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Home My WebLink About020-1116-20-000Wisconsin C)epartr'hent 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)]. Permit Holder's Name: City Village X Township Ender, Keith Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: tM ~ GS-j- TANK INFORMATION TYPE MANUFACTURER ~~S CAPACITY Septic ~` e~` ~ ? /~O Si~Ca,c.J 3 ~ ;~~ ~a ~~... ~~18 Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~' ~ ~ 2 I ' 7 5~/ ~ 5 ~ ~ 7 Sys' 39 ~ 5~,' Aeration Holding PUMPISIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System H Ft Forcemain Length a. Dist, to well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. CiroiX Sanitary Permit No: 506272 0 State Plan ID No: Parcel Tax No: 020-1116-20-000 Section/Town/Range/Map No: 19.29.19.480 STATION BS HI FS ELEV. Benchmark ~ . $~ ' A~•~ W /~ Alt. Bltd.-~~ GOJ 3 .a5 dZ .~ Bldg. Sewer ~ ~ ~ .N ~ SUHt Inlet ~ .~Z M . ~~ `~`~ utlet 3Za ~.. .~ 9 9,D5 3 Zb Dt~ ~I~- 7 ~ ~~ a p / D ~ 7 Header/Man. $ • ~ -J 7~ Z~j Dist. Pipe ~ 1~ ~ ~~ Bot. System p • q~ ! Final Grade ~ ~ 1 ~/ , /~ St Cove~,1 / _ 3 . ~~j ~ dZ ~L . 5 49~ 35 BED/TRENCH DIMENSIONS Width / ~ Length 1~ ~ ~ No. Of Trenches ~ PIT DIME,~ISIONS No. Of Pits Inside Dia. '~- Liquid Depth ` ff 3 I , ew `_ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING ManufacturerT-r ~~ 1 _ I MATION CHA E OR ~~ ~l+~A'`~ t'~W" INFOR TypeSJfS~ y~;~~ ZJ 5~ ~ ~~ ~~ UN T Mode DISTRIBUTION SYSTEM I Number: ~.~~ Header/Manifold Length Dia ~ Distribution Pipe(s) ~ Length Dia ~ Spacing x Hole Size \ x Hole Spacing ~ Vent to Air In ke /'~~ Z ~" SOIL COVER Y Praccura Svctams only YY Mnund Or At-Grade SVStems ~nlv Depth Over ` ~ Depth Over ` xx Depth of T il xx Seeded/Sodded xx Mulc ed Bed/Trench Center ~/. ~~ Z Bed/Trench Edges opso ~ ~es ~ No Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / Location: 885 Willow Ridge Rd. Hudson, W/I 54016 (NE 1/4 NE 1/4 19 T29N R19W) Willow Ridge Addition Lot 5 1.) Alt BM Description = ~, ~~ G~ J'am`" 2.) Bldg sewer length = ~; 3~~ - amount of cover = Plan revision Required? ^ Yes ~lo q ~ ~ ~' Use other side for additional information. ~ _ , G• 1b ~ SBD-6710 (R.3/97) Date Insepctor'; Inspection #2: ! !_ Parcel No: 19.29.19.480 ~ 3i~`~ _ J _ ~_1._._ _ _i Cert. No. ~'v Ctxnmerce.wi.gov Snteh- urxl Buildings 1)i~-isiun Count}' ~ ~ 201 W. Washington Ave., P.O. Box 7162 . ~ j X i s e o n S ~ n Madison, WI 537 162 Sanitart- I'ernrit Number (to bz fillzd in b~- Co. ) / n 7 " . Department of Commerce S( / ~ o C ~ ~ Sanitary Permit A 1O1] State Tramaaction Number ~ In axordanci with s. Conrm. 8~?1(?). ti"is. Adm. C'odz. submission of this f ~z appropriate go~-zrnmzntal ~ unit iu riquirzd prior to obtaining a sutitar~ pzrntit- Noti: Applyial~ orros for statz-on-nid Pt7\i'I'S are Projzct Address (if different than mailing address 1 submitted to the Lkpartntznt of Comment. Personal intiim~ation }-o sis in accordanx n ilh fhi Pticacc Lan . s. 15.( 1 m ). Stats. S a ~~n I. a 'cation Worvtation -Please Print all Womt:ttion U ~ ~ Property- (:h1-nzr's Namz ~(1d~ JUL 2 3 2007 Parcel OZO - I1l(o - ZO-oo ~ Prapzrh- Chcnzr's 1\lailiug Addrrvs ~~~ w f "~~ l~d I ST. CROIX COUN Y Propirri- Location C • ~ Govt Lot l'ih- St d i (] 1 . atz 1 ~ ( ~ Z p Lo i ~~ '~ '~ ~~ N E ~/., ~'/y Section "~ cleone) ~ ~+ bj ~ R ~ E ~ W T ~ N IL Type of Building (check aU that apply) Lot ~ ; 1 or 2 Fa il Dwelli ~ -N b f B d ~ i<-isioa Namz S ubd m y ng um er o e rooms 1 r ( ~ , /ST Block - ,, ~, w ~ 1 ~ ~~ 1~l ~~,t 1 lll/ ^ Publie/Commercial - Deacnbe Use ^ Ciri- of ^ State Owned -Describe