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HomeMy WebLinkAbout040-1304-13-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 567268 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: C&J Builders Inc., c/o Jeff J. Husby Richmond, Town of 026-1167-30-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: Ci%n rY\ 1. CST 27.30.18.1332 TANK INFORMATION ELEVATION DATA TYPE MANUFACTUR R ` CAPACITY STATION BS HI FS ELEV. Septic - . 2 / Benchmark a ^ ? — /b n po '' ll �� /15 3 l � 7 W I P.S� � 1�... 3 d Dosing-- , j Alt. BMA` 'T s p o 4ei 0'7.°T. b /a 3 �"$i-c„ PO bk- 6-ZS OA- Q.4�.�I 0,,. Aeration Bldg.Sewer * Co, 0 /6/•G.Iii Holding St/Ht Inlet 6. 1 /40 . 2f St/Ht Outlet TANK SETBACK INFORMATION �� A 7.6 /.66 . 61 TANK TO P/L WELL BLDG. IVVer Lto Air Intake ROAD Dt Inlet ,\ Septic � / / Dt Bottom `moo ►� GK'S _— �-. /U Z p 7 Z Dosing Header/Man. 71 ,5' 2 s. ,I t.. Aeration Dist. Pipe (,.771. ��, o' _ 7. '��i i, S/ Holding Bot. System '7.7 7 cri � - - — T. Z7 9 3. 5 Final Grade PUMP/SIPHON INFORMATION Z . 7 7 79 Manufacturer Demand St Cover . GPM riff �p,� J� 2 .5%s /& .1, Model Num TDH 1LFrtction Loss System Head TDH Ft Forcemain ength Dia. %st.to Well SOIL ABSORPTION SYSTEM 53 rf BED/TRENCH Width / Length / No.Of Trenches PIT DIMENSIONS No.Of Pits_ Inside Dia. Li Depth DIMENSIONS 3 /. 3 %ems t "�—. SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: EZ r/ate INFORMATION Type 9f System: nn ! / / /I A � CHAMBER OR Model Number: n i DISTRIBUTION SYSTEM i2oh J -l0- 3= .33 .....1.5 Header/Manifold /1 Distribution x Hole Size x Hole Spacing Vent ntake 1 [� Pipe(s) \ . . N Ga /�`"' Length-74'7 Dia "� 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 il., ! Bed/Trench Edges \ Topsoil �, - 1 Yes No -Zes H No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: / / Location: 1379 129th Street New Richmond,WI 54017(N 1/2 NE 1/4 27 T3ON R18W) Lundy's Preserve Lot 30 Parcel No: 27.30.18.1332 1.)Alt BM Description= t" ( Gb`t��-� CLa ',,.,,n d-' L-Q 4J-4----- c5 ✓ _ 2.)Bldg sewer length= 26 -amount of cover= r' > Z- f5n aX 1 -- I I / ® I 4k.541173.- . 11 Plan revision Required? Yes No I�I /� 7 Use other side for additional information. `!� _ :.___jr------ Date Insepctor-Signatur- Cert.No. SBD-6710(R.3/97) ti M A/ f f A Q'/ I V j ' 0z 43, ,t....77-0.6 / # 1 /-S / i 'lOiu le/r, t I 1 a3 rikt4 S ' IDb ro VI f 10 r7 e o ,LThL T S Wee 40 )7-to d a\ -Se o. i 1 `t`'1� �� ,,)I Jr 7 5 Fo , t 71< i' ; Y c 3 1 /� 3 990 ` yg,s PerrovYd v er1 c f. P d54 •-.-j------I 4,,et,fi r.pi --,... ifie i,6 r! `r ,,J) eLg¢,5 2 z t �.._ i 51,0 Id be, 0 J LeaST A,5/ ve 0„, Yo-Je ,t 0-)--.tie ri- Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 567254 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: Feyereisen, Arthur& Marilyn Rev. Trust Troy, Town of 040-1304-13-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: 961i•gli) a - /3,1- 08.28.19.1819 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER �• L CAPACITY STATION BS HI FS ELEV. Septic " " q / Benchmark l�;es . FBI -5 t%sag z .7 161.30 yt6. (fie Alt. BM i' 4,,, pc.c. ) o k 3'g-Aeration �, Bldg.Sewer ` =/ / 766 , `it, Holding - St/Ht Inlet 7. x, 766 . 5 St/Ht Outlet ,/ TANK SETBACK INFORMATION `7 `i _ $97. 1 T TANK TO P/L WELL BLDG. ent to it Intake ROAD Dt Inlet Septic 10 - / - / /�! Dt Bottom Dosing Header/Man. Aeration Dist. Pipe q,. 