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HomeMy WebLinkAbout020-1454-00-110 Wisconsin Departmertt of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: ( ATTACH TO PERMIT) 488279 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 -110 CST BM Elev: Insp. BM Ele : BM t, Section/Town /Range /Map No: I QO.O I CO . 1 ar c � i = CST g 36.29.19.2925 TANK INFORMATION 1 ( J ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic --� 6D Benchmark � , Q f 12 S6 (65.0) S J Dosing Alt B ,,, Aeration Bldg. Seer I °743 %.4, Holding St/Ht Inlet i 15 /*/3 ?S' 74 TANK SETBACK INFORMATION St/Ht Outlet 1040 1 5 7 t TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic q r 3 9 ! d i t Dt Bottom Dosing Header /Man. .04/ 6 1 4 f. �oS i Aeration Dist. Pipe 11,00 f q` 6 Holding Bot. System li� 93 . 6 t "'GG�A 7 PUMP /SIPHON INFORMATION Final Grade + •'o i ,OD • r / Manufacturer Demand St Coy Z (Ii " ) `7 t - M t' L (( rue" 6"` 4 .a4-) Model Number 6i/k- ott1/4,c 4*.dc TDH Lift Frict I,rs System Head TDH Ft Forcemain Length B : Dist. to Well SOIL ABSOR - ION SYSTEM RENC Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM ONS 3 t IV ( QQ. /- ` I SETBACK SYSTEM TO I " t /L (2) WELL LAKE /STREAM LEACHING Manufactur . INFORMATION CHAMBER OR S Type Of System: " ! UNIT CP•tlty. I d f + l / q Model Num ( c,� l0 l .... (� DISTRIBUTION SYSTEM L Header /Manifold It Distribution x Hole Size x Hole Spacing Vent to Air Intake X 4 Pie / �---1 3V Length `u' 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 Bed/Trench Edges Topsoil ffl / Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1 2 '7/ 0 % 0 49 Inspection #2: --/— -- Location: 682 Mary Jo Court Hudson, H��uu WI 54016 (NW 1/4 SW 1/4 36 T2 N 81199 - W) Cottonwood Ridge 2nd Lot 110 Parcel No: 36.29.19.2925 1.) Alt BM Description = b6�. v r 6 4144 - S■ �.J (ii b _t ` P "` -Sots s' j 2.) Bldg sewer length = 1st .0 - amount of cover = 0 Plan revision Required? k Yes No DEC . 0 p c lime Use other side for additional information. SBD -6710 (8.3/97) Date Insepcto s Signature Cert. No. i Safety and Buildings Division County � *sconsin 201 W. Washington Ave., P.O. Box 7162 � ,�d M adi son, WI 53707 - 7162 Sanitary P ..'t Num ,�/ ber (t be filled in by Co.) Department of Commerce (608) 266 -3151 . - 247 Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information rov' may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Address (if different than mailing address) I. Application Information - Please Print All IuEon/lotion RECEIVED • , , v_p d f, 4) „ Property Owner' Na me Parcel # Lot # /fie Block # t 741[)/51J DEC 0 5 2006 0-9r - /�- i9/^ - //P ( Property Owner's M ailing Address Property Location i © �� >�,� ST. CROIX COUNTY City Sta tJ Zi, -Eedk er Mt) 'k,. SG1 14 ,Section �� �e /!2/CA. • Z7 t. � i�( (circle e) I I. ype of Building (check all that apply) T a 7 9 N; R 9 E o � � 1 or 2 Family Dwelling - Number of Bedrooms ./ Subdivision Name �/,,,,,, '6SA1 --iffier ❑ Public /Commercial - Describe Use : J�oor7 L / A de ❑ State Owned - Describe Use - ❑City ❑Vi I e2Township of ot1S.oA III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System y ❑Replacement System ❑ Treatment/Holding Tank Replacement Only 0 Other Modification to Existing System B. ❑ Permit Renewal X Permit Revision ❑ Change of ❑ Permit Transfer to Ne List Previous Permit Number and Date Issued • Before Expiration Plumber Owner £t ” - ' / ° I �� . IV. Type of POWTS System: (Check all that apply) 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 Synthetic Media Filter ,K Leaching Chamber ❑. Drip Line ❑ Gravel -less Pipe Other (explai V. Dispersal /Treatment Area Information,: ..?