Use CSI\I Number ^ ~-illagz of ^~'~ Ton-n of SVn IIL T ~-pe of Permit: (C9teck oid~- one boS on lme a. ('ompletr line B if applicable) ?,. ^ New System Replacimznt Scstim ^ Treatment/Holding Tank Replacement Only ^ Od-er Modification to Existing System (expkin) B. ^ Permit Rinin-al B f E i ti ^ Permit Revision ^ Changz of Plumber ^ Permit Transfer to Ne~~- List Prz~-iovs Permit Number and Date Issued ~~ ~ ( - ~ 6 e nre xp ra on Owner j - ~ ~j 7 R". T ~ of PO~1TS Sti-ste~n/C'ont nent/De~ice: Check all that a h- Non-Pressurizzd 1n-C;rcound ^ Przssu zd In : und ^ .a t Cir ad z ^ in. of sue ~soilr, on n ~ ?•t u ~sui ~~ ~ p p p ( ~ ~ ( ~ ~ ~ ~ ~ ~ ~ ^ Holding Tani' ^ CHhzrDis etsal Com onznt z_- lain) ~~"~'~"^ Pre eatment )i~ c ~ ~~. naVTreatment ama Wotwafion: I)zsi (gpdT Design Soil Application Rate(U dst) Dispersal Aria Rzquirzd (sf) Di~epirsal Arca Proposed (st) System Eli~-ation ~ s°~ .~4 8~~. ~- ~s, ~s ~-L Tank Wo t apacih- in Galloffi Total (ialloms = of Units 1\Ianufacturer ~/ ~''~ ~ ~ ~ q'"~l ° o Nric Tant;.s Evstu~ T.u>ds /} .. ~'~^ b{ • ^'/ ~ ~, `~i o ff: U 8 ~ 8 r f~ ° 7 ( 0 r n w . .~ ~~~~ or x„I~ Tanl ~ Qp ~QO ® ~~ 2 ~ i~ Dosu~ Clxw~hrr ~ II. Responsibilih- Statement- I, the undersipped, assume responsibilin~ for installation of the PO~t'TS shown on the attached plans. Pl ber's Nanti (Print) Plumbzi s ,'- afar TIP 1\IPKS Number Businzss Phonz Number Plumber's Add re ss (Streit, C -. Stat e .Zip Cock) ~ - ~J ( ~ ~(~p ~~ ..J (fi t3tl'S t=l\V~ S~ LSZ. ~/'u ~ ~ -Tq -III. C' h-/De artment iTSe Onh- ed ^ Disapproved Pzrmit FcY 'n' Dati said Issu- g ~znt Sionatu ^ t.)naer lief-en Rzason for Dznial Ll. C'onditionc of appro~-al/Reasons for Dicappro~-al ~ s,~~~- /~~ SYSTEM OWNER:-. .d ~~ y~ ~~ effluent filter and tic tank 1 Se , p dispersal cell must all be serviced /maintained ~~ Clq,f.. (,(/(~ t l 'd d b I b as er mans emen pan prove e y p um er. T 2. All setback regUlt~F11~ nd wree-it to c'ouoh- on(<- oo paper less tlwin $1/_' s 11 inches m size as per applicable code/ordinances. _~~ ~ ~Z~ ,,G~Q~h~ SBD-6398 (R. 01/07) Valid thru 01/09 ~ ~~ ~~ ' PLOT PLAN I ~, Driveway Aspen VewCircle~ ~ \~ 885 ` I `~ ~ `~ ~` I ` i _ \ m ` I ~ :o \ ~ rr ~ ~ ~ ~~ I Pool ,,sue' I ~ Existing drywell I I i I 4 Bedroom ~ Dvuelling T Existing 1000 galbn ` concrete tank Liquid Level =99.05 tank 42 Cluick 4 Ir>fi 14 in each cell 15 ei6 Slope ~~ ne~shl~;~ ~,.selis W~In ~~ O~ G{tdi~{Gld N Scale 1" = 40' ~ =Benchmark -ELEV. 100' Top of phone ped -also HRP ^ = Sal Borir>Igs With Backtae ~ = Wirll ~ Keith Ender 885 Willow Ridge 1 NE 1/4-NE 1/4-S19-T29N-R1 Town of Hudson Parcel # 020-1116-20-000 PAGE 2 of 4 ' PLOT PLAN I Driveway Aspen view Cirde~ ~ t385 ~ `~~ ~ \ . \ . i w v i ~ ,~ >,~' I ~ Existing d II ~ and drainf Id~eo-I>s- I gal tank 4 Bedroom h Be GF10 r Dw~lx~ ~ ' Existing 1000 gallon ~ concrete tank Liquid Levet =99.05' ~15 % Slope ~ 42 Quick 4 tnfi 14 in each cell NO nei ~ hbar ~ ~ vsel K B"" whin ~~ of drd~~caal 01' N Scale 1" = 40' ~ =Benchmark - ELEV. 1 ~' Top of phone ped -also HRP ^ =Soil Borings With Backhoe ~ = WWII Keith Ender 885 Willow Ridge 1 NE 1/4-NE 1/4-S19-T29N-R1 Town of Hudson Parcel # 020-1116-20-000 PAGE 2 of 4 ' ~ f'Oll~f/1 EVALUATION REPORT Department Of Cammetce in a ance with Comm 85, Wis. Adm. Code Division of Safety and 8uitdingsd~ ~~~~ Page 1 of 3 Attach complete site plan on paperthan 1 inches in size Plan must County . include, but not limited to: vertipl and horiz reference mt B direction and St. Croix Po (~' rcent slo pe pe, scale or dimensions, no mover, and option and distance to nearest road. Parcel I.D. PJease print a 020-1116-20-000 Personallnformation Re wed ~ a~ You Provide may be used Law, .15.04 (1) (m)), Property Owner P ~ Location Keith Ender JUL 2 3 2007 Go Lrn NE1/4, NE1/4, Sts T29N R19W Property Owner's Mailing Address ~g~~ ( J~ ~~ ~ ~ ST CROIX COUNTY , , Lot Bbdc # Subd. Name or CSMa; / ; gtN . 