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040-1278-30-000
Fr 'sin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix and Building Division . 2 INSPECTION REPORT Sanitary Permit No: t 463241 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provicit may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Umbel, Thomas & Susan Troy Township - -- 040- 1278 -30 -000 CST BM Elev: Insp. M Elev BM Description: �nn Section/Town /Range /Map No: . b rd 16.28.19.1555 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. (5-46 ql ,l 6 1 5 � Septic t Benchmark _.._._ f 1 ZSb is- Alt. BM `. / , C 2 Aeration Bldg. Sewer Holding St/Ht Inlet y ? //1 Z 7 St/Ht Outlet TANK SETBACK INFORMATION 4- TO . TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet �\ Septic �b/ 725 / 16 16 Dt Bottom Dosing /J Header /Man. Aeration Dist. Pipe /3 /l, Holding Bot. System C / PUMP /SIPHON INFORMATION Final Grade 9ob. Manufacturer Demand St Cover q1Aj . 1a GPM,, ! 1 �•� Model umber TDH ift Friction Loss System H TDH Ft �P ` ✓ Forcemain Dist. to Well P5. -),%5 ` SOIL ABSORPTION SYSTEM 9 D 'g"1 BED/TRENCH Width I Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Z SETBACK SYSTEM TO / U P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: �� �I INFORMATION Type Of System: CHAMBER IT OR � 7 �� Model Number. �� l /C) � `, v e N oo a t DISTRIBUTION SYSTEM ec,,L� Header /Manifold /f Distribution x Hole Size x Hole Spacing Vent to Air Intake 1 plpe(s) **11 N- --- � --, �w .. Length a Dia Length Dia Spacing SOIL COVER a x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over `� Depth Over xx De th of xx Seeded /Sodded 1 xx Mulched� / Bed/Trench Center I g �/ Bed/Trench Edges Topso�f ! No 1 °'] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection , #1: / / Inspection #2: " / Location: 522 Omaha Road Hudson, WI 54016 (NW 1/4 NW 114 16 T28N R19W) Eagle Bluff Lot 23 Parcel No: 16.28.19.1555 �- 1.) Alt BM Description 2.) Bldg sewer length= 4e �' ,!(_ ` _ ^� � 6A— Llf 2 ' � - amount of cover = / S� U .� - 1 r �)7 l,, Use other l s de for additional information. o /"r_ D Date Inse or's Si ture Cert. No. SBD -6710 (R.3/97) P / �� Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 t Madison, 6-315 - 7162 eonsin Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 -3151 32 Sanitary Permit Application O State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s I5.04(1)(m) Project Address (if different than mailing address) I. Application Information - Please Print All Information R E C E I V �_2 Z OM ANA R o 1tD Property Owner's Name Parcel # Lot # Block # c> A-- 3Lkso,o DEC o 3 2004 a Property Owner's Mailing Address Property Location ST. CROIX COUNTY' ZONING OFFICE V4, y4, Section City, S e � Zip Code Phone Numb D ` (circl T N; R E d W) II. Type of Building (check al that apply) / ( ��< r " or 2 Family Dwelling - Number of Bedrooms Subdivision Name CSM Number ❑ Public /Commercial - Describe Use ❑ State Owned - Describe Use Q I ❑City_ ❑village ownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) (,p ; pt(,� _ (Z _ Q _ - 1 ;v A. `New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B• l Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS S` stem: Check all that appl Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter Cl Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Ch ber ❑ Drip Line Gravel -less Pipe ❑ Qther (explain) V. Dis ersal/Treatment Area Information: Z egays Design Flow (gpd) Jfiesign Soil Application Rate( ds Dispersal Area Required (sf) i aI Area Proposed ystem Eleva on q S 7 o° / JF 6 ' � �Z _Z VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units) ., t Concrete Constructed Glass New Existing / aal cC _ 10D [ � Tanks Tanks tl"� Septic or Holding Tank 5 Aerobic Treatment Unit i Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' MP/MPRS Number Business Phone Number Plumber's Address (tr et, City, State, Zip Code) w w Idt- Mmmy 6_�) LV15 VIII. Coun epartmenAA Onl Sanitary Permit Fee includes Groundwater Date Issued Issuin Approved ❑ gent Signat re o Stamps Surcharge Fee) ) iven Reason for De ' `-" IX. Conditio A pro a 1 I s� SYSTE ER: 3, 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan providaOby plumber. 