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HomeMy WebLinkAbout020-1454-00-089 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No , • 488176 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, Town of 020 - 1454 -00 -089 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: IGO .0 Iry . CST ` 1 = -{pp ° evC t 36. TANK INFORMATION I ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Li.. 6E"KS Septic Benchmark � lg � V 1, i � . � t 12.42 Q oCt� Dosing N I / / f Alt. BM Aeration Bldg. Sewe 10.D2 i17. 9/' Holdin `_ St /Ht Inlet i17 1► l TANK SETBACK INFORMATION St /Ht Outlet (t.'0 qr. S TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic > ! g l > l op 1 (, Dt Bottom Dosing Header /Man. Aeration Dist. Pipe (C) tz SU • e 2.3 ) t3..1.2 Holdi Bot. System t3•5? e t 3 / • 14.31 92: " Final Grade PUMP /SIPHON INFORMATION _ $•0 /ply Manutacturer • nd GPM St Love C st' 5 44'2- •/4 - Model umoer N -'" Ic ion oss - - • orc-m= • "- -re , : s - • 1 1 • ' Orill _.., ,, or IN0 (I DIMENSIONS • rt.! �11 ■ INFORMATION CHAMBER OR rat �i ` • UNIT 1 - - 1 • ` 1 IeddeI/Polarlifuld � Dibtrlburiun x nble Size x Mule Spai.hry Vent to Air Intake Pipe(s) • Length/ Dia Length II la Spacin. -a > t EV SOIL COVtK x Pressure Systems Only xx Mound Or At - Grade Systems Only Depllr Over Depllr Over xx AA SeedeJtSudded A. Muk.lreJ Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes No C 11 NT . S � � : ( IIn gpde iscr n ies, pe so s pre ent, a .) ph, nspe ion #4.47•4_�� Inspection #2: �' 7 Lo atio 824 Riley�ne H d o4 16 (SW 1/4 N 1/4 36 T 9 N R1 Cottonwood Ridge 2nd Add Lot 89 Parcel No: 36..1 .2904 1.) Alt BM Description = 5 ' ; 'M .045 " _ C Y4!' *diet. 3) cAAN abiellaVN, 1 2.) Bldg sewer length = 4 , .As1r•. - amount of cover = `� { `e . . "4 n n. 0 �. — - s - __ _ it r. L 4 - S .■ l .•• . ' '1 \ 1I Plan revision Required? I I Yes No ( ►. Use other side for additional information. ..� I • , p • na ire . -1 - C - e . SBD -6710 (R.3/97) Safety and Buildin' s DivijV i County 201 W. Washington Av ., P.O: B•° 5 1p Madison, WI 5 707 — 7162 - �� ni tar 'emit Number (to be filled in by Co.) S (608) 26 3 151�' Department of Co , State 'Ian ID. Number San ' App 1, x co U /V In accord with Co Code, personal information you • de T may be u oses Privacy Law, s15.04(1)(m) et Address (If different than mailing address) if I. Application Information - Please Print All Information 1 > 2 p ! N€ l`t Property Owner's Na me Parcel # Lot # own ..- - Property Owner's M ailing Address p h Property / Location 9 1 ( h1i B � AV s W t /UWt,4,Section City, Sate /� .0 Zip Code / Phone Number D S � G✓ ( 5-0(6 7( fi; - 777" T Z9 N; R_ 9 (circle one) II. Type of Building (check all that apply) 04 pkr $ . Subdivision Name CSM Number ,f 1 or 2 Family Dwelling - Number of Bedrooms S .v j ❑ Public /Commercial - Describe Use �O,F { t! N worn) R l ��Ce ,9D • ❑ State Owned - Describe Use ' • - ❑City_❑Village laTownship of (4' k DJ #.V III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. I .New System p System 8 A Only Existing Y ❑ Replacement S S[Cll] Q Treatment/Holding Tank Replacement Onl 0 Modification to Existin System • B. ❑ Permit Renewal' • ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that apply) (2 '(J , / c ilMaglayrik, lil Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade 0 Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ hecire a iniSgn1 F• ter , ❑ Recirculating Synthetic Media Filter Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (ex ain) ° " �' � " V. Dispersal /Treatment Area Information: 5'.'10 67-11444) Tr $ Des�Flow (g pd) Design Soil Application Rate(gpdsf) Dispersala Required (sf) Dispersal Area Propose f) System Elevation VI. Tank Info Capacity in Total Number 7 Manufacturer l + ' Site Steel Fiber Gallons Gallons of Units Lit ---10D t P 'n ete Constructed Glass 9 , 3 New Existing �; / Tanks Tanks -{ t l Septic or Holding Tank /Z-10 / 14/C-�-(J 9� Aerobic Treatment Unit 1 � Dosing Chamber • • VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si gnature MP /M+ Business Phone Number 4 ?MT 10 WO i ? I Z ' 7%51 �� � 6 f 9 z7 Plumbeiddre ss (Street, City, State, Zip Coda 3 �l w( L.5 1 ( VIII. Countypepartment Use Only g Approvpd 0 Disapproved l Sanitary Permit Fee ']eludes Groundwater Date Issued 'ssuin! Agent Signatur (No Stamps) I Surcharge Fee) '1 � t ❑ Ow • easo .r Denial il► 1. , ■ � !/v --/ Ili IX C onditions o • • proval/ 1 1 . _ 1 i SYSTEM • ■ ■ - , 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained • as per management plan provided by plumber. ' 2. All setback requirements must be maintained as per applicable code /ordinances. 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) • Lb-� Q �P� N��c� P Lo \- gq , go ---- AAA, ih (049 © q3,7 �Ftiz 83 /`k� ®9 G //a di o it6(11" 6 So cp pk-ft° 0,b 1 ` 4k 60' c 1I 8/4.,„ ,cs,v4/4 Q Les- Q1LN teNA)/J got AA A, /14,e 4 g3 7C ( B 3 1 /- 6 c of 6 dp ,c 0-1 1-1,(0.0 ict- ���cy Z/ . o #1638 Vsconsjn SOIL EVALUATION REPORT Comm 85, Wis. Adm. Code Page 1 of 3 in accordance with , Department of Commerce Division of Safety and Buildings Steers Soil Service, Inc. h County Attach complete site plan on paper not Tess than 8% x 11 in e si - Plan must St. Croix include, but not limited to: vertical and horizontal reference poi = ' � • irection and percent slope, scale or dimensions, north arrow, and location an • • 7 : n o nearest road. Parcel I.D. Pending Please print all information. R iewed By Date Personal information you provide may be uses s rr :r, m ••:i •' • • . • • s , a5 • ' (1) (m)) , • O 13' 2c04, Property Property Owner Location Bast, Kemon 3ovt. Lot na SW1 /4, NW1 /4, S36, T29N, R19W Property Owners Mailing Address APR 1 3 2005 -ot # Block # Subd. Name or CSM# 948 Labarge Rd. 89 na Cottonwood Ridge 2ND Addition City State Zip Cog Ci�� City Village ® Town Nearest Road Hudson 1 WI I ZONING OFFICE Hudson 1 Cty Rd N El New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement 11 Public or commercial - Describe: na Parent material Stream terraces and pitted O(. w It 5 /7 ® A, 4, Flood plain elevation, if applicable na ft. General comments Conventional system, system elevation 95.75ft. Trenches spaced and depth to and recommendations: code 5.25ft below grade. _ "V l C ad" 5� �o Wow 4'raQ.�, -' / q`?