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HomeMy WebLinkAbout020-1454-00-103 Wisconsin department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix ''afety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 506219 0 GENERAL INFORMATION 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 -103 CST BM Elev: Insp. BM Elev: BM Description SectionlTown /Range /Map No'. iDtp 16 m. t C.S 36.29.19.2918 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ei .1 CAPACITY STATION 138 HI FS ELEV. Septic 'Ce%. Z. i / z 5 � Benchmark �� 4)t es Fmv.A. 3 6 9 3' 163 _ Alt. M e _ £L Idle.. 5 :4�- 6e0 155 93 .15 Aeration Bldg. Sewer Q. 91 Holding _ T 1....___________. St/Ht Inlet R, 3 1 . 5 y 7 St /Ht Outlet t i TANK SETBACK INFORMATION g; SZ 93 • `/g! TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 3 G • 1-13° / > 5 r Dt Bottom �� q - Dosing l Header /Man. . 95 3 1 1 t ✓ Aeration ( ---- Dist. Pipe 9-'7 g3 3 Holding Bot System J • _ _ /D. /z, 3 dk Final Grade PUMP /SIPHON INFORMATION I n ' / Manufacturer 'Demand St Cove ,t tt 9S � t� PM F' C6‘) : 4 7 3 77 . Model Number te TDH (Lift Friction Loss System He. • ITDH Ft r ( , - .— Forcemain Len*, Dist. to Well `,, SOIL ABSORPTION SYSTEM BED /TRENCH Width / Length . r e �( No. Of Trenches \� �A� PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 tV44. z. �ic„p -,L .? �"`,� ~"„ \__ . , SETBACK SYSTEM TO P /L BLDG WELL LAKE /STREAM LEACHING Manufactures i j i ! � CHAMBER OR � 63 AJ INFORMATION Type Of System n / 57 ' / � _ UNIT Model Numbe ��v Q. f , (cam' ) DISTRIBUTION SYSTEM ).1p('iln Zi +' ZZ T3 -' d Header /Manifo)d 6 1 Distribution x Hole Size 'x Hole Spacing Vent tto` it take f 1 4 . Pipe(s) .� . ` .ice^ Length 7 Dia Length Dia Spacing � 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 S , g Bed /Trench Edges Topsoil ;, Yes x' No x!Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 694 Mary Jo Co rt udson, WI 54016 (SW 1/4 NW 1/4 36 T29N R19W) Cottonwood Ridge 2nd Add Lot 103 r P _ arcel No: 36.29.19.2918 1.) Alt BM Description = " / C 0.e.......... L•� "`�� �"'�3 "" O \"/ 2.) Bldg sewer length = Z2 - amount of cover = / 5 Plan revision Required? .;I Yes q ' No 1 (e Ininglingib b1 � � 75 Use other side for additional information. D Date f Insepctor's 1 ature / Cert. No. SBD -6710 (R.3/97) r commerce.Wi.goV Safety and Buildit • Division County l i t 201 W. Washington '.O. Box 7162 $ ( C--Yel le .. SCO fi Madison, WI 5 '17- 2 Sanitary Permit Number (to be filled in by Co.) 4. Department of Commerce SV 1� ' ,) / 7 Sanitary Permit Application State Transaction Num In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropria overn • ental �` unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned WTS are Project Addr f b if different than mailing address) submitted to the Department of Commerce. Personal information yo f� y. /71x y /J -) ( purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. RECEIVED (t / / 1. Application Information - Please Print All Infl _,S t1! /` eitkelA Property Owner's Name Parcel # ke y,,t/d. s ' IN JUN 0 1 2007 a, e _ /f/S/ — ao was Property Owner's Mailing Address Property Location $ ()li p 9 �/ �/ 0 ST CROIX COUNTY Q 7 F � d �d )"�' '2- /L ® Govt. Lot /Q3 City, State Zip Code Phone Number $'h) / r 3a cI 6t/ / <, Section 1.5.02/ 1.5.02/ /! % / T of circle one I z II. Type of Building (check all that apply) Lot # 7 N; R / E