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020-1376-55-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 561025 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)j. Permit Holder's Name: City Village X Township Parcel Tax No: Bast, Kernon J. & Don Ida J. Speer- Hudson, Town of 020-1376-55-000 CST BM Elev: Insp. BM Elev: BM Description: SectionrTown/Range/Map No /Op c 14.29.19.2316 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. i Septic 2 Benchmark a. l5 16Z i Af- o I LA. 4 JLO O Az Dosing 4J Alt. BM r.., -2.-7 ~ • 957 r ~ Aeration Bldg. Sewer 7./ CC Holding St/Ht Inlet 7• (o I ~TANK SETBACK INFORMATION St/Ht Outlet 7.7 474(. 2 TANK TO P/L WELL BLDG. V;t t'oo Ai Intake ROAD Dt Inlet O d ! rr~- Septic / g >i Z14 / Dt Bottom Dosing Header/Man. ~jr, 75 Aeration Dist. Pipe Q.,~ 9 3•. `s Holding Bot. System f~, Jt Z 7 2• Final Grade PUMP/SIPHON INFORMATION So ,0~ Z 9 Manufacturer GP nand St Cover 77 ko, Model Number TDH Li Friction Loss Syste TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 (O7 :1 SETBACK SYSTEM TO ,v` P/L J BLDG W-EELLcJ LAKE/STREAM LEACHING Manufactur r 1 INFORMATION CHAMBER OR T n Type Of System: J / UNIT Model Number: !~O K 11 CMS r A -A4- 44 SoL4 1L" DISTRIBUTION SYSTEM /674-pr pro- 115 Header/Man ifold i / Distribution x Hole S e x Hole Spacing Vent to eInLake 5 ♦-7 4 Pipe(s) Length Dia Length Dia pacing 1 1 -40. J, SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of Sodded xx M the Bed/Trench Center Bed/Trench EdgesTopsoil ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 935 Florence Larne Hudson, 154016 (NW 1/4 SW 1/4 14 T29N R19W) Sweet Grass Farm Lot 55 ( Parcel No: 14.29.19.2316 1.) Alt BM Description OV` 2.) Bldg sewer length - amount of cover = Plan revision Required? Yes NoI Use other side for additional information. lO GFJ SBD-6710 (R.3/97) Date Insepct 's Signa e Cert. No. Safety and Buildings Division Cow,ty C commerce.wi.gav , 7162 ~,-p 201 W. Washington Ave., P ox s, .:,_v 11--it m by > Madison. Wl 5370 4iksconsin _ 025 epartrrlent of Commerce - Slate Transaction Number Sanitary Permit Application p IV is?c a u, Project Address /v (if im erent - in accordance with s. Comm. 83.21(2). Wis Adm. Code, submission ' unit is required prior to obtaining a sane permit. Note: Application forms for st o w ifor secondary did/ than rnailing address) submitted to the Department of o r Personal information you provide may be~6ts O C, ! _ )a ^G~ e _ ~..4 t 5.04(1 (in), T' /J Ilrr/ 1 u oses in accordant a wi P 1. Application In a ase Print All Information Parcel # Property Owner's N• GIYI O a p t Property Location Property Own s mailing Address l/ _ - Govt. Lot Zip Code Phone Number AIL A-) fiction City, State role !j - 1. Type of Building (check all that apply) Lot # Subdivision Name ❑ I or 2 Family Dwelling -Number of Bed uorusQ Bloc - or.- ❑ public/commercial - Describe Use _ -CM Number ❑ Village of - State Owned - Describe Use ! -----row[ k of - _ 3 Q;s~ tts In r I., L III. Type of Permit: (Chec4olYl box on line A. Complete line B if applicable) Other Modification to Existing System (explain) A. ew system ❑ Replat eml-nt System ❑ Treatment/Holding Tank Replacement Only List Previous Permit Number and Date issued permit Revision ❑ Change of Plumber ❑ Permit'Cransfer to New B. ❑ Permit Renewal Owner Before Expiration __5 t,./Component/Devi e (Check all that apply)__ - IV. Type, of POWTS S 1✓ In-Ground Pressor ized In-Ground ❑ At-Grade F1 Mound > 24 in. of suitable soil 0 Mound < 24 in. of suitable soil Non-Pressurised In Gr L Pretreatment Device (explain) ❑ El Other Dispersal Component Holding"Cask f • (sf) System Eleva ~ n V. Dis ersaUTre went Area Information: Dis ersal Area Required (s Dis ersa P I Ar proposed g C Design Flow (gpd) Design Soil Apptica,.ion Rate(gpdsf) P Total # of anufacturer o d aacity in U VI. Tank Info Ca Gallons Gallons Units o s New Tanks Existing -rali-'s ALI 468M f ~ septic or Holding Tank Dosing Chamber _ re sibility for installation of the POWI'S s n OR the attache Pans. / f~,~ p Number N ber Busines Number VII_ Responsibility I, the tundersr P;urotie~s Si M Plumber's N e (Print} Statement Address (Street, City, State, Zip C ode) Date Issum Issuing nt Signature Count /De artment Use Only Permit Fee 00 Khpproved en Reason tar Denial ~ ~ .