•(c/ 1. Boring # Boring ® Pit Ground surface elev. 101.00 ft. Depth to limiting factor 120 in. Soil Application Ratel Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color *Eff#1 *Eff#2 1 0 -10 10yr3/1 none sil 2msbk mfr cs 1vf .6 .8 2 10 -17 10yr4/4 none sid 2msbk mfr gw na .4 .6 3 17-43 10yr4/4 none sl 2msbk mfr gw na .6 1.0 4 43 -120 7.5yr4/6 none cos osg ml na na .7 1.6 ets 3 /etq 2 Boring # Boring Xf Pit Ground surface elev. 101.00 ft. Depth to limiting factor 120 in. Soil Application Rate] Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell _ Qu. Sz. Cont. Color *Eff#1 *Eff#2 1 0 -18 10yr3/1 none sil 2msbk mfr cs 1vf .6 .8 2 18 -21 10yr4/4 none sid 2msbk mfr gw na .4 .6 3 21 - 32 10yr4/4 none sl 2msbk mfr gw na .6 1.0 4 32 -53 7.5yr4/4 none cos osg mvfr gw na .7 1.6 5 53 -120 7.5yr4/6 none cos osg ml na na .7 1.6 0.4 Ys •' - - a> 3/q c, * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L *Effluent #2 = BOD < 30 mg/L and TSS <30 mg /L CST Name (Please Print) nature: CST Number David J. Steel z 248956 Address Steel's Soil Service, Inc. G Date Evaluation Conducted Telephone Number 994 200th St. Baldwin, WI 54002 4/11/2005 715 - 760 -0347 SBD -8330 (R.07 /00) • . Property Owner Bast, Kemon Parcel ID # Pending Page 2 of 3 1 3 Boring•# El Boring 1Z 'Pit Ground surface elev. 97.40 ft. Depth to limiting factor 120 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -20 10yr3/1 none sil 2msbk mfr cs 1vf .6 .8 2 20-40 10yr4/4 none sicl 2msbk mfr gw na .4 .6 3 40 -54 10yr4/4 none sl 2msbk mfr gw na .6 1.0 4 54 -72 7.5yr4/4 none cos osg mvfr gw na .7 1.6 5 72 -120 7.5yr4/6 none cos osg ml na na .7 1.6 Horizon 3 has various sized 10yr6/6 silt indusions with c1d 7.5yr5/6 noncontigous redox features system elevatioryl's below this hoizon. 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 I Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring # El ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff #1 *Eff#2 * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg/L * Effluent #2 = BOD 5 <30 mg /L and TSS <30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD - 8330 (1.07 /001 Steel's Soil Service, Inc. I STEEL'S SOIL SERVICE INC. 3 of 3 David J. Steel Kernon Bast 994 200 St. CST - POWTSM SW1 /4,NW1/4,S36,T29N,R19W Baldwin, WI 54002 Lic. #248956 Town of Hudson, St. Croix Co. Ceti (715) 760 -0347 Cottonwood Ridge 2ND Add. Fax.(715) 684 -3449 Lot,89 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. Legend N 1 " =40' Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe / • �= Alt Benchmark Ele. 100.80 ft lam Top of 3/4" pvc pipe ❑ = Borings Boring Elevations B1 = 101.00 B2 = 101.00 B3 = 97.40 ft B4 .� 0.00 ft 9 oar • of e l ' eta t ifP . Wi t- 54 13' 4-5 G■a ",,750— ,, , - , ..::. (((t/(1 at ri`i % �I / m ` Si iijir f // r ! / l ' ol' l ♦ i � i !i0 rr0 i I ii /.1. *if, r !" elka, /,.. ;N l ;I r ., r . . % /// / 4 oa /,�`1}ttf' o` .. s :_.a�.k fii 'I��A / j h.Ir� 9' ------'''''''•41' � Ir r" r � �• , .+ 0 ii) /t r p .er rl .' }' ��/ /I %s 4._ tl _ //1 V ;7:1: / !),//' f / 'f' :ii ::•::.:' '4.4 ; E ::••":".",e ••, e .::::: 11. .... / -:re" 0 ,..■ 0, • r) i T: : I , er 0 :1 / %' r i m e , i ; i 1 4,,. `r i ' 41 i 4 •1 0 i ° I : : •fr // r --I N. . , y :/ r tr,mmor 1.4- f ! o • /e / / li/• .c. "'`• ' `':./ /r// , e z .J1 ri, i 1 r/ / // e . , i, 1 / X // �/ i4ir ♦il i a • 0. c? I ,,, •• p, :;r :: ,,,,r,f \ \ . • • iii 1 4, X1 % / #.