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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
487971 0
L I
GENERAL INFORMAON (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:
Erickson, Lee St. Joseph, Town of 030 - 1093 -60 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
32.30.19.341 D
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic / 5 , / 5Q � Benchmark 26
r
Dosing Alt. BM 3, 3 (0 l �! • q I
Olt \\ PoWeA,
Aefa*m nn 525 Bldg. Sewer , 5(p J 3$ • 2
Holding StJHt Inlet
TANK SETBACK INFORMATION St/Ht Outlet Z 3 1 b q
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
�Jeb�
Septic / / Dt Bottom
Dosing Header /Man.
Aeration Dist. Pipe '7- 63 1 /61,2
Holding Bot. System G
Final Grade
PUMP /SIPHON INFORMATION L_ „ 6" /6
Manufacturer Demand St Cover P � ,r , �.L
,� V 5,aco T. 17
Mod Number U 7P. i 0,1 )33 11, �'>✓lo yC , $�
TDH Li Friction Loss Syst ead TDH Ft M 1 T-A 1, W1 .96 ��p , 2 6 13y , [ s
Forcemain Length Dia. Dist. to Well {}
3,
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Length 2 No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 G f „ Z �r � ��
SETBACK SYSTEM TO / `v P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer.T f_'
INFORMATION CHAMBER OR
Type Of System: 3 �• UNIT Model Number. Q
66,0 ,�.,� C UNIT
DISTRIBUTION SYSTEM Z 4 en C 4 ,5 g ,
dada
Header /Manifold 'fl Distribution x Hole Size x Hole Spacing Vent to Air Intake
q • Pipe(s) \11 S�Ta
Length / Di a Length Dia \ Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over I Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed /Trench Center 3 3� Bed/Trench Edges \ Topsoil \ Yes No Yes j No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2:
Location: 469 County Rod E Hudson, WI 54016 (NW 1/4 NE 1/4 32 T30N R19W) NA Lot 7 Parcel No: 32.30.19.341D
1.) Alt BM Description
2.) Bldg sewer length = y�
- amount of cover = 5
Plan revision Required? (] Yes \)<"No �=2,L �Use other side for additional information. K '
Date Insepc s Signat� Cert. P
SBD -6710 (R.3/97)
Safety and Buildings Division County
= s 201 W. Washington Ave., P.O. Box 7162 St. Croix
,sconstn Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.)
Department of Commerce (608) 266 -3151 4fg
Sanitary Permit Application St Plan I.D. Number
In accord with Comm 83.2 1, Wis. Aden Code, personal information you provide Project Address (if different than mailing address)
may be used for secondary purposes Privacy Law, x15.0 1 in
L Application Information – Please Print All Info atiou RE 469 Co. Hwy. E
Property Owner's Name Parcel #: Pending Lot # Block #
NOV 0 1 2005 030- 1093- 60 -000, lot 7 Na
Lee Erickson
Property Owner's Mailing Address ST. CROIX COUNTY Property Location
706 Grandview Drive ZONING OFFICE
NE '/. NW ' /., Section 32.
City, State Zip Code Phone Number
T 30 N; R__ W
Hudson, W1 54016 (715) 381 -9896
IL Type of Building (check all that apply) (� }
X 1 or 2 Family Dwelling - Number of Bedrooms 3 0 0 ql • u� �� 4
❑ Public/Commercial - Describe use Lot 7, CSM Vol. 10, P .2777
❑ State Owned - Describe Use ❑City ❑Village XTownship of St. Joseyh
111. Type of Permit: (Check only one boa on line A. Complete line B if applicable)
A X New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
B. ❑ Permit Renewal Permit Revision X Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration -- P lumber Owner�(0 3 3SZ Zvi
IV. Type of POWTS System: Check all that a t S z
X Non - Pressurized In- Ground ❑ Mound > 24 in of suitable soil ❑ 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 X Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. Dispersal/Treatment Area Information: Two trenches @ 3' X 96', forty eight (48 total - 24 per trench) "Quick 4" Infiltrator Chambers at 19.1
sq. ft./chaminber+2 end ca s = 916.8 sq. ft ELSA
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) yttem Elevation
450 gpd 0.5 gpd sq. ft. 900.0 sq ft 916.80 sq ft EISA 100.00'
VL Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
New Gallons Gallons of Units wl A tom( Q ` ,� p� S Concrete Constructed Glass
Existing ( I
Tanks Tanks �J
Septic or Hold Tank 1,500 _ 1,500 1 Wieser Concrete X
Combination ST/PC as 2 comp. ST
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility State nt- I, the .,Apted, assume r es on of the POWTS shown on the attached plans.
