HomeMy WebLinkAbout020-1454-00-099 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
i INSPECTION REPORT Sanitary Permit No:
487969 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 C X / c i - 0 4 j
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
91 f-3 GS 36.29.19.11
TANK INFORMATION ELEVATION DATA ¢ . i
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELR/.
Septic — 3 - /z � b Benchmar `/ q /oz. • ,!
kJ `( 9 �
5 Alt. BM
°° ► — P Ol� l ekr 5ZS Wc,,tk. OJT L•f .7 4 . Z
Aeration Bldg. Sewer
(,, OS Tto • 3 5
Holding -----\ St/Ht Inlet
(p. 95 • S'
Co
St/Ht Outlet
TANK SETBACK INFORMATION (c • %4 95• 'S
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic ,ZO / 3 / /3 ' 4/. 2. Dt Bottom
Dosing Header /Man. //. 05 ,/ • 35
Aeration Dist. Pipe
/I•45 9/435
Holding Bot. System
/Z,ts id , �5 1 =4 1 C -
Final Grade Z 96 • Z_
PUMP /SIPHON INFORMATION (c
Manufacturer Demand St Cover e,
GPM J- .n,,b� Cool-A._ 2 • � ( / • ‘ I
Model Num
/
TDH ift Friction Loss System ad TDH\ Ft
Forcemain nth _Dial Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width r Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 qZ Z , j amc. -_ Cl J -, '�_
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer. n , �7 1 L
INFORMATION ((�� CHAMBER OR .! T ,,P, 1 o►+Q V t ,
Type Of System:
ca, & I° 24.z , (t� / A AA_ UNIT Model Ni&ierl i4
DISTRIBUTION SYSTEM 'Jon-L.\ Z3/--Z3 = 5` (o ha'..sr-,
Header /Manifold / Distribution x Hole Size x Hole Spacing Vent to Air ntaIe
LL �'' Pipes) \ '? f ( �`dv.^
Length T Dia Length Dia Spacing e, ✓�OrJ
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over r Depth Over rx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center 6.1 6. Bed/Trench Edges \ Topsoil • Yes Li No Yes \ No
COMMENTS: Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / /
Location: 687 Mary Jo Court Hudson, WI 54016 (NW 1/4 SW 1/4 36 T29N R19W) Cottonwood Ridge 2nd Add Lot 99 Parcel No: 36.29.19.
1.) Alt BM Description = L-JO`lk OJA-- Ez CcsJ.e.�
2.) Bldg sewer length = (V
- amount of cover = r I
3
Plan revision Required? H Yes � � r � � A � i i � �
Use other side for additional information. I__
3 _ �r [
Date Insepcti is Sig r ture Cert. No.
SBD -6710 (R.3/97)
k ' .. 'n1.4. Division County
A a 161 W. Was I. n :'flu. , , . . adis n, WI ' : 4- . , anitary Permit Number (to filled to by Co.) v .18) 266 -3151 , / 7 Q �
Department of Commerce (
n ' ? % 2 (105 . fate Plan I.D. Number
Sanitary Permit p . on
In accord with Comm 83.21, Wis. Adm. Code, i in o Qvide
may be used for secondary purposes Privacy w, .15. NUIX COUNTY Project Address (if different than mailing address)
ING OFFICE
I. Application Information - Please Print All Information 45'7
Pro O er Name Parcel # /`% C J I o� Block #
PertY
Property Owner's Mailing ddress Property Luca '
iT -C/� ('d 444.1_''A, 'A, Section ,:?e
City, Sta Zip Code Phone Number
c ircle )
,f l) IL) ���t® N; R E of � /
II. Type of Building (check all that apply) dl` ca S �/�����\
0 1 or 2 Family Dwelling - Number of Bedrooms Sub �+ l C7 - Subdivision Name CSIol�tamber
1-1-D,),....451..- n / �
❑ Public/Commercial - Describe Use Y 1 o.v ._ [ d� )u)Am , i/J� g ; / yT,i'[ j /
❑ State Owned - Describe Use 1 6 i.1-- . Ce..L l b Lam . Z3 4 - 23 ,,,Lai, ❑City ❑ 'lage grownship of
vid5r9 f
III. Type of Permit: (Check only one box on line A. Complete line B if applicable) O -- / 1 / 5L/- V `'' 0 7 9
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 N ew List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
W. Type of POWTS System: (Check all that apply)
N Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Pat F Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ a •ne 7 , vet-less ipe ❑ Other (explain)
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Design Soil Application Ra f) a' 4. •_ .. . • equired (sf) Dispersal Area Proposed (sf) System Elevation
leD ✓ , 7 ✓ ,57:1-z. , 9,?„ V 9 ,
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site S eel Fiber Plastic
Gallons Gallons of Units q Concrete Constructal Glass
New Existing Qa� 10 {Z 5ZS
Tanks Tanks
Septic or Rowing Tank
b" _ /46 / i 'd .e- c � '>`
Aerobic Treatment Unit
Dosing Chamber
VII. Res . onsibility Statement - I, the undersigned, ass `me responsibility for installation of the POWTS shown on the attached plans.
