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HomeMy WebLinkAbout030-2072-70-300 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 479220 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: Anderson, Michael D. I St. Joseph, Town of 030 - 2072 -70 -300 CST BM Elev: Insp. BM Elev: T Description: Section/Town /Range /Map No: CST BM Elev: Insp. BM Elev: 36.30.20.623A30 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURE CAPACITY STATION BS Hi FS ELEV. Septic Benchmark 3 r r r W 1 0 csr Z.ob IZ+% Jl2•o Dosing 0 Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet 1I �i TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake 3 e ROAD Dt Inlet Septic r Dt Bottom d Dosing Header /Man. / 0-1 0 I rl r , b Aeration Dist. Pipe Holding Bot. System PUMP /SIPHON INFORMATION final Grade Manufacturer Qemand St Cover r GP Z. 16 1 ZI •q� Model Number TDH Lift Fr on "System Head TDH Ft Forcemain ength Dia. SOIL ABSORPTION SYSTEM Q -��z ® I bo k Cf ® ob . zS I NC Width r Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DI S 3 vwrtes (3) SETBACK SYSTEM TO P/L JBLDG IWELL LAKE/STREAM LEACHING manufacturer INFORMATION Ty Of S CHAMBER OR p0� YP System: �r > !� r �` / r _. UNIT Model Number: (�V . ' vupd�q}( DISTRIBUTION SYSTEM Header /Manifold II Distribution x Hole Size Ix Hole Spacing Vent to Air Intake Pipes) l r Length '9! Dia 1 Length pacing 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 i � Yes 0'r, No Yes E�No COMMENTS: (Inc, code discrepencies, persons present, etc.) Inspection #1: OC T f 2/ lam-' Inspection #2: - - �_)L�� c>a•,s - t�� Location: 271 125th Avenue Hudson, WI 54016 (NW 1/4 SE 1/4 36 T30N R20W NA Lot 4 6.30.20.623A30 1.) Alt BM Description = Q P¢ ' °� — S S (e - wwp5 r 2.) Bldg sewer length = 31 r n (( ° 117, IS 1(.0 l ' = 113. os - amount of cover= 7 =y' "� � D (0 `10 = [13•f�� I( 8S Ilz.zr' 109�� Il3•o4 3 ) 3 �,�QQt► Cp.,� n to - = [131I6 I l 19 Plan revision Required? ❑ Yes No O cT Use other side for additional information. �! PAD-671 0 .3/97) Date Insepctor's Signature Cert . No. t i Safety and Buildings ' 201 W. Washington Ave., 1 0. $o f' „ 1 *is consin Madison, WI 53 07 7162 R w u Sanitary Pe it umber to be filled in by Co.) Department of Commerce (608) 266- 15 2 Sanitary Permit Application , State an LD. umber j In accord with Comm 83.21, Wis. Adm. Code, personal information yo pro ik Cwi1 _' O may be used for secondary purposes Privacy Law, a15.04(1)( - ress if fjrjn� than mailing address) I. Application Information - Please Print All Information - /oZ I / TH tJ Proper Owner's Name Parcel # Lot # Block # l k vO orJ 30 . O - Property Owner's Mailing Address Property Location (O 2 3 r , ^� i 6) City, State - ?n Zip Code Phone Number Jyl7 /� 7� s�lJ `�a // j050A) W d ©� T N; R aRQ EorC II. Type of Building (check all that apply) 3 DCvw&) M B U� ❑ 1 or 2 Family Dwelling - Number of Bedrooms �Q Subdivision Name CSM Number 54 El Public /Commercial - Describe Use Nv 5J t7b ❑ State Owned- Describe Use r ❑City_ ❑Village gTownship of Si, T0SEP III. Type of Permit: (Check only one box on line A. Cdfnplete line 9 if applicable) A. ❑ Replacement System g p y g y ❑ Treatment/Holding Tank Replacement Onl ❑Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that ap 5�Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground Cl Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ($Leaching CIIARber ❑Drip Line 11 Gravel-less Pipe Sr (explai ) V. Dis ersalfTreatment Area Information: 0 I Design Flow (gpd) Design Soil Application Rate(gpds Dispersal Area Required (sf) Dispersal Area Proposed (sf)) System Elevation 01 / 00 0. � � S ©� � 15,E v LO k) JDb.DO ctk VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank 26 0 1 2-6 o Er S P n Aerobic Treatment Unit iv Z <ffSf /� - /DO Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) i MP/MPRS Number Business Phone Number U M7 •�D <SC .m /7 ga376 0 715 -5 - 1 -19 _6" / Plumber's Address (Street, City, State, Zi de) VIII. oun /De artment Use Onl pproved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date Issued uing Agen Signa e o mps) Surcharge Fee) ❑ Owner Given Reason for Denial �f t! a IX. Conditions of Approval/Reasons for Disapproval �(STEM OWNER; 1 �Septic an , effTuent filter and dispersal cell must all bg serviced / maintained as per manag ement p lgn "oAdpirl by ph irnher 2. All requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x I I inches in size SBD -6398 (R. 01/03) i _ /z ST# Av e l� I _ J PRO I 6 eace PRo Pose PROP05,6 P U y 66,0,2e01m (R) W EL4, ? — _ Bu Nousr MA _ � _ �:_ 1?�o Gr�� S• T. Q I w lob .5'V3ie/71 rL/ UA7 - S M rM tr' r ee LICE/ eL. = 107- C ♦ givi _ L�1� Tom'wci v �Lr g rn v 1,3X�C,5.�7� C7 ;- 99. fu �U u _. °`I PouD ® 8fq _FL, ioO o< 2'' A & 6m cC&z -oo /11,411 /AJi2" BgxFzo6e Tei� I .SQcd �&PeeTy LINT_ �� rrUb me a N I tod e 5 o Aivm5ej o 75' lv�Toy ZETA' A ver l+f� � '4 PR P mr- QRovos job ' l a � I _1.y9o'�God� Hi(oN ril�wfN �F1.' _ ✓O�; Dd_ - _ 05.5 7 g� o_o� «use ty P6 AID ® Q jn FL, _ �/co, v0 -. - . - -- - - -- xl�� . am C_L. �o�'. oo Ns#!L a� �Z • �e sou - t+ j q �a nyro� 0 A Ll 1) A) 1,tj Yc; �' 'cni QS r -MC 5 Y0;2J I BIODIFFUSER CROSS SECTION 4 "PVC Inspection. and Vent Pipe Approximate Grade 11.30 Approximate Grade I III I 1 z �V • I —I I I 1.. El.= > 3 3 • I -1 C 3' 3 I Y " 6j 5: , 1 4 A(O h • 1171 w, Mp kne nt of corn err a SOIL EVALUATION REPORT Page 1 of 3 and Toni ScfrMt t'�vision Safely Bui�tps � wkh Come, �, Wis. Adm. code Attach canvioEe slte plan an Pow not less than 9% x 11 kwm In ". Men Mud SL Croix include, but not Nrnitsd tai veftg aid hodaonfal rAID erroe Poet (Q, dkedbn and percent sops, scale or d memsiorra, norftr arrow, and location and dials noe to nearest rand. Pteeso prtnit a9 bMornoblon. Reviewed by DSM PMreorul idomMim you Die maybe seed far eem dart' wposes (PAr W Low, a 15.04 ( (m))• Property Cnnrw Ply taxation Jewep, Crap; Govt. Lot NW 1/4 SE 114 S 36 T 30 N R 20 W p Owner's Melling; Addross 4 ct # Block # S Name or CSW 273125th Ave. City State Zip Code Phone Number _ I City .. j Wisps a TMM N Hudson I WI 1 54016 715. 549.5693 SLJoseph I 125Th Ave id Now Construction Use: jM Reefed / Number of bedrooms 4 Code derWed design flow rate 600 6PD J Replecernent Putgo or corrmwcid - Desorlbe: Perent materiel Glace TM Flood piein etava*m, if appiicMe ne Genwd comments Saw rerrormralda111 IK Area Is staitsbie far a conventional system with a 0.4 gpols ting. gft raft Possible syderrl elovation of the trenches are (high)109' (mid) 107.5! (Iron) 106. �rt� # P g Ground Surface elev. 112.40 ft. Depth to Mnitt D factor 99 + In. Sol AWcdm Rate Horizon Dep4h Dominant Color Tfedox Dssaipiton Tacbxe Stnxhse Consistence Rom GP 'E " 1 0-9 10yr'3l3 none i 2161* mfr cs 2r 5 .8 2 9 10vr4/6 none sit 2m$bk mfr gw 2f .5 .8 3 34-47 10yr514 none sl 1 msbk mfr cvir '- — . • 4 47.99 7.5yr4/4 none 91 1 mal* mfr — — .4 .6 LE a PitGround Surface e)ev. 112.40 ft In. Soil Appkdon Rede Depth to factor Flaimn Depth Dominant Color Redw