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020-1409-10-000
Wiscansin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM 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 Bast, Kernon Hudson Townshi CST BM Elev: C5fl •'~~ Insp. BM Elev: 'lam . ~~ BM Description: (~~ ~ p_ - ~ ,y_ ~ 'r~~o+ = ~iw ~~iilbr-~ ~~'`"~~rr~ TANK INFORMATION w - TYPE MANUFACTURER CAPACITY Septic cu..t"~~ ,,`~ /.~ Dosing ~ CJ~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD eptic ~ 2S / ~ z l ~ Dosing Aeration Holding PUMP/SIPHON INFORMATION ~~~ `6 `, ' ~• Manufacturer ~~ ~- Demand ~ ~ k GPM Model Number GjG ~l ' , /~ --~ /I- [ TDH Lift Friction Loss L stem Head S y TDH Ft .oS -- I.o _ .'.- $'.a orcemain LengZ f Dia. ~~ Dist. to Well ~ ~ SOIL_~SORPTiON SYSTEM j3'3 ~ ~_y~~,J~,.~ ~~ ELEVATION DATA county: St. Croix Sanitary Permit No: 420718 0 State Plan 1D No: Parcel Tax No: 020-1409-10-000 Section/Town/Range/Map No: 24.29.19.2568 STATION BS HI FS ELEV. Benchmark 3 03. Oa,a Alt. BM Bldg. Sewer !l- ~ ~ SUHt Inlet SUHt Outlet Dt Inlet Dt Boft ~~ •3Z . ids o. g~-dot Header/ ~. o as. ~2 Dist. Pipe Bot. System /~ ,3L ~ • ~ Final Grade ~ y ~ - p St Cover ., REN Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM NS ~~ ~ ~~~ , C3~ ` SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING q Ma ac er INFORMATION CHAMBER OR ~ 'k' Type Of System: ~ r ~~ ~ !~ UNIT Model Number: ~ t;~ O~ DISTRIBUTION SYSTEM Header/Mapifold " Distribution x Hole Size x Hole Spacing Vent to Air Intake (~y^~~ " ' Pipe(s) ~ r 33 Length Dia Len Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched BedlTrench Center Bed/Trench Edges Topsoil L~ Yes i=,~ No ~' ~ Yes 'CJ No M~M~C 15~ jlnc~; c e isc~r~'e~pe~nScie~ r~~pr/~sent,letc.) In tion#1 V~'~3 oc~tion: 8'f 1 Hidden Lake Rd Hu sd on, WI 54016 SEc1~/l4~SE•/16/4~24 T29N R oun a Rid a Lot 10 ( rY 9 1.) Alt BM Description = ~/~ 2.) Bldg sewer length = ~ 2 ~ -amount of cover = •J ~ ' • ~~ , Plan revision Required? Yes ~ No -{~~ ~- r Use other side for additional informa Ifon. ~~"' ~ 2~i _ 1~, aat ~S SBD~710 (R.3/97) V/ Inspection #2. / Parcel No: 24.29.19.2568 ~N~~ ~~_ ~_ ~ ~ - -- ~ Cert. No. lee~/'I 3 ~ ev Safety and Buildings Division County 201 W. Washingtpn~,y„e,;, P.O. Box 7162 ST. CROIX ~sc~nsin Madis(6n0~26563~~~~~ nitary Permit Number (to be filled in by Co.) D f C ~zo ~r8 epartment o ommerce Sanitary Permit Applicat on :.~ ~ g ~~Q~ ate Plan LD. Number In accord with Comm 83.21, Wis. Adm. Code, personal inform tion you provide may be used for secondary purposes Privacy Law, s15 4(1)(m) - _~ ~_;C?I?P17~'r roject Address (if different than mailing address) Q I. Application Information -Please Print All Information °`"" ~ ~,~ 1 ~ QO>~ll ~~ Rp Property Owner's Name Parcel # Lot # Block # ATLAS ENTERPRISES 1o NA Property Owner's Mailing Address Property Location PO BOX 2012 SE '/4, SE '/4; S 24, T 29 N, R 19W City, State Zip Code Phone Number EAU CLAIRE, Wl 54702 715-835-7872 II. Type of Building (check all that apply) / 1 or 2 Family Dwelling -Number of Bedrooms 4 Subdivision Name CSM Number BOUNDARY RIDGE \ bli i l P /C ib U f 3~ C~~ C ommerc -Descr u a e se y o c { ~ / O City o Village ~ Township of HUDSON t o State Owned -Describe Use X b~-~ ~ Cl~+' III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. / New System o Replacement o Treatment/Holding Tank Replacement Only o Other Modification to Existing System System B o Permit Permit Revision o Change of o Permit Transfer to List Previous Permit Nu er and Date Issued Renewal Before Plumber New Owner D~ / ~ ~z0~~ r ~ 3 Expiration IV. T e of POWTS S stem: Check all that a I Non -Pressurized In-Ground o Mound > 24 in. of suitable soil O Mound < 24 in. of suitable soil O At-Grade O Single Pass Sand Filter O Constructed Wetland O Pressurized In-Ground O Holding Tank O Peat Filter O Aerobic Treatment Unit O Recirculating Sand Filter O Recirculating Synthetic Media Filter '~ Leaching Chamber O Drip Line O Gravel-less Pipe O Other (explain) V. Dis ersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 600 0.6 1000 1026.3 94.0' VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank 1250 1250 1 HUFFCUTT Aerobic Treatment [Jnit I__ C~'N^' Dosing Chamber 750 750 l HUFFCUTT VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number DARRELL FRAZER ~r J.~ _ ,s ~`f~L~~ ~C 221071 715-288-6225 OR % CELL 71.5-828-5734 Plumber's Address (Street, City, State, Zip Code) 16317 160rt' -BLOOMER, WI 54724 VIII. Count /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuin Agent Signature (No Stamps) ^ Owner Given Reason for Denial Surcharge Fee) ~~ , ~ ~ ~~Q Zl3fl 3 ~ IX. Conditions of Approval/Reasons for Disapproval I~j~,~~ 1 _ ~~-Q/J lv~ ~ Jf'.f ~ ~e~ ~ OK"_ _ S~~ t S b~e.-~,-~ Iti~y~~'~Sd/ 1~~®^ (l * Q~- ';-U'~e , - I y f ~( ' lam' ~ /1:QJ'..pQQ,ptx aWOQ 'St ~ _ `~ ~ mp-iete plans (tot un on y or~sys~em on a er not less than 8~-fi-iirt`1rl~n s'i ~Rl~-h39R (R. ~1/~31 ~, 0 0 a w x J Z w Q a BAST SITE PLAN LOT Iy10 BOUNDARY RIpGE - ~ - ' -' - (BOUNDARY CIRCLE)- - I I I I I ~ (SCALE) 0 20 40 (UNLESS SHONN OTNERNVSE) M'ISCONSINL~RTIFIEO SpL TESTER DESIGNER OF ENpNEERING SvSTENS CUSTOI+ER I.D. 1 227819 I ^-25'-4" 3034 BUILDING SEWER SE-SE-24-29-19W HUDSON TOWNSHIP ST. CROIX COUNTY, WI LEGEND BENCHMARK ELEVA ON = 100.0 (top of concrete gc oge floor) o LOCATION OF SOIL ORING(S) LOCATION OF SOIL IT(S) :IC NO APPARENT COM 83.43 SETBACKS ~C PARCEL DESCRIBED S 2.01 ACRES __ _ _ __ _ ,- N3 __ __ _. - ,_- NZ (96.5) .._ ................._......_ .... BUILDING SEWER MUST COMPLY HUFFCUTT 1250/750 (3) NON-PRESS RIZED DISTRIBUTION CELLS W/COMM 82.30 W.A.C. (11)(c)~ SEPTIC/PUMP TANK EACH CELL USE I (MODEL - INFIL ATORLSYSTEMS CSTANDARO") I LOCATION OF WELL MUST COMPLY I EISA RATING = 1.1 PER CHAMBER WITH WDNR CHS. NR 811 8c 812(b) 25'- 2" SCH 40 PVC FORCEMAIN (droins bock to dose chomber) PAGE 2 OF g ~. r ,' ` Co vex Sheet A TLAS ENTERPRISES PO Box 2012 -Eau Claire, WI 54702-2012 NON-PRESSURIZED IN-GROUND SOIL ABSORPTION COMPONENT Reference SBD-10567-P (.6/99) "In-ground Absorption Component Manucil" Location: Lot #] 0 -Boundary Ridge SE'/4, SE'/4, Sec. 24, T 29 N, R 19 W Town: Hudson County: St. Croix Designer's name and license #: William J. Bergh (License No. 1577-007) 1 the arndersigned state that these plans were designed and submitted a~nder my author Designer's signature: Designer's address: 2667 113° tr t Chippewa Fa s, WI 54729 Designer's phone number: 715-723-5555 voice 715-723-7535 fax 715-577-6838 cellular Contents Page 1-cover sheet Page 2- site plan Page 3- leaching chamber x-section Page 4- leaching chamber manufacturer specifications Page 5- septic/pump chamber x-section Page 6- pump curve Page 7- management and contingency plan Page 8- management and contingency plan ~., ':~' ~ ;WILLIAM J. Q 70 ~ BERGH ~~ . ~.