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Home My WebLink About022-1030-95-400 Wisconsin G�partment of Commerce Count PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 499145 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'. Hanson, Brian I Kinnickinnic, Town of 022 - 1030 -95 -400 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: /0 'o / 0 � U � I/Yt / �� e 4-t-L2 /ZF 11.28.18.168A40 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing , (� Alt. BM to f D k &t Aeration (� Bldg. Sewer p C - B 5.. Holding St/Ht Inlet % sue/ G s i3.o 9s.3 �-. TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WEJ BLDG. Vent to Air Intake ROAD Dt Inlet Septic 7 n � Dt Bottom / 7 ry l c-0 � �-z- b Dosing f Header /M an. T Q Sir L Aeration D ist. Pi pe D gd- Holding 13 Sjste r / 47 / Final Grade / PUMP /SIP N INFORMATION __�Aj $2 2 0 Manufact % *, A ,� Demand St Cover Z L.t �-f GPM �1 J Model Number 70 TDH Lift Friction Loss, System Head TDH Ft f" t Forcemain Len th Dia. Z , Dist. to Well 1 tj SOIL ABSORPTION SYSTEM Q(t6�)Cek ,'h S , n 17e,ka 1 —aa BED /TRENCH Width Length No. Of Trend PIT DIMENSI S No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO tU O P/L W JBLDG IWE LL LAKE /STREAM / Manufa l INFORMATION CHAMBER � V Typ Of System: �.� w ` b U Model Numb . / 1" t � DISTRIBUTION SYSTEM ef' —�aLr` �it a'�. 2" C`�, 1LG�.L � 3rJ em-1.o, Head d IDistribution / x Hole Size x Hole Spacing Vent to Air Intake 9� Length h —� Spacing J Len th Dia Len th Dia S acin I i SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over y Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center L Bed / Trench Edges Topsoil Y es No Yes No COMMENTS: (Include co discrepeRci persons pre t, etc.) Inspection #1: // /0 "P / Inspection #2: Location: 1337 Christy CouftU 4VE� 1/4 4 R18W) NA Lo Parcel N9.- 11.28.18.168 40 1.) Alt BM Description =I Op o4 2.) Bldg sewer length = /2 ! � S' /1 - amount of cover = / fi r + W X U � Vvb+ t y I ►� - - if.tl/x/l Plan revision Required? Yes No 6s/ Use other side for additional information. Date Insepctor's Signature (J rt. No. SBD -6710 (R.3/97) _ Safety and Buildings Division T Counrf L N Visconsin 201 W. Washington Ave. P.O. Box 7102 c5 C e&LU_ Madison, WI 537 71 Sanitary Permit Number (to be filled in by Co ) De artment of Commerce (608) 26b- Sanitary Permit Application tare Plan I D Number i In accord with Comm 83.21, Wis. Adm. Code, personal information you provide A may be used for secondary purposes Privacy Law, s15.04(l)(m) Project Address (if different than mailing address) I I. Application Information - Please Print All Information E� / /33 C Property Owner's Na me r Parcel p Block x JUN 2 0 2006 lcbl� 3 Proper ty Owner's M ailing Address ST. CROIX COUNTY Property Location � I�IvG A, JIIGeJ A ,Secnon City, State Zip Code Phone Number - , ( 5 4 6 � 4 (circl e e) T 2$ N. R (�' II. Type of Building (check all that apply) fl� Su.