De moon Texture Structure Consistence 8orrrdany Roolo E 'E 1 0-8 10yr3/3 none ail 21sbk mfr IDS 2f .5 .8 2 8-24 10yr5/3 none d 2fabk mfr 9w 2f .5 .8 3 24-44 10yr414 none usl 2 msbk mfr gw 2f .5 .9 4 4479 7.5yr4/4 none 1 msbk mn cw .4 .6 5 79.98 10yr5/4 name me Deg ml --- --- .7 1.2 ' Ef kw t s1 = 800 30 < 22D mglL sand TSS 3-M 4150 mglL • Met 02 s BOD SM AWL and T33 c v mglt- CST Name (Please Pry) Swwture:� CST Number 227429 Thomas J. Schmitt Address Tom Sd>tmifl Ode vWuetlon Core d TOO"* Number 715-247-2941 1595 72nd 3t New Richmorxi Wl 54017 9 Properly owner lewek Gaip -- Paccei ID # Pa#s of 3 a BorkV # Borkv 107.25 ft. Depth to factor 100+ in. Ground APPdO^ Rob Pk Grod Surface ebv. Homm bs�h Domm#Color ReftDmrpbm Tmhae Samna Caeistanoe Bourdery Roots "Effif9 "Eff#2 1 0-7 10yrm none SO 2fhbk mfr cis 2f .5 .8 2 7 -17 10yr4J4 none al 2msbk mfr gw 2f .5 .g 3 17-34 7.5yr414 none St 1 msbk mfi gw --- .4 .6 4 34-45 10yr4/6 none sl 1 msbk mfr gw ---- .4 .6 5 45.100 7.5yr4/4 none al 1 m$bk mfr --- ---- .4 .6 Borft # NJ Ground Surface eW. 115.41 ft Depth to Am�A factor 101 in. Sol ApAc efim Rate Horizon Depth Dominant Color Roft Description Tech" Struchre Consistence Bmmdrry Roots 'Fsfiip'I 'EffiM2 1 0-8 10yf3J3 none I 2f9k mfr ca 2f .5 .8 2 8-21 10yr4/8 none sl 2fabk Huff 9w 21 .5 9 3 21-55 7.5yr418 none sl 1m9bk rnfi gw if .4 .6 4 55-101 5yr4l4 none sl 1 msbk mfi -- ---- .4 .6 F -I 9 # � Ground Surface elm ft Depot to wing factor in. 11ppfon RaM Horizon Do* Dormant Color Redmc Deaaip m Tincture Struchae Cmmistertoe B=Wwy Roam "Ef K" 'EfW2 " Efficrent #1= BW ? 30 < 220 n g& and TSS -30 < 150 m9 L ' Efrmant #2 = BOG 30 m9L and TSS 430 MOL The Depertmprt of Comm = is an equal oMmbmity mviee provider and employs: Kyour aced aesidattee to mccm atvvioes or +writ Atriint in sm ahernase f nnat abase contact the damtnent at 60$- 266 -3151 or TTY 603 - 26444. �3 B1 Nt —/to ► a� $/�.r ,p� d � � �� Ptf� �p�� � L • 107 - d� � lraa �k� Car; C ra y a �ra,.^�,�. b e, �'- S �,h.•„ n� J?7 3 5T*^-+ ,V 71.0 9 s�►,, G,,. Silo -(7 /5'95 ? anot V, 1 S&- 536 T30 X, 70 ✓ 1171 R!C } SOIL EVALUATION REPORT Wisconsin Department of Com rce Page 1 of 3 Division of Safety and Buildings in cor ance with Gomm 85, Wis. Adm. Code Tom Schmitt u V ! t. � +, r nty Attach com r_ f I' inches ` Cou pl ete site pl an paper not less than 8% x in s¢e. Plan must St. Croix include, but not limited to: erticaI agd horizontal reference point (EN), direction and percent slope, scale or di msior�, ndrt ow, h arr and location and distance to nearest road. Parcel I.D. Pie ° ° Revi By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). a k(/ Property Owner Property Location Jewell, Craig Govt. Lot NW 1/4 SE 19 S 36 T 30 N R 20 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 273125th Ave. City State Zip Code Phone Number _I City J Village 0 Town Nearest Road Hudson WI 1 54016 1 715 - 549 -5693 St.Joseph I 125Th Ave New Construction Use: 01 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD J Replacement Public or commercial - Describe: Parent material Glacial Till Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a conventional system with a 0.4 gpd/sqft rating. Possible system elevation of the trenches are (high) 109' (mid) 106. Boring # Boring I/ Pit Ground Surface elev. 112.40 ft. Depth to limiting factor 99 + in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' *Eff#1 *Eff#2 1 0 -9 10yr3/3 none I 2fsbk mfr cs 2f .5 .8 2 9 -34 10yr4/6 none ail 2msbk mfr gw 2f .5 .8 3 34 -47 10yr5/4 none sl 1 msbk mfr cw -- 4 .6 4 47 -99 7.5yr4/4 none sl 1 msbk mfr — - - - -- .4 .6 ►r a Boring # J Boring 0 Pit Ground Surface elev. 112.40 ft. Depth to limiting factor 98+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF *Eff#1 *Eff#2 1 0 -8 10yr3/3 none sil 2fsbk mfr cs 2f .5 .8 2 8 -24 10yr5/3 none sil 2fsbk mfr gw 2f .5 .8 3 24 -44 10yr4/4 none sl 2 msbk mfr gw 2f .5 1 .9 4 44 -79 7.5yr4/4 none sl 1 msbk mfi cw .4 .6 5 79 -98 10yr5/4 none ms 0sg ml - - -- - - -- .7 1.2 * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, WI 54017 9/13/03 715- 247 -2941 Property Owner Jewell, Craig Parcel ID # Page 2 of 3 f F31 Boring # Boring ✓1 Pit Ground Surface elev. 107.25 ft. Depth to limiting factor 100+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 1 0 -7 10yr3/3 none sil 2fsbk mfr cs 2f .5 .8 2 7 -17 10yr4/4 none sl 2msbk mfr gw 2f .5 .9 3 17 -34 7.5yr4/4 none sl 1 msbk mfi gw - - -- .4 .6 4 3445 10yr4/6 none sl 1 msbk mfr gw .4 .6 5 45 -100 7.5yr4/4 none sl 1 msbk mfr — .4 .6 4] Boring # Boring 01 Pit Ground Surface elev. 115.41 ft. Depth to limiting factor 101+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 1 0 -8 10yr3/3 none I 2fsbk mfr cs 2f .5 .8 2 8 -21 10yr4/6 none sl 2fsbk mfr gw 2f .5 .9 3 21 -55 7.5yr4/6 none sl 1msbk mfi gw 1f .4 .6 4 55 -101 5yr4/4 none sl 1 msbk mfi — -- .4 .6 ❑ 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 *Eff#1 *Eff#2 * 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. Pale 30 3 _ Ez _ tab — 106 , iu . r� yhaP tie 1 Z y It SoL•f k PrC,4 � L1'NE raw i1ti� 4W r / C lo,1 y J S we &CtAoj l -• I 7b +--1 -s J � SG�iMi a 73 1.? -- " sr-7 .2.2 74429 1 1 14-i5� � • S�lv �7 /S�9 S" 7.7 c l 5/. NIJ4 Shy 536 T°3o ��0�✓ �7�sI �y� - ST. CROIX COUNTY WISCONSIN „✓''� u. ZONING DEPARTMENT ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 M —'— Phone: (715)386 -4680 Fax (715)386 -4686 December 23, 2003 Thomas Healy S & N Land Surveying 2920 Enloe Street Hudson, WI 54016 RE: Craig Jewell Certified Survey Map Dear Mr. Healy: At the December 23, 2003, meeting of the County Planning, Zoning, and Parks Committee conditional approval was given to the 2 -lot minor subdivision. The parcel is located in Section 36 of the Town of St. Joseph. The conditions are as follow: 1. The joint access serving the proposed lot 3 and lot 4 must be built to County standards, including the proper curve radius, to the point where it divides for the separate lots. a. The county will not be responsible for construction inspection or for any problems that exist or develop from construction of the access. b. In the event that more than two lots take access from the joint access at a future time, the access must be upgraded to town road standards and accepted for dedication by the township in which the subdivision is located. c. Final approval (required prior to recording) will not be granted until the road is completed and a certification statement is received OR a monetary guarantee (120% of approved bid) is submitted and approved. 2. A copy of the purchase agreement as it pertains to the clean -u of junk items must be submitted. Permits will not be issued until the clean -up of items is verified. Once the above conditions are met you m e Zoning Office for final approval. If you have any questions or concerns, please feel free to call this office. Sincer , I� Jon onnentag Zoning Technician /jh cc: Owner, Craig Jewell Town of St. Joseph File ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address / / Property Address D T �� V t H u Sony J (Verification required from Planning Department for new construct' n) City/State Parcel Identification Number C - 7a— LEGAL DESCRIPTION Property Location %•, Lf %., Sec. 3 T 3� N -R W, Town of -5 . J 0.6 Subdivision . Lot #• Certified Survey Map # °� D d —�-- , Volume --- , .Page # 7 / . Warranty Deed # � l O .