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HomeMy WebLinkAbout020-1441-79-000 o s0)0 e I 2 e o. o ° ) § 0 , t ' • • w) k % § Ft it Z t' C.0 _ ° t E § ? 7..`, } k V / & A % K ' k k§ k- CD j ! § ; 0 § § EE e � « Q 1 ■ I $ § £ : m E :: 3 \ — § lz ® O z 00. ° S S 0 E & r • ■ ■ 7 0 0 0 - .. } Cn Co § \ G 2 [ 3 E 0 5 § g a ` e § i \ o .. FE t r..) I E. , ' \ 3 I o z E @ z E , k [0:1 2 k # o. § § £ %N 7 m E a 1 a / - us _, -1 „, I o a k / § sc \ I CO m 2 ¥ o k 2 k , ° » z i 7 z - » � * - I � � 5 .� %� � § § I E r a c c%/ % E EE kE i E= ; kE agu t [% b � �$ ; ' N . . I I §2 $ £ ) m / co o i 9 . , ii k E b • � J % 1 f �� • � 0 . �2 6 wo i et I s (4 —_— i ) --/----" _____ 6 • 1 • 0 .1 ( - -A z 0 c Or V / / Ec) l • ------- S 0./Vica V 1 e 4ep _____ 6 -1-- dae_g› 1 _ r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430400 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: Bast, Kernon Hudson Township CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range /Map No: 100 b 100 .0g _ 1;36r i AoN i) 51--, 36.29.19. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic i' l , Benchmark / l LO JaA 9./ I D5 &)ri (63-) 6. 1,5, 4 /Db. Dosing Alt. BM 14. (i{rn;n (E ce Sf a av� g! Sr /, coo 1 ),c0 10 (.qt Aeration Bldg. Sewer 7.0 955 , 0 Holding St/Ht Inlet - 7,40 `/8,& TANK SETBACK INFORMATION St/Ht Outlet Q „ / , Q TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet / 1 � j � Septic / Dt Bottom �{d o4 S► fie.. /l l, f 13 i Z Z � Dosing Header /Man. \ \ it GS cpf.33 Aeration ` Dist. Pipe 11,(0C 19'33 Holding Bot. System ] a 5 q 3.33 3 ' , — s 93,33 ` r z Final Grade � ' PUMP /SIPHON INFORMATION 5c-t_ r is 6, 3t 99. (o8 7 Manufacturer Demand St Cover c r. PM 1./.6g /o/. :33 `r Model Nu er Gt, vr l � /' /1 � � p ,9 TDH (Lift ' ion Loss System Hea 01 DH /• Force in Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM J i � ` r BED/TRENCH Width Length No. Of Trenches a, FQT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth F r Y DI 3 / Q 7/ Q �ta441 k r ��— e fll gh SETBACK SYSTEM TO c � P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: Q 5) rr /� � � INFORMATION CHAMBER OR Tr? 1'/ Type Of System: X \jV, / J 0 i / UNIT Model Number: .C1 V Ci nue4 rh)ria P `I g 1 `� s) DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake i >/ Pipes) A `/� I/ / 3rct Ira Intake k ci-CJ— Length 1 Dia / Length 'K /7 Dia L i Spacing €,,, SOIL COVER x Pressure Systems Only xx ound Or At - Grade S terns Only Depth Quer Depth Over xx Depth of xx SeededGSedidzd x L Iched Bed/Trench Center - D,,J/Trcnoh Edges Thpcoil Li Yes H No Li Yes Li No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:1 / "i3 / imsfflowasommon Location: 651 Mary Jo Court Hudson, WI 54016 (SE 1/4 NW 1/4 36 T29N R19W) Cottonwood Ridge 1st Add Lot 79 Parcel No: 36.29.19. 1. Alt BM Description = )f blk ngC(;'h b h { MDfe t�0l�'S / 2.) Bldg sewer length = 1 � 5(2_ D � �IYL�I�I �liL'�+ loi zjt' �E� t fi(C3rt°Yt 6 l V - amount of cover = 3) ,9 / mar rI / .