HomeMy WebLinkAbout020-1454-00-095 Wi_�onsin Qepartment of Commerce Count
Sty Building Division PRIVATE SEWAGE SYSTEM St. Croix
INSPECTION REPORT Sanitary Permit No: 499203 Q,QJNW
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 -095
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
IOD.n _ ICD.O cs B ( 36.29.19.2910
TANK I,ORMATION ELEVATION DATA
TYPE / / UF TURER 64R9 4 PpCITY STATION BS HI FS ELEV.
Septic
Benchmark ,
/ /
WC -S /al 0 4.1 6otrq'E) 1GD.a
Dosing Alt. BM
Aeration Bldg. Sewer
g•34 96.Y0
Holding St/Ht Inlet g. 0b !S 9i
St/Ht Outlet
TANK SETBACK INFORMATION 9.ot 9• 66
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic ZS •
i ( *) a / Dt Bottom /"
Dosing Header • /Man. 7 p ?o 9i( elf' '
Aeration S n ��- - M I „✓ y:o �- pa7 / y p-f ._____) • � 7
Holding Bot. System g GMT, l/�C/S /0-7C 95• q p
Final Grade ,
PUMP /SIPHON INFORMATION 5 q 'o 2 / 9 S'
Manufacturer Demand St Cover 0 ♦ 'c-b (1i
Model Numbe [4 02)3 2, 4: v- s
TDH Lift i '.n Loss System Head TDH Ft E' �) r •s' r
Forcemain -ngth :•.•. Dist. to Well
SOIL ABSORPTION SYSTEM
Width t Length , No. Of Trgn h s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIM 1 •NS 3 /o (Q ) (2)
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer Y s
INFORMATION CHAMBER OR f C
Type V. 2 2 1' / ` UNIT Model Number; _ - 3
C.GrA DISTRIBUTION SYSTEM (` /1 (,E
Header /Manifold L L - � Distribution
Spacing x Hole Size x Hole Spacing Vent to Air Intake
9t t � Di i s) P g _�
Len / 1
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center Bed /Trench Edges Topsoil Yes No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Dt/' 1 (i Zoo ( Inspection #2:
Location: 825 Riley Lane Hudson, WI ' 5401 , 6 (NW 1/4 SW 1/4 336 R19W) Cottonwood Ridge 2nd Add Lot 95 Parcel No: 36.29.19.2910
1.) Alt BM Description ='j T �`f"ke J s fir( &.i e s t)
2.) Bldg sewer length = 11 N
amo of cove -t. l '.‘5 f "‘ °
Plan revision Required? Yes X No ny � (44fg-2..1,0i�
Us e other side for additional information. ' f - ��`' = - L - - -
Date Insepctor's Signature Cert. No.
SBD -6710 (R.3/97
Safety and Buildings Division County�� /
\*. . 201 W. Washington Ave., P.O. Box 7162 �'
SCOOSjO Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.)
Department of Commerce (608) 266 2 } 9 c zd 3
Sanitary Permit Applicati 1 State Plan I.DN per
In accord with Comm 83.21, Wis. Adm. Code, personal informs; I ou ,4 ide
may be used for secondary purposes Privacy Law, s15.1 ` ' '' Project Address (if different than mailing address)
I. Application Information - Please Print All Info
R �5925- .�
Property Owne ' Na me / R Parcel # Lot ' 95 Block #
0 )t,- DEC 0 5 2006 - }ysi- de
Prope Owner's M ailing A ress Property Location
0 0 .."