5 Willow Ridge Addition Cdy S Zrp S9n ~ ~ Cry ~ ~Ilage ®Town Nearest Road 608-225-8264 Hudson i Willow Ridge 1 ^ New Construction l7se: ~ Residential !Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement ^ PubGc or commercial -Describe Parent malaria Glaciofluvial Deposits Flood plain elevation, if applicable NA General comments and recommendations: Site is suitable for Conventional system @ .7 loading rate. System elevation for Area 1 is 95.55'. System elevation for Area 2 is 88.T. goring # ~ Boring ® Pit Ground surface elev. 99.OS ft. Horizon Depth in. Dominant Color Mur-setl Redox Description Qu. Sz. Cont. Color Texture 1 a7 7syr3/2 ~I 2 7-26 7.5yr4/4 ~ 3 26-38 7.5yr4/6 s 4 38-42 7.5yr4/6 ~ 5 42-56 7.5yr4/4 grs 6 56-106 7.5yr4/4 --- s 30°k gravels in 5th horizon Boring # ~ Boring P it Ground surface elev. 101.35 ft. Horzon Depth Dominant Cobr Redox Description Texture in. Munsetl Qu. Sz Cont. Color 1 0-10 7.5yr3/2 -- ~l 2 10-36 7.5yr4/4 sl 3 36-48 7:T,~yr4/6 s! w/s 4 48-52 7.Syr4/6 grvcos 5 52-121 7 5 4 ft. Depth to limiting factor 106" in. Soil application Rate Structure Consisten Boundary Roots GP D/R~ Gr. Sz. Sh. 'Ettlkl 'Eff#2 2mabk mfr a 3m .6 .8 2mabk mfr rs 2m .6 1.0 Os9 mfr gw if .7 1.6 0-t- mf as if .5 1.0 Osg ~ mfi as ivf .7 1.6 Osg ml -- -- .7 1.6 Depth to laniting factor Structure Gr. Sz Sh. Consister 2mabk mfr 2mabk mfr 2mabk mfr ~9 ml • yam/ -- s psg 3rd horizon is stratified. 5096 gravels in 4th ml 121" in. Solt Appliption Rate Boundary Roots GP Dlft= "Etf#1 'Efl# 2 rs 3m .6 .8 cs 2m .6 1.0 gw if .6 1.0 as if .7 1.6 -- - .7 1.6 Effluent #1 = BOD 5> 3p < 220 mglL and TSS >30 <_ 150 mg/L " E nt #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number CeCe Tesky 265824 Address ate Evaluation Conduced Telephone Number ~151)STra;15 ~.~d-51- ~ ct:: w~+ 5 £~g 7i1sr1oo7 715-403-97Z~ SBA8330 (8.07/00) property Owner Keitlt Ender Parcel ID ~ 020-1116-20-000 Page 2 of . 3' 3 Boring # ^ Boring ®p~ Ground surface elev. 94.15' ft. Depth to limiting factor 110" in. Soi! Application Rate ~ Horizon Depth Dominant Color Redox Description Texture Structure ""`- ~ ons ~ „boundary Roots GP D/ftz in. Munseil Qu. Sz. Cont. Cobr Gr. Sz. Sh. """~, , ' "^ `Eff~1 "Efl#2 1 0-10 7.5yt3/2 -- sil 2mabk mfr ~ ~.' ~ 3m .6 .8 2 10-33 7.5yr4/4 sl 2mabk mfr a 2m .6 1.0 3 331!6 7.5y'r4/6 s Osg mfr gw 1f .7 1.6 4 46-56 7.5yr4/6 Ifs Om ml as if .5 1.0 5 56-55 7.5yr4/4 gtvoos Osg mfi as ivf .7 1.6 6 65-110 7.5yr4/4 s Osg ml - --- .7 1.6 50% gravels in 51st horizon ^ Borin # g ~ Boring ~ pg Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Cobr Redox Description Texture Structure Cons~tence Boundary Roots GPDIftz in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh. 'EtP#1 'Eff#2 ^ Bori # ~ ~ Boring ~ P8 Ground surface elev. it Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Cobr Redox Description Texture Structure Consistence Boundary Roots GPDfftz in. Munseil Ou. Sz. Cont. Cobr Gr. Sz. Sh. •t~tt "Efl#2 * Effuent #9 = BODS> 30 < 220 mg1L and TSS >30 <150 mg/L "Effluent #2 =GODS < 30 mglL 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. SBD-8330 (R.07f00) ' SITE EVALUATION _~ -~___ Driveway Aspen View Cirde~ ~ `~ `~ i \ ' \ . \ . i \ ~ `~ ' ~ i ~ ~~ N Scale 1" = 40' ~ =Benchmark -ELEV. 100' Top of phone ped -also HRP ^ = Sal Borings With Bacld~toe -~ = Wtrll Keith Ender ,J U 885 W{I{ow Ridge 1 NE1/4-NE 1/4-S19-T29N-R1 Town of Hudson Parcel # 020-1116-20-000 PAGE 3 of 3 ~ N O ~ ~ ~ ~ ' ~ ~ 0 O Yf ~G , i ~ 3 ~ '0 ~ ~ ~ N ~~~ CI ~ 'a ~ ~ ~ 3 ~: 3 K .. ~F cn z= m o m m z -o m v, Z o o ~ ~ ~ o ~, ~ rn f 3 m ra ~ N ~ w o o a ~ Q o ~ ro ~ a ~ u, ~ a ~ p m -, v+ ~ N ~ o ap ~ ~ CD W ~ _ ~ C ~ N ~ N ? O m N Q- ~ 0 ~ ~ <n ~ ~ ~ 3 ? W ? O ', ? N O 0 0 i ~ ~ O ~ N n d ~ ~ p O O ! 