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HomeMy WebLinkAbout020-1353-35-000 m Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety end Building Division INSPECTION REPORT Sanitary Permit No: 420314 0 GENEFkAL 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: Hilgendorf, Kevin Hudson Township 020 - 1353 -35 -000 CST BM Elev: 10 /6 BM Elev: BM Description: / !� NATION ELEVATION DATA /b � / � U � ' TANK IN TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic "14/6j-j- 1 a V �c �l Ben mark I 7 M/ /CO / Dosing - / . .. ` Alt BM 1_,(1, l00 , \ ' /o r . d Aeration y Bldg. Sewer /`1ar'Ga Nn/e-zr-r. 0 y ET 6. 0 6f6,1.(-- Holding _ St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION 0 31 q'S. -6 j TANK TO P/L , WELL BLDG. Vent Air Intake ROAD Dt Inlet _- Septic 1 f d �l /� le � f " iUJ- Dt Bottom / Dosing CSI- > J� Header /Man. 4 - 5e II-I-5 - urn 1,57- I• o , Aeration f Dist. Pipe Z ` ?i�. O tGM 1 12€4t5 f 2 - iit7s' •2.:; ' f7 ----____ ..---) Holding Bot. ystem � Final Grade • 4y - PUMP /SIPHON INFORMATION 1 FF I sT / fie ?e ---LW rf ?' (� , iiiiii.M1111.111..'-11111111b Demand St Cover • ‘ I 0 /. o Model tuber TDH irgr r iction Loss System Head TD _ For - Length -- " •11111 111M1111/1 Dist. to - SOIL ABSORPTION SYSTEM 0 2 g / fti)im _ BED/TRENCH Width I �t} Lp 4- No. Of Trenches 3 PIT DIMEJI.SIONS No. Of Pits Inside Dia. (Liquid Depth DIMENSIONS 3 `o (- / U 0.1 — SETBACK SYST EM TO t P/L t,) WELL ` / 0 LAKE /STREAM EAC INFORMATION /`� ER OR 1 To 1, ype stem: ? L. » J) / IJ kw L 0Ie-- UNIT odel Number: 4 (.o 3S v�T / /z DISTRIBUTION SY$T M 3R-p Header /Manifold�fn((� 7f istribution / x Hole Size x Hole Spacing ›,1„11 Air Intake EAST * Pipe(s) /( i/ /�10-� 2 / J Length lQ Dia Length Dia i Spacing ) SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only ...Si d ael ri6.cr ( S+ Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched / Bed/Trench Center Q r] /„ Bed/Trench Edges Topsoil o� » A p � ) Yes [j No [] Yes IA No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: e /a loes/ Q Z--- Inspection #2: / / Location: 665 Hillary Farm Road Hudson, D Hudson, WI 54016 (NW 1/4 NE 1/4 36 T29N R19W) Cottonwood Ridge Lot 35 Parcel No: 36.29.19.2035 1.) Alt BM Description = c I :GO- G ok..-f Dr - e ( Vt )` r 't -- 5 e le - 4 g o '�Ti 2.) Bldg sewer length = ao / +- Q.d..- - -o C- a !t 11 l � e l i - d must Liz_, ,t_ _ 6 en-� o - ccht�.� amount of cover = cuu `/. _ _ /± _ U ) y _ /)A r,L - b d, l Ut v.&5-1-`7'tp,1d , fruit ,e c/ a-s _ Plan revision Required? 41 Yes o tG��/Y /_ a I Gob O Use other side for additional information. _ _L iO L Date Insep ignature Cert. No. li■ 'D -6710 (R.3/97) r lo* Play. • PitkoAliaer : BC kvA., {I - N ef-S 4 %— dPe=' --------;;"/„7 avm /C d f - - - -- 1 --- i 9 J N — Y kg P {� f cA c) q,, to' 5 M _ ps-0 6.1. 5, }� evv�� trr .A- /O° - i S � o P v r p . 97. Svc e c-----: J �a;:!• cjS. — 3 �isr ark -5-6-'5- � - re r'Tv-ie L 4G 56 �_ 7-2. . o A ..- ,-- -- • 6 3 i ( I ■ 6V kb° .._e. . l'' %, _ cca/e /"_ yo/ _ � et ' . /On W L- t ,... tG % /ham . Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 ST CRoix Wisconsin Madison, WI 53707 - 7162 Site Address `L 12n . Department of Commerce S -. Z 03 � Sanitary permit Number Sanitary Permit Application Li2° 3 1 , -f r In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision c La w, s. � • 1 m ma be used for second l.r• • 15 State Plan I.D. Number I. Application Information - Please Print All Information — _ -� ____ Owner's Name Imo(:.. "' , :; �.. Parcel Number Property 020- 1353 -35 -00 C. "2035 Kevin Hilgendorf property Location ti''° 0 6 2002 Property Owner's Mailing Address A ' . ' . NW if NE Vii• S 36 T 29 N R19W B 515 11th Street Number Zip 1r • Lot Number City, stag Zi Code L "� rc 56 35 Hudson , WI 5400 Subdivision Name CSM Number - Cottonwood Ridge II. Type of Building (check all that apply) A70 ❑City • al or 2 Family Dwelling - Number of Bedrooms 4 ttl! Villa ge Hudson [Townshi , ❑ Public /Commercial - Describe Use /Z� � � St -2-C Nearest Road ❑ State Owned t C ' x z.4:1r _ J v as Hillary Farm Road ‘ III. Type o ' ermit: (Check on on box on line A (numbering scheme for internal use). Complete line B if applicable) A For County use 1 a N ew 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to Tank Onl Existin: S stem Date Issued S stem Permit Number B. ❑ Check if Sanitary Permit Previously Issued I A---100 / - • IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) .€ 50 ❑ Constructed - Wetland 44 ® 47 ❑ Sand Filter Non - Pressurized In- Ground 210 Mound 51 ❑ Drip Line 41 ❑ Holding Tank 48 ❑ Single Pass 22 ❑ Pressurized In- Ground 30 ❑ Other 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating V. Dis • ersal/'I`reatment Area Information: Appcation percolation Rate System Elevation Final Grade Design Flow (gpd) Respir Area Diop . Rate(Gals /Days/Sq.Ft.) (Min./Inch) 92.8 Elevation 95. Required PfOp°S 91.3 93.8 600 857 857 .7 N/A 89.5. 92.0 VI. Manufacturer Prefab Site Steel Fiber Magic Tank Info Capacity in Total Number Concrete Constructed Glass Gallons Gallons of Tanks New Existing I Tanks Tanks X -- Septic or Holding Tank - , g Huffcutt Concrete Dosing Chamber VII. Res • onsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on Signature ,. the attached ' • . • P1 /, . '�'' / MP/MPRS Number Plumber's Name (Print) . .. i '_ i 92 715/772 -32 Bennie Helgeson �� �I/� Plumber's Address (Street, City, State, Z .e) W1229 770TH Avenue Spring Valley, WT 54767 VIII. County/Department Use Only Data Issued Issuing Agent Signature (No Stamps) jit Sanitary Permit Fee (includes Groundwater Appr ❑ D isapproved S Fee) _ ..tfkit()).........._ 11 0 Owner Given Initial Adverse . �— 1 2t7p 4JjAA.,., ��j 2 , Determination "' Conditions of A roval/Reasons for Disapproval IX. Con pp p � �'�4r cJtJiA4.. r yy pt,. - : 4.°' .0.� ek f2''`/t — er(jrc visl.;tAjet f J ks+._ '�I /1Aftj (( * 1 p 4 a�f-' ‘i13;441) £., k " "Q.° (6"- Attach complete plans (to t C ounty . • ` T . on p aper not less than 3 ' x ■ loch - . su inn A•zost ru n5 /ail . _ P /0 PI 0,,,, 0(..1M ` *vi /`lI / er,cicv-F P (Aivvvioer - : Oc kve i )„ .....6 e-s , r 4 =" e51 *?ff - •=z+) M/ / lG/� Rd f ----- -- ------ - — i i i y i -e Co `f3o` r V i 0 N ' ,t) y E, R- -.ec -4 o�� Pro 4,(.. s, mil, ,4-/c . 