Phtmber's Name (Print) Plumber' igoature MP/MPRS Number Business Phone Number
James K. Thompson �--- MPRS #30021 (715) 248 -7767
Plumber's Address (Street, City, tp Code) 377- 61 3
340 Paulson Lake Lane, Osceola, WI 54020
VIII. Cozen /De artment Use Onl
Approved ❑ ved Sanitary Permit Fee (includes Date Issued Issu' g Agent Sign re (No Stamps)
Groundw Surcharge Fee)
❑ 0— j
IX. Conditions o A P rowal 3
SYSTEM OWNER: L--_ d�
1 Septic tank, effluent filter and _ -F- 0 f �
dispersal cell must all be serviced / maintained ----
as per management plan provided by plumber. Nom-
2. All setback requirements must be maintained– /P��^�'�"
as per applicable code /ordinances.
Attach complete plans (to the County only) for the system on paper not less than 81/2 s 11 inches in size
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' Wiisconsin0eparirnentof Cbmmerce SOIL EVALUATION REPORT 'page 1 of 3
Division of Safely and Buildings in accordance with Comm CC it & Site Evaluations
Attach complete site plan on paper not less than 8' %x 11 inches in size. Plan mRECEI Y
St. Croix
include, but not limited to: vertical and horizontal reference point (BM), and
percent slope, scale or dimernsions, north arrow, and location and dista to nearpgt rd. { : arcel D.
030- 1093 -60 -000
Please print all information. NO
�j 1 20
Revi By Date
Personal information you P may be used for secondary purposes (Pmmy s.1 S 4 1 61X COU TY
3 2dp
Property Owner P
Lee Erickson Lot NE 19 NW 19 S 32 T 30 N R 19 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
706 Grandview Drive 7 Na CSM Vol. 10, Pg. 2777
City State Zip Code Phone Number _j City _f Village A Town Nearest Road
Hudson I WI 1 54016 1 (715) 381 - 9896 Hudson 1 469 Co. Hwy. E
New Construction Use: 16 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
J Replacement J Public or commercial - Describe:
Parent material Glacial outwash Flood plain elevation, if applicable na
General comments
and recommendations: Site suitable for conventional P S. Install two trenches at 100.00' with >900.0 sq. Ft. E.I.S.A.
Boring # Boring
10 Pit Ground Surface elev. 102.39 ft. Depth to limiting factor > in. Sal 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 -22 10yr3/2 none Is 0 sg ml cs 2vf,f 0.7 1.6
2 22 -38 10yr4/4 none Is 0 sg ml gs 2vf,f 0.7 1.6
3 38 -52 10yr5/4 none s 0 sg ml gs 1vf,f 0.7 1.6
4 52 -90 10yr5/4 none gr Is 0 sg ml - - 0.5 1.0
a * a0,�
1-11#4 contains thin, discontinuous, irregular bands of 0 sg 10yr4/4 Ifs. Loading rate of horizon reduced to reflect reduced permeability of horizon
associated with textural changes.
Boling # _j Boring
✓_j Pit Ground Surface elev. 104.95 ft. Depth to limiting factor >103" in. Sal Application Rate
Horizon Depth Dominant Color Redox Descriptan Texture Structure Consistence Boundary Roots GPDff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2
1 0 - 25 10yr4/3 none Is 0 sg ml cs 2vf,f 0.7 1.6
2 25-45 10yr4/4 none gr Is 0 sg ml gs 2f,1vf 0.7 1.6
3 45-103 10yr4/6 none gr Is 0 sg ml - - 0.5 1.0
-1 hT
H#3 contains thin, discontinuous, irregu 10yr4/4 sl. Loading rate of horizon reduced to reflect reduced permeability of horizon
associated with textural changes.
' Effluent #1 = BOD ? 30 < 220 mg/L nd TSS >30 < 1 mg/L * Effluent #2 = BOD < 30 mg/L and TSS <-�p mg/L
CST Name (Please Print) Signatu CST Number
James K. Thompson :W-- 3602
Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number
340 Paulson Lake Lane, 0 154020 10282005 715- 248 -7767
r
'Property Owner Lee Erickson Parcel ID # 030 - 1093 - - 000 Page 2 of 3
F ] Boring # � Boring 40 Pit Ground Surface elev. 102.18 ft. Depth to limiting factor >98" in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -24 10yr4/3 none Is 0 sg ml cs 2vf,f 0.7 1.6
2 24-40 10yr4/4 none Is 0 sg ml gs 2vf,f 0.7 1.6
3 40 -98 10yr4/6 none gr Is 0 sg ml - - 0.5 1.0
2� •(� hz.�
H#3 contains thin, discontinuous, irregular bands of 2msbk 10yr444 sl. Loading rate of horizon reduced to reflect reduced permeability of horizon
associated with textural changes.
i F-1 Bonn # J Boring
Boring ft. Depth to limiting factor in.
