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Home My WebLink About020-1260-70-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORII~'IIATIO+N (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 Rudy, Roy & Alene Hudson, Town of CST BM Elev: Insp. BM Elev: / BM Description: ' cam ~ ~ 1 G~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ ~ ~": ~1~ 3 ~ `' 1~~~-~ R; Z (c~ ~ ~~ Aeration / ~ti ~ of Ing TANK SETBACK INFORMATION en o it n a e ep Ic ~^ ~ ~C'~~ ._ ~`` 7~~, $I ~ ~~~ 7 ZG' era ion o mg PUMP/SIPHON INFORMATION anu ac urer eman GP o e er I nc Ion oss ys em ea orcemai n JVIL HG.7VRr- 1 IVIV J i J 1 GIYI ~ n ~,~ / County: St. CrOIX Sanitary Permit No: 488164 0 State Plan ID No: Parcel Tax No: 020-1260-70-000 SectionlTown/Range/Map No: 21.29.19.1260 ELEVATION DATA STATION BS HI FS ELEV. Benchmark ~ 7`~' 1~2 ~ 7`i / ~ Alt. BM ~,1,'~--, ~ Cb,~~.- ~ . ~i . 3w Bldg. Sew ~~a~" / t ~' a ~'k.. ~ ~ ~~ t t ut et r ~ ~~~ ~+r ~ ,p~ 1~ .~Z t ~ c.. Ch3ar 7 `>~ 25' ~ ~ o m .~ ~ ea er an. is. Ipe ~:~~ ~T ~T3 o. ysem qJ~ ~~.~~ Ina ra e r r~ , ~~ over -t~ G.xI'`7f•'~ ~3.5 9! , 3 io \'_ DIMENSIONS ~ ~ 5~,~~ 3 Te~~l~ ''~~~ i "~\ '•--.~` INFORMATION CHAMBER OR ~/'d'1~ ~~tw~ n ~J ~~yy ~~'~/+ /ASP/'r /~/~y~~ UNIT /~ VIJ 1 I[IGV I IVIV J i J 1 GIYI r•.,A.~-- y 7-/('t'+' 7 -' G. '~ v~7-cJ~ T'/ Length / Z Dia Pipe(s) ~ Length Dia \ Spacing~_ ~ ~`'~ Z : ivy ~'' ~VI~ vvY L.r~ x rressure ayscerns only nx rv~~unu .,~ .+~-.+~au~ „r~.`~:~~ ~~~~~ Bed/Trench Center f- ~~ ~ BedlTrench Edges ~ Topsoil \ Yes No Yes I No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspecrion ~c ~ ~ Location: 560 Stagecoach Tr_aill Hudson, WI~54016 (NW 1/4 SE 1/4 21 T29N R19W) Prairie Vista 2nd Add Lot 21 Parcel No: 21.29.19.1260 1.) Alt BM Description = ~'~'`~~^'~~ "~'~ ~6V ~'"'~'~ ~~ ~~v ~C 2.) Bldg sewer length = ~~~~, JJJ , t1~„ ~~;(? k, - amount of cover = ~-+~~~d"1 ~~~ ~L~Z-~- L j t ' f'~ea.~ G ~ ~ i~ ~~' Use othesls de foruadditional informatio?n. o ~ ~ `" ~~~ ~~ -- I Date- i - ; --Insepcto ignature _ _ ~ Cert`. Na ~__ SBD-6710 (R.3/97) P A t n Safety and Buildings Division ounry m ~ 201 W. Washington ., x 62 ` S-T ` `$~'~~S",~ Madison, r„ ~ (fig) 266-31~~ sir ~,® Sani Permit Number (to be filled in by CoJ , / - L~ Qe artment of Cornmerce ~ / rp T Sanitary Permit Applicati n c stet` Plan l.D°. Number In accord with Comm 83.21, Wis. Adm. Code, you e ® ~ L006 personal informati may be used for secondary purposes Privacy Law, x15.04( xm) Proj Address (if different than mailing address) ' ~'"i. Cft0'N. CCUN , Scw. 2 I. Application Information -Please Print All Information ,. .. . ~~ Q 5 t•'a~tC. ~`~ a Property Owner's Name ~ Parc~ Lot # Bl~k # D (.w.) Pro Owner's Mailing Address ' P op e rt y Location r / ~ ~ am ~ ' ~ 5 ~ City, Ste Zip Code Phone Number -d ~•• Section ~~ ' ~• (circle I T of Buildin (check sit that l . g app y) t+~~ ~ I ~+ Subdivision Name CS M N b or 2 Family Dwelling - Number of Bedrooms '~ ~ um er ~/ ~ ~ ^ Public/Commercial -Describe Use _ I ^ State Owned -Describe Use ,~~ !/2.