HomeMy WebLinkAbout020-1374-01-000 Wisconsin Department of Commerce Count
PRIVATE SEWAGE SYSTEM St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
488055 0 _
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Thiede, Roger & Alice I Hudson, Town of 020 - 1374 -01 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
/Ub Y\J\ CS 1 _ 12.29.20.2234
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS xN HI FS ELEV.
Ill. .'C3
Septic - 7 Benchmark
/, 3 16c)
O F 1� ZG A- ( Alt.. Ca,� * 3 .5 /OAS . 77
Aeration Bldg. Sewer
Holding St/Ht Inlet �l Z7 J -6 I'
TANK SETBACK INFORMATION St/Ht Outlet Li 3
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic 7 Sa AJro' Z I 7 (P� Dt Bottom
Dosing Header /Man. Z '%1 ?5,4g
Aeration Dist. Pipe 3 , 3L 97. 1
11 9B,o
Holding Bot. System LoM so I`t
g O �,
N.
Final Grad II ��,� ,
PUMP /SIPHON INFORMATION t(vliLL ire L' 2 - `�� 1- 7
Manufacturer Demand St Cover sl 3 5(O / d� :7
GPM j.n`e.� �.�
Model Number 1. I T 4 Olser , a�.'1ty /Dd'bl It' -7Z Joe), (4)
TDH Li Friction Loss System Head TDH Ft
b 3.1 Z3
Forcemain Dist. to Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid epth
DIMENSIONS 3 W •'s �'Sa 3 ��e�C�b \ _1 e \
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer.
INFORMATION CHAMBER OR o �^
Type Of System: AS z�' 193 i JA � b UNIT Model Number:
G v`0 ej=�o V"
DISTRIBUTION SYSTEM S 4. is 4-
Header /Manifold �� Distribution x Hole Size x Hole Spacing Pipe(s) Ve }r Intake
tt/r � \
Qd1 r
Length �� Dia T Length \ Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over i Depth Over xx Depth of xx Seeded /Sodded xx Mul hed
Bed /Trench Center 2 Bed/Trench Edges Topsoil �� s �� No I _ Yes I j No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2:
Location: 184 Starr Wood Hu dson, WI 54016 (NE 1/4 SW 1/4 12 T29N R20W) St rr Wood Lot 1 Parcel NoJ12 9.20.2234
v wr �
1.)AItBMDescription x/61.7 A- � Co �� b�_ST
2.) Bldg sewer length = • � � �� �` � � �Z ' �
- amount of cover = i ,5 C 1
L j' �JVa�- 191.05
Plan revision Required? J Yes , No
Use other side for additional information.
Date Insep ors Si ure Cart. No.
SBD -6710 (R.3/97)
Safety and Buil ngs ttltf Coun
_ Washington A e., P.O. Box 7162 1. C R O
,S Madison, WI 5 707 - I a :' Zo tar Permit Number (m be filled in by Co.)
(608) 2 3151
Department of Commerce
Sanitary Permit Application ST. Number
C�01C P I.D.
In accord with Comm 83.21, Wis. Adm. Code, personal information y Project Address (if different than mailing address)
m ay be used for secondary purposes Privacy Law, s15.04(1)(m) J
/pY A—,qA t y✓aO0
I. Application Information - Please Print All Information
S
Property Owner's Na me Parcel g X Lot X Block x
Property Owner's Mailing Address - Property Location
s - , 1 ,t,,rJA/ Sf.Section Jd —
City, State Zip Code Phone Number
� E o (circle ) T
�3` T 9 N; R
H. Type of B ' ' g (check all that apply) O ,,k //`' �` �"'6 Subdivision Name CSM Number
9 1 or 2 Family Dwelling - Number of Bedrooms Y r / F o�irz� >7J52� ��an
❑ Public /Commercial - Describe Use n - ,
❑ State Owned -Describe Use \3 p,5d- ce.[Ln W 10 4- 1D+ g ❑City_ ❑Village ®Township of &&Mory
III. Type of Permit: (Check only one box on line A. Complete line B if applicable) 0 Z O - 13 7 — a / - Od
A' 10 New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date issued
