HomeMy WebLinkAbout020-1435-03-00Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM
Safeiy and Building Division
` INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT)
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
'ermit Holder's Name: City Village X Township
Fassino, Michael J. Hudson Townshi
;ST BM Elev: Insp. BM Elev: BM Description:
yc, 9b ~ - 3 GS~~
TANK INFORMATION
TYPE MANUFACTURER CAPACITY
Septic ~ d
W . ~, S.c-..
/ Z ~ C.~
Deeing
F. 1 ~.+~
it
Aeration
Holding ,,,.--
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD
Septic / 7 /
` ' V ~ Z`I / ~T /
Dosing ~ . _ .. .........
,,/
Aeration : -
~
Holding ' .,.
PUMP/SIPHON INFORMATION
Manufacturer ~-..~._.-.:,.,,,,,,~ Demand
GPM
Model Number
.-
TDH Lift riction Loss
' System Head ,..--'' ~ . TDH Ft
~,.,~.
Forcemain Length .a,~,,.,_-~~-°" Dist. to well
SOIL ABSORPTION SYSTEM
ELEVATION DATA
county: St. Croix
Sanitary Permit No:
453079 0
State Plan ID No:
Parcel Tax No:
020-1435-03-000
SectionlTown/RangelMap No:
11.29.19.2703
STATION BS HI FS ELEV.
Benchmark
Alt. BM ,
~,' ~ !~ .~-~ 9, 3 `
Bldg. Sewer ~ `~ i ~i ' ~5
J
St/Ht Inlet 5 , (~, c~U _ `I
St/Ht Outlet
J.55
~C
Dt Inlet
Dt Bottom ` \
Header/Man.
~ ~ ~
~ ~~ ~t~ ~ ~ ~ 7 ` ~ C
..J
Dist. Pipe
.~ .
'
~7•
Bot. System
N. (
d..J
Final Grade
• l~
9 I -~ b
St Cover ~.``~ ~'~ ~,~ ,~~
l 1 ~j . ~ ~(c~ - ~v
...:::.~
BED/TRENCH
DIMENSIONS Width ~ Length ~
r-~j2 No. Of Trenches PIT DIME SIONS
~ No. Pits Inside~_ Liquid Depth
~
~
, L. ~le.•~.c. ..~,~_
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:~
,
~ J
'
INFORMATION CHAMBER OR ~
~
1
-•Q
Type O~~st
em: t
~ ~~ 6 ~
~ ~ ,/~ UNIT .
_
Model Number.
2
• ~` ~
DISTRIBUTION SYSTEM ZZ d~,n L.~ F~c,'t~~ .~.~
nifold
Header/Ma
~~ Distribution x Hole Size x Hole Spacing Vent to Air Intakes
J
(~
h ~ i
Lengt
Dia Length Dia Spacing
SOIL COVER
x Pressure Systems Onlv xx Mound Or At-Grade Svstems Only
G~
I~L
~t~+-'
Depth Over / Depth Over xx Depth of xx Seeded/So ed xx Mulched
Bed/Trench Center /'_ ~~
`jJ Bed/Trench Edges Topsoil \
No
Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ 7i / ~~n Inspection #2: / /_
Location: 1028 Labarge Road Hud on, WI 54016 (SW 1/4 NE 1/4 11 T29N R19W}.~ee+aiskliLL~Lot 3 (j 1~J Parcel No: 11.29.19.2703
1.) Alt BM Description = ~~ C~„~,~;.,,~5 ~~'^
2.) Bldg sewer length = ~3~ r~~ ~ C~ ~~ t~ ~ ~ ~ ~,~ ~~
-amount of cover = ` '"""~''~S ~'''~ t
~~~c~
Plan revision Required? `Yes No ~ C ~~
Use other side for additional information. J
- -_.
SBD-6710 (R.3/97) Date
T[~'c 'J
~~~~~
Cert. No.
~~ Safety and Buildings 1?iviii~n ~ County
T
ZOi W, Washington Ave., P.C+. Box ?i6a .S
~,~~, ~~..~._
Madison, WI S 7 - ?162 _
Sanitary Permit Number (to be filled in by C
~
e 0~
fi.,
+ D
artment of Commerce
-- __-- -
Sanitary Permit Applieati ° ~.- 5 ~~
State Plan .D. Number'
'
~eduJe
persottal infofma 0n yau
Wis. Adm. Code
in accord with Comm 83.21
,
,
rosy be used for secondary purposes Privacy Law, s15. (1)(m) ~'
.1~, P eCt Address {if different than mailing address)
r
~
~
i. Application Infortnatian - 1Pieese Priat Ali Information ^-cy-.
OC .
