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Home My WebLink About020-1458-03-000-. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFO~MAT6pN (ATTACH TO PERMIT) Personal information you`ptovide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. Permit Holder's Name: City Village X Township Tostrud, David Hudson, Town of CST BM Elev: Insp. B M Elev: BM Description: / TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic t '~_ t t W j ~~~ /~ ~~ RY' l ~ 7'~' Aeration Holding , TANK SETBACK INFORMATION TANK TO P/ So WELL BLDG. Vent to Air Intake ROAD Septic /0 ~ r~ f\f ~ ~ ~ ...._ Dosing Aeration Holding M~ PUMP/SIPHON INFORMATION Manufacturer ..~-~-- Demand GPM Model Number TDH Li Friction Loss System H T Ft Forcemain Dist. to Well Sf111 ~RS[1RPTI(1N SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 479379 0 State Plan ID No: Parcel Tax No: Section/Town/Range/Map No: 16.29.19. STATION BS HI FS ELEV. Benchmark / ~ /~ ^ V / Alt. BM ~ J ~ ~ 7 ~$ • Bldg. Sewer ~7>~ 92. S St/Ht Inlet ~ .~S 9J- ~,i5 SUHt Outlet `9.6 9J~ Z Dtlnlet ~. Dt Bottom ~ 1 Header/Man. 9•~ qy / 9d. /`t Dist. Pipe { ~ ~ .21.0 qQ .9~ Bot. System ~ ~~~ ~ Final Grad~e~ T. t ~ ~ ~~` St Cover ~`~ ~ ! ` -.~ 4~. ~ e~ ~(~' ~" ~ f ' g 1 '~ / ~ .'~ p a (7 / BED/TRENCH Width ~ Length ~ / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth 'i DIMENSIONS ~ ~ ~.~ Z , `Q ~ ~\, '~+-., i. "',- SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer. ,f ~~ ~ ~ ~ INFORMATION CHAMBER OR ~ 1 ~ Type Of System: \ ` / ~~ / ~~ /[ /~ UNIT Model Number. „r, ~ r11CTRIR11Tl(1N SYSTEM G_ .f 1 d) ~ zZ~ Z~ = ~S o'~~ Header/Manifold ~~ ~ Length ~ z Dia~_ Distribution Vv Pipe(s) ~ Length \ Dia \ Spacing x Hole Size ~ x Hole Spacing ~ Vent to Air f~tok~, Z we,x ~FrD u~/~ ~- ~~~-~'S C/111 C/1VGR ., n....~~....,, c..~~e.,,~ n..i.. .... Mnnnrl nr D4.rrarla Svefems Only Depth Over / Depth Over ~ xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center ~ Bed/Trench Edges ~ Topsoil ~s ~~~ No ~~Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 595 Grange°Ro~ad Hudson, WI 54016 (NE 1/4 NE 1/4 16 T29N R19W) Wil(lo~w;,Blu~ff`Lot~3 Parcel No: 16.29.19. 1.) Alt BM Description = ~- `~-" ~~~~-- ~ ~"''~ ""~' / 2.) Bldg sewer length = '3~ '~Z ~~} /~A,$t~ ~ '1"! ~~ d -amount of cover = Plan revision Required? ! '] Yes ~'No Use other side for additional information. ! ~ ~__~' Date SBD-8710 (R.3/97) ~- ~~ Cert. No. Safety and B ildings Division County ~~ C n ~ , x . ~ 201 W. Washington Ave., P.O. Box 7162 (~- ~~~~~~~~ Madison, WI 53707 - 7162 Sanitary Pertnit Number (to be filled in by Co.) Department of Commerce (608)266-3.15 ~ ~~~ Sanitary Permit Application `~'~~~-' State Plan LD. Number In accord with Comm 83.21, Wis. Adm, Code; peisonal information you pro 'de~. ntay be used for secondary purposes Privacy Law, s15.04(1)(m) ~4 ,. ~;~ Project Address (if different than mailing address) ~~\ n I. Application Information -Please Print All Infor alto . ,. y,. -. ' / t 1 ~~ ~, Property Owner's Na me Parcel N~ Lot N ~ J" Block !/ v u ,a'C~iir~ ~ ~ Ov --Opp Property Owner's M ailing Address ST. CROIX COUNTY Property Location [~. ..