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HomeMy WebLinkAbout040-1306-06-000 s ` Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County. St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 506233 0 GENERAL "INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1 Xm)]. Permit Holder's Name: City Village X Township Parcel Tax No: Creative Homes Construction, LLC I Troy, Town of 040 - 1306 -06 -000 CST BM Elev: Insp. BM Elev: IBM Description: w Section/Town /Range /Map No: /0 0 1 M-� " 1 08.28.19.1833 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / / I 2 Benchmark Dosing / Alt. BM Fo m al Aeration Bl Sewe SC t-f / / Holding �l `-� 7 �J c TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet / r ' Septic r Dt Bottom Dosing rl n A / eader/ an. C f [L2 Aeration �* V3^ W px � Dist. Pipe �� S t F6 V -1� Holding B ot. Sys tem 3 Final e 7 PUMP /SIPHON INFORMATION r f 3 • '( Manufacturer Demand St Cover _ GPM 2.2 /CD Model Number Lf f rs� TDH Lift Friction Loss Head TDH Ft M C7kd Forcemain Lent Dia. Dist. to well tf V_ a- S �� " SOIL ABSORPTION SYSTEM C a ack BED/TRENCH Width ] Len th / } No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 0 �Gltd SETBACK SYSTEM TO � i � vvvv P /L! BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION — - T - Typeffl System: �1 /V UNIT Model Number: PISI� RIBUTION SYSTEM Header anifol r Distribution h x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) /_ + q Length lU f7Fa Length 117 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 1 xx Mulched Bed/Trench Center S c� Bed /Trench Edges Topsoil J r Yes No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: 1- / 30 / 0 ns ection # #�2: Location: 467 Dylan Court Hudson, WI 54016 (SW 1/4 NE 1/4 8 T28N R19W) Sunset View Lot 6 PNo�.28.T9.18S 1.) Alt BM Description 2.) Bldg sewer length =2� vvv -amount of cover= , r 1 _ 1_ Sy<" > dy Plan revision Required? Yes Vo 2 V Use other side for additional information. 7 36 Date jor Sign ury� l Cert. No. ;BD -6710 (R.3197) — 7 , r 1 � z X -3 - 2 a I'•+ �� 3° � I L, A G T 47#t ` b d #/ = ILiH� Toj� s� /' Tc�N Ler toc _ .loT CORNER Rob c -3 9s I r commerce .wi.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 C p i s co n s i n Madison, WI 5 3 70 7 -7 1 62 Sanitary Permit Nu (to be filled in by Co.) D of Commerce Sanitary Permit Application Stat e Transaction Number A1,4 In accordance with s. Comm. 83.21(2) Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary p urposes in accordance with the Privacy law, s. 15.04(t)(m), Stats. 1. Application Information - Please Print All Information � N� Property Owner's Name (� arcel # ,v Property Owner's Mailing Address Property Location / / S 3 3 Govt. Lot C ity, State Zip Code Phone Number fw y, �/,� y. Section ne P (ctre uZ yB� G �/ '� ��� .�!^« T N, R (circle L II. T e of Bui ding (check all that apply) Lot # or 2 Fami l_v Dwel linv_- Number of Subdivision Name U Q ,.�/G - 7 J> o hI cc- /H lock # ❑ Public /Commercial - Describe Use ❑ City of JUN 19 2007 � SNI Number ❑ Village of ❑State Owned - Describe Use � ST. CROIX COUNTY L7 Town of Ill. Type of Permit: (Check only o lie bay an line A Casuplet I if applicable) A ' kNew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. T of POWTS S stem /Corn onent/Device: Check all that appl S Non- Pressurized In -Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 4 in. ofsuitabllee{so�il 7�❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ W Other Dispersal Component (explain) Pretreat'men`t ice (explain) V. Dis ersal/rreatment Area Information: its DELL /S' 9s T Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal eq (st) Dis 1 Area Proposed (so System ElevatiorIO/ Jo �S f • S . VI. Tank Info Capacity in Total # of - Manufacturer Gallons Gallons Units U New Tanks Existing Tanks S � U in in rn w 0 Septic w4lolding4ank �Bmins ehamb— VII. Responsibility Statement- I, the undersigned, assume responsibility for installatigolPof the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP /MPRS Number Business Phone Number ,F0 gA;< I Plumber's Address (Street, City, Zte, Zip Code) 4�� 79-, 4Y _per a el ,7 3 /Z0 4(Z.z vG e _ 9 FA V111. unty /De artment Use Onl pproved ❑. Disapproved Permit Fee Date Issued [s ing Agem Si atu $ �SD (0 /2- 0/07 ❑ Owner Given Reason for Denial %1@M1 tc�"Ef�ApprovaUReasons for Disapproval C�h Septic tank, effluent filter and 3 ' � L dispersal cell must all be serviced / maintained (! ll as per management plan provided by plumber.. All setback requirements must be maintained pp CO tp system and plans for the syste and sub it to the County on on p � not les an S trz x I I " hes SBD -6398 (R. 01/07) Valid thru 01/09 �2S ' o �C o CD V . o W rA ;- ''►pfir� � W \ \y� m ® \ . • . - C n CD CD rA CD co M W \O r (1 Q oa 00 JO � cu CD 3 ()o 3 �C) ;o II II i x3 cj - - 2 ed y AAg^ � Pcd�LL /� = so y d / = ow, mp"p .awl �. �• / f 1 X .r jlo�sir/� � .CsT lorc.V,Eic lZOD 1Y / f ppc�(; Wisconsin Departmen of Corfl�ferP SOIL EVALUATION REPORT Page of Division of Safety and uildings �r�p� MAR 0 2ijt#4r with Comm 85, Wis. Adm. Code Attach complete site an on paper not less th 8 1/2 11 inches in size. Plan must rA)b County S CQ p include, but not limite to: v p66 d I refer ce point (BM), direction and percent slope, scale o dime Parcel I.D.�,� �G ��af���` lion and distance to nearest road. ease print all information. Rev ewed by ''Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner rvIGVY.Yn Z2 2� Property Location 114 NC 1/4' S e T Z8 N R E ( W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# o. Sox 3 3 G - ISU s City State Zip Code Phone Number o v l � �� [I City ❑ Nearest � Town Nearest Road 3 pr�SRM lP, . b" ) 1 s -1 b 0 (I 1 S ) t4$5 ,?3 5 3 New Construction Use: Residential / Number of bedrooms - Lt Cade derived design flow rate S Q - �j qi _ GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material G L_�AC1 `� L � ,�� } Flood Plain elevation if applicable f� General comments ft and recommendations: l+ (2 L4 E 1'M/`� M 6)(, � Boring # F1 Boring ® pit Ground surface elev. Depth to limiting factor 7 in. Soil Application Rate E� Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftzl in. Munsell Qu. Sz. Cont. Color _ Gr. Sz. Sh. 'Eff#1 •Eff#2 i I 2`F sb k r��r c \.Aj L tioKrz alb -Z i F T—] Boring # ❑ Boring ® Pit Ground surface elev. q • 6 ft. Depth to limiting factor 7 in. Soil 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 Eff#2 I - l - ?_+ Sbk W� Z m s 6k `M`�1- 3 C3 I'D tot ti y/b — S D S9 — M I •� � • z .�- 9 •/ = a�- • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 _< 150 mg/L • Effluent #2 = BOD < 30 mg1L and TSS < 30 mg/1- , CST Name (Please Print) Sig ature CST Number Arthur L ". Wegerer �_ Add 220254 ress 4>1 e g e r e r Soil Testing & Design Service Date Evaluation conducted Telephone Number 421 11. t-iain St. River Falls, UI 54022 1Z --Z Z - 03 715 -425 -0165 Property Owner Parcel ID # ��`Jl�1 hi G Page ' of Fl) Boring # El Boring ® p � Pit Ground surface elev. - ` B ` o ft. Depth to limiting factor 7 - 9 S in. Horizon Depth Dominant Color Redox Description Texture Structure Soil Application Rate Consistence Boundary Roots GPD /fl In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 I o - 1o�le -3�z - si 1 Z�Fsbh ��- cw 'Z,� •S -� •� Z �� -3 o�lrZ �!6 — si f Ztitls bk , -►��1- cS IT 3 V -ojS I D i y/6 S O S h� - .