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Home My WebLink About040-1259-80-000 Wisconsin Department Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 556303 0 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: Geissler, Doug & Barb T o ,Town of 040-1259-80-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 18.28.19.1387 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding ~.6 St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Ar, t Dt Bottom Dosing Header/Man. 1A 9 G. 4<, Aeration Dist. Pipe g.1 Holding Bot. System e q, 1r 95. a co d PUMP/SIPHON INFORMATION Final Grade cl 3. 7 Manufacturer Demand St Cover GPM Model Number TDH ift . Friction Loss System Hea DH Ft Forcemain Leng ia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Li uid De th DIMENSIONS Q P SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of System: CHAMBER OR T:.. ~~iK.i,JI r®~ 7 j~ $-7 UNIT Model Number: Ov ~z DISTRIBUTIONSYSTEM All, 4-. Z 4- 2w 1~, 4&44 Header/Manifold I _ It Distribution x Hole Size x Hole Spacing Vent to Air I ake %~-f+ L~ Pipe(s) Length l 4' -1 Dia / Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth xx Seeded/Sodded xx Mulched Bed/Trench Center / Bed[Trench Edges Topsoil Yes l No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 383 Deer Valley Drive Hudson, WI 54016 (NE 1/4 NE 1/4 18 T28N R1 9W) Deer Valley Lot 8 Parcel No: 18.28.19.1387 1.) Alt BM Description T:Z W. ~ 2.) Bldg sewer length - amount of cover = Plan revision Required? 0 Yes )~No Q' Use other side for additional information. O ' Z SBD-6710 (R.3/97) Date 4 Insepctor's 4.ture Ce rt. No. Safety and Buildings Division County " e~ 0"'-43 201 W. Washington Ave., P.O. Box 7162 t Madison, WI 53707 - 7162 Sanitary Permit Number (to be fifled in by Co.) (608) 266-3151 5 5 rtment o Commerce 3 `l~ anitary Permit APPheatl State Plan I.D. Number ``A\ 0 ~ ~ JU`- In accord'tg3oi im 83.21, Wis. Adm_ Code, personal information you*' Aj* St $'i( NkV y be used for secondary purposes Privacy Law, s15.040 xm) Project -Address (if different than mailing address) N Q~ 1. A cation Information -Please Print All Information '0393 &r 411-2 ~ Property Owner's Name Parcel # #lock # U Z Property OmWs Mailing Address Property Location M7D ~ Via, Section ttyState Zip Code Phone Number ctrele one) C T-"N, R-4EorW Type of Building (check all that apply) Subdivision Name CSM Number "or 2 Family Dwelling - Number of Bedrooms ❑ Public/Commercial - Describe Use ,~Ure zC ❑ State Owned - DescribeUse ❑City_❑Village L o-.ship of -74 -L III. Type of Permit: (Check , only one box on line A. mplete line B if applicable) A. ❑ New System tJ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to Nmv List Previous Permit Number and Date Issued Before Expiration Plumber 1 7--7 Owner .1 4 1./~r IV. Tjpe of POWTS System: Check all that a 1 a FT'Non -Pressurized him-Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At-Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized hr-Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravewess Pipe ❑ Other (explain) V. Dis rsal/I t Area