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L Wisconsin Department of Commerce ' PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No. 463290 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: Glen Johnson Construction I Richmond, Town of CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: cs 1 27.30.18.13) TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic t Benchmark LJ , / 5 • zs l05 /cra ` Alt. BM ice. Jeti z•4 /aZ-B'S Aeration Bldg. Sewer Holding St/Ht Inlet 7.3(7 95 TANK SETBACK INFORMATION St/Ht Outlet 4 -7. - c5i TANK TO �P /L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic > / / o > Dt Bottom Dosing Header /Man. c�,C /Q JJ Aeration Dist. Pipe la• 9S• 6S Holding Bot. System 10 .$ c 1q . q dk_ PUMP /SIPHON INFORMATION Final Grade 5 7 r1 Manufacturer De and St Cover &Z M Z Model Number TDH Lift Friction Loss System TDH Ft Forcemain Leng Ia. Dist. to Well SOIL ABSORPTION SYSTEM / & BED/TRENCH Width j Length i No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 1 -z— �e� %-- '_ SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR P1 W Type Of System: ! UNIT Model Number: , 1 DISTRIBUTION SYSTEM (,,, 5�-- Jq 3 b Header /Manifold Distribution x Hole Size x Hole Sp cing V to Air ntake 410 Pipe(s) � K Lengt Dia Length \ Dia Spacin 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 �• �� . I � � 1 Bed/Trench Edges Topsoil Yes No es No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: /__ Location: 1256 138th Avenue New Richmond, WI 54017 (NE 1/4 NE 1/4 27 T30N�R18W) Lundys Preserve Lot 12 Parcel No: 27.30. ( x. 1.) Alt BM Description = "� ► C, L.6v��- S�s�,M- ! ' 5 g e - `a— a rc y �` ✓ ..-Q 2.) Bldg sewer length = 1 ��� •� / b �� - amount of cover = Plan revision Required? Yes )( ( y� z[�7�j Use other side for additional information. vo ` / Date InsepySignatu Cert No SBD -6710 (R.3/97) f - I Safety and Buildings Division - - '�Couniy -- 201 W. Washiltgtan Ave., P.0 Box 7162 .��Cy0 r Madison, n W S 7 - 7 - . 1 3 1 fscons /n � R E c E I rfi�gtary P mit Number (w be filled in by Co. } Department of Comm 1_ (bOB) 2fib - 31 1 1 L.d a 4(0 3 2 `70 TT Sanitary Permit Applieatia _ j Plan .D. Number In accord with Comm 83.21, Wis. Adm. Code, t �. _ personal i r n ' may he used for secondary purposes Privacy Larw, s )' ST. CROIi C U�flt Ad ress (if differ;nt than mailing address) 1. Application Information - Please Print All Information __.— ZQ1�J1i�1 1 CE PTOperty Na me i Pa el N Lot k Block 6 Property Owner's M ailing Address - I Propor Loi.%_6on - - -- 1 City, State Zip u.� id, section a? 7 i � SS' C oe Phone Number - - t - � - _- (Cir 1 II,Ty of Building (check all that apply) S � �; T N: R E El ? or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number J Public /Commercial -- Describe Uie y� S " I State Owned - Describe Use �_- city Elviliage,Township III. Type of Permit: (Check only one - b ox on line A. Complete line B it applicable) p ',l.(p /� (Z-( C A -i-- A -New System Replacement System ' Treamient/Holding Tank Replacement Only ❑ Other Moditication to Existing System ? B. ❑ Permit Renewal L Permit Revision _ �! Change of (❑ Permit Transfer to New List Previous Permit Number and Date Issued I Before )expiration 1 P umber Owner n" Tyllie of POWTS System; ( Check all tha apply) R � _(�S) I Y-tior. - Pressurized In- Ground C Mound } 24 in. of suitable soil Mound < 24 in, of suitab a soil l.J At -Grade ❑ Single Pass Sand Filter Constructed Wetland C Pressurized In- Ground i .i Holding Tank ❑ Peat Filter Ae chic Treatment Unit IJ Recirculating Sand Filter `) Recirculating Syntheti Me Filter Lea ching Cha C Drip Line D Gravew Pipe - I Other (explain) -_— - - V. D ispersal /Treatme Area I nformati on : Design Design '- - - -- Flow (gpd) Soil Application Rate sf) D is rsal Area (sf)�TDisper 1 Area Propo ed (sr) ystem Elovativa S,ge ed 7e a V - --� .. �c v VI. Tank Info Capacity iu Tota'. T - '\utrtbzC� ,vtanufacnrrer Prefab Gallons Gallons Site r 5tcel I k'i� bey Plastic of Units Concrete I Constructed I Glass New Existing !!!! Tanks Tanks Septic or Holding Tank i i aerobic Treatment Dosing Chamber VII. Responsibility Statemen 1, the undcrsigued, assume responsihiiity fur Uat of the POWT shown on the attached platys Plumber's Na me Print - ( ) Plumber's Si gnaturz MP fPRS Number Business Phone Number 1�a 7 Plu mber's Addre ss (Street, City, State, Zip Code) I V Ill. county/Department Use Onl I ApprovtrJf 1: D rive i Sanitary Permit Tree (includes Groundwater�T Date Issued Is ring gent Signatur (Na Stamps) Surcharge Fee) ? 