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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page —j— of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code County
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. p /
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 0 ! b � �U
Please print all inf matlon. Re _ Da te
Personal inforrnatiop ynu provide y be used for seco ary p 15 (m))•
Property Owner Prope ovation
'.5 1/4 0/4 S 2 T N R(7 E( W
Property Owne Mailin t # Block # Subd Name or CSM# � a —
831 c 3(p c� /�/
City NING OFFI C ❑ Village wn Nearest R oad
�An,mat�P lJt 5 �i5 t� - �tf� '3o ev v/
New Construction Use: Gjesidential / Number of bedrooms Code derived design flow rate GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material <' YE Flood Plain elevation Wapplicable
General comments /
and recommendations: (�lS� 49A 7 S - (f / p �� C 96'� STt``� F /lv� �7y
Boring # E] Ejpd
� Pit Ground surface elev. �lo < y, ft. Depth to limiting factor -; in. Appl ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eil#1 *M
I Sc S'
Sj
®Boring # t� Pit ng
Ground surface elev. ft. Depot to limiting factor in. Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
rr..�� in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 'E
V' o `/C'i S Ok 1'h tr C � I V d
-Sj :3 LI) t S"
S C t v F r
Effluent #1 = BOD > 30 _< 220 mg/L and TSS >30 150 mgA. ' Effluent #2 = BOD <_ 30 mg& and TSS _< 30 mg/L
CST Na (Please Print Signature CST Number
�� p aCDCQ 9a
Address ate Evaluation Conducted Telephone Number
t2 tl rin )', j =moo
4 �i Sor Page —) of 3
F3_1 Property Owner _ v 7'� Parcel ID #
Boring # ❑Boring � ...
aS
pit Ground surface elev. n• Depth +r in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence ' Boundary Roots GPD/ff
'Eff#1 •Eff#2.
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. .
sr
S -y a`I 6 0 1M Lk
❑
Boring # Boring
Pit Ground surface elev. ft. Depth to limiting factor In.
E3 Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •E GPD/fF E
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor In- Soil ication Rate
❑ Pit
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu, Sz. Cont. Color Gr. Sz. Sh. •Eff #1 'Eff#2
Effluent #1 = 800 > 30 220 mg/L and TSS >30 5 150 mg/L ' Effluent #2 = BOD <_ 30 mg/L and TSS S 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.6100)
Parcel # : 028 -1 026-1 -05'50 05/07/2007 04:35 PM
PAGE 1 OF 1
Alt. Parcel #: 22.28.17.152A 028 - TOWN OF RUSH RIVER
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
O - FISCHER, MATTHEW T & MORIAH J
/ ..Ar}ATTHEW T & MOR J FISCHER
/ 1849 30TH AVE
I BALDWIN WI 54002
Aistrcts SC = School SP = Special roperty Address(es): ' = Primary
Type Dist # Description " 1849 30TH AVE
SC 2422 ST CROIX CENTRAL
SP 1700 WITC
Legal Description: Acres: 36.600 Plat: N/A -NOT AVAILABLE
SEC 22 T28N R17W PT SE NW DESC AG QOMM N _ Block/Condo Bldg:
1/4 COR SD SEC 22; TH��2.72FT
TO POB; TH S 00' E 1219.00FT TH S 90'W Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4)
1305.41FT;TH N 00 DEG W 1219.00FT; TH N 22- 28N -17W SE NW
89'E 1307.87FT TO POB
Notes: Parcel History:
Date Doc # Vol /Page Type
07/21/2003 731191 2323/205 EZ -U
03/05/2003 712135 2162/134 WD
03/05/2003 712134 2162/126 EZ -1
06/18/2002 681998 1912/157 WD
more
2007 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Valuations U490,400 Changed: 09/02/2005
Description Class Acres Land Total State Reason
RESIDENTIAL G1 5.000 42,000 532,400 NO
UNDEVELOPED G5 31.600 57,000 57,000 NO
IV� � �
Totals for 2007:
General Property 36.600 99,000 490,400 589,400
Woodland 0.000 0 0
Totals for 2006:
General Property 36.600 99,000 490,400 589,400
Woodland 0.000 0 0
Lottery Credit Claim Count: 1 Certification Date: 09/22/2006 Batch #: 06 -14
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division L -.
