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D,.,(G Parce 1)2014353 -23 -000 t nc.,1 too aG _ ..,4 IvST•s TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic AJJW 44,L, I ZS� Benchmark , ?y fr.,/ /06 — Alt. BM L Dosing 2.q 77Z D t7 Aeration / Bldg. Sewer • ,-74. QS': (a' Holding St/ Ht Inlet ?at. A=75 .re TANK SETBACK INFORMATION N � , ,i St/ Ht Outlet 7 • m g 3• VS/ TANK TO P/ L WELL BLDG. cY it I n n ta ke ROAD Dt Inlet , l'ept� r 4- at u f 2.4 l NA Dt Bottom Dosing NM � -• • Header /Man. 0 ` 9 a ' C q�. ;y� Aeration � �_� NA Dist. Pipe /'�` -�-- Holding ∎ -- = - Bot. System ' 9 � � 91, lY PUMP / SIPHON INFORMATION tictreAe V - G/. ar '.re Manufacturer D • mand . .(4 — cf. 6s' 4 P6 .2 7 Model Number • . GPM ' TDH Friction S step TDH Ft L. _i. , 7 Forcemain - c - Dia. Dist. To Well ' • SOIL ABSORPTION SYSTEM BED / TRENCH Width t Length No.O Trenches PIT No. Of Pits _Inside Dia. Liquid Depth DIMENSIONS 3 'Si DIMENSIONS Manufacturer: SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM LEACHING 14411444.4„._ INFORMATION Type , �� l CHAMBER Model Number: S 4 11 s -�� OR UNIT tCb -- DISTRIBUTION SYSTEM 1t1+`i e 1'T /` 30 e ' - o Header / Ma ifold Distribution Pipe(s) ! t x ole Size x Hole Spacing Vent To Air Intake Length e" Dia. 1 4 Length/Dr Spacrtfg SOIL COVER x Pressure Systems Only xx Pound 0 At -Grade Systems Only Depth Over Depth Over .. I xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed / Trench Edges Topsoil Ins L - ction #13 Yes / 0/No InspefdtYon #2t No / LOM MENTS: (Include code discrepancies, persons resent, etc. Location: 666 Hillary Farm Road, Hudson, WI 54016 (1 e 1/ NW 1/4 36 T29N R19W) - 3629192023 Cottonwood Ridge -Lot 23 1.) Alt BM Description = 1.p A f""" S.) ;P - 6KG1GS wCA€ -SbU[q 3 4 1-1.13 . 2.) Bldg sewer length = Z,••Feg,.f - n . (.lJ1. b ihd(witaK `"er■ " J ‘ ' ■J> - amount of cover = pit ; rv Ise -Itt 534400.4k Gl4wall 1. i•s441 et- C$ . vol se. 1) a.B (/ ¢ 1.°1 • ✓i l � 4 (% a• sT- s (o ass ezlicwvttd .8 trissi•� PIarr44 revision required? ❑ Yes ❑ No //�� _ �'• Use other side for additional information. "l 1/17 0 ( • RV/ ! �/ SBD -6710 (R.3/9 illr> 046,1.441h- P6 mitt 1s /►'l %fig n l nc e= re Ace /s , 1}1,4e v 4474/1 t/ Qcro \ 11 / 11‘S-1 • Q ✓ ' • ti 4 � t APB \ tr W b�� �y• 1;7 • in / r n° S vi t ' • 1 • 7 µher eY N„ K> .Ac (1347 O Sanitary Permit Application Safety & Buildings Division In aceond with 832f, Wfa, Aden. Code 201 W. Washingto Ave. See reverse side for ,Sf j for completing this application Doer 7302 pat meet , 4otnrriarea Personal infatuation You provide maybe used for sa°ondary Purrs= Madison, WI 53707 -7302 (Privacy Law, a. 15.04(I)(m)) (Submit completed Burn to county if not state owned. w ti�2.1� �1� ■ • �7 ...,,, State Phut I. D _ 1. A . . ;cation Information - Please Print all Information l - - -~ Property Owner fume r • ....... ale- monk ,,. _ . 7. Staler to , • MEM/ - ; ^, • ` MN ` . , Nameorf GSM Ss 3 - x ��jjY of Building: (check one) , ` � 1 or 2F f Vinage No. of Bedroottt, : p City Publics (describe use };,, ire ; e o State -Owned .Road III T j e of Permit: Check . one box on line A. Check box on line B if applicable) 36, , q. 1 9 , 0 2.O A. 1. '' 2. S Replacement 3. �� of 4. S. 6. 0 Addition to ,,.. Number khCiati . S Date Issued la ❑ A Sani .1 it was , .. ,., issued IV. Type of POWT System: (Check all that apply) g Notivrtssurized and 0 Mound 0 Sand FiUu 0 Gaped Wetland A fn- ground 0 Holding Tank ❑ Single Pass O Drip Line t V. 0 Aerobic t Unit O'- • Other. u v I ► tment Ares at atton ... � _ ��tat�� ! 1 � Required Rate ' � it.) t) . w -.- ..:: _ �� . ,. . 