13 49jj. 53 Holding Bot. System ci- 15 i q S . 61 40... el CA ' . 7 Z. Final Grade - PUMP/SIPHON INFORMATION a -13 A- 3 .% X G 6'7 J r 15`/, Manufacturer Demand St Cover // q GPM F•t'4-t.... 6 u -_ 9bla•/(p Model Number // TDH 'Lift Friction Loss System Head 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 96 2 Ti r2.��c. ----- SETBACK SYSTEM TO �✓ P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: 6 /�a , INFORMATION Type f O / / / CHA UNIT OR Model Number: f" //" DISTRIBUTION SYSTEM 9 ^ /wed? Header/Manifold/ /, Distribution _ x Hole Size x Hole Spacing Vent tp Air Intake / Pipe(s) \ S �C Length /d Dia il Length Dia Spacing FAsr. t~e__.m., (2 a_/ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only ✓'.A c.--I- c- c oc' Depth Over Depth Over xx Depth of xx Seeded/Sodded /V o r P. xx Mulched Bed/Trench Center 7 Bed/Trench Edges Topsoil ''•- ..Yes 0 No ..."- ] Yes E] No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: / / Location: 442 Horizon Court Hudson,WI 54016(NE 1/4 SW 1/4 8 T28N R19W) Sunset Valley Lot 13 Parcel No: 08.28.19.1819 1.)Alt BM Description= . 0 c.) /p 1 c i-- 2.)Bldg sewer length= $ / . Irk fD `V S -amount of cover= �I( / 7 0 fr. Go l)+�, 1..c.4. o. - A-Ate... ' v....4 a Jn am ':o Ae,Q ,.4.1.m Plan revision Required? Yes l0 4 /O 1,1_ �, 6 7 1 4 J Use other side for additional information. 1 SBD-6710(R.3/97) Date Insep•or's Sig∎:ture Cert.No. . IL OT Pi„A. iy AR -PErEPEIEly 1. 514C . LOT 13 ( C_CALEL:"-5s;t_i -atrAt -r4-I \_A. -7-7-e \...? _ 1 \ 1 \ 1 \ \N, \ Cotsfil g )3C \ 14 r r l'ir —_a-td/TREAIc4ES Wifq-/O:g--5- _ TaPtAl ',404-1-7-5 ,q-aw-r sy," DNI:-6, rz,cz -zit 4° a I— v 0 4 + 5F14, IC 30. --.3 G )3A 14`1' , -I ti p NaEsi-EsZ-__c...alycpKkp_ _ pi/pp.-4,1/e" 4 6" iv ir i 0 (19;f2.4atr-n-Lit-S0EPTICL-7176 ,. 1-1.11. ti et 10;30 ez7-50:- pi:, c;105 / I I I _F, i - _ ts r, .e , 5 c), _ -fEE-EM.I 41. 7- .4 Ita,,s r4 ..., 40571vi .2 eo 4,...4 , :-.L • 4:0:11; pp, ro,t/Eo...1,El .1,a --;os-3 460i' Ill -.1 A-, 12C,IC 4-4cr"s v CI-- 0AV: .4ft'lltiliiii:10.0 ) nacal1: tio.0 - - -- - ,eL___Ltiedc-, ' ---- (0 0 lfcl ..e.a.eil is Uvruk5 --= 61614 _--------- ----)11 -- 0 L County T r ` 7 Safety and Buildings Division D 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) P~ Madison, WI 53707-7162 6L/// -7 2 • ry Permit Application State Transacts Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropr ate governmental unit l is required prior to obtaining a sanitary permit. Note: Application forms for state-owned PV1j~TS are submitted to Project Addres (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be u4Ae0^for secondary Y1 LO purposes in accordance with the Privacy Law, s. 15.04 1 m , Slats. 1. Application Information - Please Print All Information Property Owner's Name ST. Parcel # `u% 040-1-301-) 3- 000 Property Owner's Mailing Address OG Property Location ( / Y/ ) 470 w S Govt. Lot City, State 1 -09- Zip Code Phone Number y, , ~Q ,s w /4, Section ~E-+~ k Is. e ] ~ ? J~ -,38~„ (circle one) w _ II. Type of Building (check all that apply) -7 Lot # T 2 N; R kor W 1 or 2 Family D elling - Number of B(edrooms , Subdivision Name -3 Vp/ T ~t -f" i-A Block# S if- 1 fle ❑ Public/Commercial - Describe Use ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of Town of Tye III. Type of Permit: (Check only 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) B List Previous Permit Number and Date Issued ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑Gr ❑-ound > 24 in. of suitable soil ❑ Mound < 24 in. su of ❑ Holding Tank ❑ Other Dispersal Component (explain) ~ ' EU' ,,.