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HomeMy WebLinkAbout020-1115-00-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 552332 0 GENERAL INFORMATION 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: Steffen, Aaron R. & Emil A. Hudson, Town of 020-1115-00-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: /60.1 16 C 5 T 19.29.19.469 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. CIO Benchmark Ex4 s~-~` /ooo Z~ 3z 16Z 3 /Z)~ Alt. 912 rlrb 4L 0 1 : l a j Z. / r rJ 5 Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/ WELL NG, ent to Air In ke ROAD Dt Inlet /VaC lac ! 5.71 yG SS Septic S Z 7 X O944k #mo6 5,06 5.1`'$ Dosing Header/Man. Aeration Dist. Pipe 7,78 . G Holdi Bot. System J g,88 PUMP/SIPHON INFORMATION Final Grade 14 TF, Manufacturer Demand St Covey GPM 'fModel er 6-7 9F.5z TDH Friction Loss System H /t TD Ft / . a 7 - Forcemain Length Dia. 77~ U O SOIL ABSORPTION SYSTEM !r 3. aZ BED/TRENCH Width / Length No. Of Tren ches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufact~: INFORMATION CHAMBER OR Type Of System: ^ 1,0.6'157 1~ UNIT Model umber, n0 DISTRIBUTION SYSTEM ✓ f t i9 0- lI = Header/Maninifoy i/ Distribution x Hole Size x Hole Spacin Vent to Air Intake Length ! Dia Length Dia Spacing "-SML 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 FRI ; . 4 7 / Yes Q No ®Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: / / Location: 361 Willow Lane Hudssoon,_WI X1016 (SW 1/4 NE 1/4 19 T29N R1 9W) Willow River Estates Lot 1 I- Parcel No: 19.29.19.469 1.) Alt BM Description = v' G~J ~0 G~•5 a 2.) Bldg sewer length = ~C „/1 P I I ,j~ -amount of cover = x~ ~ ' ' ~ E.x!)1♦C17w~ 1,.~ Plan revision Required? 0 Yes No / Use other side for additional information. SBD-671 0 (R.3/97) Date Insepctor's nature Cert. No. , "aTvj g. County Safety and Buildings Division St. Croix 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) &Madison, WI 53707-7162 04A llllt~ ark, ~r ermit Application ~Vk Transaction Number In accordance with S is. Adm. Code, submission of this form to the appropriate govertlmental unit" ' / J VA is required prior to ob a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04 1 (m , Slats. Same 1. Application Information - Please Print All Information Property Owner's Name Parcel # Aaron & Emily Steffen 020-1115-00-000 Property Owner's Mailing Address Property Location / 361 Willow Lane Govt. LQL-~ City, State Zip Code Phone Number _NW_'/,, _NE Section _19_ Hudson, WI 54016 (715) 381-0007 (circle one) 11 T 29 N; R 19 E or W II. ype of Building (check all that apply) Lot # 1 or 2 Family Dwelling -Number of Bedrooms 3 1 Subdivision Name i Block # Plat of Willow River Estates ❑ Public/Commercial - Describe Use 1 ❑ City of ❑ State Owned - Describe Use CSM Number ❑ viii of Na own of Hudson III. Type of Permit: (Check o y one box on line A. Complete line B if applicable) A. ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New , Before Expiration Owner A~Iw. IV. Type of POWTS S stem/Com onent/Device: Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersaVrreatment Area Information: 33 Infiltrator "Q4 Plus" standard chambers & 6 endca s, Pol Lok PL-525 effluent filter Design Flow (gpd) Design Soil Application Rate(gpdsf) ' Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 450 Gpd 0.70 Gpd/Sq. Ft. 642.86 sq. ft. 690.60 Sq. Ft. --93.50' y VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units o o v New Tanks Existing Tanks w c° Y Y a Septic or Holding Tank 1,500 1,500 1 Wieser Concrete X Dosing Chamber T 1,000 1 S ?