-ft' ~ OZ~
Q6~
Property Owrtor's Na me
.~. ~ Parcel t~ Lot N 13iaeit-~ ,
~
~ ~ 3
Property Owner's M ailing Address Property anon
~ ~~ Y Y f v ~ i
Seetion r~
u
~ ~
~
~
Zip Code
Ciry, S Phone Number ,
'
-
-
~s ..~ SYd/G .~- c~ir~le one;
R ~ E o{~ +
T ~2 N
;
~~
II. Type of Building (check ail that apply)
~
~ ,, ~~ ~
~1 or 2 Family Dwelling - Ntunber of $edrootns ,~ ~„~~.~A_
5..~ Subdivision Name CSM Number
r
^ PubliclCammerciel -Describe Use ~ ~ ~- ~` l~s-
~ ^ Start Owned -Describe Usc ~ j ^Ciry_^Village Township of~a~~'
III. Type of Permits (Chet:k arcly one box on Ilne A, Complete line Ta if applicable) ozp - ~ ~ -- 0 3 - . 020 3
A' New System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System
B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New ~ Lest Ptevtous Permit Number and Date Issuec+
Before Expiration Pttunber Owner
j i
IV. Type of POWTS System: (Check all that apply) _
Non -Praseuriaed Ia-C3round Q Mound > 24 in. of auitabfe soi3 ^ Mound < 24 in. of suitable s oil ^ At-Grade ^ 5' le d Filter
^ Constructed Wetland ^ Pressurized In-Grour-d ^ Hotdirg Tarilc ^ Ptat Fitter ^ Aerobic t
Treatment Unit ^ R rCU~ and Fil r
G Bri Line ^ Gravel less Pi
^ Reoirculatia S ndtetic Media Filter eaching Chamber ' S a
^ Other {ex lain)
~'. Dis rsaUTreatment Area Itlformatlonl S '`~,.v~ ,~ r ~. '
Design Flow (gpti} Design 5011 Application Rate(gpdsf) Dispersal Area Required (si) Dispersal Arca Proposed (sfj Sys cn Elevation
G1 "°'~a.sQ?
'
~
'
~
~
~ .e
~~
l Fib
S
I
i VI. Tank Ini!o i Capacity in Total Number Manufacturer cr ~
tee
Prefab Sit
aSU ~
I Gallons Gallons 0f Uoita I Concrete Coctatructed ~
New Fxbdng ~
Tanka Tanks
Septic or Holtlag Tank X0(1 (
,ems
~ ' .3 G Y ~
Aerobic Treatment ilt:it
Dosing Chamber 8'!jO l L,/ 1 e s' .e ~~' ~ {~
VII. Res ibillty Statement- Y, rho ~eesstg:tad, aasupse res onaibility for oilatlan of the POWTS shown au the attached plans.
Plumber's Na me (Print3 Plumber's Si gnancre MP tPRS Numher ,Business Phone Number ~
i L l •~ Q 1LL ~G!(K NLR-ii[ E~.h
G~
~/i ! [ I (/ s
I ~~s '~ ~~T G' ~~
Plumtxr'a Addre sa (Street. City, State, Zip Code} ~
.~~G
~
i
VIII, Court /De artment Use nl ,
~Approv~tt (] Disapproved Sanitary Permit Fns {' eludes Groundwater Date Isaued
i suin Agent Signa e . o Stamps)
^ Owns en Reason far Aenial Surcharge Fee) ~ ~ ~ ~
,~
IX. Conditions pprov 3 ~ ~ S
SYSTEM OWNER: rr
~ 113- c- - _ 'C'D
~-
1 Septic tank, effluent filter and
t ~
dispersal cell must all be serviced /maint
i
a
ned
as per management plan provided by plumber. ~~ 5 - ~ ~-
2. All setback requirements must be maintained
as per applicable code/ordinances `
~-- ~
~
~ ~~
,
..~
seta, cewpige t~ (to the County aaly} for the system on
cAn..kZ4ft t'R n1 ~ryzi
lU
vl
~.•
..-
0
D
~
~
v
~'
V ,
v
~
~
Y
~ \
-~ \~
b
$.
8
J~
` `V
V
\~\ ~ ~~
~ \
~-
c~~~~ ~~ ~~, J
a~„~ ;~~
\~
\\1
`~
nn\__
~l
Y
` ~
~` D
\
t
f~ ~
~ ~ ~~
~ ~ ~
~ ~
~ ~ ~
3
~\
~~'~~ g
s,' fv
~ d ~,~~ t~
l~B~/ a~O~ti ~~6d
~,th,Z
~.
~ 1.
...~
Jn
V
~ _
~~
. ,
~~~ ~~
5'< ~'v
2~3:~~7 lr-r~ ,~- 5
_ ~.
Z~'C~'~ ,'-2.YSw ~ c.~p
~ `~~
M
~~. `Q ~ ,
~4 ~'
~ f y
~-
'~..-~
~'~,~a __
~~ ~ \
C l~j ~ ~1
3 ~~
~~An...,..i y (.,
v
J
...t
` ~ 1~h
D
~
l
v
~
~
~ \ ~~
U \ `~
~ ~
C
b ` ~ ~
~ 1
d ~
s,` f~
l~ t~Z~~~ti ~~6d
~v ~. 1
~ ~ ~
~ •
b
~,
~~ r~
~ s~
~ 1~c~or-brysd uo
~! l'~~ ~~
-` ~_.