~j~❑ Pretreatment Device (explain) ~ V. Dispersal/Treatment Area Information: .1-S Ll U Design Flow (gpd) Design Soil Application Rate(gpds ispersal Area Required (sf) Dispersal Area Propgsed (sf) ystem Elevation 0L"', ~ 00 2 9. VL Tank In o Capacity in Total # of Manufacturer Gallons Gallons Units N o b New Tanks Existing Tanks q A G _ aU in o w~ a. Septic or 14"khrrg %ar& id, C 4n X Dosing Chamber U4 41 ZI VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the P WTS shown on the attached plans. Plumber's Name (Print) Plum is Signature MP/MPRS Number Business Phone Number L, k e) e 4 s 4Ra q Plumber's Address (Street, City, State, Zip Code) R90 (Z~VC1( falls 5 ~ - VIII. unt /De artment Use Only pproved El Disapproved Permit Fee _ Date Issu d Issuing Agent 3' ture $ El Owner Given Reason for Denial 'Ff~ t IX. ConftgpEot' Oe)~l/Reasons for Disapproval 1. Septic tank, effluent filter and dispersal cell must t plan chi maintained as per management t plan provided by plumber. 2. All setback requirements as must be maintained/.1- f . Attach o co s for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398 (R. 11/11) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: - /Jy 7 Frg @ v c -5,-- ✓ Owner's Name: n Owner's Address: .420 60) Legal Description: Township: r b yl County: rh r'A Subdivision Name: S n y (~}a Lot Number. 13 d Parcel ID Number: 4 Q - ( -3 64 - I QC, Page 1 Index and title gage Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information v'F Page 6 Management Plan yr Page 7 St. Croix Cty Septic Tank Maintenance Form V/ Page 8 Warranty Deed ✓7J Page 9 CSM or Plat ✓ Attachment Soil Test k House Plans Designer/Plumber. Oat A License Number: 2 6 sS Date: Phone Number 4 ?v7 RS Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 PL OT pGAly ARTHUR F rEnF1 SFry - - _ 1.504,,1}C. LOT J3 B )3c- A ao&38 13 i3R --Z ~dfTRENCNF-S Wlq-107-Z qo~ 3 ROM/ LJWU fAGH r- -eq t Eras o~[,Ne a,~ 0 2 D b 4"5~K 3S 3033 ~ ~ 3 A- 9~Q. SG PF~F~_can~,',p y ~ o /L> SAC ` t~ 7A~K_ 40 Off) flP roue~r"fir 3x33 SC~f~G )40mf, 7, oy` ...4E;( cj~ f, ~ww wsconsinDepa of RECEIVED——` SOIL EVALUATION REPORT Page I of 3 Division of Safety a ildings in accords OUT with Comm 85, Wis. Adm. Code Attach complete plan on paper o less~iri9n 81 d x 11 inches in size. Plan must county ST. CROIX include, but not li try oMaI Parcel I.D. 'E)a percent slope, s or dirr FFIitf4Cl i' and t d. L / Pf~Se Re Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). J~ d d Property Owner Property Location ARTHUR & MARIYLN FEYEREISEN Govt, Lot --JVE 114 SW 1/4 S 8 T 28 N R 19 E❑(or))WW Property Owners Mailing Address Lot # block # Subd. Name or CSWdf 420 Townsvalley Road 13 - Sunset Valley City State Zip Code Phone Number ❑Village ■ own Nearest Road Hudson, WI 54016 ( 71) 386 - 2122 Townsvalley Road New Construction UseE) Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ReplacemeM Public or commercial - Describe: Parent material outwash/sandstone Flood Plain elevation if appieable MA ft. General comments Conve 'enal-W-glom riches - to be designed by installer and recommendations: 0.4 r .0.7 1oading rated ding on location of trenches Ath"t 51-LIO - -~v 