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HomeMy WebLinkAbout020-1411-19-000Wisconsin Department of Corrfineroe PRIVATE SEWAGE SYSTEM Safety 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)}. Permit Holder's Name: City Village X Township LaCasse Develo ment Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: Boa - ~:~ g ~ ~+~ c TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic t_.~.z.~~~ 12 (o ~; Dosing • ~ g cac~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic > ~~ , > %ti 3tp > /o~' Dosing ~ ~, ~ > 75 y2 '-iZ" 7ruu Aeration ~' ~ R, ~.e,r Un Holding PUMP/SIPHON INFORMATION Manufacturer Demand ~~ L.Ic(S GPM Model Number ~ -5 W C-G ~1 ~ TDH Lift ~ Friction Loss System Head TDH Ft Forcemain Leng~~, ~, Dia. z H ~ Dist. to Wel~~~5~ ELEVATION DATA County. St. Croix Sanitary Permit No: 430643 0 State Plan ID No: Parcel Tax No: 020-1411-19-000 Section/TowNRange/Map No: 13.29.19.2589 STATION BS HI FS ELEV. Benchmark t43 .1 J ~ iD0!>cU Alt. BM 13.18 ~t2.27 Bldg. Sewer SUHt Inlet i 1, • ~e > $°i . ~~- SUHt Outlet I(o.b G gf'i•~'7 Dtlnlet Dt Bottom ~ ~ By.yS Header/Man. Dist. Pipe 9. ~ ~F / ?Q • Bot. Systemm N f S ~rznc Final Grade St Cover ~im~h~~.r-tom 5.45 SOIL ABSORPTION'~YSTEM _ ~-.1«..:~_.,_ . JC ,~~,._ .~,.c. n ~.x.L' -~e~ o~ 5 LK- . ~..~i_ t5_~.o M ~ ~e ~ ~ ~ S~~ BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ ~ Z,-) Z SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer: r ~ p ~ ` ~ ~~ ~ 1 ~ L~'t Type Of System: i ,,y ~ , ~ 1 7 / U ~ UNIT Model Number: DISTRIBUTION SYSTEM HeadeNManifold ti Distribution Pi e(s) x Hole Size x Hole Spacing Vent to Air Intake . i # Length"" ~ Dia ~• p Length Dia Spacing -'" SOIL COVER x Pressure Systems Onlv xx Mound Or At-Grade Svstems Only Depth Over Bed/Trench Center ~, :~ ~ Depth Over Bed/Trench Edges xx Depth of Topsoil xx Seeded/Sodded "^~ Yes ~ i;!.j No xx Mulched ~ Ij Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: `-~ / '~ / u`~ Inspection #2: / / Location: 843 Hillside Trail Hudson, WI 54016 (NE 1/4 SW 1/4 13 T29N R19W) Alexander Meadows Lot 19 Parcet No: 13.29.19.2589 1.) Alt BM Description = S. tt a.-{ ~.,~1 k. cr ...-1 ~°' Q , z ~..> . ~u lrsc -• ns wL G. ~ `~ '-c ~zf : „~ ~ -j -~ c i cts r-r Q ~w r/~ eat/ i1 ~ -> 2.) Bldg sewer length = ~~ ..5 ~ ~~~ ~~~ - amount of cover = ^- ~-.~t" ~ hv~, ,, ~ ~ea~ `-r ~~ ~~``~' r -----~ --r _ -- -- --- ---- -- _ _ _T_ ~ / 'siode foruadditional in Yes ~ ~ No ! ti ~ r?~ ~ L °' formatit5n. ~----~ ---- --' ~_ - _ ~~ - -' _ L'~~~,~! 3/97) Date In epctor's Signature Cert. No. 3c 24 ' Safety and Buildings Division ' ~ 201 W. Washington A e., P.O. Box 7162 IS~O~S,~ Madison, W ~' - ~artment of Commerce (~8) Sanitary Permit Applicati !n accord with Comm 83.21, Wh. Adm. Codo, persotwl Informed may be used for socontlary purposes Privacy Luw, s15. 1. Application Information -Please Print All Itil'urnuuiuu County P 't N tuber (to bo filled in b Co ) ~-3~ECEIVED n n you e ~ ~ 2064 sa 1)(m) ST. CROI Pr ZONING OFFICE tary orml u y . ~3~ Play LD. Nttatbtr .. ~ oct Atldrae t~f dlf!'~~erotu~tttatt~u -css; ( ~~f3 k~~~ ~~~ Property Owner's Na me Parcel N Lot / Block d Property Owner's M ailing Addr ss Pr'o/petty Location ~ 02 ~ / ~ n~~ ,. %~,,.~IGLu.Sxtion _l,i___ City, Sue Zip Cude Phone Number ~.