HomeMy WebLinkAbout020-1474-04-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
556365 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:
Mackey, Timothy and Am Hudson, Town of 020-1474-04-000
CST BM Elev: Insp. BM Elev: BM Description: 22 c Section/Town/Range/Map No:
/Or7.~ VJ - J 6_ 57_ 13.29.19.3001
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
M.S
Septic 1 Benchmark
Dosing Alt. BM !
p t~M. F; I G Q 5 ✓6 / z.
caw..
Aeration Bldg. Sewer 98 • 3
Holding St/Ht Inlet
9'7•bs
TANK SETBACK INFORMATION St/Ht Outlet
~7G
TANK TO P/4 WELL BLDG en to it Intake ROAD Dt Inlet
Septic Dt Bottom
Dosing o~SG. Header/Man.,
• b
Aeration Dist. Pipe s • / (o • (o
'3•Z.
Holding Bot. System ~(o .s
P~ d
PUMP/SIPHON INFORMATION Final Grade Z,
Manufacturer Demand St Cover /
GPM '6 /6 f, Z,
Model mber n
TDH Lift Friction Loss System TDH Ft
[
Forcemain Length Dia. Dist. to Well t Z
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length / No. Of Trenches PIT DIMENSI S No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS ? 5$ '3 1r4&,. A,6
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: 1
INFORMATION /~6 l CHAMBER OR
~p`,~, ~--J1 em: Typ2 n.tO t-- ~ 4) 33 AM ~ UNIT Model Num 1-j"b ut
DISTRIBUTION SYSTEM J__ 1q4--141.1-/ v
Header/Man o2w Distribution x Hole Size x Hole Spacing Vent to Air I take
Pipe(s)
Length' ia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center G Bed/Trench Edges Topsoil KYes M No Yes [K No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: / /
Location: 877 Yellowstone Trail Hudson, WI 54016 (SW 1/4 SE 1/4 13 T 9N R1 9W) Yello stone AVaVa-lllle'y~ Lot 4 Parcel No: 13.29.19..3000_1
1 J Alt BM Description = Ft ( LL,. V-801 aGx ' ` p4- a,3 or ' " '0
2J Bldg sewer length
-amount of cover = ~ I ~ k, a►.X~
c ~ Go.~~ 0 t,JT~
Plan revision Required? ® Yes No J3:1 - - - - /
Use other side for additional information.
~-7 SBD-6710 (R.3/97) Date Insepctoes Sir ture Cert. No.
PLOT PLAN
PROJECT ADDRESS
SW 1/4 SE 1/4S 13 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 10/7/12 BEDROOM 4
CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 860 # of chambers 42
BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
Scale is 1" = 40' SYSTEM ELEVATION 95.495.2 4.5' below qrade
unless otherwise
noted *B M Scale is 1" = 40'
290' Property Line unless otherwise
Well is to meet all 30' noted
setbacks required by
WDNR 45'
B-1
98.5'
3% Slope 35' 99.5'
331' Property Line
B- ~ ~ents~
10 90,
a,
45'
~ a
G
1 2 X8 1 g
ST
10' ,.ST
y
Pro 4
Bedroom
House
All piping shall be SDR 30/34, within 10'
of tank, piping shall be Schedule 40.
Vent
>6„ Quick4 Standard
Leaching Chamber
of Cover with 20.0 ft2 of Area
10.2ft^2/pair of end caps
Long 12 445' property line
34" Grade at System Elevation 0"C'
J I
I
Property Owner _ Parcel ID # Page of
Boring # Boring I
® APit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Col Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
Eff#1 .Eff#2
gZ3j '0
b( mar 07 0
'LA 9 Z-.
121 -
3 6- r d 1
i
Boring # Boring
Pit Ground surface elev. 1 D~ ~ ft. Depth to limiting factor ~ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ALL_
Z 3~ s ~ w ~
S
❑ Boring /
Boring # Ground surface elev. • S ft. Depth to limiting factor J in.
Pit Soil Application Rate
Horizon r)epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff# 'Eff#2
' Effluent #1 = BOD, > 3o:< 22p mg/L and TSS >30 < 150 mg& ' Effluent #2 = BOD5 < 30 mgA- and TSS 130 mgil
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 608-2648777.
