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020-1470-05-000
C O M O C v N N N C O N R p R Lo R O oc M .p E ? N O I III O y ` o— O c 4) L C N E o E E a L` L L N Z' 3 E " c a z R — C (n a o R N a c " N U c cua� O N � L i v c E m w _Z o (D o m � Q'3 o. ° E o Q) ' c 'S n aui�°' m° N m 3 ) co >. o Q ULCD Ufa E C _ Z a rn I' E � L C,4 H z a 00 0 0 z d O v c _ U r oo E (n r O L N Z U E M N U N N • O N 0 4 yu � 0 R ® 0 d Z z o N z E N R b l Q R r a 3 N Fo g a o o a 7� �Lo O O O a Z CL M IL c `° 0 N 0 O o N N 3 Z o a �y' O N .+ O Y H N p 0 Z N C 4 o� �I s Lo� 0i a CL p N ►- E N N a ti 7 R '? N •O yy.' O N z N `1 X N CC • .. ... E L f ;� E a N • .� Q. d .V dl a E i C w `'1 A u a O N ti Parcel #: 020 - 1470 -05 -000 09/14/2007 02:09 PM PAGE 1 OF 1 Alt. Parcel #: 24.29.19.2988 020 - TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 03/28/2006 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - DAVIS, JIM J & NIKI M JIM J & NIKI M DAVIS 13510 43RD AVE CHIPPEWA FALLS WI 54729 Districts: SC = School SP = Special Property Address(es). ' -Primary Type Dist # Description * 841 WYLDWOOD LN SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 4.509 Plat: 11- 001 - WYLDWOOD RIDGE 020/06 LOTS 4/6 SEC 24 T29N R19W PT NE SW WYLDWOOD RIDGE Block/Condo Bldg: LOT 05 ('06) LOT 5 (4.509AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 24- 29N -19W NE SW Notes: Parcel History: Date Doc # Vol /Page Type 09/11/2006 834200 EZ -U 06/07/2006 826924 WD 06/10/2004 765505 18/4769 CSM 07/23/1997 2000/329 WD more... 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/05/2007 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.509 95,000 323,700 418,700 NO 05 Totals for 2007: General Property 4.509 95,000 323,700 418,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 ®Rial"L #2461 `sn'n SOIL EVALUATION REPORT Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 3 Division of Safety and Buildings Certified Soil Testing, LLC Attach complete site plan on paper not less than 8'/: x 1 County 1 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel LDOZ / L f Please print all information. I R iewe Y Date !- Personal infor ' n yo rovi ay ed foftEr@ !nLot# / aw, s. 15.04 (1) (m)). Property Ow Property Location Davis, Jim I )L J ° Govt. Lot N /4, SW1 / 4, S24, T29N, R19W Property Owners ailing Address Block # Subd. Name or CSM# 13510 43rd Ave. ST. CROIX COUNTY 5 Wyldwood Ridge -- City State jZip Code Phone Number City [] Village ® Town Nearest Road Chippewa Falls WI 1 54729 1 715 - 726 -9979 Hudson j I Benoy 2] New Construction Use: ® Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement ❑ Public or commercial - Describe Parent material loess over pitted till Flood plain elevation, if applicable NA ft. General comments install "conventional' in- ground trench system @ 0.5 gpd /sq ft loading @ system elevations below 94.9 and recommendations: and above 90.5 1 Boring # __] Boring Z Pit Ground surface elev. 99.5 ft. Depth to limiting factor > 144 in. ISoil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh, *Etr#1 *Eff#2 1 0 -6 7.5YR 3/1 - sil 2 If sbk ds gs im .6 .8 2 6 -10 7.5YR 3/1 - sil 1 m sbk dsh cs lm .4 .6 3 10 -16 10YR 4/4 - sil 1 m sbk dsh gs im .4 .6 4 16 -32 10YR 4/4 - sil 1 m sbk mfr gs 1m .4 .6 5 32 -48 7.5YR 4/4 - sl 1 m -c sbk mvfr cw 1m .4 .7 6 48 -144 10YR 4/4,4/6 - s 0 sg dl - - .7 1.6 irregular, discontinuous 1OR 4/4 lfs band @ 89 -96 "; H6 has some fs inclusions; some gr, cob, st below 10 ", all depths 2 Boring # ] Boring Z Pit Ground surface elev. 99.4 ft. Depth to limiting factor > 144 in. ISoil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 •Eff#2 1 0 -10 7.5YR 3/1 - sil 1 f -m sbk ds cs im .4 .6 2 10 -32 7.5YR 3/3 - Is 1 f sbk ds gs 1m .7 1.6 3 32 -62 10YR 4/4,4/6 - s 0 sg dl as lm .7 1.6 4 62 -75 7.5YR 5/4 - fs 0 sg dl cs - .5 1.0 5 75 -80 7.5YR 4/4 - Ifs 0 sg ml cs - .5 1.0 6 80 -144 10YR 4/4,4/6 - s 0 sg dl - - .7 1 1.6 H5 is irregular, discontinuous stratified band; some gr, cob, st all depths below 10" * Effluent #1 = BOD 30 < 220 mg /L and TSS t30 < 150 ent #f = < 30 mg /L CST Name (Please Print) Sign to : CST Number Henry F. Grote L 222774 Address Certified Soil Testing, LLC Date Evaluation Conducted Telephone Number E. 4366 353rd Ave. Menomonie, WI 54751 6/21/2006 715- 233 -0398 SBD -8330 (R.07 /00) Property Owner Dayis,]im Parcel ID# Page 2 of 3` 3 � Boring ry ❑Boring # Pit Ground surface elev, 99.4 ft. Depth to limiting factor > 144 in. �� Soil Application Rat Horizon Depth Dominant Color ` Redox Description Texture Structure Consistence Boundary Roots GPD /ft= in. Munsell Qu. Sz. Cont. Cola Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -8 7.5YR 3/1 - sil 2 f sbk ds gs 1M .6 .8 2 8 -13 7.5YR 3/1 - sil 1 m sbk mvfr m .4 .6 3 13 -23 7.5YR 3/3 - sil 2 m sbk mfr �1 ,8 4 23 -50 10YR 4/4 - sil 2 m sbk mfr gs 8 5 50 -68 7.5YR 4/4 - Is 1 m sbk mvfr gw lm 7 1.6 I 6 68 -144 10YR 4/4,3/4 - s 0 sg ml - - .7 1.6 some gr, cob, st all depths below 23" Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 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.07 /00) Certified Soil Tesbng, LLC II -zA -Za O to 6 t �3 C t n so O m '9 n d O K p # O A Di O � m Q U) g 00 O = A N eC �rl S N < C OD < ! a N _p Hr �1J1 • \ N > > �_ N j N N so ! A 0 1 C & ' > L CO OV 0 (D au c N -{ N 't Ca 3 N (D L O C O C) Q CO C n 3 co ZJ CO 6 cD 3 O Qo Z N Z O p N C Z M Y., v y M CO R- CD s ? w a 3 O W < I z \ rn o CL 0 - o o a ,I CD o o c) r to N CD M O) ' 0 a C '',, .. °- O O O a �• Z o n N O a o p a (� OZ) a i N A O m - o a C N a M N o Z Z Q y o w O y o = CD g !