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HomeMy WebLinkAbout026-1175-22-000 3 7 0 � r. O x N O 0 al Z X w N eC O• N c a N N w a 3 O� L'7 m a — A (D N j ? L II O N Cn C 1 N O O_ !y A N R O j O 0 N N d j O W f N O 3 U T O O C ONt C N O CD U z D a s I,I I c� D 'n W T c O m CD ;=^ N z CD N N 0 0 0 0 0 .Z1 j y r . c 5. 3 t� O O O a I r3 O M 0 G ° d J .r N CD (D N D 0 O CA "me N CD p� A a I m c c CD 6 m c .. z y .. 4 Cl) W C) CL z 0 A 0 ° O N z CD A A a C I� Q G O N C z a CD N I I � I H A I + a I I h O a N O O Op A O CD dQ O n o O e o i r 7 Wisconsirf Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 514934 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 Hold„ is Name: City Village X Township Parcel Tax No: Nickell, Jon Richmond, Town of 026 - 1175 -22 -000 CST BM Elev: Insp. BM Elev: escription: Section/rown /Range /Map No: 1 00-0 D 6 r 31.30.18.1422 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. SepticBen �7 / /� fa Ie Z r /001 o Dosing Al Aeration B ld_ Se n p 0 , Z Holding -- tt l �°�• 6 p TANK SETBACK INFORMATION t Outlet L75 � �� .�0 TANK TO WEL�I BLDG. Vent to Air Intake ROAD Dt Inlet l Septic I Dt Bottom Dosing ( H eader / Man. Aeration �� Dish 5 Ir� g_ p 3 / 3 Holding B t. S stem A VV vL �{{{ ate ina�l G,f� PUMP /SIPHON INFORMATION F de U ,'f `IS 2 ' Manufacturer f J Demand St Cover GPM Model Number -Z _ i D n� /0 / 3 TDH Lift Friction Loss System Head TDH Ft 4e4 P •13 D � f3 21 � dD� /6—) Forcemain LengtIf Dia. Dist. ell SOIL ABSORPTION SYSTEM G BED /TRENCH Width Length I No. Of Trenct�s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS v` I � L/ I � O \� SETBACK SYSTEM TO P/ BLDG WELL LAKE /STREAM LEACHIN Manu rer INFORMATION /- CHAMBE R � Type f System: 6W � , 1 � Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution r x Hole Size x Hole Spacing Vent Air Intake Pipe(s) It S I Length Dia Length Dia Spacing SOIL COVER x Pressu Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center • 3' I It ed/Trench Edges Topsoil �t 1:1 Yes 0 No Q Yes F] No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: V Inspection #2: / / Location: 1316 92nd Street New Richmond, W X1 54017 (SW 1/4 SW 1/4 31 T30N R18W) Willow River Ea st of Parcel No: 31.30.18.142/2, / 1.) Alt BM Description =�P of �Idr'� uftt kU 2.) Bldg sewer length = / - amount of cover Plan revision Required? El Yes No O Use other side for additional information. Date Insepctor's Sig ature Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division County _ ` . Washington Ave., P.O. B 71 �a t be 201 W �sconsin Madison, WI 53 1 itary Permit Numr (to be filled in by o.) Department of Commerce (608) 266 - .5 L/ 1-7 3 I Sanitary Permit Application Sta Plan I.D. Nym er In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide N may be used for secondary purposes Privacy Law, s Project Address (if different than mailing address) GEIVED q Zhu 5 -� I. Application Information lea P nformation A Property Owner's Name t o S �d Parcel # Block # Property Owner's Mailing Address ZONING OFFICE Property Location City, State Zip Code Phone Number � Y4, J W A. Section sI� �ft INU_ta - ue - f„ ki. S $ 7 5 - 08Z � p8 � (circle ) I /f 2Z) R. Type of Building (check all that a I T© N; le-LE