� Volume . 9 5 ;Z� 0/ , Page # �!? Spec house ❑ yes ® no Lot lines identifiable ❑ yes U no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master 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 Wisco i 30 stating that your septic system has been maintained must be completed and returned to the St. Croix County days of the three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION we own s) of I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we am ( are ) the d the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Dep artment. ** 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 POWTS'OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner My l /('t AvDees 0 � se ptic Tank Capacity 100 al 13 NA Permit 0 D Septic Tank Manufacturer AIN* Week s C.P. O NA DESIGN PARAMETERS Effluent Filter Manufacturer Z a be 1 D NA Number of Bedrooms 4 ❑ NA Effluent Filter Model A -100 ❑ NA Number of Public Facility Units IR NA Pump Tank Capacity a l 0 NA Estimated flow (average) 400 gal/day Pump Tank Manufacturer ■ NA Design flow (peak), (Estimated x 1.5) gal/day, Pump Manufacturer 0 NA Soil Application Rate 0-4 al /da /ft2 Pump Model Y NA Standard Influent/Effluent Quality Monthly average • Pretreatment Unit 0 NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODJ 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 BiochernicW Oxygen Demand (BOD 530 mg/L 0 In- Ground (gravity) O In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ® NA ❑ At -Grade ❑ Mound Fecal Collform (geometric mean) 510' cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. r ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical es for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank ❑ month(s) (Maximum 3 ears) ❑ NA y s) At least once every: 3 0 ear(s) Pump out contents of twzs) When combined sludge and scum equals one -third (Y of tank volume O NA jti Inspect dispersal cells) At least once ovary: 3 ® month 3 years) ❑ { ' Clean effluent fUter At test once every: 1 13 month(s) ❑ NA . year(s) ❑ month(s) 0 NA Inspect pump, pump controb & alarm At least once every: ❑ ear(s) R ❑ month(s) WN Flush laterals and pressure lest At least once every: 13 ear(s) A; 0 At least once eve E3 month(s) ry: ❑ year(s) [3 tlA' Other: ❑ NA ; MAINTENANCE INSTRUCTIONSu;" insp ections of tanks and dispersal calls shall be made by an individual carrying one of the following licenses or cert)fications: P P Master Plumber, Master Plumber Restricted Sower; POWTS Inspector; POWTS Maintalner; Septage 'Servicing Operator.:`. Tank i must include a vlaW 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 surfaae. �. c The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any..po{�d' .of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requ(res�': a 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, tho.