/. > (� , 3lm s " 4 (4) C J Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area o ed (sf) r System Elevation VI. Tank Info Capacity in Total Number • Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units W r l a �_ 2 S Concrete Constructed Glass New Existing 1 Tanks Tanks 'Pi Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Respo , ibility Statement I, the undersigned, . sume responsibility for installation of the POWTS shown on the attached plans. Plumber's ■ . me Print) Plumber's Si t ature , MP /MPRS Number Business Phone Number • lu' bees" `Addre s (Street, City, tate, Zip Code) 99 - ,�l7s/ ti -/e'47 at �S r:r;51 /t1' - .--7 V II . Count[Department Use Only S proved ❑ Disapproved Sanitary Permit Fee ' cludes Groundwater Date Issued Issuing • gent Signa. % - (No Stamps) Surcharge Fee) , ❑ O �±... "-------- .. �' eon for Denial • 0 1-b , �� - _ - IX. Conditions of eprov. Re ..: ... al 3 J D_ BS - 1 , "�°f`e. / • ' • A , 174 _AAA., — OWNER: L . ; 11 1 _ _ � , © ` - a 1 Septi 1 Septic tank, effluent filter and fi''` 't ¢ � (1 n ��� dispersal cell must all be serviced / maintained �41+ n 4C) .0241) 6 ,/Q,Q,� as per management plan provided by plumber. to C /1 t T om _ n 2. All setback requirements must be maintained e J o�C pC as per applicable code /ordinances. Attach complete plans (to the County only) for the system r t less 1/2 x 1 1nA es in size SBD -6398 (R. 01/03) �•1% 4',A)o/d .fir "ilt) :S�// - s c .-3 - 79.t�-7e/9 a) N - a;.to.sa.„,J G -/D /� , I' ._.,, Avii , ,,...2„,,_________-- /' 19 / r� i s sops _ __ - - , /: / 7 ■ 4 . a4 / . � ) (1 1 9 / �/ / ‘;= ,-� .i ,S: -/ ..4 - „„ /-_-,/,,,/, s - A � ? � i / y ,-- iyi II �-°r �fl /UC' ,9 .,( /ekXs i / In j 3 ,� .9,C; Y : .„ ,,.-,,,es (.,,,,,g.,3 d,t) / A( /07 • • . - Lai //C • ■ P. ' ' , CC 466, 1 ,e3) /-- . ' 4o/t) .B > ,ofjo g/ ,Sa - ,s&.3G -7 9/11 =2e/9 a) -- 4)S 1 i ,' �0 o to / ' / 7 A , a-4'.---/---- s t j. ' . > / : 0 o 0 _ ,,,4T /= y f 15/c) /7. -4 Of -- elk_ (f/C .- 99, 9' ` .a -S, -/ s TS B /' = y .0 Ail it/ .E/°r,4 �, � e, (iri s 1 j 3G e ,.F6_ 74i�i / .0 ‘ , i, � //� Wi Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of,-2 Division of Safety and Buildings in accordance with Comm 85, Ws. Adm. Code 4 County IP Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must - /, include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 0 20 — j Li pl. — O& - 110 ( 02U, ) Please print all information. wed by Date Personal information you provide may be used for secondary pu . ose - . _ - , :. 