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HomeMy WebLinkAbout020-1353-19-000 d rool 3 -o n d `01 fl • O d # N ' cn ` 1 I # CA .g - 0 x 'CJ z to z co ._ 13 x - 0 Z 3 Z p O = ' _ C N `C N • O y 0) ro 0 O y O O y 0) ro 0) O y O O =.- 3 c m 3 3 < a m o � ' 3 a m Q 00 p ro a 7 a CAD y p a 7 . 7 CD = y M c c� O p m S c c O p m m .. co v W , O N z-t a a 7 Q a = y N a a 7 Q 7 y O N - 5 3 v a °i 3 n d a 7! 7 <ob t co c c (D c ro c ro w ° o ; r 7 CA Z Cn z D C/) z Cn z D cp C 1 1 1s t m D cS D W cif) > c D W a c 3 a a 3 a ° o c2 w O O O o O m o o o o o p o - N N O C y y a i � w Q = , v oz oz a l o o A O o / �/ � � 1 O n N N 3 O 2 N N 3 N N N- p° ' (� f ID R'S 6 ° 0 f'D ( D o o fi N g v 7 lei R m m m 3 m N = = N — _ 1 a Z •• co t 0 ` 1 o o ro `v Z a fFD a ` _ (0 O 0, "or • ' lr 1 ro a, • c • 7. o c c 7 CD ' a a II a a Q ...r 3 a B c 5 ^` \ GO z N 0 I t .A N tZ o rr 1 z o N n z f i 1 to ' " A y m o c 3 n° a c�o cn D y mo n o a c`o c D o. 0 3 co 02 a a) nom o o n W ° - . � . ( v cn ( 3 3 0 no w a �w y°�� 3 �0�00 o ( T3906_, 0 O -• y p p ! 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N ro m � pl a a C a) CD 5.O 0 ro 3 al at ' y • 7" C .. _ I m m pQ _. g am ro a8 v s m my ' -< ro a y g a � i (0 CD a) M ro y° C » Ol a y 'O y y ro y 0 y K� yyy�3 - ° O 0 m .�T •< vy '' A 0 » 0 0) 7' CD C D a ao C D ro N a o co) m D ro ? c 0 (n• O• � O co y D .° 7? ro co y ° 3 • r gal O a> N ro a Cr ro G 0 N ro Q 7 N K 0 3 ii et. d I o o b N < I ti 0 oO o oO t'‘' ° ° o ° o a o o a o ti Wisconsin Depattment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 405084 0 (ATTACH TO PERMIT) GENERAL INFORMATION 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: Homme, Dean Hudson Township 020 - 1353 -19 -000 CST BM Elev: Insp. BM Elev: BM Description: /06-0 / 0 4. 'SST EJ A '°-/ s- �-/r- TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �' F �, 0 /t• C �Q D 0 / �� / / g 0-0 Benchmark . (� Dosing /\-( Ali. BM Q /'� 7 l /0.3 >�y /06' 0 w/ 4 0 --11 / --- s r,el - /0 - Aeration Bldg. Sewer /0Y O ? X -/ Holding St/Ht Inlet ` f- 3g tf 0 3. 62 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L BLDG. Vent to Air Intake ROAD Dt Inlet Septic 7'7 5 7/ /to 1 / ( -7- / Dt Bottom ✓ �� Dosing _---� Header /Man. 1> ,� w. r n - se )tl 1 Aeration Dist. Pipe �,)breJ 1 _ b /O Holding ',-� Bot. System �o Q ,,,}1 3 -}tic S ` I Final Grade PUMP /SIPHON INFORMATION 2 .YS 1GbY 9 7 Manufacturer Demand St Cover Model . ber TDH 'Lift 'n`ction Loss System Head TDH Ft . \ Forcemain Length 1'.. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width 3 , Lemt (0 No. Of Trenches PIT DIMENSIONS No. O its Inside Dia. Liquid Depth DIMENSIONS 1illJJ SETBACK SYSTEM TO P/LI BLDG WELLS +ma L E1t,U Aryt" LEACHING Mg�reji; / . L a. INFORMATION Type�pf System: 1 I " tl CHAMBER f 7 7 / ' _ _ ` }� /� ✓)_ _ _ /) /� /� (0:4 f� D Model Number: / / t/(S yl 'J t /Ci—Af� ' T7 DISTRIBUTION SYSTEM ' 9 + lo viA4 01 D-130/ 0/�g,AI, Header /Manif Distribution Size x Hole S ze x Hole Spacing Vent to Air Intake _ V (s) / �f 7 0_ Length $ Dia q Length 102• Dia L/ f ' rfra g 3 �� SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only J.. Depth Over � Over xx Depth of xx Seeded /Sodded xx Mulched ASr /2ns'� ,p Bed/Trench y /Trench Center 1 f 11 10361/french Edges Topsoil ri Yes [] No ® Yes 7 A I(o COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: l0 / i ( // 6D-- Inspection #2: / / D Location: 658 Hillary Farm Road Hudson, WI 54016 (NW 1/4 NW 1/4 36 T29N R19W) Cottonwood Ridge Lot 19 P Parcel No: 36.29.19.2019 1.) Alt BM Description = 5 j1 66V S. hS h , (AIL a- (lam } e.tf 1-�q -� ,r�- 2.) Bldg sewer length = Jqt 4 , a y , 3 " 5 4r -- w/14',- 6 , O _ y r amount of cover = > ahe- Plan revision Required? i_ j Yes No , j L v Use other side for additional information. ( 6 G %� �0 �' SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. H 0 N M E SITE PLAN NW— NW- 36- 29 -19W LAFAYETE TOWNSHIP COTTONWOOD RIDGE #19 ST. CROIX COUNTY, WI NON— PRESSURIZED DISTRIBUTION CELLS "" " USING A TOTAL OF 28 LEACHING CHAMBERS (MODEL — INFILTRATOR SYSTEMS "STA 4bARD ") 2_q U . ____ is. .0 I-- I 1 __ _ _ --- t ef)L• ] � I , I � 2 0 -14C-4" ASTM PVC I �6Y N • '�J ELEV = 109 HUFFCUTT ODEL 1250 SEPTIC TANK � "-- WITH ZABE A -100 EFFLUENT FILTER (SCALE) 1 it \ \\ i 0 20 40 (UNLESS SHOWN OTHERWISE) ' 1 WILLIAM J. BERG/4 x WISCONSIN CERTIFIED SOIL TESTER DESIGNER OFF ENGINEERING SYSTEMS �. 