•,entite. contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter. NR :tl 13' Wisconsin Adntirtlstrative Code. All other services, Including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at Intervats•of 512 months, shall be performed by a certlfled POWTS Maintalner. A service report shall be provided to the local regulatory authority wlthln 10 days of completion of any service event. • Page Of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tanks) 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 prio�jo use. —W System start up shall not occur whbn soil conditions arrfrozen at the Infiltrative surface. Outing power outages pump tanks may fill above normal highwater levels. When power Is restored the excess wastewater will be discharged to the dispersal c UW In one large dose, overloading the call(s) and may•result in the backup or surface discharge of . effluent. To avold thb 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 16 feet down slope of any mound or at -grade soil absorption area. 'Raductlon or all rdnat)on of th e 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. rr r� • 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 falls and cannot be repaired the following measures have been, or-must be taken, to provide a code compliant replacement system: ■ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing end 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 rut" 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 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 b)omat 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 Name ' n Schttfiitt Name Owners choice Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name e Name St. Croix Ct . Zonin Rhona Phone '715 386 -4680 t This docuawnt was dratted in compliance with chapter Comm 83.22(2)tbW)(d) &(0 and 83.64(1), (2) & (3), Wisconsin Adminisuative Coda. Parcel #: 030 - 2072 -70 -300 06/02/2005 09:31 AM PAGE 1 OF 1 Alt. Parcel #: 36.30.20.623A -30 030 - TOWN OF SAINT JOSEPH Current I X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 01/16/2004 00 0 Tax Address: Owner(s): * = Current Owner * MICHAEL D & LISA M ANDERSON ANDERSON, MICHAEL D & LISA M 717 MYRTLE ST HUDSON WI 54016 Districts: SC = School SP = Special operty Address(es * = Primary Type Dist # Description * 271 125TH AVE SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 9.000 Plat: 4687 -CSM 18 -4687 030 -04 SEC 36 T30N R20W W1/2 SE1 /4 BEING LOT 2 Block/Condo Bldg: LOT 4 CSM 11/3133 EXC AS DESC 1358/451 NKA LOT 4 CSM 184687 (9.00 AC) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 36- 30N -20W Notes: Parcel History: Date Doc # Vol /Page Type 01/30/2004 753105 2501/200 WD 01/30/2004 753104 2501/199 WD 01/16/2004 752007 18/4687 CSM 03/04/1998 574319 1302/322 QC 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/31/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 9.000 99,900 0 99,900 NO Totals for 2005: General Property 9.000 99,900 0 99,900 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 MAY -27 -2005 09:24 FROM River Valley Abstract TO 5495718 P.03 U 280? P 200 ?531Qt5 �� • STATE BAR OF WISCONSIN FORM 2 - 1999 REGI AG S OF DEEDS Document Number WARRANTY DEED ST. CROIX Co. NI RECEIVED FOR RECORD This Deed, made between Donald L. Atldcrson and„ Lois E. Andeon. ha ftd and wife Grantor, 61 /30/2@04 1 i : d0A1! s s and Michael D Anderson and Lisa M Berson husband and wife WARRANTY DEED Grantee. EXEMPT 1 Grantor, for a valuable consideration, conveys and warrants to Grantee REC FEE: U the following described real estate in & Croix County, State of Wisconsin TRANS FEE: 420.00 (if more space is needed, please attach addendum): COPY FEE: Part of the NW ' /,uf the SE ' /end Pact of the SW ' /.of the SW'1af Section CC FEE: PAGE 1 