` --- -~
o ~ ~'~ ~~ ~
~\ `,
.9 V ~ ~ ~ ~~ ~ r~
~~ ~ ~
.\
.~
-~ _ ~
~ N
~ ~
-~ ~~
v
J
Wisconsin Department of Commerce
Di~rision of Safety and Buildings
SOIL EVALUATION REPORT
in arenrrlanrp with Cnmm R5 Wis. Adm_ Cade
1318
Page 1 of 3
Steel Soil Service
County
Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must St. Croix
include, but not limfted to: vertical and horizontal reference point (BM), direction and
Parcel
percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. pending
Please print a info~r revved gy D to
Personal information you provide may be u for secondary pu (~°A4a~i Yati-, s. 15. (t) (m)). \
Properly Owner M~Y
~ Q Pr party Location
2QQ
Felling, Bill & Liz G .Lot na W 1/4 NE 1/4 g 11 T 29 N R 19 W
Property Owner's Mailing Address S T
CI`OiX O L t # Block # Subd. Name or CSM#
OUnn y
1026 Tanney Ln. ZON 3 na Joshus Hills
City State Zip Code Phon _J City _J Village ~ Town Nearest Road
Hudson ~ WI 54016 715-381-1240 Hudson Labarge Rd
/~ New Construction Use: ~ Residential / Number of bedrooms 4 Code derived design flow rate
_~ Replacement ~ Public or commercial - Describe:na
Parent material Sream terraces and pitted Outwash plains Flood plain elevation, if applicable
General comments
and recommendations: System elevation 92.40ft, trenches spaced and epth toncode St.OOft bellow grade,. n
~O h2 ctil ~ • 0 '~--~lt~ 600
na
A
m.a4 GPD
Boring # ~ Boring
// Pit Ground Surtace elev. 97.40 ft G-~"`~'~
. depth to limiting factor 120 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-9 10yr 3/2 none sl 2msbk mfr gw 2f .5 .9
2 9-24 10yr4/4 none Is osg mvfr cs 1f .7 1.2
3 24-120 7.5yr4/4 none cos osg mvfr na na .7 1.6
a7F' ~Z • ~l
~o
7.5y4 5/6 streaks at 72"
Boring # J Boring
_J/ Pit Ground Surface elev. 97.40 ft. Depth to limiting factor 120 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Dlt1z
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-12 10yr 3/2 none sl 2msbk mfr gw 1f .5 .9
2 12-21 10yr 4/4 none cos osg mvfr gw 1 of .7 1.6
3 21-30 5yr4l4 none is osg mvfr gw na .7 1.2
4 30-120 7.5yr4/6 none cos osg mvfr na na .7 1.6
D
7.5yr 5/6 streaks at 96"
* Effluent #1 = BOD S> 30 <_ 220 mg/L and TSS >30 < 150 mglL * Effluent #2 =SODS < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature: CST Number
David J. Steel ~ 248956
Address Steel Soil Service Date Evaluation Conducted Telephone Number
1564 CR GG, New Richmond, WI 54017 5/14/2003 715-246-5085
~~
PropertyOwner Felling, Bill & Liz Parcel ID # pending Page 2 of 3
Boring # J Boring
1/ Pit Ground Surface elev. 90.90 ft. Depth to limiting factor 96 in. Soil Application Rate
Horizon Depth
in. Dominant Color
Munsell Redox Description
Qu. Sz. Cont. Color Texture Structure
Gr. Sz. Sh. Consistence Boundary Roots D
*Eff#1 *Eff#2
1 0-9 10yr 2/1 none sil 2msbk mfr gw 1f .5 .8
2 9-24 10yr 4/4 none sicl 2msbk mfr cs na .4 .6
3 24-120 7.5yr4/4 none Is osg mvfr na na .7 1.2
^ Boring # J Boring
J Pit Ground Surface elev. ft. Depth to limiting factor in. Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
^ Boring # J Boring
Pit Ground Surtace elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS <30 mg/Land TSS a 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 deparhnent at 608-266-3151 or TTY 608-264-8777.
Page 3 of 3
STEEL'S SOIL SERVICE INC.
David J. Steel
CST-POWTSM
Lic. #248956
Bill & Liz Felling
SW1/4,NE1/4,S11,T29N,R19W
Town of Hudson, St Croix Co.
Joshua Hills, Lot 3
~ ~'
~~~
I
l
f
I
f
_~
~~
~~//O~D~
/ ~ t~ 1
i
~-
~-
i
1
t -/
l
1564 Cty Rd GG
New Richmond,WI 54017
Bus.(715) 246-6200
Fax (715)246-9372
Legend
1" = 40'
• Benchmark Ele. 100.00Ft
0 of 1/2" PVC piper-
s Alt Benchmark Ele. 100.35Ft
op of 1/2" PVC pipe ~-
~ =Borings
Boring Elevations
B 1 = 97.40Ft
B2 = 97.40Ft
B3 = 90.90ft
B4 = OO.~ft
ysfi~~ I I~bs'
ti
~~ o5'F''' Z,9a~
~~C1o'IaFi
~u~~, ~o~ i-irt~
a./ y "
q ~ ~,°~'"
~:.
~~~~
~--~~a
d /
~~
/_._
1 1
VJ ,
9 Q
~ C
n =
n ^,
r _,_:
~z
r+--
~ ~ ly
--I ~ I
m ~'
z ~
m +
~ ~
-~ ~~
;~
r
~~ %
---I i
~' ~ of
__ _ ~I ~ of
~~ ` ~-
. `\~
\~~
---(D~.- -~
~- ~ ~ ,~' ~ ~ . ~~-~:-~~i---•~ --•~------------•~-` ~-.- ~ ~ 38.19. 7 X31
.
~_.----------- ---.~--- ~ °O 'O E 810
50' ~ ~•-.~
' % ;
~
- -
.:~ . , .. %
~
•._
- i3~--..- 09-23' 1-~ ~ 301 2T ice'--•'
-•- 53 --_ -- -~2 189- - -- -
~
__ ~ •n
i $
~~
/^ ~ -` ` ~/
_ ~ ~~ ~
~~ .~ -
'~
-~ ~ ~.
i
~~' ~ .
r ;~~+o
~~v ; ~. J
~:: ~1 ,tee o 1 % /, f,,
~17 ~1
~ r _.,
`'
' `-•a
+~+- ---_
I+i i~----..
r~J
~~
. 1 ~` ~f
~~. 1~ y _ ~-~'
~ :=
~-- i r-
- ~ ~---~ ;
1 ~ + +~
-I~
+;~+~,
I
I + ~~+-~
„~ ~
1- f~
~/~-
r
" J--1
`% -~ i nn+
7 '1
I
~? ~ i
i
c
`~/_
~8`~ / r~
.~; ~
~. \ ~_ -\
~_
~,
~- -~. ~._
~• ~ ----
~. ~..~ -
~~8 '• , ~1`z ~ i
i ' ~A. - 1
i -•-------/, ;! ~4~ - ,- - ~ - 880 - / : .vQQ ` ~ r- '.
