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Home My WebLink About020-1478-15-000 O Gt f C ~ O ro fD ~j fD 'a ~ 1 ~ ~ O ~ ~ ~ ~ ~ ~ - t d tp 3 - r: ~ '• ~* ~ ... .. ~ '.. ~ ~ Cn ~ .Z7 m Z O, ~ ' ~ W N 'C ~ ~ ~ a ; a ~~ O ~ ~ CD ~ a ~ p ~ {:+ -~ it, O CIl v f D t n p ~ _ „~ N ~~ N ~ ~ p ~ co v ~ O f Q~, ~ ~ ~, ~ ~ W ,~ N C ro O n ~ p ~'~' 7 ? O ~ ~ M p N ~ 1 ~ 61 a Ro 1 ~ ir5 V A D N ~ I :~7 O. U ~ -' W W '' ft. ~ ~ O ~ OW '', CD ;=q Z O O N 00 = ~ 1 I ` ~ Z p ~ ~ ~ n ' ! ~ c r ~ ' ~ co cD ~ , . . a I c - v ~ ~ ~ ~ a ^. i O O O c ' ~ In -D ~ ~ ~ vai N D ry ~ v vv, ~ ' ~ ' ~ ~ m ~ ~ ~ . °1.. ~ ~ - o ~ 'i ~ ~ i ~ = m ~~ a 3 f ~ 1 Z ~ Z N ~ y =~ o -' ~ ~ ~~ ~cc O w D i I 333 .« ~ g ~ l~ a ~ -o -p v i - m ~ m Boa m N p ~ ',i ~ ~ d a~ ~ c ~ .-. ~ ~~ ~ ~ 3 a 0 ~ ~ ° ~ .yo w ~ Z cNo m c ~ N ~ ~ ~ ,`~ .~. ~ O a A Z O O S ~ N ~ O Z _ N x W '0 m W O ~ o o. fD ~ ~' ~ Z 3 , A ~ y 3 N ~ z ~ ~, ~ a .. p ~ i A W N ~ v n D (D " N r. 3~'oc p~ 'I ~33 v c I ~ og y a ~ z fl, I mom v o m i 'J o ~ p. 3 ~ I o 'a ~fD ~ ~ 3 g o x Wm ~`~"N ~ ~ 7 O ~~i, O ~ O a ~ W V ~ _ (D , C, ? ~ ~ 7 E, v~~°- ~ ' ~ `2 (D ', N N d , ~ b A O ! w N I ~ V b9 ~ ~ w ~ ~ i ~ b o ~ ~. Wisconsin t~epartment of Commerce 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)1. Permit Holder's Name: City Village X Township Anderson, Thomas Hudson, Town of CST BM Elev: Insp. BM Elev: BM DescripNgn: ~~D,a D,~ 1 TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~~~~ / D Dosing ~ / ~~ Aeration W" ~~a~ V Holding TANK SETBACK INFORMATION TANK TO ~ ~ WEB LDG. en to Air Intake ROAD Septic ~ f 3D/ ~ ,~~RM ~3 Dosing ~5~/~~ y f Aeration Holding PUMP/SIPHON INFORMATION Manufacturer /~ Demand l•~ GPM Model Number D n/ ~3~ j TDH Li O 7~ Frict~OnLo~s Syste Hga ~ ~~Ft TtrH1 Forcemain Le ~ ~ Dia. Z ~, Dist. o Well, 7a y SOII ~RSORPTION SYSTEM /10 CF%lQ~r-~./~DM / PO UU = ~T Z, ELEVATION DATA county: St. Croix Sanitary Permit No: 515057 0 State Plan ID No: Parcel Tax No: 020-1478-15-000 SectionlrownlRange/Map No: 13.29.19.3014 STATION BS HI FS ELEV. Benchmark /.~ /o ,/ / OO a o Alt. BM/ Bldg. Sewer _- tr- 3 s 9 9/~ ~ St/ nlet to qY ~T a , 7 ~7 S t let b9 ~ ~ _/- Dt Inlet ~~ / Dt Bottom I n `~ ,~„ ~ ~•7~ ~0.~ ~ , eade /Man. roy•iS -p5 q~• 3 Dist. Pipe ~ ~ 6 ~ ~ 9 ~ .3 Bot. System ~- ~. q ~ b• /~ 9 Final Grade ~itS'f Sf I ~ , ~ / 7 9~.ys Coverw ~ / X75 ~ •~5 'D ~ 9y d 7 ~~-r~F- / mom- #~ Z ~ 3 BED/TRENCH DIMENSIONS Width ~ ~ Length ~ ~ No. Of Trenches ?/ PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO P/L BLDG WE L LAKE/STREAM LEACHING anuf r:~ I INFORMATION CHA uNET OR Typ Of Sy~ ~ ( ~ / ~ / ! ~ / ~j ~ Model Number: ,F71STiXIRIITION SYSTEM _ Header/ nifol 1 Length Dia Distributi n / I ~ Pipe(s) ~ 5' ~, / Length Dia_ Spacingi~ x Hole Size / x Hole Spacin ent t Air Intak~ CO11 [_OVFR ., o.o~~~~~e c.,~•e..,~ n.,i., ,.,. Mn~~nrl nr Ot_rrarle Svwfems Only Depth Over r Bed/Trench Center ~J~ Depth Over Bed/Trench Edges xx Depth of Topsoi xx Seeded/Sodded xx Mulched N ~ Y ~ ~ ; No o es ~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ Z / Location: 880 Hillside Trail Hudson, WI 54016 (NE 1/4 SW 1/4 13 T29N R19W) Alexander M/ea'dows_1st 1.) Alt BM Description = ~/ 6T ~~~~^•I u>~-~~ ~1~'~(~- ~r~""./"~' "''~ /~~ ~`~ 's~) 2.) Bldg sewer length ='3b/{~ VI.