4 —BR SITE •% CUSTOMER I / 227819 30' -4" 3034 ' _ W BUILDING SEWER f 31 °j DRIVE (COTTON WOOD DRIVE -)- -?6-°' 0 LEGEND BENCHMARK ELEVATION = )00.0 (ground elevotion CO bose of stoke) A LOCATION OF SOIL BORING(S) LOCATION OF SOIL PIT(S) BUILDING SEWER MUST COMPLY * NO APPARENT COMM 83.43 SETBACKS W /COMM 82.30 W.A.C. (11)(c) * PARCEL DESCRIBED AS 3.04 ACRES LOCATION OF WELL MUST COMPLY WITH WDNR CHS. NR 811 & 812(b) PAGE 2 of 5 r e_&-iI S` *lesIS I+ tt-- 1 -"R -Y Fl42►� Rte. �� 5 e b i Safety & Buildings Division _ /0 - L 201 W. Washington Ave. Sanitary Permit Application 11(4,0 PO Box 7302 `�sconsin 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 complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 11 inches in size. County State Sanitary Pernlit Number A if revision to previous application State Plan I. D. NUMBER ST. CRO1x 4 t-08-Li RECEIVED I. Application Information - Please Print all Information Location: Property Owner Name DEAN HOMME S E P 2 3 2002 Property NW Location 1/4, S 34 T 29 N, R 19 W Property Owner's Mailing Address Lot Number Block Number x ST. CUr 1900E 86 STREET # 110 CROIX X ONT` 19 NA City, State Zip Code !phone rr ..b A�i �i G Ol Subdivision Name or CSM Number MINNEAPOLIS, MN 55425 iii— 7 /t- • 3 - 2 - ?- / 7e ) 4 COTTONWOOD RIDGE II Type of Building: (check one) City I or 2 Family Dwelling — No. of Bedrooms: 4 Village I Public /Commercial (describe use): Town of HUDSON State -owned III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road COTTONWOOD RIDGE A) > New System 1. ❑ Replacement 2. ❑ Replacement of 3. ❑ Addition to Parcel Tax Number(s) I System I Tank Only Existing System B) Permit Number Date Issued s KA Sanitary Permit was previously issued L{O $r0 Q f mh Is IV. Type of POWT System: (Check all that apply) >Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade Aerobi Treatment Unit ❑ Recirculating ❑ Other: V Dispersal /Treatment Area Information: 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6 . System Elevation 7. Final Grade 600 Required 858 Proposed 871 Rate (Gals. /day /sq. ft) (Min. /inch) NA 98.0' Elevation 0.7 — 100.5' VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete structed Tanks Tanks 1250 SEPTIC 1 0 1250 1 ILUFFCUTT X ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ VII Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (print) Plumber's Signature (no stamps): MP/MPRS No. Business Phone Number CARRELL FRAZER — ^ tt S � � 221071 715-288-6225 OR (CELL) 828-5734 Plumber's Address (Street, City, State, Zip Code) L? 16317 160 — BLOOMER, WI 54724 VIII County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) ,Approved ❑ Owner Given Initial Adverse Surcharge Fee w Determination cO• tp Stet. 3 — 2450 Z 1 IX. Conditions of Approval /Reasons for Disapproval: 4. Lts o.w ra kS t,„.,-• c, r ev : si-s -1-ko ; g4.cp /r4m1-11+ - 'c q sa at ( 4e344 Cover Sheet DEAN HOMME 1900 e 86 street 4110 — Minneapolis, MN 55425 NON - PRESSURIZED IN- GROUND SOIL ABSORPTION COMPONENT Reference SBD- 10567 -P (6/99) "In- ground Absorption Component Manual" Location: NW ' /o, NW 1/4, Sec. 34, T 29 N, R 1,8 W Town: Hudson County: St Croix Designer's name and license #: William J. Bergh (License No. 1577 -007) 1 the undersigned state that these plans were designed and submitted under my authority. Designer's signature: , Designer's address: 2667 113 Stre Chippewa Falls, WI 54729 Designer's phone number: 715 -723 -5555 voice 715- 723 -7535 fax 715 -577 -6838 cellular ssssss sime∎ • ,,, Contents ° ° ° °G . • Page I -cover sheet 10 � Z Page 2 -site plan i ‘,\ V". Page 3- Leaching Chamber x- section schematic • :' ��® Page 4- management and contingency plan •..� °•., t . Page 5- management and contingency plan ''.•• siv Page 1 of 5 ` . HOV N[ SITE �l| � \ NW—NW-36-29 | |L/ v VE `]| | L- F- L-�t \ LAFAYETE TOWNSHIP ST. CROIX COUNTY, WI COTTONWOOD RIDGE #19 � NON-PRESSURIZED DISTRIBUTION CELLS -_-----�-----__ __�__ USING A TOTAL OF 28 LEACHING CHAMBERS (MODEL - INFILTRATOR SYSTEMS "STANDARD") ~~ � | |r ��c��.� V� \^ �l4 � [� ' ' 1 \ / / �.■ ._� � � 1 � | Bn_ - ~~ / .'�/ ��� _ -140'- 4" ASTM PVC ELEV = 109o' HUFFCUTT MODEL 1250 SEPTIC TANK ----- WITH ZABEL A-100 EFFLUENT �R (SCALE) /mmm� 0 20 40 (UNLESS SHORN ,-.. wISCONStN CERTiFiED SOIL TESTER /'/ 4—BR SITE DESIGNER OF ENGINEERING SYSTEMS msTo°ER m v227815 a/ - + ^ zos^ BUILDING SEWER DRIVE (COTTON WOOD DRIVE* 0 LEGEND S BENCHMARK ELEVATION = )000 (ground elevation � bose of stoke) LOCATION OF SOIL BORING(S) LOCAT!ON OF SOIL PIT(S) BUILDING SEWER MUST COwpLY wO APPARENT COMM 83.*3 SETBACKS W/COMM 82.30 W.A.C. (11)(c) `' * PARCEL DESCRIBED AS 3.04 ACRES LOCATION OF WELL MUST COMPLY WITH WDNR CHS. NR 811 & 812(b) PAGE 2 of 5 • The Standard Infiltrator® Chamber The Standard Infiltrator Chamber 1" Overlap at Latching Mechanism — i� i I — — I � I I r I sees.. __- _.. I I I 1 - - - j,_. j , � - - — __ - - 1 I l I � j • ii 12' 9 ... ' I i; I � i l.: r m 1 L I —�.