'dhlc__ li 167° 12 M. 97. 1 S i o f OV PCIC 4 ?P 1,M. ( CSC, CNv 2. r E '7'S V. as ....•■■• 7.2, o / - , - . ' ,,----------., A , - ,._ -- _ )1 / \ ,/ _ .S ca /€ / ' - t A )n L 0 -L_I____ , 4 6 J-J • ' Wisconsin Department of Commerce SOIL EVALUATION REPORT Page l of -3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code ty Si- Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must S CPo/ Y include, but not limited to: vertical and horizontal reference point (BM), direction and Patel ID. percent r q, a 0.7.5-- percent slope, scale or dimensions, north arrow, and location and distance to nearest road. O �-/ 33"3 •-3S - w Please print all•inkxaaat nn ee , wed by Date a19rP�7aar EtkIsE D < Personal information you provide may be used for stood :• 15 34 (1) (m))• r i-) l f 7.021Z Property Owner - (— Property Location t J■ �-Y J e MAY 2 8 ?nn7 Gov. Lot NIA 1/4 / ye 1/4 s3 T ag N R (7 E($ Property Ownets Mailing Addr ss Lot 'r I Block # I Subd. Name or � � //3-0 Cc.c/— S S •- c--kT . CROIX COUNTY r5 C am " ,,,wow City State Zip Code ht na M ' OU b � City ❑ Village 9'r own Nearest Road L0/" i LL)fi 5Y0& 1 (6$Y) 9k3-‘... c,cd sol- I /014, r r0 fed i El Construction Use: residential / Number of bedrooms 4 7 1 Code derived design flow rate 4 00 GPD ❑ Replacement ❑ Public or commercial - Describe: /f14 ft. Parent material �A� r i a / ,f3 - s k Flood Plain elevation if applicable General comments and recommendations: U S� ..2g C h 3l<( 6..-_1 p-., C11 �—^ a e,— 3 "iv ene t's,Srteln,( oh Cclvr 9673 ,5s &.. E/eJ. 98 2 53. y /, 9a, 99, / 0 Boring Boring # 7.) Eg � --, / - Pit Ground surface elev. / S' 3 ft. Depth to limiting f actor 7 In. I Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO/tP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 Ef#2 Q 7 . /6 -3 , / n\-Ik A S n <_, 14 CG r ;(- . .? /,a 3555 f win -- s o .53 Wk 1 -- , /, a 3 G Boring # 0 Bo ng U Pit Ground surface elev. �° - 0 ft. Depth to limiting factor . 7S In. Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPI in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *OM - L EIMIIIMMIIIIM r • Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L CST (Please Print) Sig ure G CST Number li -f. n < <=e /1C C.$OG� ,i',� _ ,. ____t ., �� aka - 5 ) Address 5 Date Eval lion Conducted Telephone Number W/;) 771 4 e ..) ' a s - ,)v -- 0 (?72 a &4 I • Property Owner - 1) /L,) eJ Ul l...0 V\ Parcel ID # • Page of _ .. . 13 I Boring # l J _ . 1 Pit Ground surface elev. 90• . � ft. Depth limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description ' Texture Structure Consistence Boundary Roots - GPD/ff - in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 t *Eff#2.. / (0`K a XS (3f sl,ic Mofv- ((,) i� , 1 /. a L-6 r) Sy iJc, F _ 7 /.. 1 ❑ Boring Boring # ft, Depth to limiting factor in. ❑ it Ground surface elev. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ❑ Boring I Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate GPD/ff Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •Eff#1 'Eff#2 , in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. • Effluent #1 = BCD, > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD, < 30 mg/L and TSS < 30 mglL 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.6/00) gt,.. 