•"" f/ / .1 \ \ \ \ , e j i r i i i �i i ' • ! �7 �lf j �� ` F,. i t ., o • idji 4. ., i .. // / r / : Sy • i r# / I Op i0 'ii i // // r/ . . // � r , #,C l ,,, / / /r // ///,� •` � //�ltt j pp 444•;.' ICI . I b / / , f - I �L i i i i :I�! r r �� riii �., r /i / ♦ `� , I / / � � _ Q . • i ..l 'i -: %'o'i %Pp,-f� ' f '�i ���i. r' /' r /�l / / !r, !! /♦ /I.ir'II► C 1 ' / / // / / /' • fi # ' / = i it i% r � g �y�� s� / ' /1�� / / / � ��� /�,/ / • / •• . f ill :II �i�> 00 f % �4 / i/ `��sjr,., + /J/ /l� l -r '�/1 ir f . X O UI f /f {� /rllff� ";�I / lf r�i ' / � / / L O CA U Al l // / �, . lrrt � � J �. i..i / If / / !i 1 / / // /O 41 .00 0D. iio i iiiiii %�% � � / / (U _., ::„...::::::- � ' �: r,// rr rt4.:�;9� ;,.�►���:! �// / as 1 1I�/ i �`.. 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" . \ -70 \ l / / /' L.B.O. = 988.00 \ \ 1 p ' /' / 1 ' p ' BENCHMARK \ \\ / TOP OF REBAR \ (, / , / / ELEVATION = 1039.41 1 \ 8 1 \ b. � a 1 Sse2 p'rr E � � \ 4 443 ' \ -/ /\ 2 p'r r' \ /4-.--,......_ ' - -- 70' F 467 \ — — • _ `3r \ • W 3 ., - Iw [BOO U 'NV • ° / w \ \ Q w \ LOT88 F � � � � 2.07 ACRES 8 Z � p \ \ 8 LOT 95 . - 0 � \ 9 SQ. FT. Ts = - z L.B.O. = 1038.06 o 2.02 ACRES j s n\ 0 co O • 88007 SQ. FT. �\ �\ = co A \ \` \ F- u_ - \ \ - �O O \ ' \ w , - /V68 9 , / A \I I co _ • r I••1 r 61- ,S of I �J -iO N N �L- .-- .- -. - - -- O O 70.00' _- . ° I °• ' 38 W 21684 • '19 ".' I' 96 � N89 ° ° I - g (- �1$ G - — To - -c6 co MARY JO COURT E FT, / i ��' / - DEDICATED TO THE PUBLIC N89 °38'19 "W 282.73' / / G19 _ 61.42 © - - - -- 22131' - - - -�- i . .. . ./;.\ , • • / I b / �' ,p. ti / 'y` . /' • co • / / -/ . -. LOT 110 . 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'� r} 2 L 5 r � y,,,r d•;nT'�tn> ^ t o . ,,,, t . b5 : ' i M f 4, P r . � r t F } W� ile' Fk R .. l t'1 , v ' ; e 0;11. h ' � ;' ''. � } 4 , i y � t .,. ,.s�''' ,,.tava,,.,r4::, a a.;a ,,,,,, M . ...,,q-,:.2.., a,., t„ rM _ 4,: .,:rr,t.4,...,;,,,, : .L„ „ s 21eze , an y :L 'Alr�b. 15 . 1:. J ' ,- ,,;- ., ,..- ,.Li!,- ,,..:.;.;.a s . ., r INFILTRATOR SYSTEMS. INC. STANDARD LIMITED WARRANTY (a) The structure integrity of each chamber, end plate, wedge and other accessory manufactured by Infiltrator ('Units ", when Installed and operated In a leachfield of an onsite septic system in accordance with Infiltrators Instructions, is warranted to the odginal purchaser ('Holder") against defective materials and workmanship for one year from the date that the septic permit is Issued for the septic system containing the Units; provided, however, that if a shell; permit is not required by exercise Its the warranty nod e h that Old upon the date Installation of the septic system commences. INFILTRATOR To exercise Ns wawarranty rights, Holder must molly h Infiltrator writing at Its Corporate Headquarters d Saybrook, Connectkwt wltith fifteen (15) days of the affeger detect supply re Units determined Infiltrator wgl supply replacement Units for Units eormine by Infiltrate covered to be covered by this Limited Warrant'. Infilrator's liability specifically excludes the cost of removal and/or installation of the Units. (b) THE UMfTED WARRANTY AND REMEDIES IN SUBPARAGRAPH (a) ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT INCLUDING THE UNITS, INCDING NO IMPLIED) WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. SYSTEMS INC R (c) This Limited Warranty shall be void N any part of the chamber system is manufactured by anyone other Man Infiltrator. The Umited Warranty does not extend to incidental, consequential, special or indirect damages. Infiltrator shall not be liable for penalties or liquidated damages, including loss of Environmental Onsite Wastewater Solutions' production