�.r► CSM Number � ❑ l or 2 Fanuly Dwelling - Number of Bedrooms _S ' ia�ti - ❑ Public /Commercial - Describe Use / _ _ _- ❑ State Owned - Describe Use Z 1b � Zt I +7 G at ]Ciry_'willage 'Township of /fi,t/dJxX ✓.t J.UIZ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) 6:27 - �&�3 — A New System ❑ Replacement System g p Other Modification to Existing S ❑ Treatment/Holding Tank Replacement Only g stem Y B. Permit Renewal Permit Revision evision List Previous Permit Number and Date Issued I ❑ Change of ❑ Permit Transfer o ` +e« Before Expiration Plumber Owner IV. Type of POWTS System: (Check all,that appl 7 - 1 ,Non - Pressurized In- Ground ❑ Mound >.2A in. of suitable soil ❑ Mound-4-24 in of suima'le sm, ❑ At -Grade Single Pass Sand Filter Coruwcted Wetland J Pressurized In -Gros J Holding Tank ❑ Peat Filter e: oic - eatmew t✓mt Recirculating Sand Filter Li Recirculating Synthetic Media Filter thing Chamber ❑ Drip Line ❑ Gravei -iess P,,;e Other (explain) V. Dispersal/Treatment Area Information: Design _ n Flow Design Soil Application Rat f) Dispersal Area Required (sfi � ispc. sal . \rca Pro (sfi 'Sys rem E on le i 8 (gPd) 8 PP e{BPds � _ s Tan Info Capacity in Total Number Manufacrurcr Prefab Site Steel fiber PPlastic V 1. Tan P ty I Gallons G allons of Unit _oncrete Constructed Glass N e w Tanks Tanks ng Septic or Holding Tank p f' ►'G.5'E /� C.� Aerobic Treatment Unit N C Dosing Chamber l O _ V11. Responsibility Statement- I, the undersigned, assume responsibility for installanon of the POW' _FS shos +n on the attached plans Plumber's Na me (Print) Plu is Sig rure MP /MPRS Number Business Phone Number �e .f 11A M14 Z2 41p 1 7 WS 645 05s-fO Plumber's Addre ss (Street, City, State, Zip C e E (55Cp � �e cal 5 72 -- VIII. County/Department Use Only K Salutary Permit Fee (includes GrounA� ! Date sued / Issuin / cni Signa re S m Pprovcd Pi \ Surcharge Fee) , 6 D j 00 r Given Reason Tar Denial V� 7 666 IX. Condi OY AAAAAA�p g R 3 easons for Disapproval ` /�Bc..� YNE J 1. Seplie tank, effluent iNter and n (� y ` f dispersal cell must all be services / maintained C. wrSL k� J' ac y ` as per management plan provided by plumber. t r. `7 5 �,d-r✓ r 2. AN setback requirements must ba maintained ✓U � as per appsc able code / ordinances. Ca ce CA_ b e1 ' S t 5° Attach complete plans (to the County only) ror the system on paper not Icss th 81 2 j` I1 wch size 1 a PZ J r y d'C� Oi r 5 cJ` »� srt e le,J�b a V" SBD -6398 (R. 01/03) t Co nal Pf �. j S p p VI�B �. t.�1 �l..t4� E �V� p er, ,, d—. 5 W K 3 � r c� 0 0 4y a an oa w CIL �3 0 �7 0 l� �-, r. N �0Q . � N r 2 z .� M U. a 0 Go po ap oa nn coo ' N�o o D ilu o }� ,� ° �,.... cl r NO I N S LUAT O REPORT Pa 1 of 3 Department of Commerce in acco am 85 Wis. Adm. Code x Division of Safety and Buildings Northland Plumbing, Inc. Attach complete site plan on paper not less than 8% x 11 inches in Plan must County St. Proix include, but not limited to: vertical and horizontal reference point (BM), ion and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Please p P=X s Review By Date Personal information you provide may b Law, s. 15.04 (1) (m)). Property Owner Property Location Hanson, Brian Govt. Lot N E 1 /4, NW /4, 11, T28N, R18W Property Owner's Mailing Address Lot # Block # Subd. Name or l4SM# 701 Grandview Drive ST CR 3 /�� _ Y� Vq City St a Zi Code Phone Number ❑ City ❑ Village ® Town Nearest Road Hudson I WI 1 54016 1 Kinnickinnic I Cemetary Road ® New Construction Use: ® Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD ❑ Replacement ❑ Public or commercial - Describe Parent material Sandstone Flood plain elevation, if applicable ff. General comments Convent site. and recommendations: F-11 ❑ Boring Boring # ® Pit Ground surface elev. 90.05 ft. Depth to limiting factor >82 