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020-1441-84-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 538862 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: Schmeck a er Robert Hudson, Town of 020-1441-84-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: p I - d 36.29.19.2810 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark VI, -0 2S~ _ 2,1 X02.•1 /00: a Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet It myteC) o 6 TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet r U Septic Dt Bottom t) Dosing Header/Man. Aeration Dist. Pipe Holding Bot. System /v¢Q ~ 'g 10.-71 y ' FipaL6 PUMP/SIPHON INFORMATION rade 2 • ~o !-5~ Y Manufacturer Demand St over p / GPM ~ lei Model Number TDH 11-iift Friction Loss ad TDH Ft Forcemain Leng Dia. Dist. to well SOIL ABSORPTION SYSTEM 22- Q BED/TRENCH Width I Length / No. Of Trenches PIT DIMEN S No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO lJ P/L BLDG WE LAKE/STREAM Manuf ure Y INFORMATION (!9~~Ilvodel ✓ Ty Of ystem: Number: DISTRIBUTI N SYSTEM J > Header/M n~fo d tribution~g,~~ / x Hole Size x Hole Spacing Vent =Intake Pipe(s) CY~> I Length Di Length Dia Spacing 1 "764 40 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Q I Bed/Trench Edges Topsoil ❑ Yes 0 No 0 Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:IQ/Inspection #2: / / Location: 642 Leah Lane Hudson, /n/WI 54016 (SE 1/4 NW 1/4 36 T29N R199W)(fCottonwood Ridge 1st Add Lot 4 _ Parcel No":: 366..29.19.2-810 / ~ ~YncstGGtiyn~SiA~`~ 1.) Alt BM Description= V'ACA k,&k f `UVt& 5"y-106t, 2.) Bldg sewer length - amount of cover = Plan revision Required? ❑ Yes No - Gay Q Use other side for additional information. L Date Insep tor's Signature Cert. No. SBD-6710 (R.3/97) PLOT PLAN PROJECT Robert Schmecknener ADDRESS 624 Leah Lane Hudson Wi 54016 NE 1/4 SW 1/4s 36 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/7/11 BEDROOM 4 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1200 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 44 BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 100° Filter Zabel Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 91.3 8' below qrade Property Line Scale is 1" = 40' unless otherwise noted 50' Plans Designed Using Conventional Powts B-2 Manual Version 2.0 Vent <1 % slope 2-3' X 90' cells with >3' spacing Vents >611 Quick4 Standard Leaching Chamber 0' of Cover with 20.0 ft2 of Area 10.2ft^2/pair of end 'Long 12" caps Grade at System Elevation 34" 30' B-1 75' B-3 B.M.* 15 33i 20 25' 10 _ Existing 4 Bedroom 2 Cells failed due to not house esfi being installed deep Valve enough t,•, S ~ 1 vh.ed~t,ww.. sa~~ 50' 1 ~ U7y& P ~ ]COPY Property Line Leah Lane COf171)79rce'YWtov Safety and Buildings Division County ■ 201 W. Washington Ave. P.O. isconsin Box 7162 • r Madison WI 53707-7162 BePar6r of Commerce Sanitary Permit Number ( filled in by Co.) tmlt _ Sanitary Permit Application State Tran a tion Number r In accordance with s. Comm. 93,21(2), Wis. Adm. Code, submission of this tbrm to th ropri o c tal A) /A unit is required prior to obtaining a sanitary permit. Note: Application forms for A ed Project Address (if different ham mailing T ted to the Department of Commerce. Personal information you provide may be us or sec address) suubmit ses in accordance with the PrlvacLaw, s. 15.114(1 m), Stats. 1. A lication Information - Please Print All Information Property Owner's Name ~--Q~ Parcel # -5 gee Property Owner's Mailing Address d L7-fin / H/HCRpi Property 1,owttwn r Lil/ Cl rt C`f ?ON oU Govt. Lot C' fate 2Z, / Zip Code Phone Number ~ ~ ~',ac~ Y., Se:tiom trc le qite~ 1I. ype of Building (check all that apply) Lot # f N; R ' or or 2 Family Dwelling - Number of Bedrooms 'f Subdivision Name El Public/Commercial -Describe Use Block # b ❑ City of _ _ ❑ State Owned - Describe Use CSM Number ❑ Village of con of III. Type of Permit: (Check only one-box on line A. Complete line B if applicable) A. ❑ New System lacemeat System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Exis! ing System (explain) B- El Permit Renewal El Permit Revision El Change of Plumber ❑ Permit Transfer to New List Previous Permit Number t nd Date Issued Before Expiration Owner IV. T~Vpe of POWTS S stem/C onent/Device: Check all that apply) on-Pressurized In Pressurized In-Ground ❑ At-Grdde ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank 11 Other Dispersal Component (explain - J J' at-lent I)e'L~ice 1 j t V. Dispersal/Treatment Area Information: - Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Pr osed (s S stem Eler anon VI. Tank Info Capacity in Total # of ManuFdcturer Gallons Gallons Units b New Tanks Existing Tankg c U pp a U y b w C7 a Septic or Hokling Tack ' Dosing Chamber I/ /;i _ VIL Responsibility Statement- f, the undersigned, ass responsibility for installation of the POWTS shown on the attached plans. Plum is Name (Print} Plumb ignature MP/MPRS Number Business Phone Number r Plumber's Address (Street, City, State, Zip Code) , 132- via VIII. un /De artment Use Only ermit Fee roved ❑ Disapproved ISApp $ - Date Issued Issuing Agent Sigrtatyre ❑ Owner Given Reason for Denial IXt~1~.Annroval/Reasons for Disapproval 1 Septic tank, effluent filter and ' tv •i4 [ f , r .r t~(~;r. dispersal cell must all be serviced / maintained as per management plan provided by plurrrber 2. All setback requirements must be maintains "~,...:f , . F y • `F,k.,: L ° ,J`,,/f I KI;Z ✓ ..R/ /✓t1 _ .r,. s for the system and submit to th panty only an paper rot less than 8 in 111 inches Jp'u r , i l k v i r:.Jl /l~n - 1 ,J ~ rl, SBD-6398 (R. 02/09) Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 10/7/11 Owner: Robert Schmeckpeper Location: NE1/4 SW1/4 S36 T29 N,R19W 624 Leah Lane Hudson System type: In-ground absorbtion system (conventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-5. Maintanance and Contingency Plan 6. Filter Specifications Sheet 7. Utilization of Existing ptic tank form 8-10. Soil Test Signature License er #226900 PLOT PLAN PROJECT Robert Schmeckoener ADDRESS 624 Leah Lane Hudson Wi 54016 NE 1/4 SW 114S 36 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/7/11 BEDROOM 4 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1200 LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chamber 44 BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 100° Filter Zabel Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 91.3 8' below qrade Property Line 20 Scale is 1" = 40' unless otherwise noted 50' Plans Designed Using Conventional Powts B-2 Manual Version 2.0 01 Vent <1% slope 2-3'X 90' cells with >3' spacing Vents >6" Quick4 Standard Leaching Chamber 0' of Cover with 20.0 ft2 of Area Long 12" p a 10.2ft^2/pair of end xA 4 Lon caGrade at System Elevation 34' 30' B-1 75'0j B-3 15' B.M.* 20 25' 10'. Existing 4 ST Bedroom 2 Cells failed due to not house being installed deep alv enough 50' 15' Well Property Line Leah Lane Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 10.2ft^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation 99.5' Vent Grade Vent 3' 4" f~30/34 Septic Tank 3 5' Long 1 5' S' Long 1 " 3 6" Grade at System Elevation Grade at System Elevation Spacing 5' 2-3' X 90' Cells Same on other end Observation tubeNent At end of cell A 22 chambers per cell B System elevations: A_91.3 B__91.3 LLJ ° LL. - - W -ill I r ~:a It J3 t- 41~0 i N tp ~ 'Pop fill ,Q hl M ` ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the lobe/ .S residence located at: 0r/V'~' , s~r1 zr section 3 4; N~ Rw, Town of Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be i_iunctioning properly. , Last time serviced: Oi.d flow back occur from absorption system? Yes No (if no, skip next line) Approximate volume or length of time: gallons _ minutes Capacity: Construction, Prefab Concrete Steel Other Manufacturer: (If known) A Zature) (If known).: ((Name) Please print (1,i le) (License Number) -7 1M t e t'or-m to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) certification: I;i, accepting the above statement regarding xisting septic tank condition, I certify that the tank to the bes f my knowledge will conform to the requirements of ILHR 83, Wis dm. Code (except for inspection opening o r outlet baffle). Name Signature MP/MPRS Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installej in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan Option #1. If system fails, determine cause of failure, use alternate area and install new em i tested replacement area. Option # Install syste at a lower elevation, by removing chambers, removing bio iat, an ' stall new syste ~~~~~~a D~' s Sv U~ mac. Ua' 1! Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715-246-4516 St. Croix County Zoning 715-386-4680 Pumper Tom Mondor 715-246-5148 Shaun Bird #226900 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ~t-L -SCo! ~(A 12 Mailing Address Property Address (Verification required from Planning & Zoning Departnient for new construction.))) / f Parcel Identification Number ~ 2 0 City/State LEGAL DESCRIPTION Property Location 1/4 4 ,Sec. T ~~N Rw' Town of _ Subdivision Lot# , v Certified Survey Map # Volume Page # Warranty Deed # Volume Page # Spec house Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system- Owner maintenance responsibilities are specified in §Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a mash 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. Vwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, 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 Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all. statements on this form are true to the best of my/out knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bed oms /a l7 /i A F APPLICANT(S) DATE 'Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in a rda h Comm ]~pp((~~1Nf.0de i[:G County C _ / Attach complete site plan on pa r no 1/2 x 1 inches in size. Planra J~ include, but not limited to: verti nd ontal ref ce point Parcel I.D. _ percent slope, scale or dimensi ;,or:tharr nd location and nce to nearest road. ~aG r- r Please all information. LXCouNTY Review"y,; Date Sf CRO n~v~,11~~~~~~oWCF- , r 1 / i Personal information you provide may be used for secondary purpose gQ&4C r (1) (m)). Property r Property Location S Govt. Lot 1 /4 ,J/4 S 3 ~T N R E (or) W # Block # Subd. Name or CSM/ Property Own' Mailing Address Lot # /S / 6 ,27 /c State Zip Code Phone Number ❑ Cik=_/ ge Town Nearest R d 14 S ( ) ❑ New Construction Use esidential / Number of bedrooms Code derived design flow rate A~&-Lr GPD eplaosment ❑ Public or commercial - Des Parent material '7' Flood Plain elevation if applicable General comments and reoornmendations: System Type System Elevation ! l: J M 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/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 -Eff#2 1A, 2- Ds ~ f Boring # C] Boring ® fa Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Enda Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 a Effuent #1 = BOD > 30! 220 mg/L and TSS >30 1150 ' Effluent #2 = BOD 130 mg/L and TSS < 30 mg/L 061-1 CST Name (Please Print) lure CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 - 715-246-4516 Z'o Soil Test Plot Pla Project Name Robert Schmeckpeper Sha it Address 624 Leah Lane Hudson Wi 54016 M #226900 Lot 84 Subdivision Dat 1017111 NE 1/4 S W 1/4S 36 T 29 N/R19 W Township Hudson Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Bottom of siding System Elevation 91.3' *HRPSame as Benchmark Property Line 20' Scale is 1" = 40' unless otherwise noted 50' B-2 <1% slope 0' 30' B-1 75 PC34-- oz B-3 JB 25' ExiBedST 2 Cells failed due to not houbeing installed deep enough 50' 5 Well Property Line Leah Lane w D U 2677 P 502 777276 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX Co., WI RECEIVED FOR RECORD 10/18/2004 10:30AM WARRANTY DEED EXEMPT # REC FEE: 13.00 TRANS FEE: 1002.90 A fti: IUMC Q7 -R;. Z&=... . Universal Title 7235 Ohms Lane Edina, MN 55439 MTN: Recording Dept. I L oao_~~y/-~Y_ 000 I'LUi idmliGcis;onH~oLer (Pltj) "T'US PAGE IS PART OF TIUS LEGAL DOCURElIT - DO NOT MOVE" Z3L {aWcm►tlaa moat ~ waptdod br a+bm~.d; aoc+..a+r difr. ~+yn ocfctr¢u..d j(L (((rti9'drrcd). Odtr j,~(wa,odon n~+ r4 d.uv, k~.l 4sc(ps«., e. ~e a., r~t,~t,pr ~du b~ ttncae e.. pa~~ 4f ~ d#0MW M. bk!g Wj (dd%U 09ra-pdIC -US WU pate "Y*- d«,...au a.t JL04 ro dk rjcor&mr (rc. WUCGf to Su"v, J9JJ7. WMA 2j9V 2 6 7 7 P 503 STATE BAR OF WISCONSIN FORM 2- 2000 Document Number WARRANTY DEED THIS DEED, made between Kernon Bast aWa Kernon J. Bast and Donalda J. Speer-Bast, husband and wife, Grantor, and Robert A. Schmeckpeper and Jennifer L. Schmeckpeper, husband and wife, as Survivorship Marital Property, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: Lot 84, Cottonwood Ridge I" Addition, Town of Hudson, St. Croix County, Wisconsin. Recording Area Name and Return Ad r n6rsal Tide 1gn 5 Ohms Lane Exceptions to warranties: xagson,.U7L54016 1 dhia, MN 55439 Easements, restrictions and rights-of-way of record, if any. 438335 1 "f'v: Rec:urdin r ept. 020-1441-84-000 Parcel Identification Number (PIN) This is not homestead property. Dated this 10th day of June, 2004. Kemon Bast a Kernon 1. Bast * Donalda J. eer-Bast * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) O ST. CROIX COUNTY. ) ss. authenticated this 11th day of Jun V,1Q,~C' iOlLN P. Sconr 'n Personally came before me this June 10, 2004 the above * named Kennon Bast a/k/a Kemon J. Bast and Donalda J. Speer-Bast, husband and wife to me known to be the person(s) TITLE: MEMBER STATE BA IMP WISCONSIN who executed the f regoing instrument and acknowledged the (If not, same. authorized by § 706.06, Wis. Slats.) ,/2,114- THIS INSTRUMENT WAS DRAFTED BY *Cheri Brown Peterson, Fram & Bergman - Steven H. Bruns Notary Public, State of Wisconsin 50 East Fifth Street, St. Paul, MN 55101 My commission is permanent. (If not, state expiration date: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) 3/11/2007 *Names of persons signing in any capacity must be typed or printed below their signature WARRANTY DEED STATE BAR OF WISCONSIN FORM Na2-2000 lit WIN idifiT ~4T 419 , r. WON p - . i a s 21if i LOT 81 2MACFM 0 w to $0. Fr. • i n6.: - ~ . NWWRIIE 541.70 4ea 1~.~ / Merwel- 206 7 )T Be . SACM w BQ Fr. LOT 83 2 it LOST 82 91,'x'06 SO. FT. 2F3 AOFO MW4 90. FT. J wesr+~a►~ a~.~ 1. o cn0l 3-0 0 C v1 r 0) o o H' M ci CD M o qt (D rA cn 0 CD U) 0 s ;r, 7 Z 0 W v CO m C W N tly~~i • N Q FBI A C N :3 y O j ►'9 C ~co n N CL v 3 ° N 0- n v 7 O 00 c cu c y o o p~ 3 7 in A =r N ~ O G !r N V D CD a Sr N (D a y C. m _W a- a CD ~ 3 o O CD to co_ 0. CD 0. 0 0 r- ca N a A A C 3 S7 C N• a G ~ (}tN~il _ 0 fl O ~n _~f Z CD SSO S4O SSO CD O = m 8 - 0 m 3 to N Cn cD A v C N CL ! N oZ N M 7 O n; O o d j 7 Q N ~ A y m = c N. c w a Q a m Sr 1 cn o y 3 A z m =h (D c z a 0 y a A C o cn 1 w a CD m rn z A X C 3 I ~ ~ N Z CD ? A ~ ~ i 0 o a@ -00cn3 m y 5 y 5z a 03 ~o < a 3 a • CL N 0- can A a T .a m c -0 N~ 3 coi:~ am CD ° a w 0 y (n m CND - cc 7 7 0 ~ N x o < = N y O O. CD CL =b : C o CD CD =t a d pip O ;W O a CD (D '0 VC o-a ao a.3 y N CD C (D C fD •O OO N O z p N Oa 0 (D 7 O N O U) m (D CD CD p $ ao 3 j b A rfl O ti a o ~ C) i I Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 -57, 4W PI A Nvisconsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266-3151 blot Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, perso I'viopmat'Afl -All re~ride-~ may be used for secondary purposes Privacy w, s~ Project Address if different than mailing address) 1. Application Information - Please Print A 04, 6L ' r~`1 APR 2 0 2004, Property Owner's Name Parcel, ly % Lot # Block # gc L 70MIKIG QP . - - 1 l r~tr SMc . ST.OR0; 0fl~•t,~.000 O Y l~ t e4 b Property Owner's Mailing Address Property Location City, State Zip Code Phone Number -W ~w Section_ o' AU, Sroo S k", - 3's 1 . 100 if T 21 N; R (circle e) II. ype of Building (check all that apply) ~E or~ (ur ~F~ 1 S ubdivision Name CSM Number 1 or 2 Family Dwelling - Number of Bedrooms ❑ Public/Commercial - Describe Use ❑ State Owned - Describe Use []City_❑Village []Township of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. m ❑ Replacement System El Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B• El Change of El Permit Transfer to New List Previous Permit Number and Date Issued Permit Renew Permit Revision El Before Expiratio Plumber Owner rd FC-•g. 30690 IV. Type of POWTS System: Check all that a ily) pp 2 S `.10 u- Qu. Non -Pressurized 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 Leaching Chamber ❑ Drip Line ❑ Gravel-less Pipe ❑ Other (exp n) V. Dispersal/Treatment Area Information: t Y?U^~. 6- 4P Tka-T Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Re fired (sf) Dispersal Area Pro o doff) System Elevation &co r ? Sri. 1 £?[fp Z 92. oz VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units -'-Z A. 6ti A-Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank ~ C?O ~ G+r f $qit Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' Si ture MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) P0• to oU t S VIII. County/Department Use Only Sanitary Permit F e (includes Groundwater Date Issued I sui A ent Sign roved ❑ Disapproved g at (No Stamps) proved Surcharge Fee)I ~ ❑ O n Reason for Denial IX. Conditio Ap rovaUR ~ifp+ Rt" &J-t 0-~ 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) f It t/ p .0= x b9o cs,o~ V W o r r brig Z v G N a- x ~ s { Vf. d0 N r rv ? M ~ ^ rv Se _ T ~ i"- N 3 w~~Coclo.