� Plan revision Required? ,_J Yes �C� Use other side for additional information. NO ! S , / I ! / ___ J 4 L1 o. _. Date I epctor's Signature Cert. No. SBD -6710 (R.3/97) 4 so; ! ve446ceekn Sz na, 044/ v 647 _ Ok_ -' Safety and Buildings Division ' County 201 W. Washington Ave., P.O. Box 7162 ' 'V�") .X �ScOnSf�i� Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce i (608 266 - 3151 "( CD Sanitary Permit Application State Plan I.D. Number ry In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s15.04(1)(m) roject Address (if different than mailing address) 1. Application Information - Please Print AU Information 1 RECEIVED ' ((S'( MP-9 0 Cr i Property Owner's Na me 1 Parcel # of # Block # A'evrr ,f) 1 feers7` SEP 5 2003 '19 Property Owner's M ailing Address ST. CROIX COUNTY Property Location y•ir H.et / Sy `Pe ZONING OFFICE ..5 14,.fJis) 'k,Secdon , , City, State ?� Zip Code Phone Number 7`T% e�_S� .e) Gt iJ r �GI ���(circlr U. Type of Building (check all that apply) T ._L- _ N; R y E o �1 � S 0444.1: Subdivision Name CSM Number 1 or 2 Family Dwelling - Number of Bedrooms T 4. . ...❑ Public /Commercial - Describe Use CG"7 '4f /,) ,C /9i /5 7_ - ❑ State Owned - Describe Use - ' 0City 0VillageWrownship of igVel d'_ -, ,,,,t) III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. e New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issues Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that apply) Non - Pressurized In - Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Leachin Chatn , r Drip Line ❑ Gravel -less Pipe ❑ Other (explain) _ ng// V. Dispersal /Treatment Area Information: &?e, .7 4,..4 a 14 t" „s ,6 -e !.- %' 7"v l - 4.0 , ° i Design Flow (gpd) ! Design Soil Application Rate(gpdsf) Dispe sal Area Required (sf) Dispersal Area Proposed (sf) _i.. ' _iL l cis ..5 7 . �',S-7 • F - - .sue -4� VI. Tank Info Capacity in Total Number Manufacturer Prefab . Site Stee Fiber 1 Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank r /025) / , e Se r 1'` N Aerobic Treatment Unit /` Dosing Chamber / I L &" a Gf�/ i ' G�S`iC L J� VII: Responsibility Statement 1, the undersigned, assume responsibility for llation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si gnattuu e i tP 4PRS Number Business Phone Number C.J, 1 7 .S2 v 49 L= ,' — AZ 9F e ll 3Q'. --- .2_ / Plumber's Addre ss (Street, City, State, Zip Code) /d '76 5 a'Z` / d 5e.,€1 et)/ 5 / ‘ VIII. County /Department Use Only Sanitary Permit Fee (includes Groundwater Date Issued i Issuin Agent Signatur (No Stamps) , Approved ❑ Disapproved Surcharge Fee) ❑ Owner Given Reason for Dental 4 250 / •• I i IX. Conditions of Approval /Reasons for Disapproval \\ 3c f I SYSTEM OWNER: 3 / `("� S/ '�5 r�, Nuke' 1 Septic tank, effluent filter and S aW 02J� % rn � , 5. dispersal cell must all be serviced / maintained �� as per management plan provided by plumber. t �S• - ,c� nA W -- , O• .7 2. All setback requirements must be maintained as per applicable code /ordinances. ' & -S , (54_ Sat ' ' I , J Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) I t. t. .' t i 1,11 A 4 41 t`s /Jt);r -. G — . y $ (n Si Ua a pp rU X . - 7 � 0 , y , _________-- fir' ) L sA-,,,,ks..... . -\ , A �I �,��6 ,� 1 n S �'f \,,, , ,,-,-c .t;, v . C 4 3�e Cc�tiv- s i,1 ) s s �Z Ise 't.. 0 4 MA-)21-1 /\ \ i ......I r /,E5 Q y Tv. & " ,c, 7.-e — 3 � C � f , „ b , z"� � � o j �r N. ! . % 1 0. f,' T- t • ,), \ 6 ro kpv;,,5 --ez. % .% t, , 6 4 0) j S Sly` , % h e _ 1, � ` ' 1 \ 6 �� �V� t • �Q n_ ' . \ \ C 0 PY -i.i.. T.. _ L_____ -.4. 