15.04 (1) (m)). O4 WOC Property - REC t1V ED • ropert Location --./. I, AP." • ovt. Lot 4 11 11' 1(4 S , - ' N R - (o Property Owner's Mailing Address / DEC 0 I I • of # :Io. # Su' • Na e or CSM# ` .. _ , Ai : ' r /I • , A - , /. . ► t.4 / - - � .. C' Stat 'p Code PI re p TrCOU ` ' I City ❑ Village 011 Town Nearest Road & DZ1 New Construction User Residential / Number of bedrooms • Code derived design flow rate f GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material (1r,lh ,7 Flood Plain elevation if applicable ,(/,1 ft. General comments S3s7 2•-. �� g and recommendations: ,6 A.V -1 0 14 d E Pei :,, J.e S�s�Y/n — .c� Boring # 0 Boring J ■ ig Pit Ground surface elev. ,M/. t ft. Depth to limiting factor / ?'S in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 • IIIIIMMTAIIIIIIIIIWA1111111111.111MIIMPIE. - MN= - !� /�'!'.MS111111111,411111•11111111 -- - . Q 4 Mill r Boring # 0 Boring Pit Ground surface elev. /1,1 0 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munsell Qu. Sz. .nt. Color Gr. Sz. Sh. *Eff#1 *Eff#2 .: i� 1 BIIIIIIIF� l l 1 ,. !,!III -- MIMI MINIM MN * Ef l - nt #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent #2 = BOD < 30 rng/L and TSS < 30 mg/L - Pri; 4 , l ? _ Signatu CST Nurr�er Address • ate valuation Conducted Telephone Number , --5 ' .e 4 0 . ... ., .. _ Property Owner Parcel ID # Page of 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 GPM' in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2 • Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPI? • in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. I 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 = BO; < 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 (207/00) • , — )5 4:'4 `7' �iUOn) "1s1 4114i %</ w/ .5 <',.? - 7c 9A/ 49k) - /4S64 W ,r , .5 --- /6 z /0 40 30 A � / ri ._.1_--- ,___ as �' ' 70 ` r / / 4 4 i / 1344JE4),rry 9/ ilus - 4 4;Jr,/ /46(/ 4 of 'X ?de �,X -• iceo ' 0 ..z: ' b "A/K - ,, J 4°ver';a� -iu 99 9 - 6-9 , 4 / 1 /' =�/o' CA L 1 ' ko) e , 0 _, , A5- /9 -6', ,a.../4. 6 )/e r > / C p l rs . 8 8 > / r , I Al I o° ffre 4 __ , eft /d , a . , illy, Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 488279 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 Holdee's Name: City Village X Township Parcel Tax No: Bast, Kernon Hudson, Town of 020- 1454 -00 -110 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 36.29.19.2925 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration ' Bldg. Sewer Holding ' St /Ht Inlet St /Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Cirade PUMP /SIPHON INFORMATION Manutacturer Demand St Cover GPM Model Number IUH Litt I Fnction Loss bystem Head 1.JH Ft i-orceitain Leng n uia. LAST. To well SOIL ABSORPTION SYSTEM etu/ I KCrvl.F1 vvIuul Length Flo. ur renules ri i urmCrvJiurvJ NO. UT rns msiue Lila. uquia Uepin DIMENSIONS OE DM." J TJ I tM 10 YIL IbLUL 11VtLL LHKt /J I KtHM Lmmt.nrrvta manufat.Wler. INFORMATION CHAMBER OR i ype UT Jysleni• UNIT moues rvuniuei. DISTRIBUTION SYSTEM 1 heddel/Manifuld Dbulbudun ritute Size x Mule Spac.Iny Vern iu All Intake Pipe(s) Length Dia Length Dia Spacing SOIL GOVtK x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Ovei Depth Ovel xx of xx Seeded /3udded xx MUM Ted Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 682 Mary Jo Court Hudson, WI 54016 (NW 1/4 SW 1/4 36 T29N R19W) NA Lot 110 Parcel No: 36.29.19.2925 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = T Plan revision Required? 