� Pit Ground Surface elev. Sal Application Rate
Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
F-1 Boring # I 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 GP
in. Munsell Qu. Sz, Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
Effluent #1 = BOD 5 . 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD -S mg4L and TSS <30 mg4L
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.
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa t of
FILE INFORMAT16N SYSTEM SPECIFICATIONS
Owner
ham- Septic Tank Capacity 157 a l ❑ NA
Permit # ?= c�� / Septic Tank Manufacturer LJ /65r✓C� ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer F0LVL_0 (L ❑ NA
Number of Bedrooms 3 ❑ NA Effluent Filter Model PL. !S7Z5- ❑ NA
Number of Public Facility Units A Pump Tank Capacity al A
Estimated flow (average) 39 D al /day Pump Tank Manufacturer A
Design flow (peak), (Estimated x 1.5) al /day Pump Manufacturer NA
Soil Application Rate l9 r SD gal /day /ft2 Pump Model 9rNA
Standard Influent /Effluent Quality Monthly average* Pretreatment Unit j,NA
Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODd :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 In- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound
a
� Fecal Coliform (g mean) 510 cfu /100m1 ❑ Dri p-Line ❑Other:
9 P
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: � ❑ mo yea r(s) ► (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: ❑ month(s) (Maximum 3 years) ❑ NA
years)
Cle effluent ❑ month(s)
ea a uent filter A
t least once every: year(s)
❑ NA
Inspect um ❑ month(s)
p pump, pump controls &alarm At least once every: ❑ year(s) NA
Flush laterals and pressure test At least once every: ❑ month(s) P I N A
❑ year(s)
Other: At least once every: p month(s)
�JA
Other:
A
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 Z
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:
X 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 INSTALLER POWTS MAINTAINER
E eName
ne X45 . 2 ( Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name C-90IX t`d-LN-ry ! !j Phone Phone -�S 3* , Tn�
This document was drafted in compliance with chapter Comm 83.22(2)Ib)l1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
Safety ttil ' s fXB sion County
201 W. Was n e., 162 St. Croix
consin
is Madison Sanitary Permit Number (to be filled in by Co.)
(b1181 266 -315
Department of Commerce
Sanitary Permit Applica 'o E[VED a P1anI.D.Number
In accord with Comm 83.2 1, Wis. Ado Code, personal inf on you provide jed Address (if dill than mailing address)
may be used for secondary purposes Privacy Law, s 1 4(1 Xqn) �r
L Application Information — Please Print All Information 469 Co. Hwy.
ST.
Property Owner's Name ZONING OFFICE Parcel #: P Lot# Black#
1 030-1093 -0OQ lot 7 Na
Lee Erickson
Property 's Mailing Address Location
706 Grandvi rive '1+ t /.
Nw , Section 32.
City, State Zip Code Phone Number 30 N; R 19 W
Hudson, WI 54016 (715) 381 -9896
IL Type of Building (ch all that apply)
X 1 or 2 Family Dwelling - N of Bedrooms 3 Subdivision Name CSM Number
❑ Public/Commercial - Describe Use Lot 7, CSM Vol. 10, P .2777
❑ State Owned - Describe Use ❑City ❑Village XTownship of Hudson
IIL Type of Permit: (Check only one IN on line A Complete line B if applic e)
A. X New System ❑ Replacement S ❑ Treatment/Holding Tank R acement Only ❑ Other Modification to Existing System
B. ❑ Permit Renewal ❑ Pemnit Revision X Change of - Transfer to New List. Previous Permit Number and Date Issued
Before Expiration Plumber •
IV. Type of POWTS System: Check all that a
X Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable il [IM d < 24 in. of suitable 11 Single F'
Constructed Wetland ❑ Pressurized In- Ground El Holding T ❑ eat Filter nit ❑ R g ❑
Recirculating Synthetic Media Filter 11 Leaching Chamber ❑ Drip ❑ Grave ess Pi er (exp )
V. Dispersal/Treatment Area Information: Si 60 4 bens 19.1 sq. ft./ end caps M163.4 ft ElSA
Design Flow (gpd) Design Soil Application Rate(gpdsf) Required 1 Area Pr System Elevation
450 gpd 0.4 gpd sq. ft. 1,12 sq ft 1 63.40 Sq 107.25', 105. , 8c 104.25'
VL Tank Info Capacity in Total N ufacturer Site Fiber Plastic
Gallons Gallons o nits Cow Cry
New Existing
Tanks Tanks
Septic or Holding Tank 1,500 _ 1,500 1 Wieser Con to X
Combination ST/PC as 2 . ST
Aerobic Treatment Unit
Dosing Charnber 00 V
V1Z Responsibility Statem t- L the j1dq4pd, TTW responstb f on of the PO S shown on the attached plums.