~- N ZONING OFFICE Qad`~ ,, City, S to Zip Co'de/ Phone Number (/ CJ/ ~- ~~•'~',! vV ( ~`7"~ 2 ~i - `" 7 (a circle e) T (~ L N; R / E or~ TI. ype of Building (check all that apply) S ~^^'e Subdivision Name CSM Number ~1 or• 2 Fanuly llwelling -Number of Bedrooms ~-~'~ S ',1 ^ Public/Co~runercial -Describe Use W r L" ~d `s ~L"~ ^ State Owned -Describe Use ~ ^City_^Village Township of ID~b/V 1I1. Tvoe of Permit: (Check only one box on line A. Comaleto line B iF applicable) A' New S stem y ^ Replacement System ^ Tream~etit/I•Iolding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal Before Expiration ^Pertnit Revision ^ Change of Plumber ^ Permit Transfer to New Owner List Previous Permit Number and Date Issued IV. T e of POWTS S stem: (Check all that a 1) rp~t,~a.~ ~yyc. ~lon -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Singie Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Syn[hetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pip ^ Other explain) V, Dis ersal/Treatment Area Information: Q Desi Flow (gptl) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) ispersa Area Proposed (sf) ystetn Elevatiotl VI. Tattk Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units w /~~ ~--(cX~ ,~~ Concrete Consavcted Glass New Existing l /'a r(_ Taiil;s Tanks - T~ tt~ - Septic or Holding Tank / Z ~ ~ ~_ Aerobic Treatment Unit 7~- Dosing Chamber VII. Responsibility Statement- I, the undersigtied, assume respotlsibility for fltstallation of the POWTS shown on the attached plans. Plu tier's Na me (Prinq Plumber's Si gnature MPlh~i~Number Business Phone Number ~6~ ~GSo~J ~ z.6 ~. /S"-- Z73- s~~s~~ Plumber's dre s~ [reef, City, Ststte, Zip e) VIII. Count /De artment Use Onl Approved ^ Di ved ~' Sanitary Permit Fee includes Groundwater Date Issued Issuit Agent Signature No Stamps) Surcharge Fee) ^ O Mason for Denial ~~ IX. Conditions A pr.oval/ aYSTEM 3) Nn ~t~ (~'v`~'t.e•t,•e'K'~ 1 peptic tank, effluent filter and ~- - - ----~ ~ ~~ dispersal cell must all be serviced I maintained ~ ~ as per management plan provided by plumber. d-"'~ / 2. All setback requirements must be maintained ( as per app{icable code/ordinances. ~\ ~ Attach complete plans (to the County only) for the system on paper t IgCSet 81/2`~~Ita;~ ~ `f-"w""K~ SBD-6398 (R. 01/03) s ~ - l I . 0 ~ ~~ ~-0 5 ~~. ~ D ~, ~ 2b~~7 ~L ~ok3 ~,r~° 6 --~..-~ .~+-- ~o ~~ ~~ ~,~,~~ . ~r~~ w ~d~`i ~ti~° `~ ~~~ 9 ~~~` L-~ a~ g~q . o 6~~,~6~ ~~ ~n COPY ~~ ~ ~ ~ ~ _ ,, _ .~ J 2b~~7 S ~s~ _J ~ 9c~ ' ~ ~q.o 6~~~~ I°° bo S 6'~ e~ -~ ~ ~L ~a5t ^~JY' ~tiao D ~~ ~~~ 9 p~~n ~L ~~ ~ -~ 7'Gt,~~ ~ -ire. 2'"~ ~..-Q ~ ~ '~-c.~~ S ~-!~ ~ ~~~~ #1752 SOIL EVALUATION REPORT Department of Commerce ,~,, in ac 6eaa Code Page 1 of 3 Division of,Safety and Buildings. "~'1 ~ Fp~~~~' steel's Soil Service, Inc. ~ \-,%`! County Attach complete site plan on paper n an '/: x 1 inches in size. Plan must St. Croix include, but not limited to: vertical an n nt f e e poin~(t~), ~re$ti {~ Parcel I D percent slope, scale or dimensions, north r a tion an di ance o t roa . . 1;. Please print all in i ST. CROIX COUNTY ewec~By Date Personal information you provide may be used for secondary p r ses ~Q@H~1(~~Q6.Ft!