HomeMy WebLinkAbout020-1454-00-106 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Btlding Division
1 INSPECTION REPORT Sanitary Permit No: 499178 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)1.
Permit Holder's Name: City Village X Township Parcel Tax No:
Bast, Kernon Hudson, Town of 020 - 1454 -00 -106
CST BM Elev: y Insp. BM Elev: BM Desc tion: Section/Town /Range /Map No:
l , Y ott 13 Z -- 36.29.19.2921
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic - �" a
6 X h j2 Benchmark 2, 3. (0 /ply 'fl - A
Dosing 5 Alt. BM D a �
1 (A/ Aeration Bldg. Sewer 7
Holding St/Ht Inlet 36 3 y 1 2' - h 7 ' s . - 0
? b
St/Ht Outlet
TANK SETBACK INFORMATION 7. 82 - qS - -- 8
TANK TO _ WELL BLDG. Vent to Air Intake ROAD Dt Inlet — -.
Septic > s- ).1t ( 2 I l/V 4124 Dt Bottom ' c/
1 Ni Dosing C(Lti_. Header /M
Aeration Dist. Pipe // /; ►/
Holding _ Bot. System O - 4 i5i q 9 53 .
Final Grade Z d :rlW�- I 3 •p
PUMP /SIPHON INFORMATION -( /do 3
Demand St Cover r 2-
' GPM 'L S � Q.' ��
Model Number IBMILWMIIIII v-t'��
TDH Lift Frictio = — " sP illIllillIllIl TDH Ft
Forcemain Dia. Dist. to Well -
SOIL ABSORPTION SYSTEM 2 d 7_,7, P ' .
BED /TRENCH Width e Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 g g V 2 ' c)---
SETBACK SYSTEM TO /L 5 BLDG SELL-- LAKS/S RT EAM LEACHING Manufa ur r: ji
INFORMATION CHAMBER OR
Type as Syst f J 6 / UNIT Model Number:
rn '�Ima� >zo >30 /�
D BUTION SYSTEM .
eade��r/ anifold Distribution r x Hole Size x Hole Spacing Vent to Air In ke , Pipe(s) Q
Length 0 Dia Length D D Dia T S pacing
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only s } / s` /P "
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center 6. V / Bed/Trench Edges Topsoil // H Yes i No i Yes ; No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1 iN / /9 / 46 Inspection #2: / /
Location: 817 Mitch Circle Hudson, WI 54016 (NW 1/4 SW 1/4 36 T29N R19W) Cottonwood / R i dge 2nd Add Lo 06 Parcel No: 36.29.19.2921
1.) Alt BM Description = 1 "r 6 ✓h Vl dk- ��� �, 5 ad f �
2.) Bldg sewer length = '2 ' '
- amount of cover =i t{
Plan Use o revision for additional in Yes / 10 /6 l9 g 6 Q . N
formation. — ' �� __ .i
_ a ( � Date Insepctor' 1 )Ga...--,1,-;--
nature Cert. No.
SBD -6710 (R.3/97)
. ,
Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 71 c'''' c-- ' Ye ' K d
NINtisconsin Madison, WI 53707 - 7162 lop Sanitary Permit Dumber (to be filled in by Co.)
Department of Commerce (608) 266 - 3151 / y qp 4
Sanitary Permit A 1icatio State Plan 1.D N U
in accord with Comm 83.21, Wis. Adm. Code, personal information you provid
may be used for secondary purposes Privacy Law, s15.04(1)( Project Address (if different than mailing address)
I. Application Information - Please Print All Information
GEN" O S! 7 M rre- c I(Z-C- /
Property Owner's Name Lot #t Block p
ire, Y ,/. .0 N ,C'oc • 2 nn6 CO 7e) )&/
Property Owner's Mailing Address n CpUNTY Property Locatio 3
City, State / Zip Code III Phon= . •- • w ��` ,s Section(v
/
1
VA el-.SeJ J .5-5/ ' 7 = y �/ lcrcle )
II. Type g (check all that apply) ` T _mac N; R / Y F i w
ypeofBuildir • . s' ( •�
g u I Subdivision Name CSM Number 1 - -
❑ 1 or 2 Family Dwelling - Number of Bedrooms r - i : , S• 3
❑ Public /Commercial - Describe Use C/1/ W4r /f I;•Q ,Z:
O State Owned - Describe Use ❑City ❑Villa � ge ❑Townstt of `
III. Type of Permit: (Check only one box on line A. Complete line B if applicable) 0 20 ( 1 - 5 - - 00 — 106 r 2 `I z/,
A.
