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HomeMy WebLinkAbout026-1175-19-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 479297 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 I Richmond, Town of 026- 1175 -19 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 6D , a 1 Q� - b 30.30.18.1419 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic _ _ e / 2 Benchmark i 2 J'• /� Dosing Alt. B I 3 d Aeration Bldg. Sewer , � t / /02.33 Holding TANK SETBACK INFORMATION t Outlet S• (a/ •g TANK TO PJ . -J P Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom �-- Dosing Header an. _flip Z7 /p0. Aeration Dist. Pie , S Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Z D Manufacturer GP and S Co ver fC4-16 O•' Model Number sP-,V,� TDH Lift Frictio System Head TDH Ft Forcemain r Dist. to ell SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L jtLQ W E LAKE /STREA LEACHING Manuf INFORMATION CHAMBER O Ty Of System: 30/ 1r UNIT Model Number. D IBUTION SYSTEM ! =Intake Distributionx Hole Size x Hole Spacing Vent to A en th ia 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 ` �'/ Bed/Trench Edges Topsoil J Yes No [] Yes j No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 1 /�/ Inspection #2: ond New Richmond, SW 1/4 SW 1/4 30 T30N R18W) Willow River Eastvo T9 Parcel No: 30.30.18.1419 Location: 910 131st Avenue ,,// �� �, WI 54017 � ( w � 1.) Alt BM Description = Se^"'rt� Gua.�koxf v "r / ?y4ene__ 2.) Bldg sewer length - amount of cover = u f - t Plan revision Required? El Yes No I 4 p Use other side for additional information. Date Insepctor's Signature Cart. No. SBD -6710 (R.3/97) I Safety and Buildings Division County F � 201 W. Washington Ave., P.O. Box 7162 7 • C r d i v �sconsin Madison, WI 53707 — 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 -3151 —7 Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide /�A may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Address (if differe t than mailing address) 3 t n i 3 1� I. Application Information — Please Print All Information / Property Owner's Name Parcel # Lot # # tlar I o &� ; sapi �+?FrF1E�F1' t3vlo� 1 , 7 Property Owner's Mailing Address / Property Locati t aX JUL 0 S 2005 5 w %, S � V4, Section ? City, State Zip Code P$pitC1►t1> h*C0UNl / NWG UFFICI_ (circle one) `' U T 30 N R t ? J E t �� 11. Type of Building (check all that apply) X 1 or 2 Family Dwelling — Number of Bedrooms �— Subdivision Name CSM Number ❑ Public/Commercial - DescribeUse U/l t ow l2 UEu! E 4.s ❑ State Owned - Describe Use 2- 3 X 9 3. 7T 'r s N[ #o ❑City_ ❑Village Township of JC 1. #m eK 307 13143 �, .,s.r 71 .l I S -A t c III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System y ❑Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that a 1 Non — Pressurized In- G round ❑ 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 A achin Chamber - ❑Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis ersaV'I'reatment Area Information: Design Flow (gpd) esign Soil Application te(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation ('00 �a 0.7 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank 12 .57' Wat Aerobic Treatment Unit tA/ of y L L 9 2C �;•/ Dosing Chamber 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 fV1 v�C[)aN��� VI� zzsd 3 l� /z- S' &r -i 9L7 Plumber's- Address (Street, City, State, Zip Code) /6 70 2; �- 11 L _q f So t,v VI Coun /De artment Use Onl pproved Disapprove Sanitary Permit Fee (includes Groundwater Da Issued Issuin ent Sign e Surcharge Fee) Q El 0 nReason nial 36 0 00 7 (J b5 IX. Conditions of Approval/Reasons for Disapproval h � SYSTEM OWNER: 1. Septic tank, effluent finer and , _ (� — L ot.J.I�QJI_ . P Q o `�av�2 dispersal cell must all be services /maintained C_ as per management plan provided by plumber. 