~Q h o,4~ s n VII. Responsibility Statement- I, the u dersigned, assum responsibility for i attoo of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's gna a MP/MPRS Number Business Phone Number James K. Thompson MPRS 30021 (715) 248-7767 Plumber's Address (Street, City, State, Zip Code 340 Paulson Lake Lane, Osceola, WI 54020 VIII. County/Department Use Only Permit Fee Dal(: Issued Issuing g t Si re Approved ❑ Disapproved $ 0 l < ❑ Owner Given Reason for Denial 5` 2 a. C h s of ApprovaUReasons for Disapproval / ] G 1Q CG 4 7 h C X , 9"IM OWNER: 1 Septic tank, effluent filter and 1L) .S(_ / ✓ ~u~~x dispersal cell must all be serviced /maintained /J as per management plan provided by plumber, tf j ¢l c C S -Zv,,~~lam/~q/ t;I`-/ 5'~ G am ~'G 2. All setback requirements must be maintained J h-lt71 > GO Ica I88r#G"for the system and submit to the County onl on paper not less than 8 1n x 11 inches in size SBD-6398 (R. 11/11) Conventional POWTS Index & Tilte Sheet Project Name: Steffen 3 bedroom Replacement Dose Conventional POWTS Owners Name: Aaron & Emily Steffen Owner's adress: 361 Willow Lane, Hudson, WI 54016 Site address: Same Project Location: Subdivision: Lot 1, Blk 1, Plat of Willow River Estates Legal Description: NW1/4 NE1/4, Sec. 19, T.29N., R. 19W., Town of Hudson, St. Croix Co., WI. Parcel ID 020-1115-00-000 Page 1 Index and Title Sheet Page 2 Site Plan Page 3 System Cross Section Page 4 Dispersal Cell Sizing Calculations Page 5 Pump Chamber Cross section, Calcualtions & Pump Curve Page 6 Dose Conventional System Management Plan Page 7 Filter Specifications Page 8 Septic Tank Cross Section Page 9 Septic Tank Maintenance Agreement Page 10 Certification for Utilization of Existing Septic Tank Page 11 Parcel Map Page 12 Waranty Deed Attachments: Soil Evaluation Report Mater lumber Restri ted Service: James K. Th son, De 't. of Comm. Credential #30021 Signature: Date: Page 1 Of 12 Design pursuant to In-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (N.01101) EX~'s El~~ 9r'ade eJ • L acafcc~~o~cP, 3 c ca /e: Re{' #22 177 \ Aaron ~ Eti7, (y ~E.2~f'o~ \ u.d5o~, w/. s~fo/6 LJi /~OcJ ~CiIJU E.4ba ~e5, \ O 1-06 1 Ole nwNncvYy, ~Se~ ~9, r29n., . Cro i \ w 11ow Lease 1,0a. nq D. s/~ac/c s em' L o co»crofc ~aA^ SidecaXt/~! 65c"K d Ex, s driVC~y EXi3~inq u7ell ~ \'\Q7\~= V r n po CZ>I~0O`ScO o, ~.Y+° i bZ~St da s 2 v EXi S Einq ` • S e,OE; c_b*4 )e. Po/y ~oK ~'L - 5 Qeside~cC. i aY. S6' /00cJT5 Czlns,3f%._ry oF/ crone 5V6j:, a- z r1,y we//s . L- ~,Ywc//s & 6e a,~a. don e~a,s,Je- Cede. ' drr 8~ ~ ° ~oac Cha.nbc,~ ~n ed 60 bar i ~S ~iC[~~'cm oFSc cv a~C, _ ~ ~ / ti3~ E /f . 8. ~'I. ~ Too off' Pya/oOS~c~I oC~3PQ~.s4-/C'~. /of 5~c. E/ew = 9dof!' -7- rc e (3) t~ e c S t z. 83 s/G. o, / E(ewzw-i (11) snf'/tr~vP Su~-,~a CQ ~/ed~'~~h AjoPr °l. ~,~Bue-~ 1~►^. Abe 93 so.' 2278 SOIL EVALUATION REP 'P Wisconsin Dep a merce Page 1 of 3 A.C.E. Soil & Site Evaluations Division of Saf and uildings f .lsO~hri acco nce with Comm 85, Wis. Adm. Ci - AT 1) Attach com to site pll~ol'papec inches in size. Plan must St. Croix include, but t limited fo: ve ' erence point (BM), direction and percent slope scale or I w, and location and distance to nearest road. Parcel I.D. C~ rint all information. 