W� Subdivision Name ❑tor 2 Family Dwelling Number of Bedroolts �i�3 R / `. V � 14 , (,/ e,/ Zvz,�. ! Bl ock # 1ani.Jt 1i ❑ Public /Commercial - Descri U se r'- - - -' - 0 City of CSM Number ❑ Village of ❑ State Owned - Describe Use Town of 4 e ils- t AL i 111. Type of rmit: (Check only one box on line A. Complete line B if applicable) V � A. ew System ❑ Replacement System ❑ Treatment /Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber List Previous Permit Number and Date Issued ❑ Permit Transfer to New Before Expiration Owner I T of POWTS System /Component/Device: (Check all that apply) 1)/s7 a/ S /f . - C' a' ' Zta,t- lI T' on- Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24� ta oy �y ❑ Mpund < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) V C--ea tre bevvicc ■am I irria Ai l V. Dispersal/Treatment Area Information: ' /7 • j •-• )'u2e ■ W ` C( Design Flow (gpd) Design Soil Application Rat dst) Dispersal Area I equired (st) Dispersal Area Proposed (st ystem evation - .7�7 .. 7 ��7r.. to G ,.SO/de�u/ c or,.�.'J VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units /178 / ' / p °.) U ,��, New Tanks Existing Tanks / / � Js o 2 8 ca /IL T! L., % v 'Vs U �n m rn W 0 G, Septic or Holding Tank hamber /2517 ( . i l i . r Dosing C i L_.i FO l / I L (�<'e._e,k 't { I V11. Responsibility Statement 1, the undersigned, assume responsibility for installation of the POWTS own on the attached plans. Plumber's Name (Print) Plumber's Signature / MPRS Number Business Phone Number ' 4 . - / ,0v v _____.. (9 a .., 5 -.2P - F/.2/ Plumber's Address (Street, City, State, Zip Code) VII ounty /Department Use Only _ / Permit Fee Date Issued Issytiiig Agent Si • ..ture Ili Approved ❑ Disapproved _ i` /^� � " L ,/ Owner Given Reason for Denial $ �> (, C� c U 7 l�_� Lr' Z` t'�� ,IX. Conditions of App val/Reasons for L • appr v 1 0 �, /✓ 2 /1 ` ✓ e - � )'/ 1'y G 'y � � ( SYSTEM OWNER: C a/t- v ' _ Septic tank, vent filter and '� � %yt n � ��24 7 / ' - "� yB1 Tcell must all be serviced / maintained rikc /� � S • as per management plan provided by plumber. / � L ` rz y 4 '- C4 e 4' rl, L` . .1.4) a , _ .a..4 %a '<.-e ,sL� t-. r •.: e [-1 I y * r if rt ' / , � 2. All 't � �4 5�` a a for the system and submit to se County only on paper not less Man x t i s in size as per applicable cdEir�lbYYtt'4ti � p - 7 S- , d' 473 SBD -6398 (R. 01/07) Valid Chit 01 /09i ( i \') L \‘' , \ C -4r---.-- r_._ — __ o V , I ()eg-Q- k\ '-`," `"', V C 1 . - ? •t ) 4 (-- ' ra - cN CrN : A \w a li I `a q \__________. 4t e 3 \ (-‘1, e A k 1 C , 1 W o LI A . Q z:' 4, o 0, ___._ N ca t.) _ c.. ....1 ., r .,.s u :, ' N .1‘) 1 c, 1 N .- 0 kh c % %. a I \4 �1 ''k o d • 3 SLPTIu WANK & pump w';r1AM f: i CROSS SECTION AND S PECIrICA , .TIONy 4" CI V ENT PIPE 1 " MIN. ABOVE GRADE & WEATHERPROOF > 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRI;sH AIR INTAKE WITH CONDUIT MANHOLE CCV ER W/ PADLOCK & FINISHED GRADE WARPING LABEL 7Lc iRISER Z 4 „ I N. - -.._ _ ....,,�,�,,..,,,..... -- 0... r 16" IN. 1 6" MAX. , r rt+t INLET ' r WATER TIGHT SEALS GAS - 1 : s -�— TIGHT o PPROVL:O 1 A SEAL t JOINTS WITH IPPROVED --1.— ALM APPROVED PIPE 3' ONTO ;g S(}I.ID 6 ON SOLID SOIL ;OIL v t RISER EXIT PUMP OFF ELE1 . F "T ." - .•.