HomeMy WebLinkAbout020-1411-03-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. CC
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 582005
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village Township Parcel Tax No:
Bradley McGhee TOWN OF HUDSON 020-1411-03-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
163. 4-7 6C. QQ- 13.29.19.2573
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic ~ Benchmark
l~J ~ 1a~ az 16-7. 163 . s-7
Dosing Alt. BM
A- 166 ~,)QQ Z•97- /iSl. S
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
V.
Septic 33 Dt Bottom
Dosing Header/Man.
9 --74 11 : aS
Aeration Dist. Pipe
.L o 9. 74 9 S as
Holding Bot. System M Sq -7 --1451
PUMP/SIPHON INFORMATION Final Grade
Manufacturer Demand St Cover
GPM r'-4t', Go c.~ 34~p V-61. (03
Model Number a~✓ `1. 3Z 9T•e47
TDH Lift Friction Loss System Head H Ft
Forcemain rf~_JDia. ist. to well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width P Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS ^Z QZ
SETBACK SYSTEM TO P/L BLDG l WELL LAKE/STREAM LEACHING Manufacture
INFORMATION CHAMBER OR 't.~1 T ati
Type Of System:
UNIT Model Number:
131 y3 A) A- dv% 1- 4 P~ 5
DISTRIBUTION SYSTEM ~a► ' 1.oJSk. Zb x3 = (o2g V-Itk-.Q,
Header/Manifold %Z Distribution x Hole Size Ix Hole Spacing Vegt to 'r Intake
Pipe(s) N
Length Dia T Length DiaSpacing t
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 I . Z Bed/Trench Edges Topsoil
V ~ Yes 0 No No
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: 1 spection #2:
Location: 844 HILLSIDE TRL V a kJt_ 0r..s4.e,
1.) Alt BM Description = F~ GO✓ W
2.) Bldg sewer length = EZ LoOea L') SGT@~S
- amount of cover
3~cG7'o,~►.
Plan revision Required? [-a] Yes ® No /b A 1
Use other side for additional information.
Date Ins c
SBD-6710 (R.3/97) toes nature 12/23/6 Cert. No.
ECEIVED Lfe
d Buildings Division County
201 W9ton Ave D_ Box 7
162 P
0c, 0 8 20 14 , W1 5 _7 Sanitary emit Number (to be filled in by CO.)
UNTY SQLdo
MMUNiTYg 10 ermit Application State Transaction Number
in accordance with SPS 383 ?1(2), Wis. Adm. Code, submission of this
is required prior to obtaining a sanit form to the appropriate governmental unit
:
the Department of Safety and Professionalpermitare
submitted yar ServiesNote. P pnatainformams to state-owned pimay b ed for secondary J
u uses in aceordancewith the privacy Project Address (if differem than mailing a ]dress)
I. A yeation information - Please Print All Informaat on
PropettY Owner's Name
l~-p Pareel#t
Property Owner's Mailing Address 0~ 0^ IM-0310h)
S r Properly Location
City, State
' 1 Zip Code Phone Number` Govt. Lot
b 5 U N W) I ~ , 116 ) ~ W_ y,, S w Section
11 Type of Building (check all that apply) 7 ! T 19 q (circle one
❑ I or 2 Family Dwelling - Number of Bedrooms Lot # N; £ or~
Subdivision Name e
❑ Pubiic/Cnmmercial - Describe Use Block #
Jb)4 02 IL fq. Pb ~ t
Q State ❑ City of
Owned -Describe Use CSM Number
❑ Village of
lll. Type of Permit: (Check only one box on line A. Complete line B if applicable) Town of tkl).roN
A.
❑ New System Z o /,Replacement System
Treat ment/Iloiding Tank Replacement only ❑ Other Modification to Existing System (ex lain)
R. ❑ Permit atenewai
Before Expiration
Permit Revision 1] Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date sued
IV. T of PQWTS S stem/Com onentlDevice: Check all that a i Owner ys3 ~3 7
Non-Pressurized in-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound >
Holding _ 24 in. of suitable soil Q Mound < 24 in. of suitable soil
Tank ❑ Other Dispersal Component (explain)_ _
V. Dis ersa)lTreatment Area Information: Pretreatment Device (explain)
) Design So '2 Application
Ratk(gpitsf) Dispersal a n
~V"YL~ ign Flow (gpd
„irk (sfl Dispersal Area Prnnased s
790 fl System Elevation
Tank In of u 9 • j r-
Capacity in -i Drat d of W
_ Gallons Gallons Units Nlanuta'turer
New Tanks Existing Tanks
w ° U v y
Septic or Holdiog Tank
ci. rn y rn ~ ~
Dosing Chamber / o b t, l wee
I
VII. Responsibility Statement- Y, rite unders"
Plumber's Name (Print)~+ assume responsibility for installation of the PpW Pg shown on er's Si a the attached plans.
P
M uu Q.~ WA4PRS Number Business Phone Number
Plumber's Address (Street, city, state. Zip Code) aaa 9 7 J j _
Vila. Coun /De artment Use nl
Approved ❑ Disapproved Permit Fee Date Issued Agent Signature
Owner (riven Reason for Denial q-7J • oo
IX. Conditions of Approval/Reasons for Disapproval
-~1~lusr 464VN4 e-at eENr- ICU, drt SOIL 72F57- (~L}7~, P,P-Ol/~17~` 1. Septic tank, effluent filter and
96plAus) -I*b _JLbW sfemem7ou. dispersal cell must be serviced / maintained
as per management plan provided by plumber
rr A(~joL/Gsa~3t!~ t~-T~~G~S 2. All setback requirements must be maintained
Atbch in complete plans for the system and submit to the Coun as per applicable code/ordinances.
ty only on paper not less Hun 8
in s 11 inches in size
SB13-6398 (R. I t/I 1)
REcevED SOIL EVALUATION REPORT 2424
Wisconsin Department of Page 1 of 2
Comme'
in accordance with Comm 85, Wis. Adm. Cod( A.C.E. Soil & Site Evaluations
3M?(0fQ ~j~t Ian on paper not less than 8% x 11 inches in size. Pla County
COMAR 5w: vertical and horizontal reference point (BM), directio St. Croix
pe I ml~g~p~ions, north arrow, and location and distance tc Parcel I.D.
" ",YY'' 020-141;-03-000
Please print all information. Rtd y Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. ! Z GV 01
?