SBD•9330 tR.W)
Afibak. Eln' m~ce ''9 Safety and Buildings Division Count
►CO~„~ s+ 201 W. Washington Ave., P.O. Box 7162 1, r i
2012 Madison. WI 53707-7162 S-11nry Pnrmii Numbu~ 0- be filled in by CO.)
arfrnem of Comun"W Jc
Sans 1 0~lication , State Transaction Number 5
S ~
s. Comm. 83.21(2), i, Code, submission of this form to theappropriatgove ` en , or to obtaining a sanitary permit. Note, Application forms for state-oTSepartment of Commerce.
Personal information you provide may be used for sec lest Address (rf dttlerent than madtrig address)
ance with the Privac Law, s. 15.04(1 In, Stats. ~j
1. Application Information - Please Print All Informatio 0 /G ~`Ot,.J~y-dim
Property Owner's Name : A%b r►a Parcel # ► ►
Property Owner's Mailing Address
Properly Location
e o, U - t11 Govt Lot e3601
City, Stat Zip ode Phone Number
/
ce /
j F 1/., Section
ircle op)-
H. ype o wilding (chec all that apply C 12 t Lot # r N, R E U fir)
or 2 Family Dwelling - Number of Bedr~ Subdivision Name `
dk
El e- ,
Public/Commercial -Describe Use look e- ,
❑ City of
❑ State Owned - Describe Use CSM Number ❑ Village of
2 A, Ir e t Z 1 2 tu.c Cown I1r•~
III. Type of Permit: (Check only ne bog on line A. Complete line B if applicable)
A.
New System ❑ Replacement System 1111 Trealment/Holding Tank Replacement Only TO Other Modification to Existing System (explain)
B• El Permit Renewal El Permit Revision ❑ Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner
IV. Type of POWTS S stetn/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 d5,
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (exp G
V. Dispersal/Treatment Area Infornratio
Desi Flow (gpd) Design Soil Applicati Rate(gpdsf) Dispersal Area Required (s Dis ersal Area Propose (st) Sys em Elevati r
VL Tank Info Capacity in Total it of Manufacturer
Gallons Gallons Units o
New Tanks Existing Tanks / ~
N/ e4 w rn y rn iZ c7 ciw
lSeptic or Holding Tank a
Dosing Chamber
IVII. Responsibility Statement-j, the undersigned, assu risibility for installation of the POWTS shown on the attached plans.
?lumber's Name (Print) Plumber' re MP/MPRS Number Business Phone Number
2l~-J ZG
)lumber's Address (Street, City, State, Zip Code
Z S rK.ppro ounte rtment Use Onl
ved Disappro Permit Fee Dale I sued Issuing A'At Signature
11 ow" mllr Reason or Denial Y 75
~X. Condi ' aeReasons for Disapproval ! ►
~ d~ 7 1
1. Septic tank, effluent fitter and'- ►
;dispersal cell must all be servk:es / maintained 3, ~o
as per management plan provided by plumber.
..i)11 n ' 141@Irletlts must be.f aintabW
iii pe ~ 60do I pidirtanCes
Attach to complete plans for the system and submit to the County only on paper not less than 8 uz x 11 inches in size
`.I BD-6398 (R 02/19)
PLOT PLAN
PROJECT ADDRESS
SW 1/4 SE 1/4S 13 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 10/7/12 BEDROOM 4
CONVENTIONAL XXXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 860 # of chambers 42
BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 1001 Filter BEAR Filter
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark
Scale is 1" = 40' SYSTEM ELEVATION 95.495.2 4.5' below qrade
unless otherwise
noted *B M Scale is 1" = 40'
290' Property Line unless otherwise
Well is to meet all 30' noted
setbacks required by
WDNR 45'
B-1
98.5'
3% Slope 35' 99.5'
331' Property Line
B 90' Vents
10
45'
B-3
10' 2-3' X 86' Cells with >3' spacing
ST
10'
Pro 4
Bedroom
House
All piping shall be SDR 30/34, within 10'
of tank, piping shall be Schedule 40.
