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;onsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
ety and Building Division
o o INSPECTION REPORT sanitary Permit No:
506223 0
3ENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No.
i
Personal information you pr vide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Na I I
City Village X Township Parcel Tax No.
Bast, non inred
Hudson, Town of 020-1454-00-091
CS Elev: Insp. BM Elev: BM Description: P Section /Town /Range /Map No:
/6 / INN_ 65 T 36.29.19.2906 I
TANK INFORMATION ELEVATION D ATA
TYPE MANUFACTURER ', A O CAPACITY STATION BS HI FS ELEV.
Septic /Z50 Benchmark , 4.70 /01. /G
M D i , ( w 1 C 1
T b 1 b IV.- t • Mara! Alt. BM . i � p.11.� 3. 9d • SS
Aeration t Bldg. Sewer
3 (4, Tel • oS
Holding 111140 St/Ht Inlet 4•75 $Q .4i
TANK SETBACK INFORMATION St/Ht Outlet LOS cgg • 7
TANK TO pit_ WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Ail
Septic SO. / ! 4 1 IC /Z6 Dt Bottom `
Dosing N _ Header /Man • 5.1 fn,55
Aeration (�`'^'---- Dist. Pipe
4 . 6 $4. $ *,4)04c.
Holding . . �� / Bot. System 5• g C p-
PUMP /SIPHON INFORMATION
F 2. S 9 i. �5
Manufacturer Demand St Cover
GPM 1 3 96 • ss
Model Number 'e*' (+r°"� 3. 1 1245 it gD .,s5
TDH IL Friction Loss System H- .. J TH Ft
Forcemain jLtfl ia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width . Length • No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 // Z V"Q„n c, -`_-. i
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacture I t
INFORMATION i — a +p t Q, CHAMBER OR i--✓�O•i V ��C'Z
Type y
6At +mJ * 60— /c ' •33 1 AJ r ' ' UNIT Model Numbe^ se L. ) 1 47 /
DISTRIBUTION SYSTEM A ( P i +!cs Crw.� . ZS i-Z5 " SO vi- td-a -5-..--
Header /Manifold . Distribution x Hole Size x Hole Spacing Vent Air Ir�ake /� fM,�
/ 4 Pipe(s) N �L n �
. Length / Dia Length Dia Spacing\ \ ° J.cSL
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 j
Bed /Trench Cent 3. 35 Bed /Trench Edges Topsoil Yes No \ Yes I No I •
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1 / Inspection #2: / /
Location: 838 Riley Lane Hudson, WI 5 016 (SW 1/4 NW 1/4 36 T29N R19W) Cottonwood Ridge 2nd Add Lot 91 Parcel No: 36.29.19.2906
1.) Alt BM Description = j Ca am
J- EZ 6),.) r 11 r P et. 6% i a 11
2.) Bldg sewer length = 1 A 7/ & f2b,O l a. iviSL'!z 64- G Ga4 ate.. calk out' 16u�r-
- amount of cover= /i d' C4 ' um , /, ft c e**- VvMCt P - Zre..., 4 •
. i 1 ovi Plan revision Required? Yes N }{rt`lo ZZ.• b7 111illikligilll � ' ; Y/ $3�/
Use other side for additional information.
Date Ins: actor's Si:rature Cert. No
SBD -6710 (R.3/97)
commerce.wl.gov Safety and Dui!din_- I •►ivision County 1
i Q `S 201 W, Washington A 4' .e • Box 7162 . �G° i)4 I
CO fl S 1 In Madison, WI 537 t •. 7C, Sanitary Permit Number (to be tilled in by Co.) — 1
Department of Commerce 5c Co 2-2_ 3
, St Tr an
Sanitary Permit Application saction Number
A/14- In accordance with s. Comm. 83.21(2). Wis. Adm. Code, submission of this form to the appropriate vernal al
po unit is required prior to obtaining a sanitary permit Note: Application forms for state• d P T
pP owne TS tali. Project Address (if different thanntailing address)
submitted to the Department of Commerce. Personal information you provide may be used for sec ndary
pur ' /� at Ie i,,. O ses in accordance with the Privacy Law,s. 15.04 1)(m), Stars. I d�
1. Application Information - - Plea ,k,ii • 11 urination RECEIVEU��
Property Owner's Name - -- — 1
/ e 1 - - - ta g . ! / A i s - ! � J up Parcel
2O t 7 y5 - O - d c !
