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HomeMy WebLinkAbout020-1353-16-000 Wisconsin Department o€o PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division r INSPECTION REPORT Sanitary Permit No: 395288 GENERAL INFORMATION 7(L - re , (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [I v Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Freeman, Kirk � Hudson Township 020 - 135346 -000 CST BM Elev: Insp. BM Elev: BM Description: /0 / /0 /) ' Neal fern - Tip 1 1d/h. u a,ee_ aam t.x_ 6. S — yt. tat -3 — TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Wve / 0 / � 6 d Ben A41-. Dosing 1/ D Alt BM A e ac -roti, l.„4.1I /.° /O / , -' /00 Aeration Bldg. Sewer 551 y'S 6t3 Holding ------- St/Ht Inlet (,09 9y R( St/Ht Outlet TANK SETBACK INFORMATION Io 3 y T`(- ( 6 TANK TO P/L �y N WELL BLDG. Vent to Air Intake ROAD Dt Inlet / ...=----- ...=----- " el � Dt Bottom Septic � � ) / 2 / / i!' Dosing l Hemmer /Man. 6 q 'n y' Aeration Dist. Pipe I / / . 7 I Z , � i Z 6.53 q y' Holding Bot. System / /7.84 ` 1 5, GO ;"� z 1. 3.19 PUMP /SIPHON INFORMATION Final Grade _ f v 4 z , 7I I6. 2. Manufacturer , Demand St Cover / 1C 6V1-05- Model N ber P y TDH 1Lift Fri FLOSS System Head TDH Ft • Forcemai ength Dia. ist. to Well SOIL ABSORPTION SYSTEM Q w/ /S Clt h,.. - .Q.Er-cA- — Ate. BED/TRENCH Width Length ' No. Trenches Inside Dia. Liquid Depth DIMENSIONS 2 t I 417 . i s o. Of renc P IT DIME IONS No. Of P • INFORMATION SYSTEM TO Nh, % Type BLDG WELL t j�. . LAKE/STREAM HAMBER OR Manu rer: i . 1 r. n � s f / UNIT Model Number. ` Z a f7 C f System: am • > 30 2b�► - y DISTRIBUTION SYSTEM CI kr4AL) A__ tp"is 1 I x Hole Size III* C.e./4 . 4 Header/Manifold Distribution f Vv� x Hole Spacing Vent to a ke er 1 f / n PIP9s) /2,2 / At- 9 , 1 A "• / i Length Dia Length `"I' Dia pacing W / e � < ¢ SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only o Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ® Yes E] No El Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /D 1--- Inspection #2: / / Location: 652 Hillary Farm Road Hudson, WI L E '" 54016 (NW 1 /4 1/4 3 T29N R19W) Cotton • . : Parcel No: 36.29.19.2016 1.) Alt BM Description �p tAJ '1 — 4t) oT . 04,,, G B ' S • _(' 2.) Bldg sewer length = i 2' 4v (�Y Kett s d.40 - amount of cover = Lt,S) `ooi�a / '71.1A&) A .( -00. SQ t i 4-e511" f/01 iv Le- Su h al s'i-W b is - , l3 ‘ rd - `Q /* Plan revision Required? [ No Q / / �� COW r Use other side for additional information. U 1 0 / Date Insepctor's ignature Cert. No. SBD -6710 (R.3/97) E ^r /AS sn N » r J12-1"1'-'0 (7 1 V 0 Ur)/ r/12.-/- " )C1);° fi Le, ■ . . 1 v4 I rrifY ir , Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 NVisconsin Personal 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 ♦- K 44 —O z- Q / Ap Si I state owned.) Attach complete plans (to the county copy only) fo !. - -, on oa•er not less than 8 -1/2 x 11 inches in size. — County 6)-e2 / Stag tarry I�Tyrer L h. ck if r dons C ®plicatr • n State Plan I. D. Number / I. A lication Information - Please Print all Information v Location: �/ Property Owner Name A u U 1 3 2002 PP Property Location r ! r ,i fy,Le. /,y, s7 ST. CROIX COUNTY 114/1/1/W/4, ST t , R r Owner's Mailing Address Lot Number Block Number ZONING OFFICE City, State Zip Code Phone Number Subdivision Name or CSM Number f ` ,/,..g7Y,, ,,f vzt.A€ 4 4 ,.... ( ) . o p,, ,oai/ /t'- r II. Type of Building: (check one) / ❑ City , 1 or 2 Family Dwelling - No. of Bedrooms : / c' ✓ : CI Village ❑ Public /Commercial (describe use):_ / 0/- C� � L town of /_/ 0/../...0 ❑ State -Owned Ag / -� // 4 17//‘e-..