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HomeMy WebLinkAbout038-1196-60-000 ment of Commerce ' County: Wisconsin Depart PRIVATE SEWAGE SYSTEM St. Croix Safety and Buildigg Division 1 Sanitary Permit No: INSPECTION REPORT 399468 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan IDID N 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: Lakes and Hills Inc. I Star Prairie Township 038- 1196 - 60-000 CST BM Elev: Insp. BM Elev: BM Description: ( f& k ep .a ` t bo I S ('4 � TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark iLt, Dosing U Alt. BM Aeration Bldg. Sewer / � 0 J8-67' Holding SUHt Inlet & i (0 3 3s' 8. St/Ht Outlet 6 5V � i TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 2r �+ Dt Bottom Dosing Header /Man. TOAD . Aeration Dist. Pipe 13.6 3 OZ Holding Bot. System qo•S Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Mo umber TDH Lift P Fibtion Loss System Head TDH Ft Forcemain Length IDist. to Well i SOIL RPTION SYSTEM o ; . , SPERZ RENCH Pidth ( Length No. Of Trenches PIT DIMEN NS No. Of Pits Inside Dia. Liquid Depth DIME Z J C SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufa r: v ti INFORMATION CHAMBER OR t�e4) Type Of System: 3D 2 / UNIT Mod : mb r: DISTRIBUTION SYSTEM bp Header /Manifold (I Fistribution x Hole Size x Hole Spacing Vent to Air Intake es) Length eng Di 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 Yes ❑ No Ful Yes ❑ No COMMP (Include de discrepencie ons p per resent, etc.) Inspection #1: 1 �/ D1 Inspection #2: (AIo W_& OA Cw a 4%rA*i '_ . Location: 2165 132nd Avenue New Richmond, WI 54017 (S 1/2 NW 1/4 13 T31N R18W) Pine Acres Parcel No: 13.31.18.1030 1.) Alt BM Description = NI A ( pM �` 2.) Bldg sewer length= + Z D - amount of cover = > 3(, S.41 c v'N Plan revision Required? 0 R-9 2 3 (S- Use other side for additional ' form r Rte• ci��►� -e"r �+ 7tr7_ !w Date t Insepctor's Signature Cart. No. SBD -6710 (R.3/97) � r _ _ Q C�S , ti ff t C�1R N'� Ox JZ 2ZIV71 S 13 7°3 / NK18'41 407- 3 , ;22 Z Aloe PI'Ll - o lo® � co , 1 l � l r 1 t 6 . Jg � 30 1 \ � Jrl go I Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of J Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County 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 I nformation. Reviewed by Date n Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).L &� - , 2- Prrty Owner Property Location v Govt. Lot 1/4 y4l l 1/4 S' T / N R, E (or) Property Owner's Mailing Addr ss Lot # Block # Subd. Na or CSM# 173 F(4 3 s ` CICA.a-d, City State Zip Code Phone Number ❑ S a ❑ V' ge . 0 Town Nearest Road V& — U,..J I WZ - I Vo l7 0/-T )-NiS 2 New Construction User Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Pub' or commercial - Describe: Parent material [ Flood Plain elevation if applicable ft. General comments and recommendations: 9 00 0. (o " F—/1 ❑ Boring # I Boring w $d Pit Ground surface elev. 8 S ft. Depth to limiting factor 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 *Eff#2 0 -g 7S K 4 Za 1 L d&I Z -1 71 S y/ f In �- Qo •sue Z 5 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 GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 l - 1-Y1 L , S 7 4 _ c L w F alk 1 ? 0 -Tor a t — C4 % * Effluent #1 = BOD > 30 < 220 g/L and TSS >30 _< 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name (Please Print) ignature _ CST Number z 2 l et l Address Date Evaluation Conducted Telephone Number d ">*T oo I ?