- (circle e) / T~~ N; R,,,,L,2E o~ I .Type of Building (check all that apply) / ~_ 1 or 2 Family Dwelling -Number of Bedrooms ~ Subdivision Name CStvt-IVtJtti~t" i ^ Public/Commercial -Describe Use ^ State Owned -Describe Use ~ ~/ j% G~LS W 2Q .~ '^Ciry ^Villa a ownship of ~ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) ~~ - A. _---._ __..._. ._~, Now System ~..) Rcplncentcrn System ~.~ 'I'reauncuUl IuldinY 'I'at-k Keplacoment Unly ^ Othot Mottifiatlon W Ilxutfryl Syatetn i I B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Tranafor to New Lut Provlow Pondt Ntuaber ttpd Date Issued Before Expiration Plumber Owner IV. T e of POWTS S stem: (Check all that a 1 ) Nun -Pressurized !n-Ground (...) Mound > 24 in. of suiwble soil U Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Weiland ^ Pressuriz !n-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recuculadng Sand Filter ^ Recirculating S nthetic Media Filter Leachin Chamber ^ Dri Lino ^ Gravel-! ^ Othor ex lain V. Dis ersal/Treatment Area Inform ti n: !D 1 O S - L ~ I Design Flow (gpd) Design Soil Application Rate(gpdsf) / Di sprrsaf Area Roquired (sf) Art~ropoaed (a~ System P.ltwation i ~ ~~ / ` 3 ~ i VI. 'l'ank Info Capacity in ll G '1'utal G Nun,lxr Manufacturer Prefab Slte Steel Fiber Plastic I a New ons s Existin allons of Units _~~~/~ ~/s?A%~~T~ ~~O Conccete Constructed Glass i I Septic or Holdlna Tank I V11. Kes o sibitity Statement- 1, the underslgnc , ussuuic respunsibllity fur htstallutlou of the POW'I'S shown ou tho attachod huts. Plum r' a o (Prjnq Plum r' t a e MP/MPRS Number Buahioss Phone Number Plumbe 's Addre ss (Street, City, Stato, Zip C e) ' Sanitar Permit Fec (' lades roundwater Date Issued 'Issuln A nt Si lur tam s) Approved ^ Disapproved Surcha be Pee) q JZ ~ p ^ Owner Given Reason for Denial ~/ 0 Q pproval/Reasons for Disapproval / p ~/ YSTEM OWNER. X~,(,(,{,Q~ ~Zi, , , .~~ ~{,~ /~~ Gti~W "~ ;~~ /~~~r 1 Septic tank, effluent filter and ~"~" ~ ~ dispersal cell must all be serviced /maintained nt plan provided by plumber~??"y~h- ~3- ~~ 2. All setback requirem 'nod" ~.S~s,~_ ~~ ~~~ ~.., /a~~0/G3SdtQ as per applicable code/ordinances SBD-6398 (R, 01/03) Attach cuwpMta plus (W tpa County only) fvr Ibt, ~rNwY ~ lP~ avt Itw taro {t/i a 114toMe li else '~ ". c .~, n e L I ~~ I/ ~? a r L- J` ~~~~ ~ ~~~ ~v~ ~, \ ~ ~ ~ a w o ~ ~, ~ ~ ~ ~, ~ ~ ~ ~ ~~ ~ o~ ~ \ ~ ~ R~ ~ ~~ ~' v~ i ~~-~ ~ ~ / ~~ J. ~~ ~ ~, /F .~~ _: ~g X, i~ ~~ i ~~ / ~.. ~~'~ ~ ~'~ z- ~ ~~ ( ~ z 1 ~ /~\ Y~ ~~ ~~ Q ~ a ~^ ~. ~~ w ~~ V \ ~ \ ~ ~ '~ jy' ` / /. f+, / ~~ J i i; ~v ~ ~ ~ ~ ~~ i a { ~- J~- .~< ~ ~ ~ ~ ~ ~~ U~ ~ ~ , ~ ~ ~ ~ ~ ~~ ~ ``??`` ~ ~ •ca ~ ~ ~° . ~ ~~ ~ ~~ R, 9~ a , i ~ ~jc /NE k o~ z ~~ ~ ~ ~~ ~a a ~ ~ ~ a Ea a ~c~~ ~; ~ (,\` ~-1 W \4 w a ~" ~~ ~ m -- ~" PA6E Of ' PUMP CH~MaEi~ CROSS SECTIO-~ AIJp SPECIFICAT `o ~-/9 `I~ VENT PIPE 7 2S' FROM DoOR~ WI-JOOWOA fRCSN AIR IAlTJ~KE 10' /'11 AJ. ~ IA1LE T I APPROVED JOIAIT W/ PIPC ~ CXTE-JDIIJG 3' 0-1TO soLlo solL C~.EV F7, A b c 0 ,,,_~-- V E A7 T C A P WEATHERPROOF" JUUCTIOAJ 8oX Iz'MIU. I GRADC --~ ~ I i, ~ 1~ 11l _ ~/ --~ \~ PR:;~v~OL. { ~ ~ ~~~ ~ '~I ~ I ~ I ALARM I I~~ o~, . ~'~ PUMP -~ --~ /-PP1tOVC0 LOCKING MAWHOLE COVCR W ITM WAIWING LABEL ~ ~ .~ _ _ 19~h1'IU. y° Mau, Co-JCRCTC r.