~},~,:•S *Reasons r'or Disapproval 3\ f1j.` I W o IX. Coady - J iRt77 ttia.,., o,n~.aaa~•e-~3 . { ' eptiotank,e"nt alter and n.~e. ~'%•,ti dispersal cell must all b° services I maintained 1 ra r Ss per management plan provided by plumber. 2. An i$6 Wk requirements must be maintained tin hes in size jo Wftd apofiwble coo / ordinances. oni on ,ape, unt less th S in Attach to complete plans for the system and sabmit to the County y t ra~~na- GQ. SBD-6398 (R. 02109) So' test and System PLOT PLAN PROJECT Seer Bast Land Construction ADDRESS 400 S. Second ST. Hudson Wi 54016 NW 1/4 SW 1/4S 14 /T 29 /R 19 W TOWN Hudson COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 3/31/13 BEDROOM 4 CONVENTIONAL )00( IN-GR D 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 917 # of chambers 45 BENCHMARK V.R.P. Top of foundation ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 95.0/94.9/94.8 4' below qrade Well is to meet all setbacks required by ro 4 9~1(WDNR B om H All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. Scale is 1" = 40' Replacement area will be unless otherwise original test area and will noted require a lift B-2 15' B-3 20' 01 4 Id- Bedroom 50' House B,M.* 2-3' X 62' cells with >3' spacing Vent 10' ST -1 >6" Quick4 Standard 20' of Cover Leaching Chamber with 0.0 ft2 of Area rain age easement se 4 Long 12 1 ~f` 2/pair of end caps Vents per surveyor " • 3 4" Grade at System Elevation o ,n?" 501' Property Line 170' 1 Wisconsin Department of Commerce S IL EVALUATION REPORT Page of Division of Safety and Buildings I mm 85, Wis. Adm. fide County f Attach complete site plan on paper n esg th ° 142 14' geh ift ; z~. PIa~R rff5st include, but not limited to: vertical and horizontal reference point direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nw 1 road. Please print all information. N►PR Q2 1J Review by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 1L4aif. y Z 3 Property Owner SA ' roperty Location Q~~ ) G r Govt. Lot A,1 /4 C, ?1 /4 141 T Z N R n E (or Property Owner Mailing Address Lot # Block # Subd. Na or CSM# /J7~ S S 4? 57~ ' S - c cJ City State Zip Code Phone Number ❑ City ❑ Village -01 own Nearest Road I ~L 1 C.L.A SI-1 L)/ ICJ ( > f2cNew Construction Use' esidential / Number of bedrooms Code derived design flow rate gyp/ /f GPD ❑ Replacement ❑ Publi r commercial - Describe: Parent material 4L, ~ Flood Plain elevation if applicable ft. General comments ~G S / i~Gf "/"C-7 , ~ti and recomrnendatims: 1 ~y System Type e~~ ~l . System Elevation (s 0//'~' YJ / Z' U Boring # Boring / F/-1 it Ground surface elev. , 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 Boring M eori# Pit Ground surface elev. wft. Depth to limiting factory in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence J undary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 am/ ~ Effluent #1 = BOD > 30:5 220 mglL and TSS >30 < 150 ' Effluent #2 = BOD 130 mg/L and TSS < 30 mg/L CST Name (Please Print) re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address _ Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 715-246-4516 I Property Owner _ Parcel ID # Page of Boring # ❑ Boring L (Spit Ground surface elev. ft. Depth to limiting factor in. T ~ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0- S "i l~ E 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 