Plum. r'. Na . (Print) Plum.: ' Si :4, . ,,, , MP/MPRS Number Business Phone Number
J,
PI tuber s Address (Street, City State, Zip Co. e
,5 � u' / � �s <>k--d 1, 1 S
VIII. unty/D epartment Use On
Approved ■ %tsapproved Sanitary Permit Fee includes Groundwater
Surcharge Fee) Da Is ed Issui Agent Si. , • (No % )
n y �
- . a Jt-(J . ' I l zi b son for Denial t`J
IX. Conditions of Approval/Reasons for Disapproval 3' q ^.� n
SYSTEM OWNER: A.) a t .�'`�.1 °'�' °'ti �` c� ' , it,' n,-t C ase 0 ,,
1. `Septic tank, effluent filter and
dispersal cell must all be services / maintained 4` J � t . i A e IT �('
� ' OA S (1)1 Ow . o � ,A0,,,1•c..z_.
as per management plan provided by plumber. �
2. AN setback requirements must be maintained ea.e +0 ,r\ e s"..-e_........)
o vo
- -
as psnapplicable coda / ordinances. M_
Attach complete plans (to the County only) for the system on paper not less than 51/2 x 11 inches in size
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sconsin SOIL EVALUATION REPORT #1644
Department of Commerce in accordaCg 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 Tess than 8% x 11 inches i • Ian must St. Croix
•
include, but not limited to: vertical and horizontal reference point (B , re p,,.• n and
percent slope, scale or dimensions, north arrow, and location and dis - ,.; earest road. Parcel I.D.
Pending
Please pent allittecaheyvt D Q Reviewed By WO Date
ix Personal information you provide may used for secondary purposes (Privaw Law, . 0 (1) (m)).
1/ I_
Property Owner APR 1 3 2005 Property Location /
Bast, Kernon Govt. Lot na NW1 /4, SW /, S36, T29N, R19W
Property Mailing Owner's Mailin Address Lot # Block # Subd. Name or CSM#
ST. CROIX COUNTY
948 Labarge Rd. 7ONING OFFICE 99 na Cottonwood Ridge 2ND Addition
City State up uooe rnonelvumoer — City E Village Z Town Nearest Road
Hudson 1 WI 1 54016 1 715 386 - 7775 Hudson I Cty Rd N
El New Construction Use: NI Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
Replacement Public or commercial - Describe: na
Parent material Stream terraces and pitted outwash plains Flood plain elevation, if applicable na ft.
General comments Convention system, system elevation 90 spaced and depth to code 5.92ft below grade.
and recommendations: ---
# E Boring
Boring g
M Pit Ground surface elev. 96.40 ft. Depth to limiting factor 120 / in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -9 10yr3/1 none sil 2msbk mfr cs lvf .6 .8
2 9 -36 10yr4/4 none sicl 2msbk mfr gw na .4 .6
3 36 - 10yr4/4 none sl 2msbk mfr cb na .6 1.0
4 62 - 120 7.5yr4/6 none cos osg ml na na .7 1.6
r
45) . /.<
2 Boring # Boring
® Pit Ground surface elev. 96.40 ft. Depth to limiting factor 120 / in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -9 10yr3/1 none sil 2msbk mfr cs 1vf .6 .8
2 9 -27 10yr4/4 none sicl 2msbk mfr gw na .4 .6
3 27 - 54 10yr4/4 none sl 2msbk mfr cb na .6 1.0
4 54 - 120 7.5yr4/6 none cos osg ml na na .7 1.6
* Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg /L * Effluent #2 = BOD 5 <_30 mg/L and TSS < mg /L
CST Name (Please Print) a ture: �-, 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 (8.07100)
•
Property Owner Bast, Kemon Parcel ID # Pending / Page 2 of 3
I 3 Boring # ❑ Boring ✓ El Pit Ground surface elev. 91.00 ft. Depth to limiting factor 120 hi. 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 -5 10yr3/1 none sil 2msbk mfr es 1vf .6 .8
2 5 -32 10yr4/4 none se! 2msbk mfr gw na .4 .6
3 32 -120 7.5yr4/6 none cos osg ml na na .7 1.6
Boring # D Boring
El Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
Boring # D 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
need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608-264-8777.