~: °0• ~~NAL ~ .•'~ ...... ~. ^~.~ .....r ~....~rr.•. ~~ Page 1 of 8 ~' ~ BAST SITE PLAN LOT f/10 BOUNDARY RIDGE SE-SE-24-29-19W HUDSON TOWNSHIP ST. CROIX COUNTY, WI i i ' _ _ _ _ _ --0-- _ - - (BOUNDARY CIRCLE)- - - - - a a 0 w Y Q J w LEGEND ~ ~ BENCHMARK ELEVA ON = 100.0 _ (top of concrete g oge floor) o LOCATION OF SOIL ORING(S) LOCATION OF SOIL IT(S) ' ~ NO APPARENT COM 83.43 SETBACKS ~C PARCEL DESCRIBED S 2.01 ACRES (SCALE) ' _ N3 _ ... _ _ i r,n~ u~ ~BUILDING SEWER MUST COMPLY I W/CDMM 82.30 W.A C. (11)(c) i ~ LOCATION OF WELL MUST COMPLY WITH WDNR CHS. NR 811 & 812(b) ~25'-4" 3034 BUILDING SEWER HUFFCUTT 1250/750 SEPTIC/PUMP TANK _, .. q2 (96.5) (3) NON-PRESS RIZED DISTRIBUTION CELLS EACH CELL USE (11) LEACHING CHAMBERS (MODEL - INFIL ATOR SYSTEMS "STANDARD") EISA RATING = 1.1 PER CHAMBER 25'- 2" SCH 40 PVC FORCEMAIN (droins bock to dose chamber) PAGE 2 OF 8 GRAVELLESS LEACHING CHAMBER CROSS SECTION (typical) (installations may vary & require additional cells (not shown- drawing not to scale) observation pipe (where required) growtn 11 NUMBER OF LEACHING CHAMBERS (per cell) 3 TOTAL NUMBER OF CELLS 33 TOTAL NUMBER OF LEACHING CHAMBERS (all cells) A MINIMUM OF 12" OF SUITABLE FILL MATERIAL IS REQUIRED OVER THE CHAMBERS. INFILTRATOR STANDARD CHAMBER - OPEN BOTTOM AREA = 15.5 SQFT. INFILTRATIVE SURFACE PER CHAMBER BASED ON EISA RATING = 31.1 FT2 All material and piping specifications as per the Conventional Soil Absorption Component Monuol, PAGE 3 OF 8 SYSTEM ELEVATION = 94.0' The Standard Infiltrator Chamber The Standard Infiltrator Chamber .I 2, 1 1" Over!?p at L~~tching (v12chanisn~ ,,, ;i ~ _., I~ i }._._.. ___ _ _..._ r - - f -- i ---~ ' i ~ --1i I i _ i I i! ":: ~ ~I ~ `~ I - ~ -~ "' _ _r - i -~ ~ ~ f - -.__..._ 75" -- Effiective Lenath Chamber End View ~ -~~ f/ /~ o _~ _ ~ ` ~. ~~ .f PasiLock'" End Ptate ~ r~1 ~^ ,.. f ~ ~~ CSC'' ~ ~`~~` J~C~I~O ~,~, Size(WxLxH)......34"x75"x12" 'Storage Capacity ....78 gal./1.0.4 ft' Weight .. .............................26 lbs. IN.FILTRATQR._SYSTEM$; INC.. $TANDARD._LIMlTEDWiARRANTY INr R= ~ FAQ' INC. feu ~~ Lip\nl'rr .. -- OI;; . -.~~ ~.;N ~~:~ ,, ,'s. nc~g:acr o tai~,~ o~~- n Louvered Sidewall Height............6" . • ~/ SY~T~M~ INC Environmental Onsite Wastewater Solutions " 6 Busiress Park Road PO. Box 768 Old Saybrook, CT 06475 800-221-4436 860-577-7000 FAX 860-577-7001 v~i~n~w.infilUatorSystems.com -~~ ~h ,~ ~ ,> ~ 1-800-221-4436 A~, ~~ ~ ~ ... ,>, , , ,~ , , ,~~..~ ~. ~~ 1:111 .. ~, T5. f5 =I ^ .... :~.fC ~ non.: f: I (~ f ~.-~: ~~[ i _ rii ., ii ~ " - , For technical assistance, installation instructions or customer service, call Infiltrator Systems at 1-800-221-4436. U.S. Pattn 4 75G f Ll -~,01 / u41 ~ 1~f 7r, ob, ~ ~ 401."lh' :: 401,4s~ 5 bl l ;J ,1,716,16:, ~ .,b8,778: S 639 gca Canodian F<tr~~[s 1 3 X358: ~.~u .5r. v ,~h~- Ftncr r o~ ii~lr.y. Infl~t(eiJC, F~lIi31~IZC'a'1(: Si(1~: /'/fl _ ~"(: f~C~l~, f.~''H(~CfY1d~K~ J~ If*il '.JI :,, ,[Of l~ Ifl~.,- flfilC.'..., ,.; fLyi [-;.f ,.] I~~.]i'.N~r3~~. 1, f-!HI'1(;t;. RECYCLED PAPER Inf~ItiaMr ~y um~ in 's .~i regi t i i ~Jc. i~ i f1--xico - ~onm.rt MicroLear,lid4 PoIyT ~ _ri ,,i~r_k _han~?~r_a c:ur, Po,l_.c`, ~,~dQ~:ickPWyarC:aGemarKSO ri~l,i~,u: ~, .~,ns',~~c _~~1 Intl .. ~~~~>~~ ~ P~ ... rUS CrOSC~~FNL-3 ' SEPTIC/PUMP CHAMBER CROSS SECTION (DRAWING NOT TO SCALE) Final rode Access riser with locking cover g (cover must be properly marked (slope ground away from with an opproved warning label) risers for drainage) \ Actual depth may increase see COMM 82.30 (11), (C) and (d). OF power & alarm cable (must use seperote power tank Vent and alarm circuits) q / \ (externally mounted) I I 1 junction box l' Lr l - + 4" min. ' force ma ' access riser 18" mi bottom of inlet invert ~ +,. filtered reserve water level ~ effluent ~alorm inlet ~ l -~ on I 4" inlet I: I I tee or baffle I ,;off opproved effluent filter I, required on tank outlet ~ 82.0 G Q~ ~ ~ ` I Minimum of 3" of suitable bedding beneath tank pump pad EFFLUENT FILTER ZABEL (A-100) (or equivalent) Tank monufocturer HUFFCUTT DWF (daily wastewater flow) 600 1250750 GALLON Number of dial doses septic/pump chamber capacities Y ^'7.0 (DWF / actual dose volume) Alarm monufocturer S.J. ELECTRO (or equivolent) Forcemoin volume 4.1 Alarm model number HW 101 (Or equivolent) MERCURY (or equivolent) Type of float switch Effluent pump monufocturer LITTLE GIANT Effluent pump model number 9EH Minimum pump discharge rote (gpm) NA Vertical lift (pump off to lateral elevation) 12.0' System head (distal pressure x 1.3 ft.) NA Friction loss in the force main <1.0 Total Oynomic Heod (TDH) <13.0 Actual dose volume (gal) (total dose vol. - forcemain vol.) 85.48 CAPACITIES reserve above alarm 21 inches = 313.53 gallons alarm above pump on 2 inches = 29.86 gallons on/off measurement 6 inches = 89.58 gallons off to tank bottom 14 inches = 209.02 gallons TOTAL 42 inches = 627.06 gallons PUMP CHAMBER DIMENSIONS length 49 width 70.0" th 42" li id d gallons/ inch 14.93 qu ep Page 5 of 8 9EH SERIES SUMP/EFF'LU ENT PUMP ~, w.... Specifications MODEL CAT. SOLIDS SIZE RUNNING PERFORMANCE (GPM @ NEAO) SHUTOFF PS{ PWR. CRD. WEIGHT DIMENSIONS N0. N0. LISTING HP VOLTS )Oia.ln.) AMPSIWAiTS 5' 10' 15' 20' )Ft) IFt) )WsJ (NxlxW) 9EH-C{M 509330 U4`CSA 4110 115 3r4 13.0 1000 71 66 60 49 32 13.8 20' 27 9.11 x 11.64 x 8.94 9EH-CIM 509340 UVCSA 4/10 230 3/4 6.5 1000 71 68 60 49 32 13.8 20' 27 9.11 x 11.64 x 8.94 9EH-CIA-RF9 509350 UVCSA 4;10 115 3/4 13.0 1000 71 68 60 49 32 13.8 2G' 27 9.11 x 11.64 z 8.94 9EH-CIA-RFS 509360 UVCSA 4110 23D 314 6.5 1D00 71 68 60 49 32 13.8 2D' 27 9.11 x 11.54 x 8.94 Construction 30 w zo 0 6 w r 10 0 10 ~s~ 5 ' 0 Q 2.s 0 ~ Motor Housing ~ Epoxy C=oated Cast Iron Impeller 1blaterial - ~ Poly Carbonate _ ~T -- Impeller Type ~ _Closed Vane V ul e --- -- '~ ABS __ _ r---- Power Cord I SdTW_A __ Mechanical Shaft Seal Nitrile with carbon an~ d~~~~, I ceramic faces teners _~Stainless Steel ,_~ ~, Shaft _ StaiT~less Steel -{-- - --~ Bearings ~ Upper Sleeve and Lower j Ball Bearings I 0 20 a0 60 80 FLGW- GALLONSfMINUTE PUMP PERFORMANCE CURVE SSPMA ,,,.