Information: Design Flow (gpd) Design Soil Application Rat sf) Dispersal Area Required ( Dispersal Area Proposed (s Syst lev r e)o VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Z.a Talcs Tanks eptic Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume responsibility for insta tion the POWTS sbown on the attacbed plans Plumber's Name (Print) P1um 's ignat /MFRS umber Business Phone Number Plumber's Address (Street, City, State, Zip od ) IL Coun /De rtment Use Only 75<Approved ❑ Di ved Sanitary Permit Fee (includes Groundwater Date ued Lssuin gent Si V11,110 Stem ) Surcharge Fee) 1 / 5 3Q ,l L ❑ Giv eason ial / Ix. Conditions of Approval/Reasons for Disapproval 3 6 t_ _ I rew. ~ut t'~t~~'G a SYSTEM-OWNER' 3-) : $eptic tank, effWllnt After t d~~ d 'J! ( r ` dispersal cell mustall be servtces tmaldie. 6L 4-b as per management plan provided byplumll U , ,1,~. Ge..tJ~„Q„ O~ t~ 2 A >Iqe sck n mt&t be S 6~Cw`. ~ t :c't+w as pa ~ code / 40rw *L J Attach complete plans (to the County only) for the system an taper a" less than 91/2 x 11 inches in sine SBD-6398 (R. 01/03) gm owt-hu / ft 4' SdwdWe 40 Fines Grade PVC Vert Pipe WAh Vent Cap It Leaching c D G •3 f -~ft 6evaallon -c --ft 4-ft 1 ft 7( ft ft i ft Leeching Trench 1 Chambers Trench 2 Header Vw Or t~ervaifon Pipe Trench 3 Lashio Chamber Ss xtions Manufacturer And Model I-Aq f` r u , S7q-~ 9,* V~ EiSA Rating sq ft per chamber Soil Apprun Rate * 2 gpd/sq ft gpd Design Flaw 4 o Soil Appi'c/~on Rate x EISA = ~ Chambers 3 rows of o~ r chambers each. wh r` ~t/ccI'!7`3 7p Page J, _ of - - - - - - - e - . , ~ 7Z~ v e,> ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address V\ (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number 6Ao - ~'ZS l? - c>U it I LEGAL DESCRIPTION Property Location 4~,ET 1/4, NE 1/4 , Sec. , T 2:2__N RjW, Town of Subdivision Plat: , Lot Certified Survey Map # , Volume , Page # Warranty Deed #2 S (before 2007)Volume~ Q Page # 3 Spec hour yes ko Lot lines identifiable`)yes ❑ no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & 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 septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on t ' form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a w anty deed recorded in Register of Deeds Office. Number of bedrooms - I 'A SIGNAT OF A PLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 09/07) l 71 ►t U 1 8 9 3 P 2 1 2 674a WARRANTY DEED REGISTER OF DIM S DOCUMENT NO. ST. CROIX CO., WI RECEIVED FOR RECORD This Deed made between June M. Erdman, a single 05"17-2002 10:00 AM person, Grantor and Douglas R. Geissler and Barbara L. EXRWKrY DEED EXEMPT i Geissler, husband and wife as survivorship marital property, Grantees, TRANS REC EE: 11.00 RAFEfi : 259.50 COPY FEE: Witnesseth, That the said Grantor, conveys to PCAGEES: COPY FEE s Grantees the following described real estate in St. Croix County, State of Wisconsin: Lot 8 Plat of Deer Valley in the Town of Troy, St. Croix County, Wisconsin. Tax Parcel No. 040-1259-80-000 This is not homestead property. RETURN TO: Barry C. Lundeen y 110 Second