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HomeMy WebLinkAbout020-1441-85-000 Wisconsin Department of Commerce County: Safety and Buildfnc!oivision PRIVATE SEWAGE SYSTEM St. Croix • INSPECTION REPORT Sanitary Permit No: 453093 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: Bast, Kernon Hudson Township 020 - 1441 -85 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: /6 1) , O NC Lb./ C caru r '6119 l 36.29.19.2811 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic '' ,, ,, "� Benchmark (lam RI, c-P-'Y /..,S0 5, 3.§ /65,3,— (60, 0 Dosing Alt. BM al/ ov,4 blel�� e cc - 1 - b r 4 I D y1Ad - b tuw i (. 2c /D /. /d Aeration Bldg. Sewer Y �,p 96. 1 Holding ---_ --D---- St/Ht Inlet 9 95 TANK SETBACK INFORMATION 2 A -/06 r , St/Ht Outlet /0, t .5 f TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic I I 1 i N � T 3 9/ 3 9 f Dt Bottom — Dosing eader /Ma I — r ��of CEZrv�vl ii, ye `�3. Aeration ' , ;gist. •i• - Holding BoL System J Bi lI tt .54.44(-Q.- /MID 93. 95 Final Grade( ll F0_ f f ` � 0 PUMP /SIPHON INFORMATION 11 � 6,30 99. Os Manufacturer Demand St Cover j / k f t '�7 ,L.:ri G`t-ir d7i a - Model Number r '/l J ' rifrGPM t T,.,,.�. -- 1 �'l „,,,,,, (o.„. >_P) l0,zg ,5-207 TDH'Lift Friction Loss System Head 4H Ft Forcemai Len Di.. Dist. to , ell Ab -I- in SOIL ABSORPTION SYSTEM j' Cr lI3 a" BED/TRENCH Width Length No. Of Trenches la a--5 , PIT DIMENSIONS No. Of Pits Inside Dia. 'Liquid Depth DIMENSIONS 9 7 / n l4 S a 51.Z QGj _ SETBACK SYSTEM TO P/L BLDG W LAKE /STREAM LEACHING Manufacturer: . ,/ 714_ 40, INFORMATION CHAMBER OR Type Of System” / ` j,I h -� UNIT Model Number: J/. /al di , /_, 6 S I h 6 _ 'C, - DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake 1l !J 11 Pip - Length Dia 1 Length Dia Spacing "" SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center /' '/ Bed/Trench Edges / (a 1 4' Topsoil i (r! l :- -. lb No Yo�x.-- COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: `1 / 2,1 / oc/ (ill 6- Ins Location: 833 Wilcoxson Drive Hudson, WI 54016 (NE 1/4 SW 1/4 36 T29N R19W) Cottonwood Ridge 1st Lot 85 Parcel No: 36.29.19.2811 1.) Alt BM Description = � SP.wF%, e 0p O yy1 aA u,i dr - r- QLoti2 L(d I�'i � Ii ot o 2.) Bldg sewer length = 9 ' e n OT /✓ - amount of cover= Li 'tt5 ^ ty-s 1� ,C M. AA, 116 It ..--(14,t'.---iyi Plan revision Required? Yes No 1 1p i f -� j� b b �� l j � t� Use other side for additional mformatior' Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division County y-- j • 201 W. Washington Ave., P.O. Box 7162 5 / r CA ,/ 7 �(� NvN ans In Madison, WI 53707 - 7162 Sanitary Pen it Number (to be filled in by Co.) (608) 266 -3151 3 o 3 Department of Commerce State Plan I.D. Number Sanitary Permit Applicat' -- -- -- --�-.-_.._..... Y 1,..i in .�� In accord with Comm 83.21, Wis. Adm. Code, ersonal inform ion o E / E y y P may be used for secondary purposes Privacy Law, s15. (1 Xm) Project Address (if different than mailing address) I a 1. Application Information - Please Print All Information APR 2 004 �� we; Pro ' P f_3" l # Lot '8(oek Property Owner's Name UX1,U; ; (; CS� Prope y Owner's Mailing Address '' oo ` p /I erty Location 9 e A 0 !vi'h, $ t.KY<, Section 3 (O City, State Zip Code Phone Number �/ / circle one) �. 