1 -k '1 '.1 't... _,. t % e'. % .6 e .1. e- sl ... md i / g6..J/ to c' Mil .s.e,r V- Ne... k.. •,.._ t.. `1 A 4 -r 1T ) \ \ NI. .. s —.. —.... ,,.._ *\■ —...„,... NN^ sZ ka K` '... t ..4i c...r... ..., k\ o 1 \ t• ■ N A ---?;-. 'S c° 1 k1 \ ‘r lb- _ k fi . 1 \ \ l k Z;\ 1 \1 • ;,k- ''''■:) NN, f : ■ V\ \.% K... ---\.. kr‘ - 0 - , 0 W. /30 yee 4 Dev p t� /<E/Wo, /345 o r 3 P,vN4- 5 pEeie BA-s r y q /4- BAR r� RP 1/001 w. , � s yai , , . Wisconsin Department of Commerce SOIL EVALUATION REPORT / of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan musty S r �-- indude, but not limited to: vertical and horizontal reference point (BM), dire and Parcel I.D. .5."-e..- /d U., * percent slope, scale or dimensions, north arrow, and location and distan / �,tnearest road. Please print all information. Reviewed by Date Personal Information you provide may be used for secondary purposes (Privacy l a w, s. 15.04 (1) (m)). �- - - - -__ Property Chimer RECEIVED ' FfOPertyLocation /ye of-57z) 4444, __ /VElL 1l1 /LeOX.5- 0.0 Govt. Lot se 1/4/(/W1/4 S 3‘g T .2f N R if 4.(o0W Props Owner's Main Address go► r � k # ` tx CSM# p /q-� -- �>��U p r� r 7 JAN 0 9 2003 ' ' I Bloc�Stbd. �, l zoc c: . ; /5' g6/44:41.6- fit cry. g Ai . (fit' y State Zip Code Pt 1e GOUNTY City ❑ Village 0 Town Nearest Road - 1/V Soli to. 5V' /4 7 ; e � . ' /f vpso Me" • /v 'tow Construction Use: [� Residential / Number of bedrooms 3 - / Code derived design flow rate yf d — e- az) GPD NReplaoemeM ❑ Public or commercial - Describe: o U,f4 ' 5 4(4 9 7 D U Flood Plain elevation i<appncable N/i ft. 0 c al 4, y ( ).., 6 4` , q /z`�ol . ' ,f°e Sv r 7-4 -A /-e, f /A/ f,E'oa v� Co,vv t,•1 7 /o.vA -L. 4-Z 4-1 D. r Ts' , -- Ns - i:v - / 3/ o I rtfe€ cols . -1........ •`l o. ._ 2�'sk Ground surface elev. ft. Depth to limiting factor > 90 in. Q 4- a,.A -(i- .. r t.. ei'" ( 4 _ Sol Application Rate minion - r,.ef,u. ...n,......1t Color Redox Description Texture Structure Consistence Boundary Roots GPDNF In. Mu nsel Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'EB#2 / e-1 /o vIe3 /3 L ifs ,3,40 5k) ` 3- F . . 2 / - Zo / o Y R y / 6 - ,__,5 L. / shy 7_ As► X C /. ' . 3 / •') /o ydS/ , ,,, s 4,5 .e --- . 7 / i - *e / X4-(vc( . ' # D ing /O0 } I Z I Pit Ground surface elev. ft. Depth to limiting factor f in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/If In. Mu nsen Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#l2 / o /o v,e /3 L /fihe •wt lie /& 3 f . y 1: Z- ly .2y io y/e y/ .Si ' L 2 /.sis At Avif/f as / f . s • <P 1 - 7 S I .' — A,,:. !. D ,!_/ -------- •'7 / Z " H wi 6G, `7"5 e ,. 4 • 44. 5 s %.76/ c -`f • Effluent #1 = BO; > 30 < 220 mg&L and TSS >30 < 150 mg/L. • Effluent 112 = BOD < 30 mgIL and ',ZS glt SS < 30 m. CST Naltre /3ER r ZI (Please /,M'/ GG17` Signature t " • ""`�' f C4 2 Cs Number 5 Address Date Evaluation Conducted Telephone Number Ulbricht & Associates j, 7— ©`2- 7/5.326. VS.$ C55 O`NeII Rd. Hudson, Wis. 5401( .X- P / /US 4) oa 6 •7/by•ya• A 5"E oF' ,v (910- l /D,9 .20 • cero k. i L . K T. / 0ZO•/ /O y. y°•°ao Property Owner Neri Aid C o A( So o1 p • //0? • o ' .2- 3 Parcel ID # Page of On }❑ 1Boring 1 00 .!f Pit Ground surface elev. f t . Depth to limiting factor In. Horizon Soli Application Rate Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munselt Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff #2 % o -12 /0 vie ) - - L- /fShk , .