Before Expiration Plumber Owner < - L A �
t
IV. of POWTS System: (Check all that apply)
a
® N - pressurized _Ie Gr ound ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter
C1 Constructed Wetland ❑Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit 11 Recirculating Sand Filter
❑ Recirculating Synthetic Media Filter ® Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. Dispersal/Treatment Area Information:
Design Flow (gppd) Design Soil Application RaWjpdsf) Dispersal Area Requual (sf) Dispersal Area Proposal (sf) System Elevation
dQ A- y
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank .250
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibili Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Na me (Print) Plumber's Si gnature MP /MFRS Number Business Phone Number
oC�o2��J� - O
PlumVfs Addre ss (Street, City, State, Zip
O
VIII. Count /De ent Use Onl
pproved Sanitary Permit Fee (includes Groundwater Da Issued Iss ' nt Si �Ss)
Surcharge Fee) /0 , t)O J !3
O
tL
�Remason trial
IX. Conditions of Approval/Reasons for Disapproval
SYSTEM OWNER:
I. Septic t&*. 0MU@ tt r4K WW 0 F (
doe" og n%W ON be MdM J mWnWkW p
ti. y r niumpniert plan W &Aftd by p1wri er. r r 14ce,M a re,& —,
2. All I IrrequWarlierftnv*berivilrolned se per +P � CMU / ardklaticee. P JB , s e_
UAL(,
Attach complete plans (to the County only) nor the system 00 paper not less than SUE x 111nc11es in size
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A-Iff o v101vZo /lE UO E.rtE t'o Fao r, Sol J'[o�E To a /3�oA�t�a iuE..e. PLOT r C"M MCTION PUMN
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STARR WOOD
LOCATED IN PART OF THE SE1 /4 OF THE SWI /4, IN PART OF THE
NE1 /4 OF THE SW1 /4 AND IN PART OF UOVERNMENT LOT 3. All IN
J! .
' ... e SECTION 12, T29N, R20W, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN.
I
/ I S8rjZ56 -W 2309.46
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OUTLOT 1
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OUTLOT 1 IS UNBUIlDABLE UN 11L SUCH . '
w 71ME AN ACCESS CAN BE OBTAINED.
/ z THE PLATTER SHALL RETAIN ONMERSHIP. � - ff
• 2 W__�.Ilr� � fir�i� j AM
/ �
p
ay to OUILOT 21S UNBUILDABLE AND TO BE OWNED BY �p w
STARK WOOD HOVE CWNFRS ASSOCIATION :ffi.m
�. MEANDER U NE 3
' n. 7E650 FT
OUTLOT 2 $ 1.6M,CRES
AREA TO VEUOBi UNE �
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m12E ES
a"610 Fr
AREA M EDGE 6 WATER 215EACfE3
19EMSOFT.A -
.5 ACRES 4
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C1 Ct i CONSFAV0.(.^f
/ AREA Sl]B7
— — — — _ =— N89°50'51 "E 1100.59' TW10A =E =TIED= �raF� _�.o�
TMND �V@1UE MTT ®ON =T OF NOAi1/ ENO TWA — —
L — — _ T OIJTLOT 3 IS UNOUILDABLE AND TO BE OWNED BY d� 8
I STAFIi HOOD HOME OWNERS ASSOCIATION - --
STATION CIRCLE N. - wjmLa(m PAM
ES of 12% OR -
IuRING ROAD
tMR81D BY I SCALE IN FEET 1' - 100'
too 0 •00 _ DO
REYB®
79 rye. ry}t ]D ^.ATE .1)A10
jw epartment of Commerce SOIL AND SITE EVALUATION
of Safety and Buildings Page / of
Bureau of Integrated Services in accordance with Comm 83.09, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and 5 T ` 1 k
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. #
APPLICANT INFORMATION - Pleai(e print`all nfdi140M*. Revie ed by Date /
Personal information you provide may be used f "secondary purpRsPriv y Law, s 1.04 (1) (m)).
