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HomeMy WebLinkAbout026-1175-01-000 Wisconsin Depa tment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety,and Building Division INSPECTION REPORT Sanitary Permit No: 499281 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 Homes of Hudson, LLC Richmond, Town of 026- 1175 -01 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: - 1 1 1 -2 >1 e d1n z LST' 30.30.18.1401 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. Septic LJ � � F' / Benchmark ! y� 97.31, 9 $ Dosing Alt. BM q 750 D.. Ge -j a.,. Atepetien �.; Bldg. Se er //- Da b(� . 3 �o . % Pa 16 k [-' Holding St/Ht Inlet S I TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ! / A Dt Bottom 75 I✓ft Z a ' J4. zso �' 1 Dosin Header /Man. g • /1�A- 1 26 26 14' 6- +a. -,�- 4.7 90 Aeration Holding Bot. System el� I.3S $ , of PUMP /SIPHON INFORMATION Final Grade C: Y / -cy Manufacturer Demand St Cover GPM aj 6- S 90.411 Model Number A J 1 6-3 3� , T ., , '9 --31 TDH Lifj,., S _ I Friction Lo� Sys He` TDH Ft T f y Force main Length Dia. ft Dist. to Well �,q i , Q� ey► Z SOIL ABSORPTION SYSTEM BED /TRENCH Width I Length No. Of Tr PIT DIMENSIONS No. Of P its Inside Dia, Liquid Depth DIMENSIONS 3 Oq 3 )(C•LG"L I I--- -`\ SETBACK SYSTEM TO O P/L BLDG WELL LAKE /STREAM LEACHING. Manufacturer: ^ ` INFORMATION CHAMBER OR a„ Type Of System � • � f /� UNIT Model Number: O ejt. l DISTRIBUTION SYSTEM - Z I i - Z i +Z I Header /Manifold * � Distribution x Hole Size x Hole Spacing Vryto Air Intake J Pipes) ` '--N v Length )b Dia � Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over / Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center `� aG Bed /Trench Edges Topsoil �1 P No Yes No ✓ J � '1 COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / Inspection #2: Location: 1319 92nd Str et New Richmond, WI 54017 (SW 1/4 SW 1/4 30 T30N R Willow River East Lot 1 Parcel No: 30.30.18.1401 �_ 1.) Alt BM Description = � c6o,- �a : �S 6 d` 2.) Bldg sewer length = ZO / Y / = `'�� -� ��C� �'�a'l aK - amount of cover Al - Plan revision Required? Yes No !, V A$ ✓ l�J i Use other side for additional Information. _ Date InsepctfCS, tur Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division C 1 W. Washington Ave., ox Madis 62 cOns,n on, WI 53707 Sanitary Permit Number (to be tiled in by Co.) Department of Commerce (608) 266 -3151 c( c Z 8 Sanitary Permit Application state Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal informati may be used for secondary purposes Privacy Law, s 15.0 I xm) C E I V E Proj t Address (if di Brent than mailing address) I. Application Information - Please Print All Information JAN 1 7 2 n 7 40 / 9z S Pro Owner's Name Pace # Lot Block # �!%�'� /�� O L L ST. CROIX COUNT 7 o � (1 — Property Owner's Mailing Address Location n a , © X / / 0 ) %., 4 5 Ld /., Section City, 1 State Zip Code Phone Number 1 j 1 / "� cJ C1 ® ,0 � (a 7/S = '� ! T �� N; R / EorWe)( �7�( H. Type of Building (check all that apply) r � Subdivision Name CSM Number ❑ 1 or 2 Family Dwelling - Number of Bedrooms T Tm � ✓� P ❑ Public/Commercial - Describe Use /� f 1/ y u) ` T ❑ State Owned - Describe Use �O 3 QU i S ��(� CO �NU sr Pp' ❑City_ ❑Village�T ownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) C)-Z( - n Q6 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 