GPD/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring Boring # Ground surface elev. ft. Depth to limiting factor in. F-1 ❑ Pit Soil ication Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30:5 150 mg/_ ' Effluent #2 = BODS < 30 mg& 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. Sa0.8330 (R.6A00) Property Owner _ Parcel ID # Page of a Ong # ❑ 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 GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 r e- -A nj 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 limitin factor in. nd surface elev. ft. Depth to g F-1 ❑ Pd Grou Soil ication Rate Horizon ')epth Dominant Col Redox Description. Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mgA. ' Effluent #2 = BODS < 30 mg/- 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 608-2648777. seaeaw (R.6MO) 129/R 'test and System PLOT PLAN PROJECT SDeer Bast Land ConsDDRESS 400 S. Second ST. Hudson Wi 54016 NW 1/4 SW 1/4S 14 /19 W TOWN Hudson COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 3/31/13 BEDROOM 4 CONVENTIONAL XXX IN-GR D 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 917 # of chambers 45 BENCHMARK V.R.P. Top of foundation ASSUME ELEVATION 100' Filter BEAR Filter ❑BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 95.0/94.9/94.8 4' below grade Well is to meet all setbacks required by ro 4 Q~1(WDNR B om H All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. Scale is 1" = 40' Replacement area will be unless otherwise original test area and will noted require a lift B-2 15' B-3 20' Bedroom 50' House B,M•* 2-3' X 62' cells with >3' spacing Vent 10' ST -1 >6" Quick4 Standard 20' of Cover Leaching Chamber with 0.0 ft2 of Area rainage easement se K 4 Long 12 1 5,; 2/pair of end caps Vents per surveyor ' 34 Grade at System Elevation aft • ,,,lly 19 501' Property Line 170' '1N731SAS 31lMIO8000 F r AlNf100 KIOH0'19) 3A9, v wN ONRfd39 59101 d0 31,1I1 H11:10N 3m OLL 030N383d38 3W 801,1IINFIS 0 a Z" 01 9 x ~ fp ; w \ ~I• a a~ s I 69107 • • o '80'9U340.0b40S cl! I°- ~ ~ ~ ~ ~ p W ~ z # " Z V Y \ V B ;..o \ 61 Ail 0 c6 1 c1t 17 10 < f I V0 o a I#+ w O v 'z LO o . col 74, 0 ILL co u v0 W w W } Fi O I N~ ~ y 0 LU < 8 o M~ c LL `•!III, ar W q, Ids III }r .ti LL 10 3 .0 1 Ile, w34yyyq~ "K a ddd 's r8V'89 + 1Nn04 MOON P , • ; f ~ ~ 3NV'1 b'~ZN ?ate 3----------- Zen- 0.1 'rr)1 ~ 7y s R7 a w 3 U x z Z 2, 0 (1) ci e- M. t Safety, and Buildings Division 2 County [ commerce.wl.gav t 2Q W. Washington Ave., P.U. Bt ` ~ ' Madison, WI 53707--7162 I Sanitary Permit mber (to be filled in by CoJ ISC011Sl1'" : z F 5 ~ 10215 Dtepartr>tterYt of Coxnrnerce - Sts nsaction Number Sanitary Permit Application /0 In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Proj~Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary 935 u oses in accordance with the Privacy Law, s. 15.04 1 (m , Slats. r I. A lication Information - Please Pri All I ormation reel # Property Owner's Name D 3 ~ O + ~r ~ P~ Q Property Location / 23 , Property Ow is Mailing Address C Pv~- Govt. Lot _ Zip Code v/ Phone Number y,,~ 'h, Section City, State l / Ircle o T _ N; >j( E U W 1t - II. Type of Building (check all that apply) Subdivision Name or 2 Family Dwelling - Number of Bedrooms - //'n•r~~/ 64- oA ❑ Public/Commercial - Describe Use ❑ City Ia✓~ El Vi11a e of AoJSI°, CS IvINumber ❑ State Owned -Describe Use wn of - - - - A+ 2L III. Type of Permit: (Check o y one box online A. Complete line "'if applicable) - A. El 'freatmcndNoldin Tank Replacement Only El Other Modification to Existing System (explain) ew System ❑ Replacement System g 'st Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision El Change of Plumber El Permit Transfer to Now Owner v_ Before Expiration IV. T e of POWTS System/ComPonentlDevice• Check all that 4 a 1 - - ii-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound> 24 in. of suitable soil ound < 24 in. of suitable soil El Pretreatment Device (explain). ❑ Holding Tank El Other Dispersal Component (explain)--.