/ S T. CRO
IX COUNTY
.0•0 _ '._'._" . ,.., A/h) 'k,.� J 'k,Section . ? '
City, Sta Zip C. Phone G Number
circ Eo,4� t'
• e)
l� ,3--_,(., T,—,29 T N; R �9 ( / Z /D
apply) at, Dry,'
t'
II. Type of Building (check all that a 1 `�
�
)(1 or 2 Family Dwelling - Number of Bedrooms 7 s,r �GJ Subdivision Name umber
❑ Public /Commercial - Describe Use , Q` (' .iJL�,loa - O/d. -.� 9
�
J
❑ State Owned - Describe Use Z ' .: ❑Ci ❑ illage ,• �Townshi of •
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. ❑ New System y ❑Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System
B. ❑Permit Renewal List Previous Permit Number and Date Issued
fg, Permit Revision ❑ Change of ❑ Permit Transfer to New
Before Expiration Plumber Owner 3 , cc.. 3 Gl,.. `
IV. Type of POWTS System: (Check all that apply)
g Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter
❑ Constructed Wetland ---'❑ Pressurized In-Ground II Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter
1�1
❑ Recirculating Synthetic Media Filter Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. Dispersal /Treatment Area Information:) , - , S,rg - , 3 /,- t' - 3r ,/
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
_//
.� 7 fi's / 9ao
VI. Tank Info Capacity in Total Number • Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing
/ �o II '02 5Z) e7
Tanks Tanks ks N// C't , l
Septic or Holding Tank ///
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, ass , e responsibility for installation of the POWTS shown on the attached plans.
Plumber's • a me Print), Plumber's Si g - MP /MPRS Number Business Phone Number
.2 - i a. ,/� — _ - sue s r—
Plumber's Addre ss (Street, City State, Zip ode
05 . 0 ) - .�
VIII. County /Department Use Only
Approved ❑ !' approved Sanitary Permit Fee (includes Groundwater Date I sued IssuingXnt Signa (
urcharge Fee) 4 7 5
K 1 • , - - ' ' en Reason for Denial D �(p�0 Iiii
IX. Conditions of Approval /Reasons for Disapproval (� / /
SYSTEM OWNER: 3) la do n) U. dL�. net,,) �ow.e. o c�
�(•'�
1. Septic tank, effluent filter and
O a- re 4.----e4
dispersal cell must all be services / maintaine4 .H eA.._ (�
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)
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Wsconsin Department of Commerce SOIL EVALUATION REP.'�'•" Page / ,of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County 5/. (/'U , fl
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Pare I.D.
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 020 —/V V ego.. 0 ?S
Please print all _information. Revie by Date l
Personal Information you provide may be used for secondary purposes (Privacy Law, s. 1 04 (1) (m)). 1 / Z /(p / / D40
Properly Owner er,) D ,, /3 , Location U' 1/4 51,U1/4 2 T 29 N R /9 S (or 1A
Property Owner's Mailing Ad Tess L t # # Subd. Name or CSM# n /f
9Y4'- t z 8a/ re i EGON Govt. o N p 5 29 s Block Ca //o •, wool R:elc' e .2 4'JV
City S t a t e Zip C 6 d e • • e N -R City ❑ village ® Town Nearest Road
/44�1°.l I "1 I 5 I ( ) CRO` (GO'- f16.1 1 Platy y ,jo C7.
,g . New Construction Use: f3 Residential / Numbe of • -• • s - Code derived design flow rate ‘ GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material Oa fi6 4 ` 7..0 - 1 Flood Plain elevation if applicable /f ft.
General comments ) en --. 9s%0
and recommendations:
ID
j Boring # Boring 0
it Ground surface elev. V / ' ft. Depth to limiting factor / in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -/Z / V,( 4/4 SZ /1 /9ig BPS 2r 0.6 1
2 12-29 .r,, (�6 NA S; L , 2.mrc k /71,0, 0 w 2 v4 0. 6 0. g
3 29-W - 7,..5 - 4->"
r.5 Yd >i 4",4 1 ,5 6 ,0 (�"Q G G Gv / v4 0 7 ! , b a' .
W/ Ss /VA , MY osy - — -- 0,71 i, Z
W - N
Boring # 0 Boring
Pit Ground surface elev. �60 o ft.