and profits, labor and materials, overhead costs, or other losses or expenses Incurred by the Holder or any third parry. Specifically excluded from Umited Warranty coverage are damage to the Units due to ordinary wear and tear, alteration, accident, misuse, abuse or neglect of the Units; the Units being subjected to vehicle traffic or other conditions which are not permitted by the Installation Instructions; failure to maintain the 6 Business Park Road • P.O. Box 768 minimum ground covers set forth In the Installation Instructions; the placement of improper materials into the system containing the Units; failure of Old Saybrook, CT 06475 the Units or the septic system due to improper siting or improper sizing. excessive water usage, improper grease disposal, or or improper operation; any other event not caused by Infiltrator. This Limited Warranty shall be void if the Holier fags to comply with all of the terms set forth In this Limited Warranty. 860-577-7000 • FAX 860 - 577 -7001 O �f Further, In no event shall Infiltrate be responsible for any loss or damage to the Holder, the Units, or any third party resulting from Installation a ship- $ 00 -221 -436 meet or from any product !Lability claims of Holler or any third party. For this Limited Warranty to apply, the Units must be installed In accordance with all site conditions required by state and kcal codes; all other applicable laws; and Infiltrate' Installation Instructions. (d) No representative of Infiltrator has the authority to change or extend this Limited Warranty. No warranty applies to any parry other than the origi- nal Holder. The above represents the Standard Limited Warranty offered by Infiltrator. A limited number of states and counties have different warranty require- ments. Any purchaser of Units should contact Infiltrator's Corporate Headquarters In Old Saybrook, Connecticut, prior to such purchase, to obtain a copy of the applicable warranty and should carefully read that warranty prior to the purchase of Units. U.S. Patents: 4,759,661; 5,017,041; 5,156,488; 5,336,017; 5,401,116; 5,401,459; 5,511,903; 5,716,163; 5,588,778; 5,839,844 , Canadian Patents: 1,329,959; 2,004,564 Other patents pending. v s. Infiltrator, Equalizer and SldeWinder are registered trademarks of infiltrator Systems Inc. Infiltrator is a registered trademark in France. Infiltrator Systems Inc. is a registered trademark in Mexico. Contour, Contour Swivel Connection, MicroLeaching, PolyTuff, SnapLock, ChamberSpacer, PosiLock, QuickCut, QuickPlay RECYCLED PAPER and Quick4 are trademarks of Infiltrator Systems Inc. 0 2003 Infiltrator Systems Inc. Printed in U.S.A. 0011203HP -0 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of Z FILE INFORMATION SYSTEM SPECIFICATIONS Owner (C r J C ,J S,45+ Septic Tank Capacity 1 2,y'� ga l ❑ NA Permit # t C f g'g 1 - Q +$ cl Septic Tank Manufacturer ce} d!-�� ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model 80 ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity ga l ❑ NA Estimated flow (average)? gal /day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) 6 gal /day Pump Manufacturer ❑ NA Soil Application Rate ✓ 7 gal /day /ftz Pump Model ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ 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 ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L >i In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) S30 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y8 in dia. ❑ NA Other: ❑ 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: 3 ❑ month(s) year(s) (Maximum 3 years) ❑ NA 9 Pump out contents of tank(s) When combined sludge and scum equals one -third (19 of tank volume ❑ NA Inspect dispersal cell every: ®year(s) s) At least once eve ❑ month(s) (Maximum 3 years) ❑ NA � ❑ t Clean effluent filter At (east once every: / ® yearmon(shls► ) ❑ NA Inspect pump, pump controls & alarm At least once every: 3 ❑ month(s) ❑ NA H year(s) Flush laterals and pressure test At least once every: 3 ❑ month(s) ❑ NA '® year(s) Other: At least once every: ❑ monthls) ❑ NA ❑ year(s) Other: 0 N MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for. any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All 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. GMW (4/01) Page 2- 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 replacement system: JS( A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name R03 612 M(-L 5 Name Phone 'l f $ — Z 7 3 — 414 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name 5+ C62-0 CouJV Phone Phone 7/5--- 3 VI T 6 9D This document was drafted In compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. 05/05/2006 12 :32 6514392462 MCCORMACKO_ASSICCONS PAGE 02/ mew OS 0S 08 :12a Team Speer Bast 71538€13690 p.1 rile tone IN QV e.a Mew a ewe ..���.. •_...._. _ . ST CROIX COUNTY SEPTIC 'TANK MAINTENANCE AGREEMENT AND OWNERSHIP CF.RTIFICATION FOR 4 Owner/Buyer KCeMik/ BAsr Mailing Address 9 MAORI AUbStW - 4? ro) Property Address Sony Five uyvc " \/ (Verification required from Planning 1leperonent for new co><aettaetion) City/Stare _ Nv11 4./ 1 W 1564060 J parcel identification Number _. v 02D — 1 5 L5 `f — 0 0 - q * ? ( 2 7O LwALDIESCRIZXM Property Wadi= V2_4 °A, Ilk 'h. Sec. Sic , TO N -R„ ,W. Town of MAO:5W 5uhdiivl ion Carfett>�f 5gexNl4 AflO +na�.7 . Lot # Certified Survey Map if Volume ,, P M Warr$nfy Deed M _ , Yoiurn -al 1 3 S , Pogo q , - 3 ✓mss . Spec »Dole l:3 yO5)4 no 7015 Lot lines idendlieble oI yes CI no SYSTXNUN Ir lrnpreper lee end maintenance of yew septic system could melt in its premature ratio/chi handle wastes. Pieper enatnteaen:e ceftsists alrpoir ptag out the mina tank every three yew e t sadder, if ow:dud by s beer1sed psnsper Whet you Far into the system eon Wan the Raeeifaa of the septic oak as it treatment Stage in the waste deposal aystem. The prepay owner eves to stibrnit to 51. Cr ix Zoning Demmer a cerndootioo f signed by the owner sod by MAO plserabe r.yaottt Omuta. /acne ctinttirmtim ore licensed pumper verifying Mai (1) the oti•eue weeteweterdispeset system el in proper *wain* too andror 12) afire nrpiasrtem sad parading (if neeesenry %• the septic tank 1a Ism chap V3 full of sludge. Uwe. the • aoet . it reed l he above requirements end axle to maintain the private sewage dismal system with the standards set f • . . c .vie dee Del:onencns of Commerce mid the Deparunent of Murat $tmeatrece, Sean er wise some Cer+ifcar.vo ft . alit mein m has been a;nattam ►nose tee acermieten dent returned to the 5r. rroiie Count Zeming OITiee w ,thfl 3t ys or r tan des. s 5, 5'LQ 5 A W APPLICANT DATE ,1 Ars ,. obi '1 ( all staieinertis on firm rm are tra,c ter di at e be of my lout) kna..tedgc 1 (we) u Carel the owner(s) of tit pro .....