�., �w . 31c-- • 41 . C 2 a -2.2. �!i? '/�/ - ---- -- $ /t l 7F,s/- . e 1 z • 3 3 22.30 io W / , SL /7 444-c-R_ c5. --- .1/ . 6 * A 57 - , s 0 r s 4eJ .7 : z_ e Itatl yFrD I I # ❑ 1�ri� ❑ Pit Ground surface elev. ft. . Depth b limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. MunseN - Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 I Bod # Boring • ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soli Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ f In MunseN Qu. Sz Cont. Color Gr. . •Eff#1 •Eff#2 • t . Boring ❑ El Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soli Application Rate Horizon Depth Dominant Color Redox Desaiption. Texture Structure Consistence Boundary Roots GPD/fi in. Munsell _ Qu. Sz Cont Color _ Gr. Sz Sh. •Eff #1 'Eff#2 • • • Effluent #1 = B013 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BO; < 30 mg& 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. SSD -11330 (8.6/00) I( 51 id' ,,1-'Q— • 4 2- 6.-r . 1 DP l _________ if 4400 1 /) . N 1 0 / it) ,g2, . ,_ .,_ 2 o I\ \ ( e. A `(0 i 5 o 4 -- 15 7 ,___________________-1---- w �i f6'1, V l i 0 a______________,---- .c \ , I° r3 l e\ p fri, - CIA °Arid* ' //' r 4- o (0 : -(157- . I A koc) .„ A et) y . i 5," , ( °A' 0 ,-111 ). S S T ,( Ado ` �� 0 , d i/ l P°' ----"' . f^ ,,( , /47 /' •r issuance of permits and designing Contact: Ulbricht & Associates Registered private wastewater consultant and plumbers 655 O'Neil Road Hudson, WI 54016 715- 386 -8185 or 7 15- 772 -3442 La f /0 i aLr 41_. ,i's 4 : t .4'1 ,MBER � CT. C : t - ,:- ,...- �✓ :. iiG:V .t1.iL u. at yvFi. T 1 `. i+°' CZ VENT PIPE 12" MIN. ABOVE GRADE 5 i4EAThERPROOF t25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER i: } Wr PADLOCK b FINISHE GRADE 4° WARNING, LABEL � CI RI £I RISER 4" MIN. .9" '14.1 6" X, I i .. • � w � , , „y e r 1 :NUT en 1 L11 WATER TIGHT SEALS t � GAS. ; ' ' .-�= r ri "r TIGHT '+ "'V , _ pR4VEn iPPRdVH ,,.,,, � I A SEAL ' i JOINTS WITH i aim r;ilA .M APPROVED PIPE WO 5,'1�. YD -- -- ' 0N 3' ONTO SOIL iOII. P'U'MP OFF EV . ** RISER EXIT D kola I 1 PERMITTED ONLY ,. ' IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: f NUMBER DOSES PER DAY: l TANK SIZES: SEPTIC r? GAL. DOSE VOLUME INCLUDING DOSE 454 GAL. FLQWBACK: / ... 9 GAL. ALARM MANUFACTURER: c e r � - CAPACITIES: A : a. INCHES .... .....,GAL. "•"`�” MODEL NUMBER : � SWITCH TYPE: &e,a 8 : 2 INCHES tt fQ GAL p UMP MANUFACTURER: 6-4.14/ir C e INCHES : _GAL. MODEL NUMBER: ,7 SWITCH TYPE: ,, D = ...a. INCHES $ ..La ..GAL. REQUIRED DISCHARGE RAT, sig. GPM PUMPS ALARM WIRING AS PER ILHR 16.13 WAC JERTICAL DIFFERENCE BE. "1 - - OFF AND DISTRIBUTION PIPE . . a FEET } MINIMUM NETWORK SUPPLY PRESSURE . FEET FQRCEMAIN X FT /100 . A FEET � � f 1 I'T . FRIC FACTOR . FEET T,CTAL DYNAMIC HEATS $ FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH --�- -- I WIDTH """ ' DI LIQUID L` yi " 3 ..,k/ .,,, /-' IGNED : d` . ,,,w`• LICENSE ' C ENS E N' M 8 £R : 277 fee DA: � ; " ',1' ?3 w... 8 8 Subm pig _ C.), -- T Effluent Pump r" '� •, i 44 1 3871 12 J