-- � / /' Nearest Road CO G-A et �j` -fir` , 5' z---1 G/le , :4 e.../. ..� el; r15 Parcel Tax Number(s) 4 � . � III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) 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) .--7--11h71771-4Jc4�'cl2,n 1 ion- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed land ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: 7 j - 4- , eQ - ? / 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 G Required Proposed _/ 33 S. Rate (Gals. /day /sq. R.) (Min. /inch) 7r _ / , Elevation VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks �,//f . .X - 42/17 / wze7�f ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plum1M0 Name (print) Plumb ' Signature (nos . �� . ): MP/MPRS No. Business Phone Number _ P i s Address (Street, City, State, Zip Cod 0 IX. County/Department Use Only / ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Da Issued Is . t Signature tamps) pproved ❑ Owner Given Initial Adverse Surcharge Fee) 00 / Determination X. Conditions of Approval /Reasons for Disapproval: 7 lc . 1 SO-d CmJ rn^ 1`h St r:. <c.t -0"n- 1 -9/-C4 - c-& c " S�:Q 4 d �. s .r- 1-4-1--47C°--61 dL -A iz cud 1 cu u o n a��.a�J cUt t, SBD -6398 (R. 07/00) . • ' Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County J `� Gr o • iG Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ,2�j —7y...5— 3 ,_/C Please print all information. - eviewe• .y Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). i /,' G i-11, -.. I g (// ' ;`-- Property Owner Property Locatio G /j / ,r, Xi.----a_e � Govt. Lot 0.e) 1/4 / 1/4 S3' T . N R ,,. • E (rn / Property Owner' Mailing Address l st'( '\ Block # Subd. Name r CSM# ms �2L 1 pct 4- Gv 'I 6G /l (vooC7,4e .f City State Zip Code Phone Nu er C i ❑ Village Igtown Nearest Rodd /,, /e e4 44 � I 53 I (Y /s) /7 %dh I �fiA cocld Tv' . New Construction Use:]2 / Number of bedrooms 4 Code derived design flow rate 4 7 O GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material / > G / C. // OGr/ S Plain elevation i ft. General comments , ... '," : - / and recommendations: Pr = 7 Tr- ;'- /y .. ,2 2. 1 3 2002 Boring # El Boring �/ r J Pit Ground surface elev. 7 / ft. Depth to limiting factor i d 41 in Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 / 0 70, S/ rtf ..- 7 ,s--771-, 1, 7X . C___-- /f . -- - 7 m2 X6-6 /e ,e54 /--Y- _ .-,2 .< p - fe-/e) /Z- ›' _ e97 /'/ gic ///, r / '.- -2 93.tf'7 = l 67K3./ & Boring # 0 r Boring I� Pit Ground surface elev. f 7 ft. Depth to limiting factor >�� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 / /2 /� �/Z/� --.E__. ''7 � ?/ --2 7 /%- ''5 /` - .2 , 5( /oy� i4- si , 5- _s j g ( /sZif___c_ _- , ././ 71-6.' C.. cl3. (L _ ij(o. 32'' gi 32 ' Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg /L • Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L CST Nam Please Print) Signature , CST Number Addre s % Date Evaluation Conducted Telephone Number -- C, e.7 /- ,, " r '' /a 5 e9/ = /.'- e o /s -.. -2r��✓L SBD -8330 (R07 /00) Property Owner // / d'� / i - .4-7 Parcel ID # NO + 3 S3 -� Page a of 3 /�, Boring # ❑ Boring . i Fa pit Ground surface elev. / ft. Depth to limiting factor /o `d in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 / ,/ //"O ., ir%..-e___ •*5/ , r Zl a7l. - • -0/29 G S /, s — • , .