Property Owner Property Location
Brad McGhee Govt. Lot NE 1/4 SW /14 S 13 T 29 N R 19 W
Property Owner's Mailing Address Lot # Block # Subd. Nam or CSM#
844 Hillside Trail 3 na Plat Of Alexander Meadows
City State Zip Code Phone Number City Village !V#, Town Nearest Road
Hudson WI 54016 Hudson Alexander Rd.
New Constructior Use: V, Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
✓ Replacement Public or commercial - Describe:
Parent material Glacial Drift Flood plain elevation, if applicable na
General comments
and recommendations: Soil evaluaiton completed to vevrify soil suitablity 3' below existing dispersal cell as designed and installed
9/23/04 under permit #453437 .
❑ Boring # Boring
Pit Ground Surface elev 103.95 ft. Depth to limiting factor >125" in. Soil Application Rat
Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPD/ft'
in. Color Qu. Sz. Cont. Colo Gr. Sz. Sh *Eff#1 *Eff#2
1 0-11 1Oyr3/3 none sil 2fgr mfr gw 1vf,fm 0.6 0.8
2 11-28 1Oyr4/4 none scl 2fsbk mfr gw 1vf,fm 0.4 0.6
3 28-37 7.5yr4/4 none sl 2msbk mvfr gs 1vf,f 0.6 1.0
4 37-89 7.5yr4/4 none sl/Is 0 sg/2msbk ml gw - 0.6 1.0
5 89-125 1Oyr4/4 none Is/sl Osg ml - - 0.6 1.0
Horizon #4 consists of a mixture of soils dom' a yr4/6 0 sg Is &7.5yr4/4 2msbk sl. Horizon #5 consists of a mixture of soils dominated by 7.5yr4/4
Is & 10yr4/4 1 msbk sl.
* Effluent #1 = BOD s 30 < 220 mg/L an TSS >30 < 150 g ffluent #2 = BOD5< 30 mg/L and TSS < 30 mg,
CST Name (Please Print) Signature: CST Number
James K. Thompson 5--- 3602
Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number
340 Paulson Lake Lane, Osceol , WI 54020 10/19/2015 715-248-7767
AM,
T of „
f ola-
u S 50
C~aM:~2c
ONE
F
i
Q
ell
a
f.
E
t
1
t
M-4 op
M
1 ~ W m S
rov
y r ~
F t~
r
C`\ -
1
1(
f
i
CONVENTIONAL COMPONEWDESIGN
Rezident;iai Apprlir..atinn
JNMEX AND TITLE PAGE
Project Name:
Yj IC
Owner's Name: ~b^
Owner's Addre;?fi;
Legal Description: S
Township
SubdMsion Name, p I{' pl"~QQ~ ~I~U
Lot Number:
Page 2 _ Plra1: F'1~1)
PAgP 3 5yst m izin & Cross- o"otian
Page
P/l intenartnri Ptlformatioll
Page 6 ~Mjn^aG:e eiri Pisan _
f' qe r 13, . C.rU'rx G,t ~ fiC„Tank Maintenance Fori')
Page 8 _~arrant~ CE.tad
Page g ~ ti Cu~stVl ctr F'fat~
ACt 'rPihtettts: •n ! 1'e..i. & I i0e
C'"I n,
n e s its n er/'lt rtti c~ r:
Z I U1~•Mele.,5- Licensa: Number:
IS- Rhono Number
Date: Sictnrali.lrn
Designed taursu nt to the , _ ,o nd Soil Absosration C,,omponnnt wnua,, ;.)r povvTS Version 2.0 M).107(Y,,5- P' (N.01/01).
poge 7
1
I
ray,
-°p 0~ I"p, BAI
{ Crf~v 10V. aS
I Q4 i ►~ti l,a s~ x BO
D ~ ~l,bMl~tRS Pin ~itieHc
i
I
r
t (3 kAt
1f ~S4ft, Kb~-t
~ t--X, jt', ti n n
w rA
1
r
f
r
fl
SO~~ ~3oK~ N s
~t
f
v_~_ N~ Its T4)
Sail .Abso
x ra C as s "
I as 1
4" Yft
1 PVC vent pipe Final C3rayr
NO) vent rap ~
Leaching
Charnber i
3.' o - SYstesrs 90va Ian
Soil Abso~ " 8 s► ll
n
ft L JIMAT
t..
-3-ft LeacNnq Trench I4
Chamber"S
4~ Dta.
Trench 2 Header
VeWk Or Observation Pipe
_ _Trench 3
P ~
Man ufactwer And Model ~n bivt j
LISA Rating , ,
sq fl per chamber Soil Application Rage
npd Design Flow Soil Applicailc)n Rage
4 3 rows cif l CIS I N j y
- chambers each.
~.t s) j6-) ` . _
Pace of `u
/zoo Tt
~ as p v-- l Zyva
ST. CROTX COUNTY
SEPTIC TANK: MAINTENANCE .AGR.EEMENT
AND
OWNERSHIP CERTIFICATION DORM
OwnerBuyer
Mailing Address 8 ~l S )1~Q
21~ i
Property Address S~ Y11{ _
(Verification required ft•orn Planning & Zoning Department for new construction.)
City/State
au>,,~oN ~ Parcel Identification Number -C)~ ~ DUU
T,EGA-L DESCRIPITON
Property Location Nr/ , SW t/4 , sec. ~3a Q 1
- T? 9 N R 19 W, Town
Subdivision Plat:_- ~ ~'gxb}.yep- app old ~
Certified Survey Map #
Volume _ , page #
Warranty Deed # _ (before 2007)Voluixae
Page
Spec house Cl yes\no Lot lines identifiable ❑ yes 0 no _
SYSTEM T%4ATN -r ENAIiTCE APED GVVNER CER TIIF'ICA TION
Improper use and maintenance of your septic system could result in its premature failure t:o handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §Comtn. $3.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance,
The property owner agrees to submit to St, Croix Coutr j.a.
ommer and by a master plumber, -journeyman plumber, restricted plumbernor a licensed Puna errvericertification form signed by the
wastewater disposal system is in proper operating condition and/or, (2) after inspection and
less than 1/3 dill of sludge. p p fying that (1) the on-site
pumping (if necessary), the. septic tank is
Uwe. the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by Certification stating that your septic system has been maintained muIstt be completed andreturned Resources, oState ix of Wisconsin.