1 1 Yes I No 1 1 Use other side for additional information. I- Date I Insepctor's-Signature Cert. No. - SBD -6710 (R.3/97) Safety and Buildings Division County NVitsconsi 201 W . Washington Ave., P.O. Box 7162 4t,t y n Madison, WI 53707 — 7162 Sanitary y Pefmit Number (to be filled in by Co.) Department of Commerce (608) 266 -3151p A I z/f 2 -7q State Plan I.D. Number J Sanitary Permit Application In accord with Comm 83.21, Wis. Adm. Code, personal information you provide �■�' `-/ V /4 may be used for secondary purposes Privacy • •' 1 m Project Address (i tfferent than mailing address) I. Application Information — Please Print All Information R E t' E 0 VE- —' / / 1 l (4 O. A✓ 1• 4a.c°T JUL 1 7 Parcel # /10 Block Property Owner' " ame i . L��IJn p �iiy ( ozo— 1µS, - oo !0 ..2'23 Property • er' ■ ailing Address - • 0 COUNT 4 t Property . . 95 ‘. e6.A- /�/A/ '��SbIJ in, Section :?, City, State Zip Code Phone Number _/_ r•. 4 �� S --b / ( c e one II. a of Building 7 N R ��r W ype g (check al hat apply) or 2 Family Dwelling — Number o . Bedrooms - Subdivision Name SSM IWmrber ❑ Public /Commercial — Describe Use r /07e t)A4O.o r //9 ❑ State Owned — Describe Use ❑City ❑Vi11 'ownship of III. Type of Permit: (Check only one bo. on line A. Complete line B if applicable)/ "`"ZCr9�) 1 A. yi.New Replacement Sy ❑ Treatment/Holding Tank Replacement Only ❑ Other Modifi . ;on to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Pepinit Transfer to New List Previous Petmi • -, and Date Issued Before Expiration ' lumber O' ter IV. Type of POWTS System: (Check all that apply) / i `l •• • • Non Pressurized In- Ground ❑ Mound > 24 in. of suita ❑ Mound <24 n. of uitab ❑ At-Gradf ingle Pass Sand F' ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank § Peat Filter ❑ A Treatment Un P c ] R " g Sand Filter ❑ Recirculating Synthetic Media Filter ;Leaching Chamber ❑ D ine ❑ Gravel -less pe �� 4 (Lp ain) , : V. Dis . ersal/Treatment Area Information: .'fit affe � )1; •$ rx , Design Flow (gpd) Design Soil Application Rate(gpdsf) ' spersal -: Requir=. (sf) Disp" IrArea Proposed (sf) 11 ....21 ' P . ' ' a. on • .. fir / 4;0 i. 4' : ra VI. Tank Info Capacity in Total ber , anu', r Gallons Gallons of Units P 1, i ' \ � (rd Si Steel F' . Plastic I (� _ i Constructed cted r. lass New Existing f \ !, -- r 1 1 1 i Tanks Tanks / , I Septic or Holding Tank . ' ^/ \i } ,41v s r V Aerobic Treatment Unit ��Y VVVV / Dosing Chamber ' VII. Responsibility Statement I, the undersigned, assu , responsibility for installation of \ POWTS shown on the attached plans. Plumber's V. e (' "nt) ` / Plumber's S'gn.� k MP/MPRS Num Business Phone Number / - .■ ' / 2% ,:. \ Plum .er's • d. ress (Street, . ity tate, Zip Code _ -' alt VIII. County/Dee_a °ent Use Only X Approved ❑ Di Sanitary Permit Fee (i Ludes Groundwater Date Iss • . Issuing gent Sign o Stamps) Surcharge Fee) /„� er Given Reason for ial -(t q / j,1 . IX. Conditions -f Approve t SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only),for the system on paper not less than 51/2 z 11 inches in size SBD -6398 (R. 01/03) 1 / 1 .. II ,asv.J LU 54/ -' %fr /;) a ao vi- r 4 1 44k n 404..sco tiJ ^lI ■ Cdr r/WS‘ 1 0 \\ - , , / Se - e t N "xi nO �` A ,Br4 Air v- i , ' / ,4* 41 :4 9g9 a ,$ s i <S,cJrie 4Jr- �rv� S ' zD i / / - / po - t A - 3Gj 3 -, a/ V I, 1 i/i ' / Al for . to o- ,297V6 35 A . 1 1 .