Plumber's Name (Print) s 'gnadtre P/MPRS Number Business Phone Number
James K. Thompson RS #30021 (715) 248 -7767
Plumber's Address (Street, City, State np Code)
340 Paulson Lake Lane, lyceola, WI 54020
VIII. Coun /De artment We Onl
❑ Approved ❑ Disappro Sanitary Permit Fee (includes Date Issued Issuing Signature (No Stamps)
Groundwater Surcharge Fee)
❑
Owner ven Reason for Denial
1X Conditions of Ap oval/Reasons for Disapproval
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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No
463352 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:
Erickson, Lee St. Joseph, Town of 030 - 1093 -60 -000
CST BM Elev: 777��7 BM Description: Section/Town /Range /Map No:
CST BM Elev:
32.30.19.341 D
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
Dosing Alt. BM
Aeration Bldg. Sewer
Holding St/Ht Inlet
St/Ht Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom
Dosing Header /Man.
Aeration Dist. Pipe
Holding Bot. System
Final Grade
PUMP /SIPHON INFORMATION
Manufacturer Demand St Cover
GPM
Model Number
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of System: UNIT Model Number:
DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pipe(s)
Length Dia 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 Topsoil
Yes No Yes No
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / /
Location: 469 County Road E Hudson, WI 54016 (NW 1/4 NE 1/4 32 T30N R19W) NA Lot 7 Parcel No: 32.30.19.341D
1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
Plan revision Required? ] Yes J No
Use other side for additional information.
Date Insepctor's Signature Cert No
SBD -6710 (R.3/97)
Safety and Bull J
' co
201 W. Washington ve ME rnty F St. C oix
As as
isc0sin Madison, WI 7067 Sanity Permit Number (to be filled in by Co.)
Department of Commerce (608) 26 3151 2
Sanitary Permit Application � Pl I.D. Number
In accord with Comm 83.21, Wis. Adm. Code, personal i�omtation y ovi T Z N I \
N G U F r (if different than mailing address)
may be used for secondary purposes Privacy Law, s 15.04( 10 1
C ess
L Application Information – Please Print All Information r U 469 Co. . E
Property Owner's Name Parcel # ( �: ) Block #
030 - 10 93 -00 -000 Na
Lee M. & Randi L. Erickson
Property Owner's Mailing Address Property Location . 3t4 / D)
706 Grandview Dr. NE I/ NW 1 /4, S ection 32
City, State Zip Code Phone Number
Hudson, WI 54016 (715) 381 -9896 T 30 N; R 19 W
IL Type of Building (check all that apply)
X 1 or 2 Family Dwelling - Number of Bedrooms 3 ✓ / /r Subdivision Name CSM Number
S /�oo9
❑ Public/Commercial - Describe Use Lot 7, CSM Vol. 10, P . 2777
❑ State Owned - Describe Use 3 bl 5 , - n C6ZLS W O ❑City _❑ Village XTownship of St. io
3' ' r f
lIL Type of Permit: (Check only one boa on line A. Comple line B if applicable)
A. X New sy stem ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System
B . ❑ Permit Renewal ❑ Permit Revision ❑Change of ❑ Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. Type of POWTS System: Check all that appl
X No - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ 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 Leaching Chamber El Drip Line 11 Gravel-less Pipe El Other (explain) / 7•y
V. Dispersal/Treatment Area Information: S' 60 "Quick 4" Infiltrator Chambers at 19.1 sq. ft. EISA/chamber = 1,146.00 sq. ft. EISA
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) S evation
450 gpd 0.4 gpd sq. ft. 1,125.00 sq ft 1,146.00 sq ft EISA 105.75' & 104.
VL Tank Info Capacity in Total Number Manufacturer Prefab S 1 Fiber Plastic
Gallons Gallons of Units Concre Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank Wieser Concrete 2VXV.
