HomeMy WebLinkAbout030-2079-70-000 1
Wisconsin Department of Commerce Count
Safety and Building Division PRIVATE SEWAGE SYSTEM St. Croix
INSPECTION REPORT Sanitary Permit No:
430671 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:
Ridley, Stephen & Janet I St. Joseph Township 030 - 2079 -70 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
o G ca t. doe 33.30.19.674
TANK INFORMATION ELEVATION DATA 3tv
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic � ` Benchmark
Dosing Alt. BM
Aeration Bldg. Sewer -7
Holding SUHt Inlet
TANK SETBACK INFORMATION St/Ht Outlet e
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom
3' —
Dosing Header /Man.
7.3V� 9
Aeration Dist, Pipe
Holding Bot. System
E
PUMP /SIPHON INFORMATION Final Grade
Manufacturer _ Demand St Cover X 11 Z2
GPM 7 -
Model Number
TDH rift Fricti oss System Head H Ft
Forcemain Length Dia. el+
SOIL ABSORPTION SYSTEM S-
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: —_ r e UNIT
C--,l c. -j . C, — �,C > 3V , .z S , . v -.,.,c �✓(� Model Number;
i r' w (�
DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
I' Pipe(s)
Length Dia ( Length is — 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:
"KL✓ i
Location: 556 White Oak Lane Hudson, WI 54016 (SE 1/4 SW 1/4 33 T30N R19W) Oak Knoll Lot 17 Parcel No: 33.30.19.6
1.) Alt BM Description
2.) Bldg sewer length = Iq
- amount of cover = 3 t r /
5 _
- fa SyS�'' -- - -
1/�► -s' So s -
i
Yes No
Use other side for additional
Plan revision Required?
information.
SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No.
Safety and Buildings Division COUnty 1
201 W. Washington Ave, P.O. Box 7162 / !i C7 1
NVi s c onsin Madison. WI 53707 -7162 Site Address
ss� wti,
Department of Commerce � O-k Ld �.
Sanitary Permit Application Permit Number ��U /
In accord with Comm 83 -21. outs. Adm. Code, pe soml information yon provide Chock if Revision
may be used for secondary parposcs ff :
L Application Information - Please Print All Info �� � 4 K, e + $rate Plan LD. Nt+�r
Property Owner's Name ; / Parcel Number pa k N c t C a <
L 17 ss6 _, y �„ ak
fi , -e �
Pro s Aft= E'ropery Loa°on - to
SSl SSt / L>�✓C -_._. It sW 4: s T N. R 1 F
Cary. St Zip Code Phone Number 7 O 3 D Block Number 70'
Name CSM Number
oakkNot (-
II. Type of Building (check all that apply) ❑City
)(I or 2 Farmly DweUing - Number of Bedrooms ' ®/mac OvilLage
0 Public/Coumereial - Describe Use . f ownship S ,
❑ State Owned (?--e v' C -e / �� 3 ^} a a [ - �, "�/ Nearest Road
I ! o�t� 1Z L�
IIL Type of Permit: (Check only one box on line numbering scheme for internal use). Complete line B if app ' le)
A. 1 cw 2 0 Replacement System 3 0 Replacement of 6 0 Addition to For County usse
Tank Onl Exisft System
B. Check if Sanitary Permit Previously issued Permit bee / b
IV. Type of Permit: (Check all that apply)(nnmbering scheme is for internal use) /
44 &� n - Pressurized In- Ground 210 Mound 47 0 Said Ster 50 ❑ Coamucted wetland
22 0 Pressurized In -Ground 41 0 Holding Tank 48 0 Single Pass 51 0 Drip Line
45 0 At -Grade 46 0 Aerobic Treatment Unit 49 ❑ ❑ Pther
V. D' tment Area Information: e k t Y
Design Flow (gpd) Dispersal Area Dispersal Area d Application .. Percolation Rate System Eleration / Final Grade
Requited 3 Proposed / Ram(Gals-/Days/Sq.Ft.) (Min./1>xh) Elevation
tz-
0,7. 97
VI. Tank Info Capacity in Toni Number �Ma Prefab Site Steel F bee plastic
Gallons Gallons of Tanks rQ,?7 d( Concrroc Cons Glass
NCW Ezisda;
Tanks Tanks /
Septic or Holding Tank / - / 0 a6; w e c
bins Chumber t L
VII. Responsibility Statement- I, the undersigned, ass— responsibility for lrsstafttian of the POW1S shown on the attached pbms.