3 ' O 3 d O I ~. OJ cn , 0 0 ~ ~ C o ~ C m I m ~ ' ~ rn Z D ~ a ~ ir. Z D S a o m ~~; o~ a ai D '~ a f I ~ ~ W ~ I W ~ ~ ~ ^~ c°o o°o o _ ° ~ N ~ N p. ~ ~ ~ ~ 2 f /7 3 O C .. a a N ~_ 0 0 0 ° °' " Z O O O c I o n -D ~ ~ ~ y ~ ~ ~ ~ ~ ~ ~ !I _ ~ 3 a ~ i d O 1 .Z fD ~ ~ ~ 'I a fD n m ~ _. ~ I - d N - ~ ~ gy - ~ ' y ~ ~ d ~ ~ fD M ' - p N ~ w i n a Z °. W a Z m o i ~ ~ D o ' - ~ D I a ~ w ~ ~ O ~ ~ d ~ ~ m w ~ ~ m I ~. a m ~ o y ~ c ~ y p ~ c o i i C N D i C ~ ~ N i W ~ , ~ N Q ~ a 3 ~ I ~ o~ I p N p I N A ~ ~ C J ~ ~ i .. ' o N W ~ ~ m ~ m c ~ o a ~ ~ z . 3 r: ° ; 3 " ° ~ Z ~ i o 3 o 3 ',ilm m N Z N ~ i fD ~ ~ ~ W A ~ I I f~ (D i _ N 4~ ? pD. ~ _ ~~ Q N N n d ~ ~i ~ ~ ~ ~ ~ ~ ~ o co f ~ I . . 3 ° ' T ~ I , ~ ° ' T ~ C ' m ~ ~ - Z a I w ~a y - Z a I ~ O a O a O ~ I ~ 41 VI (p t /~ D.N ~ ~ O ~ (D O W a O v' O N N ~ W fD 7 Q ~ CAD ~ 7 = C NON dQ ~ ~ O < v 7 N ~ ~ p O ~ S 7 I N N N p ~ d ~ I CD y O ~ O 7 ~ 3 ~ ~ O : O v' i ~ Z 2 m Z get O N rii Q m N ~ a ~ a ~ O a ~ ro ~ cn Qp ~ ~ _ (D W _ 3 O ~ ~ ~ ~ n °~ ~ a o ~ v~ Z D CD cC, O N ~ ~ ~ .- CD L ., z 0 z ° C) 'o w c ~ ~ ~ ' ~ s o ~ ~ ~ 7 N ~ ~ a i Z ~ o A d O 3 @ 7 fD G W (D n ~ Z ~ y O N O ~ ~ o ~ ~ o > > ~ 3 `° v ~ ~ - ~ m d m 9 ~ ~: ,~ .. '', ~~ ~ O CO W N ~ C (O N O ~ N O O ~ ~ ' ~ ' ~ N V N ',i ~ I ~ ' ~ O O c . ~ o H L '. ~~ O y C d A O I, a ~' cn O O ~ O N ~ ~ Z1 m c' o ~ C~ r N ~ 0 0 m N ~ ~a 3 n v ~ ~ ~ _ w O O O a ~ ~ ~ o cn N fA fA ? c ~ v q g ' ~ _ a, I~ O1 y O ~ I ~ 3 m ~ _ °~ , y ~ a M .. a - Z (n Z ~ D ~ 3 w ~ O ~ CD N ~ y ~ C N CD a I J .~ Z O ~ ~ ~ ~ ~ ~- i {~ ' I _ Z ~ ~ 7 .. ', oov m ~tO ~ , -' Z c 3 i' ~ o z .• 3 ~' ~ ~ N ~ A ~ W ~~ D ~ C7 N a ~ _ x ~ ~ -~. ~. ~ T j a ~ _ C O ~ Z ~ d '~ O d II I ~ ~ N ~ ~ ~ W ~. O N ~ N 7 ~ a ~ ~ o ~- c c ~ ~ a ~ ~ ~O O A O ~ ' ~ N I o ~, O 7 CD O O O (D O ~. i GRAVITY CONVENTIONAL DESIGN Index and Title Sheet Owner Name: Keith Ender Address: X85 w v14~ '~~- ~ -~-~t,~C,~.Sc~l r ~ 1 Legal Description: NE '/4 - NE '/4 - S19 - T29N - R19W Township: Hudson County: St. Croix Subdivision Name: Willow Ridge Addition Lot #: 5 Parcel ID #: 020-1116-20-000 Index Sheet Page 1 Site Plan Page 2 Cell Cross Section Page 3 Maintenance and Contingency Page 4 Page 5 Page 6 Page 7 Page 8 Designer: Signature: License #: Date: CeCe Tesky 265824 07/20/07 715-403-0726 Designed pursuant to: In Ground Soil Absorption Manual for POWTS SBD-10705-P (N.01/01) >, ~_ ~ ~ ~ ~S- 11 I ~ Oo ` ~ ~- ~_ ~" 11] ~ ~ ~o ~ ~.fl N 4~ ~ m -a..-.~. N ~ a ` \ Q" ~' ~ i~ ~ I it a`' ~ N ~ ~ A at S~ ~k ~ ,sl W O rQ ~ ~ U ~ ~ ~ .~ o ~ ,~U ~>° ~, wa ~'~ ~~ ~ ~ o •~ o ~ o~ y rA po ~" M .~ V y w . Q II .-r U w ~i ~ n u b ~ U BFI 0 H II w 0 a H ~I II _~ -: -. . .~:' : Q. ...~ .. _. ~~ .•i _ `- ff ,r ~ - '' i ~. i~ .~.. .F ~ - ~ • •• 1 ai '3 ts~ BFI a, 0 .~ .