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 420319 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:
Juen, David & Kristi I Rush River Township 028- 1026 -10 -000
CST BM Elev: 1 �1 Insp. BM Eiev: BM D ription:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchma
Dosing Alt. BM
Aerati Bldg. Se
° ° + = s hob . 32- 13,
Holding �_ SVHt Inlet SS
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic y lob f / 6 Dt Bottom
Dosing �/ Hea -VL J an
Aeration - Dist. Pipe
Holding Bot. System aA a
PUMP /SIPHON INFORMATION Final Grade ,(
Manufacturer ULZ S GPM Demand St Cover 9s• � 3
Model Number (o 7
ft 5� w Eo3r-t '3 1 G
TDH Lift Frictio System Hea TD t
�o n o .� � X3:3
Forcemain j l- jb I Dial !r Di t. o Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Length r No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. T uid Depth
DIMENSIONS �, / �v
SETBACK SYSTEM TO P/L BLDG WEL LAKE /BYRE LC
HI Manufacturer:
INFORMATION CH B OR
Type OfSysstMte''m.:: (� , ( fti >�� U Model Number:
v k n
DISTRIBUTION SYSTEM
Header /Manifold Distribution n x Hole Size x Hole Spacing Vent to Air Intake
/ r/ Pipe(s) s r l r i
Length Dia L Length Z Dia Spacing_ / g 2 S 26 d
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only lrrrLet."J •
Depth Over 1 Depth Over xx Depth of xx Seeded /Sodded xx ulc ed
Bed/Trench Center I'! r Bed/Trench Edges Topsoil Yes No YesI No
COMMENTS: (include code discrepencies, persons present, etc.) Inspection #1:�/ / �?/ Inspection #2: / // ,-0..�2-
Location: 1849 30th Ave Hammond, W1 54015 (SE 1/4 NW 114 22 T28114 17W) NA Lot ! L� 6r / Parcel / No: 22.28.17.152
1.) Alt BM Description = (O - 5 T 6 �D k�.a t P `v S�
2.) Bldg sewer length = A+ kQK431 Cs►�n t-��+ BYE- ` - 1e7d dQ to Y 4 4-.
y4 4-A4., �, 4 -
- amount of cover = L� l LPSS b G � ,�Lo
3.) Contour = �1/✓'. w /\ 0 /�� � O
Plan revision Required? l Yes No
I _ —�
az- s o
�G
Use other side for additional information. _ � i J
SBD -6710 (R.3/97) Date Insepctor's Signat re Cert. No.