7 Boring # D Boring 0 Pit Ground surface elev. 904.86 ft. Depth to limiting factor >114 in. Soft nation Rath Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -EW1 '01102 1 0-6 10YR2/1 - 1 3fabk ds cb 3vf-m 0.6 0.8 2 6-19 10YR2/1 - I 2fabk (Is ci 2vf-m 0.6 0.8 3 19-25 10YR3/3 - I 2fabk mfr cs If-m 0.6 0.8 4 25-33 10YR3/4 - sil 2fabk mfr cs lvf-m 0.6 0.8- 5 33-37 10YR3/4 - sl lmsbk mfr aw lvf-m 0.4 0.7 3742 10YR3/6 - s Osg ml aw - 0.7 1.6 Osg ml - - p 1.6 7 42-114 10YR5/4 .7 55 $ Boring # Boring 905.63 >1 12 El Pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Col Redox Description Texture Structure Consistence Boundary Roots GPDRfr in. Munsell Qu. Sz. Cant. Color Gr. Sz. Sh. 'Eff#1 *002 1 0-6 10YR2/1 - 1 3faabk ds cb 3vf-co 0.6 0.8 2 6-15 10YR2/1 - 1 3f-mabk ds ci 2vf-m 0.6 0.8 3 15-22 10YR3/3 - 1 2fabk mfr as lvf-m 0.6 0.8 4 22-30 10YR3/4 - sil 2f-mabk mfr as I vf-m 0.6 0.8 5 30-36 I0YR3/4 - sl lfsbk mfr as Ivf-m 0.4 0.7 36-48 10YR3/6 - s Osg ml gs - 0.7 1.6 7 48-112 10YR5/4 - s 0sg ml - - 0.7 1.6 Effluent #1 = BOD > 30:5 220 ngfL and TSS >30:5 150 ng/L ' Effluent #2- BM 5:5 30 mglL and TSS < 30 ng/L CST Name (Please Pram) ' ature CST Number Mary Jo Hollister L 224832 Address Date Evaluation Conducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 01 - 13 & 07 - 08 - 04 (715) 426 - 1775 Property Owner FEYEREISEN, Arthur (Lot 13) Parcel ID # (Pending) Page 2 of 3 C Boring # 13 Boring 0 Pit Ground surface elev. 905.38 ft. Depth to uniting factor > i 11 in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-5 10YR2/i - 1 3fabk ds cb 3vf-m 0.6 0.8 2 5-14 10YR2/1 - 1 2f-mabk ds ai 2vf-m 0.6 0.8 3 14-28 IOYR3/4 sit 2f-msbk mfr aw 2vf-m 0.6 0.8 4 28-36 I OYR3/6 - s QS* dl cb 3vf-m 0,7 1.6 5 36-111 10YR5/4 - s osg' dl - - 0.7 1.6 (Horizon 4 has some gr.) c~ F1 Boring # Boring Q Pit Ground surface elev. ft. Depth to limiting factor in. Sd Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rods GPDW in. Mtnsell Qu. Sz. Cont. Color Gr. SZ Sh. -Eff#1 'Etf#2 Bori ~ # S Boring Pit Ground surface elev. ft. Depth to fimitin9 facts in. ❑ Sot Rate Horizon Depth Darw>ant Redox Description Texture SbIJChM CoOnsistence Boundary Roots GPDM in. Munse8 Qtt Sz. Cont Color Gr. Sz. Sh. "Efr#1 •Eff#2 Effluent #1= BODS > 30 < 220 mglL and TSS >30 < 150 rrg& Efluend #2 = BOD, < 30 ng& and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider zmd plc !t need material in an attenuate format. please contact the deparkmem at 604-266-:t 15€ or 11Y b U&-:2- ar77_ PWr P~AN PALES 3 OIM Y Leaw /'s MAkUta MR--w --me OFD' N IPeS . E a i20 5~ C Rv • 909. 19' s CA-50L Pom W/ Elam NO COMM B3 "AGK PMWL MS 1,45M ACRSS xL4 T i B-13C B-138 a06 t : 905.3801 T 905.63731' } B-13A i) 904} 86393' V1nQ,~ .904.1 lo, FA X Ro. I W 5 ~3°5p~n. x 2~' NUN LAND USE= GRICUL"f URE V f f I RENT. ZONING=AGRIC LTURE- E 109oR6 j \ xa I r I _AGE 7 4 RESID TIAL DOCUM- RRE 908. o ] •((5 1 8 8 E cos 910.89 s X 907. , -x 91 9 X0.5 x--- _ 905 w, - - 2 .6 © - - - G--71 91Q6 I 0\ ~ 1 1 j \ ` 9070 x III '904.9 LOT 14 LOT ,~15 1.757 ACRES I o 1.57 A REST 6,534 S.F. w ' 844 S.F. 2 ~ OD Ln 90,7 0 x r+l \ 00 x I ` •u~0\` 1 O o° I 907.4 ' LOT 13\ V ' (LBO=904.0) o.4 C X :D w 1.504 ACRES ~ ~0 °IOH`x I- X I j 65,492 S.F. 