2. All setbftk requirements must ltlaintained NO It? '�"`^• as per applicable code /prdinanceR. L Attach complete plans (to the County only) for the system on paper not less than 81/2 z ll inches in size SBD -6398 (R. 01/03) rrlilfvC 1�+� • FAX NO. 0517399327 Nov. 22 2004 07: 11FM F-8; i , } FAN 2004 0a' 12F'M FS '�I �i � \7f%�f•f ilr1NU: CU � f. P IPE . �� - r.c�q�x r- , �Y2�ti'CV �S�h .�.. ;.'�`•' _ / i rG NO COMM '%D %OAGK Pmt wtq I I y.•ifv )rI a! � ,ems. /', C AX m �• � 1 i X I f1. t t .i I Lp ' I f i i I {^ '. t+ Ilk �e 1 �L. llARiNSS INC. FA?, NO. X517399327 Nov. 22 2004 07 : '11RI P8 +`, s FA}; Nt:. 85' 77 '1027 hJa 2�. 23 4 06 12PM f ="1 r ; NO COMM R� !40ACK l: U j I I I sw t i S ' v �4 � i 0�2 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County ST. [? t29 vX Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must 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 information. ev' ed by Date ./ Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ` DEC C9 1 250 Property Owner Property Locatiofi Gt'I LAE 5, C O D K t3ovt tot N VJ 1/4 N W11 /4 S 16 T Z$ N R 19 IP(q* W Property Owner's Mailing Address Lot # Block # Si ibd. Name or CSM# 114'00 - S - i• IJE Sv`tTC too Z3 - EAGtk B-,uF'F City State Zip Code Phone Number ❑ City ❑ Village OTown Nearest Road $L-A t 1E MNI 1 5 5 LA49 I 076,3) - 7 5 7 -756 S' -M( I T rjWN5V ALC6 \ / T- T, New Construction User Residential / Number of bedrooms �_ Code derived design flow rate GPD ti ❑ Replacement ❑ Public or commercial - Describe: Parent material 5ftAaS -IZIk,1C Flood Plain elevation if applicable — ft. General comments 2. JC)A r-S and recommendations: 61IST Eh Et -QvArv%DM 111 S.q$r vh�� U F Boring \, Z COtJhF Boring # pit Ground surface elev. 9 t7 ,9 g ft. Depth to limiting factor ; '`; >. Soil Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bound a `- Roptsj In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#2 ( p -5 IoVt2��► I - m f 4 ti 7,9 Z S- oY2 - S 7 rn c 3 - 0.0; Li IbVQ 2 - St r { �� - 0.5 Li 0-36 vo " 4 3 - Sol , ' Ciy M I C. 0, 4 a 5 3b - 7,sv � 51 � v b5 rn1 � 1 ,7 1.7- 11) U K4/(" S A r OS tit I - - I m , 1, Z El Boring IJ - :) "(.� � Boring # DYE i I L ' (4zl- a pit Ground surface elev 05.8 Depth to limiting factor _ in. S lication ate Horizon Depth Dominant Color Redox Des Texture Structure Consistence Boundary Roots GPD /fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 "Eff#2 I 0-4 toYRZlI — 51 3f -m A ah 3yLf 6.S Z L4 '] IOV K- I s �fsbl dl c-5 s 104- -1 -15 x.5\10 �S y- 05 d I CL s zf- o,� I,z U 15- 7. K 3 I s I rn 5bK d 5 &5 Zf -m O, 1.2 5 2-14-33 IOy u1b 1 5 05 d 5 1 M 0,1 I, 2 (- 0 A 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 CST Name (Please Print) Sionature — CST Number /Y\At2 33 "U-A5T8R jq �I, 2Z4 fr32 Address Date Evaluation Conducted Telephone Number W98 69o RIV FAt.aS to 5`+02-2- 10 -30 -DO C'It5)42b -IIIS i C, Q:) Property Owner. ,COOK C}�t�i2LEs -Rarce __ P Z of a Boring # El Boring pit Ground surface ev. _ g0!5 ft. Depth to limiting factor q0 in. Soil Application Rate Horizon Depth Dominant Color Redo escriplio Texture Structure Consistence Boundary Roots GPD /ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 -lo I D z 1 3 m 000 3V-- m 0 S 0. Ig -1z I jp \ 4f — I z lol mJ as f- o,S o.$ 3 i z -z 1 13 \1 V- — 51 2 fo-b of Z-f m 0.5 0.9 4 21- N, 10 V P- — S, r 063 1 5 2 -C-M 0.7 1.2- 5 -b rL14)6 _ szi r 0,51 6t , W 1 �-tm 0,7 1. Z (0 0-90 1 0\4K-IL 5L r 0 M d1 — — O. 1� ❑ 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 /ff 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/ff 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 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 (ROW) PLOf PLAN `; pAGt 3 0� [ECAUr E GLE LLk F 13M- - F AIL W l-4't LO rt D W o Tt1E PIW uR 2 — OF C. Ib la Iq FTfZ6 I PIPE ST, C W COLWtV SC S I AS. NO COMM 83 VWK ROPUM X V\ Q� p(3z � . cn , , II I M i l t.3�► # 11 Liz! s G �� 23 Y\ 5T.Am 516NEV C5( S SEC l b Z2-4 X13 2 , PACe OF ` COWTOU K U IDES Fot� LerrS -- .