SBD - 8330 (8.07100) 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. Cell (715) 760 -0347
Cottonwood Ridge 2ND Add. Fax.(715) 684 -3449
Lot, 99
This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use.
Legend N
1 " = 40'
• = Benchmark Ele. 100.00 ft
Top of 3/4" pvc pipe
• = Alt Benchmark Ele. 100.70 ft
Top of 3/4" pvc pipe
❑ = Borings
Boring Elevations
B l = 96.40 ft
B2 = 96.40 ft
B3 = 91.00 ft
B4 = 0.00 ft
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer j
Mailing Address
Property Address L d- O
P Y C� �� /�
r
(Verification reclined from Planning & Zoning De : l ent for new construction.)
q g g p� )
City /State , ,oc Parcel Identification Number
LEGAL DESCRIPTION
Property Location i fid 1/4 �� 1/4 , Sec.„ -Fl , q N R 9 W, Town of 1 ,j
Subdivision /4)/,4t ; &�� , �'� 4 ,4li , Lot # 99 .
Certified Survey Map # , Volume , Page #
Warranty Deed # , Volume , Page #
Spec house yes no Lot lines identifiable yes no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. 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 Planning & 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 and the Department of Natural Resources, State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded m Register of Deeds Office.
Number of bedrooms
/ /
SIGNATURE OF APPLICANT(S) DATE
** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * **
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
Nov 01 05 11:53a Team Speer Bast 7153868660 p.1
vs, _ 'Med l es: 417 rsw.:urao .a
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERRSSHIP CERTIFICATION FORM
•
Owner/Buyer
Mailing Address .
Property Address Department for new construction)
(Verification required from Planning
City/State
L Parcel Identification Number
fi-I nFSCR[P�1_ON
, TA_N -R4W, Town of
�/ �,,, ,� 1 �., seq. �
Property Location �L .- .1-r Lot p ��
r
SuhtlivicianGvv o `
/ , Volume ��- Page fI
Certified Survey Map 1
Volume _______-----, Page # Warranty Deed 1
riy
Spec housc�YCS 0 no
Lot lines identifiable es 0 no
� errhatntenance
SYST�:M MAINIFN a
Improper use mid maintertar+ccof your septic system could res in
b s eased pumper ,e to bn wa handle waste Prop
put into the system
consists of pumping out the septic lank every three Yeats of sooner. ! system.
can effect the function of the septic tank as a treatment nage in the waste dispose ys at by the owner and d 4� 5? a
The pCO1'�ty owner agrees to wbnut to St. Croix. Zoning Dcpamnen r;f i r a certification form. signed a
that (i } the on -site wastewatc.dispos
nostet plumber. journeyman plumber. testticird plumber or a licensed pumper y na the septic is less than ICI iSp of sludre.
is in proper operating cumin ion and►or 12) after inspection and pumping (if necessary)•
ds
h the standards
system taste sewage doming m witndar
e to maintain the pn yste wit Certification n r
Uwe. the un • . fined h reed the tment requirements and afire anm of Natural Resources, State of within
see forth er: a by teparttnentof Cum , ua and he lei
KC
slat tfiat • u phi s;+ s been ntamta'a`d utusr be cnmplcted and temrned to the Sr. t'ioitc County Zoning
t ys oft ee MK ,, an a • // i 0/ X01
DATE
i
SIG A ' ' � pL1CANT
i M R ICAT ON knowledge 1 (we) am {are) the oWneKsl of
! ( e) ify t t al tateine tc on this form arc uruc to the best of my (ou )
e • , • scribe • a ore, y uc of .1 .•.urnn+Y deed recorded in Register of Deeds Office -
/1 r^ p/r
.4..,--\. !, I
DATE
,. TO PL CACANT ......