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' Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162 ST R IX
isconsr►n 53707 - 71 3
g�q --
De artment of Commerc Sanitary Pe N r
Sanitary Permit Application ZTsf
In accord with Comm 83.21. Wis. Adm. Code. personal information you provide ❑ Check if Revision
MR r be used for second ses Privacv Law, s15. 1 in State plan I.D NumberSite ID #648121
1. Application Information - Please Print All Information Craps. ID # 771777
m` Parcel Number
Property Owner's Name
026- 1026 -10 -00
David & Kristi JUEN , , ; Property Location , J c v
Property Owner's Mailing Address SE if NW u• S 22 T 28 N R 17WIl
1150 Curtis., Street Lot umber r
City. State Zip Code P 0 N/ A
651 /983 -6234 Subdivision Name CSM Number
Baldwin, WI 54002 N/A
II. Type of Building (check ❑City
all that apply) 3 aS "` ❑Village
�] 1 or 2 Family Dwelling - Number of Bedrooms RUSH RIVER
esc'be Us �1'ownshi
C1 Public /cotnme Nearest Road
❑ State Owned �t ` I +L ly,tf \- 30TH AVENUE
�k
M. Type of Permit: (Check only one box on line A (numbering scheme for internal For County ase line $ � applicable)
A 1 ❑ New 2 ❑Replacement System Fed nt of 6 ❑Addition to
Existin S stem Date Issued S stem ber B. ❑ Chock if Sanitary Permit Previously Iss
IV ' (3 Type of Permit: (Check all that apply) (numbering scheme is for internal use) 50 ❑ constructed Wetland
44 Non - Pressurized In- Ground 2109 47 ❑ Sand Filter Mound S1 C1 Drip Line '
41 ❑ Holding Tank 48 ❑ Single Pass
22 ❑ pressurized In- Ground 30 ❑ Othet
45 ❑ At -Grade 46 11 Aerobic Treatment Unit 49 ❑ Reoirculatin
V. Dis ersaU'I�'eatment Area Information: percolation Rate ystem Blovation Prowl tirade
Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Elevation
Required Proposed Rate(Gals. /Days/Sq.Ft.) (Mh)
N/A 97.4. 99.23
450 450 450 1.
Manufacturer Prefab Site Steel Fiber PWdC
Tank Info Capacity in 6Gal LNum ber Concrete Constructed Glass
Gallons nks
J_
New Facistiny
Tanks Tanks
Septic or Holdi g Tank 1000 Wieser Concrete Inc C oesinY �"r 600 Wieser Concr ete
VII. Resp onsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on th e attached
B m N
Plumber's Name (Print)
Pi is Signature MP/MPR5 Number
220292 715/772
Bennie Helgeson
Plumber's Address (Street, Ciry. State, Zip Code)
W1229 770th Avenue, Spring Valley, WI 54767
VIII. Coun /De artment Use Onl Lure (No Stamps)
Sanitary Permit Fee (includes Groundwater Date Issued Issuing Ag e= Signa
K Approved 0 Disapproved Surcharg e)
❑ Owner Given Initial Adverse . 3 Z��_ IS' Determination
IX. Conditions of Approval/Reasons for Disaapprova 1 vlv i _ /1
Al� z4i" + �, Lgk�,�t�r aa W611A.�
Attach eompl «e plans (to the County only) for We system on Papa not less than 81/3: u Inches In dse
'on -10, (R n5 101) ___
P t
Y o 30-1 h Q-
i
r
� y
J
p I N >P0c a
O a �4 P
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/83 /
Po
/DoSc
y „
. R: loba� fti Elegy.
11 Pie-
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*, Safety and
4003 N KINNEY CO'
LACROSSE WI rA
TDD #: (608)
isconsin www.commerce.stat
www.wisc
Department of Commerce
Scott McCallum, Governor
Philip Edw. Albert, Secretary
July 30, 2002
CUST ID No.220292 A7TN: POWTS Inspector
BENNIE W HELGESON ZONING OFFICE
HELGESON EXCAVATING ST CROIX COUNTY SPIA
W 1229 770TH AVE 1101 CARMICHAEL RD
SPRING VALLEY WI 54767 HUDSON WI 54016
CONDITIONAL APPROVAL
Ide No. 7717 umbers
PLAN APPROVAL EXPIRES: 07/30/2004
Transaction ID No. 771777
SITE: Site fD No. 648121
David Juen Please refer to both identification numbers,
30 Avenue above, in all with the agency.
Town of Rush River
St Croix County
SE1 /4, NWI /4, S22, T28N, R17W
FOR:
Description: Proposed Three Bedroom Mound System
Object Type: POWT System Regulated Object ID No.: 862370
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
The following conditions shall be met during construction or installation and prior to occupancy or use:
General Approval Conditions:
• This system is to be constructed and located in accordance with the enclosed approved plans.