of W l PP Y) ` �J �1 or 2 Family Dwelling- Number of Bedrooms I' 1 Subdivision Name CSM Number ❑ Pti""'Commercial - De 1 e W,a�1 Jt� f � ❑ State Owned - Descri a Use " L �5 r y -I �plpS. ❑City_❑villa e of P - e ,.4 , III. Type of Permit: (Chec only one box on line A. Complete line B if applicable) A. )CNew System y El Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System B• ❑ Permit Renewal El Revision El Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV.Type ofPOWTSS stem: Check all that apply) - 2— G•o1\S tt►� Zs,4- - 2-3 Ch4gq�,Qrs y 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 El Holding Tank 11 Peat Filter 11 Aerobic Treatment Unit El Recirculating Sand Filter ED Recirculating Synthetic Media Filter aching Chamber ' E1 Drip Line El Gravel-less Pipe 11 Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Applicatj6n Rate( so Dispersal Area Required ( 0 Dispersal Area Proposed (sf) System Elevation 1000 ✓s , t�r T 3 . op VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks l I Septic or Holding Tank v Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for instal of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature M RS umber Business Phone Number Plumber's - Address (Street, City, State, Zip Code) nn 1 4 VIII. Coun /De artment Use Onl pproved tsappro Sanitary Permit Fee (includes Groundwater Date ssued Issuing A t Signature o S ps) Surcharge Fee) �L j� b� 2Z Q Owner G' Reason fo enial .J nv n I IX. Conditions of oval/Reasons for Disapproval 3> Jild AP_ .� JU2�10 g /le p �a v t .._ SYSTEM OWNER: V / 1. Septic tank, eftltlbnt filter and V%A w�. dispersal cell must all be services maintained f as per management plan provided by phamber, 2. All setback requinaments must be maintained as per applicalble code / on:lk races. Attach complete plans (to the County only) for the system on paper not less than 81/2 x I1 inches in size SBD -6398 (R. 01/03) So�� �(C (c HO NNt 5 LL VV/ K E(. AL-T D tUt azoG.( m `r E �/x R�bo�r l o IV - TvzF -N c N E:5 �� IZ GAL ST f 1. I C R .� rn y � c Jl l t I d a 0.�VY r L L T C � M C(f J r 411 a u —t _T ©N N 1 C k E //y1 C_ L C. UV / L L p w � � U,C- 5 rt 316 9 Z ,�d 5 T F� �G,e��ZZ �� 3 I V"rEt r ' ' of a'Z �(•= 100, ��, o -rvNcN ES � I �3 u i " zz� � 300 • �(S ,4 2137 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page t of 3 Divisiortof Safety and Buildings in accordance 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 St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction A unty cel I.D. percent sloe scale or dimemsion north arrow, and I on and di t pe slope, s, o oceti sta to Please print all inform 0 - 11 5 22 - 000 o Revi d By Date Personal information you provide may be u (Privacy Law, 15.04 (1) (m)). Property Owner QQU roperty Location Jon A. Nickell �- ovt. Lot SW 1/4 SW /4 S 34 T 30 N R 18 W Property 10610 North 88th a St St reet dress o1X God GE L t 2 Block # Subd. Nam Plat Of Willow River East City State Zip Code l� r _j City _ I Village e Town Nearest Road Stillwater I MN I 55 Richmond 1 1316 92Nd Street ✓f New Construction Use: W1 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD J Replacement J Public or commercial - Describe: Parent material Glacial Outwash Flood plain elevation, if applicable Na General comments and recommendations: Site suitable for conventional dispersal cell with 0.7 gpd /sq.ft loading rate. Recommended system elev. = 93.00'. 