- - l V. Dis ersaUTreat t Area Information: Design Flow (gpd) Design Soil Application Rate at) Dispersal Area Required (s Dispe at Ar Pro sed (st) stem Elevation d off d ' 7 8's-8 $70 ' nufact rer Capacity in Total # of .n ° .d VI. Tank Info Gallons Gallons Units o y New Tanks Existing Tanks k u V2 Ci ~ is 17 P Septic ar Holding Tank - t)osing Chamber VII. Responsibility Statement- 1, the undersigned, assume r ibility for installation of the POWT shown on the attached plan MP/MPRS ' S Business Phone Numb l ' Plumber's Na (Print) Plumber s i - Plumber's Address ( City, State, ip Code) VII ou>/e ar nt Use Onl i nature - - - - - Permit Fee Datc Issued Issuing A g pproved El Disapprove $ ~ ~ • ap ~ Z-7 ~r 3 even Reason for De ' IX. Couditiglltlii asonsfor,Disapproval 21 a ~U~o not 1 '5epttd tank. of uiant filter and J J rlAC I e~,J ~OwtCd dispersal ceB~must all be aerv e l maintain n1p~t~~tia►tnc~a► I ~r1d~' G~ as per management plan provided by plumber, Z• All sooacCl requilemente must be msmtair>ild 1\ ~0 Q F ~y~ kt~- dG alA pe< appaeabNt cc ft / ord(nane l ( not l +r. x fI x Ili inches tn~lze Attacb to complete plane for the system and submifto the (aunty onry un p p rt `,'gue ~J / o r'~~ r /l v t•1 e. SBD-6398 (R. 01/07) Valid thru 01109 (^p~ PLOT PLAN PROJECT Sneer Bast Land Construction ADDRESS 400 S. Second ST. Hudson Wi 54016 NW 1/4 SW 1/4S 14 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 2/20/13 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 2" pipe ASSUME ELEVATION 1001 Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 93.5/93.2 5' below grade Please note: further Well is to meet all setbacks required by testing will be done in the Pro 4 WDNR future to find a more Bedroom suitable area and expand House replacement area 30' ST Florence Lane Scale is 1" = 40' 120' unless otherwise noted .M.#1 B-2 Drainage Easement 75' 75' B-3 All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. B. .#2 3 2-3' X 86' Cells with >3' Spacing ent B-5 ~gt 15, Quick4 Standard 50 Vents Leaching Chamber with 20.0 ft2 of Area 20' j4'Long 10.2ft^2/pair of end caps Grade at Sys tem Elevation 20' 34" 501' Property Line Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 2/17/13 Owner: Speer Bast Land Construction Location: NW1A SW1A S14 T29 N,R19W 935 Florence Lane 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 Specificati n Sheet Signature A, License nu r #226900 PLOT PLAN PROJECT Sneer Bast Land Construction ADDRESS 400 S. Second ST. Hudson Wi 54016 NW 1/4 SW 1/4S 14 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 2/20/13 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 2" pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑BOREHOLE O WELL *H.R.P. SameasBenchmark SYSTEM ELEVATION 93.5/93.2 5' below qrade Please note: further Well is to meet all setbacks required by testing will be done in the WDNR future to find a more Pro 4 suitable area and expand Bedroom replacement area House 30' Florence Lane ST Scale is 1" = 40' 120' unless otherwise noted .M.#1 B-2 Drainage Easement 75' 75' B-3 All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. 