~ocu APPROVED J01~:' W/ PIPE EXTC1JDIUL 3' o-~ro soLlo so' ~y. o' ~/- RISER EXIT PERMITf£D O-JLy IF TAIJK MAIJUFACTURCR HAS SUCH APPROVAL 3" ~PPKoVED ~EDDrn+G u~~d~r TMr-SK SPEGIFIGATIOI~JS SEPTIC E ~ DOSE / __ TA-JKS MA-JUFACTURCR. ~L~~~~S I.1LL^+.fjCR OF UOSCS: ~~ PER DAy 7AA1K SIZE: i~~~ GALLO-JS DOSC VOIUMC `/ ~/~ ~~~ ~ . j GAIL ON; IIJCLU011JG 6ACKFLOW~ ~~~~ ~/ ~ ALARM NIAIJUFACTURCR: `~~ ~ `~~ ///// ^^v I-JCNCS OR ~~~~ GALLOU~ CAPACITIES: A =~1'~ ~ ' P'10DCL LJUMISCK: _ S`rIITGH 7`lPC: .~ ' ° ~:~ 1- B =,~.•~ INCHES OR •~°~ GALLO-J` PUMP MAIJUFACTURCR: r C =1c.uZ_.~uCHES OR~~ GALI.OII` '/ ~~ `' / / ` U ~ ~ INCHES OR /~fL~l~ G/,LLO~.J~ - MODEL. UUMDCR: ~ ~- ~. ~ / ~ SW17C,N TYPE: ~•.rc..,/~/~'-°j"'~ -~L"~'~ II•~' C~ f'UNP AUD ALARM ARC TO pC h111JIMUM OISCHARGC RATC ~ _ GPM WSrALLCO 0-J SEDARATC CIRCUIYS VCRTIGAL DI/FERCIJCE CCTWECAI PUMP OFF AUD 015TRIP,U TIp-J PIPC..c~ FEC7~{'U ((~~5~~/'~ +• MI-JIhiUM -JCTWOItK SUPPLY PRESSURC ~'- FC.CT l FT,,~~ ~.~c FECT -~ J~ FC ET OF i'ORGC MAIN Xc_ /~o~ ir.F_RIC ~ rG~l FAC7~il.~ TOTAL Dy1JAMIC HEAD •- ~~"^~'- f•EF_r ~ ~,i.•~,c1x-e. ~y IIJTERAJAL C1IMEIJSt01Ji OF TA-,1K: LELJGTM jL{ID'('i{ --jl.tQU1D DEPTH ~~ OA7E: -- Ue:Ki ~-~/ ~ J iiG~JED, _ ~ __. LIC6 ~ •. -- I ;C NUM Performance .~~~~ Curves METERS FEET - 90 25 ~ 70 s 20 60 r ~ 15 4 10 I - ~ 20 5 t0 C ' ~ 0 Submersiple Effluent Pumps ~ ~ MODEL 3885 - lid SIZE 3/ " S 4 s o WE15H ~ -' ~~ W r _~___ ~-._~ W 7H ~ t.-,_ • E0 - W E05H -- -l - WEOOM sc ' ~ ~ ' . . t----~- ~ ~ WE031 +. 0 .0 20 ~~ ~~0 50 60 70 8G 90 100 i t0 120 OPM __._ _..__--------------_ ..._ __. .. ^.~__.. ....._._._..1- OT +0 20 30 m'/h CAPACITY • ~GOULDS PUMPS, INC, seEU r,~us r~ew tic i3wa METERS FEET 12 35 11 ~~ t 25 7 20 60 o ; i5~- ~ ac to ~ zo 5 10 0 0 o - ~ ~-~ - ~ MODEL 3885 ; - ~ " 3 WE15HH - -, . - - -~ - - - - /a SIZE SOIIdS .. f_.... ._,. ~ _ ..f.-- .•~ _ .. ~ ..... _ .. -- - -• --- • -f -- t-- --~-- WE 06HH ~ . ._.y _,--- - ~- . ; __,_j _. , . ... _ . _ . • ---~----t- - , 0 00 80 0 0 t0 20 30 40 co 60 70 80 90 t00 1t0 120 0PM 0 ~ 0 20 30 m~/h CAPACITY ~ 1885 QOUIC{ Pump, InC, Et-~ouw Juty. ~ 995 ~~ Maas D~ ~~5a ~y VVis~nsin Department of Commerce `- SOI TION REPORT Division of Safety and Buildings n C !` C f \ / F n Page ~ of m ~cwruansw~wi+vorrxrro.TVVis. m. was C~MY Attach complete site plan on paper not less an 81/2 x 11 inches in size Pla must inducts, but not limited to: vertical and horiz l . tal reference ppir~(f~(~recti and oca p~ l,p. "~~~~ - ~ ~QQ OZ percent slope, sca e or dimensions, north a ,and l tion and istance ton crest road. ~/ ~ P/easeprinta infa~~~ppht;UUNTy Reviewed y Dat Personal information you provide may be used for ~~ 04 (f) (m)). ~j' ~y ~ / I/ Properly Own er Property Location l / ~ ,) - Govt. Lot _ 1/~ 1/4 S T N R Property Owner's Mailing ss Lot # BI # Subd. or CSM# City S to Zip Code Phone Number ^ City . ^ Vllage Town Nea t oad 1 ( ) ' New Constnac~ion Use: Residential / Number of bedrooms Code derived design flow rate _~,l GPD ^ ReplaoemeM /^ Public °~°~merdal -Describe: Parent material ~.Qi~.'~ / .'-FT Flood Plain elevation if applipble - /~ ft. bons: ~' ~ ~~e,:-..s=,~ _ /G'S,S S`t. a.~Ubv ~~ S ~~d1N t~.3 ~fiClut ~-~~"71~ v ' ~~ # ^ BOnng Pit Ground surface elev. ~~~ 1l. Depth to limiting factor //G~ in. Soil ication Rate Horizon Depth Dominant Color Redox Description . Texture Structure Consistence Boundary Roots GP D/f~ in. Mansell Qu. Sz Cont. Color Gr. Sz Sh. 