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HomeMy WebLinkAbout020-1441-87-000 r • \A. C') y O • O d * c d O ea Cn 3 m N , 7 co • A3 : aC - 0 :s - . c N 3 5E: -. ` 1 \ 3 u) T D! n o A co = W O i wV • (D CO 1 N c W l' 7 CO N U A C '" C 7 °A ? CO A 0 1 4, N E N 7 N 3 it -1 k.) "S °oCO) C 7 0 =0 I 0 * �� 2 4 V L I 7 W O z 3 Q 7 N Sjo O O •- C c N IC _ O O 41 :';5 V a J �. D I_.. A N O .. 61 ro a E. can '- G7 L N I r"1 , A N • O �J --� to (n � y � N N C G O O ' n 0 C CO CD CD A A CO .. Cr a co O O O c . v cn N to o o a C '0 0 0_ 7 A N ca o O N z , o p O D 7 (4.2 a N a3 CD o ti j 0_ . ro O N a) I '' G C G - N n D m a 7 I a _, -1 V) c A ∎ n ..a J CO d 'ii.: z 3 co CO cn m N m co m - ' z O. 3 A r. **\-- O •• z m 3 1 I N z A A " a <.0 0 a 5> > I ,...„,...t m W a'° v m a w \ O 77 cif 7 N O ; N cn N ? T - J-•' cn 00 N o ' O O c +a• l W � m z a N O O a ro .. G - G O C) (D N N (D ! a O . < G N N fAO p n N C...n 7 7 a N O O N c.= j / m -7 0 fl co O O d a O I O O CO T CD P V a 7 't .) O � co - C/) 7 co j a * W q cz sto ` O W VVV F A O tr I • K 49 O • cn O co �J O Q ti N sconsir of Commerce PRIVATE SEWAGE SYSTEM County: VV St. Croix Safety and Building Division > INSPECTION REPORT Sanitary Permit No: 453004 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 -87 -000 CST BM Elev: Insp. BM Eley: BM Description: Section/Town /Range /Map No 1, M Ps S 6/1/1 ,l, 36.29.19.2813 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ‘2-CD / Benchmark 3.3D / gt I Dosing �+ 6� I g, 1 Alt. BM Aeration .� Bldg. Sewer 3•V5 9 Holding St/Ht Inlet 1 1(so 81.(2P' . St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD I Dt Inlet .�. - --- Septic t 1 Dt Bottom > 4501 � - � 3S 3.05 -Hto $.05 •/3 Dosing ,,, u a L 6 , Header /Man. S, ors-.4g.' a Aeration Dist. Pipe (� � \ Holding Bot. System S�v `� _ VEIN PUMP /SIPHON INFORMATION v l . I Grade .0 Cc—ig.' ) Manufacturer Demand 1� St Cover r /� i(s.- �-t_ —tD S GPM C IA) Ch Y` Jur .. ?..o5 p •o5 77.. i3' Model Number O� n� _ / '� TDH Lift Friction Loss System Head TDH Ft -Io �ti ' `k 2 - ©y ((•ov �orcemain Length ( Dia. t Dist. to Well SOIL ABSORP [ T YSTEM (Z I) CL.,,.. 5 Ave-444._ = t 3) -41114 -‘tic-. 6-qt3 ) BED /TRENCH Width Length ��tI No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth g JJ DIMENSIONS 31 G , f ) , 3 SETBACK SYSTEM TO 0 P/L B LDG WELL LAKE /STREAM )CHIN Man ct a :' n ' INFORMATION HAMBER •R l'�7�✓ Ty Of System: t C /' /1/0-4-4 t ,� 51 (%) UNIT Mo tuber: G i e f at L'. - IBUTION SYSTEM (2.440 ecsak 1Z. 0.W) Header/ anifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia L Spacing - 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 El Yes 0 No L _1 Yes No COM � MNTS: (Include code discrepencies, persons present, etc.) Inspection #1��d1� / OO C f Inspection #2: / / Location: 819 Wilcoxson Drive Hudson, WI 54016 (SE 1/4 NW 1/4 36 T29N R19W) Cotton •_: - i••- s • • a — o: 3. - . 1.) Alt BM Description = r r /#11'4/ S � 1/1",-/- 1/1",-/- l t' 6:3 1. � S, r 2. 9 length = Bldg sewer len L 2� �/ 4s rCul n Q� -n L.• - • u 3S 11L�' - amount of cover = 43 • G2t. CQJ In - C�1``.d.4 , /0. c 3 • � 5 , 9' = � CIO 3) Qwske iit '" `I "^ • , 5 . 1 16.10 -.:9,-t.o. I•I - I � .Ol r a . - ig $ c IL Plan revision Required? No,' -z ,.. y . 