►i CD O N j p CD w m x a A Q 3 n Z N N c6 Z O 3 c CD a 6 O A Z 3 I O 7 N m m N A CD 0 3 -• z c j C N Z A C A -J0 rncnO D cn m M C - N 7 tD A n 2. O 0 7 1 Q 0 N Q -n O CL m C 0 4 CL o � CA -0 m 0) 'a cn C N O ff 3 c n - O Q D) a n N S r) a N * A N N CD f N N a X O O' - m m m 0 0 n N 07 C 7 a CD CL l N Oo b m b o 7c O r a o CD y a O 0 - ., y Parcel #: 020 - 1470 -05 -000 08/22/2007 08:39 AM PAGE 1 O F 1 Alt. Parcel #: 24.29.19.2988 020 - TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 03/28/2006 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - DAVIS, JIM J & NIKI M JIM J & NIKI M DAVIS 13510 43RD AVE CHIPPEWA FALLS WI 54729 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description " 841 WYLDWOOD LN SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 4.509 Plat: 11- 001 - WYLDWOOD RIDGE 020/06 LOTS 4/6 SEC 24 T29N R19W PT NE SW WYLDWOOD RIDGE Block/Condo Bldg: LOT 05 ('06) LOT 5 (4.509AC) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 24- 29N -19W NE SW Notes: Parcel History: Date Doc # Vol /Page Type 09/11/2006 834200 EZ -U 06/07/2006 826924 WD 06/10/2004 765505 18/4769 CSM 07/23/1997 2000/329 WD more. - 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/05/2007 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.509 95,000 323,700 418,700 NO 05 Totals for 2007: General Property 4.509 95,000 323,700 418,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 0 k ' ° 2 §k t% & a � C «■ m E z c m 2: } £ % I c ° 00 ; Q - � , , M R) — C @ � � / k § \ i J \ R 8 ƒ ; c @ R \ % ©a �r- 2'� to § @ > ƒ % 2 � E cc CL i f m = CL ƒ § $ CD 0 R§ g n r■ , m ; CA i � k ) z z 0 k 0 o 0 0 —; j \ { § § § 2 ° 2 E ¥ E 7 ° i . 2 C. CD F � / > k 0 ' 0 / / k / / / �- \\� k/ i Cl. 2 ƒƒ 2 § I 2 7 ° E ( % a _ E cr § ■ & A 9 I k a ■ T m # k £ E § 2 z a § 2 co { 7 2 \ 2 k # � S� » CA « e e 2 CD g � £o, §SfCGCL CD$ : 3 E72. ƒ UlK �R @F R _ CD =-a 3c 7 ; _ , J & \ / % k%E CD o $. 5D CD CD CO) CD c E :5- � k I CD � q E o $ CD / 2;& ! [ CL CL \ j k m , 0 _) i tA 4? _ � 8 CD � � « Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM C ounty: St. Croix Safety and Building Division ., INSPECTION REPORT Sanitary Permit No: 488231 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: Davis, Jim I Hudson, Town of CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: / by B M I GST' 24.29.19. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark � 2,.� 1 z5b S . U ies.r, 110 b Dosing Alt. BM B LS om 35 l4ere4iefl © c Bldg. Sewer 1 Holding St/Ht Inlet I I �5 �9 - 5 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/ WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 43 / A/ /I /-g / /g ! Dt Bottom 2,1 .5 S� S Dosing 43 NA-- 18 / g Header /Man. Aeration (� Dist. Pipe Holding Bot. System 5 , PUMP /SIPHON INFORMATION Final Grade ate ,/80 .S' Z Manufacturer J � 1 D G e P ma nd St Cover B,zS 97 - 3S Model Number 415 TDH Lift' 9 Friction Loss Syste Head T H Ft tp .Z Forcemain Length - / Dia. H of Dist. to Well SOIL ABSORPTION SYSTEM id Depth BEDITRENCH Width Length I No. Of Trenches PIT DIMENSIONS No. Of P its Inside Dia. Liqu DIMENSIONS 3 $4 j `� SETBACK SYSTE TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer. INFORMATION CHAMBER OR '+ Type Of S ystem: , � / / , / UNIT Model Number: Q /�/ Ar' DISTRIBUTION SYSTEM 4-Z ( + Z olb '' Header/Manifold er /Ma Dip 9ibution ` ` ` x Hole Size x Hole Spacing Vito Air Intakeo Pipe(s) -J' /�t Len th / Dia Len th Dia S p acing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of d /Sodded xx Mulched Bed/Trench Center &.6Z. r 5Z Bed/Trench Edges ` xx Seede Topsoil l Yes Q No Yes Q No COMMENTS: (Inclu / e code discrep ncies, persons present, etc.) Inspection #1: 7 / 7 /� Inspection #2: Location: q E��y Iri Hu� 54016 (NE 1/4 SW 1/4 24 T29N R19W) Wyldwood Ridge Lot 5 Parcel top- 24.29.19. 1.) Alt BM Description =� t / ~ 2.) Bldg sewer length - amount of cover Plan revision Required? WYes Rfl No Use other side for additional information. Date Insepctor's ignatur Cert. No. SBD -6710 (R.3/97) > Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 S % �O�S�� Madison, Wl 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) (608) 26 51 Department of Commerce Sanitary Permit Applica State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal Information maybe used for secondary purposes Privacy Law, a S. m) Project Address (if different than mailing address) 1. Application Information - Please Print AU rmation bJ 0 KAY � Property Owner's Name , ` JUL 0 5 2 0 0 6 Parcel # Block # Affi LIJ- S Property Owner's Mailing Address rtD ST. CROIX COUNTY Pro 1 1.51 � D 43 '/� e ' /�, Section City, State rr Zip Code Code Pho�nee Number pQ Q Q • L J 2� �J No ! / / T �7 N; R E l ot ) H. o Building (check all that apply) ax ,(1 or 2 Family Dwelling - Number of Bedrooms o (; c ; 5. �, k (� Subdivision Name CSM Number Cd WtaotacP 4 ere ❑ Pubh'cJCcmrmercial - Describe use �� s.e.. L 47� ❑ State Owned -Describe Use L- Z { + 71 r Z I llu� ❑City_❑Viilage cwnship of bS i" 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) A- New 3 tem ❑ Replacement ys Rep System ❑ TreaUnent/Holding Tank Replace Only ❑ Other Modification to Existing System B. ❑ Permit Renewal Permit Revision ❑ Mange of ❑ Permit Transfer to New list Previous Permit Number and Date Issued Before Expiration Plumber Owner 4eez;e5l crew 1V. Type of POWTS SystemV (Check all that appl JrNon - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter Cl Constructed Wetland 0 Pressurized In-Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ - Recirculaung S thetic Media Filter ❑ Chamber ❑ Dri llne ❑ Gravel -less Pipe ❑ Other lain V. Disper3aMestment Aran Information. Deli Flow (gpd) Design Sod Application Dispersal Area Requird st) Dispersal Area Pro ( System Elevation �� f • s � Zoo � Vl. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass Naw I Existing F� Tanis Tanks A✓ P.ti septic o iieliing ;Fs"We Acrobic Tmatm us Unit Dosing Chamber ("b I 1 O V11. Resp2nsibility Statement- 1, the unde ed, &"prm for installatlon of the POWTS s on the attached plans. PI (Print) I P I Si MP/MP Number Business Phone Number 3�' 6Z FEZ _Ufc Plumber's Address (Street, City, State, Tip V11L onn /De nt use Only Approved n ,, pm Sanitary Permit Fee (includes Groundwater Date Issued Issuing t Si No ' Sur+clrargeFee) ' 75. Cb it � d�D ven Rearm for Devi IX. Conditions of ApprovaUReasons for Disapproval SYSTEM OWNED: 1. Septic tank, effluent filter and dispersal cell must all be services / maintained as per management plan provided by plumber. 2. All setback requirements must be rneintained as per WPNC * code / ordh Mo. AttacY complete pleas (to the County oaly) for the system on paper not tan than 8112 z 11 laetses in sin SBD -6398 (R. 01/03) f J aT PLC ►m L-0 T Lk.)� IoQ wooC odic G►t7G `or gqIed Sree �a►7 12Sa�'1S'o Co�CSa a- -13 O Zb( o�S I?14 � s,el, 14.0 r - POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Val �S Septic Tank Capacity a l ❑ NA Permit # d p ! Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model — ���- ❑ NA Number of Public Facility Units - T)V' Pump Tank Capacity dd gal ❑ NA Estimated flow (average) p0 gal/day Pump Tank Manufacturer ��� ❑ NA Design flow (peak), (Estimated x 1.5) 6 D al /da Pump Manufacturer JW /��a� 11 NA Soil Application Rate r r al /da /ft2 Pump Model, ❑ NA Standard Influent /Effluent Quality Monthly average" Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) :530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Di sinfection ❑ O th e r: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 5530 mg /L Wn- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100mi ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 O m onth(s) (Maximum 3 years) ❑ NA P l y ear is) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 4 ' � A'yea�(sj(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ❑ month(s) D,G /iF„S ifJ�f ❑ NA ogr year(s) Inspect pump, pump controls & alarm At least once every: 2 3 mo nth ye() ars ) ❑ NA Flush laterals and pressure test At least once every: p year(s) month NA Other: At least once every: ❑ month(s) NA ❑ year(s) Other: NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tanl inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of, sludge and scum in any tank equals one -third (Y or more of the tank volume, the entin 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, pretreatmen units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to local regulatory authority within 10 daysof completion of any service event. J I Page of ;START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tanks) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System sfalt up - shall not occur when soil conditions are frozen at the infiltrative surface During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cells) 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 .1.5,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: Af A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name L 'e4 L I Name L. S l4 Z l All— Phone S:. Z? r (� Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name r e s li e z. Ajv Name Phone ( _ 7 - ri 'Ue sof Phone ?(,'•- 3`L ' �� This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54111, (2) & (3), Wisconsin Administrative Code. i WElTI� �RFRL50F ' WCKtnit$ CpVi�R 3Ltic1'wN QI►r G�aGCw�taC'Y –� - 4" C.T. t*+tita+t+ti�,oI+OVwM+Qr ---�. ' i nIi i t,tDt�r =taR� .. Sots_ l 24° �. 'D. �, 4 VF .wW MpHtIOlB I ; to uwcs'r • uo:r AN kov= A Pam Q 2" Wcu:•Twc�- EG7t ot�'i ON 44 ❑�. EuoCEC co iCP'K'tt E S P ATI OIJ � � 1•• . :6 Ll S PNALJUFACYURCR: klumAER OF 04SCS: PER flA�i TAWK SIZE: Z - �' i'aALLDAJ$ O$S UO � 0 LuM C ,LAAM /rIJWL►F/1G1'4lflrF►K: s S •-a INCLUDING ISACKfLOW: GALLONS P' 00r-t. i,lLtk�tK: b 1 1-{ W CAPACITIES: A= a 9 �' 7 WCHES OR 507 GALLOuS SWITCH Ty ►C; �_ � �` 1AJGNCS OR %, 't4 �rALLONS UMP KANUFAC.TU8t&K: — Lt 1r /( g, QtK C @ �,3 �uCH£S OK ,.LAl r GAL�OuS Ih!