Street Together with all and singular the hereditaments and Hudson, Wisconsin 54016 appurtenances thereunto belonging; And Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances, and will warrant and defend same. Dated this day of May, 2002. y~ j ~ - ' (SEAL) J e . E dman STATE OF WISCONSIN )SS ST. CROIX COUNTY Personally came before me this day of May, 2002, the above named June M. Erdman, to, me known to be the persons who executed the foregoing instrumeAt ~ind~acknowled d the same. Notary Public, State of Wis onset My Commission ez, THIS INSTRUMENT DRAFTED BY: JOdy A. Bak en Barry C. Lundeen Notary Public MUDGE, PORTER, LUNDEEN & SEGUIN, S.C. State of WMCOrtmin 110 Second Street, P.O. Box 469 Hudson, Wisconsin 54016 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division , 6 INSPECTION REPORT Sanitary Permit No: 405083 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: Erdman, June Troy Township 040-1259-80-000 CST BM Elev: Insp. BM Elev: BM Description: ,V , TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark t ~s"D 3-9 99 s~ Dosing Alt. BM f1/ (e7 Aeration Bldg. Sewer 1 A4 Un -10 3 U .d~ o ding U t Inlet r G TANK SETBACK INFORMATION t Outlet , / v TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic y I G 6 i t t J Dt Bottom Dosing t, Header/Man. Aeration Dist. Pipe G r J Z / -Z( Heid-ing Bot. System 44 Zq- A, Z, If C 6G Final Grade PUMP/SIPHON INFORMATION /L, 9L /O •Q acturer Demand St Cover )c Q GPM Q Model Number TDH Lift Friction Loss stem Head TDH Ft F remain Length Dia. Dist. to SOIL ABSORPTION SYSTEM 1-5 BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS p SETBACK SYSTEM TO -l P/L BLDG WELL LAKE/STREAM Man;f turer: INFORMATION AM R R Type Of System: L r + t 7(OV r Mo IN' /,r. DISTRIBUTION SYSTEM 1 Header/Manifold Distribution x Hole Size Ix Hole Spacing Vent to Air Intake 411, r J11 Pipe(s) S N > ao ' Length Dia Length 3 • Dia 11,1 Spacing _kL -1 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 FX] Yes En No I Yes [lf No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: '1/ QZ Inspection #2: Location: 383 Deer Valley Drive Hu/ds n, WI 54016 (NE 1/4 NE 1/4 18 T288N R19W)`• Deer Valf Lot 8 n Parcel No: 18.28.19.1387 1.) Alt BM Description ~ o6.it, Jo u C ViZo d c~k *4 &46Pj 2.) Bldg sewer length = 2 / ~`0 i ( 5~ - amount of cover = 4'Y T,Qy~'G'Y G~'iah ~pe61h.S7'~,1~ ~h r Plan evisi ICJ 1.es. No I - I - --I 6s~~ Use other side for additional informati ~bDate nsepctor's natCert. No. SBD-671 0 (R.3/97) w 1 ..,.w...cs Bonftp Y CT le~ 1 201 W. WuhirOm Ave t~ivP.O. Box 71b2 V~sfn Matlraoa. Wl 33787 - 7162 Stile Address d Fs6o De artQlellt of Commerce S =i 1=d z- on X33 e 4 Number Sanitary Permit Application 3au=xy Pert ~S In acmd w~ Comm 83-21. VVu. Adm. Code. peraeuel ; ~ ~ L I V E D Check iRevisioa be awed for law. . 1 L ~ InfamdIon - Plesse Mat Ali Infas7amtien Pam LD. Nraaber N propoM Owares Name t~ r OIX COUNTY D FFICE PropeM I.ocaaon PtaWW Owner's Maihr+t Address R C 4t • S "Mb" T R city, stagy Zip Code Pant RuMber Lot rer / 3 ~ 7 Name CSM Number H. Type of Bulaft (check an that sppb) DvMw 15 as 2 Fomfy DadlioE - Number of Bedrooms p- d&l xmmuvW - Describe Use r o 0 Road Owned op M60 -r-s .c R 94, UL ype permit: (Claock en4' one boot ea line A ( sehmse far tam om)• tine B V applicable) RqftcgaamSywm. 