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Parcel #: 018-2009-01-000
11/07/2007 10:53 AM
PAGE 1 OF 1
Alt. Parcel #: 04.29.17.985 018 -TOWN OF HAMMOND
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
09/28/2004 00 0
Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner
O -CUTTING EDGE FOUR LLC
CUTTING EDGE FOUR LLC
PO BOX 268
HAMMOND WI 54015
Districts: SC =School SP =Special Property Address(es): ' =Primary
Type Dist # Description ' 1794 110TH AVE
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 7.730 Plat: 10-031-HILLSIDE HEIGHTS 018-04 LOTS 1/66
SEC 04 T29N R17W PT SE SE BEING HILLSIDE Block/Condo Bldg: LOT 01
HEIGHTS (04) LOT 1 (7.730AC)
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
04-29N-17W SE SE
Notes: Parcel History:
Date Doc # Vol/Page Type
02/28/2004 775409 10/31 PLAT
2007 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/06/2006
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 7.730 40,500 101,900 142,400 NO
Totals for 2007:
General Property 7.730 40,500 101,900 142,400
Woodland 0.000 0 0
Totals for 2006:
General Property 7.730 40,500 101,900 142,400
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
Wisconsin Department of Commerce
Safety and Building Division
PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holders Name:
Cuttin Ed a Four City Village X Township
Hammond, Town of
CST BM Elev: Insp. BM Elev: BM Description:
TANK IN FORMATION
TYPE MANUFACTURER CAPACITY
Septic
Dosing
Aeration
Holding
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD
Septic
Dosing
Aeration
Holding
PUMP/SIPHON INFORMATION ~ ~ l ~
Manufacturer Demand
GPM
Model Number
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length Dia. Dist. to well
Sell ORSnRPTI(]N SYSTEM
County:
St.
Sanitary Permit No'
4 9397 0
State Plan ID No:
Parcel Tax No:
018-2009-01-000
Section/TowNRange/Map No:
04.29.17.985
STATION BS HI FS ELEV.
Benchmark
Alt. BM
Bldg. Sewer
SUHt Inlet
SUHt Outlet
Dt Inl t
Dt Bo om
Head /Ma .
Dist. 'pe
Bot. System
Final Grade
St Cover
BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer.
INFORMATION CHAMBER OR
Type Of System: UNIT Model Number.
111CTRIRIITI(1N SVSTFM
Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pipe(s)
Length Dia Length Dia Spacing
5111 CnVFR ., D.ncc.~rn c..~ren,~ nniv vx Mnuntl nr Of.Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil ~ Yes ~] No ~~ Yes (~ No
COMMENTS: (InGude code discrepencies, persons present, etc.) Inspection #1: / /,
Location: 1794 110th Avenue Hammond, WI 54015 (SE 1/4 SE 1/4 4 T29N R17W) Hillside Heights Lot 1
1.) Alt BM Description =
2.) Bldg sewer length =
-amount of cover =
Inspection #2: ! /
Parcel No: 04.29.17.985
Plan revision Required? ~] Yes [~] No ~ I~
Use other side for additional information. _ ~ `____ -
Date Insepctors Signature Cert. No.
SBD-6710 (R.3/97)
ELEVATION DATA
~~ ~ i
Safety and Buildings Division County
,~
201 W. Washington Ave., P.O. Box 7162 r
O 1
,~~~~~1~ Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.)
Qe artment of Commerce (608) 266-3151 79~3~ -7
' Sanitary Permit Application O State Plan I.D. Number
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide
maybe used for secondary purposes Privacy Law, s15.04(1)(m) ~ Project Address (if different than
m
ailing address)
I. Application Information -Please Print All Informati ~ ~ ~, ~ ~ ~ ~ ~ /
/
~ f ~~~ //,f d~
U ti
Property Owner's Name Parcel # Lot # Block #
/~
1. { ry
Property wner's Mailing Address Property Location `J
aT. CR01X COUNTY ~,
FICE
~'
~
City, State
Zip Code
um
er ~,
%a, Section
~ /'~ ~/~ ~
1 Y 1 t ~ w W
~~ (
g j _ ~p~
~~j ~-1 l(!' ~/ L7
T~ N. R i'1(cEcl W
~
IIII.