V. T POWTS System: Check all that apply) 7 ` �L,,o 17 7 on - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil El Mound < 24 in. of suitable soil . , El At-Grade El Single Pass Sand Filter El Constructed Welland XPr n- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chwkber 13 Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: ' ; 'T' r r 2 +► • ectk EN'V s Design Flow (gpd) Design Soil Application Rat g sf) Dispersal Area Required (s0 Dispersal Area Proposed (SO S stem Eleyation -ddf - U P 9/ VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units `Ito/ � SZS� C Constructed Glass New Existing / Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber X S© VII. Responsibility Statement- I, 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 `Do✓Ia -(r ! 22 1 J` ^ 0 3� �� 2F Plumber's Address (Street, City, State, Zi Code) #0 r f �S I y�/ VIII. County /De artment Use Onl Approved ❑ Di prov Sanitary Permit Fee (includes Groundwater Dat Issu Issuing nt Signa re o S p Surcharge Fee) ff L / GQ 11i 1 71 b ❑ O tven Reason enial -] J IX. Conditions of Approval/Reasons for Disapproval 4 1 0 ra ); sTo! ism QNVW 1. Sep* tank oftM t Mter and C4- ► 0 /��• dispersal cell must all be services / mairdaibed r/ as per management plan provided by plumber. l `�d vtn e 2 2. AN sefback requirements must be maintained as per applicable code I ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) , Z r i #2�S�3G ._ . . — '� TbP "pv� J 4 y� 1 Q t ��pOry' [�t1� � � � /fLa � � TC✓HiP i' f b f� Cf L� (M � 7�oo dower � I t i 1 U� N se 1 /� — ld Y 14 �ZZSo3G 3 f u� E Q m ISO c:, T K� v 7R IF/U c f' b Lf B M'1 T af 3f8 v3 3 3 ' (G 3 " �O �Q C ,.y. e✓s �m -bc.r EI_ 9 3 r �� y S � " �' ` ` of ec r aC a v S .tom' tn-t: c p g 7rOD leWmr Q i (^ /v S� 2058 Wisconsin Department of Comm SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcell.D. 026 - 1175 -01-0 Please print all information. Revie By Dat Personal inb nation you ProMO may be .04 (1) (m)). 1Z Z d Property Owner 4roperty Location Miller Homes Of Hudson, LLC vt. Lot SW 1 /4 SW19 30 T 30 NR 18 W Property Owner's Mailing Address # Block # Sub d. Name or CSM# P.O. Box 10 1 Willow River East City State Z Co Pon um r I City J Village 0 Town Nearest Road Hudson WI Richmond 92Nd Street New Construction Use: a Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement I Public or commercial - Describe: Parent material Glacial Drift Flood plain elevation, if applicable na General comments and recommendations: Site suitable for conventional gispersal cel at 0.5 god loading rate Lower trench elev. to be 8 7.W, center trech = 88.Qd,1 upper trench a Boring # I Boring 1 Pit Ground Surface elev. 94.87 ft. Depth to limiting factor >1 25" in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G in. Munsed Qu, Sz. Cont. Color Gr. Sz. Sh. -Eff#1 - Eff#2 1 0-8 10yr3/2 none sit 2fsbk mvfr as 21fm,1c 0.6 1.0 2 8 -18 10yr4/3 none sil 1 msbk mfr cw 2f,1 me 0.4 0.6 3 18-32 10yr5/4 none sit 2msbk mfr cw 1fm 0.6 0.8 4 32 -39 10yr514 c2d 7.5yr5/8 sil 2msbk mfr aw 1fm 0.6 0.8 5 39-60 10yr5/6 none g Is 0 sg dl gs - 0.5 1.0 8 60 -125 10yr4/6 none 1b ` 1 s 0 sg dl - - 0.7 1.6 ILH Comm. 85.30(3)(9)2 applied to discount rdox. eatui es reported in H#4. contains 1/8" - " ban s o 10yr4/4 Its at - B "intervals. Loading rate reduced to reflect