� _1/ 7� ,g0)/0 - i/4 may ,e 6 -- Up l • 41 % 5 i .9G L. 6 13, lLf = ‘S, 9z Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 • • Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 ' 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 altemate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD -8330 (R.07 /00) PLOT PLAN PROJECT Kirk Freeman ADDRESS 2682 Martinwav WhiteBear lake Mn. 55110 NW 1/4 NW 1/4S 36 IT 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX 1 - - 8 -12 -02 4 MPRS Byron Bird Jr. 220527 ` ° ade "ATE BEDROOM CONVENTIONAL XXX At- CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gal LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 0 LOAD RATE .7 ABSORPTION AREA 900 # of chambers 30 BENCHMARK V.R.P. top of foundation ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.p. same as BM / Vent SYSTEM ELEVATION T -1 =93.47 T -2 =93.14 >12" Sidewinder High K__,n of Capacity Leaching Cov Chamber with 17.2 440/111 6 " tA2 per chamber Y. .' . ' 11 Long 34" Elevation PL 30' 97' Cif B , 96 , U� N / 97' N ►N O., pipe✓ 30' ''''"O 3 94' V stg 15' G3 •�f�l :3 . �` • alt BM B 30' t' 60' ��' - ' B2 Cottonwood Tr __ / 4 bed House (s-n t l(i / garage 1 Drivway 300' PL 65 Z I+« -I-wey t`a-e. Q.e 6c& , 9 , 6--30&- , Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application Per PO Box 7302 \'4SCOfl Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce [Privacy Law, s. 15.04(1)(m)] p (Submit completed form to county if not state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. County. f � State Sanitary Pe it Number ❑ Check if revision to previous application State Plan I. D. Number C. 7 r- &r e. 39528 I. Application Information - Please Print all Information . L Location: Property Owner Nam �y� Property Location e, �r l �" /f 1 ' c "(-1-7 ° ,Y R I+ � #VI X 14, s � 6: D R Property (3wne 's Mailing Address ry ' `Et fl : e. Lot Number Block Number /‘ City State Zip Code p ne ' ho Numbet � ? O , Subdivisi Name or CSM Number Pie. t sT IX ' II. Type of Building: (check one) / ❑ City 1 or 2 Family Dwelling - No. of Bedrooms : el ` �` ` ' ❑ Village ❑ Public /Commercial (describe use):_ j , - ; Down of ❑ State -Owned c .i4 < VA?, /� 7/ D 0 Nearest Road ✓cg. CA ec ,,,S ' i f �! C �C /7.� / S < �' et�r ®G7�o/� ls Parcel Tax Number(s) 3> j !d III. Type of Permit: (Check only ne box on line A. e ck box on line B if applicable) 5(, .,z q, lg. 2 o / ( 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) s Ton- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line • ❑ At- grade ' l ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: ( 3 x 6 rea V. Dispersa tment Area Information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Galsiday /sq. ft.) (Min. /inch) T� ^ f -.. C�j �° �c, /- ..2-... T �. . / © 7? 7 VII. Tank Capacity in Total # of ' Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed .,C Tanks Tanks .907rC_ /0312 7. e-C/f� ❑. ❑ ❑ ❑ i ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. _ Plumber' ame (print) Plumb a (no stamps): MP/MPRS No. Business Phone Number mbe ' Address (Street, City, Zip Code) � - ^"25 ®/ �`-<- , /2 -- Le- ‘""t ..' !/tee ,...-- f , IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issui Agent Sign (No stamps) t Approved ❑ Owner Given Initial Adverse Surcharge Fee) dp Determination It 22.5, ` &e • IT, 2eo1 - ,� �,, X. Conditions of Approval /Reasons for Disapproval: '--, 1Q H.