HomeMy WebLinkAbout020-1454-00-093 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No: 488078 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 -093
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
75 • l5 fa - 3 c5 36.29.19.2908
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 2. 5 G-, Benchmark S. l s
Bestrrg , („J4 c5 g ∎ /Z GO 7. Z /a4 .35
Alt. BM
F,I Z,1 A- mo L.LIIt_ oJd_ 3. Z 0/ / 5
Aeration Bldg. Sewer
S.zS`7%1
oIF St /Ht Inlet
7 03 `/7 ,, 3z
St /Ht Outlet
TANK SETBACK INFORMATION 7.34. 9d ,`r9
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic i , Dt Bottom
54 77 2 i 7 50 —
Dosing Header /Man.
c.■'---;_____I-- • (.o 94 .75
Aeration `'_ Dist. Pipe
/a ,45 9
Holding trot. System
/l. (p 92,75 a
I Grade
PUMP /SIPHON INFORMATION (r (o 97
Manutacturer Demand St Gover
GPM F: t (.- Q-k- 3.15 /a . 55
'0 e 1 u --'1111"11t
Kim ric ion oss ys e.• -
or -- .i - ng .I.. • .
SOIL ABS • RPTION SYSTEM
. - , - r r . - . I ... - - ri 1 umcivaiuIVJ NU. ur rirs rnsiue uie. uquiu ueprnl
DIMENSIONS 2 / $ 5 ' Z rem ~ -�
J LCAl.nirvu lvianutacrurer.
x i aAl.n J Y J I tlVl i v r,t esuub v vtLL 1..KFCt/J i r �Aivr CHAMBER OR T, /
INFORMATION J d-r
i ype ur Jysreut. / t UNIT
GO o,na . / $ /Z(o /4 Z ' /0 imoder�tnrtrnet. .64-.e...Joe(
0151 RIBUTION SYS1 EM c pi I-- /`r Z7 1-bdt-...&
Meader /Manifuld // Dlsuluutlui xTbte3he A Mlle Sp tin o n le
y Vet tAlrira
/
ct Length 1 Dia T Length \ Dia a Spacing \
SOIL GOVtR x Pressure Systems Only xx Mound Or At -Grade Systems Only
g P
/
Bed /Trench Center 5 Bed/Trench Edges \ Yes No NYe No
Topsoil `
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / /
Location: 835 Riley Lane Hudson, WI 5401 (SW 1/4 NW 1/4 36 T29N R19W) Cottonwood Ridge 2nd Add Lot 93 Parcel No: 36.29.19.$908
1.) Alt BM Description =
2.) Bldg sewer length = 30 '
- amount of cover = z ' ,
Plan revision Required? ; � (a1311-4-17
( (
Use other side for additional information. No - �P - Z� "`� __ _ - - . - ctor s 1, , a. — r<` - No -
SBD -6710 (R.3/97) /
afety and Buildings Division Conn Count � . Washington Ave., P.O. Box 7162 5,k ,, citt., t
I ar.a. Mad ison. WI 53707 - 7162 Sanitary Permit Number. (to filled in by Co.)
ons�a (608)266-315 1
Department of Commerce y-Ego 7 i Ru
Sanitary Permit Applica, RE�EIVED Plan I D. Number
In accord veldt Comm *3.21, Wis. Adm. Code, personal information you prov
may be used for secondary purposes Privacy Law, al S D4(1)(m) jeer Address (if different than mailing address)
I. to FEB22 2006 f
Application io Information - Please Print All Information
pP
3c R►i .tv) Lew
Property Owner's Name ST. CROIX COUNTY P cel s Lot M beck N
I�1zN `w. 9 3 c 3 ) -_...