1/ Use other side for additional information. I i _ ) SBD -6710 (R.3/97) l� I Date ,� , Insepctor's Signature Cert. No. / t �� 3 0" Z) iih. rec t.tva 9034,1 - , Safety and Buildings Division County .5 � Wisconsin 201 W. Washington Ave., P.O. Box 7162 . Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 - 3151 4 /530 0 y Sanitary Permit Application State Pl i DD. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s 15.04(1)(m) Project Address (if different than mailing address) ! L Application Information — Please Print All Information ►— � S Pi Property Owner's Name ,,,� 430 � # Lot # Block # K 9 A.0..?3\e\—. 13(3-4-4— ,,,,- ,- ( .,: :-IAL 8 7 Property Owner's Mailing Addres 0 Property Locati c / h ST. CROIX COUNTY .5r Y., Nan, Section 3 City, State Zip Code _ Phon th bkG OFFICE (A-CU 1A-C2- Y � _ � IL ir �e) CS T N; R RILE II. Type of Building (check all that apply) Subdivision Name CSM Number 1 or 2 Family Dwelling - Number of Bedrooms S ❑ Public/Commercial - Describe Use / ❑ State Owned - Describe Use ❑City_ ❑Villa •,e To ship of / III. Type of Permit: (Check only one box on line A. Complete line B if applicable) — � t, 04, A. ' New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement • my ❑ Other Modification to Existing System B. ❑ Permit Renewal Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner 4S'3 00 /) ` / d C/ 7 IV. Type of POWTS System: (Check al that apply) '41 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 'd Leaching Chamber ❑ t rip Line ❑ Gravel -less Pipe l Other - .lain) V. Dispersal/Treatment Area Information: 1 04 •' id Own a Design Flow (gpd) { Design Soil Application Rate(gpdsf) Di . -rsal Area Required (sf) Dispersal Area Proposed (sf) System d ie - vatiionn i (O0 r d° /(7 /c �J/ 4 7 / 0 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank / -._., )RIP° / A/ - ► /I ✓' . Aerobic Treatment Unit / Dosing Chamber ©e -) E3 ) (b VII. Responsibility Statement- I, the unde igned, assume responsibility ffol ii i s taail / at - on of the POWTS shown on the attached plans. Plumber's Name (Print) PIu , is Si7 ature '° 1 /MPRS Number Business Phone Number i / Y U TG /90 . 0 .?s ? 7iS - a4 : - . s , Plumber's Address (Street, City, State, Zip Code) I/o Al /'Y. - )1/ z . S` VIII. County /Department Use Only Approved ❑Di Sanitary Permit Fee (Intl es Groundwat Date Issued Issuing Agent Signature ( Stamps) Surcharge Fee) i ZLi '� ❑ Own x Given Kensatr ror venial I rk' IX. pCCo \nditio/onns�� /R �p p.w ( g3 s ., 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) LOT 85 o LOT 84 2.70 ACRES 2.16 ACRES I. 117,792 SO. FT. g 94,298 SQ. FT. J 6 1 e' • i •• . • �� 4,-..7 ..... / I ;11v ‘ \ —= --=.. 1 • 19 / I o 2 I � I I8 v ° I N89 °55'21 "E 541,76' II 0, 5 . w 1 326.83' 214.93' I S' A I 15 1 8 1 L . i — 8 LOT 86 I i o 1 �1 2.46 ACRES o ` 107,230 SQ. FT. co 99 °55'21 "W 179.1'8' 1 z i-, m — — — I LOT 83 1 I 2.11 ACRES ° J89 °55'21 "E 179.21' in 91,703 SQ. FT. w o • �, o • • I c 5 m • • 0 ® • • `` • S75-. 4232E 394.12 i 1 N. N89 °49'59 "E 523.00' &' 241.50' 6 6' ! /1"."-----1-----. I .. 4) LOT 87 SHED N89 °49 "E 5 1 ' g • • i. / 2.74 ACRES . 0 ' 119. 