9 L I f , v VII, Tank Capacity in Total Manufacturer Prefab Site "'�_' Plastic ' - r► Information Gaflarct Gallons „ < Om- Con- 1 New Existing «etc sttueted Ink e 16 O- 0 0 D ' liliM VIII. Responsibility Statement 1 the wade , _. assume -1 ill for _, the POWTS shown on the attached Phnabm'a Address City, Coda) -� idtilinill' - i 5 -- to - Si I %0 9 l'Ke At,, .Q, N .Q....., c� mond. , t„a.1 Z yD 17 IX. County/Department Use Only � 0 Disapproved Sanitary Permit Pee (Indodes Groundwater Date Issued Determination Initial Adveraa I Pee) isp + i 1 X. Rion o M` 1 4 t Approval /Reasons i D pprovaf: � a r ' 41s Avjo3E; s «,o._ a w i , 0 J �� p . / P z. saA -1-6d- tkc s k al>o h s.4-.. - ' E . 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I - - I t i 1 1 1 1 i i , 1 ■ i. 7 1 I 1 • j , I I j t. • 1 1 1 . , _ I i i l i i ; 1 i { • } • , 1 5 . • • ; 5 I y i ■ , I • 1 1 • - a i l i I Wisconsin Department of Commerce SOIL AND-SITE .._EVALUATION Page I of 3 Division of Safety and Buildings Bureau of Integrated Services i n accordap a With S. ILHR 83:09, Wis. Adm. Code " \ County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size PiAn mum include, but not limited to: vertical and horizontal reference gbint (BM), direction and.' S-1. CrO l y percent slope, scale or dimensions, north arrow, and locatf and di a to nearest road. ,� t t �e -- i Parcel I.D. # APPLICANT INFORMATION - Please print allinf trmaticat ( ` Rev' wed by Date Personal information you provide may be used for secondary purpose4P.rivacy{90.05A 6Em)) f a A;���� . Jyf / r /// [ (oj Property Owner , �(` �a � ,' Prope tyWc e~a'tion '"Ct trci Siou -� .. ,. GovtJ NE 1/44A 1/4,S 3( T Z ` �/ ,N,R { et (or)0 Property Owner's Mailing Address Lot # Block# Subd. Name or CSM# • I. 3 AuKi+ &kee- - Tr. Z3 Ccf-tonwood Qtdge_, City State Zip Code Phone Number ❑ City / ❑ Village Er---Town Nearest Road 14udson 11.x..)1 1 S 4OII2 1 (115 )5' -to i / t Il 1rsnr) 1 t'oi-bntAraoct 1-r ew Construction Use: Residential / Number of bedrooms 3- q Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow 0� d • 7 bed, gpd/ft . 5- t rench, gpd/ft y gpd Recommended design loading rate gp gp Absorption area required 4'51 bed, ft 1 5b trench, ft Maximum design loading rate • -7 bed, gpd /f1 . g trench, gpd /ft Recommended infiltration surface elevation(s) Wet-- K90 Lor,J Cr" 9: 30 ft (as referred to site plan benchmark) Additional design /site considerations A L / - . /nor, Act. .Sysfew e/2 v. ?3,5 - 0 C-vn ,,r el, u• 9Z•S Parent material ((Q ((Qf a, 9-( 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 ®'S 1' U Ikl' S ❑ U ?1 S U © S Q U ❑ S al 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 I a -y /v■fr3 /Z SL Irnahk in-Pr- LS a • 4 ..s- •`f 1 4 -L10 /0yr L/ /q _ S I 1 mt.( bk. m-f r c 5 -- - 2 - ' - 3 _ ,, 2- Ground 3 90-0 16 L rLI i& IrY1 OS5 m t CS • . �' •1- elev. J Q1,9Oft- Depth to ' limiting factor a U 1$in. 'lb \ ' Remarks: Boring # I o-fz. ley r 3 /Z Se I /C 14A.-cr CS (c • / ; X •4 Z z-`/ to y rail 4 1 — _ 5. 1 I iJ / • rv�Cr' CS . Z .. 3 .Z 3 , a -1l$ 10 , i/Ce -- yvt 5 O s m t C S . - . 8 Ground elev. M0 ft. _ ' Depth to , limiting ` L factor HI in. Remarks: CST Name (Please Print) Signature Telephone No. ►4c.a Sbwm",k -er --- `7i5 04/7 -Y00.S- Address Date CST Number q r Ce- ce -r 57', f-/ _c7,...,--,..-4-,,,,_ s--7 Z-s' 47' /S' - ZS s c ? I PROPERTY OWNER Si u f SOIL DESCRIPTION REPORT Page ' - of 3 PARCEL I.D.# Boring # H orizon Depth Dominant Color Mottles Structure '.4k D /ft 9 Texture Consistence Boundary Roots ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 ( o -tz to 3 I - S L I rry bk rnfr C5 . y .5 �{ 2 - ►23( (O yr 4 (4 — S; I 1 mablf_ rn-.;r c,S — 2 .3 . z Ground 5 %-112 10 1tQ mS 0S5 mt c",S elev. f4_ ft. Depth to limiting factor 1tLin.�( Remarks: Boring # I O -% 16yr3IL L. )rnahtt mfr C5 . 