Property Owner's Mailing Address Property Loca
r- l,k i VA MA.) 1,4, p
City, State � % L � 5 �•/ � /.. 'h, Section
ty, Zip Code Phone Numbb�er -�
{J LOK Yin , t L 1 L i � v /•) T �l9 N; R11
(c E or W e)
II. Type of Building (check all that apply) oa • , S t/`r AO
hY Dwelli ❑ 1 or 2 Fami Subdivision Name JSM Number
ng -Numbs of Bedrooms � � � ' ��� (� ,,.
13 Public/Commercial - Describe Use C uA to n is q g r ti c, a , 1
❑ State Owned - Describe Use ❑City_ ❑Village &ownship of 1-1 et 013'4
III. Type of Penult: (Check only one box on line A. Complete line 0 if applicable) O ZO -146 - ¶3 (• Z `Tog)
A ' (New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date issued
Before Expiration Plumber Owner
IV. Type of POWTS System: (Check all that apply)
A wn - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound <24 in. of suitebk soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Consuncted Wetland ❑ Pressurized In -Ground ❑ Hosing Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Reciradating Synthetic Media Filter jelleaching Chamber ❑ Drip Line ❑ Gravei-less Pipe ❑ Other (explain) r' A \
V. Dh�gditreatment Area Information: C " C. W Wow' Ca rr J
Design Flow (man Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
40) . 7 g. t `7 () - 1L R L' TI. , O
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units t.s' E1 4 � , 'r Concrote Constructed Glass
New Exhumes I
Tanks Tanta
Septic or Hoar Tads I a lo 0 I W f ... S ‘/ /
Aerobic Treetme nt Unit
Dosing Clamber
VII. Raponsibflity Statement- 1. the underelpadepsaams pyspanalbllity for hutallation of the POWTS shown on the attaebed paw
Plumber's Name (Print) P rrs i MP/MPRS Number Business. Number
Plumber's Address (Street, City, State, Zip Code),
i 6 c; .13w '35 i 4k4bs t P a I( .. K V(! L
VIII. CountyfDepartmt Use Only
Sanitary Pamit Fee includes Groundwater Date issued lasuin r Agent ; ; o Stamps)
Pt Approved ❑ Disapproved
❑ • • . - en Reason for ill ■ t Z , d i - L A.:es.
IX. Conditions , LOTTIr ' • . • - •
SYSTEM OWNER;
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 codelordinances.
I
Attach complete plan (to Ills Cway only) for the system on paper net hss than $1R 1 11 Indies In sift
SBD -6398 (R. 01/03)
•
• i ..- ti . 6 / / /01. /71 alki --5 / to/ nclerss .
. ir.
_141.e.L.L.... .:.... • ._...... .... 1
r
...K.Kis,.r_ .44. Al/lb.ii-= .. ._/):1. I ...
cpea i Inn CM0A V\10 .gi (1 y . :. . 4../Ce.n.5e .A ... _. .-----....
fd - .V) -
_____.
._..f... ‘1(1'4.11''') 44,)
. , . ,
-7 ; ig il*
, 01 t
• 1,,,,„
. 4 .
. ,,Ci, Yo' •
(swov 9. Stel
?b,) f;i
(V
• • . B.:- *)
5' a 1- .
4
bfp
3 87,s'b Mo
• 7c
so'
< •o
- (ea
. 1 4= go. 1. 1n4
-f ut. 11 4 4 pvc 4tv-.,. ,o0..0
• - ir.1) t geh,i, tIl
1111 111110
H 9
L 9.j(
.1 ..g
!ill
•
ve
1 •. a, , , , 01
•
,, 1 . " 2
1
. A L 4
I • I (.■?
I • L
r . i
I . 1 Dri..". ' • :. i X - I I it, I ' •
1 ..
; I II 1 1: ..j: .
- 3 i a i
0 1 47-- iq- ... 41 ,, ,,, ,,,, .
' ,, A
, . I `-' LS . w / / 101: / 1 41..►
k
..t.tpai.. .L. ,,,,' __ .. .. . . 1 11 .. .../)./. .e.C ..... D(. a z c�ij C� a;�1 �1\1 C d /Y _ :'n.. uu.m,�e.� d er •-
-
C y .. � ,5c� a4 - Rte? ,2, . ..._.._..__...