'Eff#1 •Eff#2 / ~/ ~ , ® ~~ # ~ Boring ® pit Ground surface elev. ~~~ R. Depth to limiting factor in_ in. Soil ication Rate Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP D/fl? in. Mansell Qu. Sz. Cont Color Gr. Sz Sh. `Eff#1 'Eff#2 7- E .~S 1 ~ - - r E1flueM # - BOD > 30 < 220 mg/L and TSS >30 < 150 mglL ~ " Effluent #2 = BOD < 30 mglL and TSS < 30 mglL CST Name ) ! Signature j CST Number .. - Address Date Evaluation Conducted Telephone Number ~!o r/~. Property pwne~^z~~~/~5 •~ '' ~ ~%' Parcel ID # Page ~ of ~_ Boring # ^ Boring Pit Ground surface elev. ~! , ;~ ft Depth to limiting factor ~//~ in. Soil ication Rate Horizon Depth Dominant Cdor Redox Description Texture Stnrcturre Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. t. Color Gr. Sz. Sh. •Eff#1 'Eff#2 ._, ^ Pit Ground surface elev. ft. Depth to IimiGng factor in. ~~ # ^ ~~ Soii ication Rate Horizon Depth Dominant Redox Desaiption Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz Cont. Cdor Gr. Sz. Sh. •Etf#1 'EtT#2 a ^ Pit Ground surface elev. ft. Depth to Amfing factor in. # ° ~~ Soil ication Rate Horizon Depth Dominant Redox Desaiption. Texture Structure Consistence Boundary Roots GP DIff in. MunseB lZu. Sz Cont Color Gr. Sz Sh. •Eff#1 •Eff#2 • Effluent #1 =BODE > 30 < 220 rrtglL and TSS >30 <_ 150 mglL • EfBueM #2 =GODS < 30 ntglL and TSS < 30 mglL 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. sao.s3w cR.broot ~ r ~' t~U (~ ~.. ` j ~~ • ; . ` ' ~ ' I ~ '~ ' ~ ~ ; a ; I \ 1 . ~ ~ i r \ ~ ~ v~ ~ ~~ ~ ~ ~~~~ ~ ~. ® y W ~ `~ ~ ~~~~ ~ ~ o- ~ ~ ~ ~ ~~ ~~ ~~ ~. ~ ~/~~ ~/ \\ / v / ~ ~~ ~I< L' :~ ~U Z ~ ~ ~ y ~ ~ ~. ~ '1 193~i' 02 • ~ 6 4 9 ~ 5 STATE BAR OF W ISCONSIN FORM 1 l • 1982 KATHLEEN H. MALSH LAND CONTRACT REGISTER OF UEEDS Individual andCorponte ST. CROIX CO., MI (TO BE USED FOR ALL TRANSACTIONS WHERE OVER RECEI4ED FOR REC 525,000 IS FINANCED AND IN OTHER NON-CONSUMER GRU Document Number ACT TRANSACTIONS 07-29-20 02 12:30 Ph LaNi) u;N' Hilt, CONTRACT, by and between Renee E. Spott, s single woman t/cMF~i kEC FEE: 15.00 TRANS FEE: 1595.60 CDPY FEE: ("Vendaf', whether one or more) and LaCasse Development, Inc. CERT COPY FEE PAGES : 3 ("Purchaser", whether one or more). Vendor sells and agrees to convey to Recording Area Name and Return Address Purchaser, u on the rom t and full erfotmance of this contract b Purchaser, P P P P Y ICrlstina Ogland the following property, together with the rents, profits, fixtures and other Estrcen & Ogland appurtenant interests (all called the "Property"), in St. Croix P.O. Box 359 County, State of Wisconsin: Idudsou, WI 54016 (L q U~ ~ / T/~~ - ` 20-1017.70.000; 20-1017-50; and part of 20-1018-20 (Parcel Identification Number) All that part of the North half of the Southwest Quarter (N 1/2 of SW 1/4) and the Northwest Quarter of the Southeast Quarter (NW 1/4 of SE 1/4) of Section 13, Township 29 North, Range 19 West located North of the raikoad right-of--way and West of Alexander Road. This Is homestead property. (is) (is not) Purchaser agrees to purchase the Property and to pay to Vendor at any reasonable location the sum of S 533,178.00 in the following manner: (a) at the execution of this Contract; and (b) the balance of S 355,278.00 ,together with interest from date