+ ~ . ~,ESV 1419 Wisconsin Department of Co merce ~o S L EVALUATION REPORT page 1 of 3 Division of Safety and Buildin s APR I abcWJ a witl~Comm 85, Wis. Adm. Code Steel's Soil Service Inc. County Attach complete site plan n pap~[ $ Mit~flirlches Arislance ze. Plan must St. Croix include, but not limited to: erticaPdFe point direction and parcel I.D. percent slope, scale or di msior~s to nearest road. Pending Please print all information. Re ewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 7-41 Property Owner Property Location McCabe Homes Inc. Govt. Lot na SE 19 NW 1/4 S 36 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Same or C9 35 Osprey Blvd na od Ridge city State Zip Code Phone Number City I Village vl Town Nearest Road Bayport MN 55003 651-351-1018 Hudson Wilcoxson Rd f New Construction Use: i/ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD I Replacement J Public or commercial - Describe: Parent material Outwash Plain and Stream Terraces Flood plain elevation, if applicable na General comments and recommendations: Convetional system,system elevation 92.94ft. Trenches spaced and depth to code 7.08ft below grade. M Boring # I Boring Im Pit Ground Surface elev. 99.10 ft. Depth to limiting factor 120 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 1 0-8 10yr3/2 none sil 2msbk mfr cs 1vf .6 .8 2 8-20 10yr4/4 none sicl 2msbk mfr cs na .4 .6 3 20-27 7.5yr4/4 none scl 2msbk mfr cs na .4 .6 4 27-38 7.5yr4/4 none sl 2msbk mfr cs na .6 1.0 5 38-52 7.5yr4/4 c2d7.5yr5/6 sl 2msbk mfr cs na .6 1.0 I 011,2.6 6 52-58 7.5yr4/4 none sl 2msbk mfr gw na .6 1.0 7 58-120 7.5yr4/6 none cos osg mvfr cs na 7 1.6 2 L ` Boring ~Z 2❑ Boring # Pit Ground Surface elev. 99.10 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPPffl in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-16 10yr3/1 none sil 2msbk mfr cs 1vf t.4 .8 2 16-38 10yr4/4 none scl 2msbk mfr gw na .6 3 38-58 7.5yr4/4 f2d 7.5yr5/6 scl 2msbk mfr gw na .6 Z 4 58-74 7.5yr4/4 none sl 2msbk mfr cs na .6 1.0 ~Z 5 74-120 7.5yr4/6 none cos osg mvfr na na .7 1.6 * Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 <_30 mg/L and TSS < 30 mg/L CST Name (Please Print) _ ignature: CST Number David J. Steel 248956 Address Steel's Soil Service Inc. Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 4/19/2004 715-246-5085 Property Owner McCabe Homes Inc. Parcel ID # Pending Page 2 of 3 F 3]Boring # Boring Pit Ground Surface elev. 98.20 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munse►► Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-19 10yr3/1 none sil 2msbk mfr cs 1vf .6 .8 2 19-67 10yr4/4 none sl 2msbk mfr gw na .6 1.0 3 67-84 7.5yr4/4 none Is 2msbk mfr gw na .7 1.6 4 84-120 7.5yr4/6 none cos osg mvfr na na .7 1.6 Boring # I Boring F-1 Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P 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 = BOD5 < 30 mg/L and TSS S_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. Page 3 of 3 STEEL'S SOIL SERVICE INC. David J. Steel 1564 Cty Rd GG CST-POWTS McCabe Homes Inc. New Richmond,WI 54017 Lic. #248956 SE1/4,NW1/4,S36,T29N,R19W Bus.(715) 246-6200 Town of Hudson, St. Croix Co. Fax (715) 246-9372 1 Lot, 84 Legend 1" = 40' ♦ = Benchmark Ele. 100.00ft Top of 3/4" PVC Pipe • = Alt Benchmark Ele. 96.05ft Top of 3/4" PVC Pipe ❑ = Borings Boring Elevations B1 = 99.10ft / B2 = 99.10ft (fit / C &YS60 Dr B3 = 98.20ft B4 = 00.00ft ~2cr~ , Hof ~b 5`y S a3 ~5 1 2 2oi ~ Viz`' 4- Wiscom-,in Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix 4afety; nd Building Division I INSPECTION REPORT Sanitary Permit No: 430690 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 020-1441-84-000 CST BM Elev: sp._B ,Jlev: B Description: Section/Town/Range/Map No: ~.Oo'= S.T t.Owr. 36.29.19.2810 TANK INFO ATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet 3 I 'T'/-33t TANKS BACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ( 02?(o! Dt Bottom Dosing Header/Man. tl Aeration Dist. Pipe Holding Bot. System /0. q2 -o O.