Name , Property Owner's Mailing Address JUN D 6 ��07 - Property Location
1 i t
9Y ' j � ,� .� gd ST. CROIX COUNTY
Z9 d (,
Govt. Lot
City. State ` Zip C ode Phone
p ,. ,
i., ,t/Id /.. Section --56 t
sg °A) (circle enema
G✓ i Q l
T a � N; R �� � 60
It Type of Building (check all that apply) I Lot #
1 or 2 Family Dwelling - Number of Bedrooms ! 9/ Subdivision Name
subvv<,, 1 � a o f 1,3 kick e ____.� C4 �r,d/A) , ,44 94. ?4'
0 Public /Commercial - Describe Use p��-
�,"_ ❑ City of�_
❑ State Owned - Dcscnln Use CSM Number • _ ❑ Village o ---
r , D Town of ud , .t/
III. Type of Permit: (Check o Iy one box on line A. Complete line B if applicable) vT {
A. New System
y ❑ Replacement System ❑ Treatinent/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
R 1 ❑ Permit Renewal 0 Permit Revision List Previous Permit Number and Date Issued
❑ Change of Plumber ❑ Permit Transfer to New
1 Before Expiration Owner
,, p Type of POWTS Sj stem /Companent/Device: (Check all that apply) �� _��
L t►eT.Non - Pressurized In- Ground_ ❑ Pressurized In-Ground 0 At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑Other Dispersal fiotnponem (explain) P. • explain). j�
. Dispersal/Treatment Area Information: _ _ ., >�► t^/16
f Design Flow (gpd) Design Soil Applicatio ate(gpdsf) , Dispersal Area . •'� V • rea ... d (sl System Elevation
l •p , ("Sc. Q d J60 ' a Ba/
3 , C�cJ o
1'l. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units a t a u
Neww Tsoks Existing Tanks u ' / i a
46es4-. a in v to w E5 a
Septic or Fielding Tank — - - /a f/ ,�
h Dosing Chamber " - (�' L�� __
_ gde) / �, V -
NI1. Responsibility p Statement 1 the undersigned, assume responsibility tor installation oldie POWTS cans. »n on the attached ty � p y ataJ alien t p
Plumber's Name (Print) Plumber's Signature Alag PRS Number Business Phone Number
Or '
. <: / ,,.,r.- 'er i �,,; s � /� :7,577rd 7/s--.2/? /
Plumber's Address (Street, City, State, Zip Code)
7 / �G¢3 . cti acv cg� _
VIII. Count /Department Use Only
Approved ❑ Dis ..
Permit Fe Date issued Issuing A i Signature
1 ❑ Own`rven Reaso or Denial CO 7 / 6 7 it 4/7
ix
. _
Condi t �f� easons for Di sapl.roe °al ?s) Q J. l eau., ( 0 - W >xn �.
G ✓e o p2� a coo: - n g t.� �n o t., co
1 1. Septic tank,. effluent filter and 1 t _ (� f
dispersal cell must an bW se / malntejg
as per management plan provided by plumber. ed W' ` gyp (le t AA: (`�. ��.'��
f „ / a
i 2. All setback tequirelner►ts roust be maintained 41 44 5 6�.�` e • t=t l-+ ov� __ o 5' h.-1
o4J
code l ttr- 1
Atrac lt t o complete plan m ad s
s for the systenubmit to the County only ()Opener not less than 8 it: x t 1 inches in sixc . _.._— (�/ b / ^ . CJC ,
SBD -6398 (R. 0I /07) Valid thru 01/09 Q
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Wisconsin Department of Commerce +•.., SOIL EVALUATION REPORT Page / of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
Attach complete site plan on paper not Tess than 8 1/2 x 1' inche� ,' EIrVD CountySV /� / I
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. v�
percent slope, scale or dimensions, north arrow, and locat on and distance to nearest road.
Please print all informati m. J U N 0 6 2007 Revie I • b / Date
Personal information you provide may be used for secon ary purposes (Privac Law, s. 15.04 1 (m�)) • ce to d
Property Owner G , t r/ L ri" 6Te 5 f � ST.RQ t�C�'QIJY I � ,
PO K Property Location / / �T
e lk(L Sej 04% (ts-( /uc-4 ,` O� Govt. Lot 5 L v 1 /4,1',/ 1/4 (p T Z r N R ,'r E (or)opv
Property Owner's Mailing Cr' Address Lot Lot # Block # Subd. Name or CSM# /S(-
C / La ►'° — Cod Phone Number 0 m
0 'v /. W °a aQ IC i c
I / _ ❑ City ❑) / CJVillagge (l Town Nearest Road
} 150, I W 15 '1'/ ( ) rT "t Q —Sp
E r New Construction Use: ' Residential / Number of bedrooms 3 - 5/ Code derived design flow rate _ SU / 6 co GPD
❑ Replacement II ❑ Public or commercial - Describe: -------------- __
L) c
Parent material o - ) 4
a 5 Flood Plain elevation if applicable A------
. // v-i ft.