hereof on the balance outstanding from time to time at the rate of seven (7) % percent per annum until paid in full, as follows: One payment of 5177,900.00 principal and accrued lnterest due January 3, 2003. Provided, however, the entire outstanding balance shall be paid in full on or before the third day of January 2004 (the maturity date). Following any default in payment, interest shall accrue at the rate of 8 °/ per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). Purchaser, unless excused by Vendor, agrees to pay monthSy to Vendor amounts sufficient to pay reasonably antici- pated annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor, Vendor agrees to apply Qayments to these obligations when due. Such amounts received by the Vendor for payment of taxes, assessments and Insurance will be deposited into an escrow fund or trustee account, but shall not bear interest unless otherwise required by law. Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any emotsnt mny-be-prepaidavitfionFprons+wn-or-Tae-nA~*-Pt~+Aefet-e+tyfima-s€ter (OR) there may be no prepayment of principal without permission of Vendor. except as prov3 e n ~ dendtma In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated as unpaid principal) is less than the amount that said indebtedness would have been had the monthly payments been made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded here from. Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except: None Purchaser agrees to pay the cost of future title evidence. If title evidence is in the form of an abstract, it shall be retained by Vendor until the full purchase price is paid. closing date except as Purchaser shall be entitled to take possession of the Property on provided In Addendum , Cross out one. LANDCONTRACT - Iodivldaal aed State Bar of Wbmoaia Corporate Form No. 11 - 1982 tnformatbn P,°Insionab C°mPanY. Fond Ou Lec, WI a06853-2021 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~, of FILE INFORMATION Owner 1 ~- Permit # ~ESIQN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units f~NA Estimated flow leverage) el/da ,~ Doslgn flow Ipeak-, (Estimated x 1,5) ; *, al/da Soil Application Rate ~ al/da /ft' Standard Influent/Effluent Quality Monthly average" Fats, Oil & Grease IFOGI 530 mg/L Biochemical Oxygen Demand IBODa) 5220 mg/L ^ NA Total Suspended Solids (TSSI 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODE) S30 mg/L Total Suspended Solids (TSS) 530 mg/L NA Fecal Coliform (geometric mean) S1 ' /100m Maximum Effluent Particle Slze Ye in dia. ^ NA Other: O NA "Values typical for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Septic Tank Capacity al ^ NA Septic Tank Manufacturer , ~ ',c~S ^ NA Effluent Filter Manufacturer O NA Effluent Filter Model ^ NA Pump Tank Capacity a) O NA Pump Tank Manufacturer ^ NA Pump Manufacturer ^ NA Pump Model fir iT ~1~%]L ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: L~JVA Dispersal Cell(s) ~In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other Other: ^ NA Other: ^ NA Other: ^ NA MAINTENANCE_SCHEDULE Ssrvloe Event Service Frequency Inspect condition of tanklsl At least once every: month(s) (Maximum 3 years) ear(s) ^ NA I Pump out contents of tankls) When combined sludge and scum equals one-third (Y,I of tank