~o °a - Final Grade 44) PUMP/SORMATION 4 ok Manufacturer mand S Cover Model Number TDH Lift Friction L System Head H Ft Forcemain Length Dia. Dist. to Well SOI RPTION SYSTEM s s N ( Length Nof Trenches E Width PIT DIMENSIONS No. Of Pits Insid ia. Liquid Depth DIMENSIONS 3 Q("(~ 2 SETBACK SYSTEM TO OO P/L BLDG WELL LAKE/STREAM LEACHING Manuf r: INFORMATION CHAMBER OR Type/Of~S~ys~tem: 11 4u~+ UNIT del N ~.OKV/ (Y \ b DISTRIBUTION SY M Header/Man' v Distribution x Hole Size Spacing Vent to Air Intake I pe(s Length Dia Length Dia ing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes No ENTS: (Include_c discre epa p sons present, etc.) Inspection #1: 9 I zt;og Inspection '~-j L cation: 642 Leah Lane Hudson, WI 54016 9)1/4 NW 1/4 36 T29N R19W) Cottonwood Ridge 1st Lot 84 Parcel No: 36.29.19.2810 1.) Alt BM Description = M6 2.) Bldg sewer length = 2(p y [ - amount of cover Plan r vissiio e u re s f"cGR.~ M 2~~ Cl S~ other e for a ditional informatio . ~IC -AS{ry` y nsepctor's Signature T1 S'Z(„) Cert. No. III . t AID- I Safety and Buildings Division County _ Nvisconsin 201 W. Washington Ave., P.O. Box 7162 .5d , CPa Madison, WI 53707 - 7162 Sanitary Permit Number (to be tilled in by Co.) Department of Commerce (608)266-3151 Sanitary Permit Application State Plan I.D. Number 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) Project Address /if different than mailing address) L Application Information - lease Print All Infor atio 1-- "Z ea_l ;,-a- Property Owner's N t y~ FParcel I Lo Block # V FEB 1 8 2004 ,~Property Owner's Mailing Address ST. CROtX COUNTY rty Location /0 Q ~ WB tNRGL t~ ZONING OFFICE S£ y,, lN)(y) y., Section S b City, State Zip Code Phprrti lj~ nber "IASC.Q tb T2 N; Eot~ Il. Type of Building (check all that apply) 3 L1 P d55/ LA___ n vo n Name CSM Number ~lor2Family Dwelling -Number ofBedrooms Qf\L r Z1 [J~t~► W~_ t ~ Isr,M) ❑ Public/Commercial -Describe Use f t~ ` ❑ State Owned - Describe Use 3 ~~sn W City_❑Village,KTownship f t7 ,J Ill. Type of Permit: (Check only one box line A. Complete line B if applicable) ❑ TreaunentlHoldin Tank Re laceme nlY Other Modification to Ex ting System A. V-New System ❑ Replacement System g P Date Issued B Lis re ouOP and ❑ Permit Renewal ❑ Permit Revision ange of ❑ Penn it Transfer to New Before Expiration Plum Owner IV. Type of POWTS System: Check all that apply) Non -Pressurized In-Ground ❑ Mound > 24 in. of suitable soil oun 24 in, of suitable soil ❑ At-Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In-Ground ❑ Holding Tank ❑ P ilter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Leachin Chamber ❑ Drip Li avel-less Pi ❑ Other (explain) V. Dispersal/Treatment Area Information Gov c Design Flow (gpd) Design Soil Application Rate(gpdst) D spe al Area Required( Dispersal Area Proposed (st) System Elevation C19 VL Tank Info Capacity in Total Numb Manufacturer //ll Prefab Site Steel Fiber Plastic Gallons Gallons of U is J6v _ Concrete Constructed Glass Ea,4n Existing On vif~ Tanks I~- Septic or Holding Tank 1AS I ~,V t L iL Aerobic Treatment L'mt w Dosing Chamber t / 7I1. Responsibility Statement- I, the unde igned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plu er' i e MP/MPRS Number Business Phone Number P tuber's Address (Street, City, State, Zip ode) rte} rC3 Co L, ) z_ S~r~3v Vill. unty/Dc artment Use Only Sanitary Permit Fee (includes Groundwater Date sued uing Age Sign ure nips) pproved El Disapproved n ~ El Owner Given Reason for Denial Surcharge Fee) of"-O ' Qo t h) IX. Conditions of Approval/Reasongfor Disapproval - L~ TEM OWNER: -g~1.8 LM .rtLC(~ v&d (4d_&ZO h Septic tank, effluent filter and dispersal cell must all be serviced / maintained r~-~ , Ili/y, 7'~a as per management plan provided by plumber, 2. All setback requirements must be maintained (00 CG'S%~YjS, as per applicable code/ordinances L44 ~,Q~✓i~~ (J Attach complete plans (t ounty only) for the system on paper not less than 81 11 inches in size - -rz SBD-6398 (R. 01/03) n(~~ ~'c.Ur►~ J~S_~vmfQL ,4A1/AS-.BUILT ~ Pkov) ate Sp~l~jG C Ib~ATla~ ~J 7~3J✓~S ~/dTON ~GaTtZ I p'c ,DiSP6-R5-R+L 06V'6'j _P/Pe N ~ ~ ~ ~ W ~ ~ ~ _ I I s ~ ~ ~ ~ ~ ~ ~ ~ i i% ^xa ~ 4F j I -51 i ~ 04- pp t i k t ~ do, 46 st r ^ l 49 1 KERNoA) /3,45r 3 Po,vN t S/'E&V 13.4s r _ y 41k l,+ 13,rR6-E ;'p, (e Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of 3 Division of Safety and Buildings In accordance with Comm 85, Wis. Adm. Code Attach complete ske an on pa County 5 T 6R U f plan per not less than 8 1/2 x 11 inches in size. Plan must Include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. :5,e, /3.G/6 Lt> - - percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print of Information:- Revie Date LL Personal information you provide may be used for secondary pes, s. 15. (1) (m))• GL% O i Property Owner P rty Location fvt- O AIE/ •L W 11-eO 5 0A.