- - o I 2/J-,76 J GCS'7 SBD -8330 (R07 /00) Property Owner Parcel ID # Page Z– of 3 FY] Boring # ❑ Boring jq Pit Ground surface elev. 9 y o ft. Depth to limiting factor 7 �' Z 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 -- /'W sd! MYK ,y .S' F-1 Boring # E] 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 GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # ❑ Boring Ground surface elev. ft. Depth to limiting factor in. El Pit 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 *Eff#2 I * Effluent #1 = BOD > 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) Aa 2 z /Y7/ NW S / 3 - r 3 / Ne zd 7 3 5 l 8 .,a� Izz g� ' m Lori PAM' ,eo y 35 t� I 3 � q7 y-S 1 a t ate/ 2 • V Z St Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 Wisconsin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce [Privacy Law, s. 15.04(l)(m)] (Submit completed form to county if not state owned.) Attach complete plans (to the county copy only) for the system, on paper not less than 8 -1/2 x 1 I inches in siz County State a Pe rut Number ❑ Check if revision to previous application State Plan I. D. Number S C-� � t 1 I. Application Information - Please Print all Information Location: Prope per Nare D t r ) ; 1 ` `� , Pro erty Location 1/4 Wf /4, S 13 T3 I ,N, WrE (or) Pm Owner's Mailing Address Y s :`. Lot Number Block Number RdIVE0 a 3 86 Z�, s.., City, State Zip Code Phmber ��- Subdivision Name or CSM Number t.._ 14/1 - S/o 1 '7 �, ( II. Type of Building: (check one) CQllIVTy w� .ty ❑ 1 or 2 Family Dwelling - No. of Bedrooms :, � ZONINr, OPMCE lage ❑ Public /Commercial (describe use):_ / of ❑ State -Owned Nearest Road/ m2 S 68 - Is ' 4-rkAAAg Parcel Tax Number( III. Type o P ermit: (Check only one box on line A. Check box on me plicabl — 0 A) 1. ew 2. ❑ Replacement 3. ❑ Replace of 5. 6. El Addition to System System Tank O nly 3 , 3 d 30 Existing System B) Perm' ber Date Issued ❑ A Sanitary Permit was previously issued ! Type of POWT System: (Check al t apply) K- Non- pressurized In- ground d S ❑ Constructed Wetland ❑ Pressurized In- ground olding T OP ass ❑ Drip Line ❑ At -grade Aero ' ment �1�p ecirculating El Other: V. Dispersal/Treatment Area Informa n: 1. Design Flow (gpd) 2. Dispersal Area 3. ispersal Applicati 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed to (Gals. /day /sq. .� (Min. /inch) Elevation � ; y C�� z� �4! 3 �s'o 375 3 7 , � VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete strutted Tanks Tanks Op4 /C►e� � ❑ ❑ ❑ O 1 ❑ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on led plans. P Name (print) P Signature (no stamps): n /IvIPRS No Business Phone Number Plumber's Address (Street City, State, Zip Code) 3 7 Z yo S7` 4m -e , , .$ - z /00 IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuin gent Signatur (No stamps) AApproved ❑ Owner Given Initial Adverse Surc arge Fee) OD Determination 22 S , s � ��1 X. Conditions of Approval /Reapons for Dis pprovpl: « PAIL n fid ` - A ^ �� ►�.e. ^adJ 1 r �"�.' 'Ze -C}� c.j.so lmdQ -dam SBD -6398 (R. 07/00) 1 . l y l� h Zo7"' 3 Zz Iv7/ )i4le� 5 ". s ;Z2 rn �� 1 / ©o leo r yi d s� ? Off, ,- Zo7" 3.- 2 2 w 7 / w. NwS /ZI I kif /S' w t s Z, \ �qo it Wiwnrmin DopanmentorCommerce SOIL AND SITE EVALUATION Page 1 of •5 DNrsrvn o sarety and ouudtngs in accord with Comm 83.05, Wis. Adm. Code Attach complete she plan on paper not less fian 8% x I I Inches in size. Pian must County include, but not limited to: vertical and horizontal reference point (IBM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Patoal APPLICANT INFORMATION - p /eese print n/f information. .