Type of Building (check all that apply)
' I i
-k-,-
/
Ly(1 or 2 Family Dwelling -Number of Bedrooms ~ ~ ~ t5~
~ ~r"'~~ Subdivision Name CSM Number
LL1,
Public/Commercial -Describe Use Q
^ State Owned -Describe Use ^City_^Village ownship of
III. Type of Permit: (Check only one box on line A. Complete line B if applicable) ,., Z'~ r d ~ ' ~
A' ^ New S stem
Y a lacement S stem
p y
^ TreatmentlHolding Tank Replacement Only
^ Other Modification to Existing System
B. ^ Permit Renewal ^ Permit R ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. T e of POWTS S s tem: Check all that a I
on -Pressurized In-Ground ^ Mound ? 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^
onstructed Wetland Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^
Recirculating Synthefic Media Filter ^ Leaching Chamber ^ Drip Line ^ oval-less Pie ^ Other (explain)
V. Dis ersaUTreatment Area. Information:
Design Flow (gpd) Design Soil Application Rate(gpdsfj Dispersal Area Required (sf) Dispersal ea roposed (sf) System levation
45~
~
.
/ 5~ ~ 3 . oc~
VI. Tank Info Capacity in
Gallon Total
G
ll Number Manufacturer Prefab Site Steel Fiber Plastic
s a
ons of Units Concrete Constructed Glass
New
Tanks Existing
Tanks /~
(~ `
Septic or 1-Iolding Tank .l ~ ~, ,^
~j(/ ,
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, as me re ility far.' allation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plu i M PRS Number Business Phone Number
~ ~~__~ o ~ - [ l
Plumber's Address (Street, ty, ate~Zip Code)
VIII. Coun IDe artment Use O
Approved ^ 'spproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing ant Signa re Stam
^
eason for Den Surcharge Fee)
~ , ~
$ ~ OS
IX. Conditions of Approval/Reasons for Disapproval L r
~
S ~Cv1/L. ~o ~ G,I,OC~
SYSTEM OWNER: ~~
1. septic t5rtit, eMuent alter and
dispersal cell must all ~ services /maintain
d
!
~
e
J G
~
as per management plan provided by plumber.
2. All setback requirements must he maintained
as per applicahle code !ordinances.
-^-° -°••-r•-•- r•-••~ i•~ •+•~ ~-~~•„y uu,y~ ,ur we sys~cm vu paper uu~ less man at~c x 11 men0s m size
SBD-6398 (R. 01/03)
J4d1 1 .t Vy7 l U'u G'U t~1
~3avid J. Steel
rsm-~r~w~.az
~,ic. #2Ft~E~3~
~_2 ~l~u>
:~t%E+LL,'S `.iC11I Sp:fir~n I!'1C. "%% i-E$•F- ~Tt18
Cutting edge Fouur~ L~.C
SE 1/4,SE Il~,S4,'I'24N,R 17W
Town ofHamm4rrd: CtCseiY Cn.
Hillside Hei~.ts Loi, 1
p,3
3af3
994 zao~ st.
Bc ~~~V!12, ~ 54oC? i
17irec:t 71 ~-7d~7-G347
Fax' .715»irS~4-•3449
ri, c:;;rrrd ~,~
~ °> = 40'
~- = Iienchrnxrk Ele. 10Q.00 ft
Top of 3/4" pvc pipe
~ = A!t I3enclrrpark Ele. 99.85 fk
Tun of3f4" pvc pipe
~ - Barixl~,s
E3oring Elevations
B I ~ 96.45 f"c
--.-- ~______~__~._ I ~ B2 - 97.35 ft
/`~ ~`~ B3 = 45.85 tt
j ~:~ ~ ~ ~r i ,' ~B4 ~ C.oO ft
I ~i \
------- ..------- ~ `~., - , I
fi r'~ x-1,_3 ~ ` ~ l
ri.
c~:~--
:;-
r S~~"r- -
~.~5 ,~ ~
'~---- ~
r „ ' ;~
(,~/irPSK''~ 1 tl s ~ 1
1f~-
~~Ql~ ~
L.~`
~ I
c . ,-`"`'
~ % !~~' -~
t...---- ~ /~Z i f
~-~~% ~ ~~~~ i 4
~ 1 ~
~ ~ ~l
f io ~+ ~~~
.:~+.f1 i1 t~ks 1~a~"i~a Sr eel 's 5csi1 5+~:~;n~. Ins:. .. :y--Ease- ~+~5 p.3
David J. S~~I
~:ST•PE~SA!TSt!~
i.ie. #~2•t~~J~
ST'~E:~ 1 ~ ~C~~ 5~~2~I~~ ANC.
Cutting edge Faun, y.,I.,C
SE I/4, SE I~'~,54,'I'29N,rZ 17'VU
1'nunt vfFl"atttettar~d: fie Crniy C~.
Hillside Heists ~a~, 1
994 zao~ s~.