~ (1) (m) • O Property Owner Property Location Dave Tostrud Govt. Lot na NE114, NE1/4, S16, T29N, R19W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# N8215 950th St 3 na Willow Falls City State Zip Code Phone Number ^ City ^ Village ®Town Nearest Road River Falls Wi 54022 715-425-7855 Hudson Gran a Rd ®New Construction Use: ®Residential /Number of bedrooms 4 Code derived design flow rate 600 GPD ^ Replacement ^ Public or commercial -Describe: na Parent material outwash Flood plain elevation, if applicable na ft. General comments Conventional system, system elevation 96.30ft. Trenches spaced and depth to code 3.OOft below grade. and recommendations: Or adjust system elevation according to basement floor elevation. Boring # ® Ground surface elev. 99.30 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistenc Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr3/1 none sil 2msbk dfr cs 2f .6 .8 2 10-17 10yr4/4 none sicl 2msbk dfr cs 2f .4 .6 3 17-120 7.5yr4/6 none cos osg ml na na .7 1.6 Boring # ® Ground surface elev. 99.30 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr3/1 none sil 2msbk dfr cs if .6 .8 2 10-19 10yr4/4 none sicl 2msbk dfr cs if .4 .6 3 19-120 7.5yr4/4 none cos osg ml na na .7 1.6 * Effluent #1 = BOD > 30 < 220 mg/ TSS >30 < 150 mg/L * Effluent #2 =GODS <30 mg/L and TSS <30 mg/L CST Name (Please Print) Signatur CST Number David J. Steel ,~~_..._~- ~ 248956 Address Steel's Soil Service, Inc. Date Evaluation Conducted Telephone Number 994 200th St. Baldwin, WI 54002 7/22/2005 715-760-0347 ¢ Property Owner Dave Tostrud ParcellD # Page 2 of 3 Boring # ~ Ground surface elev. 93.40 ft. Depth to limiting factor 120 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 1 0-10 10yr3/1 none sil 2msbk mfr cs 2f .6 .8 2 10-28 7.5yr4/4 none grcos osg ml cs if .7 1.6 3 28-120 7.5yr4/4 none cos osg ml na na .7 1.6 r ~t .n / g`j.O ,.~.g g sz_ g~, ^ Boring # ~ Ground surface elev. ft. Depth to limiting factor in. ~ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eft#1 *Eff#2 ^ Boring # ~ Ground surface elev. ft. Depth to limiting factor in. ~ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *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 608-266-3 ] 51 or TTY 608-264-8777. SBD-8330 (R.07/00) Steel'S Soil Service, Inc. .` f David J. Steel CST-POWTSM Lic. #248956 STEEL'S SOIL SERVICE INC. Dave Tostrude 994 200`" St. NE1/4,NE1/4,S16,T29N,R19W Baldwin, WI 54002 Town of Hudson, St Croix Co. Direct 715-760-0347 Willow Falls Lot, 3 Fax 715-684-3449 Legend 1"=40' O=Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe ~. =Alt Benchmark Ele. 100.50 ft Top of 3/4" pvc pipe Q =Borings Boring Elevations (,~ B 1 = 99.30 ft ~ ~ ~ (~ B2 = 99.30 ft l ~~ x B3 = 93.40 ft ~ B4 = 0 00 ft ~~ ~! ~~ G . ~ ~~ ~ ~ . 3 of 3 N -tG,,~ S , s ~. I s ~ s~2 ~e.~~ ~ ~ ~ s s .fie ! Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Saf@ty and BUil~ings ;n ar=.ci~~an~ wirh comet ss wis Adm_ code 1586 Page 1 of 3 Steel's Soil Service, Inc. County Attach complete site ~an on paper notless thaq,SYx x 1 i in size. Plan must r St. Croix include, but not limite to: vertic~l~nd;k>aiz~ental refe e (B di ion and percent slope, scale ~r aortA ari+o~.and no t road. ~~ Parcel I.D. Pending , ~ Please print all information~~__,~ iewed By Date A Personal information you provide may be used for secondary purposes (Privacy Law, s.. 1 . (1) (m)). n -~~I ..Y ... . 