~ y~ C61~.VlYC~t,r~r~ /v/~~ - amount of cover = .~G, ~~~~ b ~-~, -~//(~ ---- -___ ~ Plan revision Required? ~ Yes ~ No ~ i Use other side for additional information ~ ~ Inspectio/n~ ~1'/,~~7 ~ 1 Lot 28 Parcel N~ 3:~'y1~/s~~ ~~~~.~ -~ ~r~ _ , .,. __ _-- Date 4 Insepctor's Sig~n~at~ur~e - SBD-6710 (R.3/97) '~ ~ ~/~j,~cf ~ C^E7.rw"-• ~~"- -" ' a~ ~f/1r2ti R --- - i;ert. No. .tN'I.gesv Safety ana Buildings Division 201 W County ~ ~ ' t ~ . WashingteAt Ave., P.O. Box 7162 ~,Y~ 1 ~On~ Madi, wR`~7~ 7~ ~ Sanitary Permit Number (to be filled in by CoJ 51505 Sanitary Permit Applicatio'$""~~ StataTrans/a~ctionNumber In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this fomt to the appropriate govemrnetuat ~ V unit is rewired prior to obtaining a sanitary permit, Note: Application forms for state-awned POWTS are pro~~ Address (if different there mailing address) subrtritted to the Department of Commerce. Personal information you provide may be usod for secondary estn accordance with the Priv Law s. 15. I m Stets. r ~ ~ ~ ~ ~ ` H ' ' ' , r I. A lication Information -Please Print Ali Informs Property (7wner's Name ~ .~ ~~ ~ ~ ~_S~{ Parcel # d Z~ • / L/7P• J S .. 7 OO Property Owner's Mailing Address Property Location ~ 3 bI 4 ~ ~ U % ~ ~ ~ Gn~rt. Lnt ~. ., City, State Zip Code Phone Num ~/~` '~+„j u~ '~+, Section ~~ ,,/ ~ ~ ~ ~ ~1~ ~fi ~R01X CORN tcMar °a'i f3 ~- G~ 1 ~}'N R Ly [~ E ~w ; I[. Type of Bnilding (check All that apply) 1.ot aK o.A 1 or 2 Famil Dwellin -Number of Bedrooms 3 ~ ~' Subdivision Natr~ y g ~ ` / SJl r ~~ Brock ~ ° ~ ~~ ?f 1 Q ' ` c s vt+~ { ,, t ^ PubticK:onanercial -Describe Use ~ ~ ~_ City of ^ State Owned --Describe Use CSM Number ^ Village of Town of ~1 u. ~-Slip-~ 2. ~ S ~. ~ t.J ~ ~" ~ Ill. T ype of Permit: (Cheek only ne box on line A. Complete line B if applicable) A. New System Replacement Treatmeatt/laotding Tank Replacemeru Only Other Modi£u~tion to Existing System (explain) System R. Permit Permit Revision Change of Permit Transfer to List Prt;viotu Permit Number and Date Issued Renewal Betbre Plumber New Owner ,~+ , iration °` IV. T of POWTS S m/Com neat/Deviee: Check ail that a ~Jt Non-Pressurized [n-Ground Pressurized In-(around At-(trade Mound > 1A in. of suitable soil Mound ~ 7A in. of svit~le soil ^ Holding Tank t ter Dispersal Comptment (explain) ®Pretnatmerrt Device (explain} Y. ersai(I'rea en:Area Information: system Elevation Design Flow (gpd) Design Soil Application t? Dispersal Area Required (sf) Dispersal Area Proposed sf) ` ~~ ~ 7 ~ ~%' ~ ~~~~~~ ce..vl J' .~' Vl. sole info Capacity in Total # of ManufaGttrer Material f(p . $ Gallons Gallons Units ~ Ncw Tanks fikisring Tmtks ~ 'D ~ ~~ ~ ` Septic nr Holding Tank ~ ~ } , "~_ ~' ,!j G l .r/ Gkr DoaingChamber ``3'''~ t G'_ G~'" VII. Responsibility Statement- I, the anderslgaed, sesame reapoasibilMy for iepattatioa of the 1?OW'1'3 ~ the attached phsr. iness Phone Number B Plp~ber's Name (Priori Plumber's Sig@atw ~ us Number Plumber°s Address (Street, City, State, Zip Code) VIII. COUn /D artment Use On ~ Permit Fee Date Issuing pPTOVed 3ignatu = er Gi nisi $ ~ 75 ' ~ 5 4 / O l'X. t.