2. AN setback requirements must be maintained as per applicable code / 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) /v, /j/ - EP2 D !hE S /Ifn i /rJ / LL E2 z ' w/ L I o u, 2 r ✓F n EAsT Z i s - M M a a� ? IL � Q HA it a - � r q'K,7S rr2ENcN�s s f c.k �lLc.+cLi Av �P S S J Na 1 Ise o° y R�,_�1'dP o� 12o �l: loo, oa � �iJIGL�✓Z �O S /.If�rl°i /7j /LL E2 �� L G T'� l S r ii 0 / `\ LX) M J`►1 � ` ' ,� 1v j cAL ST' O TREitIc / P �v' -- C �► o1.w� b Pr � l"0 7 a.- l �.z n Av c 0 X0 4 a 13 �e �o n �'.6�, T n Po�r 12ox1 �/: lov.p0/ f - Wisconsin Department of commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings In accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must County ��• Jc include. but riot 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 mad. Please p t !r7 2003 R 'awed by Date Personal irrforrrred- you provide may be oy V. s. 15.04 (1) (m))• Zbfl Property Owner Propertyo �"°" 3u1 30 ,� Govt. Lot N tw,) 114 114 S• I T d N R � E( W Property Owner's Mading Address Lot # I Block # Subd N CSW ELICZ Cd . zip G � ❑ city ❑V/ T Nearest Road �) ( ) i ,� New Construction user Residential / Number of befto=3 Code derived design flow rate `�'JrD GPD ❑ Replacement ❑ Pubic or commercial - Describe: Parent material oa-t i j C � Flood Plain apps 1 i3 ft. General c omments lots ( � la L Q / and rriconrrr►endatiorrs: s She I z/j (Z _ 04 b . � °�� Bodng Q eonng # Pit Ground surface elev. /QZ Depth m irnitir►g factor -y' i^ Sol Rabe I o Horizon Depth Dominant Redox Desaiptlon Texture Structure Consistence Bourtdeuy Roots G In. Munsel CAL Sz. Cont. Color Gr. Sz. Sh. *M1 Tff#2 2 s --- G a 2 / Co- 0 1 70 ® # Pi g Ground surface etev. l L' ft. Depth to limiting factor 2 O in. Sol Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsel flu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 3 1Z S L 2v3-r rv) CS 2 2 3 -) TY — C- L k r 1 2- • 3 . Z S`f � Eiflrrett #1 = BOD > 30 220 rrg1L and TSS >30 <_ 15r•' ` Effluent #2 = BOD < 30 ngll. and TSS < 30 mglL �CST� Number sue.✓ '� ,: - _ n Data Evaluation Conducted Telephone Number Address l Property Owner Q Parcel ID # jj Page of # . B pi tnn9 Ground surface elev. 3 V ft. Depth to limiting factor I y in. Sod Application Rate Hortmn Depth Do ninard Color Redox Description Texture Stricture Consistence Boundary Roots GPD/fP In. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. `Etf#1 I - Eft#2 2 o shy — w n a a. 671/9 B«hs # ❑ Borin Ground surface elev. R to . .. F ❑Pit Depth im factor In. v6ng Soft Application Rate Horimn Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP0/ff= IM Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eft#1 TRW F Boring # ❑ Boring ❑ Pit Ground surface elev. R Depth to GmiGing factor in. Soil Rate Horizon Depth Dor inant Color Redox Description. Texture Structure Corm Boundary Roots GPD/(f: In. Munsel Qu. Sz. Cont. Color Gr. Sz. Sh. `Efr#1 'Efr#2 Effluent #1 = BOD > 30 < 220 mg& and TSS >30:E 150 mg& ` Effluent #2 = 800 130 rng& 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 608-264 -8777. setr-saro(xsM) Soil Test Plot Pla Project Name David Railsback Sh it Address 845 133rd Ave New Richmond Wi 54017 eftM #226900 Lot 1 9 Subdivision Dat 12/12/02 SW/NW 1 /4SW /N W 1 /4S 30/31 T 30 N/R 18 W Township Richmond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. —Top of Survey Iron gN „� System Elevation 98.4/97.5 *HRpSame as Benchmark Alt. B Top of Steel Fence Post @ 104.0' Please Note: Tested area may not be suitable for desired building area. Check system location before excavating. Soil test was done to satisfy Zoning Requirement. 