020-1115-00-000 ' Q~. Reviewed 72 Personal inform o provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). " tifiv S Property Owner Property Location Aaron R. & Emily A. Steffen Govt. Lot NW 1/4 NE 1/4 S 19 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 361 Willow Lane 1 1 Willow River Estates City State Zip Code Phone Number J City Village W1 Town Nearest Road Hudson WI 54016 715-381-0007 Hudson Willow Lane New Construction Use: -fy Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD 1/ Replacement -J Public or commercial - Describe: Parent material Glacial Outwash Flood plain elevation, if applicable Na General comments and recommendations: Site suitable for conventional POWTS dispersal cell with 0.7 gpd/sq.ft./day loading rate. Recommended trench elevations to be 93.50'. ~y p i~'~~ ~e~ r. Boring # ~ Boring i j Pit Ground Surface elev. 98.24 ft. >99" in. Depth to limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 -Eff#2 1 0-12 1Oyr3/2 none I 2fgr mvfr cs Yrn,1c 0.6 0.8 2 12-21 1Oyr4/4 none Ifs 0 mfr cs 2fmc 0.5 1.0 3 21-41 1Oyr4/6 none gr Is Osg ml cw 1fm 0.7 1.6 4 41-99 1Oyr4/6 none or s Osg dl - - 0.7 1.6 r-Z c 3 S~ .rf r Horizons #3 & 4 contain approx. 20% gravel & cobbles. 7367 Boring # I Boring Pit Ground Surface elev. 98.06 ft. Depth to limiting factor >95" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 1 0-6 1 Oyr3/2 none I 2fgr mvfr cs 3fm,1 c 0.6 0.8 2 6-26 1Oyr4/4 none Ifs 0 mfr cs 2fmc 0.5 1.0 3 26-41 7.5yr4/6 none gr Is Osg ml cw 1fm 0.7 1.6 4 41-95 10yr4/6 none g ' s Osg dl - - 0.7 1.6 SV,7Z~ 2: Horizon #3 contain pprox. 15% g vel & cobbles. Horizon #4 contains approx. 25% gravel & cobbles Effluent #1 = BOD5> 30 < 220 mg/L a d TSS >30 < 1 mg/L nt #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signatur . CST Number James K. Thompson S'- 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 3/20/2012 715-248-7767 Property Owner Aaron R. & Emily A. Steffen Parcel ID # 020-1115-00-000 Page 2 of 3 3 ] Boring # Boring V Pit Ground Surface elev. 97.84 ft. Depth to limiting factor >102" in. Soil Application Rate F Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-8 10yr3/3 none I 2fgr mvfr cs 2fm,1 c 0.6 0.8 2 8-23 10yr3/6 none Ifs 0 dl cw 3fm,2c 0.5 1.0 3 23-34 10yr3/6 none gr Is Osg ml cw 2fm,1 c 0.7 1.6 4 34-102 10yr4/6 none gr s Osg dl - 1vf 0.7 1.6 0 0 gravel #3 contains approx. 30/o gravel & cobbles. Horizon #4 contains approx. 40 /o ravel & cobbles. 4] Boring # J Boring 1/ Pit Ground Surface elev. 97.33 ft. Depth to limiting factor >98" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-8 10yr3/2 none I 2fgr mvfr cs 2fmc 0.6 0.8 2 8-27 10yr4/3 none Ifs 0 mfr cs 3fm,2c 0.5 1.0 3 27-40 7.5yr4/6 none gr Is Osg ml cw 1fm 0.7 1.6 A-4 40-62 10yr4/4 none ' gr s ' Osg dl - - 0.7 1.6 w i 5 62-98 10yr5/4 none gr s Osg dl - - 0.7 1.6 Z 'P, Horizons #4 contains appro . 4 /o gravel, bble & ston . Horizons #5 contains approx. 20% gravel. e ❑ Boring # -I Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS L30 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. SBD-8330 (R07/00) A.C.E. Soil & Site Evaluations ~ EX~'s Esc y y rye e-I • ~ot~i~Etcrc%ol'o~. sfa~e. Aaron d Errt;Ce~f q+~ 3 / cc~WOe-i L4 nc ~yctd w/. SYo/6 ff so.-, \ DoE / of GJ.7~0~ ~'vt-r'E.S~a-feS \ ~ nc..,y~nc.~Ys; :See /9,T29rt., cro L'e., L -N. iK nq D. slSaC,, e s \ ~ Cor? L ° Con crcfc eleJ-- /vr~.e~." ~q aJo\ Tjdc~ vn< . EX~•s~-►, , , N~a drive EXiS~inq [.~Z(( i \ \ 1 \ ~ ~ EX%S fIn ~ ~ , ~ 1 ~ 3 6 edr4 Ila fiNPr~. /aca.fo.