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HomeMy WebLinkAbout030-2139-02-000 } ° \ 0 ' / 0 \ � \ � ' £ � ( � $ � $ k � LL ] � q � J . � f % / w E z ¥ § G«' § Z CL In � § \ • B z 2 _\ ■ 2 Q z D U) J � 9 ƒ .� a . / o \ k (D � lot _ k E « � 0 k § 2 k \ w \ k CL ) 0 IL ~ j k k k L 2 E § @ 0 0 0 •� t § a a a i 0 & _ 2 � v \ \ 2 L) § § \ E CD ] @ S _ § 'Eta < g ± § 2 2 # z e m 2 2 r § o \ ° § C) IT w 7 ® 8 S . \ \ �� 0 ' r P & a § m � A $ d § - a / k] $ j k \] 0 - g o nq o z_ a m g « & 2 E J 2 D E k a = k 0 a m 3 cn J . X33 H/Y,� „�,. :. ,.a i %/F� ,n 3S \T??.a�NR \..\v .::'..., f ,.:�Yr�:���,YY,9�Cr"�•::': '.:���e .. .. .. . \.a \ie.e' /. /ii�.:�. �... '. s a ,,, _h/,tn' irnY, +n F �R... Y /, %!LFL<:'::N..?/YiFF:t%��&. k� wk� 3 ST CRO' c OUNTY PLANNING & ZONING FAX MEMO , J DATE: Z& o To: r z L S T-� -. Code Administratz FAX N 715 - 386 -4680 U 2 Z /s Land Information &, Planning FROM' gp, 715 - 386 -4674 � / FAX NUMBER 715 - 386 -4686 Re715 -- _4677 PHONE NUMBER: R cling Z - 386 -4675 NUMBER OF PAGES, INCLUDING COVER SHEET: 2�0 �✓ y ' Z s4oz-� jay 60- ST. CROIX COUNTY GOVERNMENT CENTER 1 10 1 CARMICHAEL ROAD HUDSON, Wi 54016 715 - 386 - 4686 FAX PZ @CO.SAINT- CROIX.WI.US WWW .CO.SAINT- CROIX.WI.U Wisconsin Department of Commerce Count PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 463326 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 St. Joseph, Town of O 3 Q� - :t ) 3 g o ° ° v CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: i( - C_ S 04.29.19. z 01 10 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Alt. BM /C3 C Aeration Bldg. Sewer Holding St/Ht Inlet 2_7 zw TANK SETBACK INFORMATION St/Ht Outlet 5 TANK TO P / tt WELL :BLDG. Vent to Air Intake ROAD Dt Inlet \ �J Lti! Septic + Dt Bottom A Z0 Dosing Header /Man. Aeration Dist. Pipe ; 01'C CM - _ ( 7 Holding Bot. System Il ,� `►7. S 6At Final Grade PUMP /SIPHON INFORMATION �` �• �s3 SS Manufacturer Demand St Cove_ (OZ- GPM Model Number TDH Lift , Friction Loss System TDH Ft Forcemain Length Dia. Dist. to Well ` SOIL ABSORPTION SYSTEM BED /TRENCH Width s Length No. Of Trenches PIT DIMENSIONS No. Of Pit Inside Did. Liquid epth DIMENSIONS '3 �7 Z SETBACK SYSTEM TO G � P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:. -n J INFORMATION CHAMBER OR ,/ -✓1�-� =•�C►� Type Of System: -30 �+ � / UNIT Model Number: i C JQ__44ou c 7 ' L 7 ► � � ��} DISTRIBUTION SYSTEM SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to r Irr�kk�e q Pipe(s) • Length 1 i 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 Mul ed Bed /Trench Center /� �� Bed/Trench Edges Topsoil \ Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:_ Inspection #2: / / Location: 1154 56th Street Hudson, WI 54016 (SW 1/4 NE 1/4 4 T29N R19W) Park Hollow Lot 2 Parcel No: 04.29.19. 