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026-1142-47-000
Wisconsin �epartmr of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and building Division INSPECTION REPORT 10 Sanitary Permit No: 430213 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: Miller, Sam I Richmond Township 026- 1142 -47 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: 16-Z) lob T l " ,�i o� ' NE cotr 25.30.18.1031 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Sep - 1 Benchmark �B �� 1 113.3 Dosing � . � Alt. BM Aeration Bldg. Sewer Holding StiHt Inlet TANK SETBACK INFORMATION SUHt outlet 6.s�. t°6 43 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet ( �o Septic ' / a t ! Dt Bottom 10.7 Dosing .s. S.D ��! Header /Man. d r `00 Aeration J Dist. Pipe d S� 1 T � ll, O t Holding Bot. System A) r - PUMP /SIPHON INFORMATION Fin l �� C 14 , Manufacturer ff 114-- Demand St GPM ) l3. 2 •YY t'tD .q s Model Number 4 X TDH Lift Friction Loss System Head f TDH Ft �•(00 (A - IS -•1p� Forcemain Leng 4,_ % Dia. a Dist. to Well SOIL ABSORPTION SYSTEM Width Length No. Of4mmahe6 PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth IMENSIONS 5 O I �J SETBACK SYSTEM TO P/L l BLDG IWELL LAKE /STREAM LE HIND Manufacturer: INFORMATION CH BI OR Type Of SSyyslteem- Z4, f NIT Model Nu DISTRIBUTION SYSTEM � -fJL A- -ore Header /Manifold ? istribution x Hole Size x Hole Spacing Vent to Air Intake i e s `) Length Dia Length ��" Dia ' r� Spacing �•� , 1p rl 2 •S3 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 j Yes [ No Yes i No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:/ /O, Inspection #2• Location: 1357 141st Street NeyrRichmond, WI 54017 (SE 1/4 NW 1/4 25 T30N R18W) Red Pine Corner Lot 47 Parc I XQ60.1 po Oxx (1.) Alt BM Description = Or sT ( J ��k (p •Z = b to ' (7 K �i' 6 0` C 1 2. Bldg sewer length - r f1 � t/itCVww - amount of cover 3 Plan revision Required ?' Yes No T r3! l Use other side for additional information.'± Q�f CJ4 lis - Cert. No. f - Insepctor's Signature �f53 SBD -6710 (R.3/97) �� /J �_� 1 +K"��YG�C/ 'A f � v ' Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 2 jF_ cm CK- *isc Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) De artment of Commerce (608) 266 -3151 �3p2(3 Sanitary Permit Application state Plaan / D. Number Adm. In accord with Comm 83.2 1, Wis. Ad Code,-personal information you provide _ / `, 3 = may be used for secondary purposes Privacy Law, s15.04(lxm) Project Address (if different than mailing address) 1. Application Information - Please Print All Information o d�,.ro I Property Owner's Name Parcel # Lot N Block p 5 14/ I /K 1 r (( 4 f Property Owner's Mailing Address Property LocaAti /o. / 10 ' Z_ 5 � %., , y w ' /., Section City, State Zip Code Phone Number ( 140 � � T c irc l e E 11. Type of Building (check all that apply) �1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number ❑ Public/Commercial - Descbellse . l p ' El Owned - Describe U 6%ntpv V- e 1 0 7 , Z O ❑City_ ❑Village Township of IL� AV ✓ S' o v 4 £ L Onto G ' S hva 111. Type of Permit: (Ch ck only one box on line A. Complete line B If applicable) A. 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 I.V. Type of POWTS System: Check all that appl ❑ 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 ❑ Leachin mber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: -2 &q d E - / A - I soo F/ I- 7',reL Design Flow (gpd) Design Soil Application Rate (gpdsf) Dispersal Area Required (s8 Dispersal Area Proposed (so System Elevation � - `L/sv I Al S v 1 V1. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass Ncw Fxisting Tanks Tanks Septic or Holding Tank Aerobic Trcaimcor Unit Dosing Chambcr Vil. Responsibility Statement- 1, the undersigned, assume responsibility for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number Zz Sa 3 Plumber's Address (Street, City, State, Zip Code) o76 1 ,( 0 . A vL w Sqo( VIM County/ e artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Iss ' g Agent Signatur No Sianrps) Surcharge Fee) ❑ Owner Given Reason for Denial 35 — . 