~ O B POWTS OWNER'S MANUAL ~ MANAGEMENT PLAN Pase ~ of ~ FILE INFORMATION Owner Keith Ender Permit # ~ ~ -~_ DESIGN PARAMETERS Number of Bedrooms 4 ^ NA Number of Public Facility Units ^ NA Estimated (average) flow 4 0 0 aUda Design (peak) flow = (Estimated x 1.5) 6 0 0 aUda In Situ Soil Application Rate • ~ aUda /ft2 Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) <30 mg/L Biochemical Oxygen Demand (BODs) X220 mg/L X NA Total Suspended Solids (TSS) <150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODs) s30 mg/L Total Suspended Solids (TSS) 530 mg/L ^ NA Fecal Coliform (geometric mean) <1 ° 100m1 Maximum Effluent Particle Size '~ in dia. ^ NA Other: ^ NA *Values typk:at for domestic wastewater and septic tank effluent. SYSTEM SPECIFICATIONS Tank Manufacturer Unknown ^ NA X Septic ^ Dose ^ Holding vol. 10 0 0 gal Tank Manufacturer AK Industries ^NA x Septic ^ Dose ^ Holding vol. 5 0 0 gal Effluent Filter Manufacturer Best ^ NA Effluent Filter Model GF10 Pump Manufacturer X NA Pump Model Pretreatment Unit X NA ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Manufacturer Dispersal Cell(s) ^ NA X In-Ground (gravity) ^ In-Ground (pressurized} ^ At-Grade ^ Mound O Drip-Line ^ Other: Other: ^ NA Otner: ^ NA MAINTENANCE SCHEDULE Service Event Service Frequency Ins ect condition of tanks p O At least once eve ry~ 3 ^ month(s) X earls (Maximum 3 years) ^ NA Pump out contents of tank(s) X When combined sludge and scum equals one third Q') of tank volume ^ When the high water alarm is activated ^ NA Inspect dispersal cell(s) At least once every: 3 ^ month(s) (Maximum 3 years) X year(s) ^ NA Clean effluent finer At least once every: 1 . 1 month(s) x year(s) ^ NA Inspect pump, pump controls & alarm At least once every: ^ month{s) ^ year{s) X NA Flush laterals and pressure test At least once every: ^ month{s) ^ year(s) X NA Other: At least once every: ^ month(s) ^ year(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 (pumper). 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 a 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 local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equals one-third (3~) 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 fitters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of <12 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 (12/02) Page ~ of ~/ START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals that may impede the treatment process and/or damage the soil dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a Septage serviang operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surtace. During extended 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 and may overload them resulting in the backup or surtace 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) discharge; 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 be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks 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 re cement system: X A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ 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 pertormed 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 surtace. 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 t~C"Cr/ /~P~ZGS~ / POWTS MAINTAINER Name GJ Smith Excavati Name Phone 763-441-8888 Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name Name St. Croix County Phone Phone 715-386-4680 This document was drafted by the staffs of the Green lake, Marquette and Waushara County Zoning and Sanitation agencies in compliance with chapter ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND ~ J,~ OWNERSHIP CERTIFICATION FORM OwnerBuyer ~~~CY ~ ~ld?