• -� _ ar F � ■ PERMITTED ONLY a► IF TANK w''01111 MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE �/ TANK MANUFACTURER : t�� NUMBER DOSES PER DAY: T TANK SIZ SEPTIC 1 GAL. DOSE VOWME INCLUDING I d GAL. DOSE $at" GAL. FLOWBACX: A ,,ARM MANUFACTURER: t.f..k w...k.. ca , kre% CAPACITIES: A = sa`k INCHES = ( lb GAL. MODEL NUMBER: ID t..Y �,. GAL. el SWITCH TYPE: 'Cri1 . u. B 3 2 INCHES : ?UMP MANUFACTURER: Gq aa 1 C : 0 INCHES = ) to13 to' GAL. MODEL NUMBER : P et II SWITCH TYPE: r'R,,Rc__ D = b INCHES : ,! WO GAL. EQUIRED DISCHARGE RATE 40 GPM PUMP & ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OPF AND DISTRIBUTION PIPE . . FEET * MINIMUM NETWORK SUPPLY PRESSURE 2.5 FEET + (c L? FEET FORCEMAIN X ( FT /1clO F'T FRICTION FACTOR . . -- �� FEET TOTAL DYNAMIC HEAD - / FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH .....,- ; WIDTH " ; DIAMETER LIQUID DEPTH 3 f " e) C.4L ptit 1 V Ic;NED: _/,.'rr4. c: ►''..-- -__.,. LICENSE NUMBER: . 1 ._:1_1 0 DATE: 1/88 . . N GOULDS PUMPS Submersible Effluent Pump am t MODEL '° EPO4 3 871 EEPp05 APPLICATIONS • Fully submerged in high ■ EPOS Impeller: Thermoplas- ■ Bearings: Upper and lower Specifically designed for the grade turbine oil tor tic enclosed design for heavy duty ball bearing p y g lubrication and efficient improved performance. construction. following uses: heat transfer. • Casing and Base: Rugged • Effluent systems thermoplastic design provides AGENCY LISTING • Homes Available for automatic and superior strength and corrosion • Fanns manual operation. Auto- a Canadian Sta daods Assodation • Heavy duty sump matic models include resistance' • Water transfer Mechanical Float Switch • Motor Housing: Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficent heat transfer, in "F" or "C ".) factoty. strength, and durability. SPECIFICATIONS • Motor Cover: Thermoplastic Goulds Polls Is 190 9001 FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. 3 /4' maximum. 111 EPO4 impeller: Thermoplas- • Power Cable: Severe duty • Capacities: up to 60 GPM, tic Semi -open design with rated oil and water resistant. • Total heads: up to 31 feet. pump out vanes for mechanical • Discharge size: 1 NFT. seal protection. • Mechanical seal: carbon - rotary/ceramic- stationary, BUNA•N elastomers. • Temperature: 104 (40 continuous METERS FEET 140°F (60°C) intermittent. • Fasteners: 300 series 10 — stainless steel. 9 30 --► 14 -5GPM I ..... • Capable of running dry without damage to a 2.5 Fr components. Motor: • EPO4 Single phase: 0.4 HP, 6 zo 115 or 230 V, 60 Hz, 1550 R i , PM, built in overload with s c is automatic reset. g 4 EPOS • EP05 Single phase: 0.5 HP, o 115 V, 60 Hz, 1550 RPM, 10 built in overload with EPOa automatic reset. 2 • Power cord: 10 foot s . _ standard length, 16/3 1 SJTOW with three prong grounding plug. Optional 20 0 0 0 10 20 30 ao 50 GPM foot length, 16/3 51TW with three prong grounding plug `___ ___- - ' * ` I 1 . --4. (standard on EPOS). 0 2 4 6 8 1 12. m rh CAPACITY Goulds Pumps c 2000 Goulds Pumps ITT Industries Effective February, 2000 "�/ 63871 sconsin SOIL EVALUATION REPORT #1636 Department of Commerce in accord with 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 inch- - "" Plan must St. Croix include, but not limited to: vertical and horizontal reference point : ■ V dig= ion and percent slope, scale or dimensions, north arrow, and location and • • ^ nearest road. Parcel I.D. 02 0 — ' 7 Sq 00 print V4E €� AGhdu�y Please nt O iewect By Date Personal information you provide may tti used for secondary purposes (Pnva La 5.04 (1) (m)). y „ ) o �.,) , , f 13 ' f • Property Owner APR 1 3 2005 Property Location "AA ..)