~ (~,~ 9 } ~ + ~ ~ ) ~ w,(pc,(c~ ^City^^Village ~'ownship of yu.d s°,~ III. T ype of Permit: (Check onl one boz on tine A. Complete line B if applicable) ~ Z ,,,, '7~ ~~ A' ^ New S stem y eplacement System ^ Treatment/fiolding Tenk Replacement Only ^ Other Modification to Existing System B• ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New List Previous Permit Number and Date issued Before Expiration Plumber Owner S~~~p ~ ~ IV. T of POWTS S stem: Check sll that a 1 Z$ i,.F; l i-ro.,~o ~ _ Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pala Sand Filter ^ Constructed Welland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculatin Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (e lain) V, Dis ersaUTreatment Area Information: Design Flow (gpd~ Design Soil Application Rgte(gpdsf) ~ Dispersal Area Required (sf), Dispersal Area Proposed (sf) ' System Elevation ~~~ ~s / 2(~.gC~ 8 43,s~ Vi. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber plc Gallons Gallons of Units Concr~e Constructed Glass New Tanks Existing Tanks / ~/ ~w Septic or Holding Tank {, l 1 a Aerobic Treatment Unit Dosing Chamber VIi. Responsibili Statement- I, the unde eel, a~atne nsibility for instalfaUon otthe POWTS shown on the athcbed Ian. Plumber's Na Print) Plu 's Sign T ' MP/MPRS Number Busirtess Phone Number , a ~ o ~~-..fib - t~zv Plumber's Address (Street, City, State, Zip Code) ~" ~ a ~ /lf o Gv.Z- .~-'. ~ l h VIII. aun / De art nt Use Onl p~v~ ^ Sanitary Permit Feo {includes Groundwater Date ssu Issui Agart S' ' ^ Suteturge Fec) ~~ T ~ ( ~ 3 er iven R n for Denial . ~ IX. Conditions of Approval/Reaaons for Disapproval Slf=TEM OWNER: 1. tank, effluent FNter and dispersal ced must all be sorvices / Itaintahlad ~ PK -~ P~ Provided by plumber. 2 All eebaclc ~ must a makthMted as par applcable cod. ~ ordllwtcaa. wtacn comprete pram tto the t.omtry only) for the system on paper not leas than 91R x I1 inehq in size SBD-6398 (R. 01/03) ~io~ ~a~ ~Me ~~~~ ~ud~ ~ Tm 1~uIVlees~e~ CC~GATIOn St,o s~~ ~~p ~~, r~) G 'Geese ~a~d o ~ q ~. ~~-~ ~~~ ~ ~ ~ti-~ ~3~ Q~11 Rum Vo~vc _. A~~;r,,~ ~Gl7r~~,~ ~ la A-~UO~"~+~ ~i ~ ~Xis~'itiy -t,ovypy n1 N ~~ S inaF"~1, ~ C~.a~,~er~ I-T~N~I, c,,;~-, Jb ci,p,,~b~~s S~'pHOea '~'~~ z,~.F'; lfi~c p l f QeN ~~, ~~~< ~~ ~o~ of }~,~-io R,~~c~` ~l~v= 99.~~ COPY 93,s~ Rio ~ l~Q~ ll~,me R~~, ~ud~ ~ Tm 1~uMees~e~ Gaca~icn ~ ~ S~p~ ~ a~ ~.:~ T~~ G; G e,~se ~~!~d o q~ 1 o. ~~~ pR~ ~ ~ -~-~ ~3~ Q~,~ ~~Nv~~~~ w p-~~ o z~-„} ~~ ~~ ~x;sfi,tiy -bvoy,~ ~ I~N~~ s In~~fi1, ~ ~I~pM~er~ t - T~ N ~ ~. ~,,;-~ -, 1b c ~„~,~ b,rr~ s (S~'Awoanb }} Z~ i~fiR~w~S'~ p 1 ~' QeN ~~ h~~rc !C Tyr o~ ~~~o Ql~~k ~1-~v= ~9.~(~ ~~UM ~?`b1~L f 93.s Wisconsin Departrrrant of Commerce SO~QI N PORT Division of Safeiy and Buildings in accords ce witM C~c 85, Wis. Adm. C 1977 Page 1 of s A.C.E. Soil & Site Evaluations Attach con late site an on r not less than 8Y x 1 inches i ~ n u 0~6 P PI Pape RRjjaa gP ~ ~ County St. Croix re(•li include, but not limited to: vertical and horizontal referen point on and Parcel I D percent slope, scale or dimensions, north arrow, and ion an nce near . . o o- 2so-7a-ooo ~ Please print a!l infnrma ' SY • Revi ey Dat Personal information you provide may be used for secondary (1) (m)). 