® Depth to limiting factor /3 7 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/tf
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 6- 3 /6j1 /VA- ' S1 /snl ' 12204. as 2(' £2 6 /, O
2 13 - 27 5yX ( 76 * .57Z _ 2- f f4.- c q/ 24 Z). i 6, g
3 29-V‘ / 7, f, A/4 / - / OS , 6 c w /t- 0,74 /,‘
Y l6 /f 7 7) .4' 6 �tr' _ 14.5 0.), M G — J 0, 7 / ‘ k
1
'I
* Effluent #1 = BOD, > 30 < 220 mg/t. and TS 30 < 150 mg/L * Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/t.
CST Name (Please Print) ( Signature CST Number
,fir/ q✓� / / 1 e// X , �--- 23 /3/c
Address Date Evaluation Conducted Telephone Number
391- /72dve S0/ -rev u.L /D -// - 0 7 /T -zf 3203
Properly Owner ke Parcel ID* 020— /Vs 6 '65 Page 2 of
Boring # ❑ Boring
® pit Ground surface elev. ' 7 7 ft. Depth to limiting factor 7/`l 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 /2 /oytk A/ SG /, Ik 0,/- a.s 2, o..4 f, t
12-3 s "`l'( A _S;6 2 Ai l/ c C Lu 2 P nn J OS
tJ ��
3 30 -VY x.5rR- A/4 ms 6, vsy - L c w / a- 07q 1, t;
whb7s -rws/ ,l,.',4 M.s //)? 7 /. 6 4
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/fW •
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/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BCD, > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 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.
SaD -8330 (R.07 /00)
•
CO 7 5--
Property Owner ke/� Parcel ID # 02a"' /7.5 V "69S Page 2 of
3 Boring # ❑ Boring ,___, q
Pit Ground surface elev. / 't 7 ft. Depth to limiting factor 7/� 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
I O a lob A//( SG /fii.ak 6 0 as 2 - 0 4 40
1
/Z-3O 5 A /ilk S/6 2 i -16'k r n {-> C ri 2. P d,, ' 0 <8
3 36 -W 7, i¢ ms & as, ILL c w j v� in 7 q /, � Q
I/ yy /s 7.sr9 -/ .W/4 in s- 6 S M. 0, 7 1,d 4
, q
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 *E1
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/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/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 (807/00)
OWNER Page 3 of 3
Name /reinon 5017' Brian Parnell
Address q yg La. /34 RP. CST 231314
/ u 1-r6 1 IA- _SY6/ Date /6- //- 0(
Benchmark 1 Top ad Zo -I- P1,1 4 /00.0 g "------
Benchmark 2 To / 0 ree foss Z. /6./
i I Soil Borin_c„
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1 1.-,•
Suitable Area
40'
1" 1 = 40 Scale
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r--- Safety and Buildings Division County
NM:sconsi 201 W . Washington Ave., P.O. Box 7162 s or '
Madison, WI 53707 - 7162 Sanitary Permit N r (to filled in by Co.)