T3fr~ct ~ i ~-76c?-6347
Fay ?IS-~i~~4-:3449
i:s~e~ad
~ >, T ~,
• =13enchrnark Ere. ~ a0.oo ft
Top of 3/4" pvc pipe
~ = p.rt T3enchmark Ere. 99.85 ft
Tvp crt`3/4" pvc pipe
~-f = i3orixiP,s
I ~ - ~ r''
c...-~ i ~ C:' ~ i
1 i~(
L.z ~~m~ f
± ~ ~~
~ ~ ~
~ ~` L_".
N' S , N
Gc/s IPSK''~ r ~, U ct S ~
7ia 6O,'r A-~°~
Ifer _.__
Boring Elevations
BI = ~I6.95 Fi
~2 == 93.35 ft
B3 ~ 95.85 ft
$4 ~ CAO R
,,
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~~~~~in
Department of Commerce
Division df Safety and Buildings
c
Boring # ~ Ground surface elev. 96.95 ft. Depth to timitin factor 110 in.
® 9 Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GP D/ft2
in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 `Eff#2
1 0-16 l0yr 3/1 none sit 2msbk mfr a 2c .6 .8
2 16-36 10yr6/4 none Is osg mvfr cs na .7 1.6
3 36-80 7.5yr 4/6 none ms osg ml cs na .7 1.6
4 80-110 7.5yr4/6 none grins osg ml na na .7 1.6
Boring # ~ Ground surface elev. 97.35 fl. De th to timitin factor 110 in.
® p 9 Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GP D/ft'
in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2
1 0-6 10yr 3/1 none sit 2msbk mfr t;s is .6 .8
2 6-12 10yr4/4 none scl 2msbk mfr cs na .4 .6
3 12-62 7.5yr 6/4 none cos osg mvfr cs na .7 1.6
4 62-110 7.5yr4/6 none ms osg ml na na .7 1.6
* Effluent #1 = BOD _> 30 < 220 mglL and TSS >30 < 150 mg/L * Effluent #2 = BOD< <30 mg/Land TSS <_30 mg/L
CST Name (Please Print) Signatu CST Number
David J. Steel 248956
Address Steel's Soil Service, Inc. Date Evaluation Conducted Telephone Number
994 200th St. Baldwin, WI 54002 7/7!2005 715-7t~0-0347
SOIL EVALUATION REPORT
in accordance with 85, Wis. Adm. Code
#1728
Page 1 of 3
Steeps Soil Service, Inc.
~
Attach complete site plan on paper not less than 8'/: x 11 inches in size. I st County
St Croix
include, but not limited to: vertical and horizontal reference point (BM), di ct and
D
Parcel I
percent slope, scale or dimensions, north arrow, and location and distance Est road. .
.
0 8-2009-01-000
Please print al
d in o
L
15 Reviewed By Date
Personal information you pnw)de maybe use r
aw, . )).
Properly Owner
~
1 ~ Pro rty Location
Cutting Edge Four, LLC ~U~
Z~~J Go .Lot na SE1l4, Sf, I/4, S4 9N, R17W
Property Owner's Mailing Address ST. CROIX COUNTg Lot Block # Subd. Name or CSM#
E97ti 170 TH Street 1 na Hillside Heights
City State Zip City ~ Village ®Town Nearest Road ~~
Hammond WI 54015 715-796-2793 Hammond 100Th Ave
Ne traction Use: ~ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
Replacem t ^ Public or commercial -Describe: na
erial Glacial Outwash Flood plain elevation, if applicable na g.
General comments Conventional system, system elevation 93.35ft. Trenches spaced and depth tot code 4.OOft below grade.
and recommendations:
U'~+-
SBD-8330 rR07f001
Property Owner Cutting Edge Four, LLC Parcel ID # 018-2009-01-000 Page 2 of 3
Boring # ~ Ground surface elev. 95.85 ft. Depth to limiting factor 110 in.
® Soil Application Rate
Horiaon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft~
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eft#t •Eft#2
1 0-6 10yr 3/1 none sil 2msbk mfr cs 1c .6 .8
2 6-24 10yr4/4 none scl 2msbk mfr cs na .4 .6
3 24-44 7.5yr 6/4 none cos osg mvfr cs na .7 1.6
4 44-110 7.5yr4/6 none ms osg ml na na .7 1.6
^ Boring # ~ 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. `EfP#1 •Eff#2
^ Boring # ~ Ground surface elev. fl. 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. *Eirltl *Eti#2
* Effluent #1 = BODS> 30 < 220 mg/Land TSS >30 <_150 m9n- ' Effluent #2 = BODS < 30 mg/L and TSS <30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
SBD-8330 (8.07/001 Sbcel'S SOY SHV102. InG
~~
David 3. Steel
CST-POWTSM
Lic. #248956
STEEL'S SOIL SERVICE INC.