" ••• Any information that is mte- represnucd may result in the sanitary permit being revoked by the Zoning Deprt
ament.
" include raith this applicat ion: a stamped warrsnly deed from the Register of Deeds office warrant deed
e copy of the tcrhfied survey map if reference is trade in y
the
2•d 266G98CSTt
uosuyoe uose0 dIT:TO CO 83 1.00
POWTS OWNER'S MANUAL & MANAGEMENT PLAN . gage ofo�
Ado SY STEM SPECIFICATIONS
FILE INFORMATI s IV_ f - ,,, , , ,,, . ',4 : - . : _ r 1
Owner _ 441 - — , Septic Tank Capacity / 7 0 ' pal 0 N/
Permit # Septic Tank Manufacturer :w ' ❑ Ni,
DESIGN PARAMETERS �
Effluent Filter Manufacturer ❑ NA
Number of Bedrooms / 0 NA Effluent Filter Model a _ ❑ NA
Number of Public Facility Units ..6lf NA Pump Tank Capacity jai NA
Estimated flow (average) /6f,D gal /day Pump Tank Manufacturer 43--NA
Design flow (peak), (Estimated x 1.5) / D gal /day Pump Manufacturer 12 NA
a
Soil Application Rate , 7 gal /day /ft2 Pump Model N A
Standard Influent /Effluent Quality Monthly average* Pretreatment Unit NF'
Fats, Oil & Grease (FOG) 530 mg /L 0 Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration 0 Wetland
Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other:
•
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA .l
Biochemical Oxygen Demand (BOD 530 mg /L In- Ground (gravity) ❑ In - Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L $ NA ❑ At -Grade 0 Mound
Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Lino ❑ Other;
^ Maximum Effluent Particle Size Y in dia. ❑ NA Other; ❑ NA
Other, ❑ NA Other: ❑ NA
Other: ❑ NA
*Values typical for domestic wastewater and septic tank effluent.
MAINTENANCE SCHEDULE
Service Event Service Frequency
month(s) ' (Maximum 3 years) ❑ NA
Inspect condition of tank(s) At least once every: �' j year(s) ,,
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA
At least once every; ❑ month(s) ` (Maximum 3 years) ❑ NA
Inspect dispersal cell(s) ) year(s!
_ ❑ month(s) . ❑ NA I
Clean effluent filter At least once every: 5 j:d'year(s)
❑ month(s) .
Inspect pump, pump controls & alarm At least once every; ❑ year(s) ¢� Nf. 1
Q month(s ►f r , . 41 NA
Flush laterals and pressure test At least once every: ❑ earls)
❑ month(s) Other: At least once every: Q year(a) ANA
Other: O NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
S Maintainer; Septa is
• P T5 Inspector; POWT a Servicing Operator. Tan
Septage Master Plumber; Master
Plumber Restricted Sewer; OW p
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 thu
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 entiru
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code. f
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.
Q
MW (a/O1
. 1/2:e1 Pape of
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 aellls) 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 arca
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;; eat, 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 1 a lard.
...:,f, .>r'
• 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:
)ZE 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 musi
comply with the rules in effect at that time.
O 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. -
O 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. ..., ., ;:.... n . .
O Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomet 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
. , :ate,+' . .,.r
POWTS INSTALL • t �� �� POWTS MAINTAINER
J Name 1�:1PIi!AIWA Name
Phone
./<---- ' s ; Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Narne Name^ r� i,
Phone Phone 7/�' S,l , ^ / � ,,, ' '
(his aocument was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
I
START UP AND OPERATION ;1 4'_^' ;∎ Page of c.
:e
new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting producte 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 cells) in one large dose, overloading the cell(s) and may result in•t a 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
1 power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually 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:
e All piping to tanks and pits shall be disconnected and the abandoned pipe openings aefled,
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage .Servioing 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:
7� 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.
0 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.— • -- - -�-.w -
IDD 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.
0 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.
1.1, • ; i ,,,,,z :., .
< < 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
r tcs a
twizI .,,,,, nnisfrt .ii*:
POWTS INSTALL f; /� POWTS MAINTAINER
1 1 Name , jJ) 11 Name
i Phone �i _ S'- ;S" S ZY -- Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL. REGULATORY AUTHORITY
Name ..
