --in. Remarks: CST N nt) 1 z Signature Telephone No. Addre �,/- Date /� CST Number , 6 7C - �,0% , / � / .. J� 7— -/ ®0 .02 �r L ��1��� Page of SOIL DESCRIPTION REPORT f l • PROPERTY OWNER J g PARCEL I.D.# / Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots C'PD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 5 / ery - 45 ,1�� -_ ./ , ^ , ' /F a--: .-C • s - 2 y 7..f. ��..� 57 ,7�y� � - .,5" - s Ground 3 /; '� f c ( ! f ��" - i .7 .,- / /� � ,� - - , iT ,T- opt 1� / J� Depth to limiting 3 / factor n. Remarks: Boring # / o-. /7 "5/ „0 - 6' /� ,.� ,_,C - s ' f /7 „_ ,"‘" -- j l y .�,�� "---';‘' - s 3 O"-0 `7 40 ,x //o/t. Sc/ / /6f , ” /, i' Ground elev. 4S=pft. Depth to . limiting factor in. Remarks: I Horizon Depth Dominant Color Mottles Structure Texture Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # / 0 5 /� 44.4 // -• ",;---,-- W , ` G-' //,---- ' ..,..5- ` :6 eq ,C ,7...i.,V.; __ #,117, ..7. .,- ,i‘.e ,,...- . , ' - - ' 3 4 / e 7 z - z - 0;:e 6// , 4 / /d/ , 5 < ,14, /rte Ground elev. ' �' Depth to limiting / 1 facto 77 in. Remarks: Boring # Ground elev. ft. • Depth to limiting factor in. Remarks: SBD -8330 (R.9/98) I Soil Test Plot Plan Project Name Greg Miller Byron Bird Jr. Address 896 MicDiarmid Dr. ,/ Hudson Wi. 54016 CST #220527 Lot 14 Subdivision cottonwood Date 5/4/00 sw 1/4 nw 1/4S 36 T 29 N /R19 W Townshi p Hudson 0 Boring Q Well PL Property Line County ST. CROIX or VRP Assume Elevation 100 ft.nail in redoak tree - -; - - vation 98.9 H.R.P. same as alt. BM Alternate B. • top of steel stake SE comer of PL Alt. B.M. 4 1'PL 60' 110' 45' 30' 45' 30' ❑ • 25' mound • . • :1 2% slope o 55' driveway op B` 270' PL 55' 25' 4 Cottonwo id Tr. h bed house pond 75' 431' PL Wisconsin Department of Commerce • SOIL AND SITE EVALUATION Division of Safety and Buildings Page 1 of Bureau of Integrated Services in accordance • \ s1 1 - , r.'a3,�9, Wis. Adm. Code e .� '',\. Attach complete site plan on paper not less than 8 1/2 x 11 inc ir}size. Flan asst County include, but not limited to: vertical and horizontal reference p Iit(B'M) direotiorr'and ) . L- r() t V percent slope, scale or dimensions, north arrow, and locatiorjand distance to nearest road. Parcel I.D. # , APPLICANT INFORMATION - Please print all information. , , Rev wed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s.5.04 (1) (m)). k 1 k /_/ /? / Property Own Property Location (Y 1 V - y - tA - d CC 14. Govt. Lot SCAj 1/4AjW 1/4,S 3 (Q T Z 9 ,N,R 19 E (orig) Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# I.5 L t_� � itt -ikee (r�, 1 'l 0 f ( anti)(7_“1 P tc 1 , City State Zip Code Phone Number ❑City ❑ Village til- -Town Nearest R d 14t _l C k ` 6 r , 1 LJ i 1 S 4 L 1 (a 1 ( - )1 - ) 5 ( - i e t - 03, 1 -1 t A ( V - . ) T N I & , w a o cQ Ar. -New Construction Use: `- iesidential / Number of bedrooms J" _J Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow COO() gpd Recommended design loading rate • G ( bed, gpd /ft • trench, gpd /ft Absorption area required 4C00 bed, ft QU trench, ft 2 Maximum design loading rate • 4 1 bed, gpd /ft • S trench, gpd /ft Recommended infiltration surface elevation(s) 96 CO ft (as referred to site plan benchmark) Additional design /site considerations C'.cll - to v r el -e_J. qy U 0 Parent material GI WtC t C&) ` l IAL5, X{ Flood plain elevation, if applicable /. L) t- 9'Z d ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ❑ S ®U Ei S ❑ U ❑ S Nu ❑ S IK] U ❑ S ©u ❑ s ® 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 1 6 -13 it's yr ,3)Z- — 4 -.) L 1 ny_i0; in-Cr �S ) H 5 z 13-y► Ihyr Li h LS I m t 1 �5 — . 