%HES OR GALLON,, 9w1YCN Tl3FE: c..v �" ^r3 NDT PUMP AND ALARM AR-F TO 6C MIUtMUl'\ 0l5CKAlk&C RtoTC.,,GPM lN5TA%.L9O OW SEP^ -RATE CiRCuiTS ERTMAL 0tFFLRC#JCC 5EYWCEW PUMP OFF AUO 01STM614TIosi pIPC.. �._... FEET MILW NETWORK SUPPLE PKESSURC .... .. _ T FE!`T FC E T OF rORCC Mihi }( —" TOTAL 0 HEAD FEEr •- ti�s� TER U 1J AL. bIME510AtR OF 'S'ANI(: EEk447ht � QTK - ��LtQUtfl DCPTt -t I Td Wd00:60 TOOE ZZ 'fi - eW 8620 ZEE STL 'ON XUJ ONIISSl 710S 031JI1630 WObd i 9E (tax 6V CR NNW H SERIES SUM P /E F FLUENT PUMP 11 .86 -• ........_.__.... 8.8b n L cocifications MOBIL CAT, 90CI09 912E RUNRITIG PLiifORNANCEI� ® 01 SHUTOFF F.S.I. PWR. On. WEIGH DIYEKS10Ns A0. N0, t19TN10 HP VOLTS (Ott. W.) AMP✓�IW /TT9 S' 11 18' 29 (H,1 (Ft.) Imo ) IH x 1 t WI ULIGSA 4110 115 314 13.0 1000 71 68 80 49 32 13.8 20' 27 9.1 x 11.6{ x 6 9 4EH•GM 5011330 20, t t , 11.65 x 9.94 9[H-CIM 509340 UUCSA 4110 290 314 6.5 1000 71 68 60 49 32 13.6 2 9 5fH CIA•RFS 509350 UUGSA 4110 116 3 13.0 1000 71 68 60 40 t 32 1318 211' 27 9.11 x 11.64 x 3.94 9 H• IA•RF 3 U4'CSA 4,10 230 314 6.5 1000 11 J 32 1 . 20 27 9.11 x 11. .9J FLOW- LITERVIALllk c onstruction.... T>r7otnr IIousing E PDXY t.'nrared ' C 0 lUOU 2000 3000 d l Iron Pot arbon J Immiler Material Y �0 10 Irri eller „Tyke Closed bane - Volutc 7.5 Pawor Cord ...... SJTW -A Mechanical Shaft Soul Nitcila with cnsbEm and s vv - amic fa ces W Faste 5tainleas Slc 1u zs Sha3� Stainless Stool Bearings Upper Slecyu and Lower Ball Rcarings _ r Tr n 0 20 40 6a a 1 FLOW- GAI. t,11NS /MINUTE PUMP PFR CURVE 115V 60HZ Little Giant PUMP CO- Sox 120 10 � Pho 405.947.2511 Ok Cityty,'13K 73157 Fax: 405.951.5674 %rww. LitrleGJantPumP.com ISO 9001 CERTIFIED 6 Forrn 995235 — 01!00 1. l abed `•NIdIZ E z0 - AON . `. LZ86 Z99 9LL L - .� ;a�a'3E j dH :�8 11/29/2006 16:37 7152352592 T L SINZ PLUMBING PAGE 02/04 OIL EVALUATION REPORT #2461 Department of Commerce Comm 85, Wis. Adm. Code i Page 1 of 3 Division of Safety and Buildings C M Certified Soil Te�stlnq, LLC o t c un y Attach complete site plarf on paper not less than 8% x 11• inches in size. Plan must St. Croix but not limited toi vertical and horizontal reference point 8M , direction and include. p � ) e o dimensions north arrow, percent slope, scat r t n , and location and distance to nearest road Parcel Please print all Information. Review ied By Date Personal Information you prcode may be used for secondary purpomn (Privacy Law, s, 15.00 (1) (m))_ Property Owner Property Location Davis, Jim Govt. Lot N E1 /4, SW1 /4, S24, T29N, R19W Property Owner's Mailing ddress Lot # T1110c 13510 43rd Ave. k # $ubd. Name or CSM# 5 WylOwood Ridge City ! State Zip Code Phone Number city n village E ',Town Nearest Road Chippewa Falls WI 1 54729 715 - 726 - 9979 Hudson 850 Benoy New construction use: Residential t Number of bedrooms 4 Code derNed design flow rate 600 ©PD Replacement Public or commercial - Describe Parent material loess older pitted till Flood plal�h elevation, H applicable NA ft. General comment's install "conventional" in- ground trench system Q 0,5 gpd /sq ft loading C system elevations below 94.9 and recommendations: and above 90.5 i I 1 I Boring # i— BOnr�g hI Pit Ground surface Clow. 99.5 ft. Depth to limiting factor > 144 in. Soil Application Rat Harzan W.60h.: :'.;...,.,.: �� �,.' ii�.'Slti; ' 1��tiire VOW . te€+uMd�ry R C3 /ft' OM in :.::._• *011112 1 0 -6 7.5YR 3/1 - sil 2 f sbk ds gs im .6 .8 2 6 - 7.5YR 3/1 - sil 1 m sbk dsh i Cs 1M .4 .6 3 30 -16 10YR 4/4 - sil 1 m sbk dsh `. gs Im 4 6 4 16 - 32 16YR 4/4 sil x m sbk mfr' gs 1m .4 j .6 5 32 -48 7,�YR 4/4 �I ' sl 1 m -c sbk mvfrl Cw 1m .4 .7 6 48 -144 10YR 4/4,4/6 - s 0 sg dl - - .7 1.6 irregular, discontinuous 10R 414 Ifs band @ 89 -96 "; H6 has some I's Inclusions; some gr cob, st below 10 ", all depths Fil Boring # Borimg 1 Pit Ground surface elev. 99.4 ft. Depth to limiting factor > 144 in. soil Application Rate HonzOn beAt ? 1. Ift O . �JextGre. SCructgf r n4f; fi 68ii't1 a1(�r Rbots GPD/f!� in.. .': # °C -: gn4,.'CWar Cir. Sz.• `Eff#1 •Etra2 1 0 -10 7.5YR 311 - sil 1 fm sbk ds I Cs 1m .4 .6 2 10 -32 I 7.5YR 3/3 - Is 1 f sbk ds gs 1M .7 i 1.6 3 32 - Wyk 4/4,4/6 - s 0 sg cil ; as I 1m .7 ; 1.6 4 62 - 75 7,5YR 5/4 fs 0 sg dl Cs - 5 1.0 5 75 -80 75YR 4/4 -// IS 0 5g ml Cs - .5 1.0 6 $0 -144 10YR 4/4,4/6 Lj s 059 dl - - .7 1,6 H5 Is Irregular, disco tinuous stradned band; some gr, cob, stall depths below 10" ` Effluent #1 = BOP s > 30 220 mg /L and TSS 30 _< 150 nt #2 = BOb _< 30 mg /L and TSS < 30 mg /L CST Name (Please Print); Sign to CST Number Henry F. Grote 4 222774 Address Certified Soil Testing, LLC Date Evalua Conducted Telephone Number E. 4366 353rd Ave Menomonie, WI 54751 6/21/2005 715 - 233 -0398 se 3so (RO'tPo0) i 11/29/2006 16:37 7152352592 T L SINZ PLUMBING PAGE 03/04 Property`Owner , Qavis im Pereel lD �! Page 2 of 31 tirin * 'K• .' g Ground surface elev. 94.4 ft. Depth to Ilmlting ctor > 1 44 In. _ '�•, ';4� A ' ® Soil Application Rat Hddzon • Dtypth ','A rtfih, .• .