8 SO. FT. /90 / ` y c 4 14- j� I yr l t� � z Co I / • o qY ® vUG�LD[�G14�LD LIaG']D��S OGI, 12 "E 7057 , r (��C OUTLOT 2 5 0 g _ � oJo C • A ,OVNTM TR UN -316.33; 8 ° 32� Y M K NIC AY r y Zn _ _ _ _ _ Z ,_.7 ) A „vvc..27i ,----- S7 �� 2 E 7 - _N = Q a D 12 , ' - �o � �— 54 - ". . " JOE) c� D o 33 69, D _D .9 -` -� ao3 zF -� - $13104 ilk ZS - ) ,' DI,,, . -1 1 SCALE IN FEET 1" =100' 100 0 100 200 :LAN UM JOB 02.80 DATE 7 -1 -03 I I� .(P - ' 4 7 K)0 k 'd ' 17 '' D ' ' q::- t3" � , � ��,� _ � _ /cage ' 1 9 Din- , -,,,_, 1 I , �aoo <59 q 1.-36 r � �a �-�" 3� Aot B7 s ,.�1 . ,, yo J - do FA.frg-k. Y 1 V Ad)" i , h -V , . .r, • P IN c6.. o 1 1 ofY -,o -5 >'`- /D ldIt 11.3 1 /' I 04 10 X 7-, / 11.:: : A° r 1 (' •' ' ek I y ' ' -I 1 5 7 a ; IT3-11:y —r-© i.kv►A — fluoi Al w -. or 6 , / 71°35? 4" CI VENT PIPE 12" HTN. ABOVE GRADE E WCATHFR PROOF 2:25' FROM DOOR. WINDOW OR JUNCTION BOX APPROVE FRESH AIR INTAKE- WITH CONDUIT MANHOLE FINISHED GRADE 4• CI RISER W/ P 6" MIN r WARNING ABOVE G ADE - .- _ 0 iss_ H : 18" IN. 6" MAX. ; •1 .:.. r... IN ; ; = f • I r WATER TIGHT SEALS GAS. ; • TIGHT I 4" A SEAL CI PIPE BA ..-L.... , APPROVCC LM JOINTS w 3' ONTO B ,� ON PIPE 3' SOLID . ' C ,� SOLID SO SOIL PUHP OFF ELLV . FT. + - OFF ** RISER D 'a, PCRHITTZ IF TANK MAW PAC 3" APPROVED BEDDING UNDER TANK HAS APPRI CONCRETE PAD SPECIFICATIONS cEPTIC / DOSE 3 TANK MANUFACTUR NUMBER DOSES PER DAY: • TANK SIZES: SEPTIC Ob GAL. DOSE VSL:UME INCWDZNG DOSE GAL. FLOWBACK: 0( CQ3, ALARM MANUFACTURER: y4 3,4-K CAPACITIES: A = INCHES = 3 MODEL NUMBER: _._.�.... SWITCH TYPE: B s r INCHES= yv2 i PUMP MANUFACTURER: A,..A i - C = 1,?,cINCHES = g6,3 t MODEL NUMBER : -- , p SWITCH TYPE: _„„,,,, D = 5 - INCHES = /05 REQUIRED DISCHARGE RATE /2 S PUMP E ALARM WIRING AS PER ILHR 16.23 VLRTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . ,,,.5 , • MINIMUM NETWORK SUPPLY PRESSURE 3 FEET • __/?(D FEET FORCEHAIN X /r /OFT/ 100 A FT. FRICTION FACTOR . . g - FEET TOTAL DYNAMIC HEAD _ FEE T 4 1 3 ... fi p. FEET I NTERNA L DIMENSIONS OF PUMP TANK: LENGTH ; • WIDTH ; DIAMETER LIQUID DEPTH 3 D :IGNED: LICENSE . NUMBER: ....� 1 o�op�O -3s- � n ---) 6ccct\lepQ , GOULDS PUMPS Submersible vie! i Effluent Pump i `- 11 MODEL 3871 ., EPO4&EPOS W_ ii, _. Series APPLICATIONS • Fully submerged in high • EPO5 Impeller: Thermoplas- • Bearings: Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing following uses: lubrication and efficient improved performance. construction. • Effluent systems heat transfer. ■Casing and Base: Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms manual operation. Auto superior strength and corrosio • Heavy duty sump matic models include resistance. C an Canad Standards Assodation • Water transfer _ File # LR38549 Mechanical Float Switch ■ Motor Housing: Cast iron • Dewatering assembled and preset at the for efficient heat transfer, Goulds Pumps is ISO 9001 Registered. factory. strength, and durability. SPECIFICATIONS • Motor Cover: Thermoplastic • Solids handling capability: FEATURES cover with integral handle and 3 / 4" maximum, • EPO4 Impeller: Thermoplas- float switch attachment points. • Capacities: up to 60 GPM. tic semi -open design with Power Cable: Severe duty • Total heads: up to 31 feet. pump out vanes for mechanical rated oil and water.resistant. • Discharge size: 1 'h" NPT. seal protection. • Mechanical seal: carbon - rotary/ceramic- stationary, ,i1 BUNA -N elastomers. I • Temperature: Gi.