-> d canl;• u~o~'~r'oa-~ o~'i sea6 b~.iCg2 dry weUrls. A~yyv~(fs to be 6a„daned Es ~ code. r ■ a ti3 ~ E /f . zi rr1. ~ Tod Soil Absomtion System Cross Section 99.00 ft 98.00 ft 4' Schedule 40 Final Grade PVC Vent Pipe 94.50 With Vent Cap ft Leaching 93.50 ft Chamber System Elevation 2.8-3 ft 6.00 ft ft Soil Absomdon System Plan VieviL ft 2.83 ft ~ Trench 1 6.00 ft Leaching Mir Chambers 4' Dia. Trench 2 Header Vent Or Observation Pipe Trench 3 Leaching Chamber Speciflcagons Manufacturer And Model -yn~,`/~~c v~ ~~©-~t~~us 5 k,- a EISA Rating 20.00 sq ft per chamber Soil Application Rate 0.70 gpd/sq ft 450.0 gpd Design Flow 0.70 Soil Application Rate 20.00 EISA = 32.00 Chambers 3 rows of 11.00 chambers each. Page 3 of 1z DISPERSAL CELL SIZING CALMLAT IONS 1. (3 bedrooms)(100 gallons estimated flow)(1.5 design factor) = 450.00 Gpd design flow 2. Infiltrative capacity of native soil = 0.7 gpd/sq. ft. 3. Absorption area required: 642.86 sq. ft. 4. Absorption area as proposed: 677.40 sq. ft. (33 chambers total) Infiltrator "Quick 4 Plus" Standard = 20.00 sq.ft. EISA/chamber, "Quick 4 Plus" end cap = 5.10 sq.t EISA 642.86 sq. ft. - (6 endcaps)(5.10) = 612.26 sq. ft. 612.26 sq. ft./20.00 = 30.62 chambers required Number of trenches: 3 @ 11 chambers per trench Trench width: 2.83' Trench length: 46.00' Trench spacing: 9.00' on center Total system area w/ 6' trench spacing: 21.00'x 46.00' Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and ► Comm 16.28 WAC 4 in. min. Disconnect - Tank component is properly vented - rLForcemain Alternate outlet location diameter Unknown Manufacturer 2 in. Capacityl 999.84 Gallons -r Volume 20.83 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 30.00 624.97 B 2.00 41.66 C Pump off elevation (ft) C 4.00 83.25 _t ♦ 91.00 D 12.00 249.96 D Total 48.00 999.84 Do♦ se tank elevation (ft) 3" Bedding under tank. 90.00 Alarm Manuafacturer LevelArm Alarm Model Number DLV 2J PUMP PERFORMANCE CURVE Pump Manufacturer Zoeller MODEL 266/267/268 i Pump Model Number N 267 H 1. Force Main: Diameter 2" W 20 r o~ Length 20' I 15 2. Total dynamic head: ; Mm. supply pressure: 0.00 i j Vertical lift: 10.00, 10 Total dynamic head: 10.00 Flow rate: 80.00 gal./min. 5 - 3. Pump selection: Manufacturer: Zoeller 20 40 60 80 100 120 Model number: N267 sewage pump GALLONS LITERS 0 100 200 300 400 500 4. Dose chamber: V y1 Y15 of eU'd Manufacturer & capacity: Unknown 1000 gallon FLOW PER MINUTE Liquid depth: 48.00" 20.83 gal./inch ( 999.88± gal. actual) Sizing: A) One day holding capacity: 30.00" = 406.19 gal. B) Alarm setting: 2.00" = 41.66 gal. C) Dose volume + flow back: 4.00" = 98.32 gal. (4500gal.)(20% Design flow) + (.367)(20') = 97.34 gal. Max. Dose D) Reserve storage: 12.00" = 427.01 gal. TOTAL 48.0" = 999.84 gal. ± ~o F Dose Conventional POWTS Management Plan Pursuant to Safety & Professional Services Chapter 383.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with Safety & Professional Services Chapters 382-384 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD- 10705-P (N.01/01). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Septic Tank The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. If the septic tank is fitted with an effluent filter, it shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Safety & Professional Services Chapter 383.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Safety & Professional Services, Safety and Buildings Division. Pump Tank The pump (dosing) tank shall be inspected at least once every two years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed at the pump discharge, it shall be inspected and serviced as necessary. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is not recommended. Soil compaction may hinder aeration of the infiltrative surface within the system and will promote frost penetration during cold weather months. Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Contineency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by removing biologically clogged adsorption and dispersal media and replacing said components as deemed necessary or by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to Jim Thompson at (715) 248- 7767 or your County Zoning inspector. Go 0;- ,r t • Filters PL-525 EFFLUENT FILTER ( OM ER I J Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent filters. The PL-525 is rated for over 10,000 GPD alarm (gallons per day) making it one of accessibility Accepts PVC the largest commercial filters in its ( extension handle class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the new Polylok PL-525 has an automatic shut off ball installed 525 linear feet with every filter. When the filter is of 1/16° . removed for cleaning, the ball will filtration slots Rated for over float up and temporarily shut off 10,000 GPD the system so the effluent won't leave the tank. No other filter on the market can make that claim! Accepts 4° & 6°' SCHD. 40 Pipe' ~j PL-525 Maintenance: The PL-525 Effluent Filter should operate efficiently for several years under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned every time the tank is pumped or at least every three years. If thex installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be Gas deflector 3 done by a certified septic tank automatic shut-off pumper ler. or instoI ball when filter en ter is removed 1. Locate the outlet of the U.S. Patent No# 6,015,488 septic tank. 5,871,640 2. Remove tank cover and pump tank if necessary. PL-525 Installation: 1. Locate the outlet of the 3. Do not use plumbing when septic tank. filter is removed. Ideal for residential and com- 2. Remove the tank cover and 4. Pull PL-525 out of the housing. mercial waste flows up to pump tank if necessary. 5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the tank. Make sure all solids fall 4 or 6 outlet pipe. If the filter is not centered under the back into septic tank. access opening use a Polylok 6. Insert the filter cartridge back Extend & Lok or piece of pipe into the housing making sure to center filter. the filter is properly aligned and 4. Insert the PL-525 filter into completely inserted. its housing. 7. Replace septic tank cover. 5. Replace the septic tank cover. ~ 10j. 7a/ ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) -561e4j;11ez J Gee, ALdSr„-7 u)/. Syd/, _ located at: a) rJ 1//4. Section Town Zq N, Range W fo\vll of ~~o~S(jy~ , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84,25, and it (the\ ) appear(s) to be functioning properly. .Host recent date of inspection or service Did ilo\~ back occur from absorption system? Yes -No (ifno, skip next line.) .-%pproxinlate volume or length of time: (,~~allons Minutes Tank Capacity: 06 Construction: Prefab Concrete Steel Other \laliufacturer (if kl~o\vn): allk (lf k-nown): Sermit n Imber (if known) Z ensed Plumber Signature) (Print Name) tTitle) (License Number)~IPKS (Date) Fornn to be completed by licensed plumber (Dept of Commerce Chapter 5 and s. 145.06, `Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) 9'2008 P5, /o aF/~ D z A N D 694„ AS 93„ mm REQD D c 57" 2 D r n m C N ~ .'f7 nw-- m v ° \ m N UP 56" I N 1 m+ 4" CAS '1 O / co m \ 3., 61 5„ D m n m m~ \ m 1 my < 51< ED D m m ' c> I UP 53" N 4" CAS N T1 m C C = A G D ° z D 54" rcs v N ~ I ~n > r r v_ C z z O O r r D m I ~A o - ~ mi < m Cv my m n a) D MOO mDp -I 5L-.O?pr 0 (f) -.1 NN 0\ O 0 ~ZC :-IBC: ~mzca.. mcn N C/) O °Z zEn ~ m (n u) C.) I r-J rm-Ll co as (D cp r* m co (n O p (Jl z 000 2 n N O bo cnm> DD rev Nn'p f1 ~ O v D A O to ' to r N co x c.