Zoning Department within 30 days of the three year expiration date, o the St. Croix Court
ty Plara.nrrag &
I/we. certify that all statements on this form are true to the best of my/our knowledge. IAve am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number bedroorns 3
S UR ()T A '.PLICANT(S)
IO /-I/~
Any information that is misrepresented may DATE
3 result: in the sanitary permit being revoked by the Planning & Zoning Department. ~
Include with this application a recorded warranty deed from the Register of.Deeds Office and a co ,
reference is made in the warranty deed.
pS of the certified survey reap if
(REV. 09/tr'7)
hlov-t1 2(11C 713:15 AM St Croix Caen-ir Qt~n('_rani;rr~ 71~a-3~~~ r(~q
W-TTIM ` O 'N'RFV$ MANUAL MAXA M T Pd"
Xbv
arrnit t4 ~9 1*arck f ow ! ~.1 !fit
Ts, k my wftcwtar l~J e 1 l~K Pak
1~1r~ska0r ~~ft~+~i3a~a lM I`<!A ><•f"FlW2rtt f'lftr Mtsrdait .
a
NLlmtaer cif PuhHo Fealfty Eialra M JNA Pump TR priitty
~d
itmsted ftnynr (®rz+} 3 U~stld&v i'rasp irk Marawaastrarcar
De-SlIgn ftraw (pesk)2 (L-Irr74110d x 1 A) ~ ~ si 1"'ursslt fviartw~.,icar
~i
apil ,AppliiR Mm Itl ~tP1Ei P P14M- P Mfisrlet ~y
Srrandarrl Irdlimi lIff Zent ? trslt y Aaxgttrty sverapa Prwl errrletrr 1~1ntt N
F am, off & ora a (F0,12) 00 -MOIL M nd/Gwal Fflty rj Pam Slur
Mocha M- 10 ax-voot908 -mend (30-0,j $2z M. 9X n -RA M Maat"O"I A rt"141 T; WoVivpat
Total r?91t A Gtlairt'48r 9pri ~ ~ktai;
Pretrt:el d ffflvaM ski i ty Monthly average fyisPar0al Celt(s) 0 ,V
R{cahernlaal 0XVM Wmenc! ( t~~l G a il, t 'I~~, 3ea ~a~ 4 ra~tT ~ Ire t writ d ray utr4~e )
Tara; $npanded Aids (TS51 420 MOIL, f-7 hip, Ci AT-Pq ads 0 Mwnd
r eel. rdWi`iin ~ q[XiA rtR m i 4 WEult` MI 0 pllta"ties
Iwsrr Par;dala fto ro m gu'e, n NA
Maximum'
rt cart 0 Dili, ~ N
"'Vditt `J %ypins) Nr domeff tf wostatnraxac' w1d gsptlr Milk a`fftM t
Itlepe tttonaildcn e. tank{'et At lthwt tarlba t3wwy, fir yaantab L >tt
PM, p acts aa1"itOM d ~rrl~Isi Whets aarrfhtrlgt atwd arW ar t gqa 0 VAN", Pd WO.zf tarp yraQwnle Q t~
Inj3peat QspaI a1 CARA) At lafmx tarmis sverys { stm w -rsars9 R
011vikr, At 18001, afioa 8va~t lv Y,, ►`~'~y k IM! N
at"fiw0rlt ~
It1-Sfae= pwr ap, PIAM, p gmwrais & eurm At least anal Waf'y: } 4
f9tush lisrolt and prsssWtO At; At lout once any ~
ti~ars At Ina t;5i'11m &vet'y;
P
~ixa19r, .
I1RAtiFt'6'RA- M IST4w. X s
tneppattcns of Ekrr rand dfeper i aft rhall be wards lay an in klvlduxt aeeryli *%41 Of tho 2 P4 Ifs" rwr r~t4a ss~ -ft i4 ."Vir 1~ber; Marva PtwmW Rfrcrvlowd
01ar1 POW lzla{aoMrp PDVM ~ gar. T irk
Inspigattt na mR.&T inclL.Ws s wing] IMPWL I rr Of whaW--Isi tra MVI-TifY MY m Rq rar brOksm h9rGCwM. r IdM01--tj 8rip MrMPA tar 160 r
rvreaatrr$ the r4xt of arar btil44 artwd g afi?cf strt. and 1z rsix k Prar any faRtak tdp we igr t #t t j%j Wv .SICAraiitd a~
The CUP-ff sat ~r0119) sh%l ba V?Mtrtfty Inapa ed W, aback the of uet~ [solo In 04mm*n ; 1to-o' lvak for v-W parrd no
of o itlent on is grount a1n`fecak The pane of 4Vvant an VnD orgod surfaca ,may Indl p a ftlf g t1011an and MgUIM4 ha
tanMeAlps noffse sn of %ha 18001 rapid I awft*v;
1lU1at3n the 6tTit4M8d amumlataa rl tai $jwdp and &ota Iii ery- tailk spols vp4 tray. 4 or #M 0 jh& a vVIUMN, the a re
r~armants arf tiaa tmk Shen bo rpm ewed by a S6iV1.aqe Mini{! irlp Opar t" ;Md Op at 4 ft 1$Witrt;m with i:hgW '1 'a,
tnr<Raana-tr; €trJ,rrrrsl~+ r~s/h,a C.'adte,
All Offer omlos, hi;l0ing Iawt 1ltnfig el M ;,fta serl faith to fcterix MOM, M"W. 1t l 0 {9m&13 attend ra n-poryono, prr awm t
rantm, and crew wwwrM ae "rrrervizis of X12 rraranfhs, ahail b' Wanw IAy a ~t f S it ° 4Gl r,
A servIrs iavprf shaff it pr±vt0d rP ttm fora; resmiilstoryP %stbtyfty rnriftn 10 MW§ vF *MM. ~tOlrr trF ~
Nov-11.2010 10'45 AM 5t. Croix County Plan/zoning 715-326.4686 2/2
START UP AM pMM#1 Pegs - of
For new arrrt#tra "tom, iApPa+r'M wo at'a 0 t Ta check tragtmsm tank(a) far *he prearanae of ps g' padwoM car aftr ahgrnloalar
fllatt in nay tlial3&dR ft tr8aG non't: prrdat wwor asmap 08MI aoltfot . If 419h G'ffi 4Vnr`g'l lS1 iam t have he wrhanta
Of tiro teota? ramayso Dy A MWI 4WV ciwalar Filar to use,
Symm- tmmrt up MO no a c4ir whm wait tnsil ono arc frotan e: the tnIfta. vat au"Ans.