— 1 . } -- I r .. i.- —. I . r i t 7 n :. r _II � + Il ... .._.. sees. - . --___ ii I Effective Length Chamber End View PasiLock' End Plate Specifications • Size (W x L x H) 34 "x75 "x12" �. , l 2" Storage Capacity 78 gal. /7 0.4 ft' \ , ,0© ©© O O G /3 ` � 0 O O © () © O Weight 26 lbs. -- — 34" — ..] Louvered Sidewall Height 6" INFILTRATOR SYSTEMS INC. STANDARD LIMITED WARRANTY INEI i k'•t'GR , Y LEIS I lifiltiat ) S - A >NDARD LIMITED WARRANTY FOR SEPTIC PPCOMICTS ' P ''S 0 '^` ' 1 ' ""' -`-�'" " "''� �° " ' • 101 ;Ai Ar nighty of onth:, nrol r : nvourscorma fry Infilomm toolinnoyely "._f, erra'. 0 o, rro, ) wmin instsION mo riporame i na 1 t nine tI ro so origiim, f. I lolder S CD _ INFILTRATOR arralost roles- , r y r p r 1 l 1 pt system 1 U. r I 1[ 5 system o opP tl I tlr 1) tyf A Ill P slate trot InsTallarion or ar Sept.' ys en romances l ;freer to '.x warrant. r [older y l 1 r writing r 1 r - in Old .ybrrA rr n 1S y aleg rdof t Itfl, will ..p,ly to: tl r nose, 1 c by la I.ra.o to Ito dor:mho ono m e TI tl a Na y rl r t a y r dr. td r , E NO G f IC I t L CYSTE M E INC 11) LIMP � .ak RANT Y \ REMEDIES IN B AR C�RA I ( ) ARE E « 'HIV I E NC AR /vAl.r N of TfES WIC I r2P�r`EC1 TO Chit _, INCLUDING NO liMPI IED WARRAIOSIES DE MERC IAN Atilt Y OR FITNESS FOR . PARTICULAR F =ridPROSE mired Miarran roes nor moor,: to incidental, corsesitarrrial. special 3 inEirrator shall not be hl tor pfaltios oi lio °real Environmental Onsite Wastewater Solutions )., t. acs, r c l r 7 G loss of proorfcria and f ur•s Labor too Irtgreririb, ovt i r. N costs ot o. et locus or exponses incurred by a Helc , any tiara par., 113. Beall, OXiiriCIESO 00 111 1 I ., i Won arty .0,ar11y0 damage tc ho L T t.ue to t, 2 1 1 0 0 3 1 1. ' aru foal al Mate c dent. Th .,a, etuse of oinglOrt of She J tio Th As boi,19 s j :t cc 10 vertliitio no:fin rr ,m odirons vvIttiC,!1,1, polo—litter, polo by istaIlaton Instrorrions, failure to O, 6 Business Park Road P.O. Box 768 rain ma the a d r..nr R sot roar m n installation m :, pl t , nrn pn p r r, ls into he system comtnn a the ., ;anon, of , on sysrorn duo to improper grog inornixir stomper grease risposal or impropor r r t acy Old Saybrook, CT 06475 aahr, 0,11 net oarisod by irEiltratoi Tim; Limbed W ✓uranw Moll ue void if ti ,. I iolder loils to Lmmph RAM elf o t U tools sot INIT, 'r Inn, I Warranty ar anty Fortfor. f ' n o oven! t,tr t rbe rsoironghis lor any 1 ' 0 7 ' loss or o to 'Me i loiriel On Units, -.y 10ral < from hotollation or shionnne , 800 - 221 -4436 860 -577 -7000 OS r any prb r kobility chonIS tA 10Id r . party. rn e 1 rro m apply the t I t st he ins all ., t.o 1' Jon... MI sire t e rr e s rr r. h by roam a boar c.tla.a 11I t r r apprr hL I I a1 r _tr, :v I,t 11.0113311 FAX 860 - 577 -7001 r) V 0 O.).11e,1 of infiltraror r s • r r is _1l). �,,.01rry ' any manlier >• rats_x - ✓::r. or o e and h:; LO 12.11'aoty ur , xa,,111 "ppl0 S, y p� <,,rr u Eon t t r, g ai r 2aldef www.infiltratorsystems.com above „ r r coontio, o o, 1- 800 -221 - 4436 Any f r sc a 1 r ra ln crl- r'Ittot r potato r 7 t.: Old Saybrook, r,a � rt. pro t sore r. _. ..., ohm in .o,,, of hr•. pplis.ahl , P.; OrOy OrIO ,. tcl b.-Molly Imo Sot uarra .y prier ro • polo) as,, of L, r 'ao bystnins do, rim t nmon:1 '.?s1lll ,r.:'; 1 cr pucrtr_,t. amber. Ir 'I(3rJ _,Ri; go na,a,dttr.r:� , . E]iJ_ to tal rt,010.i ..,non's nat'trnon will warranty '�u . Infiltrator Systems recommonds la hso (b p, c trinK ribels a o I 1ot :n.119 filters in,A0 ".J ors, sf systems S r siorg c dl 1 0 , 1 21 2 1 3 0 21 1 r 1 , ' by nnt g.. :2103'.. For technical assistance, installation instructions or customer service, call Infiltrator Systems at 1 -800- 221 -4436. U S Patents: 4, 5 661 5,01'7,041: 156,488; 5,336 017 5 401 116: 5,401,459; 5,511,903; 5,7 - 5,588.77 5,8 Canadian Patent 1,329 2,001,564 Other patents Per3ing '1,1,9l',llor, Equaiiz . and '1de 02irlder are registered trademarks of Infiltrator Systc:11111 Inc. 111)1 t'ator IS a regl .ter :,d trademark to Fra11Ce. RECYCLED PAPER Infiltrator Systems Inc. is a registered trademark. in Mexico. Contour, Microt.eachinq, PoIyTu3 SnapLock, ChamdcrSnacer, '0 0 11 , 1 , 0 , 21 ( 1 0 QuickPlay are trademarks of Infiltrator Systems inc. • 2001 Infiltrator Systems Inc. Printed in iJ•S A. 0790401 3Ni -3 • POWTS OWNER'S MANUAL MANAGEMENT PLAN PERMIT NUMBER: Owner /Agent: Dean Homme POWTS Maintainer: Geo Tech Soil & Site Evaluation — Chippewa Falls, WI 715- 723 -5555 Local Regulatory Authority: Chippewa County Zoning Department — Chippewa, WI 715- 726 -7940 POWTS Installer: Darrell Frazer — Bloomer, WI 715- 288 -6225 Septage Servicing Operator DESIGN PARAMETERS Influent/Effluent 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) <250 mg/L Soil Loading Rate (SLR) = 0.7 gpd/ft SYSTEM SPECIFICATIONS The components of this septic system are intended to serve a three - bedroom (450 -GPD) single- family residence. The components include a Huffcutt 1250 gallon septic tank, a Zabel A- 100 /effluent filter and (3) non - pressurized distribution cells using graveless leaching chambers. A total of 28 Infiltrator standard leaching chambers are required when applying an EISA ratin g of 31.1 as specified P i d b DCOMM. All parts of the components must comply with WI Adm. Code COMM 84 and be P 1.l P by installed per manufacturer specifications and approval letters. DESIGN CRITERIA o "Design of conventional Soil Absorption Trenches and Beds ". R.J. Otis — ASAE Publications 5 -77 and Design Manual — Onsite Wastewater Treatment and Disposal Systems:. EPA 625/1 -80 -012 October 1980 ➢ SBD — 10567 -P (R.6/99) "In ground Absorption component Manual" o SBD — 10705 -P (N.O1 /01) "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. The septic tank contents must he removed in accordance with Chapter NR 113, WI Adm. Code when 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 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 flushed 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. 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 with an effective locking device to prevent accidental of unauthorized entry into the tank. The outlet(effluent) 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 floats. 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. ➢ In- 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 be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. ❑ 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 75% 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 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS 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. ❑ 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 CASES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OF OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. .. RECEIVED 1333 Wisconsin Department of Commerce SOIL EVALUATION REPORT T Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Geo Te Soil & Site Evaluation Cour4EP 2 3 ZUOZ r Attach complete site plan on paper not less than 8 11 inches in size. Plan must St. Croix 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. Par T1.OROIX COUNTY ZONING OFFICE i Please print all information. viewed By l Da te Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). !,^�^�„� c ,,� . � . 2^ P Owner Property Location � HOMME, DEAN Govt. Lot NA NW 1/4 NW 1/4 s 34 T 29 N R 19 W Property Owner's Mailing Address i 1 k 1 Lot # Block # Subd. Name or CSM# 1400 E 86TH STREET #110 19 NA COTTONWOOD RIDGE City State Zi 11W Hudson City 1 Village y Town Nearest Road Minneapolis MN 5C$ � 1 COTTONWOOD RIDGE 11 New Construction Use: y i Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD _ Replacement A Public or commercial - Describe: Parent material OUTWASH Flood plain elevation, if applicable General comments and recommendations: Recommend installing a non - pressurized below grade component. System elevation = 98.0'. Maximum recommended SLR = 0.7. 1 Boring # Boring ei Pit Ground Surface elev. 100.9 ft. Depth to limiting factor >106 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 - 7.5YR 2.5/1 none loam 1 m -c sk mvfr gs 1f -m 0.4 0.6 2 9 -16 7.5YR 2.5/3 none grls 1 m -c sbk mvfr gs 1f -m 0.7 1.2 3 16 - 27 10YR 4/4 none Is -s 1 -0 m sbk mvfr -I gw 1f -m 0.7 1.2 4 27 -34 10YR 5/6 none s 0 sg ml gs 1f 0.7 1.2 5 34 -45 10YR 5/4 none s 0 sg ml cs -- 0.7 1.2 t CL)cc‘f. 6 45 -54 10YR 4/4 none cos 0 sg ml cs 0.7 1.6 �JA 7 54 - 106 10YR 5/4 none s 0 sg ml -- 0.7 1.2 C,� 2 Boring # ! 