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfie in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Efr#2 1 0 -10 10YR3 /1 sil 3sbk mvfr a 2f .6 .8 2 10 -21 10YR4 /3 A 3sbk mvfr is if .6 .8 3 21 -31 10YR3/6 sicl 2sbk mfi cs .4 .6 4 31 -60 10YR4/6 s Osg ml a .7 1 1.6 5 60 82 10YR5 /8 3 �(0 s Osg ml a .7 1.6 F ❑ Boring Boring # Pit Ground surface elev. 90.68 ft. Depth to limiting factor >86 in. ® P 9 Soil Application Rate Horizon Depth Dominant Color Redox Descriptio ure Structure Consistence Boundary Roots GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -12 10YR3 /1 sil 3sbk mvfr cs 2f .6 .8 2 12 -24 10YR4 /3 sil 3sbk mvfr a if .6 .8 3 24 -37 10YR3 /6-: sicl 2sbk mfi cs .4 .6 4 37 -65 10YR4 /6 s Osg ml CS, - . .7 1.6 5 6(-86 10YR5 /8 s Osg ml a .7 , • 1.6 * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = 1300 mg /L and TSS S mg /L CST Name (Please Print) Signal CST Number Michael J. Myers 267985 Address Northland Plumbing, Inc. Q Date Evaluation Condhcted Telephone; Number E 1556 State Rd 64 Boyceville, WI 54725 5/25/06 ?/S �o f3 -2.5s6 SBD -8330 (R.07 /00) Properly Owner Hanson, Brian Parcel ID # Page 2 of 3 F] Boring ❑ Boring # ® Pit Ground surface elev. 88 , t to timilling factor >88 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture "" StruFJAW E Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color z. Sh. 'Etf#1 I - Ef#2 1 0 -13 10YR3 /1 A 3sbk mvfr Cs 1m .6 .8 2 13 -39 10YR4/6 5 Osg ml Cs 2f .7 1.6 3 39 -88 10YR5/8 s Osg ml Cs .7 1.6 F i ❑ Boring Boring # P8 Ground surface elev. 86.55 ft. Depth to limiting factor >82 in, ® Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -15 10YR3 /1 A 3sbk mvfr Cs im .6 .8 2 15 -28 10YR4 /6 A 3sbk mvfr Cs if .6 .8 3 28 -55 10YR5/6 sid 2sbk mfi Cs if .4 .6 4 55 -65 10YR4 /6 5 Osg ml Cs .7 1.6 5 65 -82 10YR5 /8 s Osg ml C5 .7 1.6 F- ❑ Boring Boring # P8 Ground surface elev. 89.39 ft Depth to limiting factor >88 in. ® Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - EfW 1 0 -11 10YR3/1 sil 3sbk mvfr Cs 2f .6 .8 2 11 -36 10YR4/3 sil 3sbk mvfr Cs if .6 .8 3 36 -55 10YR4 /6 s Osg ml Cs .7 1.6 4 55 -88 10YR5 /8 s Osg ml Cs .7 1.6 ' Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 -S-1 50 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 alternate format, please contact the department at 608 - 266 -3151 or TTY 608- 264 -8777. Property Owner Hanson, Brian Parcel ID # Page 2 of 3 3 Boring « ❑ Boring # pit Ground surface elev. 88.98 ; }; ft to lim' ' g factor >88 in. ® Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Strut Consistence Boundary Roots GPD/ltz in. Munsell Ou. Sz. Cont. Color z. Sh. •Eff#1 •Eif##2 1 0 -13 10YR3 /1 sil 3sbk mvfr Cs im .6 .8 2 13 -39 10YR4/6 s Osg ml Cs 2f .7 1.6 3 39 -88 10YR5 /8 s Osg ml Cs .7 1.6 F 4 ❑ Boring Boring # Pit Ground surface elev. 86.55 ft. Depth to limiting factor >82 in. ® Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#t •Eff#2 1 0 -15 10YR3 /1 sil 3sbk mvfr Cs lm .6 .8 2 15 -28 10YR4 /6 sil 3sbk mvfr Cs if .6 .8 3 28 -55 10YR5 /6 sicl 2sbk mfi Cs if .4 .6 4 55 -65 10YR4 /6 s Osg ml Cs .7 1.6 5 65 -82 10YR5 /8 s Osg mi a .7 1.6 5 E] Boring ❑ Boring # ® Pit Ground surface elev. 89.39 ft. Depth to limiting factor >88 in_ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eiffel 'Etf#2 1 0 -11 10YR3 /1 A 3sbk mvfr Cs 2f .6 .8 2 11 -36 10YR4 /3 A 3sbk mvfr Cs if .6 .8 3 36 -55 10YR4 /6 s Osg ml Cs .7 1.6 4 55 -88 10YR5/8 s OSg ml Cs .7 1.6 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 alternate format, please contact the department at 608 - 266 -3151 or TTY 608- 264 -8777. 