~ Mailing Address ~~~ W ~~, Property Address S~1 e- (Verification required from Planning & Zoning Department for new construction.) City/State -~~,~ ~1 ~ ( Parcel Identification Number ~ Z ~' ~ I ~ ~o -ZQ- p9~ LEGAL DESCRIPTION (~ ~ ~~6J Property Location t/a , N ~ t/a ,Sec. ~ 7 , T Z~ N R / ~ W, Town of ~ 0!1 Subdivision ~ ~ ~ ~~~ ~ d~ ~~ ~~ ~ ,Lot # Certified Survey Map # ~~ ,Volume ~^ ,Page # 7h~~err~e-~ Warranty Deed # ~ ~ ~ ~ ~ ,Volume ,Page # ~,/ ~ 91D Spec house yes n~ Lot lines identifiable ye 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 responsibilities 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 the 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. I/we, 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 the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we 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 watranty deed recorded in Register of Deeds Office. Numb bedroom SIN RE F APPLICANT(S) ?,a/~®7 DATE ***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 the warranty deed. (REV. 08/05) STATE BAR OF WISCONSIN FORM 2- 2000 Document Number I WARRANTY DEED THIS DEED, made between Michael P. Doody Sr., a single person, Grantor, and Keith J. Ender and Nancy A. Ender, husband and wife, as Survivorship Marital Property, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: Lot 5, Willow Ridge Addition to the Town of Hudson, St. Croix County, Wisconsin. * 8 5 6 1 3ii 9 1 ~~~I~ KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 07/24/2007 09:30AM WARRANTY DEED EXEMPT ~ REC FEE: 11.00 TRANS FEE: 783.60 PAGES: 1 Recording Area Name and Return Address: Edina Realty Title, Inc. 400 S. 2nd St. -Suite 1 i 5 / Exceptions to warranties: Hudson, WI 54016 Easements, restrictions and rights-of--way of record, if any. 809126 020-1116-20-000 Parcel Identification Number (PIN) This is homestead property. * Michael P. IDood Sr. ~• * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ST. CROIX COUNTY. ) ss. authenticated this 29th day of June, 2007 _ ;~,~„ i `vE~~Av t"i Personally came before me this June 29, 2007 the above * 0 ~ ~ named Michael P. Doody Sr., a single person to me Irnown to ~~ ~~~ be the person(s) who executed the foregoing instrtunent and TITLE: MEMBER STATE BAR OF W~ ~~~ ,' ~ ~ acl~towle a the same. (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY *Cheri Br Notary Public, State of Wisconsin Peterson, Fram & Bergman -Steven H. Bruns My commission is permanent. (If not, state expiration date: 50 East Fifth Street, St. Paul, MN 55101 2/27/2011 ~ (Signatures may be authenticated or aclmowledged. Both are not necessary.) *Names ofpersons signing in any capacity mast be typed or printed below their signature WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000 ul 20 07 14:20a :iJ SMITH EXCRVRTI]RS JUI. 19.2001 ~:~1PM EOINA REALTY HUUSt1N i~imnb~r+ saATS.;3r~ o,~ wrscoxsrN ~o~t z- aooo ~+VARRAl~'X A1~D 7~~YS riEEri, made ber~ccn lVfichncl P. Doody Sr., a si:agle person, C,?tanxor, sad ~eitb~! 7, Ends and Nancy A ~ndtr, husband and w1fe, as $urvivvralrip MauritaZ Property, Gzaatee. Gzammx, fdr a valuable coasideratioa, conveys and eta to CnanCee floc Following dRS~ribed =cal estate ~ St. Croix Cawcty, StritC bf W1aCOasiA' Lot S, GVillow Ridgo Addition to tbue '1'ovv» of Hudsen, Sr. Croix Cau~zty, V~lstoxvsin. F,arcpprtiotu to war~axies: )F'asameats, restriotions and xip~xts•a;Fwny ot"recard, if any. 7636310570 NU. ltlat Y. L p.2 RecorQing /1na Naa+e and l[eturn Ad ~diga Reelty 1'itfe, Ync. a40 S. 2"tl St. W SuiOC 115 IXUdson, WI Sd016 849126 oza 1116-20-000 rrrtel tdeatlllcation Number (l'W) This l~ homestaad prarltrrCy Acted t 's 29r1} day of , 20Q'1. 