— �N EA&LE tSLuFF SLk%Ij. B —F 42 2,�;! 9.0.2 C i / /Y, i � 1 i r I I Private On -Site Wastewater Treatment System ( POWTS) Index & Title Sheet Owner: Project Name and System Type: `A 5,P A Y'nnW c En VeA h 6Y1 +mil Location: o �K Street Address `/ S `� g Legal Description 5 T. Town p /County Contents: Page 1: Sanit Permit Application g �' pp Page 2: Plot Plan Page 3: Soil Test Page 4: State Approved Plans g kP Page 5: Septic Tank Maintenance Agreement Page 6: Warranty Deed Page 7: POWTS Owner's Manual Management Plan Page 8: POWTS Owner's Manual Management Plan Page 9: POWTS Owner's Manual Management Plan Page 10: Certified Survey Map Page 11: Copy of House Plans Attachments: Plumber/Designer: Mike Rogers Signed: Credential Number: 225094 Date: Chamber SAS SYSTEM ELEVATION AND SIZING CALCULATIONS Below Grade Soil Absorption Systems BUMBLE Owner's Name F 12/3/04 Review Date N Y or N Highly Pretreated Effluent 3 ft Suitable Soil Below System , 12 in Chamber /Unit Height 8 ft Maximum Bury Depth 3 _ Ezflow EZ1203HP & EZ102H 1W 600 gpd Estimated Daily Peak Flow 0.70 gpd* In -situ Wastewater Infiltration Rate 857.14 ft` Chamber /Unit Area 50.00 EISA ft / Unit 18 # of Chambers /Units 902.90 ft Proposed SAS Elevation 26.50 Bottom Area ft / Unit Soil Surface Acceptable Finished Grad EL 4 (ft) Boring Grade Limitation SAS Elevation (ft) System Minimum Maximum Number Elevation (ft) Depth (in) Lowest Highest Elevation? 904.90 911.90 1 917.98 75 914.73 916.98 No Cut required 2 905.98 .80 902.31 904.98 1 Yes 3 905.98 90 901.48 904.98 Yes 1. Depth of suitable soil required below the infiltrative surface for treatment. 2. Total height of chamber in inches. 3. Maximum bury depth as per manufacturer's recommendations. 4. Based on chosen system elevation, and chamber height. Top of chamber is finished grade may be required to meet minimum or maximum code standards. Version 4.0 04/03 POWTS OWNER'S MANUAL MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner t . ks" Septic Tank Capacity n gal ❑ NA Permit # 3 ;741 Septic Tank Manufacturer � s . - ❑ NA DESIGN P "TERS Effluent Filter Manufacturer Z, 4- ❑ NA Number of Bedrooms 100gpd/bedroom ❑ NA Effluent Filter Model ❑ NA Number of Commercial Units NA Pump Tank Capacity gal DATA Estimated flow (average)* pp gal/day Pump Tank Manufacturer T�.NA Design flow (peak), estimated x 1.5* OI)gal/day Pump Manufacturer ANA Soil Application Rate al/da Pump Model A • g y Influent/Effluent Quality (NA❑) Monthly Average ** Pretreatment Unit A NA Sand/Gravel Filter ❑ Peat Filter Fats. Oil & Grease (FOG) 5 30 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODs) Total Suspended Solids (TSS) 5 220 mg/L [3 Disinfection ❑ Other: 5 250 mg/L Manufacturer: Model: Pretreated Effluent Quality ❑ Monthly Average * ** Di persal Cell(s) Biochemical Oxygen Demand (BODs) In- ground (gravity) ❑ In- ground (pressurized) Total Suspended Solids (TSS) 30 mg/L At -grade ❑ Mound F 5 30 mg/L [3 Drip - line ❑ Other: Fecal Colifonn (geometric mean) 510 ❑ Leaching Chamber Manufacturer Maximum Effluent Particle Size 1/8 inch diameter Model L –� /8v3 Approval Stipulation *Wastewater Flow Verification on and calculations: Soil Application Rate = -7gp d11Y Area Req. 7 1 ft' (Other than bedroom based) Absorption Area Credit per unit , ' _ ( 3 ' ft Minimum Number of Chambers ❑ Aggregate Design Flow/Loading Rate= ft min * * Values typical for domestic (non - commercial wastewater Materials: all materials must comply with WI Adm. Code and septic tank effluent. COMM84 and be installed per manufacturers specifications ** *Values typical for pretreated wastewater. and approval letters. DESIGN CRITERIA ❑ "Wisconsin At -grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et.a1.1990) ❑ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. Publication 15.22 ❑ . "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publications 