• _2c—dips. Perwor+el information you p"Pekla may be used for>;acondary purposes (PrNacy law, a. t5.o4 (1) (m)). Reviewed By Date Property Owner Property Location Lakes & Hills Dey2Lq clit -- Govt. Lot 114 NW 1 /4s 13 T 31 N R 1R �• W rope Owner's ar in ddress Lot # t3lock # ISutrd. Name or CSMO 35 - - - -� Ninc_ City brats zip �� de PhvneNumber — City llage �1`fown Nearest Road 6+� ►t� ca 15jile 7ye -e"'Y 132 Nd ST. ! ' ] New Construction Residential of Addition to existing buildin Use: sidntil / Number bd 3 �._.J 9 g - - - -- rI Replacement U Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd4F •8 trench, gpolfF Absorption area required 643 bed, ft 562 trench, ft! Maximum design loading rate 3 bed, gpd/T .9 tr ench, gpd/Ft" Recommended infiltration surface elevation(s) 94.3 _ ft (as referred to site plan benchmark) Additional design / site considerations Parent material - - - - -- w Flood plain elevation, if applicable - - -- ft rNUnsuitable Suitable for system Conventional Mound In Ground Pressure AT -Grade System in Flll ( Holding Tank for system N] S 1-1 U L1 S L.I a N S E. u Fj s F u I.] S M U 1:.� s [. ; u SOIL DESCRIPTI REPO Depth Dominant Color Mottles Structure l GP D/ftY Horizon Boring# in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistent Boundary Roots eed Trench 1 ( 0 -8 10YR3/3 --------- - - - - -- 1 'Imebk nlva as 1f .4 .5 2 8 -21 10YR4/3 -- ---- --- - -- l ltnsbk mvfr gw lvf I .4 S Ground 3 2� 7.SYR4/4 ----- ----- ---- -- cs osg ml g ---_ .7 .8 elev _........ _. 49 -80 10YRS /6 - cs os - - -- 97.3 ft 4 ----------- - ----- g ml 7 .8 Depth to —_ y s l �— _ z limiting - _ g 4 is .....7 factor - - _.- - - . _r_r- t_.__, ,/ 2 1 0 -10 10YR ?/3 _---- _-- _ - - - -- 1 J ltnsbk mvfr as if .4 .5 2 10 -25 l OYR4 /3 ------------ --- --- 1 ]. msbk. .0 gw 1 of .4 5 Ground 3 25 -45 7.SYR4 /4 --- ---_ -- cs esg ml gw elev - - - - -- -- - 98.3 ft. 4 45 -89 l 0YR5 /6 -- --- -- ----- ------ es o sb ml 7 S Depth to - - -- — ....._ -- - ........ .... .... . . limiting factor ..- - - -- -- i „ 1 A ­_.. I Remarks; _ _. _......... .................. .... _..... _ .................._._.... .. ...... ... ....... ... .... . _.. ... . CST Name (Please Print) Si nature: Telephone No. Ja klo cA Hawkitrs - 7- - k Y y� -- ....._J_— _ —� - - -- - - - - -. Z_.....__._._.... __ -._ .......__. _.. Add MRS L� Date CST Number Ref N 5 6 U G C_ ,l/4 c W, J 4/ 1 B 2 Z - aos Zd WHF_S:SO TOW 60 '�o0 TZbZZLb 'ON XUA WaZld % Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 • Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Attach complete site plan on paper not less than 8%z x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal referer+ve�p w#415M), direction and f • Lx d percent slope, scale or dimensions, north arro hj to tion and`dr?3t�nce to nearest road. parcel I.D.# ` - Pendin APPLICANT INFORMATION - Pspnnt a/lL,�nformatfon. Personal information you ide may be used r ' nda rewgd By Da Y P� Y ry p!uilposes,(Pxfjcy Law, s. 15.04 (1) (m)). Property Owner 1 perry Location Lakes & Hills Development i Govt. Lot 1/4 NW l t4, S 13 T 31 AR 18 Property Owner's Mali ddress ~' % Lot # Block # Subd. Name or CSM# 35 - -- Pine Acres City State Cede, "Mbowz City llage own Nearest Road lv i'tr t� � ,✓ t� -v �� '. 