-I j 0 9 2W Govt Lot 5,0 1 14 ffljd 1 /4 S o T l9 N R f~ te(a) W Propsy Owner's Maki Address ' / i Lot # B # Subd. Name ox CSKW X/fe GTy. . N 11 Sr cp\oixcoui 1 '51Y F. P I vi Y H~ wZ1;c,9 i 14JA city State zip code Village 50 Town NeareRoad ' 110,PSoN w/. Syo14 (7/5 ) 39'6 •ziz7 /f vOSo,v ffew . N ew Constnrcdon Use: Residential /Number of bedrooms Code derived design flow rate G Oa GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material f=lood Plain elevation If applicable ft. anelf commerft ndti s: Si' TG" 7~sT ~D i S SUiT/fid L~ die 4A-1 66 A~ q-7- 13,,'6,4911C77aJ-dS-2e 6P-11-5 # Boring C M ~ ® Pit Ground surface elev. Depth to limiting factor > / o'er in [SW Applicallm Rate 1 kmimn Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G In. Munsel Qu. Sz. Cont. Color Gr. Sz. Sh. •EQ#1 '0112 Yle 31- L /fshK 1W 791? Cs • y 2 23 D G 2715*' •w1-fR CO / 7G . • ~ -2. 5 YR 4111 15 -7P Z y of __7- 01 3 S~" 76,5-& o Boring /00.33 F # Pit Ground surface elev. ft. Depth to limiting fact in. Sol Appkelim Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF In. Mtmsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 0-(4 io Yle 3 L /shoe A," 7452 Cs .2 ~ . y -.6 . s 2 6•10 10 SSG- S,br 4,4-,-,-/e Cw 124- 20 -471- 96' V/2 Y/1 Z o /•Z C-44-1 -IA~ 51'1 A-V-4 Efflluueent #1 a BOD > 30 1220 mgIL and TSS >30 1150 mg1L ' Effluent #2 = BOD < 30 nVIL and TSS 130 mgfL CST Ko 13E? Print) griature CST Number T Zt1h--fi'at 7- S 2 S Address Date Evalualloon Conducted Telephone Number Ulbricht & Associates Aac • /l c2-to Z_ 7/5.3 6 41e_$ C55 O`N'.11 Rd. Hudson, Wis. 54016 ~ )01 /Us N~ of s~ o~t~ //ay• rya o~ s~ ortik) old- l/09 . ~c~ • oaz~ i 13 0)~0-1/09• yo•oaa Property Owner Neil tu/l L 0 X S-O J Parcel ID # o1D . /fib 9 - ZO. 0-0 2 Pa 3 -of Boring # El 9 a 7f.93 it Ground surface elev. ft. Depth to limiting factor In. Shc Rate Horizon Depth Dominant Color Redox Description Texture Stnxfime Consistence Boundary Roots GPDff In. Munsed Qu. Sz. Cont Color Gr. Sz. Sh. '091 •Eff#2 a• z 313 Z- e All ,e w Zf . s Yve 3 s 5G 2-7c ilk 14K cs a ems # ° Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfff In. Munsed Qu. Sz. ConL Color Gr. Sz. Sh. •Eft#1 'EMV2 a Boring # ° Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor In. Sod Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDff In. Munsed Qu. Sz. Cont Color Gr. Sz. Sh: •Eff#1 'EM#2 a Boring # ° Boring ❑ Pit Ground surface elev. ft. Depth to iirniting factor in. Sod Rate Horizon Depth Dominant Color Redox Description . Texture Stnnfixe Consistence Boundary Roots GPDff M. Munspd Qu. Sz. Corn. Color Gr. Sz. Sh. •EMV1 *EMQ Effluent #1 = BODI > 30 < 220 mg1L and TSS >30 < 150 mglL • Effluent #2 = BOD6 < 30 mgA- 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. seoa»o pe.sroo► pV N 1,, 3 d 4: N J :4 r 00 Z i 'a ID 'D Ur- m~ao m30 4 00 o C 4 ~ Q e o 0 O C9. - Iz. I ~aLF I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address L~yg° Property Address (Verification required from Planning Department for new construction) C* City/State Parcel Identification Number b Z 6 - / C/ W DO LEGAL DESCRIPTION oZ810 I Property Location %.,Sec., T Z~ N-R~W, Town of f~ (A)56 ~J Subdivision Lot # Certified Survey Map # r Volume . _ Page # Warranty Deed # 76 ~ ~db . Volume 2 /'3 , page # ~S Spec house yes ❑ no Lot lines identifiablyyes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof 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 affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mastcrplumber, journeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, 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 a three year expire on date. Wk&TURE OF Ail'LICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property descn ve, virtue of a warranty deed recorded in Register of Deeds Office. GNATURE OF APPLICANT 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 warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed POWTS OWNER'S MANUAL & MANA(atMtN 1 PLAIN Page I of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity / 2 57) al O NA Permit Septic Tank Manufacturer ~j O NA DESIGN PARAMETERS Effluent Filter Manufacturer ~Z O NA Number of Bedrooms O NA Effluent Filter Model 4-100 O NA Number of Public Facility