~k~ 115V 60HZ r'~ Ww. 9 - gti ISO 9001 CERTIFIED Little C><iant Pump Co. PO Box 12010 `Phone: 405.947.2511 Okla. City, OK 73157 Fax: 405.951.5674 .Form 995235 - Ol/00 FLOW- LITERS/HOUR POWTS OWNER'S MANUAL MANAGEMENT PLAN PERMIT NUMBER: Owner/Agent: POWTS Maintainer: Local Regulatory Authority POWTS Installer: Septage Servicing Operator Atlas Enterprises -Lot # 10 -Boundary Ridge Geo Tech Soil & Site Evaluation -Chippewa Falls, W 1715-723-5551 St. Croix County Zoning Department -Hudson, WI 715-386-4682 Darrell Frazer -Frazer Excavating -Bloomer, WI 71 ~-288-6225 DESIGN PARAMETERS lnfluent/Efl7uent quality (values typical for domestic (non-commercial wastewater and septic tank effluent) Fats, Oil and greases (FOG) <30 mg/L, Biochemical Oxygen Demand (BOD) <220 mg/L, Total Suspended Solids (TSS) <150 mg/L Soil Loading Rate (SLR) = 0.6 gpolft'. SYSTEM SPECIFICATIONS The components of this septic system are intended to serve afour-bedroom (600-GPD) single-family residence. The components include a Huffeutt 1250/750 gallon septic/pump tank with Little Giant pump alarm and controls, a Zabel A-100 effluent filter, and (2) non-pressurized distribution cells using graveless leaching chambers. A total of 33 Infiltrator standard leaching chambers are required when applying an EISA rating of 37.1 as specified by DCOMM. All parts of the components must comply with WI Adm. Code COMM 84 and be installed per manufacturer specifications and approval letters. DESIGN CR[TERIA o "Design of conventional Soil Absorption Trenches and Beds". R.J. Otis - ASAE Publications ~-77 and Design Manual - Onsite Wastewater Treatment and Disposal Systems:. EPA 62511-80-012 October 1980 / SBD - 10567-P (R.6/99) "In ground Absorption component Manual" o SBD - 10705-P (N.O1f01) `'ln ground Soil Absorption component Manual" Version 2.0 MAINTENANCE & MANAGEMENT Inspect the condition of the treatment tank(s) and dispersal cell(s) a minimum of every three years. The septic tank contents must be removed in accordance with Chapter NR 113, WI Adm. Code when the combined sludge and scum equals one-third (1J3) the tank volume. The effluent filter should be inspected annually to ensure maximum performance. START UP For new construction prior to use of the POWTS check treatment tank(s) for 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 tank(s) removed by a septage-servicing operator prior to use. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of wastewater will affect the performance and longevity of your POWTS. The installation of water-saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also, the brine or waste from water softeners, iron removal units, and other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. The system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit peels and seeds, bones, and food solids such as those produced be a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkins, condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint. disinfectants, pesticides, antibiotics (medications), solvents, etc., should not be flushad into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain regular steady flow by spreading the laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the unit may cause it to freeze up. / Alarms Alarms should be tested on a regular basis by the homeowner. If an alarm sounds, contact an individual licensed to serve POWTS. There is normally a one day reserve capacity under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surface. Page 7 of 8 INSPECTIONS Inspections shall be made by a person carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule) / Septic Tank Component Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks of leaks. measure the volume of combined sludge and scum and to check for any backup or surface discharge of effluent. Access openings used for service of assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured v`~th an effective locking device to prevent accidental of unauthorized entry into the tank. The outlet(eff7uent) filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank during cleaning. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating properly. / Pump Chamber/Treatment Tank(s) Component The inspection must include a test of all electrical equipment such as pumps, alarms and t7oats. A visual check must me made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of the filter. Any service needs or repairs shall be promptly taken care of. / ln-Ground Gravity Component dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground must he promptly reported to the regulatory authority. Ponding greater than 7~% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. o Divertor Valve The divertor valve shall be switched to serve the opposing distribution component every three years (when the septic tank is due for it regular maintenance). However, if ponding is observed in the observation/vent pipe of any cell, the divertor valve shall be switch to the opposing component. Furthermore, ponding greater than 7~% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.5 Wisconsin Administrative Code. ABANDONMENT When the POWYS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. COMM 83.33, Wisconsin Administrative Code. - All piping to tanks and pits shall be disconnected and the abandoned pipe opening sealed. - The contents of all tanks and pits shall be removed and properly disposed of be 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 other 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(s), 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. o 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. o The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. o 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 O"1'HER TREATMENT TANKS MAY CONTAIN LETHAL GASES AND/0R INSGFFIC[EN'f OXYGEN. DO NOT ENTER A SEPTIC, PUMP OF OTHEK TREATMENT TANK UNDER ANY CIRCt:MSTANCES. DEATH MAY RESULT. RESCtiG OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICIIL"T OR Ib1POSSIBLE. Page 8 of 8 Wisconsin Department of Commerce Division of Safety and Buildings rrr.r•rr ~~ ..~+ ~~ SOIL EVALUATION REPOR ~~ in accordance with Comm 85 Wis Adm. Code 1455 Page 1 of 3 Geo Tech Soil & Site Evaluation County Attach complete site plan on paper not less than 8Y x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. 