--f ln+""« Bast, Kemon Govt. Lot na SW1 /4, NW1 /4, S36, T29N, R19W Property Owner's Mailing Address ST. CROIX COUNTY Lot # Block # Subd. Name or CSM# 948 Labarge Rd. ZONING OFFICE 103 na Cottonwood Ridge 2ND Addition City State Zip Code Phone Number City ❑ Village ❑ Town Nearest Road Hudson 1 WI 1 54016 1 715 - 386 - 7775 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 Stream terraces and pitted aw ws ti Flood plain elevation, if applicable na ft. General c omments Conventional system, syste elevation 92.30ft. Trenches spaced and depth to 5 i and recommendations: c:o 6 5` el w grade. 'ter -}- p • (o pd [ z o� rv,� i�o9 c �1 I. Boring # Boring N Pit Ground surface elev. 98.80 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 if .6 .8 2 12 -24 10yr4/4 none sicl 2msbk mfr gw na .4 .6 3 24-42 10yr4/4 none sl 2msbk mfr gw na .6 1.0 ^rP 4 42 -52 7.5yr4/4 none cos 2msbk ml gw na .6 1.0 4ti 5 52 -68 7.5yr4/4 none Is osg mfr cs na .7 1.6 4 .\\11 ?1 6 68 -120 7.5yr4/6 none ms J osg ml na na .7 1.6 . 2 Boring # ❑ Boring EI Pd Ground surface elev. 98.80 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 if .6 .8 2 12 -24 10yr4/4 none sicl 2msbk mfr cs na .4 .6 \\A \ 3 24 -38 10yr4/4 none scl _ 2msbk mfr gw na L �i 1`S 4 38 -6 7.5yr4/4 none sl 2msbk mfr gw na .6 1.0 5 69 -120 7.5yr4/6 none ms._._ .. .. osg mfr cs na .7 1.6 --• i / / / L/ 4, 12 n silt lens at 38 inches * 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 CST Name (Please Print) na : CST Number David J. Steel ``� 248956 Address Steel's Soil Service, Inc. 7 Date Evaluation Conducted Telephone Number 994 200th St. Baldwin, WI 54002 4/10/2005 715 - 760 - 0347 SBD -8330 (R.07 /00) ` • Property Owner Bast, Kernon Parcel ID # Pending Page 2 of 3 I 3 Boring # ❑ Boring ❑ Pit Ground surface elev. 98.20f 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 if .6 .8 2 15 -31 10yr4/4 none sicl 2msbk mfr gw na .4 .6 3 31-46 10yr4/4 none sl 2msbk mfr gw na G .6 1.0 4 46 -51) .5yr4/4 none n15/51 2msbk mfr gw na 1.0 5 51- 12 7.5yr4/6 none ms 059 ml cs na .7 1.6 a G/ 71 //y f Boring # ❑ Boring U ❑ 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 I 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 need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608 -264 -8777. SBD- 8330 (L07 /00) Steers Soil Service, Inc. • STEEL'S SOIL SERVICE INC. 3 of 3 David J. Steel Kemon Bast 994 200` St. CST- POWTSM SW1 /4,NW1/4,S36,T29N,R19W Baldwin, WI 54002 Lic. #248956 Town of Hudson, St. Croix Co. Cell (715) 760 -0347 Cottonwood Ridge 2ND Add. Fax.(715) 684 -3449 Lot,103 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. Legend N l " = 40' = Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe = Alt Benchmark Ele. 99.90 ft Top of 3/4" pvc pipe ❑ = Borings Boring Elevations B1 = 98.80 ft B2 = 98.80 ft B3 = 98.20 ft B4 = 0.00 ft 3 a.5.v ac/ .22 ' cc (o �., - ►, 0 1 7; cGS 2 i /el" • s \ • 50.00' 0 � \ 414.5 \ \ ROAD LENGTH 196' +i (0 • DEDICATED TO THE PUBLIC c 0.00' 4.9'.1.. 1037.1 Cf X 1036.4 X \ / X 103.t.g ~ LOT 107 ° ' 2.03 Acres - • - • " N.B.A. = 2.0 AC • . ao4 V c LOT 106 ft.?, 11 • 2.02 Acres N.B.A. = 2.0 AC x 1036.4 • 1. s5.3 X • ‘ • . 524,O1' \� 71.37' 1 - 9`538' - \ • X 1037.1 \- t?. .• LOT 105 X in \ \ w 'V 1Q35.3 2. 