3 v 3 eri J . c� we e-.7 ___ .._.__ c 7 Te. r rni � 44 cl� Ps o ‘ ,2..X") , %e W I L_ Ea(' 0 si ,f'1.-- 7 5 o e 160' 3 --1, , t �! 1.‘lt) { Gar ..�e ; ya�� Sk 1 i a 97. oM 2_ loy a lz °PUC. Ppc k g „)1, 100.6 NI ?0 �p eo' f a PuC p px -- _ - A fs 4 --E S _ _ - - --- E- `93.8 — — r- 1 = i k( , 7 '-- ..----- Exc.e ,p - f - As S lnoLAD (A- ✓ 13c mil #a a 7 k„,, i - 6 2 cP 7 / 1 — v / 1429 Wisconsin Department of Commerce SOIL EVALUATION REPORT page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Sal & Site Evaluations Attach complete site plan on paper not less than 8'Y x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location distance to nearest road. Parcel I.D. 020- 1353- 35 -000, ID#36.29.19.2035 Please print all /pKm»atfon. Reviewed By Date Persona! information you provide may be us d'Jocsewndary purposes (Privacy Law, s.15.04 (1) (m)). Property Owner / r lk- r1 ' Property Location tr a '. Kristin Mauch & David Juen I 1.� -`'`" Got. Lot NW 1/4 NE 1/4 S 36 T 29 N R 19 W Property __ � Lot Block # Subd. Name or CSM# roperty Owner's Mailing Address , 'f 1150 Curtis Street t 111 35 Cottonwood Ridge City State 44t f honrh 4' c , \0 , jJ City _f Village wil Town Nearest Road Baldwin I WI 1 03 j 71 '' 862 Hudson I Hillary Farm Road ei New Construction Use !l Res l/ Numperof bedrogms 4 Code derived design flaw rate 600 GPD J Replacement _ Public or mil,- Describe: Parent material Glacial outwash __ Flood plain elevation, if applicable na Genera comments and recommendations: Recommend installing 2 trenches at 3' x 93.75', using 30 High capacity BioDiffuser infiltrator leach chambers at system elev. = 88.00'. I 1 I ng # I Bring 1l Pit Ground Surface elev. 91.79 ft. Depth to limiting factor >97 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' *Eff#1 *Eff#2 1 0 -15 10yr3 /2 none Ifs lfsbk mvfr cs 2fm,1 c 0.7 1.2 2 15 -28 7.5yr3/4 none Is Osg ml cw l frn 0.7 1.2 3 28-43 10yr4/6 none gr. s Osg ml aw lvf 0.7 1.2 4 43 -97 10yr5/6 none s Osg mI - - 0.7 1.2 Het—contains approx. 40% coarse fragments. Boring J Pit Ground Surface elev. 91.09 ft. Depth to limiting factor >95" in. Soli Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft' *EN#1 *Eff#2 1 0 -15 10yr3 /2 none Ifs 1 fsbk mvfr cs 2f,1 me 0.7 1.2 2 15 -32 7.5yr3/4 none Is Osg ml cw lfm 0.7 1.2 3 32 -52 10yr4/6 none gr. s Osg mI aw - 0.7 1.2 4 52 -95 10yr5/6 none s Osg ml - - 0.7 1.2 -. < ... r'ns < 30% coarse fragments. * Effluent #1 = BOD ? 30 < 220 mg/L and TSS > r < 150 rng/L * E • i , 1 = BOD <30 mg/L and TSS <_,30 mg/L CST Name (Please Print) Sign: , =: / CST Number James K. Thompson i 0 3602 Address A.C.E. Soil & Site Evaluations - Date valuation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI , • 0 6/21/01 715- 248 -7767 r "Propefty lamer Kristin Mauch & David Juen parcel ID # 020 - 1353 -35 -000, ID# Page 2 of 3 3 ng # Boring Pit Ground Surface elev. — 92.00 ft. Depth to limiting factor >105" in. Soil Application