-~ ~
/ i
,- v; ~ ; ~, -~ l'
~-~- I i
+ ~ ;~e% ~
'-~_ ( (-
~-
I
~
J
1 l (l '~ ~--
--.~-
~
~
i
~- m rn _,--- "
•
'
-
~ -~ ,.
`. ---t.~- ~
' ~ '~. ~.
----
t-~~l_~~~ ,+ + I +' ~^- 'T! -~'-~--Imo-'--
-~ r-L i ~~ ~+- 1
-~`-~-"-~_ ~I.~c:=~a'"~ x-11.+' ~' -..I . +-
i
~~ /
..~--~h~+~.~l~y---:ter- ,,-- ' 1+~~r1'~ ,
~. ~
. , i
~ ~ //i ~ i
i
%~ ~ , %
4Jii! , ~+ I~{Iry
;! ,,;,,~ I ~r,r~
_ f-
f~~ly~ `~' ~ + i
+ ~~
~ i ~ y- 1 ~_ ~-. ~'
~,-~, c~ ~~~,,, ~~~~ Y?" r^rN
~' '~ ' As~v~ G.~A~E ~
F'A~Sy. ASkM:NT~K~ Wi+w~iOW FOR ~EAZ't~ERP~pC~
JL'N~CTIO:'~' ECX A,PpR7`~LD
~"aNTSHE~ ,'RAL:~E ~~ '~Z:H can-DL~rT ~.x~aLE co'r~
w,~ ~~ R25ER W/ PAL LOCK t
~ ~~ ~
~, ~ + , ~
WA~rR T ,.., ,.,,.J ""y
IvJzT SEALS t j~ ""F`"' GRS~ ; ,
f ~ ~ q ~£+~HT' r~~ ~ ' ~ R
PPRCVED L QYE~
~rpE 3' ~ ~'.,~"' ~~ALM JAPp~"S I~iT~
PUMP 0~'F ~LEV, gT. { ~ C ~ o ~ t ~ SOLtO. SOtL
""""' ~--` ~~Fr""~ ~ ~~r 1tI5£R EXIT
~ ~ 1°L~RMIiTE'D ONLY
' ~ ~~ TJaNx
s'9ANUFACT'JRER
~" APF~t~~'E~ $EDDNG J~DER T~~~K HAS AFPROV{,?
SPECx1^« •,, • ~ON~RE2"E FAD
__ CAT.rvwS
sP7IC r DOSE .
:"A~tK MANUFAC T'JRFR : ~, t"e,~,, ~.~?! 3ER L ~~ES PER DA:' :
DOSE ~ ~~"'re. ~O~w Y v~~~ ii\tiV •6rV 4/w~~01
L~,R~! 1" LC~vBACX : !..•~ S'~_.,._, GAL .
M~4ELACTVRER: ~•~:...._. CAP,~,.,,.2ES: ~~g
sw=TCH TYPE; A i .~,. ~.~cMSS ~ •rrrl~i~.....,.` A1..
~~fAC?"JRER,;
MOnEL N:1M9ER : ,~.,..~ ~ ~ ,.~„ ZNCe}ES ~,~,_,_,.~A ~.
SWITCH TYPE: '~'- ._..
«Q::REA ,L1 gC ~' •._. D ~ 3:YCHE5 s -,~..~.~..._wA;..
KARG~ R.~.T ~ GP:: ' P~:MP i .~s;aARM iJ..'~ZhG
~RT;CAL ~dFFERL!~CE BE. AS : £R ILS~k 2$.23 ~,'RC
~`IN~MUM RETWOR~d S4PPLY PItL"$SUREf}i F •A~V'L ~i STR:~ BU i I ~N Fi PE ,
<~ FTt1OO f . ~ FR:~'S:~~T FACTCR FE£T
+'07AL L'2•NAMIC ts~:AD s ~`EZT
,.~~~AL D2tKE.'~'5:~,~5 t"JF PUMP »l4!Jk : :.Etits.c. - FE:..:
~~,,, ~ W I.. TH ----
,,,
:i::EN~ ~ h.'.yBER
,. ,
c ...
_,~
.~
~,.
A
Sp~e~lar~r Ord brb,
. ~ wM,
+~~'ty`
~~
~~
~!~•~~
J~ ; toed nae~: ~a a ~~ ~,
. M~~ ~1~N NlK:
•~~~~~
. ~~
.~
~~
r.~
~ ~ b d0 IipM,
~~~~bilil~t
~~~~?~~ ,
~ T ---~-..~^ri.
1~ r
O t~ ~ ~~'~
' ~irea~r~ goo ~~ria
~ t.
~d ~ co
~4Mr
' a.4 ~;~
s E' ~aW-10~d nht~
110V~~~'0.~NP
atlt~~f d w~h~M ,
~t
~eo~: is ~
1d'a SJTp
~~ ~
~+'~ 8J71+rt +,~
~~~a~ ~ ~o o.~c
~~GE~~~ 5:~::. T~~'iN~
a~,,~ ;9
uG~.'Id3 ~a~sgF "1 of -~
S~bmer~bfe~ "_ -..
Ef~u~~t Pump
r
7 ~~~
EPQS
. ~~~
gad
x M~M~t.
f~~
P~r~~~
~tT~
~~
m~G ~ ~
011~tlC O~IIM.