7 ��W �s � � a � T N �� E or W II 1 1 . Type of Building (check all that apply) 4 — Subdivision Name CSM Number s A i or 2 Family Dwelling - Number of Bedrooms - �= t f / s ❑ Public /Commercial - Describe Use f� jt (� ❑ State Owned - Describe Use ❑City_ ❑Vi I T iship of 11I. Type of Permit: (Check only one box on line A. Complete line B if applicable) p20 — F$ MX) 6 Z211 A. New System ❑Replacement System g Replacement Y ❑ Treatment/Holding Tank Re lacement Onl ❑ Other Modification to Existing System List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New Before Expiration Plumber Owner ilk '. e o ' 1 t' stem: ec a t at a s I =.r - d o - ffillfprff i Zi�t� AraattMBIIIIIIIIIIII Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soi ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter 0q,eaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (st) Dispersal Area Proposed (st) System Elevation o • S g 74 2, 3o VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank /` I C Aerobic Treatment Unit -.■■ Dosing Chamber VII. Responsibility Statement I, the undersigned, assume responsibility for in tailation of the POWTS shown on the attached plans. Plumbe 's Name (Print) Plum.: s Signature E gi PRS Number Business Phone Number Oaiet / r � • - a35 7/S -6z2 -6 Plumber's Address (Street, City, State, Zip oy .) / 11 11. County /Department Use Only Sanitary Permit Fee i tcludes roundwater Date Issued I ruin: Agent Signature ( J�1 pp, Stamps) 'Approved ❑ Disapproved 1 ,, Surcharge Fee) � L I n5D �_ ■ ,, I ❑ Owner Given Reason for Denial h ./ • !'s i - _ 1 __.,INN IX. Conditions of Approval /Reasons for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) C5:)� fr D � � 1 14 I - t .1, 1 O ) . tt.... a 1 ,-, \ . t '' t .." * F ( 4 ... 1) -.1-- (:--Ab t t 7 ,0` 7-1'' Lei(/h 2 /- — c e..)-2,(Afdki ',.JP M Jf1 — [41/L1 V II Y l - k_ /1 /o i �1 I (&' )... -,---.1%,.. \zo Ifir. 4 (1*. --i 0 IV t . til 1 '— —21 y 1 . , , .;. . ot 1 i CO Q � q d W 1 .. 1 --- i'" il \\ 1. t E Ni , .t t , * call' o 4 tt 1 _____. ,c ,5_z .,3, F I . , ),= k l t 1 43 1 4 C7 W :\\ c) �p 1. 1 ■ X-� ZL)\ � 1 • )■- -,....% \ a Tr- ---- t ' tq P,,,..7-E57 or Go T /,v Ateto G4-RE , - 4• o N oP /1 - & -- " k / (/ Ai 1,- /J O 0 o ., . , W6onsn Department ofCommerce � �i SOIL EVALUATION REPORT p age / o f 3 Division of Safety and Buildings Q in accordance with Comm 85, Ws. Adm. Code r eon,riy C/` D it - Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel 1.0. o 10 . percent slope. scale or dimensions, north arrow, and location and distance to nearest road. / / 7 / .5' Da Please print all information. a by Date Personal kdonnarion You Provide may be used for secondary purposes (Privacy Law. s. 15.04 (1) (m)). - 1 6 Property 4 it a4 T _ govt t_ot �� 1/4 1/4 S T N R / (or) W Property owner's Mailing Address Lot nt B lock # Subd Name or CSM# q' 44- 84 '6-� /� • ' C /f 1'N w o D D R/P APP City L State Zip Code Phone Number 0 City ❑ Village ® Town Nearest Road I'UD 1',v ,/O /• , Syo /( , (7L 5) 3€ • �zz 7 t.22 , GV i /coxs&o _ aa New Construction Use; j Residential / Number of bedrooms Code derived design flow rate Cf, 0 GPD D Replacement ❑ Public or commercial - Describe: Ai /4 -- ' Parent material Flood Plain elevation if applicable • ,Ga<nd eneral °min reo : data ' Ot>1. T�'s7 / $e,7 - M4A — ) 44/ i v y c°1' v v ons 004)0B t 0. W. r 5. (7,u4 d.ds Bedn # ❑ CJ /� f / p Ground surface elev. I `' ' D ft. Depth to limiting factor ` V in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDNf M. Munsell ' Qu. Sz. Cont. Color Gr. Sz. Sh. •EfX1 'Eff#2 / d • S /0 Ye 3/3 L .2.