permeability restriction associated with banding. I 1 [Boring # 1 Boring V1 ft >1 18" in. Soil Applicaton Rate Pit Ground Surface elev. 90.55 . Depth to limiting factor Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots D in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. -E f(#1 - E 1 0-11 10yr4/3 none sl 2%bk mvfr as 2fm,1c 0.6 1.0 2 11 -17 10yr3/2 none sit 1 msbk mfr cw 2f,1 me 0.4 0.6 3 17 -33 10yr3/4 none Is 0 sg ml gs 1fm 0.7 1.6 4 33-48 10yr4/6 none gr s 0 sg ml gw - 0.7 1.6 5 48 -118 10yr5/6 none s 0 sg dt - - 01 1.6 Effluent #1 = BOD 5 > 30 < 220 mg/L and S >30 < 1 mglt, uent #2 = B09 < 3O mg /L and TSS s.30 mg/L CST Name (Please Print) Vnatur CST Number James K. Thompson -+ -- 3602 Address A.C.E. Soil ii, Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 12/13/2006 715 -248 -7767 Property Owner Miller Homes Of Hudson LLC Parcel ID # 026 - 1175 -01 -000 Page 2 of 3 Boring # I Boring 0 Pit Ground Surface elev. 92,36 ft. Depth to limiting factor >123" in. Sod Appl Rate Horizon Depth Dominant Color Redox Description Texture Stnxture Consistence Boundary Roots GPDfie in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 TOR 1 0-17 10yr3/3 none sl 2fsbk mvfr as 2fm,1c 0.6 1.0 2 17 -23 10yr3/2 none sit 2fsbk mfr aw 2f,1mc 0.6 0.8 3 23-40 10yr5/4 none sil 2msbk mfr aw 1fm 0.6 0.8 ID 4 40-52 7.5yr414 none is 0 sg dh aw - 0.0 0.0iy`� 5 52 -66 7.5yr4/6 none cos & gr 0 sg dh aw - 0.7 1.6 6 66 -123 10yr4/6 none s 0 sg dl - - 0.5 1.0 H#4 & 5 contains high iron content. H#6 contains 1/8" -1/2" bands of 10yr4/4 Ifs at 2" - 5'intervals. loading rate reduced to reflect permeability V restriction associated with banding. F 4 ► Boring # --1 Boring i NJ Pit Ground Surface elev. 100.38 R• Depth to limiting factor > 122" in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-4 10yr3/3 none sl 2fsbk mvfr as 2fm,1c 0.6 1,0 2 4-23 10yr4/4 none sl 1 msbk mfr ew 2f,1 me 0.4 0.6 3 23-40 10yr4/6 none Is 0 sg ml gs 1fm 017 1.6 4 40 -68 10yr416 none gr s 0 sg ml gw - 0.7 1.6 5 68 -122 10yr5/6 none s 0 sg dl - - 0.7 1.6 F-] Boring # Boring J Pit Ground Surface Bleu. ft. Depth to limiting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 mgA- " Effluent #2 = BOD <_30 mg/L and TSS -5-30 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. S813-8330(&07/00) A.C.E. SON & Ste Nakia"M .,- 91 • Lo cn.�r dp��P. �� C/A / = s�0 l ,Pei' �2os8 �o� / cJ , / /a�. /East Swyy3�i�/� + Tp 10// "5C.4. so A/C. did �2 SIVAC �D,PI, i`lssu.»�d elegy' = - ',0.u9' Lot ll5erdll`� 63 89. ne;�f,borinq /'es,cle�,ee o + o' � U1 � � y 8+ r t wrsoorsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm $5. Wis. Alm. Code Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must' include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions. north arrow, and location and distance to nearest road. Please print all info onRECEIVED Reviewed by Date Personal inforrnatm You provide may be used for secondary (P rivacy Property Owner - ,� A i�l 3� 3° 40 ers Mailing Address 114 1/4 S T d N R E( W Property Own /J S T. C R O .r UGC NIN 111 City f3tate . Tip Code Phone City T n Nearest Road �1 t ) i New Construction Use: Cg Residential / Number of bedrooms Code derived design Bow GPD Replacement ❑ Public or commercial - Describe: — Parerd mawai O J r� Flood elevation if applicable ICI �3 ft. �: 5 Ske �. e l��r✓t- rrrs� 2 �Q2,Z. M Boring # Boring Pit Ground surface elev. Z ft. Depth 10 limiting factor in Sol Application Rate Horizon Depth Dominant Color Redox Description Texdre Structure Consistence Boundary Roots G POR In. / M�unsell Qu. Sz. Cont. Color Gr Sz. Sh. 1 1 -E D fr#2 1'j ,�w � S � 0 Boring# Boring Pit Ground surface elev.. —✓— Depth to limiting factor in. Soa Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAP In. Munsd Qu. Sz. Cont. Color Gr. Sz. Sh. *M1 *Eff#2 3 /A S (— *101c Z 1 S 10 r — C L I w �— n3 3 �i la r L' /� S n n n I• Z Efluerrt #1 = BOD > 30 <_ 220 nqL and TSS >W _< 15r ; ' Eftdied #2 = BOD <_ 30 mg& and TSS <_ W nVL ) CST hkrriber Address °:% Date Evaluation Conducted TeWione Number NA- Property Owner Parcel ID # Page d ❑ Boin0 # ❑ Boring �� s '° Pit Groundstufaorelev. ft Depth io Gmifi g factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPM in. Munsell Qu. Sz. Cont Color Gr. Sz Sh. 'Etf#1 'Eff#2 I -10 10 31� - SC rn F L S z »- 1 0 -1 S/ I 1 le , z3 p y/ — Q h ct 7 /. Z S onng F-1 # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor m. Sol Appkabon Rate Horizon Depth Dominant Color Redox Desaipfon Texture Structure Consistence Boundary Roots GPM IM Mu nsd Qu Sz Cont. Color Gr. Sz Sh. 'Eff#1 'Etf#2 I i ❑ erg # ❑ Boring ❑ Pit Ground surface elev. ft Depth to tinuting factor in. Soli Rabe Horimn Depth DomkwdColor Redox Description. Texture Structure Consistence Boundary Rods GPD/ff In. Munseti Qu. Sz. Court. Color Gr. Sz. Sh. 'Etf#1 'Ett#2 I Effluent #1= BOD 5 > 30 < 220 mglL and TSS >30 150 mgA- ' Eftwit #2 = BOD < 30 t►g& and TSS <_ 30 mglt 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- 2648777. 1-3 Soil Test Plot Plan Project Name David Railsback Shaun Address 845 133rd Ave New Richmond Wi 54017 C #226900 Lot 1 Subdivision Date 12/12/02 SW/NW 1 /4 W/ N W 1 /4S 30/31 T 30 N/R 18 W Township Richmond R Boring 0 Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 102.2/99.2 *HRPSame as Benchmark Alt. BM Top of Steel Fence Post @ 104.0' 148' Property Line Please Note: Tested area may not be *B Alt. suitable for desired building area. Check system location before excavating. Soil test was done to satisfy Zoning Requirement. 59'"' IV 12% Slope B -1 B -2 102' 100' 30 104' B -3 106' ope Line ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer /��(- o .,&- s z G L Mailing Address T. 0 , j k - # / U Property Address (Venficahon required from Planning & Zoning Department for new construction.) c3 Qg _YS City/State �/ /e I .� f parcel Identification Number �2G_ / � - / b-z -8 LEGAL DESCRIPTION Property Location 5 '/ , 4 6 , A 14 , Sec. 30 , T .3b N R�B gTown of Q • G 44 mo 4 cc Subdivision W f ot,_) , Lot # f Certified Survey Map # 7 7 3 7 , Volume /"O , Page # 0 Warranty Deed # ,Volume a�4 ,Page # ZZ Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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 alreatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & 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 Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my /our knowledge. I /we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms n � GNATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) W (P / N ww \� fi j C ` mW s �A 't CC c rn X10 bQ^j r � / / �j• QQ � 11 6 N // i O N 0 :n w ��• d' AZd U, � r ?' W �• tf) Z r' N w 5f sti s {a >�lo$ Nv IN W ljo h \�`� _� ...................... I ' O Cli w / N 1'23"W 149.04' / 04 / 149.04' Go I / / I ' n ' r W 0 N WT 08N� N V S II N } W r O z '// I O; CO W I �. 