'e ; 132 Nd ST. ❑ New Construction Use: Reside / ' bedrooms 3 ❑Addition to existing building ------- ❑ Replacement ❑ Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate .7 bed, gpd/ftz .8 trench, gpd/fF Absorption area required 643 bed, ftz 562 trench, ft' Maximum design loading rate .7 bed, gpolftz .8 tr ench, gpd/ft Recommended infiltration surface elevation(s) 94.3 ft (as referred to site plan benchmark) Additional design / site considerations Parent material - - - - -- Flood plain elevation, if applicable - -- - - -- ft S= Suitable for system Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system ® S❑ u ® S❑ U ❑ S❑ U ® S U ❑ S ®U ❑ S N U SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Texture Structure Consistent Boundary Roots GPD/ftz Borin g# in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -8 10YR3 /3 I lmsbk mvfr as if .4 .5 2 8 -21 10YR4 /3 ------------ - - - - -- 1 lmsbk mvfr gw 1vf .4 .5 •`� Ground 3 21 -49 7.5YR ----- - - - - -- - - - - -- - cs osg ml gw - - -- .7 8 elev - - - - -- — - - -- - = ft. 4 49- 0 10YR5 /6 ------------ - - - - -- cs osg ml - - -- 7 8 �- Depth to - - -- -- - -- — -- - - -- + limiting 60 factor >80" 3 b Remarks: -- — - - - - - -- - - -- - - - - -- 2 1 0 -10 10YR3 /3 ------ - - - - -- 1 lmsbk mvfr as if 4 .5 - -- - - -- 2 10 -25 10YR4 /3 -- ---------- - - - - -- I lmsbk mvfr gw lvf .4 .5 Ground 3 25 -45 7.5YR4/4 ------------ - - - - -- cs osg ml gw - - -- 7 8 elev - — 98.3 ft. 4 4 - 89 10YR5/6 ------------ - - - - -- cs osg ml - - -- - - -- .7 .8 Depth to limiting .fig o factor >89 Remarks: -- - -- -- - - -- — - -- - - - - - -- — CST Name (Please Print) Si nature: Telephone No. Jacque Hawkins z Add ss ~fL► / Date CST Number Ref# fro U aW E A 4c W ,VP.� 4/10/00 8'� Z 408 PROPERTY OWNER: Lakes & Hills Development SOIL DESCRIPTION REPORT Page 2 of, 'PARCEL I.D,# Pen Depth Dominant Color Mottles Structure GPDI Trench ft Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. onsistence Boundary Roots Bed 3 1 0 -10 10YR /3 ------- - - - - -- 1 imsbk mvfr as if .4 .5 2 10 -24 10YR4 /4 ----------- - - - - -- 1 l msbk mvfr gw l of .4 .5 Ground elev 3 24 -48 7.5YR4/4 ------------ - - - - -- Cs osg ml gw - - -- 7 8 97.3 ft. 4 48 -80 10YR5/6 ------------ - - - - -- Cs osg ml - - -- - - -- 7 8 Depth to �, r limiting factor >80 - - - -- - - - - -- - — Remarks: - -— - - -- -- - — - -- 4 1 0 -12 10YR3 /3 ------------ - - - - -- 1 imsbk mvfr as if .4 .5 2 12 -24 10YR4 /4 ------------ - - - - -- 1 imsbk mvfr gw lvf .4 .5 Ground - elev 3 24 -53 7.5YR4/4 ---------- - - - - -- Cs osg ml gw - - -- 7 8 - -- -- - -- 98.8 ft. 4 5 -94 10YR4 /6 - ---------- - - - - - -- Cs osg ml - - -- - - -- .7 .8 Depth to limiting factor Remarks: 5 F3 2 0 -9 10YR3 /3 ------------ - - - - -- 1 imsbk mvfr as if .4 .5 9 -26 10YR4 /4 ----------- - - - - -- 1 imsbk mvfr gw l of .4 .5 Ground 26 -47 7.5 ---- - - - - -- Cs osg ml gw - - -- 7 8 elev - - -- -- - - 98.8 ft. 4 47 -96 l 0YR4 /6 ------------ - - - - -- Cs osg ml - - -- - - -- 7 ! 8 Depth to limiting — - - - -- - — — -- - - factor >96" Remarks: Ground — - -- — elev Depth to limiting - - - -- — - factor Remarks: r P z r a- 0 2 a N 4 .� to �_. POWTS OWNER MANUAL 81 r'rNr�hvc� -,��f �..�+,• FILE INfORMATION SYSTEM SPECIFICATIONS Owner P .C- EAc.t,o J!4 AJ t0 C�ZL$�J Septic Tank Capacity t�0 al ❑ NA Permit # 9 Septic Tank Manufacturer U4 PRIM ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer C3 NA Number of Bedrooms 3 ❑ NA. Effluent Filter Model — ❑ NA Number of Commercial knits NA Pump Tank Capacity gal ANA Estimated flow (average) � gal /day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) c�� gal /day Pump Manufacturer tKNA Soil Application Rate 0-1- gal /day /ft' Pump Model i$CNA Influent/Effluent Quality Monthly average* Pretreatment Unit qNA ❑ Sand /Gravel Filter ❑ Peat