1 0 - j ' o 14- 4tt v j J J (� M tz .�.- 4 4 Z o w m tj m a kr DP 00 Ln N c� \� ` So• d ff OTM m fil 01 ; Page 1 of 4 SYSTEMS INC Environmental Onsite Wastewater Solutions' Leaching Chamber Design Spreadsheet Project Name: Hanson Owner's Name Brian Hanson Owners Address 701 Grandview Drive Hudson, WI 54016 Legal Description NE ' / 4, NH► Y. Sec 11 T 28 N, R 18 H► Township Kinnickinnic County Saint Cron Subdivision Lot# 3 Parcel ID# Table of Contents pg- 1 Cover page 2 Calculations and Drawings 3 Management and Contingency Plan 4 Plot Map total # of pages: 4 Designer Name: Lyle J. Myers License #: 224617 Date: 6/12/06 Ph. #: 71 -2520 Signature: Design Methods Used "IN- GROUND SOIL ABSORPTION COMPONENT MANUAL FOR PRIVATE ONSITE WASTEWATER TREATMENT SYSTEMS" (Version 1.0) SBD- 10705 -P (R.6199) C Infiltrator and the Infiltrator logo are trademarks of Infiltrator Systems, Inc. SYSTEMS INC Y " e Spreadsheet provided under license to Infiltator Systems, Inc by: 3bAdvisement N12486 220th St, Boyeeville, WI 54725 } SYSTEMS INC Calculations and Drawings Page 2 of 0 Site Conditions Infiltration Elevations Site Type:j Private I 'w Trench #1 Trench #2 Trench #3 °r6Slope 9% Contour Elev: 90.50 90.45 0.00 Ft # of Bedrooms 3 Infiltration Elev: 87.50 87.501 0.00 Ft Depth to limiting factor 82 inches Limiting Factor Elev: 83.67 83.62 N/A Soil Application Rate: 0.7 gaVftA2/day Treatment and Dispersal Zone: 3.83 3.88 N/A Effluent QualitYj Eff #i 'w I Cover Material Required: 0 0 N/A In Design Flow: 450 gal/day Finished Grade Over Cell: 90.50 90.45 N/A Max BOD 220 mg/I Max TSS 150 mg/I Distribution Cell Choose chamber type: Septic Tank inflltr Quids 4 Standard • Manufacturer. Weser # of trenches: Volume Chosen: 1000/650LP Chamber Length: 4.00 Ft Effluent Filter Selected: Zabel 100 Chamber EISA: 19.1 1 Note: Access opening of sulficient size to be Provided to allow removal of 6fler. Endcap EISA: 5.8 Ft2 Opening to terminate at or above grade. Required Infiltrative Area: 642.9 Ft2 Actual Infiltrative Area: 661.0 Ft2 Total # of Chambers: 34 Cross Section of Septic Tank Total # of Endcaps: 4 Combined Length of Cells: 140.0 Ft 12" Min Grade Cross Section of Cell Cover Material Observation Pipe (if required) _ _ - Final Grade All joints to - be water ti ght D3034 _ Ground L Sch4 Effluerrt, Contour Filter Pi Leachin System Chamber Elevation 3" Bedding Under Tank Lenqd, L 6 L 6 O O ArA" 303 Obxrvatam ObservaUmatt wlm�lll or 5ch -10 4'. Pipe pipe PVC pipe Infiltrator and the Infiltrator logoiare trademarks of Infiltrator Systems, Inc. Spresdaheet provided under license 10 InflMaror systems, Inc by: 3bAdvisemern N12458 220th St, Boyceville, WI 54725 , SITE PLAN OWNER LOT 3 OF CERTIFED SURVEY MAP RECORDED IN BRIAN HANSON V OLUME 19, PAGE 4944, TOWN OF KINNICKINNIC, 701 GRANDVEIW DR HUDSON, WI 54016 ST CROIX COUNTY, WISCONSIN. SURVEYOR 20 WIDE NORTHLAND SURVEYING, INC. \ DAINAGE P.O. BOX 14 1 EASEMENT ROBERTS, WI 54023 fLE ------- NGTH 230.00' -------- -------------- - \ PUBLIC ROAD 85.01 - --- --- --- - - - - -- - � --------------- o 26.00 NOTE: 2a.0 , o pROPOSEP SEE C.S.M. RECORDED IN VOLUMEI9, °� o D ETACH, ED PAGE 4944 FOR EASEMENTS, SETBACKS, AND ANY OTHER INFORMATION WHICH MAY BE PROVIDED ON THE C.S.M. 0 6 yy. �O NOTE: 26 Q�O �� _LOT 3 TOP OF off" THE PURPOSE OF THIS SURVEY IS TO ELE AB"ON +y°� 2 Go �� 4.27 ACRES SHOW THE PROPOSED BUILDING SITE = 970.34 oO" o�� y 9° �` 1 S Q . FT. AS DETERMINED BY THE LOT OWNER. Lo Q _ _ oo, ?0 0' �" o1 �v s� 0 LOT 4 0 ?