°1 104 °F (40°C) continuous 140°F (60°C) intermittent, METERS FEET • Fasteners: 300 series ° r stainless steel. ' • Capable of running 9 30 —.I ).-5 GPM dry without damage to _ components. $ 25 1 — 2 5 FT ° 7 ------1 Motor w • EPO4 Single phase: 0.4 HP, u 6 - 20 115 or 230 V, 60 Hz, 1550 a — RPM, built in overload with > 5 - automatic reset. ° 15 1 • EPO5 Single phase: 0.5 HP, 0 3 _ to 115 V or 230V, 60 Hz, 1550 EPOS RPM, built in overload with �h. automatic reset. 2 - d� ER04 • Power cord: 10 foot , p tJ t ._ . standard length, 16/3 - 1 5 SJTW with three prong grounding plug. Optional 20 ' i j foot length, 16/3 SJTW with 0 00 10 20 30 40 i 50 GPM three prong grounding plug I (standard on EP05). 0 2 4 6 8 10 12 m /h APACIry ^ c, �p �"' Goulds Pumps ® 2003 Goulds Pumps `��)S / Effective July, 2003 83871 ITT Industries I Safety anti BuiA f Cc'unty (� ASP � � sconsiln 201 W. Washington Ave., P.O. Box 7162 rr ASP 'rte Madison , ) 53707 - 7162 anitary Per" mit Number (to be Lille in by Co.) ® I Department of Commerce (A08) 26 'x' 2 6 2004 5306 Late Plan I. Nr . Sanitary Permit Applica tionr. ciao x COUNTY In accord with Comm 83.21, Wis. Adm. Code, personal infornation ycaliiiiilda OFFICE may be used for secondary purposes Privacy Law, s15.04(1)(m) 'Project Address (if tfferent than mailing address) • Ao 1. Application Information — Please Print All Information / 7 G a Property Owner's Name Parcel # Lot # Block # _ Property Owner's Mailing Address Property Lofati/ S N 3 co on City, State Z ip Code Phone / Phhone Number � p I' �.� 5 „� L/- , - 6-- ;r // ' , N, R c E or W one) II. Type of Building (check all that apply) 3 8 7- l ('` �d� 2nNatM N nber or 2 Family Dwelling - Number of Bedrooms / � ` S� `/ ❑ Public /Commercial - Describe Use ❑City_❑VilljeTo ship of ❑ State Owned - Describe Use DI sr. c-eu � ....ALt �[ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System 0 Replacement System ❑ Treatment/Holding Tank Replacem: t Only 0 Other Modification to Existit stem - ` Lis iou ern' Nib e Is ed B. ❑Permit Renewal ❑Permit Revision ❑Change of 0 Permit Tr• sfer to New 1 `7 Before Expiration Plumber Owner t IV. Type of POWTS System: (Check all that a 5 • ) Non - Pressurized In- Ground 0 -. Mound > 24 in. of suita. - soil ❑ Mound < 24 i , . of suitable soil ❑ At- ade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Ta ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter !i Leaching Chamber ❑ Dri. ine ❑ G,vel -lTss Pi. 2 Other (expla' 7 G/ I „ /i . V. Dispersal/Treatment Area Information: ' -- O _M 2��1F— --=-7i- -Srp. iiiik Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Ar" ired (sf) Dispersal Area Proposed (sf) System Elevation i 3 660 , s ✓ ,O i aig '7,5": VD VI. Tank Info Capacity in Total Number ifacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Ai/ / ' Tanks Tanks _ Septic or Holding Tank ig /-,` / t J c , / - Aerobic Treatment Unit J VV Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume respo .ibility for installation of the PO shown on the attached plans. Plus Na a (Print) Plum As Sig Fr — PRS Number Business Phone Number OW liaaig VP' , alas? 7, - 2 6 Plumber's Address ( Street