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Home My WebLink About020-1371-24-000Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT .GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1 )(m}]. 'ermit Holder's Name: City Village X Township Bates, Mark Hudson Townshi :ST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic '~, (Q G5 Dosing . '1'YL~it Aeration Holding TANK SETBACK INFORMATION TANK TO P~ WEB BLDG. Vent to Air Intake ROAD Septic \ ~ ~) ~ ~ ~ ~.~- / Dosing Aeration Holding PUMP/SIPHON INFORMATION (c"~'Ytr!,c.t.c~ ELEVATION DATA county: St. Croix Sanitary Permit No: 463249 0 State Plan ID No: Parcel Taz No: 020-1371-24-000 Section/Town/Range/Map No: 23.29.19.2216 STATION BS HI FS ELEV. Benchmark 1..1 ~ lt~ i U Alt. BM Bldg. Sewer ~ O M SUHt Inlet D 7SGd-->' ~D ~~~/ ) ~ ~` 3 SUHt Outlet ' -~, a3 Dt Inlet /~ Dt Bottom ~' ,/~ Header/Man. ~"'~~- / ~ h Dist. Pipe ~ ,(~0/ ~ I b' ~l'S" f1b'~ . System 2 ~ D 1 Fina~Grade ~` S /- ~ (o -~ St Cover ~ ~Z~ ~w 3 3 .~ ~~ ~ / ~' , ~~ ~~ D ~ ~'' Demand GPM TDH Loss Ft SOIL ABSO ON SYSTEM 2 2 -~ ~ 3 ~-S BED/TRENC Width / Length No. OfTren DIMENSIONS ~~_ SETBACK SYSTEM TO P/L BLDG WEL INFORMATION Typ f System: DISTRIBUTION SYSTEM w Of Pits Ilnside UNIT r He ' ~ td Distribution ~ x Hole Size x Hole Spacing V~ept.taA'U Intake k h Pipe(s) rr ~ ~ / ~ ~ / Lengt Dia Length Dia Spacing SOIL COVER r Praesura SVS}PmS Anly YY Mnund Or At-Grade Systems Only oC ~ ~H~.~ Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~,, Yes ~ No ~ Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ ~ Inspection #2: / / Location: 743 Nicholas Drive Hudson, WI 54_016/(NE 1/4 SW 114 23 T29N R19W) Evergreen Estat t 24 Parcel No: 23.29.19.2216 1.) Alt BM Description = ~~, ~~~ ~'v ~~~~ ~ ~~ ~~ ~~~,.,, ~~„/_ _ 2.) Bldg sewer length = ~r _~ 'o "^~'r ~L ~ ,/' ~° - amount of cover = V ~ ,~~, ~ ~f~'J~'^ ~~~~ (•(~~",',~,G~W-'7~ h~Gs -i-~-~ - -- Cho ~ Plan revision Required? [) Yes [ . No ~ ~ ,,- ~ , ~' Use other side for additional information. ~? °?~_ ~,(_~ __ _- ~ __ ~/ SBD-6710 (R.3/97) Date Insepctors Sig lure Cert. I /"=~o' ~/i Y 6~ Jam' T ~~-~- l ~S ~ A~~~~s °~(o .a ~ 9r S~ ~~ .~ ~~~ ~,~~ ~~ `~ 00 ,s ~~ V p~GP 1 c~ f~'~`'k gti ~~ ~ ____, ~k' °~ m~ 22~~,~ L~ G~PY ~~ Safety and Buildings Div' ton P Washington Ave . Box ~ 201 W County ~ ~ ~ . ., . ,`_ Madison, WI 53707 - 7162 C rritary Permit Number (to be filled in by o. /~COr1 ~~~1 ce f C (608)266-3 1 0 !j 3 Z ommer Department o o~ Sanitary Permit Applicatio sT~ Sta lan .Number R ~ ou ti l i f ~ G on y p orma n J-C, r~~ In accord with Comm 83.21, Wis. Adm. Code, petsona O~ be used for secondary purposes Privacy Law, s15.OQ(1)(m) G ma ro ect ddress (if different than mailing address) ) ~ OF y I. Application Information -Please Print All Information ~ CC[^~ ~I~OCD ~r J Property Owner's Na me Lot b Z ~ Block N arcel ti Property Owner's~1M ailing Address) `-/ A J ~ Property Location 2 , 2 /~ ~ /v'~ bllV `" ~l. ~~, ~(r11 ~k,Section Z3 City, State Zip Code hone Number P /n~/ f , ' 0~ Gt -J 7 W ~ ~D(6 • y / J~ ~ ~ y / p 2 l N; R l l (CE ot~o) l S y) ~ j p.~.~ II. Type of Building (check all that app r Su division Name CSM Number 1 or• 2 Family Dwelling - Nwnber of Bedrooms - U~ ~~ l1.lt? U D ib ^ 6~~ '~ '~ escr se e Public/Commercial - ^ State Owned -Describe Use - ity_^Village {Township of (.!OlrC ~1/ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) ahce~Q ~ 020 - 7j / - Z - .22/ A' New System ^ Replacement System ^ Treamierit/I-Iolding Tank Replacement Only ^ Other Modification to Existing System B. ^ Permit Renewal Before Expiration Permit 12evision j~t. ge of Chan Plum r ^ Permit Transfer to New Owner List Previous Permit Nurnber an Date Issued ~~ '~ 3 j _' ~ S~ n l/~ v tf 1V. (Check all that a T e of POWTS S stem: 1 -) Non -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetlan •essurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treannent Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Pilter Leachin Chamber ^ rip Lin ^ ravel-less Pipe ^ Other (xplain) V. Dis ersal/Treatment Area Information: Z Design Flow (gpd) Design Soil Application Rate g dsf) Dispersal rea Required (sf) Dispersal Area Proposed (sf) y em E evasion Qb ~ji~ • ~ ~~ ~~ ~2w~K ~ l ~1Gr 95,5• VI. Tatrk Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Consnucted Glass New Existing Tanks Tarilcs Septic or Holding Tank (/ 7~ ~ rf_ (A ~• (- r~,J ,~) 7~ Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the turdersigiied, assuute