& '7 -/.2 2 S , . * �� sconsl #1632 SOIL EVALUATION REPORT Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 3 Div glbn of Safety and Buildings Steel's Soil Service, Inc. County Attach complete site plan on paper not less than 81/2 x 11 inches • Plan must St. Croix . include, but not limited to: vertical and horizontal reference poin - l� • irection and percent slope, scale or dimensions, north arrow, and location and 4 nc&to nearest road. Parcel I.D. Pending Please print • rI a► , • . - �� {[(� = Re 'ewe --- JJJ���1111�1 D�� ( � By n Date ,u Personal information you provide may be used f6r . •• • - • • . - - "(Privacy/ La .14 (1) (m)). 1--i . C; 1, f 3 � P l tw Fete Property Owner Property Location - Bast, Kernon APR 1 3 2005 Govt. Lot na NW1 /4, SW1 /4, S36, T29N, R19W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 948 Labarge Rd. ST. CROIX COUNTY 110 na Cottonwood Ridge 2ND Addition City Sta ► F 3•'rf' t• .. • - Ci Village I I City ❑ g ❑ 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 Sream terraces and pitted dcti sil phii/ts Flood plain elevation, if applicable n a ft. General comments Conventional system, system elevation 98.25ft if using .6 loading rate or 94.40ft if and recommendations: using .7 I ding rate. Trenches spaced and depth to code 3.25ft for .6 or 7.00ft for . 7, Rd rJ 6 cfc. S Qicy2s, k A. a 0 , bypeO 4-- .,k;_0 r t s.Z, ) 1 Boring # 111 Boring ❑ Pit ound surface elev. 101.40 ft. Depth to limiting factor 130 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDr'ft in. Munsell Qu. Sz. Cont. Color `Eff#1 * Eff# 2 1 0 -16 10yr3/1 none I 2msbk mfr cs 1vf .6 .8 2 16 -30 10yr4/4 none sicl 2msbk mfr gw na .4 .6 3 30 -75 7.5yr4/4 none sl 2msbk mfr gw na .6 1.0 4 75 -130 7.5yr4/6 none cos osg ml na na .7 1.6 7477-ii _ _ ❑ Boring 2 Boring # g O/ .40 ❑ Pit Ground surface elev. --;''. ? 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 *Eff#1 *Eff#2 1 0 -12 10yr3/1 none sil 2msbk mfr cs lvf .6 .8 2 12 -23 10yr4/4 none sd 2msbk mfr gw na .4 .6 3 23 -75 7.5yr4/4 none sl 2msbk mfr gw na .6 1.0 4 75 -130 7.5yr4/6 none cos osg ml na na .7 1.6 _S-7/ /Z3 * Effluent #1 = BOD 5 > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD 5 <30 mg/L and TSS <30 mg/L CST Name (Please Print) -- Sigpature: CST Number David J. Steel 248956 Address Steel's Soil Servi Inc. Date Evaluation Conducted Telephone Number 994 200th St. Baldwin, WI 54002 4/10/2005 715 760 - 0347 SBD -8330 (807/001 • Properfy Owner Bast, Kernon Parcel ID # Pending Page 2 of 3 h 3 Boring # El Boring ❑ Pit Ground surface elev. 101.00 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 -12 10yr3/1 none sil 2msbk mfr cs 1vf .6 .8 2 12 -23 10yr4/4 none scl 2msbk mfr gw na .4 .6 3 23 -73 7.5yr4/4 none si 2msbk mfr gw na .6 1.0 4 75 -130 7.5yr4/6 none cos osg ml na na .7 1.6 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I 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 (R.07/00) Steers Soil Service, Inc. • STEEL'S SOIL SERVICE INC. 3 of 3 David J. Steel Kennon 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,110 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. Legend N O 1 " = 40' = Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe Alt Benchmark Ele. 99.90 ft 1 ' Top of 3/4" pvc pipe ❑ = Borings Boring Elevations B1 = 101.40 ft B2= 101.40 ft B3 = 101.00 ft B4 = 0.00 ft A, rie 3Y f � \ i P e(2 Ci( I tr16 5 /b7 1/41- A.9 \'\ - o I 101 in o x LOT 96 x . - .