Ruring ppwar aw ry pa p toirtft. m*y 01 abavrs rrorrr of ltighvwctar, ipueis. Vften pmt r tai ra red the-wsr i mar will bat
dlao d to tm.
pms i ,aail # In ztAa too do**, aygrWet~p the c>sp(a; ~ mW 0 3n. the ~ "Ift" l pia of
stTluam To wsm t Afts"i i s amlaiixa Q-1 thn pwxrp tank rernznrad by a Sapi e pt 1 a rttt
pov atr to the eftam pump or commit a fttuber or POWTa Wtsealrrdr to aaala't in mane gwMrj0j .pidmp t$s 'eta to
MatGM na MAll alb ww t'r 019 PURV Wk.
Do not di;ka of (aark yaMelas air Wft orW &prmal Wilt. 3m not dove or park ever, or a rwto MoMb or n"A to t
within 15 feat dawn almps of Any m. wrid or al-grad* salt absmrptiiarr area.
Raadraaaimrrt or tstlrrtPngdo n of fte fgfltrwitaM ft M. time wastawaw almam me'? Yrnli<ravs tbo t; stftmalaoe =d pai tonshe tlfer of the
.i~41{PF$, oftW r-kiaby W*am► olliwi t bta r aondvrrrs; atvNer? qwt* 0Waaaa l cdn i ftea. ~ 01-M. ~mi fAU
lonadaign dr-04 (amp ptt.* wMrf tart and vagatafalo p~llt ;aaaiiirtW ? rH9fltr Ptarl~i 1d0s; ~ SYtXStpisr; i ~i~onar! all:
patr0prg piraduass pWddsat' aattfty oapkbla; tart pnsi and wator aafkenar k Il7s>
ARAN T
1 hon the t°OWT fiche an+dtar to MmM. A clay taken cut of service `ate ollowa.Ing M" eitol 60 " %t tMarm lost the, sytfttm 16
property end saft aFtta"def+ted In armtrrplitance wfCh shad %w Opiti'rrM 33Mr i•/d, goonen A-d-M t W* Owloe
All A tlatp to tanfata wid raft 0 00 be dfiwannsi tUd and the abandoned Alpo opsrtshp 0SAI A ,
a The smirkers of all tankm and p* al-ieit be rsmovet`< and pTabpork'y diepwasd of r$Y a ftptlep UYVlWltfp OparMr.
a Aftr ptarr Ing, all tanks and oft wit be sxsavaxaO pnd ramoved or their cavars roMa.vird- artd jh,4 void 6"a$1'C2 w wM
$0, wwMI or another Inert eattfi9' ms wlai.
ff tkta ,FPM8 fdtl8 00 =mnmt be rapalrsxi the following meaauraso have been, or teat ba falcon. tic pw'Ada a maft Grttt(atimnt
reptacar oM. "am.
A writable rpl;#aem- ant aratap hog been earaia and niay Iva 4li for t„aa lltp %~z cif a MoMemmIt egg el#arpwtamra
-11119 ""Fade renT, Area Slktswd IM pwscmd frstm dtatmtrbance Arv au nt etas pat : • . upon by
raalctfred sem i ACA
wAftono prpprsw a mii3' m. 104 Pllloa and weli9ta P~itir~t ~ lam Will
result Th tho i4god- fnr a n w call and site evelwailan to ss tgklioh a SUTV4 1a rrglo an't Mo. 1- vo SYM rMlat
marr PIP avafa fitZO Mao in taffac t A that ttme,
A sultftla mpliMmerit is rf avail** .due IQ $Ohglt and/or aalt nml ft Yt& Mpiti adwafte in paWTS
taeh olosw a holft Irr(t M. air lee inl lllao as a last M 42M 0 roplave the faffesf PMM.
Q The os vzt bun -aimWoo % IGlacwyr a e4j% 6stm raplapamsnt area, upzn 1'sll'ure vt Ihs P01M a =11 amct AM
avaWfon rawer bA amad to lo== a autemtait xatttaaaramatnt area, "ram cdpiais>3rdrsrat jean ie Mmilima a hcmfrfa fink
may be 1'nMW as a 121M i'sacft't to r&plaso the lied FVVM.
Mourild and Fade itl . rrprion syt MA.V lire raa>nructed in pl . fol # ORMI Of the b10M- lot in
lnflttra-MM sult°( , ROMMM TUTM of such W Mrrta mwgt coot IV iei"h the talso in 4WOM g tat fltsrs.
~ ~ i~Cltttt~ ~ ~
ANTIRX A SjMQ, f I 100MOW Tiiiil Up mil b'#lq ' Ma li:fiAV T. ZI P, OF A
PSMON FROM TT MIft OF A TAU MAY RE E11FF1W1, s OR liNPOSMLF,,
8MPAL
p 'W's
7ti, thins amns
Canans Wirt
nrsma
Memo
Friaazaa:
Rana
This deauM- nt vraa 411% d In anm IlArm w%h altsauaat'Comm sa, fg) tiltaiatl&tt} and 8st.9sLt!), tz9 $t 1511. bttlaasws;n 1rrFSTrarkrt78 Ctrart0,
` 1041
WiisconsinDepartment ofCommerm SOIL EVALUATION REPORT
Page 1 of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Steel Soil Servke
Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must county
include, but not limited to: vertical and horizontal reference point (BM), drection and St. Crobc
percent slope, scale or dinemsions, with arrow, and location and distance to nearest road. Parcel I.D. Oz0 /pZdm'do3-660
Peaseprintalinfomation. R Date
Personal whitnabm you proside may be used for second (Prirecy Lori, s. 15.04 (1) (m)). 312- Q
Property Owner KLGEIVEiRerty
LaCasse Development, Inc. Govt Lot NE 114 SW 1/4 S 13 T 29 N R 19 W
Property Owners Mailing Address A U G 4 02 FBkbck# Subd. Name or CSM#
573 Cty Rd ' A" 3 a Alexander Meadows
City State Zip Code honer IX CO N C' 10 village IN Town Nearest Road
Hudson WI 54016 715~BtU+61"FF E dson Alexander Rd.
New Construction Use: Residential / Number of bedrooms 4 Code derived design flaw rate 600 GPD
Replacement Public or commercial - Describe:
Parent material Glacial Drift Flood plain elevation, if applicable na
General comments
and recommendations: system elevation 99.65 ft, trenches spaced and depyh to lode 4.60 ft below grade
Boring # Boring tT S~. LS a0, ?,(rtD~
Pd Ground Surface elev. 104.25 ft. Depth to limiting factor 96 in. Sol A*kxbm Rate
Horizon Depth Dominant Color Redox Description Texture Stnxfixe Consistence Bowidary Rods GPDW
'Eff#1 'Eff# 2
1 0-13 10yr312 none sil 2msbk mfr 9w If .5 .8
2 13-27 1Dyr4/4 none scl 2msbk mfr 9w 1vf .4 .6
3 27-42 7.5yr4/4 none sl 1 csbk mfr cs na .4 .6 .4
4 4( 2-96) 7.5yr4/4 none silt 2msbk mfr na na 9 r ~o
2 g t Z Horizon # 4 is stratified
Boft # Boring lye 5~1 9~.