• A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of See. 145.20(2)(d), Wis. Stats.
• Comm 83.22(7) - A copy of the approved plans, specifications and this letter shall be on -site during
construction and open to inspection by authorized representatives of the Department, which may include local
inspectors.
Owner Responsibilities:
• Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and
maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.
Comm 83.54(l).
• Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as
required under s. Comm 83.54(4) shall be considered a human health hazard.
• The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is acceptable to
the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the
component(s) utilized in the POWTS.
P.O.W rs.
Conditionally
• BENNIE W HELGESON Page 2 7/30/02
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the
installation, operation or maintenance of the POWTS.
Sincerely, A Fee Required $ 175.00
Fee Received $ 175.00
Il
Balance Due $ 0.00
Gerard M. Swim
POWTS Plan Reviewer - Integrated Services
(608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm WiSMART code: 7633
jswim@commerce.state.wi.us
cc: Leroy G Jansky, , Wastewater Specialist, (715) 726 -2544
y
INDEX SHEET
RECEIVED
PROPERTY OWNER: DAVID JUEN JUL 12 2002
1150 CURTIS STREET
BALD WIN W154022 SAFETY & B LO G S 01%
PROJECT NAME: DAVID JUEN
PROJECT LOCATION: SE 1/4, NW 1/4, S 22, T 28 N, R 17 W
MUNICIPALITY: TOWN OF RUSH RIVER
COUNTY: ST. CROIX
DESIGN: PRESSURE DISTRIBUTION MANUAL SBD- 10573- P(R/99)
MOUND COMPONENT MANUAL SBD- 10572 -P (R 6/99)
CONTENTS:
Page 1: Plot Plan
Page 2: Cross Section and Plan View of Mound
Page 3: Distribution Pipe Layout
Page 4: Septic Tank & Pump Chamber Cross Section & Specifications
Page 5 WLP1000 /600 - MR ZABLE Tank Specifications
Page 6 Pump Specifications
Page 7 POWTS Owner's Manual & Management Plan - Pg. 1
Page 8 POWTS Owner's Manual & Management Plan - Pg. 2
Name: Bennie Helgeson Signe
Address: W1229 770th Avenue
Spring Valley, WI 54767
Credential Number: 220292 Date: July 10, 2002
DEP ARTMENT' OF COMMERCE //
DIVIS101y DF SAFETY AND Bl11L6M,
SE E C OR ESP DEN
CE
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Synthetic Covering
Distribution Pipe
AS C 3=3
Medium Sand
H � G
Topsoil � r'=`"� F
_ 3 E I ; 1
11
[ % Slope Plowed
Ct~L�.Of 2� 2 i Force Main
From Pump Layer
Aggregate .
D 1-- Ft.
E /- yy Ft.
Cross Section Of A Mound F , 83 Ft.
G , $— Ft.
A Ft. H �_ Ft.
Signed: B 7.S! Ft.
License Number:
K ,S� Ft.
L_ Ft.
Date: j �, Ft.
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Observation Pipe
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Plan View Of Mound
Perloroled Plpe Oeloll
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are Equally Spaced
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Pipe
Distri bution Pipe Layout
P
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x j
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Hole Diameter Inch
Signed: '•
Lateral Inch (es)
License Number:
Manifold " �_ Inches
Date
Force Main " Inches
A,)VERT Ie�. 97, y
t4olc S Per � J, c '3 1'
.. lC rW o /�Qf•�Ye�1s �!O �e'�'S
�J Ll3i1 �' S 1A Page_ �Of�
SEPTIC TANK & PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
v" fLk -VENT PIPE 12" MIN. ABOVE GRADE E WEATHERPROOF
JUNCTION BOX APPROVED
2:25 FROM DOOR, WINDOW OR WITH CONDUIT MANHOLE COVER
FRESH AIR INTAKE W/ PADLOCK E'
WARNING LABEL
FINISHED GRADE
„ 4 " MIN.