� �• Z �- Boring # ❑ Boring ❑ Pit Ground surface elev. fl. Depth to limiting factor in. Soil 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 F'Boring # ❑ Boring El Pit Ground surface elev. ft. Depth to limiting (actor in. Soil 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 •Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg /L • Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L Tlie 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. SB11-8330 (Rb/00) PLOT PLAIN Page -3 of 3 k ale 1' c wY A /1\ F-b 1 N t'n A�lv�j 15 / \ 8 �3m y y q 03 q� Lam �O Lo z b A) — -- n U Loy � a- B-_ l0p.p' -Olv 1 12v►`I I PL - LU i �Uf�/ll�Z r. - -- 1 Z - Z -U3 715 - 425 -0165 220254 U3 -Z l S - 6 CST Signature Date Telephone PTo. CST JTo. Job PTO. Wisconsin Department of Commerce SOIL EVALUATION REPORT • Division of Safety and Buildings Page \ of —% 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 5 l Cp Q ) include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. �G Please Print all information. Reviewed by 'Date Personal information anon You provide Y p may be used for seconds u secondary Purposes (Pri-vacy Law s. 75.04 1 Property Owner i Property Location Ski 1 /4.NC 1/4' S e T ZF N R Q Property Owners Mailing Address I E (cf W Lot # s Block # ' Subd. Name or CSM# � � • o. �3ox 3 3 IU r�s Ctty State Zip Code Phone Number V �� �` d [] City ❑Village � Town Nearest Road +3flM lAk.� �."► 5�l�I0i New Construction Use: Residential / Number of bedrooms S — ❑ Replacement ❑ Public or commercial - Describe: Code derived design flow rate ' Q 00- GPD Parent material G Lie l } r L � y� �� ,� ; Flood Plain elevation if applicable 1� 1Z ) General comments ft. and rec : \ '1E jy, j m F�, i zS D�-- Bo1 - c wt or= ZLS — '0 BE 1 - , . " r M A Boring # ❑ Boring ® Pit Ground surface elev. 8 - - s ft, Depth to limiting factor in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bounds Roots Soil Application Rat in. Munsell Boundary GPD /ftz Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Ef f#2 S 2 ZY4 S � �l `m'g`r r_ > . 1-� • S S O S�) M �-? 1"Z Z i E Boring # ❑ Boring ® Pit Ground surface elev. q • 6 ft, Depth to limiting factor 7 4 in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Scil Applicatio ft Rate in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 I � 10 1 o�n3 - si 1 Z�S �`� � Z� •S ;� � 1 b �. 3 6 — 0 3 Z6 -g6 to�tZ yt'6 — S S _ L) 9 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 m CST Name (Please Print) s _ ILL and TSS < 30 mg/L -Arthur ' L Wegerer sig acure Number CST Nu �_ = 03 =21S 6 22025 Addy Wegerer Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 11. 1 St. River Falls, UI 54022 1Z _ZZ_v3 715_4 *25 - 0165 Property Owner ` Z kFW 1 7 /-1 sly �, i Parcel ID # (S Page Z ; of � Boring # ❑ Boring ® pit Ground surface elev. " 'I 8 - ft. Depth to limiting factor 7 C1 S in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fl= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 I o -Iz lbtici_3 / _ ( 1 Z - C S�)T M-eP - cw 2� •S -� lo\ X16 — s f 3 6 1 yn-n- cs Ioti2 y16 _ S C) S F-1 Boring # El 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 /ft= 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 GPD /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 < 30 mg /L and TSS < 30 mg/L T7te 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 die department at 608 -266 -3151 or TTY 608 -264 -8777. SDD -8330 (RAM) PLOT PLAd Page oz 3 Scale 1' = v \\ CS lr^ "'� • 1 y � t3 3 �5 1-UT �O u) b ZD n a. a►� # z - - fit, a�•o�. � -_ _ - - -- - - - -- I . �� 1 Z- ZZ -U3 715- 425 -0165 2202 CST Signature Date Telephone No. CST No. Job PTO. Jun 10 07 09:O1p FOGERTY PLUMBING 171SG3552BG p.l JJ✓r t. A- 1 AN& 