Plumber's Name (Print) Plumber's Signanue MP/MPRS Number Business Phone Number
D ��/ �' R�ZF12 �- Fj ;� 2 l 0 -7. 7/S- Zn- C 2
7(S g'- 73 V
Plumber's Address (Street, City. Stain. Zip Code)
6 3/7 -1 6Gt--' Sf 3( wI'S'C Sys 2 y
VIII. /De artment Use Onl
Approved ❑ Disappcovod Santry Permit Fee (includes Groundwater Date Issued Ag Sigoanue Stumps)
0 Owner Given Initial Adverse .'
Surcharge Fee, 8
Determination f 2 o G
IJC���f_VprovaUReasous for Disapproval s S 10�.,_ i ' 1� VVt S4tjyyt.�.
Septic tank, effluent filter and r „
dispersal cell must all be serviced / maintained
as per management plan provided by plumber. y
2. All setback requirements must be maintained Qi�c d a
Attach complete puns (to the County only) for the system an paper not ka than Sill x 111ncJses fn size
GENERAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR01
REAL ESTATE TOWN OF SAINT JOSEPH
COMPUTER NUMBER 030 - 2079 -70 -000 Parcel Number 33.30.19.674
Claimed Date Re- certified / / Relate Number:
OWNER NAME: First STEPHEN C & JANET M Last RIDLEY
CO -OWNER
Mailing Address 2215 MISSISSIPPI LA
City HUDSON State WI Zip 54016 -
Type Vol Page Doc # Rec.Date Type Vol Page Doc # Rec.Date
HISTORY WD 2466/ 160 748014 12/02/2003 FJUDG 1102/ 408 523396 11/14/1994
PROPERTY ADDRESS:
Hse # 1/2 PD -- Street Name- Type SD Apartment Post Office
556 WHITE OAK LA
School District: 5432 - SCH D OF SOMERSET
Special District: (1) 1700 - (2) - (3) -
W ITC
Plat Code: Last Changed on: 05/13/2004 Book Number: 1
SECTION 33 TOWN 30N RANGE 19W 1 /4160 1 /440 Map Number: 00 - Sales Area:
Parcel Control 0 TAXABLE
Number of Units:
ZONING: Permit Number: Type:
Bank Numbers:
F4 -Prev, 175 -Next, F6- Legal, F7- Value, F8- History, F10 -Exit, F12 -More
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Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162 ST. CROIX
11 pisconsin Madison, WI 53707 — 7162 Sanitary Permit Number (to be filled in by Co.)
Department of Commerce 8 266- 3151J0
Sanitary Permit Applie tion state Plan I.D. Nn ber
In accord with Comm 83.2 1, Wis. Adm. Code, personal inf rmation you provide A
may be used for secondary purposes Privacy Law, 15.04( 1 004 Project Address (if different than mailing address)
OAK
I. Application Information — Please Print All Information ST. CROIX CO
U Y
ZONINGOFFI E -3 —
Property Owner's Name n Parcel # Block #
17 NA
Property Owner's Mailing Address Property Locati
SE 1 /4, SW' /4;S 33,T30N,R19W
City, State Zip Code Phone Num r
54022 715 `t
11. Type of Building (check all t apply) llJli dip✓
✓ 1 or 2 Family Dwelling -- NUmhcr n edrooms 4 Subdivision Name CSM Number
/ OAK KNOLL
o Public /Commercial — Describe Use �, � S
— �S., / t � D7 �/ 1 O C O Village Towns ipof� JOSEPH
o State Owned — Describe l fse ( 0 J
111. Type of Permit: (Check only one box on lin A. Complete line B if pplicable)
A. ✓ New System 0 Replacement Treatment/Holdin Tank Replacement Only o her Modification to E ' g in
Sv stem
B o Permit 0 Permit Revision o ange of Permit Transfer to List re ous raer d Date Iss
Renewal Plu her New Owner
Before
Expiration
IV. Type of POWTS System: (Check all that a pply)