_.__�_
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18 " I N • PIPE 18 rnt N.
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INLET
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WATER TIGHT SEALS '� TIGHT �� \/APPROVED
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APPROVED
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ONTO SOLID C
SOIL PUMP OFF ELEV • SD.O FT• OFF
D
3" APPROVED BEDDING UNDER TANK CONCRETE PAD
SPECIFICATIONS
SEPTIC / DOSE /. 3� x 5�.. (o • 7 13��.
TANK MANUFACTURER:
SIZES SEPTIC O GAL. DOSE VOLUME INCLUDING
TANK GALS
DOSE J GAL. �Ja y Gnic- �FLOWBACK: /6 .
CAPACITIES: A = Ig INCHES = .3� •6 GAL.
ALARM MANUFACTURER: P��"�' S'� � GAL,
MODEL NUMBER: B = 2 INCHES = 3,�
SWITCH TYPE: oc'�
r �� C = INCHES = �I73a GAL.
PUMP MANUFACTURER: (�� U
MODEL NUMBER: D = INCHES =
SWITCH TYPE: ) ploctJ -
23 C
REQUIRED DISCHARGE RATE /,/ GPM PUMP E ALARM WIRING AS PER ILHR e/ . ET
VERTICAL DIFFERENCE BETWEEN PUMP OFF ANDDISTRIBUTION PIPE • FEET
+ MINIMUM NETWORK SUPPLY PRESSURE . • FEET
+ FEET FORCEMAIN X X2.,2 FT /100 FT. FRICTION FACTOR . -. T
TOTAL DYNAMIC HEAD •3— Z33a
ZU WIDTH DIAMETE
DIMENSIONS OF PUMP TANK: LENGTH '-
INT QUID brFr
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pape 7 of 8
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner DAVID JUEN Septic Tank Capacity 1000 ga l 0 NA
Permit # Septic Tank Manufacturer WIESER CONCRETED NA
DESIGN PARAMETERS Effluent Filter Manufacturer ZABLE 0 NA
Number of Bedrooms 3 O NA Effluent Filter Model A -100 12" x 20" NA
Number of Commercial Units Bg NA Pump Tank Capacity 600 gal 0 NA
Estimated flow (average) gal/day Pump Tank Manufacturer WIESER CONCRETED NA
Design flow (peak), (Estimated x 1.5) 450 gal/day . Pump Manufacturer GOULDS PUMPS IIo NA
Soil Application Rate 0.5 al/da /ftz Pump Model 3885 O NA
Influent/Effluent Quality Monthly average* Pretreatment Unit M NA
Fats, Oil & Grease (FOG) 530 mg /L O Sand/Qravel Filter 17 Peat Filter
Biochemical Oxygen Demand (BODJ x220 mg/L 0 Mechanical Aeration 0 Wetland
Total Suspended Solids (TSS) 5150 m /L 0 Disinfection 13 Other.
Manufacturer
Pretreated Effluent Quality 10 NA Monthly average" Dispersal Cell(s)
Biochemical Oxygen Demand (BOD 530 mg /L O In- ground (gravity) 0 In- ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L 0 At -grade M Mound
Fecal Coliform (geometric mean) 510 cfu /100ml 0 Drip-line 13 Other
Maximum Effluent Particle Size Y inch diameter • Values typical for domestic (non- commerclan wastewater and
septic tank effluent.
�+ Values typical for pretreated wastewater.
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every 2 months 12 year(s) (Maximum 3 yra.)
Pump out contents of tank(s) F When combined sludge and scum equals one -third %) of tank volume
Inspect dispersal cells) At least once every 2 0 months Eg year(s) (Maximum 3 yrs.)
Clean effluent filter At least once every 1 0 months . Q year(s)
Inspect pump, pump controls & alarm At least once every 1 O months Q years) O NA
Flush laterals and pressure test At least once every 3 O months Q year(s) O NA
Ot At least once every O months 13 year(s) O NA
Other: At least once every 0 months 0 year(s) 0 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 ch. NR
113, Wisconsin Administrative Code.