12. DL Conditions of Approval/Reasons for DIsapproval n Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in lice SBD -6398 (R. 01/03) . • l � r 0 SOLI e ✓aA Leo �' prop. sfsi�t'e Seale: Zoe, 47, Pla OP Qc A car'n ¢rl - o4 0 0 r Proposed 4("su4. , /o P. ✓,C- y 8 btuAdinr/ Sewt� `� Proposed 3 bedrav►„ v o wail — y re o .e Proposad 1, o0o aR � Q ✓.e. e{�' /K C•+ t Ire � j v w: ese can e re-�e wL,P-7so -MR ' 63 Nu O u.»�o Rican bt/; 1 1 � 1 v Propose -d rnou.nd ak 17 -XI 45 1 W' X 416. B.nc.: Top o f ele.ets�L �a�s�i., Ede%= ro7.i0' J. 8 °�9 Safety and Buildings ' 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 *isconsin www.commerce.state.wi.us /sb Department of Commerce www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary July 24, 2003 CUST ID No.225036 ATTN.• POWTS Inspector MICHAEL P MC DONELL ZONING OFFICE MILLER CONSTRUCTION ST CROIX COUNTY SPIA 1070 HUNTER RIDGE RD 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/24/2005 Identification Numbers Transaction ID No. 887963 SITE• Site ID No. 662271 Sam Miller Please refer to both identification numbers, 141st Street above, in all correspondence with the agency. Town of Richmond St Croix County SE1 /4, NW1 /4, S25, T30N, R18W Subdivision: Red Pine Corner — lot 47 FOR: Description: Proposed Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 912684 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: • This system is to be constructed and located in accordance with the enclosed approved plans, the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD- 10691 -P (N.01 /O1) and the "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) ". • Limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • 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 Sec. 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. IL A I I a Ir MICHAEL P MC DONELL Page 2 7/24/03 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(1). • 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. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • 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. 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, Fee Required $ 175.00 Fee Received $ 175.00 Gerard M. Swim Balance Due $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm jswim @commerce.state.wi.us WiSMART,,.� °d: 7633'' cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Sam Miller 3 bedroom residential mound system Owner's Name: Sam Miller Owner's Address: P.O. Box 121 Hudson, WI 54016 Pcl. Add.: 1357 141st Street Legal Description: SE1 /4NW1 /4, Sec. 25, T.30N., R.18W. Township: Richmond County: St. Croix Subdivision Name: Red Pine Comer Lot Number: 47 Block Number: na Parcel I.D. Number: 026 - 1142 -47 -000 Plan Transaction No.: Page 1 Index and title RECEIVED Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank JUL - 9 ZD03 Page 5 System maintenance specifications Page 6 Management and contingency plan SAFETY & BLDGS DIV Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Soil Evaluation Report Designer: Mike Mc Donell License Number: 225036 Date: 06/12/03 Phone Number: 715 - 386 -8692 Signature: ` �a,.P Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Version 3.0 (03/01/01) -,,: t, -1 - " Pagel of 9 1. t F IA FIHNI a DIVISIUN OF SAFETY A bUiLbij, v SEE CORRESPONDENCE Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 8344 -3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of - 36 inches. 450.00 Design Flow (gpd) 6.00 Site Slope ( %) 107.20 Contour Line Elevation (ft) 48.00 Depth to Limiting Factor (in) 0.40 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 90.001 Dispersal Cell Length Along Contour (ft) = 5.