lilt" t , : -------i-ir • Puny submerged M ha III Motor wind: Out iron � A110M8 • • series • rase turbine d for • for e ` mews �+ i1'the • Capable a running ubricatfon and ofiiclei t �' t flng drys taut damage to gust transfer. II tNotar nnopiu wilt Infigral handle • !Mont *stems coM Available for Wa nda sod � linitl • Hornet siterawn t om: mangy o. Aatemits pokes. • Farms • Roy d a y s u m o S t a g ee: fl <t HP, II Power tom: Severe tlutY i18orY, 1 � • Dod RPM, built in overload with *0 d and wrier resistant • automatic rust. R 1be elf. 1 , d • , '' lower • 115V, E Bin phase: l.5 HP, Wowing � W.,w.,,.... i'lai 155 , t� 50 RPM, ..< . a ,.., oat Pump: rim bui r vim r EPO4 Imp. $sr. Thermo- • Ada iindeng upabllty: dutornitic reset plastic Semisepen design Awa mu Ye cntodrnum, • Power cord: 10 foot ,., out vas for Moth, 111/3 SllT , mechsnu sa t ;ro t a tion, It a oaths wawa ) • up to 55 GPM. • Tt s: up to 24 feet, w O dG , n g • EPOS : TfE PA Iisbd model numbers ' • i�a0i�1► a :vie model a 1613 8� f with plufJc aasloatd deeq M •F" or AC^ <y • set than- twos prong grounding plug "mprowd 1 . ' standard on EP05). a t =tomv iciti r allf ' t op iiad deign p rovk d iea • 3 ilia: s r *VP 3 f tl 1 t40•C continuous corrosion. resistance, 140 F t10°C ant. staibida it* iQ �,. _.�..,,..�_. h �5�- - • i10f rlrrtill a as -� components, , 'mil ` Y Pump 1 I 1 w • handling tatpabil 7 a ...� • i a�' to 60 GPM. IN ---7•44.4.11122-60 tae. up a -.. • T, • heads: up to 31 feet. • I ``"N 1 __ • NMa MMO sig : u ban. s l • eel urban. s ^ i ��� , '�",* • 't 3 tG � ; t a� 00011011$ a r� --- -�_.i itaviimmernatint 2 MUIR 1111111111111111111111 ih., L....i 6 11111111111111111111111111111111111111111111 . • , 0,) 0 0. mummaiimimanono .,i,, Q t f, CAACIYY ' s;` i,' ., , L`fi�rW.a liN+ iikl� , T�AGE of .S • F � _ ;1 • S .. A F - " - k it q T •s" iA D 3 PI 0 ,1 rirg c • Q. a u l ; ..in FT 7.1-- 13 1:11 . • : N w m 0 ..��pp(1 k e i * a m a IJ I J JUII JJ?11r ' , K 'gym 6 „0 3 I" ' � o A l i r _ a �..1 �m�t ,: I CD qm d 1 ;n �, l' �� .:,, = _J.... : .... at a Ili I i 1 - . nit >v 0 k 1 - p l• N J r `� S. n' c T1� f itI _ • t i i I 6 R 1111i� g filill AM__ ri ( co E 2 i.e. a -0 ( 2 IF" I I I I I - “, 03 ci). 8 e tc, p___Lk 0 .It cp. 6 _r:_f comom r a 411 -- —.. :E ' c Is - m J ' ° m` x -to in V) ID 0 0 *I 11111 1 1 . Y -. 2 Cr 1 m li � ►� 1 III o0 Ir.11 - a Ilium 1111 ~ � N B. cp 0 10 A) Plingli J 7-1T m a. Q C � illii ii lllil i I I s 0 2: 3 .� cr 141111111111 I v >v y w m 3 • co -i- 111(1Im161 p. o m , 1 I o " co 0 1 a m 5 = 4-- Invert 11'-) • o s • 3 • POWTS OWNER'S MANUAL & MANAGEMENT PLAN page of FILE INFORMATION SYSTEM SPECIFICATIONS - .r.... Owner k .14N r ., r' 7 0----' Septic Tank Capacity 1,2 ,Sd gal DNA Permit M Septic Tank Manufacturer 0 NA 16 O lid,: e.S'e.r/' Effluent Filter Maacturer � � DN NOON PARAMII;TEiRS nuf Number of Bedrooms '{ /Pa d NA 0 NA Effluent Filter Model _. A Number of Public Facility Unite ` Pump Tank Capacity 'd e ga l 0 NA _ _ ---- -- p NA Estimated flow (average) CO w )day Pump Tank Manufacturer f ' se Y — Design flow (peak), (Estimated x 1.5) de © gal /day Pump Manufacturer �y.