New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of I ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. Type of POWTS System: (Check all that apply)
X 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 ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ "
Recirculating S •nthetic Media Filter r.1 . :achin: Chamber ❑ Dri. Line ❑ Gravel -less Pi .e ❑ Other (ex •lain) r ll
V. Dispersal/Treatment Area Informs ion: .5'0 _r_____ f
l'
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Pro stem Elevation ut A •
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing
Tan Ta Tankks f
Septic or Holding Tank .s . j e d / 4) /' e 3' e k
Aerobic Treannent Unit
Dosing Chamber
x fel , /Zies-e-i, ''' Ir.
VII. Responsibility Statement- I, the undersigned, assume responsibility for i tion of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Signature M PRS Number Business one Number
KJ . /`.7 c 7s �c. 4cLLi2 c'I,eI.M /a4- - -��� 4 ' 2 2 9 4- 4'0 F,.:6 gkP - '?/-al
Plumber's Address (Street, City, State, Zip Code) 1 =-
VIII. County/Department Use Only
Sanitary Permit Fee (i i Groundwater I Date Issued Issuing Ant Signature Stamps) 0
pproved ❑ D .. oved . ��
Surcharge Fee) .i
111 = - n Reason for ,enial j � O�,r 56-PT: Z 5-2 —NN a j
IX. . c� , A , rova :, ill amr..1 / ")
STEM • . - 3) c�F,A�. t 1 e+S fen - 1't�S 3f..`cQi u,Sr , k l y( n
1 Septic tank, effluent filter and 64 - S t "Fees JP dc_4 fie_ SL R- tt (Ne i2e-X
dispersal cell must all be ser d / maintained ( � 0
as per management plan provided by plumber. e • P- � ° x `"e " `^ ,�,„., .0' kB a oy
2. All setback requirements must be maintained is e•e. S.cQ c.- .J&.-5 . -ileu --- eAA.S l 30J- __ Lt \5 & l an,
as per appli codefordinanceb.
�-- t Au
11 ol_ . • , 6., f f,. Elk- QN.P._ 13.4,4,,,,,,
Attach complete plane (to the County only) for the system on a_per not less than 81/2 x 11 Inches in size
SBD -6398 (R. 01/03) 1) ...c Se_4-ke 1ad> UU I z n,
b� t U — e -
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NA sconsin SOIL EVALUATION REPORT #1652
Department of Commerce in aacor.. - 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 Inc • - - V. e. St. Croix
include, but not limited to: vertical and horizontal reference poi ), Plan must rection and
percent slope, scale or dimensions, north arrow, and location an. . tars. to nearest road. Parcel I.D.
O Pending
Please print Lw
- ,
C r viewed.By 1 Date
Personal information you provide may 3e used for secon.ary p es (Priv cy - , . 15.04 (1) (m)). 0 t� erPr. Z S L?j0 /_
Property Owner Property Location
Bast, Kemon 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
g 7nNwc; OFFICE 106 na Cottonwood Ridge 2ND Addition
City State Lrp 1. adE Pl.. Nu.,,t — . City J 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 outwash plains Flood plain elevation, if applicable na ft.
General comments Conventional system, system elevation 91.80ft. Trenches spaced and depth to code 7.00ft below grade.