°Oltdltip~',easone fbr DlSappraval 1. Septic tank; efflulttt filter and dispersal cetl must all be services /maintained as per management plan provided by plumber. 2. .Aq setback requirements must be maintained so tt r e systan sod fabrMr to the Cpaaty osty on peps sot lew tYan a rR x 1 t iaela fn sFme sBD-b398 (R. Ol/07) Valid thru oll09 ~d' yii ~~ ~~ Ys ~'.~ ~-c-''~ ,cam ~1' ~.C~ ~ ~-,u c~ y ~f7 er~~~~ ~S'7`~-y'~ c~ ~_ oQ 1~~~j 4~ $ ~} , ~N~4 ~ N r~ ~~ ..F- ~~ ~~=~ ~~ ~~ c- a ,.-70 , t, -cam ~t _ s . ~i ~~ ~~ .~ s~ s ~. ~r.--c ccns~~' I 0 ax -~ ~e r -~ itc~r'~l~ ~ ~ B a' r Z ~~ ~ ~ ~ ~5~~~~ . ~COPy liJ~~~=---~~~-i~l'P a~ a ~Yd 3~7ja p ~YC~~ 6~, + ~~~ ~..~i ~~I~•~%Gi'fVG~ /U~• /V v ,~ ~ ~~" ~~ y~~~ t ~ ~ ~ ~.~ ri ~ i~ ~~ ~~` t~~ ~ ~~/ .~ ~~ ~~ ~' ~. ~. ,~ ..t. ~ a ~ i ~C~r v `''' A ~ !~ rr~ a~ ~~'~ • r~~''~ #2028 /" 1~;~, S ATION RE PORT Department of Commerce in a corda~"~R ~~IVis. A page 1 of 3 m. Code Division of Safety and Buildings Steel's Soil Service Attach com lete site Ian on a er not less than 8% x 1 p P P P i l d b t t li it d t rti l d h i t l f inch i I t ~~• ~ ~ ~ County St. Croix nc u e, u no m o: ve e ca an or zon a re ere percent slope, scale or dimensions, north arrow, an o ce po ), di c d ation and distance to nearest ro parcel LD. ~, z ~ P"I -~~~ r!'itJ ;~ ST. CROIX COUNTY Please print all info ~ n Revie d By Date Personal information you provide may be used for se dary p /Z ~ 0 tp Property Owner roperty Location LaCasse Development , Inc. Govt. Lot na NE1/ , SE1/4, S13, T29N, R19W Property Owner's Mailing Address ~ Lot # ~ Block # Subd. Name or CSM# 573 Cty Rd " A" na Alexander Meadows First Addition City State Zip Code Phone Number ~ City ~ Village ~ Town Nearest Road ~, ~ // ~lS~~~ Hudson WI 54016 715-381-5405 Hudson anderRd ~ ^ New Construction Use: ~! Residential ! Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement L ~ Public orcommercial -Describe: na Parent material Stream terraces and pitted outwash plains Flood plain elevation, if applicable na ft. General comments Conventional system, system elevation 96.55ft. Trenches spaced and depth to code 3.OOft below grade or and recommendations: to be adjusted to sand depth at the time of installation. 1 ^ Boring Boring # 'i Pit Ground surface elev. 99.55 ft. Depth to limiting factor 100 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistenc Boundary Roots GP D/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "EfF#t 'Eff#2 1 0-10 10yr3/3 none sl 2msbk mfr cs if .6 1.0 2 10-24 7.5yr4/4 none Is osg mvfr cs na .7 1.6 3 24-100 7.5yr4/6 none cos osg ml na na .7 1.6 ~! ' ,~ ,L Boring # ~ Boring Pit Ground surface elev. 99.55 ft. Depth to limiting factor 100 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistenc Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 1 0-10 10yr4/4 none Is osg mvfr cs 1f .7 1.6 2 10-100 7.5yr4/4 none cos osg ml na na .7 1.6 °f /O ~ " ~L `Effluent #1 = BOD F> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD< < 30 mg/L and TSS < 30 mg/L CST Name (Please Pri Signatu CST Number David J. Steel 248956 Address Steel's Soil Service Date Evaluation Conducted Telephone Number 994200th St. Baldwin, WI 54002 11/21/2006 