�,cc /� 0 NA ' � pump Model 0 NA Appiicat(o Rata gal /d 0 NA '" ta kdlu Month) averse' Standard Influent/Effluent Q uality Y g Pretreatment Unit 0 Sand/Gravel Filter 0 Peat Fitter Fete, Oil & Grease (FOG) S30 mg /L Biochemical Oxygen Demand (B00 6220 mg/L ❑ NA O Mechanical Aeration 0 Wetland Total Suspended Solids (T8S) A150 rng /L 0 Disinfection ❑ Other: DNA Pretreated Effluent Quaky Monthly average Dispersal Cell(s) Biochemical Oxygen Demand (BOD,) !30 mg /L 0 In- Ground (gravity) 0 In- Ground (pressurized! Total Suspended Solids (TSS) s30 mg /L 0 NA 0 At -Grade 0 Mound Effluent Coliform (geometric mean) S10 ofu /10OmI 0 Drip -Une ❑ Other: p NA . MMaximumE eM Pardo le Size K in dia. >7 0 r: Other: 0 NA Oche "' D NA "values typical for domestic wastewater and septic tank effluent. Other; DNA MAIN ANN SCHEDULE gG Frequency IIIIIIIIIIIII At least once e very: Qryearts) s ( gym 3 years) 0 NA Inspect condition of tank(*) 3 Pump out *entente of tank(s) When combined sludge and scum equals one-third (Ya) of tank volume 0 NA - 0 months 0 NA Clean e ffluent filter At least once every: /, (s1 • month s) D NA inspect pump, pump controls & alarm At least ones every: -r- d ar(a1 — momi al 0 NA Flush laterals and pressure test At least once every: Q s! • mon • a) D NA Other: A t least once every: 0 (s) Other: O NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the foliowinn Ss C}ns or cer n Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Inspections must include a visual inspection of the tank(*) 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 pore d g of effluent on the ground surface. The pending 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 shag be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. Ail other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment t units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. authority within 10 days of completion of any service event. A service report shall be rcvidsd to the local regulatory liY p 1 I - Page __� of �_ START UP AND OPERATION roducts or ether chemicals For new construction, prior to use of the POWTS check treatment tankts) for the presence of painting p that may impede the treatment process and/or damage the dispersal cellie). 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 celi(s) in one large dose, overloading the cellis) end 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 fife of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floes; 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 stops shall be taken to insure that the system is properly and safely abandoned In compliance with chapter Comm 83.33, Wisconsin Administrative Code: • Ail piping to tanks and pits shell be disconnected and the abandoned pipe openings sealed. e 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 fitted 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: -@P A suitable replacement area has been evaluated and may be utilized far 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. O �� u � bte � fio dire tank maY i be inatailed sat resort 8eplec fa l ed r POWTS $ B�rrng advances in POWTS o gy site �� p tank e n at rade soil absorption systems may be reconstructed in place following removal of the biomat at the p Mound a d -g infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC. PUMP AND OTHER TREATMENT TANKS M NK UNDER AN CiRGUMBTANCESO DEATH MAY RESULTY QF A ENTER A SEPTIC, PUMP OR OTHER TREATMENT A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTB MAINTAINER Name e✓ g `� /r ec 10'1.S u •//12 j Name Phane ? l �-- V'�+e.. ,p�„�f Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY _, Name Name S- Cl lK C �' i t N..