020-1069-10-100 Please print all information. iewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ ~_ 1 Property Owner Property Location ATLAS ENTERPRISES INC. Govt. Lot NA SE 1/4 SE 1/4 S 24 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# PO BOX 2012 10 NA BOUNDARY RIDGE City Sta ode Phone Number x City l Village ;Town Nearest Road Eau Claire ~ WI 54702 715-835-7872 BADLANDS ROAD New Construction Use: / Residential /Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial -Describe: Parent material ALLUVIUM OVER OUTWASH d plain elevation, if app licable NA General comments ~ and recommendations: site is suitable for a conventional septic system component. Recommended SLR = 0.6 (d ue to increased density at depth). Recommended system elevation = 94.0'. ~ - Boring # Boring >100 /j Pit Ground Surface elev. 98.8 ft. Depth to limiting factor 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 0-5 10YR 211 none sil 1 f-m sbk mvfr gs 2f-c 0.2 0.3 2 5-34 10YR 4/3 none sil 2 m abk mfr gs 1f-c 0.5 0.8 3 34-60 7.5YR 4/4-6 none Is 1 c sbk mvfr-fr cw 1f-m 0.7 1.2 4 60-74 10YR 414 none Ifs 1 m sbk mfr cw 1f-m b~ t3:7~ 5 74-100 10YR4-5/5 n ne grss 0 s g ml -- 1f 0.7 1.2 o .V/ ^/e IV`4 _•.-0 0 - O~N~ :~ lM s~~ -~, o- ~l~- s `/f s ~~ 2 ~ ao~-~~'ai SY1t • Cyr ., Boring # Boring /', Pit Ground Surface elev. 96.5 ft. Depth to limiting factor >80 in• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Diflz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-6 10YR 3/2 none sil 2 f gr mvfr gs 2f-c 0.5 0.8 2 6-17 10YR 4/3 none sil 1 m abk mfr gs 2f-c 0.2 0.3 3 17-29 10YR 3/6 none loam 1 c sbk mfr cs 1f-c 0.4 0.6 4 29-46 7.5YR 4/4 none Is 1 m sbk mfr-vfr cs 1f-m 0.7 1.2 5 46-80 7.5YR 4/6 none s 0 sg ml -- 1f 0.7 1.2 xl s ~`' cQ¢,o~.~a.- I - o . ~ 11 l1o-r`~ Increased den ' observed in horizon no.4. * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L uent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number William J. Bergh ~ 227819 Address Geo Tech Soil & Site Evaluation a Evaluation Conducted Telephone Number 2667 113th Street, Chippewa Falls, WI 54729 6/3/2003 715-723-5555 3 'Property Owner ATLAS ENTERPRISES INC. Parcel ID # 020-1069-10- Page 2 of 3 Boring # Boring Pit Ground Surface elev. 102.8 ft. Depth to limiting factor > 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-5 10YR 3/2 none sil 2 f gr mvfr gs 2f-c 0.5 0.8 2 5-15 10YR 4/3 none sil 1 m abk mfr gs 2f-c 0.2 0.3 3 15-32 10YR 3/6 none loam 1 c sbk mfr cs 1f-c 0.4 0.6 4 32-53 7.5YR 4/4 none Is 1 m sbk mfr-vfr cs 1f-m 0.7 1.2 5 53-83 7.5YR 4/6 none s 0 sg ml gs -- 0.7 1.2 6 83-120 10YR 4/6 none gr s 0 sg ml -- -- 0.7 1.2 Increased density observed in horizon no.4. Boring # - Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring # '' Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.o~/oo) Geo Tech Soil & Site Evaluatlon i [ , BAST PLOT PLAN SE-SE-24-29-19W LOT p10 BOUNDARY RIDGE HUDSON TOWNSHIP ST. CROIX COUNTY, WI i - - ---------~---- - (BOUNDARY CIRCLE)---- -- 0 a 0 w Y Q J w LEGEND p ~ BENCHMARK ELEVATION = 100.0 _ ~ (top of concrete goroge floor) i o LOCATION OF SOIL BORING(S) I ~ _ LOCATION OF SOIL PIT(S) ~C NO APPARENT COMM 83.43 SETBACKS ~C PARCEL DESCRIBED AS 2.01 ACRES (SCALE) M3 0 20 40 ~102~8~ (UNLESS SNOwN OTNERxtSE) -~_y YYILLIAN J- BERGH ° - "_-, ..... .........__~..,,.....,~,,,, 1MSCONSIN CERTIFIED SOIL TESTER I DESIGNER OF ENGMEERINC SvSTEYS CuSTOrtER I.D. / 227819 {` t Cal j ..._„_,....._,,._......._............_... I ' / i ~, , / , /~ / / ~ 3 ~/' ~~ .. ~ / ~~;_ 98 ~ ..,.__.... .._ -._.._~. ~~. ~- qt __. __ ~ ~ ~ ~~ I . ~~~. ~, '4-6R HOUSE ;, , ,. ~, ~' ii~ ~ ', j ,, t~~, PAGE 3 OF 3 PROPOSED (3) NON-PRESSURIZED DISTRIBUTION CELLS EACH CELL USES (11) LEACHING CHAMBERS (MODEL -INFILTRATOR SYSTEMS "STANDARD") EISA RATING = 31.1 PER CHAMBER ~l 2158P X71 . .. St. Croix County RECEIVED FE8 2 S 2003 ST. CRQIX CUUNI Y Occupancy Ai~davit Kernon J. Bast Name - (Owner) Typed or printed being duly sworn ,states, under oath, that: 1. He/she is the owner/part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume 2 0 41 Page 2~- Document Number St. Croix County Register of Deeds Office: A parcel of land located in the S E %, of the S E %. of Section 2 4 T 2 9 N - R 19 W, Towa of Hudson , St. Croix County, Wisconsin, being duly described as follows (include lot no. and subdivision/CSM or detailed legal description): Lot 10 Boundary Ridge, Town of Hudson, St. Croix County 7 1 1 696 KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX CO. , itI RECEIVED FOR RECORD 02/28/2003 12:45PM EXE)IPT # REC FEE: 11.00 TRANS FEE: COPY FEE: 2.00 CERT COPY FEE: PAGES: 1 Name and Kernon J. Bast 400 S. 2nd St - Suite 130 + 1 411 h+ 1 11+ As owner of the above described property, I acknowledge that the septic system serving this residence is sized for a 4 bedroom home, or a design flow of ~ n n gpd. The design flow is calculated by assumittg 150 gpd for 2 individuals per bedroom. There are currently__p__ occupants living in this residence; $_ occupants are permitted based on the design flow. Therefore the septic system serving this residence is code compliant. However, l understand that if there are intentions to exceed the number of permitted occupants, the system will need to be modified to accomodate any increased wastewater flows and/or contaminant loads. I also acknowledge that I will make this infomnation available to any future parties interested in purchasing this property. authenttcated this day of TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 71N.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED 8Y Kernon Bast ACtCNOWLEDGMENT STATE OF WISCONSIN ) ~s. St. Croix County. ) 2 OPOe~onally came before me this 2 g thday of FP r„ a r.~; ..ii the above named to Wisconsin I(s) who executed the the same. Notrdry Public, State of Wisconsin (Signatures may be authenticated or acknowledged. Both are not My Commission is permanent. Knot, state expiration date: necessary.) Oate: 1-.Z S - A7 "THIS PAGE IS PART OF THIS LEGAL DOCUMENT - 00 NOT REMOVE" 7riis hlbmration must be completed by submirter. , name a um address. and p„((y rd n9Quhed). outer infomrarlon such as ure granting dauses, leagal description, etc. may be placed on this lust page of u-e document or may be placed on additional pages of the document. (~~ use o1 this Dover page adds one page to your document and ,~. 00 to ure recordlno fee. Wfsoonsin Statutes, 59.511. Signature(s) Wisconsin Department 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)]. >rmit Holder's Name: City Village X Township 3ast, Kernon Hudson Townshi iT BM Elev: Insp. BM Elev: BM Description: SANK INFORMATION TYPE MANUF Dosing TANK SETBACK INFORIVI~ TANK TO P/L WELL PUMP/SIPHON INFORMATION Manufacturer GPM TDH Lift Friction Loss System Head Forcemain Length Dia. Dist. to Wen SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of DIMENSIONS SETBACK SYSTEM TO P/L INFORMATION _ _ _ _ DISTRIBUTION SYSTEM Ft I ELEVATION DAT county: St. Croix Sanitary Permit No: 420718 0 State Plan ID No: Parcel Tax No: 020-1409-10-000 Section/Town/Range/Map No: 24.29.19.2568 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer SUHt Inlet SUHt Outlet Dt Inlet Dt Bottom Header/ Dist. e • . Syste Final Gra St Cover PIT DIMENSION . Of Pits I LAKE/STREAM L ING ~ CHAM OR Header/Manifold Distribution x Hole Size x Hole Spac Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER ressure Systems Only xx Mound Or At-Grade Systems Only Depth Over epth Over xx Depth of xx Seeded/Sodded Mulched Bed/Trench Center Bed/Trench Edges Topsoil ~ Yes No ~ Yes 0 No COMMENTS: (Include co discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 811 Hidden La Rd Hudson, WI 54016 (SE 1/4 SE 1/4 24 T29N R19W) Boundary Ridge Lot 10 Parcel No: 24.29.19.2568 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = 1 • ---, ( Plan revision Required? ;~ Yes [] No Use other side for additional information. _____; L___ ___ __ __ ~ SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. S ! ~ob~ lc.