715-760-0347 ~~ SBD-8330 (R.07/00) Property Owner LaCasse Development , Inc. Parcel ID # Pendi Page 2 of 3 Boring # ^ Boring ^ Pit Ground surtace elev. 93.55 ft. Depth to limiting factor 100 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff-!:1 'Eff#2 1 0-39 10yr4/4 none Is osg mvfr gw 1vf .7 1.6 2 39-100 7.5yr4/4 none Is osg mvfr na na .7 1.6 ~J ~~ ^ 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/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ^ 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/ft2 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/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) - Steel's Soil Service STEEL'S SOIL SERVICE 3 of 3 David J. Steel LaCasse Development, Inc. 994 200'" St. CST-POWTSM NE1/4,SE1/4,S13,T29N,R19W Baldwin, WI 54002 Lic. #248956 Town of Hudson, St Croix Co. Direct 715-760-0347 Alexander Meadows First Addition, Lot 6 Fax 715-684-3449 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of this test may or may not be as shown, as permanent lot lines were not established at the time the soil test was conducted. Legend N 1" = 40' • =Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe • =Alt Benchmark Ele. 100.05 ft Top of 3/4" pvc pipe ^ =Borings Boring Elevations B1 = 99.55 ft B2 = 99.55 ft B3 = 93.55 ft B4 = 0.00 ft .3 ~ ~ ~°~- ~~~ ~ ~~r Z~ ,s ~~~~ s' I~'v ~ n ~~ ~ ~ `~o ~~ ~~_ ~~~~ U s~~ r ~~ /~ ~~~`~ 7 J( ~',~. / ~ yam, .....,.•. ~~ `' , ~ •` ~ : ••.~~ ~,/~ \ ~ ~ ~ y ~s \ Z ~ ~I ~!, i O ~. ~ : i ~ '•, ~ • ~ ~ ~ ~' ~..\ , ~--"_"~ --'~~ •,\ t ~ `~ 2.052 ~1C.: s 1 1 } : ~; ~ •~ ~ \ ~ ~ i \ ~'~ ' .(`'\ • o %/ ~ ~ ~~,;: 1` i`• \ ~g ~ ~~ ~ 1 ; '' 1 X987.'3, ;~~'~ \ '~ f y 1~ ~' fib' g ; ` ~ ~. ~ , + ~ 't i , t s -•~ ,'~ ~ ~. ~ ~ ; / ~ . J '~ / ~ s ; r s .,.., ~' ~ --.~~ ........ . ~ 2.553 AC. ~ ~ ` 1 I 3 ; ~ ;~ , t 1 ; t .~ f, ; , X57-s) ~ _ i '~- ~~ .., y~84 act '~ ~ I ~-, ~ ~ . t ~ . I; ~ • `~~, d. i w ..• ~ ~ S \ ,/ 949.0 _'_ ~~ ~ `~ ;X943.0•, ~~`.•~ i:. 3 1 ~~ X953.0 !• ~,f j % ; S i • `~ f: :y J ~ MIT ~ ' •~• ~,p i•" .1r ~ ~ i ~ ~.,• y r \. •• n r i f f s' ! ` ~- DRIVEY~Y ' • ,JOINT i ' _ i i 1 r ~ ! ~;I~ 1 ~ X951.0 ~ ~ X947.0• DRIVE~'/[Y"" .-- l.'" ~~, \` j , iwV,Il ~~ " r ".J ,LOT '~Of \ ~------~ ~.-~ ~~~~~;'~~:~ ~~~ ~~`~', %r; a~.. , ~" 3:112 ~C. ~" \~ _. ~ ~ -.._ . -~- 950 -.._ ~ ~, ..E`y~ta • . ~ • % ~ f~ i ~,~ i/// (1.29 ACa~... `., ~. '. w ` ~ - ,. _.,. .. ....._ ,,, ... -' '~ ~ r ~ .i'` ~ ;~'• ~„ ~ ~ `' ~ ~~ ~ • .~ • ' ~• ..... _ ~ • ~ \. ,2.566 AC.,, -~~ ~ .,- ~' _ _ ; . D ~ ~. / ~ ~ y _ -....,. ~®~' ~.~ w. .~ . ~: -~ -~ ° , ~ • ,..(2,02 %1C:) ,, .~ '' ~ ~~3 : , - ~ _ ; ~ : ~ , ~. -. f /~,. ! . • . ,~ .._ . _ -...'• ... _ _...._ _ ".... .... ~` . ~, `. ... _. 964.7, ,r r. ~ ~ ~'' /~' ~,! • ~ '~•~ ''/ ~''' ~ ~~ :";~ - ~ "::' ".;.,:" ,:. ~ ":1.:.:'w. M.:, .... •~- -- ~.:;:.•~...~ ~,;-.' 1F ~ ~ ~ F ~•t' 1'•d ``I ~ I ~ 1 ~ t X963.0 ~.. :-,.~ ~% /. i .s . i /` 9 ~~`,~ ~`\t\{ ..I~~j~`~~:I~~'~,' _ ...--'`w :."~: ~~ •0. P,[.~If.jF~1~•1~"Lihl,t, •.~.~i /~. !, i/ ~/ .~ , X962.0 ,~"'~ ,. ~ ., -~...~ ~ ~ •-... ,~.,,, `~. "~, ~ '- •1••J I I 1 I I I i•. \. ~: ~.~. \ \, / ~ ~ ! / ..-- ,~' / ,' ~`~ ••• ..•~•..~~~~4`t\`~`•-.~~ :'`'~.'~ '~ •...` ..~.11111~i11~1~1'~t~"I•~``y~'r h~~~~ \.