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /ft 1 I Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (c or e) c Center or End Manifold 2.50 Lateral Spacing (ft) If N above, enter the elevation (ft) 4 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 2.50 Estimated Orifice Spacing (ft) = 6.25 ft /orifice 2.00 Forcemain Diameter (in) 35.00 Forcemain Length (ft) Does the forcemain drain back? Y 101.50 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 5.71 Forcemain Drainback (gal) 5.70 Vertical Lift (ft) 81.25 5x Void Volume (gal) 0.66 Friction Loss (ft) 86.96 Minimum Dose Volume (gal) 12.86 Total Dynamic Head (ft) 29.66 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 x 1.50 x x 1.25 x 2.00 1.50 x x 3.00 2.00 x 3.00 x Gallons /Inch Calculator (optional) Treatment Tank Information 760.50 Total Tank Capacity (gal) 1000.001 Septic Tank Capacity (gal) 1 37.50 Total Working Liquid Depth (in) Wies Concrete (Manufacturer 20.28 gal /in (enter result in cell B49) Dose Tank Information Effluent Filter Information 760.501 Dose Tank Capacity (gal) lZabel Filter Manufacturer 20.281 Dose Tank Volume (gal /in) A100 Filter Model Number Wieser Concrete Manufacturer Project: Sam Miller 3 bedroom residential mound system Page 2 of 9 Mound Plan View :� J 1 /1 0 B :. ' . • Observation Pipe 3 _ j Ir w ) B . . . ... .... — ��-7 I i - • L Mound Component Dimensions A 5.00 ft E 9.60 in H 1.00 ft K 7.33 ft B 90.00 ft F 9.50 in I 7.65 ft L 104.65 ft D 6.00in G 0.50ft J 4.56ft w 17.21 ft 450.00 (ft Dispersal Cell Area 1138.72 (ft Basal Area Available 5.00 (gpd /ft) Linear Loading Rate 9.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 109.49 (ft) ► I ; : : 108.20 (ft) L Dispersal C F Lateral 107.70 (ft) Invert Dispersal Cell Elevation E D xw � Al x 107.20 (ft) Contour Elevation 6.0 % Site Slope Geotextile Fabric Cover Shading Key '� �. T Dispersal Cell See lateral details on Q S Topsoil Cap c 1.5 ft •ti• . ;; }.�:; },; Page 4 for number, ••�:;•: © • { {f, Subsoil Cap 1 e ;� Vie'' size, and spacing of 0 ASTM C33 Sand •''• : : -•''• F laterals. Laterals are 0.5 ft Typical Lateral . Tilled Layer � m �..•...• .• . '.� ' •'�'• equally spaced from ti., .ti ' '� '''�''''' ° ~' °''•''• s • the distribution cell's Q5 �•:•:. Aggregate a c � . .....: .::: ..:: ..�: �---- A centerline in the distribution cell (AxB). Project: Sam Miller 3 bedroom residential mound system Page 3 of 9 Center Connection Lateral Layout Daigram Force main connection Via tee or cross to manifold at any point. Laterals are identical I P i= Turn -up wtball valve or IE X �IEx12 I x12 +1 Laterals & force main of PVC Sch 40 cleanoutplug per COMM Table 84.30.5 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 44.28 ft Orifices per Lateral 18 Lateral Spacing (S) 2.50 ft Orifice Density 6.25 ft /orifice Lateral Flow Rate 7.41 gpm Manifold Length 2.50 ft System Flow Rate 29.66 gpm Manifold Diameter 1.50 in Total Dynamic Head 12.86 ft Forcemain Velocity 3.03 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and -� Comm 16.28 WAC Disconnect 4 in. min. Tank component is properly vented r Attamate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. Cap acityl 760.50 Gallons Volume 20.28 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 19.01 385.44 C B 2.00 40.56 Pump off elevation (ft) C 4.49 91.14 102.50 D 12.00 243.36 D Total 1 37.501 760.50 il Dose tank elevation (ft) 3" Bedding under tank. 101.50 Alarm Manuafacturer I LevelArm Alarm Model Number I DLV Pump Manufacturer JZoeller Pump Model Number 198 Pump Must Deliver I 29.66 gpm at 1 12.86 1 ft TDH Project: Sam Miller 3 bedroom residential mound system Page 4 of 9 i Mound System Maintenance and Operation Specifications Service Provider's Name Jim Thompson #30021 Phone 715 - 248 -7767 POWTS Regulator's Name St. Croix County Zoning Dept. Phone 715 - 386 -4680 system Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1000 gal Maximum TSS 150 mg /L Soil Absorption Component Size 450 ft' Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once every 3 years Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished •������������• •�������������• Grade \ 6 -8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution .......... ......... Lateral �► Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Sam Miller 3 bedroom residential mounds stem Pa e 5 of 9 Project: Sa M m y 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the finer