Units ❑ NA Pump Tank Capacity al O NA Estimated flow (average) VO D al/da Pump Tank Manufacturer O NA Design flow (peak), (Estimated x 1.5) &O D al/dg pump Manufacturer I¢ ❑ NA Soil Application Rate © '7 al/da /ft2 Pump Model ❑ NA Standard Influent/Effluent Quality Monthly average` Pretreatment Un' A Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD51 5220 mg/L \0\ NA ❑ Mechanical Aeration O Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection O Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ' O NA Biochemical Oxygen Demand (BODj 530 mg/L -Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/LNA ❑ At-Grade O Mound Fecal Coliform (geometric mean) 510• OOmI ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Ye in dia. ❑ NA Other. O NA Other: ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 2 --3 ear(s) Pump out contents of tank(s) When combined sludge and scum equals one-third IY3) of tank volume O NA Inspect dispersal cell(s) At least once every: Z ❑ ear s1 s) (Maximum 3 years) ❑ NA Clean effluent filter _ At least once every: 13 ar() ❑ NA Inspect pump, pump controls & alarm At least once every: 7, ❑ month(s) ❑ NA ear(s) ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: O year(s) Other At least once every: Cl year(s) ❑ NA Oar; O 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 (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and dispoeed of in accordance with chapter NR 113, Wisconsin Administrative Code. AN other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at Intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shag be provided to the local regulatory authority within 10 days of completion of any service event. Page y of 2 START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or-must be taken, to provide a code compliant repl tAt system: 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 su tabl placeme a is not ava' to set and/or I lim' ns. n es in POWTS techn gy a tank ma e i ed as a last resort to replace the failed POWTS. PT f1~ alua ' 1 o ing Sjank b e failed ?904418 T1EIN, ❑ 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 ~~7' b (,~/Yh !3/,J Name PP hone S Z _ S' Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name S C ( 2dtll N Phone (p Phone 1 40 L.-# This document was drafted in compliance with chapter Comm 83.22(2)Ib)(1)(d)&If) and 83.5401, (2) & (3), Wisconsin Administrnive Code. J 2 1 3 5 P 3 5 5 7JZ $8srD WARRANTY DEED REGIISTER E H. OF D DEEDEEDH S ST. CROIR CO., WI RECEIVED FOR RECORD Neil L. Wilcoxson and Mary J. Wilcoxson, a/k/a Mary Jo. Wilcoxson, husband and wife, conveys 02/07/2003 02:00PH and warrants to Kernon J. Bast the following EXEMPT # 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): 20-110940-000; 20-11-9-20-000; 20- 1109-10-000; and 20-11-90-55-000 A parcel of land located in part of the Southeast'/4 of the Name and R~t na ealty Title Northwest 1/4, part of the Southwest'/4 ofthe Northwest 400 South 2nd Street 1/4 , part of the Northeast'/4 of the Southwest 1/4, and part Suite #115 of the Northwest 1/4 of the Southwest 1/4, all in Section 36, on, WI 54016 Township 29 North, Range 19 West, Town of Hudson, St. r, 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 V4 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 %4 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 6t , 2003. h il L. ilcoxson Mary J. W o on ACKNOWLEDGMENT STATE OF WISCONSIN ) PQIY P(/~flit. COUNTY OF ST. CROIX Personally came before me this _ day of 2003, the above med Neil L. Wilco tt3ol~' d Mary Wilcoxson to me known to be the persons who executed ~thnh?q~)f oing instrume a acknowledge theme ` PRESTON Nota Public _ My commission expires: - instrument drafted by Robert F. Wall. WilcoxsontoBastWD03-1I~OFW,S~-~~" This N, i I I I I W I CY c I a; I I I LL d; g~ o 3~ a I MAD? a o oho o -iT6-a~ Is3 = M.LOAL.OON\ Mloat.00N Mp72 l91112 N7L. E~ .E9 fx2 I I ' . ~O.OV III I ~ N / I ll'K91 r, R ro F ~ ~ j I oil N t ~o~i Ii o I / H ORZ Q7f ~t o I i O 'n'• JN8 ~~o I .140 MAR \ $ W S A 3NV7HV3l O 1 SOD11001129e.1.• b 6665 I/ ~ o j ~ A a j r - O• -4 2N I I ( AVIPOE M. LOBO LOON W SorWtS.Easae9 soot aouz: 9. I J ww3.LwLA 5 aurae ( / O N I I I~ I I / I .4 9 F --i-J pe Ssg•. - - - AV _ mtx. t ILI ILI 01 I~ I a ;I w N0091~VY NOONI3" S F S W - r m.a' mm -1 211 R 1-6 $ a Ell o on. 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