1.) Alt BM Description = �:, cbo l 2.) Bldg sewer length = 8 xk � � &, � CLl_ee� - amount of cover = �" Plan revision Required? Yes No Use other side for additional information. Date Insepctor's gnature Cert No. SBD -6710 (R.3/97) Safety and Buildings Division County ` 201 W. Washington Ave., P.O. Box 7162 ,5'f- 2t9 ( K Madison, WI 53707 — 7162 Sanitary Permit Number (to be filled isconsin (O i y Co.) Department of Commerce (608) 266 -3151 /_ V Sanitary Permit Application Sta Plan I.D. Number (0 In accord with Comm 83.21, Wis. Adm. Code, personal information you provide AJ A maybe used for secondary purposes Privacy Law, s15.04(1)(m) Project Address (if different than mailing address) 5 77T4 E7 I. Application Information — Please Print All Informati n s -w CSI 1r_=M roperty Owner's Name - Pa r cel # t # Block # ��'/'� �1 lU(1;' 030 „(o1S/ i �L� , o 2.. Property Owner's Mailing Address , i? i r J i, roperty Location F - t Ci State J V4, V•, Section ty, Zi Code Phone Number Ar-A 4-S (circle ciaffi t9"YF; W / O 70 C. T Z 1 N; Rj LE or II. Type of Building (check all that apply) J thy` Y , 1 or 2 Family Dwelling —Number of Bedrooms / UU Subdivision Name _CS El Public/Commercial — Describe Use ?A 1- 14* 1IO t,,! — K& f ❑ State Owned — Des ribe Use Z "ark -1 2 ,7S I ti F_NCYa S 1 �a ❑City ❑Village 1 ownship of S01 fy O's CJ_ B;oD: �S.rs -r �- � c r III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System y El Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Permit Change of ❑ Transfer List Previous Permit Number and Date Issued t a s fer to New Before Expiration Plumber Owner IV. Type ofPOWTS System: Check all that appl `>e Non — Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerebic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter aching Chamber ❑Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis ersal/Treatment Area Information: 4111y 5 ^I" •D Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Requir (so Dispersal Area Proposed (so System Elevation tV I.Ta Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Fadsting Tanks Tanks Septic or Holding Tank Aerobic Treatrnon, Unit I w _ l0 1F Dosing Chamber L ff VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's SignatuUe MP/MPRS Number Business Phone Number • M. .0 .1 (0 4 / - I G S = Z- PlumiAddress (Street, City, State, Zip Code) cD2o v e,✓ V' 4 f Q_ QQ 4v9.so UJ Sly VIII. oun /De artment Use Onl UeKpproved ❑ Disapproved Sanitary Permit Fee (includes Grounds ❑ d ter Date Issued suing Agen ) Sign a (N S ps) Surcharge Fee) T (J a/ � /� � a Owner Given Reason for Denial IX. Co itions of roval/Reasons for Disapproval ) STEM OWNER: S ept ic c, effluent filter and P�,,,�,n dispersal cell must all be serviced ! maintained setb per ack r m 2. ack requirements must be maintained as per applicable code /ordinances h Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches ins' SBD -6398 (R. 01/03) N r rr) LA FI D � C 0 Ll \ 1 ti`s W 1 Qu II � r b o A G � S N �d Z ro ` a D W J M ll %J cc Q a �d 9 pax 0 n 'y M i M .� r r t� w pcl hi � a V p U PA t I J r �" O p Ck i N In s 6N n r 1 c p L - 1 ^` a w I p O o a J rN G � � J BioDif fuser Specifications C= Chantv End Ww '4' Knockout Universal End CaP Chamber 11" Stan• 14" High 16" High •• • • - Dimensions dard Capacity Capacity fit... ° .• • : w it:: r.J�. �t .. ... .,: %' . .' 1 � fIS ,y.If "P✓ �I.w• �. .. ..Y �! •..1t :�� W�� I . I. .... {..i• ,fiSiT.�Yo�rlt.ulLdaife }•. . 1 ` ,� y .- • I ' .••� * �M:s w•�"I�1 � k•1 � �� � 4 ��JI '! NI..v....41$1�+,, -: +; ��., .