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HomeMy WebLinkAbout020-1353-29-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division 1 - INSPECTION REPORT • Sanitary Permit No: 399653 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: Abramowicz, Keith Hudson Township 020- 1353 -29 -000 CST BM Elev: Insp. BM Elev: BM Description: /o4 / S r-i I.re 4e-9 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �(t� Benchmark - ��c �i Io 3-3 ja3.?/, /do Dosing Alt. BM - , _ , - G 42.-.5 - Aeration Bldg. Sewer / 9 / b f3.7/ - Holding St - It Inlet (� m /'2 /o 13. z- 9 TANK SETBACK INFORMATION Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom -S / e 30' - Dosing Header /Man. e-- Aeration Dist. Pipe� pp L i f 1 i G�t Aekioe• r A 9 f- 7 7. Ho Bot. System 1_ ;LP t L I� le PUMP /SIPHON INFORMATION Final Grade � facturer Demand St Cover & -11` M I /. 2- 11,11 Model Number TDH !Lift 'Friction Loss System Head ITDH Ft For -. ain Length Dia. Dist. / SOIL ABSORPTION SYSTEM I, pL , -s i .P._ BED/TRENCH Width Length No. Of T renches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS / /D (P,7.' 2.. I SETBACK SYSTEM TO l P/L BLDG WELL LAKE/STREAM L Manuf r. INFORMATION e "R L /1 1 �r�4_ 1 4) . Type Of System: r . Mod l SN �� t - 9V 5tOer,J r(Lleve" DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake 1� / v p Pipe(s) / I / Length i D 1 Length Y r ,) / Dia Spacing ± .eiQr 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 E No 0 Yes El No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Z,/ ]. In z Inspection #2: / / Location: 669 Louis Lane Hudson, WI 54016 (NE 1/4 NE 1/4 36 T29N R19 Cottonwood Ridge Lot 29 Parcel No: 36.29.19.2029 1.) Alt BM Description = '°Y 1)Y ,,,_, 1 64,E c I'J0 well AI `�t 2.) Bldg length 3p �) S Bld sewer len th = °w�^o� y �v-�(.5 .�� � /�e �1 r fr, - amount of cover = > // 3 /),`� �� /a-S d /K �� Z /[q/ z �o Ct / /e 4 a I ke ‘�'. ., 1 , Plan rev ision R e es 1 Use other for additional information. L_Z fJ _ � 1 Date Insepctor's • lure Cert. o. SBD -6710 (R.3/97) 66? l • st-66 . 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 U sconsin Personal information you provide may be used for secondary purposes Madison, 4 W1 537,27-7302 Department of Commerce . (Submit completed form to county if not [Privacy Law, s. 15.04(1)(m)] 4 t eon' ?, 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 State Sanitary Permit Number ❑ Check if revision to previous application State Plan I. D. Number S S T s 3 ` / 9 6 s - 3 ' I. Application Information - Please Print all Information Location: (,,&. cj L ` ,,,e o L a ,,,,,,,_ Property Owner Nome Nome Property Location / / d 4 - ) `+C gl.,../..., Lk- 1/4 N1 /4, S3 ( T,2 9 ,N, R/ 1E (or Property Owner's Mailing Address Lot Number Block Number //v l0 G C 124. .- .39 4ypeofBuildrn: 'y, State Zip Code Phone Number Subdivi ion Name or CSM Number ( a 4 ) CZ 1 i,,) c cl I ; c%„r,__ (check one) . t �wi`t+� �otaa2 i , — ❑City ❑ 1 or 2 Family Dwelling - No. of Bedrooms : Z ❑ Village affl ❑ Public/Commercial (describe use):_ . - Town Public/Commercial O ❑ State - Owned ' a f ' n r �,� � �EQ �_ 'N s oad k/e i! (2) 3 I clicSUlXs � 0 20_ /3s- - 8. ( I Raroel Tax Numbers) ( limp III. Type of Permit: (Check only one box on line A. Check box on l i B if ap 7 ,3 , , Z9. /9, a,0 &9 A) 1. dal New 2. ❑ Replacement 3. ❑ Replacement of '. 4." 47 C►igx 5 . 