&v'r 0.,,,,,4- L._ sw s �c� f ( h J .1, GAQ.A ` t - e�L S-61.0 � (5 k•w (l.Q-'t ' 4- A4 t I e • -Ik- 1.1erw41-8AA t S 4 ej..ao.4" f w./1/4-0-64 gR-M 4 444 " e W1/44)1AAjettjA6 SBD -6398 (R. 07/00) . (.537/e7 PLOT We , / Cr C ' ' , 4 u4f ADDRESS N / d!! , / ',/ �/ r ��e i�r PROJECT fir � '602 /����`' � � e! , �/� 1 /4,S 1 /4S y IT , -' /R /7 W TOWN / COUNTY �jr� f� MPRS Byron Bird Jr. 220527 _,>- 1 � DATE `49/ BEDROOM 7 CONVENTIONAL XXX -Grade / CONVENTIONAL LIFT HOLDING TANK � 2 �� LIFT TANK SIZE DOSE TANK SIZE MOUND SEPTIC TANK SIZE HOLDING TANK SIZE O LOAD RATE /,.2ABSORPTION AREA... # of chambers ,e, f ✓' rh l � � � ■ BENCHMARK V.R.P. ASSUME ELEVATIO 100 ' ❑ BOREHOLE O WELL * 6 ,,S:-, c�°Bcf /� H .R.P. Go �� c . - , m � 4, d Vent SYSTEM ELEVATION 73_, -/ = w. O / D ): = �Q_ D >12" I Sidewinder Hi h � of Capacity Leaching X //. ,1 7 ,1 '? /r c V c h / a " 1 : 42 i Cove Chamber with 17.2 As 6 " t ^2 per chamber � - - L ong 34" r. 11 g Elevation / 1 \.. ..9 fir eii c ‘4, /� 'ice 2 Q ( \'\C 7- / A D �i 42 � A � - , „,i,. % , • , i� 1 A 1 -...._ 4 '\ 1 „ A 4 ' J/° 4 t% "l \.) I 6. -- A - , - -- ;;" ,7g' / per \ / 60 -iy (.537/e7 /4 ' / Fr /I PLO DRESS N / Z4W- / /f 1 - -7 PROJECT ' f Y' � � � � �6 � � G'�� � � � �ar�Ca. C �/ 1/4 /�� 1/4S /T /R W TOWN < _ COUNTY Ci ra>/ \ /r � /7 c/Sd/7 v� ,c MPRS Byron Bird Jr. 220527 _'��_ ..-- 1� % DATE -) -®/ BEDROOM CONVENTIONAL XXX -Grade " CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE A 2 60 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE 0 LOAD RATE /,.ZABSORPTION AREA...evr # of chambers .72:, BENCHMARK V.R.P. ,fit (r/ rig l S r D , ASSUME ELEVATION 100' E.] BOREHOLE 0 WELL *B.R.P. G r '.c 4 4 wy c / '1 ' o ®c(/i� W ent SYSTEM ELEVATION 73... , -/ = ?/: oo 7 7..2 = >D "r >12" 1 Sidewinder High � of Capacity Leaching 19 ( { - a9/" , c Y , h i a �� z-7, Cov - Chamber with 17.2 Ai 6" tA2 per chamber Long Elevation 1 7 ( ,.. — P. (� I . \ \\C ..- 4 ' (\ , r 4 d if \‘, ..%\!ii I e % ,,, Ai % , ' ‘ gk �S-k HJ f 4 1 i 14 4 b . IV /I �cs� i 5 7g / P.-., \ Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page I of Bureau of Integrated Services in accordance with s. 3.09, Wis. Adm. Code • Attach complete site plan on paper not less than 8 1/2 x 11 inches side Plan must County include, but not limited to: vertical and horizontal reference point ,�6irecti i, an. . ct(6 percent slope, scale or dimensions, north arrow, and location ar - 41Stance to riea_r »r . Ntreel I.D. # .., r w+ Al r 1 APPLICANT INFORMATION - Please print all in gimation. r ,,, ,) , .1:1+ ed by Date Personal information you provide may be used for secondary purposes (F vatiy Law, s. 1 t) ) 01 iiiii Property Owner 0 . ;` V/Ngr Locat;iir - 7 12\ axi ��� Govt. L r h 1/4 (M 1 /4,S . ?(p T 2'c ,N,R (q E (or)6 Property Owner's Mailing Address � ' ypek# Subd. Name or CSM# p Y 9 L�ts #;_ t35 Av■)c,-4ukcee. Y �r, C'L }--Cen t c2\dCy__) City State Zip Code Phone Number ty ❑ V ®- Town Nearest Road pd ❑ City Village Hudson Ot b 0h I \A ft -5 1 ( `16 )5L14-031 1 t-tudson 1 9r4- 40nWvtic:Qr 4-r' g-Illew Construction Use: Residential / Number of bedrooms 3 - 1 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow (-1) gpd gpd Recommended design loading rate 1 7 bed, gpd /ft f o trench, gpd /ft Absorption area required ,51 bed, ft 150 trench, ft Maximum design loading rate r ? bed, gpd /ft • Sr trench, gpd/ft Recommended infiltration surface elevation(s) V, 0 0 ft (as referred to site plan benchmark) C� Additional design /site considerations /� l ! / 0 0 Parent material ,I,C ai Chu*' o. h Flood plain elevation, if applicable //W4.