1 Boring Pit Ground Surface elev. 100.0 ft. Depth to limiting factor >85 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 - 10 7.5YR 2.5/1 none loam -- -- -- -- 2 10 -20 7.5YR 3/3 none Is -- -- -- -- Z 40 3 20 -32 10YR 4/4 none Is -s -- -- -- -- 4 32 -52 10YR 5/6 none s -- -- -- -- 5 52 - 85 10YR 5/4 -6 none s -- -- -- -- * Effluent #1 = BOD 5 > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = :OD < 30 mg /L and TSS < 30 mg /L CST Name (Please Print) Signature: / CST Number William J. Bergh /// 9 227819 Address Geo Tech Soil & Site Evaluation Date Evaluation Conducted Telephone Number 2667 113th Street, Chippewa Falls, WI 54729 8/26/2002 715 - 723 -5555 Property Owner HOMME, DEAN Parcel ID # Page 2 of 3 3 Boring # ✓ Boring Pit Ground Surface elev. 101.1 ft. Depth to limiting factor >85 in Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 1 0 - 12 7.5YR 2.5/1 none loam -- -- -- 2 12 -24 7.5YR 2.5/3 none Is -- -- -- 3 24 -31 10YR 4/4 none Is -- -- -- 4 31 -46 10YR 4/6 none s -- -- -- 4-- 46 -85 10YR 5/4 none s -- -- -- 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 /ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 *Eff#2 Boring # 1 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 /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 "Eff#2 * Effluent #1 = BOD 5 > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD 5 < 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) Geo Tech Soil & Site Evaluation L H O M M E PLOT PLAN NW— NW- 36- 29 -19W LAFAYETE TOWNSHIP COTTONWOOD RIDGE #19 ST. CROIX COUNTY, WI (101.1) #3 (100.9) \\\V112t (100.0) # �....... ELEV = 109.0' N /' 4 —BR SITE (SCALE) /iii // 0 20 40 (UNLESS SHOWN OTHERWISE) WILLIAM J. BERGH WISCONSIN CERTIFIED SOIL TESTER DESIGNER CF ENGINEERING SYSTEMS CUSTOMER 1.0. / 227819 DRIVE V 9 0 (COTTON WOOD DRIVE}- LEGEND S BENCHMARK ELEVATION = 100.0 (ground elevotion • base of stoke) A LOCATION OF SOIL BORING(S) LOCATION OF SOIL PIT(S) )C NO APPARENT COMM 83.43 SETBACKS * PARCEL DESCRIBED AS 3.04 ACRES PAGE 3 OF 3 Wisconsin'Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division . , , INSPECTION REPORT Sanitary Permit No: 405084 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: Homme, Dean Hudson Township 020 - 1353 -19 -000 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH'Lift Friction Loss System Head ITDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. (Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: r DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only ound Or At - Grade - stems Only Depth Over Depth Over x Depth of xx . -ded /Sodded )or Mulched Bed/Trench Center Bed/Trench Edges opsoil Yes ❑ No 0 Yes ❑ No COMMENTS: (Include code discrepencies, persons present, .) Inspection #1: / Inspection #2: / / Location: 658 Hillary Farm Road Hudson, WI 54016 (NW 1/ NW 1/4 36 T29N R19W)'C. tonwood Rid! - Lot 19 Parcel No: 36.29.19.2019 1.) Alt BM Description = , 2.) Bldg sewer length = I / 1 - amount of cover = / Plan revision Required? Al Yes] No I 1 I Use other side for additional information. ,_ _ __.__— __ l SBD -6710 (R.3/97) Date II or's Signature Cert. No. r IIIIW Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave. S ee reverse side for instructions for completing this application PO Box 7302 \ S 4SC OflSifl personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce [Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not 5 —f S 02 — O //J 3 state owned.) Attach complete plans (to the county copy only) for the system, on paper not less an 8 -1/2 x 11 inches in size. County _ State itary Permit umber /�,❑ Check if revision to previous application State Plan I. D. Number ,� *. Ca o/X TvS� C.i1 _. I. Application Information - Please Print all Informat Location: ( PRO .- /353 - /9 Property Owner Name RECEIVED Property Location d..teGy No 4-.1 (.....,..., Ni,Vt/ 1/4, S 3 27,N, R )a' MAY 0 Property Owner's Mailing Address r 2 02 Lot m)eOrCS Block Number um 1 TOO - E. g'6 .L4 Sf. An0". (/ G° S T. CROIX rn INTY t Ciity, Sta te Zip Co (� (,/ �^ ' hone NG OFFICE Su ivisM Number IJ {rfiL�+vi.r'. I �.s t .., t'✓1 J J -1 2 7 ( 1 / N 2. ) '�3 - 0;1 Co o0 r,... OPS�/ 12 -e II. Type of Building: (check one) ` � es,- s.•.b...: k r4 ❑ City 1 or 2 Family Dwelling - No. of Bedrooms : g ❑ Public /Commercial (describe use):_ ALT n of m ❑ State -Owned 4 e;i Sa t., 4 (1-6-.4.,N1. C I Nearest Road � pp __ (_2) X `(t-ib CG h ON kno.� k C OSO � 3' X c'z .20 • cikb.162fs ) Parcel Tax Number(s) III. Type of Permit: (Check only one box on line A. Check box , line B if applicable) A A) 1. JB,New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. r 1 .. ❑ Addition to System System Tank Only ' Existing Sys B) Permit Number r Date Issued / .I ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) GC f �.Q q- km . .R tler: J / 4t - r"'� tif Non- pressurized In- ground ❑ Mound n Sand Filter / ❑ Constructed We d l.