38 Acres 1034.4 • • N.B.A. = 2.4 AC \ - . ,, d��4@ AC - . _ 480.73' 1.00 Vi i: , • K . • \ it x • 1d35.5 )34.6 . . 1035.3 - - - - • \ L 104 , • \ 2.04 Acres I N.B.A. = 1.9 AC N . - 7 S -\ N Q Vt 1 - : N. '`. .. \\ • • 405.03' -1 - i - - - .02 ' .. N 1 t/ x 1 w =res ' = :. : ::.. : 1033.1 1035.5 0 2.6 AC -=:;:. ::ter LO 103 I L031.00 ':: i m 2.04 Acre I N.B.A. = 1.0 AC • 1034.6 ., - � :.. t.; ► s. L.B.O. = 1035.00 I 0 w ❑ $ ::; ;; f 1033.1 a 1 F3 H.W.L. = 10 3.00 ) loop + I j ,...,. � 4 .64' 1031.5 X 249'± D EDICATED TO PUBL - -' :;��, II ,.- - Yl _FYI..♦ ] ' -r " . ----- fe - „r.r11 -.n . _ n n n,nr� .. a r i � / 1� 1 II ',9( / � 1_1 ri..),I ,1 1 ., t c= i 1 9E NCt11O3S 30 WI-MS 9H1 JO WI-MN 3H1 AO 3NI11Sb'3 1 1 R_ — sr•.ZZ - — — ,L£'E£ I b ,ZZ 49'99 M �£8'9OZ J.N3 S OVNIVHQ � - - 1 _ 0 co J I o a c W ca COILS g U w U Q i„ 1 8 I N J C°J 1 0 q 4 4 M S M N ' h � O . CCO © X 11 I J W r O 2 m 1 • to O N- 005 N . 2 ti:`d913S on 2C rn 00 1- z 0 GV . .,.,,• I M • • X95 G� I h 94'Oe4 ' nn �sss obos In cn . •0 �• M I ■ C3 q • ,94 M99,6001709 v) o G i / i• ......... . . ... 1. I • 1: in 3 � 0 • 1• I 2) • in I. is Yd§ 1 1 1 : 1.1:: 11 ()1DVS 3S 01.) E£ E 2 LL z FI A04 VOO w n. 1 1'1: m0 I• I r n • N 8 1: • r_ 1SlJp N ^ II • W I �0 N O0 c Q W z I. W a / N 0 0) = N b. Q , Wlr _ 119uu to: oti I1 D14 1.30.30 .,��� ...� _.. _ - - - — ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM I Owner/Buyer &nlutl cr. $Asr Mailing Address '4✓9 h 4426E 440 /J544./ w,xa4.6v4) Slo4 1 Property Address -5 /Mar .JO Cotigi Nt,ioSOav W$scc 5"4J 5-4 0 - t (Verification required from Planning Department for new construction) wip City/State J{vDSen// Ali5Cays/Ai Parcel identification Number OZQ 41 00- X LEGAL, DESCRIPTION Property Location Std 1/4, Nut t�•, Sec. -, T Z9 N -R l9 W, Town of N&10 I Subdivision ' ?OUu•C04O Pi 1 S •ti0 A it rook) . Lot # /03 Certified Survey Map # , Volume , Page # Warranty Deed # 7/1 10 Volume 2 - 1 -� � Page p • Spec house 14 ycs 0 no Lot lines identifiable 14 yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in Its premature failure to handle wastes. Proper maintenance consists of pumping our the septic tank every three years or sooner, if needed by a Incensed pumper What you put into the system can atTect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St - Croix Zoning Department s certification form. signed by the owner and by a wastes plumber, journeyman plumber. restricted plumber or a licensed pumper verifying that (1) the on -ante wastewaterdisposat systcrn is in proper operating condition andror 12) aftrr inspccnon and pumping (if necessary). the septic tank is less than 1/3 full of sludge. Ilwe the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set fool+ r • as sct by the Department of Commerce and the Department of Natural Resources. State of Wisconsin Cenifcat snt • that , ur s • vstem has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 ys of 1 . , iratiun date. • 5,29, 7 SI r A - • ; APPLICANT DATE owrivIiimir F CATION 1 (we) a 1 statements on this furni arc true to the best of my (our) knowledge 1 (we) am (are) the owners) of the propcny , •c ■ CI by t., tor of a arranty deed recorded in Register of Deeds Office- . 5 f Z9, zcb7 SIG TORE 0 " A PLICANT DATE Any information that isms-represented may result u the sanitary permit being revoked by the Zoning Department. •• Include with this application: 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 i?