2~ J~~"""'"ww Property Owner Property Location Hieb, Matt Govt. Lot na NE 1/4 NE 1/4 S 16 T 29 N R 19 W Properly Owner's Mailing Address Lot # Block # Subd. Name or CSM# (~ 1271 140th St 3 na Willows Fads, Pending City State Zip Code Phone Number ~ City ~ Village ~ Town Nearest Road New Richmond ~ WI 54017 715-381-5277 Hudson Grange Rd ~f New Construction Use: ~I Residential / Number of bedrooms J Replacement _f Public orcommercial - Describe:na Parent material outwash General comments and recommendations: Conventional system, system elevation 96.7 4 Code derived design flow rate 600 GPD Flood plain elevation, if applicable na ~ nch ce_d_ aqd depth to code 4.75ft below g~ d . Boring # .J Boring Pit Ground Surface elev. 101.45 ft. Depth to limiting factor 100 in. Soil Appli ' n Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-12 10yr3/1 none sil 2msbk mfr cs 1f .6 .8 2 12-36 10yr4/4 none sicl osg ml cs na .4 .6 3 36-100 7.5yr4/6 none cos osg mfr na na .7 1.6 9r:•~ S~- 93 goring # ~ Boring Pit Ground Surface elev. 101.45 ft. Depth to limiting factor 100 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIftZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-12 10yr3/1 none sil 2msbk mfr cs 1f .6 .8 2 12-40 10yr4/4 none sicl osg ml cs na .4 .6 3 40-100 7.5yr4/6 none cos osg mfr na na .7 1.6 ~ 93 `Effluent #1 = BOD S> 30 <_ 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 =GODS < 30 mg/Land T5S < 30 mg/L CST Name (Please Print) Signature: CST Number David J. Steel ~ 248956 Address Steel's Soil Service, Inc. Date Evaluation Conducted Telephone Number 994 200th St., Baldwin, WI 54002 11/8/2004 715-684-5680 r Property Owner Hieb, Matt Parcel ID # Pending Page 2 of 3 Boring # ~ Boring Pit Ground Surface elev. 101.35 ft. Depth to limiting factor 100 in• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-13 10yr3/1 none I 2msbk mfr cs 1f .6 .8 2 13-48 10yr5/6 none sicl osg ml cs na .4 .6 3 48-100 7.5yr4/6 none cos osg mfr na na .7 1.6 ^ 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 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring # _l Boring ,_,f Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS> 30 < 220 mg/Land 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. r David J. Steel CST-POWTSM Lic. #248956 /~-,~i 3 of 3 N .~ /~' ~-~Y STEEL'S SOIL SERVICE INC. Matt Hieb 994 200` St. NE1/4,NE1/4,S16,T29N,R19W Baldwin, WI 54002 Town of Hudson, St. Croix Co. Bus.(715) 684-5680 Willow Falls, Lot 3 Fax.(715) 684-3449 Legend 1" = 40' ~ =Benchmark Ele. 100.00 ft of 3/4" pvc pipe It Benchmark Ele. 100.45 ft of 3/4" pvc pipe ~- orings Boring Elevations B1 = 101.45 ft B2 = 101.45 ft B3 = 101.35 ft B4 = 0.00 ft C~ ~ CONVENTIONAL SYSTEM CROSS SECTION : NO SCALE I . _ ~< 12" COVER 12" COVER 12" COVER °~" . =:,i . 4 + ~ rr.:: ,i . ~ .: :' ... .. r' :,: :1' ~.: .".: . ELEVATION Tl ~~ T2 ~ 1 T3 V IN SITU SOIL QUICK 4 STANDARD TNF.I.LTRATO.R DIMENSIONS: I~IGI-IT 12" LAYING LENGTH 40" WIDTH 34" D .~" ~, POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of Z FILE INFORMATION Owner ~L ~ $.~-~~O Permit # ~~ DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units A Estimated flow (average) ~ allda Design flow (peak-, (Estimated x 1.5) (~ al/da Soil Application Rate , al/day/ft2 Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODE) 5220 mg/L ^ NA Total Suspended Solids ITSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODs) 530 mg/L Total Suspended Solids ITSS) 530 mg/L ^ NA Fecal Coliform (geometric mean) 510° cfu/100m1 Maximum Effluent Particle Size Ye in dia. ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity 2 6 al ^ NA Septic Tank Manufacturer ~ ~.s' ^ NA Effluent Filter Manufacturer ,~ [,- ^ NA Effluent Filter Model ~ ~~ ^ NA Pump Tank Capacity ~-~-r-~ al ^ NA Pump Tank Manufacturer ---- ^ NA Pump Manufacturer ~~ ^ NA Pump Model ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ^ NA Dispersal Cell(s) ^ In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA Service Event Service Frequency Ins ect condition of tank(s) p At least once eve n'~ ^ month(s) (Maximum 3 ears) earls) y ^ NA Pump out contents of tanklsl When combined sludge and scum equals one-third IYaI of tank volume ^ NA Ins ect dis ersal cell(s) P P At least once eve ry~ z ^monthls) (Maximum 3 ears) / year(s) y ^ NA Clean effluent filter At least once every: - '~ ^monthls) year(s) ^ NA Inspect pump, pump controls & alarm At least once every: ^monthls) ^ year(s) NA Flush laterals and pressure test At least once every: ~ yea~ls)(s) ~A Other: At least once every: ~ yea~ls)(s) ~NA Other: NA MAINTENANCE INSTRUCTIONS 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 tankls) 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 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 focal regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) 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. 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 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 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 celllsl. 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. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result 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 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; gasoline; grease; herbicides; meat scraps; medications; oil; 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 lie 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. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: '~ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area wilt 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 be installed as a last resort to replace the failed POWTS. ^ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ^ 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. ADDITIONAL COMMENTS POWTS INSTALLER Name ~ ~fs3 ,/(f Phone Z POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name C p /S~ !mid /Ul// Phone ~~ This document was drafted in compliance with chapter Comm 83.221211b11111d1&lf) and 83.54(11, (2) & 13-, Wisconsin Administrative Code. ST CROIX COUNTY SEPTIC TANK MAINTEI?IANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~IJ ~ ~1 ~ T (~ S~~u-~ Mailing Address ,~(~ ~ 2~,,7`` ~J~~ ~ ~ ~/'~ ~(/~72. /~,4-E[;S (~/~~v~ Property Address ~~~~~ (Verification required from Planning Department for new construction)~~~ ~- City/State Parcel Identification Number ~ z C~ - /c~ Z- ~ Q ~_~~al LEGAL DESCRIPTION ~ P~~" o-~ ~ i Property Location ~ ''/a, ,~ '/a, Sec. , T~N-R~W, Town of (,(~SOn/ . Subdivision ~A9(LCo ~..I ~_~ ~~ u~~ ,Lot # s~, Certified Survey Map # - ,Volume ~ ,Page # Warranty Deed # ZS ~' Z 2 `~' g ,Volume 2 S ,Page # - ~~_. Spec house ^ yes ~ no Lot lines identifiable ~ yes ^ no SYSTEM MAINTENANC Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenar consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the systf can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and b} master plumber, journeyman plumber, restrictedplumber or alicensed pumper verifying that (I) the on-site wastewaterdisposal syste is in proper operating condition