and recommendations: 1 rr� _ nn
(9M - S i kOlu� -` �Q d+.. -A-. 'S Su-eaQ i� r � r 0+ °mil
i
El Boring J'e °"'cO.A 0 . • I Wr • A A&S, __ — •
1 Boring # (Sr Et e,`nQ = r �+. .
❑ Pit Ground surface elev. 99.80 ft. Depth to limiting factor 130 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 -13 10yr3/1 none sil 2msbk mfr cs if .6 .8
2 13 -30 10yr4/4 none scl 2msbk mfr gw na .4 .6
3 30-46 7.5yr4/4 cld 7.5yr5/6 sl 2csbk mfr cb na .6 1.0
y Noncontigous
4 46 - 130 7.5yr4/6 none ms osg ml na na .7 1.6
--V Noncontigous Redox features in horizon #3 due to textureal changes not seasonal saturation
2 Boring # Boring
❑ Pit Ground surface elev. 99.80 ft. Depth to limiting factor 130 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 *EfffF2
1 0 -13 10yr3/1 none sil 2msbk mfr cs if .6 .8
2 13 -29 10yr4/4 none sci 2msbk mfr gw na .4 .6
3 29 -75 7.5yr4/4 cid 7.5yr5/6 sl 2csbk mfr cb na .6 1.0
Noncontiaotys
4 75 -130 7.5yr4/6 none ms osg ml na na .7 1.6
Noncontigous Redox features in horizon #3 due to textureal changes not seasonal saturation
* Effluent #1 = BOD 5 > 30 < 220 mg /L and TSS >30 < 150 mg/L * Effluent #2 = BOD < mg/L and TSS < 30 mg/L
CST Name (Please Print) / Si! nature: i __ CST Number
David J. Steel 248956
Address Steers Soil Service, Inc. _ Date Evaluation Conducted Telephone Number
994 200th St. Baldwin, WI 54002 4/11/2005 715- 760 -0347
SBD -8330 (8.07/00)
f
R
' Property Owner Bast, Kemon Parcel ID # Pending Page 2 of 3
' I 3 Boring # ❑ Boring
❑ pit Ground surface elev. 99.40 ft. Depth to limiting factor 130 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 •Eff#2
1 0 -14 10yr3/1 none sil 2msbk mfr cs if .6 .8
2 14 -36 10yr4/4 none sicl 2msbk mfr gw na .4 .6
3 36 -60 7.5yr4/4 cid /6
Nonc ontig ous sl 2csbk mfr cb na .6 1.0
ntig
4 60 - 130 7.5yr4/6 none cos osg ml na na .7 1.6
loncontigous : , .: - . m J -,,,._ : • due to textureal changes not seasonal saturation
c '? ,
Boring # P it 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. "Ef►#1 *Eff#2
Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
Effluent #1 = BOD 30 < 220 mg /L and TSS >30 <150 mg /L * Effluent #2 = BOD 5 < 30 mg/L and TSS <30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777.
SBD -8330 (R.07 /00) Steel's SOH Service, Inc.
i
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1...._....1..... \
1 ....% .. 414544 §
Ilk 50.00' 61 -'4 $6
• ROAD LENGTH 196'
DEDICATED TO THE PUBLIC co itcs.,.....
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..." 1037.1 Y
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N. • " X 103 , .g
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C \ I 1 . . .-... • :. -- --' - LOT 107
2.03 Acres N
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(P • LOT 105 X rs:
- \ '-°' 11R35 2.38 Acres
.3 . - 1034.4 cm
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x - N.B.A. = 1.0 AC w --
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) 111 W. 1 111Pr I '÷ 10 3.00 i-
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';
STEEL'S SOIL SERVICE INC 3of3
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, 106
This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use.
Legend N
1 1 " = 40' I
• = Benchmark Ele. 100.00 ft
Top of 3/4" pvc pipe
\ • = Alt Benchmark Ele. 100.00 ft
\ Top of 3/4" pvc pipe
\ ❑ = Borings
\\ Boring Elevations
`, B1 = 99.80 ft
\ B2 = 99.80 ft x \ B3 = 99.40 ft
4 , B4 = 0.00 ft
N fS \
e : ) ,, :_1/ I
(,v . `
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61610-
f
N 1
SEPTIC TANK G PUMP i:!'AMHCR CROSS SECTION AND SPECIFICATIONS
4" CI VENT PIPE 12 " MIN. ABOVE GRADE & WEATHERPROOF
? 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED
FRESH ASR INTAKE -- WITH CONDUIT MANHOLE COVER
FINISHED GRADE WARNING PADLOCK
N r1 4" CI RISER f ,' / _}�,�.. t." MIN.
18"
I. 6" MAX. ; 3 '.0'
i
INLET I , $ - II+.
TIGHT SEALS GAS - l
WATER _ IGhT SEA.� -1--- +
A SEA TIGHT y ' �I APPROVED
JOINTS WITH
,PPROVED — -- -- ' ,ALM APPROVED PIPE
B : + 1 3' ONTO
'IPE 3' )NTO SOLID a ON SOLID SOIL
1
' OIL PUMP OFF ELEV. FT. —0.---1— OFF ' RISER EXIT
D PERMITTED ONLY
IF TANK
t 1 MANUFACTURER
HAS APPROVAL
3" APPROVED BEDDING UNDER TANK
CONCRETE PAD
SPECIFICATIONS
SEPTIC / DOSE ,
TANK MANUFACTURER: l,�it.e..� _ NUMBER DOSES PER DAY:
TANK SIZES: SEPTIC 41,3 GAL. DOSE VOLUME INCLUDING
DOSE RpQ GAL. FLOWBACK: 15 GAL'.