1,500 - 1,500 1 Combination ST/PC as two comp. ST X r 3&
Aerobic Treatment Unit
4� N �j
Dosing Chamber 1
VIL Responsibility Statement - I, the underpigned, assume , r4ponsibility for Installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Pl 's Signature MP/MPRS Number Business Phone Number - Joe Stan W #223475 715 684 -5166
Plumber's Address (Street, City, State, Zip CM
P.O. Box 263, Woodville, W1 54028
VIR oun /De artment Use Onl
oved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued 1 119-in! Agent igoature )
Surcharge Fee) J�f , 0) 3 / O
El owner Given Reason for Denial
IX. Conditions of Approval/Reasons for Disapproval 3 �— l99 ^V7>7
OW M � . Y N'' CL7M c tank, effluent filter 'yh• `,� � C _ D/1 _ , � ersal cell must all be rvic � s s ervic ed /maintained G�-� P.�X�ai
�""•�
as per management plan provided by plumber C ' eAj& y en,4,- �j_ k"t�r
2. All setback requirements must be maintained /� ,
as per a licable code /ordinances.
/ Attach complete plans (to the Co ty only)4W the svm
�0�' ��� s . � ,,.• � B da� ct,�t� d ry
511 t
e
Propose.d -SOil Q,//Q/aa 6;i /,
MuI6 be ?i2 S' /orr� , � A
��opossd Proposed
3 bzt rnv rj raa C SCa /¢. / 5/
S�JL�ent C�'O SS-J°¢GL�JO� Lee$ anal' Eric,tYo+� j��o /�.
rgdC elev.
/o /0LP.� o r..
' O� a MCI( _ �niSFCu 1106
EsE•'�,a�e of slew I O(� Ey�5�-
/SO. o' f 0 G
P,^opasc.d c�resa/ Cdnc.
;.
wLA 1, cab /5 i►t.,P. ,
- - - -- - --
/ 40 rb�
Olds 6/0
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elfQn owtrS a5 /ate S /
0 ost�.+ des � � ce
Pr P �
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3121 D� B� ■ ��� •
w ki �% -
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- ok/ go _ —
67,/-5 7 rao%
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mute, be
5�6•c fa�K � dc`��' -�-
pr0 Sc d p/ o pas PCo
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rao'e elev.
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Proposk. c); Cenc.
Lo t, c� /sct� I -r.,P.
cup eF{ /u.r+E L � 1
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Co.» rrt , 8 z• 35 re a ?)
T1 � t� at 3 X80.67
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lord ch
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` scpnsin Department of Industry SOIL AND SITE EVALUATIO
j
Yfi of 3
Labor and Human Relations �� Division of Safety & Buildings in accord with ILHR 83.05, Wis. A OUNTYS � Attach complete site plan on paper not less than 8 1/2 x
11 inches in size. Plan st not limited to vertical and horizontal reference point (BM), direction and % of s pe, s ARCEL I.D. # dimensioned, north arrow, and location and distance
to nearest road. B 3 APPLICANT INFORMATION PLEASE PRINT ALL INFORMATI N � twt uAit /I
U
PROPERTY OWNER: ERTY L A
51t 0)/ ���✓�.t/ GOVT. OT NW 1/4 IV' 1 /4,S .1Z T J,0 N,R 9 E (a)
PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK N S BD. NAME 0 CSM # O .
�3 C--> . P . Asti, %D 6
CITY, STATE ZIP CODE PHONE NUMBER ❑VILLAGE [T OWN N ST AD
v�rV -) �� SVOX t - 71S) ,5�
P4 New Construction Use IXl Residential / Number of bedrooms (J Addition to existing building
j ] Replacement [ J Public or commercial describe
Code derived daily flow i�00 gpd Recommended design loading rate -7 bed, gpd/ft' trench, gpolft
Absorption area required bed, ft trench, ft Maximum design loading rate _r " bed, gpd/ft • trench, gpdgt
Recommended infiltration surface elevation(s) - 5'X- 3 ft (as referred to site plan benchmark)
Additional design I site considerations U,SE 7,-eF� mss' a i /h P,40 p 130X P PS TI* i j? 0 Tr 0 AJ
Parent material C y2. - ,v ,�, ' �,v f!(rD ! / Flood plain elevation, if applicable ft
S - Suitable for system CONVENTIONAL MOUND IN GROUND PRESSURE AT GRADE SYSTEM MI 7FU HO LDING TANK U- Unsuitable fors stem S❑ U S❑ U Q S ❑ U ®.S
❑ U C1 S E11 S � U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bolxtdary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed mrldi