4 •5 .' `'/ Z 2 -. t0 , fr y 14 -- S i t \ mclbk r fa' c_5 -- 2 3 2 34-4is t3 yr Li 14, m3 oS5 • t c.S 1 . it' Ground elev. 9y, 2aft. Depth to limiting factor _115_ 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 # 6-lS Ip p 3I Z SL I rnabk far L5 ( � .4 ; .s S 2 is-s5 k3 hII4 LS \mS mfr c — $ ,} 3 � 3-co� toyr51 CZp1.S i(f) Si 3mv"c me--C; C5 n'P fv0 — Ground elev. - gt,SDft. . Depth to limiting factor Remarks: Boring # _ ( b —t6 lOyr X1-- St_ t mabk mFr c S l 9 5• `( b io-s, t t7 y r " 14 S ►) 1 i nabk fl r c S 2 .3 2 3 543 I U y r 91(D ,M S O S c`c) .l C S . l • -4 ' Ground elev. 91.ya Depth to limiting factor 116 in " Remarks: SBD -8330 (R. 07/96) y5ric..(t 1 = /00 nc4; zo _ pact ,' ^ (.- " or.A. I� J ?. f.lev. uP -r- qs: f0 sys{e,%. v £owe,r9 e ii , A._ 4 / 3.5"0 Contour etev. 9 z. SO L L C r 5tcP 510 118"t 13M1 z • • • - • 132. � r . . • .... ......-- .... ......_ .. . ................ ... . .. .-.—......—__....._.. .. ---...- — . • _51 c 0 . - . d o . • .. . ,,...$ . . . ..... .; . . • ...c. , 5 , ('-y .....0 . 0 D Z 0 3 .• ' --. >S11 ......u. . i 1 :g 1 • .r. ...... ...,5 - 8 • : 1111111111111 • • - 0 t • - - 2 x 6 • 41 'le 3 . 1 ..........,_ ,,, g .2 . , 63 • N-- Jo 1) ta * •••• n .... o) ,- --a E . x . c i l 1 11111111111111 G Ti 1 6 C (1). •-. . W w 43 (k ) I. tn (.4 ..c (.). cy - cv 0 -. IIIIIIIIIIII "i . 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C3 C3 _________ .- 01 \•••-- it Y ••• • s . il l ILL a s 0 • {---- to ) i • 1 "v`i -Y-. • • * 4 •+? .: l a` " ..1 • t . t c..• i 1 '4 k • .:.% • ' * I . .., i - -y VA U LM £v.i( me Ili 400 40*b ST CRX CO ZONING 1001 Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Aden. Code each Private Onsite Wastewater Treatment System (POWTS) shah 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 3g3 $ti f q Number of Bedrooms y Design Flow - Peak (gpd) pp Estimated Flow - Average (gpd) y Septic Tank Capacr (gal) / a Soil Absorption Component Size (ft 5// 4!-( 2 - Sr drwt'ck Clum..N ,w Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Corn t Sod Absorption Component Design Flow - Peak (gpd) /a 3o a .S'/ -i Pi- Maximum Influent Particle Size (in) 1/8 Maximum 13OD (mgr-) 220 Maximum TSS (mg/L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 years Outlet Filter Inspect once ayear and dean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tapk The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stets. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code Sery t iCa Septic or Hold Tanks, Pumping Code ( Servicing eP log mp 9 Chambers d e Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches. Privies, or Portable Restrooms). The operating condition of the - • and outlet filter shall be assessed at least once every 3 years by inspection. T outlet flit shall be leaned as necessary to ensure re.uziparalipn. The filter cartridge • . 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 05/02/01 WED 10:27 FAX 715 388 4686 ST CRI CO ZONING • • Management Plan for a Septic Tank and Soil Absorption Component fitter is equiped with an alarm, the filter shad be serviced if the We nn is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shad 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 maudmum 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 shad be sealed watertight upon the compietton 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 acdderttai or unauthorized entry into the tank. No one should enter a septic or otter treatment or holding tank for any reason shout bung in MI compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gasss, and rescue of a person from Me interior of he tank may be dot 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. 