� virtu* tar 4 N...�amtY dead recorded in Resister of Deeds OtOes. r J ATUR~E _,ems LICAN r DATZ Any inronnet that to ens-represented may reatitt to the nuttily permit bill revoked by the 'Zoom Oapirn,ent •• mitten wrist this ■ppNeeaon: a'tamped warranty deers from the Register of Pravda Oleo s copy of the certified ewrvoy nap If reference is made its the warranty deed • a'a 2 66GSaESt;b uOSU4oc loser dTT eT0 C0 Bin .400 J 2 1 3 5 P 3 5 5 -7 12,aeala WALSH ' WARRANTY DEED R EG I ST E R H. DEEDS REGISTER OF DEEDS ST. CROIX CO., WI Neil L. Wilcoxson and Mary J. Wilcoxson, a /k/a RECEIVED FOR RECORD Mary Jo. Wilcoxson, husband and wife, conveys 02/07/2003 02:00PN and warrants to Kernon J. Bast the following EXEMPT described real estate in St. Croix County, State of REC FEE: 11.00 Wisconsin: TRANS F FEE : 2880.00 COPY 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 �� t0' A parcel of land located in part of the Southeast 1/4 of the taiina Re alty 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 Southwest 1 /4, and part Suite #115 of the Northwest '/4 of the Southwest 1 /4, all in Section 36, Township son, WI 54016 i' a ,44 Il Range 19 West, To wn of Hudson, St. ,' P 29 North, 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 '/. line, 1634.77 feet to the Northeast corner of a parcel of land described in Volume 526, page 259 at the St. Croix Count y 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 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 measures 104.84 feet; thence 02 minutes, 21.5 seconds East and , seconds, whose chord bears South 80 degrees, , 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, Rang e 19 West, St. Croix County, Wisconsin. Dated this ,,?v day of j‘i- , 2003. 'i Vi I Pee' / 6 1 11 1 /' 774 , a ‘0)0 i . ilcox n Mary J. W jr opn ACKNOWLEDGMENT . „�:':2+�'4'rZ1 , STATE OF WISCONSIN ) ,.,Y PV@ 11f COUNTY OF ST. CROIX ) . tk- .-1.1"0‘ 4 ON., d / Personally came before me thi day of J 'I , 2003, t a i = med Neil L. Wilcolt3ol° d Mary Wilcoxson to me known to be the persons who executed th f oing instrumel acknowledge the time A. * P 4 • ! P RESTON Nota Public �y _ / p _� . 14 sP c �Z's My commission expires: b 1 I ') O 0 This instrument drafted by Robert F. Wall. WilcoxsontoBastWD03 -1 1Nl y COUNTY PLAT OF: OD RIDGE 2ND ADDITION OF THE NW1 /4 AND PART OF THE NW1 /4 OF THE SW1 /4, OF SECTION SOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN. °26 "E 1182.70' il x 1107,40 x 156.21' x 31,5 x 36410' N 114.53 r cp H.W.L. = 986.00 a 8 I k Z I� C � ^ DRAINAGE ■ ■ M 1 0 IM 02 o�) EASEMENT N 0 2 1 / 6 4,"` P•--- - - - - -o - - - - - -- N S W co CJ LOT 90 �' , N8s so'o7 "w 253.31' - -- - 8 1 � § d 112036 SQ. FT 2.57 ACRES �� �/ I � , w w la . N. / 11 b E O L.B.O. = 988.00 R LOT ■ 6, 4, 4.,/ .78 AC 2_,‘ 1 C w i. // /A 208 Q. FT. 0 j 7 \ N w a� / i ,�a L. B.O. = 988.00 1� � ° l'" w (.6 �� i` 5 �1 1`� ? / 4 1 6 � X 1 / / BENCHMARK 2 m / / p a / . - TOP OF REBAR N I. // 43/ ° ELEVATION = 1041.66 1 m 4/ 389°28 4 �/ � .4, '& 10.00' 1 Se ?,�/ -� ft„,, rr � �� r)s \ 1 45 0' r� : rz \ /' 5- ti \\ \ \ w , . � \` `� �, \\ LOT 88 \ °' .f 2.07 ACRES 8 Z = LOT 95 ` \ .` 0 � \ • 90119 SQ. FT. z a 2.02 ACRES s ` " ' n� . L.B.O. = 1038.00 E 88007 SQ. FT. �\ \ a� O 70 ' '1p+ r � µ ,' rd' I 1 - • - -- JO COURT