3 ❑ >taplaaamM of 6 ❑ Adffidw ab For, Coady me A 1 .New 2 ~ Teak Date Iswod h. ❑ Check i Sanieny permit Pmviou* honed Permit Number IV. I:_ of Pft%BW (tbwk hit that spply)W=bw1ng at a is for ill use) 44 Noa Prawumod loAkowd 210 Mound 47 ❑ Surd Pear 5 ❑ constructed wedaad 22 preworind bkGvomd 4t ❑ Haidit Tank 48 S*ft Pass 51 1 Drip Line 30 ❑ Other 45 ❑ At-Gradc 46 D Aerobic;'l1rr Uoit 4911 Pet Rue 5ysea° FJavaria° ~ Desip Flaw (fpm) D 1 Am biapersol Ares SoR Application E Respired Proposed RaW(l& ;.lDays/Sq.R.) *Aaj * levatbn <3 S-7 33 7 N 4?~ 101 Total Number 1 Ptefab Sift Steel Fiber Plastic CaladW in VL Tank Info Gollow; Gallas of Tonics Concrete Caamucad Glass ?1;w- Taaks Tub or - 1 Daft Cheater VkAW VLL Rwpondbft _ !err Mebeiti~ st the P'OVVTS dmm an the sltaeited pwagn 's Name s I~PlMPRS Number Businoss Phone Number o~~ 3 ? 1 sf pinsl6i's Address greet. City. Soma, zip Code) VLQ. j7zae Ouly Dato bstied Taming Agent si~aaue (Na Ste) Unkavy Permit ) Fah (ibrcb>dea f3rdwaoar onigg Approvaa ssuft ❑ Owner Given hwal Ad-= ` EL. Cos~ditiorrs `Tk, s a p~ tr+ '(s 83 j~Q~sl ILS N/«4l lau a -ACMA t. - 1 K.! -PloT Jug Ma4C.., ua`\,O ,,10 Cs 1.~ tiE`~y S ~$?a~ N 12~q ~ 2t lno Coves R a.~ t9 Low g -Palt,2 ~ O4~-/ aS4 - 80 t a rJ0 ~Ga ~:G/ cc(o~Q, !t 1 1~~i +~s ~rS ` 3 ~ 3 cx-Q iJ rto.at 36 G Dom`, S-(-b1 ~ 2-ao G " 3J a5 37 we ' n ~ Q OOT T \4 vA .Iu+,.p, ~!'c1T~av~~IJee. Uct`~~~ Wo NE'Iy s 18-ra,s N q `ado ~o R~ zlorl~ 00, ' Loy- g ~C N ~t~CSo,. Sy of ~D Tr oY Caro p -Pa,c,&-SD DL4 a!sN - 80 - cao o a. S~~c / ~ej0`Q, R Io~~~+aS PrS E-3 ~ `t r e ~nc~f•~ s 3, 7 -5 C) O ~a Gam. ws (4 CG I" . toP P P~,c, tom, l~lfi Bra ~o~,~ P-CL- as 3 7 ~O 93TS d ~ .A ' /'~2rs a,1 j o- Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 LAbor and Numan Relations division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code ' COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Cr ix 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 n„eareeffead, 040-1070-10 ` [REVIEWED BY DATE APPLICANT INFORMATION-PLEASE PRII~fi::Q~ JAfFO~iMkTI4TN, -I - ZM) PROPERTY OWNER: P OPERTY LOCATION Pk' ~T GOVT. LOT 1/4 NE 1/4,S 18 T 28 N,R 19 J(or) W Derrick Construction, Inc. I NE PROPERTY OWNER':S MAILING ADDRESS jut v LO # BLOCK # SUBD. NAME OR CSM # 1505 H #65 ? 1 = 10~ na Deer Valley CITY, STATE ZIP CODE PHONE NUM B ~ ] TY VILLAGE [MOWN NEAREST ROAD New Richmond, WI. 54017 1 320 Tro E. Cove Rd [*New Construction Use ~ j Residential / e~i ooms [ ] Addition to existing building j l Replacement Public or commerc ' Code derived daily flow 600 gpd Recommended design loading rate .7 ed, gpd/ft2_ig_trench, gpd/ft2 design loading rate - 7 bed, gpd/ft2~_trench, gpd/ft2 Absorption area required 858 bed, ft2 75n trench, ft24,, nMa* Recommended infiltration surface elevation(sgrea A= 7 . ft (as referred to site plan benchmark) Additional design /site considerations na N,o %Ar ; VOW 6. d.3 + B S Parent material outwasr Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE 7SYSTEM IN FILL HOLDING TANK U =Unsuitable fors stems U CjS [I U k7 S ❑ U 50S ❑ U ~S ❑ U ❑ S [3a U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trer& ..........1..