~ RD . Safety & Buildings Division 3 Sanitary Permit Application 201 W. Washington Ave. ®~ PO Box 7302 isconsin In accord with Comm 83.21, Wis. Adm. Code Madison, WI 53707-7302 Department of Commerce Personal information you provide may be used for secondary purposes (Submit completed form to county if not [Privacy Law, s. 15.04(1)(m)] state owned.) Attach com lete lans (to the coun co onl )for the s stem, on a er not less than 8 -1/2 x 11 inches in size. County State Sanita Permit Numbe ^ Check if revision to previous application State Plan I. D. NUMBER ST CROIX I. Application Information -Please Print all Information Location: _ ~ ~ ~ l ll ~~1J L-/d'K~ Property Owner Name KERNON BAST ~ f'qS ~~y~ , • '[' `;, JAN 1 3 2003 ~y c P ~ ~ SE% SE I/4, S 24 T 29 N, R 19 W Property Owner's Mailing Address Lot Number Block Number 948 LABARGE ROAD R IX 10 NA City, State Zip Code Pho e Numbg~pNING OFFICE Subdivision Name or CSM Number HUDSON, Wl 54016 715 - - BOUNDARY RIDGE II Type of Building: (check one) Ct~ ~ ` City Vill - 1 or 2 Family Dwelling - No. of Bedrooms: ~ " ~ age `~~ ~"" Public/Commercial (describe use): ~ ~ ~ f% Town of HUDSON . J - ~/y~ State-owned Q)L_ III Type of Perm' • (Check only one box on line A. Check box on line B if applicable) crest Road A) - New System 1. ^ Replacement 2. ^ Replacement of 3. ^ Addition to Parcel Tax Number(s) - S stem Tank Onl Existin S P~~ 02.D - `FO q' l0 -sbp $~ Permit Number Date Issued ^ A Sanitary Permit was usly issued IV. Type of POWT System: (Chec that apply) - Non-preSauri P~grnnnrl ^ Mound and Filter ^ Constructed Wetland ^ Pressurized In-ground ^ Holding Tank Single Pass ^ Drip Line ^ At-grade ^ Aerobic Treatment Unit ^ Recirculating ^ Other: V Dis ersal/Treatment Area Information: 1. Design Flow (gpd) 600 2. Dispers lAre Requirec~1500~ 3. Dispersal 4. Soil Applicaf 5. Percolati to Proposed 1~ a Gals./d q, ft.) Min./i A 6. System E on 95.3' 7. Final Gr Elevat~ YYYYYY o.4 • 15-2 ~,6 VI Tank Capacity in Total # of anufacture refab Site Steel ibe lastic Information Gallons Gallons Tanks Con- Con- New Existing Crete cted Tanks Tanks 1250/750 COMBO 1 0 2000 1 f-[UFF(. ~"I' X ^ ^ ^ ^ ^ VII Responsibility Statement I, the undersi ned, assume res onsibilit for installatio the POWTS shown on the hed Tans. Plumber's Name (print) Plumber's Signature stamps): MP/MPRS N Number DARRELL FRAZER ~ ~'~~ ~ C~ 221071 6 OR (CELL) 828-5734 Plumber's Address (Street, City, State, Zip Code) 16317 160T" -BLOOMER, WI 54724 VIII CountylDepartment Use Oniy ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued ruin Agent Signatur o stamps) Approved ^ Owner Given Initial A rse Surcharge Fee) ~ S (J O a °~ ~ 1~/1/li t~ /°? ~ ~ ~ Determination ~ Y ~ IX.~onditions ofof Ap~/R.eas s for Disap rove ' S, b~~~ B t ~ (~' 2 GtX.crvt u;c2•au~>' ~~-~~ -~=~° 0 w,~~ ~,r,~fa.~,, :~ C~~ • ~• 3- J. I.tJ.e~ ~~'G~ ~/, 8r -~8r2~- ~-~b ~~// wlu-af- vr~~~ ~t.o~ ~r Corvrdu~s ~ C sr ~2.e~o~~ cal ~ rfs ~ s.~~z!~ z ~ ~trn-~~ -~_ ~ P(,~tm.l~.>; n•~.~.~-=-r c~-kr ~a..tt~s-~~----Q-~.v~~'` P-4,~.'~.. - m~ 5 ~,. ~ ~tiu~~ /+~ue~ ~hau-~-~ `ne~J ~ n~.'~` Cep ~~~ f t'ou~/~l ~ }~~~t.. S .f C,t'1'~?M'Yl. ~' 3~~ lv(. C~•Gt.~r- De~~ U'~..~Z ~c ~i~,# ~~ ttrt+-ate t°it~u~/ Bev ro ~ Sys .~X P~v~~ui~-~. -~, . ,~ - s (ire ~ vh. , so ~ ~ ~~ I f (~~ L I I I BAST SITE PLAN ' LOT J/10 BOUNDARY RIDGE ~~ .'" ZOELLER TRU-FLO DISTRIBUTION BOX 4" ASTM PVC DER, SE-SE-24-29-19W HUDSON TOWNSHIP ST. CROIX COUNTY, WI C- ~~ i ` ~~ ~/" / ~, '/~ ~r / / %. i / / " / l- / ~ / ~ / (SCALE) ~' ,. PROPOSED.' % , '/ 4-6R SIT '~ /'~. ~ '' ~ 0 15 30 / / ~" / , r i / (UNLESS SNOrN OTNERw~SE) / , / ^~uw a BERp+ '/ ~ "' ' / ~ ' rnSCONSIN CERTIF~O SdL lES1ER / ~ ~ ~ ~ / / / OES~GN~SiONER~%E2?~'78t9 r57Ew5 _ g3 oo ^-22'-4" ASTM PVC HUFFCUTT 1250/750 n ,~q SEPTIC/PUMP TANK ~1'~' 4 -2' 40 PVC FORCEMAIN ~ t,.y~ oins bo to pump chamber) ~ (~ f~ ,` ~~ ~ ~'~ J ~~ ~ ~- BU G SEWER MUST COMPLY a~k~ WITH M 82.35 WAC (11)(c) ^ LOCATION OF WELL MUST COMPLY It/J1 ~,C) WITH WDNR CHS. NR 811 & 812 (5) NON-PRESSURIZED DISTRIBUT N CELLS EACH CELL USES (10) LEACHING HAMBERS LEGEND {MODEL ~ INFILTRATOR SYSTEMS 'STANDARD") ~ BENCHMARK ELEVATION = 100.0'/ss.o' >(Yv EISA RATING = 31.1 PER LEACHI CHAMBER (top of 1/2" steel pipes) o LOCATION OF SOIL BORING(S) LOCATION OF SOIL PIT(S) SYSTEM ELEVATION = 95.3' * NO APPARENT COMM 83.43 SETBACKS ~G PARCEL DESCRIBED AS ____ ACRES PAGE 2 OF 7 . ~ _- '`. X .5 X.' f ~06 ..~' ~ 1058.3 1059.3 ~~ ~ . %~' • 051. 1 62.6 © X 1047.0 i/ 10 .2 t3 • 1 os 1i . , LOT X , ' X 2.02 C , ~' ~ ~ ~ .O A I I p 1049.6 • j ~ I : 106 ~ v © p X j 064.2 6.6 ~ ` ~ p ~ ,' ' 1064.2 p 8 059.4 p 0 X ~~ X 314.52' © p ---- ----- ' \ Q ~• { '. 1063.6 ~~ o ° ------------ - --- --- --- ~ ~A ~.\1 d62:6 X X 1058.8 •. \ ~•; X 1064.7 10 .8 ~• ~ ~\ 61.3 X • ~ \ to '~ ^ '• , 057.2 ~~ Lo ~ ~ ~'•: •.. '. 10'6 3 .. 2.01 AC r • ~ X 1061.5 ~ g,~ ~ 1063.4 X ' ~ ~ '•.::-'•::~.. ~ ~ 10 .~ ~ 061.5 ••~ ~~'~'~' .•~`'•'~' ..• y ~ X \ 11 i •::...'. ~~ ~ i x 1 os :o ~• BENCHMARK e ~ ~ I X 1060.9~~, :.•:,>:`. ~ ~._. 197.28'---~---- -- - - - - - - - - - •• '' _ B_ OUNDARY ~ I - ~~~••~~~~~'~•• ~~ ~~~~~ j ~ `~ CIRCLE ~ r 1059.7 ..::.:. ::•: -::•: •::•:: ..... X ~-~ ........... . •:.~: . •. ~:. . ~; -196.76' - m ~:~:~.~,~:v,•:`~: •:•`.•~:~ j ~ ~ ~ ~i 1061.6 r .. i ~ •. , ~ ..... ,~. _. , .. ..... ~...... r 1038.6 ••: '.'•:.~.:: ~`': ~ `: , '~ ••~:. ' T10 L ~ ••~ p .. ... .. •:' , ..•:.. • 2.01 ~~S' ' ~ 7.8 AC ::~1 ~•~ ~ '::fi I ••••~::, X 1041.0 .:•:.~: I ~ MINIMUM BUILDING ..... ......... .... ~'~:~`~:: •:.:. ~{ 1039.3 X •, ... •::..... i .......... ....... ...... ......... . . ...... . .......... 10 ...... '~ .