6 Mfcllael ri_ eedy * a~UTH~NTICA'[xON ~ ACKDtOAGMEN~ gi~na7ure(s) STATE OF WISCONSIN ) 5'X'. CItQ17c CvUlvi'X. ) ss. autib~eauticated tlsi9 29eti day of 7aaa x007 l,itiECj ~COti'~~ Pet~onally came baibre me this Tune Z9. Z007 tbk above itataed N~Lael p. Doody Sr., a side person m srAe ]~,bws1 to * ~c be floc pon(s) who executed the faa-egrying instxurrreat cad 'Y'I7Y.E; NIEMBF~R SaA'i'~ BAR Op ~'CS'~ IBC' C18~Y1 aglmowlc the same (~f ztot, autbarr-~-d >7y § 7~6A6, wis. Slats.) 1Cl>`;PS 1htSTRCJMENT WAS ~ YiY ~~ ' Notary Public, Start tsf Wiscontra Poterson,l2xa»~, & Bargn~ - 5tev_exi TT _13~nuss My coma8ssion is permanent. (lf not, stste expiration daft: 30 >;ast Plttlt Soccer, Sr. Paul, MN 55101 2/27!1011 ) __ _, {S~pnt[urrs may be aµiluartic~Otd or xclaw~vkdte0. aoth one not nacessaty.) "Ttamn OCpersons aigninP iq any oapauiry.nwc ba gT7aC ar ptiNra9 belM~+fheir airnatwa VVAR1lA1~'r'Y na:a'11 fi'r'A'~nc 1sAR Ow wtsCONSTN s'or3mr No.2-70A0 ' Parcel #: 020-1116-20-000 05/30/2007 10:54 AM PAGE10F1 Alt. Parcel #: 19.29.19.480 020 -TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O - DOODY, MICHAEL P SR MICHAEL P SR DOODY 885 WILLOW RIDGE I HUDSON WI 54016 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description " 885 WILLOW RIDGE RD SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 0.750 Plat: 2626-WILLOW RIDGE ADDITION SEC 19 T29N R19W WILLOW RIDGE ADDITION Block/Condo Bldg: LOT 5 LOT 5 Tract(sj: (Sec-Twn-Rng 401/4 1601/4) 19-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 11 /29/2006 839693 QC 07/23/1997 899/566 07/23/1997 874/10 07/23/1997 870/212 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.750 39,800 253,500 293,300 NO Totals for 2007: General Property 0.750 39,800 253,500 293,300 Woodland 0.000 0 0 Totals for 2006: General Property 0.750 39,800 253,500 293,300 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 206 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 . liisooasin Depat .d Sooial Seto ' Plb. ~67 3/70 Division o! Healts. SEPTIC TANK PERMIT APPLICATION ` TYPE or llS8 BLACK INK ~ZO~ /~~~- ~b~/f~i-]l /.. 7i7/S - `` ,,/ ~ ~J/ ~ W ~ ~ ~~~ ~~ . A. ,OWNER OF PROPERTY Name Address (Street, City, Zip Cods) . ~~,, G'/~ K I .~ L ,r~SD~L~~ ~' B• ~ LOCATION OF PROPERTY Wf~RE SYSTEM WILL BE CONSTRUCTED ALTERED OR E7CTENDED COUNTY ~~S/~ ~~ ~~C Check Ones ~~/ -/ _ ~T %9 ~ ~t-~ (~,, PTI023 Ll~T ~ ~%/~~ I~ I CITY VILLAGE LEGAL DESCR y - ,/ ~_ TOWNS HIP ~~ ~ " ~ ~' ~ l ~ lL1 C _ /~~ t~ r 1 ' ~ ~ ~ _ ~ { v - ~ /i C. ~ IS LOCAL PERP:ZT REQUIRED FOR THIS WORK? /~ YES NO _.~L_.L ~ PERP`IT NUMBER D. SEPTIC TANK CAPACITY ~ ~~~_ Gallons NEW INSTALLATION REPLACEMENT ADDITION MATERIALSs Prefab Concrete x Poured in Place Steel Other •NUMBER OF TANKS 70 BE INSTALLEDs / S. TYPE OF OCCUPANCY. ~Cheok Ones One or Two Family Residence ~ Coansercial Industrial Other Speoify) lli~snber of Persona to be Accommodated . ~_ Number of Bedrooms ~_ F. APPLIANCES, ETCs Food Waste Grinder YES ~ NO Automatic Clothes Washer YES NO Dishwasher ~ YES NO Automatic Potato Peeler YES NO Other (Speoify) G. MASTER,PLUI^,BER MAKING INSTALLATION (I ^~ I =~~- ~J// ~.c',~ ,S/~ Lioenss Number: Names ~ 1~, j~„~'I~, l(, (~ ~, Address s ~ -' l i ~~ e s ~~ ~ - Kp ~ `~ ~~ Signature of Appliosnts ~r, f • ~~ ! -' ~-'~-'~~-'~- ~ RSW --~-~+ H. To be C plated by .Issuing Agent) Date of Application ;~~~ ~ ~ D Fee Paid ~ /~L ~ ~~~Ti Permit Number ~ C~ C.~ Permit Issued (ate) '_1. /Q ~ ~/+~ (/ . 