�- .. ----- Phone Phone 9 �_ 3 3o . `10 This document was drafted in compliance with chapter Comm 83.22(21(bi(11(di &(f) and 83.54(11 (21 & (31, Wisconsin Administrative Goes, r FROM : Schumaker P binq FAX NO. : 7153863121 Sep. 26 2002 11:36AM P1 • ii ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer • ' a sQ. • 6,57 ' ry °w Mailing Address .. Lc cl . f d c. [ 5 L t 01 prepedy Address Let - Co ff err r too odl (`c` (St Alci1'l° 0h (Verification requited from Planning Department for new construction) City/State 1-f ud r 1 Parcel Identification Number LEGAL DZACRIETION Property Locution se 1 4, N UO '/,, Sec. , T act N -R. , j ` W, Town of H c tics 5o v] Subdivision . Co f 0 T - —urn9 (^e _ (5t 4dc1 L . Lot # . Certified Survey Map # , Volume , Page # .�. • Warranty Deed # 70 , Volume ig.L. Page # . Spec house i yes ❑ no Lot lines identifiable $, yes ❑ fil/TEMA.AZIMAIICE Improper use and maintenance of your septic system could result in its pr'emaune failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a lioensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal $ystem. The property owner agrees to submit to St. Croix Zoning Department a certification font, signed by the owner and by a reasterplumber, jo rneyflmanplumber, restrictedplumber or a licensed pumper verifying that (1) the on-site wastewaterdisposai 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_ 1/we, the undersigned have read the above inquire:net is and agree to maintain the private sewage disposal system with the standards set forth, here . as set by the Department of Commerce and the Deparaneut of Natural Resources, State of Wisconsin. Certification : .. your - .. a system has been maintained .'- be completed and returned to the Si Croix County Zoning Office within 30 days of the 0.i ear expiration da r ,p / ' 4 , / /i 6 � t ,e SIONA - OF AFPLI _ DATE 0 ' CERTVICATigti ( ) certify that all statamenj * n this form are true to the best of my (our) lasowledge. 1 (we) am (arc) the owner(s) of I. •' . described • • /��j.7 v' t warranty deed meamded in Register of Deeds Office. _ fI l 1 /' SIG ATU1 B OF DATE * * ** Any information that is misrepresented may result in the sanitary penult being revoked by the Zoning Department. * * * *s. * * reelede with this application: a stamped warranty deed awn the (Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed L . J 2 1 3 5 P 3 5 5 7088Et Ca KATHLEEN H. IiALSH WARRANTY DEED REGIST 3I OF DEEDS Neil L. Wilcoxson and Mary J. Wilcoxson, a /k/a RECEIVED FOR RECORD Mary Jo. Wilcoxson, husband and wife, conveys 02/07/2003 02:00PM and warrants to ternon J. Bast the following EXEMPT It described real estate in St. Croix County, State of REC FEE: 11.00 Wisconsin: TRANS FEE: 2880.00 COPY FEE: CERT COPY FEE: PAGES: 1 Exception to warranties: all easements and restrictions of record. This is not homestead property. Parcel