General comments 5 e- ( t U , Z
and recommendations: >l T S e
1 1 Boring # 0 Boring , c/ �)
® 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
1 0-G l e r iz S,/ ,2VTsbM< MC r c .S. 1 I/ f , .S" i ?
Z- 8 ) 0 1 c Vta g0 t- 5G 2mS6 /< ,nn.0 c c 5 4 (.t / U
3 zI-(a 0 / /d VY Z St-- �,ns4e m - -r� c5 _ , Co / 0
ty 00 -10 fc ,//G, • 31-- � S 0 5) yv ' J (c-' _ , -- / Z
5 7o -IIs' 7,s7Y3 /62C /4 /5 5G- _ 0 «- 114.4 ,;!(•2,,87
Bering # 0 Boring Gc� q
Itl Pit Ground surface elev. 73 yd ft. Depth to limiting factor / 7 in.
I 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
o 1 L 104(.3/ , Sf l _„/14/ s.b/( v►\--6- C S 1 U I rS , a
L 1Z loyi 4N( ,.t t) $ 4- ,901,54 04-/ C S , U / G
3 70--ii L (a f '/'/ gt. 0 2415W un , (5 ,_ . / o
il 4 z-rq roi/ 5 i.„ 5 0 .... vh l c 47- Z
.S 1/- 1, Sey r 3/ 69 ri l= 7 .S Yi n .5Z-- 0 i' r 'v x/11 -( I — /` A' a-, ' tF
'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 — 60e )iretatare CST Number
I � �
•dress ate Evaluation Conducted Telephone Number
! ke l .ley 414 i 44,190e (AJ/ CW /? & —/ --U 7 /S= 740 o —O
Property Owner 1 to F k 1•-:55 Parcel ID # I G 1 7 1 Page a of
Boring # ❑ Boring c)
lZif Pit Ground surface elev. 72 ft. Depth to limiting factor 9V in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 *Eff#2
1 �Z Ioy( 21 5 5.1 )Msbk cS tc,_c S r
Z ► z Z`6 /o r5"/ S. `GI g,-►?ts J( v►N-C r c S
3 21.-9q o y 5 / vyis j 1n t cS
qq-('is )eyr3f6 cvvk - -
e . .r
z. y
5e'`
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/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 *Eff#2
❑ Boring
Boring # Ground surface elev. Depth to limiting factor in.
❑ Pit . ft. Soil Application Rate
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mglL
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777.
sBD.8330 ta6ro0t
Property Owner , I
, Parcel ID # 1 Page Z of )
Boring # Boring ci5 so
LS pit Ground surface elev. ft. Depth to limiting factor 9 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
4-/
Z- 1L ),
z., ro 1-- / of? 5 c) / c) 4 7 7 z
j6 3/6, id 7-s,i/vk sz_ 00,v
Boring # 0 Boring
O 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/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
• 0 Boring
Boring #
0 Pit Ground surface elev. ft. Depth to limiting factor _
Soil Application Rate
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
•
• Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg&
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.
SEIP-8330 (R4/00)
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COUNTY PLAT OF
OWNER , i lw COTTONWOOD RIDGE 2ND ADDITION
` � r LOCATED IN PART OF THE SW1 /4 OF THE NW1 /4 AND PART OF THE NW1 /4 OF THE SW1 /4, OF SECTION I
s i ., / /\ , ,, 36, T29N, R19W, TOWN OF HUDSON. ST. CROIX COUNTY, WISCONSIN.