� t X i e hz A t ,� •,1•C .t�ryv�`•�� y.i.�+ � . ,} ; yC%t}S y ;:1►�' j L ���41'1'f�'�'+RMC: �'..� ►►.�....... .�ui� '•!',,r`�. i �y''';�„Y '. j 6: ��� \a7�;i0V I ,1 v . 1; , �:`.',•. 1 � b �Y t f �. � J 1 1� � v ( 1• it�. t+ FFI !�Ab� !••I1`L�1r1..1��1��.'!Yi! .� P'. e:tr�..M?Y:�! tig9 RECEIVED r ' JAN 16 20 A IL EVALUATION REPORT 1748 Wisconsin Department of Corn Page t of 3 Division of Safety and Buildings S T.Ci O 'O COtn 85 Wis. Adm. Code A.C.E. Sal & Site Evaluations County Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must St. Crop( - include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. Pending from 030 -1014 50-0 Please print all information. R viewed B Date Penal information you provide may be used for secondary purposes (lacy Law, s. 15.04 (1) (m)). y- Property Owner Property Location Sam Miller Govt. Lot SW 1/4 NE 1/4 S 4 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# P.O. Box 151 2 Park Hollow City State Zip Code Phone Number City Village ✓ Town Nearest Road Hudson WI 1 54016 1 (715) 386 - 2769 St.Joseph I River Road ✓ New Construction Use: ✓ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Install two trenches at elev. 99.50' using 28 leaching chambers- -� ae a Boring # ✓ Boring 2ao Pit Ground Surface elev. 104.07 ft. Depth to limiting factor 115" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/flz E in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -12 10yr3/3 none sil 2fcr ds as 2f,1m 0.5 0.8 2 12 -28 10yr5/4 none sil 2fsbk ds cs 1fm 0.5 0.8 lv 3 28 -34 7.5yr4/6 none gr is 1msbk ds cw 1f 0.7 1.2 '} 4 34 -50 10yr4/6 none gr Is 0 sg dl cw if 0.7 1.2 f 5 50 -89 10yr5/6 none s & gr 0 sg dl gw - 0.7 1.2 -0 6 89-115 10yr6/4 I none s & gr 0 sg dl cs - 0.7 1.2 s & gr very moist at 116'- 132". No redox. features observed. Max. depth of system= 97.50'. i Boring # Boring ✓ Pit Ground Surface elev. 103.43 ft. Depth to limiting factor 112" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 1 0 -10 10yr3/3 none sil 2fcr ds as 2f,1 m 0.5 0.8 (� 2 10 -29 10yr5/4 none sil 2fsbk ds cs 1fm 0.5 0.8 (P 3 29-38 7.5yr4/6 none gr Is 1 msbk ds cw if 0.7 1.2 4 38 -50 10yr4/6 none gr Is 0 sg dl cvv if 0.7 1.2 . 5 50 -93 10yr5/6 none s & gr 0 sg dl gw - 0.7 1.2 6 93 -112 10yr6/4 none s & gr 0 sg dl cs - 0.7 1.2 s & gr very st at 112" - 130". N redox. features observed. Max. depth of system ' Effluent #1 = BOD 30 < 220 mg/L and SS >30 < 150 L ' uent #2 = BOD s mg/L and TSS <30 mg/L CST Name (Please Print) nature: CST Number James K. Thompson 5 - 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, 20 11/1 3t2003 715- 248 -7767 Property Owner Sam Miller Parcel ID # Pending from 030 - 1014 -50 -000 Page 2 of 3 3] Boring # Boring ✓ Pit Ground Surface elev. 105.02 ft. Depth to limiting factor > 119" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -9 10yr3/3 none sil 2fcr ds as 2f,1m 0.5 0.8 • ( 2 9 -24 10yr5/4 none sil 2fsbk ds cs 1fm 0.5 0.8 ,(p 3 24 -36 10yr4/4 none gr sl 2msbk dsh cW if 0.5 0.9 , to 4 36-41 7.5yr4/6 none gr Is 2msbk ds CW if 0.5 0.9 , 5 41-45 10yr4/6 none s & gr 0 sg dl gs - 0.7 1.2 -� bb 2 y `� 6 45 -87 10yr5/6 none s & gr 0 sg dl gs - 0.7 1.2 .