The servicing of effluent filters, mechanical or pressurized POWTS components, pretreattment components; and any
other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintanner.
I of an service event
p rovided to the local regulatory autho completion y
A service report shall be p g ry tY within 10 days of comp
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.
OWNER: ,DAVID JUEN
START UN AND OPERATION page 8_ of _8
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 call(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:
O 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.
O A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
13 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 HELGESON EXCAVATION INC Name JOH NSON SANITATION
Phone 715/772_3278 Phone 715/273 -5811
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name JOHNSON SANITATION Name ST. CROIX COUNTY ZONING
Phone 715/273 -5811 Phone 715/386 -4680
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83. 540), (2) & (3), Wisconsin Administrative Code.
W isconsin Department of Commerce SOIL EVALUATION REPORT Page __/ of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code County � SO
Attach complete site plan on paper not less than 81/2 x 11 Inches M size t P I D
include, but not limited to: vertical and horizontal reference point ( ),
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Date print all Information. b r
Personal inform rposes ation you provide may be used for secondary Pu Eq-c4 mll• e A; ' IJ
NJ
Property Owner A
G i4� •2Cl�r'$011 F 114 /l)I�1� /4 S�� T a? � N R (? Property Owne Malling Address M A�( � # SUM Name or CSM# _ B39 OTN( Aue
�� City State Tip Code P e umbq6 CROIX Q Village wn Nearest Road
N�1hNldtcQ 01 015 ING
ZON0 r Uttr -le--
New Construction Use: esidential / Number of bedrooms
Code derived design flow rate yid GPD
❑ Replacement -/ ❑ Public or commercial - Describe:
Parent material �� / dr f�v ✓ & Flood Plain elevation If applicable
General comments - <--'e // // / � t/
and recommendation s: ' T 9� � r = � /�✓ ` /
u �r d' cam(( �v. CO� ou � 5
17/ Boring # Pit Ground surface elev: ��� y, ft. Depth to limiting favor _____ h • A Rata So l
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Horizon Depth Dominant Color Redox Description Boundary Root iption Textures Structure •El%#1 -EM in. Munsell Qu. Sz. Cont. Color
Gr. Sz Sh
�yd w. S b u r 8
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Boring # ❑ Ong
Ground surface elev. ��� ft. Depth to IImltlrtg factor RaWfe
Horizon Depth Dominant Color Redox Description Texture St ruc t ure , Consistence Boundary Root GpOJflr-
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eta
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• Effluent #1 = SOD > 30 220 mglL and TSS >30 _< 150 mglL ` Effluent #2 = BOD S 30 mgll. and TSS :S 30 mg1L
CST (Please P Signature CST Number
o aa � 9
Address ate Evaluation Conducted Taleptxarte Number
Address �� S �o - o � � 7Ja �/
��eee� 3 / Sor" Parcel ID #
Property Owner Page ,. _ of 3
E] Wing
Boring # it Depth S
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F3-1 Pit Ground surface elev. ._
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Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary 1.. `
In. Munsell Qu. Sz. Cont. Color Gr: Sz Sh.
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Boring # Boring Depth to limits factor Sop Application Rate
E] pi Ground surface elev. ft. �
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Horizon Depth Dominant Color Redox Description Texture •Eff#1 -002 in. Munsell au. Sz. Cont. Color Gr. Sz. Sh.
5 .
Boring
Boring # Depth to limiting co__ _ --
❑ ❑ Ground surface elev. ft- Sop Application Rate
Pit
Roots PD
Horizon Depth Dominant Color Redox Descripdon Texture Siru Lure Consistenm Boundary •Eff #1 'Eff<e2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
i
Effluent #1 = BOD, > 30 220 mg/L and TSS >30 150 mg/L ' Effluent #2 ■ BOD, _S 30 mgll and TSS S 30 mglL
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.