Non — Pre ssurized In - Ground 0 MOUnd > 24 in. of suitable soil 0 M < 24 in. of suitable soil o At -Grade O Single Pass Sand Filter
• Constructed Wetland O Pressurized In- Ground O Holding Tank O Pe Filter O Aerobic Treatment Unit O Recirculating Sand Filter
• Recirculating Synthetic Media I' Leaching Chat�tber O Drip Line Grave -less Pipe O Other explain)
V. Dispersal/Treatment Area I I7 rlC
Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Are Requ d (sf) Dispersal Area Proposed (sf) System Elevation
600 0.7 ✓ 857.1 870.8 ✓ 97.5'
VI. Tank Info Capaciu in Total Number Manufa rer Prefab Site Steel Fiber Plastic
OAIons Gallons of Units Concrete Constructed Glass
Tank, "fain:,
Septic or Holding Tank 1250 11 1250 1 HUFFCUTT X
Aerobic Treatment Unit l D / r
Dosing Chamber
VII. Responsibility Statement- 1, the undersigned, assume responsibil for i tallation of/the PO S shown on the attached plans.
Plumber's Name (Print) Plumber's Signature MP /MPRS Number Business Phone Number
DARRELL FRAZER 221071 715- 288 -6225 OR
CELL 715- 828 -5734
Plumber's Address (Street, City. State. /ip Code)
16317 160 — BLOOMER, WI 54724
VII Count /De artment Ilse Onl
Sanitary Permit F (includes Groundwater Date Issued suing Agent gn ture ( amps)
Approved [I Disapproved d0
Surcharge d O
❑Owner Given Reason for Denial
IX. Conditions of Approval %Reasons for Disappr
� Fee)
n _ TEM OWNER: J{'f 1 Sep Ic an fta�i it filter and d
dispersal cell must all be serviced / maintained Z
as per management plan provided by lumber. Lt7YYl�''�
3S
2. A se ack requirements must a maintained
as per applicable code /ordinances.
attach complete plans (to the County only) for the system on paper not less than 8112 x 1 I inches in size
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Cover Sheet
RICHARD & KEITH HUSSEY
537 E. Maple Street
NON PRESSURIZED IN GROUND SOIL ABSORPTION COMPONENT
Reference SBD- 10567 -P (6199) "In- ground Absorption Component Manual"
Location: Oak Knoll Ridge — Lot # 17
SE 1 /4, SW '/4, Sec. 33, T 30 N, R 19 W
Town: St. Joseph
County: St. Croix
Designer's name and license #: William J. Bergh (License No. 1577 -007)
1 the undersigned state that these plans were designed
and submitted under my auth�ty:
.'�
Designer's signature: �• �.•�
Designer's address: 2667 11.3 pP Street
Chippewa ails W154729
Designer's phone number: 715- 723 -5555 voice
715- 723 -7535 fax
715 -577 -6838 cellular
ON ��
Contents 0
a
Page I -Cover sheet
Page 2 -Site Plan
p OB
Page 3- Leaching Chamber x- section schematic
Page 4- Leaching Chamber - manufacturer specifications
Page 5- Management and contingency plan
Page 6- Management and contingency plan
Page 1 of 6
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PAGE 2 OF 6
I
GRAVELLESS LEACHING CHAMBER CROSS SECTION (typical)
(installations may vary & require additional cells (not shown)— drawing not to scale)
observation pipe (where required)
soil to promote plant growth
W 1I/
W
>12"
distribution lateral
---36" minimum
34" 34"
SYSTEM ELEVATION = 97.5'
14 NUMBER OF LEACHING CHAMBERS (per cell)
2 TOTAL NUMBER OF CELLS
28 TOTAL NUMBER OF LEACHING CHAMBERS (all cells)
A MINIMUM OF 12" OF SUITABLE FILL MATERIAL IS REQUIRED OVER THE CHAMBERS.