Property Owner - ,Property Loc tion CfV-ZQh4� "r &_ej6g k1. ovt. Lot it 1/4 dW1/4,S I Z T W
Property Owner's Mailing Address U # I Block# Subd. Name or CSM#
io9
City State Zip Coe Phon@ ( ) _ El city Village Town Near est Road
Q
9WNew Construction Use: ® Residential / Number of bedrooms 4 1 Addition to existing building
❑ Replacement ❑ Public or commercial - Describe:
Code derived daily flow 60p gpd Recommended design loading rate gi bed, gpd/ff 2. trench, gpd /ft
Absorption area required 9S& bed, ft 750 trench, ft2 Maximum design loading rate b' j bed, gpd /ft gpd/ft
Recommended infiltration surface elevation(s) —e & 124 ft (as referred to site plan benchmark)
Additional design /site considerations 4 L uA ±' 6 k ib oiu � �k 1 A 1'1 JC 6 V_A L_ Lt-J-Q-
Parent material G c_ A <- t A L r L L- Flood plain elevation, if applicable r
S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Ta k
U = Unsuitable for system S El U S 1:1 U HIS ❑ U 1 19 S ❑ U S ❑ U ❑ S [?U
SOIL DESCRIPTION REPORT
Borin g # Horizon Depth Dominant Color Mottles Texture Consistence Boundary Roots Structure GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
✓S 1 / v3't tr Ir, C A
A
r-31 log .e 3 — s / rh 5�K M cs --
Grou iJ 4 3 S J� ! Q ,T U .�
Depth to
limiting
factor
in.
Remarks:
Boring #
Ih Sr rn CS O ;n,S
lbyR
M S ,�
Gro
Depth to
limiting
factor
a / Remarks:
CST Nape (Please Print) ignature Telephone No.
N' 3 6144soti
Ad q rbp s Date CST Number
SOIL DESCRIPTION REPORT
PROPERTY OWNER Page of
PARCEL I.D.#
Boris # Horizon Depth Dominant Color Mottles Structure 2
9 Texture Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
In c, r
Ground C)Z
elex
���`J ft• '
Depth to
limiting
factor
fin.
Remarks:
Boring #
/0`11 3 — L O'A ' ,S
a 16W t 4 -- SG M:5 m, g
�
.@
` Ground
91
ft.
Depth to
limiting
facto
> 16?' in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2
in. Munsell Qu. Si. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring # -3 d` mcr al C S Zm "5'
M1 C's Z m
9 lot r� 4 — �� S n1 —
Ground
lev.
U Z ft.
Depth to
limiting
> � ' ". Remarks:
Boring #
13
Ground
elev.
ft.
Depth to
limiting
factor
in. Remarks:
SBD -8330 (R.9/98)
SOIL DESCRIPTION REPORT
PROPERTY OWNER Page of �-
PARCEL I.D.#
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
Bed .Trench
A 0_6 L ,n t r m
8) KR IbYR 4
Ground 91 l by R rn
_e
�
Depth to
limiting
factor
Remarks:
Boring #
4 /A`143 — L n A .S
t
A [-67 1biR -'-'Z I S4 t '%, S Pt- e- Lj
Ground
lev.
C 9 ft.
Depth to
limiting
fact
> lb in.
Remarks:
Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench
Boring # cr Ch CS ZM
M. CS Zm 1 03 0 .�
MI
Ground
Iev.
A ft.
Depth to
limiting
> - in. Remarks:
Boring #
Ground
elev.
ft. '
Depth to
limiting
factor
in.
Remarks:
SBD -8330 (R.9/98)
z
w
� 4
2
mv
V2
Y
m �
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20
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1
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Parcel #: 020 - 1374 -01 -000 01/12/2005 08:13 AM
PAGE 1 OF 1
Alt. Parcel #: 12.29.20.2234 020 - TOWN OF HUDSON
Current ❑X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): " = Current Owner
"
DEAN M TRUST ERICKSON ERICKSON, DEAN M TRUST
1221 MCKINLEY DR
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): ' = Primary
Type Dist # Description * 184 STARR WOOD
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 1.948 Plat: 2506 - STARR WOOD LOTS 1/25'00
SE -T29WR20W NE SW & GOV LOT 3 Block/Condo Bldg: LOT 01
A=WOOD .948AC
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
12- 29N -20W NE SW
Notes: Parcel History:
Date Doc # Vol /Page Type
09/13/2002 690200 1975/266 WD
09/13/2002 690199 1975/265 WD
09/13/2000 629835 1542/324 WD
08/18/2000 628460 8/5 PLAT
2004 SUMMARY Bill #: Fair Market Value: Assessed with:
50133 214,200
Valuations: Last Changed: 10/30/2001
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.948 165,700 0 165,700 NO
Totals for 2004:
General Property 1.948 165,700 0 165,700
Woodland 0.000 0 0
Totals for 2003:
General Property 1.948 165,700 0 165,700
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch #:
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
�1
1
1 KATHLEEN H. WALSH
Stat�'Ba>�f' qq Wisc�nsln For m 1 72003 REGISTER OF DEEDS
TRUSTEE'S DEED ST. CROIX CO., MI
RECEIVED FOR RECORD
Document Number Document Name
18/25/2805 09:30AM
TRUSTEES DEED
EXERT #
THIS DEED, made between REC FEE: 11.00
as Trustee of Dean M. Erickson Irrevocable Trust TRANS FEE: 899.70
( "Grantor," whether one or more), COPY FEE:
and Roeer L. Thiede and Alice B. Thiede,
PAGES: 1
("Grantee," whether one or more).