• - _7W7 , )
04
s_
)f
lGt t
,,A.,,
01 g Yo' ,
1 I.X,6 g' S " ac
Q? w I plot, Zb1 f;1-tta
. B3
55'.--)0 f �I ;
44 3x 87, SU
1Jo
o
Q
ea
lot 114 "pvc.
k: 100.0
•
• - N4 - Rew4.1, moz .
____ o-i //kr pvc rIvv= Io7.35
CO 1
i .. . I 1 %A
!1 I ' . 18 , ve . "
•
sc_
Nil. ..., 2
.,00- el' t i 1 . l 5 1
C ( -..... . U n . I 1 11 .
„ . O 1 . t k i 1 i 1 . 1 i I .
t 1.. 2
U t rii . . i .. .... .
r
:I
� K [? Ii A _
1111r
consin SOIL EVALUATION REPORT #1649
Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 3
Divition of Safety and Buildings Steel's Soil Service, Inc.
County
Attach complete site plan on paper not less than 8% x 11 inc ;L f k ize. Plan must St. Croix
include, but not limited to: vertical and horizontal reference -jj *�� -5 ),erection and
percent slope, scale or dimensions, north arrow, and location an.. " st8i ce to nearest road. Parcel I.D.
v Pending
Please print all information. R iewed B Date
Personal information you provide may be u 5.0 1) (m)). A An o , FO. 1 3 'Z�
1
Property Owner RECEIVED 'roperty Location 0we6.
Bast, Kernon Govt. Lot na SW1 /4, NW1 /4, S36, T29N, R19W
Property Owner's Mailing Address APR 1 3 2005 - # Block # Subd. Name or CSM#
948 Labarge Rd. 93 na Cottonwood Ridge 2ND Addition
City State 2 ip Coq. CRa491M191 I 1 City Village ❑ Town Nearest Road
Hudson 1 WI 1 cdn1a ONIWN FAf4775 Hudson 1 Cty Rd N
New Construction Use: ❑ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
❑ Replacement ❑ Public or commercial - Describe: na
Parent material Ridges and drainageways of limestone uplands Flood plain elevation, if applicable na ft.
General comments Conventional system, system elevation 96.10ft. Trenches spaced and depth to code 5.75ft below grade. o�
and recommendations: w ; �(�. 6 4 r 4-(,,, :, _kr,). &. b Lk_ t` s {, ,� 4_ .b 1 Y- �J i
1 Boring # Boring
Pit Ground surface elev. 101.85 ft. Depth to limiting factor 100 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 10yr3/1 none sil 2msbk mfr cs if .6 .8
2 8 -24 10yr4/4 none sicl 2msbk mfr gw na .4 .6
3 24 -44 7.5yr4/4 none sl 2msbk mfr gw na .6 1.0
4 44 -100 7.5yr4/6 none ms osg ml na na .7 1.6
i
6- t c i ,
61 /►0r
2 Boring # Boring
❑ Pit Ground surface elev. 101.85 ft. Depth to limiting factor 120 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fr
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -10 10yr3/1 none sil 2msbk mfr cs 1vf .6 .8
2 10 -30 10yr4/4 none sicl 2msbk mfr gw na .4 .6
3 30 -60 7.5yr4/4 none sl 2msbk mfr di na .6 1.0
4 60 -120 7.5yr4/6 none ms osg ml na na .7 1.6
v i - c fb.fd
6 --- silt inclousion are present in horizon #3 ( i ze...' e.. ....4.„ 4 : 0 . 4. , gli; f� -- � ?