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I POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity / Z S"d 7 gal ❑ NA Permit Septic Tank Manufacturer (� 5 ❑ NA DESIGN PARAMETERS 0, .affluent Filter Manufacturer P O� /© 0, 3 ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model -A* ❑ NA Number of Public Facility Units VINA Pump Tank Capacity ❑ NA S© gal Estimated flow (average) �® gal/da Pump Tank Manufacturer d � ❑ NA Design flow (peak), (Estimated x 1.5) CpOO gal /day Pump Manufacturer Z ❑ NA Soil Application Rate ©..5 gal /day /ftz Pump Model 1 9g ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) _ <30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD <_220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODO <_30 mg /L ❑ In- Ground (gravity) IsCn- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound F ecal Coliform (geometric mean) _ <10 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: NA Other r El 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 y' ye ar(s) ever ❑ m l �' f (Maximum 3 years) 11 NA 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 ever ❑ month(s) -- y' Xyear(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: / ❑ moanth(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ monthlsl ❑ NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other C] month(s) At least once every: ❑ yearlsl 1:1 NA Other, ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113 Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of S12 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. START UP AND OPERATION Page — of 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 tanks) 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 its shall be removed and d 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 utilLxed 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. /" �nvay o inSt ��!� aC a IaCt r SOr to ranl f`o t c�f •� a on�� . P Rcj Y ! 13 1 rim 1) Fa k M E w c o N STR uT! a A! ❑ 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 O - rHER 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 ( k E M b F 0— Name Phone 7 �� d a 2 Z Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name :V 06h n Phone Phone / - 0:-5, This document was drafted in compliance with chapter Comm 83.2212)ib)(1) &(f) and 83.5411 ), 12) & (3), Wisconsin Administrative Code. ® o FIItelrs PL -525 EFFL DENT FILTER ( J Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent filters.The PL -525 is rated for over 10,000 GPD Alarm "'IiiK - (gallons per day) making it one of accessibility Accepts PVC the largest commercial filters in its extension handle class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL -122, the new Polylok PL -525 has an automatic shut off ball installed 525 linear feet with every filter. When the filter is of 1/16" removed for cleaning, the ball will filtration slots Rated for over float up and temporarily shut off 10,000 GPD the system so the effluent won't leave the tank. No other filter on the market can make that claim! Accepts 4" & 6" SCHD. 40 Pipe q PL -525 Maintenance: O The PL -525 Effluent