Rate I Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft •Eff#1 *Eff#2 1 0 - 13 10yr3/2 none sl 2fsbk mvfr cs 2f,1m 0.5 0.9 2 13 - 28 10yr3/4 none Is Osg ml cw 'Ifni 0.7 1.2 3 28 10yr4/6 none gr. s Osg ml aw - 0.7 1.2 4 42 -105 10yr5 /6 none s Osg ml - - 0.7 1.2 H#3 contains < 30% coarse fragments. T Boring # _J Boring j Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Boundary Depth Dominant Color Redox Description Texture Structu re Consistence nolary Roots GPDIft •Eff#1 *Eff#2 I Boring # _j Boring ft. Depth to limiting factor in. Pit Ground Surface elev. Sail Application Rate I Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/1t *OM *Eff#2 * Effluent #1 = BOO ? 30 < 220 mg/l. and TSS >30 < 150 mg/L • Effluent #2 = BOD <30 mg/L and TSS <JO mg/I. 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 608-2644777. • P3 Arc jaw 4.; ._cl by 50 ;1 e ✓a- Imo. -ion • So,lase/'u0-4on rteo ('- Cr-v." c,ted & y A dcw, P. c.lu.. // 7/ q. • aleJain IN c 4 ° 1 8¢4c6, Wt&i 40; I • n v en rte. ss unnesi ti. = I Oo.00• A ! • 6.,sj.: Y I n Cenfrdl o at Elntrcc.E /e* =SSoo, at bay i. ♦SiEc.9z�3 /,' . 0 1 crl 7.Sbpe Pri T.-nary s S E vjO 82 a y rea eiz III 61 9/ o'Co n �o� 0-1JPCCIX. /o c o� o /6 5/6 � ' /Y,Z9 C roSS Cb het" - n 111 e.r a o rF - ii9/6"niet; 3 �h.ti. 61 - di ,POOD o) e Rea - ‘ro D 6.1? b , 7 - gs7 31•l p Pet,- Ct en--be - Df 7, S 0N- _:),g E/e r3: X 76\c-- 3 muN � c 3 m'N ( /ems• �.o (Ass CrIL(sx2Qr� - -- � 3i. ( - ■ 1112 E /' CP ‘,9,S rn ;OA Q, Lei Loweh eel/ -- - 201 CE;c4 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of . FILE INFORMATION SYSTEM SPECIFICATIONS Owner Kevin Hilgendorf Septic Tank Capacity 1250 gat ❑ NA Permit# 1421° 31' Septic Tank Manufacturer - IUffcutt Concret❑ NA DESIGN Effluent Filt Manufacturer DESIGN PARAMETERS Zabel r 1 NA Number of Bedrooms 4 • ❑ NA Effluent Filter Model k -100 12" X201' ❑ NA Number of Commercial Units II NA Pump Tank Capacity ga l IX1 NA Estimated flow (average) 400 gal/clay Pump Tank Manufacturer ® NA Design flow (peak), (Estimated x 1.5) 600 gaVday .Pump Manufacturer ❑ NA Soil Application Rate . 7 gaVday /ft Pump Model ® NA Influent/Effluent Quality Monthly average* Pretreatment Unit 0 NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand/G,ravel Filter 0 Peat Filter Biochemical Oxygen Demand (BOD 5220 mg/L ❑ Mechanical Aeration ❑Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other. Manufacturer Pretreated Effluent Quality • 0 NA Monthly average" Dispersal Cell(s) Biochemical Oxygen Demand (BOD 530 mg /L la In- ground (gravity) ❑ In- ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ At -grade ❑ Mound Fecal Coliform (geometric mean) 510' cfu /100m1 ❑ Drip -line ❑ Other Maximum Effluent Particle Size Y inch diameter * Values typical for domestic (non - commercial) wastewater and septic tank effluent. .*" Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every 2 ❑ months lil year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume Inspect dispersal cell(s) At least once every 2 ❑ months 0 year(s) (Maximum 3 yrs.) Clearteffluent filter At least once every 1 - ❑ months ® year(s) Inspectpump, pump controls & alarm At least once every ❑ months ❑ year(s) IC NA Flush laterals and pressure test At least once every 3 ❑ months Q year(s) ❑ NA Other: At least once every ❑ months ❑ year(s) ❑ NA Other At least once every ❑ months ❑ year(s) ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer, Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. i . The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatment components, and any other Maintenance or monitoring at intervals of 12 months or less 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. 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. OWNER: Kevin Hilgendorf Page of System start op 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 um tank removed b P P 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 ch. 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. If 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 m1 g F,xravg -- inc Name Johnson Sanitation Phone 715/772 -3278 Phone 715/273 -5811 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Johnson Sanitation Agency St. Croix County Zoning Phone Pho 1 715/273 -5811 715/386 -4680 This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies. This document meets the minimum requirements of ch. Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. GMW (2/01) .• ° "Aai a o : • 4a i 1 ° g .' °V o O u o , u EE VI CR) i 0 3 ° — 3 3 30 O ' S a 0. 0. ° 3' �en Y. u ... ° 3 0 0 A p c r u m a y u u •: u •a u { i A r q u y 0 l il - CO 11 C r4 1 o s u a ?. Q s o c C4 a) a� a H e, o e " o m a a O Z U .O 9 u a 5° ° id E x ma p.' 1 w a•7 -a •--• . ' .. A ,3 E D. � O . a. a Ti. a u a 0 Z ..:4 4 C - O • o °' ..§ O 3 wQ n. p y E O Z ill n. u f .2 0 a a •t Z 3 0 0 °• w ° E ° u a o •'• Cd Q U A b ° ° N - a a 9 ° u a _ U "' 11r g y 3 K a r R • D o , 'V 3 Z, ✓� 'C o � r `o o r 9 a 0 - a 3 En Y 1 a . F" O u t , l� i.° a s•°r� m .°. c -@ C a ° ° o a. W O' 1...j I '�. O° 1 n p v i 0 O w 0. T L /� c L V �'e � / ' G � u G c ° A 0 •J a+ I i Z o � I . o n . 7` I` •° V U 4 x..11 ° 3[ p .9 » r O +At O H Q " i 1 _ .. V T. N H N 67 'V Ts 3 0 G . u 1 u L gaiI >'• T u v� ? jr. L c a o 5 W y WI 1 S - Z 3 <a o �' :z: p ..moo 1.- a a u a '^ R ° a .5 0 `= 7 0 \ i 0. U .. 0. 0, U 3 cn to ° v 8 .g H w T C7 ° (7 `- h v in • .. va • . Or Wi;ra sin Department of Commerce SOIL A !E�EVALUATION ( .3 Division of Safety and Buildings Page of Bureau of Integrated Services in accordalt6e'with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 i As'in size. `Alen rnusto f County �1 I include, but not limited to: vertical and horizontal reference owtr(BM)�� direction and \ X3 CY v 1 X percent slope, scale or dimensions, north arrow, and locatio end disc a 'to 2earestroad. _parcel I.D. # j _ 1 i • "l APPLICANT INFORMATION - Please print all i forp►at r ' uN y Rev wed b Date Personal information you provide may be used for secondary purposes (Pclvap aw, s. 15.0 , j ,� / �^ !/ !'i4 [ / (r 1 Property Owner ;" PrilS ., lion R ic '\ Cy1 S-t-ku-)- - - - _ - . - 1 C w u . t 6 t AI (A , 1/4 tip 1 /4,S ?