~ • ~ , :: ~ IUS = 1 45 , .:: :., , , ' ~ , =`~ •:. '-: ~ •~: 039.5 ~ on y '~: X ~•~~,`~• `~• ~ 1025.4 Covey Sheet KERNON BAST 948 LaBarge Road -Hudson, Wl 54016 NON-PRESSURIZED [N-GROUND SOIL ABSORPTION COMPONENT Reference SBD-10567-P (.6/99) "In-ground Absorption Component Manual" Location: Designer's name and license # SE ''/a, SE %4, Sec. 24, T 29 N, R 19 W Town: Hudson County: St. Croix William J. Bergh (License No. 1577-007) I the undersigned state that these plans were and submitted acnder my authority. Designer's signature: Designer's address: Designer's phone number: Contents Page 1-cover sheet Page 2-site plan Page 3- septic/pump tank cross section Page 4- pump curve Page 5-leaching chamber cross section Page 6- management and contingency plan Page 7- management and contingency plan - 2667 1 l3`h Street Chippewa Falls, W[ 54729 715-723-5555 voice 715-723-7535 fax 715-577-6838 cellular .•''~~,yNS~N • .'~ ~~~ •. ~ ~~~~C,Q`~ ;`~u :,~09:. ~ ;: O Page 1 of 7 I I ' BAST SITE PLAN LOT #10 BOUNDARY RIDGE SE-SE-24-29-19W HUDSON TOWNSHIP ST. CROIX COUNTY, WI r s R TRU-FLO ~TION BOX 4" ASTM PVC HEADER ~) CALE) '0 15 30 (UNLESS SHOWN OTHERWISE) WILLIAM J. BERGH vnSCONSIN CERTIFIED SOIL TESTER DESIGNER OF ENGINEERING SYSTEMS CUSTOMER ID/ 227819 X22'-4" ASTM PVC HUFFCUTT 1250/750 n „/I TIC/PUMP TANK /v'/v~YV ~,,-y~/ 40'-2"S 40 PVC FOR IN `~ " tV (drains ck to pump cho ~Y~" CCU" _nQ~ J ]'~" ~~ (5) NON-PRESSURIZED DISTRIBUTION CELLS EACH CELL USES (10) LEACHING CHAMBERS (MODEL - INFILTRATOR SYSTEMS "STANDARD") EISA RATING = 31.1 PER LEACHING CHAMBER SYSTEM ELEVATION = 95.3' ~'` ~~`/v. c ,, (~ ~~~/// /// r t/ V _^ ~~ ~- BUILDING SEWER MUST COMPLY G~~~~ WITH COMM 82.35 WAC (it)(c) n ~ I LOCATION OF WELL MUST COMPLY `tIJ, „/~.C~ WITH WDNR CHS. NR 811 & 812 ,{~V~' l(~ ~ ~,. GJ1~p, n 1(N' LEGEND ~' h~" BENCHMARK ELEVATION = 100.0'/96.0' ~/l,~ (top of 1/2" steel pipes) o LOCATION OF SOIL BORING(S) LOCATION OF SOIL PIT(S) ~C NO APPAREN7 COMM 83.43 SETBACKS ~C PARCEL DESCRIBED AS ____ ACRES PAGE 2 OF 7 - SEPTIC/PUMP CHAMBER CROSS SECTION (DRAWING NOT TO SCALE) Final grade (slope ground away from risers for drainage) Actuol depth may increase see COMM 82.30 (11), (c) and (d). I tank vent Access riser with locking cover (cover must be properly marked with on opproved warning Vobel) OF power & alarm cable (must use seperate power and alarm circuits) \ (externally mounted) 1 junction box 1 _~ 4" min. .force malt access riser 18" m i ~_--~ ~. -----~ ~~ 3„ 1 bottom of inlet invert ~L- !, ~. filtered ~/ ~ water level ~ __ efflluent inlet } ' ~ ~ t ~ ~ ~ 4" inlet ~ tee or baffle opproved effluent filter ~ ` required on tank outlet '. Minimum of 3" of suitable bedding beneath tank EFFLUENT FILTER ZABEL (A-t00) (or equivalent Tank monufocturer HUFFCUTT 1250/750 GALLON septic/pump chamber capacities Alarm monufocturer S.J. ELECTRO (Or equivalent) Alarm model number HW 101 (or equivalent) MERCURY (or equivalent) Type of flout switch Effluent pump monufocturer Effluent pump model number LITTLE GIANT 9EH Minimum pump discharge rote (gprn) NA Vertico{ lift (pump off to lateral elevation) ^~ 10.0' System head (distal pressure x 1.3 ft.) NA Friction loss in the force main C1.0 Total Dynamic Head (TDH) <11.0 _~J -I--~-- reserve ~~alorm -j---- on l -.~ off ~'}~~~ , 1 P p Pod pWF (doily wastewater flow) Number of dioly doses (DWF / actual dose volume) Forcemoin volume 600 ~7.3 6.5 Actuol dose volume (gal) - l dose vol t t forcemoin vol.) 83.1 . o a ( CAPACITIES reserve above alarm 21 inches = 313.53 gallon alarm above pump on 2 inches = 29.86 gallon on/off measurement 6 inches = 89.58 gallon off to tank bottom 14 inches = 209.02 gallon TOTAL 42 inches = 627.06 gallon PUMP CHAMBER DIMENSIONS length 49" width 70.0" 42' gallons/ inch 14.93 liquid depth Page 3 of i POVVTS OWNER'S MANUAL MANAGEMENT PLAN PERMIT NUMBER: T ~ ~ ~~ Owner/Agent: POWTS Maintainer: Local Regulatory Authority POWYS Installer: Septage Servicing Operator Kernon Bast- LQt#YO Boundary Ridge Geo 7~ech Soil & Site Evaluation -Chippewa Falls, W(715-723-5555 St Croix County Zoning Department -Hudson, WI 715-386-4682 Darrell Frazer -Frazer Excavating -Bloomer, W 1715-288-6225 DESIGN PARAMETERS IntluentlEffluent quality (values typical for domestic (non-commercial wastewater and septic tank effluent) Fats. Oil and greases (FOG) <30 mglL. Biochemical Oxygen Demand (BOU) <220 mglL. Total Suspended Solids (TSS) <250 mg/L Soil Loading Rate (SLR} = Q4 gpdJft'. SYSTEM SPEC[FICATIONS The components of this septic system are intended to serve afour-bedroom (600-GPD) single-family residence. The components include a Huffcutt 1250/750 gallon septic/pump tank with Little Giant pump alarm and controls, a Zabel A-100 effluent titter, a Zoeller Tru-Flo distribution box and (~) non-pressw~ized distribution cells using graveless leaching chambers. A total of 50 Inliltrator standard leaching chambers are required whin applying an EISA rating of 31.1 as specified by DCOMM. All parts of the co~~nponents must comply with Wf Adm. Code COMM 84 and be installed per manufacturer specifications and approval letters. DESIGN CRITERIA o "Design of conventional Soil Absorption '1°renches and Beds". R..i. Otis - ASAE Publications 5-77 and Design Manual - Onsite Wastewater Treatment and Disposal Systems:. EPA 62~I1-80-012 October 1980 / SBD - 1067-P (8.6/99} "in ground Absorption component Manual" o SBD - 10705-P (N.OlI01) "In ground Soil Absorption component Manual" Version 2.0 MAINTENANCE & MANAGEMENT Inspect the condition of the treatment tank(s) and dispersal cell(s) a minimum of every three years. "Che septic tank contents must be removed in accordance with Chapter NR 113. Wl Adm. Code ~ti•hen the combined sludge and scum equals one-third (1/3) the tank volume. The effluent filter should be inspected annually to ensure maximum performance. START UP For new construction prior to use oi'ihe YOWTS check treatment tank(s) for 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 tank(s) removed by a Septage-servicing operator prior to use. OPERATION "f~he property owner is responsible for the operation and maintenance of tha POWTS and submission of required reports. The quantity and quality of wastewater will affect the performance and longevity of your POWYS. The installation of water-saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also, the brine or waste from water softeners. iron removal units, and other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. "l~he system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils. vegetablelfruit peels and seeds. bones. and food solids such as those produced be a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Ocher non-biodegradable items such as baby wipes. tampons. sanitary napkins, condoms, cigarette