1 Boring # J Borin ❑ 0 Pit Ground Surface elev. 97.07 ft. Depth to limiting factor >113" 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 -24 1Oyr3/2 none sit 2fsbk ds cs 2fm,1c 0.6 0.8 2 24 -32 1Oyr4/4 none fsl 2fsbk dsh cw 2f,1mc 0.4 0.8 3 32 -36 7.5yr4/6 none gr sl 2msbk mvfr cw 2vf1fm 0.6 1.0 4 36 -46 7.5yr4/6 none r gr cols 0 sg dl aw 1vf,f 0.7 1.6 5 46 -76 1 Oyr4 /6 none t tt gr s Osg dl aw 1 of 0.7 1.6 6 76 -113 1Oyr5/6 none a s Osg dl - - 0.7 1.6 Horizons # 3, 4 & 5 contain approx. 50% coarse fragments. Boring # J Boring i/ Pit Ground Surface elev. 98.33 ft. Depth to limiting factor >1 12" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 1 0 -21 1Oyr3/2 none sit 2fsbk ds cs 2f,1m 0.6 0.8 2 21 -36 7.5yr4/6 none grfsl 2fsbk dsh gw 2f,1m 0.4 0.8 3 36 -58 7.5yr4/6 none gr Is 2msbk dl cw 2vf 0.7 1.6 4 58 -66 10yr4/6 none t gr cots 0 sg dl cw - 0.7 1.6 5 66 -112 10yr5/6 none s l Osg dl - - 0.7 1.6 CD Horizons # 2, 3, & A contain approx. 40% coarse fragments. ' * Effluent #1 = BOD? 30 < 220 mg /L and SS >30 < 1 0 mg /L *E ent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name (Please Print) Signatu : CST Number James K. Thompson ar -- 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 7/15/2008 715- 248 -7767 Property Owner Miller Homes Of Hudson, LLC Parcel ID # 026 - 1175 -22 -000 Page 2 of 3 I 3 r Boring # Boring 11 11 r' Pit Ground Surface elev. 99.75 ft. Depth to limiting factor >117" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -6 10yr3/3 none sl 2fsbk ds cs 2fmc 0.6 1.0 2 6 -19 10yr4/4 none sl 2fsbk dsh cw 2fmc 0.6 1.0 3 19 -38 10yr4/6 none gr fsl 2msbk dsh cw 2f,1 me 0.4 0.8 4 38 -46 7.5yr4/6 none gr cols 0 sg dl aw 2f,1m 0.7 1.6 5 46 -66 10yr4/6 none �3 gr s Osg dl aw 1fm 0.7 1.6 6 66 -117 10yr5/6 none r1 No s Osg dl - - 0.7 1.6 Horizons # 3,115 contain approx. 50% coarse fragments. ❑ Boring # J Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP in. Munsell Sz. Q u. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 C o F-1 Boring # I 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 GPDN in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD 5 > 30 < 220 mg /L and TSS >30 < 150 mg /L * 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. SBD -8330 (R.07 /00) A.C.E. Soil & Site Evaluations ■ S oil ef/a&4�, - on P� A cie tic , A / Al�-.h -M.l i re J l lon , 4 • CI �r1'L/��e�r�� \ /0 7.,,2, u, i /aw Q,' ✓�+� Eases, S Wy�rs�lf; k� . 34? 7...3o�t 6 Py 2z- r ! o � � o / � ..ncl. rule.✓ :Top St�eef A , / ♦ 98.W' to op, I hI BI I r I I V) � i • , i �qDQ i . GS Ea3[.rfar� t i4PP��X. locct�.e» oE�o, -epos c.d 4� 6cdrraD•n QGs, clu1LG. : O I � 3 ce• s/B 3 03 - - - - SECTION 31, Al 70 SURVEYOR EDWIN C. FLANUM NORTHI:.AND SURVEYING, INC. Q co 856 A HWY "65" 1 P.O- BOX 1 ROBERTS, WI 54023 t- co Y- ., Q Jc Q/v e�`" Q �ji j EDWIN C. 7 80 RADIUS TEMPORARY FLAN€JM CUL-DE-SAC EASEMENT TO S - 2487 i , BE EXTINGUISHED UPON AMERY s I ROAD EXTENSION W I ` 524.70 —i32.29 \ zo DI SURD�' _,_._ .- ...__._._.__. _ _�_.