INFILTRATOR STANDARD CHAMBER — OPEN BOTTOM AREA = 15.5 SOFT,
INFILTRATIVE SURFACE PER CHAMBER BASED ON EISA RATING = 31.1 FT2
All material and piping specifications as per the Conventional Soil Absorption Component Manual.
PAGE 3 OF 6
The Standard
Infiltrator°
Chamber
The Standard Infiltrator Chamber
V O „erl,;p at Latching Mechanism
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Effective Length
S
Chamber End View Posil-ock End Plate
Size (W x L x H) ...... 34” x 75" x 12"
1_
Storage Capacity ....78 gal. /10.4 ft'
12" �` O °�O O O @
o 0 0O O
n � a0 � O O O O a 0 � Weight ..... .............................26 lbs.
i
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Louvered Sidewall Height ............ 6'
INFILTRATOR SYSTEMS, _INC. STANDARD LIMITED WARRANTY
IN 1 kAfOR ',1' . I`;r :)Il" ,'t'akn AN 'R SCPTIC FP. DJ
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For technical assistance, installation instructions or customer service, call Infiltrator Systems at 1- 800 - 221 -4436.
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RECEIVED 1547
Wisconsin Department of Commerce SOIL EVALUATION REPORT page 1 of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code MAY 1 4 Sal & Sde EvAuations
Attach complete site plan on paper not less than 8'/: x 1 Coun 1 inches in size. Plan must ST CROI §L&M Y
include, but not limited to: vertical and horizontal reference point (BM), direction and p� I. D ZONING OFFICE
percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. _
Please print all information. Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m))._� �p
Property Owner `,,(�� �� , Y ! �! Property Locntion
Richard B. & Keitt Flassey / L Govt. Lot SE 1/4 SW 1i4 S 33 T 30 NR 19 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
17 Plat Of Oak Knoll Ridge -
City State Zip Code Phone Number .J City j Village ]g Town Nearest Road
River Falls WI 54022 715 - 386 - 8415 St.Joseph 1 556 White Oak Lane
> New Construction Use: 01 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
Replacement �j Public or commercial - Describe:
Parent material Glacial outwash _ Flood plain elevation, if applicable 11 na
General comments C �!
and recommendations: Install two trenches at elev. = 98.00' using 29 high capacity leaching chambers.
�UPa� / S
M Boring # Boring
/ Pit Ground Surface elev. 99.44 ft. Depth to limiting factor >86 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtft
*Eff#1 *E
1 0-6 1 0yr3/2 none sl 2fcr mvfr cs 2fm,lc 0.5 0.9
2 6 -12 10yr4/3 none sl 2fsbk mvfr cs 2fmc 0.5 0.9
3 12 -24 10yr4/4 none sicl 2msbk mfr cs 2fm,1 c 0.4 0.6
4 24 -32 7.5yr4/6 none I 0 sg ml cw 1 f 0.7 1.2
5 32 -50 10yr5/6 none s 0 sg ml gw - 0.7 1.2
6 50 -86 10yr6/4 none s 0 sg ml - - 0.7 1.2
Boring # Ong �Y rl - aa- Y T /4j? d ew
LA Pit GroundSurface elev. 101.82 ft. Deoh to limiting factor >86" in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'
*Eff#1 *Eff#2
1 0 -5 10yr3/2 no sl 0.5 0.9
2 5 -12 10yr4/3 none sl 0.5 0.9
3 12 -30 10yr4/4 none sicl 0.4 0.6
4 30 -39 7.5yr4/6 none Is 0.7 1.2
5 39 -52 10yr5/6 none s 0.7 1.2
6 52-86 10yr6/4 none s 0.7 1.2
y„ g
* Effluent #1 = BOD 5 > 30 < ZO mg/L and TSS > < 150 mglL * Effl #2 = BOD <30 mg/L and TSS <30 mg/L
CST Name (Please Print) Sign ure: CST Number
James K. Thompson t_ 3602
Address A.C.E. Sal & Site Evaluations ate Evaluation Conducted Telephone Number
340 Paulson Lake Lane, Osceaa, WI ' 5/ 715- 248 -7767