volume ^ NA Inspect dispersal cell(s) At least once eve ry' ^monthls) (Maximum 3 ears) _~ ~ earls) y ^ NA Clean effluent filter At least once every: ^monthls) ,~ l7`- earls) ^ NA Inspect pump, pump controls & alarm At least once every: -~ ^ month(s) ~~ ~ earls) ^ NA Flush laterals and pressure test At least once every: ^monthls) ^ yearlsl »'NA ocher; At least once every: ^monthls- ^ aerial ~NA 0thor; ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or cert(fications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank insl~octions must include a visual inspection of the tanklsi to identify any missing or broken hardware, Identify any cracks or leaks, ~~~nasuro the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surfaco. ~~~o dispersal cell(s) shell be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may Indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum In any tank equals one-third IY,1 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. Ai' other services, including but not limited to the servicing of effluent filters, mochanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. OMW 14/011 .Page ~ of START UP AND OPERATION ' For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cellist. If high concentrations are detected have the contents of the tankls) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. qunng power outages pump teaks may fit) ebave Hormel ht®hwator levsle, Whoa power ie restored the exaeee waKswator w111 be discharged to the dispersal cellla) In ona large dose, overloading the oellle) end may result In the baokup or surfaos dieoharge of affluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal Levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, .the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasolin©; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. 1BAND0NMENT When the POWTS fails and/or is permanently taken out of service the following steps shall tie taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. ;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 affect at that time. D A suitable replacement area Is not available due to setback and/or soil limitations. Barring advances in POWTS technology a molding tank may be Installed as a last resort to replace the failed POWTS. v e sit has t been a aluated o entify a suitable replacement ar Up allure of POWTS a and site oval a o m st e p rfor ed t locat a su' bl replacem t area. If ore lace eat a is a hot tank may e i Iled a last re to replac a fail POW 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. iDDITIONAL COMMENTS 'OWTS INSTALLE ~ Name d Phone / -. POWTS MAINTAINER Name Phone :EPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name ~~ Phone Phone ills document was drafted in compliance with chapter Comm 83.221211b)(t)(dl&(fl and 83.64(1), 121 & (31, Wisconsin Adminlstratlve Code. S'1' CROIX CUUN'I'Y SL1''I'1C 'l'AI~I~: MAIN'T'ENANCE AGltl?1?ML~N'1' AND OWNI?1tSI111' CI?It'1'II~ICA'I'ION DORM Or~vl-cr/L3[tycr _ ~ /I ~'~4 5 SQ. l~ 6i' ~,/~fYt_~. Mailing Address _~7',~? ~'~T_~/~~Q~~~{,~.,-~~ j,(~2= 1't~oparty Ac(dress ~y,3 ~ l G 5 ~ (Vcrificalio^ Icqui,cd tium Planning I)cpatUncnt fur ncrv cunslmclion) I .