1APLIX1"E{NANC E AUREEMSNT AND OWNERSHIP CERTIFICATION FORM OwnerAR -iti lc C a 'V ><� /'0 ,07 J Mailing Address /%3/ �T,C,�.cG1 pc, Property Address q67 Q yL67'.J C0 L') -=i P /� (Verification required from Planning & Zoning Department for new construction.) to City /Sta #e /{L y � UJI Parcel Identification Number d YG - "- ® LEGAL DESCRIPTION Property Location r_ 1 /4 , ' /4 ,Sec. � T � N R_Zf of Ti�a� Subdivision f f�� / /.'emu/ /� , Lot # Certified Survey Map # , Volume , Page # T Warranty Deed # J� 7 �� , Volume , Page # Spec house yes �a� Lot lines identifiable Ks SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance responsibilities are specified in §Comm 83.52(1) and in Chapter 12 - St Croix County Sanitary Ordinance. The property owner agrees to submit to St Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Depamnent of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I /we certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number edrooms i r>Dr ( l/I 1 0 - 7 SIGNA OF APPLICANTS) DATE * * *,Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning 4)eparbrieut. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) __ _ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page L of Z FILE INFORMATION SYSTEM SPECIFICATIONS Owner, r Ck''lI Iw o M Septic Tank Capacity .2-9-4 ga l ❑ NA Permit // Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model S ❑ NA Number of Public Facility Units A Pump Tank Capacity gal A Estimated flow (average) Gp gal/day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) ikv gal /day Pump Manufacturer NA Soil Application Rate 7 gal /day /ftz Pump Model NA Standard Influent /Effluent Quality Monthly average` Pretreatment Unit ,idNA Fats, Oil & Grease (FOG) 530 m 9 /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD <220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) _ <150 mg /L ❑ Disinfec ' n ❑ O ther: Pretreated Effluent Quality Monthly average Disper Cells) (e &C�Z, tAart �� ❑ NA Biochemical Oxygen Demand (BOD,) :930 mg /L - Ground (gravity) ❑ 1 Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510" cfu /100ml ❑ 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 every: 3 ❑ 10 month earl ►(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 every: ❑ month(s) (Maximum 3 years) ❑ NA 3 )V year(s) Clean effluent fitter At least once every: 11 fif month(s) ❑ NA Year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) Flush laterals and res u ❑ month(s) p s re test At least once every: year(s) ❑ NA El I Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory . authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 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. Page 2 of Z START UP 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 POWT fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacem 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 disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site .evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ 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 replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ 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 O Name N o 7. Phone 7/s- v _ tlr Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d) &(f) and 83.540►, (2) & (3 ), Wisconsin Administrative Code. 'Jun.20. 2001 1 :50PM No-5642 P. 1 � ® ft� GI aat;NVa hc3r 332 Minnesota Street Suite 105OW St Paul, MN 55101 651- 222 -3399 phone 651- 2223320 fax P FA CSIMIL E TRANSMITTAL SHEET TO: FROM: COMPANY: DATE' Sk - LUA4 CA)N rV Z"WU L. FAX NUMBER: TOTAL NO. OF PAGES INCLUDING COVER: 115 ?8 6 40 (o PHONE NUMBER: SENDER'S FAX NUMBER: RE: SENDER'S DIRECT NUMBER ❑ U RGENT ❑ FOR REVIEW ❑ PLEASE COMMENT ❑ PLEASE REPLY ❑ PLEASE RECYCLE k NOTES /COMMENTS: i p C f�rncbo r 77'ft S 1Nt -:;o 2 94 "-ko ra ter," f P�ttlf E Jun I YX 1 N o • 56 42 P • 2 .20. 