104' B -2 13- 445' 3% Property Slope Line 90' 30' B -1 103' 307' Property Line 100' 30' * t. B.M. B.M. ST CROIX COUNTY SEPTIC TANK MAIN'T'ENANCE AGREEMENT AND OWNERSHIP CE / RTIFICATION FORM OwnerBuyer l / G LG / /y b /2 ► s / S/�/� 1 / / L L ,6�2 Mailing Address a 6 - / I 6 Property Address A ft� (Verification required from Planning Department for new construction) City/State lyE le',- o,, Parcel Identification Number LEGAL DESCRIPTION J1 /3 Property Location '/4, t '/,, Sec. , T N -R, Town of G n �l Subdivision (L C L 1 0 c-0 l2 v - - 7 , Lot # Certified Survey Map # 7 7 12 37 -- ) Volume Page # yo Warranty Deed # 7 $ V 7 s L , Volume z Z , Page # 5_ Spec house K yes O no Lot lines identifiable A yes O no SYSTEM MAINTENANCE Improper use and maintenance of your septic could result in its premature failure to handle wastes. Proper mainte ncc consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the systec: 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. Certificatio-, . stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office arithui 30 days of the three year expiration date. 2z/'& MATURE OF ICANT J 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 OW, et s) 0 the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. — 7 t /d 41311A T APPLICANT DATE • • • • •' Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. •• Include with this applicatlon: 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 l� R 2 7 2 6 P 2 S y -7 842t5 2 State Bartif Wisconsin Form 2 -2003 KATHLEEN H. WALSH REGISTER OF DEEDS WARRANTY DEED - ST. CROIX CO., WI Document Number Document Name RECEIVED FOR RECORD 01/05/2005 01:00PH WARRANTY DEED THIS DEED, made between David H. Railsback a /k/a David H. Railsback 11 and EXEMPT # Aria J. Railsback, husband and wife ( "Grantor," whether one or more), REC FEE: 11.00 and Miller Homes of Hudson LLC a Wisconsin Limited Liability Company TRANS FEE: 2115-00 ( "Grantee," whether one or more). COPY FEE: CC FEE: PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Recording Area interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is Name and Return Address needed, please attach addendum): Lots 2, 3, 4, 6, 8, 10, 12, 19, 21 and 22, Plat of Willow River East in the Town of Richmond, St. Croix County, Wisconsin. f' / ' e6 026- 1088 -95- 000 ;026- 1091 -70 -000 Parcel Identification Number (PIN) This is not homestead propert}. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated December 30. 2004 (SEAL) (SEAL) * * David H. Railsback (SEAL) (SEAL) * *Arla J. Railsb k AUTHENTICATION ACKNOWLEDGMENT Signature(s) David H. Railsback and Aria J. Railsback husband and wife STATE OF ) authenticated o ember 30 2004 ) ss. I a COUNTY ) �— * Kristina Ogland i 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 © 2003 STATE BAR OF WISCONSIN FORM NO. 2 -2003 ` Type name below signatures. INFO- PRO Legal Forms 800 - 655 -2021 www.infoproforms.com i Y. i s I _ f'9 r AW r ""1. -' Q �, / a 112 a g2N a \ \ CD j UN ' w c l Y da p Jclo k N I� VA 5 *•Wo N� Q II ?� L ,� ♦♦^� .. . J OD / \\ II W C? N ' 5rm r g 4 S d j7 ON/ONO � �1d� � 'Od '10/1 �33a NI 0391li�S30 SV SS3klfl3 4NH SS3! AO' ►90t � sZ'E S l Tot 11SM ,ZO'Z9 00 t L M.EZ MOON IX \ g E� Z 8g 8 Al � \ �I 1 BioDiffuser p a cif • End "W 4'Kn Uniyewl End Ca Chamber 11" Stan• 14" High 16" Higfi Av ailable Dimensions dard Capacity Capacity .. ,1 '!�� • . •� �; �i1,..,.:'•,• •' • ?; i t �•� i"Y.•.� =. �l a ..i •,)=i ` .' • �fr,.. .. : � �s 1 • ,, •.L a o ° �ilt'.i�6da Lb`i�� +:.. :..:....A!i {.. •. 1.... ::.. ` k3r�d w iv, l � -• ,a /;' •1F. •r•{,� +. � e +;.r }4 � "•,1�� 1 . Ills ••�'•�'�!� '6�1in� �f:•!: ° J.�i!%'��•s� 3 . • t vH�'L'�E's�:! ` ils.b, i... �• .� ;�'� �r : i�.,. :1! � ; FYI•%''•.