Filter Fats, Oil a Grease (FOG) :530 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODs) :5220 mg /L ❑ Disinfection ❑ Other: Total Suspended Solids ( TSS) :_ 150 mg /L Manufacturer Pretreated Effluent Quality ❑ NA Monthly average* * Dispersal Cell(s) Biochemical Oxygen Demand (BODs) :530 mg/L Ig In- ground (gravity) ❑ In- ground (pressurized) Total Suspended Solids (TSS) :530 mg/L ❑ At -grade ❑ Mound Fecal Coliform (geometric mean) :510 cfu /100m1 1 ❑ Drip -line ❑ Other: Maximum Effluent Particle Size A inch diameter * Values typical for domestic (non - commercial) wastewater and sepd( tank effluent. * * Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Frequency Service Event Inspect condition of tank(s) At least once every ❑ months ,K year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one -third (Ys) of tank volume Inspect dispersal cell(s) At least once every ❑ months Ayear(s) (Maximum 3 yrs.) Clean effluent filter least once every — 3 ❑ months 1F year(s) Inspect pump, pump controls at:alarm A!At least once every ❑months ❑ year(() NA Flush laterals and pressure test At least once every ❑ months ❑ year(() 9NA Other: At least once every ❑months ❑ year(() NA Other: At least once every ❑ months ❑ year(s) IT NA MAINTENANCE INSTRUCTIONS inspections of tanks and dispersal cells shall be made by an in carrying one of the following licenses or certifications: Ma: Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspectic must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure volume of combined sludge and scum and to check for any y back the observation p'pes to check for any ponding of effluent or cell(s) shall be visually Inspected to check the effluent levels 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. the entire When the combined a all be removed d a Septage Servicing Operator equa contents of the tank s and disposed of in accordance e with h vo NR 113, Wiscoi h Y Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatement components, and any other maintenance or monitoring at intervals of 12 months or less 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 f the presence of painting products or other cherr For new construction, prior to use of the POWTS check treatment tank(() . ll((). If high concentrations are detected have the he con that may impede the treatment process and /or damage the dispersal ce A( rl,a ranfr(sl ramov,- 'a ; sent;we servidng opera prior to use. i Page — of .— System start up shall not occur when soil conditions are (roam at the tnf ltradve surface. During power outages pump tanks may fill above normal hlghwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) In one large dose, overloading the cell($) 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 Servking Operator prior to restorinti power to the effluent pump or contact a Plumber or POWTS Maintainer to assist In manually operating the pump controls to restore ncrmal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal coils. Do not drive or park over, or otherwise dLswrb or compact, the area within 15 feet down slope of any mound or at -grade sod absorption area. Reduction or elimination of the following from the wastewater Weam 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; (Writ and vegetable peelings; gasolne; grease; herbiddes; meat scraps; medications; oil; painting croducts: pesticides: sanitary naokins: tamoonsi and water softener brine. ASAN DON EM ENT When the POWTS fails and /or is pemianently taken out of service the