~ / ~,•`~ f/ i ~, •/~'• ~I,. .~ i 4' ; ~~ '~ ~ :ter, ''I ~ 1° _ ~1. 1_ ~}~[`~~ .~ , i /~ ,t/ : ~ ,mil .. /, ., .. .~ POWTS OWNER'S MANUAL & M~INAGEMENT PLAN Paga cf 0.~~~- ~~ a~ na+~ ~ ~;, o~,~ SYSTEM SPECIFICA'r10NS Permit # .Septic Tank Ca acit ' : p y Q Dd al ^ NA Septic Tank Manufacturer ifCJe ^ NA Effluent Filter Manufacturer ~d jy ~,,~~;, /,~' ^ NA Effluent Filter Model j''.~,$' ^ NA Pump Tank Capacity D al ^ NA Pump Tank Manufacturer ~ shy ^ NA Pump Manufacturer ~a~i ~ ^ NA Pump Model ~ ^ NA Pretreatment Unit ^ NA O Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Dispersal Cell(s) ^ NA ^ In-Ground {gravity) ^ In-Ground (pressurized) ^ At-Grade ^ Mound ^ Drip-Line ^ Other: other: ^ NA Other: ^ NA other: O NA DESIGN PARAMETERS Number of Bedrooms 3 ^ NA Number of Public Facility Units ^ NA Estimated flow (average) ~fSQ al/da Design flow {peak), (Estimated x i .5) 5'D soda Soil Application Rate al/da /ft2 Standard Influent/Effluent Quality Monthly average* Fats, Oit & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODE) 5220 mg/L ^ Nq Total Suspended Solids (TSS- 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD81 530 mg/L Total Suspended Solids {TSSt 530 mg/L ^ Nq Fecal Coliform (geometric mean) 5104 cfu/100m1 Maximum Effluent Particle Size Ya in die. ^ NA Othef: ^ NA 'Values typical for domestic wastewater and septic lank effluent. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tankls) At least once every: month(s) ~ ,ear(s) !Maximum 3 years) ^ NA Pump out contents of tank(s) When combined sludge and scum equals one-third {Y3) of tank volume ^ NA Inspect dispersal cell(s) At least once .ever y' ^ month(s) (Maximum 3 ears) .~ year(s) y ^ NA Clean effluent filter At least once'every: months} saris) ^ NA Ins ect um p p p, pump controls & alarm At least once every: ^ month(s) ~--- ^ year(s) ^ NA Flush laterals and pressure test At least once every: .-~ ~ ^ month(s} ^ year(s) ^ NA Other: At least once every: ^ month(s} ^ year(s) O NA Other. ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shalt be made by an individual carrying one of the following licensee 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 cellis) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y31 or more of the tank volume, the entire contents of the tank shah be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. ' A service report shah be provided to the local regulatory authority within 10 days of completron of any service event. . Page of START UP AND OPERATION For new conainictlon, prior to use of the POWT$ rheek treatment rankle! for the presence of painting products or ocher chemicals that may impede the~treatment process and/or damuQe the dispersal celNsl. If high concentrations ~e detected have the contents of the tenktsl removed by a septage servicing operaeor prior to use. System start up shall not occur when sail conditions are froten at the infiltrative surtaee. During power outages pump tanks may fill above rwrmal highwater levels. When power is restored the excess wastewater will be discharged to the disperse! ceigs- in one large dose, overloading the cellla) and may resuk