9.6 ❑ "Design of Conventional Soil Absorption Trenches and Beds ". R.J. Otis – ASAE Publications 5 -77 and "Design Manual – Onsite Wastewater Treatment and Disposal Systems". EPA 625/1 -80 -012 October 1980 ❑ SBD – 10570 –P (8.6/99) "At -Grade Component Manual Using Pressure Distribution" ❑ SBD – 10567 P (8.6/99) "In Ground Absorption Component Manual" ❑ SBD – 10705 –P (N.01101) "In Ground Soil Absorption Component Manual" Version 2.0 D SBD – 10628 –P (N.6199) "Recirculating Sand Filter System Component Manual" ❑ SBD – 10656 –P (N.6199) "Split Bed Recirculating Sand Filter System Component Manual" ❑ SBD - 10572 P (8.6/99) "Mound Component Manual" ❑ SBD - 10691 P (N.01101) "Mound Component Manual" Version 2.0 ❑ SBD - 10595 –P (8.6199) "Single Pass Saud Filter Component Manual" ❑ SBD - 10657 P (8.6/99) "Drip -line Effluent Disposal Component Manual" Ej SBD - 10573 –P (R 6/99) "Pressure Distribution Component Manual" ❑ SBD - 10706 –P (N.01 101) "Pressure Distribution Component Manual" Version 2.0 ❑ Drip -line Effluent Dispersal Component Manual for Multi -flo Onsite Wastewater Treatment Units ❑ MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months years) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-thir d (1/3) of tank volume Inspect dispersal cell(s) At least once every 3 ❑ months ear(s) (Maximum 3 yrs.) Clean effluent filter At least once every 13 ❑ months year(s) Inspect pump, pump controls & alarm At least once every ❑ months year(s) ❑ NA Flush laterals and pressure test At least once every ❑ months year(s) ❑ NA Valves At leas once every p months years) NA Other: At least once every 0-months °❑ year(s) NA Page of START UP For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that ' xixay 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. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water - saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable /fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non - biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. 0 Valves Valves shall be operated in the following manner: Alarms Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back -up of sewage into the dwelling or surfacing. INFECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). N&I Septic Tanks Component Tank inspections must include a visual inspection of the tank 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 backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one -third (1/3) 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 NR113, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. p Pump Chamber/Treatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of the filter. Any service needs or repairs shall be promptly taken care of. In- Ground Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. Page of ❑ Mound, At-Grade, hi-Ground Pressure , The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Pondin eater than 75° o of / the height o tY g $I' f the component may indicate overloading oadin or impending P Y g p g hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. DEPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. 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 fined with soil, gravel or other inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. e 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 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 tune. ❑ 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 CONTIAN 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 EUIPOSSIBLE. ADDITIONAL COMMENTS POWTS STALLE POWTS MAINTAINER Name o � t� ..r `�.. Name r n Phone J 3 / a-- Phone SEPTAGE SERVICING OPERATOR (Pumper) LOCAL REGULATORY AUTHORITY Name S� c Agency t CtxWTY N/ Phone Phone �� K: \WPDATAIE"OWTS OWNER S MANUAL.doc Page of From: To: TONY ~ Date: 8/21/2004 Time: 3:50:08 PM Page 2 o12 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owmafvyer Mailing Address sa r'� a l� ws •�rpert � Address f (Vaificatioc rcwitod &m PU=iog Dogwiftumt far dew coasttt ctkM) r C , ,, d� r w res h Parcel Identification Number LEGAL DON Propaty Location !t l � y L f . 