when removed from its enclosure. If the filter is equipped with an alarm, the fitter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent fitter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg /L BOD 30 mg/L TSS, 10 mg/L FOG, and 10 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed R should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Sam Miller 3 bedroom residential mound system Page 6 of 9 HEAD CAPACITY CURVE EFFLUENT M ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ NONE..... .. ■NOME■■■■ ��a����■��� .. NONE mom 0 00 :' \ \ ■ \\ \NOON■■ . , ®mo ■ \f► \1\ \NOON . �D► m o o mom mm m ►` ■ \ ■ \1\ ■ \MM ■■�mm \ ■ ■I■ \\ \■ 1 4 I■■\ \ ■ ® ®■■� ®gym No Oak% ON ■■■ ■ \ \I MEN MEN - . NO ■■► ,, i \ ■► ME ►\ \NOON _ - MEN EMMENEME ME HMO ■■ , ■■o� ■► ����� \2 \� ■► ® ® ®�® ®ate® INE ■ WIN ■� \�� ■ ■ ■ ■ ■ ■ ■ ■ ■ ■■ Elm.- No MEM► 10■ ■ ■ ■ ■ ■ ■ ■ ■■ �� ■ ■ \simm hilm \►, ■ ■ ■ ■ ■ ■ ■■ �� \ ■ ■w\■a 4NOON ■ ■■ MENEM an ►��� \a \�► \NOON■ l■ ■ �► \OME■ ■ ■ ■ ■ ■■■ 1■ ■■■ ■HOME ■ so,� edallia �io.� P ;£ prop. st`ri,fe Lot 117, P ¢ n o 0 0 AsSU" cd a eu l Proposed K'su4, s�o P✓, e, y Proposed 3bedroo.n btelb;ngSewer t.awl -- may res idenc ° 0 P�oPos < o � P ropwl- . t, o0o aR $.Z S.T. -! AaLe! R -goo QFFlc�cnE. �'� 1 Es.r t � s.T. M . 3o3s/ t t 1 W. ese r• can cr2�e 1 ■ wc,P�so -MR �63 2' suF. y�o P ✓.e. t ! � Fo r ce PKI:Vil Propostdntow+d a.E, 17AI X' 1 6164S' (4 "5 90 ' d ;s Ce //. friar N d•'S6 ;6c 14 w `Orr {.'ceS *aced ctE.z.S3; AIE. B.nc.: T"op �f Wiscc' Department of commerce SOIL EVALUATION REPORT Page 1 _ of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St. Croix Attach complete site plan on paper not less than 8 1/2 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 ag";— and location and distance to nearest road. pending Please nn� Wi_i46rmatlon:�, Reviewed by Date Personal information you provide m be self for secor ary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner `' j (�It,!► Property Location Oakwood Land De ve l t t Govt. Lot SE 1/4 NW 1/4 S 25 T 30 N R 18 R(or) W Property Owner s ^ f '� 7�!(�' Lot # Block # Subd. Name or CSM# Owner's Mailing Addre 1611 HY. #10 NE. _i� y i 47 na Red Pine Cormer City State \Zip_Rode 0bQp0jumber / ❑ City ❑ Village ® Town Nearest Road 140th. ST. Spring Lake Plark 5 -49 Richmond [ New Construction Use: CR ResidenllaL Number =a"bdems Code derived design flow rate hOO GPD [I Replacement 0 Public or commerr�, a : Parent material glacial drift Flood Plain elevation If applicable na ft. General comments and recommendations: mound @ el. 107.70 + based on contour 1 ine of el. 107.20' ❑ Boring Boring # 1 07.90 ft. Depth to limiting factor 4 In. pit Ground surface elev. P g —�--- Soil lication Rate 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 1 cs 2f .5 .8 2 -19 75.yr4/4 none sicl 2msbk mfr qw if .4 6 3 9 -54 7.5 4/4 none sl 2csbk mfr 4 4 -78 10 6 6 c2p 7 5 5 8 777= I .. ... a El Boring Boring # © pit Ground surface elev. 107.90 ff. Depth to limiting factor 63 i n. Soil Application Rate 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 1 0 -9 10yr3/3 none L 2msbk mfr cs 2f .5 .8 2 9 -22 7.5ry4/4 none sicl 2msbk mfr 9W if .4 .6 3 22 -48 7.5yr4/4 none sl 2msbk mfr na .5 .9 4 48 -63 75 4 4 non na .4 .6 5 63 -85 10yr7/4 c2p 7.5yr5/8 lime tone residuum na na nip n ip Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L uent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number Gar L. Steel 02298 Address at valuaGo Conducted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 8 -3 -2001 715 - 246 -6200 f Property Owner Oakwood Land De Parcel ID # pwdi.ng Page 2 of 3 Boring # ❑ Boring 3 ® pit Ground surface elev. 1 05. 70 ft Depth to limiting factor 48 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 1 0 -12 10yr3/3 none L 2msbk 2f .5 .8 2 12 -25 10yr4 /4 none sic if 3 25 -48 7.Syr4/4 none sl if .5 .9 4 48 -68 7.5yr4/4 c2d 7.5ry5/6 sl 2csbk mfr Clw na .5 .9 5 68 -80 10yr7/4 c2p 75. 