Vent
>6" Quick4 Standard
of Cover Leaching Chamber
with 20.0 ft2 of Area
10.2ft^2/pair of end caps
4' Long 12 445' property line
Grade at System Elevation
3 4 r
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 1017/12
Owner: Z Ad=
Z~ cc "
Location: SW1/4 SE1/4 S13 T29 ,R19W Lot 4 Yellowstone Valley Hudson
System type: In-ground absorbtion system(conventional)
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4-6. Maintanance and Contingency Plan
7. Filter Specifications S eet
Signature
License nu r #226900
PLOT PLAN
PROJECT ADDRESS
SW 1/4 SE 1/4S 13 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 10/7/12 BEDROOM 4
CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 860 # of chambers 42
BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark
Scale is 1" = 40' SYSTEM ELEVATION 95.495.2 4.5' below qrade
unless otherwise
noted B M Scale is 1" = 40'
290' Property Line unless otherwise
30'
Well is to meet all noted
setbacks required by
WDNR 45'
B-1
98.5'
3% Slope 35' 99.5'
331' Property Line
B- Vents
10 90'
45'
B-3
10' 2-3' X 86' Cells with >3' spacing
ST
10'
Pro 4
Bedroom
House
All piping shall be SDR 30/34, within 10'
of tank, piping shall be Schedule 40.
Vent
>6" Quick4 Standard
of Cover Leaching Chamber
with 20.0 ft2 of Area
10.2ft^2/pair of end caps
4' Long 12 445' property line
34" Grade at System Elevation
Cross Section of Infiltrator Quick 4 Leaching Chamber
Typical cross section for 2 of 2 cells
Quick 4 Standard Leaching Chamber
with 20.0 ft2 of Area per Chamber
10.2ft^2 pair of end plates To be >1' above grade
Finish grade elevation
Typical Installation 99.9'
Vent Grade Vent
3' 4" 3'
X30/34 Septic Tank
191
Long 5' 5' Long 1
3 6" Grade at System Elevation Grade at System Elevation
Spacing 5'
2-3' X 86' Cells
Same on other end Observation tubeNent
At end of cell
A
B
21 chambers per cell
System elevations:
A-95.4'
B 95.2'
r
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
_7
Owner/Buyer
Mailing Address 3g t j a . G p v
Property Address 46 C.~ 10 S uva ' f kA i HCA S O WT- ,
(Verificati n required from Planning Department for new construction.)
City/State Parcel Identification Number c~ 0
LEGAL DESCRIPTION
Property Location K , K , Sec. T, N R4t W, Town of Huh t -D
Subdivision lm-4o Lot #
Certified Survey Map # Volume , Pag #
Warranty Deed # , Volume , Page #
Spec house yes no Lot lines identifiable ryes no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle waste. 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 ma' tenance
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 Zoning Department a certification form, sign by the owner and
by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site tewater disposal
system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is 1 s than 1/3 full of
sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage dispos system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, Sta of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning
Department within 30 days of the three year expiration date.
"~"'f lei
SIGNATURE OF ANT DATE
OWNER CERTIFICATION
I/we certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the o cr(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office
Ll~l jz
SIGNATURE OF APPLICANT DATE
Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning partment. ss«*«s
Include with this application a stamped warranty deed from the Register of Deeds Office and a copy of the certifi d survey map if
reference is made in the warranty deed.
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS l 5~
Owner Septic Tank Capacity O NA
Permit # I
Septic Tank Manufacturer /74 f ❑ NA
)ESIGN PARAMETERS Effluent Filter Manufacturer ~Z ❑ NA
Number of Bedrooms e7l ❑ NA Effluent Filter Model ❑ NA
i Number of Public Facility Units A Pump Tank Capacity NA
al
Estimated flow (average) gal/day Pump Tank Manufacturer NA
Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer NA
i
Soil Application Rate z Pump Model
al/da
!ft NA
! Standard Influent/Effluent Quality Monthly average" Pretreatment Unit ❑ NA
Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD5) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 rng/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BOD5) 530 mg/L n-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L ;;,"/A ❑ At-Grade ❑ Mound
Fecal Coliform (geometric mean) 5104 cfu/100m1 ❑ Drip-Line ❑ Other:
iMaximum Effluent Particle Size X in dia, ❑ NA Other: ❑ NA
Other: A Other: ❑ NA
I
''Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
IAINTENANCE SCHEDULE
Service Event Service Frequency
linspect condition of tank(s) At least once every' month(s)
ears (Maximum 3 years) ❑ NA
(Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume ❑ NA
!Inspect dispersal cell(s) At least once every: ❑ ontth(s) (Maximum 3 years) ❑ NA
Olean effluent filter At least once every: month(s) ❑ NA
ear(s)
Inspect pump, pump controls & alarm At least once every: ❑ month(s) NA
❑ year(s)
[:lush laterals and pressure test At least once every: ❑ month(s) NA
❑ year(s)
Other At least once every: ❑ month(s) NA
IDther: ❑ year(s)
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
linclude a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of
ioombined 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.