- 969'6, 9y'? ..5 S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system 4 S ❑ U EJ s ❑ u ® s ❑ U © S ❑ u ❑ s © u ❑ S I 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 b & 16•1(,- 317_ 5 L 1 Ty cibk ci (-S I -C - `--I ; - 5 Ground elev. , q :7a ft. Depth to limiting factor l2Qin. . Remarks: Boring # 0-12_ IONir 31z. S L � rnQhkZ n$r C 5 1'. . Lt ; . 5 2/ 2 12.-3 tOvr 414 LS 1 m m fr c. , 3 -lam 10.1r y!, rncs Os.. m _ 1 cs . -1 ; • S Ground _ elev. ?S,00 ft. Depth to - , limiting \V> to , factor t't(o in. Remarks: CST Name (Please Print) / Signature Telephone No. Acla A Sc - c trnake ____-, LA'S) 2y 7- -took' Address Date CST Number `1v$ '2ecler 5 +. *---/- ) - et-ef, L.,ji 5yv2,5r `f- -i6 253309 to • ,1 PROPERTY OWNER - /00) SOIL DESCRIPTION REPORT Page 2- of 3 PARCEL f.D.# Boring # Horizon De Dominant Color Mottles Structure G D /ft g Texture Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 U tb LOy 317- SL 1 mabk mfr (S . y ' . 5 2 Itp -Z► (61r y IL{ L5 1 msr mcr c5 - - • p $ Ground 3 ZI -128" Loy( `{l(e ml CS — . elev. W ZOft. Depth to limiting factor IAein. iba 1 1 0 Remarks: Boring # 0 g 1 c , - 3 ) 2 - 4 2 yr 'A io -- tns os5 rn1 S - Ground J elev. (HO ft. Depth to limiting factor 131 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 # .15 l3r 1 2 _ `_' SL \rticx\ Tit-Cr CS . 4 .5 Z 15 -31 (.0r 1-41(4 LS \m s mfr. c5 . $' 3 3J -tlt iD {fen v1 bSg rnl CS - I . Ground 1t Iv. ' oft. Depth to . e limiting g \ o factor I 2.6 in. Remarks: Boring # ......................... ........................... Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) j x F c 3 04.3 S-k,v-1 -- 0 . Co .wcy0c clot - . ..,... _. . . Sea, I2 ►= �o x Act; t ; A " ow.< 2v i efev• lo / 1 tai t i� IZ„.eivv► �mz e-kv. IUCS,() NI ____ ..Sys/ nrI. et t.,1/4.1. Q'(, p o k G Amt• aJ.e% q1.00 . L L +,- / oh 1 ta t W. :3 s5 1 0- am C: 41 i ,_:, 1 POWTS OWNER'S MANUAL a MANAGEMEt 1 PLAN rage of FILE INFORMATION SYSTEM SPECIFICATIONS ' Owner ./;—/ �j-�-,e FLU Septic Tank Capacity /024 o gal ❑ NA Permit # 39s 28' Septic Tank Manufacturer ei./.e k,5 ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 2. 4 6/ ❑ NA Number of Bedrooms it 0 NA. Effluent Filter Model / ,-, ❑ NA Number of Commerdal Units 0 NA Pump Tank Capacity gal ❑ NA Estimated flow (average) 45 ..--e, gal /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5)- gal /day Pump Manufacturer ❑ NA Soil Application Rate / .Z gal /day /ft Pump Model ❑ NA Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA 5_30 m g/L ❑Sand /Gravel Filter 0 Peat Filter Fats, Oil 8t Grease (FOG) ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BOD5) 5_220 mg /L ❑ Disinfection ❑ Other: Total Suspended Solids (TSS) _ s 150 mg /L Manufacturer Pretreated Effluent Quality ❑ NA Monthly average* * Dispersal Cell(s) Biochemical Oxygen Demand (BOD5) 5_30 mg/L A In- ground (gravity) ❑ In- ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ' ❑`At -grade ❑ Mound Fecal Coliform (geometric mean) 5_10' cfu /100m1 ❑ Drip -line ❑ Other: Maximum Effluent Particle Size A inch diameter * Values typical for domestic (non - commercial) wastewater and septic tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months ❑ year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one -third (As) of tank volume Inspect dispersal cell(s) At least once every ❑ months ❑ year(s) (Maximum 3 yrs.) Clean effluent filter At least once every , j ❑ months ❑ year(s) Inspect pump, pump controls &.alarm At least once every ❑ months ❑ year(s) ❑ NA Flush laterals and pressure test At least once every ❑ months ❑ year(s) ❑ NA Other: At least