5/8 limEstone residiium na na I nn nn I F] Bonng # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtfP 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 GPD/ff in. Munsell Qu. Sz- Cont. Color Gr. Sz. Sh. T01 'Eff#2 Effluent #1 = BOD > 30 5 220 mg/- and TSS >30:5 150 mg/l. ' Effluent #2 = BOD, < 30 mg& 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 altemate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. S8D4330 (R.N00) STEEL'S SOIL SERVICE 1554 200th Ave. Gary L. Steel Oakwood Land �v. New Richmond, WI 54017 CSTM2298 SEINWJ S25- T30N -R18W MPRSW -3254 town of Richmond. (715) 246 -6200 lot #47 -REd Pine Corner This soil. evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shorn as pensanent lot lines were not established at the time the test was conducted. N 1 =40' BM.= top of NE lot stake @ el. 100.00' alt. BM. =base of elec.-trans. @ el. 107.10 o' ow to' Gary L. Steel 8 -3 -2001 PIAIE e 7 so • So, e ✓a/lia fi'o.-? Lot X17, Iola t o jo3.S Qt cl A Ca-rnee en o o of A$5L4Med el-ea- Z iCYJ,t� t Proposed 4( `.sC,4 4 0 .4,1. C. b w/dIn Sew er Proposed 3bedreb, � o .a y �- 1 proposal 1 Wo 4 a,Z 5.7: - A" e 1 -too � ".4. s.r• M. 3035! �1 ` 1 f Gv,'esc r Can cre-E.e w..P - M /1 —� ' 63 Nu z' SuE. s�o R ✓.e. � 1 :a �I c Pro Past - d l'►tou.nd Q.;� 17.z/ (4 s'x9o•d;aPc'3a/(U/% Fic e(V) dJ'S6'%b /a Q IY�' yf!�4' 6 J w ' "o�. {, cQs SpoaCed a E X.53; — f11E. S.m.: T of ��e ✓. /0 7. /o � B °ry ' Wiso0r(sin Department of Commerce SOIL EVALUATION REPORT Page 1 _ of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St. Cr oix Attach complete site plan on paper not less than 8 1/2 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 a1rWro and location and distance to nearest road. pending Please tr 41t information..,, R iewed by Date Personal information you provide for secor ary purposes (Privacy Law, s. 15.04 (1) (m)). Au %. �Z A Property Owner ";� 1 Property Location Oakwood Lan Deve / t Govt. Lot SE 1/4 NW 1/4 s 25 T 30 N R 18 R (or) W Property Owner's Mailing Addre s; + , ! r ^ P ' 4 ?' Lot # Block # Subd. Name or CSM# 1611 HY. #10 NE. �; ST C4pa 47 na Red Pine Cormer City State \Zip Bode Bbvjw (umber ❑ City ❑ Village ® Town Nearest Road ��' Spring Lake k 8��Ay ( -0 � Richmond 140th. ST. [3 New Construction Use: ER Residertti NNniber pfked ' ms _�_ Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or comme'rcla - i escribe: Parent material glacial drift Flood Plain elevation if applicable na ft. General comments and recommendations: mound @ el. 107.70 +', based on contour 1 ine of el. 107.20' Boring a Boring # 107.90 ft. De g Pit Ground surface elev. Depth to limiting factor 54 in. � Soil lication 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 I - Eff#2 1 cs 2f .5 .8 2 -19 75.yr4/4 none sicl 2msbk mfr qw if .4 .6 3 9 -54 7.5yr4/4 none sl 2csbk mfr 4 4 -78 10 6 6 c21p 7 5 5 8 li — xiaaiduum na n;; nn —np Boring # Boring 107.90 ft. D e p th g 63 2 X❑ Pit Ground surface elev, p h to limitin factor � �tfi Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I - Eff #2 1 0 -9 10yr3/3 none L 2msbk mfr cs 2f .5 8 2 9 -22 7.5ry4/4 none sicl 2msbk mfr 9w if .4 .6 3 22 -48 7.5yr4/4 none sl 2msbk mfr qw na .5 .9 4 48 -63 75. 4 4 none na .4 .6 5 63 -85 10yr7/4 c2p 7.5yr5/8 lime tone residuum na na n n Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg /L Vuent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature . CST Number Gar L. Steel 02298 Address ate valuatio Conducted Telephone Number 1554 200th. Ave., New Richmond, WI. 54017 8 -3 -2001 715- 246 -6200 Property Owner Oakwood Land De v• Parcel ID # PE- , nding Page 2 of 3 Boring # ❑ Boring 3 ® pit Ground surface elev. 105.70 ft. Depth to limiting factor 48 in. Soil Application Rate 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 1 0 -12 10yr3/3 none L 2msbk mfr CU 2f .5 .8 2 12 -25 10yr4/4 none sic 1f 3 25 -48 7.5yr4/4 none sl 1f .5 .9 4 48 8 7.5yr4/4 c2d 7.5 sl 2csbk mfr Qw na .5 .9 5 68 -80 10yr7/4 c2p 75. 