'T'he ondin of effluent on the round
p g ground surface may indicate a failing condition and requires the immediate notification of the local
regulatory authority.
I,Nhen the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents of
I:he 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,
land any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
Page of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals thElt
may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of thj:
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 ble
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluenlt.
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 nfectng the life
fat; fo of the POn drat n
antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disi rd rali
(sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting p
pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly
and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil,
gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliipnt
replacement system:
-~E1 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 requirjed
setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the noed
for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rule:j 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 evalual~ion
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 NIOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE Op A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS -
POWTS INSTALLER POWTS MAINTAINER
Name Name. ~j f
Phone - Phone r Zy
7 -J
-241
SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY
Name ~,_w L Name S /cy
Phone Phone
This document was drafted in compliance with chapter SPS 383.22(2)(b)(%d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code.
iv
Ya{r: FILTER CARTRIDGE INSTRUCTIONS
Installation
STTFP Y pry fit the filter case -3140 the end of the outlet pipe to ensure it is
centered under the access opening. If not„ then either insert more pipe into the
tank through the outlet or solvent weld (glue) additional pipe onto the outlet
pipe.
STIED 2 Wtdk the case is still try fitted on the outlet pipe, measure the length
of Diu-inch pipe needed to brace, the filter to the tank emd wall if utilizing the
optional supplemental side support, If side support method. Jr. not utilized,
proceed to st" four.
s-7 ,VP P For installations utillxing the optional supplemental side support:
solvent weld the V4-inch pipe onto the filter case. If side support method is not
utilized, proceed to step four.
M1'~4i v.r r'A~'S4
Solvent weld the fitter case onto the outlet pipe. Insert the filter
i;.
cartridge into the case, premin l down until the filter locks into the bottom of
the case.
If a VRS switch is utili::~ed: insert into the filter and lock b turning clockwise 90e, by
Maintenance
1. The effluent filter should be cleaned every time the septic tank is
serviced. [
f '
2, open the outlet access opening to Inspect the tank and Niter,
9, pump the septic tank completely, making sure to ramwe the sludge
layer on the bottom of the Wrik and not just the scum and effluent,
a. once the effluent level has been lowered below the invert of the
outlet pipe, firmly pull up an the filter handle to dislodge the
cartridge from the case.;
5. Slide the cartridge up and of rt of the case for cleaning, y
6, it a VRS switch connected to an alarm Is present, the switch 4
should be removed by turning counterclockwise 901 and cleaned r..
with water only. r,
7. While holding the cartridge an its side (large fiat surface facing ,y
down) over the access opening, rinse off the cartridge with water' •
only, making sure an septagt> material is rinsed back Into the tank. ^N..~
` a. if VRS switch is utilized, replace by inserting into filter and " `
turning clockwise 90'. ~n
9, Insert the filter cartridge back into the case, pressing down until " ' .
the filter locks into the bottoun of the case.
Io.Repiace and secure the access upening on the tank.
'0C.
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965216
BETH PABST
STATE BAR OF WISCONSIN FORM 1 -2000 REGISTER OF DEEDS
WARRANTY DEED ST. CROIX CO., WI
Document Number 10/12/2012 12:48 PM
THIS DEED, made between Environmental Holding Company, LLC, a EXEMPT#: NA
Wisconsin Limited Liability Company, Grantor, and Timothy P. Mackey REC FEE: 30.00
and Amy B._Mackey, , husband and wife as survivorsh$marital prope TRANS FEE: 132.00
Grantee. PAGES: 2
Grantor, for a valuable consideration, conveys to Grantee the following
described real estate in St. Croix County, State of Wisconsin (the
'Property"):
SEE ATTACHED EXHIBIT A
Recording Area
Name and Return Address:
Land Title, Inc.
2200 County Road C West Suite 2205
Roseville Ivl3
i
Together with all appurtenant rights, title and interests. 020.1474.04.000
Parcel Identification Number (PIN)
This is not homestead property.