Department of Commerce (608) 266 -315I 44'39 203
Sanitary Permit Application • , Plan ID. Number
In accord with Comm 8321, Wis. Adm. Code, personal information y. . . - . " '
m a y be used for secondary purposes Privacy Law, s15.04(lXm) Project Address (if different than mailing address)
Malimim
I. Application Information - Please Print All Information
. I - 3,- l A' .. -.//1
Property • 's N. RECEIVED Parcel # 93— Block#
4 - l ip; .0 - Y/ r-- .1
Prope Owner's Mai lmg Ad •1 I 1 i s Ur Location
L • m 5t I '' i p / • , Section
. Cod . e i . " s.' n ber _74, _74, _ / I - ���/in�� T N R e c , • • fl :) (,21 V
II. Type of Building (check all that ap . . 41..10P12Lirvo, Tr
or 2 Family Dwelling - Number of Bedroom . Subdivision Name Cdr
❑ Public /Commercial - Describe Use , h gO,p.4 ° a Ar ,( j i ij ln n 7 U
❑ State Owned - Describe Use ❑City ❑Vill Fownsh' of
rP
III. Type of Permit: (Check only one box on line A. omplete. line B if applic e)
A. i New System ❑ Replacement System ystem ❑ T . .. ent/Holding Tank : , lacement Only 0 Other Modification to Existing System
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change . ❑ - •t Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber r • er
IV. Type of POWTS System: (Check all that apply)
1,,iNon - Pressurized In Ground ❑ Mound >24 in_ of suitable soil ❑ ■ .un. 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In -Ground ❑ Holding Tank f Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter Leaching Chamber ❑ D - ine ❑ Grave Pipe ❑ Other a . lain)
V. Dis . ersal/Treatment Area Information: `1,W/l�Wh�.� r
f���i � ► � .. � -- --_- � tuna -Ct�� � , ! ' .S
Design Flow (gpd) Design Soil Application Rate(gpdsf) if ,ersal Area Required (sf) •ispersal Area Proposed (sf) System Elevation
440 , '
�sz /�a �'"> °? 9
VI. Tank Info Capacity in Total N . r Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of its' (P /O ■ .1 L . Concrete Constructed Glass
New Existing ( r
Tanks Tanks
Septic or Holding Tank
Aerobic Treanmem Unit
Dosing Chamber
VII. Res 1 . usibility Statement I, the unders , d, a rime responsibility for installation of the POWTS shown o . he attached plans.
Plum. Name (Print) Plumb S MP/MPRS Number Business Phone Number I' ,) 4, , ... A O .....-
A / ■ 3 Ste- 7
Plumber's Address (Street, City, State, Zip Code)
Dy :? lb e .eals //(/.,T - ‘.-,7 I,
VIII. County/Department Use Only
Approved ❑ D : <..pzov Sanitary Permit Fee eludes Groundwater Date Issued Issui Agent Sign (No Stamps)
Surcharge Fee) / �. t f } I
❑ • . Iv- Reason for 0.- ial171°731 — " I I � (J6 s {
IX. Conditions o Approv . n.� I n -- n
SYSTEM . ' R: 3) ,n., , A:$ &. * / St aa
1 Septic tank, effluent filter and
dispersal ""`^ ` � 1
ersal cell must all be serviced / maintained Via -
p aintained a S�Q � s �� e�
as per management plan provided by plumber. 'tA Cilitua r
2. All setback requirements must be maintained
as per applicable code /ordinances. • S
Attach complete plans (to the County only),for the system on paper not less than 8112 z 11 inches hi size
SBD -6398 (R. 01/03)
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' \V i 505:p SOIL EVALUATION REPORT #1640
Department of Commerce in accordan Comm 85, Wis. Adm. Code Page 1 of 3
Division of Safety and Buildings Steel's Soil Service, Inc.
County
Attach complete site plan on paper not less than 8% x 11 inches ', ' •� 'Ian must St. Croix
include, but not limited to: vertical and horizontal reference point (: 7 re ion and
percent slope, scale or dimensions, north arrow, and location and di- . •y** nearest road. Parcel I.D.
Pending
Please part-elf-information. Re ,awed By Date
Personal information you provide may be .ised foRAee UL eePPrivacy Law, 4 (1) (m)). F6843,24°4
Property Owner Property Location
Bast, Kernon APR 1 3 2005 _ Govt. Lot na NW1 /4, SW1 /4, S36, T29N, R19W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
948 Labarge Rd. ST. CROIX COUNTY 95 na Cottonwood Ridge 2ND Addition
City Stator 7'p r. Q NI tlAWgPF&Alp. City — 1 Village ® Town Nearest Road
Hudson 1 WI 1 54016 1 715 386 - 7775 Hudson 1 Cty Rd C
❑ New Construction Use: ❑ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
Replacement ❑ Public or commercial - Describe:
Parent material Stream terraces and pitted Q'cco J7 ii) %i!?S" Flood plain elevation, if applicable na ft.
General comments Conventional system, system elevation 90.85ft. Trenches spaced and depth to
and recommendations: code 4.75ft below grade.