3ni1 Absoretli e 2011 Nnt 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 sod 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 shad Iri ide 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 wirier 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 perticularty during winter months. The compaction or removal of snow cover over the component may lead to hyic {allure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair rental weather conditions improve. In general. soil compaction over this component will reduce diffusion of oxygen Into the soli and dispersal cell, which may lead to more intense, and earlier, organic dogging of the sal. 2 ST CROIX COUNTY - SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 44AL-A 4440 MO t-Ly / , 5 7' . C o tu 4G4 Mailing Address 15 O 1 uG--N 7'i t i . c S, friA.1 553 4 3 Property Address XX #/ c-Alii G6 (Verification required from Planning Department for new construction) City/State M'o so, (,vr Parcel Identification Number 02 - / 3 - Z-77 —O CYO LEGAL DESCRIPTION Property Location / V,, A /c- A i 1, Sec. 3fO . T Zq N -R l9 W, Town of guo s o Subdivision CO Tr O o Q 0 c , Lot # 2 . Certified Survey Map # , Volume , Page # . Warranty Deed # 64c-i 3 t ° r , Volume `jO ) ° , Page # yd 3 . Spec house 0 yes 4po 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 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 pl1mber, 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 o e three ear expir ' on date. S- d / SIGNATURE OF APPLICAN 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 pro rty described above, b virtue of a warranty deed recorded in Register of Deeds Office. s viol )„.....(24of 4-. 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 the certified survey map if reference is made in the warranty deed 05/04/2001 14:14 7153861650 DERRICK NORTH HUDSON PAGE 01 • STATE BAR OF WISCONSIN FORM 2 1998 Go. w` Mt 6. + • WARRANTY DEED KATI*LEEN H. I ALSH ST6 xOF DEEDS Deromera Know VOL �.0 dF�cE 403 RECEIW1 Fait RECORD This Deed, made between 05 -*2001 10,30 AN Y DEED —Sesba tee',— �-�"""^`"" `i�, -- CrenrM, V T I FEE: and _$C _ - = w _Arno, TRAMS FEE: 170.70 husbancl ten W P , REMIND FEE: 10.00 : 1 Creme. Grantor, for a valuable constderatton, conveys and warrants to Cran ee the roltowing ' • described real estate in ...j . Croix -. County, State of Wisconsin A. Lo Plat of Cottonw d Ridge, Town of ''` " "' "" udson, St. Croix oounty, Wisconsin. Ne"1e Sad Ratan Address f�fyy Grantee, its successors and assigns hereby &a /" Q& " y •-``"-a`k agree that a single family residence only will be Constructed on the subject premises. Oatl X 353 - 23 - Waco.+ wrlllt� This is not homestead property. (s) Rs not) Exceptions to warrantee: easeMents, restrictions, rights -of -way and covenants of record. Dated this ,'6 _ day or Ap' 1 — , viol .L1111A+4i t `"1 {SEAL) *1P-'1- P (5t,AL) • R1r•hsard n q*•nut _ _ • _ Jane t „, Stout .,.._ . (SEAL) _._ (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(e) -— State of Wisconsin, ss. St. Croix Coun . authenticated this _._,._. day of Personally cent before me this day er ADri.l . 2001_, the above twined Ri her an _ P,, Stout TITLE: MEMBER STATE BAR OF WISCONSIN - Or MO known to be +1' • - .,RUJ Oxecuted the foregoing authorized instrument :”, • I . IM €ONSIN authwl:ed by706.Oti, state,) KEANON J. BAST This INSTRUMENT WAS c3 AFTEO av - •"!r' Janet P. Stout 1353 Awatuk. 3r. • r Hudson, WI 54016 Now, Public. SttASaf' - rain My .omm!• 1- Is -. low, (If not, state expiration date: (SSgnaturaelray be euth O - en1.$tad or acknowledged. loth are not ) necessary.) . 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