13 ZCO n Reason for Denia .J 1X. Conditions o ppro ayReasoas`forXikapppo*4 j SYSTEM 0 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained i as per management plan provided by plumber. j 2. All setback requirements must be maintained j as per applicable code /ordinances. t Attach complete plain (to the County only) for the system on paper not less than 81,1 x 11 inches in size ,o�� •br+ -g = Top o s 3 a°16•� r 3 Q C PY A e, , J b✓y��/J�G� 14 1,2 i i _44- -(0 4 = - Tap '� s r- 3 J g I r . ' RECEIVE] 0 JUN 0 1 2004 Lundy's Preserve Comments: S7.CR0IXC0UNTY ZONING OFFICE The soils in this subdivision are quite variable and differ across the 80 acres. Some consist of a clean outwash sand, other consist of glacial tills. In certain areas, the medium sands have a very deep red color unlike I have seen in all of St. Croix county. The color does not indicate high ground water because the color is so consistent. If you go through the red sands then the sands turn off white/yellow but not those of a sand stone. In talking with Pam Quinn from zoning, she commented that there could be a different chemical reaction with a sands. I believe this is the case for the sands have a consistent size, and no mottles were found above or below the sands. Sometimes bands were present, but were very slight, and were mentioned to have the systems sized a little bigger in order to accommodate for any inconsistencies in the soil. Also it is worth mentioning that the intersections of lots 6,7,8, and 9 have a extremely poor soil present not suitable for a mound system. The surveyor and I discussed this condition, and the resulting tests were spaced as far away from this area as possible. All the soils tests were done to the best of my ability and I hold no liability for anomalies and other oddities that can be found on this site. Shaun Bird CSTM #226900 5/28/04 r Q Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code � County��' Attach complete site plan on paper not less than Date 8 1/2 x include, but not limited to: vertical and horizontal referen poin i Parcel I.D. percent slope, scale or dimensions, north arrow, an ion and is -ante to nearest road. Vt � _ Please print all in II . IN X004 Personal information you provide may be used for s p s (PF Tacy Law, s. 1 X04 (1 4 1 (m)). 1 I S Properly Ow Sl . �R01 f�rp}ZgNjlGocati l A 1 /4 �l4 S T N R E (o W Property Owner's Mailing Address Lgt # Block # Name or CSM# City State Zip code Phone Number ❑ City ❑ Village wn Nearest R New construction Use. Residential I Number of bedrooms Code derived design flow rate GPD ❑ Replacement ] Public or commercial - D scribe: -- - - - - -- -- -- Parent material f Q G � � Flood Plain elevation if applicable / - ft General commerft and recommendations: s 151 can - ring �( l Boring # � El pit Ground surface elev. t�' " ft. Depth to limiting factor L in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP i in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - 'Eff#1 'Eff#2 Z o3 /z_ S ; U h 11 01 Fq B oring # ❑ ring pit Ground surface ele�ii . , U ft. Depth to limiting factor `D in. cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence BouD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#2 a- z � An �-- r Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mglL 'Effluent #2 = BOD < 30 mg/L and TSS < 30 CST Name (Please Print) Signature CST Number 226900 Bird Plumbing, Inc. Shaun Bird Telephone Number Address Date Evaluation Conducted P 715 - 246 -45 1008 192nd Ave, New Richmond, WI 54017 y Property Owner Parcel ID # Page of 23-1 Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor J1- in• Sail A Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •Eff#1 °Ef#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. J 0-1 Z, 1 n V 31 S I a r rr C `gyp d 2 -3 u I A rs'J C I ms K 5 I s ) ►'� F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. lioilApplication 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 a Boring # ❑ Boring El pit Ground surface slay. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence. Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD > 30 1220 mglL and TSS >30 < 150 mgA_ ' Effluent #2 = BOD, < 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. saD -8330 Ut.M i a r Soil Test Plot Plan , Project Name Environmental Holding L.L.P. Sh i Address 706 19th St. S. Hudson Wi 54016 STM #226900 Lot 12 Subdivision Lundy's Preserve Date 5/24/04 N 1/2 NE 1/4S 27 T 30 N/R 1 8 W Township Richmond Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. —Top of Steel Fence Post 4 s# r System Elevation 95.6/95.4/94.8 *HRpSame as Benchmark Alternate Benchmar Top of Survey Iron @ 96.0' 219' Property Line 120' B. 25 t. B.M. J 8% Slope B- 98' 25' B -1 60' 25' 100' B-3 Property Line Please note: Soil test was done to satisfy county zoning requirement. Soil Scale is 1 „ = 40 , test may not be unless otherwise suitable for owners desired building noted location. 9 u i c k4 r " STANDARD CHAMBER Quick4 Standard Chamber (EFFECTIVE LENGTH) 1 2" 8� 11 one SIDE VIEW SECTION VIEW MultiPort End Cap 12" 34' SIDE VIEW TOP VIEW FRONT VIEW Cap M HIP6,dInd, Quic Standard ft Nomi nal pacific K Size (WxLXH) - X34 " 2" Size (W 34':x 16"x 12" Effective Length 48" invert Height 8" or 1.25" Invert Height 8" INFILTRATOR SYSTEMS, INC. STANDARD LIMITED WARRAN (aj TI)o structural Uite;jniy A F,.acr'. rhamber, end plate, wedge and mha =4s&0rF MatkilaClUrW by IF llthakv t Unils'1, when riStaillid slid Cp"led : r, a iechfold at c4ari alms alms soptic system tin instruchms, is watrant-id tcthoorigoal poictissel (hkludw"i aoatr.3 defecii naiero!s and V,311l,"71ri, to, cus year lain the date trial the per mit -1 isaut-J for 1 1-1 �e;Alc sy rcniai, I nW )-,) Url.'s, pro��o.d, howehowever, ,' it � opir pt net L% not rst4ultod by applicable iaw, the warranly penca will her i pon the dais that nstalialon of the sefAic, syste r F cun i i , )_064. Ti.) exeFei Y war anty i-ioidw must nolify loliltralor irt writing eT -is cKirpoam o ou Saybrook, (�:Fnnecii! vitnn f1rierl 05) d.y ol, 141 ."d l,ff9I,M,,, will supply Unds For Units detwinne,j !it ot,trajor 1,) be covered by this I. united w—wiy. ®R is I I oiill,.Aor� liability specitrary excludes the eost A rem�ai and oskali.t.- i,t the j ) lt,t-L!Mlfr.DVVAf AND FEMI MSINSU13PARAGFtAPH (al ARI. LriGLLISIVL 11 I_R(_ ARE N(? OI - IL It WARRANTIES 'AriTH RCSFEcr �0;1 A PARTICULAR Fli SYSTEMS INC t-;V � h", llaod wo"notil s1zI tie .ij it PFty the clamber Oyster or y other than slithlni— The W—Ay doss ncjt to loCiderual, ciotioque,ital, special or rdnIzt damages Intillral., shall nbl tXF ibe fro poi ralt its U lCt, Kla led ci.nagel, -.100ll-9 tQ of Envimirmnlal Onsite Wastmeter Utirfions ario p fls. l aora and rnalenals, overhead costs, or othGr losses of expenses 111-ned by One tickw or any third party Spadt ewArood ri 1-1111te'd V1311&'ity CU.arago are damage to the Units dues to orinary wear and lea ater4hoo, acriclent misuse, abljw it neglect of tile. Ulls, too Units being slitiected to veh.de traffic or ether '.Qri'ttions which are not permitted by 11% installation ostrurtions: la ti? to maintain the 6 Business Park Road • P.O. Box 768 ground - w so !oill: n the stailWlon inairl� material; the bawmeni of impropematerial; into the sySlar containing Tho Lints. failure of - Joils . the sabic system d1w to mprop., siting or improper szrig, excessive w.1— mprrg:Fer grease dislx31, or improper operation, or Old Saybrook, CT 06475 arry other event riot caused by Infiritur. This Urnitea Warranty shalt be void it the Ho falls to coil.ply w all of the twirr" set k"th in this L-miterl 860-577-7000 - FAX 860-577-7001 Warranty. F rir,ho,, " no event Shall Inlilitralor oo ws�ponsib* V tiny los or clan;.9e, 1. the HkJc ihrl J olary 1hrd 1:; llssrhotl flan or sl'ip- 1101 A.IsO sPlItY, the l;oltl W b- -r1s!