__ .. ' Y � - .... o N89 °40'55'E 132.63` *- ` 15 �\ . \ l \ 4: Ln w ' � U) S89- 58371VJ LOT 22 0 22.oW, , 2.04 ACRES 88,963 sq. ft. ILJ 'u 13 I a ri 1 BENCHMARK - _- -_ .. to 6c % ELEV, =m 933.7 0 i I t ! 200.48 100.00 I I t SOT5628 W Ln 13 `. I LOT 21'. \ 1 6 , _- x —� 2.03 ACHES, 0 88,262 sq. ft.•, O LBO =930:0 to T C7 c\I ;- � 1 i3 / 4 27.A7'' . U q (Q ' o 7 0 i N �,. z - LOT 20 rf 12 ✓� s`� port Z Z . �Ovi I�� Ile uick4 Q STANDARD CHAMSEPI Quick4 Standard Chamber _ - -_ -- -._.__ _ .4$ (FFFECTIVE LENGTH) r 1 I I i I I I I I _ - SIDE VIEW SECTION VIEW I MultiPort End Cap I r / 16 V r % � 1 ,;4„ SIIY VIFV.' + TOP VIEW l FRONT VIEW I j • i Quick4 Standard Ch Nom n S` "I ications MultiPort End Ca Nominal Cap I S .P _ P Size W x L x H t; < .a� :y ( ) �F��S'��,34 x52 "x12" ¢e(WxLxF1) 34'x16'x12' Effective Length ; i 4�1 l °V� 48" overt Height 8' or 1.25' Invert Height. ME i i ` 8 1I 1 i I INFILTRATOR SYS TEMS. I STANDARD LIMITED WAR RANTY ' eMj olale wwlge 1Ml other aCCeSson »,1111 It(.Il IMI v ��I; 1 (I 'll: •.' ,r:-01 -co w Ir111111 alm's rnslrl4k0o`i w I s Ilrlolll Ir 1 �Ir II '1 I' Inl Y.II�. n c r n yr'1 60^ t >e (tale Po"I Ine smPIIC oermll is isstjw to, the seol". n - Inl. o eVr D al n'K hlo la Ihe. warrant Mood will Y Boyl llxt I, , I Ir. C y :0 I ""C. • • I 11 Nrlf I q. ly I I11 d10r ul wr I rtA at tIs CArnorale Hl kl I � -III I IIM.r I ,, Ir iv [loll IP.II Units lot Voris defer oml I,, ,III .11.,r I,, I vl N r v ' c o l 11 a /o trl 1clroval n.. ^.IAllalnrl Il,e IL ti. It n.M) AE MI [)IF.!; IN SUI..WARAGRAPH (a) ARE, E%CI.USIVF 1, 1111, N 1 - VIII tv� I I l 111 SP! I 1 IN ' NC IM1II I IH WAPRAN f ES OF MERCHANTARII.I I V OR I I I NI:S`i 1(,14 M,I t —1 I ` ,1 SY STEMS INC ! I I v . •.r.:�lh`::;r�,;�r,.. o.,1I CI '.Ilr fha lh('1 sV$Ills,ll yll:rrl,111�. hy;Irlv�x „, ., .; a otww ( M- ti llln ,Il Environmental Onsite Wastewater Solutions” .`•'. a r - a.l ill.. 'vr the o lest s. or 0114a losses 0 I.m-'s 11,1r rVt le t " .7 I the Molt rl,w n V Vo;I V p (� p I to MI 1 , aN or other ulvii eris whCh Are t I rl In I r, Un P 6 Business Park Road - P. Box 7 7 r•: 1011 Ih >--;I II tern slrl Moons Iw! Placement Ill rlllir )I" Ir I ' .. rte 1 en tl g or mae ,Ircetsvewal Old Saybrook, CT 06475 . Ill I :all" n ICY Wa ty s11.91I Ile v0 rl 11 the HoN r. In L. 860577 -7000 • FAX 860- 577 -%;,0' I IV! , r solo I( 1 V loss d rlaage 10 Ille HoVie ii ii! I 'r ,:I f.) ",r':nl; 800-221 -443 1 ,rl (. ln L L b I , I I 100(v (l lr.r1Y Ih I . l M ay ,r P Ire I Iw,': �II11 I,�r 1 "•I: r 1;111 -" I •' I- - t rIV Irr I ,tlr` t `r1-0 It", 11 Ir1IW J.. yhpr y'by N1111tl A n"IMI'p tLP , �xivvo II I. f - 'lie l'Irdlq'll .il x�. ,. :: I.w ra,,l II. II w, 11 Illy pro, le Ihl II ..�. Ir it I • I - 1 ii 1 7 0 1 !1, 5,336.017 5,401, 116, 5,401.459. S.f 4 i. r _.'; t A. S.BA <l t. i15 2.(04r l Omer nmlents Pencling. ,f SdFVw I.1er ale req,siered Irademarks of Inflllralor Systems in, I Irn11 r:1, w0n i ll I - I,,, I, Iroliralor Sytileniti Inc,. ICO CO Ic.Ur, (70n10U1 Swivel nr1P nl M � � I I ,. .. a Co .cI ( rcroLCacl'I lib � i� � .1. IInUCI:>1)acC 1�'.151L:ICK. OIACkCIII. OuICkF lnv fcrcl EDoa c Eq a,l s )I Infiltrator Systems Inc. 0 2003 Infiltrator Sysionls Inc_ 1 on ul Polylok PL -525 Support Stand AIV L L 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 exteriton pipe needs to be anchored to the filter housing with one or two #10,X 112" SS screws. r i ® Anchor 1 -2 Stainless steel screws through housing and into pipe. Use #10X112 i -- 6" Schedule 40 Pipe Pipe rests on bottom of tank -- ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer l C�- a--° G L G i Mailing Address Property Address 1 3 ( (o c r? aA ..