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except
Dated thi,,,V day of Augus , 2012. ,~E •
Enviro a Idi party, LLC
OTARY
* Jeff W en, In Manager a °,11P
PUBLIC
AUTHENTICATION ACKNOWLEDGMENT OF W
Signature(s) STATE OF WISCONSIN )
ST. CROIX COUNTY. ) ss.
authenticated this Personally came before me this
day of August, 2012 the above named Jeff Warren , the
* Managing Manager of Environmental Holding Company, LLC,
TITLE: MEMBER STATE BAR OF WISCONSIN a Wisconsin Limited Liability Company , to me known to be the
(If not, person(s) who executed the foregoing instrument and
authorized by § 706.06, Wis. Stats.) ack Vwled the same.
THIS INSTRUMENT WAS DRAFTED BY
* i
Larry S. Mountain Notary Public, State of Wisconsin
My commission is~pelt~Ianent. (ifjn~atgexpiration date: )
' (Signatures may be authenticated or acknowledged. Both arc not necessary.) (Z lot.
*Names of persons signing in any capacity must be typed or printed below their signature
WARRANTY DEED STATE TSAR OF WISCONSIN FORM No. 1-2000
1 of 2
EXHIBIT A
Lot 4, ellowstone Valley in the Town of Hudson, St. Croix County, Wisconsin.
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2 of 2
Wisconsin Department of Commem 01(_ RT Page of
Division of Safety and Buildings 6~
-vA in accordance mm 8 , A m. Code
my - r
Attach complete site plan on paper not less than 2 in es in size,`. ~~Iaa((~~ rush
include, but not limited to: vertical and horizontal reference poi t (BM . didn =0 0 6 P rcel I.D.
percent slope, scale or dimensions, north arrow, and location d distance to nearest road. Cl C L' 7 7 Q
Please print aft information. ST. CROiX COUNTY R viewed by Date
Personal information you provide may be used for secondary purposes Privac
Property Own r Property Location
r Govt. Lot .5(j 1/4 5,1/4 S I3 T Z N R E (or W
Troper(y Owners Mailing Address Lo/t/# Block # Subd. Name or CSNV /
03
City State Zip Code Phone Number City ❑ Vil ge own Nearest Road7
S 4 ( rr
Construction Use: esidentiai / Number of bedrooms Code derived design flow rate l GPD
Re aoement Public commercial - Describe:
Parent material Flood Plain elevation if applicable ft.
General comments y ' S / 3 `9ul
and recommendations:
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System Type System Elevation Z
1 4
Boring 171 # Boring Q_1__-_-
Pit Ground surface elev. ~ Depth to limiting factor 0 ~ in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
' /0" 31z- 51 17)J4
U-34, I s 1
.110 04 -5
Boring # ❑ Boring
® it Ground surface elev. O ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
1 t7 I 3 Sc rra r C .U
1v' z s e s w
.0 4f
1
I)I tt7 U) ga
Effluent #1 = BOD > 30 1220 mg/L and TSS >30 < 150 • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST NWV (Please Print) lure CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evalu tion Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 540 1<"-- 6 - 715-246-4516
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Property Owner - Parcel ID # Page of
❑
Boring # Boring
Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
F31 1
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff
in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2
sl L to ~r cs 0
L 2-3~ r g`u'
3 b- r v 1
i
i
. i
a 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 GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
Boring ° Boring
# Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Sod Application Rate
Horizon 7epth Dominant Color Redox Description- Texture Structure Consistence . Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •042
Effluent #1 = BODS > 30 < 22q mg1L and TSS >30 < 150 mglL ' Effluent #2 = BODS 130 mglL and TSS 130 mglL.
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 608-2648777.
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Soil Test Plot Plan , f
Project Name Hudson Holdings LLC Shajdh, it
Address 703 Pine St. N.
Hudson Wi 54016 #226900
Lot 4 Subdivision Yellowstone Valley Dat 4/26/06
S W 1/4 SE 1/4S 13 T 29 N/1119 W Township Hudson
F-I Boring Q Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 1 oo ft. Top of Survey Iron
System Elevation 95.4/95.2 *HRpSame as Benchmark
Alternate Benchmark Top of 1/2" pipe @ 100.5'
* B.M Scale is 1" = 40'
B.M.
290' Property Line Atl.B.M. unless otherwise
30' noted
45'
B-1
98.5'
3% Slope 35'
99.5'
331' Property Line
B-
10 90'
45'
B-3
445' property line
c _ a
mill
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