City, State, Z Code) 100 �U ` U 'o/. VIII. ounty /Department Use Only f pproved ❑ Disapproved Sanita enmit Fee (includes Groundwater Date Issued Issuing Agent g� re ( ps) Surcha .e Fee) ❑ Owner Given Reason for Denial .. � / (� c /d 0 ►� L4✓Y ' IX. ( / Reasons for 1' appri ;.1 ,��„ l / 4La M ; cC� Y TI Septic II /- � W,� Sep t ank, effluent filter and i /�� dispersal cell must all be serviced / maintain � • Q 7�' as per management plan provided by plumber , g 3. s All setback requirements must be maintained ` lip/2426..54 i ���a�- as per applicable code /ordinances. 0 Sys-feih t 1- ,yyt . g' 3. ((3- -1 Attach complete plans (to the County only) for the system on paper not Tess than 81/2 x 11 inches in siu SBD -6398 (R. 01/03) ' 4 g , n 1 0 gm - 1 :: /60 ' , 1 1 c3- V?L(I()'( rati V? i /7 l doQ 5 3 ' ( ? / ( ? ) ; ) , d y /11=31) T I/a "i 39 644,./d,•--_ 3?1<3/1-.;-. Aat B7 1- — - , Wr'', d , of , , , & . Pt i f a., 1 1 C A./ Ai-/0 >7/-iD i3 1 r V% r3 x 1 I i ` xt3- l /5 / alb ^ 9, uh-e _ Mk-- ► --� Haw Al 0 ® g , P/ 704 35- ? /3' t/pp ; p t1 p� .• KFRtiv,) /345r 3 t7o,v4,f SpE /3 � -S 7 9 5/ie.' 1.1- B, RD • Hvpso,- w/. s yo/ ( ' , . . tMsoonstn Department of Commerce SOIL EVALUATION REPORT / 3 of Division of Safety and Buildings . in accordance with Comm 85, Wis. Adm. Code County 5 T cR Of x_ . Attach complete site plan on paper not Tess 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. $.e e. 4.e./6 lc, *- percent slope, scale or dimensions, north arrow, and Location and distance to nearest road.- Please print In 11,44 evie Date Personal Information you provide mey be used x seco . a 1 6".. ` .. - Y s. 15.04 (1) (m)). I OA / 6 Du Property Owner P Location Of W �- / /ti5 /L 1(1/' -GOX„S OA) AN N 0 9 2003 Cwt. Lot 5e 1/4 A4r,l4 S 3G T 29, N R /7 4 (or) W Property Owner's Maili Address / Lit # • • .. Subd. Name or CSM# p /4-r', p,,47J2 / ,O(, d/ (p Cry A $T. CROIX COUNTY ", V n / J /� • #149.50,t) W State SYo e --J City ❑ Village 0 Town Nearest R•'• .. / 4 ( 7 /S 3 rG • 2 9 /f vpsa.o ffto , N C.§-New Construction Use: (Xi Residential / Number of bedrooms 3 - y Code defined design flow rate ySO — ep cm GPO ❑ Replacement ❑ Public or commercial - Describe: Parent material / dock .S,QvP t,/ evi- it f Flood Plain elevation if applicable - N /� - - ~ -- ft. , General and recommendations: r net* Tt /5 SO/ ri 7 ..4- {9/e of/ti M./MO/ re,()V •t)77o rJ,¢L. I i. • 6'. 4' . T. 5. W5 /.v $,°4 .41 F`ll Sit._ Cels. ( .55e - 4.3) • ❑ � q , d • Boring . o > '� / I # ® Pit Ground surface elev. { ft. Depth to limiting factor in. Soil Application Rate Morison Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff in. Munsel Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 L 'Elf#2 y/' 0 - 7 /o3 — /fshg -v - 1v 3 -F • y . 2 9•Z/ /owe y� — 3/L 2 S/, •ki f? c .2 • 5 •r§ 3 2 1-.3g /oy_R 7 4 , — 5/L 24•4 ,j7 4 5 — . 5 .8 ii 3e• 9(5* /� /-7c9w is ._ -- s • 9 . , ❑ Boring Z 8orkg # M Pit Ground surface elev. /O D • ° ft. Depth to limiting factor 7 72 Soli Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIIF In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 / o -/0 / 2 2 / 3 L / 7Cs 6 4m f / Q 9 3 - F • $ i _ - 6 i /v •ZZ /op? y / — _5 2f5be ,, 1,' c5 Z f . 5 . 8 3 22 • � 9 5/L 2 '/.." 