-F .0& nw fg 1 S 3 f ., .9 • 4 2 8. 3 /a ye 3/f — L /fs4 4 g , c 5 /. . . 4' .4 3 /3 7• S YR y /CP --- _ Se- /-P•s%A 5A cs i f . 9 f . Co . 4 2 '•' •5. / • r.' GS .wr i i5 4i — • /2 •1 r. ., / Y R Vie r i ) F , i w t t e . . 5 0. s4 d,2 , a te' _ -- .7 / Z -1- S VI)? /o Vie 7 / / e - 1 . ..4e . 5. () , 1.1. ----- .7 (Z. . - 9z. ° 2-1 g# p � 41'4/99: 8O • 1 _ Pit G round surface elev. ft Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fW in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 •Eft#2 / 0 -q MYR 313 — z.. 2'Fsb e / .-s 3 f , • 5 .. co • z '• lb ,- shrC Avi be /A .y .s .4 = 3 1 g• 3/ /byte 5 1 . Mr k44 GS / R , "5 2--c -- .7 /. .1- t. 7.sYRsi6, Of , 51— i1-6 454 ad' — . 5 •1I . io Y '31.f4 / Yg' /6 , 4 • 5 0. St- ; fie- ----- . 7 1 < -1 17/ • Effluent #1 = BoD > 30 < 220 mgr. and TSS >30 < 151' mglL * Effluent #2 = BOD < 30 mgrL and TSS < 31' mgrL CST Name (Please Print) Signature 1// CSTNumber Roseg7' '7.f /A6/e /_ • G 47 • if.' • - 2ea q 2- 2(,1'3-7 Addles Date Evaluation Conducted * Telephone Number A. � - - fel3 . z 3 - 260 7/5 3 yy2 Private Sewage Consultants 2812 10th Ave. Spring Val p g ley, WI 54767 4 rl c 04vvi flow S _ fAio Z- $ ..I s .4 -f•9- s h ,4 vP • - iki Aw-e"-- 60o.e- . �giG1NL ' � J ,U Leo- AD e • Property Owner Parcel ID # Page Z of ergs ❑ Boring p ut Pit Ground surface elev. �� '� ft. Depth to limiting factor 7 in. Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsen Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 •Eff#2 / 0 - 1/ /0YR L liskt 414 ?cif? 5 3 . s • , Z / / •2y /DJe f /2 sG /fshe 4l7ee w , 3 2 7.5WeS /u L5 / 4„ M ds cs -- . -7 ( -Z .} 4 1 7 - 5 / t h e 61 LS /4.., -- • - c • 2 • } k /O t/F I. Li0 S by ig /6 yR 7/6 • . 7 1.Z .1- Boring cY # Boring ID ID Pit Ground surface elev. ft. Depth to limiting factor in. Soil APPS Rate Description Texture Structure Consistence Horizon Depth Dominant Color Redox : • ; . Roots GPDJiI: in. Mansell Qu. Sz. Cont. Color Gr. Sz Sh. - •Eff#1 •Eff#2 Borin g # ❑ Boring ❑ Pit Ground surface elev. ft. b limiting factor in. Application ( Rate Horizon Depth Dominant Color Redox Description. T � • .� : = Consistence Boundary . Roots GPDMt in. Munsell l Qu. Sz. Cont Color Gr. Sz. . •Eff#1 •Etf#2 • Effluent #1 = BOD > 30 < 220 mg&L and >30 < 150 mgA. ' Effluent #2 = BOD < 30 mg&L and TSS < 30 mg&L The Department of Commerce is an equal op vrtunity 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. 3BD43 (xrwoo) t t oOD eale " tfeAF x ,84-57 Go f e5 Z 3 Property Owner Parcel ID # Page of 3 O # ❑ Borin Pit Ground surface elev. 96.3o ft to > 9 in Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPONF in. Munsell Qu. Sz. Cont. Color , Gr. Sz. Sh. 'Ett#1 'Eff#2 o - i/ isyR /3 L . fsh,e 4 /4 IA . 5 3 -F . s . . k 2. /I • sy io Yee fc - ---- -- sr- / fs hie /hi Ae `cv i f • ' . . Co 3 zy31 7•s 0Rs /a L5 /4, be is cs .7 (. Z I ,3/. (09 7. s yR 5/1� MII /the GS /Am y, i s Ai — • - ( . Z 5 6i. f R /6 y / e 7 / / / J . s o f s 4 GL. - -- ._ 7 I • Z d ' . 1 soring# ° Boring ❑ Pit Ground surface elev. R. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Redox Description Texture Structure Consistence : • Roots GPDVIF in. Morsel Qu. Sz Cont. Color Gr. Sz Sh. *BM 'El #2 111 r VIIIIIIIIIIII 1.11111 ME 111■ IMP/ I I #° ❑ pit • Ground surface elev. R • . to limiting factor in. Soil Application Rate Horizon Depth Dot • • Redox Description. T: . • Consistence Boundary Roots GPD/ff . in. Munsell Qu. Sz Cont. Color Gr. Sz . 'Eff#1 'Etf#2 IAIIIIIIIIIIIIINIIMII I. 11111111111111111 RR . MAI . . IN MR= ROI Effluent #1 = BCD, > 30 < 220 mg4. and SS >30 < 150 mg/i. ' Effluent #2 = BOD < 30 mglL and TSS < 30 mglL The Department of Commerce is an equal op • • nity 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 T7Y 608- 264 -8777. s01(R.6/00) 1 q 1 } • � f 1 \ D It c\ It li Z 41 , ------ C � kiv o � - a MN . �1 j�• \ ', an 3 b / Q g 9 w Q. > W� �2 O O al n w 0 0 z. f,-, -a I> 4` > 0 \ • D o � 0 vx \t•T 0 0 s ■ \-°) -s 3 7�' %, , r\ \ 0 S -.... o ?,.1‘ lJ•3 (----\ \ 't, > 7■ 01 --( V) o M -a �0 '� 1 POWTS OWNER'S MANUAL & MANAtitIVILINI 1 1'1JkN Page ' of '� FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity / 25'0 ga l O NA Permit L f 5 �C� Septic Tank Manufacturer 0 NA DESIGN PARAMETERS Effluent Filter Manufacturer Z r ❑ NA Number of Bedrooms I/ ❑ NA Effluent Filter Model 4 -/( 0 ❑ NA Number of Public Facility Units 01A Pump Tank Capacity ga l ❑ NA Estimated flow (average) 4J 0 gal /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) ( 00 gal/day Pump Manufacturer ❑ NA Soil Application Rate s 7 gal /day /ft3 Pump Model • ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit NA 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 `in- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA (❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /1 OOmI ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) .0 year(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA li m Inspect dispersal cell(s) At least once every: a year(ont hls) sl (Maximum 3 years) ❑ NA Clean effluent filter At least once every: f Et yea ) ❑ NA / ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ year(s) ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: ❑ year(s) — ❑ month(s) ❑ NA Other: At least once every: ❑ year(s) Other: ❑ 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 Teaks, 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. Page Z of "?i START UP AND OPERATION For new construction, -prior to use of the POWTS check treatment tankls) 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 repl ent system: 7(( A suitable replacem; • - = as been evaluated and may be utilized for the location of a replacement soil absorption system. e : • acen are ace should be protected from disturbance and comoactionand should not be infringed upon by required setb • cks 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. I1/411A . . : • o • mg�ank b a . 'PRI:VIZMb. �g- N= CoNS'flW L0 ❑ 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 I POWTS INSTALLER POWTS MAINTAINER Name .. /6 /� Name Phone 1 y 5-- Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name S'f. Cep 96 (±bU D 2.o,iJING`– Phone Phone -/S— 3g40— sloop This document was dratted in compliance with chapter Comm 83.22(2)(b)(1)Id) &(fl and 83.54(1), (2) & (3), Wisconsin Administrative Code. - -- .. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer "e'er/247490r Mailing Address ,e0 • , err c.6, Property Address g33 (Verification required from Planning Department for new construction) City /State / 4 7 e1;:lA G✓Z Parcel Identification Number ) Z D - PS --617 ° 263 1/) LEGAL DESCRIPTION Property Location PE %, 5 %s, Sec. 3 (; , Ta N R W, Town of hi.- Subdivision c / v 'aO AP ‘6 , Lot # g� . Certified Survey Map # , Volume , Page # Warranty Deed # - 7 1 / ©q S , Volume d9/ ? , Page # 3 . Spec house ❑ no Lot lines identifiable ❑ 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 masterplumber, journeyman plumber, restrictedplumber 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. Uwe, 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 three year expiration date. ,/ /6 /o s� �• J � • `� / ��� '"' A . r i F • PLICANf 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 abo . , by virtue of a warranty deed recorded in Register of Deeds Office. SIGNA 't' OF APPLICANT DATE * * * * ** nt. * * * * ** 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 , 60 Y ; 0v -tig p ; ,k'ERivoAI /34s r 3 p0,viy,9 SpE /3, s T 9 Vise I &wire RD. HoPso,", zei. s'f / C, ' . Wisconsin Departrnent of Commerce SOIL EVALUATION REPORT Page / of 3 Division of Safety and Buildings in accordance with Comm 85. Ws. Adm. Code y� Attach complete site an on paper Gritty 5 T `�� Of p plan p per 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. S.e � 4/6 Lc; 4— percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print i7T►'�fi =1 °_E ® Reviewed by Date Personal lnfomtat on you provide may be used tx secondary purposes Irnvvacy Law. s 15.01 (1) (m)). I Property Owner • ...ttyLocation / e oig S41 A*Age. NE / WILCOX-5 OA) JAN 0 9 2003 e. .Lot s. 114/1&114 S 3G T 4 N R if 0 (or) W Propedy Owner's Mailing # • •. Subd. Name" or CSM# ' r .r--- ' ' i t1 fi d/ (B cry. l ST. CROIX COUNTY I j / / � D G / Y• ZONI OF FICE . c6 t LOcP 4 C , (31 - State Zip Code • • - 1 . _ ■ City ■ Village (4 Town Nearest Ro //UP.SoN W/. 5 yoi4 ( 76 ) 3 re, •zii7 ¢fvosa, ' . /`iw . N 16—New Construction Use: Residential / Number of bedrooms 3 - / Code derived design flow rate '99 CP an GPO ❑ Replacement ❑ Public or commercial - Describe: Parent material /0 as 5 O V lib OJe4u- Flood Plain elevation If _ app pp8 _ ca ------------ ble N/ ft. General comments $ h T Li✓1 a t2Q•. la 5 . and recommendations: • /t/e4 Td5 r-7 / 5 JO / r'r4.6 / j dip 44- A/d i WP 5 /57 - M - -115/,1i 6-- / • a 5,A)f) fill / 1 Boring # El Boring 9 et. 'i 5 2 s. s .S•. . ® Pit Ground surface elev. ft. Depth to !knifing factor 3 in. Ride Soil Application Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots , GPDRP In. Munsel Qu. Sz. Cont Color Gr. Sz. Sh. •Eff #1 'ER#2 / D /D ye 3/ y --- L /fs, e "4-6e ,4 2 7-- . y . s 2- /D•/R /D yeW 45 /- iye 15 cs — . 7 A Z 3 a .2(0 /a rie y /& 1.5 , /7efre d $ .1.3 — . 7 /. z 9 26' 32 - i 5Y, / /`e ----- F5 /i As 4.5 — • y/ • . 5 3.2 •Go - 2•5 ; 3/!/ i l 5Z /, /p v• . 3 - S Z I B ti o Born 7 f. y.5 5. S. 5. vka pit Ground surface elev. ft. Depth to limiting factor 3 f� in. APPS Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAP In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Effil2 1 o•g / y' 3/q L /f,f4e 40-62 0 1 kJ ,z, • y _ , s Z g. If /o /q ---- L5 /A,, ff ' Is GS /7 . 