� (Verification required from Planning Department for new construction) City/State Parcel Identification Number JQ�f 15' 000_64-(01 l - 70 � pD LEGAL DESCRIPTION Property Location ' /,, i /, Sec. T 3 C-- -R (8 W )Town of W tGk AA0 A Subdivision W t kt-o w R 1 . a m r B A s Lot /# `Z tifi Z— Cered Survey Map # Volume Page # `f 0 Warranty Deed # -7 9 L l S Volume Z 7 8 , Page # _,:� - 7 7` Spec house W yes i] no Lot lines identifiable / yes O no SYSTEM MAIN'T`ENANCE Improper use and maintenance of your septic could result in its premature failure to handle wastes. Proper mama e c consists of pumping out the septic tank every throo.years or sooner, if needed by a licensed pumper. What you put into th 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 b., a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on - site wastewater disposal sys; is in proper operating condition and/or (2) ,after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sl.:d�c. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the stand :d set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certifllc= eo:: stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office «d 1� G days of the three year expiration date. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that a�,statements on this form are true to the best of my (our) knowledge. I (we) am (are) the the proper y de ribed above, by of a warranty deed recorded in Register of Deeds Office. SIGN OF APPLICANT DATE • • •' •' Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Depar=eo: " 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 decd - :.-_ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page FILE INFORMATION �� k C�p ( SYSTEM SPECIFICATIONS Owner J /LL F- 4. /�0. E5 LL t Septic Tank Capacity Z 5 b g al ❑ N .Permit # Septic Tank Manufacturer ❑ N� DESIGN PARAMETERS Effluent Filter Manufacturer L Number of Bedrooms ❑ NA Effluent Filter Model O N Number of Public Facility Units ❑ NA Pump Tank Capacity al 0 N;, Estimated flow (average) al /da Pump Tank Manufacturer ❑ N Design flow (peak), (Estimated x 1,5) ( �© al /da Pump Manufacturer ❑ N Soil Application Rate gal/day/ft' Pump Model ❑ N. Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ N- 1 Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand BOD 5220 m L Yg ( 6) g/ ❑ NA ❑Mechanical Aeration ❑Wetland i Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) C N� Biochemical Oxygen Demand (BOD 530 mg /L In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA 0 At -Grade ❑ Mound I Fecal Coliform (ggometric mean) 510` cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: Other Other: ❑ 'values typical for domestic wastewater and septic tank effluent. Other. ❑ N,: MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y,) of tank volume ❑ N4, Inspect dispersal cell(s) At least