- 1 - 1 ai�.Olda 800-221-4436 .411 up site cauli1hN15 l'i'n by state and lutist codes; all other appi.cable taws: and 1411tator� installaliuninstn.,cl nai Hoijo, The lL revaGan(s ine Stand— L—tecl Ww:ai offered by Inldnalor. A l imited ourro., A s tates aid c.o,,nlw. have J.11-4 w arranty lerjUrre- "eni" Any Tyui of Units shoutd contact Infiltalor'S Colpivalis Heack4uansT in Old Saybrook Connociz,,il. pm, 1,, s,,& mi,chase, to obtain a copy of the applicable wai end snood Careluit,, rftj that warranty price to the purchase of Units. U.S. Patents 4,759.661; 5.01 7,041; 5.156,488; 5,336,017; 5,401,116; 5,40 5,5 1,903; 5.716,163; 5,588,778; 5,839,844 Canadian Patents; 1,329,959:2,004,564 QlhW patents P6r"rUJ. InTilrator, FcI and Side Winder are registered trademarks of Infiltrator SysleqTr� Inc. ifl;,;tratar IS I ragjSjQjeo tracia hark in France. infiltrator Systerns Irlc. ReeirCLED PAPER is 6 registered trajonnaiK I Mexico. Contour, Contour Swivel Connection, MicticiLeaChing, PolyTuff. Snapt-ock, GharnborSoacer, PosiLmK QulokCut, 01�iGWOY 001 12WHP 0 I_ Proind :n Li S.A. [qGOULDS PUMPS Submersible Effluent Pump 11 :i 3871 EP05 APPLICATIONS • Fully submerged in high ■ EP05 impeller: Thermoplas- ■ Bearings: Upper and lower Sp ecifically des for the grade turbine oil for tic enclosed design for heavy duty ball bearing S p Y g lubrication and efficient improved performance. construction. following uses: heat transfer. ■ Casing and Base: Rugged • Effluent systems thermoplastic design provides AGENCY LISTING • Homes Available for automatic and superior strength and corrosion • Farms manual operation. Auto- resistance, Canadian standards Association • Heavy duty sump matic models include • Water transfer Mechanical Float Switch t Motor Housing: Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in "F" or "C ".) factory. strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic Goulds Pmps is 15 09001 L49618yed. FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. ' /a" maximum. ■ EPO4 Impeller: Thermoplas- 0 Power Cable' Severe duty • Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant. • Total heads: up to 31 feet pump out vanes for mechanical • Discharge size: 1 NPT, seal protection. • Mechanical seal: carbon - rotary/ceramic- stationary, BUNA -N eiastomers. • Temperature: 104 (40 continuous METERS FEET 140 (60 intermittent. 10 • Fasteners: 300 series stainless steel. 9 307 - ► s GPne • Capable of running — - * 15 FT dry without damage to s components. 0 7 Motor x _.._ 6 20 I, • EPO4 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, bulk in overload with s 0 15' automatic reset. a Epos • EP05 Single phase: 0.5 HP, 0 115 V, 60 Hz, 1550 RPM, 3 10 _._._ .__. ,.. _....._ built in overload with __ EPO4 automatic reset. z • Power cord: 10 foot 5 ` standard length, 16/3 SJTOW with three prong - grounding plug. Optional 20 0 0 0 10 20 30 40 50 GPM foot length, 16/3 SJTW with L L --.1- three p rong g rounding I 8 10 12 m' /h p g9 9pu9 o z a s (standard on EP05). CAPACITY Goulds Pumps a 2000 Goulds Pumps <& ITT Industries Effective February, 2000 � ��� jjjj 03871 SEPTI TANK E PUMP CHAXBZR CROSS SZ L — . T u` AN 4" CI VENT PIPE ' 12 ", Rik. `A OVE GRADE WEATHERPROOF ?!25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER � W1 PADLOCK S FINISHED GRADE ---- WARNING LABEL 7 w" CI RISER -- ��--- 4 " MIN. I Is" IN. 61, MAX. � NLET j 7 WATER TIGHT SEALS GAS- TIGHT PROVED A SEAL JOINTS WITH VEO — — AL14 APPROVED PIPE PPRO IAE V a ' ON 3 ONTO N'f0 SOL C i j 50LID SOIL T IT OIL PUMP OFF ELEV . FT. —�—+— OFF � RISER EX - --- -- PERMITTED ONLY D IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED, BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC 1 DOSE TANK MANUFACTURER: - 1 g ), ,ems r - NUMBER DOSES PER DAY : ___y..