ALARM MANUFACTURER: Ls,v , \a .r... CAPACITIES: A = .a.,, INCHES : L i b a.. GAL.
MODEL NUMBER: ■,\„V
SWITCH TYPE: 'M s__ B = 2 INCHES = GAL.
?UMF MANUFACTURER : (3‘,,, C = $ INCHES = j to % GAL.
MODEL NUMBER : � Q ip
SWITCH TYPE: D = INCHES : _ 2.t GAL.
REQUIRED DISCHARGE RATE LA O GPM PUMP & ALARM WIRING AS PER ILHR 16.23 WA'O
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . . IA, FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . r 2,5 FEET
+ 6n FEET FORCEMAIN X a.1 FT /100 FT. FRICTION FACTOR . • 1.52 FEET
TOTAL DYNAMIC HEAD = ) 3 ,S7 FEET
INTERNAL DIMENSIONS OF PUMP TANK: LENGTH — ; WIDTH -- ; DIAMETER
LIQUID ITS' X38 # Q.1 CF e.ft 1 ri
, IGNED: - LICENSE: NUMBER: ..) L 7 9 9 C) DATE:
1/88
..
n GOULDS PUMPS Submersible
Effluent Pump
v.
f MODEL
iii � .;.;
3871 EP0 5
APPLICATIONS • Fully submerged in high • EPOS Impeller: Thermoplas- • Bearings: Upper and lower
Specifically designed for the grade turbine oil for 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
• Farms manual operation. Auto- resistance. C" Canadian Standards Association
• Heavy duty sump matic models include
• Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end
• Dewatering assembled and preset at the for efficient neat transfer, in "F" or "C ".)
factory. strength, and durability.
SPECIFICATIONS ■ Motor Cover: Thermoplastic Goulds Pumps is ISO 9001 Registered.
FEATURES cover with integral handle and
• Solids handling capability: float switch attachment points.
3 /4' maximum. • 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 ' NPT, seal protection.
• Mechanical seal: carbon -
rotary/ceramic- stationary,
BUNA -N elastomers.
• Temperature:
104°F (40C() continuous
140°F (60°C) intermittent. METERS FEET
10
• Fasteners: 300 series
stainless steel. , r --► i —s GPM
9 30 •
• Capable of running
dry without damage to $ 2. FT
components.
° 7
Motor: i _
• EPO4 Single phase: 0.4 HP, Y
115 or 230 V, 60 Hz, 1550 a
RPM, built in overload with 1 5
automatic reset, ¢ 4 EPOS
• EPOS Single phase: 0.5 HP, o
115 V, 60 Hz, 1550 RPM, 3 - 10.. .. _
built in overload with EPO4
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 40 50 GPM
foot length, 16/3 S1TW with
three prong grounding plug Y 0 2 4 fi B 10 1 z mVh
(standard on EPOS),
CAPACITY
Goulds Pumps
0 2000 Goulds Pumps t ITT Industries
Effective February, 2000
B3871
."1".....".."..4P at Af4 'fr.
,................*.I............o.............•■■••■•■•■■•*... 57A411ARD Cly'AMHER
001•11111/.....011110,1• ■ ."'•1
Ouicka Standard Chamber
1 _ .. _ 48 EFF " ------
1 1 (ECTiVE LENGTH)
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----• 34'' --- - ---04 Si DP. VIEW
SECTION VIEW
MultiPort End Cap
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SIDE VIEW TOP VIEW
FRONT EW
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, .
Cluipt_4 Standard Chambecitamirtal SpetificatIonV; ...- lop rtind Ca 'Nomiaell ecititationsA:v , 7'
Size , W x L x ri) _ • • 1
34' x 52' x 12* ' • .' TB (w x L x241: ' -'..'''' '''''' ' 34' x 16° x 12"
Ett6Ctive 46 H e .....