1,e / —_ • • et s i� • rx 3f .f /1) W? - G/ / f . e5 4 1)0 • _1 .7 55:.Z" f /•'" _ • Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/i. • CST Named Print) Signatu e - CST Number • i'o /3e, r ?! /,ion/ ct I / 21c, 3 `z S Address Date Evaluation Conducted Telephone Number Ulbricht R, Associates ' - D. . Ce — ZOO Z '7/5. 26 • IMPS rrivatts z'b:rstt1tant:* 055 O'Neil Rd. Hudson, Wis. 54015 . Avg N g or s to oD. o • / /oy•ya• • se 2 c - //O7.269 • o'° • r I 1 Buy K .� 0 r - Z3 02o•I /0f. yo Property Owner Neil_ Gvi �c o ( So N oa. p . Ho/ . 2-0 . a rt) Z 3 Parcel ID # Page of I 3 I Borin o Bo �g. zo > 90 , it Ground surface elev. ft. Depth to limiting factor in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence I Sod APPS Rate Boundary Roots GPDfff In. Munson • Qu. Sz. Cont. Color Gr. Sz. Sh. • L: 'Ef #1 'Efitf2 / o • /3 %ye . L /fs, e 4f, � � 3 f • V . . 2 /3 -.21 jo y/' f/ .5 /z, /f$k 75.? 4$1 ' cs / f z 3 3 / • yo /ow <S /L 2 et 4147 • Cs • — . • s . c 9 r b . y 75 IQ 5L 244,4 Ls 44► fie 4. 5 • f yS '9 0 7 .5 5 G >C5 / f S 5 . B oring # Q B C] pit Ground surface elev. ft. Depth to limiting factor in. , Soll Horizon Depth ' Dominant Color Redox Des Application Rate Description Texture Structure Consistence Boundary Roots GPM In Munson Qu. $z. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 • I' 1 I Boring # ❑ Bori ❑ Pit Ground surface elev. ft. Depth to Nrta6ng factor In. Horizon Depth Dominant Color Redox Description. Sol Application Rate ption • Texture Structure once Boundary Roots GPDIfF _ In Munsel Qu. Sz. Cont Color Gr. •Eff#1 'Eff#2 t • • . 1 Boring # ° "ring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soli Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDNF In. Muns#N Qu. Sz. Cora Color Gr. Sz. Sh. _-- •Eft#1 'Efr#2 • Effluent #1 = BOD > 30 < 220 mg4L and TSS >30 < 150 mglL • Effluent #2 s BOD < 30 mglL and TSS < 30 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 608-264-8777. 610-11330 (R.6/00) 1 1 For issuance of permits and designing Contact: Ulbricht & Associates Registered private wastewater consultant and plumbers 655 O'Neil Road N Hudson, WI 54016 715 - 386 -8185 or 715-772-3442 • , S c /le :/ 1 3 0 q /3 4Cit o-e Pi' 7-5 G 0 --t- . 4 . = t - i Ira U2 // € 5 Tor of j3 " 5 P � y ov-� VP 1 '4) • o • u gp ,/• 'It 1 0 106 L 02- ,' w 0 T y� /OS, I 4 K o f ? d 1;� tit 1-----: �3 5 560;1, Aa�R ` . D gig. ' 9Va c v' /57 es b Z 6 1 ----PTO) /,1/, 1 R. ow. 33 ' 1 flw Y. Al CI- POWTS OWNER'S MANUAL & MANAUtMtN 1 rLMN Page ( of Z FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity » ?50 , at O NA Permit # 63 Db 91 Septic Tank Manufacturer tux �pp O NA OESION PARAMETERS Effluent Filter Manufacturer �?j, �j_. & 0 NA Number of Bedrooms 7 O NA Effluent Filter Model A--/0-0 0 NA Number of Public Facility Units 0 NA Pump Tank Capacity g a l 0 NA Estimated flow (average) /O 0 g /day Pump Tank Manufacturer O NA Design flow (peak), (Estimated x 1.5) 600 gal /day Pump Manufacturer 0 NA Soil Application Rate , gal /day /ft2 Pump Model 0 NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit O NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L O Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) 0 NA Biochemical Oxygen Demand (BOD 530 mg /L