~ City/Slate ~~f c,~1- Sc ~L,~l L _ I'arccl lllcnti(ic;llii,;l Nluul,cr L9Z0-/5! // -~9_~~j l Ll~GtiL UI;SCR[1''I'ION Nut 5~^ ~ ZS~9 Properly Location 1/,, ~ '/,, ,,cc. f 3 _, 'I' 2 ~' tJ-It~~W, 't'owtl of /~i,~ srrn SuUdivision r~~;c.ae_-~~Q-2JL, ~•3,~e~~~_1 ~ . Lol >'t l ~/ Cet•tifted Survey ~Mtlp dt' _ _, Ve,luu,c , I'nl;c ~1 ~~~ C~ ~{~-y-~~e,ctl--# _ ~~ ~ / a- `~ V o I u n I c l ~J 1'rl ~ o t'1 o Z q '7 ~ ~/OZ Spec !louse D yes [~l nu Le,l lines idcntilinl,lc ~ yes ^ no SYS'1'L+'M MAIN'1'1!;NANCI!; Inq,roperuse and meLtlcuauccof yuin septic syslcn, cunld tcsull in its plcn,elule failure to 1-aodle wastes. PropernlaicUenaacc consists of putslpiug out the septic teak evccy Ihccc ycels or sooner, if needed by a Iiceusccl pu,npcr. What you put tltlo the system cat! atI'ect ILe Enaction of tLe septic teak as a l,entn,cnt stage in the waste dispose! system. Tl-c prapcrly owner egrets to subu,it Iu St. CroixI,oniug I~cpelUncnt a cclti(icatiou form, signed Uy the owner and by a u,astprpluulber, journeyman plu,nher, lestlicted p.lwnber or a licensed pumper vcl ifying that (I) the ou-site wastewat~rdlsposal system IS Ill proper OpefBting CUIIdItIUl1 anlUUr (Z) atlCl' InSpCC11011 end pUltlOillg (If IICCCSSAIy), the acetic lank is less !!tall I/3 full of sludge. I/we, tllc underslgued have !tact the nl,ovc lcgni,cnlcnls and agree to n,ainlain the private sewage disposal system will! tLe standards set fortL, betel!!, as set by .ILe Depatlnlcnt of Cuuuncrcc and tLe I)cpalln,cnl of Natural Resources, Stale of Wisconsin. Certification stating tLat your septic systew bas been ulaintaincd must be cun,hleted and letuu,cd to the Sl. Croix County Zoutng Office wilhia 30 cif tl-e tllr~e yeah expiration date. jam- /'3e/ 0 3 SIGNA'I R Or AI'PLICAN'I' I)~•I-[3 O~~YNI!.lt CLR'I'II~ICA'I'tON I (wc) certify tl,al all slalccucnis on Ibis tinnt n,c teat In the I,cst of n,y (nut) knowledge. the pro,erty describ al,ovc, ~y villuc of a wauenly clccel,ccrndccl in Rcgtsicr of 1)ccds O[Iice. S GI~lATURE OF AI'PLICANZ' I (wc) nrn (arc) tLc owuc!(s) of / Z l X30/ D_? DATE "**** finy iuforu-atio!! El-at is Weis-tcprescnteit n,ay ccsull ill the s~nilaty penult being Icvol:ccl by !hc Zoning Departnteut. ****** '~* Iucttlde ~.Itl[ fIl_Es apt}liclEtlott: a slan,l~ccl ;vatfanfy ctccd fro,i, tiie I?cgisicr of I)a=cEs aifice _ ' -. . - - - s cohv:c]," list rc ii`Ecci~st,tvci° ciini~-i~'t I<.;aii^.,~ is u,a~iir it2; (r~ ~rarrs~ty~tlett~ "; : ~ - \ l ~~ ~ ~ ~ 7 f ~ ~'` - A % ~ ~ 975.2 ~~~ ~ ~~_. f .'~1~~~~r. i ' ~ j ~~ ~ '`~ ~ g .1 ~ ' ~ :~ 7 3 2 ~ ` r ~ , i ;-~- ~~ ~ ~ r ~ ~~~ ~ ~ ~ - .'~ .~ ~( -i - 'f ' -~ INA ., <' ~ , .. ME ,r ~ ~ ~ \. ~ 96 . _ - _ _ ~ ~ 1 ~~ i'~ I ssza . .~ '~ - _~~., ~~ _~_ L - ~-- - M 981.5 ~. 1 ~ - ~ r/ l _._ 958.4 x L T 19 y -.~ _ H.W.E. _964.0 ' 9 a':3 /~ ' ° - - `_~'.-~./ ._ ~"~ . _ ~ ~~.'. ~. ~.. , 965.4 1'WIH HOME ~ n ~ ~ . IYLI~.F.E. ~ 968.0 ~. 3Q' Ib Q ~ ~ ~ ~ ~ 1N ~' ~ /SEAS E I ~ "` f /~ j,/ 607 ~ 965.1 ~ / '~ 963.2 ~___ -- ~ ~' 3[Y DgFt; ` i t\~ ~ ~ _ ~ _"~ '~ ,. \n / t~' l~ (' /F i Eli '~~ 99,6:1 - ' ~~.~~-'-~~' x y ®'~~ X2.42 dC.j ;~ it r ! 956.7 i 958. - "~, _--~ ~ r ~~ ~ ~_ _ _ ~~ x ~ ;, ~ - ~~ ~ s<,~-~ .~-~ ___-^-1~ 1 994.7 ~. '~• , -> -~ z . ~ -~.~ ~ e `~~ ~ -,,. `` _ ~-~ _ .cam 4 ~, ~,~ ~_ ~"- `\ ~~~ `\ \~ ~ x ~~,. 