-- :. • 216 / kb b 2.00 Acres 1043.1 DEDICATED TO THE PUBLIC 6 m _ Q.B.A. = 2.0 AC .x 282.73' . / / "r 61 AZ - 221•31. - -.- . / II / . • / /1041.1. 4. X - 11.:i.4 / 0. / X • / � �,,0� j / 1040 (9 • • I • • / LOT 110 N ti `i" / 2.03 Acres LOT 111 4 / / N.B.A. = 2.0 AC 2.01 Acres N 1 N.B.A. = 2.0 AC OR / / . • x - 1040.7 f/ N - / / 35 . 3 99 9: s X '`� 1040.4 I I . LOT 109 X 272,2 856. • s. 9 5 1 2,01 Acres 1038.7 3 i N.B.A. = 2.0 AC -+ WEST 1/4 LINE OF SECTIO(*36 i - _ �� 1039.3 - - 0. 1 _ et, . (1 cN - _. -. ... LOT 108 I - ' • • 2.01 Acres r I 6 .� \ • x N.B.A. = 2.0 AC x C�,©T / ' 1037.1 1037.1 - - - I �' a • • 50.00' 61 # 414.54' ,. -. ROAD LENGTH 198' +1 .. • DEDICATED TO THE PUBLIC co itr_ 1037.1 I t ICli M x • / 1036.4 X 1 - \� J. -1-_,...., ./ • X 103(.2 • • • LOT 107 t :. • . - • 2.03 Acres io o� • - • • . • ' N.B.A. = 2.0 AC ; I LOT 106 � � ' • • 2.02 Acres �� , 10. N.B.A. = 2.0 AC POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page / of FILE INFORMATI'4 N ,--.411 O.,I .,J1,1wr) SYSTEM SPECIFICATIONS Owner ' / Septic Tank Capacity 1�G� ga l ❑ NA • _ dz. .e.... Permit # • • • 1 2 9 Septic Tank Manufacturer kl, &E--5 ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer fy / 1 /, ❑ NA Number of Bedrooms / 9 9 / s -�_ ❑ NA Effluent Filter Model / /� ❑ NA Number of Public Facility Units Jil NA Pump Tank Capacity ga l ZI NA Estimated flow (average) 1./e gal /day Pump Tank Manufacturer jai NA Design flow (peak), (Estimated x 1.5) e=z9e) gal /day Pump Manufacturer A NA Soil Application Rate , 7 gal/day/ftz Pump Model .ANA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ANA Fats, Oil & Grease (FOG) .30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD .220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) <150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD <30 mg /L A In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) <_30 mg /L I,g NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) <_10 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y8 in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event 1 Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) J:21-year(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one -third (3/ of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) year(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ❑ month(s) ❑ NA _,I4' year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) 21 NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) .G I NA ❑ year(s) t-er. ❑ month(s) At least once every: ❑ year(s) .g NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of <_12 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 Pa of g� START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: V A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTAL R POWTS MAINTAINER Name / Name Name Phone 7/S 75� _� /� Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name J Phone Phone / _ 7/ s—_ . �� — This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &1f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. 