0- /0 1 X 3/3 - '5/ l.f Sbk '" ore s ,S , 61
Ground -,�� 7S ye /s � �, 9,� ,►...,.e i • 7
el
fl
Depth to i
limiting
factor
>
Remarks:
Boring #
� o /o ,e L ( sl 1, � s�� ���e s 3 f - �•�, S
Z J3, � /o ,2 Z si �, f, s6K 2f • S ' .G
s
4"
/32- 3
Ground �L Z /0 3 (� S �, 1 , 1 f
l`/� /yrt C S 1
loin G ft - � 0 YX 5 —
Depth to
limiting
factor ��
y�
Remarks:
CST Name:— Please Print Phone:
NOMESITE SEPTIC PLUMBING 16 d
Address:
R08Ef4T Ut.BRIGAT
Sgnature: �� � _ a - �. ��. MAS LIC. N0.00663 Date: CST Number: WTALLER & DESIGNER �,��_ 03 �STi�'j 2y (FZ
lit' E_
Loa 41
0 R
o'J
ti d�``� d �-Q�, , �„ � u,Q cam► c,� I�,ar� �t•a° .�-�
L Wiscoaria Department Re of In "S�' SOIL AND SITE EVALUATION REPORT Page '— of 3
Division of Safety &Buildings in accord with ILHR 83.05, Wis. Adm. Code M R 3 °h wve cic-
` COUNTY .C,C�O� � •
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 % of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to nearest road. 6 —A d
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION VIEWE y DAT
I 6
PROPERTY OWNER:, /, PROPERTY LOCATION
GOVT. LOT NW 1/4 1/4,S . T Jd ,N.R / 9 E (orj VJ
PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # I S BD. NAME O CSM #
�3 Y
C- '- /eP • E C-SILl
CITY, STATE ZIP CODE PHONE NUMBER FIVILLAGE [WOWN I NEAREST fjPA 1
uLn� �/ SVoXZ ( - 70) 5y -,�GoG sr host h
P4 New Construction Use [X1 Residential / Number of bedrooms ( Addition to existing building
I Replacement [ ] Public or commercial describe
Code derived daily flow & gpd Recommended design loading rate bed, gpd/ft2 of trench, gpW
Absorption area required bed, ft trench, ft Maximum design loading rate r bed, gpd/ft gpd/ft
Recommended infiltration surface elevation(s) -5'4.P— Q:�- • 3 ft (as referred to site plan benchmark)
Additional design / site considerations a-<f T.f'Fti s Av, v PAO O 40X D /'S TIP i f3 V - r ,0 J
Parent material S CS 4 Z- Flood plain elevation, if applicable N ft
v w
S 7 le system CONVENTIONAL MOUND IN- GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK
U fors stem RS ❑ U PS ❑ U I @S ❑ U E]-S ❑ U ❑ S Cam} U I ❑ S E3 - U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Motes Texture Structure Consistence Y Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ranch
/ o -/o /� 3 3 5/ 1.�, sbk A0 VfIL , S .
Ground /V/ �� c , 9�
/ e
o1 ft.
� abS Dep to
limiting
factor
Remarks:
Boring #
/� L l s� 1, � s/,� ���e S 3 � • f • S
0
Ground 2- L 3 z /O 3 .S , ' , �/� �h1 C S
/o /� ft. yle
Depth to
limiting
factor ��
S
Remarks:
CST Name : — Please Print Phone:
HOMESITE SEPTIC PLUMBING 6 d fl
Address:
ROBERT Ut BRIGHT
S� nature: ' e. � nr� MASTfT t - CST Number: i � asajN. Ifd;T ILER &DESIGNER LIC. NO .00663 Date: ��_ X3
�sT� 24i�z
TiP � -t� �tt s ELF �.. S x ��!'
ORIGINAL
L• 9
PROPERIYOWN _ -S� SOIL DESCRIPTION REPORT Page ,
PARCEL I.D. # Z" ^
Boring # Horizon ant Color Mo ttles Texture Structure�� Y Roots G2
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed JM46
t3 o ./ /o s/ 2, s 6wnVf7e
Ground y 1� -,� 5 3 /
el
to
limiting � 105 — ,2/ A#V C� ?
factor to h �
Remarks:
Boring # 31 3 L. Shy 4 GS
Ground
Depth W
limiting 3lo ti /D j
fac
Remarks: �/ �'� T `1 T 4010 I'N U 0
Boring # �_ �a r/� z 1 s � /� �, 5�6� nti, f2 $ 3 � . � _• . S
Ground
elev. 3.2 13 L Y�e ----- - o
Depth to /b 3. 2 5 Yl
���.
limiting b,.0 /Q 2 7 35 `' 7S b
factor
Remarks: _.
Boring # _
O
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
can 099n 10 NC//1M
JAM1@190
v
r •
M
a m
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cn -73
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N � •�
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. W
+' ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner4kw;Pr_ G I"f? k d �-• Er1 4A'S' do _
Mailing Address 70(o Gra, e 1. 61 _
d' JI
Property Address r
/
(Verif requ' ed from Planning Department for new construction.)