following sups shall be taken to Insure that the system is properly and safely abandoned In compliance with ch. Comm 83.33, Wisconsin Admintstrative Coder 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 property 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, grave( or another Inert solid material CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, w 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 from diswrbance and compaction and should not be Infringed upon by required setbacks from: existing and proposed strucwrv, lot tines and wells. Failure to protect the replacement area will result In the need for a new soil and site evaluation w establish a suitable replacement ana. Replacement systems roust comply with the rules in effect at that time. • A suitable replacement area Is not available due to setback and /or sod limitations. Barring advances in POWTS technology a holding tank may be Installed as a last resort to replace the failed POWTS- 0 The site has not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacewnt area. if no replacement area Is available a holding tank may be Insulted as a last resort to replace the failed POWTS. O Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the Infiltrative surface. Reconsuvctions of such systems ntust.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 TKE INTERIOR OF A TANK MAY RL DIFFICULT OR IMPMUR1 F. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name b&fj I GI t Na me Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name I - ncy T • C10 0C C /AJ Phone Phone — 09/18/2001 09:10 7152686637 GILLE TRUCKING PAGE 02/02 ST CROIX COUNTY U s SEPTIC TANK MAINTENANC AGREE ,�- AND OWNERS — HIP CERTIFICATION FORM Owner/Buyer 4 CyAi Mailing Address 523 & ' GA"% L±Ll— L4 Property Address a 1 (p 57 13 a_,Y-A + (Verifi.cation required from Planning Department for new construction) - � — .� ° City/State NeG����cs � Parcel Identification Number _ D3 I(q(v -fao - wo 13. % 1- 1 1 8- 1 ,0 LEGAL DESCRIPTI A` Property Location _ ' /., W ' /., Sec., T�N R-4_W, Town of [� Subdivision � n C r e.S P Lo1 # 3 S Certified Survey. Malp # \` Volume a Warranty Deed X Volume , Page # Spec house D yes El no Lot lines identifiably: ❑ yes ❑ no SYSMM MAINTEN Improper use and m; datenance of your septic system could result is its premature failure to handle R aster. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. Wh, I you put into the system can affect the fivmction of th:: 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, signs d by the owner and by a master plumber, journeyman. dumber, restricted plumber or a licensedpumper verifying that (1) the on -site u astewaterdisposal system is in proper operating coud.ition and/or (2) after, inspection and pumping (if necessary), the septic tank is lei s than 1/3 full of sludge. Uwe, the undersigned have mad the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by th Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating t your septic systeri has been maintained must be completed and returned to the St. Croix Count} - Zoning Office within 30 days o e three ear xp' SIGNATURE OF PLICANT T,ATE OWN Ii CERTIFICA 1(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 p arty desc7d o e., b virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE O APPLIC.41d LATE * * " Any information tlic is mis resented man result in the eP Y sanit permit being revoked by the Zo: sing 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 l� V41..1517PAGE 272 KATHLEEN