butts. dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products. paint. disinfectants- pesticides, antibiotics (medications). solvents, etc., should not be flushed into the system as they can seriousl}~ damage your POW"CS and contaminate your drinking water supply. Maintain regular steady flow by spreading the laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the unit may cause it to tceeze up. o Alarms Alarms should be tested on a regular basis by the homeowner. If an alarm sounds, contact an individual licensed to serve POW`fS. There is normally a one day reserve capacity under regular operating conditions. however water should be conserved until any problems with the system are corrected to prevent back-up of'sewage into the dwelling or surface. Page 6 of 7 INSPECTIONS Inspections shall be made by a person carrying one of the following licenses or ce,rtiYications: Master Plumber, Master Plumber Restricted Sewer. POWTS Maintainer or Septaoc: Servicing Operator (per the attached Maintenance Schedule) / Septic Tank Component lank inspections must include a visual inspectial of the tank to identity any missies or broken hardv~~are. identify any cracks of leaks. measure the volume of combined sludge and scum and to check for any backup or surface discharge o1~ effluent. Access openings used for service of assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than R inches in diameter shall be secured with an effective locking device to prevent accidental of unauthorized entry into the tank. The outlet(efTluent) filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to he made to retain solids in the tank during cleaning. Filter cleaning may he necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating properly. o Pump Chamber/"treatment Tank(s) Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must me made for Peaks. backups. surfacing. missing or broken security devices and other hardware and the condition of the fiiher. Any service needs or repairs shall be promptly taken care ot: / Li-Ground Gravity Component dispersal Cells Tha inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Anv discharge to the ground must he promptly reported to the regulatory authority. Ponding <rreater than 7~% of The height of the component may indicate overloading or impending hydraulic Yailure necessitating more fi-cquent monitoring. o Divertor Va{ve The divertor valve shall be switched to serve the opposing distribution component every three years (when the Septic tank is due for it regular maintenance). However. if ponding is observed in the observation/vent pipe of any cell. the divertor valve shall be switch to the opposing component. Furthermore, ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring REPORTS Reports for maintenance, inspcciion_ and monitoring shalt be submitted in accordance with COMM 83.» Wisconsin Administrative Ci>de. ABANDONMENT When the POWTS rails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. COMM 83.33. Wisconsin Administrative Code. - All piping to tanks and pits shall be disconnected and the abandoned pipe opening sealed. - l~he contents of all tanks anil pits shall be removed and properly disposed of be 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 other inert solid material. CONTINGENCY PLAN If the POW"fS tails and cannot be repaired the following measures have keen, 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. ~I'hc replacement area should he protected from disturbance and compaction and should not be infringed upun by required setbacks from cxistins and proposed structure(s). lot lines and wills. 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. o 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. o The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation nnist be performed to locate a suitable replacement area. if no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. o Mound and At-Grade soil absorption systems may he reconstructed in place followins removal of the biomat at the infiltrative surlt~ce. Reconstructions of such systems must comply with the rules in effect at that Lime. WARNING SF,PTIC, PUA1P AND OTHER 7~KEA"h VIH:NT ~tANKS !11AY' CONTAIN LE"THAL CASES AND/OR INSUFFICIEN'h OtiYG6:N. DO 10T ENTER :~ SEP"fIC, PL ~1P OF OTITER TREATR1ENT TANK UNDER .4\Y CIRCU~1STANCES. DEATH :~1A1' RESULT. RESCC:E OF ~. PERSOti FR011 THE IN'fERiOR OF A TANK >VL~1' BE DIFFICULT OR 1111POSS113EE. Page 7 of 7 ~~ .~ t~a~rN~r^ ~~ I ST. CROlX COUNTY WISCONSIN ZONING DEPARTMENT ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 Phone: (715)386680 Fax (715)386-4686 Fax: , - ~ ~ s ~ ~a 3 -- ~ s 3 ~- Pages: ~- ~ tit,,. c~•v -- Phones: 7 ~ s - 713 - ssS.S- Date: a.- ja ~~ b 3 Re: L-0 T" l D J3G L(/J2~CG'~'1~~~~ ^ ~~C~ l~i~Q/l~..i D Urgent ~r Review ^ Please Comment ®'Please Reply ^ Please Rerycle • Comments: ~~ , _ ~~2e~ - af~ '~ P~~vhdr.~a~xd- ~--- 7'~"' f Z`~' ~hs-~~ 2 ~~- od d Crn ~a~-~/ E3a~ ~ad oh ~- a~=2. ~c,~~fi , 11i,..P.v~ y~Z.~ ~. o-a'~L~sme.~ hoar! Cons~f4u,~~o~ ~~'• ° • w. , `~`~ ~4~~~l~ed ~~.C yceed ~ dz /tam--leG `~ ~`~ ~~ T of ~PP~o~ • 3 5 ~4~•es -- M~-~ a s~ X1,4--~ /~~~~-~G- -Msconsin bepartmenl o- Commerce SOIL EVALUATION REPORT page ~ of 3 ' -Ivision of Safety and Buildings - in accordance with Comm 85, Wis. Adm. Code County ,l~' CR of /111arh complete slle plan on paper not less Ihan tl 112 x 11 Inches In size. Plan must Include, hul not Ihniled Io: vertical and horizontal re-erence potnl (8M), direction and parcel i.b. 02O ' ~Q~p q • /Q • ~~ percent Slope, scale or dimensions, north a-row, and locaifon and distance to nearest road. Please nrlnt all lnfo-matlon. ev wed by bate hersonat lu/orn+alirni yov provide may he vsr-d rot secondary purposes (Privacy law, s. 15.04 (1) (m)). Property Owner ~ Properly Location e~ ~J e kE~NoN ~3~}yT ,' D~NA~~ ~j~5~7 G NDoI 5~ 1/4 5th 1/4 S ~! T ~7 N R /9 _ ~ (or) W Properly Owner's Matting Address Lot fl Stock !! Subd. Name or•6f'iMff ~~ 9y 8 ~q• l3~tR~~ ~~ ~u~ 2 2 zooz /o ` l3ov~,~r1-k y ,P,~~E- CIIY Stale Zip Code Pl~rpn~~f rb r _ ~ City [J Village ®Town Nearest Road ~ ' lfvJ~So,~ Gvl. Syo/~ ~`,~~%7 ~upS ~ eQ - ~vf~SoN l3AA~/t New Construction Use: ~ Residential /Number o1 bedrooms 3 _ y Code derived design flow tale yS(~ - t~OCs~ GpD [_] Replacement [, Public or commercial - bescribe: Parent malerlal __ ~p~SS ~V~ ~/iVE Flood Platn elevallon if eppitcafrte /Il h, General cornrnenls s,~,wy Dv7~ev~sll , and recommendailons: " r¢~'~'~!i- TESTED Sv /Ti~/S/~. ~-- •4 ~ov/z¢K 7~rov~- G_.. /.vG-~pov,uv {moo c~ TS / Boring h ~ Boring /OO , ~~ ~, O . pl( Ground surface etev. _ n. Ueplh to prniUng factor In. Horizon bepih Uominanl Color Redox bescripllon Texture Slroclure Consistence Boundary Roots avrr nppncanon mare GPO/fh in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etta 'EItp2 _ Z X3.28 ~ /oYR 3/ 7~ S R ~t 5/L 5G /7~S~J'k / ~ 2 n4y-f'i ~~/~ w c c -• . Z • y . 