�" ❑ Pressurized In- ground ❑ Holding Tank • Single Pass ❑ Drip Line C„2 ❑ At grade 0 Aerobic Treatment Unit Recirculating 0 Other: J` p J �j 11b1�✓✓✓ """ V. Dispersal/Treatment Area Information: , / 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application 5. Percola on Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Galsiday/sq. '.) (Min. /inch) 1 ? ?0 Elevation 6 co ' 5 7.1 ti f'7 a. f o. 7 -- 2 ?I. 70 qs. a VII. Tank Capacity in Total # of Man . cturer Prefab ite Steel iber- Plastic Information Gallons Gallons Tanks Con- Si. - glass New Existing crete struc - d Tanks Tanks X 12 .1— iS e e- oe ti". ❑ ,❑ ❑ ❑ ❑ ❑ 1 ❑ ❑ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the P4 WTS shown on the attached plans. Plumber's Name (print) Plumber's Signature (no stam' ): ii'/MPRS No. Business Phone Number dfi /P« FR4zAIZ R - .. e-e E' , „erz. 2 2I a - 7 / 7/5 - 21 ? - 62 2 S — Plumber's Address (Street, City, State, Zip Code) 16 3/ 7- 160. ) /3 ae•z,.,..‘. ! t., '5 5'`/ y IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issui g Agent Signa (No stamps) Approved ❑ Owner Given Initial Adverse Surchar a Fee) es D Determination 225. (,$) 2 cD2 •% X. Conditions of Approval /Reasons for Disapproval: �. v I�Q �,;�5 S S^+- Wao �r �� v,.. ► Ks Qsa so sy s�. u,e>� at. i s w C (1' T om, a� is orb 50' -- c0 Sf 14cAmtek f.... 4,-k clozi,.ly (44.4 -\- . P° ' i Spec - gc -i s . SBD -6398 (R. 07/00) E f� �IV� M C L I / L' . / N LA, G P � R, -4_, 5'00 E. s N w Yy 1V w V S' 3 6 f 2 7 N, 12 (7 w 0 ( ed. ..:...i. 1.... r....,,. 5- S fZ /�.^�,.e s 2- 2, - it 7 7 e(- siso 1 A. V L ° t I f UIC T r ah}s P 4� Z I> Z '.r p. r „ak... F s 11, A (f- ., -s_ li _ J a/,sL•�.c_46. ;0 profds<o/ i5cx R t0,, 0- - , 1 - --.: 4 .3.. g 41 Q o7Si 1"0i., Y 1- 1 1 1 l - 1 _. 1 - 4-- 1 l- 1 -1- 1— 1 4-- - - '113'6. 3. s .`.- 12GG _ 11'`‘ S B �/ - - • - - -� VI -- Y - °f 1. y 610 LvcL� C Q Z - L..: -j t. - 1 / 9 _ oc Z_ Uj_, vim bo 93. sl — S9•i. 43. co PEA N h/ OM M 8 L,1 1 9 C o f' -. � .,. e. a/ R , I Yao E. 9 f 7 ` 6114. yy N \. - ' r 36 f 2 ? N, n w s /p ll0 f s 2 2,-( ;3c oo�, srv p R a ? ? Yews 77 \ (9 ,9 (C1 �V 1 Vet F { u2s NGh ps. k 1 fir. 30Fr Du 1 'kV B p , abc." sla / .�a � T � (t-- f_ 4151 - 14_7rSL.f-e_96 ; il k- opd -( s�o der ti ( .< ���. S ,3 .. I T � , •, ts�- Fie 0 r2eo�� hGw.< - �s z - 1 -a- I I- 1 4 1--= 1 -- q 3. s • _ 4 (1 1.266;=-= s� ,� S y — '1 . ( co Z., -ef- Vf { tt., n1. R.. &t [ 93• s — 89� z/ r►• --co 1 . Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page of Bureau of Integrated Services in accordance with -HR $q:O Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in,%xq Plan must Q, unty include, but not limited to: vertical and horizontal reference point (B») cijfection tr,'!" \ ( r�, f X percent slope, scale or dimensions, north arrow, and location and 1ist to near �lccf(4 g Pdre I I.D. # Tili 4/ APPLICANT INFORMATION - Please print all info ion. , ` '' "!' p 5T C feacl ed by Date Personal information you provide may be used for secondary purposes (Priviy - Law, s. 15.0 X /`a le L j,.P 0 « 6/ M/ �/ Property Owner `,, kcation js a ( ") Govt. Lot 1/4 ,tpj 1/4,S 3 6, TZ,1 ,N,R 7 q E or Property Owner's Mailing Address "---,,QL'o�#i ''; 'BI Subd. Name or CSM# '553 Ilk Yt- i(tkec -= - Fr. l- Co1inrAL:� 1 ( < d ac City State Zip Code Phone Number ❑City El Village E- Town Nearest Rodd 0l.ICk I Lid► 1 SLIC -Ito 1 ( ) / 1 it (C I co- tivr,„rv,,I. 44- rg Construction Use: 2-Residential / Number of bedrooms - 4 1 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow (OW gpd Recommended design loading rate ' 7 bed, gpd /ft • 8 v trench, gpd /ft Absorption area required RS 1 bed, ft - 7 4 30 trench, ft Maximum design loading rate . 7 bed, gpd /ft • C1 trench, gpd /ft Recommended infiltration surface elevation(s) V pP.e r 8 Zest .Perk g7.90 ft (as referred to site plan benchmark) Additional design /site considerations 444. q 2. 70 + 4 i w _ u' q 17 0 Parent material 1 I CI l t L , Si �_ Flood plain elevation, if applicable h4 iL r/7 /, p3.5" ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system E S El u © S ❑ u ® S ❑ U 0 S ❑ U ❑ S ] u ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 1 0 1 O it 31 Za — 5L I n bk n -cr- c S ! • 5 Z !(o- -12L. to y r-4 tP 'm o `f) fl 1 C 5 - • C Ground elev. fc qt. Depth to . limiting factor 1 ' Remarks: Boring # ' i 6 10yr 3k- 3L t rnC'4bk nNcc- 5 1. , Lf ,5 1 -- . 2 -'� gyp, � r . � 1� S i � � n�c.J1Z rYl� c � 5 5 • (o 3 ,) i8yrg -- m5 vci m1 cs -1 1 Ground , elev. ' Depth to Vw limiting S4 °tt) 3 o l G factor .119 in. Remarks: CST Name (Please Print) Signature Telephone No. Pddrn 5c.h fa rt. ker .A.--- (3_i5) 2- L17 -k-ioor Address Date CST Number ( --16 $ decle- 54 # Srrnerse'/' , / )1 s 0 Z.