~~
irn~~ 10r
~~o
won
,
rye ~ v~-
•0 ~n11~~~~~4
~ ~~
~Wdl~r01H sMtln~dq ~r
~auaror-
~~ ~~
arr.~r„w~rM
~ ~.} r~tbtr~t
rr.... ,
s
it
The Standard
Infiltrator'
Chamber
The Standard Infiltrator Chamber
T
L
'' . -
Chamber Etad View . PosiLock"' End Plate
. Size{WxLxH)
O O~ ~ 0 Storage C
12' OoAo Oo 00 Oo p o Oo
^p ~o ~ ~ O ~ o ~ Weight ....
I I 34'
cm x 31 ctt
specify . .77.5 gal (293 L'
........ ...............26 Ibs (11'.8 kg
I Louvered Sidewall Height ..........6ei(15 cm)'
4uFILTF~ATflR SYSTEMS. ING. STANDARD LIMITED WARR4NTY
riFt.TRATOR SYSTEtrIS. INC« (7Mtraloh SUNDNtD UMIED WARRAMY fOR SEPTIC PRODUCTS
Ii4 Thsatrresad Ntagty d each demher erd aM plms mn~kcY.M bpyy trlsaatar laa~aaaahl rekrrad b as 1Mis7. vAren Nafelad eM apsrred N a
lesdileld d n orate septic h ea~ordsrroe wih Yratrn«t YasYdan Yrsbrsctlara. R srarrraed b Me adgM prrdrr rHdd~ p~~
tlra meOerYls and wekrrrd~raro hl yes tan rr dins sq«s tNidt a septic pamit b kstted kr Me septie sntam ~r.~~
nawevar. rtm r .septic pains ~ mt ry~r.d kr re septic symem M eppeceek kw, re «. n1 re aarreay Pew ~ ~+ ~ eye d.oe toes
Nstelmkn d tli aaptic aymen correrrertoas. k «de b arch wertrey dglts, llolde mat rraQy Nflae« N wdlig a Its eaporaa hddgirrtats
Ok Saytraak Camedlaa. rrllit Rasn h~ deys a Me caged dersa. trRrar« w• raplecanwre IMis w tlnse Wis drenied M Nfltreor b
w dateaM aM caamd by tlis pried Werreay. tiirators wwy spaUr+h.xiwesa dte eat a ramovd nW« Ystaeeoon a me unYs.
TaIE UNITS. UDrKs NONO MPLED~W pARRANTIES OfR~G~Yp1lHITA~&U1Y OR fITNE55 FOR A PNRTICULAR PIMPOSEW~µ~S ~H RESPECT TO
p lie liried Wanady doss mat erred b NCWeael, caaaQrwilm. spadd «YdYSd drrepx. NRrm« stets not h fetk kr peeties « giideted
demo eQ s, i~dudng bin a erd pmNs, lobar eM rreMims awleed cams « atlse lasses « eepeaes Named hY dre Holder « wry Mid
~P~Y eecesdd kam llmRad Warranty oarraps k awnings b ar uKS sus b ar6rwy wem end leer. allmadar, acddmK mlvae. alxae «
rr. d d IM UNIS: tlw Udts DeYg agxaed b vaNda taFe «Msr aandYOns rAYdr na rot pemdued by lM Ytstdmbn Ytlrtctlons: Wn b nWn-
eN Ma mrinum ¢aud awes set sent N Me Nsrdeeon aeructlons: re ptaoenea d Nprape[ areeiels eia ar<aymem aas'ieMiq tic Wits: uue
d rr UNts «Ma seplk sysMm due b tnprape s1Yrp, Ytlpapsr s~!~arroasatw water rasps. Mpraper gesso dtpossl « apeml°^ «ery
err wale rtd tamed by Yil.alor. This Um~W Wanangt silts Ea weld s Ms Matle Ys b mnpy wllh al d dr tans set kM In frk UmMed YWnarsy
hareti k ro eVera a1sM kRraee b rapeatls for asy kas ar asnteps b rte Hotdsa re Wits. « MM prty rest~Mtp ham Yasastiars «alrprrat
«tmm awry P'~t ~tY deNa d Hatle ar wry Yid far cis lirrtad Warreay b appAs rre this mat W MteiW N soe«dres vM el ohs
asMbre wQtiad by ataM aM kcal codes al aMe appacanls Yws and hRretorY Yeraletbrt- ~ ~r+~s.
~ ~ ~ ~rahoslly epl~ cis liHSed wlrrarily N any mrwr wltetroew. « b ewd Mk lkied WMamy.
Tlr atrotw reprasaris Me stedrd Unied Wertasay ollr+b ~ ~~. A rotted nnber d minas ed aaeaks Mrs dress vartenry ragrtanrrss.
~~ ~~ ~yrdm/i0d ~ aepear ~s PtWtpmlde $d Dolt, Casrctlnt pri« b suds prrdra. to atsaMt a Dopy d tM
~ . • ~
SYSTEMS I NC
Environmental Onsite Wastewater Solutions'"
6 Business Park Road • P.O. Box 768
Old Saybrook, CT 06475 .
860-577-7000 • FAX 860-577-7001
1-800-221-4436
www.infiltratorsystems.com
twetor Syseesa woes rot raoonnsed tnmesYSp arets sys.rtts tads pnwrwrt
Chrdses mat he Yitaled aDaaldllp b meepaa[sY Nerrrdkre. faire b Yefa4 aoc«arq b trweienaatY Ywruedora car cold vwrraray.
twtmp Symrsa maorrerertds rte raw d atplk aerit Ross aM krerAy Res girth Y orate asPtic symams.
Syeen sYIYV k derrrrira0 Ey gosemeMr stgistier
_ .