3 . ~ 5 ~ S~ k' --- L S f S --- s • 9 U Boring # ~ Boring ~ ~~ ~ O ~ 90 hll Ground surface etev. h. Ueplh to Ilmiling factor In. Soil Appllcailorl Rele 1ltnizon beplh Uominanl Color Redox bescriplinn texture Slruclure Consistence Boundary Roots 6POiti' In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Effg1 'Eftfl2 ' Effluen t !It - p[117_ > :~n c ~~n „,,,n s.,a tee .~n .. e., .....n . ~.~. .__. ,,.. _ ....~ CST Name (Please Print Slgnalure CST Number ~o,BERT' ~1/6Ric~~" 22435 ~dd-ess Uale Evaluation Conducted Telephone Number nt ~ Asaoolatea I y' boo Z 7/S • 3t3<v • gl 8,5 Private Sewage onsu 655 O'Neil Rd. Hudson, Wis. 54018 Lam/~ D . sP~~. /3~sr ~,~ s ~ d 3 K. /3~sr- rroperl Ow-re- ono • ~o~~ •/o • /~ 2 3 y rarcel Ib N U Poring Page of Cl I-oring M z O ~(~, hll Ground surface elev. ~~ ~ fl. beplh to tlmlting lector > ~~ ~, 1lorizon bepllr bominanl Color Redox bescripllon Texture Slruclure Consistence 6ounda ry Roots Soh Application Rale GPI)lllr In. Munselt Qu. Sz. 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Z LL W C : ~ ~ °D' 0 aG~ i ___~_ ~ k ?R d ~cZ i # I Z "' ~~ ~ } W ~ 0 1 I~i~~; x F- ~ ~ ~~~~ ~~P, 0aW ~ W ~Q¢ ~ ~~ 'x ~ 1 a ~ ~ ~- ~ ,, ~ ~ i / ' ~ i ~~i ~~a ~~~ ~~ t a ~ ~ ~ ~ it 8 S ~ ! ~ ~ ~ ~ ~ o _ ~~ -~ a / k o 4 xg ` / 4- x ~ dx j x <f ~ ~ 1 % aoa x ~ 1 c 0 8 / _xo$ D dl x a bs 3 f->' '~ .. : ff • w0. ~I xx x 4_ _ °~~='~ '-x qR x~ z oC ~~ q n .r x ~ i 1• ' '4 .'` X.~ ~ R. ~ ~ x gx.T x 8X ..... ~x' 8 ° a ~. <4 8 $x n..4~ 8 x J Cj n x a' .. .. .... _.~_ ,,. n x • \~~J^ s _ ~' R g ~~ ~ ~~~~ ~ ~ ~~~~~ ~~se~~~ ~~ ~ ~~ ~ ~ ~~ ~~~ ~~ ~~$~e~~~ ~~S~S ~~ ~ O YS ~ , v I/ O O O \ O \~ Q X X ~ ~ ox O X ~ o ~ X'gg! t3 v XO n m I ;/....,./....~y... x ~~ $ ~ ~~ ~~~~ ~~~ ~~~ h ~~~~ ~~ ~~~ ~a€ e5 ~~~~ ~~g _~~s x K _ w 'di x x~ Ai x ~ 1 I I ~E~( ~ + I ` i I ~ _ ~ ~ I ~~ 9~ ~ ~~~ as N Z m RECEIVED sT cRO>~ covlvTY SEP TANK MAINTENANCE AGRBEMENT AND ;:- ~ ~~ 8 2003 O ~~, CERTIFICATION FORM ~~~IX COUNTY ~_ Mailing Address 9 ~{ g ~-'~+'~-~a~ ~-~ Property Address g~~ ~1 ~ c-n1 L 1~- K~ R. A (Verification required from Planning Department for new City/State ~ Parcel Identification Number ~Z °" I ~fOci -! 0 - eD'n ~• 2~0~, LEGAL DESCRIPTION Properly Location S~ %4, ~ `/., Sec. 2 ~ . T ~ N-R ~ 9 W, Town of ~~e+~.~SD~ Subdivision ~ t~oY4Q-`~ ~~DG ~ .Lot # ( O Certified Survey Map # ~- Volume Page # ~- Warranty Deed # ~ ~ ~" ~'( ,Volume ~ .Page # ~ Spec house ^ yes ^ no Lot lines identifiable ^ yes ^ no SXSTEM 11~IAAINTENANCE Improper use aad 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 eaa affect the function of the septic tank as a treatment stage in the waste disposal system, The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mastcrph~mber, joumeymanplumber, restrictodplumber or a licensodpumperverifyingthat (1) the o~rsite wastewaterdisposal 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, is as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification septic system has been'%~~sined must be completed and returned to the St. Croix County Zoning Office within 30 o three year expira~iy~'fitte. (~-~ OF p~j'j c~3 DATE -~~ )certify that all statements on form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the prope described above, a of ty deed recorded in Register of Deeds Office. ~ i~ 03 SI TURE OF P C DATB «« «« Any infomiahon that is mis-represented may result in the sanitary pemut being revoked by the Zoning Department. «««««« «« Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed u~ l~ I / , nocvn~rrr # ~ q ~7 9 l~ NAME OF PLAT,~~ FILED - VOLUME,~PAGE_ yo DATE J~ f ~1/ ~n~1 TnviE- ,~~ ~ ~ 4 ..~ owNERS ~e~ ~~s~ _~ s ~~ t~e~ ~ LEGAL: LUTS -~'' BLOCK ouTLOT~s~ PART OF: N~-sue- s~, sue, s- ~ y.~. ~~.~yl~/ -~ i9' ~ ~ ~ b ~5 ~ S -d3 ~ ~ rcw.rc~as~ . ~~ c~ L ~ ~ Q~v~ Q ~Ct` G~I/~1, J - ~~ ~ ~-~ ~ ~ P ~ ~. t RECEIVED St. Croix F¢ E3 ~ a cuu~ nth crzo,x coin ~Y ~nNiNG OFFICE L d d/a Occupancy A Kernon J. Bast Name - (Owner) Typed or printed being duly sworn ,states, under oath, that: 1. He/she is the owner/part owner of the following pazcel of land located in St. Croix County, Wisconsin, recorded in Volume 2 0 41 Page 2 8~. Document Number St. Croix County Register of Deeds Office: A parcel of land located in the S E %. of the S E %. of Section 2 4 T 2 9 N - R 19 W, Town of Hudson , St. Croix County, Wisconsin, being duly described as follows (include lot no. and subdivision/CSM or detailed legal description): Lot 10 Boundary Ridge, Town of Hudson, St. Croix County Name and Return Address Kernon J. Bast 400 S. 2nd St - Suite 130 As owner of the above described property, I acknowledge that the septic system serving this residence is sized for a 4 bedroom home, or a design flow of ~ n n gpd. The design flow is calculated by assuming 150 gpd for 2 individuals per bedroom. There are currently ~ occupants living in this residence; ~ occupants are permitted based on the design flow. Therefore the septic system serving this residence is code compliant. However, I understand that if there are intentions to exceed the number of permitted occupants, the system will need to be modfied to accomodate any increased wastewater flows and/or contaminant loads. I also acknowledge that I will make this information available to any future parties interested in purchasing this property. authenRcated this day of ACKNOWLEDGMENT STATE OF WISCONSIN ) ~s. t. Croi ~Coonuanty. ) 2 OPOe.S Ily came before me this 2 8 thday of FPh r, ~ a r. the above named TITLE: MEMBER STATE BAR OF WISCONSIN ra (If not, to ~q (s) who executed the foregoing authorized by § 706.06, Wis. Stats.) in~t~rid edge the same. THIS INSTRUMENT WAS GRAFTED BY State f Wisconsin Kernan Bast ~ ~•~ ~~'^ n No ry Public, State of Wisconsin (Signatures may be authenticated or acknowledged. Both are not My Commission is permanent. If not, state expiration date: necessary.) Date: "THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE" This htiomration must be completed by submltter. document title. Mme d return address. and P1lY (Jl required). Other in/omwtion such as the praMing louses, leagai description. arc. maybe placed on this ~ page of the docxxrrent or may be placed on additional pages o/the document. Note: Use of this corer page adds one page to your document and 52.00 to the reoordina /ee. ~soonsin Statutes, 59.517. 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