once every ❑ months ❑ year(s) ❑ NA Other: At least once every ❑ months ❑ year(s) ❑ NA MAINTENANCE INSTRUCTIONS lions: Mast I"la following licenses or certifica an individual carrying one of thefo g tanks and dispersal cells shall be made by a Plumber; of p Plumber; Master Plumber Restricted Sewer; POWTS Inspector; PO WTS Maintainer; Septage Servicing Operator. Tank inspector must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure tt volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually Inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (A) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 1 13, Wiscons Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatement components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION For new construction, prior to use of the POWTS c heck treatment tank(s) for the presence of painting products have other tee c emic F r s are detect the dispersal cell(s). I f high c oncentration that may impede the treatment process and /or damage P nr rho ratmet removal by A sentage servicing operator prior to use. - r Page _— of . _ System start up shall not occur when soli conditions are (roan at the Infiltrative surface. During power outages pump tanks may fill above normal hlghwater levels. When power Is restored the excess wastewater will be discharged to the dispersal cell(s) In one large dose, overloading the cell(s) and may result In the backup or surface discharge of effluent. To avold this situation have the contents of the pump tank removed by a Septage Servking Operaior.prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist In manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over sinks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may Improve the performance and prolong the life of the POWTS: antibiotla; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; dlslnfectanu; fat; foundation drain (sump pump) water; fruit and vegetable peelings] gasoline; grease; herbicides; meat scraps; medications; oil; Painting Products: oesticldes: sanitary napkins: tampons; and water softener brine. ABANDONEMENT When the POWTS tails and /or is pemunently taken out of service the following steps shall be taken to insure that the system is property and safely abandoned In compliance with ch. Comm 83.33, Wisconsin Administrative Coder • All plping to tanks and plu shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and plot shall be removed and property disposed of by a Septage Servicing Operator. • After pumping, all tanks and plu shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another Inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: O A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be Infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result In the need for a new soil and site evaluation to establish a suluble replacement area. Replacement systems rnust comply with the rules in effect at that time. D A suitable replacement area is not available due to setback and /or soli llmltatlans. Barring advances In POWTS technology a holding tank may be Installed as a last resort to replace the failed POWTS. O The site has not been evaluated to identify a suitable replaceme area. Upon failure of the POWTS a soli and site evaluation must be performed to locate a suluble replacement area. if no replacement area Is available a holding tank may be Installed as a last resort to replace the failed POWTS. D Mound and at•grade soli absorption systems may be reconstructed In place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must.comply with the rules in effect at that time. < <WARNiNG> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMP(1tSIRI i. ADDITIONAL COMMENTS POWTS INSTALLE . POWTS MAINTAINER Name 07/1 i • Name M192r /-- -er' y Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name l 4' 1 gency .