in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the -pump controls to restore normal levels within the pump tank. Do not drive ar..park vehicles over tanks and dispersal cells. Do not drive or park over, ar otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduotion 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; rattan swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump} water; fruit. and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; ail; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 63.33, 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 fitted with soil, gravel or another inert solid material CONTINt3ENCY PLAN If the POWTS fails and cannot be repaired the fallowing measures have bean, or.must bg takes, to provide a code compliant replacement system: ^ A suitable replacement area has been evacuated .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, cot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in pOWTS technology a holding tank may 6e installed as a last resort to replace the failed ppWTS. site ^ T tank e e followin removal of the biomat at the ^ Mound and at-grade sot) absorption systems may be reconstructed 'in plea 9 infiltrative surface. Reconstructions of such systems must comply with the rules in effect'at that time. < <WARNINt3> > SEPTIC. PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDlOR INSUFFICIENT OXYGEN. Ot9 NOi ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF E PERSON FROM THE INTERIOR OF A TANK MAY 8E DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name C/~`lr~~u „-. ,~-~~E'-y' Name Phone 7 l - _ ~• _ .4 :z Phone SEPTAOE SERViCINti OPERATOR (PUMPER) LOCAL REk3ULATORY AUTHORITY Name Herne 5}. C (o : e ,n. za ~ !~ Phone Phone 7 5 - 3 This document was drafted in compliance with chapter Comm 83.2212iIbli1lid)d(fl and 83.5411), (2} & (3), Wisconsin AdministratNre Code. • SEPTIC TANK E PE.'MP Ch:A~:HiR CROSS SEG:IU:V ANA SPzClr tc:t~ilviv~ +~" CI' VENT ~ PIPE ~ 12'~ ~ ~l~N. `A$QV ~ GRADE ~ uEATHERPR~F ? 25' FRpM DgOR, WINDOW QR JUNCTION BOX APPROVED V R WITH CONDUIT N FRESH AIR INTAKE ~ PADLBCK W, FINISHED GRADE - --WARNING LABEL 4" CI RISER 4" MIN. 18" IN. 6" MAX. ,; ` ~"~ ' ~ ~ 'NLET ~ ~ ` ~ , WATER TI GHT SEALS GAS- , '~ TIGHT ~ ~ ~ AR4VEp A SEAL ' JOINiTS WITH --t--• i ALM APPROVED PIPE PPROV£D ' H ' aN 3 ONTO APE 3 ~ ~ ~ so~r~ sOIL NTO SALID OIL FUMF' OFF ELEV . ~,FT . .,,~, ~ ~ OFF ~~ RISER EXST pERMITTEA ONLY D IF TANK MANUFAGTURER HAS APPROVAL 3" APPROVED. B£DDI NG UNDER TANK CONCRETE FAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: ,'~5~~! ,._____ NUMBER DOSES FER DAY: TANK SAS : SEPTIC GAL. ~ DOSE V OI~M£ INC WDING FLOWBACK: - 1i' - GAL DgSE ~ GAL . RM MANUFACTURER: A ,1_~• ~lqr„y~__ CAFAC ITIES t A = INCHES x ,~,;~~,~.GAL. ~ MODEL NUMBER: ,~ ~ v 2 NCHES = 3+vZ GAL. B ° I ~'-'"~"" SWITCH TYPE: c r , , --- PUMP MANUFACTURER : ~oc~, . .,.~ G = ~ S_ f INCHES = _L.r,GAL• """~ MODEL NUMBER: „ e p ~ INCHES = _,,,~~GAL. SWITCH TYPE: ~ar,~~^~ REQ~I IRED DISCHARGE RATE GPM PUMP B ALARM WIRING AS PER I L~3R 16.23' WAC VERTICAL DIFFERENCE BETWEEN3~UMP 0~'F ANA DISTRIBUTION PIPE -~-~~ FEET + MINIMUM NETWORK SUPPLY PRESSURE ~ + FEET FQRCEMAIN X ~.FTf100 £T AHEAD z ~ ""`"""" FEET FEET ~_~ 1~Z ~T DYNAMZC OTAL - _ INTERNAL DIMENSIONS OF PUMP TANK' LENQTH ; WTDTH~ LIQUID~~ ~ ': _• ~_+ D"I/AMETEK ____,_,_ l4' ~. /.