Cutting Edge Four, LLC 994 200' St.
SE1/4,SE114,S4,T29N,R17W Baldwin, WI 54002
Town of Hammond, St Croix Co. Direct 715-760-0347
Hillside Heights Lot, l Fax 715-6843449
Legend
1"=40'
• =Benchmark Ele. 100.00 ft
Top of 3J4" pvc pipe
• =Alt Benchmark Ele. 99.85 ft
Top of 3/4" pvc pipe
Q =Borings
Baring Elevations
B 1 = 96.95 ft
3of3
N
Private On-Site Wastewater Treatment System (POWYS)
Index & Title Sheet
Owner:
Project Name and System Type: ~ C~.~ld~~~1(101\~ ~.~(Jl
Location: L ~+ ~, 1~ i ~ ~.S I C
Street Address
c~ ~ - / x c-~c t I n C~ i1 T"~~ ~~ ~ ~
Township/County
Contents: Page 1: Sanitary Permit Application
Page 2: Plot Plan
Page 3: Soil Test
Page 4: State Approved Plans
Page 5: Septic Tank Maintenance Agreement
.~ Page 6: Warrant~eed
Page 7: POWYS Owner's Manual Management Plan
Page 8: POWYS Owner's Manual Management Plan
Page 9: POWYS Owner's Manual Management Plan
Page 10: Certified Survey Map
Page 11: Copy of House Plans
Attachments:
Plumber/Designer: Mike Ro eg_rs Signed:
C~v
Credential Number: 225094 Date: - /
Chamber SAS
SYSTEM ELEVATION AND SIZING CALCULATIONS
Below Grade Soii Absorption Systems
~~~ ~~Owner's Name
N Y or N Highly Pretreated Effluent
3 ft Suitable Soil Below System ~
12 in Chamber/Unit Heightz
8 ft Maximum Bury Depth s
450 gpd Estimated Daily Peak Flow
0.70 gpd/ft1 In-situ Wastewater Infiltration Rate
u 93.00 ft Proposed SAS Elevation
7/14/05 Review Date
Ezflow EZ1203HP & EZ102H ~~
642.86 ft1 Chamber/Unit Area
50.00 EISA ft2 /Unit
13 # of Chambers/Units
26.50 Bottom Area ft1 /Unit
Soil Surface Acceptable Finished Grade EL a (ft)
Boring Grade Limitation SAS Elevation (ft) System Minimum Maximum
Number Elevation (ft) Depth (in) Lowest Highest Elevation? 95.00 102.00
1 96.95 110 90.78 95.95 Yes
2 97.35 110 91.18 96.35 Yes
3 95.85 110 89.68 94.85 Yes
1. Depth of suitable soil required below the infiltrative surface for treatment.
2. Total height of chamber in inches.
3. Maximum bury depth as per manufacturer's recommendations.
4. Based on chosen system elevation, and chamber height. Top of chamber is
finished grade may be required to meet minimum or maximum code standards.
ersion 4.0
' POWTS OWNER'S MANUAL MANAGEMENT PLAN
FILE INFORMATION
(3wner
Permit #'
DESIGN PARAMETERS`
Number of Bedrooms 100gpd/bedroom ^ NA
Number of Commercial' Units NA
Estimated flow (average)* aUday
Design. flovr (peak), estimated x 1.5* gaUday
Soil Application Rate o gaUday
InfluentlEffluent Quality (NA^) Mo they Average**
Fats. Oil ~ Grease (FOG) 5 30 mg/L
Biochemical Oxygen Demand (BODs)
5 220 mg/L
TotalBuspended Solids (TSS)
5 250 mg/L
Pretreated Effluent Quality ^ Monthly Average***
Biochemical Oxygen Demand (BODs) 5 30 mg/L
Total Suspended. Solids (TSS) 5 30 mg/L
Fecal Colifonn (geometric mean). ~l0+cfu/100m1
:Maximum Effluent Farticle Size: 1/8 inch diameter
Wastewater Flow Verification on and calculations:
(Other than bedroom based)
~* Values typical for domestic (non-commercial wastewater
and septic tank effluent.