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Z OZ D c>~D r0° mm>o cODZ ;x, nm xX m Z zr-~ c7 0c: n 0 z D az -Dr-vz-D 0 vciv °mv =j m cc) v rN a ~FD ->o .1 (Niv En.v =v0E C) ;o or(zi,) -4 D cnm o m L = W ~~Z ~ZO mNO OZ 5 n \ r D 5 0c --4 -4 c mZCD m~ K;K ZO c rA z 0=" (AZT 0I Fl -j CPON.. aSCn~ N 0 Z m = D~Or D. m DDm Nr--1 0mN C D~k Or o D Z Co ym N Ni NNE NO 0 a\~ 0T , Q v v °n Z D r~* m O- 0-0 0 (cnmaDD I m r~W~~~- Z0 -Ti X v U N N Z 0 in a C -n D r (n s a v O v G7 W n OC 0 m 0 c O n ~O z mmr I cn O ' a O O z 0 0 mvm N CO p- a D~ r o m z 0 W z 000 c --4 (A W 0 r 0 F= > D O 0 m -D1 v m m H n ~v z A ~ O z D~ZV coo D 0 O m Z O ((n D D 10-n 00 -4 v z w 0 ~ ry* -4 p 0 O m in Co (n z v 0 0 c Z O m o m Z y 0 O 0 =O A -1 O (n m r m M D O z r O Z H 0 O Z ~ z r m \ (n W1250-MR I DRAWN BY: SME SCALE: 1/4"=l'-O" PRE-POUR: conCAETE REV. ° m SEPTIC MANUAL MIEBER \ Z W3716 US HWY 10 MAIDEN ROCK, WI 54750 DATE: JANUARY 2010 DATE:. POST-POUR: ° REVISED JAN. 2010 800-325-8456 FILE: W1250-MR POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner r~ V- 4f I Septic Tank CapacityD, gal ❑ NA Permit # Septic Tank Manufacturer ► ' S j^ ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer l ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model 2 S ❑ NA Number of Public Facility Units O-NA Pump Tank Capacity gal 014A Estimated flow (average) 0 gal/day Pump Tank Manufacturer 12-NA Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer M-NA Soil Application Rate a , gal/day/ft2 Pump Model E"A Standard Influent/Effluent Quality Monthly average* Pretreatment Unit A 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) :_150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispe~* Cell(s) ❑ NA Biochemical Oxygen Demand (BODS) :_30 mg/L Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) :_30 mg/L NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) :_104 cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Ya in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every:" p yea t 1(s) (Maximum 3 years) 11 NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA ayear(s) Clean effluent filter At least once every: 13:month(s) ❑ NA ❑ year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) bg NA ❑ year(s) Ye Flush laterals and pressure test At least once every: month(s) CkNA Other: At least once everY 11 month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A`service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) r START UP AND OPERATION Page of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replace ent system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name u t P He )6 Name Phone - 4 9 9 f Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name y c Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Oct-19-2010 01:59 PM St. Crcix County Plan/Zon rg 715-386-4686 111 ST. CROIX COUNTY S17I'71C TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Otit'tterlBuyer_ /~,RTh~P~ 1=eyei~i5t:1~ ~..CflLH2.c.~.~o i'/ut.~T Mttiiing Address _ 26 ~ Property Address Lam' 1~ (Verification required Croat Planning & Zoning Department for new construction,) City/State H Parcel Identification Number Q / 6 o O LEGAL DESCRIPTION Property Location ; . _51dl '/q , Sec. _ff, T N R_jl_W, Town of ray Subdivision Plat: ` prt, Lot # 13. Certitled Survey Map Volume , Page # v' DeM# J O (before 2007)Volume 15 5 , page # ~ Jr Spec house yes Lot lines identiriablo, yes no SYSTEM MAINTENANCE AND OYVNER 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 iioansed