35' B. #2 2-3' X 86' Cells with >3' Spacing 20' Vent B-5 15' Quick4 Standard 50' Vents >6 Leaching Chamber of Cover with 20.0 ft2 of Area 10.2ft^2/pair of end caps Long 12" Grade at System Elevation 20' 3491 501' Property 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 98.3' Vent Grade Vent 3' 411 31 .A;-~'30/34 Septic Tank 5' Long 199 5' S' Long 1 19 36" 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-93.5 B 93.2' ' POWTS OWNER'S MANUAL & MANAGEMENT PLAN page_ of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity Permit # Septic Tank Manufacturer DESIGN PARAMETERS Effluent Filter Manufacturer Number of Bedrooms p A Effluent Filter Model 0 NA AM Number of Commercial Units Pump Tank Capacity al NA Estimated flow (average) alfda Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) gal/day. Pump Manufacturer NA Soil Application Rate aUda 1W Pump Model NA Influent/Effluent Quality Monthly average' Pretreatment Unit 0 A ❑ Sand/Gravel Filter ❑ Peat Filter Fats, Oil & Grease (FOG) s30 mg/L 0 Mechanical Aeration 0 Wetland Biochemical Oxygen Demand (BODE) 5220 mg/L ❑ Disinfection 0 Other. Total Suspended Solids (TSS) 5150 m /L Manufacturer Pretreated Effluent Quality A,- Monthly average" tECOIAt sal Cell(s) Biochemical Oxygen Demand (BODs) 530 mg/L round (gravity) C1 In-ground (pressurized) Total Suspended Solids (TSS) S30 mg/L rade ❑ Moun d Fecal Coliform (geometric mea5104 cfu1100mI Drip-line ❑ Other. Maximum Effluent Particle Size Y inch diameter • Values typical for domestic (non-commerciao wastewater and septic tank effluent. Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months ear(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y,) of tank volume Inspect dispersal cell(s) At least once every O months ear(s) (Maximum yrs.) Clean effluent filter At least once every ❑ months ar{s) Inspect pump, pump controls & alarm At least once every 0 months 0 year(s) NA Flush laterals and pressure test At least once every 0 months O year(s) NA other. At least once every O months 0 year(s) NA Other: At least once every 17 months 0 year(s) NA MAINTENANCE INSTRUCTIONS of the following licenses or Inspections of tanks and dispersal cells shall be made by an Individual carrying one 9 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 (Y,) 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 ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreattment components, and any other maintenance or monitoring at irlervats of 12 months or less shall be performed by a certified POWTS Maintainer. A servicp report shall be provided to the local regulatory authority within 10 days of completion of any service event. 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 that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are chemicals detected have the contents of the tank(s) removed by a septage servicing operator prior to use. Page of START UP AND OPERATION For new construction, prior to use of the PO S' check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or d mage the dispersal cell(s). If high concentrations anre detected have the contents of the tank(s) removed by a septage servicing opera or 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 faits and cannot be repaired the following measures have been, or must be laken, to provide a code compliant replace ent system: -itable 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 04 POWTS INSTALLER POWTS MAINTAINER Name Name a<- Phone `Z J ) Phone SEPTAGE SERVICING OPERATOR UMPER LOCAL REGULATORY AUTHORITY i Name E Name Phone ~~J = Phone This document was drafted In compliance with chapter SPS 383-22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. `.Cyr 01V J>' FiLTER CARTRIDGE INSTRUCTIONS '200 /n. Installation `are?r x Pr fit Y the filter case onto the and of the outlet pipe to ensure it is centered under the access opening. If not, then either Insert tank through the outlet or solvent weld rn e pipe into the pipe (glue) additional pipe onto the outlet T P While the case is still dry fitted on the outlet pipe, measure the length of '14-inch pipe needed to brace the filter to the tank end wail if utilizing the optional supplemental side support. If side support method is not utilized, proceed to step four. .3'-.e.6' = For installations utilizing the optional supplemental side support: solvent weld the %-inch pipe onto the filter case. If side support method is not utilized, proceed to step four: Solvent weld the filter case onto the outlet pipe. Insert the filter cartridge into the case, pressing down until the filter locks into the bottom of the case. If a AS switch is utilized: insert into the niter clockwise 900. and lock by turning Maintenance 1. The effluent filter should be cleaned every time the septic tank is serviced. 