� a`'t L.B.O. = 963 J o ; W °�rJ o° Z / Q N °`� '5 d' o �° r o e ��° / O r Q �P LL (v / LL f U r Q i W 3/4" REBAR FOUND ; N + LATH SET AT PROPOSED BUILDING r I CORNER 1 1 ® HUB SET AT 15' OFFSET FROM BUILDING CORNER 1 1 SOIL TEST LOCATION 1 i 97.27' OUTLOT 1 CERTIFIED SURVEY MAP RECOR SCALE IN FEET 1 = 60' THIS INSTRUMENT DRAFTED BY KEVIN REED 60 0 60 JOB NO. 06 -59 DATE 06 -09 -06 I, EDWIN C. FLANUM, REGISTERED WISCONSIN LAND SURVEYOR, HEREBY CERTIFY THAT THE ABOVE DESCRIBED AND MAPPED PROPERTY WAS SURVEYED BY ME OR UNDER MY / DIRECT SUPERVISION AND THAT THIS MAP IS A CORRECT REPRESENTATION TO SCALE OF THE BOUNDARIES TO THE BEST OF MY KNOWLEDGE AND BELIEF. lu Q / _LOT 2_ � / a EDWIN C. FLANvM -' 04"E = x S 2487 °01 5 18.39' s AWRY -------- - - ---- - - - --' JU / � � 433.38' �o/ V17- O % -- -- KlN NICKINNIC - / -- -R ao. / 0 W UNPLATTED LANDS_ 0 W / I � / I � I 463.08' S89 0 42'02 "W 560.36' DED IN VOLUME 20, PAGE 5153. CURVE TABLE CURVE RADIUS CENTRAL CH ❑RD CHORD ARC TANGENT TANGENT NUMBER ANGLE BEARING LENGTH LENGTH IN OUT C1 80.00' 79 °47'22" N43 °52'37 'E 102.62' 111.41` N83 °46'18 "E NO3 °58'56 "E I, EDWIN C. FLANUM, REGISTERED WISCONSIN LAND SURVEYOR, HEREBY CERTIFY THAT THE ABOVE DESCRIBED AND MAPPED PROPERTY WAS SURVEYED BY ME OR UNDER MY / DIRECT SUPERVISION AND THAT THIS MAP IS A CORRECT REPRESENTATION TO SCALE OF d THE BOUNDARIES TO THE BEST OF MY KNOWLEDGE AND BELIEF. I - LOT 2 Q - - - -- U11111111NI1//p a CONS / s EDWIN C. � FLANi!M S -2487 - - - - -- 586°01'04 "E 5 18.39' I A WI S Y U' ------- -- - - - - - -� 4 33. r / � 38' 0 J 4 �° i ------ ------ o/ O / KIIVNICIC1NNIC RIV co 0 / o LANDS j / N 0 / 0 / co) 4Jl 4/ / I i 463.08' JL S89 0 42'02 "W 560.36' )ED IN VOLUME 20, PAGE 5153. CURVE TABLE CURVE RADIUS CENTRAL CH ❑RD CHORD ARC TANGENT TANGENT NUMBER ANGLE BEARING LENGTH LENGTH I IN OUT Cl 80,00' 79 °47'22" N43 °52'37NE 102,62' 111.41' N83 °46'18 "E NO3 °58'56'E 1 Page 3 of 4 In- Ground System Management Plan pursuant to comm 83.54 W. A. C. Owner's Responsibility: The component owner is responsible for the operation and maintenance of the component. The county, department or POWTS service contractor may make periodic inspections of the components, checking for surface discharge, treated effluent levels, etc. The owner or owner's agent is required to submit necessary maintenance reports to the appropriate jurisdiction and /or the department. Septic Tank: Septic tank(s) are to be inspected routinely and maintained by department approved individuals when necessary in accordance with their approvals. The use of chemical/biological "treatments" is not required or recommended. If such additives are used, make sure they are approved by Department of Commerce, Safety and Buildings Div.. Effluent filters are to be removed & cleaned as necessary, with provisions to keep solids from passing the septic during removal. No more than 1/3 of the usable tank volume may be occupied by sludge /scum. 3 year inspection: If tank has greater than 1/3 volume