Filter should operate efficiently for several years under normal conditions before requiring cleaning. It is recom- mended that the filter be cleaned every time the tank is pumped or at least every three years. If the installed filter contains an optional f { alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be Gas deflector done by a certified septic tank NNW r Automatic shut ofi pumper or installer. ball when filter is removed 1. Locate the outlet of the U.S, Paten No# 6,015,488 i septic tank. 5,871,640 i 2. Remove tank cover and pump tank if necessary. PL -525 Installation: 1. Locate the outlet of the 3. Do not use plumbing when septic tank. filter is removed. Ideal for residential and com- 2. Remove the tank cover anc 4. Pull PL -525 out of the housing. mercial waste flows up to pump tank if necessary. 5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the 4" or 6" outlet pipe. If the tank. Make sure all solids fall filter is not centered under the back into seP;tI . access opening use a Polylok 6. Insert the Rte.r cartridge back Extend & Lok or piece of e I R into the, p ng making sure to center filter. the fil r is properly aligned and 4. Insert the PL -525 filter into com letely inserted. its housing. 7. Replace septic tank cover. 5. Replace the septic tank cover i ,achnical Specific PL- -525 EFFLUENT FILTER (COMMEReIAL) -- 61 BALL GHECN( — EXCEPTS 6 SHG 40 FOR INLETEXTENTION 11 14.35 S7 / ! � OUTLET BUSHING EXCEPTS 4'SCi14086'SCA40 8.10 r ' ._ -.,_, ---- I AT 1 I T 5.13 - wu.nRw 1 i i i 33.01 i PL -525 FILTER HOUSING Ia34 PART N0. -30142-525 MATERIAL: - — i g HOUSING - POLYPROPYLENE OUTLET BUSHING - PVC 6.5BALL -HOPE SOCN(ETEXCEPTS FLOAT S'MTCH� - EXCEPTSVSCH40 )�— 98 FOR HANDLE EXTENTION i 1 11 �I l 1I1 ,. 1 10.84 -- s3aoFlns•SLOTS I � �-,\ �- � 6.24 -- 9.56 - - --� --- SOC102TEXCEPTS - — 6.04 _ BALL PUSH RCO I OPENING - 709 OPENING I I 20.71 I 19.02 2244 POLYLOK PL -525 FILTER CARTRIDGE PART NO. - 30141.525 MATERIAL - POLYPROPYLENE Polylok PL -525 Support Stand Should you feel it necessary to add additional support to the PL -525 filter, use a six -inch Schedule 40 or SDR 35 pipe to extend from the base of the filter to the bottom of the tank. The extenbon pipe needs to be anchored to the filter housing with one or two #1A_X 112" SS screws. Anchor 1 -2 Stainless steel screws through housing nd into pipe. 9 Use #10 X 112" i 6" Schedule 40 Pipe Pipe rests on bottom of tank COMBINATION SEPTIC/DOSE CHAMBER TANK & PUMP SPECIFICATIONS PER COMM 84.25 CODE CHANGES 2/1/2004 Access Opening, not top of cover, Access Opening, not top of cover, must extend to a point no greater must extend at least Gl �� de than 6" Below Finished Grade 4" Above Finished � Cover with WtTAI N ek 00r V J L� a -7�' Locking Device T NG O ,J L34Y �PPe CA (typical) Finished Grade r >EVV e T 6r Min. 23" > 36 Ff: !