r Property O . Richard B. & Keith M. Hussey Parcel ID # 030 - 2079 -70 -000 Page 2 of 3
F Boring# . Boring aAtd ait -
Ground Surfke elev. 100.41 ft. Depth to limiting factor >72" in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP
"Eff#1 *Eff#2
1 0 -5 10yr3 /2 none sl 0.5 0.9
2 5 -15 10yr4/3 none sl 0.5 0.9
3 15 -23 10yr4/4 none Sicl 0.4 0.6
4 23 -32 7.5yr4/6 none is 0.7 1.2
5 1 32 - 37 10yr5/6 none s 0.7 1.2
6 37 - 10yr6/4 none s 0.7 1.2
F 4] Boring # _ . n
C 1A Pit Ground Surface elev. 102.04 ft. Depth to limiting factor >72" in. Soil Application Rate
Horizon Depth mant Color Redox Description Texture Structure Consistence Boundary Roots GP
*Eff#1 *Eff#2
1 0 -5 10yr3/2 none sl 2fcr mvfr cs 2fm,1c 0.5 0.9
2 5 -12 10yr4/3 none SI 2fsbk mvfr cs 2fmc 0.5 0.9
3 12 -21 10yr4/4 none sicl 2msbk mfr cs 2fm,1c 0.4 0.6
4 21 -34 7.5yr4/6 none Is 0 Sg ml cw 1 f 0.7 1.2
5 34-42 10yr5/6 none s 0 Sg ml gw - 0.7 1.2
6 42 -87 10yr6 /4 none s 0 Sg ml - - 0.7 1.2
a Boring #�
Pit Ground Surface elev. _ 97.79 ft. Depth to limiting factor >72" in. Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
*Eff#1 *Eff#2
1 0-4 10yr3/2 none sl 0.5 0.9
2 4 -10 10yr4/3 none sl 0.5 0.9
3 10 -21 10yr4/4 none sicl 0.4 0.6
4 21 -28 7.5yr4/6 none Is 0.7 1.2
5 28 -44 10yr5/6 none s 0.7 1.2
6 44 -72 10yr6/4 none s 0.7 1.2
* Effluent #1 = BOD s> 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.
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POWTS OWNER'S MANUAL MANAGEMENT PLAN PERMIT NUMBER: `�Jo 0 I
Owner /Agent: RICHARD & KEITH JUSSEY
POWTS Maintainer: Geo Tech Soil & Site Evaluation — Chippewa Falls, WI 715- 723 -5555
Local Regulatory Authority: St. Croix County Zoning Department — Hudson, WI 715- 386 -4680
POWTS Installer: Darrell Frazer — Frazer Excavating — Bloomer, WI 715-288-6225
Septage Servicing Operator
DESIGN PARAMETERS
Influent /Effluent quality (values typical for domestic (non - commercial wastewater and septic tank effluent)
Fats, Oil and greases (FOG) <30 mg/L, Biochemical Oxygen Demand (BOD) <220 mg/L, Total Suspended Solids (TSS) <150
mg /L Soil Loading, Rate (SLR) = 0.7 gpd /ft
SYSTEM SPECIFICATIONS
The components of this septic system are intended to serve a four - bedroom (600 -GPD) single - family residence. The components
include a Hutfcutt 1250 gallon septic tank, a Zabel A- 100 /effluent filter and (2) non - pressurized distribution cells using graveless
leaching chambers. A total of 28 Infiltrator standard leaching chambers are required when applying an EISA rating of 31.1 as
specified by DC'OMM. All parts of the components must comply with WI Adm. Code COMM 84 and be installed per
manufacturer specifications and approval letters.
DESIGN CRITERIA
o "Design of conventional Soil Absorption Trenches and Beds ". R.J. Otis — ASAE Publications 5 -77 and Design Manual —
Onsite Wastewater I reatment and Disposal Systems:. EPA 625/1 -80 -012 October 1980
✓ SBD — 1067 -1) (R.6/99) "In ground Absorption component Manual"
o SBD — 10705 -1) (N.01 /01) °In ground Soil Absorption component Manual" Version 2.0
MAINTENANCE & MANAGEMENT
Inspect the condition of the treatment tank(s) and dispersal cell(s) a minimum of every three years. The septic tank contents must
be removed in accordance with Chapter NR 113, WI Adm. Code when the combined sludge and scum equals one -third (1/3) the
tank volume. The effluent filter should be inspected annually to ensure maximum performance.