Identification Number(s): 20- 1109 -40 -000; 20- 11 -9 -20 -000; 20- 1109 -10 -000; and 20- 11 -90 -55 -000 1-� Name and 'AN t0 ' A parcel of land located in part of the Southeast ' 4 of the ' i Realty Title Northwest 1/4 , part of the Southwest'/. of the Northwest 400 South 2nd Street 1/4 , part of the Northeast 1 /4 of the Southwest1/4, and part Suite #115 of the Northwest 1 /4 of the Southwest 1/4, all in Section 36, son, WI 54016 Township 29 North, Range 19 West, Town of Hudson, St. ' i � / 1,k `l(� i Croix County, Wisconsin described as follows: Commencing at the South 1/4 corner of said Section 36; thence North 00 degrees 10 minutes, 01 seconds West along the north - south' /4 line, 1634.77 feet to the Northeast corner of a parcel of land described in Volume 526, page 259 at the St. Croix County Register of Deeds Office, being the point of beginning; thence continuing North 00 degrees, 10 minutes, 01 seconds West along said North -South 1 /4 line, 1977.22 feet to the South line of the North 350 feet of said Southeast % of the Northwest 1 /4; thence South 88 degrees, 49 minutes, 51 seconds West, along said South line and the Westerly extension of said line, 1324.14 feet; thence South 00 degrees, 09 minutes, 43 seconds East 2,096.73 feet to the centerline of County Trunk Highway "N" being a point on 1,999.00 foot radius curve, concave southerly, whose central angle measures 03 degrees, 00 minutes, 19 seconds, whose chord bears South 80 degrees, 02 minutes, 21.5 seconds East and measures 104.84 feet; thence Easterly, along the arc of said curve and centerline, 104.85 feet to the point of tangency; thence South 78 degrees, 32 minutes, 12 seconds East along said centerline, 712.54 feet to the West line of said parcel described in Volume 526, Page 259, thence North 00 degrees, 10 minutes, 01 seconds West along said West line 304.75 feet to the North line of said parcel; thence North 89 degrees, 49 minutes, 59 seconds East along said North line 523.00 feet to the point of beginning, all in Section 36, Township 29 North, Range 19 West, St. Croix County, Wisconsin. Dated this , _ day of J� , 2003. L. ilcoxson Mary J. wi* • on ACKNOWLEDGMENT t STATE OF WISCONSIN ) '' P(Aeilfi'• • � COUNTY OF ST. CROIX ) �-��- / � � �/ � Personally came before me this day of J6 I' the above • =med Neil L. WiIco4301F d Mary . Wilcoxson to me known to be the persons who executed th fo oing instrume - , acknowledge the 'ime - PRESTON * Nota Public _ 2 r My commission expires: b — �� �1 9 � This instrument drafted by Robert F. Wall. WilcoxsontoBastWD03 -1 -4,41- OF wt S - tom.. w Z J I a 0 LOT 76 ° co 4.71 ACRES $ _ 205,328 SQ. FT. CC Z a i N89 °49'59•E 613.61' 463.61' 150.00' fl n� 66 ^ $i 1 Lill LOT 77 2.41 ACRES ffili N 104,868 SO. FT. d - ♦ 0 0 • 40' LOT 78 O �0'` 3.30 ACRES ^ L ' 143,696 SO. FT. in ), 7F a p o•'Sj. cV a c -' °� s � �► 9. LOT 79 L. •\ 115,337 SO. FT. (b \ � L.B.O. = 1033.85 E, \ \ 1 \ \ • • • \\ 2 i ® 11 l i b .0 • • \ \ I i; / •- - • • 2°. / N • • T44 / /� . 3 a °N 19 5 � • n 1 p89 °49'59 "W 118_67' �y • N ' Co. I � LOT 80 en N 3 1 g , I 2.86 ACRES v 4, 4 I Zi 124,559 SO. FT. i w o o , G �G� ,�� �`' I L.B.O. = 1033.85 O 8 l 8 � o C'`° �� N I ° I O 1 l $i It, 8 . 1 °. t J _ Z