6. ❑ Additi to System System Tank Only ` A �tArrY Existing System B) Permit Number _ "�'' Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) - Z 4- in l `' z '. . , to Non- pressurized In- ground ❑ Mound 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 v ii. System Elevation . mal Gra e Required Proposed Rate (Gals day /sq. ft.) (Min. /inch) Elevation «S0 3 - 2s " 3? i. /, z 90, 9 VII. Tank Capacity in Total # of ufa rer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks 0 0 0 0 /060 1000 y_ ❑ ❑ ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown o , . ched plans. Plumber's Name (print) PI is Signature (no . M'f, Business Phone Number fir/miss G.-.,14 V , 1 zz / I ?1.; 20- 6637 Plumber's Address (Street, City, State, Zip Code) .37 7 14/0 '7 S7 Afr)-e. / k'..Z svov / IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued I uing • gent Signatur= (No stamps) ,Approved ❑ Owner Given Initial Adverse Sur harge Fee) d )j • 03 2 -)Z - .. � Determination L. '_ X. Conditions of Approval /Reasons for isapproval • L • / a �j Q _ 1 O /, N, i. • . is el f , , `4"`,t_ , l i i I , �� ►�w�.0 -r�V' S SBD -6398 (R. 07/00) n U1.1„ .., .../.14 4.14i �/t S367T.z9Nx1 w , t . '07'.079' . _ ! i , 22 7 . �` .` •i, 1f / go, g ' 5 . 69'e "6.y i / "- Sao / Z 4/00 idi4 14 RP 4./ii I* 6 °' ) --- - . "A C s ) =1°1.141 --- - 41 tmaea 14 c2,44(.9 ---------------. 30y, 37 • ( 1 \ \ \ ‘9 , - . 10,1 -6 (/e Z as` , .4i ' , kl ti 11 / 71 t \ tO V 3Gz, gZ . e9...0.44._-.....141,4 ,I 6 T�/Gn 2z/4/7/ T) _, L i . • ' / i " /-e o22 7 1 - NI I 1, f 5'0,, / S 69 / 6., 5 7 Zatt-e Ame /, Z3-Prt / u -.: - qo / v,,,, Li ) )4 R(' 6.m ' # ter 6 AA. 2 CAP ) _ 1 ) , 0) 47i tmora 14 CewkCe. ) --------=----- 3 37 /�d). l� : J 1 (1 . t(9 17 4 \ l \ 1` ■ I:1 , .1 Gbt1J G \ 3G 8'z 1 2's -It Wisconsin D epartment of Commerce SOIL EVALUATION REPORT Page / of / Division of Safety and Buildings f in accordance with Comm 85 J40/S. 'Adm. Code County 5 CRo' y Attach complete site plan on paper not less than 8 1/2 x 11 inches • cite: PIa usll�. -` include, but not limited to: vertical and horizontal reference point ,directio 'il frg Parse I.D. c . percent slope, scale or dimensions, north arrow, and location an diiStence to nearest rot 0 � 13 5 3 �- ? 7 — 0 0 0 Please print all information i f u ,., Re i d by Date ( Personal information you provide may be used for secondary purposes (Privpcy Law, s. 1tQ4 AAA- V Q3 / Q , 2 - Property Owner P�r�ation �; -L 4 8ZA E7 w i c--2,... Govt. Lott 1/44 1/4 S 36 T a9 N R } 9 E (or )2) Property Owner's Mailing Address Lot # Block # ^., Name or CSM# i 1 to * Ciro'. x 0 e; ' 3 A Cp u o -1,... City State Zip Code Phone Number ❑ City ❑ Village 5 Town Nearest Road 4446 , 1 \tI5'I 1)It. 1 (71.5 )3V -8 YIP, . Ned SovN 1 I..oi.'s G PO�SI 51, New Construction Use: lij Residential / Number of bedrooms 3 Code derived design flow rate y S a GPD ❑ Replacement ❑ Public or commercial - Describe: , Parent material Jo+lr,...$ S 04.) e took t...)4. < k 11 M , ; Flood Plain elevation if applicable ft. General comments . • "< - and recommendations: M 1 54.),55€-+ :► a -' L. $,75 7geh1� N 6,5 r c 's or-. rte.Ry,`}-p� r, 5‘) r' I 4 / e l b i. e - 4+ 9O.7 a' V . F+ ni ay 1 3c.. nee-4441 • Boring # ❑ Boring (� M Pit Ground surface elev. / . 9g ft. Depth to limiting factor / oC.D in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I 0 - R ► oy i z 4 / 2 --- -..._ ---- , 5 ; L. ( IF & t2. ds t. q 5 a F . s • V a 9-to J o `12aia .,.. -- - -- 5 i L., a F'5 b- d 5 4, L i f • s .11 3 aD •` 1 f ( / 1 Ft5 .. y ow Orb bit A ac..., /of • s .9 5 /841„. 7 /v '5 ,0 -S i. C , — . .7 I. A. ! 