>_ 1 0-14 10 r 3 3 none 1 2msbk mfr cs 2f .51 .6 2 14-32 10 r 4/4 none Sil icsbk mfr aw if .4 .5 Ground 3 32-90 7.5 r 4/6 none cos os n .7 .8 elev. 191St. Depth to limiting factor qa . e + 90 ~g/8y Remarks: Boring # 1 0-20 10 r 3/3 none I 2msbk mfr cs 9.f .5i .6 2 2 20-38 10 r 4/4 none sil lcsbk mfr if .4 .5 Ground 3 elev. 101. at. Depth to limiting factor 'Ida ±RR" ge1A Remarks: CST Name:--Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200th. e. New Rich nd WI 54017 Signature: Date: 6-3-99 CST Number: m02298 i - I PROPERTYOWNER Derrick Construction SOIL DESCRIPTION REPORT Page 2, of 34 PARCEL I.D. # 040-1070-10 . Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-16 10 r 3/3 none 1 2msbk mfr cs 2f .5 .6 3 2 16-26 10 r 4/4 none sil lcsbk mfr gw if .4 .5 Ground 3 26-86 7. r 4/6 none cos os ml na na .7 .8 elev. 100.8ft. Depth to , ~g yb, g limiting factor 3%z c~ +86" Remarks: Boring # 1 0-18 10 r 2/2 none 1 lcsbk mfr gw 2f .4 .5 2 18-32 10 r 4/4 none sil lcsbk mfr gw if .2 .3 Ground 3 32-84 7.5 r 4/6 none cos CIS ml na na .7 .8 elev. 99.7 tt. y yr y 6 v CAS Depth to - limiting Y. ,g S 37 factor +841, Remarks: Boring # 1 0-22 10 r 2/2 none 1 lcsbk mfr gw 2f .4 .5 5 2 2 8 10yr 4/4 none sil lcsbk mfr gw if .3 Ground 3 38-84 7.5 r 4/6 none cos osg ml na na .7 .8 elev. 99.7 ft. Depth to limiting factor +84" Remarks: Boring # 13 Ground elev. j ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) w , STEELS SOIL SERVICE Gary L. Steel Derrick Construction, Inc. 1554 200th Ave. CSTM2298 NE4NE4 S18-T28N-R19w New Richmond, WI 54017 MPRSW-3254 town of Troy (715) 246-6200 lot #8-Deer Valley This soil evaluation was conducted to satisfy.a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. Z-N =40' top of 1" pvc pipe C el. 100.00' t. BM.= top of 11, pvc pipe C el. 99.55, 100 S` 61% o $ Gary L. Steel 6-3-99 l sere Is A Better War Jky, U~ A ma A" &,%Y {a,f ~1L ♦ M 344 X oDUffuser Tm Units: x 6 J ANN ac 34 x76« :II" r~3 greater $Wrfte volume ♦ Open masking r mat ♦ shadow of fie. uv+r"s proms sidc~ls + s ids o~ urfaae ands, Ukreaft mfihrative ♦ hnPrOved PCrfD. + v rY ewnnmirtl~ ~ `P Maximizes unmasked lea the Stop= Ching surface of unmasked eff Provides the optimum a objective is to~ve Ieachin mount g surface. Its design unmasked sidewail todallow open bottom and capillary action in all directions. This to now via SPECIFICAT S. achieved b This has been by combining the 0+19Ina1 Mandwd tlt / Low P ryle n bottom with a serf traditional, open l'~h........... 76" Length r'O n Ef#tuent de th es of louvers al g the h. 34" th 76" insi a chamber on sides. ofl alo fl ows to unco Height 14" r Width ............34- ng the full 1 9. r re designed eh of each The 1ou invert......._. Height 11. to all ow ch side. very invert ...........6,5" ncompacted effluent to pass into the