* 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) Sid ture. I CST Number
David J. Steel � ( 248956
Address Steel's Soil Service, Inc. Date Evaluation Conducted Telephone Number
994 200th St. Baldwin, WI 54002 4/11/2005 715 760 - 0347
SBD -8330 (R.07 /001
r
Property Owner Bast, Kernon Parcel ID # Pending Page 2 of 3
3 Boring # 11 Boring
❑ Pit Ground surface elev. 95.15 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 -12 10yr3/1 none sil 2msbk mfr cs if .6 .8
2 12 -24 10yr4/4 none sci 2msbk mfr gw na .4 .6
3 24 -36 7.5yr4/4 none sl 2msbk mfr cs na .6 1.0
4 36 -120 7.5yr4/6 none ms osg ml na na .7 1.6
Boring # El 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/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
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/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
I need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777.
SBD -8330 (R.07/003 Steel's Soil Service, Inc.
r
S TEEL ' 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. Cell (715) 760 -0347
j Cottonwood Ridge 2ND Add. Fax.(715) 684 -3449
Lot,93
This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use.
Legend N
1 " = 40'
4) = Benchmark Ele. 100.00 ft
Top of 3/4" pvc pipe
O r = Alt Benchmark Ele. 107.85 ft
Top of 3/4" pvc pipe
❑ = Borings
Boring Elevations
B1 = 101.85 ft
B2 = 101.85 ft
B3= 95.15 ft
B4 = 0.00 ft
I /s' v3'
7 4 GF-
04-, i . ~ - - -----
q Z . i
" t A ^.< 1 X k A : '
/ i 7., ?' `7(/ i /r
S
! G
- -f irm / / / /�f % 0 / / /l 1 / f s • —j
/ 4 ' . f •; , � , � ,, i ," ,4 � � /r� j / f i
� ., i , . / „ / //I / /� / /
'
•
• , fii ' rte •i •/ : ! � l � / ,'4114 ,1 11, / k
• iii , �flfl r� �J i ' /f/'f % � t � i�� ! . 3+4 r % f � ' N / 0 �+
� � rl�if '` �!� ' � i ./ { ' fig ' � f / �� � >�!j r , . ' .. * 4 �� , x • !A
•
"pot, � iyi 4h fiff / f�i r "i l � �' / �/ X O ai °
/ tt }a / /. , -, cu
y, � o /J/ / r .,f
�''/ / i +t +r rJJ f/ i I / • 1-- Q II
� � / / � ., 4, .//;: i + 0 y�• /i ii.Yl f l i / •
•
I / �' +'� + ��i , i�� j rr %fit ll :3 /
r,/ . /I /I ' it +f} /fi l 2
et
� � � t � �� 44%;.401:', : r. �� IlflJ J yyfj i ii�j / % / * •-
}0 %$$# ll ff /ff /ffJ, +: i�
( / V %!%r } r' 1 » ' +:'* 1L' +.+ +i f Jf ylf /f ."
?. /
• ` �N/ }Iii � �i +� +t •{ ff
� / % %� : I ' t �� + , � ��� � / ffl yl • / O O
j I ► O I o� �, •
as 0
f Q
/ /44 t 4IS/ r p/ v.."... ,, 1r , i F-
8. /
Ite,,, , .:.,-;111:::,... 014,, ,„,p;-- :,,,, "pi
..•
co -4- ai xi
co o
tiro .. ,e...,,,,,,,
:::::,....., „„,,,,,,,,,„2,,:::. cupl
, •
"-,,,,,..?„ .4.:c?i 1 '.-::::
/ 1 ; ,+,t r i t �
t, n
'. , .ta i � • ... �Y�i+
40 1.
Q � - , �•
/ f�'� �i i 11 +.4r.,:::'-:: I —
00
,+ ,� q + fir — Q O +1 � _ +►
�• N
X° r .. -.I
•
•
• 4 �• • • / o 'EOL � • •
• / / O ` • o o � �i
x Ni
X 5 CD
•
co
o � 6.