Z
Pit Ground Surface elev. 104.25 ft. Depth to limit= factor 96 in. F§-al Application Rate
Horizon Depth Dominant Color Redox Description Texture Stnx:trxe Consistence Boundary Rods WDW
'EW •Et'f1y2
1 0-14 1Oyr32 none sil 2msbk mfr gw If .5 .8 , (p
2 14-25 10yr4/4 none scl 2msbk mfr gw 1f A .6
3 25-36 7.5yr4/4 none sicl 2msbk mfr cs na .4 .6 .4
4 =36-96 ti 7.5yr4/4 none Ws 2msbk mfr na na ~ .9 . (o
2/9 Z Horizon #3 is stratified
' Effluent 41 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD S.30 mg/- and TSS <-0 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 7/302002 175-246-5085
' Property owner Lacasse Development , Inc. Parcel ID # pending Page 2 of 3
F3]Boring # 11 Boring
Pit Ground Surface elev. 103.15 ft. Depth to Ianitfng factor 96 in. Sol Application Rate
Horizon Depth Dominant Color Redox Description Texture Stnreture Consistence Bourdary Roots GPM
'Eft#1 •Eff#2
1 0-7 10yr3/2 none sil 2msbk mfr 9w if .5 .8 .
2 7-29 10yr4/4 none sci 2msbk mfr 9w 1vf .4 .6 .
3 29-72 7.5yr4/4 none sits 2msbk mfr gw na 9 ,
4 72-96 7.5yr4/6 none ms osg ml na na .7 1.2 , IL
Horizon #3 is stratified
[-4] Boring # 21 Baring
M Pd Ground Surface elev. 103.55 ft. Depth to limiting factor 96 in. Sol Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW
'Eft#1 'Eff#2
1 0-9 1owX none sit 2msbk mfr 9w 1f .5 .8 (p
2 9-29 10yr4/4 none sel 2msbk mfr 9w 1 of .4 .6
3 29-43 7.5yr4/4 none sicl 2msbk mfr cs na .4 .6 , q
4 43-72 7.5yr4/4 none silt 2msbk mfr 9w na CJ .9
5 72-96 7.5yr4/6 none ms osg ml na na .7 1.2
Horizon #4 is stratified
❑ Boring # Boring
Pd Ground Surface elev. ft. Depth to limiting factor
in. Sol APPS Rate
Horizon Depth Dominant Color Redox Description Texture. Stnx tune Consistence Boundary Roots GPD/fF
'Eff#1 'Eff#2
' Effluent #1 = BOD,> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent 82 = BODS 30 mg/L and TSS <-0 mg/L
The Department of Commerce is an equal opportunity service provider and employer. if you need assistance to access services or
' Page 3 of 3
rE~.r6
x
)qw
_S; d i
SOIL PROFILE DESCRIPTION
Owner: CST: JYI ,
System Elev. Proposed: Syst. Range ft to ft Ld Rate:
# Elevation: D~~s # y Elevation: /o;.-G- # 3 Elevation. 4)
/fit Boring Boring Boring
o Pit o Pit
o Pit
..rte
-
wz
SG
- -
lop
l IaZEIJI~Tt k h~,le
g g
;z saw . 7
4Ss;
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
453437 0
GENERAL INFORMATION (ATTACH TO PERMIT)
c 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: Village Township Parcel Tax No:
Murray, Daniel L & Mathew Smith City Hudson Township 020-1411-03-000
CST BM Elev: Insp. BM Elev: 3M Description: Section/Town/Range/Map No:
10 c.od L5 T_ 13Nl..a 13.29.19.2573
TANK INFORMATION ELEVATION DATA g,S'Y
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark 10D
8 4,
tti~~,~ ~5 /O aV QI+ .B.M. *Beg' (lhb,~
Dosing Alt. BM E!> 1.oC. 77
Aeration Bldg. Sewer
7.7q ioo. C,7
Holding St/Ht Inlet
~OGJ Ioo.o?
TANK, ETBACK INFORMATION St/Ht Outlet 8.01
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic 3b to v r Dt Bottom
Dosing J\A 0'r - Header/Man.
9.a~- 59•~v
Aeration Dist. Pipe \
Holding Bot. System rJ 10. Z $•3
S ~o•Z 9 ,
PUMP/ IPHON INFORMATION Final Grade S-o le) 3 .
Manuf ctu r Demand St Cover
PM Nor F:.~ s
Model Num
TDH Lift Fric oss System Head TDH Ft
Forcema n Length Dia. T t. to e
SOIL ABSORPTION SYSTEM
BED/TRENCH Width ength No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3_1 go Z
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR TM~'~lkYa-~ O~
Type Of System: >V ° r C_.0 n va.n 4 ~ ov~ae5~ ~ 20 ^~70 UNIT
i N (A Zt> NI Model Number: ~ c'l ~
DISTRIBUTION SYSTEM -+y-^vI- yp - -1;-4 ,,9
Header/Manifold Distribution Hole Size Ix Hole Spacing Vent to Air Intake
Pipe(s) 7 ~[)C) I
Length S 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 Bed/Trench Edges Topsoil Yes No Yes No
COMMENT ude code discrepencies, persons present, etc.) Inspection #1: 9 / Z3 / o Z Inspection #2:
Location: -844 Hillside Tr Unknown (NE 1/4 SW 1/4 13 T29N R19W) Alexander Meadows Lot 3 Parcel No: 13.29.19.2573
1.) Alt BM Description = (o v..r e) ~ ` o~ o vt Se „ate ~1 v.r~ 4 5 t o 1' g¢ r ve..-~ , G. ✓l S ck r-)-
2.) Bldg sewer length ¢ CAS.. w~ _e G S"f
amount of cover = is r'' may. w I I l i r `11 K pG . L
•+E cs'I' •E a con ! r h't ~A.'V `'""I' ~L • S
- o
Plan revision Required? Yes El No
Use other side for addition I i formation.
' Date Insepctor's Signature Cert. No.