7 _/ 2. p • ,, 7s • d2.aQ Moj-S SL ,- 414 U ' • . S /off/' (e j • Effluent #1 = BOD, > 30 < 220 mglL and TSS >30 < 150 mglL • Effluent ill = BOD. < 30 mg L and TSS < 30 mpg. • CST Name 3 e e re r 7l /h/e c117 Signature / 2 3' Address , 13 Date Evaluation Conducted Telephone Number Ulbricht ,R, Associates .)� • Z / --- >MP Z_,_ WS • 3 RG • g /es (355 O'Neil Rd. Hudson, Wis. 5401(3 .x... PIv N dF sly o a t9 • //b?. ya ar) o CE of NO o ld - //07. c9 • oar, r 6 o V ci'. r_ _ _ _ _ _ _ _ _ _ ___ - -. . .2 .. 1 . 02o• /0 y. yo•oixo Property Owner /Veil. W IC o K So 010 . /fib y • 0 • 0� 2 3 Parcel ID # Page of 13 I Boring # ring / o . 2 s 2r 7 S. S. s . iGg-Pit Ground surface elev. 0 ft. Depth to limiting factor ! in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary • Roots GPD/ff in. MunseA Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 / 0 / D %re 3 /y L /fs& fie "w - 4- • y . Z 17 / l e .i,g _ clot/1/2_3 5 / L 2 - F 5 4 e A►�►f e q w / f _ . 5 • 9 3 - iy fiVb s,L /f / o.€ ,,.14f C ec5. .Z .. t/ yii•40 .2.5y 9 /�o a 24_ tico f•s 5IcL if It /%44( --- ' h N P 5 Y/ 4 - Y /(Q - ng # ❑ Boring • I I ❑ 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/ff in. Mu nett Qu. Sz. Cont. Color Gr. Sz. Sh. . •Eff#1 •Eff#2 - I I El Boring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth Dominant Color Redox Description. Texture Structure Consistence � Application Rate . Boundary Roots GPDIff in. Munsea Qu. Sz. Cont. Color Gr. Sz Sh. •Eff#1 - •Eff#2 t • • I I Bose # [I Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Horizon Depth Dominant Color Redox Description. Texture Structure �e Consistence Boundary Roots GPD/ff Rate in. Munselt Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 • Effluent #1 = 130D > 30 < 220 mgt& and TSS >30 < 150 mg/L. • Effluent #2 = BO0. < 30 mg/L and TSS < 30 mglL 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. aeo41330 (.640o) • 7-_____,.,.....___.__ ,,,,--, , , ,..., ci ,.. , „ .., , ,,., -4, o - I . (N ;.li A) 1 icy) ' s ` `l,) �- b ts 4\G- — o Q ` .T s,D �` \ �x�nm�oo cn 0. v' I \ ig 8 z a- g 2 sp- zm Z 22 g -o.� . \ N , v\ \ 1 1 \ \ 1Z) C Q C gO ------- - Pi Q\ \ ..., -----___, ----- c . \ : -<( \ \ r \\.\\ • N °\ -7i, \ o� o ...„ ‘ p , a e 5 T LO T .e iN-Q. 1, il 11 . 1 DOCUMENT NO. IISTLE 3 09 7 JISCCUN 3 FORM 9 KATHLEEN H. WALSH REGISTER- OF DEEDS 11 QUIT CLAIM DEED ST. CROIX CO. , WI • RECEIVED FOR RECORD 09/23/2003 11:00AN Kernon J. Bast and Donalda J. Speer-Bast, husband and wife QUIT CLAIM DEED EXEMPT # 13 I quit-claim to Kernon J. Bast and Dona lda J. Speer- REC FEE: 13.00 Bast, husband and wife TRANS FEE: COPY FEE: CC FEE: PAGES: 2 the following described real estate in St, Croix County, - State of Wisconsin: Legal Description - see attached Exhibit A. Parcel Numbers are: 20-1109-40-000 20 Retup. ti): jj... tAANK. nik___ . 20-1109-10-000 20-1109-55-000 • Ke non stfiti,,. . 94 LaBarge Rd Hu son, WI 54016 The purpose of this Deed: To create Marital Survivorship Property Intereit fa 110 f- vo - 000 to Kernon J. Bast and Donalda J. Speer-Bast, husband and wife. 4-0-1/01-55 I This ...i.s...nsat ....... .... homestead property. (is) (is not) Dat . is rd day of September ir (SEAL) lax,L,4d49de.,,--ia.