Biol~iffusers backfill while preventin o PrOPerlY graded and c e see when installed ~'ating into the amber. in g it fro or 17-, withstand H_ 1 p' t0 o over resp~,et,_ H-201 factors 3t. A,? F POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner %.k ~r 4 Ic C_ V, C1 W V4 Q ^ Septic Tank Capacity a~j (7 al ❑ NA Permit # 69`3 T Septic Tank Manufacturer V3 ❑ NA 0&,Q C-S DESIGN PARAMETERS Effluent Filter Manufacturer Z ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model CnD ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity gal ❑ NA Estimated flow (average) C~ al/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) oc)o gal/day Pump Manufacturer ❑ NA Soil Application Rate . gal/day/ft2 Pump Model ❑ NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) :_30 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 (BODS) 530 mg/L Vn-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) :_30 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) :_10° cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Y8 in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *'Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA ❑ ear(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: p Yea t 1(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ❑ month(s) ❑ NA ❑ year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or 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 (Y3) 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) 'ZTART UP AND OPERATION Page of 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 replacements ste to provide a code compliant ❑ 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 Name `v i Name 7r q E EE Phone S a Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY EName J E Name JC`~ C ~O ~ y CS~v~ Phon e This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. i ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND . OWNERSHIP CERTIFICATION FORM Owner/Buyer o "c 4E~f L4 m A-0 1y VA- E ~ b.1 Mailing Address 2toC5 ~o P IJ t7 S~ i S i ~v Property Address J b3 Dc V4L-Ley DaA-,.f e (Verification required from Planning Department for new construction) City/State OO 5-0 is f ..t Parcel Identification Number C) 4Q - j)-9 a, 80 - a o z LEGAL DESCRIPTION Property Location% WC Sec. . T'29 N-R q W, Town of Tiro y Subdivision bC-z;;zti V.& Lot # Certified Survey Map # . Volume . Page # Warranty Deed # Volume Page # 6 1 Spec house Vyes ❑ no Lot lines identifiableXyes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and* by a masterplumber, journeymanplOinber, restrictedplumber 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 e three year expiration date. ATURE 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 aro escribedab bvirtue of a warranty deed recorded in Register of Deeds Office. OF APPLICANT 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 WARRANTY DFFD (Fonn;r Statutory Form). STAIF. OF WISCONSIN Miller-Davis Co., Minneapolis, Mon. l Form No. Y w. 29154 arhis Inben#ltre, Madc, b11 Archie J. Waxon and Lois Waxon, his wife,. grantors , of St. Croix County, Nisconain, hereby