andlor (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludg Uwe, the undersigned have read the above requirements and agree to maintain. the private sewage disposal system with the standar set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certificaci stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within ; days of the three year expir 'on date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to dic best of m}~ (our) knowledge the property described above, virkue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF ~~_' APPLICANT I (we) am (are) the owner(s) ~/!'/~S DATE ****** A.ny information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****~ ** Include with this application; a stamped warranty deed from the Register of Deeds office a copy of the ccrtificd survey map if reference is made in the warranty deed ~~ U 285? P 561 I STATE BAR OF WISCONSIN FORM 1 - 2000 Document *~~ tuber WARRANTY DEED ~s This~'Deed, made between Matthew D. Hieb, a single person Grantor, and David Toctrted and Kimberly Tostrud~ husband and wife as marital property with rights of survivorship Grantee. - -- -- Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (the "Property") (if more space is needed, please attach addendum Plat of Willow w Bluff in the Town of Hudson, St. Croix County, 8 0 2 2 9 6 KATHLEEN H. MALSH REGIS'T'ER OF DEEDS ST. CROIK CO. , MI RECEIVED FOR RECORD 08/04/2005 10:15AN NARRANTY DEED EXE1~T S REC FEE: 11.80 TRAITS FEE: 383.70 COPY FEE: CC FEE: PAGES: 1 Area Name and Retum Address The First National Bank PO Box 89 New Richmond, WI 54017 Part of O]~-1028-00-001 Parcel Identification Number (PIN) _ This is not homestead property. ~~ (is not) Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and conditions of record. Dated this 28th s * day of July 2005 _ ~. * Ma ew D. Hieb AUTHENTICATION Signature(s) authenticated this _ _ _ _ _ _ _ _ _ _ day of , s • ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. St. Croix _~ County ) Personally came before me this 28th day of duly _ 2005 the above named Matthew D. Hieb TITLE: MEMBER STATE BAR OF WISCONSIN (If not, __ to me known to be the person(s) who exec ed authorized by § 706.06, Wis. Stats.) instrument and aclrnowledged the same THIS INSTRUMENT WAS DRAFTED BY * ~ _~-~Yt.- " William J. Radosevich __ Notary Public, State of WISC SIN 502 Second street, Hudson, WI 54016 i My Comtryss~ is p~ ent. (If not, state (Signatures may be authenticated or acknowledged. Both are not necessary J - ~R ' * Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN INFO-PRO (800)655-2o2t ~ FORM No. 1 - 2000 \` :19W ~~iss.as'' NORTH 1/4 CDR. SEC. 16 VD UMINUM COUNTY CORNER MONUMENT DOUGLAS ZAHLER SdtN LAND SURVEYING 2920 ENLOE STREET HUDSON, WI 54016 MATTHEW HIES 1271 140TH ST. NEW RICHMOND, VA. 54017 WILLOW RIVER STATEPARK_ UNPLATTEDI_ANDS_ LINE OF THE NE1/4 OF SECTION t6 S89'49'34"W 2626.79' N89°49'34"E 860.34' (Nea'~~1~) BM TOP Of IRON PIPE ELEVATION=851.9 3/8" OUTSIDE DIAMETER IRON PIPE OUTSIDE DIAMETER IRON PIPE /8" OUTSIDE DIAMETER BY 18" LONG IRON ;RING 3.65 LBS. PER LINEAR F00T T_R LINE ELEVATION DING OPENING -THE LOWEST DOOR OR 1EVATION SWAY SETBACK LINE UTILITY EASEMENT I RENTING ANO/OR DISTANCE )DRIVEWAY LOCATION LOT CORNERS D7 WI1H 1' WTSIDE DIAMETER IRON PIPE NEIGHING 1.13 JNEAR FOOT for the construction and ry overhead, underground or ding rights to conduct :, This easement shall have no nces, trees, shrubs or other th fnstollation, function, or :ms, Public utilities shall not age to prohibited obstructions. CATS L27 ~\ ~ ~ ` .. t`a ~ ` 1 ~ ~ 1 ~ w 1 W~ i N , 1 1 % ~ Z -' ~i w / M'W ~ / e iY t7: ~ ~~~ `~t Y ~` ~ _ ~`N / w ~~ 'a '~~,~,~„ro OR,q N ' A~ fA~ ~ . C ` ~ fNT sTTxtM-WATER 1 DRNNAl1E EASEMENT f HWE = 851.0 =+~ J ~ i LOT 4 ~~~~ 4.79 ACRES ~ 208,731 SQ. FT. ~ 'a / L.B.O.e 855.0 e / r/ ur_,/ LOT 3 2.88 A 1 0. FT. L.8.0.