- I 7 87 -119 10yr6 /4 none s & gr 0 sg dl - - 0.7 1.2 Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz, Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 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. s ' • � 5Ci %�Q ✓Q�ICQ�iOn P; . Pcai�c-d prop. Sva,t'e 5ca /c: �= y0 , /at 2, Pld of A,'- /A All /oSo co„��ar f ti _ 83. �it�p�/SQ✓ ce /ova' 8j. 49 33' 5'89' Town Qoo.d St Assu,►,cd a lei =/DO. �. /I/ 3 o�-3 Preliminary PIi {t c Park Hollow St. Joseph Township, ,S` Croix County, Wisconsin UNPI -A TTED LAND_ Ca' RWN. frmnem, 1 - -- „r tlrlc: LOT7 \ TOTAL AREA �� \ v LOT.B IJ1,359 to. ft s a:',o TOTAL ARErI: LOTS 3.02 1JQ7D0 eq./1, TOTAL AREA. Y. SOLDABLE AREA: �o r \ 100 acres IJI,006 so. ft 9-,762 sq.1L q 1. =rum nel \.., NET BWLDABL£ AREAL 101 acres 2.15 acres 4 99, B62 sq. ft. NEr BUILDABLE AREA: LBO. =B6J0' MINL 229 oars 101,202 sq. ft. Mf.O' / I /� \ 232 acres L.L.B.O.-P-84.5' .i 5 +.5.' S 5' l 6� A � Cos me r ��)• 0 61 tots l l 7 y �tl,rmr.... K � .:. \^ . AI7.5'..f'i. !O f rL7T41�. -- __ -- 131,708 s4 ft J.02 aces \\ 1 LOT 6 NET BUJOABLE AREA: j TOTAL AREA: 77,;22 sq. R. u, 722 sq a ft. 1. ) c acres n' 3.J2 ogee LOTS NET BUILDABLE ARE TL1 rAL AREA: !0.9,369 sq.ft. 132,515 eq. ft. _ ro.m nar ^ 2.49 acres 104 acres H wr - NET BUILDABLE AREA: w �� c,Tf� e7RS' -- 11 a 860 sq. ft. v g ! 255 acres a o X61 j1 / F Lars I TOTAL AREA: 130,907 m7. ff. LOT V j JOf ocr!s I TOTAL. AREA' NET BUN. `ARLE = O EA: 1 ' _ 89, +es sL.:2 J i �� r 10x) acres _. j I 2.05 ocLo6 - ./ _ / NET BL/RDABLE AREA: — � / 7 4,446 L 1.71 oes a LOT7 / t �/ 7i wrc /l Sy ✓�ro.:,... ' rss c' TOTAL AREA Cnr nfnr a 732.039 sq. 11. rr. 3.03 acres NET BUILDABLE AREA: MNE = I. 72973 aq.ft. / / Z - q\e7s1 67 L� LOT K 3, TOTAL AREA: " ( 131, sq. ft 1— .102 ores T BULDABlF AREA: LOT ft 124,398 sq.R. % TOTAL AREA: LOT /� D 2.86 acres 131,306 sq.ft. rO rAL AREA: 731,253 s .R. Praposed Dri�e.oy .1 of noes Q --- l2' ( /l. Jdv Easernen! NET BULDABLE AREA: 101 acres [ocollon (I�p,r 66,-55 sgJt.,� .- - NET BLILDABLE AREA I �_ 9, 6 sq, It. acres - L.B.O.-881.5' 1.83 acres _ L.B.=881.5' 11,24 • 12 Lot Development • Lot and Home Packages available Starting at $270,000 ' filler Homes and Home Realty Leo Draveling Broker Associate HOMES Hudson, Wisconsin I H Direct Phone /Faz' 715.531.0714 Email: millerhomes_wi @yahoo.com ST CROIX COUNTY SEPTIC TANK MAIN'T'ENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 5 �N'1 /3'/ /� �-�-� — a- / &A bra LL� -7 A Mailing Address � � l0 �. � �� b Property Address << y s4 *K S T - e - Ea -- " (Verification required from Planning Department for new construction) City/State Parcel Identification Number o LEGAL DESCRIPTION Property Location 5 W '/4, 1Y� 'A, Sec. . T Zy N- R _AQ Town of St SO Subdivision P -r ds H ©LL O L4J , Lot # z__ Certified Survey Map # 74' 3:5- �� , Volume 1 . Page # S Wa anty De Volume Z P ge # 0 C 3 l.0 ! �'� m / / ✓, - 7 0 6_36 Spec house ;K yes ❑ no Lot lines identifiable Xyes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system - The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the