Grantor conveys to Grantee, without warranty, the following described real estate, Recording Area
together with the rents, profits, fixtures and other appurtenant interests, in St. Croix
County, State of Wisconsin ( "Property") (if .more space is needed, please attach Name and Return Address
addendum):
Lot 1, Plat of Starr Wood in the Town of Hudson, St. Croix County, Wisconsin.
lkmr w��
020 - 1374 -01 -000
Parcel Identification Number (PIN)
Dated
(SEAL) //� `T (SEAL)
s s
(SEAL) �' - �A 2 , v'V (SEAL)
s s
AUTHENTICATION ACKNOWLEDGMENT
Signature(s)
authenticated on STATE OF )
) ss.
COUNTY )
s
TITLE: MEMBER STATE BAR OF WISCONSIN Personally came be flare me o>I
(If not, the above -named Y1 711 anL45��n
authorized by Wis. Stat. § 706.06) to e known to be the person(s) w o executed the foregoing
Tracy L. Turner in m nt and ow the same.
THIS INSTRUMENT DRAFTED B f�Otary PUbIIC XY
Attorney Kristina Oeland State of Wiscons
Hudson, WI 54016 Rota PtAlic,State of
My Commission (is permanent) (expires:
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
TRUSTEE'S DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 7-2003
* Type name below signatures. INFO -PRO'rm Legal Forms 800.855 -2021 www.infoprofo ms.com
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _Z_ of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner _
Septic Tank Capacity al C3 NA
Permit # •
Septic Tank Manufacturer D NA
Effluent Filter Manufacturer ❑ NA
DESIGN PARAMETERS J
Number of Bedrooms ❑ NA Effluent Filter Model al Number of Public Facility Units ® NA Pump Tank Capacity
Pump Tank Manufacturer
Estimated flow (average) al /da B NA
Design flow (peak(, (Estimated x 1.5) gal/day Pump Manufacturer
Soil Application Rate al /da /ft' Pump Model ® NA
Standard Influent /Effluent Quality Monthly average` Pretreatment Unit ® NA
Fats, Oil &Grease (FOG) 530 mg /L ❑Sand /Gravel Filter ❑Peat Filter
Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA D Mechanical Aeration [3 Wetland
5150 mg /L ❑ Disinfection D Other:
Total Suspended Solids (TSS) DNA
Pretreated Effluent Quality Monthly average Dispersal Cells)
530 mg /L ® In- Ground (gravity) ❑ In- Ground (pressurized)
Biochemical Oxygen Demand (GODS) ❑Mound
Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade D Other:
Fecal Coliform (geometric mean) 510` cfu /100ml D Drip -Line M NA
Other. '
Maximum Effluent Particle Size Y in dia. 103 NA ®NA
Other: M NA Other.
Other: la NA
*Values typical for domestic wastewater and septic tank effluent.
MAINTENANCE SCHEDULE
Service Frequency
Service Event
❑ month(s) (Maximum 3 years) ❑ NA
Inspect condition of tank(s) At least once every: ® fear(s)
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume D NA
❑ month(s) (Maximum 3 years) ❑ NA
Inspect dispersal cell(s) At least once every: 9 ear(s)
❑ month(s) ❑ NA
Clean effluent filter At least once every: ® year(s)
D monthls) JN NA
Inspect pump, pump controls & alarm At least once every: ❑ fear(s)
❑ month(s) ® NA
Flush laterals and pressure test At least once every: ❑ year(s)
D month(s) 14 NA
Other: At least once every: ❑ year(s)
® NA
Other:
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or c e t o r catio n :
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer;
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 fot 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 IY 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 of pressurized components, pretreatment
units, and any servicing at intervals of 512 months, shall be performed 'by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
GMW 14 /011
Page - I - of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(4) 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 can t be repaired the following measures have been, or must be taken, to provide a code compl' nt
replacement system: /� ^ a (� 1 r Lp fddd���"'d�� �j, J . l� 1�oa.— c.o 'C"oC �� -. A suitable replacemhas been evaluated a6 may
be utilized for the I anon of a replacement soil a io
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon b
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable . replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< < WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS -
POWTS INSTALLER POWTS MAINTAINER
Name Name ..