5 t►sla5 - 7,51 AA/4/ -- a 5 o► L- -- -- .1 I. A 44- qo .io' . Boring # Boring Pit Ground surface elev. 94, c. y ft. Depth to limiting factor HS 5 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 a -li ►D1 .ill ----�. S; L C2 F G 12. d s L 4$ a F , 5 • s a if.-t1 i iiZ . - 5 ; L. a F 6S c L AA 1e' . 5 . ri 3 11 -a'I id1izs /3 5, 1. AF6b yz., •- , a� Ni dV - ya. )o 1RN - ,., 5.cis sb p cli,, G 10P •'I . to ��, 5 '`I-4.1 )c,Yity � F IF' � '3` 1 7•51P. I m512 k a° — . if . -- - 5 7,sl h •_ 5 0.55 �. i ill /, a • c. tot. pk`k * Effluent #1 = BOD, > 30 < 220 mg /L and TSS >30 < 150 mg /L f fluent #2 = BOO, < 30 mg /L and TSS < 30 mg /L CST Name (Please Print) Signature CST Number �Da n 14 . S . . -�' 1 ,,. oat 174 k r Add s� a tq't0 .:p Si' , l.. • i Date Evaluation Conducted Telephone Number 5+�r e* .1 It. i, 4. `Iv a � I I -1 t --b I - 7 I5 -A4 g -35 5V i Lt) s SBD -8330 (R07 /00) I r - Property Owner A 5 1 IA A 1 C Z. Parcel ID # Page OR of 9 .3 Boring # ❑ Boring , ® pit Ground surface elev. 97, I a ft. Depth to limiting factor 'a( 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 1 a —Ib Iolr /a . - - L aFCrz dt1. '(s ,* ,s . 8 ID -a) Il01ia-iI1 14 1!"" AmstA a Ak Gw 1F . 5 -51 a1 -31 7. S`f N .. -- -----• St- 4 a b le- 6161 c L t 1 F • 5 , 9 t 3I -4f 7.5404 --- 5 t - a P5 b 14 - fg' li AAA.) Jo F ,S .q 6 f9 -1ey 64 g.74 a- -----• 51— 061214 ASIA Cy — .5 q 45-►aD 1.510/Y qo �U 5 0 ell. --- -- , 7 1.2., r l Boring # ❑ Boring /17, 1 Pit Ground surface elev. at) ft. Depth to limiting factor 5 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 1 a — tb I 01 (4 ' / L F6(2.. ds><~ aS o f ,5 . S )b -) b iolie 1Y H I- arAsbvt ells Gw I F r 5 . 3 I6 -a1 7.5401 ` t. 01 " A VN c.,j I 4) F • 5 .9 I a7-40 1. s 1 Ri1 4 -.-- 0 rI tr c.w ,F a ? /.2 $ wv-Ia5 l*s1R.$)y - . S b -s el i_ --- — ,/ i. ).. •4- / & (U. B oring # ❑ Boring S pit Ground surface elev. / �y 4, 9'7 ft. Depth to limiting factor /a 0 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 1 0 lb -1 Va -- -- 5 L.. a -F lst. 45 aF 13 • a 1)47 751RJ!I .- - ---- -. sL ar-- t AS1i Cw IC . $ . ; 3 a7 -34 7,6M1e.#j -- -- s 45 — 55 a ot L 444, tt> f , 7 i. 2.,. 9 39-Q0 7,518.44 - ..----- 5 0 - 5 % L -- a 7 /• 2. . q •4 `// lo4-4, y * Effluent #1 = BOD, > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD, < 30 mg /L and TSS < 30 mg /L 4. v The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) I - 2 - 7 —‘ 16-- / --1 -----. 1P ' Ni -1N tjT IQ,, `ec,,Ic � t - Vo M' cat, 7 L ? r (9.05s 1 N) , : i ` '�'� ` -- - if ' n c , 1 \ : - . 1 _ ' i e- \ b. ' __ 6 1 ‘ \ ' , ' 1 $ 0 ' ISL SA 4--. i - 41-:— . '1 it \ N., , ... Z lr I °Per % \ I I \ ‘ i ..., . .i1.011,. , , 1 s n `-� clica \ k) ...t.!: N, lie ISI 1 - ( h Iti K i o Z, pz - 4 I / i 1 aw area.. (M0. °ut�1 l v m 1 r „.... k 0 Ne:: :, L. e s} hti ----1° $M 1 / 1 'etN r`-“--'44-s^%-e- , q of . '� Sfi�c� l � L aS"� � vcr - �-' � �5 Mgr Ma. l ot -i / bYY1� - Gc r ^ c.. . 5- L B t 97, 98 8 q�,: 1 c7 d eLt Q c� (� s B5 /logS7 B3 97,12, • • • y • i • t om -. • P i • • • 1 ....- r 11/15/01 .17:34 FAX 17152467227 HALLE BUILDERS 06 g?4,4 ....,,,, , , . L ._ _ gtv . , ....._, • 1 .......... ....---_____,..._ _011,„ _ p 4 ..,.. � � - `' .. ci. ---- __. 66' PRIVATE �►„ z _ ` . I .L.: : 1001. .. • RQAD �4 .f --- -- c • in i L4. 33 H.W.L. It ii, r ............ i 2063 ACRES 1000.5! s t t _ _ . _ _ , 6 49:8+68 S�.FT. I w r . 4 i 28 j ` i 2026 ACRES i + _ 88,258 SOFT. N 1 • r t ! ,, N89'24'11 "E • 1 r it• i m - -- ---- -_ - ' t • 1. u ' i RE'S . yQ fl i 2.0 AC 3 1 C L' i 89, 6 4 1 .S Q. FT . �,i .W. of 9 92 a i . ( HW.L C O i i t IIUI }" 1 C I i Z 1 I R I �; L _ 'V 352.82' _ 10- Try` - L3-22`PC -315.48:- 1 ig i I 30 o' I ` 1 FA 1 50' 2.055 ACRES 31 i ` z i 89,534 SQFT. L , 1 .