LtIvert Htstlt u or 1,25'
...._...., _ . ----...-
,Iven Height 8"
I ,
tKriLuept4 51.5I_EMS,Atig.ILWADARSt Lltd17111.Wattalitin
, •,,„ , . „ .,, , ,„ ,,.,- 1 al, otron molye all 0,111i W.ettf IOW , ■0 ,, , IG ,, V+ 11.0 I ' ' ' ..W 00 ' rtimitt 0
Mr. VIIIPAIOC, , 11,41,3fr. , . u tho r,t .trttat 6,40 40• r , :' ,, O." , t,t. , ,* ..-,,, ,,,,' MiliN/NAMOMIllil l iM iligagaltirtialagillMIMMON
W ...' li. 01 , Nd tfif WIC , ... ,1 4 5toir ' : .n ,,,,,Ift W,Itl 1 . 1414 i Om IA , t ...Jo,: ■,,,,..,..
,,,r,,,r),,o r4
4l . in , me : "1 &Lt ; 1 t o.. nt 1.1 0:7; . .4.0 ,: c .;`;.44 Ultother,„::1::„• 17,n
7
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op
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Paso / of
• FILE INFORMATION '^" R'� � } -- 01 SYSTEM SPECIFICATIONS
Owner
Permit # k b Septic Tank Capacity /,�5" o _gal ❑ NA
��) 9 b � Septic Tank Manufacturer
t e_. IR ❑ NA
,.
DESIGN PARAMETERS Effluent Filter Manufacturer '? 0_6 \_ ❑ NA
Number of Bedrooms
i _ Q NA Effluent Filter Model A IOD 0 NA
Number of Public Facility Units 0 NA Pump Tank Capacity ' OD 0 NA
i ----�— _gal _
Estimated flow (average) s, O 0 gal /dat Pump Tank Manufacturer W \e_ Q. R. 0 NA
Design flow (peak), (Estimated x 1.5) p Pump Manufacturer ❑ NA
gauday G o v, 1 c1.
Soil Application Rate z Pump Model T � ❑ NA
_ gal /day /ft
Standard Influent /Effluent Quality Monthly average"' Pretreatment Unit 0 NA
Fats, Oil & Grease (FOG) ! s30 mg /L ❑ Sand /Gravel Filter 0 Peat Filter
Biochemical Oxygen Demand (800 <_220 mg /L ❑ NA 0 Mechanical Aeration 0 Wetland
Total Suspended Solids (TSS) 5150 mg /L 0 Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cella) ❑ NA
Biochemical Oxygen Demand (SOD ") s30 mg /L 0 In- Ground (gravity) 0 In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L 0 NA 0 At -Grade 0 Mound
Fecal Coliforrn (geometric mean) 510 cfu/ 10Qmi ❑ Drip -Line 0 Other:
____
Maximum Effluent Particle Size Ye in dia. ❑ NA Other: 0 NA
Other Other;
0NA 0 N
*values typical for domestic wastewater and septic tank effluent. ... Othe 0 NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(si At least once every: le month(s) years} (Maximum 3 years) 0 NA
Pump out contents of tanks) When combined sludge and scum equals one - third (Y of tank volume 0 NA
Inspect dispersal cell(s) At least once every: ❑ month(s) �+- ��_
R year(e) (Maximum 3 years) ❑ NA
_ _ _w
Clean effluent titter At least once every: i ❑ month(s) 0 NA
Aear(a) _
Inspect pump, pump controls &alarm At !east once every: r.._._ 0 month(s) �MMr - __ ❑ NA
❑ year(s)
Flush laterals and pressure test At least once every: „_-_ O months) 0 NA 0 year(s) Other: 0 month(s)
At least once every: ❑years) ❑ 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 cetl(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 pending of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority,
When the combined eccumulation 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 fitters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of I 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 2_,_.0 f r Z_
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tankfs) for the presence of painting products or other ehemicals
that may impede the treatment process and /or damage the dispersal cafe). If high concentrations are detected have the contents
of the tankfs) 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 califs) end 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 POWT$ Maintainer to assist in manually operating the purnp 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 floes; 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:
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should he 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.
Q 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.
N \ cN The site as not en evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation be performed to locate a suitable replacement area. It no replacement area is available a holding tank
may b tails s a last resort to replace the failed POWTS.