st.tndards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Off1ce within 30 days of the three year expiration date. C 5ff NA OF APPLICANT DATE OWNER CERTIFICATION owne s of that all statements on this form are true to the best of m r( ) I we certify Y ( our) knowledge. I (we) am (are) the ( ) fY the described a ve, by virtue of a warranty deed recorded in Register of Deeds Office. W'7 ;A), z /zo /mss IGNA APPLICANT DATE •••r•• Any information that is mis- represented 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 certified survey map if reference is made in the warranty deed t Ste. M t L4.K'rf-- PAM<, No tl o w C -b 7 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner /Y)/ e_t d'! / 65 LLB Septic Tank Capacity Z ' ❑ NA # Permit � S al �� Z Septic Tank Manufacturer w t. ' S C_'- ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ZA 5 " (_ ❑ NA Number of Bedrooms � ❑ NA Effluent Filter Model A _ D O ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity al ❑ NA Estimated flow (average) gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), (Estimated x 1.5) 0 O g al/day Pump Manufacturer ❑ NA Soil Application Rate D. 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 In- 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 ❑ 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 eve ❑ month(s) (Maximum 3 ears) ❑ NA �' ear(s) y Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cellist At least once every: ❑ month(s) (Maximum 3 years) ❑ NA N year(g) _ 2 Clean effluent filter At least once every: ❑ month(s) ❑ NA fi' ear(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: ❑ month(s) At least once every: ❑ year(s) ❑ 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 dispoged 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. S UP AND OPERATION p age Z of 7i /new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals ,fiat 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 repl;� ent system: suitable replacement area has been evaluated and may be utilized for the location of a system. The replacement area should be protected from disturbance and compaction and should l not beinfringed upon tl 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. !v� T alua ' b a o mg tank e at e �flDf -{I'f3 rr�n �2. N,�/ CaNSr�erJca C31�J ❑ 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 TREATMENTJANK 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 t `bO NG LL Name "OOH�I/ Phone 6(2 . W ; - . I �2 Phone iz.��S - / SEPTAGE SERVICING OPERATOR (PUMPER) Nam LOCAL REGULATORY AUTHORITY S e Name Phone Phone -- J 3S 41, 60 This document was drafted in compliance with Chapter Comm 83 .22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. 