-1 Cl ! 1 ACRES � In i 33 33' a i '3 . ,4, 1 TEMPORARY CUL -DE -SAC N� a jam• _ _ - - NOTE: 1 i I CUL -DE -SAC TO BE REMOVED I 1 i UPON ROAD EXTENSION i 1 1 �G � - --- 1 1 • - � 1 _ yam , - - - . _____° S 67'19'22''V 356.74` • ° 3 -- !I yam - 1 i / ! l "�z- / i l � ---� 1 i I i I • � 1 t 1 . I 11 I p ' it s, • POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of Z " FI L E INFORMATION SYSTEM SPECIFICATIONS Owner g /ff Septic Tank Capacity ❑ NA /r/ �o o p gal Permit # 39 6 C-3 Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer z 4/00 ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model A/00 ❑ NA Number of Public Facility Units Az NA Pump Tank Capacity .�— ga l ❑ NA Estimated flow (average) Sop gal /day Pump Tank Manufacturer ANA Design flow (peak), (Estimated x 1.5) 6 . 86 gal /day Pump Manufacturer f IS NA Soil Application Rate -- gal /day /fts Pump Model gi NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit RNA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L I n- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu/100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: `0. NA Other: ❑ NA Other: •Q NA *Values typical for domestic wastewater and septic tank effluent. Other: ANA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: month (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 3 ❑ l 1(s► (Maximum 3 years) ❑ NA g Y ear Clean effluent filter At least once every: 2 ❑ month(s) ❑ NA ' [, l$ years) Insect pump, pump controls & alarm At least once every: ❑ month(s) �NA P P P. p ry ❑ years) ❑ month(s) Flush laterals and pressure test At least once every: ❑ !ELVA Other: 0 month(s) 9,NA At least once every: ❑ year(s) Other: ta NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the 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 (Y 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 chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, 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. GMW (4/01) Page of • START UP AND OPERATION ' For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater 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 avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator 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 tanks 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: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits 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 fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ 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 suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil 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 IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INST LER POTS MAINTAINER Name 0�,y POINTS Phone 2/ ats; 6c 3 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name S'T cce44 (6 ZOh,aq Phone Phone 7/5- 3 vo EA R. / This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC . ANK MAINTENANCE AGREEMENT AND OWP CERTIFICATION FORM OSvtter /Buyer — ?