• 2GSL98ESI uosuyor uoser dIT :TO 60 Be 400 POWTS OWNER'S MANUAL & MANAGEMENT PLAN P age / of '2v (FILE +1 INFORMATION 1 ►� «- --- -- • �a . .. L 1 o3 SYSTEM SPECIFICATIONS Owner vv • - C1 \ Septic Tank Capacity / . 5 O gal 0 NAj Permit # Septic Tank Manufacturer �Se.,R. ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Z ‘ .R. ❑ NA Number of Bedrooms ©fVA Effluent Eisler Mode! A toD 0 NA -– Number of Public Facility Units 8 A Pump Tank Capacity Q _�I 0 NA - Estimated ffcw (average) �alldaX Pump Tank Manufacturer t� 1e - c �. _ �� 0 NA Design flow (peak), (Estimated x 1.5) // Pump Manufacturer ❑ NA 0 Soil Application Rate J9r gailday /ftx Pump Model �. V ()S 0 NA Standard influent /Effluent Quality average" ' l Y Month( y Pretreatment Unit XNA Fats, Oil & Grease (FOGD s30 rng1L 0 Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 220 mgit 0 NA 0 N)ecihanical Aeration 0 Wetland Total Suspended Solids (TSS) <_150 mg(L i 0 Disinfection 0 Other: Pretreated Effluent Quality Monthly average Diapers ells) r1 o f A Biochemical Oxygen Demand (SOW 3(;) mgltr - Ground (gravity 0 In -Oro , C � uif d (pressurized) Total Suspended Solids (TSS) s3O mg/i. NA 0 At -Grade ❑ Mound Fecal Coliforrn (geometric mean) 4 1 1 OQmi 0 Drip -Line 0 Other Maximum Effluent Particle Size Y in dla. 0 NA tither: n NA other: __ NA Other; — T DNA `Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tankfsi At least once every: 2 -,3 ■ mont sD (Maximum 3 years) ❑ NA CI yearts) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y,) of tank volume 0 NA 3 years) ❑ NA inspect dispersal cells) (Maxl A t least once eve ❑ month(s) ___ ____ ry' 3 �$ year(s) Clean effluent filter At Ieast once twisty: f ❑ month(s) E] NA __ S iZ yearls) 0 monthfs► ❑ NA _._ _._. --- � Inspect pump, pump controls & alarm At least once every: 0 year(s) Flush laterals and pressure test �� At least once every: ❑ month(s) -_ 0 NA _ ❑ years) _ Other: ____ At lust once every: 0 monthis) w ❑ NA 0 years) Other: ❑NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the foflovving 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 tankls) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum end to check for any back up or ponding of effluent on the ground surface. The dispersal scu(s) shall be visually inspected to cheek the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent an 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,l 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 S12 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. r age of -2 " -.-- f " START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankle) for the preeence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal gall {a;). if high concentrations are detected have the contents of the tankls) removed by a septage servicing operator prior to ute. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above norrna) hiphwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(el in one large dose, overloading the cell {e} and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the purllo tent( removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWYS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or perk 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 eb®orption 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; condorne; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable rieslings; gasoline; grease; herbicides; meat scraps; medications; cli; 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 property and safely abandoned in compliance with chapter Comm 8313, 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 exceveted and removed or their covers removed and the void space filled with soli, gravel or another inert solid material. CONTINGENCY PLAN if the POWTS f ' and cannot be repaired the following rneafsures have been, or must be taken, to provide a code compliant replacem stem: 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 end wells. Failure to protect the replacernent 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 et that time. El A suitable replacement area is not available due tp setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed es a lai)t resort to replace the failed POWTS. 1 4 , l �❑ The site s not en evaluated to identify e eultabie replacement area. Upon failure of the POWTS a soil and site 1 evaluation be perforrned to locate a suitable replscerhent area. ft no repiacement area is available a holding tank may b tails s a last resort to replace the felled 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 wfth 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 CIROUNISTANcEs. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE D# FICUL? OR IMPOSSIBLE. ADDITIONAL COMMENTS POINTS INSTALLER • Q t,.s : M . 1 TAINER Name l 1 t \` IR S 6.,,,, r Qt.",R,, :. _.. 4111.10111•1111/ Phone 7 / -~ .3 ' t1 —, . / a � f�hope SEPTAGE SERVICING OPERATOR (PUMPER) OCA REGULATORY AUTHORITY Phone I Phone 7 a j 11<r 4 This document was drafted in compliance with chapter Comm f33,22(2I(b)a1)ld) &(f) and 83.84(1), (2) & (3), Wisconsin Adminstrative Code. U 2739 P 31 6 -861 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CRDIX CO., iii STATE BAR OF WISCONSIN FORM 2- 2000 RECEIVED FOR RECORD Document Number WARRANTY DEED 01/28/2005 03:15P?l DEED THIS DEED, made between Neil L. Wilcoxson and Mary Jo MARREN E 1 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— I• — 1 -1 1 020 - 1110 -30- 000... 020 Parcel Identification Number (PIN) This is not homestead property. Dated this 28 • .t. y of January, 2005. .1 141 —WAN /// CVC3 C-b L. Wi cox 1' * Mary Jo i( oxson 1\51 AUTHENTICAf1UN p jbV1C ACKNOWLEDGMENT Signature(s) 7 \1C°' sr STATE OF WISCONSIN ) ! ST. CROIX COUNTY. ) ss. authenticated this 28th day of January, 2005 Personally carne 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 le fore • oing instrument and acknowledged the same. (If not, authorized by § 706.06, Wis. Stats.) f / THIS INSTRUMENT WAS DRAFTED BY *Chen : rown Notary Public, State of Wisconsin Peterson, Fram Sc 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 aclmowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2 -2000 • u 2739 P 317 EXHIBIT A Parcel 1: A parcel of land located in part of the SW '/4 of the NW '/ and part of the NW '% of the SW '/ of Section 36, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin; more particularly described as follows: Beginning at the W '/a corner of said section 36; thence N00° 16' 10 "E, along the west line of the NW '/. of said section, 1248.49 feet to g g the north line of Lot 1 of Certified Survey Map recorded in Volume 3, page 669 at the St. Croix County Register of Deeds Office; thence N63 °02'59 "E 148.42 feet to the north