responsibllity for urstallation of the POWTS shown on [he attached plans. Plumb 's Na me (Print) Plwnber's Si gnatur MP/Mitt~B'Number Business Phone Number ~J~s ~ o ~~ ~ z6 ~9 7 ~ 2 ~ f~ Plumber's Addre ss (Street, City, State, Zip C e) VIII. Count /De artment Use Onl Approvzd ^ Disapproved Sanitary Permit Fee (it etudes Groundwater Date Issued I suin gent Signature ( o Stamps) ^ Owner Given Reason for Denial Surcharge Pee) ~_ p JQ 2t~ IX. Conditions of Approval/Reasons for Disapproval 1 (~ _ _ / -Jew, SYSTEM OWNER: 3 J ~- ~~ ('~_ ~/' i , 1 Septic tank, effluent filter and ((JJ ~ /1 dispersal cell must all be serviced /maintained / 111VVVR.C~-y` • q~ 1 / as per management la id /2 ~ G ` ~ p n prov ed by plumber. ~~ / ~/d y -_ ,,, - l ~ ,,., f/ hopg~ 2. All setback re uireme t t / l~~ ~`"' " ~ ~ _ q n s mus be maintained Tf 1 /~ as per applicable code%rdinances. G~r~tG~ y~~~G~~~'~ Attach complete plans (to the County only) fa• the system on paper not less than 81/2 x 11 inches in size SBD-6398 (R. 01/03) O m O m m ~ O 7 fD a In Z D co D ~' a c ~ .. Z 0 ~~ v 3 a ~ W v a m N C N 3 m N ~ y a O ~~ ~ ~°- o_ m c a 3~ m y W 1 Q C ~o m a 0 0 Z m 0 7 0 m o ~ o° ~- c'~v,p °c °: ~ I ~ ~ ~ 3 3 o ~ ~ W ~ w ~ W A ~' V W a ? m ~ ~ - a a N I ~ v r ~ N = c ~ N I O O O ~ I I ~~~~ I ~ v v °' ~ ~ N .d. 3 m ID 7 7=c ~ 7 O ~ ~ ~ p y I U1 O~ N A Q Q fD ~ a I ~ ~ o, 3 I O r! I 0 m Z I ~ I a I I _~ ~ I c a I I I I I I I I I I I O (a O r~i m fD fD O 7 a ~n v> ' IN n p c O 0 ~ N z~ o S a a c m z v m c o v ~ ~ 1 N -~ S m N C N 3 m v cn D m a ~~ ~ m ~ °-' co ° o C7 y O ~ ? C' Q y ~ (D 7 ~- 7 ~ m w~ m 30 v - ~~ N a v 0 'm rn 0 °o ~ ncnO °c :: ~ ~ ~ ~ ~ ~ ~ 3 ^' O ~ ~ N m ~ N ~D N w y ~ Z S' ~ ~ - a a n°-, N 0 O ~ N = o a ~ o O O O ~ ~~~~ ~ v v °' A N ~ 3 °-' ~ .. 7 ~ O O O 07 ~ ~ N p w C C n (Np ? a ~ G yr a W ~ a °o :' 3 n s ~ ~ co 0 ~_ ~ c T Q c a ~' 3~~ d ~ c ~ o ~p ~' ~ 'o ~ ~ ~ ~ ~ 1 C ~j ~ Q C W N `C ~1 • Q iv 4 -~ ryl o co ~' p W O CO ' ~ IV O ~ A ~ O ~ ~ O Q ~ ~ 0 c~rtn y'O* C N • 3 ~ ~, a m~ m m N d N N -~ -~ rn A Z ~ ~ ~ A ~Z ~ m N w Z ~ ~ ~ ~ a h b n ti 0 0 pA +~ b c.,, ~ ~ ~«_ ~~~ ~, ~~ T gA~~ f~oo ~ ~.~' ~ gs:s~' s~s~ ~ ~ . `_-- .r____-- ~ ~ Z~ ~~ q1 ~~ Z ~ ~(J~bti~^J ~ S~F-A~k ~~ ie~ <~ ~ ~~ ~kg3 ~~P n I k /' V ~~'~L gv ~y t ~~ °~ -~Gt,ts ~~ -~-e- ~~ , y , ' Wisconsin Department of Commerce SOILY Division Of Safety and Buildings ~/~'~'\~in flrrnrA~nro wi4h L'nmm RF I~,uREPORT ~~ a ~~ 1572 Page 1 of 3 Steel's Soil Service, Inc. Attach com ete site anon r~ th n 8%: x 11 inches in ize. PI PI PI P ~~ :, ~ County St. Croix indude, but not limited to: verti I anc o I reference point ( ), direction 9nd <. ! C ~~(J and location and istance to nearest road scale or dimemsi n w ercent slo e f~arcel I.D. . , p p , 020-1062-7-000 ~~.~, Please print all information. ZhNlti('~ F , ; ~, ; , ` I ev wed By Date ' ~ Personal information you provide may be used for secondary purposes (Privacy Law, s. ~ •L . t 0 ~Cp Property Owner Property Location Amadan Construction Govt. Lot na E 1/4 SW 1/4 g 23 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 245 Foster St. 24 na EverGreen Estates III City State Zip Code Phone Number ~ City J Village ~ Town Nearest Road River Falls ~ WI 54022 715-425-5338 Hudson Waldorff Rd New Construction Use: ~ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement J Public or commercial - Describe:na Parent material outwash Flood plain elevation, if applicable na General comments and recommendations: Conventional system, system elevation 96.OOft. Trenches spaced and depth to code 4.OOft below grade. Boring # ~ Boring Pit Ground Surface elev. 100.00 ft. Depth to limiting factor 110 in. Sod Application Rate Horizon Depth Dominant Color Redox Description Textun: Stnu:ture Consistence Boundary Roots GP DIft' in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10yr3/1 none I 2msbk mfr cs 2c .6 .8 2 10-17 10yr4/4 none sl 2msbk mfr cs 1 c .6 1.0 3 17-27 10yr4/4 none scl 2msbk mfr gw 1f .4 .6 4 27-41 7.5yr4/4 none scl 2msbk mfr gw na .4 .6 5 41-49 7.5yr4/4 none Is osg mvfr gw na .7 1.6 6 49-110 7.5yr4/6 none cos osg ml na na .7 1.6 Boring # ~ Boring 1+ Pit Ground Surtace elev. 100.00 ft. Depth to limting factor 110 in. Soil Application 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 0-7 10yr3/1 none I 2msbk mfr cs 2c .6 .8 2 7-34 10yr4/4 none sl 2msbk mfr cs 1 c .6 1.0 3 34-52 7.5yr4/4 none Is osg mvfr gw 1f .7 1.6 4 52-110 7.5yr4/6 none cos osg ml na na .7 1.6 'Effluent #1 = BODS> 30 <_ 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mglL and TSS < 30 mglL CST Name (Please Print) Sign ture: ~--~ CST Number David J. Steelt-`-L\J 248956 Address Steel's Soil Service, Inc. Date Evaluation Conducted Telephone Number 994 200th St., Baldwin, WI 54002 9/22/2004 715-684-5680 Property Owner Amadan Construction Parcel ID # 020-1062-7-000 Page 2 of 3 Boring # Boring Pit Ground Surface elev. 95.30 ff. Depth to limiting factor 110 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. CoM. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-5 10yr3/1 none I 2msbk mfr cs 2c .6 .8 2 5-23 10yr4/4 none sl 2msbk mfr gw 1c .6 1.0 3 23-44 7.5yr4/4 none sl om mfi cs 1f .2 .6 4 44-110 7.5yr4/6 none ms osg ml na na .7 1.6 ^ Boring # J Boring J Pit Ground Surface elev. ff. Depth to limiting factor in. Soil Application Rate Horzon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color. Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring # ~ Boring J Pit Ground Surface elev. ff. Depth to limiting factor 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 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mglL * Effluent #2 = BODS <30 mg/Land 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 I S I or TTY 608-264-8777. STEEL'S SOIL SERV] David J. Steel Amadan Construction CST-POWTSM NE 1/4,SW 1/4,S23,T29N,R19W Lic. #248956 Town of Hudson, St. Croix Co. Evergreen Estates III, Lot 24 [CE INC. 994 200' St. Baldwin, WI 54002 Bus.(715) 684-5680 Fax.(715} 684-3449 Legend 1" = 40' =Benchmark Ele. 10!0.00 ft FI3~~ser~~r, t uoo~ t ii Alt Benchmark Ele. 107.25 ft ~p ~ ~~' ~c.3er~ Ks~-Cc~~vu~ ~~ ^ =Borings `~ Boring Elevations B 1 = 100.00 ft B2 = 100.00 ft B3 = 95.30 ft B4 = 0.00 ft ' i 3of3 N ,z~~ 4.0~ ~-~• . X ~!~i~' ~ \ ~~ ~ ~ ~ \\t\ ~ \\ ~ ~, ~/// ~~~~' i ' l~ `-~ 9 .3 x Q~ i ,, ~ ~~ ~ '. . ~ ~cPjO \ ~ ' ~'" ~ ~ . ~.: o~ 9 T \ .P r"~. p ' ~.. /~/ \ / ~~ 2.17 AC S ' ' .9 C i~ x x 988.3 x 967 x - - ---- ---- --- - N __ _ _ E _- Y. ~- -----___ 948.9 -- - - -_ ~~S 97 H.W.L. 9~.6 AGI POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of 2 ' FILE INFORMATION Owner ~~~~ ,.~~ 5 Permit # ~ 3 Z DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units NA Estimated flow (average) UO gal/da Design flow (peak-, (Estimated x 1.51 ~ p"'D gal/day Soil Application Rate al/day/ftZ Standard Influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODE) 5220 mg/L ^ NA Total Suspended Solids (TSS1 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD5) 530 mg/L Total Suspended Solids (TSS) S30 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. SYSTEM SPECIFICATIONS Septic Tank Capacity Septic Tank Manufacturer ~ z ~ (~~~ gal ^ NA ^ NA Effluent Filter Manufacturer ~ ~r,LrL ^ NA Effluent Filter Model ~- - ~p-~ ^ NA Pump Tank Capacity al NA Pump Tank Manufacturer A Pump Manufacturer ANA Pump Model ~ ~A Pretreatment Unit ^ SandlGravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: I'~JA Dispersal Cell(s) In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ! Other: A Other: A eenuu~r~~~n~~rc cr•u~nr ~~ c Service Event Service Frequency Inspect condition of tankls- At least once every: ^ month(sl (Maximum 3 years) earls) ^ NA Pump out contents of tankls) When combined sludge and scum equals one-third IY31 of tank volume ^ NA Inspect dispersal cell(s) At least once every: ^monthls) (Maximum 3 years) yearls) ^ NA Clean effluent filter At least once every: ^ monthls) - Z yearls) ^ NA Ins ect um , pum controls & alarm P P P P At least once eve ry~ ^monthls) ^yearls) A ' ^ month(s) A Flush laterals and pressure test At least once every: ^yearls) Other: At least once every: ^ month{sl ^yearls) ~A Other: IG#'A~Iq 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 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 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. Page ~ of 2 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 celllsl in one large dose, overloading the cellls) 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 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. . /~ T a o In an r/ alua ' g~ be ' e ai e ~RD1-f'l8 Tf'~~ ~D~- N/~/ ~NS"T72t1~T1. D ^ 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. AnIIITIr1NAl r_r1MMFNTt PAWTS INSTALLER - - - -Name ~. /v (/ L-SD 0~ Phone ~~~ Z~~, POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name s^~-, C~Q l d U 20tiI1 ~ Phone ~/S- 3g(~_ (0 (~ This docum t was drafted in compliance with chapter Comm 83.22(211b)11)(d)&(f) and 83.54(1), (21 & (31, Wisconsin Administrative Code. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Bates, Mark Hudson Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK IN FORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL E Holding I I I PUMP/SIPHON INFORMATION Manufacturer Model Number ITDH (Lift (Friction Loss (System Head ~H Ft LForcemain Length -Dia. Tist. to Well SOIL ABSORPTION SYSTEM BEDrrRENCH Width Length DIMENSIONS SETBACK SYSTEM TO INFORMATION Type Of System: DISTRIBUTION SYSTEM ~ to Trenches BLDG WELL county: St. Croix Sanitary Permit No: 453334 0 Parcel Tax No: 020-1371-2 0 Section/Town/Range/Map No: 23. .19.2216 ELEVATION DATA STATION BS HI ELEV. BM Inlet Outlet Dt Bottom nal Gra Cover PIT DIMENSIONS No. f Pits Inside Dia. LAKE/STREAM LEA G Manufactu UNIT Header/Manifold Distrib x Hole Size x Hole Spacin Vent to Air Intake Pipe Length Dia Le Dia Spacing SOIL COVER ® x Pressure Systems Onlv xx Mound Or At-Grade Svstems Onlv Depth Over Depth Over xx Depth of xx Seeded/Sodded Mulched BedlTrench Center Bed/Trench Edges Topsoil Yes 0 No 0 Yes y~ No COMMENTS: ~nclude code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 743 Nicholas Drive Hudson, WI 54016 (NE 1/4 SW 1/4 23 T29N R19W) Evergreen Estates III Lot 24 Parcel No: 23. 9.2216 1.) Alt BM Description = 2.) Bldg sewer length = -amount of cover = Plan revision Required. ^ ~.~ L I, ~ Yes No _ _ _ L- ------- ------- --- - - __ __. -~ - --- Use other side for additional information. L_~__~ SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. . ~/,, .. .. ~~ ~~~~~t'G~X~'~-s (Ty`. ~p~/v~ s~j~j -'(p~~0 (IQ~6~03J YSTEM OWN eptlc tank, effluent fitter and ,~.3 . ~Z dispersal cell must all be service maintaTfed as per management plan provided by plumber. 2. All setback requirements must be maintained as per a plicable code/ordinances. t~.nvt~ . X3~ y3 Li • • Safety and Buildings Division ~untY ` ` ~ ~ 201 W. Washington Ave., P.O. Box 7082 ~S~~i~S~~ Madison, WI 53707 - 7082 Sanitary Permit Numb o be led is by Co.) De artment of Commerce (608) 261-6546 ~~ 3 Sanitary Permit App ----~ - -~~ ---~~~ ~ Stag Plan[.D. ber ~ [n accord with Comm 83.21, Wis. Adm. Code, person c ~ ~ inform t ~ P -~"" / ~ ~~C maybe used for secondary purposes Privacy w, s15.04(1)(m) Project A s (' different than [nailing address) I. App tion Information -Please Print All Info ma ~ 3` Property Owner ame ST.CnUiXCOI)~J~I~~ P 111 Lot>E Block# I . ZONING OFFICE --- ' ~,7 ~ ~~~.-(y3Z~ a o - PropertyOwner'sMailin ddress ~ Pr op er tyLc,,,o„~„ • ZZ~ ~ f ~ ~ - ' ~ State C Z' C d Ph N b ~'/a Section • ~- /a ~ o e one um er _ ~` ~ 8 f cucle one) N R~E T IL Type of Building (check all th ply) ~ ; o~ ~ ~ it-tu 2 Family Dwelling - Number of 8 ins Subdivision Name CSM Number ^ PubliclCottunercial - Descnbe Use ^ state owned -Describe use 3 ~ l s r ~ ^City ^ ills e o shi III, Type of Permit: (Check only one box on li .Complete line B If plicable) _ D p A' New System ^ Replacement System Treatment/Holdin ank Replacement Only ^ Other M to Existing g, Permit Renewal ^ Permit Revision ^ C e of ^ Permit T t t Pre u t ber and Date Issued Before Expiration Plumber Owner IV. T e of POWTS S stem: Check all that a I Non -Pressurized !n-Ground ^ Mound > 24 in. of suitable so' ^ d < 24 in. of s ' le soil At de ^ Si Pass ter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding k ^ Peat er ^ Aerobic Treatm tt ^ Rec' la r ^ Rxirculatin Synthetic Media Fiber Leaching Chamber Drip Line ^ el-less Pi er (exp in) V. DIs ersal/T'reatment Area Information: S ~ Des Flow ) Design Soil Applicatio d Dispersal R quired Dispersal Area Proposed (sf) Elevatio / VI. Tank Info Capacity in Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gall of Units Concrete Construct Glass New Existing Tanks Tanks Septic or Holding Tank !7 ` ~ C~~- Aerobic Treatment Unit Dosing qumbcr VII. Responsibility Statement- he undersigned, assume responsibility for dilation of the POWTS she the attached pleas. Plumber's Name (Print) Plumber' 'gn r ~ PRS Number ho e N umbtt Busines s P ~' ~1 ~~~ ~~ n ~ ^ - / > Gip / ~J 4Y0 ~`- / / Plum 's Address (Strcet, Ci fate, Zi Code) ~ - I (~ ~d VII . Coun /De art nt Use Onl App vcd ^ Disapproved Sanitary Permit Fee ncludes Groundwater Date Issued ssuin A i atur Stamps) ^ Owner Given Reason for Denial Surcharge Fee) ~7 ~j G/t/ '. ~ ~ Z~ b ~ IX. Co/tn~di_tions of Approve _ /~_/,~~G~`t,!/~ /r Q' ~Gt/~~~~ LAU-Irk- ~QNi-d F-2 ~O ',~ ~""~ ~ ~ /'w ~ ~ O ~ ~ .