- (SEAL) . .ernon J. B t . Donalda J. Speer-Bast • • (SEAL) (SEAL) . ' AUTHENTICATION ACKNOWLEDGMENT Signature(a) STATE OF WISCONSIN ) _Ste C.ro.ix county. os. authenticated this day of , 19 Personally came before me this 3rd day of September, 2003 # the above named Kernon J. Bast arid Donalda J. • Speer-Bast TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06. Wis. Stets.) .. too to be the person who executed the instrume and acypowled e tbe same. THIS INSTRUMENT WAS DRAFTED 1314 .. .V , # % . Kernon J. Bast PAM). I. tlio ..- it o'KEEFE" j iPA 01 7 akce 11. tary Public ...1 County, Wis. (Signatures may be authenticated or acli1/44 d B f CO 4 v Commission is permalien (If not, state expiration ' • a• + s • are not necessary.) w"";sco,fdate: _ /let N ■ .0. V. r 7 P. 1 o 3 A EXHIBIT A A parcel of land located in the part of the Southeast'/ of the Northwest 1/4, part of the Southwest'/ of the Northwest 1/4, part of the Northeast ''/ of the Southwest 1/4 and part of the Northwest '/a of the Southwest 1/4, all in Section 36, Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin, described as follows: Commencing at the South '/ corner of said Section 36; thence North 00 degrees 10 minutes, 01 seconds West along the north — south '/4 line, 1634.77 feet to the Northeast corner of a parcel of land described in Volume 526, page 259 at the St. Croix County Register of Deeds Office, being the point of beginning; thence continuing North 00 degrees, 10 minutes, 01 seconds West along said North — South '/ line, 1977.22 feet to the South line of the North 350 feet of said Southeast '/ of the Northwest 1/4; thence South 88 degrees, 49 minutes, 51 seconds West, along said South line and the Westerly extension of said line, 1324.14 feet; thence South 00 degrees, 09 minutes, 43 seconds East 2,096.73 feet to the centerline of County Trunk Highway "N" being a point on 1,999.00 foot radius curve, concave southerly, whose central angle measures 03 degrees, 00 minutes, 19 seconds, whose chord bears South 80 degrees, 02 minutes, 21.5 seconds East and measures 104.84 feet; thence Easterly, along the arc of said curve and centerline, 104.85 feet to the point of tangency; thence South 78 degrees, 32 minutes, 12 seconds East along said centerline, 712.54 feet to the West line of said parcel described in Volume 526, Page 259, thence North 00 degrees, 10 minutes, 01 seconds West along said West line 304.75 feet to the North line of said parcel; thence North 89 degrees, 49 minutes, 59 seconds East along said North line 523.00 feet to the point of beginning., all in Section 36, Township 29, Range 19, St. Croix County, Wisconsin. r 201.90 i 1 -1 -a 339.85' �i I N 1 LOT 69 1 g8 q 44 c 2.08 ACRES ( w rn 1 • 4,4 90,587 SQ. FT. • o T' ° o i . 0$ 0$ LOT 68 �� 1 8 ' § I Q 4,0,. 2.19 ACRES 1 :1 \'''' )5,361 SO. F. Y .s ........................ 1 1 . -- -- -- J L — • — — . — - • • N89 ° 49'59 "E 193.63' O 158.87' ;oF , — — WILCOXSON DRIVE — - — / `y ©/ • �i S89 °49'59"W 418.30' ® / / / r--- .- 1 ` 9. $ 2 — — -- -- ?� — -- � ® . . , i i 7 -- 3 / / ,�. / 33 1 33 . . , A 0 O . . • (V W Q LOT 85 ` � o LOT 84 E 358.25' I I 2.70 ACRES / 0 2.16 ACRES • 117,792 SQ. FT. c o o 94,298 SQ. FT. • • I _I "6I • • 1 N � ¶r. .. ▪ ! 1 N __ I o Igo I N89 °55'21 "E 541.76' • I \ 40 1M !'� I 326.83 214 • I 0 I 0 • I Z o Z . I • • I Imo— LOT 86 0 0 I Z i� o ° ' IP. 2.46 ACRES 1 _ I 107,230 SQ. Ff. co Z S89 °55'21 "W 179. t8' _ 1 LOT 83 ?� 4 1 N89 °55'21 "E 179.2 1' 8 I cn 2.11 ACRES b I R 91,703 SQ. Ff. I i z ..!: ) 9 i . r • � S� ° 4232.6 3" / . . 241.50'