CU L . *6 ::: .....
ilt
stn Z
QJ (7Q (V.:
• • I c \ NIL
X x
I
x Y
X x f ok
r-• C� 9E NOI103 • 0 1S3 b A t��,•,, ; // .�
1 1 ili �
a X o 1 a? � ;„1-/
/� o_ 0; iS1.5 3 �MN1� 00 0 uNna XIOa0 r �'
I A / 1'��C� a r --� I ,. n n .,,
/ ..- /,
NORTH LINE OF THE SW1 / OF THE NW1 /4 OF SECTION 36
/ �% /��' / /
_ .. • _.� x __ x x --
..� 75.30' 1 586.59'
/ 50 „ E .,...' a) --\ 6 - \
76.99' •�' \ LOT 9'1
__ - - _ c o •
15/16' IRON PIPE FOUND _ I F O' \ \ • . 2.07 ACRES
H W = °I$ _ O \ 90292 SQ. FT.
16°45'221N 0.41 FEET FROM 1 #. .50 ,), Y. \ \ LB.O. = 988.00 ��
c ∎ O \
TS COMPUTED POSITION • •
_ S89' " i'41•E — • • C � /� � � \ �Q \ �9'
� •
so, c "<<‘,O G6 ., \ /
UL �� /(/,s ue_ � \ . G a 0, \\ , /' • P -
rte. (� 11 M 8 x
V� a ^ O � Q� Z \ "\ ��s� j p \ \ •
zo LOT 92 p
n P 2.35 ACR \ •\ �
v x 102446 SQ T. . - \
B.O. = 1059.50 \ \ \ "
L \
\ 0 '6 \
0 1 5/16" IRON PIPE FOUND • + -- \ - o N24°04'29'W 0.56 FEET FROM o, c9 \ -,... /
cn 5 COMPUTED POSITION �. e .
0 - 9 AO A 25 C y 1 ! \ Ike*,
Z s6 ��_r
w . 7
x �•
4
u S�
O
w
J
L X /
/ �• .
cI _ :III:: �/ •/ T. X / N. /
co ti / /
LOT 94 / 4::51/4 /
co 2.02 ACRES /
T. / / /
87992 SQ. FT. a
1,
x .1!, F. / N
. /
a d / /
P / w ry /
t. A i //
/ /
x 28 7 T , / /
�` cy /
a/ /
x
f
, / 2.00
41 A
8719;
�� ��` S 68o r9 7 r 3 / �
W (E31 / 20'/ F / / ti
/ � sr. ?9 , / y Q
a O % / \ ` 23.,, / 3T 1 It / A
O N / \ �� / /
s / •• // 30 249,
LOT 97
x / 3.80 ACRES /
165553 SQ. FT.
% LB.O. = 1031.00 1
9 a / 1
1
\-. -
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _ 1 of 2 - _ -
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Kil 14, ti O f Septic Tank Capacity 1 � .
Permit # f I �p Q �� t�
Septic Tank Manufacturer W ga l ❑ NA
NA
DESIGN PARAMETERS Effluent Filter Manufacturer z ❑ NA
Number of Bedrooms L i ❑ NA Effluent Filter Model /I
Number of Public Facility Units - - -- --
�.NA Purnp Tank Capacity galA
Estimated flow (average) (� ry gal /day Pump Tank Manufacturer
f 14 NA
Design flow (peak), (Estimated x 0 a gal /day Pump Manufacturer
Soil Application Rate
gal /day /ft' Pump Model ANA
Standard Influent /Effluent Quality Monthly average* Pretreatment Unit iEt Fats, Oil & Grease (FOG) 530 m /L NA
g ❑Sand /Gravel Filter 0 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
y 9 Dispersal Cell(s) I
p Ilsl
Biochemical Oxygen Demand (BOD5) ❑ NA
m L
e 5
1 _30 g/ XIn- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade
0 Mo
and
Fecal Coliform (geometric mean) 510 cfu /100m1 — ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y in'di ❑ NA Other: —
Other: 0 NA
❑ NA Other -- —
❑ NA
* Values typical for domestic wastewater and septic tank effluent. Other:
P uent.
co NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: ❑ month(s)
Tex yea (Maximum 3 years) ❑ NA
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: ❑ month(s)
ijF year(s)
(Maximum 3 years) ❑ NA
Clean effluent filter At least once every: ❑month(s)
Y VV
— — — 1 ❑ N
8 year(s) NA
Inspect pump, pump controls & alarm At (east once every: ❑ month(s)
❑ year(s) ` NA
Flush laterals and pressure test At (east once every: ❑month(s)
Other: ❑ year(s) CNA
At least once every: ❑ month(s)
Other: ❑ year(s) ENNA
❑1,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 Teaks,
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.