***Values typical for pretreated wastewater.
SYSTEM SPECIFICATIONS
Septic Tank Capacity gal ^ NA
Septic Tank Manufacturer- ~ ^ NA
Effluent Filter Manufacturer ^ NA
Effluent Filter Model ~ p ^ NA
p Tank Capacity gal ^ NA
~P ^ NA
Pump Manufacturer ^ NA
Pump Model ^
Pretreatment Unit ^ NA
^ Sand/Gravel Filter ^ Peat Filter
^ Mechanical Aeration ^ Wetland
^ Disinfection ^ Other:
Manufacturer: Model:
D' persal Cell(s)
ground (gravity) ^ In-ground (pressurized)
At-grade ^ Mound
^ Drip-line ^ Other:
^ Leaching Chamber Manufacturer
Model Approval Stipulatio
n
Soil Application Rate_,gpd/fl Area Req.
Absorption Area Credit per unit ft
Minimum Number of Chambers
^ Aggregate Design Flow/Loading Rate= min
Materials: all materials must comply with WI Adm. Gode
COMM84 and be installed per manufacturers specifications
and approval letters.
DESIGN CRITERIA
^ "Wisconsin. At-grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et.a1.1990)
^ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler.
Publication 15.22
."Design of Pressure Distribution Networks for Septic Tank-Soil Absorption Systems" Publications 9.6
t+-~ i4Design-of.Conventional Soil Absorption Trenches and Beds". RJ. Otis - ASAE Publications 5-77 and "Design Manual -
Onsite Wastewater Treatment and Disposal. Systems". EPA 625/1-80-012 October 1980
^ SBl}-10570-P (R,6f99) "At-Grade Component Manual Using Pressure Distribution"
SBD -10567 P 18.6/99) "In Ground Absorption Component Manual"
^SBD --:.10705=F (N.O1J01) "In Ground Soil Absorption Component Manual" Version 2.0
SBD - .10628-P (N.6/99} "Recirculating Sand Filter System Component Manual"
SBD - 10656-P (N.6/94) "Split Bed Recirculating Sand Filter System Component Manual"
SBD -10572-P (8.6/99) "Mound Component Manual"
p SBD -1fl691. F (N.01/Ol) "Mound Component Manual" Version 2.0
p SBD -.10595-P" {RSl+~9} "Single Pass -Sand Filter Component lvlanuaI"
^ SBD - 10657 P(86/99) "Drip-line Effluent Disposal Component Manual"
p SBD -1073-F (R 6/99) "Pressure Distribution Component Manual"
SBD -10706-P (N.O1/Ol) "Pressure Distribution Component Manual" Version 2.0
p Drip-line. Effluent Dispersal Component Manual for Multi-flo Onsite Wastewater Treatment Units
MAINTENANCE AND MANAGEMENT
MAINTENANCE MONITORING 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-th d (1/3) of tank volume
Inspect dispersal cell(s) At least once every p months year(s) (Maximum 3 yrs.)
Clean effluent filter At-least once every ^ months ear(s)
Inspect pump, pump controls & alarm At least once every ^ months ^ ear(s) NA
Flush laterals and pressure test At least once every ear(s) ^ NA
Valves At least once every months year(s) ^ NA
Other: At least once every ^ months year(s) ^ NA
Yage o2
a7CAI2T UP
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 ervicing operator prior to use.
SysteYri startup shall not occur when soil conditions are frozen at the infiltrative surface.
OPERATION
The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity
and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation o_ fwater-saving
e volume. Also the rive or waste from water
.appliances and fixtures along with prompt repair of leaks reduces the wastewat r b
:softeners, iron removal units, other clear water treatment devices and foundation drains should be dischazged to the ground surface
whenever passible. Note: this does. not include laundry waste, showers, dishwater, etc.
This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fiuit
peels and seeds, bones, and food solids. such as those produced by a garbage disposal should be minimized. Toilet tissue is the only
paper that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkins
condoms, .cigarette butts, dental. floss, and cotton swabs should not enter the system.- Chemicals such as petroleum products, paint,
disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS
and contaminate your drinking water supply.
Maintain a regular steady flow by spreading. laundry washing throughout the week. Avoid vehicle traffic over all system components.
Compaction of snow over the dispersal unit may cause it to freeze up.
`Valves
clues shall be operated in the following manner:
A rms.
~~~~ s should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service
POWTS, There: is normally a 1 day reserve under regular operating conditions, however water should be conserved until any
problems with the system aze corrected to prevent back-up of sewage into the dwelling or surfacing.
INFECTIONS
Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master
Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule).
~eptic Tanks Component
Tank inspections must include a visual inspection of the tank 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 backup or ponding of effluent to the ground
surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any
defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective
' locking device to prevent accidental or unauthorized entry into the tank.
When the combination of sludge and scum in any tank exceeds one-third (I/3) 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 NR113, Wisconsin
Administrative Code.