-,S 4 t — /5 - 99 253309 1 LL 0 PROPERTY OWNER S7UcJ SOIL DESCRIPTION REPORT Page of 3 PARCEL I.D.# Boring # Horizon D Dominant Color Mottles Structure 2 g Texture Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 6-23 10 . 0- - 31Z--- n h!< vnf,r^ 'P • q : a 43 -11K /0yr`11( yr)S v Sri m l c Ground elev. Depth to limiting 4,192.16i fa // Sin. 6 32. Remarks: Boring # 1 / 1 v i r I _ �mnbllc� c 5 7 2 yo v r c — 51 I '2 rr Nc m�� c S —5 c� 3 p-{2{ I0 1)03 O (Y Z g Ground elev. 93.5 ft. Depth to limiting (o1 lad factor 1 ZI in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring# j U_Ip I b y r3 I Z SL 11nC'oL LS Ground elev. - q74o ft. Depth to limiting factor min. Remarks: Boring # Ground elev. ft. Depth to limiting _ factor in. Remarks: SBD -8330 (R. 07/96) 1 Pal c 3 043 c.)-4- Go f- lK cu` '•w-aa Scc.1•e l — /au y 1 ;,4 "cte ISM 1 -e1-e.. ✓. IOo d vl 4 # . 1 . ' n 8 " poe'te �^ c co• +I'� tl'JY•r C� •,c.rtir v, IS _,'. t..1 Z✓4 (rppe %Z ?c �o q/.70 4o r4-k L r 14 ( '' )1 G 73,5 �.v f ti Cr` vi fL 13( p\v z B'� an I I r Pear : rJ+++ee‘�� Fes— - -- t s— 2.% — (?225_ %//'''' Conventional 'Le° . ,^')"'y' ors— 386 — 4'61-1). S ys t em Manage an-t--49n— Pursuant to Comm 83.54, Wis. Adm. Code Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under e. 281.48, Stets. The contents of tho septic tank shall be disposed of in accordance with NR 113, WIS. Adm. Code. T e o eraling condition of the septic tank and cutlet filter shall be assessed at Least once every 3 year by Inspection. Th outlet filte shalt be cleaned as necaea r„ to ensure ro et o oration. The fitter cartridge should not be removed unless provisions are made to retain •solids in the tank that may slough off the ter when removed from its enclosure. If the filter is equipped with an alarm, the filler shall be serviced if the alarm is activated continuously, Intermittent filter aiarnia may indicate surge flows or an Impending continuous alarm. The septic tank shall have Its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to Maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance Is generally not required. However, if such products are used they shall approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pump Tank • The pump (dosing) tank shall be Inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary, Mound and Pressure Distribution System No`tr ees cr shrubs ahouid be'ptanteo on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic '(other than for vegetative maintenance) oh the mound is not recommended since soil conpacticn may hinder aeration of he Infiltrative surface within the mound and Snow compaction in the winter will promote frost penetration. Cold weather instafations (October- February) dictate that the mound be heavily mulched for frost protection, • Influent quality into the mound system may not exceed 220 mg/L B005, 150 mg/LTSS, and 30 mg/L FOG, influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system Is 'provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure testis peformed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an Impending hydraulic failure requiring additional, more frequent monitoring, General This system shall be operated In accordance with Comm 82.84 Wis, Adm, Code, and shall maintained in accordance with its' component manual (S8D•10572 -P (R. 6199)1 and local or state rules pertaining to system malntenee and maintenance reporting. No one should ever enter a septic or pum tank since dangerous gases may be present that could cause death. S pump tank abandonment shall be In accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used.as POWTS components. optic and • Septic or pump tank manhole risers. access risers and covert should be inspected for water tightness and soundness. Access openings used for servf and assessment shall be sealed watertight upon the completion of service, Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. - Contingency Plan • If the septic tank or any of Its components become defective the tank or component shall be repaired,or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component s or replaced immediately with a component of the same or equal performance. . P hat! be repaired If the mound component fails to a Wastewater or begins to discharge wastewater t the ground surface it will be repaired or replaced in Represent location by ihaeasing basal area if toe leakage occurs or removing biologically ciogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system int proper operating condition. ' . Questions on the operation or