1 /4, Svc. — lo, T?j-R LW, Town of Subdivision tU � 0 U FY - - Lot # 2 � CuliQed Smivey Map # � , Volume . Page # Watrnty Deed # Vobsme Page # ©Z� # S' Spot bouse O yes)3S r no Lot Baas ideati5able Q yea )Z�_no MzM MUMMA r hm�coprr me sad mamaxwoeof your septic symm oodd asmit k its pnao:atoafitlaae to htaa�e w�a�a. irrapadileaanoe ofpeampiiq� eat do septic vale every am yes or scene; ifaeededby it tieensedpoWer..What yon Pot bw the sysm Tye pcopaq owraa aptees w nbmit t St h eir Zoaiaa Depa un t a cat i5adian fan. s tined by the omm O d;f a ` kkPoaperapa&ft=ati= orsodl mectionaudr ria6 ifaooamclJl.*O"Pdehdcis dw with do d0 dsrds ehe bare seed the above and a to maiabrin systcaa ad fmi, bsek as set by de Dgsattpaest of (.bmmm sad the DepsratsM of Ndmi Rea umm. Sate of Wbmusin. aarli your septic maiatsiaed mad be compided sad reboaaod m the SL larvae Coaoty ZoaisR 0M5oo within l0 MUMCM F APKICM DATE '1 ("VIM CBR'lIItiCATION } oedi�y OR an this farm am um to the bat of my (od) laawrlodpe• I (wre) am (are) de owaer(s) d tie of a dead recorded is Regiaa of Dec& Office. OF DATE M""• AMW iofoam dark mac may venk in at nakuy po mit beep =VOW by de Z=% Depuoaeat. bebde with this sppUcMlon: a sh apod wswmty Aced from the Ragida of Dcods *Wier A copy of the cettitied settvey map C of ence is made in the waunty deed FROM : EARNES INC FAX NO. 6517339327 No 3e 2004 0?:39AM F4 ,,� .fir+ •.�„A ��r l V i f + hl F' R.' L.. ` y � v.Yxf { r E32 3 ,ry #� 11 2 oT i BARNES I NC. FAX N0. 6517389327 Nov. 22 2004 07:09PM P6 E5173C9Q274 Nov, 22 2004 06; 11 PM P3 �`;' , . i � � ', � ; • �, t 1 f 'e ' � _ • f �• tit ,• v �../,..A• ,....., e ri.` r r - 1 o ff.. �-ti,• ,. i f f • _ Ir J t •� 1' � 1 w , � . T� . t r. anummw mw N k V �y .. g7".t pp 3 i• �A i � l r J t L I .� U. 2687 P 029 -7-70r Er STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., VI This Deed, made between American Designer Classic, Inc., a RECEIVED FOR RECORD Minnesota Corporation Grantor, 11/01/2004 01:00PM and Thomas J Umbel and Susan T Umbel husband and wife WARRANTY DEED Grantee. EXEO PT # Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin REC FEE: 11,00 TRANS FEE: 408.00 (if mqjg space is needed, please attach addendum): COPY FEE- Lo 3, Plat of Eagle Bluff in the Town of Troy, St. Croix County, CC FEE: Wi nsi11. ----- PAGES: 1 Recording Area Name and Return Address guAr04 040- 127 8-30 -000 Parcel Identification Number (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights - of - way of record, if any. Dated this -- -1 -- day of November 1 2004 tri assic Inc. ��1 CA`TI01'S-: CKNOWLEDGMENT Signature(s) STA OF J - - -....... ---- •-- - - - -•. --- •---- ........_. — ._.._......_ ................. ) - -- - - -- -- - - - - -- ----- - - - - -- _ _ - - -- ) ss. _ County ) authenticated this day of Personally came before me this _clay of N ovember 2 the above named — American Designer Classic Inc., a Minnesota Corporation ------------- -•--••- -- •- ---- ----- -- -- - ----- - - - - -- -- -- -- ---- --- -•--- -- -- -- -- ... - --- -- - . -- -- -- - - - --- ........... - -- -- - - - ------- •- - - - - -- ------------ - TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to in known to be the person who executed the foregoing authorized by § 706.06, Wis. Slats.) inst nd be owl the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Kristina Ogland Hudson, W1 54016 _ Notary Public, S to of - - - - -- - - - -- - - - - - -- - My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) l Z A ) * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co., Fond du [ac, WI STATE BAR OF WISCONSIN 800 -655 -2021 WARRANTY DEED FORM No. 2 -1999 BARNES INC. FAX NO. 6517389327 Nov. 22 2004 07:10PM P7 ` - 22 2004 0G' 11P!h P4 MOM Fa ( NOS 6 � 1 +'vo.�.� N e Ow *ft VY �On�. � . - Li �. l z 2 1 69 ACRES j t I 's PIPE * s� N =908.00 ° t 23 2. 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