5/8 limEstone r na na. UP F-1 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/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring # F1 Boring 11 pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate 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 = BOD > 30:S 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD S 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.6100) I STEEL'S SOIL SERVICE Gary L. Steel teakwood Land Dev. 1554 200th Ave. CSTM2298 SE'NW' S25- T30N -R18w New Richmond, WI 54017 MPRSW -3254 town of Richmond. (715) 246 -6200 lot #47 -REd Pine Corner This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shaM as I I lot lines Were not established at the time the test vas conducted. N .-1 " =40' 'BM.= top of NE lot stake @ el. 100.00' ` m alt. BM. =base of elec. trans. @ e 0 .10 l 34 fr Ce�o Q 2 O `q to Gary L. Steel 8 -3 =2001 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATIO SYSTEM SPECIFICATIONS Owner 5 rn LL£ Septic Tank Capacity C)O0 a l ❑ NA Permit # 3f) Z( Septic Tank Manufacturer f S — ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 2.14 d / ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model _ /00 ❑ NA Number of Public Facility Units kNA Pump Tank Capacity 7S0 g al ❑ NA Estimated flow (average) L45 gal/day Pump Tank Manufacturer w JE I S E2 ❑ NA Design flow (peak), (Estimated x 1.5) y SD g al/day Pump Manufacturer Z O 1 t r ❑ NA Soil Application Rate q SU gal/day/ft' Pump Model �'(g ❑ NA Standard Influent /Effluent Quality Monthly average' Pretreatment Unit XNA Fats, Oil & Grease (FOG) 530 mg /L lf''� d v I t ❑ Peat Filter Biochemical Oxygen Demand (BO D,) 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ,Mound Fecal Coliform (geometric mean) 510' cfu /10Om1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA 'Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: , ❑ month(s) (Maximum 3 years) ❑ NA g year(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 3 5 ye ar(s)(s) (Maximum 3 years) El NA Clean effluent filter At least once every: ❑ m l p NA /, yea r(s) r(sl Inspect um um controls & alarm At least once ever ❑ mo nth ar(s) l NA ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) 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, Geptage 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 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. • ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address -' S (Verification required from Planning Department for new construction) City/State s n (t Parcel Identification Number LEGAL DESCRIPTION " p Property Location i/a, 4/., Sec. � . T 30 N -R /F—&) Town of Subdivision -� t"� r> i` i�L v . Lot # `f 7 Certified Survey Map # 7 3 / , Volume t°3 , .Page # 83 Warranty Deed # - ( '7 7 17 , Volume Z Z 1 , Page # -2- O S Spec house Wyes ❑ no Lot lines identifiable `� yes ❑ no SYSTEM MAINTENANCE / v 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal 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 of the year expga ' te. p / /,f S A 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 owners) of the p a by virtue of a warranty deed recorded in Register of Deeds Office. AP LICANT DATE «ss «ss Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.""" «s 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 Page y 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(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: • 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. / T ing tank 'PR 113 rr� �br2 /�/�1✓ CaN57RclCa t n 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 D N4F L L Name Phone ( t _ ( 5' Z 7 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name 157- C ( 0 20 1 1 Phone Phone " ] (S— 3W( 40 0 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. J 2210 P 205 71 7 STATE BAR OF WISCONSIN FORM 1 —1998 XATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD Document Number This Deed, made between Oakwood Land Development Inc., a 04/17/2003 03:10PN Limited Liability Companv Grantor, and Sam E. Miller, a single WARRANTY DEED p erson , Grantee. EXERT # Grantor, for a valuable consideration conveys to Grantee the following REC FEE: 11.00 described real estate in St. Croix County State of TRANS FEE: 