Q Mound and at - grade soil absorption systems rnay 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
POWYS INSTALLER POWTS M INTAiNER
Name 1 ,t \` i p'o„,, S GAN v.vx..,Cl. , fas,,V.., Name
Phone "7 /' 3 8 M3 / p. / Phone "�
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name • C�( ► �JTY �I.911v(
Phone Phone 2 /S 3E6 (P kb
This document wan drafted in compliance with chapter Comm $3.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code,
rTlr - 2uwa 119_40 r1DS'r3D.)O
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
r/ OWNERSHIP CERTIFICATION FORM
Owner/Buyer 1442 ) J - eR S i
Mailing Address 948 LA 64eGe. eo - NUOScIS3 u) ISCO/VSm) d
Property Address 317 MICC-H Ct(L c - W)SCoNSin)
(verification required from Planning Department for new construction) (z) City /State �lU��) Parcel Identificaton Number OZo /# 5-00
LEGAL DESCRIPTION
Property Location AU 'V., 5 t'' ) '/•, Sec. 3.. ,, T �5 N -R Iq W, Town of WOW) •
Subdivision Corroot,uco0 «t46f SecouQ AOAsTtoa . Lot # /06
Certified Survey Map # , Volume Page #
Warranty Dced # 4C (0 j , Volume 2 739 , Page a _ •? •
Spec house tgi ycs 0 no Lot lines identifiable ) yes ❑ no
•
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper matntenanee
consists of pumping out the septic tank every three years or sooner. if needed by a Incensed pumper Whit you put into the system
can affect 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 a certification form. signed by the owner and by a
maw.t plumber. journeyman plumber. testrictcd plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system
is in proper operating condition andror I2) after inspection and pumping (if necessary). the septic tank is less than 1/3 full of sludge.
I/we. the u is ed have ad the above requirements and agree to maintain the private sewage disposal system with the standards
sct fon . ere as sc the Department of Commerce and the Department of Natural Resources. State of Wisconsin Cenifcation
state •that h v. has been mainta must be completed and returned to the St. Croix County Zoning Office W tthtn 30
days oft ec yea cxpir titan date.
9 , /d', 2c
0 - • — Ei g . A A PPLICANT DATE
OWNER __4_4.10FICAT e N
(we) c ify t Il statements on this form arc true to the best of my (our) knowledge 1 (we) am (arc) the owncr(s) of
the • ropcny de i - d oho y vs tic of a warranty deed recorded in Register of Deeds Office.
51GN R.E OF 4` ICANT DATE
• •••
may result in the sanitary omit being revoked by the Zoning Department.
that is mis resented rc y t rY P
Any information p
Y
•• Include with this application: a stamped warranty decd from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty decd
z'd 266L96EST uosuyor uoser dtt:TO co 6Z 400
U 2 ?39P 316
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: 15PH
THIS DEED, made between Neil L. Wilcoxson and Mary Jo WARR X DEED
Wilcoxson, husband and wife, Grantor, and Kernon J. Bast and Donalda .1.
Speer -Bast, husband and wife, Grantee. REC FEE: 13.00
Grantor, for a valuable consideration, conveys and warrants to Grantee TRANS FEE: 4212.90
COPY FEE:
the following described real estate in St. Croix County, State of Wisconsin: CC FEE:
PAGES: 2
SEE ATTACHED EXHIBIT A
Recording Area
Name and Return Address:
Edina Realty Title, Inc.
400 S. 2' St. — Suite 115
Exceptions to warranties: Hudson, WI 54016
Easements, restrictions and rights -of -way of record, if any. 456780
1 1— 1•— 1-1 1
020 - 1110 -30- 000... 020 - 1109 -55 -050
Parcel Identification Number (PIN)
This is not homestead property.
Dated this 28 / •r: y of January, 2005.
A I (A/,(32 Cb-e--)4 6
11 L. Wi cox '. * Mary Jo i oxson
* f , Jr
AUTHENTICAY p U bC‘c 1n ACKNOWLEDGMENT
Signature(s) . \'� G
y cc()
STATE STATE OF WISCONSIN )
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 • i e fore ' oing instrument and acknowledged the same.
(If not,
authorized by § 706.06, Wis. Stats.) I' /
THIS INSTRUMENT WAS DRAFTED BY *Chen rown
Notary Public, State of Wisconsin
Peterson, Fram & Bergman — Steven H. Bruns My commission is permanent. (If not, state expiration date:
50 East Fifth Street, St. Paul, MN 55101 3/11/2007 )
(Signatures may be authenticated or acknowledged. Both are not necessary.)