/ 9 T gp ,N,R / c( E (or)C� ) Property Owner's Mailing Address Lot # Block# Subd. Name or CSSM # 135 3 Awo,i — Cr. 35 C6I tAin ca t' d q -e City State Zip Code Phone Number ❑ Nearest Road V Cif)/ Village I5 Town 4L6S(Nn 1 Wl 15 to 1(115 )54q- 14131 udsor, 1 C-k1 Qd N ®-iJew Construction Use: EResidential / Number of bedrooms 3 Addition to existing building ❑ Replacement ['Public or commercial - Describe: Code derived daily flow WOO gpd Recommended design loading rate 4 7 bed, gpd /ft . S 8 c trench, gpd /ft Absorption area required �5� bed, ft 1'30 trench, ft 2 Maximum design loading rate ' 7 bed, gpd /ft 0G' trench, gpd /ft Recommended infiltration surface elevation(s) Upper- 4Tene.k. jO.ZO LorAcr OCZ.e> ft (as referred to site plan benchmark) Additional design /site considerations I - Lt. u pptr 97, 6o Lo &e r f/40 1 Parent material l /� � t GCAe11 UTwGSh Flood plain elevation, if applicable it /4 ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system ig] S ❑ U ©S ❑ U [,� S ❑ U ®S ❑ U ❑ S 5 U ❑ S Ij 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 I 1 O Zo 16j r 3/3 SG. /insn AA.-Cr es t 4 4 ;. 5 d 2 zo-le. Loy fWt his Ost 41 C).5 . 1u4 •7 ;. 8 Ground elev. — - , Depth to ' limiting factor l /6 in. * 4.64 Remarks: Boring # 1 � 0 -/y to y r 3/3 -, 5 i- /44.5n wi-Cr- c $ VC i i . ,s.-- 0 iii-0 loyr q/ / s l ' 1 1 w1a. YVl Fr C 5 . 2- �,7 3 l o W6 -- wts o, w► 1 C s — • 7 • Ground , elev. ti2kOft. Depth to , i lim t in 9 factor 110 in. Remarks: CST Name (Please Print) S'+.ature Telephone No. Address Date CST Number 1 16 4 5' 0 J r S. S `/ <So mu- .S- e.-f_' w1 S gOZS Y - 9y AsT3307 j^�, SOIL DESCRIPTION REPORT /� / PROPERTY OWNER ✓ v v Page o� of -3 PARCEL I.D.# Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots G'D /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 044. coyr 3/3 r��r c S (� • 9- ►z - / tar r °l /6 !r►. S 05 n- ( CS -- -7 -ff Ground elev. ZO ft. Depth to limiting factor It in. "111 Remarks: Boring # rit$ t -C Z- /r✓tS r C 1 0-& toy r:3 (3 -- 5 wla5 /c \ C 3 V -i Y my( 7(0 `— /41 US 01. ( C S — .7 : ,Sr Ground elev. 93dO ft Depth to 9 e� limiting 9 4444. factor /Z 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 # ; d?z 10 r 3/ 3 S. /m s ryar- cs l ' - L/ ..s` �- zz ii 1� � �/6 .5 oSn m ! c 5 - • 7 Ground elev. 9.6 ft. Depth to limiting fa for ' "' Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) pQ1 rt e43 [# -f- u 3nale. l i % kO ne4:1 gq n env I e( rn N u P gv. zo Sys-ier N P IRA). c.o ZO Weer" C Z. 6,0 • IMO. t dU • .,r - • 4 4LT QS a z g � • • X33 04 Pr;,.,a,ry • ef►z C5 C r I S /o g w L • 985 sv +n.•c 1:,.L • U 1911P 008 /( t. STATE BAR OF WISCONSIN FORM 2- 1999 6 8 1 8 1 6 KATHLEEN H. M EED Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., VI This Deed, made between David D. Juen and Kristin L. Juen, RECEIVED FOR RECORD a /k/a Kristin L. Mauch, husband and wife 06 -17 -2002 8:30 MI — WARRANTY DEED Grantor, and Kevin Hilgendorf EXEMPT # — REC FEE: 11.00 TRANS FEE: 225.00 COPY FEE: Grantee. CERT COPY FEE: Grantor, for a valuable consideration, conveys and warrants to Grantee PAGES: 1 the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Lot 3 , Plat of Cottonwood Ridge in the Town of Hudson, St. Croix County, Recording Area Isconstn. Name and Return Address `/ /2!