line of said SW '/ of the NW `/; thence N89 °26'58 "E, along said north line, 1182.70 feet to the east line of said SW '/ of the NW '/; thence S00 °21'37 "W, along said east line, 350.04 feet to the north line of Lot 73 of the Plat of Cottonwood Ridge First Addition recorded at said office; thence S89 °26'58 "W, along said north line, 10.00 feet to the west line of said plat; thence S00 °27'24 "W, along said west line, 2096.76 feet to the centerline of County Trunk Highway "N" and a point on a 1999.00 foot radius curve, concave southerly, whose central angle measures 7°10'30", whose chord bears N84 °30'41 "W and measures 250.16 feet; thence westerly, along the arc of said curve and said centerline, 250.33 feet to the point of tangency; thence N88 °05'56 "W, along said centerline, 83.64 feet to the point of curvature of a 2700.00 foot radius curve, concave northerly; whose central angel measures 3 °17'53 ", whose chord bears N86 °26'59.5 "W and measures 155.40 feet; thence westerly, along the arc of said curve and said centerline, 155.42 feet; thence N04 °29'56 "E 244.01 feet to the point of curvature of a 167.00 foot radius, concave westerly, whose central angle measures 34°24'12", whose chord bears N12 °42' 10 "W and measures 98.78 feet; thence northerly, along the arc of said curve, 100.28 feet to the point of tangency; thence N29 °54' 16 "W 274.22 feet to the easterly extension of the north line of Lot 1 of Certified Survey Map recorded in Volume 12, page 3456 at said office; thence N89 °' 12'45 "W, along said easterly extension, along said north line, and along the westerly extension of said north line, 670.44 feet to the west line of the SW '/ of said section; thence N00 °37'50 "E, along said west line, 496.89 feet to the point of beginning. AND Parcel 2: A parcel of land located in part of the SW 1/4 of the SE '/ of Section 36, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin; described as follows: Beginning at the South '/ Corner of said Section 36; thence N00 °27'05 "E, along the north - south'/ line of said section, 1216.78 feet to the centerline of County Trunk Highway "N"; thence S76 °47'47 "E, along said centerline, 1354.82 feet to the east line of said SW '/. of the SE '/; thence S00 °07'02 "W, along said east line, 897.02 feet to the south line of the SE 1/4; thence S89 °33'25 "W, along said south line, 1326.80 feet to the point of beginning. r . [ 1 J / 414 50.00' 83 +� `k� 5 . ROAD LENGTH 196 -. 0 \ • DEDICATED TO THE PUBLIC co i 0.00' ea ,, � 1037.1 ' cX / 1036.4 X r9i N / N • X LOT 107 103 . ' . . - 2.03 Acres rn l N.B.A. = 2.0 AC co ' 11.07 6 co LOT 106 �� ? s ue I -it o� 2.02 Acres N.B.A. = 2.0 AC X 1036.4 1•;5.3 X s � .....�... 1 71.37' I 85.38' X \ 1037.1 \ r ' • LOT 105 X n - \ 6 ' 135.3 2.38 Acres 1034.4 \ `" • N.B.A. = 2.4 AC *- w $ .s � \ L� +Viii' 6 - \ - -- AC - 480.73' 1.00 � j . 1" x K - \ X 1d35.5 )34.6 \035.3 -- -- \ LOT 104 1 co 2.04 Acres o _ _ - N.B.A. = 1.9 AC a N S o l 30 . O 1 d • I • _ r w - - • ,, . a 405 - r _ w '_,6 AC ;'° 1033.1 LO 103 1 0 35.5 I o 1031.x0 -:4:: ` 2.04 Acre I z 114, 1034.6. `r N.B.A. = 1,0 AC I I w - - I " ; L.B.O. - 1035 - I -s u- t__! o 1 1033.1 N 1 -, 111k .- H.W.L. = 10 3.00 • .. 100'-F ; Ali . / . 1� -64' 1031 r,.� 249' -- - DEDICATED TO-I' PUBLIF 7 ......, _..... • . .' , : .11_I -11.1 1.►_-f =+:1 •.. 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