_ ; Name ; , t le. 4,1,2p
Phone Phone 7 c :., ..,,;.. •
this aocument was drafted In compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.64(1), (2) & (3), Wisconsin Administrative Code,
1
U 2739 P 31 6 - 7 e.1Q1
. • 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 EXHIPT
Wilcoxson, husband and wife, Grantor, and Kernon J. Bast and Donalda J.
Speer -Bast, husband and wife, Grantee. REC FEE: 13.
Grantor, for a valuable consideration, conveys and warrants to Grantee COPYSFEEE: 421'x..
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 d St. — Suite 115
Exceptions to warranties: Hudson, WI 54016
Easements, restrictions and rights -of -way of record, if any. 456780
1 1— 1'— 1 -11 '1
020 - 1110 -30- 000... 020-1109-55-05 •
Parcel Identification Number (PIN)
This is not homestead property.
Dated this 28 , .r: of January, 2005.
Y rY
' r
j , ,
..441 4111 fir( � � �0-77
� i1 L. VJi cox I * Mary Jo i oxson
AUTHENTICAM pub ACKNOWLEDGMENT
Signature(s) Ne a '�� sCO gN'1 STATE OF WISCONSIN )
ST. CROIX COUNTY. ) ss.
authenticated this 28th day of January, 2005
Personally came before me this January 28, 2115 the
above named Neil L. Wilcoxson and Mary Jo Wil oxson,
* husband and wife to me known to be the personl) who
TITLE: MEMBER STATE BAR OF WISCONSIN execut 1 e fore oing instrument and acknowledged th same.
(If not,
authorized by § 706.06, Wis. Stats.) /
THIS INSTRUMENT WAS DRAFTED BY *Chen =Town
Notary Public, State of Wisconsin
Peterson, Fram & Bergman — Steven H. Bruns My commission is permanent. (If not, state expiration a : te:
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 2739P 317
EXHIBIT A
Parcel 1:
A parcel of land located in part of the SW 1/4 of the NW '/ and part of the NW '/ of the SW '/4 of Section 36, T29N, R19W, own 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 '/4 of said section, 1248. 9 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 O ice;
thence N63 °02'59 "E 148.42 feet to the north line of said SW '/4 of the NW '/4; thence N89 °26'58 "E, along said north line, 11:2.70 feet
to the east line of said SW 1/4 of the NW 1/4; thence S00 °21'37 "W, along said east line, 350.04 feet to the north line of Lot 73 ' f the
Plat of Cottonwood Ridge First Addition recorded at said office; thence S89 °26'58 "W, along said north line, 10.00 feet to th. 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 pi int 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; hose
central angel measures 3 °17'53 ", whose chord bears N86 °26'59.5 "W and measures 155.40 feet; thence westerly, along the • 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, can' ave
westerly, whose central angle measures 34°24'12", whose chord bears N12 °42' 10 "W and measures 98.78 feet; thence northe ly, 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 easterl
extension, along said north line, and along the westerly extension of said north line, 670.44 feet to the west line of the SW 1/4 . f 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 'h of Section 36, T29N, R19W, Town of Hudson, St. Croix County, isconsin;
described as follows:
Beginning at the South 1/4 Corner of said Section 36; thence N00 °27'05 "E, along the north - south '' /4 line of said section, 1216. 8 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 1/4; 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 id south
line, 1326.80 feet to the point of beginning.
Oct 04 05 08:44a Team Speer Bast 7153868660 p•1
4( V
#1044 sconsin SOIL EVALUATION REPORT P,Qe 1 of s
Department of Commerce in accordance with Comm 85, Wis. Adm. Code steel Soil service inc.
Division of Safety and Buildings County
Attach complete site plan on paper not less than 814 x 11 inches in size. Plan must St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel D
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Pending
Please print all information. Reviewed By Date
Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m))• I
Property Owner Property Location
Bast, Kemon Govt. Lot na NW1/4. SW1/4, S36, T29N, R19W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
948 Labarge Rd. 99 I na Cottonwood Ridge 2ND Addition
City
State Zip Code Phone Number 0 City 0 % llege QZ Town Nearest Road
Hudson 1 WI 1 54016 1 715 -386 -7775 Hudson I Cty Rd N
El New Construction Use: Q; Residential / Number of bedrooms Cede derived design flow rate 600 GPO
❑ Replacement 0 Public or commercial - Describe: n
Parent material Stream terraces and pitted outwash plains
Flood plain elevation, if applicable na R.