The outlet 5lter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's
specifications. Provisions are to be made to retain solids in the tank. Filter cleaning maybe necessary at more
frequent intervals than stated in the maintenance schedule to keep the system operating.
p Pump Chamber/Treatment Tanks Component
The. inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be
made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of the filter.
Any service needs or repairs shall be promptly taken care of.
In-Ground Gravity Component Dispersal Cells
The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any
ound surface must be rom tl re orted to the regulatory
ace see a e or dischaz e. An dischaz a to the gr p p y p
evidence of surf p g g Y g
authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending
hydraulic failure necessitating more frequent monitoring.
Page of
Mound, At-Grade, In-Ground Pressure
The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any
evidence: of surface seepage or dischazge. Any discharge to the ground surface must be promptly reported to the regulatory
authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure
'necessitating more frequent monitoring.
The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals
should be flushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to
ensure that equal-distribution of effluent is occurring to promote the longevity of the system.
REPORTS
Reports. for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative
Code.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be :taken to ensure that the system is
properly and safely abaudoned in compliance with Ch. 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 other 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
replacement 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 infiinged upon by required
setbacks $om existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the
need for a new soil_from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement azea. Replacement systems must
.comply with the rules in effect at that time.
l~ A suitable replacement area isnot available due to setback and/or soil limitations. Barring advances in POWTS technology a
holding tanicmay be installed as a last resort to replace the failed POWTS.
^ The site has not been. evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation
must be performed to locate a suitable replacement area. If no replacement area is available a holding tank maybe installed
as a last resort to replace the failed POWTS.
Cp Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative
surface. Reconstructions of such systems must comply with the rules in effect at that time.
«wARNJNG» ' ,
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES AND/OR INSUFFICIENT
E?XYGEN; D4 NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIItCUMSTANCES.
DEATH MAY RESULT.` RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR
IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS MAINTAINER
Name
Phone
LOCAL REGULATORY AUTHORITY
Agency. o~ /
Phone
K:~WPDATA~EIi~POWTS OWNER'S MANUAL.doc
Page of
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEME
AND
OWNERSHIP CERTIFICATION FORM
OwnerBuyer
1vlailing Address
Property Address
~~
~v `v "~
~U
1 ~ ~ //cJ
City/State '~ Parcel Identification Number 6l$ ' ~~ ' b ~ - acE,
LEGAL DESCRiF"I'ION I
Property Location 5 ~ '/<, S ~ ~/,, Sec. `1 . T~N-R ~ ~ W, Town of ~A l'1~'1 V1n~'n~
Subdivision
Certified Survey Map # ~
~U(~ ~ P. ~00~
~i . i:R(7ix COUNTY
ZONING OFFICE
Lot # ~
Volume / v~-'- ,Page # ~
Warranty Deed # ~~ 3 ~ ~~ ,Volume 257 ,Page # ~_
Spec house O yes 19. no
Lot lines identifiable Gd yes O no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Propertnaintenaace
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (I) the on-site wastewaterdisposalsyatem
is in proper opening condition and~'or (2) after inspection and. pumping (if necessary), the septic tank is less thaw 1/3 full of sludge.
Uwc, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the Standards
set forth, herein, as set by the Department of Commerce and the Departinent of Natural Resources, State of Wisconsin. CCItifiCallon
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days_Qf the thre year expiration date.
IGNATURE O APPLICANT DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
th property des 'bed above, by virtue of a warranty deed recorded in Register of Deecls Office. '
~~ ~/3~Q5
G OF APPLICANT ~ DATE
****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department.'~'~*'~*•
(Verification required from Planning Department for new construction)
l~ta-
'• Include with this application: a stamped warranty deed from the Register of Deeds office '
a copy of the certified survey map if reference is made in the warranty deed
2576P 39?
STATE BAR OF WISCONSIN FORM 1 - 1998
WARRANTY DEED
This Deed. made between John J. Dalton and Carolyn G. Dalton.
husband and wife ,Grantor, and Cuttino Edoe Four. LLC. ,Grants
Grantor, for a valuable consideration conveys to Grantee the following
described real estate in St. Croix County State of
Wisconsin (the "Property"):
763 1 97
XATHLfiEN H. MALSH
REGISTfiR OR DfifiDS
ST. CROIX CO.. NI
RfiCfiIVHD FOR RfiCORD
05/20/2004 09:30AM
MARRANTY DfifiD
EXEMPT ti
REC FEE: 11.00
TRANS FEE: 2952.30
COPY FEES
CC FEES
PAGES: 1
ime and Rsturn Addroas
pd .Box 7`(7
~- f - Gr2d r)c ~lzG s ov 1
s~o.ay
018100690000 018100850000
Parcel IdsntMtcatlon Number (PIN)
This Is homestead property.