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`UN -11 -02 07:26 AM P.01
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AURE M11'N
AND
UWNERSHIP CERTIFICATION FORM
Owner /Buyer
Mailing Address 37
Property Address Z g yg 22 1-4 A At*_ 'n Jz
(Verification required from Planning Department for new constructio;z)
City /State _ . _ - -_ Parcel Identification Number
LEGAL DESCRI,ETION
Proverty Location Y., { _W '/., Sec. 22--, T � N - _� W, Tow.' of
C nhciivifiinn _ _ , Lot #..
rort9f ed Survey Man # 4L _ Volume _ , Page #
%N?arrantty Deed #f �� �1 0 , Vo ltame �/9 / _ , Page # /5 7
Spec hou Q9 v PA ! no Lot lines identifiable 0 pes 0 no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its prernatu,re failure to haudl6 wastes. ?roperisateusac=
consists of pumping out the septic tank every tluee years or sooner, if needed by a licensed pumper. 'v1Aat you put snta the aysteat
can aflcct the function of the septic tank as a treatment stage in h waste disposal cystcru.
The orercny owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner ad by a
master plumber, Journeyman Plumber, resuictedptumber or a licensed pumper verifying that (1) the on -situ 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.
Uwe, the undersigned have read the above requirements and agree to maintain the private sa wage disposal system with the standards
set fortli, herein, as set by the Department of Commerce and the Department of Natural FLesot rces, State of Wiscm aia- ;ettificsdOts
stating that your Septic system has maintained must be completed and returned to the St. Croix County Zoaiag O'cc witl`4 3'0
days of the three Y ear expiration date.
SmNATURf of APPL.ICA T DATE
OWNER CERITFICATION
I (we certify that all statements on this form are true to the best of my (our) kriowledge. I (we) am (arc) the owner(s) of
the property described above, by virtue of a warranty decd recorded in Register of Deeds Of:ice.
_z r1 a
A T PP IC 4 l.rT 1
St�1�.r`i r f:.. ull.:liY a DA
*•"••* 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 certitied survey map if reference is made in the warranty deed
,J 1912? 157
r=. 4S 1 998
STATE BAR OF WISCONSIN FORM 2 - 2000 KATHLEEN H. WALSH
WARRANTY DEED REGISTER OF DEEDS
Document Number ST. CROIX Co., YI
This Deed, made between Gladys Pederson, a single person RECEIVED FOR RECORD
86 -18 -2002 8:30 All
- - WARRANTY DEED
Grantor, and David D. Juen and Kristin L. Juen, husband and wife EXEMPT M
REC FEE: 11.00
-- TRANS FEE: 255.00
COPY FEE:
CERT COPY FEE:
Grantee. PAGES: 1
Grantor, for a valuable consideration, conveys and warrants to
Grantee the following described real estate in St. Croix .
County, State of Wisconsin (if more space is needed, please attach addendum:
Recording Area
Name and Return Address
T oZF - C1 .
028 -1026- 10-000
Parcel Identification Number (PIN)
This is homestead property.
(is) 01=W
A part of the SE 1/4 of NW 1/4 of Section 22, Township 28 North, Range 17 West, Town of Rush River, St. Croix County,
Wisconsin, and more particularly described as follows: Commencing at the N 1/4 corner of said Section 22; thence
S00 "E along the N-S 114 line 1402.72 feet to an iron rerod being the Point of Beginning; thence S00O10'29 "E along
said quarter line 1219.00 feet to an iron rerod on the E -W 1/4 line; thence S90 "W along said quarer line Q15,41 feet
to an iron rerod; thence N00 "W along the West line of the SE 114 of NW 114 1219.00 feet to an iron rerod; thence
N8SP59'58 "E 1307.87 feet to the Point of Beginning.