JIn- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA 13 At -Grade 0 Mound Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA I Other: 0 NA Other ❑ NA Other: O NA "Values al for domestic wastewater and septic tank effluent. Other: typical 0 NA MAINTENANCE SCHEDULE • Service Event Service Frequency Inspect condition of tank(s) At least once every: a Et year(hs)1s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume 0 NA Inspect dispersal cell(s) At least once every: CK month(s) (Maximum 3 years) ❑ NA Clean effluent filter A.S k i eD At least once every: l 0 month(s) ❑ NA iiii year(s) ❑ month(s) 0 NA Inspect pump, pump controls & alarm At least once every: ❑ yearls) Flush laterals and pressure test At least once every: ❑ ❑ yearlmontsh) ( s) ❑ NA Other: ❑ month(s) ❑ NA At least once every: ❑ year(s) Other: 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 disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. Al 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 shall be provided to the local regulatory authority within 10 days of completion of any service event. Page Z of Z START UP AND OPERATION , For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or othar chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the 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 replace 7 ent system: x1 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 VA technology a holding tank may be installed as a last resort to replace the failed POWTS. alua ' • • •• a . • i ng tank b e ai ?RD44 t8 rre2N 04- A/ - 772dC t O ❑ 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 INSTALLS POWTS MAINTAINER Name Name Phone tX .- l 9 � ` S Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name V • TKO 96 (DU 2ottli4 G- Phone Phone 1/S 3O .0— /') This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &0) and 83.54(1). (2) & (3), Wisconsin Administrative Code. r ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer i" Mailing Address �.� yam / / A/1 5 I Property Address ♦ �_.— _Al' / ` • (Verification required from Planning Department for new construction) lit City /State &t4/ Parcel Identification Number 020 ' mg '1 / - 8 - o &O LEGAL DESCRIPTION • Property Location5E %4, it) k1 ' , Sec. , ? , T 01 f N R 1 / W, Town of /r GL: 'N -` Subdivision 7ZW Af. 4 ' , FAO ,7. . Lot # 6 Certified Survey Map # b , Volume , Page # . Warranty Deed # 708 8 �`2 o , Volume ) 35 - , Page # 33:5 . Spec house ❑ no Lot lines identifiableies ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can 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 master plumber, journeyman plumber, restrictedplumber or a licensed pumper 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. I/we, 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 the three year expirati n date. MATURE OF APPL CANT DATE OWNER CERTIFICATION I (we) certify that all tements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the property descn above virtu of a warran deed reco rded in R of Deeds Office. g </1/ 1 -t,- # /SOY SIGNATURE OF APPL ANT 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 • J 2 1 3 5 P 3 5 5 7Lb888fd WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., YI Neil L. Wilcoxson and Mary J. Wilcoxson, a /k/a