5 ,5 Property Owner Property Location Roy H. & Alene K. Rudy Govt. Lot NW 1/4 SE /4 S 21 T 29 N R 19 W Property Owner's Mailing Address Lot # 81ock # Subd. Name or CSM# 560 Stagecoach Trail 21 Prairie Vista 2Nd Addifion City State Zip Code Phone Number J City ~ Village t~ Town Nearest Road Hudson ~ WI 54016 (715) 386-1302 Hudson Stagecoach New Construction lJse: N Residential / Number of bedrooms 4 Code derived design fk-w rate 600 GPD 1/ Replacement ~ Public or commercial -Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Site suitable for conventional POWTS ~ 0.7 gpd/sq.ft. install three trenches, at 93.50' using 15 "Quick 4" chambers per trench (45 total). / N # _:~ Boring Borin d l 5 ro f g Pit Ground Surface elev. 98.92 ft 0 . Depth to > 123" in. mRing factor Soil Iication Rate ApP Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP 'Etf#1 D/ft2 'Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-6 10yr3/2 & 4/6 none siUsl fil Na dsh aw 2f,vf Na Na 2 6-16 10yt2/1 none sil 2fsbk ds gs 1fmc 0.6 0.8 3 16-25 10yr4/3 none sil 2fsbk ds gw 2fm,1c 0.6 0.8 4 25-38 10yr4/4 none sil 2fsbk ds cw 2fm,1 c 0.6 0.8 5 38-43 7.5yr4/6 none gr Is D sg ml cw 1f 0.7 1.6 6 43-123 10yr5/4 none s 0 sg ml - - 0.7 1.6 Sal evaluation pit excavated to a depth of 108". Remaining depth of H#6 evaluated by use of shovel and hand auger. a g Bori 2 Bonn # N Pit ~ Ground Surtace elev. 98.57 ft. Depth to limiting factor ~ 120~~ ~• Sal Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Bourxiary Roots GP "Eff#1 Dfft= •Eff#2 1 0-13 10yr3/2 none sil 2fsbk dsh cs 2f,vf 0.6 0.8 2 13-18 10yr4/3 none sil 2msbk ds gs 2f,1mc 0.6 0.8 3 18-31 10yr5/4 none sil Zfsbk ds cw 1fm 0.6 0.8 4 31-40 10yr4/6 none s 0 sg ml gw - 0.7 1.6 5 40-120 10yr5/4 none t rt 0 sg ml - - 0.7 1.6 a °I Soil evaluation pit excavated~aa-dept of 1 '. R aining depth of H#6 evaluated by use of shovel and hand auger. Effluent #1 = BOD ~ 30 <_ 220 mg/L an TSS >30 < 1 mg/L uent #2 = BOD <30 mglL and TSS <~0 mg1L CST Name (Pl~se Print) Signature CST Number James K. Thompson 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 4/26/2006 715-248-7767 Property Ovmer Roy H. & Alene K. Rudy Parcel ID # 020-1260-70-000 Page 2 of 3 ~ Boring / ' , Boring # Pit Ground Surface elev. }8.23 ft. Depth to limiting factor > 119" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P /fl' * in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Eff#2 *Eff#1 1 0-8 10yr3/2 none sil 2fsbk dsh cs 2f,vf 0.6 0.8 2 8-13 10yr4/3 none sil 2msbk ds gs 2f,1mc 0.6 0.8 3 13-20 10yr5i4 none sit 2fsbk ds cvv 1fm 0.6 0.8 4 20-28 10yr4/6 none s 0 sg ml gw - 0.7 1.6 5 28-119 10yr5/4 none 9t s 0 sg ml - - 0.7 1.6 ~ a3 ~ Soil evaluation pit excavated to a depth of 10T'. Remaining depth of H#6 evaluated by use of shovel and hand auger. Boring # Boring ~~ Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots *Eff#1 *Effr442 ^ Boring # ~ Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soit Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots *EtT#1 *Eff#2 * Effluent #1 = BOD ~ 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. ff 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. ~.0 9. 79' ' ~So;/ e/Q/ua ~~'o~ P-"~ ~ E,rist~,i~ ~ rade -e l Cd; • ~.o cafe.dorp. Sit Scsz.le.• / •_ ~~ key' ,day ~w~ryP~o,~~Y. ia~ ~ '~ T . of f~dsan, .5'£ • crolr Cs; c~: r ~--- j~2 t A~ as' i ~ yam; J~ ~ 5~~ 9R o ~ r L ~ i o '/ ~j~is-fir ~ oao~s.