Together with an access easement described as follows: Commencing at the N 1/4 corner of Section 22, Town 11 28 North,
Range 17 West, Town at Rush River, St. Croix County, Wisconsin; thence S00 "E feet; thence S8� 54'46 "W
16.50 feet to the Point of Beginning being the centerline of 33 foot easement; thence $24 48'46 "W 1509.00 feet and there
concluding said easement.
Exceptions to warranties:
Easements and restrictions of record
4 fi� A` p
Dated this I� day of 5 V IV V 2002
r + Gladys Peder n
r
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF WISCONSIN )
) ss.
St C roix County )
authenticated this day of _ , Personally came before me this n , � .n day of
a , 2002 the above named
Gladys Pederson
r
TITLE: MEMBER STATE BAR OF WISCONSIN - --
(If not, tom wn to be the per ) who executed the foregoing
authorized by § 706.06, Wis. Stats.) i ac n d same
THIS INSTRUMENT WAS DRAFTED BY + , _
Thomas A. McCormack _ Notary Publi State of Wisconsin
Baldwin, WI 54002 My Co mission � J
nis (If not, state expiration date:
(Signatures may he authenticated or acknowledged. Both are not necessary.) - 12 - - ) _1 �� ) .. ')
r Names of persons signing in any capacity must be typed or printed below their signature.
STATE BAR OF WISCONSIN T�{r��n�r••• I „, "(UftU3f
WARRANTY DEED FORM No. 2 - 2000 INFO -PR17 (8cibo 5.ffi21 www.infoproforms.com
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<
10
Pam Quinn
From: Rod Eslinger
Sent: Monday, October 28, 2002 4:07 PM
To: Mary Jenkins; @Zoning Department
Subject: RE: David Juen road
I have had several discussions regarding this site with DNR officials for possible
violations of the County's shoreland /wetland ordinance and whether or not we need to
be involved. The wetland may not fall under our jurisdictional authority. Paul
Nadorski, warden, is handling the review for this site the DNR. I will keep you posted.
Rod Eslinger
Zoning Specialist
St. Croix County Zoning
1101 Carmichael Road
Hudson, WI 54016
phone 715 - 386 -4680
fax 715 - 386 -4686
rode @ co.saint- croix.wi.us < mailto :rode(a)co.saint- croix.wi.us>
- - - -- Original Message---- -
From: Mary ]enkins
Sent: Monday, October 28, 2002 2:35 PM
To: @Zoning Department
Subject: David Juen road
I had a call from Heather Landin today voicing concerns about a road that David Juen is constructing on his property
(the former Gladys Peterson property in Section 22, Town of Rush River. She says she has called before. She says
that the road is at least % mile long, that he has filled a wetland, and is ditching, filling and channeling water onto her
property. Has anyone been informed of this? And have we looked at it? She talked long enough so the message
ended before she left her number, but I'm sure she will call again.
Mary J. Jenkins
Assistant Zoning Administrator
1101 Carmichael Road
Hudson, WI 54016
Phone: 715.386.4680
Fax: 715.386.4686
mail to: marvii _co.saint- croix.wi.us
1
Pam Quinn
From: Mary Jenkins
Sent: Monday, October 28, 2002 2:35 PM
To: @Zoning Department
Subject: David Juen road
I had a call from Heather Landin today voicing concerns about a road that David Juen is constructing on his property (the
former Gladys Peterson property in Section 22, Town of Rush River. She says she has called before. She says that the
road is at least %s mile long, that he has filled a wetland, and is ditching, filling and channeling water onto her property.
Has anyone been informed of this? And have we looked at it? She talked long enough so the message ended before she
left her number, but I'm sure she will call again.
Mary J. Jenkins
Assistant Zoning Administrator
1101 Carmichael Road
Hudson, WI 54016
Phone: 715.386.4680
Fax: 715.386.4686
mail to: maryij(c7co.saint- croix.wi.us
1