SURVEYOR ^ rr q ` � � ' / ,,?,,,,1,-„,;,/ � Y
MING GAM. - F,vmr, t/�= ff \I:I �D' °O � -nriry 'moo ure�s' N892858En118
ENGINEER 8 ' 0 a 1 -
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... ..._._ —..._ ,, „ N v LOT 91 rw, - mm
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D � ■ rA orn N I oM 1� s , - , 2 F
U _ . � o DRAINAGE ' ° ■
I'- DRAINAGE 1 t , Pr \ , a, \ ,, LOT 90 J ' _ ^: I '
rASEMENT a f, I
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ii _ , I R I 'DO,../''''' � 1j t \ / .r,,. L 89 Y Q
� a:7 - - ', 1 LOT 92 t , �. \ \ ,� � / Ho I.IC h / y
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LOCATION SKETCH _ r:,rv.,.C.v ?.:.n., ' ,rt -_
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LOT 93 6 ,K �g � 4J r \ \ \ I
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SECTION 38, T29N, i. { U 1 �
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�,. ,.. ° Lot 97 l , y 00 1
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SCALE IN FEET V' = 100'
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\ / /} LOT 110 - I LOT 111
100 0 100 200 M a w„ ,; n t. A os S r 1
RECISTPA'S OFFICE DCG j. je " 1 _ - -r ra ` 1 - r •s - __ ; / /.p r r '' - . I I
ST. CROIXCCO O O r/ 5 r'i' . r DRAINAGE ' EASEMENT q ' ' / -- __ ■
pal` D 1 JAN s..ve S LOT 9B ' I 1 r / I - t ` „ 1
t v. 1004 m
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a LO T 109 ',ELLVATION 10079
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v,:,:.rz'�'r to rr _.nn +o 00.1, iw .,al.. se l,r r. ,au SHEET10F25HEET5 7
Owner/Buyer kerwo". &,f
Mailing Address ?g g A g / / 1Zf 4 1 �.0(
Property Address 5:5F X?V'e li/vAcsot j, 5
/
(Verification require rom Planning & Zoning Department for new construction.)
City /Statelae Al/ Parcel Identifl ;ation Number
LEGAL DESCRIPTION
Property Location, fl(,) y , L 4,?/ , Sec.36 , T O_N R / C f W, Town of *t/c ov
Subdivision _ �i� GJ� •• i .� �iy 'Owl., Lot # �� .
Certified Survey Map # , Volume 7 a� , Page #
Warranty Deed # 7 � � n � O / , Volume A J , Page # 3f� .
Spec house goo no Lot lines identifiable 110 no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could r :suit in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three yean 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 sta 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 Pia nning & Zoning Department a certification form, signed by the
owner and by a master 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.
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 an 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 tnie to the be t of my /our knowledge. I/we amlare the owner(s) of the
property desc ' : above by virtue of a warranty deed recorded in Re gister of Deeds Office.
Nu •ero ' 'roo
.r_
��► �_ 5--/.O
7
Si T RE OF AP' LICANF(S) DATE
** Any information that is misrepresented may result in the sanitary j ermit being revoked by the Planning & Zoning Department. * **
Include with this application a recorded warranty deed from the Regis er of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
U 2 7 39 P 316 861 k3
KATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CROIX CO.. WI
STATE BAR OF WISCONSIN FORM 2- 2000 RECEIVED FOR RECORD
Document Number WARRANTY DEED 01/28/2005 03:15P/1
THIS DEED, made between Neil L. Wilcoxson and Mary Jo MARRENTY #EED
Wilcoxson, husband and wife, Grantor, and Kernon J. Bast and Donalda J.
Speer -Bast, husband and wife, Grantee. REC FEE: 13.00
Grantor, for a valuable consideration, conveys and warrants to Grantee TRANS EE 4212.90
COPY FEE:
the following described real estate in St. Croix County, State of Wisconsin: CC FEE:
PAGES: 2
SEE ATTACHED EXHIBIT A •
Recording Area
Name and Return Address:
Edina Realty Title, Inc.
400 S. 2" St. — Suite 115
Exceptions to warranties: Hudson, WI 54016
Easements, restrictions and rights -of -way of record, if any. 456780
1 1 1' 1 - 1 1
020 - 1110 -30- 000... 020 - 1109 -55 -050
Parcel Identification Number (PIN)
This is not homestead property.
Dated this 28 y of January, 2005.
./ I _ .I ��� IJ 1 t w,d / l
1 L. Vi cox 1s * Mary Jo i oxson
* *
• Il
rr Ve
��.. 11�� \j'1C ACKNOWLEDGMENT
AUTHENTICA� a p U 1n
V,C >�S
t�.CC
Signature(s) re s 1'1 STATE OF WISCONSIN
)
^ rte,
ST. CROIX COUNTY. ST O ) ss.
authenticated this 28th day of January, 2005
Personally came before me this January 28, 2005 the
above named Neil L. Wilcoxson and Mary Jo Wilcoxson,
* husband and wife to me known to be the person(s) who
TITLE: MEMBER STATE BAR OF WISCONSIN execut a fore oing instrument and acknowledged the same.
(If not,
authorized by § 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY *Chen rown
Notary Public, State of Wisconsin
Peterson, Fram & Bergman — Steven H. Bruns My commission is permanent. (If not, state expiration date:
50 East Fifth Street, St. Paul, MN 55101 3/11/2007 )
(Signatures may be authenticated or acknowledged. Both are not necessary.)