START UP
For new construction prior to use of the POWTS check treatment tank(s) for 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 b\ a septage-sery icing operator prior to use.
OPERATION
The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The
quantity and quality of wastewater will affect the performance and longevity of your POWTS. The installation of water - saving
appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also, the brine or waste from water
softeners, iron removal units, and other clear water treatment devices and foundation drains should be discharged to the ground
surface whenever possihle. Note: this does not include laundry waste, showers, dishwater, etc.
The system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils,
vegetable /fruit pets and seeds, bones, and food solids such as those produced be a garbage disposal should be minimized. Toilet
tissue is the only paper that should be discharged into the system. Other non- biodegradable items such as baby wipes, tampons,
sanitary napkins. condoms. cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as
petroleum products. paint. disinfectants, pesticides, antibiotics (medications), solvents, etc., should not be flushed into the system
as they can seriously damage your POWTS and contaminate your drinking water supply.
Maintain regular sleadN flow by spreading the laundry washing throughout the week. Avoid vehicle traffic over all system
components. Compaction ol' snow over the unit may cause it to freeze up.
o Alarms
Alarms should be tested on a regular basis by the homeowner. If an alarm sounds, contact an individual licensed to serve
POWTS. There is normally a one day reserve capacity under regular operating conditions, however water should be
conserved until am problems with the system are corrected to prevent back -up of sewage into the dwelling or surface.
Page 5 of 6
r
INSPECTIONS
Inspections shall be made by a person carrying one of the following licenses or certifications: Master Plumber, Master Plumber
Restricted Sewer. POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule)
✓ Septic Tank Component
Tan < inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any
cracks of leaks. measure the volume of combined sludge and scum and to check for any backup or surface discharge of
effluent. Access openings used for service of assessment shall be sealed and /or locked upon completion of service. Any
defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective
locking device to prevent accidental of unauthorized entry into the tank.
The outlet(effluent) filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's
sped icauons. Provisions are to be made to retain sot s m t e tan urmg c eamng. ter cleaning may be necessary at
more�lt intervals than stated in the maintenance schedule to keep the system operating properly.
o Pump Chamber /Treatment Tank(s) Component
The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must me
made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of the filter.
Any service needs or repairs shall be promptly taken care of
✓ In- Ground Gravity Component dispersal Cells
The inspection s a e eve s o ponding, if any in the observation tubes and a visual inspection for any
evidence of surface seepage or discharge. Any discharge to the ground must be promptly reported to the regulatory
authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic
failure necessitating more frequent monitoring.
o Divertor Valve
The divertor valve shall be switched to serve the opposing distribution component every three years (when the septic tank is
due for it regular maintenance). However, if ponding is observed in the observation /vent pipe of any cell, the divertor valve
shall be switch to the opposing component. Furthermore, ponding greater than 75% of the height of the component may
indicate overloading or impending hydraulic failure necessitating more frequent monitoring
REPORTS
Reports for maintenance. inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin
Administrative Code.
ABANDONMENT
When the POW I'S fails and /or is permanently taken out of service the following steps shall be taken to ensure that the system is
properly and safely abandoned in compliance with Ch. COMM 83.33, Wisconsin Administrative Code.
All piping to tanks and pits shall be disconnected and the abandoned pipe opening sealed.
The contents of all tanks and pits shall be removed and properly disposed of be a Septage Servicing Operator.
Alter pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled
with soil_ gravel or other inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system.
✓ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system.
The replacement area should be protected from tstur ance an compaction and should not be infringed upon by required
setbacks from existing and proposed structure(s), 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.
o A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology
a holding tank nim be installed as a last resort to replace the failed POWTS.
T e Ae has not been evaluated to identify a suitable replacement area. Upon failur OWTS a soil and site
e uat on m c perfor o locate rtab men no replacement area is available a ank may
be instal ec as a las ort to rep ace the failed POWTS.
o Mound and At -Grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative SLINaCe. Reconstructions of such systems must comply with the rules in effect at that time.