1 ; . 8 .7 , . Ground 3 4I- 4 (() y r 'I 4( C 7p i . 5 y r `t I/ Yl 1 S O S rte I C 3 — elev. J - • , — 9yooft. Depth to - limiting factor L I i in. ' Remarks: Boring # - - - U_y AN Z - ` -,L 1 nn ar.�k, o r (S 1 -C . C - I ; • --- Z q l[)yrtl i t - ,S 1vn2 _ rnt j - . 3 (c ) - ( 6 4 IOW t I (p C Zp `I, Sy r (! I +n , (Y1 ') c' trn I c (.; .1 ' - g Ground _ elev. 4600ft. . Depth to ; limiting - , factor (D Li in. Remarks: CST Name (Please Print) Signature Telephone No. A day, 5ek wL4.k.eY- z ie -- C7 /s) z7—f' Address Date CST Number LibIY Ceder 54 .me e+ wf t Y i6 _9'9 2533c.9 SOIL DESCRIPTION REPORT PROPERTY OWNER $ 716- ti Page Z of 3 PARCEL I.D.# Boring # H orizon Depth Dominant Color Mottles Structure G D /ft 2 9 Texture Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 () 10vjt 1 Z sL f rnabk ma ( (�' . Z i7_3Z /0.,, - L_S �rn� rYl( C 5 — - 1 g Ground 3 3Z-` t X1 (4C C Z 7.'Sy YY) 5 �� J Yl "t t C S U elev. gSaofi. Depth to limiting factor 90 in. Remarks: Boring # ........................... .......................... ........................... .......................... ........................... .......................... Ground elev. ft. Depth to • limiting factor 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 # ........................... Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) PAl c 3 43 • L,pi- , ,,) . .,,u„s ro cl • - _ -e n Q. 1 I n W 00 C� i:C „ C2 po 3 orfr, 1 eit.0 . 100.0 T . h Ll 1'' ,' ✓\ r a " -e t w. (3m Z e(-GCJ , ( oc), o NI , � e� -et.au ��OU ('on -Idur Iun-e_ q` B I \ ii,54 3 ' . I ► • a ' � 1- 1 -w,G -_ qlz. d } f b U o le 4' 1 D °1-1.1 ' , 4 I. 4. • die‘sit • • 0 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 (POWT8) 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 3b 31q / Number of Bedrooms s�! Design Flow - Peak (gpd) `tea Estimated Flow - Average (gpd) Septic Tank Capacity (gal) Soil Absorption Component Size On !JO al L � - -; $ i ��/ Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) /(51 5 7 r-1 1 ' 1 -- Maximum Influent Particle Size (in) 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /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 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 • 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 Tess 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. T ry y 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 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM ■ Owner/Buyer 6 r n (V\ 'A Mailing Address y, , Mr/?7a,e /51,4-01 Property Address d ye? /L/ae ( ef Verification required from Planning De a rtment for new construction) City /State )-( d CO rx w Parcel Identification Number ‘ ,L4 /3$ 3 d LEGAL DESCRIPTION Property Location 5 W ' /a, , AJ L) '4, Sec. 3 6 , T.2`Z N -R / 9 W, Town of I4 . Subdivision C o -E -F o w l d , Lot # Certified Survey Map # , Volume , Page # Warranty Deed it b , Volume / S - 3 Z , Page # 3 8' Spec house ❑ yes f8( no Lot lines identifiable PI yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that yo septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of wee year expiration date. ./ _ _ 7 /2400 •"' APPL A TT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the prope 00 0. bed bove, by virtue of a warranty deed recorded in Register of Deeds Office. 