~ ,~T •~~• ~ ~~ S TGNED : ~~ ~~~---~~~''" LICENSE Nt1rtBER : ,z?1_ 7~~'4 DATE ~/ 1a.~ ~~sa ~GOULDS PUMPS APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIIfICATIONS • Solids handling capability: 3/a" maximum. • Capadties: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: 1'/~" NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BONA-N elastomers. * Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: • EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. •EP05 Single phase: 0.5 HP, 115 V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: l 0 foot standard length, i 6!3 S1TOW with three prong grounding plug. Optional 20 foot length, 1613 SJTW with three prong grounding plug {standard on EP05). ®2000 Goulds Pumps EffeRive February, 2000 8381 • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Auto- maticmodels include Mechanical float Switch assembled and preset at the factory. FEATURES ^ EP041mpeller: 7hermopias- tic Semi-open design with pump out vanes for mechanical seal protection. Submersible Effluent Pump 3871 EP05 ^ EP051mpeller. Thermoptas- tic enclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover. Thermoplastic cover with integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. METERS FEET ;..__....._._......._ .............:_._......___.,_..._.........,............._._...., 10 i ...... ......... __ _ __ _. ..._. ~ 9 30. ~ a ~ i 0 7 ; ug ; ... _ .._. .... x u 6 20;..._.__~................ ~d ~ _ ~ _ 5 a a o ~ 1...... _ _ _t._. 2 5 _.. ....... 1 ~ .._..... _ , 0 00 10 20 ^ Bearings: Upperand lower heavy duty ball bearing construction. AGENCY LISTING ~' Canadian Standards Assodalion (CSA listed mode! numbers end in "F" or "C".) Goulds Pumps a ISO goof Registered. -- 5 GPM 2.5 FT 0 2 4 6 8 10 12 m~/h caPACinr Goulds Pumps ITT Industries .. I - \~ ~••• ~ ~ `~ N~~'~ eacH Mac: ~ t ~ ~~ ~ __~~- ~ of ~' t~ tom. i D ~ - . - aFV~noN 954.5 t -~ x I p 1 a,$ m~~ .5p ~ f i ~, I~ ~ "' ~ LOT 29 ~ t o \ •~ , ~ ~ EAS~EAIENT JO DNR , t '~ OR REpRESENTAnvE ~~ t. - I W ~_ FAR ~4GYaESS TO \ ~j N t V i .7~' vVJ.J~rV77GJ MON/Ii7RINC H~7..L ~ /i (j i - EASEMENT (S~£ ~'~ ($~E MONITOR WELL . . , e ; ~ ~•• cavsrnucnoN ~ N ccESS -eELOw) ~ ~ •` ' ~~ ~, 6• t /~~` • .... .EAS~MQI75• BELOW) A ~~ ~ ~ ` ` ~ ~?s• ~' m - - ---- - scour 7RA/L -BEtow> '`~ 4 ~ ~~ ~~ N~•45.5~'W ~~o , ~ ~ ~,~,\~ --CI__ ~ 153.08' .~ ~ ~couT • :' ~5• cavsrnucnav TRAIL ~' ~ EA~ENr l~ ~ _ ~~ ~ cavsrnucnav ••'~ ~ EAS~MENrs -BELaw) ... ~ ,y LOT 29 j `~ ,h ~ HWL=964:0 I ~RA9NAGE ~` ~ ~y, EASEMENT ' TABLE "W" ~ D/RUCTION D/ST. ~~ ~`__~-_ 3 ~~" ~' W! S007405~W 161.37' ~ W ~ W2 53570 54 W 81.04" ~~~'y\ ~~ pRA/NAG1E ~~ W3 58573'59"W 153.17' ~~4. ~~ ~- EAS~ENT "W' p fir, 6`L' ' W4 S0074'05"W 78.23' 3 `~ ~~- yiF•g 6~~/ fN5 S32 41'10"W 84.78" '~- ~o~~ ws sso~123"w e917' ~ ~' W7 S60~1'23"W 13.89' LOT 30 `~ ~ +~ ~ w8 N60 44'29 "W 49.35' _ _ may„ W9 N2773'11 "W 75.98' o 189°31'03"E 877.05' ~ o~ T"E'- NJ~IPL~Gp~C~D ~ L~Q(t~D~ ST. CROIX COUNTY. • ~ ~ , . SEPTIC TANK MAINTENANCE AGREEMENT . AND OWNERSHIP CERTIFICATION FORM Owner/~tty~r ! c ~ "1yl ~L.