WARNING
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASES AND /OR INSUFFICIENT OXYGEN. DO
NOT ENTER A SEPTIC, PUMP OF OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT.
RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
Page 6 of 6
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer ?-it
Mailing Address ' 7Y � Z- �Lj yl -12.5 I WT
Property Address oy4v LAS e-
(Verification required from Planning Department for new construction)
City /State Parcel Identification Number 0 3 0 — d0 6 7 62
LEGAL DESCRIPTION
Property Location ' /., s�"' ' /., Sec. 33 . T 3 a N -R�.- Town of
Subdivisio �N0 L-L. � P tTf 6lV Lot # 1
Certified Survey Map # `�- . Volume . Page #
Warranty Deed # Tg 0 Volume 2 Page #
Spec house ❑ yes no Lot lines identifiable B yes ❑ no
SYSTEM MAINTENANCE �,Q/LC��n._ �3. �� )� a n fa ilure to handle wastes. Proper maintenance
) r use and maintenance of our tic tem could result in its ndture
I Y reP �
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
mastor plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal 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.
t TURE 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 owner(s) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIG TURF OF APPLICA DATE
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. « « « « ««
*« Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
U. 2466P 160 746rb14
STATE BAR OF WISCONSIN FORM I - 2000 KATHLEEN H. WALSH
WARRANTY DEED REGISTER OF DEEDS
Document Number ST. CROIX Go., WI
This Deed, made between Richard Hussey a /k /a Richard RECEIVED FOR RECORD
B. Hussey and Keith M. Hussey a /k /a Keith M. Hussey, 12/02/2003 01:30P11
both married persons
Grantor, WARRANTY DEED
and Stephen C. Ridley and Janet M. Ridley, husband EXEMPT 4
and wife as survivorship marital property REC FEE: 11.00
TRANS FEE: 285.00
Grantee. COPY FEE:
Grantor, for a valuable consideration, conveys to Grantee the following CC FEE: PAGES : 1
described real estate in St. Croix County, State of
Wisconsin (the "Property") (if more space is needed, please attach addendum):
Lot 17, O Knoll Additio Town of St. Joseph
Recording Aron
Name and Return Address
Title One Premier Group, Inc.
106 19th Street South
Hudson, Wisconsin 54016
030 - 2079 -70 -000
Parcel Identification Number (PIN)
Together with all appurtenant rights, title and interests. This is not homestead property.
(is) (is not)
Grantor warrants that the tide to the Property is good, indefeasible in fee simple and free and clear of encumbrances except
Roadways, Easements, and Restrictions of Record.
Dated this 1s yof December 2003
1. J.-J. 14� j/1 b A ' A^
i
*Richard Husse * ith Husse
i
* *
AUTHENTICATIO>�t ACKNOWLEDGMENT
Signature(s) SPRY P STATE OF WISCONSIN j
3t. Croix County. )
authenticated this day of �'r Personally came before me this 1st day of
X A- V December > 2003 the above named
P
* Richard Hussey and
'/ 14zltlf Keith Hussey
TITLE: MEMBER STATE BAR OF C�
(If not, h1t,m to me known be the person a who executed
authorized by §706.06, Wis. Slats.) the fo i a wledged the same.
THIS INSTRUMENT WAS DRAFTED BY
*
Michael H. Foreeki , Attorney Noduy P&Iic, State of Wisconsin
Eau Claire, Wisconsin My Commission is permanent. (If not, state expiration date:
rj *Nunes ma be authenticated or acknowled ed. Both am not necesa De r 1 of persons signing in any capacity must be typed or printed below their signature.
ANTY DEED STATE BAR OF WISCONSIN FORM No.1 -2000
ichael H Forecki 1830 Brackett Ave, Eau Claire WI 54701 - 4627
Phone: (715) 835 -3029 Fax: (715) 835 -4112 Title One Premier Group 77042966.ZFX
Produced wM ZipForm"' by RE Fomm'44K LLC 18025 Fifteen Mile Rood, Okdon Township, Michigan 18035, (800) 383 MM
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