(. 9~9z ~ Q ~~ d~ 96.85' ~ oF`5,'d,'~. Assum i 6le~c' ~ . ~• • = Tod at Pu,~io ~ /Yla.'oonPa~b 6/e~ EXi3~Tn~ ~~ ~ ~y,..ner o ~~ des:danc2 ; ~"/ed.' > 94~.~ Vey ' `6 '~ 1~~F=:- , ~- ~~ e ~~ v~ 3 b .h s~~. o 5-~~.eC~ac~ Ira; / P~ . 3 ~f.3 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address J~ ~ ~ 5~~.,Cpc~ ~r~, ~ca.~,s~ (,~,s- Si'4 ~ (o Property Address _5`Q~'r~.e ~ ,1i~y,,,..~ (Verification required from Planning & Zoning Department for new construction.) CitylState ~~5~ (.~~ Parcel Identification Number ~~~ LEGAL DESCRIPTION C ~ v a o ~ ~a ~. o - 70 Property Location '/a , '/a , jSec. oZ ~ , T oZ'`~ N R~W, Town of Subdivision ~(~ n ,~.~~ V 1~5 ~ ~~lo~- /~c~~ ~i~,>v 1~~s~ . Certified Survey Map # Volume ,Page # Warranty Deed # ~ ,50 ,3 4~ "~ ,Volume ~ ~ ,Page # Spec house yes no Lot lines identifiable es no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Lot # _~ ~ y0 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. 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 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. 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 bedro s _~_ (REV. 08/05) ~~ /`etc. y l~l D ~ GNA OF APPLICANT(S) 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. I l oocur~crvr No,. STATE BAR OF WISCONSINd FORM i ~- 196211 THIS SPACE RESERVED FOR RECORDING DATA ~VARRAN7Y DEi~D 4503~`i ~r~! ~~~~Pas.~~~j REGISTER'S C3~FICC Verl n E Beno and ~ ' -------- - --y..----'-'----;----•---Y------•------------ ST. CROIX CU. Wt Thls Deed, made between Rec d for Record Catherine A. Benoy_ husband and wife, _ ;~ atau~o~ 0 98. M --- -- --- --- - •------ -._--- •-- -----•------ ---- -----•-•--., raptor, ~~ ~~~~Q~ and.._.-Ro,y-,H-.---Rud-y-_and---Alene--K. Ru_dy__,-_-husband -_-•------- /17 /~r:"^~X. -- - -•- - - --- - V 1, ---and--wif-e_-as•--sur-vivo.rship-_-marital__pro-p-er-ty-,-.-- --- ,' , ~ i ~-- Register of Ce~h •---•---•---- -•-•-----------------•--------•----------•-------------•-------------- ----_., Grantee, ii Witnesseth, That the said Grantor, for a valuable consideration____.. '~ ii --of-•.one-_-dollar-_ and___o-th_er-_ valuab le-- c-ons id-erat-ion RETURN TO convet~s to Grantee the following described real estate in ... S t ----C•r o 1X•••,----- County, State of Wisconsin: ~~ . Tax Parcel No: -----------------•---•------------- Lot 21 Prairie Vista Second Addition. TRANSFER ~. _S!3~ .,.,T,t This _..___._is__-no t_•-__. homestead property. °"° (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto bclonsing; And.._-.Ve•rl•yn-•_E-.-__Be-noy-•and••-Ca ther•ine--,A-.-_-Benoy___________________-._-__ •_ -_ warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and covenants of record, if any, and will warrant and defend the same. ,,~~--!/ Dated this ... _ - --•-----•.'~,~lA(_• day of ----._--- ---......-•-------------•---•--------------•----•----------------•-- (SEAL) ------•--•------ -----------------------•------•-----•--------------(SEAL) AUTHENTICATION Signature(s) ------•-------•-------------- r --V --- ~.! _... .. .. - ---...... (SEAL) Ver yn E. Benoy --- ... .. __~_.-- ---•--•--••-- -------•---.