` %t 7 SJ tCC ) � r 1-t) iC� Mailing Address Jo° i- r , # Property Address (Verification required hew i Planning Department for new construction) City /State , Parcel Identification Number 0,7q - 3S.2 2 5--. c_, LEGAL DESCRIPTION Properly Location lir _ 1/2, .k '''/ Si c. c , TZ_,,.N_R./ 9 W, Town of Subdivision on _ , Lot # Certified Survey Map # Volume , Page # Warranty Deed # 6e_/ q / 3 Volume SOS Page # Spec house 0 yes At no Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof your sal pc system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every thr'i e year or sooner, if tse ded by a licensed pumper. What you put into the. system can affect the function of the Septic tank as a tits imeut stage in the waste disposal system. The property owner agrees to submit to St, Croix Zoning Department a certification form, signed by the tamer and by a master plu nber, jou neymanpltsmber, resirictedpl tmber or a licenaedpuxapor verifying that (I) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after in:'peetion and pumping (if necessary), the septic t&»k is lase than 1/3 full of dodge. f/we, the undersigned have read the above requires etas and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Coca' tierce and the Depart:uont of Natural Resources, State of Wisoonsln. Certification stating that your septic system has been maintain I must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. / /Z / /Y /a SIGMA • : OF APPLICANT DATE OWN_ GER CATION • I (we) certify that all statements on this it km axe true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property described above. by virtue of a wawa ity deed recorded in Register of Deeds Office. _ t Z_ //Y/ SIGMA OF APPLICANT DATE ** Any information that is mis- represented n ay result in the sanitary permit being revoked by the Zoning Department. *****• " Include with this application: a stamped warr ltrty deed from the Register of Deeds office a copy of the ci rtified survey rasp if reference is made in the warranty deed f !d • STATE BAR OF WISCONSIN FORM 2 - 1998 KATHLEEN 3- 9 I. WARRANTY DEED REGISTER OF DEEDS t i ( ; ; 1 50SPpf >_ 515 ST. CROIX CO., WI Document Ntxnber ' RECEIVED FOR RECORD This Deed, made between 04-26-2000 9:30 AM PICNABn 0 -STnTi - — 1 YRRRANTY DEED husband anA wifp, EXEMPT fi , Grantor, 1 CERT COPY FEE: __ — - - --• and KEITH J i e • ' . • , __ COPT FEE: - .. TRANSFER FEE: 167.70 u a .. , . _ .. • • f a , RECORDING FEE: 10.00 - PAGES: G rantee. Grantor, for a valuable consideration. conveys and warrants Count to Grantee the Wisconsin: ng described real estate fn St . CSOl y' Rricord; A,ca Name and Return Address Lot 29, Plat of Cottonwood Ridge, Town of Hudson, St. Croix County, Wisconsin. r r L e-- 020- 1353 -29 - 000 Parcel Identification Number (PIN) This i a oat homestead property. (is) (is not) Exceptions to warranties: easements, restrictions, rights -of -way and covenants of record. Dated this 20th day of - APRS T. • 2000 © . S c h - ex � , ' (SEAL) ( SEAL) *Richard 0. Stout • Janet P. Stout _ (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, }ss. St. Croix County Personally came before me this 20th day of authenticated this day of APri 1 000 the above named Rirhard f) Stntit a nd Janot P_ Stout � o TITLE: MEMBER STATE BAR OF WISCONSIN ' ' Y routed the foregoing ( not, instrument and me known to_b S C ONSIN authorized thorized by §7(16.06, Wls. Stars.) ' R ON J. BAST THIS INSTRUMENT WAS DRAFTED BY /� , Janet P. Stout 'o , ' 1353 AwatukeeTr. Notary 'ublic, State of ensin Hudson, WI 5401 6 My •mmission 's perm.ncnt. (If not. state cxpi 4t o fiate: ) (Signatures may be authenticated or acknowledged. Both are not necessary) , • Names of persons tieing In any capacity most be typed or printed below their signature. . n iseptsin legal frank Co ., Ic STATE BAR OF WISCONSIN W Millan C o. I c . WARRANTY DEED FORM No. 2 - 1998 p el / f C14-- 5E t 4e2fi Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page 1 of 3 Bureau of Integrated Services in accord,p4 riftli