•, r + ' ' Fc Structure ddnsie nce 06 r1MYla RodEs CiPDIIt' t ::: '' I •ErfXi •Efix2 Gr..S2. Sh. .SYR 311' - A 2 f sbk d� gs lm .6 8 2 8 - 13' 7.SYR.3 /1 - SO i m sbk m r gs 1m ,4 .6 ` 3 r 13„ -23 t,.VR /3 sil 2 m sbk mf{ gs Sm 6 i 8 I h 23 -50 OYR'4 9 /I si m sbk mfr s 1m ,6 ,8 . 4 / I 2 I 9 l S. 50-68 1,5YR 414 - Is 1 m sbk mv(r gw 1m 7 t 1.6 1 I 6 68 -144 101YR 4/4,3/4 - s 05 9 ml - - 7 1.6 some or, cob, st all depths below 23" I +r . • I i 1 I ' 1 i I I i I I. Erfluant #1 ; B - D 30 <220 MWL and TSS 5.30 5 150 mg /L • Effluent #2 BQJ 5 30 mg /L and TSS 130 mg /l, I I � I I j The Depgrlmenl of �ommerce is art equal opportunity servicc provider.and employer, if yob need assistance to access services or nee¢ olaterial'in an alternate format, please•contact the department at 608 - 266 -31 or TTY 609 -264 -8777. s0aciio. [�t nirooy . I I , r'•, , ti'• , r . � Certified Sal TeStlrq, llC I . i 11/29/2006 16:37 7152352592 T L SINZ PLUMBING PAGE 04/04 i _ ., • ��� � 0.�.�5 _ �1 v� 1�`a-`-� l.►aT � ��,' y�,�"'�CO�o`iD`g9. (aRA� t 4 t fs 3 y. 0 0— •,Y�. (44 4� U `tro o � � o o i� •. I (( i I I I i I v V I Safety and Buildings Division County visevInsin 201 W. Washington , P.O. Boon 7162 er 1 Madison, W1 7 — 62 Sanitary Permit Number (to be filled in by Co.) De artment of Commerce (608) 266- g2 3 Sanitary Permit Application ft Pin I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provi maybe used for aeoondary puspoaes Privacy (if di8ereaj A.— me► s) 1. Application Information - Plesse Print All Informatio Property Owner's Name JUN 1 3 Z0 Parcel # Block # b6; Property Owner's Mailing Address CRO COMITY Property 1.ocati 1 ,3511) 3 1., rhJ� NE ,, S Section / State e /� Zip Code ^ Pha ( o ' e Number �} q V Tiw 1 OL 54 - 7 7. I Q { J 7Z/i - 417 9 T N; RL_tEo U. Typi df Building (chock W that apply) KL I or 2 Family Dwelling - Number of Bedrooms T Subdivision Name CM Number ► c® ❑ Public/Commencial - Describe Use ❑ State Owned - Describe Use ❑City_ ❑Village Iffl ownship of S6� W. Type of Permit: ( Cbeck only one box on line A. Complete line B if applicable) A. New System ❑ Replacement ys Rep System ❑ Tmnatment/Holding Tank Replacement Only ❑ Other Modification to Existing System i B. []Per Renewal C] Permit Revision ❑ e of ❑ Permit Transfer to New list Previous Permit Number and Date Issued Chang Before Expiration Plumber Owner IV. Type of POWTS stem: Check all that ap U Non - Pressurized to -Grand ❑ Mound > 24 in. of suitable soil Mamd < 24 hm of suite a soil At-Gradc ❑ Single Pass Sand Filter Constr u W Wetland ❑ Pressurized In -Ground ❑ Hording Tank ❑ Peat Filter ❑ Aemb treat Unit ❑ Recirculating Sand Filter Cl Recirculat Synthetic Media Filter Chamber ❑ Drip Line 1- ss Pi ❑ V. Dispersal/Treatment Aron Informs Deli Flow (gpd) Design Sod App 'cation Rate(gpdsfl Dls (st) Disperse Area Proposed (sf) Sys Eleva 00 •17 W7 Syo 7 s VI. Tank Info (;apechy in Total Number Manufachuc Prefab Site Steel Fi C Gallons (kilons of Units Concrete Constructed Glass Now I Wising Tanks Tanks S`pt" mzawift-Twk- M90 ! LSb TT Acrobic Tromieat Usk Dosing Chamber -7S-b 1 n VII. Respo Statement - 1, the as sss for installation of the POWTS shown on the attached PI (Print) Pl 3i MP/1v1PRS Number Business Phone Number PP L' P 1 "44 Z - 7(s =23�= ZIYY Plumber's Address (Street, City, State, Zip Code ,ES'4 0 9 '70 ", /h/£ 4 )w oo . G,/L ?J VIII. Coln /De partment Use Only Approved ❑ D Sanitary Permit Fee (includes Groundwater Date Issued Issuing t Signahue ( Stamps) Surcharge Fee) (6 C1 Given Reason for Denial UV u1 LX. Conditions of ro 3 \ SYSTEM OWNER: � �S Vl/l� 64 1 Septic tank, effluent filter and dispersal cell must all tae serviced / maintained �O as per management plan provided by plumber. --- 2. All setback requirements must be maintained L � as per applicable code /ordinances. J A#wb eomplste puss (to the County only) for e SBD -6398 (R. 01/03) SAD r >' +� �e- ' fi .�SZnz.wP c. lumbing rvin �; • O �YE 708th Ave: Phone: (715) 235 -2644 ` 7 �;'enomQnie, WI 54751; a Fax::' (715) 235 -2592 www.tlsinzplumbing.com Y. t f 4 i h av 3 k , _ +P •- Q z 3 COP Ar Y 1; �o c1 �� 11 SA Ff Sinz Plumbing 'In .. � c.6 z '} E5609 708th Ave: ` Phone: (715) 235 -2644 ` . Menomonie; WI 54751 Fax: .(715) 235 -2592 www.tlsinzplumbing.com S. - .- � � � g N�9 Wig >•' � # s .. ' R' } v \� ♦.tee � `� �y� �+, �L ri N `^" y lit 4� o 10 " L — VJE1►"fl+SR1�IGDF 1.OlrKIW[3 CGYSR 3'>LtNCTtvN Q4�e1G D�acor+�csCf --� {" C.T. '"%v tr z%Q* OPG"%" . ro + C So1!_ �; JJo�/ VbA�t tM a» 0 6 �• ay. EstcCK � �•�� -�-- t �.� �- g, /;., fib$ �, , 1:PYit E [( S P � I= ATI OU S '4 5� �...�.ti�•�•c "AIJ^ MAiJUFACYURr6R: , JJUMBER OF DOSSS: PER 04ku TARJK SIZE: GAI.t.OI►13 00$!r VOLUME �! ,LARM AA"FACTt4Kj;St: S b k 1 a.a INCLUDING OAGKFLow: v G ALLpI15 ^00rL 1.tut4pCK: ��`° C APACI71E S :A= ° WCAESOK GALLONS SWITCH TyTC; 34,14 L� f� </ S IM OK GALLOuS UM !'1AAIlJPAGTU _ � C e S' ++JGMES ox 14D GALLOWS MODEL MUMDEk, 11rIV D� M^NES OR I m LAZ GALLO/JL 9Wl7CN 1 aPlC; NOTE-' PUMP AND ALARM ARE TO DL M1111MLJJ"1 OISCMJ lk&c swrY �-- ._.....GPM lN5TAL.LFA 0#J SEP^RATE CIKCL•tTS ERttGAL CtiFtRf$"C 6ETWECU PLUAP 0J:F AUD DISTRIbUTIpu PtPE.. 3 ., FEET MIMIMUM NETWORK SUPPLY PP.CS6URE L D _ Ft E T OF rORCC MA X J 39 rioaftFKICTIOU FACToK_. _ FEET TOTAL D'SLJAMIC" MEAD � ... g FEET TERWAt. DIMEW610AS4 Of YAAJ00 LF-AJCsTH • "_ ;k' OTH ;l.