7 /22 60 DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed VOt_ 1.532 PAGt 328 )0, STATE BAR OF WISCONSIN FORM 2 - 1998 62 ?64E16 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number ST. C R O I X CO., W I RECEIVED FOR RECORD This Deed, made between 08-04 -2000 10:30 AM and w i f P , WARRANTY DEED EXEMPT # Grantor, CERT COPY FEE: and GREGORY M. MILLER and KRTSTF.T,T, A. MILLER, COPY FEE: husband and wife, TRANSFER FEE: 179.70 RECORDING FEE: 10.00 PAGES: 1 , Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following , described real estate in St. Croix County, State of Wisconsin: Recording Area Lot 14, Plat of Cottonwood Ridge, Town of Name and Return Address Hudson, St. Croix County, Wisconsin. (1 3 A " c,�e p Box ( • OSceok a. W I 5ilo - o 020- 1353 -14 -000 Parcel Identification Number (PIN) This i S not homestead property. (is) (is not) ;I i i Exceptions to warranties: easements, restrictions, rights -of -way and covenants of record. Dated this day of .7111 y 2000 • (SEAL) (SEAL) * Richard O. Stout Janet P. Stout (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. St. Croix County. it authenticated this day of Personally came before me this 7i1 th day of July , 2 0 0 0 , the above named Richard O. Stout and Janet P. Stout * TITLE: MEMBER STATE BAR OF WISCONSIN N S T ARY PUB c to (If not, me known • • - �mi cuted the foregoing authorized by 5706.06, Wis. Stats.) instrumen . • r. e t J. BAST THIS INSTRUMENT WAS DRAFTED BY f Janet P. Stout ' _ ` 1353 Awatukee Tr. * Hudson, WI 5401 6 Notar 'ublic, State of Oall onsin My ommissiory /s p r anent. (If not, state expi t crate: (Signatures may be authenticated or acknowledged. Both are not I � ( necessary.) * Names of persons signing in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc. WARRANTY DEED FORM No. 2 - 1998 Milwaukee, Wis. I D I' , s� 60N -t p V / —•4 f g b i do W o / .o i 1 63 I 8 ^w . ��. / • / . •. • l l N 0 . � •i u � ! 'S Z 3;. _ / / N /. : •• i i §° • i 1 b u ) / / N • W pr i • N :J 1 1 N N Uc7) by / W ' � j w 1 irn g > N pp i j W c0 a , Z 1 / , // ,-.0 : N r j 2W .•. OSS • •r;o , , 1 j : ^ o I ' 'I Co , 1 CY ' 3 v ' 1 1 i ............ w *4-- v� 30g5 ........; i ....a 0 - z I v - • _, -- ,S 4 ,,,350r.. ----- , ts , � _ 1 •3 H f • 4'33'4" - - W 304.5 . 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COUNTY l� Byron Bird Jr. 220527 , / .1- ° DATE BEDROOM CONVENTIONAL IN -GR sit ,/- PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZED, o LIFT TANK SIZE DOSE TANK SIZE LDING TANK LOAD RATE ., ABSORPTION AREA 5-0? # of chambers 3 7 ENCIIMARK V.R.P. e , e.e 4 !/ ,n �ASSUME ELEVATION 100' .-- /41-'/,' BORER• E O WEL. *H.R. /f. 2 i /vim`° ( 6 ; 3 W 6 YSTEM EELEVATION 9 Z eat >12" I Sidewinder High of Cover Capacity Leaching Chamber with 31.8 ft ^2 6 ,> per chamber 6' Long Grade at System Elevation 34 a37 � We et, --7......... \ _ k de l e i al,„/ Y 9 \ , ,, 0 ,..0" ----__ 4# , y9 -- !* , cad. 1- kig. ,Q6n If icfri.t5' I \(' 01 or 0 1- 7 - 7 ----; /01 - --)7 OZO -/353- r/ -OC%D 2 _z9_ /q. z0(6/' r INFORMATION /CORRESPONDENCE (Include date) 1)0 ` [�/ / 3/Z r74 -,�. 4 /A - a-{r �, D ` fr /Z P/2- 000 /II/ --17n20.✓rQ ^ / ..4, / .G /r _ , .� _ % , — i A _ - AL:. .. , ... Li e/ is, .. ■ le / . / r. , . 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