purtpcr. What you put into the system can affect the fltnetion of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in 02 52(I) and in haptor 12 - St. Croix County Sanitary Ordinance. Tice property owner agrees to submit to St, Croix County Planning & Zoning Department a certification form, sighed by the owner and by a master plumber, journeyman plumber. restricted }dumber or a licensed pamper verifying that (1) the ort-site wastewater disposal system iti in proper operating condition tntd/or (2) after inspection and pumping (if necessary), the septic tank is less than P3 floll of sludge. 1/we, the undersigned have read the above re ~r fain the private sewage disposal system with the stands; ds sat forth, herein, as set by the Department o ncth~esit 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 forth are true to the best of mylour knowledge. I/we asn/are the owner(s) of the property described above, by virtue ora warranty deed recorded in Register of Deeds Office. Number of bedrooms 4 '1 i SIGNATURE F APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department, Include with this application a recorded warranty deed front the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 09105) _ q / LOT 14 1.7ST AC7~5 "Nu S,F. =a LOT 13 9M.0 a~ t !E L. c . 1i 55P~c~ 5 DEC 2. 8 1995 &2 9:00 A. ~ .I QUITCLAIM DEED ARTHUR N. FEYEREISEN and MARILYN E. FEYEREISEN, his wife, hereby grant and convey, to ARTHUR N. and MARILYN E. FEYEREISEN, TRUS- TEES OF THE FEYEREISEN REVOCABLE TRUST, all the real estate they own in St. Croix County legally described as: The E 1/2 of the SW 1/4, the S 1/2 of the S 1/2 of the SE 1/4 of Section 8, the W 1/2 of the NW 1/4 of Section 16, the N 1/2 of the NE 1/4 and the SE 1/4 of the NE 1/4 of Section 17, all in Township 28 North, Range 19 West, EXCEPTING parts previously conveyed. FEE 4., ARTHUR N. FE' , SEN MARILY9 E. FEYERISEN STATE OF WISCONSIN) ACKNOWLEDGEMENT ST. CROIX COUNTY ) Personally came before me on December 28, 1995 'the above-named ARTHUR N. and MARILYN E. FEYEREISEN, to me known to be the per- sons who executed the foregoing instrument, and acknowledged the s aTte . n Notary Public. Permanent commission. Dtafter: C. W. Matick, 413 Brookwood Dr., Hudson. .r tv Parcel 040-1304-13-000 10/30/2013 04:45 PM PAGE 1 OF 1 Alt. Parcel M 08.28.19.1819 040 - TOWN OF TROY Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 09/08/2004 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - FEYEREISEN, ARTHUR & MARILYN REV TR ARTHUR & MARILYN REV TR FEYEREISEN 433 SUNSET DR HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist# Description "442 HORIZON CT SC 2611 SCH DIST OF HUDSON y SP 1700 WITC Legal Description: Acres: 1.504 Plat: 10-024-SUNSET VALLEY 040-04 LOTS 5/21 SEC 8 T28N R19W PT NE SW BEING SUNSET Block/Condo Bldg: LOT 13 VALLEY ('04) LOT 13 rZD4ACT---- Tract(s): (Sec-Twn-Rng 401/4 1601/4) 08-28N-19W NE SW Notes: Parcel History: Date Doc # Vol/Page Type 09/08/2004 773695 10/24 PLAT 11/20/2003 747093 2459/594 EZ 12/28/1995 537883 1155/154 QC 2013 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 11/09/2009 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.504 78,500 0 78,500 NO Totals for 2013: General Property 1.504 78,500 0 78,500 Woodland 0.000 0 0 Totals for 2012: General Property 1.504 78,500 0 78,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00