+t~iulD DCPTN Td Wd00 :60 TOOE E •hpW 8620 ZEE SZL : 'ON Xd-� ONIlSSl 710S 0SIAli633 WOb.� � il ls ) II I � 9EH SERIES SUMP /EFFLUENT PUMP I 8.96 C specifications ' SOLIDS 32E RUN019 PEAiORMANCE Ton Rub) SHUI9FF P.S.I. PWR, CA9• WE10H1 OfYEN550NS MDQEC CAL 110. N0. C1trA6 HP V9VS (pl In,) AMPS/WATT$ 6 10' !b' 10 (14,1 (H.) 1164.) iH x l z W) 49 32 13.6 20' 27 9.11 gkK-um 509330 UL/GSA 411 11 S 3 d 13 0 IUOU 11 49 32 11d 201 21 911 , 11 6� x 9.94 9FH•OIM 509340 UUCSA 4110 230 3/4 6.6 1000 T1 66 60 9EH•CIA•RFS 509350 UUCSA 4/10 116 V 13.0 1000 71 68 60 40 32 131 20' 27 911 , 1164 1 8.94 9 H• IA•RF 360 Ul'CSA 4,110 230 3 6.5 1000 71 FA 00 4 1 32 13. 20' 27 9.11 x 11." .94 FLOW- LITERS /1-10N Construction„ o luau z000 3000 �',,?Ontor Housing Tinox� Cr>arecJ C a s Iron J Pol C:fl C>?OriRte Cmpcllcr Material y �0 10 1rr1 ellcr e ClOsed `�ana . ti'olutc �� 7.5 ' Po wor Cord SJTW -A �0 Z I Mechanical SLA1 Seal Niteila witli carbon wid s crramic fa ces Stainless Ste Li I 2 5 Shflft Stninles� Sled 8eflrings Upper Slecvc. and Lower 13&11 Bearings _ 1. N a ., n 20 4 b FLOW- GAL L ONS /mINUTE PUMP PF R Ff1. 1 60HZ ..���aaii�i P R MANCE CURVE U3V Little ��r nt Pump PO Box 12010 ` Phone: 405.947.251 i Okln. City, 0K 73157 Fax: 405.951.5674 c0 m ISO 9001 CERTIFIED n k Fouv1 9952J"5— 01,'00 l/ l abed `•NIdIZ E ZO ` LZ88 Z55 9lL t OOZE IarJeSCl c'H 8 ': POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 1 of FILE INFORMATION SYSTEM SPECIFICATIONS Owner 1 s Septic Tank Capacity Z'b a l ❑ NA Permit # 23 Septic Tank Manufacturer �jT ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model FT ©�j�Z — /rfdjF ❑ NA Number of Public Facility Units 4EMA Pump Tank Capacity -75a a l ❑ NA Estimated flow (average) 4n al /day Pump Tank Manufacturer �-�jj �GWf� ❑ NA Design flow (peak), (Estimated x 1.5) (000 g al/day Pump Manufacturer L1i { *fµT" ❑ NA Soil Application Rate t7 gal/day/ft' Pump Model �',�`� ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODO 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids ( TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L john Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) <10" cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: E NA Other: ❑ NA Other: NA "Values typical for domestic wastewater and septic tank effluent. Other: NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 2 H ❑ m onth(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 2 1-93 0 ye ar(s)(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: L ❑ month(s) ❑ NA 15.year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA 8.year(s) Flush laterals and pressure test At least once every: ❑ ye ar(s) month( NA Other: At least once every: ❑ month(s) NA ❑ year(s) Other: 110A 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. Tani inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires thi immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entin 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, pretreatmen 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 I— Li f ,:>START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; 'degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or. must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name AL vot B Name Phone !� Z3S'"� 26 Phone SEPTAGE SERVICING OPERATO UMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone 'z( — 3�(, LAO This document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. f i 1 Wisconsin Department of Commerce SOIL EVALUATION REPORT p age 1 o f 3 Division of Safety and Buildings in rd with Comm 85, Wis. Adm. Code County St. Croix Attach complete site plan on Ea n n 81/2 1 inches in size. Plan must include, but not limited to: v lzontal nce point (BM), direction and Parcel I.D, Pendin percent slope, scale or dimen , north and location and distance to nearest road. p/ag .811 sR- Reviewed by Date Personal information you provide may be u for secondary purposes (Privacy Law a. 15.04 (1) (m)). /+� • I T� Property Owner i ) t Property Location ■ Steve Jaco on Govt. Lot NE 114 SW 114 S 24 T 29 N R 19 Property Owner's Mailing Address S4.CROiXCOUNTY Lot# Block# Subd.!NameorCSM# 846 Badlan Rd ZONING OFFICE 5 City State Zip Code Phone Number ity [] Village ■ own Nearest Road Hudson WI 1 54016 ( Ni idson I Wyldwood Lane El New Construction UseE) Residential/ Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD Replacement 13 Public or commercial = Describe: Parent material Loess over outwash sands Flood Plain elevation if applicable W A ft. General comments This site is suitable for a conventional below grade system er and recommendations: ► ` rr�c ,_p� Dec . 114 700 FT] Boring # 0 Boring S pit Ground surface elev. 100.93 ft. Depth to limiting factor >I00 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDJfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -14 10yr3 /2 sil 2msbk mfr as 2f .6 .8 2 14 -25 1 4/4 sil lmsbk mfr cw If .4 .6 3 25 -33 7.5yr4/4 sl Ifgr mfr c - .4 .7 4 33 -57 7.5yr4/4 Is Osg mvfr cw - .7 1.6 5 57 -100 7.5yr5/4 s Osg ml - - 7 1.6 ❑ 2 Boring # Boring 100.57 >100 pit Ground surface ev. R. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Cor%i6t6hc6 Bi 0dalry R6M GPD/flp in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -9 10yr3 /2 sil 2msbk mfr as 2f .6 .8 2 9 -20 1 4/4 sil Imsbk mfr cw 2f .4 .6 3 20 -33 7.5yr4/4 - sl 1 fgr mfr cw _ 4 .7 4 -Ifi0 7.5yr5/4 s Osg ml 5 * Effluent #1 = 8OD 30 220 Ittg1L and TSS X30 z 150 mgll " Effluent tC1= 130 < 30 tta and TS5 < 30 nigh- CST Name (Please Print) Signature CST Number Thomas C Nelson 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, WI 9/27/05 715- 246 -2454 Pro owner Steve Jacobson P arc el D # P ending e 2 Of 3 Property P cell �9 Boring 3 Boring # E] Pit Ground surface elev. 102.83 ft. Depth to limiting factor � in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundarq Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 1 0 -11 10yr3 /2 - sil 2msbk mfr as 2f .6 .8 2 11 -36 10 4/4 - sicl lmsbk mfr cw if .4 .6 3 36-64 7.5yr4/4 - Is Osg ml cw _ .7 1.6 4 64 -100 7.3yr3 /4 - s 6sg ml - - .7 1.6 r �6 -0 R 6 � r 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 GPD1fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 Boring # Pit Boring .. . F-1 Ground surface elev, ft. Depth to limiting factor in. Soil Application Rate Heriaen Depth Dominant Delay Redox 9esoriptien Textere Structure Der"tence Boundary Reefs QPR/fi? in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. 'Eff#1 I "Eff#2 I ' Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg& Tie 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- 8330Tcst (R.07 /00) 1; Steve Jacobson 61y17bp d bvn pipe 100.60' � Top of iron pipe 100.6 Lot 5 � i6e;sr 14 o" T 0 w n NE Lot comer R 0 a d Easement to lot 4 X 30 U31 BM1 �� < 3% Slope R 33 '9 � 63 V i P1 e too 8� 9fl - 1hows Nelson W387 76�505r VOL 18 PAGE 4769 ((( KATRGEEB H. WALSH REGISTER OF DEEDS ST. CROIX CO. MI RECEIVED FOR RECORD CERTIFIED SURVEY MAP 06/10/2004 11:i5AM CERTIFIED SURVEY MAP LOCATED IN PART OF THE NE1 OF THE SW114 AND IN PART OF THE SE114 OF THE REP FEE: 17. COPY FEE: 5.00 SW1 OF SECTION 24, T29N, R19W, TOWN OF HUDSON, ST. CROIX COUNTY, PAGES: 4 PREPARED FOR: WISCONSIN. NORTH 1/4 STEVE & LAURA JACOBSON LOT AREA TABLE CORNER OF w 846 BADLANDS ROAD ,SEC. 24 U w HUDSON, WI 54016 Lot # ACRES SO. FT. �` N p LOT 1 2.03 88,378 C= i LL °, "O FF ' SURVEYOR LOT 2 2.62 114,139 1 O 1 Q i Z Z Z LOT 3 3.00 13 1 11u] , w¢ ¢ DOUGLAS J. ZAHLER LOT 4 29.98 1,306,040 . Lu I `� & N LAND SURVEYING, INC.I &3 ¢ S ¢� O 2920 ENLOE STREET 4HM PLL%4 OP a i C I a o 0 HUDSON, WI 54016 _ - Q _ NW CORNER _ OF THE NE1 /4 THE SW1 /4 N89 33" 5297.16' 1 1 - - -� m N OF SECTION 24 N89°2T33 "E 1320.00' EAST -WEST 1/4 LINE 787.34' 2657.16 1 20.00' EAST 1/4 LOT 1 CORNER WEST 1/4 ~ N OF SEC. 24 I CORNER OF SEC. 24 Cvlrwmr .� ! Gi1C PLL%V OF --- 7L DD BOO OD o =N 10?1004 ----- --------- I U, u LOT 3 YI( ,� j o i- N Q I' mt o_ -WY D O i �] i w w - " HEET 2 OF 3 `oa e UNUDLQ44GD 1 SHEETS FOR LOT T DIMENSIONS I�QIDD� LOT 2 OWNED a C3 1 @)vm19L�� D ' TIN GRAVEL - - - - DRIVEWAY - - -�- NORTH LINE F_ '6'- i I OF LOT 3, CSM — EXISTING FENCE LOT 4 HOUSE f VOL 3, PG 658 9 1" IRON PIPE FOUND _EXISTING FENCE i S87°5952 "E 15.25' SEPTIC VENTS- I S �\ - � V SOUTH OF FROM SET 1' IRON PIPE 1 -WELL PROPERTY LINE Z SOUTH PROPOSED ROAD PER - t:: CSM VOL. 3, PG. 658 1- 0 I LINE OF ! 166' ZON .z - - - - I N89 "W NE1 /4 OF WEST LINE OF LOT 3 -- -THE SW1 /4 EXISTING FENCE - -� - ~ `` EXISTI 30 /- 1 ��" FENCE 1'± ($89°24 IE 321.00') v OF SEC. 24 2.5'± NORTH OF I WEST OF t ! 1 PROPER TY $. NORTH LINE I PROPERTY UNE A 1 PROPER ! OF LOT 2 - 1 [] SHED I ' LIN E. `O _- t - ! NSW"04"W 943.93' io �1 I N00 °0 0'49 "E /* 66' Ul ��4 183.80 i !! cn ,. l ` (NQRTN) ; SOUTH 1/4 o O� C.O. t o MO� Od °, `J - I jam '. _ i I CORNER OF 00 1 Z �' V OL�o I °� / ! i SEC. 24 d; w =� _I?C�33a 4g0 � 8���� o `-° LEGEND I `" ��w�V N AP �1 1 � FOUND ALUMINUM ST. CROIX COUNTY SECTION CORNER MONUMENT FOUND 1" OUTSIDE DIAMETER IRON PIPE SET 1" OUTSIDE DIAMETER BY 18" LONG IRON PIPE, WEIGHING 1.13 LBS. PER LINEAR FOOT •••••- ••••••••••• ROADWAY SETBACK LINE (50' FROM RIGHT -OF -WAY) — — - — — - — 12' WIDE UTILITY EASEMENT SCALE IN FEET 1" = 300' W FOUND 3/4" REROD iiia ® FOUND 2" OUTSIDE DIAMETER IRON PIPE 300 O 300 0 FOUND 1 -1/4" OUTSIDE DIAMETER IRON PIPE THIS INSTRUMENT DRAFTED BY: BRIANA GEISSINGER ( PREVIOUSLY RECORDED DATA JOB NO. 6288 -01 DATE: 07/01/2003 REVISED:06/04 /2004 SHEET 1 OF 4 SHEETS Vol.18 Page 4769 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address 13510 93 CIS: Property Address 5 (Ve ' ng.Departtruent for new construction,) City /State I���s , &jx- .Parcel Identification Number JA 41 ' All LEGAL DESCRIPTION N E A 0RL 4t row Y q aNd ,'w po�+ o`* fi3�e Property Location SS C �'4 , 5 W 'l4 ,Sec. , T 9 N Rj_W, Town of Ad 5o4) ST, C r pe X eowwf of wT Subdivision a �t m- , Lot t W . Certified Surrey Map # —, Volume , page # Warranty Deed # Uro �t.Z'� _ Volume �- , Page # (� Spec house yes no Lot tines identifiable Q no SYSTEM MAINTENAN AND OWNER. CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes, proper maintenance consists of pumping out the septic tank eve three years or sooner, if needed, by a licensed pumper. What yo put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St, Croix County Sanitary Ordinance. The property wx ner agrees to submit to St, Croix County Planning & Zoning Department a certification form, sigr d by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the Sept tank is less than 113 "1 of sludge. 