•. i t tir r • •. ! ! If :�rit•i; r. •� �;'��,j,.alv.;l• ��' ��' I • �1 ' ,y ^ ' � k, �.nr:l!�?��.���� • yii i�t' lS�rir.101 /;ti►'t'1��1!�. �'/: ���✓ o ►se m 9 4f/ /r c e w " 2 / d am,/ ms .1 eoT /S _.e POWTS OWNER'S MANUAL 81 MANAGEMENT PLAN Page I of L FILE INFORMATION SYSTEM SPECIFICATIONS Owner �. J ,r� Septic Tank Capacity Z 5 p Permit ❑ NM # al Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Number of Bedrooms ❑ NA Effluent Filter Model 5 NA Number of Public Facility Units ❑ NA Pump Tank Capacity al ❑ NA Estimated flow (average) O g al/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) (� DC!) g al/day Pump Manufacturer ❑ NA Soil Application Rate — 6 1 ' 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 Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L YIn- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑ Othe Maximum Effluent Particle Size Y in dia. ❑ NA Other: 0 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'eve ❑ month(s) ry' ear(s) (Maximum 3 years) ❑ 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 eve ❑ month(s) every: ❑ year(s) (Maximum 3 years) ❑ NA Clean effluent fitter At least once every: i ❑ month(s) ❑ NA year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: At least once every: C3 month(s) ❑ year(s) C] N " 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 ponaing 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 ent re contents of the tank shall be removed by a Septage Servicing Operator and dispo$ed 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. �» •� Ul- AND OPERATION Page of Z 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 ceI4(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the punip 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 manual) operating the restore normal levels within the um to y p 9 pump controls to pump tank, - Do not drive or park vehicles over tanks and dispersal cells. Do riot 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 Cor -nm 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 arA 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 frorn disturbance Shd compaction and should not be infringed upon by required setbacks from existing and proposed structure lot lines and wells. Is. Failure to r - p otect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement p ant 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 alua a o in a nk b g e are �7'N�S. ❑ 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 Ci 6 o Name Phone I (o Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone 3eCa_ This document was drafted in compliance with chapter Comm 83.22(2)(b;i lhd) &If) and 83.54(1), (2) & (3), Wisconsin Administrative Code. I Parcel #: 026- 1175 -19 -000 07/08/2005 02:26 PM PAGE 1 OF 1 Alt. Parcel #: 31.30.18.1419 026 - TOWN OF RICHMOND Current X , ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 10/29/2004 00 0 Tax Address: Owner(s): * = Current Owner * MILLER HOMES OF HUDSON LLC MILLER HOMES OF HUDSON LLC PO BOX 151 HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 910 131 ST AVE SC 3962 NEW RICHMOND SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 1.940 Plat: 10 /40- WILLOW RIVER EAST 026/04 LOTS 1/22 SEC 30 T30N R18 PT SW SW BEING WILLOW Block/Condo Bldg: LOT 19 RIVER EAST ('04) LOT 19 (1.940AC) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 30- 30N -18W SW SW Notes: Parcel History: Date Doc # Vol /Page Type 01/05/2005 784252 2726/254 WD 10/29/2004 778374 10/40 PLAT 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/21/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.940 28,400 0 28,400 NO Totals for 2005: General Property 1.940 28,400 0 28,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00