~ 855.0 ST. CROIX CO. WIS. R~.C~1ved for Record Ihia~„dry ofc-,LINP A-D.,20b~ Wa: ~o o'clalLe,M. Raorded in Volume D o[ PC~ NE Cd SEC. i LOT 5 2.21 ACRES 96,149 S0. FT. L.B.O.= 655.0 ~ ~ is Td"~ f'~~M~` r, v ~ ~ fNT ~ ~~ s~ ~ ~~ ~ C ~ ~. \ \ o \ \ ~ ~- ~ \ \ \ 1 \ iC= i ~ ~. / ~) i C? ~, ~ GRANGE ROAD n -_ ~ ~ u -~- _ _. nDtED WISCONSW LAND SURVEYOR, HEREBY CERTIFY: TN THE PROVISIONS OF CHAPTER 236 OF THE SUBDIVISION REGULATIONS OF THE TOWN OF :CITON OF MATTHEW HIES, OWNER OF SND LAND, I MAPPED VALLOW BLUFF; THAT SUCH PLAT E%TERIOR BOUNONLES AND THE SUBaN510N OF IAT THIS PLAT IS LOCATED IN THE NORTHEAST OUARIIR OF SECTION 18, TOWNSHIP 29 NORTH, OSON, ST. CR01% COUNTY, WISCON9N, BEING LOT 1 VOLUME 8, PACE 2225; CONTNNINC 14.43 ACRES FOLLOWS: r CdiNER OF SND SECTION 18, ALSO BEING THE LOT 1; THENCE ALONG THE EAST UNE OF THE SEC110N 18 S00'22'21"E A DISTANCE OF 12BZ50 RIH LINE OF McCUTCMEON ROAD S89.58'27'W A ENCE N00'22'21'W A OISTNVa: OF 181.82 FEET TO A 185.00 f00T RADIUS CURVE, CONCAVE IRAL ANGLE OF 85'26'IY, A CHORD THAT BEARS 199.99 FEET; THENCE NORTHNESTERLY ALONG THE JCE OF 211.29 FEET; THENCE N85.48'33'W A (ENCE N21.35'12'W A DISTANCE OF 823.51 FEET; NE Of SND NORTHEAST QUARTER N89.49'34'E A 1HE PdNT OF BEdNNING. ' 2005 2145 NG AND ZONING COMMITTEE RESOLUTION ' WILLOW BLUFF IN THE TOWN Of HUDSON, '.EBY APPROVED BY THE ST. CROIX COUNTY REE. ~ ~J~~t;'~i~ DATE LOT 2 2.03 ACRES 88,829 SQ. FT. ,°t, L8.0.= 897.0 ` `C). BM TOP aF IRON PIPE e,,, ELEVATION=874.5 1 \ \ \ ~ '3,OR4W~ ~ \3p L32 ..~ ~. ~~ 3 / gSf,IIF ~ \ ~ j i C3o ~ ~~ OF W/gc0 / NT h ~ ~ ~ i Z / yP DOUGLAS J. S~ C, 3/t,BO. ~, 2AHLER Z ~ ~RTIt N6 ~~'' S4145 * FADS ,LET sO~r HUDSON, _~ \ ~ r~ LOT 1 2.00 ACRES 87,183 SQ. FT. L8.0.~ 897.0 t,u ~ \~~ STORM-WATER ~ DRAINAGE EASEMENT ~ ~ HWE = 895.0 ~'~~ ` ``\~p ~ CURVE DATA TABLE G:~88~ (ALL LENGTHS IN FEET) C/ Radlue Length Centrd Angle Chord Beaing Chord Length Me Length Tangent M Tangent Out C1 185.00 65'26'12' N33T)5'27"W 199.99 211.29 N00'22'21'W N65'48'33"W (N33~05'55"W) (N00'12'49'W) (N85'39'01"W) C2 80.00 45'04'10' N8750'18'W 61.32 62.93 589'37'39"W N45'18'11"W C3 80.00 270'08'20' S00'22'21"E 113.00 377.18 N45'IB'it'W N44"33'29"E LOT 5 80.00 34'14'25" N82'25'23.5•W 47.10 47.81 N45'18'11•W N79'32'36'W LOT 4 80.00 78'36'15' S61T)9'16.5"W tO1.J5 109.75 N79'32'36'W 521'51'09"W LOT J 80.00 56'58'07' S06'3Y54.5'E 76.31 79.54 S2I'S1'09"W 535'06'58"E LOT 2 80.00 67'28'32' 568'51'14"E 88.86 94.21 S35'O6'S8'E N77'24'30"E LOT 1 80.00 32'51'01' N80'S8'59.5'E 45.24 45.87 N77'24'30'E N44'33'29"E C4 80.00 45'04'10' N87Y)5'34'E 61.32 62.93 N44'33'29'E N89'37'39'E COUNTY TREASURER CERTIFICATE IRON PIPE ,Lp?, `. .I `~` ~``` Cf ~` .` STATE Of N15CONSIN) = N •5 -.f J• DS couNTY of sr. aTax>ss. g M DALE I, CHERri 51JND, BONG THE DULY ELECTED. QUNJFlED AND ACTING K s TREASURER OF THE COUNTY aF ST. CROIX, HEREBY CERIFY THAT THE ~ .~