7+B11SB U 2 7 0 4 P 5 3 6 KATHLEEN H. NALSH STATE BAR OF WISCONSIN FORM 3 - 2000 REGISTER OF DEEDS Document Number QUIT CLAIM DEED ST. CROIX Go., MI RECEIVED FOR RECORD This Deed made between Sam E. Miller, a single person 11/29/2004 03: 45PR QUIT CLAIN DEED EXEMPT # 15S Grantor, and Miller Homes of Hudson, LLC, a Wisconsin Limited Liability REC FEE 11.00 Company TRANS FEE: COPY FEE: CC FEE: PAGES: 1 Grantee. Grantor quit claims to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): Lot 2, Park Hollow, Town of St. Joseph, St. Croix County, Wisconsin Recording Area Name and Return Address Heywood, Carl & Anderson, S.C. 816 Dominion Drive, Suite 100 P.O. Box 125 Hudson, WI 54016 Part of 030 - 1014 -50 -000 Parcel Identification Number (PIN) This homestead property. (is) (is not) Together with all appurtenant rights, title and interests. Dated this day of November , 2004 * * Sam E. Miller * AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) ) ss. Signature(s) Sam E. Miller ST. CROIX County ) authenticated this day of November , 2004 Personally came before me this d" day of November , 2004 the above named Sam E. Miller - TITLE: MEMBER STATE BAR OF WISCONSIN �' ••• /" (If not, to me known to be the person(s) who e e • tl fore i p instrument and ,,ackn dged the sa authorized by § 706.06, Wis. Slats.) THIS INSTRUMENT WAS DRAFTED BY * 1 G .,. Heywood, Carl & Anderson, S.C., 816 Dominion Drive, Suite 100 Notary Public, State of WISCONSIN: y1 '•. Q a P.O. Box 125, Hudson, W1 54016 My Commission is permanent. (If not, sfaq%mtrert (Signatures may be authenticated or acknowledged. Both are not necessary.) !st (�(� / /• ' r '• +. l r .�� ) * Names of persons signing in any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN QUIT CLAIM DEED FORM No. 3 - 2000 INFO -PRO ( 800 )855 -2021 www,infoproforrns.com J 2 2 14 P 0 0 3 - 71824'9 (� KATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM 1 • 1998 REGISTER OF DEEDS WARRANTY DEED ST. CROIX Co., WI Document Number RECEIVED FOR RECORD This Deed, made between James E. Ebbe, an adult single man and 04/21/2003 03:00PN Thomas A. Ebbe, as custodian of Theodore A. Ebbe, a minor, under th Wisconsin Uniform Transfers to Minors Act WARRANTY DEED EXEMPT i Grantor, and Sam E. Miller TRANS FE E: 1 COPY FEEL CC FEEL PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (Ile "Property "): Recording Area Name and Return Address Sam E. Miller P. O. Box 151 H udson, Wl 54016 The SW 1/4 of the NE 1/4 of Section 4, Township 29 North, Range 19 West, St. 030 - 1014 - 50.000 Croix County, Wisconsin Parcel Identification Number (PIN) This is not homestead property. (is) (is not) v t Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except continuing easements and restrictions of record, if any. Dated this 17th day of April 2003 6�9&z 4L_- O/ / ames E. Ebbe . Thomas A. Ebbe cu – for Theodore A. Ebbe i' ACKNOWLEDGMENT AUTHENTICATI`O PUe4 4 0 1( k, STATE OF WISCONSIN ss Signuure(s) St. C roix County. OE r Personally came before me this 17th day of '— authenticated this _ day of �� P S April, 2003 the above named James E. Ebbe and Thomas A. Ebbe , h � 111 11';rr�+" 0 TITLE: MEMBER STATE BAR OF WISCONSIN (If not, 50 ersons o executed the foregoing get authorized by § 706.06, Wis. Ststs.) THIS INSTRUMENT WAS DRAFTED BY William J. Radosevich, Attorney at Law ` 502 Second Street, Hudson, Wl 54016 Notary Public, State of Wisconsin (Signatures may be authenticated or acknowledged. Both are not My Commission i rmanent. (If not, state expiration date: necessary.) 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