~ ~'~ (~/ ~" - ~~ Y ,~ ~~"~ ~ ~~I„th`~ N~ ~ Y7 3- 1~ qy ysX ~- -~o~ laso r ~l ~ , 7~ AI ~~ Wisconsscl Department of Industry, Labor and Human Relations Division Qf Safety 8 Buildings (' ~ Q1L A9~~C ~+ T~'t°r' f '~-.i S arc ~C ~ ~ ~/ ~/ SOIL AND SITE EV LUA~,~~~~P~ T Page 1 of 3 ,, ., ~r, ~ COUNTY ~ _ '`' ~!. r^- bu er not less than 8 1!2 x 11 inches in st?za Plan must ihrlutie Attach com lan on a lete site St. Croix ~ , p p p p L not limited to vertical and horizontal reference point (BM), direction and b/o of sue, scale or .;~ ~ pq~ PARCEL LD. # ~ 37/.- Z dimensioned, north arrow, and location and distance to nearest road : ... ~ APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION ~>.,,~ ~ '~~ ``~ ~~ IEWE~BY DATE 13 /~ ~_~; ~~r ~ 1~ . . PROPERTY OWNER: PROP fi~-`~ATION , Richard LaCasse GOVT. LOT tQE 1/4 1l4,S23 T 29 ,N,R 19 f(or) W PROPERTY OWNER':S MAILING ADDRESS LOT BLOCK#`! """~> <. BD. NAME OR CSM # 1 521 McCutcheon Rd. L r~ ~ CITY, STATE ZIP CODE PHONE NUMBER ^CITY ^VILLAGE ~C]fOWN NE EST ROAD Hudoon, WI. 54016 (71~ 381-5405 Hudson Waldroff Fm. Rd. [ ~ New Construction Use [x] Residential / Number of bedrooms 4 ( ] Addition to existing building (]Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate • 7 bed, gpd/ft2 •8 trench, gpd/ft2 Absorption area required 858 bed, ft2 750 trench, ft2 Maximum design loading rate .7 bed, gpd/ft2 .8 trench, gpd/ft2 Recommended infiltration surface elevation(s) A=9ti .7/>3=95.7-93.7 ft (as referred to site plan benchmark) Additional design /site considerations na Parent material outwash Flood plain elevation, if applicable na ft S =Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U =Unsuitable fors stem ®S ^ U ®S ^ U ®S ^ U L~ S ^ U L~ S ^ U ^ S g] U SOIL DESCRIPTION REPORT Boring # .................. ................. .................. ................. .................. ................. 1 < Ground elev. 101.1 ft. Depth to limiting factor +90" Boring # ................. Ground elev. 97.7 ft. Depth to limiting +~C~O ~ Depth Dominant Color Mottles Texture Structure Consistence Bounda Roots GPD/ft Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed Trer>ch 1 0-12 10yr3/3 none sl 2msbk dsh cs 2c .5 i .6 2 12-24 10yr4/4 none sl 2csbk dsh gw 2m .5 .6 3 24 90 10yr4/4 none ms Osg dl na na .7 .8 Remarks: 1 0-12 10yr3/3 none 1 2msbk dsh cs 2c .5 `:. .6 2 12-37 10yr4/4 none sil 2csbk dsh yw 2c .5 .6 3 37-42 7.5yr4/4 none sl 2csbk dh gw lm .5 .6 4 42 90 10yr4/4 none cos Osg dl na na .7 .8 ~- .~- (~v `' ~z,~r,i y - sus . ~i Co~4_ 0~ t ~++4 Remarks: ~ s~~ d~ CST Name:--Please Print Ga L. Steel Phone: 715-246-6200 Address: 1554 200th. .New Richmo WI 54017 Signature: ~ ~ Y j ~ Date: 11-19-99 CST Number: m02298 A tiN~ a~1/ PROPERTY OWNER Richard LaCasse PARCEL I.D. # 020-1062-70-000 Boring # 3~` Ground elev. 100.E Depth to limiting factor +100" Boring # 4 Ground elev. 100.2ft. Depth to limiting factor +88" Boring # .................. {? 5 ................. Ground elev. 97.3 ft. Depth to limiting factor +86" Boring # .................. ................. .................. ................. .................. ................. .................. Ground elev. ft. Depth to limiting factor SOIL DESCRIPTION REPORT Page a "of~, 3 -~' F Horizon Depth Dominant Color Mottles Texture Structure Consistence Botxicfary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-14 10yr3/3 none sl 2mgr dsh. gw 2c .5 .6 2 4-100 7.5yr4/6 none cos Osg sll na na .7 .8 Remarks: 1 0-12. 10yr3/3 none sl 2r~1yr sislLi yw 2m .5 .6 2 12-8 Oyr4/4 none cos Osg dl na if .7 .8 r-- Remarks: 1 0-12 10yr3/3 none 1 2msbk dsh cs 2c .5 .6 2 12-2 10yr4/4 none sil 2csbk dsh gw lc .5 .6 3 24-3 7.5yr4/4 none sl 2csbk dh gw if .5 .6 4 30-86 7.Syr4/6 none cos Osg dl na na .7 .8 .~-- Remarks: Remarks: SBD-8330(8.05/92) r~ ' ' ~ STEEL'S SOIL SERVICE Gary L. Steel Richard LaCasse l 554 200th Ave. CSTM2298 NE4SW4 s23-T29N-Ri9w New Richmond, WI 54017 MPRSW-3254 town of Hudson (715) 246-6200 lot #5- This soil evaluation was conducted to satisfy a zoning re:~quirement, it may or may not be suitable for your use. The location of the test. may or may not be as shown as permanent lot lines were not established at the time the test was. conducted. N 1"=40' BM. =top of 1" pvc pipe ~ e] Alt. BM.= top of 1" pvc pipe Gary L. Steel 11,E-19-99 ~(Ji ee ' Wisconsin Department of Commerce r SOIL EVALUATION REPORT Division of Safety and Buildings in ~rrnrr-snro wi4h (:nmm R~ Wic ,~rrm C:nr1P 1245 Page 1 of 3 Steel Soil Service County Attach complete site plan on paper not less than 8'/ x 11 inches in sae. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I D percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. . . o2a1os2-7o-000 Please print all inform ~ -~- ~ ~ ~ -- - ` ' ~ viewed By Date Personal irdormation you provide may be used for secondary purposed tpt aw, s. 15 tt~l (Q) ~m))• . ~ 3 Property Owner Property Lo tion LaCasse Development , Inc. ~ ~ a NE 1!4 SW 1/4 S 23 T 29 N R 19 W Property Owner's Mailing Address ~ Lot # lock # Sulxt. Name or CSM# 573 Cty Rd " A" 24 ~ na EverGreen Estates III City State Zip Code Ph .. ,~„~„Ci J Village ~ Town Nearest Road Hudson ~ WI 54016 715-381-5405 Hudson Nicholas Dr. New Construction Use: ~f Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement J Public or commercial -Describe: Parent material Sandstone Uplands Flood plain elevation, if applicable na General comments and recommendations: Mound Design, system elevation 101.80ft based on contour line elevation 100.80ft Boring # ~ Boring if Pit Ground Surface elev. 101.40 ft. Depth to limiting factor 30 in• Soil Appliraton Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Dfft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-5 10yr3/2 none I 2msbk mfr gw 2c .5 .8 2 5-30 10yr4/4 none sl 2msbk mft gw 1c 5 ~~ 3 3 8 10yr6/4 c2d 7.5yr5/6 Ifs om mvfr gw na .4 .6 4 48-72 10yr8/2 sandstone residuum na na na na na .0 .0 ~_ Machine failure at 72" Boring # J Boring Pit Ground Surface elev. 101.40 ft. Depth to limiting factor __ 4~~in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 a5 10yr3/2 none I 2msbk mfr gw 2c .5 .8 2 5-40 10yr4/4 none sl 2msbk mft gw 1 c .5 .9 3 4 72 10yr8/2 c2d 7.5yr5/6 andston residuum na na na .0 .0 * Effluent #1 = BODS> 30 <_ 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) ign~ -' CST Number David J. Steel '~ 248956 Address Steel Soil Service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 4/22/2003 715-246-5085 )~ .) Prdperty Owner LaCasse Development , Inc. parcel ID # 020-1062-70-000 Page 2 of 3 Boring # .~ Boring . ,~ Pit Ground Surface elev. 98.70 ft. Depth to limiting factor 36 ~~ 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 1 0-6 10yr3/2 none I 2msbk mfr gw 2c .5 .8 2 6-36 10yr4/4 none sl 1 csbk mfr gw 1 c .4 .6 3 36-48 10yr6/4 c2d 7.5yr5/6 Ifs om mvfr gw na .4 .6 4 48-72 10yr8/2 sandstone residuurr na na na na na .0 .0 Machine failure at 72" ^ Boring # J Boring _) Pit Ground Surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Cofor Redox Description Texture Stnucture Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 ^ Boring # J Boring j Pit Ground Surface elev. ft. Depth to limiting factor in. Soit 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 * Effluent #1 = BODS> 30 < 220 mglL and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. J David J. Steel CST-POWTSM Lic. #248956 ~' ~~~ ~~ ~~ y' ~ i ~+ u ~ ~y~ .s' 8 ,~~n '°~ ~ / Page 3 of 3 STEEL'S SOIL SERVICE INC. 1564 Cty Rd GG Lacasse Development Inc New Richmond,WI 54017 NE1/4,Sw1/4,S23,T29N,R19W Bus.(715) 246-6200 Town of Hudson, St.Croix Co. Res.(715) 246-5085 EverGreen Estates III Lot 24 Legend 1"=40' ®= Benchmark Ele. 10~00Ft op of 3/4" PVC pipe • -Alt Benchmark Ele. 98.80Ft op of 3/4"PVC pipe ~- ^ =Borings Boring Elevations B 1 = 101.40Ft / B2 = 101.40Ft / B3 = 98.70ft ~~ I ~8~ ~a`°Z~Z~ 1~ 2 \~L.. / 0 /. ~o -F-~ --a 3 7 ~~i ~~' ~ ~~ i ~Y '`\ ~` .~ J •• / ~, •. .~~• ~ O ~~ '~ ``. ,~ ~~ `~ Cn ,~ .; i ~~ ° ° \ oP . ~Q~o ,~ • ~~' T .• N X ~~\I S 0 '" x x • ~ ox, ~ ~ ~• 6. x c'7 N u~$~a~ ~4 m }~- .1 ~D = ~~ X / x; Jun 07 04 02:47p LISR RNN KROLL 715-246-5700 p.l OwnerBuyer Mailing Address ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP C'~RTIFICA"i ION FORM Property Address (Verification required froth Planning Department for new ~ Ski City/State P'~~15071~ , H/S Parcel Identification Number LEGAL DESCRIPTION ~Z 6 - l 3 71 -~ ~-d ~aa~~ Property Location ~~ ,~~~ SrA/ /., Sec. _?