1 1009 2 x ,~-~ ~ = '~ - Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, W is. Adm. Code 1057 Page 1 of 3 Steel Soil Service County Attach complete site plan on paper not less than 8'/: x 11 inches in s¢e. Plan must St_ Croix include, but trot limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. '7 p percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. OG O ~ ~ pendin~ / l ~ 6 ~ Please print all information. Personal information you provide maybe used for secondary purposes (Privacy Law, s. 15.04 (t) (m)). R ~~~r Dat3~~~/6 3 Property Owner Property Location ` LaCasse Development , Inc. of NE 1/4 SW 1/4 S 13 T 29 N R 19 W Property Owner's Mailing Address tot # Block # Subd. Name or CSM# 573 Cty Rd " A" 19 na Alexander Meadows City State Zip Code Phone Number ! Village ~ Town Nearest Road Hudson WI 54016 715-381-5405 Hudson Alexander Rd. i_/ 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 pp ~~ C t'1 plicableL C E I V ~ General comments and recommendations: Mound design, system elevation 99.00 tt based on contour line elevation 9Z5aft q~ ~ 2 1 2002 ST. CROIX COUNTY ~ Boring# Borin -~ g ZONING FFI E Y' Pit Ground Surface elev. 98.50 ft. Depth to limiting factor 96 n a e Horizon Depth Dominant Color Redox Description Texture Structure Consstence Boundary Roots GPD/ftZ `Etf#1 `Eff#2 1 0-11 10yt3/2 none sil 2msbk mfr gw 1f .5 .8 2 11-32 10yr4/4 none sicl 2msbk mfr gw 1 of .4 .6 3 324 7.5yr4/4 none sUls 2msbk mfr gw na .5 .9 ~ 4 64-96 om mfr na 5yr4/4 none scl na .0 .0 Horizon # 3 has stratified layers and # 4 is wet goring # Boring Pit Ground Surface elev. 97.70 ft. Depth to limiting factor ~ in• Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Stucture Consistence Boundary Roots GPD/ttZ "Eff#1 `Eff#2 1 0-6 10yr3/2 none sil 2msbk mfr cs 1f .5 .8 2 6-14 10yr4/4 none scl 2msbk mfr gw 1vF .4 .6 3 14-38 10yr4/4 none sl 2msbk mfr cs na .5 .9 4 38-96 7.5yr4/4 none sVls 2msbk mfr gw na .5 .9 Morizon # 4 has stratified layers x tttluent iF1 = BoD ~ 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS< 30 mg/L and TSS < 30 mg/L CST Name (Pl~se Print) Signature: CST Number David J. Steel ~ ~ 248956 Address Steel Soil Service 1~~~'`-*~'9 Date Evaluation Carducted Telephor~ Number 1564 CR GG New Richmond WI ` 8/20/2002 715-246-5085 54017 property owner LaCasse Development , Inc. Parcel 1D # pending / - Page 2 of 3 Boring # Boring ~ /• Pit Ground Surtace env. ~•~ ft. Depth to limiting factor 9 i Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' 'EtT#1 'Etf#2 1 0-6 10yr3/2 none sil 2msbk mfr cs 1f .5 .8 2 6-18 10yr4/4 none scl 2msbk mfr gw 1vf .4 .6 3 18-96 10yr4/4 none scUsl om na na na .0 .0 Horizon # 4 is wet ~l R~ry~~ ~ !Boring ' Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = 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 Bnrina # Boring STEEL'S SOIL SERVICE Page 3 of 3 David J. Steel 1564 Cty Rd GG CST-POWTSM LaCasse Dev., Tnc. New Richmond, WI 54017 Lic. # 248956 NEl/4,SW114,S 13,T29,R19W (715) 246-6200 Town of St. Hudson, St Croix Co. (715) 246-5085 Alexander Meadows, Lot 19 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be seitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. 7z' ~~~~ ~~or~ l~~~e~r -+-,bn ~ ~~~ ~~ ~f ~~ I ~~~ sipe R~~a~ N ~ ~, re' ~ ~~ s ss' A F~~ ~. ~~ s~ sr ~s~ ~% F ~ • 9'2.3d~-~- j ~ t/~!!" ~6 • ~ ~~f ~ch r,~f £/ ioo. 3oF-t- T~ ~ r/~ ~G~~PL b = 8er~.-q 3or'i n y~ IOns : '~" 25 7~~ f ~.5~ ~, n~