once eve ❑ month(s) (Maximum 3 ears) N:: �'' ❑ ❑ year(g) y Clean effluent fitter At,least once every: I ❑ month(s) n N:: year(s) Inspect um p ❑ month(s) p p, pump controls &alarm At least once every; ❑ year(s) El N Flush laterals and pressure test At least once every: ❑ El year(s) Other: At least once every: ❑O Y a ❑ N j Other: —i ❑ N MAINTENANCE INSTRUCTIONS t 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. Tare. inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or ieaKs 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 pones._ of effluent on the groOnd surface. The ponding of effluent on the ground surface may indicate a failing condition and requires tr e 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 dispo$ed of in accordance with chapter NR t Wisconsin Administrative Code, All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretream - 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. I r ` Page Z of 7/ =• J 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 utiliized 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, aot 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 alua ' 110 luplatmllellt alud i S avail a o mg ank b of e '�RD}�I� Ti✓� FOR- /AI aNSTRUC - l DN O 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 b POWTS INSTALLER POWTS MAINTAINER Name M -� O ljaFtt Name Phone (_0 L . S 1 �'� Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name S l b Phone Phone /S— 3WCp- (0 D Th document was drafted in compliance with Chapter Comm 83,22(2)(b)(1)(d) &(f) and 83.6411►, (2) & (3), Wisconsin Administrative Code. 794345 U Z 7 9 S P 3 7 9 KATHLEEN H. WALSH State Bar of Wisconsin Form 2 -2003 REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO., WI Document Number Document Name RECEIVED FOR RECORD 05/06/2005 01:00PN WARRANTY DEED EXEMPT t THIS DEED, made between Miller Homes of Hudson. LLC ( "Grantor," whether one or more), . REC FEE: 11.00 and Jon A. Nickell TRANS FEE: 240.00 ( "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 needed, please attach addendum): Name and Return Address Lot 22, Plat of Willow River East in the Town of Richmond, St. Croix County, Wisconsin. a �n 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: asements� ictions and rights -of -way of record, if any. Dated 51 Miller Homes of Hudson, LLC J � j L —i (SEAL) (SEAL) * *By: E. Miller, Me m r (SEAL) ( (SEAL) * *By: Leo A. Draveling, Member AUTHENTICATION ACKNOWLEDGMENT Signature(s) l '� authenticated on STATE OF1-- ) ) ss. C OUNTY ) * TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on 0� ilf �j (If not, the above -named Miller Homes of Hudson, LC authorized by Wis. Stat. § 706.06) BY: Some E. Miller, Member and Leo A. Draveline, Member THIS INSTRUMENT DRAFTED BY: to /?re known to be the on(s) who executed the foregoing i t me t and ac owl d the same. Attorney Kristina O„gland Hudson, WI 54016 * Notary Publ , Stat o 1 My Commis ion (is permanent) (expires: (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORDS. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 * Type name below signatures. Tracy L Turner INFO -PROTM Legal Forms 800-655 -2021 www.inloprofonns.