*Names of persons signing in any capacity must be typed or printed below their signature
WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2 -2000
U 2739 P 317
EXHIBIT A
Parcel 1:
A parcel of land located in part of the SW '/4 of the NW '/4 and part of the NW '% of the SW ' of Section 36, T29N, R19W, Town of
Hudson, St. Croix County, Wisconsin; more particularly described as follows:
Beginning at the W '% corner of said section 36; thence N00° 16' 10 "E, along the west line of the NW 'A of said section, 1248.49 feet to
the north line of Lot 1 of Certified Survey Map recorded in Volume 3, page 669 at the St. Croix County Register of Deeds Office;
thence N63 °02'59 "E 148.42 feet to the north line of said SW '/, of the NW '/; thence N89 °26'58 "E, along said north line, 1182.70 feet
to the east line of said SW '/ of the NW %; thence S00 °21'37 "W, along said east line, 350.04 feet to the north line of Lot 73 of the
Plat of Cottonwood Ridge First Addition recorded at said office; thence S89 °26'58 "W, along said north line, 10.00 feet to the west line
of said plat; thence S00 °27'24 "W, along said west line, 2096.76 feet to the centerline of County Trunk Highway "N" and a point on a
1999.00 foot radius curve, concave southerly, whose central angle measures 7°10'30", whose chord bears N84 °30'41 "W and measures
250.16 feet; thence westerly, along the arc of said curve and said centerline, 250.33 feet to the point of tangency; thence
N88 °05'56 "W, along said centerline, 83.64 feet to the point of curvature of a 2700.00 foot radius curve, concave northerly; whose
central angel measures 3 °17'53 ", whose chord bears N86 °26'59.5 "W and measures 155.40 feet; thence westerly, along the arc of said
curve and said centerline, 155.42 feet; thence N04 °29'56 "E 244.01 feet to the point of curvature of a 167.00 foot radius, concave
westerly, whose central angle measures 34 °24'12 ", whose chord bears N12 °42'10 "W and measures 98.78 feet; thence northerly, along
the arc of said curve, 100.28 feet to the point of tangency; thence N29 °54' 16 "W 274.22 feet to the easterly extension of the north line
of Lot 1 of Certified Survey Map recorded in Volume 12, page 3456 at said office; thence N89 °' 12'45 "W, along said easterly
extension, along said north line, and along the westerly extension of said north line, 670.44 feet to the west line of the SW % of said
section; thence N00 °37'50 "E, along said west line, 496.89 feet to the point of beginning.
AND
Parcel 2:
A parcel of land located in part of the SW '/. of the SE' of Section 36, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin;
described as follows:
Beginning at the South '/, Corner of said Section 36; thence N00 °27'05 "E, along the north - south '/ line of said section, 1216.78 feet to
the centerline of County Trunk Highway "N "; thence S76 °47'47 "E, along said centerline, 1354.82 feet to the east line of said SW % of
the SE %; thence S00 °07'02 "W, along said east line, 897.02 feet to the south line of the SE 1 /4; thence S89 °33'25 "W, along said south
line, 1326.80 feet to the point of beginning.
•
` POWTS OWNER'S MANUAL di MANAGEMENT PLAN Page of
• FILE INFOR IO
MATN L \ L o ,4*t�� N � c WIT > M SPECIFICATIONS
OWnet
� Septic Tank Capacity /,ZS' 0 • al ❑ NA
Permit # "^ _
�_ - __ Septic Tank Manufacturer ` �� ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer Z Ve..� 0 NA
Number of Bedrooms . ! 0 NA Effluent Filter Modal A tot ) ❑ NA
Number of Public Facility Units _ 0 NA Pump Tank capacity ❑ NA
_.. __ail -
_Estimated flaw (average) to O ° , ai & Pump Ta nk Manufacturer k \e,_, re? R � 0 NA
Design flow (peak), A 1.5) io O C3 � il• ay Pump Manufacturer .....1 � � ! ❑ NA
Soil Application Rate
_�alfdaylftt Pu p Model ❑ NA
Standard Influent /Effluent Quality Monthly averages "' Pretreatment Unit ❑ NA
Fats, Oil & Grease iFOG) s30 mg /L 0 Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD,) i 5220 mg /i. 0 NA 0 Mechanical Aeration 0 Wetland
_ Total Suspended Solids (TSS) <15O mg/I. 0 D isinfection ❑ Other:
Pretreated Effluent Quality Monthly average Cispersal Califs) __._ ❑ NA
Biochemical Oxygen Demand (BODE) 1 530 mg /L ❑ In-Ground (gravity) 0 in- Ground (pressurized(
Total Suspended Solids (TSSi S30 mg!L 0 NA 0 At - Grade 0 Mound
Fecal Coliforrn (geometric mean) ( 510" cfull OOrni 0 Drip-Line 0 Other.