sludge, tank contents must be emptied and disposed of in accordance with NR 113 Wisconsin Administrative Code by an approved individual. If the inspector does not recommend pumping of the septic tank, then the owner must be notified of when pumping should be done as to not exceed 1/3 sludge volume. Septic tank should be routinely inspected to be watertight and of good repair. Absorbtion Cell The absorbtion component must remain free of ponded surface water prior to pump operation. If 4 inches or more water level is detected in the observation pipes, the owner must be notified of possible problemstfailure. The designed daily flow capabilities of the component should never be exceeded. Trees and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the component. Activities OTHER than mowing /maintenance (i.e. excessive walking, pets, vehicles, etc...) could compress the component and reduce ifs absorbtion capabilities and /or possibly cause it to freeze in winter conditions. Performance Monitoring: Performance monitoring must be done at least once every three years following the installation or at the time of a problem, complaint, or failure. Contingency Plan: If the septic tank or other components therein (including floats, alarms, etc) become defective, the defective tank or component must be replaced immediately to ensure that the system can operate as designed. If the absorbtion component cannot accept wastewater or ponds wastewater to the surface, the component must be repaired or replaced in ifs current location by removing the clogged bacterial mat, aggregate/leaching chamber cell, and distribution piping within the cell and replacing failing components in order to return system to proper working order as required. If repair is not feasible, a new system is to be constructed in a designated replacement area ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND J' OWNERSHIP CERTIFICATION FORM Owner/Buyer Br_j &5 T 4 Mail lg Address Property Address l 3 6A ✓► S de u �- 7 (Verification required from Plann' (q Department for new co ction) City /State Parcel Identification Number G 2Z— ih 3 L y oo LEGAL DESCRIPTION Property Location A16_ `` /,, /`/ W ' /., Sec. 1 . T 2T N -R_jj_W, Town of Subdivision Lot # 3 Certified Survey Map # / ` W / 2 / Volume Page # Warranty Deed # - 71P 2 1 , Volume 7 , Page # 2S Spec house ❑ yes $6 no Lot lines identifiable 9 yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance cif 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 owiler and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set foith, 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. �_ —.K' 6 Iao1 d6 SIGNATURE OF 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 owners) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. 1,06 SIGNATURE OF APPLICANT DATE s s s s s s Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. .s 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 Parcel #: 022 - 1030- 95-400 06/22/2006 10:06 AM PAGE 1OF1 Alt. Parcel # 11.28.18.168A -40 022 - TOWN OF KINNICKINNIC Current LX ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 02/24/2006 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner BRIAN L HANSON O - HANSON, BRIAN L 701 GRANDVIEW DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description " 1337 CHRISTY CT SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 