36, Township 30 North, Range 20 West, St. Croix County, Wisconsin dead as fogows: Lot 4 of Certified Survey a Survey filed 1 Jlo z�� in Vol., page Doc. No. Z DC7 Together With Private Driveway Easement as shown on said Certified Survey Map. Recording Area Name and Return Address „0}0- 2072.70-000 Parcel Identification Number (PK This homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights - of-way of record, if any. Dated this of , 2004 Q�" dauuasY s _ e Doipald L. And. on : ✓ Lois E. Anderson AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF } 1 � County ) authenticated this day of T .�_ Personalty came before me ' day of N Public danaarlr , 2004 - the above named State of Wis consin Donald L . Anderson and Lois E. Anderson, husb and wif TITLE: MEMBER STATE BAR OF WISCONSIN (If rtot, to me a to be the perso(s) who executed the foregoing authorized by 1 706.06, Wis. Stats.) islststt a sekstowl W e. r THIS INSTRUMENT WAS DRAFTED BY At torney Kristian Oland Hudson, WI 54016 _ No Public. State of _ My Commission is pemwmt. (If not, state expiration dais: (Signawres may be authenticated or acknowledged. Both are not necessary) 0 �. _ _ •) • Names of persons signing in any capacity must be typed or printed below their signawre. information Professionals Co., rroM du Lac. wl STATE RAR OF WISCONSIN 90P455.202! WARRANTY USED FORM No. 2 -1999 Parcel #: 030 - 2072 -70 -200 06/02/2005 09:37 AM PAGE 1 OF 1 'Alt. Parcel #: 36.30.20.623A -20 030 - TOWN OF SAINT JOSEPH Current , X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 01/16/2004 00 0 Tax Address: Owner(s): * = Current Owner * ANDERSON, DONALD L & LOIS E DONALD L & LOIS E ANDERSON 275 125TH AVE HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 273 125TH AVE SC 2611 SCH D OF HUDSON SP 1700 WITC _ Legal Description: Acres: 9.305 Plat: 4687 -CSM 18 -4687 030 -04 SEC 36 T30N R20W W1/2 SE1 /4 BEING LOT 2 Block/Condo Bldg: LOT 3 CSM 1113133 EXC AS DESC 135 1451 NKA LOT 3ES11fi 4687 (9.305 AC) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) _ -- - -- 36- 30N -20W Notes: Parcel History: Date Doc # Vol /Page Type 01/30/2004 753104 2501/199 WD 01/16/2004 752007 18/4687 CSM 03/04/1998 574319 1302/322 QC 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: L t Changed: 05/31/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 9.310 118,900 12,800 131,700 NO Totals for 2005: General Property 9.310 118,900 12,800 131,700 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 APR ' 4 2005 "I . ay 752017 ST CROf VOL 18 PAGE 4687 Co SUR�EYO X �1'TY KATHEM H. YALSH R S RECORp REGISTER OF DEEDS ST. CROIX CO., YI CERTIFIED SURVEY MAP RECEIVED FOR RECORD 01/16/2004 11:00A?l CERTIFIED SURVEY MAP LOCATED IN PART OF THE NW1 /4 OF THE SE AND IN PART REC FEE: 13.00 OF THE SW1 /4 OF THE SE1 /4 OF SECTION 36, T30N, R20W, COPY FEE: TOWN OF ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN. PAGES: 2 NUMBER DIRECTION DISTANCE SURVEYOR: - PREPARED FOR: L1 S88°14'46 E 127.79 THOMAS M. HEALY Z L2 S88 °1 4'46'E 37.42' _ S & N LAND SURVEYING, INC. CRAIG JEWELL O E 273 125TH AVENUE w 0 H 2920 ENLOE STREET — U L3 S88 °45'31'E 7069' l UDSON, WI 54016 F w L4 NO2 °4823'E :16.90 HUDSON, WI 54016 0 m �` Hll L5 S65 '02'44'E 107.10' O .. .... NOTE: - LOTS MAY BE SUBJECT TO FU ECIAL � Z r C1 (f�SIA YQLOL,_ ASSESSMENTS FOR ANY UPGRADES AND :3 go Radius Length PAGE 2M,4 IMPROVEMENTS TO THE ROAD. cc cc 113.00 EAST -WEST LL C U H entral Angle 1/4 LINE S88 °14'46 "E 5219.63' 1 �, / S88 "E w z) m 30 °37'12• � 125 T N_A VENUE r�T -� - -165.21' �d Chord Bearing t . _ .. _ , ; . — r CO rn 0 — --- - - ---- v W w S75 °55'53%V 3752.12 2.30' Z 3 d Length W 1/4 CDR, L3. _ 88 °1 '41i"WW Chor ' SEC. 36, - - - - - -- - 5 E 1/4 CDR. en 0 59.67' T30N, R20W p L 2 : SEC. 36, Arc Length - RECORDED 9 94 T30N. R2ow m w Q 60.39 CENTE NE OF 'Tangent In (�� p X ��4521 EXISTING NEWAY PAGE 3133 Tangent Out W W O N88 88 °45'31 "W SOUTH LINE OF LOT 1 W -� LL cli S88 °45'31 "E 88.71' _ _ ° LL W 0 360 228.71' 0 � ° O SHED o SHED ►- r r Z 11 SILO 1 Z �] GARAGE n w APPROVED a LOT 3 "ousE A ?) �: ST,CROIX000r s (o AREA INCLUDING R -O -W tz; 3 0; Zoe Perks ComeMee 9.305 ACRES (405,32 SQ. FT,) r JAN 16 2004 i 2a AREA EXCLUDING R - -W 9.64 ACRES (403,523 SQ. FT.) 100' �; If not recorded within 30 days of 10 ' �� al date WPWl shall be 40 Hutt and void ' 687.89' C � W , S ° 50'33 'E 753.89' 66.0 H �� CSM VOL. 1, LOT 4 O TOTAL AREA ♦$GO��' Z 9.000 ACRES (392,057SQ. FT.) 1�3 rn N SOIL TESTS l�fi "1 v ' PAGE 3133 111 oi cii � SOUTH LINE OF THE W _� ! � O poNO NW1 /4 OF THE SE1 /4 S N V — NSW49'57 "W ao.01 — N86°50'51 "W 498.69' 255.34' I SOUTH LINE OF LOT 2 k0r 97 i (NORTH LINE OF PINE TREE MEADOWS) LEGEND fPINETREE I MEADOWS I kQT 9 § FOUND ALUMINUM COUNTY c 119 I PONETREE - SECTION CORNER MONUMENT SCALE IN FEET 1" = 200' , 0 FOUND 1' OUTSIDE DIAMETER IRON PIPE ig O SET 1 OUTSIDE DIAMETER BY 18" LONG IRON *4 200 O 200 PIPE, WEIGHING 1.13 LBS. PER LINEAR FOOT THIS INSTRUMENT DRAFTED BY: THOMAS M. HEALY .................... 100 ROADWAY SETBACK JOB NO. 6350-01 DATE: 10/29/2003 REVISED: 12/12/2 w as, SHEET 1 OF 2 SHEETS 1 % 003 Vol 18 Page 4687 L5 S65 "E .107.10' NOTE: O O W v Cl - ®�-_ LOTS MAY BE SUBJECT TO FUTURE SPECIAL U Z v _ VOL. �. ASSESSMENTS FOR ANY UPGRADES AND Z _3 to Radius Length IMPROVEMENTS TO THE ROAD. � It N 113.00 EAST -WEST r - r w Ir Central Angle 1/4 LINE S88 ° 14'46`E 5219.63' / w Q u7 ,� i X588 °14`46'E w cc : m 30 0 37 1 12" M ��_ - -- _� /� ,_ _ M 1 �S TH AVENUE , -- >)�S.Q�(' Q Chord Bearing O S75 °55'53"W Y S2 — — — -- — — — CO w O W 1/4 COR. 3752.12' s'' 1302.30' d w Chord Length SEC. 36, f L3 • - S:. 14'46"W E 1/4 COR. ¢ � ftk 59.67' T30N, R20W LOT 2_ W SEC. �, g Q � to Arc Length���� ®(ED N T30N, R20W m U7 Q 60.39' �.® �_ �WJ m "_ � r 0� ( C TERLINE OF Tan EXI NG DRIVEWAY S60°3717'W 1 s_��lS!s ° o 4 - PAGE 3933 0 Tangeni out -' j = w o N88 °45'31 "W SOUTH LINE OF LOT 1 jE � � S88 *45'3 NE 88.71' O s w -w .j N Z Z w S o SHED 22.71 �°. t- O � ❑ SILO QN � � � 3 � z.. GARAGE cq 3 HOUSE O; 0! a LOT 3 m: co o v AREA INCLUDING R -O -W �u' N e Nr Cal 9 ACRES (405,320 SO. FT.) �� ®� AREA EXCLUDING R -0 -W j.; E•, Y n; ,� 9.264 ACRES (403,523 SQ. FT.) ` �� „ O ®t r � { i lil 687.89 ° �1 W IL' S86 °50'33 °E 753.89' 66.00' fA Zi ' o CSm VOID_ 1 I LOT 4 o ;. TOTAL AREA � z 8.000 ACRES r (392,057S0. FT.) 1 ao r� N SOIL TESTS f / I/ L n ° PAGE 3 1 .0 • • V� SOUTH LINE OF THE 9 WI ••�O rota NW1 /4 OF THE SE1 /4 Q °"f I ki N V 86°49'S7"�f/ _ 40.01 - -' I 1�1OWS&S1"W 498.69* 255.34' I SOUTH LINE OF LOT 2 M 97 j (NORTH LINE OF PINE TREE MEADOWS) LEGEND MEADOWS j &Q UA FOUND ALUMINUM COUNTY I - (�Dlid _ & SECTION CORNER MONUMENT MEADO --- - - - - -- -- SCALE IN FEET 1" - 200' FOUND 1° OUTSIDE DIAMETER IRON PIPE Id O SET 1" OUTSIDE DIAMETER BY 18" LONG IRON 200 0 200 PIPE, WEIGHING 1.13 LBS. PER LINEAR FOOT THIS INSTRUMENT DRAFTED BY: THOMAS M. HEALY 100' ROADWAY SETBACK JOB NO. 6350 -01 DATE: 10/29/2003 REVISED: 12n22003:i- j_:;•, SHEET 1 OF 2 SHEETS