� Access Opening M5 23" Access Opening x P1 2' Outet Effluent Filter W /TH "P✓G SL. � Union A-ppeoY&�D P 1,06- 3 PT; Inlet Baffle �M i i Pump 3 ,. d o r rt+. W_ 1 n r7 de r w i 4-A oc h-let- 2 .. Rower SLha v� ed 4eS Two ComparFment Septic/PumpTank � on o v�s /ale GUT) l J SPECIFICATIONS TANK MFR: C_ (S E R DOSES PER DAY: TANK SIZE: SEPTIC 7-5 D GAL. DOSE VOLUME: GAL. DOSE '7 So GAL. (INCLUDES FLOWBACK & <20% OF DWF) ALARM MFR: CAPACITIES: A = INCHES = �� $ GAL. MODEL # f ®- ( q q t, Switch type: F ( C2aT B = 2 Y _INCHES = 3Z L GAL. PUMP MFR: 2 0 , 0 r C = INCHES = z8, 9 6 GAL. MODEL #: N I ( z � 9' SWITCH TYPE: �(p�'T , D = ti Z INCHES = 1 3 GAL. REQUIRED DISCHARGE RATE GPM PUMP & ALARM WIRING PER COMM 83.43(8)(e) VERTICAL DIFFERENCE BETWEEN PUMP OFF•& DISTRIBUTION PIPE (LIFT) _ 0' C 1, S FT. MINIM M NETWORK SUPPLY PRESSU E (DISTAL & NETWORK PRESSURE) _ + FT. FT. OF FORCEMAIN x ''7 T. /100 FT. FRICTION FACTOR ...... _ + i' T. TOTAL DYNAMIC HEAD (TDH) _ ' S(0 FT. INTERNAL TANK DIMENSIONS: LENGTH / ; WIDTH ';/ S� ; LIQUID DEPTH 5"i MP/MPRS SIGNATURE: )j)b& ,0 LICENSE NUMBER: PUMP PERFORMANCE CURVE PUMP PERFORM CURVE EFFLU 3/8". 1/2" & 314* SOLID PASSING CAPACITY WOMEN 1111110111 125- M 12t 0 MEN �- •� ®���0�0 ®����d�m�00 ®gym® lit ■ ■ ■ ■ °�■■� °■� °m °tea °moo ° ° ®0 °0 ° °° ■LI■ ■ ■ ■ ® ■ ■ ■ ■ ■ ■ ■ ■ ■0 ■ ■ ° e ■m��� ■■■■■ ea ° ■ ° � ■■ ■ ■ ° a ■ ■ ° a ■ s ■ �■LI ■■■ Mme ■ ■mm ■e ° a ■ ■ ° e ■ ° e ■ ■ ■ ■�s ■i■ ■hem ■m ° e■ ° 0 ° ° ■ ■ ° ° ° a■ ° ease ■■■ ., o■ b'Nk ° e ■ ■ ■ ■ ■ ■ ■emm ° e ° °0�e ° e 75 7 112 \sLu■11\ \■■■■■■■■ ■11►� \ \ ■ ■ ■ ■ ■ ■■ \` \► \II \1 \ ■� ■ ■ ■ ■ ■■ mom ®m ®d °o��m�mms� • ► m ®m ®m ®ai °o ° ° ° °00° ■ ■ WOMEN ■■M■■■■■ m °m ®m ®seo■ ° °0 ®00s� 5D- 101,13 �\01■ ■ ■ ■ � II■■ ■ ■■■■■ 113000101 ■E��■■■■ ° a ■�■'� ®mo © © ®�® mom■ r ®1� ■�1 ►1�I ■■ ■ ■ ■ ■ ■ ■■ a�� °��e °® ■ ■■�1V1■■■■■■■■■ a °a ® ■ ° aa ° e ° ° ■0 in 26 MOM oi 3111101,95010 ■■■■� SEWAGEAND ® ® ®m m Ems .. DEWATERING m ■o�mmm�mmm�.mm��m��� subjected to less than 15 feet TDH, m� mmm mmmmm mmmm� m ■mmmm�mmmmm��mm ■mm �m�m 66" I 50" 86" 0 c r m 57" m 3 „ z 6" N I I � I D O \ i i N ' r m O D 0 C m m 0 0 Z z O n gZ O � Z �m�r2�C�W � m - m D O pN0 �AM.,p 00opZ�ZOOD� D mss O SO = � o r (n C7 m mss m O C ;� �_ 2 0" z Z A Nr Mr MZCO O)MCF) N > f I, m n i � .5 N //1 N O \ y r -i U) �+ i Q o rnU mmCD �2 a O ',� N �nmm 1 Cn�Lpp0 v �o� D� o m \ N J N N j➢ m�� 11 m co Cl) O \� �1 O � D r r D .. r n � Dm V o C Z Z 2 O •�! D �L CO O N y D m �O 00 Li o m 0 Lo o � O mm Z F 0 s D m (n reau z Q� ick4 rni STANDARD CHAMBER Quick4 Standard Chamber 48" (EFFECTIVE LENGTH) ? a SIM SIDE VIEW SECTION VIEW MultilPort End Cap 16" '2 34^ -- __---- -- - - -__ —y SIDE VlEW TOP VIEW FRONT VIEW Quick Standard Cham'belii..Nd n lonS.. MultiPort End Cap Nominal S pecifications Size (WxL-xH k` :.iSize(WxLx1l) .34'tx 16" x 12' Effective Length ` + Invert Height 8 or 1.25" Invert Height., 7 �v I-, 4, 4 I's rA INFILTRATOR SYSTEMS INC. STANDARD LIMITED WARRANTY wed and o ther accessory mantilicii-IJ b 1,011­1 1) 1: 1 h na,r,,r,I with s Insvuct,ons. is warranted to thin ori ;il ('HoldI delocli, , I'll that th,,,e permit Is to, the C of, la ,li nq jt j✓ provided 10 I wv p 0 Irl ri py ant'j" at I" law, the warrant perOd will begin joOn the dale that installation of thf) sc s (;o r,rnen r , , ( , ,; loaly nfilt,-8to— wr,t,,, B ,IS Co,00rae H.adqi,artr, It, UItY SaVb k ( -1—h-1 with,,, Irpon f I I's ) cl, loolacem,,nt tj,,t t Unit determined b Infiltrat 10 t)a GOVe f.O I,, Warrant fl 'Is's he ­l I I removal al(l/or nstallat on of the Un[s O AND VF[)IFS IN SUBPARAGRAPH (a) ARE EXCLUSIVE THERE ARE NO 0THI-R WARRANTIES W ITH HE SPEC I SYSTEMS INC OF MERCHANTABIurY OR FITNESS FOR A FAMIGULAR Punl'Ou I I)- —d 11 any Oart of the charlhar system S rran.lacored b an-nn eth,i, th,,,, lol'Irr,lor