SBD-6710 (R.3/97)~
Cam. OV
1
ora s~~J
x a
L~
r J;7a7
i
IiA
- RY , "P"al' r7s , -
J Q
I ~
.
Safety and Buildings Division Counry
201 W. Washingtor•Ave., P,0. Box 7162
~+~n Madison, W1 53707 - 7162 Sanitary Permit Number ( be filled in by Co.)
~7 +7 (608) 266-3151
Department of Commerce 34-
Sanitary Permit Application State Plan I.D. Number
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide
may be used for secondary purposes Privacy Law, s15.04(1)(m) PA :(if different than mailing address)
I. Application Information - Please Print All Information
Property Owner's Name Parcel #~3 Lot # Block #
Property Owner's Mai ng Address Property Location_
Section
City, State Zip Co Phone Number
circle one)
TL,~ N; RE or W
11. Type of Building (check all that apply)
£Samtier
Subdivision
or 2 Family Dwelling - Number of Bedrooms ,~V t~4Q Name
❑ Public/Commercial - Describe Use
❑ State Owned - Describe Use ❑City_❑Vi lage Township of
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. Z New System Replacement System ❑ lacement S stem El Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. Type of POWTS System: Check all that apply)
la Non -Pressurized In-Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At-Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In-Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel-less Pipe ❑ Other (explain)
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (so Dispersal Area Proposed (sf) System Elevation
B
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank -
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, a ume responsibility for installation of the POWTS shown on the attached plans.
Plu e s N e(Prim Plumb s Si a e, MP/MPRS Number Business one Number
P umb s Ad ress (Street, City, State, Zip Code)
VIII. County/Department Use Only
)Approved El Disapproved Sanitary Permit FeW2 des Groundwater Date Issued Issuin Agen ignature TO tamps)
e Surcharge Fee)
11 Owner Given Reason for Denial 5D-- a2
IX. Conditions of Approval/Reasons for Disapproval
SYSTEM OWNER:
1 Septic tank, effluent filter and
dispersal cell must all be serviced / maintained
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per applicable codelordinances.
Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size--
SBD-6398 (R. 01/03)
s
~y s~ /y :sue e%3- ~~-.►1~"-/~c~1 I \
p9w l
x
J2B
cs
/Mop,/
er
Y^ ~ /
~1
1041
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Steel soil service
Attach complete site plan on paper not less than 8%: x 11 inches in size. Plan must County St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 0Z0 _ //pndin 3-6aD
Please print all information.
R Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~I 3/?-
Property Owner r®erty FBlock LaCasse Development, Inc. Govt. Lot NE 1/4 SW 1/4 S 13 T 29 N R 19 W
Property Owner's Mailing Address A Lot it # Subd. Name or CSM#
573 Cty Rd "A" 4 0023 a Alexander Meadows
City State Zip Code hone CVillage Town Nearest Road
IX COHudson WI 54016 715M Ia54MFF-E dson Alexander Rd.
New Construction Use: V Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
Replacement Public or commercial - Describe:
Parent material Glacial Drift Flood plain elevation, if applicable na
General comments
and recommendations: system elevation 99.65 ft, trenches spaced and depyh to code 4.60 ft below grade /
Boring # Boring Z'7' sL • ZS aD
sn Pit Ground Surface elev. 104.25 ft. Depth to limiting factor 96 in. Soil cation Rate 69
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'
*Eff#1 *Eff#2
1 0-13 10yr3/2 none sil 2msbk mfr gw 1f .5 .8
2 13-27 10yr4/4 none scl 2msbk mfr gw 1 of .4 .6
3 27-42 7-5yr4/4 none sl 1 csbk mfr cs na .4 .6
4 4/ 2-96) 7.5yr4/4 none sUls 2msbk mfr na na 9 ~a
dk °l4? 4TI
2 Horizon # 4 is stratified
'2-
a Borin9 # Boring 9?~Z 9G• Z
or Pit Ground Surface elev. 104.25 ft. Depth to limiting factor 96 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW
*Eff#1 *Eff#2
1 0-14 10yr3/2 none sil 2msbk mfr gw 1f .5 .8 , (p
2 14-25 10yr4/4 none scl 2msbk mfr gw 1f .4 .6 ~
3 25-36 7.5yr4/4 none sicl 2msbk mfr Cs na .4 .6
4 3696 7.5yr4/4 none sl/Is 2msbk mfr na na L .9 , (o
Horizon #3 is stratified
' Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 S_30 mg/L and TSS <.30 mg/L
CST Name (Pkme Print) Signature: CST Number
David J. Steel m 248956
Address Steel Sal Service ~ Date Evaluation Conducted Telephone Number
1564 CR GG, New Richmond, WI 54017 7/30/2002 175-246-5085
' Property owner LaCasse Development, Inc. Parcel ID # pending Page 2 of 3
a Boring # Boring
Pit Ground Surface elev. 103.15 ft. Depth to limiting factor 96 in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f?
*Eff#1 *Eff#2
1 0-7 10yr3/2 none sil 2msbk mfr gw 1f .5 .8 . Se
2 7-29 10yr4/4 none scl 2msbk mfr gw 1vf .4 .6
3 29-72 7.5yr4/4 none sUls 2msbk mfr gw na .5 .9 ,
4 72-96 7.5yr4/6 none ms osg ml na na .7 1.2
Horizon #3 is stratified
4 ] Boring # Boring
Pit Ground Surface elev. 103.55 ft. Depth to limiting factor 96 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
*Eff#1 *Eff#2
1 0-9 10yr3/2 none sil 2msbk mfr gw 1f .5 .8 (P
2 9-29 10yr4/4 none scl 2msbk mfr gw 1 of .4 .6
3 29-43 7.5yr4/4 none sicl 2msbk mfr cs na _4 .6 , cf
4 43-72 7.5yr4/4 none sUls 2msbk mfr gw na 05 .9
5 72-96 7.5yr4/6 none ms osg ml na na .7 1.2
Horizon #4 is stratified
❑ Boring # Boring
Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
*Eff#1 *Eff#2
* Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 <-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
' Page 3 of 3
POWTS OWNER'S MANUAL & MANAGEMENT PLAT 4*,
FILE INFORMATION
. 8 8T8M SPECIFICATIONS'
-
Owner
Septic Tank Capacity. L.,
, f i t el O N~
Permit #
3 =I- Septic Tank Manufacturer ljo ; i1o ❑ N,
DESIGN PARAMETERS Effluent Filter Manufacturer O Ni
Number of Bedrooms O NA Effluent Filter Modelk,,4r O N,
Number of Public Facility Units NA Pump Tank Capacity 4. , al M N",
Estimated flow (average) gal/day Pump Tank Manufacturer .0 N/
Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer'' ` 0 Nh
Soil Application Rate al/da /fts Pump Model It NA
Standard Influent/Effluent Quality Monthly average" Pretreatment Unit b Ni.