City /State 1 & &Di bJ .SSA & Parcel Identification Number 03 - 1093 -W -CWD
LEGAL DESCRIPTION
W
Property Location rl E '/< , CL '/< , Sec. ' 2 , T 3 N R1� , Town of 5 • J 4 _
Subdivision Qsm Lot # 7
Certified Survey Map # 1_�Ap 06 C1 , Volume /0 , Page # .277
Warranty Deed # -2� / � S� ,Volume c>�_ ,Page # ( 3 �OS�
Spec house ❑ yes Cry rio Lot lines identifiable eyes ❑ 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 County Zoning Department a certification form, signed by the owner 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.
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 system has been maintained must be completed and returned to the St. Croix County Zoning
Departm t within 30 the three year expiration date.
��- % V/_
SIGNATURE OF APPLICANT DATE
OWNER CERTIFICATION
Uwe certify that all state is form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the
property d cribed above, b %f a warranty deed recorded in Register of Deeds Office.
SIGNATURE OF APPLICANT DATE
* * * * ** Any information that is misrepresented 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 and a copy of the certified survey map if
reference is made in the warranty deed.
Conventional Septic System Management Plan
Pursuant to Comm 83.54, Wis. Adm. Code
General
The conventional septic system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall be maintained
in accordance with component manual SBD- 10567 -P (8.6/99). All local and/or state rules pertaining to system maintenance
and maintenance reporting shall be complied with.
Septic Tank
The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The
septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The
contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to
service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment,
maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge
accumulation in the tank. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge
should 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 filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank
manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for
service and assessment shall be sealed watertight upon the completion 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 accidental or unauthorized entry into the tank. No individual should ever enter the septic tank
as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with
Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or
chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be
approved for septic tank use by the Department of Commerce, Safety and Buildings Division.
Soil Absorption Cell
Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should
be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for
vegetative maintenance) over the system is not recommended. Soil compaction may hinder aeration of the infiltrative surface
within the system and will promote frost penetration during cold weather months. Cold weather installations (October -
February) dictate that the system be heavily mulched for frost protection.
Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not
exceed maximum design flow specified in the permit for the installation.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the
owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring.
Contingency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by removing
biologically clogged adsorption and dispersal media and replacing said components as deemed necessary or by installing a
new soil absorption cell to bring the system into proper operating condition.
Questions on the operation or maintenance of the system should be directed to installing plumber, Joe Stang at
(715) 684 -5166, or the St. Croix County Zoning Department.
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner LAD C, Q Septic Tank Capacity SpU al E3 NA
Permit # Septic Tank Manufacturer NA
Vul
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
Number of Bedrooms 3 ❑ NA Effluent Filter Model �Z ❑ NA
Number of Public Facility Units ❑ NA Pump Tank Capacity al A
Estimated flow (average) 3v L) g al/day Pump Tank Manufacturer I NA
Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer NA
Soil Application Rate Q, al /da /f Pump Model ❑ A
Standard Influent /Efflue Quality Monthly average` Pretreatment Unit E3 NA
Fats, Oil & ease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen De d (BOD 5220 mg /L ❑ NA ❑ Mechanical Ae ion ❑ Wetland
Total Suspended So s (TSS) 5150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal ravity) ❑ NA
Biochemical Oxygen Demand ( D 530 mg /L n -Gro 13 In-Ground (pressurized)
Total Suspended Solids ► 530 mg /L NA ❑ At -G ❑ Mound
Fecal Coliform (geometric mean 510` /100 ❑ Dr' ne E3 Other:
Maximum Effluent Particle Size V jin dia. ❑ NA Oth . ❑ NA
Other: 13 NA er: ❑ NA
*Values typical for domestic wastewater and septic to effluent. Other: ❑ NA
MAINTENANCE SCHEDULE J/
Service Event O f Service Frequency
Inspect condition of tank(s) At least on every: Z — 3 E ea� (Maximum 3 years) ❑ NA
Pump out contents of tank(s) When c in sludge and scum equals one -third %) of tank volume ❑ NA
Inspect dispersal cell(s) At le once eve 2 E3 mo nth ear ls) (Maximum 3 years) 13 NA
ear
Clean effluent filter AS D� 190 ast once every: Y ° i (� ❑ NA
Inspect pump, pump controls &alarm Oft least once every: ❑ month(s) ❑ NA
❑ year(s)
Flush laterals and pressure test At least once every: ❑ month() ❑ NA
Other; ❑ month(s) ❑ NA
At least once every: ❑ year(s)
Other. ❑ NA
MAINTENANCE IN /ccumulation IONS
Inspections of tad disper I cells shall be made by an individual carrying one \ha wing licenses or certifications:
Master Plumber; Plum r Restricted Sewer; POWTS Inspector; POWTS Mainage Servicing Operator. Tank
inspections must a vi al inspection of the tank(s) to identify any missing or broe, identify any cracks or leaks,
measure the volucc ined sludge and scum and to check for any back up or ffluent on the ground surface.