7L C ,t, ~,/ Pors~Z .' ('.c l'..Z~i(-/~ Agent (Name) ' , County, etc. Town, Village, City, (Specify) Note: The applioation cannot be considered. far filir~ until all of the above questions are answered and the fee paid. Agents still forccard application, the fee of $1.0c, for each ssptia tarot sad the third oop~ of the permit (oanary) to the Division of Health. Checks and rooney orders should be made payable to the Division oP Health. Do not srrit• in space below - FOR DEPARTMENT USE ONLY L ~ DATE RECEIYID ~' ~ -~ /1 ACCEPTED BY ___._~ L RETURNEfl ~ ~" (Initials) (Date) 5~~,e Co}'res. FEE RECEIVED ~ VALID.. No. Q ~ _~ ~? PERt1IT N0. `7i I/~l es or No REVIEWED HY APPROVED DATY (Initials) Yes or No COMPLETE 0?FD:R SIDE 'r + - SEPTIC TANK PERMIT N0. ~/`~" '~' REPORT O N SOIL P E R C O L A T I O N TES T AND SOIL BORINGS ?0 DIYISION OF HEAL?H - PLLYIDING SECTIbN P.O.Boz 309, Madison, W1a. 53701 . Pursuant to B 62.20, Wia. Adainistrativa Code PERCOLATION TES T Test Depth Charaoter of Soil Hours dater Reat Time Drop in Water Level Inohes utes Number Inohea ?hiolmess in Inohes Sines Hole in Hole Interval Second to Next to Last To Fall. 1st Wetted Overni in Minutes Last Period lust Period period One<Inch Example P - 0 36" To Soil 10" Cla 26N 25 Yvs or No 30 1 2 1 2 1 2 60 ~ ,,~' C „ ~ .. .. ~~- _.~ '~~ its ~, ~ ~J f~ RECORD DATA FROM MINIMUM OF 3 TEST HOLES Compute size of absorption area in accord xith H 62.20 Wis. Adainiatrative Code. SOIL BORINGS - Hinimvm 36" Halax Pro osed Abao Lion S stem Boring ?otal Depth De th to Ground Water De th to Bedrook Number Inahsa Observed Estimated Observed Estimated Character of Soil xith Thioknesa in Inches Exaaple B - 0 ~ 72" 72" Black To Soil 12" C 18" Sand~18"• Gravel ?4" ~~ i ~ ~ ~ '4JC~_ '~h~ ~l~:o-~~ + ~ ~ t` ~ RECORD DATA-FROM MINIMUM OF 3 BORE HOLES PE OF OCCUPANCY: `, NC b 5ID f d ~ AE E Es Nwa e r o roo3s Be OTHER: (Speoify) Number of Persons D 41ASTE GRINDER: :Yes No ~ Diahxashert Tes ,~(_ Ho i'~ Automatic clothes ilashert Yes ~ No ~~ FFLUENT DISPOSAL SYSTEMS NEW ~` EXTENSION ADDITION ~~ REPLACE'KEf'i 1T Tile Size ~ ~ No. Lin. Feet Trench Width Depth Number of Lines Seepage Beds Length Width Depth Tile Size Nc. LSnes Seepage Pits ;. Inside Diameter ~~ Liquid Depth ~' . Is the undersl3ned, hereby nattily that the percolation testa reported on this fora xere made by me or under ntiy super- vision in aaaord xith the procedures and method specified in Chapter H 62.20 (13}, Wieoonsin Adaiaiatrative Coda, and that the data recorded and location of test holes are oorreat to the best of my knoxledge and belief. NAME - ~t 21~C~ ~. ~l,l. ~ rrru ~ ' ~_~ ~ J Type or Print ~~ y ~~ REGISTRATION DIO. or MASTER LUI~1 R LICENSE N0. ,1 ~ ADDRESS 1 ~ /~- ' ~ ~~ ~ .~t .f' ~.S.i~' t ~_ ~L DATE ~/ .,~ ~/7C SIGNA'NRE ''/ .. .L*t.- ~Z/ ~ /L4-1..~.~-• ~ b ~ , . ~ . ~ ~~ ~f ~ ~ ~ ~~ ~, , ~ ~ ~ ~ ~ ~ C,~ ~~, s3~- 2 ~~ y~ z ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to c rtify that I have inspected the septic tank presently serving the ~~ S~ ll,~c.«,J ~~~~ / residence located at: ~ 1/4, ~I~i/4, Section ~ Town~N, Range /9 W, Town of /~UL~Sa /~-~ , St. Croix County Wisconsin. Upon. inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of Comm. 84.25, and it (they) appear(s) to be functioning properly. Most recent date of service ..) z5 Zo0'7 ~~ ~~ Did flow back occur from absorption system? Yes No )( N'`~~'~~/~ (if no, skip next line.) Approximate volume or length of time: gallons minutes Capacity: 1 QO ~ Construction: Prefab Concrete X Steel Other Manufacturer (if known): U~l1Kflpc~xl Age of Tank (if known): f 9 70 1e%)/h~rvf 9/~d I (~,C~ `TeS ~~/ (Licensed Pl ber Sign re) (Print Name) MP ~. S Zb ~ 8z4 (Title) (License Number) MP/MPRS `~ Iz~1o ~ (Date) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code)