Maximum Effluent Particle Size Y in die. 0 NA Other: ❑ NA
Other: r 0 NA Otter ❑ NA
*Values typical for dc7rnestit wastewater and septic rank effluent- fflUent. Other:
"J ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
' Inspect condition of tank(s) At least once every is month(s)
1� year(s) rY . (!(MAXIMUM 3 years) ❑ NA
Pump out contents of tanks) When combined sludge and scum equals one -third (Y3) of tank volume 0 NA
Inspect dispersal cell(s) At least once eve ❑ monthts)
_ _ r ___ R year(s) (Maximum 3 years} 0 NA
C lean effluent liiter 7-At least ones eupry; �._ ❑ year month(sl _ .. _. :_. _
� _� _ l;7 NA
)
Inspect pump, pump controls & alarm At !east puce every: I......,, ❑ month(s) . ❑ mont la ❑ NA
Mush laterals and pressure test At least once every: . - ❑ monthts) --- _ ❑ NA
—` ❑ year(s)
-
Other: ❑ monthts!
At least once every: --- ❑ NA
Other:
0 N
MAINTENANCE INSTRUCTiONs
Inspection's of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certitications:
Master Plumber: Master Plumber Restricted Sewer: POWTS Inapector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of tine tanks) to identify any missing rr broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or pending of effluent on the ground surface,
The dispersal eels) shall be visually inspected to cheek the effluent levels in the observation pipes and to check for any pending
of effluent on the ground surface, The pending of effluent on the ground surface niay indicate a felling 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,
W`sconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical Ur pressurized components: pretreatment
units, and any servicing at intervals of 512 months, aha)t 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.
Pale -- __ of
STARTUP AND OPERATION
For new construction. orior to use of the POWTS oheok treatment tenets? for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dispersal cafe), If high concentrations are detected have the content;
of the tankds) 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 fee above normal highweter levels. When power is restored the excess wastewater will be
discharged to the dispersal cellist in one large dose, overloading the molls) end may result in the backup or surface discharge, of
effluent, ro avoid this situation have the contents of the te*esp teak removed by a Septage Servicing Operator prior to restoried
power to the effluent pump or contact a Plumber or POWT'S 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 feat down slope of any mound or et -grade Boil 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 soothe; degreasers; dental floss; diapers; disinfectants; 'at,
foundation drain (sump pump) water; fruit and vegetable peeling*; gasoline, grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary reeking; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails andfor is permanently taken out of service the 4ollowing steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 8 Wisconsin Administrative Code:
• Ali 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 end pits shall be excavated and removed or their covers removed and the void space filled vd th
soil, gravel or another inert solid material
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been. or roust be taken, to provide a code compliant
replacement system:
❑ A suitable replacement area has been evaluated And may be utilized for the location of a replacement soil absorption
system, The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establlah 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 soli limitations. Barring advances in POWTS
technology a hoiding tank may be installed as a lest resort to repiaee the failed FOWTS.
IA IA pp The site es not en evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation be performed to locate a suitably replacement area, It no replacement area is available a holding tank
may b ' taile s a last resort to replace the failed POWT$.
C7 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 CQN1'AIN 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 DIPFiCtjLT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
.
POWTS INSTALLER . Aii INTAiNER
Name r \` i J ...�..�,,.
A'he. L Nam e
Phone 7 / r" _ 3 g c - 1 a / Phone
SEPTAGE SERVICING OPERATOR (PUMPER) OCAL RE t LATORY AUTHORITY
Narne n
---J
Phone Phone 715 - 34' to - 4714,y0
This document was drafted in compliance with chapter Comm $ and 83.64(1), (2) & 13), Wisconsin Administrative Cads.
SEPTIC TANK PUMP Ct'AMF:UACUS SECTION AND SPLCIFICATIOS
4" CI VENT PIPE 12" MIN. ABOVE GRAS 6 WEATHERPROOF
>26' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED
FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER
W/ PADLOCK S
FINISHED GRADE WARNING LABEL
4" CI RISER ___._.__..,. 4" MIN.
-----......„.\4___,.......--- 1 ill _ 0 ....