` For technical assistance, ~lnstallaton tns#ructions ar customer service, calhlnfiltrator Systems~~at 1-8011••221=4486• r-
U.S Palrrlls: 4,756,681; 5,017,041; 5,158,488; 6,996.017; 5,01,116; S,~Ot,459; Sb11,903; 5,716,183; 5,588,778; 5,839,644
C4eRdan f'+rleltla: 1.326.956; 2.004.584 OMter pelrnb Psr~6•
YdAtrrtor, Equrlizer end SIdeVYaldsr aro tbpietelyd tadenlsdls d Mltrabr 9ysbme Inc. IrMrranr b e repirlrred aaderrtrrk in Frrrtoe.
MlNtralor 8ytlxne Inc. k s re6lebred Vrdertlark kt Medoo. Corrosr. Mind-richin0. PbIYTup. SnepLoek (2tembsr3Pscer Posi.ock. CluidcCut
1' Overlap at Latching Mechanism
START UP AND OPEAATI4N Pa9R.~ ct _'_
For new tonstnrction, prior to use of the PQWTg chtk;k traetrnent tantrtsi for the presertCe of painting products or other chemical
that may impede the treatment process and/or damage the dispersal cepSs), if high oortcentratione are detected hay~e the content
of the tank(s) romeved by a aegtape servicing operstar prior to uee> '
Syscsm start up shah not occur when coil conditions are fraxen at the infiltrative surface.
Ourutg power outages pump tanks may flit above norms{ hlphwatar levels. When power is restored the excess wastewater wiU be
disohar4ed to the dispersal ceiils} in one large dose, overloading the cents) end may result in the backup or surface discharge o
effluent. To avoid this altuatlon have the oontants of the pump tank removed by a 8eptsge Servioinp Operator prier to restorint
power to the effluent pump or contact a Plumber or POWTS Maintainer !e assist M manually operating the pump controls tc
resters normal levels wRhin the pump tank.
Da net drive ar park vehicles owr tanks and dispersal cells. l7e not drive ar park over, or otherwiao disturb or compact, the area
within f S feet docent elope of any mound or at-grade soil absorption area.
Reduatwn of aCmination of the latiowirtg from the wastewater scream -s+ay improve the performance and praiong the life of the
POWTS: antibiotics; baby wipes; cigarette buttx; condoms; cotton swabs; depressors; dental floss; diapers; disinfectants; tat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasolino; grease; herbicides; meat scraps; rnedicaticns; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMtsNT
When the PQW'TS rails and/or is permanently taken out of service the following steps shalt be taken tc insure that the svstam is
properly and safely abandoned to compliance with chapter Comm 83.33, Wisconsin Adrrtinlatrative Code:
• All Piping to tanks end pile shall be disconnected and the abartdaned pipe openings sealed.
e The Contartta of all tanks and pits shall be removed and properly disposed of by a Ssptage Servicing Qperator.
s Attar pumping, aN tanks and pits shelf be excavated aced removed or their covers removed and the vpid space fixed w+th
loll, gravel or another inert solid neatsrial.
CQNTtNQENCY PLAN
if the POWT$ fells and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replaoement system;
A suitaible replaC rea has been evaluated antl may be utilized for the location of a replacement soli abscrption
system. The replacement ar should be protected from disturbance and compaction and should not ba infringed upon by
requMed setbac existing an txoposed structure, let #inas and walls. Fsllure to protect the replacement area w~itl
result )n the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
oompty with the rules in effect at that time.
~~A
CI A witeb)e replacement area is not available due to sett:ack and/ar soil limitations. Barring advances in POVVTS
technology s hoMinp tank may be installed as a last resort to replace the fa)led POWTS.
Q
D Mound and at-grads soli absorption systems may be -scanstructed in place following removal of the biomat at the
infiltrative surface. Recontiructions of such systems must comply with the rules in affect at that time.
< < WARNING > >
SEPTIC, PUMP AND QTHER TREATMENT TANK$ MAY CONTAIN LE1'NAL t3ASSES ANDlOR INSUFFICIENT OXYGEN. D4 N4T
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY C1RCtJMSTANCES. OIEATt~ NlAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR Of A TAAIK MAY SE oliFfiCUI.T OR IMPOSSflILE.
ADD#TIONAI COMMiENTS
POWTS INSTALLER
Name {~
'
~
f r
G( ..~~ ~~ Q ~
Phone 7 / •~., ~, ~ ~ ~
POWTS MAINTAINER
Noma
Phone
SEPTAAE FAV CINO OPERAT R IPUMPER) LOCAL REQU TORY AUTHORITY
Name
Phone
Name Si . CRS 1)C CC?t~Q.~~ ~91~~_..-
Phone l S'. ~~(. `t ~O
This doeumertt was drafted in pomplis++ce with chapter Comm 8a,ZZt2tibiltlid)&{f) srx! 83.64111. {71 8 i3I, Wisconsin Admtni:trative Code.
POWTS OWNER`S ~VtANUAI & MANAQEI~AENT PLAN p~g~ ._._ cf
FILB ih[FatMINaTtoN
owner . ~ ~. <r '~'+~ ~, ~
Permit r `~, 3 D ~
D~ION irARAMETirRB
Number of Hedroonts ~ C! NA
Number of PtiWic Faotlity Untts A
Estimated flow tsverage) p~ rd/da
Design flow (peak!, (Estimated x 1.5) li G~ ~ etld
SoU Appiiestion lints stlda -lht
Standard ktfluentlEffluent C2uatity Manthty svaraoe'
i:ab, 0tl ~ Oreue tFOG~ S30 mq/L
8ioohsrnioal Oxygen Demand IBODg1 532(3 mg/!. i7 NA
Total Suspended 8oNds tTS81 x180 mq/L
Pretreated Effluent Gusiaty Manthty average
Biochambs10xY9sn Demand tBOOdi 530 mglL
Toth Suspended 5oiids tTSSI a30 rrrgiL la NA
Feai Colttarm tgeometrk manna St0' cfullCOrnl
Maximum Effkrent Pertiate Size ~i in dta. 0 NA
her: d NA
"Values typiest for dornet>tic westewr-ter and eepeic tank sfftwrt.