Fats, Oil & Grease (FOG) 530 mg/L 0 Sand/Gravel Filter ` 0 Peat Fllter `
Biochemical Oxygen Demand (SOD.) 5220 mg/L ❑ NA 0 Mechanical Aeration Q Wetland
Total Suspended Solids (TSS) 5150 mg/L O Disinfection O Others:
Pretreated Effluent Quality Monthly average Dispersal Collis) O N/
Biochemical Oxygen Demand (SOD.) 530 mg/L Of In-Ground (gravity) O In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L 0 NA O At-Grade O Mound
Fecal Coliform (geometric mean) 510` cfu/100ml O Drip-Line O Other:.
Maximum Effluent Particle Size Ya in dia. O NA Other: O Ni,
Other: 0 NA Other, O Ni,
"Values typical for domestic wastewater and septic tank effluent. Other 0 N/
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: most is M m. S years) ❑ N-4
f9 earls emu.. .
Pump out contents of tank(s) When combined sludge and scum equals one-third ,(Ys) of tank volume 0 NA
Inspect dispersal call(s) At least once eve O monthls)
n'' ears) (Mrfudmu,m,3.yews) O Ni-
Clean effluent filter At least once every: O month(o) ❑ Ni,
t7 ear(s)
Inspect pump, pump controls & alarm At least once every: 13 month(s) t NF,
O ear(s)
Flush laterals and pressure test At least once every: month(s) .LNG,
O ear(s)
Other, At least once every:, O month(e)
D ❑ NA
Ocher: serfs
❑ NA
MAINTENANCE INSTRUCTIONS .f.yzt:tii?
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 pipos end to check`>*-jjny pondin~,
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 (Ys) or more of the tank volume, the entirk
contents of the tank shall be removed by a Septage Servicing Operator and disposed of In accordance with chapter NR 115.
Wiscon;in Administrative Code.
All other services, includ ft but not limited to the servicing of effluent filters, mechanical or pressurized oomponenta, pretreatmer
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
Page of
START UP AND OPERATION`:..,,
'-'or new construction, odor tR* use if f1hot POWTS check treatment tankis) for the presence of painting products or other chemiceis
that may impede the treatment process and/or damage the dispersal cellis). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
Svstem start up shall not occur when soil conditions are frozen at the infiltrative surface,
Quring power outages pump tanks may fill above-normal highwater levels. When power Is restored the xcess wastowater.wlll be
discharged to the dispersal oell(s) in one large dose, overloading the cell(s) and may resultin•ft backup or wrfeoe dlsohorps of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to roatoring
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; gpasoline; grease; herbicides,-,most scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water aditener 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, end 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 Strvioing 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.
ONTINGENCY 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 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.
O 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,-
O The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWT5 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,
O 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.
4DDITIONAL COMMENTS
e•
yti
~QWTS IN8TALL POWTS MAINTAINER
Name Name
Phone - Phone
PTAGE SERVICING OPERAT PUMPER) LOCAL REGULATORY AUTHORITY
Name ` Name t.
14 -
Phone ,x z ; Phone - Z4z go
I document w efted In compliance with chapter Comm 83,22(2)(b)(1)(d)&(f) and 83,54(1), (2) & (3), Wisconsin Administrative Code.
07!08/2004 07:40 7155496592 FiNALGRADE FADE 02
PROM : P C 0%.LO-Z ELMS, AW PHONE NO. : 715 S49 5911 Ian, 03 2M 0Ca:08PM 02
IT CROIX COUNTY
SEPTIC TANK MAINTONA,NCn AGR86tt!IBNT
AND
OWNUSKIP CLRTLVICATION PORM
awtterABayer dlli u any( /1:64) - ~G► M
Mil kig Addnu .35~_„ /4 ft _ L d-- a!fr 144 CG 55"07-
P+WWV Ad*vwa fS ~l ► 850'c~l -In Z4. l ~I o 0/ Lie
NO""" nquitrd dtam Pbombt Dopwtwm *w goer somwuwm)- IQ
P+re+s;et -
Iie1d#mdae Nta:sta / ,41
Pf*01Y Laaat:ioo U V4 SW 'A, $w. ~ r.Ll t~w, Tows of ~
wi exkn(6ty s ,
Cara w surm map Voltmma - w park it warslralP Dad if 36 / vokm peke 2
i*°" d y~ ~p Let Ilrw idaeteittabiri YU O na
~P~ ~e~areilwtlMVOeot?~ ~ ai~aa4tits~ fa iltptx+amaaeaGdbeeao,Lasdi. ~asaa. twprriwriabtnaaw
eatwiw adNtlti~iad tae br a.piic taalr enegr tamer "m at wed itaiedodbf a 4aeowPmwvL W5a1 retaplat im dra wow
aaae IM to Anoka at tie mwh MA m a fta mel mw $1La &Wmd WAM
Fm"17 amw w~ d O* W 0 IL 000 z0 ft Dapae&msat a aettiioali.m 16x4 atp.d ti» e~wt+e aar6 by s
is in .i* •1.w+~rtanaaMl~bacar.rr~eepaemar s*"(i)lwot .ia:ar~ew~,r~.powtarnwao
sp.wals aoat#tNa~a (l) 9ft bapowu ad p=*S Orm mM36 ft vw io talk ii tams dna La W of ewe.