H. WALLSH REGISTER OF DEEDS Document Number Document Title ST. CROIX CO., WI r'' ff�� RECEIVED FOR RECORD v N cG r r, r. n A 06-07 -2000 4:00 P WARRANTY DEED EXEMPT I CERT COPY FEE: COPY FEE- TRANSFER FEE: 980.70 RECORDING FEE: 14.00 PAGES: 3 Recording Area Name and 1 Return Address NO r'Fh (kie r� ss , i iC r t C'9 C. r-w C"fl, 3 5-55- Uq J n, 15 C- nf("r L%. f u�a Na 15 P IZ IS44 S m^ y r ilo , lost' -Sf -coo Parcel Identification Number (PM p % � -- ( 0J- q _S o - © 0.C) 9 , C _ (ord —Go— Oct) L L I� 1 This information must be completed by submitter: document title name A return address, and pjN (if required). Other information such as the granting clauses, legal description, etc. may be placed on this first page of the document or may be placed on additional pages of the d te: Use of this cover page adds one page to your document and S2 00 ro the recordine fee Wisconsin Statutes, 59.43(2m) WA 715-32 (21") Form No. 1- M— WAkRANTY DEED Minnasota Uniform Conve in Blanks 1978 Holstad & Larson, P.L.C. Individual (s) to Individual (s) VUI- 1317PAGE No delinquent taxes and transfer entered; Certificate of Real Estate Value ( ) filed( ) not required Certificate of Real Estate Value No. 19 County Auditor by Deputy STATE DEED TAX DUE HEREON: $ (reserved for recording data) Date: May 25 20 00 FOR VALUABLE CONSIDERATION, George Marvin Birkholz and Marion Violet Birkholz husband and wife , Grantor (s), (marital status) hereby convey (s) and warrant (s) to Lakes and Hills, Inc. ,Grantees, real property in St Croix County, Wisconsin, described as follows: See attahced legal description together with all hereditaments and appurtenances belonging thereto, subject to the following exceptions: 7yj(1/u Affix Deed Tax Stamp Here George Marvin Birkholz Marion Violet Birkholz STATE OF Minnesota COUNTY OF Ramsey SS. The foregoing instrument was acknowledged before me this 25th day of May 20 00 by George Marvin Birkholz and Marion Violet Birkholz, husband and wife Grantor (s). NOTARIAL STAMP OR SEAL (OR OTHER TITLE OR RANK) �-�( f / I l T DEBORAH L. TEICH Tax Statements forme real property described in this instrument NOTARY PUBLIC - MINNESOTA should be sent to (Include name and address of Grantee): MY COMMISSION err EXPIRES JAN. 31.2D05 THIS DOCUMENT WAS DRAFTED BY (NAME AND ADDRESS) Lakes and Hills, Inc. PO Box 10622 Northwest Title & Escrow Corp. White Bear LAke, FIN 55110 3535 Vadnais Center Drive, Ste. #120 Vadnais Heights, MN 55110 56030 vo+.1517PAGE 274 EXHIBIT "A" Lots 1,2,3,4,5,6,7, 8, 9, 10, 11, 12,13,14, 15, 16, 17,18 ,19,20,21,22,23,24,25,26,27,28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, Pine Acres, St. Croix County, Wisconsin o�, t sq. tt. 1.56 ocr 1.91 acres ; 6066 ^ o A 4 \, - 61 .54' : A 99 j So3° 37 0 1 177.69' 0 O? C35 "� SIZ O 37 20� "W / 1 - --, \ I 76,537 sq. ft. 2 � 1.76 acres i .w o �, 32 v ^I 67,082 sq.f \ N 1.54 acres / ap p N ry /C ° .. ' 362.83 N00 °49'4t ?0 -or' ° °�i I `� 34.06, — 10 10 23 24 3.324 sq. ft. �I I 80,129 sq. ft. o t N I :°• .80 acres `"= 1.84 acres 10' 10, ^/ ��0 ►�00 E I N "E n � — 673.68'— X00 �4o N 378.98' ° 3 4 7 294.70' ^ b Z a c 6, ) T 3 ; Q 7 , 778 sq. ft. ? sq. ft. ,0 bI r �, 1.79 acres Gres � \ 35 N \ I CO 73,243 sq. ft. 12.00' \ 1.68 acres % i ; / ' N1 0 *0( ri ,Q SIO 00 001 C s w • n O � a) O O ci c 0� y YYY x County Register of Oe�ds co St. Croi 60 2 '29 "E .76 ��'� ,•'/ BEET C5 �`�" Todd M. Hendershott, RLS 2362 g � Registered Wisco sin Land Survey r Dated this /7 day of �� 2000 This instrument drafted by Todd M.