- is ' n I I 9hont I �/�'3.d 8- - 1 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT • AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ; r lC Fre k r Mailing Address 1 Z � o� � , -' Lc a., ��h'1 Property Address ‘f2 f /; / /,e,G) $ Va /-1 (Verification required from Planning Department for new construction) Sly? Q_. City/State fl ho W L Parcel Identification Number ©,2 LEGAL DESCRIPTION / / Property Location 4AG✓' /a, , 2 %, Sec. 36 , T ��t -R /1W, Town of 174 c/ SO 'j . Subdivision ��o o w n, e� g' �� , Lot # /6 Certified Survey Map # , Volume , Page # Warranty Deed # ` 2 YY° , Volume /.5 y , Page # Spec house ❑ yes fg no Lot lines identifiable 'J 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, j oumeyman 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 your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the tee year expiration date. CA 6 e� i (Dl 0/ S AOF APPLICANT 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. I NA 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 the certified survey map if reference is made in the warranty deed • � 289 STATE BAR OF WISCONSIN FORM 2 - 1998 623796 WARRANTY DEED KATHLEEN H. WALSH • REGISTER OF DEEDS ST. CROIX CO., WI Document Number RECEIVED FOR RECORD This Deed, made between _ 05 -30 -2000 9:30 AM RICHARD 0. STOUT and JANE- P-. STOUT, WARRANTY DEED _ husband and wife - -- EXEMPT I Grantor. CERT COPY FEE: and _ KTRK R. FREEMAN and JAN M FREEMAN, — COPYFEE: TRANSFER FEE: 173.70 husband and . __ _._ — -- RECORDING FEE: 10.00 — — — — — PAGES: 1 — _ - -- , Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St _ Croi X ._— County, State of Wisconsin: Lot 16 Plat of Cottonwood Ridge, Town of Name and Return Address u.son, St. Croix County, Wisconsin. 020 - 1353 -16 -000 Parcel Identification Number (PIN) This i c not homestead property. (is) (is not) Exceptions to warranties: easements, restricitons, rights -of -way and covenants of record. Dated this 151 day of May ,200O `� dit,Ajj / LT - (SEAL) c N Qe (s� u""- (SEAL) . Richard O. Stout •_ Janet P. Stout (SEAL) (SEAL) • AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. St. Croix County. authenticated this day of — Personally came before me this 1 Sth -- day of May 2000 , the above named Rirhard n_ Stout and .T.nat P.. ----- - - - - - -- - - -- Stout • NOTARY PUBLIC _ TITLE: MEMBER STATE BAR OF WISCONSIN S ATE OF W ISCO NN to (If not, me known to A executed the foregoing authorized by §706.06. Wis. Scats.) instrument and ac no O I g Rg(�(1[jS Q s e. THIS INSTRUMENT WAS DRAFTED BY Janet P. Stout 1353 Awatukee Tr. Hudson, WI 5401 6 Not. y Public, State of sconstn My cormuission is pe anent. (If not, state expiration date: / ir (Signatures may be authenticated or acknowledged. Both are not r ` ti O ,) necessary.) Names of persons signing in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Dank Go., Inc WARRANTY DEED FORM No. 2 - 1998 Mnwaukee. Wis. 386. / 1 i J r I vv oa r . . ;• I I i t i es ~ I I •••. j j 1 l j w 1 1 ; co 1 ;N i 1 �i y ; 1 i i l Co 1 . o I IN i 3.- I i •N CO I . 1 H .: I I • 1 . 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