2- open the outlet access opening to inspect the tank and filter. 3. Pump the septic tank completely, making sure to remove the sludge layer on the bottom of the tank and not just the scum and effluent. 4. 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. . S. Slide the cartridge up and out of the case for cleaning,' 6. If a VRS switch connected to an alarm is present, the switch should be removed by turning counterclockwise 90* and cleaned with water only, 7- While holding the cartridge an its side (large flat surface facing down) over the access opening, rinse off the cartridge with water only, making sure all septage material is rinsed back. into the tank. 1 rY ,..14 ~ • . B. If VRS switch is utilized, replace by insertin turning clockwise 90g into filter and y5 ` 9. Insert the filter cartridge back into the case, pressing down untilt"' the filter locks into the bottom of the case. 10. Replace and secure the access opening on the tank. W fi 1. ..:fa:..:-_-.. ,;.1:: ".i•1 Ai .»J7,.tC '4ir Y:..':!•.':fr4f':.1':'.N...d:ftt www.beamu.site.com 877-MLRLTERS (653-4583) /2 O'S I WY3131 S 31VNIOHOOp LLd ' f ; i l.1N(100 XION913) 3.BA96.BBN' DN hwe 92101 d0 3NIl N1ki0N y¢y 3H1.010:TJNUU3W 3NV SWUM q i a _o 691O? nlossil, ~ ~l; ~ • o ® r@O~JB[• 3w96aQklQS ~ ~ (Z 0 a~ , c ~ ~ r \ \ddd: \ •R 4..N \\pa \ 1 AI O .a.xy~i. r~p.~. 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Wz' ~Slb!'6 i Pi°eperty Address !3SG t~ll,~,L_/~f!~!1.7" S~✓ (`%effication t gwred from lshtmZoning Dot for tievv ooastruet on.} CitytSWe Parcel Ic enfi&S ion Nmixber 0,70- 1 .1(0 •$S- t7~j DFSC~ Q T LEGAL X. Pin e ry Zot anon Nw rla , 11, Set OWA of ~yOSa~7 Lot 'Subdivision 5 eri8ec! Survey Msp Volume Page . J Wetrra~tty Deed it age , _ Spec house cl ~t?U+r l of llri aitt t: ' ~.St~lklrf~t£Q iuc~.vflr~uG ~v mr; ~SYS''EMiVIAI~ to rdle.vt ashes. Propot sum Improper use and rnai s of your septic s~~tera idd,tMItinimpremature. ma tYra~i2C1ffi! Lort53SCS 1 t~tlt d)e septic•tank every t1l,St lCr, tf r deft, by S 3rCra~sed ptxs r. VF'hat you put inco ttiC-system can affect &e ftlnCtlOtr of flee sEpttC tank 93 $ Mtrat SIW 0 ttw avW W'dispos8l-Sy S?~Er@r iY1~iIIt~ttrtLiCe te$p bsibehties are specified rti §Cor=. 83.52(1) and m M*a 12 - St Croix County Swfty O re. The property owner agrees t6 .'*.4n# to S* Croix County Pte' & ~¢tstitg 17epartip out $ certrfic atign foam, signed by the ttie oa site.. owner and by a auster plutdoex- eytiiaupltir, , restridtcd ptrtmber.or a licensed pumper oe~ that ) the ' *i tewa~= disposal system is in proper 6perift.con aku atftc (2) -Utet inspection and pumping (iftaecMaty),.. septic t2rIc is .less theft 113 full of sludge. L'we, the utaiersigued Isave.read the above eE{tiimmau ".to snatntaiathe pisY sewage-&!; *al system rv:th tF:s standards set forth, herein,'as set by tom. t bf.Co mid. the D%*M=6t. of Nat ual R=a tM-SWe of Wisp *m. Certification seating that y i septic system lus been a =W be computed and. eetamed to the St Croix County Piam ing & . Zoning Depanrnent within 30 days. of flat-ftee yeat:expiration date: Uwe certify that all statements on; flits .it'art tine: W tho bed of my/our knowledge. VW amfM. the OwsrEr(S) of *he propeM descnbedabove; by virtue of a' . 9 deed tecor€ted in l< r of Deeds' Office. • ..'