~ ~''y C G' ~ Mailing Address ~ '~ ~ ~'~'~L ~~ ~ /' ~ ~ ~ ~~ Property AddrP~~~ 1 ~ ~ g~ ~~ ~/ S~~d P ~~'q~` (Verificatio~nre/gutted from Planning & Zoning Department for new construction.) City/State t~S ~ w t Parcel Identification Number ~ Z~ "/ `~ 7~ ~ ~S " ~~ LEGAL DESCRIPTION Property Location,'/a ~~f '/a ,Sec. ~3 . T.~_N R j T ^W, Town of ~7' ~' ~Sd~ Subdivision ~'~~k~~~~ Y' ~ ~=L' ~~ 5 l-~/ ~'~~ ,Lot # Certified Survey Map # _ ,Volume .Page # Warranty Deed # ~ 7 ~~ ` ~ ,Volume .Page # spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a 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 responsibiiities are specified in Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by tbe owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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 the Department of Commerce and tbe Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to tbe St. Croix County Planning Bc Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms SIGNATURE OF APPLICANT(S) ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in tbe warranty deed. (REV. 08/US) State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document Number ~{ Document Name THIS DEED, made between LaCasse Development. Inc, a Wisconsin corporation ("Grantor," whether one or more), and Thomas Anderson and Jill Anderson husband and wife ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): Lot 28, Alexander Meadows 1" Addition, St. Croix County, Wisconsin. This property is subject to a water advisory pursuant to a Variance Notice by the Wisconsin Department of Natural Resources dated July 14, 2008 and recorded August 18, 2008 as Document No. 880214. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free IIIIii IIIII IIIII Illll IIIII 11i1i III! Illlii IIII IIII * 8 9 4 5 9CC~~}} 2 1 ~~~J7~ BETH PABST REGISTER OF DEEDS sT. cRDrx co. , wI RECEIVED FOR RECORD 05/01/2009 11:35AM WARRANTY DEED E%EMPi t REC FEE; 11.00 TRANS FEE: 210.00 PAGES: 1 Recording Area Name and Return Address WESTCONSIN CREDIT UNION PO Box 607 Hudson WiS4016 ozo-la7s-15-000 Parcel identification Number (PIN) This is not homestead property. (is) (is not) and cleaz of encumbrances except: easements, restrictions and reservations, if any, of record. Dated ~ ~ LaCasse Develo meet, In,~. ~, ' /l,~ t II .r *Richard LaCasse, (SEAL} (SEAL) * * AUTHENTICATION Signature(s) LaCasse Development. Inc., a Wisconsin cor ration b Ricba d La as its resident authenticated on *Kristina and TITLE: MEMBER STAT BAR OF WISCONSIN (If not, authorized by Wis. Stet. § 706.06) ACKNOWLEDGMENT STATE OF ) ss. COUNTY ) Personally came before me on the above-named to me known to be the person(s) who executed file foregoing instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: Kristine Ogiand. Estreen & Ogland Notary Public, State of 304 Locust Street. Hudson, WI 54016 My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANX MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDEN'T'IFIED. WARRANTY DEED ®2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 ' Type name below signatures. 1 of 1 INfO-PROTM Legal Fortes 800-6552021 www.infopratorms.com ,.f..