malntence of this system should be directed to your county zoning or health in� 9 spector. r 05/08/02 WED 13:14 FAX 715 386 4686 ST CRY CO ZONING Z 002 ST CROIX COUNTY • . SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer D�rrrl _ o',- X77 e1- 1 Mailing Address --Property Address 4 /la r Ffrt POI Rtorx _ // ta (Verification required from Panning Department for new construction) AP City /State _, rtit..cris G h , Parcel Identification Number st /3S--3 — /rr' ---OQD J.EGA.L DES CRIPTION Property Location _ 'A, A) .. ' y., Sec. 34 , T d9 N R /, W, Town of T , fiK clsd h , Subdivision do ?011 1060c1 _ ,644-- , Lot # 19 . Certified Survey Map # , Volume , Page # _ Warranty Deed # 436 404, 7 , 'Volume , Page # . Spec house 0 yes 0 no Lot lines identifiable 0 yes 0 no SYSTEM MAINTENANCE ;Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper- What you put into the system can a, t 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set font', herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin- Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of ; three year expiration date. / �► s / ? /o-L SION 4,- URE OF APPLICANT ]DATE OWr"'R CERTIFICATION t (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the pm .rty described above, by virtue of a warranty deed recorded in Register of Deeds Office. ( -e. --- £ Afr— S /)) / C -� SLOW TI1RE OF . • PLICANT DATE * * * *" * Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped wamtnty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed i • STATE BAR OF WISCONSIN FORM 2 - 1998 63 6067 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number VC1. .1571PAGt 259 ST. CROIX CO., WI RECEIVED FOR RECORD This Deed, made between 01-02 -2001 1200M RICHARD 0. STOUT and JANET P. STOUT • husband and wife, UIRRARTT DEED Grantor, EXEItPT N CERT COPY FEE: and `A .•y - • • • • COPY FEE: -�� TRANSFER FEE: 173.70 RECORDING FEE: 10.00 PAGES: 1 _ Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate In St . Croix County. State of Wisconsin: Recording Area •t 19 Plat of Cottonwood Ridge, Town of Hudson, St. Croix County, Wisconsin. Name and Return Address Grantees, successors and all assigns agree: • Building on this lot is restricted to single • family residence. 020- 1353 -19 -000 Parcel Identification Number (PIN) This i3 not homestead property. (is) (is not) Exceptions to warranties: easements, restrictions, rights -of -way and covenants of record. Dated this / 14 day of December 2000 I�ILJLS��.00 �Y (SEAL) or14 P. 4r (SEAL) • Richard O. Stout • Jan et P. Stout (SEAL) (SEAL) • AUTHENTICATION ACKNOWLEDGMENT Signature(s) State of Wisconsin, ss. St. Croix County. `� authenticated this day of Personally came before me this �"r " 6 day of December , the above named Richard 0. Stout and Janet P. Stout t: TITLE: MEMBER STATE BAR OF WISCONSIN Of not me know be the person S Whc7L�cItE the' authorized by §706.06, Wis. Stets.) Irtstru t nd acknowledge the set a M1 THIS INSTRUMENT WAS GRAFTED BY •.� ti J. Janet P. Stout �/ ��dr 1353 Awatukee Tr. • /A 2 /r/ €ii/ .a � Hudson, WI 54016 Notary Public. State of Wisconsin My commission is permanent. (If not. state expiration date: (Signatures may be authenticated or acknowledged. Both are not �� 4 3 .) necessary.) • Names of persons signing to any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Bank Co.. Inc. WARRANTY DEED FORM No. 2 - 1998 Milwaukee. Wis. Parcel #: 020 - 1353 -20 -000 05/08/2006 03:22 PM PAGE 1 OF 1 Alt. Parcel #: 36.29.19.2020 020 - TOWN OF HUDSON Current X] ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner RYAN G & C � C � RENEE L CORSON O - CORSON, RYAN G &RENEE L 21211TH ST I(/(2 —" HUDSON WI 54016 24--f 1-(6 7 Districts: SC = School SP = Special Property Address(es): *= Primary Type Dist # Description * 660 A &B HILLARY FARM RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.007 Plat: 0194 - COTTONWOOD RIDGE '99 SEC 36 T29N R19W PT NW NE COTTONWOOD Block/Condo Bldg: LOT 20 RIDGE LOT 20 3.007AC TWIN HOME Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 36- 29N -19W NW NE Notes: Parcel History: Date Doc # Vol /Page Type 06/08/2001 647747 1656/377 WD 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.007 59,000 0 59,000 NO Totals for 2006: General Property 3.007 59,000 0 59,000 Woodland 0.000 0 0 Totals for 2005: General Property 3.007 59,000 0 59,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 12/04/1998 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 980.2 ----.,) N\\\♦ + r 974.7 ♦ '444' ♦ ♦-•= �: .•... �.`F.. 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