~ . T 2°~N-R~W, Tourn of V09LvV Subdivision iG~{,~~ ~~ ~sr~5 3"~ ~y ~ ~-t tin! Lot # ~. Certified Survey Map # _ Volume _ .Page # Warranty Deed # ~ ,~~ ~ ~% ~ .Volume ~ ~~ Page # ~~ Spec house i] yes ~ no Lot lines identifiable ~ yes D no SYSTEM 1VtiA~IlVTENANCE Improper use and mamtenaaceof your septic system could rt~nlt is its ptemattu+c fat~ure ro haadk wastes. Proper mainteaaacc Consists of pwmpiztg 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 flu septic tank as a heatment stage is the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a cettificatiott farm, signed by Ilse owner and by a masterplumber, journeyman Plumber, resorictedphuaber or a liccnsedpumperverifyingthat (i) the on-site arastearatetdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is Iess than 1/3 full of sludge- Uwe, the undersigned have read the above regoiremeats and agree ro 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 Wiscoaun. Certification stating that your septic system has been maintained must be couapIcted and returned to the St. Croix County Zoning Office within 30 days of the three year cxpotation daft. B'v~r.~~~ „~,q ~!'i/ ~sr/S.0'i2 v a~~~ ~ ! $1 ~ lam` ~ Ofi APPLICANT DATE OWNER CERTIFICATION I {we) certify that all statemems on this form axe true to the best of my (our) lmowledgc. I {wc) am (are) the ownet{s) of ~ PrnPertY desczz`bed above, b irtue of a warranty decd recorded in Register of Deeds Office. /8~0¢ SI PLICANf DATE ""** Any information that is mis-rtpresentcd may result in the sanitary permit being revoked by flu Zoning Department. *****• *• Include with this application: a stamped warranty deed Eton the Register of Deeds office a copy of the certified survey map if reference is made in the watxanry deed r- POWTS OWNER'S MANUAL & MANAGEMENT PLAN a FILE INFORMATION Owner ~i Permit # -~ 2 3 DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Pu lic Facility Units ^ NA Estimated flow erage) ~~ gal/day Design flow (peak), stimated x 1.5) al/day Soil Application Rate a al/day/ft2 Standard Influent/Effluent lity Monthly average* Fats, Oil & Gre (FOG) 530 mg/L Biochemical Oxygen Demand OD5) 5220 mg/L ^ NA Total Suspended Solids ( S) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODS) Total Suspended Solids (TSS) 30 mg/L 0 mg/L '~/ ~NA Fecal Coliform (geometric mean) 51 cfu/100m1 Maximum Effluent Particle Size YB in ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effl t. MOINTFNONCE SCHFr)IIL F SYSTEM SPECIFICATIONS Pag ~ of Z Septic Tank Capacity Q al ^ NA Septic Tank Manufacturer ^ NA Effluent Filter Manufacturer ~ ^ NA Effluent Filter Model .- ~QQ ^ NA Pump Tank Capacity al ^ NA Pump Tank Manufactur ^ NA Pump Manufacturer ^ NA Pump Model ~ ~ ^ NA Pretreatment U ^ Sand/Gra Filter ^ Mecha ' I Aeration ^ Disin tion ^ Peat Filter ^ Wetland ^ Other: ^ NA Dispe I Cellls) ,~I round (gravity) t-Grade Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ I~q Service Event Service Frequency Inspect condition of tankls) At least ce ev ^ monthls) (Maximum 3 years) earls) ^ NA Pump out contents of tankls) When ombined slu and scum equals one-third (Y31 of tank volume ^ NA Inspect dispersal cellls) At ast once every: ^monthls) (Maximum 3 years) yearls) ^ NA Clean effluent filter least once every: monthls) yearls) ^ NA Inspect pump, pump controls & alarm At least once every: ^ yea~~s~1s) ^ NA Flush laterals and pressure test At least once every: monthls) yearls- ^ NA Other: At least once every: ^ o f~s'Isl ^ NA Other: ^ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersa ells shall be made by an individual carrying one of the fol ing licenses or certifications: Master Plumber; Master Plumber estricted Sewer; POWTS Inspector; POWTS Maintainer; Sept Servicing Operator. Tank inspections must include a visu nspection of the tankls) to identify any missing or broken hardware, ntify any cracks or leaks, measure the volume of combi d sludge and scum and to check for any back up or ponding of efflue on the ground surface. The dispersal cellls) shall be sually inspected to check the effluent levels in the observation pipes and t heck for any ponding of effluent on the grounds ace. The ponding of effluent on the ground surface may indicate a failing con ion and requires the immediate notification oft a local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third IY31 or more of the tank v~lme, 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. Pag ~ of START UP AND OPERATION ~ ' For new construction, prior to use of the POWTS check treatment tanklsl for the presence of painting product r other chemicals that may impede the treatment process and/or damage the dispersal cell(s). if high concentrations are detec 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 excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the ackup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage S icing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manu operating the ppmp 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, o therwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or eliminatio of the following from the wastewater stream may improve a performance and prolong the life of the POWTS: antibiotics; ba wipes; cigarette butts; condoms; cotton swabs; degre ers; dental floss; diapers; disinfectants; fat; foundation drain (sump p pl water; fruit and vegetable peelings; gasoline; gr e; herbicides; meat scraps; medications; oil; painting products; pesticide • sanitary napkins; tampons; and water softener bri ABANDONMENT When the POWTS fails and/or i ermanently taken out of service the folio g steps shall be taken to insure that the system is properly and safely abandoned in mpliance with chapter Comm 83.33, cousin Administrative Code: • All piping to tanks and pits II be disconnected and the • The contents of all tanks and pi shall be removed and p • After pumping, all tanks and pits s II be excavated and soil, gravel or another inert solid mat ' !. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the f wing replace nt system: A suitable replacement area has been evalua system. The replacement area should be protect required setbacks from existing and proposed i result in the need for a new soil and site eval is comply with the rules in effect at that time. ^ A suitable replacement area is not technology a holding tank may be ins (~~ T alua ~___ ___.._11_J _~ L. ^ Mound and at-grade soil infiltrative surface. Recor < <WARNING> > SEPTIC, PUMP AND OTHER TREATMI ENTER A SEPTIC, PUMP OR OTHER T PERSON FROM THE INTERIOR OF A T ADDITIONAL COMMENTS POWTS INST. Name , Phone POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone pipe openings sealed. disposed of by a Septage Servicing Operator. or their covers removed and the void space filled with have been, or: must be taken, to provide a code compliant Fd may be utilized for the location of a replacement soil absorption from disturbance and compaction and should not be infringed upon by ure, lot lines and wells. Failure to protect the replacement area will establish a suitable replacement area. Replacement systems must e due to ~tback and/or soil limitations. a last resort replace the failed POWTS. D4~118 rim ~ i2 N Barring advances in POWTS a o mg auk ~NS7Rll«l O~ systems may be reconstruc ~n place following removal of the biomat at the f such systems must comply w the rules in effect at that time. TANKS MAY CONTAIN LETHAL GAS AND/OR INSUFFICIENT OXYGEN. DO NOT TMENT TANK UNDER ANY CIRCUMSTA ES. DEATH MAY RESULT. RESCUE OF A MAY BE DIFFICULT OR IMPOSSIBLE. Name s-~-, t/ l (7 ZO~JI ~ Phone ~lS- 3~~p_ (p (~ This document was drafted in compliance with chapter Comm 83.22121(b)1111d1&Ifl and 83.54111, (2) & 131, Wisconsin Administrative Code. T 'J 2331P 528 a i ~ I STATE BAR OF WISCONSIN FORM 2 - 1999 Document Number WARRANTY DEED This Deed, made between LaCasse Custom Homes, Inc., a Wisconsin Corporation Grantor, and Mark A. Bates and Jennifer L. Bates, husband and wife Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Lot 24, Plat of Evergreen Estates III in the Town of Hudson, St. Croix ounty, tsconsm. O Recording Area 732 1 ~2 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO. , WI RECEIVED FOR RECORD 07/25/2003 10:40AM WARRANTY DEED tXE14GT # REC FEE: 11.00 TRANS FEE: 266.70 COPY FEE: CC FEE: PAGES: 1 Name and Retum Address 020-1374-24-000 ~ ~ 3~ ~ Z~'~ azce en ~ >tcation Number (PIN) / This is not homestead property. ~) (is not) Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Dated thi ay of July 2(103 AUTHENTICATICy ~.~1~~eC Signature(s) ~~a pub ' authenticated this day of S~'~e O , TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) L'a`Ca~sse Custom Homes, Inc. -y•~ ACKNOWLEDGMENT STAT F WISCONSIN ) ss. County) Personally came before me this(` day of July 2003 the above named LaCasse Custom Homes, Inc., a Wisconsin Corporation by its to known to b n(s) who executed the foregoing i r~r rgytrt and n e ~d the same. THIS INSTRUMENT WAS DRAFTED BY +~,LV~ Attorney Kristine Ogland Notary Pul Hudson, WI 54016 My Comm_ (Signatures may be authenticated or acknowledged. Both aze not necessazy.) ~~ Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 - 1999 State of Wisconsin ~io~ is~per~ anent. (If not, state expiration dat j 1. , Information Professionals Company, Fomtl tlu Lac, WI 800.655.2021 r i t a :32 ~:~~ t~~` ~ _~ ^.~crt.. ~''.~ ~~ C~'~ ~C?t~t!"t", v J T 2~ ~~~ ~, r~? ~. ~t~~°~'T ~r3 ti,1 _~ 1 (I ~ - • ~.~ , ~.~~,,'' i~~.,` _,.~, ~,