+ O (nz v I O s o v X t7 5j O z C 6) c) m -.4 m m m r (n co to p p6-0 n Z Ti z c~ai (7 D m Z Z Drv r0 v v y \ 9k O m H D o m< Gl v c m o f -1 0 m 0 o m ~v I V/ D m O ~ op z (A ca ;o N m A O mr rn ;a C ;u O co n r O O D z r D H A m m A m 0 \ (n W1000/500-MR m DRAWN BY: SME SCALE: 1/4"=l'-O" PRE-POUR: MIESER conCAETE REV. ~ SEPTIC MANUAL DATE: JANUARY 2012 DATE:. POST-POUR: Z W3716 US HWY 10 MAIDEN ROCK, WI 54750 ° REVISED JAN. 2012 800-325-8456 FILE: WIWO/5W-MR ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address 36 Property Address Swamp (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number LEGAL DESCRIPTION Property Location 4to '/4 , '/4 Sec. T _e?g_N R_e~9_W, Town of 9C ;-7 5c Subdivision Plat: Lc~//O-zo 6Lje/ Lot # Certified Survey Map # dCv , Volume , Page # Warranty Deed # Al y (2-000 (before 2007)Volume , Page # Spec house pi~o` Lot lines identifiable o1 ~S*Qe 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. I/we, 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. 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. Nu ber o bed o Vffi*t Kmru- SI ATU F APPLICANTS DA E ~7, ***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) I liifif lilll iflii IIIII ilili iilli IIII Nifil (fif lilf * 8 6 9 4 9 9 1 869499 STATE BAR OF WISCONSIN FORM I - 2000 KATHLEEN H. WALSH REGISTER OF DEEDS Document Number WARRANTY DEED ST, CROIX CO., WI RECEIVED FOR RECORD THIS DEED, made between Judy L. Dean and Jacqueline R. Solsvig, 02/26/2006 12 :30PM both single, Grantor, and Aaron R. Steffen and Emily A. Steffen, husband WARRANTY DEED and wife, as survivorship marital property, Grantee. EXEMPT N REC FEE: 11.00 Grantor, for a valuable consideration, conveys to Grantee the following TRANS FEE: 561.00 described real estate in St. Croix County, State of Wisconsin (the PAGES: 1 "Property"): Lot 1, Plat of Willow River Estates in the Town of Hudson, St. Croix County, Wisconsin Recording Area Name and Return Address: Title One Premier Group 706 19`h St. S Hudson, WI 54016 File #12489 Together with all appurtenant rights, title and interests. 020-1 115-00-000 Parcel Identification Number (PIN) This is homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except reservations, restrictions and easements of record, if any, and public highways, zoning and building regulations. Dated this day of February, 2008. * Judy L. Dean * Jac ueli . Solsvi AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ST CROIX COUNTY. ) ss. authenticated this Personally came before me this ~0 i~ day of February, 2008 the above named Judy L. Dean and Jacqueline R. Solsvig, * both single, to me known to be the person(s) who executed the TITLE: MEMBER STATE BAR OF WISCONSIN foregoing instrument and acknow edged the same. (If not, authorized by § 706.06, Wis. Slats.) THIS INSTRUMENT WAS DRAFTED BY Notary Pub ic, State of Wiscons' My commissiT is pe lanent. (I t, state expiration date: ) Michael H. Forecki, Attorney _ JJ r (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names ofpersons signing in any capacity must be typed or printed below their signature . JAYP PENFIELD Notary Po P nn s 13!-9.te, oil 1 of 1 WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1-2000 /,2orl-2, 4 ~f qo~ 00 p~ Q ,10• OJ3 10 0 0 ;1100 ~ J 4 q4l 0~ r 21 0 kyk~ 40 00 1160 15 I I i