(is) (la not)
The East one-half of the Northeast Quarter, except that portion of property described as Lot One of Certified
Survey Map filed in Volume 12, Page 3414, and the East one-half of the Southeast Quarter of Section Four (4) all in
Township 28 North, Range 17 West, Town of Hammond, St. Croix County, Wisconsin.
Together with all appurtenant rights, title and interests.
Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances
except
Dated this day of Mav, ?Q04.
(SEAL) (SEAL)
J n J. D on Carolyn G. alton
(SEAL) (SEAL)
w
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) State of Wisconsin,
W
authenticated this~~~f ~ I RI IC;
STATE OF WISCONSIN
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by §706.06, Wis. Stats)
THIS INSTRUMENT WAS DRAFTED BY
Coldwell Banker Burnet
1301 Coulee Road
Hudson, WI 54016
4-26689
(Signatures may be authenticated or acknowledged.
Both are not necessary.)
} ss.
St. Croix County
Personally came before me this day of
Mav, 2004 the above named
John J Dalton and Carolyn G Dalton husband and wife
to me known to be the rson who executed the
ore~'g instrument a ackno ge the same.
Notary Public, Sta of sconsin
My commis to\n i anent. (If not, state expiration date:
~~ l J~`~"' .)
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SCALE:
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005 JPP 04-27-04
004 JPP 03-30-04
003 JPP 03-19-04
002 JPP 03-17-04
001 JPP 02-09-04
~~ Parcel #: 018-2009-01-000
07/18/2005 12:28 PM
PAGE 1 OF 1
Alt. Parcel #: 04.29.17.985 018 -TOWN OF HAMMOND
Current X' ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
09/28/2004 00 0
Tax Address: Owner(s): * =Current Owner
* CUTTING EDGE FOUR LLC
CUTTING EDGE FOUR LLC
PO BOX 268
HAMMOND WI 54015
Districts: SC =School SP =Special Property Address(es): * = Pri ry
Type Dist # Description * 1794 110TH AVE
1792 110TH AV ~'
SC 2422 ST CROIX CENTRAL
SP 1700 WITC ~ ~vV "
Legal Description: Acres: 7.730 Plat: 10/31-HILLSIDE HEIGHTS 018/04 LOTS 1/66
SEC 04 T29N R17W PT SE SE BEING HILLSIDE Block/Condo Bldg: LOT 01
HEIGHTS (04) LOT 1 (7.730AC)
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
04-29N-17W SE SE
Notes: Parcel History:
Date Doc # Vol/Page Type
02/28/2004 775409 10/31 PLAT
7nn~ CI IMMARV Bill #: Fair Market Value: Assessed with:
0
Valuations:
Description Class Acres
Totals for 2005:
General Property 0.000
Woodland 0.000
0
0
-~ Last
Improve
0
03/23/2005
State Reason
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
Parcel #: 018-1006-30-000 07/18/2005 12:30 PM
PAGE 1 OF 1
Alt. Parcel #: 03.29.17.43A 018 -TOWN OF HAMMOND
Current X' ST. CROIX COUNTY, WISCONSIN
• Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): " =Current Owner
* DALTON, JOHN J & CAROLYN G
JOHN J & CAROLYN G DALTON
1188 CTY RD T
HAMMOND WI 54015
Districts: SC =School SP =Special Property Address(es): * =Primary
Type Dist # Description * 1794 110TH AVE
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 36.350 Plat: N/A-NOT AVAILABLE
SEC 03 T29N R17W SW SW EXC HWY &EXC CSM
12/3338 Block/Condo Bldg:
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
03-29N-17W
Notes: Parcel History:
Date Doc # Vol/Page Type
2005 SUMMARY Bill #: Fair Market Value: Assessed with:
Use Value Assessment
Valuations' st Changed: 07/13/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.000 2,000 13,200 15,200 NO
AGRICULTURAL G4 21.600 2,500 0 2,500 NO
UNDEVELOPED G5 13.750 11,000 11,000 NO
Totals for 2005:
General Property 36.350 15,500 13,200 28,700
Woodland 0.000 0 0
Totals for 2004:
General Property 36.350 15,500 13,200 28,700
Woodland 0.000 0 0
Lottery Credlt: 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
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Y
n1$iCta-/~'Si%,r'I ~OtL EVALUATIQN REPORT
E~pattmertt of Gnmmelc;e in aca~rdanca wr'th Comm 85, wis, Adm. Code
Division of Safety and Buildings
Attach complerte Bite plan on paper not less than 8!s x 11 inches In size. P(an must County
irc}~c.~~, but nat'.'s,:e~;a, ttr: vertical and horirJontai reference point'C3RA;, dir+t>ticr: srtd
pefnxnt gbpe. ':::LL.+ta ~~r tt8?n?r'?inl!$, narth arrow, anC~ docalion and dismnce rn nearest read. Farcek l.D.