1
START UP AND OPERATION . Page f 2—of .
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 cellls►. 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 sihtsMtr of MII 'IMO IOW pith ithsIi tlr rwrtlNVIM ine MHMII$PI MIisi ** of MV M •PNfM m wNPVIMINd *pili#*r.
• 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
repla ment 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 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. 1.
< < 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 +v, ecyht
rr r Name i c--� Db1AI -itA'\. ,,1.:.
Phone 7I - 1to `o'I7 Phone q 1C0- 011 -' 1 .,
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY ' !
Name DPil12 11 0 %0..1 Name S� L>Y�■ A �y4 ti,
Phone �� ‘ D 1 0 �, 5v Phone 3 c V to L� u . i
This document was drafted in compliance with chapter Comm 83.2212)(b)11)(d) &1f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
Owner/Buyer k--
Mailing Address ? F Let 6 G IQ r G� of )/ 1 0/6
Property Address E15 lei/e CI' 7 /7U15e 4)1 57 e.)/g
(Verification required frgtn Planning & Zoning Department for new construction.)
City /State Parcel Identifi ration Number
LEGAL DESCRIPTION t- (Oz I <45-4- 3
•zctoe)
Property Location SAL , /( J(� t , Sec. 34, , T N R / 9' W, Town of f 6,0 -
Subdivision ,• r �' ; ;, / 1 ' 11fe. vn , Lot # 3 .
Certified Survey Map # , Volume , Page #
Warranty Deed # ?86 /D , Volume a73? , Page # 3/6 •
Spec house yes no Lot lines identifiable& no
SYSTEM MAINTENANCE AND OWNER CERTIFI{ 1:ATION
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 yeah 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, ;e in the waste disposal system. Owner maintenance
responsibilities are specified in §Comm. $3,52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County P12 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.
Uwe, the undersigned have read the above requirements and Igree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce am 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,
1/we certify that all statements on this form are true to the be t of my /our knowledge. Uwe am/are the owner(s) of the
property desc ' :::' above by virtue of a warranty deed recorded in Re gister of Deeds Office.
Nu .ero ' A l
�.. 1 /
SI . T RE OF AP LICANT(S) DATE
** Any information that is misrepresented may result in the sanitary 1 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)
' 78E.1 09 ,3
11 2 7 39 P 31 6
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 03:15PN
WARRANTY DEED
THIS DEED, made between Neil L. Wilcoxson and Mary Jo EXB4PT t
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 COPYSFEE: 4212.90
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
020 - 1110 -30- 000... 020 - 1109 -55 -050
Parcel Identification Number (PIN)
This is not homestead property.
Dated this 28 y of January, 2005.
.L A 1 I�i� _14# ('� C 077
��1 L. DJi cox!, Mary * Jo i oxson
1
AUTHENTICA pu lp ACKNOWLEDGMENT
Signature(s) �aa �1;C STATE OF WISCONSIN )
air i.; J
ST. CROIX COUNTY. ) 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 31?
EXHIBIT A
Parcel 1:
A parcel of land located in part of the SW '/4 of the NW '/4 and part of the NW '/4 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 '/, 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 ''4 of the NW '/4; 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 '' 4 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 '/4 of the SE 1/4 of Section 36, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin;
described as follows:
Beginning at the South '4 Corner of said Section 36; thence N00 °27'05 "E, along the north - south ' /4 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 1/4 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.