aILIAR,.88,09, Wis. Adm. Code Attach Qsinsiz , : -F tom lete site plan on paper not less than 8 1/2 x 11 h ' 411 njust \ County p p p p include, but not limited to: vertical and horizontal referent ,point (BM), fitrebtiob AN i \ S , C rU1 x percent slope, scale or dimensions, north arrow, and Iota ib r� ind distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print aklanformatidn� � . ,` R � . b �� Z Date Personal information you provide may be used for secondary purpos�s i m)) ,, �+ Property Owner \ Property, tion I R ■or\ox SA-ou} - . - ` poy N E 1 /4 1/4,S T l ,N,R i et E (or)0 Property Owner's Mailing Address I of # Block# Subd. Name or CSM# \353 Awa - I - U e 1 29 en-1---1/2-on w moo. Q,d. P, City State Zip Code Phone Number ❑ City ❑ Village 5, Town Nearest Road k-VAdN)n 1 h11 15`-lotio 1 (115 )5q-Iq -(0131 4-h AC15nr� 1 1].New Construction Use: ® Residential / Number of bedrooms 3 `1 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow `p CC) gpd Recommended design loading rate . 7 bed, gpd /ft • g trench, gpd/ft Absorption area required S51 bed, ft 150 trench, ft Maximum design loading rate • 7 bed, gpd /ft • if trench, gpd /ft Recommended infiltration surface elevation(s) 70.70 ft (as referred to site plan benchmark) Additional design /site considerations A44. 9!. S Parent material C 1 6 U4 - v\it,KSh Flood plain elevation, if applicable 9 gat Aid. -. it S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system II1 s ❑ u C7 s ❑ u ©s ❑ u ®s ❑ U ❑ s ®u ❑ s Z 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 1 0-25 10 yr 311 — Si 1 2 mabk nor CS 1 -C . 5 (p 2 v -y$ 131r 414 LS I mn m 1 C5 — - ; , Ground 3 yg 12b 1Uyr -JIto tn5 0 m I CS _ .1 . $ elev. f/.70 ft. Depth to limiting ' factor 1 2o in. lk$ $ `' Remarks: Boring # 1 o 10y r 3%1 Sl' I 2 rrtabk mfr L5 1-C ' i • c 2 2 tQ 3 4o IOvr y /Lf LS I m -,9 m I c5 — • i • 8 3 310 -$20 Ip y Ito m3 O� _ m 1 S _ , ^l ; • a Ground elev. 91' 7Dft. Depth to , limiting factor 12c) in. Remarks: CST Name (Please Print) ignature Telephone No. A • Gt. AA SC- A cti, • e 7/S rco &— Address Date CST Number vo g -�- sA y ,p,s ei- 44../.4 ,_S 7,5-- - fi .� 3 7 1 PROPERTY OWNER 5 Cat SOIL DESCRIPTION REPORT Page Z of 3 PARCEL I.D.# Boring # Ho Depth Dominant Color Mottles Structure ry G D /ft 2 g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 i 0 -11 t0 y r 3i1 — Si I Zmabk mfr LS 1 C 5 2 )1 -3G IOyr 4/3 Si I Zrrabk m -1^r e5 – 5 Ground 3 310 -1zi t 0yr L-4 — r � I �S • -'[ . g elev. %tift. Depth to limiting factor tt ck Remarks: Boring # 1 IC)yr 3/1 -- 51) Zmabk rrSr (5 I 5 4 Z 13-3q Icy r 4 13 2mctblc yen c_5 : (� 3 3L1 -122 t3( ( -111,9 rr o m l c5 J - 8 Ground elev. ?YAW ft. Depth to limiting factor iZZin. 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 # 1 v - fz iwr 3(1 Si i 2mahk rn r C 5 1 5 5 Z 12 -4U Ip 4/-5 5; ZYTY11* M r C S • 5 (o 3 I�b (byr 41( m DS,` ml CS l K Ground elev. 9,S'7oft. Dept to 1P limiting 1 � � factor I Z(p in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) 1 ,;,,.. 1 ) 0 1 e - 43 alp , 1 I - 6U I nao r.► io oaK 3 6 X rivet I e►e v. /oo.6 roPo-C I °YRon p,,pt i1IL 13 elf v-. 6 1146 Sysr4r� city. 90.90 44-t. e_Iev 975 1 • /- - I c a S Pnm "r Y • ► Cif elf • 4.;""J • 63' — sols oz- I elcy:ggo 12/27/2001 12:43 7152483588 SUPERIOR AUTOMOTIVE PAGE 04 ' - -- - ---- - - ....., . _ /ill g �. ..l"' '� �:�� 1„ + --�- - 66' PRIVATE ' • Al • W,L. ! too1. - _ • PruAD to • p --�—. - 1 • I 1 1 • r - • _ , - S t 1 L8. • 33 • H.MI.I. ! r 5 • • 4 ` 2. 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