Please print aft 6nfa~rrnadon. reviewed gy
Personal inrprmsNinn ye?r ~ i°r'+.rie',e tray tae used for xCOn~y purposes (Privaey Law, s. ZS.04 (1) (m}}.
#1728
~'r.~ _ 1 of _ 3 _
Steel's Soil Service, Inc.
St. Croix
018-200&01-000 _
Date
'`Gutting Edge Four, LLC __ Govt. lot na SE1/4, Sf i/4, 54. T29N, Rf 7W
Property t7wner+s Mailir~ Address-~~~___.. ~ Let # ~Etlock * Subd. Name or GShA#
~J76170 TN Street f na _ Hstlside !•feights _
C;Ca Staff Z.ip code Phone tVumiaer , ~ City j_ 1 Jitl e 1 TownNearest Road ~------ --
___ a9 ~5.
Harrttnand wl ; S•IOtS i 715-79t;-27£3 F±arnsr:ond iGOTh Ave
I Ntlw Const~',~rtinr. -- -`t..u+: ": -r .Reaidardia~ ~ PJtiriioer pf bedrooms ~ 3 Code tlarived design flow rate 450 GPD
Z. •;
~-`'~ Regacement --
~_i Public or eamn3eereiai - Descn'be: n8
----._.. _ _ _. ___-_-._ ---------------------
Parent mater~at ~l,5'~di Cttiw9,Sh F:cooct plain elevatiar,, ;t appiiait>se _.. ~ __ ft.
Genstar oomme~^~ t.;c;~vrr;.tional syatani, system slevation 93.358. Trenches apaoed and depth tot code 4.OOft below grade.
and recammenr,•a++~ r:r.
I 1 i Borirtr ~ ~-i
a , ~ c,rouna surraCe atev. __ Vp_~~ _ ft. Depth tG iimiiir~g Factor -- 11G _ in SOkI llpplicatiorr Flatel
tKari~an Depth vominant Color pa:%~„ rJ6,Gipti;,r, ~ Texicrce Structure ~ Caxsistenee~ Boundary Roots
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4ddrea~ Sleets Soil Service, tnc. ~ Date Evaluation Cpnduded Yelephane Number --
ssa zeroth St. 8aid4rin, wt 5+t0(i2 7R/~005 715-780••0347
• Effluent #4 = BQC15> 30 ~ 220 mall. ant, YSS > 3Q < 1 °SO rngl:,_ _ " Effluent ~`2 = FC?D< < 3Q mglL anti TSS ~ 34 n~lL
SBD•$J3DrR.~Y7/UQ1 --
ProperiyOaJner Coding I:dr~e Four, LLC_ _ ----__-- Parcel IDS _018-2008-01-000_._-_--_.__-- Page __ 2._..of...3
florin # l
g ~ ~ Ground surface elev. 95.$5 i;. Depth to limning factor Soil Application Rate
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Effluerrt #1 = gQps> 30 < 220 mg/L and TS5 >30 <_15(J mglL ` Effluent #2 = BOQ~ < 3(} mg/L and T35 < 3G mglL
The 17cparIIna~ni Uf Cr1tY11*It'rCp ±~ !tT o~ual opportul~.ity service provider and employer. If you need assistaacc t0 access services or
need rnaterial in an alternate format, phrase contact the department at 6U8-266-3151 or'T'fY 608-2b4-$777.
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Jul 11 OS 1D:2Da
David J. Stee!
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Steel's Soil Seu+!:~? Inc. ~i.S-E6k-tt.~g
STEEL ~ S SAIL SERVICE INC.
Cutting Edge Four, LI.C 994 200' St.
SEI/4,SE1J4,S4,T29N,R17W B21~!It, WI S40C?
Town v~FHaaunond; fit Cmi~: C~. T?[rGct '713-76t?-6347
Hillside Heigllts Lat, i Fax ?l S-~iS~4-3449
r~ ~yeIIa
~" = 40'
• = Benchmark lrle. 100.00 ft
Top of 3/4" pvc pipe
• =Alt Benchmark Elz. 99.85 ft
Too of 314" pvc pipe
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B 1 = 96.95 fi
- -_ _ ._-_._ ~,,,_----__--.,` B2 = 97.35 ft
I ~ ,-'~ B3 = 95.85 1t
'' ~ ~' `B4 = 0.04 ft
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