(SEAL) * Catherine A. Benoy ACHNOWLEDGMENT STATE OF WISCONSIN authenticated this ________day of___________________________ 19.__._. 't'ITLF.: MEMBER STATE BAR OF WISCONSIN ss. S t ..Croix _County. ------------------------------------- Personall came before me this __.._J._._____.day of Y ------.----~~_l~__.Sf_______________ 19_g ___ the above named Verlyn_E. Benoy and L~atherine A. Benoy ILE INFORMATION Owner ~/~ Permit # DESIGN PARAMETERS POWTS OWNER'S MANUAL & MANAGEMENT PLAN MAINTENANCE SCHEDULE Service Event ___.__ Inspect condition of tank(s) Pump out contents of tank(s) Inspect dispersal cell(s) Clean effluent filter Inspect pump, pump controls & alarm Flush laterals and pressure test Other: SYSTEM CPFr_r~rrenrnuc Page of Septic Tank Capacity ~ ~ ~ ~ al ^ NA Septic Tank Manufacturer ~~ ^ NA Effluent Filter Manufacturer `~~y~ ~ ^ NA Effluent Filter Model ~ -~(,~ ~j ^ NA Pump Tank Capacity al -OwA Pump Tank Manufacturer _~-NA Pump Manufacturer $NA Pump Model _~A Pretreatment Unit DIVA ^ Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Dispersal Cell(s) ^ NA i$?'In-Ground (gravity) ^ In-Ground (pressurized) ^ At-Grade ^ Mound ^ Drip-Line ^ Other: Other. NA Other. NA Other: NA Service Frequency At least once every: ~ ^monthls) (Maximum 3 years) D ear(s) ^ NA When combined sludge and scum equals one-third IY3) of tank volume ^ NA At least once every: ~ ^monthls) (Maximum 3 years) ~ year(s) ^ NA At least once every: I ^ month(s) 1 • ~ year(s) ^ NA At least once every: ^ month(s) ^ yearls) ~~NA At least once every: ^ month(s) ^ yearls) ~-NA At least once every: ^monthls) ^ yearlsl ~`6,NA -Q 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 tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation 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 IY31 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 <12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the focal regulatory authority within 10 days of completion of any service event. values typical for domestic wastewater and septic tank effluent. 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 cell(s-. 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 Isump 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 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 replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ 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 sui>able 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 timei '" ~• < <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 PAWTS INSTALLER - -Name '~ Irr ~c~r~ ~ ~ Phone CC ~~ ii 1., ~~,~ 3C~1.` 9v~.~ SEPTAGE SERVICING OPERATOR (PUMPER) -- Name ~ ~ rC~Lst Phone '1 5 f ~ a s POWTS MAINTAINER Name Phone LOCAL REGULATORY AUTHORITY Name ~ C R ~` ~ 2U Pi i ~ Phone 3 ~ ~ y ~ ~ lj This document was drafted in compliance with chapter Comm 83.2212i1b11111d1&!fl and 83.54(11, 121 & 131, Wisconsin Administrative Code. START UP AND OPERATION Page of For new construction, yprior tQ 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 cellos). If high concentrations are detected have the contents of the tank(s) 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 cellos) and may result in the backup or surface discharge of effluent. 