1 9 the unde.rsigined have read the above requirements and agree to maintain th private sewage disposal system ith the standards set forth, herein, as set by the Department of Commerce and the Department of Natural resources, State, of Visa tsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Y fuzing & Zoning Department within 30 days of the three year expiration date_ macertify that all statements on this form are true to the best of my /our knowledge. I/we am/are the owner(s) of ie property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Nu SIGNATUTRE OF APPLICANTS) Dl TE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the planning & Zoning Depa agent. * *' Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey iap if reference is made in the warranty deed. (REV. 08 105) TO/TO 3E)Vd ot4iawn ZNIS I i Z69ZSCZS TZ Z T . 9 T 9( lZ / TE /90 626924 KATHLEEN H. WALSH REGISTER OF DEEDS State Bar of Wisconsin Form 1 -2003 ST. CROIK Go., MI WARRANTY DEED RECEIVED FOR RECORD 06/07/2006 10:15AK Document Number Document Name WARRANTY DEED EXEMPT # THIS DEED, made between Steven A. Jacobson and Laura A. Jacobson, husband REC FEE.- 11.00 and wife TR FEE: 585.80 ("Grantor, whether one or more), CC FfiF and Jim J. Davis and Niki M. Davis, husband and wife PAGES: 1 ( "Grantee;" whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real wing Area estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is Name and Return Address needed, please attach addendum): River Valley Abstract & Title, Inc. 1200 Hosford Street, Suite 201 Lot 5, Plat of Wyldwood Ridge in the Town of Hudson, St. Croix County, Hudson, W154016 Wisconsin. File k: 2688574 PIN: Part of 020 - 1066 - 10-100 Parcel Identification Number (PIN) This is homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, restrictions and rights -of -way of record, if any. Dated (S -) (SEAL) ' Steven aco son •Laura A.Jaco n (SEAL) (SEAL) AUTHENTICATION 8 � ACKNOWLEDGMENT Signature(s) o STATE OF WISCONSIN ) authenticated on 2 )` � • St. Croix COUNTY ) s C 161 Personally came before me o TITLE: MEMBER STATE BAR OF WISCONSIN the above -named Steven A. Jacobson and Laura A Jacobson, husband and wife (If not, to a known to be t perso who executed the foregoing authorized by Wis. Stat. § 706.06) ins a ow s e. ti THIS INSTRUMENT DRAFTED BY: Attorney Doug Berg ttm 1200 Hosford Street, Suite 201 Hudson, WI 54016 Notary Public, Sfate of isconsin My Commission (is permanent) (expires: «� ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED A 2003 STATE BAR OF WISCONSIN FORM NO. 1 -2003 • Type name below signatures. toff SURVEYOR: COUNTY PLAT OF: WYLDWOOD RIDGE DOUGLAS ZA/6ER LOCATION SKETCH S&N LAND SUROEMNG 7OWN OF NUDSON 2920 ENLOE STREET HUDSON. W 51016 LOCATED IN PART OF THE NE1 /4 OF THE SW1 /4 AND IN PART OF THE OWNER: SE1 /4 OF THE SW1 /4 OF SECTION 24, T29N, R19W, TOWN OF HUDSON, asL 12 aN .46 B ADLAND ST. CROIX COUNTY, WISCONSIN, BEING LOT 4 OF A CERTIFIED SURVEY 818 BS RD. HUDSON. W 54016 MAP RECORDED IN VOLUME 18, PAGE 4769 AT THE ST. CROIX COUNTY REGISTER OF DEEDS OFFICE. �J LOT 46 PLAT OF SUN RIDGE III SECTION 24 T29N R19W --- BENOY DRIVE - --- �r6st mri.19T EASr - xEaT i/1 It+E nn'� W' / � N IO � (mac Ne9zrx2'E TeT.24') ,� era 21 - N89°27'S2•E 787.91' _ � a (NEC NW'2rM E) I E 2 a � PIPE �. I N89'27'S SW FRaw --- ---- -- Dana Z �� ♦ oN 9I `\ \ LOT 1 CURVE TA ci e LOT 4 LOT 5 �♦ R . A . Um ACRES ROM. L. 225.00• 1KU SO. R. / ` \ CwW MI. 4r4Ytr 199.,1 So. R. , 4 `� O,o.1 Mar/ s2W46 y \♦ TAaa Lays, SDW3r LOT 3 \ we 1•" 9IA 17316 // � 79npO1 one a4zewosrr 3;w mw $ / C / LOT2 I / (REC 59 '0'41'Wi I0 "� / N85'10'S9•E 470A1' 3 ICy � ��♦ I ♦ 1 LOT 6 21.7M ACKS .19.0n so rt 11�ae1EWAr � IC7 1 6 1 1 N89'2 74!1 30 SAX ( &U-) ) (KC C Ne9z4tw 5nu� 1 1 8ox 1 9de10 1 rauwo 1 elOx I Re[ I 1 0 $ _LOT 3 C.S.M. IN I 5_ - __ -__ -_ i g VOL 3 PG. 658 5/4. 61w RE i � 9TAAO ser,zo'w _ r IP. EUYATNIN BAD1 /6 ' MME ` N ' E1%4 THE sM1w /a ❑ I g _ / ' — L 1rE aE n1E mm n SO /4 Of RE Sw1 /4 1 (( KL SB83T00 1 2r REC 2B9R1L 900 00 . 889 341.95' I N89°20'5PW 600.06' i LOT I C.S.M. IN ----------- VOL. 2 PG. 450 I LOT 1 - LOT 2 ( C.S.M. IN VOL. 3 PG. 659 4 ,^9 /tG • /4* t� p0 LEGEND 7 � O " SE C p10OMF1l ANT W EgA1D 1 wrax - SET 1 OUT= OIAIEIEA M 0 1r LONG 8ON I'm NOOXND j x 1.13 LOS M UNEM FOOT /� 1 =Er 2 -2,r qIT OWERW ga I {p MGT i e r 1e u2lo U" AA MFIOYIO us uo rm uxEAR REGISTER'S OFFICE 9'OOND 2 -0/6 am" gANE1ER 80N TYPE ST. CROIX CO. 0 OF W'S UN C 7L: m FOD 7 /4' OIAIETER M ROOM v.,ri21. oouoLAS r. i —.— ENSnx09tNCE 1 II.ar9r �' s:1u >4 Q ........ 1r eTUTY EASdFNT Y o4s. 11 l . ........ (50 fR011 PoDIT-0F -WAY) ` SU x: ey..rMr j2 21 06 SCALE IN IN FEET V - 1001 100' 1 "" ' 00 TMw MSnmm oRVTm n , w+ur IME ,toe No. 6299 -02 DAM 0e/15/2= RensEy. 12/14 /2oos SHEET 1 OF 2 SHEETS