RECEIVED FOR RECORD Mary Jo. Wilcoxson, husband and wife, conveys 02/07/2003 02:0ePn and warrants to Kernon J. Bast the following EXERT 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 Name and �g 1• i0: A parcel of land located in part of the Southeast '/4 of the ina Realty Title Northwest 1/4 , part of the Southwest '/ of the Northwest 400 South 2nd Street 1/4 , part of the Northeast'/, of the Southwest1/4, and part Suite #115 of the Northwest '/4 of the Southwest V4, all in Section 36, / �j }s W f 54016 Township 29 North, Range 19 West, Town of Hudson, St. 1 2) ��'I"i' a Croix County, Wisconsin described as follows: Commencing at the South V4 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 comer 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 /4line, 1977.22 feet to the South line of the North 350 feet of said Southeast 1/4 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. t/t. Dated this �� day of _joe-vea)-7 , 2003. ‘,.„9,4, `( L. ilcoxson Mary J W' o on ACKNOWLEDGMENT STATE OF WISCONSIN ) *` COUNTY OF ST. CROIX ) At A- / O <t iN r P Personally came before me this day of /a�7 , 2003, the above ' - med Neil L. Wilcoorol4 d Mary . Wilcoxson to me known to be the persons who executed th f o oing instrume - • acknowledge the PRESTON 1 , Nota Public — My commission expires: 19 This instrument drafted by Robert F. Wall. WilcoxsontoBastWD03 -1 , J ? O W;$w0 12/08/2009 15:50 FAX ST. CROIX CO. CLERK a001 * * * * * * * * * * * * * * * * * * * ** * ** TX REPORT * ** * * * * * * * * * * * * * * * * * * * ** TRANSMISSION OK TX /RX NO 0216 CONNECTION TEL 917152469744 CONNECTION ID ST. TIME 12/08 15:49 USAGE T 00'59 PGS. SENT 5 RESULT OK Wisconsin.Dtpartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix ' Safety and Building Division - . INSPECTION REPORT Sanitary Permit No: 453004 0 GENERAL INFORMATION (ATTACH TO PERMIT State Plan ID No Personal information you provide maybe used for secondary purposes [Privacy Law, 5,15,04 (1)(m)). ■--.0' Permit Holder's Name: City Village X Township Pare( Tax No: Bast, Kern on Hudson Township 020 - 1441 -87 -000 CST BM Elev: Insp. BM Elev: BM Description; Section/Town /Range /Map No: 36.29.19.2813 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic tcat / Benchma I J.1 L O r Dosing � I Lc o Alt. BM 3.3 100 � •� Aeration Bldg- Sewer I3•511ji /O' k i Holding St/Ht Inlet gCpq S1/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet . Septic I t Dt Bottom i r Dosing 0 v °` y , r 6 , Header /Man. Aeration >/ Dist. Pipe I \ ------') Holdingf Bot. System See iF 1 Grade PUMP /SIPHON INFORMATION .0 cog, l Q ' 1St � Manufacturer Demand (: over t 2 I f4- c� S 1—.6 GPM .±0__40.,.:„..p__ j Model Number C7 a �� �� • 13 'P TDH Lift q Friction Loss System Head TDH Ft ' kv �• l3 2.61 I(.07 C' orcemain Length _ t Dia. t Dist. to Well -171 L SOILABSORPTi^ � � f , - =(13)4 Q. (IfrJ) BED /TRENCH Width — Length No. Of Trenches PIT DIMENSIONS No, Of Pits Inside Dia. Liquid Depth DIMENSIONS 3/ (3) SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Man ct fit' (� INFORMATION CHAMBER OR 't'f14i�e✓ Type Or Syctem: 5 r ! ;` —�^ UNIT Mtkeleere� u l ) t J,L DISTRIBUTION SYSTEM ( (4.O. uoadnra I I nw lry.- 44..w.... — r ..I1_I _ -_ _ ,. .. i.. .. .. i