Ith, I test l .I ",o il ltntla: loloal r Idled us,, damages Infiltiralor Shall not be liable to, j I g ­,,! Environmental Onsite Wastewater Solutions" - �tld "alals oerh,iad Cos ,s. or othSr losses Or experses,nc, ­1 h er ­ h, y ts, Hold. , d Fall, I Sp I,— ) r-Pr ,gi art, do,,,ce to file Nnjj, d1 le 10 ordinary wear and y­ 1c,,u)f 1-Ine al, orne( of r, ­)­Ied 'I ehrr t at c nr ether opndt which are not PolroIlled b her tall In M e m a,nainf­ orlh h:h, placement Of ImpropOr mal vi,ii—to to, ; '0 I ,vin thr, on,t l of 6 Business Park Road • P.O. Box 768 !_­ di-,e l , r , or-pro CxCeSStve water rT np by Infill,at, TI, I- I" tell Warranty Shall be void K the Holder tails to co,npl with all i f t 11,0h,,) ihi, L,,Ow Old Saybrook. CT 06475 860-577-7000 - FAX 860-577-700' ni ,,,It I,1IIoI,, 1, I a ny oss or O,b, 11111, the 111,1, o, ar h!rd r—j", . ....... . v 'Or this LI-ed Wa,raol 11) :1)" 1 n-I 1, 800-221-4436 les1lilred by SMI' Ill .,Fp, il al oh, aopk;able law6l Id I,, 11111qe, 11 ­tol)d his Limited Warrant, N , Wj ,r,,, : ,'Ii 1 b Intliratpr A I,,,,,IOdni,n,I,n, of f;ol ,"I I ­rt)tv (pi,s, s C Headquarters In 010 Sayb ( ` �o C',n),cl,,t I r I'' IIIII(phase otilal 11, ,a,l th warrant pno, 10 the o u,n ase , o f )rl, 1 x. 5.I ) 6, 4 88. 5,336.0 5 4 01 116 0 1,4 59, 5 511 5, 7 I( 16:3, 5 588 -). 83 9. F1 4 4 g 2.004 56d (_)Ihor patents pendinq q a rc rrs trademarks of Infiltrator Systems Inc Inlillrat0 Is; a f , ,jigle red ra(le,na,t, in France 100t,alor Systems Inc'. l­ ,, r) Mexico C,nntoijr. Contour Swiv Connectlon. Microl-eaching, PolyTiff SI)aj)Lock PosiLock QuickCI,ji, OuickPlay RECYCLEOPAPER ) f Infiltrator Sy, Inc O 2003 Infiltrat Systems Inc Printed In U.S A 001 12Tti­ 801 334 U 2 8 6 5 P 2 2 1 KATHLEEN H. WALS State Bar of Wisconsin Form 2 -2003 REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO., WI RECEIVED FOR RECORD Document Number Document Name 08/12/2005 09:55AK WARRANTY DEED EXEMPT THIS DEED, made between David H. Railsback a/k/a David H. Railsback 11 and Aria J. Railsback, husband and wife REC FEE: 11.00 TRANS FEE: 1287.00 COPY FEE: ( "Grantor," whether one or more), GC FEE: and Milim of Hudson LLC PAGES: I ( "Grantee," whether one or more). Recording Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following Name and Return Address described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ( "Property ") (if more space is needed, please attach addendum): Lots 1, 9,13,17, 18 and 20, Plat of Willow River East in the Town of Richmond, St. . Croix County, Wisconsin. 11W Part of, 026-1088-95-000 & 026- 1091 -70 -000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated c�IG�Ga�G SEAL (SEAL) � T� ( SEAL) * *David H. Railsback, 11 le , (SEAL) �• f./j�0e,6OZ, (SEAL) * *Aria J. Railsback AUTHENTICATION ACKNOWLEDGMENT Signature(s) David H. Railsback, II and Arla J. Railsback husband and wife STATE OF ) authenticated on ) ss. COUNTY ) *Kristina O land Personally came before me on TITLE: MEMBER STATE BAR OF WISCONSIN the above -named (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: * Attorney Kristina Ogland Notary Public, State of Hudson WI 54016 My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED (i, 2003 STATE BAR OF WISCONSIN FORM NO. 2 -2003 ­Type name below signatures. INFO -PRO Legal Forms 800 - 655.2021 www.infoproforms.com