The dis persal celll visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on thsurface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notificthe local regulatory authority.
When the combiumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire
contents of the all 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 ?/
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 avoickthis situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
um or contact a Plumber or POWTS Maintainer to assist in manually operating the m
power to the effluent p p P 9 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; Ohapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; n ht scraps; medications; oil;
pesticides; sanitary napkins; tampons; 1
painting products; pe ry and water softener brine.
p p ,
P 910 •
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:
o
• All piping to tanks and pits shall be disconnected and the ab andoned pipe P enin g s 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 POWT ails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant
repla�7A a system:
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.
.r T
alua ' o ing lank
e ai e � TIC►
fZ� 8
b 1
❑ 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 COMMEN
POWTS INSTALLER '0 101,
POWTS MAINTAINER
Name Z (4 15 Name
Phone Phone
SEPTAGE SERVICING OPER (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name S . C ( bU ZOrJI�(l
Phone Phone 38'(10_ (0 Z)
This document was drafted in compliance with chapter Comm .22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
Parcel #: 030- 1093 -60 -000 03/21/2005 07:48 AM
% % PAGE 1 OF 1
Alt. Parcel #: 32.30.19.341 D 030 - TOWN OF SAINT JOSEPH
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): " = Current Owner
" MADSEN, CHRIST M & SANDRA
CHRIST M & SANDRA MADSEN
437 CTY RD E
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 6.220 Plat: N/A -NOT AVAILABLE
SEC 32 T30N R19W PT NW NE & SW NE BEING Block/Condo Bldg:
LOT 7 OF CSM 10/2777 6.22 ACRES
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
32- 30N -19W
Notes: Parcel History:
Date Doc # Vol /Page Type
2004 SUMMARY Bill #: Fair Market Value: Assessed with:
5564 73,600
Valuations: Last Changed: 07/08/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 6.220 72,400 0 72,400 NO
Totals for 2004:
General Property 6.220 72,400 0 72,400
Woodland 0.000 0 0
Totals for 2003:
General Property 6.220 42,600 0 42,600
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
i
2 7 6 1 P 0 4 7 ?E3 4D V_j
KATHLEEN 11. WALSH
State Bar of Wisconsin Form 2 -2003 REGISTER OF DEEDS
WARRANTY DEED ST. CROIX CO., WI
RECEIVED FOR RECORD
Document Number Document Name
03 /08/20� 0:15Ali
WARRANTY DEED
THIS DEED, made between Christ M. Madsen and Sandra G. Madsen, husband
REC FEE: 11.00
and wife TRANS FEE: 255.00
( "Grantor," whether one or more), COPY FEE:
and Lee M. Erickson and Randi L. Erickson, husband and wife CC FEE:
PAGES: 1
( "Grantee," whether one or more).
Recording Area
Grantor, for a valuable consideration, conveys and warrants to Grantee the following
described real estate, together with the rents , profits, fixtures and other - appurtenant Name and Return ddre
a 1^� ��
interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is l � Ct�
needed, please attach addendum): � a*14
Part of NE 1/4 of NW 1/4 and SE 1/4 of NW 1/4 and Part of NW 1/4 of NE 1/4 and
SW 1/4 of NE 1/4 of Section 32, Township 30 North, Range 19 West, St. Croix r
County, Wisconsin described as follows: Lot 7 of Certified Survey Map filed June
17, 1994 in Vol. 10, page 2777, Doc. No. 518009 030 1093.60 - 000
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated '�h 1c)s .
SEAL SEAL
* *Christ M. Madsen
(SEAL) aq*� v (SEAL)
* *Sandra G. Madsen
AUTHENTICATION ACKNOWLEDGMENT
Signature(s)
authenticated on STATE OF )
) ss.
COUNTY )
TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on
(If not, the above -named Christ M. Madsen and Sandra G. Madsen,
authorized by Wis. Stat. § 706.06) husband and wife
to me nown to be the perso s) who executed the foregoing
THIS INSTRUMENT DRAFTED BY: instru en and ackn le e a e.
Attorney Kristina Oland
Hudson, WI 54016
Notary Publi a of
My Commis n (is permanent) (expires: —
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003
• Type name below signatures. � ` y y } INFO -PROTM Legal Forms 800 -655 -2021 www.infoproforms.com
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Volume 10 PAGE 27- 7�7�►`��t