2007�_ 1 50PM T Ir FOWNDATION MUM Ta WALe W TYP Fokeok &B P"m �/ Va4mm IwEr. *fq wals SWOW AS Ka It -- --------------- 2)se5L I t 11-8 , C)srl oftopprD Oso QPT*40 ftWiftlows I FAN c F; 2 9 1 10-10 S FU*FL ---------- ---- — ------ ---------- ----------- --------- mm al" T�k% , 1 1 1 � � I E 0 0-1 ---------- ------------- wm*sw QKN*. 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CROIX CO., WI RECEIVED FOR RECORD 06/19/2007 12:45PM THIS DEED, made between B & L Land Development, Inc., a Wisconsin WARRANTY DEED Corporation EXEMPT # ( "Grantor," whether one or more), REC FEE: 13.00 and Creative Home Construction, Inc., a Wisconsin Corporation _ TRANS FEE: 225.00 PAGES: 2 ( "Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in i3 St. Croix County, State of Wisconsin ( "Property") (if more space is Name and Return Address needed, please attach addendum): `o x SE A3�1S 73rTt Lot 6, Plat of Sunset View Development in the Town of Troy, St. Croix County, � 6 , %ke; .. B_ Wisconsin. p File #2694290 RosEax' ", ,.w. SS 40.25- 040 - 1306 -06 -000 t Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, restrictions and rights -of -way of record, if any. Dated May 15, 2007 B & L Land De ment, �nc. \ (SEAL) (SEAL) *BY: ourtney D. T Notary Public (SEAL) (SEAL) * st a e of isconsin AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. authenticated on St. Croix COUNTY ) * Personally came before me on May 15, 2007 , TITLE: MEMBER STATE BAR OF WISCONSIN the above -named S'S in v Rs •rt YC 1. rif n� Q,`- L . LA lVt'�O�IYVLr�t� 1 Y1 (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 Doug Berg 1200 Hosford Street, Suite 201 Hudson, WI 54016 Notary Public, State of Wisconsin 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. 1 -2003 ' Type name below signatures. FOUR SEASONS Tl',—E, INC. Policy Issuing Agent For gGMMONWEALTH LAND TITLE INSURANCE COMPANY COMMITMENT FOR TITLE INSURANCE EXHIBIT A Legal Description Commitment No.: WIS -071820 The land referred to in this Commitment is described as follows: Lot 6, Plat of Sunset View Development in the Town of Troy, St. Croix County, Wisconsin. For Reference Only: Property Address: 467 Dylan Court, Hudson, WI 54016 Parcel ID Number: 040- 1306 -06 -000 ALTA Commitment Exhibit A 60/£0 SJtid NOSdHOHl LVPTLZV69L 89 :9Z L00Z /ZT /90 1 ' h May -14. 200NI:04AMIA � CURHCI NO -4825o P - 5w - un , w M 1/� OF THE K !/A HMO MI SHE WE 1/* OF SM-a011 f, T20R, aim. ovP OF TRW, S1 -f M OOYMTT, u_N LANDS --- ,- __ -- N �2O'EJ ISM7I' - -�'_ (';'; �•' MMH ygiHR MC'iKK CTH RD. "FF" t A t- '1 Fi '" n usT'Te'E sow• , w � o • - .,,. i CM1, iAl.IIiE 117], I )`I LOT 19 I I 1 266M aoa'F. �iwr.>Rr. SM A.. I SW LOT 7 '.....; OT - WT , \ \ 1 sa —TIM ' y \ . If RII�O fl ow ,4 I LOT �1 M t:F' �.` -- -7' t M r• �+ L •' I�;. /�I LOT 1 \ � H}:...' .. - 5 - .. .....................`_' .. N%.r S' . • : •; ;,' oral ft. \ `,, - sou, .. � ..1 y+-6 � �. iDOf l.N 110. � , � G ..,• .•• � ^^ -- `•-- ,__�•_ - y � —JO YM- i,1t1xE • .:: '. 100 . 0000► \ e � •� / �.._ is ' \. • , ". +78:F8•" -- '�, LOT 11 ��, . ; : -. - -••-- � ® (� I 1�t.'ei• .. \ galas f.r. � p N ST 1]'11 - E'•., j .. `, " �.. .....:. i /� , to s h z1 y PLOT 34 , ,•y o � ' L07 35 S LOT 961 ` Ij� mom Sr. $ { = sr \ i LOT 12 \ Yf! • own Sr. r� w iu - Tb� �e. Saar sa \ 1 1 h .su »]al+a' .: ► '' �- - ''LOT \ 1: t I, 1 '�i'� rt:,_ j P!1."01,_ :..'!t� �x I ' Ob i .: r \ 1 (w - „"'I I w ..a0ar 1 . NwA A M ✓I.�byr�/l = LOT 13 rl. .' �...; ( 00. 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