SIAINTl1g4tAIMCIa tiiCl~Ji,@
6YHTEM ifilECiiFICAYWN~
~ Tank cepaaity ,7 d ai a Na
Septic Tank Manufacturer ~ O NA
Effluent FAtK Manufsctwer ' ~ ~ O NA
Effkwtt PNter Model S~' d NA
Pump Tank Capacity si DNA
Pump Tank Manufacturer f ~, p NA
Pump Manufacturer ~,.,~ / ^ NA
Pump Model ~ ~ PO DNA
Pretreatment Unh `~F~1
Q Send/Oravel Filter Q P!M filter ~
d Meohsnicai Aeration D Wetland
O Oisinhation ^ Other:
Dhpersal GU1sf O HA
In-(around (gravity! ^ in-Around fpressuriasdi
O At•C~ads ^ Mound
~ Orip-Line C.! Other;
~' DNA
~' O NA
~' DNA
iefYloe SwtK iervioe Ftequenoy
~p~ oondltton of tank(s) At (sett once every: 3 • tililaxMtum 3 ysarsi O NA
PttmP out oontastts of rankle! When Combtr-ed sludge and (cum equals 4rt•third tY,~ of tank volume ^ NA
Inspect dlapersal ositfs! At lean once every; mon>~ N EVAardmum J yaaaf DNA
Clean affluent fitRer At twat once every: fnOrt
e DNA
~
s
rnspeet pump, pump oontrokc & atatm At tenet once every: r~f sl
,.-- Q NA
~
Fhish lalereis and pre+fwre test At (seat once every: ..-- ~ ~ e! O NA
otMr.
At least once every;
,..... ~ e~arlal a) 0 NA
her:
... D NA
annm t tw/sreca lNiiTRtJCTIONS
Inspections of tanks rnd diaperest cells steal+. be made by an indiwduat carrying ane of the foNowinp Noensas or oertiticattons:
Master Plumber; Muster Plummer i4estricted Sewer; POYVTS Inspector; POWTS Maintainer; Septage Servictnp Operator. Tertik
inspections must lnolude a visual inspection of the tsnkta) to tdantify any enitsir-p or broken hardware, identify any cracks or leaks,
rr-sasure the volume of combined sludge and scum and to check for any back ~ ~ ponding of efftuant on the ground surface.
The disperser celltal shall bQ vtsuaily inrpected to check the eNluent tevsla in the observation pipes end to check for any ponding
of effkreni on the ground surface. The pondhtg of effluent on the praund surface may M+dicste a failing oondhion end requires the
Immediate notMkstian of the local regulatory autl~orrty.
1Mten the oon:btrkd aoctxnutation of sludge and scum In any tank equals orae.third (Y!) or more of the tank volume, the entire
contents of the Unk shall be removed by s Septage Servicing Operator and disposed of in aceordenoe witfi ehapteu NR 113,
Wisoonein Administrative Cods.
Alt ottwr services, rnorudinq but not limited to the servki~g of effluent ftltsre, mechanical or pressurized components, pretreatr:nent
units, and any serviedrtg at interosls of s~ 2 months, shall be w-farrr+ed by s caKified POWTt3 Maintainer.
A servbe report shall be provided to the iooN regulatory authority within to days of aomptetion of any aervics event.
S'I' CROIX COL'S"T~'
SEPTIC TANK '~1AINTENANGE AGFcEEMENT
AND
QW:~IERSHIP CERTIFICATIJN' FORM
OwnerBuyer
Mailing Address
Property Address „_,,,,~
~ f ~.u.a~ ~~ dal-~-L-d~,
(Verificatiaa re aired from Plannm Department far new constructtan~
~~0~.8' ~orbaz`9'"~ ~Oa-o~ D1Q ~'~`t[?S'~03--bi7'1)l• °203)
Cityl5tate ,~~.t.d~o~~ . ~~ Parcel Identification IvLtmber ~-~-
1.Fe;e.L DE~C~'T
Property Location 5~_ t/., ' Town of ~t
Subdivision ~CkSf~-a T"f ! ~ ~~ ,Lot # ~._._..
~__ Page #
Certified Survey Map # __ , Volume - --
VFarranty Deed # ~ 5 ~ ~ ,Volume ~,,..~~~ Page #
Spec house ^ yes~no
Lot Lines identiuabie yes ^ na
S~'STEM MATIV'Y'~NA-NCE
Improper use grad maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance
consists of purxping out tho septic tank every 'twee years or sooner, if Headed by a licensed pumper. What you put into the system
can affect the fuactioa of the septic teak as a treatment stage in the wastZ disposal system.
7'ho property° awater agrees to submit to St, Croix Zoning Departtneat a certification form, signed by the owner and by a
masterplumber, journay°rr-anplumber, restzictedplumber ar a liceasedpurnperverifying that {1) the on-site wastewatardisposal system
ie in proper operating condition aad/ar {2) after inspection and pumping (if necessary), the septic tank. is less than l/3 full of sludge.
IJwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as sat by the Departmsnt of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your ugtic system has been raaintaiaed must be completed and returned to the St. Croix Cot:nty Zoning Office within 30
days of the three year expiration date.