..fi`r' Q TLW OF: ANT(S), DATE . "Any infonmdon that is mimeptesenteci may i~srtit ~ the sar~ita~l ptm* beinirevoked by'the Planning k zonili Depatttriettt . lixrtuiie with t~ applicauoa i recorded waftway deed f =6 t~ Re&oei• of Deeds Ofkv and a oboy of the certified survey map is , refire= is made in the vrarranty:heed. 974047 BETH PABST' REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD i~ STATE BAR OF WISCONSIN FORM 2 - 2004 02/27/2013 08:00 AM EXEMPT # NA Document Number WARRANTY DEED REC FEE: 30.00 THIS DEED, made between Wyatt M. Erickson and Heidi R. TRANS FEE: 180.00 Erickson, husband and wife, Grantor, and Kennon J. Bast and PAGES: 3 Donalda J. Speer-Bast, husband and wife, as Survivorship Marital Property, Grantee. "The above recording information Grantor for a valuable consideration, coneys and warrants to verifies that this document has been electronically recorded Grantee the following described real estate in St Croix County, & returned to the submitter Wisconsin; SEE EXHIBIT "A" ATTACHED HERETO AND MADE A PART HEREOF Recording Area , Name and Return Address:' 1 Edina Realty Title, Inc., ' 400 South Second Street, Suite 115 Hudson, WI 540161 1064910 0 Exceptions to warranties: 020-1376-55-000 Easements, restrictions and rights-of-way of record, if any. Parcel Identification Number (PIN) This is not homestead property. i.,Dated this February 26, 2013 r tM ya M. Erickson a~~ y eidi R. Erickson r" x' WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2.2000 V 1 of 3" ACKNOWLEDGMENT AUTHENTICATION f ~ Signature(s) STATE OF !kf fS(6n!;fY) COUNTY OF authenticated this February 26, 2013 Personally carne before me this the above Wyatt M. Erickson and Heidi R. Erickson, " TITLE: MEMBER STATE BAR OF WISCONSIN husband and wife to me known to be the person or (if not, persons who executed the foregoing instrument and authorized by §706.06, Wis. Stats.) acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY µ W le~ Martin. D. Henschel 6800 France Avenue South, Suite 410 Cheri Brown Edina, MN 55435 Notary Public, State of Wisconsin (Signatures may be authenticated or acknowledged. My commission is permanent. (If not, state the Both are not necessary.) expiration date:) 311115 "Names of persons signing in any capacity must be typed or printed below their signature. spill ZV f w{ All STATF 13AR OF WISCONSIN FORM No. 2-2000 WARRANTY Dl:Ed r~ 2of3 i~ ti Exhibit A Legal Description tt•~~ Lot 55, Sweet Grass Farm in the Town of Hudson, St. Croix County, Wisconsin. .i_ a GI I6 t i I r uG z FORM No. 2-2000 WARRANTY DE14D STATE BAR OF WISCONSIN r 3 of 3 " ~-Y wIi is Went of Commerce SOIL AND SITE EVALUATION Uivisio . atety and Buildings Page -I- of _ Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and S-~ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I. D. # 02-0 '-5~- APPLICANT INFORMATION - Please print all inform" oaf n Reviewe y Date Personal information you provide may be used for secondary purposes (Piivacy Law, s. 15.04 (1) (m)). G~ Property Owner ,~/1 Proper ty.Location " !-l r ' `Govt. Lot 114S &j 1/4,S /c( T mac( ,,R E (or) Property Owner's Mailing Address w _ Lot # Block# Subd. Name or CSM# t (3 5 3 ~~,-I u (c ~-e f-r _ 66 . 1 ~W~ e -E- (sti rCL S S City State Zip Code Phone Number ❑ .City j El Village [t} Town Nearest Road I S"Yot(v (7~S )sYN 31' 11 t4 ~l w ® New Construction Use: ® Residential / Numbet°®ff J lelo6ms Additi to existing building _ ❑ Replacement ❑ Public or commercial Describe: 1 Code derived daily flow U gpd Recommended design loading rate , 7 bed, gpd/ft2trench, gpd/ft~ Absorption area required R'S 7 bed, ft2 79 trench, ft2 Maximum design loading rate o 7 bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) -7 ft (as referred to site plan benchmark) Additional design/site considerations oeecg-13.7-3, Lo < t e- Parent material C~U-f w a--, Flood plain elevation, if applicable /lam ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U= Unsuitable for system Q S ❑ U ® S El U 0 S El u ® s ❑ u ❑ S ®u ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench (.s Z JD-yz rL L1.14 s, Ground O a.