1 ts`s.. ,ztatsn 1n_ stet is z'.r.ay.o _ - - -- • ST CROIX COUNTY S[iPTIC TANK MAINTENANCE AGREEMENT RECEIVED AND OWNL CERTIFICATION FORM I JUL 7 2006 OwnerBuyer /LzJyt " " L J • coi NTY Mailing Address e , _ � -- — / • Property Address e g� _ - o ( rification required tom Planning Depa r ent for new construction) , r' Identification Number 02-0- 1 its - t3D -- I I O 6 2 9 25 City/Stare G/ l Parcel Idcn f > FQAL DESCRIPTION. Property Location 5 ''V., NW 'A, Sec. S (' , T - . ' 1 N -R 1 1,w, Town of /411 /54)// 0(..7 10,1 Subdivision x w' i� / 4/ .- ej• . Loth //D i _ Certified Survey Map # , Volume , Page # Warranty Deed ti ---P J / , Volume 2 73 9 . Page N 3 Ic . Spec house res 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 maintenance consists of pumping our 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 scptsc tank as a treatment sage 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 master plumber, journeyman plumber. restricted plumber or a licensed pumper verifying that (1) the on - site wastewaterdisposat system, is in proper operating condition and/or (2) after rnspcctton and pumping (if necessary). the septic tank is Less than 1/3 full of sludge. 1 /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth. h . as : t by the Department of Commercc and the Department of Natural Resources. State of Wisconsin Certification statin at your s tie .. c • s been n.ainta'ftcd must be completed and gemmed to the Si . Croix County Zoning Office within 30 d s of the thre , cepa - • ate. /� -`7 DATE SIGNA OF CANT 0 ' NFR __. FICA ION we) c, ify th s tatements on this form arc true to the best of my (our) knowledge 1 (we) am (are) the owner(s) of the • ropcny de ri • - • vrh of a arrow decd recorded in Register of Deeds Office. CM" (/a'/ aftg SIGNA 'RE OF !CANT DATE •• .` Any info anon that is rats-represented may result in 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 Chap if reference is made in the warranty deed i;• 2GSL96CSTG uosuyor uosec dTt =TO co ea '-o0 U 2739 P 31 6 78E0 10'a t� 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 THIS DEED, made between Neil L. Wilcoxson and Mary Jo MARR EXEP T t DEED 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 TRANS EE 4212. 90 COPY FEE: the following described real estate in St. Croix County, State of Wisconsin: CC FEE: PAGES: 2 SEE ATTACHED EXHIBIT A • Recordin g 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 t *r. y of January, 2005. ` , �'I L. Wi cox �� � * Mary Jo i}✓ oxson • * nVr1 AUTHENTICA p11 \3 ACKNOWLEDGMENT NC a'N Signature(s) 'N ;SC - ' STATE OF WISCONSIN ) .1,- 2, j ST. CROIX COUNTY. ) ss. authenticated this 28th day of January, 2005 Personally came before me this January 28, 2005 the above named Neil L. Wilcoxson and Mary Jo Wilcoxson, * husband and wife to me known to be the person(s) who TITLE: MEMBER STATE BAR OF WISCONSIN execut a fore oing instrument and acknowledged the same. (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY *Chen rown Notary Public, State of Wisconsin Peterson, Fram & Bergman - Steven H. Bruns My commission is permanent. (If not, state expiration date: 50 East Fifth Street, St. Paul, MN 55101 3/11/2007 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2 -2000 1 I C P � Hg 0A0( I V I a ' I c I a _ I ' . I Iii ,9L'9603 I S SBti 1 99 4, ,86 vZti ° zs'9s r1 " vf L = 1'M'H a I ` 69'I.LI. ;V3 3OVNIVHO r j,. I i — OP 3.i' LZo00N 1 it I I T r ' 21. chi 8 ' ' F2 4. : rU Z I Q N b Ict NN 1. 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