•,,,, TANK_ SIZES SEPTIC 1G�„ GAL. DOSE VOLUME INCLUDING GAL. DOSE a, ,._ GAL. FLOWBACK: j ALARM MANUFACTURER: _ CAPACITIES: A = -d. INCHES 2 y - GAL , MODEL NUMBER: AV GAL . SWITCH TYPE: = � INCHES = PUMP MANUFACTURER: G C = INCHES = GAL. MODEL NUMBER: SWITCH TYPE: ,.., D = INCHES = _SAL. REQUIRED DISCHARGE RATE_ GPM PUMP E ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . FEE + MINIMUM NETWORK SUPPLY PRESSURE •� —•---- FEET + FEET FORCEMAIN X -I, FT/100 TOTAL FRICTION •_• FEET WIDTH INTERNAL DIMENSIONS of PU MP TANK: . • � � ; DIAMETER LIQUID D� " .,&, /,se�e� SIGNED: ,,.�' LICENSE NUMBER: giUlEto DATE: � --- �� � '� �aa POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICAnONS Owner A it � Septic Tank Capacity a l ❑ NA Permit # 3 2 9❑ Septic Tank Manufacturer r't! s� 13 NA DESIGN PARAMETERS Effluent Filter Manufacturer 6 ❑ NA Number of Bedrooms O NA Effluent Filter Model ❑ NA Number of Public Facility knits NA Pump Tank Capacity Q a l ❑ NA Estimated flow (average) �j� at /da Pump Tank Manufacturer S e y ❑ NA Design flow (peak), (Estimated x 1.5) g al/day Pump Manufacturer 4 5 A ❑ NA Soil Application Rate al /da /ft2 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 ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Call(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 Inspect condition of tank(s) At least once every: 3 month ( s) (Maximum 3 years) ❑ NA aerial Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cellls) At least once every: 3 Wryearisf) m r(s) ) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: month {s) p NA years) Inspect pump, pump controls & alarm At least once every: r.- ❑ month {s) ❑ NA ❑ ear(s) Flush laterals and ressure test At least once eve ❑ month(s) ❑ NA p ry ❑ year(s) Other' At least once every: ❑ month(s) ❑ NA ❑ ear(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(a) 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. Page 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 andlor damage the dispersal 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; meet scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener bfine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shalt be taken to insure that the system is properly and safety abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • AN piping to tanks and pits shall be disconnected and the abandoned pipe openinge 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 fitted 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: I A suitable replacement was 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 shouid 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. 17 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 sit d site e tank C3 Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biornat 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 DIFFICUt.T' OR IMPOSSIBLE. ADDITIONAL COMMENTS _ POWTS INSTALLER POWTS MAINTAINER Name / A-t Name �S r ��r G( CL Phone . g+ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name ST. Clio /x I N Phone Phone 4,c r 3% This document was drafted in compliance with chapter Comm 83.22(2)(biiI l(dih(t) and 83.W1 1. (2) nit (3), W+iscons"Cirninistrative Code. I ST CROIX COUNTY SEPTIC 'TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �4 e_.Aj Mailing Address ,l'ee, 4 �LA �o i/ l ✓ Property Address) �- , , Verification regtrircd frona Planning Department for new construction) City /State _ Parcel Identification Number rlbltA', LE G AL D SCRIPTION Property Location W_ ' /., "A, Sec. Z7 — , %Z N•R Town of Subdivision X44/62 e— , Lot # /z Certified Survey Map # , Volume , Page # Warranty Deed , ' Volume d // , Page # - {d7 Spec house ryes ❑ no Lot lines identifiable Zyes ❑ 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 thr, septic tank every three years or sooner, if needed by a licensed pumper. what you put into the systcm can