1. Boring # Boring
❑ Pit Ground surface elev. 95.60 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 -10 10yr3/1 none sil 2msbk mfr cs 1vf .6 .8
2 10 -20 10yr4/4 none sicl 2msbk mfr gw na .4 .6
3 20 -36 7.5yr4/4 none sl 2msbk mfr cs na .6 1.0
4 36 -120 7.5yr4/6 none cos osg ml na na .7 1.6
1
90. s
2 Boring # Boring
I Pit Ground surface elev. 95.60 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 -12 10yr3/1 none sil 2msbk mfr cs 1vf .6 .8
2 12 -24 10yr4/4 none sicl 2msbk mfr gw na .4 .6
3 24-48 7.5yr4/4 none sl 2msbk mfr cs na .6 1.0
4 48 -120 7.5yr4/6 none cos osg ml na na .7 1.6
Sin 3
* Effluent #1 = BOD 5 > 30 < 220 mg /L and TSS >30 < 150 mg/L * Effluent #2 = BOD 5 < 30 mg /L and TSS < 30 mg/L
CST Name (Please Print) . ignature: CST Number
David J. Steel 248956
Address Steel's Soil Service, I - . / Date Evaluation Conducted Telephone Number
994 200th St. Baldwin, WI 54002 4/11/2005 715 760 - 0347
SBD -8330 (8.07/00)
. Property Owner Bast, Kemon Parcel ID # Pending Page 2 of 3
A '
3 Boring # El Boring
® Pit Ground surface elev. 95.50 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 -15 10yr3/1 none sil 2msbk mfr cs 1vf .6 .8
2 15 -24 10yr4/4 none sid 2msbk mfr gw na .4 .6
3 24 -36 7.5yr4/4 none sl 2msbk mfr cs na .6 1.0
4 36 -120 7.5yr4/4 none cos osg ml na na .7 1.6
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
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 5 > 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 (8.07/00) Steers Soil Service, Inc.
STEEL'S SOIL SERVICE INC. 3 of 3
David J. Steel Kernon Bast 994 200 St.
CST - POWTSM NW1 /4,SW1/4,S36,T29N,R19W Baldwin, WI 54002
Lic. #248956 Town of Hudson, St. Croix Co. CeII (715) 760 -0347
Cottonwood Ridge 2ND Add. Fax.(715) 684 -3449
Lot,95
This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use.
Legend N r
1 " = 40'
= Benchmark Ele. 100.00 ft
op of 3/4" pvc pipe
'Z.✓ = Alt Benchmark Ele. 99.60 ft
Top of 3/4" pvc pipe
❑ = Borings
Boring Elevations
B1 = 95.60 ft
B2 = 95.60 ft
B3 = 95.50 ft
B4 = 0.00 ft
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1
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of 2
FILE INFORMATIO l bZa)e,.9ri „ j e,- 2' l/ j - SYSTEM SPECIFICATIONS
Owner
, )
�,��� Septic Tank Capacity ��LD ga l ❑ NA
Permit # L / 9
.0
792 03 Septic Tank Manufacturer 1iJse. ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer ,Q2/ -44 ❑ NA
/
Number of Bedrooms 1 ❑ NA Effluent Filter Model , _ �� ❑ NA
Number of Public Facility Units Et NA Pump Tank Capacity gal El NA
Estimated flow (average) / gal /day Pump Tank Manufacturer ANA
Design flow (peak), (Estimated x 1.5) la e d 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) 5530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids ITSS) 5150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) 0 NA
Biochemical Oxygen Demand (BOD 530 mg /L IX In- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L 21 NA ❑ At -Grade ❑ Mound
Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y 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
❑ monthls►
I nspect condition of tank(s) At least once every: ....3 year(s) (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 (east once every: 3 ❑ month(s) (Maximum 3 years) ❑ NA
l�' yearls)
Clean effluent filter At least once every: ❑month(s) ❑ NA
,E year(s)
❑ month(s)
Inspect pump, pump controls & alarm At least once every: ❑year(s) ANA
Flush laterals and pressure test At (east once every: ❑month(s) CIA
❑ year(s)
- .- e -: ❑ month(s)
At least once every: ❑ yearls) ❑ NA
Other:
❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one -third (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.