*Names of persons signing in any capacity must be typed or printed below their signature
WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2 -2000
U 2739 P 31?
EXHIBIT A
Parcel 1:
A parcel of land located in part of the SW '/< 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 '/. corner of said section 36; thence N00° 16' 10 "E, along the west line of the NW '/ of said section, 1248.49 feet to
the north line of Lot 1 of Certified Survey Map recorded in Volume 3, page 669 at the St. Croix County Register of Deeds Office;
thence N63 °02'59 "E 148.42 feet to the north line of said SW '/. of the NW %; thence N89 °26'58 "E, along said north line, 1182.70 feet
to the east line of said SW ' of the NW '/4; thence S00 °21'37 "W, along said east line, 350.04 feet to the north line of Lot 73 of the
Plat of Cottonwood Ridge First Addition recorded at said office; thence S89 °26'58 "W, along said north line, 10.00 feet to the west line
of said plat; thence S00 °27'24 "W, along said west line, 2096.76 feet to the centerline of County Trunk Highway "N" and a point on a
1999.00 foot radius curve, concave southerly, whose central angle measures 7°10'30", whose chord bears N84 °30'41 "W and measures
250.16 feet; thence westerly, along the arc of said curve and said centerline, 250.33 feet to the point of tangency; thence
N88 °05'56 "W, along said centerline, 83.64 feet to the point of curvature of a 2700.00 foot radius curve, concave northerly; whose
central angel measures 3 °17'53 ", whose chord bears N86 ° 26'59.5 "W and measures 155.40 feet; thence westerly, along the arc of said
curve and said centerline, 155.42 feet; thence N04 °29'56 "E 244.01 feet to the point of curvature of a 167.00 foot radius, concave
westerly, whose central angle measures 34 °24' 12 ", whose chord bears N12 °42' 10 "W and measures 98.78 feet; thence northerly, along
the arc of said curve, 100.28 feet to the point of tangency; thence N29 °54' 16 "W 274.22 feet to the easterly extension of the north line
of Lot 1 of Certified Survey Map recorded in Volume 12, page 3456 at said office; thence N89 °' 12'45 "W, along said easterly
extension, along said north line, and along the westerly extension of said north line, 670.44 feet to the west line of the SW V. of said
section; thence N00 ° 37'50 "E, along said west line, 496.89 feet to the point of beginning.
AND
Parcel 2:
A parcel of land located in part of the SW '/. of the SE ''/ of Section 36, T29N, R19W, Town of Hudson, St. Croix County, Wisconsin;
described as follows:
Beginning at the South ''4 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 ' /,; thence S89 °33'25 "W, along said south
line, 1326.80 feet to the point of beginning.
i ---)42. 1 LOT R 0 EAST - WEST 1/4 LINE OF SECTION 36 r�u
I 87759 SQ. FT,
T ' ° +. -- - — —
G
cv I LOT 108 1 4 i
r-- 2.01 ACRES N
.
$i $7471 SQ. FT. dOO `i� Us',
I R • I i •.-"�24`• -, r 4.
if._ tzi b OA . - -- • . N
IT, § • • � G2 2 I w 8 414. o \
i� S89 E I 1 S83 O
_ I .1 O •
z ip $ MI IR CLE U ° \
i
,. • • ?6 t a ct
ra ti
N
■ i ( zi_ -.. LOT107
2.03 ACRES
1 64,46 I i I •
I 88545 SQ. FT.
1 " 1 LOT 106 ire> i
1 \� \ 1 1 1 \ 2,02 ACRES •g /'
% W V 1 t •\ 87855 SO. FT.
\\ I
�• , `
\ __ __._:..__ -___ ... __._.__. _.._ - _. .__._ __ ._._ ._. ......---- .- -..._._ ... _
\ \/ 4 \ ` • 524.01' 71.3T
\ \ S88135' 595.3& a , • — — -- —
f \
41 \ •
\ \
LOT 101 \ \ '\ N \` LOT 105
2,15 ACRES \ • � � \ / 61 - \ , v 1 03693 SQ. W o
1 93468 SQ FT. \ +, . �+ \ I
1.8.0. = 1031.00 ■• F `5' LI
\ \ • + \ y A \. S8$°05'56'F Mf1
• 1