508.50 Wisconsin (the "Property"): COPY FEE: CC FEE: PAGES: 1 Recording Area Name and Return Address Sam E. Mill 1 361 Ne ichmurfd, WI 54016 ' f A„, w r SNol�, 026 1142 48 000 Parcel Identification Number (PIN) This is homestead property. (is) (is not) Lot 12, Red Pine Comer and Lots 47, 48, 50 and 51, Red Pine Corner 1' Addition. Together with all appurtenant rights, title and interests. none Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances except Dated this 4 day of April 2003. (SEAL) (SEAL) I Oakwood Lan evelop t Inc. t (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Si; nwure(s) State of Wisconsin, WENDY 7VVATZINA } ss. authenticated this NC )TARY N� St. Croix County C ___ma o . • �i rj_ / Personally came before me this 4Zday of April 2003 the above named Gregory J. Peterson. as Vice President to me known to • be the person who exec 4(#d the foregoing TITLE: MEMBER STATE BAR OF WISCONSIN lost mentan acknowledge ne . (If not, authorized by §706.06, Wis. Slats) f� > THIS INSTRUMENT WAS DRAFTED BY Notary Public, Stat of Wisconsin Coldwell Banker Burnet 1301 Coulee Road My commission i pe anent. (If not, state expiration date: Hudson, WI 54016 } ) /v 1 3.31793 v ) (Signatures may be authenticated or acknowledged. Both are not necessary.) Names of persons sicining in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc. WARRANTY DEED FORM No. 1 —1998 Milwaukee, Wis. O W f, O�Z Ay�yA 0 t.l Owsi NAZ a � Q Z Q oo" y A�A2 0 '^ ) 0 ��npp yD X p C - A - 9 _ O M A 1ez Czc c� z o h o y 2 NZV1 -aD x o g�3oo f <�'^vZ 0 2 z 2 z •a' P UO C -n M O 3 Z C m92. n S Z i R _ Q ^^c rN A Z�nl.Aj Q NN-cZiom6 y n o m Z r V14 2 ZZZ ZZZ zZ ° DA 222 m A m + A m O zzzzzz zz � r / / zzzz zz zz viz / FF FF + F r+ + nm /� = 193.i�• 5'e 421 .24' l I �Q �O• �QQS \ C v v 7JZ_ 'r O � F IN co V Iro O r J tn ew9= a4r Cb �. \ oy 1 w 13, at g y.£tN' � S ?? 7j•IZ � �OJ• a <• � w r I r w �\ n ti n H 10 11 1 ( !! I I q T o � No 11 � j \ O Ob'O o s, S16 'so G 284 '91' r rn 20 31 o W 265.28, S02'34'37 "W 300.28' O Z w F n U _ N? C A L A N D S O F w — _ -- 0 W N E R .tr coe k iN�nsr� x 66'x5 t m ./il Z9S I i ON - PLA TTED LAP - - -- -- - - --- s POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner L£ Septic Tank Capacity 000 gal ❑ NA Permit # Septic Tank Manufacturer S ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 2 BE ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model ' q_/60 ❑ NA Number of Public Facility Units 0( NA Pump Tank Capacity 70 al ❑ NA Estimated flow (average) t45 gal/day Pump Tank Manufacturer W£ t S £/L ❑ NA Design flow (peak), (Estimated x 1.5) 50 g al/day Pump Manufacturer Z O ((@ r ❑ NA Soil Application Rate 'f sV gal/day/ft' Pump Model �'(Q ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L K Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ,(Mound Fecal Coliform (geometric mean) 510` cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency ❑ month(s) (Maximum 3 years) ❑ NA Inspect condition of tank(s) At least once every: RI y ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third 1 I of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 3 N year(s) Clean effluent filter At least once every: ❑ m ) ❑ NA /� year(s ) Inspect um ❑ month(s) p p pump controls & alarm At least once every: ❑ year(s) NA Ins ' ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) 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 dispoped 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 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. � e Page 2 of 2� 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 riot 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: ❑ 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. I" T alua ' a o ing tank b e tai le . ?fZ D4418 rrEIN f62- A/ig�✓ a"S"T72(IC - pN ❑ 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 E NjfL Z— Name Phone ( t _ ( 5' Z 7 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name ST. C k 4D l 1 4 d 2 Phone Phone /S— 3�(p_ q&p 910 This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.