affect the function of the septic tank as n (rcatnicnt stage in the waste disposal system. The property owner agrees to sabmit to Sc Croix Zoning Department a certification form, signed by the owner and b� a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposaI systcm is in proper operating condition ancbor;2) aficr utspcclion and pumping (if necessary), the septic tank is less than 113 full of sludge Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standares set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Centfcat on stating (ha ur se tr systcm s been Iit;iinitilrCc1 1uust be �omplcicd and returned to the St. Croix County Zoning Office wiihen ±G days of ree car xpirat n date. 0 SIGNATURE 0 PLICANT DATE O WNER CER ?IFICATION I (we) cc tha II statements on tuts form are tnic to the best of my (our) knowledge, I (we) am (are) the owricr�s) of the pro desc ibe ab e, by vtrtuc of a warranty deed recorded in Register of Deeds Office, SIGNATURE 0 PPLICANT DATE Any information that is mis•rcprescr�cd 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 certt "ed survey map if reference is made in the warranty deed ' yt U 2611P 507 - 7 E, 01Z3z STATE BAR OF WISCONSIN FORM I - 2000 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX CO.. W I This Deed, made between Environmental Holding RECEIVED FOR RECORD Company, LLC 07/07/2004 01:20PH Grantor, WARRANTY DEED and Glen Johnson Construction - ;XE.NPI # REC FEE: 11.00 TRANS FEE: 969.60 Grantee. COPY FEE: Grantor, for a valuable consideration, conveys to Grantee the following CC FEE Y g PAGES: 1 described real estate in St. Croix County, State of Wiscon i (the "Property ") (if more space is needed, please attach addendum): Lots 12, 13, 16, 17, 18, 19, 22, 23, Lundy's Preserve, Town of Richmond Recording Area Name and Return Address Title One Premier Group 706 19th Street South Hudson, Wisconsin 54016 Partof 026 - 1078 -10 -000 Partof 026 - 1078 -30 -000 Parcel Identification Number (PIN) Together with all appurtenant rights, title and interests. This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Roadways, Easements, and Restrictions of Record. Date his 30th day of June 2004 * 4 --D Bi l Sherman * Jeff Warren Environmental Holding Company, LLC Envirionmental Holding Company, LLC * * AUTHENTICATI ACKNOWLEDGMENT -(PAY p�eri STATE OF WISCONSIN ) Signature(s) O C� ) ss. St. Croix County. ) authenticated this day o Personally came before me this _ 30th day of PALM June , 2004 the above named Bill Sherman and ar TITLE: MEMBER STATE BAR OF QII�I r :`r Jeff Warren (If not, It� to me known to be the person s who executed authorized by §706.06, Wis. Stats.) the foregoi g i ment d o ed th same. THIS INSTRUMENT WAS DRAFTED BY * Kay pilin Michael H. Forecki, Attorney Notary Pdl5lic, State of Wisconsin Eau Claire, Wisconsin My Commission is permanent. (If not, state expiration date: ( Signatures may be authenticated or acknowledged. Both are not necessary.) December 12 2004 . Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. I -2000 ttorney Michael H Forecki 3452 Oakwood Hills Pkwy Ste 1, Eau Claire WI 54701 -7928 Phone: (715) 835 -3029 Fax: (715) 8354112 Michael H. Forecki T4632009.ZFX Produced with ZipForm TM by RE FormsNet, LLC 18025 Fifteen Mile Road, Clinton Township, Michigan 48035, (800) 383-9805 01/13/2005 TKU 11:25 PAX 715 386 4687 S T ROIX :' REv OF DEEDS �Q O1 /OQ1 , •; s J; ,'. ��a.Tf TAB LOT 5 RA NUMB r; Ul ` V 'LOT 14 U3 u5 7%Tn M Fr. uo � e1 -1 LOT 11 r9I us 1.794 AM us 78.143 SQ. FT. ulo N ull 07 12 1 .- U12 dR U13 •.. LOT 1 o W X.255 SM FT W LOT 13 w cup cww 1.630 ACRES �►` � Numb 71. Sa FT J r — , _ H C Le.o.. �' cre 9BLO ... r c - - - - - -- C2 ce C3 ---- - - - - -- -- r C5 vi 20. C7 fi co t CID I db C11 ! . w C12 .. . ... ;� LOT 25 LOT 24 a zaee ADES Ca g+ a9,998 SO. FT 0 C14 LO 23 1. "W ACRES LOT 23 67.723 $Q. Ft. CIO I.C7 ACM &%ON Sa F< LBO. - 983.1 ale 129174' r �h�wl� 5�8s °3T02'Mi 2235.30' N1 /2 aF NE+ /# a , • y . s ���`✓i� Y C W17l. eAmAl'I._u np%mn. a9J23/2W4