=n Notary Public State of Wisconsin Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3— Division of Safety and Buildings in accordance with Comm 85, Wis. Aim. Code e- / Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must !c Include, but not limited to: vertical and horizontal reference point (BM). direction and Parcel I.D. 0 � percent slope, scale or dimensions, a � to nearest road. (o u v Please prJr f all n rmaon.`° Reviewed by Date Perso"M hdbmwtion you provide may be for secondary p (Privacy s. 15.04 (1) (m)). / Property Owner \ .=r M t e Property Location Govt. Lot W� 114 1/4 S• T N R 4 0 E( W ProperiyOwner' r'h:li�G OFFICE BlOdc# Subd Name or CPW 1(�'L& City Pete , Zip Code Phone Nuanber ❑ city ❑ V T Nearest Road ' ,1h New C=ftcdon Use: n Residential I Number of bedrooms 3 Code derived design flow GPD ❑ Replacement ❑ Pubic or commercial - Describe: — Parent material Oa-t -c 1 �� j� FloodoPlaln elevation if applicable /i-1 I3 ft. General comments and recommarKlations: 5y Ske, ,, G le` ck :;(. � Boring # Borkv a a Pit surface slay. 2,Zit Depth oo Uniting factor in. Sal Application Rate H=w Depth Dominant Color Redox Description Texture Strucb" Consistence Boundary Roots G PQW In. Mimsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'E11#1 *Eff#2 g - ,-- s � y a✓l} y7 X - Z - ® earing # / � Pit Ground surface clay. � DePlo to knift favor �-=-- in. Sol Rate Horb= Depth Dominant Color Redox Description Texture Structure Consistence Bound/ Roots GPDW In. Munsell Q u. Sz. Cont. Color Gr. Sz. Sh `Ef1#1 'E1f#2 L 2 r;-?!).- m p✓ c S Z r'yl ! s � LL rM 1 9 K MAY, 0C 3 1 . y ,� S c I ✓1 a ►� a 7 �. Z. • Effluent #1 = BM 30 220 mglL and TSS >30 < IV ' Effluent #2 = BOD < 30 mglL and TSS <_ 30 mglL CST ( ) �Z> s Address Date Evaluation Conducted Telephone Number r — — �- t Property Owner Parcel ID # Page or 3 1 B oring# ° Pit Ground surtace elev. % ' ft. Depth to Wnffing factor in soy Awkinjon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Mtmsell Ou. Sz. Cont Color Gr. Sz. Sh. 'Ef1#1 '01#2 2 - 1 TA S b k ry► W Z 3 Boring I t� Q # p Bortrrg ❑ Pit Ground surface elev. ft Depth to lirri ft factor in. Sol Applicabon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDNf In. Munsell Qu. Sz. Coat. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 # ❑ awing ❑ Pit Ground surface rev. ft Depth to WnWng factor irn Sol Awkedon Rate Horizon Depth Dominant Color Redox Descroon. Terdure Stricture Consistence Boundary Roots GPDflf In. Munsel Ou. Sz. Cont Color Gr. Sz. Sh. 'EB#1 'Eff#2 Eftm t #1 = BOD, > 30 1220 mg& and TSS >30 150 mg& ' Effluent #2 = BOD, E 30 mgil. and TSS < 30 m9 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. ssoaawtnsroo> Soil Test Plot Plan Projects Name David Railsback Shaun Address 845 133rd Ave New Richmond Wi 54017 #226900 Lot 22 Subdivision Date 12/12/02 SW /NW 1 /4SW /NW1 /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 System Elevation 96.2/94.2 *HRPSame as Benchmark Alt. BM Top of Steel Fence Post @ 104.0' 300' Property Please Note: Tested area may not be Line suitable for desired building area. Check system location before excavating. Soil test was done to satisfy Zoning Requirement. 100' B -3 99' 30' _ 98' j v B -2 40' 40' -1 6% -� Slo 75' AA .MJ1 M.a 316' Property Line