Page ,- of 0 •
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:
0 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
Phone 5/" >c3 7/�— Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name .5---jdo,X aiLdi
Phone Phone j ' 0
This document was drafted compliance with chapter Comm 83.22(21(b )(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
Oct 05 06 03:11p Team Speer Bast 7153868660 p.l
t7yt . Loon 10:40 • / 1 J:.os s 3U.7o .ws .�� �... . _ .
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer { rt. $A5r
Mailing Address _ 90 z Are e . Nvosicy, w.E. se,o ,
Property Address $2 ' lecfy 59:04
VSL (verification required from Planning Department for new construction)
City /State $1/440Z&u /tar Parcel Identification Number 02 4521- 075'
b 4AL inScRIPTION
( 2 9 / 0 )
Property Location WO t /., S`±/ 'A, Sec. Yfr , T N -R /T W, Town of 4111
Subdivision CO1Tuu.)Co0 (ZiA E SC AOOrriaA) Lot lit Q5 .
Certified Survey Map X 'Volume , Page X
Warranty Deed ii W6, � ( , volume Z ? 3 9 , Page ti 3I4
Spec house ycs 0 no Lot lines identifiable, yes no
SYSTEM MAINTENANCE
improper use ant& maintenanceof your septic system Could result in its premature failure to handle wastes. Proper matntenan:c
consists of pumping out the septic tank e•-cry three years or sooner. if needed by a licensed pumper What you gut into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The properly owner agrees to subaltt to St. Croix Zoning Department a certsficetion form, signed by the owner and by a
ream , plumber. journeyman plumber. restricted Plumber or a licensed pumper verifying that (t) the on wastewater disposal sYstcrn
IS in proper operating condition aodrnr (2) after inspection and pumping Of necessary). the septic tank is less than Ili full of sludge.
1rwe. the u dersigned have read Ibe above requirements and agree to maintain the private sewage disposal system with the standards
set fo• . '*rein et by the Department of Commerce and the Department of Natural Resources. State of Wisconsin Certification
eta ng.t ur system has been maintained must be completed t►ntt returned to the St. r,oix County Zoning Office within 30
clays • re xptrariun data.
v' /ors/ ZeaA
SION c�T�4r OF APPLICANT p DATE
R r - CAT ON !�
i enify that all statements on this form are true to the best of my (our) knowledge l (we) a 7.m (are) the owner(s) of
pro • h des 'be Al p c, b virtue of a 1. arranty deed recorded in Register of Deeds Office.
NATU' APPLICANT DATE
Any information that is mu-represented may result sn the sansiary permit being revoked by the Zoning Department.
'• Include with this appiicauon: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
2'd Z 86L8888 roan o uose
4 C C *ITT :TO co 88 1.0 t)
SEP 02,2005 15:02 7153868660 page 1
U 2739P 316 '7 8610
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?l
WARRANTY DEED
THIS DEED, made between Neil L. Wilcoxson and Mary Jo EXEMPT
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 1
020 - 1110 -30- 000... 020-1109-55-050
Parcel Identification Number (PIN)
This is not homestead property.
Dated this 28 • •r: y of January, 2005.
./ A 1 ALS _4# `in CvA37 cz-tid 0'77
! Mary Jo i oxson
rl L.Wicox � * Ma
AUTHENTICA1PIb�I� D ACKNOWLEDGMENT
• Signature(s) �O . t�J , v... STATE OF WISCONSIN )
c4. 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.' e fore oing instrument and acknowledged the same.
(If not, A
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
vu6 uo uo uo:icp team Speer bast 7153868660 p.
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SEP 02,2005 15:04 7153868660 page 6