4.270 Plat: 4944 -CSM 19 -4944 SEC 11 T28N R18W PT W1/2 NW1 /4 BEING LOT Block/Condo Bldg: LOT 03 4 OF CSM 10/2861 NKA CSM 19 -4944 LOT 3 (4.27 AC) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 11- 28N -18W NE NW Notes: Parcel History: Date Doc # Vol /Page Type 03/ 010nna 789121 --1 914944 S /16/2005 789669 254 W 09 2402/107 C 09/05/2003 739011 2402/106 TD more 2006 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/06/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.270 85,000 0 85,000 NO Totals for 2006: General Property 4.270 85,000 0 85,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 0y01 3 m o C `r1 C c �. r: co 3 - 0 .Z7 vi Z o 2 -Tj N `C Q• Cfl =r O d c ° 7 CD 3' CD H ao OD p o �CD a �.� N `te �0 0 N a W 7 O T p O O CD N fA O O H y 8 O O C C, 1 p m c C ° m U> z D a n CD m D W a y . ° a c o o < 3 0 CD o n 00 (D C z oo ;o nrti ° 0 < N 0 c CD 3 c y+ o o o j w l&I� o < w z m CO) to m o D `� y @ CD �vv0 > CD A N o o CD N 0 c 0; > CD oc y C � CD I) C cn l I C O N Cl) N ? C1 d O N p 2 CD 3 c ` i0 v CD CL A z o CD N N � CO a Iv z B ;o 3 °o y m I � R OM'.' C�iC� ° m o m c a° ° S D3 a m °v m- -= a< N o m a �• y y d (1 a 7 fD N y. 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Lot N 1 /4 Nud1 /4 S �t T N R if E (or) Property Owner's Mailing Address, Lo Block # Subd. Name or CSM# .5 0 : -& •— city State Zip Code Phone Number City ❑ Vllage Town Nearest Road New Construction Use Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement > ❑ Public or commercial - Describe: -- ._ - - -- - -- - - - - - -- - -- -- Parent material Flood Plain elevation if applicable : " / ft. General comments / and recommendations: / �� S� e 1 Cy t/- 14LjL1 M Boring � � q � # " f—'� -- — pit Ground surface ele . ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 •Eff#2 0 ot4 G 3v .0 s Baring # E] Boring ❑ pit Ground surface elev. Depth to limiting factor In. eRootsGPD n Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Eff#2 IA Effluent #1 = BOD > 30 220 mg/l and TSS >30 _` 150 ` Effluent #2 = BOD <_ 30 mg/L and TSS < 30 mg1L CST Name (Please Print) S' a CST Number Bird Plumbing, Inc. Shaun Bird 226900 Date Evaluation Conducted Telephone Number Address 715- 246 -4516 1008 192nd Ave, New Richmond, WI 540 �� Property Owner Parcel ID # Page of J Boring # ❑Boring C ,� pit Ground surface e1ev . � ft. Depth to limiting factor �• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfT in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Eff#1 Eff#2 t l 4 F-1 Boring # C] 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/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efr#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/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg& and TSS <_ 30 m91L 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. SOD4330 (86100) Soil Test Plot Plan Project Name Lee Christianson Shaun d Address 2037 50th Ave Baldwin Wi 54002 CST #226900 Lot 3 Subdivision Date 11 A 0/04 NE 1/4 NW 1/4S 11 T 28 N /R W Township I(innickinnic ❑ Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of survey iron System Elevation 100.2' *HRPSame as Benchmark Alternate Benchmark Top of 1/2" pipe @ 99.8' Pro 45 55B 1t.B.M. Town Road 10' Property 20' Line B -2 40, 5 ' B -3 8% Slope 0 ' ITI B -1 98' 100' Property Line Scale is 1" = 40' unless otherwise noted