Uw., fir'. w,t lhww na>tid sbow+a ngabamwis aady~s le>♦eidria ik pdY+ak,nsap d+lepoaai a~tem with 66 ek6k*
.a ttas h DWAaaea er ciammaM ud an urmmi mm t e m wP ho meg. sale o f wbooal w C.=mwtl4o
wWt iR yWgt otrplba "am to bMlt rms:>a(aed eeuat bs itiad r+ow m d to dw It Croix can* Zoe 6Rka W" 34
d'fryR at'~. tla.. ~wiraapiea~r,vr,
DATT
ow UK* " ON Oman& *a A
da ve*wa*vY eboe~ by vletw oi form are arse to Wa We o#'noy (our) beawtodp. i (we) m (am) the owber(s) of
deed raeoakd m itAS4tW of Dco6. Celtift
DAYS
I'W, b+Weee.tioalitist Is -
m&T ago io dw aeWWT F=dt briar ftvWW br dw tooift 01paKW19
e' T4eiait erit~ tlds a0frk.alatta a o~olp,p w.aaw 6" ~m dae Reviver of Deade egsoe
a ssry vt dae a ms' tiRadvet to eerde is do mmem t
f dew
U, 2 6 1 3 P 2 6 `I -7
STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH
WARRANTY DEED REGISTER OF DEEDS
Document Number ST. CROTX CO., WI
RECEIVED FOR RECORD
This Deed, made between LaCasse Development, Inc.. 07/09/2004 01:00P!(
Grantor,
and David Robert Murray and Matthew Smith. WARRANTY DEED
Grantee. !_XElPT
Grantor, for a valuable consideration, conveys and warrants to Grantee REC FEE : 11.00
the following described real estate in St. Croix County, State of Wisconsin TRANS FEE: 215.70
e space is needed, please attach addendum): COPY FEE:
CC ES:
Rounty, Plat of Alexander Meadows in the Town of Hudson, St. Croix PAGES:
Wisconsin.
Recording Area
Name and Return Address
k~~t &4 A
020-1411-03-000
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 day ofdabe , 2004
* * LaCasse Development, nc.
AUTHENTICATION _ -AJPKNOWLEDGMENT
Signature(s) STATE OF )
_ ) ss.
Tracy county W
authenticated this day ofN LIp bI1C _
of Wisconsin Perso Il ame before me this day of
State 2 the above named
- LaCasse Develo nt, Inc.,
* - by
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, to me kno to be the persons who executed the foregoing
authorized by § 706.06, Wis. Stats.) instrume d ckno edge me.
I
THIS INSTRUMENT WAS DRAFTED BY _
Attorney Kristin Ogland_
Hudson, WI 54016 Notary Publ' , tate of -
My Commi n is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not necessary.) , ` )
* Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du Lac, Wt
STATE BAR OF WISCONSIN 800-655-2021
WARRANTY DEED FORM No. 2 - 1999
VOL79 tit"
i mom
ten ACM j
""Awl "4
C
3 _
y
LOT 9MAaM
yhMffQll~TIMiTIG11 ~ '
AWA
W.L UK$ )
I 11
COUPRY PLAT OP: ALEXANDER MEADOWfx
W"TED M PAIR op "m NW1M OP "m am/4. PMR OP nm NE1/4 OP THE aw1l4. NO MIIT O~ 0~14
OP THE 881/4 OF SHOTION 1s,, :"K."OW. TOWN OP IIUOSON, Wr.MM OOUKM. WISCONSIN.
NrwN+ww -
-NN7TSA s.T1.sr wM+wlNw ~LSTTS) 6A0®0 I we:"
vyAr.,rw ' y OUINS DATA TASK
*i aruwr I tal wriw N1
L0 t
III LCT7 Wrefi `Aws .vn dwnM-_ a wIw au'
L1 G f0 aw./w]
NAMw+J -T- w4 /MALT Lam
~L
~'w A1/ brtJ
a_iau om
LOT I ow
J ' LOT pw~J ua LIO ii wiv.Awi m
.0-4 12
WT m t
am
w-- J~ I ar. LT O »au
`r '.w~.. ~ N.d_Ny MAN tw ,nlw aNJ
'i.r ICI lw
w7m mw
• ' I• ~191i IOT N _
Tv~ I unN w
L AI • wAW av
~N
Aw.Das w Iv r waw"'m ax
Vu qYJ 1oT w to
w w1w Oar
IL lr- of wiw
04 2"
, wm We
LOT 1s LOT 1s Iv 17 .1. ~c•,~„a ? - ' - r " was .N••a'
' J ,Dw JJOO'
LOT 1S ""A•+" i' " A. wvm w'vr
N mm nTr.
nwu'w~ J/ " . • ( i 1 IA wvm Na'
m wvm niT
~ ~ r ~ : 11 a wvm i sn
V -ry N wim tOir
LOT 10 ' 1- 1 `w N wlw ..'.r
veADw J \ w ►uw v+r
u~D.~iJ ~ \ rn wwm aTA'
wr 2 \ •
C (+AR.wrtJ
,wrNa.
as
LW or
1 a °r
WE S"
Nu-IIY. +
la
Lar
urr
wuauevwr
~ wuNwanlria. \.wNVI,awAr
. anrww
bOMM TTMASIIIIM OW"W OM TOWN TIIMS~ OXIONW1AT8
STAN v wmwN7 STAN v wwalwl)
G i v ff. awcpa C"V v ST. aarML
_t..._!L.IA« MW M axr AWWTM WNJM MID ACW A MMA rnA low M MY UMIM QVAMW AND ACIM TD+1 MWAaN I
TvdA74N,r a M WINn or ST. OWL I =u TINT M Iwc N W M wwl OF HONK NOW WtT 11MT N AWawMla wN M IwW M
r1 oTKC wwr MD MNwwOM TM &Na NO MD N MD TM a M N Y~p{p~, ~~w~ AK MO N MD IAZI ON MAN. AIMMUSM AS
Adw,1wp11! Ida TND
M RT D/ M IND7 NawN O MI~a1D1 al MIT OF M LAV 94CUM N TW PLAY Of
NLYMICa AMUN4a KADCAa
r1µ ,JO~Ylw . Tra.M.~ eD_-.om - 4 a5 Oa
Wl~lvn IwArulw DAN d wrt
TIwA~AIIIe
n co 0 ic -0 n d v1
K
c (D 3 3
3 m
O N N O ° IW~Jt W N 'c •
CD 7Z' m y W O Vi C 1
C: z w m o v v K
N O
° _ - $
O C m ~ y c)
3 y ~ S ° 0
c
qn Z D v
N (D D N a s
c CD
3 g. - co 0°o (A
N
wNT O
z
go ! U) 0
a = ,0.+, a N~y~
I = ~ N
m Oro
0 o o o CL °Y
~ I W
D
N j m
0 O n c N co
m y c a
°i ego y
N 7
d (CD
N m C N
CL C O.
.r O
Cil O_ y
C g Z °
-5 7 O
cni F:? ~ O 7
CD =r
O F CL N o m
Ul
(D C
a m 7.
j P a
Z v N m N tb -1 to
m C). (a m e A
y O"m0 @ a A
s
a
c
m w T m w
o m m Z
CL 9
M
O
3 y Z
CD a
W
a
o -
:3 n
I m ~ I
o a
CD
I b
I
0.
I
I I CO)
'I a,.
N
N
I o°
I ~
= b A
CD °a
ti
EA 0