7o 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 be taken to insure that the system is properly and safely abandoned in compliance. with chapter Comm 83.33, Wisconsin Administrative Code: • Atl 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 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 andlor soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. rQ} 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. tf 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 timei ~ ~~ < <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 ''~ 1''~ ~ouw,4- ~ Phone f ~~ , ~` ~ ~ 1, " ~ ~ ~. SEPTAGE SERVICING OPERATOR IPUMPERI Name ~ ~ +'Cd"LQ Phone y ~ ~ li a S POWTS MAINTAINER Name Phone LOCAL REGULATORY AUTHORITY Name ~ ~ IZ ~S ~4 2l) N 1 Y., Phone ~ ~ ~ 7 This document was drafted in compliance with chapter Comm 83.22(2-(b11111d!&(fl and 83.54(11, 12) & 131, Wisconsin Administrative Code. ST. CROIX COUNTY TUNING OFFICE CERTIFICATION S`.['A`1'EMEN`1' FOR UTILIZATION OF AN EXIS`i'TNG SEP~i'IC `i'Atdt: This is to certify that I have inspected the septic tanY, presently serving the ~~~_ residence located at: ~_~, ~~;, Sec. -~~, TTt, R /q W, Tvwn of _________ St. Croix County, Wisconsin. Upon inspection, I certify that I leave found the tank and baffles to be in good cond'.tio and it apl~ea.rs to be functioning properly. Last time serviced ~ ~ ~ ; ~(l~ _ Did flow back occur from absorption system? Yes-__ IJo~ (if no, skip next line. Approximate volume or length of time: _ gallons minutes Capacity: ._.lv~~ b~--- / ----- ---__-.. Construction: Pref~b Concrete / _ Steel _ Ottler Manufacturer (if known): __ Age of Tank (if known) : z -- - -----___ M1.l---_._...-- -- ---------. ~~ ~S ___ (Title) ~ - ~ i C~~ ( Date ) r~ (Name) Please Print a~~9~ (T.,i.cense Number) Form to be completed by licensed plumber (s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Admini:;trative Code) Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank, to the best of my knowledge, will conform to the requirements of ILHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name n ~ j~ n~ p per- Signature MP/MPRS ~ ------ - - - Parcel #: 020-1260-70-000 05/05/2006 11:21 AM PAGE 1 OF 1 Alt. Parcel ~: , ,1.29.19.1260 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 CaOwner O -RUDY, ROY H &ALENE K ROY H & ALENE K RUDY 560 STAGECOACH TR HUDSON WI 54016 Districts: SC =School SP =Special Property Address(es): " =Primary Type Dist # Description * 560 STAGECOACH TR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.384 Plat: 2355-PRAIRIE VISTA 2ND SEC 21 T29N R19W NW SE LOT 21 PRAIRIE VISTA 2ND ADDITION TOWN HUDSON Block/Condo Bldg: LOT 21 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 21-29N-19W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 847/640 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.384 76,500 159,300 235,800 NO Totals for 2006: General Property 2.384 76,500 159,300 235,800 Woodland 0.000 0 0 Totals for 2005: General Property 2.384 76,500 159,300 235,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 211 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ~~O c m f C ~ 3 7 ~p K ~ v `•°, 3 i 3 '~ ~ °. 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