convey and warrant h,' Jack J. Erdman and June M. Erdman, husband and wife as joint tenants arantefs , of St. Croix County, Wisconsin.. for the sum of One dollar and other good and valuable consideration the following tract of land in St. Croix County, State of TVisconsin- , Northeast quarter of Section Eighteen (18), Township Twenty-eight (28) North, Range Nineteen (19) West, (NEI 18-28-19). `I . f - ~ I~ ~ I ~ l •L7aiF 1011 REGI%Tf!R.s OFFICE ST. CROIX CO., WIS. Recd f(.,r Ftocord Ihi4i. _ -17th deyOf -Awast__.A.0.1:)_ 59 Oaiiid Hope Deputy fn Witness Mlyrreaf, The .caul ~e,nrtnr s heivCherconto srt the it hoed sur,rl .wr„/ s t/ri:. 1.4th r/(,y of August .1. 1). 19 59 SIGNED AND SEALED IN PRESENCE OF ~ ✓ , ,gip .llugh F_Gwin. Lois Waxon ,__Ilarold..Valbrandt ~#u>~e of ~Iisrnnsin, f St. Croix l•r,,,nt./ j Personally came beforr nw, this 14th day of August .4. D. 19 59 the rthorr nrrnrcrl Archie J. Waxon and Lois Waxon, his wife, to me kn.oum. fn hr the /~rrsurr. :rleo r.trrrrlrrt lhr 1(,m oind instruYnent and arknorolccl! efrl, the snare. 1l r .Notary Public, ---8t_CrIIIx County, Wis. 'Xy commission crpires SBpt. 12 60 • Typewrite Name tinder each Signature ' 360 r; "E631 O 'Q Z W H 0 ON N a a / w C4 C4 rap 0 9 l a A J 00 44 N O LL 9 ~ ' N r a Q M to r! N N a N O, 40 Cato N p~ N N N d, N 9 N o r, d N w `n N 0 0 o Q N N ~ ~a O C4 o C4 ~ a 44 t=1, as 00 LLEY OF THE SE 114 OF THE NE 1/4, PART OF THE 4 f14 N "HE NE114, OF'SECTION 18, T28N, R18TP, TORN OFF TROY 1 SOUTH FORK ADDITION i LOT 14 LOT 13 LOT 12 e 1 (pel~5.36'WQ 1 . HE CORER d NMM8'02'W 1324.32• I NORTH UE OF THE NEI/4 SECTION 18 3aa. a $ 11 12 ~ 2711 ACRES ~I 2524 ACES 118A9B S4 FT. N96938 SO. FT. LEGEND b ALUMINUM COUNTY SECTION CORPIR MONUMENT FOUND / •'•A 6p • 1' ZION PIPE FOLIO 1 I i m 0 32' X 30' RON PIPE 65 LOS. PER UNEARR FOOT SET 1 1 f / ~ NONE ALL O1RER LDT NXNBERS ' YOM111fI/1ED MI1N 1~ 12a~ to L799 AGES ICON PIPE W7O•NC 1.13 UTS. PER LINEAR FOOT 121.924 56 FT. m RAILROAD $PIKE FOUND 7 1 1 1 7E--X FENCE T ~ N8414'49'W 383.41' (NIOIV36-W) PRETACOSLY RECORDED DATA 1 9 ROADWAY SETBACK LINE (AS SHOWN) 2966 ACRES g IX WIDE UUM EASflM31T I i 128.939 S4 FT. 1 I PROPOSED OItlME 1 ~ . RQ~• NBBZ6'42`W 62LW DRAINAGE RETENTION AREA TO - ' 1 0 I XXX.X NON WATER ELEVATION xQ~ NOTE A oRAONc THAT ITa= ALTER THE CAPACITY 8 Z - tar San OF THE S10RM WATER RETENTION AREA 1 FT. 6 PROMOTED 1 j EXCLUOtNG EASEMENTS I n ' 2989 ACRES NOTE 8 BUILDINGS ARE PROHIBITED W1NN THE STORM wATER RETENTION AREA r 2. 1 I 90•~ t ~2s• ,66' ROAD EASEMENT TO MVN I e~ -MM IM LANE '.NSI3t'2s`w ua.6a' 11 ~ 1 5.3 ~ CS{I N88St m ~ 1 Q 1 (n i ' . 1 1 H.W.L 854.5 , O 1 ; { M 23 ~ ' , 11 7 o 1 4.742 AGES 4,, I 4 ACRES TOO 204343 SO. FT, d I I . 06 "ASENEK>j5 / ` o T ,p0 E 426 ACRES AND SSVJTTC SYSTEM i 0 `Tf 185623 SO. FT. G.•EVATITN TS I90 A 7O1 ACRES FT. ` BSB ON LOT 7 J3 T . ' 7.44-w sao.31 SCALE IN FEET 1' = 100' se 21a ( p 100 0 100 200 300 -'--mci j 2766 ACRES V) aT 1M470 SO. FT. N 24 r%1 ip °r0 w s6s.6r C S z MATCH LINE SEE srTEEr s SHEET 1 OF 3 SHEETS M DRAFTED BT MCIIAEL .NOB NM 24 26 DANE 6/21/99 A