~( o r}
~ ~ DATE
SIGNA OL ANT
~3WN~R CERT FICATIOI~I
I (we) certify that all statements on this form are true to the best of my (air) lcio~s~ledge. I (we} am {are) the aw~nar{s) of
the property described above, by virtue of a warranty decd retarded in Register of Deeds Office,
~~ ! ! 8
DATE
SIGNA ~ xT
Any it~'ormatiaa that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ** ° *'*
wst**+s
'~"` Iacludo 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
u c5:syt' y95
I STATE BAR OF WISCONSIN FORM 2 - 1999
Document Number WARRANTY DEED
This Deed, made between William J. Felling and Elizabeth E.
Hurlev-Fellin¢. husband and wife Grantor,
and Michael J. Fassino and Mares C Fassino husband and wife
Grantee.
Grantor, for a valuable consideration, conveys and warrants to Grantee
the following described real estate in St. Croix County, State of Wisconsin
(if mor ace is needed, please attach addendum):
Lots 2nd 4, Plat of Joshua Hills in the Town of Hudson, St. Croix
County, Wisconsin.
KATHLEEN H. ~IALSH
REGISTER OF DEEDS
ST. CROIX CO. , wI
RECEIVED FOR RECORD
03/26/2084 10:80Ali
MARRANTY DEED
EXEf~T #
REC FEE: 11.00
TRANS FEE: 810.00
COPY FEE:
CC FEE:
PAGES: 1
Recording Area
~/~ and Ret~urn~Ad'dress
020-1435-02-000,020-1435-03-000,020-1435-04-000
Parcel Identification Number (PIN)
This is not homestead property
(is) (is not)
Exceptions to warranties: Easements, restrictions and rights-of-way of record, if any.
Dated this ay of March , 2004
AUTHENTICATION
Signature(s)
authenticated this day of ~ ~v \\G
-eta ova ~~\5~0~
+~~atie
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not,
authorized by § 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY
Attorney Kristina Ogland
Hudson, WI 54016
(Signatures may be authenticated or acknowledged. Both are not necessary.)
ACKNOWLEDGMENT
STATE OF \~ )
ss.
County )
Personally came before me th' y of
March 04 the above named
William J. Felling and Elizabeth E. Hurley-Felling, husband
and wife
to me known to be the son(s) who executed the foregoing
inst ent and ack o le e s e.
t
i
" f1~QY'
Notary Public, to of
My Commission is permanent. (If not, state expiration date:
tZ.-^t--~-41 .)
-~
"Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac, wi
STATE BAR OF WISCONSIN 800-655-2021
WARRANII' DEED FORM No. Z -1999
~ ~ ~ ~-
W ~ ~ \ / /~O
• `. ~ ~ ~
s,~ ......... ~„ ............
r~
~-
.1 J r _._._ , . -- .--
,..`` -~~
~ tip d \ bzN .~..~...
v --- ~
. ~ \ ~6<~
\ \_ ~, _-'
`\~a t:
~`-'I
d1.
/.~ '~. ~X
~.~
~ ri
~" Q O
rn
O N O
N ~
~N
~O
~ ~ ~~
~~} ~ sIx
$3
O
es ~ ~
0
,pg'O ~9 3„~-p~gOo00N
I
I
~ b0~] ~ ~~ ~O~l
6 ~ ~
N~ y ~
f ~
~~~ ~
~ I
~~ ~ aC7~7b~~J[-~OGJ i
Nw~
~Q~
O O N
O
N ~
9IX
r ~~
sx -"
9X
.~ ~ ~ ~~~~-~1
_ _/ ~e ~N
Z O ~~ ~Z~~a~B y~~ ~ G 6~ S00°25'00'E
_ 92 61 ~a09~ ~ - ~
~'S--- ~ --- ` ~ --------~ ~
e ~~~~ ~
k O
. ~,, \ ~
~• ~ T-~
w • ~"'~
t _~ ~
dH
Z ?~-
Aga
W
~ZQ_Z
Q
m
S ~~•
O
8 r N
O•
d W
U N
~ M `_+ i
~ .
~ ~.
O Q O
~
0
cr
`u ~ ~
O (A ~
0
N
r
N N
r N
N a
D
T•• 0 ~ yy
J ^
N
Vl
~^
~: ~
.~~ ~~
~.
T `~ -~ ,,`83C
"` X~
00 - - . T r.-
M
O o~
8
m ~~Q•C5z
~„~•~,. ,,..•~~ ,8S•EL4
,b£' 68 L
,98•~J£ l
~
~ I
N ? ~~
~
r w
O
r--~
`° ~ ` ~
~
~
~
~
o~~ ~'O~, ~~ ~~
~
--~~
y ~\ ~
~~ ~~~
~
~ \ ~~
~~
I
w
\ ~
'
^
VJ
O O I
~ ~' ~ ~
-~ o O ~
_ °I
_
~~ ~I
w
0
J ~
/
/
Q
r ~,L•2 ~~~
/ ~I
/
~ ~nnnnn
LJI
/
/ Q~ ~~
/ ~I ~
~ 1
~~
\
ao 4 ~ ~
a~
O ~~
~
~
~i. Z ~
.
+~ ~
NI
I
P~'I MPS
~. a,,.b - ~."~
W-!yLL A rFayy k
/W WYO NN ~ A\ IYIO ^'}~~
I'Ulwminlo ~•ws ww4v+w
1'DI w ~m ~H~ iYR~S
NISNO~SYX '.LLNf10:) XIOlp '1S 'NOSOIIH d0 tYM01
~NIll3~ N
s~-IIH dnl~sor ~
waiar