~... , elev. 9 73 ft. Depth to limiting factor qin. Remarks: Boring # 0-& IC7 S 4~V, ~ C.5 Z tL -ZY _ 3 y q~ ® C5 love- Ground elev. 9g y aft. Depth to 5 limiting f In. Remarks: CST Name (Please Print) Si re Telephone No. -7iS = z y 7- cQa gc_- e,r Address Date CST Number Z~f3 S0 Sf ~a,r.e~ wr s-~orys~ /-G oC' as33aq v- f- SOIL DESCRIPTION REPORT y ` r PRO PTY WNER r Page ~ of PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots G~pjft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench 2 1c9 5 1 Z rti~b~ L S; 6 Ground C1 5 L S a elev. 9Y~ft. Depth to limiting factor ; in. Remarks: Boring # k o-(o Ova- I-" w4 'R, L5 2 'o_zd Zw~ b1~ v~~ R C S 6 _Ia Ground elev. Depth to limiting factor q+6 in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Q- 2 ' 3 _zo p ' G -3 loviz cis k Ground ; elev. 9f2ift. Depth to limiting S ; factor q b in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD-8330 (R.9/98) VQi#cons~a Dep~rtrhent of Commerce SOIL AND SITE EVALUATION 15ivision of`Safery and Buildings Page 1o _ Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and S c-R® t'G, percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # ©20' J-%b APPLICANT INFORMATION - Please print all inffirmati6. Review y Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). G~ Property Owner Property Location 1~ l ' l Govt. Lot 114SW 1/4,S ~c( T ,N,R 1c~ E (or) Property Owner's Mailing Address 4 Lot # Block# Subd. Name or CSM# P_ -E- CsL- ra S S City State Zip Code Phone Number El City r° ❑ Village ED- Town Nearest Road ® New Construction Use: ® Residential / NumbeToi~edrooMs Additi to existing building ❑ Replacement ❑ Public or commercial Describe: Code derived daily flow O U gpd Recommended design loading rate 7 bed, gpd/f? trench, gpd/ft~ Absorption area required bed, ft2 rn trench, ft2 Maximum design loading rate -1 7 bed, gpd/ft2-, -5?trench, gpd/ft2 Recommended infiltration surface elevation(s) q ft (as referred to site plan benchmark) ee c6'G 3 Go ~c r 7 3 ~ L_ Additional design/site considerations 41A . Parent material U+ -s t'l Flood plain elevation, if applicable /lam ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank S U U = Unsuitable for system Q S ❑ U ®S ❑ U ®S ❑ U ®S ❑ U ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench In Z S~~ lw. w LS Z 3 ` 6-10 Z IO-yz 10 ► \ 2 h..Ab 6 Ground 10 L j f~ 0 w._ ~S , elev. 95.73 ft. Depth to limiting factor q_in. Remarks: Boring # 1 d-& to ,2 S ~ \ 1 irk ~ ~ Z; 3 1 JL2_ i-z'y wt/ 4~ 3 y-eft o C5 _ Ground elev. 9Ljft. Depth to limiting for in. 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CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner 0 - CROIX CUSTOM HOMES INC CROIX CUSTOM HOMES INC 707 GRANDVIEW DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description 935 FLORENCE LN SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 2.130 Plat: 2530-SWEET GRASS FARM LTS 1/78'00 SEC 14 T29N R19W PT NW SW SWEET GRASS Block/Condo Bldg: LOT 55 FARM LOT 55 2.130AC EZ-U-1558/119 Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4) 14-29N-19W NW SW Notes: Parcel History: Date Doc # Vol/Page Type 12/13/2005 814153 2943/13 WD 04/30/2004 761178 2561/231 WD 03/31/2003 715320 2189/269 WD 08/31/2000 629124 1539/081 WD more... 2007 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.130 69,500 0 69,500 NO Totals for 2007: General Property 2.130 69,500 0 69,500 Woodland 0.000 0 0 Totals for 2006: General Property 2.130 69,500 0 69,500 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