-C, 020- 1353 -35 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: all easements and restrictions of record. Dated this - / V day of /j„,Q , , 2002 . '6.- 41/ 1.7.,...aa...*--- . ' David D. Juen ‘`-e _ / ?.‘"z"."---- . * Kristin L. Juen AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) o nnInn Hr r N ) ss. c 4 . t ? 1h St. Croix County ) authenticated this ` day of r`` f, t - / _ • nal y came b efore me this day of I Y ' •`;\ : _ 1 2002 the above named t .dam ::{ :David 0 . Juen and Kristin L Mauch, a/k/a Kristin L. Juen, * - ` L• \ i• husb d and wife TITLE: MEMBER STATE BAR OF WISCOI5O h ' (1f not, to me kno . • o re the person(s) wit. - ecute• the foregoing instrumerf r cknowledged t • ' �'`r authorized by § 706.06, Wis. Scats,) / THIS INSTRUMENT WAS DRAFTED B :sr i " �I � � Y * ' c 4 ,--- , Thomas A. McCormack _ Notary Public, State of Wisconsin Baldwin, W154002 _ My Commission is permanent. no , state cxp.r ti • ate: (Signatures may be authenticated or acknowledged. Both are not necessary.) .411 ' Names of persons signing in any capacity must be typed or printed below their signature. information Professionals company. Fend du Lae. $61 STATE BAR OF WISCONSIN BOO WARRANTY DEED FORM No.2 -1999 a • ■ 4 RIDGE N ' PART OP THE N21/4 OF THE 1111/4, SW1/4 OF 721/4 AND IN PART OP THE SW1/4 OP THE SE1/4 ROIX COUNT); WISCONSIN. — MATCH LINE SEE SHEET 3 OWNER \ ebi 283.45-4,, 5 ROAD —_ • 3 • RICHARD 0. STOUT N- P.I1 HILL ARY FARM JANET P. STOUT PLATTER TO RETAIN OWNERSHIP Cc OU1107 1. N57 --- - -- - ^ 1353 ANA TUKEE 1RAIL OUTLOT 1 IS RESERVED FOR TORN ROAD t g 47* - ----- _ .., Sp,.._ HUDSON. NI 54015 EXTENSOR. LOT 27 TO HAVE EASEMDIT OVER • Wlitl • Z4e - ---..........7.1. .... A ...... ...... OUTLOT 1 FOR ACCESS TO CO 1RML. 1 S.W. ,,, t. , -'...........,. ft, ... ■.... '211 ee• 1 ' ..... i .......... . ..... 4. .... .. . t ...:te- ----__ • _ t i" IT {1 . . -....11 IX ,-; '' es4 ----------.__,______ 0.453 A01E3 I 1 ■ s 1 I .. ........ - --__ 19.740 SIFT. 1 1 ‘ I \ ....... ■ "' ,....._* --....._- -...._ --------- 1 Fp 11 1 1 ..... ' I - .• ■ ........ • ... - ---- r! • \ 33 .,._ - - . •.••• ""-- - , yr --------.... ----- ____ 2.436 ACRES 1 ! .. 1 . ...... . ----'. .. ---1 a I % 100.106 SCUT il I Vi...lt WM ' ------------.. • • I x . ...... - ..... 1 l . ... .. ........... 1 • ------ - 3 1 . IS l e ' 41 34 .1 I, I I r --- , , — -. ," I W.L N. :' I. , ----------_, yi I e I P., 1 996.4 33 H4 f 1 i ,,,' J i ................................ 1 . 3 35 1 1 I 2003 ACRES 'CPU I j-- : --7 - I - -- -- .................. . I § ' 5 q 2434 ACRES t., . 222 ACRES t • f .1.- . Iowa sarr. N I slum SQ•FT• 09.006 9317. ' IN ' ':: i 28 I ___.1 1 I .1 1 I ■ 6 I - - .:.. - : 1 2026 AMES 1 ; 1 43 ' 1 1 a / i 612611 sorr. i \ 11 1! di k s nrrevirs I / 1 / ! i 1 , 1 i 1 ‘ 1 1_____ _ ______,.,g94,.. Li L. - __L ......... i 1441 --..--.---.Fti i \ \ 1 1 1 I i 1 I , ir 6 • . ,....,,.......,_ I 1 ---------' ,-, 1 S091.733mE 1 ' L. 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