Phone Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name T _ Name
Phone Phone
This document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d) &(f) and 83.54(4), (2) & (3), Wisconsin Administrative Code.
Page —9L of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(rj) 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 Isump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
stem is
When the POWTS fails and is permanently taken out of service the following steps shall be taken to insure that the system
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 cann t be repaired the following measures have been, or must be en, to provide a code compliant
replacement system: •� d� 8 w! • 1 I[ / �
Q 5
IM A suitable replacement area has been evaluat" and may be
utilized for tife location of a replacement soil absor ion
system.
not be infringed upon by
coon and
should 9
. The replacement area should be protected from disturbance and comps
y p p
required setbacks from existing and proposed structure, t area will
lot lines and wells. Failure to protect the replacemen o
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 df the POWTS a soil and site
evaluation must be performed to locate a suitable 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> > T
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NO
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON. FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name Name
Phone Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
E e Name 7-' _ Nam
Phone Phone - ?&,6 — A4?Q E
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &M and 83.54(1), (2) & (3), Wisconsin Administrative Code.
. ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer oti e ir 4- t ir e P_ 1� e
Mailing Address 2 brn In Vo( I IQ -14 j
Property Address
(Verification required from Planning Department for new construction)
City /State A - c o N Parcel Identification Number Z� Z P - 7 " O d C�
LEGAL DESCRIPTION
Property Location %,, W %,, Sec. Z , T _aN -R_,&) W, Town of R�
Subdivision 4-kirf Wdo Lot #
Certified Survey Map # Volume , Page #
Warranty Deed # V 1 D 2 - 6 Volume ,Page #
Spec house ❑ yes N no Lot lines identifiable 11 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 out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
masterplumber, journeyman plumber, restricted-plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days ofthe three year expijation date.
SIGNATURE OF APPLICANT
DATE
OWNER CERTIFICATION
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIGNATURE OF APPLICANT DATE
* * * * ** Any information that is mis- 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 map if reference is made in the warranty deed
1
1992
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 1
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations
Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D.
percent slope, scale or dimemsioaa, north arrow, and location and distance to nearest road. 020- 137401 -000
Please print all information. Review y Date
Personal information you provide may be ui ad for 04 (1) (m))• a
Property Owner qoperty Location
Roger & Alice Thiede vG Lot NE 1/4 SW 1 S 12 T 29 N R 20 W
Property Owner's Mailing Address 2 t # I Block # I Subd. Name or CSM#
184 Starr Wood Road 1 Plat Of Starr Wood
City State Z COC9 P City J Village 0 Town Nearest Road
Hudson I WI Hudson I Starr Wood Road
New Construction Use: V1 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
Replacement J Public or commercial - Describe:
Parent material Glacial Outwash Flood plain elevation, if applicable na
General comments
and recommendations: Evaluation completed to verify soil suitability for POW re place ment dispersal cell.
1
61 Boring # _ I Boring
1 J ,�
d Pit Ground Surface elev. 99.60 ft. Depth to limiting factor >106 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PDKt
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2
1 0 -6 10yr3/3 none sl 2fsbk mvfr as 2f,vf 0.6 1.0
2 6 -17 10yr4 /3 none s1 2msbk mvfr cw 1f,vf 0.6 1.0
3 17 -24 10yr4/6 none Is Osg ml gw - 0.7 1.6
4 24 -73 10yr5/4 none s 0 sg dl cw - 0.7 1.6
5 73-106 10yr6/4 none s & gr 0 sg dl - - 0.7 1.6
" Effluent #1 = BOD 30 < 220 mg and TSS >30 150 mg/L uent #2 = BOD S30 mg/L and TSS a 30 mg/L
CST Name (Please Print) Signa re: CST Number
James K. Thompson 3602
Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number
340 Paulson Lake Lane Os WI 54020 6/27/2006 715 -248 -7767
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