16" IN. 6 n MAX. 1 r..w .■.w+= **
N �ET r a , ,,
...._
\ qi ` . WATER TIGHT SEALS - GAGHT , ',, • r '"
r � „ " 1 4. " 7
1 A PPROVED
A SEAL ` ' JOINTS WITH
;PPROVEO - 'HALM APPROVED PIPE
'IPE 3'"" : ' ON 3' ONTO
INTO SOLID SOLID SOIL
' OIL PUMP OFF ELEV . FT. OFF " RISER EXIT
D PERMITTED ONLY
IF TANK
-� � ...�,..r... -- MA NU FAC TU R E R
HAS APPROVAL
3" APPROVED BEADING UNDE t TANK
CONCRETE PAD
SPECIFICATIONS
SEPTIC / DOSE 4 /
TANK MANUFACTURER:. NUMBER DOSES PER DAY: T
TANK SIZES: SEPTIC I`�S O GAL. DOSE VOLUME INCLUDING
DOSE �'b� I GAL. FLOWBACK: GAL.
ALARM MANUFACTURER: Lt4 CAPACITIES: A = g):4, INCHES = ( 16a, GAL.
MODEL NUMBER: t'.•V
SWITCH TYPE: 8 2 INCHES = ��, GAL.
'M��,.Q,�;,.
F MANUFACTURER Gvu.\ s C = g INCHES = a GAL.
MODEL NUMBER: E. 1"3 0 r
SWITCH TYPE: n D = b INCHES = l oa,,lo GAL.
AE QUIRED DISCHARGE RATE L 0 GPM PUMP & ALARM WIRING AS PER ILHR 16.23 WAC
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . . _._ ia. FEET
+ MINIMUM NETWORK SUPPLY PRESSURE , 2.5 FEET
_Lc_ FEET FORCEMAIN X . ,.VbFT /1OO FT. FRICTION FACTOR . FEET
TOTAL DYNAMIC HEAD =FEET
_L NTERNAL DIMENSIONS OF PUMP TANK: LENGTH! .,,�- ; WIDTH .--�° ; DIAMETER
La DEPTH B ,r e i 6 pert a
IGNED: __,,_,__�'"..- LICENSE NUMBER: , DATE:
1/88
r
G OULDS PUMPS Submersible
u,
Effluent Pump
Ir
__W,._ , MODEL
Ag :„,, EPO4 EP0
K 387 1
5
APPLICATIONS • fully submerged in high • EPOS impeller: Thermoplas- • Bearings: Upper and lower
5 eciTlcall designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing
p g lubrication and efficient improved performance. construction.
following uses: heat transfer ■ Casing and Base: Rugged
• Effluent systems thermoplastic design provides AGENCY LISTING
• Homes Available for automatic and superior strength and corrosion Arip
• Farms manual operation. Auto- lir Canadian standards Assodaoon
• Heavy duty sump matic models include resistance.
• Water transfer Mechanical Float Switch • Motor Housing: Cast iron (CSA listed model numbers end
• Dewatering assembled and preset at the for efficient heat transfer, in "F" or "C.)
facto ry strength, and durability.
SPECIFICATIONS ■ Motor Cover. Thermoplastic Goulds GPs is ISO 90O1 Registered,
FEATURES cover with integral handle and
• Solids handling capability: float switch attachment points.
3 /4" maximum. 1 EPO4 Impeller: Thennoplas- ■ Power Cable: Severe duty
• Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant.
• Total heads: up to 31 feet. pump out vanes for mechanical
• Discharge size: 1'/s" NPT, seal protection.
• Mechanical seal: carbon -
rotary/ceramic- stationary,
BUNA -N elastomers,
• Temperature:
104°F (40°C) continuous
140°F (60°C) intermittent. METERS L FEEt
• Fasteners: 300 series 10 — ---
stainless steel. .______—... . 30 - - - ----- .
-i► Al— SGPM
• Capable of running
dry without damage to 8 zs Fr
components, z5:.
0 7 .
Motor: s
• EPO4 Single phase: 0.4 HP, u 6 z0` ..__.. _ _
115 or 230 V, 60 Hz, 1550
RPM, built m overload with 5
c is .. _ _.__
automatic reset. EPOS
• EP05 Single phase: 0.5 HP, o
115 V, 60 Hz, 1550 RPM, *- _w. _ . .
built in overload with EPO4
automatic reset. z
• Power cord: 10 foot 5
standard length, 16/3 1
SJTOW with three prong
grounding plug. Optional 20 0` 0 0 10 20 30 ... 50 GPM
foot length, 16/3 SJTW with 4
three prong grounding plug L-- -_.1--- _.1___ _ 1
(standard on EPOS), a z 6 e 10 1 z m��h
CAPACITY
Goulds Pumps 't> 2000 Goulds Pumps ITT Industries
Effective February. 2000
83871
.4 .4 ,
tIsconsIn SOIL EVALUATION REPORT
#,650
- .