General comments Conventional system, system elevation 90.488 Trenches spaced and depth to code 5.92ft below grade.
and recommendations:
y 1 t6orIfl9l D Boring
® Pit Ground surface elev. 96.40 ft. Depth to limiting factor 120 in. I Application Rale
r GPD/ft'
Horizon Depth Dominant Color 1 Boundary Roots r , Redox Description I Texture Etta1
in. Munsell 1 Ou_ Sz. Cont. Color Gr. Sz. Sh.
1 0-9 10yr3/1 none 1 sil 2msbk mfr es lvf .6 .8
2 9 -36 10yr4/4 none I sid 2msbk mfr gw na .4 1 .6
sl 2msbk - mfr cb na .6 I _.0
3 36 62 10yr4 /4 none .
' ..
4 62 -120 7.5yr4/6 none cos osg ml na. na� .7 1.6
_
I 2 I Bofin9# ❑ Boring
® Pit Ground surface elev. 96.40 ft. Depth to limiting factor 120 in. jsoll APplitati Ratel
Horizon I Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD
*(fit EffN2
in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh.
•
1 1 0 10yr3 /1 none sil 2msbk mfr
a lvf .6 .8
2 9-27 10yr4 /4 none sid 2msbk
mfr gw na 1 .4 .6
3 27 -54 10yr4/4 none sl 2msbk mfr cb na .6 1.0
ml na na .7 1.6
4 54-120 7.5yr4/6 none cos osg
t _ _.
• Effluent 01 = BOD S > 30 < 220 mg/Land TSS >30 < 150 mglL *effluent #2 = SUD < 30 rnglL and TSS .5_30 mg /L
•
CST Number
CST Name (Please Print) ignature: / ', %- 248956
David J. Steel
rrr Date Evaluation Conducted Telephone Number
Steel's Soil Service, I 4/11/2005 715- 780-0347
994 200th St. Baldwin, WI 54002 SBD-B33 marmot
Oct 04 05 08:45a Team Speer Bast 7153868660 p.2
Property Owner Bast, Kemon : parcel ID #
• ( Pending Page ' 2 of 3 •
f 3 I BO r in # 0 Boring 91.00 Depth to limiting factor 120 in. Sod Application Rate
• II g 0 pit Ground surface elev.
Horizon I Depth Dominant Color Redox Description Texture ' Structure Consistence Boundary Roots
•Ett#t - -EtfC2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. GPDfft2
1 0-5 10yr3/1 none sil 2msbk mfr cs lvf .6 .B
2 5 - 32 10yr4/4 none sd 2msbk mfr gw na .4 .6
3 32 -120 7.5yr4/6 none cos os � � na ,7 1.6
9 1
'Boring # a Boring
0 pit Ground surface elev. Depth to limiting factor T in. Sal Appkcation Rate
.
Horizon . Depth . Dominant Color Redox Description Texture Structure Consistence Boundary Roots *EM GPDJfta
In. Munson Qu. Sz. Cont. Color Gr. Sz. Sh. 1
}Boring # 0 Boring pit Ground surface elev.. t Depth to Inviting factor in. Soil Application Rate
GPD/ft=
Horizon Depth Dominant Color Redox Description Texture Structure Sh. Consistence Boundary Roots •En#t •EttrE2
in. Munsell Cu. Sz. Cont. Color
111Mim -- /a
• Effluent #1 = BOD 30 <220 mg/L and TSS >30 < mg/L ' Effluent #2 = B00 < 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- 2648777. soed a Sod senxr. Inc.
SBD•833D rR07/001
Oct 04 05 08:45a Team Speer Bast 7153868660 p.3
• STEEL SOIL SERVICE INC 3 of 3
David J. Steel Kernon Bast 994 200 St.
CST - POWTSM NW1/4,SW1/4,536,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,99
This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use.
Legend N
1" = 40'
= Benchmark Ele. 100.00 ft
Top of 3/4" pvc pipe
• = Alt Benchmark Ele. 100.70 ft
Top of 3/4" pvc pipe
Q = Borings
Boring Elevations
B1 = 96.40 ft
B2 = 96.40 ft
B3= 91.00 ft
Bit= 0.00 ft
•'3rs`
35 1 / a5 D //k
hats
vrlti-of o31 I
Sy
05 16 1 6"V
A
/OS
•s
w
M f2 7"
t ' `v
erk
�f
Oct 04 05 08:45a Team Speer Bast _ 7153868660 p.4
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