Department of Commerce in accordan with Comm 85, Wis. Adm. Code Page 1 of 3
Division of Safety and Buildings l
Steers Soil Service, Inc.
</� County
Attach complete site plan on paper not less than 8% x 11 inche • j ,^-. Plan must St. Croix
include, but not limited to: vertical and horizontal reference poin B • i r ion and
percent slope, scale or dimensions, north arrow, and location and t• • t Barest road. Parcel I.D. 020--
Please print all information.
Z ewed By Date
Personal information you provide may be usM fnr c:_ 000Ar n it s ie (e.N' �„ aw, . .04 (1) (m)). I • 1 3 • 212 a0 lv�- �J� ���111JJJ`���
Property Owner RECEIVED Property Location
Bast, Kennon ovt. Lot na SW1 /4, NW1 /4, S36, T29N, R19W
Property Owner's Mailing Address APR 1 3 2005 Lot # Block # Subd. Name or CSM#
948 Labarge Rd. 91 na Cottonwood Ridge 2ND Addition
City State r 'ip Cc ci:Mettlmheir' City [ Village ® Town Nearest Road
Hudson 1 WI 1 Hudson I Cty Rd N
IX New Construction Use: ® Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
F Replacement ❑ Public or commercial - Describe: na
Parent material Stream terraces and pitted outwash plains Flood plain elevation, if applicable na ft.
General comments Mound design, system elevation 107.60ft based on contourline elevation 106.60ft.
and recommendations: •
1 Boring # 111 Boring
® Pit Ground surface elev. 107.50 ft. Depth to limiting factor 6 _7 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 -8 10yr3/2 none sil 2msbk mfr cs 1vf .6 .8
2 8 -19 10yr4/4 none sicl 2msbk mfr gw na .4 .6
3 19 -30 10yr4/4 none si 2msbk mfr gw na .6 1.0
4 30 -76 7.5yr4/4 none cos osg ml cs na .7 1.6
5 76 10yr8/2 Fractured imestone na na na na .0 .0
2 Boring # [I] Boring
® Pit Ground surface elev. 107.50 ft. Depth to limiting factor 58 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 -14 10yr3/2 none sil 2msbk mfr cs lvf .6 .8
2 14 -31 10yr4/4 none sicl 2msbk mfr gw na .4 .6
3 31-40 10yr4/4 none scl 2msbk mfr gw na .4 .6
4 40 -58 7.5yr4/4 none cos osg ml cs na .7 1.6
5 58 10yr8/2 Fractured imeston€ na na na na .0 .0
* Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg/L * Effluent #2 = BOD 5 < mg/L and TSS < mg /L
CST Name (Please Print) Skiature: CST Number
David J. Steel ti� 248956
r
Address Steel's Soil Service, lae. Date Evaluation Conducted Telephone Number
994 200th St. Baldwin, WI 54002 4/11/2005 715 - 760 - 0347
SBD -8330 mono)
Propprty Owner Bast, Kernon Parcel ID # Pending Page 2 of 3
p 3 Boring # � Boring
FA Pit Ground surface elev. 105.0 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 *Eff1/2
1 0 -7 10yr3/2 none sil 2msbk mfr es 1vf .6 .8
2 7 -27 10yr4/4 none sct 2msbk mfr gw na .4 .6
-
3 27 10yr8/2 Fractured imeston( na mfr gw na .0 .0
f
Boring # E] Boring
, [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 GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
Ell
Boring # Boring
D 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 (R.07 /00) Steel's Soil Service, Inc.
1
' STEEL'S SOIL SERVICE INC. 3of3
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. Cell (715) 760 -0347
Cottonwood Ridge 2ND Add. Fax.(715) 684 -3449
Lot,91
This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use.
Legend N
1 " = 40' I
�= Benchmark Ele. 100.00 ft
Top of 3/4" pvc pipe
Alt Benchmark Ele. 100.85 ft
`\ Top of 3/4" pvc pipe
\ ❑ = Borings
Boring Elevations
B1 = 107.50 ft
B2 = 107.50 ft
o B3 = 105.00 ft , -
" y- B4 = 0.00 ft
4> 0 /� ' . ��
...
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3/
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